The Ovarian Clock Nobody Told You About: Female Hormone Health Across Every Stage of Life

All right. If you're a woman in your early 40s and you're feeling like not so great, but your doctor's saying that everything is a-okay and you're wondering what's going on, then this is the episode for you. And we're also going to talk about how to optimize your health as a woman all the way through way past into the latter years.

Welcome back to Cell to Systems, episode 21. In this episode, we have a special guest, Lexi Yoo, who is a family nurse practitioner and CEO of Yoo Direct Health located in Indiana. And she is definitely an expert in this particular area. So, we're going to cover a lot of topics today around female health. All of which I have very little to contribute to other than to say that I've watched my wife go through some of the challenges of being a woman and having those changes happen. So, Lexi, welcome to the show. Maybe you can kind of start us off.

Yeah. So, yeah, I'm excited to be here and so many familiar faces. So, my name is Lexi. I'm a nurse practitioner. I'm boarded in family practice and pediatric medicine, and I specialize in perimenopause, menopause, as well as peptide therapy and advanced testing. We focus a lot on root cause medicine in our practice. And so a lot of times, specifically in women's health, women go to the regular doctor. They present with a certain level of symptoms and it's usually, "Let's give you some birth control," "Let's give you an antidepressant," or "You just need to relax," right? Which are copout answers.

And so what we do is women come in, we focus on really trying to dig into some blood work, some advanced testing. But not only that—and this is what I tell practitioners when I teach them—the answer's right there. The patient will literally tell you what's wrong with them. You just have to listen. And so what we do is we try to marry all of that and then focus on once we kind of get them out of that volatility of hormone dysregulation, where do we go next? So really being proactive with their care instead of reactive, which is what traditional medicine is, and then gearing towards longevity.

That's fantastic. You know, it's interesting. I recall a couple episodes ago, Dr. Farie, you talking about birth control and the downsides of that. Might be interesting just to talk about that really quickly as we sort of start to move into all of this.

Well, it's interesting how birth control works. You know, birth control is awesome for preventing pregnancy, but it does sort of put the person in a menopausal state. You're increasing the person's sex hormone binding globulin, which is this—I always describe it to patients like it's the overflow valve in the bathtub. When you have too much hormone, your SHBG, your liver is going to start producing this binder that's going to bind up all of your hormones. It binds up thyroid. It binds up cortisol. It binds up to estrogen, testosterone, everything. So, you're now putting this person into a hormonal deficiency state by putting them on these birth control pills, and they'll experience what that feels like. Like, you know, a lot of women will experience a lot of perimenopausal or menopausal symptoms like depression, migraines, hot flashes. They'll have no libido at all.

So, when young women come to me on birth control pills, one of the first things I do is show them what their hormone levels are. And unfortunately, many of them have undetectable estrogen and progesterone levels. And this is in women who are super young. They're losing their hair, their skin is looking not so fresh and thick and nice. And so, these poor young women are coming to me with this problem. The great news is we have alternatives to that. One of my favorites if we need to prevent pregnancy in patients is—of course, the only therapy that is effective 100% against pregnancy is abstinence. But if that's not an option, then we talk about things like IUDs. We can use—there's lots of other options that are available, but one of my favorites is the non-hormonal IUD. The benefit of that is we can do other things with the person's hormones.

The other time we'll see a similar situation is in our elite athletes. So, especially the women who are really doing a lot of long-distance training or they're playing sports like soccer or basketball, they're going to really be in this deficient state, and they call it the athlete triad. They'll end up with amenorrhea as one of those pieces, where their bodies are not making hormones because of the low percent body fat that they have. The body is sort of saying, "Hey, I don't want to produce any more hormones because what we're doing right now is not about that." So, they become in this somewhat oxidative stress state. Unless we're being really intentional about nutrition and other lifestyle things in these elite athletes, we're going to see them be in this same sort of menopausal low hormone state. And we can see all of those situations where they lose bone mass. So, those are things all for us to consider as we're treating these younger women.

And that just goes straight to Christy as an elite athlete, collegiate athlete, D1 long-distance runner, track athlete. Christy, what was the effect of that on you? I mean, I remember having a conversation with you talking about all sorts of things around this, but I think that just leads us right down the path as we start at the young age and then move up. But what are your thoughts here?

