The Truth About Hormones and Your Skin—A Top Endocrinologist and Dermatologist Explain

17:47Dr. Harriet Comite:Usually they're dry. They're not really getting moisturized enough. They weren't used to really using a lot of moisturizer. The water loss because of the estrogen, the decrease in estrogen, you have more water loss through your skin. You may heal a little slower because the estrogens protect you. Well, the acid mantle and the pH protects you from infections. You have a healthiest skin biome before menopause and premenopause. So you want to put people on moisturizers that have either ceramides or something that will hold water in. I love hyaluronic acids because it's a humectant that absorbs water and it's not oily at all.

18:35Dr. Harriet Comite:So everybody can use it. Your skin can get more irritated and sensitive to any products you use. So a lot of times we're switching products in patients. Maybe not the medicine, but the base of the product we're switching. Can I add something to that? It's very broad when you say perimenopause and hormones, because every woman traverses that differently. There are some women who go into menopause, which usually is defined as a year after your last period. The average is 50.8, actually. But I've had patients at 38 and patients at 58 and patients in their 50s who are pregnant. So when you talk about perimenopause, right, your hormones are fluctuating and usually is a brief period of maybe excess androgen.

19:18Dr. Harriet Comite:But testosterone is the key hormone that's falling in your 30s. And that's the reason a lot of women who are maybe in perfect shape, not me ever, but they have their they've gained two or three pounds and they notice it around the middle because it's testosterone. Usually estrogen is overproduced. I don't know if you've ever heard the term of excess, you know, estrogen, estrogen overload. You don't make eggs as frequently. And in eggs, the eggs, the ovulation happens, you get progesterone. And that counters the estrogen and balances it. But what's steadily decreasing and probably having an effect on the skin as well, because we see it, is testosterone.

19:55Dr. Harriet Comite:We women have more testosterone than estrogen, but it starts falling by one to three percent every year in our 30s. So the reason for the more infertility in your 30s, the weight gain around the middle, the lack of energy, the brain fog comes from the fact that our systems are shifting and testosterone is really falling where we can be cycling every month. Doesn't mean we're ovulating, but we could have a period every month where some people skip time starting in the 30s all the way through the 40s. And also you, testosterone may fall a little bit, but you sometimes then get a lower level of estrogen.

20:30Dr. Harriet Comite:So relatively speaking, the androgens, the testosterone is higher. And that's why people perimenopause may see acne for the first time because their skin is getting, they're getting oilier. The relative mix of it. The relative, not the absolute level of testosterone or estrogen. I mean, I'm sure you've had friends, for example, that may bleed heavily and other people who say their periods practically stop. All of that's related to hormonal fluctuations and every person has their own pattern of how they get through perimenopause.

20:59Dr. Florence Comite:Yeah, it's interesting. So they put me on estrogen and progesterone. I just do the progesterone. That's the first 12 days of the month. But there was no talk about testosterone at all.

21:10Dr. Harriet Comite:Testosterone is actually off-label in the States. In the UK, it's been prescribed and for over, I think, 60 years. But only if you report severe libido issues that affect your whole life. So when I was there speaking, I said every woman should just tell their doctor that they have severe lupido issues because it's such a critical, we have more testosterone than estrogen and the shifts during perimenopause, depending on whether you're still making eggs, you're still ovulating can be variable, but inevitably it goes down, which is why we gain mid, we gain visceral fat. It's hard to lose it. Why we can get skin issues as well.

21:46Dr. Harriet Comite:And we have brain fog. There's a whole, testosterone affects every cell in the body and we have actually more of it in our body than estrogen at any given time. So maybe that's why I was falling asleep earlier today. I'm not on testosterone. But you do need progesterone usually because when you make unopposed estrogen, so you're making your follicles are being stimulated, you're secreting a lot of estrogen. A lot of women feel great during that stage. But if you're not ovulating, your uterus is getting, seeing only estrogen and is not organizing and there's a higher risk of endometrial cancer.

22:21Dr. Harriet Comite:So in the OBGYN world, you would have to take progesterone at least every three months to shed the lining because progesterone organizes the lining. So if you don't get pregnant, it then falls at the time you start your period. That's what starts your period, actually. And then you shed the lining and clean up again. That doesn't always happen routinely during the perimenopause. And menopause is when everything stops. You don't have any more eggs. You can't make estrogen. You can't make testosterone. And so all of a sudden, your body is really shifting then when you go through menopause.

22:57Dr. Florence Comite:One Skin is one of our show partners this week. I am a big fan of female founded brands, especially those that are leading the charge with innovation and skincare. And that's definitely the case with One Skin. It was founded by four female scientists and they did do some jaw-dropping research. After years and years of testing more than 900 novel peptides, they developed OS1, which is their proprietary peptide that's proven to address skin aging signs. It's really the foundation of every single product that they create. And the whole idea is that over time, you'll see smoother skin, more even tone and radiance, and visibly fewer lines.

