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Sex Hormones and Thyroid Health with Dr. Tara Scott

Recently I interviewed Dr. Tara Scott, as she discussed the relationship between sex hormones and thyroid health. If you would prefer to listen the interview you can access it by Clicking Here [1].

Dr. Eric Osansky:

With me, I have Dr. Tara Scott. She is known as the Hormone Guru. Dr. Scott helps people find the cause of their symptoms and get back to optimal health. With over 25 years of experience and three board certifications in OB-GYN, functional medicine, and integrative medicine, Dr. Scott has helped thousands of patients struggling with hormone issues. This includes endometriosis, breast cancer, weight gain, and other conditions. Dr. Scott has been speaking, including a TEDx talk, and educating for over 10 years and has taught doctors her approach in over five continents. For her expertise, she has been featured on The List TV, Women’s Health, Shape, Newsweek, Authority Magazine, and on numerous podcasts. Thanks so much for joining us, Dr. Tara.

Dr. Tara Scott:

Thanks for having me.

Dr. Eric:

When did you do that TEDx talk?

Dr. Tara:

It was last October, 2021. It’s still in final editing. It’s not up on their page yet.

Dr. Eric:

Before we start diving into the questions about hormones, I’d like you to briefly discuss your background. How did you become known for helping people with different typesof hormone imbalances?

Dr. Tara:

I am a traditionally trained MD and OB-GYN. After residency and training, I was in a very busy practice delivering a lot of babies. Then I had my own struggle with infertility and had my own hormone imbalances. I wasn’t ever able to get pregnant without fertility drugs. Thankfully, due to that, I did get pregnant. After that, when you have a hormone imbalance, you are either trying to get pregnant or prevent it. There is nothing in between to help balance it.

I became interested in women’s hormones. I first became a certified menopause practitioner with the North American Menopause Society. Then I did a lot of studying of bioidentical hormones, perimenopause, and menopause. The more you learn, you find out the less you know. I went ahead and did a functional medicine fellowship and was able to sit for my integrative medicine boards from the American Board of Integrative Medicine as well. I really have focused on women’s health for the most part and have expanded it to integrative medicine. We are talking about all things that affect women and their health, including the gut, thyroid, adrenals, metabolic issues. They are all connected.

Dr. Eric:

When it comes to hormones, a lot of people have low sex hormones (estrogen, progesterone, testosterone). Why do so many people have low sex hormones?

Dr. Tara:

One of the biggest reasons today that people have low sex hormones is the effect of stress. Men, your testosterone can decrease as the effect of chronic stress. DHEA is made in the adrenal gland, and that is a source for men and women of hormones. If you were stressed before the pandemic, you capped it out. Our lives are changed now. We also have environmental stressors. All the endocrine disruptors in our environment are affecting us. Which came first, the chicken or the egg? The environment changed, which gave everybody issues. The obesity epidemic, which certainly is connected to your hormone issues. It suppresses ovulation and theway your body gets rid of estrogen. It’s like a vicious circle.

Dr. Eric:

Would you say that low progesterone is the most common hormone imbalance in terms of lower sex hormones?

Dr. Tara:

For women, that’s very common. You are born with so many eggs. So many eggs are obviously released first. We all know that when you’re trying to get pregnant, over 35 is called advanced maternal age because you have an increased risk of chromosomal problems because the eggs aren’t as good quality. Even though we’re not trying to get pregnant potentially, it still would transfer. If those eggs are not as good quality for pregnancy, they are not as good quality for hormone production. It’s very normal over the age of 35 and certainly 40 for your progesterone to decrease. But there exists the phenomenon that stress can affect ovulation and deplete your hormones and hormone precursors. It can prevent ovulation, which would prevent you from producing progesterone and estrogen. That all can be tied in.

Dr. Eric:

Like you said, stress is huge with all the hormones. Not just progesterone, but estrogen, testosterone, adrenal hormones, like DHEA, cortisol, etc. How about elevated sex hormones? Estrogen dominance, elevated testosterone levels. What are some of the causes of those?

