The 10-Second At-Home Walk Test for Longevity (Easy Biohack) : 1317

Exactly 70% of Alzheimer's is in women. Most osteoporosis is in women. The number one killer of women is cardiovascular disease from microvascular disease which we can prevent with estrogen.

Pharmaceutical industry will make less if women are healthier. Dr. Vonder Wright is a double board certified orthopaedic surgeon, an internationally recognized authority on active aging and mobility dedicated to helping people not just add years to their life, but life to their years. She's redefining what it means to stay strong at every age.

I have clinics full of people who have never heard of perimenopause. Are we going to wait until 40% of women have fractures because we let their bones disappear at a rate of 20%? Or are we going to tell the 40 year olds, let's find out what you built when you were young. Let's optimize your hormones and never let you lose your bone in the first place.

What are the top four hormones that women should track you're listening to the Human Upgrade with Dave Asprey. Hey guys, quick reminder. If you're listening to this on your favorite audio podcast app and you haven't been over to my YouTube channel, check it out. Just search for the Human Upgrade or find me under Dave Asprey bpr. I post full video versions of every episode and a bunch of other cool content outside the pod. It's a great way to go deeper into the content and connect with other biohackers like you. So leave a comment for me. Yeah, I'm actually going to read them and poke around while you're there. There is a lot of stuff specifically for you. It really helps and it means a lot to me. Is it true that how fast you walk predicts your death better than cholesterol?

You know, studies show, especially as it pertains to preparation for surgery and outcomes, that your functional mobility and how fast the muscles below your belly button propel you actually can predict outcomes not only for aging but for surgery outcomes.

Don't a lot of women though have a problem? If you delivered by C section, isn't that muscle kind of cut?

Well, you know, C sections actually cut through six to eight layers. I'm not an OB gynae, but this fan and steel incision across the inferior portion of our abdomen goes through six to eight layers and although they're sewn back, the thought is, and I often say this, and we have programs for this in our office is that the 10 months after the nine months actually are incredibly important for not only rebuilding and restrengthening the pelvic floor, which is like a basket of skeletal muscle, but also reconditioning the abdomen. And if you have a diastasis, which is where your rectus abdominis muscles actually physically come apart, those can come back together, but it gives you a mechanical disadvantage for six to nine months. So it's not something that you can just passively let nature take over. I like my women to really invest time in rebuilding that functional motion.

Having had a hernia, a very small hernia repair about three years ago that directly affects the lower pelvic floor. The recovery from that's been really interesting where some of those muscles just get turned off. And I noticed changes. I've always had really strong hip mobility and on the left side it got jacked. So I've been doing a lot of functional movement to bring it back. And it feels like a lot of women, in fact, the majority of women who have kids now are doing C sections, despite the medical risks from that. So if they're not doing proper rehab of their lower pelvic floor, we're having some serious long term aging problems. Right.

Well, let's talk about two of the things you just said, the turning off of muscles and the long term effects. So I'll give you another example. When anyone, man, woman, two examples. Let's say you tear your ACL within one week of hearing the pop, right? That's the classic acl. We heard a pop. My knee became swollen. The quad muscle receives information from the joint that it's injured and shuts down because the body's not stupid. So within a week or so we have 25% or more quad muscle atrophy. Another example of that is the glutes. Low back pain is endemic in this country. People sit a lot. We're not working out enough. I mean, 70% of people in our country do no purposeful exercise. And so when we get low back pain, again, body's not stupid. It's shutting down the glutes that are really hard to recover. So imagine in the example of carrying a weight on our pelvic floor for nine months or cutting through the layers in a fan and steel incision, our muscles are going to atrophy. So this long term recovery that you've experienced, even from a smaller incision than a fan of steel, I keep saying that that's the guy's name who named the incision after him, but that's what it's called in medicine. Women need to give themselves grace, that it's not going to happen overnight, but it requires a lot of hard work because the long term sequelae, if we want to get really granular, no matter how tuned in you are, how obsessed we are with our aging process or the hacking processes, you must reinvest time because a high portion of women are incontinent. And you see that in every arena. Think of, I don't know if you've ever watched the box jumpers that happen in. I mean, they're box jumping the fittest athletes in the world. And if you've had a child, you can have stress incontinence, which can be retrained, but only if you pay attention to it.

Yeah, sneeze peeing is a thing so many friends have mentioned. And I'm like, what is that? I don't seem to have that, obviously. And since it's such a common thing, how hard is it to retrain those muscles? Like, what do you do?

So it's more than just simple Kegels, right? Everyone's taught, oh, do some Kegels, but. But sometimes we need to be taught to engage our cores and our glutes for the first time. I know plenty of fit people whose glutes don't fire because you can get by without it. So everyone needs to be taught how to feel your glutes, how to engage them. For the pelvic floor. It's more of a sucking in feeling. It's like a. As a true kegel than a squeezing. Like women are taught to do a kegel by squeezing their urethral sphincter together. It's more of a sucking in, a contraction, raising your pelvic floor. And it takes time. Sometimes the pelvic floor is so shut off that there are actual physical therapists. In fact, the head of my physical therapy department is a pelvic floor therapist. And it takes manual therapy, which is what it sounds like to re engage the pelvic floor. But here's something that the other 49% of your audience will be interested in. Men can have pelvic floor dysfunction too. And it.

Oh, it's common.

Yeah, very common. And it's painful. And you're like, why is this hurting me? Or why aren't things responding? Pelvic floor weakness. So it's not just an XX problem. It can also be an XY problem, but it's not paid enough attention to the same way that we're paying attention to common weightlifting. Right.

It's interesting. I did get pelvic floor weakness after the surgery and I have recovered it. I would say 90%. But I have access to all the tools and all the experts out there, so I'm pretty lucky that way. But a lot of people, I think they do it. And, um, I can tell you that if I didn't know what I know and have access to the right people in tech, I would have had left hip mobility issues that would have gotten worse and worse. And then 15, 20 years from now, I would have needed a new hip.

Well, and let's talk about. I love that you're bringing up all these things. People usually don't ask me about the orthopedic side of my life. So I'm thrilled that you are.

But the reality, you're very well trained.