23:37Dr. Florence Comite:It's all about skin longevity in the long term. And one of my favorite products from the line is their moisturizer. It's called the OS1 Topical Supplement. So you put it on. It's very lightweight. Goes on beautifully. I also adore their lip mask. That's an essential for me in the winter. I actually have it on my nightstand. Very hydrating. Comes with this chic little silver spatula so you can scoop out just enough product. Slather it on your lips before bedtime. I'm absolutely love it. Can't be without it. And born from over 10 years of longevity research, One Skin is helping you unlock your healthiest skin now and as you age.

24:16Dr. Florence Comite:For a limited time, try One Skin with 15 % off using code BREAKINGBEAUTY at oneskin.co slash BREAKINGBEAUTY. That's 15 % off oneskin.co with code BREAKINGBEAUTY. After you purchase, they'll ask where you heard about them. Please support our show and tell them that we sent you. Once again, it's oneskin.co slash Breaking Beauty. We'll link to this offer in our show notes and on our website. Today's episode is brought to you in part by Wakul. So I'm wearing one of the most comfortable bras I've ever owned because, you know, I'm 50 now. I'm 51. And comfort matters to me more than having lacy, pretty bras under my clothes.

24:56Dr. Florence Comite:But I still am, you know, that girl and I care about what I look like. So also the way that my chest looks outside of my clothes and under my t-shirt is really important to me as well. Wakul really understood the assignment when I did a virtual or online call with one of their experts to help me find my perfect fit because they're the ones who connected me with this bra and that's what they do. In fact, Wakul has been helping women find a better fit for more than 40 years. It's more than just about size. It's also your breast shape. So I explained that I'm shallow on top and heavier on the bottom.

25:34Dr. Florence Comite:That's kind of code for like a banana boob, you know, I'll just say it. And so they then connected me with this bra that just really helps to account for that by kind of tucking you in at the top so you don't get that gap. I feel like a lot of us probably know what I'm talking about. So that's what Cole, they just get it. Support for every you. Underneath it all lies Wacol. If you want to try it for yourself, visit wacol.com and use code beauty at checkout for 10 % off your first purchase. That's W-A-C-O-A-L.com. Use code beauty for 10 % off your first order. Offer valid for new customers only and limit one code per customer.

26:14Dr. Florence Comite:Visit wacol.com. Use code beauty at checkout for 10 % off your first purchase.

26:27Dr. Florence Comite:Coming back to what you were saying, Dr. Harriet, is Jill and I used to work at magazines before we did the podcast. And I can't tell you how many stories I wrote about your skin in your 20s, 30s, 40s and 50s. And it was always that idea that your skin loses moisture from declining estrogen in your 50s, sagging because you're losing collagen. Nobody that I interviewed had ever mentioned to me that your skin can become more sensitive or that underlying conditions such as eczema or rosacea, anything like that can surface at that time. But there has been more recent data. There's a paper that came out earlier this year, Beyond Hot Flashes, understanding and treating menopause-associated skin changes in the Journal of Integrative Dermatology.

27:18Dr. Florence Comite:And they talk about how your skin pH changes and also your skin barrier just becoming rashy. Your skincare that you've used for many years now stings all of a sudden. Like that was never the top of conversation. So I'm curious from your point of view, the unexpected symptoms that people might have that are actually related to perimenopause. Like I said, my skin was freaking out and it was only maybe nine months later when I missed a period for the first time in 35 years that I realized, aha, this is perimenopause.

27:52Dr. Harriet Comite:Well, I think it's because of the changes in hormones. Generally, the surface of your skin should be acidic, which is a lower pH of 4.5 to five or 5.5. But then with the changes in perimenopause and menopause, your skin becomes more alkaline. And alkaline is not, it lets water evaporate. It thins your skin. Your organisms or bacteria that are not good for your skin have more easily entry. You're more fragile. You bruise more easily. So your skin should not have an alkaline pH. And so that's why it's important to use certain cleansers, to use ceramized, umectant moisturizers to protect your skin and not use a straight soap, but soaps that are protective of your skin.

28:42Dr. Harriet Comite:Yeah. The microbiome affects all of the body from the gut to the skin and the skin and the gut like interact with the environment a lot. So protecting your skin means you're going to have a healthier microbiome. Yeah. And of course, Just to be clear, this is so different for every woman. You have to look at every patient or I look at every patient as unique to themselves, just like my sister uses N of one to explain you're your own control. I may have two patients that seemingly have the same symptoms and yet I treat them differently depending on who they are and how they function in life and what they're willing to put on their skin.

29:20Dr. Harriet Comite:Are they a minimalist? Will they do whatever I say, recommend and get to the end point faster? So it's all very unique. It's not one size fits all.

29:30Dr. Florence Comite:Yeah.

