Ep 143: Her Power. Her Joy. Her Longevity. — Rewriting Menopause

0:00Welcome to Journey to Joy Lied, a podcast to promote wellness resilience and inspire joy. Be empowered to balance your mental, physical, financial, aspirational, and social health while providing mental health awareness and breaking down the stigma of mental illness in the black community. I'm your host, Dr. Itt Joy, and I'm here to help you transform life's challenges into opportunities for joy. Let's begin the journey together. Hello, everyone. We are an episode 143, her power, her joy, her longevity, rewriting, minipause. And my special guest is Nell Stranger, too, Journey to Joy Lied, Dr. Renee Allen. She's an OB-GYN physician. This is what your fourth time? Third. Because I think the very first one is like your 91st episode. I know you were like a hundred.

1:02You came on. Okay. Okay. So this is third. Okay. Finishing for the fourth. Yes. Well, thank you for coming back. Minipause, parry minipause. That's the hot topic. That's what we're all talking about. I mean, not the minipause. It's been something that we haven't been talking about. But it just seems like it's what we're all in, especially me and my friends, because I'm in that age now. And I was shocked at when you were saying around 41, even as low as 37 at the first podcast you came on episode, you were just like, yeah, you can start seeing a symptoms. I'm like, no, I'm not ready. Yeah. Yeah. Exactly it. So basically, you know, minipause is not a phase. It's actually a biological inflection point. It will system accelerant for aging in the brain and the heart, metabolism in the mood. And it starts silently years before the last, your last menstrual period. So yeah, pinipause begins about eight to 10 years before that final menstrual cycle.

2:07And ovarian reserve is already declining during that time. It labeled as stress or anxiety a lot of times, but and most women are told to wait and see, but the biology is already in their late 30s. Yeah. Oh, wow. Makes sense. So you said minipause isn't just a phase. It's an act of an accelerant for aging. So can we explain what you mean by ovarian aging or what is met by ovarian aging being a root driver of women's health span? Right. It's an inflection point. I wish I could show you a graph. So like estrogen or estradiol, that's the more the most powerful form of estrogen that our body produces. It protects women cardiovascular all through their life when, especially in the reproductive years. And it's the years that and it makes sense. There's estradiol receptors all over a body, every single organ system. And what you need to understand about your body is that your body is not going to expend energy to do things.

3:07What if it's functioning normally, unless it's something that's going to help you, okay? Many times your body, this is my opinion. The two main imperatives of your body, it's two things. Keep you alive and if you're a woman, and also for men, but more so for women is for you to reproduce, okay, for you to grow great. And it actually, those two things, your body throughout your life will do certain functions in order to put you in the best chance for both those things. So like for example, if you get into a car accident, your body in an effort to keep you alive may cut off certain, like blood flow to certain organ systems and leave only the essential ones. And it may, you're not fully functioning, but you're still alive, right? So it does that. With regards to reproduction, the estradiol levels, once you reach puberty and your sex hormone levels are starting to increase, this is my opinion.

4:10But it actually allows you to become the most strong in your life to do the hardest work. I think I've talked to you friends, yeah, the hardest work that a woman can do, which is to procreate to actually, everything about it is set up actually for failure. I'm telling you, the mere fact that we're here, it's like an Ameri, a miracle. So and even, yeah, even the risk that it takes on the woman who is undergoing this to bring forth life, it is a very dangerous period in a woman's life, especially right after she delivers with the hormonal shift changes, which changes if you have, like for example, if you have like a history of heart disease, you're going to most likely find yourself being closely monitored those first 24 to 48 hours after delivery because we know that your body's undergoing such rapid changes. And if you have heart disease, that could be the time where you make it heart failure or cardiac vent can occur.

