1 00:00:00,000 --> 00:00:08,040 So we eventually end up doing everyday dosing because the whole point of HRT is to avoid 2 00:00:08,040 --> 00:00:19,120 feeling like crap, right? 3 00:00:19,120 --> 00:00:23,880 Welcome to the Hormones Happen podcast, a podcast designed for individuals like you 4 00:00:23,880 --> 00:00:27,840 who are curious about the amazing benefits of hormonal placement therapy. 5 00:00:27,840 --> 00:00:33,000 I'm your host Jeremiah and I'm a nurse practitioner who specializes in HRT. 6 00:00:33,000 --> 00:00:38,280 I've seen firsthand the debilitating effects of hormone deficiency and have personally experienced 7 00:00:38,280 --> 00:00:40,560 the benefits of optimization. 8 00:00:40,560 --> 00:00:46,640 My goal is to arm you with information regarding the good, the bad, and even taboo aspects 9 00:00:46,640 --> 00:00:50,280 of HRT while answering your burning questions. 10 00:00:50,280 --> 00:01:06,160 Please join me for today's episode of the Hormones Happen podcast. 11 00:01:06,160 --> 00:01:09,040 Welcome back to the Hormones Happen podcast. 12 00:01:09,040 --> 00:01:13,960 Last time we talked about the amazing benefits of estradiol for both men and women and today 13 00:01:13,960 --> 00:01:16,040 it'll be a very similar topic. 14 00:01:16,040 --> 00:01:20,560 However, we're going to be talking about the redheaded stepchild of hormone replacement 15 00:01:20,560 --> 00:01:22,960 therapy called progesterone. 16 00:01:22,960 --> 00:01:26,880 Many people just like estradiol feel that this is a female only hormone. 17 00:01:26,880 --> 00:01:32,560 However, there are a plethora of benefits for both men and women that all occur from 18 00:01:32,560 --> 00:01:34,780 progesterone. 19 00:01:34,780 --> 00:01:38,200 So without further ado, let's get into it. 20 00:01:38,200 --> 00:01:43,400 Progesterone is a steroid hormone that is produced in the ovaries in women, the testes 21 00:01:43,400 --> 00:01:47,240 in men, and the adrenal glands in both sexes. 22 00:01:47,240 --> 00:01:52,840 It acts as a precursor to other vital hormones such as testosterone and cortisol. 23 00:01:52,840 --> 00:01:59,120 It's primarily known for its effects on regulating the menstrual cycle, supporting pregnancy, 24 00:01:59,120 --> 00:02:01,560 and balancing estrogen in women. 25 00:02:01,560 --> 00:02:08,320 However, this hormone also supports testosterone production in men and prevents estrogen dominance. 26 00:02:08,320 --> 00:02:15,040 Now, typically after the age of 30, progesterone levels slowly decline, leading to a plethora 27 00:02:15,040 --> 00:02:24,000 of symptoms such as difficulty sleeping, mood swings, anxiety, weight gain, brain fog. 28 00:02:24,000 --> 00:02:27,480 Is this starting to sound like low testosterone a little bit? 29 00:02:27,480 --> 00:02:28,480 Perhaps. 30 00:02:28,480 --> 00:02:33,880 A common scenario that I often see play out in my office is a woman between the ages of 31 00:02:33,880 --> 00:02:40,640 30 and 50 coming to me with a main complaint of difficulty sleeping, irritability, and 32 00:02:40,640 --> 00:02:45,400 just feeling anxious when she was never an anxious person before. 33 00:02:45,400 --> 00:02:49,680 And when she does go to sleep, she has a hard time staying asleep, oftentimes waking up 34 00:02:49,680 --> 00:02:52,960 with anxiety or even with cold sweats. 35 00:02:52,960 --> 00:02:54,560 That's the main complaint. 36 00:02:54,560 --> 00:03:00,140 The other complaint I often hear is a woman, same 30 to 50, will come in saying that she 37 00:03:00,140 --> 00:03:01,480 eats healthy. 38 00:03:01,480 --> 00:03:07,800 She exercises routinely, however, she just continues to have weight gain and just fat 39 00:03:07,800 --> 00:03:11,000 accumulation, especially around the midsection. 