29:31Dr. Harriet Comite:As I've learned from my twin sister. Yeah, for sure. That's incredible.

29:34Dr. Florence Comite:I also just appreciate that this conversation that we're having this conversation and that I think to your point before, when you were walking into that room and you were the only woman, like I just think the more females we can have talking about this and in roles like both of you, that is really what's going to change and empower women to know more. And like the fact that you wrote that book, like I just think you have the firsthand experience as a woman and that is hard to.

29:59Dr. Harriet Comite:Yeah, because we're not. You can't teach that.

30:01Dr. Florence Comite:Exactly. Like, so I think it's amazing.

30:05Dr. Harriet Comite:Keep in mind that antibiotics change the direction of health. It's what keeps us living longer now. So they came about in the mid 19th century, right? 1950s. In fact, the first woman treated was the wife of a doctor who was dying from a urinary tract infection and sepsis. And she was given penicillin that they had to recycle through her body. They collected it in the urine and they gave it back to her by drying it out and creating it. And she survived. And so that changed our life expectancy now. And we're living longer. In this century, I think the GLP-1s are going to do the same thing because they're way beyond just losing weight.

30:39Dr. Harriet Comite:They're about the way they interact with our organ system and our genetics. And since I believe genetics, which is key, you should know your family history. That's a great place to start is dementia, diabetes, skin issues in the family, like rosacea and PMOS. You mean PMOS? Yeah. Oh, you know the new name for PCOS? Yes. Oh, I see. All of that runs in the family. And the more you know about it, the more you can do to change that, the direction of it, because there's another field that lies above genetics called epigenetics. And that's why understanding the kinds of things you can do with your skin, your sleep, your food, your activity, your stress, changes the direction of how your genes are expressed.

31:23Dr. Harriet Comite:That's the whole notion of invincible, defy your genetic destiny to live better, longer. That really helps. And it's almost a how-to. I built it because I wanted women to be able to help themselves because I know the basis of the wisdom is not really out there yet.

31:38Dr. Florence Comite:I thought it was fascinating what you said about GLP ones there because peptides are all the rage and people are, I think they're so excited by the GLP one that there's this notion that all peptides that you inject are going to be good for you. And I think this is a bigger trend in the US than in Canada. So maybe you could just break it down. Like what is happening?

32:01Dr. Harriet Comite:So I've been using GLP ones and varieties since 2005 when the first one became known. It didn't become a celebrity big hit until Ozempic and Zetbound, but because it was more major. But it worked even then. And I tested it then as well. You had to take it before a meal. If you didn't, you missed the opportunity in the window. But it does change the way your brain works and the way your gut works in terms of desire to eat. You don't want to eat and you feel full. So the combination is good. But it's much beyond that. The other peptides, there's so many that are great. The problem is that they haven't been available because the FDA decided we shouldn't have them available.

32:40Dr. Harriet Comite:There's a lot of lobbying from companies that wanted to sell them and not let doctors order them. And so it became a black market where you can get it. And even in Silicon Valley, you'd be able to go to the refrigerator on a Friday and find your peptides and stack them. And the more people I talked to, the more I realized they had no idea what they were doing when they stacked it. But peptides can be amazing. I remember a patient, and I've had many like this, but she was striking. She was the first one I used a combination because I've used peptides in my research, even in children, going back to my training at NIH, treating early puberty and reversing it, and then in women with endometriosis fibroids and infertility and other issues.

33:19Dr. Harriet Comite:So I was very familiar with them, but I would only use a safe source. But this woman called me after we started her on these peptides, and we were very careful. I made sure the source was correct. You need to have certain certificates. it. You want to make sure you're giving what you think you're giving. Right. And she called me and she said that she went to her tailor and her tailor had a fix. She was kind of a large size woman, bone wise. And she always wanted to be tiny and petite. And I never thought that would happen. And when she called me, she said, my tailor told me that my body has completely shifted, almost like my bone shifted.

33:52Dr. Harriet Comite:And she came in about a month later and I didn't recognize her. And so you can change from the inside out. Peptides can have a major effect. The particular combination she was on was mimiporelin and CJC-1295, which act like growth hormone. Their signature is, and I've used growth hormone too, which is a peptide. It's not a hormone. It's not a steroid hormone. So all of these combinations have to be carefully kind of judiciously applied to each person because as Harriet and I agree, and of one, even between the two of us, we're different. There are medications she can take, like metformin. I can take it.

34:27Dr. Harriet Comite:There are other issues between us. Goldbladder is one of hers. My bowel is sensitive. I can't do much because I have a bowel disorder that interferes from time to time if I'm dehydrated and under stress. I have to make sure I drink a lot of water. Or even our percent chances of getting diabetes. Yeah, we have genes expressed a little bit differently. Exactly.

34:48Dr. Florence Comite:Is it through an IV that people are doing this?

