00:00 - Speaker 1

The following is an Operation Podcast production.

00:03 - Speaker 2

Women typically live longer than men, but they do live a significant portion of that in poor health. From that 2002 through roughly, I guess you could say 2023 or 24, the percentage decline in prescriptions was 82%.

00:20 - Speaker 1

In what other leg of healthcare or drug has that ever happened? If anything, it's the opposite, right, correct.

00:28 - Speaker 2

When we look at muscle. To me, muscle is the organ of longevity because it has so many functions and we lose about three to five percent of our muscle mass per decade. But it's definitely accelerated after you pass menopause. Why oh, I'm sure it has something to do with estrogen, I don't know Accelerated after you pass menopause.

00:45 - Speaker 1

Why? Oh, I'm sure it has something to do with estrogen, I don't know. While over half of women age 40 to 64 reported perimenopause or menopause symptoms, only about 8% received actual, confirmed diagnosis. Yeah, adequate training on menopause and perimenopause was never a very big part of what we learned, even as an OBGYN, very big part of what we learned even as an ob-gyn. Are we saying here that these comorbidities are because of perimenopause and menopause, or being in perimenopause and menopause, you are more likely to fall victim to these comorbidities and other illnesses?

01:18 - Speaker 2

so it's not a direct cause. What our body relies on in the ecosystem, in where it is optimized and functionality does its best, is in the presence of estrogen to the levels that it is during your 20s and 30s, but it really is. The body's ecosystem, or equilibrium, does take a shift with the decline of estrogen, therefore heralding the ability for your body to present with things that were maybe already there or didn't have the opportunity to progress because of estrogen being around. Hey, everybody, it's dr jessica shepherd. I am an ob-gyn, I am a clinical advisor for women's health at p-volve and the author of generation m. We have everything you need on this segment here for women's health and longevity, so so catch this session on Ever Forward Radio.

02:15 - Speaker 1

I would like to first kind of dive into redefining women's health and longevity. So when I say that women's health and longevity, what first comes to mind for you, compared to what do you think comes first to mind for women out there, is this even top of mind for most women.

02:32 - Speaker 2

I think actually it is not top of mind and I think that has to do with the framework of how women were socialized. Just the life that we live, I think it really is. We are so invested in taking care of a lot of other people rather than ourselves, and many times when we think of midlife, that really is that crux of time that we really get the opportunity I'll say it as an opportunity to do some things a little bit differently in order to prepare for that next chapter of your life. And I think that in that, longevity really isn't one of the hallmark terms that comes to mind for most women, and I think it is rather new when you think of the industry in general of health and wellness.

03:16

Longevity, what does it really mean? And what do you think of quality of life and how you're showing up later on in life in your 70s, 80s and 90s? Right, we're living longer. Women typically live longer than men, but they do live a significant portion of that in poor health. So how can we reframe those last few years? To be more functional, to be thriving, is really what we do now in midlife.

03:41 - Speaker 1

I love it. This is exactly why you're here. I love how you kind of already are reframing health through a mindset lens looking at opportunity before we get into all the other scientific goodies.

03:54

Start with mindset. Start with this opportunity. How could you maybe help the the woman listening or the partner listening right now who is struggling with their partner is struggling with just flipping that switch or getting into? No matter what my health situation is or is not, right now, I do have an opportunity to allow it to continue or I have an opportunity to change it or to get ahead of it. How can we start with opportunity? How can we start with mindset first when it comes to our health?

04:23 - Speaker 2

Yeah, I think mindset is one of the key things that you have to focus on, because, if you think of when we get to that time frame in our life, it usually is based on habits, routines, things that we've done for many years, and many of those habits and routines have to change.

04:36

And that is easier said than done.

04:38

And that's where mindset really is a big part of that, because we really need to change the mindset in order to then start the action right, I always said that the mind is really what navigates how we do things in the body just follows through, and so if you can start there, then you can start to change some of the intentions that you have for yourself or the routines and habits that you've already formed, which is why the brain is so good at what it does, but it loves routine and habit You've already formed, which is why the brain is so good at what it does, but it loves routine and habit.

05:12

So, in order to change that narrative is to start with mindset first and say how do I want to show up for myself and usually it has to be very internal in order for you to continue in that progress of change and then also community. I think that community plays a big part in who's there to support you and show up and get you through those rough days. But mindset really will propel your body into doing the thing that you want it to do.

05:32 - Speaker 1

I feel like I probably know the answer to this question but I want to ask you directly was this something taught to you in medical school? Was mindset ever? Was it an elective? Was it a part of a seminar, and where did this come from for you if it wasn't taught?

05:47 - Speaker 2

Yeah, it definitely was not a course or an elective rotation that we did in med school because you know, I really honor medicine for what it is and the amount of years that we spend really studying very furiously and very intently for so many years, like 14 years. Most people will say that when they started the whole process of medical and pre-med going into, oh God yeah.

06:11

Fellowship, all those things, but what we do focus on is the art of pathology, right, and when someone is outside of a quote, unquote normal phase, right. We're really good at fixing bad, and we're really good at fixing pathology and abnormal and what we haven't been taught, and for good reason, because when people do go in that category, most people don't know how to fix that. So that's what we're there for. But if we can change the narrative to how can we allow people to be more in the well space that is? I think you could even think of all the different obstacles that people have to stay well, there's a lot of them out there, and I mean we can go into a whole nother section of nutrition alone, right, and so I think that we're not taught that. I think that we could do a better job and I do see some improvement there, but that will take time to get to the point where a physician truly understands the well span versus pathology.

07:13 - Speaker 1

Ladies, if you've been feeling unlike yourself lately, maybe your energy's low, your mood is off, sleep is inconsistent at best, or weight gain and brain fog are creeping in. It's not just getting older, it could be your hormones. Hormonal shifts, especially through perimenopause and menopause, can dramatically impact how you look, feel and function. The key is knowing what's really going on inside, and that's where my partners today, Joy and Blokes, come in See, Joy is changing the game for women's health by offering simple at-home diagnostic lab testing so you can get a clear picture of your hormone levels and overall internal health. And if you're considering hormone replacement therapy, HRT Joy offers safe, personalized plans backed by board-certified experts designed to help you feel balanced, energized and like yourself again. Right now, you can take the first step and save 50% off any one product or diagnostic lab when you go to joyandblokescom, or use code CHASE at checkout. You can head to j-o-i-a-n-d-b-l-o-k-e-scom slash chase or use checkout code CHASE for 50% off either of those two options. Knowledge is power. Know your body, Support your hormones. Start today.

08:32 - Speaker 2

Now for me, I think that's where I'm a little bit different, because I had a background in exercise physiology. So I truly understood the mechanics of the body and what the human is capable of doing with effort and seeing at its best, what someone can do as far can accomplish and achieve. And even in the light of pathology there still is that light of what you can do outside of that, and so there was always kind of this hope behind. You know how I practice in bringing out the best in people. I would say you know, even in my practice now it is, the hardest part of my practice is inspiring people to turn that narrative around or to partake in the things. That's really going to help them in the long run. Consistency is key, but it is hard work.

09:33 - Speaker 1

You know, you were kind of just hitting on it. But even people that are, you know, air quote here well, you're in good health, you have good health, thank God there are barriers to that of staying well. Or you know you get a sickness and injury and then you know you have to deal with it. But I think it's even more difficult for someone now who is a type two diabetic who maybe is in a less than ideal socioeconomic status, or the whole world of nature and nurture.

10:01

You grew up not knowing any better and so what you, what is your perceived norm, is objectively unhealthy. So for someone who is not even in the well state yet can you kind of just want to go a little bit deeper there, and you know cause. I think for them to hear a doctor go mindset first, or mindset is a great place to start when trying to get well regardless of age here.

10:26

That's probably got to land a little odd to most people. Yeah, I think most of us have to convince them a little bit more, right oh?

10:32 - Speaker 2

yeah, we got to find different ways to draw them into this realm of wellness, because it really is a different feature to how you live. Right, it really comes with planning, being intentional and setting kind of goals for yourself. So typically, I always love you know, I love this saying is that curiosity breeds growth and sometimes, just you know, a few more questions or reading just a touch more doesn't have to be overwhelming, but the more that you crack at the what is behind the curtain of wellness, but the more that you crack at the what is behind the curtain of wellness, I think that that's where you can be inspired to find what works for you Staying authentic, staying authentic to who you are, whether it's like a cultural thing, whether it's a what my community is right. You can still stay true to that while still getting into the scope of wellness. And I think that's one of the misnomers that I think is out there is that you have to be a certain size frame category in order to achieve the best in wellness, and I think that that is that is something that can prevent people from wanting to get into that space because there's a fear of it or there's a notion of I don't look sound, you know, feel like that. So therefore, I can't do that.

