The #1 Menopause Doctor: How to Lose Belly Fat, Sleep Better, & Stop Suffering Now

If you’re struggling through menopause, or know that it’s happening soon for you, this episode is a must-listen.

To healthily move through menopause, rather than suffer through it, you should start having the hormone conversation with your doctor. In today’s episode of the Habits & Hustle podcast, I talk with Dr. Mary Claire Haver, about menopause, hormone therapy, and talking with your doctor.

Listen as we discuss the importance of estrogen for reducing the risk of chronic diseases, why women should take testosterone, and how strength training can improve the menopause experience.

We also discuss the benefits of using weight loss peptides paired with HRT for more effective fat loss as well as how to improve your chances of keeping the weight off.

Dr. Mary Claire is leading the conversation about changing menopause healthcare. She founded The ‘Pause Life, a comprehensive approach to menopause education and support, using techniques that focus on overall lifestyle, helping women reach their best-feeling selves. Additionally, she just released her second book, The New Menopause.

What we discuss…
(6:00) Using social media for education
(8:15) The difference between peri and post menopause
(20:00) The importance of estrogen
(26:00) Using HRT to reduce disease risk
(36:00) Have the HRT conversation
(43:00) Testosterone for women
(48:45) Strength training can drastically improve the menopause experience
(55:00) Belly fat and semaglutide peptides
…and more!

Thank you to our sponsors:

Find more from Jen:
Website: https://www.jennifercohen.com/
Instagram: @therealjencohen
Books: https://www.jennifercohen.com/books
Speaking: https://www.jennifercohen.com/speaking-engagement

Find more from Dr. Mary Claire Haver:
Website: https://maryclairewellness.com/ www.thepauselife.com
Book: The New Menopause
Instagram: @drmaryclaire

females have to live with a set egg supply and then it it ages our ovaries age twice as fast as the rest of our body by the time we’re 30 we’re down to 10% of our egg supply and by the time we’re 40 we’re down to about 3% this is why fertility declines as we age all this hormonal replacement therapy like when do you know when you’re a good candidate for it why is there so much fear is there a benefit for going on something like that like the o PS of the world um if you are gaining belly fat from menopause when you lose weight you’re losing fat and muscle all right well hi nice to meet you same it’s really nice to meet you you’ve been doing very well with this book I have to say I’ve seen you like everywhere it’s yeah it’s kind of overwhelming but it’s great I can imagine I can imagine I mean first of all I think it’s the way you describe explain things in such wonderful layman terms that people can really understand what you’re talking about really you know which I think is half the battle right so I think it’s my superpower that you know i’ done it for years with patience it just oneon-one in the office and then I just was able to kind of take that skill and start talking about it on social media and who knew you know I started with no followers like everybody else so wow when did you actually oh by the way I should we can start and we we could talk about this cuz we actually haveen well let’s actually just let’s just say we started because it’s actually very organic this way I I think it’s great and you pronoun I wanted to say who you are the book is called the new menopause by Mary CLA by Dr Mary Clair habber It’s a Wonderful read if um just because you explain things like I said exceptionally well and it it’s it’s an you explain it in a way that everybody can understand very sometimes very scientifical things scientific things that are quite difficult so and you were just not to interrupt you you were saying you started on social media how long ago have you when did you actually start um I want to say I started on Facebook like everybody else right um in our age demographic really just for friends and family and then before there were business Pages or anything and someone asked me a question one day just about Gynecology stuff and I answered it like on social and and like that’s and I there a lot of people were like oh my God you know and so I was like does anybody else have any questions and it just kind of grew organically from there and then we we had a business page and then um during the pandemic my kids were like Mom you should be doing this Tik Tok thing and I was like no that’s for kids and dancing and and whatever but I was like whatever and so I just put a toe in the water on Tik Tok and it exploded like it was crazy how fast it grew and then you know my dopamine’s firing every two minutes and you know you’re like you’re like oh my God and you I grew to a million followers on Tik Tok within like a few months and then that conversation just got bigger and bigger and then we really started get it busy on Instagram which really was where most of our demographic hangs out now so wow is that you know it’s true I think that Instagram became the new Facebook you know when we would be like oh Mom like our mom’s on Facebook and now it’s like actually our grandmas are on like great grandmas are on Facebook and you know you’re right like I believe like it’s Instagram is for our our demo and then Tik Tok which is for the younger however like you were just saying you thrive on Tik Tok which is L crossover there is but I do tailor my message depending on how I explain things knowing that Tik Tok sk’s younger and mostly male like well no actually 89% of my followers on Tik Tok are female 98% on Instagram are female so I’m a little bit broader and trying to talk to a a wider AUD you know so I really do tailor and Facebook is my age plus like 55 65 70 year olds who still want to learn and so but I have to really curate that message so it’s but it’s fun you it’s like a game to me it is it is but you still have a practice you still you still see patience so how often are you in like in office patient so I am I’m in clinic about two days a week and I have a team um who fill up the rest of the days so that I can work on my other businesses and social media the other three days a week wow so social media is become like how much of it would you say is your business now social media like 70% what you know time spent 70 60% probably um but it’s like I’m researching something for the book or for the next book which we are still kind of playing with and I’m like oh this particular subject would make a great informational video for Instagram you know and so then I’ll make a long form video for YouTube which is where we do like long teaching and then we can cut that down we’ve gotten really good about being efficient with the same with the same message right you know what actually now that we’re talking makes sense why you would do so well on Instagram because if it is the age demo of 40s 50s late 30s let’s say that’s who would be affected by pre you know per menopause menopause right so you’re like you’re like right in that strike zone of information that is completely of interest and which is what I was going to ask you and now I kind of just figure it out myself like is it because I’m in that age demo now and that’s possibly like affecting me that all I seem to see now are things about metapa and per metapa and hormones me too and I just think well that’s all I you know like that I’m like is are we talking about anything else anywhere else yeah you know I’ll see some of my favorite creators on Tik Tok and they’re like B now you’ve