Hormonal imbalances in both women and men can lead to low libido, mood swings, and other symptoms that strain relationships. To address these challenges, we need to prioritise hormonal balance and support each other.

In this episode, Lorin speaks with Prof Annice Mukherjee, a leading women's health and hormone expert. With a medical career spanning over 30 years, she has supported thousands of women in managing menopause and hormone-related challenges to improve their quality of life and health.

Prof Annice urges both men and women to learn about the hormonal changes that occur and how they can affect our bodies and emotions. And she encourages creating safe spaces for open and honest conversations about how these challenges impact relationships.

When hormonal issues are ignored by doctors, this leaves women disempowered. And when they speak to men, their inclination to want to “solve” problems can be unhelpful. But by having open and compassionate conversations about the potential impact of hormonal changes, both parties can navigate these challenges and strengthen their relationship.

About Prof Annice

Prof Annice Mukherjee is a leading women's health and hormone expert in the UK with a medical career spending over 30 years. She has supported thousands of women going through menopause and hormone related challenges to help them manage their symptoms and improve their quality of life and health. She is the author of the bestselling book, The Complete Guide to the Menopause, which is a deeply holistic and personalised approach for women to manage menopause and truly any hormone related challenges.

Mentioned in this episode:

The Deep Polarity Program
An 8-week immersive journey to unlock the deepest intimacy through masculine & feminine dynamics.

The Deep Polarity Program
An 8-week immersive journey to unlock the deepest intimacy through masculine & feminine dynamics.

The Deep Polarity Program
An 8-week immersive journey to unlock the deepest intimacy through masculine & feminine dynamics.

How do hormonal challenges in women or men affect relationships?

What can a man do about low testosterone?

How does low libido affect intimate relationships?

And what do women really need from us men during hormonal challenges?

This and so much more was covered in my interview with Professor Annice Mukherjee.

She's a leading women's health and hormone expert in the UK with a medical career spanning over 30 years.

She has supported thousands of women going from menopause and hormone related challenges to help them manage symptoms and improve their quality of life and health.

She's also the author of the best-selling book, the Complete Guide to the Menopause, which has a deeply holistic and personalized approach for women to manage menopause and truly any hormone related challenges.

In this episode, we talked about the taboo, the topics you want to hear about, but no one is talking about.

Welcome to the Masculine and Feminine Dynamics podcast.

My name is Lorin Krenn, and I am a relationship coach and hypnotherapist.

I help you to unite the masculine and feminine within in your relationships and life.

Let's dive in.

Hi Lorin.

Thank you for having me.

So good to have you.

It's a true pleasure.

Um, I really wanna start with something powerful here.

So you mentioned in your amazing book that one of your clients came to you with early menopause symptoms, but was prescribed by someone else wrongly diagnosed with depression, and she was taking, was prescribed antidepressants.

Correct me if I'm wrong, please, but how does this happen and is this common that women get dismissed with, for instance, early menopause or any hormone related challenges?

Absolutely, it's common, it's epidemic that hormone problems are dismissed in women.

This is part of our patriarchal medical system where women's health issues tend to be dismissed.

So in fact, menopause can be misdiagnosed.

But equally in younger adult women, many hormone, uh, imbalances and hormone problems can be missed, such as thyroid problems and premenstrual disorders, which actually, uh, affect many, many women, uh, from puberty onwards, uh, through the, a woman's fertile adult life.

So, a, a very common condition, which almost most or all women will experience at some point is called premenstrual syndrome or premenstrual symptoms where women will experience symptoms at certain times in their menstrual cycle.

And a more severe form, uh, of premenstrual disorder called PMDD, which is really a significant mood disorder.

And if these problems are diagnosed correctly, you know, sometimes we will use antidepressants understanding that the problem is hormone related, but we will also be thinking about and addressing hormone problems.

But if a woman knows that a woman can feel that the hormones and are contributing to their problems, I, I see it all of the time.

Really healthy women who are empowered, who are doing everything right for their health and they say, this is my hormones out control.

When, if you are told that something you understand about your body is wrong, it doesn't matter.

And the treatment is simple and binary, a, a tablet for depression, it doesn't help.

Even if that antidepressant might actually help some symptoms, if you understand why you're on it, that's different.

But actually as a first line, just saying here, treat every woman's health problem with, uh, antidepressants, whereas we know that many women's health problems affect mood, it's not right, and it needs to change.

Thank you for sharing that.

One of the things I read in your book as well is that one of the things that gets wrongly diagnosed, even though it there are hormone related challenges, is for instance, chronic fatigue syndrome.

So I just wanted to bring that up as well and how you have noticed that.

Well, I mean, chronic fatigue syndrome, it, it's more widely known as ME or MECFS.

It is, it is a, a fatigue related disorder, which causes really extreme fatigue, worse by physical and mental exhaustion.

And it's much more common in women than men, although it can occur in men.

And the thing with, with MECFS s is that it can, it tends to peak at times of hormone changes in women.

So it can actually peak in, in puberty and around menopause.

So, you know, actually the condition may be there, but it may be being made worse by the hormone changes.

You know, all these things typify the fact that our bodies are complex and we might have one thing, but it might be linked to another thing.

And if we try and see health as binary, you know, fatigue is all to do with ME, uh, low mood is all to do with depression, then we miss really important pieces of information that when put together and if a woman understands what she's experiencing, she then has the agency, the understanding that the, the empowerment to know what she can do for herself and what treatments might be needed, if any, uh, to support her recovery, her healing.

And I believe the key point you just mentioned is understands.

I believe that is one of the most important thing because when a woman or, or a man with hormone challeng doesn't understand what is going on and perhaps even gets the wrong diagnosis, because as you said, we are complex, that is going to cause a lot of, a lot of challenges, um, both physically and of course and emotionally.

Absolutely.

I think I've got many patients who've said they've walked away from their, their doctor, uh, or another health professional, feeling ignored, feeling dismissed, almost even ridiculed for the symptoms.

