The Get Healthy Tampa Bay Podcast

E128: Dr. Jacovino on Menopause, Metabolism & Hormones That Help You Feel Like You Again

• Kerry Reller

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Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week, I’m joined by Dr. Crystal Jacovino, a board-certified endocrinologist with a passion for optimizing hormones, metabolism, and overall quality of life. In this episode, we dive into the science and lifestyle strategies behind perimenopause and menopause. Dr. Jacovino explains how hormones like estrogen, progesterone, and testosterone impact metabolism, fat distribution, sleep, and emotional wellbeing—and how strength training, diet, and carefully tailored hormone replacement therapy (HRT) can transform your health journey. Tune in to learn what “hormone optimization” really means and how to take action, whether you’re just starting to notice symptoms or deep into menopause.

0:29 – Introduction to Dr. Crystal Jacovino
2:54 – How endocrinologists approach perimenopause and menopause
4:26 – What “hormone optimization” really means
6:36 – Estrogen decline and belly fat: the shift in fat storage
8:33 – Visceral fat, insulin resistance, and sarcopenia
10:58 – Cholesterol, metabolism, and strength training in midlife
14:39 – When and how to add testosterone
19:19 – Biggest HRT myth: the breast cancer fear
23:21 – Bioidentical vs. commercial hormone therapy explained
26:26 – Sleep disturbances as a symptom of perimenopause
34:15 – Patient success story: GLP-1s + HRT for metabolic renewal

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Kerry:

All right. Hi everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller, and today we have a very special guest, Dr. Crystal Jacovino. Welcome to the podcast.

Crystal:

Thank you. It's a wonderful day to be here.

Kerry:

Yeah. I really love your background, by the way. So tell me a little bit about who you are and what you do.

Crystal:

Sure. So I'm board certified in internal Medicine and Endocrinology. I'm a fellow of the Academy of Clinical Endocrinology. And I currently work online at a company called Henry Meds or Colius Medical. And we do a lot of, obesity management, weight loss, HRT, TRT for men, erectile dysfunction. Many other endocrine issues. But the thing that I wanna talk to you about today is perimenopause and menopause.

Kerry:

Awesome. So how did you get into, like, did you always love endocrinology, like hormones or, and how'd you get into that?

Crystal:

Yeah, so I really enjoyed treating weight loss and diabetes. Especially when I was in residency. I spent about two years working in the emergency room after sort of residency and I didn't like people. Having very bad conditions. I didn't like seeing pet people pass away. And endocrinology is kind of one of those fields where like people don't really, people can get better. Like you can you know, prescribe insulin, you can prescribe a, a medication and people can do better. And turn themselves around. And so it's one of the kinda nice, like lifestyle me medicine, you know, versus regular medicine. And you kind of come together, you can really help people's lives. And it was kind of a just exciting merging of experiences that I really liked.

Kerry:

Yeah, I definitely agree. I think it's a very rewarding discipline and certainly now obviously it's becoming, you know, even more important and thank God we're changing things, so that's awesome. And clearly you and where you're working is definitely changing things as well. So like you said, you wanted to talk about like perimenopause and menopause and we've, it's been a hot topic of conversation lately, but I don't think it's like an ever ending conversation. So what is your, I guess, favorite aspect of that from like, being an endocrinologist? How would you like to begin the discussion on that?

Crystal:

Sure. So as an endocrinologist, our job is to optimize hormones, and we're trying not to path, you know, to pathologize a natural condition, but there are some ways within a. Perimenopause and menopause that our patients are not living to their healthiest life. They're not optimizing their their condition, and by intervening with either medication or lifestyle modifications, we can help them prevent than just the distress of perimenopause and menopause so that they can live their full life. If you aren't able to exercise if you're not able to get up in the morning and help get your children ready for school without, you know, yelling their heads off. And now you're upset and now you stress eat a bowl of cereal, sugary cereal, like you're, you're not set up well for the day. So I love the fact within perimenopause and menopause, we can tweak hormones just a little bit and optimize them so that our patients could live their best lives so that they can do the things that they need to do.

Kerry:

Yeah, I love that. What's interesting is you're using this term or phrase optimizing hormones, and sometimes we're hearing that a lot, and maybe it's a marketing claim, but it definitely draws patients in there because like, what is this? So what does that mean to like optimize hormones? What hormones exactly are we talking about? And I don't know, how do you go from there?

