Episode #106 Featuring Dr. Mariza Snyder! The science of menopause and hormonal decline, Stigmas of testosterone and progesterone, Embracing menopause, Estrogen facts and more!

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All right, everybody.

Welcome back to the Dylan Jamele podcast.

So as I always say, I am super blessed that I have amazing guests that are willing to

come in and see me and talk to me in person and I am extremely thankful.

And today's guest has a plethora of information.

And when I saw her talking about her new book, I said, okay, I've got to have her.

I got to get her on here.

And it wasn't just because of the book, it was because of the content and the stuff that

I was seeing that she was putting out the impact that it was having.

And I look for people that give out heartfelt information.

Not people that are just giving out info to give it out to draw for whatever they've got

going on, but people that I can see actually care.

And you can see the intricacies on what they do.

And that's why I invited my guest here today because I want to spotlight what she does.

Yeah, just briefly here because I can't do justice on a short bio, but we're going to

get into everything.

She is a powerhouse advocate for midlife women, leveraging 17 plus years as a practitioner

and author, a speaker.

And she has a top rated podcast is called energize and also a new book, which we're going

to talk about amongst the many books that I just found out that she wrote.

But she has so many skillsets.

Her new book is called the Perry Menopause Revolution.

So my friends welcome Dr. Marissa Snyder.

Thank you.

I'm so happy to be here.

Thank you for making the trip down to see me, especially during all of this busy time

with your book that you've been all over the place, rightfully so.

Let's talk about all of these things that you're doing that I brought up because I feel

like you are trailblazing for menopausal women's health, but all women's health and really

for men too.

I mean, we can look at it from multitudes of ways.

But I think the impact that you're making is very prevalent.

It's noteworthy.

And so I kind of want to get into everything that you're doing right now.

So I love it.

Yeah.

Let's do that.

Well, let's do this first before we get into anything.

I don't do all the backstory stuff and everything, but I do want to know what your driving

force and factor is into the work that you do because it is impactful and you're so passionate

about it.

Why the kind of menopausal route and in that realm, so to speak.

Yeah.

I love this question.

And my mom had me when she was 19 years old, so she's a young mom.

And if you look at her today, you would say she's in her 40s.

This woman is gorgeous.

She's retiring this year.

And she plays competitive tennis.

She is training for a marathon, the LA marathon right now.

This woman is a force of nature.

And that's how I always had seen my mom in whole life.

She was a single mom raising us.

And she was super woman like she was super woman in high heels.

I could hear her.

She had this walk, this like this walk.

And she was always physically active when we were growing up.

She was like, these little power suits, you know?

Like it was very much that vibe, you know, like the 80s mom or the 90s, like, working

mom, you know, just trying to get in the room where it's happening.

That was my mama.

And I really, I get to stand on her shoulders.

Like she, she opened the door for me.

She allowed me to see what was possible for me as she was trying to get in the room.

And she, this invincible woman.

I remember she, my sister was having some pretty big struggles.

She's in her knees.

And again, mom's often won't tell you what's going on, you know, they, they kind of keep

it to themselves.

And she was struggling in the beginning of her 40s.

We weren't talking about period menopause then, you know, menopause was just your period

stop.

That was it.

Maybe some hot flashes, maybe some night sweats.

And that was it.

But my mom was struggling with weight.

She was struggling with energy issues.

She was struggling with mental energy.

She was struggling with mood, particularly the rage.

And it's finally when she got into her late days, she had been dealing with a lot of these

things kind of under the surface, not telling people just kind of powering through the way

that we tell women to power through.

But in her late 40s, I want to say was 48 years old, I'll never forget, I got a call

at 11 o'clock at night.

And when your mom was calling you at 11 o'clock at night twice, it's not good.

And she was in, she was really struggling with her mental health.

She was really, she was really scared about what was going on.

And she had been to OB-GYN, she had been to primary doctors and just kept being told

that it wasn't menopause, maybe some antidepressants and just keep, keep it moving until she got to

a point where she did not know what to do.

And I just watched this woman who was bulletproof become a shell of her former self.

And when I started taking care of her, I took over her care immediately.

And what I realized is that not only had the medical system and healthcare system really

failed her every turn, every time she went for support, they kept gaslighting her, they

kept dismissing her and just sent her on her way.

This is a woman who was silently suffering and just trying to survive this season.

And as a result, like it affected her work, it affected her relationships, it affected

every aspect of her life.

And when I took it, took over her care, you know, we had, I mean, over 90 days, it was

like a massive turnaround in transformation.

And I thought, you know, how many millions of women are suffering like this?

I also thought, I'm like, is this coming for me?

Is this going to happen to me when I get into prairie menopause?

And I'll be honest with you, prairie menopause blindsided me.

And it looked very similar in the beginning to my mom's prairie menopausal journey.

But I just knew this was when I was 30 years old.

I was like, I have got to be a part of the solution, not a part of the, of the problem.

And that is when I literally pivoted my practice into supporting women.

I mostly had women in prairie menopause and menopause, but I was like, we, this has got

to be a focal point because this is a biological initiation.

Things are shifting profoundly in this transition and women are being ignored.

The reason why, you know, we, in a way we failed women is that we only considered those

hormones reproductive hormones.

We only thought of those hormones.

Like my physicals coming up in a month and they're going to, they're going to ask about

my mammogram.

They're going to make sure I had a pap smear.

They're going to, you know, colonoscopy is always on the list now too, now that I'm

in my mid-40s.

Fun.

But when we think about preventative care for women, it is bikini medicine.

Yeah.

Even today, it's, it's, it's ovaries, it's uterus, it's the cervix, it's the boobs and

done.

You know, and we don't think about these hormones being whole body hormones that they're

affecting every single system of the body.

But most importantly, the silence shifts.

We're talking about bone loss, metabolic changes, body composition, the brain is shifting.

All of this is happening, mental health concerns, cognitive issues like, and again, not every

woman, it's going to be very unique to every single woman.

But this is, it's a reckoning.

It is a full body recalibration and the fact that we are minimizing it to this is a reproductive

transition and oh, your periods are over is doing no one any favors.

Ormonally, because I know a lot of women still, even though it's more acceptable and understood

now, they still have a fear of testosterone and nobody really talks about progesterone

like they should and the balance of testosterone, progesterone estrogen, which I'm sure we're

going to get into thoroughly there.

