Dating Daycare
Welcome to "Dating Daycare," the ultimate safe space for women navigating the unpredictable world of modern dating. Join hosts Melissa Firpo and Allison Waterman as they dish out candid advice, share hilarious anecdotes, and tackle the toughest dating dilemmas faced by women today.
In a dating landscape filled with frogs disguised as princes and a jungle of jerks, Melissa and Allison offer a nurturing haven where women can laugh, learn, and empower each other to find love on their own terms. From ghosting to breadcrumbing, from disastrous first dates to navigating online profiles, "Dating Daycare" covers it all with wit, wisdom, and plenty of wine.
With Melissa's no-nonsense approach and Allison's comedic charm, each episode feels like a heart-to-heart chat with your best girlfriends over brunch. Whether you're swiping left or swiping right, "Dating Daycare" is your go-to guide for surviving and thriving in the wild world of modern romance.
So grab your favorite beverage, kick back, and join Melissa and Allison as they navigate the highs, lows, and hilarities of dating life. Because when it comes to matters of the heart, everyone could use a little TLC from "Dating Daycare.
Dating Daycare
Navigating Menopause, Libido, and Hormone Therapy with Dr. Frank Albano
Have you ever noticed the stark difference between how men's and women's hormone issues are addressed by the medical community? Our eye-opening conversation with endocrinologist Dr. Frank Albano pulls back the curtain on hormone replacement therapy and the striking gender disparities in sexual healthcare.
Women approaching menopause are often left navigating a confusing landscape of symptoms without clear guidance. Dr. Albano explains why comprehensive blood work measuring estrogen, testosterone, and pituitary hormones is essential before starting any treatment. We explore the safety differences between oral medications and transdermal options like patches and gels, with Dr. Albano recommending the latter to avoid increased blood clot risks. For women with intact uteruses, the crucial combination of estrogen and progesterone prevents endometrial cancer—a vital distinction many don't understand until speaking with specialists.
The most shocking revelation? While men have numerous FDA-approved treatments for sexual dysfunction, women's options remain severely limited. Testosterone, the primary hormone driving libido in both sexes, isn't approved for women despite its effectiveness. Dr. Albano shares how he helps women through this treatment gap with careful off-label prescribing at about 10% of the male dose.
We also tackle surprising connections most people miss—like how sleep apnea significantly lowers testosterone in men, and how obesity affects hormone levels differently between genders. The discussion extends to weight management with GLP-1 medications (like Mounjaro and Zepbound), offering practical guidance on proper usage, potential side effects, and why medical supervision matters.
From practical tips for managing hot flashes (keep your bedroom at 62°F!) to hilarious stories about an 80-year-old judge who misunderstood his testosterone dosage (leading his overwhelmed wife to lock herself in the bathroom), this episode delivers equal parts medical wisdom and real-world humor.
Whether you're experiencing hormonal changes yourself or supporting someone who is, tune in for this essential conversation about optimizing your hormonal health and reclaiming your quality of life. Dr. Albano will return in future episodes to share more insights on health and dating—you won't want to miss it!
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Welcome to Dating Daycare, where we help you navigate through the jungle of jerks. Welcome back. Ladies and gents. Today we're excited. Yes, we have a guest on today, frank Albano, and he's going to introduce himself and we are going to talk about hormone replacement therapy for men, for women, libido. We're going to cover it all. Welcome, frank.
Speaker 3:Thank you. Thank you for having me we're excited about this.
Speaker 2:I know I am with my hot stories. This is very timely because you guys know that Melissa and I are the same age. We're 77 babies over here, so there's a lot going on.
Speaker 1:There is.
Speaker 2:You need to help us.
Speaker 1:Yeah, and a lot of women. Yes, you need to help us, women and men. We're going to discuss the men, though, too.
Speaker 3:It's always the men's fault, always, obviously, of course it is. Where do we begin my crazy stories that you want to?
Speaker 1:Let's talk about like so a lot of women, right? How do you say it, perry?
Speaker 3:They're going through their changes. They're going through their changes. They're not there yet.
Speaker 1:They don't know what to do. Their periods are skipping Right. Ladies, like you get it and then you don't get it.
Speaker 2:You get it for a day and you're like what's going on? Am I pre? Then the panic starts and you're like am I pregnant? Yeah, three weeks.
Speaker 1:You get it for like three weeks, right, right. So this obviously me. You go see a gyno and they want to put you on some sort of hormone therapy, so how do you suggest what is the right way to go about doing that?
Speaker 3:so so, first we need blood work. We've got to see your levels. I want baseline estrogen blood test, testosterone and there's hormones in the brain, the pituitary hormones that regulate the estrogen. So it's LH and FSH prolactin. You definitely want to check a pregnancy test because there's something called polycystic ovarian syndrome, that younger girls have the opposite actually high testosterone instead of low and that younger girls have the opposite actually high testosterone instead of low and they come in and the first thing you want to make sure is they're not pregnant, because that was something that happened. One of my colleagues said oh, they have polycystic ovarian syndrome. They started them on treatment, but they were pregnant.
Speaker 3:You know, maybe that's why they missed their period.
Speaker 1:So that's first and foremost Right, of course.
Speaker 3:So yeah, get some levels and figure out what you need, you know, and how much you need. Start slow, start low and go slow.
Speaker 1:And then what do you suggest? Do you suggest I know there's creams out there, there's pills is that dependent on your blood level? Like your blood work? What you prescribe, like what are just so women know, because I think when you get there I know for myself. Like we're clueless, you know what I mean. Like we're clueless, you know what I mean. Like we don't know. None of this was discussed.
Speaker 2:Right, nobody told us this.
Speaker 1:So we don't know what the healthy route is. You know there's, there's the, and of course you're going to be able to dictate this better than me. But I've heard of creams, I've heard of pills, I've heard of the little pill that gets implanted in your tush over there the pellet pill that gets implanted in your tush over there, the pellet, the pellet.
Speaker 1:I've heard. You know what I'm saying. So there's so many options out there. I don't think, and I would imagine, that every doctor will prescribe different things, like I know. I was telling you that I was on, my doctor prescribed pempro and you're like that's not the best because, it could cause blood. I don't know that yeah you know, women don't. So how do we know what's best for us?
