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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There are three other questions that I want to ask you going back to hormones post-menopause. I'm saving the three most contentious questions for last on this topic. Question one, someone's posing this question to you, not me. I buy your argument that hormones are safe, but I am now 56 years old. I finished menopause at 49. Isn't it too late to do anything about it?
Or the window idea.
Throughout life.
Okay. Now I'm going to ask another question that is the extension of that question, but I think your logic is going to hold the same, which is the hedging strategy, which says not only use as little as possible for as short a duration as possible, says you really need to stop this after 10 years.
So even if you were lucky enough to catch a woman through perimenopause, you got her on hormones by the age of 49. Now that she's 69, you got to stop it, right?
By the way, that was the argument put forth to me with one of the authors of the WHI, who is by far the most willing to concede that mistakes were made, which was, okay, yes, I will concede that the estradiol is doing amazing things for the woman's bones. But remember, they're going to go away when you stop the hormones. As though that was a necessary thing to do.
Yes, and it actually dovetails perfectly into my third critical situation, which is how do we manage hormones in women who are at risk of breast cancer from a familial standpoint, who have been diagnosed with DCIS, which is not cancer, but increases the risk of cancer. So that's kind of a subset of the first group.
And then in women who actually have breast cancer or have a history of treated breast cancer. So I would imagine you see women that fit into all four of those buckets. How do you handle it?
It's insanely helpful. And of course, it echoes exactly what Ted Schaefer said when we spoke about this after discussing the Traverse trial, which was, I think, to me, the most telling thing that Ted said was, look, if I have a man who's got a Gleason 3 plus 3, means he has prostate cancer and we are going to follow this.
And if it becomes a three plus four, we're going to actually have to take this thing out. We'd put him on TRT if he needed it. And his argument was exactly your argument on the pregnancy side, which is the reason we would happily give him TRT is let's just assume he's a man replete with testosterone. Would we castrate him during that period of time of observation? Of course not.
So why would I not give him testosterone if he needs it, even though he actually has prostate cancer?
because I don't pay any attention to social media, there are people out there saying they're anti-HRT, but they- Use HRT. What's their argument? What are they talking about?
What do women need to be aware of? Not every woman can come and see you. Not every woman has access to a doctor who has the breadth of knowledge that a select few do in this space. So, A, how can women find... practitioners near them, and what do they need to be aware of?
What are the exploitative practices out there that they need to be mindful of and not get duped into either dangerous therapies or overly extractive therapies?
What are some of your favorites?
And what's the website?
Do you feel that there are too many women that are still getting their hormone therapy in the dark alley with highly sus individuals? And if so, what would be a clue that you're in that camp? Because there's nobody that's in that camp that knows it.
I want a woman who's watching this who's not getting great medical care, but thinks she is to maybe get a bit of a hint as to what that might look like.
Rachel, as expected, this was a fantastic discussion. And I think it adds to what we're trying to do in this podcast, which is really have nuanced and deep discussions about important topics. Not every podcast I do gets to impact that many people. Some of them impact nobody. They're just really esoteric, but they fit into my curiosity window.
But this is kind of a topic that really impacts almost 100% of the population. Because 50% of the population is who we just talked about. But the other 50% of the population would be hard pressed to say that they don't care about at least one person in that other group. So 100% of people are heavily impacted by what we just discussed.
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