Speaker 1: Hello, this is the Itchy and Bitchy Podcast because being
itchy is bitchy and our medical system sucks. I'm doctor
Keith Nolica, a vetnary, allergist and dermatologist.
Speaker 2: And I'm Stephen Miller, a doctor of nursing practice and
a Q Care nurse practitioner.
Speaker 1: Send us your questions at ask at itch not dot com.
We love you, but we're not your doctors. The information
we discuss is not direct medical advice. Please talk to
your provider who is the expert on your care. The
Itchy and Bchi Podcast is sponsored by doc Itchy Medical
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send us a quest question at ask at itchnot dot com.
Thanks welcome back, and I hope this finds you well.
How are you doing, Doc?
Speaker 2: I'm good. I hope everyone's good. It's a rainy day
here in Knoxville.
Speaker 1: All right, So this episode is titled Menopause Science, the
hormone dumpster Fire and pituitary Chaos. Explain so simple even
a husband can understand, and that may sound a little derogatory,
but I realized after talking to Karen, who's taught me
so much, Thank you very much, Karen, and doing an
episode on menopause, that I actually didn't really understand menopause.
And I'm even a veterinarian. I did a master's which
turned out at Auburn University to be in endochronology, just
because that's what was their expertise. But so I thought
today that we would try to explain menopause and I
educate myself in the process. And one of the couple
other things that kind of stimulated this was my realization
that I didn't quite understand, and being embarrassed to tell
Karen that I didn't quite understand. And then I saw
this really great We try to be trendy and pay
attention to social trends, but there was this really cute
Facebook post with this teenage boy and his mom, and
the teenage boy was talking about I think this was
all AI generated, but if they were actors, kudos to you.
But the teenage boy was explaining how the mom was
going through cougar puberty, and so cougar is the slang
is for sort of a semi aggressive woman who's self
empowered and willing to date younger men and out and
about in the world. And so, but that really funny
thing was basically how menopause is like puberty, and I
started thinking that, you know, that actually is probably pretty accurate.
So we clinically talk about medical issues, and what we
deal with clinically predominantly is single hormone deficits, so like
low thyroid and then we do a thyroid test and
supplement the thyroid hormones.
Speaker 2: Is that correct, Stephen, Yeah, I mean in medicine we
do certainly hormone replacement therapy on many levels, not just
estrogen or progesterone, but things like thyroid hormone and testosterone
and that kind of thing.
Speaker 1: Yeah, So it's so clinically though, it's very much sort
of a single item kind of concept. So the way
the system works. And I really like Jesus for a
variety of reasons, but one of the reasons I like
Jesus is that he told a lot of stories and
parables to make things very simple, and so, like the
story of the mustard seed, a little bitty problem can
turn into a great big issue. And so that's kind
of where we're headed with this. So I'm going to
try to explain the whole pat tuitu a teary hormone
access in the frame of your toilet, And that sounds
really crazy. Hold sick with me, doc here, but and
you're gonna check fact check me as we go along.
But I think this will make sense even though it
sounds really really crazy. So there are a lot of
different terms and many many many names, and various hormones
and pre hormones that are involved in this. So they
have names like act H and TSH and prolactin and
all of these kinds of things. And if you want
us to do a whole episode on what the terms
mean and the actual names, we can do that send
this comment at ask at itchna dot com. But we're
going to ignore all the big words for now. So
the peturitary releases all of these hormones and then they
affect various glands in your body, your testicles, your ovaries,
your adrenal glands, and there's this big cycle. But the
way that it really works is kind of like your toilet.
So you have a toilet bowl and then a tank
of water which represents the hormones and so when you
flush your toilet, you get a surge of water, you
get a surge of hormones, and most of these are
on a circadian rhythm, So like when you sleep, a
lot of hormones get released to help kids grow and
help you your brain regenerate and all of these good things.
So daytime, nighttime, even seasonal in animals. So that's kind
of the water tank. But then when your hormones are low,
the pituitary gland in your brain, just a little BITDP
sized thing in the base of your brain release recognizes that.
So it's like the flute valve in your toilet that
the water goes down and it says, oh, we need
more water, and it the pituitary gland fills, turns on
and starts filling up the hormones, and so your brain
then sends signals to the glands the test testicles, ovaries,
adrenal glands to start producing more hormone and then there's
a negative feedback loop that the when the water gets
high enough, the float valve recognizes that and it turns off.
Speaker 2: Yeah, so the pituitary gland starts to produce stimulating hormones,
and that's the s in many are releasing hormones, so
they're pre hormones.
Speaker 1: That's Sh'S thyroid stimulating hormone and that comes from the petuitary.
