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GLP-1s and Metabolic Health: Beyond The Weight Loss Hype with Aleksandra Gajer · The Menopause Disruptor Podcast

• 0:00
  SPEAKER_00: We're not going to just put you on the drug and say, good luck, come back in three to six months with a whole bunch with losing a whole bunch of muscle and loose skin and all of that.
• 0:10
  SPEAKER_00: Not everybody wants that kind of experience, but our women get healthier.
• 0:16
  SPEAKER_00: And we do body composition scans along the way, and everyone gains muscle or at least maintains it because I think it's not a worthwhile tool if it's going to cause loose skin or loss of muscle.
• 0:29
  SPEAKER_00: So we use it very carefully and put it in a category that's reserved for people who are willing to work with us in that way.
• 0:40
  Mary Lee: What if the secret to healthy aging isn't about chasing youth, but understanding our biology and learning how to work with it rather than against it.
• 0:52
  Mary Lee: Welcome back to the Menopause Disruptor Podcast.
• 0:55
  Mary Lee: I am your host, Mary Lee.
• 0:57
  Mary Lee: This is the podcast where my guests and I are challenging outdated narratives around aging and hormonal health.
• 1:04
  Mary Lee: One conversation at a time.
• 1:06
  Mary Lee: So if you are new here, welcome to this show.
• 1:09
  Mary Lee: Glad to have you join in.
• 1:12
  Mary Lee: For so many women, midlife can feel like someone has quietly changed the operating manual for our body without giving us the updated version.
• 1:21
  Mary Lee: Our hormones shift, our metabolism changes, and the strategies that once worked for managing our weight and our energy, as well as overall health, suddenly seem to stop delivering.
• 1:33
  Mary Lee: But what if this stage of life is actually an invitation to become more proactive about our health rather than simply reacting to symptoms?
• 1:42
  Mary Lee: My guest today is Dr.
• 1:43
  Mary Lee: Alexandra Geier, the founder of the Geier Practice, a physician whose journey from emergency medicine to personalized preventative health care reflects a fundamental shift in how we might approach health and longevity.
• 1:57
  Mary Lee: Originally from Poland and raised in the United States, Dr.
• 2:00
  Mary Lee: Geier graduated with top honors from the University of Maryland School of Medicine and completed her residency in academic emergency medicine at George Washington University.
• 2:12
  Mary Lee: After witnessing the consequences of chronic disease in emergency medicine, she became increasingly passionate about helping people address their health concerns before they escalate.
• 2:23
  Mary Lee: And today, her work focuses on sustainable weight management, hormone health, metabolic wellness, and longevity, helping patients understand their unique biology and make informed decisions about their health.
• 2:38
  Mary Lee: We're exploring what it means to age well, why weight management is about so much more than willpower, and how personalized health care can help women navigate the hormonal and metabolic transitions of midlife.
• 2:53
  Mary Lee: We'll also talk about personal power when it comes to aesthetics and taking care of our skin, as well as some vital supplements to help us age wisely and healthy.
• 3:04
  Mary Lee: Menopause isn't the beginning of the end.
• 3:06
  Mary Lee: It just might be that wake-up call we need to start investing in our future.
• 3:10
  Mary Lee: And I think this conversation is gonna inspire you to do just that.
• 3:15
  Mary Lee: So let's get right into it.
• 3:17
  Mary Lee: Please join me in welcoming Dr.
• 3:19
  Mary Lee: Alexandra Geyer to the Menopause Disruptor Podcast.
• 3:29
  Mary Lee: Dr.
• 3:30
  Mary Lee: Alexandra Geyer, welcome to the Menopause Disruptor Podcast.
• 3:33
  Mary Lee: Very happy to have you here today.
• 3:35
  SPEAKER_00: Thank you so much.
• 3:36
  SPEAKER_00: Thanks for having me.
• 3:38
  Mary Lee: Let's just dive in right away.
• 3:40
  Mary Lee: Your backstory.
• 3:41
  Mary Lee: You trained in academic emergency medicine where you were often seeing people at a crisis point.
• 3:47
  Mary Lee: What did you witness in the ER that ultimately led you to move more upstream and focus on prevention?
• 3:56
  SPEAKER_00: Great question.
• 3:57
  SPEAKER_00: I was drawn to emergency medicine because I felt like traditional medicine or conventional medicine was good at fixing acute injuries, you know, the people who were in a car wreck or had broken an arm.
• 4:12
  SPEAKER_00: And um I also really liked being at ground zero with patients.
• 4:18
  SPEAKER_00: There was something about that was very satisfying to me of just like really meeting people where they are, whatever they needed in their unplanned emergencies.
• 4:28
  SPEAKER_00: And I really enjoyed my training.
• 4:31
  SPEAKER_00: I loved being able to sort of serve in that way.
• 4:36
  SPEAKER_00: But I had my own level of burnout.
• 4:39
  SPEAKER_00: We have a healthcare system that is very dysfunctional.
• 4:43
  SPEAKER_00: And not only was I watching people come back over and over again with the same problems that were invariably getting worse, most of what we see in the emergency department is actually the result of chronic health conditions.
• 4:56
  SPEAKER_00: So high blood pressure, resulting in heart disease, congestive heart failure, COPD, kidney disease, diabetes.
• 5:05
  SPEAKER_00: This is what 85% of the time I was working with.
• 5:09
  SPEAKER_00: And even though I could patch people up and get them better from their episode, I would see them a month later, two months later, and they invariably got worse.
• 5:19
  SPEAKER_00: And I was working in a system that is inherently broken.
• 5:23
  SPEAKER_00: I think that my training very much tried to train empathy out of me.
• 5:30
  SPEAKER_00: And I really, I had this really strong calling to go into medicine to contribute something.
• 5:36
  SPEAKER_00: I wanted to do something meaningful.
• 5:38
  SPEAKER_00: And I felt like the further I went along, the harder it was to find meaning in my work.
• 5:44
  Mary Lee: Wow.
• 5:44
  Mary Lee: So Dr.
• 5:45
  Mary Lee: Geyer, is it a would you prefer Alexandra or Dr.
• 5:48
  Mary Lee: Geyer?
• 5:49
  SPEAKER_00: Alex is fine.
• 5:50
  Mary Lee: Alex, you mentioned a healthcare system that's broken.
• 5:54
  Mary Lee: We're waiting for people to become sick before we intervene.
• 5:58
  Mary Lee: But what's happening with a woman's body is the hormones are shifting and changing.
• 6:03
  Mary Lee: They're changing the biology of the brain, changing the biology of our entire body.
• 6:09
  Mary Lee: And yet we're still looking at it as though it's something that is broken.
• 6:13
  Mary Lee: The women are getting sick, but it's just a shift.
• 6:16
  Mary Lee: So, how do you take this approach of optimizing biology or hormone health in simple terms so we can treat women for the whole person that they are rather than it being something to fix or a disease?
• 6:30
  SPEAKER_00: Yeah.
• 6:30
  SPEAKER_00: Yeah.
