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How to Optimize Female Hormone Health for Vitality & Longevity | Dr. Sara Gottfried

Episode 109 Jan 30, 2023 2h 30m 27 insights
My guest is Sara Gottfried, M.D., a Harvard-trained, board-certified gynecologist and clinical assistant professor of integrative medicine & nutritional sciences at Thomas Jefferson University. Dr. Gottfried specializes in hormone health, vitality and longevity using precision/personalized approaches. We discuss female hormone health, puberty, perimenopause, and menopause, hormone testing, the microbiome, stress related hormone challenges, their causes, and various treatments. We also discuss fertility, birth control and tools for improving microbiome health, treating PCOS, insulin management, and the best nutrition, supplementation, and exercise programs for women. While the episode focuses mainly on female hormones, males will also  benefit from our discussion because it includes  actionable tools suggested for managing stress, bolstering the gut microbiome, and immunity—all of which stand to improve overall health, vitality and longevity in males and females. For the full show notes, visit hubermanlab.com.
Actionable Insights

1. Know Your ACE Score

Understand your Adverse Childhood Experiences (ACE) score to gauge the impact of childhood trauma (abuse, neglect, alcoholic parent) on your psycho-immuno-neuro-endocrine (PINE) system. This insight can help explain long-term health risks and inform a more holistic approach to well-being.

2. Get Coronary Artery Calcium Score

By age 45 (or sooner with family history of heart disease), get a Coronary Artery Calcium (CAC) score via a CT scan of the chest. This provides a critical ‘fork in the road’ for understanding cardiometabolic health and guiding necessary lifestyle changes.

3. Prioritize Quality Sleep

Ensure adequate sleep, as sleep deprivation negatively impacts overall health, vitality, and hormone balance. Poor sleep also disrupts crucial growth hormone release.

4. Lower Perceived Stress

Actively work to lower your perceived stress, not necessarily stress itself, using an a la carte menu of tools. High cortisol is linked to depression, suicide risk, and metabolic dysfunction.

5. Avoid Hormonal Birth Control

Avoid oral contraceptives due to risks such as micronutrient depletion, increased inflammatory tone, rigid HPA axis, thyroid dysfunction, and elevated sex hormone binding globulin (SHBG), which reduces free testosterone and can lead to clitoral shrinkage.

6. Manage Chronic Constipation

Address constipation, defined as less than one complete bowel movement every morning with full evacuation, as it is a critical signal of dysfunction in the psycho-immuno-neuro-endocrine (PINE) system and is more common in women.

7. Increase Daily Vegetable Intake

For all ages, especially teenagers, blend steamed vegetables (e.g., broccoli, kale, cauliflower) into smoothies to improve microbiome diversity, support hormone health, and reduce future breast cancer risk. Greens powders are a less ideal alternative.

8. Optimize Exercise Ratio

For optimal cardiometabolic health, combine approximately one-third cardiovascular exercise with two-thirds resistance training. Avoid ‘chronic cardio’ alone, as it can excessively elevate cortisol levels.

9. Limit Alcohol Consumption

Limit alcohol intake to a maximum of two drinks per week. Alcohol significantly disrupts heart rate variability (HRV) and nighttime sleep patterns, impacting growth hormone release.

10. Benchmark Hormones in 20s

In your 20s or 30s, get baseline testing for estrogen, progesterone, and testosterone to understand their balance and identify potential estrogen dominance. This proactive approach helps in managing hormonal health throughout the lifespan.

11. Prefer Dried Urine Hormone Testing

Opt for dried urine testing for hormones (estrogen, progesterone, testosterone, DHEA, estrogen metabolites) and saliva for cortisol. These methods provide more comprehensive metabolomics compared to static blood levels.

12. Monitor Gut Estrobilome Health

Include stool testing to assess beta-glucuronidase levels, as high levels indicate an ’estrobilome’ that recirculates estrogen. This can increase the risk for estrogen-mediated conditions like breast and endometrial cancer.

13. Address Micronutrient Deficiencies

Consider nutritional testing (blood/urine) in your 20s (or earlier) to identify deficiencies in key micronutrients like magnesium, B vitamins, and glutathione. These are crucial for hormone production and detoxification processes.

14. Consider Copper IUD for Contraception

Explore the copper IUD as a highly effective, non-hormonal contraceptive option that lasts 10 years, offers reproductive autonomy, and has the highest user satisfaction rate. It avoids the systemic risks of hormonal birth control.

15. Practice Cyclic Sighing Daily

Perform cyclic sighing, which involves a double inhale through the nose followed by a long exhale until the lungs are empty, for 5 minutes daily. This practice has been shown to improve mood, lower resting heart rate, and enhance sleep quality.

16. Use Rhodiola Rosea for Cortisol

Take Rhodiola Rosea, an adaptogen, later in the day to help reduce cortisol and potentially improve late-day cognition, especially if you experience high cortisol levels. Refer to specific doses in ‘The Hormone Cure’.

17. Use Phosphatidylserine for Cortisol

Take Phosphatidylserine (PS) at 400mg to reduce cortisol; 400mg has been shown more effective than 800mg. Take it in the morning for high morning cortisol or at night for high nighttime cortisol, which is linked to anxiety, depression, PTSD, autoimmunity, and decreased breast cancer survival.

18. Personalize Omega-3 Supplementation

Measure omega-3 levels (e.g., OmegaQuant) to personalize intake. Prioritize food sources like salmon or other ‘smash fish’ twice a week, and supplement with 1000mg fish oil on non-fish days, potentially adding Specialized Pro-Resolving Mediators (SPMs) for inflammation resolution.

19. Supplement Vitamin D Daily

Supplement with Vitamin D, aiming for a serum level between 50-90 ng/mL. A general dose for those not testing is 1000-2000 IU/day, but individual needs may vary, with some requiring up to 5000 IU/day due to genetic variations.

20. Utilize Continuous Glucose Monitors

Use Continuous Glucose Monitors (CGMs) to gain real-time insight into how food, stress, and sleep impact your blood glucose. This empowers you to make informed behavioral changes for better metabolic health.

21. Track Fasting Insulin Levels

Measure fasting and postprandial insulin levels, ideally starting in teenage years. Insulin changes can precede glucose changes by years and are crucial indicators of metabolic health.

22. Pulse Ketogenic Diet Short-Term

If considering a ketogenic diet, use it as a short-term (e.g., 4-week) ’end-of-one’ experiment, measuring biomarkers before and after. Avoid long-term adherence due to limited data on prolonged use and potential microbiome effects.

23. Understand Family Hormone History

Discuss family history of hormones, pregnancy, perimenopause, and menopause with grandmothers and mothers. This provides valuable insight into potential genetic predispositions and specific health needs.

24. Avoid Toxic Relationships/Isolation

Recognize that toxic relationships and social isolation are detrimental to overall health and well-being. These factors can significantly impact biological systems, including hormonal balance.

25. Quit Smoking and Vaping

Cease all smoking and vaping activities immediately. These behaviors are severely detrimental to overall health and all biological systems, including the endocrine system.

26. Regular Gynecologic Exams

Undergo regular gynecologic exams, especially if at high risk for ovarian cancer or experiencing vague symptoms like bloating or lower belly pressure. Early detection is crucial for conditions like ovarian cancer.

27. Advocate for Hormone Testing

Challenge conventional medical advice that dismisses hormone panel requests for women not trying to conceive. Comprehensive hormone testing is crucial for all women’s health, regardless of reproductive intent.