I'm incredibly well trained. Right. So. And. And elite sports medicine is what I've done all my life. But it's interesting. You were very spec specific. My left hip motion. What people don't realize is that for locomotion, our body needs a certain amount of motion. If we can't get it from the lumbar spine, we're going to steal it from a hip. Or if our SI joint is seized up, we're going to steal it from a hip on the other side of it. If our hip doesn't move. If your left hip will not go through a full range of motion, you will steal it. You will steal motion from your low spine, your symphysis pubis, your SI joints. So when I prescribe exercise, people think I'm gonna stop at aerobic, and I call weightlifting carrying a load. But I start with range of motion joint mobility because we're not doing anything effectively unless our joints move.

It makes me so happy that you're bringing this up, especially in the context of women and hormones and aging. Part of what we're doing at Upgrade Labs is an AI functional movement assessment where you lift up your hip and a computer watches you and lift up your leg and your shoulders and we score you. Is one side better or worse than others? If it is, that is going to get you as you age. And that means you need remedial work in order to strengthen the side or figure out what muscles are turned off. And can you explain how a muscle gets turned off? Because I've had to deal with a lot of that and it makes no sense. What do you mean turned off? A muscle's there. What's happening?

A muscle's there. But for a muscle to operate at its most optimal capacity, it has to be at a proper length. Right. Because if you think about muscle at the very Cellular level, there are sheets of fibers that slide back across each other based on whether calcium is attached to the myosin or not. So this is how a muscle works. It doesn't work so well when it's already totally aligned. It doesn't work at all when the fibers are not overlapping. So you must have optimal overlap of the muscle fibers so that when the nerve stimulation comes from your brain down a motor neuron into the. To the batch of muscle fibers that it innervates, that you get the contraction and relaxation in an organized way, not in a disruptive way, not in a short way. So when we're talking about joint motion, it's incredibly important for proper muscle function. Muscle will stop being receptive to the stimuli that it's getting if it can't move through a range of motion, if you're really, really tight, if your muscle is not a proper. It's got nowhere to go, it's going to stop. And without stimulation, it will atrophy. Right. So it's this continuous, dynamic interplay between muscle, the nerves that stimulate it, the bone that the muscle is attached to. I mean, people think of the body, or we speak of the body, you probably don't. But medical people in general, as a part a heart, a lung, or the musculoskeletal system, as a tendon, a ligament. But the reality is, the musculoskeletal system, every tissue comes from the same stem cell, the mesenchymal stem cell. They're all cousins. They speak the same language. They secrete hormones that talk to each other. So why wouldn't we think that when the neuromuscular pathway is not working or the muscle's too tight, that the bones can't move. Does that make sense?

It totally makes sense. And it's so different than most people think about aging. Like, oh, I'm walking and it hurts. And it must be because the muscle's tight. But it's quite often because one other muscle around that isn't doing its job, and it's totally invisible to you. And then a good therapist or physician will work with you and they'll poke on that muscle and you can't move your leg. And to me, it was really vexing. But what the therapists will do, functional movement people, you know, they'll tap on the muscle just so there's a nerve signal, and then you learn how to use it again. But how does that work? Lower pelvis? I mean, you're supposed to be like, tap it on your lower pelvis.

Is that so that's what internal pelvic therapy is. I mean, you enter like you're having a vaginal or prostate exam, tapping on those muscles, pressing on those muscles so that your body feels them. Because on an average day, do you feel your pelvic floor? I don't. I mean, you may be more in tune with it than I do, but until somebody. Because you've had to rehab it, right? So until somebody taps on it, stimulates it and then you feel it, your brain will catch on pretty quickly. But sometimes that's what it takes. And don't worry people, it's done in the privacy of a room, it's not in a gym. This is a, a medical PT procedure, but sometimes necessary. But when you think about, I love that, that in your practices that you do functional motion assessment. In fact, you may not know this or you probably have it on your schedule. One of your businesses opened in the same building as my office. So you're having this grand opening. So is that great?

That's incredible.

In Lake Nona. Yeah, Lake Nona.

Oh my gosh. Yeah, Lake Nona. I was just there in Florida.

Exactly.

It's incredible.

But I love that you're doing functional motion assessment because if you don't mind, I'm going to give you an example of why that matters. From my own example. Right. So, yeah, when I ramp up my running, I will always, always. This is an example of compensatory motion and things not firing. I will always develop left Achilles tendonitis and right hip flexor pain. Now why is that? Here is what people don't get. Because if you just go and you don't know about the kinetic chain and functional motion, somebody's going to work on your hip and somebody's going to work on your Achilles tendon, which they may have to do. But in a functional motion assessment, they would discover in me that my left great toe, because I'm a stiletto wearing orthopedic surgeon. Yes. And I was a former dancer. My left great toe does not have full range of motion. It has arthritis. So instead of when my heel strikes, bear with me, people. Heel strike. And I roll through. I don't roll through the middle of my left foot because my left great toe is stiff. I roll through the outside, which prevents. Bear with me, my tibia from internally rotating. It prevents, therefore, the next link, my femur from internally rotating, which prevents my glute from activating. That is the kinetic chain. Isn't that amazing? Because I don't have motion in my toe. My Achilles gets Pounded. My left glute is not turned on, so my right side has to compensate, including my hip flexor to keep my pelvis stable. It is so important that you do a functional motion assessment.

Now we seem like we have some related issues. All of my stuff started because I did a yoga pose. Crow and I kick back to plank and I injured my toe and it just wouldn't heal. And over time it started calcifying.

Yes.

So I couldn't push through my right big toe and I did all the stem cells. Nothing would fix it. Finally, I had to go in and rebuild the joint and I did a whole podcast episode on. They cut the bone and reshaped the thing. It was a huge pain in the ass, but at least it can move again. But the reason I got the hernia on the left lower pelvis is because I couldn't use my right toe and I was compensating too much stress there, which turned off my left glute, which made my right shoulder raise more than it should. So the whole body is this big S curve. No one talks about this. So we have this weird pain and we don't understand. You probably should have functioning feet and ankles, which is the focus for everything. But you wear stilettos and you know better.

