Dr. Peter Attia
speaker
5,258 appearances
36 recordings
6 series
first heard Jan 2024
last heard Jun 2025
Dr. Peter Attia’s voice in public audio — every appearance, attributed to the second.
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So if I said to you, Rachel, I have a treatment for you that is going to fix a hundred problems, but it increases your risk by 100% of getting hit by an asteroid, would you take the medicine or not? Well, you'd have to know what your base level risk of getting hit by an asteroid is. And given that it's almost zero, doubling it doesn't mean anything.
So the absolute risk increase for these women was 0.1%. So to put that in less technical terms, it meant even if you believe the results of that study, and you've offered a great explanation for why the actual results should be questioned, but even if you take them at face value, for every 1,000 women who were put on HRT, an additional 1%
got breast cancer, though she didn't die from it at any increased rate to the women who didn't get the hormone. This to me, and I'd like you to push back on this, although I'm worried you won't be able to because you share my bias. This is the greatest injustice imposed by the modern medical system in our lifetime.
Yeah, it's really interesting to hear you say that because you're highlighting something that's as dramatic and potentially more dramatic than the thing I've tended to focus on. I've focused more so, maybe I just take for granted that I got lucky and I had amazing mentors and they taught me how to do this stuff, but it's also the nature of my personality to just
be endlessly curious and show up in somebody's clinic for two weeks and do this. I've tended to focus on the lost generation of women. So I had my analysts do this analysis two years ago, and I don't remember the exact numbers, but the analysis was
Calculate for me or estimate for me the number of women who were deprived of HRT because of the WHI and calculate the excess mortality that was achieved through that injustice, through hip fractures, cardiovascular disease. We just went through the entire list.
calculate the number of lives that were lost, the amount of disability that was incurred, because to your point, even if you don't die from a hip fracture, 50% of survivors never regain the same level of function. And I didn't even know how to quantify all of the sexual side effects that women unnecessarily endured, all of the vasomotor side effects that they unnecessarily endured.
I didn't even try to quantify that because I don't know how to. But that's the thing that I focus on. And again, it's personal to someone my age because my mother and my mother-in-law are in that category. They're the ones that got absolutely screwed by this system.
You're highlighting something equally catastrophic with potentially a greater impact, which is we failed to train a generation of doctors to do anything about it. And if that's not reversed, the problem doesn't get much better.
I did learn that hormones were bad.
Let's talk a little bit about how we go about doing things. So there are two hormones we've talked a lot about, but there's a third that we haven't yet talked about that is very linked to these two hormones, doesn't get enough attention in women, and of course that's testosterone.
So before we get into how one should think about replacing hormones, can you talk about the relationship of testosterone to women's sexual health and what's happening to testosterone levels during this transition from peri to menopause? Because of course, I want to bring this into the HRT discussion.
You've probably heard me make this point before because you alluded to it a few minutes ago. We measure testosterone in nanograms per deciliter. We measure estradiol in picograms per milliliter. If you normalize those to the same level, Women are shocked to learn that they have 10 times the amount of testosterone in their body that they do estradiol, at peak estradiol.
I think this is an area where women sometimes are also a bit concerned about what happens if I take testosterone because testosterone, understandably, conjures up images of all sorts of things from large muscles, big mustaches, lots of other things. So how do you talk to women about this? We enjoy having these discussions and also acknowledging side effects from
The most common side effect we see in women is acne. I don't think I've ever gotten to the point where I've seen any of the really dramatic side effects, but I do tell women, I say, look, there's a decent chance if you were shaving your legs every five days, you're going to be shaving them every three days. That's a chance.
If you were kind of susceptible to acne growing up, you might get a little bit more of it and we'll have to back off. How do you talk about the risks of testosterone therapy?
So let's just finish the swing on testosterone. Do you prefer then to rely on the topical version, which would be like an Androgel-type product, and just dose it at a much smaller dose?
Hmm. That's an interesting question. I mean, I definitely agree that that's true for some people. That said, I've also seen people who within weeks report feeling better. Now, the challenge here, of course, is the only way you could understand this is through blinding. We just don't know how significant the placebo effect is. And therefore, it's hard for me to discount or know.
I want to ask you another question about Natesto. So Natesto, for the listener, is a nasal formulation. It's an FDA-approved formulation. In theory, it seems like a great idea. In practice, it has not really panned out just based on its messiness. It's a gel, a nasal gel. We've had women use it vaginally, nasally. What's your experience been with it?
Why isn't a female formulation being made?
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