Recently, I interviewed Dr. Kristi Tompkins, and we talked about the significance of managing stress, the importance of individualized dietary plans, the interplay between hormones and thyroid health. If you would prefer to listen to the interview you can access it by Clicking Here [1].
Dr. Eric Osansky:
I am super excited to chat with Dr. Kristi Tompkins, as we are going to have a comprehensive chat on hormones, including hormone stressors. I am going to dive into Dr. Kristi’s bio:
Dr. Kristi Tompkins is a naturopathic doctor, functional medicine practitioner, and transformational coach. Having treated a variety of clients over the last 15 years, her specialty is helping women to become more aware, adapt, and thrive during the perimenopausal and early menopausal years. Integrating a blend of personalized lifestyle medicine, brain-based coaching, and mind/body healing, Dr. Kristi enjoys encouraging and empowering her clients to make better choices in their health and their lives. Thank you so much for joining us, Dr. Kristi.
Dr. Kristi Tompkins:
Thank you, Dr. Eric. So happy to be here with you.
Dr. Eric:
Before we talk about hormones, can you give a little bit more of your background? How did you start focusing on helping women with hormones?
Dr. Kristi:
I trained as a naturopathic doctor, so I have a doctorate degree in naturopathic medicine up in the Pacific Northwest at Bastyr. In medical school, you learn about treating everybody: men, women, children, all the different health conditions.
After I graduated, I started working with an integrative medical doctor. He would now be considered a functional medicine doctor, but very much integrative. Trained as an MD but integrated a lot of botanical medicine and nutrient therapy. He also had a specialty in hormone replacement therapy, bioidentical hormones, hormone testing for men and women.
Early on in my practice, working as a naturopathic medical doctor, I learned about how to diagnose, how to test, how to read the functional labs, how to prescribe bioidentical hormones for women going through perimenopause, which is anywhere from 4-5 years up to 10 years before menopause, leading up to when their period stops, on how to help them holistically but also with bioidentical hormones.
Same thing with men. Prescribing hormones, not just bioidentical hormones, but also thyroid hormone as well.
It also happened to interest me. I’ve had an interest in women’s health for quite a number of years, just based on my own female hormonal symptoms that I had many years ago when I was in my teens and 20s. I naturally gravitated toward women’s health.
At some point, I moved from the Pacific Northwest back down to California, where I’m from, and I started a practice there. It was back to general medicine again, treating a variety of people. It’s been probably within the last 4-5 years that I have really narrowed my niche on women’s health, specifically perimenopause. I still treat a variety of people with different conditions. That seems to be something that really calls to me.
It’s that time in a woman’s life where there is a lot of changes that are happening with her body. Of course, life changes as well around her. There is a lot of things that happen that women don’t necessarily direct or pinpoint it to, “This might be related to my hormones changing or menstrual cycle changing in preparation for menopause.” It tends to take a lot of women by surprise, the weight gain, the hormone changes, the sleep, the mood, vision changes, and thyroid changes.
I want to help take out the mystery and the confusion and the stress of these symptoms and help women feel more empowered as their body is inevitably going through these changes, so they feel a lot more confident and in control, as much as they can during that time.
Dr. Eric:
You mentioned a number of different symptoms. Would you say these symptoms associated with perimenopause are normal, or would you say they are common but not necessarily normal?
Dr. Kristi:
Great question. I would say it’s both. It depends. If you throw in unhealthy foods or pro-inflammatory foods, and you add in chronic stress and environmental exposures, and the list is infinite, that will affect not only the entire body, but it will also affect the ovaries, uterus, communication between the brain, the pituitary gland, and the ovaries. It will affect the cycle indirectly or directly.
Things like changes in their menstrual cycle, like heavier bleeding or a shorter cycle, where it’s a shorter time in between. Women are starting to notice more headaches right before their period maybe, mood changes, sleep changes. Some of those things can be mild, but they can also be exacerbated and worsened through some of those other stressors in our lives.
That’s where personalized lifestyle medicine, stress management, exercise, meditation, mindfulness, treating the whole person can help everybody, but it can really help women as their body is having the dip in hormones. Having this dip throws them off balance. They don’t feel like they can adapt to life changes as well, just with the hormones dropping anyway, but then you add in all these other factors that makes it worse.
