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How To Revive Low Libido With Hypothyroidism

Hear from Dr. Lyndsey Harper of Rosy and Dr. Hanisha Patel of Mahan Health about the connection between thyroid function and sex drive, and how to revive your libido.

How To Revive Your Libido With Hypothyroidism

Welcome, welcome. We're just gonna give everyone a minute to filter in here. My name is Katie. I am part of the team at Paloma Health, and we are hosting this event today with our cohost Mary Shomon. Paloma Health is an online medical practice that provides care exclusively for hypothyroidism and Hashimotos.

[00:00:27]And we, monthly, do a deep dive into a topic related to hypothyroidism. So this month we are talking about low libido or low sex drive with hypothyroidism, and we've got two awesome speakers with us. We've got Dr. Lindsay Harper of Rosie and Dr. Kenisha Patel of Mahan health. And they're both going to talk about why this connection exists and what you can do about it.

[00:00:50]We will also have time at the end for live Q and a question and answer. So you'll see a chat feature at the bottom of your screen. I invite you to start putting your questions in there now, or as the speakers are talking and we will get to as many as we can at the end today's event is about 60 minutes long and we will provide a replay afterwards, so you can rewatch it or share everything that you learned today.

[00:01:13]So I will introduce Mary. Mary Shomon is a hormonal health advocate. She's been advocating for therapy patients for a long time. She's written 15 bestselling books. She's a wealth of knowledge and she's going to help moderate our event today. So Mary, I will pass it over to you and you can tell us a little bit about who you are and what you do, and then introduce our speakers.

[00:01:33] Thank you, Katie. My name is Mary Shomon and I am an author patient advocate, and I've been doing the co-hosting with Katie for our Paloma speaker series since we started. And. We are having such a great time because we're having these amazing experts come in and doing really focused, deep dive conversations about all sorts of different issues that affect people with thyroid.

[00:01:59] And today we're doing one that I think is probably near and dear to a lot of our hearts, especially during February Valentine's day, just passed. And it's the month of love. And, as a. 59 year old woman, myself gone through menopause and have had the thyroid issue for a couple of decades.

[00:02:18] There are times when we can all relate to the issue of low libido. So we are going to take a dive in there and talk to two amazing experts. Dr. Hanisha Patel and Dr. Patel, did I pronounce your first name correctly? Yes, absolutely. I wanted to make sure I had it correctly. So Dr. Hanisha Patel and Dr. Lindsay Harper, and they are going to be sharing some of their information and ideas about the issue of low sex drive and low libido and how to get back on track and get that sizzle back between the sheets.

[00:02:56] And so we are going to start with Dr. Patel. And let me give you a little bit of background before we have her jump into her presentation. Dr. Patel is a licensed naturopathic physician and the founder of Mahan health. Did I say that one? Yes. All right. I'm batting a thousand, which is a results driven naturopathic medicine practice.

[00:03:21] And she since birth, she has dealt with her own autoimmune issues. So she's one of us ladies until she finally saw a naturopathic doctor who really helped her get control and reverse her own symptoms. So now I guess the inspiration of that. Experience really informed her career decisions. So she's a naturopathic physician herself, and she is really working towards a world where Mahan, which means great health is not only achievable, but the norm something we would all love to see.

[00:03:54] So she works with patients in person and via telemedicine and shares information. More widely through her podcast, Mahan health. And so I want to welcome first Dr. Hanisha Patel. Who's going to share some of her thoughts on the issue of thyroid and libido. Great. Thank you so much for that great intro introduction, Mary, and you were right on point with pronouncing everything correctly.

[00:04:18] So super impressed. But yeah, so a little bit about me. So as Mary stated I went through my own autoimmune issues and. For the longest time up until about seven years ago, I didn't even know that it was Hashimoto's that I was dealing with because no one had ever tested beyond TSH for my labs.

[00:04:40] And but whenever I finally saw the naturopathic doctor, that's when she was like, you need to do some extended lab testing, all of your gut health issues are not normal. You're not supposed to be constipated and have a bowel movement once a week. That's not enough. You need to Your hormones, like you're not having a cycle, every period.

[00:04:58] Like you need to have a normal cycle. There's more to that. Your anxiety, all of these things are connected. And so she did some extended lab testing. And then that's when I finally found out that I did have Hashimoto's hypothyroidism. And so I'm very grateful that she did that. And Mary said at that point I, after I was able to reverse my symptoms, I was like, This is how life is supposed to feel.

[00:05:24] And I was just shocked. Like I didn't realize that it could feel this good. And so that's where my practice came about. And so I became very passionate about spreading that same knowledge and awareness and helping women reverse their diorite symptoms so that they can also experience Mahan or great health.

[00:05:41] So that's a little bit about me in terms of the. The rest. Do you want me to talk a little bit about my specialties and what I do in my practice? If you can tell us a little bit about how that that has informed your approach to helping women deal with their issues related to libido.

[00:06:02] Yeah, definitely. Okay. So with the background that I have from my own personal health history, but also the knowledge that I experience I have from a naturopathic medicine, I do use a lot of. This interconnected approach to helping support women. So I'm not only looking at the thyroid markers, right?

[00:06:24] We're also looking at your gut health. We're also looking at your other hormones and understanding what is going on. As you as the whole picture, right? So we're not going to reduce you to one symptom or one organ. All of these organs are connected and our thyroid hormone or sorry, our thyroid gland affects literally every organ in our body, our thyroid, we have thyroid receptors on every organ of our body.