40 00:03:11,000 --> 00:03:16,660 Now, I don't only hear these complaints from a woman who's not on HRT, but if a woman has 41 00:03:16,660 --> 00:03:23,780 had a hysterectomy in the past and is now on estradiol without progesterone, I oftentimes 42 00:03:23,780 --> 00:03:29,780 hear the same exact complaints, sometimes to even a worse degree. 43 00:03:29,780 --> 00:03:35,240 While I do hear these similar complaints in men, typically once we start testosterone, 44 00:03:35,240 --> 00:03:36,800 they subside. 45 00:03:36,800 --> 00:03:41,800 When a man starts TRT, this can increase the amount of progesterone that's produced in 46 00:03:41,800 --> 00:03:43,680 the adrenal glands. 47 00:03:43,680 --> 00:03:48,520 And although it doesn't appear that there's a large quantitative difference between progesterone 48 00:03:48,520 --> 00:03:54,320 in men and women, it does appear that men are less sensitive to the outward effects 49 00:03:54,320 --> 00:03:58,600 such as anxiety, insomnia, and weight gain. 50 00:03:58,600 --> 00:04:03,880 I have, however, supplemented progesterone in men with a great effect on anxiety and 51 00:04:03,880 --> 00:04:06,120 to help with sleep. 52 00:04:06,120 --> 00:04:10,920 I personally take 200 to 300 milligrams of progesterone when I'm having a difficult time 53 00:04:10,920 --> 00:04:15,720 sleeping and it honestly works miracles. 54 00:04:15,720 --> 00:04:20,240 Let's talk about progesterone's role in weight management for a minute. 55 00:04:20,240 --> 00:04:25,440 There are several mechanisms in which progesterone helps to control weight gain, such as regulating 56 00:04:25,440 --> 00:04:30,960 cortisol, balancing estrogen, and supporting thyroid function. 57 00:04:30,960 --> 00:04:34,800 Progesterone acts as a buffer to the stress hormone called cortisol. 58 00:04:34,800 --> 00:04:41,160 And when progesterone levels are low, cortisol levels spike, leading to a fat storage predominantly 59 00:04:41,160 --> 00:04:43,520 around the midsection or belly. 60 00:04:43,520 --> 00:04:49,720 Now, although estradiol promotes fat loss, high levels can cause fluid retention and 61 00:04:49,720 --> 00:04:56,040 progesterone helps to regulate this by decreasing bloating or swelling in the extremities. 62 00:04:56,040 --> 00:05:01,640 And finally, progesterone has a reciprocal relationship with the thyroid by decreasing 63 00:05:01,640 --> 00:05:07,560 thyroid binding globulin, increasing the activity of thyroid hormones, increasing synthesis 64 00:05:07,560 --> 00:05:14,600 and metabolism of thyroid hormones, increasing conversion of T3 to T4, and up-regulating 65 00:05:14,600 --> 00:05:16,440 thyroid peroxidase. 66 00:05:16,440 --> 00:05:23,600 So basically, it helps to increase the amount of thyroid hormone while improving its efficiency. 67 00:05:23,600 --> 00:05:29,880 Another physiological effect of progesterone, which I do feel contributes to weight loss, 68 00:05:29,880 --> 00:05:35,080 specifically fat loss, is its ability to increase thermogenesis. 69 00:05:35,080 --> 00:05:37,800 Progesterone does increase your basal temperature. 70 00:05:37,800 --> 00:05:42,800 And I've noticed firsthand that if I take a progesterone and go to the gym the next 71 00:05:42,800 --> 00:05:49,200 morning, I do sweat a lot more than if I had not taken the medication. 72 00:05:49,200 --> 00:05:53,300 Some other amazing benefits of progesterone include a positive effect on bone health by 73 00:05:53,300 --> 00:05:58,680 stimulating osteoblast activity, promoting brain and nerve repair, maintaining healthy 74 00:05:58,680 --> 00:06:02,000 blood vessels, and reducing inflammation. 