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#275 - AMA #52: Hormone replacement therapy: practical applications and the role of compounding pharmacies

The Peter Attia Drive

Release Date: 10/16/2023

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In this "Ask Me Anything" (AMA) episode, the discussion zeroed in on the practical application of hormone replacement therapy in women. Peter walks through the signs, symptoms, and hormonal changes in women approaching – and going through – menopause. He provides an overview of the FDA-approved HRT formulations and explains how women might go about choosing the right option for themselves. Peter also describes the significant changes in testosterone levels in women over time and the options, as well as the considerations and challenges of testosterone replacement therapy (TRT) for women. Lastly, Peter highlights the necessary role of compounding pharmacies in HRT, underscores concerns regarding the quality and sterility of compounded drugs, and offers guidance on locating a trustworthy pharmacy.

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We discuss:

  • Why hormone replacement therapy is such an important topic [2:00];
  • The onset of menopause: symptoms, blood tests, and when to consider HRT [6:00];
  • Tests that may provide indications of perimenopause and their implications for fertility [9:15];
  • Vasomotor symptoms: hormonal changes that cause hot flashes/night sweats, and HRT therapies that can help [13:45];
  • The role of estrogen in menopausal HRT [17:30];
  • The limited role of progesterone in HRT protocols [25:15];
  • What is a “bioidentical” hormone? [28:30];
  • Overview of the FDA-approved HRT formulations [31:45];
  • Determining HRT dosing and considerations for perimenopausal women [37:45];
  • Choosing the right HRT formulation: pros and cons [43:30];
  • Examining the link between certain forms of estrogen and breast cancer [46:45];
  • Changes in testosterone levels in women over time and why it matters [50:00];
  • Recognizing low testosterone in women: common symptoms and diagnosis [53:45];
  • Testosterone replacement therapy for women: options, considerations, and challenges [57:30];
  • The long-term use of testosterone in women: examining the limited data [1:00:15];
  • What is a compounding pharmacy? [1:09:30];
  • Reasons to opt for a compounding pharmacy over a pharmacy that adheres to stricter regulations [1:16:00];
  • The tragic incidents that heightened concerns about compounding pharmacies [1:20:45];
  • Tips for finding a reputable compounding pharmacy [1:27:45]; and
  • More.

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