#169 – Women’s health: How hormones impact our daily lives | Dr. Trevor Cates & Dr. Lauren Kelly-Chew

Episode introduction

Episode Transcript

Dr. Trevor Cates (00:07):

I think that’s one thing that’s really important, that you just don’t have to just suffer. That if you’re having symptoms, it’s a sign that something’s out of balance. Your body’s just yelling at you, saying, “Hey, pay attention to me!” And so you don’t just have to put up with it.


The other thing is that, don’t be embarrassed by your body. Your body is wise. It’s amazing. If you’re having problems like urinary incontinence problems or you’re having difficulty with your sex drive and you don’t have any sex drive or you’re not able to perform the same way that maybe you did before, certainly, it’s important to talk to your doctor about these things because there are solutions. If you do talk to your doctor and they do give you that kind of excuse like mine said, “Oh that’s just normal because you’re getting older.” Or, “That’s just normal because you’re a woman.” Then it might be time to find a new doctor.

Ben Grynol (01:04):

I’m Ben Grynol, part of the Early Startup team here at Levels. We’re building tech that helps people to understand their metabolic health, and this is your front-row seat to everything we do. This is A Whole New Level.


Metabolic health can be affected by so many different things. It’s not just the lifestyle inputs, it’s not just the food that we consume, the exercise we have, the sleep that we undertake. It is driven by so many different factors. A lot of them are different biomarkers. When it comes to things like hormones, hormonal imbalance can have a significant impact on different implications for metabolic health.


So Dr. Lauren Kelly-Chew, Head of Clinical Project at Levels, she sat down with Dr. Trevor Cates, who has deep expertise in women’s health, skin and hormones. They discussed a lot of things like hormonal imbalance and some of the implications around it. How does this happen? Well, things like endocrine disrupting chemicals in personal care products, they can cause hormonal imbalance. And there are all these different factors, many of which are environmental, that can contribute to poor metabolic health. Anyways, no need to wait. Here’s a conversation with Lauren and Dr. Cates.

Dr. Lauren Kelly-Chew (02:35):

I’m so excited to have Dr. Trevor Cates with us today. Dr. Cates is a nationally recognized naturopathic doctor and was the first woman licensed as a naturopathic doctor in California. Her focus includes women’s health, skin and hormones. She’s the founder of The Spa Dr skincare line and the author of the bestselling book, Clean Skin From Within. She has a new book, Natural Beauty Reset, coming out in September. She’s also host of the docuseries, Hormones, Health & Harmony, as well as The Woman’s Dr podcast and the PBS show, Younger Skin From Within. Dr. Cates’ goal is to inspire and empower women to harmonize their hormones and open their eyes to their natural beauty. So excited to jump in. Thank you for being here.

Dr. Trevor Cates (03:18):

Thank you for having me. It’s great to be here.

Dr. Lauren Kelly-Chew (03:21):

I was thinking as a starting point, I would just love to hear more about how you got interested in hormonal health and what your personal journey has been to be doing the work that you’re doing in such a powerful and impactful way.

Dr. Trevor Cates (03:33):

Absolutely. Well, I would say that my health journey started out with skin issues. My skin has always been my Achilles heel. I also realized that my skin was a good barometer of everything else going on in my life. I had a lot of skin struggles as a child, which I got on top of, thanks to natural medicine and integrated medicine, but when I was around 20 years old, I went on a birth control pill and after I started taking it, I’m not sure if it was a few days or a week, but I didn’t know the correlation at first, but I broke out and bumps all over my entire face. I looked like I had chicken pox and or something just completely covering my face.


I went in to see a different doctor because I was traveling than who I’d normally seen and at first they weren’t really sure what was wrong with me, but then we started to realize it was a reaction to these birth control pills and it was actually acne. It was the worst that I’ve ever experienced before and so immediately went off birth control pills. That’s when I started to realize, “Okay, this is interesting, this connection here.”


And then again, I guess I didn’t quite figure it out because when I was 30 years old, I went in to see my gynecologist at the time and I said, “I think I’m putting weight on because of the hormonal birth control I’m on.” She looked at me and she said, “Well, you’re 30 now, so that means that you’re not going to be able to lose weight like you could when you were in your 20s. So it’s okay, you’re just getting older.” And I thought, “No, there’s no way. 30 is still young.” And so I went off the hormonal birth control and that’s when I really started to make this connection. I was already a naturopathic doctor at the time, but I started to realize how often hormones play a role in our health. When we go on hormonal birth control, it’s one of the times that we can definitely see a huge change in our health, but hormones are impacting our health on a day-to-day basis throughout our lives and as women in particular, we have some interesting complexities.

