AGEIST
The AGEIST podcast is where we rewrite life after 50. Hosted by David Stewart, founder of AGEIST and Super Age, we talk with extraordinary people—scientists, creatives, and thinkers—about living vibrantly in your 50s, 60s, 70s and beyond. From longevity science to emotional well-being, fitness to purpose, we explore the tools and mindsets that help us stay curious, energized, and deeply engaged with life. This isn’t about aging gracefully—it’s about living boldly.
AGEIST
Dr. Suzanne Gilberg: What Doctors Miss in Menopause
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This week on The AGEIST Podcast, Dr. Suzanne Gilberg explains why menopause care needs more science, more honesty, and more respect for women’s ability to make informed choices. Listeners will learn how to think about HRT, breast cancer risk, testosterone, brain health, bone health, and the limits of one-size-fits-all medical advice. She also explains why community matters, why menopause education has been neglected, and why women should keep asking harder questions of their doctors and the medical system. This episode gives listeners a clearer way to advocate for themselves, assess the flood of menopause information, and build a practical path through midlife health.
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Key Moments
“Science is not a religion. It is not a monolith, it is not unchanging and unmoving. That is not what science is. Science is a process of inquiry. Period. End of sentence.”
“There’s actually quite a bit of data on the potential health benefits of estrogen specifically in all of us and in breast cancer survivors.”
“This is not a disease; this is a state of being alive. So you have options in terms of how you want to live and age well, whatever that means to you.”
Connect with Dr. Suzanne Gilberg
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Click Here for the full interview transcript.
Welcome to the Ages Podcast. I'm David Stewart. This is episode 285. This week, we're looking back on a conversation I had this fall with Dr. Suzanne Gilbert. Suzanne is a board-certified OBGYN. She's also board-certified in integrated and holistic medicine. And she's been practicing in Beverly Hills for more than two decades. She's the founder of Menopause Bootcamp, author of a book on the subject, and one of those rare physicians who can speak fluently about conventional medicine, traditional practices, sexuality, cancer survivorship, hormones, and community. And what it actually feels like to be a human being moving through midlife. And I just want to touch on this idea of community. One of the main things that we put into the Super Age games, which are in New York, November 7th, it's about community. People are coming as teams, and we've set the competition up, less as a competition between people, but as a competition with yourself and having others help you through that, that sense of community. Because what we found was one of the number one markers of how well you're going to live long is how many friends you've got. Do you have a community? Are you social? So super age gains. I also want to bring in of the tickets that we've sold so far, and we've sold a considerable amount of them, something like 60% of them are women. And most of these folks are in their 50s. So super interesting there. Let's get back to Suzanne. Suzanne does not treat menopause as some small medical side issue because it isn't. She breaks down how to ask better questions, push your doctors, reclaim agency over what kind of life you want to have in post-menopause. Here are a few moments from our conversation.
SPEAKER_01Keep pushing the science, keep pushing the policy. Every single change that I've seen in my lifetime in women's health, and so I mostly am dealing with physiologic events, has been pushed by the community. It has been grassroots. It has absolutely not been top-down decision making.
SPEAKER_00All of those things absolutely do matter. But we can't overstate the importance of agency. The ugly truth is that most medical systems lack the time, training, or incentives to really understand each of our exact experiences. This leaves it up to each of us to advocate for ourselves and for one another. Suzanne is smart, funny, and direct. She's done the work professionally and she's also lived it personally. Before we get into this conversation, a quick request. If you enjoy the podcast, please give us a five-star review. It really helps support the show and it helps other people find these conversations. Thanks. Let's give Dr. Suzanne Gilbert a call right now. Hey Dr. Suzanne, how are you today?
SPEAKER_01How are very well. It's nice to talk to you.
SPEAKER_00It's wonderful to speak with you. Uh I guess we should start with tell everybody a little bit about yourself and what your practice is and what your interests are.
SPEAKER_01Yeah. Yeah. Where to start? Okay. So I am a board-certified OBGYN. I have been in practice in Beverly Hills, California for 22 years, which kind of blows me away. I'm also board-certified in integrative and holistic medicine. So I have a, I mean, and how I went got into that actually was that I trained in Ayurveda. Very early in my career, I got very interested. I was doing yoga and meditation for my own purposes, which of course, you know, ended up influencing my entire career and life. And got interested, I had always been interested in indigenous and traditional holistic medicine and ended up studying Ayurveda, which is the ancient traditional holistic medicine of the subcontinent of India. And really just did it for my own curiosity, but it led to made down a lot of other paths, which has been very, very interesting. And that led me to integrative holistic. I practice in a completely conventional practice in Beverly Hills. I have a reputation at this point for having sort of a deeper and a wider toolkit and openness. But I think that sort of set the stage for what I was doing in my own life personally and professionally. And, you know, I've I've tended to be interested in whatever is in front of me. So as my patients presented problems that I hadn't learned about, I dug into them. And that became cancer, survivorship, gynecology, that became menopause. That actually is what led me to menopause, which has been my focus in the last decade or so, sexual health, a lot of like third rail topics that nobody else seemed to want to talk about, which of course everybody's talking about now. But botanical medicine, all that. So that that's kind of the where I am. I out of that started seeing the need for more opportunities to educate and empower women specifically around menopause and their aging process. And didn't have enough time to really do that in a 10 to you know 15-minute insurance-based encounter in the office, and was at this time also doing a lot of education and public speaking, anyways, and developed something called menopause boot camp, which was a live experience, two to four hours depending on how where we did it, where we had more time to really delve into the terminology, the definitions, which confuse people to this day, the actionable items, the problems and solutions from a deeper and a wider toolkit, because I have conventional medicine and I believe in it and science, but also I have traditional practices. And this is not a disease, Dave. This is a state of being alive. So you have options, you know, in terms of how you want to live and age well, whatever that means to you. Fitness, huge part of it. Mindset, I thought people were coming for facts and information. We all left with community. Hugely important. Don't know why that surprised me, but it did initially. And that grew into a book. And so I wrote wrote this book, and then it got purchased by the publisher during the pandemic, and we came out of the pandemic, and everybody was talking about menopause.
