Katie Jo, NP:

Hi everyone, welcome today to our live webinar with Thrivelab. I'm Katie Jo, nurse practitioner with Thrivelab. Our mission statement with Thrivelab is to offer hormone care, testosterone care that's evidence-based to help balance hormones using natural bioidentical hormones to help alleviate age-related, or I would say hormone deficiency-related symptoms, and restore to youthful vitality. Today I have a very special guest. I'm really happy to introduce our chief medical officer, Dr. Ryan Jones. Dr. Jones and I have gotten to work together for a couple years now. We're both based out of Texas. Dr. Jones, I'm gonna brag that you love to golf.

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Ryan Jones, MD:

I do, I do, uh oh.

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Katie Jo, NP:

And in addition to being an amazing provider and traveling to patients' homes and seeing them in person, tell us a little bit more about yourself and your connection with Thrivelab.

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Ryan Jones, MD:

Absolutely. Thank you for that introduction, Katie Jo. Like you said, I've enjoyed getting to know you well over the past two years and kind of the entire team over at Thrivelab. So a couple of years ago, I connected with our CEO, Josh, who had a mission to make hormone health affordable, accessible to patients nationwide. Leading up to that moment, I'm a Dallas native. I did my residency and med school education, UT Southwestern in Methodist, a local community hospital there in Dallas. I say that UT Southwestern is the Harvard of the South. I don't know if other people agree, but I enjoyed my time there. One of the great things I loved about that particular institution is that you get to experience medicine at all levels, right? They train you in the Veterans Affairs system. You get some private hospital experience. You get some community last resort hospital experience. You get clinics, both of our more affluent and our more underserved patient populations. And so you got a really front end view of healthcare practice, at least at the time it was practiced, about a decade ago. And then from there, I did my residency at Dallas, which is a community hospital where you get a bit of a broad-based experience there. They take care of both traditional and then underserved patients as well. So what I learned kind of through all of that process though is that medicine is typically geared both on the patient and the provider and on the back end, right? Once something has gone wrong, we treat more disease states. There's not as much focus on prevention or holistic medicine. And so I had been searching for a position that allowed me to express that portion of myself. I'm involved, like you said, in some skilled nursing facilities. I do home care for a lot of patients, meeting them at their level and on their turf kind of makes the power dynamics a little bit more even. It puts me more in a servile position, and I've always believed that's what I'm there for. So I connected with Josh one day, and after hearing his message, it immediately registered with me as something that I wanted to participate in. As I am big on holistic, preventative, and total body care, and this particular aspect of care, health care, hormone health, is one that is not emphasized enough. I can tell you in med school training and in residency, you get almost none. You get a little bit of embryology, the development of how these hormones affect a fetus and its development into a baby, but beyond that, they don't give much information on that. So it's kind of up to the providers to kind of self-educate in real-world experience and via evidence-based medicine. So we've connected. We've had a mission since then. We've assembled what I consider to be a crack team, a top-tier team of nurse practitioners and physicians across multiple states, who share the same passion for hormone health and for total body care. Of course you were one of the superstars in that effort. We're glad to have you on board. And so here we are trying to blend. that version of care with the future of healthcare being, I guess, in many ways, telehealth, right, and more on the patient's terms, giving them more opportunity to connect on demand and spending more time directly with them, listening to them. So we're trying to build our model to focus on that. And so far it's been a great ride. Sorry if that was a bit long-winded.

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Katie Jo, NP:

That's a wonderful introduction. And I like that parallel with going to people's homes and providing this telehealth platform because it has revolutionized medicine for a patient to be able to be in their pajamas if they want, in their bed, on a phone call with me or on a video conference. Or to be taking a break at their work or to have dropped their kid off a soccer and then jump onto a telehealth, it makes healthcare accessible. I tell our clients that I don't want to be in an office somewhere where you can't access me. I want to be accessible and available to you and that's one of the missions of Thrivelab. And so with that said, one of the other patient questions that we often are presented with would be low energy levels, which is sometimes why the patient is calling me from their bed because their energy is so low. They say, Katie Jo, my energy's low. I wanna sleep all day long. Or Katie Jo, my energy's great in the morning and by afternoon, my energy's slumped by 3 p.m. I wanna go to bed and I still need to make dinner and do dishes and clean up or finish my work for the day. So I'm curious in your practice, Dr. Jones, how often do you feel like patients come to you that are experiencing low energy or fatigue or feeling sluggish? Is that a common, what we say in medicine, complaint, or is that a common concern that you hear?

