1 00:00:09,560 --> 00:00:09,720 Speaker 1: Hi. 2 00:00:09,960 --> 00:00:13,840 Speaker 2: I'm Laura Vanderkamp. I'm a mother of five, an author, journalist, 3 00:00:13,880 --> 00:00:14,440 Speaker 2: and speaker. 4 00:00:15,320 --> 00:00:19,120 Speaker 3: And I'm Sarah hart Hunger, a mother of three, practicing physician, writer, 5 00:00:19,440 --> 00:00:22,280 Speaker 3: and course creator. We are two working parents who love 6 00:00:22,320 --> 00:00:24,000 Speaker 3: our careers and our families. 7 00:00:24,720 --> 00:00:27,360 Speaker 2: Welcome to best of both worlds. Here we talk about 8 00:00:27,360 --> 00:00:30,360 Speaker 2: how real women manage work, family, and time for fun. 9 00:00:30,880 --> 00:00:33,360 Speaker 2: From figuring out childcare to mapping out long. 10 00:00:33,280 --> 00:00:34,200 Speaker 4: Term career goals. 11 00:00:34,440 --> 00:00:39,320 Speaker 2: We want you to get the most out of life. 12 00:00:41,120 --> 00:00:43,559 Speaker 4: Welcome the best of both worlds. This is Laura. This 13 00:00:43,720 --> 00:00:47,240 Speaker 4: episode is airing in early June of twenty twenty six. 14 00:00:47,680 --> 00:00:50,520 Speaker 2: Sarah is going to be interviewing doctor Jillian Goddard, who 15 00:00:50,600 --> 00:00:53,320 Speaker 2: is repeat guests on the show. She's also the author 16 00:00:53,360 --> 00:00:56,400 Speaker 2: of the brand new book The Hormone Loop, talking all 17 00:00:56,560 --> 00:01:01,200 Speaker 2: about hormones through women's life cycles. Lot we are going 18 00:01:01,240 --> 00:01:06,360 Speaker 2: to learn about that. So, Sarah, you've met Gillian in person? 19 00:01:06,760 --> 00:01:07,880 Speaker 5: Yes, I love Jillian. 20 00:01:07,959 --> 00:01:11,520 Speaker 3: Jillian is a three time about before time attendee of 21 00:01:11,560 --> 00:01:14,040 Speaker 3: Best Leaved Plans Lives, so it's been thrilling to get 22 00:01:14,040 --> 00:01:16,720 Speaker 3: to actually know her that way. Although even before that, 23 00:01:16,840 --> 00:01:20,119 Speaker 3: she was a vocal member of our Patreon group and. 24 00:01:20,040 --> 00:01:21,360 Speaker 5: Now she's someone that I text. 25 00:01:21,840 --> 00:01:24,160 Speaker 3: I wouldn't say all the time, but definitely when various 26 00:01:24,200 --> 00:01:26,120 Speaker 3: things come up that I know that would amuse her 27 00:01:26,920 --> 00:01:30,520 Speaker 3: different hormonal related stuff. We bond on the pediatric versus 28 00:01:30,560 --> 00:01:34,720 Speaker 3: adult endochronology kind of playing field. And yeah, it's been 29 00:01:34,760 --> 00:01:37,399 Speaker 3: so fun to get to know her. You have actually 30 00:01:37,560 --> 00:01:40,560 Speaker 3: traveled with Jillian, I believe. Yeah, well, I sort of 31 00:01:40,600 --> 00:01:43,440 Speaker 3: met her in person. We'd corresponded over the years, and 32 00:01:43,440 --> 00:01:46,639 Speaker 3: then she did a Tranquility by Tuesday in real life 33 00:01:46,760 --> 00:01:49,560 Speaker 3: video for me, so I traveled to our house in 34 00:01:50,160 --> 00:01:53,880 Speaker 3: Upstate New York and filmed with her, and then she 35 00:01:54,000 --> 00:01:58,280 Speaker 3: and I actually went to Boston to gather to go 36 00:01:58,440 --> 00:02:02,480 Speaker 3: see Beethoven's eighth and ninth Symphonies and for the Boston 37 00:02:02,520 --> 00:02:03,520 Speaker 3: Symphony Orchestra there. 38 00:02:03,560 --> 00:02:04,280 Speaker 4: That was a lot of fun. 39 00:02:04,440 --> 00:02:07,320 Speaker 2: We'd also done a trip to the New York Botanical 40 00:02:07,360 --> 00:02:09,400 Speaker 2: Gardens to see the Orchid Show the year before that, 41 00:02:09,480 --> 00:02:10,360 Speaker 2: so we've had a lot of. 42 00:02:10,400 --> 00:02:13,040 Speaker 4: Fun getting to know her. Afinite friend of the show. 43 00:02:13,560 --> 00:02:16,040 Speaker 2: And yeah, now it was fun to see her writing 44 00:02:16,160 --> 00:02:17,519 Speaker 2: career take off too. 45 00:02:17,919 --> 00:02:20,520 Speaker 3: Yes, Jillian's kind of like one of those like up 46 00:02:20,520 --> 00:02:23,079 Speaker 3: for anything kind of people, and it makes her a 47 00:02:23,120 --> 00:02:24,680 Speaker 3: lot of fun to be with, and she also has 48 00:02:24,680 --> 00:02:26,919 Speaker 3: a gift for explaining things really well, which I think 49 00:02:26,960 --> 00:02:29,880 Speaker 3: you will get to experience in this episode, which is 50 00:02:29,919 --> 00:02:31,920 Speaker 3: going to be all about hormones, and we'll certainly be 51 00:02:32,000 --> 00:02:36,160 Speaker 3: touching on topics like menopause and perimenopause. So I'm going 52 00:02:36,200 --> 00:02:40,560 Speaker 3: to pivot to that subtopic. Laura, I think you're in 53 00:02:40,600 --> 00:02:42,359 Speaker 3: perimenopause today. 54 00:02:42,520 --> 00:02:45,640 Speaker 4: I don't know. I mean, I don't exactly have a 55 00:02:45,639 --> 00:02:48,079 Speaker 4: whole lot of symptoms related to that. 56 00:02:48,560 --> 00:02:52,839 Speaker 2: I guess just through sheer age, one would suspect that 57 00:02:53,160 --> 00:02:55,639 Speaker 2: I'm or at least in the late reproductive years, as 58 00:02:55,680 --> 00:02:57,800 Speaker 2: she would put it, as I am in my late 59 00:02:57,919 --> 00:03:01,880 Speaker 2: forties here, I mean, knock on wood, gosh, I don't 60 00:03:01,880 --> 00:03:06,160 Speaker 2: want to jinx myself here, like I'm about to get 61 00:03:06,200 --> 00:03:09,600 Speaker 2: struck down by the hot flash like bolts of lightning here, 62 00:03:11,440 --> 00:03:12,560 Speaker 2: how about you, Sarah. 63 00:03:12,680 --> 00:03:14,840 Speaker 5: Yeah, I'm not entirely sure. 64 00:03:15,720 --> 00:03:21,040 Speaker 3: I am definitely in the like enhanced PMS, mood swings, 65 00:03:21,320 --> 00:03:26,440 Speaker 3: periody symptoms era, but with like very regular cycles. So 66 00:03:26,680 --> 00:03:30,400 Speaker 3: I'm just not sure that qualifies because that's sort of 67 00:03:30,400 --> 00:03:33,000 Speaker 3: been true for me for even since late thirties. So 68 00:03:33,040 --> 00:03:36,120 Speaker 3: I'm just not sure I can call it perimenopause. And 69 00:03:36,200 --> 00:03:38,680 Speaker 3: also I didn't have a lot of years of, like 70 00:03:39,040 --> 00:03:42,360 Speaker 3: ever experiencing nice, normal cycles to compare it to. 71 00:03:42,600 --> 00:03:45,200 Speaker 5: So yeah, I don't know. I know my day is coming. 72 00:03:45,560 --> 00:03:47,760 Speaker 3: Every once in a while, in the right phase of 73 00:03:47,760 --> 00:03:49,760 Speaker 3: my cycle, I'm like, I do feel kind of hot. 74 00:03:50,000 --> 00:03:54,640 Speaker 2: So it comes for all of us eventually. But we 75 00:03:54,720 --> 00:03:57,560 Speaker 2: will hear what Jillian has to say about that. So 76 00:03:57,600 --> 00:04:01,320 Speaker 2: here's the interview Sarah did with Jillian about the Hormone Loop. 77 00:04:02,200 --> 00:04:04,440 Speaker 3: Well, I am so excited to be here today with 78 00:04:04,520 --> 00:04:07,360 Speaker 3: doctor Gillian Goddard, who has been on the show before 79 00:04:07,560 --> 00:04:12,119 Speaker 3: as a endochronologist and hormone expert, and is also part 80 00:04:12,200 --> 00:04:14,960 Speaker 3: of the Best Laid Plans Best of Both Worlds Universe 81 00:04:15,120 --> 00:04:18,159 Speaker 3: because she has been a three time Best Laid Plans 82 00:04:18,200 --> 00:04:19,120 Speaker 3: Live attendee. 83 00:04:19,720 --> 00:04:21,880 Speaker 5: Introduce yourself, Billian. We're so excited to have you. 84 00:04:22,760 --> 00:04:26,400 Speaker 1: Yes, I'm doctor Gillian Goddard. I'm an endochronologist. I'm also 85 00:04:26,640 --> 00:04:31,120 Speaker 1: the author of the forthcoming book The Hormone Loop and 86 00:04:31,360 --> 00:04:33,080 Speaker 1: the sub Stack, The Savvy Patient. 87 00:04:34,040 --> 00:04:35,839 Speaker 4: I'm delighted to be back. 88 00:04:36,440 --> 00:04:39,800 Speaker 3: Yes, and remind our listeners you live outside of New 89 00:04:39,920 --> 00:04:42,520 Speaker 3: York and you have kids at wet age stages. 90 00:04:42,920 --> 00:04:46,240 Speaker 4: Yeah. So I live just north of New York City 91 00:04:46,320 --> 00:04:47,560 Speaker 4: and I have four. 92 00:04:47,400 --> 00:04:52,600 Speaker 1: Kids and they are eighteen, fifteen, thirteen, and ten. 93 00:04:53,520 --> 00:04:57,159 Speaker 3: Awesome, And currently you are splitting your time between this 94 00:04:57,320 --> 00:05:00,159 Speaker 3: amazing kind of public facing work that you've done with 95 00:05:00,160 --> 00:05:02,120 Speaker 3: the hormone move that we're going to talk about today, 96 00:05:02,400 --> 00:05:05,719 Speaker 3: as well as your awesome newsletter The Savvy Patient, as 97 00:05:05,720 --> 00:05:07,600 Speaker 3: well as still very active clinically. 98 00:05:07,640 --> 00:05:08,080 Speaker 5: Is that right. 99 00:05:08,839 --> 00:05:11,520 Speaker 1: Yeah, I still see patients for two very full days 100 00:05:11,640 --> 00:05:16,320 Speaker 1: a week, but I really like the division between being 101 00:05:16,360 --> 00:05:19,000 Speaker 1: in the office seeing patients. I have patients that I've 102 00:05:19,000 --> 00:05:22,000 Speaker 1: been seeing for so many years, and I really love 103 00:05:22,040 --> 00:05:26,320 Speaker 1: having those relationships. But you can only meet so many people, 104 00:05:26,480 --> 00:05:28,960 Speaker 1: and you can only connect with so many people one 105 00:05:29,000 --> 00:05:30,040 Speaker 1: on one in the office. 