Dr Louise Newson: [01:00:00] Today on my podcast I've got Dr Harpreet Sood who is a UK and US trained doctor and he currently works in both London and Dubai. We talk about the global health problem of not being well for long enough, about how we can personalise medicine and how of course we can have hormones in our everyday consultations and helping people make the right choices for their future health.  [01:00:26][26.1]

‍
Dr Louise Newson: [01:00:28] So Harpreet, you're in the studio. I've dragged you in at short notice because you're over from Dubai for a short period of time, but you're UK trained. I've known you on and off for a few years, but I feel like I'm getting to know you a bit more and you're getting to know the work that I do a bit more, which is great. But we're both GPs. We're both really keen in keeping our patients as healthy as possible. But just tell me a bit about your background if that's ok? [01:00:54][25.5]
‍

Dr Harpreet Sood: [01:00:54] Absolutely. So we've actually known each other since 2015. We got introduced by a woman called Gwen Reese. You don't remember her?  [01:01:00][5.9]
‍

Dr Louise Newson: [01:01:00] Yeah, I do remember her. She's great.  [01:01:01][1.0]
‍

Dr Harpreet Sood: [01:01:01] She was like, Louise, amazing, fantastic doctor. She wants to do more in women's health and set up a clinic. Please get in touch. That was the email. So we did speak. But no, it's been great following your journey and really seeing where you've got to. So and thank you for the invitation, delighted to be here. You know, it's always great to have this moment to talk with friends, but also colleagues. So my background, as you know, GP in the UK, trained both here and the US, background in public health, health systems, but increasingly been doing a lot more in preventative health, proactive health, and thinking about how we flip the model from being essentially a reactive service that we're all used to here in the UK to a more preventative, proactive service. And in particular, combining that with the role of technology and wearables, as we've seen advancements, as you know, great advancements in diagnostics, therapeutics, but also wearable technology. I mean, I wear Aura. I wear Whoop. You know, all sorts. But, you know. Are they 100% accurate? I don't know. Probably not. But at least it gives you enough of the data to do something meaningful with it. And I think that's the main thing. So that's really where I'm spending a lot more time now. And you mentioned Dubai, so with my partners, we've just set up a clinic out in Dubai, which is essentially doing that. So we're creating a new model of primary care, a lot more focused on concierge primary care but really thinking about prevention, proactive diagnostics, but also how we bring elements of longevity/health span into the conversation. And so that personalised approach that I think all of us strive to do, but we find it very hard to do in the NHS.  [01:02:40][98.4]
‍

Dr Louise Newson: [01:02:40] It's really hard, isn't it? Because we've been trained in probably a similar way. We've been trying to diagnose a disease, think about the treatment pathway, but it's almost waiting for the accident to happen, isn't it? And, I'm sure you have as well, I've worked in some really busy jobs in really deprived area where you just feel like you're firefighting the whole time. You're just personally trying to get through that shift, especially working in a hospital. But also for the patient, you're literally just going from one disaster to the other. And if you work in a hospital long enough, you'll see the people coming back and back and back. And it is that cycle of, you know, someone's maybe got an asthma attack, then they have a chest infection, then they maybe have a clot or then they have osteoporosis. You know, you just see or you see it in families, don't you? And it's, and as a general practitioner, I mean, I was at the same practice for 20 years. So that was, really gave me a feel for what it's like to get to know the families. But you can see it's generational as well. And since I left the NHS, things have got even harder. It's so reactive. Whereas we know if we can invest, not money-wise, but invest with education, with the right tools for our patients, it can just transform their future can't it? [01:03:58][77.3]
Dr Harpreet Sood: [01:03:59] One hundred per cent, and my ambition always has been, currently seeing 40 patients a day but actually really need to see 10, 12, 14 patients a day but actually really have that dedicated time with them where we're spending half an hour, 40 minutes with them and their families on educating them but also coaching them, guiding them on various elements of it but unfortunately the system is against us from that perspective but also from the perspective of using the latest biomarkers and diagnostics.  [01:04:26][27.6]
‍

