I am delighted to have Dr. Renee Wellenstein joining me today! Dr. Renee is a double board-certified doctor who has been working with women for over 20 years. Due to her own health challenges, she stepped outside the box of conventional medicine to take a radically different approach to heal herself from the deep depths of burnout. She has had her fair share of obstacles throughout her journey, and she has mastered the art of leaping into transitions with each pivot! Now Dr. Renee empowers women to take control of their health, jumpstart their energy, improve their confidence, and reignite their libido!
Low libido in women is a topic that is grossly misunderstood on many levels and does not get discussed often enough between doctors and patients. Research has shown that 43% of women experience low libido at some point in their lifetime. That is why we need to discuss it and keep the conversation open. We have to talk about low libido even though most women feel some degree of stigmatization around it and tend to feel uncomfortable talking about it with their girlfriends, loved ones, and especially their significant others.
In this episode, Dr. Renee dives into connection, intimacy, sleep, exercise, and the influence of food choices on libido. She gives her specific recommendations for women who have experienced vaginal changes and the effects of hormone replacement therapy. She discusses options that can help support women who have had breast cancer treatment whose healthcare providers do not advocate hormonal replacement therapy. Dr. Renee and I explain why we do not love pellets. We also discuss some of the physical reasons for women having low libido, including the effects of certain types of medication, alcohol, gynecological surgery, the impact of hormonal changes and fluctuations, and neurotransmitters.
I hope you will learn a lot from this conversation and enjoy it as much as I did! Stay tuned for more!
IN THIS EPISODE YOU WILL LEARN:
Where did Dr. Renee's desire to talk openly to women about libido and their sexual issues stem from?
How do the synthetic hormones in contraceptives dampen a woman’s desire to have sex?
Medications other than oral contraceptives could also cause low libido in women.
How does alcohol consumption contribute to low libido in women?
Sometimes, gynecological surgery can result in women having low or no desire for sex.
How the rhetoric around hormones being harmful hurts women.
Some of the synthetic and bioidentical hormone options.
Women who suspect they might have too much estrogen should consider changing their diet.
Dr. Renee discusses the types of progesterone she usually recommends for women at different stages of their lives, their side effects, and their benefits.
Feeding the gut microbiome can help prevent a low libido. Dr. Renee talks about the foods that will assist in keeping the gut microbiome healthy.
Supplements can boost and support libido.
What can women do about vulva/vaginal atrophy?
Mindset is often a contributor to low libido.
The problems with pellets.
Bio:
Dr. Renee is a double board-certified doctor who has been working with women for over 20 years. Due to her own personal health challenges, she stepped outside the box of conventional medicine to take a radically different approach to heal herself from the deep depths of burnout.
About a decade ago, Dr. Renee was living what she thought was her dream life; she was an extremely busy Ob/Gyn, married to a doctor, with toddler twins, and had moved to a quaint, quiet town in the country. In May 2012, Dr. Renee fell off her horse during a riding lesson and broke her back. She not only struggled with severe back pain but also with fatigue and the inability to focus. Her doctor diagnosed her with depression, but her symptoms did not improve after trying two different antidepressants.
Two years after her injury, Dr. Renee still struggled with unexplained symptoms. After exhausting all of her options in the conventional healthcare system, she was put in contact with a doctor who was an “anti-aging” practitioner. She finally received the appropriate diagnosis, her symptoms resolved, and she got back on her feet and joined the world of functional medicine. In August 2019, Dr. Renee started Kaspira Elite Health Consulting, LLC. Throughout her journey, she has certainly faced her fair share of obstacles and has mastered the art of leaping into transitions with each pivot. Now Dr. Renee empowers women to take control of their health, jumpstart their energy, improve their confidence, and reignite their libido!
“As a gynecologist, I was told that if a woman does not have a uterus, she does not need progesterone. However, I’m all about balance.”
-Dr. Renee Wellenstein
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Transcript
[intro]
Cynthia: Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent are to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
This is the podcast intro for Dr. Renee Wellenstein. She's a double board-certified doctor, who's had the opportunity to work with women over the last 20 years and I couldn't think of a better individual healthcare practitioner, friend to talk to about a topic that I feel on so many levels is grossly misunderstood, not discussed enough with patients. We know based on study research that 43% of women go through low libido throughout their lifetime. I bet you that is probably a worse underestimation. We talked about some of the physical reasons why this can happen. The net impact of certain types of medications, alcohol use, GYN surgeries that can interrupt blood flow to the ovaries, as well as the net impact of different hormonal fluctuations and changes, as well as neurotransmitters. I think it's really important to keep the conversation open. I love that Dr. Renee really dives deep into connection, intimacy, sleep, exercise, and the impact of food choices, as well as specific recommendations with regard to changes to the vagina, vulvovaginal atrophy, and the net impact of hormone replacement therapy, not only for that, but also options for women that have gone through breast cancer treatment, whose healthcare providers are not comfortable with hormonal replacement therapy, but options that can help support libido, and why both Dr. Renee and I do not love pellets. I hope you enjoy our conversation as much as I did.
Dr. Renee, I'm so excited to have you joining me today to talk about a really important topic. One that I feel most women feel a degree of stigmatization about, they don't feel comfortable talking to their girlfriends about it, their loved ones, certainly, not their partner, their spouse or significant other. How did you get so vested and interested? I know, obviously, as an OB-GYN, you love women, you love taking care of women, supporting women, but where does your desire to talk to women very openly about libido and some of the sexual issues that they're dealing with? Where did that desire stem from?
Dr. Renee: It was fairly recent, to be honest. Before I go into it, thank you for having me. I'm really excited to be here and talk about this, because I really think we need to bring it to the forefront of topics in women's health. But honestly, when I was an OB-GYN, I didn't want to talk about it. I would literally crouch down in my chair every time a woman would bring up low libido in her visit. I know many of your listeners probably experienced that with their OB-GYN as well, because I constantly see on comments and social media. And why is that? Because there's not that one research as conventionally trained docs, we rely on the research that one paper to tell us do this with this. Make the diagnosis, do this. The problem with libido in women or low libido in women, there's never been that one study to do that for us. As a matter of fact, there's not hardly been any studies that focus on women's low libido. It's always men, erectile dysfunction and such. We can go down that rabbit hole of why, but it's just not there. Essentially, in the past, I was trained to give that hormone, that pill, whatever to treat the symptom and in my five minutes with my patient, I really want her to feel heard and treated.
