Menopause 101 for Men: Jennifer Gularson Explains All

[Uncle Marv]
Hello friends, Uncle Marv here with another episode of my Unhealthy Podcast. It's the show where we look at the realities of unhealthy habits, unhealthy lifestyles, and we try to transform them so that we can do everything we can to live healthy and be happy. That's right, folks, we are back.

And I have with me today Jennifer Gularson, and this is going to be a little interesting conversation. So let me first just welcome her to the show and we'll jump right in. Jennifer, how are you?

[Jennifer Gularson]
I'm doing great. Thank you so much for having me.

[Uncle Marv]
So I should probably at least get the official, you are a board certified physician assistant and you work in functional medicine and aesthetics, but you're mainly known for something called HRT.

[Jennifer Gularson]
This is true.

[Uncle Marv]
Hormone Replacement Therapy.

[Jennifer Gularson]
Yes.

[Uncle Marv]
And I'm just going to be a man as much as I can and say the biggest topic that that understanding comes from me is the word menopause.

[Jennifer Gularson]
This is true. You are in need of hormone replacement when you are in menopause.

[Uncle Marv]
Okay. So this is a topic and I'll let the listeners in on a little secret. So I attended a podcast convention in January and I remember talking with another guest, another podcaster there, and she said, yeah, we're going to talk about menopause on your show.

And I'm like, no, we're not. And for some reason I have talked to five, six, seven other people and the word menopause has come up so much. And I'm like, you know what?

The universe is talking. So Jennifer, you are the first person that I am talking menopause with.

[Jennifer Gularson]
Yay. That's so exciting. You're going to dive right in.

You're jumping in the deep end.

[Uncle Marv]
Yes, I am. Now let's just, you know, be clear. Most men are afraid to talk about menopause and there are many reasons why.

And a lot of times it's because we are so afraid of how our spouse is during that time or we've been conditioned to think that that is a horrible time. And I have learned that there are different phases to menopause. So I'm going to ask you to just do the basic menopause 101 for men and help me and my listeners understand what is it that, what is it we need to know?

[Jennifer Gularson]
Right. So I think, you know, one of the reasons that maybe the conversation, it's turning, it definitely is with some really big names, Halle Berry and Oprah, Naomi Watts, and a lot of people are talking about their experiences, which is great. Sometimes it takes that level of celebrity to bring attention to a subject.

But one of the things I feel like we do to women and what society over time has done is the things that happen to us, and I'm just going to bring up menstruation, like having your period, it's, you know, shushed about. It's something to be embarrassed about. It's something that happens every month, but we don't really talk about it.

And then all the derogatory things like, oh, she's on her period. No wonder she's being a pain or she's moody or she's, you know, whatever. So it starts with that.

And then if you layer on a whole nother layer of that is the stigma of a woman no longer being able to bear children. And that is a, if they, you know, never had children and then now they can't, or if, you know, they were hoping maybe for a third, fourth, fifth, or whatever that is. There's sort of that stigma that you're no longer needed.

And honestly, when you think about it, and I say this all the time, it's almost as if, you know, your ovaries stop working. It's as if mother nature doesn't need you anymore and you're cast off. You get wrinkly, you get saggy, you get your brain stops working and you get sort of dried up.

I think that women just aren't talking about it and we didn't because we didn't have a lot of options. But I think the conversation is turning and it does take a lot off of the female partner with the male partner to take that conversation to the next level of intimacy and to help them wade through that time. So that's why I think it's happened.

But I think men also need to be vulnerable and feel uncomfortable asking the questions. But then the women also have to have the answers in order to answer their partners.

[Uncle Marv]
Right, right. Now, is this something that has kind of happened over the years as women have become more independent, they're more part of the workforce? We have to deal with these things now because women are working.

And we now have to acknowledge that these are things that have happened. They're part of life.

[Jennifer Gularson]
Right. Yes. But I also think something really critical has happened and it may have taken COVID for it to happen is that women were sort of asked to take a pause, a literal pause, and to take inventory and then take a look at their health.

