How to Balance Hormones for Healthy Aging: Naturally vs. HRT

How to Balance Hormones for Healthy Aging: Naturally vs. HRT
Dr. Lorraine Maita, MD

In this episode

In this long-awaited episode, we spoke with Dr. Lorraine Maita, MD, a functional medicine doctor who specializes in anti-aging medicine and hormonal health in men and women.

Dr. Maita shared shocking facts about the dramatic effect age-related hormone imbalances can have on our physical health, emotional wellness, and relationships, and how to balance hormones naturally with a healthy lifestyle.

Some of the main topics we discussed include:

Surprising signs and symptoms of hormone imbalance many people are unaware of
How to balance hormones naturally with healthy lifestyle habits, foods, and supplements
Some of the leading causes of age-related hormone imbalances
Common mistakes and pitfalls of hormone replacement therapy (HRT)

Also, in this episode:

Dr. Patti Shelton, MD, LongevIQ medical communications officer
Amir Ginsberg, LongevIQ founder.

Once you figure out the underlying cause and what levers to turn, you can turn this around without having to manipulate hormones or give hormones. That’s the beauty of the body. You take away what’s impairing it, and you give it what it needs. It’s a beautiful instrument.

Main topic

(0:01:14) Why are hormones so significant for anti-aging?
(0:01:56) Sex hormones and aging
(0:02:36) Symptoms of hormone decline in women
(0:04:00) Symptoms of hormone decline in men
(0:05:13) Cortisol and aging
(0:06:27) How managing cortisol and stress can balance other hormones
(0:11:13) Balance hormones in two weeks with detox and elimination diet
(0:14:26) Midlife crisis and hormonal imbalances in men and women
(0:16:38) Hormone balance supplements
(0:18:39) Testosterone supplements for men
(0:19:53) The best exercise to balance hormones
(0:23:25) Common vitamins, minerals, and nutritional deficiencies
(0:24:46) The effects of intermittent fasting on hormone balance
(0:27:11) Supplements to balance hormones in women
(0:31:39) Testosterone, estrogen, and DHEA in men and women
(0:35:50) Lifestyle basics to balance hormones
(0:41:49) Vitamin K2 and vitamin D3: testing and dosage
(0:43:58) Hormone replacement therapy (HRT): benefits vs. risks
(0:50:52) Bioidentical hormones vs. synthetic
(0:55:33) Risks of DHEA supplements and DIY HRT
(0:58:07) Once you start testosterone therapy can you stop?
(0:59:35) Testosterone replacement therapy and its role in aging
(1:01:45) Low testosterone in young males – therapy options

Transcript

This podcast episode was edited to improve readability.

Dr. Patti (00:00:00): This is Dr. Patti Shelton, and you are listening to the LongevIQ podcast. We discuss anti-aging and longevity science and how to benefit from it so we can all live long, healthy, happy lives.

Just before we get started, a quick medical disclaimer, this podcast is for informational purposes only. It is not intended to diagnose, treat, cure, or prevent any disease or to provide or replace medical advice. Please use this information to educate yourself as much as possible and share this information with a qualified health practitioner that you trust.

In this episode, we are gonna talk about hormones, how they affect our aging process and how we could balance them naturally.

Our guest in this episode is Dr. Lorraine Maita, MD, a functional medicine doctor expert in anti-aging medicine and hormonal health in men and women. Joining with us as always is Amir Ginsberg, the founder of LongevIQ.

Dr. Maita, such a pleasure having you here. Thanks for joining us.

Dr. Maita: It’s such a pleasure to be here. I think we really need to get the word out. Hormones seem to be scary to some people, but it’s part of our normal process, and you can’t live without them.

Why are hormones so significant for anti-aging?

Dr. Patti (0:01:14): Yeah, that’s a perfect place to start. Let’s talk in general about the role that hormones play in the aging process. Why are hormones so significant for anti-aging?

Dr. Maita: Well, some hormones build you up. Other hormones break you down. And what happens as we age – the ones that build you up go down. The ones that break you down go up. So trying to restore balance is really important to slow the aging process because we are gonna age, but it doesn’t have to be fast or a process of suffering.

Dr. Patti: Beautiful message. Let’s just touch on maybe some of the specific hormones that are important for aging. And I know that there are too many to fully cover everything in one podcast episode, but kind of what are maybe the most significant ones you’d like to talk about?

Sex hormones and aging

Dr. Maita (0:01:56): The ones I’d like to talk about today because they’re all interchangeable. (* They all can convert into each other) are sex hormones: estrogen, progesterone, testosterone, and DHEA. There are a lot of other hormones that have a lot to do with aging, but it would be impossible to get through the whole podcast on all of them. So these seem to be the ones that go down as you age, except for cortisol, which goes up as you age.

Dr. Patti: Ah, okay. So talk about that. Maybe it’s different for men and women. So if you’d like to talk individually for men and for women, but what, what naturally would tend to happen as we age to some of these hormone levels?

Symptoms of hormone decline in women

Dr. Maita (0:02:36): Women have maybe 10 years before they get to menopause where they don’t feel like themselves, they get anxious and irritable, get breast cysts, they get ovarian cysts, and they bleed heavily. Their periods are irregular. What they tell me is that they feel like a hot mess. They feel like a hot mess, and they have PMs type symptoms. And that could go on for about 10 years. And usually somewhere, and between 45 and 55, that happens. But for some people, it happens earlier. Then as they progress and get close to menopause – that’s when progesterone drops first, and then estrogen drops. And that’s when they get the symptoms of menopause: hot flashes, night sweats, dry eyes, dry skin, dry vagina, and lack of sex drive. But even hormone imbalances cause the lack of sex drive, and they don’t feel good.

Dr. Maita: Many women lack testosterone. And when the testosterone goes low, they lack self-confidence. They lack self-esteem, and they’re very sensitive. Things that never bothered them before bother them now. And their libido goes into reverse, and they just don’t feel good. So those are the main things that happen. And a lot of these are controlled by cortisol. So managing the cortisol helps manage the other things even without having to take hormones.

Symptoms of hormone decline in men

Dr. Maita(0:04:00): For men, it’s not as obvious as for women. There is a very gradual decline when testosterone declines in a man. Now they have some estrogen. If they convert their testosterone to estrogen, this is when they get the man’s boobs and the big belly, and they feel malaise. It’s sort of that grumpy man syndrome. They could feel that way with low testosterone where they don’t have the energy, the strength, the endurance, or the vigor, but in many men, if they’re overweight, if they lack zinc, if they drink too much alcohol, the fat cells are going to turn any testosterone into estrogen, and they’re not gonna feel good.

Dr. Maita: So that’s a big issue for men. And what I used to see is when men came to me on hormone replacement, and they saw other doctors, and they just kept increasing their testosterone and just felt worse and worse. It’s because they didn’t look at what the testosterone was turning into. Now with all of these, you have to look for the underlying cause. Like, why are these things happening? I mean, there are a lot of other symptoms, but these are the main symptoms.