So I do. But you know what? Word to the wise. I wear stilettos for two reasons. For three reasons I'm going to tell people listening like, how can she get away with it? Number one, you have to have pretty normal feet. If you're at the pool side and your wet footprint doesn't look like a stereotypical foot, it looks flat or it looks like you have to have pretty normal feet to get away with it. Number one. Number two, I was a friggin ballet dancer. I'm as strong as a bull. You cannot expect to put one on heels on and get away with it once a week, once a month, it's just your body's not strong enough. Those are the two main reasons. So I forgot the third one, but. Oh, because I just want to, Dave. I just want to.

Right, Fonda? That is the most honest answer. There's nothing wrong with doing something that you want to do even if it's not perfect because it was fun. Like that's completely okay.

It part of my old age. Bad badassery, Dave. I mean, I don't know why you want to what you want when you're 97, but I want to be doing what I want to do when I want to do it. And if it's wearing heels. I'm going to do whatever to get there, so. Isn't that funny?

Same here. But I'm. I'm hoping that when I'm 97, wearing heels isn't on my personal agenda.

But yeah, whatever your, whatever your equivalent is. You know.

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Oh, let's talk about perimenopausen. I've never heard it.

I just saw that on Instagram today.

And it made me laugh. Well, let's see. I call this whole period. Let's compare it to adolescence or puberty. Yeah, okay. But you know what? In a mindset way, maybe it is. We are so free when this happens. But it is nothing to fool around with. And I wish that every single person, your listeners are probably all tuned in. But. But I'm going to tell you, most women in this country, I still am practicing. I have clinics full of people who have never heard of perimenopause. So I call the whole thing the menolescence. Because we have lived through adolescence, right? That cataclysmic. We come into our hormones and we're like different people. It is the same with menolescence, except we are losing our native estrogen because our ovaries are retiring. But here's the deal. In the spirit of prevention, in the spirit of growing older, because aging is the most natural thing we do. But not aging old. Right?

Right.

I just got yesterday. I'm in. I'm in this place. I am now. Because yesterday I testified before the FDA on the merits of estrogen therapy for women. And they thought I was going to talk about. Yes, they thought I was going to talk about estrogen to prevent fractures in old women. And I am, because I'm sick of putting metal in old ladies. But listen, people you need to make your hormone optimization decision in your early 40s before you go through this intense period of aging, which happens around 40, 45, and you're already on a downhill slope. There is no organ in our body, from our brain to our bone to our heart, that do not have estrogen alpha and beta receptors. So why let's take bone. Because I was screaming. Not screaming, very calmly. Talking to the FDA about, are we going to wait until. Until. Listen. Are we going to wait until 40% of women have fractures because we let their bones disappear at a rate of 20%, or are we going to tell the 40 year olds, let's find out what you built when you were young, let's optimize your hormones and never let you lose your bone in the first place. I could make the same argument for every body part. Look how passionate I get about this, Dave, because here's what we're doing to women. We're saying, oh, you know, you're gonna be fine. Just age naturally. Well, okay, what's more natural than having the hormones that you began with? So here's the deal, though. Just consumer alert. I think every woman is a sentient being with agency, and you get to choose. But I refuse to let you choose based on fear. Fear Wh I versus fact. And so the first step in mastering your mental lessons is becoming literate. You had to become an expert in yourself. Please, you have to investigate. I mean, it's like when I'm at your conferences and these expos are filled with all this stuff. People are so curious. They're asking hard questions. They're investigating. Right. That's what I expect for you when you're making your hormone decision. Because if you know what you're gonna do and you start before you lose your brain, before you lose your bone, before your heart goes down the clicker, that is the best time to get in front of it.

Wow. I couldn't agree more. The crime against women of letting them go through perimenopause without any good advice. And the data is so clear. And I put a lot of this in my longevity book. If you go on bioidentical hormone replacement starting at perimenopause, your risk of everything bad for the rest of your life goes down. And it's not very expensive to keep yourself young, and it's really expensive to reverse your age. So I have to ask, given that the FDA is under new ownership, if we can call it that. Mm. Was it any different than it would have been a few years ago? Because your message Basically says pharmaceutical industry will make less. If women are healthier, it seems like they'd be fundamentally opposed as an arm of the pharmaceutical industry. Was your message more received now?

We were invited by them. We didn't form the castle.

Excellent.

10 of us. Well, if 20 of us were invited, 10 of us showed up. There were the legends of women's health who have written the research for 40 years and have been trying to scream from the mountaintops. We have re evaluated the WHI and there is virtually no reason to withhold this. Right. So they were there and then there were four or five of us that are leading the charge now. There were two urologists. I'm an orthopedic surgeon. There was an internist laying out the data in our prospective fields about how we're going to help women live longer, better. Because the reality is, Dave, women are already winning the longevity race, meaning we're living four to. Well, you know what? You guys are living better and I'm happy to talk about that. We're already winning in terms of years, but we are the dead last losers when it comes to quality of life.

Like Alzheimer's.

Exactly. 70% of Alzheimer's is in women. Most osteoporosis is in women. Women. The number one killer of women is cardiovascular disease from microvascular disease, which we can prevent with estrogen. So. So, but. And women live in this sphere, but they also live in this. Dave and I, I certainly hope none of the people lift listening man or woman will allow this to go on. But women say to me every day in my clinic, they say a lot of things to me, but they say, you know what, Doc? I didn't want to come in today because I have a really high pain tolerance. As if we should be wearing some badge that says I will suffer because that's what's expected of me. I have a really high pain tolerance. And I didn't want to come in, but one of my messages is that we don't have to suffer in silence for years. But when you think about your own mother or grandmother, I think about mine and it makes so much more sense. Like how did my robust grandmother, who raised 10 children and had three businesses dissolve into a frail woman that we had to help around? How did my own mother, same immigrant, came here with less than $1,000, so smart and vital, shrink and become shorter than me? And you know what? But we can prevent that. So when we talk about cougar puberty, if we give women back their hormones, they are going to continue to have brains they're going to be. Continue to be sexually vital. They're not going to start being. They're not going to be anxious and enraged all the time. I mean, I'm getting so off topic, but. Dave, research has shown Louise Newsom did a survey of her thousands of patients in. In England, up to 70% of the women she surveyed thought that their menopause directly affected their midlife divorces. This is. Of course, men don't know that their women are not rejecting them as people, but it cuts like razor blades to have sex when your vagina is atrophying. So there are so many reasons. See what you did? You got me going. Dave, there is work to do in this.