Speaker 3:Right. So the best thing you ever hear when women are on birth control, they say after age 35, you should come off of it. The risk they're thinking is blood clots because you're taking estrogen orally. What it does is tell the liver to produce more clotting factors, which is not good. So the best way to go is the transdermal. Like you mentioned, there's gel and there's patches, like you were on the patch.
Speaker 3:So, that's definitely a better route than pills, but the pills that you can take is the progesterone. So when a woman comes in, the first question is well, for her symptoms, do you have a uterus? That's important because if you do, then you have to take the opposing hormone, progesterone, because if you don't you run the risk of endometrial cancer. So you have to do the opposing hormone, so you got to take estrogen and progesterone if she doesn't have a uterus, and then it's just estrogen without any risk. But then it's all about how they feel and the levels. You know. Some people just say oh, how do you feel?
Speaker 3:you know you could feel great, but you know, if you feel tired and people like I want, I want to. I get this a lot with men. I'm tired, I have low testosterone. Well, did you check your level? No, so, and how do you know you're not tired from you're not eating enough, you're not sleeping enough, you're not drinking enough water?
Speaker 1:the family is crazy right, you're stressed out, you're stressed out exactly.
Speaker 3:So you got to look at the levels and a lot of guys come back and their levels are normal and then sleep apnea is huge. The major cause of low testosterone in men is sleep apnea.
Speaker 2:Did not know that, yeah.
Speaker 1:Really not being able to sleep causes low testosterone.
Speaker 3:Absolutely, Because cortisol it all comes down to the hormones. It's all about the hormones.
Speaker 1:Interesting.
Speaker 3:Because cortisol is a stress hormone. When you're stressed, do you want to have sex?
Speaker 1:No.
Speaker 3:No, because your cortisol is high and it's dropping all your testosterone. Women have testosterone also, and that's the libido hormone, and then we give all these men all this testosterone and Viagra, and what do the women have? Because they're not in school. We didn't learn about testosterone for women or replacement, because years ago there was a study that showed increased risks of breast cancer.
Speaker 1:Right, which we've heard that about. Like I was just saying that to you originally, I was nervous because I have heard from different women who have had breasts that this, that they're like, oh no, the hormones can cause cancer.
Speaker 2:And then you get scared and you're like well, I'm not suffering too much, right like I just have a few night hot at night, a little bit tired, so I'll just keep rolling on the way I am I mean that, that that impression that it causes different kinds of cancers, wasn't that taken from like studies in the 90s, the woman's health initiative?
Speaker 3:yeah so, and it was like very, very small percentages, very small percentages, and it was taken blown out of proportion. And we all said, ok, we can't touch this, and that was the study that's left. It's one of the biggest problems of studies in the past that we go back and say we screwed up big time.
Speaker 1:And as a female, what should you be experiencing besides not getting your period monthly to say you know what? Maybe I should go, you know, navigate through hormone therapy, like what are some?
Speaker 2:And who do?
Speaker 1:you go to first Do you go to your your gynecologist, who do you go to?
Speaker 3:The gynecologist. Some are more progressive than others, meaning they're interested in giving you estrogen after the age of 35, because it's all about quality of life also. And like we mentioned, if you take the pills, there is an increased risk. If you smoke, then that's an increased risk also, but we don't some most of them. That's why I'm thinking I want to start doing this, because I'm giving men testosterone and viagra and these poor women and I see their women come in and like he's on too much.
Speaker 1:Please lower his dose oh my god, she can't handle it. She's overworked and underwhelmed. Yeah and then, and then she has.
Speaker 3:You know, women lose the estrogen. You know they lose their progesterone and testosterone.
Speaker 1:And that's sex drive.
Speaker 3:It's a drive, yeah. Right Sex drive is testosterone, yes, yeah. So what are we doing? So, unfortunately, in this country, in most countries, testosterone is not indicated FDA-approved for women, so there's no treatment for women and that's sex treatment for women. And that's what sex drive, that's testosterone.
Speaker 3:Yeah so testosterone replacement is not FDA approved. That's why people go to the compounding route, but what I would do is just give them 10% of the man's dose, like I was talking about earlier today about the test them. There's a testosterone concentration that I give to men. It looks like a little tube of the travel toothpaste and you can take a little bit out. So I do have a story. I have tons of stories.
Speaker 1:No, tell us a story, Frank. Tell us a story. Yeah, somebody did this a long time.
Speaker 3:So I had a judge it was a Supreme Court judge years ago in his 80s and he came in and he wanted his hormones checked. And when they say their hormones I love when they say that, because which one? There's a lot of them. There's thyroid hormone, but usually they mean the sex hormone.
Speaker 1:Well, because he's coming in, she's like does that mean he's not getting it up anymore?
Speaker 3:Yes, exactly.
Speaker 2:Can you imagine at 80 years?
Speaker 1:old, we still got to work, ladies. I thought by 80,. I can lay back in the bed and just chill out. But 80, I can lay back in the bed and just chill out.
Speaker 3:But no, the men still want to bang at 80. It's unreal. It's unreal Undo a button. It's getting warm in here, All right. So yeah, so he comes in. We check his levels and, yes, his testosterone is low, Low. If you want numbers, I can give you numbers also. So low is usually under. They say they lab under 250. But I have under 250. But most men, you know, 18, 19 years old, they're 800, 900.
Speaker 3:And guys, want that same thing you know, so I'll do what I can without harming their organs. You know you want to go slowly. You see these bodybuilders that are dying of blood clots Right absolutely. Destroying their organs, their heart, their liver, their lungs. Their increased risk of cancers go up dramatically when you overdo it. But everything in moderation, like even the water I just drank. You could be intoxicate yourself of water and die absolutely.
Speaker 3:Salt goes too low so you start low and go slow. So this particular gentleman I said you know what, instead of taking a full tube of test him every day, because it's dosed daily, and you just rub it on your upper back, take a half a tube. He's like okay, and he comes back. No, he doesn't even come back. So a couple days later I'm in an exam room with a patient like banging on the door and I tell the medicalist don't bother unless the place is on fire I'm in the middle of a conversation.
