Navigating Menopause: The Popkin Method Approach to Hormones, Metabolism, and Women’s Longevity

Welcome back to The Popkin Method, where we connect symptoms to science, and science to solutions. In today’s episode, we're tackling one of the biggest blind spots in modern medicine: perimenopause and menopause. Millions of women are told their labs are normal while silently struggling with fatigue, anxiety, weight gain, sleep disruption, and a loss of vitality. But what if these symptoms aren’t random? What if they’re actually signals from your body?

Dr. Matthew C. Popkin breaks down the complex physiologic transition of midlife hormonal change and reveals how the Popkin Method offers a systems-based, whole-body approach. We’ll dive into lifestyle medicine, nutrition, exercise, strategic supplementation, hormone modulation, peptides, regenerative medicine, and the science of longevity. If you’ve ever felt dismissed or misunderstood during this phase of life, or you want a better strategy than band-aid solutions and social media fads, this episode is for you. Let’s get started and redefine what thriving through menopause can look like.

Timestamps:

00:00 Understanding menopause and the Popkin method

06:07 Weight gain frustrations and body changes

06:57 Menopause and weight gain issues

12:28 Diet tips for maintaining muscle

16:06 Choosing quality supplements

19:15 Importance of individualized hormone therapy

22:00 Importance of Testosterone in Women

26:44 Testosterone therapy options for women

27:47 Testosterone treatment methods and issues

31:29 Benefits of Testosterone Therapy

33:57 Testosterone and breast cancer risk

37:47 Testosterone therapy side effects

42:33 Discussing peptide treatments and benefits

44:47 Discussing GLP-1 medications usage

48:01 Discussing regenerative medicine basics

52:07 Discussing effective menopause treatments

54:22 Discussing women's health and longevity

You can see Dr. Popkin through his online virtual functional medicine program anywhere in the country or the world for that matter.

You can visit Dr. Popkin in his Hollywood Florida office for an in person weight loss experience.

Visit thepopkinmethod.com to send a message to schedule an appointment with Dr. Popkin or email Dr. Popkin at mcpopkinmd@yahoo.com.

Podcast Website - https://thepopkinmethod.com/

Matthew C. Popkin, M.D. - https://thepopkinmethod.com/about

Podcast Partner - TopHealth - https://tophealth.care/

“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Transcript

SPEAKER_00 0:12

Welcome back to the Popkin Method, where we connect symptoms to science and science to solutions. Today we're discussing one of the biggest blind spots in modern medicine, perimenopause and menopause. Millions of women are told their labs are normal while simultaneously struggling with fatigue, anxiety, weight gain, sleep disruption, brain fog, low libido, inflammation, and a complete loss of vitality. But what if these symptoms aren't random? What if they're signals? Today we're diving into the physiologic transition of midlife hormonal change and discussing how the Popkin method approaches menopause through a systems-based lens involving lifestyle medicine, nutrition, exercise, supplementation, hormone modulation, peptides, regenerative medicine, and longevity science. Dr. Popkin, welcome. However, before we get started, I do have a quick announcement for you and for all of the listeners out there. A little bit of an exciting surprise. The Popkin Method Podcast is ranked 21st in the medicine category on Apple charts in the US out of all of the medicinal podcasts. We're number 21 in the country, and we are number one in the Dominican Republic and in Turkey. So congratulations to you, to our show, and thank you so much to the listeners uh for loving uh the conversations we're having.

SPEAKER_01 1:40

So oh, thank you, Jamie. That was uh that that's good to hear. Uh, I guess we have to um thank everybody out there. And uh it's really nice to see how well we're being received, and uh it's really nice to see these uh these numbers. We really try to do our best to educate everybody. And you know, thank you for that wonderful introduction and welcome everyone to the Hopkin method where we connect symptoms to science and science to solutions. So today we're discussing one of the most misunderstood and under addressed transitions in women's health, which is perimenopause and menopause. And Jamie, I know you know you're not anywhere near this age. However, I'm sure you know lots of people who are suffering with this. And for millions of women, this phase of life can bring fatigue, as you mentioned, as well as brain fog, anxiety, sleep disruption, weight gain, inflammation, uh, and a feeling of simply just not recognizing themselves anymore. And too often, uh these women are told that their labs are normal or this is just part of aging. But these symptoms, they're not random, Jamie. Um, they're physiologic signals. And when we understand the underlying changes happening within the brain, the hormone system, metabolism, inflammation, and the nervous system, begin creating individualized strategies to help women not only survive this transition, but truly thrive through it. So today we'll explore the Popkin method approach to menopause through the lens of lifestyle modification, diet, exercise, supplementation, hormone optimization, longevity science, and regenerative medicine. So let's begin.

SPEAKER_00 3:18

Let's get into it. All right, let's start off first with why you think that so many women feel perhaps dismissed or misunderstood during periodopause and menopause.

SPEAKER_01 3:30

Yeah, this is common. And, you know, it's a shame because we have such access to really good therapies, and so many women are suffering in silence and just told that they're it's just part of aging. And I think one of the biggest problems is, you know, women are often told, as I mentioned, it's just aging or your labs look normal. Um, but you know, hormones they don't operate in isolation. Perimenopause is not simply an estrogen problem, it's a full-body physiologic transition involving the brain, metabolism, inflammation, sleep uh quality, cortisol, insulin sensitivity, neurotransmitters, and even muscle physiology. And the Popkin method always addresses the fact that symptoms are signals. They're telling us something. But when women experience things like brain fog and anxiety, insomnia, stubborn weight gain, which seems to be pervasive throughout our uh our environment here, uh loss of motivation or loss of vitality, those symptoms often reflect underlying physiologic shifts that deserve investigation, not dismissal. So we need to address this with our patients and not tell them it's just something you have to live with.

SPEAKER_00 4:40

Right. It doesn't have to be normal. Um, can you explain to us what's actually happening physiologically during perimenopause?

