I am thrilled to reconnect with Esther Blum today. She is an integrative dietitian and menopause expert who has helped 1000s of women master menopause through nutrition, hormones, and self-advocacy.
We begin today’s conversation by looking at the disparities in menopause care for women, the midlife suit of armor, and the importance of developing mental strength and maintaining bone density. We explore the impact of meno-washing, facial estrogen, foods for menopausal health, and strategies to address facial aging, including peptides, lasers, and collagen peptides. We also dive into carb tolerance, testosterone, and low-dose Naltrexone, and Esther shares her hormone replacement journey and some of the common challenges she sees as an integrative dietitian.
You will love this valuable and insightful conversation with your fan-favorite, Esther Blum.
IN THIS EPISODE YOU WILL LEARN:
How disparities in menopausal care impact women- especially those in rural areas
The difficulties women face in finding capable clinicians to prescribe HRT
Esther explains her concept of the midlife suit of armor.
Why women in menopause must maintain their muscle mass
How meno-washing gets used in marketing to target products toward menopausal women
The benefits of using vaginal estrogen on the face
Various anti-aging techniques and the value of vitamin C, vitamin A, and peptide therapies for skin health
Why women in perimenopause and menopause must consume enough protein to build muscle, maintain bone density, and support cognitive function
How hormonal changes in menopause disrupt the microbiome
How testosterone can improve women’s mood, energy, and body composition
“I think the greatest gift of midlife is coming into full alignment unapologetically with yourself.”
-Esther Blum
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Connect with Esther Blum
Transcript:
Cynthia Thurlow: [00:00:01] 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 is 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.
[00:00:29] Today, I had the honor of reconnecting with fan favorite Esther Blum. She's an integrative dietitian and menopause expert and she has helped thousands of women master menopause through nutrition, hormones, and self-advocacy.
[00:00:43] Today, we initiated our conversation around disparities in care for women in menopause, the midlife suit of armor and mental muscle, the impact of menowashing. The benefits of facial estrogen, including relevant research. Strategies for addressing facial aging including peptides, lasers, collagen peptides and more, foods for menopausal health including common challenges that she sees as an integrative dietitian, specifics around carb tolerance, Esther's hormone replacement journey, testosterone, low-dose naltrexone and more. I know you will find this to be an invaluable conversation.
[music]
[00:01:22] Esther, always a pleasure to have you on, my friend. Welcome back to the podcast.
Esther Blum: [00:01:26] You're my queen, Cynthia, you know that.
Cynthia Thurlow: [00:01:28] Let's talk about the state of hormones in 2025. I couldn't think of anyone I'd rather have this conversation with because you address things that come up for middle-aged women with grace and humor. And in fact, Esther has some of the best memes on social media. And I can't actually tell you about the meme that really gave me a chuckle the other day. But suffice it to say it was very funny but not appropriate for me to talk about on the podcast. Anyway--
Esther Blum: [00:01:57] We'll just hashtag that one, “Vagtastic.”
Cynthia Thurlow: [00:02:00] Yes, yes.
Esther Blum: [00:02:02] [crosstalk] Mm-hmm.
Cynthia Thurlow: [00:02:02] Absolutely. One thing that I found really interesting, Esther and I had a conversation prior to recording and Esther had provided me with some ideas about the direction of where this podcast could go. And one thing I found really surprising and troubling is the impact of disparities in care for women in menopause. And so probably not surprisingly, we assume that people that are in suburban or urban centers are going to probably get different care than people in more rural parts of the country. And I think it really speaks to why it's so important that telemedicine is part of the conversation. Meaning if you do not have a qualified, comfortable provider in your area that you have access to someone who can provide the level of care and certainly give you the options of-- And there are many with regard to hormone replacement therapy. And that means starting the conversation in perimenopause and not actually waiting until menopause, because we know now that the standard of care is really starting in initiating HRT or menopausal hormone replacement therapy earlier as opposed to later. What are your thoughts on this? I know that, for me, having trained in the Intercity, I kind of look at the extremes of the population. The indigent poor patients and people in very rural areas of the country where maybe there's one provider and they have to travel quite a way to get to one. Talking about those disparities, which can be quite significant.
Esther Blum: [00:03:31] Yes. And I too, trained in-- My first job out of college was at WIC in Roxbury, Massachusetts and Boston City Hospital. And it was really challenging to get resources. And it's challenging for a couple of reasons. We know statistically, women of color have more severe symptoms due to more trauma, less resources, abuse, less care, medical gaslighting, less availability of care, there're so many factors at hand. But the interesting thing is too, I'm seeing in areas that are not even rural that there just isn't a good-- I can't name the states or places, but I don't want to throw people under the bus here. But I will tell you, it surprises me, even in places where I would think, “Oh, that's a healthy state, they're going to have good practitioners.” And my clients repeatedly come back to me and say, “The practice you sent me to or the practice that I thought was so great? No, I received horrible care. They wouldn't give me tests, they gaslit me,” and they just keep pounding their heads against the wall.
[00:04:48] My team and I are always doing due diligence on places and practitioners who provide telemedicine for this exact reason, because we don't want you to have to travel an hour to three hours. We don't want you to have to take a day off just to go and get a hormone prescription. This should be no different than a physical or a visit to get a Pap smear. It's just in and out, “Glam, bam, thank you, ma'am.” It should not be this hard.
Cynthia Thurlow: [00:05:21] Oh and I think that one of the things that I find so troubling, and I agree with you, it's not just rural areas. It's not just urban areas. I think it's astounding to me. I live in what I would consider to be a much smaller city than what I lived in for 20 years. And I hear horrific stories about patients, clients, friends, family members that live in Northern Virginia that are struggling to find capable, interested clinicians to prescribe them hormone therapy. And, I live very humbly in central Virginia and I have this amazing, very young GYN who's just out of training and she was like, “I love middle-aged women. I don't have to worry about birth control in most instances. I don't have to worry about delivering babies. You guys are very clear about what your needs are.”
[00:06:10] And she's like, I am more than happy to prescribe vaginal estrogen for women that have a history of breast cancer. I am totally happy to prescribe progesterone and estrogen patches and talk about testosterone therapy. She's like, it is not a big deal. I don't know why there is still so much stigma. And it's interesting hearing that from her because she's at a total other end of the age spectrum, but acknowledges some of the challenges that patients will come in with. They're like, “I've gone to five providers till I could find someone that was willing to prescribe oral progesterone of all things.”
