Safety and Future of Peptide Therapy

Welcome back So Hp Day hormones. Today we're going to GLP one summer schoolchool. A few years ago, nobody had heard of GLP one medications. Now they're everywhere Some people think they're a miracle Others think they're dangerous And most women are kind of stuck in the middle. just trying to figure out what's actually true Today we're going to GLP one summer schoolool and we're gonna to answer real questions that we hear in clinic every day. ppy Hump Day. Welcome to the Hump D Hormone podcast. I am Dr. Jill Jennings, a board certified OBGYN and menopause Society certified practitioner. And I'm Courtney Span. I'm a nurse practitioner and we work at the womomen's cllinic in Little Rock, Arkansas on the campus of Baptist Health We are here to talk about all things female hormone related. From puberty to menopause and everything in between, we are here to inform you from a medical point of view about the latest scientific evidence in the world of hormones You can find us on Facebook and Instagram as hump Day Hormones. and you can also email us at hump dayay hormones at gmail. comot Welcome back. We are back from vacation. Courtney and have both been to the beach. We have. We went to Turks and Cico a couple weeks ago and it was so beautiful. Yeah, we went somewhere a little less glamorous. We just went oki right past Orange Beach for the family vacant. So nice. So n a good beach trip. I know. We had a couple days of like double red flags, like basically do not get in the ocean. It was so rough. And then we had One full day of rain and then kind of spotty rain. and now it's raining here. L just stop raining. It is June. Literally. I feelelt like we've had such a weird summer already. L this rain and like some cooler weather.'s I don't know, it's weird. I'm ready for seveal summer I know and my little boy I take him to summer camp today down in hot Springs and I'm like, It doesn't need to rain at summer camps. So I'm ready for it to stop raining, but yeah while I was driving to the beach, I was trying to think It's like an eight hour drive down there. and so I' trying to think of like How to efficiently use my time and wanted to kind of plan for podcasts when I got home, so I wouldn't have to think about it the whole time I was on vacation And so I was like, okay, what You know, I was going to the beach. I was thinking about trying to be skinny in my swimsuit. and it just kind of naturally led me down the GLP one road. becausecause we get a lot of questions about GLP one ss. We get a lot of questions about weight gain. That's one of the main things that happens in period menopause and menopause And so naturally GLP ons come into the conversation for weight lost. And then we're starting to see them used so much more for like inflammation and PMOS, the old version of PCOS. I mean, that's kind of the hallmark of what they target is that metabolic syndrome, insulin resistant stuff. So we have a lot of uses for those beyond like just being skinny. sure. So today we're gonna talk about all the things like semig glutide Ozimpic, Wagovi, Zetbound, Manjaro, Trozepatide, and even reed a true tide becausecause like what the heck is that? And then also what is up with compounding because it's kind of the only affordable way you can get those. So Unless you've been under a rock for the last two years, you kind of probably know something about this. The science is evolving quickly, but we just want to kind of get down to the science of it and and talk all about it And then my big thing is like I don't know. I feel like skinny's not even that cool anymore. It's like cool to be healthy and strong. That's right.. And especially as we age because like we talked about last episode with Sason Campbell, we can't not age, right. Anti aging is not a thing, but we can age well And so when I prescribe GOP ons, I'm more doing it, not so you can be skinny and look cute in your swimsuit, but so that you're not insulin resistant and don't become a diabetic and have lower risk of heart disease and things like that. That's right. And they help with some of that visceral fat that will just kind of naturally accumulate accumulate during menopause, you know, kind a through your through your menopause transition. And you know, I think obviously I feel like everybody knows about GLP ones at this point, but I feel like the majority of our patients are like Okay, I get the whole hormone thing. you know, I'm on board for hormones, but You know, I'm still struggling with my weight and things like that. And I think that GLP onees can be a great tool. There's still some like fear around it, you know, I think just because initially kind of You know, peopleople are losing like fifty pounds in three months, like that's crazy. Right. you know,. So I think there's still someh, I don't know. I don't want to do that, but can it be helpful. So yeah. And I think I wanted at first when we really started diving into this hormon stuff, I wanted like hormones to be the answer. likeike, well, yeah If you have estrogen on board, then maybe your body won't need to produce so much visceral fat. Like it won't be starving for other ways to make estrogen that comes from that fat. so you know, maybe we'll slow the roll of our weight gain just with hormens. Like I wanted that to be the answer. like you won't have as much cortisol dysregulation and you won't make as much mistcerl fat and all this stuff. but sometimes I mean, at the end of the day, like Estrdol is a lot of great things and it does help your inflammation and it does help your cortisol and all those things, but it's not a weight loss medication. so And I don't know anybody going through like this whole hormon transition that that doesn' say something about their weight. I mean, it is very uncommon if somebody does not have a white complaint whether it's pounds or seventy five, honestly. Yeah. and we're going to touch on this here in a little bit. It's like on the It's on the plan somewhere, but hormones can Hell. with a GLP one, right? Like they can work synergistically together. So it's not it doesn't have to be one or the other or it doesn't