SPEAKER_01 4:48

Sure. So perimenopause is essentially a neuroendocrine transition. And most people think estrogen simply drops. Um, but early perimenopause is actually characterized by hormonal volatility and fluctuation. Uh, progesterone is often the first one which will actually decline and then usually disrupts things like sleep and mood stability, um, anxiety regulation and nervous system resilience. You just don't feel yourself. Uh, then we start to see estrogen fluctuations, cortisol dysregulation. And here is that nasty cortisol coming back, right? We talk about it on every podcast. Uh, cortisol dysregulation, impaired sleep architecture, increased insulin resistance, same common theme, insulin resistance that leads to stubborn weight gain and inflammatory signaling. And at the same time, women are often dealing with career stress, aging parents, raising children, chronic sleep deprivation, and loss of recovery capacity. You just don't feel like you used to. So the hormonal transition collides with lifestyle stressors, and that creates physiologic overload. And these are the symptoms that patients come in talking about. They don't come in saying, I think my blood pressure is high or I think my biomarkers are off. They come in saying, I just don't feel good. I don't feel well. And oftentimes they're just dismissed. And it's it really doesn't have to be that way.

SPEAKER_00 6:07

Right. And those are a lot of things to handle all at once. Uh and not to mention when your system, when your vessel starts kind of breaking down and not performing because we have all of these outside, like you said, stressors uh and kind of different categories of life that all demand our attention, um, as well as our body completely changing, it's an absolute overload uh of the system. So definitely something that shouldn't be brushed aside or made to feel that it's not a big deal because it is. One of the biggest frustrations women talk about throughout this process is the weight gain, right? Because we still want to look beautiful, we still want to be attractive. I mean, we can be stressed, we can be sleep deprived, we can be confused, but oh my gosh, we cannot be overweight. Um, why does this happen?

SPEAKER_01 6:57

Well, Jamie, this is one of the most misunderstood areas in medicine, right? You know, people they just associate weight gain with um, you know, a lack of willpower, or they associate it with just with aging. And it really doesn't have to be that way. And now you add in their menopause and hormonal-related issues, throw that on top of some insulin resistance, uh cortisol dysregulation, stress, you know, and it's really a bad combination. So menopause-related weight gain is not simply a willpower issue, right? We see declining muscle mass, uh, we see worsening insulin sensitivity, we see mitochondrial slowing, poor sleep, elevated cortisol, reduced metabolic flexibility, and changes in fat distribution. And women often notice abdominal fat accumulation, reduced recovery when they go to the gym, or just reduced recovery from work, increased cravings for sweets and carbohydrates, and difficulty building lean muscle. So the Popkin method reframes this completely. And the goal is not simply weight loss, the goal is metabolic restoration, it's muscle preservation, it's inflammatory reduction and physiologic resilience. I'm not just looking at your scale weight, I'm looking at fixing all of the processes that are working in your body. And this is everything that we've been talking about throughout the entire Popkin Method uh podcast series, right, Jamie? I mean, we talk about these common themes, and now we add on top of it hormonal issues, and it just makes things worse. So using all the elements of the Popkin method in sequence to solve a specific problem, in this case, it's perimenopause and menopausal symptoms. Uh I focus on the same things, right? Everyone can rehearse this uh and recite this right now, right? I focus on lifestyle modification, diet, exercise, uh, basic and targeted supplementations to create the base. And then I use more targeted supplements, peptides, hormone modulation, and hormone replacement therapy, and in certain cases, advanced biologic therapies like stem cells, exosomes, and secretomes to make your body function better. And then at the end of the day, we're managing as well any prescription medications that might be necessary or being used. So essentially correcting glucose fluctuations, decreasing insulin resistance, decreasing fat, increasing muscle mass, uh, decreasing inflammatory issues. You know, this is most of what's causing these menopausal symptoms or making them worse. So this is what we're going to address today.

SPEAKER_00 9:18

Uh so then exercise becomes incredibly important during this transition when you're already exhausted, but talk to us more about uh, you know, the importance of exercise.

SPEAKER_01 9:29

Yeah, I mean, this is critically important, Jamie. And this is, you know, it's basically uh it's a non-negotiable and the conversation it needs to evolve beyond just do more cardio or you know, just go for a walk. And I'm not saying walking is bad. In fact, I tell all my patients, whether you're in your 20s or 30s or in your 80s or 90s, walking is one of the best things that you can do. But at the same time, one of the biggest mistakes that people will make is over-training and under-recovering. So if you're doing 30 minutes of cardio, the answer is not doing an hour and a half of cardio. The answer is continuing that 30 minutes of cardio, but then working on adding resistance training so that you can build muscle. And one of the common themes here is that muscle is your longevity reservoir. And your priorities should really start to become resistance training so you can build that muscle, muscle preservation, bone density support. When you exercise your muscles, you're also stressing your bones and you're and you're basically making them stronger. That helps with insulin sensitivity, VO2 max conditioning. We'll talk more about this later on, and uh recovery optimization. So it's not just about you know blasting out more cardio, it's it's understanding that you have to do multiple things in order to keep your body healthy and understand that muscle is your metabolic currency. Muscle is your glucose reservoir, it's your longevity barometer. And as estrogen declines, most women become more vulnerable to something called sarcopenia, which is muscle loss. And we talked about sarcopenia with the GLP1 medications. We do not want to lose muscle as we age, we want to gain and maintain muscle. We do not want to lose it. Uh osteopenia, which is bone loss, which if it gets to be too much, becomes osteoporosis. Uh, we also uh address insulin resistance, and overall, we want to prevent you from being frail in later life. So therefore, strength training becomes longevity medicine.

SPEAKER_00 11:21

I love that. Um, okay, we got the exercise part down. Now let's talk about the next component, nutrition. Uh, is there anything special or what does nutrition look like through the Popkin method for uh women in midlife?

