Ep 147 Hormone Replacement Therapy with Dr. Cassie Wilder

Conversation with Dr. Cassie Wilder regarding hormone replacement therapy for women going through menopause and its emerging research.

Topics of Discussion:
-An explanation of hormone replacement therapy (HRT) and when to start to reduce risks
-HRT prescriptions acting as an art form rather than a science
-Ways to find doctors that will support the patient’s personal choice in medicine

Dr. Cassandra Wilder, registered Naturopathic Doctor (NMD), is the Founder of Minneapolis Integrative Medicine Center.

After graduating from Iowa State University with a Bachelor's of Science in Kinesiology and Health, Dr. Wilder earned her Doctorate of Naturopathic Medicine from Southwest College of Naturopathic Medicine & Health Sciences, a fully accredited and nationally recognized institution in Phoenix, AZ. During her clinical training, she received extensive hands-on training with many leading experts in the field of functional medicine and developed a passion for treating hormonal imbalances, thyroid disorders, cardiovascular concerns, and adrenal fatigue.

Dr. Wilder emphasizes individualized patient care and employs a variety of modalities in order to tailor treatment to the patients needs. She believes in an integrative approach to medicine and is up to date on conventional treatments to disease as well as naturopathic and will integrate seamlessly into your healthcare team.

Minneapolis Integrative Medicine Center Links
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Transcript

Ep 147 Hormone Replacement Therapy with Dr. Cassie Wilder

[00:00:00] Cynthia: You are listening to the Well Connected Twin Cities podcast. I'm your host, Cynthia Shockley, and I'm here to learn alongside you through meaningful conversations with health and wellness practitioners. This is your time to experience some mindset shifts, learn practical tips, and get excited about what is possible.

[00:00:22] We want you to own the power of choice in your personal well being journey. Let's discover what's possible right here in our Twin Cities community.

[00:00:33] In today's episode, I speak with Dr. Cassie Wilder about her professional journey and we dig into the topic of hormone replacement therapy for women going through menopause. I'm constantly impressed by Dr. Cassie's deep interest and passion in medicine and how she stays up to date on emerging research.

[00:00:51] She educates us on how hormone replacement therapy works and shares the best time to start I was surprised to learn that this treatment, when done in a timely and artful manner, may actually reduce the risk of breast cancer and provide a ton of other benefits. Dr. Cassie pointed out that some doctors may not be up to date on the emerging research and, with good intentions, may deny life changing care to their patients based on outdated information.

[00:01:18] If you or someone you care for could benefit from hormone replacement therapy, this is a great episode to learn more about the treatment and walk away feeling empowered to find the right provider for you. Dr. Cassie Wilder, registered naturopathic doctor, is the founder of Minneapolis Integrative Medicine Center.

[00:01:36] After graduating from Iowa State University with a Bachelor's of Science in Kinesiology and Health, Dr. Wilder earned her Doctorate of Naturopathic Medicine from Southwest College of Naturopathic Medicine and Health Sciences, a fully accredited and nationally recognized institution in Phoenix, Arizona.

[00:01:53] During her clinical training, she received extensive hands on training with many leading experts in the field of functional medicine and developed a passion for treating hormonal imbalances, thyroid disorders, cardiovascular concerns, and adrenal fatigue. Dr. Wilder emphasizes individualized patient care and employs a variety of modalities in order to tailor treatment plans to the patient's needs.

[00:02:17] She believes in an integrative approach to medicine and is up to date on conventional medical treatment as well as naturopathic and will integrate seamlessly into your healthcare team. Thank you to our sponsors, Human Powered Health, the Minnesota Institute of Ayurveda, and Wellbeing that make this episode possible. 

[00:02:37] And here we are with Dr. Cassie Wilder. Hello, Dr. Cassie. Hello. How's it going? It's going well. I was just reflecting on how the first time you and I met, Was actually through Alex. I think she was like, Oh, yeah, you've got to talk to Dr. Cassie because I was exploring different career paths and I was like on the MD path and I was exploring what else is there.

[00:03:04] And we had such a wonderful conversation about your journey and how naturopathic is what really called to you. And so I'm excited for us to dive into a little more about you, but then also specifically hormone replacement therapy because I know that's something that you're really passionate about.

