Menopause & BRCA: Hormones and Cancer Risk With Dr. Bruce Dorr - Episode 292

Dr. Bruce Dorr is certified by the American Board of Obstetrics and Gynecology in OB/Gyn and Female Pelvic Medicine and Reconstructive Surgery.  He is a member of the American Urogynecology Society and the American Association of Gynecological Laparoscopy.  He became certified as a Biote medical practitioner in 2015 and provides hormone optimization with pellet therapy for both men and women. Dr. Bruce Dorr is the Senior Medical Advisor for Biote.

We dig into menopause timing, BRCA risk, HRT choices, and why estrogen isn’t the simple villain it’s made out to be. Dr. Bruce Dorr helps us distinguish between real cancer risk and fear, and map practical steps that protect both lifespan and day-to-day well-being.

• redefining perimenopause symptoms and timelines
• how progesterone loss disrupts sleep, mood, and cycles
• heavy bleeding, iron deficiency, and thyroid slowdown links
• toxins, stress, and insulin resistance as hormone disruptors
• BRCA risk, modern gene panels, and smarter screening
• estrogen metabolism pathways and detox support
• ovarian cancer risk and timing of oophorectomy
• prophylactic mastectomy tradeoffs and monitoring
• bioidentical vs synthetic: receptors, delivery, and risk
• oral vs transdermal estrogen safety differences
• pellets pros and cons: compliance vs flexibility
• HRT after cancer: options, limits, and quality of life
• building a personalized plan with labs and follow-up

Be sure to follow my show, rate it, review it, and share it.

Send me an email, sandy at sandyknutrition.ca
Follow me on all my social media channels. It’s @SandyKnutrition everywhere.  Share this episode with another beauty who would benefit from hearing the wisdom that Dr. Bruce Dorr shares with us.

Chapters

• 0:02 Show Vision: Balanced Midlife Wellness
• 1:27 Guest Return: Dr. Dorr’s Credentials
• 2:43 Why And When To Consider HRT
• 5:15 Perimenopause: Rollercoaster Hormones
• 7:55 Heavy Bleeding, Iron, Thyroid Links
• 10:15 Toxins, Stress, And Hormone Disruption
• 13:17 BRCA Risks And Genetic Panels
• 16:42 Estrogen Doesn’t Cause Breast Cancer
• 19:46 Screening, Ovaries, And Prophylactic Choices
• 23:05 HRT Decisions For High‑Risk Women
• 26:15 Remission, ER+ Cancer, And HRT Options
• 29:18 Quality Of Life And Whole‑Person Care
• 31:25 Starting HRT Later In Life
• 33:19 Bioidentical vs Synthetic: What Matters
• 36:09 Oral vs Transdermal: Safety Tradeoffs
• 38:21 Birth Control And Why It’s Synthetic
• 40:11 Pellets: Pros, Cons, Compliance
• 43:46 Resources, Gratitude, And Closing

Transcript

SandyKruse: 0:02

Hi everyone, it's me, Sandy Cruz of Sandy K Nutrition Health and Lifestyle Queen. For years now, I've been bringing to you conversations about wellness from incredible guests from all over the world. Discover a fresh take on healthy living for midlife and beyond. One that embraces balance and reason. Without letting only science dictate every aspect of our wellness. Join me and my guests as we explore ways that we can age gracefully with in-depth conversations about the thyroid, about hormones, and other alternative wellness options for you and your family. True Wellness Nurtures a healthy body, mind, spirit, and soul. And we cover all of these essential aspects to help you live a balanced, joyful life. Be sure to follow my show, rate it, review it, and share it. Always remember, my friends, balanced living works. Hi everyone, welcome to Sandy K Nutrition Health and Lifestyle Queen. Today with me, I have a return guest. Dr. Bruce Door is back with us, and he is going to talk to us all about menopause, HRT, breast cancer, and what women with the BRACA gene should know. This is going to be a great conversation. Dr. Bruce Door was part of my podcast a couple of years ago. I had him on and we were speaking about how women have been misled about menopause. We broke down the New York Times article. I think it was called Women. I can't even remember the details, but he was first on my podcast, May of 2023, episode 166. If you want to go back to that. And I included that episode in my summer reboot series on July 28th, episode 282. It's called The Truth About Hormones, What Women Aren't Being Told with Dr. Bruce Dore. And now we're going to talk about the BROCA gene. Now, this is a really important conversation because often there is older research recited to patients who have this gene. Then there's those who have breast cancer. I mean, this is such an important conversation. And while I do want to remind you that this is a conversation, this is not medical advice. It is important that you take this information to a practitioner who knows you personally. And I say that all the time because I think we kind of have gotten into this habit where we hear something online and we take that advice and we run with it. And I think it's important that we almost go back to how things used to be, where we don't just do things on our own and we do things that obviously have to have resonance. We need to go and look within, first of all, if we feel aligned with it, and then go and work with a practitioner who knows us. I've made the decision to change the format a little bit of my podcast. And the reason I came about this, most of you who follow me know that I'm a big believer in following your intuition. And this summer I had so many podcast guest pitches, and majority of them I didn't even respond to, at least not yet. Something just didn't really resonate with me. And I mean, I've even had guest pictures of guests that had over a million followers. Sure, that would benefit me. Does that mean that this would help my audience? Does that mean that this would create a really engaging conversation or topic? No, not necessarily, not for my audience. And over the last almost six years, I think I know that you guys love that I put a lot of heart and soul into all of my recordings. So I have decided that I won't always have a guest on my podcast. And I'm not a big believer that every single guest is the only person who is able to speak on a specific topic. Most of you are aware, I'm a registered holistic nutritionist. I'm also a certified metabolic balance coach. I have numerous certifications, including peptides and aging and endocrinology and hormones, clinical nutrition. I could go on, and I am a big believer that while you cannot discount somebody's expertise in the world, in their field, it doesn't mean that somebody else who has exposure and knowledge cannot speak about it, especially when you're adding in personal experience. So some weeks I'm gonna come to you with topics that might just be on an important topic to myself that might resonate with you. I'm still gonna have great guests, including guests like Dr. Bruce Doer, but I wanted to share that with you because I felt this change from deep within that authenticity is much more important than publicity. And a lot of the podcast hosts in the area of health and wellness just circulate the same guests, the same topics over and over again. And we have podcast hosts who pay to play, these are the facts, my friends. And I can't do that, I won't do that, I won't charge my guests. I feel there's a credibility issue there, and my guests don't pay me either. I've done a lot of research in this area with other podcasting grades, and they don't charge either. Whereas there's a lot of people in this industry in the biohacking world that do charge. I don't believe in it, I don't buy it. I don't think there's anything wrong with working closely with advertisers to build I guess trust and credibility. I still haven't found that either. So I don't believe in one-off advertisements, so that's why I don't have sponsors. A lot of them want to spread their advertising dollars amongst, you know, 20 podcasters and do one-offs here and there. So this is me speaking my truth with you guys who I appreciate so much. I appreciate that you come and listen every single week, that you share my podcast, that you send me little notes. And I just appreciate the fact that I have a voice and that my voice might, might just help make a difference in this world where there's a lot of darkness right now. So I am more than happy to hear from you. I love to hear from you. Send me an email, sandy at sandyknutrition.ca. Follow me on all my social media channels. It's Sandy Knutrition Everywhere. Instagram, Facebook, TikTok, YouTube, threads, you name it. Lemonade, that's another one I'm on. I don't even know. I I do my best. If you have any business propositions, feel free to check out my profile on LinkedIn, Sandy Cruz, Sandy Knutrition. And I'm always grateful, forever grateful for all of you. And if you can, please review and rate my podcast wherever you listen. Apple and Spotify are the best for this. And share this episode with another beauty who would benefit from hearing the wisdom that Dr. Bruce Doer shares with us. Thank you. Hi, everyone. Welcome to Sandy K Nutrition Health and Lifestyle Queen. Today, with me, I have an amazing return guest, and his name is Dr. Bruce Doerr. He is certified by the American Board of Obstetrics and Gynecology in OBGYN and Female Pelvic Medicine and Reconstructive Surgery. He is a member of the American Eurogynecology Society and the American Association of Gynecological Laproscopy. There, I said all the words correctly, didn't I?