[00:06:49] And this is why so many of these thyroid symptoms are so random. So we get like joint pain and digestive issues and fatigue and depression and anxiety, low libido, all of these like super random symptoms because it affects everything right. I like to say the thyroid is like the queen. And so she like controls everything.

[00:07:10] And and so when it comes to sex drive, this is something that I see very often in my practice. A lot of people will come see me because of low sex drive and this often can occur. And. From the research. We know that this can occur from low estrogen levels are low testosterone levels, which thyroid hormones can impact.

[00:07:30]However, it's always really important to note that. It's rare that people only have one thing. So it's rare that I see someone with hypothyroidism or Hashimoto's, and that's the only thing that they have going on because it's likely that they have some other things going on with our gut health.

[00:07:47] They might have some endometriosis or PCs or some other factors involved too. And so using all of that to figure out what exactly is going on beneath the surface. And then. Helping support women, not only physiologically, but also psychologically. Because so much of this, I think I was just reading about how people with Hashimoto's hypothyroidism are.

[00:08:13] Very quick to get the diagnosis of anxiety and depression, and then be put on antidepressants way before they're even tested for their thyroid problems. And if that is contributing to your low libido and it's not necessarily the estrogen or testosterone, like I talked about before, then we need to address.

[00:08:32] That too. So there are multiple different factors that, that can play into it. And that's how I guide my practices. Like, all right, let's get all the pieces. I like to call myself a health detective because I'm like putting together all these pieces. And then I get to work with you to try to figure out what exactly is going on and why and what then we can do to help support you physiologically and psychologically.

[00:08:55] Great. That's a fascinating overview and I hope, but it also starts to explain for people a little bit about how a naturopathic physician actually works because they're taking into account the medical factors and the nutritional, the lifestyle, the hormonal issues. So they're trying to put it all together for you.

[00:09:16] So I think that's a great overview of your approach, Dr. Patel. Now we're going to welcome Dr. Lindsay Harper and Dr. Harper is a board certified obstetrician, gynecologist, OB GYN for short and the founder and CEO of Rosie, which is a women's health technology company. That connects women who have sexual health concerns, excuse me, with hope community and research backed solutions.

[00:09:43] So this is not a wound craziness. This is solid science with a good dose of extra hope and the support of a community. She has been named a Forbes top 53 women disrupting healthcare. That's fantastic. People newspapers. 20 under 40 a top innovator in North Texas for 2020 and a DBJ top women in technology honorary.

[00:10:09] So she is a busy woman. And she's going to take some time to share with us some of her valuable ideas about libido. Amazing. Thanks, Mary. I'm feeling pretty good. I appreciate that introduction. I always love the 20 under 40, because it gives away my age category. I'm like 39 and seven months.

[00:10:32]But anyway, thank you for that. And I, I loved hearing Dr. Patel's intro and your passion, and I have this same passion actually on the sexual health. Side. So my story is that, I always, when I was a little girl, either wanted to grow up to be a babysitter or a doctor. And so I chose to be a doctor after I was a babysitter for many years, however and that has always been my passion.

[00:10:53] I loved, I love OB GYN. I love surgery. I love women relationships. Long-term relationships with women. That fills my cup. And when I was in practice, the same as Dr. Patel, women would come to me all the time with sexual complaints and concerns. And even as an OB GYN, we think that we're the women's health experts, but I had not been trained on women's sexual health, not, maybe bare minimum, like one hour lecture in medical school, but not anything further than that.

[00:11:22] And so it was confusing to me because I was getting all of these. Questions and concerns, these people that I had taken care of and we'd had babies together and, like life changes, but I was really dropping the ball when it came to their sexual health. And so I started asking around and I'm like, what are y'all do for low desire or for.

[00:11:40]Trouble with orgasm. And I was just getting really terrible ideas like drink a glass of wine or go on vacation, or all of these really things. The things really what brought it home for me is that we would never say that to men with sexual dysfunction, right? Like we're like all in there.

[00:11:55] I run into the urologist, they spend half of their time treating men with sexual problems. All those medicines are covered by insurance and Medicare, and surgeries, but yet women are left out in the cold and when they turn really anywhere for help, they're getting sold something or they're getting, bad information.

[00:12:12] And I just really, that really actually just kinda made me mad. And so I joined a medical society called , which where they study evidence-based interventions for women's sexual health, and really learned actually at mirrors, Dr. Patel's practice that, when we treat sexual health, just like when you're looking at just women's general health or particularly hypothyroidism, that it should be multidisciplinary, we should look at the medical issues. We should look at the psychological issues. We should. You talking about the relational issues and how we can help women plug in there and really treating the whole person. And I think hypothyroidism is an excellent example of that as is sexual health.

[00:12:50] Because if you're just treating sort of one lab or one symptom, you're definitely gonna miss the big picture and a lot of opportunities for more meaningful intervention that can really help in the longterm. So I left practice a couple of years ago, two years ago, I practice now on our telehealth platform.

[00:13:06] At Rosie. And then also as a hospitalist, I'll randomly go in and deliver some babies just because it's really fun. Most of the time. And so I decided to create Rosie as a platform where the 43% of women who have a sexual problem or complaint, which that's a really, most people think that's a really high number that almost half of women have an issue can go to find these resources.

[00:13:27] So there's a bunch of just educational videos that you can watch that, for example, how to my antidepressants affect my sexual function or. What do I do for vaginal dryness? Or how do I talk to him partner about sex? Like all these questions that maybe we need to know the answers to, but we're afraid to Google cause who knows what might pop up when, who knows if that information will be reliable.

