WIWIK S1E5 Ali Rezaei
Irene Ortiz-Glass: [00:00:00] I just wanna thank our partner Mira Mira fertility tracking for working with us to help women to get connected to the opportunity to actually measure hormones at home. It is the technology that I personally use during my menopausal transition. It was life-changing for me. You can find more information on Mira on our website at coaching.com, and you can also find it on our show notes.
We look forward to supporting you and your hormone transition.
Ali Rezaei: I actually prefer. When the doctors are heavily involved because it makes my job easier and it’s always better to have two minds. And then the third part of this is, is that having the patient involved, you know, it, we call it the triad of pharmacist, doctor, and patient, the three together really, you know, you get the best outcome that way.
Irene Ortiz-Glass: [00:01:00] Hello and welcome to What I Wish I knew. I’m your host, Irene Ortiz Glass. What I wish I knew is dedicated to providing women with information and a guided path to finding healing purpose and joy. It is to also give women power and permission to go inward during this time of perimenopause and menopause, to find their inner compass and to actively make changes that will allow them to thrive during this period of time in their lives.
In this season, we’ll be focused on the issues surrounding the menopause transition, and I will be sharing what I wish I knew. Um, just as a disclaimer, this does not displace you working with a physician, um, and a doctor of your choice around, um, these issues. This is simply information only. Today I’m very excited to have Ali Reza with us today.
Um, he is a compounding pharmacist, a doctor of [00:02:00] pharmacy. Um, he is the founder and owner of King’s Pharmacy and, um, works in the community in Orange County. He is, um, you know, somebody I’ve worked with personally. He consults with physicians and patients on medication dosages, on drug interactions, medical equipment, disease management, and the side effects of these hormones and over the counter medication.
Um, he dispenses and compounds over 500 prescriptions weekly, so it is just such an important topic. Today we’re gonna be focused on bioidentical hormones and testing. What do we need to be thinking about when we go down the road of getting into hormone therapy and what do we need to be testing for to find balance?
So, um, it’s just great to have you here, Ali. You’ve helped me, you know, in my own personal life so much at King’s Pharmacy. I think I’ve worked with you now over 15 years and have been so blessed by what you’ve provided for me in my own body. Um, maybe tell us a little bit about how and why did you [00:03:00] become a pharmacist and how did you get into compounding pharmacy?
Ali Rezaei: Well, it’s interesting, um, my mom actually is a pharmacist. She graduated from U S C School of Pharmacy, um, in 1994. And being exposed to that at such a young age, I kind of saw some of the benefits of being a pharmacist and, and how much freedom you have. Um, And time you have to spend with patients. Um, and when she came outta school, she gravitated towards becoming a compounding pharmacist.
And I, you know, when I got out of school, I, I joined her for a brief stint about a year. Um, and I just really, really enjoyed being a pharmacist, but more importantly, a compounding pharmacist because I was able to, Customized medications for patients, uh, like yourself. Um, ’cause no two patients are alike and it’s just a proper recipe.
You’re given certain details, certain [00:04:00] variables, and you gotta take that all in, blend it together and give you the perfect smoothie, so to speak.
Irene Ortiz-Glass: Yeah,
Ali Rezaei: And, uh, it’s, it’s all about customization and I, and I like customizing. I like building. So that’s kind of why I gravitated towards that. Obviously my mom was a huge factor.
Um, very inspirational woman, taught me a lot about what I know and patient care and spending the time to listen more and talk less, which I think is key as a pharmacist.
Irene Ortiz-Glass: And are you of the belief that we should be looking at labs and symptoms or more symptoms versus labs? Like what’s your take on that?
Ali Rezaei: I think the subjective and the objective symptoms and labs. Together should be used in order to get to paint the best picture. Um, and in the world of laboratory testing, um, blood testing, saliva testing, you know, there’s so many different companies, who do you go with? And I can be overwhelming and confusing.
I, I always say more information is always better. [00:05:00] if, you know, if someone goes out and gets blood work done and then they feel like, you know what, the picture’s not properly painted well, at that point, they can go on and get saliva and see if that can help clarify some of the questions that both the provider and the patient may have.
