63. Q&A: HRT, MOTS-c, and Cholesterol

0:00Welcome to the NERSHA Thrive Podcast, Faith Forward Science Back Strategies for women who want more energy, less weight, and real answers. I'm your host, Tonya Pennington Miller, a functional nutritional therapy practitioner and functional blood chemistry specialist with a master's degree in applied clinical nutrition. If you're tired of feeling dismissed by your doctor, confused by your labs, and stuck in survival mode, you're in the right place. Here, we simplified the science. We get to the root, and we anchor it all in truth, because God made your body to heal and thrive, not just survive. It just needs the right kind of support and less noise. Hello, hello, my friend. Welcome into the NERSHA Thrive Podcast. I'm so glad you're back with me today. So we are kicking off September the same way that we have started the last couple of months, and that is with a Q&A episode. So it really seems like you're loving this new style that we've

1:01been doing where we start the month with a Q&A, and then we really get the opportunity to go deeper on one of those topics that are sent in for the remainder of the month. And I'm loving it because it's really allowing us to go deep on topics rather than just touching on the surface of a lot of different things every week. So today I have three questions, and one of the questions is going to set us up for the rest of the month, because we're doing a full series on HRT for the next three weeks. So today will be a bit of a preview of what that conversation is going to look like. So question number one came from a woman who is 47. She is currently on HRT, an estrogen patch, progesterone, and testosterone. Now I don't have all of the information on delivery systems for the progesterone and the testosterone, but we're just going to do the best with the information that we have. So she's feeling significantly

2:03better than she was, but she's dealing with some side effects that are they're pretty hard to ignore. So she's seeing some acne, some hair loss, specifically since starting the testosterone, and she's wondering if there might be more natural approaches that might be just as effective. And whether there are things that she can do to address the side effects, because she feels like she shouldn't have to choose between feeling better and also dealing with what, you know, she's now experiencing on her skin and in her hair. So first of all, I want to say she's absolutely right. So women should not have to choose, and I want to spend a moment here before I go into more depth, because the full answer to this question is genuinely the whole series that we're going to do in September. Okay, but let me give you the quick version today so that you understand what is happening here. So the acne and hair loss that she's experiencing from the testosterone is almost always a DHT conversion issue. So when testosterone is introduced into the

3:12body, some of it gets converted into dihydrotestosterone, which is a more potent androgen. And some women convert more aggressively than others, and that is largely genetic. So DHT is what drives androgenic side effects like oily skin, acne, that looks and feels different from hormonal hair loss. So it's a very specific mechanism, and there are very targeted things that we can do about it. The first thing I would want to know is how much DHT she is actually making. So you can do a Dutch test here, which is a comprehensive urinary hormone panel. So it's going to show you exactly how your body is metabolizing the testosterone that you're trying to give it, and whether it's converting aggressively into DHT. So that's the question to answer before anything else. I can tell you,

4:12so often when a woman is experiencing hair loss and she's on some form of testosterone, so often when we get that Dutch test back, we can see that she is converting a higher amount of her testosterone into DHT. And if DHT is running high, there are some natural options for inhibiting the enzyme that is responsible for that conversion. So that enzyme is called 5-alpha reductase, and it is what converts testosterone into DHT. So saw Palmetto is the most well-known natural 5-alpha reductase inhibitors, and it has pretty decent evidence specifically for androgenic hair loss, which is the type of hair loss we're talking about here. And then pumpkin seed oil works through a similar mechanism and also has research for hair thinning as well. There's also spirament tea, and it has anti- androgenic properties as well, and some evidence for reducing DHT. And then nettle root is another option in this same family. And also zinc reduces

5:185-alpha reductase activity as well, which makes it another low risk and broadly beneficial addition. None of these supplements are going to completely override this process, so you really want to make sure that you're working with your practitioner to optimize the dose and the delivery method of your testosterone. And if you've done DNA testing, that includes your SRD5A variants. That information is incredibly useful here too, because it tells your practitioner exactly how aggressive of a converter you are by design. So that information is available on the DNA test that I provide in my DNA reset for fat loss academy. And this is one of the reasons why we include that. So these natural options really can help to reduce the side effect burden in the meantime. But again, you really want to make sure that you're working on finding the right dose and the right delivery system for you specifically. Now, do I think bioidentical hormone replacement therapy has value? I do.

