Do Bioidentical Hormones Fight Aging Or Do They Fight Us? With Dr. Christopher Asandra

Dr. Heather Furnas (00:12):
76 year old actress, Suzanne Somers calls bioidentical hormones the secret to staying ageless. Yet the Medical Board of California charged her doctor with gross negligence and being unaware of the potential treatment risks. Risks? What risks? Do bioidentical hormones fight aging, or do they fight us? Welcome to Skintuition. I'm Heather Furnas.

Dr. Josh Korman (00:42):
And I'm Josh Korman. From pimples to wrinkles, our skin effects how we feel about ourselves as two plastic surgeons. We discuss what's new, what's safe, and what to look for when you're ready to hit "refresh."

Dr. Heather Furnas (00:57):
I'm delighted to introduce our special guest, Dr. Christopher Asandra. Dr. Asandra is a world renowned anti-aging and hormone therapy physician with practices in Beverly Hills and Newport Beach, California. Using the treatments that he developed during years of research, he has helped men and women around the world regain their youth and vitality. Welcome to Skintuition, Chris.

Dr. Christopher Asandra (01:27):
Thank you guys so much for having me.

Dr. Josh Korman (01:29):
So Chris, let's start with some definitions. What is a hormone and what does bioidentical hormone actually mean?

Dr. Christopher Asandra (01:38):
Well, hormones are actually chemical substances in the body. They kind of act like messenger molecules. They're made by the endocrine system or in certain glands of the body. And these substances travel to different parts of the body where they help control how cells and organs kind of function and do their work. And as we age, as we know our hormones tend to decrease. So the definition of bioidentical means it's the exact same molecule that your body produces. It's not a synthetic form of it. And the best example I feel I can give for this is, you know, if you take birth control pills and you look on the name on the packet of birth control, it's not estradiol or estrogen, it's always some offshoot nor ethanol, estradiol 17 beta, whatever it could be. So with bioidentical, it's exactly the same hormonal molecule as the human body produces.

Dr. Heather Furnas (02:34):
So our bodies have so many hormones floating around. How do you decide which ones to replace and what is their effect?

Dr. Christopher Asandra (02:43):
Well, I think everybody knows if someone has insulin deficiency or diabetes, start out you need more insulin. And insulin's actually a hormone as well. A lot of people, you know, suffer from thyroid disorders where they can feel symptoms of low or high thyroid. And that's kind when you know, okay, you go to your doctor and they may check some blood work on you and they notice that you may be lacking in certain hormones such as thyroid, estrogen, testosterone, and by doing these blood tests, saliva tests, et cetera, you can kind of see where you rank or where you're at for your age. And if you're symptomatic with some of the deficiency parts of the hormone, it can be replaced safely.

Dr. Josh Korman (03:22):
So we often hear women consider bioidentical hormone replacement at menopause. Can you talk a little bit about men and andropause?

Dr. Christopher Asandra (03:34):
Sure. Well, men, as we know, we tend to lose, our testosterone levels start declining actually after the age of 21. And every year from then on, it kind of slowly decreases, especially after the age of 30, about one to 2% a year, sometimes faster if you have other medical problems. Obesity, diabetes, heart disease. We're seeing it a lot more now in younger folks whether it's stress whether it's our environmental factors that could play a role in it. But generally we're starting to see more of a decline in men in their forties and fifties now. And, you know, men start suffering from certain symptoms, fatigue, erectile dysfunction, low libido, or they start amassing more fat around the central portions of their body or fat where they don't like it and it's harder for them to gain muscle or lean muscle with that. So best example I can give is, you know, when you're 16 years old, 18 years old, you can eat a whole pizza, probably not gain any weight, but as we get older, we do have to watch, you know, what we eat and muscle is much harder to put on and fat is much easier to retain.

Dr. Josh Korman (04:37):
So does that mean that if you follow your suggestions or whatever, that everybody gets their mojo back? Like how does that work?

Dr. Christopher Asandra (04:49):
Well, I think it's first important to make sure that you don't have other medical problems going on, whether it's, you know, high blood pressure, diabetes, high cholesterol, to rule those out first, which could be contributing to some of your symptoms. What we do know is type two diabetics tend to have lower testosterone levels, people who are living unhealthy lifestyle as well. Sleep apnea is a huge thing now that we see a lot in a lot of people. And that affects their testosterone levels or in their endocrine system, which may be making them fatigued. So if someone tells me they're just tired and they're having ED and it's just harder for them to have a, a healthy libido, I, I ask, want to make sure that it's not another medical problem that may be going on that is really the root because of it, which secondarily could affect their hormones, but it's important that you see your doctor and just get checked out thoroughly first.