Speaker 3:They could be telling me they're in for their hormones, but they could be telling me that someone just died. You know, there's something terrible happened. If the door's closed, don't come in and I get this and I just had and I just had this conversation just the other day and I'm like what the fuck is going on. Mr So-and-so is on the phone. It's an emergency. I told him you're in a room, You'll call him back, and he said he needs to talk to me now. Like, oh my God, what happened?
Speaker 1:He died Right he had a heart attack while he was banging.
Speaker 3:I killed him with a little testosterone, exactly.
Speaker 1:Right.
Speaker 3:So he goes. Frank, I got a big problem. He goes. My wife locked herself in the bathroom and she won't come out.
Speaker 1:The poor woman was on vacation, but not anymore. I go.
Speaker 3:What do you mean he goes? I think a tube and a half is way too much for me. I swear to God, I'm like a tube and a half. I said a half a tube.
Speaker 1:He goes oh my God, wait, that makes him get an erection.
Speaker 3:Yeah, so in other words, so you're saying he's level, poor guy had a hard-on for days. Pop-ups.
Speaker 2:Come and get pop-ups For days, so I wanted to bring up his testosterone.
Speaker 3:It was around 200, 300 is better. So I gave him a half a tube, thinking we'll just put it on a little bit. He's an older guy. How much want to protect the bones at that point and just give him quality of life. But he took triple the amount. So his wife yeah. So I'm like no, no, I said a half a tube.
Speaker 1:He's like oh, I don't think my hearing aid was on when you told me oh, my god, two and a half, so wait, will that give him a hard-on for days like viagra?
Speaker 3:well, you have to it's. It's gonna give him the drive that's, that's what that poor woman left herself in the bathroom.
Speaker 1:He was chasing around her, around the apartment with a walker. He wants a bag like 10, 12 times a day. Yeah.
Speaker 3:So after that I'm always telling him repeat what I just said. How much are you going to take when you get home? You know you live and learn. Oh, that's funny. But at 80. At 80. You're still looking to bang at 80.
Speaker 1:Oh my God, Unreal that never, change, though that doesn't surprise me, that doesn't surprise me.
Speaker 3:It's not our fault. You know what Men never change In the wilderness, you ever see women chasing men.
Speaker 1:Never Like the tiger or the fucking lioness. Doesn't one chase, doesn't the?
Speaker 3:We gotta look that up, yeah one of them, I think.
Speaker 1:Doesn't the woman tiger go hunt and do freaking everything, while the male's laying out in the field? I don't know.
Speaker 3:I don't know, but it's always the man, like the peacock, always trying to show his fat. We're always trying to impress the women.
Speaker 1:Of course that's the way it should be.
Speaker 2:So I mean you got to tell that. Say that loud.
Speaker 1:Yeah, say that loud for the people in the back.
Speaker 3:What about where the traditional men you know they're?
Speaker 1:gone Right, okay, so we went through the different types of hormone therapy. Now, what about like? What about like sex drive? Like do you find that it goes down in women and men? I feel like men always have to drive more than women.
Speaker 3:I'm hearing Okay, but do you find that?
Speaker 1:around what age do you find the men coming to you, versus what age the women come to you?
Speaker 2:Do you know what I'm trying to say? Yeah, that's a good question. You know how they?
Speaker 1:always say a man's prime is between 18 and whatever it is 35. And a woman's is like totally after the men's, supposedly like 35.
Speaker 2:So there's this like disparity, like who, who are the, you know, like the women? Well, you know why?
Speaker 1:because let me give you an example. Like I'm right, we're in our 40s, right? So when I meet a guy in his 40s, I don't know, like I don't know about men's testosterone and their sex drive, like that's the last thing I got going on in my life with my kids and my whatever. Like when I meet a man in his 40s and 50s, is he? Is he, like you know, still banging around like he was in his third?
Speaker 1:because you're not in your 40s. As a woman, I can guarantee, I can tell you that my sex drive is completely different today than it was in my 20s it's more or less Less. I couldn't give a shit, like I couldn't give a shit. I mean, I give a shit but I'm not sitting there like, oh my God, I haven't, you know, had sex in. You know, like usually men would be Like men can't live without it. Traditionally, men will say cannot live without it.
Speaker 2:But also we have control over ourselves.
Speaker 1:Everybody should have sexual discipline, but I'm talking in general. So do men in their 40s and 50s? Are they still banging it out and getting hard?
Speaker 2:When does that end for them? But I feel like maybe the drive is there, but the body is not. Well, that's what I'm asking, that's where I come in, that's what I'm asking. So.
Speaker 1:I feel like when a man sees an inkling of he can't get it up at any age, he's running to you Because that is probably the biggest fear for a man.
Speaker 3:Yeah, so the good thing is with that. So I treat diabetes also. So to get people to test their blood sugar and take their medication, I use a different approach for the different age groups and men. All you have to say is diabetes can cause erectile dysfunction. You never told me that.
Speaker 1:Wait a second Right. They dysfunction.
Speaker 3:you never told me that wait a second, right, they panic exactly. And then I'm getting phone calls. He needs a refill of his medication, he wants his testing supplies to break his finger. So yeah, so that's a man's that. Yeah, you don't want to lose that but when do men usually go down?
Speaker 1:do you know what I'm? Saying like women physically no right no, like women, right, start to lose their sex. Not lose it, but it goes down. They say menopause right, because your hormone levels are off. When does it hit for men?
Speaker 3:And we have menopause.
Speaker 1:So after 40,.
Speaker 3:Usually the testosterone goes down, maybe 1% each year but every guy is different. Do you go to the gym and raise your testosterone? Do you eat right? Do you sleep right? Do you not drink a lot?
Speaker 1:of alcohol. Do you treat your body right?
Speaker 3:Do you sleep right? Do you not drink a lot?
Speaker 1:of alcohol.
Speaker 3:Do you treat your body right? Food is medicine. I have guys that are in their 30s with erectile dysfunction and low testosterone. Obesity major cause of low testosterone because the fat cells hold estrogen and estrogen is the opposing hormone from testosterone. So that's why polycystic ovarian syndrome. They're high in testosterone because it's schizophrenic in the body. So men that are overweight have low testosterone, high estrogen. Women that are overweight have high testosterone.
Speaker 1:So it's the same for the women as men. If you go to, oh, it's that.