Um, I do believe the most amount of information you can get from laboratory testing or even just asking, doing a proper medical history with a patient. We’ll give you the best outcome
Irene Ortiz-Glass: Mm.
Ali Rezaei: because a lot of times things are overlooked. Uh, Some of my providers that I’ve worked with over the years spend 30, 45 minutes getting a proper medical history, um, from, you know, fam familial cancers, mother’s side, father’s side, sister, aunt.
Um, when did your symptoms start? How did they start? Was it a surgical menopause? Was it a natural menopause? At what age? You know, what is the trend in your family? These things all help paint that [00:06:00] picture and that makes our job easier. Ultimately, otherwise we’re shooting in the dark If we don’t know these things.
Irene Ortiz-Glass: Yeah. So when you’re thinking about testing and you’re going through perimenopause and then into menopause, what should we be testing for? You know, what levels should we be even looking at? Because I know, you know, some people believe that it’s just the hormones, other people believe it’s adrenals and thyroid, and you know, we sort of like to look at the whole system.
What is your point of view on that?
Ali Rezaei: I always say that in every scenario it, it’s always best to start off with some the basic hormones, estrogen. Progesterone, testosterone thyroid, D H E A, um, F A F S h, lh. Um, uh, you can get into even more details as far as the types of estro, um, with in, in salivary testing, but I think estrogen, progesterone in those, the big players.
You should start off with those as well first, um, as well as a proper, you know, doing a, a [00:07:00] complete blood culture cholesterol, blood glucose, and seeing how those levels also are, because that can also play into, you know, overall wellness. Um, but during perimenopause specifically, I target the big players, the E P t as I call ’em, estrogen, progesterone, testosterone, um, because they all contribute.
To how a woman feels. And although people will say, well, if you’ve got hot flashes or night sweats, that usually means that you have a lack of estrogen. Well, it could also mean that you have too much progesterone.
Irene Ortiz-Glass: Yeah,
Ali Rezaei: So that’s the thing. It’s not just as simple as pinning a specific symptom to a specific level.
I wish it was that easy,
Irene Ortiz-Glass: too.
Ali Rezaei: right? Because then I would see a patient and after three months we’d have it nailed down and patient would be going along their way and they’d be happy. The fact of the matter is it’s not that easy. Uh, Hair growth is the big thing. You can have too much testosterone and that can cause hair loss.
You cannot not have enough estrogen or [00:08:00] progesterone that can also cause hair loss. So there’s multi, like, there’s so many different elements to this. And even answering the question of perimenopause versus menopause, look, I say get me as much as much information as possible. Give me the estrogen, the progesterone, your thyroid, tsh, free T three, free T four.
Uh, give me everything and allow me to digest it with your provider and hopefully we can come up with a remedy that works.
Irene Ortiz-Glass: So how do you work with the providers? Is, are these people that you’ve worked with for a long time? How do they find you? What’s the. Relationship that you have with the providers. I know for me, I, I’ve worked with one woman for years who always goes to, to King’s to get, you know, my stuff compounded. So I’m wondering how does that relationship work?
I mean, many of the women we work with are really struggling with their providers and, and I’ll ask you the question about synthetics in a minute, but they don’t even believe in compounding. You know, I bring it up to them and they’re saying to me, Wow. You know, my doctor doesn’t even believe in [00:09:00] compounding.
So how do you work with the provider to, to, to find, you know, the what’s best for a woman,
Ali Rezaei: You know, I always joke, there’s certain things that you have to understand, like providers, like in-laws like parents, you can’t change the way they think. Right. Some providers were educated in a specific way that where they were maybe not exposed to. What you and I have been exposed to, and I’m not in the business or nor do I have the energy to sit here and try to convince a doctor or nurse practitioner or provider who is so far on one side that if they don’t see the benefits, then that’s okay.
That doesn’t mean they’re not a great provider. They may not be the best provider for our scenario, but I can tell you there are thousands. They’re everywhere and the more that are coming outta school are open to these [00:10:00] therapies. Um, how I’ve developed my, you know, network of providers over the years starts off with a simple conversation, Hey, I’ve got a patient that has X, Y, Z issues and these are her levels.
