HHS 19 | Hormone Truths

 

A number of people blame every issue on their hormones. However, how much do we really know about it? Nurse practitioner Chelsea Hoese talks hormone truths while sharing the wonders of being in her profession. Chelsea discusses where to go for lab tests when you have fatigue, low energy, low libido, or low sex drive. She also talks about putting patients on hormones as well as the right lifestyle and nutrition. Covering SHBG or the sex hormone binding globulin, pregnenolone, and DMI, Chelsea discusses how much these things become health factors, and gives some advice on how you can find the right hormone doctor for you.

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Hormone Truths with Nurse Practitioner Chelsea Hoese

I’ve got one of my favorite guests because she works with the doctors in our office and she’s a nurse practitioner. Her name is Chelsea Hoese. She’s going to tell us all about the wonders of what a nurse practitioner does and how she became a holistic minded nurse practitioner. We’ll share some stories about her father as well and her father’s transformation. From what I know of her dad Ian, if Ian can make the transformation, anybody can. If I myself can make the transformation from eating deep dish pizza, Italian beef sandwiches, hotdogs in Chicago, drinking too much alcohol along with the toxic cardiology lifestyle, anybody can. Welcome, Chelsea. What’s happening?

Thank you for having me.

You’ve been working with us. We’ve known each other for a few years. Patients are loving working with you. I don’t know if you would call yourself a hormone specialist. I would call you a hormone specialist, male and female hormones. We’ve got a lot of people of course that are coming to you specifically for that but maybe dial us in a little bit. Who is Chelsea Hoese and how did she become a nurse and nurse practitioner?

I became a nurse back in 2009 and I worked in the ER setting. A lot of sick people would come through and I started realizing that these people were not getting better. The same patients were coming over and over again and getting admitted to the hospital for the same issues. I noticed there was really no education on diet, lifestyle, and exercise even for that matter. I was always drawn to more of the natural approach. Before I was even in nursing school, I used to follow Dr. Mercola and read his articles all the time. I was always into that aspect of it. I got sick and tired of taking doctor’s orders and I wanted to make a larger impact. I went back to NP school and I actually worked in conventional for my first year. I was trained on bioidentical hormones by one of the specialists in the area. I do love hormones and I would consider myself pretty specialized. I wanted to step even beyond hormones, more of the total body holistic approach and dive into cholesterol issues, blood sugar issues, autoimmune disorders, and thyroid problems. I take a look at the whole body instead of focus on the hormones.

Whenever I think about nurses, I get such a warm feeling inside. Nurses are such great people. They have no ulterior motive. There’s nothing that they’re concerned about, as far as saving the hospital money or getting the patients out as fast as possible. They only want to care for the patient. They only want the best care of the patient. I learned that right from the get-go when I was in medical school. I’m an intern, resident, cardiology fellow and I’ve always had such a strong relationship with the nurses. To me, whenever someone says, “I see a nurse practitioner,” I always know that they’re in good hands because they’re not trying to get the person out the door as fast as possible. They’re not trying to write the script as quickly as possible. They’re not influenced by big pharma dollars. They want what’s best.

HHS 19 | Hormone Truths

Hormone Truths: If the SHBG is high, then it is binding with all of the testosterone and making it unavailable.

 

You’ve taken that to another level. You’re sitting there in the emergency room and the doctors are barking out orders. Half of them you disagree with and the other half you’re like, “There’s a better way.” I could feel your frustration because I had the same frustrations as well. To come over in the natural side has been miraculous. When someone comes to you and they have fatigue, low energy, low libido, low sex drive, where do you go? Where do you go right off the bat as far as lab testing? What are the important lab tests we need to know with these people?

I would obviously draw their hormones and I’m not looking just at estrogen, progesterone, and testosterone. I’m also looking at the sex hormone binding globulin and thyroid because that all plays into it. I’m looking at inflammation markers. I’m looking at their cholesterol, are they on a statin which is going to block all of the sex hormones. It’s what’s literally needed at the top of the pathway for your body to make its hormones. That’s getting blocked in a lot of patients. I’m looking at micronutrient tests. There are certain vitamins and nutrients that are needed for the body to produce testosterone. I’m looking at cortisone marker.