Speaker 2: Yeah yeah, and so that technically is considered sort of
this feedback loop, and that's why it's called the petuitary axis.
Speaker 1: And so the body says we need more hormones, the
petuitary says, okay, well this is how you make more hormones,
and it goes and it says how to make the hormones,
and then the glands make more hormones. So but the
whole system very simple. So toilet more water, the petuitary
produces more water, you flesh, get the cycles. All of
that makes sense. Imagine if you have fifteen toilets all
lined up in a row and they're all interconnected, and
that's actually what the hormone system and petuitary gland is
doing in our bodies.
Speaker 2: Yes, So there's five different axes, and without getting too
thick in the weeds here, the thyed axis, the adrenal axis,
the gunadal axis, the growth hormone axis, and prolactin axis,
and all of those axes help control varying hormone levels
throughout the body.
Speaker 1: So what happens during menopause and why this is such
a crazy time, and why it actually is pretty fitting
to compare it to puberty. So this cougar puberty little
Facebook post actually was pretty clever. Is that menopause is
not like a program stop sign. So in animals, when
they cycle through estrus and fertility periods, it's a very
organized stop sign kind of event and then it can restart.
What menopause is is this chaotic, crazy situation where the
ovaries basically burn out and they stop producing the estrogen
and the progestine, which provide the negative feedback to the
pituitary gland, and so the pituitary gland goes crazy producing
all of these pre hormones, which then stimulate all of
the other glands in the body. And it's like you're
toilets overflowing and going crazy because the float valve is broken.
But in addition, it's all five of these access so
all fifteen toilets in are connected and it's all going crazy,
and it's this giant dumpster fire of hormone imbalance, and
the protuitary is trying to get the body to make more,
but the body doesn't have more to make and it's
just insane. So that's what menopause is. We're going to
take a break here and we're going to be back
and we're going to talk about the four other medical
conditions where the same kind of crazy dumpster fire and
hormone chaos can occur. So we'll be right back right,
we're back, and we're going to talk about the dumpster
fire of menopause. But actually there are four events that
happen in our lifetime that are similar where the peituitary
gland and the bodies glands like the testicles, ovariase, adrenal
glands are just totally going crazy. So menopause is one
we talked about that now it's not an organized stop sign,
it's just total pituitary hormone chaos. The other situations are
true puberty. So we've all most of us, I guess
listeners have gone through puberty, and we can remember we've
watched our teenagers go through puberty. And it's another one
of these times where the peturitary gland is secreting huge
amounts of hormones to get the body to do all
sorts of different things. So it's producing estrogen's progestins testosterone,
but it's also precing growth hormone. The prolactin controls the
circadian rhythms. We have cortisol levels that are being increased,
and so you can imagine all of these fifteen toilets
connected and the body is trying to regulate them to
get your body as a child to mature into an
adult and become sexually functional. So that's a really really
complex period and a lot of chaos going through and
it really is pretty similar to menopause. So if you
think about increased hair growth is happening, you think about
mucous membrane is changing, you think about skin pigment occurring,
skin thickness, flakiness, oil secretions in the skin, it's just
a turmoil. So the other couple of situations are sleep disorders.
So if you're not getting enough sleep, that's when a
lot of hormones are released and a lot of pituitary
activity happens due to the circadian rhythm, and prolactin may
regulate a lot of that.
Speaker 2: Yeah, so I think it's important to point out melatonin
is produced by the pineal gland, which is in the
center of the brain, and then the pituitary gland does
interact with melatonin in that it interacts with the circadian
rhythms and hormone influences sleep wake cycles, which is influenced
by growth hormone actchtsaging the gonadotropins. So there is definite
interaction between the pituitary gland and melatonin that's produced by
the pineal gland.
Speaker 1: And that's why you'll hear a lot about taking melatonin
to improve sleep, which then improves hormone balance. And we
have a condition in dogs called geriatric hormone imbalance that
has melotonin sensitivity, and so melatonin can help sort of
stabilize a lot of these hormone axes. It doesn't really
replace deficient hormones, but it just makes the whole system
kind of wake up and function a little bit more normally.
And then the fourth one is aging. So as we age,
all of our hormones tend to change. And part of
that is like with menopause, where they max, the ovaries
may burn out and not be able to produce the hormones,
which messes up the whole feedback loop and the pituitary
gland goes crazy. But all of the hormones tend to
kind of slow down as we age, and that causes
a lot of dysregulation, and that's starting to be recognized
now in dogs with this geriatric hormone imbalance that responds
to melatonin every evening. So it's kind of this weird
rejuvenating kind of effect that we see in dogs. Is
that happening in people where older people are responding to
melatonin beneficially?