Dr. Tara:

For a female, estrogen dominance happens when either 1) you don’t have a lot of progesterone as you age, or 2) you just make a lot of estrogen, and that is common in perimenopause because these old eggs can’t hear. The brain is sending out a signal called FSH to stimulate the egg to grow. When the egg is old and it can’t hear, it requires more of that pituitary hormone, the FSH, and LH. What you have then is an increase in estrogen as you get older, and also an increase in testosterone at that particular time. But you don’t have an increase in progesterone that follows because those eggs ovulate, and you still have poor quality follicles, so you have low progesterone.

You can also see high testosterone in younger women who are not ovulating for the same reason. FSH and LH are increased, and it’s that LH that stimulates the production of testosterone. You get high testosterone as in PCOS or someone who is not ovulating. Then it’s a vicious cycle because high testosterone prevents ovulation.

Dr. Eric:

Also, with high testosterone, one of the potential causes or at least factors is insulin resistance, like PCOS. Is that correct?

Dr. Tara:

It is definitely related. There is no agreement as to what the inciting hormone imbalance is with PCOS. Some say it starts in the pituitary. You have abnormal pulsations of the gonadotropins.

The second theory is it starts with androgens. The theory to support that is you will have high androgens in two different cell lines. You have high DHEAS and high testosterone, which comes mainly from the ovaries, not the adrenals. A lot of girls who are young will have higher DHEAS.

The third theory is it comes because insulin is high. You have high insulin, so you get insulin resistance, which suppresses ovulation and causes the vicious cycle.

Dr. Eric:

You mentioned DHEAS. I’m glad you said that. I’ve seen some of my adult patients with elevated levels of DHEAS. Two questions: 1) Can you explain for those who are not familiar what the difference between total DHEA and DHEAS is? 2) What are some of the potential other causes when you see DHEAS elevated on a test?

Dr. Tara:

DHEAS is the sulfated form of DHEA. It’s the most populous hormone in our human body, men and women. There is the most quantity of it. DHEA is made in the adrenal gland and gets sulfated in the liver. DHEA is the unconjugated form that is made, and it’s a much lower quantity. We always monitor DHEAS.

I always explain to my patients: Think of your ovaries as your monthly paycheck. You’re getting a little bit of estrogen every month and some progesterone. Your savings account is your DHEA; that’s your adrenal gland. When you retire, when you stop getting paid by your ovaries, you will live off of that bank. Your DHEA is highest in your teens and 20s, and then it decreases as you age.

It would increase when everything is upregulated in times of stress. The brain doesn’t know if you’re running from a bear or if you have a deadline at work or if you have just lost your job because of the pandemic or COVID. The physiological response to stress is the same. Cortisol up, blood sugar high, to feel your muscles so you can runfrom the bear. The result and increase of cortisol is like fire. DHEA will compensate to try to be a teeter-totter of catabolic/anabolic in your adrenal gland and your homeostasis. DHEA will go up as a response.

Here is the difference between cortisol and DHEA. There is a feedback loop with cortisol back to the brain, but there is not with DHEA. What eventually happens is DHEA goes up at first from stress. If stress is prolonged over time, it will decrease. There Is no signal that goes back to the brain, saying, “DHEA is low. Let’s make some more.” There is for cortisol and testosterone and estrogen, but not for DHEA. A lot of people will have DHEA that is decreasing, and nobody really checks it in the traditional world. In the functional world, we check it.

Dr. Eric:

I should mention that most of the time, when testing for DHEA or DHEAS, it’s usually on the lower side. There have been situations where I see it elevated. I work with a lot of hyperthyroid patients. I have a history of Graves’ Disease as I mentioned when we were chatting earlier. With hyperthyroidism, a lot of people lose weight, though some people do gain weight. I also work with Hashimoto’s patients, who also have more of a tendency to gain weight. Of course, it could be many different factors when it comes to weight gain. Can you talk about the relationship between some of these hormones and weight gain?

Dr. Tara:

That’s a main thing that I think is overlooked. A lot of women go to their providers, and they say, “I have put on weight. I’m exercising and eating less.” The providers sometimes dismiss them because they think all that has to do with weight is calories in/calories out. I can tell you that for a woman, if you’re not hormonally sound, that will not work.

We do know from some studies out of the University of Colorado that around menopause, your basal metabolic rate will drop. Exercise does not counteract that. A lot of women around the time of menopause will start to see weight gain in that visceral area and their abdominal area. In those studies, they try to increase exercise, and it did not counteract this drop in basal metabolic rate and weight gain in the abdomen. They then did another arm where they gave estradiol(bioidentical estrogen), and that did counteract weight.

