Is Estrogen Replacement Safe? The Truth They Might Not Tell You | Dr. Felice Gersh

Dr. Gersh: [00:00:00] Estrogen is not a hormone. It's a family of hormones. So there are three estrogens. E one is estro, E two is estradiol, and E three estriol. All of these are present in a reproductive aged woman, but in different quantities, percentages based on what the body needs. Estradiol controls the immune system for turning on inflammation and turning off inflammation.

But when you end up with too much estro, you end up with too much inflammation and simulation of cancers. 

Dr. Brighten: A lot of people are afraid of hormone replacement therapy because of the cancer scare. Talk to us about that. 

Narrator: Dr. Felice Gersh is a world renowned O-B-G-Y-N, integrative medicine pioneer and bestselling author who's changing the way we talk about women's health 

Narrator 2: with over four decades of clinical.

Experience and dual board certifications. She's leading a [00:01:00] revolution that fuses cutting edge science with holistic healing from PCOS to perimenopause. Dr. Gersh has become the go-to expert for women who want more than band-aid solutions. 

Dr. Gersh: Estradiol is very key to, boy, you have a lower risk of dying if you get breast cancer when you're on hormones.

Is that estradiol causes? The cells to be more like 

Dr. Brighten: when it comes to the conversation of cancer and hormone replacement therapy. How do you approach hormone replacement therapy in women? 

Dr. Gersh: Well, I always say I'm a simple thinker, so I want to 

Dr. Brighten: replicate. Welcome back to the Dr. Brighten Show. I'm your host, Dr.

Jolene Brighten. I'm board certified in naturopathic endocrinology, a nutrition scientist, a certified sex counselor, and a certified menopause specialist. As always, I'm bringing you the latest, most UpToDate information to help you take charge of your health and take back your hormones. If you enjoy this kind of information, I invite you to visit my [00:02:00] website, dr Brighten.com, where I have a ton of free resources for you, including a newsletter that brings you some of the best information, including a.

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Dr. Felice Gersh, welcome to the podcast. Well, I'm so excited to be here and talk about my favorite hormone estrogen. Oh yeah. We're gonna get in good with estrogen, but I want to make sure everybody is on the [00:03:00] same page. So when we say estrodiol, what are we talking about? Well, I'm glad 

Dr. Gersh: you brought that up, because the word estrogen is bantered around and people don't know what it is.

Yeah. So estrogen. Is not a hormone, it's a family of hormones. Just like there's a family of B vitamins. Mm-hmm. You wouldn't interchange them if you're deficient in B12, you can't solve the problem with B one. 

Dr. Brighten: Yeah. 

Dr. Gersh: So there are three estrogens that are in the adult female and they have a number and a letter just like the B vitamins.

So E one is ESTRO E two, which is. The one made by the ovaries is estradiol. Mm-hmm. And E three Estriol is the dominant estrogen produced by the placenta during pregnancy, but all of these estrogens are present in a reproductive aged woman, but in, in different. Quantities, percentages based on what the body needs.

Mm-hmm. Estradiol can be converted back and forth to estro and [00:04:00] a one way street from estradiol into estriol. So it's all managed by the body to make everything right. And there's different estrogen receptors that bind differently to the different estrogens, creating different effects in different organs.

So it's really important to understand that when you say the word estrogen, that means. Lot. Not that much actually. Yeah. If you're getting down to the nitty gritty of what is actually happening. 

Dr. Brighten: Yeah. So you said Estriol or E three, that's predominant in pregnancy because it's predominantly made by the placenta.

When do we see estro and estradiol in a woman's life? 

Dr. Gersh: So you see a teeny bit of Estriol and the reproductive age woman. Mm-hmm. And. The estrogen from the ovary is estradiol, but there's plenty of estron. Mm-hmm. In the adult reproductive age, female, and unfortunately sometimes too much in the. Woman who is metabolically unhealthy, which usually involves having some excess abdominal fat, you know, with the visceral fat, [00:05:00] the really hostile inflammatory fat.

Yeah. And also in postmenopausal women. 

Dr. Brighten: Mm-hmm. 

Dr. Gersh: And so estradiol can convert appropriately to estro when the body wants it to be into that form, and it can convert back. But it turns out that adipose tissue. AKA fat. 

Dr. Brighten: Yeah. 

Dr. Gersh: Has the same. Enzyme aromatase that's present in ovaries that can actually make different conversions and can convert the androgens that are predominantly coming from the adrenal gland a little.

Mm-hmm. Testosterone, that's about 25% of all the androgens is coming from the ovary, testosterone, and the rest is predominantly coming from the adrenal gland. But when you have a lot of. Inflammation. Yeah. It upregulates this enzyme called aromatase and starts converting these androgens. Intoone. Mm-hmm.

