Hormone Replacement Questions with Dr. Derrick DeSilva

INTRODUCTION: Welcome to Qualgen's podcast where we talk about all things health and wellness related, including hormones, pharmaceuticals, health trends and ways you can help better your life. 

INTRODUCTION: Welcome to Qualgen's podcast where we talk about all things health and wellness related, including hormones, pharmaceuticals, health trends and ways you can help better your life.  

Jennifer: Hi everyone, thank you for taking time out of your day to listen in. Today, I am joined with Dr. Derrick DeSilva who is joining me for our second podcast. If you missed the first one, it has some great information on some of the top supplements you can utilize and how they work and I would definitely recommend listening to it! Today, I'm going to be asking Dr. DeSilva some of the top questions I see individuals ask before getting and after receiving bio identical hormone replacement therapy which is also known as BHRT. Dr. DeSilva, thank you so much for joining me today. 

Dr. DeSilva: My pleasure, thank you for the invitation always.  

Jennifer: Always! Let's just jump right into it. So, one of the first questions I see constantly is regarding hair, both growth and loss. Can you explain why this happens and what can be done to correct it?  

Dr. DeSilva: Sure. So, we're talking about bio identical hormones as you mentioned and the hair loss and hair growth, both has to do with testosterone. If you overdo testosterone in any way, shape or form, you can either grow hair, or you can and/or you can lose hair. So, believe it or not, you can grow hair in places, now I'm talking about more for women, okay? And this is more for women than it is for men, but you can grow hair specifically, on the chin, you know in the areola area and also in the pubic area. So, you can grow hair there if you give too much testosterone. Also, if you give too much testosterone, the testosterone can convert to what is called DHT, Or dihydrotestosterone. DHT is the hormone, if you will, that is responsible for hair loss in men as they get older. So, there's two keys here, Jennifer, number one is when you're dosing testosterone go lower and not higher because a lot of people, especially women will say “no, you know, I want that testosterone, I want to feel good” and then they either grow hair and/or lose hair and they just freak out. I mean what woman wants to grow hair on her chin or lose hair on her head? So, you have to be very conservative. I'm very conservative. I'm just telling you I'm very conservative with that. Now, I guess the next logical question would be okay, so how do we prevent that? Go ahead, Ask me that question.  

Jennifer: How would you prevent it?  

DD: Well, as I said, the number one thing to do really is not to overdose, not to give too much. The other thing that I use. And again, this is for women and we can talk about men in just a moment, but in women I use Saw Palmetto and Pygeum Africana, things like stinging nettles and we have a prostate formula that I use in my female patients and they say wait a minute, Saw Palmetto and Pygeum Africana, common stinging nettles? This is for a man, this is this is for the prostate. True, it is for the prostate, but when you give women testosterone, the saw palmetto will stop the conversion of testosterone to dihydrotestosterone, and that's what we want to do in men also, right? We want to make sure that the DHT levels in men are not going too high and causing a problem and the same thing in women and we can prevent it by using the saw palmetto in women. Now, the key here is in women that we use it three times a week at the max five times a week. So, Monday through Friday lay off on the weekends. There's no downside. There's absolutely no downside to doing this in women and it's just one a day. 

JP: Interesting. I know we've talked about the prostate control, but for whatever reason it didn't make sense to me until you just said that about the DHT I've never heard of DHT. I don't feel like either.  

DD: Right, Well, DHT as I said before is so prevalent, you know the DHT, dihydrotestosterone, and that's another thing that I tell physicians and practitioners to do check a baseline DHT level when you do your baseline blood work because then you have something to go by. 

JP: Well yeah and then after you do your bloodwork six weeks down the road and you can really see what's happening. So, for men that are worried about balding after starting testosterone therapy -that can help with that? I mean if it's genetic it's just going to happen, right? 

DD: Right. Right, right. I mean look, if you're if you're 50 years old and you're balding and have male pattern balding already, it isn't always a genetic issue, Jennifer, more of this and we're starting to learn more and more about this. What we're finding out is that the follicles on the on the scalp will literally go into dormant phase. So, when they go into this dormant phase, what happens is that they can you can develop and you can get hair loss and that's where the problem really begins is in that situation. And that's again why the prostate formula is really important for men. I started using our prostate formula at the age of 40 and boy, I'll tell you, I really feel the difference. If I go off of it, it does make a huge difference just to take twice a day for men.  