[00:03:24] Dr. Cassie: It is. Yeah. I remember that conversation too. And that was, it feels like a lifetime ago. So 

[00:03:30] Cynthia: Yeah, I would definitely pre pandemic, but I think it was like maybe even six or seven years ago. Cause it was, I think when I was first moved to Minnesota and I was just starting to like network and get to know people and 

[00:03:41] Dr. Cassie: wow.

[00:03:42] Wow. Yeah. Cause I I was in Northeast from 2017 and I got our class clinical space in 2019. So it might've been in that like little timeframe. Then. 

[00:03:53] Cynthia: Yep. Yep. That's super exciting because now I know you're in a new space and you just keep growing and expanding and clearly what you're doing is something people need.

[00:04:04] And so I'm excited for us to dive in a little further. But first, for people who aren't familiar with you, why don't you share a little about yourself and what brought you into your role as a naturopathic doctor? Thank you 

[00:04:19] Dr. Cassie: Sure. Yeah. My name is Dr. Cassie Wilder. I'm a naturopathic doctor and I have wanted to be a doctor my entire life.

[00:04:27] And I, for a brief second wanted to be Elle Woods from Legally Blonde and then realized I would not be a good lawyer. So went back to medicine and through an experience that I had in undergrad with a really wonderful doctor in the hospital setting, it, Really showed me and actually like knocked traditional medicine and conventional medicine down a peg and really like Removed them from the pedestal that I thought they sat on in terms of medicine It really just as I reflected on that over the years it going into it.

[00:05:00] I really thought that doctors were there to figure out what's wrong with you and then really just give you the solution to, to treat that. And through my experience, it was like, Oh, we don't know what's wrong with her. Like it, it's not our problem. Move her on to dietitian or, Oh no, that's not our problem.

[00:05:18] That's physical therapy's problem. And it really just felt like you're kicking these people around to different aspects of medicine. Or he would just say it's not her GI. So send her off. And to me, that was like, wait, we're the doctor. You're the doctor. We're not supposed to just send her off.

[00:05:34] Like what the heck, what's going on? We're supposed to have all the answers. And so I really just felt very disenfranchised after that experience and then decided not to go the traditional route, withdrew my applications and interviews from med school and decided that if that's what I had to be, and if that's what the system was going to make me be, then I didn't want to do that.

[00:05:53] Through going to a conference on the nutritional like nutritional genomics and MTHFR specifically, I met a naturopathic doctor and I was like, who are you? How do I do what you do? Tell me everything. And she really really inspired me and I found a this career path. And within a few months, since I had already done pre med, I had all the prerequisites to get into naturopathic school.

[00:06:17] And I just went ahead and did it and jumped, I went, I really ran into, I didn't even jump. I sprinted into this profession and it's been wonderful. I've felt a lot of like joy and impact and just being able to do medicine the way that I think it should be done and really experience care with patients in the way that I feel like doctors and patients should be interacting.

[00:06:39] So it's been great. 

[00:06:40] Cynthia: Amazing. And I'm so glad that you really listened to your own intuition in this whole process and I know the application process for med school is awesome. A lot. So for you to withdraw a lot. That's a huge a huge step and a brave step.

[00:06:55] And so I'm glad that you were able to 

[00:06:57] Dr. Cassie: three times. Oh my gosh. What a commitment. It's like I did. I took it twice. I did so bad. I was like, I did it. So I did so bad the first two times. And I was like, you know what? Third times the charm. Let's do it. Did a better on that one. But yeah like now that I look back, I laugh.

[00:07:14] I'm like, I spent so many hours studying for that test and so much stress to where. Yeah, I didn't do anything with it. 

[00:07:22] Cynthia: Oh man. Yup. It's do I even remember any of the things on the test? No, absolutely not. Nope. 

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[00:08:49] Cynthia: Oh, well,

[00:08:50] so now you are a naturopathic doctor and you found a really unique path professionally with your own business.

[00:08:58] So you started MIMC tell us a little bit about MIMC and what makes it different. 

[00:09:04] Dr. Cassie: Yeah so interesting. I started my own clinic because of lack of options of places to work. So I really wanted to come back to the Twin Cities and be an employee in someone else's practice. And turns out that's not really what happens here.