[00:13:47] So all of that information is actually totally free available in the app. So all the educational stuff is free and it's curated based on the woman's current circumstances. So A post-menopausal patient with sexual pain would see different content than a person who's just had a baby and has maybe having trouble with depression.

[00:14:03] So there's all kinds of different ways to look through that content. But we also have a library of erotica, which is really fun. We can get into that if y'all want to later, but it's an evidence-based intervention would really good results where sexual dysfunction, we have a community where women can come and chat with one another about the shared experiences that they're going through.

[00:14:22] We have self-help classes created by Psychologist sex therapist, sex medicine, doctors like myself, and then telehealth here in Texas where we can treat patients through ma with medical care or with sex therapy as well. So love what I do love talking about these issues and prompts to Paloma for bringing it to the forefront because so many times these.

[00:14:44] Issues go undiscussed. And because of that, women suffer and isolation and shame and embarrassment unnecessarily, and that's the exact work that we're here to do to help women understand that they're not alone and that there are actual evidence-based interventions for the really common symptoms that they might be experiencing.

[00:15:02] Fantastic. Thank you, Dr. Harper. We are all here to learn and to share. And like you said, there is no embarrassing question that can be asked. There is no reason not to put this right out in the open and deal with it because it's a really important part of our health as well. And so we want to really acknowledge.

[00:15:25] That that it's not an isolated piece and no, we're not just stressed and depressed or menopausal or PMs, or need to get off the couch or need to take a vacation. There are medical reasons, there are physical reasons that go into this, that we can address and that we can work on so that we can get back and start really feeling great about that part of our life.

[00:15:48] So we're going to start out with a couple of questions that we at Paloma have for our doctors. And again, we encourage you to be sharing your questions in the chat area, because once we've gotten through our couple of questions that we have for the doctors, we'll be opening it up to your questions. So as things come up, please feel free to share them in the chat and we will be getting to them.

[00:16:11] Okay. After this particular section of the presentation. So my first question, and I'm really going to put this out to both of you and Dr. Patel. Maybe we can start with you with this question, but we know that low sex drive can be a symptom of hypothyroidism. And obviously one of the things that our doctors through Paloma are focusing on is helping people identify.

[00:16:37] And then optimally treat their hypothyroidism. So we're not just saying, Hey, we're going to get you in the normal range and leave you there. And if you don't feel well, good luck to you, our doctors are really focused on trying to get people actually feeling well. But we still have cases and a lot of women will say, Hey, I'm optimal.

[00:16:56] My thyroid is great. All my thyroid symptoms for the most part have been relieved, but my libido is. Still struggling. So what kind of evaluation do you do? If a woman's libido is still low, if she's still struggling after she's gotten her thyroid treatment optimized. Dr. Patel, if you can start out and then we'll have Dr.

[00:17:19] Harper weigh in with her thoughts. Yeah, definitely. So again, it's still very comprehensive and holistic, but I would say one of the main sorts of evaluations I would do is like an extended, formal testing. So getting into the estrogen, progesterone, testosterone, and their metabolites, as well as Testing for their cortisol rhythm or of the cortisol awakening response so that we can understand understand their adrenal function as well as their other reproductive hormones.

[00:17:50] And and see if maybe there's some imbalance in not only the level of estrogen or testosterone, but the way that it's metabolized. And so this is why I use this test called the Dutch the Dutch hormone test. And this is. It goes into much more detail than conventional blood work would do.

[00:18:10] And so I do really appreciate using that to further evaluate when a woman continues to have low libido when every other symptom is. Has been reversed. The other aspect of it would going into a little bit, I really love what Dr. Harper is doing and all that she's created, because there, there is so much of a, socio-cultural Stigma against even talking about sexual health for women.

[00:18:35] And I'm so excited that we are like there. So already, so many of us here who are willing and open to talking about it. And so realizing where that comes in, because I know Dr. Harper was talking a little bit about like how to overcome that shame and all of that with it. So having those kinds of conversations too.

[00:18:53] So how has the. How has your relationship, how is your relationship with sex? Do you still feel shame or guilt? As so many of us were taught to feel around, around that act. So addressing all of that, but then also, like I said, physiologically, evaluating the hormones and making sure that things like vitamin D are and their blood sugar levels are intact, but of course, usually that is pretty good if they've already started to work on all those other things, but I think the next step would be like doing more extended hormone testing.

[00:19:28] Yeah. Dr. Harper what would you like to add to Dr. Patel's approach? Sure. Yeah. I think from a medical perspective definitely I agree that we should rule out all the medical causes first and for me as well, that would include any, resulting or existing anxiety or depression.

[00:19:47] Oftentimes, obviously those are concurrent with hypothyroidism and they are the number one comorbidity or. Thing that you find along with sexual dysfunction. So if someone is depressed, they're more than, two or three times likely to have a sexual dysfunction than someone who's not. And so that, we always want to do a medication review.

[00:20:05]Are you on any SSRS that might be affecting your sexual function negatively? Even the things like over the counter anti-histamines can affect sexual function negatively. Some women have trouble with the type of contraception that they're using and low desire. So it's it's about this comprehensive review, just like Dr.