And. When you have a lot of [00:06:00] inflammation, it downregulates the enzyme that can interchange to convert estro back to estradiol. So you get stuck Yeah. With Estro. And Estro isn't evil. Mm-hmm. It's all about proportions. Like you can die of water intoxication. You know? We always use those analogies. Yeah, yeah.

Because Estro isn't evil, it's just you don't want too much. You could have too much of a good thing. Mm-hmm. And estro. Differently than estradiol binds pretty exclusively to the alpha receptor. Mm-hmm. Which has different functions. So I like, it's kind of simplistic, but really it's easy to think this way.

Estradiol controls the immune system. 

Dr. Brighten: Mm-hmm. The 

Dr. Gersh: on off switch for turning on inflammation and turning off inflammation. Estro is predominantly the on switch uhhuh, and you can think of Estriol as predominantly the off switch, but you need the balance. Mm-hmm. And that's estradiol. That's why [00:07:00] that's like the master of the different estrogens for the typical reproductive age woman.

When you end up with too much eOne, then you are turning the on switch to inflammation to proliferation, like un like uncontrolled growth. Yeah, 

Dr. Brighten: because 

Dr. Gersh: one of the wonderful things about. Estradiol is that it controls growth factors which are so important for rejuvenation, replacement of cells. Mm-hmm. And control of mitochondria, the energy factories of cells.

All this is under the auspices of estradiol. Yeah. But Estro has different effects. So you end up with. Too much inflammation, uncontrolled proliferation, and that can underlie stimulation, not causation. Mm-hmm. But stimulation of cancers that have estrogen receptor positivity. And so it unfortunately, a lot of the drugs that have been [00:08:00] used for as.

Estrogens mm-hmm. Are oral estrogens. Yeah. Some of them from a horse's urine, you know, conjugated equine estrogens. The ethanol estradiol, which is not a real human estrogen. Mm-hmm. That's the dominant one in birth control pills, which you've talked about so much. Yeah. And they take in orally, they are converted predominantly into aone.

Mm-hmm. Creating an abnormal balance of these. Hormones that are so important, and so it's really, it's really so important to understand the differences. Yeah. Between the estrogens and that's led to unfortunately. A dislike and fear of estradiol. Mm-hmm. Because of the harms that can come from inflammation.

Yeah. It's the inflammation that underlies the problem and then the creation of too much estro. 

Dr. Brighten: Mm-hmm. So I wanna recap and say this back to people because I think it's just so important to underline what you've said. So Estriol E three, that's gonna have an [00:09:00] anti-inflammatory effect, and that is. I think anyone who's been pregnant and has an autoimmune disease is like, this is why I feel better in my pregnancy and like that's one of the contributors to having less.

Inflammation and autoimmune disease progression during pregnancy. But once you enter menopause, we've got ESTRO coming online and there's a lot of changes that are happening with ESTRO and with menopause altogether. And ESTRO is the on switch. We're turning on inflammation, whereas. Estradiol, it can be on or off.

It's a regulator. So I just wanted to re the Oh. That, integrate all that. 

Dr. Gersh: Perfect. And it, that is so true, that many autoimmune diseases, the one that has the most research is like multiple sclerosis. Mm-hmm. They go into remission because of the estriol, downregulating, the, the innate immune response. Mm-hmm.

And that's of course, so part, so important and part of pregnancy. So. That you don't actually kill your fetus. [00:10:00] Yeah. With your immune system, which also involves progesterone, so it's really complicated. But learning about pregnancy is really amazingly significant for understanding the immune system and how these hormones interact and how they relate to immune function.

Dr. Brighten: Yeah. And so people know if they're like, what? Why would my body kill my baby? Because. Your immune system is designed to attack anything that is non-self, that's not you and baby is genetically distinct different from you. So your immune system would identify that and say, we have a foreign invader, but the body exactly.

With its wisdom, I mean, and, and the way it's orchestrates, everything is so beautiful and how it builds that tolerance. I wanna go back to the metabolic piece because you really underscored the issues with. Inflammation. Talk to us about the interplay between estrogen and our metabolic health. 

Dr. Gersh: Oh, it's so key.

So, and it's of like always is more complexity than first meet the eye. Yeah. When you have inflammation, the inflammation [00:11:00] creates in, well, part of inflammation is circulating. Inflammatory cytokines. Mm-hmm. These cytokines are produced by immune cells, and they're designed to signal and tell other immune cells to do things and to create reactions.

