Why Midi Health is expanding into 'hormone-informed skin care' with Chief Medical Officer Dr. Kathleen Jordan, MD

0:07Hi, everyone. Welcome back to the Glossy Beauty Podcast, a show about the business of beauty and wellness. I'm your host, Glossy's West Coast correspondent, Lexi Lebsack. Accessing healthcare remotely through telehealth platforms has rapidly grown in popularity, especially since the 2020 global pandemic. This big shift in consumer behavior opens the door for better access to many areas of care, including perimenopause and menopause care, longevity treatments, peptides, weight loss drugs, hormone replacement therapy, and many more gaps in everyday care. But today we're going to be talking about the role of skincare in telehealth.

0:47And to do that, I had the chance to sit down with Dr. Kathleen Jordan, MD, the chief science officer over at MidiHealth. MidiHealth, which is a nod to midlife, is a telehealth platform for women that launched in 2021 and currently treats around 25 ,000 women every week. Midi wants to be a one-stop shop for women's health, which is why it expanded its skincare selection this summer to better treat the issues women experience in midlife, like dryness and hyperpigmentation, with prescription ingredients like retinol, estrogen, hydroquinone, copper peptides. These are ingredients that can be far more effective and more affordable when going toe-to-toe against many over-the-counter anti-aging products.

1:33I wanted to talk to Dr. Jordan about the role of skincare in telehealth, what the runway for growth looks like in this category, and what's next for Mitty's skincare ambitions. Here's my conversation with Dr. Jordan.

1:53Dr. Kathleen Jordan, thank you so much for coming on the program. Thank you for having me. I'm excited for this. Yeah, me too. Well, your resume is so incredibly dynamic. You are a medical doctor. You're also an executive in this very quick growing segment of women's health. If you had to say, what has been sort of the thesis of your work and your career?

2:17Dr. Kathleen Jordan, MD: I think the thesis for me has been trying to be helpful where there are care gaps. So I initially started a practice, private practice, and was serving patients that were not otherwise being served. And then I got more and more involved with the hospital and healthcare system and meeting healthcare gaps systemically, right? So we started using telehealth. We started using to answer care gaps that were a little bit farther even from the hospital. And then with that, I think it was really increasingly appreciating the huge gap in women's healthcare. I mean, there was a shortage of healthcare clinicians trained in women's health.

2:58Dr. Kathleen Jordan, MD: There was a definite paucity of access outside of concierge care. So I sort of used my background in programmatic setting up and using telehealth to actually answer care gaps and then joined the founding team at Mitty to really answer this care gap for women. Wow. You've accomplished a lot. Can I get you to brag about any of your sort of bigger or biggest accomplishments so far? I think one of the biggest, I mean, Mitty has been probably one of the bigger accomplishments in my career. It really has been the culmination of everything I've learned about how to programmatically set up and also how to lead teams.

3:36Dr. Kathleen Jordan, MD: I brag about the fabulous clinical team we have at Mitty. We have, you know, many hundreds of clinicians serving women across the nation. and the joy of my job is that I get to meet with experts nationally in all fields like naturopathic medicine, cardiology, internal medicine, skin and hair, right? And then bring those best practices back to my team. And then that team executes it for women. And it's been fabulous. And I think my proudest moments are really when we get patient accolades and patients commenting at how much we've impacted and changed their lives. Yeah. Well, big, big congrats for all the success at MidiHealth.

4:17I got a number from your team earlier this week, more than 25 ,000 patients visit MidiHealth each week. Who are these women and what would you say they're sort of looking for?

4:28Dr. Kathleen Jordan, MD: So most of the women that come to Midi are in midlife. So they're past, you know, fertility and birth issues and really looking to be their best self, right? To feel well and do well. And they're becoming increasingly concerned in longevity concerns, right? As they see their parents aging and they're facing new care concerns. For the first time, they're exhausted. They can't, they have trouble sleeping. Some of them for the first time, they're gaining weight. They're seeing changes to their hair and skin. So we use that. We use these concerns to sort of engage them in their healthcare. This is a great time to look at what you're doing for your own health and really engage them in meaningful evidence-based things they can do to feel well and do well.