Being told there's either nothing wrong at all, which is, which is even worse because, yeah, I mean, somebody comes, I see thousands of of patients who come to me and they say, these are my symptoms, really severe, really intrusive symptoms that affect everything in, in terms of their daily lives, and they've got those symptoms and their doctor says, there's nothing wrong with you.

You know, go and do some exercise.

I'm not saying exercise is wrong, I'm very big on exercise.

But for a doctor to say there's nothing wrong, that not only doesn't help, it actually is harmful.

It disempowers.

And it's wrong, and it's part of our modern healthcare system.

The way our healthcare system works is looking at simple solutions and very much dismissing complex issues, and women have more sort of, of those complex hormone issues because in women from puberty onwards, hormones are a moving target every single day of that woman's fertile life.

Whether she's menstruating, whether she's pregnant, whether she's breastfeeding, postpartum, you know her, her hormones are moving.

Your hormones are never the same two days in a row.

So it's complicated.

Symptoms can be complicated and to be told there's nothing wrong is the worst possible thing.

thank you for sharing that.

And I also believe, and I'm sure you will agree on this, is that it teaches women or men when, when they're told nothing is wrong with you, it teaches them to not trust their own body, to not trust their own intuition, which again, then ties completely into this sense of disempowerment.

Because when we can't trust ourselves, we will feel disempowered.

Yeah, it, it, it, it dis it's disempowering.

It, it's confusing 'cause uh, you know, people will think, well, but this is what I think is wrong.

And, and my doctor said that there's nothing going on, but I feel so ill, it adds to confusion.

And actually it adds to something that I see a lot, particularly in relation to women's health issues, but all hormone issues in men and women.

It sort of increases the health related anxiety.

So you've got health symptoms, you don't know what's going on in your body.

You are told.

Something that doesn't make sense to you, or you're told that there's nothing wrong, which you know is, is, is dismissive.

And you know, that actually makes you feel worse, not better.

It increases your health anxiety, it increases the stress around those symptoms because you feel like, you know, it's almost suffocating.

You feel like there's nothing you can do.

And that is a, a really powerfully negative narrative.

So that's something that it's wrong because the alternative, which is even if a doctor says, I don't actually know what's wrong, but you are, you've clearly got a major burden of symptoms and I want to try and help you to find out what's wrong, even if a doctor doesn't know, 'cause many doctors aren't well trained in hormones.

If they validate symptoms, that's actually very empowering.

Something very simple.

I, I often, when I give talks to doctors say, under, if you don't understand what's going on with your patient, at least validate those symptoms.

They're real symptoms.

There may not be a simple, easy solution, but it's real, and it's affecting the quality of life of your patient.

Leading into something else here, in my personal opinion, in your highly specialized profession, you are not just a doctor who prescribes medicine, but you are also a coach guiding your patients in your journey.

Could you talk a little bit more about this and how this should be done, please?

I, I love the idea that you, you described me, what I'm, what I'm doing sometimes in my clinics is coaching.

I don't have coaching qualifications.

I am a consultant physician.

So consultant physicians, that means I've got decades of experience understanding the complexity of the human body and how every system works in, in conjunction with every other system.

We call it scientifically homeostasis, body balance.

And that the, the problem is that because doctors say, here, have this pill for depression, or Here have this pill for cholesterol, or here have this pill for, for blood pressure.

They're not looking at the whole individual.

And what I do is I look at my patients holistically.

I look at the whole patient.

Every part is linked.

And when I talk about strategies, I will not just say, oh, you've come with hormones?

Here's a prescription.

I will talk about everything that's going on in that patient's body, that the, the stress, the medical problems, the medications, everything.

So I think when, when we say I, I'm actually coaching, I'm trying to teach my patients about their body to understand how their body works and how there is no one size fits all solution.

Any single medication in isolation will never be a solution to lifelong health, wellbeing, you know, to solve health issues.

For example, if you have high blood pressure, which many people as they get older experience, lots of people say, I've never had high blood pressure.

But it's something that tends to happen when you're older.

You can go on medication for blood pressure.

But the blood pressure is caused by other things.

It's caused by poor lifestyle.

It's caused by lack of exercise, weight gain, stress, you know, lots of other things.

So what I do is I try and help to, to, you know, facilitate my patient with the agency to understand that actually it's not just the pill.

They can do a lot more for themselves to help that blood pressure.

Maybe they can even reverse it.

Same with diabetes.

You know, they may have to have medication, but maybe if they can take back control for themselves, they can actually reverse disease.

We know it's true.

It's not a, it's not a popular narrative on social media because it, it, it's kind of free if you, if you, if you heal yourself, you know, no one's making a profit outta you.

But it, it's very powerful.

So it's that holistic view.

It's providing my patients with understanding an agency, I guess that links with how I'm coaching them.

I'm coaching them to, to heal themselves.

Yes.

Yes, absolutely.

Thank you for sharing that.

And the, the, one of the reasons why I asked that is because I personally am see it as this kind of gray line, right?

Because you can't separate these things entirely.

In the sense, of course, I understand, um, about the coaching qualifications and all of that, of course, they are separate.

If there are specific challenges that need to be addressed, I, I completely understand that.

But still, they are not entirely separate because as you said, you have to give people and patients who come to you a more holistic approach to it, for them to really be equipped in every possible way to work through and heal, to heal themselves ultimately.

Yeah, and it goes back to what you said about a patient or a person understanding what is going on.

If you understand what is going on in your body, you are so empowered.

I had, I have had the same personal experience when I've had health issues.

You know, if you are empowered, the solutions are really there at your fingertips.

If you are disempowered, there is just chaos inside.

You don't know what to do.

Your anxiety goes up, you feel stressed, and the solutions don't come.

Yes.

And I, I, I like that you used the word empowered because it makes such a difference when someone goes on the healing journey or managing certain chall, any hormone related challenges.