have to be like, man, if I would get my horms corrected, I shouldn't need this GLP one. because like we talk about all the time, sometimes by the time we got to perimenopause and menopause, we were already so cortisol dysregulated and insulin resistant. We're going have to have something to directly help those things. And estrogen is a part of that puzzle, but what if GLP ones are a part of that puzzle too? Let's just get into it before we get into like, basically I have like there's like kind of ten questions like that we kind of get answered asked all the time in clinic that I just wanted to go through. But before we get to the questions, let's just start with like What is a GLP one? Be I feel like most people don't even know. They just know O ozypic. Yes. So GLP one stands for glucagon like peptide one. And so it's a hormone that your body already makes naturally. It's released from the intestines after you eat You know, and this has a huge, huge kind of connection with gut health. I mean, you're gonna to have better GOP one production if you have better gut health. I feel like everything kind of circles back to that. So that hormone specifically sends several important messages. It tells your pancreas to release insulin whenever your blood sugar goes up. So like after you eat It tells your liver to make less glucose. It slows how quickly food leaves your stomach And it kind of sends that signal to your brain telling you that you're full And so these medications, like the GLP one medications are essentially just kind of giving your body additional support there, adding in Z Mag or GLP one Yeah, I think it's, I mean, the difference is like I think most people don't even know their gut naturally makes it. like we didn't make this up in a lab and just create a medication about it, where it's like biohacking likeike you're haacking into this peptide that you naturally make. But we make it in like the shortest spurts. like it lasts for a minutute when we naturally make it. When you give yourself a shot we're giving you like kind of this sustained level of it for about a week with these shots. And so that's the difference is you're no longer relying on these little spurts from your own gut. You're kind of just giving it all the time. And if I think Yalek Courtney was saying, if we don't have good gut health then we make less GLP one in the whole first place. And so we've done an episode on that before about how to like basically biohack your GI microbiome and make you produce naturally more GLP ones. That's a very interesting thing but would be sort of a wholenother podcast. So and And then I think most people get them all confused like first we have like the standard GLP one. It's one peptide. It's what's in semiglutide, which is under the brand name Ozimpic and to aoe, which is always so freaking shady to me that the FDA can do that. Like it's the same drug. You just got a new pat because you got a new indication. So ye Smag gllutide, the GLP one compound is FDA approved as Ozympic. to treat diabetes. That's right. And is the one that kind of hit the market first. first. And it's actually been out for it's been out for a really long time. like, yeah, three, four years, maybe. But like it is not going to get approved if you're not diabetic. That's right That's it. That's I mean, your ANC has to be above seven, which is like you're not just kind to diabetic at that point. Like you're for real deal diabetic and you've probably been insulin resistant for fifteen years at that point. that is it is going to be strictly for diabetes and really, really almost impossible to get covered any other way. And then WovV, which is also semiglutide, is FDA approved for weight loss So same medication, all different names. Yeah. But then insurance was like, oh, yeah, well, we don't cover weight loss. So that's on most people's plan and exclusion to the policy because weight loss is considered cosmetic And I'm not agreeing with that, but I'm saying that from an insurance company standpoint, that's the way that's looked at. But Wovi and Ozempic are the same thing. They're both semaglutide. You can also get compounded sezmaglutide and we'll talk about that And then we have Tzepatide, which Tzepotide is the same thing as Menjaro. And then also again, FDA approved as Zet bound. So and it's the same thing. Menjaro's for diabetes And then Zet bound is for weight loss and also has a sleep apnea indication. So I mean, those are the strict FDA, you know approvals on those, but seemiglotide ozympic wigovi, Drazepotide is Zet bound and Manjaro. So And then the difference in like trizepetide and semiglyide is that trizepotide is a dual peptide. So it's not just GLP one. it's GLP one plus this thing called a GIP. Yeah, G the G IP u is released when we're eating and it helps with insulin signaling. And so U That is like going to help more with the metabolic dysfunction that comes along. So semoglutide, I think if we think of it like It is helping with that insulin signaling, but it's really working on a lot of the appetite stuff, making you feel full, making you not feel hungry. I think Chure's appetite is doing a little bit more on the insulin signaling side of things because of this added GIP that goes with it. So I do find it I think we're going to talk about this too. just just from like my own observation with patients. patients tend to tolerate the Terzep appetide a little bit better with like less GI effects. and we're seeing a little bit For the most part, I feel like better like weight loss with it. Yeah. And that's think be like Yeah. And I'm super interested about like Redit true Tide, you know, ' it's like GLP three. So is it gonna wr even more? It has that third on that tide in it. Yeah it's like a triple There's But yeah, so I think if we just get into the questions And this kind of speaks to what Courney was talking about about the like, how much weight are you really going to lose? And we have goodood scientific evidence for that really on all three of these peptides at this point U But the step one trial, this is answers that question about really kind of how long semaglutide hass been