About Jeff Grimm, MSN, NP-C, FAARM
Jeff is a member and Fellow of the American Academy of Anti-aging Medicine, a clinical specialty focused on the early detection, prevention, treatment, and reversal of age-related dysfunction, disorders, and diseases. Evidence based protocols used in practice include optimizing diet and nutrition, proper supplementation, exercise, stem cell therapy, and hormonal therapies. His level of training is unique in Oregon, as he has completed a fellowship and board certification in this exciting new field of medicine.
Connect with Jeff
Liver support (milk thistle, S-Acetyl Glutathione, alpha lipoic acid) is great for people using bioidentical hormone therapy
#1 Health tip
We should stop subsidizing unhealthy foods and start eating more organic, non-GMO foods.
Top Books and Resources Discussed in this Episode
Women’s Health Initiative study showed that women taking Premarin (conjugated equine estrogen) with progestin (hydroxyprogesterone acetate) had an increased risk of cardiovascular disease and breast cancer (8 more cases per 10,000 women per year of breast cancer in women who were taking hormone therapy (HT) compared to those who were not).
This study prompted a national shift to cause doctors to stop recommending hormone therapy.
The Women’s Health Initiative study has been reanalyzed several years. The biggest issue was the study design. 49% of the women smoked and majority of the women were overweight or obese and the average age of the women in that study was 63 years old and the women were not symptomatic.
JAMA study showed that the data gleaned from the Women’s Health Initiative study can’t be translated into clinical practice.
Jeff advises starting hormone replacement early.
The second major issue of the Women’s Health Initiative study is the type of hormone used in the study:
a) the estrogen used was Premarin (equine-derived product)
b) the progesterone was hydroxyprogesterone acetate
Using synthetic estrogens in isolation are not linked with an increased risk of breast cancer, but the bigger issue is the synthetic progesterone derivatives. These are problematic. Names include Implanon, Nexplanon, Norethindrone.
Additional analyses of the Women’s Health Initiative study showed that if you add the progestin in, you increase your relative risk of breast cancer by over 69%.
Many studies have showed this link between synthetic progesterone use and adverse health outcomes (breast cancer and heart disease).
Much of the medical community is confused about synthetic progesterone and real progesterone. For example, real progesterone and synthetic progesterone have opposite effects in the body.
However progesterone and synthetic progestin have similar effects on the uterus, which is why they are often used interchangeably to prevent uterine cancer.
Progesterone that is derived from wild yams is identical to the progesterone that is made in the female ovary, but synthetic progestins (found in birth control pills) are not molecularly identical to the hormones found naturally in the body. The study abstracts themselves will show that “progesterone” was used, when in reality, it was synthetic progestins.
All the words for progesterone are often used interchangeably.
Progesterone deficiency is quite common in the 10 years before menopause and can persist much longer after that. So, it can start between 25 and 45 years of age. A good gauge is to see when a woman’s mom, aunt, or sister started going into menopause.
Common symptoms: Anxiety, depression, insomnia, fluid retention, migraine headaches, painful menstruation, excessive menstruation, or irregular cycles. Anxiety, depression, and insomnia are very common in post-menopausal women.
These symptoms are frequently tied into the luteal phase of the cycle (days 12, 13, or 14 through day 26, 27, and 28 of the cycle)
Progesterone converts to allopregnanolone that is a direct GABA agonist in the brain. The female body makes natural volume, so when progesterone is low the female brain might have more glutamate and less GABA, causing irritability and agitation. This anti-anxiety benefit is best achieved through oral progesterone (micronized, oral progesterone).
Allopregnanolone is a neuroprotective agent as well, and there is some great research on progesterone and traumatic brain injury.
Jeff shares a case study of a woman that was given two different birth control pills to help with her excessive menstrual bleeding. Jeff gave her low dose (200 mg progesterone) and the bleeding went away.
Progesterone can also be used as a muscle relaxant, so it helps with menstrual cramping as well.