75 00:06:02,000 --> 00:06:07,360 One of the most beneficial and quickly recognized effects of progesterone is the calming effect 76 00:06:07,360 --> 00:06:12,240 that it has by increasing the production of GABA, which is a neurotransmitter that promotes 77 00:06:12,240 --> 00:06:18,040 relaxation and well-being, leading to fillings of calmness and reduced anxiety. 78 00:06:18,040 --> 00:06:23,640 I do want to further elaborate on some of the anti-anxiety and calming effects of progesterone, 79 00:06:23,640 --> 00:06:27,600 as this is one of the most beneficial aspects for both men and women. 80 00:06:27,600 --> 00:06:34,360 Now, the interaction between progesterone and gamma-aminobutyric acid, or GABA, receptors 81 00:06:34,360 --> 00:06:36,640 is truly amazing. 82 00:06:36,640 --> 00:06:41,240 GABA receptors are a key component of the brain's inhibitory system, and are responsible 83 00:06:41,240 --> 00:06:49,080 for the calming effects that promote relaxation, and they act as almost a brake on an overstimulated 84 00:06:49,080 --> 00:06:50,640 mind. 85 00:06:50,640 --> 00:06:55,040 When there's not enough stimulation of the GABA receptors, the brain experiences symptoms 86 00:06:55,040 --> 00:07:01,720 such as increased neuronal activity, leading to symptoms like anxiety, nervousness, difficulty 87 00:07:01,720 --> 00:07:08,680 relaxing, mood swings, trouble sleeping, and in very severe cases, seizures. 88 00:07:08,680 --> 00:07:14,520 When progesterone is metabolized, one of its primary metabolites, allopregninalone, acts 89 00:07:14,520 --> 00:07:20,520 as a powerful modulator of GABA, amplifying its brake-like effects on the brain. 90 00:07:20,520 --> 00:07:26,400 It's been known colloquially as the valium of the brain for this reason. 91 00:07:26,400 --> 00:07:32,720 Oftentimes when I follow up with a woman or man who's recently started HRT or TRT and 92 00:07:32,720 --> 00:07:39,640 I've used progesterone, they'll describe the sensation as almost turning down the volume 93 00:07:39,640 --> 00:07:42,560 on a noisy or chaotic mind. 94 00:07:42,560 --> 00:07:48,920 Now it is used less often in men, but typically if a man is on TRT and they're still having 95 00:07:48,920 --> 00:07:57,480 a lot of anxiety, progesterone is a very useful tool in your toolkit to help to combat that. 96 00:07:57,480 --> 00:08:02,960 Now like I've said, I've taken progesterone and I still do, and I can attest to the fact 97 00:08:02,960 --> 00:08:09,680 that it helps you sleep, but it also helps produce a sense of calmness the next day. 98 00:08:09,680 --> 00:08:16,600 And it varies from person to person, but progesterone's amazing effects on essentially sensitizing 99 00:08:16,600 --> 00:08:20,520 the GABA receptor is paramount. 100 00:08:20,520 --> 00:08:26,240 Key effects of progesterone, allopregninalone, and GABA receptor activity result in anxiety 101 00:08:26,240 --> 00:08:32,200 reduction, better sleep, mood stabilization, and neuroprotection. 102 00:08:32,200 --> 00:08:38,960 Now let's go one step further into the neuroprotective or brain protective properties of progesterone. 103 00:08:38,960 --> 00:08:44,880 I try to keep this podcast more conversational and less academic, but to really emphasize 104 00:08:44,880 --> 00:08:51,200 the benefits of brain health and progesterone, we really do need to dive a little bit deeper. 105 00:08:51,200 --> 00:08:53,680 So stay with me on this. 106 00:08:53,680 --> 00:08:58,360 Research has shown that progesterone exerts neuroprotective effects, offering hope for 107 00:08:58,360 --> 00:09:04,640 better outcomes in cases of traumatic brain injury, stroke, and even neurodegenerative 108 00:09:04,640 --> 00:09:07,760 diseases, but how does it do this? 109 00:09:07,760 --> 00:09:13,360 The powerful anti-inflammatory effects of progesterone help to reduce damage, promote 110 00:09:13,360 --> 00:09:18,620 repair, and enhance recovery after an injury to the brain, but it also helps to stabilize 111 00:09:18,620 --> 00:09:23,120 the blood-brain barrier, which is a critical structure that protects the brain from harmful 112 00:09:23,120 --> 00:09:25,920 substances after injury. 