5:20So what are the big skin changes that women are experiencing during perimenopause and menopause?

5:27Dr. Kathleen Jordan, MD: well there's a lot actually so i'd say a common one is dryness right so you get dry skin we see age spots so you see changes in pigment so you're gonna see there's a thing called melasma which is sort of splotchy looking uh pigment changes i've got that you also yeah i know but you know you also see crepey skin which is like loss of collagen skin turgor you actually get skin thinning with age, right? If you think about sort of grandma with, you know, the bruising on her hands, right? That's it at an extreme. So all of these don't happen overnight. It's happening, right, sort of across our mid decades and it's accelerated by the hormone changes of midlife.

6:08Wow. Do you, with this skincare expansion at Midi, do you kind of have a, have a solution for all of those problems somewhere in the lineup?

6:18Dr. Kathleen Jordan, MD: We're committed to meeting these healthcare needs for women. So we have several care solutions for the major ones, but continue to add offerings as we see new evidence and new products and new care gaps. Was the skincare expansion sort of driven by consumer feedback or want or, you know, what sort of feedback do you get from your patients around skincare and body care? Well, we see a lot of loyalty where people, if they start one, they stay on it, right? So So we've gotten a lot of feedback. You know, there was a lot of inquiries about peptides and which ones actually had evidence. So we spent a lot of time deep diving on where the best evidence was, being engaged with experts on that.

7:01Dr. Kathleen Jordan, MD: So, yeah, that was in response to patients inquiring. It also offered an option. We're starting to see patients across a broader age range. We see women, right, in their 20s, 30s, 40s, and 50s that weren't necessarily getting the estrogen-driven changes yet. And the copper peptide is a way to actually, is a way to support their skin health care even prior to hormone changes, right? So we have different needs from different patients, right? And I mentioned we started with Trent Noen, the longest and probably most evidence intervention. But women, the majority of women, and studies will show this too, and it was our experience, is that it's very irritating.

7:40Dr. Kathleen Jordan, MD: So coming up with alternatives in response to that has been really what's been driving the growth of the hair and skin line at Mitty. What are the primary treatments that are sort of prescribed during these sessions? Well, one of the bigger care gaps we saw in these women is that they weren't getting evidence-based advice and current advice on hormone therapy. So we definitely saw that as a huge care gap. A lot has changed since the WHI trial. We use different formulations. We use different dosing. We've had more safety data. We also have more efficacy data. So, and people and clinicians that were trained prior to the WHI trial or only educated on the WHI trial were actually had their patients missing out on some of the newer evidence and newer ways we can use hormone therapy very effectively and safely for women for a lot of their healthcare needs.

8:39Dr. Kathleen Jordan, MD: So many women come in and ask about hormones, right? They know their hormones are changing. They know they have new life challenges and they want to know what they can do about it. Sure. What was the trial that you mentioned? What is that for people who are unfamiliar? There was a very large trial published around the turn of the century. The results were published in 2002. It was called the Women's Health Initiative Study. It actually was a massive trial with many findings, but some of the early data interpretations misinterpreted some safety issues and raised a concern about whether hormones would be related to breast cancer.

9:20Dr. Kathleen Jordan, MD: follow-up is they followed these women they published another study in 2010 2020 that showed no increased mortality from breast cancer we've also had dozens of studies since then that showed that these formulations actually are very safe and estrogen not only does it not cause breast cancer many of the large-scale trials show that it may decrease the risk of breast cancer So there's been a lot of assurance since then. But that nuance was lost and it created a lot of concern, sort of outsized concern, which has largely been put to bed by follow-up research and ongoing data analytics. But that message is still out there and the concern is still out there.

