SPEAKER_00 0:00

I remember going through clinicals in in NP school. I was with a a doctor who we were prepping for the patient going in. She was a woman in her forties complaining of fatigue. And he said, Okay, well just prepare yourself. She's gonna be fat because she's 40. She's gonna be tired because she's stressed. And he just painted this picture of this whiny woman before even walking into the room to meet her. I didn't like that approach. I didn't like categorizing somebody before I walked into the room to actually meet them and talk with them about their concerns. I didn't like putting women in particular in a box.

SPEAKER_02 0:36

Hi, Huntresses.

SPEAKER_01 0:39

This is Top Rich to Me.

SPEAKER_02 0:42

Where we get more comfortable talking about money and dealing with money.

SPEAKER_01 0:46

Brought to you by Huntress Wealth. 71% of women are investing, but only one in six feels confident about where she's headed. Huntress is the all-in-one financial app built to help you make a plan, get actionable steps, and build your wealth. Join the wait list at HuntressWealth.com and get good with money. Katie, why don't you start by telling everyone a little bit about yourself?

SPEAKER_00 1:26

I've been a nurse practitioner for about 15 years. I specialize in family medicine, but I've done everything from lung transplant to community clinic to now starting my own business. And so I'm a mom of two, live here in Austin with my husband and family, and just love what I do.

SPEAKER_01 1:44

You're technically a family nurse practitioner, but that's not what you're necessarily doing today at Moxie Health. So can you tell us a little bit about Moxie as well?

SPEAKER_00 1:54

Yeah, so now I focus more on uh weight loss, peptide therapy, and hormones. Um, we see both men and women, but it's uh adults only, and it's all virtual as opposed to being in a clinic. So it's more specialized. I've got a little bit more time with my patients, and we're focusing mainly on those three areas, along with certain wellness things that come along with those specialties.

SPEAKER_01 2:17

And what was the impetus behind starting Moxie?

SPEAKER_00 2:22

So I just found myself in the clinic environment, being rushed to see people every 15 minutes on a hamster wheel of sorts, uh, with a never-ending to-do list and just unable to relax. When I was at home, I was charting. When I was riding in the passenger seat on car trips, I was charting. And I just felt like I was not doing a good job being a mom and then just always behind at work, no matter how hard I was trying. And so I really wanted a better work-life balance. And I also wanted to be able to treat people more thoroughly and just have time to talk and get to know my patients a little bit better and really focused on a whole bunch of these kind of vague complaints that I found that women and men were bringing up relative to hormone health or general health that we just didn't have time to address in the clinic setting.

SPEAKER_01 3:11

So I know that you have a lot of compassion for your patients as a patient of yours, but you're a family nurse practitioner. So, what really like credentials did you have in order to start focusing more on hormone therapy? What does that look like?

SPEAKER_00 3:25

Yeah, so a lot of it was self-taught and personal experience. Um, there's not a degree that you can get for hormone health or peptides or weight loss. And so it was a lot of continuing education, going to conferences, and then learning also from societies that promote research-based guidelines. And so the Menopause Society here in the US is wonderful and they break apart the research, you know, behind the benefits of hormone therapy and such. Um, William Seeds is another provider that I I have learned a lot from, and he offers a course on peptides. A lot of it was just my own seeking out and wanting to delve more into these things because they're not generally talked about very much in trading. I have a master's degree. I went through four years of nursing school and then two and a half years of clinicals and schooling to be a nurse practitioner, and it's very generalized, and it's not until you're really out and and doing it that you can figure out what you really want to focus on.

SPEAKER_01 4:27

When I've talked to other people or other clinicians about this, I ended up learning how little training even gynecologists and obstetricians get in hormone therapy. Like their practices, even though it is women's health, is very focused on basically delivering babies. What spurred you into it to be like, okay, there has to be other ways to do this.

