The Hidden Cost of Waiting on HRT

Philip Pape 0:01

If you're a woman approaching or experiencing menopause, your doctor may have told you to tough it out that hormone therapy is risky or that you can start at any time if symptoms or labs get bad enough. But what if waiting too long to begin menopausal hormone therapy doesn't just mean suffering through hot flashes and sleep disruption? What if it means missing a critical window that could determine your metabolic health for the rest of your life? Today, my guest reveals why the timing of hormone therapy is about preventing a metabolic storm that fundamentally changes how your body processes energy, stores fat, and maintains muscle and bone. You'll discover why the conventional advice to delay therapy could be setting you up for visceral belly fat accumulation, insulin resistance, and accelerated bone loss. And if you think you can simply overcome these changes with more exercise and stricter dieting, you're about to learn why that approach falls short and what to do instead. Welcome to Wits and Weights, the show that helps you build a strong, healthy physique using evidence, engineering, and efficiency. I'm your host, Philip Pate, and today we're gonna look at one of the most critical but misunderstood aspects of women's health, and that is the timing of hormone replacement therapy and the very profound impact it has on your metabolism. Now you are gonna love my guest today as she returns for the third time, the wonderful, knowledgeable, and always friendly Karen Martell. Karen is a certified hormone specialist. She's a weight loss coach, she's host of the hormone solution podcast. I can't believe you're not following that by now if you're not. And she's helped thousands of women navigate that fine dance between hormones and metabolism. She's here today to discuss the cue the thunder metabolic storm of menopause and why the timing of starting HRT may be more important than you think. Karen, always an honor, always a pleasure to talk to you here on Wits and Weights.

Karen Martel 1:59

Thank you, Philip. It's so good to be here. I love coming on your show. I

Meet Karen Martell and the Mission

Karen Martel 2:04

love talking to you. It's always good.

Philip Pape 2:05

Likewise, likewise, because we I think we have a lot of overlap. And then there are also things that are just like totally in your wheelhouse that I love to learn. I learn something new every day, 10 things when we talk. And so does the listener, and they're always asking for you as well. So it's going to be exciting. And it all you're also going to be coming into our group to do a live Q ⁇ A very soon after this comes out. So look for that, everybody. But you've had a lot of interesting guests on your show, like Bill Campbell, who I know very well. Um, you've been talking a lot about the menopause transition, which is roughly a, I think, three and a half year phase on average for a lot of women. You've been talking about how hormone uh changes, especially hormone loss of the key reproductive hormones, can drive fat distribution, changes in insulin sensitivity, bone health, muscle mass, metabolism, and weight, all the things. What is the latest we know about all this specifically with what you call the metabolic storm? Because we want to focus on that and how we can get ahead of it.

Karen Martel 3:03

So I will correct you on something there. It's not just three years, Phil.

Philip Pape 3:08

Okay. It's okay.

Karen Martel 3:09

We're we're looking, it's average now for women, the perimenopausal phase is typically eight to ten years, and it can go on longer. And and I think that that's an important thing to recognize because a lot of women don't realize what's happening to them when they're in their late 30s

Perimenopause Takes Longer Than You Think

Karen Martel 3:28

and early 40s, and they're like, hmm, what's happening here? My I'm getting a heavier period, or I've gained a little bit of weight, or my hair's falling out, or my joints starting to hurt. I'm got suddenly a whole bunch of new wrinkles that I didn't have a year ago. You know, these little things that just like this can for someone they can slowly creep in, and they typically start to do all of the other things besides look at their hormones. They're like, oh, I better start, I better change my diet, I better exercise more, I better do this, I better do that, which you kind of have to do those things. But you should also be looking at the hormones because the earlier you can catch the hormonal loss that starts to happen, the better off you're gonna be. And then the less of that metabolic storm, it's gonna be sunny skies. It's not gonna be a storm. And this is where so many practitioners are going wrong, and doctors are going wrong, is that they wait until a woman is a hot mess way into her 40s, even into her 50s and post-menopausal. Then they're like, oh, okay, now we'll give you hormones because you are still suffering so badly. And it's like at that point, many of these women are 10, 20, 30 pounds overweight. And these are women that are coming from a background of exercising and healthy eating and listening to our podcasts, and they're like health-conscious women, and they're going, what just happened to my body? And then it's so hard to reverse once it happens. So it's easier to prevent.

Philip Pape 5:08

Yeah. So there's two things that are big takeaways from what you said that I got. The first is the education on the timing, which is what we're talking about. I'm glad you mentioned the, you know, the three and a half years that I was referring to is the MT from the literature, right? It's that tiny period right before the final end and end of menopause, right? When you haven't had a period for a year and you're at menopause. And what you're saying is really, we have to back this thing up and look at the whole spectrum that goes from as early as potentially your late 30s, I understand, but mainly through your 40s and in your 50s. We were talking about Zora Benamu, right? Who's she's been on my show and vice versa, and you you're good friends with her. Um, and she talks about all the misconceptions that not just, you know, people, but women specifically have with menopause. And so that that's part of the discussion. The second thing you mentioned is how a lot of these women are doing the things, right? And and this is this is my population too. And those who listen to this podcast of like, you know, I know to track food or macros or whatever, you know, I know to, you know, eat the right portions, I know to eat protein, I know I should be lifting weights. Now, maybe they're not all doing that, but even the ones who are, and they're still frustrated and like, what's going on? And like you said, a little bit of gaslighting, whatever you want to call it, maybe it's more ignorance than anything, lack of training in the healthcare industry. And it's like, no, you gotta be a hot mess, you've got to be totally like begging for, you know, hormone therapy before you do it. So those are two huge takeaways that I think set the stage for like, okay, what is happening, Karen? Yes. And what do we do about it? Let's unravel the mystery.

Karen Martel 6:35

Yes. And so let's get into like the meta, like what's happening to the metabolism through these phases, because that is like the so important. And and it starts when we start to lose