Speaker 2: Yeah, they do, and certainly there are certain forms of it,
and there's a lot of science that has gone into
levels of oral melatonin that people should and should not take.
So I always encourage people to discuss these issues with
their provider.
Speaker 1: Yeah, we are not your doctors. Please talk to your provider.
So that's sort of the controversy between high dose melatonin
and low dose melatonin. We use high dose melatonin, but
they can't tell us if they're uncomfortable or have insomnia
or a variety of things like that. So humans may
be much more sensitive to some of the side effects.
The nice thing about melatonin is that there's really not
a toxic dose in dogs at least. Definitely check with
your provider about the human issues if you're going to
take any supplements. Again, we're not your doctors. So we're
going to take a break here and we'll be back
and talk about some of the treatments that we can
do for these disorders. Again, the four big disorders we
talked about, menopauses the starting place for this chaos of
fifteen toilets all interconnected that are overflowing, and that's the
pituitary gland and the body's glands. And then we have
real puberty and teenagers, we have aging and sleep disorders.
So we'll be back in a second and I'll talk
about what maybe we can do about some of those.
All right, we're back, and I hope you're still with us.
So we're going to talk about some possible easy therapies.
Really nothing prescription at this point, although Stephen may want
to add some things. But so, the four disorders that
cause the fifteen toilets to overflow in the pituitary hormone
axis dumpster fire are menopause, puberty, aging, and sleep disorders.
So what do you want to talk about first?
Speaker 2: Yeah, I mean we can we can address the sleep
disorder pee certainly. I think sleep apnea contributes to so
many issues, including heart a rhythmias and many cardiovascular issues
as well as aging. Sleep's very important for our bodies
to heal, and so I think it's important for people
to have a sleep regimen that's been set for, like
this sleep hygiene which we've talked about in another episode,
where people begin to prepare for sleep at nine, turn
off stimulants, turn off their computers and their iPhones, and
turn the lights down in the house.
Speaker 1: And I think if there's one single thing that I
could say makes a huge difference having kids and teenagers
and even with myself, is really get rid of the
smartphone and the tablet, Like having those in the bedroom
really affects your sleep and sort of this scheduled relaxation
process getting ready to go to sleep is also really important.
And part of that needs to be to get rid
of the smart devices and get off of social media
and stop dooms growing and brain rot and get your
body ready to have a good night sleep.
Speaker 2: Yeah, I mean, I think it is vital to avoid
caffeine and stimulants after about five pm.
Speaker 1: Any chocolate or any caffeine after four pm.
Speaker 2: Yeah zero, and sort of get the body prepared for sleep.
So I think that's the sleep hygiene piece. Making sure
that your bedrooms put together in a way that's conducive
to quietness and peacefulness and darkness.
Speaker 1: So how much do you think melatonin helps? So? And
dogs melatonin really doesn't seem to make them sleepy at all,
but they sleep twenty hours a day, so it's hard
to know. Does melatonin actually help sleep in people or
is it working in a different.
Speaker 2: No, it helps people sleep and certain the issue is
and there are lots of issues around melatonin. A lot
of people overplace their melatonin, which then suppresses their internal
production of melotone.
Speaker 1: What do you mean overplaced?
Speaker 2: Taking thirty milligrams of melatonin at night as opposed to
starting off with lower doses that would just stimulate melatonin
production in your body, and so you can suppress melatonin
production and then that.
Speaker 1: Causes issues as well.
Speaker 2: You have to retrain your body to sort of get
all that worked out. So, but melatonin is very effective.
I think people historically have either taken too little or
taken too much and not had good results based upon
their lack of knowledge around melatonin utilizations.
Speaker 1: Okay, so definitely talk to your provider about that. Also,
sleep apnea, that's something that you would talk to your
provider and get a sleep study and medically. You know,
people can die with sleep apnea, so that can be
a really serious medical issue.
Speaker 2: Well, and I think too people believe sleep apnea is
only obstructive sleep apnea, and I think it's important to
sort of help our audience understand that they're varying forms
of sleep apnea that are treated very differently. So some
folks have central sleep apnea.
Speaker 1: Which is like a brain neurologic nerve.
Speaker 2: Yeah, So I mean, I think it's really really important
that if you have symptoms of sleep apnea. There there's
a screening tool called the stop bang which you can
find anywhere online and take it and if you achieve
certain number of points on that, then certainly consulting with
your provider to get a sleep evaluation.
Speaker 1: Okay. Aging also kind of relates, So as we age
with a sleep app near you're typically we gain weight.
