Stop Feeling Overwhelmed: The Hormone Solution for Women’s Confidence, Sex Drive & Energy

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[SPEAKER_02]: Like I'm so thankful for it.

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[SPEAKER_02]: Let's just put it that way.

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[SPEAKER_02]: You know sex is more fun and enjoyable Do not take my testosterone away.

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[SPEAKER_02]: Yeah, exactly.

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[SPEAKER_02]: I will die with a testosterone pellet in my butt.

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[SPEAKER_01]: Let me see

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[SPEAKER_02]: Hi, I am Kim Peters, welcome to the Alumine podcast where we're going to talk about women in business, aesthetics, health, beauty, just about everything that has to do with women and our busy busy lives.

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[SPEAKER_02]: Today we're going to be continuing our talk about HRT, which is hormone replacement therapy, and I have Brandy with me today.

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[SPEAKER_00]: Hi.

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[SPEAKER_00]: Thank you so much for having me back.

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[SPEAKER_00]: Yeah.

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[SPEAKER_00]: Hey, sorry to interrupt.

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[SPEAKER_02]: If you or someone you know is interested in building your confidence and feeling like you're best self, both inside and out, I encourage you to visit Horizon Medspot and Wellness in Kansas City.

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[SPEAKER_02]: We have two locations in Shawnee and near the Kansas City Plaza.

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[SPEAKER_02]: We offer so many different things.

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[SPEAKER_02]: If you would like to check us out, go to Horizon Medspot and Wellness.com or you can see us on Instagram that horizon underscore Medspot underscore wellness.

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[SPEAKER_02]: And now back to the show.

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[SPEAKER_02]: All right, we are back, and I have brought Brandy with me.

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[SPEAKER_02]: I love Brandy's brain, and I want to talk about estrogen specifically, because even from my perspective, my view of estrogen was, hey, that, you know, sluffs off, stops your ovary stop producing estrogen in a certain at a certain point, which we call menopause.

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[SPEAKER_02]: And that's when you have hot flashes, and you're really

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[SPEAKER_02]: And you just kind of power through this phase of life and that it gets better and there's some medications that you can take to help with the hot flashes, but really you just have something you have to muscle through, but the truth is that's not the truth.

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[SPEAKER_02]: So tell me a little bit about estrogen as of.

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[SPEAKER_02]: like I'm someone who really doesn't know much about it because I feel like what I'm and what I'm communicating is like the general public understanding of estrogen.

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[SPEAKER_00]: Mm-hmm.

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[SPEAKER_00]: Yeah, I think estrogen has gotten a lot of negative press with the Women's Health Initiative study.

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[SPEAKER_00]: It has been blamed for causing breast cancer, causing issues with stroke, heart attack.

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[SPEAKER_00]: those things don't take into consideration the route at which the medication is being prescribed at the dose that the medication hormone is being used at as well as the duration of time.

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[SPEAKER_00]: Estrogen is something that we already have in our body, so replacing it when it is low seems like common sense kind of.

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[SPEAKER_00]: Right.

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[SPEAKER_00]: Right.

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[SPEAKER_02]: Yeah.

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[SPEAKER_02]: Absolutely.

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[SPEAKER_02]: I mean, if you're deficient in something, then you replace it and you feel better.

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[SPEAKER_02]: So other than like hot flashes, what are some other things that would tell me that I am Perry Menopausal Menopausal or that I should look into replacing my estrogen?

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[SPEAKER_02]: What are some of the things that I may not know about?

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[SPEAKER_00]: Yeah, so Perry Menopaus, your estrogen is going to be all over the place.

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[SPEAKER_00]: It's going to be up down, up down.

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[SPEAKER_00]: And often it is the lack of progesterone that is going to cause a lot of the

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[SPEAKER_00]: kind of like crazy feelings that ladies feel, then it'll dip down and it's more of the inconsistency of the estrogen.

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[SPEAKER_00]: Then it is the lack thereof until you get two menopause.

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[SPEAKER_00]: Then when you get to menopause and you've had a full year retrospectively past your last menstrual cycle, that's when it's fallen off the cliff at that point.

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[SPEAKER_00]: You have no more estrogen at that point, minimal.

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[SPEAKER_02]: So I would feel obviously like hot flashes, right, then that's part of like that.

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[SPEAKER_02]: Is that the dip in estrogen going down?

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[SPEAKER_02]: Is that feeling hot flashes, okay?

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[SPEAKER_00]: Yes, you can have hot flashes during Perrymenopause as well.

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[SPEAKER_00]: Sure, has menopause.

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[SPEAKER_00]: But the classic symptoms tend to be the menopausal ones, not so much the Perrymenopausal ones.

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[SPEAKER_02]: right.

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[SPEAKER_02]: So what about, um, I think this is something that I've heard a lot, um, which I actually learned from you, was I just don't feel like myself.

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[SPEAKER_02]: So what exactly is that with?

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[SPEAKER_02]: Is that part of partly estrogen or?

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[SPEAKER_00]: I think it is the...

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[SPEAKER_00]: The variation in the estrogen, you're not getting, you know, that nice rise in the first half of the cycle and then the nice rise in Progesterine and second half of the cycle, the estrogen's up down up down so it then leads to feeling short tempered, not having as much patience, sleep disturbances, which then again also leads to lack of patience and that's like a domino effect.

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[SPEAKER_00]: Exactly.

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[SPEAKER_00]: Just the cognitive function, the loss of words

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[SPEAKER_02]: those things memory maybe like forget things okay yeah focus I think cognition and focus is a big one because I and also testosterone plays a role in that as well so if you are depleted into testosterone estrogen it's like a compounded effect of not being able to think clearly um anything brain fog is something that we overlook her.

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[SPEAKER_02]: kind of blame, you know, life things or I'm just getting older is what I hear a lot.

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[SPEAKER_02]: When I, now I haven't needed to replace my estrogen, but definitely when I replaced my testosterone, I just felt like the world was more crisp.

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[SPEAKER_02]: And that's like I can't think of another way to explain that.

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[SPEAKER_02]: I was able to finish tasks better, which I thought, do I have a, she I think we talked about the last podcast, but like, I was able to finish those things.

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[SPEAKER_02]: So I imagine like if you

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[SPEAKER_02]: how bad I felt when I was my testosterone is low.

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[SPEAKER_02]: I can't even imagine what it would be like to have both your estrogen and your testosterone low and how debilitating that might feel mentally.

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[SPEAKER_00]: Right.

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[SPEAKER_00]: Well, in the sladies, I think that we often will excuse our symptoms.