Progesterone Loss and Sleep, Stress, Cravings

Karen Martel 6:48

our our progesterone. So that's usually the first to go. And that's in our late 30s, early 40s. We run out of eggs, we come into this world with a certain amount of eggs, we start running out of them. And when we no longer ovulate, we are no longer producing the bulk of our progesterone. Well, second half of your cycle, progesterone is supposed to come on the scene, which raises our metabolic rate, it raises the basal metabolic temperature in the body. It also helps your thyroid to function properly. And so that is the first thing that starts to happen to the metabolism, is that is we don't get that rise in body temperature in the second half of the cycle. Progesterone is also super key for GABA production in the brain. It influences the GABA receptors in the brain, which GABA helps us, helps us all to sleep. It induces sleep. We know that when people do not get a good night of sleep, if you have, if you've ever worn a CGM, you will see that your blood checkers will be spiked when you wake up in the morning. Because it's like instant insulin resistance the next day when you don't sleep well. So without that progesterone, which is helping you sleep, that starts to go. So now we're not sleeping as well. So now we're getting more insulin resistant, right? Every time we, you know, especially if we're going for longer and longer stretches and if not good sleep, that's gonna start to really impact your body composition, your blood sugar regulation, etc. The other thing is GABA is an anti-anxiety neurotransmitter. So GABA helps you to be calm. So now we don't have as much of this GABA response happening in the second half of the cycle. So we hear from so many women that anxiety starts to go up. And if you're not sleeping and you're so you're tired, you're slightly insulin resistant, but not only that, you're you've got anxiety, a little bit of, you know, just that like low-level anxiety feeling all the time. I'm sorry, but do we want to eat really well when we feel that way? Typically not. Typically, your body goes, give me the sugar, I need that dopamine hit, I need something to give me some energy, I need something to, you know, up my blood sugar here a little bit because it's wonky. And so you so this is the metabolic storm is now starting. As this continues on, you get less and less ovulation, less and less progesterone. Now we're bleeding heavier, all these things start to compound. Then, typically around mid-40s to late 40s, estradiol starts to kind of go up and down, but slowly starts to go down. So it'll have times where it goes high, but then it'll drop back down. And then, but it's slowly it just goes lower and lower. And it's estrogen, oddly enough. And I think this surprises a lot of women because women tend to associate estrogen with weight gain because of estrogen dominance. And we've got so much estrogen in our environment right now that acts like estrogen in the body, but it's a lot stronger. And so, yeah, estrogen, too much estrogen and too much xenoestrogens absolutely will make you gain weight, but too little estrogen makes you gain even more weight than too much, which is very surprising. But estradiol, so there's three estrogens. Estradiol is the one that we produce in our ovaries. That is the one that is like the master of our metabolism. And so as it starts to go down, many things start to happen. Number one, we have estradiol receptors in the hunger centers of our brain, right? So it helps

Estradiol, Appetite Hormones, and Insulin

Karen Martel 10:43

regulate your eating patterns as well as how much you're eating. So people, women will become more leptin resistant, they'll have dysregulation with ghrelin levels. And so these are the hormones, these are our appetite hormones that tell us when to stop eating, gives us the signal to the brain, like, hey, I'm done, I'm full, and then as well as hunger, right? So just drives hunger sensations in the stomach. And so that becomes dysregulated as estradiol starts to go down. So we start eating more and we start craving more sugar and we start becoming more insulin resistant. It also helps us just to process glucose. Estradiol helps you to process it. So now we're becoming more insulin resistant as the estradiol is dropping, and that is not good either. And then as estradiol is dropping, another estrogen starts to come up because your body's super smart and it's like, oh my god, we need estradiol. This is the most important hormone for this body because it is. We have estrogen receptors on every organ, it helps every organ to function properly with in our brain, bones, skin. I mean, it is so crucial. It is not just about fertility. And so your body goes, we need to get estrogen somehow. And you can make estrogen from fat cells. And that kind of estrogen is called estrone. But that's an inflammatory estrogen. And so, and and it's terrible because it's a vicious cycle. The more fat you put on, the more estrone you're gonna make, and the more estrone you make, the more fat you're gonna make. So it's just this vicious circle that feeds into each other and makes you gain more and more weight. So we have this inflammatory storm happening, which is not good for weight or metabolism. And then our esterdiols dropping, we're getting more hungry, getting more insulin resistant. Where do we see, you know, you look at somebody that has type 2 diabetes or insulin resistance, where do they carry the weight in their gut?

Philip Pape 12:54

In their visceral, yeah.

Karen Martel 12:56

In their visceral, which is the worst kind of fat and most dangerous kind of fat is visceral fat. And this is the classic menobelly that happens. And I will tell you that you can be the healthiest woman in the world, and I really want everybody to hear this. And this can still happen to you, and it's an awful thing. It happened to me. I had been, you know, this Puritan paleo 10 years. I had kept at the same weight for 10 years. I thought I had this in the bag. I was like, oh, perimenopause, menopause, yeah, not gonna touch me. This is gonna be like a couple days of some hot flashes. I'll lose my period, and that'll be it. I'll be in menopause. Well, in my early 40s, I went into early menopause, which my health status didn't help with that, right? Like I'm very healthy, and yet I still was losing ovarian function early, earlier than I should have. And I gained about 15 pounds within a few months. And I lost my period, I was losing my period, I had itchy skin, I was hot flashing and night sweats like crazy. I was in the metabolic storm. And I'm like, how is it? Like, I didn't drink, I didn't

Visceral Fat, Estrone, and Inflammation

Karen Martel 14:18

smoke, I ate so clean, I didn't have sugar addiction, I was working out, I did everything, I was in this industry. This is what I did for a living, and I practiced what I preached, and it still happened. And so I I want women to hear that because they tend to blame themselves and they think, oh, I'm not doing XYZ hard enough.

Philip Pape 14:38

Yep.

Karen Martel 14:39

And it could purely be from the drop of hormones.

Philip Pape 14:43

And that's why I wanted to have you on, because there's two big aspects here. There's lifestyle, which we talk to death on this show, of course. And then there's hormones. And I mean, I know just from men talking to all every day in my communities about why can't I sleep over 40? Why can't why does this get hard over 40? You know what I mean? And it's like, take that times 10 for some of the women I speak to, not all. And that leads me to my question, though, Karen, because I want to get into even more of like the mechanisms of this because I know people love that, but it sounds like pretty much everything in the body is affected at some level. It's in the population, how would you break down women that are like affected by this severely versus kind of it's noticeable, but it's surmountable versus like they don't even notice it? You know, how would you categorize just in general?

Karen Martel 15:32

That is a tough question. And I've thought a lot about it. Like, why is it that some women just sail through this? And they could be women that are overweight, eating McDonald's every day, you know, like that don't exercise and they're like, Yeah, hop flash. Oh, I think maybe I had one hopflash, you know. Like, it's like, what? How is this possible? You know, so sometimes there's no rhyme or reason. I think that there's a genetic piece for sure. Uh there is some research that kind of shows, like, if your mom had a bad menopause or an early menopause, then you might as well. And that was definitely like my mom had a horrible menopause, and she went into it really early as well. And she was really prone to hot flashes, like me. And you know, so there we there is a genetic component and how you process those hormones. It is also what were you exposed to? You could be really healthy, but if you had exposure to some of these very common toxins that are in our environment, I mean, none of us are free from the toxins right now. Like we're we're all overloaded with them. So did you have a lot of heavy metal exposure? Did you have mold exposure? These things really mess with the hormones. Did you have trauma? There's a lot of really cool new research coming out that's showing that if you had PTSD or you've had early childhood trauma, that this affects how the hormone receptors work. And so when you're losing those hormones, you can be affected by it a lot more than the average person because you're more sensitive to these hormonal drops. So there's many different things that can go into this. And of course, of course, eating healthy, managing your stress, all of these lifestyle pieces, sleeping, et cetera, et cetera, they have to be part of this picture. And I'm not saying that that's a waste of your time because no matter what, that's gonna like maybe I would have gained 30 pounds instead of 15 had I not been such a great eater and a good in exercising, et cetera, right? So there's these are tools. HRT, it's like it gives the body the tools to allow it to lose weight so that if the efforts are put in, it's gonna be a lot easier for that woman to let go of that extra fat that she may have gained. And I think that that's a that's important to hear.

