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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But what's the risk of not doing something is very significant. So let's talk about all of the different ways in which a woman can get estradiol through an approved, tested, chemically sound means.
Let's start with systemic. Let's come back to that as we talk about genitourinary syndrome.
Let's start with the oral. So we have an oral formulated estrogen. We don't use it that much. I'm trying to think. Used to use it a bit more than we did now. Honestly, sometimes I would use it for women who we were struggling to get the dose right on something else and I just needed something to get them through the weekend.
And it was like, OK, I want you to just take a milligram of this estradiol tablet tonight while we readjust your cream or your patch or whatever. When are you using oral estradiol?
It's no more increase in risk of blood clot than a birth control pill.
Yeah. So given the ubiquity with which women are on birth control pills- It shouldn't scare you. We tend to blow this out of proportion. Yeah. So what is your patient selection criteria on that? In other words, who are the women that you would say I don't want you on oral. Is this just factor five laden? Is this women who are obese? Where do you say, ah, the risk is a little too high?
And it doesn't drive up SHBG, presumably?
Does that mean you can get away with a lower dose?
You must, right?
Because of that first pass effect. So how do you dose it?
Did you ask this guy?
How does he dose it?
Okay. Let's talk about the panoply of topical ways you can do this. Creams, patches. What are the challenges of using these things? How do they limit women's activity levels? I mean, I used to have this whole talk I would give women about what I thought was the best way to maximize the absorption of the cream and what I wanted them to do before they put it on.
And I wanted them to have a shower and I wanted them to exfoliate their inner thigh. And I just had this whole routine that was probably so elaborate that it decreased compliance because like.
All right. Talk to me about it.
We also notice women who use the sauna, who are very, very athletic and exercising like crazy. You just have an adherence, physically an adherence problem.
What's the case for not just using the ring all the time?
And it's sitting right up against the cervix?
And it's just dose is the only difference between the two.
Yeah, yeah, yeah.
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