Understanding Menopause: Hormone Replacement Therapy, Risks and Benefits with Dr. Michael Green

Have you ever found yourself waking up in the middle of the night in cold sweats, or dealing with sudden mood swings and brain fog? If these symptoms are sounding all too familiar, then you're not alone. This episode, we're thrilled to be joined by Dr. Michael Green, Chief Medical Officer of Winona, who shares his wealth of knowledge on menopause symptoms and breaks down the intricacies of hormone replacement therapy (HRT). His career transition from family practice to OB-GYN, and his role at Winona, provides a unique perspective on the subject which will leave you informed and empowered.

Venturing deeper into the realm of HRT, we tackle some of the big questions surrounding its risks and benefits, particularly its link to cancer. Dr. Green provides insights from his research and experiences, shedding light on these concerns. As we commemorate the two-year anniversary of WINONA, we reflect on our journey and discuss the safety boundaries of HRT; a conversation that is both timely and revealing.

In the final part of our enlightening chat, we switch gears to discuss the role of Dehydroepiandrosterone (DHEA) in providing testosterone to women. Dr. Green guides us through the benefits of DHEA, stressing the importance of sourcing from reliable providers and how it helps to monitor testosterone levels without the need for costly and tedious blood tests. Throughout our conversation, the passion for assisting others through Winona is evident, providing a comforting assurance that we're on the right path. Tune in, and let's navigate this critical women's health journey together.

RESOURCES MENTIONED IN TODAY'S EPISODE:
Join the Winona Facebook Page here
Winona Website

Chapters

• 0:03 Menopause Symptoms and Hormone Replacement Therapy
• 14:21 Hormone Replacement Therapy and Cancer Risk
• 28:27 HRT and DHEA for Women
• 42:06 Appreciating Illinois, Invitation to Connect

Transcript

Speaker 1: 0:03

Hello and welcome to What Women Want Today, podcast season three, the Soul Sister series, where we will tackle tough topics straight from our heart to yours. I'm Terri Kellams, your host and coach for women who struggle to find meaning in fulfillment in midlife.

Speaker 2: 0:17

I am Amanda Kieber. I am your new regular contributor. I come straight from the Midwest Rockford Illinois. I'm a public speaking teacher and leadership development professor. I'm also a coach and clinical mental health counselor. I am so thrilled to be here, and let's get started.

Speaker 1: 0:34

Let's do it. Hello and welcome to this week's episode of the podcast. I'm your host, terri Kellams.

Speaker 3: 0:41

Hi there, i'm Amanda Kieber, your co-host for today, excited to be here.

Speaker 1: 0:46

Amanda, are you as excited about interviewing Dr Michael Green as I am?

Speaker 3: 0:51

I don't know how excited are you.

Speaker 1: 0:52

I'm very excited. Yes, i concur, this is one of my very favorite topics and I am so glad to have Dr Michael Green, chief medical officer of Winona, on the line with us today. Welcome, dr Green.

Speaker 4: 1:10

Thanks, i'm really happy to be here too. I'm excited as you too.

Speaker 1: 1:14

Did I pronounce it right, winona?

Speaker 4: 1:16

Winona correct.

Speaker 1: 1:17

Good Great Well. Dr Green, do you want to start off by just giving us a little bit of background about how you went from I know you started out as family practice and how you worked through your career and got to be the chief medical officer of Winona.

Speaker 4: 1:32

Sure, i loved here. So I came out of medical school and I thought I wanted to do family medicine. I'm kind of a bosse kind of guy and I was like I want to do a little bit of everything. And when I got to my family medicine or residency it kind of hit me that I really didn't like taking care of sick people. It's kind of depressing. I love delivering babies and women's help was really kind of a passion for me And people around me surgery attendings and gynecologists were telling me that I had really good surgical hands and I was wasting my talent. So I did a whole second residency after becoming board of chair of endocrine medicine at WGYN. That's pretty much what I've done my whole career. So I spent 17 years race or kids in Ventura, California doing sort of full scale WGYN WGYN practice.

Speaker 4: 2:21

Then I took a job It was more of a lifestyle change as a OB hospitalist, which is I'm still doing now, although Winona started sort of as my side gig and now it's kind of taken over my life. So I kind of done a lot. I'm doing a lot less of the OB hospitalist. And then I live in a small town So I see patients. They have a little rural health clinic. I see patients a couple of half days a month here, basically part of the community. So that's sort of what I'm doing now. Winona was interesting. My son's company, winona's, were business partners Maybe a month before COVID it was like January. Before COVID we had a conversation about doing a telehealth platform And we were kind of talking but they were picking my brain about different ideas And maybe nine months later they asked me to come on as a advisor and then eventually chief medical officer. Then an amazing project ever since.

