Katie Jo Dixon:
Hi, I'm Katie Jo, a nurse practitioner with Thrive Lab, where our goal is to help others thrive with the use of bioidentical hormones and hormone replacement therapy. If you've listened to some of our recent podcasts, you've met me, and today I am introducing one of our other providers. Her name is Brittany Meeker. We're so happy to have you today, Brittany. If you'll tell us about your journey with Thrive Lab. and what you love about hormones, why are you a part of this team?

Brittany Meeker:
Yes, Katie Jo, thank you so much. This is so exciting. I think we get to dive into all the things, especially with testosterone, which is a fascinating hormone for both men and women. But really my journey with Thrive Lab, June will be two years, which is absolutely amazing. Started with you, Katie Jo and Dr. B in the beginning in our texts. state as going to homes and now we find ourselves reaching people all throughout the U.S. which is such a beautiful thing. You know when I did interview with Thrive I was looking for something outside of the modern medicine. Just some background my clinical rotation was 600 hours in emergency medicine, family practice, constant revolving door of blood pressure, cholesterol, depression, postpartum depression the list goes on and I saw the same standardized orders being sent filled and sent and refilled and all I could think was my god. It cannot be like this. There's no way I mean, we're not really getting to the root issue here and so I remember having a conversation with Josh about the norm is no longer acceptable. 

We have to get to the root issue with things and treat the patient of what's being caused. And so to this day that's still my mission and I'm so so thankful that the universe has guided me in this direction because it's probably the most fascinating thing I'm doing. And honestly too in my other practice I find that patients are sending me their hormone levels and wanting me to look at their thyroid because they find that even their PCP, primary care has kind of let them down and they're just still not getting results when it comes to outcomes. So that's really some background on, you know, where I stand with things and my passion of why I'm still here. 

Katie Jo Dixon:
Thank you, Brittany, for sharing a part of the history of Thrivelab. Like you said, we first opened our market in Texas. And at that point in time, we were traveling to patients' homes and we would meet patients in their homes, collect the lab specimens at that initial visit and then drop it off to the lab. And now we've expanded using the telehealth platform where we can see clients all over North America, including one of our excellent providers in Hawaii, who I hope will join us soon. Now you mentioned the failure of modern medicine and many of the primary care providers are simply not trained in bioidentical hormone replacement therapy and they're not trained to recognize the symptoms of hormone deficiency. And they're doing their best they can with their high patient loads and helping individuals with what you mentioned, high blood pressure, high cholesterol, risk for diabetes. Early on in your introduction you mentioned testosterone and that is our focus today is on the female not the male but the female hormone testosterone. So for our female clients what would you say to them if they're experiencing low testosterone? What symptoms would you be looking for with low testosterone?

Brittany Meeker:
Testosterone to begin with is an inner hormone. So what I find is women, even at the young age of starting in their 30s, being affected by low testosterone. I think there's a lot of things that can scare us. And the first thing is libido. We find if you have no sex drive, libido must be low. It really goes more beyond that. I think that's more of the tail end sign of when it's definitely low. But really there's lots of functions within the body that testosterone does. Yes, it helps increase sexual interest, but it decreases excess fat within the body, helps increase your muscle tone, it really helps maintain your memory and helps with muscle mass and strength. So when I see a female client who has low energy, was once in the gym throughout the week, no longer has the energy to do so. And if she does work out, she no longer has those results that she once did when she would work out in the gym. And then also, the cherry on top is now libido's deficient. I would find that yes, there is most likely a testosterone deficiency. It really plays a big role in fat loss and also when it comes to bone strength and even aids pain control. There's just a lot of things that testosterone does within the body than just our sexual interests when it comes to having a deficiency. 

Katie Jo Dixon:
I'm so glad, Brittany, that you brought forward the libido, because often libido can be one of the later signs. And we noticed that in our female clients, like you mentioned, that loss of muscle mass, we call that sarcopenia in medicine, where you start to lose your muscle plumpness. And that loss of muscle mass contributes to the risk of decrease in your bone density. And we know that as women age, bone density is essential. Studies indicate that if you fall and you have a hip fracture and you're over the age of 65, your risk for death within one year is highly increased. So many individuals think hormone replacement is a vanity. I'm using it for looks alone, so I look toned, but it's not only what we're seeing on the outside, the outside reflects what's happening on the inside. So I'm so thankful that you were able to bring forward many of the symptoms that women experience with low testosterone. With the low testosterone symptoms, how would you explain the differences in testosterone for male clients and female clients? 