And this is lifesaving if you have trauma injury or you're infected with a pathogen like bacteria or virus. So we do not want to have no functional immune system with the creation of inflammation. Mm-hmm. It's out of control, inflammation that is. Key to all the diseases known as the degenerative diseases of aging.

Yeah. Which plague women in menopause even more than men. 

Dr. Brighten: Mm-hmm. So 

Dr. Gersh: estradiol because when you don't have it, uh, which a hundred percent of women are gonna lose it. Yeah. With their ovarian senescence. 

Dr. Brighten: Mm-hmm. And. 

Dr. Gersh: So you end up in this state of inflamm inflammation. It also relates to the gut microbiome.

You get leaky gut, you get alteration. So it's multiple [00:12:00] levels. Yeah. That you get this systemic level of inflammation, these inflammatory cytokines, damage directly the mitochondria. Mm-hmm. So mitochondria are essential for the creation of energy and control of the cell cycle. Part of the cell cycle is.

When a cell should die, we call that apoptosis or program cell suicide. Mm-hmm. So when a cell gets old and yucky, and sometimes we call them senescent cells, or even zombie zombie cells, zombie. Right. I do love that word. I know, I know. I wish I had coined it. I know. Because they are. Insidiously Harmful to the body.

Yeah. Like they're invading or civilization. So yeah, they create this ongoing inflammation. Because they just won't die. It's like the grade B movie. Yeah. Where the monster won't die. Like, didn't that monster die already? No, no. It's back. It's back. These zombie senescent cells create [00:13:00] ongoing inflammation, which is so harmful.

Mm-hmm. And you know, damages the lining of arteries. It creates neuroinflammation, which can trigger all the diseases of the brain, including Parkinson's. Alzheimer's. Yeah. All of your vascular dementia. It's just horrible stuff that happens in joints and bones and everything. So we do not want zombie cells and.

You need to have this mechanism, which is controlled by mitochondria. Mm-hmm. To say, now cell die. Yeah. Now also these zombie cells, because they're ongoing old yucky cells, they can have damaged mitochondria. I mean, they can have damaged DNA. Yeah. Which can lead to the formation of cancer. Mm-hmm. So these, these zombie cells have multiple levels of harm.

So, promoting cancer, we all know, I, I hope everybody knows that. Which demographic has the most cancer? Young people? Mm-hmm. Or old people. Yeah. It happens to be old people by a lot. Young [00:14:00] people unfortunately, get cancer for other reasons, endocrine disruptors, antibiotics, gut dysbiosis, and things like that.

But old people get it because of this mitochondrial problem that doesn't allow these old, yucky cells to die. Mm-hmm. In addition. Yeah, mitochondria create energy. Yeah. And estradiol, it turns out, has a role in all the different aspects of mitochondrial function to maintain mitophagy, which is like.

Cellular renewal. One is called autophagy. Autophagy is renewal like within the mitochondria itself. It's like rejuvenating the mitochondria and when it's time for them to die, it allows them to die. Mm-hmm. To then be replaced with mitsis under the control of estradiol, the creation of energy with the electron transport chain that makes a TP.

Mm-hmm. People have heard of that. We want plenty of that. Yeah. So that we can do everything we want and have all the organs work. [00:15:00] Optimally that requires estradiol. Now, in the process of making a TP, you have a metabolic byproduct that is very toxic, called superoxide. Mm-hmm. It's two oxygen molecules. Now we need to get that outta the mitochondria, but it can't, it doesn't have any mechanism to exit and then get outta the mitochondria, but it's poisoned to the mitochondria.

Yeah, so there's an enzyme. That's in the mitochondria called manganese, superoxide dys mutase, which converts this toxic superoxide to another poison hydrogen peroxide. Yeah. But unlike superoxide hydrogen peroxide can. Diffused outta the mitochondria into the cell where other enzymes converted to harmless water.

So we have O2 to H2O two, whoops, out of the mitochondria to H2O. Mm-hmm. Water under the auspices, the control of estradiol to have this enzyme work. So when you lose [00:16:00] your estradiol with menopause there. Are so many things that are going wrong in that mitochondria. 

Dr. Brighten: Yeah. 

Dr. Gersh: You, you have the promotion of inflammation that damages it.

You can't make energy with the electron transport chain. You can't do the renewal and the proper elimination of mitochondria with mitophagy, and you can't get rid of the superoxide byproduct of mm-hmm. Creation of energy. So what happens? Everything deteriorates in the body energy, which is. What metabolism is.

You know, everyone knows I want a really good metabolism, right? Yeah, yeah. I don't want a slow metabolism. Well, you gotta have mitochondrial function metabolism. Mm-hmm. The production, distribution, storage of energy. Energy is what differentiates life from death. Mm-hmm. You know, when we look at. Energy in the brain.

