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Why Women Spend the Last 5–6 Years of Life in Worse Health Than Men (And What to Do About It) · The LIVING Room Podcast | Inside The WNDR Lab

0:00
SPEAKER_01: Ovaries are like a second brain.
0:02
SPEAKER_01: They talk to my heart, my bone, my muscle, my brain for sure, my liver.
0:08
SPEAKER_01: Almost every tissue in the female body is somehow connected to a brain signaling.
0:12
SPEAKER_01: The messages that ovaries are the architects of health and female bodies and also the peacemakers for aging.
0:17
SPEAKER_01: And so reproductive aging is really just intrinsic aging in reproductive organs that impairs fertility or the country, or really just basically impairs your ability to reproduce.
0:27
SPEAKER_01: Aging in ovaries drives aging in the rest of the body.
0:30
SPEAKER_01: For women, understanding what your normal is across time is probably the most important and most powerful thing that you can do.
0:37
SPEAKER_01: Women are desperate for answers.
0:39
SPEAKER_01: How and why do ovaries age faster?
0:42
SPEAKER_01: That's the key question for female health.
0:44
SPEAKER_01: The idea that female bodies are noisy or that our cycles make things difficult to interpret, that's just bullshit.
1:04
SPEAKER_00: Jen, welcome.
1:05
SPEAKER_04: Thank you.
1:06
SPEAKER_00: So I wanted to start today with just some very high-level statistics that I'd love you to tell me if they're correct or not, because this is kind of frightening.
1:16
SPEAKER_00: Um only around eight to nine percent of NIH research funding is dedicated to women's health research.
1:23
SPEAKER_01: Correct.
1:24
SPEAKER_01: That's correct.
1:25
SPEAKER_01: Yeah.
1:25
SPEAKER_00: Eight to nine percent.
1:27
SPEAKER_01: Somewhere, you know, it hovers, it changes every year, but it hovers around 10%.
1:31
SPEAKER_00: Only 5% of health RD funding goes to women's health.
1:36
SPEAKER_01: I yes, I might even say 4%.
1:39
SPEAKER_01: Yeah, that's correct.
1:40
SPEAKER_00: And of that, it says here 4% goes to women's cancers, just 1% towards all other female specific conditions, menopause, endometriosis, PCOS, and infertility.
1:50
SPEAKER_01: Well, it depends on uh it depends on which funding you're talking about.
1:53
SPEAKER_01: So if you're talking about private investment, um it's uh for the last five years, so you have to look at the historic data, for the last five years, that's a you know, uh approximately in the ballpark, um, something like uh 4% of all the investment has gone to everything except female cancers, fertility, and maternal fetal health.
2:18
SPEAKER_01: So that means that more than 95% of the investment has gone to those three areas and everything else, quite literally everything else related to women's health is is in that little tiny bucket.
2:30
SPEAKER_00: I mean, help me and the audience understand why that might have happened.
2:35
SPEAKER_01: I mean, okay, well, I think I think at this state at this stage of the game, we're all uh familiar with the historical bias in research in terms of like sex bias towards male systems, um like historic underfunding, right?
2:50
SPEAKER_01: So the underfunding really leads to this massive gap in data that we have.
2:54
SPEAKER_01: And I I think that, you know, until recently there was a real taboo around talking about female bodies, right?
3:00
SPEAKER_01: We didn't talk about pregnancy, we didn't talk about menstruation.
3:03
SPEAKER_01: You know, certainly from my mother and her mother talking to her, would never have talked about, you know, any of these things.
3:11
SPEAKER_01: And so that's changed and um everything is changing in a positive direction.
3:14
SPEAKER_01: But and I would say, I I like to um a dear friend, uh CJ Jenkins likes to say, let's stop admiring the problem and actually just like fix it.
3:25
SPEAKER_00: Deal with it.
3:26
SPEAKER_00: Yeah.
3:26
SPEAKER_00: Are we just are we playing catch up now?
3:28
SPEAKER_00: Do you think?
3:29
SPEAKER_01: I would say we're generations behind where we need to be.
3:33
SPEAKER_01: Wow.
3:33
SPEAKER_01: So we're missing an extraordinary amount of data on female bodies.
3:37
SPEAKER_01: I'd like to call it a puzzle that we haven't yet solved.
3:40
SPEAKER_00: Does that have anything to do with it being more complex to study?
3:45
SPEAKER_01: I wouldn't say that it's more complex.
3:47
SPEAKER_01: So you know, if you look at um, there's a couple, and again, like direct comparisons are hard because we have a lot of data on male bodies and not so much data on female bodies.
3:56
SPEAKER_01: But if you look, for example, at uh neuronal imaging, so Emily Jacobs did this amazing set of studies where she followed a woman across her menstrual cycle.
4:06
SPEAKER_01: So every single day she took a brain scan um and she took blood and measured hormones.
4:12
SPEAKER_01: And she did that across several different cycles for one person.
4:15
SPEAKER_01: And uh the study was called 28ME.
4:18
SPEAKER_01: And it was it was like a landmark study.
4:20
SPEAKER_01: And it's true that across a cycle, you know, your hormones shift and your brain activity shifts.
4:26
SPEAKER_01: And it was beautiful.
4:27
SPEAKER_01: And she's now like doing this much larger scale study with hundreds of women across multiple different sites.
4:32
SPEAKER_01: It's incredible across pre-menopause and menopause, really important research.
4:36
SPEAKER_01: But she did something that I think a lot of people don't know, which is that she did then the same thing with a man and followed a man across, you know, a month and looked at brain activity and hormone fluctuations.
4:49
SPEAKER_01: And there's just as much flu, there's just as much dynamic fluctuation in males as in females.
4:54
SPEAKER_01: The difference is the time scale, yeah, the regions of the brain, the hormones, all of it.
4:58
SPEAKER_01: It's all different, but you know, the amount of variability is the same.
5:03
SPEAKER_01: And um the idea that like female bodies are noisy or that our cycles make things um difficult to interpret, that's just bullshit.
5:13
SPEAKER_01: Like, and and we have data in animals to show that that's true too.
5:16
SPEAKER_00: So is the fluctuations in males like intra-daily?
5:20
SPEAKER_01: Yeah, there's they're much more like like they're they're much bigger on like a circadian tensor.
5:24
SPEAKER_00: Just as complicated then.
5:26
SPEAKER_00: It's just as complicated.
5:26
SPEAKER_01: Yeah, it's just different.
5:28
SPEAKER_01: And so yeah, the the idea that that female bodies are are somehow more complex.
5:33
SPEAKER_01: They are complex.
5:34
SPEAKER_01: Like female physiology is complex, but human physiology is complex, right?
5:38
SPEAKER_01: The the the the distinction is that we need to acknowledge that male and female bodies are different.
5:43
SPEAKER_01: Like every cell in your body has a genetic sex, right?
5:47
SPEAKER_01: And and and every cell in your body is is, you know, that matters.
5:52
SPEAKER_01: It matters like in terms of what genes are expressed and and and how your physiology functions.
5:57
SPEAKER_01: It's just, it's, you know, it's just not, it's knowable.
6:00
SPEAKER_01: We just haven't looked.
6:01
SPEAKER_01: Yeah.
6:02
SPEAKER_00: Yeah.
6:02
SPEAKER_00: We're just catching up.
6:04
SPEAKER_01: We're just catching up.
6:04
SPEAKER_01: Yeah.
6:05
SPEAKER_00: Can we talk um about specifically about what you're studying now and what what you have been studying for someone uh who has no idea, what would be like a a 60-second version of what you've been studying in the lab?
6:22
SPEAKER_00: And then let's unpack that because it's astonishing.
6:26
SPEAKER_01: Oh, you're very kind.
6:27
SPEAKER_00: I think so.
6:28
SPEAKER_01: Uh well, thank you.
6:29
SPEAKER_01: Um, I I mean, I think all science is really cool.
6:32
SPEAKER_01: So uh I'm a neuroscientist by training.
6:35
SPEAKER_01: And so um what we studied in my lab was um how the brain communicates with the rest of the body outside of synapses.
6:44
SPEAKER_01: So synapses are just like physical connections between two neurons.
6:48
SPEAKER_01: Um and that's what most people picture when you talk about neuroscience.
6:51
SPEAKER_01: They like they see this like this weird little button structure.
6:55
SPEAKER_04: With a little gap in the middle.
6:56
SPEAKER_01: And a little gap in the middle and little molecules going back and forth between them.
6:59
SPEAKER_01: So that's synaptic signaling, and that is like I would call that wired signaling.
7:03
SPEAKER_01: So in your body, like we have wired signaling that's like hardwired, and those are nerves, right?
7:08
SPEAKER_01: We call them nerves.
7:09
SPEAKER_01: Uh and that kind of signaling is super fast, like on the millisecond time scale.
7:13
SPEAKER_01: And it's also mediated by just like about a dozen different chemicals, neurotransmitters, most of them you've probably heard of, things like GAPA and glutamate and serotonin and dopamine.
7:23
SPEAKER_01: And um, that is not what I'm talking about.
7:26
SPEAKER_01: So, what we are studying is um is is the Wi-Fi signaling that your brain has.
7:32
SPEAKER_01: So, your brain can communicate with the tissues in the rest of your body, and it's a bi-directional conversation, but your brain can talk to other tissues without any physical connections.
7:44
SPEAKER_01: So, over long distances, over long timescales.
7:47
SPEAKER_01: And um, essentially your brain is making like rich use of hundreds, thousands of different kinds of signaling molecules, certainly those small molecule neurotransmitters that we just talked about, but also bioactive peptides, um, lipids, proteins.
8:04
SPEAKER_01: There's just a whole host of different signaling molecules that can mediate this conversation.
8:09
SPEAKER_01: And um, when I started my lab, there was this really interesting piece of data that had just come out from several different groups, which essentially showed that, you know, with aging, you know that inflammation goes up in your body everywhere with normal aging.
8:23
SPEAKER_01: And in your brain, it's not uniform.
8:25
SPEAKER_01: So it happens in like particular hot spots.
8:27
SPEAKER_01: It's not happening everywhere all at once.
8:29
SPEAKER_01: It's like particular regions of the brain.
8:31
SPEAKER_01: Yeah, particular parts of your brain get like these incredibly like elevated levels of inflammation with age.
8:38
SPEAKER_01: And um one of those hot spots is hypothalamus.
8:42
SPEAKER_01: And hypothalamus is the part of your brain that governs like all of the homeostatic systems that keep you alive.
8:48
SPEAKER_01: So things like body temperature regulation, um, energy, fluid homeostasis, like the ways that your circadian rhythms work.
8:59
SPEAKER_01: And so, you know, your body sets these levels, you know, that are pretty narrow in terms of the ranges.
9:05
SPEAKER_01: If you go outside of these ranges, you die.
9:07
SPEAKER_03: Yeah.
9:08
SPEAKER_01: And so the systems to keep you like inside that that narrow range that will keep you alive are pretty robust.
9:14
SPEAKER_01: And hypothalamus is right when I, you know, a neural circuit is a bunch of different parts of your brain that talk to each other to control something.
9:21
SPEAKER_01: Hypothalamus is like command central for all of those homeostats.
9:25
SPEAKER_01: And it is also a place where um it uses this kind of Wi-Fi signaling a lot.
9:31
SPEAKER_01: And it happens to be a hot spot where inflammation goes up with age.
9:35
SPEAKER_01: And so what we, what we, what we posited in my lab was that maybe that age-related increase in inflammation in that particular part of the brain dysregulates that Wi-Fi signaling, that chemical conversation between the brain and the rest of the body, and that that might be one of the first dominoes to fall with respect to systemic aging.
9:54
SPEAKER_01: And I'm not talking about diseases of aging, I'm just talking about normal aging.
9:58
SPEAKER_04: Yeah.
9:58
SPEAKER_01: And so what we spent, you know, the better part of a decade doing was trying to develop tools to measure these signals, um, because gene expression doesn't really tell you about this.
10:09
SPEAKER_01: And um, and then to figure out what changes with age and whether or not we could, you know, find things that changed and use those as, you know, particular levers for intervention.
10:19
SPEAKER_03: Yeah.
10:20
SPEAKER_01: And um about eight or nine years ago, we were hunting down, like we had found something that changed with age, seemed really promising, and we were trying to figure out how it was working.
10:31
SPEAKER_01: Like what was it doing?
10:33
SPEAKER_01: Um, and it turned out to be working through the reproductive system.
10:36
SPEAKER_01: And so that was what led us kind of to take like a left turn in the research and and really delve into female physiology.
10:43
SPEAKER_01: I hadn't honestly, I had not thought about female bodies too much before that, even though I happened to own one.
10:50
SPEAKER_00: Yeah, you do, yeah.
10:51
unknown: Yeah.
10:51
SPEAKER_00: And so what did you find?
10:53
SPEAKER_01: Well, what I found was what you started with, which is that we really genuinely don't understand how female bodies work.