Some of the symptoms can be normal, like skipping periods. Maybe you skip a few months in a row, or maybe it ends up being 21 days in between your cycle. That’s pretty common as you’re approaching that time when the period stops. That can actually be worsened by things that you are doing in your life that you’re not aware of, or maybe you are aware of. What you’re eating or what beverages you’re consuming or how much sleep you’re getting. That can throw that over the edge. It can be a fine line between “natural” symptoms and exacerbated symptoms.
Dr. Eric:
Makes sense. You’re going to get some symptoms regardless of how healthy of a lifestyle you live. The problem is that many people don’t live a healthy lifestyle. If you’re eating a lot of refined sugars and gluten, and you’re stressed out all the time, that almost definitely will lead to an exacerbation of symptoms.
Let’s talk about some of these stressors. Starting with stress itself, let’s say if everything else was perfect. Overall eating a very healthy diet, doing things to minimize exposure to environmental toxins, which we can get into more of. If everything else was in alignment, but the person was in a state of chronic stress, how dramatic of an impact can that have on one’s health?
Dr. Kristi:
As you and I both know, a little bit of stress sometimes can be to your advantage. That acute stress, the stress of writing a book or starting a business. There can be “good stressors” in our lives. Sometimes, that pushes us to grow and change and evolve in our life. Usually, that is considered maybe more of a positive excitement, something new.
Then there is the chronic stress of financial stress, maybe the stress of relationships or divorce or something happening with your children. There are a million different types of stressors. Sometimes, there is a lot of internal stress. Probably more than sometimes. There is a lot of perception of things that may or may not happen, or maybe recounting stories from however many days, weeks, months, years ago that we’re still reliving.
A lot of times, our emotional/psychological distress comes from within. That can be the same type of stressor as anything outside of us. That puts our body into a higher focus on the sympathetic nervous system. If there are more of those stress hormones, there is not a lot of time or opportunity for growth, repair, relaxation, restfulness, absorbing your nutrients, creating new hormones, and creating new proteins. There is a static interference between the stress hormones and our other nutrients, neurotransmitters, and hormones in our body. The body can’t thrive. It can’t expand if it becomes too constricted, too inflamed.
The body is pretty fantastically wise and resilient. It can usually help you. Your body really does have your back. Over time, if you’re constantly in that fight or flight, feeling threatened or feeling like you might be attacked from an ancestral perspective, like if you are going to die, it puts you in that state of chronic stress hormones. Your body can’t really grow in the way that it’s supposed to.
That is when a lot of cells start to change. They become different, and the organs change. The body is trying to adapt, but it’s maladaptive over time. That is when you start to see illnesses and diseases set in. There is a whole assortment of those. The body is trying to adapt with you, with the stress, but that is not a normal state. Blood sugar, blood pressure, weight changes, changes in the brain, changes in your skin, changes with your hormone levels, changes with your thyroid.
That is when people wake up. They have all these symptoms, “Wow, I feel terrible.” Maybe it’s been gradual over a period of time. “I’m just tired all the time. I’m achy. I’m not sleeping well.” “I’m chronically congested and have this mild achiness throughout my body. I don’t know what’s going on.” Then it gets to be really bad. That is the body’s way of saying, “We need to get your attention. Something has been off for a period of time.” That is usually when people seek out care.
Fortunately or unfortunately, a lot of people go to their regular, conventional doctor for a prescription, for help. Sometimes, that can be helpful, lifesaving in emergency cases. Sometimes, that can be incredibly therapeutic. It’s a very limited amount of tools in the toolbox. Whether it’s medication or somebody running a lab test that comes back “normal,” a lot of people are sent away going, “Okay, the problem is still here.” In some cases, “I feel worse.” The root cause wasn’t addressed.
For a lot of people, they don’t understand that they might be part of the root cause. Their own internal overreaction to stress or life, they might be part of the problem. Not to point fingers and blame them, but to show people what you’re doing in your life might be contributing to how you’re feeling. There is a lot of personal accountability and empowerment that you can share with your patients or clients, that you can make these changes in your life in so many different ways, so your body can get back into that balance again. It’s not constantly in the fight or flight stress, so it can actually heal.
