See all The Referral with Dr. Karan transcripts on Applepodcasts

This is The Referral with me, Dr. Karan, and in this podcast, we talk about all things science, health and medicine, how to make your life better, how to make your life easier, how to live life more happily, and more importantly, disregarding all the misinformation and pseudoscience you see out there and also talking to interesting guests, to world-leading experts, to scientists, to doctors and taking their take-homes so you can apply it to your daily life. On today's episode, we're going to be covering a condition that can increase the risk of heart disease, dementia, and even early death. And it's been around with humans, well, for as long as we've been humans. And some of the symptoms are pretty insidious.

Weight gain, low mood, anxiety, headaches, memory problems and even worse. And it affects 50% of people at some point in their life. Now you're probably thinking, such a serious condition, it's probably got millions and millions of research money pumped into it. Well, sadly, no. This is the menopause and perimenopause state.

And today I'm gonna be joined by British GP, Dr. Louise Newsome, who is a menopause specialist, and she's helping to improve education around the perimenopause and menopause and hopefully de-stigmatise this crucial condition.

What are the risks of not taking HRT? And that's what we're not talking about. Why is no 1 thinking about their hormones? If you think when someone's pregnant, 9 months of their life, the amount of investment we give to pregnant women is brilliant, but we should be doing that more for other women. We shouldn't just be making them invisible.

I'll be answering 1 of your questions in CrowdScience. If you have a burning desire to get in touch with me and ask me a question, drop a note at thereferralpod.com. Also in the run-up, if it ducks like a quack, the bit where we debunk nonsense, myths, and general useless information. But first, you know what time it is. What the Health.

What the Health is going on in the wide world of science, health and medicine. This is groundbreaking stuff and it might sound a little bit dystopian. Bear with me now, synthetic embryos are here. Scientists have created synthetic embryos using stem cells that bypasses the need for sperm cells or even eggs. So why are scientists growing these synthetic embryos?

Don't worry, it's not to grow a farm of lab-grown babies, rather, it's to explore the impact of genetic diseases and do a bit more of a deep dive into the earliest stages of human development. Now, before we get worried that we're going to be messing around and experimenting with babies, these are synthetic embryos and they cannot be used clinically to be implanted into wombs. They do not have a beating heart, they do not have any structures resembling the brain or a gut or anything like that at all. But they do contain the same cells that would eventually go on to develop into the placenta, the yolk sac and the embryo itself. The problem here remains an ethical and legal 1 because the pace of scientific development and research has been so fast, scientists haven't had time to draw up ethical guidelines, legal guidelines and moral guidelines as well.

So the current legal guidelines in the UK and most other countries allow scientists to look at embryos and cultivate them in a lab for up to 14 days. After that point, you're not allowed to do any more. But if these synthetic embryos are not real embryos or potentially embryo-like, should they then be made to stick to the same guidelines as we do for real human embryos? Who knows. This development was announced at the International Society of Stem Cell Research and so far it's not been published, it's not been peer-reviewed, so scientists are still waiting for this data to be made available so they can comment with a bit more authority.

So it's still just a bit of a buzz right now, we need more details. Okay, this 1 might make you cringe and not in a fun way. 1 man has broken a world record you never want to break. He's got the largest kidney stone in the world. He is the proud owner of a 5.26 inch kidney stone.

That is the size of a 6-9 week old kitten, although slightly less cute. Kidney stones are solid, stone-like objects that are made of a buildup of chemicals after the kidney has filtered them out of the blood. When people have pain with kidney stones and talk about it being 1 of the most painful things they've ever experienced, the kidney stone, that phrase is a bit of a misnomer. The most common type of stone that's in the urinary tract are called ureteric stones, not kidney stones. Your ureters are the pipes which connect the kidneys to the bladder.

There are very thin pipes which measure a few millimeters in diameter. So naturally, if you've got something which is bigger than a few millimeters, it's going to cause a hell of a lot of pain. Now usually You can pass these kidney stones or ureteric stones on their own if they're 5-6mm in size, although sometimes you may need a medical intervention for those. If they're any bigger, like this guy, 5 inches, that's gonna need surgery. Although according to 1 study, there is a slightly more fun way to get rid of kidney stones, but don't try this at home.