And then when the world sort of slowed down, they kind of were like, wow, I was on a roller coaster and now I have time. And I also think that that specific epidemic happened, COVID happened. And at the same time, a really pivotal study came out at the end of 2019 that had a look back at the Women's Health Initiative.

So the Women's Health Initiative was something that was started in the late 1990s and 2000s, that looked to see how do we do better for women's health. And recently it's been in the news because Trump said he was going to defund it, but he refunded it. But it's really a longitudinal study.

So we've been studying women for 20 years and a small, small part of it was whether we should put women on hormones. Does estrogen really help women? Is that the answer?

Do they need to take hormones? The study was flawed in many ways, and I can go into more detail about that, but the study was flawed. But now we have 20 years to look back and we think we now know that the dangers of hormone replacement is not as great.

But we have two decades of healthcare providers that have been taught that hormones are dangerous and now these are the veteran practitioners that, like me 20 years in, that people want to see. You have 20 years of experience. They think you know everything.

You've had a lot of experience. But they haven't gone back to relearn hormones, which is something that I've, out of necessity because my patients need it, I've taken extra time to relearn all this. But I can tell you they're not teaching it in medical schools.

They're not teaching at PA schools currently. So we have a long time to turn this dogma around. But that study showed that hormones weren't as, they weren't as dangerous as they thought.

Then we have a lot of women leaders in medicine who had a little extra time on their hands because they weren't necessarily busy with seeing COVID, you know, because of COVID, they weren't seeing as many patients. And they had time to start podcasts and write books about how we need to help women. So the conversation is increasing.

But I could, I feel like I scream from the rooftops and there are so many people in the space talking about it. But I had a patient in my office today crying because she says, I wish people were talking about this more. And I'm like, how can we talk more?

We're talking, I talk about it all the time. So if the women start talking amongst themselves, which they're doing, eventually it trickles down to home and then with our husbands, and we just need a vulnerability and open mind. And it's not gross.

And it's not, it's not silly. And it's not all in our head. And to be believed is I think the most, and received and understood is like, I think that's what women want from their partners.

[Uncle Marv]
All right. So there's a lot to unpack there.

[Jennifer Gularson]
Sorry about the long winded answer.

[Uncle Marv]
That's quite all right.

[Jennifer Gularson]
It's a complicated, it's how we got there is sad. And then to try and fix it is a bigger issue.

[Uncle Marv]
So I mean, let me at least address the study that you talked about. So the Women's Health Initiative, that was the one started in 1991. Is that right?

[Jennifer Gularson]
I believe so because they closed, it was mid-nineties and they accrue. So they start a study, but then they start accruing different facets of, and one small section of that was hormones.

[Uncle Marv]
Okay. Now, did that study specifically start out to study hormones? Because I thought it was kind of like a broad spectrum.

[Jennifer Gularson]
Yes. A huge, broad spectrum of it. And then in a subset is hormones, whether to take them or not, and whether they prevent chronic disease.

[Uncle Marv]
Okay. So let me ask the question that goes back a little bit further. When did hormone replacement therapy even start and why?

[Jennifer Gularson]
Cool question. So it actually, if you look back into ancient texts in China and Japan, young men and women would urinate into cisterns, which collect the urine. And when you evaporate the liquid out of urine, you actually get minerals and things.

And the empresses and emperors would drink, take those crystals, the dried urine and sprinkle them into their teas as an elixir. So I think that that is like the earliest form of bio-identical hormone replacement because we excrete byproducts of hormones in our urine. That's actually how we test a lot of our urine or some of our hormones.

We can test it through the urine. So that was way back. But then we have studies of people using ovaries of animals and taking those.

We do that now with armor thyroid, which is a thyroid medicine. It's a pig thyroid that we desiccate and then we create a pill for it. So I think it goes way back, but when did we really, really start doing it?

When they had the estrogen, oral estrogen pills back in the forties and fifties. So even into the fifties, sixties and seventies, eighties, the estrogen was like the number one or two prescribed medication for women. Not statins.

We didn't even have those yet, but not any of the products.

[Uncle Marv]
I have no idea what you just said.

[Jennifer Gularson]
Yeah. So way back.

