Broad Ideas with Rachel Bilson & Olivia Allen - The Perimenopause Survival Guide with Heather Hirsch

Episode Date: January 19, 2026

Rachel and Olivia sit down with author Heather Hirsch to explore her background in women’s health, unpack hormones and related symptoms, and discuss her new book, The Perimenopause Survival Guide.Watch the video of this episode here!Like the show? Rate Broad Ideas 5-Stars on Apple Podcasts and SpotifyAdvertise on Broad Ideas via Gumball.fm See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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Thank you. You're welcome. She was just talking about her boss, Shepard, because he rules the roost. Yes, he does. He gets mad if you're not there. But you're going to pick him up. Yeah, but if I'm late, he's going to be like,

you're not going to be late. You're not going to be late because we're going to talk to Heather Hirsch today. It's such an important conversation. We have so many questions. she wrote a book, The Pary Menopause Survival Guide. Big deal. All you need to know, listen up. Okay.

Bye. Bye. Bye. Welcome. Thank you for having me. We're so excited to have you. I know. Well, I feel like there's so much.

You can just ask me anything. Oh, we intend to. Yeah. You're like an Oracle. Thank you. Yes. And thank you for this wonderful cozy setup you have. I was just saying this is my first cozy podcast.

It's our, we've never done anything but. The only thing I really care about in life is being cozy. Yeah. Me too. And eating. It means a lot. She both. Food for her for sure.

One of the worst things about getting sick is like, you know, when you lose your appetite and you're like, so depressing. Oh my gosh, what do I want for dinner? And you're like, you look and you're like nothing and that, you just like feel worse because you just aren't even excited for food. Yeah. That's a sad feeling. I don't know if that's ever happened to you other than a stomach flu.

Well, we just, we had a stomach flu, but I've talked to, so my husband's in the world of the GLP ones. And he was like, would you ever consider it? Because I have a lot of food noise and whatever, just like as in microdosing. Yeah. And I was like, I don't think I could because I think that I would go into a depression. Yeah. Like if I wasn't craving things, like what? is the point.

Right. I think I would actually get depressed. I think you would. And that's the real thing. Like I have a patient and she, like every summer they go to Cape Cod and like they love their like fried fish and ice cream. And she's like this year and like, you know, their group texts are like, when are we going here? And like who's going to bring this? And she's like, I just wasn't excited for any of those.

And it definitely felt weird. Oh, wow. Because you look forward to that dopamine rush of like the best. fried food on Cape Cod. And I briefly had a little cottage on Cape Cod when I lived in Boston. So I know that feeling. And she's like, and I just didn't want anything. And I felt disconnected. Yeah. So, you know, a lot of these things play a role in like the biopsychosocial model of like, you know, not just medications and our body's now healthy we are, but then like how we really connect with people or how that changes. Yeah. So speaking of that, you are. You are.

Tell us a little bit about your background and how you got to where you are today. How I got to this cozy podcast? Yeah. How did you get into this room? So, you know, I always wanted to take care of women. My grandfather was an OBGYN, and I just loved, like, watching him, you know, bring humans into the world. I was like, what a cool thing. And so I went to medical school, and I was like, well, I wanted to take care of women, so I have to go into OBGYN and deliver babies.

So I did that. And I get there. And I was like, you know, after I got there, I realized certain things about myself that I loved slow talking and being cozy. Okay. I know for the cozy. And that world is very fast-paced. You're like delivering babies and you're going to surgery and you're staying up all night. And I just wasn't like in the flow.

So then I moved to internal medicine, which is more of your, you know, high blood pressure and, you know, weight like we talked about. And diabetes and all of those things, preventing disease. and I loved it, but I always really was interested in the women's health aspect. So I was at the same hospital. So all of the residents knew I was like the former obstetrician gynecologist girlie, and so they would ask me all their questions. And they'd be like, oh, Heather, can you give colase to someone when they're pregnant? And I was like, guys, you're going to go to Mayo Clinic and be a cardiologist.

You have to know some basic stuff about women's health. This is crazy. So I think that was 2010, 2020. 2012, so dating myself. So then one night I was on call and I found this fellowship down the street at Cleveland Clinic in Advanced Women's Health Training. And I was like, that sounds perfect for me. And I was really interested in contraception and peripartum and postpartum. So I go to my fellowship and my mentor, her name's Dr. Thacker, and she just did menopause and perimenopause. And so I was like, okay, what's this? You know, it's never my plan to be a menopause doctor per se. And I would just see women come

come from all over the country and say like all of these things are happening me. I'm not sleeping all of a sudden. I'm feeling anxious. I'm gaining weights. I have so much brain fog. I don't want have sex anymore. Like what is wrong? What is wrong with me? Like nobody knows. And she would treat them and she would use hormone therapy and taught me how to do it. And they would come back and they're like, you saved my life. And I was like, wow, what is this? How did I not ever learn about this. And it was really like at that moment that I was like, this is what I want to do. I mean, a lot of people are learning about birth control and contraception. And there's a lot of good doctors who can help with pari and postpartum. But at this time, this is 2014, like no one's talking about

pari menopause and menopause. And I was, even though I was in my early 30s at the time, so it was 10, 12 years ago, I could already see like no one is thinking about the intersection of chronic diseases as we start not feeling like ourselves. We're not sleeping and then we're feeling depressed and then maybe we're binge eating and then we're not social and we have more anxiety. And so it's like this is something really important is happening to women in this time and no one's watching this. And so that's kind of how I then dedicated my career to that. So then I worked at academics for many years and then I started my own practice and then I started training and teaching other clinicians and then I got here. And you wrote book.

Yes, I did. I wrote a book along the way. So the pari Menopause Survival Guide was such a fun book to write because I started experiencing perimenopause too. And the funny thing here is that I remember, I think, getting night sweats and thinking like, oh, it's just like, oh, it's so hot in here. And I'm like, oh, we just must have turned the heat on. And, you know, just like tossing and turning and thinking like, my kids probably got me sick. Like even I wasn't like, putting the pieces together. Right. And this is something I've been talking about for a decade at this point. Wow. So, like, when these things start to happen to us, because we have kids and we have friends and partners and pets and jobs, like, you just get so, you know, kind of thinking one thing led to another.

And it's really hard to actually, like, see the forest through the tree. So then I was like, I think I'm in pari menopause. And one day, I don't know if you guys. I've had this short fuse where you just snap at like either your kids and you feel so all the time. I never experienced that. I know, right? What's that for? Just short fuse, yeah.

Yeah. So I had one of those and I was like, that's it. All of your old toys, I walked around with like a garbage bag in my house. My kids grabbed their favorite toys and like all went to their rooms and like they're all afraid I was going to come in and just kind of take all their toys and throw them out, which I probably proceeded to do when they went to school because I don't play with them anyways. But then I kind of had these short fuse moments And I was like, wow, I like

Yeah And my team was like, Heather, do you think it could be? And I was like, I'm too, I'm 43. And they were like, but somehow when it's you, Yeah, it feels different. It does. You're like, no, it's something else. It's something else.