Speaker 3:Did I say that back? So men that are overweight have higher estrogen, low testosterone and women that are overweight usually have the high as a PCO, polycystic ovarian syndrome. So it's usually seen in younger, younger women that have high testosterone, irregular periods and that causes hirsutism.
Speaker 1:Yeah, that the hair. We don't want it yeah, male pattern baldness okay, stuff like that. So if you're going to the gym, eating healthy, doing all the things that you should do, your sex drive, man, or should stay a little bit more elevated.
Speaker 3:Yeah, absolutely, because the sex drive hormone is testosterone for both, and I do have guys in their 80s that have great testosterone.
Speaker 1:That's crazy, and I have guys in their 30s that have low testosterone Like you have none, still banging it out at 90-something with bunnies.
Speaker 3:Well, he's probably on testosterone and viagra.
Speaker 1:Yeah, he's dead now, but he probably was. He had twins at like 90.
Speaker 3:yeah, he had a lot of crazy, oh my god but also I find out a lot of these places that are giving testosterone are not being thorough. I do endocrine, so I'm looking everywhere, so I want to find a cause for everything, so a lot of times it's from I shouldn't say a lot one in ten people have a mass on their brain blocking the signal from the.
Speaker 3:That's crazy luteinizing hormone and follicle stimulating, which is the two hormones to tell the testicles and ovaries what to do, blocking the signal. That's why it's low testosterone. So a lot of these places that just testosterone mills yeah, that's what I call them, yeah, yeah they just have some testosterone and we've had some in different areas that come in and they had a two centimeter, which which is huge. The pituitary is only two centimeters.
Speaker 2:Yeah.
Speaker 3:So it's like halfway this way.
Speaker 1:So it's really important to get the blood work done so that you know, don't just slap on some testosterone gel, don't just give Viagra.
Speaker 3:Another cool statistic is that 50% of men with erectile dysfunction have heart disease. Because, if you have blockages in your heart, you can have it in your penis.
Speaker 1:Right.
Speaker 3:So have blockages in your heart.
Speaker 1:You can have it in your penis right, so I don't have the blood flow right yeah, it's all about blood flow. So I don't do not give viagra to men unless they have a cardiologist. Interesting, yeah, because that is really used in the market.
Speaker 3:I mean, it's like it's like candy yeah I did have a guy years ago there's another funny story that he came in and he's like I want, I need viagra, I'm not, you know, and he was vocal about it and vocal and vulgar and I'm like he had uncontrolled diabetes. So we talk about risk factors, right? So there's all the independent risk factors If you're over 45 as a male, if you're overweight, sedentary lifestyle, high cholesterol, high blood sugar and hypertension family history of heart disease.
Speaker 3:I got seven independent cardiac risk factors for a heart attack and he fit the bill there and he's like my this isn't working. I need medication. I said no. First of all, we need to check your testosterone. We need to check all these levels and make sure is it coming from your brain or your testicles? Do you have a cardiologist? No, I don't. So I refused to give it to him and he stormed out of the office, slammed the door and yelled at us like F, this guy, you know, I just know what he's talking about. Okay, I don't see the guy back. I figured he's done with me. Whatever he comes back in with a woman in tears.
Speaker 3:I just got the chills In tears and you saved his life. He goes. He wanted sex so bad he caved and went to the cardiologist. He he had a quadruple bypass. Oh my God, he almost died yeah.
Speaker 1:That's crazy. That's why he had ED. So it's not all about you know, right, you never know. You really have to. Completely physiological.
Speaker 3:You've got to be thorough Is there Viagra for women.
Speaker 2:Good question.
Speaker 3:Good question. So again, women are always put on the sideline.
Speaker 1:I feel like. I feel like. I don't know if you feel like this, but you're probably usually gonna look at me like I'm not.
Speaker 3:I feel like you're not keep going.
Speaker 1:I know right, I feel like as a woman, right, dating. Right, since we're younger, let's you know, 18 and right you're dating, you're having, you're sexually active, like we're always supposed to be on point, like, like. Do you know that Like? Do you ever feel that Like when, like, women are always expected to be like, sexy and ready to?
Speaker 2:go Supposed to be everything to everyone at all times.
Speaker 1:Like your man want. Like you know, I had a hard day Like I don't know, just not old, not like aggressively, I'm not saying demandingly, but I'm saying when you're in a relationship I always feel like the woman. You know, we do all these jobs the kids, the this, the how, the job, what and we're always just supposed to be like ready to like strip down, look good and like be sexy for you and have sex yeah, that's just you know what I
Speaker 1:mean you feel like you have to be and I don't feel like that pressures on the man, although we have different kind of pressures.
Speaker 3:You know what I'm saying.
Speaker 1:Like I feel like you're always expecting me to be sexy and this, and that you know. You go out, you go to dinner, you're wearing a hot, tight dress. The minute you like walk into the car, the guy's hand's like halfway like up your thigh in the car.
Speaker 3:You know like it's a different pressure, you know what.
Speaker 1:But we could go out to dinner or do whatever, or go to a wedding or whatever, and the man can look hot and we're like all right, we're tired, let's go to bed. You know what I'm saying? I feel like the pressure is always on women, but meanwhile there's Viagra for men Pressure on us to perform.
Speaker 3:Yes To be in the mood.
Speaker 1:To be in the mood to perform, to look, I don't know, I feel like that.
Speaker 2:I mean, it's just a symptom of like.
Speaker 3:Let's check your levels. Yeah, let's go.
Speaker 1:Yeah, I know, but I feel like that's why. I'm saying is there Viagra for women?
Speaker 3:Yeah, Well, Viagra doesn't do anything with the desire. Viagra just increases blood flow to that area. Oh, so it just treats the physiology.
Speaker 1:So a man could be taking Viagra, have a hard-on for 10 hours and still not want to have sex if his levels are off. How does that work?
Speaker 3:Well, you can only so. If I took Viagra before I came here, I wouldn't have a hard-on. I'd have to want to have a. You know what I'm?
Speaker 1:saying Got it? I'm not familiar with it, Although you keep opening your jacket. I don't know. I'm sweating.
Speaker 3:I'm having a hot flash.
Speaker 2:It goes so many places with what you just said.