Esther Blum: [00:06:44] Yes, exactly. It's crazy. I was talking to my cousin this morning because she's in her mid-40s and I was like-- And she's complaining of some symptoms. And I said, “It's probably time to bring in progesterone, just the last two weeks of your cycle.” And, she went to her primary care of all people. And he said, “Great, let's run your prolactin. Let's run your FSH and LH.” I said—Estrogen-- I said, “Throw in testosterone,” and I said, “Hold on to this doctor. This guy's amazing.” And she was upset because he was like, “By the way, you should lose 10 pounds.” And she said, “Well, why do you think I'm here?” And she's like, “I didn't appreciate that.” I said, “Okay, communicate that,” but I'm telling you. Because she said, “Well, I'm going to go to my GYN.” I said, “Not advisable. You're going to waste your time. You're going to likely be gaslit.” I'm sorry, my apologies to the awesome GYNs out there, who are not gaslighting, but the majority are. I said, “Save your time and money, stick with this guy, work on his bedside manner a little and call it a day.” You are out of the gate.
Cynthia Thurlow: [00:07:54] Yeah. And it's interesting because the one thing I have found working with thousands of male physicians or male providers, they just tend to be direct and they may not smooth the delivery of the message, but they tend to just be direct. Whereas I think most women-- not all women, I think most women try to soften the blow. I used to say to patients. When I was in cardiology, I was like, “We need to talk about like losing 5 pounds as a starting point.” And I found that just saying it that way was a bit more benign than, “Oh, you have to lose 20 or 30, whatever pounds,” because people hear that and it automatically puts them on the defensive. There may be a desire to convey the information, but I think that so much of it is dependent on how we convey the information.
Esther Blum: Yes. And meeting people where they're at and say, “What are your goals? Are you happy? Are you at your goal weight? Where do you want to be?” And then when they hold the vision, then it's like, I don't have to tell you this. Then it's just their vision, so that's even greater. And someone may never hit their so-called ideal body weight on paper, but it's a weight that they're comfortable with and can sustain and they can still dramatically improve metabolic markers, so win-win there.
Cynthia Thurlow: [00:09:11] Yeah, I think it's important. And I think for a lot of women, and maybe this is tangential, I feel like a lot of women have a vision of what their weight was when they were 18 years old. Like back in the day, if you can believe this, when I went to college, they put our weight and our height on our college IDs, honest to God. And I happened to find said college ID a few years ago and I was like, “How bizarre.” They would never do that now. But the point of what I'm saying is at 18 years old, what I weighed is not what I weigh now, nor would I want to weigh as little as I did at 18. I was just skinny.
[00:09:47] And so I think it's kind of helping people understand like we don't want to be skinny, we want to be strong. What are the things we need to do to ensure that we're happy where we are? Obviously, we're working towards a goal, but also having a goal that's realistic, because losing muscle mass is not a question of if not when. It's helping people understand how important it is to help maintain muscle. That muscle's just not about body composition, that it is truly about avoiding frailty, avoiding falls, ensuring that you have a metabolic sink to dump glucose in so you can enjoy your carbohydrates.
[00:10:24] In fact, I think one of the things that I found really interesting over the power of the N of 1, and I know we'll talk about your story as well, is over the past six to seven months, less fasting, more carbohydrates, more protein, and my weight hasn't changed, and the body composition is shifting. So, I think for a lot of people, we've been conditioned to believe that we want to be as tiny as possible, we want to weigh as little as possible. And I'm here to tell you that that is really an unfortunate metric to focus in on. There're so many other things. I think a great deal about, especially given what happened to my father this past year. We don't want to become frail. We do not want to begin falling.
[00:11:10] And so one of the ways we do that is making sure we're strong, making sure we maintain muscle mass and being conscientious about that and worrying less about the number on the scale and worry more about the breakdown in body composition. How much body fat do we have? How much muscle mass do we have? I mean, that's an important metric to look at.
Esther Blum: [00:11:30] Amen. It's the midlife suit of armor, is what I call it. [laughs] And it is time to muscle up buttercups. And it is the time, not just physically, but spiritually, emotionally, to also put on mental muscle, to put on a psychological or spiritual muscle where we're really standing in our sacral power and we're using our voices and we're using that drop in estrogen and that lowering of inhibitions to fully express our deepest thoughts and desires and acting on those. What I really think the greatest gift of midlife is coming into full alignment unapologetically with yourself. You and I talk about this all the time, who stays, who goes, what opportunities we say yes to, what opportunities we say no to, and what is going to give us balance and freedom and joy in our lives. And I just love it. I'm like, I'll trade some wrinkles for this time in life because it's really really worth it.
Cynthia Thurlow: [00:12:43] Well, and I laugh because I don't know if your son is like this, but my kids are, they just see that switch in my brain go off and I'm like, “I can't not share my opinion.” They’re like “Please, please don't do that.” I'm like, “No. No. I'm going to just say, I know this is unsolicited, but—[Esther laughs]
Cynthia Thurlow: [00:12:59] And if it's another small business owner or something else going on, it's like I lost the ability. It's not that I am at all insensitive, but I do feel that my opinion will be expressed more often and more frequently. And my kids oftentimes are just like, “Oh my God, you're so embarrassing.” I'm like, “I can't help myself. I've lost that estrogen drive to be a people pleaser. Now this is my next role. This is the evolution of myself.” And I think for so many women, understanding how empowering it is to feel like you found your voice.
Esther Blum: [00:13:30] Amen. I couldn't agree more. I love it. Yeah, it's a joke with my son. I'm always like, “Are you ready to learn the lesson yet or do you need to fail a few more times? Fail forward?” And he's like, “Oh, no, mom, I need to learn a few more times.” So, I try to really stay in the question of it all of like, “Wow, was that really a good choice?” Or like you actually need to pause because you're a knee jerk person and you actually need to pause if there's a shred of doubt in your gut or a little voice that says this probably isn't a good idea, but that's the time you need to pause, so that's where we're working at now, but yes, the lectures, the soliloquies, the monologues, they're in full force too, for sure.
Cynthia Thurlow: [00:14:21] Absolutely. Now, one of the things I find interesting, especially at the start of the year, is the concept of-- PR communities, the marketing communities are becoming savvy and understanding that middle-aged women have a great deal of buying power. And so, there's a lot of products that are being, I guess, targeted to women in our demographic, our time of life. And so, I know you've talked about the word of menowashing. And so, what does menowashing mean to you personally? Do you find it frustrating? Sometimes I do, like as an example, a company that will remain nameless just very generously sent me a lot of their supplement line. And it's all targeted towards women in perimenopause and menopause, but it's not anything I would ever agree with because there are ingredients in this product that wouldn't apply to everyone, but maybe they don't realize that. So, when I think about menowashing, I think about these targeted products that are designed to perhaps deflect attention from consideration to menopausal hormone replacement therapy or maybe being an adjunct to hormonal replacement therapy. What are your thoughts around this?
Esther Blum: [00:15:30] My thoughts are to always follow the money when you know, I just did an interview this morning with an NBC reporter about these menopause friendly delivery meals and what sets them apart. And she wound up reaching out to all of these supposed menopause delivery meals and they copped to the fact that it was a marketing term that there indeed weren't anything that differentiated menopause meals from regular meals within their delivery system. Of course, we know there is, but-- And that nobody would buy it without that term on it.
