Dr. Peter Attia

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.

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 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.

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?

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.

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?

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?

And it doesn't drive up SHBG, presumably?

Does that mean you can get away with a lower dose?

Does that mean you can get away with a lower dose?

You must, right?

You must, right?

Because of that first pass effect. So how do you dose it?

Because of that first pass effect. So how do you dose it?