• 6:31
  SPEAKER_00: I think one of the most important things to me is meeting a woman where she is.
• 6:35
  SPEAKER_00: I think that really a huge part of what I feel like I do is build a partnership with a woman.
• 6:43
  SPEAKER_00: And the most important things for me, especially in my initial visit with someone, is to understand what's important to you.
• 6:51
  SPEAKER_00: And I, if we're going to build a treatment plan, I think a lot of medicine is quite paternalistic.
• 6:59
  SPEAKER_00: And I don't want to sort of rag on conventional medicine because I think we've accomplished a lot in helping people live through cancer diagnoses and finding cures for a lot of chronic illnesses.
• 7:10
  SPEAKER_00: But medicine did grow up in this sort of paternalistic system.
• 7:15
  SPEAKER_00: It was mostly men.
• 7:17
  SPEAKER_00: And it the whole perception was let's find somebody, let's fix it.
• 7:21
  SPEAKER_00: And if they're complaining too much, let's get it, get them out of here.
• 7:24
  SPEAKER_00: So I think for myself and for the women that I treat, finding a little bit more of a feminine way to practice medicine and to understand the woman in front of me and what the biological changes are looking like in her life.
• 7:39
  SPEAKER_00: When we usually I end the initial intake visit with saying, you know, if we could wave a magic wand and make three things better in your life, what would make the biggest difference for you?
• 7:50
  SPEAKER_00: And I'm often surprised with the answers.
• 7:52
  SPEAKER_00: Sometimes we'll have talked so much about sleep and her weight, but then she's like, actually, I think number one is my libido.
• 7:59
  SPEAKER_00: I think it would make such a difference in my marriage.
• 8:02
  SPEAKER_00: I think it could save my marriage.
• 8:04
  SPEAKER_00: And then we look into her biochemistry to see how we can support you around that goal.
• 8:20
  Mary Lee: Wow.
• 8:21
  Mary Lee: You're touching on a very delicate topic, it's near and dear to me, personal to me.
• 8:26
  Mary Lee: I had this very same conversation with my family doctor, my GP.
• 8:30
  Mary Lee: And I said, you know, I've gone through the menopause transition.
• 8:33
  Mary Lee: I'm on the other side now, a couple of years without a menses, full postmenopausal and weight training and muscle, building muscle.
• 8:42
  Mary Lee: We can get into that.
• 8:43
  Mary Lee: It's very important to me.
• 8:45
  Mary Lee: But in the last couple of years, energy level has really declined.
• 8:50
  Mary Lee: And one of those areas of concern was libido.
• 8:54
  Mary Lee: To which, and I've heard these stories from guests on my pot my podcast before, from my friends, my colleagues, and then it happened to me.
• 9:02
  Mary Lee: Immediately thought that some counseling was required, and perhaps an SSRI.
• 9:10
  Mary Lee: What are we doing to a woman's confidence?
• 9:12
  Mary Lee: And what are we saying?
• 9:13
  Mary Lee: What is that message that we're delivering?
• 9:15
  Mary Lee: We immediately turn to this as being an emotional or a mental crisis rather than the changing biology of the body.
• 9:22
  SPEAKER_00: Right.
• 9:23
  SPEAKER_00: Absolutely.
• 9:24
  SPEAKER_00: I've worked with a lot of women who were offered an SSRI, an antidepressant for the variety of ways that perimenopause and menopause can show up.
• 9:36
  SPEAKER_00: And sometimes a depression is a factor, but I think that helping a woman understand what's happening with her body and helping her understand all her options and what that these things are very, very normal.
• 9:51
  SPEAKER_00: And we're actually blossoming into a new part of our life that can be so fulfilling and beautiful.
• 9:58
  SPEAKER_00: And I think my role is just partnering with a woman to help her reach her version of that.
• 10:05
  Mary Lee: Partnership.
• 10:06
  Mary Lee: That is key.
• 10:06
  Mary Lee: And I like when you said that meeting her where she's at and forming a partnership based on her, your patient's values.
• 10:14
  Mary Lee: And then designing, creating a treatment plan for the patient rather than these preconceived ideas in mind, or as you said, the pr paternalistic system that's already built in these checks and balances.
• 10:28
  Mary Lee: And if it's this, it's that.
• 10:30
  Mary Lee: And I believe Dr.
• 10:31
  Mary Lee: Mary Claire Haver actually had said that when she went through her gynaecology training to be an OBGYN, it was considered a WW.
• 10:42
  Mary Lee: And she'd even asked the professor, what does WW mean?
• 10:45
  Mary Lee: And he said, the whiny women.
• 10:48
  Mary Lee: When they hit this magical age around midlife in their 40s, and they start to whine and complain.
• 10:56
  Mary Lee: We didn't even have an opportunity to look at why that was.
• 11:01
  Mary Lee: So let's do that.
• 11:02
  Mary Lee: Let's dive into it, looking at some of the treatment options that could address libido.
• 11:08
  Mary Lee: And then the the one that's one of the biggest complaints next to that, weight gain, belly fat.
• 11:15
  SPEAKER_00: Yeah, absolutely.
• 11:17
  SPEAKER_00: So as a woman starts her hormonal transition, and this can happen at a variety of ages.
• 11:24
  SPEAKER_00: A lot of women feel like they're too young to be starting to have hormonal imbalances, and they know their mom maybe went through menopause at 50.
• 11:33
  SPEAKER_00: But I see women even in their late 30s, and especially women who have had periods of very high stress, periods of burnout, trauma.
• 11:43
  SPEAKER_00: Our hormones are so sensitive to what happens to our nervous system, our mental health, that all there's a huge interplay there.
• 11:51
  SPEAKER_00: So we are seeing younger and younger women who are having hormonal imbalances or are starting to see the signs of perimenopause at a younger age.
• 12:01
  SPEAKER_00: I think the most common age to really start feeling things that I see in my practice is like 44, 45.
• 12:08
  SPEAKER_00: I think that most women feel like something's different now.
• 12:12
  SPEAKER_00: And the first thing that usually happens is that our progesterone drops gradually.
• 12:18
  SPEAKER_00: And again, that can start in the late 30s.
• 12:21
  SPEAKER_00: That can also start in the early 40s.
• 12:23
  SPEAKER_00: For some women, it's later.
• 12:25
  SPEAKER_00: But progesterone is a calming hormone.
• 12:27
  SPEAKER_00: It's a hormone that helps us with sleep.
• 12:30
  SPEAKER_00: And it has a lot of anti-inflammatory properties.
• 12:33
  SPEAKER_00: And it one of the metabolites of progesterone crosses the blood-brain barrier and acts like a Xanax, pretty much.
• 12:41
  SPEAKER_00: It kind of calms you down.
• 12:43
  SPEAKER_00: It releases the GABA neurotransmitter.
• 12:46
  SPEAKER_00: So there's a lot of little things that are happening and it drops very slowly.