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[SPEAKER_00]: We will say, oh, I'm busy with the kids, or I've had a stressful week.

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[SPEAKER_00]: I've had this.

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[SPEAKER_00]: I've had that.

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[SPEAKER_00]: And so before they get around to take care of themselves,

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[SPEAKER_00]: they're already depleted.

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[SPEAKER_00]: And so when they feel like not themselves anymore is typically when they're no longer able to sleep, they have no more libido.

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[SPEAKER_00]: They are feeling like they can't get tasks done.

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[SPEAKER_00]: They have no motivation, no energy, they have fatigue.

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[SPEAKER_00]: When I don't have my estrogen,

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[SPEAKER_00]: My eyes are more dry.

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[SPEAKER_00]: I feel like I don't have the, like you get right testosterone, even.

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[SPEAKER_00]: I have more brain fog, forget words.

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[SPEAKER_02]: So what are the symptoms that you would like if somebody presented to you and their postmen of puzzle, you suspect that maybe they're low on a lot of different things.

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[SPEAKER_02]: But like what are the things that would really point you to the area of estrogen being the most responsible?

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[SPEAKER_00]: Definitely vaginal dryness, but that can be more of a later symptom.

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[SPEAKER_00]: Just changes in their menstrual cycle altogether can be indicative of that.

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[SPEAKER_00]: What about hair loss?

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[SPEAKER_00]: So yeah, hair loss is definitely a big thing when estrogen is dropping and even when it's erratic.

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[SPEAKER_00]: A lot of people blame testosterone for hair loss, and that can be the case sometimes, but more often than not, especially in middle-aged women, I feel like a lot of the hair loss if it's not thyroid related is more attributable to lack of estrogen, because estrogen is a growth hormone.

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[SPEAKER_02]: We've run across this a few times, so there's different things that can contribute to hair loss in for different reasons, and it's a different pattern, right?

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[SPEAKER_02]: So diffuse hair loss, so you're brushing and finding out more of your hair is coming out.

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[SPEAKER_02]: It's thinning in general, and no specific pattern is probably more of a thyroid deficiency, or thyroid problem, and an estrogen-depletion.

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[SPEAKER_02]: Yeah.

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[SPEAKER_02]: Where as, you know, some people are getting, let's say I started like myself.

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[SPEAKER_02]: I started HRT before I needed any estrogen.

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[SPEAKER_02]: I don't need estrogen.

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[SPEAKER_02]: My bodies, my ovaries are producing that just fine.

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[SPEAKER_02]: But I didn't need to replace my testosterone.

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[SPEAKER_02]: So, if I started to lose hair, my first thought would be, oh, it's my testosterone.

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[SPEAKER_02]: Mm-hmm.

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[UNKNOWN]: But,

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[SPEAKER_02]: It really could have been just that my estrogen is starting to go down.

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[SPEAKER_02]: And we found that out with a lot of patients that really, it was, the hair loss was not attributed to the fact that they were getting to testosterone replacement.

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[SPEAKER_02]: It was that they were ready for estrogen.

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[SPEAKER_02]: Right.

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[SPEAKER_02]: Replacement.

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[SPEAKER_02]: And I think that's something that's missed often.

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[SPEAKER_02]: I've even had patients come back that have gotten to testosterone replacement.

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[SPEAKER_02]: And they say, well, my dermatologist or my another

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[SPEAKER_00]: Provider they've seen another specialty say well, you've got to get off that testosterone because that's cutting the hair loss Yeah, and really hair loss can be a number of different things definitely even non-hormonal things It could be nutrient deficiency it could be really Stressful situations it can be right genetic all those different things to look at so tell me a little bit about purgester own

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[SPEAKER_00]: I love progesterone.

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[SPEAKER_00]: Okay, tell me why.

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[SPEAKER_00]: So it is like, you know, that I'm an anxious person.

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[SPEAKER_00]: So it is like your natural anti anxiety.

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[SPEAKER_00]: It helps with sleep.

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[SPEAKER_00]: It is the Yin and Yang to the estrogen.

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[SPEAKER_00]: So the estrogen and progesterone, they need each other.

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[SPEAKER_00]: We know that for endometrial health so that we don't get overgrowth of the uterus, uterine lining, and get endometrial cancer.

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[SPEAKER_00]: But it's the hormone that we have a ton of more pregnant.

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[SPEAKER_00]: It gives us that, like, breath of fresh air feeling.

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[SPEAKER_00]: Like when you're getting that, like, buzzy irritability that I described to patients, and they're like, oh my god.

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[SPEAKER_00]: Gosh, I'm having that.

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[SPEAKER_00]: It's when they feel like illogical, irrational things are just lurking the nerves to the point that it's like nails on a chalkboard, like my husband chewing, or my kids crinkling a bag of chips.

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[SPEAKER_00]: And I'm like, my husband's gonna be like, give her a book for just her own.

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[SPEAKER_02]: I can't stand it when they can hear people eat.

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[SPEAKER_02]: I think that's just me.

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[SPEAKER_02]: Yeah.

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[SPEAKER_02]: Okay, so it's that, like a new onset.

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[SPEAKER_02]: I'm so irritated and I don't know why.

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[SPEAKER_00]: Right.

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[SPEAKER_00]: Or you're like, you are driving me nuts.

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[SPEAKER_00]: But logically, I know that you've done a thing wrong.

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[SPEAKER_00]: And I feel bad about the fact that you're annoying me, but I can't help but be annoyed by you.

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[SPEAKER_00]: Right.

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[SPEAKER_00]: Right.

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[SPEAKER_00]: Get away.

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[SPEAKER_00]: Get away from me.

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[SPEAKER_00]: Okay.

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[SPEAKER_00]: And then it helps with sleep.

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[SPEAKER_00]: Yeah, definitely.

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[SPEAKER_00]: That's one of the first things I feel like women notice improvements in.

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[SPEAKER_00]: It kicks in the fastest

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[SPEAKER_00]: a common early complaint during Perry menopause.

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[SPEAKER_02]: So do you have to be on estrogen replacement to get progesterone?

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[SPEAKER_02]: No.

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[SPEAKER_02]: Does progesterone benefit people the same way even if you don't need to replace your estrogen?

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[SPEAKER_00]: Yeah, it actually has a lot of good benefit for people that are not ovulating regularly.

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[SPEAKER_00]: So PCOS patients or patients that don't have adequate cycle length to be able to generate appropriate amount of progesterone.

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[SPEAKER_00]: Progesterone can be protective against breast cancer.

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[SPEAKER_00]: It can be protective against uterine cancer.

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[SPEAKER_02]: progesterone can be used or can be beneficial to people that don't necessarily have to replace their estrogen.