Cortisol and aging

Dr. Maita (0:05:13): Cortisol seems to be one of the major hormones. They call it the major ager. When you’re under stress, it goes high. And I used to joke around, but it was so true. Women and men as well said they feel fat, flabby, flaky, foggy, fatigued, forgetful, and frumpy.

Dr. Maita: They really don’t feel good. And they get all this weight around the belly. And as stress is sustained, the cortisol goes down. And when cortisol is too low, that’s where you get fibromyalgia, chronic fatigue, muscle aches, pains, salt craving lightheaded, low blood pressure, low libido, and poor memory. They get infections all the time. And this puts people at risk of autoimmune disorders, as well as cancer. It’s not adrenal fatigue. That’s a term where it’s outlived its usefulness. What happens is the brain is really what’s controlling the adrenals. The adrenals don’t fatigue. Your brain just said, look, you’ve been flooding me with cortisol for so long. I’m not listening anymore. And it turns off. So it turns off the controls, cortisol drops, and then, the other hormones follow suit.

How managing cortisol and stress can balance other hormones

Dr. Maita (0:06:27): So I found that managing the cortisol can manage all those other hormones. If you catch that early, you can still feel good. Even if your other hormones are changing because you have better balance.

Dr. Patti: So it sounds like what you’re saying is cortisol suppresses the secretion of testosterone, estrogen progesterone, and it will tend to drive those levels lower.

Dr. Maita: Yes.

Dr. Patti: Yes. And even though naturally they’ll decline anyway, with more cortisol, that will just happen more quickly or earlier.

Dr. Maita: Yes. Most men who come to me want the hormones. So they come because they want the hormones. But I had some that said, look, I don’t really wanna be on hormones. What do we do? I see high cortisol. We treat the cortisol. Testosterone comes right up. I just had one last week. And I said you know what? You don’t need to be on testosterone anymore. So he said, well, why would that happen? And I said, well, are you still working? He said, no, I just retired. I said, there’s your answer. Your cortisol went down, and now your testosterone is up, and you’re back to normal. And, and he was retirement age. So it can be good at any age.

Dr. Patti: So his testosterone actually went to normal. Yeah, just because of the lack of stress. That’s beautiful.

Dr. Maita: Yes. And I had others where once I lowered the cortisol with herbs and lifestyle and stress management and finding the underlying cause of any type of stress, then the hormones bounced back. And I look for the underlying cause, and I brought in the term stress. Stress could be physical. It could be mental. It could be toxic. It could be a hormone imbalance. It could be infection, inflammation, food, reactions, nutritional deficiencies, or lack of sleep. And another big mistake that men and women make is overdoing. Overdoing exercise and overdoing different foods, eating or alcohol, those types of things. Once you figure out what the levers are to turn, you can turn this around without having to manipulate hormones or give hormones. That’s the beauty of the body. You take away what’s impairing it, and you give it what it needs. It’s, it’s a beautiful instrument.

Dr. Patti: What would be the process if somebody has potentially high cortisol and then low sex hormones? What would be the process for looking for those stressors and how often do people maybe need supplements or something to help versus just shifting various other things?

Dr. Maita: Well, when it comes to cortisol, it depends. That’s driven mostly by lifestyle. So you wanna make sure they’re sleeping. It takes a lot of history and questioning. You wanna find out if they had exposure to mold or to metals or any kinds of toxins. I have somebody who did environmental cleanup, and they were exposed to toxins, and they had high levels. You fix that. You detox them, and they get better. If you get somebody sleeping, they get better. Most people who are under any kind of stress or hormone imbalance need a lot more vitamins B, C, and magnesium. And then I always recommended adaptogenic herb, depending upon if your cortisol’s too high or too low. The things that I tell people in a standard formula – you have to look because something like licorice or ginseng can raise your blood pressure and raise cortisol.

Dr. Maita: So you wanna avoid those if your cortisol is high, and if your cortisol is low, you want those because it makes your own cortisol last longer. And we’ll bring up the blood pressure because when cortisol’s low, the blood pressure gets low, and people get lightheaded. So testing cortisol is important, and tests are available over the counter. I always recommend a 4-point saliva test, but my first step with most people, I detox them. And it is amazing, amazing how different they feel. So many people come to me, and they think they need hormones, and they have every symptom in the book. And once they finish the detox and we remove foods that tend to cause inflammation, they feel like a million bucks. And then when they add foods back in and they see what foods are causing symptoms, they can avoid those foods. And then, if they stay away from them for a period of time, and it depends upon how long their symptoms and what their underlying problems are, once they stay away from them, they can add them back, but not have it every day. They tend to get sensitive to the things that you have every day.

How to balance your hormones in two weeks: Dr. Maita’s detox elimination diet

Dr. Patti (0:11:13): Yeah. So detox. When you say “as I detox them”, what does that look like? Does that look mainly like removing certain foods? Does that look like using herbs to help the body do that?

Dr. Maita: It’s a little bit of both. Everybody does a detox differently. After years of trying different things, I have an approach. We have our signature detox and elimination diet so that we can get to the heart of things very quickly. So for two weeks, we have people avoid the 10 most troublesome foods: alcohol, artificial sweeteners, caffeine, corn, dairy, eggs, sugar, soy, wheat, and anything with gluten, just for two weeks. We have them take detoxifying herbs, and I pick a shake for them that will heal the gut, calm the immune system down and help remove toxins. And people feel like a million bucks.

And then they add the foods back in and see if any of the foods caused any issues. And those foods – they just stay away from a little bit longer, those foods tend to cause a lot of inflammation. And it’s that inflammation that causes the fat, flabby, flaky, foggy, fatigue, and forgetful. It’s a stress on the body. Cortisol goes up and drives the other hormones down.

Amir: How soon can people expect to see their hormone levels coming back?

Dr. Maita: It depends. The longer something went on, the longer it takes, but people with high cortisol, it can go back pretty fast. People with low cortisol take a lot longer, cuz those are people that are burned out. They’ve gone a long time without it. I can tell you that some of my women who came in with severe PMS symptoms or perimenopausal symptoms, felt extremely better after that two-week deep detox and then some of the hormones normalized. It could be as short as two weeks. I can’t guarantee that in everyone, but, it all depends on how well they can remove the stress. Some people are extraordinarily stressed, and they have to learn techniques to manage it and take things off their plate and address nutritional deficiencies because stress will deplete your body of many nutrients and correct their eating.