[00:16:10] And the same goes for supplements too. Like you and I are absolutely-- We want full transparency when it comes to supplements and not-- You can smell it a mile away when companies just have like 20 something influencers selling a menopause product or menopause skincare. Don't get me started. When you see skincare ads and it's women in their 20s, like women in their 20s are not necessarily targeting what women in midlife are targeting. They still have the collagen, elastin, they're not like wrinkled, they don't have the same sun exposure. So, it's trying to really delve deep into our wallets and prey on our vulnerabilities rather than having scientific or research-backed proof that something works.
[00:17:02] There is a lot of noise to sift through. And also, you want to make sure that the products are clean and they're not. I've seen a lot of menopause friendly products, especially when it comes to treating vaginal dryness. And you see propylene glycol in there, like absolutely not. Like you talk about an area of the body that has the most circulation and absorption even better than our skin and you're putting these toxins in there, like no, that can't be the case. So, you really do have to do your research. Environmental working groups or there are apps where you can put the skincare product in and it will tell you on a spectrum just exactly how toxic it is. Because I don't, I don't know about skincare products, what all the ingredients are, but I certainly know enough or at least look them up to be dangerous and say, “This is not for me.” So, we do have to be careful.
Cynthia Thurlow: [00:18:01] Yeah, no, I agree. And if people are listening and they're not familiarized with what propylene glycol is or what it does to the body, do you mind kind of highlighting some of the negative aspects of putting something in such a sensitive body part?
Esther Blum: [00:18:15] No. Off the top of my head, I don't exactly remember. I don't know if it's like a petroleum-based product. I don't know the exact definition. I would have to look it up.
Cynthia Thurlow: [00:18:29] No, that's okay. Offhand, I didn't. I just know there were certainly like parabens and phthalates and things like that. Again, just for the same reason, like if I were still having a menstrual cycle, I wouldn't want to use the typical tampon variety that's out there. When you think about absorption of bleached cotton and other chemicals right into vagina and vaginal wall, which is never a good thing. But, you know, back in our generation, we didn't even think about these things because we just assumed if it was in the grocery store, it was probably safe.
Esther Blum: [00:18:59] Yeah, there weren't discussions. It was only the like “weirdos” at the health food store that we thought were nuts that we were like, “Oh, the tree huggers and the granolas, they want all this natural stuff, big deal, it's never going to hurt you.” And then sure enough, endocrine disruptors come out. And we are now seeing the downstream effects with changes in fertility, changes in menstrual cycle, mental health, of hormones not reaching their targeted receptor sites because we have these chemicals mimicking them and displacing hormones at the cellular level so, yeah.
Cynthia Thurlow: [00:19:37] It's so interesting. I had this amazing college roommate that was in my sorority and she was from California. And as most people know, California tends to be way ahead of the East Coast, which is where I went to college. And she had very unusual food preferences for the 1990s. And I think about how far ahead she was of her time because so many of the things she was conscientious about then in the early 1990s are things that I became very vested and interested in probably 5, 10 years later. And so, we've had some ongoing discussions over the years about how far ahead she was, having grown up in California, and how conscientious and focused they were quite frankly on food quality and being conscientious about where they source things from.
[00:20:21] And so obviously, each one of us kind of come to the table with different previous experiences. But irrespective of where we've been, we can always course correct. We always have the ability to change course. And Esther and I are not saying to change everything all at once. We're just saying just be more conscientious so that maybe you change one thing at a time. Maybe it's your deodorant, maybe it's your body moisturizer, maybe you buy organic milk. It could just be one change, but one change has a tremendous amount of impact.
Esther Blum: [00:20:52] Absolutely. Even just switching-- Going to HomeGoods and getting glass containers instead of plastic, life changing or just a glass bottle or a metal yeti cup instead of plastic, life changing, unbelievable.
Cynthia Thurlow: [00:21:08] Yeah. It's amazing how that works. So, one of the things I thought would be fun would be to talk around a subject that comes up a lot in terms of questions that are submitted to the podcast. Everyone wants to talk about using estrogen on our face. And I know that a lot of the heavy hitters in the menopause space have been talking about using vaginal estrogen on their face. It's completely okay to do so. And you mentioned in our email that you've been using estrogen on your face and you feel like it's made a tremendous difference in probably fine lines and wrinkling.
Esther Blum: [00:21:42] Yes. And it's so awesome because, A, it's really affordable. When you look at, you could spend hundreds and hundreds of dollars on really expensive skin care that doesn't necessarily work. But you can also go to rx.com and get your vaginal estrogen filled through there. And it's like $8 to $14 a tube, which is really nice and economical for skincare. And what I do is at night, I take a pea-sized amount. I have a beautiful facial oil that I use and I mix it in with the facial oil and smear it on my face and then moisturizer over that at night. And the moisturizer I use at night, FYI, is beef tallow.
Cynthia Thurlow: [00:22:29] No way. You smell like beef.
Esther Blum: [00:22:32] I don't. It doesn't have a smell. There is carrot oil in there as the base.
Cynthia Thurlow: [00:22:38] Maybe that's what helps.
Esther Blum: [00:22:40] It's creamy, it's moisturizing. I walk outside. It's 14 to 20 degrees out. My skin is not dry or cracked at all. I have no chapping, nothing. It's hydrated all day. So, I really like it. Now, the vaginal estrogen, in full transparency, it's 0.01% and a lot of people will say you need to go up to like 0.03%. So, I will have to have my doctor change my prescription in order to get that high of a dose. But even so, even 0.1% is really helpful. But again, a lot of your skin is from within and I don't drink alcohol, except occasionally on vacation is when I usually drink, but other than that, not so much.
[00:23:31] And hydration-- I don't even drink caffeine right now. And I love doing my infrared saunas and getting in a lot of electrolytes and minerals there. And eating real whole foods as unprocessed as possible, so that really is kind of a guarantee. But the other piece of it is also accepting. I'm not someone who wants to do a lot of filler. I'm not someone who wants to eradicate every single wrinkle on my face. So, part of the deal is like, “Okay, you are going to have some wrinkles and you're not going to like all of them.” And even it was really hard for me to send out our Christmas cards this year because-- our New Year's cards, because I noticed a lot more wrinkles on my face than usual. And I was like, “Oh,” but you know, and I'm like, “No one's going to notice or care. They're going to notice the joy and the fun you were having with your boys. So just shut up and don't talk about it or think about it and move on with your life.”
[00:24:32] It is a gift to be aging. It is a gift to be here. There's people my age are people who should be here and be my age and who are not, they are up in the heavens above, so I'm like, “Really? These are my problems. Like, people have very real problems. People's homes have burned down in California. People's lives have been uprooted. So, like, why am I complaining about a couple wrinkles? Come on.” [laughs] I think in that perspective like--
Cynthia Thurlow: [00:25:03] Well I think it's also human nature. I think that we can be our own worst critics. And I have your card and I thought it was a beautiful photo. But I do understand, like, it's not until I look at photos from 10 years ago, 15 years ago, that I'm like, “Oh, yeah, things have changed over that time period, [Esther laughs] but I'm healthy, I'm happy, I'm doing well.“ And one thing that I looked for last night was that the treatment of skin aging with topical estrogens. There's an article, a research article from 1996 looking at estradiol, which is E2, and estriol, which is E3. So, these two types of estrogens. And it says after treatment for six months, elasticity and firmness of skin had markedly improved and the wrinkle depth and pore size had decreased by 61% to 100% in both groups.