All of your hormones are kind of like Goldilocks. Too little is not good, and too much is not good. It’s on a bell curve, but the symptoms on either end can be similar. We also know that estrogen is a growth hormone, so it makes everything grow, including tissues like breast and hips for women. Having too much estrogen without that balancing progesterone can be another factor in weight.

You mentioned low androgens, low testosterone. Think about a man and his body fat. Where does a manbdistribute his fat when he has low testosterone? He usually gets man boobs and a big pregnant belly. He either has low testosterone, and his balance between testosterone and estrone, which has just one enzyme dividing them called aromatase, that is usually how they distribute fat.

Men with a normal amount of testosterone are going to naturally have lower body fat, whereas women don’t. We have to grow a baby and store fat for that. Estrogen’s job is to get you ready for a pregnancy. Without that balancing progesterone, you can gain weight. With low DHEA and androgens, you gain weight. With high cortisol, your body is constantly trying to get the blood sugar up. Cortisol goes up, blood sugar goes up, and insulin goes up. They start fighting each other. Your insulin stops working, and you become insulin resistant. That is another hormone that can be off.

You can certainly have functional hypothyroidism. You know that as a thyroid expert, TSH is made in the pituitary gland. T4 is made in the thyroid. T3 is the active form. It’s like clocking your hours. That’s your TSH. Your paycheck would be your T4. Then you have the cash. You can’t walk into Walgreen’s with a paycheck. You need cash. T3 is what you need. These hormones are tightly bound to binding proteins, which estrogen will manipulate. If you have too much estrogen, it will increase the binding protein. You will have less free hormones available at the receptor.

In addition, there is that enzyme that has to be cashing your check, that 5-deiodinase. If you don’t have enough iron or Vitamin D, if you have too high or too low cortisol, which most of our population does now, you won’t convert that T4 to T3. Instead, you will convert it to reverse T3. That’s like taking your paycheck and putting it all in your 401(k). You have the money, but you can’t get to it. It’s reverse T3. That is what is missed a lot with women patients and potentially men, too. The effect of estrogen on cortisol, on insulin, on thyroid is really predominant.

Dr. Eric:

It’s all really interconnected. As far as knowing whether or not it’s a hormone problem, I imagine the only way is through testing.

Dr. Tara:

Yes. You can take a history. If someone comes in with weight gain in a specific area, and they have really heavy periods, more than likely it’s estrogen if they’re 42. But you’re right. It’s always hard to guess and know what the hormones are. It’s always better to test.

I don’t know why there is such resistance in the traditional community, my traditional colleagues, who are saying, “You can’t test hormones. They fluctuate every day. There is no validity.” Yet we test male hormones all the time with pre-testosterone placement, post-testosterone placement. We have no problems testing hormones when you’re going through fertility treatments. I went every day for estrogen levels when I was having my IVF. We tested progesterone levels. It was valid then. Why is it not valid when you’re not trying to get pregnant? It’s really confusing. We can test hormones, even if you’ve been told we can’t.

Dr. Eric:

As you mentioned, things like T3, the active form of thyroid hormone, many times they don’t test that. When they do test, it’s usually in the blood, which for thyroid, that’s the way I test. Not to say blood doesn’t have value when testing for sex hormones, but dried urine testing, the Dutch test, is one way. Even saliva testing, which I don’t use- I used to use in the past for adrenals sometimes. I actually used that for sex hormones in the past, too.

The point is many times, when you go to a regular medical doctor, they don’t look at the complete picture. If they are willing to do any type of testing, they might just do a TSH test for thyroid alone. Sometimes they will do a TSH and free T4. It depends. There are some medical doctors who do the entire thyroid panel. Same thing with sex hormones. Many times, they are resistant to do any testing at all. When they do, they will try to get away with the bare basics.

Dr. Tara:

In places like Canada or the UK, where they have the NHS, they are limited. They are not allowed to order the reverse T3 or T3 generally. We don’t have those limitations that I know of in the United States. I have been an employed physician with a hospital system, and they never told me not to order certain things. They may not be covered by insurance.