seen the video about low and the crop top I hadn’t seen it I had to go dig and find it like like the algorithm is only showing me Dr menopause stuff so I you know that’s my fault well I also think though like in this business so like I do a lot I I talk to a lot of people in like productivity and health wellness fitness longevity all the things right and obviously also business mindset um but I will say I have noticed a major uptick and upswing in even people who don’t necessarily talk about hormones and metapods are now putting these guests on their shows because it’s a very hashtag friendly thing now right so people are what they’re doing is they’re gravitating to people who will get them views and what’s trendy and popular and this has become a very trendy popular area because I guess it was a vacuum there was a dark zone no one was talking about it and I think I was willing to talk about it before a lot of other people were and before other people had educated the cells you know we don’t have a great medical training program you know part of the medical curriculum for a standard you know osteopathic like regular MD or a do does not include a robust menopause curriculum so you have this whole generation of practitioners who are out practicing who really know like the most cliche minimum about menopause yeah and I went back to school and educated myself you know and decided to talk about it and share what I’d learned some of it is shocking you know and so I think that’s you know and then I found the menop posi which are kind of my my social media friend group of other like-minded practitioners who are doing the same thing some in sexual medicine some in general medicine some cardiologist you know but we’ve all kind of bonded together this this Sisterhood and a couple of good men and it’s incredible and so I’m always like oh I’m booked here here go talk to my friend Dr men you know yeah on your podcast trust me she’s amazing so I love that I love you called metapa that’s hilarious by the way and we’re in the meterse you know like we have all that’s so great I feel okay so the let’s let’s start from the beginning okay because there’s a bunch of stuff when I read your book and a a couple things really were shocking to me and I I’ll get to that in a second but let’s first talk about what really is the difference between paropa and menopause because I think there’s a lot of confusion and nobody really knows let’s start in the middle we’ll go back to the very beginning and then work our way back forward okay okay menopause is one day in your life that’s it one day medically it is one day after or the day that is one year after your last menstrual period the LMP the final menstral per period if it’s naturally occurring okay that is a terrible definition it you know it it it was designed by people who what if you don’t have a period what if you’ve had a homy what if you have an IUD what if you know you have polycystic ovarian syndrome like how you can’t Define your menopause that way what it represents is the end of your ovarian function of the ability to create estradi and progesterone so let’s go way back to the beginning when we were in our mother’s uteruses so you’re in your mom’s tummy and you’re a fetus and you’re growing and you’re about five months along okay she’s five months pregnant you have the maximum egg supply of your whole life right then and there before you’re even born and they start deteriorating from that minute by the time we’re born we have one to two million eggs in our ovaries that active very different than males who have testes that make their genetic material what we call germ cells in medicine so the eggs are the female germ cell the the sperm are the male germ cells okay they make their stuff fresh every day from puberty till death if they you know a healthy man um females have to live with a set egg supply and then it it ages our ovaries age twice as fast as the rest of our body this is the fastest fasinating thing to me so here we go we go through puberty okay and we start ovulating every month you lose about 11,000 eggs in the race to the have the one ovulate okay and the quality of those eggs is deteriorating every single day because they you were born with them they get hit by X-rays and environmental things and they’re just getting older they’re aging very very quickly so by the time we’re 30 we’re down to 10% of our egg supply and by the time we’re 40 we’re down to about 3% this is why fertility declines as we age as well as the risk of a chromosomal abnormality like down syndrome and and the others okay because that egg quality the health of that egg is deteriorating with h menopause represents you’re done the eggs are gone and when that happens you can no longer ovulate there’s no more eggs left so there’s no more and in that ovulatory process is where the EST diol is made and then the progesterone after ovulation what is per menopause okay so here we are normal reproductive Cycles in a healthy female okay your ovulation every month is a cycle so we have the hypothalamus is in the brain right and then the pituitary sits right below it two glands that are part of our endocrine system the hypothalamus has a little sensor in the blood that is always looking for estrogen and it’s also looking for thyroid hormone and some other stuff okay so it’s like all right estrogen we’re good we’re good we’re good whoop we’re getting low it sends a signal to the pituitary gland that says hey tell the ovaries we need more estrogen so the pituitary sends out LH and FSH in different pital Fashions I’m simplifying this greatly and says hey thank God says Hey ovaries let’s get an ovulation going we need some estrogen so the ovaries are like gotcha boss they start looking for that one egg to ovulate and the cells that line that egg are starting to produce estradiol more estradiol more estr more estr it’s pumping water around that egg and then that makes a cyst that pops the egg comes out gets caught up by the fallopian tube blah blah blah and the whole thing starts over again every single month okay the second half of the cycle the progesterone is made in the Corpus ludum that little sack Left Behind where we ovulated from and that is a very predictable repeatable pattern for healthy women month after month after month after month after month it looks like an EKG when you look at the hormone surges every month which is why we have this phase we act like this that phase we act like that and we have metabolic changes we have all kind of changes throughout the month per menopause the ovar is starting to not respond to those same signals because it can it’s harder it can but it needs more juice so the hypothalamus is like hey I told you we need more estrogen and the pituitary is like I sent the signal and the hypothalamus is like well it must not have hurt it sin more so we get these bigger surges of LH and FSH and the ovary is like okay it’s coming it’s coming it might be a little delayed you might have you might skip a period or it’s it’s a few days late but then all of a sudden all right we got it and the egg comes out because you had so much more stimulating hormone to make that happen we have a bigger surge of estradi so what used to be this very predictable EKG month after month after month now becomes erratic you get surges of much lower drops progesterone lags quite a bit it’s often quite low so now you’re in the hormonal zone of Chaos in perimenopause on your way to those final eggs until you’re done and that per menopause process could takes seven to 10 years okay yeah I mean so that’s that’s what’s