11:49

I think one of the best ways for people to see wellness at its like grand stage of whoever you want to be in you can still accomplish, is like the Olympics, like think of the difference in body shape, size characteristic of all these different athletes who are accomplishing like these major goals. And you would be like I never thought that they would be able. I did, and that is, I think, the underlying theme of wellness that we should embrace, rather than it has to be a certain thing. I'll give you an example of like yoga, right. So yoga, its fundamentals are from India, right, and when it was kind of, I think, modernized or brought to America, it was great because it really is mindset. But then it became more of an exercise, which is fine I actually don't have a problem with that but kind of chipping away from, like the intention of it. And then it became a certain type and a certain look and a feel.

12:46

And then it actually became more inclusive, or exclusive rather than inclusive. Right, right, and so now we're seeing kind of a shift in that where anyone can do yoga which was the intent anyway. Right, and it really is based on mindset, and now we are coming back to that in mindset first, and then really nurturing that so that your body reaps the benefits of that too.

13:10 - Speaker 1

Where do you think most women are right now In America? We'll say when it comes to I feel like I have good wellness, I'm not in disease, or even if I do have an ailment or an illness, I'm navigating it in some capacity. What do you think is the general mindset of most women right now in America when it comes to their health and wellness?

13:32 - Speaker 2

I would say, if you looked at it from the entire population, I wouldn't say that it's categorically well. I think that there's still so many barriers for women that is not their fault that prevents them from entering into the wellness space.

13:49 - Speaker 1

Like what.

13:49 - Speaker 2

So that can come from being the primary person who has to do all the caregiving at home, whether it's with children, whether it's with older parents, managing If there is now a career woman who's like really reaching her heights in career.

14:05

We have seen already that, even from economics, if you want to bring it down to an economical standpoint they are paid less on the dollar than a male Right.

14:13

So there's that where they're not getting the full benefit of their return on investment for their expertise, and most times I would say, women who are in a career and really rising still have yet the burden of the home to take care of. So in that, what I have found is that women who do want to try their hardest to be, you know, just do a little bit more for themselves and wellness than they have constraints of what is the expectations for them to fulfill in their home, of what is the expectations for them to fulfill in their home, the barriers that we just talked about with childcare and career, aging parents, and so I do feel that there is a category of women who do want to do that, but it is a little bit harder for them to accomplish it. And then for women, if you think of we had mentioned it earlier in maybe a less socioeconomic standpoint don't have the capability to do the thing that they would want to, or even knowing that it's there. So I think exposure is one of those big things yeah, that's so true.

15:15 - Speaker 1

That's so true. Um, where do you see currently the biggest gaps in how health care supports women? Um, in general, before we even get into perimenopause and menopause, oh, we're going to do this for a whole nother hour.

15:28 - Speaker 2

No, I'll shorten it. You know, I actually was at a roundtable very recently with women who were at the top of their game in many different sectors, whether that's with VC, financial, you know, retail health and one of the things is that we know that there's a major gap in women's health, and that can be even from the level of research. Women were not typically held in research projects up until like the 70s meaning like actually contributing to the research in the research part of the study, part of the study right.

16:01

So the physiology of women is is drastically different from men. So in order to understand the physiology and the path physiology of women is drastically different from men. So in order to understand the physiology and the pathology of women, they have to be included in studies. So there was a lack of that. I think. Even when you look at what is the expected, whether it's a medication dosage or a reference range for a lab, many times women were not included in that and so it is hard to man their health overall if they weren't really inclusive of research. I think, when you think of innovation for women, when you look at VC funding, I think it's only 3% go to women founders. Still, yeah.

16:38 - Speaker 1

Wow, that's nothing. It is nothing. So you know like there's barriers. So then now there's funds, there's money, there's research.

17:02 - Speaker 2

And I'll give you another example. When you think of the pharma industry, in the last 10 years most of the top pharma companies have obliterated their women's health divisions. Obliterated, that's a big word, that's a harsh word, meaning so you can have a whole sales force, you can have a whole team that's devoted to outcomes on what women are doing on their medications, right? So, looking at outcomes, so they may still have the medication as part of their portfolio, but there's no engine behind it as far as who's going to get it to the right physicians or how the ads are placed or who knows what's out there. So I think there's so many barriers, especially when you are able to see that.

17:30

You know in the forefront, because I've been part of those industries, you know trying to propel them forward. And then you see the obstacles, and so I, you know, I think of being at those tables and in those meetings and seeing the obstacles at the level that we're speaking at, and I can only think of the women who have no idea that all of these conversations are going on or something was taken away, or that research wasn't offered to women, you know, as early or as late as the seventies. So they're just kind of trying to survive day by day and all these decisions are being made about their health and they have no clue.

18:05 - Speaker 1

Yeah, it reminds me of, uh. There was a show recently I forget what it's called with um Brie Larson on Apple. She was, uh, this budding um biochemist, I think, uh, phd I think in like the sixties or seventies, uh, and was all around this whole aspect of getting shunned from research, even though she was quite literally the primary contributor. She wasn't even, I think, like in the top five names of like this study or this work. So hopefully times are changing with that.

18:35 - Speaker 2

Yeah, I mean, I think the only way to really push that forward is to stay present and to be optimistic, to be advocates. Forward is to stay present and to be optimistic, to be advocates and I think that's where men really come into the circle of how we push that forward is to be advocates and adversaries as well.

18:53 - Speaker 1

Absolutely Well, let's get a little away from like health policy and the behind the scenes and when I really help my audience myself even more understand things like perimenopause and menopause. So what are the earliest signs of perimenopause that women, you think, often overlook?

19:10 - Speaker 2

Well, I want to frame it to what is perimenopause. I think that actually is one of the most confusing terms for women.

19:16 - Speaker 1

Yeah, define our terms, please yeah.

19:18 - Speaker 2

Because we do know about menopause. I think most people, if you were to say menopause, what's menopause? Are like even if I don't know about it, I've heard about it and menopause. I always like to define that first, because it's easier and they work backwards a little bit.

19:30

Yeah they will work backwards. But menopause is a very clinical term. It's a diagnostic. It really helps healthcare providers to be able to define where a woman is in a reproductive state, and so the hallmark is they haven't had a cycle for 12 months consecutively, meaning that their ovaries are no longer giving enough estrogen off, or estradiol, to elicit a cycle. So that means the end of their reproductive years. They can't get pregnant, they can't conceive, and the lack of estrogen is the cause of that.

20:00 - Speaker 1

Now does this typically land on the same, around the same year of age? For most women, there's an average age of 51.

20:08 - Speaker 2

But I have seen many of my patients who are 55 and still have cycles right. So there's no, I would say most 5152. But you do have some who might end at 47, some at 55. And then kind of pushing it back to perimenopause is that confusing time frame? Because it's almost like it could last 10 years, seven years, three years. There's no definitive start to it, there's no end to it until you get to menopause, and so that whole time frame is when women start to maybe have irregularities in their cycle right. So that's the estradiol kind of like going down and declining, as well as progesterone and testosterone and also the symptoms. So I like to categorize into two buckets symptoms and cycles right. So you may have a woman who has regular cycles all the way up till she's menopausal. Most will have irregularities right.

20:57

So that takes care of the cycle bucket irregularity, meaning what exactly in their cycle, so it can be in frequency flow duration always the same time they could have it every three months.

21:05 - Speaker 1

They could miss six months and then it comes back again, or now it starts to be heavier, sometimes it's lighter, it's just like all over the place and you know it's like you know, for years I thought optimizing my health was really just all about training harder, dialing in my nutrition, taking the right supplements during the day, and while all of that matters, what I've learned is the real progress happens at night. Sleep is where your muscles rebuild. Sleep is where your hormones rebalance, your brain clears out the clutter and stores everything you learned. It's the single most underrated performance enhancer out there. That's why I've made the new Dream Gummies from today's partner, cured Nutrition, part of my nightly routine. About 30 minutes before bed I take one, put my phone down, dim the lights and just let myself unwind, see each gummy blend CBN, CBD, reishi, mushroom, l-theanine and a touch, a touch of melatonin all working together to calm the mind and ease the body into deep, restorative sleep. I wake up feeling clear, restored and ready to train or podcast at 100%. So if this sounds like something that would add value to your life, if you're struggling with sleep consistent quality sleep you're ready to take your recovery and your mornings to the next level.

22:26

Check out curednutritioncom, scoop up the dream gummies or any one of their other amazing functional mushroom and adaptogen products. I currently am using so many of their stuff every day. I love it and at checkout you can save 20% with code EVERFORWARD. That's curednutritioncom. Check out code EVERFORWARD to save 20% off, because the real gains don't happen in the gym, they happen in your dreams. That sounds wonderful and amazing. I'm kidding, of course, but you caught me right there. You said it could go even six months. Yeah, I'm curious.

22:59 - Speaker 2

Without a cycle. Without a cycle, yeah.

23:01 - Speaker 1

Is there ever a situation, have you ever seen a situation where that happens? That's a long stretch of time and then the woman and maybe their PCP go. Oh yeah, you're going into menopause and like begin things like hormone replacement therapy or make changes too soon.

23:16 - Speaker 2

And then it kind of comes back. That's a great question and we can kind of tackle that later is because it's the treatment and that's what has changed probably in the last five to 10 years of treatment. So we'll put that in a like a pause for now, cause that's actually a really important feature that I want the women who are listening.