Speaker 4: 3:18

I don't know how that all worked out.

Speaker 1: 3:21

Well, what I learned about Winona, one of the things that jumped out at me that I was so impressed with and that really excited me was that it's plant-based HRT that you're offering. How is that different from a woman just going into an OB's office that doesn't maybe specialize in it, or it doesn't have a lot of interest in home-worn replacement therapy? What would be the differences?

Speaker 4: 3:42

Sure. So the sort of classic hormone replacement therapy are two medications called premarin and provera, premarin being estrogen and provera being the progesterone, and all the big old studies were done with those two hormones. Premarin actually stands for pregnant Mary urine, and that's exactly where it comes from. So they have all these pregnant horses, they collect their urine and they collect all the estrogens out of them, and some of them are what humans make, but a lot of them are unique horses. There's like I forget the exact number, but in the teens different estrogens in this And I sort of put together in a pill or a cream, depending on how they do it, and so it works well, but it doesn't work great because there's all these hormones that aren't exactly really what the body makes.

Speaker 4: 4:30

There's also synthetic hormones that are made. So basically they just take chemicals in the lab and turn them into hormones that are close but not exactly the same, and they call that biosimilar hormones. So it's similar to what the body makes, but not exactly the same. So bio identical hormones are chemically identical to what the body makes, and ours are a plant based And these are. So when your body sees these, it's exactly what it's used to, and so most of us think that they work better and have fewer side effects, because they are exactly the same things.

Speaker 3: 5:09

So, dr, when a woman comes into the clinic and she is describing what she's going through, what will you often hear her talk about?

Speaker 4: 5:19

So the most common or sort of famous symptoms are hot flashes and night's, and that's, you know, can be pretty disturbing for people in causal But there are. You know, it's amazing how many women don't have that symptom but still have menopause symptoms. So sleep disturbances are very common. Brain fog, where you just you feel like you're half a step behind, maybe can't quite pull someone's name when you normally put. things like that are very common.

Speaker 4: 5:47

Weight gain is, by, the most disliked symptom of the menopause transition And what happens is the weight tends to accumulate around the middle when that never used to happen And the things that used to work when you gain weight are walking, they're exercising and you're eating right, and the weight just keeps accumulating around the middle, and that's also a sign of the menopause transition. There can be also a lot of vaginal changes vaginal dryness, irritation that can cause bladder problems, pain within her course and just irritations throughout the day, and those are common symptoms as well. It's also skin and hair changes that we see, general fatigue. People just don't feel as well, and there are some women get joint pain that is caused by this. So really there are estrogen receptors all over the body And so when the estrogen is not coming out right, not enough or not consistently, it can really throw things off pretty much everywhere.

Speaker 1: 6:49

I think this kind of sneaks up on women, and here's why I say that We go from all the pregnancy things that are. No, i'll start even back just a little bit further than that. My youngest daughter hits horrible time with her menstrual cycle lots of pain, just lots of symptoms. And then we move into our childbearing years and the raising of those children and still maintaining our home and having a career. We feel like shit a lot. And so I think I think period menopause kind of sneaks up on us, because we already don't sleep well, we already have a lot of unexplained body pain. Help me out here, amanda. You're younger than I am. You're still Oh do be.

Speaker 3: 7:27

But you were speaking my language when you were just When you were describing all of those symptoms. I mean, i'm 47 and the most troubling part for me is all the weight gain around the waist When I had like the flatest stomach for years. And now I'm like, well, what is happening to my body? and feel like enslaved. My body feels enslaved.

Speaker 1: 7:49

Yeah. So that's why I say I think it sneaks up on us a little bit and maybe a lot of women are experiencing these things in period menopause and don't even really realize it, because what would be the average age that you see that this is starting to become a problem for women and they're coming to seek medical advice or care for it.

Speaker 4: 8:09

And yeah, that's actually one of the things that makes it sneak up on women is that I think it starts a lot younger than people give it credit. So if you look at just statistics about 51 per Sorry the average woman in the United States completes menopause at about 51, but symptoms tend to start seven to 10 years before menopause is completed. And the surprising thing is 15% about one out of six women complete menopause by 45, which means if you go back seven to 10 years, we're talking mid-30s.

Speaker 1: 8:40

And they've still got growing children at that point.