Speaker 3:But you have to be aroused mentally.
Speaker 1:Got it.
Speaker 3:And it just makes it easier because now there's more blood flow, it's ready to roll.
Speaker 1:Because I've heard about men getting erections from Viagra and they can't get it down like they is.
Speaker 3:That true, yeah, so that's one. In the package insert it says if you had an erection for more than four hours, go to the hospital. I'm not, I'm going to the broth. What do you mean? The hospital, but wait a minute.
Speaker 1:But, and you know me, but I gotta ask the questions how does that work? Like it's not good you get a hard-on, we have sex. It doesn't go, you don't come it doesn't go down, I don't understand it yeah, ejac, ejaculator or not, it just stays hard.
Speaker 3:No, yeah, you have to actually go to the hospital legit, I've never seen this, but I've read about it and the urologist has to take a syringe and suck out the blood. Sounds fun, gentlemen, if you don't, then it might not work.
Speaker 1:I mean, necrosis can happen because there's no blood flow anymore. Then we got to cut it off.
Speaker 2:There's a lot of blood stuck in there.
Speaker 3:But that's usually super rare and it's usually when guys if I take one, that would be good. What if I take five?
Speaker 2:That would be five times better.
Speaker 3:It's not. It's never Slow and low as an NP. That's what we're always taught. Okay, Slow no start off with a low dose and go slow with it.
Speaker 1:Okay, so it wouldn't work on women anyway, because it's just for blood flow but they might get good blood flow down in that area anecdotally.
Speaker 3:So anecdotally means that like if we try it and it's not really FDA approved the feedback I'm getting off label exactly. So if the man says take a pill and I've heard my patient say I gave it to my wife, she enjoyed herself more than usual.
Speaker 1:Got it Because it increases blood flow to that same area. Got it, you can orgasm better. Got it, yeah, because it's all about blood flow, if you want you know there, so it does work.
Speaker 3:Unfortunately, they were going to come up with a pill, but women are not. As like we're very mechanical, like we're easy to please, you know, like have to be in the mood and we'll get in the mood quickly.
Speaker 1:Well, this is my point. Yeah, that was my point with my other thing, so we could be turned on like a switch 100% Women.
Speaker 3:that's why Viagra would 100% probably work, because if you take Viagra, you might get the increased blood flow, but you don't have the desire. That's why you need it.
Speaker 1:And that's why men are more like physical right, and women are more mental. Oh, they're definitely mental 100, but you know what? I always say this, but I always say like and not all, because we know you quote me when I say most, not all, but I always say this like a man could have sex with you know three women and just, it's just an act, it's just a whatever. Where we've discussed this, women are more emotional, like I am not having sex with a man that I'm not emotionally attached to. It skeeves me out, I don't want you touching me.
Speaker 2:But what happens, even if you're not into them initially, after you have sex because of all the you know, the hormones that are released, all of a sudden Oxytocin yes. You start looking at this thing that you thought was a beast, and you're in a different way, because this might be the potential father to your children and then all of a sudden you're looking at him with a different lens. So I think it's a kind of a dangerous thing.
Speaker 1:Slippery slope, yeah, but most women have to have some sort of emotional attach Most.
Speaker 2:Where men don't? Not you, linda In the background, yeah, not you, linda, who's writing into me right now saying I can fuck 20 guys and it wouldn't matter, I don't give a shit, not you, not you yeah, not you, linda okay, yeah, but I think that's why it's so different and that's why the hormone replacement right is important for women.
Speaker 3:Yeah, as they get older just a little bit of testosterone. You don't want to make them a man. You.
Speaker 1:No.
Speaker 3:I do do also transgender, and it's a big difference between giving a woman a slight amount of testosterone versus what I do for the trans community, where I give them a boatload and give them enough for a man, different dosing it's a man's dose versus a tenth of the man's dose.
Speaker 1:Okay, okay, so Okay, and, like we said, the different symptoms that women should be going would be libido, tired fogginess, moodiness, low attention at work.
Speaker 3:Sometimes I hear also getting short with the kids. You know temper stuff like that, the hot flashes, that's usually what brings them in Right.
Speaker 1:No, those, a lot of women die from those. I know I've been getting them Like. It wakes me up in the middle of the night and I toss and turn. I have to change the pillow Because the pillow's physically hot Right and then I got to switch it out to the cold pillow and it disrupts my sleep. It's horrific.
Speaker 3:Also, a lot of times anxiety is at night, because that's when your mind starts to calm down, but all the thoughts and the rumination starts happening.
Speaker 2:Oh, rumination, I'm a ruminator, are you? Yeah, I don't know.
Speaker 3:I always have been Rumination at night.
Speaker 2:All the time, but at night, yes, especially so, because everything you know I used to just sleep right through, no problems.
Speaker 1:Well, there's different sheets.
Speaker 3:You can get the cooling sheets keep the temperature really cold.
Speaker 1:I got the cooling.
Speaker 3:PJs I got them from how cold do you keep the room?
Speaker 1:Like 69, 70. You need to go lower than that. Oh so it frees my children out.
Speaker 3:Oh, you don't have a separate one for you?
Speaker 1:No, it's all upstairs.
Speaker 2:You got a fan I could do. Can you shut off their little thing in their rooms? I have the most glorious sleep at like 62. I'm out like a baby.
Speaker 3:Yeah, you need to be colder. Remember, in school, with the computers, the computer room is always colder.
Speaker 2:Yes.
Speaker 3:That's because it's like your brain is a computer. It needs to be cold at night, especially at night. All right, maybe I'll do it a little lower. I feel nervous. 69 is too high. I'm get him another blanket.
Speaker 1:He's under tons of blankets. We're all good with the fluffy blanks 69 is too hot, that's hot, yeah.
Speaker 3:I didn't know. 69 is always hot, that's our number.
Speaker 1:Oh, my god. Okay, so is there anything else that you think that we should discuss?
Speaker 3:Well, also when you were saying about sweating and things. So sometimes you're going to have an overactive thyroid. So I think blood work and being thorough with all the hormones is good. So a baseline Kidney, liver, thyroid function. You want to check your cholesterol also.
Speaker 1:Make sure that's good, but I'm sure this is the panel when they come to you, if someone comes to you when they come to me? Yes, yes, and we're gonna have frank on again, but you're opening a medis what is it called?