34:51Dr. Harriet Comite:You can get IVs that will... One of the most popular ones are BPC-157, and that's been around for 200 years. It was isolated from the gastric juices of dogs back in Russia. A funny part of that is one of my patient's mothers was a doctor in Russia at the time, and she remembers her mother injecting her grandmother with it because it helped with arthritis and inflammation. And it's actually available orally because it's useful in reversing gastritis and reflux as well as Crohn's and ulcerative colitis. So a tiny little pill. There are others that act in all different ways. In fact, in fact, some of them affecting the skin.

35:31Dr. Harriet Comite:And also, for example, the product I was sharing with you earlier that changes the way the DNA is expressed in your body that almost has a Botox-like effect. And what's that called? Well, it's a combination of GHK with copper. and it's actually known, I think very popular out there called the glow injection and it's given as an injection, but you can also take it through the skin and it's absorbed. And there are major studies in it that show it has an effect. Yeah.

36:02Dr. Florence Comite:And of course, everyone's going rogue and sharing tips on TikTok because again, a lot of this stuff hasn't caught up necessarily. And there is this gap. So people are just piecing things together. And one of them is this hack, this viral hack of women taking PEPCID in combination with an antihistamine. And they're saying that it's helping them with their PMS or their PMDD. So what is this? And is it, is there science behind it?

36:35Dr. Harriet Comite:I'm not aware of any solid science behind it. I will tell you that having done tons of clinical studies in men, women, and children with peptides and with different agents, there's a huge placebo effect, which a lot of doctors believe is real. And it usually lasts about three months. There can be underlying science. One of the areas that it might be affecting is prostaglandins. So when women get their period within a day or so, they might have that day or even pre-period, they might have cramps. And you can cut that off with NSAIDs, for example, but you actually have to start before the cramps get underway.

37:10Dr. Harriet Comite:I just gave Carleen one before you came in here.

37:12Dr. Florence Comite:I gave her an olive. I'm like, it's really strong. Don't drink tonight. Anyway.

37:18Dr. Harriet Comite:And so, but it stops the prostaglandins and the prostaglandins may be affected by the antihistamines. I would have to really look at the data, but that's what I suspect might be if it's not a placebo effect.

37:31Dr. Florence Comite:Because there is, there does seem to be a relationship between histamines and your hormones. Yes, it can be.

37:38Dr. Harriet Comite:Some people get allergies related to their cycles. Some people get migraines related to their cycle. So it is absolutely going to affect, because it affects your whole body. In fact, when I started Women's Health at Yale in 1992, the patients would say to me, my doctor told me that this is all in my head when they'd have symptoms. And I would have to say, you know, your doctor isn't wrong because hormones and neurotransmitters, which are affected by hormones, are in your head. And so those changes are going to be perceived by you. But it's it's meaningful. It's not just you're not just faking it.

38:08Dr. Harriet Comite:It's not just so that is a part of it that they skip. You know, well, just forget about it's in your head or, you know, you don't have to worry about it because you probably have panic attacks and it's not real chest pain when it might be really indicative of a heart attack. And so I think we have to question and we have to know more about our own bodies. And wearables are great for that, by the way.

38:28Dr. Florence Comite:Right now. Yeah.

38:32Dr. Harriet Comite:Wearables are great for what? For everything. One of the ways that I like people to start for the whole body, your cycle too. And what's going on if you get headaches. So I particularly love the continuous glucose monitor that shows you what happens when you eat, when you work out. I mean, yeah, Carly needs that. They should have it in Canada. In writing my book, I had a woman I came into contact with and she was telling me her story and it was clear to me that she was perimenopausal. I could tell by the story all the data I've collected on thousands. And I said, you know, why don't you start?

39:05Dr. Harriet Comite:And she told me a little bit about her family history, which had dementia and diabetes in it. And I said, why don't you get an over-the - counter? Like I prescribe them and there are versions for prescription and versions that you can get over-the-counter. In fact, there's one connected to the aura called Stella, which is related to Dexcom, which is the prescription version. And it's this little tiny disc, no bigger than a, it's like a nickel and it sits, you don't even feel it because you kind of press it against your skin and it pops right in and it sits in the interstitial tissue or water around muscle.

39:37Dr. Harriet Comite:So in looking at it, you can see fluxes going up and down. And if you want to keep your health for life and not get sick and reverse anything that's emerging, you want to keep your sugar in a certain sweet spot, just like we like to keep our temperature. So that is a great way of seeing what happens. Oh, I need to do that.

39:54Dr. Florence Comite:Either that or go for a walk after you, like do like 10, they're saying now like 15 or 20 squats an hour or something like that. They're talking about engaging your glutes.

