By: Mari Salazar, PA, MMS

Patient education. We all know it’s important, we’d like to do more of it, but it’s time consuming and, frankly, some of us aren’t good at it. Some patients like a lot of it, while some patients feel overwhelmed and are turned off. And when you add to this the fact that we are asking for saliva, blood, urine, stool and money, it’s no surprise patients may feel that this type of medicine is not for them and decide to just double up on their antidepressants!

I ask myself “what is my job here, with THIS particular patient?”, and the answer is always –help them feel better physically, mentally, and emotionally. This almost never works when we overwhelm them with information that is confusing without actionable steps for improvement.

So, what I’ve learned after a lot of trial and error is to not over-do it with labs in the beginning. Order what will give the most valuable and actionable information first. Let the patient see the value in the tests you pick and how much better they feel with the treatment plan you customized based on those labs and symptom profile they present with.

Physician’s Lab 24 Hour Urinary Metabolite test is one of the labs with the most valuable information I do on my patients. But we’ve all heard, “I went to another office for hormones and I didn’t have to do this urine test!”  How do we overcome this push back?  Here is one of my little scripts…..

“We are optimizing your hormones so that you feel better physically, mentally, and emotionally not to mention improve the way you age. We want to do this responsibly because all these hormones need to get broken-down/metabolized. Some of us do this well, and some of us don’t. Certain things happen when we don’t metabolize our hormones well. It could be the reason you don’t feel as great as your friends do on BHRT, and it could even give us an idea of how at-risk you are for breast, uterine, ovarian, or prostate cancer.

The beauty of this is that even if you are an at-risk person, there are certain things we can do to make us healthier metabolizers and not only reduce our risk of certain cancers, but make your experience with BHRT an amazing one.”


Good Metabolizers

  • – Prevents bone loss
  • – Natural antidepressant
  • – Improves insulin sensitivity
  • – Decreases fatigue
  • – Maintains elasticity in arteries
  • – Increases skin collagen
  • – Prevents Alzheimer’s disease
  • – Reduces cataracts
  • – Maintains memory
  • – Works as an antioxidant

Bad Metabolizers

  • – Menopausal symptoms
  • – PMS
  • – Heavy bleeding
  • – Tender breasts
  • – Cancers: Prostate/Breast/Ovarian/Uterine

So, when I see that a particular patient is not metabolizing their estrogens down the healthier 2-OH pathway, here are some general changes in lifestyle that should be implemented.

1. Decrease exposure to fake estrogens (xenoestrogens).

Avoiding all of these is impossible, but being aware of those we can avoid can make a huge impact on your health. Read your labels! Ingredients to stay away from as much as possible:

(EWG.org makes picking products easier without having to read labels)

  • – DEA (DIETHANOLAMINE), MEA (MONOETHANOLAMINE), TEA (TRIETHANOLAMINE)
  • – PARABANS PRESERVATIVES (METHYL, PRPOYL, BUTYL, ISOBUTYL, and  ETHYL)
  • – MINERAL OIL: PETROLATUM, PETROLEUM JELLY (LIQUID PARAFFINUM, PARAFFIN OIL, PARAFFIN WAX, POSH MINERAL OIL)
  • – PROPYLENE GLYCOL/ BUTYLENE GLYCOL
  • – SILICONE DERIVED EMMOLIENTS (DIMETHICONE, DIMETHICONE COPOLYOL, CYCLOMETHICONE)
  • – TALC
  • – DIBUTYL PHTHALATE
  • – 1,4-DIOXANE
  • – BHT (BUTILATED HYDROXYTOLUENE), BHA (BUTILATED HYDROXYANISOLE)
  • – BENZALKONIUM CHLORIDE and BENZETHONIUM CHLORIDE
  • – TRICLOSAN and TRICLOCARBAN
  • – PARFUM
  • – Air fresheners, deodorizers, fabric softeners, scented candles, body perfumes
  • – Fabric detergents, dishwashing detergents, clothing softeners, clothing, cosmetic and personal care products

2. Promote detoxification

  • – We detox through foods, supplements, exercise, and sleep!
  • – Fresh, whole, unprocessed, organic, colorful, HIGH FIBER, nuts, seeds, omega 3’s, herbs, fermented products, cabbage, cauliflower, broccoli, high fish consumption (Sardines)
  • – Soluble fiber and low glycemic load
  • – Increase green leafy vegetables (10-12 servings)
  • – Green tea
  • – Berries
  • – Flax
  • – Chia seeds

3. Enhance elimination (poop)

  • Daily bowel movements are essential. We rid our bodies of estrogens when we poop. If you’re constipated, you’ll actually reabsorb the estrogen that was supposed to be eliminated, and it gets circulated again throughout the body, causing more havoc.

4. Decrease insulin stimulation

  • This means you should eliminate sugars and processed carbs, as well as reduce the frequency of eating. Every time we put something in our mouths, we spike insulin. If we strive to eat 3 (ideally 2) meals a day with no snacking in between, we will stabilize and lower our insulin leading to fat loss and better hormones.

5. Targeted supplementation: Based on individual labs and symptoms

  • – Reduced glutathione
  • – NAC
  • – Lipoic acid
  • – Whey protein
  • – Magnesium
  • – Vitamin C
  • – Silymarin
  • – Pantothenic acid
  • – SAMe
  • – DHEA
  • – DIM
  • – Vitamins Bs 6,9,12

6. Lifestyle modifications

  • Stress management: healthy levels of cortisol will keep your hormones at happier levels, as well as allow weight loss and detoxification. Stress needs to be managed. Make it a priority. Go out in nature, get natural sunlight, yoga, meditation, exercise, sleep.

7. Address digestion

  • Optimize gut health with the 5 R program

8. Exercise/movement

  • We know all the benefits of exercise. Get on a routine that works for you and stick to it. Our lives are more sedentary than what we were made for. You need to move for proper muscle mass as well as lymphatic flow (which keeps you healthy and helps prevent cancer)! High intensity Interval Training (HIT) is what we recommend.

9. Sleep

  • Improve your sleep habits! All of the effort made to eat the right things and exercise will not pay off unless you get good quality sleep.  This means get in bed earlier, use blue-light-blocking glasses if you’ll be on your phone or watching TV, do not eat right before bed, put cell phone on airplane mode or keep out of the room (EMFs), and bedroom should be as dark as possible (lights from TV, phone, and window interfere with your production of melatonin, which is needed for healthy sleep).

10. Mind-body-spirit connection

  • Whatever your spiritual practice is, make sure you have reconnected and aligned with that.

11. Support

  • We are social beings. Connection with friends and family is of utmost importance in a world where we have replaced the rewards of real relationships (the “reward” I am talking about is actually production of feel good hormones that connection and touch provide) with social media. Put your phones down and reconnect with those you care about.