113 00:09:25,920 --> 00:09:31,680 Additionally, it helps restore the protective sheath around neurons, preserving their functionality 114 00:09:31,680 --> 00:09:38,120 and enhancing brain recovery while mitigating apoptosis, which is a medical term for the 115 00:09:38,120 --> 00:09:43,520 natural process that removes damaged or unneeded cells from the body. 116 00:09:43,520 --> 00:09:49,360 And lastly, progesterone stimulates the growth of new neural connections in the process called 117 00:09:49,360 --> 00:09:56,880 neurogenesis, which is essentially rebuilding the brain's neural network after an injury. 118 00:09:56,880 --> 00:10:01,000 Now that we've talked about the importance of progesterone for both men and women and 119 00:10:01,000 --> 00:10:07,300 the issues associated with low levels, what options do we have regarding replacement? 120 00:10:07,300 --> 00:10:13,640 Now progesterone, much like testosterone and estradiol, comes in a variety of forms, including 121 00:10:13,640 --> 00:10:20,760 oral, transdermal, pellets, patches, and probably some that I'm not even aware of. 122 00:10:20,760 --> 00:10:25,280 I will tell you the most common variations are pills and creams. 123 00:10:25,280 --> 00:10:31,280 From the research available today, I always recommend as first line an oral micronized 124 00:10:31,280 --> 00:10:37,160 progesterone because of the conversion to allopregnanolone when it's metabolized by 125 00:10:37,160 --> 00:10:38,920 the liver. 126 00:10:38,920 --> 00:10:45,240 Now there are some women who are overly sensitive, and probably men too, I just haven't experienced 127 00:10:45,240 --> 00:10:49,720 it, who are overly sensitive to the effects of allopregnanolone. 128 00:10:49,720 --> 00:10:55,800 And despite decreasing the dosage, they just report feeling drowsy the next day. 129 00:10:55,800 --> 00:11:02,000 And so for these individuals, cream is a great option because at the end of the day, the 130 00:11:02,000 --> 00:11:07,560 main benefit to the progesterone and the most important aspect is basically antagonizing 131 00:11:07,560 --> 00:11:14,880 the effects of estradiol to prevent uterine lining thickening while you're on HRT. 132 00:11:14,880 --> 00:11:22,760 Now with the cream, you will not get the same neurocognitive benefits as far as the anti-anxiety 133 00:11:22,760 --> 00:11:27,560 or the increased sleep effects, but you're still getting the most important aspects, 134 00:11:27,560 --> 00:11:32,000 which is preventing negative complications of HRT. 135 00:11:32,000 --> 00:11:37,280 Now I've seen quite a bit of variance as far as the studies and expert opinion regarding 136 00:11:37,280 --> 00:11:45,240 the oral versus the creams of progesterone, but one concern with the creams is that progesterone 137 00:11:45,240 --> 00:11:51,840 is a larger molecule size and there's concerns that it may not be adequately absorbed into 138 00:11:51,840 --> 00:11:57,360 the capillaries causing less protection against estrogen. 139 00:11:57,360 --> 00:12:02,400 I have heard several experts dispute this claim and report that while on progesterone 140 00:12:02,400 --> 00:12:09,040 cream checking levels is trickier because it tends to under sense on blood work and 141 00:12:09,040 --> 00:12:11,600 over sense on saliva testing. 