But then when you talked about bone loss and muscle loss can be fatal and people don't

realize that.

Like they think that when, when you say something like that, that you're fearmongering,

no, that can kill you.

Well, and that is, I think that's the other issue that I see playing out is there's a lot

of narrative around this being a fearmongering conversation because I think, again, if all

you ever thought, well, that menopause is natural and just grit through it, you know, push

through it.

Yeah.

And it is just a loss of a period or hot flashes, night sweats, maybe some sleep issues,

maybe some, you know, general urinary symptoms, and that's it.

It's not doing us any favors when we know that women, you know, in terms of quality of

life, it's significantly more diminished than men in the second half of our lives.

And I mean, the, the stats are there.

We know that more women than men are going to get Alzheimer's in dementia.

We know more women than men are going to die of a mostly preventable heart attack.

We know more women than men are going to have migraines and are going to have, you

know, even osteopenia, they're going to fracture a bone like these, these are real stats.

And the, what I call kind of the, the window of opportunity because it's a window of vulnerability

is perimenopause.

And even into early menopause, I think it's not fear mongreen.

It's just letting women know, you know how you're not feeling good right now?

Things are massively shifting.

These are signals.

The body is telling you, hey, I need a new level of support.

And we've got to be mindful at looking at these silent shifts.

No one feels blood pressure creep up.

No one feels fasting in slingo into prediabetes.

We don't feel these things.

But ultimately they are devastating down the road, especially in our sixties and beyond.

You brought up something I think is of so importance.

I have always been Mr. Planahead because I coach steroid users and bodybuilders and

I've dealt with supplements and I've always, always always stressed doing blood work early.

Yes.

Do it often.

Yes.

And don't think because you're too young that you don't need to check certain things.

You may not need to check it as often, but you should still in your early thirties.

In my view, start testing heart signs, cardiovascular signs.

See if there's anything there, you know, that you were passed down.

You never know.

And no, I had a best friend, 38 years old, not in Perry, Menopause yet.

I would call her in late reproductive, you know, so hormones are shifting.

The parents are like, you know, I'm thinking about not doing this job anymore.

And she's worn down.

She's a mom of two.

I could tell that, you know, weight gain and I made her run at advanced cardiovascular

panel and sure enough, her lipoprotein, little A was was extremely high.

And right, this is a genetic, you know, and so, but she didn't know.

We're talking about, we were catching this in her thirties, thankfully.

And I wish we would have caught it even sooner, because she was literally,

she was prediabetic, her, she was a severe insulin resistance.

I mean, every she had metabolic dysfunction, but more important,

the thing that I was most worried about was that lipoprotein, little A.

And if we hadn't, I mean, luckily we're making all of these lifestyle modifications.

We are on top of it now.

But I think about all the years that we, you know,

if we had known even sooner, how many interventions would have been a lot easier to implement?

Anybody listening to LP, little A is a genetic condition.

You're not going to control it with diet.

You're not going to control it with any of the other things.

Statons will increase your LP, little A.

All of these things need to be known.

And that is something that you can, you can spot it early.

Yeah.

If you take cardiac IQ tests, you need to be checking APOB LP, little A particle sizes,

all of that.

And that's one of the things that I would stress to people.

You could find that in your 20s.

Absolutely.

I had a 330 LP, little A, and was able to get it down in the 90s.

Yeah.

She was a 220.

Yeah.

And that's extremely high.

And that's a great way to get like silent plaque buildup that you never know was coming.

I walked in.

It got a calcium score and was blown away because I don't know how the hell it could have

been so high.

And there was the culprit.

So it's good that you did that and found it early enough because if you don't, then

one day you wake up and you have a 70% blockage and you wonder what the hell happened.

Exactly.

Yeah.

Yeah.

Yeah.

Even earlier than you think.

Let's go down the stages.

Yeah.

Let's go down the stages.

Okay.

So first, maybe let's give some tell tell signs.

Sure.

And I understand that there is no magic answer in when this starts.

I know.

Right.

No, there is no magic.

It doesn't announce itself one day.

There is not lab like a fasting insulin or an APOB or kind of let you know what's going

on.

It is a clinical diagnosis based on symptoms, based on your age and and menstrual cycle

changes.

Are there anything that could put you into it early and or what is the average when

it would start?

That's a great question.

So the average, let's reverse engineer menopause really quickly.

Yeah.

I feel like everyone knows menopause.

Right.

That defining moment when you have it and even that definition needs to be redefined.

But the defining moment where you haven't had a period for 12 consecutive months, the average

age is 51.6 for women here in mostly globally, but here in the US anywhere natural menopause

can fall anywhere between 45 and 55 years old.

And so if we reverse engineer that, you know, and I have a lot of colleagues who go into

menopause in their late 40s, not there, not the early 50s or mid 50s.

And so if perimenopause is the four to 10 plus your transition leading into menopause,

then we're talking about as early as your mid-eighths for some women.

And the only way we really know, besides starting to pay attention to those that clinical

diagnosis of symptoms and the things that I mentioned, is asking your mom.

Now, unfortunately, a lot of moms didn't know, you didn't know when they were in perimenopause.

Some of them remember when they went into menopause, some of them don't.

And many, I can't tell you how many times I've had a patient, tell me my mom doesn't know

because she had a hysterectomy in her 40s or in her 30s.

And so just note that that would be one of the ways that you would know is ask your mom

and that's kind of a proxy of when you'll go into menopause and when you'll be in perimenopause.

So you asked what would potentially kind of bring you into a perimenopause and menopause

earlier.

Two really big ones are going to be smoking and an alcohol.

So excessive alcohol drinking or pretty consistent alcohol drinking.

We don't know if stress is a major player here, but when I think about, you know, kind of

reproductive longevity and ovarian longevity, I think of mitochondrial longevity.

Ultimately, they go in hand in hand.

You cannot 3D print human beings without mitochondria.

Right.

It's important.

And so excessive stress is a big one.

Not having children could potentially put you in because again, if you, when you have

a baby or when you're pregnant and postpartum, you don't have a cycle for quite some time.

Depending on when you started your period, that could elongate you into menopause, but

I would say chronic stress, chronic metabolic dysfunction, makes sense of smoking and drinking.

These are things that could set you back and have you start perimenopause and menopause

earlier.