Crystal:

Well, I'll give the example in perimenopause. So it, it's often thought that you just, especially, you know, even just a few years ago when then people were having perimenopause as long as they were still having periods that they were okay, or you just give full dose either birth control or full dose HRT and there's really no in-between. And now we know that we can go ahead and support estrogen, especially if they're having vasomotor symptoms, meaning like the sweat night sweats and you know, the classic menopausal symptoms you support menopausal throughout the entire cycle, but you might only hold the progesterone in what we call a cyclical or sequential way. Towards the end of the cycle, which mimics someone's natural hormonal cycle, and you can use that, what we call sequential or cyclical progesterone throughout perimenopause to support the hormones where they need it. Additionally, we can plus or minus in some women utilize testosterone. As we age our estrogen and progesterone, they go up and down in different ways and sometimes you can have high estrogen. Sometimes you can have low progesterone and vice versa. And there's really no good way to figure it out in perimenopause. But one of the things we can count on is testosterone will go down in a kind of a stepwise way. And so depending on the level that testosterone can be replaced,

Kerry:

Yeah, I like to think of perimenopause as like a rollercoaster of hormones'cause like no matter where you are in doing lab testing, you never know. Exactly what's gonna come in. So that's why you have to maybe either do it several times or really realize that it is maybe not about the labs Exactly. But yeah. That's a interesting, you've already brought up testosterone, which is obviously one of the other hormones that is, you know, pretty important with certain side effects that occur in, you know, perimenopause and menopause, like so I just didn't know if you wanted to elaborate on that a little bit, because I think one of the other things that you brought up was talking about maybe body composition. So I wanted to see what you wanted to say about that.

Crystal:

Oh yeah. So as your estrogen goes down you will start to, your body will start to store its fat it's visceral fat into like abdominal fat. So it's not just a matter of calories in calories out at that point, you actually store fat differently because of the way your body responds to the different levels of estrogen. And so what I find in a lot of my women, and what we have found in a lot of studies about body composition is that if we. Early on help support the estrogen and then of course, support the progesterone kind of on the backend, whether they have a uterus or not. We can help shift that storage. Shifting that's happening from visceral adiposity to abdominal adiposity, then abdominal adiposity is the thing that is, that's, that's really bad, right? Those are the things that cause disease. Those are the things that, you know, that is the bad fat, and we can help prevent that if we help support the estrogen early on.

Kerry:

Yeah, sometimes I like to make the comparison like prior to perimenopause that the female body was created to like house I mean, initially housed a baby, right? So they didn't want fat storage in that area, right? So men, unfortunately for them, they can gain that belly fat in earlier age or throughout their whole life. But after, you know, perimenopause and menopause for women, we still slowly get to that shift where we're able to accumulate, you know, the fat in that area. When previously it was like, I don't know, maybe God made it so that we'd have room for the baby. I don't know. But so yeah, like you mentioned, you mentioned visceral fat, so you, can you explain that a little bit more? Because that's the fat that we're talking about that's in the abdomen that causes the problem. So why is it so problematic?

Crystal:

Right. And so that is the type of fat that can cause type two diabetes. That's the one that's associated with insulin resistance, and that's the one that's associated with heart disease. So that truly is a worse fat. It's harder to, to lose. You can't exercise that off. And so this shift in the storage of fat is also accompanied by lower muscle mass too. So not only do you have a slower metabolism to try to get off this visceral fat, like you can develop something, what we call sarcopenia or loss of muscle mass. So it's the combination of the two that could really put people in a bad situation where they can't get off this fat and they have higher risk of what we call adiposity related comorbidities, or as you guys might typically know, type two diabetes, heart disease, everything bad, that can happen because of belly fat.

Kerry:

Yeah, I think some people also describe that visceral fat as like inflammatory, right? I mean, both types give off certain inflamma inflammatory markers, but I think the visceral one is known to do that a little more, and I think a lot of people are always trying to you know, another marketing term like hearing buzzwords, right? Inflammation, trying to get my inflammation down. Eating an anti-inflammatory diet. And that's usually'cause you wanna target that kind of fat that causes these issues. Would you agree?

