Ep. 174 – Dr. Doug – Hormone Optimization Therapy

Have you given thought to the possibility of having the hormonal replacement therapy conversation?

As we age, hormones will inevitably decline and it’s something that everyone will have to deal with. The hormonal optimization therapy is something we should discuss now that the benefits outweigh the risks with the current literature.

In this episode of the Secure Your Retirement podcast, we have Dr. Doug Lucas, a triple fellowship-trained physician with a passion for health optimization, epigenetics, bone health, hormone optimization, and orthopedic surgery. Listen in to learn about the hormone decline symptoms to look out for and how to start the testing and treatment process.

In this episode, find out:

• Understanding hormonal replacement therapy and the benefits of it.
• The common symptoms of hormonal decline in both men and women and the age they occur.  
• The symptoms of hormonal decline in women and when to consider the optimization conversation.
• How to approach hormonal testing and treatment from where you are now to where you want to be.
• Benefits to expect from hormonal replacement therapy for both men and women and the time it takes to work.

Tweetable Quotes:

• “Hormonal replacement is something that if you do, you should plan on doing indefinitely.”– Dr. Doug
• “Giving somebody hormones will deplete them of some things pretty predictably, and that’s another thing that needs to be considered along the way.”– Dr. Doug

Get in Touch with Dr. Doug:

• Website: https://optimalhumanhealth.com/

Resources:

If you are in or nearing retirement and you want to gain clarity on what questions you should be asking, learn what the biggest retirement myths are, and identify what you can do to achieve peace of mind for your retirement, get started today by requesting our complimentary video course, Four Steps to Secure Your Retirement!

To access the course, simply visit POMWealth.net/podcast.

Here’s the full Transcript:

Radon Stancil:	Welcome everyone to Secure Your Retirement podcast. We now are so excited to have back a guest that we had previously on episode 166, Dr. Doug, who is a health optimization physician. Episode 166 was all about how to deal with osteoporosis, how to prevent it and how to reverse it potentially. And so we thought, man, it was such a great episode, we asked Dr. Doug would he come back and talk to us again. So, thank you so much for coming back and having another discussion with us today.
Dr. Doug Lucas:	Thanks for having me back. It’s great to see you guys again.
Radon Stancil:	Great, great. There’s a lot of different things that you deal with in your practice and how you help individuals, and one of the things that we had in a discussion with you last time was we said, what are some of the things that we could discuss? And we were looking at different topics and one of the things that came up and you were describing it to us is one of those topics that everybody wants to know about but nobody really wants to ask about, and that’s really this idea of hormone optimization and how do we deal with these different things that happen as we get older? Maybe some of it is things that we don’t really want to talk about, but the reality is it’s happening, so how do we deal with it? When we use the word hormone optimization therapy, could you kind of say, well, what is that and how does it apply maybe to men? How does it apply to women? And then we can kind of walk that through.
Dr. Doug Lucas:	Yeah, thanks for that lead in, that’s actually really well said. This is something that I find that people really want to know about. They’re afraid to talk to, whether it be a primary care, OB-GYN. It’s often not brought up because it just is something that is so controversial, that’s really become that way over the last couple of decades, which is unfortunate because it is something that everybody will deal with. All men predictably will have a decline in their main sex hormone, which is testosterone, and women have a precipitous decline in all three sex hormones, estrogen, progesterone, and testosterone. So it is something that we will all deal with as we age, if we are fortunate enough to live long enough for that to happen. So then the question is, what do you do about it? That’s a discussion that everybody should have, but you should have that discussion knowing what the risks and the benefits are with the current literature.
	And that’s really where things fall through the cracks is because a lot of physicians are not up to date on the current literature, but have been trained in the traditional literature, which when we were all, most of us that are physicians now, was around the time when there was a big pullback on hormone replacement therapy. So a lot of us that are in practice are still thinking with that old dogma of the literature that said that it’s very dangerous and the benefit doesn’t outweigh the risk, but that thought has been changed in the realm of people that are actually doing it on a regular basis.
Murs Tariq:	So what are, I guess, some of the signs, or someone that doesn’t really know what hormone optimization is or someone who just feels like, “Hey, maybe this is just part of the deal as we get older. We get a little bit more tired and things start to change.” What are some of the signs that would trigger someone to say, “Oh, maybe I should talk to my physician about this and see if everything is working the way it should be, or should I start looking at optimizing some of these different genetics?”
Dr. Doug Lucas:	Yeah. I think we look at a lot of these signs of aging as normal. And I think it’s a little bit different for women than for men because for men, the loss of testosterone is usually pretty gradual and so it’s kind of slowly over time, you lose the benefit of the hormone, and I’ll talk about what that does. But for women it’s precipitous. As they go through menopause, usually their hormones fall off of a cliff. And so that’s why they get symptoms of menopause. And there’s a discussion of hormone replacement for those symptoms, but there are also a lot of other potential benefits too. And so the symptoms that men would feel, and this can even happen long before the same age and time as menopause in women, in men this can happen in their forties and thirties and I’ve even seen it in men in their twenties.
	And we’re seeing this average decline of testosterone in men. And the problem with that is that, like I said earlier, testosterone will slowly go down as we age, and we can talk about whether or not that’s normal, but when the starting point gets lower and lower, then you’re going to see symptoms earlier. And so those symptoms basically are fatigue, brain fog, kind of loss of vitality, that’s what I hear a lot of patients describe it as; they just don’t have that drive, their resilience to get through the end of the day. They just don’t have the steam that they used to have. Those are the things that I’m mostly treating. And you’ll hear some men talk about some things like loss of libido and loss of sexual function. And that is a component of testosterone, but that’s generally not what I’m treating.
Radon Stancil:	So you talk about this idea of it could be happening younger. So I guess then, depending upon who’s listening to this right now and whatever age they are, I’m assuming that there are things that you… Oh, well, let me ask it this way, are there things that you would do? Let’s say I was listening to this and I’m in my forties versus if I’m listening in my sixties, or whatever, is there a different approach depending upon when I’m thinking about this or talking to someone about this?
Dr. Doug Lucas:	Yeah, there really is. Because there’re really three main ways that I treat this, and I’ll just focus on men for now. So for men, if you were to go to your doctor and say, “I’m tired,” and you kind of list that, you put out that whole list that I just said, the likelihood of them testing your testosterone if they’re a traditional physician is actually pretty low. Because they’re probably not going to be comfortable treating it and they’re definitely not going to be comfortable treating it the younger that you are. Also, if you do get checked in a traditional setting, they’re going to likely say that your testosterone is “normal.” And the reality is that the reference range for labs, if you think about what that means, is that it is two standard deviations from the average. And I just said that the average has been slowly declining and these reference ranges change over time.