We look at an e, EG, right? Yeah. It's energy in the heart. An EKG. That's the little, you know, when you see it, and everyone knows from watching movies, tv, that when you see [00:17:00] the EKG monitor in the person in the hospital room and then it goes through, that means no energy in the heart. Mm-hmm. That's called death in the brain.

It's brain death. 

Dr. Brighten: Yeah. 

Dr. Gersh: We need energy and we don't want a little. We want plenty. Mm-hmm. And women are unique. They're different from men because only women can do what? Make babies. Yep. So when a woman is pregnant, her heart has to pump. At least 50% more blood volume. Mm-hmm. So a woman's heart has to have extra energy.

So the mitochondria that produce energy in the heart are extra special in women and their ability to make energy. And even not only estradiol has receptors, but metabolic byproducts mm-hmm. That are created in the liver from estradiol, like to methoxy, estradiol. It's a metabolic. Byproduct. It's made from estradiol, but it has its own unique receptors.

Dr. Brighten: Mm-hmm. [00:18:00] 

Dr. Gersh: And there are other things, we don't know what they are. They're called estrogen related receptors. So what that means is we don't know what binds to the receptor that's called the ligand, but we don't know what it is. Yeah. But what we do know, if you don't have estradiol present, it won't bind. And that.

Binding creates more energy in the heart. Mm-hmm. So women uniquely get what's called mild diastolic dysfunction. They have a low energy heart. Yeah. A stiffer heart. And this can lead to a unique form of heart failure. Most common in postmenopausal women called. Heart failure with preserved ejection fraction.

Mm-hmm. Ejection fraction is a blood coming outta the heart. When you pump, that part's fine. That's the part that usually is what causes heart failure in men. Yeah. After they have like a heart attack. This is unique. This is truly a low energy heart, which you can actually see on an echocardiogram, but it's not even [00:19:00] usually.

Like looked at or talked about by most cardiologists, they simply say, oh, lots of women have this. Mm-hmm. Yeah, they do. That's a sign of a low energy heart. And of course the brain needs so much energy. Yeah. Women have two and a half times the incidence of Alzheimer's as men. Mm-hmm. Due to this low energy and then the dysregulation of the immune system.

And of course, you know, having. Other problems like inflammation from systemic inflammation coming in neuroinflammation. So there's a host of reasons, but mitochondria are also at the key at the focus of having a low energy brain. And now it's been shown that just about all women. At they're transitioning into menopause.

Yeah. Have problems with word finding. Mm-hmm. It's always nouns, like, so, oh, they can, everyone can remember their adjectives and their verbs, so it's like a game of charades, you know? Like, what was that thing that we [00:20:00] saw? You know? Yeah. What was the name of that restaurant? What was her name? She was wearing a red dress.

Her hair was this way. They can describe, they can, but they can't remember anybody's names. Yeah, they can't remember places. It's, and they feel like they're losing their mind. It's not totally not true. Yeah, it is kind of true. They are having changes in cognition and that is not a good thing. So that's why I cheer estradiol every day, you know, because understanding is the first step to solving the problem.

Dr. Brighten: Yeah. You've mentioned cancer a few times. A lot of people are afraid of hormone replacement therapy because of the cancer scare. Talk to us about that. 

Dr. Gersh: That is so, so sad. For me, when I think back, I was only among the 20% of doctors who were actually practicing medicine when the Women's Health Initiative came out.

Mm-hmm. In 22. Yes. That's like. 2 0 0 2. Yeah. That's a long time ago now. [00:21:00] And it turns out they did a survey. Only 20% of actual practicing doctors today were in practice then. Mm-hmm. So like the lost wisdom of what happened prior was gone and, and education went down the tubes as far as menopause and hormones and, yeah.

The, the current practitioners, they weren't taught. And what happened was so devastating because this. Women's Health Initiative. Actually we knew before the study even started that this combination of hydroxy progesterone acetate. 

Dr. Brighten: Mm-hmm. 

Dr. Gersh: MPA, which is not progesterone. Yeah. It's uh, and actually you can call it an endocrine disruptor for progesterone and.

The conjugated equine estrogen. This is estrogen from a pregnant horse that it's trying to get rid of. Yeah, it's already gone through the liver to be modified, so it can be. Water soluble and go out the urine and the horse is trying to get rid of it, and it contains estrogens, like [00:22:00] equal line estrogens, equine es.

These are not even found ever in a human. Mm-hmm. This is a form that would never be in a human. Then they swallow it, which makes whatever is human turned into estro. Yeah. And then you have all these other unique horse estrogens going into a human female. Well, it turned out that. A little bit and actually not that much.