6:25But I also believe strongly that the foundational work is so incredibly important to do prior to getting on a hormone protocol. And that includes understanding your SHBG, your sex hormone binding globulin. Knowing this particular number can really help to explain why some women will get on 100 milligrams of progesterone and they will sleep like a baby while another woman needs 800 milligrams to get that same effect. So we're going to go deep on that in episode 64. So stay tuned. And there are also some natural approaches for women who are not yet on HRT or who just aren't quite ready for it yet. And so we're going to dive into some of that this month as well. So if any of this is landing for you, whether you are on HRT and dealing with any side effects or you're thinking about starting it or you're looking for some natural support kind of in the waiting, then September is going to be a big month for you. So make sure you come back every week.

7:29All right, question number two. I keep hearing MOTS C described as exercise in a bottle. And that really caught my attention because my energy and fatigue have just been stuck no matter what I do. I am 52. I actually tried MOTS C and didn't notice much of anything. Am I doing something wrong or is this peptide just not for me? Okay, I love this question. And I want to start by explaining what MOTS C is actually doing because the whole quote unquote exercise in a bottle description is pretty compelling, right? But it needs a little bit of context here. So MOTS C is a peptide that is derived from the mitochondria. So specifically from mitochondrial DNA. And it works primarily by activating an enzyme called AMPK, which is the same enzyme we talked about in episode 62, I believe, when we covered burberine and the hydro burberine. Okay, so AMPK is like a metabolic switch. When it's

8:31activated, it improves insulin sensitivity. It supports mitochondrial biogenesis. And it shifts the body toward using fat as fuel more efficiently. Exercise activates AMPK, too, which is where this exercise in a bottle description comes from. So it's actually mimicking some of the metabolic signaling that exercise produces. Now, why did she not notice anything? And this is the part that I think is really important because she is definitely not alone in this. And there's actually a very specific reason this happens. MOTS C works by activating and energizing the mitochondria. Here's a thing. If the mitochondria themselves are damaged, you can activate them all you want. And you're not going to get the result you're looking for. And listen, mitochondrial damage is really common in women over 45 women over 50 because mitochondrial function declines with age. It declines with

9:31chronic stress. It declines with accumulative oxidative burden. So for some women, MOTC is like hitting the accelerator on an engine that has a cracked block. The signal is there, but the machinery can't respond the way that it should. This is where a different peptide comes in called SS31. So SS31 targets something called cardio-lippin, which is a lipid found on the inner mitochondrial membrane. And it's critical for mitochondrial structure and function. So cardio-lippin gets damaged by oxidative stress over time. And when it is damaged, the mitochondria can't produce energy efficiently regardless of what signals they're receiving. So SS31 essentially helps to repair and restore the structural integrity of the inner membrane. First, it's the repair before the rebuild. And once that foundation is in place, once the repair has been done, then MOTC has something to

10:36actually work with. What the research and clinical observations suggest is that for women who have tried MOTC and felt nothing. When they have instead started with SS31 to address the mitochondria membrane integrity, and then added MOTC, the response tends to be significantly different. So, again, SS31 does the repair work first, and then MOTC has something to actually activate. Again, like I've said in every episode, both of these are research use only peptides and not mainstream interventions. So I will leave a link in the show notes to the same research use only resource that I shared in episode 62 for anyone who wants to explore further here. But I really hope that that helps to answer your question. So feel free to reach out more if you have any deeper questions on that. Okay, question number three, I started an estrogen patch and progesterone

11:37about two months ago. And I'm already feeling so much better, but my doctor just ran labs and my LDL went up. She's now talking about putting me on a statin on top of the HRT. Could the hormones be causing this and should I be worried? Okay, this question is actually the perfect bridge between the cholesterol series that we just wrapped up and the HRT series that we are embarking on next week. So I want to spend some time here because there's a lot going on. So let me give you let me give you three layers of what could be happening. So the first is the form of delivery of the HRT, which I kind of touched on a little bit earlier. So she mentioned that she's on an estrogen patch, which is actually the more liver friendly route for estrogen delivery. Trans dermal estrogen doesn't have to go through that first past liver metabolism the way that oral estrogen does. Okay, which means it tends to have a more neutral or even positive effect on the lipid picture. So the patch itself is probably not the culprit here, but I always want to know what