interesting but I want to go back a second because I know that you’ve said that I’ve heard you talk about it about I’m still on the fact that you are at 30 years old you only have 10% of your eggs that is an insane a number that’s almost like 90% s now you know like why this is happening to you and does that does that mean though at at 30 years old you’re then you could be technically in per menopause because you are losing these eggs like at such a rapid scale average woman so per menopause so average age of menopause is 51 in in in North America okay normal is still 45 to 55 so 95% of women will have their final menstrual period between 44 and 54 years old meaning menopause is 45 to 55 right because it’s a year later okay and so that 7 to 10 years let’s back that up so most women will start seeing some disruption in the forest between 35 and 45 you follow me so okay yeah I totally am so now 30 is possible but that’s putting you in a different category either early or premature menopause but it’s possible okay so my question is there a way is there a natural way to keep your eggs healthier and healthy as you’re at a younger age great question wouldn’t there be a great study on that but we haven’t can done it so now we know that there are things we can do to to chip away at our eggs hysterectomy you lose four and a half years off the shelf life of your ovaries okay having one ovary removed you lose a year and a half being africanamerican or you know having African cult um genetics you lose two years you know you go through younger your symptoms are more severe so if you smoke you lose about two years if you um have chemotherapy if you have abdominal surgery there are multiple things we can do to chip away at the natural shelf life of the ovary but we have yet to discover things that will you take Twins and otherwise healthy what can one do to push her menopause out we have no idea now there’s studies going on right now looking at medications that can turn off the signaling that causes the the ovaries to age but they’re all experimental we’re not there yet but they’re looking at it because so so basically you’re saying there’s nothing that you know of as of as of yet that I literally have read every study on the subject like like we know that there’s things you can do to mess it up but there’s no pill Potion No matter what anyone says on the internet that will extend the life of those ovaries and also what that is interesting yes which is interesting is because let’s say people who have fertility problems right and you look at somebody who you think would have no problems who who are super healthy they appear to look super healthy they’re doing all the right things they’re eating well they’re exercising they’re not smoking doing drugs and they’re unable to have a child which means there’s some disruption in their in their air quality but then you see a crap addict on the street and they can have 47 kids you know as a OBGYN resident who was older who had massive fertility issues and needed lots of drugs and medication and all the things to actually have a baby I lived that you know looking at people making all of these incredible choices and able to conceive and I couldn’t you know it was hard and hard to not be resentful or or you know and then you have your baby you eventually get pregnant for me I was lucky and you know but yeah it’s it’s almost like menopause symptoms you can definitely if you make poor lifestyle choices you’re not going to have as easy of a menopause but even people who have the most on point nutrition exercise the whole nine yards can still suffer horribly so it’s not 100% right right so does it really depend how much of it is genetics then of what your experience is well that the age of menopause is definitely genetic there’s a huge genetic component so if your mom went through early especially if she had premature or early menopause you’re much more likely to have that than her now it’s not a of course you get half your DNA from your dad so that’s going to play in a factor too but we always ask when how old was your mom if she knows you know when did she go through menopause if she can figure that out most ladies don’t know in my mom’s generation you know yeah I know talked about it they never clocked it um it was very like I don’t know if it was it wasn’t a shameful thing it was just something that you just never it it was something that was like private or you just kind of dealt with on your own in in the back my mom um was on HRT and she never came off of it until her 70s and you know she did really well she’s not doing well now um in her 80s she’s on a walk she’s been on a walker for 10 years and she she’s now demented and dealing with Dementia and um she’s a mess but um you know she I remember her being in a dark room and shutting the door now I was one of eight kids so our house was crazy but I would lock myself in the dark room too if I had that many kids and um she would and she would my dad would blame menopause it’s menopause is menopause and then she got on hormones and I don’t remember that being a thing again so I I I have a lot of questions about hormones but I I want to first ask you about a couple different things cuz some of these signs for per menopause really surprised me um one of them because I had this last year people made fun of me but I had I and I got I had a frozen shoulder and everyone you know so my my my friends were like oh that’s the old person uh that’s the old person mageed woman middle-aged my and so my sports medicine doctor was like oh yeah CU a lot of middle-aged women get frozen shoulder I was like what are you talking about I thought I got it because I’m a workout fanatic overuse wear and tear well that may be a a part of it but adesive capsulitis is directly Rel like you are much less likely to develop adhesive capsulitis if you’re on HRT okay I’m not on anything I’ve never taken anything I’ve never done anything because I have something that most people are like I think a lot of people are are fearful which I want to talk to you about about and by the way HRT is hormone rep uh replac thery for yeah for people who don’t know but so to me that frozen shoulder symptom was shocking to me that that could be one so it’s because of decreases so can you explain why so so when we look at them here’s what your audience should understand estrogen does a lot of fabulous things in our body that we take for granted it is a hugely powerful anti-inflammatory hormone um and when it goes away we lose resilience to a lot of muscular skeletal inflammation and diseases so we see more joint pain we see arthritis we see argas there’s a direct the collagen is not as healthy without estrogen the tendon joint interact you know where those things kind of hook up is less elastic we see more stiffness I mean we 80% of women will have some form of muscular skeletal syndrome of menopause and for 20% of us it’s going to be their most severe symptom their most most bothersome of all things and this correlation was just made in the last few years so what we’ve learned in modern menopause medicine which is going to take a whole generation to propagate back down through the ranks is that there are estrogen receptors everywhere in our body our brains so cognition issues mental health changes our hearts palpitations our lungs Asma our gut gut health you know the quality of your gut microbiome how you absorb glucose everything is related when estrogen goes down the muscular skev system muscles bones joints osteoporosis the genital urinary system you know both the bladder the urethra the vagina