I mean, 100% is what Dr. Farie said. I mean, I can count on my hands how many periods I had in my teens and 20s—very few. And I think, to be honest, I have to thank my orthopedic surgeon that really introduced me into hormones in my 30s as far as why I was experiencing so much bone pain, because I didn't understand it at the time. I wasn't practicing this type of medicine. But absolutely—I mean, progesterone is life-changing for so many women in their upper 20s and in their 30s. How I like to explain it is that typically (not always), progesterone is that first hormone that will start declining because ovulation is becoming less consistent. And then without progesterone, sleep worsens, anxiety worsens, inflammation rises, and then you start getting those vicious estrogen variabilities.

Then, to Lexi's point, the classic standard: we have these mid-30s women presenting to these standard practices, complaining of depression, their fuse is a little bit shorter, they're not sleeping well, and what do we do? They get sent to therapy. But yet, if the same person comes in that's in their 50s, "Oh, it's menopause." But it's the same biological issue. I mean, it's the same biology.

Really interesting. Hey, this is the point in time where I think Dr. Pestana is going to have some questions, right, Leonard? I think I know you well enough to know by now I can see the wheels turning. What are you thinking?

Well, you guys have been talking about a lot of different scenarios. When we're talking about longevity medicine, one question that I always have is: it seems that there's a lot going on, so how do you identify it? Because the one thing about longevity medicine is we're trying to identify risk and disease earlier than you typically do, and you guys mentioned that this isn't something that usually happens in a traditional practice. Lexi, you started off by talking about how some of these symptoms are just kind of ignored. So, what are the things that people should know about when they're going to their doctor to see if they're being checked out correctly? What are those signs that are probably not being looked at by their traditional doctor?

Yeah, I think probably one of the first signs that we see is fatigue. That's probably one of the most common complaints that we see in our practice. I would say weight gain is probably the second most common one. And then the third one is kind of like, "My libido is not good," or "I don't feel like myself." That's probably the biggest complaint that we see a lot. What's hard in traditional medicine is, you know, we have the subjective and they have the objective. In traditional medicine, they're very good at the objective: What can I see on blood work? What can I see on a DEXA scan? What can I see on a PNOE? What can I see as far as quantifiable numbers?

The subjective requires you to listen to what the patient's telling you. I think that's what's hard sometimes—to say, "Well, what does that mean exactly, 'I don't feel like myself'?" Really doing an evaluation on symptomatology—when it starts, does it get worse throughout the cycle? A lot of times in our perimenopausal patients, I tell them their period is literally our sixth vital sign. So, I can get so much information based on where you're at in your cycle. I'm a huge fan of the Oura Ring. I have a lot of women track their menstrual cycles, their sleep, and all kinds of stuff like heart rate variability on their Oura. The amount of data that I can pull from that and then tweak their progesterone around it is really cool. Really, really cool.

Yeah. So how are you able to know... because a lot of these things mimic poor metabolic syndrome. How do you know that it is not just poor metabolic syndrome, or that it is the beginning of ovarian aging?

Yeah. So there are some biomarkers that we check on what we call our longevity panel. On our longevity panel, we'll look at things like apolipoprotein B, Lp(a), adiponectin, HOMA-IR, insulin, high-sensitivity C-reactive protein, and oxidized LDL. So it helps us look at a really good metabolic picture. On the hormone side, we also look at something called an anti-Müllerian hormone (an AMH). So that kind of gives us a little bit of insight as far as ovarian reserve, and I always tell patients it's like how much juice we still have in the lemon to squeeze. So we look at it from a hormonal perspective, we look at those advanced cardiometabolic markers, and we also look at an InBody. We look at body composition—or whatever body composition test an office has. That is also very helpful.