The problem is majority of those women, I didn't have anything for, because there wasn't that magic bullet hormone. Because again, as a trained gynecologist, testosterone equals men, progesterone equal women, I don't know what it is with men as sexuality, it is just much more again at the forefront regarding their decreased desire related to testosterone. I think we are so conditioned as gynecologist to think women are exactly the same way. Honestly, in my practice, I was looking for that next best testosterone. But in the conventional world, testosterone in women is a no-no. There was one menopausal hormone replacement, but essentially, I don't think to this date it's ever gotten that FDA approved. It was oral, which oral estrogens, hurt woman's liver, kill a woman's liver, and then we put on top of that testosterone, oh, my gosh. That is all I had. If you fit the frame of a menopausal woman, I might have that to give to you. Although, I have to say when I pulled my prescription pad out of my pocket to write it, I always felt uncomfortable. Because I just was like, "Oh, I'm told testosterone in women is a no-no. Ah, what am I doing?" I'm trying to help her. To be honest, for those 15 years in conventional gynecology, I just would run from the topic. It would come up maybe once a month at that, really like that frequently, and I really didn't know what to do with women that were in their 20s, 30s with a low libido. I was just really at a loss of like, "What to do?" Decrease your stress. It's normal. All the things that women hear nowadays.
Let's fast forward to current day, I went into functional medicine, gosh, seven plus years ago, and I actually started to ask women about their libido. Because I was so frustrated with my 15 years of not being able to help these women. But now, my mind was opened up to an entirely different way of treating women. That meant looking at more than just one thing, looking at the root cause like what is it that's causing her to not have that desire? Really, what I found is no one woman was alike. Everyone's different, personalized medicine. Generally, for women, it just wasn't one thing. It was more than one thing. Not to say, testosterone's not great in women. I love testosterone. To be honest, I think it is great for especially lean muscle mass, and strength, so important as we get older, and I would have to say for the women I tried it because I got brave when I went to my functional medicine practice, and I tried a lot more with women including compounded testosterone, and I really found that, yes, it helps other things, but was it really that bang for the buck that I wanted with libido? Really, this is the evolution of me starting just ask more and more questions of, "What else could it be?"
Even to this day and I took on the subject about a year ago, number one, because I'm tired of women thinking it's normal at all these different ages. Number two, I'm tired of us not talking about it. It's a huge problem out there. When I started to go public online about the topic, women came out of the woodwork in my DMs, in my messages on Facebook saying, "Oh, my gosh, this isn't normal. Oh, my gosh, there's something I can do to help it. Oh, my gosh, thank God, I found you." It really came out to really start the conversation. I call myself the libidoologist, because I continue to study it. Anything in medicine is constantly evolving. I think every day, I have an aha moment like, "Oh, my gosh, another little pearl of what could be causing her, what other underlying could be the root cause of her low libido?" I do think it's an ever-evolving topic, I do find that I've had to piece together a lot of the research myself, and I have to admit, I was a little scared to take on the topic a year ago, because it is so big. There isn't that paper out there and there isn't a ton of research.
Again, this piecing together like, "Am I really going to help these women?" Yes, I am helping these women. I think a lot of times even women listen to this podcast today, if they get one little aha moment of like, "Oh, that might be me," and take whatever recommendation is given and run with it, that might be part of cause of her low libido.
Cynthia: Yeah. I'm so grateful that you pivoted, because that benefits so many of us. I think even entertaining the possibility of having an open honest conversation with a healthcare provider is so critically important. I'm laughing/not laughing because I know what that's like, I spent all my time as an NP 16 years in cardiology, and you better believe that really brave men and women would talk about their sexual concerns whether it was libido, erectile dysfunction. In fact, it's one of those things I reflect on that my discomfort is not their issue, like that should not be their issue. But I agree with you that there's so little that we have available for women in particular. With men, we know, yeah, it's probably medication induced, it's probably insulin resistance. Let me give you some Cialis or one of the other erectile dysfunction medications, and then they're happy. But women are so much more complicated, because when we're thinking we're very good at multitasking.
To your point about the fact that they're concerned about low libido, but it could be five separate things that are contributing to that low libido very likely all their to-do list, the things with the kids, something with work, someone they forgot to call that, because your brain is programmed to be able to multitask constantly. Unlike men and I jokingly say to my husband, he doesn't care when, where, what, why. Anytime, he's always available and ready to go and I always say, "I'm not like that." I'm so grateful. Like I said that there are healthcare professionals and physicians that are leading this discussion, because it is so so important. One of the statistics I read when I was doing my prep was it, 43% of women go through a low libido. It has to be higher. I kept thinking, that number has to be higher, because even just girlfriends unknowingly joke about it. One of my best friends from college says all the time, "My mom had a low libido, I have a low libido. It's genetic." I was like, "Well, maybe you have low normal testosterone."
But the irony is, when I think about those young women that you're alluding to, we give women hormonal synthetic contraception to prevent pregnancy and there's no judgment there. But the sad thing is a lot of things that prevent fertilization, also tank your libido. You have these young, healthy 20, 30 somethings that want to have amorous relationship with their partner, and they have no sex drive. Let's at least start the conversation and we'll talk about how synthetic hormones as an example, can dampen the desire to have sex, to be able to explain in a way that people really understand, because I find it isn't just the 20 and 30 somethings that are put on oral contraceptives or given a contraceptive IUD, and they wonder why they have literally no sex drive. So, it's a byproduct many times of the medication they're given.
Dr. Renee: That is correct. I want to just add one little thing talking about the difference between men and women. I worked with men for four years. The funny thing is, I would say, I can't say 100%, because there was one gentleman I can think of that didn't come in with this complaint, but 99% of the men I took care of would come in and their primary complaint was low sexual desire, low libido. When I further question them, I asked them about how else do you feel? "Oh, well, I've had low energy and I'm gaining weight, losing muscle mass, I cry at the drop of a pin." I was like, "Wow, how long has that been going on?" "Oh, like a year?" "Why are you here today?" "Because I don't want to have sex."
Cynthia: [laughs]
Dr. Renee: I was like, "Oh, my gosh." Versus the women that would come in, they would come in with low energy, gaining weight are the two biggest ones. I had actually questioned them. When I uncovered all the other stuff, they did have a low libido underneath there. But that was their primary complaint coming in. You can see where men and women were we even prioritize sex, like, men is at the forefront, because I think, what's the number, like, they think of sex over 200 times a day.
Cynthia: Yeah. It's just evolutionary ones.
Dr. Renee: Yeah.
Cynthia: It does makes sense.