Crystal:

Yes, yes. And back in my academic career I actually did a lot of studies looking at inflammatory factors within different types of diets. And one of the, the co-founders that we used to have in a lot of our studies was perimenopause versus menopausal women. And oftentimes the inflammatory factors were so high. In our perimenopausal and menopausal women that it overcame whatever dietary intervention that we tried. Ultimately, we were looking at a lower carb diet versus a just a traditional standard American diet. And in the true premenopausal women we were able to lower inflammatory factors just by diet alone, utilizing a low carb diet. But we couldn't do that with diet alone in perimenopausal and menopausal and older women.

Kerry:

Hmm. Very interesting. And also like cholesterol markers tend to get worse as well in perimenopause, right?

Crystal:

Yes. Yes they do. And that often is a sign of the insulin resistance starting to happen, and so oftentimes I do tell my patients that this may be a time that we may need to start medication, but this is also a really good time to start the lifestyle modifications of increased strength training. So one of the big things that you can do at this time in your life or a lifestyle perspective is increasing your strength training. So resistance training supports like lean muscle, not not only lean muscle, but bone health, and it helps preserve muscle manage appetite, and it will help preserve the same premenopausal metabolism that you have. Unfortunately at perimenopausal menopause, you can wind up reducing your me metabolism almost by 500 calories a day. So one of the biggest things people come to my practice are, is they say, I'm doing the same things I normally do. I'm utilizing cardio for my exercise. I'm eating the same amount of calories, the pounds are just piling on. I have to say, stop. Your metabolism is much less than what it was just a few years ago. So you either need to eat less or we need to boost your metabolism by adding some strength training plus or minus adding in the hormones. And most of the time we're able to turn things around by adjusting their diet, their exercise, and potentially adding hormones if necessary.

Kerry:

I'm glad you brought up the metabolism again'cause I was gonna ask you, how would you explain that there's this reduction. In metabolism or presumed reduction in metabolism in menopause.

Crystal:

Well and we see it. We put these people on in either DEXA scans, we do their body compositions. We can see that their basal metabolic rate is lower as they age. A lot of times that is because of the loss of lean muscle mass. Women, especially women my age, you know, in your forties and fifties, we don't prioritize strength training. It wasn't, remember when we were growing up in the eighties and nineties, people were afraid of bulking up. not many people are strength training. They go to the gym, they spend 45 minutes on a treadmill or an elliptical, and they're not strength, they're not prioritizing strength training. We have a lot of different things that are going on in our lives. We have work, we have kids, we have parents, and they think that they don't have time or the energy for strength training, and that's just not true. And strength training is one of the biggest things you can do to help turn around that metabolism. Sorry, I got on my little soapbox about strength training, but yes we

Kerry:

I'm always on a soapbox about strength training. I certainly welcome it. I mean, I, you're, yeah, I mean, these are the same things that I tell my patients. So in our office we do the resting metabolic rate test, like, you know, measuring the exhale carbon dioxide, and then we do the body composition as well. And it, you know, it's really wonderful to see it, when they, have improvements, but clearly, yeah and as per this conversation, you know, perimenopause with the, the way that the fat shifts, the way that metabolism goes down, because of the lack of, you know, lean muscle, it can make a big difference of why the patient is unable to eat as much as they, you know, they're doing all the same things and still struggling. Right. So it's, it's, it's wonderful that we're now getting this advice and education to be able to treat the things that could be causing it. Like you mentioned. Balancing those hormones and giving that estrogen back. But how would you how would you fold testosterone in, in this situation?

Crystal:

Okay, so generally just because of, you know, order of operations, I will if a patient comes to me and they're having vasomotor symptoms, estrogenic symptoms fatigue, excess, like PMSE symptoms in a perimenopausal state. I generally will try to get the estrogen and progesterone, progesterone only necessary if they still have a uterus. You know, kind of optimized first. So I may do that first. See how symptomatically they're doing. If they choose to do labs, I don't always need labs. I you know, will try to make sure that they are in a comfortable place for their estrogen. And then what I do typically then is I'll get labs for testosterone just because, for safety wise with compounded testosterone, which is the type I use there could be excursion, you know, very high excursions of testosterone depending on how you're using it. So I don't always say you need labs for perimenopausal menopausal care for estrogen For testosterone, I do. So we'll get labs, and then I use a version of compounded testosterone that's 0.05%. And we use one or two clicks depending on what I what we believe is necessary and depending on symptoms to the inner thigh up to every day, sometimes just twice a week. And we kind of just try to keep the levels lower than 30 to closer to 70. At least in my practice, is what I see seems to help. besides just not having to deal with three hormones at one time, which is very difficult. Sometimes I like to optimize estrogen progesterone first because sometimes some, the same complaints that people have in terms of like libido and fatigue are often helped with just the progesterone alone. And so then I'm able to use much less testosterone to get the same symptomatic relief because you always just least dose of everything possible for the least amount of time for symptom control. So I also like to listen to the patient and a lot of times you know, they're complaining very specifically, libido issues. They're complaining of muscle weakness. They're complaining of very specific testosterone symptoms, so I, I try to very quickly get that estrogen, progesterone, where it needs to be so I can get them to the testosterone.

Kerry:

Yeah, no, I agree. Typically, you wanna optimize estrogen first because it's the, you know, main one and then kind of add in. It's best to do them one by one. I agree. Like how you do that approach. I think that's nice. Do you ever use testosterone just for like I guess improving the lean muscle mass.

Crystal:

I haven't yet in a lot of my patients just because, oftentimes if they come to me talking about sarcopenia and obesity, sometimes we'll consider like, I know we're not talking about it today, but we'll talk about GLP ones. We'll about other weight loss strategies within lifestyle modification. So I just, I haven't had a patient where just testosterone monotherapy was the answer for lean muscle. But I do have a lot of patients that I will utilize testosterone monotherapy for what we call HSDD or hypersexual desire disorder. And these are premenopausal women where, i'll utilize low doses of testosterone for libido and desire, even if they're having great menstrual cycles, even if other, all their other hormones are normal.

Kerry:

Yeah. I mean, I haven't obviously used that either, but I think that I mean, what I ask with the testosterone alone, because that's not usually the only goal, right? For a female anyway, that's not what they're asking, right? So typically, you know, we want to address the patient's needs and what their, you know, pain points are. And that's not like, Hey, I wanna be the leanest, you know, whatever. But, and like you said, most people aren't even, doing enough resistance training in the first place or could do more, but yeah, that's clearly a place to focus on first anyway. Yeah.

Crystal:

Yeah. Yeah. And I, I definitely have some patients that do talk about, you know, their spare tire and their, what we call this, like not like they're, they're lean, but they're, not fit. And sometimes in those patients, they have a lot of other metabolic issues anyway. Lots of risk for type two diabetes, or they have heart disease in their family. And so I may be optimizing their hormones in an HRT way, but I'm also in the metabolism and weight loss management category, potentially working on some other things too. And whether they qualify for something like a GLP one. Or not, or we're just lifestyle modifications.

Kerry:

Yeah. What are some of the biggest myths that you kind of hear from patients about menopausal weight gain?

Crystal:

Sure. So patients come into my office or my online office now, and they are so worried because their family members have breast cancer, and that's probably the biggest thing is they are so scared because they've had an aunt, they've had a cousin, they've had a family member with breast cancer. But we even have studies now where even women with BRCA one, BRCA two, so these are the most increased risk of breast cancer you can get, and they still were able to utilize some amount of hormones for their HRT journey in a very safe and effective way. In this particular study, these women happened to have a, oophorectomy, meaning they had their ovaries removed but in those women, they had the same risk as a patient without a BRCA gene. So I always try to tell my patients that, that even the most risky patients. Can utilize some form of HRT and whether that means we're using a transdermal version, maybe we're just using vaginal only, so that there's no systemic absorption. Maybe we're only using a certain amount for a very short amount of time in their lives. Maybe we're making sure we're up to date on their mammograms that we're doing breast exams, maybe we're looking at how many people in their family have had breast cancer. We have to individualize that risk for everyone. But probably that's the biggest thing that my patients are worried about is I don't wanna get cancer from this, and You know as much as I do, that's the because of that stupid WHI study that, you know, erroneously showed that there was some increased risk in breast cancer and heart disease 20 years ago when they were using giant horse pills of estrogen in basically everyone. And it didn't matter if you had gone through menopause 10 years ago or if you were 80 years old, they were giving you pills of synthetic estrogen and progesterone. In those patients yeah, that is not a good candidate for HRT. That is not a good candidate for oral pills most of the time, and we wouldn't do that nowadays. Right now we're all about individualizing your risk, your dose, and then your time on hormones and we can make it so that we don't increase your risk of breast cancer. So, sorry that was very long answers that, but that's kind of my spiel that I give to patients who are concerned about breast cancer.