Dr. Eric:
One of the strategies you recommend is doing mind/body medicine, meditation, yoga, and other techniques?
Dr. Kristi:
A lot of people feel, “I can’t meditate. I have too much going on in my life and brain.” That’s a lot of people. That’s why they call it meditation practice. You don’t exercise one time. You don’t have one healthy salad, and you’re good. You really do keep going.
It’s the whole person perspective, healthy eating, moving your body, strengthening your muscles. It’s taking whatever supplements, nutrients that you need. Cultivating healthy relationships. It’s that mind/body connection, whether it’s meditation, breathwork, yoga. There are other ways to meditate. Listening to music and focusing on your breathing can work wonders at calming the nervous system.
The whole point is not only to calm your nervous system or regulate it, because we don’t always want to be in the parasympathetic or always in the sympathetic. It’s more about the balance and regulation.
Oftentimes, meditation can also help you make changes in your life. It can help you shift your thinking and shift the beliefs you’ve had about yourself and your life. It can help you shift your emotions in a way.
A lot of times, you can make positive changes in your life, in your habits, or get rid of self-sabotaging habits and beliefs, and actually create new things in your life. You’re continually growing. You’re letting go of the old ways of living and doing and thinking and being, but you’re moving toward more of a positive, expansive way of living.
That also naturally resets the body back to homeostasis, where it’s actually functioning normally. It’s got many different benefits to it.
Dr. Eric:
If you could talk about some of the other stressors, the other factors that can cause imbalances in your hormones?
Dr. Kristi:
I would say a big one is the food that you put into your body. Whether it’s alcohol or too much caffeine or sugary beverages, pro-inflammatory foods. My undergrad is in nutrition, and I know you have a heavy nutrition background as well.
Putting these foods into your body once a while is okay, but when you put these foods into your body over time, chronically, and your body reacts in a way that actually causes the immune system to be overactive, so foods that your body is like, “What is this? I don’t totally recognize this. Yes, this is food, but I don’t know what to do with this. I don’t know how to break it down. I’m perceiving this as something foreign or potentially a threat.”
It creates this cascade of inflammatory cells that react to the foods or beverages. That can cause a dysregulated immune system, but it can also cause a lot of symptoms like pain, congestion, inflammation, hormone imbalances, and things to become more swollen. Sometimes, we get these benign tumors throughout our body because of things that have gone awry over a period of time.
That in itself is a stressor. It can affect the gut, the digestive function in the body, the liver, your skin, your joints, your muscles. That over time can cause problems in each organ system. Ultimately, it affects the entire body.
I think that is not so much the biggest surprise to people because people know if they eat the wrong foods, they’ll gain weight or have heartburn, or they’ll get IBS. A lot of people don’t make the connection between their autoimmune disorders or female hormone or male hormone symptoms or conditions or their skin or chronic headaches or chronic respiratory symptoms. They don’t make the connection between the foods you’re putting into your body, even if you might think they’re healthy.
A lot of people eat foods as part of their family ancestry, part of what they know. If they’re eating those foods that maybe were relevant to a different generation, but now they are eating this food today, which may or may not be processed, and you add in their own biochemistry and life stressors, things are different. It’s really showing people not only through testing but through spending time with your clients and asking questions. I want to understand not only what their current symptoms are but what their past medical history is. What has led them up to this point?
If you get rid of those “stressors,” the diet, certain foods and beverages, again, the body has a chance to calm down. That nervous system can regulate. The immune system, the gastrointestinal system can now regulate.
It’s a pleasant surprise for a lot of people if they are not already doing that. Getting rid of those foods. Often, it’s not just, “I think this is healthy for me.” It’s an addiction. There is a lot of comfort foods out there that people choose because they’re stressed, or it’s “Why change now? I’m this age, so I will keep eating these foods because that’s what I’ve always done. These are my staples.” That can affect the body.
Showing people that the stress in their foods might be contributing to their own symptoms. They can make those changes to help the body heal.
