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Appearance on Dr. Drew’s Podcast

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Dr. Drew:
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Speaker 3:
This is Carolla Digital.

Dr. Drew:
And welcome to the Dr. Drew Podcast. Very interesting show I've got planned for you guys today. This is in response to something that happened on Loveline, on the radio program, where I was talking to a gentleman, a man, whose girlfriend had a somatoform disorder and I described how unrelated to any of the diagnoses that she had been granted that ... She had to look into the fact that she might have trauma. Low and behold, she did. She was a severe sexual abuse survivor. And I said, "Why don't you look into that trauma?"

Dr. Drew:
Well, somehow, that became this huge, huge problem because I mentioned that, when people don't have a pathological diagnosis, in other words, you can't prove a diagnosis ... They get multiple diagnoses and we tend to call that garbage bag diagnoses. And somehow, that became me calling endometriosis, which by the way was one of the many, many, many diagnoses this guy mentioned. I was somehow calling endometriosis a garbage bag diagnosis, which of course I was not.

Dr. Drew:
I've apologized on every platform I have and I will apologize here, as well, that if anyone felt diminished or harmed or not heard or whatever, the feeling was that that created, I've certainly apologized for that. I was not talking about endometriosis. I was not even talking to a woman. I was talking to an anxious man with a partner with somatoform disorder. And it's tough on the radio, a minute and a half to make an assessment and then think of something to do that's useful for that caller and also sort of a teachable moment.

Dr. Drew:
But in any event, it raised the issue of endometriosis, which is a miserable condition. I've treated it for many, many years. Why people feel marginalized by it will be something that we'll talk about here. Very kindly, Dr. Tamer Seckin, the founder ... Is that right, guys?

Gary:
Co-founder.

Dr. Drew:
Co-founder of the Endometriosis Foundation of America. He's actually calling us from Brazil. Dr. Seckin?

Dr. Tamer Seckin:
Yes. I'm online. Dr. Drew?

Dr. Drew:
Hey. You're on the program. Thank you so much. I really appreciate you taking the time and I know you're out of the country even. So I wanted to take a few minutes to talk about endometriosis since, clearly, there's a lot of emotional energy around this diagnosis for people that suffer, which understandably so. Did you hear what I said about how this all happened?

Dr. Tamer Seckin:
I just heard. Yes.

Dr. Drew:
So there's been grotesque misunderstanding. And now, by the way, my family is in danger. People are calling me vile pig. This is the mob mentality of social media. It's very, very dangerous. And by the way, multiple media outlets have picked up on it, misreported it, and attempted to diminish my standing, which is, again, people trying to harm through the media and then can't be held accountable.

Gary:
Not the media I know.

Dr. Drew:
Right. Exactly. So anyway, let's get into the reality of this condition and how horrible and miserable it is. By the way, there is some websites, if you want more information, endofound, E-N-D-O found, .org. Let's see if there's anything else.

Gary:
Dr-

Dr. Drew:
Yeah. It's Twitter handle for @DrSeckin, D-R-

Gary:
And DrSeckin.com.

Dr. Drew:
Okay. S-E-C-K-I-N is Dr. Seckin. And we'll have this all up on the website. So how did I get to you? How did you get involved in all this?

Dr. Tamer Seckin:
Well, it was Friday. I get out of the OR, I turn on my emails, messages. I said, "Oh, my god. What's going on here?" It was a Friday that everything broke and I was so late to hear about it. It was in the evening, actually.

Dr. Drew:
No, it was Thursday night that I took the phone call. So by Friday night, it was a freaking wildfire. So anyway, am I reporting this wrong? Was this not a gross misunderstanding?

Dr. Tamer Seckin:
Well, I could understand the context of what you got into. I must appreciate, first of all, the opportunity to address this issue and thank you for allowing me to express. I can't speak for all endometriosis patients, but this is a very, very strong community and they have very negative feelings of being misunderstood. So we all are kind of being education, me, myself all the time.

Dr. Drew:
See, if the caller had called in and said, "Oh, my god. My girlfriend has been given a diagnosis of endometriosis. She's had three laparoscopies. She has endometrial cysts now on her diaphragm. They're concerned that they may need to do a pelvic exam to [inaudible 00:05:35]. And in the meantime, they're going to put her into menopause," I would've said, "Oh, my god. Endometriosis sucks." That's a story that I've seen a million times. And by the way, her fertility is threatened the whole time, whether she has the pelvic procedure or not.

Dr. Drew:
That wasn't the call I took. The call I took was an anxious young man whose girlfriend had a somatoform disorder and had multiple diagnoses, none of which were proven. Clearly, doctors were throwing the diagnoses into the garbage bag, trying to come up with some explanation for unexplained pelvic pain. Low and behold, I came upon the sexual trauma.

Dr. Drew:
Now, I think the reason this maybe was a flashpoint is I'm, and I'm speculating, you correct me if I'm wrong on this, that a lot of people with endometriosis also have sexual trauma and the endometriosis sometimes gets marginalized and not treated thoroughly because of that. Is that accurate?

Dr. Tamer Seckin:
Well, it's certainly true. Endometriosis is always dismissed. There's a huge delay in diagnosis, approximately 10 years. I am not certain about the sexual trauma issue part of it, but there is always that possibility, but one thing is these patients are significantly symptomatic and really dismissed throughout their medical care.

Dr. Drew:
Why? Why the delay?

Dr. Tamer Seckin:
And by the time they're diagnosed, it's really too late. The disease really is advanced. So they have really difficulty having sexual intercourse at times because it's very painful there. They don't have any life, really.

Dr. Drew:
Why the delay? Back when I was more involved with gynecological procedures, there was a huge enthusiasm for laparoscopy. And back maybe 15 years ago, there was a conversation about endometriosis being over-diagnosed. Is this now a backlash to that?

Dr. Tamer Seckin:
Well, you might say there's a backlash, but there's also ... There is the prevalence of [inaudible 00:07:30]. Approximately one out of 10 women get sick with this. And the world is approximately 200 women, worldwide. And it really affects-

Dr. Drew:
But of the 10% that have it, though ... I think it may be more common than that. Right? Let's define what it is. It's inspissated endometrial tissue outside of the uterus. It gets out of the uterus and gets all over the place and, during normal hormonal cycling, gets inflamed, causes pain, and it's really like having little periods all over your body. It's terrible.

Dr. Tamer Seckin:
You're right on that. It's the mini periods all over the body. And because it does not involve primarily reproductive organs all the time, majority is in the lining of bowels or other organs, so the symptoms are not specific, initially. So if the right question is not asked, which is, are you having painful periods or is it more than usual? Are you debilitated with it? So killer cramps is the main question everybody seems to miss and they don't really ask. If it is so, they say, "Well, you get pregnant, it will be over."

Dr. Tamer Seckin:
So that's the attitude many physicians also take, along with families. Awareness is poor, but the bottom line is, once the question is asked properly, and there are quite a few questions around it, you can really extract endometriosis patients with the right questions, which is painful periods, gastrointestinal system, particularly around period time, bowel problems as I said earlier, difficulty during sex. There's pain, constipation, ovulation pain, leg pain, back pain, but it all has to be around the period. Then it becomes chronic. They suffer throughout the month.

Dr. Drew:
Now, again, back in the day, there was the huge enthusiasm for laparoscopic documentation. And we live in a different medical economic system now where you can't do things you want to do to patients because there's no resources for it. Is that affecting all this?

Dr. Tamer Seckin:
You're right on that. I think the system, the practice of gynecology, the practice of medicine has changed. First of all, endometriosis is one of the main causes of infertility, is endometriosis, actually, but the IVF-

Dr. Drew:
Yeah, but wait a minute.

Dr. Tamer Seckin:
... industry has really bypassed endometriosis. Nobody bothers in the IVF circles about their complaints.