You can ride on roller coasters. 1 study created a 3D model of a human kidney and then placed real kidney stones inside it and then took it on 20 rides of Big Thunder Mountain. And stones placed in the upper part of the passage were dislodged 20 times. Some of the classic symptoms of kidney stones include pain in your lower abdomen, in your groin, in your groin, sometimes even in your testicles, and maybe even your back, and you might even see some blood in your urine. It might be associated with a urine infection.

So if you think you've got a kidney stone, go and see your doctor. And fun fact, 1 of the most effective medications that your doctor might give you to help with your kidney stone pain is a rectal analgesia. Yes, you will receive pain relief from the bottom end. Okay, so I'm going to assume that your insides are not currently being sandpapered by kidney stones and that's a wrap for What the Health. Tune in next week for more topical science and health news.

Now, let's get onto the main topic with our guest, Dr. Louise Newson and all things menopause.

I'm Cameron Esposito, I have a lot of jobs. I'm an actor. You've seen me on ABC's A Million Little Things. I'm a stand-up comic, best-selling author, but I am no expert at survival. On my new podcast, Survivor Die Trying, we're gonna learn together.

From shark attacks to tsunamis and bad breakups, this is your one-stop shop to prepare for the absolute worst case scenario. Join me and some special guests on Survivor Die Trying, a comedy podcast that prepares you for anything. Listen and follow wherever you get your podcasts.

In this week's episode, we're gonna be talking about perimenopause and menopause. And without further waffle, we have Dr. Louise Newson in the studio with me. Not only is she a doctor and a Menopause Specialist, but she's helping to provide free science-based, evidence-based information around the menopause to help women improve the education and their own health around this period of their lives. So I'm so excited to have someone like this talking about a crucial topic.

So Louise, Dr. Louise Newson, menopause specialist, thank you so much for coming down. First of all, I want to ask, just for everyone listening at home, they're probably thinking, why the hell are we talking about this? Such a niche subject. What is perimenopause and what is menopause?

Well firstly thanks ever so much for inviting me, I'm so excited to be here and I'm loving your studio by the way, I'm very jealous, I've got a bit of podcast studio envy, I don't know if that's a thing but I am jealous. But it's interesting when we break down the words, which is what we do in medicine, isn't it? Menopause, people just think, oh, we're overusing the word, it's in the media all the time, how annoying we're done with it. Well, actually, let's break down the word. Menomenstrual cycle periods, pauses, stop.

Now, I think that's really weird in itself because what happens in the menopause, our ovaries stop working. It's often because we get older, they run out of eggs or the hormone levels are lower. Some women have a menopause very abruptly if they have their ovaries removed or damaged by drugs or radiotherapy. So it's actually a loss of ovarian function. Some people define menopause as loss of fertility.

When I'm 52, I don't actually want periods and I don't want any more children and it would be a bit unusual to be 52 and pregnant. But actually what I do want is my hormones to work in my body. So we need to think about menopause in a slightly different way. It affects 100% of women. Women, even if they don't have many symptoms, can still have the long-term health consequences of not having their hormones.

And the symptoms, there's so many. If you Google, some people say

83, 96, 112.

But there's estrogen and testosterone receptors on every single cell in our body. So, you know, symptoms can vary from the odd headache to dry eyes to irritable bowel type symptoms to breathing symptoms even. You know, commonest symptoms are brain fog, memory problems, anxiety, poor sleep. And then the perimenopause, peri is just the time around, isn't it? We use it a

lot in medicine.

So in the run-up is when people start to experience menopausal symptoms but their hormone levels are starting to change but if people are still having periods, their periods change. But a lot of people think their periods become less frequent and lighter. I see a lot of women whose periods become closer together and very heavy. So, and again, in the perimenopause, our hormone levels can be very high and very low, literally in the same second sometimes. So you get a huge fluctuation.

