Dr. Jila Senemar, MD: How Early Perimenopause and Insulin Resistance Drive Skin Aging

Welcome to Biohacking Beauty, your go-to anti-aging skincare podcast. We are your hosts, Anastasia and Amitai, the founders of Yango Skincare. And around here, we don't separate skin from hormones or beauty from biology because real skin health is systemic. Today's episode is all about women's hormones and not just the classic estrogen goes down, symptoms go up kind of way. We're talking root cause, bioidentical interventions, and how to actually optimize your skin and your metabolism through the lens of hormonal change. Our guest today is Dr. Gila Sanamar, a board-certified OBGYN, certified menopause specialist and founder of GLMD. She's on a mission to change the conversation around midlife medicine and she's doing it with science, empathy, and decades of clinical experience. If you ever wondered why your skin texture changed overnight, why perimenopause feels like a metabolic mystery, or what hormone trends are actually worth your time, this episode is for you. We cover everything from progesterone's role in collagen support to the truth about HRT, which lab tests every woman should run before her 40th birthday. And yes, we get into the hardest takes on what women should stop doing when it comes to viral hormonal trends. Whether you're in your 30s and thinking ahead, or you're in your 40s navigating the shift, or in your 50s ready to optimize instead of just cope, this is the episode that will give you a new roadmap. Hormones drive skin, mood, energy, and aging. And Dr. Chila is here to show you how to reclaim control over it all. And before we do all of that, every week we choose one of you guys' lovely reviews and gals, lovely reviews, and we read one aloud. Does it cringe me? Absolutely, yes. That's why Anastasia does it. And if we read your review, listen, it helps this podcast grow. Your reviews are important. We are on a mission to really support as many people in their journey to optimize their skin, optimize their health. It's important. I get it. And that's why if you leave a review and we're reading it, you're going to get a free product. we're going to tell you how to do it after we read the review and i also want to say that amitai reads your reviews at night on the couch and doesn't cringe him to read them he just cringes him to read it out loud on camera just so you guys know so best uh this review goes best beauty and longevity podcast based on up-to-date science no hype just straight facts delivered in an interesting way. Give amazing tips, easy to incorporate. Plus, the Youngo's products are actually highly effective. Thank you for continually educating people on skin. Debunking social media viral misinformation is also something this podcast does well. Tune in, you'll learn so much. Youngo's products are amazing and scientifically backed. I currently use three of them and can't wait to try more. And the handle is longevityTG. So thank you very much for this lovely review and please contact us either on instagram or email service at young goose.com and we'll send the product your way hey man i just want to say that i read the reviews to anastasia okay not to myself ah sure i'm just saying that sure sure but i read them aloud and she's there how about that he comes prepared he's like listen look at the review we got and yeah Sure, just for me. Just for me. So selfless. Yes, I do my homework. And thank you. Thank you. I love hearing them. Great. So we're in agreement. It's all for you. Anyway, without further ado, please welcome Dr. Gila. Well, Gila, it's so fun to have you here. Thank you so much. Thank you for having me. We should have recorded the podcast before the podcast. I know, I know. We had our own podcast going on right now about motherhood and AI. And I don't know, we touched on financing, entrepreneurship, we touched on so many things. But in this podcast, the theme, really the theme is midlife. And it's something you took on as a mission to really prepare women when they get into midlife, support them through midlife. And my first question to you is, is there a hormone that women like 35 plus should really obsess over? That's a great question to start with because it's not the one most people would think to look at. And it's honestly insulin. Let me tell you why. Insulin plays a role in metabolism, inflammation, and a lot of women in their mid-30s can start having inflammatory reactions going on on a cellular level that can lead to insulin resistance happening and they don't realize it, a simple glucose or, you know, that isn't, or a hemoglobin A1c isn't going to pick it up. Okay. And the way it presents in these women, they start gaining that middle body weight that they can't shed and they get frustrated with it. And they're like, you know, I'm working out, I'm eating the same, everything's fine. I just can't shed the weight. And they become more restrictive, more cardio, things like that, which actually worsens the situation. So there are better tests that can be done actually at that point to see if there is insulin resistance happening on a much lower level where they can then address it appropriately. So they would need something called a HOMA-IR, which is a glucose insulin, fasting glucose, fasting insulin calculation that shows you if it's elevated, if that ratio is elevated, then there is some background insulin resistance already happening. And by changing some lifestyle, making some lifestyle modifications with the foods that you eat and things like that, you can actually help prevent prediabetes and diabetes 10 years earlier than