Episode 292: The Power of Bioidentical Hormones — Are They Right for You?
Listen on Apple Podcasts | Listen on Spotify
There is a huge spectrum of opinions on the use of hormone replacement therapy. On one side, it’s presented as the only option to balance your hormones, and on the other, it’s villainized.
Today, Erin unpacks it all with Alise Greenfield, a Funk’tional Nutrition Academy graduate and NP with over a decade of experience in both conventional and functional medicine. Their discussion dives into the nitty-gritty of bioidentical hormone replacement therapy (BHRT), how it’s used, and what options are available on the market today. This episode offers a fresh perspective, challenging the narrative that aging for women must simply be accepted as "it is what it is."
Alise Greenfield is a functional medicine nurse practitioner with a focus in women’s health and wellness. Her expertise includes hormone health, period problems, bio-identical hormone replacement and gut health, as well as skin health from an inside out perspective. She received her degrees from the University of New Hampshire. She has over a decade of experience in conventional and functional medicine in various settings. She has also been a patient herself with chronic Lyme and overcame complications by blending these two medicines. These experiences led her to the conviction there is no one right way to health and when combined appropriately, these two modalities can drastically improve people’s lives. Her practice is located in Dover, NH.
When she’s not working, you can find her in the kitchen cooking or baking gluten free treats, in the ocean on her stand up paddle board, spending time with her young daughter and husband, at the gym or reading an entertaining book.
In this episode:
HRT vs BHRT: is BHRT really “natural”? [9:46]
Signs & symptoms that you may (or may not) be a good candidate for BHRT [20:07]
The 3 forms of estrogen & how each are dosed [21:45]
An unexpected protective benefit of bioidentical hormone therapy [27:31]
Monitoring BHRT & why the delivery method matters [34:10]
Debunking the history of fear behind BHRT - what the data tells us [45:22]
Resources mentioned:
Funk’tional Nutrition Academy™
Connect with Alise Greenfield:
Kion Aminos (Get 20% off monthly orders and 10% off one time orders)
Ned Natural Remedies (get 15% off your order with code FUNK)
Organifi supplement powder (save 20% on your order with code FUNK)
LMNT Electrolyte Replenishing powder (Use code FUNK get a free sample pack with any purchase!)
Qualia Mind (get $100 off and an extra 15% off your first purchase with code FUNK)
Learn more about Hormones
Related episodes:
274: Supporting the Perimenopause Transition
206: Weight Gain in Menopause: What Gives??
187: Metabolism Series Part 1: High Blood Sugar, Insulin, & Weight Loss
165: Hormone Lab Testing, Estrogen Dominance & Balancing Hormones at Home
-
Erin Holt [00:00:02]:
I'm Erin Holt, and this is the Funk'tional Nutrition Podcast, where we lean into intuitive functional medicine. We look at how diet, our environment, our emotions, and our beliefs all affect our physical health. This podcast is your full bodied, well rounded resource. I've got over a decade of clinical experience, and because of that, I've got a major bone to pick with diet culture and the conventional healthcare model, they're both failing so many of us. But functional medicine isn't the panacea that it's made out to be either. We've got some work to do, and that's why creating a new model is my life's work. I believe in the ripple effect, so I founded the Funk'tional Nutrition Academy, a school in mentorship for practitioners who want to do the same.
Erin Holt [00:00:45]:
This show is for you if you're looking for new ways of thinking about your health and you're ready to be an active participant in your own healing. Please keep in mind this podcast is created for educational purposes only and should never be used as a replacement for medical diagnosis or treatment. I would love for you to follow the show, rate, review and share, because you never know whose life you might change and, of course, keep coming back for more. Hello, my friends. Today we're going to talk about bioidentical hormone replacement therapy. We're going to get all into it. But first, I want to remind you that this is the last day of our Funk'tional Friday sales. All of our programs and courses are on mega sale right now, and that ends at midnight tonight, Tuesday.
Erin Holt [00:01:35]:
So if you've been thinking about it.
Erin Holt [00:01:36]:
Now is your chance. I also have an announcement for you, and that is I am taking a sacred pause. It has been a really big year. My team and I really just need a month to pause, to reflect, to catch our breath. We have been working behind the scenes on a huge project that we will be rolling out in January, and we want to make sure that we have the appropriate amount of space to dedicate to that while also enjoying time off for the holidays. So I'm doing something that I have never done before in over six years of podcasting, and we are taking the entire month of December off from releasing new podcast material. I feel like this is a real practice what I preach moment, because I have been getting this internal call from inside the house, if you will, for a hot minute. And my body, she loves me so much that even when I was leaning away from the call, she was like, oh, no, you don't, Erin.