40:02Dr. Harriet Comite:Do you really have time to do 20? I don't know about that part. So one trip tip is walking, right? Yes, yes. After you eat. Not waiting an hour because that's when sugar and insulin are released as hormones. And so if you walk, you change the dynamic. Also, if you take protein before you eat any carb, that's another way. Resistance training three times a week. exercise puts on muscle and keeps it there. Enough protein to sustain your body. So those are all hormonally driven as is testosterone important. So that's something you might want to go back and look at. Yeah.

40:40Dr. Florence Comite:Osea is one of our show partners this week. It's officially fall, everyone. That's got me thinking about luxurious moisture from head to toe. And if you haven't had the good fortune of trying Osea yet, this is your time to try it because I've fallen in love with so many products from this line, especially the Unduria Algae Body Oil. It is silky smooth. You put it on right after the shower. It's very lightweight. It's kind of like liquid gold, and it just gives your skin this really beautiful sheen. It's also super nourishing for the skin. I also really love their Algae Body Butter. It's clinically shown to hydrate for up to 72 hours, and I love that one, morning, noon, or night.

41:22Dr. Florence Comite:It is so wonderful. It gives your skin kind of this cocooned effect. And really the secret with Osea is that it's all powered by underrea seaweed, which is hand harvested from the sea and soaked in barrels of botanical oils. So it's this very special process. It's owned by a family, a mother and daughter, and it's all clean clinical. That's what they say. And great news for Breaking Beauty listeners. we have a very special promo code from Osea. So go to oseamalibu.com and get 10 % off your first order with code beauty. That's O-S-E-A malibu.com and use code beauty to save 10 % off your first order.

42:05Dr. Florence Comite:Once again, that's oseamalibu.com and use code beauty to save. We will link to this offer in our show notes and on our website. Now back to the show. So today's episode is brought to you in part by Kiyuchi. Okay, so I have created a pretty good sanctuary in my room for rest time, sleepy time, and it all centers around my bed. So major key is a king size bed. I will never go back. Once you go king, trust me, you're not going back. And the other thing is natural fibers. Okay, especially when you're going through a perimenopausal change, which I know I'm always talking about that, but you know, you get those night sweats and even my husband gets night sweats.

42:46Dr. Florence Comite:That's a bit TMI. I don't know if I should be telling you that, but yeah, you need those natural fibers. So Koyuchi, I'm so excited. I just ordered one of their premium natural fiber, a hundred percent organic cotton sheet sets. They also have a hundred percent organic linen, by the way, natural materials that are made to deliver your best sleep ever and only get softer with time as you wash them. And I'm so excited because I needed a new set. And Kiyuchi is everyday luxury that you can feel good about bringing into your home. I think it's worth it because you get to be comfortable and it feels natural and cooling.

43:25Dr. Florence Comite:And they've been around for 35 years, so they really know what they're doing. There's no polyester in sight. It looks great. You're not compromising on style in any way. And if you want to try it for yourself, you can visit kayuchi slash breaking beauty for 15 % off your first purchase of the most comfortable bedding you'll ever own. That's C O Y U C H I.com slash breaking beauty and some exclusions apply. Now back to the episode.

44:04Dr. Florence Comite:speaking of me Dr. Harriet why not I knew this was going to have a double Dr. Harriet skin tags once I knew I was in perimenopause all of a sudden skin tags galore on my neck under the boobs like under my armpits inguinal area

44:25Dr. Harriet Comite:groin all the folds yes why they think it might be related to insulin resistance, actually. And those, of course, are areas that your skin is thinner and rubs against each other. And then with the changes in your skin due to hormonal changes, it might be easier to cause those little growths. And by the way, their tags are also called fibroepithelial papillomas. They're totally benign. I'm going to test you on that. They never become malignant or cancerous. They're very easy to snip off, which is the best way of doing it. And once you snip them off at the base, a lot of times they're on a little stem and it could be very thin.

45:05Dr. Harriet Comite:And then I don't even need anesthesia. You could just do a bunch of them at a time. Sometimes if they're broad based, I will numb it a little bit and they don't come back. You can develop new ones, but it is recommended to get tested for diabetes and hormonal. Because in my book, I isolate five particular biomarkers. And insulin is one of them because you see insulin resistance years before you get diabetes. And you might have prediabetes because as you enter perimenopause, your testosterone is now low. You can't put on as much muscle and you can't package sugar effectively. And so that's an early sign.

45:42Dr. Harriet Comite:And almost all of us are on a journey to diabetes because it's a survivor thing. In the days, we inherited genes from people who survived cavemen, cavewomen during lean times, the Holocaust, the Irish famine. And so with those, I would test for those five biomarkers, which include testosterone, insulin, sugar, hemoglobin A1C, and cholesterol. And all of those will tell you your picture of your future that you want to change.

46:08Dr. Florence Comite:I'm clipping that and taking it to my doctor.

46:11Dr. Harriet Comite:OK, it's in the book actually has references on every chapter because I knew how do you convince your doctor? And one of the ways to convince them is to know your family history and say, well, my father had a heart attack or my grandmother had diabetes. I don't want to go down my brother's pre-diabetic, pre-diabetic right now. Ninety percent of people are.