Dr. Drew:
Let's stop because, in my experience, that's the most pain ... Although it's a painful condition, the most poignant, let's say, part of it is it has a dramatic impact on infertility, on fertility rather. That warrants highlighting it. If you have endometriosis, it's not a benign diagnosis, if you intend to have kids. Yes?

Dr. Tamer Seckin:
That's correct.

Dr. Drew:
So what's the workup, then? So somebody has painful periods with these protean symptoms during the time of the period. What should the proper workup be?

Dr. Tamer Seckin:
Well, it depends patients' age and everything. Usually, one must understand, the symptoms of endometriosis, really, 75% starts during the age of 12 when the periods really start. These kids should be picked up early in their life. And they don't need to be laparoscoped, obviously, right away, but the algorithm, they need to be followed by a caring environment, medical/family wise. Awareness is the key and doctors have to really know about this disease.

Dr. Tamer Seckin:
But the bottom line is the workup really comes up to a doctor who really knows about endometriosis. So usually, to the sonogram, it is an exam in the office. Many times, with the exam and with the exam in the office, sonogram and by the story, by the complaints, the diagnosis is there, really. Very clearly, it is there, but the final [inaudible 00:11:33] has to be the standard by laparoscopy. Even that is not enough. It has to be under a microscope.

Dr. Drew:
Oh.

Dr. Tamer Seckin:
So that's the key to this.

Dr. Drew:
Meaning microscope in the laparoscope or meaning biopsies and then look under a microscope?

Dr. Tamer Seckin:
Well, the lesions need to ... One of the really sad part is we, gynecologists, have significant role on that. Many of the endometriosis patients, even though they're diagnosed, they are mistreated.

Dr. Drew:
So let's talk about the treatment because that-

Dr. Tamer Seckin:
Under-treated and there's lots of incomplete procedures are being done. That's another aspect of it.

Dr. Drew:
Okay. There's that. And then, to me, the treatment is part of the tragedy because the treatment, the way it's applied, anyway, is sometimes worse than the condition. So let's talk about treatment. What should proper treatment be, once somebody identifies this condition?

Dr. Tamer Seckin:
Well, proper treatment obviously starts with education of the patient. The fear factor should be abolished and the trust has to be given by the physician that this is a treatable condition with the right approach. And really, the right approach is, when it is seen, it needs to be removed very cleanly, very precisely with all elements that margin-free removal has to be done. That's called excision [crosstalk 00:12:49].

Dr. Drew:
But is that an open-

Dr. Tamer Seckin:
When it is done, really, many patients do exceptionally well.

Dr. Drew:
Is that an open procedure or is that through laparoscope?

Dr. Tamer Seckin:
That's a laparoscopic procedure, but it's really intense, very difficult, technically. However, with the people who does this all the time, it is very feasible.

Dr. Drew:
I'm going to ask you a totally ... almost a sidebar here. I had a prostatectomy by the DaVinci robot. I am a super fan of the DaVinci. And it's been used a lot more recently in gynecological procedures, not so successfully. Will the DaVinci ever be deployed for this?

Dr. Tamer Seckin:
I'm sorry to tell, I may disappoint DaVinci people, but I think endometriosis is the last area that DaVinci has to get in because many of the surgeries, these lesions are tip of the iceberg and you can't really do this surgery if you're not feeling it. In DaVinci, you totally lose your-

Dr. Drew:
I see.

Dr. Tamer Seckin:
... touching feedback [crosstalk 00:13:45].

Dr. Drew:
Okay. Well, there you go.

Dr. Tamer Seckin:
It's a great instrument, but it's just an instrument. It cannot make an average surgeon a better surgeon, really.

Dr. Drew:
Yeah. I totally get what you're saying. All right. So that actually is exciting to me because I have a feeling that one of the reasons people became less enthusiastic about making ... I mean, how can doctors not be aware of endometriosis? If somebody comes in with dyspareunia, which is painful intercourse, the first thing you go is, "Well, is it infection? Is it an ovarian cyst? Is it endometriosis?" That's it, right? I mean, that's the work.

Dr. Tamer Seckin:
That's it.

Dr. Drew:
That's the initial thought the doctor has. So how they could not be aware of endometriosis is almost ... There's got to be an explanation for that. So then I think, okay, well, now back in the day, over the years, the treatment of endometriosis has been Draconian. So I wonder if people shy away from the diagnosis because they don't understand the effective treatments that are now available. They immediately jump to, "Oh, Christ. We're going to put this woman into menopause. I don't want to do that."

Dr. Tamer Seckin:
Well, many doctors are not trained to do endometriosis surgery. They don't get it enough in their residence program. And after that, they get into a very heavy cycle of workload, of delivering babies, seeing patients, pap smear, breast cancer screening, this and that. Endometriosis doesn't take any priority in their life. You can't do endometriosis surgery by delivering a baby until five o'clock in the morning, then eight o'clock surgery. There's no way you can do it. And even the surgery is very challenging. It takes many years to get expertise on it.

Dr. Drew:
So what do we do with it? That, to me, is the most exciting thing you're telling me, is that there's this curative procedure there. You don't have to shut down the pituitary and put them into menopause, which is, by the way, again, that's horrible when they end up doing that to women. It ruins their lives emotionally, as well as sexually.

Dr. Tamer Seckin:
It's terrible. It's a young age. They go and look and they diagnose and give Lupron, as you were just going to say.

Dr. Drew:
See, I think that's what-

Dr. Tamer Seckin:
And it's worse and you're basically punishing the girl-

Dr. Drew:
Yeah, I agree with you.

Dr. Tamer Seckin:
... who already gets the worst diagnosis in the world and you're putting her into menopause.

Dr. Drew:
See, I think that's why they avoid the diagnosis, because they don't understand their ... That's what I would think. I would think, "Oh, I don't want to give her that diagnosis because then we're going to go down this path and I don't want to go there." Do you think that's happening?

Dr. Tamer Seckin:
That's happening all over. I must say, this disease is really unforgiving. We see patients with sciatica pain-

Dr. Drew:
Of course.

Dr. Tamer Seckin:
... lesions there. We see patients with nephrostomy. I mean, these are patients whose kidneys do shut down. Their bowels are obstructed. The nature of my practice, I see the worst cases that are with 10 surgeries, six surgeries, and none of them have had excision surgery, none of them had their endometriosis removed. Many of them don't have a pathological diagnosis. So there is a big burden on practicing physicians, especially particularly on us, gynecologists. If we don't really get ourself together on endometriosis, I don't think it's fair to the public to have anything change because the teaching and the programs of residency and medical schools have not been there. However, lately, there is some awakening. I must say that also.

Dr. Drew:
Does being on the birth control pill help this?

Dr. Tamer Seckin:
It does. Definitely, it does. It's not treatment, though. It just masks it, but it's not treatment. Any pain symptom that breaks birth control pill suppression should be evaluated. And the people who are established with the diagnosis of endometriosis who are on birth control need to be checked frequently because some form of endometriosis still do progress and it's a progressive disease and birth control pills can mask the symptoms and progression of the disease.

Dr. Drew:
Does pregnancy reduce the progression rate?

Dr. Tamer Seckin:
Well, pregnancy does not cure or treat it, but obviously, with pregnancy, the symptoms are delayed another month. After the periods resume, the pain comes. So I just want to get you back on this cure business. I think we should be very careful with endometriosis and cure because I like to use it's highly treatable. There is always microscopic disease. There's always very, very unhappy patients around. It is very unfair to them, really, if we say there is cure. But in certain cases, if there's a congenital malformation, you take care of it, then you can say, for those group of patients, yes, there's cure. It doesn't come back again.

Dr. Drew:
You're right. Again, this is how I get myself in trouble, by not speaking with ... It's impossible when you're just taking about it to somebody on a radio podcast. You just have to qualify everything. But yes, by curative, I mean moving towards cure as opposed to, in the past, just suppressing. You're actually removing the inciting agents and, yes, you have to chase them because [inaudible 00:18:40].