It changes everything when we, when we approach it from an empowered place, which you are providing for your patients, or from a more disempowered place, or we're confused, we don't understand what is going on.

And it might sound simple, but it's, it's truly life changing.

I, I know this from myself when I work with clients, when they approach a specific challenge now talking about coaching, when the, when it comes from an empowered place, it completely shifts the energy.

Absolutely.

And you know, I wouldn't be doing what I do if I, if I didn't have feedback from patients again and again.

They say, you know, I've seen so many doctors, they've just given me simple solutions.

It's never worked.

And you've provided me with understanding of what's going on.

I understand that it's different for me compared to maybe somebody I speak to.

You know, other people's hormone journeys.

Anecdotes are interesting.

They raise awareness, but anecdotes don't help healing because every single person's individual experience is different.

So, understanding what you are going through.

Is hugely important and, and I think what you do and what I do overlap very significantly.

Uh, one thing I'm really, really curious about and I believe will serve the audience really powerful is, um.

This is not just for women, but also for men.

Any hormone related challenges now, specifically talking about women such as PMS, perimenopause, menopause, or post menopause, how do you notice this affecting women in their intimate relationships?

it it in a very diverse set of ways.

And again, it is different for everyone.

But one thing I want to emphasize is that today.

How women live is different from how women lived 30 years ago, and that is relevant to the partner.

So I, I, I'm, this is for everybody, this, this information that I'm just gonna impart initially is that women today are more likely to, to be working, they're more likely to have care roles, whether it be, you know, care roles for relatives, children, elderly, um, you know, people, they're very, very overcommitted.

Particularly as life goes on through, through inter midlife, women are very overcommitted.

And if you're overcommitted and your stress levels are higher, the, the stress adds to symptoms.

The stress affects hormone symptoms, and that can, you know, impact on premenstrual symptoms, perimenopause, the, the whole menopause transition.

And coping strategies for women are often.

But what you need to do is often counterintuitive.

So you know, if you're exhausted, you are more irritable.

You don't want to exercise, you crave sugar, you might be irritable with your partner, you know, um, as a partner of somebody who's going through hormone issues.

And to be honest, it can be men or women as a partner, you get frustrated.

You don't know what to say.

If you don't understand as a partner what's going on, it's very easy to be reactive, a bit like the child's child fight reaction, and then it all can escalate.

So in terms of hormone health issues in women, it can cause tension in relationships.

If a woman is exhausted, for example, and I write about this in my book.

There's, there's, I've even got tables describing scenarios.

But if a woman is exhausted and, and you know, there's a big planned trip or night out or social gathering and both members of the couple are really excited about doing it, but then the woman says, I'm exhausted, I don't want to go, I don't feel good about myself, I feel low, then it spoils the social aspect.

And it's, it's just so diverse the way it can impact on relationships, because you've got another person in that relationship.

You know, there may be other family members, you know, friends who get affected.

So it's, it's very, it's very difficult to kind of pinpoint it in one thing.

It just affects everything.

It can affect people's sleep, you know, couples say to me, you know, oh, we, we can't sleep in the same room because, you know, the pa female partner might be having hot sweat.

The male partner might be freezing.

If there's two female partners, one's going through hormone changes, one's not.

You know, there's so many different scenarios, it is absolutely huge how, hormone changes can impact on relationships.

Equally, it's also huge how understanding it can result in small tweaks, perhaps attitudes, behavioral changes from both partners that can be transformationally in a positive way.

One of the teachings and concepts I teach about is this idea of holding space for women.

So for men to cultivate the capacity to hold space rather than, as you mentioned, already very powerfully, emotionally start to react and to become reactive, which is only going to aggravate the tension and difficulty in that moment.

But instead, without trying to fix o often the way ma, the kind of masculine brain mindset works is problem solution.

So her going for challenges, whether it's PMS or um, perimenopausal menopause, whatever it is, is something that needs to be fixed, a solution needs to be found.

Whereas if in that moment men are able to just hold space to be present and support in the ways you've already mentioned, um, I believe that changes everything.

From, from your point of view, what is it that women need in these challenging moments from us men?

It's exactly as you just put, put it.

Exactly.

Women do not need advice.

They certainly don't need a, a dismissive comment.

A little bit like when the doctor says, oh, there's nothing wrong, or pull yourself together.

They do not need a dismissive comment that's very emotional.

And because it's, it's difficult for the partner.

If they're feeling frustrated, it's very easy to throw in a throwaway comment.

And it's so destructive.

It's, it not only doesn't help, but it makes everything worse.

But as you say, adding that space, even saying nothing, just even giving a hug, saying I'm here for you, I understand this must be difficult, you are clearly struggling, it diffuses the situation, like diffusing a bomb.

A simple strategy.

Pause, don't rush in, and perhaps don't offer advice.

You know, in those moments, advice, I would say rarely, if ever, or even never works.

It's never effective.

What is highly powerful is that pause, that reflection and just being there, showing that you are there and that you understand there's difficulty.

And it's, it's so powerful.

It's so powerful.

this is, it's so powerful what you're sharing.

And the reason why I'm laughing is because when I work with men, one of the things I always like to say is, 20, it takes 20 or 30 seconds to just be present, to not become emotionally reactive and to just hold space in the ways you have already pinpointed here.

And at the same time, getting emotionally reactive then leads to, similar to what something you shared already, it then leads to this tension.

And I've seen this with couples.

I work or with individuals I work where then little moments you, you use the word bump, diffusing the bump, suddenly these little moments of tension explode into something so much bigger.

Both don't understand what is going on.

Both are deeply confused by what is truly the underlying dynamic.

And if in that moment we as men can just be a safe space and provide support in the way you've mentioned, then um, then most likely, most of the disconnects that would happen when women are going through any hormone related challenges, no longer need to happen.

Yeah, I would say a a, a huge amount of the disconnection and the relationship difficulties and degeneration is exactly that.

It's completely unnecessary moments where both parties end up more frustrated.