106 00:05:30,200 --> 00:05:32,000 Speaker 4: And one of the things that I really wanted to 107 00:05:32,040 --> 00:05:33,320 Speaker 4: do was. 108 00:05:34,360 --> 00:05:38,400 Speaker 1: Help people who I can't see in the office understand 109 00:05:38,440 --> 00:05:41,800 Speaker 1: what's going on from a hormonal point of view. Most 110 00:05:41,839 --> 00:05:45,359 Speaker 1: people don't have access to an endochronologist. As you know, 111 00:05:45,520 --> 00:05:49,320 Speaker 1: there are very few of us, relatively speaking, and so 112 00:05:50,279 --> 00:05:54,719 Speaker 1: writing really felt like a good way to reach more 113 00:05:54,760 --> 00:05:58,000 Speaker 1: people and give people the information they need so that 114 00:05:58,040 --> 00:06:01,760 Speaker 1: they can talk to their primary case doctors. They're gynecologists 115 00:06:02,520 --> 00:06:04,680 Speaker 1: and feel more prepared for those conversations. 116 00:06:05,120 --> 00:06:08,320 Speaker 3: Yes, and you are so good at explaining these concepts, 117 00:06:08,360 --> 00:06:11,440 Speaker 3: at kind of explaining different options for different things in 118 00:06:11,480 --> 00:06:14,280 Speaker 3: a very non judgmental but also very clear manner, and 119 00:06:14,320 --> 00:06:17,440 Speaker 3: I think that's what's going to make your book so special. 120 00:06:17,520 --> 00:06:20,840 Speaker 3: And just to remind listeners, I'm a pediatric endocrinologist and 121 00:06:21,080 --> 00:06:23,839 Speaker 3: Jillian is an adult endocrinologist. And yeah, I guess we 122 00:06:23,880 --> 00:06:26,719 Speaker 3: both see patients part time, but what we do with 123 00:06:26,760 --> 00:06:29,239 Speaker 3: our creative portions is definitely a little bit different because 124 00:06:29,240 --> 00:06:33,039 Speaker 3: hers is still entirely clinical. Well, we're going to kick 125 00:06:33,040 --> 00:06:35,320 Speaker 3: things off talking a little bit about Well, this one's 126 00:06:35,360 --> 00:06:37,880 Speaker 3: almost my realm, but you have a whole chapter dedicated 127 00:06:37,920 --> 00:06:41,640 Speaker 3: to it in the book, and that is puberty. Jillian, 128 00:06:42,120 --> 00:06:44,400 Speaker 3: what do you feel like people get wrong about puberty? 129 00:06:45,120 --> 00:06:49,039 Speaker 1: Well, I think people are really fearful of puberty. They 130 00:06:49,120 --> 00:06:54,160 Speaker 1: have negative memories about it themselves. They tend to be 131 00:06:54,360 --> 00:06:58,159 Speaker 1: times when we don't feel always so confident in who 132 00:06:58,160 --> 00:07:01,440 Speaker 1: we are, and so I think as parents, a lot 133 00:07:01,440 --> 00:07:04,159 Speaker 1: of times we're projecting that onto our kids, and our 134 00:07:04,240 --> 00:07:08,040 Speaker 1: kids don't necessarily have those preconceived ideas about puberty, So. 135 00:07:08,760 --> 00:07:10,440 Speaker 4: That's one thing. I think. 136 00:07:10,480 --> 00:07:13,640 Speaker 1: The other thing is there have been a lot of 137 00:07:13,720 --> 00:07:17,760 Speaker 1: discussions around this idea that puberty and girls in particular 138 00:07:17,960 --> 00:07:22,800 Speaker 1: is moving earlier, and while there are aspects of that 139 00:07:22,880 --> 00:07:27,640 Speaker 1: are true, this is both a phenomenon that's not new. 140 00:07:28,720 --> 00:07:32,000 Speaker 1: Puberty has been moving earlier in girls since at least 141 00:07:32,080 --> 00:07:36,560 Speaker 1: the eighteen fifties, so definitely not a new phenomenon, but 142 00:07:36,800 --> 00:07:41,200 Speaker 1: also the start of puberty in girls, which is marked 143 00:07:41,240 --> 00:07:45,560 Speaker 1: by the development of breast buds, it has moved earlier, 144 00:07:46,720 --> 00:07:50,600 Speaker 1: and this time of the first menstrual period has also 145 00:07:50,680 --> 00:07:54,800 Speaker 1: moved earlier, but not as much. So puberty is starting 146 00:07:54,800 --> 00:07:56,960 Speaker 1: a little earlier, but it's also gotten longer. 147 00:07:57,760 --> 00:07:59,880 Speaker 5: Yay yay, I know. 148 00:08:00,000 --> 00:08:02,560 Speaker 3: But I also find that, like, actually just the fact 149 00:08:02,600 --> 00:08:06,600 Speaker 3: that puberty is a year's long experience is something that 150 00:08:07,160 --> 00:08:09,560 Speaker 3: some people struggle with, either thinking of it as like 151 00:08:09,600 --> 00:08:13,400 Speaker 3: a moment like, oh, the period means puberty, or thinking 152 00:08:13,440 --> 00:08:16,840 Speaker 3: that the minute that a child shows one change like 153 00:08:16,960 --> 00:08:20,000 Speaker 3: having some hair growth or breast development, that things it's 154 00:08:20,040 --> 00:08:21,600 Speaker 3: going to be all over in a month or something 155 00:08:21,640 --> 00:08:21,960 Speaker 3: like that. 156 00:08:22,360 --> 00:08:24,800 Speaker 1: Yeah, And I think that in particular can cause a 157 00:08:24,800 --> 00:08:28,760 Speaker 1: lot of anxiety among parents and kids because they like 158 00:08:28,800 --> 00:08:32,960 Speaker 1: smell some body odor, or they see a little tiny 159 00:08:33,000 --> 00:08:37,319 Speaker 1: breast bud and they're convinced that their eight or nine 160 00:08:37,360 --> 00:08:39,040 Speaker 1: year old's going to get our period next week. 161 00:08:39,080 --> 00:08:40,720 Speaker 4: And luckily that is not the case. 162 00:08:41,040 --> 00:08:44,880 Speaker 1: Puberty lasts on average for two to two and a 163 00:08:44,920 --> 00:08:49,360 Speaker 1: half years from breast bud to first period, so it 164 00:08:49,440 --> 00:08:51,480 Speaker 1: is definitely not an overnight phenomenon. 165 00:08:52,240 --> 00:08:54,640 Speaker 5: Yes, so it's definitely helpful to clear that up. 166 00:08:54,640 --> 00:08:57,080 Speaker 3: And your book talks about all of the loops and 167 00:08:57,160 --> 00:09:01,920 Speaker 3: how we have like the GnRH stimulating the pituitary hormones 168 00:09:01,920 --> 00:09:05,200 Speaker 3: to then start causing the overreas and girls to make estrogen, 169 00:09:05,200 --> 00:09:07,240 Speaker 3: and if you want the total details of that and 170 00:09:07,280 --> 00:09:10,480 Speaker 3: how that loop works, including the magic of well not magic, 171 00:09:10,520 --> 00:09:13,240 Speaker 3: the science of ovulation. You get that in the hormone 172 00:09:13,320 --> 00:09:17,320 Speaker 3: loop as well. Yeah, so I think this is great 173 00:09:17,360 --> 00:09:20,280 Speaker 3: for parents of teens or parents of younger kids who 174 00:09:20,280 --> 00:09:23,960 Speaker 3: they're wondering what is going to happen. But I think 175 00:09:24,000 --> 00:09:26,080 Speaker 3: the bulk of the book, and probably the bulk of 176 00:09:26,120 --> 00:09:30,640 Speaker 3: all the interests comes from lots of explanation about perimenopause 177 00:09:30,679 --> 00:09:35,360 Speaker 3: and all the changes that might go with perimenopause. Julian 178 00:09:35,480 --> 00:09:38,480 Speaker 3: the pendulum has definitely swung. There was a time when 179 00:09:38,520 --> 00:09:41,320 Speaker 3: there was almost nothing, but then that phrase got so 180 00:09:41,440 --> 00:09:43,480 Speaker 3: tired and it was like, now everyone, I mean, maybe 181 00:09:43,520 --> 00:09:44,760 Speaker 3: I'm just targeted. 182 00:09:44,320 --> 00:09:46,280 Speaker 5: But it seems like that trope is over. 183 00:09:46,400 --> 00:09:48,480 Speaker 3: Like the idea that no one's talking about menopause like 184 00:09:48,559 --> 00:09:50,040 Speaker 3: clearly has come to an end. 185 00:09:50,040 --> 00:09:50,520 Speaker 5: Am I right? 186 00:09:52,000 --> 00:09:54,880 Speaker 1: I have that experience too, And again it could be 187 00:09:54,960 --> 00:09:57,199 Speaker 1: that I'm definitely targeted. 188 00:09:56,880 --> 00:09:57,760 Speaker 4: For these things. 189 00:09:58,280 --> 00:10:00,160 Speaker 1: But I do find that as I go out and 190 00:10:00,200 --> 00:10:03,439 Speaker 1: talk to women, they're still very hungry for information. 191 00:10:05,000 --> 00:10:06,040 Speaker 4: And I think that there. 192 00:10:05,960 --> 00:10:09,520 Speaker 1: Is this perception that now there's a lot of information 193 00:10:09,880 --> 00:10:12,800 Speaker 1: out there, but they don't know how to sort through it. 194 00:10:13,280 --> 00:10:17,120 Speaker 1: They don't know how to understand what information they're getting 195 00:10:17,440 --> 00:10:23,680 Speaker 1: is evidence based, is factual, and what information is the 196 00:10:23,800 --> 00:10:27,439 Speaker 1: latest product trying to market to them and get their dollars. 197 00:10:28,400 --> 00:10:32,559 Speaker 1: And in fact, perimenopause there's a huge opportunity for marketing there. 198 00:10:32,600 --> 00:10:34,720 Speaker 1: But that means that there's people going into that space 199 00:10:35,320 --> 00:10:37,920 Speaker 1: with lots of information that may or may not be 200 00:10:38,440 --> 00:10:39,520 Speaker 1: exactly correct. 201 00:10:40,200 --> 00:10:42,840 Speaker 3: Yeah, so then let's talk about it and let's dispel 202 00:10:42,920 --> 00:10:45,600 Speaker 3: maybe some of the myths around it. I guess let's 203 00:10:45,640 --> 00:10:50,839 Speaker 3: start with basics, What defines perimenopause, What discriminates between the 204 00:10:50,920 --> 00:10:53,439 Speaker 3: late reproductive phase and true perimenopause. 