Dr. Renee: Yep. Testosterone has a lot to do with it. They have a lot more. We have a lot less, but we're a lot more sensitive to it. However, our brains are different, how we process everything from emotions to, how we process everything what was said, facial expressions. Studies show that women are more givers and men are more takers. Women are actually much more satisfied with just deep connection versus men more about frequency. It's really very interesting the dynamics and just trying to take this like at bird's eye view of coming out, looking at the big picture of like, "What else can we help her with?' Because all those 99% of the men, they were all low in testosterone. The problem what I had in my practice is I would replete them their testosterone, because I cannot deprive them, even though it is very-- There's a lot of doctors out there that won't even give men their testosterone back. They're very scared of it. That was not me. But the problem is a lot of these men never want to get to the root cause of why their testosterone was low. I had someone as young as 22 with a low testosterone.
Cynthia: Was it insulin resistance or just exposure to toxins in the environment?
Dr. Renee: Toxins. He was Amish, so a lot of toxins and potentially-- Although, he was thin, his insulin was good, his glucose was good. Of course, they pay out of pocket. You got to be careful with all the testing that you do. A lot of times, it's still scratching your head like, "What is it?" But I do believe for him, it was a lot of toxins, believe it or not, food and environmental. But getting out a topic of women 20s, 30s, 40s, even in the 50s, because ironically, we were taught to transition a lot of perimenopausal women into menopause on the birth control pill. Oral synthetic hormones, particularly estrogen actually increase something called sex hormone binding globulin, a protein that actually will bind up your free testosterone. I actually kiddingly and I don't laugh at this anymore for 15 years as a gynecologist when girls would come in on the pill and complain of a low libido, I said, "Oh, that works two ways that preventing pregnancy. Number one, you don't ovulate. Number two, you have no sex drive, because it binds up all your testosterone."
I'm sad I said that in the past, but it was true. I knew that was a side effect and a lot of women were unfortunately willing to take that side effects at the expense of prevention of pregnancy. Then, of course, we're talking to women in their 30s, 40s, 50s, we're doing the same thing to them. Their hormone levels are already decreasing, especially testosterone and what they do have were binding up with these synthetic oral hormones. There's a reason for it. I have a lot of women come to me, "Do I have to come off my pill? Can I maybe we could find a different option?" It depends on how important is it to you. Because when I talked about a low libido also, I don't-- I got asked in another podcast, why not demonize it? But I don’t demonize it, I'm raising awareness. If I don't characterize a low libido as a frequency of intimacy, it can just be connection for women. It can just be holding hands and cuddling. But if a woman is bothered by her frequency of intimacy with her partner, that's why I'm here for to talk to. If you have no intimacy, and you don't care about it, and you don't want it, you don't have to listen to me. [laughs] So, I'm not here to say you're bad because you don't have a sex drive. I'm here to just raise awareness and help those women, who are bothered by it.
Cynthia: Yeah. I think it's important for people to understand that there's this fine line between side effects from medications and taking medications to prevent pregnancy or "regulate hormones." I'm stunned at how many women are in their late 40s, early 50s, and they have no idea where they are. They don't get menstrual cycles. They have no idea where they are and they're like, "Oh, well, my doctor, my NP, my whomever said I can stay on this until I go through menopause." I said, "Well, how do you know?" The average age of menopause in United States is 51 and you're 52. Guess what? You're probably already there. I think keeping that communication open as you mentioned for those that are interested in investigating, but what are some of the other medications that you see-- I used to prescribe a lot of beta blockers like atenolol, Lopressor that had a lot of sexual side effects, because they also impact neurotransmitters like dopamine and serotonin. But what are some of the other medications that you might have prescribed that you would see this low libido issue with as well?
Dr. Renee: Yeah, I did the other biggest one that I prescribed. Because I was very limited. I wouldn't do the antihypertensives. It was the antidepressants, definitely. Anti-anxiety, most of the antidepressants. It's one of those topics, again, you look at the side effects of antidepressants, same thing. Again, the effects on the neurotransmitters-- It does say low libido there. It comes down to-- Unfortunately, it's a side effect and I would say, just like the birth control pill, a large number of women would have the side effects of a libido, a large number of women would've the same side effects with an antidepressant or anxiety medication.
Cynthia: I know, it's unfortunate that that's not disclosed often enough, because I think I in fact, I know that if someone's taking anti-depressant with the hope of their depression improving, and then they have the byproduct of now having no libido, maybe for some people, that tradeoff is worth it. But for many others, that may make their depression actually worse if that becomes problematic.
Dr. Renee: Correct.
Cynthia: Now-- [crosstalk]
Dr. Renee: I was actually looking at research on that like, "What comes first? The chicken or the egg." The low libido or the mood issue. A lot of times it's like a vicious cycle. The mood issue being on antidepressant leading to low libido will actually further contribute to the depression. So, there's a definite correlation there.
Cynthia: Makes sense. How about alcohol?
Dr. Renee: Oh, big time. Yeah, alcohol, the biggest thing with alcohol is its effect on estrogen. Even as little as one drink a day for women will actually do that. We've seen a rise in alcohol consumption over the past 20 months and it'll definitely increase a woman's-- We talk about estrogen dominance, that will definitely contribute to her low libido.
Cynthia: When I was in those perimenopause years and the city that I moved from, there was a huge wine culture. Again, no judgment. Alcohol became something that almost guaranteed I would have a terrible night's sleep, even with a glass of something. But I see a lot of women, as you mentioned self-medicating at night, where they go to a party. Maybe we haven't had as many of those over the last 20, 22 months. But alcohol in and of itself, if you're already in perimenopause, already leaning towards estrogen dominance, because your ovaries are producing less progesterone, that can make your symptoms worse as well, and more inflammation, and all those other symptoms that I know many of my guests talk quite a bit about, because we're trying to raise awareness. Women are just aware, like, as you go into your 40s, this may no longer serve you well. When you're working with your women, do you have an amount of alcohol that you think is a threshold? Maybe a couple drinks a week most or are you more concerned about the binge drinking behaviors that you see?
Dr. Renee: I take into account how often she's drinking, and obviously, if estrogen dominance. Most of the women I work with, estrogen dominance is definitely in the picture. Here's the interesting thing in doing my research on alcohol. Actually, higher estrogen levels, so, we're talking about women either with that already estrogen dominant picture or in the perimenopausal phase will actually change the brain's reward center as far as its sensitivity to alcohol. Meaning, it's going to take less to become more pleasured by the alcohol. Actually, the woman is going to feel even better with the alcohol. This is why women are even more, it's more dangerous in their 40s, 50s when you're naturally estrogen dominant, because of our ovulation status that actually more addictions occur, because of that brain reward center that gets a little tweak from the higher estrogen levels, which I thought was really interesting. Because you have to think like, I am seeing it all over social media, especially like women my age, late 30s, 40s, 50s that are really having a hard time.