So epigenetic driven stress and trauma.

So we know that, you know, women of Latin descent, African-American women, we do see them

going into perimenopause earlier and we do see them having more exacerbated symptoms

even earlier and that their in perimenopause longer.

Would you say that people that tend to go in there early have like higher levels of inflammation,

lower mitochondrial health?

Yes.

Things like that.

Without a women again, we can, we are quick even as patients, as women, to gaslight ourselves,

to second-guess ourselves because it's always at motherhood, is it burnout, is it stress?

You know, is this, is this, can't be perimenopause?

Like what is this?

Yeah, and I will tell you that as I am running labs, especially if I have a timeline of labs,

like you just alluded to, starting as early as your early 30s or at least your mid-sleeves,

I can tell when you're highly sensitive CRP goes up.

When your lipids begin to go up, when you're fasting insulin begins to go up.

So I can identify perimenopause sometimes just based on labs alone.

Again, it's a composite of many things that I'm looking at in alignment with symptoms.

And so yeah, I will see that as you move into perimenopause, hormones are beginning to

erratically shift.

And again, life is life-ing, right?

Stress is still happening.

You were, you're carrying a lot that I will begin to see labs move out of range and I have

diagnosed perimenopause through labs, but not the labs that you think of, not, I wasn't

through hormone labs.

So I was looking at metabolic labs and inflammation labs.

Okay.

Is there any sort of diet that you could be doing for many years, example, like low fat

or high carbohydrate or something that could throw you into it early or anything like that?

We don't have any evidence on that in moments.

So I won't speak to that.

What I will say is that we know that a majority of adults are already struggling with insulin

resistance and metabolic dysfunction before perimenopause.

You know, by a time a woman is 45 years old, she's more likely to be obese or overweight

than men.

We know that often we, about 90% of women by a time they're 45 years old are going to

have one or more labs, metabolic labs out of range.

And so, you know, a lot of women are coming in with polycystic ovarian syndrome, which

I feel is a metabolically driven, you know, infertility, potentially infertility issue

or reproductive issue.

So if you've got these issues coming in, you know, again, a fasting insulin that's headed

into prediabetes or your lipids are going out of range or you have liver enzymes that

are out of range, like all these types of things that are going on, I will see an exacerbation

of symptoms of my patients in perimenopause.

Okay.

So yeah, if you're coming in metabolically, you know, busted, let's call it, you know,

it's, you're going to see bigger body composition changes, you're going to see more mood and

brain changes.

You're going to see more belly fat.

And so you're starting to see these exacerbation of the most common symptoms of perimenopause,

mainly because we're coming into this season already struggling with some issues.

So when you start to get into this perimenopause state, what are some early, just telltale

signs that could warn you like, okay, it's coming.

Yeah, absolutely.

So if we're looking at early perimenopause, and I would say on average for my patients,

it's usually 41, 42, 43, and they come in and they're like, I don't feel like myself anymore.

I can't pretend like this is something else at this point.

And they may notice some cycle changes, usually in the luteal cycle.

So after ovulation, we know that we need to ovulate in order to make progesterone, progesterone

is the progestation hormone.

And in that cycle, if she shows up to the party or at least, you know, robust, we feel

pretty good, you know, you know, maybe some PMS symptoms, you know, those last couple

of days before your cycle, before your menstruation hits.

But for the most part, we feel pretty good.

It's when we're not ovulating, we're having those an ovulatory cycles or ovulation just

isn't the way it used to be.

It's not as robust as not, again, with the mitochondria aren't doing in their due diligence.

They didn't show up to the party either.

And so we'll notice, maybe you feel great in the follicular phase, but the luteal phase

is feeling even harder than it used to.

So you'll notice more mood changes, you'll notice more PMS symptoms.

But instead of two days, we're talking five, six days, more rage, more irritability,

a more bloating and water retention and inflammation in that last week or maybe even the whole

luteal phase.

So that's some of the symptoms that women will experience.

Also, instead of 29 days of their cycle or 28 days or 27, maybe now it's 25 or it swings

all the way to like 37, so we're starting to see some swings in the cycle.

That's an indicator.

And more so, what I hear more than anything is that I don't feel like myself in relation

to things feeling harder.

Things that used to be effortless are now requiring more mental effort.

Now they don't have the same stress tolerance that they used to have.

Things are hitting them harder than they used to be.

They're not remembering what they were going to say in a presentation or they're not feeling

as motivated or as confident.

So it's almost, it feels a bit like an identity crisis in a way that you're like, this

is the woman I've always been.

These are the things that I'm fully capable of.

But now I don't have the same bandwidth to do what I know I know how to do.

And it's that grappling with yourself about, why can't I do this anymore?

Why is everything requiring so much more of me?

This is usually what early parry menopause can feel like for women.

And some people don't understand that that mind body connection.

So if you get off really bad hormonally, you lose your sharpness.

You start to get brain fall.

You can't focus.

You're probably way more irritable and just sometimes I wonder, do women kind of go through

this?

They react to certain way and don't even realize you're doing it.

Absolutely.

Yeah.

Yeah.

I mean, I think again, when you lose that stress tolerance, not just estrogen testosterone

and progesterone that are shifting cortisol is often deregulating melatonin.

It's beginning to decline as well, along with progesterone again, because of that bidirectional

relationship with insulin and estrogen, you know, our energy capacity, again, even on

a physical level is shifting as well.

We're seeing our bodies change without permission, you know, the workout recovery is not the

same.

You're like, I used to be the woman who could do this big workout.

And now I feel like I can't function for the rest of the day.

So all of this is up for review.

But it's a lot of, I would say the mental shift, I always call that neuro, neurochemical

transition that really can destabilize women.

Along with the physical changes that are happening as well.

So those are often the early signs that I see that again, in the beginning, we can easily

brush off as, well, I'm just not going to bed early enough.

I'm not honoring my, you know, circadian rhythm.

I'm not optimizing my sleep consistently.

I use my, I have too much work going on.

It's really easy to ride those things off.

And again, a lot of women that I meet patients, including myself, you know, I didn't come

into perimenopause with the cleanest bill of health.

I have a, I have a hygiene mode with thyroiditis.

And you know, I've had burnout before, I've had deregulation of my stress response system.