[00:25:50] And it also mentions that on immunohistochemistry, when they're looking at skin biopsies, significant increases of type 3 collagen labeling were combined. So, this is not new, but yet I feel like nearly 30 years later, we're just starting to talk about this, but the research has been there. It just hasn't been something that's been focused on because estrogen is so inexpensive to actually use. You mentioned the costs are pretty minimal-
Esther Blum: [00:26:22] Yes.
Cynthia Thurlow: [00:26:23] - yet, we have a lot of companies that really benefit from us not being aware of what the research is demonstrating. That was research from 1996. Facial estrogen, we could use vaginal estrogen on our face or just facial estrogen. Wrinkle reduction, pore size reduction, skin hydration, you mentioned how hydrated your skin is. Collagen production, skin elasticity and firmness. And I think these are all things that universally women are noticing or changing about their skin, but this is a way to use something that's totally topical and something that can be relatively inexpensive, which I think is really exciting.
Esther Blum: [00:26:57] Yeah. As you mentioned, it doesn't change your serum concentrations. And Maybelline had estrogen in their cosmetics in the 1950s.
Cynthia Thurlow: [00:27:07] Really?
Esther Blum: [00:27:08] It was revolutionary and they stopped for whatever reason back in the day, but there was quite a period where it was in their makeup product.
Cynthia Thurlow: [00:27:20] No way.
Esther Blum: [00:27:21] And so, yeah, you look at how glamorous those movie stars were. They didn't have Botox, they didn't have IG filters, and their skin was stunning, so--
Cynthia Thurlow: [00:27:31] That's amazing. Well, I think people also live differently than they do now.
Esther Blum: [00:27:36] They did.
Cynthia Thurlow: [00:27:38] I think that people ate real food and-
Esther Blum: [00:27:39] Yeah.
Cynthia Thurlow: [00:27:40] -probably we’re more active and certainly didn't have all these electronics to be consumed and obsessed with. Now, when you think about other things that are helpful for facial aging or being proactive without surgical intervention, if there's a way to kind of differentiate that, what are some of the things that you have found to be very effective, topical agents or lasers or microneedling? What have you found to be helpful?
Esther Blum: [00:28:06] I have done a lot. I spent last year doing a lot of microneedling and laser, and I found it gave me somewhat of a collagen boost. But what I'm really working on now, I'm playing with our topical peptides that my esthetician gave to me, because I really want to make sure that again, I'm rejuvenating the collagen underneath. She also recommended a red-light therapy mask, an LED mask, but at a very high concentration. You can't just buy-- not all red lights are created equal.
[00:28:46] Now, again, I'm going to be really transparent and say, have I bought it yet? No, because I honestly don't think I will do it religiously enough. the other thing I'm looking into are like those under eye patches. That I would do. I would just sit and slap that on at night. And I've looked at-- I have had facials with microcurrent, which seriously ladies, it got rid of all my wrinkles, and I was like, “This is what I need.” I've seen these devices. They almost look like a bifocal, like the half readers, but without a lens, and it just delivers like red light and electrical current. So, I need to bring that to my esthetician and say, “What about this? Because I do love the electrical currents to.” Have you tried any of those? I was looking at these at-home devices. There's so many ads where you literally see it lift up your face instantly.
Cynthia Thurlow: [00:29:42] Yeah. So, when I lived in northern Virginia, there was this amazing herbalist and acupuncturist that used to do these acupuncture facials. And she would incorporate Gua sha, she would incorporate microcurrent therapy, she would do red-light therapy, and then she would do acupuncture, and I would fall asleep. It was the most wonderfully relaxing thing ever. Unfortunately, I think she's no longer in business, but because inevitably someone will ask me who I was going to. She's amazing. But I do think that a combination of different modalities. Like, I do have red-light therapy at home, and I've used it more for when I get bug bites. I'm just one of those people that gets--
[00:30:20] We came back from Belize and I stopped counting at 40, I got bit by 40. I don't know, no sedums. I don't know what they were. But I came home and was like, “I look like I've been attacked.” And so, I did two days of getting in front of red-light therapy and they basically look like they are completely gone. Sometimes when you get an insect bite and it stays red for a while. Within two days, it looked 100% better. So, for me I do think there is definitely value from doing red-light therapy. But I'm at the point now where I've got like a larger box. I have a face mask. I just out of just a desire to try something funny that I think higher dose had a hat that you could wear that seriously stimulates hair growth. And I was like, “Oh, I'll try it.” So, I’ve got that, I haven't tried that yet. But I do think red light therapy and mitochondria ATP production can be really beneficial. And so, I think that can be helpful if you think you're actually going to use it, that being the caveat.
[00:31:16] Admittedly, I've done ProFractional almost every year over the last 10 or 15 years and I feel like that always does quite a bit. Although I feel like as I get older the law of diminishing returns, I felt like I’ve got bang for the buck years ago than I do now just because there's less collagen and elastin in my skin. But I haven't delved into the microneedling space, but it's definitely of interest. But I do think vitamin C, vitamin A. I do think peptide therapies can all be very helpful.
[00:31:48] And it's interesting I kind of got away from Retin-A, but you know after consulting with several friends of mine that are physicians, I was like, “You know, it's inexpensive, it's relatively easy, it helps with collagen elastin formulation. And I have seen some significant improvements. Although I have to figure out how to-- It's like, do I do the vitamin A first and then the estrogen? I'm not sure. I have to figure out the timing of everything, but I do think all of--
Esther Blum: [00:32:12] You can layer it. You can stack it for sure.
Cynthia Thurlow: [00:32:15] Yeah, it's like figuring out how to do it all. But I also think things like specific supplementation like collagen peptides-
Esther Blum: [00:32:23] Collagen.
Cynthia Thurlow: [00:32:24] -in particular I think that I will take forever just because it's easy, effortless. I think it really helps my nails in particular, but I do think it's helpful for hair. I think I see bigger improvements there. I actually had someone I was so proud. I was getting my hair done and someone said, “Oh, do you have extensions?” And I was like, “No, but thank you for asking.” [Esther laughs] As a middle-aged woman, I was like, “Yes, that's an awesome compliment.”