the vulva the labia all of it terribly affected by the loss of estrogen um our ability to sleep our ability to process alcohol our ability to be resilient to stress and mental health changes how our our liver hugely affected massive increases in cholesterol with no changes in diet and exercise through the menopause transition massive changes in visceral fat for most women through the menopause transition zero changes in nutrition or movement and we see increasing visceral fat deposition what I was going to say is when do we know when do we know if a symptom or an ailment we’re having is because of a lack of estrogen versus just some other type of yeah so the thing about per menopause and menopause is that it’s usually a constellation of things and so we have validated scoring systems that have that were developed I think in in Australia where they look at severity of like 12 15 different symptoms and then you get a number score and the higher the score the more likely it is to be related to your per menopause so I have a patient coming in with multiple vague complaints and she’s still having regular periods you know so I can’t use her cycle to kind of Judge where she is in the process I will do blood work to Ru Ru out hypothyroidism autoimmune disease you know multiple different things nutrition deficiencies I want to make sure I have a good Baseline on all of that but if everything else comes back normal we’re not checking hormones in per menopause why because it is the zone of hormonal chaos and depends on the minute of the day as to what your levels could be so a one-time blood test a onetime urine test a onetime saliva test is rarely diagnostic for per menopause so we those us who do what I do don’t we don’t use hormone levels they’re not helpful so they’ll come back normal 98% of the time and so even though you you are just completely chaotic remember in a regular healthy cycle the estrogen level is peaking midcycle and dropping off you know it’s low at the beginning it Peaks mid cycle it drops off then you have a second small rise and then the whole process starts over again so without predictable timing of when the blood’s drawn drawn in relation to your cycle which goes away because it’s so chaotic and Parry menopause it’s not helpful so if your doctor is charging you hundreds of dollars for all these hormone tests I I would save your money and find a different provider that’s interesting because everything goes through where your hormones are like um the people want to put like I’ve got I’ll tell you so like they’ll say oh you have low testosterone you have low this is very stable in a woman so there is a low level of tea that’s different estrogen goes crazy progesterone goes crazy tea is stable or down so that’s that’s a good one to check so but to so is there some type of correlation with per menopause and low testosterone because I have like zero testosterone and a lot of my friends AB are abely so women have a more steady state decline in testosterone throughout their life just like men so men have about they Peak at 19 and it’s about and they kind of drift off a little quicker until like mid-30s and then it’s like a 1% decline until they die you know and so if so only about 30% of men have just testicular or have testosterone low meaning dysfunction for women once we go through menopause we lose like half of our testosterones being produced in the ovary that drops off 20 you know 50 75% we never go to zero I mean it’s going to be low but you still have the adrenal pathway working to produce some testosterone but not to say you wouldn’t benefit from replacement but it’s not surging and falling throughout the cycle and it’s not chaotic in per menopause it’s usually kind of low so that’s a reasonable one to check but I just put people on testosterone I know they’re low they’re in Parry menopause especially if they no libido so I wanted okay so I want to ask you about uh HRT horal replacement therapy who’s a good candidate who is not um um is it a myth that HRT um is something you should stay away from if cancer or breast cancer runs in your family I I I think there’s a lot of fear around it so the HRT is is hormone replacement therapy or menopausal hormone therapy depending who you read and basically I look at it as giving your body back the exact same hormones that you used to make when you were your healthiest to allow these critical processes to continue unfettered as well as they could what’s happening is when we lose our estrogen we have an acceleration of cardiovascular disease we have an acceleration of neurod dementia we have an acceleration of osteoporosis and Frailty we have you know all these things kind of Skyrocket rather than go with this usual path due with AJ we have an acceleration of the chronic diseases associated with aging and the diseases specifically affecting women including autoimmune disease and women on HRT especially starting young in their menopause like early in their menopause in par menopause or in the first 10 years of menopause have lower all cause mortality 50% decrease risk of cardiovascular disease year fore and a decrease in cancer so so where did this come from like you know don’t eat soy because it’s estrogen producing right and so oh God women who have high soy diets have lower breast cancer rates by the way so where did this whole thing remember this whole thing about 20 years ago like I’ve been staying away from soy my entire life because I thought that that was going to kill me never been proven never been proven nothing and now when I go and look at demographic data on women sorry my lips are dry on women who have naturally High soy diets like Asian women who eat Adam mamy all the time um they don’t have breast cancer like we do so here’s what happened there was um we’ve known for years that women on hormone therapy as 38% of women were on before the Whi so about 40% of menopausal women were on HRT not only for hot flashes and night sweats but for the protective benefits of decreased osteoporosis decreased heart disease we knew that that was the thing but it was observational data so there was the healthy woman hypothesis meaning are women are natur just healthier because they’re whiter and more educated and they have more access to healthcare you know and and we’re just seeing an artifact or is this real and the way to prove it is a randomized control trial so finally we had a female leader of the National Institutes of Health she puts this study together it’s amaz I mean we’re like so excited it’s a high quality study thousands and thousands of patients and they’re like okay we’re the end result that we’re looking for was is heart disease going to be delayed or stopped with hormone therapy so they chose is the average age of the patient as 63 63 okay yeah not 50 the average age of the woman starting hormone therapy 63 why because they can’t run the study forever it’s too expensive so we’re going to start it later to see if there’s cardiovascular benefit because these women aren’t going to have heart attacks till they’re in their 70s or 80s so to save money and that made sense they were also tracking multiple factors they were looking at Frailty scores all kind of stuff so I here we go with the study and we have two arms we have women who have uteruses and women who don’t two groups okay the women with uteruses got estrogen and progestogen or Placebo and then the other group got estrogen only because they don’t have a uterus or Placebo here we go so remember average age 63 they see that versus placebo the rate of breast cancer went from four out of a thousand women