And so initially when I started going to perimenopause, I thought it was, it was the first thing

I pointed to was like, oh, it must be my thyroid, but it must be, oh, it must be, it must

be burnout.

It must, you know, it's all these other things.

And it's kind of like when you finally kind of cross those off, because it can be a yes

and you're like, okay, you know, send me a sign, make it impossible for me to miss.

And for me, it was the rage.

And I knew it because I knew my mom's rage.

I see.

Okay.

What about sleep cycles, like circadian rhythm throwing off anything like that?

Is that an issue?

Yeah.

Oh, absolutely.

66% of women in perimenopause are in midlife, even even more like from 40 to 60 are going

to have sleep issues.

And that just exacerbates the problem even further.

Because the sleep, lack of sleep just makes everything worse.

Everything worse.

I always say sleep or make or break you.

Yeah.

Yeah.

I, yeah, it's, it's, we're talking about a second puberty, except that women are meant

to, we're just supposed to smile through running households, taking care of kids, running

careers, being leaders, you know, and just all the things.

And it's, it's this, it's this major upheaval.

And so yeah, in your sleep goes there, that motivation to get up at 6 o'clock in the morning

to go work out in the gym, like, that's gone.

You know, it's not one thing people always ask me, what's going on with the belly fat

and the body composition changes.

And it's not just estrogen.

Yeah.

You kind of repositioning fat or messing with insulin sensitivity.

It's the fact that you're deregulated at night, and you can't get to bed.

And that line down, just wreck your sleep, you know, and you wake up, just feeling like

hot garbage.

You don't have, you have the capacity to do the non-negotiables, to survive, to get your

kids off to school, to do the work, but you don't have room for anything else.

Yeah.

So a lot of the lifestyles begin to slip.

You're noticing that you can't lift the way that you use to in your 30s.

You can't train the way that you use to in your 30s.

And so you pivot.

Maybe you're spending more time on the cardio machines now, you know, maybe you're, now

and now maybe you're doing a Zumba class or you're doing more Pilates, you know, you're,

and so you're actually losing more muscle in the process.

Right.

So it's not one thing.

I find they can really, there's a lot of things that spiral out of control a bit.

So what is, what is the actual reason or cause of when you start to not have your cycle

anymore?

Why do these hormonal changes occur?

What is it about the cycle itself stopping?

It causes all of this to go haywire.

I love this question.

It's eggs.

Okay.

How many eggs do you got?

You know, it's eggs supply.

And so we don't have an ability to keep these ovaries going, right?

Oh, they have, they have an expiration date.

You know, we are born with a, oh, about a million eggs give or take.

By the time we get to puberty, we're down to half a million to 300,000, and then we

start cycling every single month, rhythmically, you know, and so, and you have to understand

that even with puberty, it takes four to six years to really come online.

Again, that, although, you know, your periods one day in time, I think we really have to have

extra grace for our girls who are navigating, you know, the teenage years because their

brain is massively remodeling.

Everything is massively remodeling in puberty.

Finally, you know, by the time we're in our 20s, we're running, this is running pretty,

hopefully in lockstep and, you know, estrogen is showing up consistently throughout the entire

cycle.

Let's be honest, progesterone is showing up in after ovulation is showing up in allodial

phases cycle.

Stostroin is in the first phase of the cycle and the follicular phase of the cycle and the

body, all of the receptor sites that are receiving these chemical messengers, they are expecting

them rhythmically every single month.

So we know when that estradiol peak is going to happen on day 11, day 12, right?

So many things are going to happen.

And ovulation is going to be initiated to begin with, right?

And that moves, you know, our species forward, but we're suppressing, like we have tumor

suppressor genes that activate.

We are optimizing brain capacity and function, like there's so many things that are happening

because these hormones are doing their job every single month.

But every month we are priming eggs that one egg gets chosen and we release it in hope

that we are going to propagate the bus species of the human race and we start moving through

them.

By the time we're about 35 years old, give or take, we have about 10,000 eggs left.

The ovaries know it, the brain knows it, although they pretend like they don't aren't communicating

really well.

And so we're talking in our mid to late 30s.

If it isn't perimenopause for many of us, we're in our late reproductive years.

And so we will start to have an ovulatory cycle.

We will, as I mentioned, we will start to notice that progesterone is declining.

And for, in today's world, it seems to be happening sooner and sooner, earlier and

earlier.

Due to stress and the toxic world that we live in, there's nothing about this modern day

world that lends to optimized hormones, let's be honest, they're already fighting to keep

rhythmically, cycling every month.

And yeah, now we're running out of eggs, the, ovaries know it, and so then there becomes

this miscommunication.

It's like trying to play telephone with a five year old or a four year old, you know,

you're just going to get a garbled message that HPO access, the hypothermic pituitary

ovarian access, that relationship begins to get a little wonky.

Oh, by the time we're in our, let's say, early 40s, we're early perimenopause for most

of us, it was really showing up are even, we're down even more eggs, we're down to like

maybe five to seven thousand, a.o.o point.

And so that's really what's coming happening.

And as a result, that miscommunication between the pituitary hormones, follicular stimulating

hormone, foodizing hormone, body and the ovaries to keep moving eggs, you know, and the ovaries

are like, maybe, maybe one month, and then it pops to the next month, that's why we have

more twins in our 40s and late 30s than any other time.

But then as a result, that miscommunication happens with estradiol and progesterone.

And then that becomes erratic.

Initially it's progesterone, it's erratic, it's declining erratically, but a bit more

of a study decline than estrogen, estrogen can be more, we can be more estrogenic

in the beginning, some more estrogen dominant type symptoms.

But then ultimately, towards late perimenopause, where we're skipping at least a period every

60 days, give or take, we now are in an estrogen decline.

And so that's when we really start to see what I call the eye of the storm.

This is where the hot flashes in the night sweats and the vaginal dryness in the low libido

with the depression, the anxiety.

This is where we start to see the greatest amount of bone loss.

This is where we start to see pretty big, we'll see muscle loss.

This is where we really begin to see the major changes.

This is when estrogen is beginning to significantly decline.

And by the time we're in menopause, we have less than 1,000 eggs, give or take.

And we're done at that point, we're not.

Yeah.

Yeah.

So there's more complexity here.

So for men, there's always a testosterone estrogen balance.

And when a man's estrogen gets too low, there's a lot of problems.