Thyroid isn’t as controversial as far as how to test; it’s just what to test. We all agree that blood is the best place. Thyroid hormones are large peptide hormones. They are not lipophilic, steroidogenic hormones. They are peptides. It’s a little bit different in the blood. They are bound of course, but we do have the assays to do free assays. We don’t for sex hormones. We have free testosterone. Sometimes I have seen a free estradiol, but it’s not that common. With progesterone, you don’t know if you’re getting a free assay.

Dr. Eric:

I have actually seen Labcorp, I think, where they do offer the free estradiol or even free progesterone. I have never seen doctors order the free tests other than testosterone or thyroid hormones.

Dr. Tara:

We do have now an ultrasensitive estradiol that seems to be a lot more accurate. If you order the LC-MS, it’s supposed to be more accurate also. I know if you order progesterone LC-MS and estradiol ultrasensitive at either Quest or Labcorp, those are getting a little bit better. There is some data coming out of the North American Menopause Society about those lab assays as well.

Dr. Eric:

I don’t know if you can answer this, but when it comes to blood testing and sex hormones, I have noticed in some patients, and I don’t know where I started testing for total estrogens. Sometimes estradiol will look fine, and total estrogens are elevated. There are multiple estrogens, including estradiol, estrone, estriol. Would that be your explanation: If total estrogens are elevated, but estradiol is looking fine, it could be more related to estrone, for example?

Dr. Tara:

First of all, estriol is very hard to measure in the blood because it’s a metabolic byproduct of estradiol and estrones. It’s not made and circulated in the blood; it’s only made during estrogen metabolism. Then we’re talking about estrone and estradiol. 95% of your estradiol comes from the developing follicle and the ovary. Estrone is made in a lot of places but mostly with aromatization from DHEA or testosterone. There is a bidirectional enzyme, 17beta HSD, that you can make estradiol into estrone, and vice versa.

When we are talking about blood, you have to think about what you’re measuring. Where is it coming from? If you’re measuring blood levels on somebody who is having a menstrual cycle, their ovary is producing those hormones and putting them out into the blood. If you’re measuring someone who is postmenopausal, it’s not coming from the ovary. It’s happening in the periphery, in the muscle and fat. DHEA in the periphery is converting to either estrone or estradiol.

You wouldn’t expect to see high estradiol in somebody either postmenopausal, not on hormone therapy, or someone with no ovaries. That would be like if my 20-year-old daughter said, “Mom, I’m going to the library tonight to study.” She left the house in sweats. I thought, “I’m so lucky. She’s such a great kid.” She gets to her friend’s house, pulls off her sweats, and reveals a tank top and miniskirt. She pulls out her fake ID and goes clubbing. I am never going to see that conversion because it happens outside of my house.

The estradiol to estrone, testosterone to estrone, DHEA to estrone, that all happens outside of the blood. I don’t know how accurate that estrone is in the blood. Yes, I will see it high if it’s so high that it’s recirculating. That bidirectional enzyme.

I have seen those assays of the total estrogens. I don’t prefer them. I would prefer to do the estrone LC-MS and the estradiol ultrasensitive. Again, if you’re somebody who is menopausal, I have seen estrone go up almost to compensate because your estradiol is low because your ovaries are not working. Sometimes, if we give them an estradiol patch, that may drive the estradiol up. You will see the estrone come down because those hormones act differently at the receptors. The concentration is important.

Dr. Eric:

Dried urine testing, such as a Dutch test. It’s one example. There are a few other labs that perform that. One of the big advantages of the Dutch test is looking at the estrogen metabolites. Would that be the main advantage? If you were just wanting to look at estradiol, estrone, estriol, progesterone, would you say there is an advantage looking at the levels in the urine compared to the blood?

Dr. Tara:

I think that the Dutch test is a great test. We do a lot of it. I kind of analogize it to like if you came to me and said, “I’m bankrupt. I can’t pay my bills,” I would wonder if you’re not making enough money or spending all of your money. What is the problem? Maybe you make a lot of money, but you spend it. When people have a lot of estrogen, it’s good to know if they are making a lot or just not getting rid of it. It’s like charging a credit card and not paying off that balance. Cut up that credit card and never use it, and you would still be paying a finance fee if it went on long enough. I see that in women.