So it was really fun to write because for the first time, even though I've been talking patients through this for many years, like I can sort of say like, I know what that brain fog feels like. Yeah. It's crazy because all the things like you were talking about. And again, it's like you are distracted so you don't really think about yourself going through it, you know? Or like gaining weight like you used to not do or, you know, not sleeping is a big one. Yeah. And more anxiety. Yeah. But what's the science behind all that? Yeah. So our ovaries are our little precious glands that make all of our hormones. So they make out. estrogen, which is so important. And then our brain kind of talks to our ovaries and sends them those signals of like when to do the natural rise and fall of estrogen, progesterone, and then testosterone. And all of that like beautiful synchronous stuff that happens ideally every 28 days,

but not a lot of people are that regular, kind of keeps us in what feels like that premenopausal state where you kind of, if you're someone who's menstruating and you're not on contraception, you know what it feels like before your period, during your period, the week after, when you're ovulating. A lot of women feel really great in like the first part of their cycle. And then as the estrogen starts to decline, naturally in the second part, sometimes you get some of those PMS. And so the science is really then as we get into perimenopause, that cyclic pattern kind of starts to go away and just kind of become really volatile and super sporadic. So even though symptoms of PMS aren't like our favorite, at least we're, kind of like, oh, I must be getting my period. Yeah. And you can kind of clock it. Yeah.

And then into perimenopause, those symptoms get a little bit worse and at the same time, just unpredictable. And so you can't put the pieces together like you normally would. And so you're thinking to yourself, oh, I must have the flu. I must be getting early Alzheimer's. I must just be super anxious about something. And of course, even in our 40s, like, you know, I remember being like in my 20s and thinking that was, you know, and now we're in our 40s, we're like, oh gosh, that's like, we're young, right? And so this isn't, this can't be happening to me now. There's no way.

And you're still sometimes even having regular periods. They might not have even changed yet. So it's really hard to clock all of those. It definitely feels like two weeks, well, like you used to be able to, like PMS was right before your period. Yeah. But as you get older, I feel like I'm PMSing all month long. Yes, exactly.

Like there's not really a break. There's no break. Exactly. That's the perfect explanation. Yeah. And so then your estrogen, which is, you know, sometimes your happy hormone, that is just steadily kind of declining. And then sometimes you get these big peaks in them. And then you get like all this breast tenderness and you feel like you're going through puberty again.

Or you'll get a really heavy period out of nowhere. And you're like, what? Every month. Yeah. Or every month. Exactly. And you're like, what is happening? Like I had a rhythm.

Where's this rhythm going? And those hormones are really important. They play a huge role in our body, but mostly in our brains. And so it really has a big impact on our mood. And I think that's not talked about enough. Right. And also, so question on this. Yeah.

I would love to know your thoughts because my husband's in that world too. And he's a huge fan of hormone therapy and hormone replacement. And he's like, you treat it. But like you go to a regular doctor and they're like, you're fine. And he's like, but you're not because you're symptomatic. You treat the symptoms. And if you're starting to have symptoms, they should be treated. And then we had a woman on not that long ago who talked about the emotional impact of what we go through as far as even statistically how most women are the ones who leave marriages.

And it's between these ages. And there is a correlation between the estrogen being the nurturing hormone that makes us more apt to nurture and have more patience and be understanding. When that starts to go away, we're more irritable. We have less tolerance. And so what happens is we're sent to a million different places. It's like, okay, you're sent to a therapist for depression. You're sent to someone else for a gyno for your periods. you're sent to, instead of having this kind of holistic approach where it's like, no, these are not all

isolated things, you're having a holistic reaction to your body's hormones changing. And what that means as a mom, as a partner, as a friend, in work, like what emotional impacts are you seeing in women's lives? Oh, my gosh. So you nailed it. Thank you. An average, this is exactly why, and this is why I wanted to write this book. because on average, women will see five to seven different health care professionals.

And that's just on average. Before it really kind of comes to light, this could be one thing, which could be perimenopause, five to seven. And think about how many different, like, you have to take this day off or you have to, like, get a sitter for this day. And you have to get all this blood work and all this testing. And everyone's like, well, everything looks normal. And your husband's like, but, you know, it's a clinical diagnosis. And so what that means is there really isn't a lab or a number that says you're in pari menopause or you're not.

It's really just about your symptoms. And this is kind of like the thing. So, you know, as women, and I don't want to go too far down this rabbit hole, but there's certainly a long-standing history of women's symptoms being ignored, you know, and us being called whiny or, you know, too stressed or too emotional, which is bullshit. we're really feeling these symptoms. And so much of medicine became really black and white, you have diabetes or you don't. You have hypertension or you don't. Whereas perimenopause is like, you probably have a little bit of it. So let's just treat you and get you feeling better as opposed to like searching for all of these other random or different things. Right. So when you're going to see this have a sleep study and see a psychiatrist and see your gynecologist and then maybe see an endocrinologist,

like, really, if we just treated perimenopause, and there's lots of ways we can treat it based on your symptoms, like, that would be it. You could just go to one place and then feel better faster and have the right diagnosis. The other thing is then women are told, oh, you have anxiety, so they're put in anti-anxiety medications. And there's not that there's anything wrong with that. It's just technically would be the wrong treatment, right? You're really not so much that you have anxiety. You might have perimenopause, and maybe you need to replace the estrogen, because we talked about how that lowers. And so there's so many things here. when we kind of misunderstand it from the clinical aspect, that's one aspect. So, you know, I do a lot to

train clinicians and to really support them so they can get their patients diagnosed better and sooner. And then, of course, like, we have, you know, women talking about this topic more openly, which has helped open the floodgates for everyone else to talk about it. Yeah, I feel like perimenopause, the word, has exploded within the past, even a couple years. Like, it's just, and you, you know, you've obviously been studying it for so long. Yeah. But it's now like, what's the word I'm looking for? It's like in your feed constantly.

Even this morning, my friends were like, I can't like not go through my feet and not see supplements for perimenopause. It's just, it went viral. Perimenopause. Yes, kind of went viral. It's having a real moment. A real moment, which is good. Although then there's still a lot of myths and misconceptions, you know, I'll still find myself.

Certainly we're in a better place, but then, sometimes there's also just more noise, right? Sure. There's more noise with any time you're bringing awareness to anything. And what do they call it? Cougar puberty? Yes. Cougar puberty.

Yes. That's funny. Yes. Puberty before you become a cougar. Okay. Yeah. Yeah. So thoughts on testosterone for women.

You know, I always sort of say that everyone's different. But, you know, for the most part, I think testosterone is, for many of my patients, I would say about at any given time, 30 or 40 percent of my patients are using testosterone. Okay. And it really, really helps. Right. So I think testosterone is a really important hormone. And one of the things that I always say to my patients is, you know, there's almost like, I'm going to say this, but I think there's more to it, but like there's almost no harm in. trying it. Sometimes hormone therapy is kind of like trying on genes. Like you'll look at them and

you're like, these would be perfect for me. And then you put them on and you're like, oh, maybe the cut's not perfect. Or, you know, someone gives you a pair of jeans and you put them on and you're like, oh my gosh, these are, I never would have thought. Sometimes you almost have to try on hormones if you have a good clinician that you can do that with. Like a lot of times I'll say, let's try all these hormones to see because you'll either know if it helps or if it doesn't. And, you know, even still, there's probably still benefits from low doses where some women might say, you know, Heather, I don't know if I really feel much on it, but I'll just kind of, I'll stay on it. And I'm like, okay, that makes sense because there probably is bone benefits and brain benefits and all these other

benefits from that. What are some of the side effects if you do take these replacements? Yeah. All right. Let's go through like each. Yeah. Let's do it. Let's do testosterone since we're on it. Yeah. Testosterone is side effects are very dose dependent. So when that dose gets really high. You get really horny. But also sometimes it's so problematic. Women will be like, all I want to, all I'm doing is thinking about it. Like, I literally cannot do anything else. And so they'll go from zero to 100. And they're like, it is a problem. So obviously you shouldn't be that spicy. I mean, great, great for a good 24 hours. But also, we have lives to live, right? And so it's usually probably a sign that it's too much. So yes,

You could also have acne. Oh, I don't want that. And lose your hair. Mm-mm. And your voice could deepen. What? Yes. What?