[Uncle Marv]
Okay.

[Jennifer Gularson]
Then we had the study and then it went from 60 to 70% of women being on hormones to today, depending on the study, it's between five and 8% are on hormones.

[Uncle Marv]
Really? That big of a drop?

[Jennifer Gularson]
Look where our chronic disease in women is now.

[Uncle Marv]
Interesting. So all right. So I'm thinking part of that study, so it was the hormone replacement, but there was a whole thing on diet modification as well.

Right? Correct. And was it something where we thought, well, we don't need to do the hormones.

Let's do diet modification. Let's do other things because we think so badly of hormones.

[Jennifer Gularson]
Yeah, there were definitely all parts of this. And like I keep saying, like it was a small part was this hormone arm of it. There were different arms of it and the hormones were one of it.

It was like, okay, does diet and exercise alone decrease chronic disease? Does blood pressure lowering decrease chronic disease? It's why are women aging and what parameters should we be studying and what works to prolong life and what works to have less cancer, less chronic disease, less events.

A part of that study was if they take hormones, do we decrease those events in the long run? And actually now that we, you know, are moving forward and looking 20 years back, even though that study stopped early because of the fear of breast cancer, which turned out to be not such a big deal. We now know that the women who took the hormones, even though they're not the same hormones we prescribe today, but it was what we had at the time.

Those women do better long run, i.e. they have less bone fractures, they have less cardiovascular events, heart attack, stroke, and less cancers.

[Uncle Marv]
Okay. All right. That's, this sounds too scientific for me to continue, but I do want to get back to some of it because I do think it's important, but I want to take a step back and talk about this from this perspective of men.

So let me first, let me first ask you this, because it sounds like this wasn't like your college goal was to study HRT. So let me first ask how this ended up being your, I don't know, passion. Is that what you call it?

[Jennifer Gularson]
Yes. So I worked in traditional medicine. I did liver disease.

[Uncle Marv]
Straight family medicine.

[Jennifer Gularson]
And then, yep, I did internal medicine, oncology, and then worked at a med spa. So I wanted to do just aesthetics, which I still do now, Botox and fillers and stuff. And it just so happened that my practice that I joined and I was blessed to have joined was owned by three women.

One of which was a physician who was going through menopause. She found herself screaming at the checkout stand and it was like, what is happening with me? So she went on her own personal journey at that time.

I was only like 35, 37 years old, but went through a personal journey of her own and said, I want to start doing hormone replacement for myself and did it on herself and her sisters first and then opened it up to the rest of the practice. And that was back in 2008, nine, 2010. So not a lot of people were doing it.

So then to help support the practice, I just started doing that and I became educated and I just saw how much we help women and how changed their lives can become. So I sort of out of necessity, I sort of got a niche and I did, you know, I learned more and I saw I could help people. And then it was word of mouth.

And then, you know, it's kind of like once you find, you know, in that little group of people, they start talking and they're like, well, I don't feel good and I don't like sex anymore. And I don't I don't know. Maybe I need a divorce.

Maybe I need to find a new job. I hate my kids. I hate what I'm doing.

Like just all I can't sleep. I'm gaining weight. None of my clothes fit like all they start talking about that stuff.

And then they're like, oh, I see this girl and she does a good job.

[Uncle Marv]
All right, so half of that stuff just described me, but I don't know.

[Jennifer Gularson]
There is andropause, which is like male menopause where your testosterone starts to decline.

[Uncle Marv]
OK, so let's go ahead and do this. So the whole thing that I think we need to do is help men understand this whole concept of menopause and you just andropause. Is that what you said?

[Jennifer Gularson]
Andropause. Yeah.

[Uncle Marv]
OK, never heard of that either. So let's start with that. And tell us about all the pauses that are out there that we should know about.

[Jennifer Gularson]
OK, so when men are aging, I have this scenario and I think some men said they resonated with it, but wives resonate more. So women have this thing, a monthly cycle. So we're used to be going to the doctors.

We have kids. So we're used to we go to the doctors and we take care of ourselves, if you will. We tend to go to the doctors more.