[00:09:18] There's a lot of independent contractor positions. There's a lot of renter room spaces. And I really did not at that point, want to start my own business at all. So out of necessity, I was like I have to work and if I'm no one's going to pay me maybe I'll have to figure out on my own. I decided to just venture out and do what I had to do.

[00:09:36] And turns out I actually really love owning a business. I think that the way that naturopathic medicine practices and particularly the way that I've really learned and developed that my critical thinking skills over the last six and a half years. I really enjoy having a place to put that into practice and having a team who really also believes the exact same things as I do and all practice together.

[00:10:00] I would say what makes MIMC different from other like integrative practices is that we really take the time that we need to focus on the diagnostic aspect of things.

[00:10:11] The diagnostic piece is the most critical aspect. So if you're talking root cause medicine, you really have to get to the root cause or on the first go around as close as you can get. And so our diagnostic process really starts with that deep dive first intake and sitting down and saying, Oh, you have anxiety.

[00:10:29] What does that feel like to you? Is that heart palpitations. Is that mental rumination? What is it about your anxiety that is unique and different? When did it start? When did it stop? Oh, it started when you entered into a moldy home? Interesting. That's fascinating data. So just being able to sit down and take that time, work people through that process, and come up with what you're gonna do on the other side.

[00:10:52] So we are pretty data driven. So a lot of lab testing, a lot of environmental testing. And then looking to see what your actual levels come back at. So we can be pretty specific on what it is that we're doing. Even if we're talking about something like thyroid health, whether that's your TSH is abnormal, or if you're a poor converter from T4 to T3, or if you're over converting from T3 to reverse T3, all of that matters.

[00:11:15] And all of them are completely different treatment plans, root causes, things like that. So that's where I feel like we're really different is that we, take a lot of that extra time to work up that diagnostic and then overlap all of the holistic aspects on top of that because that's how, in my mind, where you get the most bang for your buck is if you can be the most specific.

[00:11:38] Cynthia: Yeah. And I remember being really struck when we first met about how much you hold in your brain. Like you have so much information and you clearly like the details are where you shine and you have such strength when you can pinpoint and figure out what are the most like, Yeah. How specific can we get?

[00:12:01] And so that can make a huge difference. And I know one area in which you really thrive is also with hormone replacement therapy. Let's talk about what hormone replacement therapy even is. If someone has like maybe heard of it, but not really dove in yet. Sure. 

[00:12:19] Dr. Cassie: Yeah, on the treatments for perimenopause menopause, as you're starting to shift over from normal cycling and moving into that separate phase of your hormones, where it was once, Potentially like a 28 day rise and fall beautiful symphony you get into this the drums might be not playing at the same time as The other instruments and you just get this crazy sounds that happen and where hormone replacement therapy is On the continuum of treatments that you can use to really get your orchestra back to sounding correct.

[00:12:51] You could do anything from do nothing you could do herbals and natural things. hormone replacement therapy or a combination of all of them. But hormone replacement therapy is something that we really like because it has a lot of good data around it for, being some of the most effective for not only helping your symptoms feel better.

[00:13:09] So like the insomnia, the moodiness that can happen, low energy, brain fog, it can be symptom relief, but it can also be really helpful for, really protecting vital organs. So hormone replacement therapy is essentially a replacement therapy. You take hormones that are.

[00:13:27] There are synthetic ones and there are bioidentical ones. You take a hormone to replace the hormones your body is no longer making. 

[00:13:35] Cynthia: Yeah. So being able to, I'd imagine, get specific as you talked about is important to know how much of what you're helping people with replacing. So when it comes to hormone replacement therapy.

[00:13:49] What does that process look like at the biophysical level? How are you figuring out what's needed? And then how, like, how does that replacement process work? 

[00:14:00] Dr. Cassie: Yeah, the, if you could think of your if you have a lot of estrogen that you normally make, I won't say a lot, like it's over the top, but if you have the normal amount of estrogen and progesterone that you're naturally making, And your body has those receptors that it needs to take that hormone and do something with it.

[00:14:17] If you start to decrease the amount of hormones that you are naturally making, but your body has the same amount of receptors, which it does at the very beginning, that's where that mismatch creates a lot of symptoms. So we're talking like. the hair loss, the straw feeling of your hair, the brain fog, the moodiness.