Mission accomplished.

Yeah. So, yeah, mena lessons is the psychological, the physical, the hormonal, the social transition. That doesn't have to be an endpoint of suffering. The women like me, I mean, I've been through this more than a decade ago. I have mastered this. Right. The women like me who have gotten in front of it, gotten our education, know what to use, continue to exercise. In a crazy way, the wisdom of our age allows us to be more authentic than we have ever been in our entire lives, more sure of ourselves and just out to conquer the world. But you're never going to get to mastery if you don't get to your hormone decision first.

Some of the happiest, most powerful people I know are women who went through perimenopause with appropriate bioidentical hormone support. Just like you said, they've got wisdom, they know what they like, they own it, and they're in such a good place. And you contrast that with someone who's, I'm just anxious and tired all the time. And like, look at your dhea. Look at your pregnant.

So miserable.

It's so easy.

Yeah.

What are the top four hormones that women should track?

Let's start up here. Right? I suggest if you care about the 30% of collagen that you're going to lose in your face and skin that you think about estradiol or estriol for your face. You know what? I started doing this in Secret more than 12 years ago.

When I look at you, that's really cutting edge. 12 years ago. Wow.

Well, because, I mean, you know, listen, I'm curious and I'm sorry. And I'm like, if I'm putting this. Because when I started on hormones, I had to go to the secret guy in Chicago that. I mean, it wasn't commonplace. Right. So I'm calling up the secret medicine guy and he gave me a compounded estrogen for systemic use, which I don't use anymore. But I'll tell you, so I'm. I have this cream, I'm thinking I gotta put it somewhere. Why don't I put it on my face? And my, my esthetician, I know the esthetician I went to, she's like, what are you doing? Because you're pretty old and this stuff is working. So, number one, estriol, estradiol, formulated for your face. Now, here's the deal. It's a very low dose. It is not systemic doses. It was not probably okay that I was putting my systemic dose on my face. Really low dose. Number two, systemic estradiol. Systemic estradiol, it's my opinion is best delivered transdermally because there are no first pass effects through your liver. Like if you take a pill, a. It's conjugated estrogen from horse's urine. Number two, it has a first pass effect, meaning it has to go through your gut. The blood will then go through your liver. The liver will take out all the stuff. Your blood clotting factors will be affected. It's still the right choice for many women, but not for this woman or not for my patients. So I prescribe and take transdermal estradiol, which means a patch or a cream, the third kind of estrogen. And then I'll get to the other ones. The third kind of estrogen that I think every woman in midlife needs is vaginal and perineal estrogen. Because the genitourinary syndrome of menopause is real. And when sex hurts like razor blades or you're having bladder infections, 30% of the time, people will die of urosepsis and chronic recurrent bladder infections that prolapse of their uterus. Because we talked about pelvic floor so well treated by vaginal estrogen. And the data show that it is safe for everyone, including women who have breast cancer. Have been treated for breast cancer.

Thank you.

Have been cured from breast cancer. The data shows there's a new study this year, Vaginal estrogen. The three kinds of estrogen you can also, for genitourinary syndrome of menopause, use dhea. It's also a great solution. Fourth hormone. If you have a uterus. If you have a uterus, you must protect your uterine lining with micronized progesterone. Not synthetic progesterone, progestins. Micronized progesterone. It's a pill. 100 milligrams usually every night. And by the way, it helps you sleep. I do. If I get in bed and I don't take it, I get out of bed. Cause it helps me sleep so.

Well, oral progesterone is a gift. Not quite at that dose, but even for men, it's really important.

Dave, my husband's going to kill me. He was having trouble sleeping. I put him on it.

Yeah, it totally works.

It totally works. And then finally, I am a big, big believer in testosterone for women. And why wouldn't I be? Yeah.

So important.

It's like I forget the movie where I just forget it. But it's a perfect scene. It's in black and white. And then the camera rolls and it's suddenly Technicolor Vibrance. That is what form testosterone feels like to me. It like, gave me this thing back that I've always been. The dullness came off. And women have to be careful. I mean, we have to keep track of testosterone levels. I'm a big, big fan of transdermal testosterone, mainly because I don't like the results of an overshoot. You cannot control what you get in a pellet or how your body is going to metabolize it. And so it is not uncommon to overshoot and shoot your testosterone up into male levels. And that's fine if you're trying to transition, but not everybody wants those changes. Right? I mean, so we need female testosterone less than about 100. And so with. You know. And I've seen. I've seen pellet testosterone up in the four hundreds, and it's miserable until you absorb it.

So much knowledge there. And the best place to put topical testosterone for women would be on the vulva, right?

Well, you can put it there. I happen. You can put it on any fatty place.

I happen to call that scream cream. Because of the vascularization.

Yeah. Yeah.

I mean, it has beneficial effects for women, but you can put it anywhere you want.

Yeah. Women have erectile tissue just like men. People don't know that, but they do. We do so.

Oh, yeah. You also mentioned topical estrone and estradiol for the face and that it's not systemically absorbed. I have a really good skin on my face, don't I?

You look good from here.

Well, I have filters on. I'm kidding, but I do. And one of the reasons is I use a very low dose.

Good for you.

Right. I'm kind of a leader in longevity, so I know this stuff. But very few guys will do it because you're afraid it's systemic. But the data is Very clear. It's not systemic. It's just local. And you start doing that a month later. Like, what is going on with your skin? I'm like, my skin is looking better than it has in a long time. And it always looked pretty good because I have access to every toy there is and all this stuff.

So, Dave, I love that because it just goes to show what the data say. You're. You're not transitioning to a woman. It's only. It's 03 milligrams. It's so tiny doses.

Super tiny dose.

Yeah, it's just local. Oh, I love that you're doing that.