23:31 - Speaker 1

Cause. Things like misdiagnosis, early diagnosis are a very real thing for everybody.

23:38 - Speaker 2

And that's why I like to put it in buckets, so the cycle kind of like it can be regular or irregular and then you have the symptoms.

23:43

So the symptoms are when women can have changes in mood, irritability, decrease in libido, hot flashes, night sweats, sleep disturbances, changes in skin, skin ringing ear, so literally about 34 to 50 things that can happen, but it is not. Yeah, 34 symptoms and a lot of women don't connect the dots because we have kind of typecast perimenopause and menopause to the pelvis, right. But if you think about the body going back to like bringing it all together is that the body has estrogen and progesterone receptors all over the body. Going back to like bringing it all together is that the body has estrogen and progesterone receptors all over the body muscle, heart, brain and so when you decline the estrogen over time, that's when the organ systems are not going to respond as well because they're not getting the estrogen that they need. So that's why we start to see these symptoms start to occur, usually like very infrequently, not too severe, and then over time it starts to kind of ramp up until they get to that point where estradiol is like I'm out, peace out, I'm not here anymore I've heard um.

24:45 - Speaker 1

My wife is uh, she's an fmp and specializes in hormone, health and functional medicine. I've heard her talk ad nauseum about just how most people don't get. The most women especially, don't get the cardiovascular protective benefits of estrogen and estradiol. You kind of just hit on heart health. Can you go back real quick and kind of paint the picture? Because still in America and I think the world, cardiovascular disease is the number one killer of all people, not just women.

25:14 - Speaker 2

Yeah, all people. And I think that that is one of those statistics that really stops people in their tracks is that we talk a lot, and for good reason. We talk a lot about breast cancer, we talk a lot about cancer in general and other diseases, but when you bring it right back to it, I'm like heart health is imperative and that's the number one killer of women and all people. Back to it, I'm like heart health is imperative and that's the number one killer of women and all people. So the reason why estradiol is pivotal when we think of cardiovascular health is that most women who die from heart disease die after the age of menopause, right, so after they have depleted from that estradiol. And we know that estradiol is cardioprotective. We know that there are estrogen receptors on the heart. So it would only make sense that if you're depleting the body of something that a hormone, which is a chemical messenger, helps organ and its functionality is not there, what do you have? So it and it ranges from.

26:09

When we say heart disease, I think most people think of a heart attack, but when we think of heart disease, that really is the scope of now. My arteries are getting more firm, right, so there's no more flexibility or distensibility within. So that's what leads to atherosclerosis. Now we have plaque forming right. So then we have muscle strength and the ability for it to pump blood into the different chambers. That all decreases as well. So there's an aging component, but the aging is compounded with the decline in estrogen, which therefore you start to have this declining functionality of the heart muscle. Arterials are starting to and arteries are starting to stiffen and fill with plaque and it's just like it just keeps compounding. But estradiol is cardioprotective.

26:53 - Speaker 1

And these are all kind of what we call the silent killers. Right, Because it doesn't have to be to your point, just a heart attack.

26:59 - Speaker 2

There's no like oh my gosh, my arteries are stiffening today.

27:02 - Speaker 1

Yeah, when I'm like oh, I feel like my arteries are so stiff you know, it's not that, it's not that yeah.

27:06 - Speaker 2

It's very progressive, I would say, is like the most silent killer, because you don't necessarily feel hypertension.

27:18 - Speaker 1

Right, yeah, well, until it's, until it's killing across a certain point, right? All right. Ladies and fellas, too, if you're looking for the perfect gift for the men in your life this holiday season, listen up. Whether it's your husband, your boyfriend, your dad, your brother or even just a friend who could seriously level up his self-care routine, caldera Lab has you covered. Their award-winning men's skincare and grooming products make it simple for any guy, even me to look and feel his best, from their best-selling, the Good Serum one of my favorite products, by the way and the Clean Slate Cleanser, to their powerful hair care system that strengthens and nourishes hair as you age.

27:53

Everything Caldera Lab makes is clean, science-backed and designed specifically for men who care about quality and performance, without the hassle or guesswork. And right now, you can save 20% off your entire first purchase when you use code EVERFORD at checkout. When you use code EVERFORD at checkout. So skip the socks and gift cards this year. Give the guys in your life something they'll actually use and love. Head to calderalabcom. That's C-A-L-D-E-R-A-L-A-B, calderalabcom. Grab a bundle and make this holiday season the one where he finally starts taking care of his skin. How do you help women differentiate between, or how can we learn to differentiate between perimenopause stress and just other health conditions.

28:43 - Speaker 2

Well, I do like to embody and help women embody the fact that they all play a part right. It's never just one thing that's causing just one thing. And so helping women be more self-aware of what's going on in their body, but also learning that mind body connection Cause many times it stress can then contribute to maybe the severity of a perimenopausal disease, or stress can somewhat place more anxiety towards a certain symptom that you're having, and so that's why I think it's so important. And when we look at actual mood disorders, anxiety, irritability and depression the ages of 45 to 55 in women is when we'll see an increase in that and more diagnosis, and that's when we see a lot more prescription or prescribed antidepressants. But when you think of neurotransmitters such as serotonin and dopamine, which really are neurotransmitters that make us happy there are happy, uh kind of neurotransmitters, but they also interact with estrogen how so?

29:48

well, because they're. They're both hormones and they all message each other are they fighting for the same like neuroreceptor sites? They're not fighting for them. They are helping. They're helping potentiate right, and so when we think of thyroid, we see more thyroid disorders, and estrogen does have a connection to that as well. So they're all kind of talking all the time, communicating, kind of saying you should be doing this, hey, I'm going to do this and then when there is a disruption in one of those hormones, it usually will impact the other hormone that it communicates with.

30:17 - Speaker 1

And so we do see One has a downstream effect to all of them, most of them.

30:21 - Speaker 2

No, they just all. They're just kind of all talking to each other. And so when you have a decline in estrogen, its ability to communicate with serotonin and dopamine is therefore lessened, and that's when you start to see mood changes, irritability, and that's why we do have an increase in prescribed antidepressants. And they have shown in studies, when women are typically on some form of hormone replacement therapy or menopause hormone therapy, you do start to see changes and shifts more towards decrease and decline of mood disorders.

30:56

Yeah, I mean, that makes sense, it's all connected right, it's an all body experience and that's why I want to really help women understand that that's why those symptoms start to appear. That's why they start to occur is because your body really is dependent on estrogen.

31:13 - Speaker 1

What role does hormone therapy? You were just talking about HRT there.

31:17 - Speaker 2

What role does?

31:17 - Speaker 1

hormone therapy play in menopause management today, compared to a decade or two ago.

31:23 - Speaker 2

Yeah, now we can take that pause, but not earlier. I'll start with how it's different today than it was maybe 10 or 20 years ago.

31:36 - Speaker 1

I feel, like just by having conversations like this, I feel like only just because I'm in the wellness space, but I feel like we're having so much more education and just sharing of information, so that's gotta be a start right.

31:45 - Speaker 2

Yeah, it's definitely a start and there's a lot of work to do because of the WHI study, which was done in the early two thousands, really put a damper on hormones itself.

31:55 - Speaker 1

Yeah, can we maybe bucket that one as well and come back to that? Yeah, that one's pretty mind blowing as well. Not in a good way, not in a good way.

32:00 - Speaker 2

Exactly the horror story of the WHI, but from that. So it's kind of like when you think of, like someone who has to take care of the press of something when it goes bad. We're just trying to like repair all the bad press from that. So now we're restarting the conversation and that's why I starting to hear about it a lot more. We have really good evidence and data behind the benefits of hormones and that's why we're starting to hear about it more and kind of navigating women back to that space of hormones actually impact you from a symptom perspective, but also longevity.

32:32

And when we look at the numbers are actually quite depressing in the sense that only 5% of women today are on some form of hormone replacement therapy. So there's a lot of work to do. Still, even though we're hearing about it more, we really would hope or you know, when we look to the future see that number increasing, because we definitely know the benefits of what a woman can get from HRT. And so how it differs is we look at also differently. We don't look at it just for categorically, we still look at it just for hot flashes and night sweats, right, which is probably the most common symptom of perimenopause and menopause, and now I always like to put it in buckets again. I love putting things in buckets and kind of like separate it out.

33:14 - Speaker 1

I got to get some buckets here for the table. Yeah, we got to get some buckets right here for the table. We'll come back to this point and that point.

33:19 - Speaker 2

Is symptoms right. So we know hormones are going to dissipate or decrease the symptom that a woman is going through because we're replenishing, we're giving them a buffer of some type of hormone that the symptom was. Uh, the symptom came because of the um decline in that hormone, but also longevity. That one's a little bit more avant-garde if you, if you say um, not many doctors are talking about the longevity aspect of it, but usually the symptom perspective of which is why. To what you were saying about perimenopausal women being on hormones, or if they missed a cycle for six months and they were put on hormones, that's okay, we've changed.