142 00:12:11,600 --> 00:12:18,520 So it's really difficult to say, does the cream protect the uterus as much as the oral 143 00:12:18,520 --> 00:12:19,880 virgin? 144 00:12:19,880 --> 00:12:23,440 And it's really impossible for us to know because I do not think there have been any 145 00:12:23,440 --> 00:12:29,640 significant studies where they've done, you know, uterine lining biopsies or specific 146 00:12:29,640 --> 00:12:32,600 ultrasound imaging to really assess it. 147 00:12:32,600 --> 00:12:37,280 But at the end of the day, these are all calculated risks that we have to take and we have to 148 00:12:37,280 --> 00:12:38,560 consider. 149 00:12:38,560 --> 00:12:42,300 And so my first line is the oral. 150 00:12:42,300 --> 00:12:44,920 Second line would be the creams from me. 151 00:12:44,920 --> 00:12:47,060 Now this is not medical advice. 152 00:12:47,060 --> 00:12:50,640 This is just how I run my practice. 153 00:12:50,640 --> 00:12:56,220 How much to give and when to give it are also highly controversial due to the variabilities 154 00:12:56,220 --> 00:13:02,440 and thought processes among experts and the lack of study designs used for this specific 155 00:13:02,440 --> 00:13:04,100 population. 156 00:13:04,100 --> 00:13:09,960 Now regarding dosage, this varies anywhere from 50 to 400 milligrams. 157 00:13:09,960 --> 00:13:16,300 I will start my patients off at 200 milligrams, which appears to be a great dosage to help 158 00:13:16,300 --> 00:13:19,700 with anxiety reduction and promoting sleep. 159 00:13:19,700 --> 00:13:24,700 Now that's not to say that I haven't had to make dosage adjustments, either decreasing 160 00:13:24,700 --> 00:13:27,040 it or increasing it from there. 161 00:13:27,040 --> 00:13:33,920 But 200 just seems to be a great middle of the road starting point from my experience. 162 00:13:33,920 --> 00:13:38,800 Some experts believe you should mimic a natural menstrual cycle and use the progesterone for 163 00:13:38,800 --> 00:13:44,720 14 days at the beginning of the month, then refrain from use for the rest of the month. 164 00:13:44,720 --> 00:13:49,640 Whereas some say use every other day or every day. 165 00:13:49,640 --> 00:13:55,840 Now my biggest issue with the 14 day on 14 day off approach is that the 14 days that 166 00:13:55,840 --> 00:13:58,200 you're taking it, you feel great. 167 00:13:58,200 --> 00:13:59,640 You're sleeping great. 168 00:13:59,640 --> 00:14:02,000 Your anxiety is controllable. 169 00:14:02,000 --> 00:14:07,740 But the 14 days that you're not taking it, you feel horrible, maybe even worse. 170 00:14:07,740 --> 00:14:14,400 So from my personal opinion, I do not see the point in not treating those symptoms that 171 00:14:14,400 --> 00:14:17,700 you're coming to me to treat. 172 00:14:17,700 --> 00:14:24,320 The reason that the 14 day on 14 day off and every other day frequencies exist is because 173 00:14:24,320 --> 00:14:30,360 there is some speculation that the progesterone receptor can be down regulated with everyday 174 00:14:30,360 --> 00:14:36,400 use causing like a desensitization effect in addition to down regulating the estradiol 175 00:14:36,400 --> 00:14:37,400 receptor. 176 00:14:37,400 --> 00:14:44,560 Now, while it will down regulate the estradiol receptor, I haven't seen any research or scientific 177 00:14:44,560 --> 00:14:50,960 studies that do show that everyday use will down regulate the progesterone receptor needing 178 00:14:50,960 --> 00:14:55,200 you to increase your dosage to get the same effect. 179 00:14:55,200 --> 00:15:01,040 I typically start most of my patients on every other day dosing, but oftentimes what I hear 180 00:15:01,040 --> 00:15:05,200 is that on the days they don't take it, they feel like crap. 181 00:15:05,200 --> 00:15:10,340 So we eventually end up doing everyday dosing because the whole point of HRT is to avoid 182 00:15:10,340 --> 00:15:12,720 feeling like crap, right? 