And I've seen that time and time again, because the concern is always for the elevated estrogen.

So kind of comastia, holding water, high blood pressure, loss of libido.

And then it'll cause depression, but low estrogen has a lot of similar symptoms.

And there's a balance issue there.

So with women, it's like a trifecta, right?

So testosterone, progesterone estrogen.

Can you explain the roles of each, especially progesterone?

Because I think that's the one that more people don't know enough about.

But also the importance of testosterone levels for women as well, especially the ones that

have this, you know, and I get it, that there's almost a stigma on, you know, we're trying

to tackle that.

Yeah.

And I'm trying to help too, because I went through it on the man's side with the estrogen

thing.

And there's a greater understanding there amongst bodybuilders and people that deal with it,

but not mainstream people.

And with women, one of the things I see that bothers me that I wish I had a bigger voice

in was explaining the role, the importance, even though it's not a lot, it's still that

little bit makes a big difference.

Yeah.

Let's talk about, I mean, absolutely.

Let's talk about the balance, right?

When we think about, you know, women and men are very different.

You guys are running on 24, very simple, very easy, you know, and we're running on this

monthly cycle, you know, that a lot of things can throw that off as well.

And so, you know, progesterone and estrogen, I mean, these are, they are initiators for

one another, you know, in order for estrogen to really show up, we need progesterone on the

back end.

Right.

And they are, they are really helping to support one another, you know, when I think about

progesterone, I mean, the number one job, and this is kind of where we, we kind of put

progesterone in its little, like, we kind of put in this little box, if that progesterone,

as I mentioned earlier, is that progestation hormone.

And so, this is the hormone that shows up, it's got receptor sites all over the body.

For some reason, we think it's only on the uterus.

And, you know, that's the reason why progesterone is prescribed for women with a uterus.

Yeah.

But if you don't have a uterus, you don't need progesterone.

And I'm like, what about the brain, the immune system and the gut microbiome and the ligaments

and tendons and muscle and even metabolism?

Progesterone is involved.

I don't know why do we think that it's just the uterus.

It's mind blowing to me.

So, but we do know that it's a major player in maintaining that pregnancy.

Yeah.

If we get pregnant, right?

Every single month the body's like, do we, do we get pregnant?

And if we don't, then everything begins to decline and we have, we have menstruation.

So progesterone is that, that beautiful hormone that helps us to maintain pregnancy.

But also, we know that it is, it's a neurotransmitter known as alopregnenolone.

I'm sure you guys have talked about this on the show.

And it, it activates GABA A receptors to help kind of calm the system, but it's doing

even so much more.

I mean, we know that it's helping with neurogenesis.

We know that it's helping to reduce inflammation of the brain.

If anything, progesterone is helping to modulate inflammation across the entire body.

So those are the things I think about when I think about progesterone.

But it helps for sleep, it helps for calming, and it's, it's no wonder when we start

to see it decline in the luteal phase, in early parimenopause, that women are experiencing

a lot of these more neuro, neurological-based symptoms.

So it's going to be progesterone that's not showing up again, the way that it used to.

With estrogen, estrogen is throughout the entire cycle.

But in the folicular phase, it's playing the, the big role of basically prepping the

uterus for implantation of that, that egg, but also initiating ovulation.

That's the really big role, but it's doing so much more than that.

And estrogen is driving energy metabolism.

Again, there's this direct relationship between mitochondrial capacity and energy and

ovarian capacity and function.

And so estrogen is a very big part of that relationship.

It is the CEO regulator of the brain.

And not just in terms of energy metabolism, but helping to initiate and regulate neurotransmitters

like dopamine and serotonin, it's helping to ensure that we have, we, our brain is actually

getting clear of inflammation.

It's helping to manage insulin sensitivity in the brain.

It is helping to keep, I mean, I think about collagen and, you know, our, you know, the

health of our joints, the health of our muscle and tissue, everything you think about when

it comes to a woman's body, estrogen is pretty much involved.

All the way down to arm got microbiome.

I know you've talked to Cynthia about this, a great, great length, you know, when estrogen

begins to decline, we see diversity drop.

And that's the thing.

And when we talk about dominant hormones for each sex that they need to understand how

big of a vital role they play and testosterone.

Yes.

And I want you to touch on that.

Please.

Yes.

And it's, it's your build you up.

Hormel.

I mean, it is a confidence.

But evasion.

You know, I always joke that everybody loves day 11, day 12 us, I even, even me, I felt,

you know, when I didn't understand what was going on with the cycle, I was like, why

can't I feel like this day, this week, I can make a follicular phase.

All the time, you know, I would hit day 26, day 27.

I would try to, you know, do a PR, you know, a personal, no, there was no, that was not

happening.

And I would be so angry.

I'm like, why can't I push the way that I was pushing two weeks ago?

Yeah.

So, and that's testosterone is showing up at the party right then as well.

And so that's when you feel the most vibrant, the most confident, the most self assured,

you want to go out, you want to, you want to create more intimacy and connection.

Like, this is where we feel the most alive.

And that's because testosterone into the party as well.

And when we start to lose testosterone, you know, the only thing that we can even, well,

we can't even off label, prescribe testosterone to women, right?

It's not FDA approved.

When we think about it, the only way that we can even get approval for it is that, you

know, it's a, it's a libido issue.

It's not that, you know, we're not looking at confidence, we're not looking at motivation,

we're not looking at drive, we're not looking at work out recovery.

These aren't things that we are considering for testosterone therapy, but these are the

things that make some of the biggest difference in women when they start testosterone.

Yeah.

I mean, like, I've been doing this for two decades.

I'm the biggest TRT advocate on the planet if you need it.

And I have found over the years, because I was like, really male dominant in my coaching

for too long.

And I find that so many women need, so many women, and they don't even know, don't test

it.

And then if you bring it up to them, it's like, no, I don't want to do that.

Well, we won't, we won't test it.

Yeah.

We're not really prescribing it.

Women have to, I find so many people, so many women I know are fighting to try to get

it.

And the dosage is messy.

Oh, yeah.

That's another problem altogether, lack of education and understanding on how to actually

take care of the women, because they haven't done it enough.

Yeah.

I know that there's a big, I mean, there's a big push right now for the FDA.

It's going to be a minute, but I think, you know, with the advocacy that's happening

right now for women to get testosterone therapy, I'm hoping within the next five years,

we'll have a solution.