5:11So at the preeclampsia, not the mention of over the age of 35, you're elderly, I don't do hospital medicine anymore, but I remember when I was doing it, if you had a certain diagnosis, let's just say that you came in, all right, this diagnosis is over the top, but it still proves the point. Let's say that you have pulmonary hypertension, which is elevated pressures within your, the vasculature of your lungs, right, your respiratory system. For those women, it's actually a contraindication to be pregnant, that's the first thing. But let's just say that you have, because of that very reason, because we know how, what the stress that undertaking reproduction pregnancy and delivery and surviving that, what it can do on your body, right? So for those women who may have that diagnosis, she's going to end up in the ICU directly after she delivers, because we need like, really close monitoring, because we understand that. So estradiol, that hormone, it is set up in your body in order to make you the strongest

6:19that you can be in order to undertake the hardest work that a woman's body can undertake. When your estradiol level start to decrease, then it starts to reveal everything that the estradiol was doing. And the main thing with women, the main thing with women is that the estradiol was really protecting your heart. And that inflection point I told you is that once a woman crosses over into the menopause period and her estradiol's plummet, she starts to now have the same risk of cardiovascular disease as men. And then at a certain point, she can surpass men. So all throughout her life, estradiol was protecting her heart, menopause, game over. That's the inflection point. Now you're at risk and even more risk of developing heart disease than men. And what women don't realize is that cardiovascular disease is the number one killer for women. It's not breast cancer. That's what a lot of women don't understand.

7:20So, and so, you know, most women, you know, the ovarian aging, it drives not just hot flashes, but also, you know, this is your area of expertise, cognitive decline and depression. And it also drives cardiovascular risk and metabolic disease. So when the ovaries go, every organ system downstream is affected, including and specifically the brain. So I think, you know, this is a good bridge because I remember in one of the episodes, the earlier episodes, you were new and you were talking about a patient that you had that stopped her, um, HRT because she, remember that? Yeah. I do. Yeah. I'm looking back to that because it's still here. Yeah. It looped. It didn't. It's actually the declining estrogen that her body was just naturally, and that's causing depression. Not necessarily her whole more replacement, causing the person, well, that's true because looking back and I'm glad we're circling back to that. I still see that patient, you know, and I was just like, oh, maybe we're in the clear.

8:23Maybe it really was your HRT. Yeah. And she ended up having a reoccurrence of the depression. So it's not like, yeah, she bent in the very thing that was protecting her mood. So this is missed attribution to the estradiol that it was causing the depression is happening to thousands of women and correct the record. You know, the clinical truth is that restoring hormones reduces depression risk by nearly half in the randomized controlled trial data. And your patient's worsening of mood after stopping her tea. It was withdrawal from protection, not proof that the therapy was harmful. And a physician who understands that mechanism changes the game for everybody. That's really good. I love how you started out from puberty because we need to really hear like what is happening when that happens when Eschardal is increased and what it's doing over the lifespan. And then now we're removing it. So it's like all these things are happening.

9:24That's really well. It's fine. Yeah. And so, you know, basically what we undertake at this point is now we need to understand that there is cutting-edge therapies that can actually delay this. And that's kind of what I wanted us to get into. Yeah. I wanted us to get into that. Yeah. Yeah. Well, let's jump right in because I was going to ask you. So you mentioned to me about rapamycin peptides. There's also that I think it's mTOR, targeted strategies for slowing ovarian ages. I mean, what's scientifically grounded, what's just still theoretical. Yeah. Yeah. Let's talk about how we can slow the aging of the ovary itself. But how they're, what does it mean for women's health span for their mood and longevity? So basically, real quick. While we are born at birth, we have about 1 to 2 million follicles of birth, okay? And then at puberty, our eggs, unlike men, men, and produce sperm for life, okay?

10:25When they're born with every egg they will ever have and then they lose them constantly from that point on, from that point on, okay? So the weight of follicular loss doubles by the age of 40. It's not gradual. It actually accelerates. So, we're born with about 1 to 2 million and then by the time with puberty, we're at about 300,000 at puberty, okay? By the time we're about 38 to 40, years old, we're about at about 25 to 30,000 eggs and then- Which is wild that we still have that many. Yeah. I'm starting it in about 2 million. Right. Rapid decline. And then at menopause, by the time we're at menopause, you probably have about 1,000 eggs. So the, it's gradual and once you hit 40, it just accelerates. So AMH, have you heard of AMH? It's AMH. What is it for? Anti-malarion hormone. Oh, yeah. I know AMH. It's a biological clock that you can actually measure. It's the test marker. And women who have gone through fertility treatments like me, that's all you need to bring