10:59
SPEAKER_01: And I mean, honestly, I was um I was I was about your age, I was in my early 40s, and um I was very early 40s.
11:09
SPEAKER_01: I was about 40.
11:10
SPEAKER_01: Okay.
11:11
SPEAKER_01: I think it was 40, 40 or 41.
11:14
SPEAKER_01: And I um yeah, I mean, I was embarrassed.
11:17
SPEAKER_01: Uh I was really like kind of shocked and embarrassed at how little I knew about how my own body worked.
11:21
SPEAKER_01: Like I had not thought for I just had not considered anything related to my physiology except for, you know, like once a month when I had my my period of whether or not I was having, you know, cramps or if it was interfering with my life, you know, as a as kind of like a nuisance.
11:39
SPEAKER_01: And and I had thought about it with respect to whether or not I wanted to have kids.
11:43
SPEAKER_01: That's it.
11:44
SPEAKER_01: I had not like it had not crossed my mind for any other reason.
11:47
SPEAKER_01: And it had never all been brought up to me either by any of my physicians.
11:51
SPEAKER_01: So yeah, I was embarrassed.
11:53
SPEAKER_01: And then I was, I called the four stages of grief.
11:56
SPEAKER_01: And I think every woman of a certain age goes through this like embarrassment at how little you know about your own body, then like shock and horror once you go to try to learn some things and then realize like how little there is to know.
12:10
SPEAKER_03: Yeah.
12:10
SPEAKER_01: And then um, for me, like abject rage at why that is.
12:17
SPEAKER_01: And then um, I think most women come around to this point where it's like, okay, like roll up your sleeves and let's fix this.
12:24
SPEAKER_00: Right, all right.
12:25
SPEAKER_01: So that's where I've been for the last eight or nine years.
12:27
SPEAKER_00: I think one of those big sh like shocking facts for me especially, but I suspect for everyone or the majority of people listening is that this that we've conflated this idea of ovarian function aging health with but reproductive function aging.
12:48
SPEAKER_01: Ah, yes.
12:48
SPEAKER_01: This is uh this is an important pu this is something that a lot of people get wrong, and not because people don't talk about it.
12:55
SPEAKER_01: Yeah and because you know, I didn't know this when I started working in the field, and it's something that I came around to.
13:00
SPEAKER_01: And I think at the beginning I also conflated ovarian aging and reproductive aging.
13:05
SPEAKER_01: Um, but the idea is simple.
13:08
SPEAKER_01: It's that ovaries in a female body are essentially like the architects of health.
13:14
SPEAKER_01: So ovaries are like a second brain.
13:18
SPEAKER_01: They are also sitting at the center of a really complicated signaling network that is making and utilizing this kind of Wi-Fi signaling, just like your brain.
13:27
SPEAKER_04: Yeah.
13:27
SPEAKER_01: And so ovaries in female bodies are talking to almost every tissue.
13:31
SPEAKER_01: They talk to my heart, my bone, my muscle, my brain for sure, my liver.
13:37
SPEAKER_01: Like, you know, almost every tissue in the female body is somehow connected to everyone's signaling.
13:43
SPEAKER_01: And, you know, we don't understand those chemical conversations.
13:46
SPEAKER_01: We don't even know all the words yet, much less how individual conversations are happening.
13:52
SPEAKER_01: But what we do know is what happens when you take ovaries away or when they're not functioning properly.
13:58
SPEAKER_01: And in so what we can discern from that is that ovaries are essential for health at every age.
14:06
SPEAKER_01: So not just at midlife and beyond, but in, you know, girls who are 10 and women who are 80.
14:13
SPEAKER_01: And what we can say for sure is that if ovaries aren't working properly at any age, it uncovers different health risks.
14:20
SPEAKER_01: So if you're a girl who's 10 and your ovaries aren't working properly, you might have issues going through puberty.
14:26
SPEAKER_01: Or if you've already gone through puberty, you might have um, you know, challenges with irregular periods or, you know, problems with acne or all kinds of things that are completely different from the health risks that are uncovered if your ovaries aren't working in your 20s.
14:40
SPEAKER_04: Yeah.
14:41
SPEAKER_01: And um you can step through, and it depends entirely on who you are as an individual.
14:45
SPEAKER_01: So, like, how old are you?
14:47
SPEAKER_01: What are your genetic risk factors?
14:48
SPEAKER_01: What environmental exposures have you had?
14:50
SPEAKER_01: And so you can step through adult life and you can look at like what happens if ovaries aren't working properly.
14:57
SPEAKER_01: And so, you know, in like 20s and 30s, if your ovaries aren't working properly, one of the outcomes there is that you have potentially issues with fertility.
15:06
SPEAKER_01: And so that's something that we've hyper-focused on because it's clearly very important.
15:10
SPEAKER_01: Um, and of course, at and after menopause, when ovaries stop working the way they were before, they don't stop working entirely.
15:16
SPEAKER_01: It's it's that's a myth.
15:18
SPEAKER_02: Yeah.
15:18
SPEAKER_01: Um, but when they stop working the way that they were before, that really um changes your health risks and it changes dramatically, like your risks for cardiovascular disease and osteoporosis and all kinds of other things, autoimmune disorders.
15:31
SPEAKER_01: And so, you know, the the message is that ovaries are the architects of health and female bodies and also the the pacemakers for aging.
15:40
SPEAKER_00: I just think it's fascinating because it's not something we get taught.
15:43
SPEAKER_01: Yeah.
15:44
SPEAKER_01: And you asked the question you asked that I'll come back around to is um what's the difference between reproductive aging and ovarian aging?
15:51
SPEAKER_01: And for me, it's just this idea that reproductive aging is like intrinsic aging in reproductive organs.
15:58
SPEAKER_01: And in the case of ovaries, you know, they're aging faster than the rest of the tissues in the female body.
16:03
SPEAKER_01: And that, you know, that sets up this dramatic disparity in health span between males and females.
16:08
SPEAKER_00: Yeah, I was gonna reference that.
16:10
SPEAKER_00: It's kind of frightening, right?
16:12
SPEAKER_00: The I think it's the percentage of time spent in.
16:16
SPEAKER_00: I mean, I think on average women live five to six years longer.
16:19
SPEAKER_01: That's right.
16:20
SPEAKER_00: But they're spending more time struggling with poor health in those extra years.
16:25
SPEAKER_01: Exactly.
16:26
SPEAKER_00: And we've spoken about this many times but off camera this morning, about this big distinction.
16:31
SPEAKER_00: We we both are in agreement that the word longevity has been way overused and and means different things for different people, but that like healthy lifespan or health span, whatever you want to call it, matters so much more.
16:43
SPEAKER_00: And we're not doing a great job of it right now.
16:45
SPEAKER_01: Yeah.
16:46
SPEAKER_01: And um, I mean, at baseline, like female health span is much shorter than male health span, which is terrifying as a female.
16:53
SPEAKER_04: Yeah.
16:53
SPEAKER_01: Um, and that is directly because we have these organs that are aging faster than the rest of the tissues in our body, and that that's what sets up this disparity in health span.
17:02
SPEAKER_01: And so reproductive aging is really just intrinsic aging in reproductive organs that impairs fertility or fecundity, really.
17:10
SPEAKER_01: Just basically impairs your ability to reproduce.
17:12
SPEAKER_01: And so that's super important.
17:13
SPEAKER_01: Don't get me wrong, like that's really important.
17:16
SPEAKER_01: But ovarian aging, it essentially aging in ovaries drives aging in the rest of the body.
17:21
SPEAKER_00: And so they're communicating.
17:23
SPEAKER_01: Exactly.
17:24
SPEAKER_01: Both ways.
17:24
SPEAKER_01: So that accelerated aging in ovaries is is really driving this disparity in health span.
17:29
SPEAKER_01: And so ovarian aging is just it's the idea that um that it impacts the whole system, like it's impacting your whole body.
17:38
SPEAKER_01: And that has nothing to do with reproduction, yeah, right?
17:42
SPEAKER_01: Nothing at all.
17:44
SPEAKER_00: Why do the ovaries age faster than the rest of the body?
17:47
SPEAKER_01: I mean, if we knew that, then I I I mean I would be on a beach in Jamaica.
17:51
SPEAKER_01: I don't know that this is the this is the whole thing.
17:54
SPEAKER_00: What are some of the hypotheses?
17:57
SPEAKER_01: I mean, well, so it's clear that aging in ovaries is, at least as far as we've investigated, and when I say we, I mean there's uh dozens of of research groups that are working on this.
18:09
SPEAKER_01: The same pathways that we know about and care about with respect to aging in the rest of the body.
18:14
SPEAKER_01: So, you know, inflammatory signaling, um, mTOR signaling, all of these things that we know impact aging in other tissues also seem to impact aging in ovaries.
18:24
SPEAKER_01: The difference is this acceleration, and that's what we don't understand.
18:28
SPEAKER_01: And so that's the real question is is what is driving ovaries to age faster?
18:32
SPEAKER_01: Um, also, why does ovarian aging, you know, there's there's a lot of different ways you can measure it.
18:38
SPEAKER_01: None of them are perfect.
18:39
SPEAKER_01: Yeah.
18:39
SPEAKER_01: Obviously, like fertility is one way, um, agent menopause is another way, like it's a proxy for ovarian aging.
18:47
SPEAKER_01: And so, you know, it's incredibly variable at the level of the individual.
18:51
SPEAKER_01: There's no other signature in human health that's so variable at the level of the individual.
18:56
SPEAKER_01: And if we understood that, that variability, like why it's so different, that would give us some clues about like the underlying genetic components that are important there.
19:04
SPEAKER_00: Yeah.
19:05
SPEAKER_00: And um, do you think if we were to discover how to slow that process down, that that would close that gap in health span?
19:13
SPEAKER_00: That's the goal, right?
19:14
SPEAKER_01: That's I mean, that's one of the hypotheses, and that's something that we've seen in animals.
19:19
SPEAKER_01: Yeah.
19:20
SPEAKER_01: Right.
19:20
SPEAKER_01: So there's really compelling data in animals.
19:24
SPEAKER_01: Um, you can take you can take mice, and I don't know if this is like too much for this audience, but uh you can you can take old mice and um take out their ovaries and put in young ovaries and swap them out.
19:39
SPEAKER_01: Yeah, and um those animals uh then you know they're healthier for longer and um they live longer, which is pretty compelling evidence.
19:49
SPEAKER_01: Um what's really interesting is that then you can take those young ovaries, remove all the follicles, so all the things that are important for, you know, so the eggs and the the surrounding.
20:01
SPEAKER_01: So you can remove all the follicles and do the same experiment, and those older animals live even longer.
20:08
SPEAKER_01: And so that tells you that there's there's some separation between the reproductive function of ovaries and this health-promoting function of ovaries, yeah, which is compelling.
20:17
SPEAKER_00: But then they're not reliant on one another.
20:19
SPEAKER_01: Well, they're they're certainly linked, and we don't understand that relationship well enough to say, but they're they're at least partially separable.
20:26
SPEAKER_01: So I, you know, I don't like, I think it's a mistake to talk about ending menopause.
20:31
SPEAKER_01: Doesn't make any sense.
20:32
SPEAKER_01: Like menopause is about menstruation.
20:34
SPEAKER_01: Yeah, we're not talking about prolonging menstruation.
20:37
SPEAKER_01: That is, we're talking about prolonging health span.
20:40
SPEAKER_01: And so, you know, what we want to do is is preserve ovarian function, that endocrine, the signaling function of ovaries.
20:49
SPEAKER_01: We want to preserve that for longer so that we can extend health span.
20:52
unknown: Yeah.
20:53
SPEAKER_00: Do we have any idea how to do that?
20:57
SPEAKER_01: No, absolutely none.
20:59
SPEAKER_01: I wish that we I wish that I could say that there was something.
21:03
SPEAKER_01: I mean, it's just like with health span in in in in the rest of that discussion.
21:10
SPEAKER_00: Um But we know how to improve health span.
21:14
SPEAKER_00: Well to some degree.
21:15
SPEAKER_01: To some degree.
21:16
SPEAKER_00: But you know, there are there are things that we have really great evidence for.
21:19
SPEAKER_01: Yeah, like exercise.
21:21
SPEAKER_00: But but do we have any data on uh the impact of some of these lifestyle interventions on ovarian aging?
21:26
SPEAKER_01: Or is it too early to we're just at the beginning.
21:28
SPEAKER_01: So, you know, that these are studies, the all of this data is just you know, we're just starting to realize that we should be collecting it.
21:34
SPEAKER_01: Yeah.
21:35
SPEAKER_01: And um, I think that in the next five to ten years we'll have an extraordinary amount of information.
21:41
SPEAKER_01: But right now we're just at the beginning.
21:44
SPEAKER_00: You can only imagine or hope that the same thing applies.