Dr. Lauren Kelly-Chew (05:45):

Absolutely. Thank you for sharing that story. I think the birth control piece really stands out to me because I was put on birth control when I was I think 19 for the first time and there wasn’t really much thought that went into it. I think it was, “Well, you can just go on.” Sadly, I don’t think that there’s been really that dramatic a change in the conversation around birth control. It’s starting to happen and so thankful to voices like you who are out there, bringing these topics into more common conversation and making them something that is not only open, but that is filled with research and just as much evidence for understanding our bodies from that perspective as there has been from other aspects of health. Unfortunately, there hasn’t been nearly enough research on women’s health in general, but I think that starting to have hormones and things like birth control come into the picture more is so helpful.


You’ve noted that over 80% of women and 35% of men are dealing with hormonal issues, but the vast majority, I think something like 70% don’t even know it. What are some of the signs that someone is dealing with an imbalance?

Dr. Trevor Cates (06:56):

I really think that pretty much everyone struggles with hormonal issues at some point in their life, especially women. We have to remember that hormones rule our health in so many different ways, and it’s not just sex hormones like estrogen, progesterone and testosterone, but we have hormones that help us with metabolism like thyroid hormone. We have hormones that help us with stress like adrenal hormones. Cortisol is an example. We have hormones that help us with sleep, melatonin for example. And we have hormones that help us with our appetite, leptin and ghrelin, and we have hormones that help us with our blood sugar balance, insulin.


So we can have all kinds of issues related to hormonal imbalances. Some of the ones I most commonly see in women are fatigue, weight gain, period problems, and then for women going through menopause, hot flashes and night sweats and things like that. Also, infertility is another big one. These are some of the common ones I see, but really, there’s so many of our health issues can go back to core hormones.

Dr. Lauren Kelly-Chew (08:11):

My guess is that a lot of people, before they take that step to see you, that they’ve been thinking that being tired is just normal or that everyone feels tired or like you said, that well, they’ve gotten to a certain age and they’ve always been told that that means their metabolism slows and everything changes and it’s just inevitable that these changes occur. What is sometimes the trigger point that brings someone out of that thinking into saying, “Actually, I really do think something is going on here that’s not normal for my body.”

Dr. Trevor Cates (08:40):

It’s a really, really good point. I think sometimes when people see other people that are their age or older that are thriving and they start to think, “Well, wait a minute, why is that person have so much energy, they’re my age or they’re older or they’re super fit and they’re not having any issues.” I think oftentimes as women in particular, we talk to each other, we talk to our girlfriends, we talk to our moms or sisters or whatever and we start to realize, “Oh, wait, maybe what I’m experiencing isn’t totally normal or maybe it’s normal but maybe it’s not optimal.”


I think a lot of times with conventional medicine there’s a, “Just as long as you don’t have a disease, you’re fine.” But we don’t really want to be just fine. We want to be free of symptoms and we want to be just really embracing life, especially as we get older, in our 40s, 50s, 60s, 70s, 80s, my mom is 82 and she’s such a great role model because she’s out riding her horse almost every day, riding through streams and over fences and in her art studio. I just keep thinking, “Okay, this is what’s possible.”

Dr. Lauren Kelly-Chew (09:56):

Completely. It’s such good inspiration. I guess I’m curious, I would think that being in the field of hormonal health brings up a lot of questions from people and concerns that they might feel a little bit embarrassed to talk about. You’ve been seeing patients for over 20 years. Are there common themes in terms of things that new patients confide in you that you might be able to share with the audience, just as a way of normalizing these shared experiences?

Dr. Trevor Cates (10:23):

Absolutely. I often am told, “Oh, I bet I’m the worst case you’ve ever heard.” Or, “I bet you’ve never experienced anything quite this bad before or anything…” When you talk to your doctor, remember, doctors have heard just about everything, especially if they’ve been in practice a long time. So don’t be afraid to share things with your doctor. But certainly, I think some of the things that we are sometimes afraid to talk about or thinking, “Oh, well, I shouldn’t be a complainer.” That’s one of the things as women, “You just need to suck it up because it’s just period problems, pain, PMS, which is just part of being a woman, so you just need to suck it up.”


Believe me, that’s not the case. There are plenty of people out there, plenty of women that do not have period pain, that do not have PMS and that you do not have to suffer through these things just because they’re common. I think that’s one thing that’s really important, that you just don’t have to just suffer. That if you’re having symptoms, it’s a sign that something’s out of balance. Your body’s just yelling at you, saying, “Hey, pay attention to me!” And so you don’t just have to put up with it.