Esther Blum: [00:32:49] It is. And yes, and omega is too you know essential oils are so important. Primrose and omega-3s really do wonders for hair, skin, and nails too. And just that healthy glow. To me, I always want to look hydrated. I don't mind looking a little shiny if possible because it's just your radiant at that point. It's so beautiful. And like wild Alaskan salmon, I mean, years and years ago I worked with Dr. Perricone at his spa. I was the nutrition director there. And his three-day diet, OMG, it is so incredible. It's just three days of-- It's an anti-inflammatory diet. It's salmon, berries, cantaloupe, little avocado, just fresh whole foods that are fatty and rich in omega-3 fats. That to me is such an incredible transformation what happens when you do that kind of diet.
Cynthia Thurlow: [00:33:51] Is he still around?
Esther Blum: [00:33:54] He is. He sold his company a long ago, he sold it, but back in the day, I mean, man, I remember his neuropeptide, his contour cream and you could put it on half your face and it was like an instant facelift compared to the other side. Brilliant, brilliant scientist, an amazing man. They weren't as clean as I wanted them to be to be honest, but he had some oils and he also sold astaxanthin and DMAE, which are both in wild Alaskan salmon, so both of them. Astaxanthin, it's the red algae that give flamingos and salmon their wild pink color. Like farmed salmon is chemically dyed, but real salmon is orange and it's an internal antioxidant. And DMAE, dimethylaminoethanol that really stimulates the neurotransmitters under the skin so it really gives you that contour boost. We look old when we lose collagen and sag. So really getting that nice gentle lift makes a big difference.
Cynthia Thurlow: [00:35:07] So interesting. See, I learned different things about you every time I interview you. I had no idea that you worked with him. What are some of the other foods that you think of that are so beneficial for skin health when you're working with your patients?
Esther Blum: [00:35:21] Bone broth and collagen. Again, it's not the processed collagen per se, but like real bone broth is amazing and I love to-- People are going to be horrified, but I get chicken feet because they're so-- It becomes this like meat jello. Yeah, I throw chicken feet in a slow cooker with dill, a little lemon, some salt, carrots and onions. And I put it on low for 19 hours and then let it cool, put it in mason jars and it's liquid gold. A, it's immune boosting, but it's very gut healing. And most of us have some level of inflammation in the gut for a thousand reasons, hormones, stress, environmental.
[00:36:07] And then it also again is great for hair, skin and nails, so I do love bone broth. If chicken feet gross you out, you can get narrow bones or neck and knuckle bones of the cows. Again, you throw them in a slow cooker. I wouldn't-- In that I will do just onions, carrots, celery, salt, and parsley, but I won't do lemon. And you could put-- What I like to do also is put a little apple cider vinegar over the bones and let it sit for a few-- To really start, you need an acid to help pull collagen off the bones into the broth. So that's some of my favorite foods.
[00:36:47] Again, I love fresh fruits and vegetables. I love pineapples, papaya because their digestive force is incredible. I love pomegranate and wild cherry and even like some cherry juice concentrate for sleep. But it's just which is also really important for your skin is sleep. But all of those help prevent, E. Coli and H. Pylori from sticking to the bladder wall and the gut wall, respectively. And certainly, greens, dark green leafy vegetables. And this is why, I'm going to just interject like, I know people like the carnivore diet, but I'm telling you, we do need those plants and antioxidants to really fuel the bacteria in our gut. Your skin is your gut turned inside out. So, I do also a lot of flaxseeds and chia seeds. I do that almost daily. It's really easy to eat. You just put it in a smoothie or a little cod cheese or yogurt and just make a pudding. It's super-duper easy. So, I think all of those.
[00:37:55] And again, you'll notice all of these are just real food. I'm not talking about, pretzels, Doritos and sugar. Sugar is really the enemy for skin. Sugar and too much caffeine and smoking. Smoking depletes your collagen. It pulls vitamin C right out. And you know, sugar is very inflammatory. It causes glycation, which really causes the sugar molecules to adhere to collagen. It's not so beneficial for your skin. That's like wrinkle city right there. So, if you want to really transform your skin. Sweet potatoes also, anything that's very nutrient dense, organ meats, you will see me regularly posting my rabbit liver or chicken liver.
Cynthia Thurlow: [00:38:39] Impressive.
Esther Blum: [00:38:41] And people are like, “No freaking way.” But I live for that stuff. I love it. Yeah.
Cynthia Thurlow: [00:38:47] What do you typically think are some of the greatest challenges that women in perimenopause and menopause have with regard to nutrition? Is it they're not eating enough? Is it that they don't eat enough protein? Is it they're still fixated on. Well, we all know everyone. It's not unique to middle-aged women. We as a society are fixated on the scale. What do you see as some of the unique challenges in dealing with women at this population?
Esther Blum: [00:39:15] It's trouble meeting. It's an embarrassment of riches really, when they see how much they can eat and they see how much they're not eating. So, protein and fiber are the top two nutrients that women are not getting. And we need protein to build muscle. We need protein to support bone density, cognitive function, prevent type 3 Alzheimer's, give us energy, boost our serotonin and dopamine, regulate our blood sugar. So, this is not news to your audience. But also, fiber is really important because that microbiome takes such a nasty hit in midlife because without enough progesterone, which is a motility agent, and enough estrogen and to a small degree, testosterone, our whole microbiome changes. We lose that gorgeous mucous lining of the small intestine. It directly impairs our motility. So, we're not pooping out our estrogen daily as we should be. It impairs our digestive force. It impairs our ability to produce enough stomach acid to break down all that protein we need to eat. And then it also impairs our ability to absorb nutrients.
[00:40:39] So, “When a woman says to me, I've lost my taste for red meat, I can't eat it. I feel so bloated, I don't digest it well.” I can tell you without looking at her test that she is severely deficient in digestive enzymes and she is probably deficient in her commensal or keystone bacteria. So those nutrients alone can be a game changer. And for some women, we add in a fiber supplement, something that's very fodmap friendly, like a Guar gum is really good. But certainly, even starting with flax and chia seeds is really good. And we can also tell if you start adding in fiber and you blow up like a balloon, go very slowly, it's a really clear sign that you are deficient in your healthy bacteria, because healthy bacteria do need fiber to populate, to proliferate and really optimize your population in your gut.
[00:41:40] So, the third thing, the macronutrient we want to talk about is really caloric intake. It's calorie as a whole. Most women come to me eating 900, a 1000 calories per day. They've dieted themselves down to the point where they have dysfunctional thyroid. You need enough carbs to convert T4 to T3, but you also need enough calories to run. So, the adrenals also are flatlined, the cortisol curve is flatlined. And then women have insomnia, which perpetuates that, and they're working out hard.
[00:42:17] A client I saw yesterday, she runs 6.5 miles four days a week, she lifts three days a week, she swims, she is a personal trainer, she walks. Beautifully active, beautifully, but her cortisol, she is on the verge of complete shutdown and burnout. And her gut, even though she was asymptomatic, was an absolute situation of severely high calprotectin to the point where we have to send her back to her gastroenterologist. Like, so much inflammation going on. And surprisingly, she feels wonderful. But when we looked at her diet, we were like, “My gosh, like she's barely eating. She probably needs another 500 calories a day just to fuel her muscles.” And she was a healthy weight, but metabolically she was not. And her insulin was very, very high. So, we can look beautiful on the outside, but we do need to really be mindful of not undereating, of not underfeeding and under nourishing ourselves, because it will come and it will bite you, I promise.
