Welcome back to Truly Expat Podcast. It's Rachel here. I'm just letting, you know, that we have another two-part series. And this is on. Hormones.  We all go through it. And we have engaged Dr. Low to talk about them. Stay tuned. Hope you enjoy it. Thanks. 



Welcome to Truly Expat Podcast. 

Today, we are thrilled to have Dr. Caroline Low, a family physician with a special interest in hormone health and proactive aging for both men and women. Dr. Low brings a wealth of knowledge and expertise to the table, making her the perfect guide to help us navigate the complex world of hormones.

Whether you're dealing with hormonal imbalances, curious about hormones, how they affect your overall perimenopause or menopause journey, or just looking for practical advice, Dr. Low can help.  Thank you so much for joining us today, Dr. Low.  

Welcome.  

 Thank you for having me 

and you can call me Caroline. 

Ah, hello Caroline. 

So tell us a little bit about yourself,  you know, about who you are, what you like, what you do. Um, 

Yes, how, how I got into doing what we call known as proactive aging, otherwise also known as functional medicine, we,  I feel that number one, a lot of medical profession has  stopped  knowing how to doctor patients.

You see, I use the word doctor as a verb and not as a noun. And, and, and given the fast pace of life that we are all having now, the patient walks in with three symptoms, and then you're given three drugs, and then you go away. But I find that's not satisfying for both the doctor and the patient. I find, you know, the patients that come and see me, they have gone through six, seven different doctors, and their first complaint is usually, I'm fatigued, and what doctors usually tell them, well, I'm fatigued to deal with it, life is such, but I think that's not right. 

Because the word fatigue, I can write, you know, three yellow page large for the reason of being fatigued,  ranging from husbands to children to actually what's happening inside you. And, and, and I think we have got to take two steps back patient as well as doctors to evaluate.  every symptoms that the patients come into the clinic for.

And I've always told all my patients that no symptoms are in your head.  A lot of medical professions seem to think that if they can't find there's anything wrong with you, the next thing is you are,  you know, they send you to see a counselor or they send you to see a psychiatrist and then before you know it, you are walking around like a zombie with all the antidepressants. 

Um, I think there's a lot more that we can do. Before you go down there,  so I always tell my patients, no symptoms are in your head or symptoms coming in, uh, that's presented by any patient. They are real. They are real to them.  You may not appreciate it, but they are real. And my job, our job is really to find out why. 

So that's, that's basically how I look at it. And, you know, given my age and the longevity is, Um, your mortality is becoming more and more real  and, um, and, and how I treat my health. I just want to pass it on to my patients.  

So when you say symptoms,

you're saying, does everybody have the same symptoms? 

No, no, but I just want to say every symptom is real.  Depression is real, fatigue is real, brain fog is real, inability to remember what you ate yesterday, but what you could remember three years ago, that's real. All that's real. There's nothing wrong with you.

It's just  the, the, uh, chemical.  The biochemistry has gone a little bit like this as we get older. So the whole idea is how, as a medical profession, um,  how we are able to find out where that, that little, um, uh, what do you call it, um, biochemistry has gone wrong. That's the hard work.  Because that takes time.

Yeah.  

And I mean, um, what is the difference then between perimenopause and menopause and how do you know which stage you're in? 

Yeah. So basically, hormones, when we talk about hormones, every woman and man thinks about estrogen and testosterone.  They're not wrong, but it's only one of the 100 hormones that you have in your system. 

And, um, I have always told my patients that  no hormones ever work independently. I'm sure you've all heard this. Um, I, I always say you are like a dining tabletop supported by multiple legs. That's what I always say. And each leg represents one hormonal organ.  So when you go into menopause or when you go into perimenopausal, one of that dining Table leg has become loose. 

So when that happens then the other legs which represent your thyroid, your adrenals, your insulin, your sleep, your growth hormone, now they all have got to carry that same  tabletop except it's x minus one leg now.  Correct? That make sense?  And that's why when you go into menopause everything seems to go down south, everything seems to fall apart. 

So  To answer your question, what's the difference between perimenopausal, menopause? So when we go through  what we call our sexuality longevity,  which is obviously the female hormone,  between the age of mid 30s to about mid 40s, um, you may have this thing called the luteal insufficiency, otherwise also known as estrogen dominant.

That means  people come in and say, my hormones are out of whack, they are not balanced. That's hormonal imbalance, that's all.  It doesn't mean you're perimenopausal, it certainly doesn't mean you're menopausal.  So, when we say that, then the type of symptoms that patients come in their late 30s, early 40s, usually tend to be the more PMS-y like type of symptoms. 

Hormones are still there, they are all normal, except the ratio between de estrogen and progesterone has changed. Purely because, from the age of 35, the progesterone  dips at a more acute angle comparing to de estrogen. So the progesterone falls faster than de estrogen. So between the age of 35 and 45, you have hormonal imbalance, the word is hormonal imbalance, um, because they're still normal, but the ratio has gone out of whack. 

So after the age of 45 ish,  Then the estrogen starts due  as well. That's when the word perimenopause.  And if you're in your late forties, early fifties, the word menopause.  Now these two words are used interchangeably because at the end of the day it is. But a textbook definition,  we are not textbook. You know, it, it's, it's not.