Sorry, I've got a bunch of questions because they keep leading me on to thinking about the next thing. So many physicians don't test those things and don't look at those things. When patients have the typical fatigue issues, do you believe this is maybe one of the reasons why we have the overprescribing of benzodiazepines or SSRIs? Because they're not looking at the potential of this being potential early perimenopause, and it doesn't seem like they have solutions for that. Tell me if I'm wrong, but I believe that they're waiting for irregular periods and hot flashes before they even start thinking about that. And since they're not thinking about that—and I'm not sure about the guidelines, but the guidelines are telling them, "Hey, when this is happening, this is when we intervene"—their solution is maybe an SSRI or an anxiety medication, one of these band-aids that just kind of makes things worse.

Sure. I like to be honest with patients, and I tell them I'm not anti-medicine. Sometimes we have to use those to buy me time to figure out what's actually wrong with you. But a lot of times with those patients, I like to start with progesterone. I find that that's typically the first hormone to go for a lot of different reasons. I think I actually just saw a podcast I did for a new BioAge where I said, "Women have never been more stressed." And I'm going to go ahead and say that again: women have never been more stressed. Plus, our soil is depleted in many of our nutrients. Our food sourcing is depleted in many natural nutrients, so we have an overabundance of calories, but we're very nutrient-depleted individuals. I think that has a lot to do with it.

So what I tell patients is, "You have a progesterone deficiency," or "You have a magnesium deficiency." I think looking at it more from what is actually the root cause of it, instead of just putting a band-aid on it, is important. Now again, sometimes we have to use those to buy us time to figure it out. Why do we have that issue? I think that's important.

Craig, I've got some specific questions for you, but I just want to go back to Suzanne really quickly and ask you... as I listen to this, I remember you describing this situation and the antidepressants that you were given, and alarm bells are just going off for me based on that. If you're a young person and that's what you're running into, what's the question that you need to be asking, or who do you need? Obviously, if you're not getting the right information, where do you go? What do you do next to avoid this kind of situation?

Well, the first thing for us to think about in this is that conventional medicine tends to dismiss our ovarian decline symptoms, and functional medicine sometimes can overattribute our symptoms. So we just need to be aware that there may be a Goldilocks middle that is valuable for the patient. I love the big panel that Lexi was talking about—this is what's necessary to make sure we're treating the right thing, that we're getting the patient what they actually need.

What was happening to me—and I'll just reiterate it—was I was taking birth control pills in my 20s and 30s and was so depressed that I got put on an antidepressant medication, an SSRI. And because of the side effects of the SSRI, I got put on another medication to mitigate the side effects. So now I'm on birth control pills plus two antidepressant medications. This was terrible. I was in my 20s.

When I turned about 38, I came off of birth control pills, and the lights came on. All of a sudden you see the scales fall from your eyes and you see all these things that you finally learn when you start doing research and learning. So I came off of birth control pills, and all of a sudden I didn't need my antidepressants anymore. I'm not depressed. It was because of that. So it doesn't mean that every single person who's depressed doesn't need them; it just means it needs to be part of the investigation. We need to look at your thyroid, we need to look at all the hormones, we need to look at the way that your FSH is, what's happening during your cycle—and not just at a blood level. We need to be looking probably at urine hormone levels; I think those are particularly valuable. And I love all of the oxidative stress markers that Lexi was talking about.

There are lots of reasons for that. If a 35-year-old is having those things, the primary cause is probably the oxidative stress and not the hormone decline, although they'll go hand in hand. I usually say to patients, if you're being chased by a bear, your body's not going to put energy toward having a baby. It's not going to put energy toward skin and hair and full breasts. It's going to put it towards fighting the bear.

Well, that's really interesting. And it's interesting the way that you talked about that, Lexi—the notion of thinking about it as a toolbox, using every tool that's at your disposal to figure out what the right solution is. That makes perfect sense.

Craig, when you see a patient in your practice that presents, and you're thinking about the long term for that patient, I know you have all those tools at your disposal—not just medications, but diagnostic tools. How are you approaching this?

Very much in a similar fashion to everyone else who's already contributed. I mean, thorough, comprehensive laboratory evaluation, doing the body composition analysis, looking at their metabolic performance with the PNOE that we have here at the office—which, incidentally, I'm having technical issues with today. I actually did my own PNOE test this morning just so I could get on video with the team and look at the data and see my output. But anyway, that's a whole aside.

