(Health Secret) If you are in the Midwest you are fortunate to be close to Kathy Maupin, MD, a pioneer in bioidentical hormone replacement. Dr. Maupin spent the first years of her medical practice as an OB/GYN, but after experiencing the effects of hormone loss first hand and the rejuvenating potential of bioidentical hormones, she has devoted herself to the practice of bioidentical hormone replacement. Dr. Maupin was one of the first to prescribe pellet therapy, and to describe the role of testosterone in women. She is the founder and medical director of BioBalance Health, and the author of the recently released book, The Secret Female Hormone: How Testosterone Can Change Your Life. Here are excerpts from her podcast designed to answer frequently asked questions (FAQs) from those contemplating bioidentical hormone replacement. She is being interviewed by Brett Newcomb, LPC.
Brett: You started as a gynecologist and you evolved into doing hormone replacements because of the issues women who were menopausal and post menopausal were having that nobody seemed to treat — they just fell into the gaps.
Dr. Maupin: Nobody knew how to treat, including me.
Brett: And when as you were successful in learning how to treat, there began to be a demand from these women that you also look at what was going on with their husbands. So now your practice is both male and female. As you look at the mass of literally thousands of people who have come through your office in the last few years for treatment, there are a lot of questions you get asked repeatedly.
Dr. Maupin: Most of the questions are from people who have not done pellets, when they are looking at should I do this, should I not do this. Like a blank slate, they are just deciding.
Brett: This flies in the face of mass production medicine. You have to spend some time with somebody to learn about their lifestyle, choices and personal habits.
Dr. Maupin: Diet, exercise and all of those things. And what they want out of it. I always want to know what is it you came for. What is the most important thing. Most people say everything I listed as my symptoms, but some people just want to feel better. I had someone yesterday who said I just want to have my personality back. I don’t feel like myself anymore. I feel like I’m someone else in a body that is not my own. And I’m confident that she will by what she had in terms of her labs and what her symptoms were. I’m positive she will be better with the pellets.
Brett: I understand that. As I have aged I get really frustrated if I can’t command my body to do things it used to do easily and readily. I remember being in France with some friends and we were all hiking to the top of a mountain and they were all a lot younger than I am and they were all just running up the mountain and I was struggling to get up and willing myself to get to the top of the mountain and it was really difficult.
Dr. Maupin: And it would have been impossible without muscles and testosterone.
Brett: Well I got there. I didn’t have a heart attack and die. But I haven’t liked that. I don’t like having me be not alert and responsive in ways I remember from when I was much younger.
Dr. Maupin: It’s one of those things you don’t remember until you come up against it again. I used to run all the time but I stopped running because my dad’s knees went totally horrible and needed to be replaced.
Brett: You stopped running because your dad’s knees needed to be replaced?
Dr. Maupin: … Yes, I was never having that surgery. I was running with the dogs the other day … running, walking, running, walking, and I felt like I was in someone else’s body because it didn’t feel fluid like it used to. My muscle memory wasn’t there. I’m not going to do what he did which was to run miles and miles everyday. I’m just going to run with the dogs and walk in between and when they get tired I will get tired, and listen to my body and not ignore the signs. I’m going to do that but I have to retrain my muscles. Now I do have the muscles to do it! If I had done this before pellets I could never have run. I was barely able to walk without getting out of breath.
Brett: When you get to the place where you are interviewing the patient and the patient is interviewing you to see if they want to do this … where you start?
Dr. Maupin: When they have filled out a form of all their symptoms (the forms are all on the website) and they’ve filled out the medical problems they’ve had, the medicines they are on, allergies and things like that. I basically, before they walk into the room, have all their vital information so what I want to know is how did this start, when did it start, what was your first symptom. It is the story that helps me know how it impairs their life and how much of which hormones they need. It’s not just hormone levels. It’s their life and how this is affecting it.
Somebody who is always sedentary is not going to say Oh I need to go run a mile or do a 5K. They just want to be able to think, and that’s their biggest thing, the thing they notice first. I want to know what I should be attending to when first talking to them, and then tie that in with the information I need to do their treatment. I need to know how much activity because the pellets will dissolve faster if you are exercising everyday for an hour or more.
Brett: Because they [pellets] follow your body’s natural metabolic conception. If you run your body harder, it will consume more [hormone].
Dr. Maupin: Right, the blood flows past them [pellets] faster and they dissolve faster, and you need it too because when we exercise we need more testosterone and more estrogen.
Brett: Sort of a demand system?
Dr. Maupin: Right, it’s not as good as God gave us but its better than anything else out there … I ask them [my patients] that so I know how to dose, but also I need to know if they are healthy, what they eat. If they come in and say I haven’t lost any weight in six months, but they’re eating a lot of fast foods, carbs, drinking alcohol every night, no amount of hormone is going to help them lose weight. In fact, they have a bad lifestyle. I have to look at the lifestyle as well … not only do we replace the hormones, we look at your entire health history. But I also look at lifestyle changes you should make to be healthy. I mean it doesn’t help me one bit to give you hormones if you are not healthy, and nobody does this anymore. Nobody looks at your whole picture and says these are the things you should do, these are the tests you need, go to the doctor and do this, take these supplements because these are the supplements you need, this is what you need to weigh. These are the types of things we try to offer. It’s not just hormones, it’s preventive medicine.
Brett: It’s holistic.