SPEAKER_00Yeah. Yeah, I've noticed that. So let's let's talk about that for a second. So there's there seems to be, and there seems to be a lot more I mean, it used to be 20 years ago, you couldn't even use that word. And there seems to be a lot of interest uh in menopause and a lot of products that allegedly have some impact on menopause systems, uh symptoms. And I what what's your thought on all that?
SPEAKER_01You know, I'm kind of of the mind that the more we're talking about it, the better it is. I'm aware that I have colleagues who don't agree with that. They I mean I think they they want it to be discussed and they want people to have tools and they want people to have information and for it to be normalized and not, you know, stigmatized. But I I know there are some people who object deeply to sort of the menopause marketplace, right? And I I understand where they're coming from, but I have a little bit of a different idea about that. I I first of all feel like look, we are living in a capitalist society, for better or worse. And so to think that there isn't going to be monetization of this is just, I don't know what planet you live on. That's not how this works. Second of all, one of the things that I talk a lot about, just I I've experienced personally and that I talk a lot about in my work around menopause is that, you know, one of the beautiful things and one of the beautiful gifts of this is like really developing a stronger sense of who you are, really connecting with your own agency and your wisdom. And honestly, if you get to this point and you feel a lack of confidence about how to manage all the information coming at you, I think that that is totally legit and real. But I think we're grown-ups and we can sort of assess information. And I think as long as there are resources out there and these are starting to be developed in a more legit way, then we can make decisions that make sense for us. There are a lot of predatory practitioners and practices out there of all stripes. And they're not just aimed at menopausal women, they're aimed at all of us because this is how we roll, apparently, in this country. And I just I I think to infantilize us is not where I'm coming from. I I think we're smarter and better than that. And I do think the more we're having the conversation and the more people are involved and more people are coming to the table from different walks of life, you know, not just the one perspective. The better off we're gonna be, the better we're gonna be served, the better we will serve. We have to communicate and have a conversation. And honestly, if somebody wants to buy a super fancy cream for their face, like have at it if you can afford it. Like you should do what you want to do. I I think some of the, I get it gets fuzzy, the science gets fuzzy, people's capacity to assess accurate statistics gets fuzzy, and social media is both a gift and just a bonanza. It's like a fire hose that you're trying to sip from, right? It's like uh so but I honestly I'm 57, like I know that. Like I know that. I know that what's being fed to me on my phone is being it's an algorithm. Like I I know that, and it's not just because I'm a doctor, it's because I'm like a 57-year-old woman. You know. So I don't know. I and I I also I feel like I know where I can turn when I don't know stuff and I can ask questions. I mean, honestly, your community is a great platform for that too, because I think that you guys amplify voices that are open-minded and educated and elevating a conversation. So that's the way I look at it. It's an opportunity.
SPEAKER_00Let's pause here for a quick word from our sponsors. We'll be right back with more of Dr. Suzanne Gilbert on hormones, menopause, and what it means to be an advocate for your own health. When it comes to the pillars of health, hydration has a way of influencing everything. It affects how you recover, how you feel, and how well you move through the day. That's one of the reasons I like Element. It's a zero sugar electrolyte drink designed to support hydration. Lately I've been reaching for their new 12-ounce sparkling cans. I especially notice the difference after a workout when I want to recover well and get back to feeling steady and clear. Beyond that, I found it just as useful when I'm traveling, which is one of the easiest ways to get dehydrated without really noticing it. Flights, long days, changes in routine, more coffee, less water, it adds up quickly. Element makes it easy to stay ahead of that. Each sparkling can has 500 milligrams of sodium along with potassium and magnesium, and the flavors are genuinely good. Lemonade salt, black cherry salt, orange salt, and pineapple salt. It's a simple thing, but it can make all the difference in improving your routine and keeping your body optimized. Get your free element sample pack with any order at drinklmnt.com/slash agist. Most of us think about muscle health in terms of lifting weights and consuming protein, but there is a deeper layer underneath all of it, and that is cellular energy. Your muscle cells are packed with mitochondria because muscle takes a lot of energy to do its job. As we age, mitochondrial function naturally declines, and that can show up as lower energy, less strength, slower recovery, and a little less bounce back than we used to have. Timeline has spent more than 15 years researching mitochondrial health and developed mitopure, which contains urolithin A. Urolithin A supports metophagy, the body's process for clearing out damaged mitochondria and recycling cellular components. In one study, participants saw a 12% improvement in muscle strength in four months with no change in exercise. That gets my attention. For me, healthy aging means protecting capacity, the ability to move, train, recover, and keep showing up for the life I want. Supporting the cellular machinery underneath strength and energy feels like a very smart place to start. Timeline's clinically proven formula is now available at a new lower price. Midopure now starts at$79 when you go to Timeline.com slash ageist. You know, as you're talking about this, I love what you're saying. Like, we're grown-ups, we can discern. You mentioned the word community early on, and I'm sort of have this idea that, like, you know, there are people that are into Nike or they're into Adidas. Yeah.
