Navigating the Hormone Rollercoaster with Dr. Elena Zinkov

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We're with you all the way, Walgreens. I'm JJ Virgin, PhD dropout. Sorry, Mom. Turned four time New York Times bestseller, best selling author. Yes, I'm a certified nutrition specialist, fitness hall of famer, and I speak at health conferences and trainings around the globe. But I'm driven by my insatiable curiosity and love of science to keep asking questions, digging for answers and sharing the information I uncover with as many people as I can. And that's why I created the well Beyond 40 podcast to synthesize and simplify the science of health into actionable strategies to help you thrive. And in each episode, we'll talk about what's working in the world of wellness, from personalized nutrition and healing your metabolism to healthy aging and prescriptive fitness. Join me on the journey to better health so you can love how you look and feel right now and have the energy to play full out at 100. All right. We can never seem to get enough of going deep into perimenopause and menopause and especially like busting all the crazy myths around it. Today we're really going to dig into, you know, when should you start hormone replacement therapy? What else can you do that is going to make you need less? How do you know how to dose what things help? Could peptides help? We are digging into all of this today and I've got Dr. Alena Zinkov with me today to do this. She's an award winning board certified naturopathic medical doctor and she specializes in hormone health and helping women in perimenopause and beyond. Kind of get out of the conventional thinking about hormones that I can't believe still to this day we are, you know, it's like we can't escape the misinformation of the Women's Health Initiative. So we'll be talking about that as well. What you can do beyond hormones. When is the right time to do hormones? So we're getting into all of that and it's interesting because Dr. Elena, you know, started waking up to all this. Her mom's an MD and when she was in high school, she was put on a birth control pill for some different symptoms. And then, you know, also again had some issues where she was put on birth control pills again. So she's been through that journey and been able to recover from it and really understand what hormone imbalances feel like and what you can do to recover from that and also to balance your hormones and, and then again, when should you use hormones, how much should you use, what else helps? So those are all the things that we are going to be digging into today at well beyond 40. I will be right back with Dr. Alaina. Stay with me. Hey, jj, Virgin here. Okay, real talk. So often the holidays sneak up on me. Travel, gifts, hosting, you know, all the things. And suddenly it's like, wait, who spent what and where? And I know I'm not the only one who's looked at a bill in January and thought, wow, that escalated quickly. If you want to keep your finances under control this holiday season, you need to be using Monarch. It's rated the Wall Street Journal's best budgeting app of 2025. Monarch is the all in one personal finance tool that brings your entire financial life together in one clean on your laptop or on your phone. Monarch lets you link everything and gives you real time visibility so you're not shocked later. Right now, I've been checking the holiday spending category so I don't accidentally start the new year with that dreaded debt hangover. And honestly, just seeing everything laid out is already helping me stay more aware. This season, Monarch does the heavy lifting. It links your accounts in minutes, gives you smart categorization and super clear visuals. Yes, that end of year reset could be a real goal. This time, don't let financial opportunities slip through the cracks. Use the code virgin@monarch.com in your browser for half off your first year. That's 50% off your first year@monarch.com with the code Virgin Ray Ban Meta glasses come with open ear audio so you can listen to your favorite music without blocking out the world around you.

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Sweet Ray Ban Meta glasses available at Ray Ban stores and other authorized retailers. So today we are digging into perimenopause and menopause. It's a subject that everybody always can't get enough of and especially busting more of the myths around it that, like, it feels like a lot with this whole perimenopause menopause world. It almost feels like that, you know, that toy where the things keep popping up and you keep taking the hammer and hitting them down and more show up. So I've got Dr. Elena Zinkoff with me, and we are going to be digging into this, and I'm thrilled to have you here. Welcome.

Thank you so much. I'm so excited.

Well, you're clearly not perimenopausal, so you.

Would be surprised, actually.

You look like you're 25.

Oh, thank you. I am actually 39, so I am almost 40 years old. But that's actually a really big misconception, is that you can't be in perimenopause in your 30s.

All right, well, you didn't even look like you were in your 30s, so that's. That's my cover. But, you know, so the obvious question, since you're not in the big throes of it yet, what got you so interested into this whole whole topic that we're going to be digging into?

Yes. Well, number one, I am a woman, and I did end up going into perimenopause a little bit earlier than expected or anticipated. I had a hormone imbalance when I was a teenager, and I didn't realize that that's what it was until I was going through medical school and learning about what hormone imbalance symptoms are and starting to see patients and thinking to myself, wow, that was me. And the only real options at that time were birth control and antidepressant medications and anti anxiety pills, which you and I joked a little bit about this earlier, but those treatment options haven't changed too much, you know, since then. We're starting to talk more about it and there's a lot more information and we're empowering women with more choices and options. But a true catalyst for me was the postpartum hormone imbalance symptoms that I experienced. And I went through autoimmune. I ended up getting rheumatoid arthritis. I lost a bunch of hair. I wasn't sleeping at that time. I had a really busy clinical practice. Still do. But basically, the good and the bad stress that came with postpartum threw me in into a major hormone catastrophe or an imbalance. And it really put things into perspective for me of what women go through day in and day out when they face hormone imbalance symptoms. So I really made it a priority for me to Empower women to help them understand that what they're experiencing is not normal and that we can fix these underlying hormone imbalance symptoms.

