Andrew Huberman interviews Dr. Sara Gottfried on optimizing female hormone health across the lifespan
Andrew Huberman speaks with Dr Dr Sara Gottfried, a physician specializing in precision medicine and female hormones, about biomarkers, hormonal health, and longevity strategies for women.
Summary
Dr. Sara Gottfried, a physician specializing in precision medicine and female hormones, joins Andrew Huberman to discuss hormonal health across the lifespan, from the teenage years through menopause and beyond. She argues that understanding intergenerational patterns — particularly a mother's and grandmother's hormonal and trauma history — is essential groundwork for any woman's health strategy. She presents a decade-by-decade framework for hormonal testing, emphasizing cortisol, estrogen, progesterone, testosterone, thyroid function, and micronutrient status as the most critical biomarkers. A significant portion of the conversation focuses on oral contraceptives, where she raises concerns about micronutrient depletion, elevated sex hormone binding globulin, suppressed free testosterone, and the finding that the pill can shrink the clitoris by up to 20%. She also highlights research by Dr. Lisa Mosconi at Cornell linking the estrogen decline of perimenopause to a roughly 20% drop in cerebral glucose metabolism — a change she connects to increased Alzheimer's disease risk in women — and argues that hormone therapy should be considered well before severe symptoms appear. The conversation also covers the disproportionate rate of constipation in women, attributed to a longer GI tract, higher rates of trauma and perceived stress, and subclinical thyroid dysfunction, as well as her strong advocacy for continuous glucose monitors (CGMs) and fasting insulin testing as early windows into metabolic health, and her broader call for democratizing health data so patients can act as their own clinicians.
Key Takeaways
FULL TRANSCRIPT
Introduction and the Value of Family Hormone History
Andrew Huberman: Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health, and performance. I'm Andrew Huberman and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. And now for my discussion with Dr Dr Sara Gottfried.
Dr. Gottfried, Sara, welcome.
Dr Dr Sara Gottfried: Thank you. So happy to be here.
Andrew Huberman: I'm delighted and very excited to ask you about an enormous number of topics. You are expert in so many things, female hormones in particular. Is it ever informative for a woman, regardless of age, to know something about her mother's — perhaps even her grandmother's — experience vis-à-vis hormones? What sorts of conversations should women be having with themselves and with family members to get a window into what their specific needs might be?
Dr Dr Sara Gottfried: My work is really at the interface between genetics and environment. And I think it's essential that you understand what your grandmother went through and especially your mother. I would probably start first with trauma and intergenerational trauma, because I think that affects the endocrine system so hugely, especially cortisol signaling. And then there are certain female conditions that have a very strong genetic component, most of which run in my family. That includes endometriosis, fibroids, and polycystic ovarian syndrome.
Biomarkers by Decade — Teens Through Thirties
Andrew Huberman: Maybe we could march through and just say: for a woman in her teens who's already hit puberty, what sorts of biomarkers should those young women be paying attention to? Likewise for women in their 20s, 30s — maybe we could take it more or less by decade, starting at puberty.
Dr Dr Sara Gottfried: In your teenage years, what I think is really interesting is to look at cortisol. Looking at the dance between estrogen and progesterone in those years is less helpful because there's a lot of variability due to the immaturity of the system. If you've got someone who's got really regular periods, it's probably better to do some benchmarking at that age. But generally, I find that benchmarking is best performed in your 20s or 30s.
Andrew Huberman: Are periods not that regular in terms of duration of the menstrual cycle when the menstrual cycle first sets in?
Dr Dr Sara Gottfried: For a lot of women, they're not regular. And then there's the whole piece of oral contraceptives and other forms of contraception where you have no idea what the normal cycle is. But getting back to your original question about biomarkers per decade — in your 20s, that's when you want to do some base-casing with estrogen, progesterone, and testosterone. What happens a lot of the time is that estrogen dominates in that tango. And when that happens, it sets you up for greater risk of fibroids and endometriosis. I'd want to know about DHEA and the whole androgen pathway. I'd want to know about the metabolites of estrogen, because some of them are protective and very helpful. Others are a bit like Homer Simpson — they are just causing all kinds of problems in your body. I'd also like to know about their stool. I want to know about the microbiome.
