In this episode, Coach Erik sits down with Viking Athletics members Kayse and Amber Barry to discuss their new business, Eminence Hormone and Weight Loss Center. They discuss Kayse’s and Ambers’ backgrounds in medicine, what led to this business venture, treatments offered, and who might be a good candidate. Don’t feel like listening? You can read the transcript below the video.

Chapters:

00:00 Introduction
01:08 Amber & Kayse Medical Background
05:00 Perimenopausal Treatment
19:30 Testosterone Replacement Therapy
30:51 Ozempic and GLP-1’s

Transcript:

Erik: Welcome to Skol Sessions, the Viking Athletics podcast where strength meets smarts. I am your host, Erik Castiglione, owner and head coach of Viking Athletics. And today I am joined by Casey and Amber Barry, who just opened Eminence Hormone and Weight Loss Center. Welcome ladies.

Kayse & Amber: Thank you.

Erik: Coincidentally, they also happen to live up the street from me. So this was very easy to organize, thankfully.

Amber: Easy commute. Thanks.

Erik: Yes. So today we’re going to be discussing their background in medicine, what led them to open their newest center. And we’re going to delve into the services provided, who would be a good candidate and other interventions that should be done in conjunction or maybe prior to starting any kind of hormone treatment. Thanks for coming on. Skol!

Kayse and Amber:  Skol!

Erik: All right. So before we dive into the services that you ladies provide, just kind of wanted to get into your background in medicine, what got you into it, where you’re coming from and what prompted you to open the center in the first place.

Amber: I’ll go first. So my name is Amber. My background, actually my undergrad is in exercise science. I went to Texas A&M and then I wanted to actually get into fitness, that world, and then got geared towards a cardiology internship, which ultimately evolved into going to PA school.

Since PA school, I’ve died in critical care. I did cardiology for about five years, but I work in critical care now. So I’m actually at the Hospital of Central Connecticut in New Britain. I do surgery there, trauma, critical care, and some medical critical care.

Erik: Cool. So you got into medicine through the fitness avenue.

Amber: Exactly.

Kayse Hi, everyone. I’m Kaysey. Thanks for having us, Erik, by the way. So I don’t know exactly what got me into medicine. As a kid, I would sneak into the family office and read the medical encyclopedias and was just always fascinated with it.

So just knew one avenue or another, it would be medicine for the rest of my life. And then it was deciding between PA or medical school. And I chose the PA route, which has been very rewarding. And I as well do critical care medicine.

So I work in a medical intensive care unit for the last several years where we treat patients oftentimes at the end stages of their chronic illnesses. So needless to say, we’re very passionate about now opening up this center, where we actually help patients start their journey to become a healthier version of themselves, whether it be get on hormone replacement therapy, drop, you know, 20 pounds, whatever their goal is, we guide them towards nutrition, working out, whatever that may be to ultimately keep them out of the hospital and out of getting in the health care loop of needing hospitalizations, living their life indoors instead of outdoors with fulfillment and functionality.

Erik: Medical encyclopedia – that’s a little bit of a light reading there.

Kayse:  It was at the time of, you know, I’m going to age myself, but when Doogie Hauser was out, so, you know.

Erik:  So would it be fair to say then that one of the driving factors for opening the center is because you deal with people towards the end of care you wanted to intervene earlier?

Kayse: One hundred percent. and it was kind of multi-factorial, a lot had to do with that and both Amber and I have both in our personal lives have women or know women, or you know our mothers for us for instance have gone through menopause, and suffered and not been able to get the treatment that they need and so that was the majority of the passion behind opening up the center.

Erik: So the menopausal aspect is what drove you to open and you focused on men’s health and weight loss as well because it’s all kind of encompassed under hormone replacement.

Kayse: Absolutely.

Erik: Awesome. Perfect segue. Let’s talk about some of the services that you offer and kind of who might be a candidate so as I told you guys before why don’t we start with menopausal treatment since that’s one area where I definitely don’t have a lot of experience, and we certainly, you know at Viking Athletics we have a lot of women that have either gone through it or are right about that age.

So who would be, what is perimenopausal treatment and who might be a good candidate for it?

Amber: Ingeneral just kind of defined it perimenopause is the period of time before menopause and then menopause is an exact date where it’s 12 months after your last menopause

Kayse: Period.