Speaker 1:oh yes, coming soon, coming soon, yes, so someone can get all their hormones, someone people are going to be able to get their hormones from you and what like everything they need and their botox and their botox and their phyllis and the phyllisers, god knows, are my favorite, um, and then you know what else I wanted to discuss, also because a lot of women, my friends, have been complaining about this what's that waking, oh gop1 yeah, that, but like that, but with prairie menopause, they say their period, and you know what this is is another stupid question which you probably you may not know.
Speaker 1:I love stupid questions, I love this, but this is a question I have. Okay, so let's say you're perimenopausal and you're skipping periods, or you know how they. Well, the gynecologist says if you don't have your period for a year, you're done right. Let's say you're in that year period and you know you got it three months. Then you didn't get it, or you got like how do you know when you can't get pregnant anymore?
Speaker 2:yeah, you might need to still take precautions.
Speaker 1:You might, or your two kids might have a little baby. I'm just saying even for like the married women that are listening, or the people in relationships. I'm not saying the hoes.
Speaker 2:Or the hoes out on the street Right, the hoes out on the street.
Speaker 1:But let's just say you're with somebody and you're like oh, I haven't had my period in eight months. Let's do like.
Speaker 3:And I feel kicking in my stomach.
Speaker 1:Do you know what I'm trying to say? What could this be? And then you know you don't use any precaution and you're like I'm cool, how would you ever know? Like, how would you ever know? Because, right, for years, ladies it's always been like oh shit, I'm late, yeah, right. If you were late and you're like, oh my God, let me go take a pregnancy test, I'm late, yeah. Or if you're trying to get pregnant, you knew. Because you were late Right Now, I would be in pure panic mode. When do you not like? Because how would you know I'd be taking pregnancy tests every month because you're not skipping, you're not late. I haven't got my period in eight months. How would you ever know if you were pregnant? How do you know when you can, when you can't do that?
Speaker 2:when it's safe to do that, when your cycle is so whack you can.
Speaker 3:If you're still getting a cycle. That's why an IUD probably is the best thing.
Speaker 1:Okay, just to be cautious. And then, after you don't have it for a year, you're free to go or no.
Speaker 3:Yeah, free to go there or no? Yeah, free to go there, but the IUD is still hormonal, so that's another route.
Speaker 1:But you can't get pregnant anymore After a year.
Speaker 2:They say so they say we're going to come back to you when. Melissa has a bun in the oven. Oh my God. No, and it's all your fault, Frank.
Speaker 1:Oh, my God.
Speaker 3:So five years, Frank. You said Five to 10 years. That's my new thing.
Speaker 1:Oh my God. Five to 10 years, okay.
Speaker 3:When you're 75. Yeah, 75.
Speaker 1:All right, and now the weight gain A lot of women are talking. And they're talking about my cousin, always In the middle. Yeah, says, says right here she gets like the pop bell. All of a sudden her stomach was fairly flat and now she's getting this bulgeous pop bell love hand. Like women are saying, their metabolism slows down. So what do we take for that?
Speaker 3:so before I? Even so, when I get a patient for weight loss, what I do is check. You guys heard of cortisol, right?
Speaker 3:so it's all over the place. It's actually real. So sometimes people talk about cortisol and adrenal fatigue not real. But there's something called cushing's disease. So remember I said one in ten people have a mass on the pituitary. It can be producing cortisol and it's called cushing's. That could cause belly fat, that could cause waking and cause diabetes. So I've found a ton of people lately. I would say when it's supposed to be one in a million. In school we were taught Cushing's is super rare. I found maybe five in the past six months.
Speaker 1:Oh wow, that's a lot, and it's a simple blood test.
Speaker 3:You take a pill at 11 pm it's called dexamethasone, and then you do an 8 am cortisol level and if it's elevated over 1.8, then and I've been- doing. Mris and I have some in my phone. I was checking the portal this morning at work. A guy has a mass on the pituitary, One has on the. It could also be on the kidneys.
Speaker 1:It could be anywhere in the lungs. And this causes weight gain.
Speaker 3:And it causes weight gain.
Speaker 1:Because some people are like I'm eating less. I'm not the women. I'm going to the gym.
Speaker 3:I have a nutritional program and I just can't. I'm doing everything and nothing's working. I usually check that baseline and if I don't do a baseline, if I notice they're not losing weight on the GOP. Once I have a patient on 15 milligrams of Zepound, which is the highest dose, hasn't lost a pound. So I did a Dexmedzone suppression test and I'll let you know about that.
Speaker 2:I've lost 15 pounds in the past three months, but I have I've as heavy as I've been in my life. I've never had this like stomach thing going on well, that's what I'm saying.
Speaker 1:Like it comes with the peri, I hear it comes with the perimenopause.
Speaker 3:A lovely silhouette, oh my god or you should make sure it's not cushing's you know because it's, it's, it's kind of. It's not as rare as we thought. We weren't checking, because if you google what cushing's looks like, they'll it'll be a moon face, buffalo hump, this woman that's just huge.
Speaker 2:Oh, the buffalo hump.
Speaker 3:Yeah, the thin arms, the thin legs, and they could also have purple stretch marks on their stomach. They have like a red face, like stretch marks on their face.
Speaker 1:That's an extreme case. Wow, and what's your if all that's okay and they're just normal you know there's nothing wrong with them and they're going through menopause? What's your take? Because GLP-1s are huge, yeah, so let's get into that.
Speaker 3:Yeah, no, I definitely love them Like.
Speaker 1:Monjaro ZipBound. Even microdosing is great.
Speaker 2:Yeah.
Speaker 1:And how long is it safe to be on. You know, go through that with us.
Speaker 3:I always find. I always wonder when the reps come in to detail us, we always say who do I not give it to before, Because they'll love to tell you who to give it to.
Speaker 3:Give it to everybody who can I not give it to? So it's people that have a history of pancreatitis. That's something that you don't want because it can cause pancreatitis. So if you had it before and you don't want to take this class of medications. Also, it's a super rare thing called medullary thyroid cancer. I've never seen a case of it. It was seen in rats, not humans. That's one thing if they have a family history of medullary thyroid cancer or they have medullary thyroid cancer. Other than that, it's fair game. What I like to do is make sure that triglycerides are normal, because high triglycerides can cause pancreatitis.