around. twenty twenty one showed that semaglutide produced an average of fifteen percent weight loss over about sixteen months. So you do have to use these things. You can't use it for three months and lose fifteen percent of your body weight, you know, you will probably lose you know, five percent or I mean, you'll lose something. but the average fifteen percent over sixteen months. And then there's a trial called the surmount. one trial and it was the one that looked at Tzetotide and it showed a twenty. Plus percent. So twenty or maybe even a little bit more in about seventeen months, obbviously you're going to lose more on higher doses of these medications So You know, we have studies that show and then when we talk about Reditue tide later, you'll see it's up to like twenty five percent or closer even sometimes to thirty percent in the trials. And so that's a big deal because that approaches like what we see with bariatric surgery And so I mean, we potentially could eliminate the need to be doing gastric bypasss and things like that, which is insane U yeah, but And And I would say from an insurance company standpoint wouldouldn't it be a lot cheaper to pay for that? But And Anyway, Yeah, ye. whichich brings us to the next question, is it just for white laws You know, we're learning more about these medications. I feel like every day and we're kind of learning more about like the the insulin side of things and inflammatory side of things that this can be helpful in. So so no, it's not just for weight loss. And like we said, like being healthy and strong is kind of more of the goal now, not just like being super skinny. Yeah So kind of the cool thing is GLP one receptors are found throughout the body, including the brain, the heart, the kidneys, the immune system. So if those receptors are there, a GLP one can potentially be helpful in those areas This is a big area of like active research and there's some established benefits already out there and large clinical trials going on. There's a lot of info about like cardiovascular disease and heart failure and it shows reduced risk of heart attack, stroke and cardiovascular death in high risk patients, which is whichich is huge. You know, I mean, heart disease is the number one killer of people in the United States. So this can be helpful there. I mean, that's massive. Yeah. And I think it's really cool that semag glutide demonstrated the cardiovascular benefit even in people with obesity who did not have diabetes. So these drugs were kind of like designed as diabetes drugs and then have sort of become obesity drugs because we figured out, you know, that they work so well, even in a non diabetic person. And so I also think it's one of those sometimes when you read like headlines for medical studies, sometimes I always think like, well no shit, right? I'm like, thank you, Captain, obbvious. Like it'll be like, you know, these weight loss drugs reduce your risk of heart attack No crap, rightight? If you are not morbidly obese anymore, you have less risk of heart attacks. So some of it it seems like kind of common sense. like did we need a whole probably million dollars worth of trials to figure out that if you lose weight and you are healthier that you're gonna have less things with sleep apnea too. Yeah. Well, clearly if you lose weight, sleep apnea risk is gonna go down. Yeah. And I mean, that to me, it's like so obvious about like inflammatory things. L if we lose visceral fat, we talk about this all the time how inflammatory visceral fat is. Yeah. And like if we lose visceral fat, we're going decrease our inflammation, which Yeah, that's like pretty obvious to me. I'm going not You wouldn't even have to have a study to make me believe you about that. Right. But it is always, I guess handy and we're not going to be able to convince everybody without a study, but Another thing they have a big like large clinical trial to support is kidney disease. So we slow the progression of chronic kidney disease in patients with diabetes. Again, Captain obvious, we make your diabetes better. We're going to ruin your kidneys at a slower pace. R. I mean. and then sleep apnea, like you said Um I mean, those to me all seem like captain obvious, like if you're healthier, then all of your little organ systems are going to work better. and you're going to be able to breathe better if you're not as big. Right, rightight. That exactly right. Yeah I mean. Yeah. And some of the other kind of emerging areas that are coming out, which also kind of makes sense but it's cool to think about too, alcohol use disorder, alcoholism. So researchers believe that Gilt be ones withffect dopamine and reward pathways in the brain whichich makes sense. I mean, if it is kind of decreasing appetite and turning that down, I mean that pathway in your brain is going to like kind of decrease your need and want desire for like drinking alcohol, alsoso like gambling, addictive behaviors, drugs. I mean, there's like that all kind of like falls under the same umbrella. you know, seeee if you can kind of turn that off potential for that being helpful there. I know. And then I mean, so cool, Alzheimer's disease and cognitive decline. and really it's like, okay, that sounds crazy at first, but just stop and think about it. The neuro inflammatory pathway that we think leads to Alzheimer's and cognitive decline and things like that I mean, we've talked about that estrogen is highly anti inflammatory and is so good for your brain. But I mean, these are directly reducing inflammation by reducing your visceral fat. And so and then if you improve that insulin signaling in the brain and improve your brain's ability to use glucose, then that's obviously going to be really good for the neurons. Neurons run and thrive. That is their fuel is glucose. And so if insulin's going to work better to get them their glucose, then that's just going to help everything out. And so It is kind of weird when you say that this thing that was designed as a diabetes drug now might be one of become one of the leading things that they give for Alzheimer's prevention. but it makes a lot of sense when you think