Amber: Your last period. And then you go into post-menopause. So the women really in any point during this time are candidates for hormone treatment. People usually come to us for vasomotor symptoms, so women that are having you know the typical hot flashes, insomnia, joint pains.

There’s a multitude of symptoms that women start having during this time and a lot of times they don’t even attribute it to being in this menopausal period. But you know it’s something that unfortunately you know I don’t I can’t remember when the Women’s Health Initiative 20-something years ago was.

It kind of put hormone treatment on the map for being something at very high risk for breast cancer. And a lot of research has come out since then that’s really shown that the quote-unquote lessons learned during that point in time weren’t very accurate and that hormones are much more safe than, kind of the message, I don’t want to say misleading but looking back at the data, and Kayse can kind of help me a little bit more, with that really said. So the women that are candidates, really I mean most women are.

Kayse:100% of women will go through menopause of course so so yeah so it’s not only the vasomotor symptoms that we’re worried about it’s with menopause women, women while they have their full on estrogen have a cardio protective effect from it that’s oftentimes why you’ll hear that men will have heart attacks at an earlier age than women do.

Once women go through menopause they lose that protective effect so so you know there’s the hot flashes are the most annoying thing that’s often what compels women to seek treatment but where we step in is try to provide an overall education to them that you know by repleting the estrogen you will have protected protective cardiovascular benefits osteoporosis benefits.

Amber: Yeah, those are the big ones. Because women, just relating it back to what we do and kind of the trajectory for where women are right now, I do trauma critical care and we see a lot of falls from frailty and from osteoporosis, they get osteoporotic fractures and hormone health, you know, these women could have been started on treatment and had the ability to abstain from the progressive effects of osteoporosis, osteopenia.

And you know, we really try to educate women, not only with the hormones, but doing it in conjunction with, you know, resistance training and strength building. And then the other component to that being the cardiovascular effects, it really, our coronary arteries are protected by estrogen whenever we’re younger.

And then as we age, as we lose the estrogen, we lose the component, the nitric oxide within the vessels that dilates those. So, you know, that’s a big, a big reason why we look at these women that come in that could have been started on this.

And I’m not saying that it would completely alleviate the burden that they’ve sustained, but it definitely is something that could help, you know, in conjunction with a lifestyle change.

Kayse: In addition to just the obvious health benefits, we oftentimes see women that come in, they’re going to the gym, they’re not getting the results that they think they should be, they’re not putting on muscle, they’ve accumulated belly fat, and they’re in their forties.

So as women in our forties, our testosterone levels oftentimes are half what they were in our twenties. So that’s something we look at as well. We get a lot of women saying that their gym performance just isn’t where they like it to be at.

Erik: Yeah, we definitely have. experience with that, the accumulation of belly fat. And one thing I didn’t want to circle back to, you mentioned that for a while hormone treatment was, did you say it was considered to increase the risk of breast cancer? That was the misconception for a while?

Kayse: Yeah.

Erik: Okay. So to clarify, there is no additional risk of breast cancer. All right. I wanted to hammer that.

Kayse: This comes just briefly. This comes from a study that was done back in 2002 called the Women’s Health Initiative. Basically the results were misinterpreted and the media blew it up that estrogen causes cancer. So we actually, people in med school, PA school, that’s actually what we learned was that hormones are going to cause cancer, so stay away from them.

Amber: Yeah.

Kayse: So experts the past few years have gone back over the results of that study and have debunked a lot of it and are now coming forward, just talking about the errors that were made. And actually estrogen alone was found to decrease the risk of breast cancer. But yeah, so when we see a woman in consultation, we go through all this. A lot of times women are still questioning this and they want to feel safe. But it’s something we go over during the consult.

Erik: Yeah, there’s a lot of that. I harp on that frequently. Media misreporting results or seizing on, if you actually read the studies, there’s a lot of cases in which the conclusion is not supported by the data or people with agendas end up pushing things.

I don’t want to go down the road of claiming corruption, but a lot of times people have confirmation bias and they see what they want to see. And yeah, or the media absolutely does a poor job of representing things.

So I, we’re big into education here at Viking Athletics. That’s one of the things that we push is how do we eradicate these misconceptions about a lot of things, whether it’s youth training and, you know, stunting of growth.