21:48
SPEAKER_00: That you know, if we optimize for all of the things we know to work, that that's gonna help us cross that bridge.
21:55
SPEAKER_01: Yeah, that's the whole point.
21:56
SPEAKER_00: Yeah, there's so many things in science that we Just want the answers for, but we just don't quite know yet, which is why we need people doing the research, I guess.
22:05
SPEAKER_01: Yeah, I'm sorry.
22:06
SPEAKER_01: I wish it's just like, I mean, it everyone wants a magic bullet.
22:10
SPEAKER_01: And there is no magic bullet.
22:13
SPEAKER_01: Uh, I mean, you you know this, like exercise, diet, like the things you put into your body, how you move your body, and how you interact with other bodies, like those are the things by a mile, like that we know improve health span.
22:27
SPEAKER_01: And anything else that we've tried, any intervention that we've tried, any so-called magic bullet is like orders of magnitude less effective, right?
22:36
SPEAKER_01: In the best case, often more expensive as well.
22:38
SPEAKER_01: Often more expensive, often has, you know, comes with a lot of um risk.
22:42
SPEAKER_01: And so, like, we don't have it.
22:44
SPEAKER_01: There's probably not going to be a magic bullet.
22:46
SPEAKER_00: Yeah, I don't can we double click on that for a minute because you know, there are places offering ovarian regeneration and PRP.
22:55
SPEAKER_00: There's lots of different promises that I have seen at least.
23:00
SPEAKER_00: And and I suspect I'm getting bombarded with it less being.
23:04
SPEAKER_01: I mean, who knows?
23:05
SPEAKER_00: I don't know what your algorithm is, but that's mostly puppies, yeah, mostly dogs these days.
23:09
SPEAKER_00: Um, lots of longevity claims, at least.
23:12
SPEAKER_00: What's your perspective on that?
23:13
SPEAKER_01: I suspect I know the answer, but I mean, I think that just like the rest of the field, I I think it's it's even worse.
23:20
SPEAKER_01: Women are marketed to in a way that really takes advantage of what I would call a deep disparity, right?
23:28
SPEAKER_01: Like women are desperate for answers.
23:30
SPEAKER_01: We're in this space right now where we had no conversation about this, no acknowledgement, no knowledge.
23:36
SPEAKER_03: Yeah.
23:36
SPEAKER_01: Now we've had, you know, I hope we had something to do with it, but we've had like a lot of realization that there's a problem and real acknowledgement of this gap and a huge amount of discussion around it.
23:47
SPEAKER_01: And so now women are desperate to find solutions.
23:50
SPEAKER_01: And um, yeah, the marketing is incredible and really predatory, I would say.
23:56
SPEAKER_01: Yeah, I agree.
23:56
SPEAKER_01: So, you know, I think there is no such thing as ovarian rejuvenation at this point.
24:02
SPEAKER_01: And what we know is that everything that that works in the rest of the body seems to also be beneficial for ovarian function.
24:10
SPEAKER_01: And so right now that's that's where we're at.
24:12
SPEAKER_01: Yeah, that's not where we're gonna stay.
24:14
SPEAKER_01: Like we'll we'll definitely get beyond this, but right now that's where we're at.
24:18
SPEAKER_00: I'm gonna ask you something that's could be very naive.
24:21
SPEAKER_01: Spicy?
24:22
SPEAKER_01: No, not naive.
24:23
SPEAKER_01: Go for it.
24:24
SPEAKER_00: Um when women are born, you have a like a predetermined number of follicle follicles eggs, right?
24:35
SPEAKER_00: Which I think is north of a million typically.
24:39
SPEAKER_01: Um actually, so you actually the number of of eggs that I have peaked when I was about 26 weeks gestation.
24:48
SPEAKER_01: Yeah, that's six or seven million.
24:51
SPEAKER_01: But by the time I was born, that number on average had dropped to about a million.
24:56
SPEAKER_00: And then by the time you hit puberty, it's less than a hundred.
25:00
SPEAKER_00: Why?
25:01
SPEAKER_01: No idea.
25:01
SPEAKER_01: So though I would say, I mean, who knows?
25:04
SPEAKER_01: I wait, nobody's ever bothered to look.
25:05
SPEAKER_01: That's um that's not true.
25:06
SPEAKER_00: But that seems counterintuitive to me.
25:08
SPEAKER_01: I think, I mean, if you're if you're trying to apply reason to how our um reproductive function and ovaries are set up, I I Good luck, yeah.
25:18
SPEAKER_01: Yeah, I'm I'm not sure that uh it doesn't make a lot of sense to me either.
25:21
SPEAKER_03: Yeah.
25:22
SPEAKER_01: What we do understand is that first drop.
25:24
SPEAKER_01: So that's really the only piece of this puzzle.
25:26
SPEAKER_01: Because you you described the first, the first drop, and then the second drop is from birth to puberty.
25:32
SPEAKER_00: Yeah.
25:32
SPEAKER_00: So there's a drop even ingestation.
25:35
SPEAKER_01: Huge.
25:35
SPEAKER_01: That's the biggest one.
25:36
SPEAKER_01: Six or seven million to one million.
25:38
SPEAKER_01: That's the one we sort of understand.
25:40
SPEAKER_01: Because I don't know if you know this because you probably haven't thought about it.
25:44
SPEAKER_01: But eggs, like eggs are the coolest but the most bizarre cells in our bodies, like super weird.
25:51
SPEAKER_01: They're huge, like compared to other cells, they're enormous.
25:54
SPEAKER_01: And the way that you're the way that my reproductive system was set up was that was when I was in utero, so it was in my mother's uterus, yeah, my ovaries developed.
26:06
SPEAKER_01: Um, right.
26:07
SPEAKER_02: Yeah.
26:08
SPEAKER_01: And all the eggs that I'll ever have developed.
26:11
SPEAKER_01: And so that means that like eggs within eggs.
26:14
SPEAKER_01: It means that, um, well, it means that uh I was born in the 70s, but the egg that I came from developed in my mother's ovaries inside my grandmother in 1956.
26:29
SPEAKER_00: And and and her eggs, and so like like yeah, her eggs.
26:33
SPEAKER_01: So so the egg I came from was was made in 1956.
26:39
SPEAKER_01: So it's like it's like a nested Russian doll situation.
26:44
SPEAKER_01: Um crazy, right?
26:47
SPEAKER_01: So the egg that you came from, you can if you know the year of birth that your mom when was your mom born?
26:53
SPEAKER_00: Hang on, Jan.
26:54
SPEAKER_00: I'm trying to be baffled.
26:56
SPEAKER_00: Uh in the oh no, she's probably gonna watch this.
27:01
SPEAKER_01: Okay, never mind.
27:02
SPEAKER_01: Let's just stick let's stick with my my example.
27:05
SPEAKER_00: Yeah.
27:07
SPEAKER_00: We might have to cut that.
27:08
SPEAKER_01: Oh, okay.
27:09
SPEAKER_01: Do you want me to say it again?
27:10
SPEAKER_01: Okay.
27:11
SPEAKER_00: Um I'm gonna say 56.
27:13
SPEAKER_01: That's when my mom was born.
27:14
SPEAKER_00: Yeah.
27:15
SPEAKER_01: Um, so yeah.
27:16
SPEAKER_00: So the egg that that sorry mom if that was wrong, by the way.
27:19
SPEAKER_01: That the egg that that you came from was was was made sometime in the 50s.
27:24
SPEAKER_00: And uh wait, I'm just gonna change my answer to 59.
27:27
SPEAKER_01: Okay.
27:28
SPEAKER_00: 1959.
27:29
SPEAKER_01: Okay.
27:30
SPEAKER_00: Okay.
27:30
unknown: Yeah.
27:31
SPEAKER_01: And the eggs that both of us derived from were made in the 1950s.
27:35
SPEAKER_01: Yeah.
27:36
SPEAKER_01: And you were born in the 80s, I was born in the 70s.
27:40
SPEAKER_01: Like those eggs, they um they just sat there.
27:43
SPEAKER_01: They were just quiescent, hanging out.
27:46
SPEAKER_01: Um, but that first drop is really um what happens is all of the the immature eggs that are in there, they form these cytoplasmic bridges.
27:56
SPEAKER_01: And so that means that they're not just individual cells, they actually connect to each other and they form this lattice structure.
28:04
SPEAKER_01: And so they have bridges to all the cells that are around them.
28:08
SPEAKER_01: And the ones that are in the middle, the ones that have the most connections to other cells, kind of win.
28:14
SPEAKER_03: Yeah, yeah.
28:15
SPEAKER_01: And then the the cells around the edges donate all their cytoplasm.
28:20
SPEAKER_01: So all the stuff that's inside the cell outside the nucleus.
28:23
SPEAKER_01: So, like mitochondria and other organelles and RNA, and they just donate it all to the one in the middle through these bridges.
28:33
SPEAKER_01: Yeah.
28:33
SPEAKER_01: And it they get bigger and bigger and bigger.
28:35
SPEAKER_00: So they're effectively feeding central end.
28:40
SPEAKER_01: They take all this stuff, these organelles and um like ribosomes and mitochondria and RNA, and they make a little cage around it.
28:49
SPEAKER_01: And then they go into quiescence, and then they sit there quiescent, so like silent for decades until they get recruited to grow.
28:58
SPEAKER_01: And so that first drop from six million to about a million, that's what happens.
29:02
SPEAKER_01: So it's basically defenders.
29:04
SPEAKER_01: It's like basically getting them fully formed.
29:07
SPEAKER_03: Yeah.
29:07
SPEAKER_01: And then so we sort of understand that process.
29:10
SPEAKER_01: But the rest of it, the drop from a million to about 300,000, give or take, um, at puberty.
29:17
SPEAKER_01: And then, and then, you know, every year you're you're losing a lot of eggs.
29:23
SPEAKER_01: Um, but but the, you know, there's there's a lot of drop in um the numbers.
29:28
SPEAKER_01: And we don't understand that.
29:29
SPEAKER_01: We don't understand any of it.
29:32
SPEAKER_01: And these are the kinds of questions that you know we're trying to answer.
29:36
SPEAKER_00: I guess the pre-investment funding, brilliant scientists that were working on these problems, it wasn't just that the information didn't exist, it was that the information we had, we were being we were effectively treating women like little men.
29:51
SPEAKER_01: Yes, right.
29:52
SPEAKER_00: Like for want of a better term.
29:53
SPEAKER_00: And so the the the health information we were getting wasn't only not correct for us or for for for women, it just didn't exist.
30:03
SPEAKER_03: Yeah.
30:05
SPEAKER_00: I think another area that has so much misinformation and probably not enough real information is menopause.
30:16
SPEAKER_00: Right.
30:16
SPEAKER_00: And on top of that, I think is so individually variable.
30:22
SPEAKER_00: Like some women have little to no symptoms, some have very severe symptoms that can start at different decades in in life.
30:29
SPEAKER_00: Yeah.
30:31
SPEAKER_00: What what is it that women can be doing to prepare themselves for that and then manage throughout that process if they are someone that experiences really severe symptoms?
30:42
SPEAKER_01: That's a great question.
30:44
SPEAKER_01: If you buy what I told you earlier about ovaries talking to every tissue in the body and those those conversations being mediated by different kinds of chemicals, you imagine that you know the graph that you see that you were referencing of the number of follicles over time, it's those that's a statistical average.
31:06
SPEAKER_01: That's sort of like there's like a single inflection point and then a cliff around midlife.
31:12
SPEAKER_01: But at the level of the individual, it's actually quite variable and really stochastic.
31:17
SPEAKER_01: And so what happens between uh, you know, a woman's 20s and her 50s is that there's a decline for sure in the average number of eggs, but there's also this dramatic fluctuation in the signals that ovaries are sending and receiving.
31:35
SPEAKER_01: And so the reason that there's such a disparity in the symptoms that individuals experience is because like things go offline in different ways.
31:45
SPEAKER_01: Like those conversations get disrupted in different ways in different people.
31:49
SPEAKER_01: And so that's why there's, you know, over at least 130 symptoms associated with perimenopause.
31:56
SPEAKER_01: Right.
31:57
SPEAKER_01: So it's kind of hard to know.
32:00
SPEAKER_01: I will say, I think that the conversation has shifted in a way that's maybe not so beneficial to women.
32:09
SPEAKER_01: Like now, if you're in your late 30s or early 40s and there's anything going on with you, now the immediate idea is like, oh, it's perimenopause.
32:18
SPEAKER_01: Definitely perimenopause.
32:19
SPEAKER_01: And that might be true.
32:20
SPEAKER_01: Um, but you know, it's it's become like a I feel like women are now almost being um, they're they're being sort of like, it's like fear-mongering.
32:28
SPEAKER_01: Do you know what I mean?
32:29
SPEAKER_00: Gaslighting.
32:29
SPEAKER_01: Gaslighting and and really just taking advantage again of their desperation for for answers and for solutions.