46:31Dr. Florence Comite:Yeah. Right.

46:31Dr. Harriet Comite:Actually, I would say ninety nine point nine percent. I have yet to find someone with those five biomarkers who are optimal. They're not. And it's your food, right?

46:39Dr. Florence Comite:It's like we're just eating so differently.

46:41Dr. Harriet Comite:Right. And the food isn't that healthy from the ground. But it's also the way we live life and not enough sleep. When you don't sleep, when you have quality sleep, not just the number, the six to eight, but you don't get deep sleep. You actually secrete a hormone called ghrelin. And that ghrelin makes you hungry for donuts and bad carbs. So you gain weight by not sleeping with quality sleep. The aura can tell you. I'm on a CPAP. I have to say, I'm really glad that my sister made me wear a glucose monitor. Yeah. Because we've never been hungry in the morning. I sometimes would wonder why my employees needed to eat lunch.

47:17Dr. Harriet Comite:I went, can't we just work through and get home early?

47:20Dr. Florence Comite:Yeah.

47:20Dr. Harriet Comite:But it turns out Florence wants my sugar between 70 and 80s. My sugar, even at fasting sugar, my sugar, even after a 14 hour fast could be 100 and over 100. And then it showed me the food I could eat. Like I can eat dark chocolate after I have protein, of course. Ice cream doesn't make my sugar go up, but I can see how it's affecting my diet. So I'll never develop diabetes, even though I do have insulin resistance.

47:46Dr. Florence Comite:I'm doing this. So Jill and I, this is our ninth year of Breaking Beauty podcast. And when Jill and I first started working together, this was back in your old office, probably nine years ago. And she said to me in the afternoon, do you need a nap? What the hell is wrong with you? Because every time in the afternoon, I need a nap. And to this day, it just keeps getting worse. What do you eat for lunch? And breakfast. No, but it didn't matter what I ate. So the sugar would go up. And what happens is... It could be a salad with tuna. Remember, I was doing that Weight Watchers thing.

48:21Dr. Harriet Comite:Sugar goes up. And as sugar goes up, the higher it spikes, the longer it takes for insulin to come out. Your sugar is dropping. And then your insulin goes up and your sugar falls. and you don't have any sugar anymore left to chew on. So that's reactive, you have reactive hypoglycemia. So you're definitely a pre-diabetic. I don't know where your numbers lay, but I can tell you if you want to send me your numbers exactly where you are.

48:43Dr. Florence Comite:Oh, I sure will. And get that, you start bookmarking that book. What's your phone number? You can laugh, but on the - We're going in a group chat after this.

48:55Dr. Harriet Comite:The CBS morning show, Gail gave me her phone before we started talking and said, put your number in the phone. Yeah. And I'm going to bring my friend with me to see you. My friend Oprah. I don't want to live to three digits without my best friend. It was funny. Well, you know, Jill and I are our own version of Oprah and Gayle. We're Oprah and Gayle.

49:16Dr. Florence Comite:Anyway. I do think like that's the whole conversation around GLP-1s, right? It's like most of us would all just be healthier with less sugar in our blood.

49:24Dr. Harriet Comite:Can you get it in Canada? Oh, yeah. No problem. Oh, yeah.

49:28Dr. Florence Comite:Guess what? You can actually get it very cheap.

49:30Dr. Harriet Comite:Really?

49:31Dr. Florence Comite:Because Novo Nordics. No Nordics? How do you say it?

49:34Dr. Harriet Comite:Nordics.

49:35Dr. Florence Comite:Yeah. Yeah. They forgot to renew their patent in Canada.

49:38Dr. Harriet Comite:So now it's available without a patent? Or they have competition?

49:43Dr. Florence Comite:So we're going to have...

49:44Dr. Harriet Comite:How can a company forget to renew their patent?

49:46Dr. Florence Comite:Precisely. I don't know if they have, like, what's the big one everyone's excited about right now? Like, it starts with an R. Retretide? Retretide. Retretide.

49:54Dr. Harriet Comite:I don't think we have that yet.

49:55Dr. Florence Comite:Why do we call it RET?

49:56Dr. Harriet Comite:RET. Is that better, do you think? It's complicated. It's going to help. Each one of them helps people in different ways. So a chisepatide, which is also Zep-bound, was the next advanced by Lilly after Ozempic and Wagovi. And chisepatide has a combination of two. It has the GLP-1 and it has another peptide, GIP, that works in sync pretty well. And for 30 % of people who can't tolerate Wagovi or Ozempic because of bad reflux or GI symptoms, we move on to trisepotide. This next one, Rep, has... It's Rep, right?

50:30Dr. Florence Comite:I think it's Ret.