SPEAKER_01 11:36

It's the same as I've been talking about since episode one, right? And that's the good part about this. There's no specific diet for uh, you know, for menopause, perimenopause, fatty liver, diabetes, you know, it's it's all essentially the same. It's the same blueprint. And as we've discussed all throughout the Popkin Method podcast, the foundation is metabolic stability and inflammatory reduction. So we focus heavily on protein optimization, blood sugar regulation, anti-inflammatory nutrition, hydration, microbiome support, fiber intake, reducing ultra-processed foods, which I've said a thousand times, and structured fasting and feeding windows. So essentially, you want to prioritize protein, you want to prioritize fiber in the form of vegetables, which means you want to deprioritize the starchy carbs, bread, rice, potato, pasta, cereals. And by all means, you definitely want to deprioritize sugar and sweets. Uh, and you want to emphasize healthy fats, things like avocado, extra virgin olive oil, nuts, things of that nature. So our listeners can go back to previous episodes to refresh on these topics. I believe episodes seven, eight, and nine really focused on diet and the effect on gut health and inflammation and things of that nature. And one of the biggest problems that many women are doing is they're under-eating protein uh while simultaneously losing lean muscle mass. And that's why I always tell patients men, men, women, young, old, it doesn't matter. One gram of protein per pound of ideal body weight is what you're trying to achieve. So if your ideal body weight is 125 pounds, then you should be eating 125 grams of protein throughout the day. And if you prioritize protein, you're going to maintain your muscle mass. Then on top of that, if you exercise your muscles, you'll help to maintain and grow muscle. So we also need to address things like alcohol reduction, sleep supportive eating, meaning we're not eating right before we go to bed, um, strategic carbohydrate timing. And I talked about this. If you are going to have any type of starchy carbohydrates, potatoes, rice, any of those things, it's really to fuel an exercise. It's not just for basic things throughout the day. So if you are going to have those starchy carbs, you're going to have them before a workout so that you can actually consume them and decrease your insulin response. Uh, this is why we talk about individualized nutrition plans. So everybody functions differently. But for the most part, prioritize protein, prioritize fiber, deprioritize the starchy carbs, and prioritize healthy fats. So there's no universal menopausal diet, Jamie. It's really, it goes back to everything I've been saying throughout the podcast series. The physiology matters, the lifestyle matters, stress load matters. But at the same time, if you individualize these things to your particular lifestyle, it'll help you with not only insulin resistance and inflammation, but it'll help with the menopausal symptoms as well. And the Popkin method will individualize this on a case-by-case basis. But for the most part, follow those rules and you're going to be in good shape.

SPEAKER_00 14:38

I love it. So again, prioritizing protein, but also with prioritizing protein, you need to prioritize yourself so that you can start doing this, stay consistent and committed to it. Um, because again, like you keep saying, this is lifestyle modification. And that's not something where it's like a light switch where you just, you know, one day. I mean, maybe some people, and good for them. But I think for the most part, if we're looking at a whole kind of diet and exercise overhaul, that's something that you need to give serious focus and attention to and to prioritize. Yes, the protein and yourself so we can get this done the right way. On top of that, the supplement world is just exploding right now, almost to the point of overwhelm. Yes. Um, what foundational supplements tend to matter the most for women in this age range?

SPEAKER_01 15:35

Yeah. So, you know, there's so many supplements out there, and you know, I'm definitely someone that focuses on the proper supplementation. And the key is targeted supplementation, not supplement overload. And some of the foundational tools that I usually discuss are things that are in my core five supplements that I feel most people uh would benefit from. First and foremost, magnesium glycinate. So this helps with numerous metabolic processes in the body. Take this at night for sleep optimization, it really helps with that. Omega-3 fatty acids, omega-3 fish oils to decrease inflammation. You want to make sure you're getting this from a good, trusted source because there's a lot of bad actors out there. And unfortunately, if you're getting a rancid omega-3 fish oil supplement, it can actually be pro-inflammatory rather than anti-inflammatory. And just as an aside, store your omega-3 fish oils in the freezer and then, or at least in the refrigerator so that they don't go bad while you are waiting to consume them. Vitamin D3 and K2, as most people are deficient in vitamin D, even down here in Florida, I test everybody. And even people that are super tan, you think they'd have a lot of vitamin D, and they don't. So good supplementation with D3 and K2 is important. Creatine monohydrate, I shout this from the the rooftops for lean muscle mass, energy production, reduction in brain fog. Creatine monohydrate is fantastic. It's one of the most studied and safe supplements out there. And lastly, pre and probiotics for gut health. So those are the core five that I like to I like most people to take. And then we can consider more targeted supplements like ashwagandha, which is really good for decreasing cortisol. So people that are stressed, take some ashwagandha dinner time and nighttime, you know, 300 to 600 milligrams in the evening generally works. Ouron, which our soils are depleted in, which will help us absorb vitamin D more effectively for hormone optimization. I like toncatele and phedogia restus, which helps to stimulate your body's own production of hormones if you are able to. If the organs are still producing hormones, then this will make them produce more. I like the branch chain amino acids and protein powder supplementation to help you hit your protein goals. Remember, one gram of protein per pound of ideal body weight. Collagen peptides are actually very good, really more to get your protein in there and to hit your protein goals because you don't necessarily eat collagen, so you can produce more collagen. And that's a bit of a misnomer, but really it does help in increasing your protein, which that in itself will help you produce collagen and protein in your body. Um, and sleep supportive nutrients like GABA, L-theanine, and vanilla valerian root, if you are having difficulty sleeping in magnesium, isn't doing the trick. And these are more targeted approaches depending on your cortisol patterns, your sleep quality, your level of insulin resistance, inflammation, any cognitive symptoms you may be having, or recovery deficits. So everything is individualized, Jamie. It's not just, you know, there's there's no one blueprint for everybody. But remember the supplements should support your physiology, not replace the lifestyle fundamentals that we talked about. And as I always say, you can't out-supplement bad habits. So you've got to have the foundation in there, and then the supplements will do exactly what they're supposed to do, supplement your good habits.