Cynthia Thurlow: [00:43:34] From personal experience in just working with thousands and thousands of women that we have gotten women conditioned to believe that they just need to eat as little as possible, they need to exercise really, really hard and they need to overfast. And I'm here to tell you that that is setting you up for disaster. Like the patient that you described is that super type A, disconnected from their body, doesn't acknowledge that they're under fueling, is chronically tired, doesn't acknowledge it. Those are the types of people that end up getting sick because they have no bodily awareness and it's incredibly unfortunate.
[00:44:15] I think that in some instances when I'm working with women and they just have a complete lack of ability to be connected to their bodies, it can be a sign of other things that are ongoing whether it's like chronic trauma or trauma response, that's their way of like working away from uncomfortable feelings. And I say this as lovingly as possible, whether you're an over exerciser, you're an over worker, the type of people that are very achievement oriented, in many instances, there's a whole lot more going on beneath the surface.
Esther Blum: [00:44:49] Amen. And so, ladies don't be afraid to actually listen to your body. And if your body's hungry and wants a snack, it's okay to have a snack. It will actually help you meet your macronutrients. You can grab some beef jerky, you can throw some collagen or protein powder in a glass of nut milk or even just mix with some water and flax and just shoot it back, get an apple with some nut butter. I mean, whoo, these are life. [laughs]
Cynthia Thurlow: [00:45:23] Life changing.
Esther Blum: [00:45:25] Life changing. And your energy and your mood and I admire people who fast for hours and days on end. That has never been-- Me personally it works for some of my clients, but I know my body. And the greatest gift I had was a practitioner who had such incredibly great bio-chem, chops. And he said to me, he said, “Your genetics are such that you will always need a good deal of carbs.” And that's just how my body runs. Even though, you know, for all intents and purposes, I should not be eating the level of carbs I eat midlife. But according to the books, according to the papers, but in real life works for me. And I actually have to measure out my carbs to make sure I'm eating enough because I know when I'm not sleeping. Even my husband said to me, he's like, “Did you eat enough carbs yesterday?” I'm like, “I don't think I did.” And then I'll like start tracking my food to make sure I do, because I always think I'm eating more than I'm actually eating. So that's the other thing I would say is if you don't believe me, don't take my word for it that you're undereating, track. There're so many free apps. MyFitnessPal is a great one. Like just go track or [unintelligible 00:46:37] track what you're eating for three days, you will be shocked. You are probably not eating the amount you think you are.
Cynthia Thurlow: [00:46:45] So out of curiosity. So, when we talk about carbs and I think carbs have kind of been bastardized over the last five or ten years, [Esther laughs] in all honesty, and I think it's very much the power of the individual. How metabolically healthy are you? How active are you when you're talking about you eat more carbs than most people do in middle age? Like, roughly how many grams of carbohydrate are you consuming a day?
Esther Blum: [00:47:10] My goal is always around 160 to 170, and 30 of that is from fiber.
Cynthia Thurlow: [00:47:17] Okay. I mean, that is a good amount. I think that's probably-- I have a bodybuilder kiddo, and so he tracks his protein and carbohydrate intake and he's up around 200 g of carbs as a 17-year-old. But this is the beauty of the N of 1. For me, I probably 75, 80 is probably a lot for me, but I do well there. But I think a 100 would probably be high for me, but that's what makes my body feel good. But I would never be under 30 g. That would be too restrictive for me personally. But I've had patients who don't do well on more than 50 g of carbohydrate a day. So, I think it's very individual.
[00:47:59] And again, if you're physically active, metabolically healthy, you have a bit more wiggle room, [unintelligible 00:48:04] you have on your body, the more wiggle room you're going to have with carbohydrates. But ultimately it always comes back to you as an individual. And Esther's a really good example of this because, I'm like, “Hey, if that works for you, awesome.”
Esther Blum: [00:48:19] Yeah. And believe me, I track. My insulin is like in the 2s. My sugars are in the low 80s and after my walks, they're in the high 70s and my A1c is great. So, I'm always like, “Shoot, is this the year I'm going to have to cut back on carbs?” but knock wood so far, so good, but I am. In probably February, I'll do my blood sugar tracking again once my hormone tests are back because I just want to make sure that I'm within-- The guardrails are up. I'm careful.
[00:48:54] But, when you're lifting too, your son is really a lifter. My son's a lifter too. Like, if I don't have enough carbs, I can't fuel my workouts the same way either. And it was so fun when I worked with a macro coach. She was like, honey and rice cakes before your workouts. And I was like, “Yes, that is like the best thing you could ever tell me.” It made me so happy. But I had much better workouts. But again, other people are like, no protein all the way and fiber and like, that's it, don't mess with my blood sugar, the insulin wrecks me, so it is, it’s so individual.
Cynthia Thurlow: [00:49:33] Well, and I can tell if I've had too much carbohydrate. I generally, I'm always gluten free. I'm generally grain free. But if I'm out to dinner and some rice is on my plate, I'm not going to have a problem with it. And for me, I think it's more portion mediated, like, I can get away with some grains, but if I sat down and ate two cups of rice like my teenagers can do, that would be different. That for me personally would-- I probably would sweat, my heart rate would go up. That's usually my tell. That's my tell if I've had too much carbohydrates, so I just kind of, I generally don't experience that, and I don't get hot flashes, thank God. But having said that, I think that for each one of us, it's a little bit like our own science experiment.
[00:50:12] Now, Esther, you had mentioned to me that you had started having more symptomatology related to this perimenopause and menopause transition. And so, I'd love for you to share with listeners what has been going on. I know you and Dr. Fenske, who's been a guest on the podcast, have been working together to kind of MacGyver fine tune this all. So, what has been going on for you?
Esther Blum: [00:50:36] Yeah, well, I'm 54 now and I still do get cycles. I'm not--
Cynthia Thurlow: [00:50:41] Amazing.
Esther Blum: [00:50:42] not [unintelligible [00:50:42], but they're not regular by any means. I still have months where I get cramps, which is so not fun. But no cycle, just raging, raging cramps. I'm like, really --
Cynthia Thurlow: [00:50:58] Like, I'm ready. I'm ready for this to be over.
Esther Blum: [00:51:00] Girl, I'm going to fill my menstrual cup with confetti and have a freaking pinata party when this is all done, okay? I am, like, so over it. So, yes. And, you know, a couple weeks ago, it was really windy out, and it was garbage day, and our trash. We put our trash and recycling out. And I came back from my walk and it all over the driveway. Soup cans, boxes from air pods, whatever was in our garbage and recycling. It's out for the whole world to see. And so, I'm laughing hysterically. And I come inside and I'm telling my husband. I'm like, “Ha-ha. The garbage was all over.” He's like, “Why is that funny?” And I immediately burst into tears, like, sobbing.
