Dr Louise Newson: Today's podcast, you're all going to really enjoy and learn from I've got with me Jo Salter, who's a great friend and also the first female fast jet pilot. We talk a lot about her own hormonal journey, how it took her a bit too long than it should have done to recognise her hormonal imbalance. But we also talk about ways that women can really become strong and advocate for themselves and others. It's a great listen, so please enjoy it and share with others. So Jo, it's great to see you here in the podcast studio. We were just talking, I think it was about two years ago actually that I met you and you came to our conference. So every year we have an in-house conference. And in fact, our next one's in two weeks time because it's eight years since we opened the clinic. So it would have been six years that we opened clinics, and you came. We all needed a boost. We were having a difficult time in the public with various things. And you came to really boost the staff, my clinicians, people that work with me, and we had just such a great time. So just tell me a bit for those people that don't know you, just tell a bit about your story and why you're so inspirational.

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Jo Salter: Of course. I mean, I remember it really well, because it was quite a pivotal moment for me coming to speak to you. So I was Britain's first female fast jet pilot flying the Tornado and and I speak about it and I tell stories about what that really was like and how that happened and some of the challenges and how you overcome them. My belief is that the biggest barrier in life is getting over ourselves. But why it was so pivotal for me, based on my age and the menopause, is I remember sitting at a desk surrounded by all of these wonderful people and many doctors listening to the talk before me. And there was a piece of paper that had menopause symptoms and I remember just mentally ticking every single one of them. And even though I was, you know, through the menopause and had coped with it and dealt with it on my own. And so I started my speech with that, and immediately I was booked in for an appointment and saw one of your wonderful doctors. And of course we have become friends over the time. And it's made a real difference to me if I could explain the difference in my clarity of thought, if I could explain the difference in my sleep. And just, there's almost like a level of anxiety that used to exist that's completely gone.
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Dr Louise Newson: Yeah. Well, I remember seeing you and just having a little chat beforehand and I said I just think you need hormones. Saying to one of our doctors, can you see her quite quickly? And the thing is you don't know how much is life and how much is anything else or how much is your hormones. And, you know, I'm highly trained. I'm very specialised. I see, you know in our clinic, we've seen tens of thousands of women so it's pattern recognition. But as an isolated person on your own, you don't know whether it's just, you're super busy with your life, whether it's just part of age, whether it's whatever, and then people normalise their symptoms all the time. So, and also you probably never have time where you sit down and think about yourself for more than a millisecond. So you did have more than a millisecond to look at those symptoms and the penny dropped and...
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Jo Salter: And also I thought it was a once done and gone, you know. And so going through that whole perimenopausal time, when I had migraines that came on, I didn't recognise people. So it was quite severe and I was quite hormonally sensitive to it. So and it was seven years ago now. But what I did is I did this sort of, I read and I couldn't find much, no-one was talking about it then. Seven years ago, you see, you were just starting. And that whole approach of, I did fasting, I found a difference with green leafy vegetables, I don't know why, if there's anything in that and keto and I just tried everything and I managed my symptoms and I think that that was significant. I don't think it got rid of them all, which is different.
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Dr Louise Newson: Yes and I think that's the thing because the majority of women are unable to access hormone treatments they will try things and actually eating green vegetables will change the pathway of the hormones being broken down in the liver so some people do find it has a small effect, exercising can have a small affect, all these things can have a small effect but they're not the same as replacing those missing hormones, but women do try anything because you want to feel better, you know, you've, you know, you're really busy and you need your brain. I mean, you do some incredible lectures and you want your brain to be up there because it always has been in the past.
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Jo Salter: And being sharp, yes. And interestingly, I have a couple of friends of mine who have gone through, one's gone through a complete hysterectomy and she was saying to me, can I take hormones? And then my, now she's gone through surgical menopause and then my other friend, and they're both in their 50s, had breast cancer and it was an estrogen.
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Dr Louise Newson: Receptor positive.
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Jo Salter: Thank you. Probably wouldn't have used the right words. But again, she's asking me, can she take HRT because I don't think we know?