Dr. Drew:
So let's go back to the multiple procedures. Back in the day, you'd diagnose in a laparoscopy and then you'd [inaudible 00:18:47] and they burn it. Right?

Dr. Tamer Seckin:
Unfortunately. It makes it worse. Imagine a burn on the skin. It contracts the skin, it makes it ugly, and it heals very bad.

Dr. Drew:
So are they training the gynecologists to do something different now?

Dr. Tamer Seckin:
Well, we are pushing forward. That's why I'm at a World Endometriosis Conference in Brazil. You should see there's really thousands of people here. It's so lively and young physicians are so enthusiastic learning. I don't see really this much interest in the United States on endometriosis teaching, unfortunately, but it will happen. And really, it's the patient that really is changing also the scene. There's significant social media movement on it and patients are really so aware. They know better than doctors, many doctors right now on this stuff.

Dr. Drew:
They need to be careful. They become dangerous bullies, at a certain point. And that's not a way to create allies. It's not. They need to be-

Dr. Tamer Seckin:
Well, I think many of them are so, but I will carefully agree with you or disagree with you, but the bottom line is they are very understanding when you hit the right tone with it because they need people who does understand this disease because-

Dr. Drew:
Of course, but they need to build-

Dr. Tamer Seckin:
... this is a political wrap-up, in one hand. So it's a very important social disease, not the ladies involved in your case. The husband, who doesn't know anything about periods. I mean, they have no idea. They learn it through their girlfriends and they're so helpless.

Dr. Drew:
Yes.

Dr. Tamer Seckin:
And it's their parents, their children get affected. It's very terrible. And it's really treatment, I have to say, and you would not disagree with me. The surgery, itself, if it's not properly done, for the people and for us, it is much difficult than cancer cases. Cancer cases are easy. Known cancer, you go on, most of them are early diagnosis and [inaudible 00:20:42], but endo, when they come to us, it's all over. So it's very difficult. It's [inaudible 00:20:47].

Dr. Drew:
You're chasing it. Is there somewhere that people can peek into this conference on the internet if they want more information? Uh-oh. There you are. We lost you for a second.

Dr. Tamer Seckin:
I'm here. Are you asking the question to me?

Dr. Drew:
Yeah. I was asking, is there some way to peek in on this conference? Is there something on the internet we can look to to sort of-

Dr. Tamer Seckin:
I am not sure it is online, but it is World Endometriosis Conference in Sao Paolo. You can log in. I'm not sure it's being broadcasted live.

Dr. Drew:
Okay. What else would you like people to know about this, other than raising awareness, change physician training, understand the range of treatments, be sure to be aware of asking the right questions, making sure people ... I guess, again, this podcast goes out to people distributed throughout the country. Not everyone has access to high-level specialists. The average gynecologist, what should the average patient go in and say to him or her to make sure the proper workup and attention is being maintained?

Dr. Tamer Seckin:
Well, I think the most important thing is early diagnosis. Early diagnosis and proper and timely intervention is the best prevention of the disease, progressive disease, prevention of it. So the idea is being aware and being aware that the disease cannot be treated with hormones and birth control pills completely. If the symptoms persist, there has to be proper intervention done and this proper intervention has to be excisional surgery, not burning, not lasering, not DaVinci, not those things that are very, I would say, sexy terms in medicine to get patients, but they don't work. I mean, they need to really see specialists that does this and for specialists who patients can trust.

Dr. Tamer Seckin:
So there is a proper use of birth control, which I agree that many patients should be on temporarily and see how they respond, but if they don't respond, they should get treated. A sonogram of small cysts, for example, that persist. Many doctors don't do anything about them, but endometriosis, that starts in the ovary, for example, they become like chocolate cysts. And many of them are misinterpreted as normal cysts, the patient's pain continues, and these patients ... Oh, it's from ovulation. Nobody pays attention. Actually, that cyst is, every month, leaking and implanting all over.

Dr. Drew:
You're talking about cysts [crosstalk 00:23:21].

Dr. Tamer Seckin:
Ovarian cysts [crosstalk 00:23:21] are diverse type because they tend to spill all over, from diaphragm, all the way up.

Dr. Drew:
Interesting.

Dr. Tamer Seckin:
So no cysts should be sit on by any doctor if they are persistent. [crosstalk 00:23:34]-

Dr. Drew:
So every ovarian cyst, let's state it in a way that people can hear it, every ovarian cyst that persists over what period of time, years, months?

Dr. Tamer Seckin:
No, no, no, no, no, no, no. More than three months-

Dr. Drew:
Three months.

Dr. Tamer Seckin:
... that has a consistency of chocolate cyst should not be sit on, in my opinion. Regular literature, for example, says, "Hey, wait until it's six centimeters." If the patient is symptomatic, six centimeters or the size of it is irrelevant because it's leaking and emptying itself every month.

Dr. Drew:
So have a laparoscopy at three months. Right?

Dr. Tamer Seckin:
Unfortunately, that's the way to go, but it should be done safely by people who does it all the time.

Dr. Drew:
I listen to what you're saying about seeing a properly trained specialist and I get crestfallen a little bit when I just think about how hard it is for people to get to the right care, regardless of what their diagnosis is. There are many different frustrating diagnoses out there that some people do a great job at taking care of and general, out in the world, general community practice can be frustrating. It can be very ... And especially, the way the system is going now, it's going to get worse.

Dr. Tamer Seckin:
And one more thing I'd like to emphasize is family history of endometriosis, family history of-

Dr. Drew:
Very important.

Dr. Tamer Seckin:
... hysterectomies, family hysterectomy of troubled periods, which is, in the old time, never get [inaudible 00:24:54], particularly family history of ovarian cancer. And there is a group of endometriosis ... And it's not very small, the ovarian cancer group. It's almost 15% to 20% of the ovarian cancers, today we know, are endometriosis-driven. So with excision surgery, with proper attention, one may think that we, and there's literature that supports that, we could decrease the ovarian cancer rate, probably, and possibly these women should not go into menopause, possibly I'm saying. There's not enough research on this, but they should not be let go menopause with their ovaries having or the pelvis having endometriosis. We really don't know. Majority of ovarian cancers really pop out at the age of menopause. We really don't know how many of those women had bad reproductive years with cramps and other problems.

Dr. Drew:
And again, just a side question, would sustained treatment, hormonal contraceptive reduce that risk of ovarian cancer, do we think?

Dr. Tamer Seckin:
Well, we know that. That's true in reproductive ... for other reasons also because ovarian cancer is associated with, as you know, with multiple ovulations and things like that. It's been pointed many times.

Dr. Drew:
But maybe this is part of that story, too, it just hasn't been connected.

Dr. Tamer Seckin:
Exactly.

Dr. Drew:
Well, listen, I was saying about how frustrating it can be out in the community, trying to get the proper care. I think this is a great opportunity to say an educated patient, a patient who's motivated, who keeps going back, who doesn't take no for an answer, who really works with their physicians, doesn't make it adversarial, but doesn't stay away from the system if they're not getting adequate attention or don't feel like they've got an adequate, complete explanation for what's going on for them ... The doctors want to do that. The system doesn't want you to do that, but the doctors want to do that. So please, be educated and go back, and go back, and go back until you feel satisfied with the explanation.

Dr. Drew:
And Dr. Seckin brought up a couple of times, pathological proof, actually being able to look at your condition under the microscope ... This is how I got into trouble. That guy I was talking to, I guarantee you that girl never had a pathological diagnosis. That was why she had multiple diagnoses, because no one ever took the energy to really prove exactly what was going on with her. And again, she may have not had resources for it. It may have been impossible, but that's our system.

Dr. Drew:
So you keep going back. And if you think endometriosis is a likely explanation for the misery you may be in, it's important not just from the standpoint of now we've learned ovarian cancer, it progressing, fertility. Go to Endofound.org, Endometriosis Foundation of America. Educate yourself. Dr. Seckin, are you present there on that website?

Dr. Tamer Seckin:
Yes, I am the founder of the foundation.