What do you think we should do? The moment I hear that question, it’s like, well, this doctor’s, I can just tell. Wants to find the best solution for the patient. When she says, what are we gonna do? She wants to know my input, he wants to know my input, and I’m here to help. Um, some doctors will say, Hey, you know what?
These are the levels, these are the symptoms. You take care of it. So in those scenarios, it’s kind of like we’re navigating a little bit more. I actually prefer. When the doctors are heavily involved because it makes my job easier and it’s always better to have two minds. And then the third part of this is, is that having the patient involved, you know, it, we call it [00:11:00] the triad of pharmacist, doctor, and patient, the three together really, you know, you get the best outcome that way.
Um, and then there’s a third type of doctor that says, you know what, I don’t really care much for it. You know, I haven’t done any hormone levels. I haven’t really asked a lot of questions. What do you think we should do? And those ones are kinda like a blank canvas. And so I’ll say, Hey, listen, let’s get as much information as we can.
We’ll talk to the patient, get some details. They’ll call, order some labs. And then together we’ll come back and have a quick five minute chat about the patient and what they’ve experienced with as much information as possible, and we’ll come up with a remedy or a therapy that works for them. So there’s multiple avenues, and I’ve seen certain doctors that really, really over the years, have gone above and beyond in doing a full medical history, getting as much lab work as they can, and then, you know, they’ll recommend the patient to us and we will go from that direction.
So [00:12:00] it really, there’s just, there’s not an exact way to do this, but I’ve just seen so many doctors over the years do such a great job that that network has
Irene Ortiz-Glass: It’s a, it’s available to us. I think the other thing you’re mentioning is like the triad, it’s the patient advocacy, right? Like for myself, I’ve had to really learn my body to go to you and say like, Hey, I mean, I had a really great conversation with one of your pharmacists the other day because I was like struggling with the dosage and, you know, um, he recommended something that nobody had recommended before and it really helped.
So I think there’s this whole idea too about like the advocacy of the, the patient, um, talking to you. So tell us the difference now, you know, everyone is talking about bioidentical versus synthetic. Um, there’s some doctors that, you know, really don’t believe that. Bioidentical matters or it’s not as effective even as a synthetic hormone.
Can you give us a, some insight into the differences of those two things?
Ali Rezaei: Sure. So let’s start off with the word bioidentical. Bioidentical meaning statement is what the body produces. I mean, that’s literally what the [00:13:00] word means. So when I’m giving someone estradiol, Um, that’s the same hormone that their body is producing. Therefore, when I test their levels via blood test, I can see how much estradiol is in the system because there’s not a specific lab for a synthetic drug.
There’s a lab for that hormone. So when I replace it, I can see what it’s doing in the body. So that’s, that’s an example of a bioidentical hormone. Now, if a doctor’s not really familiar with bioidentical hormones, they’re probably fa familiar with Vel dot. Mini Vel estro gel. These are all bioidentical, commercially manufactured hormones.
Vi vel dot and mini vel are a patch. They’re available commercially and it is bioidentical estradiol. So if they’re comfortable with Vive and mini vel, we’re not too far away from a compounded by estrogen cream. Um, and then the question of synthetic, I mean, synthetic. As, as the word states is to be essentially synthesized in a [00:14:00] lab, um, is a deceiving word, and it, it causes a lot of confusion.
Um, I wanna make sure that when I compare natural versus synthetic, natural literally means that comes out of the, the ground comes out of the earth and we just grind it up and give it, and there’s no alterations made once, uh, at all. Whereas a synthetic hormone is something that we have to obviously adult in some way, shape or form.
We have to adjust it so that it’s chemically identical. So there are bioidentical hormones that are made in Al Labin. They’re synthesized. So I try not to use the word synthetic. Now, there are some types of hormones that are not bioidentical. Um, for example, Premarin is a conjugated, equine estrogen That’s not a hormone that we produce.
Um, and we don’t really, we’re not able to measure it. In the body, we can see the effects, we can see what it does to the symptoms. You know, it could possibly alleviate hot flashes and night sweats, but it [00:15:00] also has some other side effects that some patients really don’t care for. Um, so that’s what a synthetic is.