10:01I mean, I remember when the like, quote unquote, black box warning came off of

10:05Dr. Kathleen Jordan, MD: hormone replacement therapies. Was that this year, last year? A lot of women were terrified, right, to approach this kind of healthcare, like, you know, hormones? Yeah, it was long overdue for it to have that label removed. It was actually put on largely in response to the WHI trial kind of data. But we use different formulations now, different dosing, and have a lot of insurances that what was on that label was not actually accurate. So super happy. We were part of the group of women's health clinicians that were really celebrating removal because it was difficult to explain to patients that these are not only safe, but very effective formulations for the things that are concerning them and negatively impacting their lives.

10:52Dr. Kathleen Jordan, MD: And hard to explain why the black box label was really incorrect. So great that that's come off. So happy that that happened. It was years of really lobbying by women's health experts. Well, MidiHealth is in a very, very good position right now. Another stat I got, first midlife-focused women's healthcare company to surpass a billion-dollar valuation earlier this year. These themes that we're talking about, is that sort of why you feel like it's resonating so much? Or I guess the better question is, why do you think that you've had so much success? Why is this resonating with women? Well, I think women needed us.

11:29Dr. Kathleen Jordan, MD: I mean, this is a huge care gap. Like they didn't have anywhere to go to have these informed conversations and answer their questions. It requires a long conversation. There's shortages of trained women's health clinicians, for one. Also, all clinicians are pressured for time. So this care suddenly became really focused and only available through high-end concierge cash-paid practices, because that's where you could take a long time to meet with patients. So what Midi's been able to do with the investor money, which has been fabulous, is really build in efficiencies and ways to transfer information, have these discussions collectively and efficiently, really to make this care be available through regular insurance coverage.

12:17Dr. Kathleen Jordan, MD: And that just opened up the access to swaths of women that otherwise would not have been able to get the care. And it's what I'm really proud of. I shared with you before, I'm a daughter of immigrants. I'm all about access to care for everyone. I do think every woman deserves care and deserves great care and deserves informed care. And that's what the Mitty mission is. Yeah. All right. So we're going to talk about skincare today, which is really exciting. Mitty announced an expansion of the prescription skincare line built specifically for hormonal skin changes. And when we talked before, you refer to it as hormone skincare.

12:53And I have to know, what is hormone skincare and what kind of products?

13:00Dr. Kathleen Jordan, MD: Well, I usually talk about a sort of hormone-informed skincare because that's really what the market's been lacking. So women in midlife go through amazing changes with their hormones, right? I get asked about menopause all the time, but the fact is men do have lowering testosterone about 1 % per year over decades. Women, on the other hand, go through menopause, which is dramatic, huge drops in estrogen and progesterone. And those huge swings will suddenly and actually bring out a lot of different symptoms and changes. And estrogen receptors are not just in our uterus, right? Driving our periods.

13:38Dr. Kathleen Jordan, MD: We have estrogen receptors everywhere. They're in our skin, they're in our joints, you know, they're in our blood vessels, right? So it really, when we see these huge changes, our whole body experiences challenges. And then when I talk about hormone skincare, it doesn't mean that the treatment is hormones. I think what it is, is it's informed by how much these hormone changes and how these hormone changes impact our skin and hair. So when estrogen depletes, we lose collagen, we lose skin turgor. our glands are actually impacted. So some women will get oily skin, you can get black pores, but you also, a vast majority of women will suddenly get dry skin, right?

14:22Dr. Kathleen Jordan, MD: So you see, I call it dry everything, dry hair, dry eyes, dry mouth, dry skin, right? Vaginal dryness, it's all part of menopause. So when women hit these periods of time, right? Midlife, they suddenly need in their skincare regimen, more moisturizing agents, right? And more attention to collagen and skin turdor. So your skincare needs actually change over time and on your hormone evolution. So what sort of, well, I guess that sort of answers my question. So I was going to say sort of, you know, what kind of is driving the strategy behind this? And do you think that it's going to be a big chunk of Midi's business?

15:03Is people, you know, adding on skincare or are they coming to you just for skincare? What is that sort of customer journey or patient journey look like?