it would be picked up on a hemoglobin A1C. Wow, that's fascinating. And you mentioned the belly fat, right? And then I remember I read that one of the other things that sometimes signals insulin resistance that some blood tests might not show is skin tax. Have you heard of that? Absolutely. Is that also one of the signs? That is one of them. And this little hump that some people get here. Yeah, I've seen that. And darkening of the neck tissue right here. So what happens is this insulin resistance is something, it's a component of also polycystic ovarian syndrome. And a lot of those women, they have insulin resistance happening in the background and elevated androgen levels. And that's where a lot of these little, you know, signals start happening in the body. And they need to be addressed rather quickly. And even the way we kind of approach polycystic ovarian syndrome and things like that, because it's an inflammatory metabolic disease that can lead to long-term, you know, sequelae, chronic, you know, infertility, metabolic problems, prediabetes, diabetes, heart disease. So to avoid all of that, honestly, we used to just do birth control pills and metformin to kind of help improve this insulin resistance. But now we know better. And we need to approach those women differently, even in their 20s and 30s, with lifestyle modification. It is such a key factor in everything, especially with our environment, with the microplastics, the hormone disruptors that we are exposed to on a daily basis. Making those changes really can help impact a woman's glucose and sensitivity. Yeah, absolutely. Of course, at the end of the day, talking back about skin health, that's one of the biggest factors that we can control and that we can modulate as far as, you know, staving off or, you know, delaying the onset of the signs of skin aging, because that's a big driver of glycation or the apt name AGEs, right? Yeah. So right now on social media, at least in my algorithm, there is so much talk about perimenopause and myths and people debunking the myths and then people debunking the debunking there are response videos to response videos to reaction videos too yeah but in your experience because yeah definitely you are an expert and we're so happy to have you what is the biggest lie that women still believe about perimenopause i get this i don't know how many times a day where I have women sitting in front of me and they've been told, you still have your period. You don't have any hot flashes. Hence, you're not in perimenopause. And that is the biggest myth, lie, false statement, whatever we want to call it, because hormone fluctuations are in the background. The period changes, those do not need to be a component of perimenopause. they typically aren't. They're not the most common symptom of perimenopause. They're more common with menopause or late perimenopause. In early perimenopause, which can be a good 10 years prior to menopause, so now we're talking mid to late 30s, these are women who are still fertile technically. They can have a regular cycle every month, not skipping any periods, not having a single hot flash, yet they can be full-blown perimenopausal and not even realize it. Yeah. Because the symptoms are completely night and day different. And there is so much, like you were saying, with the lifestyle changes and the information we have now, if you are told that you're not in perimenopause and therefore delaying acting on what you're feeling is happening with you, you will end up having worse menopause and just suffer through it. Yeah, it's heartbreaking really to know that women are still told this every day. It's really, I have seen women lose between five to seven years of quality life because they were dismissed of their symptoms. And the thing is, they go in, they see their primary care doctor, their gynecologist, whoever have you, once a year. They have 15 minutes with that provider, if that. And they're not even asked a lot of these questions. You having your period? Yes. You feel good? Okay. All right. Let's do your breast exam. Let's do your pap smear. And they're out the door. No one is addressing, how is your relationship with your partner? Are you sleeping at night? How are your moods? How do you feel? No one is talking about any of that. And that's where it's at. In perimenopause, one of the most common symptoms that women are dismissing of themselves as well, sleep disturbances. They're not sleeping at night. They're waking up and they wake up in the morning, in the middle of night, 2, 3 a.m. They wake up in the morning unrefreshed, yet they have a slew of things to do. They have kids to get ready, take to school, drop off, get to work, come back, do after school activities, then make dinner. They're not thinking about what is happening to themselves. and women tend to put themselves last because we're moms, we're providers, we're wives, you name it. We do it all yet. We're not paying attention. So then all of this starts to build up on itself until the woman gives, like it just, something gives, they just can't take it anymore. And they finally get to somebody. Now at this point, this is a, it could be a pivotal moment where someone like Oh I get you Yeah You have your period You fine But you were in perimenopause Every patient I say that to they like are you sure Do you need to check a lab test I actually don because there is no lab test to tell me if you're in perimenopause, right? The hormones fluctuate from day to day to day. But if you have enough symptoms where it's affecting your quality of life, that's enough for me to start some kind of treatment