JP: That's so interesting. So, the next one is kind of along the same lines, I think in terms of dosing, but it's about adult acne. I see people complain about getting acne after receiving testosterone therapy. So again, what causes this and then what can patients do to help control it? 

DD: And again, you know, this is again due to testosterone. When do young men develop acne? They develop acne when their testosterone is really surging, right? And it's that's typically what you will see. You will see it in the, in the face, you'll see it on the forehead, you'll see it in the chin area and it's a complete break out and you'll see this. If you look at an 18 or a 19-year-old young man, you will see that type of acne, that cystic acne from the testosterone. It's the surges in the testosterone. Now you combine a crummy diet with that with a little bit more sugar and simple carbs and you're just asking for trouble. They're just totally asking for trouble with that. So again, be careful with the testosterone, don't overdo it.  

JP: So, if somebody gets pellets and they're having that issue, is there anything that they can do to control it before the pellets wear off, then they can get on a lower dose? 

DD: Absolutely, Absolutely. There's two things that that really can be done for men and women that I do any kind of hormone therapy on, especially the pellets, what I always do is I start the women on the prostate formula as I said once a day, five days a week and on men twice a day every day. That will really help prevent some of the problems. The other thing that can be done, especially in men is DIM, Diindolylmethane. DIM is another thing that will help prevent aromatization and it will help with some of that conversion prevention right from testosterone to DHT, dihydrotestosterone, but it's more the saw palmetto than it is the DIM because the DIM has a very separate role, but it also has a secondary role in that conversion, preventing that conversion. 

JP: Can receiving hormone replacement therapy attribute to weight gain or weight loss? 

DD: Let's talk about weight gain. One of the other things that I'm very careful with, especially in women, the worst thing that you can do to a woman is to have her lose hair, grow hair or gain weight because she will strangle you. There's no question that she will come into the office with gloves on and she will strangle you and you know what? Quite honestly, they'll never do it again. Right? Women will never do it again if they're gaining weight and if they're losing hair or growing hair, they won't do it again. So, this is where dosing estrogen comes in. A lot of dosing sites that I have seen use too much estrogen, estradiol. Alright, I'm talking about estradiol, they use way too much. The recommendation is way too much estradiol. For example, some of the dosing sites will say use 12.5 mg of the pellet with estradiol, I always back off. I always back down because if you give too much estradiol, you're going to have the belly thing, right? I know you can't see me doing this, but you're going to have the belly thing here, and you're also going to have, which is going to contribute to the weight gain. The weight loss I don't typically see. What I see is if the person, I mean, you do see weight loss. Absolutely, because you're balancing hormones once you get the testosterone right, once you balance the estrogen, again, you're going to have improved in metabolic function, which is where the weight loss is going to come in. You still cannot go home and eat bonbons and yo yo's. 

JP: Right. 

DD: You still need to watch your diet, and I'll tell you what, this is another time that it is wonderful to try intermittent fasting. This is a great time to try intermittent fasting, eat for eight hours fast for 16. It's a great way to do it.  

JP: I've heard a lot of really interesting stuff on intermittent fasting. It has a lot of more studies now than it did a while back. I mean, everything does.  

DD: Absolutely. You know, I've been I've been doing intermittent fasting for about five years and I've really, you know, I can stand up and show you my flat belly, but I really have been able to maintain, I'm 65 years old and I've really been able to maintain that without the aromatization, without the belly holding onto muscle tone, but I think it's just everything, Jennifer. It's not just hormones, it's not just diet, your lifestyle, it's all of it.  

JP: I just don't know if I could go without eating breakfast. I wake up hungry a lot of days. I'm a person that gets hangry.  