Dr. Eric:
What dietary approaches do you have in your practice? Do you tell someone to eat whole, healthy foods, like following a paleo diet? Or do you have them follow some type of elimination diet? Do you do food sensitivity testing to see what foods people are reacting to?
Dr. Kristi:
It comes back to the individual person. Not to say that if they love ice cream, yes, keep eating a bunch of ice cream every day.
I personally and professionally love the paleo diet. It really does have this beautiful assortment of different macro- and micronutrients. Proteins, healthy carbohydrates with fruits and vegetables, healthy fats. Not as much emphasis on grains, starchy vegetables.
There are different variations of a paleo diet. I know some people are following the ketogenic diet or a vegan diet. Maybe they have a little bit of grains every day. It’s case by case. There are some people who can eat grains or sweet potatoes. They can have red meat or pork. Their body might process that really well.
There are other people who can follow a paleo diet, for example, but it might need to be modified based on their inflammation, weight, digestive system, age. There is a big difference between a younger male who is in his 20s versus a 50-year-old, menopausal woman. The metabolic rate is different. The caloric demands are different. It depends on your activity level, your body mass index (BMI), and other factors. I love the paleo diet as a general guide.
To answer your question, I do food allergy testing. I do gut testing. I do hormone testing. I do nutrient devaluation testing. I do DNA testing. There are a lot of different tests. I have been in practice for a really long time. I have run pretty much every single functional lab out there, it seems like. I have tailored that to a certain array of labs that I really feel accurately capture what’s happening in the body.
I love doing a whole custom panel, like a comprehensive metabolic panel for men or women, which really looks at the thyroid, the liver enzymes, the advanced cardio-lipid panel. Looking at all that data in relation or in addition to their symptoms, in addition to their preferences. If somebody is not into kale, that’s okay. You don’t have to eat kale. If they’re not into eating quinoa, you don’t have to eat quinoa. I try to meet them where they’re at.
I give them the guidance and data and recommendations and insight as much as I can. “If you continue eating this, you will probably have these same symptoms.” I try to work with them as best I can. I realize it’s a process. I had major food allergies when I was younger. I didn’t realize it. I didn’t even know what the term “food allergy” meant. Looking back, I had a lot of that. I didn’t understand that was affecting my body, and I was doing that to myself. That was affecting my hormones.
It took me a period of time to really make those changes to my diet. Now, I notice, because I have done so much work on myself physically and emotionally, that when I eat those foods, I know when it feels off. I know I have those symptoms right away. A lot of people don’t realize that they feel so bad or miserable all the time because they are eating it day in and day out. They don’t realize the connection there.
It is mostly paleo. If they’re vegan, that’s okay; I work with them. If they prefer to have a higher caloric intake, based on their individual preferences, I do try to work with them. It’s not a cookie cutter approach to any person. Again, I do try to give them my best recommendations to help them heal.
Dr. Eric:
Sounds good. I like paleo as well. If someone is a vegan/vegetarian, it sounds like you will make modifications if necessary.
Dr. Kristi:
Yeah, I want to add to that though. You brought up a good point. If someone is vegan or vegetarian, and they are specifically not having any animal protein. I know there is a lot of vegetarians who will eat dairy or gluten. We know there is protein in dairy and gluten grains.
If I feel that somebody’s health is adversely affected because they’re vegan, like thyroid. That’s a big one I see a lot. I have seen this many times over the years with men and women. If they are vegan or vegetarian because they chose it, or their partner is eating that way, so they will do that, too, because it’s easier. Or their partner is giving them a hard time for eating chicken or steak. If I see it affecting the person’s thyroid level or energy or testosterone, or their ability to repair and heal and thrive, I will point that out. I don’t do that a lot, but I’ll point it out from time to time.
Your body might actually function better with this type of protein from turkey or chicken or seafood. You might have this assortment of amino acids that you’re now absorbing, so you can produce these basic building blocks. Using food as your medicine, food can be your therapy. Reminding people that we’re eating for a reason. Yes, we’re eating to live, and we’re eating for enjoyment. We’re also feeding our body with the things that it needs to rebuild and repair. I have mentioned that to a few people over the years, and it’s amazing that when they start introducing maybe in small amounts, their body is able to heal.