183 00:15:12,720 --> 00:15:17,800 I have seen in a couple cases that the progesterone will decrease the estradiol levels, but this 184 00:15:17,800 --> 00:15:21,320 is an easy fix while on estradiol replacement. 185 00:15:21,320 --> 00:15:23,580 We just increase the dosage. 186 00:15:23,580 --> 00:15:28,840 So as you can see, there are several different ideologies regarding how, how much, and when 187 00:15:28,840 --> 00:15:31,280 to take progesterone. 188 00:15:31,280 --> 00:15:35,600 Remember when I said the world of hormone replacement therapy was still the Wild West? 189 00:15:35,600 --> 00:15:38,440 This is exactly what I was talking about. 190 00:15:38,440 --> 00:15:46,040 We interrupt this program to bring you an important announcement. 191 00:15:46,040 --> 00:15:51,160 Look guys, the harsh reality is that aging naturally is no longer possible. 192 00:15:51,160 --> 00:15:56,920 We're bombarded with endocrine disruptors every day without even knowing it. 193 00:15:56,920 --> 00:16:02,720 Seeking treatment usually leads to the prescription of unnecessary medications and unwanted reassurance 194 00:16:02,720 --> 00:16:06,880 that what we're experiencing is normal, but it's not. 195 00:16:06,880 --> 00:16:13,680 At SteelCity HRT and Weight Loss, we not only ask questions, but listen to answers and believe 196 00:16:13,680 --> 00:16:17,160 that treatment cannot be a cookie cutter protocol. 197 00:16:17,160 --> 00:16:21,560 If you're curious about the amazing benefits of hormone replacement therapy or have been 198 00:16:21,560 --> 00:16:30,240 turned away by our traditional Western medical society, don't hesitate to call 719-669-4223 199 00:16:30,240 --> 00:16:45,520 now to schedule labs and discuss treatment options. 200 00:16:45,520 --> 00:16:47,640 All right guys, let's get into some Q&A's here. 201 00:16:47,640 --> 00:16:50,040 I have a couple questions. 202 00:16:50,040 --> 00:16:52,120 Can TRT be injected like insulin? 203 00:16:52,120 --> 00:16:54,320 Well, this is a great question. 204 00:16:54,320 --> 00:16:56,680 I am assuming he just means subcutaneously. 205 00:16:56,680 --> 00:16:59,880 So the answer is absolutely. 206 00:16:59,880 --> 00:17:06,040 Now subcutaneously just means the fat tissue, whereas intramuscular is just into the muscle. 207 00:17:06,040 --> 00:17:09,640 Now there are a couple variables you want to take into account here. 208 00:17:09,640 --> 00:17:13,280 One of them being the carrier oil that's mixed with testosterone. 209 00:17:13,280 --> 00:17:17,160 Now testosterone is hydrophobic, meaning that it hates water. 210 00:17:17,160 --> 00:17:19,780 So it has to be mixed with some type of oil. 211 00:17:19,780 --> 00:17:22,560 There are some oils that are more inflammatory than others. 212 00:17:22,560 --> 00:17:26,440 For example, grapeseed oil and cottonseed oil. 213 00:17:26,440 --> 00:17:28,040 These are the ones you would typically get. 214 00:17:28,040 --> 00:17:30,760 Let's say Walgreens, CVS. 215 00:17:30,760 --> 00:17:35,320 Whereas grapeseed oil, which is the oil that I personally use for all of my testosterone 216 00:17:35,320 --> 00:17:41,080 products is not as viscous or thick and it's also not as inflammatory. 217 00:17:41,080 --> 00:17:45,520 The other thing you want to take into account is the size of the needle. 218 00:17:45,520 --> 00:17:51,360 Traditionally needles as big as 23 to 25 gauge, one and a half inches were used to inject 219 00:17:51,360 --> 00:17:53,340 deep intramuscular. 220 00:17:53,340 --> 00:18:00,080 For subcutaneous or even shallow intramuscular, we use, well, insulin needles, 27 gauge half 221 00:18:00,080 --> 00:18:01,600 inch needles. 