15:12Dr. Kathleen Jordan, MD: Well, how we're different than like skincare product companies is we actually see patients, like we saw patients for many years without having products, but what we saw was them struggling to get good products that were actually designed for them. So we see now tens of thousands of women every week and we actually hear from them. We hear their questions. We understand where they're struggling to get products that actually are meaningful. And then in response to the needs that we see, we can develop products that actually help them. So these are prescription level products. What kind of ingredients are in them?

15:50Dr. Kathleen Jordan, MD: Well, if you look at women's skincare, sort of the best evidence over time has always been tretinoin, right? This has been the mainstay of sort of the aging skin approach. It actually helps young. It's also used in teenagers for acne, but for aging skin, decades of evidence, it helps increase collagen. But here's the problem we were seeing, we're prescribing that for women, it causes, it triggers cell turnover. So with cell turnover, it becomes redness, irritation, dryness. So women couldn't use it every day. The majority of women, in fact, get some amount of irritation. So they're looking for other products.

16:26Dr. Kathleen Jordan, MD: Sometimes we still rely on tretinoin a little bit. So we just have them use it maybe every other day, or we package it in ways that isn't a skincare regimen that makes sense for them, right? But they're looking for other skincare solutions as well. Some women just can't tolerate Trentinoans at all. So we really deep dove into what actually works, where is their evidence? And lo and behold, as we've talked about, right, is there are actually hormonal topical care solutions that have been historically used on women's skin with great success, right? So estrogen was put in makeup in the 1950s, right?

17:09Dr. Kathleen Jordan, MD: Because these makeup companies knew that it helped skin, right? As things became more regulated over decades, they had to take it out because they hadn't done the studies. But it goes to show you that we have known for a long time that topical estrogen actually helps skin, right? And we're hormone experts, right? So it makes sense from a sort of functional viewpoint, if estrogen depletion is triggering some of this, does adding estrogen back in help it? And when we looked at this collective studies, it does, right? So topical estrogen products have been shown to increase collagen deposition on biopsy studies.

17:48Dr. Kathleen Jordan, MD: It's been shown to increase skin thickness, skin turker, overall skin health. It's also been shown to help with moisturizing and combating sort of dry, crepey skin, which is what Trentinoin didn't have, right? So Trentinoin generally is good for collagen skin turgor, but it's more of a drying agent and irritating. So it can be good if you have acne in aging skin, but less so if you have sort of dry skin. So we introduced that as a hormone expert and as a company with expertise in hormone changes, we introduced the Estriol-Based Face Cream. So interesting. It's so interesting that used to be in skincare products that were just over the counter.

18:29Do you remember what brands used to have estrogen in their skincare?

18:33Dr. Kathleen Jordan, MD: Oh, there were several. I remember Revlon had it, right? And there's old ads that I'm happy to send you after the podcast, but yeah, several. So fascinating. It wasn't even banned from skincare products until 1993. Wow. Wow. So much has changed in the skincare market. And when you compare prescription compounded skincare, like what you're doing at Midi with something that you can get at the drugstore, it feels like they're not even in the same category. Do you think that skincare should kind of inherently big picture kind of belong to healthcare in a way?

19:13Dr. Kathleen Jordan, MD: well that's sort of a broader question on just sort of the role of a the role of prescribing in health care right there's a lot of telehealth companies that are setting it up to be on demand and for purchasing but the bigger difference the biggest difference between what you find over the counter and what you get a prescription is strength often they have somewhat common methodologies and ingredients right so over the count, I mentioned tretinoin as being the prescription, you can get over the counter retinol, which is really a precursor to tretinoin, right? So think of it as sort of a lower potency, but similar mechanism of action.