And a lot of women actually have worse symptoms in that time, especially the brain symptoms. We're funding a PhD in suicide prevention at the minute because a lot of women are in real crisis in this time. And I think it's because, you know, our brains like homeostasis, they let everything nice and calm, don't they? If anybody's been hungry, you know that feeling when you're not quite... So, with our hormones up and down, our poor brains are just all over the place.

So, the perimenopause can last for around a decade before the menopause and then once people are menopausal, whether they still having symptoms or not, they're still menopausal until the day they die because they still have low hormones.

I didn't realise how little I knew and that most people knew or know about both of these conditions And it wasn't until a few years ago, I was doing some rotations in breast surgery. And in those clinic appointments, almost every clinic, there was 1 to 2 women, they were mentioning other symptoms they were having. And I was of this archaic, outdated thinking then, this was only 2 or 3 years ago, that it's a transitional phase that people go through. And, you know, that's it, it's something to go through. I mean, my mom's gone through it, and for whatever reason, I never took notice of that.

But then doing a deep dive, doing my own research, am I missing something here? And I realised it could be classified, and it maybe should be classified as an actual disease because it's not just a transitional phase but a quite a deleterious, insidious physiological state.

Yes, you're very right. You know, I don't know how much menopause education did you have.

That's the worrying thing in medical school. I cannot remember a single lecture or module that I had about menopause.

No, I tell you 1 thing that I was taught actually in medical school and I'm older than you, so this was in the 80s, was saying that women are protected from heart disease until after the age of 50. And I've got quite an inquisitive mind, I've also got a pathology degree, so I was thinking well what's the difference between a 51 year old and a 49 year old? And the only thing I could come up with was with hormones. Yet you're absolutely right. You know, if you think about the history of our hormones, when estrogen was discovered, if you like, it was associated with vasomotor symptoms, which is the hot flushes and sweats.

When thyroxine was discovered as a hormone, it was associated with hypothyroidism. And then if you think of insulin, it was associated with a disease, diabetes. But then menopause is not, it just seems to be these symptoms. And as you say, even now, if you look on social media, a lot of people will say, it's not a hormone deficiency, it's a transition. And it's like, what are we transitioning into?

I've got no idea as a menopausal woman I want to be really healthy actually and the way that I can improve my health is by having my hormones and We have to remember it's not just a middle-aged woman problem either. There's a lot of young women who are menopausal and perimenopausal yet being fobbed off all the time to say, no, it can't be your hormones.

I was literally having a conversation yesterday with my mum, you know, in light of me chatting to you today. And I was talking to her and said, when you were going through menopause, you didn't take HRT. So immediately I was thinking, you know, estrogen has a role on bone density. If you have low estrogen, you have lower bone density, increased risk of osteoporosis and bone fractures. You know, it's gonna affect your heart, increase your risk of dementia if you've got low estrogen.

So I was saying, why haven't you taken that? And I was really panicking about that. But just like you said, the number of women who, first of all, because of probably societal issues, They're not taking up HRT, but also they're not, you know, almost taking knowledge and being cognizant of the fact that menopause is a serious thing that affects your future health risk and current health risk because it's kind of been brushing the carpet as just this thing that we need to get through.

Well it is and I think it's also stems a lot from the WHI, the Women's Health Initiative study 2002, many years ago now, which showed this risk with breast cancer. But what people have forgotten is there are still benefits from hormones. So we can talk about the risk, that's fine, or potential risk, but actually what are the risks of not taking HRT? And that's what we're not talking about. And also what about informed choice?

What about shared decision-making? So, you know, more and more, and wrongly or rightly, I've worked really hard to empower women with the knowledge so they can understand that they haven't got clinical depression, that they haven't got fibromyalgia, that they haven't got early dementia, they haven't got, you know, worsening migraines. It's all related to their hormones often. And then giving them the choice. But time and time again, women are told, oh no, have some antidepressants, you're too young, it can't be, go and buy a relaxation tape.

A lady told me a couple of days ago that her doctor had just said, it's just a natural process, you've just got to go through it. Well, why have we just got to go through something that increases our risk of disease?

