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

**Andrew Huberman** (0:00)
Welcome to Huberman Lab Essentials, 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.

**Sara Gottfried** (0:22)
Thank you, so happy to be here.

**Andrew Huberman** (0:24)
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-a-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?

**Sara Gottfried** (0:51)
So my work is really at the interface between genetics and environment. 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, an intergenerational trauma, because I think that affects the endocrine system so hugely, especially cortisol signaling. 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.

**Andrew Huberman** (1:31)
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 decade, starting at puberty.

**Sara Gottfried** (1:46)
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.

**Andrew Huberman** (2:11)
Are periods not that regular in terms of duration of the menstrual cycle when the menstrual cycle first sets in?

**Sara Gottfried** (2:19)
For a lot of women, they're not regular.
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.
When that happens, it sets you up for greater risk of fibroids, 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, 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.

**Andrew Huberman** (3:15)
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 or in the luteal stage of their ovulatory menstrual cycle, when would you suggest they do that?

**Sara Gottfried** (3:35)
So if you forced 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 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.