222 00:18:01,600 --> 00:18:06,800 These are small enough to be able to inject the fat, but big enough to be able to inject 223 00:18:06,800 --> 00:18:11,040 the muscle without really worrying about hitting any major blood vessels. 224 00:18:11,040 --> 00:18:12,040 Definitely not the bone. 225 00:18:12,040 --> 00:18:17,400 And it gives you a lot of freedom as to where you want to inject. 226 00:18:17,400 --> 00:18:23,220 Now the biggest difference between subcutaneous and intramuscular injection is the absorption 227 00:18:23,220 --> 00:18:27,680 times because there's greater vascular supply to the muscle. 228 00:18:27,680 --> 00:18:33,080 So if you inject it into the muscle, it's going to absorb more quickly, which is not 229 00:18:33,080 --> 00:18:38,080 really a big deal if you're injecting it at least twice a week. 230 00:18:38,080 --> 00:18:42,880 If you're doing it only once a week, which I don't recommend, then subcutaneous may be 231 00:18:42,880 --> 00:18:49,100 a better option for you just because it's going to be more of a slower absorption rate. 232 00:18:49,100 --> 00:18:53,720 And the one other caveat to subcutaneous is that when you do inject it, you're going to 233 00:18:53,720 --> 00:18:57,760 develop a little bit of a nodule, which is the oil depot. 234 00:18:57,760 --> 00:19:02,100 And if you rub it, it'll usually just dissipate a little bit, but it can be a little irritating 235 00:19:02,100 --> 00:19:03,280 for most. 236 00:19:03,280 --> 00:19:06,360 I've done both subcutaneous and intramuscular. 237 00:19:06,360 --> 00:19:08,560 I much prefer intramuscular. 238 00:19:08,560 --> 00:19:14,780 I just feel that it gives me better symptom relief and better effect. 239 00:19:14,780 --> 00:19:17,680 Why is my testosterone level lower? 240 00:19:17,680 --> 00:19:24,440 First question, I am a 38 year old male on TRT and my doctor has me on 200 mg every two 241 00:19:24,440 --> 00:19:25,480 weeks. 242 00:19:25,480 --> 00:19:30,560 When I started the shots, my testosterone level was 214, but when I recently got my 243 00:19:30,560 --> 00:19:33,120 levels checked, it was 60. 244 00:19:33,120 --> 00:19:38,960 I feel good a couple of days after my injection, but feel worse than before treatment the week 245 00:19:38,960 --> 00:19:42,600 leading up to my next shot. 246 00:19:42,600 --> 00:19:44,840 This is more common than you guys think. 247 00:19:44,840 --> 00:19:49,600 However, it's been a minute since I've seen dosing every two weeks. 248 00:19:49,600 --> 00:19:54,200 As a little background here, when you take an exogenous form of testosterone, whether 249 00:19:54,200 --> 00:20:00,560 that be injections, creams, or pills, your endogenous or natural production stops because 250 00:20:00,560 --> 00:20:05,740 your brain doesn't know you're now getting testosterone from a needle and it thinks that 251 00:20:05,740 --> 00:20:07,880 it's making too much. 252 00:20:07,880 --> 00:20:11,640 So it stops its natural production, which is called shutdown. 253 00:20:11,640 --> 00:20:17,520 Now, assuming he's using testosterone cypionate, that means he's getting a peak effect of the 254 00:20:17,520 --> 00:20:22,600 medication in about three to four days and half the medication is out of his system in 255 00:20:22,600 --> 00:20:23,600 a week. 256 00:20:23,600 --> 00:20:24,600 We call this a half life. 257 00:20:24,600 --> 00:20:30,600 Now, going one week further means that he's essentially getting half of the half out of 258 00:20:30,600 --> 00:20:31,960 his system. 