SPEAKER_02Whatever, right?
SPEAKER_00It's like the brand becomes a community signifier. Yeah. And I'm sort of have this little idea that it's coming to me that perhaps some of these products that are out there are no better or worse than anything else. Nike's no better than a D, I don't know. Nike probably wouldn't take a different point of view on that, but it they're basically sneakers, right?
SPEAKER_02Right.
SPEAKER_00They help you run.
SPEAKER_02Right.
SPEAKER_00And there may be an and I think that there, I don't think there may be, I think there is a strong element of community identification if one is buying a menopause-specific skin cream that says like it sort of reminds me, remember like the the gay rights movement in it was like uh act up, right? We're here, we're queer, get used to it. And I think there's sort of there's sort of a thing similar happening. Is that sound right?
SPEAKER_01Yes, but also don't forget, it's the same generation. Well yeah, yeah, because that was like me post-college, right? I mean, those are my friends. Yeah. I'm 57, I I think we're in the same cohort-ish. Gen X, this is very Gen X. And I do think a lot of what's going on right now is very Gen X rising. And I mean, everybody's of course talking about this now too. But I think, I think you're right. And I think I think there's good things about it. And it's so interesting that you brought that up specifically because I have involved myself with other voices in partnership, sponsored in terms of events. Like, I'm not sponsored, you know, I'm not, I'm not, we're not there yet. We're menopausal. This is an idea, you're a marketing guy, right? Like, perhaps you could sponsor menopausal people and they could go out and do their thing. That's that's a conversation for another time. But, you know, a we'll we'll not name the brand, but it doesn't matter. A recently launched beauty brand that is aimed at menopausal women, which I really appreciate. And it's a celebrity-owned brand, and God bless her. She's trying to get something out there. She has been working with another, with a platform to create these menopause symposia. And they've been wildly successful because of that. It's like a we're here moment. And actually, we just did, I did one with them in New York the week of my book launch in October. Super powerful experience. We did one here in LA two weeks ago tomorrow. Amazing, like 250, 300 women in the room, just the energy, the palpable excitement and love and curiosity and support. And it was unbelievable. And so, yes, I think there is an opportunity. And I think that they are very, very by design creating these opportunities for people to have a conversation and to be educated. And of course, they're associating themselves with it. And again, like everybody in that room is a sophisticated user of the market. So I think we can understand like what we're getting out of it and take, you know, like what I say to people all the time, it's like a total 12-step thing, but like take what you like and leave the rest. It's okay. It's all right.
unknownYeah.
SPEAKER_01That's the what that's the way I look at it. I know everybody doesn't agree with me. That's that's also okay. I'm okay. That's part of menopause. I'm okay with you not agreeing with me. It's wonderful.
SPEAKER_00So I I want to get into something medical here that I am I tell everybody all the time, I'm not a doctor, I'm not a scientist, but I know a lot of them. So um this, so HRT. And there's the Women's Health Initiative study back, whether it was about 23 years ago, which seems to have been rather debunked at this point. I'm seeing you're nodding your head, yes. Yeah.
SPEAKER_01It's really, it's a it's a very sad story. A billion dollars wasted. I mean, not wasted completely, but just just a debacle, honestly.
SPEAKER_00Debacle. That's a yeah. Um we don't have we don't have to get into the granularity of that, but just to say like there's nothing in that data that made any sense.
SPEAKER_01It was rough. It's rough. But it had a massive, massive impact.
SPEAKER_00Yeah.
SPEAKER_01In such a bad way. And yes, you're right, it's all getting kind of unwound. And then, of course, the recent New York Times magazine article, which I think is super important.
SPEAKER_00Yes, that was great. That was like the best thing I've ever read on that.
SPEAKER_01Mm-hmm. Me too. So, anyways, I I'm cutting you off, but it's okay.
SPEAKER_00So where I want to go with this is there's some thinking, I think somewhat well established, that estrogen has a neuroprotective effect. Women have a higher rate of Alzheimer's.