I mean, you mentioned that Women's Health Initiative study in the early 2000s, 2002 when it came out into the media. And I think there hasn't been another paper, a landmark paper, which has ruined the lives potentially of so many millions of women more than that. And I'm a sucker for stats and particularly bad stats. And I often see people quoting various statistics on social media about this can increase X, Y and Z by 10% or whatever. But actually, in that study, the increased risk of breast cancer and blood clots that they noted from the group which had HRT, the absolute risk was 6 in 1000.

And in the non HRT group, it was 5 in 1000. So the absolute risk is non significant, but the relative risk that they put out there was 10%, 25%. So that turned women and doctors away from prescribing HRT for millions of women and who knows what the cost was to the healthcare providers, but also to the individual women who had maybe lost life years.

But it's all about breast cancer. We know since 2002, the incidence of breast cancer has increased because of other factors, mainly Obesity as well. We know obesity can contribute to many cancers. A lot of women I see are putting on weight because they're so tired, they're comfort eating, their metabolism changes without their hormones, and also they're not exercising, they're drinking more wine, so they've got more modifiable risk factors for breast cancer. And actually, I'm a menopausal woman, but I've got a brain, I can decide what I want to do.

I am more worried about osteoporosis because I've seen so many people with osteoporosis of their spine. I'm actually quite worried about dementia and I've made an informed choice that I want to take HRT. I also without HRT I couldn't work. I was literally looking at patients thinking, I can't remember what you've told me. I can't remember drug doses.

I'm looking at my examination couch thinking, I just need a nap. And I was only working 1 day a week as a GP. So, you know, as a government, telling men and women, reduce your hours, have flexible working, work from home. Well, you know, less hours means less pay, less income to the family. More stress.

Yeah, and actually, I've worked really hard to be a doctor. I don't want to have a second rate job that isn't suited to my professional career.

Why isn't it at the top of the conversation rather than us having to have a podcast to then, you know, destigmatise it?

Well, you know, I was, as you know, I was just chairing a conference, it was a women's health session this morning and I just had to give an address. So I was reflecting the last few days, what can I talk about? And actually what I did talk about was medical gaslighting, which is what's happening, misogyny. But also if you think back about the word hysteria, you know, hysterical but also hysterectomy. So if you look back in the history of women, which is always fascinating, isn't it?

People thought that our wombs were our cauldron.

The wandering womb.

The wandering womb and the treatments that people had for that. And you know, they were quite barbaric treatments. But in my clinic, I can't even begin to tell you how many people I've seen that have been given quite heavy duty anti-psychotic medication. Recently I've seen a few that have been given ketamine infusions for their treatment resistant depression in inverted commas but no one's thought about their hormones. But I think some of it is because it's a female problem and actually people are scared of strong women.

Women who take HRT, especially when they take testosterone as well, you know, we stand up for ourselves a bit more. We contribute more but actually that is a good thing, you know, men do need women as well and I really worry about women who haven't got money, haven't got English as their first language, can't speak for themselves. We know more and more, as you do as a doctor, with chronic diseases and, you know, areas of deprivation, are really struggling with heart disease, with mental health, with obesity. These women are just being told, oh, you will feel like that because of your way of life.

Age related.

Of course, but actually, why is no 1 thinking about their hormones?

I think, you know, we were talking a bit before about, you know, you worry about the risk of dementia, etc. You know, when it comes to dementia and Alzheimer's, they often say, you know, actually the disease process starts decades before. And, you know, the perimenopause and even before pre-perimenopause, probably the disease process or that kind of decline into that physiological state would maybe start several years before that average age of 51. So in your experience and expertise, what would someone be able to do to just to optimize their hormones in themselves in the run-up to that before they're at the stage where they need HRT?

Yeah, so you don't want to wait till you're too late. No 1 gets a medal or a badge for suffering or for being menopausal. And as you know, the diagnosis of menopause is weird because it's a retrospective diagnosis. You have to wait a year until your last period.

12 months of no periods.