33:56

That's one thing we've definitely changed in the last 10 years before I remember when I was training, we would ask a woman like over and over are you sure you haven't had a period for 12 months? We're just wanting to make sure that they were menopausal in their diagnosis before giving them hrt. And now my women who come in in their early forties and they're having these symptoms, I'm like this is quality of life, this is a symptom. Let's put you on HRT.

34:20 - Speaker 1

Yeah, so now can we go back to the WHI study. It was the Women's Health Institute or Women's Health. Initiative.

34:27 - Speaker 2

Excuse me, it happened what like maybe a decade or so ago it was oh no, that was 20 years ago. It doesn't feel like that it was. Oh no, that was 20 years ago, it doesn't feel like that long ago.

34:36 - Speaker 1

It was 20 years ago, so walk us through what when? I remember now, looking back, when it came out, it was a very landmark study, it was very like progressive um, but it kind of steered the ship in the wrong direction. For women, for women's health care, uh, for what reason?

34:52 - Speaker 2

the reason was so this was a great study. It was up to 40,000 women that were in the study, so it was like landmark in the sense of A huge rainy study. When you have a power that big.

35:01

I mean you know that you're going to have outcomes that are going to impact a wide population of people, and so that was a good start. I think the intent of the study was phenomenal and the study was actually for a cardiac based study. It was looked at heart health and it was looking at the impact of hormones on heart health, right, so it was from a cardiovascular perspective In the study. They had many arms right, so they had arms who were meaning people in the study who were on this certain drug. Some were on estrogen alone, some were on estrogen and progesterone.

35:31

The downfall came of that study, when every study has like a limit, when you think of what is the limit of what we will say. This needs to be looked at, the study may need to be stopped. We really need to look into that, which is what every study should have. And in the breast cancer category and also for cardiovascular incidents such as stroke, cardiac events, there were increased levels of that. But you have to know how to read a study, right? That's the most important part is what does the study show? What is the relative risk? So, going into epidemiology and we're not going to do that today, but they stopped the study, yeah, and from that what came out? It was a lot of media like sound bites estrogen causes breast cancer and that's what people ran with and ran in the streets. I mean like everyone was running in the streets like get off estrogen. I mean even health care providers, that's all was being spread around.

36:34 - Speaker 1

Stop that, I mean doctors like stop prescribing it. Stop prescribing it, do you want to?

36:38 - Speaker 2

hear the statistic behind that. From that 2002 through roughly I guess you could say 2023 or 24, the percentage decline in prescriptions was 82 percent in what other leg of healthcare or pharmacy?

36:56 - Speaker 1

I can't talk today, excuse me, drug. Has that ever happened? If anything, it's the opposite, right, Correct.

37:02 - Speaker 2

So there was a significant drop, I mean, I think, in the education perspective and like a healthcare perspective providers, they weren't really given like the fundamental reasons on what was found in the study until years later, and so kind of that knee jerk reaction was uh, patients were like I'm coming off healthcare providers Like I'm not writing that, and then it just stopped, um, and you know I I think it's long enough that we can say let's put that to rest and move on. But women still come into the office and saying is this safe, which is a good question, will I get breast cancer? And so now the education has to start in how to kind of give them contextually because I can't go into statistics about it, but contextually what that is. So I would say three points that I usually give when someone has that fear is we already talked about it? Yeah, there was a significant. No, it wasn't actually even significant. It was not a significant increase in breast cancer.

37:58 - Speaker 1

It wasn't statistically significant.

37:59 - Speaker 2

It was not statistically significant, the risk of you dying is more so going to be placed on cardiovascular disease, I'd be like you can put breast cancer, you can put uterine and ovarian cancer together in the same bucket. Heart disease will still win right. So there's that. And also when we look at the main reasons why women have a long-term disease or die from later on in life is dementia, cardiovascular disease and osteoporosis, and they break a bone, a hip, and then they have a really sharp decline in quality of life or living.

38:31

You know all cause mortality, and one of the things that helps, those things as estrogen like directly linked. So I always put it back in their space of here. I'm going to give you statistics and truth. In fact, you get to decide, because if they still walk out of that office after having that discussion and they still don't feel like they want to start estrogen, I am still okay with that because at least I know, you know what the truth is. Now, if you decide I want to, then at least you still know the truth. At the end of the day, you have that self-advocacy to decide what you'd like to do.

39:06 - Speaker 1

What do you think it's going to take now from a public health initiative, from a provider level even initiative of kind of rewriting this? Yeah I'd say even misinformation, but just rewriting this whole new narrative of estrogen hormone replacement therapy for women, because that kind of left such a bad taste and in most of the public's mouth, bad taste in the public mouth.

39:30 - Speaker 2

I think there's two things to that. I think we have started to see it in the consumer side and for women who are just like oh, I heard about estrogen, now can I get it right? So there's that kind of push from them going to their providers. But then also now we need to educate the providers on those statistics and how the benefit outweighs the risk by any day. I even have patients who have had breast cancer and now, because of whatever treatment they've been on, maybe their ovaries removed, and everyone's like oh my God, don't go on estrogen. They're like I can't live like this, I can't live with these hot flashes, I can't live with this irritability. I'll take the risk Right. So it always is. There is a risk with everything. You get to assess that risk for yourself personally and decide do I want to take that risk?

40:10

I mean, we bungee jump I mean we jump out of planes, don't we?

40:13 - Speaker 1

There's risk with that I love jumping out of planes. I love jumping out of planes, so everyone has to have a risk assessment. What's that?

40:20 - Speaker 2

movie where he, like it, was a funny movie. It was Ben Stiller and he was the risk assessment.

40:26 - Speaker 1

Oh, along Came Polly. Thank you, yeah, right, yeah.

40:29 - Speaker 2

So I think, like that's how we we get to live our lives.

40:32 - Speaker 1

That's a sleeper comedy, by the way. Pause this podcast and go watch A Long Game of Polly. It was so good.

40:36 - Speaker 2

I thought it was a great movie, but his whole thing was like how much risk is assessed with this?

40:41 - Speaker 1

like one activity. He had to assess the risk of this, like Australian girl-seeking CEO, wasn't it like Ben?

40:48 - Speaker 2

Was. Who was the guy who was always? Oh no, it wasn't him, it was just some random. It was some other, some other guy, but he would be like I'm jumping off a building right now his meet and greet was a base jump in like the opening line exactly spoiler alerts, but uh yeah yeah, it's so true.

41:02 - Speaker 1

Yeah, and this is again. I hear my wife talk about this all the time because I think this is an important through line for women perimenopausal, menopausausal, but for everyone. When looking at your health, your life, it has to fundamentally all come down to risk versus benefit. Risk and that is so I think, objectively, we can say some things that are in each of those buckets for most people, but ultimately, I'm not you, you're not me. We know what our quality of life when it's on and when it's off. I'm using that information to drive the rest of our information with our provider of epigenetics, family history Am I sedentary, am I active, what's my nutrition, what's my sleep? Use all that to make a more empowered and informed joint decision with your provider or team of clinicians.

41:51 - Speaker 2

In some capacity, it has to be this you know what's best for me, it's a balance, and here's what I always say you can start HRT MHT today and, in two years, decide you don't want to do it. You get that choice. Or you can not start today and then in six months being like you know what. Let me get on that.

42:08 - Speaker 1

HRT and I'm like great, let's do it.

42:10 - Speaker 2

You get to change your mind.

42:20 - Speaker 1

I did that. I was on TRT for about 14, 15 months and I've been off now entirely for almost two years, or at least like 18 months.

42:24 - Speaker 2

So tell me like what was your decision-making process?

42:28 - Speaker 1

So for me it was I think for a lot of guys specifically, but I think you know women as well it was just a drop in motivation. I turned 36. I I tell people I didn't start feeling 30 until I turned 36 and it was decreasing motivation. Uh, it was taking me way more work in terms of physical activity sleep exercise nutrition to maintain my preferred body composition, to keep muscle mass.

42:53

um, I mean, I've been in it personally and professionally in the health and fitness game for two decades and I was having to just like sit down, height myself up so much just to get off my ass and go to the gym.

43:06 - Speaker 2

And that's the same thing that women feel, and testosterone is great for them as well, like the same features that you were just expressing, and so again like quality of life. You're like what is going on, yeah.

43:18 - Speaker 1

So it was that coupled with and I got my labs um, because I know how I felt I wanted the qualitative and the quantitative data and they weren't terrible. My T was, uh, I think in like the mid five hundreds it's not terrible, but my free T was on the lower side. My uh sex hormone binding globulin was a little bit on the higher side right, so I wasn't able to maximize most of what I had so your conversion and then your kind of like absorption to the globulin was there's something yeah awry there, yeah so I went on trt uh, I forget my exact dosage, but I tiptoed in.