205 00:10:53,840 --> 00:10:54,719 Speaker 5: I guess let's start with. 206 00:10:54,679 --> 00:10:59,840 Speaker 1: That, sure, So I think this is the biggest misinformation 207 00:11:00,040 --> 00:11:04,160 Speaker 1: out there. We talk about perimenopause and menopause as this 208 00:11:04,320 --> 00:11:10,920 Speaker 1: like monolithic thing, but the entire process of transitioning through 209 00:11:11,000 --> 00:11:14,760 Speaker 1: the end of our reproductive lives involves a number of 210 00:11:14,800 --> 00:11:18,280 Speaker 1: different stages and phases that each kind of have their 211 00:11:18,320 --> 00:11:22,800 Speaker 1: own flavor, And I think that it is this distinction 212 00:11:23,000 --> 00:11:26,840 Speaker 1: between those stages that is often missed in these conversations 213 00:11:27,120 --> 00:11:32,000 Speaker 1: and leads to a ton of misunderstanding between patients and 214 00:11:32,040 --> 00:11:38,960 Speaker 1: their doctors. So technically, perimenopause is defined us having irregular 215 00:11:39,160 --> 00:11:42,960 Speaker 1: periods related to the fact that the eggs and the 216 00:11:43,000 --> 00:11:47,640 Speaker 1: ovaries are starting to dwindle down in number. But when 217 00:11:47,640 --> 00:11:50,240 Speaker 1: we talk about perimenopause, a lot of times we talk 218 00:11:50,280 --> 00:11:54,160 Speaker 1: about symptoms, and we talk about symptoms like mood changes, 219 00:11:54,280 --> 00:11:59,480 Speaker 1: hot flushes, night sweats. Those symptoms can occur before your 220 00:11:59,520 --> 00:12:05,160 Speaker 1: technically in perimenopause, and this throws people off like crazy. 221 00:12:05,480 --> 00:12:08,439 Speaker 1: So I think it's helpful to just talk through quickly 222 00:12:08,960 --> 00:12:12,840 Speaker 1: what each of the stages of the perimenopausal transition are 223 00:12:13,520 --> 00:12:16,240 Speaker 1: so the first stage I always talk about, and I 224 00:12:16,240 --> 00:12:19,160 Speaker 1: think the stage that does not get talked about enough 225 00:12:19,520 --> 00:12:22,720 Speaker 1: is a stage called the late reproductive stage, and this 226 00:12:22,880 --> 00:12:28,880 Speaker 1: is really a bridge between the peak reproductive years and perimenopause. 227 00:12:29,440 --> 00:12:34,360 Speaker 1: And at this stage, periods are still regular, but our 228 00:12:34,520 --> 00:12:38,240 Speaker 1: swings and estrogen levels are much larger, and this can 229 00:12:38,280 --> 00:12:43,800 Speaker 1: create a lot of symptoms, symptoms like irritability. Some women 230 00:12:43,840 --> 00:12:49,200 Speaker 1: will get diagnosed with PMDD in this stage, hot flushes 231 00:12:49,200 --> 00:12:52,200 Speaker 1: and night sweats, especially around times in this cycle when 232 00:12:52,760 --> 00:12:56,439 Speaker 1: estrogen levels are low. And so that's confusing to people 233 00:12:56,480 --> 00:12:58,199 Speaker 1: because they go to their doctor and they say, I'm 234 00:12:58,200 --> 00:13:01,040 Speaker 1: having all these symptoms. I think it's perimidopause, and their 235 00:13:01,080 --> 00:13:04,040 Speaker 1: doctor asks them a single question, which is are your 236 00:13:04,080 --> 00:13:07,439 Speaker 1: periods regular? They say yes, and the doctor says, well, 237 00:13:07,480 --> 00:13:11,160 Speaker 1: that's not perimenopause, and then we haven't actually dealt with 238 00:13:11,200 --> 00:13:14,600 Speaker 1: the issue, which is that someone's experiencing symptoms that. 239 00:13:14,520 --> 00:13:15,960 Speaker 4: Should be addressed. 240 00:13:17,200 --> 00:13:21,320 Speaker 1: So that is the late reproductive stage, and about half 241 00:13:21,360 --> 00:13:24,960 Speaker 1: of women enter the late reproductive stage between the ages 242 00:13:25,200 --> 00:13:27,199 Speaker 1: of thirty five and forty five. 243 00:13:27,920 --> 00:13:29,520 Speaker 4: Most women enter the late. 244 00:13:29,360 --> 00:13:33,960 Speaker 1: Reproductive stage in their very latter thirties and early forties. 245 00:13:34,480 --> 00:13:37,000 Speaker 3: I definitely am one of those women, and I feel 246 00:13:37,000 --> 00:13:39,320 Speaker 3: like maybe we need a rebranding, like should it be 247 00:13:39,360 --> 00:13:41,400 Speaker 3: called like peri perimenopause? 248 00:13:42,600 --> 00:13:46,959 Speaker 1: I know, right, technically it's not part of the perimenopausal transition, 249 00:13:47,040 --> 00:13:50,960 Speaker 1: and I think it really should be, because the way 250 00:13:51,000 --> 00:13:54,080 Speaker 1: we're talking about perimenopause at this point, it really does 251 00:13:54,240 --> 00:13:55,600 Speaker 1: include some of that time. 252 00:13:56,559 --> 00:13:59,080 Speaker 3: And the truth is, if you have something that has 253 00:13:59,120 --> 00:14:01,400 Speaker 3: some kind of a n name, then maybe it's more 254 00:14:01,520 --> 00:14:04,360 Speaker 3: likely to be addressed. And I guess late reproductive phase 255 00:14:04,400 --> 00:14:08,040 Speaker 3: to me, that just sounds like, eh, it doesn't. 256 00:14:07,760 --> 00:14:10,240 Speaker 4: Exactly trip off the tongue either, does it. 257 00:14:10,760 --> 00:14:14,520 Speaker 1: No, So, the difference between the late reproductive stage and 258 00:14:14,559 --> 00:14:18,520 Speaker 1: or early perimenopause is really about cycle length. And so 259 00:14:18,679 --> 00:14:21,120 Speaker 1: a lot of times when we talk about period regularity, 260 00:14:21,520 --> 00:14:24,640 Speaker 1: people think we're talking about all different aspects of your period, 261 00:14:24,680 --> 00:14:27,560 Speaker 1: But when it comes to perimenopause, we are talking about 262 00:14:27,760 --> 00:14:30,360 Speaker 1: cycle length from the first day of one period to 263 00:14:30,400 --> 00:14:32,320 Speaker 1: the first day of the next, And so what. 264 00:14:32,240 --> 00:14:35,840 Speaker 4: We're really looking for is periods starting. 265 00:14:35,480 --> 00:14:39,160 Speaker 1: To become a regular and irregular is a variability of 266 00:14:39,240 --> 00:14:43,240 Speaker 1: more than seven days from the first day in cycle 267 00:14:43,320 --> 00:14:47,200 Speaker 1: lengths so meaning like, now you have a period that's 268 00:14:47,440 --> 00:14:52,320 Speaker 1: twenty two days, cycle length twenty two days, thirty five days, 269 00:14:52,800 --> 00:14:55,880 Speaker 1: twenty eight days, and you're kind of going back and 270 00:14:55,920 --> 00:14:59,160 Speaker 1: forth between shorter cycles and longer cycles. 271 00:15:00,320 --> 00:15:02,240 Speaker 4: And there's a really interesting study. 272 00:15:02,440 --> 00:15:05,040 Speaker 1: We used to think that people marched through these stages 273 00:15:05,080 --> 00:15:08,120 Speaker 1: in a really organized way, but there's a really interesting 274 00:15:08,160 --> 00:15:12,560 Speaker 1: study that shows that about half of women will seesaw 275 00:15:12,720 --> 00:15:17,960 Speaker 1: back and forth between early perimenopause and the late reproductive stage, 276 00:15:18,320 --> 00:15:23,560 Speaker 1: which confuses people even more because it's unexpected, but it is. 277 00:15:23,480 --> 00:15:25,200 Speaker 4: In fact quite common. 278 00:15:27,040 --> 00:15:30,760 Speaker 1: Once periods space out, once they're more than sixty days 279 00:15:30,960 --> 00:15:34,760 Speaker 1: in length, then we say that you're in late perimenopause 280 00:15:35,560 --> 00:15:38,360 Speaker 1: and that you are likely to have your last menstrual 281 00:15:38,440 --> 00:15:41,280 Speaker 1: period in the next twelve to thirty six months. 282 00:15:41,680 --> 00:15:43,440 Speaker 3: That makes sense, We're going to take a quick break 283 00:15:43,480 --> 00:15:45,800 Speaker 3: and then kind of go back to those earlier stages 284 00:15:45,840 --> 00:15:48,560 Speaker 3: and talk about whether they're interventions. 285 00:16:00,840 --> 00:16:01,880 Speaker 5: All right, we are back. 286 00:16:01,920 --> 00:16:04,800 Speaker 3: So doctor Dylan Goddard has very clearly defined all of 287 00:16:04,840 --> 00:16:09,600 Speaker 3: our phases from the late reproductive phase to perimenopause to 288 00:16:10,040 --> 00:16:13,040 Speaker 3: late perimenopause, which I didn't realize was a thing until 289 00:16:13,080 --> 00:16:17,720 Speaker 3: this book. And then full on menopause, including the fact 290 00:16:17,760 --> 00:16:19,680 Speaker 3: that there are definitely simpler re lines there because you 291 00:16:19,720 --> 00:16:23,040 Speaker 3: can actually bounce back and forth. Is there a time 292 00:16:23,760 --> 00:16:27,720 Speaker 3: at which intervention becomes appropriate or not appropriate? 293 00:16:28,400 --> 00:16:32,480 Speaker 1: If you are having symptoms, we should see if we 294 00:16:32,520 --> 00:16:36,120 Speaker 1: can make those symptoms better, no matter what age or 295 00:16:36,160 --> 00:16:40,760 Speaker 1: stage you are in. The intervention might be a little 296 00:16:40,760 --> 00:16:44,840 Speaker 1: different depending on what age and stage you're in and 297 00:16:44,880 --> 00:16:48,840 Speaker 1: a couple of other factors. But the idea that there 298 00:16:48,920 --> 00:16:51,680 Speaker 1: is a time when it is too early to intervene 299 00:16:52,560 --> 00:16:55,400 Speaker 1: even if you're having symptoms is incorrect. 300 00:16:56,280 --> 00:16:58,040 Speaker 4: And I think that's really important. 