Exactly. So when those doses get high. No, no. No. Yes, I had an opera singer as a patient who was overdosed and her voice changed. Wow. Yeah. So, you know, those things don't happen every day.

Right. But it's important. But it could happen. Yeah. Yes. So could it happen. and even in small doses? Well, you want to be on small doses so you don't have the side effects.

Got it. They're really dose dependent. But, you know, I think a lot of times when we're getting started, you're like, more, more, like more. Right. This feels great. Like, let's go more. And sometimes I'm like with my patients, I think we're good, where we are.

So that would be testosterone. But what it can also help with is, of course, libido, which is really important because you mentioned something, right, that like, are. Our social lives change, our relationships change, and those things are important. So a lot of people, when they feel that lack of desire, they do feel sad about it. Because I miss that. I, like, want to feel lustful. You could just watch, he did rivalry at this point, and that would be.

Everyone keeps talking. I'm going on a plane and I'm downloading it. But maybe I shouldn't watch it on a plane? I don't know. Just tilt on it. Yeah, actually my son saw me watching it and he was like, Mommy, should I be watching that? And I was like, well, maybe a good time to talk about this. But, you know, so people, that desire is really important for just maintaining relationships or feeling like yourself, right?

If you're someone that's very sexual, when you lose that, it can be a big change. Okay. So then if we go to estrogen, estrogen also, all of these, of course, should be, you know, dosed with a knowledgeable clinician. But too much estrogen can cause breast tenderness, bleeding. We don't want any of these to be, like, out of the range. Those are usually side effects with estrogen. Some of them might have migraines or sometimes say they feel overly tearful. But at the same time, these are kind of broad.

Sometimes we just feel overly tearful sometimes. I'm like, that's totally fine. I do have a question on that because this has been hard as far as following mine. My husband says I'm estrogen dominant. Yeah. And so he's tested me at all different days of my cycle. Yeah. And he's like, I think you need progesterone because I've really, really, really,

really heavy. This is TMI. TMI. No, it's so good. A lot of women have this question. And so he was like, I think we should just start you on progesterone. Yeah. Because your estrogen's really high. Yeah. And then I went on progesterone and I called Rachel. And I was like, I feel like a psychopath. And she was like, that's what it did to me too. Really? Yeah, like wildly insane. So can you tell us about that? Because I did feel like a little bit unhinged. And he put me on the lowest possible dose. He even did it at like a compounding pharmacy to go down in dose. Yeah. Yeah. So it's easiest to think about this in terms of help, Heather, help. If you have, yeah, I'm trying to think how do how to explain this to make sense? For women who have, let's start with women who have polycystic ovarian syndrome or

PCOS. With PCOS, you might have a little bit higher testosterone. So this, this is where you, you can kind of have some natural, not natural acne, but you just, you know, women with PCOS tend to have acne flares. And they tend to have maybe some signs of insulin resistance or maybe high sugars. And they tend to have a disproportionate amount of estrogen progesterone where I also sometimes like to call it lazy progestone versus estrogen dominance. But it's really just where the imbalance of estrogen progester is so much so that it actually leads to elevated testosterone and then insulin resistance.

Now, you might not have PCOS, but when you get into perimenopause, you basically have little flares of PCOS because remember we talked about the estrogen's declining and so is the progester, but then sometimes you get these big spikes in estrogen. So a lot of times in perimenopause, everyone almost has little flares of PCOS, where it looks very much like the discrepancy between estrogen and progesterone, as you mentioned. So your husband's like, hmm, just like I would think, let's replace the progesterone. But, for whatever reason, maybe it just didn't kind of work with your own brain chemistry. So sometimes progesterum can be helpful because it can help with anxiety and insomnia.

Progesterone releases Gabba, which is like this Netflix and Chill sort of hormone. Didn't do that for me. It didn't do that for you, exactly. So this is so important because, you know, women will hear on social media, progesterone is the best. It's the relaxing hormone. But not everyone's going to have the exact same experience. So, you know, then when you guys take progester, you're like, what's wrong with me?

But that's totally normal. I feel like it made me, like, super depressed. Yeah, it made me, like, a sensitive depressed. You guys might have progesterone intolerance then, which is like another. Interesting. I've noticed a lot of women because progesterone, a lot of women will, none a lot. Let's say maybe a third of women. But I say a lot because I feel like if you have it, you will be talking, my patients will be talking about it.

Because they're like, wait, I hear progesterone is the best. but it made me feel like the opposite. So for some women, progester, specifically that primetrium can make you feel like sedated or like your mood is on the downside, not the upside or not the relaxed side. Right. Why do they put pregnant women on it?

They put pregnant women on it because interestingly, progesterone's main role is to sustain the first trimester of a pregnancy until the placenta forms. What? Yeah. Oh.

And so you're as, first trimester of pregnancy, a lot of women will have really high progester levels, which is kind of why first trimester of pregnancy, even though you're not super pregnant yet, you're so tired, it's all that progesterone. Interesting. Yes. So progester has like an important role in like keeping the species going. Wow.

But so interesting. Yeah. But then again, sometimes when you try it in your 40s, you're like, oh, this is not what everyone is saying. Yeah. And so sometimes, interestingly, even though you might. might see a discrepancy between the estrogen progesterone. Sometimes if you replace the estrogen, here's another fun trick.

If you replace the estrogen in tiny amounts, what it kind of does is instead of giving it that like volatility that's really, really obnoxious to us in perimenopause, it kind of just chills out. So interestingly, even though you're like, well, it looks like my estrogen's always higher, my progesterone's lower, you try the progesterone, it did not make you feel better. potentially like an option would be if I was your clinician I'd be like maybe we try a tiny yeah maybe we try a tiny dose of like a super low dose of estrogen and that might actually cause it to almost like normalize a bit more isn't that makes sense isn't that interesting well it's

kind of like um it's like any kind of you know addiction or whatever if you give a little bit of it it might satiate the body so it doesn't think it needs it as much. Mm-hmm. You know? Exactly. So then it stops being so volatile. Yeah. And so angry that it doesn't have it or it has too much.

It just kind of satiates it a bit. It makes sense. And so I see this a lot. So I think actually, and like your journey sounds about right. I'd probably start my patient too on progesterone. Mm-hmm. But then after, and usually did you feel it pretty fast? Yeah.