43:52

It wasn't anything crazy. Uh, I titrated, I did it, like you know, twice a week, or I guess you call it microdosing a little bit but then I got amazing results. My motivation was back, body composition was there, and those were my two main things. But then, like anybody well, I think a lot of people, that's an important factor as well your goals can and will shift, especially as you age. So my drive for wanting to go to the gym, the same frequency, my drive for, you know, motivation shifted into fertility. My wife and I wanted to start getting pregnant and you know, with tea there comes the risk of decreasing, especially for men, fertility, lowering sperm count, um, and so I. I always played it safe because I knew we wanted kids. So I began, I titrated off, I lowered the dose and then I went on, um, uh, uh. What's the medication? And clomiphene, yes, I did that for 90 days and then off entirely, and then now, boom, I have a seven month old.

44:49 - Speaker 2

That's great.

44:50 - Speaker 1

Yeah.

44:50 - Speaker 2

Do you see that decision-making at its best, risk and benefit analysis at its best? I love that personal story.

44:57 - Speaker 1

Yeah, thank you.

44:58 - Speaker 2

I try to weave in my story a little bit, I think you know, I think in the expert field, when you know people may listen or hear or be in company of that, the personal stories really matter, and so that's why I always share, like my story with patients and you know, I'm on hormones as well.

45:16 - Speaker 1

What is your story?

45:16 - Speaker 2

Yeah, story with patients, and you know I'm on hormones as well. What is your story? Yeah, I think you know, for me being perimenopausal, you know, being almost 50 we can cry later.

45:24 - Speaker 1

I turned 40 in a few weeks. Yeah, so we're almost sitting those next decades together.

45:29 - Speaker 2

I know we're like hitting it. And so my first symptom which is funny because, like this, is like my wheelhouse again it's like those subtle things that start to happen and you're like wait a minute, did that happen, did this happen? And mine was cognition, so being able to remember things. Multitask was probably or concentration, like you're literally talking to someone, and either like forget what you're talking about, forget a word.

45:55 - Speaker 1

Just kind of like blank mid-sentence kind of thing and you're just like.

45:58 - Speaker 2

That was a thought when it was there and, and I just you know after some time you're like, oh, something's, then you start paying attention to it because of the frequency of it so I was just like that's so weird maybe I'm stressed.

46:10

You know, you go through the whole thing maybe I'm stressed, maybe I'm too busy and then I was like holy shit. I was like I'm perimenopausal, and so my first actual introduction to hormone replacement therapy was testosterone, because I knew for cognition. I knew that that's where we do really see some, some benefit to testosterone. I think a lot of people only associate it with libido, but for me I was like all right, well, I already work out a lot, but I could maximize some of my muscle building potential, but also the cognition. And so I started out with testosterone. And then and I didn't really have hot flashes, night sweats, which estrogen is amazing for, but remember we were talking about the buckets I was like longevity wise, I want to be able to kind of start the process now, and so I started adding estrogen in my therapy regimen.

47:00 - Speaker 1

Around. What age was this for you?

47:02 - Speaker 2

So if I'm 48, so it's about like two years ago, okay, so it's about 46. And I noticed the changes in my energy and the cognition in the areas that I spoke about, and then in estrogen. Really, for me it wasn't for symptoms, so I haven't really noticed a change in a symptom because I never really had one that was specific to estrogen. But I do know, and I'm sure you've heard of that study where I think it's 44, 46, and then 65, where you have these main things in your life, where you start to change your epigenetics, like the aging process, kind of like really curtails.

47:37

Yeah, so they've identified two ages at which kind of like. You know, if you were to look at a graph like your decline afar of aging, I mean, as your cells start to age, you know your organs are like, why are we still here? So that hallmark is, I think it's 44, 46. And then again it's 65, 46 and then again at 65, I believe it is, that your body starts to take like this toll, like another big, significant decline in the aging process, and so I knew I had just passed that and so I was like, let me maximize as much as I can, um, and you know, then the supplements.

48:12

I don't, I don't take a ton, I'm not like a supplement whore.

48:15 - Speaker 1

But you're a supplement whore. I want to hear about your regimen when we finish, but I focus on vitamin D, because my D was very, very low.

48:24 - Speaker 2

I focus on creatine, again for working out, but also for brain health, and then sometimes I'll dabble in like CoQ10. I would say, I'm just not the best consistent person, but CoQ10 and then Urolithin.

48:40 - Speaker 1

Urolithin A.

48:40 - Speaker 2

Urolithin A is probably my four that I focus on.

48:44 - Speaker 1

Love it. We're in the same company. I take ubiquinol for CoQ10 daily. Now I've been taking Urolithin A, probably pushing three, four, almost four years.

48:54 - Speaker 2

Oh wow, yeah, I think I'm probably pushing three, four, almost four years. Oh wow, yeah, I think I'm only like about eight months into it.

48:58 - Speaker 1

That for me was probably, and actually I went off of it for about a month and a half, almost two months, to kind of do a self-test. That for me was the biggest mover in my daily baseline energy, above anything.

49:11 - Speaker 2

All right, well, I'm going to get. I'm going to make sure I'm more consistent with it. It's so good. All right, well, I'm going to get.

49:16 - Speaker 1

I'm going to make sure I'm more consistent with it.

49:17 - Speaker 2

It's so good, it's so good, I got some, even though the brand I use timeline yeah, I use timeline too.

49:20 - Speaker 1

We got the gummies out here. Oh, I already had them. They're so good, they're so good. Yeah, see, doctor approved. And you know, shout out timeline because actually and they are a partner, a sponsor of my show- but I love how they waited years.

49:38 - Speaker 2

They now have, I think, 12, 13 years of human clinical evidence showing the efficacy. Yeah, I would definitely say that. And, um, I, I've looked into their products and then so I have the powder, the pills but I need, maybe I need the gummies now.

49:46 - Speaker 1

The gummies are great. Yeah, I'm a I'm a supplement whore, but also a gummy whore. I got a little creatine gummies, any of that stuff, yeah now we know too much about you. Huh, this has got to be HIPAA compliant. I can't get up any, can't give up anymore. So, speaking of, let's kind of get into the science of longevity and healthy aging here a little bit. What is some of the latest science telling us about women's health span and how we can extend it?

50:10 - Speaker 2

Yeah, I think so. There was a pivotal study which I help my patients with because it kind of falls into like the glp category is when we look at muscle. To me muscle is the organ of longevity because it has so many functions and we lose about three to five percent of our muscle mass per decade, but it's definitely accelerated after you pass menopause. Why, oh, I'm sure it has something to do with estrogen, I don't know. And also testosterone. You know testosterone takes a steady, uh, decline from the age of 35 in women, right, so you have the steady decline.

50:39

Then estrogen, kind of like, falls off, falls off a cliff at, you know, when you 51, 52, but it was already on the decline through your 40s. So if you know that muscle mass is starting to decline in your 30s and three to five percent per decade and then compounded, you know, after menopause is, the goal is to how do I restore muscle as much as possible? Because that's gonna help with your glucose control, helps with cognition, it definitely definitely contributes to maintaining that muscle strength in the bone muscle complex so that you don't have frailty issues when you're older. And so for me, women really have to worry about bone density, sarcopenia, absolutely, you can really alleviate, so that you don't have frailty issues when you're older.

51:16

And so for me, women really have to worry about bone density, sarcopenia Absolutely, and you can really alleviate that by focusing on muscle-centric work, and that's why I was talking about the compounding of muscle loss after menopause is because, not that men don't lose muscle mass either, but they don't go through that kind of critical point of menopause and estrogen loss which, like, really curtails the loss as well.

51:38

And so I think that one of the biggest things I've tried to, you know, impart on myself as well, but like my friends and my patients, is really resistance training, strength training to build that muscle mass back. You know, to kind of go against that sarcopenic change, to go and help you with your glucose management, because glucose to me is that wheelhouse of how our body functions and when it can't metabolize glucose and when too much glucose is lying around, that's when your body's not utilizing this fuel and that's when it's sitting there. And when it sits there we all know it converts to fat. So I'm like and things like diabetes Absolutely. So it's the control of it, it's making sure that we're staying strong, but also helping with brain health as well. There's a big impact on muscle mass and brain health too.

52:25 - Speaker 1

What would you say right now? The pun intended the first thing that comes to mind, the biggest thing that comes to mind, when looking at muscle mass and brain health, particularly for women.

52:34 - Speaker 2

Yeah. So the brain health, particularly for women, yeah. So the brain health comes with a lot of the neuroplasticity that we were talking about. So as your muscles are staying strong, so your movement right, so it's more in the movement part of what your muscles are able to accomplish, that's going to fire to the brain to do that movement right. So we typically, as we start to get older, become more sedentary, just from nature, biology. I think a lot of it has to do with society, I think the westernized society in general, because if you look at, oh, you're aging.

53:01 - Speaker 1

Slow down, take it easy, take it easy. No, we should actually be encouraging the opposite, absolutely.

53:17 - Speaker 2

Because when you look at blue zones, the people that live the longest and the healthiest are people who live in areas where they have to. What move it was all about. Movement was what kind of sustained them in the aging process, and so that has a lot to do with balance, flexibility, posture and then learning movement your brain to remember the movement is enhancing your cognition and your ability to kind of like fire off the neurons, which keeps them young beyond disease.