[00:20:24] Patel was saying. And I think another, there's actually two more things that I all that are always on my radar. The first is this idea of. Having a negative relationship with sex, or actually like being outside of this, what we call sexual response cycle. And what I mean by that, is that a person who is having sex regularly, having sexual pleasure from that sex regularly, meaning orgasm or not, but finding some, either emotional or physical sort of benefit from that sexual connection, that woman is going to be seeking out and actually more receptive to future sexual experiences.

[00:20:58] But if I've had hypothyroidism and as a result, low desire, then I'm actually over here kind of way outside of the sexual response cycle. And I can't remember what I ever liked about sex to begin with. I'm like, that sounds like a lot of work and I'm only doing that because my partner wants me to, and clearly this has no benefits for me.

[00:21:15]But what we need to do is recouple that like positive. Center in the brain with this idea of sex instead of it being work and, or your partner and all of those things. So sometimes there can be some work around scheduling sex for a little while, making sure that in your relationship, you're experiencing orgasm equality, which is a really fun idea that I like to talk about, which is that.

[00:21:36]Every time you have a sexual experience, it's not necessarily a one for one, but your pleasure should be prioritized as much as your partners. And that's how it becomes a benefit to us, both psychologically and physically. And so if, and the other thing to remember in a woman, Is that oftentimes arousal comes before desire.

[00:21:52] So that means we may, when we're young, we may have this idea of spontaneous desire where we're like at our computer and we think, Oh I think having sex sounds fabulous, but as we age, we may move out of spontaneous. Sexual desire and more into responsive sexual desire. And what that means is that when we're exposed to an erotic hue, that could be really anything.

[00:22:13] You can put anything in there, but we'll use, for example, erotica that you have maybe an, a physical Response of arousal. And so arousal then begets desire, right? So then you say, Oh wow. I am actually have a responsive desire. That's totally normal. There's nothing wrong with me. But what I need to do is seek out those.

[00:22:34] Things that make me feel like I want to have sex if my goal is to have sex more often. So that's not a diagnosis, that's actually just very normal. And we unfortunately just don't talk about it. And the last thing that I'll cover briefly is a diagnosis called hypoactive sexual desire disorder. And this is a change in the brain a little bit like depression, where when you are stimulated by erotic cues.

[00:22:55] So for example, in this one study people watched porn. And when they saw those erotic images, the places in their brain that are, that usually respond to that and women without HSDD no longer responded. And so in that case, and there are two FDA approved medications to treat HSDD. And so that, we would consider that those patients as a candidate, but just to be clear about 38% of women report, low desire, and about 10% of women would qualify for a diagnosis of HSDD.

[00:23:23] So that Delta is where all of these lifestyle interventions. Retraining how our brains work, all of these, relationship and communication issues can really make a huge difference. And as long as there aren't any other medical problems. Okay. I want to stay with you for my next question. Dr.

[00:23:41] Harper One of the things that we know is that perimenopause and menopause post-menopause are times when more women start to complain about low libido. And I think that to some extent, women have gotten the idea that it's just. Comes with the territory. You hit 50, your sex drive goes away and goodbye.

[00:24:01] It's not coming back. So what's the big deal. But we know that when women are, a lot of women are also getting thyroid issues at around that same time. Perimenopause and menopause is a bit very big period when we see an influx of new diagnoses. So how do you suss out. Whether it's thyroid or whether it's menopause, perimenopause that's causing the low libido, or is it likely to maybe be a combination of both.

[00:24:31] Yeah. I mean that, honestly, that is, that requires a highly communicative relationship between the patient and her provider. And I think just generally, my my approach to that is definitely to get that thyroid replaced. First and foremost, and then to see what the residual symptoms are. Right?

[00:24:48] So once we've corrected the thyroid, are we still having trouble with low desire? Are we, if we're having true intrinsic menopausal symptoms, then I might do them at the same time, but we definitely, it's harder to assess out if we're throwing the kitchen sink at you, then we don't really know which one.

[00:25:03] Works. And so then therefore, do you actually need the hormone replacement therapy now in a peri-menopausal and just after the menopause, I love hormone replacement therapy and the right candidates. We don't, we're not handed out to people who that's going to increase their risk of death from stroke or cancer.

[00:25:19]But we, but in the appropriate patients, They, I mean are life-changing. And so I think that, we have a lot of fears in the medical community and amongst patients about replacing hormones. Most of those are unnecessary, especially when given at the time of war of dramatic hormonal changes like Perry and menopause.

[00:25:38] And, as long as you're make it keeping a close eye on those things, then it's an entirely appropriate. So my, approach is to start one thing, understand how that's affecting symptoms and then add or remove as needed rather than just doing everything at one time, because then you're not sure, what part of what you did worked.

[00:25:58] Great. Thank you. Dr. Patel One of the questions that that we had that we really wanted to ask you about is if Dr. Harper was mentioning hormone replacement therapy, and which has a really valuable role for some women who need that balance and to get those hormones back on track.

[00:26:19] Have you found any. Supplements or herbal remedies that you feel have been helpful for libido in your practice and, full disclosure. I went through my menopause without having to take any hormone replacement. And I used a heated and prepared organic form of maca and a little bit of melatonin, which regulated my.

[00:26:44]My menstrual cycles through my peri-menopause and helped with all of my menopausal symptoms. And then the mama got rid of the hot flashes and I never had to go to any formal prescription hormones, sailed through it with very few symptoms. So I'm a big proponent of using. Whatever approaches herbal remedies or hormone replacement, whatever you can find.