'cause you know all about birth control pills, about the same degree as a birth control pill can increase breast cancer. Yeah. Happened with medroxyprogesterone acetate. Mm-hmm. Not with the Premarin. Unbelievably, yeah. Even that horse urine stuff turned out to be breast cancer protective. Like who would've figured that?

Yeah. 'cause they've done now. Many studies have come out. There've been big publications recently showing that any of those forms of estrogen are actually breast cancer protective. 

Dr. Brighten: Mm-hmm. And 

Dr. Gersh: why would that be? Because it creates energy, and energy keeps the cells alive so you don't get the senescent cells and all that stuff we [00:23:00] talked about and.

The hydroxy progesterone acetate turns out to be a, an agonist or like a similar to progesterone. Mm-hmm. In some places, like in the uterine lining, but it turns out that it's actually an anti progesterone in other places. Uh oh, like in the breast? Yeah. And progesterone. And I talk about this more and more now.

Progesterone is anti breast cancer. Mm-hmm. The real thing. The real thing. P four, not these pre pretend. And we've got, that's another problem. We talk about estrogen. People don't know what you're talking about. They people use the word estrogen for endocrine disruptors. Yeah. Like, and for estrogens, it's like, I'm going, I'm gonna give you your estrogen today.

Lick this plastic. Bowl and you're like, what? You know? 'cause it's a xenoestrogen. Yeah. Yeah. And progesterone is anti breast cancer. Mm-hmm. It's anti-proliferative. It doesn't stimulate growth. Mm-hmm. It's the opposite. It's so, [00:24:00] I have a whole list of studies that show it's pretty indisputable that progesterone is anti breast cancer.

Mm-hmm. So estrogen and progesterone. Both individually and separately are anti breast cancer. No one should think that nature gave females hormones to give them breast cancer. Yeah. And you think who gets the most breast cancer? Women with? Their own bioidentical functioning hormones are working around their body doing all the things they're supposed to do, or old women who have no hormones in their body.

Mm-hmm. It's the old women. In fact, the biggest trigger to postmenopausal breast cancer is obesity. Uhhuh, which underlies. Inflammation and then all the stuff we talked about. Yeah. And then breast cancer. In the breast. This is where a lot of the misunderstanding came from too. When breast cancer develops in the [00:25:00] breast, most of it, not all of it, there's the triple negative, but most of the breast cancer has positivity for estrogen receptors.

Dr. Brighten: Mm-hmm. 

Dr. Gersh: It's alpha now. What triggers only alpha, predominantly alpha eOne. So it turns out that, going back to what we talked about, when you have a lot of inflammation, it upregulates the enzyme aromatase. And in a postmenopausal woman, or a woman that is quite obese and inflamed, it's going to trigger the conversion of.

Androgens mostly from the adrenal gland. Mm-hmm. Intoone. Well, breast cancer creates tremendous inflammation. Of course it does. All the mitochondria are not the same. Things are not the same. So you have inflammation right around the breast, cancer in that mm-hmm. Tissue surrounding the breast has fat and the breast has other connective tissue that contains the enzyme aromatase.

Yeah. And that's actually for a purpose. Just think [00:26:00] that when you have. A woman who has say breastfeeding, her ovaries are not working. You don't, they're not making estradiol. 

Dr. Brighten: Yeah. 

Dr. Gersh: And then she gets a breast infection, estrogen in the form of estradiol, which would be what would be made at that point.

Mm-hmm. You know, because you don't have all that inflammation. You have a healthier woman, young woman. So estradiol controls the immune system to help fight off a breast infection. Yeah. Yeah. So everything that happens has a purpose. Mm-hmm. But when you have something go wrong, you're, you're like misguided purpose, like you're, you know, it's like, it's, you know, just like sabotaged.

So you have the aromatase turning on and converting. These androgens into eOne. Mm-hmm. Which creates growth factors, proliferation and the breast cancers have positivity for the alpha receptor, which is what is activated by the eOne that's made by the breast cancer. Mm-hmm. So there's [00:27:00] actually some issues because.

Estradiol Downregulates, the immune system. It helps prevent that inflammation controls the all of this process. So there actually is some question that Estradiol can actually help to calm down this. Inflammatory process of the breast cancer. Mm-hmm. And we know that women who are on estrogen, if they get breast cancer, although being on the bioidentical types of hormone replacement, lowers their risk.

Mm-hmm. It doesn't mean you have no risk. Yeah. It just lowers so you can still get breast cancer. It's not because of, it's in spite of mm-hmm. Having hormones on board. But women who. Do get breast cancer who are taking the hormone therapy for menopause with the bioidentical, they have a better prognosis.