11:28me on for. Oh, yeah. I can tell you what you can do. I can talk about that. Oh, girl. I went through 16 cycles in order to have a little month or a year old son that I have here. But anyways, that's a full, other story. I can't wait. In a special, biological clock, it actually measures, you know, most women haven't had this test unless you're a fertility and every woman over 35 should know what AMH level is. It reflects remaining reserve of your ovarian form and it's actually a decline. And so as your ovarian follicles go, so does your ester dial. And that means, which is, remember, I said in the beginning, this is the ester dial level affects your brain, cardiac bone, bowel, every part of your ornid. So as your follicles are decline, your ester dial is declining. So it impacts your body. So losing it is a whole system event. It's not just a reproductive one. And that is what I think women need to understand.

12:29And so what's the science showing? Yeah. It's really exciting. We have... That's an FDA-approved, immunosuppresent, not an anti... It's not like an anti-cancer medication. It's not... Okay. Cancer medication. It more comes from... You don't want that. Yeah. Okay. So it's not a chemotherapy. Let's just put it back. Okay. It comes from bacteria. What it does, it inhibits M-tore. Is the signaling pathway that accelerate whether or not it kind of tells your cells, are you going to divide or you're going to grow, you're going to stay kind of like silent or you're going to, you know, clean up and kind of like go away, you know, it kind of directs your cells as to what your cells are going to do. So M-tore in this situation, it signals, it accelerates follicular burn out. So there is... In Colombia. Yeah. It's a trial that occurred. They did a mini-s trial, a little small trial I think about.

13:32The country of Colombia or Colombia? University. Of course. Yeah. Because my husband is from Colombia. That's what I'm saying. Yeah, you know, you didn't hear me. But Colombia University, they did a small, little mini-trial of 50 women, menopausal women. And they looked to see if rapamycin could slow down ovarian aging and it showed that they did to the point where they now have a larger study called the vibrant study is going on. And it specifically looks just how to slow ovarian aging and extend reproductive health span. I was going to say what would that look like? So if you're expanding reproductive health, you can continue to have kids. Yes. That means that you can delay menopause. And you know, for some women that be like, I don't want to delay menopause. But if you're looking at it from what the hormone decline does to your body and how it increases your risk over time on it diseases of aging, then this is a significant breakthrough.

14:36Okay. What you guys have to understand is we living past menopause, this is a new event in human evolution. We used to die off now seeing what the effects of 30, 40 years past menopause, which means past those hormones that we're protecting us all our lives as women, what that means, like what does that mean? What is the outcome of that? We also had a real nice glimpse with the W.H.I. study. That whole fiasco back when I was training in memory as a resident back in the early 2000s when it came out and it was the data was completely wrong. It was based only on synthetic medications and even to the spray, they're trying to extrapolate the findings for the synthetic meds to the bioidentical hormones that we have now. You talked a lot about that on the last time you were here. Wow. You can't. But we saw that because that came out and scared everybody. I remember, they used to have like the good old boys because you know, I'm really

15:39Southern. They had good old boys and they had their menopause clinics and they were doing their thing. They had their partnerships with compounding pharmacies and they were telling them to do all these custom made formulas for their women in the menopause clinic and they were teaching residents all of these secrets and you know, protocols that were handed down to them because this is not new. This is not anything new. Like back in the 20s, women were taking women of affluence who had money. They were taking ground up cow ovaries and it was helping them. What they found that was in the way. My dear menopause treatment is not new, all right? So the truth is not new, but cow ovaries and they were taking women, you had to have money in order to afford that. I'm talking about almost a hundred years ago, but we're maintaining it or injecting it. Just they were having it as they were eating it. Round up, they were able to put it like a pill, like it was medicine.