Dr. Drew:
But they'll see your words.

Dr. Tamer Seckin:
They will see my name as the founder. Yes.

Dr. Drew:
Great. All right, listen, is there any last thing you'd like to say? I really appreciate you joining me and helping educate about this stuff.

Dr. Tamer Seckin:
Well, first of all, I do like to thank you for giving me the opportunity to converse with you. I'd like everyone to know that killer cramps are not normal and our foundation has done significant progress on this matter. I'd like to really acknowledge my co-founder, doctor, co-founder Padma Lakshmi here also. She has been really-

Dr. Drew:
Is she down there with you?

Dr. Tamer Seckin:
... powerful. I'm sorry?

Dr. Drew:
Is she down there with you at the convention?

Dr. Tamer Seckin:
No, no, no. She's not.

Dr. Drew:
I've done some stuff with her on-

Dr. Tamer Seckin:
But she's been an exceptional voice in getting this to the attention of the media.

Dr. Drew:
Yeah. I think everyone knows who Padma is. Chris and Gary will go, "Oh, yeah. We know Padma." Look her up if you have any questions, but it's important to have a spokesperson like that. And hopefully, people feel, in the endometriosis organizations, that they have now a place they can refer people to hear you talk about these sorts ... because this podcast has pretty good reach. It gets out.

Dr. Tamer Seckin:
It's not only me. There are quite a few doctors who does what I do. And I'd like to emphasize this. We all know this problem and we agree. We tend to agree with every aspect of what I said. They are unanimously agreed upon in my circle of friends who does this type of surgery.

Dr. Drew:
Dr. Seckin, thank you so much. Back to your Sao Paolo convention. I really do appreciate you taking time to talk to us.

Dr. Tamer Seckin:
Thank you, Dr. Drew.

Dr. Drew:
All right. Take care now.

Dr. Tamer Seckin:
Bye.

Dr. Drew:
Before I go to break ... We're going to take a break and then welcome Dr. Jennifer Park in after the break, but before I do go to break, I want to mention our friends at Hulu Plus. Undoubtedly, everyone knows what Hulu is. Everyone has used that, but Hulu Plus is more, much more. You can watch current seasons of your favorite shows, like Modern Family, Daily Show, Scandal, current, ongoing seasons, and watch every episode of shows like Nashville, Lost, Dr. Who. You get ad-free movies, and as well, there's kids' shows. Now it's time to use Take Control with Hulu Plus. Stream these shows, thousands more. It works on your smart TV, Roku, Apple TV, Xbox, PlayStation. Pretty much anything streaming, you've got it.

Dr. Drew:
Now, you can also now watch it on your iPhone and iPad, which is ridiculous. You also get originals that you can't get anywhere else. Deadbeat, a comedy about pot-smoking guy who talks to ghosts. I have to see this. It sounds awesome. I will see it because my kids use Hulu Plus a lot. So no doubt, I'll be exposed to it and I will use it. Oh, and it's just $7.99 a month. Get shows anytime, anywhere. It's a quarter a day. So sign up at Huluplus.com/Drew, D-R-W. to get two weeks full access, completely free. Again, we give all this free stuff away. I don't know how these guys do it, but they do. Whole extra week more with this special offer when you sign up at Huluplus.com/Drew. So get with it and start streaming TV with Hulu Plus now. Take a quick break and back with Dr. Jennifer Park.

Audio:
[Music 00:30:30]. Hey, everyone. It's me, Alison, from Alison Rosen is Your New Best Friend. On Thursday, I sat down with Matt, Chris, Janet, and Gary and we tried to figure out who was the most, quote, fit with a kissable face. And then, on Monday, Dave [Vaneshek 00:30:43] stopped by again to tell all about the tough issues.

Audio:
I mourn the fact that I have no dancing ability. If I did, I would dance to and fro, here, there, and everywhere. I don't have it, though. Men, though, should not be using emoticon.

Audio:
And to spread his good cheer.

Audio:
It's all going away. Nothing matters. Lighten up.

Audio:
Subscribe to Alison Rosen is Your New Best Friend on iTunes or go to Alisonrosen.com. New episodes every Monday and Thursday. I love you. [Music 00:31:14].

Adam Carolla:
Buying a car can be a stressful experience. Truecar.com is changing that forever. Simple, fair, and a fun way to buy a car. True Car users save time and money, helping them to never overpay.

Dr. Drew:
You know you get the fair price because the show you what others paid for the car you're looking for. True Car analyzes what people are paying for their cars in your market and shares it with consumers so they never have to overpay.

Adam Carolla:
Genius. Over a million cars have been sold by the True Car certified dealer network and users see an average savings of $3,046 off MSRP. Drew, stifle yourself. Three steps here.

Dr. Drew:
All right.

Adam Carolla:
Go to Truecar.com. All right was not stifling yourself. Go to Truecar.com, find out what other people paid.

Dr. Drew:
Then register to see upfront pricing information and lock in your savings certificate.

Adam Carolla:
Then take it to the True Car certified dealer for a hassle-free buying experience.

Dr. Drew:
Save time, save money, never overpay, Truecar.com.

Dr. Drew:
That is a preview of volume three of the Swinging Sounds of Dr. Drew Podcast. Gary likes this one. I can see it on his face. He thinks it's cool, right?

Gary:
Yeah, absolutely.

Dr. Drew:
Chris and Russ and I have gone to great lengths to select just those songs that you guys will love. So please support that at iTunes at DrDrew.com.

Gary:
You sure heard the pride in Chris' voice before we started and he just mumbled, "Yeah, I'll give them a little preview."

Dr. Drew:
Well, what I like is his face lit up. I've never seen him light up [inaudible 00:32:46]. He doesn't like the other stuff we've picked out. Chris, I'm sorry.

Gary:
He's picky.

Dr. Drew:
He is picky, but we're into it. We'll find something for everybody. And for your summer parties, I say get part two, but part three is coming. And please be sure to support the people that support this podcast by getting Hulu Plus and Shari's Berries and all the things I talk about today and clicking through at the Amazon banner at DrDrew.com.

Dr. Drew:
We've been talking about endometriosis for reasons that have been beyond my control. We just heard from Dr. Seckin, who is an international expert on this topic. I hope everyone learned something, but I wanted to bring it back down to earth a little bit and bring Dr. Jennifer Park in and talk about hormone replacement, another thing that makes women miserable and is unattended to. I think, to me, that's why it's dovetailed into this topic for me. Let's back into it this way. Well, let's describe who you are and your practice.

Dr. Jennifer Park:
Oh. Well, I'm an OBGYN. I practice both obstetrics and gynecology, but I do have a special interest and love of menopause and hormone replacement.

Dr. Drew:
Did you a fellowship in that or something or [crosstalk 00:33:48]?

Dr. Jennifer Park:
No. I just fell into it, in a way, worked for a doctor who's very involved with menopausal women and just learned from her. And then I moved out to California and just kind of started.

Dr. Drew:
Where was that, this [inaudible 00:34:00]?

Dr. Jennifer Park:
In St. Louis, Missouri.

Dr. Drew:
Okay. Was it part of Wash U or something?

Dr. Jennifer Park:
No, just a practice that was also, again, just had a special interest and involved.

Dr. Drew:
Very involved in it. I mean, it must've been early in your practice.

Dr. Jennifer Park:
It was.

Dr. Drew:
How did you notice that that was a significant problem?

Dr. Jennifer Park:
Basically, I worked for this doctor who found this method of hormone replacement that worked very well for patients. It was hormone pellet therapy. And she was at-

Dr. Drew:
Did she discover it?

Dr. Jennifer Park:
No. She was a gynecologist who had had a hysterectomy and was-

Dr. Drew:
Herself?

Dr. Jennifer Park:
Herself, and was undergoing terrible menopausal symptoms and looked for the right answer for herself and found pellets to be the answer. So even as a gynecologist, she had to go look for something that would work for her.