You mean and we don't need to fix them with birth control and anti anxiety?

No, because all those things are just band aids and they make things worse in the long run.

Yeah, I mean, I'd love to start. There is what happens both with someone who maybe like you in their teens was put on a birth control pill to solve things, or maybe after they had a baby or they're going into perimenopause now they've done that. What do you have to do to, you know, like what does that do to the body and how do we recover from that?

That's such a huge question. And that's been more of a common question I've been getting. Nowadays birth control effectively mimics post menopause hormone levels because we suppress, especially with oral contraceptive pills, we suppress the own production of estrogen and progesterone and that impacts our brain health, obviously reproductive health. Our ovaries don't know what to do. How do we get back to producing our own estrogen and progesterone once we're taking off of birth control? But then long term it just predisposes women for metabolic disease, increased risk of cardiovascular disease, weight gain, so obesity and of course cancer. Increased risk of cancer. Whenever women have a history of being on prolonged use of birth control.

And what's long use considered to be.

I would say more than 10 years, for example, five to 10 years. So a lot of women will start on birth control, let's say when they're 14 to 16 years old, and then they start coming off of birth control around the age of 30 to start having kids. And then they go back on birth control after taking a bit of a bit of a break until they come off of birth control again maybe in their mid-40s. And I have women in their 50s, they're just considering coming off of birth control. So it's quite a roller coaster ride, unfortunately the women go through. But what we want to do is as women come off of birth control, we want to make sure that one the ovaries remember what to do. So we sometimes have to start women on even bioidentical hormone therapy before even perimenopause or post menopause period to sort of bridge that gap from them having zero hormones to now their body learning how to produce those hormones again. And then of course we have to compensate for nutrient deficiencies that come with using prolonged use of birth control pills or other devices. So we have to treat the whole person, which is no surprise in functional medicine. Doesn't matter what we're treating, what we're looking at. It's a total body approach from gut health to lifestyle changes to incorporating potentially natural or actual hormone replacement therapies.

Okay, so there is a way to get people who've been on the pill, you know, to recover from being on the pill.

Absolutely.

All right, so. So then someone in perimenopause, because again, it seems like the age range for going into perimenopause is getting younger and younger. Yeah, but the question would be then how does someone know, is it perimenopause or is it just stress? Like, what is really going on? How would someone be able to tell?

Yeah, there's a couple of things that we can look at. One is I highly recommend getting a hormone baseline. We want to know what your estradiol levels are, progesterone, testosterone, and what your FSH and FSH and LH levels are. I recommend that women do or test these levels in the luteal phase of their cycle, the second half of their cycle. So usually about day 19, 20 or 21 on average. If a woman has a 28 day cycle, day one of your cycles, when your period starts. I know there's some confusion for women about counting day 19, 20 or 21. Day 19, 20, 21 is we want to test and what we want to see is estrogen peaking. How much is it peaking? What about progesterone? Because frequently what will happen is in even earlier stages of perimenopause is we start to see higher levels of estrogen, but lower levels levels of progesterone. This is frequently we hear the term estrogen dominance. It's not that even your estrogen is super high, it's just that your progesterone is having a hard time keeping up with the estrogen. What I like to see is for women is if their progesterone is starting to decline, and let's say it's starting to drop below 15 nanograms per deciliter, then we want to make sure that one, we check for the ratio between estrogen to progesterone. We also want to make sure that we test their FSH and lh, because once the FSH and LH starts to rise and start to climb above 15, then it could be signs that they're potentially entering perimenopause paired with the symptoms that they're experiencing. So it's not just the labs, we want to make sure that we're also pairing it with a story, the patient's story of what their experience is like.

And what are you recommending for lab testing?

So the gold standard has always been blood, right? So that's how we can monitor treatment outcomes. Because if we do end up starting hormone replacement, we also want to make sure that we can monitor treatment effectively. I also want to pair it with potentially a urine test to see whether 24 hour cortisol levels look like. I want to see a nice cortisol curve, even if it's too high or too low or just right. We want to see their estrogen metabolites because estrogen is not the bad guy here. We want to make sure that it is getting metabolized properly by the liver because we can have cancer protective estrogen metabolites and then we can have harmful estrogen metabolites. And so a woman could have excellent levels of estrogen and we can say, oh my gosh, well, she's not estrogen dominant, most likely she's going to have a reduced risk of breast cancer. But if we look at the estrogen metabolites, she could actually be producing or breaking down the more pro inflammatory estrogen metabolites.

And is that also a blood test or are you seeing that in the.

That's a urine. That's a urine test, yeah. So it is very helpful if I were to walk women through the best testing combination is we want to do the blood test because that does give us only a one snapshot or point in time, but that's what we're going to use to monitor treatment outcomes. But then if we want to look a level deeper, we can use the urine testing to look at estrogen metabolites or. But also see what is cortisol doing throughout the day. Because unlike hormones, yes, they do fluctuate day to day. And depending on where you are in your cycle, cortisol, it fluctuates hour by hour. Not so much fluctuates, but it peaks. It's supposed to peak and then it declines throughout the day. And that's why the urine testing is really useful, because then we can see does it peak and does it decline.