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[SPEAKER_02]: So I take progesterone to 200 milligrams at night because one of my biggest problems is sleeping.

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[SPEAKER_02]: So it's nice to know that there's something natural out there that can benefit sleep without having to ask my doctor to prescribe ambient or

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[SPEAKER_02]: Trasodone or take a bunch of Benadryl or something like that.

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[SPEAKER_00]: Right.

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[SPEAKER_00]: And progesterone is it's affordable, it's easy to take, you know, take it orally.

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[SPEAKER_00]: There are very few patients that will have kind of the

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[SPEAKER_00]: opposite effect when they take progesterone, but the majority of patients when they take it, they just feel so much improvement in there.

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[SPEAKER_00]: I know it definitely might suit their sleep, yeah, in their quality of sleep too.

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[SPEAKER_02]: So progesterone does it drop after having a baby.

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[SPEAKER_02]: Yes.

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[SPEAKER_02]: I believe I promise.

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[SPEAKER_02]: So there's postpartum depression.

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[SPEAKER_02]: So women have a baby and then they get very depressed or just have a depressed mood, I could say.

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[SPEAKER_02]: I read the study about how they did.

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[SPEAKER_02]: They just gave women that experience postpartum depression, progesterone and it was like a remarkable like 90 something percent success in alleviating their symptoms of postpartum depression.

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[SPEAKER_02]: Right.

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[SPEAKER_02]: And how many people have, and then we're, you know, we're giving them an item presence and hoping that they can still take care of their babies and stuff like that one.

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[SPEAKER_02]: Really, they just need to replace some progesterone.

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[SPEAKER_02]: Okay.

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[SPEAKER_02]: So do women need testosterone because, you know, testosterone's a male hormone, right?

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[SPEAKER_02]: Negative.

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[SPEAKER_02]: No.

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[SPEAKER_02]: Okay.

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[SPEAKER_02]: So women actually need some testosterone.

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[SPEAKER_02]: Now, not, not as much as Ben, right?

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[SPEAKER_02]: But I was floored.

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[SPEAKER_02]: at how much of a difference that testosterone made for me.

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[SPEAKER_02]: My symptoms I was having night sweats, I could not sleep through the night.

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[SPEAKER_02]: I used to be a gym rot.

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[SPEAKER_02]: I loved being in the gym.

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[SPEAKER_02]: I loved working out and part of that was that I had a direct result from what I was putting into it.

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[SPEAKER_02]: So if I knew that if I did this certain amount of exercise that I would get this result and that was not happening anymore, so then I was getting more and more discouraged.

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[SPEAKER_02]: So I replaced my testosterone

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[SPEAKER_02]: we talked about last podcast, the difference between normal and optimal.

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[SPEAKER_02]: Yep.

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[SPEAKER_02]: So normal is what it's normal for somebody my age after having kids.

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[SPEAKER_02]: It's normal for that really it's normal for it to be low.

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[SPEAKER_02]: That's normal.

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[SPEAKER_02]: However, optimal is different.

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[SPEAKER_02]: That's getting more out of it.

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[SPEAKER_02]: So optimal testosterone no one is a minimum of about 150.

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[SPEAKER_02]: You could go up to, I know some women do 300 to 400 and that might not be.

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[SPEAKER_02]: I actually haven't had anybody that was comfortable with 400.

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[SPEAKER_02]: I think that's probably a little excessive.

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[SPEAKER_02]: But in a man, you would treat clinically, considered clinically low into testosterone if it's less than 300.

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[SPEAKER_02]: So huge difference in the number there.

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[SPEAKER_00]: Yeah.

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[SPEAKER_02]: So optimized, I would, what range would you like women at most?

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[SPEAKER_00]: You know, I think the lowest that I see patients happy at is about 75 and that's if they're very sensitive and a lot of that's going to depend on how much sex hormone binding globule in they have because that's going to eat up some of the bioavailable free testosterone that's floating in their brain stream.

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[SPEAKER_00]: So that's a factor, but some ladies do require their levels to be higher for them to have adequate benefit.

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[SPEAKER_00]: So as long as the benefit risk ratio, they have more benefit than they do bother.

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[SPEAKER_00]: I am okay with their like serum level being, you know, up to 300.

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[SPEAKER_02]: Okay, and so that's basically we're really following the symptoms.

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[SPEAKER_02]: We're filing, are you feeling better?

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[SPEAKER_02]: Are you feeling great and you're not having any side effects and that's kind of optimized?

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[SPEAKER_02]: And we know that that's what's within a certain range.

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[SPEAKER_00]: Yeah, well one thing I will say about

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[SPEAKER_00]: you know, with the normal optimal conversation is that my hope is that if we can start to test more women, then maybe we can improve what average looks like if we actually check them when they were at their prime, that's true because we don't really have any reason to check.

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[SPEAKER_00]: No, ladies don't get checked until they've, you know, begged and have been feeling bad for a long time.

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[SPEAKER_00]: And then the only one, I'll check it just as thrown and they'll check it.

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[SPEAKER_00]: But it'll say normal because normal per the lab is an average of all the patients that are in that age.

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[SPEAKER_00]: gender, bracket.

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[SPEAKER_00]: If you had something wrong with your kidneys, you wouldn't go see a kidney specialist.

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[SPEAKER_02]: Yeah.

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[SPEAKER_02]: So I think there's a value in saying like if you want to have your hormones checked and you want somebody to take it seriously and know exactly what to do with those then you would go see someone who specializes in hormone replacement therapy.

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[SPEAKER_02]: Correct.

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[SPEAKER_02]: So let's talk about the different routes of which you can receive hormone replacement therapy.

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[SPEAKER_02]: You can get injectable.

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[SPEAKER_02]: You can do a pellet, which is a pellet is about the site a little bit larger than a grain of rice.

15:34.550 --> 15:39.398
[SPEAKER_02]: It's injected under the skin into the fatty layer and it rusts there for several months.

15:39.378 --> 15:45.608
[SPEAKER_02]: delivering the hormone, as if it was mimicking what the body would do, if it was going to do it naturally.

15:46.389 --> 15:53.841
[SPEAKER_02]: We do have creams and oral, some oral options, trophies, rapid dissolvable tablet.

15:55.183 --> 15:58.669
[SPEAKER_02]: What is your preferred method in why?

15:59.442 --> 16:06.725
[SPEAKER_00]: So if we're talking perimenopause, I would say either injectable, if we're talking about testosterone, all right?

16:06.746 --> 16:08.591
[SPEAKER_00]: I would say injectable or pellet.