With the pandemic, and drinking a lot, and it could be a hormonal reason why we're more prone to addiction than men. If it is an issue, then we definitely start cutting down or out. Obviously, I know you're talking in your world with weight loss and insulin resistance. It's just not smart to do it frequently. I don't love binging on the weekends, but having a glass or two on the weekends is acceptable. Again, as long as we're making headway with her symptoms as far as her estrogen dominance goes.
Cynthia: Well, I think it's really important for people understand that each one of us are individuals, like, I stopped drinking completely during the pandemic, because for me, it was always a very much a social thing and we weren't doing much of anything of social. But also, as I got into my mid to late 40s, what started happening for me was, I never got a hot flash, my sleep was generally really good, but if I drank a glass of wine, had a martini, my sleep was terrible and I would get hot flashes, which-- For anyone that's listening, if you haven't yet experienced them, they're not fun. Certainly, mine were pretty mild in comparison to a lot of the patients and clients I've worked with over the years. But for me, I made that connection almost immediately. I was like, "That is not a good feeling for me." So, it was very easy to say, I choose not to, but I think a lot of people don't necessarily make those connections. I think it's a valuable one to say, a lot of the research that I've been looking at with regard to blood sugar stabilization, or dysregulation for that matter, and alcohol use, and hot flashes, it seems that the research is suggesting that those with the most degree of insulin resistance or propensity for insulin resistance generally also have the worst hot flashes. If you're listening to this and you're trying to dig deep down into figuring out why your hot flashes are such a problem, really look at blood sugar stabilization, what your diet's like, etc. I know that's a little bit of a tangent, but I want to [crosstalk] that end.
Dr. Renee: No, it was great.
Cynthia: Because I found it fascinating that blood sugar dysregulation, insulin resistance drive hot flashes and can sometimes make the people that have the most severe like people that are in the small-- I think it was 20% of the population will have significant prolonged severe hot flashes, it's generally related to insulin resistance, which makes sense given how metabolically unhealthy the population is.
Dr. Renee: I agree. Yeah.
Cynthia: But what I think is really important for women to understand, this is something that I admit. I probably didn't understand enough about, because I did not practice in GYN. I was not a women's health NP initially. How many women have-- they get to the point where they need some type of surgical intervention, whether it's for fibroids, endometriosis, they have hysterectomy where they remove the uterus and/or potentially their ovaries and no one talks to them about the fact that, if you have surgical menopause as one example, you're going to make that transition so quickly that it may explain why you have no desire to have sex, or have no libido, or have a very low libido.
Dr. Renee: Yeah, it's probably the worst kind of menopause to go through, because it's not-- I feel even that woman, who one day wakes up never has appeared again. I feel it's a lot more gradual than going into, especially if you're having issues with heavy periods, you have a lot of estrogen onboard most likely because estrogen dominance, one of the symptoms is heavier, crampier, more frequent periods that tells you right there, there's more estrogen onboard. Then you wake up after surgery you no longer have a uterus. Historically, what we were doing for these women is popping a patch on them postop, but here's the reality. A lot of docs are scared of hormones nowadays, gynecologists, ever since the Women's Health Initiative came out in what 2000-- I know I was shortly out of residency because our phones were going off the hook. Ringing off the hook with women like, "Oh, my gosh, I'm an estrogen. What do I do?" There're a lot of docs nowadays that-- Again, they're not the same hormones that I actually recommend. They're completely synthetic. Premarin, did the study that was done was using a completely synthetic estrogen from horses and a completely synthetic progestin. It's not even a progesterone, it's a progestin. There's a significant difference. In our body, I think it breaks it down to 27 different metabolites, the estrogen that is. It doesn't recognize it. It's not human. It's horse estrogen, so I just think about what that does to our cells in our body. It's a foreign chemical. It's a foreign estrogen. I'm sorry, I digress.
Cynthia: This whole thing is so relevant, because I'm getting ready to do a webinar talking about hormones related to middle-age and beyond. Obviously, all the listeners-- this will be in the show notes. But there's a book called Estrogen Matters. I have dived down a massive rabbit hole looking at Women's Health Initiative, looking at how unhealthy the population was, they excluded healthy women, who had just gone through menopause. The average age was 63. Most of the women were overweight and obese, most of them were former or current smokers, most of them have were treated for high blood pressure. You can't look at a population of women like that and extrapolate again with synthetic hormones on top of it that hormones are bad. I think this rhetoric about hormones being harmful is hurting women.
Dr. Renee: It is.
Cynthia: I cannot tell you. Every time I speak out on social media about this, for every 20 women that are thrilled that the conversation has been opened, I have people in my DMs and telling me that I am going to hurt women. I said, "We need to be open and honest." This book Estrogen Matters is written by an oncologist, who has gone to the mat for women's health. In many ways, I think that this fear about hormones stem from that 2002 study and this is a study that was done by the National Institutes of Health. There're over $1 billion invested in the study. A very large-scale study. There were so many things in the scientific process that weren't done properly. When this information was released, that it pains me because I think you and I are roughly the same age. I was finishing my Nurse Practitioner program, and when that came in, I remember telling my mom, I was like, "You have to get off hormones. This is harmful." That was the general consensus.
Most studies don't do a press release before they're actually published. I think in many ways and talk about tangents, but relevant, because we're talking about women's health, we're talking about hormones, we're talking about libido. I think about how many women have needlessly suffered, because I look at my aunts, who are now in their 70s and my mom is osteoporotic. My mom is fearful of hormones because of everything that had come out. I look at her loss of muscle mass. You see a lot of these cognitive-- that cognitive impact and there's a whole other excellent book recommendation The XX Brain by Dr. Lisa Mosconi talking about how critically important hormones are for brain signaling. We just think about hormones for our sexual function, but everywhere in the body, we have receptors for estrogen, and progesterone, and testosterone, on our bone, on our muscle, in our brain. I'm so glad you touched on that study. But again, I apologize because I'm going to try to bring us back to our original intent for having this conversation, that it's so, so important that everyone get educated about how this impacts, how you're going to age, because women will spend 40% of their lifetime in menopause. So, it's important that you figure out for yourself what the best decision is and connect with clinicians like Dr. Wallenstein to determine the appropriateness of these types of different therapies.