Dr.BruceDorr: 10:03

I think you're doing great, Sandy. Keep going.

SandyKruse: 10:06

Okay. He became certified as a bioT medical practitioner in 2015 and provides hormone optimization with pellet therapy for both men and women. And so Dr. Dore has some tenure in this space of hormones and women and men's health. And I had an amazing conversation. I'm going to link the podcast where we talked about, I think it was Women Have Been Misled About Menopause. It was about that New York Times article that came out about maybe a couple years ago. But today we're going to talk about a very important topic. And it is all about menopause, of course, HRT, BHRT, so bioidentical. I know people are using different terms interchangeably. Breast cancer and what women with the BRCA gene should know. So I will preface this conversation just by saying none of this is medical advice. It is here, just as those breadcrumbs, for you to take to your own medical practitioner to discuss if any of this pertains to you. We're just putting this out there as information so that you have that in your back pocket if it applies to you. And I'm a big fan of having a hormone practitioner who knows you, who knows your situation. So I just wanted to make sure that we preface this conversation with that. And now I welcome you, Dr. Dorr. Thank you so much for coming back.

Dr.BruceDorr: 11:53

Yeah, it's wonderful to be here. Uh and with breadcrumbs, does that make me a crummy uh, you know, ho or uh guest? I hope not, right?

SandyKruse: 12:01

No, no, no. These are breadcrumbs for you to follow for your own path to wellness. I kind of use that a lot because perfect, you know, it's not specific medical advice. But I think it's very important that you give us your background because, you know, on social media you hear this all the time. Oh, well, they're not a doctor, or well, they're not this, and they're not allowed to speak about this. Well, you certainly have a lot of credentials, and your background is pretty lengthy in this space. So can you let us know what your background is?

Dr.BruceDorr: 12:36

Well, if you if you can't see uh from the lines on my face, I'm an old guy. Uh so you know, I've been around for a minute, uh, and I was around and there before hormones were labeled bad. My cupboards, uh, what I prescribed and how I prescribed was uh very much hormone forward. And then when the WHI came out and said hormones were bad, I'm looking at this and I'm like, I know differently. My whole practice had been involved in that. And I was a general OBGYN delivering thousands of babies. I subspecialized in urogynecology and female pelvic reconstructive surgery. And what I would find is in that practice, I was great as far as helping and guide women through painful situations or maybe through their breast cancer or things like that. I wasn't always great as far as really sitting down and going over and being good about looking at this entire picture of hormones and longevity and lifestyle. And that led me and my bioT certification. Actually, our office went forward in 2013. Uh, and um, I it became so overwhelming with the need for this in our area and in our practice that all of us had to do that. I thought this would just be a couple people a month. Well, it turned into 600 people a month, and I'd have women say, Hey, you know, my biggest hormonal problem is my husband. Uh so I had to get certified through that. I'm now uh part of the Sexual Uh Society for North America. It is uh Eurogynes and urologist uh for both men's and women's uh sexual health. And this led me to be the senior medical advisor for BioT, which is an educational marketing company, and I lecture nationally on this topic. And certainly I now talk about many things, and I am sitting for my functional medicine certification next month that is about root cause medicine. So, why do we get disease? Why uh are we struggling with our hormones? Why do we struggle with digestive issues or cancers? Uh, and so it's just led me in a whole direction I never thought possible. And it you're absolutely right. It does give me breadth uh and depth to be able to help patients and to be able to educate providers also.

SandyKruse: 15:10

I actually love that because as I always say, we have to look at the body in a holistic way.

Dr.BruceDorr: 15:19

Oh, yeah.

SandyKruse: 15:19

Right? And whole meaning W-H O L E. Whole.

Dr.BruceDorr: 15:24

Right.

SandyKruse: 15:24

And so I think that that's wonderful. Now I have to, I think we can preface this conversation by saying, because you mentioned this, why do we need hormones now? Maybe let's start with when at what point does, because this is going to be mostly for women, does a woman need to consider hormone replacement? At what age? Because like it's so confusing for a lot of women. They're like, wait, no, no, no, I'm still getting my period. So should I even consider it? But then they're having some symptoms. So at what point is menopause? And you should start thinking about hormones.

Dr.BruceDorr: 16:09

Right, right. You know, I see certainly see women in all phases uh of life, and it's interesting. I'll even see, you know, women in their teens. It's usually their mother, and I have now delivered them and they're dragging their teen in to see some old white guy. Uh, but you know, they're pleasantly surprised because I will find, you know, hormone imbalances because of diet and gut and digestive issues that are going on for very young women. So the opportunity to go over hormone imbalances, not because of hormone production, but because of hormone, say distribution or how things are bound up when we're not careful about our diets or relationships or those kind of things going on. When we look at hormones, specifically the sex hormones, women start losing their testosterone, specifically in their 20s. And by age 40, women have half of the testosterone production that they had when in their um uh 20s or earlier on. And starting about mid-30s or so, women start losing progesterone production, which is estrogen's counter hormone. So you have estrogen made by the ovaries that grows that lining of the uterus. And then at mid-cycle, usually uh women will ovulate, release that egg, and on that spot from the ovary, that forms a cyst that makes estrogen's counter hormone progesterone. Progesterone then matures the lining of the uterus, and if no pregnancy, progesterone falls, that causes that period. Well, that progesterone production starts coming down mid-30s or so. And that lack of progesterone can be problems with sleep or PMS or cycle regularity or cycle heaviness or flow that goes on. So you have to start thinking 20s loss of testosterone, 30s loss of both testosterone and progesterone, and then starting in the 40s, about 10 years prior to that final menstrual period. So uh menopause is not defined by lab values, menopause is defined by cycles and no cycles for a full year in women who are having their cycles regularly. Uh so there's other conditions that interfere with regular cycles. But 10 years prior or so to that final menstrual period is what we call the perimenopause. And so some hours, some weeks, some days, some months, pretty good estrogen, and then not so good estrogen. It is a roller coaster. And so people will start experiencing night sweats and hot flushes and classic menopausal symptoms, sometimes even in their late 30s or early 40s, 10 years prior to when their periods stop altogether. And so that is another look at hormone balance and and and potentially things that can help with hormone supplementation during that time. Menopause, on average, age 51. Most women by age 55. I have women that still have their periods till into their 60s. Wow. It's not fair. Uh, but is that good as far as estrogen and the positive things that estrogen uh does? Yes. Uh, so it's all about balance and figuring that out. But it's women of every age. So women that are experiencing symptoms, they need to find somebody who can sit down and talk hormones with them because I I get it right for a lot of people on a regular basis.