16:09.153 --> 16:12.203
[SPEAKER_00]: The reason being that testosterone is not

16:13.634 --> 16:21.544
[SPEAKER_00]: absorb very well through the skin and you can't swallow it, so it has to be sublingualy absorbed through the bloodstream.

16:21.725 --> 16:23.527
[SPEAKER_00]: So it can't go through the GI track.

16:23.607 --> 16:24.789
[SPEAKER_00]: It's just not going to work.

16:24.849 --> 16:25.510
[SPEAKER_00]: It's not going to work.

16:25.870 --> 16:25.970
[SPEAKER_00]: Okay.

16:25.990 --> 16:34.341
[SPEAKER_00]: And so I feel like it's hard to get your serum levels up to an optimal level when you're using that alone.

16:34.722 --> 16:36.604
[SPEAKER_00]: I think they're better than nothing.

16:36.584 --> 16:38.568
[SPEAKER_00]: But they're not my ideal estrogen.

16:38.588 --> 16:42.977
[SPEAKER_00]: My preferred is I like the pellet personally.

16:43.638 --> 16:44.761
[SPEAKER_00]: I like injectables too.

16:44.781 --> 16:47.847
[SPEAKER_00]: I feel like we can adequately raise the serum values.

16:48.468 --> 16:52.416
[SPEAKER_00]: I do have a lot of success with patients on like estrogen patches.

16:52.396 --> 16:53.277
[SPEAKER_00]: Okay.

16:53.297 --> 16:55.259
[SPEAKER_00]: It really is patient-specific.

16:55.320 --> 17:03.690
[SPEAKER_00]: I feel like I'm a huge fan of course of the intervaginal estrogen cream, but that's not going to increase your whole body, you know, estrogen level.

17:04.130 --> 17:04.230
[SPEAKER_00]: Okay.

17:04.250 --> 17:13.982
[SPEAKER_00]: And so the creams that go topically like on the arm that are intended for absorption for full body estrogen improvement.

17:13.962 --> 17:23.978
[SPEAKER_00]: I just personally did not see improvements when I used those nor did I, I couldn't get my serum levels up high enough on creams or patches.

17:24.599 --> 17:33.253
[SPEAKER_02]: I feel like people go, cream seems like a safe, from the patient's perspective, because I do have patients that ask me if they could get a cream.

17:33.233 --> 17:38.908
[SPEAKER_02]: Which I'm always willing to do, but then we have the whole conversation and what's your expectation?

17:39.148 --> 17:39.449
[SPEAKER_02]: Right.

17:39.569 --> 17:42.015
[SPEAKER_02]: And can this route meet that expectation?

17:42.076 --> 17:44.522
[SPEAKER_02]: So creams and I've tried creams on myself?

17:44.542 --> 17:44.863
[SPEAKER_02]: Yeah.

17:44.883 --> 17:45.645
[SPEAKER_02]: It's a good gateway.

17:46.527 --> 17:46.728
[SPEAKER_02]: Yeah.

17:46.748 --> 17:48.492
[SPEAKER_02]: I could kind of get with the gateway drug.

17:49.197 --> 18:01.528
[SPEAKER_02]: creams will like I mean there's a lot of factors to go into it right so the pharmacy can can deliver something that has like a pump at a certain click so that it's distributing the the same amount of medication each time when you click it if it's a pump.

18:01.768 --> 18:13.499
[SPEAKER_02]: However I don't I think that's hard to be accurate on and then when you rub it on so they say rub it on your arm or the back of your knee is what I've been told or in the vaginal area.

18:13.779 --> 18:19.204
[SPEAKER_02]: You don't know how much of it was left on the skin versus how much it was on your

18:19.184 --> 18:30.066
[SPEAKER_02]: And then, how soon did you put on clothes and did some of that get absorbed into the clothes or into your bed sheets or did you touch your partner and did you partner get some of that child?

18:30.186 --> 18:36.338
[SPEAKER_02]: Oh, yeah, I didn't even think about that or a baby like if you, so I have never really been able to figure out the serum thing.

18:36.358 --> 18:37.681
[SPEAKER_02]: I've kind of just to be honest with you.

18:37.701 --> 18:38.523
[SPEAKER_02]: I've just sold patients.

18:38.563 --> 18:41.108
[SPEAKER_02]: I'm like, we're just going to base on how you're feeling.

18:41.088 --> 19:03.838
[SPEAKER_02]: more so than anything because like when do you check it do you check it like right off you don't check it right after the cream or how many hours after you put the cream on do you like when you like if you're checking a serum level I mean is there much value of I don't you check it I don't think so because you're just not going to absorb them once yeah and enough and really when we're doing labs we are ensuring safety

19:03.818 --> 19:07.886
[SPEAKER_00]: more than we are necessarily carrying about hitting a mark.

19:08.026 --> 19:08.327
[SPEAKER_00]: Got it.

19:08.688 --> 19:09.008
[SPEAKER_00]: Yeah.

19:09.028 --> 19:09.549
[SPEAKER_02]: That makes sense.

19:09.589 --> 19:16.603
[SPEAKER_00]: Making sure it's safe rather than rather than looking on a certain particular number like, oh, I've got to get you at 758 or something.

19:16.644 --> 19:18.908
[SPEAKER_00]: It's the current symptom.

19:20.103 --> 19:33.214
[SPEAKER_00]: improvement that you are receiving as well as any potential side effects would be what we're really looking at but then we're backing that up by ensuring that the labs haven't changed in a negative way from your baseline.

19:34.095 --> 19:44.824
[SPEAKER_02]: So labs are a little bit hard to follow with creams, a lot of variability there and from my experience I didn't really experience that much benefit from it that I was looking for.

19:45.324 --> 19:49.688
[SPEAKER_02]: But patients like it because it's simple they're not taking a pill

19:49.668 --> 19:52.971
[SPEAKER_02]: it's easy, they could stop it in any time, so I totally understand that.

19:52.991 --> 19:53.651
[SPEAKER_02]: Am I willing to do it?

19:53.692 --> 19:57.034
[SPEAKER_02]: Yes, but I let patients know that prepare to be a little bit disappointed.

19:57.355 --> 19:57.655
[SPEAKER_02]: Right.

19:57.755 --> 19:58.516
[SPEAKER_02]: At the outcome of that?

19:58.796 --> 20:19.354
[SPEAKER_00]: Or I like, I kind of like creams maybe for a patient who was unfortunately part of that women's health initiative study, unable like love their hormones, taken off of them, maybe want to get started on something, but I'm wanting to be as conservative as

20:19.334 --> 20:19.635
[SPEAKER_00]: Yeah.