And, you know, certainly we’ll delve into that with, when we get to the TRT aspect of it. But can you talk a little bit more about testosterone levels in women? Is that something that you supplement as well in addition to the estrogen? So what would typical menopausal treatment look like in terms of hormone replacement therapy?

Kayse: So typical treatment would be, like I said before, we’d sit a patient down, kind of go over everything, what her symptoms may be. Sometimes women are just complaining of vaginal dryness. That’s really all they’re worried about. So we have treatment for that.

If they do have the brain fog, the, you know, vasomotor symptoms, which are the hot flashes, sometimes they have memory issues and fatigue, irritability, joint pain, moodiness, depression. The list goes on and on. It’s actually really rather compelling when all is affected by menopause. So if that’s the case, then we go into estrogen replacement. And if they still have a uterus, it’s imperative to start progesterone along with the estrogen.

And we don’t, I will spare you the details of all that. So basic menopause treatment would be systemic estrogen progesterone plus or minus testosterone. If the libido is really low, their energy is low, they’re not seeing the results of the gym, they’re trying to put on muscle, just can’t do it, we’ll go ahead and check the testosterone levels and quite often they’re about half of what they do. should be. So at that point, we usually prescribe a cream or daily cream and slowly bring that level up.

With our male patients, we do injections. We try to avoid that with the females and just do the cream and that is to avoid super therapeutic levels or really shooting up way too high. And so the side effects of shooting up way too high with testosterone levels and women can cause deepening of the voice, hair growth, hair loss, oily skin, stuff like that.

So this is something we monitor very closely and start a low dose cream and work our way up from there.

Erik: So they will not turn into the bodybuilding females. That was actually gonna be my next question is the list of symptoms that you just gave for kind of low T for females. That’s largely the same that you would see with men with low T?

Kayse: Oh, yeah, absolutely. Absolutely.

Erik: And what I know you mentioned testosterone cream, what form does treatment take for estrogen and progesterone? Is that orally? Is that injections? What does that look like?

Kayse: So there is oral estrogen. We prefer to use a transdermal estrogen or an estrogen patch. It tends to be a little bit safer. So the again, this is very the boring medical details of it that oral estrogen gets metabolized by the liver and there’s a tiny increased risk for blood clots with the oral estrogen.

So we prefer to, our first line is an estrogen transdermal patch that stays on a week. They can either keep it on a week or there’s one that they can change out every three and a half days or so. And then the progesterone is just an oral pill that they take nightly.

A lot of women, I guess I left out, a lot of women have trouble sleeping. Almost every single woman we see has trouble sleeping in the perimenopause, the menopause. phase. And so the progesterone really helps with that. Gives them a good night’s sleep, usually.

Erik: Highly underrated.

Kayse: Yeah, 100 percent. I will say that a little side story. Before we really jumped into doing this ourselves, I used to get calls from my mother-in-law that just started hormone replacement. She started some testosterone. I actually don’t know if she’s on estrogen.

Amber: Yeah, I think she’s on, yeah, testosterone.

Kayse: She was having a great time. She noticed a huge change in her libido, and I was getting way more details. And I ever wanted to know about this woman. But she was so happy. She was a totally new woman. And, you know, honestly, that’s kind of what opened our eyes. Like, wow, this can really help people’s lives. Yeah, it can really help people.

Amber: Yeah, she was in a place. This is my mother. So that’s why I told her to call my wife and talk to her instead of me. But she went through menopause pretty hard for about a decade, and nobody treated her.

I mean, she didn’t know to ask for treatment. Nobody offered it, but she had done really well all her luck. I wouldn’t say well, she’s part of that age generation that doesn’t want to lift weights because they’ll be bulking immediately.

They, you know, yo-yo diet. Don’t eat. Don’t eat for their diet. But anyways, nonetheless, she had had weight. Her weight was, you know, her BMI was fine. She probably didn’t have much muscle. And then went through menopause and gained weight.

And then just couldn’t, I mean, she was sleeping like two or three hours for years and I, like, I don’t know how she did it. And she has a pretty demanding job. So I was really worried. You know, she started having these weird, almost like systemic inflammatory symptoms.

She would have these, like, issues with her eyes. They would become injuncted. She was just complaining of a lot of joint pain and then when she was I guess 60 got put on testosterone and estrogen and then like out of nowhere just you know, those symptoms seem to alleviate and then yeah, her libido went off the chart, so

Erik: Yeah, it’s always fun when your parents talk to you about that.