SPEAKER_00 4:46

In my training and in a lot of OB and medical training, there's not a whole lot that's talked about in regards to perimenopause and menopause, and that's changing. But a study from 2025 showed that 25% of residents and and medical students that were interviewed, only 25% felt like they were equipped enough to care for somebody throughout the perimenopause and menopause transition. There's just not a lot of training. I remember, you know, going through clinicals in in NP school, and I vividly remember I was with a doctor who we were prepping for the patient, going in. She was a woman in her 40s complaining of fatigue. And he said, Okay, well, just prepare yourself. She's gonna be fat because she's 40, she's gonna be tired because she's stressed. And he just painted this picture of this whiny woman before even walking into the room to meet her. And I was like, Okay, well, that's depressing. And so it kind of stuck with me. And and I didn't like that approach. I didn't like categorizing somebody before I walked into the room to actually meet them and talk with them about their concerns. I didn't like putting women in particular in a box. When I came to Austin, um, I was fortunate enough to start working in a clinic where the medical director was more functional. Um he was very pro-hormone. And I feel like, you know, hormone therapy and the awareness of perimenopause and menopause has really flourished over the the past three to five years. It's becoming a topic that's talked about. But before that, this was 10-ish 11 years ago, he was really pro, let's start bioidentical hormones, let's talk about this. This is something that you guys need to learn about. And he was the one that really pushed me to delve into hormone care and peptide therapy as well. And so I really credit a lot of that to my experience at my my previous employer and just how that kind of shaped my clinical practice and put me in environments where I could learn from other clinicians that looked at women's health care from this holistic perspective.

SPEAKER_01 6:49

Paramenopause, peptides, and hormone therapy are kind of buzzwords in society, or at least in the circles that I flow in right now. We're all concerned about it. There's questions about it. What were the things that you were seeing as a family nurse practitioner in the clinical setting?

SPEAKER_00 7:05

As a clinician, it's my job to be a patient advocate and to present information. And I think that as women, there's a lot that's thrown at us, balancing careers, maybe being a mom, trying to run your own business or or be good in a high pressure business, let alone, you know, running a household, which is a lot. A lot of women would say, I don't feel like myself. And, you know, that doesn't lend itself to one diagnosis. There's not a bullet point list of how to deal with diagnostics for I don't feel like myself. And so fatigue, brain fog, not sleeping well, you know, these are things that we were taught, okay, get some labs, let's start some antidepressants. We think this person's anxious or depressed, and that's why they're not sleeping, or let's start a sleeping pill. It wasn't as much of preventative care as I would like, just because the time was so rushed in the visits, and you feel like you want to give patients a solution, you want to give them answers. My job as a clinician is to give people good research-based evidence for things like hormone replacement and uh peptides and what the data is actually out there on weight loss products and present this in a way that women can make their own decisions. As women, we can do hard things. And, you know, I'm here more as a guide and a resource and a partner with my patients. I don't want to feel like I'm talking at them, but that I'm making a decision with them.

SPEAKER_01 8:30

Have you always just treated mostly in this category, if that makes sense?

SPEAKER_00 8:35

So in primary care, you treat everything. Um, you know, you're treating the whole person. And what I love about primary care, it's also the most frustrating part when you're in an environment dictated by insurance, because they dictate the reimbursement per patient, which forces you to see more patients in order to essentially make ends meet as a clinic to keep the clinic doors open. And you want to do a good job looking at all the things, but after you get done with the hypertension and diabetes and high cholesterol, and then a woman says, Oh yeah, and by the way, I'm not sleeping and I want to kill my husband, you know, as you're walking out the door, you're like, Okay, and then that's another thing. So I found that I really enjoyed spending time with women especially and being able to give them a level of comfort where I could, you know, take off the white coat, talk to you as a human being, and really get to know your story. Because I think as women, we present differently with a lot of illness. Even if you're looking at the textbook picture of what happens in in heart disease with women. Well, we don't present with chest pain a lot of times when we're coming in with a heart attack. Our bodies are different, and that is something that's starting to be studied, but hasn't been studied a lot. And so when I had my patients come in that were women, I was just noticing a lot of the same complaints, but they were were different than their male counterparts. I was finding that a lot of these like vague complaints were really the ones that were affecting people the most, and especially women, the brain fog, that can be debilitating. And, you know, the not sleeping well, uh the I don't feel like myself is probably the biggest one that I would would get. You know, people would come in and they felt less resilient, they felt unable to perform at their their high stress job because they couldn't get their words out or remember, you know, the the bullet points they were supposed to talk about in their business meeting. And these were things that, yeah, there's no medical diagnosis for I don't feel like myself, but these same symptoms kept coming up over and over. And I just thought to myself, this is what's really affecting quality of life. We need to address this because if you're not functioning well, um, if you're not sleeping, if you have brain fog, add on top of that, you know, the classic hot flashes and and night sweats and stuff like that. But you're not gonna show up for your family. You're not gonna show up at work, you're not gonna show up for yourself. And that, you know, kind of spirals and it affects more than just you.

SPEAKER_01 11:06

What's the weirdest symptom that comes through your door and you're like, actually, that might be paramenopause?