Erin Holt [00:02:43]:
Listen, I'm going to flare some things up for you right quick, because I'm not letting you do this again, not letting you go dark on your inner voice and your inner knowing. Again, we are doing this, and I'm just so grateful that our sponsors are so terrific and understanding and we have the opportunity to give ourselves this sacred pause in this space that we all need.
Erin Holt [00:02:58]:
We will be back January 2, recharged and ready to go with a mega announcement. So definitely stay tuned for that. You're going to be interested in this. Trust me on this. And I will absolutely miss you all. I hope you all have wonderful holidays and enjoy the remainder of the year. So today, bioidentical hormones.
Erin Holt [00:03:30]:
We have a recent FNA grad, Alise Greenfield, on the show. And I really wanted to highlight her voice because it's showcasing a trend that we've seen through the past year. We are really seeing an uptick in non RD students. So the majority of our students in the Funk'tional Nutrition Academy have always been nutrition professionals and RDs, and they still do make up the majority. But we're seeing more chiropractors, acupuncturists, registered nurses and nurse practitioners join FNA. And that's what Alise is. She is a nurse practitioner. So I just wanted to remind all of you guys that you can apply to FNA anytime, talk with our team.
Erin Holt [00:04:15]:
You can schedule a Discovery Call with Rachel, talk to her about the program. She's our lead clinical mentor, and we can kind of get the process started. So that's exciting. But like I said, Alise Greenfield, she's a functional medicine nurse practitioner. She focuses on women's health and wellness and has over a decade experience in both conventional medicine settings and functional medicine settings. She's been a patient herself with chronic Lyme. She overcame complications of Lyme by blending these two medicines. And these experiences have led her to the conviction that there's really no one right way to health, there's no one path to health, which is what I say all of the time.
Erin Holt [00:04:55]:
And when she combines these two medicines, these two modalities, appropriately, they can drastically improve people's life. So her practice is located in Dover, New Hampshire. That's right. She's a New Hampshire gal. And I'm just really excited for you all to get to hear from an FNA grad, and she can speak into this concept or this topic, bioidentical hormones, in a way that nutrition professionals really can't. She has a different angle in terms of her scope of practice. So that's why I was excited to bring her on the show. So without much further ado, here we go.
Erin Holt [00:05:30]:
Welcome back, friends. Today we're going to be talking about bioidentical hormone replacement therapy, or BHRT. We'll talk about what it is, how it differs from HRT. There's really a spectrum of opinions on the use of hormone replacement therapy. On the one side, it's presented as the only option to balance your hormones, and then on the other end of the spectrum, it's really villainized. So we're going to unpack all of that today. I am really excited to announce our guest because she is an FNA, a Funk'tional Nutrition Academy grad, Alise. So welcome, Alise.
Erin Holt [00:06:09]:
I'm absolutely thrilled to have you here.
Alise Greenfield [00:06:12]:
Thank you. Thank you so much for having me today.
Erin Holt [00:06:15]:
And the reason that I wanted Alise to talk about this is because a lot of what we're going to get into is beyond the scope of what a nutrition professional or an RD would do in practice. We had Lauryn on Episode 274, and she was talking a little bit about HRT, but really doing it from more of a perspective of what we as nutrition professionals can do. Alise is an NP. She's a nurse practitioner, and so her scope of practice differs slightly. She's going to be talking about things from a clinical perspective that I wouldn't be able to see as a nutrition professional. Before we even get into today's conversation.
Erin Holt [00:06:59]:
I want to take a moment to speak into that because we really have had an uptick in interest for the Funk'tional Nutrition Academy from NPs, from RNs, from PAs, from chiropractors. And what a lot of people don't understand is that our curriculum is catered to medical professionals beyond just RDs. Over a third of our current students and grads are actually not even RDs or nutrition professionals. There are other medical professionals. So, Alise, I really wanted to hear your perspective for anybody who's interested in FNA who's not an RD, who's not a nutrition professional, as a nurse practitioner, why were you interested in joining FNA? And what benefits have you received from the program?
Alise Greenfield [00:07:46]:
I'm happy to talk about that. I was interested in FNA after listening to you on the podcast for many years and just being a fan of your work. I have a lot of training and education, a lot of functional medicine training and education. And I felt kind of twofold, that I was missing some implementation work. I needed some support with that, and then I opened my own business, and I really appreciated your perspective on business. So both of those things combined made me join Funk'tional Nutrition Academy, and I absolutely don't regret it. So the knowledge and training, again, really, it did focus on implementation, which is, again, what I felt like I was needing, and it was kind of the missing piece. My patients are getting better results.