with you. Yeah. Yeah. I think, again, I don't know. I think the same way where you know hormone replacement therapy was uh was uh almost taboo to some extent in conventional medicine up to a few years ago i think also the the idea of of true optimization is now taboo and what i mean by that by the way it could be for men and women but obviously anything uh if men experience it within medicine women experience it 10 10x or 100x and within that I think it's very important to understand that most people, who do you see trying to optimize their health? People that have a lot of money and a lot of time. Normally, that doesn't happen in your 20s. And maybe the unspoken idea behind optimization is trying to turn back the wheel. The newsflash is that this is impossible or extremely costly and extremely costly both in energy and finances to do, but most of the time impossible to do at large scale. Real optimization is as the word is. It's optimizing your performance right now, how your body performs right now, so you can gain that five, seven years that you talked about before, so you could delay the onset of menopause, or by the way, you can smooth out that transition. And that is, I think, someone such as yourself. I mean, we've heard you talk. That's how we've gotten to know each other. And that's something you touched on when you were talking, which I've actually never heard about before, is that the smoothness of the transition is one of the kind of the qualitative factors that you should be aiming at for. And of course, from our vantage point, from the skincare vantage point, skin health vantage point, we know that the two crises that we are called to serve are kind of late 30s and early 50s. And guess what happens in those areas or what can drop off a cliff in those areas? That's your perimenopause, menopause, hormonal balance, etc. Yeah. Yeah. I mean, honestly, when you think about the fact that when you get to the last three or so percent of your eggs and that the collagen production drops by like 20 percent, I think 30 percent it is. It's crazy that our fertility affects so much of how we look. And once that starts to decline, everything goes downhill. But with that, I think thanks to you and other women that are talking about this, there is a lot more awareness. And there are certain viral trends online. And including like viral hormonal, you know, practices that are trending. Out of those, out of what you see online, is there anything that's really worth trying for our listeners that you see women start implementing in their perimenopause? Lemon in the morning. No kidding. And it actually like makes sense and works. You know, there's a lot of different things out there to employ. And I don't want everybody to think that they have to go to hormone therapy right off the bat because that isn't the fix-all for everything. It's not a magic bullet. It doesn't work like that. It's a part of the puzzle piece. You know, you got to put it all together. But in your 30s, if that's really what's happening, I would go for muscle building. You need that muscle. That's what's going to carry you through because muscle is a metabolic organ in and of itself, right? It helps with insulin balance. It helps with cortisol. It helps keep you strong, keeps your bones strong, and it's good for metabolism. And also testosterone plays a role in muscle as well. So if you're going to do anything, the most proactive thing I recommend to my patients, like start building muscle in your 30s, two to three days a week of strength training. But again, with somebody who knows what it is that they're doing, don't just go to the gym and start lifting heavy and doing deadlifts because you're going to hurt yourself. Okay. But really dedicate the time and the effort to doing the appropriate workout regimen for yourself, which could be a combination of things. It could be two, three days in the gym and then the other days of the week you're doing Pilates or biking or swimming or whatever you like or enjoy doing because you're really only going to do it if you enjoy doing it. If it's a chore, if you make yourself go, it's not going to work. It's not going to last long term. Your husband makes you go. I mean, that has been trying to convince me to start lifting weights for years. And it was so hard for me because I'm such a bar and Pilates girl. I just really enjoy bar and I see how it changes my body. It gets me to the shape of the body that I love seeing. And I enjoy Pilates as well. and last year 2025 was the year of me actually being consistent with training with a personal trainer shout out to Jacqueline very very uh well informed for perimenopause and and in general and yeah that's um that's a habit that uh I got influenced last year and that's I actually yeah for me it was also trending like uh I've seen women talk about it more and more and men also recommended that and so yeah i think that's a great one for sure yeah i think you know where we are now is that we're they're actually we we're starting to understand i mean starting the last 20 years we really are rediscovering the aging process of our bones we're really you know if 20 years ago it dawned on everyone that we need you know uh thicker or more robust skeletal structure as we grow older. Now, thanks to very interesting, by the way, very interesting ways to measure or to, spoiler alert, to measure the quality of bone, right? We're starting to understand there's much more there. And it's not only the mass there, but it's kind of a functional ability to bend, to stretch, to carry load, etc. And one of the things that is becoming kind