[00:27:05] But I'm wondering if you have any recommendations on supplements, herbs, food products, we hear about soy, but we also worry about that with our thyroid. What are your thoughts on that? Yeah, definitely. That's a great question. And I love that you brought up the mock-up because that's always one of the first things that I would talk about because it is extremely powerful and that's one of the most well-researched nutrients or supplements in general that have been studied to help improve libido and sexual function and help women transition from.

[00:27:38]From perimenopause menopause or post-menopausal. And so that is definitely something that's powerful, but I want to backtrack a little bit, again, reiterating to find what else is going on the underlying cost. So if there are thyroid issues while a woman is reaching that perimenopause age, Let's address that like Dr.

[00:27:56] Harper was talking about, we need to address that first before we start, like throwing other things at you. And then from there, if we've addressed all those things in there, and there's still that aspect of low libido, that's where I would say yes. I think maca is a great resource. I also really rhubarb is something that has helped a lot of women transition also into menopause and have.

[00:28:18] Like most of my women who do maca and or rhubarb or both together don't usually have any symptoms with menopause, hot flashes go away. The vaginal dryness goes away. It's there, they're both very powerful things. But otherwise so I have a few things in my toolbox for women who are. Premenopausal or still in their fertile ages.

[00:28:42] Oh, if they still have low libido after all that saw Palmetto is a great herb that has also been researched to help improve testosterone levels and in both men and women actually. And and so that, that can help with libido, but like we said, the maca and then there are a few other things that I will have, like in my toolbox.

[00:29:03] There, there are some amazing herbs are amazing, and I'm definitely a huge proponent of herbal medicine because, these are things that have been practiced for thousands of years. I do agree with Dr. Harper and with there's a time and a place where hormone replacement can be very helpful, but I do go a little bit more of a conservative approach and try to go the more herbal route first, because that's how people have been doing it for.

[00:29:28] Millennia. And so many people have not had symptoms. And one of the examples that I like to use is if I don't know if you've heard of the blue zones, but the blue zones are areas in the world that are still in existence today. They're communities that still exist today, where everyone lives to be at least 100 and healthy they're healthy centenarians.

[00:29:50] They are still having sex. At a hundred years old and and they're still dancing and, and they're like completely they're, they're mobile, they're active, they're doing all these things. And So I like to use them as examples of like how we can transition and age gracefully. And it does not have to be this like, Oh, now I'm getting older.

[00:30:09] So don't, I, that's why I have no desire for sex or I'm getting older and this is why I have joint pain and all these things. So this is why I think herbs are really powerful. Some of the other herbs, I said, South hamano Maka fenugreek is also a great herbs. And cacao I'm like,

[00:30:24] More reason to eat some chocolate. I'm all about it. That out was also great. And even in terms of foods that are high in collagen, so like bone broth can be very supportive. Anything that helps support your gut health? I actually was very passionate about this topic when I was in medical school.

[00:30:42] So I actually did a whole research paper on gut health and sexual dysfunction and and females. And there's the very strong correlation between that. As long as you're optimizing your gut health constantly, this, that should definitely help. But other than that, the last thing that I want to imagine, again, going back to this, the psychological like Dr.

[00:31:01] Harper was talking about before, how depression and anxiety are extremely common. Amongst women with hypothyroidism. And so addressing that as well. And so sometimes I'll, if no one, if, as long as they're not on any antidepressants, I will recommend some herbs like St John's wort or Labella. And St.

[00:31:19] John's wort does interact with a lot of medication. So I usually don't recommend it unless they're not on any medications, but it can be extremely helpful if they're not on any, if there aren't that great medications it's safe, but otherwise we gotta be a little bit more careful. Fascinating.

[00:31:35] I'm wondering if you have any thoughts about the issue of soy, because that's one of the we see all these remedies and that are out there that are commercial remedies, and they're always based on soy. And we get told, Oh, the Asian women don't have any menopausal symptoms. They eat a lot of soy and their soy pills and powders and shakes and potions.

[00:31:56] And everybody's pushing it at us as a menopause remedy. And I'm wondering if you feel that soy is all that it's cracked up to be for menopause or perimenopausal symptoms. Yeah, that's a great question. So this is a very controversial topic as you as you mentioned, because the research is so all over the place with soy because there, there was some research that was showing that it can increase risk of breast cancer.

[00:32:19] And of course we don't want that. And then there is some research that, like you said, that show that it could potentially help with sex drive and with menopausal symptoms and the way I approach that is usually, so the reality is. Right now, most of our soy products in the United States at least in other places too, but at least in the United States, most of the soy products are extremely genetically modified and sprayed with pesticides.

[00:32:46] So we're godless. You're not really getting the benefits of the true soy that once did exist. It's I think it was like 90% of it is not legitimate soy anymore. And so being very mindful of that and understanding how these chemicals can affect our thyroid, our hormones, our gut health, all of all aspects of our health, our mental health.

[00:33:05] And so trying to avoid foods like that in general, as a general rule of thumb for me. And so I'm like, I don't usually promote soy in my practice because of that reason. But if you are somehow able to find that quality soy and have it in moderation I don't see a problem with that. And I think that could definitely be beneficial, but unfortunately, a lot of it's not legitimate anymore.

[00:33:27] Okay. Thank you. Just one more thing, Mary, on this topic, if you don't mind. Yeah. The supplement that I'm aware of that has the most data. Is called LR Janine. I'm not sure if you ever use that Dr. Patel, but it's an active ingredient found in lots of supplements that you're going to see. And on it's called the supplement is called origin Maxx.