Throughout the day and how would that impact your sex hormones if your cortisol was not where it needed to be?

Well, you, you know, it's the classical story of the saber tooth tiger, right? You're either running away from the saber tooth tiger or you're procreating. So if you are in a fight or flight state, Your body is going to prefer cortisol production over sex hormone production. So we produce. The majority of our sex hormones are produced by the adrenal glands and in our ovaries, when we are in a fight or flight state, our adrenal gland will always prefer the production of cortisol. That pathway gets shunted toward cortisol production. It doesn't leave much of the building blocks for progesterone, for estrogen, for testosterone. So everything gets shunted toward cortisol. And that can, and that can lead to lower than normal levels for these sex hormones. So we wanted. This is why stress, stress management and focusing on the lifestyle factors is so important in even preventing early onset of perimenopause.

Because what you're saying is really, when I started with, how do you know if it's perimenopause or stress? It could be stress creating perimenopause, lowering your hormones. Now, could you fix your cortisol and bring your hormones back up?

You know, I want to believe, yes, that, that. And, you know, so many times I read blogs and posts and about, you know, just get your cortisol back on track and your hormones will thrive. And I love those people who can accomplish that. I really do. I tried that, you know, when I went through my own hormone imbalance issues postpartum, where I was, you know, losing my hair, and my hairdresser was brutally honest with me and my esthetician was brutally honest with me, you know, saying things like, oh, you're going through puberty again, because I was having cystic acne. I wanted to fix things naturally. I was trying to fix my. I was fixing my sleep. I was eating well. I'm a naturopath. I know what to do. I, I know how much protein, how much fat I should be eating. I was doing all the right things. You, you would think that by improving my cortisol levels, my sex hormones would just, you know, would thrive, but no, it didn't happen. And that's when, after giving it a good go, a couple of years of trying to do things more naturally and improving my stress management and doing all the correct lifestyle things, it didn't move the needle for me. And that's been not only my personal experience, but also the experience that I've had with my clients and my patients is I've had over 20,000 women go through my program. So it's not just one, 10 or even 100 patients where I always say, let's try the most natural thing possible first. And if we don't see a change whether how you're feeling and or in the labs. We're going to try some other therapies. And I love it when we can do things naturally and the younger we are. I see this a lot in my 20 year olds, 20 to 24 year olds, we can still do things a little bit more naturally, but after 24, we start to include a little bit more of other therapies.

So that brings me to this question then, because I was doing a talk in Austin and this gal came up and she goes, okay, I'm doing all the things you talked about. I'm eating protein first. I'm lifting heavy weights, I'm getting my steps in, I'm getting my sleep and I'm dealing with my stress and I cannot lose this weight. You know, I went through menopause and I cannot lose the weight. I'm like, are you on hormone replacement therapy? She goes, no, I want to do things naturally. I'm like.

That'S going to be hard.

I go, I go, you've gotten to where you're going to get like, that's it. Like, go get some hormones.

Yeah, absolutely. Well, and what's interesting is that it ends up being like a vicious cycle because we know that even just going through perimenopause, women will lose about 10% of their lean muscle mass and we lose about 3 to 8% after.

But they don't have to, right? I mean, they don't have to.

And this is where, you know, one of the most common hormone myths is that we shouldn't be addressing any sort of hormone imbalances until we're in post menopause or until we're starting to have signs of declining hormone levels. And part of healthy aging and thriving into the next decades of our life is being proactive and addressing potential hormone imbalances, even if you're not feeling them. If you get a DEXA scan and you're working out really hard and you're eating your protein and you're lifting the heavy weights, but it shows that you're under muscle. Oh, my gosh. You definitely need to start looking into potential hormone imbalance imbalances that could be contributing to low lean muscle tissue.

I just think it's just like, why make this hard on yourself? You know, it's like, why you're doing everything. And we know that estrogen drops, your metabolism drops, you don't have testosterone, you have trouble building muscle and estrogen too. You'll have trouble burning fat. You know, you'll have trouble recovering from your workouts, it's like. And I think there's this idea of natural. Mike, wait a minute. We're going to do, we're going to restore our hormone levels. So when can people. Let's, let's bust the natural thing and then talk about when we really should start to think about hormones.

Absolutely. So, you know, if you look at about 100 years ago, we were lucky to live to 55 years old. We were. Women were lucky to go through menopause about 100 years ago. So when I sometimes hear questions such as, well, how did our ancestors, ancestors live and how did they make it through menopause? And I'm like, well, they were lucky to get that far, you know, and they probably, some of them didn't even experience menopause or know what it was or post menopause. And we're living longer. Let's say an average woman is living about, until about 79 years old nowadays. But are we living a quality of life? Women are two times more likely to experience Alzheimer's compared to men. So if you're thinking about we're living longer, we're denying ourselves these medical advancements that have been proven to be safe and. But then can we remember the life that we live? Can we chase our grandkids? Can we, you know, play golf, tennis, whatever, whatever it is, are we living the quality of life? It's not just longevity, but it's about the health span. And I think a lot of women have just misled. So I think it's not that they. There's a couple of things. Yes, there's this desire to do things naturally which just kind of bites us in the butt long term. But then there's this fear that's been instilled by conventional medicine with the Women's Health Initiative and the potential increased risk for breast cancer, etc. But when to drop? Not necessarily drop the natural route, but I would say when to take an integrative route. Because you're still going to be doing some things naturally. It's not just, you're just going to be plumping up yourself with hormones. That's not what we're talking about. We're talking about supplementing with hormones and not going above and beyond the super physiological doses, even if it starts to register on the labs, like, hey, you've got some estrogen, you've got some progesterone, great, we're moving in the right direction. But we start to supplement with hormone replacement when natural methods do not work. Let's say you're trying to boost your B12 levels and your iodine and your selenium to try to get your thyroid to work properly. You read somewhere that vitamins B5 and B6 improve your progesterone levels and you start taking those supplements. But guess what? You're still not sleeping well, even though you're taking magnesium before bed. You're still losing hair even though you're taking that thyroid support supplement that has iodine and selenium in it. And this is when we're like, okay, we've tried the natural route, we've done what we can. And then we introduce the hormone replacement as needed in the minimum effective dose.