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Dr Louise Newson: Yeah and what's interesting is that you know those are two separate questions but you know if someone has a surgical menopause, so they've had their ovaries taken out. If I changed it and just said to you what would you say to a man who had both his testicles removed do you think he'd get testosterone?
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Jo Salter: Well, of course, but then... It's a good question.
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Dr Louise Newson: Yeah, but if somehow, when the ovaries are removed, I speak to so many women who the doctors, the gynaecologists, they say to them see how you get on. Well, I tell you how a man's going to get on if his scrotum going to pot and...
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Jo Salter: So we already know how she's going get on and she's three, four weeks post and she is not sleeping well and hot flushes and so I'm sending her to you Louise.
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Dr Louise Newson: So she needs to be seen. And it's really sad actually, we did an audit of some teaching hospitals of people who'd had a surgical menopause, who had their ovaries removed, to see the percentage of women who were given hormone treatments afterwards. And the guidelines are clear that all of them should be, you know, have a conversation at least about hormone treatments. And less than 15% have been given estrogen. When you look at testosterone, it was 0%. Now our ovaries make all three hormones, not just estrogen. So even though she's had her womb removed, a lot of gynaecologists think you only need progesterone for your womb, but progesterone is a really important hormone that works on every cell in the body and brain. So a lot women after hysterectomy, we should be talking about all three hormones, not just one.
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Jo Salter: So that's really good you've said that.
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Dr Louise Newson: And that's important because I was at a conference earlier this year in Los Angeles and someone was presenting some guidelines about surgical menopause in women. And it was someone from one of the menopause societies and they've got this flow chart, you know, do they have a womb? Yes or no. No, well just give them estrogen only, hormones. And so then I went up afterwards with a microphone, you know in front of the big lecture theatre and said, oh, I'm just a bit confused here because most people, most girls really know that our ovaries make estrogen, progesterone and they make testosterone. So I'm just wondering why your guidelines only say estrogen when progesterone is made in the ovaries. They're being removed, so you're removing progesterone. Why is it you're not giving progesterone? And you know, the female professor who was presenting just said to me, Louise, that's because the guidelines say estrogen only, and that's what we do. We work out of the guidelines.
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Jo Salter: Even though the guidelines are wrong.
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Dr Louise Newson: Yeah, and it was really interesting because the whole audience just went, Oh! And then she said, next question, please and that was the end of the, you know like I was like a little annoyance in her perfect life. And I don't think it was a stupid question to ask because why would you, like, if you remove the thyroid gland, you wouldn't say, oh, I don't think thyroid hormone is relevant, so let's ignore it.
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Jo Salter: Well it's not again, because my friend has already told me, she's been told she doesn't need progesterone because she doesn' have a womb. So actually they're following the guidelines still today.
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Dr Louise Newson: Yeah, and guidelines will never change unless they are challenged, if you see what I mean and they are guides, they're not a legal document or anything like that.
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Jo Salter: Well law, look at how law evolves, doesn't it, as you have case law. And we should be doing the same as we practice medicine.
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Dr Louise Newson: Absolutely. So, progesterone, you should be talking about all three hormones, definitely your other friend who's had estrogen receptor positive breast cancer, its a more nuanced conversation. Estrogen receptor just means that when they look down the microscope, it's got estrogen receptors on it. But every single cell in your body has estrogen receptors in it. So there is a form of breast cancer that's estrogen receptor negative. And that generally means that the cancer has sort of mutated and changed in appearance, so it's lost the receptors on its surface.
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Jo Salter: Oh, I see.
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Dr Louise Newson: [01:09:08] So, but a lot of people think estrogen receptor positive means it's been caused by estrogen.
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Jo Salter: That's exactly what I thought.