per year to five out of a thousand women per year on on the medication so that is a 25% increase in relative risk mhm not absolute risk relative risk they stopped the study call a press conference before the paper was published before any physician could look at it it was the number one news story medical news story of 2002 it was on the cover of every single newspaper ABC Good Morning America Nancy Sniderman got on there was like I took all my patients off people are throwing their estrogen in the trash the estrogen only arm showed a 30% decrease risk for you know of breast cancer it was the progestogen which was synthetic so then but what did the headlines say estrogen causes breast cancer so this is so interesting because all relative risk which is what is like your individual risk as a patient was 8% less than 1% per year so then you’re saying that anybody who’s in parim menopause who has deficient hormones should be going on HRT they should consider it they deserve the conversation and that’s what’s not happening not that they would not choose it it is a shared decision between the patient and her provider they’re being denied access in conversations around it doctors are just saying they don’t believe in it like in Santa Claus or it’s going to kill you they hav it all of those findings have been redacted okay and what is the reason behind it like this whole it’s going to kill you because if you’re just supplementing your body with what it had before exactly what is like where is the disconnect how is that something that is dangerous okay so if you have so say you breast cancer is a healthy cell that has gone through a malignant transformation right through tits to the DNA and you know if we look at how we’re dividing cells and and all that if your breast cancer cell through the malignant trans formation retains its estrogen receptor which healthy cells have to have to be healthy okay yeah we need estrogen receptors to make the breast cells do what they do if it retains its breast cancer its estrogen cell it is now estrogen receptor positive and they can use that receptor against the cancer cell to stop the breast cancer from growing so if you have an estrogen re receptor positive cancer that you know that we don’t want to feed then you might be getting tamoxifen or a serum or one of the anti-estrogens an aatase inhibitor you know to fight your breast cancer that’s totally reasonable so not everyone is a candidate for hormone therapy if you have an a hormone sensitive cancer anywhere in your body to that particular to estrogen or progesterone you’re not a candidate if you have severe liver disease you’re not going to process and break down estrogen the appropriate way you’re not a candidate if you have unexplained vaginal bleeding you’ve not had the ultrasound or workup or biopsy you’re not ready for HRT so there are you know patients all of these are very nuanced conversations but just because you’ve had breast cancer does not mean that you are going to be categorically denied hormone therapy but what was the first thing you said if you have hormone like what you said something like if you’re somebody that has a hormone def issue like positive cancer like if you have cancer not to go on it yes obviously but the other you said cancer vaginal bleeding you said enough and you said um severe liver disease so other than those things you think that anybody else those are the big ones so like family history no problem blood clots don’t do oral estrogen do transdermal you know again Nuance conversations so much misinformation I these poor women are crying to me who are absolutely suicidal at the end of their rope like they are miserable and they’ve been told oh your grandmother had a blood clly you can’t you know I’m like what you know these people don’t know how haven’t educated themselves the system is not educating them I agree we have so much work to do this is why the truth is most people I know who are getting hormone therapy they’re not going to the regular OBGYN a regular doctor they’re going to some back alley they’re going to a back alley place they’re going to these like Rando doctors these functional medicine yahoos that I don’t even know who they are who are giving them I don’t know what are these Med they’re going to Med Spas really it’s where they’re going they’re going to Med Spas that’s the truth dressed up as functional Med that’s where they’re going and they’re going masquerading oh and you can get your Botox and you can get your Botox you get your F I love boto listen I I’m not I’m just saying is you’re going to these like second like you’re going to these second rate places that are not even a proper medical facility so women have a long history in this world of having to go to Alternative or back alley places for needed medical services and they’re going to do it and this is just another example so where do people find it like like if I went to my obgy it’s getting better yeah no no well she’ll say like she’ll say oh here take this like what it’s like if if you do so are you saying go to your doctor your regular normal doctor have try to have a an intelligent conversation about hormone therapy that does include not just estrogen but you’re saying hormon therapy is also testosterone progesterone everything right now are they sh like subcutaneous shots that people are putting in or is it like maybe but you can get safe efficacious high quality bioidentical hormone therapy from your local pharmacy with insurance if if you have you know that’s your JM for $30 a month for but for all the hormones no so testosterone in the US is not fdaa approved and I don’t know what the same board is in in Canada but um you you’re going to have to pay out of pocket for testosterone because there’s no FDA has not gotten a wrong to improving improving it for women even though we have tons of studies to show how helpful it is so for my patients we can do I usually do an estradiol patch an oral micronized progesterone and we do some topical testosterone in the form of a cream usually from a compounding pharmacy right that’s what my doctor always recommends these creams but uh the creams from what I understand CU like I haven’t done any of these but I want to is they’re not they’re like they don’t do anything they’re cream are not very so you never want to do a progesterone cream with estrogen like if you if you do a pro remember it’s a huge molecule testosterone oh testosterone yeah so I’ve got a couple of trusted phes I work very closely with the pharmacist but still it’s not they’re not as regulated you know no one’s going in to test to see in a compounding pharmacy this really what they’re putting in there were they having a bad day that day and they didn’t you know so like the things coming from Walgreens and the the FDA approved stuff they go through extensive testing and monitoring yeah so we know 98% of the time what they say is in it is in it so that’s my preferred Source I don’t have that option for testosterone because there’s not an FDA approved option and it’s really hard in Texas where I practice to get them the men’s version there’s a a gender ban and you only if you have gender dysphoria or you’re transitioning can you legally get they’ll turn you in um yeah so what about pellets are you putting people you can’t even do that right absolutely not no no pellets um are just you know I don’t want to demonize the pellet okay it is simply another compounded form of therapy there’s nothing magical about it it’s not better it’s not safer it might be more convenient but you can’t take it out once they put it in