about it. I was just listening to U, I think it was. Oh no, it was this podcast that one of my best friends sent me. Her mom actually passed away last year from Alzheimer's. And so, you know, she is very interested for herself to know like Alzheimer's prevention as we age and like how can she not have to do that, you know? And so but it was this podcast about this guy who has the Apo for or whatever that gene is that that puts you at such high risk to have Alzheimer's, he has a double copy of that gen.. So he's like Almost guarante. Alm guaranteed that he's going to get Alzheimer's. And he's working, he's a big podcaster And he's working with this like renownedzhe this person who has an Alzheimer's prevention clinic, like up in the Northeast, some famous medical center. I can't remember which one, but and they have put him on a GLP one almost as a preventative L. Yeah. and he takes like my her doses of a GLP one and he's like literally don't care what compound you tell me to put in my body. Like I willll do anything, everything I can not to have to put my family, you know, through that. but They believe in it so much and this Alzheimer's prevention center that is like the mecca for this believes in it so much that they have him on that. You know? Yeah. But again, it's going it's going to come down to can you afford that? I mean, he's a big town podcaster, so he can sure do that. It's not a small town podcaster like us. Yeah. But I mean, it's going come down to we know these things work, but when is when is insurance and stuff going to get on board I think that's so cool that they're starting to use it that way. Yeah, yeah, for sure. I do too. There's some other areas that are that are kind of coming in too. So Parkinson's which feel like that kind of falls under the realm of brain thing on CNA. Yeah. fatty liver disease A lot of people are saying this is the next approved indication which I had a patient last week who who her primary care doctor got her a GOP one covered with the indication of fatty liver disease.. So I don't know, that might already be author or author enough that they're approving it. makes so much sense. Yeah Osteoarthritis, which inflammatory I mean, decreasing your weight is going to kind of help your bones. mean, I feel like that makes sense And then on the script literally I wrote PCOS du. I mean, if y'all have not connected connected the dots with PCOS and insulin resistance by this point. Yeah I cling on. Yeah I mean, and why that's not an FDA approved indication? I don't know.. I guess just because nobody even understands PCOS or PMOS. But I mean, with that course that Courtney and I went to, which I think dor. Rusier's a genius But and he was that four part course that we went to talking a lot about hormones. and he briefly touched on GLP ones. I think all that was out at that time was semig gllutide, but he was like, these are the drug of the century. There'll never be another drug in our lifetime that does what this drug can do. It's like penicilline of two hundred years ago. Lit know. Yeah. Yes. Yeah. I know. I feel like I feel like I say that in in a in various ways to patients, you know and because they're like, you know, what can I do to get some weight off? What can I do to help with my insulin? My I know this is crazy, but like we have the availability for like the best drug. I mean, it is going to just be Is your insurance going to cover and if they're not, are you going to be able to afford the compounded version? That's right. Yeah Okay, so will I gain all my weight back if I stop taking it? So I hear that all the time. don I don't want to just take this and lose the weight and then and then the weight comes back, which part of me just wants to be like Okay, so you just don't even want to try then. Like we'll just stay insulin resistant and not try at all. I mean, you know is kind of my smart ass answer. But the honest answer is that many people will regain some weight after stopping. think that that's true though With any diet program you look at, I mean, really. if anything like If you do weight watchers and you stop doing weight watchatchers, you're going to gain some weight back. If you are doing jazz exercise every day and you stop doing jazzerc anythingthing. this is probably yourion, baby. U Well and I think looking at it from the like standpoint that open Oesity, insulin resistance, I mean, these are chronic conditions. So look at them the same way as like yperension, high blood pressure and you're put on medication for that. Obviously if you stop your blood pressure medication, your blood pressure is going to go up. So it's like if you stop your treatment for chronic obesity or chronic insulin resistance or pre diabetes or diabetes or whatever, then yes, the wayight it's going to come back, the insulin resistance is going to come back, all of that. Yeah. And I think if you look at those studies too, it can't be that you use it for two months probably not long enough to like, the underlying problem, you know. If you're just trying to look cute in your swimsuit in a couple months, I mean, maybe that'll be enough, but like that's probably not enough to fix underlying real deal insulin resistance. So that same step one trial that you know we used talking about semaglutide and showing the weight loss and kind of to get it approved. there was an extension trial that followed patients after semaglutide was discontinued and the participants regained about two thirds of the weight they had lost within a year U But I think what's interesting about that is that that's withmically tide. So I wondernder and we'll see those same kind of results with Tu' appetide and especially with Reditue tide because they are working so much more on the metabolic pathways side of things U and Smbically Ch is a lot working on your appetite. right and and you're like food ceues and like that food noise that people talk about. And so like you were slamming the brakes on your appetite and then you just let off, of course your appetite's gonna come back, you're going to eat more, of course you're going to gain weight. Right, you know Yeah. especially if you're