Speaker 4: 8:43

They've got a little kids, not for funny sometimes. So yeah, it's a surprise for women, you know, and honestly a lot of doctors don't really understand this, and so you know they're 30, 38 or 39, and they go to the doctor. It's like, well, you're too young for this to be menopause, you know, and so they kind of blow it off, and I think a lot of women feel the same way Well, this can't possibly be that, so they don't even consider it. But it's actually quite surprising how common it is, like 30s, early 40s, and unfortunately nobody really gives that credit And so people don't get the treatment That can help.

Speaker 1: 9:21

Well, and there's a stigma, right. I mean, menopause is like I don't know I'm going to be dramatic here for a second It's almost like the death sentence for a woman, because when you know, when our mother is the one that talked about it which I don't think a lot of women might age our mothers they didn't really talk about it, but when you did hear a little snippets of menopause, it was awful, it was dreadful, and so, you know, i remember going to a little gathering with a group of women that were quite a bit older than me and they started talking about it and I left there thinking God, i don't ever want to hang out with those women again. That all sounds so depressing, you know, but the truth of the matter is is if we don't talk about it and if we don't have guests like you on our podcast educating women, then we're stuck with a lot of women who go through life feeling terrible and having it affect their relationship with their husband, having it affect the way they feel about themselves. because, you know, just like Amanda said, i didn't really have a weight problem, so to speak, and then it just happened overnight where, all of a sudden, the things that I could do. before I'm an exerciser, i eat healthy. they weren't working anymore.

Speaker 1: 10:30

And so, you know, i feel like it kind of piles up on us in midlife, because now we're facing, you know, we're facing the empty nest, we're facing body changes, we're facing the way our relationship may be with our husband. and why do you think there's I don't know, i feel like there's two movements out there kind of butting heads right now. There's the movement where there's a lot of women out there, pro-hrt. come on, ladies, let's get on board with this. you know, seek medical attention. this is not a bad thing. And then there's the women that are saying this is just natural, this is what our bodies are supposed to do at this time of life. What do you think about that?

Speaker 4: 11:07

So yeah, i mean I, that is absolutely true. I've never understood that this is natural argument, because natural doesn't necessarily mean good. I mean nature's pretty mean, and you know that's a doctor. Honestly, what we do is try to beat nature. You know it's like she.

Speaker 4: 11:26

Nature says 15% of women should die in childbirth, like well, that's not good, let's fix that. You know. Nature says you know, well, we're going to suffer through this period, this transition period. Well, why? You know, when we can, when we can fix that and make it better, Nature, it doesn't necessarily equal good, nature's pretty mean, and so I understand people making that argument. I just don't think it's a great argument. But again, you know, my career has been devoted to trying to make things better than what nature wants to do. So you know I'm biased from that point of view. But I agree it's an interesting, you know, this sort of well, tough it up, this is part of life. It's kind of a harsh thing to do, especially when there's treatment. There's some things there aren't treatment for and then it's like, okay, we got to figure out how to get through this as best we can, but there are other things, like the menopause transition, that there's really safe and effective treatment for Why not feel better Yeah?

Speaker 1: 12:32

I agree.

Speaker 3: 12:33

That's where I want to follow up. I'm a researcher by nature, and so can you tell me about how you really dove into the research, who you are following and what kind of tracking are you doing of the success rates of the product?

Speaker 4: 12:49

So, yeah, let's start kind of with the basic research. I'm old enough that my career has spanned the pendulum, so I was practicing before the women's health initiative study, when we were giving harm or place for therapy to everybody, and at the time, appropriately based on the research we had, but in hindsight, inappropriately. When the women's health initiative study came out, it scared everybody And people just stopped everything, which was a total overreaction to that study. And so, as people started looking more carefully into that and more and more data came out, we realized that the data doesn't say that home replacement therapy is unsafe. It says it's a medicine like everything else and you've got to do a risk analysis and make sure that you're doing it correctly and safely. And when done that way, it's very safe. And so there's a lot of data that has come out now that guides us in how to do this safe. And so it turns out, if you look at the data overall, if you start women on hormone replacement therapy before they're 60 and they're on an appropriate candidate for it, they actually have a longer life expectancy and they live healthier lives than women that have never been on. So when done correctly, it's very good for people, not just for their symptoms but for their lung, and I think that is slowly becoming more accepted and realized as people understand what the data says.