Dr. Eric:
You mentioned protein. Is there a specific amount of protein that you recommend for people to consume?
Dr. Kristi:
I don’t do that. I don’t do a lot of macronutrient numbers. I really think it’s based on the person’s metabolic rate, how much you’re exercising. There are so many factors involved.
I tend not to overrecommend a lot of protein because sometimes, people get too much. I know that’s a very common topic these days: making sure you are having enough animal protein. I get it. We do need those amino acids for certain reasons in our body.
I have seen some women in my practice who are doing more of the ketogenic, higher protein and higher fat, and limited carbs. Maybe it’s 20-30g or less of carbs per day. I see that change their lipid levels, and I see it change their mood. It changes the gut. Sometimes, there can be adverse effects. Again, it might be mild.
I usually don’t give people a gram of protein per day to eat. I put it back to them. If you love chicken, seafood, turkey, that’s great. If you love to have steak a few times a week, your body seems to be taking that in and absorbing it well, then keep doing that.
I tend to think that people overdo it quite honestly with the amount of protein. They overestimate the amount. If your body is getting too much, it’s going to excrete it or store it, or it can cause other problems.
I give general recommendations to people. I give them a guide.
Dr. Eric:
I’d like to talk about testing. You said you do a good amount of testing. I don’t know if you do all the tests on everybody. You mentioned gut testing and DNA testing. Can you talk about what tests you recommend on most people? If there are other tests that you recommend, depending on the person? I don’t know if you recommend genetic testing for everybody or just a subset of your patients. Same thing with gut testing. If you test for not only sex hormones but adrenal hormones, do a saliva test or dried urine test?
Dr. Kristi:
As I mentioned, I’ve run almost every test on clients over the last 15 years in practice. There is so many. There are almost too many possibilities out there on what can be evaluated with the body.
There are certain programs I have in my practice that I have built in the last few years. I have a six-month program called Elite that contains a lot of cool features. It includes all the testing in the program.
I do food allergy testing. I have been doing it for so many years. Sometimes, I think about getting rid of that test. I personally love it. Professionally, I love it because it’s a blood test, and it’s showing an IgG and IgE antibody or immune globulin reaction to those foods. It seems to be very sensitive. I have looked at other food sensitivity panels over the years, but I keep coming back to this one. There are certain favorites I have. We tend to think of gluten and dairy and the common foods that are talked about so often today, but there are other foods like green beans.
You asked me earlier about food elimination. If I see certain foods that might be elevated, maybe in the moderate to high category, or simply based on what they shared with me. I do know certain tests are very accurate, or there can be a false negative, where it doesn’t show much, but I am suspecting they might still be sensitive to a food. I will have them get rid of it for at least a month if not longer. Some people are okay with that; other people have a really hard time.
If it’s the holidays, I don’t usually have people get rid of eight foods right before Thanksgiving and Christmas. If you really want to start cutting back, maybe start at the beginning of the year. Really clear this out of your body, so you will feel much better. Usually, they’re on board with that.
The food allergy test, anywhere from 100-200 foods. People love it. They love that kind of data. That’s the one test they are super fascinated by. It shows them what’s happening when they put these foods into their body.
I also do that custom comprehensive metabolic panel. All the different systems, the livers, the kidneys, the reproductive hormones. I love to look at the sex hormones on a serum level, but I also do the Dutch test, which is part urine and part saliva. I love to compare those two because there are sometimes certain test markers, certain hormones that are more sensitively picked up on a blood test compared to urine or saliva. Pros and cons to every test.
It also looks at all the different thyroid markers, the antibodies, the advanced cardio-lipid markers, Vitamin D, iron, FSH, LH. It’s something I’ve put together myself as a custom panel. Based on my years of experience. It’s so simple. It’s just a simple blood test that I order through Quest, but it shows so much.
I love to do the Dutch test, as I just mentioned. Looking at reproductive hormones, sex steroid hormones, corticosteroid hormones. It’s part urine, part saliva. It shows that cortisol awakening response and that Circadian rhythm tendency or influence and how the corticosteroid hormones will affect the reproductive hormones.