• 12:51
  SPEAKER_00: So sometimes women don't notice it and the change in their sleep, or some women notice that they're just less resilient to stress, where they feel like, you know, two years ago the same thing happened, and I kind of just rolled with it and I was fine.
• 13:08
  SPEAKER_00: And now it happened, and I'm a mess.
• 13:10
  SPEAKER_00: I can't focus.
• 13:12
  SPEAKER_00: I feel so upset by it.
• 13:14
  SPEAKER_00: And it's the same thing.
• 13:16
  SPEAKER_00: And I don't understand why I'm reacting differently, and that lower resilience to stress can be the loss of progesterone.
• 13:24
  Mary Lee: Right.
• 13:25
  Mary Lee: And then, of course, we see the rise of cortisol when we have more stressful moments, either from the changing within the body, in the body trying to find its way back to homostases, or the changing from our environmental stress is external to us.
• 13:42
  Mary Lee: So let's talk about that.
• 13:44
  Mary Lee: When we become more sensitive to those external stresses that can elevate cortisol while also the progesterone is dropping, and then the estrogen starts to its little crazy fluctuation in there too.
• 13:57
  Mary Lee: So, what exactly is happening in the biology of the body when it's met with these stresses that we can no longer buffer anymore?
• 14:07
  SPEAKER_00: Yeah.
• 14:08
  SPEAKER_00: So just like you said, we touched on estrogen too, and estrogen is on a roller coaster.
• 14:14
  SPEAKER_00: So during perimenopause, we see higher levels of estrogen than we ever did during our reproductive years and also lower levels.
• 14:23
  SPEAKER_00: You know, just in terms of lab numbers, most women in their reproductive years feel happy and comfortable when they're about 150.
• 14:31
  SPEAKER_00: I have had women as high as 900 in perimenopause, which is just a crazy high.
• 14:38
  SPEAKER_00: And of course, very, very low, but we don't realize how much that roller coaster, those huge ups and downs, can be a huge factor in how we feel and our mood and those mood swings.
• 14:50
  SPEAKER_00: And I'm a different person today than I was yesterday.
• 14:53
  SPEAKER_00: And my husband's chewing too loud and all that stuff.
• 14:56
  SPEAKER_00: And then we take um the higher cortisol and the raw ingredients that your body uses to make progesterone and cortisol are similar.
• 15:06
  SPEAKER_00: So if you're having periods of very high stress, the cortisol is stealing all the ingredients that it would have used to um make progesterone.
• 15:17
  SPEAKER_00: And so that influences your progesterone levels and it goes down maybe faster than it would have if you didn't have those cortisol swings.
• 15:27
  SPEAKER_00: And there's there's a lot of nervous system dysregulation.
• 15:30
  SPEAKER_00: This is sort of the softer side of it where it's hard to keep ourselves balanced when our hormones are on such a roller coaster, um, and it can feel very destabilizing.
• 15:44
  Mary Lee: So, as you as a as a medical practitioner now, and you have a woman come in, she says, I just don't feel like myself anymore.
• 15:53
  Mary Lee: Um, lingering symptoms from increased belly fat, stubborn belly fat that just won't go away.
• 15:59
  Mary Lee: How do you then distinguish between, okay, these are the normal hormonal changes and fluctuations associated with your aging perimenopause?
• 16:08
  Mary Lee: And then distinguish that from the problems that deserve more medical intervention?
• 16:14
  SPEAKER_00: We do, I do labs, of course, to try to understand a woman's biochemistry and a physical exam.
• 16:22
  SPEAKER_00: And I think what's normal for different women really varies, you know, and and some women's hormonal transition can be fairly easy and light.
• 16:32
  SPEAKER_00: And of course, there are lifestyle factors that are some women are exercising, lifting, eating super healthy, are able to have a low stress sort of life, whereas others don't have that option.
• 16:47
  SPEAKER_00: Or maybe they are in a career, or maybe they have a number of young children, or the life situation is such that they cannot spend the time doing the strength training and the eating rate and all that.
• 16:59
  SPEAKER_00: And their hormonal journey can be a lot more complicated.
• 17:03
  SPEAKER_00: But of course, we rule out that there's an actual disease process going on.
• 17:09
  SPEAKER_00: And then I am a believer in bioidentical hormones in the right women.
• 17:14
  SPEAKER_00: And that is an option to support her in any part of her journey, really, where when it's appropriate, of course, when that sort of biochemical support would be healthy and safe and would add to the quality of her life.
• 17:34
  Mary Lee: As it's been said before, coin the term by many in the field of hormone health, like yourself, is that biodenttical hormone therapy is yet another tool in the toolbox, but it's not the tool for doing all as in building a house.
• 17:50
  Mary Lee: The saw is not going to replace the hammer.
• 17:53
  Mary Lee: Exactly.
• 17:54
  Mary Lee: Now that we're looking at the toolbox from a new lens with new medications coming on, specifically peptides, how does the role of peptides now enter into the scene of managing hormone fluctuation, managing all the effects that come with it?
• 18:11
  Mary Lee: We spoke libido, but in particular, weight gain.
• 18:16
  SPEAKER_00: Yeah, great question.
• 18:17
  SPEAKER_00: So weight gain and metabolic health, I kind of like to look at all these things as sort of a triangle or a pyramid.
• 18:25
  SPEAKER_00: And I think metabolic health is the base of the pyramid.
• 18:28
  SPEAKER_00: And that doesn't mean that you're a size something or your BMI is something, but that means that your body knows how to turn food into fuel.
• 18:38
  SPEAKER_00: That means good metabolic health means that you can extract nutrients from the food that you're eating and turn that into energy.
• 18:47
  SPEAKER_00: And different weights are healthy for different people, but I want you to feel good and to be able to use food effectively.
• 18:55
  SPEAKER_00: So metabolic health to me is a foundation for everyone, regardless of where they are in their hormone journey.
• 19:01
  SPEAKER_00: And again, I also want to meet a woman where she is.
• 19:07
  SPEAKER_00: And there are some women who have overwhelming cravings, who have a brain that's constantly thinking about food and have this family history of obesity.
• 19:16
  SPEAKER_00: And despite trying really, they spend most of their energy during the day fighting those cravings.
• 19:22
  SPEAKER_00: And GLP1s, especially at lower doses, can be a great tool for a woman like that.
• 19:28
  SPEAKER_00: I use them very, very carefully.
• 19:31
  SPEAKER_00: Again, they are a tool.
• 19:33
  SPEAKER_00: I don't think there are, of course, people will always like the magic bullet.
• 19:37
  SPEAKER_00: They will not do all the heavy lifting for you.
• 19:40
  SPEAKER_00: But I think they're useful when you are willing to build good habits, but there's something kind of standing in the way, and we can make it a little easier for you.
• 19:51
  SPEAKER_00: And I never want to go to a dose on a woman where she doesn't have an appetite or all cravings go away completely.
• 19:57
  SPEAKER_00: It's just a little bit of help so that maybe you can start making the good choices.
• 20:02
  SPEAKER_00: And when we use them in my practice, I like to meet with a woman every week because we're talking about diet.