Alise Greenfield [00:08:38]:
I feel more confident delivering care plans. I'm really identifying and treating what's happening. And then you have such an amazing way of explaining these complex topics and complicated processes to really make it more simplistic in a way that I also can have language to give to my patients as well. So as a tool to educate my patients. And then, of course, from the clinical in addition to the clinical piece of business and personal growth have been really priceless, like improving my confidence as a business person, understanding business. Because, of course, I didn't go to school to be a business person. I went to school to be a clinician. So, yeah, really amazing investment, and I would make it again and again.
Erin Holt [00:09:20]:
You know, what's so funny is, first of all, I'm so thrilled to hear that. And I like how you kind of talk about the ripple effect too. It's like, it's not just me that's receiving the benefits. It's my patients, my clients as well. But I did go to school to be a business person. That's where I went to college, right out of high school. And I was like, I hate this. It's all come back full circle where I'm like running a business anyway.
Erin Holt [00:09:44]:
I always get a kick out of that. Okay, so let's get into BHRT basics. What is it? In case somebody's not familiar with this term, what is it? And then also, how does it differ from HRT hormone replacement therapy? A lot of people are like, well, it's a much more natural hormone replacement. Is that true? If so, why or why not?
Alise Greenfield [00:10:09]:
Yeah, those are obviously key points, and I want to answer those. And I want to just start by opening and saying that hormones have been a controversial topic. So even when women are menstruating, when we're going through menopause, we don't talk about symptoms. They're dismissed. Women are often offered a single solution, which tends to be birth control, and that doesn't go away when we go through menopause. There's a lot of red tape around hormone therapy and even having a conversation with your provider about options when it leaves women feeling really lost and neglected at a vulnerable time. So my whole perspective is really about alleviating suffering, and that's why I do this work. And that's at the core of today's conversation.
Alise Greenfield [00:10:53]:
Bioidentical hormone replacement can be a powerful tool to help alleviate that suffering. And we're going to talk about them providing symptom relief. And that's something that should be considered. And you alluded to this in the beginning, that there's kind of two sides of this spectrum, and there's people that are, yes, everybody should get them, and people that are no, they're villainized. And the truth is in the middle, right? Like, as with everything in medicine, there is a risk versus benefit. They're not right for everybody, but they can be exceptionally helpful and powerful in the right situation. This is a hard time for women. They don't feel like themselves, their body doesn't feel like their own, and they don't feel like they have a place to go to provide them with adequate support.
Alise Greenfield [00:11:40]:
And that's really hard. And women are suffering unnecessarily. And that is where bioidentical hormones can come into play. So to answer the question about what they are versus conventional hormones, and are they really natural?
Erin Holt [00:11:57]:
Back up. So when you're saying hormone replacement therapy is conventional hormones, is that what you mean when you say conventional hormones?
Alise Greenfield [00:12:06]:
So, yes, there's like two arms, right? So when we talk about hormone replacement therapy as a whole, it's the idea of replacing hormones that are lost. And then there's two kind of branches to that that I consider conventional hormone replacement therapy and bioidentical hormone replacement therapy. So when I refer to either I'll say like conventional or bioidentical because it does get confusing and it can be a mouthful, but please ask anytime that it's not clear. So in general, there's confusion around hormone replacement. But as I mentioned, there's two arms of conventional and bioidentical. Sometimes those words are used interchangeably, but they're not the same. So the difference is that bioidenticals are chemically identical to the hormones our bodies produce. Conventional hormone replacement therapy is not.
Alise Greenfield [00:13:00]:
So conventional hormone therapy are hormones our bodies don't necessarily recognize or know what to do with. It doesn't offer a balanced hormonal response the way bioidentical hormones do. So an example of conventional hormone replacement is Premarin. So that's one of the commercially available estrogen options. So that means you can get it at your local pharmacy versus having to get it at like a compounding pharmacy. It's actually conjugated equine estrogen or CEE and it's collected from the urine of mares. So horses, mares make estrogen that we don't make. So what we're doing is introducing a foreign estrogen to our body when we take it.
Alise Greenfield [00:13:47]:
Provera is another commercially available prescription used for conventional HRT and often marketed as progesterone. It's a progestin, not a progesterone. We have to make that differentiation. We do not produce progestins, we produce progesterones. So with conventional HRT we're not replacing our body's natural hormones. It's not an exact match. Bioidentical hormones are literally as they sound, bioidentical. They are the same structure and chemical match that our bodies make.