That’s usually done at a certain time of a woman’s cycle. If she is not bleeding anymore because she is menopausal or had a partial hysterectomy or a Mirena IUD, which is pretty common for a lot of women, to have an IUD and not get their period anymore. That’s another topic. The Dutch test can be done. If you’re not using a period, it may not be as sensitive.
I love to do stool testing. This is in the Elite program I have. I do the Genovva GI Effects. There is a one-day or three-day. I have a mid-tier six-month program that will still incorporate many of those labs, but it might be quite the expanded, detailed nature of some of these other labs. They have other modifications, other smaller versions of these labs, too.
The GI Effects, I love because it looks at the healthy gut bacteria, potentially disease-causing bacteria, candida, yeast, protozoa, parasites, inflammatory markers, digestive markers, absorption markers. It’s what your body is excreting. Nobody really likes to do that test. It’s not the most favorite one to collect for. It does show quite a bit of data.
The last two would be a nutrient devaluation, which looks at how well your body is absorbing your proteins, amino acids, antioxidants, vitamins, minerals. And the organic acids, which is what we excrete in the urine as a way to show a deeper level of what’s happening biochemically, metabolically within the body.
The DNA test, I have recently started doing that one. I know it’s been around for quite a while. That one is in the Elite program I have. I love it because it shows these detailed reports that accompany- It’s a very simple salivary collection that shows genetic potential or susceptibility that is not a diagnosis by any stretch, as you and I both know.
Epigenetics plays a big role here. You can influence not only what happens to your body, but you can also make changes now, so you may not be at a higher risk for certain things developing. You may need to make some modifications along the way. I like the detailed nature of the reports that accommodate the different body systems.
Those are the types of tests I love to order. Based on my history of having been in practice for so many years. I’ve run SIBO testing and heavy metal testing and all sorts of different valuations to see what’s happening. I think it’s easy to go down that rabbit hole.
For some people, that more one-on-one care, where it’s somebody coming in for a variety of different health conditions. My practice or business has now focused more on women’s health and hormones. I have chosen certain labs that I feel best reflect or best show what’s happening in the body.
The patients love it. They love the data. They like the one-on-one connection as well. I do spend a lot of time with my clients. But they love the data. They are always curious about what each test will show. “That’s why I’m feeling so tired. That’s why my body feels so inflamed. That’s why my eczema flares up when I eat these foods, and I’m under a lot of stress.” People find it really interesting.
Dr. Eric:
Can I ask what company you use for genetic testing?
Dr. Kristi:
I use the DNA Company.
Dr. Eric:
Since you use Genovva for the GI Effects, where you talk about Nutreval, is that what you use for nutrient testing and organic acids testing?
Dr. Kristi:
Yeah. There is a lot to this. That’s why I have a six-month program. People meet with me consecutively for six months. My practice is completely virtual, so I do a screen share. We go over all the testing. The testing procedure itself can be complex for some people. I can always go over that with them directly.
Fortunately, each lab has collection instructions on their website. Genovva has completely revamped everything, but they have a beautiful description and summary and tutorial of how to go about collecting. Same thing with the Dutch test and some other tests. This can be overwhelming.
I usually tell all my clients, “You don’t have to do all this testing right at the beginning.” I have a three-month program, where they meet with me for three consecutive months. That doesn’t include any testing. That way, they get to pick and choose which labs they want. It’s less involved, and it might just be one or two tests, especially for younger clients under the age of 30. They don’t have a lot of serious health problems, so they often choose the three-month program.
The lab testing shows a lot of data, but it can be overwhelming. I usually tell people, “Let’s have you do one or two tests per month” to break it up. I am giving them a specific, personalized treatment protocol to go with each appointment. They are following the treatment, making changes to their diet, getting the supplements. Now they are doing testing. The six months is a good start. It seems like a long time, but that’s just the beginning of them making substantial changes in their life and body.
From that point on, they can continue to work with me on a monthly membership basis. If they feel like their body has healed, and they feel like they have a really good handle on the resources and information and guidance that they have received, they can now go on their own. That happens a lot. “I had no idea my body was reacting in this way. Now that I know what to do, I can take this with me and move forward.”
Some people need more help. I have clients who have been working with me for 10-15 years. I have some five-years. I have some who go through the program, feel great, and move on.