SPEAKER_00 18:57

Awesome. All right, so those are the things that we can control, right? On our on our side. So let's move into hormone replacement therapy. Can be a little controversial for some people. How do you approach that conversation if that's the right step for someone?

SPEAKER_01 19:15

And it this is a real complex issue because unfortunately, you know, most of the women out there, they either go to their GYN who does an incomplete job of treating their hormones because they really just focus on estrogen and progesterone. And they usually do so in a pharmaceutical fashion, meaning they're sticking to pharmaceutical-based medications where you can't really make those fine adjustments. And for some reason they're they're just totally leaving out testosterone, which I'll throw, I'll talk about a lot in a little bit here. But first, you know, we need nuance and understanding here. Okay, so hormone therapy is not universally dangerous, nor is it universally appropriate. And the conversation really has to be individualized. If you have symptoms of hormone deficiency, then we need to treat those symptoms appropriately with the appropriate hormones. And for appropriate candidates, the hormone therapy can support anything from sleep to cognition, bone health, cardiovascular health, vasomotor symptoms like hot flashes. People out here that are listening will understand if you have hot flashes, they are not pleasant. Muscle preservation, sexual health, and quality of life. However, the risk assessment matters here. And the Popkin method looks at your personal history, your family history, metabolic health, inflammation, what your cardiovascular risk is, your clotting risks, and your symptom burden. We don't just treat people with hormones if they're if they're not symptomatic. So hormones are just one tool within a much larger physiologic framework. And this is important here. Unlike men, where we can generally get them to increase their own production of hormones, women in perimetopause and menopause generally have very little reserve to fall back on, which is why we really need to be thoughtful on which symptoms we're trying to correct and which hormones we're going to use to correct them, all within the context of risk versus reward, based on the individual's health history with very close follow-up. And we make the necessary course corrections as needed. So really it's symptom-based, and you really have to follow along and make the proper adjustments to make sure that we're getting rid of all of those symptoms appropriately.

SPEAKER_00 21:25

Yeah, I love that you mentioned, you know, it's not universally dangerous, but it's not universally appropriate for everyone either. So I think that's an important takeaway for people to not kind of vilify it or, you know, regard it too high one way or the other. Everything really is so individualized, like you mentioned. So testosterone in women is becoming a bigger topic. What is testosterone therapy for women? That's not a woman kind of a thing. So well, we know we have a little bit, but tell us more about why that's Important.

SPEAKER_01 22:00

Yeah, we're jumping on the testosterone bus here, ladies. I'm going to spend a bit more time on this topic because it's such a valuable treatment tool and hormone replacement therapy in women. And it is often overlooked and pretty much flat out ignored, mostly due to an imperfect understanding by most physicians on how testosterone relates to female health and its potential impact it can have on decreasing menopausal symptoms. So let's get into it, right? When you're when women are in their 20s and 30s and 40s, they're making estrogen, progesterone, and testosterone. But for some reason, when we do hormone replacement in women, we only look at estrogen and progesterone and we completely disregard testosterone, which makes absolutely no sense. And a lot of times what happens is the symptoms that the that women are having, we start estrogen and progesterone. The symptoms are not relieved completely because some of these symptoms are related to testosterone. But instead of giving them testosterone, they just keep raising the estrogen and progesterone, and it's not fixing the other symptoms. So the dose keeps getting escalated, where it would have been, you would have eliminated the other symptoms by adding in a little bit of testosterone. So that's an oversimplification, and I'm going to get way more into this here so we can understand this. So when discussing hormone replacement therapy, estrogen and progesterone typically dominate the conversation. However, testosterone is a key hormone that significantly influences how women feel physically, mentally, and sexually throughout the menopause transition. So women naturally produce testosterone in the ovaries and the adrenal glands. That's basically how it's done. During perimenopause, hormone levels begin fluctuating and gradually decline, often creating symptoms that may that may not fully improve with estrogen and progesterone therapy. And those include fatigue, low motivation, decreased sexual desire of mood changes and mental fog. So, as I mentioned, you know, women are put on estrogen progesterone. They still have these symptoms. So instead of adding testosterone that will relieve a lot of them, their dosage of estrogen progesterone just keeps getting increased, which is not what we should be doing. So many women are told that these changes are just simply part of aging or symptoms to tolerate rather than treat, which is very frustrating for people. And then it's it's unfortunate that these women are told this. And in reality, these complaints are often hormonally driven and frequently they begin a lot earlier than most people expect during the perimenopausal stage, long before your periods stop, you know, stop coming. So one of the most overlooked contributors is the natural decline in testosterone that occurs both in perimenopause and menopause. And although it's often labeled a male hormone, as you mentioned earlier when we were talking about this question here, uh testosterone is really essential to women's health. It supports energy, it supports your cognitive clarity, sexual function, mood regulation, muscle maintenance, and just overall vitality. So testosterone therapy for women, it restores hormones. What we're trying to do is restore hormone levels to a healthy physiologic female range. What you were back in your 20s and 30s and 40s. We're not trying to turn you into men by any stretch. We just want to return your testosterone levels to what they were when you were feeling well. And this will help improve symptoms associated with hormonal decline and just overall support your quality of life. But before women produce, it's important to understand, right? Before menopause, women produce estrogen, progesterone, and testosterone. So why are we not replacing testosterone when we treat women with hormone replacement therapy? In 2026, we have all the technology, we have all the testing abilities, we have all the tools out there, we're just not using them.

SPEAKER_00 25:39

So, like you said, we're not trying to take you to a level you've never been to. We're just trying to get you back to where you were, back to baseline. Um how does testosterone work in the female body?

SPEAKER_01 25:50

Okay. So testosterone supports many, many symptoms that are critical to maintain female health and healthy aging. That includes sexual desire, arousal response, energy, stamina, motivation, cognitive function, mental clarity, a preservation of lean muscle mass, bone strength, metabolic health. It's really quite important, Jamie. And as testosterone declines during perimenopause, which is in your 40s, and menopause, which typically happens in the late 40s and early 50s, most women they'll notice subtle but very meaningful changes, right? They have less drive, less clarity, less strength, less overall, less overall vitality, decreased libido. So restoring testosterone to appropriate levels, not super therapeutic levels, appropriate levels, can help rebalance these symptoms and improve your daily function and how you feel.