I hope so.

I just switched to chiseterrex, which is the oral form of it.

And so I'm hoping that that has the same, but you know, the chiseterrex is nice because

it doesn't crush your luteinizing hormone or your follicle stimulating hormone.

It's not supposed to have the effects on estrogen.

So it's really nice.

Yeah.

I'll be curious how that works.

Yeah.

Yeah, but I mean, I have so many friends and colleagues and even patients of mine that

are on testosterone therapy and feel amazing.

It's like, like, this light comes on, but more so they can, and not that estrogen can't

do this as well.

But with testosterone, particularly, especially with high level women, where they are so used

to the confidence and the motivation, like again, if that identity shift, you're like,

I was always motivated, I was always ready to do the thing and all of a sudden it's all

flat.

Yeah.

And then you look at the levels and they're pretty much ground zero perimenopause.

We've got this like 12 month buildup of not having a cycle.

And so that's the perimenopause phase than a year, right?

No, 10.

Oh, it's 10 years.

We're talking about a freaking career.

I mean, who you are at the beginning of Harry and who you are at the end, like, you're

talking about a completely different person.

Okay.

So you got a decade in.

We're talking about a decade.

So yeah, like I said, those late reproductive years are usually late 30s, middle late 30s,

progesterone is already declining.

You're starting to notice some symptoms.

Like again, maybe your ability to push in the gym and the recovery isn't there.

A little bit more irritability, a little bit more PMS symptoms.

This is the time where we're often just saying, oh, no, it's this, it's this.

Now, and then 4142, it's full early parry cycles are changing at this point.

You are like, I don't recognize myself anymore.

Something isn't right.

And it's none of these other things.

That is early parry.

Again, you're still cycling regularly.

And if you look at the CDC, they will say that perimenopause is technically late perimenopause.

Because the only way that we really recognize perimenopause until this last decade or so

is that you were skipping periods more than 60 days.

That's not until late.

So there's this whole, you're still cycling regularly.

This is where women are told it's not perimenopause.

You're too young.

It's just dead a dog, go relax, eat less, exercise more.

And they're already doing all of that.

You know, something isn't right or here's some, here's an antidepressant, maybe some birth

control and like send you off on your, in your, you know, back in your life.

That's early usually.

And this is where we really miss the boat.

And there's, you know, there's a little middle, I'm in middle parry.

I'm kind of not in early anymore.

I'm 46.

I'm heading into late parry.

I'll probably be there by 47, 48 because I'm still not skipping periods.

I'm still regularly cycling.

How we define late perimenopause is your skipping periods more than two months.

You are having, you know, often crime scene periods at this point too.

Like one month that's not there, the next month you're bleeding through everything.

And this is where the hot flashes, the night sweats.

And this can go on for three to four years.

Now, this is where this is more severe depression, anxiety.

This is where we see higher rates of divorce.

And this is where women really start to feel a seismic shift.

So I was a little dick all the times that I was told, oh, you just don't understand.

You just don't get it.

And I said, I don't like that excuse.

So I was a real jerk.

Yeah.

This is, yeah, this is, this is the really hard time.

Again, you know, hopefully, and that's why I love these conversations.

Because what if we could have caught her at 42, 43 when we just kept saying,

oh, no, just keep pushing through.

Like, what if we would have caught my mom and then, you know, I caught my,

we got, I caught my mom when we all caught my mom, which was 48,

crime scene periods, you know, hot flashes, night sweats,

severe depression, anxiety, like was, like untethered, did not know who she was anymore.

And didn't think she was going at that point for so many women,

they don't, they're like, is everything going to explode?

Like am I going to get through this without losing my job or losing my marriage?

For so many women, it can feel that intense.

We're talking another, you know, three years in that transition.

And then you're in the perpetual waiting room where you maybe don't have a period

for six months and then it comes back.

And then maybe don't have a period for three months and then it comes back.

And so you're just kind of waiting for men to pause.

But at that point, all of the hormones at this point are low for the most part.

You have testosterone can be relatively stable for some women,

you know, 50% of women give or take.

But progesterone test or estrogen have left.

They have left.

And I think a lot of women think this is the, where we've really miseducated.

There's a lot of women think that now that the hormones are stable or that they're gone,

at, you know, everything's going to level out.

But because we've lost these hormones, you know, we are seeing it exact,

we see the bone loss, the muscle loss.

We start to see the cardiovascular risk go up.

We start to see more brain inflammation.

Again, it's these silent shifts due to the fact that we've lost these hormones

or that they are erratically going away for years that puts us at greater risk

for the silent shifts, the big diseases.

So yeah, no, maybe you're not as irritable as you used to be.

Maybe the hot flashes have kind of dissipated.

Maybe some of the, your period is now gone.

You're not having the crime scene periods.

But what about the bone loss?

What about the lipids that are now at a range?

What about the climbing blood pressure?

These are the things that I want women on, on their radar.

What about the, you know, the potential sarcopenia that's starting to develop?

This is why I think we have to be having this conversation.

And it's not fear mongrain.

It's just a deep understanding that there are major shifts that are happening

during this transition, that if we know and we take intervention in this time,

we can future prove our health.

But if we keep, you know, following a dialogue of, oh, this is only natural.

And this is what's meant to happen.

Well, we're going to see a lot of the statistics that we see playing out right now today.

Yeah.

One of the things I talk about, especially lately is implementing creatine use,

not just for the muscle, which, that's the obvious, but then the, right appear.

And I think that a lot of people are now catching on to the creatine benefits for the, the

mental side, but then a couple other things that I have been working on or are talking

about.

One is higher protein intake to, to build the muscle.

And that's really for anybody anyway, but especially during this time period of importance.

And then I think that other things that we were kind of talking about, you got your mitochondrial

decline.

So I'm looking for ways to improve mitochondrial health.

Any D levels are dropping.

These are dropping naturally for men and women anyway, that can happen.

That's happening.

Yeah.

And then it's accelerating.

Yeah.

Absolutely.

Yeah.

All of these things are naturally going to decline.

So you've got to catch on to it early, be preventative diet wise.

Are there better diet structures as you enter those stage like higher protein, higher fat

lower carb, higher carb, like whatever, or is it kind of variant among individuals?