The Dutch test for the dried urine is all your hormones that are being excreted. It’s like me looking at your receipts and seeing how you spend your money. My accountant doesn’t care what my bank balance is. He wants to know what I spent on rent, payroll, supplements, salary, etc. He wants to see how I break it down. That’s what we see in the urine. It’s also a great way to look at your cortisol because you get your cortisol and cortisone metabolites. What is going on with that lone betaHSD? Are you favoriting conversion to cortisone? You can see how you metabolize your androgens. Do you have a 5-alpha or 5-beta preference? That’s really helpful.

I think one of the reasons we really missed the boat on hormone therapy with a lot of people is this estrogen metabolism problem. They can have genetic SNPs that affect estrogen detox. Or their environment or lifestyle choices affect those enzymes as well. Giving one person a dose of estrogen with good estrogen detox, they pay their bill every month, they might be fine. The other person might get the exact same dose but accumulate estrogen.

Dr. Eric:

Sticking with the topic of estrogen metabolism. If someone on a Dutch test is showing higher levels of the 4-hydroxy metabolite, which is the—I hate calling it the bad estrogen because they are all important, but you don’t want this one to be too high. Let’s say that’s above the range. It’s showing low methylation. You mentioned the genetic variations, the SNPs. Would you dig deeper and recommend genetic testing for COMT, MTHFR, for example?

Dr. Tara:

We do in many of our patients, especially my patients with breast cancer. There is data that says that a high 4-hydroxy estrone has been isolated in breast cancer patients. If it’s not detoxified, it can intercalate and agonize DNA and cause rapid division. There haven’t been a lot of studies that looked at it because it’s just not a focus. I found quite a few that do reinforce that.

Dr. Eric:

You mentioned breast cancer. If someone has elevated 4-hydroxy metabolites, could that also be a factor with other conditions such as endometriosis or uterine fibroids?

Dr. Tara:

Endometriosis is a tricky disease. There is an abnormal hormone response, but also we’re finding out so much more, that it also involves inflammation, an altered immune response. Yes, it is driven a lot by estrogen.

Fibroids are different. It’s a different tissue. Endometriosis is a tissue of the uterine lining or endometrium that responds to estrogen and quiets down with progesterone. Fibroids are a different cell line. They are part of the muscle.

There is data that shows both estrogen and progesterone play a role. I haven’t been able to pin down the authors and say, “Is it progesterone or progestin?” That also stimulates the growth. I just did a talk at the World Congress on Fibroids, so I looked into this data. I was surprised to hear that progesterone may play a role in fibroids. Because it’s a different cell line, it acts a little bit different than endometriosis. Endometriosis is also an altered immune response and inflammatory. Fibroids also, but not quite as much as endometriosis.

Dr. Eric:

You’re saying that as far as the estrogen imbalances, endometriosis would be a great factor when compared to fibroids. I know you said for endometriosis, there were other factors, too, like the immune system.

Dr. Tara:

I do see that at least with myself, I have estrogen metabolism issues. I had endometriosis for many years. That seemed to be the case for me. Once I fixed my methylation, you gotta fix the gut. I don’t have issues with it now.

For fibroids, it’s not as common a thing, so I can’t say I have done quite so many Dutch tests on people with fibroids. I had one patient that had rather large fibroids. She did seem to have lower progesterone, but it wasn’t terrible. Her estrogen detox was flawed. What the studies are showing is it’s almost like estrogen primes the growth, and progesterone also contributes to the growth. I am not sure that’s clearly understood as far as the mechanism and the connection to hormone issues with fibroids right now.

Dr. Eric:

I have seen research studies when it comes to thyroid nodules showing potential problems with estrogen metabolism as well as other factors like insulin resistance. I don’t know if you have seen any of the research or in your patients because I know you also work with thyroid patients. Have you seen any connection there?

Dr. Tara:

I haven’t seen any data on thyroid nodules. You’re talking about hot nodules or cold nodules?

Dr. Eric:

It just said “thyroid nodules” as well as uterine fibroids. It actually mentioned estrogen in those. None of the studies I saw mentioned specifically what type of nodule.

Dr. Tara:

There is definitely that relationship we discussed with estrogen and thyroid, so I would not be surprised if there was a connection there.

Dr. Eric:

And you mentioned breast cancer. Whenever one of my patients has a history of breast cancer in the family, or if they personally had breast cancer, then I would recommend doing a Dutch test. I’m guessing you also recommend it probably in all of these conditions.