I love that philosophy. That's my philosophy. We're going to talk about the, what things you can do so that you can use a minimal effective dose. But I just, you know, I think about it, Elena, and, and I've heard this about the Okinawan women that they don't really even have a name for any of this because they don't go through the big menopause thing that we go through. And you look at a lot of these cultures where they get their periods later, they go through menopause later. Menopause isn't this horrible thing. Their hormones don't fall off a cliff. And I just wonder if a lot of this is just created purely by modern lifestyle.

Absolutely. And a lot of, you know, I just, I just think about even myself and my day to day experience, right. As a, as a mother and as a business owner and as a physician. The day to day stress that I put myself through, that and my average female patient puts herself through, there is a bit of a, quite a bit of an imbalance and the demand that we have mentally, physically, that we put on ourselves in our careers, but also as parents, the schedules that our kids have. I absolutely agree with you. We do have to look into the lifestyle piece, the stress element and culturally, right, our sort of approach to work, life balance, even.

Oh, what is that?

Oh, what is that? It doesn't exist.

It doesn't exist. I think that you're focusing on one thing, then focus on the other. I'm like, it's like there is no such thing. But I do, I really love the concept. To me, this is the smart way to think of this is you do everything you can, diet and lifestyle wise, to balance yourself as much as possible. And then you use hormone replacement therapy to get yourself up to the minimum effective dose to feel good and get rid of the risk of Alzheimer's and heart disease. And you know, you look at what this stupid Women's health initiative did. Yeah, that has been so disproven, but yet still lives on. Like no big. Where are the big headlines saying the Women's Health Initiative was completely ridiculous? No, those don't come out. But you look at that and go, okay, women die the most of heart disease. We have more Alzheimer's than men. You know, then we have osteoporosis way more than men. Like, like these are the risk factors to us. And you know, and you know, hormone replacement therapy reduces that dramatically. So, you know, the idea that we can get to a point. What I don't like is the same thing I don't like with weight loss peptides. You don't give them in a vacuum any of these types of things you do with the appropriate lifestyle stuff. So let's talk about the holistic, the complimentary, the natural. Like what are the things that you're recommending so that you can use that minimum effective dose of hormones?

Yeah, absolutely. But we have to think about the building blocks. So if we think about supplements, for example, and you would agree with me on this one, we have to start with nutrition first. Right? You got to be eating right first. And how you eat should change as you go from the different stages of life. What you could get away with in your 20s is not going to work in your 30s, it's not going to work in your 40s and your 50s. It's just not smart to eat the same way that you did in your 20s. It's not going to work for your metabolism. And we don't want to just plump you up again with hormones and think that, okay, now that my estrogen progesterone is balanced, I can just eat whatever I want. No, it doesn't work that way. Right. And we're not, especially when we're in our 40s and our, in our 50s and so on. We're not trying to get our hormone levels to be of those fertile levels that they are potentially in their 20s. But so we definitely want to work on the diet piece and we're getting rid of the junk and the processed foods and optimizing our protein and fat intake. And I would suggest that people have to go on their journey of self discovery of what that magic protein intake number is, because for some people, especially if they're prone to insulin resistance, there is such a thing as too much protein. And I've seen this in my clients, especially if they have some sort of underlying hormone imbalances to begin with. Some of that protein will get converted to excess fat. And they have to be on a lower protein diet, potentially about 75 grams compared to like the recommended 120 grams as an example. So you kind of have to go on.

Okay, but wait a minute. I'm going to play devil's advocate and push back. Do it because it is very hard for protein to get converted to fat. It would get converted to glucose and then get stored as fat, but only in a caloric excess.

Right. And I'm talking about a small percentage, but of people. And this is where, you know, the type of, the type of patients and clients that I see, they are those unicorns who, when they eat protein, even higher amounts of protein, let's say about 120 grams of protein, and they are working out and they're diligent about their workout and they're doing all the right things that somehow they're gaining weight. And that's a very small percentage of people. I'm not saying that this is. Now everyone needs to go and, you know, change their protein intake. I'm just saying that those folks who are doing all the right things and eating more protein compared to, let's say, carbohydrates and fats and who are potentially gaining weight, that's a very small percentage. And you're right. I skipped that step between protein.