Andrew Huberman: In terms of blood testing or various tests for these other biomarkers — getting estrogen, testosterone, and other ratios — women will need to do it at different stages of their menstrual cycle. If they had to pick one, either in the follicular phase or in the luteal stage of their ovulatory menstrual cycle, when would you suggest they do that?
Dr Dr Sara Gottfried: If you forced me to pick one, I would say probably day 21 to 22 for someone in her 20s. For most women, they've got a menstrual cycle that averages out at 28 days, so this is about a week before they start their period. For women who are more irregular, it's harder to do that. As women get older, usually the cycle gets a little shorter. As they start to decline in their progesterone production, their period gets a little closer together. At that point, you want to test sooner — like day 19 or 20.
A blood test is the cheapest thing and usually what's covered by insurance. But my preference would be to do dried urine so that I get metabolomics in addition to the levels of these hormones. If I'm forced to, I'll use blood testing, but it's not as comprehensive — it's a quick snapshot while the needle's in your vein for about 30 seconds.
Let me go back and say one other thing about biomarkers. A big part of the testing I do in phenotyping my patients — I practice precision medicine — is to almost start with nutritional testing. That would be potentially a helpful thing to do in your 20s, and it becomes less important as you get older and develop more micronutrient deficiencies. But micronutrients play a huge role in hormone production. Magnesium is hugely involved in the way that you get rid of estrogen, as an example. So micronutrient testing — what I usually do is a combination of blood and urine, looking at all of the micronutrients that we can measure that have some clinical scientific basis behind them.
Intake of vegetables and polyphenols is such an important predictor of future risk of breast cancer — like when you're 50, 60 plus. And the most important time is when you're a teenager. If you have evidence that you could show a 17-year-old that they've got micronutrient gaps, I think that would be a motivator for them to eat differently at a time when it's so critical, even though it's 25 years in the future, because it's going to potentially change the arc that they're on.
Andrew Huberman: What do you do for a young woman who doesn't like vegetables, or is not somehow able or willing to get those five colors a day of vegetables to help support the microbiome? What other sorts of tools — behavioral or otherwise — are useful?
Dr Dr Sara Gottfried: What I try to get them to do is have a smoothie. If I could get them to have a smoothie three times a week and throw some of these vegetables in, that makes a huge difference. We know that makes a difference in terms of microbiome change. I have them do steamed broccoli that's in the freezer because it's got very little taste — they could put that in a chocolate smoothie. They could add some greens. Greens powders are super convenient. That with a taste they like, whether that's chocolate — which is what most of my clients want — or vanilla with berries, that sort of thing, can go a long way if you don't like vegetables. Short of that, I would say some supplements, but that's a distant second to making a smoothie.
Micronutrient Testing and the Magnesium Deficiency Problem
Andrew Huberman: What is going to be the best way to test the microbiome?
Dr Dr Sara Gottfried: What I like to do with nutritional testing is run a panel that's looking at antioxidants — vitamin A, vitamin C, alpha lipoic acid, plant-based antioxidants — because you can measure those in the blood. I like to look at some of the key vitamins, especially the B vitamin range, because if you've got particular genetic polymorphisms, you might be less likely to be absorbing the right level of vitamin B9 — folate — vitamin B12, and so on. I'm also looking at glutathione, because I think that's such an important lever. And then I'm looking at some of the minerals. Magnesium is really the most important, and we know that somewhere around 70 to 80% of Americans are deficient in magnesium. That's the lowest-hanging fruit.
Andrew Huberman: I would be curious — with magnesium, if that number of people are deficient, does that mean that number of people should be targeting their nutrition toward foods that contain magnesium and/or supplementing with magnesium? And if so, what forms of magnesium?
Dr Dr Sara Gottfried: You have to measure red blood cell magnesium — whole blood. And with deficiency, it's interesting: with supplementation, for my patients who tend toward constipation — and that's frankly about 80% of the women that I take care of —
Andrew Huberman: Really?