19:50Dr. Kathleen Jordan, MD: So it depends on how much you need and how much you can tolerate. For some of my patients where the tretinoin is too strong, I have them switch to an over the counter retinol. But for people wanting to get sort of more of an effect, right, or a prescription product is generally going to be, you're going to get a little bit bigger or better response. Yeah. I mean, I would assume if we're talking about women in midlife, I'm assuming they want something a bit more effective that once they find their way to midi, you know, they've kind of done the rounds in the Sephora's and the Ultas and the drugstores.

20:22Is that sort of what you see with patients' journeys?

20:27Dr. Kathleen Jordan, MD: I see that for sure. So people wanting something more potent and they want what's best for them, right? They deserve it. They deserve it. There's also people that just are lost in the purchasing aisle, right? So if you go to any sort of, there's so many choices at any store. So some of them don't know where to begin. So we often direct them. We also, I mean, we're a care company. So we give advice on how you can approach skincare. We talk a lot about sunscreen. It's an essential part of any skincare regimen, right? So there's a lot we can talk about just on skincare in general. Using moisturizers is important, right?

21:08Dr. Kathleen Jordan, MD: So you need to treat your skin differently as you get into this time of life. And also just telling them like, it's normal. People are wondering if something's wrong because their skincare has changed or their skincare needs have changed. And I think normalizing it helps them sort of take action. And we can share what has helped our other patients and what might help them. That makes a lot of sense. And sometimes it's over the counter and sometimes it's prescription and often it's a combination, right? So your skincare regimen may need a moisturizer that you buy over the counter, but may also benefit longitudinally from a Trentinoin, from an Estriol cream, right?

21:46Dr. Kathleen Jordan, MD: Or you now have the GHK copper topical as well, which offers a slightly different care solution. I wanted to talk to you about that. Copper peptides, I mean, peptides in general right now are just so popular across the health spectrum. Why did you sort of select the copper peptides for this? We selected because it's one of the most evidence-based, right? Peptides is a big category. I mean, peptides includes Wagovi and insulin and things that have gone through FDA approval processes and are well-evidenced that we've been using for decades. And then there's another extreme of peptides which really have only been studied in animals, and we don't even know what they do in humans, right?

22:28Dr. Kathleen Jordan, MD: So there's a wide spectrum when we talk about peptides. But this particular peptide has been used for decades topically. Now, some people are marketing it for use systemically, and I think those studies are not quite there yet. So we, but we do, we have reviewed everything that's been published about its topical use. It's great. It helps with collagen without the irritation you get with trepinoin. And it's actually soothing. So if you're someone who has irritated skin, it can actually help there as well. Wow. You know, I had one experience with copper peptides topical and it made a big difference.

23:04It was very, very effective. And, you know, it was very, very expensive.

23:08Dr. Kathleen Jordan, MD: I'm curious as to sort of the average consumer who, sorry, the average patient who comes in to Mitty, you know, and has their telehealth, how much do they normally will spend for like one product? You know, it varies. And, you know, I don't, I'm not going to impose my, sort of my judgment on what they can or cannot afford or where they spend their money. Sure. But what I can say at Mitty is that we optimize healthcare coverage. So your visit and advice is going to be covered under your insurance, which already opens up access. And then our clinicians are very informed and we actually share the information about how to get things affordably.

23:49Dr. Kathleen Jordan, MD: We have a whole team that does prior authorization. So some skincare products are actually going to be covered by insurance. We'll help you with prior authorizations when they're appropriate. And we tell them up front that some of these are just not covered, right? So some of them are non-formularies. And we talk about sort of affordable and accessible ways to do it. I mean, one of the reasons we bring some of these products in-house is because they're only available with compounding. But with MIDI, because we're compounding similar solutions for many women, the affiliated compounding pharmacy will actually make it more affordable because they're not just making one bottle for one patient, it's more, they can make the price more affordable by actually making 10 bottles for 10 NIDI patients, right?

24:35Sure. Yeah. So what you're saying is it can be pretty affordable.