I was like going, wait, wait, wait, wait. Because I don't want people get so phobic about all these different foods. And I think the bigger takeaway with all of this is diets are tools, you know.

Exactly. Yes, exactly. And it's. And it's. And I'm, you know, I'm certainly not a dietitian. I can talk about the basic principles, but we want to make sure that, you know, your diet is on track and you're, you're eating free metabolism, your body type as well, as well as your lifestyle, different lifestyle factors. But when we think about supplements, for example, the basic foundational supplements that women should be on is we want to make sure that we have a good multivitamin. And I would recommend that women test their vitamin D, their iron levels, copper levels, B12 levels as well, just to make sure that we get the right multivitamin on board. Because some women in perimenopause and even post menopause can be a little bit more on the anemic side for whatever reason. Could be absorption issues. Some people blame it on the parasites. I don't want to go down that.

Today we'll never get out of that.

Hole yeah, we're not going down that rabbit hole, but we want to make sure that we test our basic nutrient levels and get on the right multivitamin.

All right, well, you're saying you said D B12 copper. I'm assuming you also would want iron in there, looking at those levels. But talk like we've actually never brought up copper. And I think it's interesting, especially in light of people having been on birth control pills. So talk about copper and what way you're having them test those levels. Yeah.

So it's interesting because a lot of times when I test women who've been on either oral contraceptive pills or IUDs, what I'll notice is depending on the birth control, they can store excess amounts of iron and their ferritin will be elevated and their total iron stores will be elevated. And the reason why I want to test their copper levels is potentially that creates an imbalance between iron and copper. And sometimes we see their copper levels tank. So there's an imbalance between copper and iron. Sometimes if they're depleted or deficient in iron, we test their copper levels and their copper levels are through the roof. And then we start looking at, do they have Wilson's disease as an example. These are a lot of things that just don't get talked about.

Yeah.

With their primary care physician or their OB gyn. And so what I want to make sure is that we're then not causing any sort of organ damage. Right. As it creates the spleen or the liver. Because I want to make sure that people are healthy and that they're going to live a long and healthy life. And so we just want to make sure that before we get on any multivitamin that we know those basic nutrient levels. Because for a lot of women, they're can be an imbalance between their iron and their copper, depending on what the birth control is doing to their iron levels. The holidays are all about family, but at the Chrysler wrap of the year sales event, it's all about you. Enjoy every mile in the most awarded minivan in America, the Chrysler Pacifica. With the most standard safety features in its class. Available Stow N Go seating and the available Stow n Vac built in vacuum. Make the most of the holidays with a great, great deal at the Chrysler Pacifica. Wrap up the year sales event based on Ward's small van segment. Based upon the latest available competitor information, Chrysler is a registered trademark of FCA US llc.

And do you find that a vitamin D can be done in a multi or are you Doing it separately.

So it will depend on the patient's vitamin D stores. So if someone just needs a maintenance, if someone just needs to maintain their vitamin D levels, usually a multivitamin will also have some vitamin K in it. And that's what's really important to consider is we don't want to just be taking vitamin D because then it's going to get absorbed in all the wrong places. And then vitamin K will help us get it to where it needs to be, which is our bones. And so usually just a basic multivitamin will have a good proportion of both vitamin D and vitamin K. So I'm not worried about that. However, if someone is really depleted in vitamin D or someone who constantly smothering themselves with sunblock for all the right or wrong reasons, I might put them on an extra vitamin D supplement, maybe 2000, maybe 5000 AU. But I want to make sure that it's paired with vitamin K. Yeah.

And that's to get calcium to be in the right places.

Absolutely, yeah. Because otherwise it can get stored in the blood vessels.

And then there's a very important thing that people miss.

Yeah, yeah.

So other than that, any, any herbs that you see that are working.

Well, let me, let me back up a little because we talked about the multivitamin. And the multivitamin is really important because a lot of the nutrients in the multivitamin, they are present in a lot of the enzyme reactions that help us in the creation or the production of neurotransmitters and as well as hormones. And that becomes really important because especially with birth control, it has a tendency to deplete us of many of these nutrients. And besides the multivitamin, magnesium is really important for women as well. It's important for brain health. We talked about stress management. Even though work life balance doesn't exist, magnesium can help us sort of pretend that there's a work life balance, but it can also help us with our bowel function.

Right.

So it can help us with sleep. So magnesium is really essential for women as well. Probiotics. You know, we talked a little bit about postmenopausal women and difficulty losing weight. It's really important to potentially do a gut test to see what the microbiome imbalance is, because we know from different studies that Eckermansia bacteria, for example, can support proper insulin sensitivity and glucose metabolism. And so before you start supplementing with Lactobacillus or Bifidobacterium or even Akkermansia or started loading with prebiotics, you know, getting A nice gut test can be helpful to decide what probiotic is beneficial for.

You in the first, which gut test do you love?

I like the GI map. I think it's pretty straightforward. It's really generally easy to understand, really quick to go through. It gives you a nice overview of the pathogenic opportunistic bacteria, really nice to see the inflammatory markers and if you really need the digestive aids. So I think it can be a really nice compass for what sort of digestive support someone might need.

And do you use that all to kind of get an idea of estrogen detoxification or are you doing that all off the urine tests?