SPEAKER_02Yes.
SPEAKER_00They're they're more likely to die of a heart attack. And there's some thinking that, you know, Dr. Lisa Muscone will say, you know, there's the it's the estrogen and the neuroprotective effect. Okay, so if we if we think that that is true, and and we think of HRT, hormone replacement therapy, bioidentical hormones, but then something like one in eight women, and I I think you're one of them, has had a breast cancer diagnosis. So if you have that, HRT is off the table. Now we have this problem. Yeah. So we have a conundrum. So we, you know, we're gonna have all kinds of con health consequences from the dropping estrogen or the total lack of estrogen. Yeah. Because my understanding is sometimes people are given drugs that whatever residual estrogen is in their system gets removed. Right. So now we've got sleep problems, we've got brain problems, we've got possible cardiac problems. How do you approach this? This the sort of risk reward on either side of that equation.
SPEAKER_01It's really, really challenging. And I will tell you, as both a physician and as a breast cancer survivor, I've just thought so much about this. And I my thinking has evolved. And I think this is a very important point that we have to make. I feel like the people listening to your podcast probably realize this, or at least intuitively recognize, you know, science is not a religion. And I do think, I'll tell you, I object to my colleagues who make it a religion. It is not a monolith, it is not unchanging and unmoving. That is not what science is. Science is a process of inquiry, period, end of sentence. And curiosity and inquiry never ends, it evolves. And I think we're at a really important inflection point in in the menopause space because of the we're here and we're queer kind of, you know, call to action, and because of the evolution of science. So it's so interesting to me, though. It's talk about third rail topic. I mean, hormone replacement in a breast cancer survivor is just like you can't even go there. And there are even practitioners who incorrectly tell their patients that they can't use vaginal estrogen for genitourinary syndrome of menopause, which is not systemically absorbed and wouldn't have any impact on their disease, anyways. And that's just wrong. There's a massive amount of fear-based medical practice out there. And in general, I don't like to disparage my colleagues because I think they're really doing the best they can, but I have to call that out. That is that's just bad medicine, and it's wrong. Now, here's the other thing there's actually quite a bit of data on the potential health benefits of estrogen specifically in all of us and in breast cancer survivors. So here are, I don't, I'm sure, I don't know if you know Avram Blooming and Carol Tavrist, who were quoted in that New York Times magazine article. And Avram has definitely been kind of an outlier because he's been saying this for decades, and he's been studying women who were treated after their breast cancer diagnoses for just the reasons you stated, because they really were non-functional. And they said, you know what, risk reward. I've got to look at my quality of life. And they have so they do have decades of data on these women who have largely done well. Here's the reality the vast majority of us who are diagnosed with breast cancer are gonna be diagnosed at early stages. The vast majority of us who are diagnosed with breast cancer are gonna die of what, Dave? Breast cancer or heart disease?
SPEAKER_02Heart disease.
SPEAKER_01Heart disease. So I have to tell you, I'm in my nine, my entering into my tenth year, and I was a pre-menopausal breast cancer survivor. So that's even a different situation, right? And I am really rethinking my own treatment because I have not used systemic hormones, and I'm starting to think that I might do that. I'm outing myself here and now, which is a little bit dangerous because I want people to understand that I am making that decision based on my accountability to myself as a physician and as a patient. I'm not saying anybody should do anything other than that. They should talk to their physicians. They're gonna have a hard time finding a physician who will support that, to be perfectly honest. And I think that that needs to change. I think we really have to change the way we're looking at the data and supporting our patients' choices. It's so complicated. The other thing I want to say is that breast cancer is not one disease. Like, and we don't want to spend the whole podcast on breast cancer, but breast cancer is not one disease. And I think people get confused because their cancer may have had receptors for some of these hormones. That doesn't mean that those hormones caused the cancer. Okay, so we could get into a much Deeper dive at some point, and perhaps we'll do that, or I can direct you to somebody who would be willing to talk about it. But I think you're bringing up an incredibly important point. We I think the data on osteoporosis and heart disease is settled. I don't really care what American College of OBGYN says or North American Mentopause Society, and I'm members of both, and I'm a big fan of NAMS. I think they're great, but they're conservative. And I think the data is very clear that for sure with osteoporosis, we all agree, osteoporoporosis is prevented by use of hormones. Okay, it's not treated by use of hormones, it's prevented. Your risk decreases. And osteoporosis is a huge health problem as we age. Huge. Mortality rates skyrocket in the year after a hip fracture. This is for real. Heart disease, I think that's settled science. And it was, honestly, before they did the women's health initiative. And one of the reasons they did it was to sort of prove it, but they screwed that up and we'll leave that alone. The dementia thing is not proven. Okay, so here's the deal. You're right. Alzheimer's specifically is two to three times more prevalent in women as we age than men. The loss of estrogen clearly has something to do with it. What we don't have yet is data supporting that estrogen replacement would change that risk. I think it's coming. I think you're right. Lisa Muscone and I are buds. I actually just saw her at this event. I'm going to go to New York and get a brain scan. I'm super excited because my brain is really important to me, just like everybody else's is. And I am kind of in a moment myself of like evolution of where I would go with this. But I can tell you, I I you have to be so careful because the other thing, too, is if I'm now going to be like that doctor, you know, the medical board could come after me. Like I'm just being real. So for people who are listening who are having questions about this, keep asking the questions, keep pushing your di doctors, keep pushing the science, keep pushing the policy. Every single change that I've seen in my lifetime in women's health, and so I mostly am dealing with physiologic events, has been pushed by the community. It has been grassroots. It has absolutely not been top-down decision making. If you look at the birth world, which I was involved in for the vast majority of my career and the rise of physiologic birth and support for that in hospital systems, that was a thousand percent people in the community saying, we want you to do better, or we're gonna go elsewhere. It was not from the American College of OBGYN or the American Hospital Association. Are you kidding me? That's not how it worked. And if people think that menopause needs more attention, more research dollars, better payment for your practitioners, like that's a policy thing. That's not coming from us. It's got to come from you. You got to demand it. So when people get educated and then they are in community and they feel agency and they are empowered, really things do change. I think that's gonna be the next thing that we're gonna see change. I don't know how long it will take, though.