Brittany Meeker:
You know, that's a really interesting question. I find that a lot of them overlap. You know, I feel that with men, sometimes it's kind of just muscle mass, strength and libido, that's kind of some of the focus that's mainly noted when it comes to their stamina, if they were working out or having any intimacy. With women, it's interesting. You have anxiety, you have... not only that your skin elasticity is changing, hair changes, feeling hypersensitive or even hyper emotional, even hair declines when it comes to pubic hair or like, you know, hair throughout the body, right? That starts to decline. Mild depression, you're having more of these, you know, emotional changes and that's the beauty of testosterone is there's receptors throughout the whole entire body. for testosterone when they're not being utilized, you start to experience physical and emotional changes. Even thin lips, you know, weight gain, feeling muscle wasting, low energy. So a lot of those overlap with both men and women, but definitely with women, I find that it's more the emotional changes that are experienced that makes them wonder what is going on? This used to not be such an issue for me. and then the cherry on top as well. And physically I'm changing and intimately I'm changing, right? So it's almost like a snowball that we kind of see as it gets worse.

Katie Jo Dixon:
I like that you mentioned the snowball effect because that's how hormones are depleted from our body and that's also how we replenish our hormones as well. When I'm speaking to my female clients, I let them know, which is misinformation for many individuals, that testosterone is the most prevalent reproductive hormone in the female body. We have four to five times more testosterone than we do estrogen. Most women know about estrogen deficiency or estrogen dominance. Now men do have a substantial more amount of testosterone than we do, but testosterone is our dominant hormone. I was training with Cathy Moffitt, she's a medical doctor who specializes in hormone therapy based out of St. Louis. I want to give a shout out to her. And she was teaching that with the perimenopause, around menopause, that the hormone regression often includes testosterone first, becoming deficient in testosterone, then progesterone. and then estrogen lasts. So many people come to us and they want us to evaluate their estrogen, which we will, but we also want to pay attention to your testosterone. And I think it's great that you mentioned hair loss because in clinical practice, I'll often ask my patients if they're noticing any type of hair loss, especially in the lower extremities. And I often associate that liver decline with aging and we know our livers, and we spoke about this with Dr. Patel, I love the liver. But our livers are what process our hormones. So when we're able to replenish our hormones and support our liver, then we can lead that optimal life and feeling like we are ourselves and our skin. You mentioned women and the emotional aspect that maybe because women are noted to be more in touch with their emotions, I'm not saying that's true for all women or for men in the inverse, but that feeling, I just feel like something's wrong. And my female clients will tell me, I went to my doctor, and I was prescribed an antidepressant. I was prescribed Zoloft or Prozac. And we know that these symptoms aren't related to a Prozac deficiency, they're related to a testosterone deficiency. 

Katie Jo Dixon:
So what cases do you notice in your practice with women experiencing low testosterone? Are there certain diagnoses or certain clinical pictures that you see and you say, yes, you most likely have testosterone. What do you see?

Brittany Meeker: Ideally, I'm seeing that age get younger, even in the early 20s, early 30s, and then as that gets older, which is still very young, they're showing signs of a testosterone deficiency. I think there is a trigger point where it has gotten worse, whether it's adrenal stress and burn up, high stress jobs, lifestyles. a general and junkies, right? Just constant madness and going, going, going, birth control. Now I am a previous user of it. I think it does, you know, certain things within the body that are helpful. As my knowledge base has grown, I probably have a lot of my girlfriends off of control because of what it does within this system. You are suppressing your natural production of hormones and so women who are on birth controls tend to have a lower testosterone. Childbirth completely depletes hormone levels, right? So a lot of women who I always constantly hear this and I am expecting myself but after childbirth, after I had the baby, after I gave birth, I find that to be a huge catalyst for women, even depression, right? Women who have depression tend to usually have some sort of testosterone deficiency. And interesting enough, of course, we have menopause, meaning absolute zero function of the ovaries, which testosterone is produced by. And then also surgical menopause, right? If you have a total hysterectomy, you have no uterus, which really that job is to house a baby, or ovaries, which that job is to release consistent hormones. Those are more of the clinical pictures where absolutely there is a deficiency going on. What helps kind of, you know, target those certain areas is ideally age. And then as you gather information and in our clinical intake forms, we do go into social history, right? Do you drink, do you smoke? What do you do for work? Kind of paint us this background because there's a lot that goes into that to really kind of be sure of the targets. is hit there when it comes to a deficiency. 