Kayse: Yeah.

Amber: Yeah, yeah, it’s been great. I see a therapist often.

Erik: You mentioned that orally if you’re taking estrogen it can cause clots in the liver.

Kayse: Actually, this is systemic blood clots like clots in the legs

Amber: Yeah, it’s It’s metabolized through, so if you’re taking it orally, it’s metabolized, it’s first passed through the liver.

Erik: So that was one of the concerns, and I think this is a good segue to talk about TRT. Obviously, a lot of men seem to think that if they go on TRT, they’re going to feel superhuman like they would if they were on anabolic steroids.

But that is one of the concerns with taking anabolic orally, is that it is also processed through the liver, and that is the only way that it can lead to liver failure, is through taking them orally.

But yes, segueing to TRT, I know I’ve told you both about a couple experiences I’ve had with clients who were either interested in or on TRT. What is testosterone replacement therapy? Who might be a good candidate for it, and what can you expect if you’re on it?

Kayse: Yeah, so a lot of guys… So first off, a lot of people associate aging with a decline in men’s testosterone. It’s really not necessarily the case. It’s more so of lifestyle factors that cause guys to have a decline in their testosterone, and that’s such as sleep apnea, obesity, diabetes, just chronic illness in general, alcoholism…

Erik: Cheers!

Kayse: Cheers! Guys that may have chronic back pain, taking daily opiates, things of that nature can decline the testosterone. Symptoms of low testosterone in guys is similar to that of women. They’ll see a decline in their energy, their libido, less ambition, not getting results at the gym, not putting on the muscle despite, you know… everything they’re trying to do at the gym.

So we take those guys to come in, we do a full-on consult, we get their medical history, we discuss the risks and benefits of TRT.

Erik: What might the risks be?

Kayse: So there was a recent study that just came out, it’s called the Traverse Study. So there’s been a lot of back and forth over the last several years on whether it’s safe from a cardiovascular standpoint to be on TRT.

So this Traverse Study came out and actually showed that their… let’s see, let me go to my notes here… bourbon’s kicking in a little bit. Okay, so the Traverse Study was a randomized double-blind placebo controlled study. So this is very legit, guys.

Erik: Gold standard.

Kayse: Exactly. So it evaluated the cardiovascular safety and efficacy of TRT in men with hypogonadism. And what they found was TRT did not increase the risk of major adverse cardiovascular events as compared to placebo.

What should be said, though, however, is there was a slight increase risk of developing atrial fibrillation. And that, when I say slight, I mean 3.5% versus 2.4% in placebo. There was also a slight risk of pulmonary embolism, which is a blood clot that often starts in the legs and travels to the lungs.

Erik: My father had one.

Kayse: Oh, really?

Erik: Yeah, that was actually before he started at the gym. It was one of the reasons he was reluctant was getting out of breath, kind of triggered PTSD for him.

Kayse: Oh, wow, yeah. So the pulmonary embolism, 0.9% on TRT. compared to 0.5 in the placebo group. So very small increased risk, nonetheless, this is a risk, which makes it very important that if you’re gonna go on this stuff that you be managed and closely followed by a provider.

I know there’s a lot of these online companies that are making it really convenient for TRT, but guys really should be followed up. The blood clot risk possibly is due to what’s called erythrocytosis.

That just means increase in the red blood cell count. So that’s something we watch closely. We do labs initially, and then we trend labs every few weeks to start and then kind of spread that out. But so it’s not to say that it doesn’t have its risks.

So the guys, when they come in, we do the consult, we talk about the risks and the benefits. Of course, it’s patient’s choice. Their life is really being affected by all this. And a lot of guys do think that the benefits outweigh the risks and they go for it.

And what we’re seeing is they have improvement in their energy, their ambition.

Amber: Happier wives.

Kayse: Which is the most important thing. But yeah, their sex lives are happier.

Erik: So what does, you said it needs to be closely monitored, obviously for both menopausal treatment and TRT. How often are you checking in with clients and what does that kind of oversight look like?

Kayse: So it kind of depends. It’s very individualized. A lot of the menopausal patients that we have also complain of weight gain.

So we offer a kind of life. lifestyle guidance. We give them pointers on their nutrition, their exercise. So with that being said, I like to check in on them every couple of weeks for a while, just see how they’re doing, whether it’s through a text or a phone call.

