Dr. Florence Comite: The 5 Biomarkers Every Midlife Woman Must Test | #156

**Dr. Florence Comite** (0:00)
How do I stop biological aging so that I could reset your future health trajectory? How do I get it so you don't get sick of disease and you live till 100 and 120 in great shape and then one day your cells get tired, you go to bed, you don't wake up because everything's worn out?

**Dr. Vonda Wright** (0:17)
That's how I want to die. Dr Florence Comite is the original gangster. Before longevity was a thing, before preventive women's health was a thing, you started it.

**Dr. Florence Comite** (0:28)
Testosterone's a critical hormone. We have more testosterone in our body than estrogen as women. And 99.9% of doctors don't know that. Testosterone starts decreasing in our 30s, 1-3% a year, and that subtly but absolutely definitively sets us on a track to get disorders of aging.

**Dr. Vonda Wright** (0:49)
What do you think are the priorities?

**Dr. Florence Comite** (0:51)
When I first started this work, I thought the order was food, exercise, sleep, and I flipped it.

**Dr. Vonda Wright** (0:57)
I am squarely in your camp now. That sleep is the critical element because you will eat poorly and you will not exercise. If we're going to boil it down, do not get 9,000 biomarkers tested.

**Dr. Florence Comite** (1:10)
Okay. Let me start with the five.

**Dr. Vonda Wright** (1:15)
Dr. Florence Comite is the original gangster, if you'll let me call you that because before, longevity was a thing, before preventive women's health was a thing, before treating each person as an individual, an N of 1, that's how you were treating your patients.
You have been doing this. Yes, you started it. You've been doing this for more than 25 years. You originated the first women's only clinic in 1992 at Yale, and now since 2005 are running your own Center for Precision Medicine and Healthy Longevity in New York, Palo Alto, and Miami Beach. So Dr. Florence, I am so excited to have you here today.

**Dr. Florence Comite** (2:04)
I'm delighted too, because you have such a unique background that it's exciting.
It's where kind of the rubber meets the road with muscle being the longevity organ and also bones needed strengthening, and that was a major issue for me years ago. I've been on testosterone for 30 years because I knew as a 30-year-old that I had high risk of osteoporosis because I helped bring some of the treatments to market and develop the whole logic. So I started Women's Health at Yale for perimenopausal menopausal women. It was PMS meets perimenopause. Not much fun. And when I got the stories and I understood from a very personal point of view as an identical twin that every woman, even my identical twin and I are unique. We're each unique. So that's where it all began for me.

**Dr. Vonda Wright** (2:53)
So you know what? What's happening now in the market is that people want to feel better. They don't know where to go. And so on every street corner, almost, you can get panels of thousands of biomarkers that may or may not have any clinical utility or if they do have clinical utility, we don't know how to prioritize what will move the needle. Because you are so experienced in this, how do you parse that for people?
What do you think are the priorities?

**Dr. Florence Comite** (3:29)
That's a great question. So let me start by saying that that is the most critical piece of it.
The ability to connect the dots between the biomarkers, whatever they are, the life you live, which I think of as your health story, way beyond chief complaint, which is reactive medicine. I never thought of a chief complaint as telling us much of anything.
Rather, I need to know how you work out, how you sleep, if you sleep, what's your quality of sleep? How do you eat? What's your nutrition like? And all of those factors, the stress in your life, and particularly integrate it with your family history, which I used to think of as the poor man's genetic test. And I now know over the years that it's richer than genetics because we know how to see the emergence of genes. What runs in your family is what shows up in you or has the potential to show up in you. And so putting that all together, I think of it as connecting the dots from whatever biomarkers are, moving on to integrating it with your health story and your continuous glucose monitor, which I feel is an important, it's a game changer, along with the GLP-1s, but we'll talk about that later, and then interpreting the values. And it's not even the knowledge, it's the wisdom, the ability. And I think that's very hard to do even with superb medical training. I'm still learning what it all means. And I've been in this field for a very long time, starting with perimenopause and menopause in women. Because I did a lot of women's health, I did a lot of endometriosis, fibroids, ovarian cysts. I was there, the first person to do retrieval using external retrieval instead of an open laparoscopy, so that women could get pregnant. I love that piece of it, because the deepest part of my training is reproductive endocrinology and hormones. So while I had a triple appointment at Yale in adult medicine, endocrine, pediatric, I also did reproductive endocrine and the relationship between the brain, ovaries, the testicles, in men, of course, and the adrenal glands.