16:41Okay, like a pill. Yeah, it wasn't. Yeah. Right, yeah, like a pill, but they were eating it. It was their form of therapy and they specifically honed in on the cow over what, and we tested that and what it was that they were really getting is testosterone. But the women were, it was helping, so menopause therapies on you. So you know, secrets that have been passed down, there's different protocols, women were helped. They stopped teaching it, at least they stopped teaching what they were doing in their menopause clinic. And we started on this minimum dose for the shortest period of time because they were talking about synthetic met, and of course, they're not good for you. Yeah. And so they stopped teaching us. A lot of women came off of menopause hormonal therapy because a lot of physicians were scared to with the results. And now we're seeing twenty something years later, what the outcome is, there's a high incidence of osteoporosis, Alzheimer's disease, heart failure, hip replacements, amongst

17:43women because of that very WHOI study. So living past menopause, that's a natural, that's a recent change in human evolution. So now, do you really want to live thirty-forty years without these hormones? Because what that means is, it's the difference sometimes between being able to open a jar. Like that's what, that's what aging comes down to you. People don't understand that when you age, some people can't even open jars anymore. Yeah. You're causing change things, like if you are a person who maintains a high level of fitness or if you take creatinine and you're a little bit more stronger or high protein, does that change anything? It does. It will help you to improve different markers that your body needs to do different functions, but nothing is going to ever replace hormones. Hormones are white. Hormones magic. Wow. You have the myosin slows the process, kind of like how the medications for all time

18:43was it slows the process, but it doesn't prevent it obviously. It does not. So I'll give you more of an example that's more concrete, so you guys didn't understand. Like, in the study, it actually says that, like, just say that you per day, when you're in that rapid acceleration period after forty, when you're losing your eggs, say that you lose fifty eggs a day. Rappamlycin will let it slow down where it's like only fifteen eggs a day. So it's a significant reduction. But it doesn't stop it all together, okay? And that's really important because with the high achieving woman who has focused on her career all this time, she forty two just now get a marry and still would like to have kids. That's a good one. Other topic that you and I need to delve into, I've always said that at one point in my life, I do want to start to go back to medical schools and residencies and lecture and tell them listen girls. Don't believe the height that you can do it all because you can't, okay? Like, there is something that you're going to give up and it may be something that you never thought that you would have to make that kind of decision and so you need to start

19:46planning because when you go down this path of, I'm just of our journey, okay, because you and I know what it took for us to become MDs and to be up in this medicine, right? It took a lot. Yeah. More than half my life in order to do it, like all did I have like three degrees, right? And that doesn't even include getting, yeah, it took, all right. So you're on this journey and it's like your tunnel vision and you understand, you remember residency and all that. You're going to delay. If you want to, if you want to be a mom, I'm going to tell these go and freeze your eggs. I was going to ask you about that because people talk about that too because I know I certainly delayed dating and all that, but there were classmates who were having that case in med school. And they were the smart ones. I mean, I'm telling you honestly, they were the smart ones. So if you were set up where you have a partner, whatever, and you're in med school, you have a partner. Um, babies. Don't listen to any of your fellow residents or residency director telling you to wait

20:47because they will. Because they want you to be in the work pool so that you're on a call or whatever. You do what is best for you because you cannot have it all. That's why I'm telling you, you need to come and we need to come back so I can tell you about those 16 IVF cycles that have my work because I believe the hype that I could have it all and you can't. So you have to make certain decisions as a woman in your life, especially if you want to be a professional woman where there's a certain track where it's going to get a number of your lives, you need to be smart about it and your fertility is not going to wait for you. Yeah. And we both have young children. Is that your only child you mentioned? Oh, girl. I couldn't. I went through four years back to back of injecting myself every day. I'm not joking and I'm not exact. Oh, yeah. So we'll do that again. Yeah. That's stressful. Yeah, we can definitely talk about the mental load of that. But since you mentioned the freezing of the eggs, so obviously that's safe, right? There's, there's. I mean, well, you're going to have to get, so in order for you to freeze your eggs,

21:47your reproductive endocrinologist and infertility specialist has to put you on a cycle so that you are producing more eggs than you normally would per month. So there is hormones involved with that. They are bioidentical, meaning they're the same type of hormones that are making your body. So it's not like they're synthetic, but yes, that is involved. And so you do have to increase your hormone level significantly in order to freeze your eggs because you want them to only do it one time, right? It's going to be one outpatient surgery, so you want them to get as many as possible. And we really only, every month, maybe ovulate one or two eggs, but we want a lot. When you're freezing your eggs, you want them to, once you want them to get a lot, so you have to give them a lot of hormone. Yeah. Okay. Makes sense. All right. So Rabbimisin, really exciting. Okay. There's other peptides too that we can use help not necessarily slow down ovarian aging, but we can layer it in to help with other things like, for example, and some of these that