Dr Louise Newson: [01:04:27] When I went into private medicine, I made this unwritten rule to myself and I still do it, that I wouldn't do anything different clinically than I had done in NHS. But the one thing that I do do differently is I have time, like you say. And actually, you know, that time is such a luxury, but actually to have that time means that we don't have this cycle of people coming back so much. So actually, if I spend three or four, times the time that I would spend as a 10 minute appointment in general practice, but actually that's probably worth two hours of them coming back and forth, you know, multiple times for those 10 minutes.  [01:05:02][35.6]
‍

Dr Harpreet Sood: [01:05:04] Yes, 100% and look, the nation, the NHS, the public are used to going to their GP just to see their doctor. But actually, I believe that the world is changing, that you don't always need to see a doctor, and a doctor may not be the right person to see, right? And actually, I think we've seen progress, in particular in the NHS, where we now have physios, pharmacists, healthcare assistants, social prescribers, health and wellbeing coaches, and there's a good multidisciplinary team that could initially see a patient before they see you, right? And it shouldn't be that the first appointment that you see or the first contact you have was a doctor. The doctor potentially could be the last resort for those complex patients or those that need it. So it's a mind set shift, I think firstly, cultural shift secondly, but also raising awareness amongst the public to say, just because you're not seeing a GP doesn't mean we're fobbing you off. It's actually because we believe there's others that can help you more.  [01:05:56][51.7]
‍

Dr Louise Newson: [01:05:56] And I think it's a really important model because I feel very strongly as a doctor that I'm the patient's advocate and you're not arrogant at all, whereas, I don't want to talk out of turn, but there are quite a few doctors that are arrogant and they want to be in control of their patients and, you know, when I was at medical school in the 80s and 90s, it was very unidirectional because there was no internet, there was very little information available for patients. So they would be handed their prescription and really ask no questions. I'm the doctor, I'm in control. And it's been wonderful to see how, for many of us, that consultation model has really changed and put the patient in the centre. But the patient now has a unique advantage for having almost as much information available to them that we have. You know, you can go onto PubMed, you can read all the evidence, you can look at the guidelines.  [01:06:47][50.8]
‍

Dr Harpreet Sood: [01:06:48] Chat GPT, I mean everything.  [01:06:48][0.5]
‍

Dr Louise Newson: [01:06:49] Yeah. Whereas years ago you couldn't have that. And I think that's the same with wearables as well. As you know, there are quite a few articles often in the medical press saying this is terrible that people are monitoring their pulse or their blood pressure or their stress or their sleep. But I actually think more data is really important. It's what you do with it and how you interpret it.  [01:07:10][21.3]
‍

Dr Harpreet Sood: [01:07:12] I love it actually. A lot of people, like you said, against it. I love it because, A, I learn a lot. B, I believe that those people who have actually made an effort to do that are generally interested in their health. So I know that if we do engage with them in a different way, we learn together, we think about shared decision-making, and like you rightly said, you know, continue to remain the advocate for your patient, then the outcomes will generally be better, right. And also, that it's amazing to push this innovation, which has always been the backbone of what I do, is that how do we bring the latest to our patients and if the system doesn't allow you to do it, get the patients to do. If you can't work the system get the patients to be their own advocates and we support them through that.  [01:07:52][40.9]
‍

Dr Louise Newson: [01:07:53] Yeah, I think that's really important. And again, it's about ownership and choice. And I think it's really important because so often we're medicalising people to make us feel better as doctors. And I reflect back to some of the patients that I treated in the past. And I know, I feel bad saying it, but I know that I gave people antidepressants who probably didn't really benefit or need them. I probably gave antibiotics. I gave other things because I just needed to give them something often when they'd come back and back. And I often wasn't thinking so much of the bigger picture. And you probably know what I'm going to say, I obviously didn't think about hormones either, but for men and for women here. And, I feel like we've got to be looking across the board. And also, like 20 years ago, if I'd start to talk to someone about exercise or nutrition, they probably would have thought, well, you're a doctor, why are you talking to me like this? Where's my prescription? So you sort of feel that's almost your job is the prescribing, whereas I've really changed in my practice in that actually 99.9% of what I prescribe is hormones and I don't see that so much as medicine because it's just a natural replacement of body identical hormones. But the rest of my time is really digging quite deep into nutrition, exercise, lifestyle, supplements if needed, which is quite different to how I was as a quick, fast turnaround GP.  [01:09:18][84.8]
‍