Dr. Tara:

These are all conditions that I think the Dutch test is extremely beneficial for.

Dr. Eric:

How about cycling women? That’s another advantage of the dried urine testing. They can look at the hormones throughout their cycle and not just a single snapshot, which is what you’re getting through blood testing. Would you recommend certain cases? The question is would you recommend for all cycling women to get the cycle map?

Dr. Tara:

That’s available in both salivary and urine. There is a company that does it in salivary; I think it’s Genova.

Dr. Eric:

Diagnos-Techs also does it.

Dr. Tara:

I don’t love their assays. Genova does a cycle map. ZRT and Dutch for the urine. Gosh, if everything was free and the same price, I would have everyone do it. It’s not. The cost is really prohibitive. I’m in middle America. It’s over $400 to do that test. I guess that makes sense. There is a lot of collections. Mark Newman from the Dutch was telling me how hard it is to process those tests because there are a lot of things. If somebody wanted to do it, I would love that information. In the patients who have had the resources to be able to do it, it’s been extremely valuable information for us.

Dr. Eric:

How about a fertility case? Would that be a good reason to do that? If they are doing IVF, they are spending who knows how much money on that. When you compare the cost- But I agree, the average person, I don’t recommend the cycle map testing either. Just in certain situations.

There is a lot more we could talk about testing. As far as balancing out the hormones, different treatment options. Earlier you mentioned bioidentical hormones. When is it time for bioidentical hormones? When is it time for using herbs and other more natural methods?

Dr. Tara:

My protocol would be everybody really should start with diet, exercise, lifestyle, stress management. You can go pretty far from cleaning up your diet, getting off inflammatory foods, decreasing your alcohol and sugar, taking the plastics out of your environment.

For a patient who is younger, in her teens and 20s, I am more likely to try something like Vitex, which is an herbal supplement. Look at their estrogen detoxification and see if we can foster enzymes. Sometimes it’s a problem with phase one detoxification, so we will work with that.

When you are getting an older woman who has a lot of estrogen, my concern is the health of the breast and the uterus and the increased risk of breast cancer with all that estrogen. We know that estrogen upregulates its receptor, and progesterone will downregulate its receptor. I more feel compelled to use progesterone in somebody like that because I know that progesterone will cause apoptosis or cell death, which is what we want. We don’t want that unregulated cell growth.

When you are talking about the indications for menopausal hormone therapy, it’s individualized. The FDA suggests the indications are vasomotor symptoms, prevention of bone loss and osteoporosis, and vulva/vaginal, which they call genitourinal symptoms of menopause (GSM). Those are the FDA indications.

Although there have been studies that show a 19% reduction in diabetes, we can’t say that it will reduce your diabetes. We can’t say that it will prevent heart disease although there is a lot of data saying it has a favorable effect on your cholesterol and does reduce the risk of heart disease. We can’t say that because it didn’t get the indication for that.

More importantly, there are some studies out of the Women’s Alzheimer’s Translational Research that they looked at over 400,000 women taking hormone therapy. They saw a 60% reduction in neurocognitive disorders, including Parkinson’s and Alzheimer’s. That’s a pretty steep reduction. There is a lot with estrogen and brain health that we still are trying to find out. Estrogen in the older age.

There is all of the vanity symptoms. We talked about weight and the studies out of University of Colorado. Yes, bones. Yes, heart. Hair, skin, mood. There are a lot of studies about depression in midlife because of low estrogen. Anxiety, those kinds of things.

It is an individual choice. I don’t think every single person needs to take hormones. I think every single person needs to be told of the risks and benefits and alternatives and given that option.

Dr. Eric:

It sounds like obviously you’re going to recommend dietary changes, lifestyle changes. As you mentioned, when someone is younger, less likely that you recommend hormones. I’m sure there is a time and place sometimes even in younger people. With the bioidentical hormones, when you do recommend them, it’s mostly in women postmenopause. Like you said, not everyone postmenopausal will get bioidentical hormones.

Dr. Tara:

That’s not my practice pattern. I know some places are like, “Take your hormones, and your skin will be-“ The Suzanne Somers approach of “Still have periods at 80. It’s good to have your periods. It’s good to have all this estrogen.” I’m not really in that camp.