Katie Jo Dixon:
Wow, so broad and that is a huge umbrella. So I see why for many of our female clients when they first enter Thrive Lab that they feel confused or not sure exactly what's happening because there's such a large umbrella to capture all those symptoms.

I've been studying with Sarah E. Hill and reading her book, This Is Your Brain on Birth Control. It's interesting that you mentioned hormonal contraception because many women are misinformed that the pill and bioidentical hormones are in the same category and they are completely different. And we know that the pill makes your hormones a pancake. They suppress your hormones to a subpar physiological level and you can start to experience symptoms of hormone deficiency. And one interesting thing that Dr. Hill spoke about in her book that Progestins, the synthetic version of progesterone, is actually made from a synthetic form of testosterone. So I would notice in clinical practice, my female patients who are using hormonal contraception, that can be the pill, that can be the depo shot, that can be a nuva ring, which show signs of both hyperandrogenism. Hyper, so both signs of low and high testosterone at the same time, where they would have lack of libido, they would feel depressed, they would feel anxious, but then they would also be experiencing abnormal hair. It's usually on the chin. Sometimes it's on the chest or the neck, and they'd also have cystic acne. When hormone levels of testosterone are elevated, for women, it causes more of a masculinizing effect. Well, you'll notice cystic acne. I will tell my female clients, if you're experiencing symptoms like you're a 14 year old boy, that is not hormone replacement therapy, that's hormone excess. So cystic acne, abnormal hair growth, excessive libido, those could be all symptoms of excessive testosterone. Tell me Brittany about the Thrive Lab use of testosterone. How do you prescribe that for women? What modalities do we use? And how do you assess that a female's testosterone level is optimized?

Brittany Meeker: 

You know, that's interesting. I feel that that has really kind of grown in the sense of application. Ideally, we would do more of a topical cream in the beginning and modern medicine is totally the opposite of this because our treatment modalities are completely different, right? Our skin is the largest organ and so it's the perfect place for hormone absorption. But we also have found that labia is great. It's a very vascular area, lots of blood flow capillaries, right? And you rapidly absorb it. So ideally testosterone, what I find is a labial, interlabial application for women does great. Now when it comes to the patients that I treat, ideally I have found a little bit late 30s, 38, 39, and then 40 and on is when I would treat. with testosterone initially. Every patient background presentation is different. It's not black and white. There are some exceptions, but just a broad overall picture that is ideally the range that I treat with testosterone. 

There are women who rapidly absorb that testosterone in the inner labia, and they might, for example, after a month to six weeks, start to get oily skin. Not a bad thing, that is a great glow for some women. I had a patient who said, please don't lower my testosterone. I look amazing. She's probably one of our first year patients we had, which is great, and she still loves her testosterone, but we dialed it back a little bit, because then she started to notice some acne. So what we did is kind of switch it to the wrist. The wrist is still on the skin, that's a topical application. Again, your body's rapidly absorbing that. But ideally, that is my approach for treatment. Again, we like to have labs drawn to maybe assess the levels of what those results look like when it comes to labs to kind of target the range. Thrivelab is about treating the patient and not a lab value and treating symptoms, which is the most beautiful aspect of treatment in this practice, because I'm not looking at labs and telling you. this is fine, you don't need this. I'm going based on your outcome. So really to answer your question, it's either the inner wrist on the skin or intralabia. Those are my two approaches with female patients. 