Dr Harpreet Sood: [01:09:19] Yeah I'm right behind you. So a few years behind you, but we're doing exactly that, right. Which is, you know, look, globally, I think we still have a challenge that there are very many differing cultures and perspectives on what it means to go and see a doctor and what you expect, right. I think the vast majority of the world still today expects a pill. They still expect a prescription of some sort. But I believe that is changing and it requires, it will require a lot more for it to change globally where we will see a pivot. But nonetheless, let's take where we are in Dubai at the moment. You know, it's probably got hundreds of nationalities, lots of different people. With the members that we see today, we have a spectrum of people who are doing that, right. Some of them are coming and saying, I know exactly what I want and I want to get it, versus some who are willing to go down the journey of what you're talking. But what we're building at Skai, similar to what you are talking about, is to say, look, fundamentally, it is about the holistic assessment for a lot of this stuff, right. Hormones is an absolute key player in that because both men and women, you know, science is getting better, evidence is getting better. Awareness is also getting better, right. But it doesn't mean it's for everyone because, you know, for the vast majority of people, yes, but there might be some people that we can optimise their sleep, their nutrition, their strength. You know, we do VO2 Max, metabolic. You know the list goes on, right. But if you do it in that context, undoubtedly you'll have a better outcome for that individual if you top it up with the hormones. And I think that's the important thing is to say, hormones, yes. Medication, yes but let's put it in the context of everything. [01:10:46][86.4]
‍

Dr Louise Newson: [01:10:46] And that's really important because I think over the past, lots of people have misunderstood my work thinking all I do is give hormones. And like, yes, I take hormones myself, but actually if I didn't exercise, if I didn't eat well, like the hormones are good, right, but they're not that good, you know, and that sometimes is forgotten because for me it's basic bread and butter, right. Well, saying bread and butter, I don't eat bread. But you know. But for a lot of people, the basics has gone, but not just patients, I think, for doctors as well. And, you know, you're healthy, you look after yourself. There's lots of our colleagues that don't, or they don't see it as a priority. And even my husband this morning was telling me how many chocolates there are, lots of chocolates on the wards. And he just looks at the back, looks at the labels and said to the nurses, do you really want all of this in your body? And he knows the nurses very well, so it's fine and they know what he's like. But he said, I kid you not Louise, it's taken me about seven years for them to understand there are different types of chocolate and there are different types of food and you know what it's like in a hospital, it is impossible to get really nutritious food if you're doing long shifts.  [01:11:49][62.7]
‍

Dr Harpreet Sood: [01:11:49] 100% Yeah, yeah, yeah.  [01:11:50][0.5]
‍

Dr Louise Newson: [01:11:50] But they're understanding, because they have had Paul in their ear for ages, but it can take a while and I do feel we have a duty as healthcare professionals to educate, but give people choice, you know, and I think that's the other thing that's often misinterpreted is choice. You know, I actually, if you were my patient, I wouldn't care if you smoked or not. I wouldn't t treat you any differently. I wouldn't judge you any differently, but I do think my duty would be to tell you it's not good if you smoke. Don't get me wrong, you don't smoke, but I'm just saying as an example. And it's the same with hormones, you know, I think it's really important that people know that there are health benefits of hormones, but I feel like our education in the past about hormones, especially focusing on menopause has been very much flushes and sweats and you could have HRT, but actually try to avoid it almost. So opening up the conversation and thinking about our hormones being biologically active, having big anti-inflammatory properties in our bodies, then it's almost symptoms are secondary. Often people take them for their future health, but just because we haven't been taught like that, it's quite different to sort of change your mind and perception about hormones, isn't it?  [01:13:06][75.6]
‍