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Dr Louise Newson: That it's estrogen-driven or hormone-driven, and everyone goes, oh my gosh, because a lot the treatments for those women are blocking hormones, blocking estrogen, they're like, so people think estrogen is the baddie, really. There are no studies that show that estradiol, the estrogen that's in the gel or the patches that we prescribe, is associated with a worsening of prognosis after breast cancer either. It's not associated with an increased risk of recurrence or metastatic disease or mortality from breast cancer. And so, but we haven't got good studies because, of course, unsurprisingly, not really, you won't be surprised to hear that the studies haven't been done because it's about women. So,then we go back to basic science and think, well, would our own hormone, estradiol, worsen a cancer? It's very unlikely because estradiol is very anti-inflammatory as well. But it's not just about one hormone. We've got these three hormones. And we've just published a series that we've studied of women who actually were given testosterone on its own after having breast cancer, because we... It's all about choice but there's more certainty that testosterone is a different hormone to estradiol and testosterone can be very beneficial for a lot of symptoms. There's some data that show that women who take testosterone after breast cancer actually have a better prognosis as well.
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Jo Salter: Oh interesting.
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Dr Louise Newson: Which is really interesting because it's anti-inflammatory, it's really important. So often in the clinic, especially if someone's been recently diagnosed, I'll talk about testosterone first and then see how the symptoms are, see how the people feel. Or I might see somebody, I saw someone recently in my clinic who'd had breast cancer seven years ago and she'd had the most awful symptoms and she's now got osteoporosis. She can't remember things, she's given up her job. She's asked two different oncologists if she can have hormone treatment. One of them just laughed in her face. The other one said, Are you stupid talking about hormone treatment? So then that made her do nothing, but doing nothing has caused her all these problems. But she's so like further on, if you see what I mean, because she's seven years cancer-free. Her cancer was very small. It was an early stage, low grade. She had a, sorry, she had a mastectomy. She had chemotherapy. She had estrogen blocking drugs. She had everything thrown at her. And she said, do you know what I want all three hormones. I don't want just one. I want my life back. I really want to feel better. I've made the decision, I want hormone treatments. Please give me everything. So this is where women, our patients, are central to everything that we do. And then we can share uncertainty. I mean, you've been the highest risk job probably ever. And did anyone ever sit down to you and say, well, Jo, I don't think you should fly that plane because it might be, you know, you know that there's a risk.
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Jo Salter: Only my mum who said are you sure you want to do that?
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Dr Louise Newson: Yeah, but do you know what I mean? It's like, I feel as, there was a brilliant doctor, or she still is brilliant, but she's retired now, Charlotte Fleming, and she mentored me a lot, you know, eight, ten years ago when I was on my own. And I said I feel really scared giving women who've had breast cancer HRT and she said, Louise, let me tell you something, I've been practising as a doctor for 35 years, and I've been prescribing hormone treatments to women with breast cancer for 35 years. And I've never been sued once. She said, but I'll tell you something else. She said, I've had breast cancer and I take hormone treatments, but I also do bareback horse riding without a helmet. None of my oncologists or doctors have ever told me not to do this high-risk activity, which I can assure you has a higher risk of death than me taking hormone treatments. Yet so many doctors have tried to stop me taking hormone treatments but it's about choice, Louise. And I thought, actually, isn't this a great mentality? You know, as doctors, we're always watching our backs and thinking, are we going to get sued?
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Jo Salter: And being driven by fear.
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Dr Louise Newson: And we're being driven by fear. And when you're in fear, you become paralysed and you stop doing things. And the immediate reaction is to protect yourself in all measures and not think about the benefit of what you're doing. And if I said to you as a patient, sorry, Jo, no, you can't have hormones, close the door. I'm thinking, oh, good, I'll never get sued by that woman. But actually, your life could have fallen apart. And, you know, so I think we have to be responsible for our decision making and...
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Jo Salter: I feel so balanced now with where we are. And when I look back over, you know, becoming a teenager where teenagers are very difficult with all of the hormones and the pain that came with it. But then going into the Air Force and flying and I don't know if you're aware or if this is just me or if it's a medical thing. But the moment that there was something stressful, I would have my period, even though it wasn't quite in time. It was almost like the body...