Speaker 4: 14:21

I can tell you that I did a ton of research. When we started with NONA, i was reading everything I get my hands on Because, honestly, as a generalist at OBGYN, you really do very little mental parts management. Most of our time is spent with pregnant patients or writing a book or a book Or writing first-control prescriptions or doing surgery for women, and relatively very little of our time is spent doing hormone replacement therapy. So none of us get really good at it when you're sort of a generalist at OBGYN. So when it was like, okay, this is going to be my responsibility, then I really did a deep dive and started reading everything I could and realized how misinformed I was about what's the right way to do it, what's safe, what's not safe, what are even some of the symptoms of menopause that I wasn't recognizing, the age thing we already talked about. And so that continues, obviously, and we move our patients very carefully to make sure that things are safe and working and not causing problems We just had.

Speaker 4: 15:28

So I just had a meeting with our doctors. It's like, hey, just want to make sure anybody seen this problem or that problem or anything that anybody's seeing as a pattern, because we want to make sure that there isn't something that we missed or that's inadvertently. And so far, so good. So April was our two year anniversary. We've had tens of thousands of patients And we haven't seen any problems that would be outside of what you were expecting statistically. You know there's been some tragedy to a couple of patients dying of car accidents that kind of thing, life happens But we really haven't seen anything that really was outside of sort of what you would expect for the normal experience. So I feel very good that what we're doing is safe and it's safe.

Speaker 1: 16:18

Now they'd heard at one point they would. I'm sorry, amanda, go ahead.

Speaker 3: 16:21

I was just gonna say, you know, thank you for that detail. that's explanation. And also, i wonder, coming from a background and this is a very personal question of a mom who died at 62 from stage 4 ovarian cancer and found that obviously, as you know about ovarian cancer very, very late, it's one of those hidden things that people don't find. Is there a connection that you found in your research between hormones and cancer?

Speaker 4: 16:46

So yeah, that's a great question. So, assuming somebody doesn't have a genetic, one of these genetic markers for female cancers, you know there's sub-ethics, the BRCA gene or like the Lynch syndrome, those kind of things. So taking those people out, it turns out that a family history of cancer actually does not increase risk with hormone replacement there, even a close family history On average. If you look at cancer in hormone replacement therapy, you know it's a little nuanced. So there is a for. It's actually kind of interesting For women that have not had a hysterectomy, so they're using both estrogen and progesterone.

Speaker 4: 17:27

There is a slight increased risk of breast cancer, but there's a decreased risk of colon cancer.

Speaker 4: 17:35

When dose correctly does a decreased risk Butteurine cancer, ovarian cancer, sort of neutral, and the big thing, though, is that the cardiovascular risk goes way down, and so that's why, in balance, when you look at the full picture, women on hormone replacement therapy live longer than women without it, and so I think you know you can always sort of pick and choose depending on what argument you're trying to make, and say well, it's increased risk of breast cancer, so women shouldn't be on it. Oh, but it's a decreased risk of colon cancer, so women shouldn't be on it. But to me, what do we want out of life? We want to live longer, healthier lives, and this helps you do that when screened appropriately. So that's kind of the way I look at it. But yeah, the family history thing is actually fairly surprising. Again, once you take those genetic markers out of it, really the data's pretty strong that even a close family history, even of a one-month-sensitive breast cancer, really shouldn't stop somebody from taking on those.

Speaker 1: 18:37

Thank you. So I am currently doing HRT, i do the bioidentical pellets. So my husband asks me this all the time and I never get an answer to this question from my doctor. but how long can one expect to stay on hormone replacement therapy?

Speaker 4: 18:57

Yeah, that's a great question. So it's honestly safe to be on it as long as it's relieving symptoms. My personal opinion and I think that of sort of the consensus opinion is that in general it's best to be on the fewest medicines and the lowest of medicines. That is necessary to achieve your goal. So for some women they come to time when it's no longer necessary And so at that point there's no point. Average women's on hormone replacement therapy for about five years, we'll say so my recommendation generally is, after you've been on it for a few years, things are going well. It may be worth doing a trial off of it. So go off of it for a couple of months, see how you feel. If you feel the same, you don't need it anymore. If you don't go back on it And how I say, be careful about your time, don't do this before your kid's wedding or something You might have been. Life, that's reasonable.

Speaker 1: 19:50

Good advice.

Speaker 4: 19:52

But I mean, I think that's a reasonable way to do it. is the body, is it's very sensitive, and it's the best thing we have to really test how these hormones are working. And so a trial off of it, time in life, where, okay, if you're a little uncomfortable, it's not gonna be, it's not gonna add to some horrible stress you're already under. I think there's a reasonable way to do it And if you don't feel any difference, maybe it's time to be out.

