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

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Welcome to Huberman Lab Essentials, [music] where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health, and performance. I’m Andrew Huberman, and I’m a professor of neurobiology and ophthalmology at Stanford School of Medicine. And now for my discussion with Dr. Sara Gottfried. Dr.

Gottfried, Sara, welcome. >> Thank you. So happy to be here. >> Yeah, I’m delighted and very excited to ask you about an enormous number of topics. You are expert in so many things, female hormones in particular.

Is it ever informative for a woman, regardless of age, to know something about her mother’s, perhaps even her grandmother’s experience vis-à-vis hormones? What sorts of conversations should women be having with themselves and with family members to get a window into what their specific needs might be? >> So, my work is really at the interface between genetics and environment. And I think it’s essential that you understand what your grandmother went through, and especially your mother. So, I would probably start first with trauma and intergenerational trauma, because I think that affects the endocrine system so hugely, especially cortisol signaling.

And then there’s certain female conditions that have a very strong component genetically, most of which run in my family. So, that includes endometriosis, fibroids, and polycystic ovarian syndrome. >> Maybe we could march through and just say, for a woman in her teens who’s already hit puberty, what sorts of biomarkers should those young women be paying attention to? Likewise for women in their 20s, 30s, maybe we could take it more or less by by decade, at starting at puberty. >> In your teenage years, what I think is really interesting is to look at cortisol.

To look at the dance between estrogen and progesterone in those years is less helpful, because I think there’s a lot of variability due to the immaturity of the system. If you’ve got someone who’s got really regular periods, it’s probably better to do some benchmarking at that age, but generally I find that benchmarking is best performed in your 20s or 30s. >> Are periods not that regular in terms of duration of the menstrual cycle when the menstrual cycle first sets in? >> For a lot of women, they’re not regular. And then there’s the whole piece of oral contraceptives and other forms of contraception where you have no idea what the normal cycle is.

But getting back to your original question, which is about biomarkers per decade, in your 20s, that’s when you want to do some base casing with estrogen, progesterone, and testosterone. What happens a lot of the time is that estrogen dominates in that tango. And when that happens, it sets you up for greater risk of fibroids and endometriosis. I’d want to know about DHEA and sort of the whole androgen pathway. I’d want to know about the metabolites of estrogen because some of them are protective and very helpful.

Others are a bit like Homer Simpson. I mean, [clears throat] they are just like causing all kinds of problems in your body. I’d also like to know about their stool, so I want to know about the microbiome. >> In terms of blood testing or various tests for these other biomarkers, getting estrogen, testosterone, and other ratios, women will need to do it at different stages of their menstrual cycle. If they had to pick one, either in the follicular phase and or in the luteal stage of their ovulatory menstrual cycle, when would you suggest they do that?

So, if you force me to pick one, I would say probably day 21 to 22 for someone in their 20s. So, for most women, they’ve got a menstrual cycle date that averages out at 28 days. So, this is about a week before they start their period. For women who are more irregular, it’s harder to do that. As women get older, usually the cycle gets a little shorter.

So, as they start to decline in their progesterone production, their period gets a little closer together. At that point, you want to test sooner, like day 19, 20. Blood test is the cheapest thing, it’s usually what’s covered by insurance, but my preference would be to do dried urine so that I get metabolomics in addition to the levels of these hormones. And if I’m forced to, I’ll use blood testing. It’s not as comprehensive, and as you know, it’s a quick little snapshot while the needle’s in your vein for, you know, 30 seconds.

Let me go back and say one other thing about biomarkers. A big part of the testing that I do in phenotyping my patients, I practice precision medicine. I like to almost start with nutritional testing. That would be potentially a helpful thing to do in your 20s. Becomes less important as you get older and you develop more micronutrient deficiencies, but micronutrients play a huge role in terms of hormone production.

Magnesium is hugely involved in the way that you get rid of estrogen, as an example. So, micronutrient testing, what I usually do is a combination of blood and urine. And so, I’m looking at all of the micronutrients that we can measure that have some clinical scientific basis behind them. Intake of vegetables, polyphenols, is such an important predictor of future risk of breast cancer, like when you’re at 50, 60 plus. And the most important time is when you’re a teenager.

If you have evidence that you could show a 17-year-old that they’ve got micronutrient gaps, I think that would be a motivator for them to eat differently at a time when it’s so critical, even though it’s 25 years in the future that it’s going to potentially change this arc that they’re on. >> What do you do for a young woman who doesn’t like vegetables is or is not somehow able or willing to to get those five colors a day of vegetable to help support the microbiome, what other sorts of tools, behavioral or otherwise, are useful? >> What I try to get them to do is to have a smoothie. If I could get them to have a smoothie three times a week and I throw some of these vegetables in, that makes a huge difference. I mean, we know that makes a difference in terms of microbiome change.

Like I have them do steamed broccoli that’s in the freezer because it’s got very little taste. They could do that in a chocolate milk smoothie. They could add some greens. I like greens powders are a super convenient. So that with, you know, kind of a a taste that they like, whether that’s chocolate, which is what most of my clients want, or you know, vanilla with berries and that sort of thing.

So that can go a long way if you don’t like vegetables. And short of that, I would say some supplements, but I would say that’s a distant second to making a smoothie. >> What is going to be the best way to test the uh microbiome? >> What I like to do with nutritional testing is run a panel that’s looking at antioxidants, so like vitamin A, vitamin C, alpha lipoic acid, plant-based antioxidants cuz you can measure that in the blood. I like to look at some of the key vitamins, especially the B vitamin range because as you probably know, if you’ve got particular genetic polymorphism, so you might be less likely to be absorbing the right level of vitamin B9, folate, vitamin B12, etc.

I’m also looking, going back to the antioxidants, at glutathione because I think that’s such an important lever. And then I’m looking at some of the minerals. Magnesium is really the most important and we know that somewhere around 78% of Americans are deficient in magnesium. That’s like the the lowest hanging fruit. >> I would be curious, for instance, like with magnesium, if that number of people are deficient, does that mean that that number of people should be targeting their nutrition towards foods that contain magnesium and or supplementing with magnesium?

And if so, what forms of magnesium? >> You have to measure red blood