DD: Well, the reason you wake up hungry is because at night you have eaten too many carbs. Your dinner and this is, and I've tried this a couple of times, for example, the other day we had, we had a really nice pasta meal. You know, I love a red sauce with shrimp and pasta and a salad. I just love that. I'll tell you what I woke up in the morning, I had to eat because here's what happens when you eat that pasta during the course of the night, your sugar goes up, right? Because you're eating the simple carbs your sugar goes up. What happens is your body then releases insulin and from that your sugar starts to come down. So, now you wake up and your blood sugar is really low in the morning and you have to eat, you have to eat. If you eat protein at night for your dinner meal or you know, you don't eat a bunch of sugar before you go to bed. What's going to happen is that you're going to have an increase of sugar, insulin kicks in and you're going to have a gradual decrease. So, it's not this, it's more of a steady curve - 

JP: It lasts longer 

DD: That's why. Try this, all right? You try, you know, just more protein at night, just a piece of chicken.  

JP: I try to base my meals off of my protein source, but I mean, I do have occasional pasta.  

DD: I mean, I'm not saying don't eat pasta.  

JP: No, I know I'm going to pay attention to it though now because I'm very interested to see the relevance between the two. That's very interesting.  

DD: Oh, it works. It totally works.  

JP: So, is there a certain age someone should be before starting hormone replacement therapy? 

DD: For women, this is my own thing, okay? There are other practitioners that are out there that don't agree with me, but I'm going to tell you what I do. I will not put a woman on estrogen, progesterone if they still have a menstrual cycle. I won't. I am not a gynecologist, I'm a primary care physician. I'm an internist and I've been doing this a really long time, but that is my rule. You, you know, I've had some very, very good, you know, Jackie, you know, Jackie, from House of Hilt. She really wanted to start hormones and she was still having her cycle and I said, and she's a dear dear friend of mine, you know that. I said, Jackie, I'm not going to do that. If you need to go one year without a menstrual cycle and being true, menopause before I'm going to give you estrogen and progesterone now, do you need a little bit of testosterone? No problem. I will give you a little bit of testosterone, that's not an issue. For men, at what age? First of all, I need to do a workup. You know, if you're a 30-year-old and your testosterone is 200 I've got to make sure that you don't have pituitary adenoma. I've got to check a prolactin level. I've got to do all that. I've got to rule out heavy metal toxicities. I've got to do a full work up. And the other thing I do in men is if they're young, I'm talking, let's say under 40 under 40 and 40-45. I send them to a urologist and make sure that they have a urologic work up to make sure that there isn't some other pathology that's going on in men. If they're over 50 and a man comes in, his testosterone levels low, he's finished having babies, you know, they've had a family, it's established, I don't have a problem with giving them some testosterone, but again, I want to see, but I still do a prolactin level just to make sure that there isn't something going on in the pituitary. It's just my baseline of what I do. 

JP: Well, it makes sense. You just gotta do your homework to make sure there's no underlying reasons before. So, you mentioned that stopped having babies, how does testosterone therapy for those that are younger and possibly still trying to have babies? How does that affect women and men separately?  

DD: Well in women, first of all, if a woman comes in and she's 35 or 40 years old. As I said before, I'm not going to give her estrogen, progesterone. I'm not gonna do that. Even at that age, I still won't do testosterone. I'm very, very conservative because there's usually other things that are going on in a person that is that tired if you will at that age, thyroid, right? Thyroid is notoriously a problem. you have to make sure they don't have an iron deficiency, anemia, or something's going on with their iron stores. You know, other issues do they have some other infectious disease, do that they have Lyme disease, do they have something else? So, I have to rule all those things out. In a man, so I think the women thing, I usually send them to a gynecologist if they're that young, and a man, you know, are you married? How long have you been married? Are you going to be getting divorced? Is your wife younger? Is she going to want babies? So, there's a lot of questioning that that needs to be involved in that. If they do for some reason, they're 50 years old and they've got pellets. Okay, how long are the pellets going to last? They're going to last five months. So, you're not going to have any sperm or I shoudn’t say any sperm, your sperm production is going to be down. So, chances are you're not going to get pregnant, right? I mean it's going to be a problem. So that's number one. Number two is if a man is in childbearing years and he really wants testosterone, what I always do is I will send them for a sperm analysis, a semen analysis, because if they have a problem at baseline, let's say sperm motility, insufficient number, etcetera etcetera, you know, deformity of sperm. I won't do pellets on a man that young of childbearing age without that baseline, without that semen analysis because once I do the pellets, they could come back to me and say, hey, you know, the pellets or the testosterone did that. Well no - 

JP: You're the reason I can't have babies.  

