Hormone Optimization: The Women’s Guide to Vitality (Performance & Longevity Series)

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Transcript: Hormone Optimization: The Women’s Guide to Vitality (Performance & Longevity Series)

Season 11, Episode 10  | August 28, 2025

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Welcome to Life Time Talks in our series on Performance and Longevity with MIORA. I’m Jamie Martin, and I’m here today with Dr. Greg Pippert. He is the Medical Director of MIORA. And we are talking in this episode about hormone optimization. This one specifically a women’s guide to vitality. We know that there is a rise of hormone issues in women of all ages, and we want to know what we can do to take back control of this aspect of our health. So, Greg, thank you for joining me. How are you?
I’m well, thanks for having me.
Awesome We’re going to dive into this because as you know, you and I have talked off camera about different things related to this topic. But I really want to dive in right away into why we’re seeing such a significant rise in hormone issues among women today, and not just women who are in that perimenopause menopause phase, women at all ages and stages are experiencing hormone issues.
One of the factors is we’re just talking about it more. I think in the past it was a conversation that maybe didn’t happen. People just accepted these things as normal occurrences or they didn’t want to share too much information, sort of thing. But I think as a society, we are talking more about these things. I think part of it stems from the fact that we’re developing a comfort level around hormones and hormone replacement. And women are recognizing that things can actually be done. And so why not ask about it? Why not have that conversation?
But more to your point, why are we seeing more of it now? Are we? Yes, we are. We are as for an example, I mean, really to take the extreme example here, when we think about the early years in a woman’s life, we think about the sexual development, so puberty, so ages anywhere from 8 to 18. It’s a wide range but it really can vary. But when we look at the average age that a girl is having her first period or the average age of sexual development starting this development starting, has gotten younger and younger and younger.
We’ve not mutated. We’re physiologically the same as we were 20, 25 years ago, yet we’re seeing these changes in our physiology. So it’s not us. It’s something that’s doing that. There is something driving that. And that can be multifactorial. In fact, it is multifactorial. So what could those things be? Well, I was just using the example of the younger child, but as we go on through every stage of life, we do things or encounter things that are making a difference. And those things — probably one of the biggest things right now that’s going on is the endocrine disrupting chemicals.
Now we’re awash in chemicals in our lives. Women, especially exposed to fragrances might be their perfume, yes, but it might be laundry detergent, fabric sheets. All of those scents contain compounds that may disrupt our endocrine system, so-called endocrine disrupting compounds. That means they disrupt how the system works. So these compounds may impact how our brain signals the body to release hormones, or how it monitors the hormone levels, and they may impact how the hormone and the receptors meet up, how they work together. So if you can’t get a receptor to hormone to join up, they can’t do their work.
So these chemicals they’re in plastics. So that’s why we say, don’t microwave in plastic. Don’t store your food in plastic. So they’re plastics, pesticides, herbicides, personal care products, things we’re putting on ourselves in ourselves every day, and they’re now in our foods too. We’re getting pesticide residues in our food. So these things are impacting how our hormones work. So it’s no wonder that we’re seeing changes.
But then there’s a lifestyle things, the things that we actually do have a little bit more control over. Sleep, for example. We’re just not getting enough sleep.
It’s the first thing we compromise.
It is. I got more to do. What am I going to do? I’m going to shave a little bit of time off. But then, of course, now we’re less productive at the next day, which means that I have to work a little harder and a little longer. I’m going to shave that sleep off. It just becomes this spiral downwards and downwards. It’s a never ending spiral. We need to stop that. But sleep is where we recover. That’s where our brain starts working. But it’s also where we make hormones. So when we’re not sleeping, we’re not making the hormones that we need. So sleep is terribly important.
Exercise. We need exercise. We need to move our body. Studies have shown the more consistently we move our body, the better we age. But it’s also the better we are in control of our hormones. When we’re not exercising, we become insulin resistant, blood sugars start to go up. We become diabetic. When we’re diabetic, our hormones don’t work as well. And you start to see everything’s connected. It starts a cycle.