Kerry:

Yeah, no, I mean that's super important. You know, I guess I don't know what to say is, but the, where, the reservation, I guess, for the patient to want to do any sort of hormonal therapy, they, you know, learned that study. Oh my gosh, everything is, you know, forget it out the window and we're gonna get breast cancer if we use hormones, so when that happened, it was, such a disservice to everybody, but I think currently, I think we're in the right direction with everything, so it's important to dispel that myth. But there are, you know, cases where it might be not a best thing, but it still, maybe it's a shared decision between the patient and the person prescribing it. Yeah.

Crystal:

Yeah. And so the WHI study actually has, has still been going on and they were able to very recently update their data and it's the basis of the Menopause Society guidelines and estrogen in and of itself actually doesn't cause any sort of increased risk of breast cancer. Now, if you pair oral estrogen plus oral progesterone in patients that are high, higher risk, there is a slightly higher risk of breast cancer in those patients. And so I would, in those patients, sometimes advise them, maybe we're not gonna use an oral pill. Maybe we're gonna use a transdermal. Maybe we're gonna use this for a shorter period of time. Maybe we're gonna use a compounded cream that is giving estrogen at a lower dose. Also known as maybe bioidentical as compared to maybe like a commercial oral pill. I may use a patch. And so lots of things are on the table.

Kerry:

So you bring bioidentical, I was just talking about this with the patient. Why don't you dispel the confusion around that.

Crystal:

Sure. So it's all estrogen. It's all progesterone. With Bioidentical I can make it like a 50 50 mix of like estriol and estradiol and Estriol is the, the pregnancy hormone. With progesterone, I can use a or I can use like a prometrium instead of like meth, methoxy, progesterone, but ultimately it's all the same. The reason why I might choose a bioidentical in some patients compared to a commercial product is honestly'cause I'm trying to nail a dose that may not be commercially available. not everyone fits into the little boxes of like these patches or these pills, and some people want to use the lowest possible dose. So in those cases, compounded meds sometimes or bioidentical meds. I don't love that term'cause it's not a real term, but compounded meds sometimes are the answer for those patients compared to what is the commercial dosing. But in reality, there is commercial dosing for progesterone of Prometrium as well as medroxyprogesterone. There is estradiol out there as well as other forms of estrogen. It's all about what's works for the patient. And I have some patients that are so fearful of starting estrogen that I wanna start them on an itty bitty, itty tiny dose. And in those case, bioidentical or compounded is a perfectly legitimate and safe way to titrate up sort of little bit by little bit. And actually I could, I was about to show you. We're able to, with our compounding meds, utilize you know, clicks, you know, kind of little by little by little if necessary. But reality, if you look at the studies, there's really no difference. Is that what you see with your practice too?

Kerry:

Well, yeah, no, I, I normally say that the bioidentical is, you know, basically most of the FDA approved medicines are bioidentical. So

Crystal:

They, yeah. I don't love.

Kerry:

the horse equine pill, you know, or whatever. So they are the ones that are already available. They're just using a marketing term to make people, you know, feel better. Like this is identical to the hormone that your body produces, but yes. Yeah.

Crystal:

It? Yes, it, they're the same thing. It's, it's, it's you can compound with like a couple of different things in it, like if you wanted to, but it's not, it's not necessary. The only thing that really bioidentical, and again, I hate that term, compounded does that commercial doesn't, is it doesn't pigeonhole you into a certain dosing. That's it. Otherwise, commercial is absolutely fine and it's really convenient too, especially if you're talking about things patches.

Kerry:

Yeah, I mean, typically it's usually a little bit cheaper for the patient too, so sometimes even covered by insurance. So those are like important things that I try to stress as well. But yeah, that's super, super helpful. So what else did you wanna discuss on this topic so I don't lead you astray to a different way.