Philip Pape 18:00

You're right. I mean, that tools is the way to think about it, just like with GLP ones, which can get so emotionally charged. And as a coach myself, like I don't want to be the one saying, well, you have to do it this one way, and I'm gonna help you white knuckle through a lifestyle change when that's not gonna, that's gonna look great for me either. When you

Muscle, Recovery, and Bone: Estrogen’s Role

Philip Pape 18:17

all of a sudden your metabolism keeps tanking and tanking and taking, and we're doing everything. I'm like, yeah, but we're following the science, something else is going on. Well, the body's complex, there's physiology and there's chemistry involved, and that's what we're hitting on today. So, okay, you can't do anything about your childhood. You can't go back in time and change any of this stuff. Well, you can.

Karen Martel 18:35

You can work on your traumas and stuff if you have not. Yes, you're right.

Philip Pape 18:39

You're you can work on who you are today as a result of your childhood. Um, but so you've mentioned a lot of cascades, right? Related to thyroid and then sleep and insulin resistance and anxiety. You mentioned um fat distribution and inflammation from which can probably be measured in blood markers from something like estrone and glycemic control, you also mentioned. Now, what about the bone density and muscle side of this musculoskeletal piece? Where does that, how does that get affected by all this?

Karen Martel 19:11

Yeah. Testosterone starts to go too, which is a very important hormone for women. And that, of course, has lots to do with, you know, increasing protein synthesis, muscle building, bone formation. It's great. It's great for many, many different things. And so we do see that coming down as well in women in perimenopause. So that starts to affect muscle. But estradiol is also extremely important for muscle. It helps the the uh the satellite cells to work better. It they influence the satellite cells. Now, satellite cells, they're like muscle stem cells, it just helps your body to repair and after working out and helps to grow with the grow the muscles, etc. So without the estradiol, you can actually have more muscle loss and start lacking in that repair. So women will say, Oh, I don't recover the same anymore. Estrogen is really important for lubrication, lubrication of everything. Your vagina, your eyes. Like women will say, I'm getting dry eyes, dry skin, joints. So women will say, my joints are sore all the time, my back is sore all the time, suddenly. And this can be because of that estradiol loss. It also helps your body to make collagen. So all of these things really important when you're lifting weights and trying to put muscle on. And so we need the estradiol. It's also really important. This is kind of an odd one, but neuromuscular health. And that's like how your brain speaks to the muscles, and vice versa. And so that starts to go down when estradiol starts to go down. And so we have this once again, this perfect storm happening at the same time that all this other metabolic stuff is happening, your cholesterol starts going up, the blood sugar starts going up. Estrogen helps to raise cortisol binding globulin. Now, this is a uh binding globulin that binds up your cortisol, which you want the perfect amount, you want the Goldilocks amount. We don't want too much cortisol, we also don't want too little, right? Astradiol, as it drops, it actually makes it so that we have more free cortisol around. But in this day and age, women, we we tend to have a little too much cortisol in most cases already because we're stressed out, right? We're running around, we're doing all the artificial lighting and all these things that are coming at us all the time. And so now we get this increase in cortisol. Well, cortisol is catabolic, it's not anabolic, it's catabolic. It also raises your blood sugar. So this is all going up. Cortisol also, like you, if you have too much cortisol, guess where you put the belly, the belly fat on because of the blood sugar dysregulation. So now we've got more fat going to our belly because of the cortisol going up, and cortisol can affect, of course, then the muscle tissue. And muscle is the biggest processor of glucose that we have. And I know you talk about this all the time, fellow. This is huge. So as the estrogen is going down, our muscle can be going down as well. It's gonna impact all of these things on how your body functions, how it repairs, how it recovers from your workouts.

Does the Storm Ever Settle?

Karen Martel 22:39

So why we would deny women estrogen during perimenopause, during this 10 years, is just it's mind-blowing that we say, no, you can't have it because all of these things are gonna start to compound on top of each other. And like it is, it's the metabolic storm.

Philip Pape 23:05

Yeah, and does that storm, because I want to I want to talk about labs and markers and some of the things we've we've discussed on the other two times you were on, which for the listener, if they're curious, we did talk about testosterone in detail last time, and then ages ago for first time you were on, was just more general hormone and weight loss. But um, this storm, right? Is there an eye of the storm? Does it calm down? Does is there a fierce part of it? And the reason I ask is, you know, I hear this narrative of, okay, it's things accelerate, right, into the what I was calling the menopause transition, which was more of the short period right at the end. And then after that, are you, you know, do things calm down or are you kind of at a new baseline that's just suppressed all of this stuff for good? You know, like what exactly does that curve look like if you don't do anything?

Karen Martel 23:51

The curve typically looks like it is the worst during perimenopause and during the first few years post-menopause. That is where we see the biggest impact on weight, on our metabolism, on our uh brain function, all of the things that start to be impacted by the loss of that estrogen and progesterone and testosterone really hits hard during those years. And then there is a somewhat of a plateau for most women where they come out the other side of it, they don't lose the weight. And you can look, you can see this, and it's unfortunate. You know, you look around, I can see the women that are on HRT, and I can see the women that aren't on HRT. And I people get really angry when I say this. They do, because then then they think that I'm insinuating that everybody's needs to be on HRT. That's not what I'm insinuating. But look at the average woman that's in her 60s, and it is a very common body type, which is once again the insulin resistant, the belly fat, you know, it starts to affect your vocal cords, your skin starts to age a lot faster without the estrogen on board and the progesterone and testosterone. You know, the hair thins, you know, the body starts to go down, like as far as like posture goes, because the bones, we need estrogen, test, we need all three hormones for bone health and bone regeneration. So bone health starts to go down, hearts, heart problems start to go up, things like this. So all of this, it stays with you. So what we'll see on labs is women that aren't on estrogen or have never been on HRT or little too too little HRT, their LDL will be up and usually out of range. Triglycerides will sometimes be up as well. Hemoglobin A1C and blood sugar are all up, and they tend to stay up. And you can look at this if you have older clients that are you know in their 60s, 70s, and this goes for men as well. And you look at their labs, most of them are insulin resistant to some degree, and then many go on to get type 2 diabetes. And it's not all from hormonal loss, of course, right? There's so many factors in this, but that is just typically what we see. But the emotional roller

Proactive Testing: FSH, LH, and Strategy

Karen Martel 26:16

coaster, the hot flashes, night sweats, the continual weight gain, that seems to chill in once they get through to menopause a couple years in. It's not such a wild ride, and things can stabilize, but that's not for everybody. I mean, my mom is 70 and she still gets hot flashes. And you'll and I've talked to many women that have felt the same way. Um, a lot of the urigen, like the you know, women will get uh vaginal dryness, atrophy, uh chronic UTIs, like all of the the genocuritant. I always get it mixed up.