And, you know, Lorin, I want to emphasize we understand this, these, these, you know, emotional reactions, because what's happening in that moment is it's, it's the amygdala in your limbic system, in your brain.

It's a, it's the emotional sensing center in your brain, and it wants to, it's basically saying, get the situation sorted out as soon as possible.

It's actually hardwired into our genes to solve problems.

And it, so it's understandable that any man is going to have that reaction quickly.

Because our ancestors, you know, in a situation of war or famine, it would create solutions and they'd be able to survive.

But it doesn't work in these sort of situations in the modern world.

So what you have to do is you are o, when you are stopping and pausing, you are overriding that emotional reaction with your frontal lobe.

Your logical brain going, hang on a minute, it's your raining, the emotional center in, and your logical brain over that just short pause is saying just wait.

Just use a hug.

Just use a, I understand, rather than, or it must be difficult rather than a, a reactive comment.

So we understand that, that this is our brain trying to work for us, but it works against us in those situations.

One of the things I say to men, what makes them good in business, for instance, right?

What makes them really powerful in business, is the very opposite that makes them the most conscious husband or partner that they can be.

So sometimes there is this kind of, it's the very opposite.

It's the kind of the finding a solution and fixing it as quickly as possible, it works so well, and our world rewards us for it as well.

It rewards men for find a solution, achieve something, push through.

And this is the very same thing that then in relationships where it's more about, like you mentioned, having that pause so I can totally see also how based on what you shared already, how challenging that is for men in these moments to realize, wait a moment, it requires a different approach here than actually in business or in any other, in other area where such behavior is, um, awarded.

And you know, also, because women are working, women have that approach as well.

So the woman who's there with her hormone problem will also be wanting a quick solution, and her solution will be different to the man's solution.

So you can see how it, it can degenerate so easily in that moment or those moments that can happen again and again in relationships.

So you, you are, you are so a hundred percent right.

What works in that nurturing relationship is, you know, a business environment is not nurturing, is it?

It's just not, it's completely different.

So it's, it's, again, it's overriding that in instinctive, uh, strategy, which works in all those other aspects of life, with the frontal lobe going well, hang on a minute.

That's not gonna work in this situation.

Moving into something else here, the one elephant in the room, the effect of hormonal changes, as you've mentioned already are of course not only experienced by women in relationships, but also by men, namely, for instance, the testosterone levels for men.

Could you speak a little bit more about men's hormonal changes here?

Absolutely.

So, you know, a healthy man, um, whatever age, there isn't a recognized situation where men go through an acute hormone change like menopause.

So, uh, sometimes I get asked, what is manopause?

You know, the male version of menopause.

And actually there isn't a, a, a male menopause that's the same.

However, there are some big things that affect men's testosterone levels.

First of all, men's testosterone levels tend to decline very gradually over the adult lifespan towards, in line with aging.

So, um, you know, men, men don't become infertile, you know, at any point, like women do.

Men can father children to the end of their lives.

But testosterone levels, which the testosterone production and the sperm production are controlled actually through two different pathways between the brain and the gonads.

So whilst the testosterone doesn't drop very much, it can decline over time with age and sperm production is maintained.

But there's some other things.

First of all, stress is a huge, and I'm talking about chronic stress.

I'm talking about things that are associated with chronic stress, like burnout and trauma and recurrent major life events, including relationship difficulties.

That can actually, the stress hormone cortisol has a profoundly negative effect on reproductive hormones.

So that's estrogen in women and androgens in men.

And actually androgens in women too, because women also produce testosterone.

So.

If a man is stressed, it can affect his testosterone production and that can affect his His libido.

It can affect his wellbeing.

So there's stress.

And then the other thing is lifestyle.

Because exercise, maintaining a healthy weight, and again, it that links with stress reduction as well, are very beneficial to men's testosterone levels.

We also know, and we know that we're going through an obesity epidemic, and I don't say that in a judgmental way.

I work in obesity medicine.

The obesity epidemic, and putting weight around the middle, which many of us do, men and women today.

This has a really significant negative impact on men's testosterone production, libido, et cetera.

And um, and actually we've got very good clinical trials showing that, that men who gain a lot of weight and who have problems with low testosterone when we can help them with weight loss just to get back to an appropriate weight, testosterone recovers.

So it's really complicated.

Uh, testosterone issues in today's world link with chronic stress, which is worse than in any time in history.

Uh, adverse lifestyle and the obesity epidemic, which is unprecedented.

You know, in the last 30 years, it's skyrocketed.

So today 75% of the Western populations are overweight or obese, and the World Obesity Atlas, uh, predicts that in 2035, 75% of adults will be obese.

So that's something we have to be aware of because if you've got a relationship difficulty and you know the relationship's affected by lack of intimacy, problems with intimacy, that adds another layer of complexity.

it's a kind of taboo topic, both for women, but also I believe in that sense, even more for men, this is like, it's like, um, as a man, you don't even think about getting potential help or having changes.

So what would you advise a man to do in, in such a situation?

So they would have to have symptoms that might indicate that there could be a problem with testosterone.

So for example, loss of spontaneous morning erections.

This is something that many men, you know, they, they don't wanna talk about anything to do with sex and intimacy is generally shrouded in secrecy.

Nobody wants to talk about it.

You know, it's my job, so I talk about it every day, all the time.

But, you know, thinking about if you are not having morning erections, it's difficult to have to have erections, you know, at times of intimacy.

Plus things like loss of motivation, loss of energy, that joie de vivre, that, you know, mojo.

Those are important telltale signs that there could be a significant problem with testosterone.

The other symptoms that can be linked with a low testosterone in men are sweating.

So a bit like women with low estrogen, low testosterone in men can cause terrible sweating.

Can also cause joint aches.

Um, it can cause sort of making it easier to put weight on, on the middle, a little bit like menopause.

So that's why lots of people talk about this manopause or andropause.