you’re stuck for 3 months and let me tell you it is the most profitable for your physician so here’s the red flag you go into your healthcare provider and they only offer you pellets all we do is pellets run because you are there to make them money because if they’re not having a logical discussion and they’re making you promises like girl you’re going to feel so good you’re I don’t make those promises I’m like listen we’re going to try this we’re going to try this we’re nothing’s better than your 25-year-old ovaries I can’t put those back in you you know we are just trying to get you to some level of you can function again and then we’ll figure out the rest so it’s so funny I’m only laugh who do only pellets are in it for the money and not in it for the patience and they’re not dealing with the effects they’re not I mean it’s horrible so like but if your if your physician is like look we got pellets we got Patches we got Rings you know my patients can’t afford pets you know they’re hundreds of dollars a month where they can pay 30 or 40 or 50 maybe and go get what they need I I’m only laughing in a not because it’s haha funny but like I live in LA and uh everyone’s running to these particular doctors that I know here uh and he’s just like doing one like he’s basically banking like one like he’s doing like a 100 pellets on these people poor people here’s here’s what um yeah guess what about pellets about biote they don’t make a woman’s version of the testostrone plet they just put the men’s lowd dose pellet in the women and so normal physiologic range of a healthy female you can Google it right now for testosterone is about 25 to 70 okay picograms for de don’t worry about that the biote literature I wouldn’t signed up on biot CU I wanted to see what they were teaching these people they say no no no no one’s died yet let’s run them between 150 and 250 okay that is a transitioning level so basically taking these women and turning them into teenage boys and sure their libido goes up but this is not without side effects and risk and so no thank you I would just want I I try to get my patients 50 60 in the high normal range you know they’re very happy and they’re not having the beards and the cholesterol and the side effects and the the Androgen and the acne and the hair loss and the you know because that’s what I’m scared of these women are coming to me after getting a pellet I’m drawing their levels they’re in the three and 400s and I’m like girl yes what are you doing that is why I am scared to go on these things because it was gonna the guy says to me because I went to one of my friends who’s like a you know this girl’s she’s a famous girl she’s like you have to go see my doctor he’s amazing he’s going to make you feel amazing so I go she’s like yeah and yeah but at what cost right and he wanted to put he’s like don’t worry we’re gonna start really low it’s going to be at about 100 it’s 150 whatever amount of that’s double that is double high normal for and I said to them I’m like my doctor told me it was about my my normal level should be at this place or whatever he’s like real he’s like he’s like medical doctors don’t have the knowledge they don’t they don’t they’re not they don’t know okay and so but then like guess who taught him that biote right and this is the best when the company who’s in who’s giving you the medicine to put in the patient is teaching you there’s a problem well and also these pellets are like to your point 800 bucks a pellet um but and obviously I didn’t I I do not have any pellet but the the thing that really kind of was scary for me is all these side effects yeah does it work for so it’s a really 5050 split if I talk to 50% of my friends or people I know who are on it they like it if I talk to another PE 50% they gained weight they got bloated it’s an anabolic steroid yeah so who that might this is the question I have for you who’s a good candidate for for for these for high for testosterone I mean women not men um like why are why are half the women you know just thriving on it and the other half are are really just not liking them what who’s a good candidate for so you know if were they not liking it because they were overdosed and they were in super physiologic they both got the same doses like these all let’s say out of like 10 friends all the pellets they were overdosed so they don’t like it because they’re overd no no like 10 of the women five of them let’s say loved it five of them did not like it now what how what were their levels all pretty low but this is what my listen I’m no doctor but what I noticed where the friends of mine who liked it they were naturally very thin already and it wasn’t a weight like they didn’t gain weight the ones who didn’t like it like gained weight because they didn’t have the genetics that was going to take them that was going to keep them at a baseline of being very thin the thin friends got thinner and more fit the friends who were a little bit more like more voluptuous got more voluptuous and and didn’t like the so higher levels of testosterone you also convert more estradiol so it it’s a so we start really low and slowly slowly titrate up most of my patients you know I have three indications to put a patient on it though the sexual medicine docs think that we have testosterol receptors everywhere in our body as well and they feel like it’s probably helping with cognition with sleep and lots of different things I started it for low muscle mass my whole life I’ve not you know I’ve just was genetically very low muscle and I’m super high risk for fracture and falty as they get older based on my family history and I’m just fighting that tooth and nail I lift heavy I do all the things I was like I’m going to add some testosterone so I started you know really low dose I never thought I had a libido issue which is what I put most of my patients on for for decreased H hypoactive sexual desire disorder we’ve ruled out other causes and it’s just down to desire but I definitely have seen an uptick in that area and I think I would miss it if it was gone so I never complained before but I’m just having like a little more and I am having gains so but I am working out like a main you know I am heavy lifting very consistently much more than I ever did and then I’m I’m eating much more protein than I did before so you what so what number are you taking testosterone as a doctor what are you doing so I’m doing uh 10 milligrams a day trans dermal so that comes up so your levels would be at what point so myel my last level checked was at 59 59 so trans Dural does that mean cream cream cream yeah okay um okay I’ve got so many other questions okay so let’s talk about exercise we have to talk about exercise we’re we touched upon it a few times um can we talk about how is that like I I’m a big believer in string training and lifting heavy um especially as you age I know you talk about that as well in your book um what can you tell us on the research that you’ve done of of how strength training and menapause or as you age the importance of those two are together so most women Peak at their muscle mass at about age 30 and then we have an age related decline in muscle mass and in order to overcome that natural progression we have to work harder and harder and harder every single year or we’re just going to have to give up that you know and so as we’re living longer than men we’re becoming more and more frail in those years and so when you look at long-term um Care Homes um 66% are female 33% are male and the most likely reasons a woman is going to be admitted is for dementia and