Dr Harpreet Sood: [01:13:07] 100%. To be honest with you, I can't remember what I got taught medical school, because so much of it is out of date or not relevant to our practice today. But actually, even a lot of our training as a GP, family consultant, I think there are massive gaps in the education, especially with things we're talking about, right. So we talk about Medicine 3.0. We talk about prevention, we talk hormones. We hardly spend time on things like sleep, nutrition, exercise, you know, VO2 Max, all the things that we're talking about for example, but it plays such a fundamental role in who we are today. Okay, granted, like I said evidence has improved considerably over the last five, 10 years, but nonetheless, I think it needs to start becoming a lot more mainstream. But going back to your point earlier, you know, hormones for me has become a much lower threshold now, right. And that's partly, honestly speaking, that's probably due to raised awareness, people like you have done, you know we've spent a lot of time together and education through you and your work I think has been fantastic because often people get very scared when it comes to things like HRT or testosterone, because A, we're not used to it. But I think for me personally, it's been that kind of gender issue, which is a male thing, which I've had to come over myself and I'm a lot more confident in that space now, but also that because there's been a lack of training, right, so, and I think people always share these horror stories of you might get cancer or you might get XYZ, stay away from it. I mean, I saw a patient from India recently and India is so far behind right because everyone there is saying absolutely no to HRT because it's going to lead to everyone getting breast cancer and I think these misconceptions, misinformation I think is dangerous because ultimately a lot of women are missing out on these important hormones and I that needs to change very quickly.  [01:14:53][105.4]
‍

Dr Louise Newson: [01:14:53] It needs to be quick because women really are missing out, and I'm sure you know there was the FDA announcement in America, and you know, to hear Dr Makary, the FDA commissioner for health, talking about the millions of women, like tens of millions of woman that have missed out on hormones, and often I'll talk to healthcare professionals about the risks of not having hormones to their patients, because like you say, we've always thought about the risks, or perceived risk usually, because the risks aren't there for the body-identical hormones. But the risks, you know, thinking about your patient from India, her cardiometabolic risks, so her risk of heart disease, diabetes, hypertension.  [01:15:31][38.1]
‍

Dr Harpreet Sood: [01:15:32] Strength, I mean, you know, the list goes on.  [01:15:33][1.3]
‍

Dr Louise Newson: [01:15:33] Absolutely, it's so important. Whereas if you've not been taught about it and the patients don't understand, then it's almost like the elephant in the room that no one talks about.  [01:15:43][9.9]
‍

Dr Louise Newson: [01:15:46] If you've ever felt confused, dismissed, or just left to figure out your hormone health on your own, that's exactly why I created my free Balance app. It's designed to educate women about their hormones at every stage of life. You can track your symptoms and periods, if you have them, read evidence-based articles, and connect with a community of women who are asking similar questions that you might be asking. I see every day how powerful knowledge is. When you understand what's happening in your body, you can make informed choices about your health and your treatment. And you can advocate for yourself when you speak to healthcare professionals. If you want clear, trustworthy information without the noise or the misinformation, then download my Balance app today. It's there to educate, support, and help you take back control of your hormone health.  [01:16:38][52.5]
‍