SPEAKER_00 11:11

I would say itchy ears. Um, and this happened to me. I went to an ENT even and I was like, what is going on? There has to be like something going on. My ears are itching. Is it just allergies? I'm on an allergy pill. Um, they were like, Oh, there's nothing in there, there's nothing wrong. And then I was reading a little bit in the menopause society guidelines and saw that that was listed as a symptom of perimenopause. And I'm like, oh my gosh, all these women that came in with itchy ears, and I was like, here's an allergy pill, you know, it was a hormonal thing.

SPEAKER_01 11:41

Itchy ears, isn't there like a like a restless arm or something? Uh-huh or like a shoulder, frozen shoulder.

SPEAKER_00 11:48

Frozen shoulder, yeah. So I I vividly remember now looking back, my, you know, middle-aged women that would come in with this frozen shoulder where, you know, there wasn't necessarily an injury, but they couldn't reach back to put their bra on. It was starting to become a thing. And eventually when they had the time to make the doctor's appointment, they would come in and they'd lost so much mobility. And I was like, how did this happen? Like, are you sure you didn't injure yourself? Are you sure it wasn't a workout thing? And no, it was hormones. And so that's something now that we're recognizing more and treating more proactively in perimenopause and menopause. So perimenopause, simply put, is the time all of the time before you hit menopause. So the time leading up to menopause when you're having erratic hormone fluctuations. Menopause is literally one day. It's the day that you experience 12 months without a period. So once you hit 12 months without a period, you are in menopause. That one day is technically menopause, and then everything after that is postmenopause. So we spend about a third of our life in postmenopause, which is interesting, which is part of why I think it's important to really optimize how you're feeling during that time.

SPEAKER_01 13:02

That's insane. So we spend a lot of time talking about puberty, but no time talking about the third of your life that actually happens. Pretty much. So we know the clinical definition of what paramenopause is. What are the symptoms that you should be looking for as your hormones are going whack?

SPEAKER_00 13:18

I would say brain fog is a big one, certainly hot flashes, vaginal dryness, night sweats, a loss of resilience, you know, the same stressors that once used to not bother you, you're just unable to deal with, literally not feeling like yourself. I validate that as a true symptom. Hair changes, skin changes, those are some of the most common.

SPEAKER_01 13:38

When would you say a person is like seeking or needing this help?

SPEAKER_00 13:42

Statistically, if if we're talking about, let's narrow it down to perimenopause and menopause. Statistically, menopause occurs 51, 52, and perimenopause occurs seven to 10 years prior to that. Statistically, so every woman's different. When you start noticing a shift in your ability to do your day-to-day activities, seek help. You know, there's nothing wrong with talking to a qualified health practitioner. There's nothing wrong with getting your labs checked. I think developing a partnership with a provider that you trust is important so that when you do start to notice things within your own body, you can have somebody to talk to. So statistically, I'll say early 40s, but a lot of women in their late 30s, all the way up to late 50s and 60. Um, that's kind of the window that we're really looking to capitalize on to treat symptoms for prevention of other things. Have you yourself gone through perimenopause yet? I actually got my labs done. I didn't think it would be a big deal, but my progesterone level was zero, not measurable. And my estrogen was through the roof. And so, long story short, kind of looking at that, it's it's a picture of the estrogen fluctuations that do occur in perimenopause. I'm a clinician, I know the signs, and I was thinking I can't focus like I used to. I'm not sleeping well. I was like, oh no, it's stress. Like, just like a lot of women walking into my my office, and I was like, okay, it's time to talk with a provider and like get this figured out. Cause yeah, I don't want to be my own doctor. But it was very eye-opening. Um, because yeah, I felt like, oh gosh, you know, there's something going on with my body that I need to address, and it's it's real, like all those spikes and drops that we talk about in perimenopause with regards to hormones. I I literally saw it on my labs.

SPEAKER_01 15:31

So we talked about when these shifts actually happen for women statistically. What are the anomalies that could affect why this would be happening or happening earlier?

SPEAKER_00 15:39

There's something called premature ovarian failure where you you do go through menopause sooner. Some women that are going through cancer treatments and such, the chemotherapy will force them into menopause sooner. Some women with endometriosis will choose to have a hysterectomy and an ouperectomy where their ovaries as well as the uterus is taken and that throws them into menopause. And that's because of the scar tissue that builds up from endometriosis. So some of these factors, you know, just force women to experience menopause in their 30s. And if they don't seek care, they're really at risk for a lot of heart disease, vascular disease, bone loss. These factors really are heightened for them at a younger age.

SPEAKER_01 16:21

Interesting. You have these people that walk in the door with itchy ear, frozen shoulder, other things that are people often misdiagnose as depression. What can a patient expect when they walk in and have those questions?