Yeah. Yeah. You'll feel it pretty fast with progester in like 24 to 48 hours. You're like, no. nope. Yep. And, you know, another point here is that I have seen, if you try it again, like maybe in a couple of years or just like later, sometimes you won't have as bad of a response

to it. So interesting to also know. So if someone kind of offered it to you again and maybe you're on a little bit of estrogen at this point or maybe you're on a little bit of testosterone, however, things work out because everyone's so different, it might not be as bad in a little bit more time. And also, isn't this? so interesting. The brain is doing so much rewiring in our 40s. Oh. Like this is a lot of the reason why as those hormones are changing, they're sending these different signals to our brain to

start rewiring. So exactly what you said to you, we kind of start to have less Fs about things. And this is because we are losing some of that nurturing hormone, but our brains are trying to rewire to kind of figure out what for survival makes the most sense for us. us and just adapting to this new physiologic body that we're in. And so it's also exhausting. I think that's another reason we also, like, don't you feel like you're like, how am I so tired? In my 30s, I used to like run around. I had a little kid. I'd make dinner still. And now I just want to be comfy cozy all the time. I was born that way. Yeah, she was born that way. You never had the other thing. Yeah. Ever. That hasn't changed for me. I've always been tired.

I mean, the brain thing, like, and I know it's like mom brain, right? Like you have your kid and you forget things and I have other reasons why I forget things. But it just keeps progressively getting worse and worse. And then the anxiety kicks in. I'm like, oh my God, am I going to have dementia? Like it literally like you spiral and you cannot stop. You can't. I was on the podcast once and I couldn't remember the word pump.

I was like I'd go to the office and I'd have to do the thing where you put the thing. And she was like, you know, they're talking. And I was like, you know, they, they sectioned it. She was like, pump. And I was like, yes. And you'd feel like such an idiot, right? When you have these word-finding. It's scary.

It's scary. You're like, oh my God, am I losing my marbles? But it's, and that's normal. You hear all your friends say the same thing. Like, how many times do you walk in a room and you have no fucking clue what you went in there for? Yeah. Yeah. Someone was like, go get the.

Someone was telling us this. They were like, go get the thing. And they're like, what thing, mom? And she's like, it's got. spikes and you do it with your hair and she's like a brush. Right. Do you remember that? So this word finding is also, exactly.

This word finding good news though, it's normal. And a lot of times that we see if women don't do hormone replacement therapy, because I always want to make it clear. Like I talk a lot about hormone replacement therapy. And of course that's what I do. But not that it means that's the only right way to do it. There's not. So if a woman was to not take hormone therapy, we do see this kind of word find.

or brain fog actually get better, like into menopause. They just raw dog it? That's what it's going to say. But, like, also, it could be a long time. Yes, I guess they, yes. That's how we talk here on this cozy podcast. You can't coin that. Raw dog.

It's kind of rock dogging it in a way of like, wow, you're just going to grit and bear it, which I know so many did because there were so many fears and confusions and misinformation. about hormone therapy. Can you talk a bit about what they've come to now in the safety zone of it? I would love to because it would be such a different world if so many of us were like, yeah, that's the normal thing to do would be to talk to our doctor. And I always say trial hormone therapy because like everyone's going to, you know, maybe have a different regimen or ultimately feel like it didn't make them better.

But if that was the norm, it would be such a complete 180 from where we're. we are now. So a lot of this started in the early 2000. They did this huge study called the Women's Health Initiative. And this came out in 2002. So if you place yourself in 2002, I was in college at Syracuse. Like I was nowhere near like medical school or anything like that. So like this for for a lot of women in our 40s like may not really register. But what it did was it really scared everyone about hormone therapy because they said it's going to increase your risk of breast cancer, heart disease, stroke, and it's basically kryptonite. And so what happened was everyone threw it down the drain, women started suffering, antidepressant prescriptions skyrocketed,

and then, very importantly, doctors just stopped teaching it. And so it just became extinct. So if you've been listening to the whole show, when I went to do that fellowship training, I was like, what is this doctor talking about? She's talking about like estrogen patches and estrogen gels and these things are at CBS. Like, how did I learn? Interesting. Nothing about this. Yeah, we can talk about compounded or we can talk about commercially available. But I was just like, what is going on?

How is this? How did this just, it's just like not, it's not even written out of textbooks. It was literally just like never written in textbooks. Wow. And so anyways, I think that really kicked off like two decades of pure extinction. So that's actually where things like compounded and. sort of injections or pellets kind of started because women were like, some women are like, wait, no, I still feel like shit.

I will figure this out because women are like proactive and they're smart. And so, you know, if your doctor doesn't talk to you about hormone therapy, you're going to go figure it out for yourself because you have to survive. So then I think through the pandemic, I think this major change happened because a lot of men of puzzle women were like now like on TikTok and things and like, hey, is anyone like what are people doing for this thing? Right. And started talking to each other, then we had more celebrities and public figures and people

talking about menopause, which was huge. Because once somebody who's well known kind of says like, it's okay to talk about this, I'll talk about this. It's like we can talk about it for me. And that's fantastic. Yeah. It's amazing. You know, we had Oprah talked about it.

We had Naomi Watts. We had Hallie Berry, like some, you know, major celebrities who were talking about, menopause, which, you know, I'm not in the industry, but I would imagine it's pretty scary to talk about that sort of aging. It's ageism. It's all of it. Yeah. And that really opened the doors.

And then you have clinicians starting to talk about it on social media. And then, you know, a lot of times now what I see is that women will DM me all the time and they're like, my doctor said X, Y, or Z. And I think the answer is this. And I'm like, yes, we now have women who know more than their clinicians. I mean, I just had a conversation with a friend the other day because she was going through a journey in the fertility world. And she was bringing all this information to her doctor.

And, you know, through my experience with my son and being married to a doctor, I realize doctors only have so much time in a day. Nobody is going to care about your life as much as you do. No one's coming to save you. Never. And so, like, there is a lot of grace for that. The way the system is built doesn't really allow for that kind of. care except for people that move out of it and start to focus in different areas. But there's only

so many hours in a day. And so no one's going to holistically look at your life and your health in the same way that you are. Right. I know. I know. And it's really cool now that like there is newer models. You know, we have. Yeah. Like I have a concierge's practice. I think, I think, and again, here's another rabbit hole. We can do a separate podcast someday. Like, AI might be helpful because it can kind of follow you during the day and kind of think about things like exactly, what are you eating and what are your stressors at home and what's your home environment like and all of these things. But you're right. It really is very, very holistic as we're going through perimenopause. It's that bioseco-social. So it's like our bodies are changing, but also what's

going on with our kids. Are we taking care of our, now I'm taking care of, you know, my parents, like we're taking care of parents. At the same time, we're at the peak of our careers. And there's just so much information flying around. And so another part of my life, I love to do education for clinicians. And the cool thing here is that a lot of even younger clinicians are really becoming more interest in this. Oh, yeah. It used to be, you know, if you were gynaecologist, and then you kind of phased out of delivering babies and you wanted something more in the clinic. You could do more gynecology, non-procedures and menopause.