Speaker 3:So, triglycerides are in the cholesterol profile. It's usually from genetics or a lot of carbohydrates consumption. You fix that and you can fix that with fish oil prescription. Fish oil I use that brings it down and then I start the medication and you start slow and people don't realize. Manjaro is the same thing as Zetbound Same exact molecule, just appetite. Manjaro is marketed for diabetes, Zetbound is marketed for weight loss.
Speaker 1:Okay, and can, just that, like I know, a lot of women can't afford it, can it go through insurance right? Yeah, some of the plans.
Speaker 3:They're getting harder and harder. Years ago I know some providers that would lie and say, oh, they have diabetes and then get it. And then these people are going out of business now because the insurance company is saying I want the chart notes. Where's the diabetes?
Speaker 1:And it's not there, right it's fraudulent.
Speaker 2:As I always say, I don't look good in orange Right, so I play by the rules.
Speaker 3:I play by the rules. If you can't afford it, I'm sorry, but the pharmaceutical companies do have medications that are a little cheaper now, like $300, $400 a month, depending on the dose depending on the dose.
Speaker 1:And how long can you be on it? For Forever.
Speaker 3:So I always ask about side effects. Major potential side effects is nauseousness, diarrhea, constipation, so some people can get bound up, some people can have diarrhea. Acid reflux is another one I hear sometimes but they could be on it forever, so it's a gastric.
Speaker 2:It's manageable. It's a GOP1. Generally, the side effects are manageable.
Speaker 3:Yeah, it's manageable. It's a GOP1. Generally the side effects are manageable. Yeah, especially the Zetbound. So the majority is a two-in-one hormone. It's GIP and GOP1. That's more efficacious and it has more weight loss and less side effects. So that's the one, yeah.
Speaker 1:And I know a lot of my girlfriends are like oh, but you know how can you be on it forever? It was originally for diabetes. It forever. It was originally for diabetes. And the minute you come off of it, let's say you lose all the weight. The minute you come off of it you're going to gain the weight back.
Speaker 3:Not necessarily. So usually this is a tool that once people start losing weight, now they're motivated to go to the gym. Now they're motivated to exercise and do better things, motivated to eat the right foods. So I like to keep them on. You know whatever dose is maintaining their body weight and if you could, always Like a maintenance dose.
Speaker 2:It wouldn't be like at the highest dose Exactly you would stay on indefinitely right.
Speaker 3:It depends. So I have people on the 2.5 is the lowest dose. I have people on 2.5 and they lost what they wanted and they're fine. And then I'm like, okay, if you ever want to come off it, if you lose, I also if they start to lose too much weight, too much. Yeah, then I definitely need to come off it. It's not. People get obsessed with this stuff and they don't see themselves their body's dysmorphia.
Speaker 2:Absolutely.
Speaker 3:They look in the mirror and still see themselves 100 pounds heavier. And you know a lot of these people. They need counseling and things to help them out get through things Right. But yeah, start at the 2.5. And they say after four weeks you can increase the dose. But I only increase the dose when it goes, when their weight either goes up or plateaus.
Speaker 3:I have to hit it on my phone, rob, so a lot of people did they do want to keep going up and up and up every month, but then you're going to run out of doses right you know, so you only have you know they have to 2.5 to 5 to 7.5, 10, 12.5, the 7.5, 10, 12.5, and 15. So you have six doses to work with. Do you want to go every single month? Then you're six months and you're capped out.
Speaker 1:Right, no, you got to wait until you, but a lot of places they do that You've heard of the ozempic face.
Speaker 2:Yeah, I was just going to say you need someone reputable like face, or perhaps a zempic butt. Yes, and it's time to back away.
Speaker 1:Yes, and you should be working out while you're on it and eating healthy 100% resistance training. I had a woman.
Speaker 3:Actually this is a case study, so the schedule is so crazy, especially with the GOP ones coming out. And I do endocrine, so we have everything endocrine plus weight loss now thrown at us. So what I would do is I would say okay, call me every month, month tell me how you feel, tell me your weight and if you're going up, I'll give you it. You know. The next, the next dose, just a quick phone call, not even a video visit, and I and you know you live and learn, you make mistakes and you find out.
Speaker 3:So six months later she comes in. She looked like she has cancer, like you could see the clavicle bone. Yeah, you know it's women. You shouldn't really see this bone that prominent yeah and, uh, she looks sunken in. No, no, no, I mean like, like, like the, you know the no, you could say, but the divot, like you know, like the huge hole where you could like fill a drink in there you know. So it shouldn't be like that yours is your perfect so um, thank you, wait, let me see let's check out the clavicle.
Speaker 3:Good looking, all right. So so you can't put any you can't put any fluid in there, you know what I'm saying.
Speaker 1:It looks like a hole. I know it's sunken in.
Speaker 3:Yeah, and they have, like, their face sunken in, they lose the face muscles and all that. So she came in and I'm like, oh my god, she's dying you know I'm talking to her, I'm killing her, is everything okay? Like she's like no, I'm good, I'm doing all right. I'm like no, you're not what happened you? Literally lost like 80 pounds, that's all you last you look not good.
Speaker 3:I said I think you should see a hematologist, oncologist you know you might have cancer. You know she's like. I went to my primary care, he thought the same thing I did and he told me to tell you I need to lower my dose. I'm like, are you kidding me? Like you lied to me all these months. I'm not losing weight, I'm not losing weight. Then she shows up 80 pounds lighter in six months and I'm like and the primary care is thinking this guy's a hack.
Speaker 3:What is he doing? Yeah, I'll never do the six month thing without looking at you doing a video visit, at least it's a huge.
Speaker 2:I know patients who did like a busy video visit with a provider and they put on the biggest, bulkiest sweatshirt and just and stuffed it with things, so they could, you know, get their little, of course, a glute-tied fix.
Speaker 3:yeah, yeah and if they don't lose weight with the insurance companies now, are not having the medication oh yeah, now some of them are mailing a scale to the house. They have to weigh themselves and if they don't lose five percent body weight, they take the medication away. Because why should they pay a thousand a month if you're really not going to lose weight on the medication? So yeah, it's changing times now. It's not like a free-for-all right how you could lie on the chart notes and get it covered.