Dr Dr Sara Gottfried: Yes.
Andrew Huberman: Wow. I'd be curious as to why that is.
Dr Dr Sara Gottfried: Patriarchy, rage, the pine system — psychology, immunology, neural and endocrine factors combined.
Andrew Huberman: Is that right?
Dr Dr Sara Gottfried: Yes. And then I would say there's another factor. Being female is a health hazard. We have twice the rate of depression and insomnia. We've got a three to four times increased risk of multiple sclerosis. We've got five to eight times the risk of thyroid dysfunction. If you look at subtle, preclinical thyroid dysfunction, a large number of the women I take care of have thyroid dysfunction that's contributing to constipation. And if we go back to that control system — the hypothalamic-pituitary-adrenal-thyroid-gonadal-gut axis — and they have a lot of perceived stress together with this borderline thyroid function that no mainstream medicine doctor has told her is a problem, and then she's got a problem with the tango between estrogen and progesterone, she's going to tend toward constipation.
Women have a lot more constipation than men. The gut is about ten feet longer in women compared to men, and they are much more likely to have a tortuous colon — and the way you know that is you get a colonoscopy. Women experience more trauma than men. This is well established. If you look at the ACE studies done by the CDC and Kaiser in 1998, we know that about 50% of middle-aged men experience significant trauma as defined by the ACE questionnaire. Women are at 60%. And that's been pretty durable since 1998. Women have different forms of abuse — much more likely to have sexual abuse. They have a different HPA response than men; their perceived stress tends to be higher.
So if you look at the physiology of a female, I think that constipation — and that need to control and restrain and hold things in — I think that's part of the physiology. I'm veering a little away from the science, but I do think it is a really important signal to pay a lot of attention to.
Stress Reduction Tools
Andrew Huberman: What sorts of tools do you recommend people use to relieve constipation? Sounds like reducing stress is going to be a huge one. What are your favorite stress reduction tools — things that can really lower the baseline?
Dr Dr Sara Gottfried: I'm not a fan of lowering stress. I'm a fan of lowering perceived stress. I think all of us need an à la carte menu of what is most effective. What works for me now at my age is different from the transcendental meditation I did as a college student. I became a certified yoga teacher when I was in my 30s — that is very effective for a lot of people. I do holotropic breathwork.
Andrew Huberman: I think people are starting to appreciate that there are ways to relieve stress that don't only fall under the categories of vacation and meditation.
Dr Dr Sara Gottfried: Meditation is obviously a wonderful tool — it's got such a scientific basis behind it — but there are so many things on this à la carte menu. Sex, orgasm, connection, feeling heard and seen and loved.
I want to use this as an opportunity to return to a question I didn't close the hatch on earlier. I'm now clear on the fact that a woman in her late teens and early 20s ought to know something about her testosterone, estrogen, thyroid, and cortisol levels; should start at least thinking about her microbiome; should be thinking about the number and timing of bowel movements per day. And I'm assuming that what I just described is also true for women in their 20s, 30s, 40s, 50s, and on up. Is that correct?
Andrew Huberman: That's correct. But I would say there are differential opportunities by decade. I'm glad you circled back to teenagers and testosterone, because if you know in your teenage years that you have high androgens and that you've got this potential phenotype that may persist well into the future — maybe you notice you've got a few extra hairs on your chin or something — if you know that your testosterone is elevated or some other androgen is elevated, it might change the arc of how you take care of yourself. So I think that could be very helpful in your teenage years.
In your 20s, for people who are a stress case like me — at age 27 on the wards at UCSF — if I had known that I was such a high-cortisol person, I think I would have done things differently. I would have changed my behavior. Your testosterone can decline starting in your 20s, depending on how much stress your system is under. For women, that can start as early as 28. Usually your testosterone declines by about 1% per year.
Andrew Huberman: What level of testosterone do you like to see in a woman, say, after age 25?