But, you know, the problem is that stress in itself can cause, even with a normal testosterone stress can cause put people putting weight on the, on the middle.

Anxiety, low mood, um, sweating.

So I think the thing is if you have those symptoms, it's pretty easy to check a testosterone level.

Uh, in men testosterone has a diurnal variation.

So checking a testosterone late in the evening is not good because it may well be low.

But it, if it's checked in the morning on an empty stomach because actually food lowers a, a, a big meal can lower testosterone.

So if you have a morning fasting, testosterone, and it's within the normal range, if you've got lots of symptoms, you might want with your doctor to do it two or three times at different points.

If, if your testosterone is within the normal range, it is unlikely that testosterone is the only cause.

If the testosterone is low, then a wider hormone panel is needed to investigate the cause and what else might need to be done.

There are other things that can affect, um, sex drive, libido, erections in men.

Um, cardiovascular disease.

So many men in midlife will have blood vessel disease, and blood vessel disease affects the blood supply to the penis.

So that impact on erection.

So it would be really important to talk to your doctor about, is there any suggestion of heart, heart or blood vessel disease?

And that's looking at things like cholesterol, blood pressure, whether there's diabetes, overweight, and stress.

All of those factors are very, very important.

So this is a medical issue.

You know, if you've got those problems, these things should be talked about.

And actually, because they're not talked about, I'm afraid, there's a whole black market in testosterone.

Many men who don't really need it are getting it through the black market and not being monitored on treatment.

So it's, it's, it's really important that these things are read, and every man should be able to talk to their doctor about these, about issues if there are issues.

And, and I believe also it's something so archaic in men in the sense, a strong man, there shouldn't be anything wrong with testosterone, right?

It goes into, so in such an archaic fear that a man is not man enough or not masculine enough.

And I believe that's part of what creates this stigma.

That's part of what creates this, as you mentioned already before, this kind of secrecy around all these kinds of topics.

No one is speaking openly about.

And I believe it's so important that we're having this conversation for both women and men, because as they listen to this, they can start to acknowledge these things.

And if.

And something else I wanted to share here as well is, um, because you already mentioned of course also the, the impact of chronic stress, that all of this is very, it can be very complex .Because at the end of the day, it's not as easy to say as, oh, this is just a, this is, this is because of this reason.

There could be many factors contributing to that.

Um, one of the things that I've seen also.

A lot more on the rise is, and I believe, based on what you mentioned specifically in men who their testosterone levels are within the realm of where they're supposed to be or what is prescribed, described as as healthy, um, but they have, they struggle with erections because of, um, the mental aspects, because they're, they're not able to relax, because of performance anxiety.

There are many, many reasons, but chronic stress is, um, um, something I didn't think a lot about before, but now when you mention it, it, it, it makes perfect sense.

Just to give an example quickly and then you can share more about this, uh, it's very common that I work with men and we have one breakthrough session, right?

And obviously here, there is no deeper issue that needs to be treated.

But it's simply a, a, a mindset issue or it's a limiting belief.

And once they experience a breakthrough, suddenly the problem disappears.

Yeah, so psychosexual issues is what you're describing.

It can be a real block.

And yes, it's like liberating sometimes that can be a real light bulb moment where they're kind of released, almost freed from some of those factors.

Um, on the chronic stress side.

What, what I try to emphasize, and it is relevant to both adult men and women today of all adult ages, is that the way we live our lives has undergone a paradigm shift in the last 20 to 30 years.

You know, the internet, the connection that everyone has and, and everything that's going on, and the way women are working more so men have greater shares in household roles, and women are having to work as well as carrying on with household roles and everything.

Is adding to chronic stress in our world.

And, you know, we've, we're conned into thinking life's easier.

We can get ready meals, we can get fast food, we can, you know, do quick exercise regimes that are gonna get us back on track if we've, we've gone off kilter.

Weight loss programs, if we've gained weight.

We're, we're conned by a lot of misinformation that our lives are easier than they've ever been and our lives have never been more complicated.

And that's where the chronic stress aspect comes in.

And I'm not saying chronic stress affects everybody, but the thing is, if you recognize that you are perhaps under more stress, it's so much easier to find solutions to reduce that impact of that stress.

Um, because you don't need to go and just.

Reject modern life.

You just need to do small things that are stress relievers within your everyday life.

So recognition of the impact of stress and recognition of the psychosexual factors, as you say around, you know, intimacy and, and, uh, sexual function in both men and women is really important and it's just not talked about.

Which ties into the whole topic of what we talked about before, holistic to approach this from a holistic, in a holistic way because that is what's going to be required in order to really work through these things.

Now, we have already touched this subject, but specifically this is now relating to women and men.

Low libido caused by any hormone related challenges.

How can a couple deal with this in the most empowering or powerful way so it doesn't lead to disconnect and so much pain for both.

There are so many factors and there are hormone factors.

So if there are hormone factors in the man or woman, we've talked a little bit about male hormones, women at menopause test, they have testosterone too.

Women have testosterone and testosterone drops a little bit through the menopause transition.

But there is also testosterone production from the adrenal glands, and the impact of loss of estrogen from the ovaries affects testosterone as well in a complicated way.

You'll have to trust me on that.

So.

If there is a hormone factor, it is important to recognize it.

And if it can be addressed, then it should be addressed.

Because these, these, these are, these can be very powerful.

You know, women can be treated with estrogen replacement in, in hormone replacement therapy or menopause hormone therapy.

They can be treated with testosterone.

Men if needed, can also be treated with testosterone if that's needed for their, uh, problems.

There are other treatments for men for erectile dysfunction.

As you know, the phosphodiesterase inhibitors, well, your audience may be aware, um, there are medications that can be used to help with libido in men when, when that libido problem is not related to hormones.

So there's quite a, a whole spectrum of treatments that can be used.

But you know, I see men and women in my clinics who have problems with libido.

They've seen me specifically for hormone related problems.

We've treated the hormone problem and the libido problem is still there.