Dr. Brighten: Wow. So 

Dr. Gersh: we need to rethink everything and, and I say there's plenty of things to be afraid of in this world, but bioidentical [00:28:00] hormones should not be on the list ever. You know, what we should be afraid of is not having our hormones in our body. Mm-hmm. The foundations of creating. Information delivery.

That's what hormones do. They tell the cells what to do. They're the instruction deliverers. You know? So it's like you're trying to create a complex dish with, but you don't have a recipe. Mm-hmm. And you've never made it. You tell a cell, you're supposed to make proteins, you're supposed to make enzymes.

You're supposed, and they have no, they don't, they're not told what to do, when to do it if you don't have the hormone. You, the cell's not gonna behave properly. It's not gonna do what it, the job it's supposed to do. Yeah. So the fear of hormones causing breast cancer should just exit the scene. I keep saying I'm so tired of that over 20-year-old study that has poisoned the Well.

Yeah, like, come on. We cleaned out that well, that that study has been, you know, refuted and reviewed and everything else. [00:29:00] Just bury that thing and let's. Create a whole new paradigm of thinking of hormones for what they are, their life giving. And I actually was really mad at Mother Nature for a while because it's like, why'd they do this?

Why'd she do this to us? Taking away our hormones? Yeah. But you know, I figured it out. So if we stayed fertile and it's all intertwined, the prime directive of life, whether we want to or not. And I'm totally for women's reproductive choice, you know, I don't want people to have babies when they don't want 'em.

Yeah. But. The prime directive of life is the creation of life. Our female bodies are designed mm-hmm. To create life. That's just how it is. You know, all animals in the animal kingdom are designed to create new life. Yeah. So understanding that we can really, uh, see how hormones are. The hormones of life, not just reproduction, they maintain every organ system.

Mm-hmm. For the purpose of having a healthy body so that you can actually be [00:30:00] successful with fertility and reproduction and do it multiple times over. So that's why I don't call these hormone sex hormones anymore. Yeah. So the life hormones, we need to rethink all of this reframe. All of that and then come to love our hormones.

And the reason that we go through menopause is that we can't. Stay fertile forever. If we did, we would die. Mm-hmm. Can you imagine if women, thousands of years ago, were getting pregnant in their late forties and fifties and sixties, they would die? Well, it's energetically expensive. 

Dr. Brighten: It, it's a very expensive process for us.

Couldn't, they couldn't 

Dr. Gersh: do it like I did obstetrics for like 30 years. I delivered thousands of babies. When I had a patient who happened to be in her late forties, I knew she was. Big potential trouble. Mm-hmm. You know, they have higher risk for every kind of medical complication of pregnancy. So nature had to give us menopause, not because it wanted to take away our life hormones.

Yeah. But because it had to take [00:31:00] away fertility and it's a package deal. Mm-hmm. It just is. So, being the clever creatures that we are as humans, homo sapiens, if we have been able to figure out how to give the hormones back. Reasonably similar to what we had in our reproductive years to enable all our organ systems to work properly in our mitochondria and so on.

But out leaving out the fertility part, what's wrong with that? 

Dr. Brighten: Mm-hmm. 

Dr. Gersh: Nothing that's like perfect now, you know, they're even talking about, you know, creating pregnancies in older women, but that's another whole story for another day. That's another podcast. That's a different podcast. Exactly. Yeah. But. You know, understanding that hormones are essential.

Mm-hmm. They're not sufficient. You gotta do all the other stuff to be healthy for healthy aging. You gotta exercise, eat the right foods, avoid toxicants and you know, stress control and everything else Fitness. But without those vital life [00:32:00] hormones being replaced at reasonable levels. Mm-hmm. And rhythms to somewhat not the same, but somewhat replicate the environment, the hormonal environment of a woman at her peak health, like in her early twenties.

We don't have the same medical probability mm-hmm. Without those hormones of being what I call a super ager, you know, that you can do everything as you get even into your late nineties to a reasonable degree Yeah. That you did in your thirties. Travel talk, have complex discussions, read complex novels, and, and do what you wanna do and have a quality life without lots and lots of degenerative diseases.

Mm-hmm. That completely. Uh, destroy quality of life. 

Dr. Brighten: Yeah. 

Dr. Gersh: So this is, you know why I am so excited to have this opportunity to talk to you, to get the word out to, to get rid of the, the, the fake news of hormones. Yeah. That was started with the Women's Health Initiative and that, you know, it's like, you know, [00:33:00] zombie cell.