The other thing is that, don’t be embarrassed by your body. Your body is wise. It’s amazing. If you’re having problems like maybe you’re having urinary incontinence problems or you’re having difficulty with your sex drive and you don’t have any sex drive or you’re not able to perform the same way that maybe you did before or you have concerns about what’s going on, certainly, it’s important to talk to your doctor about these things because there are solutions. If you do talk to your doctor and they do give you that kind of excuse like mine said, “Oh, that’s just normal because you’re getting older.” Or, “That’s just normal because you’re a woman,” then it might be time to find a new doctor.

Dr. Lauren Kelly-Chew (12:13):

One thing that I love about the podcast that you host is that you bring on a lot of physicians, especially female physicians who do have very open conversations about many of these topics. I was listening to one of your recent ones where part of it touched on aspects of sex education and women understanding their own anatomy and understanding their own bodies. As I was listening to it, I realized even having gone through medical school myself and working in healthcare for my career, it’s still surprising when you hear those conversations and to have people out there having them on a public forum, I think is so powerful. So I appreciate that and I appreciate what you said about not needing to suffer.


I’d be actually curious, your thoughts on this, but I think so often people think that what they’ve experienced for the majority of their lives is their normal and they’re actually probably shocked when they find out what their new normal is, when some of that suffering is taken away.

Dr. Trevor Cates (13:14):

Absolutely. I think so many women that have come in to see me or that I’ve interviewed for my Hormones, Health & Harmony Docuseries or for my podcast, that they come out on the other side of that and they realize, “Wow, I went through all these years of struggling when I really didn’t need to. I wish I had found this out earlier.” A lot of the doctors that I’ve interviewed have been conventional doctors or even gynecologists that practice more of a conventional approach and did prescribe a lot of birth control pills for period problems or for premenopausal symptoms and not really for birth control, but for other symptoms, not realizing the harmful effects of that. And then later on when they had their own health struggles, that’s when they started to realize, “Wait a minute, I don’t want this option. I don’t want all these side effects. I want to look for other solutions.”


And realizing that when you look to the underlying cause and you really look to things like nutritional deficiencies, gut microbiome issues, inflammation, oxidative damage, blood sugar issues, some of these underlying causes, and you address these, then you can help a person’s health in so many ways. Hormones are a part of that, skin is a part of that and a skin is another big focus of mine, but you can help people just feel more vibrant and healthy.


I do want people listening to realize that if you are struggling, that there are answers and don’t stop looking, don’t settle. It’s important. These doctors that I’ve interviewed, if they had given up, they wouldn’t be helping as many people as they are now. Just keep looking for solutions and watch the docuseries, listen to my podcast because we’ve got some great, and I know you’ve got some great guests on as well. Knowing that there are functional medicine doctors, naturopathic physicians and similar doctors that can really help with doing some specialty lab testing, looking at hormonal imbalances and some of these other root causes that can really help address an underlying cause.

Dr. Lauren Kelly-Chew (15:36):

Speaking of solutions and getting to the root causes of these things, when people work with you, whether it’s through your books or with you in person, I know that you work with several key pillars, food, movement, mindset, skincare. Would you mind just walking us through each of those and maybe highlighting areas where you find it’s the hardest for people to change or there’s the most resistance or it’s most difficult and how you navigate that?

Dr. Trevor Cates (16:04):

Absolutely. With my new book, Natural Beauty Reset, I go through these four pillars for each season because I feel like it’s so important for us to get back in rhythm. Women in particular, we have these rhythms in our body, we have our menstrual cycles, we have daily cycles with our cortisol, we have sleep cycles, circadian rhythm, all of these things and we also have seasons. A lot of times we get out of sync with that. So resetting that with each season is a great opportunity for that. Doing those with food, movement and mindset and skincare, as you mentioned, is a great way to do that because our needs change.


With food, I think a lot of times we get stuck in a rut of eating the same thing over and over again. For some people they’re unhealthy choices. Maybe it’s a lot of processed food, maybe it’s fast food, maybe it’s sodas, whatever. Or for some people it’s, they’re eating super foods every day, but they’re eating the same foods and they’re missing out on an opportunity to mix it up, because when we eat foods in season, we have a chance to get more nutrient dense foods, they’re also more flavorful and they also can help support our gut health even more. When we eat a variety of produce, it can help the gut microbiome diversity, the biodiversity of our gut. And so that can help with our hormones, our skin, our gut health and our brain health, so many different things. That is a really important one when it comes to food.


And then with movement and mindset, those are also important because so many of us are stressed, we’re all really stressed and stress is a normal response. So our bodies are adaptive and quite capable of dealing with stress, but the problem is we have to give ourselves a break. We can’t just keep stressing ourselves out because then the hormones and the glands that we have that help us and the neurochemistry that help us with responding to stress, it just doesn’t work as well if we just burn ourselves out.