Dr. Maita: So it depends on the person how bad their lifestyle and habits are. But I’ve seen miracles in two weeks. One woman said she was so miserable and she had a lot of aches and pains. She could barely walk, and she couldn’t believe it. Then it is a little two weeks. She just felt like a million bucks. That’s powerful. I don’t wanna promise that to everybody, but it’s really a beautiful thing. And that is one of the very first things that I do because I won’t even put people on hormones until I detox ’em first because I wanna see what’s left after that. Your liver processes your hormones. So that’s why you have to understand if people are drinking a lot of alcohol, especially men, it’s gonna turn all that testosterone into estrogen.

Dr. Maita: And there may be zinc deficiencies. Men need to replace zinc deficiencies.

Midlife crisis and hormonal imbalances in men and women

Dr. Maita (0:14:26): I used to say that midlife crisis, my theory is it’s hormonal because women get anxious and irritable and in your face, and the men pull back and get withdrawn and lethargic. And I would have couples sitting in there. I would talk to both of them together and both of them would just start nodding their heads. They related to these symptoms. I would explain to the husband, I’ve had a lot of men find me for their wives because their PMS symptoms were so bad that they saw how much they were suffering. And they said, I wanna help you. I wanna find help for you. And once they understood that it was hormonal, they would be so grateful, because some of them could just be fixed with the detox.

Dr. Maita: Other people (women) needed progesterone in perimenopause or estrogen and progesterone in menopause. But there are so many things that we can do using herbs and nutrition to bring people back, to restore their health without the hormones. And then the men, a lot of times the women would feel so good. They’d say I want my husband to come. And sometimes it was a husband that came first. Sometimes it was a wife that came first. And as I said, once you figure out what triggers stress, trauma, toxins, adverse food reactions, inflammation, infection, nutritional deficiency, sleep disturbance, and overdoing, you take away, what’s bad. You add what’s needed and missing and you multiply the good habits and people transform. But the men and women really relate to the symptoms. They see it in each other and they feel help and hope are available to them.

Hormone balance supplements

Dr. Patti (0:16:38): This is a great place to segue into. So let’s say somebody has gone through the detox process. You’ve gotten their cortisol where it needs to be. And maybe the sex hormones are still not quite where we’d like them to be. So what would we do next? And you can start with women or start with men, whatever you’d like to do, but like where would we go in terms of what to do with lifestyle next? Would you recommend any supplements? Would you recommend starting hormone replacement therapy? Where would we go next?

Dr. Maita: Right. Well, it depends on the stage with women, and men too, who are making too much estrogen or (in women) they have enough estrogen and not enough progesterone. Estrogen is a hormone of energy and growth. Too much, they get those PMS symptoms, anxiety, irritability, impatience, insomnia, growth of the breast, cysts of the breast, tender breast, breast bleeding, spotting, and weight gain.

We can give things like DIM (diindolylmethane), I3C (Indole-3-Carbinol), resveratrol, and sulforaphane to help process the hormones better. And I give those things to men too. Men who have the man boobs and the belly, I give them DIM, I3C, resveratrol, and sulforaphane. I have a special formula that I like to use. They feel better because their testosterone stays testosterone and doesn’t convert to estrogen. And women, especially women with either PMS or perimenopause – that will bring the estrogen levels down.

Dr. Maita: And I can add herbs, such as chasteberry, some call it Vitex, that helps bring progesterone up. Once you’re in the later stages, like women who have certain symptoms like menopausal and they don’t wanna go on hormones – I’ll use things like extract of rhubarb, which stops the hot flashes and help them sleep. Once they get sleep, they feel so much better. I work on sleep a lot. So, again, it depends upon the issues. I may give herbs for cortisol. We talked a little bit about that. I mean, there are so many different cortisol formulas, but the main thing is to make sure if your cortisol is high, not to take ginseng and licorice. And if the cortisol is low, to add those things or glandulars.

Just trying to figure out how many more details, because there’s a lot of it, and it varies based on the person, but there are a lot of herbals that I use that really make a difference.

Testosterone supplements for men

Dr. Patti (0:18:39): And what about testosterone supplements for men? I know that it’s popular now sometimes to get herbal testosterone boosters. Men who wanna increase their testosterone levels. Are there any that you would recommend or what would you recommend doing first before you start reaching for something like that?

Dr. Maita: Well, as I said, I would detox and take care of the cortisol first and any underlying issues that could be causing it. I see a lot of people who wanna lose weight, they overexercise and it actually raises their cortisol. So if they’re doing that, there’s nothing with them, that’s gonna undo that. So it’s figuring out the reason and the underlying cause. Tribulus (Tribulus Terrestris) will help. it’s not as easy for men. What I tell men to do that helps them raise their testosterone, get their vitamin D optimized, do resistance training, and make sure we have enough zinc. I might add zinc, cut down on alcohol, and give selenium. Those things can really make a big difference in changing testosterone. I haven’t had as much success with the herbals for men, but those things you take care of that you detox, you fix the cortisol – I’ve had some really, really great success with that.

The best exercise to balance hormones

Dr. Patti (0:19:53): And you mentioned over-exercising, is, is there any kind of a rule of thumb about how much would be the right amount of exercise? How much would be maybe too much? And of course, not enough is also bad in its own way. So kind of, what do you recommend

Dr. Maita: Again, it’s hard to say. I would say, you wanna go moderate intensity exercise. What do you wanna accomplish from exercise? When it comes to weight loss, you have to be careful because if you do too much, you’re actually raising cortisol, and that will raise blood sugar. So sometimes I’ll prescribe a continuous glucose monitor for people so that they can actually see what’s happening to their blood sugar. You wanna feel rested and restored after exercise and a part of it is conditioning – if you were doing things and conditioning your body, you could obviously do a lot more than if you’re a weekend warrior or if you’re just trying to fit in a two-hour workout into one hour, and you’re going so full out that you’re exhausted afterwards. So a lot of it is gonna depend upon how you feel afterwards and what is the result of your body and how much you’ve conditioned your body to be able to add more and add more and add more.

How to know if you are over-exercising?

Amir: And this is actually a super popular topic that often confuses many people. They hear that exercise has a positive impact on hormones. For example, heavy, strong resistant training in men. But then just like you said, there’s this balance where if people overtrain, it can totally backfire. Is there any truth here and how can people find that sweet spot?

Dr. Maita: Well, it does work. I mean, you can boost growth hormone. You can boost testosterone from high-intensity interval training (HIIT). Resistance training works better for testosterone. The interval training works better for growth hormone. It’s just that when you overdo it, you’re gonna feel some level of exhaustion. You’re gonna feel some level of burnout or weakness at times. You might get blood sugar swings. So looking for lightheadedness, looking for cravings, or feeling voraciously hungry. These are all signs that you’ve overdone it. And that’s why I like using the continuous glucose monitor because that will mimic a little bit what your cortisol is doing because it’s just too hard and too expensive to always measure cortisol. (* You will be able to understand your cortisol response by looking at your glucose results).