That's a zombie study. Yeah. You know, 

Dr. Brighten: we gotta get rid of it. It just keeps coming back. Oh, right. Get rid of that zombie study. Yeah. So when it comes to the conversation of cancer and hormone replacement therapy, do not blame estrogen for what fake progesterone did. Let me ask you, 'cause I know a lot of people listening, they're gonna be interested.

How do you approach hormone replacement therapy in women? 

Dr. Gersh: Well, I always say I'm a simple thinker, so I want to replicate what nature did. Mm-hmm. I, I always say the biggest catastrophe of trying to outdo nature is ultra processed food. Yeah. Let's have food that never spoils. I don't think that's worked out too well.

It's weird, right? Like, let's have more. 

Dr. Brighten: Why is that Twine 

Dr. Gersh: still on the shelf Exactly. More colorful foods like. Fruit loops, you know? No, let you know. Sweeter than nature. Yeah. No high fructose corn syrup hasn't worked out. Yeah, exactly. So I'm not gonna try to create a new paradigm for how hormones should exist in a female.

Mm-hmm. Because [00:34:00] we know a lot, we can know more about how hormones interact with the different genes, turn on off receptors and genes and all of that. But what we definitely know is that when you look at. A real menstrual cycle. 

Dr. Brighten: Yeah. 

Dr. Gersh: That there's a rhythm of the hormones. Mm-hmm. They're not static. Like you have the same amount all the time.

Especially progesterone is not produced like at a static level all the time. So we're not gonna recreate. I wish, you know, there are people working on like cloned ovaries and mm-hmm. You know, so future generations will have maybe ovarian replacements. 

Dr. Brighten: Yeah. 

Dr. Gersh: And so on, but right now we don't have that. So I wanna give hormones that are similar to what the ovaries did.

So I look at what happens in a menstrual cycle, and I'm still evolving. I mean, my, my story of what I recommend I know is not done yet. Yeah. Because I'm always learning and I had to like, and I'm still in the process of reprogramming my own brain from all the negativity. [00:35:00] Not that I ever was negative, I never was, but just in terms of.

How is it best? This really critical question, once you get over the, should you have hormones? Yeah. Then the question becomes how do you, how to give 'em mm-hmm. In the best way, and I'm, I'm still actually a work in progress on figuring out how to do that. All the best doctors are because we update on the new research and how to do it in a way.

That is doable. Mm-hmm. You know, to make a regimen of hormones that is so complex that you're gonna have 0.1% of women actually comply. Yeah. For any particular length of time. And I want women to be on hormones for the duration of their lives. So it has to be. Reasonably easy to do. Other totally. Other people are not gonna do it.

So, but what you don't wanna do is create hormones that have really high, then middle, then low. Uh oh. That's pellets. Mm-hmm. I'm sorry for pellet lovers out there. That is not physiologic. It is not it. Alliance with what nature does, you know, or every [00:36:00] night Progesterone. Every night Progesterone. No.

Progesterone is a wonderful hormone, but you're not supposed to have it. In your body every day in that manner. And progesterone, downregulates, estrogen receptors. Mm-hmm. It downregulates libido. I mean, think of the men. Everyone in their luteal phase knows this. That's right. I'm so glad you brought that up.

That's exactly right. In the luteal phase is the, the sex drive is the lowest. You want that every day and. This is a new area that I'm really exploring more and more when you take progesterone orally. 

Dr. Brighten: Mm-hmm. 

Dr. Gersh: Like up to like 90% of it is converted to metabolites by the liver. Mm-hmm. Because it goes to, you know, we know we don't wanna take oral estrogen as estrogen replacement because it's converted predominantly to estro.

Yeah. Well, when you take oral progesterone, it's converted largely to allopregnanolone. Mm-hmm. Now that's. Another hormone, which is actually very beneficial. 

Dr. Brighten: Yeah. 

Dr. Gersh: But it doesn't bind to progesterone receptors and you're giving [00:37:00] it in. Non physiologic doses every night. It has protective effects in the brain.

It's antidepressant. Um, they actually give a mimic of it for postpartum depression. Yeah. So it's like it So it's antidepressant, it is sedating, it, it acts, um, to upregulate gaba. Mm-hmm. Which is a very important like calming sort of neurotransmitter. It's like, like estrogen is more activating like focus Yeah.

Thinking. Like cognitive awareness and the allopregnanolone is more like sedating. Mm-hmm. But here's the problem. Chronic chronic exposure can impair memory. 

Dr. Brighten: Oh, so you can't, 

Dr. Gersh: uh, I mean, it's just, and they're using it as a drug. Mm-hmm. Like a sleeping pill. Yeah. But we know that when people take sleeping pills every night.