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Ryan Jones, MD:

Absolutely, it's a very common complaint. I'd say that at some course throughout treating my patients, I'd say close to 60 to 70% of them will experience one of those symptoms or mention them by name, sluggishness, fatigue, low energy, trouble with sleeping. They kind of all blend together in some ways for the patients and sometimes they mean different things when they say those words. And so what I've learned to do is kind of get the temporal profile and to separate out the specifics of what they're complaining about or bringing to my attention. I don't really like to use the word complaint. I know you kind of threw it out there. That's what they teach us in med school. But it's really a concern. It's something that patients are saying, hey, this is suboptimal for me and what can we do to help out? So in my practice, I see kind of two peaks, I would say. For men, the peak is very distinctly around age 40 to 50. And for women, I see a similar peak, maybe a little bit later, 45 to 55. But in addition to that peak, there seems to be several smaller peaks, particularly in the female patient population, that occur earlier in life. And so I have a theory kind of about why that is. So typically with our male patients, taking you from birth through adolescence, basically your hormones are off at first for males, right? And then puberty hits and then they ramp up to a million. It's your first experience with them. I was a seventh grade teacher before I went to med school and I can tell you those kids get hit with those hormones hard, right? Absolutely. So for guys, what tends to happen is they get this big burst and it kind of gradually and slowly declines over their life, right? Just little by little by little. And so for the most part depending on their level of activity and how attentive they are to their own bodies, they tend not to notice much in the decrease unless they're particularly in tune with their body. Until about age 40, where it seems to cross some kind of threshold, either in the levels where they start to mention fatigue, I can't keep up with the kids, I don't have this drive anymore. And from there, I kind of further elicit the symptoms just a little bit more. So I see a peak for men around 40 to 50. Sometimes it's a little bit later, only because they've been experiencing symptoms for a decade, but you know, it's tough to get men to go to the doctor sometimes. They have a lot of machismo and bravado, and so we like to extend an open arm to those guys to let them know the help is needed. But sometimes it's a little bit later, but then they'll give the history of having experienced those symptoms for the past 10 years or so. For women, I think things are a little bit different. As always women are more interesting.

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Katie Jo, NP:

Ha ha

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Ryan Jones, MD:

So kind of the same initial process where women kind of get hit with the hormones, you know, somewhere between like 10, 13, 14, 16, depending on the individual, and they turn on. But immediately, those hormones begin to cycle for women. And so instead of being kind of a continuous steady state relative as compared to guys, immediately women are going through experiences of higher estrogen versus higher progesterone, those levels being in different quantities, having a background level of testosterone is different for women, their activity, further activity. They go through sort of a self-social experiment, many women experience or at least delve into birth control, which further alters their hormones, which gives them another clue to how this may be impacting your life, their sleep patterns may change, appetite, their weight, swelling, all those things may be impacted. And then of course, they kind of get a societal lesson to expect that sometime around 45 to 55, the whole system is going to turn off in some way, right? And it's going to have a significant impact. They kind of have some clues about what to expect about, you know, fatigue or night sweats or hot flashes, all those things that kind of come with it. And so even though I see the biggest peak, perimenopausal, menopausal, slightly postmenopausal, there are those smaller peaks that occur earlier. And also because it's unfortunate, but across the spectrum of hormonal diseases that tend to affect men and women, women tend to bear a heavier burden in that way. Thyroid disease tends to affect women more. Things like depression tend to affect women more, which can also be hormone related. They have a second, they have a kind of a set of conditions that men won’t experience, PCOS, endometriosis. And so all those things they know are related to their hormones. So it tends to cause them to seek care sometimes earlier and more frequently than guys otherwise would. So that's kind of the long-winded answer to that. Peak kind of in the middle age, but with women I see more cases a bit earlier. Of them complaining of fatigue or low energy, et cetera. Go ahead.