Looking at all of that information in conjunction with each other helps to try and get a solid indication as to what is currently vexing or plaguing the patient and what's holding them back from meeting their health goals. The latter 30s and early 40s is a very challenging time for these female patients. I often say and emphasize to my patients that perimenopause can be much more difficult to treat than menopausal symptoms for women. There's just so much dynamic change that's happening. There's the obvious decline in progesterone that can happen for some women in the early 30s—perhaps even earlier if they've been on contraceptive medications—but significantly so in the latter portion of their 30s and through their 40s. That decline is going to bring about a lot of unfortunate symptomatology for the patient.

Then there are the occasional FSH surges that are leading to higher estrogen levels some months and lower estrogen levels other months. That's contributing to a whole other piece of the puzzle, and the patient needs to have their hand held through this process a lot of times. So ultimately, working to get those hormones balanced as much as possible, really focusing on the lifestyle issues. We see so much metabolic disease. There's a lot of PCOS and PCOS-like phenotypes out there that's driven by insulin resistance and chronic inflammation. Again, we harp on this all the time, but what can we do from a lifestyle standpoint? Are we eating our larger meals in the beginning or middle of the day? Are we avoiding calories a few hours before bedtime? Are we doing our postprandial walks to improve insulin sensitivity and help manage glucose? Are we doing resistance training for glucose disposal?

Craig, in a previous episode, we talked about this in metabolic psychiatry. Lexi, we were talking about the notion of—and Christy just gave a great explanation of this—maybe depression is not an issue of lack of serotonin. It may be an energy issue with metabolism. What I'm getting from all of you is that there's some sort of workup that you're using to get a whole picture of the person, to understand exactly where you start and where you're going to try to take that patient over time. Christy, just out of curiosity, when you have a patient come in, is your workup similar to what's been described so far?

Yeah, I think it's dependent on what they're coming in for. We start with basic labs and then add labs as needed. But just like what Lexi was saying, the answer's right in front of us. We just have to become better listeners. The patient is telling us what's wrong. We just have to have that mindset of really interpreting what they're saying and matching their symptoms to the biology of what's actually happening during that phase.

So, we're kind of talking about three different groups of people, right? If I'm reading this right—correct me if I'm wrong—we're talking about younger people, potentially people that are entering into perimenopause, and then menopausal patients. How do you look at this whole spectrum of health for a female patient? As a father of a daughter and a husband, these are all things that I'm concerned about, just wanting to be a good husband and a good father. Help us understand what's the bigger picture to all of this. What's the longer trajectory?

I think part of what you have to keep in mind is that when we're checking labs, where patients are in their cycle provides really helpful information. In the luteal phase of the cycle, checking progesterone is ideal—that's the best time. Day three of the cycle is the best time to look at estrogen. So it's going to be dependent. Now, you'll have patients who say, "I have an IUD, so I have no idea where my cycle is," or "I had a partial hysterectomy, so I don't know when my cycle is." Part of that when you're initially developing a plan is that you should consider cycle mapping, where you can see where they are—maybe you have them pee on a luteinizing hormone strip to see where they would be.

So you have these early 20- or 30-year-olds, and a lot of times it's going to be supporting their adrenal glands, getting them on some good nutraceuticals, looking at things like DHEA. I'm a big proponent of advanced hormone metabolite testing. I like to look at a diurnal cortisol pattern, so this way I can focus on foundational stuff before throwing in cool things like hormones or peptides. We've got to get the big rocks out of the way.

Then you get your 35- to 45-year-olds, and this is where I tell women, "Unfortunately, this is where you're going to go face-first into perimenopause, and it's going to be brutal." One day you're going to be like, "I've got it all under control. Nothing can take me down." Then the next day you're going to be like, "I'm on the ledge, and I don't know what to do." And then the next day it's going to change again. Unfortunately, that volatility is probably the worst part of hormone fluctuation. Those are my perimenopause patients. I see Suzanne nodding here because she's like, "Girl, I know."