SPEAKER_00 26:41

I love it. So what are the treatment options? What does that look like?

SPEAKER_01 26:44

Yeah. So part of the problem is that because there are no FDA-approved testosterone products out there designed specifically for women, therapy is prescribed off-label using carefully adjusted formulations. So typically what we see are topical creams and gels, which is the most common. And topical testosterone remains one of the most commonly used approaches. The creams and gels, they provide steady absorption and allow precise dose adjustments, which is especially helpful during perimenopause when the hormones are still fluctuating and going up and down. And this is what I typically prefer on my patients. Um, then there's testosterone pellets and injections, which I don't tend to use for the reasons I'm going to mention. So testosterone pellet therapy for perimenopause and menopause of women is another option. The pellets are small, bioidentical hormone implants that are inserted under the skin in a in a brief office procedure. And they release testosterone gradually over several months and offering consistent hormone delivery, unfortunately, without the, you know, without the need for daily application. But unfortunately, what happens is although it's a good choice for women who prefer convenience and stable hormone exposure, unfortunately, you can't adjust the dosage once these pellets are put in. So for this reason, I generally don't recommend this route. And I just saw a lady yesterday who had been treated with pellets in the past. The dose was too high. She started to get acne, growth of hair on her chin and deepening of her voice. And she was stuck with the dose until the pellets wore off. So really, I don't recommend using testosterone pellets in women, and not even in men either. It's just not a good way to adjust the dosage. Um, so testosterone injections, kind of what we do when we replace testosterone in men. We also use these, and some of the hormone practices do as well. And injections are typically administered in low doses on a schedule, usually once a week, to provide very predictable absorption and consistent blood levels. And the advantage is that you can control the dosage. Adjustments can be made more easily compared with pellets. You can adjust the dose on a week-by-week basis. So you can fine-tune the dosage here. However, the injections require, you know, intramuscular administration. So you have to give yourself a muscle injection, which is not a horrible thing, but some people don't like that. And very, very close monitoring to maintain the levels in a healthy female physiologic range. And I use this in a smaller subset of my female HRT patients, but for the most part, I use the cream. So the best delivery method, it depends on your symptoms, your lifestyle, your treatment goals, how your body responds to therapy, but always a personalized approach is best so you get the best results.

SPEAKER_00 29:22

Good to know. Good to know. Okay, for the people who still have some confusion or incorrect information about testosterone in women, what are some common myths that you hear?

SPEAKER_01 29:34

Yeah, so one of the most common myths is that testosterone will cause masculine side effects. And it's it's not necessarily a myth if you're using higher doses, right? If the dose is too high, you can absolutely cause masculine side effects. But in the low doses that we're using in women, it is a myth because again, we're giving you levels back to what you were in your 20s and 30s, not achieving levels that men have. So uh when prescribed correctly, this does not occur. The goal is to restore hormone levels to a healthy female range and not exceed it. Another misconception is that testosterone is only about sex drive or libido. So while it is, yes, highly effective for treating low libido, many women notice improvements in mood, motivation, cognitive clarity, muscle maintenance, and fat loss. So it's not just about libido. So testosterone therapy is really increasingly recognized as part of a comprehensive approach to supporting women through perimenopause, menopause, and healthy aging. It's unfortunately just even though it may be recognized as not being done. So really, if if you're having these symptoms, consideration for for low dose testosterone therapy, adding it to your estrogen progesterone might be the right thing for you.

SPEAKER_00 30:45

So, what are the benefits of a testosterone therapy for perimenopause and menopause?

SPEAKER_01 30:50

Okay, so first and foremost, the main reason is used for improved libido and sexual function. So everyone knows testosterone supports sexual interest, arousal, and satisfaction. It helps many women restore intimacy and confidence, which is important in a lot of relationships. I've had several of my patients tell me that, you know, I've saved their marriage because you know they were able to get their intimacy level back. And that's very important in in relationships. So this is, you know, it's not just about you know vanity and how you look, how you feel, it's how you interact with your uh with your significant other. So it can be quite helpful in relationships as well. Other things, increased energy and mood support. I mean, this is really important, right? Hormonal shifts, they lead to fatigue, emotional flatness, uh just not feeling yourself. And testosterone therapy, you know, may improve your energy levels, motivation, emotional resilience, helping women feel more engaged in daily life. And as we talked about, right? Uh, women are, you know, everyone in general are more stressed. But you know, we're talking to women who are they're hormonally challenged, but they're also working, taking care of you know, families and doing more and more things as we just become advanced as a society. You know, men and women are just becoming so overwhelmed with physical and and emotional tasks that you know, we really need our hormones to be optimized. Another really important benefit is maintaining muscle mass and bone health. And this is super important because as hormones decline, you're you're losing lean muscle mass and bone density. And testosterone will help maintain your strength, support long-term musculoskeletal health, which is critical for active aging. And lastly, is improved mental clarity and focus. And I don't understand why people don't put more of an emphasis on this. You know, how your brain functions is how you know you're going to function in life. I mean, we have, you know, we've advanced our smartphones to, you know, or our cell phones to the point where we call them smartphones. Well, what about our brain? We just completely disregard these things because the smartphone smartphones and the computers and the laptops and the tablets and the technology does so much stuff for us. But you know, really brain fog, reduced concentration, mental fatigue, these are common complaints during menopausal transition. And optimizing testosterone levels can help with focus and memory and cognitive performance.

SPEAKER_00 33:09

Love it. Okay. So testosterone therapy. Some say that it's unsafe for breast health. Is that true? What does the actual research say?