And then what are the most important vitamins somebody needs to be making sure they may

be beginning extra?

Is it vitamin D, vitamin K?

Like what are essentials that we need to really wrap our head around like, this is going

to help.

This is going to mitigate a lot of this shit that I'm going through.

Absolutely.

I love this question.

Again, we talked about mitochondrial function.

And I think everything cellular and energy is the epicenter of all of it.

If you want your brain to work, you want to be able to pay attention and focus.

You want to have capacity to pick up your grandkids, like, that's what we're talking about

here.

And so I always think about what is a proxy for cellular energy?

It's going to be blood sugar.

So how do we make sure that we're balancing blood sugar and a majority of us coming into

this time in our lives?

Blood sugar is probably not ideal or optimal.

And many of us don't know.

We don't know that it's variable is jumping all over the place.

We don't know that our fasting blood glucose is maybe 95 milligrams per desk later, which

is just not things we know.

So I would say, you know, I always want to keep it simple.

I want to keep it accessible, but we have to be thinking about balancing and optimizing

blood sugar throughout the day from the beginning of the morning to the end of the day.

So protein is always first and especially in the morning.

I want to make sure that you, one, protein so that you are not hangry at 11 a.m. and

making some decisions that maybe you're going to regret that we, yeah, we start with protein,

but also we start with fiber.

I want to make sure mitochondria really thrive when your microbiome is thriving.

So I don't want to forget about the fiber piece as well.

And then some good healthy fats.

And I think that can be depending on how you tolerate fats, look at your lipids, kind

of pay attention to that.

Some people do better with saturated fats.

Some people do better with more plant-based fats, like kind of figure out, look at your

numbers.

This is where it can be more bio individual, but protein forward, again, you have to get

of the ultra processed foods.

You have to get rid of the added sugar.

And it's so sneaky.

I know.

So it's really paying attention to those things as well and being very honest with yourself

about where is it in your creamer for your coffee?

Are you having a little probiotic drink and it's got a grams of sugar in that little,

and you think you're doing a good thing, but you're messing with your blood sugar.

Read labels.

Read labels and ingredients.

Yeah.

So those are the things that I, so I talk about this in the book, is how you build metabolically

healthy meals.

How do we build muscle?

Balancing blood sugar.

How are we protecting our gut microbiome?

And how are we ensuring that you feel energized?

Yeah.

That's going to be important.

And in reducing inflammation.

Those are going to be, I always talk about just protein, healthy fats, and fiber.

And then you have to get rid of the rest.

But even alcohol is up for review.

You've got to renegotiate that relationship, because that's going to be messing with

you.

Yeah.

That's a big proponent of early time restricted eating.

Okay.

So meaning, I look at blood sugar numbers all the time, on continuous glucose, I would

get to say CGM's all day.

Yeah.

I mean, it's even for two weeks, just to know, like how you're living, how you're operating,

you know, is that, is it the meetings that are stressing out that are driving blood sugar,

is it the, you know, that little late night snack right before bed, that I'm messing with

your fasting blood sugar in the morning, this kind of data is so important, even just

two weeks to kind of take a look.

But in all the research I've looked at, or all the data points, you know, we can keep

it pretty nice in the morning, and it starts to creep by the end of the day, yeah.

And so it makes a big difference what time you eat dinner.

And I always say, you know, and I've looked at this on so many patients over the years,

you know, patient can have salmon, talking of salmon, salad, and, you know, maybe, you

know, some roasted broccoli, like they could have that dinner at six o'clock or 530, and

blood sugar looks great.

Yeah.

So, you know, when you eat dinner at 8 p.m., blood sugar is going to start to shift.

And so the earlier we can eat, and then the kitchen is closed, like it is closed.

It was closed when I was a kid, like there was not going back into the kitchen.

And then you don't eat until the morning, and you start with what I call kind of a metabolically

boosting breakfast.

I'm just having a good metabolically boosting morning routine that sets the tone for

the rest of the day.

If you start your day with a latte and a croissant, you're not getting off that blood sugar roller

coaster.

I don't care if you eat only salmon, and broccoli for the rest of the day, you're not

recovering from that blood sugar, but that's going to be important.

So, and if, if indeed, like you are so hungry after eight o'clock at night, that you don't

know what to do, and then it's going to be a very protein focused, little snack, so that

you're not stressing your system out.

I don't want to stress out because you're so starving, you can't get to sleep.

So, you know, there's always little swaps and things that you can do, and so that is

where I land on basically on, in terms of meals.

And then for people listening, when you got to plate, you can protein first, eat your

fat second, eat your carbs last, and that will help to blunt the glucose spike too if

you...

Absolutely.

Eat in order.

And always do not eat naked carbs.

Yes.

Please.

Jeez.

Gone are the days when we could just eat grapes.

You know, by themselves, like my son, my five-year-old, he can do that.

I got a pair of that with something you know, so it's just been really mindful about how

we're pairing it.

I find ways to...

You know, I eat about a tablespoon of seeds, either flax seeds or chia seeds every single

day.

Yeah.

And in the book, I'm so practical about how do we go from only five or 10 grams of fiber

a day?

How do we get to closer to 25, 30 grams?

You know, how do you move up?

Or how do you go from only 65 grams of protein to, let's get you to about 90 to 100 to maybe

110?

Like I always say, we're aiming for 100 grams, but I get.

Like we got to work our way up there.

And so I have all this whole book is all about practical ways to do that.

I love that.

Yeah.

Because sometimes the numbers can look crazy, then if you see, this is what I have to do

to myself a lot is look in the mirror and say stuff out loud.

So I realize, okay, all right, okay.

I love being my own height, man.

You have to.

You've got to be your own height, man.

You have to.

That's how you stay accountable, too, as you look in the mirror and you can't...

I mean, if you can sit and lie to yourself and I don't know, I can't.

This one I'm the most honest is when I look directly at myself and go, all right, dude,

you know?

And that's what I'm saying with a lot of these foods, especially when you look at numbers

on protein, it can look daunting until you sit there and like for me, I go, okay, well,

I just had 12 ounces of salmon, 78 grams of protein like that, right?

And you can digest it.

I know there's been these, I won't even get into it.

But anyway, you can do it and you can probably certain hacks throughout the day to do it properly,

eating real food.

I don't like to depend on protein powders or anything.

They're there for a purpose.