	So now the reference range includes really low testosterone, which is “normal,” but terrible. And so you could go potentially to a physician and you could say you have these things and even if they test you could still be told, “Hey, it’s normal. Don’t worry about it.” So when I see these patients, we say, well, you likely have symptoms of low testosterone. But we still start with things like lifestyle first because testosterone levels are exquisitely sensitive to deficits in sleep, to stress, to poor diet, to not exercising. So you change around all those lifestyle things and you may see what is really bad testosterone become really good testosterone. So we really start there. But once you start actually intervening, there’s the supplement pathway, which I consider part of the lifestyle pathway, because it helps but it’s not huge. And then there’s actually doing something about it from a medication perspective.
	So for younger guys, you can use off-label drugs like Clomid or clomiphene, which will increase your testosterone levels kind of naturally, although you’re still taking a medication, but it’s not a replacement. And then there’s actual replacement. And then replacement is something that if you do, you should plan on doing indefinitely because if you ever come off of it, you’ll have very low levels of testosterone for a while, but eventually they’ll come back up. The question is how much and how much will you actually get back? So if we’re going to replace it, I do that in older folks and plan on doing that indefinitely.
Murs Tariq:	So you mentioned supplements. That was kind of leading into my question. I enjoy working out and I use some supplements here and there and protein is one that I typically will take on a daily basis. But I like things to be nice and clean and it seems like there’s a supplement out there for every little thing that you may be deficient in these days, and then some. So tell us what would be, in your eyes, wrong with self-diagnosing and just going the supplement route.
Dr. Doug Lucas:	Yeah. I mean, the answer is probably nothing as long as you have an unlimited budget, because if you look up testosterone supplements, you’ll find just hundreds and hundreds or thousands and thousands of different things. Some of them have some evidence behind them, and I’m happy to share those with you. But again, when you look at the evidence, it’ll say, well, it is significantly different and it is statistically significantly different. But again, it depends on your starting point. So let’s say our goal is to get you to 1,000 of total testosterone, and let’s say you’re at 850 and you want to bump it up a little bit. If you get 10% improvement from 850, yeah, that’s great. But if your testosterone is 200 and you get a 10% improvement, you’re not any better. So there’s nothing wrong with trying it, it’s just a matter of what are you expecting to get out of it? But again, if you do that with lifestyle changes, then you could really see some benefit.
Radon Stancil:	So you talked about that a little bit and we can come back and forth, but I just kind of want to now just hop over here for a second and talk about what you mentioned with the women. From what I understand, the idea of going through menopause can be at a few different age points for women. It’s not everybody’s at this age and this is when it happens. So when should a woman really start thinking about this idea of hormones for themselves? I mean, is it something you get ready for prior to menopause?
Dr. Doug Lucas:	You can, yeah. And so this is a tough one. So women, it’s more complex because you’re dealing with more hormones. And women, when they’re premenopausal, they’re cycling, the hormones of progesterone and estrogen are up and down, testosterone’s a little bit more consistent. When they start entering into menopause, this perimenopause timeframe, it can last for years. And so if you’re having symptoms of menopause but you’re still having regular cycles, you can start having the discussion around what kind of hormones are appropriate, because you can kind of layer these things on. And I see that women will become… They’ll have symptoms of testosterone deficiency early on or symptoms of progesterone deficiency, but they still have plenty of estrogen. So you don’t want to overload them with all three. And there is definitely an art to layering that on. But as soon as you start having symptoms, then absolutely have that discussion with somebody who knows what they’re doing.
Murs Tariq:	So tell us a little bit about your process here. So someone went to their physician and their physician owned up to it and said, “Hey, I might not be the best person for this. So seek help from…” And they happen to land on Optimal Human Health. Right? So tell us a little bit about your process. Someone knows that they’ve got something that needs to be checked and balanced a little bit and they come to you and say, “Do your workup on me.” What does that look like? So when we’re building out retirement plans, when we’re talking to clients, we talk a lot about, well, we have to know where we are right now to help us know where we want to get to and the path in between that. So tell us a little bit about how you operate there.
Dr. Doug Lucas:	Yeah. Great analogy. And it’s so true. You can’t just pick a point in the future and not know where you’re starting from and create a plan. And that’s where I see a lot of people, a lot of companies, unfortunately, have really developed in this space around hormone optimization because the traditional medical community is not really addressing it. Some OB-GYNs will address it, and I can talk about some of the challenges there, but primary care typically doesn’t. And it’s one of those things that people just aren’t talking about it. And so when a patient goes home and they start Googling these things and they find companies that are making these promises, if you look for the bottom dollar way to replace hormones, they’re not going to do any testing at all, which is scary in my opinion, and probably not a good idea. And so you’re right, you have to figure out where you are.
	And so we have two different avenues in which we can do hormone replacement. I have my hormone replacement-only programs, which even so they’re still done through an optimization lens. So we start out by getting a pretty extensive lab panel. We look at things, not only the hormones of where you are right now, but then we also look at some of the things that can potentially change if you go on hormone replacement. So that includes things like your cholesterol, your cardiac risk factors, inflammatory factors, thyroid, a couple other micronutrient things. It’s not our full optimization panel, but it’s a streamlined version of it. And then based on that, then we start replacement after a long discussion of the risks and benefits, assuming that they want to move forward, then we start replacement. And then we continue to test and we figure out, okay, now that you’re on it, especially for women, how are you detoxing those hormones?