Dr. Heather Furnas (05:35):
So you mentioned obesity, so if you are like Daniel Craig and you're, you know, playing James Bond and you're really working out then, is that preventative against loss of testo lower levels of testosterone?

Dr. Christopher Asandra (05:53):
Yeah, absolutely. I think people who do a lot of lower body exercises who exercise regularly, get really good sleep and follow a good diet, eventually I don't, you're not going to be able to turn back the clock and you're not going to be producing as much testosterone in your sixties as you were when you're 18. However, you can slow it down and definitely maintaining the healthy lifestyle besides the other benefits does keep your endocrine system in your hormones at at good healthy levels, especially for your age.

Dr. Heather Furnas (06:18):
So Dan, you know Daniel Craig is, you know, very masculine and, and Suzanne Somers very feminine, you know, 76 year old gorgeous actress. So we usually think of testosterone as a male hormone and estrogen as a female hormone. But do we have some of both?

Dr. Christopher Asandra (06:38):
Yes, I think wom women have both. And I think one of the key elements that sometimes gets overlooked is testosterone in women because that's really what provides you with the energy, the mental clarity, the lean muscle mass and the, you know, having a healthy libido on top of it. It's really one of the key hormones that's overlooked. And I think there's a stigma of, you know, you're going to become this like masculine bodybuilder if you do it, but it's really about just going to the right level so you're optimized and you're not have suffering from the side effects of it.

Dr. Josh Korman (07:08):
So why are some in pill form and others get injected? Can you take us through the process a little bit from an initial appointment through treatment and maintenance?

Dr. Christopher Asandra (07:21):
Yeah, so I think first and foremost it's important that people recognize some of their symptoms. Whether it's a woman going through menopause, for example, they may be having the hot flashes, the vaginal dryness, irritability, mood swings, restless nights, you know, they're waking up drenched. That's one of the first things you should try to look for in yourself. And then see your doctor or a specialist for it so that they can run some blood tests on you to see if you're truly deficient in those hormones. And if you are, they can be replaced safely. Now there's pill forms as you were mentioning, and there's injectables and we also have pellets. The pill form must be taken daily. And one thing to remember, when you take any type of hormone or pill, it must go through the liver. So a lot of times you have to worry about clotting factors, et cetera, if you're taking a pill because it does have first pass metabolism, meaning it goes through the liver to be filtered first, which can increase your clotting. The injectables tend to have less of that if you take it. And then the pellets are really the best form, which is subcu, subcutaneous, right into the fat hormone pellet bioidentical. And what that does is slowly release over a period of time and you don't get that first pass metabolism. So you don't, you have less risk of clotting, et cetera.

Dr. Heather Furnas (08:27):
And you can take estrogen by a patch. How about testosterone?

Dr. Christopher Asandra (08:33):
Absolutely. Testosterone can be given orally, transdermally or through the skin. It can be injected or it can be appellate as well. It's a matter of compliance sometimes with patients because sometimes they may think that they can't remember to put on their cream every day or maybe they, you know, take their injection every week. You know, did I take it last week? What day did I take it on? And so, you know, whether or not you have that discipline, it's a matter of compliance for a lot of these patients to, you know, help them feel the best they can.

Dr. Josh Korman (09:00):
So Dr. Asandra, I wanted to ask, go back one second to talk about blood levels and what are blood levels, the right blood levels or the correct blood levels for certain hormones? I know certain labs or certain physicians, for example with thyroid hormone, they'll give supplements when the levels may be a little bit lower than even though that the normal level they're in normal, but low normal. How does somebody figure that out?

Dr. Christopher Asandra (09:27):
Well, I think the first step is really listening to the patient. So a lot of times, you know, I always tell people levels are just a range. You know, they're taking this big subset of the population and they're saying whatever's in this range, you know, from here to here is considered normal. A lot of people, let's say for example, you said thyroid, you know, they only check a TSH sometimes, but really you need to see the active hormones like free T3, free T4 levels in the body determine if it's really working or not. So if you have this range and someone's at the bottom of the range, a lot of times doctors will say, you know what, you're normal, go home. But if they're telling me that they're actually symptomatic with their thyroid or testosterone, whatever it may be, being at the bottom of the reference range there may make them feel symptomatic.

(10:09)
So I like to put everybody at the top near, you know, middle the top range so that they overcome a lot of those symptoms. A lot of times, you know, ladies tell me, you know, they look at their testosterone levels after a pellet placement, they're like, oh my gosh, I'm off the charts here. Well yes, but if we just kept you in that range, it would not relieve the symptoms that you're having. You know, sometimes if they complain of low libido or energy and fatigue and you know they can't put on muscle, that's because just being in that range there, that window may not be optimized for them. And that's why it's important to listen to the patient and find out what symptoms they may be having so we can adjust it correctly.