It’s like this cascade effect of things that just keep going on.
Absolutely. And how much more can you pile on to that? And then we think about stress. Stress is the biggie. I mean, who doesn’t have stress these days?
Well, and when you think about women with stress, there’s a lot of studies about this mental load that women carry in addition to, you know what I mean, compared to men. And that’s a generalization. But there is a lot of research around this in terms of the additional stress that women carry.
Yes, a lot of female patients talk about their mother guilt.
Yes. Oh, yes.
It’s the top thing on their list. I’m more likely to do or not do something because if I’m going to feel guilty related to my children and do it for my children. I’m going to sacrifice sleep, a good diet, all those things for your children. But stress. So we’ve got our family concerns, commitments, work commitments. And work doesn’t necessarily know how bad things are going at home. Then when we start to sleep less stress levels go up. Now, why does that matter?
It’s not just being busy and me taking a lot of time out of my day to do things that I’d rather not be doing. The stress is actually impacting our cortisol levels. So cortisol is the stress hormone. Also adrenaline and noradrenaline. But why is that a problem? Well, cortisol is important. If we didn’t have it, you’re not going to run from the tiger when it’s chasing you. We have to have cortisol to deal with stress. If we don’t have it, nothing’s good. But too much of a good thing is not a good thing.
Our body is wired to see a stressor, deal with the stressor, surge the cortisol, surge the blood sugar, get away from whatever that stressor is, and then de-stress. We’re not living that way. We just go from stress to stress to stress to stress creating this constant stress load. And now we’re talking about hormones here. So why — we can talk about cortisol forever.
We have a whole episode on that. We’ll point people back for that. There we go.
But why is it important in hormones? Well, cortisol works in the brain also to impact how the hormones are released, the signaling of how we perceive what our hormone levels are in the body. The body’s always checking hormone levels and responding. So cortisol will affect that. Cortisol also affects how the hormone receptor and the hormone interact. So you can have a perfectly wonderfully good hormone level, but if your receptor is not able to join with that hormone, it’s like it’s not there at all.
And we see lots of people who would say, I’m sure I have this — say, pick your hormone deficiency, thyroid deficiency. You check levels and they look wonderful. They look very normal. But if you talk to them about their stress levels, or, even better, measure their cortisol, which could be serum salivary testing, urinary testing, measure their cortisol, you’re going to find that they are very stressed, and that cortisol is impacting how the hormone is working. And then talking about all the things that could impact our hormone levels, diet, nutrition.
Well, right. And that was what I — what are the symptoms that most often signal hormonal imbalance in women because I mean, what things should we be looking for that could be happening in causing or could be a source of that?
Well, in females, most often it’s menstrual irregularities.
Oh, yeah. That’s the thing you’re going to see. First, periods may get longer, shorter, heavier, lighter, more PMS, more cramping. So those are the earlier changes. You can see acne, oily skin. But going forward from that, we can see the perimenopausal changes as hormone levels start to become less consistent, start to drop. Those can be your poor sleep, foggy thinking, hot flashes, night sweats, mood issues, depression, anxiety. And then going further forward, then you see tissue issues. So thinning hair, thinning skin, vaginal dryness, low libido.
And that’s across the various stages of life, going across from that puberty stage all the way up to perimenopause, menopause. These are some of the shifts that you’re going to start to see.
And throughout time you’ll see different changes in that shift. There’s always something, but you’ll see different constellations of those depending on what the hormones are doing at the time.
Yeah. Let’s talk for a minute about that kind of stage between puberty, between perimenopause, those prime reproductive years. A lot of women use hormonal contraceptives. What are they doing to contribute potentially to a hormone imbalance?
Sure. Well, thankfully, the oral contraceptives are doing their job. I mean, they’re there to prevent pregnancy and that’s their forte, and they do a good job of it. So we need them for that purpose. But what are they doing? Well, birth control pills or oral contraceptives usually are a synthetic estrogen and/or a synthetic progestin, not progesterone, but progestin. So they work with the brain and the ovaries basically to suppress ovarian function, to thin the uterine lining to prevent pregnancy.