SPEAKER_00 16:35

So the first thing I do is take a really good history. Um my intakes are about 45 to 60 minutes. Um, and we really delve into the weeds. I'm a big believer that you can figure out a lot about your diagnoses just based on listening to your patient and also asking them what they think is wrong. And then I listen. And we kind of after we get through all of the, you know, the jumble of symptoms that can kind of come out with that question, I organize things into buckets and read those back to the patients. These are the the three things that are bothering you the most. How can we address it? Most of the times that is going to be lab work because we want to rule in or out a lot of other medical conditions that can kind of mimic hormonal changes or be the cause of these symptoms. And then from there, we formulate the plan. Don't make this visit part of your well woman because visits in in the clinic are more brief. Well visits are focused on screenings. You know, gotta get your papsmere, your mammogram, your bone density, all of these things in. So, in order to have time to talk about, you know, these symptoms of perimenopause or menopause that are concerning you, make a separate visit and talk to your provider, see if it's something that they're willing to delve into with you, because not all providers are comfortable with providing this type of care. So if you find that you're in a place where your provider's not receptive, find a new one. Talk to friends that have had good success with their providers, look on the menopause society website. Um, they have a list of providers that are credential to take care of these things. But you really have to have somebody that's gonna be willing to work with you on this because it will take a few visits. The average amount of time it takes a patient to get diagnosed with this after all these vague complaints is seven to ten visits. And so that's seven to ten copies, seven to ten car rides, seven to ten times waiting in the waiting room. You know, it's it's a lot of time. And so narrowing down the provider that you want to go through this with, I think is very important because they're gonna be your guide and they're gonna be the ones that you're really working with to figure this out.

SPEAKER_01 18:44

Can you walk me through what hormone therapy actually looks like? I know, for example, for myself, I got diagnosed with PCOS. Like it was, like you said, a lot of visits before we got that, which it's no longer called PCOS, it's POS. I know that like the words hormone therapy can kind of sometimes be scary, or they lent themselves a negative connotation for me personally. What does hormone therapy actually look like?

SPEAKER_00 19:10

Yeah, so I want to preface it by saying that every woman is individualized, and so I prescribe hormone therapy, but I don't want every woman to feel like it's something that is necessary to have good quality of life. So when we're looking at a candidate for hormone therapy, we do have to take into consideration certain safety precautions that may or may not make you a good candidate. So women that have had active hormone responsive cancers like a breast cancer, uterine cancer, ovarian cancer, they are generally not a good candidate. Certainly active cancer, not a good candidate. Pregnancy, obvious one, not a not a good candidate there. Women that have had a clotting history, a history of a genetic blood clotting disorder or something like that, that's definitely a conversation we have to have along with women that have severe liver disease or recent heart attack or stroke. So those are people that we have to kind of, you know, really evaluate and see is this going to be something that's safe for you. But for other women that are coming in in their late 30s, early 40s with some of these vaguer complaints, um, there is no lab test that tells you you're in perimenopause, but we can use the timing of your cycle and certain hormone labs to kind of figure things out. So we're we're first testing to establish a baseline. We're again looking at those other factors like thyroid disease, iron deficiency, things that can mimic the symptoms. And then once we narrow down that somebody's a good candidate, I present them with the options. So there's a slew of estrogen products out there. There's creams, gels, rings, you know, fairy dust, like all the things that you could have could think of. And we choose a route that's most appropriate for that patient based on risk factors and lifestyle. So you're typically getting the estrogen replacement. And then if you have a uterus, we have to put you on some sort of progesterone or progestin. I like to use micronized progesterone, and that's a capsule that you would take at nighttime. And then after we get those optimized, I talk about testosterone. So testosterone is not just a male hormone, but interestingly enough, there is no FDA-approved testosterone product for women. If you go to the pharmacy and ask for all of the testosterone products that are available for men, you'll get a slew of things on the counter, but none are FDA approved for women. So with that, I'm either using a qualified compounding pharmacy to make a cream, or I'm actually prescribing men's androgel, which insurance won't cover, but newsflash, good RX coupon, it's about 40 bucks at most local pharmacies. Um, we prescribe a tenth of the amount. In perimenopause estrogen, instead of rising, peaking mid cycle, and then lowering before your period, it literally looks like a roller coaster if you were to measure it every day. You're getting spikes and drops, and it's typically the changes in the estrogen that cause. The symptoms. And so the the low dose of the estrogen that we're providing kind of raises the level so you're not getting so much of a drop. And it's it's nuanced and a lot, you know, there's a lot that goes into it. But typically, even my perimenopause patients could benefit from some estrogen.

unknown 22:18

Amazing.

SPEAKER_01 22:19

So I know in as part of your practice, you also focus on weight loss or peptides. What is a peptide for the people that may not know?