SandyKruse: 19:44

Okay, I have to ask, just because you mentioned it, like, is that unhealthy to have your periods still at age 60? Like, can it be?

Dr.BruceDorr: 19:55

Uh, you uh when you are still having your cycles above age 52, there's an increased risk of endometrial or uterine cancer. So you got to be careful because of that irregular balance between estrogen that builds and too much estrogen over prolonged periods of time from the body or outside of the body can cause precancer or cancer changes. So you have to be careful in women that are still having their cycles long term. And so sometimes, yes, we have to do biopsies and make sure that they're careful. Uh, prolonged estrogen in the absence of progesterone is a is a not a good thing. So you you many times we're looking at progesterone supplementation uh for those women to be able to help them with the balance of that irregular uh estrogen production.

SandyKruse: 20:44

That makes all the sense in the world because it's really it's not necessarily about that estrogen, it's about that loss of balance that's happening. Because I hear it all the time, Dr. Dorr. I hear women saying, oh, you know, I'm 55 or I'm 56 and I still have my period, but damn it, I can't sleep at night. I'm agitated, I have anxiety. And so that's when it's an ideal time to get tested to see what's going on with the other hormones.

Dr.BruceDorr: 21:18

Right. And sometimes it's also you just didn't look at that history and you look at this menstrual cycle. And like I said, that balance giving women that control over that irregular bleeding that can go on. You start losing blood like that, your iron levels go low, and with low iron levels, your thyroid stops working, you start gaining weight, your cycles become even more irregular. So I catch imbalances not just in estrogen, not just in testosterone, but in thyroid and metabolic or nutritional things that start happening. Because when you don't feel good, what do you do? You you go out and you you eat crummy, is the deal. You you uh start stressing uh more with your adult children or aging children, and you have high cortisol, and that starts shutting down your sex steroid production. So it is a web. When you pull on one piece of that web, other pieces of that web start coming or getting pulled on too. So you have to look at this entirety of the hormones and people as a whole. What is their nutrition status? What is their relationship and stress status or work status, and what is going on with them and how can you help them rebalance?

SandyKruse: 22:34

You know, I I love that you didn't really put a very specific age category on hormone balancing. The reason I love that is because obviously I have a daughter, and you know, I've seen habits that you know we didn't have when we were, you know, I'm I'm a little on the older side there too, Dr. Dore, but there was no Starbucks in 1975, you know, and our our poison was once in a blue moon having a can of Coca-Cola, right? And versus uh a Starbucks drinks drink, which can be triple the sugar. I've analyzed it, trust me. And I'm like, oh my gosh. So their interference uh and hormone disruptors, and then there's like the makeup and the stuff that they're putting on their skin, and I think they've got way more interference, and that might be like, what do you think? Is that maybe one causative factor of why there's more hormonal disruption now?

Dr.BruceDorr: 23:37

Yes. So these EDCs, endocrine disrupting chemicals, uh, they're in parabens, they're in these things that yes, we're putting on our skin, or they're you're spraying on yourself, uh, you know, to uh smell better. Uh, there are uh, you know, the insulin resistance and the high sugar levels that are going on, or people carrying extra weight, that is the body's signal to say, mmm, shut down the sex hormones. We have a lot of inflammation going on now. And so testosterone and estrogen get lower when we're inflamed, whether or not that's from our diets or stuff that we're putting on our bodies or exposed to in our environments. So that's that whole window of the world that came into my view that I wasn't quite ready for as a traditional trained MD allopathic doctor. That people are like, Why are you doing all this? Why? And I'm like, because this is what is going on with us, and you can't just think, oh, you've got this. Let me give you this pharmaceutical. No, people have to be a participant in their health care because it's about diet, nutrition, stress, relationships. It's many different things, and you get those under control. Sometimes I don't have to put people on pharmaceuticals, and that's a Christmas wish I have of every patient I sit down in front of. What can I do that I can you can incorporate this into your life long term without having to go to the pharmacy every month and think, ugh, what is this gonna cause me cancer? Is this gonna be you doing something bad? Because that's when people start popping pills, people think, yeah, is this good or is this bad for me? Uh, is the thing. And a lot of society, you know, will view that and taking exogenous hormones as bad. Okay, yeah, there are risks, so you just have to balance that all out.

SandyKruse: 25:30

That's actually a perfect segue into my next question. Because something I'm trying to help you, Sandy. Yeah, you're doing a good job. Um, because you know, we're talking today about cancer, the brackagene. And truly, you know, one of the things that I always say, I know I'm not a doctor, but you know, I am educated in hormones. I know a lot about this stuff. And so I'm always like, you can't blame estrogen only for cancer. You, you know, as a woman, I've had a lot of estrogen ever since I hit puberty. So there's other factors that come into play. And so I think there's a big misunderstanding. We we we touched on it just now of other things that are going on in the body, um, as to you know, hormones and breast cancer, and especially those who who carry the brackogene. So maybe let's kind of get into that whole part of the conversation on what comes into play. Is it just the brackogene? No hormones do not ever take, or what's the situation there?