SPEAKER_00Hope you're enjoying this chat with Dr. Suzanne so far. More from her in just a moment. As someone who thinks a lot about aging, I've tried most everything from cutting-edge tech to the simplest things like walking more and sleeping better. But what really caught my attention recently is something that feels quietly revolutionary. It's called Fatty 15. This isn't just another supplement. Fatty 15 is built around C-15, a newly discovered essential fatty acid, the first to be found in over 90 years. That's right, discovered by Dr. Stephanie Ven Watson while working with aging dolphins in the U.S. Navy. Dolphins, who knew they'd teach us so much about human health? What makes C-15 remarkable is how it repairs and protects our cells, boosting energy, supporting sleep, cognitive function, and even smoothing out those stiff joints we start to notice more as we age. Based on over 100 studies, we now know that C-15 strengthens our cells and is a key healthy aging nutrient, which helps to slow biological aging at the cellular level. In fact, when our cells don't have enough C15, they become fragile and age faster. When our cells age, our bodies age too. Fatty 15 is clean, 100% pure, vegan, and free from all the junk you don't need. Over 70% of users report real benefits within 16 weeks. Fatty 15 is on a mission to optimize your C15 levels to help support your long-term health and wellness, especially as you age. You can get an additional 15% off their 90-day subscription starter kit by going to Fatty15.com slash AGIST and using code AGIST at checkout. So if you want to age like you mean it, gracefully, powerfully, and with purpose, Fatty15 is a smart place to start. I've tested a lot of products over the years, but Our Place has truly earned a permanent spot in my kitchen. The reason? It's clean. Most nonstick pants still use Teflon or PFAs forever chemicals that end up in your food and your body. That's not the future of cooking, that's the past. The Our Place Cookware set gives you everything you need: two always pans and two perfect pots, all toxin-free and designed to replace a stack of bulky, outdated cookware. Eggs slide right off of the nonstick surface, cleanup's a breeze, and they look incredible in their signature colors. I've been loving the Always Pan Pro lately. No coating, pure titanium, nearly indestructible. If you're serious about what goes in your body, start with what you're cooking with. RPlace is having their biggest sale of the year right now. Save up to 35% site-wide now through January 12th. Head to FromRPlace.com/slash agist to see why more than a million people have made the switch to RPlace Kitchenware. And with their 100-day risk-free trial, free shipping, and free returns, you can shop with total confidence. Shop the R Place holiday sale right now. No code needed. I have noticed, and you can have more in-depth knowledge on this than me, but I have noticed that as regards to women's health, anything to regards with women's health tends to move glacially in compared to like men's health. But what's up with this sort of stuff? I don't get it. Like you're half the population. You're cute, Dave.
SPEAKER_01That's sweet. Because patriarchy. Hello. Let me do you are you aware of the fact that women were not even required to be part of clinical trials by the FDA until 1993 while I was in medical school? That is insane. That is how slow this shit moves. And it's misogyny, it's blind spot. Okay, you can say, I uh I'm uh being nice today, I'm in a graceful mood today. It's a blind spot. People don't know what they don't know. But women are not men with boobs or like what? We have different physiologic physiologic responses. We uh we are made differently, our heart disease is different. So until women have a seat at the table and are in power, in a sh power sharing capacity, that this is not gonna change. But that's why I always tell people, especially women people, but people in general and people of color, anybody who's marginalized by colonization, by patriarchy, by capitalism, you have you really do have to take to the streets. You have to because they're they're not gonna listen otherwise. And and because there's this weird capitalism that's you know ingrained into even like the FDA and everything else, they respond. They respond to demands and threats. I really hate to say it, they do, but if you're gonna vote with your feet and go somewhere else and go have your baby down the street at the birthing center instead of bringing your dollars there, they're gonna respond. So, I mean, I have nothing less than, you know, a a takeover, you know, on in my mind. I mean, when I wrote when I started doing menopause boot camps and wrote the book, and now I have a certification program that'll be rolling out. My goal is to help people on a personal level with their health and with their experience of themselves as they age, but also to have community specific responses and um empower them to visualize and then manifest changes on a societal level. If we don't reestablish our connection with wisdom cultures and with the wisdom of aging, we are toast. We're toast. There's we age and gain wisdom and survive for a reason. And if we are unwilling to hear and accept that knowledge, I don't understand what we're doing. I took that way over time. That's what I you go, girl. A little bit of coffee, didn't sleep a lot last night. Quite a combination.