• 20:09
  SPEAKER_00: We're talking about I have a nutritionist and health coaches.
• 20:12
  SPEAKER_00: And we're not going to just put you on the drug and say, good luck, come back in three to six months with a whole bunch, with losing a whole bunch of muscle and loose skin and all of that.
• 20:24
  SPEAKER_00: Not everybody wants that kind of experience, but our women get healthier.
• 20:29
  SPEAKER_00: And we do body composition scans along the way, and everyone gains muscle or at least maintains it because I think it's not a worthwhile tool if it's going to cause loose skin or loss of muscle.
• 20:42
  SPEAKER_00: So we use it very carefully and put it in a category that's kind of reserved for people who are willing to work with us in that way.
• 20:50
  Mary Lee: Right.
• 20:51
  Mary Lee: You know, you mentioned the metabolic health being the foundation.
• 20:56
  Mary Lee: And that makes sense.
• 20:57
  Mary Lee: I never heard it framed that way, that visual of the triangle and the metabolic being at the very foundation.
• 21:04
  Mary Lee: So clever.
• 21:05
  Mary Lee: And we also understand now that metabol that gaining muscle, muscle is the most metabolically active tissue in the body.
• 21:14
  Mary Lee: So, what kind of conversations do you feel are important for women who are pursuing the GLP ones, even if it's at the low dose, to take them, just to give them that little extra, take them over the edge or meet those obstacles that are still seem to be getting in the way?
• 21:28
  Mary Lee: But also understanding that muscle mass has a such a cons important role to play in her staying consistent with her body composition and weight loss, while also at the same time meeting her demanding lifestyle that might not always afford her the time to go to the gym.
• 21:49
  SPEAKER_00: Movement is sort of a non-negotiable.
• 21:51
  SPEAKER_00: And again, there are a lot of very specific guidelines that women are hearing now, or you have to lift heavy, you have to do this many minutes this many times a week.
• 22:03
  SPEAKER_00: I think women absolutely need to be moving and need to be gaining muscle, but I also feel Like you need to be doing a movement that you like that brings you joy.
• 22:13
  SPEAKER_00: And that's not going to be lifting weights at the gym for every woman.
• 22:17
  SPEAKER_00: And there we have to be a little more flexible.
• 22:19
  SPEAKER_00: In my opinion, we have to be a little bit more flexible than that.
• 22:23
  SPEAKER_00: And there are lots of ways to build healthy lean muscle, whether it's a Pilates class or yoga or some form, we would like to have some form of resistance training, even if it's just body weight.
• 22:38
  SPEAKER_00: But I want women to be moving in a way that brings them joy because movement can bring us so much joy.
• 22:43
  SPEAKER_00: And we're fighting frailty.
• 22:45
  SPEAKER_00: We're fighting all those things that will come with age if we don't preserve that muscle mass.
• 22:52
  SPEAKER_00: So I guess if women are considering this, I would like a commitment to movement.
• 22:59
  SPEAKER_00: And, you know, some women have a Peloton bike and they can do it after their kid goes to sleep for 30 minutes.
• 23:05
  SPEAKER_00: And that's great.
• 23:06
  SPEAKER_00: Do some hill rides where you have some resistance.
• 23:09
  SPEAKER_00: And if you can't get out of the house, I think there is some way that a woman can exercise as of what's going on.
• 23:15
  SPEAKER_00: And if your life is so busy, you can give me 10 minutes a day.
• 23:18
  SPEAKER_00: Do do an intense 10-minute workout and do that every day.
• 23:23
  SPEAKER_00: And then we'll build on it.
• 23:24
  SPEAKER_00: But we just have to start somewhere.
• 23:25
  SPEAKER_00: I think just having that shared view that the muscle is really important and we're not going to lose muscle in this process.
• 23:32
  Mary Lee: And we're now facing a GLP one Instagram influencer trend and a dangerous one.
• 23:41
  Mary Lee: This is now at the point where we're seeing celebrities, spokespersons with these gaunt faces.
• 23:48
  Mary Lee: They're just walking skeletons.
• 23:50
  Mary Lee: And that is being now touted as the new sexy.
• 23:55
  Mary Lee: Yeah.
• 23:56
  Mary Lee: So what is a wise GLP1 journey look like, particularly as we spoke about the moving?
• 24:03
  Mary Lee: But on the other terms of metabolic health and other things that we haven't spoken about, which I wanted to address, it's probably in your triangle.
• 24:11
  Mary Lee: And that is what's going on below the surface, things like insulin sensitivity, or now insulin resistance.
• 24:19
  SPEAKER_00: I think that the the base of the triangle is metabolic health because insulin is such an important hormone.
• 24:26
  SPEAKER_00: And it all the more recent research um ties insulin resistance to cancer risk, to of course heart disease, to all the things that actually are the major killers of women, even to dementia.
• 24:41
  SPEAKER_00: And so managing healthy blood sugar, I think, is one of the most important things.
• 24:48
  SPEAKER_00: I think there's multiple layers.
• 24:50
  SPEAKER_00: First of all, we want a woman to be nourished.
• 24:53
  SPEAKER_00: I always try to frame this in if we use this, it's not going to be to make you smaller.
• 24:59
  SPEAKER_00: You know, culturally, women have been given messages about becoming smaller and smaller and skinnier and quieter and more docile and all these things.
• 25:08
  SPEAKER_00: And that's that's the opposite of what we're going to do here.
• 25:11
  SPEAKER_00: We're going to build you up.
• 25:12
  SPEAKER_00: I want you to eat.
• 25:14
  SPEAKER_00: I want you to get your nutrients.
• 25:16
  SPEAKER_00: I want you to get your protein.
• 25:18
  SPEAKER_00: I want you to build your muscles, or this is going to be a building up journey, not a breaking down.
• 25:23
  SPEAKER_00: And I think most women feel more confident and feel better.
• 25:28
  SPEAKER_00: And women feel confident and good in their bodies when they're really healthy.
• 25:31
  SPEAKER_00: And so what are we targeting?
• 25:33
  SPEAKER_00: We're targeting sometimes percentage of body fat rather than the weight, the total number on the scale.
• 25:39
  SPEAKER_00: We like to use the in-body impedance scale.
• 25:42
  SPEAKER_00: It's just an easy way to do it where we look at your muscle mass.
• 25:46
  SPEAKER_00: And rather than targeting a weight, I'd like to just target your percent body fat.
• 25:51
  SPEAKER_00: And most women, I think, feel best and are healthy as around 25 to 28% body fat.
• 25:59
  SPEAKER_00: And to target your fasting insulin, hemoglobin A1C, those are labs that can show us that you're getting healthier on the inside and that we're counteracting that insulin resistance.
• 26:11
  Mary Lee: I was just about to ask that very question: what biomarkers and health matrix should we be looking at and a woman be concerned about on her journey through menopause, but also managing her weight as well.
• 26:25
  Mary Lee: So she's doing it safely.