301 00:16:57,640 --> 00:17:00,000 Speaker 1: Because I think there's a lot of women out there 302 00:17:00,160 --> 00:17:03,720 Speaker 1: sort of who've either been blown off, been told that 303 00:17:03,760 --> 00:17:07,280 Speaker 1: their symptoms can't be treated or fixed, or they have 304 00:17:07,359 --> 00:17:11,200 Speaker 1: this idea that there's like a correct time to treat 305 00:17:11,240 --> 00:17:14,240 Speaker 1: their symptoms, and that is not true. We can always 306 00:17:14,240 --> 00:17:19,200 Speaker 1: manage symptoms, It just depends the modality just changes. 307 00:17:19,480 --> 00:17:22,000 Speaker 3: And I guess the treatment depends a lot on other 308 00:17:22,080 --> 00:17:24,800 Speaker 3: factors and then also what the symptoms are specifically. 309 00:17:25,760 --> 00:17:30,119 Speaker 1: Yeah, I think one myth that's out there about perimenopause 310 00:17:30,200 --> 00:17:33,360 Speaker 1: right now is that there is one treatment. That treatment 311 00:17:33,440 --> 00:17:37,360 Speaker 1: is hormone therapy and that hormone therapy must be in 312 00:17:37,400 --> 00:17:41,840 Speaker 1: the form of an estrogen patch and a progesterone capsule. 313 00:17:42,119 --> 00:17:44,880 Speaker 4: And not only are there many. 314 00:17:44,680 --> 00:17:50,600 Speaker 1: Other forms of estrogen and progesterone. BIRST control pills can 315 00:17:50,680 --> 00:17:53,360 Speaker 1: be hormone therapy, and I think that catches a lot 316 00:17:53,400 --> 00:17:58,800 Speaker 1: of people off guard. Progestine eluding IUDs can be a 317 00:17:59,080 --> 00:18:02,359 Speaker 1: part of a hormone therapy regimen, and so as many 318 00:18:02,400 --> 00:18:06,320 Speaker 1: people as there are, we can customize a program that 319 00:18:06,680 --> 00:18:09,360 Speaker 1: gets at the symptoms that are causing you the most 320 00:18:09,520 --> 00:18:13,800 Speaker 1: trouble and kind of making sure that we're not causing 321 00:18:13,840 --> 00:18:18,359 Speaker 1: more problems. Women who start on an estrogen patch plus 322 00:18:18,359 --> 00:18:21,479 Speaker 1: the lower dose progesterone when they're still having regular periods, 323 00:18:21,480 --> 00:18:24,040 Speaker 1: it can actually cause a lot of breakthrough bleeding and 324 00:18:24,080 --> 00:18:28,520 Speaker 1: a lot of problems that they didn't have before. And 325 00:18:28,560 --> 00:18:33,320 Speaker 1: so that's why sometimes we'll choose one formulation over another. 326 00:18:33,640 --> 00:18:36,680 Speaker 5: That totally makes sense. So is there a cutoff? 327 00:18:36,840 --> 00:18:40,399 Speaker 3: I guess, like if someone's like I feel like I 328 00:18:40,520 --> 00:18:43,000 Speaker 3: have I don't know, I don't like my periods or 329 00:18:43,000 --> 00:18:44,680 Speaker 3: I don't like my moods around my periods, but they're 330 00:18:44,720 --> 00:18:48,480 Speaker 3: still regular, I guess there's just multiple different options. But 331 00:18:48,560 --> 00:18:51,800 Speaker 3: do those patients ever start on estrogen replacement really early 332 00:18:52,000 --> 00:18:54,639 Speaker 3: or is it usually those patients would be more gravitated 333 00:18:54,680 --> 00:18:57,200 Speaker 3: towards like a birth control type poll. 334 00:18:57,600 --> 00:19:00,480 Speaker 1: Yeah, I find that when women are having regular peers 335 00:19:00,720 --> 00:19:03,360 Speaker 1: of birth control pill tends to be the better way 336 00:19:03,400 --> 00:19:05,840 Speaker 1: to go, even if they take that birth control pill 337 00:19:05,880 --> 00:19:11,800 Speaker 1: continuously without taking breaks to have a withdrawal lead or 338 00:19:12,240 --> 00:19:17,480 Speaker 1: a kind of period, but not, and so that's. 339 00:19:17,320 --> 00:19:18,119 Speaker 4: One great option. 340 00:19:18,320 --> 00:19:21,400 Speaker 1: Another option is if you use a progestine eluding IUD 341 00:19:21,600 --> 00:19:24,919 Speaker 1: for contraception, that can be your progesterone and then you 342 00:19:24,960 --> 00:19:29,840 Speaker 1: can add estrogen in many different forms to your progestine 343 00:19:29,840 --> 00:19:32,960 Speaker 1: eluding IUD to help with your symptoms. So there are 344 00:19:33,000 --> 00:19:36,400 Speaker 1: a couple of ways to handle symptoms and women who 345 00:19:36,440 --> 00:19:39,679 Speaker 1: are younger and still having regular periods. 346 00:19:39,480 --> 00:19:42,280 Speaker 3: Well, let's talk a little bit about the newer kind 347 00:19:42,320 --> 00:19:45,520 Speaker 3: of non traditional or maybe even non hormonal therapies that 348 00:19:45,560 --> 00:19:47,560 Speaker 3: you've seen use, because I think this is a very 349 00:19:47,600 --> 00:19:49,840 Speaker 3: exciting This is an area by the way, where like 350 00:19:50,480 --> 00:19:53,199 Speaker 3: there's a lot of overlap between pediatric endrochronology and adult 351 00:19:53,600 --> 00:19:57,720 Speaker 3: but not here. I know nothing about these medications, but 352 00:19:57,760 --> 00:19:59,720 Speaker 3: you have some newer stuff that you can use for 353 00:19:59,760 --> 00:20:01,160 Speaker 3: some the vasomotor symptoms. 354 00:20:01,160 --> 00:20:02,080 Speaker 5: Can you talk about those? 355 00:20:02,359 --> 00:20:02,520 Speaker 2: Yeah. 356 00:20:02,600 --> 00:20:03,240 Speaker 4: Absolutely. 357 00:20:04,359 --> 00:20:07,879 Speaker 1: Most women can safely take estrogen, but there are a 358 00:20:07,960 --> 00:20:11,080 Speaker 1: small subset of women who cannot, and there are many 359 00:20:11,200 --> 00:20:15,560 Speaker 1: women who prefer to avoid estrogen for a number of reasons. 360 00:20:15,960 --> 00:20:18,000 Speaker 1: And for a long time, we didn't have a lot 361 00:20:18,000 --> 00:20:20,800 Speaker 1: of great options for them. We had some sort of 362 00:20:20,800 --> 00:20:25,760 Speaker 1: off label uses of like antidepressants. They didn't always work 363 00:20:25,960 --> 00:20:29,240 Speaker 1: very well and they didn't work for everyone. So a 364 00:20:29,240 --> 00:20:32,920 Speaker 1: couple of years ago the first of two medications was approved. 365 00:20:32,960 --> 00:20:37,240 Speaker 1: There's actually two of them now, and these are treatments 366 00:20:37,240 --> 00:20:40,880 Speaker 1: that are approved just for addressing hot flushes and night 367 00:20:40,960 --> 00:20:42,800 Speaker 1: sweats without hormones. 368 00:20:44,160 --> 00:20:45,840 Speaker 4: They're called Viosa. 369 00:20:45,480 --> 00:20:50,760 Speaker 1: And Linquet, and the way they work is really interesting 370 00:20:50,800 --> 00:20:55,280 Speaker 1: because they act like estrogen at a single well, at 371 00:20:55,320 --> 00:20:57,680 Speaker 1: one receptor in the case of Viosa, and at two 372 00:20:57,840 --> 00:21:01,359 Speaker 1: receptors in the case of Lindquet, in the brain that 373 00:21:01,400 --> 00:21:05,000 Speaker 1: are in the hypothalamus and the temperature sensing centers of 374 00:21:05,040 --> 00:21:09,199 Speaker 1: the brain, and in doing so they help the body 375 00:21:09,520 --> 00:21:15,840 Speaker 1: tolerate a slightly larger core body temperature range. And so 376 00:21:16,600 --> 00:21:19,480 Speaker 1: that's how they manage hot flushes and night sweats. And 377 00:21:19,520 --> 00:21:22,080 Speaker 1: then it turns out In their clinical trials, they showed 378 00:21:22,240 --> 00:21:25,120 Speaker 1: that when you get rid of hot flushes in night sweats, 379 00:21:26,119 --> 00:21:28,800 Speaker 1: people sleep better too, because a lot of the reason 380 00:21:28,840 --> 00:21:32,119 Speaker 1: women are waking up is because they're having vasomotor symptoms 381 00:21:32,200 --> 00:21:34,600 Speaker 1: in the middle of the night. So I think that 382 00:21:35,520 --> 00:21:39,280 Speaker 1: these can be really great options. I've used them by themselves. 383 00:21:39,359 --> 00:21:43,160 Speaker 1: You can also off label use them with estrogen if 384 00:21:43,160 --> 00:21:47,840 Speaker 1: somebody's still having breakthrough symptoms even on a higher dose 385 00:21:47,880 --> 00:21:51,760 Speaker 1: of estrogen replacement. And they're completely safe for women who 386 00:21:51,840 --> 00:21:54,960 Speaker 1: can't take estrogen, like women who've had estrogen positive breast 387 00:21:54,960 --> 00:21:56,040 Speaker 1: cancer for example. 388 00:21:56,960 --> 00:21:59,399 Speaker 3: Can you talk a little bit about testosterone, which I 389 00:21:59,400 --> 00:22:01,320 Speaker 3: feel like, all so it's having a little bit of 390 00:22:01,320 --> 00:22:04,000 Speaker 3: a moment in older women right now. 391 00:22:04,600 --> 00:22:04,959 Speaker 4: Yeah. 392 00:22:05,560 --> 00:22:13,040 Speaker 1: So women have testosterone naturally, men have estrogen naturally. It's 393 00:22:13,080 --> 00:22:17,320 Speaker 1: just women have much smaller levels of testosterone compared to men, 394 00:22:17,359 --> 00:22:20,520 Speaker 1: and men have much smaller estrogen levels compared to women. 