Speaker 1: 20:18

Well, i had to. I was scheduled to have a surgery and when my doctor heard that I was doing the pellets, he asked me to go a cycle without them. And so by the time I went to cycle without them, had the surgery, went through recovery. My husband actually asked me to go back on them. Here's your answer. I'm gonna say I still need them. So you know, i found a significant improvement in my, in my symptoms, and I am an advocate. I know that women are gonna make their own choice. We're just here to educate and, you know, offer resources. So can you tell me a little bit about how you administer them? Is this a pill form, a patch form, like? how are you helping women? And can you do it outside of California or only in California?

Speaker 4: 21:04

So we're in. We just added our 21st state. The first we had it Idaho. So we're in 21 states. We're trying to be. Our goal is to be in all 50 states a year from now, but our 21 states cover over two thirds of the US population. So so we're getting there And it really has to do. Each state has different rules and laws and so obviously we have to do things correct And we also have to be able to ship there. So there's pharmacy laws, there's menace, it's fairly calm. So I work with our pharmacy folks and we kind of look at the legislation, what needs to be done. Idaho is interesting. We actually successfully lobbied Idaho to change some of the rules so that we could work there. So those went into effect July 1. So that's that's why we started there. So that's the. Are we outside of California? He answer. And I'm sorry, i had the, the first half, which was the most more important, have I just Oh, how do you administer?

Speaker 1: 22:09

Is it a parent?

Speaker 4: 22:10

That's right. So we have choices. So we do pills, patches and we do compounded creams. So the pills are sure probably the most. Those patches are pretty traditional. So the pills, you would take a pillow every day. The patch you put on, and you change it twice a week. If you need progesterone, you would take a progesterone pill along with the patch.

Speaker 4: 22:35

The cream is compounded in our pharmacy. So we have our own compounded pharmacies, one in Idaho in California And so those creams are made specifically for the patient's needs And they can be estrogen or progesterone or a combination of estrogen and progesterone, and this it's a little amount of cream that's rubbed, usually into the inner arm, but there's different places that can be placed And that's done once a day as well. So there's different options And really they all work well. Mostly it comes down to sort of personal preference, cost and the thing. But occasionally I have somebody who for one reason or another and I don't really understand why seem to respond better to one over the other. So sometimes we'll have somebody on a bill and it doesn't seem to be quite doing it And we'll switch them to the cream and it works better, or sometimes vice versa. But for the most part my experience is most women will respond well to any of those modalities And they're all pretty pretty easy to do and and to use.

Speaker 3: 23:41

So you were saying if a woman is a good candidate, what is the screening process like?

Speaker 4: 23:46

So we have an onboarding, what's called an online adaptive interview that basically asks probing questions And the questions will change, you know, depending on the answers, and it's really so. This was interesting, so I designed this And it really, for me, it was a whole had to change my thinking pattern to design this because, you know, when you go to a doctor's office for the first time, they give you a big book to fill out of like everything you know, and that's sort of what I was used to And I realized this is just too cumbersome And it's like do I really need this information? Like I don't need to know if you sprained your ankle on your kid safely or why do you want to replace on therapy. So the idea was really to wean this down, ask everything I really needed to note into safely and nothing else, and so that was a process, and so the, the, the onboarding really is designed in some ways to kick you out.

Speaker 4: 24:47

So I want to make sure that safety is our safety. Safety, safety is our most important thing. I really love your off lashes, but I kill you. I haven't done you any any good, so that's absolutely what's important. So you know, we ask age, gender, certain medical conditions that would be unsafe. If you've got a serious heart condition, if you have uncontrolled high blood pressure blood pressure is controlled, that's fine. You have a history of blood clots, like dbt or something called a PE or a condition that puts you at higher risk for that, that would be a reason not to use it. If you have active liver disease or a serious liver problem, that would be a reason to use it. So it's all these different questions to make sure that you know your medical history is safe and your reasonable candidate for this. We also obviously. Then we ask your symptoms And we show you options.