Another synthetic hormone would be, I. Provera, which is a, uh, hydroxy progesterone acetate that’s not bioidentical. Our body does not produce that. And if you look at the warning label, for example, for Provera, it says contraindicated in pregnancy. Now, the bioidentical version, I, I don’t wanna say version, but it’s, you know, let’s call it its identical cousin, would be progesterone.
Irene Ortiz-Glass: Right.
Ali Rezaei: Progesterone is actually used in pregnancy. The, the literal word of progesterone means to promote gestation to promote birth. So that is a bioidentical hormone that I can measure. OBGYNs will actually measure a progesterone level in the first trimester of a, a woman’s pregnancy to see if that level’s higher, low, and in some cases we will supplement them with progesterone suppositories or a commercially available drug like crone to help boost that progesterone level to help promote [00:16:00] gestation.
So bioidentical. Is something that is the same as what the body produces. Synthetic is a term that I don’t use as much anymore, but really I stick to bioidentical. That’s really what it comes down to. I give you what you are already producing and I replace, um, I’m, I’m not substituting here. That’s the key.
Irene Ortiz-Glass: Yeah. And, and do you find that women’s bodies are more receptive to that because they’re, you know, their body’s feeling like it’s what they sort of know, like in my instance, I don’t have ovaries, so I’m reliant on the hormones to give me what, as close to what I would be getting. If I could make them.
Ali Rezaei: In the case of let’s say a diabetic patient who no longer produces insulin, I would give them insulin at the end stage of their diabetes, and I don’t wanna say end stage, but when they’ve gotten to the point where they’re dependent on like a type one diabetic needs insulin, I wouldn’t give them, um, a different version of insulin.
I would give them insulin because ultimately that’s, that’s the hormone that we know [00:17:00] in your body that’s going to do A, B, and C. Sometimes when you give these synthetic hormones, like, let’s just call it, you know, Premarin or Provera, it’s hard for me to know. I mean, we have evidence and we’ve seen studies, but it’s really hard to gauge how the woman’s gonna respond to it.
Whereas if I give her estam progesterone, I know that at some point in her life, her estrogen level was here and her progesterone level was here. So theoretically I should know how she’s going to respond. And I gotta stay within those parameters as far as labs go as well.
Irene Ortiz-Glass: What you can measure. So, um, the other question that, you know, we’re asked all the time is, okay, what are the delivery options? So I had this crazy experience, which, you know, I, I don’t know if I’m unique, I always feel like I am in some ways with this experience, but I, um, had started with a patch that was not vil.
It was something different. It was, um, a non-branded generic patch and I was having horrible fluctuations on it. And then [00:18:00] my, uh, NAMS doctor suggested. Try the vil dot branded patch. You may have a better, you know, response, right? And so I, it was like night and day for me. I had a whole, a whole different experience after that.
Um, I know other people take, you know, biased or creams or they take, you know, different forms. Is there, what are the delivery methods? What options do women have? And is there one that’s better than another?
Ali Rezaei: Well, in the world of estrogen, I always say, in my opinion, just based off evidence and, and decreasing the risk of, uh, clotting and so forth, topical administration of estrogens is always better. Um, that’s, that’s what I believe. That’s what the evidence shows. Uh, oral estrogens in general are not used to the same degree, uh, as topical estrogens anymore, at least in our practice.
Um, Vive brand versus Vive generic. I’ve seen [00:19:00] so many cases of where a generic manufacturer’s estrogen for some reason, causes one outcome, but its branded counterpart gives a better outcome. Where the patient and, and, and that could be an issue of quality control. Nothing that we have anything to do with that just has to do with manufacturing.
That’s something that should realistically be handled by the f d A. Um, so as far as what’s the, there is no best, but as far as estrogen goes, I love topical for my patients. Um, creams, gels, uh, patches in this case, which we don’t make, um, are fantastic avenues. Um, in the world of compounding, we have so many options as far as dosing goes.
We can go up, down in small increments if we need to. Um, we put things in a click system so that if someone wants to go up based on their provider’s recommendation, they can one click, two clicks, three clicks, whatever they need, um, and they rub it in and they go, it goes away. I mean, it disappears. A patch, although is [00:20:00] convenient because it’s twice a week or once a week, depending on the patch.