Katie Jo Dixon: 

I love that you gave the example of the age range, Brittany, because I do notice as women age, if they're presenting and they're telling me, I have crepey, dry skin, Katie Jo, my skin is sagging. I think there can be a testosterone deficiency. Testosterone helps to maintain that plump muscle and to maintain your skin turgor, the elasticity in your skin. However, if you have skin that has sun damage, wind damage, and is aged, you might not absorb as well. And so having the labial application as an alternative is a great way to enhance the absorption. And I love that you mentioned the daily application because we know that our hormones are produced in pulsatile fashion, sometimes throughout the course of the day. Testosterone is one of our anabolic growth hormones. It's energizing, which is why we often use it to treat fatigue. And so often I'll have my female clients apply it in the morning and I tell them over the course of the day, testosterone will naturally decrease and that's why we need the daily application. I have some female clients that will tell me, Katie Jo, I want an injection. I just want to inject it once a week and be done. And I tell them, I understand, but physiologically that's not how you're made. You can use injectable testosterone. I only have one, I have two female clients on injectable and we inject micro doses once. every two weeks. So it's a very small dose that can be an option for very few female clients, but most people respond well when we're mirroring your natural physiology, which is that pulsed style fashion with the daily application. Now, what can be some of the possible side effects? You mentioned hair loss as a side effect of having low testosterone. What are some of the side effects of having too much testosterone? 

Brittany Meeker: 

That's a great question. It's almost like you mentioned before, going through puberty all over again. And I tell patients, my job is to make you feel as though you are maybe a little older than that age, but with more wisdom. And so I really want to avoid things like acne, oily skin. Agitation right we have to kind of revert back to how was that in middle school, right? How were emotions then because hormones were just so skyrocketed right so Anxiety, you know feeling sometimes even you know you can have you know that the facial hair or possible, you know problems with irregular periods at that time, right if you have too much testosterone and Having weight go on feeling sugar cravings, right and salt cravings And so there's really some mood related symptoms too. And then interestingly enough your good cholesterol within your body It's called HDL. That's a marker for how good cholesterol actually gets depleted if you have too much testosterone so And one thing too, you know, that we have to monitor is excess testosterone has the possibility of making you a higher risk for breast cancer. 

We do screen all patients. We wanna make sure they're up to date with their annual exams, but we also wanna be safe with the range that we're prescribing in and that the outcome is good and not risky. So those are really kind of signs of those excess testosterone levels. that would make me think we need to kind of dial it back a little bit, right? So skin changes, mood changes, and even within the system, right? Cholesterol levels, things like that that would change.

Katie Jo Dixon:
That is a good marker to look for in our clients. A few other symptoms that are not very common, and you would see these if a patient was allowed, in which we have intimate contact with our patients in the sense that we maintain great follow-up. We don't send you with hormones and say, here, follow-up in. three to six months, we use our self-assessment tools to have real-time feedback on how our patients are progressing. Are you making progress in the right direction or have you stalled or have you taken steps backwards? We know that hormones are not static. They change in response to our environment, our internal environment and our external environment. And you mentioned stress and adrenal glands. We know in our female clients, when the ovaries are no longer able to produce hormones, in sufficient amounts, that the ovaries will often try to take over and they'll do their very best to produce the hormones, but eventually, especially if there's a lot of other stressors in life, the ovaries say, I'm out of this game. I'm putting the ball down and stepping off the court because I can't keep up with this level of stress.

Katie Jo Dixon:
Can you tell me about a patient's story, a success story? the treatment plan that you use for a patient? Is there anyone special that comes to your mind that you could share with us today?

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Brittany Meeker: 
That's a great question. And I had emailed Taylor who's done an amazing job at capturing patient testimonies. I find that in a world of technology, we have more of a platform of talking to patients virtually and on the phone, but capturing their testimony, whether it's through an email or a video that we can actually have that reference of a testimony. The one that comes to mind is actually a new patient. She had just started our program. I spoke to her probably two weeks ago. This is her one week follow-up. She, I said, hey, I wanna hear from you. I'm right alongside you on this journey. Check-ins, questions, girl talk, what have you. Let me know, I wanna hear from you. And so she did. She made an appointment. It was one week in. She was crying and saying that she had never in her life thought she could be the way she is now. Some back stories, she's about a 52 year old female, retired menopause, complete menopause, non-surgical related. She was actually going to her primary care doctor, and was prescribed Menjaro for weight loss, some depression medications. And again, on my outside practice, I run a medical weight loss, bariatric general surgery practice. So I get the familiarity of those different treatment regimens that she was prescribed like Menjaro. but she just did not feel that these treatments were really helping her. Still had insomnia, still had low energy, could barely make it to the gym. She called me and said, I don't know what this is, but I actually jogged on the treadmill today. I don't know what's going on with my sleep, but I have never not known that I was never sleeping. I was up before my husband and he said, what are you taking? I need to get some.