Dr. Heather Furnas (10:46):
So we need to ask you about safety. Is Suzanne Somers taking a big risk as a 76 year old woman taking bioidentical hormones? We want to look and feel young but not at the risk of getting cancer.

Dr. Christopher Asandra (11:00):
Absolutely. So I think a lot of the stigma comes from the cancer when they were using back from the Women's health Initiative, when they're using a lot of the synthetic or the equine horse derived hormones, we all remember Premarin, which actually stands for pregnant mares urine. So they were getting it from horses urine and they were mass producing it that way and people were getting a lot of side effects from it that way. I think it's important that, you know, there needs to be a discussion with the patient about risk versus benefits, but also quality of life for a lot of these people. And then on top of that, to make sure that someone like Suzanne Somers has had her mammograms, had her pap smears yearly checkups with her OBGYN, to ensure that everything's in order and before you start this type of treatment. And then it's also monitored after that via blood, via regular mammograms and visits to your OBGYN and doctor just to monitor and make sure everything's safe. But I can tell you most people are, will take the quality of life that they feel over feeling symptomatic from the lack of hormones.

Dr. Josh Korman (11:55):
So tell us about peptides.

Dr. Christopher Asandra (11:58):
So peptides are actually a string of am amino acids that are strung together that tell the body to perform something. And that's why there's so many peptides, whether it be for fat loss, muscle gain, healing, the body arthritis, healing the gut, et cetera. It's really a string of amino acids that are strung together in a certain format that produces, will induce a response. For example, you know, we all heard about people doing HGH or human growth hormone before, but they've kind of moved away from that towards the peptides because one, it's a lot more affordable. And two, it's probably safer to use a peptides because you're telling your body to produce more growth hormone versus actually giving yourself growth hormone. So if people want to recover from injuries quicker, you know, they use peptides to signal the body to, hey, repair tendons, repair muscle quicker. Or you know, there's ones that heal your gut quicker. So they kind of elicit the body to produce a response based on the type of peptide we're using.

Dr. Josh Korman (12:54):
And are these also injectables or orals or both?

Dr. Christopher Asandra (12:58):
They're both. So a lot of peptides can be taken via oral that can be just what we call sublingual or under the tongue. So it's absorbed into the body a lot easier, but a lot of times it can be injected as well. And the injections tend to work a little bit faster, I feel, and, and people feel the effects a lot sooner than they would with an oral because sometimes you do have the first pass metabolism where the body's filtering out a pill or a sublingual troches as we call it.

Dr. Heather Furnas (13:23):
What's the range of peptides? You know, sort of the purpose of how many peptides do you have?

Dr. Christopher Asandra (13:29):
Oh gosh, <laugh>, there's probably, you know, 40 or 50 different ones. There's ones for neuro, neuro disorders, but I think the main ones that people like to use are the ones that are similar to growth hormone or ones that slow down the aging process by stimulating the body naturally to produce more growth hormone in the body so that you look younger, you feel younger, you know, you're not retaining as much fat, you're able to put on lean muscle and you sleep better too.

Dr. Josh Korman (13:54):
Can these peptides, I guess, convince the body to make more growth hormone in any age? Or is there some storage that you can't after certain age it's, it's harder?

Dr. Christopher Asandra (14:05):
It's probably harder in older people, I think elderly where, especially if they have, if they're unhealthy, but in general it, it does stimulate sometimes the pituitary or cells in the liver, et cetera, to produce more. I think as we get older, peptides may be less effective and I think those people are probably more of a candidate for actual hormone bioidentical hormone therapy instead.

Dr. Heather Furnas (14:26):
So is there an ideal age to start bioidentical hormones and peptides?

Dr. Christopher Asandra (14:32):
Really good question. I, I think it varies because I'm seeing it in a lot younger individuals now with my patients. You know, people that, you know, had covid, they're suffering from long covid. So these people, it somehow, and we don't know how yet it interfered with their, interrupted their endocrine system and their testosterone levels have never been the same since. And they're feeling fatigued. Some ladies are going into earlier menopause or some ladies may get surgical menopause where they've had a hysterectomy for whatever reason. And those people, you know, that could be at any age. And, and I think that subset of, of patients would benefit from hormone replacement therapy because otherwise they're going to be suffering from the effects of basically castration for, for a female. And that can be devastating for them, especially if they're in their, you know, early thirties or so.

Dr. Josh Korman (15:16):
So what are the costs and is any of this covered by insurance?

Dr. Christopher Asandra (15:22):
Well, you can always get the, sometimes it is covered, sometimes it's not covered. My practice, we don't take insurance because they, it's really hard to get reimbursed for this type of treatment. And a lot of times the insurance companies look at a hormone replacement therapy. It's almost elective as if you're having plastic surgery or some sort of elective aesthetic procedure because it is a quality of life issue. But the more we educate the public about it, I think it would become more accepted among that the cost can range vary. it really depends if you know how much labs you're checking, you know, but you're looking at a, a couple thousand at least a year for hormone replacement therapy. But, you know, most people tell me it's worth every penny because of the quality of life and the vitality that it gives them back overall.