Alise Greenfield [00:14:21]:
So our bodies understand what to do with that compound. The raw materials in this case are sourced from yams or soy usually. And I do always add that people with soy allergies can use bioidenticals without an issue because the protein that causes the allergic response isn't present. So sometimes BHRT is incorrectly referred to as natural. And I say incorrectly just because I think what people mean when they are looking for something natural or asking about natural hormone replacement is that they're looking for something that isn't a chemical or doesn't exist in nature, or sorry, that does exist in nature. And whether it's bioidenticals or conventional HRT, it's still manufactured in a lab or in a pharmacy. I know it sounds like semantics, but it's important because the differentiation isn't that bioidenticals are natural and conventional hormone therapy is not. The differentiation is that bioidenticals are an exact chemical match for what our body produces.
Erin Holt [00:15:26]:
And that is better? So you are saying, for example, there's a difference between progestin and progesterone and the potential benefit of these bioidentical ones are that they're an exact match. So is the philosophy or the theory that that's better for our bodies?
Alise Greenfield [00:15:48]:
Yes. So what the data actually shows is that there's less side effects too. So we see that there can be more adverse effects with the conventional hormone replacements versus bioidenticals. They do get lumped into the same category a lot, but when you actually piece apart the data and start to look at the individual options or the individual studies. There is a difference between the bioidenticals and the conventional. There are more apt to be negative effects from conventional HRT because, as I mentioned, our body doesn't know how to balance our hormones with conventional. Like it's using extra energy that it doesn't need to use because there are compounds in our bodies our body doesn't know how to utilize.
Erin Holt [00:20:07]:
In terms of consideration for BHRT, if somebody's listening to this and they're like, okay, I think I might be a good candidate, how would they know that?
Alise Greenfield [00:20:18]:
It's a good question. So there's a few reasons to consider it. The most obvious is symptom relief. So that's the classic symptoms of menopause that we think about. Hot flashes, night sweats, fatigue, brain fog. Some women experience vaginal, dryness, insomnia, some people just don't feel right in their bodies, so that the symptoms are a great reason to consider it. And that's why hormone therapy in general started being used years and years ago, is to relieve symptoms. But another reason to consider is longevity.
Alise Greenfield [00:20:53]:
So, prevention of memory loss, heart health, heart protection and bone protection. We're using bioidenticals in perimenopause and menopause. So the goal is to ideally start in perimenopause or as close to menopause as possible, versus waiting several years after menopause has occurred. It can still happen at that point, but the goal is to really help promote homeostasis so that balance in our body and to help maintain the level of hormone. So the longer we wait after menopause, the more careful that we have to be. But at that point, when you're starting hormone therapy, bioidentical hormone therapy later on after menopause has happened, it's really for longevity, so really for quality of life, and again, supporting the brain, supporting the heart, supporting bones.
Erin Holt [00:21:45]:
And so when you're talking about hormone replacement, what hormones are you talking about? Are you talking about estrogen, progesterone, testosterone? All of the above? Sometimes it's this, sometimes it's that. Based on hormone lab testing?
Alise Greenfield [00:22:00]:
Yeah, absolutely. So it's most often estrogen and progesterone, sometimes testosterone. Although in the United States, testosterone for women is not FDA approved. DHEA is also another hormone that can be used. Estrogen and progesterone tend to be kind of the biggest ones that we think about and that we utilize.
Erin Holt [00:22:22]:
And how are you dosing those? Are you always basing them off of lab tests? And if so, what kind of labs are you running?
Alise Greenfield [00:22:31]:
It's a good question. So it is a combination of labs and symptoms. So if somebody is coming for bioidenticals because they're having symptoms, we're looking for the lowest effective dose to help improve those symptoms. If somebody's just looking for longevity and they are past the point where they are symptomatic or they aren't experiencing any symptoms, then it would be the lowest effective dose that keeps their labs in a safe range. And when I'm talking about labs, for me, I do two different types of labs when I'm using bioidentical hormones. So I often do a DUTCH test, almost always do a DUTCH test because that is showing us not just the levels of the hormones, but how our body is metabolizing the hormones if we need to do some liver support because that's how estrogen is broken down in our body. And then I will also do serum or blood testing because that is a more convenient and easier way to monitor therapy. So it is a combination.
Alise Greenfield [00:23:35]:
Yeah. Cheaper as well.