We do like to keep track of these people pretty closely. A lot of them do need support and kind of initially to be told, it sounds funny, to be told what to do.

Amber: I mean, just they have a lot of questions.

Erik: That’s what coaching is, really.

Amber: Yeah, yeah. We try to be available for them directly. They have our business number and we’re pretty available for questions and concerns.

Kayse: Kind of turns into concierge of medicine at that point, but that’s what we feel like our patients deserve.

Yeah, as far as the lab work with the testosterone, from day one of the start, we like to check levels six weeks later. If we have to make an adjustment, we’ll check levels again in six weeks. We get them to a place where you’re kind of at a good level, stable, feeling good, then we’ll start spreading it out every three to six months, follow up, basically.

Erik: So you said with females, topical cream, with men, it’s an injection?

Kayse: Men, it’s a weekly injection.

Erik: And what would constitute a level that’s too high? Or what we would like to call in the fitness industry, TRT plus.

Kayse: TRT plus. So yeah, a level too high with the guys. We’d probably shoot for a level, maybe 700- 800. So if we really shot several hundred over that, we would adjust the dose and recheck.

Erik: The healthy level is considered what, 300 to a thousand? Is that the healthy range?

Kayse: You know about that, a lot of guys are coming in though and they have a level at about 500, 400, and they’ve got all the symptoms. So we treat about 550 is our cut off.

550 and below, we’ll go ahead and treat. So 300 was this number that was thought to have been made up, yeah. Made up for, you can get insurance coverage if you’re below 300, which is really hard to do.

Erik: So that’s probably from insurance is where that came from.

Kayse: Exactly, yeah.

Erik: So my understanding of the subject is it’s not just the levels, it’s also how receptive you are to androgens. So you could theoretically have low testosterone levels but be absorbing all of that.

So if you have low levels, but you’re not symptomatic, it’s not really an issue. I had the question from a member the other day, is there a way to test for androgen sensitivity or is that largely based on symptoms?

Kayse: It’s largely based on symptoms.

Erik: Yeah, I was just curious. I know I’ve talked to various male members who’ve had levels kind of all over the place and the story I related to you guys, was a former member that was at 293 and I know that alcohol consumption and lack of training is a big issue there.

So yeah, at what point do you start treating versus recommending lifestyle changes?

Kayse: It’s really dependent on the guy, actually. I just had a patient a couple of weeks ago that his level, let me say it was about 400, he has all the symptoms and he elected to try the lifestyle changes first.

So he’s gonna come back probably in a couple more weeks, we’ll check his levels again and go from there. But yeah, no, it’s definitely an option. Hit the gym, clean up your nutrition, give it a few months, recheck your levels.

Erik: So how often, whether you’re treating someone or checking on a prospective client, are you checking levels?

Kayse: So, so day one, we’ll check the- level. If we start treatment say the next day we’ll check the levels again in six weeks.

If we have to make an adjustment we’ll check it again in six weeks. If we do not have to make an adjustment we’ll spread that out to maybe a three-month follow-up.

Erik: Yeah makes sense. Yeah the I know the example I gave you guys was a client that was on what we call TRT Plus and we were in the tail end of a nutrition challenge. They weren’t happy with their results and a week later they came back and had gained about a pound of muscle and lost 2% body fat in a week. So very clearly their TRT their testosterone dosage went up.

My coach was quite confused I had to I had to explain that. It’s like it’s nothing you’re doing. It’s not additional compliance to the recommendations. This is what happened. So yeah you get some great benefits with testosterone and that was why I was always curious about TRT Plus.

I know there are some people that think it will make you superhuman and kind of give you all the benefits of anabolics and my understanding again is at that point if you’re trying to jack up your levels to that height you might as well go on anabolic because the risk factors are largely the same but you get better benefits that way.

I don’t know if you ladies have any experience with anabolic versus straight TRT or if that’s well beyond your scope I wouldn’t be surprised as medical providers.

Kayse: Yeah we try to stay away from that.

Amber: Any supraphysiologica; levels in general and medicine aren’t recommended.

Erik: Fair enough. Beyond my scope as well.

Amber: Every medicine has a risk-benefit profile so we kind of you know take an oath that we only provide a medicine if the risk, if the benefit profile outweighs the risk. So, yeah.