Then you've got your menopausal patients, where I'm almost like, "Okay, well, at least now I can control the hormones and I don't have to worry about your body trying to do something on its own." I say ovaries are kind of like Gen Z employees. If you have a Gen Z practice, you would understand what I'm saying: sometimes they want to come to work, but sometimes they want work-life balance. Sometimes they want to telework, and sometimes they actually want to come in. So you're getting these little spurts of estrogen, but then your body's still making it.

I think what is helpful with those patients is you really have to look at what their symptoms are, where they're at in their cycle, and really—this is where I think advanced testing is helpful—you can look to see what metabolite their body is making. I think one of the problems is we look at just a single point in time, a single test. Progesterone is so elusive, right? It's so hard to catch the right day, right time. Even if you're doing it on the right day, right time, sometimes it just doesn't show up. But when I do the advanced testing, it's there.

This is the art that I know that you have mastered. I've heard you say before about starting with treating cortisol, the stress hormone. That's where we start. And of course, as the autonomic dysfunction lady, this is where I will always start: trying to get their nervous system controlled. At this practice, we do a lot of neural therapy. Even just local, little under-the-skin things work super well. This is where we can get a lot of benefit from treating their pelvis, from doing injections in their pelvis. These women tend to do better with the inferior hypogastrics than they do with stellates, and so that's kind of fun.

Even in our perimenopausal or menopausal women, we can see that they're bleeding through their hormones and that sort of thing. We can get some improvement with that by treating them with inferior hypogastrics, because that whole process is also a sympathetic-dominant state. If we can get their sympathetic dominance under control, a lot of the other things help. You've got to get their sugar under control, evening out their blood sugar throughout the day. A lot of these women, I'll put them on a continuous glucose monitor and have them give me two, three, or four weeks of "What are you eating? What's going on?" Most of them come back to me—I'm sure this is your all's experience as well—saying, "Wow, I had no idea that this was spiking my blood sugar so high." Then they can actually make a change when they have information.

Hey, really quickly, Dr. Farie, you just mentioned these injections, and I think for the listener who hasn't heard about this before, maybe this is a good point in time to explain that more in a consumer-friendly way. What does that mean to have a pelvic injection versus a stellate injection?

Sure. So we do a procedure here in our office, and I know Lexi does too, and Christy in her office. We just came back from Craig's office and did a big training. Super fun! This is a really cool procedure. There's a medicine called procaine, which is a local anesthetic that we use in precisely placed amounts, usually just under the skin. It's quickly picked up by the nerves and travels to the brain, where it works both at the local level and at the cognitive level. The cool part about procaine is it increases blood flow to areas of tissue that have been damaged for whatever reason. It will improve the cell membrane; the wall of the cell can also be damaged in its ability to transmit signals, receive nutrients, or remove toxins.

When we think about the autonomic nervous system, this is your fight-or-flight and your rest-and-digest nervous system. Almost all of our patients can understand what we're talking about when I say those two things. Most of us live in a fight-or-flight dominant state. If we can get that fight-or-flight state more in balance with the parasympathetic or rest-and-digest state (sort of like a seesaw), then lots of things fall into place. The whole system works a whole lot better. We prevent a lot of chronic disease—things like high blood pressure, heart disease, brain disease. These all have a base of sympathetic dominance that controls them.

So if we can work on that, there are these injections we can do. One of the motherboards for the autonomic nervous system lives in the neck, sort of behind this muscle here called the sternocleidomastoid—big muscle. That's sort of the motherboard for the body from the diaphragm to the top of the head. The inferior hypogastric bundle lives in the pelvis, and there's two of them. They control pretty much everything from the belly button to the bottom of the anus. A lot of women have been through some sort of childhood trauma or pelvic trauma from childbirth, and those things can be stored in the tissue and in the fascia with that physical trauma.

Using procaine restores the ability of the cells to communicate with one another more efficiently. Overall, people will come away in our practice from any of those procedures with a sense of calm, mild euphoria, and a sense of release. I say it's like having half a glass of wine, and that effect can last several days or even weeks depending on how often they get therapy. This is one of the first things that a lot of us do in our practices before we even think about pulling out the hormone prescription pad.

Quick question for you going back: if someone has really difficult periods, is that an indication...? You know, there was the study that came out that talked about how bedwetting was a determinant of sleep apnea in the future. For women, are difficult periods an alarm going off that you may have a more difficult perimenopause in the future?