Dr. Drew:
Well, I have noticed how profoundly altering menopause is for women. I've been practicing [inaudible 00:34:54] for almost 25 years. And when the Women's Health Initiative was evaluated where we were all told that now the science is out and we must take women off hormone replacement, it was devastation for [inaudible 00:35:08] and I knew it would be.

Dr. Jennifer Park:
Oh, absolutely.

Dr. Drew:
It was like, this is ruining people's lives for maybe some reduced risk, but not even clear because that ... It was a good, big, long study, but it was on a very narrow population. Right?

Dr. Jennifer Park:
Absolutely. Yeah.

Dr. Drew:
Yeah. And so I was noticing, early in my practice, I thought, "Wow, these women that are 90 all are on hormone replacement and they're quite alert and spry. I wonder if that means something." I mean, always.

Dr. Jennifer Park:
Oh, absolutely. Yeah.

Dr. Drew:
Always. And then I'm looking at these 75 year olds who feel like shit and have never been on therapy. And I'm like, "Mm, I wonder if that has something to do with this." So I got interested early. And when we were all mandated, we were mandated to take women off hormone replacement, I always explained it to every patient, I said, "Well, the science now suggests we need to take you off. My experience suggests and many of my colleagues' clinical experience suggests there's something wrong with this study, but we're obliged to take you off. So let's try it, but know that, if you and I want to, together, keep you on it, here are the potential risks, here are the potential benefits." Let's talk about that. What are the potential risks and benefits?

Dr. Jennifer Park:
Yeah. Well, actually, nowadays, the North American Menopausal Society did come back.

Dr. Drew:
I know. I know it's swung back. I knew it would.

Dr. Jennifer Park:
It has swung back because-

Dr. Drew:
I knew it would because it just didn't make any sense.

Dr. Jennifer Park:
Yeah, absolutely right. And they looked at the data a little more carefully and divided it by age group. But yeah, actually, in the women in their 50s, there was less heart disease seen in those women.

Dr. Drew:
Who started replacement and stayed on it?

Dr. Jennifer Park:
Who started replacement, stayed on it. And within, they said, 10 years of menopause, if they started hormone replacement, they actually saw less heart disease in those women.

Dr. Drew:
That fits and I'm going to bet, I haven't proven this yet, less cerebrovascular disease.

Dr. Jennifer Park:
Yes.

Dr. Drew:
Absolutely. Okay, go ahead.

Dr. Jennifer Park:
It showed a decreased risk of bone loss.

Dr. Drew:
Osteoporosis. Of course.

Dr. Jennifer Park:
[crosstalk 00:36:53].

Dr. Drew:
We knew that. Everyone knew that, but again, the early the better, right?

Dr. Jennifer Park:
Yes.

Dr. Drew:
Because the rapid bone loss is right when you get into menopause.

Dr. Jennifer Park:
Yes.

Dr. Drew:
So you protect women against that.

Dr. Jennifer Park:
Absolutely. As far as dementia, cognition, it actually didn't really show any difference, but-

Dr. Drew:
I think that may be a cerebrovascular thing, ultimately.

Dr. Jennifer Park:
Yeah. Exactly.

Dr. Drew:
Okay. We're talking about blood vessels, arteries in the brain.

Dr. Jennifer Park:
Yeah.

Dr. Drew:
Okay. So it's good. And how about in terms of breast cancer risk, ovarian cancer risk, uterine cancer risk?

Dr. Jennifer Park:
Ovarian cancer, there was really no difference, hormone users and non-hormone users. As far as breast cancer, it was those that were on combined-

Dr. Drew:
Combined estrogen and progesterone.

Dr. Jennifer Park:
... with estrogen and progesterone, again, both synthetic, on top of that that did have an increased risk of breast cancer. There was an estrogen arm of the WHI, the Women's Health Initiative, of estrogen alone. And they studied that as far as seven years and did not see any increased risk of breast cancer.

Dr. Drew:
Which is kind of weird. It's the exact opposite of what you'd expect.

Dr. Jennifer Park:
Exactly.

Dr. Drew:
Because we think in terms of progesterone protecting estrogen receptors and-

Dr. Jennifer Park:
Absolutely.

Dr. Drew:
... from the stimulatory effects of exogenous hormone. Synthetic, you had a certain twist in your voice when you said that. Talk about that.

Dr. Jennifer Park:
Yes. Synthetic hormones are different than what our body used to make.

Dr. Drew:
Any by the way, let's be fair, it wasn't synthetic, it was horse urine.

Dr. Jennifer Park:
Right. Exactly.

Dr. Drew:
It was straight out of horse urine, initially.

Dr. Jennifer Park:
Yes. From a natural source, but not really a human source, I suppose, if you want to say that. But yeah, no, synthetic hormones are different than human hormones, basically. The premarin is very, very similar to a very potent estrogen called estrone that our body makes.

Dr. Drew:
I'm going to get in the weeds here a little bit. I thought premarin was nine different estrogens.

Dr. Jennifer Park:
Yeah. It's a conjugated [ecoin 00:38:29] estrogen, essentially.

Dr. Drew:
And the premarin comes from ... What's the name for female horse? Mare.

Dr. Jennifer Park:
Yes.

Dr. Drew:
The mare is right in there, premarin.

Dr. Jennifer Park:
Yes. Pregnant mares.

Dr. Drew:
Pregnant mares is where they got the damn hormone from, everybody. But I thought it was estrone and estradiol in there and then several others. No?

Dr. Jennifer Park:
Mostly estrone. It's mostly estrone. So it's not estradiol. estradiol is kind of what we're shooting for now in most hormone replacement and even, in this day and age, patches and gels are available for women in the form of estradiol.

Dr. Drew:
Synthetic estradiol.

Dr. Jennifer Park:
It's still estradiol. estradiol, chemically, [crosstalk 00:39:01]-

Dr. Drew:
So estradiol is estradiol.

Dr. Jennifer Park:
... is what we want. Yeah.

Dr. Drew:
Why did you, when you said synthetic, you sort of-

Dr. Jennifer Park:
Well, synthetic, again, it's just not-

Dr. Drew:
But you had a little disdain in your voice when you said synthetic.

Dr. Jennifer Park:
I mean, that's what the study was on, something synthetic versus something that's-

Dr. Drew:
Well, what I'm pushing for is whether your bioidentical is also synthetic or is bioidentical something different?

Dr. Jennifer Park:
No, bioidentical is estradiol and that's what we're shooting for. Chemically, down to the chemical, we want it to be ... Basically, estradiol is what our body wants and needs and functions with.

Dr. Drew:
Let's talk about the constitutional effects. We're going to walk through each of the hormones because I think this is the important thing that's ... We haven't even gotten to the important stuff, guys. So listen carefully. The important stuff is coming. I'm building to that. The constitutional effects of estrogen on a woman who might need estrogen.

Dr. Jennifer Park:
You mean-

Dr. Drew:
Constitutionally, how do they feel?

Dr. Jennifer Park:
In general, it helps with mood.

Dr. Drew:
Mood. So their mood is a little better with it, but some people get off mood on estrogen. Sometimes it can make them moody.

Dr. Jennifer Park:
Too much, perhaps. Perhaps too much, but most women [inaudible 00:39:59] depressed when they don't have enough estrogen.

Dr. Drew:
Okay. Mood, good.

Dr. Jennifer Park:
Hot flashes.

Dr. Drew:
Okay. [inaudible 00:40:04] hot flashes.

Dr. Jennifer Park:
Sleep.

Dr. Drew:
We said protect bones. Sleep.

Dr. Jennifer Park:
Protect bones.

Dr. Drew:
Sleep better.

Dr. Jennifer Park:
Sleep disturbances. Dryness, vaginal dryness.

Dr. Drew:
Vaginal dryness, which is ... By the way, I did a whole couple of podcasts on this with a guy named Goldstein, who was talking about the ... Gary, would you put up there which episodes that was? About the effect of powerful progesterones, and the current oral contraceptives, and the cause of vaginal dryness, and dyspareunia, and mood disturbance and stuff. And it's common. It's profound. Anyway, vaginal dryness is corrected.