50:31Dr. Harriet Comite:Ret. R-E-T. Retetatride. Retetatride? Retta or Retta. Right. Yes. I studied it, but I can't really pronounce it well. I think many people can. And it has a third peptide in it called glucagon. And not everybody is going to respond well. If you do, it will have a major effect. But I think sometimes baby steps and doing it slower is better for the body. Right. Have you seen... We're testing it already. Yeah.

50:58Dr. Florence Comite:Dr. Harriet, what kind of skin changes have you seen with people that are on GLP-1s or is that bound to be a infection?

51:03Dr. Harriet Comite:The dermatologists mostly have seen volume loss. Oh, yeah. I see people who are losing weight pretty rapidly. Yeah. And if you have healthy skin and you don't lose weight rapidly, your skin will naturally contract unless it's really sun damaged skin and then it doesn't have much elasticity to contract.

51:21Dr. Florence Comite:What is your take on like radio frequency and the Morpheus 8 kind of thing?

51:26Dr. Harriet Comite:Oh, I love the Morpheus 8. We've been doing it in my office for over four years. We have great results. We do it in all skin types, although as a dermatologist, I like to prevent side effects. So with the inflammation, darker skin types can get inflammation and pigment changes. So I pre-treat with a lightning agent, post-treat with steroids. So I calm down their skin. But Morpheus 8 is great. The only thing there's been a lot of negative reports out there because it depends on the user. It has. Yes. It has to be done in the right way by people who know what to do and not just anyone. I would trust you.

52:05Dr. Harriet Comite:That's true for every laser. It's true for every treatment. Very much. True for every GLP-1. Yeah. The more support you get by someone who actually knows what they're doing, the better the outcomes are going to be and you won't run into problems.

52:18Dr. Florence Comite:Yeah. People probably aren't going to either of you strictly for cosmetic purposes, asking about going on what used to be called HRT. But have you noticed like an improvement in some of your clients' skin if they do go on MHT?

52:35Dr. Harriet Comite:I actually ask a lot of questions about their history and what medications they're taking, especially in menopausal, premenopausal women. And most of them, I recommend that they talk to their gynecologist or endocrinologist if they have one, but about going on hormone replacement, because I know that will support their skin better. Their skin won't be fragile. They'll be able to, it won't bruise as easily. And so I strongly recommend it unless there's contraindications where you can't take it maybe because you've had breast cancer and it's estrogen receptive or progesterone receptive. but even then, I don't know, do you have any different thoughts about that?

53:15Dr. Florence Comite:Yeah, what's the elephant in the room here? Because there's definitely a people are concerned about taking MHT and develop, you know.

53:24Dr. Harriet Comite:I think it arose, unfortunately, from 25 years ago when there was a study at NIH and they used one kind of estrogen called Premarin that actually was collected from pregnant mares urine, which had a lot of other ingredients in it. And I remember commenting on it. And they also used a not a such a great form of progesterone called medroxyprogesterone acetate. I never use those. I actually stopped them in any patient who came to see me even 30 plus years ago and never changed the way I treat people except to evolve with data. And so I believe hormones support every cell in the body, you know, inside and out, and particularly mucosal cells.

54:00Dr. Harriet Comite:As far as risks, I have an unusual position on it because I've been And using testosterone had a protocol for 30 years in women with breast cancer who didn't want to live. They felt their lives were over. They didn't feel like they looked well. They couldn't function. They lost their jobs because they didn't feel good. And they didn't look as well as they wanted to. And it changed their life. So testosterone is, in fact, recently there was a great study in men that showed if you had low testosterone, you had a much higher risk of cancer than if you had higher testosterone. So the group at the lowest versus the group at the highest.

54:35Dr. Harriet Comite:And again, we don't even have it. It's off label in the States and in Canada, I think. But you haven't gotten it. And all the women on birth control pills are not having, they don't have enough testosterone. They're suppressing it. So it also increases the risk of osteoporosis. So there are many diseases, all the chronic diseases of aging from heart disease, heart attacks, stroke, osteoporosis, increased insulin is actually inflammatory. And you have the makeup, you're fair with light hair. that is usually a genetic indication of higher risk for osteoporosis shrinking as we get older or the buffalo hump fracturing our hip fracturing our wrist and so that connecting those dots for each person is really important but in general i would default to hormones and start slowly if somebody's in their 60s or 70s but start as close as possible to perimenopause and menopause

55:24Dr. Florence Comite:I've definitely noticed a glow that came back when I started taking estrogen and progesterone. Yeah. Yeah, I definitely think so.

55:33Dr. Harriet Comite:I call it hormonal optimization, by the way, because we're not mother nature and you can't really replace the way we know that we cycle. And those hormones go up and down. Estrogen is very low when you start your period. So is progesterone. Then it starts climbing. And two weeks before your next period, when you ovulate, estrogen can be as high as 200 and then go back down to 10. And so those hormones shift all the time. Testosterone, not so much. We just start losing it very young. And so it's a clear cut way to keep your body as healthy as possible inside and out.