Yesterday I was perimenopause. Today I am man, meno pausing. It's, it's, um, it's a very slow gray slip.  You never fall off the cliff until the word menopause hits you. When the meno, the word menopause hits you, then you fall off the cliff. But, oh, menopause is only bad. Like I said, one textbook definition, Louise's  a one line definition. 

See, people don't think of it like that. They, they tend to compartmentalize, um, male and females, whether you are perimenopause or menopause or menopause ing. I think I look at it as it is a journey.  It's a journey. You are on a slide, you know, like a roller coaster slide and it's eventually it's going down But there would be the ups and downs, but it's never going to be off the cliff So the only time you actually fall off the cliff is on the day itself when you have 366 Days,  excluding the leap year  where you have no menstruation.

So it's one calendar year of no menses. That's why I say the word menopause is but a textbook  definition.  So menopause means one calendar year plus a day of no menses.  That's all it means. So, you know, the word, whether I am menopause is only to tell people that you've just stopped, stopped menstruating one year and one day,  but you can still be menopausing. 

The symptoms of menopause,  God can go on for years  after you stop menstruating.  Oh, great.  . So, you know, so, so, so the word perimenopause, menopause. Menopause, it's.  It's only labeling.  Yeah. But I like to think that it is a journey.  

Yeah. 

It's a journey in one's lifespan whereby we don't like, you know, falling off a cliff too much.

We like a little gentle slope going down and my job is to guide. you  

My job is just to guide you, make things logical, make things understandable. So when we give you programs to do, the compliancy is there. Nothing is worse than I, you know, the doctor say, I talk, you listen, and this is what it's going to be.

But. You have to remember that 8 billion people in this world, half of them are female, and out of those half,  50 percent are adults. That is somewhat perimenopausal, menopausal, post menopausal, whatever. So you're going to get two billion different combinations of things because we are all an individual. 

And that's why I said functional medicine is when we treat you as an individual.  And the other thing for us to note is, yes, we need blood tests.  We need some sort of testing to put you in some sort of category.  Your like  or your love for a certain part of the range is very different.  I can have twins  coming together, do the blood test, and they both have identical numbers.

But one,  

hot flushing away, the blues,  

low sexual libido.  The other one, identical numbers, lady that are happy, happy as a lark, everything seems to be doing fine, full of confidence, hasn't put on an ounce, love sex. How do you explain that? Well,  it's just that you don't like your numbers.  So remember, we never put a patient in the number, we put the numbers in you. 

Make sense?  

Yeah, so the only way you can find out whether or not you're actually in menopause or perimenopause  is by a blood test? Yes. 

Well, you can do a few things. In Singapore, it's by a blood test.  Um, you can also do it by saliva testing. You can also do it by urine testing. Um. Um. But the most common one that is used in Singapore is a blood test.

I hope that makes a bit of sense about an introduction to 

what are the symptoms? What are some, I know you said that, that it's all, the symptoms aren't the same, and I know that you mentioned that.

There were certain symptoms like, uh, brain fog and,  you know, I've forgotten all the other 

things, because I have brain fog right now. 

But what are some other symptoms that 

you  

can be looking 

for? 

So, um, everyone's symptoms is going to be different, and really, Menopausal or perimenopausal symptoms can be as thick as three yellow pages.  Um, but the most common ones are hot flush,  hot flushing. And let me elaborate this thing about hot flushing.

The word hot flush, it's very personal. And hot flush doesn't mean you will stop. When you stop menstruating,  I am 58, I still get hot flush occasionally. So hot flush is, I call it seasonal. You get bad days, you get good days. And it's all to do with the expansion of your vascular supply.  Responding to this,  um, hormone called luteinizing hormone.

So alcohol can increase hot flush. Weather can increase hot flush. Dress can increase hot flush. Um, hot flush because it increases the vascular expansion, so you get rid of the heat and that's why you feel hot.  So that's, that's hot flush. That's the most common. The second thing that people always say is not so much.

Not able to go into sleep, but the waking up at 2 o'clock every night. 

Yeah, 

you can tell 340 you know 330 you wake up. You don't have to look at the alarm clock You know, it's the same time now whether you can go back to sleep almost immediately or you  Once the brain starts going and you sit there till five o'clock and then you fall back to bed and before you know it the kids wake you up at six and it's a bloody nightmare. 

So, that is the second thing that people tend to complain is that disturbed sleep.  

Can I, um, ask,  because,  oh, sorry. Um, so,  my husband does,  Have that thing as well that he wakes up at 3. 30. I wonder is that part of andropause? Yes, 

yes, so this is one thing  that people forget. They think andropause and menopause are very different.

No, they're not. They're very much alike. I have had men coming in to me with hot flush,  hot flush, and nothing else.  Yes. So,  that's something that, you know, a man and woman, why are we different? You must understand that from the age of 12 or 14 years old, we totally understand menopausing because our mothers are undergoing it. 