Dr. Jennifer Park:
Yeah.

Dr. Drew:
Dr. Goldstein.

Dr. Jennifer Park:
I was about to say, just skin, dry skin, dry eyes, dry mouth, hair loss.

Dr. Drew:
Let me throw in something that people don't talk about very much. I think it's important. Episode seven, 12, and 39 with Dr. Goldstein where we talk about this and how to identify it and how to test for it and all this stuff, and what to do with it. And there's a book out there, by the way, called Why Sex Hurts on our website you can click through and get that I'm hoping also talks about endometriosis. I haven't read it, but Dr. Goldstein tries to go through every little possible cause of sexual pain.

Dr. Drew:
Estrogen also causes something I call receptivity, that women are more receptive to their partners and sort of ... Is that a term that makes sense to you, receptivity?

Dr. Jennifer Park:
Yes. Oh, absolutely. Yes.

Dr. Drew:
Men don't understand this concept. It's something I've observed in patients and they've described and it's an important thing.

Dr. Jennifer Park:
Yes.

Dr. Drew:
Can you put words to that?

Dr. Jennifer Park:
I do also think that's a function of another hormone, too, which-

Dr. Drew:
Testosterone.

Dr. Jennifer Park:
Testosterone, absolutely.

Dr. Drew:
We're going to get to that, but I bet testosterone amplifies receptivity, but receptivity is a uniquely female human sort of ... Men don't have receptivity because that's why they're confused by it. They're like, "Huh, what is that?" How do you explain that.

Dr. Jennifer Park:
Huh.

Dr. Drew:
A willingness to sort of be ... I don't know. I don't know if I have words for it, as a male.

Dr. Jennifer Park:
It's a good term, receptivity. Being, I guess, willing and-

Dr. Drew:
Openness, open to receiving somebody.

Dr. Jennifer Park:
Exactly. Yeah, open to receiving something. Mainly, even when you're talking about intercourse and sex and desire, being willing to act upon your desires.

Dr. Drew:
And to somebody else's desire. [inaudible 00:42:17] receive and being receptive. You should be aware, men have zero experience with this, zero. They are testosterone-driven. They're going out, out. Okay. So estrogen has significant benefits, limited risk. And you particularly would say the pellets are a good way to go, why, as opposed to patches or pills or shots or [inaudible 00:42:36]?

Dr. Jennifer Park:
Mainly because it delivers a hormone into your bloodstream, just like your ovaries used to. So it's the most physiologic.

Dr. Drew:
Meaning, in terms of the low continued tonic release.

Dr. Jennifer Park:
Yeah. When we were cycling, actually, we had highs and lows, but actually, the pellets make you more stable and women feel [crosstalk 00:42:54].

Dr. Drew:
Why is that different than a patch?

Dr. Jennifer Park:
Well, patches is probably the closest, I would say, to the pellet in terms of delivery system. It gives you a nice, stable level. It'll drop off at the end of the week and you just have to replace it.

Dr. Drew:
Did your colleague that was looking for a solution that found the pellet, did she go through the patches?

Dr. Jennifer Park:
Yes, she tried everything.

Dr. Drew:
And why did those not work as well for her, I wonder?

Dr. Jennifer Park:
I think, partly, it was lack of testosterone. There was no-

Dr. Drew:
Okay. So let's get into testosterone. So really, the reason I asked Dr. Park to come in here is about the forgotten hormone for women, which is testosterone.

Dr. Jennifer Park:
Yes.

Dr. Drew:
I think I was trained that the majority of women's testosterone comes from their adrenal glands and that, after menopause, they're fine because they're still making it from the adrenals. But in point of fact, the major producer of testosterone in a woman is their ovaries.

Dr. Jennifer Park:
Yes.

Dr. Drew:
And when their ovaries shut down, they lose testosterone. I actually was involved with some research on this 15 years ago. At Cedar's, they were doing some endocrine research on this. And I was talking to these women who were going from shut down to turned on. And we'll talk about what that is. And the weird ... the endocrine community was like, "No, no. I'm not sure anything really is happening," as women were describing what you've seen, I'm sure-

Dr. Jennifer Park:
Oh, absolutely.

Dr. Drew:
... these vivid changes. You see it still hasn't caught on, really. What is that?

Dr. Jennifer Park:
I don't know. I don't know if it's just a lack of, just for women's health, a lack of priority for women's health and needs and wants.

Dr. Drew:
Like, women aren't supposed to be sexual or directed after a certain age or something?

Dr. Jennifer Park:
Right.

Dr. Drew:
It's really comical. Now, we've always had estratest, which is a combination of estrogen and testosterone. And I've seen that prescribed a lot, but doesn't seem to have the same effect.

Dr. Jennifer Park:
No, it doesn't really get your testosterone level high enough.

Dr. Drew:
And how do we decide what high enough is?

Dr. Jennifer Park:
I do somewhat by blood levels and just by how they feel.

Dr. Drew:
How they feel.

Dr. Jennifer Park:
Yeah.

Dr. Drew:
Is there any risk to replacing testosterone?

Dr. Jennifer Park:
No, not that we know of, not in females. I mean, there's side effects, but there's no risk of cancer. In males, you have to watch their prostate, but for women-

Dr. Drew:
Well, there's no concern about vascular illness. Did you see the recent study in men?

Dr. Jennifer Park:
Oh, yeah.

Dr. Drew:
Heart attacks and stuff.

Dr. Jennifer Park:
Although that was very specific. That study was on a very specific population, much like the WHI. It was on older men who had heart disease.

Dr. Drew:
Well, not only that, but I would imagine the opposing effects of estrogen would protect [crosstalk 00:45:14].

Dr. Jennifer Park:
Absolutely. They get a combined effect with the estrogen.

Dr. Drew:
So the side effects are hair growth, lowering of the voice.

Dr. Jennifer Park:
Yeah, acne.

Dr. Drew:
I imagine they might reverse some of the bone loss, even if you-

Dr. Jennifer Park:
Oh, absolutely. It's actually the only thing that builds bone-

Dr. Drew:
Yes, is testosterone.

Dr. Jennifer Park:
... in women, but the side effects are manageable. You can lower the dose. You can adjust the dose. There's medications you can give.

Dr. Drew:
So why get on it? What do you see? Why would a woman want to get on this? What do you see?

Dr. Jennifer Park:
Oh, mainly symptom relief, more than anything. So low libido. It helps with energy, mood, fatigue.

Dr. Drew:
I'm going to ask you to speculate wildly. A lot of post-menopausal women are on anitdepressants.

Dr. Jennifer Park:
Yes.

Dr. Drew:
What percentage of those, do you think, could be treated successfully with testosterone and no longer need their antidepressants?

Dr. Jennifer Park:
Oh, I mean, probably 90% of them and they at least-

Dr. Drew:
You're saying something rather bold. Even I, who's an enthusiast, would say maybe 60%, 70%, because some of that's got to be depression.

Dr. Jennifer Park:
Right. Some is depression, but maybe they'll need less.

Dr. Drew:
But the point is, they don't think about the hormone replacement and it's massively important for women, massively.

Dr. Jennifer Park:
Absolutely.

Dr. Drew:
It's frustrating. I don't understand why it's not ... Well, let me ask this. Does every woman respond equally well to these replacements or is it sort of a mixed bag?

Dr. Jennifer Park:
Well, it's a mixed bag, I'll say, again, because you're right, there are patients who have other issues and we can't fix everything.

Dr. Drew:
But even if it is, let's say it's a cohort, let's say, of 20 just purely post-menopausal symptom with pure menopausal symptomatology and you're going to put them on those pellets, what percent are going to be not only completely relieved of those symptoms, but feel better than they have in a long time?