SPEAKER_01 33:19

Yeah. So again, it just shows an incomplete understanding of what the hormones do in the body. And as we mentioned, it's not universally dangerous nor universally appropriate. And this is where risk versus reward comes in. So we'll talk a little bit about some of the science behind it. So breast health is certainly one of the most important concerns women raise when discussing hormone therapy, and understandably so, whether it's estrogen, progesterone, or testosterone. And the relationship between testosterone and breast tissue is very complex, and the scientific literature continues to evolve. So what we know is that testosterone behaves differently than estrogen in the breast. And laboratory and clinical studies show that testosterone acts through the androgen receptor, and it may actually have some anti-proliferative effects, meaning they can counterbalance estrogen-driven stimulation in certain breast tissue environments. So that's a good thing. And several observational studies have actually reported some very reassuring findings showing that breast cancer rates in women treated with testosterone therapy, including pellets, these results were comparable to or lower than expected population rates. So again, breast cancer being somewhat lower in these populations is a good thing. And again, that is in the patients that are replaced with testosterone, not in patients that have normally elevated testosterone, which I'm going to discuss here. So at the same time, larger epidemiologic studies that evaluate naturally occurring hormone levels, not TRT, but patients that have just higher overall testosterone levels suggests that higher endogenous testosterone or the testosterone that your body already makes, higher levels of endogenous testosterone in postmenopausal women may be associated with increased breast cancer risk. So this is not a good thing, although it's referring to naturally occurring testosterone, not TRT, not replacing that testosterone. So this highlights how complex biology really highlights how complex hormone biology is and why therapeutic replacement or TRT can't be directly compared to natural hormone patterns. And because the findings are mixed, major menopause and sexual medicine consensus statements emphasize that testosterone therapy is not recommended as a breast cancer prevention strategy. So we're not using it for breast cancer prevention, we're using it for symptom control. And current evidence suggests that physiologic testosterone therapy does not appear to increase short-term breast cancer risk when properly prescribed and monitored, but long-term data continue to evolve. So what we're comparing is people with normally elevated testosterone in menopause, okay, people that just have naturally normally higher levels of testosterone versus the testosterone that we give to women in post-menopause. So these things have to be compared and contrasted. And again, it's a risk versus reward thing. Everybody is different, which is why you need to go to somebody who really understands this and knows how to follow you, treat you properly, follow your results, and to make sure that you're mitigating any potential risks. So the clinical takeaway here, Jamie, is that in clinical practice, testosterone is prescribed to address symptoms such as low libido, hot flashes, fatigue, mood changes, and reduced vitality, not to prevent cancer. And the safest approach includes individualized hormone therapy, as we discussed, uh, with the lowest effective dose, which I always say this. And as in all by Hopkin method recommendations, less is more when we're talking about treatment. Regular breast cancer screening and surveillance is necessary regardless of if you're using testosterone replacement therapy or not. So whether you're using estrogen, progesterone, testosterone or or not, you should be checking, you know, doing self-breast exams and following up with you know regular mammograms. And as always, careful monitoring by an experienced women's health specialist is essential. Okay, you do not want to be DIYing this. You definitely don't want to be doing this based on the recommendations of you know these internet influencers. And if you're going to a practitioner that you feel doesn't have a complete understanding of this, find another practitioner, find someone that does. And when use thoughtfully, testosterone really can be part of a really balanced hormone strategy that will prioritize both your symptom relief and long-term safety.

SPEAKER_00 37:39

Excellent. All right, so let's talk about potential side effects of testosterone. Are there any if we're doing it the right way?

SPEAKER_01 37:47

Yeah, well, when prescribed at physiologic doses or normal doses and monitored appropriately, testosterone therapy is really generally well tolerated, Jamie. Some of the potential side effects may include acne or oily skin, increased facial or body hair, typically on the chin, the armpits, the chest, some mild voice changes, a deepening of the voice, and in some women, clural enlargement. These are typically dose related. And if the dose is appropriate, you generally do not see these symptoms. It's typically you're going to see that when the dose is too high. Most of these side effects, they are preventable with very careful dosing and regular follow-up. And the presence of these symptoms, as I mentioned, generally indicates that the dose is too high and needs to be adjusted. So in the right doses, you really shouldn't see any side effects. Safe testosterone therapy requires ongoing monitoring, including baseline lab testing, periodic hormone evaluation, and clinical follow-up. We just don't set it and forget it, right? The goal is symptom improvement and functional wellness at the lowest effective dose, not simply achieving a target lab value, which there really isn't a lab value that I'm looking to hit when I look at women's testosterone. I'm looking at dose that uh is going to keep their symptoms at bay. Okay.

SPEAKER_00 39:03

You got it. Okay. So how long does it take to see results? Is this an instant thing or will it take a while to see its effects?

SPEAKER_01 39:10

That is a great question. And just this week, you know, I had a lady call me and she said she hadn't seen any results yet. And I had just seen her like in the beginning of the week, and she just got her product, and I think she had it on for like a day or two. It was it was a cream. And so I do get this a lot. Most people, you know, I do in all my patients, I manage their expectations. And most women notice early improvements within about six to eight weeks. Okay, so you're not going to see it in you know a day or two, with fuller results typically occurring around three months. And ongoing follow-up allows me to make adjustments based on symptoms and clinical response. So you do not notice this, you know, within a day or two. And you know, you have to manage your expectation. We always start low and work up. So again, that's another reason why it takes a bit longer. Some of the people that notice earlier uh results typically are being started on too high of a dose, and those are the ones that are getting the side effects. So again, start low and increase. You can always add more. If you give too much, then you know you're just gonna start getting into some issues. So, again, working with a clinician that's experienced in women's health is essential to assure both safety and successful outcomes. So, to kind of wrap this up here, Jamie, some key takeaways are that testosterone supports more than just libido. And the therapy may improve energy, mental clarity, muscle strength, bone health, sexual wellness, all during the perimenopause and menopause period. So, this is important to understand. And symptoms of low testosterone, they often begin way earlier than expected. Many women get symptoms of testosterone decline in perimenopause before their period stops. So in their 40s, they're experiencing this. So that's why it's important to test your hormones if you're not feeling well, even if you are in your late 30s and early 40s. Treatment has to be individualized, right? Proper dosing requires experienced hormone management tailored to your physiology. There's no cookbook recipe here, and there are multiple treatment options that exist: topical injections, pellets, and it just depends on your goals and your lifestyle. And pretty important here is that most of the treatments are self-pay, right? Testosterone therapy for women is prescribed off label in the US and is typically not covered by insurance. So this is something that's gonna be a cash pay opportunity here for the for women that need it. So you have to understand that it's not gonna be covered by insurance.