56:05Dr. Florence Comite:Yeah. Women are putting estrogen cream on their face, like what you would normally prescribe to someone for vaginal use, right? Is this something that you recommend? Like some germs are giving it to their patients for off-label use.

56:21Dr. Harriet Comite:I don't think there is much evidence that it's that effective, especially on facial skin, photo damaged and aged skin. There has been a study reported where they did see an increase in pre-collagen formation to produce it, but it's on hip skin and not on facial skin. And as a matter of fact, estradiol or estrogen directly on the skin in people with sun damaged skin, it seems to increase the breakdown of the collagen more than increase the collagen itself. There's so many other great products out there to use on your skin that maybe there'll be more studies in the future. But I think products like retinols and exfoliants and green teas and vitamin C's and E's, niacinamide, all of those will give you much more results in terms of minimizing wrinkling and dryness and signs of aging.

57:17Dr. Harriet Comite:Of course, the biggest way of preventing it is no matter what the weather outside is you use a mineral-based sunblock that has zinc or titanium, some combination of it. So because any sign of sun on your skin, tanning, burning is damage. Yeah, absolutely. Prevention is the key. It's much, much easier to prevent than it is to correct. So if you're using sunblock, you need vitamin D, which is actually a fat soluble steroid hormone. It's not just a vitamin with K2 because it'll protect every cell in your body. It's important.

57:49Dr. Florence Comite:I'm taking so much of that now. It's like absurd. Yeah, because we interviewed a pedicurist and I was talking about my dry cracked heels. And she was like, oh, well, vitamin D deficiency. I'm like, I already take 2000 IUs a day. She's like, take more. And I swear to God, it did improve it. Really? Yeah.

58:05Dr. Harriet Comite:D is good for the immune system to heal, for the heart, for the brain. It's known for bone. But we actually can't absorb it from the sun anymore. There's one study I read where if you're at the equator and you're nude for an hour at noon, you might get some D. But I've seen a lot of people who go from New York to Florida over the years. And no one's increased their D with that. So don't depend on sun exposure.

58:28Dr. Florence Comite:Flip it for TikTok. Yeah. Yeah.

58:31Dr. Harriet Comite:Yeah. Don't expose your, don't go out without sunblock because you think you're increasing your vitamin D. All right.

58:37Dr. Florence Comite:If each of you has to leave our audience with, we've covered a lot of ground here. Leave our audience with one takeaway tip that really is going to help them better understand hormones in their skin. What would you say, Dr. Forrest?

58:49Dr. Harriet Comite:invest in a CGM or continuous glucose monitor so that you can see what your body is doing for a two-week period and make changes that will get you healthy in every aspect, sleep, food, activity. It will really reflect what you need to do. And it won't be hard. It's like small habits, small changes. I think of it as atomic habits for longevity. They compound over time. So that's a real, I think that's a game changer. And you can get that at the drugstore. Yes. Okay. Lingo and Stella are two of the most popular over the counter. And you get an app and you get to what? Okay, great.

59:22Dr. Florence Comite:What would you say, Dr. Harriet?

59:24Dr. Harriet Comite:I would say to have a very good at-home skincare regimen. It's not going to change your skin or reverse back what's happened to it due to exposure and time. But having a good cleanser that is pH balanced so it's more acidic rather than alkaline. Having a very good moisturizer that's lightweight so you're willing to use it. And of course, the gold standard is wearing a mineral-based sunblock, at least an SPF 50 or higher. It's actually my favorite product from her because it acts like foundation. It's your own product, right? I have a few of them with tinted. You might have one. Yes, yes. Okay, we will link to that, everybody.

1:00:02Dr. Harriet Comite:And I have ones with tint and without tint. And so a lot of my patients will use them instead of foundation.

1:00:08Dr. Florence Comite:Well, this has been so insightful. Thank you so much. We could easily have talked to you for three hours. Once again, thank you, Dr. Florence and Dr. Harriet. Thanks for listening. You can find details on every product mentioned in today's episode, along with our exclusive promo codes on our blog at breakingbeautypodcast.com. While you're there, be sure to sign up for our newsletter. Every episode will be delivered directly to your inbox so you won't miss a single thing. And get social with us. Let us know what you think of the episode. You can follow us on Instagram at Breaking Beauty Podcast.

1:00:40Dr. Florence Comite:And did you know we also have a private Facebook group? Just search Breaking Beauty Podcast chat room. You can even leave us a voicemail at any time with questions or feedback at 1-844-227-0302. And don't forget to subscribe to us wherever you get your podcast fix. Spotify, Stitcher, Google Podcasts, and Apple Podcasts, where you can show us some love by writing a review. See you next Wednesday.

1:01:21Dr. Florence Comite:Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.