[00:14:33] And that's where hormone replacement therapy will actually replace the hormones that you're no longer making and that will satisfy those receptors. So they're no longer thirsty for that signal. Things like and, during that initial phase of transition into perimenopause, some days your hormones, and maybe this is not just days, it's weeks, months can be really high.

[00:14:55] And then other times they can go really low. I like to explain it, it's like a toddler at a dimmer switch, they're just constantly going back and forth, but the trajectory of the graph is always downwards, the trajectory is always over time, and I don't know how much time that could be, it could be a year, it could be five years, ten years, the trajectory is always going towards zero amount of hormones naturally produced by your system.

[00:15:17] Or as close to zero. And so if you're looking at that hormone replacement therapy, how, like it's more of an art form than a science is really what I'm trying to get at is you have to listen to the patient. What are they saying? We do run labs just so we can see where you're, where you are. So if we're giving you replacement therapy and we can test your blood again after that, we know.

[00:15:37] how much of this was already there, how much are we replacing with, and we can get a little bit more data on things like safety and overdosing or underdosing, quite honestly, too. But we don't necessarily need labs to, to prescribe for you. We think that it's necessary and safe and we will ask for them and require them.

[00:15:56] But But symptoms alone are a good enough reason to come in and talk to your doctor about hormone replacement therapy, especially if you're having a lot of those, they're called vasomotor symptoms. 

[00:16:06] Cynthia: Outlashes, night 

[00:16:07] Dr. Cassie: sweats, vaginal dryness, etc. 

[00:16:10] Cynthia: I see. Yeah, and so then over time, if eventually that trajectory is to get to zero in terms of how much hormone is being output, do The receptors start to fade away or what's happening with the receptors over time.

[00:16:27] If let's say there's no hormone replacement, if 

[00:16:30] Dr. Cassie: there's no replacement, yes, they do go away over time which is actually a little bit of a side tangent, so maybe I shouldn't go into it, but the. It's where a lot of the safety studies originally, like 20 years ago, when they did these studies, they were saying that that increased their risk of cancer strokes and heart disease, really negative things that were coming up hormone replacement therapy.

[00:16:52] They were actually finding that was happening in women who were so far postmenopausal. They probably didn't have any receptors left because they had no HRT throughout their transitioning years. And so if you, Have no receptors that are thirsty, but you give your body the hormone. It really has no way to assimilate it in that way.

[00:17:10] Of course, you can get adverse effects from that, but if you start HRT earlier in the transition process, when you have majority of the receptors you've had your entire life, they're starting to go down over time, but that curve is softened, and that's where we see a lot of the positive benefits on the other vital organs, as well as the lowest amount of adverse symptoms, is if you start it early, your likelihood of developing breast cancer strokes, heart disease, any of that is not statistically significant to anyone else in your cohort who did not do HRT.

[00:17:45] Cynthia: I see. So if you start earlier rather than later, it's a way to soften the symptoms but also reduce the risk of negative symptoms down the line. 

[00:17:58] Dr. Cassie: But I would say also, if you did start midway through, if you've had symptoms for a year or two, that's where I think the labs can be really helpful to see how much are you naturally producing.

[00:18:08] We maybe won't know how much you've been producing that amount for how many years, so that trajectory we might not know. But that's where finding a provider who believes that HRT prescribing is more of an art form than a science. You can start on really low doses typically found it either compounding pharmacies or sometimes a patch.

[00:18:27] If you don't dose it differently than maybe what's conventionally standard, you can ease into it and you can actually have those receptors come back over time. Not that you would want all of them to come back unless you maybe want to start cycling or keep cycling. But we can find that if you just really take that like personalized approach to prescribing, even if you're halfway through your transition, it can still be extremely safe for you.

[00:18:51] Cynthia: Yeah. And I know I've talked to my own clients who are going through menopause or perimenopause and gosh, to start hormone replacement therapy. It's such a relief when all of those symptoms go away, they feel more like themselves. And it's just such a game changer because it can really ruin a day, a week, a month when you're just, the dimmer switch is going on and off, on and off.

[00:19:14] Yeah. 

[00:19:15] Dr. Cassie: It can. And people start to feel crazy. They'll feel, quote unquote normal, for a bit. And then they'll start to turn around and feel like, why am I just going off the handle at people? Why can't I tolerate my stress anymore? Why? Do I have no libido and I have no sexual interest in my partner?