• 26:28
  SPEAKER_00: Those are a few, but there's a number of biomarkers that I think are really meaningful in kind of the wellness and health span longevity journey.
• 27:25
  Mary Lee: So when you are working with women in your clinic and they come to you and you're managing it, whether it's just to help them through the menopause transition or prescribe some bioidentical hormones or help her on her GLP1 journey.
• 27:40
  Mary Lee: Let's talk about how that process looks for the woman when she comes to see you.
• 27:45
  SPEAKER_00: In the initial visit, a lot of times I will see a woman who may be struggling with her weight, is overweight.
• 27:53
  SPEAKER_00: She's kind of doing the same stuff she's always done, and she's losing her confidence and she doesn't fit in her clothes like she used to.
• 28:00
  SPEAKER_00: And then she's not sleeping quite as well.
• 28:03
  SPEAKER_00: And having these mood swings that just feel like so many times I hear I just don't feel like myself.
• 28:10
  SPEAKER_00: I'm reacting in ways that don't feel like me.
• 28:14
  SPEAKER_00: I look in a way that doesn't feel like me.
• 28:17
  SPEAKER_00: And a lot of women also lose some of that vitality and energy where women feel like their spark is gone, or the things that used to bring me real joy, or I'm just so impatient with my husband.
• 28:30
  SPEAKER_00: I love him and I love my family, but I'm not behaving the way that I used to.
• 28:36
  SPEAKER_00: You know, every little thing is sort of like nails on a chalkboard.
• 28:40
  SPEAKER_00: Um and all those things can just a lot of women carry shame and self-blame.
• 28:47
  SPEAKER_00: And a lot of women come in feeling like, what's wrong with me?
• 28:52
  SPEAKER_00: What how have I caused this personal failure?
• 28:55
  SPEAKER_00: So I'm the problem, yes.
• 28:57
  SPEAKER_00: Exactly.
• 28:58
  SPEAKER_00: I'm the problem.
• 28:59
  SPEAKER_00: So I think the most important thing is to normalize that and to say, no, this is just, this is just what the body is doing.
• 29:06
  SPEAKER_00: And, you know, I like to think about it from an evolutionary perspective as well, you know, where we've, as humans, have been on Earth for about 200,000 years.
• 29:15
  SPEAKER_00: And most of that time, like 99% of that time, we've lived until age 45.
• 29:22
  SPEAKER_00: So we've genes adapt over a very, very long period of time.
• 29:27
  SPEAKER_00: So we have over 170,000 years of living to age 45.
• 29:34
  SPEAKER_00: So of course our hormones start to decline after 45 because the body is very efficient.
• 29:39
  SPEAKER_00: It doesn't want to waste energy producing things that we don't need.
• 29:43
  SPEAKER_00: And for most of human history, we had children, then we died, and that was it.
• 29:48
  SPEAKER_00: And conventional medicine has earned us that extra 40, 50 years now, but our genes haven't caught up.
• 29:57
  SPEAKER_00: So we get to be alive, but we don't always feel that great.
• 30:00
  SPEAKER_00: And sometimes we experience chronic illness.
• 30:04
  SPEAKER_00: So this is just kind of our biology not catching up with the modern world.
• 30:09
  SPEAKER_00: And maybe in 100,000 years we won't go through menopause because our genes will catch up, or maybe we'll go through it at 80.
• 30:17
  SPEAKER_00: But right now our genes have not caught up.
• 30:20
  SPEAKER_00: So it's how do we support your body for this phase of your life?
• 30:24
  SPEAKER_00: Because we're still, most of us are still in our prime, in our 50s.
• 30:28
  SPEAKER_00: And what happens when we sort of try to address these things is women come back to life.
• 30:34
  SPEAKER_00: I see women engaged in their lives in a way that they haven't been in years, or all of a sudden enjoying their career, feeling like they love the things that they used to love, finding a new spark in their marriage, feeling more connected to their children, finding new hobbies, you know, actually engaging in with the world in a way that they didn't before.
• 30:57
  SPEAKER_00: Maybe they were hiding because they felt a lot of shame, or they just a lot of women feel like, I don't know what's wrong with me.
• 31:03
  SPEAKER_00: This just isn't me.
• 31:04
  SPEAKER_00: And I don't want to go out and do those things until I feel more like me.
• 31:08
  Mary Lee: And I've heard so many analogies from it being birthing into our second spring to a total recalibration, to uh an integration to the age of wisdom, a time of revealing the things that we've always put off, hidden, shoved away, pretended, and now we can just finally let all those personas, if you will, drop to step into who we really want to be.
• 31:35
  unknown: Yeah.
• 31:36
  Mary Lee: And so, what should healthy aging, now that we are in this era of outliving uh what history has deemed to be old age and moving on well past the 50s, 60s, and 70s into the 80s, even 90s now, what does healthy aging look like?
• 31:54
  SPEAKER_00: Yeah.
• 31:55
  SPEAKER_00: I often encourage women to think, sometimes they think, oh, I feel the same whether I'm exercising, getting healthy, or not right now.
• 32:03
  SPEAKER_00: But what you're doing now is a blueprint of what you'll feel like in 10 to 15 years.
• 32:09
  SPEAKER_00: I am 44, and most of the habits that I'm building are around what I want to feel like at 54 and 60.
• 32:18
  SPEAKER_00: I can't really conceptualize 70 or 80, but I can conceptualize 54.
• 32:23
  SPEAKER_00: And I know that I want to be active and I want to be able to hike, and I want to be able to do all the social things that I want to do and travel.
• 32:34
  SPEAKER_00: I really think it's about healthy aging, is understanding that we're investing in the future decades of our lives and what do we need to do to feel a certain way in that next decade.
• 32:45
  SPEAKER_00: So we talked a lot about exercise and protecting healthy muscle.
• 32:49
  SPEAKER_00: There's no way to talk about muscle without talking about protein.
• 32:53
  SPEAKER_00: Our muscle needs protein in order to develop, but we also need fiber.
• 33:00
  SPEAKER_00: And um, fiber is so important for heart health and gut health and to feed all those microbes in our guts.
• 33:07
  SPEAKER_00: So trying to eat as many different vegetables and plant species with having a multicolored diet and really rather than just eating to kind of quiet the hunger and to go back to what you were doing, trying to go on a nutrient hunt with each meal.
• 33:22
  SPEAKER_00: And talking about this second spring is also a time where women come back to themselves.
• 33:29
  SPEAKER_00: And for a long period of time, life demands for us to be caregivers and worry about other people and take care of other people.
• 33:37
  SPEAKER_00: And so I think this kind of nutrient hunt and the muscle building and all of that is a self-love journey.
• 33:44
  SPEAKER_00: It's like, what can I do to feed this body, to build up this body so that I can go on this sort of healthy aging journey?
• 33:53
  SPEAKER_00: So the food, the movement is a part of it.
• 33:57
  SPEAKER_00: But also, we talked slightly about nervous system regulation and how we are coping with the stressors of our lives.