going back to eating Not healthy things. Absolutely. Yeah. I was gonna reinforce that to patients. like You have to like lay down a good foundation. I mean, you have to be doing the good things already. You have to be getting in some strength training and exercise and eating enough protein, like all the things, you know, and then you can use this as a tool And so yeah, the next question is people ask, do I have to take it forever? No, you don't. I think the other question that I get asked a lot too is women have had really good success on it. Can I take it forever? I mean, yeah, but you know in you know it's like I mean, it's sort of the same as people say about estrogen. Like I feelerally a lot better on this. Do I have to stop it And it's like No, like what what reason do we find that you need to stop your estrogen? And like, I mean, I think the reason that you might want to stop a GLP one or, you know, a dual peptide, whatever is that you're, okay, like I don't need to keep l weight. Like we've all seen those people who are like, okay, put the e pic down, sister, like you are skin and bones. I mean, I think there are ways to still be on them and like microdose, which just means you're using less than the standard dose or you're spreading it out. You're doing a shot every two or three weeks instead of every week. And I think there's other ways to step down too like Mbe we work on like our gut and our own natural GLP one production and maybe we do berberine, which helps with gut health and GLP one production and insulin resistance. So I mean, maybe you don't just cold turkey like you're on you know, a full dose and then you just stop. I think that's probably a bad idea. Yeah. And I think just like if we were weaning somebody off of hormones, we don't just, hey you're taking two milligram oral pill every day, just stop I mean, we would tell people to stop their hormones that way. We would kind of want to like taper them down. So I think probably the same thing would be true for GLP on s or dual peptides, whatever But I think You have to know that There are like you know, some ramifications to stoping those, but that you can do other things at that point not to stop abruptly. and that the medication was just one of the tools that you were using. It wasn't the entire treatment plan, right? There should have always been diet and exercise and healthy l cell stuff in place along with it. Yeah. And sometimes the confusing thing is is like what are the protocols? What are the guidelines for microdosing? There's not. I mean, you know, you just kind of have to work with your provider and find that sweet spot for you and that's so different for everybody. That's the same with hormones. I mean this is it's just kind of a we have to find what works the best for you, whether that's you know, micrdosing and and kind of determining what that does is for you or spreading it out or Yeah, it's kind of an ongoing conversation. That's right. And I feel like the other thing we hear about all the time is, am I just gonna lose all my muscle too? So you know when you lose weight and you lose weight fast, sometimes you're gonna lose some lean muscle mass stududies there's actually like again, not just what we think, but studies suggest roughly twenty percent to forty percent of the weight loss during weight reduction can come from lean tissue. So this is why prrotein and resistance training matter like they mattertered anyway. They matter in people not on a GLP one in really good shape, they matter, but they matter a whole lot more to try to combat this kind of side effect of it U Also like there's nothing that says you have to like jump in with the biggest dose right away, right? I mean, you could start with just microdosing Yeah So He doesnt This medication does not melt muscle, but rapid weight loss without proper nutrition does. And so again, like this is not a unique phenomenon to a GLP one. This is going to be true for people who go get a bariatric surgery and all of a sudden are under fueling their body. They're going to lose a lot of muscle mass too. And so this is true for just a rapid weight loss pes I mean, anything that causes you to rapidly lose weight. and could have the same type of side effects. So it's not a it's not a unique Oh just GLP ones melt your muscle away. Right.. That's exactly right. Same thing with hair and that's a big question that we get a lot. willill it cause me to lose my hair or get a face? whichound feel like that is like Just all over. like you say that all over, right? So yeah, I mean, if you if you're doing it, if you're doing too much too fast I mean, your hair is gonna to shift out of that like just good growth phase. And I mean, yeah, you may not like grow new hair and you may shed some, but you have to look at properly fueling your body and nourishing your body, you know? I mean, same kind of things that happen with like a surgery or an illness or after you have a baby and you're postpart of, I mean, your hair shifts to that like teelagen oblvian phase. And so, you know, weight loss does that as well significant fast Whitewals does that. Yeah. ye. and I think the same thing is true from Ozmpic face. that's just what people call when they lose that like facial fat and they're You know, I think it's like we your face is kind of more sunken in looking those jaws bones are more prominent, that kind of stuff. Again, that's not something unique to a GLP one. That is something that happens with rapid weight loss. We lose fat everywhere, including in our face.. So You know, I think that It's the question of whether the health benefits of losing the weight and becoming less insulin resistant and all that kind of stuff are going to outweigh those kind of cosmetic changes. And I think for most people, the answer is probably going to be yes. and I also think like there's some people that don't have fifty pounds to lose.. And so it's not going to be that dramatic in you U or some people like we're just trying to fix your insulin resistance L I don't care if you lose weight or not. You probably will because when I fix your insulin resistance, you can't help it. You will