But now, like, I'm training a lot of young nurse practitioners who are coming out of NP school. And they're like, I want to do paramedopause and menopause because it's so impactful. Because it's coming for you. It's coming for you. And, you know, like I said, when women would come back to see my mentor at the time and say, you saved my life. Like, it is so impactful. Because as an internist, you know, learning how to prescribe so many different medications,

there's nothing where people come back and say, you saved my life for starting. any other thing. And so again, it's this whole body, your whole body changes. Our whole environment change. Our brains change. The way we look in the mirror, we look different sometimes. And so it is, I mean, just the emotional aspect of what even it all means, right? So there's so much to it. So I love this topic because it's just like, you can talk forever. Absolutely. I wanted you to go back and touch on the commercial things that are available versus the compounded pharmacy or whatever, because I think that's. It's really. confusing actually because people will hear the term bioidentical hormone therapy and kind of think

that that is better. But let's actually break down what bioidentical means. Bioidentical actually is a brilliant marketing term. And so what it really means is that the estrogen is plant-based, so estradial, and then the progesterone is prometrium, which is more plant-based, versus the other type of estrogen you can use is conjugating equine estrogen, which does come from pregnant horse's urine. Okay, so we just have that. So we have two different types. Look at your face.

Okay. I'm right. I don't think Premon's going to be very popular here in Southern California. So I think we're going to be more of the like, you know, the astrodial is much more popular. But is the horse urine way more better for you? Better?

Can you say? I'll take a horse's urine if it's going to. I mean, what's the better? We want to know what's the better drug here. Do we get energy? You know what? This is a very astute question. because honestly, a lot of all of the safety data, we, I shouldn't say all, but a significant

portion of the best type of research, which would be a randomized control trial, actually does come from Premarin. Wow. But most women, is it more like Europe's doing that? Like, is it a European, like, you know what I mean? Because it's so different when you go out of the states. So I'm curious if there's any studies on that. No.

Like there's still both the bioidentical esterials and there's still conjugated equine estrogen in most countries, you know, it was really conjugated equine estrogen, I think, was developed in the, oh my gosh, you guys are, I'm like, I think it was like the 60s. Oh, wow. I think it was like 1960s. Wow. So that was the primary form of estrogen that they used.

And actually, my grandfather has this amazing textbook from the 1930s. No. Yeah. And actually, it does recommend, like, you know, conjugated equine estrogen. So it couldn't even meant in like the 1920s. That's wild. That's crazy. But Cremarin has been around for a really, really, really long time.

Antiquated a little bit. But still going strong. And so most people choose estradial. So that comes in like your tip, like patches that a lot of women will talk about or gel or there's a spray. And I actually even take it orally. We can talk about that. So that's what esterile is. There's more different routes and different formulations, different routes, different doses.

And that's esterdial. Now, bioidentical just means ester. So if you were to go to CVS, I can send you an esterile patch. It'll say estradial on the patch. It is bioidentical because it's that plant-based esterdial. If I sent you esterile cream to a compounding pharmacy, that's also bioidentical. So then the difference is what's FDA approved and what's regulated or not regulated. So the biolidentical medications that I can send to any commercial pharmacy are FDA approved,

whereas what goes to the compounding pharmacy is not FDA-approved. Okay, so let's break that down even more. What's the difference there? What I will say is that the FDA-approved medications have been thoroughly studied, thoroughly studied. So, you know, we brought up the 2002, and then women hormone therapy training became extinct, and a lot of women stopped using it, and then the pandemic came. And so actually, in those two decades, there's some, not a ton, but there's some research about how safe the FDA approved or the regulated bioidentical estradial and prometrium, there's so much data on how

safe they are. So, you know, the compounding pharmacies, though, did gain a lot of popularity because between those two decades, that was really for a lot of women, their only option. And so there's now a lot of well-established, you know, commercial or unregulated clinics doing hormone therapy. So the way I practice is I really will sway my patients. I have not sway them, but really start with FDA approved hormone replacement therapy because it's so safe, it's so well studied, and it's been around for a really long time. And I've been, you know, using these medications on patients for more than a decade at this point. And they do really well. Is there a risk with the estrogen with breast cancer? So, okay, let's break down the most common, like, question. Yeah.

I did a study a year or two ago. I can't remember. Maybe it was 2024. And it was just on my socials and I asked women to like vote what's your biggest fear about hormone therapy. And the first one was still breast cancer. So that was like 24. So it's still there. And then the second one was being dismissed by their doctor. Wow. Wow. So the breast cancer risk is a long story. But in that initial study, they used that medication premarin, the horse's urine estrogen. Right. And they used a synthetic progestron called mojoxyprogesterone acetase, kind of a mouthful or MPA for sure. That was the progesterone.

They didn't use, like, probably what you had was prometrium. Did you guys try progesterone? Like, did it say progesterone on the bottle? Probably. I don't remember. I don't remember. I wouldn't either. Probably. So, mojoxy progesterone acetate was combined with conjugated equine estrogen and

women who were between the ages of 50 and 79. After five years on that oral combination at one dose, which remember not all women ever would take one dose and one route, which would be oral, but that's what they did in the study. They stopped this study due to a safety threshold being crossed. What they actually found was two to four women, two to four. Out of a thousand over five years, we're getting, were diagnosed with breast cancer, which the media reported a 26% increased risk of breast cancer. which is the absolute risk, which always sounds worse. That's the part that I think that there needs to be public service announcements on,

is decoding what those statistics mean. Right. Because when we hear statistics, we go, whoa. But this is something that is not, it's not really explained to us that like 20% doesn't mean what you think it does. Right, exactly. That sounds scary. So then you think thinking to yourself a fourth quarter of women are going to get breast cancer when it was much lower. Now, interestingly, at the same time.

Pause on one second because I have one question on that. What are the statistics on all women in that age group getting? Is it comparable? It's somewhat comparable. The risk in the general population is still one in eight. And age is typically the biggest risk factor. and there were women who were between the ages of 51 and 80 in this study. So nowadays, why this is so important, it's like...

Do we know the ages of the women that did end up getting... Yeah. So they just pulled them all. So all we know is those two to four out of thousand over five years in that big 50 to age. Right. So we don't know how old they were. Right. Within that age group.

Yeah. Yeah. Okay. Now the crazy part is some women were on just ostrac. estrogen and they didn't take that mojoxy progester and acetate. And the only way you could do that is if you didn't have your uterus anymore.

So they didn't have a uterus and so they were just given estrogen. The main role of progester, now you know, is to sustain the first trimester of a pregnancy and keep your uterus healthy. So if they gave them estrogen and they didn't have a uterus, they didn't have to take a progestone. They had reductions in breast cancer. Wow.

They literally, it's crazy because that got no, that got no press. So then, okay. So should we take out our uterus? Exactly. No. I don't want you to take out your uterus for that. But then you think to yourself, maybe it wasn't the estrogen, maybe it was the synthetic

progesterone. That was the difference. So then when they repeat the studies with that progesterone, that's the bioidentical kind that I see if you guys probably had, they don't see any increased risk of breast cancer above a woman's baseline. So we all have a baseline just sitting here just because we have boobs. But if you take hormothotherapy or not, if you're using those formulations, the progester and the prometrium and or esteradile, and, you know, again, we didn't do those studies on like transdermal bioidentical esterial. But, you know, the risk of breast cancer is, is, it's, I'm going to kind of say it's fairly close to just your baseline risk.