Philip Pape 26:58

GSM will call it genital related uh diseases. I'll just go with that.

Karen Martel 27:08

It's always a mouthful for me. Uh, but that is in 50% of women, that doesn't go away. You know, you you know, I've women will say like, no, my vagina's dried up. There's no it's it's not getting better as I age, it's staying the same. And it gets thinner, the skin gets thinner and thinner, and and that's a horrific thing to for women to go through. And it's it's absolutely terrible. I've talked to women that have said that they've torn, you know, through when they have sex, they tear, they have micro-tears, that they can't even have sex anymore. There, I had one woman early, oh, it's closed, like there's nothing getting in there. You know, and this is real all of this is reversible. A lot of it's reversible, which is nice to hear. But yeah, so I would say that for some women, yeah, it plateaus and it gets a little bit easier for sure.

Philip Pape 27:58

So it's reversible. That's kind of the silver lining, but what if we just don't have the storm cloud at all? That's what we want to talk about now. How do we get ahead of the storm based on this bleak picture of the future that you don't want to have and decide I'm gonna take control of my health? Because I think that's what it comes down to is you're empowering yourself, listening to you know, your podcasts and others like it, that the healthcare industry may not be the one doing it. And I see that on my end. You and I were talking before we got on about performance-based blood work. You know, if you go to your doctor and you get just any old labs for whether it's cholesterol or testosterone or it's um blood markers or inflammatory markers, they have their ranges and it's based on sickness and disease. It's based on the population, it's not based on optimality, performance, and being proactive, right? So, and I know you you talk about this stuff all the time on your show. So, at what age should women start to do what to get ahead of it and at least understand, maybe I don't have to do anything, but I've got the knowledge, or hey, this is giving me the indicator that I need to think about that, you know, taking action.

Karen Martel 28:55

Yeah. So embrace that you can't diet, you can't supplement, you can't intermittent fast and cold plunge your way out of hormonal loss. It's gonna happen to every single one of you. Whether you have symptoms or not, you know, it doesn't matter because what's going on on the inside happens to all of us, right? So you will lose bone. You are gonna lose cognitive function to some degree. Uh, you're gonna lose skin elasticity, you're gonna lose vaginal elasticity. Like these are things that just they depend so much on hormones that I don't know of any woman that isn't impacted by this. Like we start losing bone in our 30s, I do believe. Like it or even earlier. So this is happening across the board. And so it's really good to go, okay, I'm losing ovarian function, changing my diet is not going to bring back ovarian function. There's nothing that can. We're not there yet. One day I think we will be, but right now, no. There's nothing that's going to bring that back. And I think that that gives a big relief for women because this is the time to start looking now at your hormones. And now there are many things that they could do at that point. Like if you're in your late 30s, early 40s, and you're just starting to notice some of these things, oh my gosh, there's some great supplements that can really help with, you know, helping with the production of progesterone when you ovulate, helps with ovulation, helps helps with the hot flashes and night sweats. And so for sure, if you don't want to go to the HRT thing yet and you're still cycling regularly and your periods seem to be okay, for sure, support your system through the diet lifestyle and supplementation. But then when it starts to get to the point where those things are no longer working, you're getting up there in your age in your 40s, and then you go, okay, let's go in and test. We want to see what's your glutenizing hormone, what's your follicular stimulating hormone? These are brain hormones that are telling your ovaries what to do. And those signals and those levels of FSH and LH start to go up the harder they're having to work to get your ovaries to ovulate. And so that can be a really good sign for women to go, oh, I'm struggling here. I have a regular period. I

When to Add Progesterone and Estrogen

Karen Martel 31:22

would not have thought that my FSH was up. And so that's one of the markers that I always want to see is the FSH, because that really tells us a lot about estrogen because women can have regular periods, but their FSH can start to elevate, which is just telling us, once again, the brain is going, ovaries, come on, what are you doing? Like, like let's wake this up a little bit. Like, and so FSH in a fertile woman ideally is below 10. When and it fluctuates, there's a different range throughout the cycle. You're supposed to test it on day three is the ideal day to test it. So if uh you're a cycling woman, you're usually going to be around three to five on your the first, you know, within the first three days of your cycle. As you get older and you stop ovulating as often and your ovaries are starting to quit, then once it gets above 10, that's that's like okay, start watching. But if it gets above 20, I would say that is your like, oop, now I've got to really look at HRT because there's nothing else that's gonna bring that down except for HRT. And there's actually a little bit of research that shows like women that the FSH, when it gets above 23, is when they start to see the weight gain happen. So this can be a really good like indicator of what's coming down the pipeline and when to start intervening. And so for some women, it's just like baby baby dose of that estrogen during if they see that their FSH is 15, 20, and it's like, okay, maybe I need a little bit of estrogen, even at just certain times of my cycle. You know, this is when you want to work with a hormone practitioner. Progesterone for sure, like as you stop ovulating, your periods are getting heavier and they're getting maybe closer together, and your sex drive has gone out the window, you're not ovulating anymore. Because sex drive goes up for women when the when they ovulate, obviously. It takes and it tells us, go out and have sex, right? So women will say, like, my libido just is like gone and I'm bleeding super heavy and my periods are getting shorter. Progesterone. Because remember, if you don't ovulate, you're not producing progesterone, and that's your signs. And so putting in some progesterone in the second half of your cycle can be a lifesaver for women and fast, like where they start using it and they're like, oh, like this is amazing. I sleep, my mood's better, I don't have anxiety anymore, I feel so good, I lost five pounds. And they can ride that out, they can ride the progesterone train by itself for a while, typically. And then, like I said, mid to late 40s. Now we're gonna watch that estradiol. And as that FSH goes up and the estradiol goes down, which is very hard to test at this point because, like I said, it's a roller coaster ride. So you'll sometimes test it and it looks great, and it's like, well, that looks okay, that's enough. And then, you know, suddenly you're getting hot flashes and night sweats, and you're like, what? But my estrogen was fine. So really go on symptoms, right? So estrogen, once again, really important for libido. People think it's all testosterone. Heck no, we want estrogen for libido too. And so if you're getting these little symptoms like the hot flashes, night sweats, a little bit, you know, a lot of weight gain or a little bit of weight gain in the belly weight gain, dry skin, dry hair, itchy ears, all of this is signs that your estrogen is not high enough for you. So it could look okay on paper, and your doctor could be like, you're great, you're in, you're well within your range. Well, the freaking range is like if you're between 20 and 400, you're good. So for you, and every woman's different. Me, I'm very estrogen driven. So when my estrogen even drops a little bit, and I have a high SHBG, which means I have a lot of my estrogens getting bound up and not being used. And so for me, if my estrogen drops even a tiny bit, it's a I get every symptom