22:52I'm going to be bringing up are FDA approved, and we're using them as off label. Okay. Like, so for example, there is a medication called Tess Morallon that recently FDA approved for HIV-associated visceral lipid, this trophy. So what that means in layman's terms is specifically for people that are in layman's or as I know, specifically for the people who, so in certain subset of HIV positive patients, the way that the disease manifests within them is that they end up putting on a lot of fat and specifically in the visceral fat, which is surrounding your internal organs, can you deliver, your pancreas, if you've heard of fatty liver term, that is considered visceral fat. So for whatever reason, these HIV, it triggers something where that's how one of the ways that the disease is manifesting within that individual. And this medication, this peptide, Tess Morallon, is specific in that it's identical fat phenotype.

23:59Well, let me just say the reason why it's really promising for menopause is that visceral fat, as your estradiol levels go down, your visceral level goes up. It's the same phenotype that we're looking like in menopause, where you have more fat internally surrounding your organs and wild pauses, aberrant hormone release. So hormones that don't want release will be produced and released, and chronic inflammation that can increase your risk factor of everything, okay? So the mechanism of Tess Morallon is that it stimulates the growth, GHRH, growth, releasing hormone, receptor, and then increases growth hormone, and IGF1, okay? I'm taking you way back to, you know, med school hormone group, okay? And once it increases growth hormone and IGF1, this is the visceral fat to break down, and then it preserves your lean muscle mass, and then it stores the growth hormone access restoration. Because a lot of times you have an HBO access dysregulation that everyone, and so this reduces,

25:06ends up producing your inflammatory markers significantly, and then there is, like, within vessels, the crotted intima-media thickness, it actually makes it go down. So the vessels become more client, and the decrease in inflammation, it ressulting in decrease in visceral fat. It also has a nortropic effect, so it helps with brain function as well too. Well, that's good. Right. And then, the spread of this metabolic and cognitive decline in one agent, Pesmeralan, okay? Gotcha. And so I use that. I will use that at any point in a woman's journey, if she's just for weight loss, or VHRT, if we can, if we can, if we can, if we can, an amount of visceral fat, and how I find out is that my patients end up getting either full body dexascans, where I can see what their lean body tissue is versus the amount fat that is internal within their abdomen, or even subcue, and, or some of my patients get at home in body, they can

26:12see it. But either way, I can measure what we're looking at, what is the percentage of fat, lean body tissue, and then I can give you Pesmeralan off-slabel use, and we can significantly measure it going down over time. And can you also be on it, also with the wrapped amycin as well, because it seems like they do completely different things, a completely different mechanism of that. I think wrap amycin in that bag. What are the different indications? Yeah, I didn't tell you, and I take wrap amycin every week, it's weekly dose, five milligrams, you know? Yes, you can, because the wrap amycin is going to work on a completely different mechanism that's working on it. So what have you noticed, since being on it, how long have you been on it? I've been on it, so I, I think I started like a three-month course, and I might be, I might have five pills left, it's once a week, um, a little bit more energy, um, my diet. I'm still menstruating, I'm perimenopausal, so, um, I think the first couple of weeks when I took it, my period came a little bit quicker than it was supposed to, so that

27:14was interesting, I thought, oh, I just felt like, to me, I felt like it was taking some sort of effect, and I was looking forward to see what would happen. My period that came that day was, or that month wasn't, um, wasn't painful, I normally have really painful periods. Um, so, um, period, um, and I, you know, so I, I'm halfway through the therapy, so bringing back for me to tell you what exactly is all of that. I mean, just my test markers is every three months, I, I take repeat follow-up labs, because I'm being optimized myself, I'm a patient, and, um, you know, I'm under care to get be a turtle. Yeah, of course. Yeah, but I could hear that you actually take the things that you are promoting. Oh, yes, I don't listen. I don't practice conventional medicine anymore. Honestly, if I look at how I pray, I know, I'm fine, completely different, everything that I recommend, I, I do it myself, and either myself or my husband, you know, I treat

28:17men too, and he's my patient, um, yeah, and that's what in this longevity, regenerative medicine, because that is the type of medicine I practice. The foundation is, um, hormone restoration, because that's the foundation. But then I add on other things that are longevity and regenerative medicine focused, like the peptides or bioregulators or the rapamycin. But, um, you know, this is something where in this space, doctors who decide to venture out, you are iconoclastic, you are standing out and you're taking a stand and you're a little bit of a target. Um, we don't have a lot of research because the research, all right, randomized, controlled trials are run by the pharmaceutical company, yeah, and a lot of times, what, if they do do these, these studies on these peptides, it's because they want to take it themselves so that they can make a lot of money. Mm-hmm. People are looking for alternatives these days, they're looking for off label.