So they’re hormones, but the hormones are not received by the other cells in the body in the same way. So they do their job, but they may not do other jobs, which is why in females on birth control, you often see things like mood issues, depression. Women on birth control pills have a much higher than average likelihood of going on an antidepressant medication because that natural progesterone is calming and soothing to the brain. It helps support a mood, and the synthetic is not the same thing. It does not operate in the same way.
Not doing the same thing.
And then there’s the transition when you go off the hormones or the birth control. There’s a period of hormonal recalibration, you might say, where the body’s trying to figure out, OK, I got to do this on my own now. And there can be a period of time when things are irregular. And you really don’t know where you’re going to end up until you’re there.
OK, got it. So you mentioned a couple of these hormones that we have. But let’s talk about the key female sex hormones and the roles that they play. And there are about five of them, I believe. So we’re going to — we’ll start with estrogen.
So estrogen is primarily for — we think about for sexual development female sexual development although men need estrogen too. So estrogen positive things it’s protective for heart. We don’t think about that much. Women when they’re deficient have a higher risk of heart disease. Estrogen is also tissue supportive. It’s our skin. It’s our hair, fingernails. But estrogen is there for reproduction, sexual development as I said earlier. It’s there for vaginal dryness — to prevent vaginal dryness. Estrogen in excess — let’s think about excess, of excess, endometriosis, PMS.
Got it.
So on the low end, when we’re missing estrogen it would be things like hot flashes, night sweats, vaginal dryness, depression, anxiety. On the high end it’s irritability, PMS.
Got it. So you got the spectrum there.
Yes.
OK. How about progesterone.
Yeah, progesterone in essence when we have it in the reproductive years is there to support the endometrial lining to facilitate pregnancy, but it balances estrogen. It’s also brain protective. It helps with mood. It can help with skin and hair.
The one that we often think is for men only, testosterone. We all know that women need some testosterone, too.
Yes, absolutely. So testosterone goes down as you age. And don’t , say, assign that to a female issue, but it can help with muscle mass. And part of aging is not losing muscle.
We have to maintain that. And we start to lose muscle typically in our — starting in our seconds is when it starts to naturally decrease.
And supporting testosterone, or at least maintaining a good testosterone level can help prevent that. It also helps with libido, just strength, bone health. And I’m sorry I didn’t mention that with estrogen. Estrogen is a huge, huge factor in bone health and preventing osteoporosis.
Got it. So going back to that for just a second, I mean, that’s important because when estrogen drops in menopause, that’s often when you hear about women having their first fracture or breaking something for the first time.
Absolutely. Which can be life altering.
Yeah. And have a lot of consequences.
OK, DHEA.
Yeah. So DHEA is an adrenal hormone. It is a precursor or raw material for making all of the other hormones. But because it’s an adrenal hormone, it also helps with stress tolerance. Now when we think about exercise DHEA that can be like acne and oily skin, but deficient DHEA that can also be fatigue, foggy thinking.
And last one DHT.
Yeah, so DHT is a byproduct of testosterone. It’s very powerful. It plugs into testosterone receptor very well. The problem is it plugs into the receptor very well. So we get the testosterone excess symptoms when we expose ourselves to too much DHT, that’s hair loss and acne and females.
OK, got it. So what about sex hormones effects on other systems in our body, on heart health, brain function, joints, digestion. You’ve alluded to some of these things, but let’s talk about it because they’re not just singularly focused on one aspect of our health.
So cardiac health is one of the things that we didn’t think about much in the past. But women’s heart disease risk increases as estrogen drops, so right around that time of perimenopause menopause. So heart is going to respond very well to estrogen. It actually helps with cardiac contractility. It helps with the heart muscle to be healthy. It also helps with dilating blood vessels, blood vessel compliance. We have to have healthy blood flow. So estrogen can be very helpful there.