lose weight. but U you don't have to go guns Blazon and try to lose fifty pounds in two months. Play. Yeah. Yeah. And I mean, yeah, if you do that and you get to where you're just like not eating because your appetite is so so suppressed, then yeah, your hair's going to fall out. But it would do that if you were in a famine too Yes. Yeah. I mean, I've had one two patients that I can think of off the top of my head that they were just Too hot, too fast. And then, you know, we followed up in three months and I was like, whoa, p the banks, girl. You know like they were super happy with their weight loss, but it was too fast. I mean, you've got to have somebody that is kind of overseeing that and like you know, telling you yes or no and telling you, yeah, slow down or or keep going. I know. And then people we're all impatient, right? You know they're like, I've been on this medicine for two months and I've only lost five pounds. I'm like Okay I mean, that's a good job. Yeah. So I think we all want it to like fall off and we're wearing a couple pant sizes less in two months. and that's not always going to be the case. That's right. That's right Yeah This is one of my favorite questions is can I take a GLP one with my hormone replacement therapy? And andase Yes. and you probably should if you're menopausal be have your hormones optimized before you get on a GLP one. like that should be kind of our first step, like your moat around your castle. and then we can come in with like Okay, you really are menopausal but also insulin resistant. So let's do something to target directly that insulin resistance. I mean, estrogen is one of the pieces of that puzzle. It literally helps your insulin receptor work better. But we have big studies on this. twenty twenty four Mayo Clinic study published in the journal of menopause showed that weight loss response to semog gllutide and postmenopausal women with and without hormon therapy. So that was like literally the title. I mean, that's exactly what they were looking at. It was a retrospective cohort study. post menopausal women who were overweight or obese and were treated with semag glutide for at least three months were included in the study. And they compared women on systemic HRT versus women not on HRT. The key findings at twelve months, women on hormone replacement therapy lost sixteen percent of their body weight and then women not on hormone replacement, there would be lost twelve percent. So that was a significant difference in women on hormon'es actually had better weight loss on these medications. So in practical terms, women using hormone therapy lost about thirty percent more. This is where people play with statistics and it this kind of stuff drives me crazy because you know, the difference in sixteen and twelve percent is about thirty percent if you If you do those. Yes. So that's where you kind of make it seem fancy. but women on hormone replacement therapy lost about thirty percent more weight than women not using hormone replacement therapy when taking we're talking about semag gllutide here. This difference remains significant even after adjusting for potential confounders. that would be like, you know, people who were diabetic beforehand, people who were more obese beforehand. So they kind of are different ages or whatever. They adjusted for all that. You just had to be menopausal and either taking hormones or not. So try And I think, you know why? I mean, obviously we know estrogen improves insulin sensitivity. Eestrogen helps reduce central fat accumulation. So again, like I said in the beginning, I kind of wanted estrogen to be everyone's answer and it does do both of those things, but I think for some people, it's not the only thing they need. So And then if we are sleeping better and we have less hot flashes and we're in a better mood, then we can probably make better food choices too. So hormoneotherrapy improves sleep quality inv vasomotor symptoms And that, you know,' going to make you overall feel better and be able to stick to an exercise plan. And estrogen also helps preserve lean body mass and energy expenditure. So it's good for your muscles. it's good for your bones. I would say that I mean, we haven't really looked at this, but Testosterone is probably really beneficial here as well because it's so good for muscle, but that is something that probably just needs to be looked at That's right And the Mayo Clinic released a newer report this year looking at Tzepotide, kind of foundar similar findings. So post menopausal women using hormone therapy lost approximately thirty five percent more weight than those not using hormone therapy. So a little bit better than the doosm and glutide you, so that study is helping drive ongoing research into the synergy between estrogen and GLP ones. So how they just like work so well together. Yeah So the answer to cananot take them together? yes. Please do Yes, ye. U So and then we all the time, like I' like this is true with hormones too. L is this safe? Like is this gonna give me cancer? Am I gonna regret taking this later? Do we have enough safety data? I mean, all this kind of stuff I think the good news is that for most people, GLP on s are very safe and generally very well tolerated. Again, it matters what your dose is, how fast you're ramping up, all that kind of stuff But yeah, it's going to be different And some of the like common side effects that you see are usually gastrointestinal things. so like nausea, constipation, diarrhea, heartburn, vomiting. Those are usually gonna be there like whenever you first start or whenever you increase your dose But some things to just kind of help combat that are going to be like smaller meals, staying hydrated. eating enough protein. I mean, those are going to help tremendously. So and I think it's I mean, I feel like the way that we do it going low and slow and really reinforcing you know, diet and those kinds of things. I feel like a lot of our patients do so well. I feel like it's rare that we see you know, adverse side effects. Yeah I know. and I feel like that whole it's kind of like we tell our pregnant women, like you need to