of more and more and more popular is its contributing ability to contribute to the organism as far as anything from energy, from metabolic output, from input to things like collagen production and hyaluronic acid production and things like that, and even releasing of stem cells to the bloodstream and everything. And that is something I think is not, you know, not relate back to what people mostly, you know, care about, at least from our field, is like how they look. And I remember I had, when I was, I don't know, 16, 17 years old, I went to the gym. And all I cared about is the way that my body is. I don't have developed pecs. I don't have developed, you know, chest. That's what I cared about, you know. And the guy said, oh, you should squat, like my trainer's like. I'm like, I don't get it. All I want is to have like a big chest. What does squat have anything to do with it? And back then, bro science was like, hey, if your lower body is not going to grow, your upper body is not going to grow. So it's like, I'm going to understand there is a cap there. But we're starting to understand like hormonally, there is something that's going on when you carry a lot of weight. And more than that, there is something that's got to do with bone density that you also want to preserve as you grow older. and your bone density in your whole body is affected by the amount of weight you can lift. By the way, you're also exerting a lot of pressure on your jaw when you're lifting and exerting energy. There's even ways to expand that. We're maybe going to do it in a different episode how to really even do that more. But just to emphasize your point is that we want to lift weights because it does way more than give us a round shoulder or whatever, or a chiseled, I don't know. Jawline. Jawline, no, yeah. That's much more. But no, it does much more than just provide us that metabolic output that lifting weight does. Yeah. Let's take a second to talk about skincare during winter. Here's the part most people miss. Winter does not just dry your skin. it changes how your skin produces energy and repairs itself. When temperatures drop, trans-epidermal water loss spikes, mitochondrial output slows, and the barrier starts losing ground faster than it can recover. This is why skin becomes reactive, inflamed, and unpredictable in winter, even if your routine worked perfectly all year. Most people respond by adding a heavier moisturizer that does not address the problem. So we built a system instead. The Winter Skin Protocol is how we protect the skin when repair capacity is compromised by cold, wind, and low humidity. It is not a generic routine. It is tiered by metabolomic skin age with clear guidance on when the priority should be protection versus repair and how to adjust when travel, treatments, or environmental stress push the skin past its threshold. Inside the protocol, you will find structured morning and evening routines, red and near-infrared light timing, and targeted strategies for the areas that break down first in winter, including the neck, chest, and hands. If your skin becomes tight, red, or reactive every winter, this removes the guesswork. If you want to go deeper, you can download the protocol and see the full system. The link is in the episode description. Your skin already knows winter is different. Your routine should reflect that. I have actually a question about testing. So you kind of mentioned talking to patients about the blood work results. And Amitai and I recently went to do blood work. And because of what we wanted to test, we actually opted for going like self-paid and just, you know, like just give us all. We went to a functional medicine doctor and we tested everything that we want to test. And I was just talking to a friend about it yesterday and she's pregnant and she's 40. And she's like, oh, my God, I think I'm going to need to go to this doctor that you went to see because my OB, you know, tested just only this, I don't know, let's say four or five things. and I told her that I'm known to be very close to be anemic and I really want to test my ferritin, iron, etc. And she's like, well, you don't have, I kind of can't test you for that because I don't see anything alarming. So long story short, she basically told her, no, this is what I can't have you test. I understand that she's paying with her insurance and it's very complicated. I guess the question I'm asking, if people really want to get a full picture and get like really proper blood work, can they ask it from their OB that they're seeing and it's up to OB? Or is it really that unfortunately the medical practitioners are very limited and yes, people actually have to seek help outside of their OB that they're working with? You know, medicine is quite complicated, especially when there's insurance involved. You know, doing conventional medicine with insurance for the past 25 years, I can tell you, even if the patient understands and wants everything done, you can still run it. There's a chance insurance is or is not going to cover it And so as long as they aware of that I would run anything and everything that the patient wants In terms of pregnancy actually what I think may have been going on I don know but normally we do a CBC, looking for the hemoglobin hematocrit. That's one of the first things we check. And if we see an abnormality in that where it's borderline to the lower level, where we would think somebody may be anemic, then we would run the full iron panel to look for the ferritin and the iron binding capacity and all of those markers to see because somebody can have a normal hemoglobin