20:19.735 --> 20:24.805
[SPEAKER_00]: As long as we can get it, you know, high enough that it can improve their their symptoms of bother.

20:25.506 --> 20:29.895
[SPEAKER_02]: So I definitely like pellets the best.

20:30.075 --> 20:34.865
[SPEAKER_02]: I feel like pellet therapy, it's like looking at Lollipop.

20:35.025 --> 20:40.195
[SPEAKER_02]: So it is just slowly delivering that hormone at the rate of

20:40.175 --> 20:42.559
[SPEAKER_02]: would do it if it was able to do it naturally.

20:42.739 --> 20:45.103
[SPEAKER_02]: And there's not a lot of peak and trough, right?

20:45.123 --> 20:47.147
[SPEAKER_02]: It's just a steady, a more of a steady state.

20:47.768 --> 20:56.563
[SPEAKER_02]: The downside is people just don't like the idea of something being inserted into their body, which I truly understand, or they're worried that if they don't like it, they can't take it out, which you can't, you can't take the pill it out.

20:56.543 --> 21:06.214
[SPEAKER_02]: But in my experience, you know, when you're starting somebody in hormonal placement there, but you're starting at kind of a relatively moderate to low dose, based on how they're feeling and how nervous they are about it.

21:06.334 --> 21:09.237
[SPEAKER_02]: And often they come back and they're like, okay, I could use some more.

21:09.277 --> 21:10.919
[SPEAKER_02]: Like I definitely felt a lot better.

21:11.059 --> 21:14.683
[SPEAKER_02]: I'm really loving these this relief that I'm getting and feeling good.

21:14.943 --> 21:15.864
[SPEAKER_02]: I'd like a little bit more.

21:15.985 --> 21:25.335
[SPEAKER_02]: And so I honestly and knock on what I have not had anybody come to me and ask me if I could take a pill it out or can I reverse this because they haven't

21:25.315 --> 21:27.259
[SPEAKER_00]: So I really like the pellets that we use though.

21:27.299 --> 21:28.521
[SPEAKER_00]: I think that makes a big difference.

21:28.541 --> 21:28.761
[SPEAKER_00]: True.

21:28.922 --> 21:31.206
[SPEAKER_00]: Because I've done pellets just in general before.

21:31.266 --> 21:33.931
[SPEAKER_02]: And so the type of pellet matters too.

21:34.051 --> 21:36.135
[SPEAKER_02]: So not only just the type of route, the type of pellet.

21:36.155 --> 21:42.126
[SPEAKER_02]: So the pellets that we use have just a little bit of just a trace amount of triumphs in alone.

21:42.106 --> 21:48.122
[SPEAKER_02]: And the benefit of that is this anti-inflammatory so that when we insert the pellet, let me back up and say what the risk is.

21:48.282 --> 21:50.688
[SPEAKER_02]: So there is a possibility of pellet extrusion.

21:50.789 --> 21:54.218
[SPEAKER_02]: And that is where we insert the pellets, but then the pellet comes back out.

21:54.318 --> 21:58.208
[SPEAKER_02]: And that's just the body's natural waves like I don't recognize this.

21:58.188 --> 22:01.354
[SPEAKER_02]: I'm going to remove it or push it out or reject it.

22:01.554 --> 22:04.500
[SPEAKER_02]: Causes some inflammation, pellet comes out, no big deal.

22:04.620 --> 22:07.926
[SPEAKER_02]: However, then you're like gosh darn it, I lost my pellet that I just paid for.

22:07.966 --> 22:08.367
[SPEAKER_02]: Right.

22:08.527 --> 22:17.443
[SPEAKER_02]: Whereas if they put just a little bit of try and sit alone in there, it's anti-inflammatory, it tells the body to like, it gives, it's like just this warm blanket for the body just says, it's okay.

22:17.463 --> 22:17.624
[SPEAKER_01]: Yeah.

22:17.644 --> 22:22.272
[SPEAKER_02]: This is where we want this here, we're accepting it, and so the extrusion rate,

22:22.252 --> 22:25.356
[SPEAKER_02]: is zero on the pellets.

22:25.376 --> 22:28.481
[SPEAKER_02]: Now, and also, I've actually just as a company and then a Vexapela is the pellet.

22:28.641 --> 22:46.926
[SPEAKER_02]: The way that they have patented how they package that pellet allows the medication to be delivered more rhythmically and slowly so that you're not getting that spike, whereas some other pellets that are packed differently, so maybe you're more or less your Walmart brand of ORIR, I shouldn't say

22:46.906 --> 23:01.688
[SPEAKER_02]: of a pellet is going to not, it's not going to be packed in such a way that it delivers us slowly, so you'll get like this steep increase in side effects, maybe, and then it's going to dip down a little bit faster.

23:02.088 --> 23:05.353
[SPEAKER_02]: So you're going to get a little more of that roller coaster rather than that steady ride.

23:05.553 --> 23:06.775
[SPEAKER_02]: Right, injectables.

23:07.476 --> 23:08.758
[SPEAKER_02]: So speaking of the roller coaster.

23:08.938 --> 23:09.319
[SPEAKER_02]: Yeah.

23:09.299 --> 23:13.524
[SPEAKER_02]: injectables, you're going to get a little more of the up and downs, right?

23:13.764 --> 23:14.846
[SPEAKER_02]: So I get my injection.

23:14.966 --> 23:18.290
[SPEAKER_02]: I'm going to get kind of a surge of that benefit day two and three.

23:18.430 --> 23:18.610
[SPEAKER_02]: Yeah.

23:19.011 --> 23:23.896
[SPEAKER_02]: And then it's going to slowly roll down and then I'm going to get my next injection by the seventh day.

23:24.137 --> 23:27.180
[SPEAKER_02]: So the benefit of that is it's a little bit more adjustable, right?

23:27.321 --> 23:29.003
[SPEAKER_02]: So I can customize it a little bit more.

23:29.283 --> 23:38.614
[SPEAKER_00]: If a patient's nervous about, you know, the inability to unring the bell of putting in a pellet, it's a nice, you know, transition

23:38.594 --> 23:50.308
[SPEAKER_00]: We can at least ensure that you tolerate this fine, even though it's a natural part of our body, we would expect them to, but you know, they just want to make sure that they're not going to have any ill reaction from it.

23:50.348 --> 23:50.548
[SPEAKER_02]: Right.

23:50.608 --> 23:51.850
[SPEAKER_02]: So they want to test it before they.

23:51.970 --> 24:07.048
[SPEAKER_00]: Yeah, they can test the water just a little bit, but having done injectables as compared to the effects about pellets that we offer, I definitely prefer the pellet for myself now, especially now that I know kind of where my sweet spot is.