There is some correlation. The interesting thing is to not alert your patient of a big concern, right? We don't want to alarm someone for something or manifest something that's not necessarily going to be there. So yes, I want to say, "Hey, if you're having irregular periods as a younger person, let's be aware that that's a possibility, and that means we need to start with lifestyle modifications earlier." We need to be looking at the things you need to do maybe from an earlier age.

When you say difficult periods, that can look like a lot of different things. So when you said that, I was thinking heavy periods, or maybe the patient is more estrogen dominant, maybe they struggle with detox, or maybe they don't methylate well. So I think, "Oh, they're going to be that patient with the uterine fibroid, or they're going to be the patient who has dense breast tissue." They're going to be more of that gynoid body type through perimenopause into menopause. That's kind of more what I think about when I think difficult periods—like they hurt, they're painful, there's a crime scene, you're on the floor, those kinds of things.

What I was getting at was where it was just really almost unbearable. There's this massive amount of discomfort, and sort of like everything was too much. I was like, "Wow, this is really difficult, and it's hard to watch when somebody's going through that that you really care about." So I was just kind of curious, and it makes perfect sense—you don't want to set off alarm bells. But at the same time, if you are a person who's had that happen to you, is that a red flag for trying to be hypervigilant around it anyway? You'd be more attuned to that and what you'd want to do. Certainly there's more information available to people now than there ever was before. If we go back just 10, 15, 20 years, we're completely worlds apart in terms of information, Lexi, from where we were back then, right?

Yeah. I mean, if you look at five years ago till today, the black box warning on estrogen came out, the TRAVERSE trial came out... I mean, there's so many things that have changed just recently. It's a cool time to practice medicine, but yes, we learn more. The more advanced diagnostic testing data we get, the better we're able to make predictions for patients.

Integrating AI into a practice is probably one of the coolest things we've done in our practice as far as looking at data. What's hard is finding good research specifically in women, seeing what the levels look like, and where that goes. What's really cool is we've been able to extract a lot of information showing that at certain thresholds, patients report more symptoms, and we were able to analyze and synthesize that with the use of AI. So it's a very exciting time to offer hormone therapy and just to see how we can integrate and make better predictions for longevity down the road.

Yeah. I mean, how far in using AI? Leonard, you said something the other day that was so good. You were talking about AI and how people are starting to talk like AI talks, which I thought was absolutely hilarious and totally true.

He's so right. What you have to do is develop a moat. [laughter] He's not right. He's just really smart.

That's why I'd rather be smart than right. But the interesting thing there is, we think about AI, and then, Christy, you always say to me like, "Reference ranges are just ranges within a population of people who may or may not represent who you are." So how do we maximize AI in this process, Lexi? We're in the Wild Wild West. It's a long way before we get to the point in time where we decide what color to paint the library. How do you see that progressing?

Oh my god, I don't even know. That could be a whole episode on its own! And I know Suzanne's laughing—she's like, "Oh, here she goes."

We use AI for so many things in our practice, not just Chat GPT. We've gotten into things like Claude Code. We've developed our own robot that reads labs. My husband and I are working on something called Proven IQ, where we can synthesize labs. Not only that, it can generate a response and look back specifically at what their last value was, so it can help kind of guide that. In my own training academy, we're able to now use it to start training practitioners, which is really, really cool.

A lot of it I want to get published. I think we're at a spot where we can start looking at that because we have two locations and we've got a good sample size. Training the next generation... it's not going to replace us. It's going to help make us better when you're using it correctly. I think that's a big thing.

Also, Suzanne's been a mentor of mine for a very long time, and I know she blushes when I say that. But one of the things that I really use it for is helping my practitioners get better. I have five other nurse practitioners, so utilizing their transcripts from their appointments, I can say, "Okay, when you said it like this, this would maybe be a better way to say it," or "Have you thought about this?" Because I can't be in 20 million places at once, but if I can have my AI robot that I've built synthesize their transcripts, I can better help coach them to be better practitioners. So there are all kinds of ways that we're using it.