Women who produce less progesterone before menopause have an increased risk of breast cancer. Women who are non-menstruating have an increased risk for breast cancer later in life.
Progesterone is a natural estrogen blocker. So when it’s in balance, we don’t see proliferative diseases like PCOS, endometriosis, uterine fibroids, and breast cancer.
Breast cancer is an over proliferation of cells in the breast that is mediated by the stimulatory effects of estradiol.
Synthetic progesterone causes vasospasm, increasing risk of heart disease.
Real progesterone has a cardioprotective effect and that is why it also helps with migraine headaches (vasospasm can trigger migraines).
Men and Progesterone
It can help prevent anxiety, depression, and over conversion of testosterone into DHT. Oral doses for guys are around 20-50 mg orally at bedtime. It’s a weak 4-alpha reductase inhibitor that may help with balding in men.
Estrogen deficiency before menopause is quite common; it really starts to decline at menopause.
Hot flashes, night sweats, brain fog (feeling like their body is divorcing itself from them) someone you’ve known for ten year you can’t remember their name, vaginal dryness is very common, and atrophic vaginitis, dry skin, dry skin, dry hair, dry eyes, eyes are getting blurry, dry course hair, natural curl goes down, fine lines above the lips, bone density issues.
You get the most bone loss within 5 years of menopause. So it’s important to get DEXA scan right at menopause to give a baseline. Many cities have case pay-based DEXA scans, and Jeff suggests that many women in their 40s should start on this.
Why do you have vaginal dryness, course-dry hair, fine lines and wrinkles, and dry skin? Water follows estrogen in the body.
If estrogen declines, water goes with it. For example, there is a 50% reduction in wrinkle depth using a topical estrogen face cream. Estriol is the form to use.
Vaginal dryness will typically disappear within two weeks of using estrogen. The tissue of the vagina thins out after menopause.
Any type of oral estradiol can increase SHGB and preferentially convert to estrone, which is linked with breast cancer.
The preferred method is a path, pellet, or vaginally delivered cream.
Testosterone was ignored in women for years. Women produce about 10 times less testosterone than men. But they need it for drive, self-confidence, self-esteem, motivation, muscle mass, sex drive, libido, and energy.
It declines a few years before menopause, it might be noted around the same time as progesterone (10 years prior to menopause).
It’s becoming more pronounced in post-menopausal women.
Women with a lot of stress/adrenal stress will have more testosterone. DHEA is made by the adrenal glands; and in women, DHEA will mainly convert into testosterone.
NEJM shows that testosterone replacement therapy is safe and effective for women for improving arousal, lubrication, sex drive, libido, orgasm, sexual stimulation.
DHEA is related to testosterone (50 mg /day) and has the effect of preventing bone loss. Since DHEA and testosterone help increase lean muscle mass, this helps protect bones against fracture.
Testosterone helps with anabolic status, tendon ligament issues.
Use and application: testosterone cream, it helps with vaginal dryness and hot flashes. Compound the dose to 0.25-2 mg per day. Pellet or vaginal cream is ideal.
Testing testosterone in women: optimal range of 50 and 150 ng/mL
If you overdose on testosterone, you can use spironolactone to offset.
Testing for hormones using serum testing is best to get things going. You want to test progesterone during the luteal phase.
Typically estrogen is dosed with estriol and estradiol (80/20). But Jeff Grimm likes E3/E2/T 0.3/0.3/0.5 per mL and patient uses a1/10th of an mL vaginally daily.
Top supplements: If someone is on HRT (hormone replacement therapy), liver support with milk thistle, alpha lipoic acid, 5-MTHF, B6, magnesium, and cruciferous vegetables.
Jeff strongly feels that every woman should undergo BHRT at the time of menopause, particularly if they are symptomatic, as they would really benefit from hormone replacement therapy.
Estrogen helps increase blood flow to the brain. Brain fog is linked with reduced blood flow to the brain.
Fornia trial is the largest trial to date to show that BHRT is safe, effective, and doesn’t increase breast cancer or cardiovascular disease.