hematocrit but have iron deficiency still. And women, especially in pregnancy, that can shift and change. So we do routinely run it if we see a problem. Now, the woman comes in and tells me, I don't feel well or I feel dizzy or lightheaded. I would run both of those on her because there is a chance due to hemodilution of pregnancy, she can drop the hemoglobin and the ferritin enough where she's feeling it. So it is to our benefit. I tell a lot of patients, I'm like, listen, even if they don't cover it, it's worth it to get that test done. They're not thousands of dollars. These tests are not going to break the bank. Now you do a full genetic panel on a ProNovo scan and add everything else on, we're talking thousands of dollars. But if you're just doing simple blood work, it's not going to be cost prohibitive to do that. Outside of pregnancy, like what I do now in my new practices, they get the full head-to-toe biomarker check once a year at least. And depending on what the results are, if there's something I need to follow up on, then I would repeat that incrementally as we go throughout the year. And with that in mind, is there anything in particular that you think women often don't know that they need to test? Like what do you recommend any woman should test for before her 40th birthday? Before the 40th birthday, I would say definitely you need a full blood work panel, all that. But I really love my DEXA scan, my bone density. Going back to the bone density. Back to the bones. because based on recommendations by the U.S. task force, we don't check a bone density until 65. Oh, my God. By 65, we're behind the eight ball. Yeah. If you don't have osteoporosis, you definitely have some kind of osteopenia by that point. So too little, too late. So I've actually moved that. It's not a recommendation by anybody but me based on my own research and knowledge that I have And based on what I've seen in my practice, just by doing this over the last two years, I have picked up 40-year-olds with osteopenia setting in already. Had I not done it, she's like, why did you do this test on me? I said, because I wanted a baseline. Because if it's perfect, then great. I will do lifestyle modification, supplementation, do all of that, and then repeat it at 50, let's say. But I have found more than I would have liked. so because I'm like everybody gets a bone density at 40 or if I see I'm like 45 they all get one and again it's a $100 test and there are other benefits to DEXA you can also find out that you need more muscle just saying it's a very vivid test it gives you a clinical picture that you didn't have and again remember what is our goal with what we're doing? And this is really, you know, a lot of women think we're just trying to cover symptoms with hormone therapy. And yeah, that's goal number one. Obviously, they don't feel good. You want to make them feel better. Goal number two is longevity. What does that mean? It means you want to avoid that heart attack. We want to avoid that hip fracture, the silent disorders that are happening under the surface due to this drop in estrogen level that happens in midlife. And, you know, I've had patients tell me, listen, I went through it pretty easily. It wasn't a big deal. I'm fine. But when I do testing on them and I check their bone density and I do a calcium score on them, they're not that fine. And then they're surprised by that information. And now we have to kind of re-educate everyone from the start. Yeah. Like, thanks to the education that I've received over the last year, we had so many speakers and educators, I've learned that estrogen is actually a signaling molecule because we always think about it as a hormone. But it's like, it basically signals our body to do so many things, like I mentioned collagen production, but even like it has to do with the insulin and so many more things that, yeah, once it drops, we have to be prepared and we have to, you know, counteract. What were you going to ask? I kind of interrupted you. God knows. I know. it's in the ether now that's about right I think you know I'm always super curious first of all you know you you've opened your clinic almost a year ago which is a clinic that really focuses on people once they I loved how you called it off air once they're done having kids first of all I'm curious if you had to have like an 80-20 rule or 80-20, you know, whatever, splicing, 80% of people, like, what are they coming with as they're burning, might be physical, but like how with their burning desire or what's on their mind, like what do you see a lot of? And then, you know, you did, you know, you did talk about hormone replacement therapy. One of the, what are some of your, what are some of your kind of star treatment star approaches that you're taking and you're seeing profound change in those people? Not, you know, end case scenarios, but really that 80% and then 80% of the things you're doing to them. So 80%, I would say what I see is they don't feel like themselves. Their quality of life, everything has changed and shifted to the point that they don't recognize themselves. and I feel terrible saying this, but they're at their wits end. I'm like their last resort. They're like, I've gone. I had a woman drive down to see me from, I want to say two, three hours north, almost by like Orlando area, had been dismissed by, I don't know, a slew of doctors over the years, seven years of struggling with symptoms that have worsened. And how old is she? she was 43 wow okay that's so sad that's exactly what we said it's such heartbreaking thing to know that these women are out there seeking