Wow.

Yeah, absolutely you can't cure every single problem of intimacy, libido with hormones actually.

because I've been in this for so long, that's why I know the holistic approach is needed, because I've been there, done that, said, Hey, your hormones are fine now, we've sorted them all out.

And they go, still got a problem.

And that's what goes back to what you were saying about many psychosexual factors, and then what I was saying about other factors like stress.

So historic trauma can be carried by men and women and impact later on things like sex drive, wellbeing, energy.

And it must be acknowledged that our adrenal stress response, which is our fight or flight, our famine feast, are reactive response to emergencies.

If you've got chronic stress, all of the adrenal hormone productions are imbalance.

They're not fit for purpose.

So cortisol becomes dysregulated and testosterone and other androgens are suppressed in men and women.

So your reservoir of testosterone and androgens from your adrenals is then affected.

Now there's, there's no way you can really treat that unless you've got adrenal failure.

We can use drug called DHEA.

That's, you know, that's really for more complex adrenal problems.

But the underlying stress needs to be addressed, and then the psychosexual factors need, so you need to be addressing everything.

And I, I use an analogy for many of the conditions I look after, which is like, and, and I actually, I use it in my book.

If you think of a house in winter and it's, it's, it's freezing cold, and there are 15 windows in that house and they're all open and the house is cold.

And you want to get that house warmer so you go around closing the windows.

And you can close 12 windows, but the house will still be cold if you've left the other windows open.

And it's kind of a metaphor for you can, you can address some things, but if you ignore other important windows to get the house hot, you just leave them open, you will not get the function that you want.

And it's, it's like that with sex drive.

There are many factors.

So with women, uh, there's the hormone factors, there's the psychosexual factors, there's the stress.

There's also pain.

Pain on intimacy is common in women, um, across the adult lifespans.

And we, we've got many things we can do to address local pain.

Take the pain away, there's no problem with men, as you say, performance issues.

It, it's so complex.

It, again, if we don't have the conversa, I'm not trying to make it more complicated, but if you recognize and you think, actually this is, I've addressed, I've addressed all of those things, but I haven't addressed this one thing, then you are empowered to know that that's the next step in healing and recovery.

You know what I find so powerful about your work?

And as I'm listening to you right now, the feeling that I'm getting is, for instance, when a couple would come to you in regards of hormone related challenges, which of course might be mixed with the psychosexual related challenges, right?

As they often are, it's more complex as you said.

But what I find so powerful is, um, of course the holistic approach, but also the way you speak and the way you are so passionate about your topic, there is a sense of we can do something about this.

As you mentioned the analogy in your book, for instance, I just remembered it when you mentioned with the 15, 15 windows open, it's a total different approach and energy with this, because often I believe and let me know what you think about this, but for couples it's a sense of, this should be working.

Why is this not working?

And that's kind of the, that's kind of the belief around it.

This, there's, there shouldn't be any problem, right?

Everything should be okay.

So why something is wrong with me, something is wrong with us.

And of course, if you, if you are in that belief, then it's going to be really, really using your own language, disempowering the whole experience.

Because you are already in a place of, this is wrong, we shouldn't be here, but we, but we are here.

So for people who are listening right now to acknowledge, okay, we are here and we can do so many things.

And if the hormone related challenges, of course working on them and then don't mean immediately that everything is solved, okay, we've got these other windows we need to close for it to work.

Absolutely.

and I saw a couple on Friday last week, so this reminded me of, of of their, their scenario.

And, and it reminds me of what else to mention is that I saw a couple who'd had complicated health issues, particularly the female partner.

And we, we've, we've, we've worked really hard and we've addressed lots of complex issues that related to major life events, menopause and other hormone issues.

And we addressed them all and the couple came back, um, including sex related issues.

And we've addressed all of them.

And the couple came back and, you know, the male partner is happy and really happy that his female partner is feeling so much better.

And, and, you know, she was, she was expressing how much better she felt compared to the first time she'd ever, ever seen me.

She, it's really, I mean, it's been transformational.

But she said everything is better except.

My sex drive.

I have no sex drive.

And the other thing that's really, really important, because there's, there's two things, sleep and sex drive, which are, they are really difficult to budge when they stop functioning.

So insomnia and libido.

So what I said was actually, now you are feeling better, it's just a matter of time before then the sex drive will return.

So if, if you are then stressed thinking, but I'm better, why is the sex drive not back?

It makes you more stressed.

'cause you think I'm doing everything, and we all want quick fixes.

We all want solutions as quickly as possible.

We wanna live our live lives.

But so I said, you know, actually now you're doing everything right.

She was doing everything right by this point, and as was her partner.

I said, now you just need.

Sort of clamp everything you're doing, you're doing everything right and let's see how you go over the next few months.

And actually they were really happy with that because when they thought about it, they were, everything was so much better.

It's logical that it's gonna take time for their, that intimacy side to improve.

So I think that's something that's, that people need to take real positives from it.

It's not, you know, you can't, Rome wasn't built in a day.

I always say, you know, it takes time when things aren't working to get things back on track.

The other thing that I haven't actually touched on, which is important, and because I'm a consultant physician, I look after a whole number of really serious health issues.

and if a man or a woman has very complex health issues, they need to be addressed.

All the physical health issues need to be addressed.

The cardiovascular disease, the diabetes, the high blood pressure, the, you know, gut issues, whatever they are, they do need to be addressed as part of that holistic approach.

It's not just about being empowered and, and, and managing symptoms yourself or the psychosexual side.

The physical health issues can impact on relationships, you know, sexual function, sexual health.

And it goes back to that holistic approach.

It goes back to looking everything.

You can't just make any aspect of your health, a binary, standalone issue.

Everything affects everything else.

And more so with hormones than anything.

There, there is something really key that you have mentioned here, and that is when you gave us that example that I believe serves the audience really powerfully of the wom the woman, and experiencing all these amazing changes, but, um, low libi, li, libido, um, it, it's all of these ties into this, um, mindset of, okay, things are going better, but why is not everything better immediately?