SPEAKER_00 41:31

All right. We talked a lot on the show about peptides. Yes, they like we say all the time, they have become increasingly popular in longevity medicine. I think I even saw a post the other day saying that in 10 years, we won't even be aging past age 35 or something like that. Probably some fun clickbait. But um, but where do peptides fit in in ribbon's health at this age?

SPEAKER_01 41:57

Yeah, so we're gonna hop off the testosterone bus and we're gonna jump in with the peptides. And peptides are one of my, you know, one of my go-tos that I like just because they're they really are a more natural form of treatment rather than prescription medications. Um, and they're super fascinating because peptides represent signaling medicine, right? These are signals in your body that your body makes. So we make GLP1, we make GIP, we make glucagon, we make all of these different peptides in our body that we're giving through injections now. So these are things that we ordinarily that we already make. And certain peptides they may support recovery, tissue repair, sleep quality, body composition, mitochondrial function, one of my favorite topics, and uh and inflammation. So some of the examples of the peptides we talk about, you've got all the growth hormone secretors, CJC1295, ostermoralin, impomorin, tesomorlin, those all help you to increase growth hormone in a pulsatile fashion. BPC157, TB500 for for tissue repair, uh throw in some copper peptides to those two, and then you get the glow stack that everybody's talking about. Can't even keep it in stock. Mitochondrial support peptides, uh, things like MOT C, NAD Plus. We've talked a lot about that. In fact, we had an entire podcast episode about NAD plus, and I prescribe all of these and a host of others. So I really do like peptide treatment. And but again, I think it's very important to emphasize here these are advanced therapies, right? Lifestyle fundamentals must come first. So lifestyle modification, diet, exercise, and some basic supplements. Clean all that up first, and let's see what peptides you need, if any, after that. And no peptide can outsupport chronic sleep deprivation, poor nutrition, excess alcohol, unmanaged stress, or or just physical inactivity. And I saw a patient yesterday who was taking the glow stack and CJC1295 and ipamoralin. But her hormones were completely no estrogen, no progesterone. Testosterone and she felt horrible. Yet she was injecting these two peptides from another provider and wondering why she didn't feel well. So here she is spending arguably $300 a month or more on peptides, probably more, and feels horrible because nobody addressed her hormone issues. And again, you can't out-peptide these issues, you can't out-supplement these issues. You have to have the basics, then we move into peptides, and we move into hormone modulation, and we talk about more advanced therapies after that.

SPEAKER_00 44:30

Yep. We cannot supplement bad habits, like you say time and time again. Another peptide, GLP1 medications, they've changed the weight loss conversation. How do they fit into the framework into all of this? Is that even a good idea at this stage?

SPEAKER_01 44:47

Yeah, so you know, the GLP1 medications, they're really are, you know, pervasive throughout the internet. And, you know, everybody, it seems like everybody is on them. And that's not necessarily a bad thing, but as I mentioned, if we're using the GLP1 medications in the right population and your hormones are off, it's going to affect their performance. And these medications, they can be very, very powerful tools in the right patient population. Um, but they should not be viewed simply as cosmetic shortcuts, which I think is what we're seeing in in social media. You know, these influencers that, you know, click on the link below for my PEPs, and you know, we can get it. That's that's just not appropriate for most patients. And when used appropriately, they may help improve insulin resistance, appetite regulation, inflammation, metabolic dysfunction, and obesity-related disease burdens like diabetes, high blood pressure, high cholesterol, and things of that nature. However, preserving muscle mass becomes absolutely critical. Most of the patients on these medications are going to lose 50% fat and 50% muscle. So if you lose 10 pounds, five of it is muscle, and that's a bad thing. And it's it doesn't have to be that way. If you're on the GLP ones and you prioritize protein and you're doing strength training exercises, you can mitigate those muscle losses. And unfortunately, we're not seeing this in in most of the providers. And I again saw this yesterday. I had a bunch of people come in that we were that we were dealing with, and patient that was put on on one of the branded medications from her doctor, insurance paid for it. She was on it for a year, she lost 15 pounds. 15 pounds in a year. She lost a tremendous amount of strength and energy, and she was just wondering why this medication is not working. And she was sent to me to find out why. She was not told to increase protein or prioritize protein, she was not told to decrease starchy carbs, she was not told to exercise or do weight training, and she was on a middle, a middle dose of this prescription medication and was being advanced to the next levels and without doing all the basics. Lifestyle was horrible, diet was horrible, no exercise, hormones were off. Yet we're prescribing this medication, having it paid by insurance, and it's not working. So she just wasted, or the doctor just wasted a tremendous amount of time and resources without giving her the proper instructions. So we want to make sure that if you're using a GLP1 medication, you're doing this in a structured format that addresses all of those issues with lifestyle, diet, exercise, and things of that nature. So this is where the Popkin method will emphasize resistance training, protein optimization, nutrient support, and long-term metabolic rehabilitation. It's everything that we've been talking about in the Popkin method. So you want to make sure if you're using these things, you've got the basics cleaned up. So the goal is not simply losing weight, it's improving your body composition and your longevity trajectories.

SPEAKER_00 47:42

Excellent. So let's move into stem cells, exosomes, secretomes. There's a growing interest in all of them in the regenerative medicine space. Can you explain the difference on this episode about stem cells, exosomes, and secretone of those therapies?