Erik: Awesome. Glad to hear it. Speaking of which, I know Ozempic and other GLP-1’s are all the rage right now and I haven’t seen a whole lot of coverage on side effects and what might be negative there, but very clearly it is, well, given what your oath is and the fact that it is now the CDC’s recommended intervention for childhood obesity, I imagine that there’s got to be a lot of benefit for that. So, let’s dive into that topic.

You know, who might be a candidate for that type of treatment? What does that involve and what are some of the risk factors there?

Amber: So, the medications that you’re referring to, so the GLP-1’s are, those are glucagon-like peptides, and then the GIPs are glucose-dependent insulinotropic polypeptides, and basically these are incretin hormones and they are endogenous to our own system.

So, they’re, you know, when you, it’s a postprandial hormone that’s secreted from your bowel in regulation to the food that you just ate basically. So, the GLP-1’s are released, I think, in the upper portion of the bowel and then not that it really matters all that extensively, well, I guess they’re actually the lower portion and then the GIPs are secreted from the upper portion, but they have receptors throughout the body.

So, they have receptors in the brain, which affects satiety, they, you know, the GLP-1’s specifically decrease gastric motility. And then they affect the pancreas by increasing insulin secretion. So effectively lowering circulating glucose.

Erik: So to put all that in layman’s terms, as much as I personally love the jargon, no, that’s fine. That’s why I do the same thing a little bit. Trust me, I’m a former engineer. I get it. In layman’s terms, we produce all these hormones naturally and they are created after we eat food and they deal with making us feel full and preventing further digestion.

Amber: Correct, yeah.

Erik: Is that part of the reason that when people are on Ozempic, they feel full or they feel like, I know in some cases, it greatly affects their digestion, they either have the runs or they feel nauseous all the time.

Kayse: Not so much all the time, that is a definite common complaint, but it usually subsides within, I don’t know, a day or two. Yeah. It’s not something they’re walking around with daily feeling nauseous.

Erik: Okay.

Amber: If it’s persistent, you definitely need to talk to your provider who’s prescribing it.

Erik: Try to lower the dosage.

Amber: Yeah, exactly. Lower the dosage and you shouldn’t be having pains from these medications.

Erik: That was I’ve been following this for a bit now in Ozempic is what fourth or fifth generation in terms of GLP-1’s? Like the product itself?

Amber: Semaglutide was I can’t let the first generation start with an L.

I can’t remember the name of it, but it. came around, I don’t know, was it 15 years ago? And it was made for diabetics. So in diabetics, those hormones are decreased or it’s not as sensitive. So they were initially, you know, that first product was for diabetics.

And then they, you know, subsequently evolved and they started noticing the weight loss secondarily to that, so I’m not sure if it’s a fourth generation or not exactly.

Erik: But it’s been improved upon?

Amber: Yeah, exactly, it’s been evolved.

Erik: So my understanding is that from people I’ve talked to, the dosage seems, and again, I have no medical training whatsoever, but it seems like the dosage has been incredibly high initially, so would it be worth talking to your provider about possibly titrating the dose?

Kayse: Yeah, what we do at Eminence is we start patients at the very lowest dose, of course. So if you come in, you get started on semaglutide, day one, we’re gonna call you one week following, see how you’re doing, see how you’re tolerating it.

Common symptoms are the GI symptoms, the nausea, vomiting, constipation, diarrhea. I say they’re common, but I’ll be honest, I’ve really only heard of the nausea and vomiting out of all my patients so far, so I don’t really know how common the runs and.

Erik: Perhaps your dosage is lower than what other doctors recommend.

Kayse: Yeah, possibly,

Amber: We’re conservative.

Kayse: I don’t know what other providers are doing, but maybe they’re just starting at a different dose, but less is more in my book. So we tend to start patients at the very lowest dose, see how they’re tolerating it and go from there.

If they’re nauseous or having any GI side effects at the end of their fourth dose, we certainly won’t increase the dose. We’ll either taper back or just hold them at that lowest dose for another four weeks, basically.

Erik: And questions I’ve gotten on the subject, is this, obviously if you’re a type one diabetic, you’re pretty much on insulin the rest of your life. Is this a lifelong intervention? Is it designed to just help people lose weight initially? What are we looking at in terms of treatment timeline here?

Amber: So the studies. show that you basically get a plateau effect at about 68 weeks with these meds. There, you know, we’ve mentioned the GI side effects, but one of the other big concerns that we are very aware and try to mitigate is the muscle loss or sarcopenia associated with them.