32:37
SPEAKER_01: So I think that right now uh we don't know a lot.
32:42
SPEAKER_01: What we do know is that, you know, the transition through um perimenopause and postmenopause is um something that most people didn't talk about or know about before.
32:55
SPEAKER_01: And so finding a physician or, you know, having physicians who really are fluent and in understanding and and knowing about these things, that's not everyone.
33:05
SPEAKER_01: Um, a lot of physicians didn't get the training.
33:08
SPEAKER_01: And so talking to, you know, if you have a doctor who gaslights you or, you know, doesn't listen to what you're telling them, I would say find a new doctor.
33:17
SPEAKER_01: Right.
33:18
SPEAKER_01: That's like task number one.
33:19
SPEAKER_04: Yeah.
33:19
SPEAKER_01: But then there's a lot that, you know, there's a lot that exists in modern medicine today that is not is being underutilized, especially for females.
33:28
SPEAKER_01: And because of what you just referenced, the idea that like the way we have applied modern medicine to females is just to say, like, okay, you are about like, I don't know, three quarters the size and approximately like three quarters the weight of an average male.
33:45
SPEAKER_01: Therefore, we're gonna take the things we do in men and just like reduce them by three quarters.
33:50
SPEAKER_01: Yeah, and do that for you.
33:52
SPEAKER_01: And of course, that doesn't work because everything about our bodies is different.
33:56
SPEAKER_01: Um, and that's you know, that's one of the reasons that um women tend to experience like more side effects from medications because they weren't tested, you know, the dosing was, you know, yeah, it's just cut by quarter, figured out in a male and then cut down.
34:10
SPEAKER_01: And uh, and that's that's just not how biology works, unfortunately, you know, as it turns out.
34:16
SPEAKER_01: Um, but yeah, in terms of like practically what what I do, what I tell my friends to do.
34:21
SPEAKER_01: And of course, I'm not a medical doctor, so I'm not giving medical advice, but um for females, you know, cardiovascular disease risk is one of the main things that that really changes as your ovarian function fluctuates and declines.
34:35
SPEAKER_01: And then at an aftermenopause, like my risk of cardiovascular disease went up somewhere between two and fourfold at menopause.
34:44
SPEAKER_01: Wow, like overnight.
34:45
SPEAKER_01: And, you know, a lot of the steroid hormones, so estrogen, progesterone, testosterone, all of these steroid hormones that we associate with ovarian function, which are, you know, three of the chemical signals of hundreds, but three really important ones.
35:00
SPEAKER_01: There's steroids, which means that they um the one of the precursors for making them in your body is cholesterol.
35:10
SPEAKER_01: And so cholesterol signaling is really tightly linked to like this decline in ovarian function.
35:16
SPEAKER_01: And a lot of women have um a pretty dramatic increase, not everyone, but a pretty dramatic increase in their cholesterol levels in that perimenopause period.
35:25
SPEAKER_01: And um, you know, these are the kinds of things where getting a cardiac workup early, right?
35:33
SPEAKER_01: I think in the US, the rec recommendations for men are something like 50.
35:38
SPEAKER_01: The recommendations for women are 55.
35:41
SPEAKER_01: So it's like, I I mean, that makes no sense.
35:46
SPEAKER_01: It's all the same, it's all the same answers, like societal taboos, persistent sex bias and medical medical research and lack of funding, which leads to this lack of data.
35:57
SPEAKER_01: Um yeah.
35:58
SPEAKER_00: So I think despite knowing that the risk is higher.
36:01
SPEAKER_01: Well, this is a new thing, right?
36:02
SPEAKER_01: Uh I will be uh perfectly honest with you.
36:05
SPEAKER_01: When I uh started experiencing perimenopausal symptoms, I demanded to see a cardiologist because I have a familial risk of cardiovascular disease.
36:15
SPEAKER_01: And my cholesterol was creeping, was creeping up.
36:19
SPEAKER_01: And it had always been like really great and healthy.
36:21
SPEAKER_01: And um, and I went to a spectacular cardiologist um who was like trained to the best places.
36:29
SPEAKER_00: Name drop him.
36:30
SPEAKER_01: Who is no, I'm not going to because I went to see this person and um and and to I'll I'll come around to to being kind about this, but I went to see this person and um he I said, you know, I'm worried because I have this risk in my familial background and I have all these markers, and and uh, you know, I really think I I should have like a full cardiac workup.
36:56
SPEAKER_01: And and he said, and I said, you know, and my risk of of cardiovascular disease is gonna go up dramatically at menopause.
37:02
SPEAKER_01: And he said, no, it's not.
37:03
SPEAKER_01: And I said, yes, it is.
37:06
SPEAKER_01: And we went back and forth.
37:08
SPEAKER_01: And to his credit, after we discussed it, and I sent him all the references, he acknowledged he was like flabbergasted.
37:14
SPEAKER_01: He was like, I this is not something I knew.
37:17
SPEAKER_01: I did not receive any training on this.
37:19
SPEAKER_01: And I, you know, I've been taking care of women in their 40s, and I didn't this did this knowledge is new to me, which was horrifying.
37:28
SPEAKER_01: Um, so anyways, I think that women should, you know, get a baseline.
37:32
SPEAKER_01: You should know, like at 40, you should know like, what does your cardiac function look like before all the changes start to happen so that you can monitor it.
37:42
SPEAKER_00: Does does that cardiovascular risk start creeping up in perimenopause, or do we see the sharp increase at menopause?
37:48
SPEAKER_01: This is a good question.
37:49
SPEAKER_01: And I would say we're still like, yeah, the data's still out, but a lot of the changes, right?
37:54
SPEAKER_01: So, you know, measuring cardiovascular disease risk is takes a lot of like it's these are longitudinal studies that require large numbers of people.
38:03
SPEAKER_01: And um, I would say a lot of the measures, so we have great measures of of cardiovascular function, right?
38:12
SPEAKER_01: Both um metabolic measures and and things you can get through blood tests, but also I mean, you do a lot of them uh at Wonder.
38:19
SPEAKER_03: Yeah.
38:20
SPEAKER_01: Um, you can measure lots of different things and you can get a very good idea about where somebody's out and what what their risk is over time.
38:29
SPEAKER_01: And so um those like those metrics do start to change early.
38:34
SPEAKER_01: Early.
38:35
SPEAKER_00: Do you think then there's there's an argument to be made for for having that done even earlier, like in your like late 2030s?
38:41
SPEAKER_00: I mean what you're comparing that data to, otherwise.
38:44
SPEAKER_01: Yeah, I mean, I I I always say at least by 40, um, especially because I want to catch the women who are who are now aware that there's like gonna face some challenges in the next decade or two.
38:55
SPEAKER_01: Um, but certainly, yeah, I I think as early as possible, so that you have you have something to compare to, right?
39:01
SPEAKER_04: Yeah.
39:02
SPEAKER_01: Now most people get a physical, most people have their cholesterol measured and can watch those numbers go up.
39:07
SPEAKER_01: But a lot of times, you know, and in my case, actually, my primary care doctor saw this happening in my early 40s and was like, you gotta, you know, exercise more and you gotta like lose a little weight and you gotta, you know, watch what you eat.
39:22
SPEAKER_01: And I did those things.
39:23
SPEAKER_01: I did all of those things.
39:24
SPEAKER_01: Um, and over about 18 months, it was like a cosmic joke.
39:28
SPEAKER_01: You know, I was like doing all the things and you know, really in some ways, like reducing my joy.
39:37
SPEAKER_01: And my cholesterol just kept going up.
39:39
SPEAKER_01: And then I I went to this, see this cardiologist, and um, he prescribed a statin.
39:46
SPEAKER_01: And across two months, so we tested before and we tested two months after, those numbers dropped by over 100 points.
39:54
SPEAKER_01: So for me, that was the answer.
39:57
SPEAKER_01: It's not always the answer for everybody, but for me, that was clearly the problem.
40:01
SPEAKER_01: And um, and you know, it was it was something so simple.
40:04
SPEAKER_01: And these are again, these are things that we already have at our disposal.
40:10
SPEAKER_00: Can I give you a scenario?
40:12
SPEAKER_00: You know, someone is you we we are, and I do this a lot, we you know, telling people these are the things we know to work, you know, most of which are lifestyle interventions for many different domains of of aging and and optimizing for health span.
40:26
SPEAKER_00: If someone's doing all of those things and yet they're going through perimenopause or have reached menopause, and having they're on that side of the spectrum where they're experiencing a lot more symptoms, what are the other things that they can do?
40:41
SPEAKER_00: And like can I think touching on hormone replacement therapy would be good, but you know, I think there is just so much conflicting evidence perspectives that people are a little concerned, um still, even after all these years.
40:58
SPEAKER_01: Yeah, I think uh the data is very clear.
41:01
SPEAKER_01: There isn't there's absolutely no question that menopausal hormone therapy, we're not calling it hormone replacement therapy anymore, because um, well, it sort of implies that there's something wrong with you, and there's nothing menopause is not a disease.
41:17
SPEAKER_01: Yeah, there's nothing wrong with women who are postmenopausal.
41:20
SPEAKER_01: Um, but uh, but there is, you know, there are conditions that happen to women who are much younger, so in their teens and twenties, who have what we call primary ovarian insufficiency or failure, so POI or POF.
41:33
SPEAKER_01: And that means that their ovaries just stop working for reasons we don't understand.
41:37
SPEAKER_01: And in those cases, or if a woman has to have her ovaries removed for whatever reason, oftentimes cancer or um, those women um we do call it replacement because those women experience like dramatic and in like really dramatic um impacts, like you know, they essentially go through a menopause overnight.
41:59
SPEAKER_02: Yeah.
41:59
SPEAKER_01: And so we call that replacement.
42:00
SPEAKER_01: But we call, you know, in midlife, um, menopausal hormone therapy is by far the best band-aid that we have available.
42:08
SPEAKER_01: So it's not perfect, and it is uh, it's uh, I would call it primitive the way that we administer it, because there has been quite literally almost no innovation in hormone therapy for menopausal women since it was introduced in the 40s.
42:24
SPEAKER_01: There's been one piece of innovation, one, which is uh estradiol, which is you know a really important hormone for bone health, for heart health, for all kinds of things.
42:36
SPEAKER_01: Um, estradiol, as it turns out, if you take it orally, it gets metabolized by the liver into things that induce clotting factors and also suppress anti-clotting factors.
42:47
SPEAKER_01: And what that means in practice is that just if you take oral estradiol, it can really increase your risk of having a stroke.
42:53
SPEAKER_02: Right.
42:53
SPEAKER_01: Um, and so nobody, the data is very clear, nobody should be taking oral estradiol.
42:58
SPEAKER_01: Um, and so there's uh the transdermal patch was was developed, and the transdermal patch essentially bypasses that first um metabolic step in the liver.
43:08
SPEAKER_01: And so it there's there's no increased risk of officer.
43:12
SPEAKER_00: Was the oral estradiol the reason we had this big scare in the early 2000s?
43:16
SPEAKER_01: No.
43:17
SPEAKER_01: Well, okay, actually, that's a complicated answer.
43:20
SPEAKER_01: What happened in the early 2000s?
43:22
SPEAKER_01: You're referring to the the first study that was published from the WHI, the Women's Health Initiative data set.
43:29
SPEAKER_01: Um, there have been books written about this.
43:32
SPEAKER_01: So if anyone's really interested, they should go and read about it.
43:35
SPEAKER_01: But um, what happened was that uh hormone therapy was uh pretty like it was pretty prevalent um in the US and the UK.
43:44
SPEAKER_01: Um, and and it's it's really important, you know, it's it's so important.
43:49
SPEAKER_01: It it preserves your bone health, which, you know, at and after menopause, osteoporosis goes your risk of osteoporosis goes through the roof.
43:57
SPEAKER_01: Um but there were a lot of women on menopausal hormone therapy.
44:00
SPEAKER_01: And there was this beautiful study.
44:01
SPEAKER_01: And it's important not to demonize the study.
44:04
SPEAKER_01: So it was a longitudinal data set that was collected on women, like so women across a long period of time.
44:12
SPEAKER_01: And um the first study that that was published essentially put out a message to the public that was both incorrect and not supported by the data.
44:25
SPEAKER_01: So actually none of the data was it wasn't statistically significant.
44:29
SPEAKER_02: Right.
44:29
SPEAKER_02: Okay.
44:30
SPEAKER_01: And um, and most important for women today is that none of the hormones that were used in that study do we use today.
44:39
SPEAKER_01: Right.
44:39
SPEAKER_01: So, so we can argue about this all we want, but it's totally irrelevant.
44:45
SPEAKER_01: Yeah.
44:46
SPEAKER_01: But but the study was also set up in a really strange way.
44:48
SPEAKER_01: So, you know, the average age of menopause is around 51, 51 and a half, 51.7, but 51, and that number hasn't shifted much over, you know, 100 years.