help and you know what gets better is she didn't want to come because she told her husband what's the point she's going to say the same thing everybody else has at reputable institutions and i'm not going to get anywhere he drove her down he said you know what we're going to go no matter what i want you to go let her say the same stuff and then at least modern romantic for sure or he couldn't take it anymore but yeah I mean this is like the highest one of the peak times people get divorces like when women hit their perimenopause and if the husband is not aware that this is not his wife gone crazy and he needs to go look for a new one or whatever by the way I meant he couldn't take it anymore that every doctor tells her the same but sure yeah yeah that too that too it's a little bit of both you know it can happen both ways i know we always look at things differently but yeah anyway so that was still very admirable that he drove her down and he was like no we're we're resolving this for you that's it makes me like want to tear up no but it was really it was an impressive situation to see this happening? And, you know, I spoke with her first, obviously. And I'm like, so tell me what's going on. And she gave me her whole story. And I looked at her, I said, and this is what we're going to do about it. And she started crying because she said, you're the only one that told me that there's something to do and that there's nothing wrong with me because the last provider wrote in her chart needs a psychiatric evaluation. Wow. That's, and to your point where my wife's crazy this is what we've been what's been out there this is our culture unfortunately this is how women have been looked upon you know yeah this doctor needs a psychiatric you know which used to be done to women for yeah you know and called hysterical right so with her you know then i spoke with the husband obviously and he was like yes this is kind of what we were here for is to listen and see that there's nothing wrong and that there is a physiologic, biologic reason for this and how we're going to approach it. That's my 80%. So I see a lot of that. Not to that extreme. It's very well put. Very, very well put. You know, most of the people that you meet, I feel like they still think of themselves as like an 18-year-old. There's a 15-year-old, really. Is this some, you know, child stuck in an old person's body or a mature body, if you would? It's very true. Listen, this is a shift that we were never taught about. We know about puberty. We know about reproductive years. We're happy. We celebrate all of those. No one talks about this because it was a taboo. It was like the falling off the cliff component. It's like kind of put her to the side. It is what it is. We deal with it. We move on. But what did that look like? It didn't look too optimistic. If you know, if we remember, like our grandmothers were cute and all, but like they would get shorter and smaller and frail looking. We're not looking like that. This generation of peri postmenopausal women are not that. And with that, we're living longer, but we want to live healthier as well. This isn't just lifespan. This is all about healthspan. And if I can live seven, eight years longer, but healthier, I'm all in with what we can do about it. So that's like the 80, the 20%, you know, where, you know, they're just kind of like, they don't, they, you know, what will we do? And how do we modify things for women? I really like to like kind of break it down for them into like, okay, now we're going to do handholding here. And a lot of what I, you know, pride myself on doing is really walking the patient through the next phase because you cannot give them a treatment plan and say, okay, go, go be on your way. They need handholding because there's a lot of fear. There's a lot of misinformation out there. And so I can put them on a treatment plan. And then they talk to a friend who says, are you sure you need that? You know what? I don't know. Did she look at your labs and maybe you don't need that? And no, she didn't tell me about my labs. Oh my God, what am I doing? This is where I come in. I'm like, give me a call. Call me. They send them an Instagram reel. yeah exactly and i get it's funny i get them on my social media my dms like i saw this i'm like i did too i'm on the same feed you are and i know what's out there that's why i'm not a social media guru by any stretch of the imagination but i realized that's how people are getting their education and how misinformation is out there i'm like well let me get on there and put on you know the stuff i know that i know is fully balanced a little bit let me balance it out a little bit but it's that hand-holding. You need that guidance. And then once they're past the worst of it, they're great. Like you have a new person in front. When I see him back in six to eight weeks, I have a new individual in front of me who's now, okay, I'm better. I'm not a hundred percent, but I'm getting there. And we have something to work towards. So I think that's kind of how I approach things. Got it. It's very cool. One of the questions we received in preparation for this podcast was if there are any, let's say, one habit that you say it's really impactful for metabolism, which we know slows down. So is there anything that you saw really working? I know we talked about weightlifting. Right. Anything else Injecting GLP That is part of it In the right patient population Yeah I think a lot of it really has it goes I go back to lifestyle with all of this because they need sleep They need quality sleep because that will help lower the stress