It increases their long-term risk of dementia. Mm-hmm. So is this really the right thing to do as well? When you take the progesterone pill orally [00:38:00] because it downregulates estrogen receptors? There's actually some little studies that have been published showing that the arteries, instead of being dilated, like they are like really relaxed when they're, the estrogen comes on board the estradiol instead they constrict.

Mm-hmm. Oh my goodness. So this is not good. So I'm re-exploring, rethinking everything. Yeah. With the whole progesterone routine. But I never give, unless people I get, you know, I can't, there's just so much I can do, but I try really hard to convince people not to have progesterone every night. Mm-hmm. And.

To give physiologic levels so you get levels of estradiol in your blood that are similar to what you would get sort of on average in a menstrual cycle. Mm-hmm. Not this, the Relic, you know, legacy of the Women's Health Initiative. The lowest dose. 

Dr. Brighten: Yeah. 

Dr. Gersh: No, what do I want? In everything, the most efficacious dose.

Mm-hmm. [00:39:00] Not the lowest dose. Yeah. Would I say I want you to have the lowest amount of exercise to keep you alive, the lowest amount of vegetables? Like what the heck? Yeah. You know, you want the best amount? Mm-hmm. The most efficacious. That's going to give you the. Best health to optimize everything in your body.

And that's not the lowest dose. In fact, the lowest dose of estradiol that's made by the ovaries is when you start your period. Mm-hmm. And that's the most pro-inflammatory time. Yeah. Of a woman's cycle. And it is inflammatory because you're actually contracting that's inflammation induced with inflammatory cytokines in the uterus to give a little bit of contractions.

It shouldn't, if you have two extreme menstrual cramps, it means you're overly inflamed. Yeah, yeah. 'cause you're making too many of these pro-inflammatory cytokines. Mm-hmm. And so a little bit just to, it's like a mini, mini, mini version of labor. Just get out that. Dead dying uterine lining. Yeah. And that's a pro-inflammatory time.

That's not what we want all the time. Mm-hmm. In the body. No. Oh, another [00:40:00] thing I just wanna make sure I mention really quickly. Yeah. Estradiol is very key to one of the other reasons why it, you have a lower risk of dying if you get breast cancer when you're on hormones, is that estradiol causes. The cells to be more like super glued together of the cancer.

Mm-hmm. Because what kills people with breast cancer isn't cancer in the breast. It's when it metastasizes. Yeah. To the liver, the lungs, the brain, and so on. And metastasis means that the cells are not together and they start breaking off. Estradiol helps to keep the cells like. Glued together cohesiveness.

So you're less likely to have metastasis. Yes. So that's, I just wanna throw that in. There's multiple ways that estradiol is protective for everything. Mm-hmm. For like literally everything in the body. And we just need to, you know, get on board and give hormones in a way that is similar to what a woman had in the most.

You know, the healthiest time of her life and stop [00:41:00] with these made up regimens that do not align with anything physiologic. And think of all these other weird regimens bias like, you know, estriol is great. Mm-hmm. But what, you're not supposed to have that as your dominant estrogen in the, in the reproductive years or any other time of life other than in pregnancy.

And why would I ever wanna even try, which is a ridiculous, a biased. Crowd. They're not replicating pregnancy anyway. It's ridiculous, but it's not even close. I mean, the levels are not even near what happens in pregnancy and the progesterone, it's, it's all made up concoction with these ratios. Mm-hmm. But estriol is, is wonderful hormone, but that's not the hormone of life in terms of like reproductive age and pregnancy.

Is a time when your like immune system is altered so that women who get sick, like they get COVID, they get the flu, they get chickenpox, their immune system because it's downregulated. [00:42:00] Just like an immune modulator. Yeah. You know, that's why they all have warnings. Like, you know, you can get infection, you could die.

So women who get infections when they're pregnant have a much higher morbidity and mortality. We wanna do this to our postmenopausal women. Right? Yeah. And you know, we want to have an activated. Immune system when we want it activated. That's how we fight infections and that's how we fight cancers. You know, we want to have estriol, but we wanna have estriol produced by the body to self-regulate its production of estro and estriol from estradiol the way nature intended it.

Mm-hmm. So these fake regimens with pellets and biased and nightly progesterone. Two thumbs down. 

Dr. Brighten: Well, I think that's a wonderful place to end this conversation. I could literally talk to you for hours. I wish we had more time, but I do just wanna express my gratitude for the time you have given us this great wisdom [00:43:00] that you have shared.

 

Thank you so much. Oh, it was so fun. I hope you enjoyed this episode. If this is the kind of content you're into, then I highly recommend checking out this.