24:41Dr. Kathleen Jordan, MD: We work at the pharmacy to have them make it as affordable as possible, but we also will lead, I mean, Trenton Owen is available by prescription, so we prescribe that. We also train and have our experts talk about over-the-counter solutions that may be less potent, but may be enough for your care needs, right? So we're a care company. Like, we're there to care for you and inform you and then facilitate easy access to the tools that we see women benefiting from. Yeah. What do you think the runway looks like when you think about MidiHealth in one year, in a few years? Will skincare be a huge part of your business, a huge part of the care that you provide for these women?

25:20Dr. Kathleen Jordan, MD: Well, I think it's part of a holistic care solution. I mean, we do everything from managing your cardiovascular risks to talking about hormone therapy, right, to getting your mammogram done. So cancer screenings and skincare is part of it. Skin is our largest organ. It definitely experiences changes in midlife to our core audience, right? So it will always be part of the holistic care regimen. I think there's also some exciting things coming down the pipe with skincare. care. FDA just approved a new sunscreen for the first time in 25 years, right? Yeah, it's one, yeah, it's one that people have wanted, like women have been saying they have the sunscreen in France because it's already been used in Europe.

26:00Dr. Kathleen Jordan, MD: So that's exciting. I also see, and we hear from women, a lot of women are asking about body care solutions. We've, you know, to date, I think the industry is really focused on face care, right? But body care, we start to get crepey skin, and the dryness is not confined to our face. So I think there's a care gap there that I think that we're gonna see people filling and I'd like to see Mitty filling. So lots happening, lots happening. That's very exciting. There seems to be this blurring line between health and wellness and beauty and everyone's kind of entering different markets. We see wellness companies that are very health focused coming up through beauty and aesthetics And then we see beauty and aesthetic companies that are launching clinical skincare with all of this science vigor.

26:51But if you think about the future, it feels to me like skincare could just end up being part of holistic women's care. And I mean, especially with so much of the skincare market charging so much for so many products that don't even have a fraction of the efficacy behind some of the things that, you know, your clinicians are prescribing. I'm curious, you know, what you think this will all look like for the industry as a whole in a few years.

27:19Dr. Kathleen Jordan, MD: Well, I mean, the beauty of my job at Mitty is that I get to design the care experience for what I would want as a consumer and as a woman, right? So we're a care company. We're an advice company in the end, right? We're giving medical care advice. We also, through telehealth and a lot of technology, can facilitate these things happening, right? We vet and find great compounding pharmacies. So we can also give you that as part of our care advice. So I much prefer that. And I think that's where women really want. They want advice waiting through all that you're talking about. That's a very different experience than other telehealth experiences that are really selling you a product.

28:03Dr. Kathleen Jordan, MD: Their sole goal is to sell your product. And if you don't want that product, they don't tell you where else to go. Sure. So I think we're a care first company and a vice first. And then we learn from those care visits what women are needing and wanting. And then we create care solutions where we see voids. Right. So most of the prescriptions we write are for FDA approved things that you pick up at your pharmacy. Right. So if we're creating a solution, it's because it doesn't exist on the market. Yeah. Well, Dr. Jordan, thanks so much for talking to us. I got one more question for you. You know, looking ahead a couple years, maybe, I know that feels really far nowadays, but what does the future of MIDI look like, you know, when you fast forward?

28:52Dr. Kathleen Jordan, MD: Oh, I want us to be the one-stop shop and holistic care solution for women that really gives care that's informed by the unique experience of women, right? We have mass And it's not just hormone changes. It's reproductive changes. It's mental health challenges, right? So the women's experience is different than the male experience. So I want care that's really driven. I want care that's really best care, informed by the female experience, and really be a one-stop shop and holistic care solution for all women. I love that. Well, Dr. Jordan, congrats on all the success at Midi. And yeah, thanks so much for coming on the show.

29:31Thanks for having me.

29:37And thank you for listening to this episode of the Glossy Beauty Podcast. If you enjoyed it, please leave us a rating and a review on Apple Podcasts, Spotify, or wherever you're listening. And for even more coverage on the beauty industry and more, please visit glossy.co slash beauty.

30:04Thank you.