• 34:07
  SPEAKER_00: And I think stress is inevitable in our modern lives, but um we can intentionally create periods of time where we bring our parasympathetic nervous system, our rest and digest system online so that we can counteract some of the physiologic effects of stress on our body.
• 34:28
  SPEAKER_00: And I think that's also something that that I want women to remember is that we can't stop the stressors, but we can bring that parasympathetic nervous system on board and try to release some of its effects.
• 34:43
  Mary Lee: Right.
• 34:43
  Mary Lee: And I'm not going to shy away from the fact that with your clinic and on your website, you make it very clear of your offerings that you address the medical, like we talked about the hormone therapy, medical weight loss, GLP1 consultation and monitoring, and testosterone therapy you have on your website, but you're also looking at other areas, the aesthetic side.
• 35:09
  Mary Lee: Um, and then you know, how do you find that bridge between telling a woman longevity or proper metabolic health starts with maintaining a good weight or maintain that good weight, movement, hormone therapy if it's appropriate, and that's what she desires.
• 35:27
  Mary Lee: But at the same time, say, hey, we have these other offerings that address maybe more of the exterior side.
• 35:35
  Mary Lee: Let's talk about that, how you bridge the medical with the aesthetic.
• 35:40
  Mary Lee: Yeah.
• 35:41
  SPEAKER_00: Yeah.
• 35:41
  SPEAKER_00: Well, I mean, I think the skin is, of course, is the largest organ in our body.
• 35:47
  SPEAKER_00: And it is how we kind of show up in the world and we have this one skin that we live in, and we offer a number of a couple of regenerative aesthetic services.
• 36:00
  SPEAKER_00: So what that means is that I have nothing against Botox and fillers, they're great.
• 36:05
  SPEAKER_00: Lots of people get them.
• 36:06
  SPEAKER_00: We don't have them, but what we do have is a laser and some radio frequency microneedling.
• 36:13
  SPEAKER_00: And what those therapies do is that they stimulate your body to produce more of its own collagen and elastin and resurface some of the skin.
• 36:24
  SPEAKER_00: So rather than injecting something foreign, it's kind of another regenerative strategy to help the skin remain healthy, to keep a healthy glow.
• 36:36
  SPEAKER_00: The laser actually can reduce the risk of pre-cancers from becoming skin cancers.
• 36:45
  SPEAKER_00: So some of those ectino keratoses that can turn into skin cancers, it takes away the sun damage.
• 36:51
  SPEAKER_00: So again, this is more about like what is important to the woman in front of me.
• 36:55
  SPEAKER_00: And there are ways we work with a number of women who have jobs where they're in front of people and how they feel and how they look is really important to them.
• 37:05
  SPEAKER_00: And I think that's really valuable.
• 37:07
  SPEAKER_00: And I want to support them in that journey as well.
• 37:11
  SPEAKER_00: And I think a lot of women, even with weight loss, they come in and they're like, this isn't about vanity.
• 37:15
  SPEAKER_00: This is, I just want to be healthy.
• 37:17
  SPEAKER_00: It's more virtuous to lose weight for the sake of health, and we're not supposed to want to look good.
• 37:24
  SPEAKER_00: But I think we deserve to feel good about how we look.
• 37:27
  SPEAKER_00: Maybe some women, of course, take that to an extreme, and there's there are things that are unsafe or unhealthy.
• 37:33
  SPEAKER_00: But I think feeling confident and feeling like the version of ourselves that we want to be can be a big part of our overall health.
• 37:42
  Mary Lee: I fully believe, and I've had other guests say this, that they would shame themselves for years and years thinking that this is all about vanity.
• 37:51
  Mary Lee: But wanting to look good shifted something inside.
• 37:55
  Mary Lee: And as you got older, you said, No, I deserve to have that experience, that feeling of looking good.
• 38:03
  Mary Lee: Men are feeling it too.
• 38:05
  Mary Lee: I know for a fact they're just not maybe as openly admitting it to us.
• 38:08
  Mary Lee: But I know of several men who have real issues with the aging process and how it's showing up on their skin as well.
• 38:18
  Mary Lee: So, on that note, do you have men coming into your clinic for those same services?
• 38:23
  Mary Lee: Of course.
• 38:23
  SPEAKER_00: Yeah, absolutely.
• 38:25
  SPEAKER_00: We love working with both men and women.
• 38:26
  SPEAKER_00: And the the approach is a little different in certain ways.
• 38:30
  SPEAKER_00: Of course, some of the issues that men have are different.
• 38:33
  SPEAKER_00: We work with a lot of men who are on a longevity journey and want to stay healthy and vital.
• 38:40
  SPEAKER_00: And honestly, a lot of women come in first and then they start feeling good, and their libido comes back, and then the men are like, okay, I need to, I need to keep up with that.
• 38:53
  unknown: Yeah.
• 38:54
  Mary Lee: We could talk at great length just on just on the aesthetics alone and how to help age healthy using the exterior resources in such a way that are effective and safe for our skin, for our bodies.
• 39:10
  Mary Lee: I want to finish off with some more insightful questions with you.
• 39:14
  Mary Lee: Something a little bit more fun, a little bit more insightful on who you are and what you have to offer, then learn about where they can find you.
• 39:22
  Mary Lee: So let's just bring it full circle.
• 39:25
  Mary Lee: We're gonna imagine a 45-year-old woman.
• 39:27
  Mary Lee: She's exhausted, she's now starting to show signs of gaining weight and stubborn belly fat.
• 39:32
  Mary Lee: Um, and she says, I've tried everything.
• 39:35
  Mary Lee: It's now rolling into impacting her sleep.
• 39:38
  Mary Lee: Very important, and feeling like she's all over the place.
• 39:43
  Mary Lee: What would you focus on investigating within her first and also tell her so that she can feel a little bit more confident in this journey that could last 20 years?
• 39:55
  SPEAKER_00: Absolutely.
• 39:55
  SPEAKER_00: Yeah.
• 39:56
  SPEAKER_00: So I would start with first just understanding a little bit more about her.
• 40:01
  SPEAKER_00: So this is more of kind of a traditional medical history taking.
• 40:05
  SPEAKER_00: I want to know if she's had any major health issues in her life, if what her family history is like, if she's taking any medications.
• 40:14
  SPEAKER_00: And then I would ask her a little bit more about each symptom and really try to dive deep.
• 40:22
  SPEAKER_00: And I go through a number of different questions about sleep, about energy, about brain fog, and and really get to know her.
• 40:31
  SPEAKER_00: And then we talk a little bit about what's important to you right now.
• 40:37
  SPEAKER_00: You know, I want to know what you do for a living, what you do for fun, what brings you joy, and what is limiting you in your life right now?
• 40:46
  SPEAKER_00: Which of these symptoms is the most bothersome?
• 40:49
  SPEAKER_00: Once we get a good understanding of what's going on, I think labs are really important for most women.
• 40:55
  SPEAKER_00: There are some women for whom it's kind of obvious.