Dr Louise Newson: [01:16:41] And it's the same for men, I remember years ago, one of the things that we had to do was measure testosterone levels in men who had diabetes. But then we found that they were always low. So then they changed it to say, don't measure it. But I remember once there was one of my patients who was a male patient and he had awful night sweats and was really tired and I was doing all these tests, I couldn't work out what was going on and then I... his wife I knew really well, was coming in and saying they had no sexual relationship either and he just wasn't himself and his mood was low. And I was like, what else? I mean, I'd done everything. I didn't know what else to do. So in the end I did his testosterone level and it was so low. And I remember then saying to my husband, oh, should I give him testosterone? I don't really know. And I probably felt how a lot of doctors do now about HRT for women because it's all about having confidence. And as a doctor you can have confidence with knowledge. But it's very different when you've got a patient and you're giving that prescription. So I wasn't sure what to do. So I thought, well, I know it's gonna take him quite a few weeks for the appointment to come through with an endocrinologist. So in the meantime, I can't watch him suffer because the quality of life is so awful and I'd found a diagnosis and the guidelines are very clear, it was low enough. So anyway, I gave him some testosterone and then I got a letter of complaint back from the endocrinologist that went to the senior partner and I got hauled in front of them and said, how dare you, he's got a risk of stroke because he'd had a mini stroke, a TIA many years before. And I said, well, my understanding is this is natural testosterone, I gave it as a gel through the skin, it's the same structure as his own testosterone, there's no risk of clot, very different if I'd given him a synthetic testosterone, of course, and they wouldn't have it. And it was so awful and I was about to leave that surgery for my clinic and the last time I saw him and his wife, they said, well we've still got some left, we're using it, but we've been to the endocrinologist and they've said, you can have a very low dose, but the problem is he's so tired he's not able to drive. But they said, well, maybe you could just not drive on a motorway and drive on the A-roads. It was just like so ridiculous. But I didn't have the confidence to go back to that endocrinologist with the evidence because, you know, male testosterone still isn't my specialty. My gut feeling was that it was absolutely safe and I was following the British Society of Sexual Medicine guidance, but I didn't have enough clinical experience. I didn't have enough scientific knowledge. I was 'only', you know, a GP in a practise where I wasn't getting supported and the consultant endocrinologist was telling me that I was really wrong. And I remember feeling, gosh, this is really awful, but that must happen a lot for GPs and other clinicians who aren't experienced with women's hormones as well.  [01:19:33][172.4]
‍

Dr Harpreet Sood: [01:19:34] Yeah, absolutely, and I've probably experienced something similar more so for women, rather than prescribing testosterone. But look, I think it's how you approach it, right, and what I've done, and you could probably vouch for this, because I've built a network around myself of people who I trust but also who I know are working in this space, who I can just pick up the phone and say, look, what do you think? [01:19:56][22.2]
‍

Dr Louise Newson: [01:19:57] It's amazing to do that?  [01:19:59][2.2]
‍

Dr Harpreet Sood: [01:19:59] Yeah, and I think with WhatsApp today, it's so much easier, right, emails, texts, and I think, you know, look, ultimately, there'll always be naysayers, they'll always be people who are protecting their corner, but frankly, as we said at the start, I'm there to be an advocate for my patients, my members who are part of our clinic, where we want to do the best for them, right? And I'll go to lengths to figure out whether it's, you know, so UK, we've got people in the US, we got people in the local region, and, I think if we come together more together as a network and raise the awareness. Raise the voices around it. I think more and more people will start listening and that's the way to go.  [01:20:32][32.7]
‍

Dr Louise Newson: [01:20:32] And I think actually as doctors, there are a lot of doctors that put each other down. We know that, but there are lot that really support each other. And I'm on this menoposse group, which is a group of menopause specialists, hormone specialists across the world, a lot in the US and some from other countries, including Australia. And it, I'm often an observer from it, but I will, you know, join in as well. But often people say, I've seen this patient, what do you think? No one's judging them at all. And often we'll add in references or papers and give support. And it's... you know, people are so grateful for that. And that's something that we couldn't have done 20 years ago. And I think, like, it's fine for patients. If you say to them, look, I don't really know, but I'm going to find out for you. Or I haven't had much experience, but I would like to help you. And like, I'll talk to you. Patients love that. And what I hear a lot from women is that they see their doctor who says, no, absolutely you can't have hormones, or you're too old, you're to young, or whatever. And they're giving them inaccurate advice. And it's obviously because they're not educated in that area, but the patients would like it a lot more if they just said, sorry, I don't know the answer today. And that's fine as a doctor. I mean, we're not, we're not robots. [01:21:41][68.9]
‍