Dr. Jennifer Park:
You mean, out of 20 with [crosstalk 00:46:55]-

Dr. Drew:
Out of 20. Yeah. And we're going to assume they have no other conditions.

Dr. Jennifer Park:
Yeah. Then I would say 90%.

Dr. Drew:
Okay. All right.

Dr. Jennifer Park:
I mean, [inaudible 00:46:59].

Dr. Drew:
See, that's crazy we don't consider that routinely. How about perimenopause? Let's talk about that because that's where this stuff really spins out of control. It's where marriages are ruined. That's where careers are changed. And perimenopause can be a long window and it can start at a very young age.

Dr. Jennifer Park:
Absolutely. Yeah. And I do think that is the testosterone factor there. Testosterone starts to decline after we're 35 and, symptomatically, really in the 40s, women start to feel that lack of testosterone, which is basically irritability, worsening PMS, some get migraine headaches, weight gain in different areas, loss of muscle. Those are all classic perimenopausal symptoms and that happens in the 40s. So I treat those women with testosterone and, if they're still making estrogen, we don't give them any estrogen. We let that run its course.

Dr. Drew:
And they get better?

Dr. Jennifer Park:
And they get better. PMDD, it's the severe PMS-

Dr. Drew:
PMS.

Dr. Jennifer Park:
... testosterone works very, very well for that.

Dr. Drew:
Should we be giving it to very young women?

Dr. Jennifer Park:
No. Testosterone can cause birth defects. So they have to be done having kids.

Dr. Drew:
And let's weave in a little bit endometriosis, which was sort of the opening topic on this podcast. Any role to be played there? Any issue of interplay with women that have endometriosis?

Dr. Jennifer Park:
As far as I know, there's no contraindication to getting hormone replacement, if they had endometriosis. I'd be careful in them because we do believe it's estrogen-driven.

Dr. Drew:
Endometriosis is. Yeah.

Dr. Jennifer Park:
Endometriosis. But for those that have had a hysterectomy because of endometriosis, which is a treatment for that, as far as we know, as long as the surgery was successful and there was no visible endometriosis, a low dose of hormone replacement is reasonable.

Dr. Drew:
I'm going to ask you an opinion. Is there excessive enthusiasm for hysterectomy for endometriosis? I'm kind of surprised how often they go to that. Or is it okay, it's adequate? You feel-

Dr. Jennifer Park:
It's adequate. I don't feel like we excessively do hysterectomies for endometriosis.

Dr. Drew:
Okay, because that's what non-gynecology looks, like, really? It's an awful lot of surgery.

Dr. Jennifer Park:
Hysterectomy.

Dr. Drew:
A lot of hysterectomies.

Dr. Jennifer Park:
At least in my practice, I don't feel like we do a lot for endometriosis.

Dr. Drew:
All right. We have to wrap up in about five minutes. So let's give people an understanding ... oh, okay, we've got 10 more minutes ... an understanding of how to access this kind of treatment and how to know if they might benefit from it. Who would you like to see and where should they go? And by the way, please do promote your practice because I've seen you do magic. So if they want someone [inaudible 00:49:44] in Southern California, go see Jennifer Park.

Dr. Jennifer Park:
Yeah. Well, they have to talk to their gynecologist and really talk to them and tell them what your issues are.

Dr. Drew:
Are they likely to get a sympathetic-

Dr. Jennifer Park:
It depends on their attitude and how much they know about it. There are a variety of other hormone doctors there, but [crosstalk 00:50:01]-

Dr. Drew:
Is there a website?

Dr. Jennifer Park:
Well, we have ours, which is just www.fowh.com.

Dr. Drew:
F-O-W-H.

Dr. Jennifer Park:
W-H-. Fair Oaks Women's Health, .com.

Dr. Drew:
Fowh.com. And do you give information there in addition to-

Dr. Jennifer Park:
Yeah, I actually have an email. They're welcome to email me and ask me any questions, if they like.

Dr. Drew:
Okay. And if I could say, I specifically asked Dr. Park to be here because I believe she's really on to something. And I've believed this for a long ... way before I met you, I thought this testost ... because I was in that research at Cedar and I thought, "This is remarkable and it's being ignored."

Dr. Jennifer Park:
Absolutely.

Dr. Drew:
And then to see patients go through these transformations where they feel like ... a lot of them are pissed, like, "Why didn't somebody come up with this 20 years ago? I could've skipped some Prozac and other things." And I understand that. Again, I don't know what's our problem that women aren't supposed to be sexual or aren't supposed to have testosterone or, if they have libido, it's an out of control vagina. We're in trouble now. It's weird.

Dr. Jennifer Park:
Yeah, absolutely. I don't know. And there's Viagra and there's all these other medications for men available.

Dr. Drew:
But for men, we don't worry about ... Well, that is another point. I wanted to ask this, myself ... what's the word I'm looking for? Selfishly. I'm jealous of people that get it. Can we, 50-year-old men, get on testosterone?

Dr. Jennifer Park:
Oh, absolutely. Yeah.

Dr. Drew:
Do we know the risks?

Dr. Jennifer Park:
There's lots of good studies out there that shows that there's benefit in men. Less heart disease.

Dr. Drew:
I don't have a prostate. You can put that stuff in me. Let's go do this. But I've had prostate cancer. So would that be a contraindication?

Dr. Jennifer Park:
Yeah. I mean, it can stimulate in prostate cancer.

Dr. Drew:
But [crosstalk 00:51:37] zero.

Dr. Jennifer Park:
Yeah. I mean, you could do it ... Yeah, just watching it very, very carefully.

Dr. Drew:
Or would the urologist just freak out?

Dr. Jennifer Park:
Again, it depends on their experience level with it. But yeah, no, I think you'd be good.

Dr. Drew:
Can you give low-level testosterone to guys? Just a little bit?

Dr. Jennifer Park:
You can. The levels in men are-

Dr. Drew:
Oh, I'm going to bust my urologist's balls on this.

Dr. Jennifer Park:
Ask him.

Dr. Drew:
Because, really, men have the same thing.

Dr. Jennifer Park:
Absolutely.

Dr. Drew:
It falls off and it really significantly affects their vitality and mood and all kinds of ... The question is, at what risk?

Dr. Jennifer Park:
Right. And I think there does need to be a study on healthy 50 year olds that [inaudible 00:52:11]. 50 year olds [crosstalk 00:52:12]-

Dr. Drew:
Are you implying that I am not healthy? How dare you.

Dr. Jennifer Park:
No, because the study that just came out was on unhealthy 65 year olds.

Dr. Drew:
Yes, yes.

Dr. Jennifer Park:
So I'd really like to see one on healthy 50 year olds.

Dr. Drew:
But when you look at guys on anabolic and androgenic steroids, you see oncogenesis of all kind, especially prostate cancer, and you see vascular disease, hypertension, kidney disease, whatnot. So it makes you wonder, "Mm, could it ..." but we're talking about just replacing things back to normal, aren't we?

Dr. Jennifer Park:
Exactly. And actually, there's been studies that show that, if you replace men's testosterone back to the level where it was, their lipids get better.

Dr. Drew:
Oh, that's interesting.

Dr. Jennifer Park:
Yeah. Just like in women, when the decline of estrogen, their lipids go off, there's got to be some-

Dr. Drew:
I'm going to bet, though, there's some function of testosterone, somehow, on the mechanism of cholesterol deposition in the intima, above and beyond the actual circulating levels of cholesterol and then fat. I'm going to bet. Maybe it's even blood pressure mediate or blood volume mediated or something, but I'm going to bet there's something there, but we should be able to control for that. We should be able to give enough that you don't cause those sort of ... because, I don't know, it just doesn't make sense to me that ... Again, this is part of the bias we have. We're biased against testosterone, generally, it seems like. Right?

Dr. Jennifer Park:
Right. Yeah.

Dr. Drew:
We don't want to give it to men, we don't want to give it to women.