Dr.BruceDorr: 26:44

Yep. So it's important to understand we're making cancer cells every single day. So how we uh are able to repair and help prevent that from taking off and becoming a thing that takes us over, that's what that cancer wants to do. So, like I said, it's about what we're doing, positive antioxidants, cancer repairing things that we have in our bodies to be able to help us through that. And when we look at genes or genetics, so you can have a genetic predisposition that things that many people have to help them repair a potential cancer, the you sometimes we're just genetically not able to do that as well. And when we talk about BRAC or genetic predisposition, yes, BRAC's got the press, and certainly Angelina Jolie and other people have been out there uh pushing that forward. But when you have a susceptibility, when you have a strong family history, you should get uh genetic testing for the risk of that going on. And so it's not just about BRAC testing. Now there's at least 11, most of the standard panels from the National Cancer Umstitutes uh are 21 panels. So that kind of drives us in this area uh insane uh a little bit because we um have uh it updates uh about every couple of years that all of a sudden there's yet another panel uh or another couple of genes that are added on. And then the people who I told were negative off their previous panel, okay, now I've got two more gene add-ons. I gotta retest you again every few years. So depending on what that gene is, will be a defect hormonally or something that helps them heal or process cancer. When we look at the BRAT gene specifically, these patients have a problem with what we call the progesterone beta receptor. So you have receptors all over your body, uh, and then estrogen, testosterone, progesterone, these are messengers that click into the receptors. So some of that interaction, when that clicks in, that makes proteins that help us heal, proteins that can hurt us. So there is a lack of a protective effect of progesterone in these BRAC patient positive. But like I said, there's many other genes uh when you're looking at that. So um, yes, they are about an 80% risk of developing breast cancer before age 50 and a 20% risk of ovarian cancer. When you have that knowledge, people are like, oh, I don't want to know that. That's scary for me. Well, you can uh pick it up early. So we're pretty good at helping with breast cancer if you get it in an early stage. Women in general are not necessarily dying of breast cancer, they die of ovarian cancer. So that's a big part of that brack is once you're done childbearing, is to remove the ovaries to save a life because that is very rarely preventable. But breast cancer with screen. Knowing a patient has that kind of risk, we pick up at very early stages and cure women of that. Or some women, when they have that positive gene, will be very proactive and get a prophylactic mastectomy and uh and uh have their ovaries removed in in that situation.

SandyKruse: 30:21

So, okay, you said 80% chance of getting breast cancer before age 50 if you have the bracket. That's pretty significant.

Dr.BruceDorr: 30:31

Pretty significant, right? And then all the other genes, like I said, most people, depending on the gene uh test facility that you're going to, it's usually a 21 panel, and there's varying degrees of 30% risk. I mean, it all depends on which gene that is that they're positive for. And and what we know now, so we know what the gene as we look at people's chromosomes, we know what gene should be there. And then we look and we see genes that um or sequences that are different than what should be there. And we're like, oh, is this a problem? Is this not a problem? So sometimes I'm telling people, you don't have what's normally there. We don't know if this is a problem in 2025, but in 2028 or 29, it could potentially be a problem. So then we have to follow them for what's called a variant of undetermined significance. So we don't know if this abnormal sequence is going to be a problem for them long term. So then, you know, about 10% of those people that have an abnormal sequence like that become a it becomes a positive gene for breast cancer in two years, in five years, and 10 years, as we get to know people's genetic uh variations uh across the board. We're just getting more and more knowledge as more people get these tests.

SandyKruse: 31:54

I find that really interesting because I know genetics, these genetics tests, they're they're a big kind of fad right now. And honestly, Dr. Dore, I must have done at least 10, 15 of them. Different tests, different ones.

Dr.BruceDorr: 32:12

And I think you have the nice gene. I think you got that one.

SandyKruse: 32:16

Oh, thank you. But you know what?

Dr.BruceDorr: 32:19

You're you're coding nice all over you, yes.

SandyKruse: 32:22

Except you know, the thyroid thing, right? So, and my uncle had something to do with thyroid, but this is like old school Croatia, they don't even know, they just know they took it out, and that's all they know. So I the one thing I do know is I look at epigenetics and it's like at what point first of all, it's never just about the one gene, but if you're if you've got the BRACA gene and then you've got that gene that makes detoxification very difficult for you, and you have a lot of that recirculating estrogen in your body, like would people, I think it's important to touch on that because it's never just about the one gene, and you did touch on that, it's kind of like how what's the big picture?

Dr.BruceDorr: 33:09

Yep. So, yes, in general, so estrogen does not cause breast cancer, so it that's very clear because when you look if estrogen, and it always didn't make sense to me when the WHI came out and they said, you know, estrogen is causing breast cancer. And when you look at what they said when that came out, they said it almost achieved statistical significance in the WHI when they said that Premarin and Provera uh was increasing the risk of breast cancer. They said it almost reached statistical significance, almost means that it can be still left a chance. So you have to be careful on how things are worded and the alarmists uh that are out there, and there's hormone haters that are out there that way too, but estrogen doesn't cause breast cancer. So women's highest time when they have estrogen is during a pregnancy. So they can run normally women are running estradiol levels, say 60 to 90 around ovulation, maybe uh levels of uh 200 to 300. Well, women during pregnancy can run 10,000, 20,000, 80,000 on their estradiol levels. And and women in pregnancy don't get breast cancer. So if estrogen caused breast cancer, you know, pregnant women should be delivering a tumor the same time as their baby. So it's about healing, it is about how we're able, just like you said, how we detox and eliminate when you look at how estrogen is detoxed and broken down in the body. Women that get young or earlier or more aggressive cancers are much more prone to have a phase one elimination or phase two elimination problem with their estradiol. It goes down something called a four or sixteen hydroxyesterone pathway rather than a two estrone pathway. Basically, what that means is that genetically you weren't gifted in forming anti-cancer metabolites. You're unfortunately sentenced to cancer-causing metabolites. Now, can you change that around? Yeah, to some degree, but unfortunately, if you're constantly making cancer-causing agents, then it's a problem for you. Uh, and so that's uh a thing that goes on.

SandyKruse: 35:26

I'm so glad that you clarified that. I remember when I posted and I said estrogen in and of itself doesn't cause cancer. That's what I was saying. I got really slammed. Like, people do not want to hear that. And it's like, well, you know, there's just so many other factors. Like, I know, I can't remember which gene, but like, you know, there's homozygous and heterozygous. And I know this podcast is not about specifically genetics, but I think it's an important piece that people, if you if you come out of anything to understand about hormones and cancer, understand how your body is making do with everything that you're putting in it and everything that's surrounding it. And just like what we said about the sugar, about the chemicals, about all that. If you've got a ton of that going into your body or around your body, and your genetics show you have trouble getting it out and and detoxing it, well, you need to work with somebody, maybe, about that, right?

Dr.BruceDorr: 36:35

Yeah, it's also important because people get confused when they come back because 80% of the time when women get a breast cancer, 80% of the time it is estrogen and progesterone receptor positive, meaning, yes, that is lighting up that cancer because cancers are smart, they want that it wants to grow and divide and take over. And so it makes the receptors for that. It didn't cause it, but once it's there, it propagates it. So that's where that comes into play because yes, people get that diagnosis and they they hear yes, it was estrogen and progesterone, or it is estrogen and progesterone fed. That's not what caused it, that's what develops so the cancer can ruin your life. So that's what you need to shut down short term, and so hormonally positive cancers tend to be better able to be treated because we can go anti-hormone for a period of time. Uh, but in general, hormones that's what makes us youthful, that's what helps us with our brains and our bodies and our sex lives and everything like that. So hormones are very much needed, but in the face of cancer, do we want to shut that down for a time because of how cancer grows and operates? Yes, but it didn't cause it.

SandyKruse: 37:54

Yeah. Uh, I know. Do you know who Dr. Jen Simmons is? Do you know who she is?

Dr.BruceDorr: 38:00

Yeah, I I've heard the name uh specifically. Yeah.