At least I've gained a fair amount of weight, and
so you know that may be part of the issue.
But as we age, all of our hormones tend to
slowly decrease, and it's almost just kind of like the
body's wearing out. But it also relates to other things.
So as we age, we stop exercising as much, we
don't move around as much, we become more sedentary, we
definitely can gain weight, and our whole metabolism, fatty liver syndrome,
a lot of those things can happen as well. And then,
like I said, in the dogs, we're recognizing this geriatric
hormone imbalance that we don't really have a specific disorder,
but we give a melotone and they seem to kind
of rejuvenate a little bit. So what would be some
simple aging things exerc mobile.
Speaker 2: So in humans, the reduction of growth hormone is kind
of referred to as somematopause, sort of like menopause, but somematopause.
Speaker 1: Somatotropin is like growth hormone, and.
Speaker 2: So somatopause which is decreasing growth hormone and IGF it
leads to things like reduction in muscle mass, increasing body fat,
low energy, decreased bone density, and reduced exercise tolerance.
Speaker 1: And that sounds like aging.
Speaker 2: It sounds like aging because it is aging, and so
certainly there are many things we can do to offset that,
like exercise, a routine exercise regimen, you know, five to
seven days a week. If some form of aerobic and
muscle resistance training.
Speaker 1: Get up and Move. Used to do this Facebook post
where it was get up and Move. It was even
just parking at the end of the parking lot so
you would walk more steps.
Speaker 2: Yeah, so I did that in an effort to encourage people,
for the patients and friends to continue to push it.
Even though you're tired, you need to move, and so
daily ways to incorporate more movement would be to part
further away from the building, take the steps instead of
the elevator, you know, lifting objects to use your upper
body muscles.
Speaker 1: Certainly, I think even simple nutrition can play a big role.
So as we get older and exercise less gain weight
than just better nutrition pain attention to it. Yes, what
we're putting in our.
Speaker 2: Bodies low fat and then certainly higher protein intakes. So
in order for our bodies to build muscle, we need
good protein intake, and so protein really becomes vital to
us as we age.
Speaker 1: All right, So the other issues are than puberty, and
there's not much that we can actually do to help
puberty other than get through it. But definitely mental health
is important during puberty. So it's a crazy time young people,
you know, they're not wise and worldly like some of
this older people, and so you know, understanding counseling, but
also for them, you know, make sure that they're having
really good sleep, that they're prepared for sleep, get rid
of those iPads and smartphones, you know, really even prepare them.
With my daughter, we were really good about trying to
set up a pre bedtime sort of events, even starting
as a young child, with that continued into her teenage years,
sort of getting this relaxation schedule, getting ready to go
to sleep. So that can be really important for teenagers.
Speaker 2: Yeah, and then on the other end of the spectrum,
you've got things as we human beings age, you get
a reductions in LH and FSAH, the gonautotropic hormones, and
so then people suffer side effects from rectile dysfunction, infertility,
low energy level, and so certainly there are some HRT
options for those things as we as we get.
Speaker 1: Also hormone replacement therapy. So that's more of the menopause,
which is the next kind of section, the last of
the four. So in menopause again it's that the big
problem is not just that you run out of estrogen,
but that you run out of estrogen progesterones LHFSH and
then that signals the pituitary to produce more pre hormones
and the whole system goes crazy, so your fifteen toilets
start overflowing. So some of the therapies for that is
one just recognizing that this isn't just a behavioral mental
disorder of older women. That's kind of where a lot
of medicine used to be for way too long, and
so now with hormone replacement therapy, it really can help
to just provide some of the hormones like estrogen that
reverse some of these negative symptoms like mucous membran drying,
some of the sleep disorders, erectile dysfunctions as men age
and have kind of the menopause man version that can
happen as well. But what else could women do with menopause.
Speaker 2: That would be well, I mean, I certainly think that
Karen Nicol, who initiated this podcast years ago, would be
the expert and certainly has had many episodes on HRT
and of course on HRT.
Speaker 1: So she has two hundred and seventeen episodes and they're
all at the website which is Itchy andbitchi dot com
So if you want to hear the expert actually talk
in an expertise rather than a toilet metaphor or parable,
that's your source.
Speaker 2: Yeah, when it comes to hormone replacement therapy, it is
such a complex topic, a complex treatment plan and individualized
treatment plan, and certainly I think, can you know, having
consultation with an expert talk just in hormones becomes something
that I think is extremely beneficial.