• 40:59
  SPEAKER_00: And I think with labs, I can give her a better idea of not only where she is when it comes to her hormones.
• 41:08
  SPEAKER_00: And um we do fairly extensive labs.
• 41:11
  SPEAKER_00: So, of course, we'll look at estrogen, progesterone, and testosterone.
• 41:17
  SPEAKER_00: And I'll explain what each one of those does and where she is with it.
• 41:21
  SPEAKER_00: On the day that we drew it, we talked a little bit about progesterone.
• 41:24
  SPEAKER_00: The estrogen is more of that vitality hormone.
• 41:28
  SPEAKER_00: It is the hormone that gives us energy, nice skin, sex drive.
• 41:34
  SPEAKER_00: It is also important for joint health and it's anti-inflammatory and helps us heal muscles.
• 41:39
  SPEAKER_00: So, so when I'm listening to her, in my head, I'm putting her symptoms in categories and trying to anticipate what her labs would probably look like.
• 41:49
  SPEAKER_00: Um, and then testosterone is important for women too when it comes to body composition and building muscle and recovering from workouts.
• 41:57
  SPEAKER_00: But then I'm also looking at inflammation.
• 42:01
  SPEAKER_00: I want to understand do you have an autoimmune condition?
• 42:05
  SPEAKER_00: Do you sometimes get food sensitivities?
• 42:08
  SPEAKER_00: Do you get rashes for no reason?
• 42:11
  SPEAKER_00: Do you get achy and joint pains and feel bloated?
• 42:16
  SPEAKER_00: I will ask a lot about gut health as well, to try to understand how different parts of her biology are contributing to some of the things that she's feeling.
• 42:27
  SPEAKER_00: And then for some women, I will recommend hormones and we'll have a discussion about that.
• 42:33
  SPEAKER_00: For a lot of women, I don't actually.
• 42:36
  SPEAKER_00: And we might be working more on inflammation and her gut health.
• 42:41
  SPEAKER_00: And I think that that's the stronger lever.
• 42:43
  SPEAKER_00: We check micronutrient levels, also B12, folic acid, vitamin D, ferritin, iron, to understand if she has enough micronutrients to actually support her body.
• 42:55
  SPEAKER_00: Is the thyroid working well?
• 42:57
  SPEAKER_00: Is her adrenal health intact?
• 43:00
  SPEAKER_00: So it doesn't always end up like two women may come in with the same symptoms, but their biochemistry can be quite different.
• 43:10
  SPEAKER_00: And often we take a piecemeal where we kind of build a foundation and try to give her support around the most important things.
• 43:18
  SPEAKER_00: Maybe we're supporting adrenal health, trying to get the inflammation down a little bit and working on her gut.
• 43:25
  SPEAKER_00: And she's still in the early perimenopause period, and that actually gets her to where she wants to be.
• 43:31
  SPEAKER_00: And there's and then we come back in a year, and then it's like, well, that worked for that period of time, but now you probably maybe you'd need a little bit of bioidentical progesterone to get you to sleep because now it has dropped.
• 43:45
  SPEAKER_00: So that's kind of the journey.
• 43:48
  Mary Lee: I think the important message that I draw from this is the fact that you're monitoring, and when you come back, it's not going to be the fix all the time.
• 43:57
  Mary Lee: That each phase things are still changing and shifting.
• 44:00
  Mary Lee: And of course, those whatever she's implemented is going to show improvements.
• 44:04
  Mary Lee: And so it'll help areas of the body that are of concern.
• 44:09
  Mary Lee: But that it's still like a snapshot in time doesn't mean that that's going to be the whole situation.
• 44:15
  Mary Lee: And that's what I found in my case is that recovering from workouts, no problem.
• 44:20
  Mary Lee: But as I moved further into post-menopause, the recovery was taking a lot longer.
• 44:26
  Mary Lee: And rain fog wasn't going away as quickly as I had anticipated.
• 44:30
  Mary Lee: And what needed to be tweaked and changed.
• 44:33
  Mary Lee: And this is where the work that you're doing in this field is so vital that we can't get on telehealth in 10 minutes, that we can't get with our GP that are do not have the education.
• 44:44
  Mary Lee: And this could get into a hot topic right here.
• 44:47
  Mary Lee: It's just talking about the education level or the lack thereof.
• 44:50
  Mary Lee: In family practice, family medicine.
• 44:53
  Mary Lee: But that you are looking at that.
• 44:54
  Mary Lee: So I think that would.
• 44:55
  Mary Lee: Be one message I'd really want the listeners to hone in on is the fact that ah, it doesn't have to be the fix I get right now for the next five years.
• 45:04
  Mary Lee: There's going to be tweaks, it's going to be changes, checks and balances.
• 45:09
  SPEAKER_00: Yeah.
• 45:10
  SPEAKER_00: I always like to start slow, you know, and I always ask a woman if she's willing to work with me.
• 45:16
  SPEAKER_00: So that I want to give you the minimum amount of support or minimal amount of intervention that you need.
• 45:22
  SPEAKER_00: So maybe our first try won't get you completely there, but I'd like you to come back for in three months and then we can work with things and maybe give you a little more, but I don't want you to be taking more than you need or throw drugs at you that you don't need.
• 45:35
  SPEAKER_00: So let's see how we can sort of build a level of support that's just right for you.
• 45:40
  Mary Lee: Beautiful.
• 45:41
  Mary Lee: Meet them where they're at, individualized treatment planning.
• 45:44
  Mary Lee: Yeah.
• 45:44
  Mary Lee: All right, we're going to move on to some rapid fire to really interest four pillars of health.
• 45:51
  Mary Lee: And we've touched on them.
• 45:52
  Mary Lee: Let's just say break them down.
• 45:54
  Mary Lee: Movement, nutrition, lifestyle management.
• 45:58
  Mary Lee: So that would mean stress.
• 45:59
  Mary Lee: I should just say no, stress management and sleep.
• 46:03
  Mary Lee: Of those four, if a woman were to start focusing on one to start off, which one should she choose?
• 46:12
  SPEAKER_00: I'd say food.
• 46:14
  SPEAKER_00: Okay.
• 46:15
  SPEAKER_00: And the simplest thing is just fiber and protein.
• 46:18
  SPEAKER_00: Get a hundred grams of protein, 20 grams of fiber every day.
• 46:21
  SPEAKER_00: If you're going to do nothing else, that's where I would start.
• 46:24
  Mary Lee: Okay.
• 46:24
  Mary Lee: On the heels of that question then, and your answer, one supplement you actually think is worth a woman to consider.
• 46:33
  SPEAKER_00: So I will say it depends, depending if she might be deficient in something.
• 46:38
  SPEAKER_00: But I think magnesium goes a long way.
• 46:40
  SPEAKER_00: Magnesium would be super powerful, magnesium glyceride at night for both muscle recovery and sleep.
• 46:48
  Mary Lee: Nice.
• 46:49
  Mary Lee: Yeah.
• 46:51
  Mary Lee: Resistance training or cardio?