Yeah. What's interesting, so I've compared estrogen metabolites and estrogen levels and I mean estradiol and estrone when I say estrogen levels to the microbiome. And what I look for is the Bacteroide species, which is sort of estrobolome and can affect, you know, if you have too much of that Bacteroides firmicutes type of bacteria, then technically you could be a little bit more on the estrogen dominant side. And it's hard for me to tell because again, like after, with a number of thousands of women that have seen through my practice, sometimes it adds up and sometimes it doesn't. And so I have to go off of more of the urine test and what's happening with the estrogen metabolites. Now if someone is not having proper bowel function and their estrogen metabolites are also pro inflammatory, they're producing more of those pro inflammatory estrogen metabolites. That's the first thing we're going to do. We got to make sure that you're eliminating every single day. Right. But we talked about the multivitamin. Also mentioned vitamin D, magnesium. Fish oil is extremely important. A lot of women with hormone imbalances will complain sometimes of joint pain or musculoskeletal pain in general, things like even fibromyalgia. So fish oil becomes really important, really also really important because our brain is predominantly made up of fat, right. So we need those healthy omega 3 fatty acids. And I like to dose my fish oil so that women get at least about 2 grams of EPA and DHA. Total, not total Omegas, but total EPA and DHA. So those are the main supplements that I would consider. And then you asked about the herbs and I actually would put herbs into the specialty category. So we have our foundational supplements, but then the herbs are part of that specialty, the next level up, because someone might need adrenal support. And this is where maybe we need a little bit of radiola, depending on their cortisol levels. Maybe we need a little bit of cortisol mushroom or reishi mushroom. Maybe we need some holy basil. It just depends on the patient profile. Are we wired? But tired? Do we wake up feeling tired in the morning? Can we fall asleep at night? So herbs would go more in that specialty category. And some women, especially in perimenopause, will benefit from herbs like Vitex. If they're a little bit low on estrogen and progesterone, they may benefit from just wild yam, which has more phytoprogesterone like properties. So it's not going to increase your progesterone levels, but it's going to at least stimulate those progesterone receptors. And you know, I've been on different podcasts and every once in a while there'll be an MD ob, GYN who hop on and comment that, you know and laugh at wild YM and laugh at Vitex. But I have to say that for women who are especially sensitive to hormone replacement, a little bit of wild YM can go really, really far, a really long way. And it can be sort of our introduction to even hormone replacement because we can gently stimulate those hormone receptors so that your body doesn't completely freak out when it starts to see actual hormones.

It seems like a good step into before you need hormone replacement therapy. Like I was able to use those things first. Yeah, well, I wasn't. It was like, okay, these are great. Okay, now they're not, you know, 100% like.

And they might be helpful to a certain extent. Like for, for some women, maybe they're having less painful menstrual cycles or it helps with their cycle regularity. Especially if we're in our 40s and kind of in the mid to late stages of perimenopause. It might help with the like black co host. Right. Can be used to help with that. Some of the night sweats and hot flashes. But then it's not really working.

Yeah, it's like, it's like, it's good, it's good, it's good, it's gone. It's like what happened.

Exactly. Yeah.

Right.

So we have like the diet, lifestyle supplements, then using herbs and then when those herbs start to fade out, adding in hormones. What about peptides?

I love peptides. I love, love, love peptides and.

Well, first of all, let's talk about what they are just in case someone's like, what what are you talking about?

Well, and peptides are basically amino acids, right? So collagen, the collagen that people add to their matcha or lattes in the morning is made up of amino acids. And depending on that amino acid configuration, you'll have a different peptide. So insulin is a peptide, has a certain, made up of certain amino acids. Fatty acids. What am I even talking about? A different amino acid configuration. Growth hormone is a peptide, it's a hormone. Peptide also has a different amino acid makeup. And just like hormones, they're signaling molecules. What's interesting about peptides is they do different things in our body depending on their formulation. So growth hormone, it's super important in collagen synthesis. So you can take collagen, but if you don't have optimal growth hormone levels, chances are you're not going to be generating, creating collagen to the same extent that you would when you were like 24, for example. Our growth hormone production starts to decline after the age of 24 and actually some people will say around the age of 20 and it declines by 15% every decade. We don't really have that much growth hormone left by the time we're in our 60s and our 70s, for example. Growth hormone, really important for connective tissue. So ligament, tendon, muscle mass. BPC157 is another really important peptide that's also very important for even connective tissue regeneration, but especially gut health, also tendon, ligament injuries. There's so many different peptides and they all target different systems in the body. There's some peptides that are really great for skin. There are some peptides like Thymus and beta 4 and Thymus alpha 1. They're immune modulators or regulators that have anti inflammatory properties. A lot of the peptides and peptide hormones we actually produce on our own. And just like with everything else, it's not just hormones that decline. Our own peptide and hormone peptide production declines as well. So when I think about women's health and hormones, I don't just think about estrogen. Progesterone, poor testosterone has just been left in the dust. And that's, I would consider even testosterone to be even more important than estrogen to some extent. But since we're talking about peptides, we can't talk about aging well without talking about peptides because that ends up being the missing link. So when I'm thinking about the pyramid, the classical way of thinking through things is through a pyramid we have our foundation, the diet, the lifestyle, the lifting weights, the proper supplements. Then we have our Herbs. We're getting more into the specialty. Maybe we need some turmeric to control inflammation, a little bit extra fish oil. Then we have the hormone replacement piece, and then we have the peptides. And that's the pinnacle of the pyramid, as I would see it. And some people would go as far as introducing stem cells and exosomes and all that other fancy stuff. But we can do a lot with just hormone replacement paired with peptides. And I call peptides that cherry on top of a sundae.