Dr Dr Sara Gottfried: The way I tend to describe this is: the top half of the normal range.
PCOS — Diagnosis, Androgens, and Cardiometabolic Risk
Andrew Huberman: I get a lot of questions about PCOS.
Dr Dr Sara Gottfried: PCOS is one of those really poorly understood conditions. It kind of flies below the radar until a woman wants to get pregnant or she's got some other issue that drives her to a physician. The problem is that it is a syndrome — polycystic ovary syndrome, sometimes polycystic ovarian syndrome — and syndromes don't necessarily fit together into really clear diagnostic criteria. In this instance, there are three different criteria that we look for: cysts on the ovaries; clinical manifestations of hyperandrogenism — so that could be hirsutism, acne, and other things; and then usually irregular periods, which by the latest criteria means having a period every 35 days or less. So typical cycle length of 28 days, 35 days, skipping a period here and there. Those are the criteria we use to diagnose PCOS. There are about four different systems in the literature for diagnosing PCOS, which is where it starts to get confusing. So there are some women who have no cysts on their ovaries but they've got hirsutism and irregular periods.
Andrew Huberman: Could you define hirsutism?
Dr Dr Sara Gottfried: Hirsutism is increased hair growth, usually in places that you don't want it. For women, it can be kind of male-pattern — they might notice it on their breasts, on their chest.
What we know is that PCOS is not just a problem in terms of irregular periods and difficulty getting pregnant — those are mostly problems in your 20s, 30s, and early 40s. But it is a massive risk factor for cardiometabolic disease as you get older. Many people tend to pigeonhole PCOS as a problem of reproductive age. We have to be thinking of it over the entire female life cycle, and I would say it's even more important to consider it over the age of 50. The average age of menopause is 51 to 52, and we know that elevated testosterone and high androgens are probably the greatest cardiometabolic driver of disease for women with PCOS.
The thread we haven't talked about is the role of insulin and glucose. For some of the phenotypes of PCOS, the problem is hyperinsulinemia — high insulin in the blood is driving the theca cells in the ovaries to overproduce testosterone.
Continuous Glucose Monitors and the Democratization of Health Data
Andrew Huberman: Are you a fan of continuous glucose monitors?
Dr Dr Sara Gottfried: The hugest, most gigantic fan of CGMs. I've never seen any tool that I've ever used in medicine change behavior the way that CGMs do. Really understanding what the mediators are of your glucose control is essential. That said, it's also kind of a later effect. I'd rather know your insulin, and we know from the Whitehall study that insulin — especially postprandial insulin, and fasting insulin too — can change years and years before you get a change in glucose. So that's more relevant for pre-diabetes and diabetes.
The third thing is that it democratizes data. One of the most hopeful and exciting things I'm seeing right now in the health space is that we're going from this patriarchal relationship where doctors hold the power and are the gatekeepers of data, to patients and clients having much more access to information about their own chemistry and their own biology — teaching the patient to be their own clinician. To me, that is a loop of benevolence and integrity that I think is essential to creating health. We've got a disease care system. We need the democratization of data to become a health-based system.
The Six Biggest Threats to Female Vitality and Longevity
Andrew Huberman: If you had a magic wand and you could give two or three "don'ts" to maximize vitality and longevity — let's focus first on female patients, but if it extends to male patients as well — what would you like to see them not do?
Dr Dr Sara Gottfried: I would say: poor sleep, alcohol, high perceived stress, eating the wrong foods, toxic relationships, and isolation. And then number six: not moving enough, or not moving and exercising in a way that really fits with your body.
Andrew Huberman: Can we start with that one actually, and then work backwards?
Dr Dr Sara Gottfried: For me, because I have a phenotype that produces a lot of insulin — depending on how on my game I am — I have a lot of glucose. So I have to exercise a lot more to dispose of that glucose. I think you then have to move from medicine for the population to what works for the individual.
One of the mediators I think is important, especially for people who do what I call chronic cardio — which is what I did — is cortisol. We know that runners, especially marathon runners, people who do a lot of cardio and don't do much resistance training, tend to have much higher cortisol levels. You can buffer that with vitamin C — vitamin C can decrease the effect. But chronic cardio doesn't always serve people.