Speaker 1: Okay, we're going to take another break, and when we
come back, we're going to do our legit or bullshit section,
So we're going to be talking about microplastics. Stick with us,
all right, we're back, and this is the legit or
bullshit section where we have some interesting medical science facts
and we try to determine if this is something that's
real or if this is really just insane. So are
you ready, doctor Miller? Yeah, okay, So here we go.
So this is about microplastics. So this actually topic came
up again. We try to be trendy and stick with
the times here. So we were at a dinner event
with our dearest friends. I'll leave all the names out,
but you know who you are, and they are very smart, educated,
curious people, and it turns out that one of our
guy friends a straight guy, which will become important in
the future in the story, but was horrified to learn
during the day that microplastics were found in penile tissue
in men. So is that real? Stock?
Speaker 2: It is? It is, and certainly, you know, we are
learning more and more there's emerging research and emerging data
on this particular target topic. There was a twenty twenty
four study that was done looking at microplastics in the
tissue of men undergoing surgery for a rectile dysfunction. Okay, well,
they found polyethylene, tetraphalite, and polypropylene in erectile tissue. And
so microplastics or nanoplastics can enter the body through food
and water, air inhalation, packaging material, synthetic fibers, and in
very very tiny particles nanoplastics they enter through the intestinal barriers,
the lung tissues, and so that's leak like that.
Speaker 1: Kind of situation, which we'll have other episodes on. So
what I found really funny about the story, just to
kind of give you the details, is that all of
the straight men, so we're two gay men here, and
I think that kind of made things on our side
a little bit less panicky, but anyway, they were horrified
that they may have microplastics in their penis, let alone
that they've been found in placentas and female ovaries and
brain tissue. But for some reason this penile microplastic thing.
The whole evening revolved around the horrible finding of microplastics
in their penis.
Speaker 2: So that was just I do want to make sure
the audience understands these are emerging evidence. These are not
huge randomness trials. So it's important to know that the
current clinical evidence is based upon very small studies. Small
sample size. Detection methods are not consistent. They vary what
is considered normal.
Speaker 1: We don't know. So, doctor Miller, what organ has the
highest And I don't want you to look this up
before I ask you? So what organ in the body
has been identified to have the highest micro plastic So
I'm going to give you some options. So is it
the penis or the placenta which I mentioned before? Would
it be the kidney, the liver, or the brain? So
you have several options there. What do you think I
would pick the liver? Yeah, and that makes sense because
the liver normally filters out toxins and does a lot
of really good stuff for us, the cytochrome P four
fifty enzyme pathway, all of that really good stuff. It
turns out it's the brain. The brain has twenty times
more level of microplastic than the liver or the kidney.
So that's you know, again, this comes back to our
dear friend that was really worried about the microplastic and
their penis rather than their brain, and their brain has
twenty times more. So I think Karen would appreciate the
sarcasm in that that the men would of course be
worried about their sexual organs more than their neurologic cognitive organs. Yeah.
So then the last question here is there's all sorts
of craziness and part of this whole discussion about having
microplastics in your organs and your penis specifically is oh
my gosh, what is it going to do? Is my
junk going to fall off? And so does do these
microplastics cause disorders like dementia, a rectile dysfunction, inflammation in
the body.
Speaker 2: So again, as I said earlier, the issue comes down
to we're not sure because the studies are not consistent.
There's small sample size in this that We're not sure
what the clinical outcome becomes, but we do know that
these microplastics are plastics cause things like oxidative stress and
inflammation and that type of thing. So there may be
some correlation with autoimmune issues or whatever. We just don't
really know.
Speaker 1: And this gets back to previous discussions we've had about
the medical system with causation versus correlation, that just because
we have some plastics in our brain and penis doesn't
absolutely mean that they cause disease, and so we do
need more studies, We need more information. And it sounds
horrible to have plastics in your body. I think we
all don't want plastics in our body. But it's also
wrong to assume that they're immediately going to kill us
based on a TikTok, Facebook or social media post as well.
Speaker 2: I think we need a valid evidence that's been peer
reviewed and you know, sample size bigger to represent represent
population impact and that sort of thing.
Speaker 1: So I would say this microplastic thing is both legit
and bullshit. So it's a mixture of both. What do
you think.
Speaker 2: I don't know that I would call it bullshit. I
think I think it's it could be legit. It's it's
still sort of questionable what what we know it's there,
so again it comes down to what what's the clinical impact?
Speaker 1: All right, So that ends this podcast and thank you
guys for sticking around and listening to us. Please click
that follow button and we really really do like some questions,
so email us at the ask at itchnot dot com. Thanks,
stay well and goodbye. Thank you for joining us. This
is the Itchy and Itchy podcast and please click that
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itchnot dot com. Thanks