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Dr Louise Newson: It's really interesting. There is a physiological reaction, sort of reason for that. So I don't know how much you know about hormones, but they're made from cholesterol, you know, cholesterol, which everyone thinks is bad, but actually isn't. So cholesterol makes progesterone and progesterone obviously makes testosterone and estrogen, but it also makes cortisol, our stress hormone. So if you're suddenly doing something that's highly stressful, your body needs that fight and flight adrenaline hormone but also cortisol. So your progesterone is pushed to making more cortisol, and then it forgets about your estrogen and testosterone. So you have like a drop of those other hormones so your body thinks, oh, I'm having a period, and that's what happens. So it's not a made up thing.
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Jo Salter: Well, I observed it happening. I went on my survival courses and the only good thing about when you went on survival courses is all the guys bought tampons because they were compressed cotton wool ready to be able to light fires. So I was completely, had enough tampons for however long I needed them.
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Dr Louise Newson: But that must have been hard though, doing some of the stuff that you did and having a period as well?
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Jo Salter: You just deal with it. It's just something that we learn to deal with isn't it. I think the first time I ever went to the tanker where you're going to have a much longer trip, I had my period as I went there. I'd think again the stress, my interrogation training course I went on, period. I just got used to wherever I went having to deal with it and I think as women it's just part of our day-to-day, how we operate.
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Dr Louise Newson: But what worries me in that though, is that so much is normalised. So I see a lot of women with premenstrual syndrome and a lot women with PMDD, premenstrual  dysphoric disorder, which is a more severe form of PMS. And then it's got so bad that they've come for help. But when you talk to them, it's gone on for years and they said, but it's only a day a month that I don't go out. It's only few hours a month that I feel like it's the end of my world. And it's just part of being a woman. But if you said to a man, well, you're gonna feel terrible or you won't be able to go to the gym for two or three days a month because you'll feel so tired and exhausted and you'll have muscle aches and pains, it wouldn't be acceptable. So it's that fine balance where, yeah, we're strong, we can get on with most things and we can cope with a lot as women, but then if it's something that's impacting us, we should be reflecting and try and get help if there is help available.

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Jo Salter: Especially if there's a way of making a balance. I think my worst time if I think about over my sort of life with periods was post-children and the hormonal response and really feeling low after that and there not being any discussion about the impact post having a baby. And especially to my first to go from being a fighter pilot to suddenly having this baby at home and then all of those hormonal things going on as well.

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Dr Louise Newson: Yeah, and I think about it a lot because I see a lot of women who've had postnatal depression and postnatal psychosis and they often don't admit it because at the time they're so worried that they will get misjudged and one of my good friends recently told me she'd had postnatal psychosis twice and her husband who thankfully she's divorced from now was a complete control freak and she said if I ever told him how I was feeling then the children would have been taken away from me, and I couldn't have that. And luckily he worked long hours and she could hide how she was feeling. But it's only now she's menopausal, now she's taking the right dose of hormones, especially progesterone. She's like, I wish I had had this after both my daughters were born.

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Jo Salter: I wish had. Nobody was even talking about it and I'm not sure they're talking about it now.

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Dr Louise Newson: They're not actually Jo and there's a big case obviously with Lindsay Clancy.

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Jo Salter: Of course, yeah.
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Dr Louise Newson: And I feel so sad I've written about it on my website and done some posts about it because it's horrendous what's happened. Of course it is and no-one will ever know the full details. But I just look at this poor woman and think is anyone giving her hormones? Even now, whatever the outcome you know is going to happen in the future, wherever she ends up. Is anyone actually looking after her hormone health? Because we've all seen the list of dozens of medications that haven't helped her, all these psychiatric medications. But it's a hormonal problem, and we've known this for decades. Katharina Dalton was a very pioneering doctor 50 years ago. More than 50 years ago she qualified. And she talked about this big hormonal drop, progesterone dropping, falling off a cliff after giving birth. So she gave women progesterone at quite high doses. And I've spoken to quite a few of those women and she saved their lives. And some of them had had postnatal psychosis the first time and she gave it to them as soon as they gave birth and prevented other episodes. And, you know, it feels so sad that no-one really listened to her. People didn't really like her because she was 'only' a GP. So the gynaecologist didn't really like her. But she was also working in the 50s and 60s when all the synthetic contraceptives were coming to market and there was a big move to market these through the drug companies, through the Department of Health and they didn't want anything to stop their way. So her talking about natural progesterone and they're pushing out the progestogen-only pill, the contraceptive that contains synthetic progestogen. They didn't want her in their way so she got reported to the GMC. It was the first GMC tribunal in 1959. Where she was hauled in front of a male panel because she'd been prescribing progesterone to her patients. None of the patients had complained. They all felt better.