I’ve had people measure their cortisol and saliva after a workout and just see what it does because I would see saliva tests and a big spike. And then I wouldn’t show it to the person. I’d say, what time did you work out? And they told me, and then, I show them the spike. And it was right at the time that they were working out. But your body is gonna tell you because if you still are trying to workout to lose that belly fat and the belly fat isn’t going away, it’s either your food or your lack of sleep or you’re overdoing it.

Amir: And that’s such a key takeaway for people to remember about working out. More is not always better. And in fact, the opposite is the case. So whenever they finish working out, a reminder to be mindful and ask yourself: how do I feel? Am I full of energy or am I pooped out and all I want to do is just to eat or sleep.

Dr. Maita: Exactly. Once you work to exhaustion, it’s not always a good thing. And that’s a common thing that I see, and then not replenishing, hydrating enough, or getting the right nutrients. You need to sustain that kind of workout.

Common vitamins, minerals, and nutritional deficiencies

Dr. Maita (0:23:25): I wrote a book (* Vibrance For Life: How to Live Younger and Healthier, see amazon link) because I was shocked when I had people come in to see me, and they were all deficient in nutrients. I used to analyze their diet in a program with the USDA database. And I’d say, they’re deficient. I would measure. And they were deficient. And then I looked at the literature. I said, well, maybe it’s just people coming to me, even though I had people who were healthy and wanted to stay healthy. I had sick people who wanted to get better, but I found that most people and the literature supported this were deficient in vitamin B, vitamin C, magnesium, calcium, fiber, and omega-3. So making sure your body has what it needs is important because heavy-duty workouts can cause a lot of oxidation and that breaks down your tissues and the oxidation causes inflammation.

Dr. Maita: And so I, I also like to measure nutrients, but if you’re talking about doing it yourself, I do a pretty potent multivitamin-mineral fish oil and vitamin K2 and D3. That’s sort of the baseline. I came to that conclusion when I did these years of measuring and studying and analyzing people’s diets and looking at the literature and that takes care of most deficiencies. And then when someone doesn’t feel better or get better, then I’ll go deeper and I’ll measure more.

The effects of intermittent fasting on hormone balance

Dr. Patti (0:24:46): Another really popular topic these days is fasting, especially intermittent fasting. So could you speak to the effects of intermittent fasting on hormone balance, for both genders?

Dr. Maita: And that could vary too because some people tolerate (* fasting) very well. Other people’s bodies will make cortisol because it’s stress for them. People who have blood sugar swings may not tolerate intermittent fasting very well. I mean, it’s very good. The 16/8 intermittent fasting has been a pretty popular one, it will reduce weight, but it doesn’t reduce fat. Interestingly enough, the ones that reduce fat and change your metabolism the most are fasting for two days. Now, fasting could be just cutting your calories back to 500 to 700 calories. Those are the best for changing your metabolism. Now, if you’re one of those people that you get lightheaded after fasting, you feel weak. You’re probably having blood sugar issues, then it might not be good for you. And one of the interesting things that I did when I was presenting to the American Academy of the anti-aging and regenerative medicine is I had some people, especially during this pandemic that used to always be fine.

And all of a sudden people were getting terrible, hot flashes, and they weren’t going away. So I found out that intermittent fasting is popular. Do you know that fasting can increase hot flashes in certain people? So the main thing is to listen to your body. And again, I love the continuous glucose monitors. If you get your doctor to write a prescription, usually you can get the first week for free. And it’s enough to know and to test what is this doing to my blood sugar. How do I feel? But check in, check in to see how you’re feeling. Most people do fine.

The 12:12 fasting is a no-brainer, but understand that not all fasting is good for everybody. So if you’re getting hot flashes when you’re fasting and it goes away when you eat, that’s your answer. If you’re finding you’re feeling weak or lightheaded, and that belly fat doesn’t go away, it may be causing cortisol surges. So if you check your blood sugar, you may be able to figure out if that is a cortisol surge. So it’s as popular as it is, and as good it is for us, especially for anti-aging, it has to be individualized.

Supplements to balance hormones in women

Dr. Patti (0:27:11): We talked a little bit about supplements. I know for women, especially around perimenopause, supplements can be very popular- evening primrose oil, borage oil, black cohosh, all of these things. Do you recommend using any of those things? Do you find them beneficial?

Dr. Maita: I find them especially beneficial in PMS. Black cohosh is good for hot flashes. It’s good for mood. People don’t realize that you can get very depressed when your hormones are all over the place. And black cohosh is a mood elevator as well as helps with hot flashes. So I do use that in perimenopause. The chaste berry I find effective in younger women. I don’t find it as effective in older women, because at a certain time, your ovaries just aren’t gonna work anymore. You’re not gonna make progesterone. So we work on bringing the estrogen into balance and using more phytoestrogens, soy and rhubarb, and some of the other phytoestrogens. I find that that’s very helpful for women that are having issues.

Dr. Patti: If a woman isn’t sure exactly where she is on that continuum. You know, have I gone through menopause yet?

Dr. Maita: The evening primrose oil and borage oil are very good for PMS. Very good for PMs. So if you’re feeling PMS symptoms, you’re probably in pre-perimenopause or PMS, or you’re in perimenopause. What happens during this perimenopausal time, it’s all up in the air. Your estrogen is gonna fluctuate and you stop some months, you’ll ovulate and you’ll make progesterone, and you’ll be calm and it’ll be a good month. And your spouse is happy. Your children are happy. Your coworkers and friends are happy. And then I had a woman say to me, I get Ragy. So if you’re still bleeding and you’re still getting your periods, they may be shorter or more spread out. You’re perimenopause. The definition of menopause is a whole year without a period. And I’ve had people go 10 or 11 months without a period. And they think they’re there. And then all of a sudden, wow, there’s no easy way. But if you’re bleeding and you feel those PMS symptoms, you’re still in perimenopause because you’re making estrogen and no progesterone.

The importance of detoxification for hormone balance

Dr. Patti: So would you recommend testing those levels or do estrogen levels fluctuate so much that it’s not really helpful to test those in perimenopause?

Dr. Maita: I definitely test them because you wanna see the difference between your estrogen and progesterone. If they’re not in balance, that’s what’s causing the symptoms. So you either bring estrogen down with, I use a lot of fiber and telling people to stay away from toxins. This is why I detox everybody, men, and women because toxins like herbicides and pesticides, hormones fed to animals, and animals that have eaten grains that have been sprayed with herbicides and pesticides it’s get stored in their fat. And then you eat it and it gets stored in your fat. These are obesogens, and you’d be surprised at all the personal care products that we use that have chemicals in them that disrupt your immune system, your hormone system, and your nervous system.