12:43a form of progesterone someone is on as well because bioidentical progesterone and synthetic progestins have very different effects on HDL specifically. Synthetic progestins can lower HDL, which then shifts the overall lipid picture. And if her doctor sees a shifted lipid panel and jumps to a statin without really asking some more questions first, I would suggest pumping the brakes on that conversation before agreeing to anything. Okay, the second layer is phase two liver detoxification. And this is one that I feel really strongly about because it's almost never discussed in the HRT conversation. We talked about phase two liver detox in episode 62 in the context of broccoli sprouts and sulforaphane. And here's why it's important in the HRT picture. When phase two liver detox is not working optimally, estrogen metabolites that should be conjugated and excreted, don't get

13:48fully cleared. They get recirculated instead through a process called enterohapatic recirculation. And when the liver is backed up processing partially metabolized estrogen, its capacity to handle other functions, including producing LDL receptors and managing cholesterol metabolism, becomes compromised. So the LDL going up may have a lot less to do with the hormones themselves and more to do with the liver's ability to process everything it's being given. So supporting your phase two liver detoxification is foundational to any hormone protocol. And this is one of the reasons I talk about doing the foundational work before layering on the HRT. And that is really, I think the bigger takeaway from this question. The LDL picture after starting HRT is telling us something important about what was already going on underneath before the hormones were introduced.

14:52What the liver is doing, how well the detox pathways are functioning, where the blood sugar and insulin are sitting, what the stress load looks like. All of that creates the environment that determines how your body is going to respond to any hormones you give it. The women who do that foundational work first tend to need lower doses to get the same effect and deal with fewer complications that come up afterward. And that is exactly where we are going for the rest of the month. So don't miss it. Yeah, I always say when you do the foundational work prior to hopping on HRT, hopping on HRT is like topping off, right? Instead of having to like fill the full gas tank, it's like we just have to top off that top layer. And I think it's nice when you don't have to be on such a large dose of hormones. So anyway, stick around. Isaiah 40, 28 and 29 says he gives

15:53strength to the weary and increases the power of the week. And you know, I've really been thinking about that verse and what these three questions that we answered today have in common. Because when I read them together, what I see are women who are exhausted. The woman managing HRT side effects while trying to feel like herself again, the woman at 52, whose energy will not budge, no matter what she tries, the woman who started hormones and thought she was finally getting somewhere only to have a new problem show up on her labs. You know, there is a weariness in all of that. There's a kind of fatigue that goes deeper than just being tired. The kind that comes from trying hard and not getting the results you expected from asking your body for more than it has felt able to give. And I find something really grounding in this promise that strength is not

16:57something we manufacture through effort alone. That the God who designed this body also knows every place where it is depleted. And that restoration is available even in the places where we have been running on empty the longest. So to every woman who came into September tired of the side effects of unexplained fatigue of labs that do not match how hard you're trying this month is for you. And the one who gives strength to the weary already knows exactly what you need. I would love to pray for you today before we close. Lord, I lift up every woman who is listening to this today who is carrying that deeper weariness. The kind that comes from trying hard and not getting the results she expected from asking her body for more than it feels it is able to give. I ask that you

18:02would meet her right where she is that she would feel the presence of the one who designed her. And who knows every place where she is depleted. Lord, would you give her strength that she needs for this season? Would you give her the wisdom to ask the deeper questions and the courage to advocate for herself? And may she know, Lord, that even in the middle of this that restoration is available because you promise it. And you're a glorious name we pray. Amen. Okay, so next week we are starting our September series on HRT. And I think it's going to be a really good month. We are covering the foundational work that needs to happen before and alongside any hormone protocol. We're going to cover the natural approaches for women who are not yet ready or maybe who aren't a candidate for HRT because not everybody is. So I hope that you'll come back

19:07every week this month. And if you have questions about HRT that you would love to hear answered, please send them to me on Instagram at taunya.pennington.miller. Again, I genuinely read every question and your questions help to shape what it is I teach on this podcast. So and if this summer of content has you thinking seriously about doing the deeper root cause work, including running the right labs, doing DNA testing and actually building a personalized protocol around what your specific body needs, that is the work we do inside of my DNA reset for fat loss academy. So the link to that wait list is going to be in the show notes again for you as a reminder enrollment will open early 2027. So thank you so much for spending time with me today and I will see you right back here next week's sister. That's it for today on the NERSH to Thrive podcast. If you found value here, I'd love for you to subscribe, leave a review or send it to someone who's walking a similar path. Keep showing

20:11up, keep asking questions and know that healing is possible, especially when you trust the one who designed your body to heal. Until next time stay rooted in truth and nourished in grace.