You use the word quick fix.

We're looking for that quick fix.

So it's almost like, I, I, I just wanna reiterate and, and, and, and just add to what, what Annice already shared here.

For everyone listening here, slow down, right?

Slow down.

Don't try to fix it immediately and, and stress yourself because that stress is only going to cause more anxiety, which is then of course, for instance, all the psychosexual challenges, as you've mentioned before.

Address everything and then have patience.

And with time, everything should be solvable for most people at least.

And, and again, it, knowledge is empowering.

So if you understand that there are these different things and you think, right, actually, I think I've, I think I've addressed everything or we as a couple have addressed everything, but, but it's not, you know, suddenly, I'm not suddenly feeling any better, the, the issue that I, that I'm concerned about isn't, isn't fixed.

You know, you've, you've addressed everything.

It, it's not like you've addressed it and that's it.

You're continuing to, uh, uh, uh, go down those strategies.

Things get better and better with time.

A little bit like, you know, when you do exercise or you start exercise for the first time, you don't suddenly have big muscles.

You have to wait for that to happen.

You have to keep going, and then you see the rewards.

I believe this is a, this is a game changer for people listening because, uh, I believe that there is a, there, there is this, uh, this mindset for most people okay, with, with the gym, for instance, with exercise, people tend to understand it's a journey.

And, and just like that people should approach what we are talking about here as a journey, step by step.

And I believe that will change everything.

So I, I wanna ask so many more questions, but at the same time, I'm aware of time and there is something else I wanted to mention here that I really, really feel will serve the people listening so incredible and we need your expertise on.

So just to give a little bit of background before I can ask you the direct question.

I always say we live in a very masculine orientated world.

It's all about profit, productivity, pushing through, getting the job done no matter what.

Achievement and achievement, specifically in the external sense of what we define as success or what our society defines as success.

Now, for instance, we know that in ancient tribes, when women were menstruating, they would spend several days or during the, the time of bleeding with other women embracing their feminine energy, relaxing, and going within, and not staying in that, in that mode that so many women in today's world have to of keep getting things done, keep being productive, and kind of very kind of, uh, very masculine virtues.

So, um, this seems to be almost impossible in today's world.

What should women do when they're menstruating, what is your personal opinion about this?

Well, I do have personal opinions, but there's very little evidence to support for sure what women should do.

But it's absolutely true that the stress hormones go up at that time if you keep trying to push, push yourself.

Because when the menstruation happens, the female hormones are dropping really low and that it puts stress on the system.

The energy is lower, the vitality, the ability to get things done is lower.

You know, things like brain fog, aches and pains, tiredness, sleep problems can come in at those times of the month, particularly if women don't slow down.

So there are schools of thought that women should.

Live, particularly if they have female hormone imbalances, like premenstrual syndromes that are severe at the time of menstruation, they should perhaps just make some small changes.

I'm not saying every woman should stop work for a week every month.

There's, I, I'm absolutely not saying that.

But here's the thing.

If a woman's really fit and doing lots of exercise and she's maybe going to the gym two or three or four times a week doing high intensity exercise, really that's not going to work when her hormones are drip dropping off at the end of the month.

So she can just do a little bit less of the high intensity that's putting more stress on her system during the days when she's either menstruating or running up to her menstruation when period where the symptoms are coming.

You know, we all have meetings, we have deadlines.

If you can plan around your period, you can reduce the number of really big intensive meetings or deadlines around your period.

That takes organization, but that can be really powerful too.

If a woman, like many women are, and men are, and we've talked about weight management in the obesity epidemic, if a woman is restricting her calorie intake to lose weight, that might work when she's feeling pretty stable.

When her, when her hormones are fine, but that week before or during the period, she's gonna feel exhausted.

Exhaustion will your, your, your instinctive reactions will result in sugar, sort of cravings.

And so trying to restrict calorie intake during those days is problematic because you end up exhausted and then, you know, craving sugar and eating more, and then self-loathing because it hasn't worked.

So making some small changes, not quite like the ancient tribes.

It's not gonna work in today's world, but.

Just small changes, organization, making sure that your sleep is particularly good at that time because we all, a lot of people cut corners on sleep.

Making sure that perhaps, you know, if you're gonna have a late night or it's gonna be challenging, you need to, even if you can't change something, you need to be really aware that if you are doing too much on those days, you are likely to feel more stressed.

You may be more likely to feel tearful, emotional.

Understanding that, that, that, that the menstrual, the changes during the menstrual cycle will impact on your wellbeing.

And that there's things that you can do to mitigate, because if you, you're not as stressed, you're not as over committed, you're going with your body rather than against your body, that those few days can go from being chaos and awful to being much more manageable.

And, and we know that that's, that those are some of the recommendations along with others that, that I recommend and the international organizations recommend for women who have, um, you know, significant, uh, difficulties with, with, um, around the menstrual cycle.

Wow.

What, what, what comes up for me, what I want every woman who is listening to this here is you are allowed to slow down when you are menstruating.

Almost like a mantra, that's what's coming through me right now.

You are allowed to, because I believe many women need to hear this because the kind of societal conditioning thateveryone receive is no, you just gotta have to push through and well, it's an inconvenience.

It's almost like it's an inconvenience.

It's an inconvenience that you experience this because today's world is only about profit productivity.

And, and, and how dare you have this experience.

But guess what?

Guess what the thing is?

And that's, it's all to do with self care and self love.

You know, if you.

Go for that.

If you're a woman and you just push through and push, and I've seen it so many times, you end up in a heap on the floor, you're under pressure.

The hormones just go more and more outta balance.

And believe me, hormone imbalance is a big deal.

It's not.

And there's no quick fix.

So guess what?

You end up less productive if you ignore your body.

And if you go with your body and you listen to your body and you're kind to your, to your body, particularly at those times, you'll be more productive.