Erin Holt [00:23:39]:
If somebody were to, so now we're drilling into more of the DUTCH test and looking at the part of the lab that shows us how we're clearing or metabolizing our estrogen and which pathways our estrogens are going down. Is that going to influence the type of estrogen you use? This might be a dumb question, but this is just not my zone of genius, for sure. Would that influence the type of estrogen that you're using? Are there different types of estrogen that you can use with BHRT? And then also is that if somebody's metabolizing inefficiently or not clearing estrogen, would you be less apt to use estrogen? Or like you said, would you just be using the estrogen hormone replacement therapy and also supporting those pathways in the liver as well?
Alise Greenfield [00:24:31]:
The DUTCH test wouldn't change the type of estrogen we use. So with bioidenticals, so we make three types of estrogen as humans, right? So we make estradiol, which is the predominant estrogen during our menstruating years, estrone, which kind of takes over during menopause, and then estriol, which tends to be predominant during pregnancy. But at any time, we have a combination of all three of those estrogens. Bioidentical hormones typically are estradiol. We can also use estriol. Estrone has been used, but I don't use it and don't recommend it because it doesn't have the protective effects that the other estrogens do. So we're always using estradiol. At a minimum, estriol can be added if in a lot of cases, I do like to use estriol.
Alise Greenfield [00:25:21]:
And then as far as helping determine what happens with the liver and estrogen burden, looking at that data would help determine kind of from that functional medicine perspective, how do we support the liver, how do we support your body breaking down and excreting estrogen appropriately? So if somebody looks like they have a high estrogen burden or they're not detoxifying their estrogen really well, it doesn't preclude them from using bioidenticals. It just means that we have some work to do on helping support all of the detoxification pathways supporting the liver, making sure they're pooping every day, making sure that the foundations are in place through both lifestyle and sometimes supplements.
Erin Holt [00:26:08]:
Okay. And inquiring minds want to know, now you've piqued my interest. What would be the situations where you would use estriol? Or e3. What would make you be like, this person needs a little extra e3. What would make you say that as a clinician?
Alise Greenfield [00:26:24]:
So in general, I actually like to use that kind of period. I just like the combination of the two. The determining factors are usually convenience. Estradiol is available through the regular pharmacies. You can get it as a patch. So that's like the Vivelle-Dot and you can get it, go to Rite Aid and get it. So for some people, for the convenience of being able to go into the local pharmacy and using their insurance is really the determining factor to use estradiol. And estriol, it is compounded into a cream.
Alise Greenfield [00:27:01]:
So you have to have access to a compounding pharmacy, and most of them will mail things away. So if you don't have one locally, they will mail it. But then it's utilizing a cream every day versus a patch. You're changing every three days. So it depends on what each person's preference is. I like estriol because it has anti inflammatory and protective effects, but we can still use estradiol alone if somebody prefers a patch or doesn't want to use a cream.
Erin Holt [00:27:28]:
Okay, and then you've mentioned the protective effects of estrogen a couple of times now, which is probably interesting for some people to hear because estrogen can get a really bad rap for a number of different reasons. So speak to us and you have training in longevity that's like one of your sort of specialties. Would you say that or am I just making that up?
Alise Greenfield [00:27:48]:
No, I have training in that. Yeah, I accept this.
Erin Holt [00:27:57]:
So I would love to hear a little bit more about the protective effects of estrogen. And you said that you use BHRT for longevity. So how does this all fit together? How can this help us live longer, healthier lives with having more hormones, more estrogen?
Alise Greenfield [00:28:13]:
What we understand now is that estrogen replacement can be really helpful for longevity. Estrogen has over 400 functions in the body because we have estrogen receptors everywhere and not just in our reproductive system. So as our natural estrogen declines, the functions elsewhere can be impacted. The loss of hormones are going to lead to effects on brain function. So we can see things like memory loss, insomnia, loss of muscle and skin tone, poor cellular function. There's an increase in oxidative stress, which is the DNA damage. We can see changes in the gut diversity, some increased inflammation. So the loss of estrogen can cause quality of life and more morbidity and mortality as we age.
Alise Greenfield [00:29:05]:
So adding estrogen actually can help with a lot of that. So one example is that we know the loss of estrogen has effects on things like osteoporosis and thus fracture risk. Women are more likely to be diagnosed with osteoporosis and the statistic is somewhere like one in five women over age 50, because what's happening over age 50, we lose estrogen. And there are some studies that show adding estrogen therapy like bioidentical estrogen, and it will even say that conventional hormone therapy can also have this effect, that it is protective of our bones and it can help prevent more bone loss.