Dr. Jennifer Park:
Well, I don't know. It works well. It's a little bit more natural. It gets us off other drugs that-

Dr. Drew:
Other medication, yeah.

Dr. Jennifer Park:
... make a lot of money. I don't know if that has anything to do with-

Dr. Drew:
Well, and also have a lot of side effects, like shutting libido down.

Dr. Jennifer Park:
Yes.

Dr. Drew:
That's a big side effect from SSRIs. So relationships are profoundly affected by this.

Dr. Jennifer Park:
Absolutely.

Dr. Drew:
A woman is already without libido and then you shut her down further with antidepressant? For god sakes, no wonder things are falling apart. You have a book. There's a book out there about this, right? The Forgotten Hormone or something?

Dr. Jennifer Park:
Yeah. The Secret Female Hormone is written by the doctor I learned it from, Dr. Kathy Maupin, who's in-

Dr. Drew:
We've got to put that on the website, gentlemen. Got it? On it?

Gary:
On it.

Dr. Drew:
Secret Female Hormone. Yes. And?

Dr. Jennifer Park:
And it's written by Dr. Kathy Maupin, who I learned this from.

Dr. Drew:
Okay. Dr. Park, I've got to wrap up. Is there other things you'd like to say, mention about your practice?

Dr. Jennifer Park:
No, I mean, if they're interested-

Dr. Drew:
They could call you or email you?

Dr. Jennifer Park:
Yeah.

Dr. Drew:
You could get [inaudible 00:54:12] emails. By the way, if your male partners have females with these kinds of issues, email Dr. Park. I mean, she may be able to sort of enroll them in this way of doing things.

Dr. Jennifer Park:
Yeah.

Dr. Drew:
I just am very enthusiastic about it and I hope it catches on for other practices throughout the country. Are there localities doing it? Do you guys have conference of pellet replacement therapists?

Dr. Jennifer Park:
Dr. Kathy Maupin is trying to train other doctors around the country. So yeah, there's an interest in learning, as physicians, too, that are out there that want to learn about this. You can talk to me about it or Dr. Maupin.

Dr. Drew:
You make it [inaudible 00:54:45] with email. Be careful. This could be a lot.

Dr. Jennifer Park:
But yeah, they just need to-

Dr. Drew:
I want to help you and help patients and not put you underwater. [crosstalk 00:54:53] spending a whole day doing emails.

Dr. Jennifer Park:
But they should talk to their doctor, try to get maybe their levels checked, and look into it as a viable cause for their symptoms.

Dr. Drew:
I bet you what's going to happen is that a lot of people are going to get put on patches and creams, which is probably okay. Right?

Dr. Jennifer Park:
Yeah, it's better than nothing. I mean, it's absolutely better than nothing.

Dr. Drew:
Better than nothing, yeah. And one last question, why is a testosterone pellet better than a cream, like AndroGel?

Dr. Jennifer Park:
For some reason, creams tend ... the absorption is variable, there's transfer issues with transferring-

Dr. Drew:
To your partners and things.

Dr. Jennifer Park:
Partners. Some of my women have kids, I mean, young kids.

Dr. Drew:
Oh, kids get it.

Dr. Jennifer Park:
Yeah. So it's just issues-

Dr. Drew:
So we're saying is that you put these testosterone creams on your skin and then you rub against your nine-year-old child and, all of a sudden, his voice drops.

Dr. Jennifer Park:
Yeah, exactly. So you've got to be cautious with creams. A lot of hormones convert between other hormones, so it just tends to do that more.

Dr. Drew:
Testosterone goes to estrogen.

Dr. Jennifer Park:
Estrogen or dihydrotestosterone, which is a more potent form of testosterone.

Dr. Drew:
Is that bad?

Dr. Jennifer Park:
Yeah. It can cause hair loss.

Dr. Drew:
Balding, okay. So this one doesn't do that.

Dr. Jennifer Park:
Not as much.

Dr. Drew:
That's weird.

Dr. Jennifer Park:
Not, in my experience, have I seen it, maybe just because of the way it's delivered. It goes right into your bloodstream, just [crosstalk 00:56:03].

Dr. Drew:
That's got to be an explanation for that. That's a peculiar one. Well, I want to be a guinea pig of yours, as soon as I convince my urologist.

Dr. Jennifer Park:
Absolutely.

Dr. Drew:
It's clear that I don't have metastatic disease. I don't know what that time is, if it's three years, five years or what. Just for the listeners, what you do after a prostate cancer surgery is you look for tiny, tiny metastasis, that it spreads elsewhere. It shouldn't have happened to me because they seem to have gotten it early enough, but you never know, is the problem. And so there's a 2% chance of it coming back. Question is, is it worth that risk to feel good for a little while? I don't know [crosstalk 00:56:36].

Dr. Jennifer Park:
Right.

Dr. Drew:
All right, Dr. Park, thank you so much. Before we go to wrap the show up, I want to remind people, in addition to hormone replacement, you can make your female partners feel better with Shari's Berries, everybody. How's that, Chris, Gary? Good transition? All right. Order a gift for even your mom or your girlfriend or your wife. Make it as unique as she is. Giant freshly-dipped strawberries delivered from Shari's Berries, starting at $19.99. That is a 40% savings, more than 40%, and you can double the berries for just $10 more.

Dr. Drew:
Click the mic at the right upper corner and use the code Dr. Drew, D-R-D-R-E-W. White chocolate, milk chocolate. I can't resist these things. These swizzles and chocolate chips and the ones with the nuts, I can't resist. It's ridiculous. So visit berries, B-E-R-R-I-E-S, .com. Click the microphone at the top right corner, type in Dr. Drew. That's berries, B-E-R-R-I-E-S, berries.com. Click the microphone, type in D-R-D-R-E-W. The deal expires Friday night at midnight, so order now for Mother's Day.

Dr. Drew:
So Dr. Park, let's give out all your vital stats here. Give me the website again.

Dr. Jennifer Park:
Oh, it's www.fowh, Fair Oaks Women's Health, .com.

Dr. Drew:
And I don't really want to give out a phone number because-

Dr. Jennifer Park:
Yeah, they can find everything else on there and my email.

Dr. Drew:
I don't know what to tell you. Just be kind to her. This is something that I'm enthusiastic about. Is there anything else I need to mention about your practice or website or how to make an appointment? No. I've also got your email. Do you want to give that out?

Dr. Jennifer Park:
Yeah. You can.

Dr. Drew:
You sure?

Dr. Jennifer Park:
It's on the website. it's free reign.

Dr. Drew:
it's Dr. Park, D-R-P-A-R-K, @fowh.com. If you have questions, I hope we don't overwhelm her, but this is really important stuff. It really is. I've been wanting to do this for awhile and I'm really appreciative that you came in and talked about it. And hopefully, more people will avail themselves, particularly you ladies that are perimenopausal. You might be 30 years old and wondering why you're so irritable and unhappy. It can be just premenopause, whole thing, and people don't think about it.

Dr. Jennifer Park:
Yeah.

Dr. Drew:
All right. That does it for the Dr. Drew Podcast. We'll see you next time.

Speaker 3:
[inaudible 00:58:35] times and topics, follow the show on Twitter @DrDrewPodcast. That's D-R-D-R-E-W Podcast. The music from today's episode can be found on the Swinging Sounds of the Dr. Drew Podcast, now available on iTunes. And while you're there, don't forget to rate the show. The Dr. Drew Podcast is a Carolla Digital production and it's produced by Chris Laxamana and Gary Smith. For more information, go to Drdrew.com.

Dr. Drew:
This episode of Dr. Drew is brought to you by Hulu Plus. Watch your favorite shows anytime, anywhere with Hulu Plus on your TV or on the go with smartphone or tablet. Shows like Family Guy, Once Upon a Time, New Girl, Scandal, and more. Right now, you can try Hulu Plus free for two weeks when you go to Huluplus.com/Drew or click on the banner on my website. That is Huluplus.com/Drew.

Speaker 3:
This is Carolla Digital.

 

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