When we think about — see we had heart health, we had brain health. So we need hormones for our brain. And any woman in perimenopause will tell you I feel foggy. I don’t feel like the thoughts are coming as fluidly. So we can see foggy thinking. But there’s also the mood component to that. There’s depression. There’s anxiety. Progesterone can be helpful. Estrogen can be helpful. And then digestion. So we need good hormones to maintain good general gastrointestinal motility, prevent constipation, but also excess hormones can sometimes produce bloating.
So some of those uncomfortable feelings that we get.
PMS bloating, some people describe.
How about joint health? So I heard this study — or maybe it wasn’t a study, it was a fact on another podcast at one point about a woman who was having a lot of cold shoulder. And I’ve heard about that a lot in women in perimenopause or menopause. And I was like, really? That was tied to — what they talked about was that it was kind of tied to estrogen levels. So let’s talk about joint health.
Estrogen is good for joint health, bone health, but also joint health. Cartilage, joint lubrication. So yes, a frozen shoulder something that’s stiff. As estrogen drops women will start to say I just feel creaky, I feel old, I feel like I’m getting up in the morning and everything is stiff.
It’ll just feel a little creakier.
Yeah.
I’m starting to feel a few of those things from time to time. Just very transparent here, why not? OK, so in this case, as you’re noticing some of these things, what are some of the hormone tests, the specific hormone tests, that someone might request if they want to get a really comprehensive look at their current hormone status?
So obviously you’d want to check estrogen, progesterone, the DHEA sulfate, so DHEAS, testosterone even in a woman. You may eventually want to look at DHT. It’s not on my normal panel, but it’s an important hormone to look at. That’s the core hormones. But then you also think about looking at FSH and LH.
So what are those?
FSH is Follicle Stimulating Hormone. LH is Luteinizing Hormone. So those are the pituitary gland in the brain sensing how much hormone is floating around in the bloodstream and trying then to stimulate the ovaries in this case to produce more hormones. So it’s the — think about it like the thermostat on your wall. So if we see FSH and LH discordant or off from what you would expect with hormones, we know that there’s instability there.
Also we need to think about other hormones, thyroid hormone and especially cortisol. So even though we’re talking sex hormones here, we need to look at thyroid because there’s so much overlap and thyroid interacts quite significantly with hormones. But cortisol especially, it impacts everything.
Well, and we have talked on this podcast both in this series and just broadly, I mean, there’s no one thing that’s operating in isolation in our bodies. There’s is these different ways that we affect each other. You can pull one thread of the web and another part moves or is affected. So we have to be cognizant. So we want to make sure we’re getting, again, that fuller picture of what this looks like, and what’s really at the root of what might be happening too.
Right. And it’s oftentimes looking deep inside ourselves to say, how am I sabotaging myself? What do I have control of? Because I can’t control my own hormones, but I can control some of the things that may impact those hormones.
Well, and that brings me to that kind of well, what then? So now I have all this information about my hormones, where do you start in terms of working with someone? I know we can talk — we’re going to talk about bioidentical hormone replacement as one thing. But once you have that full panel back, what’s the next step?
So the next step is really just finding someone that you’re comfortable working with, somebody that is well versed in the area, and is comfortable having a conversation with you as an individual, listening to your concerns and trying to figure out again, root cause, where did some of this start. So there’s just finding that advocate for you. That would be the first step really.
Yeah. So let’s talk about the different paths because we keep hearing about bioidentical hormone replacement therapy. There’s been some studies that have come out in the past that have caused a lot of concerns around it, that those have since been debunked. But let’s talk about the rise and using BHRT for hormone health.
Yeah. So just to talk about the term bioidentical, just for reference. So bioidentical means that it’s a — yes, it’s a hormone that’s made in a lab, but it’s made to the exact chemical composition and structure that your body would make it. So your body can’t tell the difference. I mean, they are apples to apples. So that’s why I say bioidentical. Now, when we think about synthetic hormones, those still function on a certain levels of hormone by plugging into the receptor, but because they’re not the same shape, they may do things a little differently, a little harder, a little softer.