So doing things to think about, how can you move your body and how can you incorporate mindset practices that really help with managing your stress, making sure that you get a good night’s sleep. And also realizing that there are different times, different seasons when you might sleep better or you might not sleep as well or that you might be more sensitive to stress. Like in the winter months, our cortisol levels tend to be higher and our feel-good neurotransmitters like serotonin and dopamine tend to be on the lower side. So we could do things to get ourselves going and to shift out of those patterns.


Then with skincare, we also go through changes. Part of it has to do with the sun and we are outside in the summer, outside in the sun more and that might cause some damage so we need to make sure that we’re protecting our skin first of all, and then reversing any oxidative damage that may be happening in our skin. And then also there might be times when our skin tends to be more dry, we might need more hydration with some really nice plant-based oils in our skincare or we also might be needing some exfoliation, those sorts of things.


Our needs really change with the seasons, but when we get back in track and when we give our body the right foundation, it can really align. Our bodies are so incredibly wise and I think we often forget that. I think we think that we have to tell our bodies what to do. We have to take medications to suppress symptoms and ignore things, but really, when we’re given the right environment, the right tools, our bodies, it’s amazing how they can heal.

Dr. Lauren Kelly-Chew (20:19):

I completely agree. If someone is struggling with hormonal issues and they want to start to make a change, of the pillars you mentioned, is this something where it really is best to make progress on all of those pillars at the same time? Or is it possible to get progress out of just saying like, “Okay, I can’t do all of this right now, but I’m just going to change my food,” or, “I’m just going to change my mindset.” What is the impact of doing it on a sequential basis like that, rather than everything all at once?

Dr. Trevor Cates (20:48):

Well, of course, it’s better than not doing anything at all. To make some sort of movement in the right direction is good. I do think that ideally you want to be able to do at least a little bit with each, and it doesn’t have to be time consuming. For example, the next time you go to the grocery store or shop online for groceries, try and just pick a couple of foods and pick up a couple of different types of produce that maybe you’ve never tried before that are in season. And just add those maybe to a smoothie or in a salad or saute them somehow, just try something new. And then just getting out and going for a walk, that’s an easy way to move or walk to your car, park far away and so you have to walk a little bit further. And then take some time to take three deep cleansing breaths and then use a natural skincare cleanser. Those are just simple things that you could do that actually can make a big difference.


When it comes to skincare, I think one of the biggest things with that is that we often are exposed to a group of chemicals known as endocrine disrupting chemicals in our personal care products. These endocrine disrupting chemicals or hormone disrupting chemicals have been associated with a lot of different health issues, from infertility, thyroid disease, even obesity, breast cancer, all kinds of different hormonal issues. So it’s really important for us to reduce our total exposure to these chemicals.


For example, choosing things that are scented with organic essential oils instead of synthetic fragrance or that are fragrance-free. Or choosing a mineral sunscreen that’s based with a zinc oxide or mineral sunscreen ingredients, instead of a chemical sunscreen with oxybenzone. Some of these things, they’re pretty simple. And also there are easy ways to do, if you want to, to do DIY skincare. That’s one of the things that I love including in my books. I did that, included those recipes in my first book, Clean Skin From Within. And then I have even more recipes in Natural Beauty Reset to help people with the DIY skincare. Then of course, the foods that we eat are also going to impact our skin too, so I also had to include recipes for food as well.

Dr. Lauren Kelly-Chew (23:17):

I’m going to have to try some of the DIY skincare because I started using ewg.org, the environmental working group database years ago. For our audience who’s not familiar with that database, they actually have several databases, but their oldest one I believe is the cosmetics database where you can really look up many of the products that are out there and it’ll tell you a breakdown of the ingredients. I can’t speak to exactly how credible that is, but I know that it’s a resource that many people use. What I learned from that is that simple is really likely to be better. Where, if you know exactly what’s going in it, you’re much more likely to come up with something that is cleaner. And yet the vast majority of products have so much in them. Even for me, sometimes I just get exhausted trying to figure out what’s what.


I’m curious, do you have shortcuts, other than the DIY stuff, do you have shortcuts for using clean products but not going so crazy on it that it’s paralyzing?

Dr. Trevor Cates (24:18):

Yeah, and I do appreciate you mentioned ewg.org, their Skin Deep database, and they have products that are verified. My skincare line, The Spa Dr skincare line are verified by EWG so I do know that they have a very rigorous criteria that you have to meet and then you have to submit things for them to prove that your products truly are free and clean of all the toxic ingredients.