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Jo Salter: It would be interesting today, I mean, especially for anybody listening to this podcast now, that suffered after their first child, that's pregnant again. Would they, would GPs today do anything about it?
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Dr Louise Newson: Well sometimes, if they've been under the psychiatrist after their first pregnancy, then they will be referred. And I was speaking to seven psychiatrists this morning, we're hopefully going to do some research in Australia. But what they do is they talk about, would you want to go on your antidepressant in the late stage of your pregnancy, or maybe throughout your pregnancy? Or an anti-psychotic?
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Jo Salter: And the answer is no, obviously.
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Dr Louise Newson: Yeah, but people do because they're so scared, you know, and...
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Jo Salter: And it is horrific, can I say, having been there.
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Dr Louise Newson: Yeah, and the other thing is people keep saying, well, there isn't enough evidence, Louise, for progesterone for postnatal depression or postnatal psychosis, but that's because studies haven't been done. And so this morning they were presenting some data where they looked at every single study. And a lot of the studies were given synthetic progestogens. Well, that's not the same as natural progesterone, or a very low dose, or it was only for a short period of time, so all the studies were not very well set out. So I said, well, that doesn't prove they don't work. It just proves that there isn't the studies haven't been written up and done. But I said I'd really love to see the studies of the effectiveness of antidepressants and antipsychotics given to women who have postnatal depression and postnatal psychosis. Because what I've read, there isn't good evidence. Has anyone else scrutinised those drugs in the same way? And they said, well, we don't need to Louise because it's already in the guidelines.
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Jo Salter: We are back to the guidelines again.
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Dr Louise Newson: We are back to the guidelines but who's written the guidelines...
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Jo Salter: And when were they written?
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Dr Louise Newson: Of course, and they were written by psychiatrists. So it feels like this sort of groundhog day really.
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Jo Salter: [01:21:55] It's a sort of circular element to it.  [01:21:58][2.3]
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Dr Louise Newson: Whereas, you know, if you had low iron because you'd had massive bleeding after a pregnancy and your iron had dropped, well, if it was really bad, I'd give you your blood back and if it just low and you're feeling a bit weak, I would give you iron back. You wouldn't question it. So if your level of progesterone have gone from 40,000 to nothing overnight and you're feeling awful.
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Jo Salter: So here's some progesterone.
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Dr Louise Newson: Progesterone. It feels really weird, doesn't it?
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Jo Salter: It feels very simple.
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Dr Louise Newson: It is so simple though.
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Jo Salter: That's what I hear. And again, looking at it from the non-medical point of view, you know, for all of us women out there, it should be simple.