24:07.332 --> 24:12.580
[SPEAKER_02]: I will offer patients who are maybe a little bit nervous about it.

24:12.700 --> 24:14.923
[SPEAKER_02]: I will offer for them to start with injectable.

24:15.584 --> 24:23.416
[SPEAKER_02]: And then once they kind of reap the benefits of the hormone replacement, they will then want to transition to pellet because it's easier.

24:23.436 --> 24:26.160
[SPEAKER_02]: I mean, for women, it's like three to four months for men.

24:26.220 --> 24:29.785
[SPEAKER_02]: I would say it's four or five, maybe six months, rarely is it six months.

24:30.246 --> 24:32.209
[SPEAKER_02]: They get that benefit and they don't have to do anything.

24:32.189 --> 24:37.060
[SPEAKER_02]: they don't have to take, they don't have to come and get a shot on, so we don't have to take a pill, they don't have to put on a cream.

24:37.301 --> 24:51.413
[SPEAKER_00]: But I think it's also building that rapport with them that, you know, you're going to be as conservative with them as they want to be until they feel comfortable enough to trust that, you know, what you're offering is going to be of benefit to them.

24:51.393 --> 24:55.037
[SPEAKER_02]: Well, what about the troquies or rapid dissolvable tablets?

24:55.237 --> 25:00.162
[SPEAKER_02]: So I know some people have asked me about that and they have experienced having those before.

25:00.182 --> 25:10.713
[SPEAKER_02]: I would say it's very similar to, well, in some aspects, it's similar to a cream in that it's a little bit hard to hit the nail on the head, I guess, yeah, or the right amount.

25:10.733 --> 25:18.160
[SPEAKER_02]: Because some of it's absorbed through the buical macosa, which means it's directly into the bloodstream, which is what you want, but then you're swallowing some of it.

25:18.140 --> 25:23.666
[SPEAKER_02]: I tried to trokey, so a trokey is something you're going to put in your mouth and let it sit there for 30 minutes.

25:23.946 --> 25:25.568
[SPEAKER_02]: Yeah, like a loss in a lost age.

25:25.588 --> 25:29.472
[SPEAKER_02]: Okay, 30 minutes, to be honest, I can't even chew gum without swallowing it.

25:29.833 --> 25:34.598
[SPEAKER_02]: I was just like, I can't imagine having something just sit in my cheek for 30 minutes.

25:34.938 --> 25:39.583
[SPEAKER_02]: And then the rapid dissolvable tablet, they're a little bit more pricey, but they dissolve very quickly.

25:39.603 --> 25:43.247
[SPEAKER_02]: I tried one of those and it tasted horrible.

25:43.287 --> 25:45.670
[SPEAKER_02]: That was one that had testosterone in it.

25:45.690 --> 25:48.012
[SPEAKER_02]: Yes, it was horrible.

25:48.818 --> 25:52.623
[SPEAKER_02]: Somebody put sugar on a aspirin is what it takes to play.

25:52.643 --> 25:53.363
[SPEAKER_02]: Yeah.

25:53.383 --> 25:55.666
[SPEAKER_02]: I'm sure there might be some other options out there.

25:55.826 --> 26:08.702
[SPEAKER_00]: But again, it's just not, I've never been a fan of like testosterone or estradiol in a trokey form, progesterone I have used in a trokey form.

26:08.942 --> 26:11.846
[SPEAKER_00]: And I think it can be helpful.

26:11.986 --> 26:16.311
[SPEAKER_00]: I do like the liquid form better than the,

26:16.291 --> 26:19.219
[SPEAKER_02]: Yeah, it's like sub magna.

26:19.560 --> 26:22.067
[SPEAKER_02]: Is it like a dropper and you just drop out on your mouth or something like that?

26:22.087 --> 26:23.170
[SPEAKER_02]: Okay, I didn't even heard about it.

26:23.190 --> 26:30.050
[SPEAKER_00]: It felt a little more potent, but nonetheless, the micronized progesterone is kind of the standard of care.

26:30.451 --> 26:31.313
[SPEAKER_02]: What about?

26:31.293 --> 26:38.119
[SPEAKER_02]: something that I think is a question and something that's really brought up, we think of testosterone and has a lot of different benefits, right?

26:38.179 --> 26:50.050
[SPEAKER_02]: Like exercise efficiency being able to manage your way, increase your muscle mass and maintain it, lower your fat mass, sleep through the night, be able to focus, however there's a big subject of a libido.

26:50.811 --> 27:01.300
[SPEAKER_02]: And I think what makes me sad is when women come in and they want, they're like, my husband is upset with me for not having a libido,

27:01.280 --> 27:04.564
[SPEAKER_02]: And I, I'm kind of like, well, don't you want it?

27:05.285 --> 27:05.725
[SPEAKER_00]: Right.

27:05.865 --> 27:06.226
[SPEAKER_00]: Like, yeah.

27:06.566 --> 27:12.193
[SPEAKER_02]: I don't want to get you to a place where you're just like, okay, I can tolerate having sex with my husband.

27:12.353 --> 27:15.436
[SPEAKER_02]: I want to get you to a place where you actually enjoyed as much as they do.

27:15.737 --> 27:15.957
[SPEAKER_02]: Yeah.

27:15.977 --> 27:24.487
[SPEAKER_02]: Because we should be able to, I know it's women seem to experience more low libido than men do in general, although it goes both ways.

27:24.787 --> 27:27.490
[SPEAKER_02]: What I have found with testosterone replacement,

27:27.470 --> 27:32.717
[SPEAKER_02]: is that it's not, like I'm so thankful for it, let's just put it that way, you know, sex is more fun and enjoyable.

27:32.737 --> 27:34.119
[SPEAKER_02]: Do you not take my testosterone away?

27:34.259 --> 27:34.980
[SPEAKER_02]: Yeah, exactly.

27:35.080 --> 27:37.103
[SPEAKER_02]: I will die with a testosterone pellet in my butt.

27:37.303 --> 27:37.664
[SPEAKER_00]: Me too.

27:38.165 --> 27:47.277
[SPEAKER_02]: It wasn't so much that I suddenly became like this, I'm gonna say like a sex kitten, where I was just like always wanting it and wanting it to be spontaneous and all that stuff.

27:47.638 --> 27:50.862
[SPEAKER_02]: It was more that if my husband,

27:50.842 --> 27:53.747
[SPEAKER_02]: showed interest or initiated something.