[00:33:46] They have published randomized controlled trials to show that women who took that their particular preparation did see a statistically significant improvement in levels of desire and things like that. And other aspects of sexual function as well. The one counsel there is that women who have very active herpes.

[00:34:04] So if you have frequent outbreaks, it can sometimes exacerbate those outbreaks, but otherwise it's a pretty safe supplement that has shown good results for desire, particularly. Fantastic. Great information. Thank you. And I was going to come back around to you Dr. Harper, because I want to revisit the topic of hormone replacement therapy, because as Dr.

[00:34:26] Patel was saying, there are some controversies, there's a lot of misinformation. We had the big study women's health initiative. And if, for a while there, everyone was terrified of using hormone replacement and. Now, I think things have calmed down a bit, but some of the doctors that I've spoken with have always said, look, the way we want to do it is the safest possible form in the lowest possible dose for the shortest amount of time to relieve your symptoms so that it's not debilitating.

[00:34:57] And that's the philosophy that I've always taken along with this. And wondering if that is similar to your philosophy. And if so, what do you consider to be the safest form for manufactured drugs, patches, bio identicals. What's your take on that? Sure. So I was very traditionally trained and trained with the same mantra that you've heard for a long time, Mary, which is lowest dose shortest course, but what we've learned from looking back at whi is that really the women who showed this increased risk and and the reason they stopped the study were women who had actually not been on any hormone replacement from the time of their menopause.

[00:35:35] Until at least 10 years later. So for example, the average age of menopause is 51. So these women were new, starts on HRT at 61, sometimes even into their seventies. That's the risk category that had the highest negative outcomes like breast cancer stroke. And the difference in that patient and in a patient who is transitioning through menopause at the time with HRT is that the older patient has been without any hormones for a decade.

[00:36:01] And there have been changes in her body because of that. Then we're, re-introducing those hormones again. And that's really where the elevated risks show up. But a patient who starts on hormone replacement therapy during peri-menopause and just after cessation of her cycles, those risks do not appear to translate.

[00:36:17] And so a lot of us who. Are going to go through menopause who care for women who are going through menopause, and have family members who are watching suffer. I feel very passionately about, the idea of having these efficacious and safe and the right patient drugs available for these miserable times of life.

[00:36:36]We want the highest quality of life throughout our entire time of life. And that requires careful evaluation of the data without, all these. All they use the frightening things that actually wouldn't, didn't extrapolate to the users or to the women or the patients, whatever you want to call them, who would be using them at the time.

[00:36:53]Yes, I prescribe estrogen. I prescribe testosterone specifically for sexual problems and that's actually a bit more controversial in I would say traditional training. So coming through residency, you don't, you're just not exposed to that many practitioners who prescribe testosterone, however, on a Aycock who is the like governing body of obstetricians gynecologists.

[00:37:15] They say that, we can use testosterone safely without concern for at least two up to six months. And the ideal candidate for that is a peri-menopausal or post-menopausal patient. So we have guidance on it. It's just that it's not in practice very much, unless you are a sex medicine doctor like me, and I'm like we have testosterone receptors in our bowl, but we definitely need some testosterone.

[00:37:34]It's definitely the missing piece, but it's not for all patients. It's not for all ages. Once again, it's an, a selected population after a council of risks and benefits with your provider because it is not an FDA approved medication. So it is off label. We have to get it compounded and all kinds of things.

[00:37:50] But once again, in my opinion, Another sort of representation of how skewed men's sexual health and women's sexual health, research and funding and development really are. And in terms of the safest form of of dosing transdermally is definitely the preferred route that eliminates a lot of the first pass effect that's seen as it gets digested through your liver and through your gut.

[00:38:14]And so those have the least effect on your lipid profile on your risks. Or deep vein thrombosis. So I always recommend a transdermal, either cream or patch. Okay, fantastic. I think you've answered a few of our viewer questions already. We have a number of questions. So I think we're going to jump over to the question portion of our presentation tonight, and we have a couple of different questions about vaginal dryness.

[00:38:42]Which have come up. Mark has a question about, is vaginal dryness worse after hysterectomy and does radioactive iodine treatment for thyroid or perhaps just being hypothyroid contribute to vaginal dryness? Also another question is vaginal estrogen, such as vaginal fem or permanent.

[00:39:04] Premarin cream safe. Are there other options, so maybe both of you can address that starting with you, Dr. Harper the issue of vaginal dryness, which is, I know is one that a lot of women complain about. Totally. So we see, I see vaginal dryness all the time. It definitely happens in association with hypothyroidism.

[00:39:23] It can happen with lots of medications that we take and it we see it most often in peri-menopausal post-menopausal breast cancer patients whose hormones are no longer acting normally. And in those cases there are lots of interventions, right? So the sort of least I would say disruptive might need just to add a lubricant.

[00:39:43]And you can, there's lots of lubricants available that are water-based silicone-based and you can find them all, all over the place. My personal favorite is Uber lube, which is silicone-based. So it might not be Dr. Patel's favorite. I bet she has a favorite Liam as well. But so that's the first place you can start.

[00:39:57] The other thing that I think we lose in translation is that it takes most women 20 minutes. To get adequately lubricated for intercourse. And I think a lot of times, especially for more LA yeah. Everyone's Oh Lord. So a lot of times when we're in long-term relationships, we're probably not spending 20 minutes getting anything ready.