395 00:22:22,280 --> 00:22:25,919 Speaker 1: Around perimenopause, a couple of different things can happen, But 396 00:22:26,119 --> 00:22:28,600 Speaker 1: one of the things that can happen is that testosterone 397 00:22:28,680 --> 00:22:33,000 Speaker 1: levels can fall, and so there's this idea that if 398 00:22:33,040 --> 00:22:36,159 Speaker 1: testosterone levels are falling, they may be contributing to some 399 00:22:36,240 --> 00:22:40,080 Speaker 1: of the symptoms that women are having in perimenopause. The 400 00:22:40,400 --> 00:22:44,840 Speaker 1: tricky thing about this is, while many people talk about 401 00:22:45,000 --> 00:22:49,800 Speaker 1: testosterone is like the thing that fixed whatever ails you like. 402 00:22:49,880 --> 00:22:53,080 Speaker 1: It's gonna help you keep your muscle masks, put a 403 00:22:53,080 --> 00:22:55,960 Speaker 1: spring in your step, make you fall in love with 404 00:22:56,040 --> 00:22:59,720 Speaker 1: your partner all over again, it actually hasn't been studied 405 00:23:00,119 --> 00:23:03,239 Speaker 1: for most of those things. So the only thing that 406 00:23:03,280 --> 00:23:09,320 Speaker 1: testosterone has actually been studied for is something called hypoactive 407 00:23:09,400 --> 00:23:14,320 Speaker 1: sexual desire disorder, which is a fancy name for you 408 00:23:14,400 --> 00:23:17,360 Speaker 1: don't want sex and or you don't find it pleasurable. 409 00:23:18,240 --> 00:23:20,160 Speaker 1: And those two things, if you think about it, often 410 00:23:20,240 --> 00:23:23,359 Speaker 1: go hand in hand, because why would you want sex 411 00:23:23,400 --> 00:23:24,960 Speaker 1: if it wasn't going to be fun. It's sort of, 412 00:23:25,160 --> 00:23:28,160 Speaker 1: especially in perimenopause and menopause, it's kind of the only 413 00:23:28,240 --> 00:23:32,080 Speaker 1: point is to have a good time. We're not reproducing 414 00:23:32,119 --> 00:23:36,000 Speaker 1: anymore at this point. So that is the one thing 415 00:23:36,000 --> 00:23:39,639 Speaker 1: that testosterone has been studied for. It has been shown 416 00:23:39,760 --> 00:23:47,520 Speaker 1: to increase. The metric is the number of satisfactory sexual encounters. 417 00:23:48,840 --> 00:23:51,399 Speaker 4: It has much, oh, isn't it? Though it's based on 418 00:23:51,480 --> 00:23:52,240 Speaker 4: survey data. 419 00:23:52,359 --> 00:23:57,159 Speaker 1: Obviously, there's not really an objective way to measure these things, 420 00:23:57,160 --> 00:24:00,879 Speaker 1: we really have to rely on women's self for it. 421 00:24:00,880 --> 00:24:02,600 Speaker 4: For which is fine. 422 00:24:03,359 --> 00:24:05,480 Speaker 1: But one of the things that means is that there 423 00:24:05,600 --> 00:24:10,359 Speaker 1: is massive placebo effects in these studies. So even though 424 00:24:10,680 --> 00:24:18,840 Speaker 1: testosterone results in more satisfactory sexual encounters than a placebo does, 425 00:24:19,359 --> 00:24:24,359 Speaker 1: just getting a placebo also significantly increases the number of 426 00:24:24,400 --> 00:24:28,480 Speaker 1: satisfactory sexual encounters. And what I think is happening there 427 00:24:29,080 --> 00:24:32,440 Speaker 1: is just that women are just happy that people are 428 00:24:32,600 --> 00:24:37,200 Speaker 1: finally taking them seriously and trying to find something to help. 429 00:24:37,000 --> 00:24:39,159 Speaker 5: Them super interesting. 430 00:24:39,560 --> 00:24:42,199 Speaker 3: I know, I've seen a couple of parents who have 431 00:24:42,280 --> 00:24:44,000 Speaker 3: told me they're using it, and I think they're using 432 00:24:44,040 --> 00:24:46,159 Speaker 3: a lot of it because I can hear it in 433 00:24:46,200 --> 00:24:51,320 Speaker 3: their voice. So I think people, just from my outsider perspective, 434 00:24:51,320 --> 00:24:54,000 Speaker 3: people do need to be careful when they're playing with 435 00:24:54,040 --> 00:24:54,880 Speaker 3: some of these things. 436 00:24:55,160 --> 00:24:58,240 Speaker 1: Yeah, my goal is really in someone where we're using 437 00:24:58,320 --> 00:25:02,320 Speaker 1: it to help with sexual function, My goal is really 438 00:25:02,400 --> 00:25:04,280 Speaker 1: just to bring the levels up into. 439 00:25:04,040 --> 00:25:06,600 Speaker 4: The normal female range. 440 00:25:06,720 --> 00:25:07,280 Speaker 5: Makes sense. 441 00:25:08,200 --> 00:25:12,520 Speaker 1: Some of the treatments that people are using injected testosterone 442 00:25:12,600 --> 00:25:15,879 Speaker 1: and testosterone pellets can raise the levels so high that 443 00:25:15,920 --> 00:25:21,320 Speaker 1: they're actually approaching the male range for testosterone, and the 444 00:25:21,359 --> 00:25:23,920 Speaker 1: problem with that is you can see changes in voice, 445 00:25:24,280 --> 00:25:28,360 Speaker 1: you can get clitteromegaly, which is an enlargement of the clitteris. 446 00:25:29,480 --> 00:25:34,520 Speaker 1: You can get changes in body hair growth patterns, and 447 00:25:34,600 --> 00:25:36,439 Speaker 1: it may we don't know for sure, but there may 448 00:25:36,480 --> 00:25:39,680 Speaker 1: be some cardiovascular effects of taking such high doses as well. 449 00:25:39,800 --> 00:25:42,640 Speaker 4: So I really try to encourage. 450 00:25:42,200 --> 00:25:45,119 Speaker 1: People to use it for the things that we've studied 451 00:25:45,119 --> 00:25:48,680 Speaker 1: it for hasn't been studied for maintaining muscle mass and women, 452 00:25:48,840 --> 00:25:53,200 Speaker 1: for example, and to really be a little bit more modest, 453 00:25:53,640 --> 00:25:57,000 Speaker 1: a little more moderate with the dosing so that levels 454 00:25:57,000 --> 00:25:58,440 Speaker 1: stay in the female range. 455 00:25:59,200 --> 00:25:59,960 Speaker 5: All right, makes sense. 456 00:26:00,040 --> 00:26:01,920 Speaker 3: We're gonna take one more break and then talk about 457 00:26:01,920 --> 00:26:15,000 Speaker 3: a couple more hormonal medications. 458 00:26:17,119 --> 00:26:19,280 Speaker 5: All right, we are back, and. 459 00:26:19,359 --> 00:26:23,399 Speaker 3: We cannot end a discussion about hormones today without talking 460 00:26:23,440 --> 00:26:28,040 Speaker 3: about GLP one agonists. And that is because they are everywhere. 461 00:26:28,119 --> 00:26:31,040 Speaker 3: They're in your Instagram feed, they're on a billboard, they're 462 00:26:31,080 --> 00:26:34,600 Speaker 3: on TV, your friends are talking about them, et cetera. 463 00:26:35,400 --> 00:26:36,880 Speaker 5: You and I know these are not new. 464 00:26:37,080 --> 00:26:40,159 Speaker 3: I remember putting like an eighteen year old in Victoza 465 00:26:40,320 --> 00:26:43,840 Speaker 3: in like the mid Auts and being like, wow, this 466 00:26:43,920 --> 00:26:45,119 Speaker 3: is pretty good stuff. 467 00:26:45,800 --> 00:26:45,960 Speaker 4: Right. 468 00:26:46,800 --> 00:26:51,000 Speaker 1: My first prescriptions for GLP ones as a medical student, 469 00:26:51,440 --> 00:26:54,000 Speaker 1: like obviously with oversight at that time. 470 00:26:54,119 --> 00:26:58,880 Speaker 3: But yes, so these medicines are not new, but they 471 00:26:58,920 --> 00:27:01,600 Speaker 3: have gotten stronger, they have gotten easier to use, and 472 00:27:01,640 --> 00:27:04,040 Speaker 3: they've hit the mass market in a way that we 473 00:27:04,119 --> 00:27:06,399 Speaker 3: maybe haven't seen most drugs do in the past, or 474 00:27:06,400 --> 00:27:07,960 Speaker 3: at least I haven't. 475 00:27:08,640 --> 00:27:09,760 Speaker 5: I mean, I prescribe them. 476 00:27:09,760 --> 00:27:12,520 Speaker 3: I think they're incredibly useful for many patients, so I 477 00:27:12,520 --> 00:27:16,280 Speaker 3: want to make that very clear. And I've also heard 478 00:27:16,320 --> 00:27:20,040 Speaker 3: more and more really interesting vignettes, like a friend who 479 00:27:20,320 --> 00:27:23,320 Speaker 3: has very normal thin body habitsts telling me that she 480 00:27:23,400 --> 00:27:26,960 Speaker 3: is now the largest one in her very urban, very 481 00:27:27,000 --> 00:27:31,160 Speaker 3: posh pilates class because everyone has started taking these, whether 482 00:27:31,200 --> 00:27:34,760 Speaker 3: they have any clinical need for them or not. And yeah, 483 00:27:34,840 --> 00:27:36,720 Speaker 3: I just want to hear. You're in a New York 484 00:27:36,760 --> 00:27:40,640 Speaker 3: City private practice. These plotate students are not seeing you, probably, 485 00:27:40,680 --> 00:27:43,000 Speaker 3: but you get what I'm saying. So I guess, can 486 00:27:43,040 --> 00:27:45,320 Speaker 3: you talk a little bit about JLP one agonists where 487 00:27:45,359 --> 00:27:47,920 Speaker 3: we are now and whether or not they should quote 488 00:27:48,040 --> 00:27:51,520 Speaker 3: be in the water, as I have heard some people suggest. 489 00:27:52,359 --> 00:27:56,120 Speaker 1: So what I would say is I think that GLP 490 00:27:56,200 --> 00:28:01,240 Speaker 1: one agonists are fantastic tools. I mean, as I said, 491 00:28:01,240 --> 00:28:05,760 Speaker 1: I've been using them my entire career, and I think 492 00:28:05,800 --> 00:28:09,240 Speaker 1: that they are a really important tool in some areas 493 00:28:09,240 --> 00:28:12,880 Speaker 1: where we don't have a lot of great tools. The 494 00:28:12,880 --> 00:28:19,359 Speaker 1: more we understand about overweight and obesity and the role 495 00:28:19,520 --> 00:28:24,399 Speaker 1: of genetics and environment in contributing to overweight and obesity, 496 00:28:24,880 --> 00:28:27,960 Speaker 1: I think, the more we understand that we need tools 497 00:28:28,000 --> 00:28:31,679 Speaker 1: to help people manage not the number on the scale 498 00:28:31,760 --> 00:28:35,679 Speaker 1: so much, but the health implications that often come along 499 00:28:35,720 --> 00:28:35,960 Speaker 1: with that. 500 00:28:36,240 --> 00:28:38,920 Speaker 4: So when I talk to patients. 