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Katie Jo, NP:

What a great explanation. I like the way Dr. Jones, that you mentioned about how society sets the expectation of women. Women are expecting menopause and perimenopause to come. There's a theory, it's called the grandmother theory, and there's a couple of species of mammals outside of humans. I think one of the species is a type of whale that women and men live beyond the reproductive prime. Most mammalian species after your reproductive time and you've spread your seed onto the next generation, you die. But with humans, the grandmother theory is that we need to stay around as grandparents to help nurture that next generation of our grandchildren. So whether or not you choose or have grandchildren, we know that this is one of the supporting factors that why we end up living decades past our reproductive time, time of our lives.

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Ryan Jones, MD:

Oh, yes, absolutely. I think it's a fool to just ignore the wisdom that a person can accumulate in that time. So I have a special place in my heart for our senior citizens on the extreme end and for the people who have just been through more life experience kind of than myself. I take everything they say with a bit extra of gravitas.

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Katie Jo, NP:

So with these grandmother theories, it's primarily focusing right now on the sex hormones. There's some other hormones that many of our clients will bring to the table that I like to discuss as well. This can include thyroid, cortisol, which is a popular hormone right now, and then insulin. So focusing on thyroid first, how can thyroid contribute to people's feelings of fatigue or low energy and sluggishness?

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Ryan Jones, MD:

So that's a great question. A lot of the people I went to med school, I always say this, I think they're smart and I'm the one who kind of got away with it, right? They let me in by accident and I somehow made it through. So in my mind, I have to organize these things a little bit differently. So sometimes when I have a discussion with my friends and muster their disdain, whenever we're discussing a particular topic, I really like to define certain terms to make sure that we're on the same page about what we're discussing. So particularly when it comes to a complaint like fatigue, low energy, I kind of group it in my mind into different aspects, right? So the first one I have is kind of pure tiredness, the way that a five-year-old or a six-year-old would say it. I have eight-year-old twins at home. My son also loves golf, so I'm going to throw that out there. But when they say they're tired, the main thing that they need at that point is sleep, right? So sleepiness is kind of a better term for it. But the distinction I want to make when I discuss with patients is, they say they feel tired, they feel fatigued, they feel low energy. And I come back with them at this question. I say, well, if you were to get a good night's sleep, right, a good solid 10 to 8 hours, do you think that that would fix your problem, right? Is it an issue where you've been sleep deprived, you're a resident who's been on call more, you're a lawyer who's had to stay up working on a case extra nights, and what you really need at that time is just a good night's rest, right? So that's kind of one classification that I put it in. The other is, well, one of the others is fatigue. And so it is similar in feeling sometimes, but specifically it is not cured by just one good night's sleep. They say, you know what, I'll go to bed. I'll sleep mostly through the night, maybe get up once to pee. But the next morning, I just feel like I don't have much energy to do the things that I typically love and like to do. And so I put that in a separate category. And the reason I'm organizing in this way is because I tend to think of different hormones for different kinds of tiredness. Exhaustion, there's two kinds there. There's typically just the abrupt physical exhaustion, someone who has finished running a marathon that one’s more relatable or a very intense workout. But also I feel like there's kind of a mental and or emotional exhaustion. So you can imagine getting into a very heated argument, a prolonged heated argument with someone one day, and just at the end of the day you're just ready to be done with everything, relax and kind of call it quits for a little bit. I think those are kind of relatable. One of the ones that sneak in there a little bit, and this particularly I see more in our male population is when they say low energy. Sometimes what they mean is lack of motivation. So maybe they're on competing sales teams and the quarter is about to end. And 10 years ago, I mean, they were doing everything to win, they were rallying their troops, investigating how can I make this sale, this sale, this sale. And this year, they just don't have the same drive, right, to succeed in that competition they did before. And they remember their former selves and they're wondering, well, what's different, Doc? Why don't I have the same drive? And sometimes they'll describe that as low energy. And then kind of the final two is on the depression spectrum, I don't want to clinically label it specifically there, but on the depression spectrum, and what that means is things that you like to do, you're just kind of not interested in doing it. It's like, my friends would come to me, hey Ryan, we've got a great tee time at this fancy club here in California. We'll even pay for the round for you. You want to go play with us? And I'm like, no, I don't feel like doing it today. That's a special kind of low energy that some people experience. And then finally, when it is highly specialized, I think it's related to libido, right, is where a husband and wife have been together for a long time, and the husband says something along the lines of, I feel okay, I get through the work day and all that, and I love my wife, I want our relationship to remain strong, but I just don't have the same umph, the same desire there, and sometimes they'll describe that as low energy. So the reason I separated that way in my mind is because each one of those conditions causes me to focus on a different aspect of hormone health. So after I’ve kind of gotten my picture of which one of those they may be, I like to work my way from the brain down. That's typically how I think when I'm addressing these issues. And it starts actually, even though the hormones we're ultimately going to talk about are the secondary products here, it starts actually at the hypothalamus. And the reason I like to focus on the hypothalamus is because it's a part of your brain. And I think everyone knows that. But I think the part that really needs to land with some practitioners particularly is that it's mostly made of neurons, right? And it is directly connected to the rest of your brain. And so your hypothalamus' job is to kind of maintain a, it's homeostasis is the medical term, but basically a steady state to keep things relatively in balance. But it has one extra function in addition to that, which is to adapt when some change warrants it. So it senses things in five categories, right? So number one, you have physical, right? Something easy like is it hot or is it cold? Right? I think people intuitively grasp that. It senses things physiologically. That's a big broad category. Things like, you know, how's my salt, how's my water balance, how much thyroid hormone in there, how much testosterone in there, what's my blood pressure. It senses things like that. And I think most providers and practitioners, they're very comfortable with that part. But again connecting it back to being a direct brain structure. It also receives a couple other kinds of input that are very important in understanding how it's working. Number one is subconscious input. That is input that it experiences and communicates with other parts of your body that pick that up, but that does not appear to your consciousness, right? You're not necessarily aware of what's going on. The pre-conscious, right? And so that's a bit of a hard one to determine for people or to explain to people. But what I typically like to say is, maybe you've seen some kind of dumb prank video or something on TikTok where somebody's mom is, you know, cleaning the kitchen, they put a toy rat behind her, right? She turns around and sees a toy rat and jumps, right? Now, she's not scared of toy rats, right? She's scared of rats, right? But some part of her brain has to kind of make a decision about whether or not she needs to be afraid or alert there before it can reach her consciousness, right? So that's kind of preconsciousness. Another great example of something that's preconscious is laughter. A lot of times you laugh at a joke, you're not quite sure how to explain why it's even funny. It seems like another part of you has made that determination. And then the last part is conscious input, which is things that you're aware of. And that part really relates mostly to stress, which will play a role into what's going on. Your hypothalamus, I don't think quite knows that, what a test is, but it knows that you're concerned about that test. And so that triggers kind of a hormone cascade from there, sometimes adaptive, sometimes maladaptive. Understanding that I think helps people ultimately develop a plan in addition to our therapies for maximizing their benefit when adjusting those hormones. Okay, sorry, it’s a little bit long-winded. So we got the hypothalamus and it's detecting all those things, right? And then, so the pituitary largely just kind of lump in there. The hypothalamus tells the pituitary to do things. Sometimes that connection isn't great, right? And certain disease states arise from that. However, we'll go one step below there, make it to the thyroid, which you brought up, right? So before I go in there, tell me a little bit from your understanding, what does the thyroid do, what is it about?

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Katie Jo, NP:

Wow, following that, I don't know what to say, but I'll tell you what I tell my patients, which is a more abbreviated version, that our thyroid is one of our master metabolizers in our body, so helps with our cellular energy level, specifically our free T3, which is the free form of three iodine molecules of thyroid that's able to enter the cell. And we also have our thyroid as being one of our master gauge of temperature. So if patients are experiencing hot or cold instability. If they can't tolerate heat, they go out into the heat and they feel like they're going to faint or they're very, very cold. They need a blanket all the time, cold hands, cold feet. That could be a sign of thyroid. It's one of our master engages for our body's temperature. And then also with that metabolism, often people think about weight only, but I think about the other systems in our body. So I like that you use this systems approach, Dr. Jones, you talked about the brain moving down to

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Ryan Jones, MD:

Absolutely.