Now mind you, all three hormones were replaced because she wasn't in a menopausal state, so we want to kind of replace what the ovaries are lacking, but she was on testosterone and an energizer hormone. She was back in the gym and this is only a week after treatment. It's amazing when you sprinkle into the system what it was lacking, how much a patient can transform. And like I tell all patients, If this was not life changing and fascinating, and this is what I do all day long, I probably wouldn't do it. So it's pretty amazing. I get to witness it and I can't wait for your testimony. And so she really took that to heart and kind of gave me that testimony. And we got labs back and made some little tweaks to her plan to space on symptom management and little things that we could add in. But that's the most recent story that really touched my heart. because then she went on to talk about intimacy with her husband. And you know, there's just so many different things that not all hormones do, but definitely, you know, testosterone when it comes to play with treatment plans.

Katie Jo Dixon: 
What a beautiful story. I love that illustration of sprinkling in some hormones because some hormones, some patients need just a whiff of hormones and it activates your bodies. Other ladies, they need full dose testosterone, double down because their bodies need more of it. So each person is unique and meeting those uniquenesses is what I call bioidentity. If you look at the lab value. there is not a lab value on traditional labs that's specific for women and testosterone. There's not even a diagnostic code for suboptimal testosterone for women. There is for men, call it testicular hypofunction, but for women, there's not a diagnostic code. So that area of health has been overlooked for women. And we know that many of the studies that have been completed on hormones have been completed with men. and not women, so women haven't been equally represented in the field of hormone replacement therapy. So we get to be pioneers in the field of hormone replacement therapy with the use of testosterone for our female clients. And one of my patient stories is that my client came to me and she had zero libido, had zero interest in having sex, and she said, it's affecting my marriage. It's... a big part of me and my husband's relationship. She said, my husband is handsome and attractive and I have no interest in sex at all. And she was on the verge of tears. She was concerned that a divorce might happen. She said they were having more arguments. And so we were able to replace her testosterone and that was a part of the tools to save her marriage. So we know that hormone replacement therapy, the ripple effect is not just the woman but also her community around her. So what a beautiful story with your client in just such a short amount of time. We know that hormones do take time to replace and every person's different. Some people may have a more immediate response within one to three weeks. Other individuals, it may take closer to three to six months. So your own genetics determine how fast your body may respond to the testosterone replacement. Brittany, what closing remarks would you like to leave to our listeners today?

Brittany Meeker:
I would have to say that if you have anything within your life that you feel is missing in the sense of outcomes when it comes to, you know, there's different things and approaches to help balance your hormones. Getting a restful sleep. working out, getting enough hydration. If those things are seeming to just not really help you feel the most optimized, it wouldn't hurt to at least look into having your hormones looked at. Now, like you mentioned, Katie Jo, there is no gold standard of measuring your hormones. This is just more of a snapshot in time and a way to gauge things, but really there's lots of other ways that we can help when it comes to outcomes. Yes, meditation, and we encourage patients, meditation, exercise, different things to help manifest those great outcomes. But I would say that in a world where our intake of food and environment isn't probably the most substantial for us with just pollution and all of that. It's at least a way to let you know that you are not alone, and this is something more preventative than it is just based off of age and going through menopause and suffering through things, especially for women who are going through perimenopause, menopause, that get told by their doctor time and time again. Patients tell me that they say that's normal, that is part of aging, it'll get better there, but they're left with vaginal dryness, insomnia, the list goes on. So whether it's patients who still have cycles or don't have cycles that are still struggling within themselves and feel that they're not feeling better with other ways of just meditation and things like that to look into it, that most likely there is some sort of imbalance that is treatable.

Katie Jo Dixon: 
Well, thank you, Brittany. And if for those who feel inspired as I do with Brittany's treatment and focusing on the best outcomes for her patients, you can visit thrivelab.com. There's a chat box. You can complete a brief survey to give you insight if testosterone deficiency is what you're suffering from. From there, you could have a consultation and dig in deeper to determine whether or not hormone replacement therapy would be the best option for you. Thank you for taking your time to listen today and until next time, be well and take care.