27:53.767 --> 27:59.538
[SPEAKER_02]: I was a lot more into it and it didn't take me much to get to a place where I really enjoyed it.

27:59.718 --> 27:59.938
[SPEAKER_02]: Yeah.

28:00.399 --> 28:04.988
[SPEAKER_02]: Once I experienced that and really enjoyed it, I was like, oh my gosh.

28:05.228 --> 28:09.015
[SPEAKER_02]: Like, I feel like all these women are missing out on the ones that are just to have no libido.

28:09.035 --> 28:09.916
[SPEAKER_02]: And they're like, yeah, I'm fine.

28:09.936 --> 28:10.618
[SPEAKER_02]: I could take it to leave.

28:10.658 --> 28:11.259
[SPEAKER_02]: It's no big deal.

28:11.279 --> 28:11.880
[SPEAKER_02]: No, no, no.

28:12.160 --> 28:12.942
[SPEAKER_02]: It's really cool.

28:13.262 --> 28:13.543
[SPEAKER_02]: Right.

28:13.563 --> 28:14.605
[SPEAKER_02]: If you can get there.

28:14.645 --> 28:15.246
[SPEAKER_02]: Yeah.

28:15.226 --> 28:21.094
[SPEAKER_02]: So anyway, I just, I think testosterone is great, obviously testosterone is great for that for men and women.

28:21.114 --> 28:28.964
[SPEAKER_00]: Our anatomy is more complex, the fact that we need, you know, three hormones go towards that complexity as well.

28:29.004 --> 28:41.520
[SPEAKER_00]: And, you know, there's psychosocial components to it, there are a lot of other factors, but just, you know, hormones alone, if you are lacking testosterone,

28:41.500 --> 29:03.812
[SPEAKER_00]: You're more than likely not going to have enough comfort during sex to be able to tolerate it, which then gives you a negative feedback loop, but much like you were staying with the testosterone, when you are deprived of the testosterone for so long that you don't really desire it, then a lot of ways just find themselves avoiding it and trying to come with reasons for not

29:03.792 --> 29:05.075
[SPEAKER_00]: not wanting to participate.

29:05.115 --> 29:19.067
[SPEAKER_00]: And that's what I'll tell ladies, like you may not have like this ravenous libido where you're going to, you know, go attack your husband, but maybe you won't see no is often, or maybe, you know, maybe it'll be like, it'll sound like a good idea.

29:19.047 --> 29:19.468
[SPEAKER_00]: Like, right.

29:19.508 --> 29:19.749
[SPEAKER_00]: Yeah.

29:20.190 --> 29:22.194
[SPEAKER_02]: And that's definitely what the difference was for me.

29:22.275 --> 29:27.246
[SPEAKER_02]: It wasn't that, like I said, that I was thinking about sex.

29:28.108 --> 29:34.924
[SPEAKER_02]: Sometimes I was, but it was that, like, if he showed interest, I was just like, oh, yeah, right.

29:35.085 --> 29:36.448
[SPEAKER_02]: I kind of feel.

29:36.428 --> 29:37.429
[SPEAKER_02]: Like I was supposed to be.

29:37.449 --> 29:38.110
[SPEAKER_02]: I'd like guess.

29:38.210 --> 29:41.933
[SPEAKER_02]: And then, you know, with a little bit of foreplay, man, I was all in.

29:41.973 --> 29:45.416
[SPEAKER_02]: And of course, he appreciates all of that.

29:45.737 --> 29:50.902
[SPEAKER_02]: It's nice to see some marriages really start to connect more and enjoy that more.

29:51.102 --> 29:56.307
[SPEAKER_02]: And it makes me wonder how many relationships have actually been destroyed or ruined.

29:56.507 --> 29:57.348
[SPEAKER_02]: Oh, I always wondered that.

29:57.988 --> 30:02.673
[SPEAKER_02]: Just from yeah, lack of the right hormone balance in both partners, right?

30:02.713 --> 30:05.035
[SPEAKER_00]: I think it's a tistic show that like

30:05.015 --> 30:15.786
[SPEAKER_00]: the majority of divorce is occurred during kind of like, you know, what we would call like men's midlife crisis, which is often low testosterone in them, right?

30:15.806 --> 30:19.310
[SPEAKER_00]: And then women going through period to lead into menopause.

30:19.490 --> 30:31.343
[SPEAKER_02]: I guess my crusade is that both men and women really need, like if they're experiencing any of these symptoms, which I bet most people listening could mark

30:31.323 --> 30:39.336
[SPEAKER_02]: There's a ton of value and very low cost or risk of just getting your lab's checked by somebody who specializes in it.

30:39.416 --> 30:44.003
[SPEAKER_02]: Now, if you go to primary care, they may, and I'm only saying this because I worked at primary care for so long.

30:44.945 --> 30:46.187
[SPEAKER_02]: I wouldn't have known what to check.

30:46.687 --> 30:48.811
[SPEAKER_02]: I didn't know what a sex hormone binding globular is.

30:48.831 --> 30:50.574
[SPEAKER_02]: I didn't know what DHEA was.

30:50.594 --> 30:53.398
[SPEAKER_02]: I didn't really understand how to look at

30:53.378 --> 30:58.985
[SPEAKER_02]: thyroid, efficiently, or how to look a progesterone, or even estrogen, really well.

30:59.246 --> 31:08.959
[SPEAKER_02]: I would go to someone who specializes in that, just get a consult, sit down, talk about your symptoms, have them draw the labs, come back for a follow-up, and then it's just a discussion.

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[SPEAKER_02]: Right?

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[SPEAKER_02]: It's not like, okay, we're going to sit on you and inject you with testosterone now, because we think that's what you need.

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[SPEAKER_00]: It looks like it made you so eager that you're like,

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[SPEAKER_02]: And often times when we have that follow-up appointment, we initiate hormone therapy.

31:24.000 --> 31:29.549
[SPEAKER_02]: I would say 99% of us 100, we initiate therapy, and to see them back.

31:29.810 --> 31:36.902
[SPEAKER_02]: So I would encourage everybody, men and women, that if you're experiencing these symptoms that you would go, just go get checked.

31:36.950 --> 31:43.925
[SPEAKER_00]: especially when you have so many symptoms that could be written off as something else, but you're like, what is going on with me?

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[SPEAKER_00]: Like, why?

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[SPEAKER_00]: Like, for guys, like, why do I not enjoy to play golf and I've always loved golf?

31:49.116 --> 31:49.918
[SPEAKER_00]: No motivation.

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[SPEAKER_00]: Motivation, low mood, and then in women, you know, it could be that irritability, the lack of sleep, and just the...

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[SPEAKER_00]: just feeling right.