Yeah, that's really interesting—that patient experience and interaction. Coaching providers to actually speak to patients in a way that's going to get a better outcome. There's tons of data around how the words that we say, how we say them, and when we say them make a huge difference, because we all know that we have different communication styles. Different people hear things differently; you could be saying something to somebody and mean it a certain way, and they're taking it a totally different way, which is the big challenge. Super exciting!

Leonard, you said something—I always laugh when you say this, but it's really true. It's not actually a laughing matter. Someone's going to... What did you say?

Someone's going to use AI in their practice and get sued, and someone's going to not use AI in their practice and get sued.

Yeah, well, that's coming. Anytime you're in a transitional period, right? Things are completely changing in medicine, and things are completely changing in AI right now. You might get sued for something you do from listening to AI, and at the same time, you might get sued because AI told you to do something and you didn't go ahead and do it. So we're just in one of those weird times where there's a lot of gray areas, and we're not exactly sure how we're going to move forward.

Medicine's that way now, too, right? We're finding that we are changing our minds about the traditional way we evaluated drugs, and about when we give physicians the ability to make decisions for their patients. We see that with peptides and what they're voting on next week in Washington, and just changing the way that we evaluate literature and make better decisions. So yeah, it's a fun time to be involved in this world in general—not even just medicine, but AI.

But you have to be able to recognize it. That video that I was making the other day was just... I was in a research section of AI, and it was giving me a reference for a study that didn't exist. They were pulling that reference from a research peptide site. That's the two sides of it: it's exciting, but really dangerous. It's so dangerous that gray markets like peptides are so abundant out there that even AI can't figure out if it's legitimate or not, because it's the majority of the information on the internet and it's scraping the internet. Unfortunately, the majority of the information on the internet about peptides is not coming from physicians. But I think that's changing, and you just have to be careful and not so trusting.

Well, and a big reason for that, of course, as you know, Leonard, is because we have licenses to lose, right? The health coaches and the folks that don't have an actual license, the gym personal trainers—they are able to talk about all the things that we're not allowed to talk about. I can't say, "This is a dose that I would give for this disease state or this presentation of patient." I have to say, "This might be helpful in these kinds of situations." I can't reference any ICD-9 codes. I'm not allowed to talk about those things. And the reality is that you wouldn't even go that route anyway, simply because that's not the right way to go. Isn't that true?

Yeah, I would want to know the person first. Yep.

Even things like, "My patient who I had with XYZ presentation..." I still wouldn't.

Yeah, I think it's all that N-of-1 sort of getting down to what you guys were talking about—getting the bead on the patient individually.

Craig, I don't know if we've talked so much, and I didn't give you a chance to jump in, but you've been awfully quiet today, which is not normal for you. I think I cut you off earlier, so...

No, yeah, no worries. I mean, I don't really have much else to contribute. You guys have absolutely crushed it today.

One of the questions that came to mind—we kind of moved past the topic, but earlier in the episode, we were talking about those patients that are really training hard, the elite athletes. They are skipping their periods, anovulatory. A lot of times we're seeing these changes reflected in the labs. I know personally from these patients that I've had, one of the things that I'm doing is encouraging them to tone down their training for a little bit and increasing carbohydrate exposure in the diet. I'm curious, Sue and Christy, what techniques or interventions have you deployed historically that have helped these people regulate?

Well, I mean, I'm actually dealing with it with my daughter right now. She got a scholarship to play volleyball at the Air Force Academy, and so we're full-force dealing with this right now. I'm really just trying to help her understand the importance of sleep. The amount of stress that they're putting these kids through right now at this level... I don't even know if I could have been able to handle it, to be honest. So I'm prioritizing sleep and then downregulating. There have been some stressful weeks this past month just trying to get her ready for the academy, and emphasizing the importance of recovery. In all these youth athletes transitioning—these teenagers that are transitioning to college and even just the high school athletes—they have no concept of rest and recovery. It's just as important, if not more important, than the actual play.

Yeah. And one thing I would say is I'm so grateful to you guys for really hammering on me for being a chronic overtrainer. I've really paid a lot of attention to that, actually—about the 10- or 11-day cycle. What is it, 10 or 11?