	We have to do more extensive testing for women with the detox of estrogen and making sure that you’re looking at the urine metabolites so that we’re actually improving your risk rather than making your risk worse. For men, it’s a blood test, which is a little bit more simple. But again, we’re retesting and make sure that now that we have these hormones on board, that they’re not doing things that we don’t want them to do. And that’s where I see the programs that don’t do any testing or do very little testing, they’re very inaccurate. And I get a lot of patients that come from these programs and saying, “Well, I tried it and I didn’t feel better.” And then you kind of look at some of their old labs if they have any and you’re like, whoa. Yeah, you didn’t see the big picture there.
Radon Stancil:	And I understand that the question I’m about to ask can vary from person to person, but could you maybe give us some examples? Because we’re talking about all this and so maybe I’m listening and I’m going, okay, is it worth it, so to speak? So could you maybe give us some examples? And I’m not asking for the best case scenario, but I’m just saying kind of an average. If I come to you and let’s say I’ve got those things I’m talking about, I don’t have that. I do run out of steam. I don’t feel like I’ve got that drive I had before and I’ve had all these things. And so then I start talking to someone like you and we start talking about the idea of hormone replacement or optimization or whatever it might be. Could you lay out maybe some of the expectations of what I could expect?
Dr. Doug Lucas:	Yeah. And again, we’ll go by gender because there are some differences there. So for men, as I lay it out, that feeling of the change in vitality, that’s one of my favorite words for it, because men just feel more energy. They have the stamina to get through the day. They feel like working out, they recover better, they think more clearly. They’re a little bit more competitive, not like you think roid rage, going overboard, but just they have that competitive nature, which you can think of even in the world of finance and retirement. You want to have the right amount of competitive edge there in order to not get just rolled over. And so that’s what I hear from guys now. Then I also hear the benefits from an improved libido and sexual function. But again, that’s usually not their main goal.
	For women, it’s pretty different. So for women, especially women that are having symptoms of menopause, the hot flashes, just the discomfort through the day from that, the changes in body composition. Now they’re gaining fat around the midsection and they don’t feel good in their body. They’re very uncomfortable, some women going through this are very uncomfortable. And if you give them their estrogen back, then those symptoms of menopause completely go away. Now, the progesterone and the testosterone is not quite as obvious, but progesterone is wonderful in paving the right way for sleep. And so a lot of women, as they enter into menopause will have a really hard time sleeping.
	Giving them an adequate amount of progesterone to help balance the estrogen really helps them with their sleep. It is the best sleep medication on the market. And then the testosterone is really good for maintaining your lean muscle mass. It’s great for your skin quality, your texture. And they get some of that same energy, vitality, but probably not quite as much as men because the levels are about, could say 5% of what it is in a man. But everybody gets that kind of bump in libido and just desire for the day.
Murs Tariq:	So how long does this process take for them to start seeing… Everybody wants results right away. And sometimes when you go on a diet, if you do it properly, you don’t get results right away is what we’re told. You don’t want to overdo things for that immediate satisfaction. Where do you start to see those benefits? And I assume a lot of these are things that are going to be… You’ve mentioned lifestyle, so lifelong changes that someone is kind of signing up for, in all essence, if they want to see progressions happen.
Dr. Doug Lucas:	Yeah, that’s right. Yeah. So to answer the first part of that, it’s actually really pretty quick. So in men, I see changes in a week to two weeks. That first follow up that we have with them is usually a really fun visit because they’re happy, things are feeling better, they have energy. They’re like, “Dude, this is awesome. Thank you so much.” They’re usually so happy. Women are just happy, if they have symptoms of menopause, they’re happy to not have those anymore. Some of the other changes, like skin changes and body composition, obviously that takes time. But adding estrogen back, that’s really powerful. Something I did want to mention, too, is I tend to not do hormone replacement alone.
	I look at hormone replacement as kind of a layer in the whole optimization package. And so if somebody comes to me and they are metabolically a mess, they’re eating terribly and let’s say they have really bad habits, like smoking and drinking excessively, I sometimes won’t even treat those patients because you really have to consider this as sort of a layer in the whole optimization triage triangle, and you do have to do the foundation stuff first. You also have to, when you’re replacing them, also consider other things like micronutrient deficiencies, because giving somebody hormones will deplete them of some things pretty predictably, and that’s another thing that needs to be considered along the way.
Radon Stancil:	Very good. All right. Well, this is one of those things we could probably sit around and talk about all afternoon, but could you just walk us through, let’s say somebody’s listening to this and they know that this is a topic that they’d like to have a discussion, and let’s say with you, how would they do that? What’s the best way to enter into this conversation with you, Dr. Doug?
Dr. Doug Lucas:	Yeah, I think just go to our website at optimalhumanhealth.com and you can see there’s, under programs, we talk about the programs of hormone replacement. But ultimately right now the lead pathway is just send us a message, a couple of different ways to do it on the website, but send us a message and our team will get you scheduled with me to have a review of what you’re interested in. And then we’ll either talk about doing the hormone optimization pathway alone or doing an optimization program, which always includes a conversation of hormones, but it’s a little more… Actually, it’s a lot more comprehensive, just depending on what your needs are and what you’re looking for.
Radon Stancil:	Great. Well, thank you so much as always. Now we’ve got two of these big topics that we’ve been able to discuss and you make it super easy for us to understand it and be able to have a good conversation. So we thank you again for coming on and talking with us.
Dr. Doug Lucas:	Awesome. Well, thank you. And this is a topic that I think really needs to be brought out to the public so I’m happy you guys are willing to do that. Appreciate it.