So, you know, there’s… I think that’s probably the biggest concern for a lot of people and I guess my response to that is you know people who are obese their risk profile is increased for pretty much everything I mean with the exception of maybe osteoporosis at that point so really our motivation is to use these medications to get to a point to where you have had weight loss enough to make yourself hopefully more motivated to you know work out.

Start resistance training you’re not so timid to go to the gym or you know you just you’ve seen a lot of people are in the gym and they need to see that little bit of change to really propel them into like sticking with a routine so really we’re trying to get them to do a lifestyle change with it so anyone you know who’s prescribing these and isn’t doing that you know I would be hesitant to follow up with but what was your question initially?

Erik: Is it a lifelong intervention?

Kayse: So we’ve had a lot of patients coming in and asking that and you know and my response to them is I you know I feel like if people are dependent on a medication for the rest of their life possibly we didn’t do our job and like what Amber said our main goal is to assist people with weight loss with the medication but we really, really promote the nutrition changes the lifestyle I start every single one of my new patients with just walking three times a week just getting them to do some sort of activity and eventually start guiding them towards the gym for weight training and to you know keep their muscle mass.

We just opened in October, so all the patients we have are on their second and third round, so, you know, no one has stopped the medication yet, and certainly we haven’t been doing it long enough to see anyone just staying on it for the rest of their life.

However, personally, I have witnessed individuals that go on these medications, completely turn around their lifestyle and come off the medication and keep the weight off. A lot of people come off the medication and rebound, gain the weight back, and that’s probably because they’re not doing their part.

They’re not changing their nutrition. They’re not hitting the gym. Being healthy is a very intentional thing. You wake up every single day with the intention of being healthy, and that’s what I tell my patients what they’ve got to do.

They’ve got to do it like their life depends on it, because it actually does, so I believe that people don’t necessarily need to be on it for the rest of their lives if they’re motivated to come off and keep the weight off.

Erik: Yeah, you’re preaching to the choir here. Obviously, that is the same space that I occupy is habit change, and, you know, as I told both you ladies before we started, I have encountered a number of fitness trainers out there that are opposed to GLP-1 interventions, and I can’t for the life of me understand why, but in that same space, one of the concerns is obviously what we call Ozempic Butt, which is sarcopenia.

And that’s, again, people that are not undertaking resistance training. They’re just eating less, so they’re not—they’re relying 100% on the drug. They’re not taking action themselves to change that behavior.

And ultimately, you know, what is my job as a coach? It’s to try to get people to change their behavior, so it seems like there’s massive overlap here.

Kayse: Yeah, exactly. We also really try to promote each one of our patients to eat 0.8 grams of protein per pound of ideal body weight as well in just all the effort to maintain that protein and avoid the ozmpic butt, the ozmpic cheeks, all that stuff.

Yeah. And then also, you know, really it comes down to losing weight at a safe and healthy pace, one to two pounds a week. You know, I recently talked to a patient last week who she was about to do her eighth injection and had lost 11 pounds and was disappointed by that.

Amber: And, you know, we’re happy with that.

Kayse: Yeah, exactly. So you’re doing great. You don’t want to lose it faster than, you know, so I think that contributes to the Ozempic Butt and the Ozempic Face as well.

Erik: Do you guys have a DEXA scan or in body or something that?

Kayse: We are working on that. Amber has diligently been trying to get that.

Erik: Right, you did ask me about that.

Amber: Yeah, just on a tangent of that, because I am kind of passionate because I don’t, I think I could speak for a pace, basically everyone in this room that you don’t think it’s, you know, these medications or the panacea of weight loss.

We are using them as much as the pharmaceutical companies are using us. So I think we, you know, just try to get the benefit out of it and then hopefully use it to transform our lives. But a DEXA scan, it’s kind of the gold standard for evaluating muscle mass.

It looks at your mineral bone density. So unfortunately, most people don’t get them. Women can get them covered by insurance at the age of 65, which by that point is, they’re also too late. Yeah, so when you’re, you know, going through menopause and the postmenopausal phase, you start to, you know, you can lose bone, bone mass pretty drastically.

So at that point, you know, you’ve already entered the space where you could have effectively done something a decade ago about it. You can also potentially, this is what I’m working on, is getting it covered with insurance if you are post-menopausal with a risk factor.