Erin Holt [00:29:48]:
Which is like a pretty big deal as we age. It's not something you're thinking about in your 20s and your 30s, maybe not even in your 40s, but I'm turning 40 in five months. So this is definitely something that's more top of mind now is like, what can I put in place to support myself further on down the road? And I would just encourage anybody listening, however old you are, to kind of adopt that mentality or that mindset of like, what can I do now to make sure that I feel good in the future.
Erin Holt [00:32:42]:
You know, what I thought was interesting is that you mentioned that lower estrogen or losing estrogen as we age can actually impact our gut diversity. And it's like we tend to think about that almost in reverse. Like, what's happening at the level of our microbiome can really influence our estrogen levels and our estrogen clearance. So I think it's just like one more way in which the body isn't like a step by step process. It's all so interconnected. I think that's really interesting. You know, what I'm wondering about hormone replacement therapy is once you start, is this something that you have to continue forever?
Alise Greenfield [00:33:25]:
That's a really good question. I think that there's a little bit of disagreement about that. So as far as symptom management, if that's what we're utilizing it for, you would continue to use it until symptoms seem well controlled and there are no symptoms. And then at that point, you could theoretically come off of it. As far as the longevity piece.
Alise Greenfield [00:33:50]:
What we see is that when you come off of hormones, the benefit you received while you're on them is not there or it's not as robust. So there are a lot of women who do continue to use bioidentical therapy through the rest of their non menstruating years.
Erin Holt [00:34:11]:
Okay, and then when would you start this? Obviously you're talking about perimenopause and menopause, and I heard you say that it makes sense. It's almost like preventative care is kind of the way that I interpreted what you said. It's like the longer we move through the perimenopause and into the menopause process, the more challenging it might be to reduce symptoms without the use of HRT. So we want to start that early on. In terms of symptom management, are you also advocating for people to combine that with dietary changes and lifestyle changes or do you prefer people to start with the dietary and lifestyle changes first? Where do you fall based on what you see clinically?
Alise Greenfield [00:35:02]:
A little bit of both. I think bioidentical hormone replacement really by itself can be really powerful and then combined with the functional medicine tenants just makes it exponentially more effective. So that is diet and lifestyle and looking at gut health. And that's why I do a DUTCH test, because we're looking at how we're metabolizing estrogen and really supporting all of those processes. I don't require people who come to see me to do all of the functional medicine things. Yes, it is better and I see better results. But I also don't think that women should not have access to this because they're not in a place where they're ready to make these changes. I've also seen a few times too, that what happens during this time is women are so overwhelmed, they don't feel like themselves, they are stressed, they don't sleep, they're physically not feeling like they can be in their body the way they used to.
Alise Greenfield [00:36:03]:
And the idea of having to now change how they're eating and add stress reduction and exercise and all the things that we know are helpful is just another thing on their to do list and they're already overwhelmed. Sometimes just starting with bioidentical hormones is enough to help kind of add some balance and some stability so that then they can say, oh, okay, I actually think I have room to do these things. So then the change can come afterwards.
Erin Holt [00:36:33]:
I think this is just like it's opening up like a whole separate conversation too, which is like being so convicted in our beliefs about the correct approach as practitioners. I'm talking about has the potential to limit our clients capacity for healing. We have to meet people where they're at, which is at this point such like a kind of like a trite cliche thing to say, but this is what it actually means to meet people where they're at. It's to hang your beliefs on a hook when they walk in the door and to really take widen the lens of how we're seeing the human being sitting in front of us and saying, what is the appropriate path or options for paths for them. Because I think what you're saying is kind of radically different than a lot of the messages that we receive in the functional medicine space, which is, you must collect $200 in order. What is the Monopoly saying? Do not collect $200. Do not pass go. You've got to do all of these things before you can almost earn the right for the next level intervention.
Erin Holt [00:37:51]:
And I sort of subscribe to that. And also there's always exceptions to the rule. And what I've seen, and I think this requires you being in practice, working with people in order to arrive at this. But what I've seen is that sometimes we need to do the thing that we have deemed not correct in order to get people to a place where they can feel better and make the appropriate change. So even though it might seem counterintuitive or opposite of what we typically say here, which is focus on the foundations, focus on the basics. Do that first and see where you net out. What I hear Alise saying is that yes, and some people don't have the bandwidth or the capacity to do those basics, and giving them a little boost via BHRT can stretch their capacity to be able to feel well enough to attempt the basics.
Alise Greenfield [00:38:47]:
Yeah, absolutely. That's definitely what I have seen happen. And I agree. I think we're on both sides of the aisle kind of saying, this is the way it is. Do it or else. And that doesn't serve anybody.