[00:40:17]And so I think that's another opportunity for improvement. It's let's go back to the basics. What do we know? And we're probably not spending enough time on that anyway. That's not to say that this isn't a true medical condition, because it absolutely is. That can lead to a lot of sexual pain, which negatively influences that sexual response cycle that we were talking about earlier.

[00:40:33]So after lubrication, Then there are definitely moisturizers that you can apply to the vagina and vulva every day for daily lubrication. If you're feeling uncomfortable, that's particularly good for post-menopausal and breast cancer patients. There are also vaginal preparations, which I saw the question vaginal estrogen the Analee.

[00:40:50] Okay. So those are very safe, but we don't, I don't know enough about your personal medical profile to say, yes, you need that prescription or no, technically, traditionally we consider them a very low risk medication because not a lot of it gets absorbed into the bloodstream. They act locally on the tissues of the vulva and vagina.

[00:41:07] If you're having other sexual problems. My actually preferred preparation is called prasterone, which is actually a dag GA. That is is supplemented vaginally. And that's. Because it gets metabolized to estrogen and testosterone, and it actually has shown the most sort of beneficial effect on sexual function in addition to vaginal dryness.

[00:41:27] So if you're having both vaginal dryness and maybe trouble with arousal and orgasm, I usually would go with prasterone because we have data to show that it positively influences both of those rather than just the dryness, which is what the estrogen is going to tackle. I don't know if I got all the questions.

[00:41:42] Yeah. You gave us a great overview there. Dr. Patel are you going to weigh in on the loop issue? Yeah, I did want to talk a little bit about that as well. I do. Again, like to address, like why? Cause usually Bacchanal dryness is usually a result of low estrogen levels, right? And so that's why so many women postmenopausally can experience that.

[00:42:06] So we're going to address the low estrogen and try to improve the estrogen levels, whether it's naturally or through working with your OB GYN or endocrinologist on hormone replacement. Addressing that aspect of it. And I really liked that she Dr. Harper talked about how it actually takes 20 minutes to really get anywhere because I was one of the things I was going to also talk about was the foreplay is actually really important.

[00:42:30] And for women. And this, these are again, conversations to have with your partners because for women, it can like things like just doing the dishes. If you're a partner just as the dishes or something, those are things that can start, like just doing things for you can start to stimulate you.

[00:42:47] And so yeah, you might not have time, when you get to bed, you're too tired or whatever it is, or like you only have 20 minutes even. Have sex, let alone have 20 minutes of foreplay, like doing all these little things throughout the day, sending you a text saying, Hey, I love you sending some flowers or chocolate again helps with libido.

[00:43:06]Dark chocolate specifically. So doing things like that and having these conversations is really important. And then the other part of it I did in the, a lot of the Dutch testing that I do, we do test for a DHA levels. And so seeing if those are actually low, so Dr. Harper was talking about DHA and how, when those levels are lower, that can that can impact sex drive.

[00:43:27] And or, and the vaginal dryness. And so that's why I often will just actually supplement with DHA if those levels are low also in terms of the lubricant. I actually liked the Lola brand if if it has still necessary because it's organic and it has a little bit cleaner ingredients, but but I've, and I've heard good things about it.

[00:43:47] So that's yeah, that's me. Okay. We have a lot of questions. And I think I'm going to wrap them all into one here related to the other half of the equation. Cause we're talking about 20 minutes of foreplay and stimulation and it takes to for this. So what do we. How do we have this conversation?

[00:44:12]We've got a few of our viewers have said, my partner may not be quite as understanding of where my lack of desire is coming from or may not be on board with this 20 minute to get ready kind of thing. How do you recommend Dr. Patel, we'll start with you. How do you recommend having that conversation with your partner?

[00:44:35] Yeah. Communication of course, in any relationship is absolutely essential. So I think asking your partner, so starting with them, right? Starting with asking them. When would be a good time for me to talk about the needs that I have because sometimes we approach them and then they're like, I'm just trying I was just trying to do this thing and then you just throw this at me.

[00:44:57]So just giving them that space to be like, Hey this is something that I've been going through and I would like to talk to you about it when would be a good time for us to have this conversation. So starting with that. So giving them that space to like, give you like, okay, yeah, let's talk this afternoon instead of just throwing out the first thing in the morning or whatever it is.

[00:45:15] And so give them that space. And then from there, Starting to have that conversation of these are the feelings that I've had, and this is what I've been going through. I would either like to address and figure out what else might be going on with my hormones, with my thyroid, with whatever it is.

[00:45:34]But I would also love to have your support while I do this. And so it's going to take a team effort and and approach approaching it in that way. Let's do this together. Dr. Harper. We have, we had a, another comment at the end of what, when Dr. Patel was speaking one of our viewers said, I've tried to talk to my spouse and he's just rude about the situation.

[00:45:58]We're, we've got everybody from disinterested to absolutely rude about it. What kind of advice do you give to your patients? Yeah. I think that, we can use this idea of, I am. I appreciate you as my partner, intimacy is a big deal to me. And I know also, probably to you, I'm making an assumption there and these relationships, but we'll do it for the sake of this conversation.

[00:46:25]And it's one of my goals or priorities, or however you want to phrase it to really work on our sexual connection or level of intimacy. And so you make it more about. Dr. Patel was saying like this journey together towards this place that probably they want to get to as well. And so I think when you frame it like that, it's you mean a lot to me, this is really important to us.

[00:46:46] I'm going to spend some time working on this and trying to understand it better. You know what I mean? And so I think when it's framed like that, when you're trying to benefit that not only, your personal health in life, but also your relationship that oftentimes that opens the door, maybe to more understanding conversations and more of a partnership.