So getting rid of those toxins, and having more fiber and the big trick for men and women in relieving constipation. If you are not moving your bowels, at least every day – whatever your body’s trying to get rid of all those toxins, just get reabsorbed. And any woman that I have corrected their constipation, anybody that had issues with their hormones or had issues when I was replacing their hormones, it was because they were constipated. That’s huge.

Should I test to see how close I am to menopause?

Dr. Patti: Would you recommend testing FSH and LH for women to see how close they are to menopause?

Dr. Maita: I do, but you still don’t know . When it starts to creep up, you know you’re getting there, but it could be weeks. It could be months. It could be years. So I do measure it when we’re uncertain or we don’t know how close. In perimenopausal or PMS women, I don’t always do it, but once you’re totally menopausal, there’s really no point. But in perimenopause, I’ll measure it. I have some people that have symptoms and they’ve had symptoms for a long time – where they’re not sure we’ll measure it.

Testosterone, estrogen, and DHEA in men and women

Dr. Patti (0:31:39): And what about measuring testosterone in women or measuring estrogen in men? Do you normally recommend doing that?

Dr. Maita: Absolutely. Because women who have low testosterone have low libido, they feel sensitive, they don’t have a sense of well-being. Testosterone can give women a really nice sense of well-being. So I absolutely measure it. And in women, if you give DHEA, it can turn into testosterone. That doesn’t necessarily happen with men. But the important thing to know is that the dose for DHEA in a man is very different than the dose of DHEA in a woman. So I usually start women at five milligrams of DHEA and men, I start at 25 milligrams and I measure. And another mistake that people make is if your cortisol is low and you give DHEA, you turn off the part of your brain that’s gonna stimulate your adrenal glands to make cortisol.

High DHT in men and women

Dr. Maita: So what I’m saying, they’re all interconnected. So it’s best to measure all of them together. Now in men, I definitely measure estrogen and I measure, both in men and women, something called dihydrotestosterone (DHT). Testosterone can stay as testosterone. It can turn and convert into estrogen by an enzyme called aromatase, or it can turn into dihydrotestosterone. So understanding that (* is important) because I’ve had some men where they’ll look at their testosterone levels and they’re a little low, but they are just jacked up. And I have many of the wives call me saying you better lower his dose because they…if your dihydrotestosterone is high, you can get acne, facial hair, hair loss on the head. And this happens in men and women, and you can get aggressive behavior.

Dr. Maita: And it can really Jack up your libido so much that it’s scary. So I had a woman who said she came in with her husband and she looked at him and said, if you don’t get… he decided he wanted somebody who was gonna be very aggressive with him. And cuz I’m not that aggressive with them because I know it could cause problems. She said she was gonna divorce him unless he stops or come to me, But yeah, I mean it’s a pitfall.

The other thing is that women want that good feeling and may not want to go on testosterone. They take DHEA and they might take the male dose and it’s a little too much for them and they get angry, and they can get aggressive too.

Low estrogen in men and women

Dr. Patti: Yeah, and can a man ever have too little estrogen? Because we’ve talked about women having too much or too little testosterone, what happens with men in estrogen?

Dr. Maita: They don’t feel good. I mean, estrogen’s very important for the brain. It’s very important for memory. And it also has to do with sperm production as well. So low estrogen can also cause a low sex drive in men and women. People think only testosterone is responsible for sex drive, but if you’re tired and you have no energy from lack of estrogen, you’re not gonna have a sex drive either. You need all the components to work and, of course, low estrogen in men decreases that bonding experience and this sexual and social behavior. And both in men and women, you get bone loss.

I don’t see low estrogen in men very often. What I see is when men come from other doctors who put them on something to lower their estrogen, because their testosterone is converting to estrogen. When the more proper thing is to give selenium, zinc, decrease alcohol, lose the belly fat, do some resistance exercise, that’s the first line of treatment. If that doesn’t work, they give them something called Arimidex or anastrozole. And that lowers the estrogen too much. And then the men just don’t feel good. They feel their sex drive is gone, even though they’re on sufficient testosterone.

Lifestyle basics to balance hormones

Dr. Patti (0:35:50): It is really important to have that balance for everybody.

Dr. Maita: Oh, totally. And you have to know how everything converts into other things and what’s going to affect it. But lifestyle is the most important: to eat nutritionally, dense food that’s not processed, manage your blood sugar. That’s huge. That’s huge for hormone fluctuations and mood swings, that many, many people who are aging, even not people who are aging – They complain about that. And sugar swings also affect your weight. It affects your cortisol. It affects your mood, affects your energy. So eating a nutrient-dense diet that’s low in processed foods, and low in sugar. You, don’t have to go totally low carbs, but if you eat the right kind of carbs, you’re energized, getting enough sleep, having a sufficient amount of exercise without overdoing it, and finding joy in life too. I have people who came in, they checked off all the boxes and they were just joyless. And you need stimulation for your mind as well as for your body. And you need social connections. I mean, we all experienced what it was like to not have that during this pandemic. That was tough.

Lifestyle and hormone balance for bone density support with aging

Dr. Patti: Yeah. And you mentioned bone density, so let’s just touch on maintaining bone mass and muscle mass and how to avoid frailty as we age. So can you just touch on the importance of that?

Dr. Maita: Absolutely. Well, what I do is I have people measure their own acid-base balance in their urine. You can get test strips. A role of testing paper from Amazon is like $4 or $5. It will last you a lifetime, practically. If your pH is between 6.8 and 7.4, you’re good. If you’re too acidic, just like people used to take Tums, which is calcium to help with stomach acid because the calcium buffers acid, well, your body is smart. It’s gonna take it (* calcium from your bones) if you’re too acidic, cuz you need the right pH for all the enzymes to work. Enzymes convert food into energy. And they convert different hormones into other hormones. If you’re too acidic, it’s going to take calcium from your bones. So first and foremost, look at acid-based balance. I give out a handout and you could Google it.

Dr. Maita: But what are acidic foods and what are alkaline foods? Because lemon tastes acidic but it actually leaves your body alkaline. And that’s why it doesn’t always make sense. So I give a list, and I just say, look, you’re going to eat all these foods, but you’re getting to eat more alkaline foods and less acidic foods.

Weight-bearing exercise is important. Like I have people that are swimmers, but they’re not getting the pressure on their bones to build bones. So you have to combine it with some resistance training.

Having the right hormone balance (* is important). Cortisol’s a big one to leach. It breaks down bones. It breaks down everything: it breaks down muscle, breaks down bones, and breaks down the memory centers of your brain. It raises blood pressure, raises blood sugar, raises heart rate, but it makes you store everything as fat. So getting the cortisol into control, see, you’re always going back to cortisol. Getting the cortisol in control is extremely important for bones. Getting the exercise.