[00:51:50] And I started sobbing because I was getting two to four hours broken sleep a night, waking up hot, heart pounding. And this is with my six miles of walking a day, this is with my eating carbohydrates, this is taking cherry juice and 15 pills at night, plus hormones, and I'm still not sleeping. I was like, “What?” So, I reach out to Suzanne Fenske, and I'm like, “I am psychotic right now. Something is wrong with me.” Even though we know all that we know, it's really hard to apply the rules to yourself and have this objectivity. You need a third party. She was like, “Girl, it's time to bump up your hormones. It's okay. I'm bumping up mine too.” And within 12 hours, she was like, “I called in your prescription.” I got my patch an hour later. Within 12 hours, my mood was completely level and I completely started sleeping through the night all over again.
[00:52:53] I say this to make you laugh because we're all in this together. None of us are immune. Just because we have all this knowledge doesn't mean our bodies don't have the symptoms. And my mom had a hysterectomy. She had an enormous like grapefruit size fibroid on her uterus. And her doctor had a hysterectomy. How old I was? I was 18. So, she was 48. So, she had her hysterectomy. So, I had no idea what her menopause trajectory would have otherwise looked like, but she never got the cramps I get. And castor oil helps me, but I stopped castor oil a long time ago because my periods aren't regular anymore. So then when the cramps come on, they're vicious. And it's always my left ovary. My left ovary, I've got a lot of profane curses for my left ovary, [laughs] but as my mother would say, I have two words for you, and they're not happy birthday. [laughs]
Cynthia Thurlow: [00:53:57] I love that. I love that.
Esther Blum: [00:53:59] So I'm here going through it too. Menopause is easy, comparatively, in terms of you're going to still have your symptoms. I'm not gaslighting anyone or making light of it. But your hormones are stable, so you go on your hormones, you titrate up your dose, and you're pretty good versus chasing, it's like herding cats. Perimenopause is like herding cats and it's much harder. There's a thousand variables at play. Your body is going through tremendous physiologic and emotional changes. I definitely have put on about three to four pounds, and it's just not budging right now. And I'm like, “It's okay. You're going to be okay. This is temporary. You're going to figure it out.” But I'm just letting my body-- I'm doing as much as I can, and I'm going to really get more into weightlifting a bit more consistently. I haven't been as consistent with this horrible lack of sleep. So, well, transparent with y'all.
Cynthia Thurlow: [00:55:05] Well, and you have to if you're not getting the sleep, you've got to focus on why you're not getting the sleep. So, what did she bump your estrogen patch to?
Esther Blum: [00:55:13] So now I am at 0.1 mg of estrogen, I'm on 250 mg of sustained release progesterone, and I'm on 1.5 mg of topical testosterone cream, and I take 10 mg of pregnenolone. I've tried bumping up and gotten a wicked hangover. And then I am also on DHEA, I take 25 mg in the morning.
Cynthia Thurlow: [00:55:43] Okay. It's interesting to hear because pregnenolone, for me, gives me a horrible headache, so I'm down to 3 mg a day. I could not tolerate and it gave me chronic headaches. And so pregnenolone is a very important hormone for memory. And so, for anyone that's listening, I think getting this tested is critically important. You want your levels to be above 50 mg/dL. That's what you're aiming for. And so, for me, the greatest challenge I personally have had is tolerating the pregnenolone because it gives me horrific headaches. I tolerate everything else though. Having said that, what was your patch on before they bumped you up? Were you half that dose?
Esther Blum: [00:56:21] It was at 0.075.
Cynthia Thurlow: [00:56:23] Okay, so just a little bit more.
Esther Blum: [00:56:25] Just a little bit more, but it's enough to make the difference. And again, I just redid my DUTCH. It'll come back in about two weeks. And we rechecked my blood, but again, we rechecked just to show you. We just did my blood, I would say, in November, and my hormone levels looked fantastic then. And then all of a sudden, when I can tell when my hormones are dropping because I feel like I've fallen off a cliff, I have crushing fatigue, horrible brain fog. I feel like I'm getting the flu, but I don't have any immune symptoms. I just feel absolutely awful, like I'm dying, and I'm like, “My hormones are dropping. I know it.” Did you feel that when your hormones were dropping? Did you know--
Cynthia Thurlow: [00:57:16] So, this is something that's interesting. And talking to different experts on the podcast, I think there are people who are just more sensitive to the changes, meaning they're more symptomatic. Because for me, it's like I got shoved off a cliff. You know, when I was hospitalized, I lost 15 pounds and that was it. I didn't have another period. So, December of 2018 was my last cycle because then I was hospitalized two months later. So, for me, it was like a precipitous shove off the cliff. And I do think perimenopause, for me personally, was much more symptomatic. But I didn't realize my perimenopausal journey was going to be shoved off a cliff. I think that I probably would've had a couple more years before I transitioned, but I think that for every individual, that's why there's over a hundred symptoms that women will experience. It is as unique as we are and there's not a right or wrong, but there absolutely needs to be the degree of support like you have with Dr. Fenske.
[00:58:10] You acknowledged something wasn't right, something had changed. And I do think there are some people who are just more sensitive to those subtle changes. And so, I think that's probably-- what's unique about you is that you were just attuned to how you felt. And instead of suffering for months on end, which is what I think a lot of women do because they're like, “Oh, it's going to get better. My sleep's going to get better. I'm not going to be so irritable.” One thing that I think is interesting is estrogen is so intricately involved with two neurotransmitters, serotonin and dopamine that can impact irritability, can impact mood, impact so many things, impacts appetite. And so, when estrogen starts really plummeting, like, I do think estrogen is high, high, high, the [unintelligible [00:59:02] perimenopause, and then it drops off that cliff. I think for some people, it really is a marked and dramatic shift.
Esther Blum: [00:59:02] Amen. I know. My poor husband he's like, “Oh, my God, I'm sorry. Like, what did I say?” And I was like, “It's not you, it's my hormones. We try.”
Cynthia Thurlow: [00:59:13] Oh, quite a good guy.
Esther Blum: [00:59:14] We try so hard to hold it together. And listen, I am treating people in my clinic, like, I got to bring my A game on, but listen, the good news is I learn how to treat people better the more I go through. But I'm like, “Okay, God, I think you've taught me enough. I'm good. Can we do this now?” [laughs]
Cynthia Thurlow: [00:59:38] Yeah, I can share my story and people can relate to this and understand. I always tell people like that probably beginning part of perimenopause for me was so rocky. That's what got me very interested in pivoting within my career. And so, I think it can be really impactful. Let's kind of wrap up the conversation today talking about testosterone. It's interesting when I was looking at stats, over the past decade testosterone prescriptions have increased by almost 50% in the US alone, but yet it's still not FDA approved for women, which I think is criminal.