And that's madness because then it's defining menopause as something to do with our womb rather than what is going on with our hormones. So the perimenopause, as you say, can last many years before. And so 1 of the reasons I developed the free Balance app is that people can monitor their symptoms and I really strongly feel that every 6 months any woman of any age should be monitoring and looking at their symptoms and of course many symptoms can be due to other things, they can be just due to life stresses or they can be due to other diseases. But if someone's getting changes in symptoms with no other apparent cause, then we as individuals should be thinking, or could it be our hormones? And we know from the evidence the earlier women take HRT the better.

And so it shouldn't really be HRT, it's not replacing, it's just topping up. So it's just hormone support treatment really, derived from yam plants, really safe, same structure as the hormones we produce when we're younger, so a lot safer than the contraceptive pill of course. And then women should really consider just topping up a bit. So if they've got even PMS

and

they're getting that dip just before their periods, well, just take a bit of oestrogen then. You know, think about testosterone as well, maybe progesterone, and then you just gradually increase with time. So what you want to do is sort of morph into the menopause without symptoms because We also know as soon as your hormones start reducing, that's when you've got this increased risk of inflammation and this inflammatory conditions that occur, all the diseases that we know are associated with the menopause. So also, you know, a lot of women often just feel so awful that they've not just reduced or changed their job, but they've started to put on weight, their cholesterol started to creep up, they started to take a bit more medication, they've started to just not feel themselves. Well, wouldn't it be great to just prevent as many diseases as possible, do it as early as possible, so then women can carry on being the best form of themselves.

So the HRT is an important and essential adjunct for women undergoing that perimenopause stage or the menopause, but it's not a golden bullet to just change someone's life. They also need to do the peripheral things like optimising their sleep hygiene, their diet, exercise, all of these other things, in addition to the HRT, can get them back to at least somewhere close to where they used to be maybe.

Yeah, absolutely. I mean I feel, you know, I'm not 1 of, you know, me too big-headed, but I feel the best I've felt for many, many years and I wish I'd started testosterone probably 10 years before I did, but it's enabling me to sleep better, to think better, to work harder, perform better, but also it enables me to exercise. If I didn't do yoga regularly, my mental health would be terrible, my physical health would be awful. You know, so there's no point me taking HRT and having, you know, whiskey on my cornflakes every morning and McDonald's every evening. I've got to be thinking in a different way and we need to, I think, as healthcare professionals, really help people think, well, you're perimenopausal or menopausal, you might have the next 30, 40, 50, 60 years if you're young when you're menopausal, how are we going to help you?

You know, if you think when someone's pregnant, 9 months of their life, the amount of investment we give to pregnant women is brilliant. But we should be doing that more for other women. We shouldn't just be making them invisible and thinking, oh, their menopause or their transition through it and never mind, it doesn't really matter.

What do you feel, I mean, this whole topic of menopause and perimenopause is still taboo, even though it shouldn't be. And when you're treating your patients with these things and giving them HRT, what's the kind of feedback you face from colleagues and other people? Because, you know, you're more well known now than you were, I would say, 5 years ago, you know, particularly with the rise of social media, and you know, you're advocating for all of these things, which are fantastic, but there will be some, you know, pockets of people who are thinking, what the hell are you doing?

Yeah and they do. In fact a patient I had to speak to, I was late today, because she got phoned up by the chief pharmacist from her practice and said this is absolutely outrageous, I don't know why you're going to that clinic, it's really dangerous, you should not be doing this, do you realize that you're putting your life at risk because you're on a higher dose of oestrogen and we're never going to prescribe that for you. You can go back to that social media doctor who runs a big private clinic. She's actually a really clever woman and she said I had complete informed consent, I know what I'm doing, I know these hormones are biologically active and help the way that I function and work and improve my future health. And you know, I'm really shocked actually, the more that I do and the more that I expose myself, that It's actually the healthcare professionals that, some of them, it's a minority, are really quite nasty on social media.

And when I opened my clinic 4 and a half years ago, every week we'd have letters of complaint from GPs to say, how dare you, what are you doing, da da da da. But it often comes from a place of ignorance, and usually those GPs, I'd phone up and say, oh, what are you worrying about? Oh, there's a risk of clot, whatever. So, no, did you know? Oh, no, I didn't.