Safety, Stigma, and Bioidenticals

Karen Martel 35:42

in the book. And so I'm very sensitive. So I have to keep my estrogen up. And I've talked to other women, they didn't even notice anything. They're like, it just gets lower and lower and lower. And then they're like, Well, do I need the estrogen? I don't have hot flashes, I feel good, I don't have vaginal dryness. I'm like, I feel awesome. Can you feel your bones going? Can you feel the muscle going? You know, like there's things that you can't see. What about your brain? You know, you may not think that you you or you may think that you're fine, but maybe you're not with your cognition. You know, it impacts your sleep, it impacts your mood, it helps to estrogen helps us to make serotonin. So it's, you know, if you're a little bit more depressed, if you don't have the energy, it helps with dopamine, it helps with glutamate, it's like oxytocin. So it's like help even thyroid sensitivity. So these things women don't maybe realize are from estrogen loss. And so you just you want to monitor, you want to tune into yourself and go, you know what? I am a little, I'm not how I was five years ago. So maybe we, you know, biohack ourselves, put in a little baby dose of estrogen, and just see how it makes us feel. The beauty of hormones is you stop them, it's a it's gone in a day. So it's not like you're gonna have this like lasting impact. So if you don't feel well when you start taking HRT, then that's your sign that either you don't need it, or you need a different delivery form, or you need a different dosage.

Philip Pape 37:26

So anybody listening might be thinking, well, that's really great information and it's overwhelming, uh, Karen. Because I was thinking when I try to communicate anything in this optimization realm or performance realm or health. You mentioned biohacking. I love the idea of experimentation, right? Especially when you can get a quick feedback like that. You mentioned several buckets, and I just want to like reframe them from what you said to me for the audience. The first one is the first one is the biomarkers, which which I'm categorizing as your labs, you know, it could be urine tests, could be saliva. Like there's different forms of this, and you're the expert in that. And go check out Karen's podcast for like deep dives on you know specific labs and tests and all that. Um, so there's that, but then understanding how to interpret that, which is where the real trick is in terms of optimal ranges, but also your range and your trend over time and understanding what you should be, plus cycle to cycle, which for women is an extra wrinkle that you know, men don't have to deal with that. So that's kind of the blood work optimization or biomarker piece. The second piece you mentioned is symptoms, which I'll I'll label as part of biofeedback, right? That is just your body's telling you something. And it could be in a so many different ways. Like you said, it could be physical manifestation, it could be mental, it could be uh emotional anxiety, and um, it could be just things that aren't what they used to be for you, like like you said, you know, libido and vaginal dryness or whatever. And then the, I guess the last bucket I heard, and maybe I'm missing something, is self-experimentation of you've got to do something at some point to at least understand this beyond just the data and trying the progesterone cream or trying the estrogen. And a lot of these are safe. And like, you know, the Women's Health Initiative did did horrible things for our understanding of safety in this world. But understanding that means you could approach

GLP‑1s with HRT: Who Benefits

Philip Pape 39:16

it with a little more freedom and flexibility to try things, get off of them, and not worry if it's gonna like grow a third arm or something. Um, and I'm just just joking, but you know, or it's gonna give you cancer, which is the real serious thing people are worried about. Did I kind of paraphrase like the big buckets, Karen, that we just talked about?

Karen Martel 39:33

Yeah, I think that that's a great way to put them all into the buckets like that. And and and I don't want to overwhelm, like I I always try really hard not to overwhelm the woman, right? Because you get so much information out there, menopause is a real hot topic right now. There's all these different opinions. And the bottom line is when we look at the research, we know we see that they're very safe. And you always have to remind yourself you had these hormones for the majority of your life. And so when you question, like, oh, like maybe I'm not a good candidate, or maybe I shouldn't do research here. Is this dangerous? Is it gonna cause cancer? Is this blah, blah, blah, blah? Did you think like that when you were 16 years old, when you were flooded with these hormones? No. And so hormones are part of our physiology. And yes, menopause is natural and all of that. And people will say, Yeah, but this is natural for us to lose our hormones. Well, it's natural for us to also get heart disease and die early. Like that's the this is the thing. And it's like, well, what's the alternative? You know, we we are trying as a species to live longer and longer, and we are grabbing on to anything and everything that helps us do that. We're taking the supplements, the medication, the everything, the diets, and so hormones are in those categories where it's like at least these are bioidentical. This is something your body's produced in your whole majority of your life, and they impact our wellness. And without them, we do start to age much faster. And they've done their research on this. They did one study that showed that women within like six months of being in menopause biologically aged nine years. So biological ages, how fast are you aging on the inside? That's insane. And so hormones are one solution to this life of ours, that we want to live an optimal life. We want to stay as healthy as we possibly can. Then hormones should be something to be looked at and don't get dogmatic about it. Don't think like, I'm not gonna do hormones, and so I'm gonna, I see this all the time, right? I'm better than all of you, basically, because I don't need to take hormones, or I'm not going to, and I'm going to get through this without them. And it's not a badge of honor to do that. It to me, that's stupidity. It's like, why would you say that? You know, like because what are you saying to all the women that are suffering immensely? Do you know that women, the highest rate of suicide is women in menopause and perimenopause? So to say that, what you're saying to some woman who, you know, is on the brink of taking her own life because of the loss of these hormones. You're saying to her that she is weak and that oh, she should be able to get through this. And we don't want that. Like if you're cho if you're choosing not to do hormones, great, that's your choice. Awesome. But don't make it sound like it's that oh, some other woman for choosing to do hormones is in the wrong and is less than you. Yeah. And I think that that's like really important to get across.

Philip Pape 43:08

It is because you see that a lot, that kind of messaging a lot in the fitness industry on Instagram with a lot of things, especially by younger people who haven't experienced it yet. Let's be honest, who are like, yes, like I'm gonna do it now.

Karen Martel 43:21

People that didn't have it bad, and they're like, oh, it's that bad.

Philip Pape 43:24

Different experiences. Same thing with GLP1s, like having talked to like I was a little bit a little bit intransigally when it came out, just for a brief moment. And then I shaped up after talking to just a couple human beings who like have experiences, right? Which is what happens in that um, yeah, it's a tool, and you choose to do it, and nobody should judge you, and you shouldn't judge them, and whatever. So speaking of actually speaking of the GLP1s, GOP1 agonists and all the new ones coming out, where does that play into the hormone situation? You know, I'm not we talk a lot about appetite and weight loss and all that, but specifically with HRT and GLP1, like what's the overlap or interaction? And what should people be aware of if they're gonna do one or both potentially? Um, yeah, because that's kind of a new new thing now.