Dr Harpreet Sood: [01:21:41] No, absolutely. And actually, through my experience, you get more people that trust you on the back of that. Because you've actually gone out and not tried to fib your way through or, you know, try and question. You've actually said, look, I don't know, but I'm going to go and find out. And I've seen that more and more patients are actually very happy with that kind of approach. And it builds a much stronger trust, is my view.  [01:22:01][19.9]
‍

Dr Louise Newson: [01:22:01] Yeah, absolutely. We have a clinical Teams chat going all the time and you know, we've got dozens of doctors and we've just recruited some new ones. And you know they feel really well supported. And I think that's really nice for the patients to know. And, you know I don't know everything. Sometimes I'll be thinking and I think I've done what's right, but I'll always maybe say to someone else, look, I've seen this patient, I done XY,Z, what do you think? And it's really nice and validating. And I think to have that professional curiosity is really important as a doctor, we've all seen arrogant consultants who don't want to learn from others. [01:22:35][33.6]
‍

Dr Harpreet Sood: [01:22:35] Yeah.  [01:22:35][0.0]
‍

Dr Louise Newson: [01:22:35] And I think we can always learn from others. It's really important. [01:22:37][1.9]
‍

Dr Harpreet Sood: [01:22:37] Yeah, learn from others, but also do it yourself, right? So like I said, I've done CGM, I have done my VO2 Max, Ive done my DEXA, I have done my sleep scores etc. [01:22:43][5.8]
‍

Dr Louise Newson: [01:22:43] Hope they were good?  [01:22:46][3.1]
‍

Dr Harpreet Sood: [01:22:47] Yeah, I mean, look, the VO2 Max can certainly get better. The DEXA body composition is good, I've already dropped four percentage points since the last two months. I believe I can get down even further.  [01:22:56][9.4]
‍

Dr Louise Newson: [01:22:56] Very good.  [01:22:57][0.2]
‍

Dr Harpreet Sood: [01:22:57] But the thing is, when you walk yourself through that journey, it makes it A more realistic because you've felt the pain or you've gone through the motion of it, then you can talk more confidently, right? I'm not at that stage where I need hormones, but when I do, then I will certainly take them. [01:23:11][13.9]
‍

Dr Louise Newson: [01:23:11] Well, totally. And I think that's probably why I'm even more gobby because if I wasn't taking hormones, I wouldn't be working. There's no shadow of a doubt my brain had just not worked. And in fact, one of my husband's colleagues has just been off for two weeks with flu, like really bad flu, and he's not been ill. He's not had time off at all. And Paul said to me, oh, he's come back and he just said it's the first day, his brain's felt clear. And I said that's just like being menopausal, that brain fog is so horrid. And it's so hard when you need your brain, you know, it's, um, and you don't know until it happens, of course, but it's also, you know, again, it's about choice. And that's where I think, you know, our work of empowering our patients and following them on a journey and involving others, you know, who are allied healthcare professionals is crucially important.  [01:24:01][50.3]
‍

Dr Harpreet Sood: [01:24:02] But also on that, like again in Dubai, but we also see this in London, but most places now that a lot of women are in many more senior positions in executive roles. And I think it's good to see more corporates taking this seriously, given the opportunities for women to have the treatment, but also the space they need. But it's incredible because, maybe 10 years ago, as short as that looking back, this wasn't there, right. So you can imagine all these women who were in high-powered jobs were really struggling to get the attention and the space they need. And I think people like yourself and the others who have been really pushing for this is I think it made a big difference, but I still think we've got a lot more to do. A long way to go. [01:24:42][39.5]
‍