And we, we just did a. Another episode of the show where we talked about men using up to 1 milligram of estrogen because of the cardioprotective effects and the libido effects in men. And it's not enough to have any feminization whatsoever, so.

Well, isn't it funny? Can I be a little political for you right now? Is how funny is it that we are so able just to let men experiment on themselves and we're not worried about you crumbling, but we cannot get the box label off estrogen for women when there is no data in the first place to support it. What's up with that horrible misogyny that we're going to control women, but we let men just accept experiment.

Well, they. That wasn't really something a doctor let me do because. And also for a minute, like our. The black box warning for testosterone which lowers your risk of dying for men from everything that had a black box warning until about what, three months ago? So it's like fda, we didn't hire you guys to tell us what hormones to use. Like, shut the F up and get out of my life. If you want to provide advisory stuff, I don't care. But don't you regulate it? And so it's funny for women. Like, I don't want to take testosterone. I'd be too manly. And men are like, I don't want to use the estrogen. I'd be too female. Like, women have more testosterone than estrogen. Like, you have to have some.

Well, listen, they're not sex hormones. They're just like thyroid and, you know, cortisol. They're just chemicals. Your body doesn't know that we care so much about what's assigned to one person or another.

And you just, you have to get the right levels for your biology. And, and I think this is a bit personal because your, your description of like the, the lights coming back on the colors returning. When I was 26, my testosterone levels were lower than my mom and had her lab tests.

You felt like, terrible. You felt terrible.

300 pounds. My thyroid was low too, and I went on testosterone and got my thyroid working. And within three days of that, like, oh, my God, this is how I was supposed to be feeling. So that low T, which is now an epidemic in men and women, it's so big because it's not about libido, which is nice. It's about desire to do things that matter. And it's tragic when you see someone who has, you know, 40 or 50 years of life experience who's just like, I can't. I just don't care. And it's not they don't care. It's that they don't have the testosterone to care and they don't have all the important estrogen effects, which also are in the brain. Right. So it's just about having young people hormones when you're a hundred.

Yeah. Well, you know what? I have four millennial sons and I have told them all, get your baseline testosterone now so that when you are 50. Yes. We can elevate your testosterone to your level. Because when I test men's testosterone now, which I do, because when men come into my clinic with multiple tendon, multiple ligament problems, I test their testosterone and they may be within the guides of normal. And we said 250 or 350, which is really low, but they may have been 1050 when they were younger. Right, right. So that's why with my own family, my own sons, I'm like, we're gonna get it tested and we're gonna put that in our back pocket so I can elevate you to what you were when you were young.

Wow. Literally three hours before we recorded this Axo Health, which is the lab testing part of Upgrade labs, I had them send someone to my house. My 18 year old daughter's here, and so we're getting her hormones run to see where they are. So now we know. Right. And she's learning to be comfortable with needles. You know, not the most fun thing, but she's willing to do it because she's seen, you know, well, I've seen that biohacking might have some merit, which is kind of cool. But if you know your young vibrant levels, they could be radically different than the person next to you.

Right. I would love for every woman, if I'm setting policy the very minute, if you decide to have children, that you are done with children and they're. Weaned and everything. We need to know what your hormones settle back too. So in the future we can know that information. Right. And now, I don't personally prescribe perimenopausal hormones based on levels, but I think it's important to know when we felt our best, what we were. And that's just my philosophy as a physician.

I like to treat symptoms as a non physician, which says, you know, if your body needs more testosterone to feel good than we think is the right level, we let's just treat until you feel good.

Unless you start to transition. I mean, some people don't like those changes.

Yeah, if you're, if you're growing a mustache and that's not your vibe, granted. But it rarely happens and you back off if it does. Unless it's a pellet, because pellets don't have anything.

Oh, I was going to say. Oh, thank you for clarifying. Creams, you can go up and down daily. Actually, pellets, you're stuck and I'm not. Okay. Dave, we've said a lot of things on this program already, but clitormegaly is real and it's irreversible. So if you don't want that, okay.

There's a group of 40,000 women on Reddit right now who are intentionally doing clitoral enlargement. And they're putting, oh yeah, they're putting a low dose of testosterone, one drop right on the clit and the hood. They're using a little pump and they're reporting incredibly explosive orgasms. And they're saying, I've got more nerves, I've got more blood flow, flow. I'm really happy. And it's only, you know, a little bit bigger. They're not, you know, growing two inch things or whatever.

Right.

But that may not be a bad thing to have a little bit more blood flow.

They're just saying interesting to think about, actually.

Yeah. I haven't experienced that myself for obvious reasons, but like, hey, if I had that kind of equipment, I'd probably hack it too. It's not like I'm interesting.

Yeah.

There's also one of my company's Wasabi method, does shockwave therapy, and we make a device that works on women and men. It helps with pelvic floor stability, but it will grow more blood vessels and nerves in men or women when you use it, you know, around the recreational zones.

Yeah.

And you know, there's all these different technologies for, for women around restoring the thickness of tissue. There's stem cells, there's, there's RF there's LEDs, electrical stimulation, there's the topical stuff you just talked about. So it's almost, we're to the point where if you are in a place in life where you can invest in your health and you have thin walls, you have pain on sex, you have lack of lubrication, all those things are eminently hackable. Starting with hormones, probably first. Then pelvic floor strengthening, and then maybe you need a little stimulation to get the tissues to thicken or to have more blood flow. And then the difference in quality of life and quality of relationship is so big. But most people don't even know this stuff exists. And I love that you're just talking about it together with the muscle conversation.

Well, and I'm certainly glad that you started in that order. I treat a lot of people who come to me for longevity and what I find is that many people have listened and they're very curious, but they want to start on the outside of what we already know works. So I always start with health optimization. And so you said hormones first and then you said muscle second and then you started delving into can we augment tissue, can we use lights? And I love that sequence because I don't think skipping ahead to mechanics will ever be better. And replacing your hormones and working on your muscles, I mean, you need a little endurance to, if you're, if your parts are all working, you need a little endurance, right? So muscles matter.