44:59
SPEAKER_04: Yeah.
45:00
SPEAKER_01: Um, and they were looking at women who were on average 65 years old.
45:06
SPEAKER_01: So way past menopause.
45:08
SPEAKER_01: So they were looking at hormone therapy in those women.
45:12
SPEAKER_01: And because it was such an it was an older population, they didn't control for things like like people who are it was 65 was the average age.
45:21
SPEAKER_01: So they had women in their 70s, they had some women in their 50s.
45:24
SPEAKER_01: It's an odd choice for well, you know, yeah, again, this is why it's important to look at, you know, to really um talk to experts and examine the studies that are done.
45:33
SPEAKER_01: Um, but you know, a lot of those women in the study already had cardiovascular disease.
45:38
SPEAKER_01: Like they already had a lot of age-related challenges in their health.
45:43
SPEAKER_01: And so the question of whether hormone therapy, you know, started long after menopause and in women who are already sick, like bananas, right?
45:52
SPEAKER_01: But but the most important thing is that the estrogen that they used was um a conjugated equine estrogen.
45:59
SPEAKER_01: So you basically take, and and you know, I I I don't want to disparage, you know, you work with the tools that you have available.
46:06
SPEAKER_04: Yeah.
46:06
SPEAKER_01: And so you, you know, this was um you take horse urine, pregnant horse urine, which has a lot of estrogen in it, yeah, but it has a lot of other stuff too.
46:15
SPEAKER_01: And not just one kind of estrogen, like lots of different kinds of estrogen and lots of other things.
46:19
SPEAKER_01: And you you essentially, you know, purify that.
46:22
SPEAKER_01: And then that was that was a source of estradiol.
46:24
SPEAKER_01: And then um the progesterone, so if you have a uterus, you need to take progesterone along with estradiol to protect against endometrial cancers.
46:32
SPEAKER_01: The progesterone they used was not progesterone.
46:35
SPEAKER_01: It wasn't what your body makes.
46:36
SPEAKER_01: It was a small molecule, it was a synthetic drug that uh essentially interacts with the progesterone receptor, but it was completely different than the hormones we use today.
46:48
SPEAKER_01: The hormones we use today are complete, totally safe.
46:51
SPEAKER_01: Every study shows that they have a beneficial impact on bone.
46:54
SPEAKER_01: There's a lot of, I would, you know, we have when we talk about data, there's like levels of um of certainty.
47:02
SPEAKER_01: Yeah, right.
47:03
SPEAKER_01: And the gold standard is double-blind placebo-controlled studies in tens of thousands of people.
47:08
SPEAKER_03: Yeah.
47:09
SPEAKER_01: And so we have gold standard studies for osteoporosis.
47:13
SPEAKER_01: Like, no question.
47:14
SPEAKER_01: If you take hormone therapy, it will protect you against losing bone mass.
47:19
SPEAKER_01: Um, for things like cardiovascular disease risk, I would call it one click down, meaning we have a lot of really, really, really important and robust data that's, you know, related to cardiovascular disease markers.
47:33
SPEAKER_01: And then for things like cognitive health, we're still at the stage of, you know, we've got many studies from different groups that are in the hundreds to thousands of people, but not the double blind placebo controlled.
47:47
SPEAKER_02: Yeah, gold standard.
47:47
SPEAKER_01: And so, but but in every place where we look, you know, it's it's a positive signal.
47:52
SPEAKER_01: Yeah.
47:53
SPEAKER_00: Um, so what would be really useful for the general public is if we had a clearer understanding of those rank, like how you rank research.
48:02
SPEAKER_01: I mean, maybe you want to take this on.
48:03
SPEAKER_01: I think there's a really there's a there's somebody could I it would be so great to have um like a scale, yeah, like a rating scale, like for a couple of different things, right?
48:14
SPEAKER_01: Like, so like call it a bullshit scale.
48:17
SPEAKER_01: Yeah, right.
48:18
SPEAKER_01: And then like, you know, just just in general, how how dependable is this data?
48:23
SPEAKER_01: How well was the study designed?
48:24
SPEAKER_00: Who designed it?
48:25
SPEAKER_01: Has who designed it, how many people was it repeated, you know, like that kind of thing.
48:30
SPEAKER_01: Um, and then a couple of other, you know, like so that somebody could hear something in the news, like, and then look at a single site, yeah, and and get a sense of the metrics and then without having to pass through the whole yeah, and then decide, like how because you're always weighing evidence, it's always like risk reward benefit, yeah.
48:50
SPEAKER_01: And nothing is a hundred percent.
48:51
SPEAKER_01: Yeah, and so you just have to decide like how risky is this versus how much do I trust the evidence.
48:57
SPEAKER_00: And then one layer on top of that, which I think we'll get to eventually, but is still some way off, is how does that evidence apply to my biology?
49:04
SPEAKER_01: Right.
49:05
SPEAKER_00: Because that just because something was proven or seems to be valid in a group does not mean it is gonna work for me.
49:12
SPEAKER_01: But that's where we're going, right, with personalized medicine.
49:14
SPEAKER_01: We'll get there, but we're not there yet.
49:16
SPEAKER_00: Isn't it funny how you know that referencing that study in particular, these things seem to hang around, these perspectives or you know, um the misinformation is huge.
49:27
SPEAKER_01: I mean, uh the the challenge is that for a long time, the regulatory bodies, the governing bodies, the you know, the the societies that put out information for patients, sort of, you know, they in some ways, I I think it was a little irresponsible.
49:43
SPEAKER_01: They were kind of equivocal or they didn't put any information out.
49:47
SPEAKER_01: And in the absence of information, like in a vacuum, that's where misinformation really, really thrives.
49:52
SPEAKER_04: Yeah.
49:53
SPEAKER_01: And so we're in a situation now where there's so much misinformation out there, especially about hormone therapy, but also just about a lot of things related to female health.
50:03
SPEAKER_01: Um, so that's why it's so important that we talk about it.
50:06
SPEAKER_00: Hey, given the lack of great resources then, you know, or the lack of funding, which is in turn has meant with playing catch-up, where can, you know, women listening or men that want to, you know, learn more, where can they, where should they go to learn more about this?
50:23
SPEAKER_01: So I think I would direct women to the National Menopause Foundation, which is a nonprofit research resource, um, which is the only, the only um, actually, yeah, the only source of information that I'm aware of, which is 100% for the patient.
50:40
SPEAKER_03: Okay.
50:40
SPEAKER_01: Um, the other, I think, really great resource in the US is um the menopause society, which is the professional society for physicians um that work on menopause.
50:51
SPEAKER_01: They have a great patient resource section.
50:54
SPEAKER_01: And uh, and then I mean, honestly, there's I would say when you're considering a source of information, this is true for everything, but especially in female biology, is you know, look at the person who's telling you this information and then ask, are they selling me something?
51:13
SPEAKER_01: Like, is there something they're selling me?
51:15
SPEAKER_01: And that doesn't necessarily mean that you shouldn't listen to them, but it should, it should be a red flag that that gives you pause and sort of maybe gives you a moment, a pause where you evaluate, like, do you like how much do I really believe this?
51:29
SPEAKER_01: And how much are they really just trying to sell me some supplement or some book or some something?
51:34
SPEAKER_01: And um look for the people who aren't who who don't have these conflicts of interest.
51:40
SPEAKER_01: That that would be my advice.
51:42
SPEAKER_00: Yeah, and I think it's really easy to feel compelled by some of the misinformation because we don't know what we should and shouldn't be listening to.
51:50
SPEAKER_00: And often because often they are pulling on a thread of evidence.
51:54
SPEAKER_01: Yeah, there's always like an element of truth, right?
51:56
SPEAKER_01: That's the problem.
51:57
SPEAKER_01: It's it's that's the challenge, is when there's an element of truth that's sort of weaved in with a bunch of bullshit.
52:03
SPEAKER_00: Yeah, you're like, well, it sounds compelling.
52:04
SPEAKER_01: How do you yeah, how do you uh parse that?
52:07
SPEAKER_00: I I think the a good takeaway for people is that there isn't a halo-tipping single solution for many things in regarding our our health, you know.
52:17
SPEAKER_00: So it's usually a combination of different approaches.
52:20
SPEAKER_00: So if someone's saying this is the supplement, uh you know, I had Darcy Moore on yesterday, we were talking about stem cells and neurogenesis in adults.
52:29
SPEAKER_00: And last night, uh it's almost as if my phone is listening to me.
52:33
SPEAKER_03: Of course you're phone listening.
52:34
SPEAKER_00: I got a uh a promotion for a supplement saying after 12 weeks of using this, you'll experience neurogenesis.
52:41
SPEAKER_01: Oh, how funny.
52:42
SPEAKER_00: Right, and we'd literally just spoken about the fact that we don't even know that for certain that that's possible in in adults, right?
52:48
SPEAKER_00: And so I don't know, it's it's tough out there, it's like the Wild West.
52:53
SPEAKER_01: Yeah, well, I mean, that's why you're doing this, right?
52:56
SPEAKER_00: Hey Jen, I'm gonna ask you some quick fire questions.
53:01
SPEAKER_00: Okay.
53:01
SPEAKER_00: They're not that quick though, so I don't want you to feel like you have to rush through these.
53:05
SPEAKER_00: Um there's no time limit.
53:07
SPEAKER_00: I've already asked you that one.
53:09
SPEAKER_01: Which one?
53:10
SPEAKER_00: I was gonna say, has the pendulum swung too far on hormone replacement therapy from fearing it to overselling it as an anti-aging treatment?
53:19
SPEAKER_01: No.
53:21
SPEAKER_01: And I wouldn't call it an anti-aging treatment.
53:24
SPEAKER_01: It is it is a preventative, it's like a preventative health measure.
53:28
SPEAKER_02: Yeah.
53:28
SPEAKER_01: It's like it's like if you have high cholesterol, you take a statin and it fixes the problem.
53:35
SPEAKER_01: Um, but if you have poor ovarian function or low ovarian function, or if you've gone through menopause and your ovaries have stopped working the way they were before, this is a this is a preventative, like this is a way to to reverse or in you know, slow down, slow down um those uh negative health consequences.
53:57
SPEAKER_00: I think so many of these preventative health measures are being packaged as anti-aging.
54:02
SPEAKER_00: I I don't love that term either, to be honest.
54:04
SPEAKER_01: Yeah, I would just call it like I mean, I the goal is to preserve ovarian function, just to preserve the part of ovarian function that keeps you healthy.
54:12
SPEAKER_01: That's it.
54:13
SPEAKER_00: Okay.
54:15
SPEAKER_00: What's the biggest claim in women's health today that makes you cringe?
54:21
SPEAKER_01: I mean, I have a visceral reaction to people saying that hormone therapy causes cancer or that it um that it's unsafe, or or that it's uh that it's a personal choice.
54:34
SPEAKER_01: Like sure, it's a personal choice whether or not to take medicines.
54:38
SPEAKER_01: Yeah.
54:39
SPEAKER_01: Um but but you know, it's it's um the data's really, really clear.
54:47
SPEAKER_01: And most women are bombarded with all this misinformation.
54:51
SPEAKER_01: And I think having a, you know, we just don't have a place where there's a clear, like unfettered conversation that has that information.
55:01
SPEAKER_01: It drives me crazy when people are like, oh, I don't, I don't take hormone therapy because I want I want to be natural.
55:08
SPEAKER_01: I'm like, do you like do you bathe?
55:11
SPEAKER_01: Do you like you know, there's like yeah, do you if you had diabetes, would you would you take insulin?
55:18
SPEAKER_01: You know, just like this idea of of of of medicines being um unnatural, it really bothers me.
55:25
SPEAKER_01: And especially in the context of hormone therapy.
55:28
SPEAKER_00: Yeah, and you can make that argument about taking an aspirin, right?
55:30
SPEAKER_01: Like, yeah.
55:32
SPEAKER_00: Where do you think the wellness industry has gone ahead of the science?
55:37
SPEAKER_01: Everywhere?
55:38
SPEAKER_01: How much time do you have?
55:41
SPEAKER_01: Uh I think um I think that there are so many promising studies, like preclinical studies, studies in animals, even like really small numbers of human studies that are promising.
55:56
SPEAKER_01: And I think that educating the public about how, again, how we evaluate data and how we make those decisions.
56:02
SPEAKER_01: Like, how do I make those decisions about like, do I believe this enough to put something into my body as a consequence?
56:09
SPEAKER_01: I think that educating people about science is so important.
56:12
SPEAKER_01: And and I think that the way we get away from the like extraordinary number of overclaims in the longevity space is to educate people about how to evaluate the data.
56:22
SPEAKER_01: And so, I mean, like, where do I start?
56:25
SPEAKER_01: Peptides, yeah, NID, like supplements.
56:28
SPEAKER_01: I mean, I think you should take supplements if you have a deficiency.