DD: But it's always good to have that baseline just to cover yourself. 

JP: Yeah, that makes so much sense. So, we already talked about this. My next question was going to be what should someone who has not gone through menopause but has unbalanced hormones, what should they do?  

DD: Well, I think this is where really good gynecologist comes in Jennifer, you know, they need to have a gynecologic work up. I don't think we as if, you know, if you're not a gynecologist. I think you need to be careful. I really do. I think you need to have that evaluation done. You need to have a full checkup done. And by the way, in women, I have three things that I must have as a baseline in women. Number one, a mammogram, women have got to have a yearly mammogram and before I start pellets, you must have a mammogram. Number one. Number two, you need to have a trans vaginal ultrasound. Why? Because I need to see what your endometrial stripe is. I need to see what your ovaries are. Do you have cystic ovaries? Do you have something going on on your uterus. Do you have cystic uterus? So, if that endometrial stripe is thickened and I put you on estrogen and you start to bleed, what's gonna happen? It's gonna be a problem. So, I need to know baseline what that is. And the third thing is pap smear, not critical, but I'd like to see a pap smear, right?  

JP: Just to make sure everything is good? 

DD: Yes. Absolutely. And I think this is where, you know, some of the clinics that are out there, they're just throwing hormones on people and giving all of us a bad name is where the problems are. They don't do baselines. They don't do follow ups, they have no clue what they're doing and it really gives all of us a bad name and then the authorities get involved and say look at what you guys are doing and ladies are doing and you're hurting people. No, we're not hurting people, we’re helping people, but it's got to be done right.  

JP: Yes. Absolutely. I could not agree with you more and we hear people that go through bad experiences and we're like, it's not the hormones that are causing it, it's who you went to and possibly the treatment that they caused because like you said, you don't do enough of your homework on somebody and then you just you're going to have problems. 

DD: Absolutely. 

JP: Seems like common sense.  

DD: I like that. I like that.  

 JP: So, is there a chance that you could have reoccurring headaches after hormone therapy? And if so, what could the cause of that be?  

 DD: Well, you know, the treatment, one of the treatments for migraine headaches that has been used for a really long time is low dose estrogen.  

 JP: Oh really? 

 DD: Yeah. I don't know if you knew that. I mean that's that is probably the exception to the rule. And I've only done this once, maybe in all the time I've been doing this. Is women that have severe migraines that are hormonally related, we can give them, and again, this is this is not for the average person that's just starting hormones. You can give them 6 mg low dose estrogen in a pellet form if they have these severe migraine headaches, alright? So estrogen if it's hormonally related if the headaches are hormonally related cyclic, right? We can use things like low dose estrogen, estradiol when I say estrogen I mean estradiol. Typically, I don't see headaches. No, I don't typically see headaches. Is that something that you've - 

JP: it's something that I saw, yeah, It's something that a lot of people were experiencing. So, I wasn't sure there was any correlation. I think it was mainly women. I think what a lot of people fail to remember is that there's a lot of outside sources. I mean allergies. I get headaches with allergies all the time. So, I think once people start on hormone replacement, they want to blame the hormones on everything and forget that there's other causes.  

DD: And again, this is where I spend a good 45 minutes to an hour before I put anybody on hormones going through their entire history. You know, what is it that you have? And I always ask, and I always ask men and women, what are you trying to achieve? What is it that you're trying to achieve? Is it more energy? Is it more more libido? Is it dryness? I mean, what is it that you're trying to achieve? Because once you know what you're trying to achieve I think then tailoring, actually tailoring the therapy for what they want is really the best way to go here. 

JP: Right. So, another question that I saw a lot of was bloating specifically, people noticed that they were bloating after starting DIM. Is that common? And if so, what is the cause of that and how can they help that? 