I think that using resources like that can be really helpful. I have a list of ingredients to avoid in both of my books. I think just even if you start with a handful of ingredients or even just the two that I mentioned and start with that, but I think it’s interesting, so often if we get ready to put something in our mouth, we might hesitate and say, “Is this going to be good for me?” But yet when we put stuff on our skin, we don’t have the same level of criteria. So maybe just start with that. Say like, “Okay, would I put this in my mouth? Probably not. Okay. Then maybe I should turn it over and look at what the ingredients are that are in it.”


You can put things like honey and oats and yogurt and things like that on your face and DIY skincare and you would put those in your mouth as well. I’m not saying that all, I mean certainly skincare products are not made to be consumed. Even my own skincare products are not made to be consumed, but if you can’t put something in your mouth, you might want to think, “Why is that?” And start to learn a little bit.


And don’t get overwhelmed by it, but there are also some simple things too to think about. It’s like when we talk about seasons and things to do, a change of seasons could be a good time to evaluate what’s in your bathroom or what’s in your makeup drawer, what’s in your purse, and how long have you had these products? They do have an expiration date. I think a lot of women, we buy stuff and they get pushed in the shelves and then we’ll pull things out and we’ll keep using them for years and years and years. So it might be time to just do an overhaul of just clean them out, get a garbage bag in and start cleaning some of these out. Also, cleaning out your makeup brushes and things like that. We want to do that on a regular basis to make sure that we’re taking good care of our skin.

Dr. Lauren Kelly-Chew (26:44):

It’s such great guidance and I really appreciate your sharing about the EWG because I have used that as really my primary reference for these things for all these years. So it’s good to know that someone who’s been behind the scenes on how the verification process works, that it’s really a rigorous process. It’s really good to know. For those in the audience who haven’t checked it out, it’s worth checking out, even if you don’t use cosmetics. They have a sunscreen database, they have all kinds of different databases that can help you understand pesticides on your food and just really everything. It’s such a great resource.


If someone is at the beginning of their journey with hormonal issues and they’re starting to make these changes, how long does it typically take to start seeing results?

Dr. Trevor Cates (27:28):

Well, it really depends on what their issues are and how long they’ve been having them. If someone’s been having them for a really long time and they’ve been struggling with them, they’ve tried a lot of different things already, sometimes it can be a little bit of a longer journey, but the earlier you start to notice these symptoms and you go in and you start to get help, the easier it often can be. And then it also depends on how dedicated to you are to making changes, because if you’re going to see your doctor and they say, “Oh, your thyroid, it’s not low yet, but it’s on its way to being low,” that’s when it’s a good time to start being proactive. And then if you do have some of the signs and symptoms, for example of low thyroid, of fatigue and constipation, weight gain, hair loss, these really can be really debilitating symptoms for women.


So getting on top of that right away, getting tested, finding out where your levels are and getting treatment. That can be a combination of what you’re eating and supplements and maybe medication as well, but making sure that you’re taking these things. If you do, what I like to see with my patients, I like to see them back in three weeks. And if in three weeks we haven’t at least seen some kind of progress, then we need to reevaluate, we need to look, what else might be going on? Maybe we’re going after the wrong root cause, that we need to go after something else first.


So I might order more testing, maybe I’ll look at gut microbiome testing or something like that to see what’s going on, nutritional deficiencies, those sorts of things. Or certainly if someone’s getting worse, then we really need to do things some more. But to really get a full recovery, it just depends on the severity of it. I’ve seen women get better within a few weeks. I’ve seen people fully recover in a few months, six months, but some people it takes over a year to really get things back on track.

Dr. Lauren Kelly-Chew (29:40):

I would think that because hormonal issues are so often linked to things that are very visible on the outside or that are very impactful on the way that you feel about yourself, not that they should be necessarily, but I think they often are. For example, if you’re having a lot of acne, for a lot of people, I think that creates stress. I’ve had friends who have said that they don’t really even want to go into social settings because having that acne really has gotten to their sense of how they want to present themselves to the world. As you’re guiding people through this journey of coming to hormonal health, how do you approach the psychology of it or this other side that I think so often is missed in conventional medicine?

Dr. Trevor Cates (30:28):

Absolutely. One of the reasons why I call my second book Natural Beauty Reset is that we are all already beautiful, we’re beautiful, but sometimes when we get things like acne, we see ourselves through a different lens. When we look in the mirror, we don’t see our true beauty. So it’s really helping people get back to their natural beauty or recognizing their true beauty.


Things like acne can show up, but we have to remember those are signs that something’s out of balance. We just need to address those root causes and you’ll get back to seeing your skin the way it used to be. So you might just be in this transition period, but to realize that your natural beauty really comes from within, so that’s still there.