be eating multiple small meals a day. So it's going to be a thing on these on these medications. You're not going to be able to sit down and eat a big o, you know lunch and then a big o old dinner. I mean, that's just not It's going to probably work better for you to have like five small meals a day. And it would be even better if those could be like protein type meals. Yep. deffinitely have to do that. Yeah. And then I think there are some potential serious risks that we have to think about and be aware of. and that is like gallstones, gallbladder disease. sometimes that stuff can get worse. And then pancreatitis has been reported. So if you're somebody who's like, oh, I've had pancreatitis three other times in my life, well, I mean, maybe we should this before, you know, ye, a little bit harder in those people. significant dehydration and nausea vomiting, that happen like if people either use too much too fast or they're just like overly sensitive to these medications. I mean, you know, there have been reports people have to go in the hospital and get dehydration, things like that. That is exceedingly uncommon. I think I've seen that one time. and then delayed gastric emptying. So that's a big deal, not like For the weight loss standpoint, that helps you because it makes you feel full longer. but delayed gastric emptying is the big deal with surgery. And when you're going go to sleep because whatever is in your stomach, you could aspirate. And so for this reason, most procedures that are going to require anesthesia are going to want your last GLP one dose to have been at least a week ago. And so talk to your doctor or prescriver or whoever if you're going to have surgery about when you should stop your GLP one because anesthesia has some rules about that right. And then yeah, who should not take a GLP there your indication Yeah. So I feel like we've all heard this on the commercial, but if you have a personal or family history of metillary thyroid cancer I mean, I always kind of ask people that, you know, just to make sure or if you have multiple indeorine Noplasia syndrome type too. Yes. those are kind of the big big contraindications. If you're pregnant You're not gonna to take a jokey one while you're pregnant we want to be real. kind of the pancreatitis stuff that we talked about before, if you have a history of pancreatitis, if you have severe GI issues like gastropresis or just severe digestive ility issues, these can slow that down even more. So you would probably not be a good candidate for a GOP one If you have active gallbladder disease, if you are seeverely dehydrated anyways if you have an eating disorder. mean these don't need to be part of your plan right now Yeah. But I feel like in general, it's just like hormones. in general, most people are going to be a good candidate if it's done correctly. Absolutely U Is compounded semlyide orrrazpetide safe? So we run into this question almost every single time we prescribe this because we're notin treating diabetes.. And so it's hard to get this stuff covered and then it's so expensive if it's not covered. The companies themselves have come out like Lily pay offers like a lower cash pay price, still the most affordable is probably going to be to get it compounded. And so it's I feel like that's a complicated answer with is that safe or not? L I can't give a blanket yes or no. reallyally. I know. And I think it just matters like which compounding pharmacy that you're using. like we have been using one for I don't know, three or four years. I mean ever since you could compound these. Yeah. We've been using the same compounding pharmacy. And so I really know how their product works. Yeah, know like we haven't had, you know, side effects kind of things off it there. Yeah. So I mean, and they are like an FDA registered and put themselves up voluntarily for FDA regulation. I mean, that kind of thing because that's a thing. In the compounded world, you don't have to be FDA regulated. R. But you can as a compounding pharmacy volunteer yourself up for like, please come and test my products. and then there's third party testing where you allow other people to test your products. So we need to be using kind of place and it's hard to know as a general consumer, is it that kind of place? And so yeah, you also need to be careful like that you're not how to like not say this in a tacky way. like some places give you the cheapest GLP one they can find so they can make the biggest profit. That's right. I mean, it's just like every other facet of business. And so This was a big profitable industry for a while and still really is. We personally don't like to necessarily profit off of a GLP one. I'm not running a weight loss clinic up here. I'm running a like be healthy, live the age well, be the best version of yourself in menopause. And so I'm really not doing a lot of GLP ones just strictly for like vanity weight loss purposes. I'm doing them and treat the billion other things on the list of things that they treat, which is long and most people are going to have one. But we don't make money off of a GLP one given for a medical reason. That's different than a lot of med spas. And so paying a ton of money and they don't know where the products came from. I mean, those are just red flags. So maybe ask, who is your compounding pharmacy? How long have you been using them? You can look up the compounding pharmacy. You can figure out if they're an FDA regulated type of place. So just just ask some questions. If they don't know those answers, that's a giant red flag. Yeah, I don't know. not all compounded products are created equally. and so that's why that's a hard H thing to answer. I think the compounding pharmmsy do we use is safe? Yes. I agree. Yeah And, you know, you can you can go online and like get all of these medications now like you can just order them yourself like off the black market or you know, whatever it's called. but I mean, I would advise you probably not to do that. like I think working with First of all, a provider, but then also just like a well established, good compounding pharmacy that we know is good is definitely