Sometimes patients are in adrenal fatigue, especially with men. When cortisone goes up, the testosterone goes down. That’s where I’ve moved from doing bioidentical hormones. There are a lot of providers out there that’ll, “Low testosterone, let’s pitch to you on bioidentical testosterone.” Sometimes that is a good option but first I want to try and figure out why. Why does this male in his late 30s, early 40s have low testosterone? That’s not normal. I’m taking a look at the bigger picture and trying to always fix the underlying cause.

There are so many these docs in a box places and a nurse practitioner is even that. Once again, “The testosterone’s low. Here it is. You went through menopause and you’re having all these different symptoms. Here are your hormones, whether they’re synthetic or bioidenticals.” They’re not going after the causation. I like that about you as far as what your approach is. It should be every practitioner’s approach, MD, DO, Nurse Practitioner, no matter what specialty you’re in to always go after the cause. If the hormones are off-balance, why? If they’re extremely out of whack, like say a male with a testosterone level of under 100, we probably want to start with that person on some form of therapy as soon as possible. They’re in a danger zone, whether it’s physical but certainly mental.

We ask questions as we go along, as we try and minimize the dosing. For those people that are borderline, that’s where we go after the cause. We look at things like the sleep and we look at the sunshine exposure. We look at the diet, we look at additional pharmaceuticals and we look at all these other factors in their life. I certainly applaud that for you and what you’re doing. How do people feel though? Let’s say they’re feeling down and out, we’re addressing all the cause, we’re putting on the right lifestyle and the right nutrition and we put them on hormones. What are the stories you’re getting from these men and women?

If you can make the transformation, anybody can. Click To Tweet

They’re reporting that they’ll feel a lot better. For men, for example, the classic one is low libido but oftentimes they’ll be misdiagnosed with depression and be put on an SSRI and then they feel worse. Oftentimes, they’re feeling a lot better right away mentally, emotionally, motivation-wise, their mood, their energy, their libido, their overall outlook on life. They feel a lot better for women. When they’re going through menopause sometimes it hits them hard right away. They don’t even feel like themselves. Like, “I feel legitimately crazy.” My husband says, “I’m not myself, super snappy, irritable, depressed, I don’t enjoy anything.” They’ll notice that benefit usually within a couple of weeks. It’s like a complete 180, they feel so much better. That would be the normal outcome.

It’s pretty rewarding for us obviously to get into this space and when people are so down and out. They were labeled with depression and no one ever checked the hormones. They were put on pharmaceuticals without any improvements. Somebody can also be told that their hormones are in the normal range yet they may not be normal for the individual person. We used to say one male’s testosterone level could be 500 or 700. We’ve got to find the perfect level for each person. You mentioned before the sex hormone binding globulin. What is that and how has that affected?

SHBG will bind with your testosterone. It binds with a lot in the sex hormones but for men, in particular, may have a normal total testosterone level. Most conventional providers are only checking total testosterone. They’re not looking at your free testosterone. They’ll have plenty available but then when we looked at their free testosterone, that’ll be low. If the sex hormone binding globulin is high as well, then that means that that’s binding with all of the testosterone and making it unavailable. By lowering sex hormone binding globulin, which can be done.

One of my favorite ways too and they talk about intermittent fasting. It can free up that SHBG. Overall and I know you find this as well when you follow the healthy lifestyle and maybe we do some strategies to clean out the liver a little bit, that a lot of that stuff goes down. The doctors aren’t checking the SHBG. What about SHBG as far as binding up testosterone in women? How much is that a factor?

It’s as much of a factor in women as it is for men for sure. Sometimes the SHBG will go up in women from being on thyroid medication or from being on oral estrogen. There’s a fine balance between them. Sometimes we have to lower the estrogen medication a little bit or they’re creating their bioidentical estrogen cream. We’ll have to lower that a little bit sometimes in order to free up more of the testosterone. There’s definitely a fine balance between them all. A lot of people are being put just on one type of estrogen but they all need to be balanced together with the testosterone, DHEA, the estrogen. They’re supposed to be a nice balance of each other along with the thyroid.

HHS 19 | Hormone Truths

Hormone Truths: One woman may have hormone levels of zero and feel fine, whereas another woman won’t.

 

What about pregnenolone? Is that a factor? Do you have any experience working with pregnenolone?