SPEAKER_01 48:00

Yes. So this is one of the most exciting and evolving frontiers in medicine. And before I discuss any of these therapies, such as stem cells, exosomes, and secretone-based treatments, it's really important to note that many of these therapies are considered emerging and investigational in certain applications. And the evidence as it continues to evolve, the information shared today is intended for educational purposes only and should not be interpreted as medical advice or a recommendation for any specific therapy. So individuals interested in regenerative medicine should consult with a qualified healthcare professional to determine what may be appropriate for their unique medical situation. And you can message me directly at thepopkinmethod.com if you want to discuss these therapies with me further. So having said that, getting all the legal disclaimers out of the way, Jamie, stem cells, their regenerative cells with the potential to support tissue repair and healing. Exosomes and secretomes, these are the signaling components that are released by these cells. And they may influence things like inflammation, cellular communication, tissue recovery, and other regenerative pathways. And potential future applications being explored include things like orthopedic recovery, sexual wellness, inflammatory modulation, tissue repair, and other longevity medicine. But it's essential to remain scientifically grounded here, right, Jamie? As we always say, some therapies are promising but still emerging, and evidence quality varies significantly. Patients should seek qualified, ethical, and medically supervised care.

SPEAKER_00 49:32

Yes, they should. Okay, Dr. Popkin, if there's one message that you want the women listening today to walk away with, what would it be?

SPEAKER_01 49:42

That message is that you are not imagining your symptoms and you're not broken. And I get patients coming in all the time that are just, you know, they they're overwhelmed with their symptoms and they just think that there's no there's no cure for it. Perimenopause and menopause are very profound physiologic transitions. They're not simply hormone deficiencies. And the good news is that women today have more tools, more science, and more options than ever before. And when we connect the symptoms, the physiology, and the lifestyle, and the hormones, and the metabolism and recovery, we can create individualized roadmaps that help women not only survive this transition, but potentially thrive through it. And that's the essence of the Popkin method. And, you know, I got a big hug yesterday from one of my patients who was just, again, she had a laundry list of symptoms. She had been on a bunch of treatments and just could not understand why she was experiencing this. And just a thoughtful discussion with her on what we were going to do. First and foremost, you know, I just acknowledged her symptoms. They're real, they're somewhat easy to correct as long as we identify them and we follow a method and she's going to get better. And she literally came in in tears and left smiling. And I got a big hug out of it too. So it was very nice. So it is rewarding work. It's very helpful for people to understand that there are options out there. And in closing, if there's one thing I really want you to take away from this conversation, it's this there is no medication, no peptide, no hormone or protocol that can outperform a well-built physiological system. And hormone replacement therapy, GLP1 therapies, peptide stacks, even the most advanced regenerative treatments, they're all very powerful tools, but they are not replacements for the fundamentals. And when those fundamentals are missing, results slow down, muscle is lost, metabolism adapts in the wrong direction, and weight gain becomes almost inevitable. The Popkin method was designed to solve that problem. We build the foundation first to relieve perimetopause and menopause symptoms, lifestyle modification that promotes restorative sleep and stress reduction, nutrition that stabilizes insulin, resistance training that preserves muscle, strategic fasting that restores metabolic flexibility, and core supplementation that supports the system at a cellular level. Then and only then do we layer in these advanced therapies. And when we do so, we use them very differently. We use peptides at the lowest effective dose. We carefully select hormones for hormone replacement therapy. We have a focus on body composition, not just your scale weight, and a long-term strategy built around sustainability, not a quick fix. Because the goal is not short-term reduction in symptoms. The goal is to correct the physiology that contributes to the menopausal symptoms so that the therapies work more effectively and most importantly, safety. And that's the difference between chasing outcomes and actually building health solutions. So if you found this episode helpful, I encourage you to share it with someone who may also be trying to navigate the complexity of modern health care, especially as it pertains to perimenopause and menopausal symptoms. Because the reality is that many people today are stuck in what I call the revolving door of treatment plans, seeing multiple specialists receiving fragmented advice, being bombarded by so-called internet influencers who offer no real solutions other than purchasing products and never quite developing a clear strategy that ties everything together. The goal of the Popkin method is to change that. This podcast series is designed not only to educate, but also to help people understand that there is a more structured and integrated way to approach health, one that combines the principles of internal medicine with functional medicine and regenerative medicine in a thoughtful, coordinated care plan. So if you feel like you're ready to move beyond scattered treatment plans and start building a personalized care strategy to address your menopausal symptoms as we discussed today, or any other health concerns you may have, I invite you to start a conversation with me. And you can learn more by going to thepopkitmethod.com. And from there, you can schedule a discovery call with me. You can schedule a virtual functional medicine consultation or an in-person consultation with me at my Hollywood Florida office. You can also follow along with additional education and updates on my social media platforms, including Facebook, Instagram, and LinkedIn. And you can find longer form educational content and lectures on my YouTube channel as well. So my goal with all of this is simple to help patients understand their physiology, organize their care, and develop a clear path towards better health. So thank you for listening to the Popkin Method podcast, and I look forward to continuing the conversation in the next episode.

SPEAKER_00 54:23

Dr. Popkin, this has been an incredibly powerful conversation. Today we explored hormone physiology, metabolism, inflammation, exercise, nutrition, supplementation, hormone therapy, peptides, regenerative medicine, and the future of women's longevity care. So if you enjoyed this episode, please subscribe, share it with someone navigating midlife hormonal changes, and follow along for future conversations where we continue connecting symptoms to science and science to solutions. You don't need more opinions, options, or overhyped social media gimmicks, and you certainly don't need your hormones recommended by Instagram influencers with zero credibility and treatment plans that lack physician oversight. You need the sequence and structure that the Popkin Method provides. And that starts with one plan that's built to last. If you're ready to explore these therapies the right way, visit thepopkinmethod.com to learn more and schedule a discovery call, an online consultation, or an in person visit with Dr. Popkin today. This is the Popkin Method, and we'll see you next time.