56:31
SPEAKER_00: Yeah.
56:32
SPEAKER_00: And where do you take any supplements?
56:34
SPEAKER_01: I take vitamin D because I am almost chronically vitamin D deficient.
56:39
SPEAKER_01: Um, one of the fun wearables that I have now is a little um amulet that sits right here, so on a necklace that measures my UV exposure.
56:50
SPEAKER_01: And what's kind of cool about it, and I, you know, I don't, I've only been, I've only used it for a bit, but um, but I'm melanin challenged.
56:58
SPEAKER_01: And so I have to wear sunscreen or I will burn like 10 minutes.
57:04
SPEAKER_01: And so I'm you like even if I'm in the sun.
57:06
SPEAKER_00: I'm British, so it's the same for me.
57:08
SPEAKER_00: Right.
57:08
SPEAKER_01: So even if I'm in the sun though, I'm not getting enough vitamin, like I'm not getting enough um actual exposure in my skin to to generate vitamin D.
57:14
SPEAKER_01: So I'm vitamin D deficient.
57:16
SPEAKER_01: I take a supplement.
57:16
SPEAKER_00: Yeah, I do too.
57:17
SPEAKER_01: I'm also um deficient in some of the B vitamins.
57:20
SPEAKER_01: I take those if I need to.
57:22
SPEAKER_00: B12.
57:22
SPEAKER_01: Um, yeah, and I I I supplement some of the um some of the I take like fish oil um to supplement some of the fatty acids.
57:30
SPEAKER_01: But beyond that, I don't know, I don't, I don't take anything else.
57:34
SPEAKER_00: Creatine.
57:36
SPEAKER_01: I mean, it's on the counter.
57:39
SPEAKER_01: Certainly, there's someone in my house who who religiously does every day.
57:43
SPEAKER_01: And um, I think the for for women, I think the data is like equivocal and it's probably very individual.
57:50
SPEAKER_01: I don't think it's bet I don't think it's harmful.
57:53
SPEAKER_01: So when I when I remember, yes.
57:55
SPEAKER_01: Yeah, nice, but not religiously.
57:57
SPEAKER_00: I kind of asked this one, but I think it's worth unpacking a little more.
58:03
SPEAKER_00: If someone claims that they can reverse menopause or rejuvenate the ovaries, how should we think about those claims?
58:10
SPEAKER_00: And I know the answer is we should be very skeptical, but do you think that there is any promise for those treatments?
58:19
SPEAKER_00: Absolutely.
58:19
SPEAKER_01: Oh yeah, I don't, I don't, I often come across as incredibly like um critical of these things.
58:28
SPEAKER_01: But there's I think there's huge, there's a huge promise in the idea that we will find things, whether they're drugs or interventions of other kinds, like there we will find things that will have a beneficial impact on ovarian function.
58:45
SPEAKER_01: We're just not there yet.
58:46
SPEAKER_01: And you know, the the consortium that I ran where we gave grants to scientists to study ovarian aging, a lot, several of those grants were were in that direction.
58:56
SPEAKER_01: And um, one of them was looking at rapamycin um for ovarian function, and they did a small study that had positive readout, and now they're doing a slightly larger study.
59:07
SPEAKER_01: And you know, it will take time to get to the to the answer, which is does rapamycin actually have a beneficial impact to the level and to the extent that we would recommend it for women more broadly.
59:21
SPEAKER_01: A lot of there's a lot of ground to cover there in terms of like if the answer is yes, for whom is it beneficial?
59:27
SPEAKER_01: At what time point do you want to administer it?
59:29
SPEAKER_01: What dose?
59:30
SPEAKER_01: What all that stuff?
59:31
SPEAKER_01: And so, you know, like I would not start taking rapamycin for ovarian function, but that's a really promising area of research.
59:39
SPEAKER_01: And, you know, we'll get to an answer there soon.
59:42
SPEAKER_01: And there's like dozens of things like that.
59:44
SPEAKER_00: Are there things that we don't yet have enough clinical data on, but don't have the same level of risk that like ingesting a molecule or injecting something has that because I think people will often, you know, everyone has their own choice to do what they want with their body?
1:00:01
SPEAKER_00: And I think sometimes we're beholden to this very slow process of approval of anything in medicine that we there's an argument to be made that if you wait for everything to be FDA approved, then you might actually just be accumulating loss of function for too long.
1:00:20
SPEAKER_00: Like are there things other than the obvious that we suspect might work with little risk?
1:00:25
SPEAKER_01: No.
1:00:26
SPEAKER_01: I mean, it's all the obvious stuff.
1:00:28
SPEAKER_01: Like uh, you know, it's um it's uh it's how you move your body.
1:00:31
SPEAKER_01: And and you, I mean, if you're female, you need to pay attention to if you're still cycling, you need to pay attention to what part of your cycle you're in.
1:00:40
SPEAKER_01: And if you're postmenopausal, you need to pay more attention to bone and muscle in different places.
1:00:46
SPEAKER_01: And and and you know, so it's how you move your body, it's what you put into your body, and it's how how you interact with other people.
1:00:53
SPEAKER_00: What what do you feel about these um like cycle trackers that we have on wearables?
1:00:59
SPEAKER_00: Any degree of accuracy?
1:01:03
SPEAKER_01: Um I am delighted that um especially the the large trackers that uh everyone has um have started to pay attention to female physiology.
1:01:15
SPEAKER_01: Like thank God.
1:01:17
SPEAKER_01: And I think that we're we're gonna get a lot of information from that and probably a lot of actionable information over time.
1:01:24
SPEAKER_01: Um what we're missing is this kind of longitudinal large-scale data collection.
1:01:28
SPEAKER_01: And so it's happening, and I think we'll get there.
1:01:31
SPEAKER_01: I do not think that there's anything that I have seen in a digital tracker today that really gives you anything super actionable that's different from what we already knew.
1:01:41
SPEAKER_03: Right.
1:01:42
SPEAKER_01: But that doesn't mean that it's not coming online, and those things will happen much faster than like a drug, yeah, which is great.
1:01:48
SPEAKER_01: Um, but yeah, I I um I think there's I mean, there's a there's again like a risk reward system here.
1:01:57
SPEAKER_01: And um, you know, waking up and checking your app to see how well you slept is generally speaking net negative, right?
1:02:06
SPEAKER_01: Like I know so many people who yeah, I I yeah, yeah.
1:02:10
SPEAKER_01: Um but I I think that for for female physiology, because we have this deficit of data, like the more the better.
1:02:18
SPEAKER_00: Yeah.
1:02:20
SPEAKER_00: Yeah, I guess it can be at times counterproductive as well if the action like some of the wearables and like we encourage wearable use for a number of reasons, but like I don't personally personally wear them because I it I find it frustrating when I haven't had a good night's sleep.
1:02:35
SPEAKER_01: Yeah, I can high I mean I'm uh can really like obsess about things.
1:02:40
SPEAKER_00: And I think but what I've noticed is that some of them are now making more recommendations, but could they be counterproductive if it's not all that accurate?
1:02:52
SPEAKER_01: I mean, so in general, probably not to be fair.
1:02:55
SPEAKER_01: I I am not an expert in um in what wearables are doing right now.
1:03:01
SPEAKER_01: I um I am in contact with several of those companies, and I think that they are putting real real resources behind this idea that that males and females are different, and I think they have a lot of like historic data, like a treasure trove of historic data that they can mine.
1:03:19
SPEAKER_01: Yeah, and then they're being more thoughtful going forward about their prospective data collection.
1:03:23
SPEAKER_01: And so kudos to them.
1:03:25
SPEAKER_00: Yeah, which is great to know.
1:03:26
SPEAKER_00: And and they're doing something that is unaffordable in research, like to do that kind of study is yeah, a long time, a lot of money.
1:03:34
SPEAKER_00: And so we do want people wearing them.
1:03:36
SPEAKER_01: We definitely do, yeah.
1:03:37
SPEAKER_01: We do.
1:03:38
SPEAKER_01: We do.
1:03:38
SPEAKER_01: I wear them sometimes.
1:03:39
SPEAKER_00: And some people actually like get real benefit from them.
1:03:42
SPEAKER_01: Definitely.
1:03:43
SPEAKER_01: I mean, I think for I I mean, for like when I'm working out, having a one of those wearables on is is really tell me about your workout regime.
1:03:50
SPEAKER_01: Oh god.
1:03:52
SPEAKER_01: Um I run, but not as a serious runner.
1:03:56
SPEAKER_01: I run for like cardiovascular health, which means that I'm not a fast runner.
1:04:01
SPEAKER_01: Yeah, I'm not a long distance runner.
1:04:03
SPEAKER_01: Um, but for me, that's like the easiest way to get my heart rate up.
1:04:06
SPEAKER_01: And it's also the easiest way to like bring it up and down.
1:04:09
SPEAKER_00: Yep.
1:04:09
SPEAKER_00: Yep.
1:04:10
SPEAKER_01: Um, I I love to do Pilates, machine Pilates.
1:04:14
SPEAKER_00: Um like a reformer?
1:04:16
SPEAKER_01: Yeah, on a reformer or you know, a Ligree or whatever.
1:04:20
SPEAKER_00: Um I embarrassed myself at a reformers class very recently.
1:04:23
SPEAKER_01: Oh, that's good.
1:04:27
SPEAKER_01: Really?
1:04:28
SPEAKER_01: Well what's so hard about it?
1:04:30
SPEAKER_00: Just grace in general.
1:04:32
SPEAKER_00: I had none.
1:04:33
SPEAKER_00: And just holding specific poses.
1:04:36
SPEAKER_00: I'm just not built that way.
1:04:38
SPEAKER_01: You really have to learn which muscles are permissive and which ones are not.
1:04:42
SPEAKER_01: Because if you're watching someone else, you might go a little too far and that can be catastrophic.
1:04:46
SPEAKER_00: Yeah.
1:04:47
SPEAKER_01: Um bits for like two days.
1:04:50
SPEAKER_01: Uh well, yeah.
1:04:51
SPEAKER_01: But you should go back.
1:04:53
unknown: Maybe.
1:04:55
SPEAKER_01: Uh, and I do yoga.
1:04:57
SPEAKER_01: Um, and then I ski.
1:04:59
SPEAKER_01: You know, I do a lot of things that are I like to walk.
1:05:01
SPEAKER_01: Like when I'm in a city, I try to walk when I can.
1:05:04
SPEAKER_01: Um and uh I love to ski.
1:05:07
SPEAKER_00: Do you and Zach work out together?
1:05:09
SPEAKER_01: Never.
1:05:10
SPEAKER_00: Is there anything that you do based on your research, like this that your your own personal um healthcare routine?
1:05:21
SPEAKER_00: Is there anything that you don't do that you would recommend that other people do?
1:05:26
SPEAKER_01: Well, I don't go to the doctor as often as I should.
1:05:30
SPEAKER_01: Um let's see.
1:05:37
SPEAKER_01: I don't I mean, actually I've been much better at um taking time away from work and just like focusing entirely on me.
1:05:48
SPEAKER_01: I've been better about that, but historically um I was very bad at separating work from uh downtime.
1:05:54
SPEAKER_03: Yeah.
1:05:55
SPEAKER_01: Um and I, you know, I religiously tell people that they should do self care.
1:06:00
SPEAKER_01: And uh take down time and and even to my employees, like I actively encourage them to take time off.
1:06:06
SPEAKER_01: And have I taken time off in the last year?
1:06:10
SPEAKER_01: Um no.
1:06:12
SPEAKER_00: Preaching to the choir.
1:06:14
SPEAKER_01: Yeah.
1:06:15
SPEAKER_00: What's one piece of women's health advice that's become widely accepted, but you don't think is really backed by any good evidence?
1:06:24
SPEAKER_01: I think that there's a push right now to um to think about women's health through and and especially female performance through the four four phases of the cycle.
1:06:38
SPEAKER_01: And that, you know, that four-phase thing, that's like that's like thinking from the 50s, you know, like that's really dated, sort of out of date thinking.
1:06:51
SPEAKER_01: And so whenever I hear someone, especially someone who has a platform um who has a loud voice saying, like, you gotta, you gotta pivot your exercise routine around the four phases, I'm like, well, actually it's it's quite it's more nuanced than that.
1:07:08
SPEAKER_01: And we have a lot more data now to to understand like fluctuations and how things, um, how things move.
1:07:16
SPEAKER_01: And and there might be a lot more rich information that you can get about yourself.
1:07:21
SPEAKER_01: So this is something that you can do today, right, with those trackers is so you can really understand on a day-to-day, even on the same day, how things change and um calibrate your own workout routine or whatever, um, the way you live your life to that in a way that is a lot more nuanced and higher resolution than the four phases of the cycle.
1:07:43
SPEAKER_01: So that drives me bad.
1:07:44
SPEAKER_01: It just drives me baddie when I hear it like pronounced as though that's some huge insight.