Which one specifically are you using the most in your practice with peri and postmenopausal women? Yeah.

So the FDA has made it a little bit more challenging recently. I know, I'll just start there.

Let's just say, if the FDA wasn't involved and you could get your hands on whatever you wanted, which ones would you be using?

Yeah, well, the good thing is that the ones that I use are still the ones that they've been sort of grandfathered in, thank goodness. The nice thing is that even like BPC157, one of the pharmacies I use, they've been able to compound with another peptide that the FDA seems happy about, and we can use that. So I use a lot of BPC157 for gut health, for hair, for skin, for nail health, collagen regeneration. I use a lot of Sermorelin. And women. So this is a growth hormone releasing growth, growth hormone releasing hormone, which stimulates your own production of growth hormone. And why do I use this? So for two reasons. One is if women have a hard time producing growth hormone on their own, let's say that they test their IGF one and it's below 120 and. Or they are potentially maybe low normal or normal growth hormone levels, but they have all the classical signs of low growth hormone, which is potentially hair loss, trouble sleeping, even though they might be doing hormone replacement already, trouble gaining lean muscle mass, or a hard time recovering from injuries, or hard from recovering from their workouts, feeling exhausted the next day, more than usual. I also use a lot of Tesla Marellin, which is another growth hormone releasing hormone. It is more powerful. It is sort of the elite of the growth hormone releasing hormones. You get more growth hormone release. It's also very effective at reducing visceral fat, and that's stubborn abdominal fat. So you're doing all the right things. You know, you're shrinking fat everywhere, you're building muscle, but that stubborn belly fat is not going anywhere. Enter Tessa Marellin. A bit more expensive, but really does the trick. To the point where women start to notice an improvement in their visceral fat and abdominal fat reduction within two to three weeks of starting on it. And then, of course, they use a lot of the GLP1 and gap agonists like semaglutide and tirzafatide or Mounjaro as needed. So whenever someone calls my clinic and is like, hey, a girlfriend of mine lost weight and she was on semaglutide. Can I get some? No. I won't even return a phone call because I never put anyone on any of those weight loss peptides unless they've gone through the process. The patient needs to prove to me that they've done all the right things. I need to see a DEXA scan. I want to make sure that their hormones are balanced. And then after we've done that work, like, okay, you know what, let's do this. Because clearly we're not going to be able to do this on our own.

I love that you're using it that way. There was a great talk by Ashley Koff and Dr. Darshan Shah in New York and what they do when they're going to put someone on one of the weight loss peptides and how they monitor. And I was like, these drugs wouldn't be getting a bad rap if everyone was treating them this way.

Absolutely.

You know, I hear Dr. Tina Moore talking about how she microdoses them, and I go this, like, there's amazing applications for these drugs, and they're getting a bad rap. And the funny thing is they get a bad rap for causing muscle loss. But when you look at a poorly designed diet, it causes muscle loss. So all it is is that you have people putting someone on using a weight loss drug without giving them the right diet and exercise routine. And so they're having side effects. Sex, you know, like, there you go, you know, don't do that.

Yeah. Or, you know, even an average postmenopausal woman, let's say I. I see, for example, two patients come to mind that I saw recently, 53, 54 years old, have never had their hormones evaluated by their primary care physician or their OB gyn, never had a DEXA scan, not even a body composition, but a bone density scan comes in and has osteoporosis and osteopenia. These women who get and is overweight, so these women get put on these peptides for weight loss, and they end up getting even more bone softening or increased risk of bone fractures because we're not monitoring their bone density. We're not Monitoring their muscle mass and at least support outcomes. And then. And then we're outraged. Right. That this is what we see. Well, nobody was testing this in the first place.

Right.

Yeah. So we need to have a good baseline before introducing those things.

Yes. I love that you brought up a dexa. Gosh, I just hope that becomes standard of care.

Like, you know, I saw this post and I shared it on my Instagram platform because you said it so perfectly. Women generally are scared of stepping on the scale because of the number that they see, whereas that number is simply a data point. It can tell you if you gain five pounds overnight, that there's something wrong that shouldn't happen. For example, it's a clue whether or not you're moving in the right direction or not. Some of my patients, they would be scared to get a DEXA scan because of what they would see.

Right.

Potentially higher fat percentage than they. They. They want to acknowledge or a lower muscle mass percentage than they want to see. And there's a little bit of counseling around that that we have to do, which is. It's a number. And we have to. We have to know what that data point is in order to understand do we need the peptides, do we need the hormones, do we need to change protein fat intake, what is that we need to do? Now, if we have that same approach when we're looking at our bank account, we're in real trouble. Right. Because then we're having other issues.