When I first started measuring hormone panels in myself, I went to my physician and I said, "I'm 35. I've never been so exhausted in my life. I just feel like I'm pushing a rock up a hill. I've got this belly fat that I don't like, and I don't want to have sex with my husband. What can we do about this?" And he offered me a birth control pill and an antidepressant.
Andrew Huberman: Oh, goodness.
Dr Dr Sara Gottfried: So I left him and I went to the lab and I ran a hormone panel. My cortisol was three times what it should have been. My insulin was in the 20s — fasting. My glucose was 105. My thyroid was mildly abnormal. My progesterone was low. And that set me on this course of realizing that what I was doing as a physician — taking care especially of women — was not getting to some of these root causes that are so essential.
I had to start first with cortisol. At that time, I was running four miles three or four times a week. That was just raising my cortisol further. So that was not the right exercise for me. I needed more adaptive exercise. I started doing Pilates and more yoga. That helped to lower my cortisol, started me on changing the way I was managing perceived stress, and it also changed my supplement regimen.
Oral Contraceptives — Benefits, Risks, and Informed Consent
Andrew Huberman: I'd like to make sure that we circle back to birth control — in particular oral contraceptive birth control. What are your concerns? What do you like about oral contraceptives? What do you dislike about them?
Dr Dr Sara Gottfried: In terms of benefit, especially when they first came out and even now, oral contraceptives give women reproductive choice, and that's essential. We've got a lot of data to show both the risks and the benefits. I'll speak first to the benefits, because I'm going to get on a soapbox a little bit about the risks.
We know that oral contraceptives reduce the risk of ovarian cancer. There's something about this idea of incessant ovulation that is not good for the female body. If you look at women who are nuns — who don't take oral contraceptives and have a period every single month of their reproductive lives — they have a greater risk of ovarian cancer. If you look at women who have several babies and have a period of time when they're pregnant and not ovulating, and then breastfeed for some period of time, they have a lower risk of ovarian cancer. Oral contraceptives help by reducing ovulation and reducing risk. We know that if you take the oral contraceptive for about five years, it reduces your risk of ovarian cancer by 50%. And that's significant because we're so poor at diagnosing ovarian cancer early. There's really no method that's reliably effective. We use CA-125 and ultrasound screening, especially in women who are at greater genetic risk, but even that often results in a later-stage diagnosis.
Andrew Huberman: Maybe just because that statement is going to highlight for a number of people the question of what are some of the earliest symptoms that people can recognize without a blood test — is ovarian cancer going to be pain?
Dr Dr Sara Gottfried: The problem is the symptoms are so vague and non-specific. One of the most common symptoms is bloating. And we've already talked about constipation, and how women have this longer GI tract, so bloating is a really common experience for most women. You can have bulk symptoms — feeling like your lower belly is kind of pressed out. The way we inform women in terms of watching for this is to get regular gynecologic exams. For women who are at high risk, where they have an ultrasound for some reason and it shows a mass that we're concerned about, there's a way to triage that in terms of what kind of evaluation they need — and that's a situation where you might get a blood test called the CA-125.
Andrew Huberman: Taking estrogen and thereby reducing the frequency of ovulation lowers the risk of ovarian cancer. Should women — even women who are not sexually active, so they're not actively trying to get pregnant or avoid getting pregnant — be wise to suppress ovulation periodically using hormone-based contraception just to offset the risk of ovarian cancer?
Dr Dr Sara Gottfried: That's a very rational question, and I would say that's what mainstream medicine has had at its back to recommend oral contraceptives — not just for women who are seeking contraception, but for acne, for painful periods, really at the drop of a hat. That's what I was taught to do. And I think a lot of that is pharmaceutical influence.
The oral contraceptive is two hormones: it's ethinyl estradiol and it's a progestine. So it's not the normal progesterone that your body makes — that your ovaries make and your adrenals make. It is a synthetic form of progesterone, and it is the same progestine — similar class — that was shown to be dangerous and problematic in the Women's Health Initiative. So I'm not a fan of progestines. I do not recommend them for any woman unless they give her some freedom in some way.