Let's assume your hormones are in place. And you know, you, maybe you, you made the mistake of listening to Peter Attia, who is afraid of testosterone therapy, but he's telling you that VO2 max and exercising like 20 hours a week is the only way to die. At the same age, you were going to die, but at least die healthy. So what's up with the obsession with VO2 max?

So you know what the in scientific, in the science world, VO2 max is the best predictor of longevity. And I'm going to tell you why. There is a line called the fragility line. It is the line when your VO2 max is low enough that you cannot live independently, meaning you can't get up from a chair, which means you're not getting off the toilet, which means you're probably not cooking food. For men it's 18, for, for women it's 18, for men it's teen. So let's put that in com. Your people know this, but an amazing VO2 max is 40 to 50, right? For mere mortal athletes like me, for, for world class athletes who are born with special protoplasm. They're usually 75 or more like the Tour de France, but people. But here's why it matters, and I'm going to tell you why I don't think it's the only thing that matters to your point. Last time I got my VO2 Max tested, I was 50, and it was about 50. Let's use round numbers. Because I was. I've always been an athlete, an endurance athlete. So we will lose 10% of that per decade if we do nothing, if we do not reinvest. So 50. It was 50. 60. It's going to be 45. 70. It's going to be 40 ish 70. You see where I'm going? I am never crossing, even at 90, crossing the fragility line. But if we start out in midlife at 30, because we've been sitting on our butts our whole life, or we're too digital or whatever, it you've been sick your whole life, you will very quickly cross the fragility line before for your 70s or 80s. So in that sense, I think it's very useful to know what it is and to train for it. But here's the deal. When I prescribe it, I prescribe it after health optimization for health optimization phase. Because my phase is go health optimization. Peak performance because I'm an elite sports doctor. And so I pull in all the techniques I use with my athletes. And then finally, finally, longevity. Let's do all the stuff that's been tested on rats, right? So in my health optimization phase, we're not doing VO2 max training. We're walking, and twice a week we're sprinting, right? We're max min. We're getting to get the max out of the minimum because that's all people will do for me. I think, more importantly, and you've had so many guests about this, you gotta build the muscles below your belly button. We are designed to move. If we were designed to be sedentary, we would be like sessile mushrooms. We would have a mushroom stalk with our brain on top. That's not how we're designed. So we gotta build some muscle. And so I always tell people, take your hormones, build your muscle, walk until we optimize. Only when we optimize do I then train people how to train their VO2 Max because it's just hard and people don't want to do shit anyway. Oh, I just swore on your podcast.

Oh, you can. You can swear. It just. It means that you're a highly trained doctor.

I mean, it means that I'm an orthopedic surgeon. We all do.

What? Surgeons don't swear. Come on. Yeah, yeah, but here's the thing about VO2 Max. Yeah. It's an important marker, but we have this idea that. Oh, it's hard to train it in 15 minutes a week.

Yes, yes.

And that's not very much time. We have technology using AI that will increase your VO2 max by 12%. That's at Upgrade Labs, and it's just an AI bike. There's another 10 to 12% available with another technology we have there, the metabolic trainer, but it's intermittent hypoxic therapy. So for people who don't want to go beat themselves up, you know, sweet sweating all over the place, then. Well, you could sit here for a half hour and breathe through a mask and get 12% and five minutes three times a week. You could do something mildly hard and combined. That's about a 20% increase in VO2 max, which is enough. In fact, that's probably going to get from like, eight hours of Zone 2 training. I don't have eight hours, and I don't like Zone 2 training. I'll do if I have to. I don't have to. So I just want women who are listening and men. No VO2 max matters. And then do something about it. But it doesn't have to be going out there and beating yourself up unless you like that, and take the time you save and do some squats or some functional movement. Right.

You know what, Dave? I find, and this is. It's genetic. I mean, we are built to survive. I just. For the majority of people that I serve, not all of them, it's hard to be consistent. So if you're offering ways for people to get it in and get it over with, that's a good. That's a good outlet. Because I even count the steps walking up and down my hallway in my clinics because I'm gonna count everything so I don't have to do extra. Right. I mean, I'm not. Yeah.

And, you know, we. We all wanna do well, and there's only so many hours. Okay. Do you wanna spend a half hour cooking proper food, which is gonna drive your bone density and your muscle mass and things like that? Or did you want to skimp on that so you could do more exercise, but then, you know, eat at a restaurant that didn't do it? Right? So I'm always trying to say, well, how do I get the biggest bang for the buck? Because I have a few companies And I have a life and all this. And perfection is not required, but hormones are required.

Right? That is the line I fall on. Yes, it is. Yes, it is. And you know what? Personally, the reason I'm so vehement about spreading the gospel to the 40 ishes, that's what I call them, is because I sure wish I would have done it earlier. I didn't know it's been over a decade. And so when I went through this, nobody was talking about it. Right. So that's, you know, what, what could. I could have been so much even more like, masterful of this had I done it earlier, because I just, I don't want, I have millennial daughters in law. I don't want them to suffer like I did.

Yeah, I had a lot of the diseases of aging before I was 30, which at the time sucked, but it did, it did make me an expert in longevity.

Yeah, that worked for you, right? It worked out.

Yeah. But man, I, I just, I don't want to go back to that. And I, I see friends who don't, who don't do the basics and like, man, you don't know where you're going. There's some other, some other weird stuff that, that I don't talk about very much. But I've seen you talk about what's velocity training and what does it have to do with longevity.