Crystal:

Oh, I was just gonna talk a little bit about sleep disturbances. A lot of women with the you can get vasomotor symptoms up to 10 years Prior to the start of official menopause and it sneaks up on women, like they don't really know, like, why am I getting up at 1 45 at night? You know, why am I getting up at four in the morning? Because it's not a true, you know, you're not soaking the sheets. And in reality, this sleep optimization is very affected by estrogen levels, but also over time, if you plot it, your melatonin levels actually decrease too. And so you actually, this is not like a thing, like you have to then take melatonin supplementation, but it's this idea of like sleep optimization and stress management can reduce this idea of like. Visceral fat, but just also from a very practical standpoint, if you're waking up multiple times a night, you're not gonna wanna get up at five in the morning to go exercise. You're not gonna wanna, you know, make healthy foods for your kids and you later on throughout the day, you're gonna pull over and get fast food. And it's because you're tired. And so my point to sleep optimization is like, sometimes it's really subtle. You know, you are, you're not always just like, you know what they show on TV where it's like you wake up in the middle of the night covered in sweat. It's like sometimes it's like this, like subtle, like I'm just sleeping throughout the night. I am ga waking up more. I'm having more restless leg. I'm having more. You know nighttime awakenings that have nothing to do with like urinary issues. And so sometimes I'm like, that could be perimenopause. Let's go ahead and treat because it's safe and see how that helps. Assuming, you know, you don't have sleep apnea or other things that could be causing those sleep issues. But sometimes I find that just getting people their good sleep I don't even have to use hormones. Then sometimes if we're able to sleep optimize, they're able to do the things that they need to do lifestyle wise to get back on track, and I love that for them. There's nothing better than I could prescribe that a good six to eight hours of sleep a night. We as this in-between sandwich generation oftentimes don't get.

Kerry:

Yeah, so you mentioned, well, vasomotor symptoms. Just to clarify, that's usually what we call about, like the hot flashes, right? For everybody. Okay. And that can wake people up. And then, I mean you mentioned just in general like it, maybe it's not the hot flash waking you up, but it could be something else. Right. And so sometimes I think like anxiety and stress is obviously interplaying that, and we know that perimenopause, menopause can increase both of those. So that could be another reason that you're waking up. Right. And then I did not know about the melatonin melatonin decrease, so that's very interesting.

Crystal:

Yeah. I have a, a cool chart. I I can provide it for you too, but it shows. How estrogen, you know, will go down as well as testosterone. And then it has melatonin. It's not as steep of a curve as testone is, and there's really no evidence to like support supplementing it but I have found just in general optimizing sleep than really does help. And in my practice I talk about more like CBT type ways where we go through that first before we work on. Any sort of medications?

Kerry:

Yeah. Well that's, that's a really, I think, nice approach. I mean, a lot of times I think if you're already supplementing with estrogen and adding the progesterone, sometimes just doing the progesterone every day instead of in the cyclical pattern that you mentioned, I think that can help some patients too.

Crystal:

Oh, a progesterone pill at night is really nice sleep. It makes you really sleepy, so sometimes that helps in and of itself.

Kerry:

Yeah. And then obviously with what we're discussing, like the sleep weight connection, right? Super important. Like you said, you're not going to, if you're sleeping well, you're less likely to go to the fast food. You're less like or more likely to do some meal prepping and paying, making good choices, really. Because it's. Hopefully not as hard to do those things when you have rest. Right. So it's super important and I think that's great and you make, it made another good point about like getting up to work out, like who's gonna get up early to work out if you didn't sleep at all. Right.

Crystal:

You're gonna be catching up on your sleep. You are not gonna be getting up to work out.

Kerry:

Yeah. Well, yeah. So sleep is. Super important. So I, I think that's an excellent addition to the conversation. Is there anything else that you can think of that is really a hot topic right now? Or do you have a good patient case to share where someone just, you know, started doing a lot better or a win?