So it's not that staying away from it also decreases your risk. a lot of breast cancer is also environmental and genetic. And, you know, we could go down that rabbit hole too because the idea is probably not so much that the estrogen, even in the women's health study, it's probably not that it gave or caused the breast cancer. They were probably going to have it regardless. But it showed up faster, so those women were diagnosed.

But they actually lived longer. Because they were diagnosed faster. Sooner than the women in the placebo group who got breast cancer. in that study. Oh. So there's layers. And that's important, too, that women in the placebo group got it as well. Exactly.

Right. So it was kind of, it was, it's, it, it's complicated. And breast cancer is very emotional. So no, no, I, nobody wants that diagnosis. Like, nobody wants that diagnosis. And so it made clinicians ever since that came out, very trepidious. Yeah. around prescribing hormone therapy if they weren't deeply aware of all that and could counsel their

patients. And now more women are also like, well, wait a second, my quality of life is the most important thing. I can figure that out, even though, again, that's not what we want to happen, but like it can be figured out. But not feeling like you're having good quality of life every single day, that's hard. It's crazy. Well, also, I think this was funny. I was at a party and someone and said, where's your husband? And I said, oh, he's speaking on something. And they're like, for what? And I'm like, he's in longevity medicine.

And this guy gives like a, like, oh, it's all bullshit kind of thing. And the wife goes, he thinks this all bullshit. And I said, oh, do you? Well, what do you do? And he's like, I'm a cancer researcher. And I was like, oh. I was like, do. You're basically in the same field.

Yeah. Yeah. Do tell. You know? And he was like, well, he's like, what we've. And obviously, I'm paraphrasing. a man at a party. Okay.

But he said what we've looked at and what we've learned of cancer, one of your biggest risk factors is stress. And these people that stress themselves out to be healthy or are enduring that much stress to be like, I need to figure out everything that's going on, you're increasing your risk of cancer. And I went interesting. He's like, so my biggest, what I, you know, what I'm. the most focused on is live your life and eliminate stress as much as you can. Like, don't stress

about health. And so my takeaway from that is it's what you're saying. It's quality of life. So if you're going to endure anxiety, depression, sleepless nights, all because you're afraid of increasing your risk of breast cancer, you very well could be increasing your risk of of breast cancer by enduring that amount of stress. You're absolutely right. Right? You're literally, exactly. So sometimes it's even a conversation of risk of not taking hormone therapy.

Or risk of not taking any medication when your body maybe really needs it. Because I know there's sometimes a lot of reservations. I mean, my patients struggle a lot with these decisions. Because a lot of times, if we're healthy and we're lucky, we really don't see the doctor that much outside of obstetrics, like when we're pregnant. And then all of a sudden in your 40s, you're making all these health decisions. And so it feels very heavy to sort of have to put yourself on medications. But exactly that.

What will happen if we don't add these medications on? You are not. The morbidity of not sleeping well for decades is way more. Way worse. More significant. Right. And also, here's a little fact for your friend who doesn't believe in longevity. This is a good one.

So as we know, this is like a hot topic and everyone's looking for like the newest wearables or, you know, is it going to be cold plunging? It's going to be saunas. Like what's going to, the only thing that has proven to increase women's lifespan is estrogen by three years, 3.2 years, if you're counting. And there is nothing else that has been proven to increase women's health and lifespans besides for estrogen replacement. Wow. There you go. bring that to him. Yeah. So, and I don't know, I'm really bad with all this stuff. But like, for example, I was put on birth control at a very young age. Yeah. And I was on it for, I don't know, at least 20 years.

Yeah. Or something. What does that do to your body? Good question. You know, so I think that, honestly, I think birth control actually can have actually more benefits than probably it is harmful to you. I know it would prevent like cysts from forming or help that because like I'm prone to getting them and they you know they just go away. Yeah. But I know that was one thing. It can decrease the risk of ovarian and uterine cancer. Interesting. Definitely

ovarian, probably uterine. If you take it enough and you maybe some women have PCOS, this can be very helpful. Sometimes if you know, here's what I think about birth control pills. I think that we have a lot of questions about them as well. Overall, though, it's kind of like risk of taking them versus not taking them, especially if you don't want an unintended pregnancy at that time. Or you're using it for another reason, like heavy periods or heavy bleeding. Yeah. Which also can happen or terrible cramps or all these other things.

And so the one thing about birth control pills, the one thing I guess I would say is when we're comparing that to postmenopausal hormone therapy, the doses are much. lower on postmenopuzzle hormone therapy, and there's so many different ways to take it. So I do see a lot of clinicians recommend, like, patients in their 40s just go on birth control pills, which I actually think in this time post-minal puzzle hormone therapy is probably going to help better. Not always, but often. But then in our 20s, like, what is the best option for all the things we need to sort of kind of do with that time? It's so hard to be a girl. You know? We have so many things to think about.

it's like, um, so overall, I want to ease any fears that the birth control pills did anything worrisome to you. I actually think they probably kept things nice and stable and steady for you during that time period. Um, and, you know, I think as we think about better ways for women or men to prevent pregnancy, wouldn't that be great if it's all that. Wouldn't that be cool? That'd be great. Yeah. Um, you know, it's kind of like what will holistically fit. So I think Worth Control pills are something that's getting a lot of attention on, you know, are these the best option? We're seeing younger women not want them, like not want to take them. And it's difficult as a clinician because same thing. Like, what if you do have an unintended pregnancy at like, you know,

at 16? Yeah, that's rough. Yeah. So it's kind of one of those same type of things. I do have a question on that because we had someone on and they told us this theory that I think is really interesting is that who were genetic? supposed to mate with, we tend to be able to smell and sense in the pheromones. Yeah. And that birth control kind of deads that. And people are picking the wrong partners. I will tell you, I heard that too.

And I was like, hmm, interesting. I don't know anything more than that. But I do think that our bodies are probably really smart. They're probably smarter than we think. But now we like live in this crazy world. into like, what are we supposed to do? I heard that too, and I was like, so interesting. I was like, oh, my 20s.

You think you're like, huh? I'm glad it was off it when I met my husband. I know, doesn't that mean? Like, that explains that. But I don't know. I don't know any more than that, but I also did think it was interesting. Yeah, it's fascinating. This whole conversation is so fascinating.

I know. Good. I'm glad. Like, there's so many questions we have about our bodies. And historically, like, I really do think we were. weren't even given space to like, what are our questions? We were just kind of told, like, you're going to bleed every month, and it's going to be pretty terrible. And, you know, and then you could get pregnant and, you know, you should prevent pregnancy. But you really weren't

even given the space to be like, wait, is this stuff right for me? Why do I feel like this on progesterone? But everyone on TikTok says they're sleeping the best they've ever slept. Like, yeah, it's nice to be able to ask these, just so many questions. Everyone's so different. Everybody's so different. And I think to one of the big questions, I saw this recently, on TikTok and I thought it was interesting. I see, I learned everything on TV. Me too. I'm a big connoisseur. But I did think it was interesting and it points to a why in the sense of they were saying

married couples or partners of any form that have higher sex, like higher amounts of sex, actually that it equates to higher levels of pay, success. Like they were putting all of that together. I don't know if it's all bullshit. but I was looking at that thinking, oh, that is a good why. Because I think what happens once we have children. To me, it's almost like sometimes there's, do you want to go back to the restaurant that gave you food poisoning? You know what happened to you.