Like with almost any pharmaceutical, the oral contraceptive depletes certain micronutrients — magnesium, certain B vitamins. It also affects the microbiome. That data is not as strong, but there seems to be some effect. There's also an increased risk of inflammatory bowel disease and autoimmune conditions. It increases inflammatory tone — the studies I've seen show it increases high-sensitivity CRP by about two to three times. It seems to make the hypothalamic-pituitary-adrenal axis more rigid, so that you can't roll with the punches and wax and wane in terms of cortisol production the way that you can off the birth control pill. It can affect thyroid function. And anytime you take oral estrogen, it raises sex hormone binding globulin.
I think of sex hormone binding globulin as a sponge that soaks up free estrogen and free testosterone. So when you go on the birth control pill, you raise your sex hormone binding globulin, and it soaks up especially free testosterone. For some women, it's not a big deal — they don't notice much of a difference. But then there's a phenotype, maybe related to CAG repeats on the androgen receptor, who are exquisitely sensitive to that decline in free testosterone. This opens the portal of talking a little bit about testosterone in women. It's the most abundant biologically active hormone in the female system. It is so important for women — essential to so many things, not just sex drive and muscle mass and seeing a response to resistance training, but also confidence and agency.
So those women who are so sensitive to their testosterone level, who've got this high sex hormone binding globulin and their testosterone declines — what they describe is vaginal dryness, maybe a decline in sex drive. But there's also this bigger issue related to confidence and agency, even risk-taking, from studies done with MBA students, that I think is a serious problem.
Maybe the most important of all of these things is that the pill can shrink the clitoris by up to 20%. If I've got a woman that I think should not be on the birth control pill — maybe she's taking it for acne or because her periods were a little painful — what I'm going to do is say, let's leverage other ways of making your period less painful. Let's take the message of your painful periods and figure out: is it your inflammatory tone? We give you some fish oil and SPMs, maybe a little aspirin when you've got your period. Let's find some other ways to deal with it than to take the oral contraceptive, which you have not received informed consent about — because it can shrink the clitoris by up to 20%. That usually convinces most people.
The data we have is limited. There's one researcher — Claudia — who looked at sex hormone binding globulin a year out from stopping the birth control pill, and it was still elevated. It wasn't as high as it was when they were on the pill, but it was still elevated. So in terms of reversibility, I don't know if we know the answer to that.
Perimenopause, Menopause, and Brain Metabolism
Andrew Huberman: What are your thoughts on menopause? When should people start thinking about it? And I'm guessing, based on everything you've told me today, that there are women in their 30s who — while they may be 20 years out from menopause — probably should be doing things now in anticipation of that.
Dr Dr Sara Gottfried: The more you know about your phenotype — your hormonal phenotype — when you're in your 30s, the better set up you are in terms of what to do in the future. Especially things like your thyroid, your estrogen and progesterone levels, because you can replace to a state of euthyroid. I don't usually go exactly back to where the estrogen and progesterone levels were, but we can get pretty close. So in your 30s, having a base case is really essential.
What's more interesting is to talk about perimenopause. Perimenopause is the period of time before your final menstrual cycle. For most women, depending on how attuned you are to the symptoms, it can last for 10 years. I'm still in perimenopause — it's been like 20 years because I've been tracking it so carefully. It usually gets kicked off by having your cycle get closer together. So that can happen in your 30s or your 40s — you go from 28 days to 25 days, that sort of thing. You may notice it as more anxiety and difficulty sleeping, and that probably is related to the estrogen receptor.
What's most fascinating to me is that there is this massive, massive change that happens in the female brain that people are not talking about enough. Looking at the work of Lisa Mosconi at Cornell — starting around age 40, there is this massive change in cerebral metabolism. You can do FDG PET scans, you can look at glucose uptake, and there's about a 20% decline on average from premenopause — up to around age 35 — through perimenopause to postmenopause. The women who are having the most symptoms in perimenopause and menopause — the hot flashes, the night sweats, the difficulty sleeping — those are the ones who have the most significant cerebral hypometabolism.