on their body, which will then lower the cortisol level, which then will help with inflammation and kind of rebalancing their whole metabolism, insulin, all of that. They all go hand in hand together. You mentioned it, estrogen. We have estrogen receptors everywhere, all over our body, including our fat cells. So that's why you get this, the lack of estrogen causes more fat to be kind of surrounding your organs. So the visceral fat rather than the subcutaneous fat, which we know that visceral fat is much more dangerous for us. So if you can rebalance all of that out, then you start to notice kind of the weight balances itself up. Not saying hormone therapy helps with weight. It doesn't. It doesn't make it go up or go down. So you cannot gain weight. You don't tend to lose. You don't tend to gain weight on hormone therapy and you don't tend to lose on it either. But indirectly, it can affect metabolism because if you balance things out, then everything else downstream kind of falls into place. Got it. Do you think, would you want to see, you know, talking about weight loss, HRT, would you want to see a test, like what do you think is the role of testosterone replacement therapy in women? Obviously, right now, you need to have like a diluted form of men's testosterone replacement products do you want to see a women's specific one are you comfortable with the way things are do you think it's unnecessary most people like what where do you stand on it i love testosterone yeah um some women make women make estrogen progesterone we all do and as we go through perimenopause there's actually really progesterone that starts to decline first then estrogen testosterone last but we still need to be cautious and cognizant of that and replace it as needed. Because looking at a number doesn't tell you, again, with a lot of blood work, what I try to relay to my patients is a number doesn't define what's going on. It's about optimizing that number. So you can be within the normal range, but where in that range are you? And maybe for one individual, being in the middle is good. And for another individual, they need to be on the upper end of normal to be optimized. So it's really about replacing based on what they're feeling. So I'm all about testosterone replacement. Some people, depending on, again, symptoms, when they walk in to see me, we do it at the same time. So they get estrogen, progesterone, testosterone. Others, I may hold off on it, do the estrogen and progesterone first, and then later sprinkle in the testosterone, depending on how they're feeling. We need a female formulation. The specific, using the men's version is really not working that way. It works, but it's not amazing. I do two things. I can get a compounded version from a compounding pharmacy where they use like three or four clicks, which is a lot of cream to be using every day and waiting for it to absorb. It's a lot of volume. So because of that, I've switched over to the male version, the testosterone gel, but even that can become messy. And the patient's like, how much am I really getting? I don't know. So we're trying to, okay, put it in a syringe and try and use half an amount pea size amount what does a pea size amount look like you know so again going buying peas in the in publics and comparing it i have a dog what do you mean i'm like like like this much okay like like this much i'm like yeah you know back of your leg you know this and that make sure you don't it doesn't get on anybody else it's a little bit cumbersome to do something every morning and listen we're already having them let's say use a patch twice a week and a pill at night every night and some women need vaginal estrogen so add that in and now put a cream on like yeah it's like it's a mission so really we need to make it easier so i think that's the next thing for the fda is to get us our own testosterone yeah we need it amen yeah the testosterone our own testosterone for women 2026 let's go so um you know we talked about some of some of the some of hormones and their effects i think estrogen does get a lot of a lot of attention rightfully so am i correct to say like progesterone is not there yet even like looking at social media looking at oh i see progesterone all the time so i'm incorrect videos about progesterone i mean i've seen you're gonna be the expert but this is what i heard that probably that's what other listeners heard i've seen this uh video where it basically goes you are in your 30s would you benefit from progesterone yeah actually you would you are in your 40s would you benefit from a supplementing on progesterone yeah actually you would and then they just go down and down and down and age and it's like unanimous everyone could benefit from progesterone so i think that maybe It's brought to you by Big Progesterone. Big Progesterone Corporation. So that's information I have. Do you agree with that? So it's interesting what you said is that estrogen gets all the credit. Yes, because there's a lot that goes on with estrogen and we know it works everywhere. But so does progesterone. Progesterone is the calming hormone of our bodily system. It helps with sleep. It helps with cognition. It helps with mood. is stability, anxiety, all of that is progesterone mediated. And to be honest with you, a lot of perimenopausal women, regular cycles, they benefit from the progesterone first. So we, you know, I tend to looking at a case by case situation, but I would, you know, be inclined to start them on the progesterone first, see how they do, and then add in the estrogen as we go. Because again, they may be okay on the estrogen