Dr. Maupin: … We don’t take care of hearts of lungs. We refer out if we find problems. But we at least do what the patient needs to do to be healthy with the hormones, because they give them the opportunity to be healthy. The next thing that nobody I know of does who replaces hormones of any type, is we look at all the hormones … We look at thyroid and cortisol, and we look at the pituitary hormones, prolactin and LH/FSH. All of those hormones are tied together so I want to make sure they are all in line. If the cortisol is high, testosterone doesn’t feel really good. So I have to send them to yoga which doesn’t always work. Asking patients to do things to change their lifestyle is a lot harder than treating hormones.
Brett: Yes, they say they’re going to, but you know they’re not really going to.
Dr. Maupin: When I see them again I say did you do that, you need to do that. There are ways to suppress the cortisol that is spiking because you have long term stress. So not only do you need to change your situation, but we just need to help that hormone [cortisol]decrease so you can feel the testosterone and feel better.
Brett: It’s blocked or it overrides.
Dr. Maupin: Yes, it overrides the testosterone. Actually it makes testosterone less available and ties up testosterone. So instead of being active you may have a lot of testosterone that is tied up and not active so that doesn’t make you feel better. That’s why we always ask what happened during the last four months. Did you have an injury? Did you have surgery or do you have a surgery planned, because we can adjust the hormones for it and explain why they didn’t feel as good.
But all of that is in the first and second visit hopefully. Without a lot of medical problems I can have a maintenance dose figured out so then I’m not drawing blood every time … That’s the benefit of having done this for eleven years. We order it only the first and second time, and only if there is something else, thyroid or something that needs to be looked at do we need a third draw that year, and then we just do one draw every year and make sure everything is stable and that you feel good …
Brett: The demand covers such a gambit. People come in who are worried about cancer. People come in who are worried about osteoporosis. People come in because they don’t have a sex drive and they used to have one.
Dr. Maupin: That’s a big one. Fatigue is another big one. When you look at physicians books about how to work out fatigue, there are twenty thousand things it could be and there’s a hundred tests you can do. You have to narrow that down. One of the things that gets better with testosterone is energy. You feel more energetic and more motivated which means you want to get out of the house and do things, like you used to when you had testosterone. I do a lot of testing to make sure the fatigue isn’t something else … low blood sugar or high blood sugar.
I’ve had a lot of people complain about how much blood I draw on the first panel, but that’s how I know what’s wrong and whether I’m treating the right thing. If you have a high prolactin … you could have a tumor in your pituitary.
Brett: Some of this can be genetically disposed, like breast cancer. You recently affiliated with somebody that gives saliva tests to determine the genetics.
Dr. Maupin: It’s called Pathway Genomics and right now we are not testing for the BRCA 1 and 2, for the risk of breast cancer, but we are testing for all the things that can make you obese, including the obesity gene, how you handle sugar and all the behavioral things you inherited … And whether or not exercise is going to help you with your weight: sometimes it’s not going to help. It’s your diet, not exercise and diet as for most people. We find people who have genes for heart attack and high LDL and the bad cholesterols and low good cholesterols.
Brett: So you get a print out that tells you what you are at risk for and what you are not, and you can sit down with them and say, you know in your situation you can exercise all day long and you’re not going to lose…
Dr. Maupin: Unless you eat properly. But that is not one of those things we do initially. That’s one of our option treatments. People can come in and get their hormones fixed and that is our primary goal and mission, to balance all the hormones and get people back in action, back to their old selves, and back to their old sexual selves because that is very important to them. And then they have the option of coming in for genetic testing to see why they can’t lose weight.
Brett: When you say back to your old sexual selves, are you talking stamina, endurance, orgasms, desire.
Dr. Maupin: Yes, all of it.
Brett: People experience that change differently.
Dr. Maupin: Right. It’s just like appetite. Some people have a very high sex drive, and some barely know they have a sex drive. That’s inherited. Or they have been on medicine their whole lives that has kept them from having much of a sex drive, so they are used to a certain normal, and that’s what we’re trying to achieve. We are not trying to achieve higher than normal … We are trying to achieve what was normal for you. Sometimes people get a little higher level of sex drive during the first insertion, and that’s because they don’t have any testosterone and they have all these receptor sites on every cell, and all these receptor sites are open and waiting for a tiny bit of testosterone to come by to hit that cell … But this doesn’t happen to everybody, and I don’t want anyone to expect this to happen.
So these are the things we look at commonly when we treat people for hormone imbalance and hormone deficiency. It’s not just testosterone, it’s not just a hormone – come in and get your hormone and go. Often times my nurse practitioners help me keep track of thyroid and make sure everything is in balance when patients come in for their reinsertions.
Women are seen three times a year at least, and men are seen twice a year. During those times … there’s opportunities to ask questions, and we try to keep our website up to date with all the information. We have all the articles, and we try to keep everyone apprised of what’s going on with hormonal research — news articles of the month …
Just recently we were talking about the WHI [Women’s Health Initiative Study], and I’m feeling really good about myself because we had two other articles.
Brett: You’ve been saying this for years.
Dr. Maupin: Yes, I’ve been saying this for years, testosterone does not cause prostate cancer. Who knew? We knew! Low testosterone causes prostate cancer … We were justified also in the fact that everybody went off hormones with the WHI study, and now they have found that 50,000 women or more … died because they didn’t have replacement hormones after hysterectomy. It is necessary to have your hormones and right now if you look at television, they are mostly talking about men and testosterone, but honestly for the very same reasons men need it, that is going to keep them stronger, healthier, virile … thin, and keep a bunch of different diseases at bay, like Alzheimer’s and diabetes, that’s what women need too, but no one is taking about it.
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