Dr Louise Newson: [01:24:41] There's a long way to go yet. I remember about 10 years ago when Dame Sally Davies was the CMO, the Chief Medical Officer, and going to a meeting at the Department of Health and saying then, you know, 40% of NHS employees are menopausal women. We know around 10% give up their jobs. We did a survey and found that 37% of women were going to their jobs but not enjoying it. They would reduce their hours if they could afford to. Because of their menopausal symptoms. And we know the main symptoms are, that affect people at work are anxiety, fatigue and memory problems.  [01:25:15][34.3]
‍

Dr Harpreet Sood: [01:25:16] Mm-hmm  [01:25:16][0.0]
‍

Dr Louise Newson: [01:25:16] So, you know, even looking at our NHS that employs so many people.  [01:25:21][4.5]
‍

Dr Harpreet Sood: [01:25:22] It's massive numbers.  [01:25:22][0.0]
‍

Dr Louise Newson: [01:25:22] There should be clinics everywhere for people, there should be easier access to hormones.  [01:25:26][3.9]
‍

Dr Harpreet Sood: [01:25:27] Yes, I think you raise a really important point, right, because today we've got really well-defined pathways when it comes to frailty care or paediatrics or diabetes or the list goes on, but when it come to menopause, it's terrible. It's fragmented, it is inconsistent, it often looks at menopause equals hormones, but I think like we've discussed, it was about the holistic approach of how we think about sleep, mood, nutrition, metabolic, strength, all of that, right. And I think these clinics will help, but I think there needs to be a much more structured pathway programme.  [01:26:01][33.4]
Dr Louise Newson: [01:26:01] Absolutely, and it's multi-organed, you know, our hormones get everywhere. So what we're basically saying is we should probably take it off gynaecologists and as GPs, we're...  [01:26:11][9.3]
‍

Dr Harpreet Sood: [01:26:11] Is it a gynaecologist thing? I don't know, right?  [01:26:13][1.7]
‍

Dr Louise Newson: [01:26:13] No it's not.  [01:26:13][0.0]
‍

Dr Harpreet Sood: [01:26:13] It's more a generalist thing now? [01:26:14][0.7]
‍

Dr Louise Newson: [01:26:14] If I had type 1 diabetes, which my pancreas is not working well, I wouldn't go and see a pancreatic surgeon. And it's the same if my ovaries weren't working well. Why would I go and say gynaecologist? It doesn't make sense.  [01:26:26][12.6]
‍

Dr Harpreet Sood: [01:26:26] So our GP, we have a women's health GP now. She's doing a menopause clinic, women's health clinic, in a general practice setting. And it's amazing, actually. The clinic's always full, and it's that relationship, right. And obviously, when you need specialist input, we know where to get it, but on a day-to-day basis, it doesn't require specialist input unless it's a complex patient.  [01:26:45][18.9]
‍

Dr Louise Newson: [01:26:46] It's got to be routine, far more routine, rather than opting in for hormones, it should be opting out because the majority of women should be considering them for their future health.  [01:26:57][11.4]
‍

Dr Harpreet Sood: [01:26:57] Where are you seeing the most progress being made in this, like, globally?  [01:27:00][2.6]
‍

Dr Louise Newson: [01:27:01] Which country?  [01:27:01][0.2]
‍

Dr Harpreet Sood: [01:27:02] Yeah, or region, or...  [01:27:03][0.9]
‍

Dr Louise Newson: [01:27:03] Well, lots of people say UK is the best, but I think, it is best in that it's about 14% of menopausal women are prescribed hormones. [01:27:11][7.6]
‍

Dr Harpreet Sood: [01:27:11] One four? Is that good or bad?  [01:27:13][1.8]
‍

Dr Louise Newson: [01:27:13] It's still rubbish, but globally it's only about 5% of menopausal women.  [01:27:17][3.7]
‍

Dr Harpreet Sood: [01:27:18] Wow, 5%! [01:27:18][0.0]
‍

Dr Louise Newson: [01:27:20] Yeah, whereas before the WHI study, you know, the terrible study, it was about 30% in the UK and 40% in the US. [01:27:30][10.1]
‍