[00:47:03] There are certainly situations in which, for whatever reason. And a lot of times, I think personally, and from what I've seen, that it relates to sexual shame that these conversations are just closed down and it's really hard to make progress. And those cases, I, a hundred percent of the time would recommend a sex therapist or even just a couples therapist, because a lot of times that Inability to get anywhere on a particular topic is going to show up in other places as well.

[00:47:30]So when we have a partnership with healthy financial communication, that might also be mirrored about sex, it's just about the ability to understand someone else's point of view and know that their motivations are true. And so there's some, problem with that. Then I think that probably I would.

[00:47:45]In the past, I've always recommend that the person see a therapist. There are some great books on the topic though. One of my favorite sex therapists is named Laurie Mintz and I N T Z. And she's written two great books, a tired woman's guide to passionate sex which I love. And then also another book called becoming clutter.

[00:48:02] It all about like female pleasure. And there's a partner, there's a chapter in there for partners. And then also a lot of the way that Rosie gets out into the world, that's that. That the free app is that doctors recommend it to their patients. And what they tell them to do is, watch these videos with your partner because there's a ton of educational content it's coming from like a, unbiased third party.

[00:48:22] And we're just delivering facts. It has nothing we're taking the emotion out of it. We're taking the drama and the stress and all the negativity that may be surrounding your sex life at this point. And just like telling it like it is, so I think also. Like someone else said they were watching this with their partner.

[00:48:36] I think you could use Rosie in the same way and say, Oh, this is a crazy doctor talking about sex all the time. Come watch it with me, and blame it on me. That's one way to do it. And for those of you who don't have your partners watching with you now, remember we're going to be sending out in a couple of days, a link for you to watch a rebroadcast.

[00:48:56] So might be a good excuse to pour a couple of glasses of wine and say. Hey partner, let's sit down and watch this so that we can get this really figured out and, get on track and, it might be helpful to see other women and these experts talking about this in a very straightforward way.

[00:49:15] And, we might be able to get through to some of these guys who aren't completely understanding of it or completely relating to what we're talking. I would love to wrap up. I want to. Pass it back to both of our speakers just to share. Maybe final thoughts like someone has hypothyroidism or Hasimoto's, they want to know where to start with their low libido or sexual dysfunction.

[00:49:37]What's the first thing that you might recommend? They do takeaway that I would love for all women to know. Is that. You are not suffering alone, even though you might be experiencing multiple symptoms that like Dr. Purcell was saying, seem unrelated or seem random, they are all very related.

[00:49:57]Our body is a very intricate machine and the thyroid is, has a lot to do with most things that happen. And so I would say that, while you might feel Confused or hopeless that there are lots of different places to get help, both for hypothyroidism and for sexual problems. And unfortunately, a lot of us have to learn to be our own advocate and to find, to keep searching for answers until we find those.

[00:50:22] And so that would be my. Rallying cry is never give up and continue to advocate for yourself because help is available and out there. And there are people who really care about these issues and care about patients as individuals and as whole women. Like I think both myself and Dr.

[00:50:37] Patel do. Great. Thank you so much, Dr. Harper. Yeah, I think that is super important to remember that you are not alone. And one of the things that I want to leave you all with is that, remember that you also, you have the power, you are extremely. Resilient and you have the power to take back your health.

[00:50:59]And I think sometimes we forget and we think that this is it, but really it's not. So there are things that you can do. So starting with realizing that yourself, like I have the power to take charge of my own health and I have the ability to do whatever. I'd like an experience that Mahan or optimal health and and start with that.

[00:51:20] And then from there, Reach out to these resources. Rosie seems like an amazing resource. I actually have a few podcasts episodes on sex drive and we talk about all these different things that I I mentioned on what it takes to turn a woman on. And I think it'd be so good for, I always tell all my patients to have your partners listen to it so that they know what's going to turn you on.

[00:51:43] And then they get to the benefits of that. These are the, this is so amazing that Paloma health is having these conversations and we're finally getting out there and w another good resource. I know Dr. Harper talked about a few books and I wanted to throw one more book in there that I really like a sex psychologist, doctor.

[00:52:02] Alexandra Solomon. She wrote a book called taking sexy back and I really liked that book because she goes into a lot of having those conversations and everything like that as well. So I hope that was helpful. And thank you. Thank you, Dr. Harper for being here with me and lightening me with all that Rosie does.

[00:52:19] And it's super exciting to see that all that you're doing and thank you, Katie and Mary for having us. Of course, thank you both so much for your time. I think you both touched on it, but this is so important to like, name and bring light to, because it can be embarrassing or feel shameful and it really doesn't need to be, so thank you both for.

[00:52:39] Being here and sharing your wisdom and knowledge and experience with us. Thank you to everyone who's joined us live. We will send out a replay likely on Sunday or Monday of next week and included in that replay is also an exciting giveaway that we're doing in collaboration with thyroid refresh. And we will make sure that you know where to find Dr.

[00:52:57] Patel and Dr. Harper. And if you are looking for a place to start with your thyroid Paloma health has awesome thyroid doctors available who take a whole body approach. To your health. We're not treating just on lab results. We're treating on symptoms, your medical history, your lifestyle, and your lab results.

[00:53:13] So again, we'll make sure that you have all of the links that you need to find us and our speakers and a big thank you again for joining us live. Thank you so much, Dr. Harper and Dr. Patel, we will see you. Thanks so much.

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