53:36 - Speaker 1

How can women thrive physically and mentally in their 40s, 50s and beyond?

53:42 - Speaker 2

Mindset. We've already, you know, started our conversation with that as mindset and I do think that there has to be a shift in how women see themselves. I think, if you think society or societal pressures on women have been to their worth, like I guess you can say, and not in a good way, is placed a lot on reproductive years, right, like, kind of like that's what they're. Obviously men can't have children, and that's what we're really good at, because we can do it. But I think we've placed like a almost like a price tag on it in the sense where, if you think of career, if even if you think of Hollywood, right, and actresses have said this like, after a certain age, and it usually kind of like is right, with that reproductive timeframe ending, there's a lot of decline in confidence worth, uh, what your value is.

54:32

And so with that comes oh well, mental kind of like, oh well, what am I here for, what am I useful for? So then you have kids leaving the house, right, and so then there's now to take care of elderly parents, and so, again, that shift is away from focusing on them personally, while all these things are going on biologically. So it's this really like pivotal time that we really have to change the narrative of you get to have an opportunity to really allow the second chapter of your life to be vibrant. But it's going to take some work and that's not always the fun part, but it's so worth it. What?

55:12 - Speaker 1

do you think is one thing a woman's partner can do, that is not only just going to be supportive let's say perimenopausal or menopausal but what can they actually do? What can I do for my wife when she gets to this place in life that is actually going to move the needle and help her through this next health era?

55:32 - Speaker 2

I think a lot of it has to do with emotional capability and emotional distensibility, because as women we talked about it earlier. But the irritability the mood changes right is something that can occur and I think the strengthening during that time frame from the mindset has to do with these changes in emotions. What is my worth Does my partner see me as the same person is to be that emotional support and not to fix. I think men are really good at fixing things like they want to fix it, we think we are, we try at least.

56:04

I mean, I was gonna let you say it, we try, but I think you know just being that emotional support and how can I help? How can I best help you through this time frame? Or even being supportive in the physical feature of it of let's go take a walk together. Do you want to work out together? Or is hormone replacement therapy something that you would like to start, because I'll support you in?

56:29 - Speaker 1

that right.

56:30 - Speaker 2

I think the support is sometimes something that we want, want but maybe don't voice it as well as we should or knowing how to voice that, and I also think that for so long, this is this is where I I see most of the issues between partners when they come in to see me like a woman who's like, oh, I don't know if I can do that, or is because we have created this, that it's icky and like taboo to talk about this change right. So most women will be like, well, if it's taboo already, I'm not going to bring it up, and so they suffer in silence. And I think that's kind of like a mismatch for people who have partners and spouses is that intimacy of what is going on with your life emotionally is missed, and then a lot of times when that emotion part is missed, some of the other layers start to fall apart.

57:20 - Speaker 1

I want to go back, if I can, and revisit your first tip there of the emotional support for the partner to be more emotionally supportive. You know to be there more for their partner. Can you maybe? I want to dig a little bit deeper. Can you kind of explain scientifically what are we actually doing by me being there for my partner, by me being more emotionally supportive? Help me understand from a scientific level what is that actually doing for my partner? So maybe because you know sometimes when we understand how and why things work it kind of just like anchors in a little bit better.

57:52

So from a scientific perspective, what is going on with my wife when I am there for her more?

57:58 - Speaker 2

Yeah, asking the question and lending the support, instead of having them to ask you I need this, is I'm coming to you to shoulder this burden, to take, to kind of help. Take the burden off of her of having to think it through or who should I tell, how do I tell? So there's that, it's kind of like a landing place, but in that what happens is we've seen in science the connection when people have emotional intimacy allows them to strengthen their ability to accomplish the task Right, and so that we see that as people age, or we saw that during the pandemic and where we saw isolation.

58:36 - Speaker 1

Oh yeah.

58:37 - Speaker 2

Right, isolation, feeling like displaced I don't have anyone around that kind of emotionally is just there can create a lot of physiological damage or physical damage, right, and so I do see that women so this is out of the context of perimenopause and menopause is when we think of like chronic pain, chronic, any chronic pain syndrome a lot of fibromyalgia, yep, all of that is a lot has to do with what is the support around that and who is there emotionally for that person can help alleviate some of that pain, right.

59:16

And so that's where the mind body connection comes in, and being able to support the mind so that the body can do better.

59:22 - Speaker 1

Yeah, Great, Thank you for that. So we touched on, you know, perimenopause. Can we kind of shift gears into you know the next stage?

59:30 - Speaker 2

Yeah.

59:30 - Speaker 1

Menopause. What's going on there? Is it you know? Is it you know these signs?

59:37 - Speaker 2

and symptoms, the age, all this stuff you know. Walk us through menopause a little bit more. Yeah, menopause, we said that kind of categorical age or the average age is 51, 52, and so this really is where the ovaries are, like we're peacing out, we're not giving really any estrogen. Uh, best of luck to you.

59:49

We're not really doing anything anymore, thanks right and you were like but you were so good to me. Um, so from that time of menopause until the day that a woman dies, they are post menopausal right. So there's no, I'm out of menopause, you were just menopausal until you die, and that's why it's like it's a clinical term, all it means is that you don't have menses, haven't had menses and your ovarian follicles are not giving off estradiol.

01:00:13

Now, typically in the first two to three years after reaching that menopausal age for any woman, if they have symptoms, that's usually when they'll intensify the first two to three years, and that's why we were always, I was telling you when I was training, we'd always wait for them to be like we're menopausal and then we would give them, you know, their hormone replacement therapy if they wanted it. And then after that, the body has a beautiful way, the body is a beautiful machine and it really knows how to. I guess you could say figure it out, and after some time, Homeostasis.

01:00:44

Yeah, homeostasis, we see that. You know that menopausal transition can occur from anywhere from two years, three years to even as late as when we think of symptoms, I'm talking about anywhere to like 11, 12 years. But they may. They may decrease. Typically they wane over those years and then they, the body gets into homeostasis where it figures out how to rely on itself without estrogen. From a symptom standpoint, and the women will typically not have symptoms as severe. But the other part of that is the internal work on the cells in the body without estrogen over time is why we start to see disease progression Right, so their symptoms may go away. And I even have some women who are like in their 60s or 70s who still have hot flashes. So there's no again. There's no like.

01:01:33 - Speaker 1

That's not common. It's not common. It's not common, but it's possible.

01:01:43 - Speaker 2

It's possible. It's possible. I say the vast majority will stop within about eight to nine or ten years and they usually decline over those course of those years. But really, what's going on, wreaking havoc inside the body from a cellular standpoint, from a metabolic, is the other part of the story that I think that we need to shed light on more, and that's what I try to really impose on when I'm speaking, when I see my patients is we're training for a marathon. This is not a sprint. And how do we prepare ourselves for marathon? Is consistency, because there's a lot of stuff that is going on internally we just don't see. But if you don't want the aging process to show up how you've seen it, maybe in your parents or your grandparents, then this is the opportunity. That midlife time frame is that opportunity to being like all right, marathon is starting now. I'm going to start training, I'm going to start small, I'm going going to be consistent, but I know the outcome, the return on investment is so great.

01:02:39 - Speaker 1

I personally have done things as I've gotten into my mid and late thirties now to help maintain and even improve my hormone levels, particularly testosterone. For the women out there, what are some key nutritional and even supplemental factors that can really help maintain, preserve, alleviate symptoms? What can they be doing from those angles to help with perimenopause and menopause?

01:03:05 - Speaker 2

Right. So I go back to metabolic and mitochondrial health, because those take kind of a hit as well. So when we look at glucose, I would say glucose is probably that number one kind of fuel or nutrient that we really have to pay attention to and that can come in the form of what we're fueling our body with, in the form of food, and that's when I really start to look at what does that pie graph look like for women? And what did we do, maybe in our 20s and our 30s, because we are metabolically more active, movement, we were doing more, but our bodies also were like I can metabolize anything at this point. So as that metabolic rate starts to drop, muscle mass starts to drop is looking at how can I now increase my protein source in order to fuel the muscle and offset the sarcopenia that's occurring? And so I focus a lot on the protein aspect in order to fuel the muscle and offset the sarcopenia that's occurring, and so I focus a lot on the protein aspect.

01:04:04

I look a lot at the supplements because I don't want you to wait until you're completely deficient in something before I would start to. You know, pay attention to it, and then how we prepare our foods. Obviously we live in a westernized world where everything is very convenient, processed, and so the more that we can offset processed foods and then also calories. When you look at studies as we start to get older, we really our body actually doesn't necessarily need as much caloric intake, and so how does that work? But I don't like putting that into the framework too early, because then what comes is that diet culture that I have to restrict myself completely of nutrition, and I was like that's, that's not the, which actually can be extremely detrimental.

01:04:44 - Speaker 1

Oh my god detriment.

01:04:45 - Speaker 2

I mean the whole diet fad trend is like that's not how our bodies function, right uh, so I heard in that paraphrasing here lowering sugar, lowering decrease, and alcohol, and alcohol.