They might stimulate other receptors, have unintended consequences, which is some of what we’ve seen with non bioidentical hormones. So take for example, the Women’s Health Initiative Study 2002 was stopped because of stroke, blood clot, heart attack, and breast cancer.
Yes.
Ultimately, talking about the debunking, the breast cancer was found to be related to the synthetic progestin that was used, which is different than the bioidentical progestin, but micronized progesterone that we use. And studies have shown that that does not increase the risk of breast cancer. So it’s all in what you’re using and how you use it.
Yeah. So let’s say you want to go the route of progesterone, what does that look like for somebody?
So progesterone comes in a few forms. It comes in capsules that you can take. There’s creams you can use. There’s suppositories. There’s sublingual lozenges or drops. Typically, progesterone is dosed once a day. And it’s important with all hormones when you’re using them to look at not only how you feel like you’re responding symptom wise, but also the level. Levels are partly a gauge of effectiveness, but I look at them as much a gauge of safety to make sure that we’re not exceeding a level that maybe we shouldn’t cross. Or maybe we’re actually making sure we’re getting sufficiency. So we’ve got a good level, symptoms aren’t better. There’s a problem somewhere else.
So we know that there’s these options. We get these tests. We’ve got all these things. What I do know is unique about the way we work with people at MIORA is that it’s really about the whole lifestyle. It’s not just about the medical side of it or the therapeutic. It’s also how does this fit in with other lifestyle habits and factors. So talk about why that is important, whether or not you’re using BHRT or not?
Sure. I mean, we know from studies that we can impact how our hormones work by doing different things in our lives. Let’s say like sleep. We make hormones in our sleep. We don’t make as much cortisol when we sleep well. So it’s important to think about the pillars of things that we were referring to earlier — sleep, diet. Our diets are poor these days. Too many calories, really poor nutrition. And if we’re not getting the right micronutrients, it’s really hard to make a hormone if you don’t give the body the building blocks. We’ve got nutrition aspects in there.
Exercise. We’re not moving the body, things don’t work the same. Diabetic, blood sugar issues. And social things. We need to get that connection. We need to also have social outlets. We need to have relaxation, that downtime, which helps our cortisol but helps us to be better human beings. So if we’re not working with all of those things, if we’re not taking all of those things into consideration, we’re just throwing a band aid on something. We’re not fixing the problem because it’s way easier to feel OK and do very little. It’s a little harder to feel awesome. But it’s worth the effort.
But that’s where we can get comfortable with that baseline of OK, because it’s like I’m not sick. Just I can’t get off the couch or whatever in many cases. But you’re getting by day to day. But being able to get to that place where you feel awesome, that’s a whole new baseline. And then where do you go from there?
And I see that. You’ll see somebody and they come in for a first visit and they’re describing all their maladies, and what’s wrong, they feel terrible. You see them back for a second visit and it’s like things are so much better. I feel wonderful. This is awesome. Yet when you talk to them, it’s like, oh yeah, I’m still waking up at night, and oh, I still have two hot flashes, but that is so much better than it was. So then we still take a step back and say, yeah, we have opportunity to make this even better.
Yeah. That’s awesome. How about supporting — we talk a lot about supplements and what are some strategic supplementation strategies that might be especially useful for women in supporting hormone health?
Yeah, for supporting hormone health, I’m a fan of a good pharmaceutical grade multivitamin, just because it fills the gaps in the micronutrients we’re not getting in our diet. I do like fish oil for the omega 3 to omega 6 balance, we’re getting way too much omega 6 in our seed oils. And you need omega 3s to make hormones, to make tissue compliant, blood vessels compliant. I love probiotics because so much of the immune system is in our gut, and if we don’t have the gut happy, a lot of things don’t work, including hormones.