501 00:28:38,600 --> 00:28:41,560 Speaker 1: About these medicines, I think about them as being a 502 00:28:41,680 --> 00:28:47,280 Speaker 1: very holistic treatment for a lot of different body changes 503 00:28:47,680 --> 00:28:50,600 Speaker 1: that can happen are more common in women in midlife, 504 00:28:51,000 --> 00:28:53,560 Speaker 1: but can happen to anyone at any point, depending on 505 00:28:53,600 --> 00:28:58,080 Speaker 1: their genetics and their environments. So when I talk to women, 506 00:28:58,640 --> 00:29:02,360 Speaker 1: I'm actually shifting the converse away from the number on 507 00:29:02,400 --> 00:29:09,720 Speaker 1: the scale and toward other factors. So blood pressure, cholesterol, 508 00:29:10,000 --> 00:29:16,760 Speaker 1: liver function, blood sugar levels. We can treat now a 509 00:29:16,840 --> 00:29:21,560 Speaker 1: lot of brewing problems that maybe we wouldn't have treated 510 00:29:21,640 --> 00:29:25,840 Speaker 1: in the past. Because golp ones both help with weight 511 00:29:25,880 --> 00:29:28,360 Speaker 1: loss and weight loss can help with those things, but 512 00:29:28,520 --> 00:29:32,760 Speaker 1: also can directly help with many of those things. We 513 00:29:32,840 --> 00:29:36,240 Speaker 1: know that there are golp one receptors in the linings 514 00:29:36,240 --> 00:29:40,040 Speaker 1: of blood vessels, and it reduces inflammation in the blood vessels. 515 00:29:40,520 --> 00:29:43,240 Speaker 1: We know that there are GOLP one receptors in the 516 00:29:43,280 --> 00:29:46,479 Speaker 1: cells of the liver. What we do know is that 517 00:29:46,520 --> 00:29:51,160 Speaker 1: at a certain point, you don't have more fat cels 518 00:29:51,200 --> 00:29:55,720 Speaker 1: to lose, and you will start losing muscle. When we 519 00:29:55,840 --> 00:29:59,760 Speaker 1: lose muscle, women in particular also can lose bone density, 520 00:30:00,320 --> 00:30:03,880 Speaker 1: and losing muscle and bone density really sets us up 521 00:30:04,040 --> 00:30:08,480 Speaker 1: for frailty. And so one of my concerns about the 522 00:30:08,520 --> 00:30:12,920 Speaker 1: people who are using these medicines for things that they're 523 00:30:12,960 --> 00:30:17,840 Speaker 1: not necessarily intended for or studied for, is that we 524 00:30:17,920 --> 00:30:20,800 Speaker 1: will see that they are really set up and in 525 00:30:20,840 --> 00:30:23,760 Speaker 1: the long term will struggle with some of the side 526 00:30:23,800 --> 00:30:25,400 Speaker 1: effects of those losses. 527 00:30:26,000 --> 00:30:28,040 Speaker 3: Yeah, I can imagine that, and we don't really have 528 00:30:28,080 --> 00:30:30,680 Speaker 3: a way. You even said something like, well, you run 529 00:30:30,680 --> 00:30:32,440 Speaker 3: out of fat to lose, but it doesn't even happen 530 00:30:32,480 --> 00:30:35,920 Speaker 3: like that. You're losing muscle even while you're losing fat. 531 00:30:36,800 --> 00:30:40,560 Speaker 1: Well, anytime you lose weight, you will lose some muscle. 532 00:30:40,720 --> 00:30:43,960 Speaker 1: So I like to think about this. So if you 533 00:30:44,320 --> 00:30:49,880 Speaker 1: imagine you put on a weighted vest and you did 534 00:30:49,920 --> 00:30:54,360 Speaker 1: all your everything you do in your life, including shower, sleep, 535 00:30:55,240 --> 00:30:58,320 Speaker 1: wearing this weighted vest, it would be more work to 536 00:30:58,360 --> 00:31:01,160 Speaker 1: do all those things than you would build muscle. And 537 00:31:01,200 --> 00:31:04,160 Speaker 1: then if you took off that weighted vest and changed 538 00:31:04,280 --> 00:31:07,680 Speaker 1: nothing else but kept doing all the same things, you 539 00:31:07,720 --> 00:31:11,719 Speaker 1: would lose that muscle that you had gained unless you 540 00:31:11,760 --> 00:31:14,400 Speaker 1: did something very specific to try to keep it. And 541 00:31:14,440 --> 00:31:16,760 Speaker 1: so one of the issues with these medicines is people 542 00:31:17,040 --> 00:31:22,400 Speaker 1: are getting the message that they don't need to continue 543 00:31:22,440 --> 00:31:26,640 Speaker 1: to do things like exercise to maintain their muscle mass 544 00:31:26,680 --> 00:31:31,600 Speaker 1: and to maintain their body composition while they're losing weight, and. 545 00:31:31,520 --> 00:31:33,200 Speaker 5: You're saying people do need to do those things. 546 00:31:33,280 --> 00:31:36,640 Speaker 1: To be clear, absolutely one hundred percent. Not only that, 547 00:31:36,720 --> 00:31:40,080 Speaker 1: we have studies that show that people who are physically 548 00:31:40,120 --> 00:31:43,800 Speaker 1: fit are less likely to die then people who are 549 00:31:43,800 --> 00:31:46,240 Speaker 1: not physically fit. There's a study that shows that even 550 00:31:46,240 --> 00:31:48,560 Speaker 1: if you have a body mass index in the obese 551 00:31:48,680 --> 00:31:51,600 Speaker 1: range but are physically fit, you are less likely to 552 00:31:51,680 --> 00:31:54,840 Speaker 1: die than a person with a body mass index in 553 00:31:54,880 --> 00:31:58,440 Speaker 1: the quote unquote healthy range who is not physically fit. 554 00:31:58,600 --> 00:32:02,760 Speaker 1: And so, in case you needed yet another reason to 555 00:32:02,800 --> 00:32:05,320 Speaker 1: maintain physical fitness, there you go. 556 00:32:05,440 --> 00:32:07,400 Speaker 3: So jilty ones in the water not yet, but if 557 00:32:07,440 --> 00:32:11,400 Speaker 3: we could put exercise in the water, we would do that. 558 00:32:11,400 --> 00:32:13,440 Speaker 4: That's exactly right, That's exactly right. 559 00:32:13,560 --> 00:32:14,720 Speaker 5: I love it all right. 560 00:32:14,760 --> 00:32:17,240 Speaker 3: Well, the final part of your book talks a lot 561 00:32:17,280 --> 00:32:20,840 Speaker 3: about how a patient can bring the right mindset to 562 00:32:20,880 --> 00:32:23,360 Speaker 3: an encounter to get what they need out of that 563 00:32:23,440 --> 00:32:26,080 Speaker 3: doctor's visit. And even though I am a physician, I 564 00:32:26,160 --> 00:32:27,800 Speaker 3: know how it feels to go to an encounter and 565 00:32:27,840 --> 00:32:30,320 Speaker 3: be like, wow, I did not get what I need, 566 00:32:30,400 --> 00:32:32,880 Speaker 3: or I was not listened to, or I feel like 567 00:32:32,920 --> 00:32:35,840 Speaker 3: I knew more about that thing than the doctor. Perhaps, 568 00:32:36,920 --> 00:32:40,680 Speaker 3: But you're also very careful to tell people what to 569 00:32:41,040 --> 00:32:43,800 Speaker 3: kind of avoid from a physician's perspective. So can you 570 00:32:43,800 --> 00:32:46,920 Speaker 3: give us a taste of that savvy patient knowledge that 571 00:32:46,960 --> 00:32:47,720 Speaker 3: you share in the book. 572 00:32:48,760 --> 00:32:52,480 Speaker 1: Yeah, I mean I think that we should approach our 573 00:32:52,560 --> 00:32:55,600 Speaker 1: doctor's visits the way we would approach any other meeting. 574 00:32:55,680 --> 00:32:57,360 Speaker 4: We should have an agenda. 575 00:32:58,520 --> 00:33:00,920 Speaker 1: Our doctor probably does have a little bit of an 576 00:33:00,960 --> 00:33:04,120 Speaker 1: agenda when they come in to see us. I promise 577 00:33:04,160 --> 00:33:06,320 Speaker 1: your doctor looks at your chart before they walk in 578 00:33:06,320 --> 00:33:10,440 Speaker 1: the room, and so they have formulated a little bit 579 00:33:10,480 --> 00:33:13,680 Speaker 1: of an agenda for the meeting, and the meeting is 580 00:33:13,680 --> 00:33:16,560 Speaker 1: obviously much more consequential for you is the patient. So 581 00:33:17,200 --> 00:33:19,560 Speaker 1: you should have an agenda for the meeting as well, 582 00:33:20,040 --> 00:33:22,640 Speaker 1: and so sort of what do I mean by that? 583 00:33:23,440 --> 00:33:25,960 Speaker 1: I think you should have a goal or two what 584 00:33:26,080 --> 00:33:29,400 Speaker 1: you're hoping to get out of the meeting. And I 585 00:33:29,440 --> 00:33:32,960 Speaker 1: think that goal should be a little broad. I don't 586 00:33:33,040 --> 00:33:36,040 Speaker 1: mean like I'm going to get a prescription for X 587 00:33:36,080 --> 00:33:38,239 Speaker 1: when I go to the doctor today, unless it's like 588 00:33:38,400 --> 00:33:43,040 Speaker 1: a routine refill. It should really be about I have 589 00:33:43,200 --> 00:33:47,720 Speaker 1: these symptoms or I'm experiencing XYZ, and I would like 590 00:33:47,760 --> 00:33:51,200 Speaker 1: to either better understand why I'm having those symptoms, have 591 00:33:51,360 --> 00:33:56,440 Speaker 1: those symptoms treated, talk about these different treatments that I've 592 00:33:56,440 --> 00:33:57,880 Speaker 1: read about and whether they're. 593 00:33:57,720 --> 00:33:58,760 Speaker 4: Appropriate for me. 594 00:33:59,480 --> 00:34:02,080 Speaker 1: I think that's the kind of goal that we should 595 00:34:02,120 --> 00:34:05,000 Speaker 1: be setting when we go in to meet with our doctor. 596 00:34:05,800 --> 00:34:08,440 Speaker 1: I'm sure you've had this too. I've had patients come 597 00:34:08,440 --> 00:34:11,399 Speaker 1: in and talk about how they have indeed done some 598 00:34:11,480 --> 00:34:14,719 Speaker 1: research on whatever it is they want to talk about, 599 00:34:14,760 --> 00:34:17,320 Speaker 1: and then they apologize. They're like, I know doctors don't 600 00:34:17,400 --> 00:34:18,600 Speaker 1: like that, and I. 601 00:34:18,560 --> 00:34:19,480 Speaker 4: Don't think that's true. 602 00:34:19,560 --> 00:34:23,879 Speaker 1: I think doctors are happy to talk to informed patients. 