Speaker 4: 25:49

You know those patch cream kind of. Here's the advantages for advantages, see what you want. And then I have an algorithm I developed took me about 1000 patients, really nail this down. That then puts out this is the recommendation And then if that looks good for the patient, they say, yeah, this is something I would like mechas to the doctor. The doctor reviews it, sometimes follows up with some questions they might have or, if everything goes great, goes ahead and approves the prescriptions let's go to our pharmacy and then get miled. So it's a really convenient way The way I ever ask to leave their house convenient And the nice thing is convenient for the patient but it's also convenient for the doctors, so we can do this in between patients or, you know, get up in the morning over your morning coffee, kind of, see the patients, right, and so it makes it a nice way where the doctors to practice medicine as well, which I think is also important, and that's something, quite honestly, that's been going away quite a bit in health.

Speaker 4: 26:58

So the idea was to try to design something both patient friendly and doctor friendly to. You know, make this work fast.

Speaker 1: 27:08

So you didn't. you didn't say it, but I kind of heard you talking, you saying insurance companies there When you said doctors, life aren't so easy, that's what I heard you say was insurance company. But speaking of insurance companies, is your product covered by insurance companies?

Speaker 4: 27:23

So we don't do insurance. However, we do take HSA and FSA cards, sure, so a lot of patients use that And then some patients will build the insurance strictly themselves and have had success for that. So it really depends on the insurance and deductibles and there's just so many plans. But we don't sort of take insurance in that matter, but a lot of Probably helps keep your cost down a little bit too right.

Speaker 4: 27:54

That keeps definitely helps keep the cost down, and that's one of the things, that's one of the other things. you know, we try and do this as efficiently as possible because we want to keep cost down and make this as affordable as possible.

Speaker 1: 28:10

Yeah, because pellets definitely are not cost-effective.

Speaker 4: 28:15

They're not cheap, that's for sure, but if they work well for you, it may be worth it. Yeah, it's worth it. Yeah, this should be significantly less expensive than pellet therapy.

Speaker 1: 28:27

So you didn't mention testosterone in there. So part of my pellets is estradiol And I don't remember how to pronounce it, and a little bit of testosterone, but you don't prescribe testosterone as part of your therapy.

Speaker 4: 28:41

So the problem is testosterone is a controlled substance And so legally we can prescribe testosterone in the way we do pellets. However, we use a supplement called DHEA, which is also a bioidentical hormone, and DHEA gets broken down into estrogen and testosterone really within 30 minutes of taking it. The estrogen is pretty minimal. It's a testosterone that we're really after, and DHEA will raise testosterone. So that's how we give women the testosterone they need. It's sort of an indirect way to do it legally.

Speaker 4: 29:14

The other nice thing about DHEA DHEA is an interesting medicine really. Dhea is a performance enhancing drug. So you see bodybuilders and other athletes using these ridiculous quantities ridiculous, the wrong word, but very high dose quantities or dosages of DHEA, and in those dosages it can cause significant side effects, because it works, yeah, if you really raise testosterone and cause, you know, these testosterone side effects. So we are really careful and we don't prescribe above 50 milligrams And mostly we start at 25 and we go 50. And at that dose it's enough to get your testosterone sorted to normal female levels, but not enough to push it into sort of athlete levels. That's really what we're after.

Speaker 4: 30:03

So we're not prescribing this as a performance enhancing drug or that kind of thing. We really just trying to get people back to where they should be normally so they can feel better, and the DHEA works quite well for us. So that's how we do our sort of quib testosterone. It's also when you're using testosterone injections or testosterone cream. Testosterone levels really need to be watched, because testosterone is tricky And it's pretty easy to go overboard and cause problems with DHEA. So let me say 50 milligrams or less. You really don't need to do that. So it makes it a lot more simple for the patient And, again, it's affordable, because blood tests are expensive and they're kind of a hassle.

Speaker 1: 30:45

So DHEA is over the counter supplement.

Speaker 4: 30:48

DHEA is over the counter supplement, we do provide it. We treat it like a prescription through Winona. So you know, someone can't just kind of go on and order DHEA. Everything wants again just as a safety feature. You want everything to go through the physician.

Speaker 4: 31:08

The interesting thing, which I think is really cool and proud of, we've gotten big enough that we are.

Speaker 4: 31:17

We've got a lot of DHEA And so we're ordering pills in millions of quantities at a time And because of that we have a lot of control over the manufacturer of this. So we have our sources, are basically doing runs just for us And so we can demand what we want, and so we know that our DHEA is really high quality. We're able to demand a really small capsule, make it more convenient because of the volume we're doing. It gives us a lot of control, which we like, and we think that it's sort of a safer way to do it, especially with a supplement, because there isn't the same quality control of supplements as there are with the pharmaceuticals. So this gives us a lot. It gives us more control And we know you know, we know with our DHEA what women are getting and that it's really the real thing and it has what it's supposed to have, and so that is, you know, one advantage. But certainly DHEA can. You can order on Amazon as well.