I’ve just had so many patients, with skin in particular, that they were so embarrassed by it. That’s where I started as a kid. I had hives and rashes and eczema, things that would show up and I was so embarrassed by my skin. I think when you’re in it, it’s hard to ever imagine that you’ll be out of it, but to know that there is a way to come out on the other side of it and that conventional medicines can sometimes help suppress symptoms for a period of time, but they’re not necessarily going to help really get your health back to where you want. Especially with something like acne, just going on birth control pills is probably not going to be your best option. There are other things to look to, to help address the root causes. And of course, birth control pills are, they’re meant for birth control. They weren’t really designed for acne, they are just now being used for it. And there are so many other things that we could do to get our health back on track.


There are ways to get through and you can make it through. I know acne is one of, it’s the most common skin issue in the United States. The thing though is that, we have to remember is that, acne actually doesn’t exist in certain parts of the world. If you’ve traveled internationally, you’ll notice that in some parts of the world, it’s very rarely that you will see people with acne. So that does make us think that a lot of this has to do with our lifestyle, so if we can change our lifestyle, we can oftentimes reverse acne.

Dr. Lauren Kelly-Chew (33:00):

For people who are, let’s say, listening to this or have read your books or listened to your podcast or any of these other pathways into having this broader view of health, but then they go to their typical primary care physician or their gynecologist and they’re essentially trying to share with their provider that they think there’s something going on. And the provider is either saying that that’s not correct or ignoring it or is saying, “Well that may be, and the fix is this medicine,” let’s say. What is your, I guess, guidance for people in that situation? Of course, ideally, everyone would have access to working with you, but practically speaking, what is the next step for someone who’s just hit that wall with the conventional system?

Dr. Trevor Cates (33:48):

I think that gone are the days where we look to our doctor for everything. I think that our doctors provide a lot of information, but we need to take control of our own health, realize that you are the CEO of your own health. One of the things that I want to do is help educate consumers to be, especially women, to be the best CEO of their own health and oftentimes for their families. Women are typically the decision makers when it comes to healthcare and health consumer products and all of those sorts of things.


My goal is to really help women be the best educated and informed decision makers, so that they can make these decisions and they can also know what to talk to their doctor about. If their doctor says, “Well, with thyroid panels, I really only run TSH.” But if this person is educated and they think they might have thyroid problems, they say, “But can you also add free T3, free T4 or and thyroid antibodies? Because I’ve heard that that’s really important. It can give additional information.” A good doctor’s going to say, “Oh sure, if you’re okay, you might have to pay out of pocket for those. Your insurance might not cover it, but sure, let’s add that and see what comes up.” And then asking your doctor, “Hey, can I get a copy of my labs?” And they’ll probably tell you, “Oh yeah, you have access in your portal, the online,” and tell you where to go to get that.


So if people just understand a little bit, they can actually work with their doctor. The problem with conventional doctors is these days that they take insurance, they probably don’t have a lot of time to spend with you. So if you come in ready and prepared for your appointment, it’s going to make it easier for your doctor too.

Dr. Lauren Kelly-Chew (35:28):

That makes a lot of sense. I want to loop back to how we started this conversation just briefly, because I think it’s so interesting and that’s the topic of birth control. Given your clinical focus on hormonal imbalance, and you’ve mentioned some context within which birth control really isn’t the best solution, I guess, what are the trade offs in your mind, knowing that it is still very commonly prescribed and often to very young women and then they’re on it for years and years. Is it possible to achieve hormonal health while you’re on the pill? Or in your mind, is that not really a pathway towards hormonal health?

Dr. Trevor Cates (36:02):

Well, I would say first of all, why would someone be on the birth control pill? If you’re using birth control pills for birth control, then yes. You and your doctor determined that this is the best form of birth control for you, then yeah, you can sort out ways to address some of the issues that might come up. Some of the issues that might come up taking birth control pills are certain nutrient deficiencies like B12 deficiency for example. So just taking some supplements to help support your nutrient levels. And then also, it can create gut microbiome imbalances, so making sure that you’re taking probiotics and you’re getting plenty of fiber in your diet. And then also, it could suppress testosterone levels and create imbalances in other hormones. So just being aware of your body. And if you’re not having symptoms and you’re on birth control pills for birth control, you’re probably going to be okay if you just add some additional support.


Now, it’s not my favorite form of birth control. I think that hormone-free versions that are more like IUDs or barrier methods or things like that, that’s my preferred birth control for most women. But I realized that there’s a certain level of convenience and some people, those other methods don’t work.