Erin Holt [00:39:05]:
Yeah, it might serve the people that might serve the people who need that kind of approach, which is just like, just tell me what to do. Just tell me what to do, I'll do it. I just need a little kick in the pants and I'll get it done. And that's probably not the majority of people, to be honest, if somebody's listening to this, and they're like, oh, I'm kind of interested in this approach, but maybe would like a little bit more information so they're not feeling super nervous about it. Can you talk about how you mentioned there are some that are more of a topical cream? What are the different ways that you can deliver hormones? Because I know that there's multiple which ways do you find the most success with? If you have an opinion there just so people can kind of know what's a day in the life of somebody who's taking hormone replacement therapy.
Alise Greenfield [00:39:53]:
Absolutely. So we kind of alluded a little bit to the estrogen before. So you can get any of the bioidenticals at, not any of them. I should rephrase that. You can utilize a regular pharmacy or a compounding pharmacy, and depending on what your needs are, will depend on which pharmacy you can use. In a regular pharmacy, you can get the estradiol patches. They also can offer progesterone orally. So the benefit of that is, of course, you walk into your pharmacy and you can just leave with it.
Alise Greenfield [00:40:28]:
The downside where you talked a little bit about the estradiol is that there is no estriol. There is no ability to add estriol to the patch through a regular pharmacy. The downsides of progesterone is that if somebody has a peanut allergy can't use it it's made with peanut oil. And then the other downside is that there isn't any ability to change the dosing. So what the dose is in the patch or the pill, that's a dose you get. And if somebody needs something a little bit more or less than what's available, we can't do that. In a typical pharmacy compounding is where you have kind of this whole realm of options available to you. So the delivery methods can include things like creams, liquids, trophies, which are little lozenges that can go under the tongue, capsules.
Alise Greenfield [00:41:22]:
You can get suppositories and pellets. Compounding pharmacy is going to make the hormone to the specifications of the person's needs so that's obviously at the discretion of the prescribing provider. Again, the benefits are that the dose can be adjusted however it needs to be in order to help support what that individual requires. And again more options available. So you can combine estradiol with estriol and again, that estriol has anti inflammatory effects and it has some actually DNA damage protecting effects. And then there is also the ability to compound more than one hormone into one delivery method for ease. So after somebody has been on hormones for a little while and the dose is known, you can add the estrogens with DHEA or testosterone if somebody is on testosterone. And then also progesterone can be compounded to exclude peanut oil if somebody has that allergy.
Alise Greenfield [00:42:18]:
I also do want to caveat that so both progesterone and DHEA can be found over the counter progesterone in a cream, DHEA in like a capsule. And I really advise people, even though it is available that way, to not just kind of willy nilly utilize it. They are hormones and using them under the discretion of a trained provider is really important.
Erin Holt [00:42:43]:
Yes agreed wholeheartedly with that statement. I mean, to me it's like a little bit bonkers that you can get them over the counter. So it sounds like if cost and convenience were not a factor, going the compounding route is maybe more beneficial just because you can really tweak what you're doing for the individual client or patient.
Alise Greenfield [00:43:10]:
That's my preference. But again, it's always a conversation with people and talking about the pros and cons of each and meeting people where they're at.
Erin Holt [00:43:17]:
What a good provider you are, taking all of that into consideration.
Alise Greenfield [00:43:30]:
Another thing to note about delivery methods is that estrogen can be compounded orally or in that trophy form, which is the lozenge. But oral estrogen is something I recommend avoiding.
Alise Greenfield [00:43:41]:
When taken orally, it passes through the liver, and that's where we see negative effects of estrogen. So especially clotting risk. I never prescribe estrogen orally, and most of my or many of my colleagues who practice bioidenticals avoid it orally as well. There is some suggestion that because a trophy is sublingual means it goes under your tongue and it's absorbed through the mucosa and not through the GI tract. There isn't risk, but you just can't ever guarantee that somebody isn't swallowing it, so I avoid it. Progesterone doesn't carry the same risk, though, so oral progesterone is the best option because it's actually not absorbed quite as well through the skin like estrogen. And then the one other caveat that I think it's important for women to know is when going on bioidentical hormones, estrogen should always be paired with progesterone. Progesterone helps to balance the estrogen and help decrease the negative estrogen burden that we talked about.
Alise Greenfield [00:44:42]:
Conventional thinking says you don't need progesterone if you've had a hysterectomy, because the only reason to give progesterone is to thin the lining of the uterus. So if you don't have a uterus, why do you need it? But again, progesterone is balancing out estrogen, and the loss of progesterone is huge. It shows up as anxiety and depression and irritability. It's also going to support sleep, help decrease pain and inflammation, help protect bone health. It improves HDL by adding progesterone and can help improve weight. So the only benefit is not too thin, the lining of the uterus. So really giving estrogen and progesterone together is important.