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Katie Jo, NP:

the next organ system, the thyroid. But thinking about other systems, so cardiovascular impacts on the heart, my understanding in severe cases of hypothyroidism, low thyroid, you could have changes in your heart rate or heart rhythm. And then also the digestive system, so there is this influx of, I often tell my patients, we'll talk about peristalsis, about those contractions to the digestive system that help our body move nutrients and stools through it and in cases of low thyroid that's not working as well there's often experiences of constipation. And some of my clients will tell me, Katie Jo, I've been constipated my whole life. I only go every three days, which I'm of the camp that that's not normal and if it was normal, I don't want it to be normal for you, but also some of my patients will have a new onset, especially that population you spoke about, the 40-year-old women were all of a sudden they're noticing, I'm not going regular like I used to. My diet hasn't changed, my exercise hasn't changed, I'm drinking a gallon of water a day, and I'm still having symptoms of constipation. So those would be

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Ryan Jones, MD:

Absolutely.

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Katie Jo, NP:

some of the leading symptoms that I look for. I like your explanation, Dr. Jones, of how you broke down the different types of low energy, because it's so important to go into that detail. And one thing you mentioned would be the lack of motivation, which is not often associated with energy, but it can also show it for women. We associate it more with our mood if we're feeling sad or wanting to cry or that lack of the ability to feel as if we can accomplish what we used to in our days that gives us a sense of accomplishment and purpose to our life and that often shows up in the depressed mood. So those

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Ryan Jones, MD:

Absolutely.

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Katie Jo, NP:

would be some of the main symptoms that I speak about when I'm speaking about thyroid.

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Ryan Jones, MD:

I believe it's called the master gland for a reason, right?

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Katie Jo, NP:

Mmhmm.

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Ryan Jones, MD:

And the key point that lands with most people is that except for a few inert cells like red blood cells, every living cell in your body has thyroid hormone receptors. And so the analogy there or the way that it works for me in my head is when I think of the thyroid, I think of it as determining what kind of engine is your body going to run on. Through your day-to-day needs, through all the things that it senses, like you said, the temperature, caloric intake, how much physical exertion you have to do, how hard is it to digest the type of foods that you eat, things like that. It makes a good integration of that. And then the output is I can handle this with a four cylinder engine, a six cylinder engine, an eight engine, a turbocharged V10 and beyond, rocket ship, whatever it takes, right. So your thyroid's kind of in charge of picking that. The main thing I want people to know about that though is that it moves kind of slowly, right. So you can't typically go from V4 to rocket ship kind of overnight. Changes in thyroids are typically a little bit more gradual. But where I relate that to low energy is if your demands typically exceed what that engine is capable of, you're a person who is likely then to experience symptoms related to hypothyroidism. So there are clinical diagnostic tools that we use, right? Our patients aren’t numbers, lab values do have numbers and we use those to guide us, but I tend to focus on what the patient is telling me and use that as an adjunct tool to determine if that's likely the cause for them. So when patients are thyroid deficient, they usually experience the kind of classic fatigue, the ongoing fatigue. Using that described necessarily as exhaustion, right? Sometimes there is an overlap with depressive symptoms, right? Like you described, your mood not being what you ideally like it to be. But generally what I say it is, is like you just don't, you're trying to haul 10 tons, you know, with your Honda Civic, right? And it's just not right. You're trying your best. You want to do it, right? You have the motivation to drive. But that part is missing. So when patients give me a story that fits kind of into that category, thyroid is one of the major ones that jump into my mind. As a side note, every time they teach about it in school, they always say, it's the butterfly-shaped organ beneath your neck. And I like that particular description of it, because thyroid disorders disproportionately affect women, and I always just consider them as butterflies that need to learn how to fly again. So anyway, so that's kind of where I land on the thyroid part. It's difficult to separate from a couple of other hormones. But again, so after thyroid, I typically move down a little bit in trying to determine what the cause of someone's low energy is. Next stop is a big jump, but it's all the way down to the adrenals. Right? And I'm sure most practitioners are aware, or at least they have nightmares about remembering when they were taught. It has three layers. The outer layer that's responsible for hormones that really do things like salt and water balance, right? In extrements, when those things are really out of whack, they certainly can cause fatigue and other issues. That is one that just immediately jumps out on the labs. So typically it doesn't take a lot of investigation. If you see someone with a salt of 125 or something like that, you might, you can ask the hormone questions the remaining hormone questions I think later, but you're certainly going to treat that a little bit first. But the next layer in it's kind of the interesting one, right? Which is where I think the biggest hormone related to fatigue, tiredness, sleepiness lies and that's cortisol, right? So cortisol has a huge role on multiple levels when it comes to chronic fatigue and so our viewers might be aware or I've heard somewhere that cortisol is sort of the catabolic one that breaks things down and seems otherwise useless, right? It's nicknamed the stress hormone. And people are like, why is that there? Why do I need a particular stress hormone? If all it does is tear my body apart, right? And so in short bursts the cortisol does good things for you, right? When you're in a stressful situation for which you can achieve a theoretical end goal, it has a couple of target effects that are beneficial, right? Number one- sorry, right before I get there, one thing I think people need to know to make these things make a little bit more sense is how much of your energy is dedicated to being alive versus how much is related to motion. I think people tend to think that the things that they do throughout the day, putting on the backpack, walking or typing, sitting, dancing, take up a significant portion of your energy. And it kind of does, but the total amount there is typically between 15 and 20 percent of the calories you have taken in in a day are related to the things of physical activity, right? The other 80% is dedicated to homeostasis and keeping you alive, making new proteins, your immune system, your blood pressure, your temperature regulation, things like that. So when cortisol has these effects that are meant to be beneficial, even though it seems like shunting them in a certain way would be more helpful, you'll start to understand I think, some of the effects better. So one is it temps down your immune system, right, because that's a huge energy suck. It basically says, hey if I'm battling a little virus or a rash, I'm gonna have to go to the side for now, I need some energy to deal with this acute problem I have. I don't know if it's a bear attack, I don't know if it's that my boss is putting some pressure on me, I have to pass this exam with both those conscious, subconscious, and other inputs get there. My body makes the decision to release some cortisol. And in short bursts, it's fine. It basically provides generalized energy. It tells your liver to release some of the glucose that it has. Keep your pancreas from emitting too much insulin so that you don't want too much of it taken up by your muscles. Because your brain, again, uses 25% of your calories. You want some of that extra energy to think. And it breaks down some of your, and actually, kind of intuitively, when it interacts with the muscles, it breaks down some of the proteins, which seems like the exact opposite of what someone would want. But again, in an acute phase, I think these things are okay, and they're beneficial in helping you get over that response. Where the problem typically lies is when that cortisol elevation becomes chronic, right? Then things kind of turn on their head a little bit. Cortisol, in addition to being a stress hormone, is kind of like a readiness or a get up and go hormone. So very classically, your sleep cycle is related to cortisol peaking in the early part of the day, and then melatonin kind of dominating towards the evening part of the day. So in the morning, you want it. It gets your blood pressure going. It gives you the wake cycles, the wake signals that you need. Get up, brush your teeth, start getting prepared for your day. When people start to get chronically elevated, it dysregulates your body's sleep cycles pretty heavily. I feel like they're both crucially important. But dysregulation of cortisol related to sleep, I think is tremendously more impactful than dysregulation of melatonin. And so that's typically where I focus most of my efforts. And so I'm trying to get people to manage their cortisol through the various techniques that they can in that regard. So there's a whole host of things that people have to watch out for when it comes to that. But the way that it inputs other hormones is what I'll kind of jump to here today. Cortisol itself needed in the mornings, right? Less so at night. But if you're chronically stressed, right? That includes physiological, physical, subconscious, pre-conscious, and conscious stressors. That level is going to remain elevated throughout the day. It keeps your brain active and thinking. Because again, it thinks you're supposed to be problem solving for something acute but that becomes maladaptive when it's the fourth, fifth, sixth, seventh, eighth day of interrupting your sleep, right? And of course, if you're getting poor sleep, the first thing people are going to say is that I'm tired all the time. I can't get a good night's rest, things like that. Have you had many discussions with any of your patients regarding cortisol? Has that been something they brought up to you?