You won't have days out exhausted.

You'll get more done, not less done.

And, and actually it's not just women.

This is something that I see across the board in, in, in people who get burnout, men and women, uh, through adult life because they will not allow their body to stop.

And what then happens is at some stage, and I see it many a time, people say, I've, I've managed to with no sleep and, you know, doing 24 7 working and not eating properly and, and drinking too much and smoking and not exercising.

I've done it for all my life.

It's never affected me.

Believe me, it affects everyone given enough time.

And so it's not just women, although it's really important for women because it's something that does, it does happen every month for most women.

You know, those hormone changes.

But actually for men and women, we're all living far too fast.

And that, you know, it works for a while and some, some people get away with it for longer than others, but it catches up with all of us.

Whether it catches up through physical health issues, hormone health issues, or diseases in later life, things like high blood pressure from, from that chronic stress load.

I've recently talked to, to a friend, um, she, um, she works in a, in a, in, in a top legal firm.

And also there is, I've heard from her that in the kind of blue chip companies and, and top legal firms and the like, that there seems to be much more investment into informing their employees on, on menopause for instance, the media is broadcasting more about this topic.

And it was very interesting because that friend of mine told me it's almost saturated.

So she's getting this extreme bombardment of information and information, but it's almost like lacking the practicality side of it.

And, and, and you shared so many practical things in almost every single sentence.

And from what I heard from her is more like information and more information.

So to make my question really clear here for you Annice is,specifically with blue chip companies, where it's all about this relentless pursuit of more and more profit and productivity, can these two things coexist

Going back to the, the saturation of, of menopause information in the corporate sector, um, it is saturated.

I worry that it's saturated in a very negative way.

There's a lot of fear-mongering about hormone issues.

I don't think I've said at any point, anything that we've talked about is not resolvable.

And that actually the aim is to improve wellbeing, improve health, and improve productivity, whether that be in your own personal life or in the corporate sector.

So with regard to menopause and hormone health issues, the aim is to thrive, personally, economically, you know, in terms of the workplace.

Um, and so I worry that there's, there's, there's all this fear mongering about hormones because I think if employing organizations think menopause is some sort of catastrophe and women's health issues are insurmountable, then what's gonna happen?

Women, they're not gonna be in the workplace soon again, 'cause nobody will want to employ women, and that's wrong.

Women have a huge wealth of knowledge and lots of really different approaches to bring to the workplace compared with men.

So, you know, this is something.

We need female leadership in the corporate sector.

So it's, it's really, really important.

But it goes back to what I said about burnout for men and women.

If big, uh, organizations invest in their workforce in terms of helping them with wellbeing, with empowering information, helping them understand how to thrive in the workplace, how to thrive through this fast lifestyle that we all have to lead, and the things that we can all do that help, you know, harness energy and, and improve our overall health.

If corporate, uh, organizations invest in those things, then they get better productivity in the workplace, they will get less sickness, absence.

And I know that many big, uh, corporate companies invest in wellbeing programs like, you know, gyms and, you know, time off for, for, uh, lunchtime, you know, period of downtime during the day because it improves productivity, not because they're nice, you know, although we obviously want big organizations to be nice.

It improves productivity.

We are not saying let's make female health issues a disease, and women should be off work every month for a week.

No, not at all.

Let's make women more productive.

Let's keep women in the workplace and let's, let's not lose women, um, from the workplace when they go through menopause because they're terrified and they feel ill.

Let's, let's change that narrative altogether.

Yes.

I love it.

That sounds so empowering.

Um, and also you mentioned about female leadership.

I would now say, and let me know what your thoughts are about this, but based on what I heard, if there are more women in leadership positions, that in itself, if they are coming from a place where they're kind to their body, where they're honoring their body, where they're acknowledging, acknowledging what is happening inside them, that that in itself could also lead to some really, really powerful changes.

Absolutely.

Uh, I, I have nothing against men being in leadership roles.

Men are great, but.

Uh, having women, some women in leadership roles helps to balance our world, but whether it's politically, whether it's in big institutions, because you will get a different perspective from a woman who's a leader than who, a ma, a man who is a leader.

We all bring different things.

And you know, we talk about equality and diversity all of the time, and there's lots of a push to, to have more diversity in, in the workplace.

But when we look at the boardrooms, they're dominated by men, and I don't, you know, I don't have a problem with men being in the boardrooms, but we need more equity in those places because, you know, you'll get some in, incredibly helpful, empowering voices if you keep the women who've, who've, you know, built up all that experience and knowledge in that workplace.

And you, and you are right.

Some of the, the personal experience those women will have had through, through their careers will help to, you know, and gender future female leaders and actually be empowering to help people, you know, retain their job roles.

To be honest, we lose so much money from the corporate sector by losing women who've been trained up and trained up, and then they disappear.

We lose their productivity.

So it, it, it's, it's a win-win to, to support women, to empower women.

And I want to empower men as well because I think, you know, we need to think about burnout in men.

It, it is affecting men.

Uh, men do have poor men issues and men and women benefit from that holistic view, which actually, corporate organizations can, it's not a lot that they have to do to, to really empower their workforce.

Now, to wrap this up, I would like to ask you three last questions and you're only allowed to use one word or one sentence, but no more.

Okay.

The first question is, if you were to meet your younger self now, what advice would you give her?

Have more self-belief

Second question.

What does this world need more of?

Listening.

And the last and final question, what is the number one reason why you became the person you are today who is having such a deep impact on women's health?

I treat everything as a long game.

Annice, thank you so much for being on the podcast.

It was a, it was a true pleasure and the ripple effects.

I already feel that the ripple effects of this podcast are going to be incredible.

This is going to literally change people's lives.

So thank you so much for being here.

Well, thank you for having me.

Thank you for listening and being here.

You can find the link to Annice's social media platforms, her bestselling book, the Complete Guide to the Menopause, her website, and other powerful resources in the link in our show notes.

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