Karen Martel 44:12

It is. And we we started using GLP1s a couple years ago in our clinic. I also took them. Um it and it was a lifesaver for me. Like it really was. It it changed, it literally changed my life. And and I hear this all the time from women. And there's some women that, you know, no matter what they do, no matter what, they can't get off the weight that they gained from menopause. And it's and we don't know why, because these women will replace their hormones, they'll they'll be lifting weights, they're prioritizing protein, they're doing all the right things, myself included, and they still can't get it off. Like I got some of mine off through prioritizing

Beyond Appetite: Metabolism, Thyroid, Mood

Karen Martel 44:56

more protein and lifting heavier with with my trainer, Pam Sherman, who you know. And she really helped me out, and I was able to get off quite a bit of weight, but I still was left with probably about 10 pounds that I just couldn't shake. And I was like, okay, well, I guess this is it. Like, this is my body now. I'm gonna accept it. And then the GOP1s came out, and I'm like, hmm, I'll try that. Yeah, why not? I've been waiting for this my whole life. It's a medication that actually works for weight loss that doesn't make you suffer. And I I did very small doses, I never went very high. I got off that 10 pounds plus another five, which you can see I'm not too skinny. I don't have wasempic face. I didn't take it too far, which for sure some people do. And I just take a very micro dose now, and it's really helped all my markers, it's really helped with my menopause. I don't get night sweats anymore. You know, I can keep my body at a really good weight, which is awesome. Like to be. I'm 40, I'm turning 50 in a couple months. And I'm like, oh my God, I look better now than I did at 40. And this has helped from hormones, it's helped from my lifestyle for sure, but also from the GLP ones because, and it's like, that's such a nice thing to be able to have that as a tool for menopausal women that you know, all else fails. We could have, you know, a micro dose of these GLP ones, get off that weight that we gain, go back to ourselves. And that's a it's it's glorious. Like it's just a huge relief. And we get a lot of the that's what we get for in our peptide program, is we get that midlife woman that and you uh you get the stories all day long in the community of I hit perimenopause, I hit menopause, I I hit 52, I'm 55, I gained 20 pounds, I cannot shake it. I've been trying to lose this 20 pounds for the last five years. It will not budge. I don't know what else to do. And then they go on these and they lose the weight, and they're just like, they're so grateful. And the research shows that women that are on hormone replacement therapy and do and go on a GLP one, that they'll lose 45% more weight than a woman that's not on HRT. So that just goes to show that you know it's really important to have those tools in place, even though you're doing even though you're doing a GLP one, which is a quick fix, but it is important to have the diet in place, the HRT in place, the weightlifting in place so you don't lose the muscle. Do it right. Like I really, really I what I promote the most is we can do these and we can do them in a way that is safe and that is right for the body. And what what we're seeing and all the fear-mongering, a lot of it is because it's not being done right and they they're being overdosed and they're not eating well, they're not being taught how to eat properly and work out, you know, and take the proper supplements and stuff like that while you're doing it. So it is important to do that.

Philip Pape 48:05

Yeah, and by the time this episode comes out, the one with Jamie Sells or would have come out, or we get into some of those exact topics. But it's funny because I think of some of my very earliest clients before any of this stuff existed, where they were consistent, they were training, they were controlling for their calories, they were eating protein. Some of them were even on HRT, and something was just keeping that metabolism lower. And I wonder, so with the GLP ones, I mean, it really is just the appetite that it affects. I mean, that we know that's basically all it does. The the dual agonist does a little bit more, and then there's new ones in the pipeline. Like Eli Lilly has a triple agonist that affects your like liver fat and glucagon, right?

Karen Martel 48:45

I think it's way more than the appetite.

Philip Pape 48:47

Oh, well, you mean just the semaglitide? Yeah, you're right. It's like addiction and everything else. Is that where you're gonna go?

Karen Martel 48:53

But not even like it is. Yes, I do. But number one.

Philip Pape 48:59

I was gonna actually ask that. I was gonna, I was setting that up. I was setting up the question, not like saying it as truth. I was gonna say, so what worked for you then? Like, were you controlling, were you monitoring your calories and did you eat less, or did you eat roughly the same and you just actually started losing?

Karen Martel 49:13

I definitely ate less.

Philip Pape 49:15

Yeah, yeah, yeah.

Karen Martel 49:16

I definitely ate less, and that the appetite suppression is definitely a real thing. And it's like, oh my god, it's so it can be really hard to eat. And sometimes that's actually a sign that you need to lower the dose because you still want to be able to put in the calories, and because the weight loss isn't dependent only on the appetite suppression, which is a very weird thing, but so I'm two years out since I've lost the weight. Okay. So I went on it, I lost the weight, and then I've been maintaining since. And I'm at such a low dose that my hunger is the same. I'm eating the same amount of calories as I did pre-GLP one, and I'm not gaining any weight back. And even the pre my practitioner, she's like my peptide hormone coach that does all of our coaching. She's jacked. She should see her. She's shredded. Like you've never seen a woman like this. It's just she's crazy, huge guns on her. And she's been on the GLP ones for she had total weight loss resistance, could not, no matter how much she worked out, could not lose the weight.

Judgment, Addiction, and Real-World Relief

Karen Martel 50:24

And like me, it was maybe like a 15-pound extra weight on her, but she didn't like that, right? Like maybe 15-20 pounds. Anyway, so she loses it on GLP ones. She now, she was just telling me the other day, she averages, I think she said 2300 calories a day. She's maintained the weight loss, and she she eats a hundred, I think she said 150 grams of protein a day. So she's not having any problems. And she is not, she has not gained any weight back. My thyroid, I had to lower my thyroid medication, which I'd been on the same dose of thyroid for seven years. I had to lower it because my thyroid started to function better and my levels went over range. So that's metabolism. My metabolism got better. My friend Dr. Amy Horneman, she's a the thyroid doctor. Same thing with her. She's been on the same dose for 10 years, and she had to lower her medication because she's she was my redosing GLP1. Lowers inflammation, it does something to the metabolism. It's so it's like the appetite suppression that tends to go away after a couple of months or lighten up for most people. And everybody freaks out, oh, my hunger's coming back. Should I increase my dose? And we're always like, no, don't increase. Like, don't increase unless you've been stalled out for a while. You know, if you're not losing weight and you still have more to lose, okay, slightly increase the dose then. But in most cases, hunger starts to come back and the weight still continues to come off.

Philip Pape 52:08

You need to eat more. It's like you do need to eat more in that case, right? To maintain the same. Yeah, I've heard it's gonna be interesting because I it's too early for any long-term studies to tell us exactly what's going on. It will be fascinating to see. By the way, Amy Horneman's coming on not till next year, though. So I didn't know your friends are there. I would have reached out. Yeah, no, she's very busy. Oh, it's amazing. I try not to, you know, you know, take too much advantage of our contacts.