01:04:58 - Speaker 1

I'm saying that like, because I'm like it's not fun to decrease alcohol, but I also, if you're a drinker.

01:05:04 - Speaker 2

If you're a drinker. But I will also say I am definitely not a doctor who's like you can have no alcohol. I mean, if you have cirrhosis, then yeah, maybe yeah, but it is no one you know. If you have cirrhosis, then yeah, maybe yeah, but it is it no one you know. I don't think that's a good way to impact and find change in people is to completely like what diet works where you know. I mean, we've seen diets in the in the past decades where I'm like wait, you can't eat what. No one can maintain that is it sustainable?

01:05:32 - Speaker 1

five to ten years and it's back and it's the opposite. Right also, I mean beside, you know, going back to your point earlier, a blue zones. Besides the Latter-day Saints, one of the other common denominators in every place, every group of people across the world that are living to be a hundred years plus, they consume alcohol. Yeah, they're not binging Limited amounts Limited and it's with friends, it's with community, and and it's with friends, it's with community and typically they're walking to get there. So it's not any of these, you know, silo things.

01:06:00 - Speaker 2

And that's why I think the silo approach in how we deliver information today is so dangerous because there's no complexity to it, there's no holistic view in how you're living your overall life. It's just very like don't do this, don't do this, and I'm like that's not helping anybody.

01:06:16 - Speaker 1

Yeah, I think in fact of all the centenarians. I haven't read Blue Zones in a while, but I think it's females in Okinawa, females in Japan.

01:06:25 - Speaker 2

Yeah, yeah, yeah.

01:06:25 - Speaker 1

They tend to like. There's a high percentage of them that live to be at least a hundred years or more, and it's women who walk to meet together I think daily, if not weekly, and they sit and talk shit, they talk, they spill the tea and they drink sake.

01:06:43 - Speaker 2

Yeah, isn't that amazing. I think that that again is looking at the complexity of life itself and being able to still enjoy it while still having, you know, limitations. But connection and community is a big part of that.

01:07:02 - Speaker 1

Yeah, so everyone's racing to drink sake now with their, with their besties. Um so, decreasing alcohol. If we drink, decreasing sugar, increasing sugar I would probably put sugar first. Yeah, if.

01:07:07 - Speaker 2

I were to like name one thing. Um, I was recently on a longevity panel, uh, with a PhD who has a lab and you know they they really look at things like exosomes and so they're looking at the aging process of cells, like the cellular aging process, to like a microscopic, and one of the things that they've categorically said is like sugar, additional sugar in your diet or like adding sugar, is like catastrophic oh, externally, internally everything I mean.

01:07:36 - Speaker 1

Now, that's how we get into, well, type 2 diabetes, but what we now see as type 3? Yeah alzheimer's dementia? Yeah uh, inflammation caused by things like excess sugar, glucose in the diet yeah, and what did we say?

01:07:50 - Speaker 2

exercise and all. So that's what I'm saying is it has to be exercises, nutrition and what we're intaking in our body using hormones, if you decide to, and then the supplementation of other things as well. But it has to be more than one thing, and I think when someone focuses on just one aspect of it, the outcome to me is not going to be as profound found now for women, particularly perimenopausal and menopausal, when we're looking at an increasing protein?

01:08:20 - Speaker 1

um, does uh, the old adage still hold up of one gram per pound of body weight of protein? Or yeah, I usually do like one to one point two one, two. Wow, I love to hear that per kg.

01:08:30 - Speaker 2

Um, what I will say is it is not easy to do, and so that I like to reassure women, because what I, what we are hearing now a lot is a lot more about hormones or a lot about protein intake and weight training like lift heavy, but we have to put parameters around that or teaching people how to accomplish it, so we can't just put taglines out there and expect people to just like by the next day. Rise to the occasion is because you can also fall into trouble if you just follow something but you didn't do it in a safe way or you didn't do it with really good knowledge base behind it. But protein increase to what your body should utilize is also.

01:09:09 - Speaker 1

Then you have to be exercising as well right, it's not just don't just like have the bigger piece of steak or protein shakes without actually giving your body a reason and need for that excess protein. I shouldn't say excess, but adequate protein, but adequate protein.

01:09:24 - Speaker 2

because also, if you're just increasing your protein but not finding a way to utilize it or using it to actually build the muscle store that you're trying to to get back from the loss, then you're not really doing the thing that it was done for.

01:09:37

And then also the type of protein and how you're going to incorporate it throughout the day. Don't like do it in one meal. Make sure that you're trying to like push it throughout the day. So there's so many different things to it, but I just believe that when we say things as an expert is to give parameters around it, reassurance and also guidelines.

01:09:58 - Speaker 1

So I found some recent studies, or studies at least, that have been published within the last five years that I wanted to kind of just share with you, and all this will be linked in the description box and show notes for you guys. I want to just kind of like share some recent pretty wild American you know American, us data at least and kind of get your your take on it and also what maybe can we do to hopefully improve these statistics. Uh, in fact, a 2025 survey of almost 5,000 women age 30 plus revealed a high symptom burden in frequent clinical help seeking Um. This underscores really the early and significant impact of perimenopause. Another one um from a 2025 analysis showed that, while over half of women age 40 to 64 reported perimenopause or menopause symptoms, only about 8% received actual confirmed diagnosis. How do those stats land on you and how can we improve them?

01:10:52 - Speaker 2

Oh, I think that those stats are probably very realistic in the sense that in the health care community you know health care providers adequate training on menopause and perimenopause was never a very big part of what we learned. Even as an OBGYN, I think that was not the biggest part of our training because it was not focused on pregnancy, right Fertility, and that's why I always say that that's the timeframe in which women are kind of revered. So after that they're like, yeah, your hormones are going to decrease and you'll be perimenopausal or menopausal. Perimenopause, I think, is the most confusing part of that whole transition because, like I said, it could start at 40, 45.

01:11:34

Is it a hot flash, maybe here and there? Is it irritability, is your sleep pattern disrupted? And so putting the pieces together, both from the patient, historically giving context, but also for the provider to sit there and kind of sift away possibly other things that could be causing that. Perimenopause to me is one of those like diagnosis of exclusion, like making sure it's not something more serious, or obviously not being dismissed as well, which I think a lot of the complaints I hear from women is they feel dismissed Because if you think about it, if you go to your doctor, you're just like. I just don't feel myself.

01:12:09 - Speaker 1

Yeah, we're like. Don't ever say that to your doctor. If you already have enough problems with them already, they're just going to dismiss you even quicker.

01:12:16 - Speaker 2

Right. So there's this dismissive nature, and then women get frustrated and then they're just like I'm not who, who else are they going to talk to about it? Who could help? And so it creates this cycle of I'm not going to talk about it, I was dismissed, and doctors being like well I what? The complex of perimenopause is.

01:12:34

So it makes sense. I think that we have to give more I think the word would be um intentionality around perimenopause and menopause as not just a symptom of a decrease in estradiol but a whole body experience, and we have to use that experientially to follow up.

01:12:58 - Speaker 1

Questions for that come to mind for me. One is our. Is a woman's primary care provider, just a family medicine provider, whether that's a PA, md, do, fnp, are they the best person to go to to maybe navigate perimenopause and menopause, or do they need to be going to fertility specialists, ob? Is there a better provider, more educated provider, to navigate?

01:13:21 - Speaker 2

No, I think that perimenopause, when you think of women in general, it shouldn't be that they should have to go to their OBGYN Do. I think that we probably, as far as like a background and how we were trained, might have the most uh, experience with menopause and hormones in general, but I don't think it should be just OBGYNs who are able to detect and diagnose and treat Absolutely not.

01:13:48 - Speaker 1

It's like a specialty or a certification a woman can look for with their provider to go. Oh like they've got some more training at least.

01:13:54 - Speaker 2

Absolutely so. When you look at the Menopause Society it's online. They have a I guess you could say a certification for people who, whatever discipline they are they don't have to be OBGYNs who can get that certification, which means that they've taken extra time to learn in a course and pass the course to be certified online in offering treatment modalities to women who are going through. That. That's good news. That's great. It is good news.

01:14:16 - Speaker 1

My other question from your original reply was with a lot of things we might share family history and go oh, my dad went through this, my mom went through this With perimenopause and menopause. If a woman talks to her mother or grandmother to get that data, does that really play a role in what they can maybe expect in terms of when it happens, when it stops and symptoms? Or is every woman, generation to generation, really different?

01:14:42 - Speaker 2

We are. We do know that typically when a woman is able to ask her mother and or grandmother, there are going to be similarities in the experience, whether that's like time of it occurring, menopause, any symptoms that may have been, uh, experienced by their previous generations. That can be definitely a good talking point to talk to them about. What we do see is that a lot of women, mothers, grandmothers, because it was not talked about they didn't know they were going through it either they were dismissed or they were.

01:15:17

no one was talking about it. So there is not good recollection for most women and maybe I'm wrong for saying most, maybe for some women of asking their mother, but like, even in my experience, like it wasn't something talked about.