And we know what it's like to be PMS y, because, you know, we're all undergoing it.  And when you get four women coming together,  In the early fifties, what do they talk about? Hot flush, can't sleep, and low sexual libido.  So a lot of women go, Oh, you know, I pretend to sleep so my husband doesn't come to me at night.

I mean, it's, it's, we talk about it. We talk, we, we all talk about it and we laugh about it. And it's part of our sort of lunch group that we all talk about it.  Yeah. Men, you get four men coming together.  What do they talk about?  They talk about their career. They talk about how much muscles they have. I mean, it's, it's, it's, it's also a gender thing, but the fact is because they are never exposed to it.

Their father never talked to them about the word andropause. They don't even know that it exists. Whereas our moms, we see our mom going through and, you know, everyone at home going, Oh God, she's menopausing. Yeah, leave her alone. Right, so, so, it's instilled in us that it is going to happen,  and we know so much about it, for better or for worse, correct information or not, but it's all out there.

Where else the word male menopause or anthroposystem is spoken about? So a lot of men do not understand. That they can get hot flush. They go into the blues. They do. They suffer low, flat moods and they also have mood swing  and with mood swing, which they don't understand, it goes into anger management. 

They have anger problem.  Yeah. So it's not very cantankerous,  but the worst thing about them is that they don't understand why this is happening.  And because it's not talked about, they don't get the help. That is really out there.  And that's why I said a man. Yeah. Yeah. Sorry.  

Sorry. Is that when they go out and buy Maserati?

Oh, you want me to go down that road? 

No, I, you know, when I give public lecture, I try to break the mood. I make it sort of find a bit of. Comedy. I tell, I tell my, you know, the, the public, uh, when I do a public lecture, I said, you know, a man, when he's under pausing, he goes out and buy himself a Harley Davidson. Um, he goes out and buy himself, you know, a beautiful car or he changed the model of the wife. 

Yeah. Which is a fact, which is a fact,  but I'm not saying that they are, I'm not saying that, you know, they it's all their fault, but it's because  they have no one to talk. They don't really know what's going on in their life.  Yeah. Yeah. And that is why I always say when I see a lady who's menopausal or especially if I see a man who's menopausal, I like to see the couple  separately, of course, but they should be treated together so that they understand the symptoms and the change of behavior.

And because what do we want at the end of the day when we are both 75 years old? All you want really is to walk down the sunset together.  That's pretty much what we want. Absolutely. Absolutely. But it is between the age of 50 and 60 when there's so much change in your  hormones, uh, mentally, physically, spiritually, there is a lot of diversion  because you don't understand each other. 

So, you know, as a functional practitioner, you end up being a counselor at the same time.  

Yeah,  because I heard a fact, um, I don't know the exact statistics, but, um, last year I read somewhere where they were saying that majority of, um, women that go through divorce go in, go through divorce or separate in their fifties. 

And I know why 

that is? You see, the thing I like about, the reason why I like about hormones is hormones control our character. It gives us character, for better or for worse, and it makes us what we are. So, just to give you an example, and you just go down to your regular supermarket, you just watch, or you just go down to the shopping mall and you watch, two 35 year old couple, man and woman, both in their 30s, a man raging testosterone, a woman raging estrogen, you know, and if you watch them as they're shopping for furniture or whatever, the woman is always half a step behind the man.

And a bit clingy,  you know, and all she wants is she must have date night once a week, must have date night, the boy, you know, the, the, the, the spouse or the boyfriend can't wait to go out and hang out with the boys. It's, it's, it's, I know it typifies a relationship, but if you just go out and watch, it's kind of a little bit like this.

Now, the interesting part is that same couple.  You fast forward, they are both now 55 years old.  The woman is now half a foot in front of her partner.  A woman tends to walk in front of her partner.  A man tends to walk a little bit behind. And this is when  the woman now, all she wants to do is hang out with her girlfriends.

She wants to go on girly trips. She wants to go and, you know, do things with her girlfriends. And, and, and it's the husband or the partner now asking, What time are you going to be home?  And if you're half an hour late, you know, they'll send you a text.  And, and this is, this is by sheer observation. And the reason why is because  when you are both 35, your estrogen is 10 times more than his.

He has estrogen. Likewise, we have testosterone.  Fast forward 20, 20 years down the line, you're both 55. Do you know that he has got more estrogen than you  as a woman?  

I didn't know 

that. Yeah. And usually he has got two to three times the amount of estrogen comparing to a woman. And that is why, like you said, women in their fifties tend to get a bit short.

And if they're going to divorce, it's usually around this time because the only thing left in their system is  The male hormones.  Testosterone.  

Ok. 

Yeah. 

So interesting. And while we're talking about It's interesting 

and that's why I love the hormone work. This is the way our body is going to be. This is the way the amount of hormones that we have. We have to make the best of it. With our partner. 

Yeah. Yeah. No. Really? Yeah. We have to understand those things. Like, like you said.  

Um, 

 📍 so can, um, we often talk with our friends about an estrogen belt. Do men get that as well? 



That's all. We have time for., next week where we'll have the answer to your question  about estrogen belts.  And do men get them.

 Have a great week. See you next week.