DD: One of the big things with hormones and you're going to see this more commonly in women than in men. Again, as I said, a belly weight gain, right? Weight gain in the belly area, too much estrogen. Bloating, absolutely unequivocally, too much estrogen. And I have seen this repeatedly on numerous occasions. If you give a woman too much estrogen, if you give her too much estradiol, she is definitely going to bloat and that's why I said in the beginning, Jennifer, I said cut the dose down and remember don't stack estrogen, alright? Make sure if you're dosing estrogen, I don't do it, If a woman is getting pellets every four months, I don't do it every four months. I do it, I do it at baseline, I skip the next month and then I do it the following months. Otherwise, you're going to end up stacking estrogen which is really going to become a problem. Here's one other thing that I think needs to be changed and this is what I am doing in my own practice. I check hormone levels, FSH, estradiol, testosterone free and total, progesterone, DHEA, I check all of those hormones a week or two before the next pellet. Again, this is my own bias. Okay, this is Derrick DeSilva’s bias. Checking it at six weeks, it is going to be elevated. Estrogen is going to be up, testosterone is going to be up, progesterone is going to be up, FSH is going to be down, but if you're getting ready to pellet, let's say in four months and let's say that their testosterone level is still elevated, you know that you need to cut down the testosterone. If their estradiol level is a little bit low, you know, okay, now I can give estrogen, I can give estradiol, right? If their FSH level is up, you know, okay, I can give them a little bit more estrogen. So that's my own bias. I don't understand the whole six-week thing. I just don't, it just doesn't make any sense to me, but if that's what people want to do great, but also check it again before you're going to pellet them again.  

 JP: So, do you ever do post pellet blood work?  

 DD: Not really.  

 JP: Okay.  

 DD: Not really.  

 JP: I thought that was just like a standard. I thought I thought everybody 

 DD: And again, think about this. Alright, If you think, and again, I have always been somebody who does things based on not only science, but on logic. If I check your levels at six weeks, they're going to be up. I bring people back at six weeks or two months, 6-8 weeks and say, how do you feel?  

 JP: Go off the symptoms. 

DD: What are your symptoms like? Are you still having hot flashes? Is there dryness? What's your libido like? What's your energy like? What's your memory like? What’s your focus like? And then if they say, you know what, there’s still dryness, I mean, okay, I know I need to give you more estrogen. Or, my libido is really still not there. Okay, well maybe I need to do more next time or I'll pellet you sooner. So again, that's my craziness. That's my logic.  

JP: But it makes sense. It totally makes sense because like you said, obviously the numbers are going to be up, you just gave hormones six weeks ago. So, I mean what good's it going to do unless you put in a booster, I guess if they're still too low then I guess it could be a good gauge for that. But - 

DD: Right, that is the and that's the exception to the rule, right? That's the exception to the rule. If there're really not feeling, I mean if they're really not feeling it at all. Okay, let me check your levels. But I have not run into that very often because I dose, I know how to dose.  

JP: So, that wraps up the questions that I have at this current time. Is there anything additional you would like to add?  

DD: I think just for everybody out there, look, the role of bioidentical hormones are phenomenal. You know, I just don't know there are patients of mine, my own family, you know, my loved ones, you know, I mean, I don't know how they would function without these hormones and the thought of these going away it's just frightening to me even for myself, but you know, I think we need to, the issue here is that there are way too many people that are doing this. I'm talking about clinicians and practitioners that are doing this. They have no clue what they're doing. They have no clue what they're doing. For you, the patients for you, the folks out there that are watching this you need to find people that have been doing this not for a month or two, but for years because this is where the experience really comes in. So, seek them out, take the time and seek those people out and then pursue this and make sure they do the appropriate testing and then you know you're going to have some good results.  

JP: Amen to that. It's all about finding someone with experience that you can talk to and that hears you because I think that that is so important but that's all I have. So, thank you again for joining me. If you would like to learn more or purchase any of Dr. DeSilva’s, the Common Sense Supplements please visit their website at cssupplements.com you can also find them on Facebook at Common Sense Supplements. If you'd like more information on Dr. DeSilva please visit his website at askdrdesilva.com. Thank you again, Dr. DeSilva. 

DD: and don't forget my Instagram. It's Derrick DeSilva, Jr MD. I've got a bunch of stuff that I do on Instagram and it's Derrick DeSilva, Jr. MD and just follow me on Instagram.  

JP: Yeah, I'm gonna go follow you now. I don't even think that I know you had on instagram. 

DD: I do. I do! 

JP: Perfect. Well, thank you. You have a great day.  

DD: Thank you so much, appreciate it. 

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