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Dr Louise Newson: But it is simple and I, it's almost too simple to believe almost. And I'm a very inquisitive doctor and I like to ask questions and I like to challenge myself and challenge my clinical practice a lot and one of our doctors is amazing, they're all amazing who work with me, but she had postnatal psychosis and depression, had a very difficult time. She had a history of PMDD and her mother had died from breast cancer. So, with her first child, she tried, you know she was offered antidepressants and everything else and then she, I think it was her second child, she just thought, this is too much, I can't, nobody would help her. So she managed to get medication for some progesterone. And within days, that was it, she felt completely different. And then, she started reading Katharina Dalton's work and her books and her papers. And when she came to work with us, she kept talking about progesterone. And I was sort of, but Hannah progesterone is just for the lining of the womb. It's only for the womb, it's only for the womb because that's what I've been taught. She said all right and she bought me some of Katharina Dalton's books and so I read. And then I'm like why didn't anyone tell me this? And then you have to, well you don't have to but usually we give the progesterone at quite a high dose either rectally as a suppository or vaginally as a pessary and she said no you have to because a lot of the lower dose actually can make people feel a bit worse. So it's always hard in medicine, trying something new, that I've learned a lot and read a lot. It makes sense, offered to the patient. And then you see the results and it's incredible. I've got one lady who's had postnatal depression twice and she's had PMDD and she has also been a drug addict because she was trying crack cocaine and heroin to improve her mood those days before her periods. And she was on a bit of HRT when I met her and I said, well, I think you need a proper dose of progesterone and probably some testosterone too. So I gave her the Cyclogest pessaries and she messaged me and she said, it feels like gold going through my veins. I have not felt this good ever. Not even with heroin did I feel this great.
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Jo Salter: Oh my goodness.
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Dr Louise Newson: I was like... And then she messaged me last week and said, I'm on holiday with my children and it's the first family holiday that we've had and I've enjoyed. And it's, but it's just a hormone.
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Jo Salter: What a gift to give to women who are suffering, you know, I mean it makes such a difference.
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Dr Louise Newson: It does, but it's frustrating. And I feel like there's millions of women suffering. I've just written an article that went out today about, you know as doctors we're taught, do no harm, yet harm is being given to millions of woman every day because they can't access hormone treatments. And it's how we change perception. It's not good enough to sit back and say, oh sorry Jo, I don't know about hormone treatments, you just crack on with your life. And you're an inspirational speaker, you do the most amazing talks. How do you get people to change their thinking? Because that's what this is about, really.
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Jo Salter: This is about mindset, isn't it?
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Dr Louise Newson: It's totally about mindset, isn't it.
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Jo Salter: One of the techniques that I talk about, which is really simple. And I say that what you're paying attention to is effectively, and I don't quite know if this is right, and I shouldn't say this in front of a doctor, is where your glucose and oxygen or whatever happens in your brain, that's where you're feeding and spending your energy, whatever or wherever that energy is coming from, versus the things that you don't want to think about, you know, the work that's been done on neuroscience. Brilliant professor called Dr andrew Huberman, who's in, I've forgotten, Stanford. I listened to his podcasts when I couldn't sleep on the menopause.
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Dr Louise Newson: Okay, yeah.
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Jo Salter: He had a really good two and a half hour podcast and a lovely voice. And he talked all about this rewiring of the brain and where you are paying attention. And so what I use as a real, I suppose, technique is pluck out those thoughts that you don't want to have, because once you stop feeding them and you actually are focusing on other parts of your brain, you are rewiring and rebuilding the brain that you want that has the mindset shift. And I absolutely believe that the hardest thing we've got to do in life is get over ourselves. That we are that barrier, just stopping us. And it can come from so many places. It can come from things that people have said to us in the past, the self belief we have, that little voice that's saying we're not worthy, we're good enough, we won't make it. All of those different elements, but actually just say no to them. Stop focusing on them and just start becoming and being and saying the version of yourself that you dream of being and want to be. And before you know it, you've taken a step down that path rather than the other one.
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Dr Louise Newson: And I think that's such great advice, because a lot of the work I do, and I've worked quite hard, well, very hard, and quite differently, I suppose, to other people, is it's about empowering other people. You know, I don't actually mind if people take hormones or not, but I want them to be able to have a choice and I want to be to advocate for themselves. And so many women that choice is taken away because the doctors are just saying no. But what is changing is that women are stronger together, they're stronger with this voice of reason and logic and belief. And I think that is so important, isn't it. When we're trying to, it's like a groundswell really. They don't, people don't need me to the extent that maybe they did in the past, because I'm just talking about basic science. It's not like a new drug I've invented that I want people to take. This is just established basic physiology. And once people understand it's giving them the confidence to ignore the breast cancer nuisance noise in their head from older types of HRT and helping empower other people. So it has that ripple effect, isn't it. It's really important.