SPEAKER_00We're gonna take a brief break. When we come back, Suzanne and I get into testosterone, lifestyle, and why the simplest tools are often still the most powerful. Hydration is one of those simple things that can change the whole day. More energy, clearer focus, and fewer of those sluggish afternoon stretches. I've been reaching for Element's new 12-ounce sparkling cans because they make hydration easy. They're crisp, refreshing, and formulated with 500 milligrams of sodium plus potassium and magnesium with zero sugar. It's a smart addition to the day, whether you're working, training, or just trying to feel a little sharper. Get your free element sample pack with any order at drinkellmnt.com slash aegist. Get your free element sample pack with any order at drinklmnt.com slash AGIST. Every movement we make starts with energy, and that energy starts inside our cells. As we age, our mitochondria, the little engines that power us, can become less efficient. That affects strength, recovery, resilience, all the things we actually care about. Timeline developed MitaPure with Urolithin A to support metophagy, the process that helps clear out damaged mitochondria so our cells can work better. I think of it as working closer to the source. Timeline's clinically proven formula is now available at a new, lower price. MidaPure now starts at$79. When you go to Timeline.com/slash agist, that's Timeline.com slash agist. What else are you seeing, you know, in terms of medical uh uh prescriptive medical inter, I guess I use the word intervention for intervention for menopause. That's not even the right word. Um uh symptom to decrease symptom. That's what I want, that's where I'm going with this. What are you seeing behind HRT?
SPEAKER_01I mean, there's definitely listen, that's the other thing that's kind of interesting when you talk about like why are things going so slow. You know, there was the whole that whole menopause marketing during the Super Bowl, and that was because there was going to be a new medication that was supposed to get FDA approval in January, which got pushed off again. So there are some new meds that are non-hormonal that are for vasomotor symptoms. I mean, the science is kind of interesting. There's some interesting science happening. I do think the big thing coming really is the brain health stuff because that that data is so interesting and so important. And Dr. Musconi is one of the leaders in the field, but there are other people. I'm totally backing somebody in Arizona. So I think the other thing that I've been hearing kind of in the background, and I don't know where how far along this is, is also looking at we do have medications called selective estrogen receptor modulators. So where you can target estrogen to the tissue that you want it to be affecting, like the brain or the bone, without increasing risk of breast disease or you know, uterine cancer, things like that. We already have those things for bone health, for instance. And then we also use them for targeted for like endometriosis treatment. So starting to really fine-tune rather than just blast the system. Although the reality is, menopausal hormone therapy, systemic therapy is amazing. And one of the things that I'm seeing growing, and I think it will now really open up more, there'll hopefully be less sphere now that the New York Times wrote that article and people, I think that seeps out. The thing is, we have all these effects in our bodies all over our bodies as we age because we have estrogen receptors in pretty much every tissue. And so the reality is that we really do need estrogen everywhere. So for those people who need to or want to target one or the other, I think that will probably become more available, hopefully in the next decade. But I think people will also become less afraid of using menopausal hormone therapy because they understand that their brain, their joints, their blood vessels, it's not just, you know, sexual health and vaginal dryness, which is incredibly important. It's not just hot flashes and sleep. It's what's happening at the endothelium, at the lining of your vascular tree, you know, like it's metabetabolic changes. So that's really exciting. I mean, there's lots of pharma out there. And, you know, I have this like I have a background in botanical medicine. I love a lot of herbs. We're never gonna have the robust bus science that we do with pharma. There's just not the, there's not the money for it. But there are things that people can do. And then in the end, the reality is the number one tool for healthy aging is lifestyle. Like that's always the best. Exercise, movement, getting the blood flowing, staying flexible, mindset. You know, it's really not rocket science. It's really something people can do on their own. Sleep hygiene, we all know what it is. None of us do it, you know, that kind of stuff. Rela like enjoying your life, having gratitude, stuff that's free. Meditation doesn't have to be fancy. You can just like do box breathing for two minutes. You know, anybody can do that. So I think again, one of the great things as we age, if we have community, we have support, we have tools, is we start to settle it more into maybe who we are and just sort of appreciate that and realize like it doesn't have to be so fancy. This is my own observation for myself and what I see around me. And it's kind of beautiful, like enjoying the sunset. You know what I mean?