29:18These doctors tend to work and fight out on their selves when they're in this space and then they'll venture out, um, to select patients. So very carefully, we don't jump really quickly into it, we need to see, um, anecdotal, a lot of anecdotal data for, especially if we don't have studies to kind of back it up. But yeah, it's not anything new, that's what we do in this space. Yeah, for sure. Yeah, and that's everywhere. Of course, we use a lot of off label medications in the field of psychiatry as well. Yeah, yeah. So, I mean, I think it's really exciting, um, you know, the brain, one thing, and I think this is, because this is your area of expertise with regards to mental health and the brain. Brain runs on estrogen, you know, it is when ovarian function combines brain glucose metabolism, significantly declines with it, about 30%, and it's measurable on a PET scan. And this begins years before that last menstrual cycle, years before. And, you know, to be really specific, it regulates mitochondrial bile and energetics in the brain.

30:24And so that loss of ovarian estrogen is a loss of brain fuel. That's why women are getting like the brain, brain fog, retrieval loss, the concentration failures, and period menopause. Oh, I hear that all the time. I have a patient who has 70s of talks about that attention issues, brain fog, just like, is energy defense deficit at the cellular level. It is a kind of energy of your brain cells. So, of course, you're going to manifest it and express that word loss retrieval. So, there is a scientific reason for what women are experiencing. That'll for it's just aging. It is treatable, reversible. You know, you just restore hormones. That's all you need to do. It reduces depression. Okay, there's a randomized controlled trial where they gave estradiol and micronized progesterone and it cut depression by rates from 32% to 17%. Oh, my goodness. Now, that's a lot when it comes to depression. So, and you were saying on the previous episode that anxiety is the first sign of

31:29perimenopause. And, of course, you can get depression when you're losing these hormones. So, that's important to know, don't just see your psychiatrist, see your OB guy too. That might be something else going on. I mean, you know this, but I'm sure your audience doesn't know this, that Alzheimer's, two-thirds of Alzheimer's patients are women. With early Alzheimer's, I mean, changes. Two-thirds, it's majority women. There's a critical five-year window at menopause on site where estrogen, like if you start, if you give it the estradiol at that point, you're going to have a significant neuroprotective effect. It's time-dependent. We actually have studies that show that. And that if you start estradiol later than that five-year window, that's important. But we also just get on it, or do we have the way? You just need to find a hormone specialist window. What the window is, the window I was talking about with regards to protection for Alzheimer's, is within five years of menopause on site.

32:30And menopause is 12 months. That's a good window, it's a big window. Five years. Then if you were able to start it within that window, it has a significant neuroprotective effect. That's time-dependent. If you go outside of the window, so if you start it like 10 years out, it doesn't confer the same protection. There is protection, but it's not as significant. Does that make sense? Yeah, yeah, for sure. So let me ask this. We truly have these tools that might actually slow ovarian aging. What are the ethical considerations? Who gets access? How far should we go in the laying menopause? So this is cutting edge. So these studies, that vibrant study I told you about with rapid mice, it's underway. It's not been completed. They still are gathering data. We know about it because we know that they wrapped up the many study and that they were so excited about it that they ended up getting the larger study. But certain people in this space, they took that and they are starting to treat with it. So I am willing to treat a patient

33:31with these off-label agents as long as they are the right appropriate candidate. So you just have to go to someone, speak with them, give them their history, let them determine if this is right for you. Even hormone therapy, because I'm not saying that this is the pantheia for everybody because there's certain people out there that they have significant risks they're coming in with, like genetically or what have you that in that, you know, not all the hormone therapy may be appropriate or a certain delivery form because a hormone optimization is not just a hormone. It's actually like the route of delivery, are you going to give it injection form? You're going to give it transdermally through like the skin, or you're going to get poorly. That there's different risks associated with the different routes and then the frequency and the timing. So it's all interrelated. So I wouldn't say that everyone needs to be on hormone. I would say that you need to talk to a hormone specialist, let them really dig into your history, get testing,