This is great. And as you might know, we've developed a free education training program that's had over 30, 000 downloads now which has been great. So those numbers of complaints, if you like, have reduced but more recently they've gone up again because people are sort of trying to get at me, there's various things in the media and I feel it's such a shame because it does come from misunderstanding and actually lack of professional curiosity. But then the other thing I think we always have to think about is our patients are the most important thing. That's why I'm sure you did medicine, I do medicine because I'm caring.

So if people know that there might be risk but they still want, you know, you do risky surgery. There are risks with everything that we do.

Risk versus benefits is the equation.

And that's really important, you know, we've got to involve the patient, haven't we?

Yeah, exactly. We've gone from that didactic conversation to holistic and it's a conversation that we need to keep having.

We absolutely do and it really saddens me when I've been to quite high-level meetings where they've said we're overprescribing HRT, the pendulum has swung the other way, we need to reduce and rein these people in, we need to reduce this media attention of the menopause. And I'm saying well there's now 16% of women who are menopausal taking HRT, that's still the minority in areas of deprivation that's as low as 2%. So I don't understand, they say well we don't think the percentage should be more. And I keep saying I don't care what the percentage is, I feel very strongly that 100% of women who want to take HRT should be allowed it. But you see, it's quite difficult because I run a private clinic.

So people think it's all about me making money.

Of course.

And this is where something I suppose I'm naive I never realized as a doctor I didn't want to do a private clinic but I couldn't get a job in the NHS because there was no there was no funding for it but actually we're doing it because we're helping women from all ethnicities and all backgrounds and a lot of our profits are going to fund Balance App, which has had a million downloads, it's free. It could only be free if we made some profit through the clinic, but people don't want to see that.

I think, you know, I'm at the stage now where I'm suffering from the reverse Dunning-Kruger effect. The more I'm reading about menopause, the more I realise how little I know and just thank you for the stuff you do to empower women to destigmatise this physiological state and just bring more awareness to it. So thank you very much for coming down.

Well, I'd like to thank you for actually doing this. I mean, your podcast is quite new and you, you know, right in there in the first 10 episodes, you've got menopause, which is just phenomenal.

Yeah, it's not a niche subject. I mean, you know, I'm just thinking back to my mum. When she was going through menopause, was I as open and kind and helpful as I could have been? Maybe she was stoic and didn't show any symptoms, or maybe I had no symptoms, I don't know. Maybe she kept it to herself because of the stigma.

So hopefully, not that I'm not a compassionate person, but hopefully have that extra insight now into dealing with people as a surgeon in clinics. So thank you so much.

Oh, thank you very much for inviting me.

So Louise, you've got a question for me, I don't know what it is, but go for it.

So I wanted to ask, you know, did you really believe that you would be doing as much social media? But also, were you surprised how it's bringing out some of your personality? Because I was really touched actually, when I was obviously looking you up, there was a video of you saying that your book's done really well and this lovely emotion came out. And I think when you do social media stuff or when I do video stuff, I'm quite happy going on this morning and talking to millions of people but I haven't got much self-confidence and I always have got a lot of self-doubt and I always think I'm not doing enough well and I look at you, it's so amazing on your TikTok and social media, you've got so much presence and then suddenly you look very vulnerable and is it bringing out, do you mind bringing out this different side of you or is that something you'd expected?

I think yeah it's an interesting 1 so when I'm online I want to be professional but I also want to be human and compassionate and bring myself so the 1 of the things I pride myself of bringing to the fore on my social media is authenticity. And that includes the credibility and the years of expertise that I've built up and giving accurate science-based information. But also, I don't want to be a robot. I don't want to be replaced by AI that can also give the same information. So I think giving that human side is good.