259 00:20:31,960 --> 00:20:38,520 So from the initial 200 mg, he's really only working with about 50 mg, but there are a 260 00:20:38,520 --> 00:20:43,240 lot of variables to this and I'm just making a broad assumption based off normal half-lives 261 00:20:43,240 --> 00:20:45,120 of medication here. 262 00:20:45,120 --> 00:20:52,560 So remember, the natural production of testosterone is still shut down, but now as the exogenous 263 00:20:52,560 --> 00:20:57,880 levels fall, you actually dip below your starting testosterone level. 264 00:20:57,880 --> 00:21:03,120 Now, if you were to stay off of it, your natural production would start again, but in that 265 00:21:03,120 --> 00:21:06,160 two week window, you're pretty vulnerable. 266 00:21:06,160 --> 00:21:12,360 So as I've said before, I recommend at least twice weekly injections to avoid this issue. 267 00:21:12,360 --> 00:21:17,340 All right, this last question hits pretty close to home as far as this podcast goes 268 00:21:17,340 --> 00:21:18,340 right now. 269 00:21:18,340 --> 00:21:22,440 I'm a 35 year old female looking to get on HRT. 270 00:21:22,440 --> 00:21:27,360 I've had a hysterectomy five years ago and my PCP is telling me that I cannot have progesterone 271 00:21:27,360 --> 00:21:28,360 now. 272 00:21:28,360 --> 00:21:33,720 I am thankful that she has started me on estrogen and while I do feel a lot better, still have 273 00:21:33,720 --> 00:21:37,080 a lot of anxiety and difficulty going to sleep. 274 00:21:37,080 --> 00:21:38,960 What are your thoughts? 275 00:21:38,960 --> 00:21:41,560 Pretty good timing for this type of question. 276 00:21:41,560 --> 00:21:47,560 And I do want to preface this with this is not medical advice, just my personal opinion 277 00:21:47,560 --> 00:21:50,000 as an HRT provider. 278 00:21:50,000 --> 00:21:55,080 Now, I don't see any reason why you cannot have progesterone. 279 00:21:55,080 --> 00:22:01,200 I have heard this many, many times before and while it is not necessary in terms of 280 00:22:01,200 --> 00:22:07,600 preventing endometrial hyperplasia due to not having a uterus, you would still benefit 281 00:22:07,600 --> 00:22:14,560 tremendously from the effects of progesterone, including the bone protection, breast protection, 282 00:22:14,560 --> 00:22:20,040 and of course the palethora of the mental benefits that you get from progesterone. 283 00:22:20,040 --> 00:22:25,040 Now one thing to consider is, you know, did they spare the ovaries? 284 00:22:25,040 --> 00:22:31,160 Now even if they did a hysterectomy and they left the ovaries, I would say from my experience, 285 00:22:31,160 --> 00:22:36,240 these women are still having hormone deficiency symptoms. 286 00:22:36,240 --> 00:22:39,920 And when I check the blood work, they're objectively low as well. 287 00:22:39,920 --> 00:22:46,600 So even if the ovaries are spared, I'm still seeing from my experience, these women highly 288 00:22:46,600 --> 00:22:48,880 benefit from HRT. 289 00:22:48,880 --> 00:22:55,240 But as far as progesterone use after a hysterectomy, there's no data, literature or research that 290 00:22:55,240 --> 00:23:03,880 shows risk, but you will get benefit. 291 00:23:03,880 --> 00:23:08,400 I want to thank everyone for listening to today's episode of the Hormones Happen podcast 292 00:23:08,400 --> 00:23:13,000 and hope that you were able to find some value in the information that was provided today. 293 00:23:13,000 --> 00:23:17,400 If you have any questions that you would like to have discussed on the podcast, please send 294 00:23:17,400 --> 00:23:22,600 them to the email listed below or message us on the StillCity HRT and Weight Loss Facebook 295 00:23:22,600 --> 00:23:23,600 page. 296 00:23:23,600 --> 00:23:27,240 And remember, you are not alone in the war on hormones. 297 00:23:27,240 --> 00:23:54,240 Stay optimized.