Speaker 1:No one's looking because now it's became ever since elon musk started taking it and kim kardashian oh yeah, exploded, of course, so that they've been taking it for years years when we didn't know about all I feel like all those movie stars that you were like how did they lose all that weight for that movie in six months? Now we know how.
Speaker 3:These GOP ones have been around for more than 10 years.
Speaker 1:Well, that's what I mean. Nobody's talking about it, right? No, but now it got out.
Speaker 3:Yeah, the story's out. All the celebrities are like. Now we know.
Speaker 1:Right now we know how they all like for the Emmys or for the. They look so amazing. And you're like how did she lose all that weight to fit in that Marilyn Monroe dress? I couldn't lose, I couldn't lose. Would she lose 20 pounds in a month? Like I couldn't do that?
Speaker 2:with a gun to my head. I love when they do, I know.
Speaker 1:With a gun to my head. I couldn't do it. Like with my awesome trainer, like if I ate, you know, 100 grams of protein a day, I couldn't do it.
Speaker 2:It's just horseback riding and long walks. Yeah, right, yeah, extra sex. Oh man, that's some more testosterone.
Speaker 3:I worked it off in bed.
Speaker 1:Oh, my God.
Speaker 3:Certain tricks, like your brain doesn't know if you're hungry or thirsty, so if you drink a ton of water, yes, I do that Coffee. Coffee's an appetite suppressant. It's awesome.
Speaker 1:I always have it every morning. That's a little thing. Coffee's an appetite suppressant. It's awesome. I always have it every morning there it is there, it is In the corner.
Speaker 3:The half-life of coffee is going to be up to 12 hours, so maybe that's why, at night too, if you can't sleep, stop the coffee like around 12.
Speaker 1:No, I just have one, okay, and I don't even drink the whole thing.
Speaker 3:Okay, good, I'm like, how do you know? Like espresso, right, yeah, he's like I can see it.
Speaker 1:Yeah, not happening.
Speaker 3:Yeah.
Speaker 1:All right, good All right Do we have? Any other questions?
Speaker 2:I think I covered a lot, so I think, are we going to get workups, melissa? Yes, should we do before and afters?
Speaker 1:Yeah, we should do before and afters, we'll bring that on to the done.
Speaker 2:I, I need it. I have stuff going on.
Speaker 3:Yeah, let's fix it, yeah and the dexmed zone suppression test. Remember, just make sure you know, because everybody I'm checking everybody for cushions, no matter what your weight is, you know, if you're struggling you could have it and then, when you open up your place, we'll have you back on yeah, you'll be able to promote it everybody in long island. You could go to frank and video visits anybody in the country oh awesome, yeah, okay.
Speaker 1:So like telehealth do we do tell absolutely okay, awesome so um check our show notes. So um we'll have frank's contact info yeah, we're gonna have your contact info, your email yeah, I'm at nyu now, but I'm doing video visits also, okay perfect, so we'll have all that in our notes and that way, if you have any questions about hormones or sex drive or anything, you can email Frank and you do video visits telehealth.
Speaker 3:Yes, absolutely.
Speaker 2:Ladies, Frank is cute, so you might want to and single.
Speaker 1:He's single that's right.
Speaker 3:Single.
Speaker 1:I'm trying to hook you up with my girlfriend.
Speaker 3:Single looking to mingle, let's go.
Speaker 1:But Frank is single Great guy. I've known him for a little bit and no kids never married.
Speaker 2:No baggage ladies, which is the best? Well, we might need you on, for, you know, just like dating stuff.
Speaker 3:Oh, I could totally talk to you. I could tell you so many dating stories. Oh, we'd love that. So can I.
Speaker 2:I'm on the dating app girl, she's on the dating app Are you?
Speaker 3:on no dating up here, so there's plenty of pigs right on the plenty of pigs there's plenty of horrible people out there no, but no. I don't want to be jaded with the dating no, I try to be positive. Yeah, I try to be positive, but unfortunately there's a lot of people out there that are not genuine.
Speaker 1:That's true, you know, oh, we know.
Speaker 2:There's filters, there's married people fish catfish, catfish, whatever it's called, all kinds of fish. Yeah, I don't go into that.
Speaker 3:And there's women that want an ATM, not a boyfriend.
Speaker 2:I'm learning kind of you know. So there's all kinds. Yeah, oh, there are all kinds, but there's always people out there, though. I'm not gonna give up yeah, no, ladies, they say there's a lid for every pot, right?
Speaker 1:That's right.
Speaker 2:Or like someone told me their Polish babsha, their Polish grandma, said there's a seat for every dupa. There's a seat for every S? Okay.
Speaker 1:There seems to be, I'm still looking for my seat.
Speaker 3:So I think going out is the best, because I've been going to the city a lot, as Melissa knows, every weekend To meet people there. I think it's a little bit easier.
Speaker 2:Well, I think, when you change locations, I'm working in the city now and it's so much different.
Speaker 3:Yeah, of course it is, but the problem is too, women. I feel like they're unapproachable.
Speaker 2:This is true Because you have to worry about your safety too, and safety the safety aspect.
Speaker 3:But how do we know? Just say we're at a bar. How do I know that you're interested, like a lot of men Eye contact.
Speaker 2:Oh, this is a whole other. You have to come back.
Speaker 1:Yes, we're going to have Frank back and we're going to talk about.
Speaker 2:How do you know?
Speaker 1:that you will get flat out rejected.
Speaker 3:Because yeah a lot of men are scared of that. It's you know I'm fearless, I don't care.
Speaker 1:Right.
Speaker 3:But a lot of men have fears yeah of course they do the last thing they want to do is be rejected in front of their friends or whatever.
Speaker 1:Right, yeah, Well, it was great having you on.
Speaker 3:Frank, we're going to have you on again.
Speaker 1:Oh, I like that let's go, it's awesome. Frank's our resident doctor on the show. So when we have questions we're gonna ask Frank. Thank you for coming and thank you for joining us with Dating Daycare. Make sure to check the notes and if you have any questions, we'll have all Frank's info and we'll see you next week, okay, bye, bye.