Men, I feel like you are the brand new car off the lot and you have the hundred thousand mile warranty. So you don't have to do anything really maintenance wise to yourselves until the wheels start coming off. You start, you know, getting a little pudge.

You can't perform in the gym.

[Uncle Marv]
What's that smell?

[Jennifer Gularson]
You can't sleep. You're getting angry and irritable. You're yeah, maybe the libido goes down.

You're just not happy work. You're like not as bright, you know, functional at work. So that is a decline depending on depending on what's going on with you.

A lot of lifestyle choices tend to exacerbate that slow decline of the testosterone. If you are impeccable in your lifestyle choices, diet, exercise, stress, sleep and relationships, then you can maintain that. I don't need to do checkups for a really long time.

But, you know, men get away with a little bit more than women. And the women all the time are like, my husband stops drinking soda. He loses 20 pounds.

I gain five. You know, you guys have a better metabolism. But there's a lot of environmental things.

The things we put on our skin, the things that we imbibe, the things that we eat, the stress that we're under, all the chemicals out that we breathe in. They all are sort of attacking, if you will, the man's ability to make testosterone. And if you look at studies of men's testosterone over time, starting in like the 1900s to now, there has been a slow, slow, slow, steady decline with the way, as we get more industrialized and we get more access to food and poor food choices and lack of exercise, increased technology, less exercise, more convenience, less exercise, the testosterone decreases.

And as that happens, your muscle mass decreases, your brain capacity decreases. We all know you can't multitask. I'm just, I'm giving up.

I wasn't listening. What? Yeah, I know.

Exactly. Libido will decrease. And then your metabolic system gets a little bit worse.

Like you could become more insulin resistant, your cholesterol increases and gets worse, your plaque and you're just more susceptible to those things. So there's testosterone replacement. I'm sure you've heard of that.

You can replace the testosterone.

[Uncle Marv]
Well, yeah, but the only time we hear about that is when you see those low T commercials and it's always and your wife will like it, too. Yeah, I mean, that's that seems to be the only the only selling point that they're giving us is that, you know, you're feeling sluggish and you're not performing in the bedroom. So.

You know, you've got low T.

[Jennifer Gularson]
Right, so I always try and make it about everything else, the cardiovascular risk, your risk of depression as you are there, there are studies as your T decreases, there's a there's a point where increased rate of depression and suicide. I think if your total T is like under 300, that you're at a very, very high risk of depression and suicide. Then there's like the next thing up, like under 500 cardiovascular disease risk.

And it's sort of stepping up from there. So as that testosterone decreases, then your risks of chronic disease and all the things that you're describing, the low libido and this not sleeping, all of that increases.

[Uncle Marv]
All right. Now, since men don't go to the doctor.

[Jennifer Gularson]
Correct.

[Uncle Marv]
The only time they're going to figure this out is when their wife or their spouse or their significant other tells them to go get checked out. What would be a normal way for a man to find out about their level of testosterone? And first of all, what is normal?

[Jennifer Gularson]
Right. So for men, you can get blood drawn and find out what your level is. It's best to do it in the morning.

That's like you're you know, that's when you're in the highest point and it fluctuates day to day. So for men, and I'm speaking in generalities for men, most men feel good and are metabolically good with a total testosterone. This is a serum testosterone.

And I'll just tell you the difference. Total testosterone between six, seven hundred and like eight, nine hundred. Now, what is the lab value that you look on the chart when you look in your when you get your lab value?

You probably, depending on the lab, it'll start at like three fifty maybe and go up to eleven hundred. So that's a really wide margin, but there's normal and then there's optimal. So it depends on what you want to be.

But there's a second part of that story. That's just one number. That testosterone is bound in your serum and your blood by proteins.

And think of it as testosterone. It's in the testosterone bank. You really can't get it.

But there's a certain percentage of that testosterone that is free. So you have to ask your doctor to do a total testosterone and a free testosterone. That means that's the money in your wallet, in your pocket, ready to spend.

The free testosterone is a better indicator of where you are. So I had a patient today who had a total testosterone of five sixty six. He's 67 years old.