then for Frailty she can’t get off the toilet she can’t you know lift her leg she can’t get off the floor if she falls she can’t pick herself up and so this is the end result or she’s fallen and broken you know a bone and can’t take care of herself all of this is pretty much avoidable but you know my generation Our Generation I was a cardio Queen I ran I everything was about th to be thin like my whole Focus for movement was to be skinny okay which I had skinny privilege I ran marathons I did all this stuff you know super proud of that but God if I could go back and talk to that girl pick up some freaking weights you know because I chipped away at my bone and muscle strength to be thin I never looked at nutrition outside of calories you know I tried to eat healthy I didn’t know what that was till I went back to school they didn’t teaches that in medical school just you know donate french fries okay so um but for movement two to three days a week of progressive load resistance training that scares the hell out of women because they’ve never done it they don’t know how but it is so important so when they did studies on elderly women which is 65 plus okay I am eight years away from that or nine how old are you um uh 55 oh you look great though so almost 56 so they were looking at vibratory training putting them they put them in 10% weighted vests they had them start lifting they were doing deadlifts these women were making major gains in their 70s and 80s for muscle mass and Bone strength and osteoporosis and I’m like okay osteoporosis prevention program let’s go there’s great studies on collagen there’s great studies on wearing weighted vest I wear one all the time now when I’m walking the dog when I’m doing housework when I’m you know walking on my treadmill which I do a lot of work on my walking desk but I put the weight of vest on to do it cuz I’m cheating the system I’m just you know I’m never going to be obese that is not in my genetics it would would be a lot of hard I could do it a lot of hard work yeah um so but you know for me it’s avoiding the Frailty card and I want to be 90 and playing on the floor with my grandkids yeah I agree great grandkids what you know I want to be climbing a mountain I don’t want to be on a walker like my mother at 85 yeah who can barely get around she can’t get in and out of the tub we’re trying to figure out converting her bathroom right now she’s sits on the toilet and does a spongebath that is the best she can do right now wow you know and that I know no so I’m I’m doing squats like nobody’s business right now because this is my mother so these are the things I talk to my patients about they’re not coming in saying I want a bikini body we’re you know those ships have sailed and it’d be great I mean who doesn’t want that but they’re like look I’m looking at my future I’m looking at my aunts I’m looking at my mom’s what plan can I get on right now what habits can I change what do I need to focus on so that I can be healthy and vibrant as long as possible and not 10 years of horrible morbidity not being everything in pain breaking hips breaking you know so women 50% of women will have an osteoporotic fracture before they die yeah and men don’t do that yeah you know like very fent so it happens but it’s rare and so I want to be like a man I want to die like a man they just die they live and die we have a protracted horrible last 10 years of our life completely dependent on others and that doesn’t have to be like that so this is what we talk about when we talk about menopause care and this we’re talk for stet training is being is is an essential piece of it do you think that cardio because cardio is known to break down muscle muscle mass right I think I think you need a walk a brisk walk a brisk walk with a way to vest I sto running is that good for my knees you know I might do a few Sprints just to get my V2 Max going but you know a few Sprints here and there a little bit of Tata you don’t have to go crazy you know but like if you’re on the couch get up and walk baby that’s it just walk the we patience I love it if you okay all right you’re walking good grab a weighted vest let’s get some hand weights let’s you know let’s work you have to meet the patients where they are and you know saying you need to do three days of resistance training girl she’s goingon to run out of my office screaming but you know she’s like hey I’m walking every day this used to work for me it’s not working anymore I I measure the muscle mass in clinic I have an embody scanner so I’m doing visceral fat muscle mass uni and really can look at their insides and be like okay here’s the path you’re on right now here’s what we can do to to reverse this I want yeah I I I’m a big believer in strin training for your for your bone density for the weighted the weighted vest is amazing then now the cardiovascular data you know women are much less much more likely to decrease their risk of cardiovascular disease by 20 to 50% if they strength train yeah absolutely more than men like they can do less strength training and have more benefits than a man they can they will have more cardiovascular benefits with less work oh I love that what yeah okay let’s talk about semi glutide and the you know seml tide the glp1 yeah um is there a benefit for going on something like that like the OIC of the world um if you are gaining belly fat from menopause or from per menopause or so most of my patients you know again I usually defer to people who have training in obesity medicine you know um I don’t have unless my patients are obese and especially patients with lifelong obesity and they’ve done everything they’ve done every diet you know this is a whole mind you know it’s more than just mindset for so many patients but I do think that there’s a place I have a handful of patients on it we monitor them very closely before they leave the office they know they’re coming back every six weeks we’re monitoring their muscle mass we talk about acceptable muscle mass L we talk about protein intake like going to the Su the long-term success of you being on semaglutide where you’re going to end up healthier in the long run is really dependent on the doctor who gives it to you and how they take care of you and monitor you weight loss at any cost is rarely sustainable and rarely better for your health long term the yeah and the reason why I’m even asking you this question is because we’re talking so much about muscle uh muscle mass right and keeping you know lean muscle mass on your body it breaks down your it when you lose weight you losing fat if you are severely chally restricting okay if you severely chloric restrict half of what you lose is muscle which is why so many people yo-yo because muscle is what controls our Bal metabolic rate so you’ve lost 10 PBS five of its muscle you immediately put on another 10 pound you know you go back but you’ve gained 10 pounds of fat and you could never get that muscle back without eating all the protein and doing all the resistance training so this semaglutide can is a tool in your toolbox to be healthy you cannot ignore the value of nutrition of movement and the right you know doing the right movement you know just getting your shots and not eating is not going to serve you long term but also when you get off I mean you’re the doctor I’d like to ask you once you get off of it your appetite I would imagine rebounds and if you don’t change your habits and you go back to your old habits you’re G to gain the weight back it’s how do you change your habits it’s not a it’s not a habit for it’s not about habits it’s