Dr Harpreet Sood: [01:27:31] Oh wow, so it's dropped considerably.  [01:27:32][0.8]
‍

Dr Louise Newson: [01:27:32] So it's dropped hugely, it went down and it's come up, but it's plateaued the last year at 14%. Areas of deprivation, it's a lot lower. So you know, but the guidelines are clear, the majority of women, first line treatment is hormones, majority is not 14%. So this inequality of this poor access to safe, effective medicine has got to change.  [01:27:52][20.6]
‍

Dr Harpreet Sood: [01:27:53] I mean the other thing I think is a lot of people look at it from a lens of what age are you? And I think that needs to change because actually women or men, you know, everyone's different.  [01:28:03][10.5]
‍

Dr Louise Newson: [01:28:04] Yeah. And also it's not just menopause, obviously with perimenopause but also PMS and PMDD. So, you know, my 23 year old has PMDD, she uses natural hormones and they've transformed her life. And I see a lot of younger people in their 20s who maybe just have hormones for a few days when their progesterone is dropping before their periods and it's transforming them. So I think the biggest difference is women are empowered for knowledge and then they can choose. I think that's that's... You know, when women get together, like some quite powerful things happen as I'm sure you know. So yeah, so it's great. So it's, there's lots to do. And I know we're going to do a lot more with education, a lot more global work. We're going to just join forces and just do a lot more. So it's exciting, there is exciting stuff happening, I'm sure. So, so what three things do you think we can do like, at speed, that's going to make the biggest difference to health generally? [01:28:58][54.8]
‍

Dr Harpreet Sood: [01:29:00] So look, I think firstly, we need to grapple the whole concept of personalisation and the use of wearable tech, but also understanding the individual in front of you, right? Guidelines are guidelines, but you need to understand the individual and provide that holistic assessment. So I would like to see more people focusing on that and thinking about that in a different way. I think secondly, the space we've just talked about, hormones, I think it needs to start becoming more mainstream. I'm shocked to hear such low numbers of people around the world, women around the world who are prescribed hormones and I think we all have a duty to raise the awareness and do more and I'd like to see that number go from 5% to 25% and I'll think that will be amazing. Again not just purely hormones but how we bring that holistic approach to the individual and do all the other things. And I think the third thing is that we all need to educate ourselves and educate the public because again cultural shifts, shifts in thinking amongst professionals around the world will only change when we bring used cases, case studies, we educate one another, but also bring the latest science. I think we can actually move quite quickly on that because there is already tonnes of stuff out there that we can leverage on. But it's about taking that advocacy approach to the individuals, which I think we can do more of everyone. So those would be my two or three things if that's helpful. [01:30:15][74.9]
‍

Dr Louise Newson: [01:30:15] That is pretty good, yeah. So let's see what the next few months and years bring. But yeah, I think it's an exciting time because partnering with each other, partnering with our patients, with communities, we've just got to have a group effect to really work at speed to improve future health, which is what we want really.  [01:30:33][18.2]
‍

Dr Harpreet Sood: [01:30:33] Yeah, and I think globally there's multiple cultures and we need to shift those cultures. In particular, like I said, Middle East, India, Asia generally, I think they're are a lot more risk averse to this and I think that could change considerably if we put our forces together.  [01:30:49][16.2]
‍

Dr Louise Newson: [01:30:50] Excellent. Thank you so much for coming.  [01:30:51][1.4]
‍

Dr Harpreet Sood: [01:30:52] Thank you so much for having me here.  [01:30:53][0.9]
‍

Dr Louise Newson: [01:30:53] Thank you.  [01:30:53][0.2]
‍

Dr Harpreet Sood: [01:30:53] Thank you  [01:30:54][0.2]
‍

Dr Louise Newson: [01:30:56] Thanks so much for listening. It would be amazing if you could follow me or subscribe because it will really make a difference to grow numbers and enable this to reach even more people. Thanks so much.  [01:30:56][0.0]
[1812.6]

‍