Pregnenolone is literally the first thing after cholesterol. Cholesterol is at the top that’s needed to turn into pregnenolone. Pregnenolone will literally convert all the way down into all the hormones. Pregnenolone is good to use to let the body do what it means to. It will convert it into a little bit of estrogen, a little bit of testosterone, a little bit of DHEA. Unlike estrogen and testosterone where there’s a very fine line between too little and too much, you don’t have those issues with the pregnenolone.

If somebody thinks maybe their hormones are an issue, how do they find a good hormone doctor? How do they avoid that doc in the box, who puts up a sign that says, “You’re a man with low libido, come on and get testosterone injections,” or “You’re a woman who’s got depression, anxiety, stress. Let’s cure it all once. Let’s put you immediately on bioidenticals?” How do we find the right practitioner to work with?

Someone who’s been trained in bioidentical hormones is important. You definitely don’t want to be put on the synthetic hormones. Those cause a whole bunch of problems and that’s actually why hormones have a bad name is from the synthetic hormones. They had to stop a study of about 5,000 women. They had to stop it because it was causing so much cardiovascular events and cancer. Bioidentical hormones got lumped in with them as well but bioidentical hormones, the body recognizes them the same as they would their own hormones. We know our own hormones don’t cause all those issues, otherwise, women in their twenties and men in their twenties would be running around having all these events. Someone who specializes in bioidentical BHRT, definitely naturopath functional medicine providers and advocating for yourself and saying, “What kind of tests are you guys looking at? Are you just looking at testosterone and estrogen? Are you going to look at my nutrient status? Are you going to look at my gut health? Are you going to look at my cortisol?” It’s almost like you’re interviewing them to find out what’s their process for treating you.

I know obviously when people come out to see you, you run through the whole gamut. You talk about nutrition, sunshine, sleep, we work hard to get people off of pharmaceuticals, statin drugs or other pharmaceuticals that are inhibiting the natural function of the body. All of these drugs, they’re all inhibitors like statins are inhibitors of the HMG-CoA reductase enzyme, ACE inhibitors, angiotensin receptor blockers, H2 blockers, proton pump inhibitors. It’s all inhibiting or blocking some critical necessary function in the body. We work to get people off of those pharmaceuticals and using the most advanced testing in the world to look at their overall nutritional status, looking at leaky guts, looking at markers of inflammation, addressing their teeth, recommending that people get a functional bodywork. People are under the care of a doctor of chiropractic. All these things that we do and we get tremendous success. At the end of the day, if their hormones are not perfect, I know we both agreed that that is a place for hormones. What about some of these doctors they’ll think, “No, every woman who is postmenopausal needs to be on hormones.” What would you say to one of those people?

How you’re feeling tells the whole picture. It lets you know if your body is functioning properly or not. Click To Tweet

I would say that it’s a case by case process. There is a benefit to our hormones. They are very protective to us but one woman may have hormone levels of zero and feel fine, whereas another woman won’t. We’re living longer and longer. We need to replace those hormones in order to protect us from chronic diseases. I wouldn’t say that’s necessarily true because the body has a good ability to adapt. A lot of stuff with hormones goes back to how you were feeling. How you’re feeling tells the whole picture. It lets you know if your body is functioning properly or not.

That whole point is that people often think that our ancestors all died when they were 50. The answer is actually that’s very far from the truth. Our prehistoric ancestors lived a very long life. Once you started moving into modern societies, modern food, modern civilization, there was a lot of sicknesses and lead to people to die at an earlier age. Even then, a lot of people lived into older age. If you’re a 50-year-old woman going through menopause and now you’ve got an extra 30, 40 years of your life. I’ve done this without the use of hormones, to me that stands to reason that all women don’t need hormones. My mother is 74 years old and she’s not on hormone therapy and feels fantastic. Why do so many people think it’s always better living with hormone therapy?

I’m not sure. They’ll hear, “So and so went on testosterone and he feels great.” I’ve had patients come to me and they say, “My friend told me it was awesome. I got to get on it.” I said, “What kind of symptoms were you having?” “None, I felt fine.” Why is somebody putting you on something when you don’t even have a clinical indication for it?

Especially some of these younger guys too. I guess anybody would say your normal is above 350 and that’s the total testosterone. There should be a good range of free testosterone as well. We both seen men who were put on testosterone, had no symptoms whatsoever, yet their levels were a little bit low for conventional testing and now they’re stuck on testosterone. How do we get these men off the testosterone if they never needed it in the first place?