1:07:50
SPEAKER_01: Um, and it's pretty misleading.
1:07:52
SPEAKER_01: And there are um smaller voices who don't have platforms who are, you know, essentially putting forward really great information about this kind of stuff, which I'm happy to share.
1:08:02
SPEAKER_00: I would love you to.
1:08:03
SPEAKER_00: I mean, I the I I think I probably got some slightly archaic thinking about that.
1:08:07
SPEAKER_00: I'd love to learn more, you know.
1:08:10
SPEAKER_00: Um and I think such a good point is that, you know, even if that were to be true, it would be different for different people.
1:08:17
SPEAKER_01: Different for everybody.
1:08:18
SPEAKER_00: And we now have the agency to kind of run our own N of one.
1:08:22
SPEAKER_01: Exactly.
1:08:22
SPEAKER_01: And why wouldn't you?
1:08:23
SPEAKER_00: Yeah, yeah.
1:08:24
SPEAKER_01: Yeah.
1:08:24
SPEAKER_00: Yeah.
1:08:25
SPEAKER_00: And I think the same applies across all aspects of performance and aging, is like we we're getting more agency now, right?
1:08:31
SPEAKER_00: And so we don't have to rely on just like big longitudinal studies making suggestions about any element of our life without testing for it.
1:08:40
SPEAKER_00: Just have to wear the wearable.
1:08:44
SPEAKER_00: Um we touched on um, you know, going for a a CV screen earlier in life, um, or even doing it at all.
1:08:56
SPEAKER_00: Are there other tests, biomarkers, panels that that we could recommend that you do earlier in life, specifically for women's health?
1:09:06
SPEAKER_01: I mean, I think that um, and again, I'm I'm not a physician, so take all of this with a big grain of salt.
1:09:13
SPEAKER_02: Okay.
1:09:13
SPEAKER_01: I think that it's very clear that you know, ovarian function starts to decline in a woman's 20s, right?
1:09:20
SPEAKER_01: So much earlier than what we typically think of as aging.
1:09:24
SPEAKER_01: And so the message to young women is important to broadcast that they should start paying attention.
1:09:32
SPEAKER_01: You know, we do have agency to monitor our cycles, to pay attention to our bodies in ways that maybe we didn't 10 or 15 years ago.
1:09:40
SPEAKER_01: And so the earlier you start that and the earlier for women, like understanding what your normal is, really like paying attention to your body across time is is probably the most important and most powerful thing that you can do.
1:09:55
SPEAKER_01: And so the earlier you start that, the better.
1:09:58
SPEAKER_01: And there certainly are signals that can be measured um early, meaning like in childhood, even.
1:10:07
SPEAKER_01: You know, some doctors, people who are on your advisory committee, people like Kara Goldman, will tell you that when someone comes to her office, you know, she's often, she's a reproductive endocrinologist, she's often seeing people for infertility in their 30s.
1:10:20
SPEAKER_01: She'll tell you that there were there were signs, you know, in their, in their blood work, in their, there were signs much earlier that could have been caught.
1:10:31
SPEAKER_01: Um, and that's because, you know, I didn't, I didn't touch on this before, but ovarian function is really tightly linked to both immune function and metabolic function.
1:10:40
SPEAKER_01: And so we don't understand those relationships.
1:10:43
SPEAKER_01: But what we do know is, for example, women who have PMOS, which is what we're calling what used to be called PCOS.
1:10:50
SPEAKER_03: Yeah.
1:10:50
SPEAKER_01: Women who have PCOS are much more likely, they have a much higher risk of having metabolic disease later in life.
1:10:56
SPEAKER_01: And they pass that increased risk on to their offspring, to their kids, both males and females.
1:11:04
SPEAKER_01: So there's a through line there, like a genetic through line that's important for both males and females.
1:11:09
SPEAKER_01: And that's true for many things in female physiology.
1:11:11
SPEAKER_01: Like if we figure it out in females, it will have a beneficial effect on males.
1:11:15
SPEAKER_01: But that link between ovarian function and metabolism is really clear.
1:11:19
SPEAKER_04: Yeah.
1:11:19
SPEAKER_01: And so you, if you spot like metabolic dysfunction early in life, that that could be like a like a sign or a signal that that you might be predisposed to maybe like ovaries aging faster, right?
1:11:33
SPEAKER_01: Which could be measured.
1:11:34
SPEAKER_01: So there's a lot of things.
1:11:35
SPEAKER_01: And and I I think it comes down to making sure that you're working with physicians who understand that, and then um paying attention to your body.
1:11:44
SPEAKER_01: Like again, here I am telling you to do something that I don't do myself very well.
1:11:49
SPEAKER_00: Yeah.
1:11:50
SPEAKER_01: Yeah.
1:11:50
SPEAKER_00: I think that there are so many things that I I've chat, I I've spoken to the our guests about, and I preach as well, that we know we should be doing, but it's hard to weave into your life in a way that you can do consistently.
1:12:07
SPEAKER_00: And and that is the big problem, I think.
1:12:10
SPEAKER_00: Is like I don't think it anyone listening will think anything other than they should exercise more or or eat nutrient-dense foods or find time to you know optimize for sleep and stress.
1:12:21
SPEAKER_00: That's the knowledge that it's important, isn't the problem.
1:12:24
SPEAKER_00: It's how do how do I get myself to do the thing?
1:12:26
SPEAKER_01: I think, I mean, for me, it's like what works for me is um is like baby steps.
1:12:32
SPEAKER_01: Yeah.
1:12:32
SPEAKER_01: Like you just like I'm tomorrow, I am definitely gonna take five minutes, like literally five minutes, between the time when I wake up and I touch a phone or any kind of like computer, any electronic device.
1:12:46
SPEAKER_01: I'm gonna take five minutes.
1:12:48
SPEAKER_01: It doesn't have to be more than five minutes, but just five minutes to like sit quietly and you know, for me, meditate, but could just be like think about my day or or do something.
1:13:00
SPEAKER_01: And similarly for exercise, like five minutes.
1:13:03
SPEAKER_00: Yeah, I do this.
1:13:03
SPEAKER_00: I said this five minutes.
1:13:04
SPEAKER_00: I said this to Darcy, yes.
1:13:06
SPEAKER_00: Really?
1:13:06
SPEAKER_00: Yeah.
1:13:06
SPEAKER_00: Oh just carving.
1:13:07
SPEAKER_00: She didn't tell me that.
1:13:08
SPEAKER_00: Yeah, just carving out a very low barrier to entry is works for me because quite often that five minutes will turn into 10, 20.
1:13:17
SPEAKER_01: Yeah.
1:13:17
SPEAKER_00: Very rarely more than 30.
1:13:18
SPEAKER_01: But but for you, like what you should do since you had so much trouble with the Pilates is um take five minutes and do like the what you need is um more flexibility in your hips and do some of those, like sitting on the floor.
1:13:31
SPEAKER_00: Mobility work.
1:13:32
SPEAKER_01: Yeah, mobility work.
1:13:34
SPEAKER_00: I think you're probably right.
1:13:35
SPEAKER_00: If you had unlimited resources, funding, headcount, time, what's the number one question you'd like to answer in your field of research?
1:13:48
SPEAKER_01: I mean, that's what I'm doing right now.
1:13:50
SPEAKER_01: Um it's it's how and why do ovaries age faster?
1:14:00
SPEAKER_01: That's the key question for female health.
1:14:02
SPEAKER_01: Yeah.
1:14:03
SPEAKER_00: Is there a test?
1:14:04
SPEAKER_00: I don't know if I've already asked this, but I'm gonna ask it anyway.
1:14:07
SPEAKER_00: Is there a single test or a suite of tests for ovarian function?
1:14:14
SPEAKER_00: Like to say like this is how I mean we have some proxies.
1:14:17
SPEAKER_00: How do you know?
1:14:18
SPEAKER_01: No, this is, I mean, this is where we're at.
1:14:20
SPEAKER_01: That like this is the state of the science.
1:14:22
SPEAKER_01: It's um, it's primitive, like especially how it's applied.
1:14:26
SPEAKER_01: Um, we we don't know anything, therefore we have very few like tools at our disposal.
1:14:32
SPEAKER_01: And so for measuring ovarian function, we have a lot of proxies.
1:14:35
SPEAKER_04: Yeah.
1:14:36
SPEAKER_01: And um, they're the things that you already know about.
1:14:38
SPEAKER_01: They're things like AMH levels or hormone levels or folcle count or um, you know, like uh what else?
1:14:47
SPEAKER_01: Metabolic panels.
1:14:48
SPEAKER_01: Like those are the kinds of things that we have available right now.
1:14:51
SPEAKER_01: And and so biomarker um development and diagnostic tools are, I would say maybe the lowest hanging fruit.
1:14:58
SPEAKER_01: Right.
1:14:59
SPEAKER_01: And so those are the things that we'll get to first.
1:15:01
SPEAKER_01: Yeah.
1:15:01
SPEAKER_01: And then that will help us better characterize populations of women.
1:15:05
SPEAKER_01: And then what we really need are these longitudinal data sets.
1:15:08
SPEAKER_01: And we need to capture information that hasn't historically been captured.
1:15:13
SPEAKER_01: Like age at natural menopause is the differentiator, meaning, like people call female data sets noisy, right?
1:15:22
SPEAKER_01: Because there's so much variability.
1:15:23
SPEAKER_01: But that's because we use chronological age as the way to bin the data, as like the ground truth.
1:15:30
SPEAKER_01: And chronological age is meaningless when you have this huge variability.
1:15:35
SPEAKER_01: So age and natural menopause, when you bin data around, when you use that as ground truth in a data set, it cleans it all up and you get these sharp signatures.
1:15:44
SPEAKER_01: There's a study that's going to be published in a couple of weeks where they were able to go into um historic data sets.
1:15:52
SPEAKER_01: So, like the Swan study, all these beautiful large-scale data sets that we have already where they didn't capture this information.
1:15:59
SPEAKER_01: And they're able to intuit agent natural menopause, and that it cleaned up the data in ways that are like mind-blowing.
1:16:10
SPEAKER_04: Really?
1:16:10
SPEAKER_01: Mind-blowing.
1:16:11
SPEAKER_01: Um, I just saw this presented um at a conference uh a few weeks ago, and it's it's really gonna change things.
1:16:17
SPEAKER_00: How do you feel about measuring age in any way other than chronologically?
1:16:24
SPEAKER_00: Because we're being, you know, we're being sold a lot of different tools or tests by which companies are hanging their hat on.
1:16:32
SPEAKER_00: And I am not convinced right now.
1:16:35
SPEAKER_00: I think this is incredibly promising.
1:16:37
SPEAKER_00: And I think in in a research setting, I think it can be um much more valuable.
1:16:43
SPEAKER_00: But as a consumer, like being told you're biologically anything feels a bit of an overreach.
1:16:49
SPEAKER_01: No, I think you're wrong.
1:16:50
SPEAKER_01: Do you?
1:16:51
SPEAKER_01: I'm just kidding.
1:16:52
SPEAKER_01: I totally agree with you.
1:16:53
SPEAKER_01: Right.
1:16:54
SPEAKER_01: Oh, okay.
1:16:54
SPEAKER_01: You got me there.
1:16:55
SPEAKER_01: I think I think that I mean, I I'm sure you've heard this before, but I think that um the question is whether we can measure molecular or cellular features that tell us something about your rate of aging, right?
1:17:09
SPEAKER_01: That's what we're saying.
1:17:10
SPEAKER_03: Yeah.
1:17:11
SPEAKER_01: And I think the answer is probably yes.
1:17:14
SPEAKER_01: However, I don't think we have yet enough data to say what it means.
1:17:19
SPEAKER_01: And so these are like there's so many ways to measure cellular and molecular features that change with age.
1:17:26
SPEAKER_01: And we're basically we're at the point where we have so many tools that are good for research.
1:17:31
SPEAKER_01: But at the level of the individual, like at a population level, that data is really clear.
1:17:36
SPEAKER_01: But then when you go down to like Chris, when you take this biological age test today and then you take it again tomorrow.
1:17:44
SPEAKER_01: Yeah, yeah, yeah.
1:17:45
SPEAKER_01: Um, and it's just it's at the level of an individual, it's just stochastic noise.
1:17:50
SPEAKER_01: And so I do not like I think that probably if you were to live your life based on your horoscope, that would be much more likely to hit than using a biological age test to tell you about your rate of aging right now.
1:18:05
SPEAKER_00: Yeah.
1:18:06
SPEAKER_01: But I think that in the future that might change, right?
1:18:08
SPEAKER_00: So I agree.
1:18:09
SPEAKER_00: I love it conceptually because it would be incredible to know.
1:18:12
SPEAKER_00: And we know that you know, different systems of biology age at a different rate, or we suspect that across the board.