Um, You know, it can be uncomfortable for some patients. They have to leave it there and you know, they may, they may not want to, although most of the times it’s discreet. Um, progesterone, um, one of the things that I like, oral versus topical is that oral I, I’ve seen and because of some of its me through the metabolic pathway of progesterone and taken orally because it goes through the liver.
You get, um, four allopregnanolone, which is a kind of a. Uh, has a similar structure to, has a kind of gaba GABA effects and it can cause drowsiness. So you see as with oral progesterone more so than topical, you still see it with topical, you get some drowsiness, which why a lot of providers will say, Hey, I want you to take an oral progesterone capsule at bedtime to help you fall asleep.
Um, so that’s one of the side effects that a lot of my female patients who are going through perimenopause and menopause [00:21:00] actually want, they wanna sleep better. I. Because that’s one of the things, unfortunately, when you’re perimenopausal, menopausal, postmenopausal woman, you suffer. Sleep is one of the first things that gets affected,
Irene Ortiz-Glass: Yeah. Is that the progesterone loss or estrogen or both, do you think?
Ali Rezaei: so I’ve always learned that falling asleep is a progesterone issue.
Staying asleep is an estrogen issue. So again, it’s an intricate balance and not having too much testosterone. Is also beneficial for your sleep. You have too much testosterone, you’re gonna be wired. It’s not something you want. So keeping that testosterone within that range, blood levels typically between two and 45, that’s a, that’s a sweet spot that I like to be, and I like to be not too high on the end of norm.
Somewhere more towards the middle to high. Uh, and then estrogen, progesterone, all of them all contribute too much thyroid. That can also affect, you know, how late you take your thyroid, how late you take your testosterone, how early you take your progesterone. I. So even the time of taking these [00:22:00] medications can affect the outcome, but
Irene Ortiz-Glass: That’s so interesting. What about a real quick thyroid? Um, you know, I’ve been on compounded thyroid for my whole life. Um, and only one other time was taking an alternative that didn’t work for me. Um, is, is it, do you find that women move over to a compounded thyroid and have a different level of success?
Like, I know that’s a big topic for a lot of the women who come to us who are taking Synthroid and other things and feeling like they’re not, you know, managing well.
Ali Rezaei: You know, thyroid is a very touchy subject and because. And I, I hate to say this, but Compounded Thyroids has its shortcoming, shortcomings, but it also can be beneficial for those patients who are not responsive to armor and, um, Synthroid and so forth. Uh, Synthroid obviously is Levothyroxine, and then you’ve got Leo Thionine, which is, you know, T three and Levothyroxine is T four.
Um, the, the [00:23:00] thing is, is that those are obviously being bioidentical. Um, There’s a lot of fluctuations and, and thyroid is something very hard to, to kind of get a grasp on. That’s why a lot of doctors will just give Synthroid. It’s easy and metabolizes itself from T four to T three, and patients get good responses.
If they’re teeter tottering between one dose and another dose and they just can’t nail it, I think that’s a great time for thyroid to come in. Or when there isn’t a dose option, a ratio available, because like Armor, for example, has a four to one ratio of T four to T three. Some doctors will say, well, armor only comes in a, you know, quarter grain, half grain, full grain.
We want someone to be at Threequarter Grain. You know, we don’t want them to take three pills. Um, because, and we want also not the other, there’s other additives sometimes in armor that some patients don’t do well on, so they’ll ask us to make something. So in those cases, when I see that Levothyroxine is not working, I think bioidentical thyroid can be hand handy.
[00:24:00] Um, when armor’s not working, the compounded T four T three can be helpful. It really just depends on the patient.
Can you hear me?
Irene Ortiz-Glass: Yeah, I’m just at the end too. Yeah, I gotta wait for him to come back on. It looks like he is dot, dot, dot on my screen. I can’t see him.
Ali Rezaei: I am here.
Irene Ortiz-Glass: Okay. So as long as you can I, Ali, are you there? No, I can’t even hear him
Ali Rezaei: Yeah, I’m here. I, I can hear you loud and clear.