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Katie Jo, NP:

Well, it's interesting that you mentioned the sodium levels at 125, which would be a very low sodium that we would wanna treat medically before we move forward with hormone replacement therapy. But one of the labs that we check is that sodium and potassium ratio, and it's available on your comprehensive metabolic panel, even a basic metabolic panel that you can get from any primary doctor today even. And in that ratio, you can see, is your body showing signs of high ratios? Are you having an acute stressor that your body's responding to? And we spoke about cortisol, but there's another hormone produced by your adrenal glands, aldosterone, that works really close with your lungs and with your kidneys to help regulate your blood pressure. So if you're in acute state of stress, your blood pressure is going to increase. And then we can check that ratio if it's been a chronic stress for a long period of time, then we can see that ratio decrease. And that gives me a sign that you've been stressed out for a long time. So this very basic blood work, we can have clues about your health. And I love to tell my clients, the blood work is a snapshot of you at this moment. It's like you're on a roller coaster ride and you're climbing up and you're about to go down the roller coaster and that camera shoots off right when your mouth is open and you're screaming. And then we get a picture of what's happening inside your body, but it's not static. And you spoke earlier, Dr. Jones, about the different symptoms of fatigue and breaking those down. And we know that cannot be checked into blood work. That can only be coming from the person's own lived experience. So I do see it in my practice and I use the blood work to help confirm to our patients what they already know intrinsically inside themselves that's happening. Well, Dr. Jones, you've been a wealth of information today. I know our clients are gonna walk away from this webinar saying they know more about their thyroid, their butterfly in their neck. They know more about their adrenal glands, stress response. And if you identify with any of the words that Dr. Jones spoke today, if you're feeling that lack of motivation, if you're feeling emotional fatigue, where you're feeling depressed, if you're feeling the lack of stamina in the bedroom or in your work, in your life, those could all be clear signs of hormone dysregulation. And our goal here, go ahead.

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Ryan Jones, MD:

Absolutely. And I certainly want to take a little bit of time just to go through a tour of the other major players here.

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Katie Jo, NP:

Okay, wonderful. You lead the road on that. I want to be mindful of your time as well.

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Ryan Jones, MD:

Absolutely, absolutely. So just one more kind of comment then on cortisol then. So for guys whose low energy means... girls, particularly guys, is testosterone is kind of the main hormone at play here. So for guys who mean by low energy that they are struggling sometimes with their workout, and also they typically have questions since cortisol is catabolic and it breaks down muscle tissue. What's the right amount of time to work out? What optimizes my workouts and their utility as time goes on? What seems to matter most there is the ratio of your testosterone to cortisol, right? So, excessively long workouts typically don’t produce additional benefits, right? There's a sharp, sharp amount of diminishing returns around the 45-minute mark to an hour. And then beyond that, sometimes it's literally deleterious, right? Again, inflammation doesn't sound good, but then the acute phase, when it helps to break down those muscles, and then later, as you rest and recover, allows them to repair, it's typical where you get the most athletic and performance-based benefit. So that ratio is really key. The hormone testosterone is the other part of that balance, however. And that is one that via various mechanisms our patients may try to boost naturally, dietarily, healthy lifestyle and living, but ultimately through a variety of factors, some environmental, some genetic, some related to age, they just can't get that level quite up to what they want it to be. And of course, that's where we can step in and help them out a little bit more. Just to again, take our step down then from the adrenals to the kind of the next level. Is the gonads, both male and female. I always consider guys to be a little bit easier because there's one major, major player there, which is testosterone. DHEA plays a significant role as well. But when it comes to energy, I think testosterone typically is more of a prominent feature. So that ratio certainly is important, right? You want your testosterone to be relatively high. You want your cortisol to be low. And cortisol being low is related to sleep cycles and stress management. So those are two key areas you're gonna wanna focus on. You’re gonna try to maximize the benefit there, help get your energy back. So I do want you to exercise, right? Being sedentary is kind of the worst of those things, right? But there certainly is kind of a peak at which the benefit seems to occur. Now, I also want to say if something's not broke, don't fix it, right? If you're out there crushing it for two, three hours a day and you feel the best you ever have and you're happy with your performance goals, by all means, keep it up. We can continue with supplementing testosterone as needed. But then there's a couple of big other ones and that's related to the females. Progesterone and estrogen in their relation to sleep I think is kind of the biggest contributor and then there's the direct effect of estrogen on metabolism which I think is the next biggest factor when it comes to the energy that women experience. So obviously when women are cycling they get very in tune with the fact that they feel different at different times and for some people depending on their exact physiology one phase actually typically might be better than the other. So progesterone being high is typically what's called GABAnergic. GABA is one of the neurotransmitters that kind of calms the brain, shuts it down, helps you get a good night's sleep. And so high progesterone levels in the second half or the later phase typically can be associated with better sleep for some women. However, the decreased estrogen leads to a whole host of symptoms that they themselves, even if not directly impacting sleep hormonally in that way, do the effects that they cause your body can disrupt, your bloating, your mood swings, things like that. So it really is about a balance and a fine tuning. And of course, having an expert in that, like yourself or any of our other excellent staff, is really key because they have the experience and wisdom to help you find those right balance in that number as time goes on. For our older women, where typically the... once menses has stopped and progesterone is kind of the only one hanging around albeit sometimes in lower levels and the estrogen has dissipated, progesterone tends to help by giving it in burst doses particularly closer to night. The topicals tend to absorb a little bit slowly and while that's okay, it rapidly absorbs when you take it orally and has more of that GABAnergic, you know sedative effect helps women get a better night's rest. And then of course the estrogen is kind of the other part of that and getting sleep ideal. But one thing I think to just to kind of round that off is that the estrogen is kind of a direct metabolism booster. Progesterone releases energy from fat cells, which sounds good, and that's fine, but that's a limited return, typically estrogen, kind of like thyroid, but not quite. It kind of gets the whole machinery turned on and keeps your energy levels high. So many women feel the estrogen replacement gives them the jolt of energy that they need. Women have all the hormones and so do men, albeit in different ratios. Testosterone also is very effective at boosting metabolism in women by increasing muscle mass and mitochondria density and function. So that's kind of a last area for them to look. So I know it's kind of a whirlwind tour there. I'm sorry, I could say a million things about each one of these hormones. And for the patients who land on my doorstep, I certainly will take the time to explain each one of them should they have the time and the interest. And I'll make future appearances, obviously, to clarify some things as people may have some questions there. I know I tend to try to say a lot, but as a 50,000 foot view, that's kind of my view on hormones and the benefit that our company can provide to those who are experiencing any of those symptoms in any of those categories, right? You know, the fatigue, the loss of that edge and that drive, the low energy, the trouble with sleep, all of those are kind of falling under the umbrella of low energy.

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Katie Jo, NP:

Wow, Dr. Jones, thank you so much for your time today and for explaining from the brain down to the thyroid, down to the adrenal glands, down to our reproductive glands, the gonads, the ovaries in women, the testes in men, and showing how those are all interconnected. And I know that the patients that we get to serve every single day, they report back to me and they may not use the terminology you're using, but they'll tell me, Katie Jo, I got to go and have ice cream with my kids and I wasn't mad, I wasn't grumpy. Or Katie Jo, I wanted to spend time with my husband while before I just wanted to fall asleep at the end of the night. Or Katie Jo, like you said, I'm crushing it in the gym, I'm putting on muscle mass, I no longer feel weak, I'm able to lift up my suitcase and put it in the top part of the airplane all by myself. So our patients' lived experiences and stories help confirm exactly what you're saying here in your beautiful description with medical terminology.

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Ryan Jones, MD:

Absolutely, that's why I'm glad to have providers like you and I always say if it's important to you as my patient and it's important to me. We take that seriously and together we're going to find the right solutions for you.

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Katie Jo, NP:

Exactly, you said it wonderfully. So for those who are joining us for the first time, we're at thrivelab.com where we have a list of our providers. I think Dr. Jones' headshot is there. If you want to read more about him, you can also read about our foundation, where we came from our background with using hormone replacement therapy to treat a traumatic brain injury. So we know there's multimodal aspects of hormones. Our goal is to help balance your hormones. so you can show up in your life at the highest level possible to offer gifts to the world and those around you. So thank you for taking your time today, and we hope to see you on a telehealth call or video conference very soon.

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Ryan Jones, MD:

Thank you guys. Thank you for your time. Goodbye. Thanks, Katie.

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Katie Jo, NP:

Thank you.

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