• 46:54
  SPEAKER_00: Resistance training, but do what you love.
• 46:57
  Mary Lee: Ah, I love that.
• 46:59
  Mary Lee: Resistance training and do what you love.
• 47:01
  Mary Lee: Yes.
• 47:01
  SPEAKER_00: Yeah.
• 47:02
  Mary Lee: What's one thing a woman can do every day?
• 47:04
  Mary Lee: A simple technique for her own longevity.
• 47:10
  SPEAKER_00: Carve out some time to yourself and ask yourself, what do I need?
• 47:14
  SPEAKER_00: Spend some time with your own body, with your own brain, and check in on your own needs.
• 47:20
  SPEAKER_00: This may not be every woman, but a lot of women are focused on what other people need.
• 47:28
  SPEAKER_00: So give yourself a five-minute check-in.
• 47:31
  SPEAKER_00: Say, oh, hello self.
• 47:33
  SPEAKER_00: What do I need today?
• 47:34
  SPEAKER_00: What do you need today?
• 47:36
  Mary Lee: True.
• 47:37
  Mary Lee: And with that question, then, what is the most underrated stress management technique that you think more women should employ?
• 47:48
  SPEAKER_00: Unstructured time.
• 47:50
  SPEAKER_00: Unstructured time either with somebody you love or by yourself.
• 47:54
  SPEAKER_00: Just giving some time to yourself where there's no goal, where you're not striving towards something where you just allow yourself to be.
• 48:05
  Mary Lee: Yes.
• 48:06
  Mary Lee: What piece of information would you eliminate from health tips or health misinformation?
• 48:13
  Mary Lee: Would that be?
• 48:14
  SPEAKER_00: I think some of the health hack trends out there that have people waking up at 4 a.m., going to bed at 11 p.m., doing a thousand things to the level of perfection that end up creating more stress than actual positive results.
• 48:34
  Mary Lee: I think I know the answer to this next question.
• 48:36
  Mary Lee: What's one thing every woman over 40 should stop apologizing for?
• 48:42
  SPEAKER_00: Needing her own time and her space and being herself.
• 48:47
  Mary Lee: Yeah.
• 48:48
  Mary Lee: And last one, what's one word you want every woman to associate with aging?
• 48:55
  SPEAKER_00: Blossoming.
• 48:56
  Mary Lee: Oh, love that.
• 48:59
  Mary Lee: Tell our listeners where they can find you, what any special offers you might have at the moment in your clinic.
• 49:06
  SPEAKER_00: Yeah.
• 49:06
  SPEAKER_00: So we are online.
• 49:08
  SPEAKER_00: Our website is theguyerpractice.com.
• 49:12
  SPEAKER_00: We're also on Instagram at theguyerpractice.
• 49:15
  SPEAKER_00: On our website and on Instagram, there's a link to a free introductory call.
• 49:21
  SPEAKER_00: That is the best way to make contact and we can give you a good idea whether to work with us or whether it would be a good fit, depending on what you're dealing with and where you are.
• 49:32
  SPEAKER_00: We see people in person in Maryland, Virginia, and Washington, D.C.
• 49:36
  SPEAKER_00: And we do some degree of telemedicine, but we'd love to hear from you.
• 49:40
  Mary Lee: I was just going to ask: do they have to be residing in the same state as you to be able to work with you?
• 49:45
  Mary Lee: And you've just answered that question.
• 49:47
  Mary Lee: Beautiful.
• 49:48
  Mary Lee: Wow, Dr.
• 49:49
  Mary Lee: Geyer, Alex, this has been a tremendous conversation.
• 49:52
  Mary Lee: I'm really looking forward to sharing your Sage advice, your insights from emergency medicine all the way to hey, the you're in control and you can choose.
• 50:02
  Mary Lee: And these are some important preventative measures that you should be taking right now for your metabolic health or longevity.
• 50:09
  Mary Lee: So we'll get all those links to where people can find you in the show description below.
• 50:13
  Mary Lee: Go check them out.
• 50:14
  Mary Lee: Thank you.
• 50:15
  Mary Lee: Thank you for your time, your energy, and sharing this space with me, disrupting the conversation around how we think, treat, and ultimately act on menopause.
• 50:24
  Mary Lee: Thank you.
• 50:26
  Mary Lee: What a refreshing conversation with Dr.
• 50:28
  Mary Lee: Alex.
• 50:29
  Mary Lee: I think one of the things that struck me most was Alex's approach to medicine.
• 50:33
  Mary Lee: Not simply asking what's wrong with a woman, but asking what's important to her.
• 50:37
  Mary Lee: What does she want to feel?
• 50:39
  Mary Lee: What does she want to reclaim?
• 50:40
  Mary Lee: And what would improve her quality of life.
• 50:44
  Mary Lee: So here are my key takeaways from this conversation.
• 50:46
  Mary Lee: Number one, personalized medicine begins with listening.
• 50:50
  Mary Lee: Alex emphasizes asking women what matters most to them rather than assuming that weight, sleep, or libido should automatically be the priority.
• 51:00
  Mary Lee: Healthcare should be a partnership built around a woman's values, circumstances, and her goals.
• 51:06
  Mary Lee: Number two, metabolic health is the foundation, not a number on the scale.
• 51:11
  Mary Lee: Insulin sensitivity, nourishment, muscle preservation, and metabolic markers deserve attention.
• 51:17
  Mary Lee: Alex discussed GLP1 medications as one possible tool, emphasizing adequate nutrition and movement and monitoring the body composition with a doctor is key, rather than just trying to go for weight loss alone.
• 51:33
  Mary Lee: Number three, menopause care needs to evolve as we do.
• 51:37
  Mary Lee: Hormonal changes, symptoms, and personal priorities shift over time.
• 51:41
  Mary Lee: Alex favors individualized assessment, cautious interventions and reassessment, rather than assuming that one treatment plan will remain appropriate for years to come.
• 51:52
  Mary Lee: Number four, build yourself up instead of breaking yourself down.
• 51:56
  Mary Lee: Her practical advice centered on protein, fiber, muscle building movement, and finding physical activities that bring you joy are key.
• 52:05
  Mary Lee: Alex suggested starting with nutrition and choosing sustainable habits rather than chasing perfection or another health trend.
• 52:13
  Mary Lee: And number five, rest, self-awareness, and personal space are part of longevity.
• 52:19
  Mary Lee: One of Alex's most memorable recommendations was a daily five-minute check-in, along with unstructured time that is free from goals and expectations.
• 52:30
  Mary Lee: Her chosen word for aging was blossoming, a fitting reminder that vitality includes emotional well-being and personal fulfillment.
• 52:40
  Mary Lee: You'll find the links to the Gaia practice in the episode show notes below.
• 52:45
  Mary Lee: And if this conversation resonated with you, please share it with another woman, a friend, a colleague who might need a reminder that midlife isn't an expiration date.
• 52:56
  Mary Lee: It's an invitation to evaluate your health habits and see if you're setting yourself up successfully for longevity and quality of life.