That's normal. But his free testosterone was something ridiculous. And it was a different lab that I usually don't use.

But let's just say it's say it's between one and twenty one is normal. He was on he was two. So his primary didn't get the get the free, but I ordered it.

So he's going to try and go back to the primary care because the primary care says, oh, look, you're five eighty eight. You're great. But his free is very low.

And he's symptomatic. He's losing muscle. He can't perform.

And he just wants he's like, I just want to stay young. So those are the that's the test that and there's some other tests that you should probably do. But those are the two biggies that let you in on like, yeah, my serum is seven hundred, but my free is really low and I feel like crap.

OK, and that would be an indication.

[Uncle Marv]
So let me ask this question before you move on. Is there. Something that we can do in our normal lives that would keep our testosterone levels up because you said protein, it almost means like, well, if I eat enough protein, that would help.

[Jennifer Gularson]
Yes. Protein is in the serum that is bound to the testosterone. But yes, it's that that those lifestyle changes that I know that you've made in your life is the sleeping, the food, huge, huge food.

And what's your insulin resistance? If you are pre-diabetic, then your testosterone is probably going to be low. If you if you're so in sleeping and lifting heavy things.

So having a weight program, lifting heavy weights increases your muscle mass, which increases your testosterone receptors and helps with your metabolic and your insulin receptors, helps with your metabolic system and what makes you less insulin resistant. So it's sort of like all the underlying things, which is functional medicine. We're looking for the underlying cause of why you're feeling crappy or why you have this disease and why you have this chronic disease, doing all that first and then, you know, seeing like, well, maybe, you know, you're older, 70, 65, 70, and your testosterone is low.

And if you're impeccable and everything else, then you should consider maybe trying some testosterone replacement with the caveat that once you start it, you're pretty much on it for life.

[Uncle Marv]
OK. You made a couple of things in there. You probably didn't listen to the beginning of my show when I talked about one of my goals was to never go back to a gym.

[Jennifer Gularson]
Well, you can carry bags of mulch around your yard. You can. And if you're in your I know you're in Florida, if you have like rock garden or whatever, you carry heavy rocks around.

You can do, you know, fireman's carries and farmer carries, suitcase carries dumbbells, things around that you can you can lift heavy things and work out.

[Uncle Marv]
That's just like I might as well just work out at that point.

[Jennifer Gularson]
Yes.

[Uncle Marv]
So, OK. All right. So there is this male menopause called andropause.

So we need to be aware of that. It exists and it's sounds pretty serious in a sense that if we don't pay attention to it, we're going to decline. So.

Yes.

[Jennifer Gularson]
And if your partner says that you are snoring and that you may have sleep apnea, get a sleep study, please, because having sleep apnea puts you at risk for lower testosterone and cardiovascular disease, meaning heart attack, stroke.

[Uncle Marv]
Wait a minute, it puts you at risk, so it's not like a symptom that. That doesn't sound right.

[Jennifer Gularson]
So a symptom of. If you have sleep apnea, you are at risk, it increases your risk of cardiovascular disease because you're not oxygenating your brain. OK, so it can also clue you in that if I don't fix my sleep apnea, I may get lower testosterone, so I may want to fix that.

I know sleep apnea is a pain in the butt to sleep with, but it definitely will help you in your overall health and lengthen your life.

[Uncle Marv]
OK, does that work the same for her? So if she snores.

[Jennifer Gularson]
Yes. So you're getting decreasing your oxygen to your brain, increased risk of dementia, heart disease. Yes.

[Uncle Marv]
OK. Make a note to myself to let her know that it's yeah, sleep studies. OK.

All right. So now is that the only male pause that we need to worry about? Because I know that the women have many pauses.

[Jennifer Gularson]
Yes. And one thing that I think is interesting is that everybody complains that like women's skin gets like saggy and wrinkly and stuff and men sometimes, too. But the thing you have to remember is that men have testosterone until they die.

Even if it declines, they have testosterone. Testosterone gets aromatized or turned into a little bit of estrogen. So men do have estrogen in their body, not to the extent that women do or the levels that women do.