SPEAKER_00I mean, I tell people if you people always, you know, they they want the blue, is it the blue pill or the red pill or what's gonna do it? And it's I I tell them the same thing. It's like, you know, exercise, nutrition, sleep, reduce your stress. You do that, that's like 95% of it. And my my favorite, I hate the word biohack, but I'm gonna use it. Yeah, my favorite biohack is smiling. Yeah, just smile more. It's gonna be this epigenetic signal to your body that everything's cool and you can calm down. And how hard is that? I know. Come on, guys. I know, I know. I mean back to medicine for a second.
SPEAKER_01Yeah.
SPEAKER_00How long can someone safely be on HRT?
SPEAKER_01That's a great question. I think most of us realize now, so first of all, I uh we know that if we start our menopausal hormone therapy within 10 years of the actual cessation of your period, which is what the definition of menopause is, before the age of 60, we are gonna accrue these positive health benefits. Um, and that's as long as you don't have or develop any real contraindication reason you cannot, like you've had a heart attack or a stroke, you have a propensity or have had blood clots. Like those are people that really can't be on those things. The cancer thing we're gonna leave aside because we sort of already talked about that. So if people start within 10 years of their menopause before the age of 60, they're gonna get those benefits. And I'll be honest with you, most of my patients will want to stay on those hormones because they feel better. So there isn't any real science about how long you can or should be on it. I have patients in their 70s and 80s who are, trust me, never gonna stop their hormones. They feel better, they're functioning at a higher level, and their health is excellent, and they don't want to stop, and I would never stop them. I think one of the other things that kind of leaked out there in space was like, oh, at three to four years you should reassess, which then turns into you should stop. That's made up. There's no settled science on how long to do it. I think you just have to be in constant conversation with your physicians who are keeping up, hopefully, with science. And that you have to advocate for yourself, too, by the way. And as long as you haven't developed anything new that would make it dangerous, I I stay, stay on it. I still have some patients who do it really primarily for the transition and for the side, the symptoms they're having. And they really just are people who just like don't want to be taking anything and they decide to wean off at some point. And again, this is all in conversation. The other thing that I'd like to remind people is that not only is this never a one-size-fits-all situation, it's also never a one and done. This is an evolving state of being. So, like, you kind of have to keep checking in where are you, what are your goals, what are your priorities, how's your health, how's your life? Okay, how are we going to re-jigger this? You have to be willing to continue to work with somebody. And and it also requires a partnership that's long-term with a trusted medical professional who actually knows what they're doing and cares about this. Because a lot of people don't have the the real interest in it and haven't studied, and it's just not their wheelhouse, you know.
SPEAKER_00Yeah, even OBGYNs have found like don't fully many, I can say s wait, I'm gonna back that up. Some OBGYNs don't really have a grasp on this.
SPEAKER_01Certainly, we don't have time in our training. I mean, here's the thing if you spend four years in your specialty training and you're learning how to manage and attend birth, all kinds easy ones, hard ones, crazy ones, tw twins, surgically, okay, also all gynecologic health, all gynecologic health, okay, again, sexually transmitted infections, birth control, fertility, surgery, cancer. Okay, how are you? Menopause falls by the wayside because there's only so many hours in a day. And also, you know, our medical training is ageist, like, you know, so it's like, oh, well, we'll just deal with that later, you know. So, but you're right, there's all sorts of stats about how few people, how many hours people get in training, and you know, like the that like something like 70 to 80 percent of graduates of of accredited OBGYN programs, residency programs come out not feeling competent to deal with menopause. I taught myself. I didn't get it in my residency.
SPEAKER_00I have also heard some people post menopause are taking testosterone.
SPEAKER_01Absolutely. Testosterone is really interesting. I think it's just like anything else, testosterone can get oversold. It's like, you know, the elixir of use for everybody and it's gonna do everything, which is of course that that isn't that's not a thing. Sorry, folks. Here to debunk that one. Damn. But the the funny thing is that I think a lot of people don't realize that actually women's most abundant hormone in our younger years is testosterone, not estrogen. We don't have as much as men, but we actually have more testosterone than estrogen. So all of those things are declining as we age. And we know that the science really does indicate that testosterone can be helpful for libido and for sexual function. So there is a role for that. I think when people are using it for energy and other things, the science is not that great on it. I don't have a problem with people using it as long as they understand what we do know and what we don't know. And also, I really need to say that pellets are just not okay. So pellets are these little rice-sized things that are inserted into this under the skin in your buttock. And usually they will be either estrogen or testosterone or both. And of course, you have a end up with a huge superphysiologic dose that is uncontrolled. And I mean, I am I've been in I was in a long-term relationship with a former bodybuilder. So I can tell you for a fact, you just because you feel great doesn't mean it's okay for you. You're giving steroid hormones to people in high doses, they feel great. Sometimes they also feel completely crazy and there's complications and issues, but testosterone can be delivered via patches or creams or sublingual. There are ways you can do it that are safe, and it can really be helpful for people. So I don't have a problem with that as long as they're being monitored appropriately.
SPEAKER_00Yeah, I I'm I'm aware of some people that are taking super physiologic doses and we are. They feel awesome.