Dr. Renee: Totally agree. And I think a lot of docs out there in the conventional world, which was me for many years after that study, we're scared. I have to say as a traditional doc and I'm sure you are as well, I always say, I was trained in defensive medicine.
Cynthia: Yeah.
Dr. Renee: I was trained in defensive medicine. Medicolegally, I was so scared of getting sued, especially since I was also in obstetrics. I was delivering those babies, God forbid the baby didn't go to Harvard at 18, I might get sued. This is like, I woke up, I went to bed, every clinical decision was not what is best for the patient. I mean, it was but risk-benefit is going to harm her. What we're taught is, hormones are going to harm her. This magic five-year window of just being on estrogen-- At five years, I'm ripping it away from you like, "I don't care if you feel good on it. I'm not listening to you." This Women's Health Initiative tells me I have to do this. I remember myself having this conversation with women. Unless, they had debilitating hot flashes, I was not going to put my license on the line and prescribe estrogen to them. It's really sad how I've come full circle to look at it a lot like you have also with a study, and how poorly it was done, and how-- European countries actually advocate for hormone replacement but using bioidentical hormones, they don't even use the crap we use here in States. These are studies I'm reading for my OB-GYN board certification. My jaw is dropping that they're getting this natural estradiol and I'm like, "Whoa, we fight our insurance companies to get anything." For your audience, you can get natural bioidentical hormones from your doctor prescription. They're called estradiol. But the problem is most insurance companies don't want to pay for them, because they're more expensive than say, a Premarin.
Cynthia: But what they find frustrating is that, we have a very patriarchal medical establishment. You better believe the erectile dysfunction meds get covered, which I think it's completely inappropriate that women's hormone replacement therapy, bioidenticals and otherwise. We should be asking for bioidenticals are not covered or women are shamed. I was talking to a colleague of mine, someone I went to nursing school with a thousand years ago. She's a smart nurse and she said, "Oh, yeah, I've been on hormone replacement therapy." I said, "Okay what are you taking?" "It's just only oral estrogen."
Dr. Renee: Ah.
Cynthia: Oral estrogen. I said, "Well, you have a uterus, right?" No progesterone. All I could think of was, that's why I think more and more of us have to be speaking up, so that women understand that there are other options. You started the conversation and when you take hormones by mouth, it's hard on the liver, because it says this first pass effect and the liver has to break down and detoxify. But let's talk a little bit a little sooner in the conversation I intended, but let's talk about some of the options. Because this is relevant as a GYN, relevant to what are the options that are available for women? Let's start with estrogen. There's lots of estrogen options that are not just oral, and obviously, there's synthetic and then bioidenticals. But what options are available for women? If you're listening to our conversation, and you're at that stage of your life, and you want to enter into a conversation, what are some of the options that women can be asking before?
Dr. Renee: Yeah, contraception, we will go way back, I think a non-hormonal IUD is probably the best. However, a lot of women experience heavy periods with them and they don't really want to deal with that. I found in my practice of really special woman that wanted non-hormonal, which is not the average woman out there. I think second in line would be a progestin-containing localized contraceptive, which will not have the effect in your libido like an oral combination birth control pill would. Those are my two favorites. Obviously, barrier methods are the best, but a lot of women don't. Diaphragm and condoms in the female like-- But I know they're not as glamorous as the others and you can't be as spontaneous. Then when it comes to women coming into the perimenopausal, menopausal phases, a lot of women just at that phase, before they enter menopause don't even need to think about estrogen, obviously, because majority of them are estrogen dominant. Meaning, either you're making a lot more estrogen naturally, combined with potentially external sources of estrogen, which could be from too much alcohol, or too much stress, or endocrine-disrupting chemicals that are actually putting you over the edge.
The fact that many women in this phase of life are not regularly ovulating. What gives us a rise in progesterone is, when we ovulate. When you ovulate, you release the egg. 14 days later, if you don't get pregnant, your progesterone level comes down abruptly, you get a period. That beautiful cycle doesn't occur on a regular basis generally in perimenopause, which is why women 14-day periods, 55-day periods, 60-day periods, no period for six months, that tells you probably you're not ovulating. For those women, number one, if you think there's underlying reasons why aside from your age that you have too much estrogen really look into that. Dietary obesity will actually contribute to higher estrogen levels. Perimenopause, pre-menopause, post-menopause, so you got to really think about that, because that in and of themselves are endocrine organs. They produce their own estrogen as well as other hormones. There's that. Look at the big picture. But while you are trying to figure out like, "Why is my estrogen high?' You can consider progesterone.
Now, there's two different ones that I usually recommend. If you go to your regular doctor, I'm sure they'd be happy to give you an oral progesterone, which we do not have to worry about oral progesterone with the liver as we do with estrogen. As a matter of fact, I really love oral progesterone in the peri-menopausal stage of life, because a lot of these women are having insomnia. They're having difficulty sleeping. A great side effect of oral progesterone is it makes you dizzy but sleepy. I obviously take it at bedtime, and you'll probably get amazing night's sleep, and it'll balance out hopefully the estrogen. You hopefully have more frequent periods, lighter periods, hopefully, less crampy periods, and you can ease into menopause.
Now, the brand that your doctor can prescribe is called Prometrium. It's something that hopefully would be prescribed by your or-- covered by your insurance and prescribed by your doctor. Your doctor probably wouldn't have a problem with prescribing Prometrium. I would just stay away from Provera if possible. Now, if we are transitioning into the menopausal stage, that's where we have to look at combination hormone replacement. It's interesting because you made a comment about the uterus. Conventionally, trained as a gynecologist, I was told that if a woman doesn't have a uterus, she doesn't need progesterone. However, I'm all about balance and we can easily make a woman estrogen dominant. I generally would put a woman on both estrogen and progesterone even when she was menopausal, just so she wasn't thrown out of balance, just getting estrogen by itself. But that was how I was taught in functional medicine and that's what I did.