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Jo Salter: And you never know what the word that you say or what you're reading, how the impact it has. I spoke at a dental conference just a couple of months ago. This lady came up to me and she was really emotional. And she said, I don't know if you remember me, but you spoke for us three years ago and I came to your conference and I decided to do what you said. And I said, yes. She shifted her mindset. She was just brave. You know, I'd talk about feeling the fear and doing it anyway. How do you learn to be comfortable in discomfort.
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Dr Louise Newson: Yes.
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Jo Salter: That stretch zone so that you are saying, oh, I don't know if I can do this, but still giving it a go. She said, I woke up the next morning and I just said, yes. She said I've had two promotions, my life has changed.
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Dr Louise Newson: That's amazing, isn't it?
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Jo Salter: And then she tried to share it in the Q&A session after I'd spoken and she just broke down in tears. And I said, would you mind if I share this? But actually your emotion is because it's real. Actually, how we are feeling when we're holding ourselves back. Or those voices that we believe or the hormonal issues or the medical issues. All of these things are stopping us from becoming the version of ourselves that we're meant to be. So how do we take a step again towards that?

Dr Louise Newson: And that's really important because a lot of women I speak to have been turned away. And you know, I don't want to big myself up, but a lot of people think...
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Jo Salter: Big yourself up, Louise.
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Dr Louise Newson: Yeah, go on then.
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Jo Salter: We love you bigging yourself up.
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Dr Louise Newson: But a lot people think that doctors are godlike and what we say is the only way. And this is where we have to have a mind shift to think actually doctors are human beings. We can not know everything. We might not be trained in hormones, we might not have the knowledge, we might have the consulting skills, we might just be arrogant, you know, we are human beings. So I think one thing is for people to know that not every doctor is right for them. You know, they might be the best doctor, but it might just not be right for then. So having that confidence that they can talk to someone else. And then also, if someone has decided that they want to have testosterone, for example, then it's making them feel that it's okay to ask for it because it's really hard when people have been pushed back time and time again by doctors. And then you become worse because your hormones aren't balanced, you feel maybe it's not a hormonal thing, maybe I should be feeling like this and then you lose all that confidence and inner strength and I think the way that you talk and giving people the information and the positivity to go back. We're doing a lot of work with Balance app. We've got this 'Navigating No' series where we're even giving people little scripts to say. So if you were my doctor and you said, no, you can't have testosterone, Louise, and I could say, well, Dr Salter, sorry, could you just give me the evidence where it's harmful? Could you just write down exactly why you don't want to give it to me so I can show my husband later? Then you might feel a bit uncomfortable, but I'm not being rude to you. I'm just asking you in a, do you know what I mean? And it's having those tools, really, to challenge in a positive way, because when we're emotional, the fear can come to anger and then we can be more threatening and that doesn't always help.
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Jo Salter: There's something about pushing the appointment as well because one of the reasons I never went and saw a doctor is it's impossible in my old doctors, I've moved now.
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Dr Louise Newson: Yes.

Jo Salter: To get an appointment, you have to sign on at 8.30 in the morning. And if you haven't got your appointment by 8.31, then try again the next day. And so it just became too difficult, which is why I thought, Oh, I'll just use the internet or Dr google and then of course, we've already talked about what happened. I've changed doctors though. And I have, they now are actually really keen on supporting you through menopause.
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Dr Louise Newson: That's great, yes.
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Jo Salter: And I contacted them on Monday. I had an appointment yesterday and they've agreed to take on the progesterone and the estrogen. Of course, the testosterone is another story because the one that I got from you, which is, I think, from Australia?
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Dr Louise Newson: It's a cream, isn't it, so they don't have it on the NHS.
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Jo Salter: They don't it on the NHS, in fact, she said to me, how much do you pay for that? Isn't that very expensive? But my understanding is that the only testosterone you can get through the NHS is one that is for men, but you have a smaller amount of it, because we are just little men, is my thought.
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Dr Louise Newson: So well, that is right, but we are not little men, as you realise.
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Jo Salter: No, that was a tongue in cheek.