31:58.195 --> 32:13.806
[SPEAKER_02]: It's we've got both people in a marriage that for like a better term feel like shit and are not feeling good about themselves or not energized or an exercising or gaining weight and then of course a woman when they are gaining weight the less less than they want to do is take their clothes off.

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[SPEAKER_02]: And that all those things could just be probably easily resolved or at least

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[SPEAKER_02]: help.

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[SPEAKER_02]: And yes, people are happy with just an improvement, right?

32:24.723 --> 32:33.513
[SPEAKER_02]: You know, I just feel like I need to dissolve things at 100% and I realize that if I can just make somebody feel better, they're a 100% happy with that.

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[SPEAKER_00]: Right.

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[SPEAKER_00]: And I think that's what is also important is setting realistic expectations and letting them know, you know, this is kind of the timeframe for which we would expect some improvement to occur.

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[SPEAKER_00]: So that way they're not

32:48.550 --> 33:03.842
[SPEAKER_02]: Well, again, especially if the certain therapies, if you're only doing it for certain therapies, where you're having a slow incline, they may not notice a marked improvement, some improvement, not a marked improvement, however, if you take them off of it.

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[SPEAKER_02]: Correct.

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[SPEAKER_02]: So I have had people where they, they were like, well, I, yeah, I noticed some benefit, but not enough for me to do it again.

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[SPEAKER_02]: And then it wears off like the pellet wears off.

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[SPEAKER_02]: And I've had a couple of patients who are like, oh my gosh, I just can't, like, they go back to the way they felt before they had the pellet, but they forgot what that was like.

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[SPEAKER_00]: Oh yeah, it's crazy how fast you can forget feeling that bad?

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[SPEAKER_00]: Yes.

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[SPEAKER_00]: Yeah.

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[SPEAKER_00]: So that's why I'm always like so concerned about what your baseline symptoms are because I'm going to give you that paper and we're going to go

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[SPEAKER_00]: Right, because that's a big reminder because a lot of patients are like, if you ask them how you're feeling.

33:38.380 --> 33:43.806
[SPEAKER_00]: Um, yeah, I think I maybe have a little bit more energy, but then if you're like, okay, well, how are you sleeping?

33:44.487 --> 33:45.808
[SPEAKER_00]: Oh, yeah, I'm sleeping pretty good.

33:46.389 --> 33:47.851
[SPEAKER_00]: Have you had any more of those night sweats?

33:48.711 --> 33:49.652
[SPEAKER_00]: No, none.

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[SPEAKER_00]: Have you been able to work out?

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[SPEAKER_00]: Do you feel like your house your exercise going?

33:54.318 --> 33:56.120
[SPEAKER_00]: Yeah, I've been doing good with that.

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[SPEAKER_00]: And I'm not as achy anymore.

33:58.542 --> 34:01.926
[SPEAKER_00]: So then you start getting down that avenue where you're like, okay, well,

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[SPEAKER_02]: Okay, it is making a difference for me.

34:03.949 --> 34:13.303
[SPEAKER_02]: I thought I was getting sick when my pellet were off the first time because the first pellet I did, I just kind of did like a lower dose than what was recommended, just because I was a little bit nervous and you're telling.

34:13.623 --> 34:18.651
[SPEAKER_02]: Yeah, I was dipping my toe and it wore off and I thought I was getting sick that week.

34:19.392 --> 34:20.594
[SPEAKER_02]: I was having night sweats back.

34:21.054 --> 34:22.216
[SPEAKER_02]: I just felt shitty.

34:22.456 --> 34:23.097
[SPEAKER_02]: Yeah.

34:23.197 --> 34:29.787
[SPEAKER_02]: I felt really tired

34:29.767 --> 34:37.583
[SPEAKER_02]: This is exactly how I felt before my pellet, and of course that, and then I checked my lab and yeah, sure it's shit, that's what it was.

34:38.084 --> 34:41.952
[SPEAKER_00]: Anyway, so confidence is another thing I think testosterone really.

34:41.992 --> 34:47.083
[SPEAKER_00]: Oh, it's a weird way to put in it, but yeah, you know, like the ability to get stuff done.

34:47.063 --> 34:52.030
[SPEAKER_00]: I think as ladies, sometimes we pride ourselves on being able to multi-task and do all these things.

34:52.771 --> 35:04.988
[SPEAKER_00]: And we get really down on ourselves when we feel like we're not superwoman anymore, and often times like whenever my testosterone gets low, that's when I start to notice like,

35:05.204 --> 35:07.869
[SPEAKER_00]: everything feels overwhelming like not as productive.

35:07.990 --> 35:08.350
[SPEAKER_00]: Right.

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[SPEAKER_00]: Like, oh, I have to make dinner again.

35:10.635 --> 35:13.661
[SPEAKER_02]: What I have to do, I have to like, I have to take a shower.

35:13.701 --> 35:17.168
[SPEAKER_02]: Yeah, I have to organize the schedule for everyone.

35:17.208 --> 35:23.601
[SPEAKER_02]: So yeah, I definitely think that's a really good perspective to that testosterone can give you confidence.

35:23.665 --> 35:25.969
[SPEAKER_00]: Yeah, not in a, you know, a direct way.

35:25.989 --> 35:31.699
[SPEAKER_00]: Not in a direct, like I'm all of a sudden physically fit type of right it just feel much better.

35:31.739 --> 35:32.500
[SPEAKER_02]: Yeah.

35:32.520 --> 35:34.884
[SPEAKER_02]: Well, that is all we have time for today.

35:35.125 --> 35:36.247
[SPEAKER_02]: So thank you, Brandy.

35:36.327 --> 35:37.329
[SPEAKER_02]: Can you tell us where you're at?

35:37.349 --> 35:38.150
[SPEAKER_02]: Where can we find you?

35:38.491 --> 35:44.982
[SPEAKER_00]: So I'm at a rising mid-spawn wellness on the Plaza for two days out of the week and Shawnee for one of the days out of the week.

35:45.198 --> 35:55.520
[SPEAKER_02]: If you'd like to see one of us at Horizon Medspon Wellness, you can go to the website www.herizonmedspotandwellness.com or you can go to our Instagram.

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[SPEAKER_02]: It is Horizon Underscore Medspot Underscore Wellness.

35:59.789 --> 36:03.517
[SPEAKER_02]: You can also find me at Kimberly Losek N.P.

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[SPEAKER_02]: That is my Instagram.

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[SPEAKER_02]: And that is all we have for this week.

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[SPEAKER_02]: So thank you for joining us.

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[SPEAKER_02]: Have a great day.