You need a little bit of extra sweet.

But like you said, naked carbs.

I love fruit, but I pair it with full fat yogurt when I eat it.

It's always together and I'm in control and I like data.

I think that what you said is perfect.

We need data.

You can't just play guesswork the whole time.

No, especially in this season, we're talking about that midlife season or that pregnant

apostle season, data is going to really help us.

We can't change.

We can't optimize where we're not measuring.

If you don't know what your sleep is looking like, you don't know what your steps look

like.

You don't know what your stress is looking like.

I love a wolf or even what your blood sugar is looking like throughout the day.

How are you going to make changes?

It's so easy to tell ourselves that we're eating healthy.

We're doing all these right things, but yet we're not seeing the results.

You want to see.

And this is why I think it's so imperative, particularly in this time of our lives, is

that your body is going to change without permission.

And if you're not looking at that, you're not looking at your lab numbers, at least annually

if not maybe twice a year or quarterly.

If you're not looking at real-time data every day, you just aren't going to be able to optimize.

And one of the things that I find particularly for women is that we have been told, women

have been told to not trust themselves.

Yeah.

To not trust their intuition, to not trust what's going on with their bodies.

So we don't listen to our bodies very well.

And so sometimes data can really help validate what we're experiencing.

That's right.

But you have to do your own data.

Yeah, you have to do your own data.

You have to know your pattern.

You have to know your energy patterns, your mood patterns, your sleep patterns.

And I know again, just like the protein numbers, it can feel a little bit daunting at first.

But you start to look at your info, you start to track your data, and it's a quick look.

That's it.

And then you just keep going from there.

And so I am a big proponent of tracking data.

For me, it's accountability.

Yeah.

You know, just like, okay, I'm on track.

Okay.

That's it.

Yeah.

And some days we're different than others.

Right?

We talk about your book because I just looked up and I'm like, shit, and I didn't get

through half of what I wanted to talk about.

So you've written several books like we talked about.

What makes this one different or so special?

Because I know this one is doing extremely well.

Yes.

What makes this so special?

I mean, it's deeply personal.

Yeah.

As I mentioned, Perry Manipaz blindsided me.

I thought I knew after watching my mama in so many patients, I mean, this has been

the group of women that I've been blessed to take care of for 17 years.

And I will tell you, it's one thing to support women through a transition like

this is another thing to go through it.

I'm like, whoa, okay.

So I just understanding through the research how important this biological inflection point

is.

And knowing that there's so much that we can do to future proof our health, to be resilient,

to feel resilient.

And if women just had that information that they could begin to implement, it would change

everything.

It would change the trajectory of the second half of their life.

That is why this book is so important.

If anything, this book is more leaning towards longevity, but also helping women to know

that they feel seen, they feel heard in their journey.

And so that's really what this book is bringing to the table.

So part one is, am I in Perry Manipaz?

I'm going to help you dissect that really quickly.

Part two is, okay, these are all the symptoms.

What does it mean for my future health outcomes?

How do I track this?

How do I know what's going on with my body?

How do I advocate?

And then the pillars from community to mental health, to blood sugar balance and metabolically

healthy nails, movement, building muscle, building resilience, that is all of what that

the pillars are.

And then it's a five-week plan that puts it all together so that you don't have to second

guess what you're doing.

You can just implement.

You're giving people hope here and understanding that this doesn't have to be miserable and

the lifetime.

No, I am not settling up for survival through this period.

I want to thrive.

I do, and I have no desire to survive, Perry Manipaz.

So before we stop here, I want to talk a little bit about when I brought up the creatine.

Are there any other essentialists?

No, no, no.

It's okay.

We add under the diet, right?

Yes.

Creatine is definitely one of us.

Yeah.

But what else would you say?

Because, okay.

So when I brought up, like, uralythin apolice.

Uralythin A?

Very important.

Yeah.

And then, you know, I...

NMN.

NMN at the low end.

100% precursor.

Vitamin D.

Yeah.

I cannot...

98% of women will have subpar vitamin D levels.

E3K2.

Always.

Yeah.

Always.

Omega's.

Big one.

I love a good probiotic.

I think it's important.

I think our gut microbiome can use all the help it can get.

I am a big fan of activated methylated B vitamins.

Those are in our deficient there.

As some type of magnesium, whether it's three in eight, three in eight, malate, glycinate.

I'm a big glycinate girl.

Two.

As for sleep.

And we all need that little sleepy mocktail before going to bed.

I just take my supplements.

And then I'm a big fan of antioxidant support and liver support.

So a good tumeric supplement or curcumin, polyphenols are going to be a big one.

Man, I know I'm forgetting.

You know, my list of supplements.

I try to keep it tight.

Tag cup for the liver.

And then so, yeah.

So milk thistle or good liver supplement that's kind of hitting.

Because you can just get a good liver support supplement that's got a lot of the polyphenols

and the milk thistle in there.

And to other mitochondrial precursors.

You take.

Okay.

You know, some of the big precursors that I love, again, you're a lithin A.

That's such a great job of delivering what we need for mitochondria.

I see those would be my big heavy hitters.

And then I love HRT.

I love hormone replacement therapy.

Absolutely.

If needed, that can be a life saver.

I'm on it.

Yeah.

I've been on it for.

My brain loves it.

Me too.

I've been on it for, I don't know, 10 years now.

So I get it.

I totally do.

So thank you so much for what you do for the help that you're providing for sacrifices

that you've made to do what you do.

As I know, it's not easy having a kid and traveling all over and being everywhere and

discussing everything, writing books and everything else.

So we need more people like you and your work is greatly appreciated.

And I know you're making a massive impact and hopefully we've gotten you out and out

of more people.

Thank you so much for having me.

Yes.

Thank you for coming to see me.

I appreciate it.

So tell everybody where to get the book, where to find you and we'll put everything

in the description.

Yes.

The book is Dr. Mesa.com forward slash book.

I've got insane bonuses because I believe women deserve the best of things and not the

least of things.

So go and get the book and then you can find me on the energized podcast as well.

Awesome.

We'll make sure to follow.

Check out her book, Please and every other piece of content that you have online because

of this phenomenal.

I've seen plenty.

So, all right, everybody, that wraps up another one.

Stay tuned for plenty more to come.

Dylan Jamelli and Dr. Marissa Snyder signing off.