603 00:34:24,320 --> 00:34:30,040 Speaker 1: What I think patients are often reacting to is Sometimes 604 00:34:30,080 --> 00:34:32,760 Speaker 1: in some settings, people will come in with a very 605 00:34:32,800 --> 00:34:36,600 Speaker 1: specific I think I have this and I need this medication. 606 00:34:37,400 --> 00:34:39,920 Speaker 1: And what we want you to do is use research 607 00:34:39,960 --> 00:34:43,799 Speaker 1: as a way to develop what questions you have for us, 608 00:34:44,200 --> 00:34:48,759 Speaker 1: and to think about how that conversation should go. It 609 00:34:48,760 --> 00:34:52,600 Speaker 1: should be preparation for your meeting and not necessarily deciding 610 00:34:52,600 --> 00:34:53,400 Speaker 1: what the outcome is. 611 00:34:53,520 --> 00:34:55,560 Speaker 3: Yes, I mean, it's interesting to hear if people have 612 00:34:55,640 --> 00:34:58,520 Speaker 3: opinions of what they were thinking about. But there's such 613 00:34:58,520 --> 00:35:00,719 Speaker 3: a difference between going in and like, oh, I've heard 614 00:35:00,719 --> 00:35:02,759 Speaker 3: about this medication, would this be a good fit for me, 615 00:35:02,880 --> 00:35:06,120 Speaker 3: versus like I really wanted to leave with this medication, 616 00:35:06,760 --> 00:35:10,560 Speaker 3: and if I didn't done this encounters of failure, It's like, well, 617 00:35:10,440 --> 00:35:12,719 Speaker 3: well let's talk about it and then maybe this is 618 00:35:12,760 --> 00:35:14,680 Speaker 3: going to work out. But we have to start from 619 00:35:14,719 --> 00:35:15,560 Speaker 3: the beginning a little bit. 620 00:35:16,400 --> 00:35:16,640 Speaker 2: I mean. 621 00:35:16,680 --> 00:35:21,120 Speaker 1: One of the things that we have as clinicians is 622 00:35:21,160 --> 00:35:27,399 Speaker 1: a lot of experience prescribing medications. We've often seen what 623 00:35:27,480 --> 00:35:28,680 Speaker 1: side effects people. 624 00:35:28,480 --> 00:35:29,719 Speaker 4: Are most likely to get. 625 00:35:30,719 --> 00:35:33,719 Speaker 1: We can kind of troubleshoot down the road. We've seen 626 00:35:34,320 --> 00:35:36,960 Speaker 1: this type of patient does really well with X, Y 627 00:35:37,080 --> 00:35:40,680 Speaker 1: or Z, and you can't get that from Google or 628 00:35:40,800 --> 00:35:41,520 Speaker 1: chat GPT. 629 00:35:42,680 --> 00:35:44,279 Speaker 3: You can get a start, but yeah, you can't get 630 00:35:44,320 --> 00:35:47,720 Speaker 3: the whole picture. I agree, at least not yet. Well, 631 00:35:47,800 --> 00:35:49,680 Speaker 3: I love the chapter. I'm going to keep it in 632 00:35:49,719 --> 00:35:52,160 Speaker 3: mind with my own appointments as well as of course 633 00:35:52,200 --> 00:35:54,719 Speaker 3: when I'm on the listening end with my patients, and 634 00:35:54,800 --> 00:35:58,000 Speaker 3: everyone should read Jillian's book. You will learn about the thyroid, 635 00:35:58,040 --> 00:36:00,400 Speaker 3: you will learn about breastfeeding, you will learn about the 636 00:36:00,600 --> 00:36:04,319 Speaker 3: reproductive access and growth, hormone and cortisol and all of 637 00:36:04,360 --> 00:36:06,279 Speaker 3: the things. But also you learn about those things in 638 00:36:06,320 --> 00:36:10,200 Speaker 3: a very evidence based and practical and accessible way. So 639 00:36:10,520 --> 00:36:12,919 Speaker 3: I just actually cannot wait for it to come out 640 00:36:13,200 --> 00:36:15,840 Speaker 3: because when my patients kind of want a deeper knowledge 641 00:36:15,840 --> 00:36:19,320 Speaker 3: but not full on medical perspective, I think this book 642 00:36:19,360 --> 00:36:20,840 Speaker 3: is just going to be a treasure trove. 643 00:36:21,400 --> 00:36:22,480 Speaker 4: Well, thank you so much. 644 00:36:22,719 --> 00:36:26,600 Speaker 1: I've really enjoyed our conversation and I'm excited for the 645 00:36:26,600 --> 00:36:27,120 Speaker 1: book to be. 646 00:36:27,080 --> 00:36:27,800 Speaker 4: Out in the world. 647 00:36:27,960 --> 00:36:30,839 Speaker 3: Yay, and remind everybody the exact release date it might 648 00:36:30,880 --> 00:36:33,560 Speaker 3: be today actually as this airs, but also where they 649 00:36:33,560 --> 00:36:34,640 Speaker 3: can find you online. 650 00:36:35,120 --> 00:36:39,240 Speaker 1: Absolutely, So The Hormone Loop comes out on June second, 651 00:36:40,320 --> 00:36:44,840 Speaker 1: and it is available everywhere books are sold and people 652 00:36:44,840 --> 00:36:48,880 Speaker 1: can find me. I am the savvy patient on substack 653 00:36:49,320 --> 00:36:50,759 Speaker 1: and on Instagram. 654 00:36:50,960 --> 00:36:53,359 Speaker 3: Awesome, thank you so much for coming on, Jillian. It's 655 00:36:53,360 --> 00:36:54,520 Speaker 3: always a blast chatting with you. 656 00:36:55,120 --> 00:36:56,000 Speaker 4: Thanks for having me. 657 00:36:57,080 --> 00:36:59,959 Speaker 3: All right, well you're back. I always enjoy talking to Jillian. 658 00:37:00,200 --> 00:37:03,200 Speaker 3: It is just such a good time every time. And 659 00:37:03,280 --> 00:37:06,040 Speaker 3: we got a question that was actually from one of 660 00:37:06,040 --> 00:37:11,560 Speaker 3: our Patreon members about practicing music. So this listener says 661 00:37:11,640 --> 00:37:15,200 Speaker 3: that she doesn't have music experience herself, and her oldest 662 00:37:15,239 --> 00:37:17,799 Speaker 3: is seven and six months into learning piano. And it's 663 00:37:17,840 --> 00:37:20,680 Speaker 3: curious about how our kids practice music and how much 664 00:37:20,719 --> 00:37:23,799 Speaker 3: we pushed and do we require a certain amount. How 665 00:37:23,840 --> 00:37:26,560 Speaker 3: do we handle if they don't want to practice and 666 00:37:26,920 --> 00:37:28,960 Speaker 3: we are here to give our experiences. 667 00:37:29,120 --> 00:37:33,319 Speaker 2: Laura, Yeah, I'm really trying to figure this out. I mean, 668 00:37:33,320 --> 00:37:37,799 Speaker 2: the problem with musical instruments it's just not fun until. 669 00:37:37,520 --> 00:37:38,400 Speaker 4: You're good at it. 670 00:37:39,040 --> 00:37:41,920 Speaker 2: And it takes a lot of work to get good 671 00:37:42,000 --> 00:37:43,840 Speaker 2: at it, like to get to the point where playing 672 00:37:43,880 --> 00:37:49,520 Speaker 2: feels like relaxing and recreational on anything, right, And so 673 00:37:50,040 --> 00:37:54,839 Speaker 2: you kind of just have to push through the practicing at. 674 00:37:54,840 --> 00:37:55,439 Speaker 4: Least for a while. 675 00:37:55,560 --> 00:37:57,319 Speaker 2: But I mean, obviously there's ways to make it more 676 00:37:57,400 --> 00:37:59,759 Speaker 2: or less pleasant. I mean, I think standing over a 677 00:38:00,080 --> 00:38:02,920 Speaker 2: child for an hour with a timer and like I 678 00:38:03,000 --> 00:38:05,319 Speaker 2: steel like a schoolmarm with like a ruler in their hands. 679 00:38:05,400 --> 00:38:07,440 Speaker 2: Like I think, yes, that would probably terrify somebody, even 680 00:38:07,440 --> 00:38:11,160 Speaker 2: if they might get better quickly. But obviously we don't 681 00:38:11,160 --> 00:38:13,439 Speaker 2: do that. It's only the two younger kids that I'm 682 00:38:13,520 --> 00:38:17,360 Speaker 2: really supervising the practice. All my kids are in music lessons, 683 00:38:17,440 --> 00:38:19,239 Speaker 2: but the older two, I mean, of the four who 684 00:38:19,239 --> 00:38:22,160 Speaker 2: are still at home, play in their school band and 685 00:38:22,480 --> 00:38:24,799 Speaker 2: play very frequently through that, so there's a lot of 686 00:38:24,840 --> 00:38:27,960 Speaker 2: just sheer time spent playing their instruments between that and 687 00:38:28,040 --> 00:38:32,480 Speaker 2: the lessons. The younger two less. So right now, it's 688 00:38:32,520 --> 00:38:35,160 Speaker 2: like they practice when I go tell them to practice, 689 00:38:35,360 --> 00:38:38,560 Speaker 2: but I have not figured out how to automate this 690 00:38:38,719 --> 00:38:40,640 Speaker 2: like that there's a time they always go do it. 691 00:38:41,719 --> 00:38:43,920 Speaker 2: They need to be reminded, they need to be like 692 00:38:44,520 --> 00:38:47,000 Speaker 2: cajoled to do it to a degree. So it only 693 00:38:47,000 --> 00:38:49,560 Speaker 2: winds up happening usually about three times a week, because 694 00:38:50,280 --> 00:38:53,640 Speaker 2: that's when I remember, and I'm around, and they don't 695 00:38:53,640 --> 00:38:56,120 Speaker 2: practice very long each time, and so progress is a 696 00:38:56,160 --> 00:38:58,839 Speaker 2: little slow, and I would like to see, especially like 697 00:38:59,440 --> 00:39:03,399 Speaker 2: my eleven year old it could go faster, but here 698 00:39:03,440 --> 00:39:05,840 Speaker 2: we are, so I don't know, I don't really have 699 00:39:05,920 --> 00:39:09,320 Speaker 2: a Yeah, this is one of these like less pleasant 700 00:39:09,440 --> 00:39:12,200 Speaker 2: parts of parenting that I haven't quite figured out. 701 00:39:12,320 --> 00:39:14,279 Speaker 4: Someone like orthodontia perhaps. 