Heather 52:36

Yeah. Hello, my name is Heather, and I am a client of Philip Pape's. Just six days after I started this cut, my family and I were in a 7.9 magnitude earthquake here in Adana, Turkey. As I tried to process the stress and trauma, my first instinct was to say, oh, you've been through something hard. This is not a good time. But instead, I reached out to my coach and he got me under the bar that day, and he helped me keep my macros that day. And not only did I realize that I was doing something fantastic for my body, but I realized that I was doing something fantastic for my mind, and that it was going to help me keep the mental clarity that I was gonna need to get my family through what really has been a very difficult two months. Here I am on the other side of eight weeks. Got my kids through all the things that we have been through. And I weigh 12 pounds less than I did, and I got a new PR on my bench press. I have a long way to go, and there are still things that I really want to accomplish, but now I know that I can, and I'm really grateful. Thank you, Philip.

Philip Pape 53:38

Yeah, it's just it's a whole thing. I mean, there's we're gonna be talking about this stuff for ages, and there's still gonna be lots of controversies about it. But look, if from a medical and a health and a metabolism standpoint, there are other benefits that we start to see, it'll be fascinating. Not to mention, I did mention addiction, like people who have addictive, get more addictive brain chemistry are helped tremendously to the point where they may need to be on it for the rest of their life, so to speak. But yeah, no, I I guess that that's all that's all I wanted to cover on that.

Karen Martel 54:04

Well, and well, and women have so much, like, I mean, so do men, of course, but you talk to these women and myself included, where their whole life uh was spent watching everything they put in their mouth: calorie counting, exercising, doing the math, like freaking out about, oh my God, I ate the cupcake. Oh no, okay, I'm gonna have to like intermittent fast tomorrow. I'm gonna have to like go low carb, I'm gonna have to go keto, I'm gonna have like we as women drive ourselves insane. I have been thinking that way since I was 13 years old. I have been fighting my weight and I've been fighting with everything that I put in my mouth. It was always a constant tally in my brain. I'm not proud of this, but it's just the way it was because I was so I could so easily gain weight that if I if I wasn't that strict, I would immediately start to gain weight. So I had to be so careful of everything that I ate. And I had to stay eating like paleo and grain-free and low carb and watch my blood sugar and make sure I exercised and all of these things. Not to have to worry about that for the first time since I was 13 is like I can't believe how much uh space I have in my brain to think of other things. It's just a

Better Care Ahead: Policy, Training, Tech

Karen Martel 55:26

huge mental relief. And I hear this all the time from women that have had the same struggles where they've fought this their whole life, and maybe they had food addiction and sugar addiction, and they've were obese their whole life, and then suddenly they can lose the weight. It is like, how can some I just don't understand how people judge that? How do people judge that somebody wants to take this medication?

Philip Pape 55:52

Right.

Karen Martel 55:53

Food addiction is is just as harsh as cocaine addiction, for heaven's sakes, but yet people don't see it like that. It's like, well, you chose that, you you could choose to exercise, you could choose to eat better, and it's like, screw you, you don't know what it's like to be overweight and not to have the energy to work out or the mental capacity to eat well, and maybe you've got sugar addiction or food addiction, like it's a disease.

Philip Pape 56:20

Yeah, and everything you kind of alluded to when you said talked about stress and addiction in the brain, and makes me think of the um some of the work that like Stephen Guillonet talks about, uh you know, he's about about brain-related genes and how um, you know, the genetic component, there's such a difference between people. Um, there's another guy I want to get on the show, I forget his name, that he's like 19 or 20, and he's like a genius when it comes to appetite research. And he talks about this stuff all the time. There's such a wide spectrum that what if, Karen, it's just the fact that you're reducing that anxiety and that brain, that cognitive load and all that stress. And that's why your metabolism's approving. I don't know, right? Like so many things that cascade.

Karen Martel 56:59

And a lot of people will say that. They'll say, I don't have anxiety anymore, I don't have the the hamster brain anymore. And they don't know what it's what it's doing, but they're like, I've I have so much relief in my brain from taking GLP1s. People that have inflammation, they're like, My inflammation's gone, my gut's better. Like all of these things can start to improve. And I think, you know, would we ever say to the person that's been depressed their whole life or been riddled with anxiety and they choose to go on an antidepressant or they choose to go on an anti-anxiety? Would we sit there? Would we attack them the way people are being attacked for taking a GLP one? Right. Never. And would we start to do you see all over social media the side effects of SSRIs? Hello. The side effects are they're long lists. So, yes, GLP ones, yes, they can have side effects for sure. And we don't want those side effects. However, the the like, do does the good outweigh the bad? I think so.

Philip Pape 58:03

Yeah, yeah. Is that and it's all individual. It it's funny you mentioned the um, well, not the SSRs, but I did an episode called Osempic Envy or something. I came up with this term called Osempic Envy. It was the idea that there's this like weight loss wars that are war that are waged in public on social media, just like there's political wars waged in public where if you were in a room with human beings, you would not be talking like that or treating each other that way because it's on such a point. We do this. So it's like imagine you're in the room with the person, how would that conversation go, you know? Um I wanna the I guess the last thought I have about all this, because we're I know we're barely scratching the surface, but it's going back to the complexity of some of this is our healthcare industry is inadequate, in my opinion. I think I think in yours as well, to address this. And if, you know, unless you get lucky and there's an individual here or there, what does the future hold? Like, I this is more of an optimism side of me trying to and trying to pull this out of you too, Karen. Like, what does the future hold as the different industries change, as maybe there's more practitioners like you, as maybe technology like AI or and more advanced like labs and genetic testing comes into play? Like, how do you see all this coming together like 20 years from now? What are women gonna have as their resources? What is your vision for the future?

Karen Martel 59:17

I have a really positive vision. Like, I really see a lot of change happening, and there's you'll get the naysayers on social media, they're like, oh, menopause is just becoming a money grab and blah, blah, blah. And it's like, you know what, you guys, stop. Like, we need to be talking about it. Even like the good, the bad, all of it. We need to be talking about it. And it's finally getting talked about. So it's like, let us let us talk about it, let us scream it from the mountaintops, because only four to seven, I think it went went from four to seven percent of women are on HRT. So the majority of the public, the women, then there's millions and millions of women that are in menopause. So majority are not on HRT and are not getting. This information, so we may see it because we're in social media and in the field in this field, but majority of women still don't get have that information. Doctors don't have that information, and they're trying to change that. And I see that change coming. I mean, we just had a big panel at the FDA where they're working on getting rid of the black box warning off of the estrogen package packages because right now it says estrogen causes cancer. And they have zero, zero research to back that up. And so they're like, why is this on here? Like this just is unnecessarily scaring women that they something that could really benefit them. Like, take this off. And so that's gonna happen, I think. I think that they're gonna start. There was another woman that was at Congress that was trying to get so that um in med school that doctors that there was more on education on menopause. Because right now, less than 7% of doctors are taught anything about menopause. And if they are taught something, it's like, you know, a couple hours basically, and that is it. But none of them are taught anything about perimenopause, none of them are taught about bioidentical hormones. They actually have to go get extra training for that. So I think more doctors are going to start to be educated in this. Public is starting to be more educated in this as we're becoming, you know, more and more, we're taking our health into our own hands. And so it's all about finding the right information out there with podcasts and blogs and all of this. And so I see that women are becoming more and more empowered. They're seeing that, hey, you can be 50 and you can rock your 50s, 60s, 70s, and beyond. And like you can do it in a way that is super healthy. You can use hormones, you can work out, you can lift weights, you can take the right cell phones, all these amazing biohacks, peptides, peptides are exploding. And these can be incredible, not just weight loss. I'm not talking weight loss peptides, I'm talking about all the other peptides. There's hundreds, if not thousands, of them at this point. And they can be this amazing like therapy that, you know, working with somebody that understands peptides, it they can enhance everything. I've tried, I've tried so many different ones, like growth hormones and uh mitochondrial stuff. And like, I love it. I love being my own like little biohacker and taking my health into my own hands and being like, how good can I feel? And so I just think we're