But I’ve been talking to companies about DEXA scans and getting them, there’s different companies, they’re not ubiquitous at this point, but they are gaining traction just because of people like Peter Attia really advocating for them.

So it would be nice, I wanna recommend that people get a DEXA scan initially before we start these medications. And then maybe annually from there forward to take a look and see if they’re on these weight loss medications, what their muscle mass is looking like.

It also gives you an idea of what your visceral fat looks like, which is a fat that’s much more at risk to put you at for heart disease and liver disease, pretty much everything. But it’s… it’s very you know at this point in time they offer it at different radiology clinics but it’s not going and just finding one it’s not been the easiest thing so I’m kind of working on that right now.

Erik: Yeah I mean that’s we have an InBody obviously at the gym it’s not I always tell people it’s not an absolute scale I actually ran into an issue a couple years ago we had a member who went and got breast implants and that obviously changed the outcome of her scan. And so I had to reach out to the company I was curious how, well she asked, and I was curious how it impacted you know how is that registered?

And the company didn’t have an answer they’re like, “take one and that’s the new baseline and use that.” So it’s all it’s it’s relative it’s not absolute. Whereas I think a DEXA is definitely like you said the gold standard.

But yeah in terms of weight loss that’s the same thing that we advocate is slow change over time and if you’re doing it super quick you’re more likely to lose muscle mass in addition to body fat. So you know one of the things we preach is obviously don’t live and die by the scale.

We just finished a six-week nutrition challenge and since my wife’s upstairs I’m gonna bring her into this, she wasn’t thrilled with the results on the scale, and I was telling her just go do go do the body scan she pretty much recomped during the challenge.. She gained muscle and lost fat, but her weight stayed the same. So she was very successful in the challenge and we saw that a lot across the board.

So obviously the scales not the only factor there and in terms of sustainability that’s one of the things we push is slow gradual weight loss over time you know if it were as simple as a linear trend then the ridiculous example I like to give is theoretically we could all weigh zero pounds at some point and obviously that doesn’t happen.

So yeah mindset and education is huge and I’m really, really happy to hear that that’s a big part of your guys practice. So I like to keep these things to about 45 minutes and we’re pretty much right on the mark right now.

Where can we find you guys? Where is your actual practice and how do we get in touch with you?

Kayse: Yeah so we’re in the West Hartford Center. Where are we at? We are across from Luna Pizza.

Erik: Luna Pizza. How appropriate.

Amber: Zohara is that vicinity too. It’s the building right across there’s a pharmacy in the corner.

Erik: Is that where the IV treatment was?

Kayse & Amber: Yes we’re right beneath them. Yeah the door next to them. We’re in the 998 door you go downstairs on Farmington Ave, Suite 100A.  

Kayse: Yeah and we are eminencehormoneweightloss.com.

Erik: Do you guys take insurance or what’s the preferred protocol there?

Kayse: We don’t take insurance at the moment. We may in the future it takes months to get credentialed with the insurance companies and we’re a fairly new clinic so.

Erik: Yeah I don’t blame you.

Kayse: Yeah we’re kind of seeing how things go just avoiding the insurance companies and you know.

Erik: We have a physical therapist on staff that treats clients on site. He does not take insurance there as well and since we’re on the topic hormone therapy, for all of our listeners that happen to watch South Park if you get the chance, “The End of Obesity” was their special on Paramount Plus for I think 2024 and they delve into Ozempic and compounding pharmacies and navigating the American health care system and mocking the insurance system as it exists. It’s fantastic.

Amber: How is that show still around?

Erik: When they want to make a point about current events, they are biting and brilliant. They are spot on and they are hilarious. But other than that, they can get pretty far out there with the bathroom humor.

In any case, thank you to our listeners. I hope you guys enjoyed this episode. I hope it was informative. We at Viking Athletics firmly support the mission of these ladies here at Eminence Hormone and Weight Loss Center. And we wish them the best.

If you have questions, feel free to comment wherever you happen to catch this podcast, whether it’s on YouTube, our blog, Spotify, what have you. Thank you, ladies, for joining us today.

Kayse: Thank you for having us.

Erik: Hope you enjoyed the bourbon.

Kayse: A little too much, yes.

Erik: And yeah, we’ll catch you guys next time. All right, skol!

Kayse: Cheers!