Esther Blum: [01:00:09] It's criminal. And I heard a depressing statistic from our girl Kelly Casperson, where somebody said, “How long do you think it's going to take before women are regularly prescribed testosterone?” She was like, “At least another two to three years.” I was like, “Oh, dear Lord.” I treat a surgeon in my practice who went to her doctor. Her blood level of testosterone, it was either 3 or 5 . Ladies, you can really go much higher than your testosterone. I really like to see at least 40 to 60, at least. And we did her DUTCH, and DUTCH is less indicative of testosterone, but all of her other androgens were low.
[01:00:50] So, she goes to her doctor and her doctor said, “I don't even know what women need testosterone for anyway.” I was like, “You have got to be kidding me.” So, I sent her a long list of research articles about testosterone in women. But, it's the predominant hormone in a woman's body prior to perimenopause, and yet women are not prescribed it. It is maddening, it's offensive, it's egregious, it's neglectful. And the shame of it is just how dramatic of an impact it has on mood, on that get up and go energy to some degree body composition. But let's be clear ladies, we're on a microdose. We're not Michael Phelps here or Arnold Schwarzenegger. We're using it topically. But even that microdose can have a profound effect on how we feel. And so, it's really imperative.
[01:01:50] Sadly, it's going to be grassroots. It's going to be enough doctors getting together at their conferences and saying “With all these ladies asking for testosterone, maybe we should do some research around that. Maybe we should get it in medical school curriculums.” It doesn't make sense that it is not FDA approved for women. And the only thing I can make sense of is there has been rampant abuse of testosterone in the industry. And that is really from an injectable place. You see a lot of bodybuilders. I mean, my son, I'm sure yours do too. There's like no shortage of young bodybuilders. There's these influencers called The Tren Twins. Have you heard of these guys?
Cynthia Thurlow: [01:02:37] I have heard of them.
Esther Blum: [01:02:38] Yeah. And one of them already tore his pecs, already has connective tissue issues, and had surgery. And then his doctor said, “No lifting for a year,” and the schmuck is already lifting again. And I'm like, “Well, then you deserve it.” And, it's like, there is so much abuse in the industry, but I can tell you it's not women, [laughs] [say for a few bodybuilders, it's really not women abusing, the testosterone, so can we just get our ladies a tiny microdose to give you a perspective of my dose of 1.5 mg, men, it's easily like a packet of Metro gel is 10 mg right to stop.
Cynthia Thurlow: [01:03:22] I usually get a tenth of the dose.
Esther Blum: [01:03:22] Yeah, we get a tenth of that. So, the other egregious thing is that, you know, if we do want to get testosterone covered under insurance, we are given the men's packet, okay? It's like the size of like a mayonnaise or a ketchup packet. And then we're supposed to figure out what a tenth of that dose is and put that on ourselves. There's no standardization. It's not in a syringe where we can measure and cap it off. It's like, come on, guys, this is so offensive versus, like a compounded cream. It's one pump or one click and you're done. And it's standardized care. And so, it's funny a lot of shade is thrown at compounding pharmacies except for testosterone. Have you noticed that?
Cynthia Thurlow: [01:04:13] Yes, it's very arbitrary. And I think it's really unfortunate because I think most compounding pharmacies do a really beautiful job. They're providing a service that's absolutely needed. I have some compounded hormone replacement therapy, and I have some conventional, like, I'm on an estrogen patch that works well for me. It actually works better than compounded estrogen was. Obviously, I have compounded testosterone. I've compounded thyroid medicine because there's no conventional dose that could match what I needed. And I take low-dose naltrexone that's compounded, although that freaks everyone out. If you ever need to have surgery and you tell an anesthesiologist you're on low-dose naltrexone, they think you're an addict. I'm like, “No, no.” Emphasis on low dose, I have an autoimmune condition that's why I take it.” They're like, “Oh. It's fascinating.”
Esther Blum: [01:05:02] That's another great tool. Oh, my God. LDN is just-- What do you personally notice on LDN? Does it keep your biomarkers? How has it benefited you?
Cynthia Thurlow: [01:05:13] Yeah, it's interesting because Aaron Hartman is my primary and he said, “Cynthia, I'll be honest with you. We don't 100% understand how it works. We think we have an idea, and I can't predict in who it's going to work. So, if it's going to work.” And so, for me, we were struggling to get my thyroid optimized and it was like we were literally making dosage adjustments every two weeks for like two months. I'm not kidding. And so, when I got put on low-dose naltrexone, my thyroid numbers finally fell into therapeutic range. That was number one. It wasn't like I had pain or discomfort or insomnia, but I had no side effects. We just did a really, really slow increase in taper. And so, for me, it's been more like my thyroid is happy.
[01:05:59] And it was literally two and a half years of my thyroid not being optimized and had nothing to do with fasting. People always ask me that. I was like, “No, it was like I went from a drug that was no longer created to trying Synthroid to trying Cytomel. I had one functional medicine practice that had me up to 15 mg of Cytomel.” They just kept increasing, increasing, increasing. And I kept saying, “I don't think it's that I don't have enough T3. I think there's actually like a conversion issue. There's something that's not working properly.” And so, then I went to a new person and he figured it out.
Esther Blum: [01:06:33] Thank God. That's beautiful. What an awesome outcome.
Cynthia Thurlow: [01:06:38] Yeah, yeah. So low-dose naltrexone works for some, but not all. But we think there's this immune regulatory autoimmune suppression component that goes on. And so, for a lot of us with autoimmune conditions, it's been a blessing. And I tell people all the time, I think for many of us, like, once you have one autoimmune condition, you're prone to others. And I just think that in many instances it can be a blessing. And so that's how I look at it. I take one pill a day and I take that and my thyroid and then I take my other hormones and I'm all good.
Esther Blum: [01:07:10] Gorgeous. Absolutely gorgeous.
Cynthia Thurlow: [01:07:12] Well, Esther, I know that you have some resources that are available to people that want to be able to advocate with their providers about hormone replacement therapy. Please let listeners know how to connect with you on social media. You must follow Esther. She's so funny, so knowledgeable, and then she obviously also has these resources available.
Esther Blum: [01:07:31] Thank you. Yes, on Instagram at The Tren twins. And if you go to my website, you can certainly receive my newsletters, which come out weekly. But if you go to estherblum.com forward/trainings, I have six beautiful trainings. I have recordings of a live event I did for World Menopause Day where I interviewed, I call them my menoqueens, incredible women giving out information on menopause. I have five-part miniseries on how to make menopause your bitch. I have recipes. So, I really have a lot of fantastic resources there that are absolutely free. And you know, feel free to shoot me a DM over Instagram if you want to get in touch or reach out to my team. We're here to support you.
Cynthia Thurlow: [01:08:21] Thanks as always my friend.
Esther Blum: [01:08:24] Thank you.
Cynthia Thurlow: [01:08:27] If you love this podcast episode, please leave a rating in review, subscribe and tell a friend.
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