Crystal:

Yes, yes. I actually just had a win the other day. It was a patient who I had been seeing for GLP one weight loss therapy. She was, she had come in wanting to do I think phentermine like that was, she came to me asking for phentermine. I said, no, no, no, let's, let's, her metabolic was much better for semaglutide. We wound up doing semaglutide on her. She had lost weight, but she was still complaining of issues with this visceral adiposity. She was complaining she was tired all the time. And she had just got that really like, she had gotten that look to her that you see a lot with our semaglutide or, you know, tirzepatide patients where, you know, sometimes they get the sunken in cheeks and like, you know, I had talked about strength training, but maybe I didn't talk about it good enough because I was so worried about other metabolism issues with her. We had finally gotten to a point where I was like, listen, your BMI is like 22. I am so proud of you, but I, I, I'm looking at you and you're complaining of it too this visceral fat you know, you're still complaining that your arms are all flappy and you are your skin laxity. You're complaining of fatigue. You know, you should be living your best life, right? You had just lost 35 pounds on Semaglutide. You're doing amazing. What else is going on? And so we wound up actually not even choosing to do labs with her. The Menopause Society doesn't recommend labs unless some sort of special scenario. And so I said I was just gonna treat on symptoms alone. We did a low dose, I believe, an estrogen patch, and then we did sequential or you know, cyclical progesterone with her. And in just two months she came back feeling like a million bucks. She, we hadn't got to testosterone yet with her, but she says that she, now can move her body in ways that she couldn't before. Right? Because she had the obesity before. And so now she's getting to the gym, she's utilizing resistance bands, she's utilizing therapies that are helping her. And she just says she feels energized in a way she hasn't before. And I. You know, there are so many factors there. She's able to sleep throughout the night. She's able to wake up and she's exercising and just exercising alone, right? Makes you want to feel better and it just makes you feel energized. She was already making better choices for food because of having the semaglutide on board. So I am just very excited for her. She had never even known that sequential progesterone was an option, and she was one that was super scared of using too much, too many hormones. And I was like, listen, you are not even using hormones the entire part of your cycle, and. I just, I'm so proud of her. I'm so proud of what she's done, and I'm so proud of us as providers and society where we can help support perimenopausal women in the same way that we're supporting menopausal women. So it was just, it was a really big win for her.

Kerry:

That is a great, great case. And I would say I, you know, I've had a lot of patients as well, or maybe a select few, maybe not that many, but are, you know, on a GLP one journey, and then, you know, I'm realizing they're at that age as well, whereas some of these symptoms that they're having could be like, perimenopausal or menopausal and kind of combining that hormonal therapy with their GLP one treatment really like, kind of gets like a little bit better package where they're getting back to more feeling like themselves. They're able to do these things as well. So it's very similar story in case. So it's so nice to see and it is an interesting combination of now, you know, combining the GLP ones with the HRT. So I think it can be very effective for patients too. And adding in that lifestyle component will allow them to continue on.

Crystal:

Yeah. And not that particular patient, but I've had another patient where this was a true menopausal patient. And she's like, it feels like the lights came on that she didn't realize how poorly she was doing until we gave back the hormones. And sometimes it's because you have let it gone for too long, right? You, you went through your forties, you went through your early fifties, and you don't even realize how drained you are. You don't even realize how like much is not in your bucket anymore and that you need hormonal support. In addition to other support too, you need to be talking to a therapist. You need to be you know, making sure that your mental health is on the forefront. You know, sometimes these things just build up and you don't even realize you're drowning until someone hands you a life preserver.

Kerry:

Yeah. So Dr. Jacobo, where can well, do you have anything else you wanna share before we wrap up?

Crystal:

I just wanna say that there is more and more studies out there where they use dexascan Ultra sonography body composition, and they do show that early. Use of hormonal interventions can help body composition. I tell my my friends this and I tell my other cheer moms and gymnastics moms these changes are not inevitable. You do not have to gain 10, 15 pounds in menopause anymore, perimenopause just because your mom did just'cause your aunt did. We now have the science to show we can help you. And the earlier, the better.

Kerry:

Yes. That's a very good message. The earlier, the better. I love that. Yeah. Okay, so where can people find you if they wanna follow you, work with you or anything like that?

Crystal:

Sure. So if you wanna see me you can just go to henry meds.com. And there are a variety of ways to see me or any of our other providers, and we would love to see you for HRT or anything else.

Kerry:

Awesome. Well, thank you so much for being a guest on the Get Healthy Tampa Bay podcast. We'll put all your information in the show notes and everybody stay tuned next week for next week's episode. Thank you, Dr. Jacovino.

Crystal:

Thank you. Thank you.

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Dr. Kerry Reller

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