The risk of bringing a lot of your personal life into social media is you have these parasocial relationships with your audiences and you're judged sometimes on every little thing you do. You know, sometimes if I, on Instagram, if I put a story of there's something I'm eating, I might get a reply like, should a doctor be eating X, Y, and Z? So, you know, you've got to temper, I think a little bit of both, but like you mentioned, you know, when I released the reaction of my book doing well and topping the bestseller list on Amazon when it first was out for pre-order, that was genuine because I was shocked that, you know, as someone who started in medicine just to, because I really wanted to do surgery and operate on people and remove cancers and things like that to not ever thinking I would have a social media presence to then, you know, in that 10, 12 years to then be asked to write a book and that book doing well, it's an overwhelming thing. Similarly, you've got hundreds of thousands of people online and you probably, when you started medical school, that was all just never even, not even in the horizon.

No, no, not at all. And I totally, it really resonated with me because I think people don't realise, I think it's different when there are celebrities because that's all their job. Whereas I think it's really humbling and it's a real privilege to still be medicine and I would hate to ever change and not be able to have my empathy as you say and emotions because then I think you miss things and I think we're really good aren't we in medicine to just have this sort of gut feeling about people and that's really key so it was just lovely to see that come across so don't change.

No, no, thank you so much, thank you. If it ducks like a quack. This is the bit where we debunk all sorts of crazy nonsense you see or hear online. So in keeping with the conversation we've been having, the manopause, the male menopause. Is it a thing?

Is it just some made up nonsense? Well, yes, it is mostly made up nonsense by the media. Who else? The media love to make these catchy, viral, clickbaity headlines. And let's dive in some of the science as to what they could be talking about.

So in women, as we've talked about in this episode, there is a steep drop off in certain hormones, progesterone, estrogen, that happens around the age and leading up to the age of 51. In men, the key thing is that the testosterone in men peters off slowly. We're talking about a rate of decline of testosterone of 1 to 2% per year after the age of 30. So there's never a steep drop-off unless there is a specific medical condition. So often men won't notice this, you know, lower testosterone over a number of decades.

There's a compensatory mechanisms and the body would just get used to this age-related drop-off in testosterone. Now, the male menopause that the media have come up with, this is probably most likely related to a constellation of symptoms similar to the ones you can experience with low testosterone states, maybe a change in composition of the fat in men where they maybe get gynecomastia or man boobs, irritability, low mood, low sex drive, erectile dysfunction, all of these things. These are not always related to low testosterone or a declining testosterone with age, which is normal physiology. It could be related to various other things like substance abuse. Someone is abusing marijuana.

Someone is having excessive amounts of stress and then the stress and the high cortisol, chronically high cortisol is impacting their testosterone or they're not sleeping well enough or they've got other medical conditions or medication they're on, which are producing some various zany side effects. So there's a number of things which could account for these male menopause symptoms, but the word terminology male menopause or the manopause is total misinformation. And it's important not to compare this manopause or a constellation of symptoms, which may be due to various other causes with the female menopause or perimenopause, which is a serious condition and affects future health risks as well, as we've thoroughly explained in this episode. Now, a myth around 1 of my favourite topics, and actually a topic we're going to be covering next week. Sleep.

Napping, siestering, long snoozes, power naps. I love them all. Now, 1 of the myths I constantly get asked by people, get told by people, see online, is that your body can get used to a lack of sleep. Now, 1 of the most dangerous things about poor sleep is that it can affect every organ system in your body. And over time, if you're chronically sleep deprived, you build up sleep debt.

And sleep debt is something that you can never pay back. You can never compensate for days, weeks, months, or years of poor sleep. You can only draw a line in the sand and say, all of those years of poor sleep have done the damage to my body. I can just now try to limit the damage going forward. All of us are biologically, genetically hardwired, depending on our circadian rhythm and these clock genes that we have in cells in our body to require a certain number of hours.

Now, for some people, they may be able to get away with 6 and a half hours. That's probably the rarity, but most people probably require somewhere in the range of 7 to 9 hours. And the best way to figure out how much sleep you need is actually not to use an alarm clock or anything, and just go to sleep when you feel tired and wake up when you naturally want to wake up, when your body naturally wakes you up with its natural internal alarm clock, the spike of cortisol in the morning, and then just figure out how much sleep that is. And that is your ideal sleep pattern. If you're forcing yourself to wake up with your alarm in the morning and binging Netflix or anything at night and then delaying your sleep pattern, there's a very, very good chance you are having an awful sleep pattern.