SandyKruse: 38:03

She talks exactly about what you're saying in terms of because she used to be a breast cancer surgeon. I think she stopped doing that, but she talks about the estrogen um receptor positive cancers and how actually those are like easier to work on and easier to cure because they're not rogue. They're attaching to something that's like inherent in your body. I probably didn't explain it properly, but I love that you you mentioned that. Now, here's a question Is, and I don't know if there's any research on this. Is there any research out there about women who carry the BRACA gene and go on hormones, bioidentical, hormone replacement therapy, and then their incidence of cancer goes up? Is there any research on that? Probably not, right?

Dr.BruceDorr: 38:57

Well, it's a limited population, and these women are being followed very closely because, in general, they have had, so when you look at the screening guidelines, uh, it most people know that there's badness going on in the family. So their mom had breast cancer under age 50, or they have two relatives with, say, a breast cancer and a pancreatic cancer, uh, or they had a male in the family with uh breast cancer, or they had uh somebody in the family with ovarian cancer. So there's reasons to do genetic testing early and understanding that this can happen all under age 50. Many women are discovered prior to needing hormone replacement therapy that they're making their body's own natural estrogen. And just because they're BRAC positive, we don't necessarily go in and remove their ovaries to decrease the risk. We remove their ovaries in the face of a BRAC patient because of ovarian cancer risk, not because of that estrogen going on. So she's running an 80% risk of getting breast cancer. Is that because of the estrogen specifically? No, it's because of this defect in actually her progesterone receptor uh problem uh that's going on. So those women you've got to follow closely. And so once we know a patient is BRAC positive, okay, when do you want your ovaries out? Because that can kill you. And I can see a patient with a normal ultrasound, normal imaging. And the next month she's got stage three out of four ovarian cancer with a 10% five-year survival rate. So it is not able to pick be picked up early. We still screen with early uh blood tests and with ultrasounds, uh and we follow them with alternating MRIs and mammograms every six months. So we pick up things as early as possible until they're ready to do something about it. Or unfortunately, if we discover a early breast cancer. But many of these patients were picking up early actually before they're on hormone replacement therapy. But we don't take out people's ovaries or shut down their estrogen in the face of a breast cancer or a BRAC positive young women, and that's a majority of the women who know that they're BRAC positive. Uh, once they're through menopause, uh you just have to have that counseling session. You know, what are you more likely to die of? Well, certainly with this BRAC, ovarian cancer. That's that's gonna kill you. So get those ovaries out, is is what we all say. And then, okay, how are you feeling? How are you handling menopause? Is estrogen a risk? Um, like I said, it's it it it's once it's there, then it tends to be very risky. But prior to that, estrogen is a very positive thing for women.

SandyKruse: 41:45

So then for those women, let's uh this is totally hypothetical, but uh you know, I know people are gonna have this question. So let's say I I let's say I carry the brackogene and I want and I'm suffering with hot flashes, and I've done my research and I know how much the estrogen can benefit me and my brain and my bones and all of that, and ease my suffering. And I say to you, I want to go on hormone replacement therapy. What would be the first thing you would do?

Dr.BruceDorr: 42:25

Yeah, so um it's it's always so when I look at hormone replacement therapy, you have to look at that individual. And I say to my patients every single time, your dosing and what we do is between you and I. There are risks in you walking out of my building and getting hit by a car. You know, I don't consent them for walking out of my building. So when we look at hormone replacement therapy, there are risks and benefits as we look at that. When you look at the oncology world, they feel like there are many things out there that are equivalent or just as good as hormone replacement therapy for bone or for symptoms. And you can always go that route because it is a little bit of a gray area. Um, not in my mind, but when we look at research and when you look at oncology or cancer specialists, they like yes or no. They like, does this drug cure or stop this cancer? Uh, you know, so they like yes or no questions. When you go into hormones or estrogen, it becomes so multifactorial, uh, and how people process and things like that going on that it becomes that individual uh decision. When you look at not a high-risk patient like a breathe patient, but if you look at it at hormone replacement in general, as many women die about 40,000 a year of osteoporotic related fractures uh or complications surrounding an osteoporotic related fracture as they do a breast cancer every year. So, what are women most likely going to die of? It's heart disease, it's brain disease, it's bone disease. And estrogen can potentially help in all those brain gets a little bit fuzzy uh when we look at dementia and dementia risks. But an abrac patient, they are going to die of ovarian cancer. I worry about that most. So we handle that. And then for the patients who are really suffering, I say, you are running an 80% risk of breast cancer here. So um is estrogen going to cause this? No, but once it's there, it can feed it. So, how much are these symptoms affecting your day-to-day living, your sleep, your stress, your sex life, whatever it is? And so we have that conversation, and then we go over okay, is hormones right for you? And I say, Yeah, you're at a high risk of getting breast cancer here. Most of those women are, in my experience, have been proactive and they've chosen a prophylactic mastectomy. When their breasts are gone, uh, that risk of breast cancer, you can't say is totally zero, but it's clearly less than uh half to one percent, depending on the study that you look at after a prophylactic mastectomy. So I say that to my patients before we get this testing or along with the testing, are you ready for a positive test? Are you ready for something every six months on your ovaries, on your breasts? Is that gonna be okay to live with? Is this going to push you and you are you okay getting your ovaries out and or getting a prophylactic mastectomy? Because that conversation is gonna happen on a regular basis. And how are you able to handle that? And menopause or that going on, and in and how do we handle that? And what are the choices for that going into those choices?

SandyKruse: 45:47

That's really you know, this is why social media can be really not great, because you get those tiny little snippets of information. I'm so glad we're having this conversation that's a detailed conversation. You get a tiny little snippet of information and then you pass judgment, like, oh god, you know, Angelina Jolie, like that's just crazy. But now the way that you're really explaining it, it makes a lot more sense. And a lot of people don't take the time to research it thoroughly and have really deep discussions with their medical practitioner, which is really important. So, like you're kind of changing my mind about this, I have to say. I had a different opinion before.

Dr.BruceDorr: 46:39

Okay. Well, I'm giving you a piece of my mind, that's for sure.

SandyKruse: 46:42

I like that though, because you're you're really you're stating fact and like of what is fact with these women who carry this gene. So here's another scenario. Yes, it is, it is and you know, I'm not a big person who, you know, I don't like to fear monger. I don't like that, but I also believe that knowledge is power as well.

Dr.BruceDorr: 47:08

So these women can get this BRAC positivity at 20 years old before kids, you know, or 30 years old because their mom got an early breast cancer, or all of a sudden their dad got an early prostate cancer or something that kind of that going on. And so that is a patient you've got to talk off the ledge and go over all of these things that are going on now. Because I have women who are 18 with a positive brac gene. And okay, how do we handle this? How a screening and stuff like that, I counsel them even before we get it, you know, this is what is what may happen, and these are the things that we're gonna have to do the rest of your life until I get your ovaries out or unless you have your breasts removed. These are things that we're gonna have to consider that are hard.