Speaker 1: 32:13

Yeah, we just worry about that when you're ordering supplements or any supplement that you take, whether it's DHEA or, you know, magnesium, like how much of it is actually bioavailable to your body?

Speaker 4: 32:24

Exactly And that's a big question that with the, with the pharmaceuticals, it's a full. The FDA treats them in a whole different way And there's a lot more oversight and supervision, but with the supplements kind of a lot more loosey-goosey, and so you know, there can be a lot more games played, unfortunately, with what's being supplied.

Speaker 1: 32:45

Amanda, I want to keep interrupting you.

Speaker 3: 32:49

You're fine. I'm just going to switch gears a little bit to you as a professional, like when you gave the last example, is your eyes lit up like a Christmas tree. So as we go through our careers, our purpose changes like what is the? what is your purpose in this season of your career right now? What brings your career bliss?

Speaker 4: 33:07

So Winona has just has been amazing. This is, it was just sort of surprise thing and it's just turned into this incredibly cool thing. So to start something like this from scratch and get to where we are now and really we make such a difference in a lot of women's lives, it's. It's funny. You know, we all have bad days, so my docs I'll tell them if they're having a bad day. I'm like, go on Trustpilot and read a few reviews. That'll, that'll make you, i'll give you that good feeling inside that we make.

Speaker 4: 33:43

So, as you forget, what a difference that we make And it's spending incredibly rewarding. It's also, you know, i've never done anything like this before and apparently I mean I guess success will says that but apparently I have some skills that I didn't realize I have in running and growing a business And the amount of stuff I've learned, not just medicine but business-wise in the last three years. I love to learn And it's just been an incredible experience And so for me this has been great. And then the other nice thing about it, quite honestly, is that I was doing eight to 10, 24-hour shifts a month in the hospital And now I'm only doing two shifts a month and I'm spending. I'm honestly just part of the thing. I'm more time working, but I'm doing it from home. So my wife, 35 years, so that I, you know, we get to go, i run errands with her or we'll take a walk in the forest or whatever, and then I can get back, and so it's been for me personally, this has been a really, really great season.

Speaker 3: 34:52

Yeah, i was picking up on that. I was picking up on the skill of the medicine and being a doctor, but also adding in the entrepreneurial side of you and the creative side, and so I was expecting that answer And I think that's super exciting for our listeners too to let them know and remind them like, as we grow and transition in our lifespan, we can redefine our careers and find some agency so we find more joy and do what we love but have more time with our families, which is really cool.

Speaker 4: 35:20

Yeah, it's been great for me.

Speaker 1: 35:22

So if our listeners are tuned in today and they're on the fence you know about HRT maybe they should just go get the synthetic from their OBGYN or maybe reach out and work with you Like, what advice would you give to these women?

Speaker 4: 35:38

So do something. And you know what do we say in the operating room The enemy of good is better. And so if you're more comfortable seeing your doctoring sort of a brick and mortar, traditional sense and that's your comfort level do that, but don't. And then if you get sort of blown off or whatever, then maybe explore another option. If, on the other hand, this sounds like a more convenient and a comfortable way of doing that, this is a very safe way to do it. And so, you know, go online, buywanonacom or one of our competitors. But, you know, don't not get yourself feeling better because you're sort of a parade of the process. I think there's no reason to suffer through this. You know, you might as well feel the best you can.

Speaker 1: 36:38

I love that advice. I will add my unprofessional advice, but just as a professional podcaster. if you walk in there, excuse me and tell your doctor that you're having these symptoms, you can't sleep, and he hands you a prescription for an antidepressant based on those few symptoms alone, i think you probably need to seek some other opinions on that. That's just been my experience. So that's my two cents. Amanda, you got anything to add to that?

Speaker 3: 37:05

Just that, if he or she hands you an antidepressant. Oh yes, that's true. We have a lot of fantastic female doctors.

Speaker 1: 37:13

Sorry, sorry, sorry.

Speaker 3: 37:15

No, it's Dr Green. I have to say it, it's my treaty.

Speaker 1: 37:19

No worries. So, dr Green, where can people sort of like find out more about you? I know you have a YouTube channel called see I wrote it down here MedTwice which there are lots of videos on there that were very interesting. You have a Facebook group called Winona Women and I understand you are doing some bi-monthly webinars for free. is that, if they're inside your Winona program?