It can seem like a lot. I am there to guide them the whole way. The communication, the interaction is really key here. That’s what I love about functional medicine, naturopathic medicine. There is so much more care and attention involved in somebody’s healing versus “Here’s your medication, here’s your pill, send you on your way, come back in a few months.” I don’t think that delivers the best resolution for people with regard to their health.
Dr. Eric:
I agree. I want to talk to you quickly about bioidentical hormones. Obviously, you do this testing to try to find out the imbalances they have and make recommendations to correct those. For hormones, especially the sex hormones, like progesterone, estrogen, testosterone, when do you recommend bioidentical hormones? Are there times when you don’t recommend bioidentical hormones? When you try to correct the hormones through diet and lifestyle.
Dr. Kristi:
Another great question. Coming back to an individualized approach to each person, that’s why I love the lab tests to show what’s happening in the body. I have been doing this for a while. I can often assess what’s happening in the body based on their symptoms. “Oh, I bet they are not producing enough progesterone in the second half of the luteal phase of their cycle if they are still menstruating.” “I’m suspecting their testosterone is too high or low. Maybe their estrogen is too high.” Based on their symptoms. Having spoken to thousands of patients by now.
I like to use the lab test data, the blood tests, the comprehensive panel that looks at the sex steroid hormones, plus the Dutch test. Sometimes, they don’t need to do both. Sometimes, doing one or the other is sufficient for me or them.
For some clients, I will prescribe all three: estrogen, progesterone, testosterone, especially if they are post-menopausal. If they are post-menopausal and having hot flashes and night sweats and trouble sleeping and low libido and all sorts of other estrogen deficiency symptoms, I will prescribe all three.
I love prescribing to compounding pharmacies. I have been working with compounding pharmacies for over 15 years now. I love them. They really do work with the doctor and the patient to get the right dose.
I learned from this doctor up in the northwest, Dr. Jonathan Wright. I learned about how to really lower the dose, so it’s not so high. I see a lot of other doctors and practitioners that are prescribing a cookie cutter recipe of hormones for every client: Here is the estrogen patch or pill. I think that often gives the female too much, and now she is gaining weight or having adverse symptoms. I think it should be tailored.
I don’t prescribe high doses of hormones usually. The application site matters. The amount of cream, the concentration of the hormones. Sometimes, I use bioidentical oral hormones. Sometimes, I use progesterone, based on her symptoms. Sometimes, I will just use one hormone, and I won’t use the other two. Sometimes, it’s just twice a week instead of consecutive days in a row. Maybe it’s only two weeks out of the month.
That’s where that personalized care for each person comes into play. “This is what I have always done. Here is your recipe. Here you go. Pick it up at the pharmacy. I’ll see you in two months.” I want it to work for her.
That is the benefit of working with somebody like me, where there is a program. If you’re having a reaction to something, you can send me a message and say, “Hey, my body isn’t responding well to this.” “I don’t think this is enough. I think we need a higher dose because it’s not fully addressing.” That’s where that adaptability of “Let’s use this hormone. Let’s take this hormone out. It sounds like your body may not need that quite yet. It’s causing a reaction.” I typically use a variety of bioidentical hormones if I feel it’s a good fit for her. If not, we tried it. Maybe we reduce the dose.
I use botanical medicine. I love botanical medicine, herbal supplements, nutrient therapy, diet/lifestyle. It’s going back to the whole person. It’s not just take this pill for your night sweats, and take this pill for your sleep. It really is looking at the whole person and giving them a recipe. It’s a personalized treatment protocol for that person, men or women. I don’t see a lot of men in my practice like I used to. It really is a personalized approach to giving her what she needs and knowing that that can change over the course of several months or years.
Dr. Eric:
It sounds like you do like bioidentical hormones, but you don’t give the same dosage or hormones necessarily to everyone. I like that you said that you’ll tend to give lower doses. If someone needs a higher dose, I’m sure you’ll give it. It sounds like there are practitioners out there who give the same dose to everybody. It doesn’t make a difference to the person. Probably also giving all three hormones to everybody as well. More cookie cutter. If someone needs a higher dose, you will give it. You won’t give every single person a high dose of all three hormones. Some people might just get one hormone. It really does depend on the person.