SandyKruse: 47:53

Yeah. So let's say, again, a hypothetical situation that I'm sure that you've actually seen in real life. Let's say I'm 45, no breast cancer, no ovarian cancer. I decide to prophylactically remove the ovaries, remove the breasts, do that.

Dr.BruceDorr: 48:11

Yep.

SandyKruse: 48:11

And then I'm 52. Wait, let's say I'm I I wanted to start hormone replacement therapy. Let's say I want to now. Can I do it if I did all these things? Is it possible with monitoring?

Dr.BruceDorr: 48:28

So if we remove the ovaries, you're in menopause. Yes, right, right. That will be an immediate harsh sentence. So rather than your ovaries stopping and starting and kind of giving you some estrogen at times and giving you progesterone at times and not, um, it's this gradual introduction to no hormones on the estrogen and progesterone side. You are done, you know, once you leave that operating room. And so those levels come down and with a couple of weeks, you some women handle that pretty well. Some women are like, This is the worst thing ever, Dr. Dore. So, how they're going to handle that is kind of the thing. Usually within a couple of years, almost all women start feeling that negative effect of that loss of hormones. And when it's abrupt, it tends to be a harsher sentence than that natural decline that goes on that way, too. If the offending organs, the ovaries and the uh breasts, hopefully that doesn't sound harsh, but if those are removed, your risk of having a breast cancer is it's not zero, but it's extremely low. What's going to kill you? Heart disease, bone disease, and brain disease. And what is going to affect your life and your relationships? It's it can be those loss of hormones that go on. You can band-aid that with nutrition and or you know, other things, acupuncture. There's many things that help us with stress and and other hormone levels, cortisol and things like that that go on. Um, but the loss of hormones, that is not fair. And that's, you know, every woman is eventually going to have that, unfortunately. Uh, but how women are able to handle that, and then it's that counseling piece on how do you feel about going on hormone replacement therapy? This is not zero risk, it's extremely low risk. But when I look at the risks and balances and how this can uh positively affect, especially quality of life moving forward after that surgical menopause or after natural menopause. Am I a hormone person? Yeah, I'm a hormone person. But I have that talk with every patient. I get patients who are like, I don't want to go on hormones after door. What can you do for me? You have to have other tools in your chest, depending on what is that patient's orientation, what they are comfortable in doing, and being able to help them through those symptoms. So you give them the best quality of life that you can with or without prescriptions or hormone replacement.

SandyKruse: 51:02

So you're monitoring them if they choose to go on hormones, you're monitoring them, which is really important.

Dr.BruceDorr: 51:10

Yep. With levels, with symptoms, you know, it all depends on what we can incorporate into their lifestyle and help them with that quality of life. And then what am I doing? I'm helping in their heart in many different studies uh that's saying it's beneficial to heart. There's some societies who say, you know, there's no long-term prevent that hormone replacement therapy shouldn't be done for prevention. But we know that estrogen in virtually every study out there increases bone density. And all you have to do is see a mom or somebody suffer through an osteoporotic fracture and they can't walk again, they can't do anything, quality of life. You you look at that, and we know that it certainly helps very consistently heart and bone for sure.

SandyKruse: 51:51

So let's look at another scenario, which would be let's say I had breast cancer. I have the brac gene. Let's say I have that, I'm in remission. I had my ovaries removed, but I had the cancer. Is that still an option to go on hormone replacement if I'm in remission?

Dr.BruceDorr: 52:18

I think uh option being the keyword there. Uh so it is in many oncologists' mind, uh, kind of heresy, or I don't want to necessarily say malpractice, and going on estrogen after an estrogen receptor positive breast cancer. There are 20% of women that will have estrogen progesterone negative breast cancers. So you're probably in a safe space, probably because you it's not very well studied as we look at that long term. There are observational studies, not randomized controlled trials, on looking at that. There's a great book by a medical oncologist out of Southern California, Fornia, Fornia. His name is uh Dr. Avram Blooming, uh, and he has a book called Estrogen Matters. I've read that. It is an awesome chapter that uh it goes over when women have an estrogen receptor positive breast cancer, putting them on estrogen and how he decreases both their recurrence risks and certainly their all-cause mortality by helping them with their bone and brain and those kind of things long term. And I see women who handle uh that hormone loss very well, and I see women who do not. And I get regular referrals from uh medical oncologists in the area that have tried all the non-hormonal tricks, and they're like, I need you to go talk to Dorr, he'll put you on hormones. And yeah, I have that conversation with my patients. I'm like, there is no such thing as no risk. But how do you want to live? Is this affecting your quality of life, your sleep, your relationships, all this kind of stuff going on? And we go very low to be able to help them. What's that minimum dose that we have? And there's no, you know, studies looking at what that dosage is. Uh, but you know, when men get prostate cancer, yeah, we pull them off and and you know, we make their prostates sick by depriving them of testosterone. But once they're cured, these guys go back on testosterone and we're able to follow them with PSAs or other tests. Uh, you know, we just don't have a BSA, a breast cancer antigen uh gene to be able to follow women uh to catch it early with recurrences. So that would be kind of my hope and dream is could we come up with a liquid test for women that once they're cured of their cancer, I can then put them back on estrogen because virtually everybody across the board is like, this is how I used to feel, and testosterone. That's a whole nother uh bag of tricks that I use. Uh, and uh then we screen them with something we can pick it up very early with. So that would be my medical Christmas wish with women with pre-existing breast cancer is can we get a liquid test to um help pick up stuff early, like men?

SandyKruse: 55:12

I think you raised something really important just in that little uh segment because you mentioned quality of life. So we all know that you don't sleep, your stress levels are through the roof. All of that in and of itself affects your quality of life, and that can affect you getting sick again. I mean, listen, I have had stressful situations that have brought me to my knees, and I know like there is nothing worse than when you don't have a control. Like I had hormones when my daughter was sick. I was 40 years old, so I was in perimenopause. But I'm like, I'm just saying, like, even then I had trouble. And so imagine having had uh breast cancer, having your uh double mastectomy or whatever, having your ovary ovaries removed, and then you're not sleeping, you can't handle the stress, and it's this vicious cycle, Dr. Dore.

Dr.BruceDorr: 56:22

Yep, exactly. Yeah, so uh, you know, when you don't have your sex hormones, what does your body do? It stresses your thyroid, it stresses your adrenals, and then you start to get negatives in those territories that way. So we start to see this imbalance uh that's created. And like I said, uh certainly uh diet, lifestyle, nutrition, uh, that all helps. So you want to help them in that kind of least invasive way possible. But am I a hormone believer and I see women turned around every day on hormones? I I do, uh, but it's important to look at that whole person. And what if they when they put that cream on or when they put a patch on, or when they get a pellet, I say, if every time you do this, you think you're going to get cancer, you're going to get cancer. So the mind is a very positive, is a very powerful thing. So you've got to be on board that this is okay. I feel very comfortable in prescribing this for you. Again, there's no such thing as zero risk, but if you are powerfully going towards a negative direction, we got to turn that around or you can't be taking hormones.