34:34because there are like a lot of people saying that you don't need to test. Yes, because the hormones affect so many different things. You need to test your inflammatory markers, your lipid panel, your thyroid, all of that. Get tested, let them dig deep. Yeah, it's case by case. It really depends on who you are, your body, but it doesn't hurt to go in to see somebody. So let's say a woman walks into your office, she's 40, she's exhausted, she's anxious, she's like, I'm just not like myself. How do you approach the evaluation and design a plan for her? So if she's not a patient yet, then coming into my world, she would get like an initial visit. I call it the ground zero consult, because I want to see where she's at, where her mind's at, what her goals are, what does she want, what's going on with her, what does she ultimately want to achieve? You know, I talk about that, she understands a little bit more about the practice, the things that I can offer, because it's not a conventional practice, it's different, right? And then we kind of determine

35:36if it makes sense to partner together. So that's the first step, someone coming in. Then let's just say that we decided they were going to work together. So she's going to get a very comprehensive lab panel, done my own, and I'm changing it all the time, as I'm learning, because I'm always learning. Every other month, I'm going to different, you know, three-day workshops to keep learning and learning, right? So she'll get a comprehensive panel, and then about two weeks after that, she and I will meet for a two-hour visit, and we are going to go through that panel in detail. She's going to comment, understanding exactly where she's at, exactly what the literature and the medicine says, and what we can achieve, like what we can prove, like what we can improve, okay? Then we'll come up with a plan that's specific to her, based on her lab values of where, what we want to improve. And so every plan is different. May layer in peptides, right away, I mean, not. She may come in with a lot of gut health issues,

36:38and I mean, get that all prepared either before or concurrently. Everyone is a unique, beautiful butterfly in my practice. And she gets very, a lot of hands-on care. So my practice operates outside of insurance. Like, when's the last time you think you can do a two-hour visit with a patient in insurance? No, and be able to be able for it. And your practice is at Renee Allen MD, correct? And the type of therapies that I offer are considered experimental, so it wouldn't be approved through insurance anyway. But if it is attractive to a certain type of patient who is very health-span focused and is out there in the wellness space and wants that longevity regenerative medicine, that is the practice that I have. I'm for you. Yes, that is so awesome. And I just keep saying every time you come on, like, who would not want to go to your practice? It sounds like you're offering all the good stuff,

37:39all the innovative techniques, and that is pretty awesome. So Renee Allen MD.com, this has been a great conversation. Yes, you are coming back for the fourth. I already made a premonition. You know, this was the fourth. I'll cast her. You know that. Oh, thank you. And I have to have you for March because this is the end of Women's History Month that we've been talking about all things, women. So our joy has to do with our hormones and our body changes and all these things. So it was really good having you and talking with you. Yeah, ladies, just don't accept that it's ageing. It's not. I mean, it is ageing, but you don't have to feel the way that you do. And you can actually feel like you did in your late 20s. I take my patients back to feeling that way. You know, yeah. That's a good closure. She takes people back to feeling like they're in their 20s. Yes. So to her website, right now. Thank you.

38:39I love spending time with you. I love it. Thank you too. Thank you so much. And I will see you next time. Bye. Bye. Bye, bye. This has been an enjoy life production. If you're in a crisis, don't hesitate. Call text for chat 988 for immediate support. Please note, this podcast is for informational purposes only and is not a substitute for professional treatment. If you're looking for therapy or medication management through enjoy life, visit www.DrEnjoyLife.com to request a consultation. I'm Licensing 13 States. I accept Etna in Georgia, Florida, and Virginia. Be sure to grab your copy of the enjoy notes to help you on your wellness journey. Also, check out Inspire Joy for the Wife Mom Boss to help you balance it all without losing your stuff. Better yet, get the full joy bundle for just 45 hours. Remember, journey to joy live is every Thursday at 7 p.m. Thank you for joining me. And until next time, may you continue to transform

39:41stress into joy. Girl!