Can you get Neil Rouzier on the podcast?
Neil has an alternative perspective using HRT to modify CV risk and has supporting data. I would appreciate a conversation between you guys about traditional lipid lowering agents - statin/PCSK9 vs HRT. I can provide his contact information if needed.
Determining if low LDL or treatment causing fatigue
I brought an LDL of 165 to 135 with diet, and down to 105 with 5mg Rosuvastatin with no issue. Adding ezetimibe or increasing the statin to 20mg both got LDL into the 70s, but I didnt feel great and greatly reduced activity and exercise, so not a good tradeoff. I tried lower doses of ezetimibe based on the trial data but no change. Given I've tried two drug pathways, how reasonable is it to suppose the the low cholesterol is the cause of the fatigue vs. just not tolerating the treatment well? Trying to hypothesize whether I could expect a drug using the pcsk9 pathway to cause the same issue.
The Attia Network of Health Care Professionals
Long time listener, first time caller and recent subscriber: I am working with what I hear on the show. My doctor isn't. I am sure I don't understand the liability and ethical issues with my question. How can I find a Peter Attia aligned/recommended/disciple doctor in my area?
Treatment of PCOS
My question is that, is there any evidence to treating patients with PCOS, even with normal labs, with thyroid replacement and progesterone? Background story, is that I was diagnosed with PCOS when I had issues getting pregnant. I was put on Metformin to see if it might help with ovulation, and it worked. I have stayed on it since (8 years later, and I am 40 years old now), and I feel good on it. Since having my son, I have regular menstrual cycles (1st time in my whole life), and my labs all look good. I wanted to start rapamycin for longevity, so I found Dr. Morris out of TX who does a rapamycin program for a fee. After my first virtual visit with him, I found out he also specializes in PCOS. He ordered all the hormone labs plus more for me, which I have never had tested before. They all came within normal limits, but he believes, similar to what I've heard you talk about, that the "normal" levels for many labs are not ideal, and he feels most women with PCOS should also be on desiccated thyroid and progesterone. I guess I had never heard of that before from my OB/Gyn or primary, and I am having a hard time finding evidence for this. My TSH, free T3, and free T4 were all normal, just on the lower side. He still recommended the thyroid medication, but specifically desiccated thyroid and not levothyroxine. Sorry for the long round about, but I'm just wondering if there is any evidence to treating patients with PCOS, even with normal labs, with thyroid replacement and progesterone? One last snippet is that I am an atypical PCOS, meaning that I have always been thin and have not had any of the other symptoms of PCOS other than the anovulation. Thank you!!!