Now, if you’re given birth control pills to manage symptoms or to, “balance your hormones,” that’s really not going to be, from my perspective, the best way to address things that a lot of women are put on birth control pills for, like acne or irregular periods, PCOS or perimenopausal symptoms. I think that there are other things that you can do so that you don’t have to worry about those side effects, but you can instead look at what’s going on behind it. Because here’s the thing is that the women that I see in my practice, they’re the women that have been on birth control pills and are now wanting to come off. They were put on for acne, they were put on for these other things and now they want to go off and all their symptoms come back. And then they have to deal with all of the adverse reactions or the problems that have come up from taking the birth control pill.


So it doesn’t address the underlying problem. So I’m trying to tell you this, for people that are… Maybe they could find a better alternative. The sooner you do this and find that root cause, the better, because if you go off and you’re trying to get pregnant, it might be harder or whatever your symptoms were that you were trying to address, they might just come right back when you’re ready to go off them. So I think a lot of it depends on the person’s scenario.

Dr. Lauren Kelly-Chew (38:52):

That makes sense and it definitely resonates with me because I was on birth control for years and when I came off, it was really, really challenging. I mean, it almost felt like my entire body was changing and I was almost becoming a different woman that I hadn’t gotten to know yet because of all those years of birth control. I think that experience has been mirrored in many of my friends and it’s actually so well known how difficult it can be to come off of it that I have many friends who are basically like, “I like the idea of coming off of it. That’s important to me in theory, but I just can’t imagine going through this phase in my life where everything feels out of whack.”


As you’re coaching women who are on the fence about coming off birth control or not, I guess what is your perspective on how to think about that transition? And even if the motivation is there, but then there’s also that fear of what’s to come, how do you help women navigate that?

Dr. Trevor Cates (39:49):

Of course. So first of all, it depends on what their symptoms are. I mentioned some of the things like acne or PCOS or period pain, heavy periods, period problems really, it really depends on what you were put on it for. What you want to look at is what are some of the hormonal imbalances that you could address naturally? So what you can do is you can start addressing those even before you go off the birth control pill.


For example, if you tended towards an androgen excess where you had, from acne for example or PCOS and you’ve got problems with that, you might start looking at, what can you start doing before you even go off birth control pills? Are there things like making sure that your fiber intake is adequate, that your blood sugar balance is where it should be? There are herbs like saw palmetto or things like that, that might be helpful. And then also if you tend to be more estrogen dominant, that is something that you might want to consider.


I have a hormone quiz that people might be interested in because people are like, “Well, how do I know if I have low estrogen or low thyroid or low progesterone or high progesterone?” Whatever it is, people can go to hormoneseries.com/quiz. Hormoneseries.com is the link to my Hormones Health & Harmony Docuseries. It’s a nine part documentary series that we show online, that we air online and then when you do /quiz, that’ll just take you to the quiz. It’s just that you just answer a series of questions and it basically is showing you the symptoms and then when you take it, it shows that you might possibly have a higher or low level of various hormones. Of course, it’s important to go and talk to your healthcare provider, get some testing to see if you do the quiz and it says, “You may have low thyroid,” to still go and see your doctor and see if you can get some testing to look for that.


But that is something that when women are trying to figure out, “What is going on, why did I have to go on birth control pills in the first place and what’s going to happen when I go off them?” Understanding where you are in that and start addressing those, but really until you go off the birth control pill, you’re not going to fully be able to address it because that’s just suppressing. So it’s just suppressing your testosterone, but as soon as you go off of it, whatever issues were there are going to come right back because it’s not addressing it.

Dr. Lauren Kelly-Chew (42:34):

That completely makes sense. Shifting gears a little bit from this conversation around birth control, which is very much about hormonal balance from the inside out. I also know that you’re the creator of a skincare line and would love to hear what inspired you to do that and also how you think about products, specifically skincare products meant to work, I assume from the outside in, and what role those play when you’re also working from the inside out. I guess where I’m going with this is also curious, I think some people view skincare products as icing on the cake, but they’re not really that impactful, whereas other people really think that a good skincare product can make all the difference in the world when it comes to your skin health. So curious to hear the origin story of your line and also just what your approach is to products.

Dr. Trevor Cates (43:21):

When I turned 40, I’m 49 now. When I turned 40, I remember starting to think, “I wonder if I should start using more skincare products?” I was really more focused on the inside out approach. Just like, “Oh, healthy skin only comes from within.” So I started to look at it for myself and then at the same time some of my patients were saying, “Dr Cates, I know you told me not to have these endocrine disrupting chemicals in my skincare products, but I can’t find one that actually works. I can’t find one that I like the results from using.” So I started to look at some of the research and started learning more about the skin microbiome. There’s more and more research over the last decade that’s come out about the skin microbiome and these microorganisms that live on our skin and actually protect our skin and what are part of what causes us to break out an acne or other skin issues like eczema or even premature aging?