about making you turn it’s turning off like your your hunger point I’m seeing something different so my patients are using that food noise going away that time that they now have in their day and has a time to we talk about this you know how they’re this is a multifactoral disease and we talk about habit changing is it successful for everyone no but I’ve seen some beautiful results and when the patients come in and they’ve held on to their muscle mass and they see that visceral fat going down they’re watching their cholesterol go down you know even and semog glutin plus HRT they lose 30% more weight by the way really more fat yes wow women menopausal women on semog glutide lose x amount women on semog glutide plus HRT lose 30% more wow I’m siding up and they’re more likely to keep it off because you’re more likely to maintain your muscle mass if you have your hormones on board including estrogen that’s amazing does I thought estrogen again this is a myth um doesn’t it make you gain weight is it more no it doesn’t Okay um because because when I have whenever I when you’re menstruating you you feel like why do you feel so bloated and water water prester Prest that’s progesterone okay gosh it’s a it makes you retain water so which is why we like blow up when we’re pregnant progesterone’s so high okay does that mean seml I’ve heard there was a correlation between inflammation and that does it help with inflammation so talking to the Obesity medicine specialist this is not my jam right they feel like because of the lowered insulin levels which is pro-inflammatory they don’t feel like the semaglutide is in and of itself lowering inflammation like it’s directly acting on certain receptors that will lower inflammation they feel like because insulin levels are going down and that means your visceral fats dropping that those two things combined or lowering inflammation because insulin’s a pro-inflammatory hormone well seig glutide is like an old it’s like it’s like the it’s the old version now everyone’s talking about tpti what is the difference between um my friends call it like iPhone 12 versus iPhone 13 that’s exactly you know so so patients are having less gastrointestinal side effects less nausea less diarrhea less constipation on their tepati they’re um it seems and now there’s so many that are coming out and they’re looking at Oral versions as well to make it easier to prescribe um I think it’s pretty exciting in the nextto and and you think you spent money on developing covid vaccines these people are spending some money because they know people are going to buy it and so developing the latest and greatest on you know decreasing side effects and improving efficacy wow okay and then how about in terms of supplementation is there any particular supplement that you recommend yeah so remember supplements are not a menop poost cure take that away okay and supplements are meant to supplement a healthy diet you cannot swallow a handful of pills and expect to have Miracles if you don’t eat what you’re supposed to be eating okay so most women are not getting enough fiber in their diets and so I really advise try to get your fiber from food 25 grams per day push to 30 35 with your supplement um most of my patients are deficient in vitamin D our gut changes are we’re protecting our skin from the Sun for good reason we’re you know there’s lots of reasons why we live in climates well it’s sunny today in Texas but you know so massive amounts of vitamin D deficiency so I am recommending a routine vitamin D I am recommending a certain bioactive collagen for prevention of osteoporosis pretty good studies on that it’s called forone um I turmeric is not for everyone but I sometimes will recommend turmeric especially if they’re having osteoarthritic pain it does seem to help with thisal fat it’s a pretty powerful antioxidant anti-inflammatory um so if you’re doing teas or supplements you know but just be careful because too much toric can be H liver toxic um it can make sure you’re staying oh yeah yeah so you know too much of a good thing is not always the best thing and so you know we have some supplements that we take to correct deficiencies magnesium is a big one of that other we could take in a little bit higher doses past you know FDA is to keep you out of a deficiency sometimes higher doses of things can be medicinal like magnesium so magnesium alate has been studied in SSRI resistant depression it crosses the bloodb brain barrier really well and you know I a lot of my patients use it for sleep so you know then we’re kind of looking symptom by symptom to see where we can Shore up I’m doing iron studies and all kind of stuff on my patients to see where they’re deficient well what’s okay you you mentioned magnesium which magnesium would you recommend because it’s very confusing there’s lots of different magnesium forms so like milk of magnesia right that gives you diarrhea on purpose it’s is for constipation so there you know depending on the formulation some of it stays in the gut and makes everything move quicker some goes into the bloodstream but doesn’t get to the brain so that’s like glyc tarate some cost the blood brain barrier okay um but so most of my patients are on mag for the neuro protection neuro and cognitive benefits or sleep or calm and so we’re going with the etherate is what I’m usually recommending but probably glycinate is not a bad choice either what does that one do so etherates for your brain basically okay yeah and glycinates Crosses pretty well into the brain as well it’s cheaper too so if the the there’s only one maker well there’s only one manufacturer of etherate like in the world I know this because I looked into trying to provide it to my patients and it was just too expensive and um and so and he only Farms it out to three or four companies so or I think it’s a heat anyway so that that one’s a little more pricey which one is it has the patent on it El the elsir in it no no no which what company like which brand oh magine and neuromag so Life Extensions is the brand I get it from oh life extension yes yes yes gotcha okay good to know wow okay well listen I think uh thank you for this I think this is great information and um I I love that you like like I said I love that you came on this podcast you guys the book is called the new metapo by Dr Mary CLA Haver she is an OBGYN are you are you accepting patients right now in Texas right now I’m full I have you know we’re expanding our clinic but right now I cannot take off one more patient I don’t blame you I have to take care of the ones I have in my in my little in your I’m sure wow well listen the the book is fantastic I it’s it gives it gives a really good overview of all these things that we spoke about and it goes more in depth and I I’m really just I’m grateful that you came on this podcast so thank you for being a guest you’re welcome and where can people find more information about you if say s um so we have the paus life.com is our website we have free guides we have free you know blogs tons of information how to talk to your doctor what test to ask for ETC um we are all over social media Dr very Clair or Dr very Clair Haver on every channel you can think of except for Twitter um I just never got around to that one and then it now it’s weird but um so but I’m on Facebook and Instagram and Tik Tok and YouTube are the big ones in Pinterest all the things all the things thank you I appreciate you being here and uh thank you for just some great very very pertinent information I’m gonna go tell my I’m gonna send this to all my friends well thank you thank you