[00:19:33] And they just are like, what is happening to me? And so sometimes those early years can just feel really like that toddler at a dimmer switch. And it really can help it soften all of those symptoms. And just make your life. 

[00:19:47] Cynthia: Yeah, so yeah, earlier is better as soon as you start feeling those symptoms, just go in 

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[00:21:41] Cynthia: it 

[00:21:41] sounds like there's different 

[00:21:43] approaches to 

[00:21:44] hormone replacement therapy.

[00:21:46] And I love how you said someone who sees it as an art form and they can take it slow and steady. They really make it an intuitive process where you're checking in. How would people know or what questions can someone ask a provider to make sure that they're finding someone who's going to take that gentle approach?

[00:22:05] Dr. Cassie: That's really interesting. I thought about that what my answer for that was going to be and what I really came to the realization is there's not a professional organization of art form HRT prescribers. I wish that there was some form of certification program where it's I believe it's an art form.

[00:22:22] Like people could just see you out, but it's that doesn't exist yet. So I think that my initial answer would be if your prescriber immediately tells you no, will not give you a reason for telling you no, and or tells you that it's unsafe and that you could have increased risk of cancer, strokes, etc.

[00:22:39] If they just blanket tell you no without any conversation, run. Run away. And that's more or less because that provider is just not open. They haven't reviewed the literature. They have not stayed up to date on even like The women's health initiative paper that just came out earlier this month in May, like they're, they haven't kept up on this.

[00:23:01] And so why would you take advice from someone who hasn't actually dedicated time to thinking about a therapy that you would like to explore? So that's my first is if you automatically get a no runaway get a second opinion, at least if that provider tells, as well, perhaps boil down to, why are they telling me no?

[00:23:20] Do I have a family history of something? Do I have some form of, what is it that they're telling me no? And is that a true contraindication to the therapy? So I never want someone who's been told a multiple times to just seek out the first person that will tell them yes each provider will at least give you some data points that then you can start making your decisions with the, with a provider who I think starts asking questions and will offer to meet with you more regularly.

[00:23:47] So in those beginning stages, you might try a try, if you do a patch, you could, that's a very. easy and acceptable way of doing HRT. If you do a patch and they're like, you know what, cut this patch in half and start there. And then if it doesn't improve your sleep, take, do a whole patch at this time frame and, really give you and Experimental range of listening to your body and then saying, Let's meet again in three weeks.

[00:24:14] Let's meet again in four weeks and talk about how that went before we, increase the dose to this next amount that we're thinking so they can give you ways to analyze your own body symptom improvements and trajectory of symptom improvements percentages that they think that you should be meeting those milestones.

[00:24:32] And if you're not being those milestones, you need to come back in sooner. And then someone who also, takes the time or gives you the resources, like you can always call, our patients can always call our front desk and say, I have this question, and I think it might be related to my HRT, and the provider will get back to you.

[00:24:49] And so just having a resource that a patient can call in and get support if they needed it. 

[00:24:56] Cynthia: I see. Yeah. So it sounds like it's really about finding a provider who's going to stay open to communication. Be really transparent about what that process is going to look like in order to ease into the HRT process.

[00:25:10] And is, yeah, gonna be easy to access because especially, I'm guessing, in those early weeks you want to be able to ask those questions or if something's a little different and you're not sure if it's right or wrong or what's going on, you have at least that peace of mind knowing you can connect and ask those questions with your provider.

[00:25:28] Dr. Cassie: Yeah. And everyone's body is so different. And, if you're looking at potentially age 40, age 45, age 50, starting these therapies, you have that amount of time in health history of exposures, toxin exposures, like you just have many opportunities for other dysfunction in your body. And as you're going through that transition and your hormones are changing, and now you're adding other hormones to the system things just can get a little bit weird.

[00:25:53] And it's nice to sit down and. And go line item with your symptoms and be like, that could be HRT. That's probably not, that might be this. And just really, yeah, sit down and take some personal inventory. 

[00:26:06] Cynthia: Yeah and because the Minneapolis Integrative Medicine Center, MIMC, is your baby and something that you've created and cultivated and you've, hired the right providers it sounds like that would be a great place if you are in the Twin Cities to go check out and get that High quality care where someone's going to be artfully walking you through the process and supporting you so tell us a little bit about the new space because I know you just announced you moved It's been a whole process, but tell us about your new space 

[00:26:40] Dr. Cassie: I know we moved in here April 2nd.