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Dr Louise Newson: So what's really frustrating is that the AndroFeme cream, which is licensed for women in Australia, it is licensed over here. They've had the licence for about a year now, but they don't have any stock. So it's like, why do they bother doing the licensing if they're not actually going to give it to us? So the amount of testosterone we produce as women is roughly about a seventh to a tenth of what men produce, but were all different. So there is gel. But what happens is it comes in a sachet and we say to the women, make this sachet of really slippery gel last for about seven days. Like it's just, it's a bit bonkers.
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Jo Salter: Oh I see, so it's actually the man's one day's worth.
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Dr Louise Newson: Yes, because there is a pump but the pump produces like one day's worth for a man so to do a tenth of a pump is really impossible. So then people use paperclips or they decant it into pots. I've got some patients who literally weigh it or use tiny syringes. So it's really ridiculous. So by the time you've done all that, and then sometimes it gets absorbed differently or it doesn't get absorbed as well as the cream. Some people find it gets absorb better than the cream so everyone's different, but it's a complete faff. So how we're allowed almost to prescribe something which is dosed so poorly is just beyond me. And it's the same in America as well.
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Jo Salter: My other observation was immediately I'm allowed to be prescribed just by showing her the bottle and showing her, the packet, the estrogen and progesterone, but I have to have a letter from you, so I'd like you to write that, for the testosterone. So it has a different permission level, is that right?
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Dr Louise Newson: Well, this is, it all stems back, so because it is down as a controlled drug, but not controlled to the extent of morphine or heroin. But what happened was in the 60s and 70s, once they discovered testosterone, the drug companies made a synthetic type of testosterone. So they chemically altered it and then it became an anabolic steroid. So it was in the, sort of the Olympics in the 70s, people started injecting this synthetic testosterone. People got big muscles, so then they thought that's really bad so they banned it from all sport. They made it a controlled substance. They were concerned because that, this synthetic chemical testosterone was associated with risks to heart disease and clots and various things. But what they forgot is it wasn't actually testosterone, the same way that the contraceptive pill is is not estrogen and progesterone. It's a synthetic version. So we still got this hangover that people are petrified of testosterone because they think it's dangerous or it's going to cause side effects or it, you know, and it's not, it's just a natural hormone. So until people have this mind shift and realise that it's really safe and really effective, it carries on and it...
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Jo Salter: It seems to me that this is part of what we should be learning at school, just the basic information about how our bodies work on the hormonal side.
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Dr Louise Newson: Yes, absolutely. I think boys, girls, they all should know. And it's really crucial, actually. So, yes, we could talk for hours. I'm really grateful. I like your inspirational talks. It's given me more positivity. So that's great. But before I end, I always ask for three take home tips. So if people are listening, there will be people listening who either are struggling to be believed, listened to, understood by their doctors, or they'll have friends who are maybe are too scared to even talk about hormone treatments because of unfounded fears. Using your positivity techniques, what three tips would you give them to become a positive version to actually ask for hormone treatments from their doctor?
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Jo Salter: One, number one would be trust your intuition, believe your gut. Because I absolutely believe that there is so much sense there and we don't spend time listening to it. And in fact, I'm writing a whole book on that at the moment about, you know, in this AI world about how we need to go back to listening to what we know already. The second one really is about, talk to a friend. Talk it over, speak it out. Say what outcome you want and why you're a bit scared, what's the fear, what might happen. And I have a technique which I use, which is called, 'so what'. And the so what is so what. So what might happen so what, and just keep saying so what, which usually drills down to something which is a bit unlikely and quite small or ridiculous. And you think, okay, so what, let's go and do it anyway. And the third one is feel the fear and do it anyway, step out, take a deep breath, use that as the energy that courses around your veins and say, do you know what, I am going to go and speak out and see what happens.
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Dr Louise Newson: Brilliant, great, so keep listening to those three tips and we can change the world.
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Jo Salter: Absolutely.
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Dr Louise Newson: Thanks, Jo, for coming today, it's been great.
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Jo Salter: Thank you.