Typically, I tell them to stop taking it and I’ll supplement them with DHEA and some DIM because DHEA is another male hormone but it’s also an adrenal hormone. It helps to balance the adrenals and keep your stress hormone cortisol down. I’ll put them on that and then I’ll put them on another supplement that helps to healthy conversions into the good estrogens instead of into the bad ones or to prevent it from dihydrotestosterone, which is one of the bad testosterones. I typically have them stop right away. I’ve never had to taper somebody off and that’s something that I’m concerned about. If it was a young male, then I would be more concerned because we’re trying to figure out why they’re not making it, as opposed to an older man who’s already used to having a little bit lower levels and feels fine.

HHS 19 | Hormone Truths

Hormone Truths: If you are looking for a holistic practitioner, find a health coach first.

 

You mentioned DIM. Tell me what DIM is and why would somebody want to use it? Why would someone be taking DIM and what’s its function?

Anybody who I have on hormones, even pregnanolone or DHA, I have them on that, in order to prevent the conversion into the bad testosterone and the bad estrogen, which are cancer causing. I believe it comes from cruciferous vegetables and it helps to cause healthy conversion of hormones. Anyone on hormones needs to be on that. Sometimes men will come to see me and their testosterone is actually normal. They’ll have all the symptoms of low testosterone but we’ll do their levels, they’re normal but their estrogen is high, especially men who are a little bit overweight. They have insulin resistance. It causes higher conversion into estrogen. Their estrogen is blocking the testosterone from working because those are supposed to be a fine balance. Men should have a small amount of estrogen-like women should have a small amount of testosterone but definitely not more than the hormone that’s driving them.

That’s where a lot of the danger comes in. Cardiologists like myself, I’ve seen men and women get into trouble with hormone therapy. They’re put on the hormones but there’s no follow up done. The appropriate testing is not there. If you’re a male on testosterone, you better know what your estrogen and estradiol levels are because if they’re high, you’re in trouble. That obviously accelerates cardiovascular risk, oftentimes men are put on an Anastrozole, which is a pharmaceutical that would block that conversion from testosterone into estradiol. Correct me if I’m wrong, that’s something that DIM can do and that’s what we’re using. We’re using something in a natural way in the form of DIM that comes from cruciferous vegetables as opposed to a pharmaceutical with a whole host of other side effects.

I would say most men respond well to the DIMs and some don’t. It’s, “Are we using too much testosterone?” I look at that because I do always try to avoid pharmaceuticals whenever I can. I can’t tell you how many times that my family practice, the conventional medicine one, I would see men all the time who I took over their hormone therapy. They’re having their testosterone level checked once a year and just their testosterone, not their estrogen. I do an estrogen level and then it comes back like 90, 100. For men, it should be more in the 20 to 30 range. It definitely puts you at higher risk of cardiovascular events and blood clots.

Chelsea likes to work hard and she likes to party hard. There’s no doubt about that. They’re relatively newlyweds compared to Heather and I who have been married for over twelve years. You guys are relatively newlyweds, you guys like to travel and have fun. You like to work harder too. For every hour you’re spending with a patient, I know you are doing another hour on the backend, researching stuff about that patient and making sure that everything’s dialed in. I can tell you that other practitioners are not doing that. I didn’t do that. If it was a ten-minute office visit, that was the only ten minutes I ever thought about that person. That’s one thing I commend about you, Chelsea, is that you’re talking the talk. You’re walking the walk as well and once again providing tremendous service to your patients and clients. I really respect that about you, thank you.

Men should have a small amount of estrogen just as women should have a small amount of testosterone. Click To Tweet

I love it. I’m a total nerd and I could go researching functional medicine things for hours. When I have that first lab review with my patient, I’m always getting on the night before and looking at all of their labs. I’m trying to put together the bigger picture and I’m putting all kinds of educational links on their notes so that they can further go educate themselves because even though we’re with them for an hour, there’s always more education that they can have. I love doing that. I like to give them lots of notes and lots of resources because ultimately, they need to be advocating for themselves as well. A lot of the patients that we see already have done a lot of their research on things.

Health coaches, when we see a person, whether I see them or you see them, at the end of the day you and I are both very busy and we want to continue to educate people. Continue them on the process as opposed to we spit out all this information, go over the lab test results and they’re like, “What do I do now? I get some of it.” How did the health coaches help to assist you and your patients?