As far as I would continue to use this one your options for the progesterone oral by mouth or even a cream, and then usually from the estradiol aspect, you can get a patch from your doctor. That is actually usually my favorites. The only problem with getting a patch from your doctor is that there're fixed doses. What I really loved about actually prescribing a biased, like a bioidentical estrogen cream is that I could actually titrate her dosing based on her symptoms. I did find in evaluating women's bloodwork and estrogen levels being on a cream versus a patch that a lot of times, she was having a lot higher, obviously, estradiol levels since they were 100% estradiol with the patch. If you have the availability of a doctor, who prescribes bioidentical hormones in the form of like a Bi-Estrogen cream, that's awesome, because then they can-- Again, they can also change the percentage of how much estradiol is in there versus estriol, which is a little bit of a weaker estrogen, but nonetheless really important, especially for the vaginal tissues. Estriol is wonderful. I've had women that really didn't want a slug of estradiol, I'd put them on 90% estriol. Yes, it's weak, but it's something and we would just hydrate the doses from there. So, those are my favorites definitely.
Cynthia: It's really interesting, because it provides the opportunity to open the discussion with providers and say, "I'm aware that there are these other options." I know I always actually appreciate it when people would do a little bit of homework before they would come in for an appointment which would tell me they were vested certainly in their health as well. Now, I know that if we take this back to libido piece, so, we've talked about how to replace hormones, we've talked a little bit about contraception, when we're talking about other things that contribute to low libido and we've touched on some of them. There are some significant things that can occur. There's low libido and then I think it was 10% of the population actually has this HSDD, this hypoactive sexual desire disorder, which I would assume is the extreme end of individuals that are impacted by a lack of libido. Did you see much of this in your practice or just like one of those uniform diagnoses that--? In my research, it's mentioned, but it's probably only seen in ivory tower research environments.
Dr. Renee: Yeah, I didn't see it a whole lot, to be honest. Just like that while you're quoting 43% of women have low libido, I think it's completely underreported. We're not talking about us. Of course, where are they getting that number from. The women that are talking about it, which is not many. The same goes in my clinical practice. Even if women had it, number one, I wasn't generally talking about it and number two, they were definitely generally not telling me that they had it. So, I didn't see it often.
Cynthia: Yeah, I can imagine because I never even heard of it. I was like, "Wow." Some foods that can be contributory towards a low libido, I would imagine are the things I probably talk a lot about processed food, Standard American diet. On the opposite side, what are some foods where I would assume nutrient dense, less processed [crosstalk] much more beneficial? Not just for your health overall, but also for production of hormones. I know there was this whole anti-fat movement. We are bastardizing fats for such a long period of time trying to explain to people that we need to be able to make cholesterol. From cholesterol, we cleave off and actually make these sex hormones. If you're not eating healthy fats, not eating the right kind of fats, that can impact the quality of the hormones that your body makes.
Dr. Renee: Yeah. I think your audience already knows, because you talk about it all the time.
Cynthia: [laughs]
Dr. Renee: Again, if you eat animal proteins, lean animal proteins, carbohydrates aren't bad, obviously, but just stay away from the refined carbs like the things that have the fiber taken out. Because I'm big on fiber. I'm big on feeding that gut microbiome, because that's really important for your hormone balance your estrogen metabolism as well. Healthy fats, super important. Olive oil, coconut oil, avocado, dark chocolate, [giggles] some of my favorites. Obviously, again your veggies. I'm big on veggies as well because of the fiber and also green leafy veggies have, like your cruciferous veggies have something called sulforaphane in it. Sulforaphane actually helps us break down estrogens into a healthier form. Now, genetically in the state of New York, which is where I live, I cannot test women for this. But there are some fun fancy tests out there that you can actually see how you break down estrogens to see if you make more of the more dangerous break down product, the estrogen. What decompounds in cruciferous veggies do is actually help you make more of the beneficial estrogen. So, super important. You can also take it in a supplement called diindolylmethane or indole-3-carbinol. But food first, veggies first if possible and just your fibrous veggies again, mostly for your gut microbiome. We got to make sure that we keep those gut bugs happy, healthy, and breaking down our estrogens.
Cynthia: Well, there's this ugly term called the "estrobolome." I know, it's like tomato tomahto depending who I am talking to. But again, this is what Dr. Renee is reinforcing is so critically important, because we package up and get rid of excess estrogen or should, if we are stoking this healthy gut microbiome environment. Now, I got a lot of questions about how does exercise and sleep impact libido, which I found fascinating as well as supplements? So, are there supplements that you in your practice recommend to boost support, etc., libido?
Dr. Renee: Again, let's not talk like we're men.
Cynthia: [laughs]
Dr. Renee: Let's not talk about the testosterone boosting, because there are. I've done TikToks on testosterone boosting, Tribulus, and maca, and all of that. They're all great., but what if testosterone is not the issue? What I focus on as far as supplements is, I would say 100% of my clients have stress as one of the root causes. I definitely love what they call an adrenal gland adaptogen. My favorite is ashwagandha to help with stress. Obviously, stress management awareness, number one, management, number two, and again, I work with my clients on that. Regular doctor's like, "Okay, just go, he's less stressed." I'm just like, "How?"
Cynthia: Go meditate.
Dr. Renee: Go meditate. How in this day and age do we calm our brains enough to do that? I do definitely love ashwagandha. I also love as a staple for pretty much everyone B vitamins like a B complex, as well as magnesium to help make your hormones. B vitamins, actually-- Even if we're talking about this beautiful pristine veggie rich diet, our food is so deficient in nutrients. I live in New York. Again, most of my food comes out of truck across the country. By time it gets me, it has very little nutrition left, even if I get fresh. I do love a B complex. The other thing with B's is that they get depleted with stress. So, really important. Again, I'm talking about stress being one of the biggest things I see in women and just goes to show that probably they're deficient B vitamins. I can't say there's been ever one woman that I've actually tested that's not been deficient B vitamins. Now, just empirically put every woman on a B complex, and also helps make things like serotonin, and dopamine, the things that make us happy, and feel rewarded, and calm. There's a double whammy there for the B complex. magnesium, super important.
Again, natural anti-inflammatory, but actually also helps with hormone production to my favorite vitamin D, obviously. What else? I'm trying to think of what else I like across the board would--? Obviously, if I'm thinking of estrogen dominance picture again, personalized medicine, I would recommend diindolylmethane and upping her cruciferous veggies. If a woman, again, also estrogen dominant picture, another great supplement called Vitex, which actually will help produce the progesterone and help balance out the estrogen. These are great options for women, especially if they don't want anything hormonal like really tap into the supplements, definitely.
Cynthia: And those are definitely a great starting point. I think for so many people, I did a talk a couple years ago, and I talked about maca and ashwagandha, because there was so much research on them and figured that was the safest thing. There we go, protecting ourselves. We're going-- something that's research based if I'm going to be speaking to a large platform. I'm always surprised how often and this is conditioning. I acknowledge that in many ways, we have conditioned our patients to ask for a supplement or a medication before thinking about the lifestyle medicine piece. I got so many DMs about maca. I found it really interesting when I was talking to people that, we can do all these different aspects of lifestyle medicine and yes, maybe this one supplement can be hugely impactful. However, we really need to back up the bus and get a full view of what's going on with our hormones before we start layering in lots of complicated things.