[00:26:43] So we have been in here for a few months now During the pandemic things, picked up quite a bit once people were really okay with doing zoom and telehealth it really showed us that there was a community here that really needed to be served and then as we grew in patient population.

[00:27:01] It also had other providers who were reaching out to us for positions to come practice here, join our team. And when you really find the right people to put on your team, I feel magic happens. And it was really the at our last practice, our last clinic location, we only had three rooms and we were doing like a rotating hybrid fun thing.

[00:27:22] And we You know, post pandemic now, people really are interested in person care where they can see you face to face. And it really showed us that we needed a larger location and I have big dreams for what I really believe integrative medicine can be as well. So we wanted to have some room for some new therapies to be able to offer.

[00:27:43] And we also I feel like the bigger you are, the more loud you can be. So if we could get some media attention, if we could really help change conventional medicine and make this type of medicine the norm, not the exception I felt like growing and being bigger was our way of being able to like really fight for ourselves and throw our hat in the ring.

[00:28:03] And so that was another kind of reason I wanted to grow and expand is I want this type of medicine and this way of thinking and the diagnostics and the critical thinking aspect of patient care to be the norm. And I felt like we needed to be bigger in order to have that kind of impact on our community in the way that I really want to.

[00:28:21] Cynthia: Yeah, gosh. And just from the pictures, I want to come in person too, but I've seen the pictures and it's just, Big, bold, beautiful, the colors on the walls. It's just so modern and fresh. And so I, it's, it feels like the, even the decor, it's been very thoughtfully designed to invite that sense of excitement of newness of, this is the future.

[00:28:46] And so I'm really excited that you're embodying that in your space too. Yeah. 

[00:28:51] Dr. Cassie: And I wanted people to be able to walk in and say wow, my nervous, this doesn't feel like a doctor's office. Like my nervous system just dropped an octave and I feel comfortable and I feel safe here. I can tell my doctor all about my poop and I'm not even embarrassed about it because like I said, those details are so important to us.

[00:29:09] And if you're like sitting on plastic couches and it feels cold and sterile and everyone's being mean to you and you're like frustrated. If that's not making your nervous system feel safe at all. And so a part of the decor and a part of what we wanted was it to feel really homey like you were coming into your living room and just having a conversation with someone who's there for you.

[00:29:31] And so that was another big part of it. And Studio BV is who designed our space and they did an amazing job. She made my dreams in my head become a reality, which I was so thankful for. 

[00:29:44] Cynthia: That's amazing. And gosh, and now after like nearly a decade for you to be providing a space for other practitioners to come and be that employee that you were looking for back in the day.

[00:29:58] Full circle. 

[00:29:58] Dr. Cassie: I think about that often. I think about that often where I'm like, I also think it's I won't go into the side tangent, but I just feel like there's ways to treat employees in an integrative health space. When I came here, I was like, floored at how people were into these contractor models, but actually they were employees and they were being mislabeled.

[00:30:18] And there's a lot of protections and benefits employees get over contractors. And quite honestly, it's not fair to put another person in a role and in a. In a legal situation that is just not, there's no benefit to both. And so I feel like business can be in this integrative functional healthcare space.

[00:30:37] There can also be employers that are good at taking care of their employees. 

[00:30:41] Cynthia: I love it. I love it. And I love everything that you stand for Dr. Cassie and I appreciate everything you're doing to support the community, whether it's the patients or the providers that also need their own home base.

[00:30:55] I'm curious if someone wanted to say start at MIMC, what's that process look like to, find a provider or, what does that look like? 

[00:31:05] Dr. Cassie: Yeah. So we have a 90 minute initial appointment. And during that appointment, we really do get to both hear your story. So starting with those open ended questions, getting you talking, getting you, tell us your story.

[00:31:18] And then, Appreciate it. taking what you said and starting to ask those more detail oriented questions. Have you ever noticed this? Does this happen when this happens? And direct you a little bit and ask those questions. And then if you have labs you've already done from other providers, we will review those.