recommended And And then the next one, what is Red A Tree Tide? It is happening. I feel like a lot of people have already kind of dipped their toes into Red A Tree Tide because they have been able to snag some. It is technically like not available yet Right? Like it's still NA approved. Yeah. like it's still in trials. like I don't I don't think that like we like we can't get Red a trrue tide, like prescribe it from our compounding pharmacy. No our compounding pharmacy doesn't yet compound Red a true tide, but they' There are some places, some people are getting it because patients come in. But I think like our and that's why I like our compounding pharmacy, they're like we just don't have enough information on that yet and we are not currently compounding that. It is a triple cut tide. so GLP one, a GIP like like Dspetide that would be like Drawzpetite. But then it has a glucagon agonist. So the glucagon agonist part is what kind of sets it apart and they think that that may improve energy expenditure and basically help with fat oxidation. Like N, burn more fat. Do brereak down your fat and so that your body uses that for energy when it thinks we have an absence of like glucose and when you're getting your insulin down so low, then that's what your body does is start burning fat. So yeah It's going to be even more potent. The phhase three trial released in twenty twenty six just this year showed approximately twenty eight percent weight loss in eighty weeks. eighty weeks is a long time. But and that patients lost almost thirty percent of their body weight. And so the big deal there is that that's what we see with bariatric surgery. So It is more potent so the catch is that we're probably going to see more side effects. But I saw somebody broke this down in a very simple way. Sma gllutide makes you eat less. Rs epide makes you eat less and it improves your metabolic signaling. and then Redatry tide makes you eat less, it improves your metabolic signaling and it potentially burns more fat. So love that. Yeah, it's just, I don't know, I feel like here in a while we're gonna to have like ten pep tides in one shot. I know. I feel like probably in the next six to twelve months, we'll have a whole episode on Reditue tide because it's gonna be out there more. We're gonna know more about it. I mean, I think TD on that. I'm interested to see. It's like where is the tipping point? Like how many peptides can you put in there and it still be okay? I don't look at what point you just inject the shot in your skinny tomorrow I think I mean, this is getting crazy. Oh, I know all the like bio hacking and peptides. I mean It It's definitely out there. L it's it's undeniable for sure. Yeah I interestnterested in all of it. I don't know enough about all of it yet, but Yeah, we're learning everything. I's take a peeptod for everything now. Literally Yeah. So in closing, I feel like the biggest mistake we see people thinking is that This medication or this peptide is the entire plan. This is my weight loss plan. And I feel like that shouldn't be true. I feel like the medication is there and it's available and it's wonderful. And like Dr. Rzi said,'s probably the drug of the century But we have to have our foundations correct, which start with the very basic, like let's sleep good, let's move our ass, let's, you know, do the things that are readily available and honestly free to do Um, and then gettingetting h I put Horm in there be right of there withs just like it's basic. like Yeah don't foundational Yeah. Yeah. just like that's your your architecture getting that stuff right. And then still at the end of the day, if we've done all those things and we're not losing weight, this is a wonderful tool or especially if you are very insulin resistant, either because genetically you have PCOS or something like that and you can't help it. and you're just insulin resistant or whether you're truly like pre diabetic insulin resistant type person and it's just so much that you need something to break that vicious cycle. So we still have to do all of our basic things. but I think that HRT helps a lot here and we can't forget about all these foundations and just rely on this little peptide shot or triple or double or whatever to do all the work for us. So much's right. Okay, quick reminder everything we talk about here is for informational on supported purposes only and is not medical advice. Your body is unique, so be sure to chat with your health carere provider before making any changes to your health routine What are we doing next week? I don't even know. Mbe maybe puppy drinks We just got a puppy and I down my head's like spinning with lot even I feel like we have a newborn in our house again. Oh my gosh. That hard' so hard. So yeah really know what we'll do Probably something Yeah Something easy and fun. I feel like it's the summer. like I want it I want Yeah to be bit light and Yeah. Yeah. I do have a guest coming on, but we're we're busy. she's busy. She can't come until like kind of early fall, September. So Um, I don't know, We'll do something. Yeah. have any requests, defefinitely emailion day hormone. Do anybody know? Yeah. if anybody wants to know about like puppy potty training, or I mean, seriously this could be an episode. People probably want me to shut up, but like I've been driving my family crazy about it. Should you neuter or spay your dog? I mean, why are we runing there There moreorm I I want to ask this exact question, but I know they'll think I'm like Ba crazy, but as somebody who like sits here in tout fororms and all their benefits, it feels really weird to like, I'm cut that off. Go neuter a little non mentthal puppy. Anyway, we're not gonna to really have an episode about that, but it's just youent to ponder. If anybody has any ideas or if there's any vets listening, you can email me and tell me I'm completely crazy or that maybe we're onto something. like do they do vestectomines in dogs? Do we have to cut their balls all the way off Right. Yeah Yeah. Anyway, let me know. H day Hormons at gmL dot com foollow us on social, all the places. see y'all next week. Happy upday. Be M.