01:15:31 - Speaker 1

They can't even firsthand go, even though they lived it like oh for sure, they have no idea Exactly.

01:15:36 - Speaker 2

So, and then the other part of that, too, is epigenetics and environment. Right, we are seeing shifts in the age of women going through perimenopause. What that experience is like, just because of you know where we are in innovation, what we're exposed to environmentally, I think that there are some shifts in that.

01:15:54 - Speaker 1

OK to environmentally. I think that there are some shifts in that. Okay, uh, also have another question around. We're gonna get your take on some uh study around um comorbidities and looking at women, particularly in these ages where perimenopause and menopause happens. So a 2025 study focused on us women from the midwest identified that several conditions, including hypertension, hyperlipidemia, osteoarthritisritis, sleep disorders, thyroid issues and more increase in prevalence by 45% or more between ages 40 and 59. These are right within the perimenopause and menopause ages. Are we saying here that these comorbidities are because of perimenopause and menopause, or being in perimenopause and menopause, you are more likely to fall victim to these comorbidities and other illnesses?

01:16:41 - Speaker 2

A little bit more of the latter, you know remark that you had there. So it's not a direct cause. What our body relies on in the ecosystem, in where it is optimized and functionality does its best, is in the presence of estrogen to the levels that it is during your 20s and 30s. So that's why we do see more comorbidities with heart disease, hypertension, hyperlipidemia, autoimmune diseases and also joint issues which could, I mean, technically fall under autoimmune when you think of rheumatoid arthritis. But it really is. The body's ecosystem or equilibrium does take a shift with the decline of estrogen, therefore heralding the ability for your body to present with things that were maybe already there or didn't have the opportunity to progress because of estrogen being around. Estrogen is really a very potent anti-inflammatory, so that's why we see a lot of more inflammation. That's why we see that the glucose insulin ability for it to be in homeostasis is dysregulated, which causes more inflammation.

01:17:49

Or we look at glycans. You know glycans are an indication of longevity and when estrogen declines you do see a change in glycans which then can lead to the diseases that you were just talking about. So there is a really whole body physiologic shift with the decline of estrogen and it does make sense, and I think that's why we're able to link this a little bit more to that timeframe in a woman's life of perimenopause and menopause, with the disease progression is because now we're looking at it rather whole body than just a fertility pelvic issue it really is a neuro, you know.

01:18:25

So some even categorize as a neuroendocrine dysfunction or disorder perimenopause and menopause, really yeah yeah is that always the case?

01:18:35 - Speaker 1

or only if certain things well neuroendocrine in the sense of what it does for brain functionality, you know, when we yeah, yeah, yeah? Is that always the case? Or only if certain things cross certain?

01:18:37 - Speaker 2

thresholds Well, neuroendocrine in the sense of what it does for brain functionality. You know, when we look at, there is a book called the Menopause Brain by Dr Lisa Moscone, a good friend of mine, and they have the data now that shows when we look at brain scans and MRIs and how the changes occur in the decline of estrogen in the brain. Matter is again having to do with brain health, cognition, and so that has a lot to do again with estrogen decline.

01:19:03

So it's fascinating. I think we're at a really historic time frame in life and in medicine where we're able to really connect all the dots in a different way than we have before, which I think should improve the long-term morbidity of women. Connect all the dots in a different way than we have before, which I think should improve the long-term morbidity of women, improving quality of life and allowing women to give them the tools in order to thrive in the best way, especially when we see that the statistics of women and disease is really, really terrible.

01:19:35 - Speaker 1

Kind of getting towards the end here makes me think. You know, we live in a day and age now of a lot of information. A lot of people are doing some wild things with their health and wellness, particularly.

01:19:45

No shade here. But you know, in the world of biohacking people can go pretty far for their own personal wellness reasons and goals. But I think you'll find a lot of people will biohack, will supplement, will do anything they can to attempt to thwart getting an illness, getting a disease, injury, or even people like brian johnson oh, yeah, who is saying I'm gonna be the first person, first documented human, to be over what? Like 200. He's like you know, you know, f?

01:20:16

aging kind of thing right right are we at a place, can we ever get to a place where you think women can biohack against or biohack their way out?

01:20:24 - Speaker 2

yeah, of perimenopause and menopause uh, two different answers to that. I don't think currently we're at the phase where women can biohack their way out of perimenopause and menopause. I think that we definitely are at a place where we can ameliorate some of the symptoms but also improving longevity because of the estrogen and the testosterone and progesterone that we are starting to see, and starting at a younger age than we did, right. So it's kind of like we're allowing the tank not to get empty and we're kind of facilitating it.

01:20:54

When it's in the yellow, you know, the blinker is on instead of waiting what we used to until it's empty the other part of that. There is another biohacking feature that I think you know for a lot of my PhD friends who are doing a lot of work in the ovarian function studies. So, in the sense that they're like how do we allow the actual natural organ of the ovary to sustain estrogen production longer than it has? Right, so therefore, not looking at it from a fertility issue, which they could, they could be like oh, maybe people want to have babies at. I mean, I wouldn't, but anyway you're braver than me, right?

01:21:34 - Speaker 1

not doing it?

01:21:35 - Speaker 2

but for the longevity aspect of estradiol. How can that help?

01:21:42

right so there are a lot of studies that are looking at that. Um, I know my good friend she's based out of new york city is looking at, actually, ovarian longevity and what does that mean? So the fact that we're even looking at that as a possible way of, I guess you could say, biohacking is a way that you could look at it from a purely women's perspective. But I think biohacking can be done in stages and phases. I think that sometimes you can go a little bit overboard, but I do like the notion that there are people out there who are pushing the envelope right, that there are people out there who are pushing the envelope right, and I think that's what's innovative in science is that you just keep pushing the envelope until something is studied, recognized and then can be proven.

01:22:24

I think we're we're years out from you know, the days of being brian johnson, but, um, I think I like that. There is the notion that it could happen. The other thing that I would say is the best biohack and the only reason I feel that this is important to bring up is something that's sustainable is exercise. To me, biohacking is as simple as exercise. You know, as the clinical advisor for women's health at P-Evolve.

01:22:50

We focus on that from a holistic standpoint because there's a lot out there about exercise, but you want to be able to present it in a way that feels engaging, right, so the community, but sustainable and not someone yelling in your ear left, heavy, right, but you can attain that and you can get that, and I think at P-Evolve we have been able to establish a real fundamental framework in what does this mean for you now, but what does this also mean for you later couldn't agree more.

01:23:19 - Speaker 1

I mean, I think, if, whether you're a woman going through perimenopause, menopause, man, I mean anybody, any human if you prioritize or made exercise your only quote, bio hack, um, you really can't go wrong, cannot? You cannot go wrong, um, barring anything like, you know, injury or stuff like that. But a body in motion stays in motion and the body at rest stays at rest. So I would love to ask you my final question, please. This has been a great session on perimenopause, menopause, longevity, and so I feel a lot more informed, educated and empowered about this area of, I'll say, my wife's well-being. I don't think I have to worry about perimenopause anytime soon, but you know, taking educating myself to help those around me is definitely a part of what I say living a life ever forward. What can I do to learn more, apply more and to move forward more in my life and also help those around me? So, collectively, we're all moving forward. Those two words, what do they mean to you? Ever forward? How do you live a life ever forward?

01:24:26 - Speaker 2

Yeah, I think living ever forward is to allow for the pause and flexibility in your life as you start to learn more Right, the more rigid you are, the more that you were beholden to you know just kind of the firmness of it. Then that's sometimes where we don't grow, and so I've learned that a lot in my life, you know, in the last two years personally in my career is really leaning into the pause and the flexibility.

01:24:57 - Speaker 1

We have all of our power in the pause.

01:24:59 - Speaker 2

Yeah.

01:24:59 - Speaker 1

Yeah, that's, I think. What is it, viktor Frankl? You know, the moment between stimulus and response is where we have or give away all of our power. Yeah, where can my audience go to connect with you and learn more about you, or maybe even pop into a clinic in Dallas if they want to become a patient or something you know?

01:25:17 - Speaker 2

Absolutely Mostly on my social Jessica Shepherd MD, on Instagram, and then you can also catch me on P-Volv, you know as their clinical advisor. We are really looking into women's health.

01:25:29 - Speaker 1

Are you leading classes?

01:25:30 - Speaker 2

I am, I actually am leading classes and conversation and education on that platform. So at P-Volv, okay. And then, if you're ever in Dallas, I mean look me up. I would love to see anyone who's in the Dallas area or even the Texas state you know, come and see me.

01:25:44 - Speaker 1

You're my second Dallas doctor I've had on the show in the last like month.

01:25:48 - Speaker 2

I have.

01:25:48 - Speaker 1

Dr Tiffany Moon was on the show recently. I know her, we actually, I did. I hosted her during her book tour. Uh, we live very close in Dallas and we know each other really well and good friends. So much fun. Dallas people are the best Dallas doctors. You guys are welcome back anytime. Um, thank you For more information on everything you just heard. Make sure to check this episode show notes or head to ever forward radiocom.