Dr. Kristi:
If a woman is getting acne breakouts because I gave her testosterone to help support her libido, or getting chin hair or having hair loss, that is not going to make her a very happy woman. She doesn’t want those reactions. That’s where you cut back.
There is a dance between what is the right amount to help you with your symptoms, and what is the amount that is going to cause adverse side effects? Same thing with progesterone and estrogen. It’s really tuning in to each woman to ask the right questions, so it can be changed. It should be.
Going back to compounding pharmacies, I love that I get to modify the dose, send it over, and it’s usually a better fit. It is more personalized for the client as well.
Dr. Eric:
Dr. Kristi, you have covered a lot. Is there anything that I should have asked you that I didn’t ask you? Anything else you’d like to talk about? Any final thoughts or advice to give to the listeners?
Dr. Kristi:
We did cover quite a bit. I know your specialty is thyroid. I would say that with women’s health, I’m sure you’ve encountered this over the years, having thyroid health be your specialty. That tends to be more common in women.
A lot of times, with the hormone changes that a woman will experience, that will sometimes affect her thyroid in a way that will either lower the thyroid hormone or sometimes raise it. It can change the thyroid markers and levels in her body, so her metabolic rate is different with the hormone changes, which can change metabolic rate. Of course, thyroid tends to change for a lot of women in their 40s as well. As we know, it does change in the second half of everybody’s life.
That’s where focusing on diet and exercise- Muscle strengthening raises your overall metabolic rate and mitochondria. That helps with everything. Why is my thyroid off right now when I am going through perimenopausal changes? Why is my thyroid off when I am going through this stressful time in my life? Bringing that piece in, too, and making sure that gets normalized.
You have probably found this before. When you work with somebody to treat the whole person on every level, as much as you can, the thyroid can correct itself over time. it can often regulate.
In working with me over a period of time, a lot of times, they are able to come off their thyroid hormone completely. It surprises me to this day still. It surprises them. They feel too revved up on it because their body is functioning at an optimal rate and working more efficiently, so they don’t need it anymore. If you don’t need it, you don’t need it. That’s with anything. If you don’t need a medication or extra supplement or a higher dose of bioidentical hormone creams, and you can come off of it, I think that’s a win. That’s one last piece I wanted to add in.
Dr. Eric:
I agree. Quick question: Do you recommend desiccated thyroid, or is it more levothyroxine for thyroid hormone replacement?
Dr. Kristi:
It depends. There are some people who do really well with the desiccated. I know there have been some changes with the desiccated thyroid availability in the last few years. I have a lot of clients who have been on desiccated over the years, and they do well.
I have some who don’t. It just makes their body feel worse. We do either the standardized prescription levothyroxine Synthroid. Sometimes, I will do a compounded version of synthetic T3/T4. I do that for some of my Hashimoto’s patients, working with everything else in their health. That goes back to the case by case. I want to make sure I am giving them the right medication, so it works well for their body. As much as I love the natural T3/T4, some people overreact to that. It varies from person to person.
Dr. Eric:
Where can people find out more about you? You mentioned your programs. If someone is interested in joining one of your programs, can you mention your website? I also know you have a podcast. If you want to bring up social media, feel free to do that as well.
Dr. Kristi:
My website is DoctorKristi.com. I am on Instagram, @DoctorKristiTompkins. I have a Facebook group called Perimenopause/Menopause Like a Goddess that you can join, all about hormones. We talk about a variety of different women’s health issues.
I have a new podcast that I just launched called Fire, Soul, & Grace. It’s going to be a lot of different episodes on women’s health, hormones, functional medicine, mind/body medicine, meditation, ways of healing the body, and ways to optimize your health and life, and uplevel your health, too. Really excited about that. If you go to FireSoulAndGracePodcast.com, that will reroute you back to my website. Lots of great guests I have on my podcast coming up.
I have been so excited to be here with you, Eric.
Dr. Eric:
Same here. Thank you so much. I’m sure the listeners learned a lot. As usual, I learned some things as well. Appreciate you taking the time to share your thoughts on hormones.
Dr. Kristi:
Thanks, Eric.