When our skin is in this really nice balanced place, then it can help prevent breakouts, blemishes, and premature aging. One of the things that really helps with that is the pH of products. Our skin is naturally mildly acidic, but a lot of the skincare products out there have a high pH, especially cleansers and lotions. They tend to have a high pH, which disrupts our natural pH. So when I was looking for skincare products to recommended to my patients, I was looking for truly clean and natural, rather than just the marketing claim because the word natural unfortunately doesn’t need to have any backings, there’s no FDA regulations around it. The word hypoallergenic doesn’t actually, it means nothing really except for marketing.


So wanted to really create something that was truly clean and natural and that also had that mild acidity that the research was showing was important for the skin microbiome. And then also all of these active ingredients and natural skincare products that I was finding research on, I wanted to make sure they had the right amounts because instead of just having a teeny little amount with a bunch of other toxic ingredients, I wanted to make sure that it was all packed full of natural actives.


That’s what led me to create The Spa Dr skincare line. I thought it would be great, but I truly didn’t realize how much it was going to change my patients’, my customers’ lives. The results that people see on their skin is really truly beautiful because one of the biggest things that we hear from people using the products is women say that they don’t feel like they have to wear makeup anymore. So if you choose to wear makeup, of course it’s up to you. But a lot of women will say, “I just feel like I don’t have to, I don’t have anything to hide anymore. I don’t have to cover blemishes or uneven skin tone.” That’s a really great thing to hear.


I think that oftentimes we either think that we don’t have to worry about our skincare products because we’re taking care of it all from the inside out. Or like you said, all you have to do is use skincare products and you expect a miracle like that. But really it’s a combination, is what I find, is that most of the health of our skin, I really believe comes from the inside out and our food habits and our exposure to toxins and how we’re really treating our bodies, but also what we put on our skin is really important. That’s what I learned at 40 when I was doing this research in the little bit of the last nine years of creating the products and then the results, getting to hear feedback from our customers, and that you really can get results. And when you do the two together, that’s really when you get the magical combination.

Dr. Lauren Kelly-Chew (47:03):

Definitely. I’m going to have to try your skincare line because really the philosophy that you’re describing makes so much sense to me and I think especially your call out of the fact that oftentimes products will advertise great ingredients and it’s a minuscule amount. I mean it’s barely even there. And even if it is there, maybe depending on what the stability of that compound is, sometimes they’re not even active anymore. They’ve moved past the time when they’re even bioactive. So you’re paying a lot for brand essentially, or you think you’re putting something on your face and unless you can see actual results, it’s just on the good faith of the marketing promises.


This is why I think databases like EWG are really helpful so that at least you’re not harming yourself by what you’re doing. As to whether or not that product is actually effective, I think that’s much harder to find. So I appreciate that you have such an eye towards all of these things together and are doing it in such a way that builds credibility and trust with patients that you actually see in a longitudinal sense. You can’t give them something that isn’t going to actually help because you have a shared responsibility to each other and it’s an ongoing relationship. So I really appreciate that.


Is there anything that we haven’t talked about that you want to make sure that we touch on?

Dr. Trevor Cates (48:25):

Well, I think that we’ve covered a lot today and there’s so much, I think it can be sometimes overwhelming, but just remember that whatever steps you can make, you’ll move in the right direction. You can start cleaning up your skincare products, start asking questions of manufacturers, talk to your doctor about getting some testing for your hormones if you think you might have some of these imbalances and start looking at resources that are reliable. Stop just searching something on Google. You actually want to go to reputable, reliable sources that help you understand your health condition or whatever’s going on with your health. That’s why I put together the Hormones, Health & Harmony Docuseries with interviewing over 50 experts for that to really help provide solutions. So it’s not just me that’s telling you this, but a bunch of different people and also The Woman’s Dr podcast and things like that, going to places where you can get information and resources to help you on your journey.

Dr. Lauren Kelly-Chew (49:33):

Absolutely. I want to reiterate what you said at the beginning, which is that people don’t have to suffer and that you don’t need to feel like you can’t speak up or that you can’t advocate for yourself, even if the changes that you make are small to start with. I so appreciate your work in this area and all the advocacy that you do for women and men, but especially women on topics that I think really haven’t gotten nearly the amount of attention that they deserve. I just so appreciate your working to make an impact there. Where can listeners find you, access all the resources that you’ve described? What’s the best way to get in touch with you?

Dr. Trevor Cates (50:15):

Absolutely. People can go to thespadoctor.com. It’s T-H-E-S-P-A-D-R.com and you can check out the Hormones, Health & Harmony docuseries at hormoneseries.com. The Spa Dr is also on social media and The Woman’s Dr podcast is on all the podcast locations.