Yeah. So when we talk about weight training, and I get a lot of criticism about this because I prescribe for people low reps, high weights, and there's a method to my madness. Listen, I had a woman come into me the other day who was told to lift very light weights 25 times for two sets. And I said, okay, well, what's our goal? Is our goal endurance? Okay, if your goal is endurance, then you lift the lightest thing you can forever and you'll build some Endurance is your goal. Hypertrophy, like bodybuilders do you want big, bulging and they look great? Of course you want those. That is a different set of reps and sets. I, as the orthopedic surgeon who puts rods and bones, when you become frail, I want you to have strength. Strength means in one movement. Right. Strength means I can lift something heavy. And I want you to have power, which is strength over time, strength with motion, so that you do not fall down, so that you can get out of the way, so that you can use your power to get up. That requires strength, requires fewer reps, fewer sets, but heavier weights. If we want power, then we have to train for the fact that we lose type 2 muscle fibers first. And when we don't have estrogen, then we lose the anabolic stimulus that those have. So we have to train our bodies and we do it with speed. So when I'm training, I don't really love this, but, but, but my. When I was first training in powerlifting, we mastered the power lifts, we mastered the low reps, high weights. And then when I was taught this, it was we are going to go down regular, let's do a squat, we're going to go down regularly and then we are going to explode up like really tempo lifting. That will then add the strength over time element that will train us in, in power, we don't lift quite as heavy. When we do that, we cut back on the, on the really heavy weights because we're adding that component of explosive power. You can get at this by box jumping. Lots of people, whether they're in my clinic or on the Internet with me, they're really afraid of jumping. It never occurred to me before I showed people I jump a 24 inch box right now. People are afraid of that. So you can get at it with plyometric drumping, or you can get at it with increasing tempo with lifting.

You talked about bone density as well. When you're doing that velocity training, you flex the bones a little bit, which causes them to become more dense. If you have the right minerals and the vitamin D and K2 and all that kind of stuff, Right.

So bones respond. Bones are not static pillars. We think of them that way. The. I like to tease. They're the. People think they're the strong silent type, not saying anything. But actually they are talkers. They are talking all the time, communicating. What they are also doing is adjusting to the load. Not by just bearing the load, they are bending under it. And we can see in a femur bone, which is shaped like this, the femoral head, the femoral neck, we can see the trabecular lines in the bone on an X ray following the stress lines so that when you step on your hip for an instant, it goes like that a millisecond, it goes like that. And that teaches the bone to lay down in those arcs of stress. Right? So that's what you're talking about. We're not only impacting the bones, we're bending them ever so slightly.

It's an important part of staying young for a very long time. Just having bones and fascia and muscles that work. And the kind of training you're talking about, it's so important. After you have at least enough muscle mass in order to be useful. There's something else that seems to be a problem and we talked about it a little bit earlier. You know, some of your muscles can just sort of get turned off and then your brain does not address them. What do we know about micro instability and fall risk as a brain signal, not necessarily a body weakness?

You know, there's this phenomenon within weightlifting called beginner's gains. Right. You suddenly go from lifting no weights to you're like oh my God, I'm so strong. That is retraining of your neuromuscular pathways. Because the way motor neurons work is one nerve goes down and it ends kind of like this and it innervates one bunch of muscles. So what we're doing when we're first learning to lift and putting a lot of load across, we're actually retraining that neuromuscular pathway so that it's more efficient. You recruit more muscle bundles with a single stimulation. So much of the functional gain that we get when we begin lifting is that neuromuscular pathway. In fact, when I first started doing longevity research, I was reading some of the original studies. There was this researcher named Maria Feitarrone and her studies were done in 90 year old men living in a nursing home. She did a bunch of chair exercises and really low key stuff. But what she got was 150% increase in their function. They could get up, they could walk around. That was retraining their neuromuscular pathways.

Some people think, oh, that this, this isn't possibly real. But there's two examples. One is you see a Shaolin trained monk somewhere doing one finger pushups with no visible muscle mass. But somehow there's incredible strength. And then you see Anatoly on YouTube.

Oh my God, isn't he.

I love this guy. He looks relatively normal and he's lifting things that people three times his muscle can't wait. So the neurological side of strength is incredibly important. But here's the question for longevity. What's more important? Strength or muscle mass?

Strength.

I think so too. It's about strength and power. And you can, you know, have a giant bicep or have a smaller bicep. As long as your strength is there, that's going to keep you young longest. And there's probably some upper limit where having too much muscle mass in relation to strength isn't even good for you. There's a lot of professional bodybuilders for very unhealthy. Yeah, their, their heart has to deal with all that muscle that isn't actually as powerful as it looks. I'm not saying that you don't want muscle mass. You do. I'm saying you want strength more than muscle mass. And both would be ideal.

I think when you're training for strength, you will gain muscle mass. In one year, when I gained eight pounds of muscle as I through menopause, I had to correct myself here. And so you will gain muscle, you will look leaner, which is what people want anyway. Right. But I also think there's a certain genetic component. There's the, you know, Anatoly, he's probably a genetic specimen and lifts for strength. There's also this phenomenon. I grew up on a farm in Kansas and it's called Farm Boys Strong. These kids, oh my God, they could lift a cow. But they don't look like they could lift a cow versus the bodybuilder you think could do it, but they're. And listen, I'm not trying to make enemies of the bodybuilder crowd, but there's a difference.

Yeah. And there's physique and then there's some other kind of strength that I think is more neurological. Plus muscle and plus fascia and bone. And I'm interested in all the above.

Yeah.

So I gotta ask you this, you're an orthopedist.

I am.

So there was a time where I might have used some sarms. These are kind of research grade things, selective androgen receptor modulators. Wrote a big blog post about it. But I put on 29 pounds of muscle in six weeks to the point going on stage at a Tony Robbins event. And I packed the normal shirt I would wear for that and I blew out buttons putting on. I had to like go to the local TJ Maxx or something and find anything fit this dumb looking blue shirt. And I just remember like, this is crazy. Why wouldn't women just use SARMs and put on 20 pounds of muscle in a month or two and just be done with it?

Well, number one, there is no such thing as be done with it. You will, you will lose muscle that you don't use. Number two, that is the surefire way for women to do what many women use as an excuse not to lift at all. Bulk up. Especially the story you just told because if you put on 29 pounds of muscle, you're going to change your body shape. Which most women want to change their body shape in midlife. But to that extent now I don't have an answer for. Why wouldn't they just do it? But, but you would not maintain muscle if you didn't keep working out. Right? There's. So you can use additives like that, but in my opinion, it can't be the end all, be all. You can't skip ahead of nutrition. You can't skip ahead of. You can't skip ahead of continuing to lift weights for all the other benefits.

You still. I mean, you're going to lose the mental aspect of it and the neurological aspect of it if that was all you did. I'm just assuming that if you're going to work out and you're doing something like that, you could work out less. And I'm not suggesting you do this, because what happened to me was your muscles can grow fast, but, I mean, you're an orthopedist. How do tendons and ligaments respond to growth compared to muscles?