1. Yeah, I've been thinking about that a lot, too.

It makes so much sense ever since you said that, Suzanne.

It's a nervous system reset recovery, big time, for people that are under intense amounts of stress all the time. When you want to optimize, you want to make sure that your relationships are as clean as you can possibly have them and deal with people. I think it's really starting to make sense. As a person who likes to train all the time because that's a way that I release a lot of energy, now I'm starting to think, "Okay, I do think there's something in that." It kind of goes back to Arthur Jones and Mike Mentzer—and I guess Dorian Yates after, in the bodybuilding community. You were a powerlifter, so I'm curious: where did you get that 10-day cycle?

I actually got it from Anthony Castori. That guy's so smart.

Well, I bet he got it from... I bet that's an Arthur Jones or Mike Mentzer sort of influence. He's mentioned that before; he's a student of all those classic bodybuilders.

Well, guys, I mean, this has just been a phenomenal episode. Lexi, it's been so great to have you on. I hope you'll come back and join us again. It seems like we could just keep talking for hours about all of this stuff, but as always, we have to keep it to the right amount of time. Lexi, take us out. Wrap us up. Tell the listener out there, or share with the listener out there: How do we go from being a teenager to a 20-year-old, to a 30-year-old, to a 40-year-old and on up? What are the things that we need to be looking at? How do we handle ourselves?

I'm laughing because I actually have twin 16-year-olds, so we're in it right now. They're boy/girl. My son, who is an amazing Olympic weightlifter, is on the USA team. He just took fifth in the world. So, like, whoa!

Oh, congratulations!

Yes, super cool! So he has made the decision—and it's kind of destroyed my husband a little bit, so if he hears this he's going to be like, "Why are you sharing my stuff?"—he has made the decision to stop wrestling because he's trying to get to the Junior Olympics. He's in it! He's number five in the world in a 56-kilo weight class.

One of the things that I'm really trying to teach him is that going into the gym and lifting the weights is the easy part. That's the fun part that you like. You have to sauna, you have to cold plunge, you have to sleep, you have to stretch, you have to do mobility. We just got him set up with a PT where he's going to go in and work on all these things. Sunday, we're doing a tour of macronutrition in our kitchen. His homework this week was to just track his protein, just for awareness. We're not focusing on calories; he knows how to cut, he knows how to do all that stuff.

So what I'm trying to teach my twins right now is basic nutrition. Sunday, we have a date after our call, Suzanne—we have a date in the kitchen and we're going to talk about a food scale, just so they can see what awareness is. I don't want them to be neurotic, but it's homework, right? So I think foundational recovery, sleep, nutrition, mindset, movement—all those things to avoid injuries, to avoid being knocked out, to avoid getting pulled out of that sport, and overall to be a good human, in general.

Then as you transition to college and all those things, you're going to do what you're going to do. But stick to foundational stuff: good supplementation, really trying to focus on the relationships you have with people, because nowadays they're all staring at their phones, right? So I tell them, "You've got to go out, you've got to talk to people, you've got to share things," and they just roll their eyes.

Then in the perimenopause phase, whatever you're going through—whether it may seem weird or not, like the burning gums or the itchy ears—talk to somebody. Get in with a hormone provider. If you're struggling with finding one, I would say call a compounding pharmacist and ask them, "Hey, who are your best hormone providers?" That's the best referral right there, because they at least know who knows how to prescribe. Get in there and then build out a longevity plan. I always ask our patients, "What are your top three goals?" And then I tell them, "These are the ways I'm going to get you to those goals." Once I've met their goals, now I've got my own goals: How am I going to extend your lifespan? What are we going to get your phenotypic age to?

Wow. Absolutely amazing.

All right, guys. Lexi, just so great to have you on. It was really truly a pleasure, and I just love what you brought to the table here.

Well, that was a great episode, everyone. Please remember to like, share, and subscribe. And if you have someone who is dealing with any of the issues that we talked about today, please share this episode with them. Hopefully, it will help them to find the right solutions for them moving forward. Again, thanks for watching, and we look forward to seeing you on the next episode of Cell to Systems.