I think one of the tests that you are alluding to that unfortunately, you can't order in the State of New York is the DUTCH. For women that are listening, I certainly talk about this test a lot in conjunction with serum blood testing as well, as well as other types of tests. But the DUTCH, in most instances is saliva based, but also can be dried urine. It can provide a really comprehensive view of how your metabolism, your estrogen, what your circadian rhythm, cortisol distribution, etc., look like. I find it oftentimes very [unintelligible [00:45:03] what you'll get on blood testing that gives another nuanced kind of view. Now, a lot of the questions that I receive beyond what we've already talked about were related to topics that I think for a lot of women are very, very uncomfortable for them to discuss. Anything related to our vulva and vagina. people don't like to say the word, let alone talk about it. For many people, especially women, who are tend to be smaller, maybe don't have as much adipose tissue, maybe they're leaner, they're just lower in estrogen, normally, heading into perimenopause and menopause are getting a lot of concerns, questions about their lack of libido is really a reflection of physical changes that have gone on in their bodies.
We talk a little bit about this vulva or vaginal atrophy that can occur during this transitional period and what women can do about it? Off camera, we were talking about the fact that this is a great example of, if you're having issues in this area in particular, you have to have the conversation sooner rather than later, because it's almost like, if you don't use it, you lose it, which is unfortunate. So, let's unpack that a little bit.
Dr. Renee: Yeah, that's so true. And a lot of women don't. They'll think is going to get better or they don't need to be intimate and that's so not true, especially if it goes on years and years like you just said. If I've actually seen this clinically that the area will start shrinking, it gets smaller. Of course, putting something larger in it will hurt, those dilators. If you wait too long it becomes much more of a process to get it back and a lot of women just don't want to go through that process. I think number one is if you're starting to have discomfort, of course, you probably have a low libido, because you don't want to be intimate that hurts.
Cynthia: Right.
Dr. Renee: Communicating with your partner is huge, because you got to slow things way down. As far as what you can do about it, there are vaginal moisturizers you can use on a regular basis. Actually, when you're going to be intimate, lubricants, and they make them super fun nowadays and you can have fun with it. It is definitely not something I think a lot of women stigmatize lubricants like, "Ah, I don't want to have to use one." I think a lot of women that have no problem with lubrication, use it, because it can be fun to use. Lubricants are definitely an option, obviously, got to be careful of the kind you get. You could be sensitive to some of the lubricants out there. I'm sure, Cynthia and I have lots of friends with great companies that have these kinds of nontoxic lubricants. Then hormonally, and again, we won't go into vaginal dilators, because I feel that's the little bit of an extreme, but there are options out there to be able to use what they call dilators to introduce slowly. They're just exactly what they are dilators. A woman can actually insert, and work on herself, and get ready to be intimate again. But again, that's a little bit on the other side of-- That's a little more reactive. We've already got a problem. Let's try to be a little more proactive. We have a problem, it hurts, communicate with your partner.
Again, moisturizers are great and daily use lubricants for in the moment. If you need something more, also, actually hormonal. I know we have a common friend that has a hormonal DHEA that you can put down there. That would be great to start if you don't want to go to your doctor, because I do you think a lot of women are hesitant to go and talk to your doctor about it. Getting on this earlier and continuing to be intimate is great. If you need the next step in hormones, a lot of conventional docs actually, ironically, don't have a problem with giving vaginal estrogen. Because that didn't come out as a big no-no in the Women's Health Initiative. Localized estrogen is very well accepted in the conventional world. There are a lot of options, there's vaginal creams, there're rings, which I found most of my patients prefer the creams versus the rings. The only times I ever had women that really wanted to ring is that she had any sort of prolapse. Sometimes, rings would actually help a small prolapse, nothing large. It would actually help hold up her bladder potentially. But I think for my patient population, they like the creams, because it could be used remotely from intercourse, her partner didn't feel it. Like I said, the biggest complaint I would hear from the ring is that, her partner felt it, and she didn't want to continue it. There's a little continuum of what to do when you first notice, get right on it all the way up to hormonal treatment.
Cynthia: It's really interesting, because if you are familiar and I know you are, but the listeners familiarize with what actually starts to happen in the vagina, as there's less and less estrogen, it impacts the vaginal microbiome or the vulvar microbiome. The lactobacilli bacteria that would otherwise be living there and be happy, they start dying off, the pH level changes, so, women, all of a sudden, they're like, "I have weird discharge or it doesn't smell the same, and now, it's dry, and now the skin feels really fragile." I love that you walk through that and I always think about Dr. Anna Cabeca's Julva cream and it was [crosstalk] recommended Holiday Gift Guide, because you don't need a prescription for it, it's safe. I think for a lot of women, we got a lot of questions about women, who are cancer survivors and obviously really hot topic given the fact we've just been talking about hormone replacement.
What's interesting is this book, Estrogen Matters is actually written by an oncologist and what I think is really relevant is his wife at 45 was diagnosed with breast cancer. He said, after a few years, she started noticing this cognitive decline and he has in his practice and his wife is an example of this. Cautiously, they went on hormone replacement therapy and actually, they are doing a whole lot better. I know that conventional allopathic medicine, this is a no-no, but [audio cut] and I would just refer the resource the book. Go check it out. He spends a whole chapter talking about women. What are some of the things that you typically would recommend for women that were not hormonal that could maybe help support their body, their libido post cancer treatment?
Dr. Renee: Well, I was going to say soy, but soy will fall into that same, the phytoestrogens, which is not the case. But again, the research out there that it's not, but if you're in the conventional world, they're going to say stay away from soy and stay away from hormones. If you want to walk on the edge, you might want to think about phytoestrogens. Obviously, soy is a highly genetically modified crop. Definitely get some organic soy products first and foremost, because we're not going to do any good if we're adding extra toxins to our body. Again, I think a lot of the Vitex would definitely help also. I think, being a little more proactive as far as recurrence, weight loss is super important, because one of the biggest causes of any malignancy, even postmenopausal have to do with the estrogen production from adipose tissue. Like why is a woman, who's 60 have high estrogen levels is from adipose tissue? So that's definitely a healthier lifestyle.