Erin Holt [00:45:22]:
So we've talked through some of the benefits of BHRT, but we also know that there's a lot of fear and concern around the use of hormone replacement therapy. Do you feel like that fear is a good thing? Should we be using some trepidation or using some discernment with this. And I guess where do those fears come from? Where do they originate from?
Alise Greenfield [00:45:46]:
Yeah, so good questions. I think with any medical intervention, yes, there's always reason to be cautious, right? Nothing is risk free. What we're finding in the data is that there is actually less risk than we have been led to believe when we're using bioidenticals. A lot of the fears generated around bioidenticals came out of the Women's Health Initiative study, which was the study done in the 1990s and early 2000s that looked at hormone replacement therapy, and it had to be shut down early because of negative effects. That study had a lot of issues, and certainly like a whole podcast could be dedicated to breaking that apart. But the general idea is it had a lot of issues, and there was immediate criticism from other people in the industry as soon as it came out that the data wasn't interpreted well, the study wasn't designed well, that they were only looking at conventional hormone replacement therapy. It wasn't bioidentical at all. And some of the conclusions that were drawn from that study just were not statistically significant or an accurate representation of the data.
Alise Greenfield [00:46:53]:
And since then, there have been repeated studies that demonstrate either no risk or the same risk as the general population when people use bioidentical hormone replacements.
Erin Holt [00:47:05]:
Okay, so if folks are citing that study as a way to say, hey, HRT is not safe, like categorically across the board, maybe that's not the best study to reference to really showcase that. And also it wasn't looking at bioidentical hormone replacement therapy. Those are like the two big takeaways, I would say, from that.
Alise Greenfield [00:47:32]:
Yes, exactly.
Erin Holt [00:47:37]:
Okay. We're not really getting into the nitty gritty of perimenopause menopause, but I know that something that you kind of hold space for is this transition into the mother, into the crone archetype, which is really rough. I mean, I honestly still feel like I'm stuck in the maiden to mother transition. I was completely unprepared for that. Nobody told me about that. I was like, I just walked through this threshold that I was unprepared for, and now I am a mother and no longer made it, and holy hell, that feels weird. And so I can imagine that was almost ten years ago, so I can imagine that stepping into the next kind of archetypal transition would be equally as rough and tumble, if not more. And I'm just curious if you have any words of wisdom to share. I always preface this conversation also by saying I myself have not been through menopause, have not been through that transition.
Erin Holt [00:48:34]:
Alise, I know that same for you, but we are working with people who navigate this, and we can, at the very least, hold space for conversations about this too. So what would you say to anybody who is going through that transition and feeling some feelings about.
Alise Greenfield [00:48:53]:
So as Erin said, I haven't gone through this myself. But what I see is a lot of women who feel like they're just supposed to suffer, right? Because as I talked about in the beginning, in our culture, we don't really talk about hormones a whole lot, and then when we do, it's kind of like, well, this is just you're a woman, this is just what it is, and the options really are limited, or women are just made to feel that there aren't any options. And so I think the overall message is we're not meant to suffer. There are providers out there that are willing and able to help you. And if you are in a situation where your provider is not offering that, you can fire them. You can find an alternative to what you're experiencing, and then just knowing that, again, we are not meant to suffer and there are ways to help support you through this transition.
Erin Holt [00:49:50]:
Yeah, I think that's a really beautiful closing sentiment. I remember years ago, somebody saying to me, motherhood is the ultimate sacrifice. I was like, I would prefer that not to be true for me, but that collectively, we are just okay with women suffering. Period. End of story. And so what you're saying is that doesn't have to be our existence and our reality anymore. We actually have more tools at our disposal than ever before. So let's lean on that support.
Erin Holt [00:50:17]:
Let's lean on those resources. Alise, thank you so much for sharing some of your wisdom with us. Can you tell listeners where they can find more of you?
Alise Greenfield [00:50:27]:
Absolutely. So you can find me online and my website, which is www.alisegreenfield.com. And that's Alise with an A. I'm on Instagram at @thegreen_NP, and my office is located in Dover, New Hampshire.
Erin Holt [00:50:45]:
Awesome.
Erin Holt [00:50:45]:
Thank you so much.
Erin Holt [00:50:52]:
Thanks for joining me for this episode of the Funk'tional Nutrition Podcast. If you got something from today's show, don't forget to subscribe, leave a review, share with a friend, and keep coming back for more. Take care of you.