702 00:39:14,040 --> 00:39:15,560 Speaker 3: Well, it's kind of funny because you said like, well, 703 00:39:15,600 --> 00:39:18,319 Speaker 3: practicing isn't fun until you're good, and I'm like, for me, 704 00:39:18,440 --> 00:39:21,080 Speaker 3: practicing was never fun even when I was pretty good. 705 00:39:21,200 --> 00:39:23,000 Speaker 4: Well, playing was playing was fun? Playing? 706 00:39:23,640 --> 00:39:27,279 Speaker 2: Yes, if we're just looking at sheer, okay, not like 707 00:39:27,320 --> 00:39:30,239 Speaker 2: playing to learn a tricky new part and get better 708 00:39:30,280 --> 00:39:32,520 Speaker 2: at Yes, that may still be challenging and a little 709 00:39:32,560 --> 00:39:35,759 Speaker 2: tedious at times, but you can play for fun, yes, 710 00:39:35,920 --> 00:39:36,560 Speaker 2: once you're good. 711 00:39:36,719 --> 00:39:36,959 Speaker 4: Yes. 712 00:39:37,120 --> 00:39:39,560 Speaker 3: And the practicing, like you felt like there was a 713 00:39:39,600 --> 00:39:41,640 Speaker 3: reward in practicing, like oh, I'm going to show up 714 00:39:41,640 --> 00:39:43,600 Speaker 3: to string quartet and be like really good at this 715 00:39:43,680 --> 00:39:45,160 Speaker 3: and it's going to be fun to play with this 716 00:39:45,200 --> 00:39:47,360 Speaker 3: group and hear us sound good and that kind of 717 00:39:47,360 --> 00:39:49,879 Speaker 3: a thing. So there's like satisfaction in it in that way. Yeah, 718 00:39:50,560 --> 00:39:52,840 Speaker 3: but yeah, expecting the actual practice to be fun, I 719 00:39:52,840 --> 00:39:54,799 Speaker 3: guess I don't want anyone listening to this to be like, 720 00:39:54,840 --> 00:39:57,000 Speaker 3: oh what am I doing wrong? Like it's not super 721 00:39:57,000 --> 00:40:00,520 Speaker 3: fun when I practice, I am so to you. 722 00:40:00,600 --> 00:40:01,320 Speaker 5: I'm not super. 723 00:40:01,640 --> 00:40:03,440 Speaker 3: My parents were a little bit more intense with this. 724 00:40:03,680 --> 00:40:05,839 Speaker 3: I mean they would say they weren't. It was sort 725 00:40:05,880 --> 00:40:08,480 Speaker 3: of like, oh, you don't have to keep playing piano, 726 00:40:09,120 --> 00:40:10,880 Speaker 3: but if you do want to keep playing piano, you 727 00:40:10,920 --> 00:40:13,239 Speaker 3: had better practice your X amount of minutes, and then 728 00:40:13,320 --> 00:40:15,520 Speaker 3: like it'd be like, oh, I'm gonna not pay for lessons. 729 00:40:15,560 --> 00:40:17,400 Speaker 3: If you like it was just a whole loop. Then 730 00:40:17,440 --> 00:40:20,160 Speaker 3: it wasn't my most favorite part of my childhood. So 731 00:40:20,200 --> 00:40:22,359 Speaker 3: I have not approached it with my kids with any 732 00:40:22,400 --> 00:40:26,280 Speaker 3: level of intensity. I try the only one doing Cavin's 733 00:40:26,280 --> 00:40:27,640 Speaker 3: gonna do a guitar with a school of rock. I'm 734 00:40:27,640 --> 00:40:29,080 Speaker 3: gonna leave it up to him. If he wants to 735 00:40:29,080 --> 00:40:32,080 Speaker 3: be prepared for his group rehearsals and his lessons, great, 736 00:40:32,160 --> 00:40:34,320 Speaker 3: he's twelve, and if he doesn't, then he won't practice. 737 00:40:34,320 --> 00:40:36,360 Speaker 3: I actually think he will because I think he wants 738 00:40:36,400 --> 00:40:39,239 Speaker 3: to be able to learn these songs. Genevieve does, at 739 00:40:39,280 --> 00:40:41,640 Speaker 3: age eight, take piano. I think it's her like third year. 740 00:40:42,760 --> 00:40:44,560 Speaker 3: We have a lovely teacher who comes to the house, 741 00:40:44,560 --> 00:40:47,759 Speaker 3: who I really like and who is not pressureful. We 742 00:40:47,880 --> 00:40:51,040 Speaker 3: try to sit down most weekdays. It ends up usually 743 00:40:51,080 --> 00:40:53,359 Speaker 3: being like three of the weekdays. The lessons are actually 744 00:40:53,400 --> 00:40:56,280 Speaker 3: on Friday, and we try to play through her assigned 745 00:40:56,320 --> 00:40:59,680 Speaker 3: stuff two times, which usually takes less than ten minutes, 746 00:41:00,160 --> 00:41:02,600 Speaker 3: and sometimes there's frustration, but I'm like, well, you don't 747 00:41:02,600 --> 00:41:03,799 Speaker 3: have to play it perfectly. I just want you to 748 00:41:03,840 --> 00:41:05,720 Speaker 3: like try to work through it, and it's like, okay, 749 00:41:05,760 --> 00:41:08,239 Speaker 3: we're done. So I think it's low dose enough that 750 00:41:08,320 --> 00:41:10,640 Speaker 3: it hasn't been super stressful, although I do usually have 751 00:41:10,719 --> 00:41:13,480 Speaker 3: to say like, we're not turning on the TV until 752 00:41:13,800 --> 00:41:17,520 Speaker 3: you are finished with this, and that seems to be 753 00:41:17,560 --> 00:41:19,640 Speaker 3: her motivator. It doesn't feel like it's in any sort 754 00:41:19,680 --> 00:41:22,440 Speaker 3: of toxic place, so that's kind of where we are 755 00:41:22,480 --> 00:41:23,560 Speaker 3: with it right now. 756 00:41:24,080 --> 00:41:24,400 Speaker 1: Yeah. 757 00:41:24,480 --> 00:41:27,920 Speaker 2: I mean some people definitely do sticker charts. My children 758 00:41:27,960 --> 00:41:30,200 Speaker 2: have never been motivated by a sticker chart, so I 759 00:41:30,239 --> 00:41:32,560 Speaker 2: don't really know what to say about that part. But 760 00:41:33,520 --> 00:41:36,279 Speaker 2: one thing that kind of blew my mind, but one 761 00:41:36,280 --> 00:41:40,120 Speaker 2: of our Patreon members posted, which is that she has 762 00:41:40,200 --> 00:41:43,320 Speaker 2: kids doing piano lessons, but she does not play the 763 00:41:43,360 --> 00:41:45,319 Speaker 2: piano or read music or anything, so she doesn't feel 764 00:41:45,320 --> 00:41:47,360 Speaker 2: like she would be very helpful in terms of practicing, 765 00:41:47,560 --> 00:41:50,200 Speaker 2: so she told the teacher that they are a lesson 766 00:41:50,280 --> 00:41:55,520 Speaker 2: only family and does not require or push or anything 767 00:41:55,600 --> 00:41:58,319 Speaker 2: practice in between it, And I'm like, you could do that, 768 00:41:58,960 --> 00:42:02,080 Speaker 2: and you could probably if you wanted to, Like this 769 00:42:02,200 --> 00:42:06,120 Speaker 2: is not the structure of most like youth music lessons, 770 00:42:06,600 --> 00:42:10,960 Speaker 2: but you could do lessons twice a week and then 771 00:42:11,200 --> 00:42:14,200 Speaker 2: understand that is the playing right, and you would probably 772 00:42:14,239 --> 00:42:17,279 Speaker 2: make some progress. The second lesson might be a little 773 00:42:17,320 --> 00:42:20,520 Speaker 2: bit more like supervised practice with a teacher, but you 774 00:42:20,520 --> 00:42:23,600 Speaker 2: would definitely be playing as much with that as my 775 00:42:23,719 --> 00:42:25,560 Speaker 2: kids are playing with one lesson in my sort of 776 00:42:25,600 --> 00:42:27,560 Speaker 2: half hearted supervision of practice. 777 00:42:27,600 --> 00:42:30,040 Speaker 4: So there might be something to be said for that. 778 00:42:30,440 --> 00:42:31,279 Speaker 4: If you could do like it. 779 00:42:32,000 --> 00:42:34,520 Speaker 3: I could think of a very if you really really cared, 780 00:42:34,600 --> 00:42:37,000 Speaker 3: which again maybe you do and maybe you don't. There 781 00:42:37,080 --> 00:42:39,279 Speaker 3: might even be like a teen in your neighborhood who 782 00:42:39,320 --> 00:42:42,160 Speaker 3: could provide a much lower cost practice. 783 00:42:41,719 --> 00:42:44,160 Speaker 5: Session lesson that yes, still would feel to the. 784 00:42:44,200 --> 00:42:45,960 Speaker 3: Kid like, well, this person's here, I'm going to do 785 00:42:46,000 --> 00:42:50,120 Speaker 3: it with them, but wouldn't be like a supervised official 786 00:42:50,160 --> 00:42:52,680 Speaker 3: supervise that's it. Yeah, I mean it's true, you forget, 787 00:42:52,680 --> 00:42:56,240 Speaker 3: like not every parent would even know how to supervise practice. 788 00:42:56,280 --> 00:42:56,480 Speaker 4: I don't. 789 00:42:56,560 --> 00:42:57,919 Speaker 5: I wouldn't know how to supervise guitar. 790 00:42:58,000 --> 00:42:59,200 Speaker 3: I have no I might be able to say that 791 00:42:59,280 --> 00:43:01,080 Speaker 3: sounds bad, but that's so hard to put out. 792 00:43:01,160 --> 00:43:05,440 Speaker 2: That doesn't sound like an a major card. But okay, exactly? 793 00:43:05,520 --> 00:43:08,719 Speaker 2: Oh dear, all right, well, this has been best in 794 00:43:08,800 --> 00:43:12,920 Speaker 2: both worlds. Sarah has been interviewing doctor Gillian Goddard, author 795 00:43:12,960 --> 00:43:14,640 Speaker 2: of the new book The Hormone Loop. 796 00:43:14,680 --> 00:43:17,399 Speaker 4: Please check that out. We will be back next week 797 00:43:17,440 --> 00:43:19,600 Speaker 4: with more on making work and life fit together. 798 00:43:21,760 --> 00:43:24,560 Speaker 3: Thanks for listening. You can find me Sarah at the 799 00:43:24,560 --> 00:43:29,000 Speaker 3: shoebox dot com or at the Underscore Shoebox on Instagram, 800 00:43:29,360 --> 00:43:30,000 Speaker 3: and you can. 801 00:43:29,840 --> 00:43:34,120 Speaker 2: Find me Laura at Laura vandercam dot com. This has 802 00:43:34,160 --> 00:43:37,440 Speaker 2: been the best of both worlds podcasts. Please join us 803 00:43:37,480 --> 00:43:40,880 Speaker 2: next time for more on making work and life work together.