Because like you said, a lot of times that will be the biggest problem solver across the board, start with lifestyle. I don't even know if we hit on sleep earlier. Adequate sleep and exercise definitely would improve bone health, confidence level. I think the biggest one I would see, again, is that woman who's having the hot flashes and night sweats, she was the one who's always asking. I think a lot of women out there that are just menopausal that don't have any menopausal side effects aren't even asking for hormone replacement. For them to even go to the dark side and consider bioidentical hormones is really radical, which I don't think is radical. I'm a lover of bioidentical hormones myself and as soon as I cross the threshold myself, I'm popping right on them. But I think it's a risk-benefit thing and I think you really need to see if hormones are appropriate for you. If not, there are some other supplements like the Vitex, consider phytoestrogens. There're tons of phytoestrogenic supplements out there, creams, as well as oral supplements.
Cynthia: Oh, that's super helpful. I know, again, that question came up multiple times just from people, who post-cancer treatment have really suffered and many of whom are post-breast cancer treatment and they're on drugs that are designed to plummet any estrogen in their bodies. They're achy, they have headaches, they don't sleep, well, etc. So, thank you so much for all of this. Obviously, we'll have to have you back, again, because there are so many different directions we could have taken with our conversation. Is there anything that you feel like we left out of the conversation about libido that would be helpful or beneficial for listeners?
Dr. Renee: Yeah. When I have my roadmap, a lot of women we start with-- Hormones for me are always icing on the cake and they're usually a component definitely. But I always go way back of talking about mindset like, "How do you feel about yourself, how do you feel about your relationship?" Because I find, we're not going to fix a broken relationship. Communication and your relationship is a big one. But again, working on mindset, how you think about yourself and there's actually also a study of, you have to have a growth mindset in order to improve your libido, just like anything in life. A growth mindset is believing that it can get better just like your health. If you're stuck in that, "Oh, I'm never going to feel better, I'm never going to lose weight, I'm never going to have a better libido," you're going to be stuck. You have to try to shift that as more of a growth mindset of saying, "You know what, it is not great now, but we're going to get to the bottom of why I'm not desiring intimacy," and we're going to work on it. Mindset's huge, relationship, communication, setting boundaries huge, women are super stressed right now and I think that's obviously from what we've just gone through in the last 20 months.
But a lot of women including myself lost myself a little bit there with everything going on around me. Giving to everyone else, and forgetting that I need to take care of myself, and I need to communicate, where I need help. Super important and that will actually also start helping break down that stress a little bit when you can start identifying like-- I always have my four Ds. What do you have to do in a day to day? Around the house with the kids, what can you delegate, ask the kids to do, ask your hubby to do? What can you delete completely off your list? What don't you really have to do that's on your list of 15 things and what can you put off to a later date? I think when we wake up with 10 things on our list, when we realistically cannot get three things done, we're already setting ourselves up for failure. I know ladies, we don't want to fail. So, set yourself up for success, do your four Ds, put on your to-do list of things that you have to get done, and take some time for yourself. Self-care is very important.
Cynthia: Absolutely brilliant. I just realized there's one area that I need to ask you about before we end this [laughs] call.
Dr. Renee: Okay.
Cynthia: A lot of women are getting pellet injections for testosterone. This is now coming up with so much frequency. People that are coming to me, that already have testing done, and I look at it, and trying to figure out why their testosterone is so high and I'm like, "Oh, I've been using pellets." What are your thoughts on pellets? I'm not a fan because it's just so unpredictable and I'm assuming that you're probably thinking exactly the same thing, but we'd love to have your input as well.
Dr. Renee: Yeah, exactly the same reason as you. I never trained in pellets, because in my opinion, I like to be in control as best as I can. I'm not God, but I do like to be in control, especially of hormones. I do find that once you put something in and keep again for three months, you have no control. I think the biggest side effects I saw from women were from testosterone. Not necessarily even pellets, even the creams I would give them. If they came in with hair loss or increased acne, I actually also seeing it with DHEA, which you can presume, because it was feeding into testosterone. I saw how exquisitely sensitive women were to testosterone. The precursor to testosterone that I never wanted to go down the route of pellets, because it's literally you put it in and it's like, "Okay, hands off until we have to remove them." That's just not how I wanted to practice personalized medicine. Especially, starting out a lot, even with female hormones, there's a lot of titrating that goes on. There's a lot of like, you empirically put a dose onboard based on her symptoms and her testing, and then you up or down frequently until you find your sweet spot, and then that cannot be done with pellets.
Cynthia: Right. It's literally a shot in the dark. I've just seen a lot of women that have either ended up with very high testosterone levels that aromatize. Testosterone can aromatize to estrogen and then they would be worse with their estrogen dominance. I think much to your point, the lack of predictability makes it a little less advantageous. But certainly, I do know there are individuals that are doing testosterone with creams. But with women, we do also up until menopause make our own testosterone, but it's such a smaller, I think it's like a 10th of the amount that men make. So, if you get too much, it can be problematic.
Dr. Renee: Well, we're also much more sensitive. We don't have a lot, but we're much more sensitive. We can't be dealing with male doses of testosterone without starting to look like a man. There're so many other side effects prior to that, but it's not good for women. They do not feel good.
Cynthia: Absolutely. Well, Dr. Renee, it's been a pleasure connecting with you today. Can you let my listeners how to connect with you? You have a wonderful podcast that I've been fortunate to have been a part of as well. How to find you on TikTok and Instagram. I do love watching your TikTok. I always say, you make me aspire to get better about doing reels in TikTok.
Dr. Renee: I don't live on my website, but I have a website drreneewellenstein.com. I am all across social media, because my feeling is if I can say one thing like-- I said earlier in this interview, if I could say one thing, and a woman has an aha moment, and it changes the course the trajectory of her health and her libido, my job is done. I try to be as present as I can across all social media platforms, at least to put on women's radar that this is an issue and we can do something about it. I am Dr. Renee Wellenstein on Facebook, TikTok, Instagram, I have a YouTube, I have a podcast called The Real Heal, which you were on it. It was an amazing episode. I actually just rebranded that to The Real Heal. So, it used to be called Love the Leap with Dr. Renee. Yeah, so, I'm everywhere. I don't know where I'm going to be in the future, but that's where I am, and come hang out with me, and learn a little bit more about libido.
Cynthia: Awesome. Thank you. It's been such a pleasure to connect today.
Dr. Renee: Yeah. You, too. Thank you.
[outro]
Cynthia: If you love this podcast episode, please leave a rating and review, subscribe, and tell a friend.
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