Andrew Huberman: So it's almost like a — I don't want to scare people with this language — but it's a low-level, or let's call it pseudo-dementia of sorts.
Dr Dr Sara Gottfried: Yes. It seems to be a phenotype that you can then map to Alzheimer's disease, because that's Lisa Mosconi's work. She's looking at the fact that Alzheimer's disease is not a disease of old age — it is a disease of middle age. What are some of the biomarkers that we can define that can tell you what your risk is? I've got a mother and a grandmother with Alzheimer's disease, so you can believe I am all over this data.
Andrew Huberman: And insulin resistance and insulin sensitivity, as we talked about before, seems to be somewhere in there — which I think, when that idea first surfaced, a few people were like, "Really?" But then of course it makes sense. The brain is this incredibly metabolically demanding organ. You deprive neurons of fuel sources, or you make them less sensitive to fuel sources, they start dying — they certainly start firing less. It makes perfect sense. And I think now, thanks to Lisa Mosconi's work, that metabolism and metabolomics is going to be as important as genes and genomics when it comes to dementia — perhaps especially in women. Is it safe to say that?
Dr Dr Sara Gottfried: I think so, because we believe that this system is regulated by estrogen. The decline in estrogen starting around age 40 to 43 — that's kind of the average — seems to be the driver behind cerebral hypometabolism. I describe it to my patients as slow brain energy. You walk into a room and you can't remember why. You just notice that you can't manage all the tasks the way that you once could — things are just a little slower. And I say that to women and they're like, "I have that — help me."
We've got all of these women who are marching toward potentially a greater risk of Alzheimer's disease, and they have this opportunity in their 40s and their 50s to take hormone therapy — and they may not be offered it, because the typical conventional approach based on the Women's Health Initiative is to say: unless you're having hot flashes and night sweats that are severe, I'm not going to give you hormone therapy. And I just want to call that out. I would say no — that is not the way to approach it.
The concept right now in conventional medicine is that hot flashes and night sweats are nuisance symptoms that we will take care of temporarily. Doesn't matter that you're not sleeping anymore — turn down the temperature in your room. And that's not right, because hot flashes and night sweats are a biomarker of cardiometabolic disease. They are a biomarker of increased bone loss. They are a biomarker of changes in the brain. So many of these symptoms that occur in perimenopause are not driven by the ovaries. They are driven by the brain.
Coronary Artery Calcium Score — A Critical Test for Women
Andrew Huberman: I just want to say you've taught me a tremendous amount. The knowledge you've shared is immense and is going to be very useful and actionable for women in particular.
Dr Dr Sara Gottfried: Can I just add one last thing, because I didn't talk about it — we didn't get to the 40s and the 50s in this list of biomarkers.
Andrew Huberman: Please do.
Dr Dr Sara Gottfried: If women went away with one thing today, it would be to do a coronary artery calcium score by age 45 — and sooner if you've got premature heart disease.
Andrew Huberman: How is that taken?
Dr Dr Sara Gottfried: It's a CT scan of the chest. You can self-order it. It almost gives you this fork in the road in terms of how much you need to pay attention to cardiometabolic health as a woman. It's so fascinating because there are some women who have a zero — my score is zero. But if you're 45 and you're starting to be elevated, or you've got PCOS or some other biomarkers trending you in this direction toward the number one killer, that allows you to really start to make changes. I think it's essential to know that data. Most conventional doctors are not going to order it.
Andrew Huberman: So if I were to go to my doctor and say I want a cardiac calcium score — that's what people should ask for?
Dr Dr Sara Gottfried: Coronary artery calcium score.
Andrew Huberman: There are certain people — they are exceedingly rare, but you are one such person — that when they speak, knowledge just comes out of them, and it's incredibly useful and helpful knowledge. So thank you.
Dr Dr Sara Gottfried: Thank you.