And I love that you correlated to that, because that's how I look at. I look at all of this the same way. No one would sit there and go, okay, I'm going to look at my bank account and with one eye closed. Yeah. And like, no, you know what? You measure and monitor, you can improve. And when you really look at this improving, you improve your body composition, everything changes. And we really have to think of it just like we're investing, you know, for retirement. We're investing for retirement by. By putting on muscle, you know, but you can't tell that from a scale. You have to be able to look at your body composition. Otherwise you have no idea what's shifting in your body. And so we've got, like, I can't believe in 2024 that you go to a doctor and they still put you on a regular scale. And I keep. When I go into the doctor and they put me on a scale, I just wonder, what are they looking at that for? What. What information did you just get from that?

You know, I just, I just recently had a Patient reach out to me. And she was about five pounds heavier. So she was 125, and she went up to 130. And she said, you know, I'm concerned about this weight gain, even though my clothes are feeling really good and I'm feeling extremely strong. And her previous DEXA body composition analysis showed that she was about 30% body fat. And when we did the repeat of the. Of the DEXA scan, you know, she went down to, I think it was like 25 or 24% body fat, and she gained muscle. And she went from being sort of worried and concerned to so happy that she did this test because it showed that she was actually moving in the right direction.

Yeah, it's such a reframe. It is so important. We've got to look beyond weight to what that weight is made up of. We've got to hold on to and build muscle. That is it. That is your retirement account. It is super important. You cannot tell it from the scale. And we women are so wacky that we can say, my clothes are fitting better. I'm stronger. I look better. My weight went up. Oh, my gosh. You know, I'm like, you know, this is like old conditioning that just won't suit. Seem to die. It's sort of like the Women's Health Initiative.

As you were saying. I was just thinking about that. We have it ingrained in our amygdala that hormones are bad, that estrogen is bad, that hormones cause cancer, that your BMI and your weight is a sign of good or poor health. And those are just the things that I think have been collectively as a society and culturally carried on for decades, and that we just need to start breaking away from that. It's sort of like, eggs are bad. Eggs are not bad. Cholesterol is not bad. It's all in the framework that we see it and then the context in which we see it.

And calories aren't bad. I literally. I had someone DM me and go, well, Dr. Neal Bernard says, don't eat wild salmon because it's 40% fat. And I go, wait a minute. You know, it's nutrient calorie dense. I go, a, we need calories. Without them, we die. B, that's amazing. It's 40% fat from wild. From omega 3s. What am I missing? Am I missing something? She's like, oh, you know, this is the stuff. So there's. We have a lot of work to do. Thank you for being out there doing the good work. And I know you have a guide for Everybody that we are going to put@jjvirgin.com Dr. Elena D R E L E N A what's in the guide that they're all going to get?

Yeah, so in this guide it is a list of the most common hormone markers that every woman should get tested. So this is a great thing to print out and maybe take to your doctor to see if they're open to testing these lab markers. Don't be surprised if they say no.

And then you find a new doctor.

And you find a new doctor. Simple as that. You know, people get married to doctors and I'm like, no, don't do that. You know, this is the you can go on to institute functional medicine website or the American association association of Naturopathic Physicians and find a new doctor, interview your doctor. But this is the baseline. This is the hormone baseline that we need to test. And there's a few nutrients listed on there as well.

Awesome. That's fantastic. Okay, I've got one more question for you. Just some 40 plus brilliance, even though you're not quite 40. So you're gonna have to go into your future self here, but you can. This one I picked, I picked one that you can do as a not qu40. What is one urban legend out there in the health and wellness space about getting older that you would love to bust.

That we need to suffer as we age. That because we don't need to suffer, we don't need to have poor heart health, we don't need to suffer from memory loss because people have normalized. Oh, you know, I forgot. I can't forget. I can't remember that person's name or I forgot my keys. That's just, that's just age. And that's just something. All those signs and symptoms that we don't have to deal with, that as we get older, we can thrive.

Amen. I know I caught a friend. I was at an event and one of my buddies was like, oh yeah, it just sucks getting older. I go, oh my gosh. Cancel, cancel. Aging is a privilege and aging well is a choice. Choose wisely and knock that verbiage out. He's like, oh, you're right.

Absolutely. I 100% agree.

All right, so again, JJ virgin.com forward/doctor Elena. And thank you so much for busting these myths and giving us so much great information today. I appreciate it.

Thank you so much.

Be sure to join me next time for more tools, tips and techniques you can incorporate into everyday life to ensure you look and feel great and are built to last. Check me out on Instagram, Facebook and my website jjvirgin.com and make sure to follow my podcast@subscribetoj.com so you don't miss a single episode. And hey, if you're loving what you hear, don't forget to leave a review. Your reviews make a big difference in helping me reach more incredible women just like you to spread the word about aging powerfully after 40. Thanks for tuning in and I'll catch you on the next next episode. Hey JJ here. And just a reminder that the well Beyond 40 podcast offers health, wellness, fitness and nutritional information that's designed for educational and entertainment purposes only. You should not rely on this information as a substitute for, nor does it replace professional medical advice, diagnosis or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional. Make sure that you do not disregard, avoid or delay obtaining medical or health related advice from your healthcare professional because of something you may have heard on the show or read in our show notes. The use of any information provided on the show is solely at your own risk.

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