[00:31:33] If you have medical records from other providers, we'll review those to try to make your care start as seamless as possible. But typically at that first appointment, we really are coming up with our game plan of what data do we have, what data do we need, and what questions do we still have that are unanswered that either you should journal about and bring back your homework or we figure out who to send you to be able to get those answers as well.

[00:31:57] And that second appointment is a 60 minute lab review where that's really where you get to create your grand master plan. So we have data that you've brought. Potentially data that we've run. Other questions and answers that we have that we can integrate all of that together and come up with.

[00:32:12] Okay, what types of supplements do you need to be taking? What are all the different options of yet? The medicine recommendations, diet recommendations, lifestyle recommendations. What are some additional labs that maybe we were abnormal, but okay. We need a second set that we that might answer some other deeper questions that were, scratched the surface on a root cause, but some of these would actually get us closer to what we thought it would be.

[00:32:36] And then what are some timelines for following up? And with the timelines with following up is you should expect to feel x y and z in the next how many weeks. If you don't, let's talk. Or if you notice it notice even just a little bit in that movement. So I'm setting, I guess maybe what I'm trying to say is setting expectations for what your care journey would look like.

[00:32:56] And that's that second appointment. And from there, that's where people's care gets to be a lot more customizable. Sometimes people need to come back every month, every six weeks, every three months, every, every six months, every year, it just becomes whatever you need and whatever. However, we can support you 

[00:33:14] Cynthia: wonderful.

[00:33:16] And I know you also have a membership model. So that's available to people if they want more of that, like consistency and being able to stay connected and make it affordable. So I think that's great that you have that option as well. 

[00:33:30] Dr. Cassie: Yeah, and our membership comes with unlimited health coaching. So we do have a board certified health coach who is on our team and she sees all of our members and really helps them make these plans actionable asks really insightful questions that I feel like I will read some of her charts and I'll be like, I didn't even know you're writing a book.

[00:33:50] You're writing a book? Some things I don't even tell you as the provider they'll tell her and it's really insightful to be able to see from a different perspective what people, what lights people up and what their goals are. And so the Unlimited Health Coaching also comes with a membership.

[00:34:06] Cynthia: And as a health coach, I feel like that's invaluable right there.

[00:34:11] Thank you so much for sharing. We, I feel like we learned more about hormone replacement therapy, about MIMC and what you're doing. What is one takeaway that you hope listeners leave this conversation with? 

[00:34:26] Dr. Cassie: I hope. And my one takeaway would be that there are more people who qualify for HRT than are disqualified.

[00:34:33] And so if you are being disqualified or if someone is telling you no for whatever reason, I just really want people to get a second opinion and keep asking why? Give me a reason why this therapy can't help me. And until someone really gives you a contraindicated reason, keep asking. Because Advocate for yourself.

[00:34:53] There are much, many more people who qualify than who do not qualify. And if it is your personal choice to try this therapy and to be on this therapy, then keep advocating for yourself because there are providers who and it does not have to be us and it does not have to be me that believe the way that we believe and who really advocate for women in this space and for this modality.

[00:35:12] So whatever your personal choice is, just make sure that your provider is supporting you in that. 

[00:35:17] Cynthia: Yeah. Beautiful. I feel like Dr. Cassie add it to your list, but you'll start a certificate program for artfully guiding people through HRT in the future. 

[00:35:30] Dr. Cassie: I know don't add that to my list.

[00:35:31] I know right as you were saying I 

[00:35:33] Cynthia: need to do less. No we'll just bookmark that but no 

[00:35:36] Dr. Cassie: i'm just joking. I know you said don't add it to my list Because i'll actually do it. I will sit down. i'll figure out how to do it 

[00:35:43] Cynthia: I know you will Oh thank you so much. Dr.

[00:35:47] Cassie for everything you're doing everything you've shared today. I really appreciate you and We'll have links for how to get connected Cassie and her team in the show notes if you're interested in learning more. 

[00:36:00] Thank you so much for listening to the Well Connected Twin Cities podcast. Did you learn something new? Did you feel that spark of hope and excitement for what is possible? Because so much is possible. Tell us about it in a review on Apple podcast. Not only would we absolutely love hearing from you, but these reviews help our ratings and help other curious minds like you find this resource.

[00:36:26] We are always better together. Thank you again, and see you next time.