Our health coaches are amazing. I’m constantly learning from them and they’re constantly learning from me. They actually are there to hold the patient’s hand for the first three months or so after they sign up with us. They’re there to answer. They have unlimited emails. They have phone appointments with them. Say they’ll have a simple question about a supplement, “Am I supposed to take this in the morning or am I supposed to take it at night?” That’s where they come in and they’re able to help with things like that. If it’s a question they can’t answer, then they’ll definitely email me or call me but they’re a great support for patients. We go over so much information in that one hour and then they walk out confused or don’t know where to start. They’re there with great education and they have tons of knowledge. They’re there to hold their hand through this transition to health.

It’s something very unique. We’re lucky because we’ve got such amazing health coaches but our health coaches are available to anybody on their own. Anybody can sign up for health coaching package with our health coaches but find a good health coach because they’re really your advocate. Oftentimes I tell people if they’re looking for a holistic practitioner, find a health coach first. The two of you together can find a doctor in your area that suits your needs. They’re your greatest advocate and they can help synthesize the information the doctor gives and keep the doctor on their toes to make sure that everything is dialed in. I promised we will talk about your dad. Tell us a little bit and without spilling the beans too much and your dad’s confidentiality. I’ll let you say because you’re the daughter. I know Ian is very proud of you. I know he’s very proud of himself and his accomplishments. I know you’re proud of him. I know I’m proud of him. Everybody’s happy for each other.

He’s actually given me permission and he wants to do a testimony. My dad has always been overweight, always ate pretty unhealthy growing up. He smoked cigarettes for a while. He drank for a while. What pushed him over the edge to change was that my stepmom, Helen, died from brain cancer. In that process of her with that cancer, she was going to a major cancer hospital and they were putting her on medication after medication. She was on fifteen different prescriptions before she died and she was never on any and they’re trying to figure out, which one is causing this symptom. It all made her a lot worse, to be honest. He said, “I don’t want to ever be like that.” He’d had a four-way bypass surgery a couple of years prior. That’s when I was referred to you and I brought him in here. He walked out of those doors 100%, never drink an energy drink again, doesn’t drink coffee anymore. He eats only Paleo. He got rid of all the gluten and he’d lost about 70 pounds. His blood work looks perfect.

He says he feels better at 60 than he did at 50. He’s working out at Orangetheory Fitness four times a week. His blood pressure started creeping up a little bit again. He’s a high stressed person in his job. I said, “Are you going to the chiropractor?” He said, “No.” I was like, “You need to get into the chiropractor.” Within three weeks of going to the chiropractor three times a week, followed by a bunch of stretching that they would do with them, his blood pressure dropped back down twenty points and it was perfect. That’s a great example of people don’t realize that chiropractors help with things. They think they’re in musculoskeletal problems but it’s the entire body that they’re able to help.

It should live in a lot of places because it’s very motivational to show a before and an after picture of your dad. Chelsea, thanks so much for being on this episode of the Healthy Heart Show. You represent the holistic nurse practitioners so well. Thank you for being part of our lives and part of our practice. For those of you that are interested, if you want to come out and see the best holistic cardiologist on the planet, it’s myself and if you want to see one of the best holistic nurse practitioners, I don’t know how it gets any better than Chelsea Hoese.

Thanks for having me.

We’ll see you next time.

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About Chelsea Hoese

HHS 19 | Hormone TruthsI obtained my Bachelor of Science degree in Nursing in 2009 and began my career working as a nurse in a hospital. I quickly grew tired of seeing the same patients over and over again who continued to get sicker and sicker, instead of healthier. I became drawn to a holistic approach of integrative and functional medicine, one that sought to cure people of sickness and disease. This inspired me to earn my Master of Science in Nursing and Family Nurse Practitioner Certification in 2014.

I’ve worked directly alongside Dr. Jack Wolfson and received much of my functional cardiology medicine training from him. I apply the same care to my patients and witness the drastic improvements in their health. I have lots of knowledge and experience in nutrition, lifestyle recommendations, and evidence-based supplements. I am also proficient in female and male hormonal analysis and bio-identical hormone therapy. I have watched nature in its purest form heal chronic health conditions and have a passion for healing sickness and disease naturally.