You know, tendons and ligaments don't have a real intact blood supply. They get their blood supply from the peritoneon and the, and the, the coating around the ligaments, and they don't repair themselves very well. That's why they get, you know, every time we work out and they're pulled hard. And I can only imagine what happens with 29 extra pounds of muscle. They're going to be under a lot of stress and strain and they're going to develop a lot of these micro tears that don't heal. And so what happened?

I tore both my shoulders. That's what happened.

Oh, no. You had a point to this, right?

I have stem cells. I fixed them, but it was painful for a couple of years. It sucked. It's painful.

And then they're torn, and then your muscles stop responding because they're not connected to anything. And then. Yeah.

And that said, if you were to follow your advice and get on the right dose of testosterone when you exercise, you'll build muscle. And if you're a woman or a man who's low in testosterone, when you exercise, you just don't get results. And then of course you're not going to do it because you sweated, you worked hard, and you put muscle on. Right.

Well, and I live in the camp that you have to feed your muscle. And I also get a lot of criticism for this. But when I evaluate women just off the street and they're telling me they have a salad plus or minus a protein, and they don't eat breakfast and they're getting less than 60 grams of protein a day, I don't know where they think they're going to build their muscle from. So from Kale. Yeah, let's get it from Kale. But so, you know, you got to. It's all the things to truly build a society, sustainable system. And that's why my approach is if you're truly optimized, listen, if you are so optimized and we're moving on to peak performance and you are. I had, I had a guy who wanted to climb to base camp. He was 63. He thought it was the last time he was going to get there. I'm like, okay, here's the things we're going to do for peak performance and then I'll entertain all these extra things. Because he truly had done the work right. Yeah, that's just me as a physician philosophy, you gotta put, you gotta build and do the work or else what you have so honestly said is that you're gonna hurt something.

Exactly. I've heard people say, you know, there's no such thing as a free lunch. Which is absolutely provably false. You can get free lunches in lots of places. So you know, as, as an adage, no, you can get a free lunch and for a unit of exercise you can get very little results. And for the same amount of work, you can get greater results by setting yourself up for success hormonally, nutritionally, sleep wise, like the whole thing. And it's okay, let's do enough of that. That exercise is worth it. And even if you didn't do the exercise, you would be better off because you fixed your hormones. And if you do both to the point of your whole practice here, like that's the recipe for women to be really powerful.

That's it. That's right. There's there, you know, it's, it's not one thing. Sometimes people are like, I'm going to get the one thing or I'm going to buy the one thing. It's. I'm sorry, we are a biological system. That is not how we work.

If you could offer three pieces of advice to turn menopause into something positive like a metabolic renaissance. Three most important things.

Number one, we are going to pivot our mindset. I, I call it mindset mobilization. We are going to stop. Our mind will do what we tell it to do. And if we are telling it that I always look over my left shoulder. Oh, 26 was the most amazing time. Which we know. In your life. It wasn't in my life. It wasn't. Then you are never gonna pivot your mindset. To be curious enough to work hard enough to understand that these can be some of the best years because, yeah, there's a lot of value to being that young, but there's so much more value once you are established, you have a little bit of money. We're more settled in ourselves, right? So we gotta pivot our mindset, and that includes building mental resilience by understanding what we feel about control. Right. When you're older, our hard things make no. Hopefully no longer make us feel like we have no control. I firmly believe we have agency in most things. Number two, it. It has to do with commitment. How committed are you to being 97 and doing what you want, when you want, when you want it? And number three, do we view aging, which can be hard for some people, as a challenge worth taking, or we're just going to sit in a corner? Right. So mindset mobilization is probably the surprising answer because usually it's physically better. Right. Number two. But I don't think you're going to put in the work unless you believe you can be a badass. Again, I don't think you're going to do it. So number two is the things we've talked about, if you choose one thing other than eating well, you're going to lift weights. In my opinion, you're going to invest in your muscle mass. And then number three, I guess it's another attitudinal thing, but I see this all the time. I think by the time people get to you, they have made it through this. But I get people when they just start and they don't believe they're worth it. They believe everybody else is worth their time, their energy, their money. And so I just encourage people that you are worth the daily investment in your health, and in doing so, you can take care of everybody else.

Wow, that's such powerful advice. I very much resonate with that. As we're wrapping up the show, I've come to the conclusion that we're lacking our village elders. You know, and in my life, in my mid-20s, people in their 80s and 90s mentored me in longevity. And that's the only reason I can do the things I'm doing today. And right now, so many women and men, they hit 60 and their energy's gone. They can't remember anything, they're in pain all the time, and they can't show up the way that they want to in the way society's designed. And if we're going to make make it, everyone's getting older, we're not having any babies. So our only choice is to take our people as we age and turn them into powerful elders who are like, no, no. We saw the last two times you tried to run that scam on us fda, so we're not going to let you do it again, things like that. So the work you're doing is societal, Vonda. More so than I think people might recognize, because we have a bunch of powerful people here who are are full of wisdom, energy, and we'll call it peace and calmness because our hormones work. That's when it's really hard to program us and get us to do things we don't want to do. And that's the world I'm working to build. I can tell you are too. And thank you for being on the show.

It's my pleasure. I love talking to you.

Now, if you like this episode, there's a lot more wisdom that Fonda has for you in her new book. It's called Unbreakable and you go to doctorvondaright W-R-I-G-H-T.com or just look for Unbreakable Vonda. You'll find it wherever books are sold. This is important stuff and I will suggest this for you. If you're a guy and you're with a partner who is going through perimenopause, buy this book as a gift because this is precious knowledge that all women should have and it's just not evenly distributed. It is not very expensive to do the things she's talking about and they save hundreds of thousands of dollars in medical bills later in life. But more importantly, they save all the suffering that most people, especially in the us, go through as they age. It is entirely optional. So this is an important book and it's worth getting for someone you care about or just for yourself. Thanks Vonda. You're doing great work in the world.

Thank you. I'll see you soon.

See you next time on the Human Upgrade Podcast.

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