Dr. Heather Furnas (16:03):
Yeah. In plastic surgery. And we deal with skin and so we can really see, particularly we do more women than men facelifts and and whatnot. And the, the skin thins and you can really see the impact with menopause. Somebody comes in before menopause, they come in after menopause, there, there can be a notice, really noticeable change. So, and then there's thinning of the hair. So even just quality of life that we think about in, in terms of hot flashes and whatnot, there are aesthetic concerns as well that can really, I think, impact your self-esteem and healing from injuries, from cuts, things like that.

Dr. Christopher Asandra (16:46):
Sure, absolutely. I think you're, you hit the nail, the collagen decreases as we age, et cetera. And I think sometimes the hormones help retain that a lot. But also kind of on that same line as, you know, a lot of you, me, you mentioned quality of life, but you know, the intimacy portion I think for patients is important with their partners. You know, when they lose that, and a lot of ladies have atrophy of the vaginal area, you know, they're unable to have intercourse with their loved ones. It, it has, it can be a devastating effect for the relationship as well, or men who have erectile dysfunction. So a lot of these things play a factor into considering whether or not, you know, hormone replacement therapy is right for you.

Dr. Josh Korman (17:21):
So when I search for a bioidentical hormone replacement in my web browser, lots of places near me popped up. How do you choose which one to go to?

Dr. Christopher Asandra (17:32):
Good question. I would, you know, personally, I think it's someone who has experience with this and it's been doing it for a long time and the best thing to do is really ask your friends, because I can guarantee you, you probably at least have one or two friends that are on the hormone therapy and have kind of done it themselves. So it's really important that you ask around, see who's an expert in this field, who's been experienced with this long enough and have been trained the right way to do it. And then it's also important to consider whether or not you'd feel comfortable with a pellet, a patch, a cream because you know, in certain practices they prefer one or over the other. So really look into that to see, you know, if they've been certified by the A4M or

Dr. Heather Furnas (18:08):
What is the A4M?

Dr. Christopher Asandra (18:10):
A4M is the American Academy of Anti-Aging Medicine. It's a really good place for start. We have a, you know, they've got, gosh, I want to say probably 50,000 physicians that are part of that network now that have kind of branched and, and from all different areas of medicine. But they really go back to the basics, biology and physiology kind of, you know, versus being so pharmaceutical driven, lifestyle changes, et cetera, that are really diet nutrition that are really important to us in, in that field. So really looking into it, I think asking around, especially women, your or men your age, I'm sure you can find somebody that's being treated right now. And you can also gauge, you know, how they look and how happy they are with, with their treatment.

Dr. Heather Furnas (18:48):
And we've talked about testosterone usage in women. Is there any place for estrogen in men?

Dr. Christopher Asandra (18:53):
Hmm. I think it's actually important to have estrogen in men. A lot of guys just think if you have estrogen, it's just bad for you because it's a female hormone. It's actually not true. It's really important for brain health, for mood osteoporosis, for bone health, et cetera. Now you don't want to be too high on the estrogen, but you also don't want to be too low on the estrogen because it actually helps. Like I've seen some patients come in who were mismanaged and they, the doctor just thought we should just not have any estrogen in you and these men suffering from osteoporosis now and memory issues. So it is important to control anytime you're on hormone replacement therapy for men you will get some estrogen. Usually get some estrogen elevation unless you're, you know, working out every day and burning it off. But it is important to also monitor and control and manage the estrogen levels in men, but probably never give estrogen to a man.

Dr. Josh Korman (19:45):
So this is all so fascinating. Obviously it encompasses so much more than we can talk about in just one episode. Is there anything else we should all know?

Dr. Christopher Asandra (19:57):
Yes, I think the biggest stigma kind of we touched on earlier is will it give cancer, et cetera. And the answer to that is really the biodentical should not give you cancer now if you already have it. If you have a high risk for it, then it's something you should discuss with your doctor and your hormone physician first for that. But overall, it's safe. It really is a matter of issue of quality of life for people. And it really has a profound impact on changing people's lives in a positive way, if it's managed and if it's done right.

Dr. Heather Furnas (20:25):
Great. Thank you, Chris. This has been a pleasure to have Dr. Christopher Asandra on Skintuition. This is Heather Furnas.

Dr. Josh Korman (20:35):
And I'm Josh Korman. Thanks for tuning in. We'll see you next time.

Dr. Christopher Asandra (20:39):
Thank you.