side, meaning cycles are fine, nothing crazy, nothing else is happening. Okay, let's do some progesterone. Let's see how you do. And then as time comes by, then we decide to add in the estrogen down the road. How common is it synthetic, like progestin? How common is it right now to prescribe synthetic progesterone? Why would someone not do that? Why would someone should be aware of what they're getting and opt for bioidentical progesterone? So there's a lot out there. But to be honest with you, like most people will be getting bioidentical, especially in the perimenopause phase, as long as they have other forms of contraception, whether it's a vasectomy or tubalization or things like that. Now, the only time I would really need to use a synthetic version is if we need contraception. Because again, in perimenopause, we're still fertile and can conceive and ovulate. So because of that, I would tend to go to like a progesterone-only birth control pill to give them contraception from that angle, or maybe even use a progesterone-containing IUD to get the progesterone into their system, helps with contraception. And then down the road, we look at estrogen and then add in the estrogen component, bioidentical. And once they kind of graze into that menopausal phase, then you can switch them off of the synthetic onto the bioidentical. But 90% of women will be on a form of bioidentical progesterone, which is either prometrium or micronized progesterone. Why would you opt for bioidentical? What are some of the issues that people might get with synthetic progesterone? So the synthetics are, you know, physiologically, your body breaks it down completely different than a bioidentical. bioidentical. It's basically, it's chemistry. So the bioidenticals, again, it's a marketing term, by the way, it doesn't mean anything, you know, it just means the way your body recognizes that progesterone is the same as if the ovary was producing it internally. So and the side, the byproducts through the liver are not detrimental, so they don't go back into the bloodstream and cause problems. The progestins, that's where we get into trouble, is the breakdown products, then get into the bloodstream and they can cause anxiety, mood, other problems. And that's why you kind of want to steer away from them as much as possible in perimenopause. Got it. Interesting. Okay. Let's go to some of the rapid fire questions. Okay, we always wrap up the episodes with the rabbit fire. Okay, what is one thing women blame on aging that is actually fixable? On aging? I think it's weight gain. Like do they wake up in the night? No, weight gain. Oh, weight gaining. The gaining the weight, the midlife in the middle, higher that they call it, or the metal belly they call it. Oh, like do they give up on being in shape because they're older? that also and also the fact that now what used to work doesn't work anymore so they used to do more cardio and eat less yeah and they want to continue doing that regimen and unfortunately it backfires in midlife because of the high cortisol and inflammation you're only going to kind of get skinnier fatter you're gonna get fatter so yeah so it doesn't work for them so they get it you know they kind of give up on it skinny fat exactly okay what is your hottest take on hormone replacement therapy? My hottest take on that is in the right patient at the right time, they should start definitely impairing menopause and not have to wait till they're in menopause to begin. Yeah, that's hot. That's hot. Okay. That's hot. What is one thing women should start doing in their 30s if they want to age well in their 50s? They need to really pay attention to their lifestyle, minimize the alcohol, improve their sleep habits, minimize stress and toxic relationships, really, and listen to their body and their cycles and learn what their body is trying to tell them. And build muscle. And muscle, obviously. You see, I learned well. Yeah, no, you passed the test. Well, I think that's a beautiful wrap up to this episode. You're such a wealth of knowledge. Thank you so much for coming. So I have a couple of questions. So first of all, how can people work with you? And then I don't know if you want to talk about the online educational platform. So thank you both for having me. It was so amazing to meet you both, you know, a few months back. And I'm glad we've kept the relationship going and conversing and seeing each other at other events. And this was amazing. I love this. You can find me on social media at my Instagram, Dr. Gila Sanamar. The website is GilaMD. That's where they can sign up to be, you know, looked for as a patient and find an appointment there. And in terms of online platform, education coming, launch will be in about two to three weeks. Wow. So this is going to be by the time this is out, it's going to be launched. We're going to be launching. So that's what we should do. We should, yeah, we should air it when it's launched so we can have it linked in the show notes. Yep. So how do, you know, so people post it. I will definitely keep you posted, yes. But do you have any information as to what's going to be called? There's going to be an Instagram page for it. It's going to be Second Bloom Health. And we will have all of that information on social media. And I will pass it along to you as well. Amazing. So that's going to be in the show notes. Second Bloom Health. I want a Bloom. You want a second Bloom too? Yeah, exactly. But that's going to be in the show notes. and we're going to make sure to link to it. Yeah. I appreciate it. Thank you. Thank you. Good luck. Thank you. Bye. Yes. you