And then estrogen’s a big one, both in men and women. And even if you don’t have estrogen. I do supplements. I don’t give calcium that often because there are some studies that say you’re better off getting calcium from food. And there were some studies that found there was an increased risk of calcification of the arteries and of the aortic valve when you took calcium supplements. But sometimes you have to because people are just not getting enough. I also combine it with vitamin D and vitamin K (* Vitamin K2) because vitamin K not only helps you absorb more vitamin D, it helps you absorb more calcium, prevents you from losing calcium and it directs the calcium to go into your bones rather than into your arteries and soft tissues.

Dr. Maita: Plus there’s a compound that I use, it’s a supplement that also has Orthosilicic acid. So that’s kind of like the spark that sets collagen production. It initiates collagen production. So that combination of having vitamin D, the type of calcium, which is calcium hydroxyapatite, vitamin K, weight-bearing exercise, alkalinity, and the orthosilicic acid – that works for most people. And, those that want hormone replacement. Yeah. I give hormone replacement, but it’s not estrogen alone. Estrogen builds bone, testosterone strengthens bone, and progesterone preserves bone.

Progesterone in men

Dr. Patti: Would you also measure and look at progesterone in men or just testosterone and estrogen for them?

Dr. Maita: I do sometimes. It’s very rare. I know that there were some colleagues that used to give men progesterone to help stop the conversion to that strong testosterone (DHT) we talked about, cuz it does do that. And it does do that in women too. So for women who get hair loss from estrogen dominance and not enough progesterone, you give them progesterone. It helps. But I found that most of the men I gave it to just didn’t feel good while on it. And I very rarely see, I’ve never seen high progesterone in a man, and in men, it’s almost normal to have low progesterone. So I do measure it just because I wanna see what’s going on if I see any outliers, but it’s kind of rare.

Amir: Just a quick follow up question about vitamin K. You meant vitamin K2, right?

Dr. Maita: Yes, it’s vitamin K2 MK-7 (menaquinone-7). Thank you for clarifying that, there’s so much in my head getting it all out. I don’t know how specific and nonspecific to be, but yes, it’s vitamin K2 MK-7.

Vitamin K2 and vitamin D3: testing and dosage

Dr. Patti (0:41:49): You mentioned both vitamin D3 and vitamin K2. How much do people normally need to take?

Dr. Maita: I measure. It’s safe and I found the majority of my patients take 5,000 international units (IU) of vitamin D3 and 45 to 90 micrograms (µg) of vitamin K2 as MK-7 per day. That’s generally, but some people have high levels. So I measure and I’ll drop it down and some people need up to 10,000 of vitamin D3 a day. So I measure and a rule of thumb is that 1,000 international units will raise your vitamin D by 10. And then, the optimal dose in the functional medicine world is 50 to 90. Hardly anybody measures vitamin K.

Dr. Patti: You just take the supplement and it doesn’t have any kind of negative side effects to worry about.

Dr. Maita: K doesn’t. D can, but it’s kind of hard to get toxic on vitamin D.

Dr. Patti: And we have so little naturally, most of us.

Dr. Maita: Yeah, we do. A lot of people are indoors at a computer, wearing sunscreen or makeup or something to block the sun. And we actually lose the capacity to convert vitamin D into its active forms. And they actually did studies on people in Miami and surfers in Hawaii and they had low levels. I had so many patients tell me that, oh, I don’t take it in the summer, and then I’d measure and I’d say, see, it’s low. I actually did an experiment on myself. I went out in a bikini and I laid in the sun for a while with no sunscreen. It’s just an experiment, not too long, for about a week or two for an hour or two and nothing. Didn’t budge. So it’s, it’s a misnomer that you’re gonna get enough from the sun, maybe when you’re younger, but as we age, nothing works quite as well. We don’t absorb things as well. We don’t convert things as well. We don’t detox as well. Things slow down and we have to just keep tweaking.

Hormone replacement therapy (HRT): benefits vs. risks

Dr. Patti (0:43:58): That’s really good for people to know. How about we talk about hormone replacement therapy a little? How often do you see people who really benefit from taking hormones as opposed to being able to balance naturally using all of these lifestyles and nutritional things?

Dr. Maita: What I think is important for people to know is, is that it has been a 180-degree turn about hormone replacement therapy in women. And I put together a synopsis that I give to my patients because I want people to make informed decisions. Doing nothing has its consequences. So when women don’t take hormones, they can still get breast cancer. In fact, the latest studies and the analysis of the old studies show that the risk of breast cancer really has been overblown. I can’t say there’s no risk if you’re on hormones, but there’s a risk, even if you’re not on hormones. There’s more of a risk of cardiovascular disease. It affects your heart, your blood vessels, it affects your brain. There’s a higher risk of dementia and a higher risk of osteoporosis. And all of those are far more common than breast cancer in women.

Dr. Maita: So a lot of it is a choice. I give my patients a choice. (* Some women do not want to take hormones). I don’t push it. I let them make a choice. I give them the information. And other women are – give me those hormones right now. And I do have a good portion of my patients on hormone replacement therapy.

The good news for men is testosterone has never been tied to cancer. And actually, there were some studies saying that men with normal testosterone levels did better in COVID. They survived COVID better. And they didn’t end up in the ICU like men with low testosterone. But I think the trick with men is when they don’t have a good lifestyle. And that’s true with any hormones. If your lifestyle isn’t good, they’re not gonna work as well.

Dr. Maita: And that’s why eating clean, exercising, sleeping, managing your stress is a foundation for everything. Hormones are not going to be all end all, and can’t make up for a bad lifestyle. They totally make you feel better.

I’ve had some women who’ve been on them for quite some time and I just tell them, listen, why don’t you just try going off for a while and see how you feel? We could always put you back on because at the 10-year mark (* 10 years of HRT in women) that’s when hormones, the risk of cancer goes up and the older you get, the risk of cancer goes up. But I’ve had quite a number of women come back and say, look, I just don’t feel good off of them. And even the north American menopause society and 20 other societies all said, the quality of life matters. Because if you can’t sleep, you can’t think, you’re miserable, you’re moody, you’re depressed, you’re anxious, you’re irritable. You’re losing your bones, you’re losing your memory. Your blood lipids are going up. I had three doctors tell one of my patients to go back on the estrogen, go back on the hormones. Cause you did better with them. But at least I give them the opportunity to take a break and see how they feel.

Dr. Patti: So it sounds like what you’re saying is that some people will stay on for the rest of their lives. Some people will stay on for a few years and then taper down. Is that true for men as well?

Dr. Maita: It’s the same. Most men tend to stay on it because they feel so good on it. But hey don’t have that dilemma where people are still working off old knowledge, that old women’s health initiative study (WHI), where they lumped everybody together, women whose average age was 63, 10 years past menopause. The ship has sailed already. So I don’t generally give women hormones if they’ve been away from hormones for 10 years. I’ve had some women come from other doctors and they were on hormones for 10 years and they wanna stay on them. That’s okay. But if you’ve been off hormones for 10 years, you lost your bones, your arteries got hard. It’s hard to turn that ship around. Not that it’s contraindicated, but I tell women you’re not gonna get the big, wow that everybody else felt.