I would say fiber, really underappreciated nutrient when it comes to hormones because fiber allows us to bind up excess hormones, excrete them. Fiber helps to maintain the good, healthy bacteria, which really impact our hormone levels. So it’s important to get plenty of fiber in our diet. There’s also magnesium, zinc, iodine, selenium for thyroid hormones. There’s a lot of micronutrients that we need to think about, but a lot of those are taken into consideration when they’re formulating a good pharmaceutical grade multivitamin.
Awesome. We’ve got those foundational ones. Anything — we’ve talked in different episodes like adaptogens and things like that. Anything that becomes a little bit more targeted, potentially, depending on the unique situation that a woman might be in?
So if we’re thinking about stress, cortisol, because we keep coming back to that, L-theanine, derivative of green tea, one of my favorite supplements. It really can be calming without being sedating, kind of takes the edge off. Ashwagandha, another adaptogenic herb really can be helpful with stress tolerance. But then we think about herbs or even nutrients that can be helpful from a hormone world. Things like diindolylmethane or DIM, that’s a broccoli derived supplement that helps with estrogen metabolism, really safe.
OK, so you’ve got this information at hand, now, what do I do as a woman who’s like, how I build a sustainable, personalized plan in partnership with a health provider?
Well, first consistency is important. Consistency wins over perfection every time. So we need to figure out maybe where we’re sabotaging ourselves. Not intentionally, but we are. I’m going to correct my sleep. I’m going to correct my diet. I’m going to correct my exercise, my personal relations, but realize that I’m going to have good days and bad days.
Yeah, there’s always ups and downs. Yes.
And so we need to forgive ourselves and move on. Taking on things that are manageable, small things that can become a habit. But the most impactful things, typically sleep and stress reduction. And if we can impact those, a lot of other stuff falls into place because it’s a lot easier to exercise when you’re not tired, when you recover well.
Well, and when you’ve slept well, again, that affects what you want to eat sometimes versus other things. So again cascade effect of choices. In this case, if you’re sleeping well, it can be in the positive direction for all of these things, right?
Absolutely.
OK. We’ve covered a lot. Is there anything we missed or you want to make sure we cover before we wrap up this episode?
Well, I would say we’ve missed a lot because there’s so much we could talk about.
Well, that’s why we have more other episodes.
Not an intentional miss, but there’s so much more we could talk about. But really, when I think about how we approach this is for women to be aware that there is a way to take care of these symptoms. It’s not just something we just deal with in silence and just tolerate. We as providers can help. So again, finding someone that is well versed in the field is comfortable working with you as an individual, because maybe what they suggest, you don’t feel is right, well, they have to honor that.
Finding the ways to adjust our lifestyle, fix our own problems. So somebody just says, well, here’s your prescription for, say, an estradiol patch. That’ll make you all better. OK. That’s helpful, but it’s not the end all. Somebody who’s willing to look outside the box and within you to say, what can we do to fix the inner workings to make everything else work better.
Yeah. Well, I just want to add, I think what’s so important that you said there is that the relationship between the provider and the patient, because it has to be this back and forth and what’s actually sustainable in your life right now. Like, at this phase, at this time, right now, this might work or it might not, but being very realistic and very honest about that, and being willing then to revisit it over time as shifts happen.
We talk about we’re shooting at a moving target that may be moving in a 28 day cycle, or we may be talking at a moving target that’s varying over years, but it’s still a moving target. So you’re correct. What worked today might not be appropriate two years from now. So just being on top of that, continuing testing, continuing to ask the questions, how are you doing, has anything shifted.
Yep. Like I said, we covered a lot. I want to point our listeners and viewers. We have covered hormones in depth. In a panel, in a longer session, we can find that online. Miora.lifetime.life has lots of resources. Experiencelife.lifetime.life we’ll point people to as well, because we can go more in depth and we will go more in depth on many of these topics in future episodes. But Greg, thank you for joining me. Thanks for going in on this topic.
Thanks for having me.
Yes.
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