You know what's coming from that. So it's like not to say that you don't want to have sex, but there is a difference between being really like young and fertile and your body just being. like get me pregnant, get me, like, it's just like out there to get pregnant. And then when we're not looking for that in our bodies or in our lives anymore, there is something that happens like, there is a, right? There's a, I mean, sometimes it's like, you're just like, please don't touch me. Yeah. Like, just nobody touch me. All of you. All of you. All of you. Um, yes. I think this is so interesting. And, you know, a lot of times I say to my patients, too, like, your bedroom, your house becomes like the unsexiest place. Like for me, I still have kids that sleep in my bed. I love like their

toys all over. I'll like roll over and I'm on like a hot wheels truck. Like, no thank you. You know, all I want to do is sleep at this point. And so you're right. You're like, I've, I've had the babies. I've had the bleeding. I've done the breastfeeding. Like, I've done enough. I've done my job. But yeah, I think it makes absolute sons. You know, sexual health is so important. There are some studies that the peak age of the sexual decline is like 40s and 50s. And then honestly, my patient sex drives start to go up in their 60s and 70s and 80s? Oh, that's amazing. As long, and there's hope. I like that. As long as we don't have pain with intercourse or vaginal dryness. So there's plenty of ways to take the replacement for that, right? Like, yes, yeah,

that's one of the things it does. One of the things it does is going to keep that pelvic floor really healthy and keep, you know, even though you're not using it, whatever, we're still always, our pelvis is a whole. We're always using those muscles, whether there's a penis in there, or not or poison there or not. We're still using our pelvis. But there's this whole like if you don't use it, you lose it. I don't like that phrase. That's very scary to a lot of people. So it is normal to actually have a dwindling of your sexual life or even sexual desire at that peak of like your kids and your parents. And then sometimes people move out and you're like, ha ha, we're back. And so there might be some usefulness in like maintaining some sexual chemistry between those times.

It doesn't have to be like when you're 20s and 30s when you wanted to do it all the time. Right. But yes, you know, a lot of times, like, that's what I'm saying to my patients when they're talking about libido and testosterone. It's sometimes I'm like, the goal shouldn't be thinking that you want to have sex every single day because that's probably not normal. But, I mean, if it is for you, all the more powerful for her husband. Right, exactly, right? But, you know, you want to sort of think to yourself, like, when you have sex, you know, you might not initiate as much anymore, but you're like, oh, like, that was, that was fun.

I should, yeah, I should do that more. Like, next time maybe, maybe I'll say yes. Like, that is, that's, that's all we need. Yeah. Kind of skate through this, like, very difficult time. And then maybe get to the other side where, you know, you get to sort of be just comfortable having sex again, like, because your house isn't full of all these other responsibilities. That's great. Yeah.

There's hope. Ha! I've seen my patients go on, like, they go on these, like, little couples cruises and, like, Like they're 70s and they are, that is, that is peak. Yes. That is like peak life goals. Amazing. Yes.

The two week cruise and just all the fun you could ever imagine. I know. So it's really normal for women for their desire to dip in the 40s and 50s and then actually kind of go back up. That's great. Yeah. That's great. That is. There's a lot of cool things coming.

I'm so excited that you brought us your book. Yes. I'm assuming. Are those for us? I know. I'm like there's. I was like there's two there. I was like there for us.

Of course they are. The peri menopause survival guide. Thank you so much, though, for talking about this topic. Oh, my God. We're so, like, we could just go on and on. Yeah, we're going to have a million questions. So many more questions. I know.

But we're going to read the book. Yeah. That'll be our, you know. Yeah. You guys can just text me anytime. Great. Teach all the women that listen because this is really the point. The more that we talk about this and the more that they're like, I bet this is perimenopause.

the sooner that women themselves, besides for their clinicians, I'll work on that part. But the sooner that women are like, I think this is perimenopause, the better. Because for far too long we existed in this, you know, we're just anxious or we're just depressed or what is wrong with us or why do I feel this way? I feel alone. Nobody else feels like this. The more that we can kind of get that to the forefront and really sort of say like, yeah, this is just like puberty, just in reverse, they're going to be better prepared. It's going to help so many, so many of us, so many women. Yeah, I love it.

I love it. And on the last note, can you just tell us what to make our hair thicker? Oh, yes. Oh, I can tell you because I have also had the hair shedding. So, you know, estrogen is wonderful. So we'll just start with estrogen because it is really good for hair. Oh, shite. Shite, right?

Maybe you need that low dose, right? But estrogen's really great. It's not after you approve for that. It's approved for hot flashes, nights wise, vaginal and dryness. bone health, but it does so many things. It helps with mood. It helps with hair, skin, nails, all of these things. Asrogen controls a lot of our, like, moisture. And so when you're drier, your hair will break and then fall out more or it won't grow as much. So, you know, there's a lot of things. There's nutritional deficiencies that can happen that can cause hair

loss. It's probably not that. But hair is, you know, zinc, iron, these things are good. So sometimes if you're vegan or vegetarian, sometimes, you know, if you're not getting enough iron, that could be something to just check if you're not getting enough iron. Also, a lot of heat damage. So I know, like, us girlies by the time, like, just time happens and we've had a lot of heat on our hair. And so, like, repeated, like, the heat. So sometimes taking a break from the heat or even, like, tension. So ponytails, those things could actually cause hair loss. So not putting tension on your hair. I know. I know. My hair started falling out last year, so I went down to wrap. Yeah, it looks great.

I know. I've been looking at it the whole time. I'm like, it's really shiny and shiny. Thank you. Well, I just started on my estrogen, like, about, well, I've been noncompliant for a while, which is funny because I'm a clinician. But like it took, even me, it takes the right time. I tried gel. I tried the, then I did better on oral esterile. So that's kind of what I is. I have an IUD. So I have progesterone in my uterus. So I take estrogen. And that's, it's been really helpful. And I noticed that brain fog is. better. My mood is better. It's, it's, and it's, it's so embarrassing because, again, I've been teaching women this, teaching patients this, and then it happens to you. No, it's actually, it's relatable. Yeah, it's real. Yeah, you're like, it's just what I would tell my patients before, but it happens to you. Other things, of course, just, you know, making sure like the water's not too hot, you know, keeping tension off your hair and getting regular trims. I don't do that. I know, I don't either. Because you're like, no, I don't want to lose any of it. It's never been a trimmer.

But when you get a trim, it kind of teaches the hair to like regrow. I know. So these. No, this is great. We needed this. We needed this. This is what you need the doctor for. Get a trim.

Yes, exactly. Thank you. Thank you so much. This was so wonderful. This was fantastic. Yeah, it's fantastic. Thank you guys. Thank you.

For my comfy couch. How excited are you that you got all kinds of new things to be posted? Me? You? Kevin? Not that I know of. Oh. I don't think I should have caffeine. Are you okay?

No. How's your London fog? It's not. I was going to get one. You got mixed it up. Well, no. Then she got an iced almond milk honey latte. And I was like, you know, it's kind of hot. I kind of want coffee.

I'm going to go iced honey. But I guarantee you, only like a quarter of this will be. be drunk, drank. So weird. By the time we're done today. You got one of you got me the honey latte and it was so good. I think I need to start introducing a little honey. I was surprised when you didn't just like stick to that from here on out.