But all your life, you do have a little bit of estrogen and it keeps going and keeps going. Whereas when we when our ovaries stop, we have zero estrogen. None.

That's why we get wrinkly and dry and all that stuff. So one thing to remember is that estrogen is good for both men and women. Testosterone is good for men and women.

So if men have a female partner who is getting hormone replacement and they have testosterone, they're getting testosterone, we need it, too. So it's not just a male hormone.

[Uncle Marv]
OK, I'm going to ask a question because. So I played sports growing up and one of those one of those. I don't want to say bullying comments, but one of those male egocentric comments was, you know.

That if you weren't strong enough, you weren't fast enough, it's like, oh, you got too much estrogen. And you just said we're supposed to have estrogen because I grew up. I grew up thinking we weren't supposed to have it.

[Jennifer Gularson]
Now, just a little bit.

[Uncle Marv]
OK.

[Jennifer Gularson]
Yes. If you have too much. So if any of you guys and I do realize and I just want to say this, that I am a female and I, you know, I was never a male.

And I get kind of frustrated with when men talk about menopause because they're not they don't understand. But so I'm saying this having treated a lot of men. But I just thank you for the grace for letting me say this.

So when a man injects testosterone or like when you're in the gym, I'm sure in the nineties and whatever, when you're injecting steroids or testosterone, a lot of men will take an estrogen blocker because they're pushing that physiologic level of testosterone, which I don't do and I don't recommend when you push it that way. A lot can go down that pathway. And that's when you get the man boobs.

But you can also get man boobs and you can take your testosterone and make it convert into estrogen if you are overweight, if you have insulin resistance. So when you get that coach and you're pre-diabetic, you are more. Your estrogen is going to increase a little bit because your insulin resistance is going to increase also.

[Uncle Marv]
OK, so I did not take steroids, so I did not do any of that. So my pooch in my man boobs might be related to my estrogen.

[Jennifer Gularson]
Yes, you say it's something I test.

[Uncle Marv]
OK. All right. So let's do this, because I knew we were going to have this stretch into multiple episodes.

This feels like a natural breaking point. But I do want to since this is probably going to be titled something menopause one on one for men or something like that. Let me ask before we take a break and move into the next part.

What is, in your opinion, probably the biggest thing that men need to know around this entire topic about menopause?

[Jennifer Gularson]
As it pertains to women or pertains to them in their own health and their.

[Uncle Marv]
Well, let's stay on us since that's where we were. Let's start with us and then we'll talk about the women in the next episode.

[Jennifer Gularson]
So for men, taking control of your health is a big thing because they don't go getting knowing your numbers, cholesterol, all your heart markers, your blood pressure, your hemoglobin A1C, like know your numbers and don't be afraid of them, because if they're off, you can fix them. They just and the younger you are, the better. So gathering information and gathering information over time is also really good.

If you know at age 40, you were here and now you're 50 and you're here. How are you progressing? And then, yeah, know your testosterone numbers, know your free testosterone and keep the healthy lifestyle, sleep, stress, gym, exercise, relationships and your food.

It's it sounds simple, but it's hard, especially in a stressful, entrepreneurial, you know, kind of way.

[Uncle Marv]
Yeah. All right. So, Jennifer, thank you very much for that.

I want to say enlightening, but it's a little troubling as I start to understand that you were under the 100000 mile warranty. Yeah, I was at I'm at ninety. I got to get it checked.

So, OK, so Jennifer Gularson, board certified physician assistant. So you are you certified in functional medicine as well?

[Jennifer Gularson]
I am through the Institute for Functional Medicine. Yeah.

[Uncle Marv]
OK. And do you have a nice, holistic patient centered approach focused on. Uncovering and addressing the root causes of health issues, right?

[Jennifer Gularson]
This is correct. Yes.

[Uncle Marv]
OK. All right. So thank you for part one of our discussion on menopause.

We're going to take a break and come back and record part two. And we'll dive into the other side and all the things that we needed to know both as men and as women when it comes to menopause and hormone replacement therapy. So, Jennifer, we'll see you in a little bit.

[Jennifer Gularson]
OK, thanks.