Men don’t have that issue. They can stay on it unless they have issues with their prostate. And even that is somewhat controversial. I mean, some will argue that even if you had prostate cancer, you can take testosterone, but I’m not one to do that. I don’t give that, but it has not been shown to cause prostate cancer. So there’s the only reason men go off the hormones.

Men on injectable testosterone tend to get high liver enzymes and they tend to get high red blood cell count. And that high red blood cell count makes it clogs your arteries. That’s dangerous. That’s why I only give testosterone through the skin in men. And they are only a handful where they just don’t absorb it or they don’t do well, so I will give it subcutaneously, which is through different types of testosterone. But the older we get, the forms of injectable testosterone can cause side effects like that. And then I take them off.

Dr. Patti: And it’s a big takeaway for women that if a woman is in her sixties and she’s never really thought about her hormonal health it might not work as well for her to go on hormones at that point. So it’s something to think about kind of earlier in the process and stay on top of it rather than waiting until later and then trying to get it back.

Dr. Maita: So what they showed in one of the studies that was done in France, it was more of an observational study where the first two years, the risk of breast cancer decreased. For the first five years, the risk of breast cancer was the exact same as what was in the normal population not on hormones. And it increased slightly after five years. But if you were on synthetic hormones, the risk of breast cancer went up right away immediately. So I think most people who are in the know would agree with five years. You have nothing to worry about. You bought five years of better brain, better bone, better mood, better sleep, better, everything. But after that, it all depends.

And I have people that are in their late seventies that say, I just feel so good on them. I wanna stay on them. And I say until I find some reason not to…I make sure everybody gets a mammography. At the 10-year mark, I ask people to get a pelvic ultrasound because I can’t see inside. I can’t see what their ovaries are doing. Knock wood, I’ve been pretty fortunate with people and made a lot of people very happy and healthy and feeling young and vibrant and vigorous. And it saves a lot of relationships because both men and women go through hormonal changes that can totally affect their relationships.

Bioidentical hormones vs. synthetic

Dr. Patti (0:50:52): Yeah. And you touched a little on the difference between the bio-identical and synthetic hormones, but if you maybe wanna talk a little bit more on that for people who aren’t aware of that.

Dr. Maita: Sure. What they find is that it’s also how you give it. The estrogen was always given orally in the past. When you take it in your mouth orally, it goes through first pass in the liver and it can cause clots. And these were made from horse urine. And there is oral bio-identical estrogen, but it’s still gonna cause blood clots and the blood clots increase the risk of heart attack, stroke, and thrombosis. Oral progesterone, on the other hand, the natural progesterone does not cause blood clots. It does not cause any problems with the gallbladder. It relaxes the smooth muscle in the arteries, the coronary arteries. It has a lot more beneficial effects, and it has a lesser degree of the risk of breast cancer. They felt that synthetic Progestin (* synthetic progesterone medication) can cause gallbladder issues, and thrombosis, meaning blood clots, and spasms of the coronary arteries. It does not help with the brain and the neurological system progesterone does. And there are big differences between both of them.

Forms of estrogen and progesterone therapy in women

Dr. Patti: Would you normally recommend women a patch or cream rather than taking it orally?

Dr. Maita: Estrogen – I only give in a patch or a cream. You can give it vaginally. It’s just a little more messy. Or troche, which is between the cheek. I hardly use those because it’s hard not to swallow. It’s supposed to just absorb. So if you swallow it, it’s like taking it orally. So, I tend to just use the patches or the creams. They’re very available. The patches are made by pharma companies and there’s also a gel that’s made by a pharma company that’s covered by insurance and it’s bio-identical.

And the same thing with progesterone, but progesterone doses – pharmaceutical companies only make it in 100 or 200 and that’s not enough. Some people need 50, some people 125. So I tend to have that compounded in a pill and for the very few people who can’t tolerate the pill because it makes them too groggy, I’ll have it compounded into a cream.

Customized HRT with compounded hormones

Dr. Patti: So the compounding is for anyone who doesn’t know the exact dose?

Dr. Maita: Yeah. I worked in New York City during the AIDS epidemic and I was fortunate that when we did rounds in the ICU, patients couldn’t swallow things. Certain things they couldn’t put on their skin. So we had a compounding pharmacist that came with us and we’d say, okay, we need this medicine. How are we gonna give it to him? Oh, I can make it into a lollipop. I can make it into a swish and swallow. I can make it into a liquid. So they made ways of getting a medication into somebody who couldn’t take it the traditional way or they couldn’t tolerate a certain dose. So they kind of made it customized for the person. And I just thought that was normal. I had no idea that was so unusual.

Dr. Maita: And that’s why people got so scared about compounds and compounding pharmacies. Yes. Compounding pharmacies are not FDA approved because it’s a difference between manufacturing on a large scale that FDA oversees versus it’s like somebody making cupcakes at home versus somebody having a big factory. So they’ll make it in very small batches that are individualized. And I visited most of the pharmacies that I know of and they have their own certification process. They have to send samples to their oversight organization to match and see: is it pure? Does it have the dose that you say? Even in pharmaceuticals – the doses can vary. So there’s a certain percentage of wiggle room that they have. So there is some oversight. There were some fly-by-night pharmacies that cropped up when bio identicals became extremely popular. But I think they’ve been weeded out for the most part.

Dr. Patti: Then, the lesson would be – go to a healthcare professional that you trust and they’ll be able to send you to a compounding pharmacy that you can also trust.

Dr. Maita: Believe me, if there was a problem with a compound, my phone would be ringing off the hook because I tend to use some of the same pharmacies and I would definitely know it.

Risks of DHEA supplements and DIY HRT

Dr. Patti (0:55:33): Would you recommend that people try to just test and manage their own hormone replacement? Or, I would think, definitely talk to somebody about this?

Dr. Maita: I have very knowledgeable patients and I teach them a lot to understand their body and how the hormones have an effect. And one day (* a new patient) I was like, what is going on? She took a male dose of DHEA and her DHEA went through the roof and she was getting snippy. Thankfully, not with me, but I think it was affecting her relationship and I measured. So you don’t know what the hormone is gonna do in your body.

In women, the DHEA can turn to testosterone and then they get hair loss. And you just don’t know where it’s gonna go because all of these hormones interconvert. It starts with cholesterol, turns into pregnanolone, then goes to progesterone, and progesterone can go down many pathways. It can go to DHEA. It can go to cortisol. It can go to testosterone, which then turns to estrogen. It’s like a ping ball where you don’t know where the ball is gonna go. And that’s why I think you really should measure. You should go to somebody who knows what they’re doing because you have no idea what’s going to happen.