Practical Resources and How to Get Help

Karen Martel 1:02:28

gonna start seeing more and more of this. And women are gonna start taking more and more in charge of their own health and go, oh, I can, I can feel amazing. It doesn't matter what age I'm at.

Philip Pape 1:02:40

That's great. So it's like uh it's like a perfect storm the other direction, the way we want it to go, right? Maybe a little regulation over here, education for doctors over here, controlling your health, lots of choices, lots of options. Who knows what amazing technology is going to come down the bike path. I I tend to go to that first as my engineering brain of like, oh, we can get AI and clone Karen's brain, and then we can, you know, get everybody the hormone help they need, you know?

Karen Martel 1:03:05

I think that's all coming. I do. And I think there's lots of like cool at-home testing that's happening right now where women are able to test their hormones from home, like by just peeing on a stick, and they have these little devices now, and we're gonna start seeing like stem cell transplants for the ovaries that's happening right now in Mexico where they're rejuvenating the ovaries. You know, it's not legal here, but it's legal that they do. Well, let them try it out first. Yeah, it's like ridiculous expensive. I'm like, why wouldn't I just take hormones? I'm like, I asked the guy, I met the guy that owns the clinic, and I'm like, it's like $30,000 for treatment of the ovaries, and you might get a couple more years before you hit menopause. And I'm like, nah, just take the hormones. It's cheaper. But these are all things that are happening, and I think that we're demanding that more research is done on women and on women's bodies. And I think that that's starting to happen. We're starting to see some really cool stuff coming out of different uh, like Felice Gersh is coming out. She's come out with some great research papers on hormone replacement therapy. Um, Louise Newson, these are like the menopause like gurus in social media. The Newsom Clinic, she just came out with some new research. Uh, mental health stuff is coming out, like being brought more awareness is being brought to it. So I think that it's going in the right direction. Of course, you're always gonna get the shit with it. Sorry if you don't swear on your podcast, but you're always gonna get the garbage going along with the good. And that's all gonna be part of it. You're gonna get the people that are out just trying to make money. It's like, well, whatever. Like, just who cares? You know, it's just do what's right for you and your health and educate yourself on it.

Philip Pape 1:04:48

Totally agree, totally agree. And that's what we're trying to do, right? So people need to connect with you. I'm sure a lot of our listeners already know you, Karen, but I want you to connect with them even more. So I'm gonna mention one thing and then I want to turn over to you to send them the best place. For those of you who are already in physique university, um, you're gonna get to see Karen in there on the 14th of October for a live QA. You can ask her anything you want.

Karen Martel 1:05:10

I love it.

Philip Pape 1:05:10

Yeah, there you go. So if you're in there and you're listening, you get it included. If you're not, I'll have a link to register. Yes, just full transparency. It's a paid coaching program, but it's very accessible. And so if you want to see Karen in there, that's your chance. Karen, where would you like people to go right now and check you out? All right.

Karen Martel 1:05:28

So I got something for everybody, which I'm so happy I get to offer that. But we can prescribe in every state. So I run and own a telemedicine clinic where we focus on women in midlife. We do not deny the woman that's in her perimetopausal years hormones. Uh, and so we take a very functional approach to HRT, which I feel is is missing and is lacking a little bit right now. And so we look at every, we look at the lifestyle, and and Phil's gonna come into my group as well and do a QA. And so we focus a lot on, you know, all the lifestyle aspects and then as well the HRT, and we really try and look at everyone from an individual standpoint. We don't, we're not, you know, set on one type of protocol or delivery form. It's like, what is gonna work for you? And we will work for you with you until we find what is gonna make you feel your best and to give you that protection, the heart, the brain, bone protection that these hormones can give you. And if you choose not to do hormones, well, we've got a whole arsenal of other stuff that we can help you with that well, if you're choosing not to do hormones, that we can still do all of these other things that would it's gonna help you to age better. And then on top of that, I also have a membership group for those that can't afford the private coaching. Um, we also have this very affordable group where we have an amazing community of women. We've it's been going for like seven or eight years now. And uh, and then I also just came out with my own line of over-the-counter hormone creams and oils, which is amazing. Um, and I'd love to give your audience a coupon for them. So these are creams and oils that contain bioidentical USP grade hormones. These are no different than the hormones that are in them are no different than what you would get from a pharmacy. That's the grade they're at. We do all sort of like third-party certificate of analysis and purity of the hormones. They're very clean products, and they are marketed as beauty cosmetic hormones and creams. That's how we can promote them and how we can sell them online without a prescription. And many, many women buy these. We have an incredible estrogen face cream that has been shown to just do absolute wonders for the face, um, shrinks your pores, helps with your fine lines, etc. Uh, just came out with a vaginal moisturizer. Uh, we've got a progesterone melatonin oil that's amazing for sleep. So that's, you know, I'll pump up my own stuff here, but it's it's such an awesome thing to be able to offer women because it's so affordable. It's way more affordable than prescription hormones. And you don't need you don't need the actual prescription.

Philip Pape 1:08:22

What's the name of the line? What is like what's the brand? Or what do you call it?

Karen Martel 1:08:25

Hormone solutions.

Philip Pape 1:08:26

Hormone solutions. Okay, just like you. So if everybody wants to grab that, you can go to witsandweights.com slash Karen Martell and you'll get uh 10% off with my code Wits and Waits. Um, I'm gonna be checking those out myself. I know we have a lot of women in the community that would be interested. And then Karen's uh hormone coaching, which I hear nothing but great things about over the years that I've known her. And then this new telemedicine clinic is awesome. I love that uh direct approach to healthcare in a way that's individualized and functional. So thank you, Karen, so much again for doing this with me. I'm excited for our upcoming collaborations, and I hope everybody listening really enjoyed and got a lot of this episode. I know they did. Thank you so much, Karen. Thanks for having me.