Dr. Eric:

I agree. I can’t prescribe bioidentical hormones, but if I could, I don’t think I would recommend it to everybody. I would try to do things to optimize their adrenal health and gut health. There is a time and place, just like there is a time and place for thyroid hormone replacement.

You mentioned Vitex. If a younger woman, a woman of cycling age, if she had low progesterone, would you automatically recommend that? Or in certain situations, would you work on adrenal health first?

Dr. Tara:

We are always working on adrenal health, diet, and stress. Some of them might start with something called seed cycling, which is a regimen where you do certain types of seed in the first half of the cycle to boost your estrogen and a certain type of seeds in the second half of the cycle to boost your progesterone. That’s an alternative.

The Vitex is not progesterone. Does not cause apoptosis. Doesn’t have the benefits of downregulating the estrogen receptor. Somehow, it works with the HPG access to try to foster your own body to have better quality ovulation. I don’t really know what the exact mechanism is. Somehow, through the HPG access. It’s not progesterone. If I am worried about at the cellular level upregulation or downregulation of estrogen receptors, or hyperplasia or apoptosis, then I am more likely to go with progesterone.

Dr. Eric:

Sounds good. What are your thoughts on maca root?

Dr. Tara:

I can’t say I am an expert in maca root. I have looked into the data on it. What I have seen is it’s mostly helpful for libido. It’s an adaptogen. I know some hormone preparations that have a lot of stuff in it might have that in there, plus Vitex and some other things. I don’t have a lot of experience with it myself.

Dr. Eric:

I was just curious. Figured I’d pick your brain on that. There is so much more we could talk about. Is there anything urgent that I didn’t bring up that you thought I should have asked you?

Dr. Tara:

I jump at the chance to educate people because I want to validate women out there. The people who are struggling, the people who have been dismissed, the people who have had these symptoms and don’t really know who to go to. They are thinking their PCP should know. They are not trained. They are thinking their OB-GYN should know. As a traditionally trained OB-GYN, we do not get this kind of training. They don’t know who to go to. They are told, “We can’t check hormones.” They should be checked. People should have the option. Doesn’t mean everybody needs to take something. We discussed many options from food to lifestyle to herbs to hormones.

I want to encourage anyone who is struggling, if they have their gut feeling telling them something is wrong with their hormones, they may have gone so far as gotten a doctor to order hormones, and they say they are normal because they don’t know how to interpret them. It’s frustrating. That’s my message and my megaphone. It’s why I spend time on social media and try toeducate. I want to advocate for people and educate them.

Dr. Eric:

Thank you so much. You’re right. If someone does a Dutch test on their own, and if they were to bring it to their medical doctor, most medical doctors wouldn’t know what to do with it. Some might be interested, but most of them probably would be like, “I don’t do that type of testing.” Maybe they will recommend something in the blood or to go to someone else. It’s probably a good idea, to go to a functional medicine practitioner, someone like yourself.

Dr. Tara:

Hopefully that would be what they do instead of slamming it and saying- I have had providers saying, “Anyone who talks about the Dutch test, unfollow them immediately.” Those providers get money from the Dutch test. Do you get any money from the Dutch test? I don’t. It’s just crazy.

Dr. Eric:

I deal a lot, especially with the hyperthyroid patients seeing endocrinologists who don’t want to hear anything about diet or lifestyle changes. It’s all about taking medication or getting radioactive iodine or thyroid surgery. Same with Hashimoto’s. Take your thyroid hormone replacement. Nothing else is going to help. Similar here.

Where can people find out more about you, Dr. Tara?

Dr. Tara:

They can follow me on TikTok. I’m @hormoneguru. On Instagram, it’s @revitalizemed. I have an online course at hormone-guru.com. We have a lot of free programs. We have some courses for sale as well that they can enroll in at their own pace. Usually, we are doing workshops and things like that as well. Those are the main things. My YouTube is Tara Scott, M.D. I am also trying to upload things there. It’s easier to search there than in the TikTok format. I am trying to get caught up on that as well.

Dr. Eric:

Thank you so much for doing this interview. I learned a lot. I’m sure the listeners did as well. Appreciate you taking your time to share your knowledge with others.

Dr. Tara:

Thanks for the time you’re putting into this. It’s your time as well to try to educate people.