1:18:18
SPEAKER_00: But like if you were to if I did one today and it said you're biologically 40, and then I did everything right for the next six months, and it said you're biologically 45, just because of a variation in you know the test itself, it'd be incredibly disheartening.
1:18:35
SPEAKER_01: Yeah, it's a variation in you, right?
1:18:37
SPEAKER_01: Yeah, like I had a drink last night, so today my biological age would probably measure a lot lower than it did yesterday.
1:18:44
SPEAKER_00: Or if you're jet lagged or if you're stressed, or yeah.
1:18:47
SPEAKER_01: Yeah.
1:18:48
SPEAKER_01: Um, but that's not to say that we won't get there.
1:18:51
SPEAKER_01: Yeah, I think it's a laudable goal, and I think we're like well on our way.
1:18:55
SPEAKER_01: There's so many, but yeah, I don't think it's consumer ready yet.
1:18:59
SPEAKER_00: Yeah.
1:19:00
SPEAKER_00: What what fills you with the most optimism about the future of your field?
1:19:05
SPEAKER_01: Um, when I started, uh, like I said, I was I was kind of shocked at how little information there was to know.
1:19:12
SPEAKER_01: There has been a revolution in the number of people who are working in the space.
1:19:18
SPEAKER_01: And there is more funding, right?
1:19:20
SPEAKER_01: I mean, I hope we helped a lot.
1:19:22
SPEAKER_01: I hope we seeded the field um with the grants that we gave away.
1:19:26
SPEAKER_01: And now there are other larger funders, foundations, and who are coming in to fill those gaps.
1:19:33
SPEAKER_01: And I think that all of the movement is in a positive direction, which is great.
1:19:38
SPEAKER_01: Um, for me, I I'm really heartened by the fact that like you're even having this conversation with me, right?
1:19:44
SPEAKER_01: Like that people are talking about it and that that we're, you know, as a society, we're coming into a space where, you know, the acknowledgement that sex differences matter in medicine, like for men too, like it really matters.
1:19:58
SPEAKER_01: Um that that that's an important component.
1:20:01
SPEAKER_01: I think that's gonna really rev revolutionize things going forward.
1:20:05
SPEAKER_01: So it's all, you know, it's I and and you know, I I'm right now working on um the thing I want to see in the world.
1:20:14
SPEAKER_01: And I'm I'm you know, I'm very bullish about it.
1:20:17
SPEAKER_01: It's gonna be great.
1:20:18
SPEAKER_01: Yeah, yeah.
1:20:19
SPEAKER_00: So I'm gonna ask you two questions to finish.
1:20:22
SPEAKER_01: Okay.
1:20:23
SPEAKER_00: If you had 60 seconds to talk to all of the women in their early 20s now and give them like one high-level takeaway, one thing that you'd want them to know, what would that be?
1:20:38
SPEAKER_01: I would want them to know that their ovaries are important now, not just for baby making.
1:20:43
SPEAKER_01: They're more than just egg factories.
1:20:45
SPEAKER_01: They are quite literally defining their health across the rest of their life, and that they need to pay attention to them.
1:20:52
SPEAKER_01: So that they need to like pay attention to their body, figure out what what's normal for them, find doctors that that they trust and who are educated and who are constantly, you know, this is an area that's changing so fast that are constantly continuing their education.
1:21:11
SPEAKER_02: Yeah, yeah.
1:21:12
SPEAKER_01: Um, and to like, and to not let anyone gaslight them, right?
1:21:16
SPEAKER_01: To like, to really turn it around.
1:21:19
SPEAKER_01: Um, because yeah, because they're in a position, an enviable position.
1:21:24
SPEAKER_01: I never had this opportunity.
1:21:25
SPEAKER_01: They're in this enviable position where they can really, really establish their baseline and then they can see when they deviate from it, right?
1:21:33
SPEAKER_01: And I think that makes a huge difference.
1:21:35
SPEAKER_01: And most women don't start thinking about their ovaries until they start to experience challenges like fertility, for example.
1:21:42
SPEAKER_01: And by then it's often way too late.
1:21:44
SPEAKER_01: Yeah.
1:21:45
SPEAKER_01: So so it's the young women who have like the best and most exciting future here.
1:21:49
SPEAKER_00: Yeah, knowledge is power for them for sure.
1:21:51
SPEAKER_00: What about the same question?
1:21:53
SPEAKER_00: But for oh women that are older, you know, women that have either, you know, reached menopause or even, you know, decades older than that.
1:22:01
SPEAKER_00: We discussed this off camera.
1:22:02
SPEAKER_00: Like our parents didn't have this information, right?
1:22:06
SPEAKER_00: They didn't have access to this.
1:22:08
SPEAKER_00: But so many of these things, you know, it is never too late.
1:22:12
SPEAKER_01: It's never too late.
1:22:13
SPEAKER_01: Um, and for, you know, people just in general.
1:22:18
SPEAKER_01: I mean, I don't know about you, but as I like click through the decades, I feel like, and I'm 50, right?
1:22:25
SPEAKER_01: So I feel like every decade is better than the last.
1:22:28
SPEAKER_03: Yeah.
1:22:29
SPEAKER_01: And I felt that about my 40s, and I'm super excited about my 50s.
1:22:32
SPEAKER_01: And I do feel like I have crossed into some kind of like wise person realm.
1:22:38
SPEAKER_01: I don't know how to explain it, but I do feel like, you know, people in their 70s and 80s and 90s have an incredible wealth of like knowledge and know-how and just being in the world.
1:22:52
SPEAKER_01: And um, I see, you know, one of my closest friends is 90.
1:22:57
SPEAKER_01: She's 90 and she is, she is vital and spry, and she lives by herself, and she is like, my life goal is to be like her.
1:23:05
SPEAKER_03: Yeah, yeah.
1:23:06
SPEAKER_01: But the things that she's done to maintain that are um, you know, she, I mean, she makes friends with younger people because a lot of the people that she had in her life are gone.
1:23:15
SPEAKER_01: Yeah.
1:23:16
SPEAKER_01: She maintains those social connections.
1:23:17
SPEAKER_01: Um, but my my I'm sorry, I'm I'm really just gone all over the place.
1:23:22
SPEAKER_01: But uh for older women in particular, I think it's important to point out that, you know, if they didn't take hormone therapy, because a lot of women were either taken off of it or advised not to take it, um, that there are other things to be done, right?
1:23:39
SPEAKER_01: Like you can increase muscle mass and and cardiovascular output and and you can increase all of those things uh at any age.
1:23:47
SPEAKER_01: And, you know, there is like quite there's so much data to to support the idea that like it doesn't matter how old you are, you can make improvements in your life.
1:23:57
SPEAKER_01: And they are um there are ongoing studies to to ask the question, like, can you start hormone therapy later?
1:24:07
SPEAKER_01: And the answer is we don't know.
1:24:09
SPEAKER_01: So there were, you know, small studies and data that suggested that starting hormone therapy 10 years after menopause or beyond might be detrimental.
1:24:18
SPEAKER_01: But there's more recent data, and again, levels of evidence.
1:24:22
SPEAKER_01: I'd say it's down here right now.
1:24:23
SPEAKER_01: And so it's kind of it's like it's like this.
1:24:27
SPEAKER_01: But as the large-scale studies happen, we'll get an answer.
1:24:31
SPEAKER_01: But the question is, you know, I think, can you start hormone therapy later?
1:24:35
SPEAKER_01: And I think for some people the answer will be yes.
1:24:37
SPEAKER_00: Yeah.
1:24:37
SPEAKER_01: And so, you know, there's there's a lot happening.
1:24:40
SPEAKER_00: Huh.
1:24:41
SPEAKER_00: What a time to be alive.
1:24:43
SPEAKER_01: Yeah.
1:24:43
SPEAKER_00: Jen.
1:24:44
SPEAKER_00: That's the end of my questioning.
1:24:46
SPEAKER_00: But what we like to do is add a question from the audience.
1:24:50
SPEAKER_00: Oh, okay.
1:24:50
SPEAKER_00: I have a family history of breast cancer.
1:24:53
SPEAKER_00: I'm in a high risk category.
1:24:55
SPEAKER_01: Yeah.
1:24:55
SPEAKER_00: Should I still consider hormonal therapy?
1:24:58
SPEAKER_01: I am not a medical doctor, and I'm not going to give medical advice.
1:25:01
SPEAKER_01: Yeah.
1:25:02
SPEAKER_01: But there is data um looking at just that question.
1:25:06
SPEAKER_01: And um what the data shows is that hormones do not cause cancer.
1:25:15
SPEAKER_01: However, there are types of cancer that um are especially sensitive to hormones where hormones can increase the rate of growth.
1:25:24
SPEAKER_01: And so it's a very like complex question.
1:25:28
SPEAKER_01: And so there are um, I would say that's a conversation to have with your doctor.
1:25:35
SPEAKER_04: Yeah.
1:25:35
SPEAKER_01: But there are studies and there's clear data showing that women who have had breast cancer in the past can safely take hormone therapy.
1:25:44
SPEAKER_01: But again, like this is a really nuanced question.
1:25:47
SPEAKER_01: Nuanced and individual.
1:25:49
SPEAKER_01: Individual and and hormone therapy is not for everyone.
1:25:52
SPEAKER_01: That's another important thing to say.
1:25:53
SPEAKER_01: I will also say that, you know, as someone who is on hormone therapy, it is so it takes forever to find the right combination for you.
1:26:04
SPEAKER_01: And a lot of women start it, get some side effects, and then stop it.
1:26:08
SPEAKER_01: And that's thinking that it's not for them.
1:26:10
SPEAKER_01: Yeah.
1:26:10
SPEAKER_01: Yeah, it takes, it's really, you have to be, you have to persevere.
1:26:14
SPEAKER_00: I'm gonna ask one more.
1:26:15
SPEAKER_00: At what age should I start thinking about testing for fertility?
1:26:21
SPEAKER_00: I'm 23.
1:26:23
SPEAKER_01: Um, I think that it's probably good to get your baseline as early as possible.
1:26:28
SPEAKER_01: Because again, so many women, a lot of women, don't know that there's, you know, don't think about their ovaries until they they come to a health challenge.
1:26:37
SPEAKER_01: And um, you know, primary ovarian insufficiency, you could be 20 and you know, you wouldn't know that you're infertile unless you checked.
1:26:48
SPEAKER_01: Um, so for some women it it happens a lot earlier than than for others, and it's you know, so it's worth checking.
1:26:56
SPEAKER_00: I think that's that applies across so many aspects of biology that like we these things start happening upstream of symptoms or like the ability to to even diagnose, right?
1:27:11
SPEAKER_00: And so encouraging people with some degree of urgency without gaslighting them ourselves to to like take care of themselves because yeah, it we we have to be able to we have to do this upstream of and of feeling ill.
1:27:26
SPEAKER_00: And so many of the the interventions, treatments that we apply to people are to treat disease and illness, not to prevent it.
1:27:34
SPEAKER_01: That's right.
1:27:35
unknown: Yeah.
1:27:35
SPEAKER_01: I think that you know, we don't we don't necessarily have like a solution.
1:27:40
SPEAKER_04: Yeah.
1:27:40
SPEAKER_01: Um, however, I think that knowledge is power.
1:27:43
SPEAKER_01: And if you know when you're 23 that you might, you know, have an accelerated ovarian aging profile, or that you might, you know, be experiencing some things that could impact your fertility, that at least gives you information to to like plan your life.
1:27:58
SPEAKER_00: Yeah, yeah.
1:27:59
SPEAKER_01: And then you can determine you might make decisions differently, yeah, knowing that than you would otherwise.
1:28:04
SPEAKER_00: Yeah, agreed.
1:28:05
SPEAKER_00: Jen, where can people find out more about what you do?
1:28:08
SPEAKER_01: Oh, um, that's an interesting question.
1:28:12
SPEAKER_00: The living room podcast.
1:28:14
SPEAKER_01: The living room podcast is a great place.
1:28:16
SPEAKER_01: Yeah, we can put it in the show notes.
1:28:18
SPEAKER_00: We're we're we'll we'll add we'll add some bits to the show notes in general.
1:28:21
SPEAKER_00: Yeah.
1:28:21
SPEAKER_00: Hey, this was both enlightening and a privilege.
1:28:25
SPEAKER_00: Like I think every day is a school day for me, at least specifically on this as a topic.
1:28:29
SPEAKER_00: And so thank you so much for coming in.
1:28:31
SPEAKER_04: Yeah, of course.
1:28:32
SPEAKER_00: We we could speak for hours on this.
1:28:34
SPEAKER_04: We could thank you for coming.
1:28:36
SPEAKER_00: It was um I hope that that's that's uh something that everyone can take something away from.
1:28:42
SPEAKER_01: Yeah, it was great.
1:28:43
SPEAKER_01: Thank you.
1:28:43
SPEAKER_00: And we're having you back for a very special episode in the not too distant future.