SPEAKER_00 22:27

So a peptide is a short chain of amino acids, which is literally a building block of a protein, and they act as signaling messengers within our body. And so we naturally have them. They help regulate hormone processes, metabolic processes, our how our cells function. And the purpose of peptide therapy is really to help replace what our bodies lose as we naturally age so that we can optimize the aging process. And that looks like better skin, more energy, sleeping better. But I do feel that peptides, they're not a fix-all. You really have to optimize lifestyle factors, diet, quality sleep. Like if you don't optimize those things, peptides are not going to do anything for you. So I definitely don't overpromise on peptides, but I think they're a really great adjunct to the treatments that we use with hormone optimization and weight management to help somebody feel their best.

SPEAKER_01 23:23

So let's get into the finances of it all. I know that I've heard a lot about just how perimenopause or going through these hormone fluctuations really affects women's career and their ability to perform and make money, therefore. So just curious, as a clinician, have you seen this? Can you enlighten us a little bit?

SPEAKER_00 23:41

I do see it. I have high-functioning executive women that come in that literally have left their job because they feel like they cannot function. They cannot uh multitask or manage stress in the same way. Um statistically, there's there's some interesting studies, one out of Stanford in 2025. It followed women in the essentially the four years after menopause and found that earnings actually decreased 4.3 to even 10% in the four years after menopause. And so that's 10% that's not going into your 401k. That's 10% that you're not able to use to plan for retirement. It's really going to affect you in the long term. And I think that that's significant. Treating the hormone imbalance can actually, you know, affect your finances in that regard, if we're going to look at it simply.

SPEAKER_01 24:31

Yeah, I know one thing that can be daunting is just not only do you have to go to the call at these seven or ten visits before you finally get diagnosed, but then there's the financial aspect. And for example, you said you left the family practice situation, you're now not booking through insurance. What is the cost of call it hormone therapy?

SPEAKER_00 24:54

Yeah. So if you're looking, you know, down to the bones of it, an initial visit with me is 150, but in that visit, you're getting an hour-long appointment that is helping you really get to the root of your problems. People can use insurance for labs. Usually that runs about 150 to 200 for things that your insurance may not cover. But your insurance will dictate essentially how much they're going to cover with your labs. With regards to the actual medications, they are commercially available. So bioidentical is a it's kind of a buzz term and people associate it with compounding pharmacies, but bioidentical means hormones that are the same as what your body is naturally producing. And we now have those commercially available. So you can use insurance and spend, you know, your $10 copay on a 90-day supply of estrogen patches. You know, so the the medications themselves are are affordable. I would say the the part that seems daunting may be the visit price.

SPEAKER_01 25:52

It's not as cross-prohibitive as I thought it would be. You hear these buzzwords and you're like, oh, I don't know how expensive it's going to be. When I spoke to my mom about it, who's 75, she was like, Oh my God, I wish I would have known some of these things during this period where I literally just thought I was going crazy. This is 20, 30 years ago for her. Since you've been actively practicing and doing what have been some of the things that someone's told you after they started hormone therapy, just out of curiosity.

SPEAKER_00 26:18

Have women that come in thinking they're getting dementia that are then able to focus and function and feel confident in their daily life. The comments that I get of I'm feeling alive again, or I feel like I have my brain back or my body back, that resilience, that confidence, I think that is really what makes me keep doing what I'm doing because I love helping women kind of navigate this life change and get back to feeling like who they were. And that's probably the most rewarding thing that I get from my job.

SPEAKER_01 26:50

What advice do you have for all the huntresses out there?

SPEAKER_00 26:54

Trust yourself. If something doesn't feel right, uh, it's your body, you've known it longer than anyone else has. Go seek care and find a provider that can help you. Find somebody that you trust that is willing to listen and that is credentialed to deal with these issues.

SPEAKER_01 27:12

And then lastly, what does the word rich mean to you?

SPEAKER_00 27:14

Yeah, I think rich is not necessarily a monetary gain. I would classify it more as being able to live a life where you do what you love and you can show up every day, pouring enough into yourself so that you can help other people. And not putting your yourself in a place of burnout, but equipping yourself to feel confident in your decisions, have good conscience with what you're doing, and use that to love people well.

SPEAKER_01 27:46

Thank you so much for being here, Katie. Thanks for having me. For all the huntresses out there, you can find her at gotmoxiehealth.com.

SPEAKER_02 27:55

If you enjoyed this episode of Talk Rich to Me, you'll love the Huntress Wealth app, where you can get more comfortable with money, make a financial plan, and make your money move. Sign up now at huntresswealth.com.