Your body needs a fixed number of hours that is unique to you. So that is an absolute myth. Your body never gets used to a lack of sleep and it probably hates you. And this next myth is 1 that's been going crazy viral on TikTok. Salt water flush to clear your intestines.

Now definitely never do this. Salt water is not something you should drink. You don't drink ocean water, so you shouldn't do a DIY salt water flush at home, which is basically the human biological version of drain cleaner for your intestines. Now, aside from the fact that it tastes horrific to drink salt water and there's more than a fair chance that it'll make you vomit, there's also the risk of dehydration because when you drink salt water or something that is hypertonic in that way, has a very high salt concentration, then all of the water from the surrounding cells will be drawn into your bowels and it will just cause an explosion of things the other way. And it wouldn't be a conversation if I didn't talk about gut bugs as well.

If you're constantly drinking salt water and rapidly flushing things out the other end, so you've got molten arse fire, you're also potentially changing the balance and composition of gut bacteria that are constantly being flushed by all this salty water. So you might be thinking you're flushing away the toxic colonic matter inside your intestines, but actually you're making your gut bacteria potentially a lot worse. It's time for Crowd Science and we have a question from our listener, Carl. What are the symptoms of ADHD and how would you approach your doctor and ask them to diagnose you? Now, this is a very tricky 1.

Now, chances are, if you approach your GP or general practitioner or family doctor, chances are they may not be an expert in ADHD, but they may be able to ascertain whether you have certain symptoms or you meet some criteria from which they can then refer you on to a specialist, either a healthcare professional who is an expertise and has qualifications in diagnosing child and adult onset ADHD, or they could be a psychiatrist or a pediatrician with a specialist interest in those things. ADHD is attention deficit hyperactivity disorder. And it's important to note that these are most commonly diagnosed when people are children, and it's less frequently diagnosed as an adult, although adult onset ADHD is a real thing. There is some disagreement as to whether the diagnostic criteria they use to diagnose ADHD in children are the same or different to the diagnostic criteria for diagnosing adult onset or adolescent onset ADHD. We need more research and this is still a contentious area.

But the classic symptoms of ADHD that we talk about is impulsiveness, inattentiveness, and hyperactivity. Now that's not to say that if you don't have these things, you don't have ADHD. As we know, there are various, various symptoms of ADHD. And 1 of the symptoms actually is hyper-focus. Someone is hyper-focused on a certain task that really engages them.

And equally, if someone has hyperactivity or is inattentive, it doesn't mean they have ADHD. Some of the symptoms of ADHD can be mimicked by various other things. It can be just mimicked by someone's personality. It could be mimicked by poor sleep. So they're tired and they're fatigued and they're inattentive or they lose focus for certain things.

Various other conditions can also mimic this as well. So if you're concerned that you may be having ADHD or you've got symptoms similar to someone else who's been diagnosed with ADHD that you know of, go and see your doctor so they can do an initial screening and then refer you on to a specialist who can do more thorough interviews and history-taking and actually assess whether you might meet the criteria for ADHD. Carl, I absolutely love that question and if like Carl you want to ask a question as well, feel free to get in touch at thereferralpod.com Thank you so much for joining me for this episode of The Referral. It was eye-opening. But don't worry, I'll be back for more next week.

And if you haven't caught up yet, go back and check out the previous episodes. And if you enjoyed any of the content that I'm putting out, make sure you give a rating. Thanks for listening to this episode of The Referral. I am a real doctor. I'm a real surgeon, but it's important to know that if in need, please contact your own personal doctor.

Nothing on this show can replace or provide additional specific medical advice that you would receive from your own doctor. This has been a Sony Music production. Production management was Jen Mistry. Videos by Ryan O'Meara. Studio engineer Matthias Torres.

Music by Josh Carter. Grace Lakewood and Hannah Talbot were the producers and Gaynor Marshall is the executive producer. And Special thanks to Chris Skinner.