Yeah. I did. That's a. Please explain. Issue where if I get something I like, I'm just like, that's it. That's it till death. Right. And I'm trying to get better about mixing it up with the orders and whatnot.

Okay. I did that last week. I went to a coffee shop and they had like a protein ice latte and I got it and I was like this sucked. But I'm glad I mixed it. I don't understand all that protein shit. It's weird. It's just marketing.

Yeah. Like what are they putting in it? Milk. Seriously? I don't know. It's probably just like milk. I am curious though. On Starbucks's menu.

Yeah. Oh, are they putting protein powders? Yeah. Is it protein powder? Yep. I think so. It was not good. I want to like to invest.

I do put collagen in. my coffee though. Do you? No. Should I? Yeah. How do you do that? Every morning you just put it, you know, you just put a scoop in your coffee and mix it in with the cream. Does it make it taste weird? Not at all. If you get the, um, what is the brand called I get? Whatever, I'll show it to you, but it doesn't taste like anything. Nice. Interesting. I put it in every morning. I think I have too much caffeine. Yeah. Like are you freaking out? Sometimes I freak out and I think it's caffeine. where I think I'm about to have a panic attack, but I have a new solution. You know this.

I carry sour candy. And you instantly suck on something sour and it takes it away. Wow. So, you tried it? Rachel on a flight with turbulence pulls out the sour cake. 100% I've been trying this out sour candy nightly, but I haven't been having anxiety. But we're going to talk about. anxiety and our age and sour candies.

You mean we did. Oh. I think that this, I think anxiety and our age is a good topic, don't you? Yeah. It's very, she's making me feel weird today. She's in a- too much caffeine. Did you eat? No, I had my shake.

I did too. I did it. What'd you do? What'd you put in it? I did spinach. Mm-hmm. Raw almonds, almond milk, protein powder, collagen, and frozen blueberries. Wow.

What'd you do? Well, spinach. Like at the Golden Globes when there, did you see it? No. Oh. What'd they do? They're like in the deeply moving conversations and then they clip to like smartless and they're like, what kind of cookie do you like?

Do you like food butter cookie or do you like the, I was like relatable. Go ahead. Spinage, raw almonds, milk. yogurt, apple, banana, lots of cinnamon. Spinach. Did I say spinach? Yep. That was my breakfast.

So do you ever do a morning smoothie? I would love to. I call it a shake because nothing's frozen. Oh. Interesting. That's the determining factor, is it? In my mind. Is it?

But is that actual facts? Oh, so mine's a smoothie because I always do the frozen fruit. Right. And frozen banana. So I'm going to have to freeze my bananas because they're not going to all like make it. Although I did see that if you wrap a wet paper towel around the top of the banana bunch and then foil over that, it makes them last maybe twice as long. But don't you like the frozen banana better in the smoothie? Because it makes it colder.

I do like that. Yeah, it's delicious. But what I'll do is I'll make it and then I'll put my cup in the freezer. Oh, we'll just put the bananas in the freezer in your golden. Well, I have some bananas in the freezer, but I have some fresh bananas. So I use fresh today. Okay. Wow.

I made my first steak in 20 years. That's a big deal. What cut? I did a filet mignon. I went fancy. What? Yeah. You cooked your own filet?

How'd you do it? That's risky. We did a pan. We didn't do a grill. And I think why I'm glad we did it. Did you use a cast iron pan? Yeah. Kind of like a fake one.

But what I think helped is we did so much butter that it was just the most delicious. Yeah. It was like, I was so nervous that it was going to be really bad. And I was like, no, this is delicious. With that mashed potatoes, asparagus. Yum. I'm hungry. We'd like to know collectively.

Yes. What is a fake cast iron pan? It gives the vibe of cast iron. I'm dead, but what is it? I'm sure. I don't remember. Was it black? Yes.

Is it heavy? Yes. It's cast iron. It probably was cast iron I don't really remember I don't really remember to be honest I need you to call Leah right now This feels like an episode of Law and Order

and I think you did it I think you killed the person because I don't think you're recalling this accurate and you're giving shady information Do you ever think that? I don't watch Law & Order so no but you never think like if I had to properly recall this

could I? Like when you know when you see like the sketches of the murders. I actually could not recall. Aren't you ever like... I'm not a recaller. I don't think I could recall. No, obviously, a horrible memory

where I will get like hyper-specific details from third grade, line by line down. And then I'll be like, I just talked to and they'll be like, Jennifer, you just met her? And I'm like, Jennifer, sorry, that's what it was. Right. So it's sloppy. Slapid Joe.

Slap is. La Bejo. It always comes back to food. It does. It does. It's problematic. Did you hear about the famous chef from, I want to say Holland, the Noma restaurant that's going to open in L.A.

And it's $1,500 for what? Per person to eat there. Oh, I heard about this, yeah. Yeah. No. It's like Michelin status stuff. I bet we're up there right now. Oh, I saw the article that it was coming.

He's like, oh, I'm well aware. I'm already signed up for the emails. Mr. Golden Globes. Do you know, did he post any what? Yeah. He did? Yeah. He was all fancy.

And I was like, that must feel good. Yeah, he told me he got a tux. He was very excited. He was all ready. We weren't nominated. I don't understand why. What the hell happened? Where were we?

You know what happened? We got snubbed. At the Golden Glove? Yeah. We did. We got snubbed. Amy Baller. Amy Puller won.

Oh, I love her. I know. Who does it? Her show's awesome. She's amazing. She's all nominated. Armchair, Amy Poehler, Smartless. Yep, yep. Mel Robbins.

Mel Robbins. Mel Robbins. Oh, yeah. Past Broad Ideas, guests. And like an NPR show. Amy Poehler knows what she's doing. Big winner. She's a big winner.

She kills me. She's like, I don't know much about awards show, but when they get it I agree. Something like that. Like just the way she did it. She's just so damn good. Yeah, and she was poking fun at the, and she was like, I like, you know, all the contestants except NPR,

those celebrities just cashing in on podcasts. Yeah. They don't know what they're talking about. That's cute. She's great. Clearly. Clearly. Clearly I didn't watch the gloves.

I like to watch it. I don't know. Shepard was really hyped on K-pop Demon Hunters winning. Oh, but it won what? Best-animated? Best song. And best animated. Really?

Yeah, yeah, yeah. Oh, he saw his people. He was like, yes. He's obsessed. Obsessed. Yeah. But now he's obsessed with stranger things. Oh.

So I pick him up from school yesterday, guys, and his one-on-one ASL aid is like, it took us all day and five adults to figure out what he was talking about. There was a lot of guesses going around, and the strongest contender was silence of the lambs. I was like, she's like, then we figured out it's stranger things. And I was like, can you give me the sign for that? So I think she was like, stranger things. That's hilarious. Then I got it because he kept talking about this girl Barb.

And Barb's only in it very, very. briefly. Isn't she in just like the first season or something? First episode basically. Yeah. Yeah. He is so upset about Barb. Who wouldn't be upset about Barb? Yeah. What about Barb? We're on season two and he's like, but Barb, we're like, get over it, Shepard. She's dead. Oh, poor Barb. All right. All right, guys. It's been real. Love, you mean it. That was a hate down podcast.