Amir: This is super important because DHEA is actually a supplement so people can get it in Amazon and they can get into some really big trouble.

Dr. Maita: Yeah. And I have very educated patients and some of them just did the wrong thing. They don’t know their cortisol is low. They know DHEA can really help and lift their mood. But it actually keeps the cortisol (* too) low. It’ll make them feel worse.

So, you really should know what you’re doing when it comes to these things. It’s not like a supplement, like a multivitamin where if you take too much vitamin B or something, you’re just gonna pee it out. Your body will use what it needs and just get rid of it. But hormones aren’t like that. And especially the steroid hormones. They can be stored in your body. Especially if you take the creams like women take those over-the-counter, progesterone creams. Some of them stay in the fat. And I used to see the do-it-yourselfers (DIY) come in all bloated. And it takes a long time to get that out of your body. That’s why I like oral progesterone the best. It reduces anxiety and helps women sleep. They love it. They feel good immediately. And if you overdo it, it’s outta your system in two days, you don’t have to worry. Whereas the creams are like, okay, it’s gonna take while , it’s gonna take a while.

Once you start testosterone therapy can you stop?

Amir (0:58:07): We get tons of question in this one. There’s this notion that after some time on HRT, the body stops producing some hormones on its own, especially with testosterone replacement therapy in men. And that means basically it’s a commitment for life. However, you just mentioned that it can be valuable for some people to cycle off and see how they feel. How can someone know if HRT is a good option for them?

Dr. Maita: Well, that’s why you can overdo it. First of all, I would never give testosterone to a man that wants to stay fertile. Most of the people I give testosterone either had a problem with their pituitary gland, or had damage to their testicles. And there’s no way to know how their body can make testosterone and that I’m not impairing their fertility. And this is another reason why I don’t wanna overdo it in men, even when they’re older because they’re gonna make some testosterone. They may not make enough to make them feel good, but the higher the dose, the longer you’re on it, the more it may turn off your own testosterone. So I replace to a reasonable level.

I’ve had some people come to me and they say, I only feel good when I’m at a 1000 (* mg testosterone). I say, well, then I’m not the right doctor for you because I think it’s a disservice to you to do that. But if you’re not looking to have any more children, it’s not as big of a problem, but if you do stop it, you may or may not bounce back. And it’s very variable.

Testosterone replacement therapy (TRT) and its role in aging

Amir (0:59:35): What is the role that testosterone plays in somebody’s ability to maintain good muscle mass, in particular, frailty issues with aging?

Dr. Maita: It’s huge. Testosterone and growth hormone are important for that. I mean, growth hormone is illegal to give in many (* situations)…you have to really go through a lot to get it, but testosterone is important for muscle mass and feeling a sense of wellbeing. It’s not just for libido. It’s very important for muscle mass and it can reverse frailty. So men don’t have that same issue as women. So if they’re frail and you give them testosterone, it’s not like women waiting 10 years past menopause. You can still get some benefits

Amir: What about growth hormone (HGH)? A lot of people consider whether they should or shouldn’t use it as a part of HRT. Do you have any experience you can share?

Dr. Maita: I used to, but then when the regulations prohibited me from doing it, I stopped doing it. So people use growth hormone analogs. I’m in New Jersey. They don’t even allow growth hormone analogs, and we found that some of the analogs didn’t last. It could boost your growth hormone, but it didn’t last. So they’re coming out with a lot of other things. And because of where I practice, they were very, very, very strict about it because they had some big issues with somebody abusing it. It was a big scandal. So I just stay away from it. But I’m not saying it’s bad because it’s not. Anything used right, any tool when it’s used right is a good thing. And I don’t have as much experience with the analogs because of where I’m practicing. And other colleagues are using them with success.

Dr. Maita: So I’ve actually referred people to clinics out of state if I felt that they needed something that I couldn’t give them.

Dr. Patti: And it’s really important for people to be aware with the growth hormone, with the testosterone, with any of these, that just because something feels really good, kind of short term doesn’t mean it’s good for you, especially kind of on a long term basis. So paying attention to that long-term effect.

Low testosterone in young males – therapy options

Dr. Maita (1:01:45): And young men, if they have an issue with low testosterone, I’ve given Clomid. It acts like luteinizing hormone (LH), which its stimulation comes from the pituitary gland in the brain that stimulates the testis. That worked in some people and that’s cheap, it’s easy. Or, HCG (Human Chorionic Gonadotropin), it’s known as the hormone in pregnancy, but the thing is, it does the same thing. It acts like LH. Some men still do (* take) testosterone and HCG. HCG is now hard to get, but it preserves testicular mass, and it’ll stimulate your own testes to make some testosterone. So I have some men who do both, but it’s become so expensive and hard to get now. But that’s a way young men can get their testosterone boosted without taking testosterone and to preserve their fertility.

Dr. Patti: So kind of paying attention to the lifestyle, to the cortisol. And then these natural ways that can help boost your body’s own production.

Dr. Maita: Yeah. I use the acronym STAIN:

S – stress, T – trauma or toxins, A – adverse food reactions, I – inflammation or infection, N – nutritional deficiency, sleep disturbance… And then I added the last O – overdoing But if you look at those things, you take care of those things, your body bounces back.

Dr. Maita: You had some great questions. You know, I could talk about this forever.

Dr. Patti : Yes. I wanna say yes, please.

Dr. Maita: Love it. And I love the transformations I see in people. And even with some of the very simple things, it’s so heartwarming. This is what keeps me going. This is what I love about this work because people change sometimes with very simple things. And if in the right hands, you can balance your hormones and take hormones safely.

Dr. Patti: Oh, any tips for somebody who’s looking out there for the right doctor to help them balance their hormones? Like, are there certifications or things that they could look for somebody who knows how to do this?

Dr. Maita: Well, I’m pretty much a bit of a nerd when it comes to this stuff, but I trained through many, many places and some were very aggressive. Some only did oral, and some only did injectables, but the best place was A4M – American academy of anti-aging and regenerative medicine. I think that they have the best training for hormone replacement therapy and mostly bio-identical hormone replacement therapy. If they’ve (* doctors) completed the fellowship and, even better, if they did the advanced endocrinology course, they’re solid, they’re solid. So the A4M (a4m.com) has a directory. And look for somebody who’s fellowship-trained, it will be FAARM (fellowship, American academy, regenerative medicine). You’ll know they’ll have the best training.

Dr. Patti: Fantastic. That’s really helpful. I think this is gonna be really helpful for a lot of people out there who are struggling with questions about these things. So thank you so much for your time. We really, really appreciate having you here and having you share all of this wisdom and knowledge with people.

Dr. Maita: My pleasure.

Amir: Thank you so much. This is such life changing information for people to hear, for all of us to hear actually. So thank you so much and we can’t thank you enough.