Dr. Peter Attia

I'm actually surprised, but you have to understand, I don't spend any time paying attention to the buffoons in the periphery on this topic. I don't like the whole terminology around functional medicine. I don't buy into the idea that you need to be spending an inordinate amount of money on esoteric, non-validated labs.

I'm actually surprised, but you have to understand, I don't spend any time paying attention to the buffoons in the periphery on this topic. I don't like the whole terminology around functional medicine. I don't buy into the idea that you need to be spending an inordinate amount of money on esoteric, non-validated labs.

You can go to LabCorp, you can go to Quest, you can go like any CLIA approved lab that knows how to do an assay correctly is all you need. Our view and what we tell patients is the symptoms are the most important things, but the numbers help direct my thinking. This is how we manage thyroid. This is how we manage sex hormones.

You can go to LabCorp, you can go to Quest, you can go like any CLIA approved lab that knows how to do an assay correctly is all you need. Our view and what we tell patients is the symptoms are the most important things, but the numbers help direct my thinking. This is how we manage thyroid. This is how we manage sex hormones.

And to be clear, there's a caricature of the Dunning-Kruger curve that I just find so helpful. So for the folks who aren't familiar, on the x-axis, you have experience. And on the y-axis, you have confidence. In the sort of character version of the representation of this curve, you initially have a huge spike, which then falls into a valley and then a slow rise.

And to be clear, there's a caricature of the Dunning-Kruger curve that I just find so helpful. So for the folks who aren't familiar, on the x-axis, you have experience. And on the y-axis, you have confidence. In the sort of character version of the representation of this curve, you initially have a huge spike, which then falls into a valley and then a slow rise.

And of course, the huge spike is referred to as the peak of Mount Stupid, followed by the Valley of Despair and the Slope of Enlightenment. It's just important for people to understand that when you are on Instagram and YouTube, disproportionately, you are seeing people at the peak of Mount Stupid, which is to say they have very low experience, insanely high confidence.

And of course, the huge spike is referred to as the peak of Mount Stupid, followed by the Valley of Despair and the Slope of Enlightenment. It's just important for people to understand that when you are on Instagram and YouTube, disproportionately, you are seeing people at the peak of Mount Stupid, which is to say they have very low experience, insanely high confidence.

These are the ones that are telling you that TSH, I'm making this up as one example, TSH must be between 0.4 and 1.9. And if it is any bit above 1.9, you have hypothyroidism and you need to be on armor thyroid or naturethroid or whatever. And it's sort of like, no, none of that is correct.

These are the ones that are telling you that TSH, I'm making this up as one example, TSH must be between 0.4 and 1.9. And if it is any bit above 1.9, you have hypothyroidism and you need to be on armor thyroid or naturethroid or whatever. And it's sort of like, no, none of that is correct.

And you just have to take care of enough patients for enough years to get humbled enough to know that whatever you think you know with rigidity is probably wrong.

And you just have to take care of enough patients for enough years to get humbled enough to know that whatever you think you know with rigidity is probably wrong.

Yeah. So here's what we do. We focus relentlessly on the symptoms and we care what the estradiol level is. We also think the FSH is a very helpful marker. So if a woman's FSH is 78 and her estradiol is 40, I'm inclined to believe she needs more estrogen, especially if she's saying, I think I feel a bit better. I'm just not sure. Like to me, that says I'm going to go more.

Yeah. So here's what we do. We focus relentlessly on the symptoms and we care what the estradiol level is. We also think the FSH is a very helpful marker. So if a woman's FSH is 78 and her estradiol is 40, I'm inclined to believe she needs more estrogen, especially if she's saying, I think I feel a bit better. I'm just not sure. Like to me, that says I'm going to go more.

And by the way, with the labs being where they are, I'm more inclined to push a little bit. But again, nothing tells me I've given her too much estrogen more than her saying her breasts hurt. And that's the advantage of doing it with these short-term estrogens because I can pull it back really quickly.

And by the way, with the labs being where they are, I'm more inclined to push a little bit. But again, nothing tells me I've given her too much estrogen more than her saying her breasts hurt. And that's the advantage of doing it with these short-term estrogens because I can pull it back really quickly.

So I don't know if that answers your question, but I would consider myself an essentialist on labs. kind of a minimalist essentialist, but not an absolutist in either direction.

So I don't know if that answers your question, but I would consider myself an essentialist on labs. kind of a minimalist essentialist, but not an absolutist in either direction.

Anything else you want to say about systemic therapy before we go and talk about local therapy in the context of genitourinary symptoms of menopause?

Anything else you want to say about systemic therapy before we go and talk about local therapy in the context of genitourinary symptoms of menopause?