SPEAKER_01Right. And they don't realize how crazy they are acting, but we do.
SPEAKER_00Exactly. Before Dr. Gilberg and I wrap up, we have one final message from this show's sponsors. We talk a lot about what goes into our food, but rarely do we think about where it comes from, how the animal lived, what it ate, whether it ever saw the sun. The first time I cooked Maui Nui's Ohana Reserve venison, I could taste the difference. This was meat that lived well and free, and it shows. No stress, no hormones, just clean, nutrient-dense, unbelievably tender, wild venison aged for 14 days. What's more, you feel better after eating it. That's not hype. It's 22 grams of protein for 100 calories and a freedom you can taste. But this isn't in stores, it's subscription only. The Ohana Reserve box gives you three premium aged cuts and ground venison delivered frozen right to your door. Go to MauiNuiuiVenison.com slash agist and grab your box before subscriptions fill and get this. They're throwing in a free 12 pack of jerky sticks with your first order of$79 or more. That's M A U I N Uivenison.comslash AGIST. Once you've tried this, nothing else measures up. Last thing here, when they ask Where you heard about Maui Nui, make sure to mention the Ages podcast. It really helps support the show. Thanks. People should just buy your book. And we should just stop now. Just like just like buy the book. Guys, come on. You know, what's gonna happen here is we're gonna, you know, we're gonna go down this path of like, okay, you need to, you know, you lean it need to lift weight, you need to exercise, you need to like recalibrate your diet. And we could talk about that all day.
SPEAKER_01But I don't, I mean, look, I'm not reinventing the wheel here. I'm just sort of creating another opportunity for people to hear the information. I it's data driven, but it's also heart-driven. That's the way I've always done things. Like I deeply care about people's experiences. And what happened was I couldn't get the information out there fast enough, like I said. And so like I just thought, okay, let me just put this on blast. Let's see how that works. That's how people are responding.
SPEAKER_00Um before we we leave, because I know you're you have a lot to do here. Um, is there anything you want to tell our folks out there that you think they shouldn't that they should know?
SPEAKER_01I think, you know, I feel like people who are already coming to your site have a maybe a different perspective. But I think one of the most satisfying things for me has been to assist in the rebrand. You know what I mean? Like menopause is awesome. Is it easy? Is it fun? No. Some of it sucks. Like I don't want to be up all night sweating and I'm not, you know, psyched about like not getting great sleep or I'm gaining weight around my belly and that kind of stuff. But when you get through it, what's there at the other side is you, and it's kind of fantastic. I want people to realize that when you have the right community around you and you have the right tools, you can do anything. This is yet another experience of our resiliency. And it's it's really, really, it's been really fun for me. I have met so many awesome people. The other thing is like this whole reinvention thing that I'm meeting so many amazing people who are present and available and interested and curious and growing. And that is so great. Like this idea that we're invisible or something is just nonsense. I mean, I'm anything but invisible. So me growing great apparently made me way more invisible. And so I I just I have a really excited, sort of positive outlook on that. And I like I said, I think the next thing is world domination, nothing less.
SPEAKER_00And so the you personally or your tribe? What are we talking about? The tribe. The tribe. Oh, okay.
SPEAKER_01But we're here to help. We're here to help. It's a helpful domination.
unknownOkay.
SPEAKER_01I don't know if that's a thing. But seriously, for people who are interested in this work, who either are community building already or are medical professionals or medical professional adjacent, doing boot camps in your community is a really great way to create that community, create opportunities to grow and to educate and to empower. And I'm super excited to see how that rolls out.
SPEAKER_00Awesome. And everybody, you should follow her on Instagram. What's your Instagram handle? Tell everybody.
SPEAKER_01Ask Dr. Suzanne. A-S-K-D-R-S-U-Z-A-N-N-E.
SPEAKER_00Very similar forms. Wonderfully information dense Instagram feed. And it's I I spend very little time on social media, but I watch yours.
SPEAKER_01Oh, thanks. That means so much. Wow.
SPEAKER_00That was Dr. Suzanne Gilberg. I love the emphasis on agency. Agency, as in, ask better questions, gather better information, understand the trade-offs, and make decisions that actually fit your life. Be your own advocate. I also found myself thinking about how often we look for the one answer, that one medication, the one supplement, the one protocol, the one person who is going to tell us exactly what to do. And yes, medical part matters. Hormones matter. Sleep matters. Exercise absolutely matters. Science matters. But Suzanne kept returning to something larger. Community. Community matters. Mindset matters. The ability to tolerate uncertainty matters. And maybe most importantly, being willing to keep checking in on yourself matters. Going forward, I'm going to be a little more attentive to where I might still be carrying old assumptions about women's health, about hormones, about medicine, and frankly, about aging itself. We all have blind spots. I for sure have mine. The useful thing is to notice them and then get curious enough to do something about it. You can follow Suzanne Gilberg on Instagram at A S K D R S U Z A N N E. That's Ask Dr. Suzanne. That's it for this week. Stay strong, stay vibrant. We'll see you next time.