Speaker 4: 37:42

So I'll back up. So MedTwice actually is kind of interesting. That was a project my son and I did years and years ago. It's not really HRT focused, it's mostly focused. And we he got frustrated online because he's like there's all this stuff, but how do I know that it's real advice, like who's doing this? And so we made these little videos of me explaining stuff. It was like 250 videos, Yeah, But mostly it was OP. That's mostly what I was doing, Me kind of seeing me younger back then. Yeah, we didn't really promote it and it became actually a fairly successful YouTube channel. It's kind of funny, But that sort of still lives. But we haven't touched that long time.

Speaker 1: 38:21

It's on the internet. It's always there.

Speaker 4: 38:23

But it's unknowful. Yeah, it was funny. Last year I was covering for another doctor. I ran into to do a delivery because they weren't making it in time And she's you're the YouTube doctor. I think it was worksided that I delivered. I was like it was a big celebrity delivering it.

Speaker 1: 38:39

It was funny.

Speaker 4: 38:41

But so, yeah, that is a place to go, but we don't have a lot of HRT. So on, i went on. We have a very large patient education section. I've always felt that my primary role is an educator, so my job is to educate people about various options, what I think they're going through my advice, but here's ways to do it, and then the patient has to decide, you know, what's going to be the right match for them, and so we've really done that, i think. Well, on our site.

Speaker 4: 39:10

So there's a huge library of blog articles, all sort of referenced, you know, to show the scientific, you know, merit to what we're, what we're talking about. There's also a lot of videos, depending on the format that you're interested in. We do you two live Q&As a month. One of them is primarily for existing customers and one of them is for, you know, what we call prospects. People are thinking about this but have questions. So, and the reason that we do it that way is the questions tend to be different. We do have some crossover. We don't say you can't come on unless you're this, but that's sort of the emphasis, because the questions, when you've been on it for three or four months, may be different than the questions when you're considering. So we do that And you see, myself, dr Brown also. She calls, or sometimes she does them kind of depending on our schedules, and so we spend about an hour people put in their questions and the answer in our lives format. So we try to reach out.

Speaker 4: 40:12

Our Facebook group is very active. That's moderated, but not by the doctors. We purposely kind of don't want to do that. We want to let the really up here to peer discussion group. In case you're, there's crazy stuff we take down, but not very often. So if people started getting mean or abusive, we take that stuff down. Or if somebody's putting stuff that they can't back up, that's crazy. We take that down because we don't want misinformation. But for the most part we let it be up here to peer discussion. That's been very helpful for a lot of patients. So that's another avenue. We've tried to many different ways as we can think of, as people learn, different ways We try to supply education for patients or perspective patients.

Speaker 1: 40:57

Any Instagram channel that you have heard of.

Speaker 4: 41:00

Yeah, we do And honestly I don't. I'm embarrassed. I don't know the handle or the name or whatever it's called for the Instagram channel, but I'm sure if you search by one of them and I on Instagram.

Speaker 3: 41:14

You'll find it. She's really good with that stuff. So let me ask you just out of curiosity how did you name the company?

Speaker 4: 41:21

So the company was named actually before I sort of was brought back in. It's named after. It's a Native American name, i forget which, i forget which name. American language now, that basically is strong daughter, strong woman. Oh well, that is.

Speaker 1: 41:40

Oh, so we'll have to look that up. Well, Dr Green, thank you so much for taking time out of your busy schedule to come on and answer all Amanda and my questions and to help educate our audience. Really appreciate you being here with us today.

Speaker 4: 41:55

It's a pleasure.

Speaker 3: 41:57

I'm definitely signing up for a consultation, so you have one new prospect.

Speaker 1: 42:01

Bea and I already met my goal for the day right there.

Speaker 4: 42:06

Well, what? Yeah, hopefully you're in one of my states that I'd be very happy to take. You are the Illinois guy, i am the Illinois guy, all right? Well, it's been a lot of fun. I appreciate the opportunity to talk to you too.

Speaker 3: 42:23

People. What you're doing, i love it. What a great mission and purpose. So thank you so much. It's been a fascinating conversation with you.

Speaker 1: 42:29

All right, everybody, until next week. Please remember to take good care of you. Well, that's a wrap for this week. Thank you so much for joining us. We're so glad to be here with you.

Speaker 2: 42:39

And just remember, we're here to reach out, connect with us on social media platforms and dig in deeper.

Speaker 1: 42:46

All those links will be in the podcast show notes. So join us. We can't wait to continue the conversation with you over there.