Irene Ortiz-Glass: into the universe. I wonder if his internet just cut out. I hear him. Oh, you can? How come I can’t? Yeah. Oh, great. Um, I don’t know what my options are here. Um, I mean, why don’t I just ask the, or I can ask the question and see if he can, um, respond
Ali Rezaei: can let her know that.
Irene Ortiz-Glass: won’t hear it.
He totally hears. Yeah, go ahead and ask the question. Okay. Okay, great. So, Ali, tell us, um, how people can find you if they’re interested in connecting either their practitioners to you or working with you directly to get, you know, some recommendations. Um, how can they find you?
Ali Rezaei: Well, first and foremost, one thing I forgot to mention is, um, in the first question is why compounding pharmacy? And, and I just wanna let you know the. The viewers know. Um, we are actually gonna be moving to a brand new facility here in Irvine in about 90 days, um, right by John Wayne Airport, which is gonna be kind of like a state-of-the-art facility that myself and my business partner, uh, Dr.
Ronnie Dei, um, are gonna be coming together from our stores, bringing all of our patients together so we can kind of bring the best of all worlds together and manage all these patients under one. You know, facility rather than having multiple locations. Um, that’s [00:25:00] number one. Uh, we’re, we’re at 17 500 Red Hill Avenue, suite two 50 in Irvine, California.
You can reach us on the web, um, at ww dot kings pharma.com or dr compound.com. Um, you can also Google us. We’re available at both of our locations currently in Newport Beach and Irvine. And, uh, we’re here to help in any which way we can.
Irene Ortiz-Glass: So thank you everyone today for joining us. This has been such an informative session. I know many of you have questions about. Out hormone therapy and compounding pharmacy. So, um, make sure that you go to the King’s Pharmacy website. Also on our website you will see a link to Ali’s information, um, this podcast as well as video on demand, which will be available to you if you so [00:26:00] desire to get additional coaching and assistance.
We do have coaches available on menocoaching.com. As well as a lot of other resources, so please make sure and leave your feedback on these podcasts as it really helps us to get the word out and educate others. Thanks so much for being with us today.
Ali Rezaei: you so much for having us.
Irene Ortiz-Glass: That’s really weird. Alright, a second. Mm-hmm. Irene, you can hear. Can’t see him. Can’t hear him, but I can hear you and I have no idea why. It’s like a weird. Yeah, like, that’ll be easy. The pauses will be easy though. Okay. Okay, good. Yeah, I figured we got, it still says 99%. That was well done. Good, actually. Good. Yeah, this
Ali Rezaei: next time we’ll do one about nail hormones.
Irene Ortiz-Glass: doing work on the, yeah, I gotta figure out what’s going. They’re doing work outside on the street and I don’t know if that has anything to do with, I don’t know. But it’s weird how it just went away completely. I have noticed a couple of times I know. Talk about that. Yeah. I don’t know what I need to get a different provider. It came and knocked on her door better. my, I don’t ever wanna move house. Oh really?
Ali Rezaei: You, you know, it’s, it, it’s interesting Adam, I, I, it’s interesting at my new
Irene Ortiz-Glass: keep whatever you have now and it’s on top of that, or you replace it completely? I just got rid of internet and
Ali Rezaei: so it’s interesting you said that because we’ve always had internet issues at both of our facilities. We were with at and t back when there was like, I mean, we’re talking about six megabytes down. Then we went to Spectrum, which is like better, and then in my Irvine location we had Cox Communications.
But the new location, it’s the first time I’ve actually ever experienced at and t Fiber. And we have like 500 megabytes down. It is unbelievable. It’s so fast.
Irene Ortiz-Glass: I don’t.
Ali Rezaei: Yeah.
Irene Ortiz-Glass: Readily available. Well, I’m gonna find out about it ’cause this is starting to be a problem. It was this morning on my call too, so I don’t know what’s going on. Oh, gotta love it. Yeah. Three megabytes left to upload happening. Yeah, I
Ali Rezaei: now when I run a.
Irene Ortiz-Glass: actually. Um, sorry. Lemme stop the, okay.
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