SandyKruse: 57:33

I agree. Yeah, the mind is powerful. And it's just like when you kind of get your hormones dialed in a little bit, then your sleep is better. Then you want to eat better, then you want to go for that walk. Then you, you know what I mean? Like then you want to make an effort with your partner instead of yelling at them all the time, which that doesn't work, right?

Dr.BruceDorr: 57:59

You know, it's interesting. Uh, this is not a breast or brack uh cancer patient, but I had a patient I've been seeing for years. She's a major athlete and just done wonderful with hormone replacement therapy. She goes, Dr. Dork, you know, could could you do you would you see my mom? Do you think my mom could benefit from hormone replacement therapy? This is a woman in her um uh mid-50s. I said, Oh, sure. So, you know, she brings in her 95-year-old mother, uh, you know, who's, you know, she's got a cane, she's a little bit unsteady. And I'm like, oh boy, what you know, why did I sign up? You know, she'd never been on hormones, but she was getting progressively weaker, she couldn't open the doors. They were looking at um moving her into a skilled nursing facility. Uh, and um, so I kind of went over her and we start very low, uh, you know, and slow on hormones, kind of went over all that risk with her. It's funny because uh she had high high blood pressure and some kidney concerns, and she went to her cardiologist and he said, Hey, uh, she said, you know, I've got this gynecologist who wants to put me on estrogen and testosterone. What do you think? And he says, You're 95 years old. What's it gonna hurt you? Uh and so anyway, so she went on hormones and she came back into me, and she's and so her strength came back, so she's able to open up doors, she was able to cook for her eight children, Easter dinner. Um, and her biggest thing was on hormones, her bladder got so significantly better that she wasn't getting up two or three times in the middle of the night. So there were many quality of life issues that improved on the hormone replacement therapy. And she said, Dr. Dora, the biggest problem is every guy around my place looks fantastic. Uh so uh, so I said, Okay, let's dial your hormones back a little bit that way. So I brought her her libido back on top of all of her strength and everything. But now she's still living independently now at almost 98. Um, and she got rid of a lot of her negative quality. Of life symptoms. So, you know, that was another eye-opener for me that I think people of any age can benefit from healthier hormones. You just have to watch dosing and how you get it there.

SandyKruse: 1:00:10

I'm glad you mentioned that because that used to be what you would always hear. If you didn't start by this time in your life, you cannot take hormones ever. Like that used to be the common thing that you would hear that you just if you know you have this like little window. And if you don't start by that in that window, then it's too late for you. You're done.

Dr.BruceDorr: 1:00:35

Well, you get the best benefits uh under age 60 or within 10 years of menopause. After that, you have to uh it's not quite as good when we look at uh cardiac data uh and when we look at uh but bone can be regenerative virtually at any age. Uh, you know, it's still not FDA approved for uh uh for osteoporosis, but certainly for osteoporosis prevention. So you do have to be careful, especially with oral hormones on women's women greater than 10 years or uh, you know, above age 60. Uh so that that was the biggest thing that came out of the WHI. Don't put women on Prem Pro that are above age 60, they stroke. Uh so you do have to be careful on oral hormones. So transdermals tend to be a better or through the skin, not oral, uh taken, uh tends to be safer in those uh you do just get less benefits and a little bit riskier.

SandyKruse: 1:01:29

Okay, so we should we covered a lot on the uh BRCA and breast cancer and ovarian cancer. This was so informative. I think it's important that we just kind of give a little information about synthetic versus bioidentical because this is a question that it's almost like it never ends. The same question over and over again. And that is what's the difference? Can't I just take anything? So can you just explain what the difference is?

Dr.BruceDorr: 1:02:06

Yeah, so unfortunately, when uh the term bioidentical has a negative kind of uh non-approved or not medically indicated slant to it. So when we look here in America and when we look at uh that that slant, the the FDA doesn't like that. Uh they like human identical or they like isomolecular. What we mean when we say that is that you're putting the same thing back into your body that you have receptors for and that you were meant to respond to. When you look at synthetics, it means that it is similar to estrogen, but it's not the same. So when you look at premerin, uh, for example, none of those uh uh estrogens, uh there are horse urine-derived estrogens, none of them are what uh the uh what the ovaries made naturally. It's similar, but when your body sees similar but not the same, you start hitting other receptors, and how you process and break those down starts to become negative. So you do get positives, and we know there are positives in taking horse urine. Uh, is it as good or the same as putting in 17 beta astradiol? No. So, same with testosterone, there are modifications of that that way too. And when you look from a pharmaceutical industry standpoint, what you need is a uniquely patentable drug. So if it is identical to the human body, that can't be patented. You can patent the uh delivery method to it, but you cannot patent 17 beta-estradiol. You cannot patent testosterone, uh, you cannot patent insulin, you cannot patent dopamine or epinephrine. So they didn't want one pharmaceutical company to have the rights on insulin or those kind of things going on. So the modifications and the synthetics altered uh kind of like progesterone, but it's a progestin, starts hitting other receptors. It can block testosterone receptors or bind testosterone receptors, it can start binding um glucocorticoid receptors or other things. That's why some women that go on progestins gain weight, uh, or because you're hitting other things, not just the progesterone receptor. So it's important that similar is not the same and it has different reactions in our body. So when you put back in what's meant to be there and you deliver it in the right way, we weren't meant to get our hormones uh, you know, through our stomachs, uh and they uh and through then process through our livers, that becomes a little bit more risky when you look at that. So similar and so same delivery, same chemical, you tend to be in a safer space.

SandyKruse: 1:04:58

Okay, yeah. So I've I've heard that taking oral estrogen poses a whole other uh risk to menopausal women, right? Like what is that risk again?

Dr.BruceDorr: 1:05:09

Well, when you look at there was an increased risk of clot and gallbladder uh risk in the WHI uh when uh you took uh oral uh synthetics uh and combined with uh the progestin. So again, that's not bioidentical and that's not the same estrogen or estrogens, that is not the same progesterone. It is a progestin, specifically it was uh madroxy progesterone acetate uh in that that study. But um, when you look at bioidentical, when you put in 17 beta estradiol, they don't necessarily even see that in some of these big like 16-year studies, the Danish osteoporosis uh trial that looked at women over 16 years on uh it was uh oral 17 beta astradiol, and they didn't have an increase uh clotting risk uh in those that way too. So putting in the same uh tends to be better. Uh oral tends to be less safe when we look at that, but like a patch or a gel or a spray or a pellet uh that is uh that is not going through the liver tends to be safer that you uh decrease the gallbladder and clot risk.

SandyKruse: 1:06:18

You know, this just totally just came to mind. I just never understood, and maybe you provide clarity. Why is there no form of birth control that is more of a I know bioidentical isn't the right term anymore, but like all the birth controls, the IUD, the pale, all of them are all synthetic, all of it. Why is why did nobody make a bioidentical version of a birth control? Like everything is progestin, everything is the um estrogen, okay, not the horse um urine, uh female, what is it, pregnant mare's horse urine? But why do you have any answers about that?

Dr.BruceDorr: 1:07:07

It's about absorbability and it's about the half-life of that drug. So oral progesterone, uh, you have to go to very high doses for absorption and then protection and then potential uh suppression of ovulation. So the modifications of that um you can get by with better absorption and less expense uh when you look at progestins uh over bioidentical progesterone. It's very hard to absorb and you have to go to very high doses. And the side effects of it are uh sleepiness, sedation, uh, and that going on. So bioidentical progesterone tends to be ill-tolerated when you look at um suppressing ovulation and to help with birth control specifically. Progestins do a better job of that. Um, and then there have been formulations with bioidentical estrogen. So birth control pills are mainly progesterone and progestins uh uh, you know, modifications uh with a little bit of estrogen to help with the bleeding. And there are certainly what they consider now natural uh forms. It's called estrol uh that's out there now. It is a fetal-derived uh estrogen. Uh, it is a quaternary uh estrogen, is what they call that, but it is bioidentical, but it's not like 17 beta estradiol or those kind of things that when we look at hormone replacement therapy, but it's about absorbability, it's about side effects and tolerability when we look at why a progestin rather than a uh bioidentical progesterone.

SandyKruse: 1:08:42

Oh, that's interesting. So, because aren't pellets, so that's your expertise is the pellets. Aren't pellets customizable?

Dr.BruceDorr: 1:08:52

Yeah. So uh again, the reason, and again, you can customize many different things. Uh, the reason I like a pellet is because people forget to take their hormones, or uh you get a hundred uh hundred percent compliant when we look at compliance when you look at uh putting a pellet in. And so a lot of people, you know, just coming in a few times a year do better because they don't leave their prescription for estrogen or progesterone, uh, you know, in the cabinet at home when they go to Hawaii or wherever, uh, as a deal. It sounds like Toronto is as warm as Hawaii, so we just all should be going to Toronto uh instead, right? Right now, yeah. Right, right. So you get that compliance issue. Uh, and yes, it is customizable. You just have to be careful on the dose. So when I look at a pellet, I am clearly getting it into that patient's body. Whereas when you do a transdermal, when you do pills, there's varying rates of absorption. But the beauty is that you can stop those if they're having any problems or concerns. Pellet, you can't take out. So that's a negative thing that goes on. So it's cost, it's about uh compliance, it's about uh, you know, that dosing, and then how frequently I give them that. Uh, that is also the other thing. So you just have to be cautious on how much you're putting in, how frequently you're putting in it. And you start out low to figure out that you don't give them too much, whether or not that's estrogen or testosterone. So there's a smart way to do that, and that's what we do uh at the company that I lecture for.

SandyKruse: 1:10:28

Okay. And yeah, because it it just goes under the skin. So if you if you need to take it out, you have to go to your doctor to have it removed.

Dr.BruceDorr: 1:10:37

Can't take it out. Can't take it out, can't take out a pill. Uh so that is something it dissolves like a Tums or a ROLAIS or a Tic Tac. So it you can dig it out, but you're gonna leave a big divot. You do not want to do that, uh, is the deal. So you have to look at like this is going in you, and I can't take it out. So that's why you go very low to see how they tolerate that, because it will be out of their system within a few months. So that's the beauty of it, but it's also the negative of it, is the thing. Whereas other forms you can stop or take out, and that's the criticism from many factions or societies is that yeah, you can't take that out. What if they have a problem? And you can get problems. So it's about that counseling piece on what is incorporable. Uh, you know, are you going to remember to do this or take this? Uh, but people that go on pellets, uh, in in my experience, uh, you know, a majority of people continue with pellets. When I do other forms, people get fatigued and they don't want to put a cream on every day or they don't want to wear a patch or things like that. The compliance rate is not as good as with pellets. So it's just all figuring out what they need. You just got to go very low and figure out what their uh what their tolerability and absorption uh is.

SandyKruse: 1:11:48

That actually makes a lot of sense. Cause even still, like just in my brain, I'm like thinking, okay, well, you know, I I've been a lot of this up and down hormonally initially, but then you kind of get to that point where you're like coasting.

Dr.BruceDorr: 1:12:03

Yep.

SandyKruse: 1:12:04

Right? Like, and you're you're you I know hormones, listen, we all anybody who's listening would know that your hormones are affected by your circadian rhythms and you still have hormones. You you're not flat. It's not like you go dead after menopause with no hormones. So there is still a little bit of fluctuation, but you're more stable. So it kind of makes sense that that's a time that would be okay, Dr. Dorr, I'm having this conversation with you as you're you're my doctor, and and I know I've been in menopause for a couple of years. I've pretty been, you know, pretty stable in terms of my dosage on creams and progesterone pills. I want something that I don't want to have to think about. So that might be a good time, right? Yeah, yeah.

Dr.BruceDorr: 1:12:52

Nice to be able to offer everything because everybody's different uh as far as what their tolerability, whether pocketbook, you know, all that kind of stuff going on. So it's important to be able to uh offer everything to a patient uh because it, you know, pellets aren't for everybody and uh and creams are not for everybody and patches. So, you know, we're all we uh all have different uh needs and uh tolerability and uh and compliance uh rates that they go on.

SandyKruse: 1:13:20

Yeah, yeah. I I I know from experience. I walk around like this, you know, when I put it for like, don't touch me, I can't touch anything, you know, because what is it like 45 minutes before it's completely absorbed or something like that, right?

Dr.BruceDorr: 1:13:33

Yeah, depends on the cream or whatever that you're using, sure.

SandyKruse: 1:13:36

Yeah, yeah. This has been such a wealth of information, and you definitely you killed it, Dr. Dore. You you did like that everything, you all the information that you provide is just so useful. And I appreciate you so much. I just want to know where can people find more information? Where can they find you? Where can they find information on pallets? Let us know.

Dr.BruceDorr: 1:14:04

Yeah. Well, um, you know, I'm available uh or uh our my bigger organization that I lecture for and educate uh providers, uh certainly around the country and Canada, uh, that uh that's biotee.com. And you can find a uh professional just like me uh on there. Um I'm pretty busy uh here in Denver, but there's a locator that you could find our clinic is a thing that way too. So uh, but in general, uh we uh it's that over 8,000 plus uh provider network uh through biotee that offers pellets, but it's training on many different aspects, not just uh pelleted therapy.

SandyKruse: 1:14:43

That's great. Thank you. Thank you, thank you. Thank you so much for your time today.

Dr.BruceDorr: 1:14:48

Okay, you're welcome, and thanks for having me. It's always uh wonderful uh talking with you.

SandyKruse: 1:14:53

Yeah, me too. I hope you enjoyed this episode. Be sure to share it with someone you know might benefit. And always remember when you rate, review, subscribe, you help to support my content and help me to keep going and bring these conversations to you each and every week. Join me next week for a new topic, new guest, new exciting conversation to help you live your faster life.