They're In Control

Hi {{first_name|friend}},

We’re awash in hormone talk these days. It feels like everyone is extolling the virtues of good old estrogen, testosterone, and progesterone – but also GLP-1 receptor agonists like semaglutide, tirzepatide, and retatrutide (a yet-to-be-approved triple-hormone-receptor agonist). And certain high-profile figures in our current administration are all-in on testosterone supplementation…while working quietly to cut off others’ access to such supplementation.

When it comes to women in perimenopause, content about hormones and health has become an industry in and of itself. It’s not just limited to social media; though it does dominate there, a popular topic for wellness influencers. It’s also one of the main products offered by the many new, women-focused telehealth services — including one that recently emailed us with the subject line, “Do you have low-estrogen face?”

Can a few new books by female endocrinologists help cut through the noise? Dr. Gillian Goddard, whose newsletter The Savvy Patient is a solid resource for midlife health concerns, is publishing a hormone book next month. And next week brings the debut of Signals: The Hidden Power and Secret Language of Hormones by endocrinologist Dr. Saira Hameed.

We spoke with Hameed a few weeks ago to talk about the book, what she makes of the current frenzy for hormones, and why so many women feel tired all the time. Read on for our convo, plus a few recommendations for your weekend.

Bye,
Your friends at Gloria

Can you give an overview of what hormones are?

Hormones are the way we get our 30 trillion cells to talk to each other so the body is working in harmony towards a common goal. Hormones are chemical signals. They are released by a gland. You’ve heard of the thyroid gland, the adrenal glands, or the pituitary gland. These are all endocrine glands. They are like the transmitter, which releases a hormone. The hormone travels in the bloodstream to another part of the body and conveys the message. And when the message is picked up by those distant cells, they must follow that instruction. A very well-known hormone right now, GLP-1, is released by the gut after eating and travels in the blood to the brain with the instruction, stop eating, you're full. Then we get a physical sensation of feeling full and it also elicits a behavior. We stop eating. 

Hormones are pinging around the body like hundreds of thousands of text messages or emails. And they are very powerful. They are entirely fundamental to life. None of us would exist without hormones because for fertilization to take place, to grow a baby for nine months, for that baby to grow to a toddler, to a child, to an adult — all of that is driven by hormones. They're responsible for our big milestones, but also for our day-to-day, moment-to-moment experience. And as you've read in the book, when they go wrong, people really feel it. Sometimes it can even be fatal.

Are there more hormones that we're just not aware of? Or have we already discovered them all?

When leptin, the body fat hormone we were talking about, was discovered in 1994 — that was sensational. How did the brain know how much fat you've got stored? Fat is your body's main fuel tank and we've discovered the fuel gauge. That's brilliant. GLP-1s, that is a pretty modern story. Other gut hormones have been found. Possibly they’ll find more body fat hormones or gut hormones.

In the book, you share a shorthand for tired all the time, TATT, which is a common reason people visit an endocrinology clinic. (The case you describe ends up being adrenal failure, which is very serious.) A lot of women suffer from TAAT. Can you list off some typical reasons why women, especially in middle age, might feel that way?

Adrenal failure would be a rare outcome. It's obviously one not to miss, as the chapter makes clear, but it's unusual. And also, as we see with that patient, it's associated with other symptoms: dizziness, weight loss, the tanning of the skin, and so on. We divide up tiredness, as I mentioned in the book, into a sort of ... pathology and non-pathology. Pathological reasons why you might feel tired could be anemia, Vitamin D deficiency, iron deficiency — you might've had absolutely straightforward periods and suddenly they become very heavy in perimenopause, so iron deficiency is one to look out for.

I will always check things like B12, folate, other minerals, selenium, copper, and so on, because it's important to look at diet. Blood glucose is super, super important. Someone might have undiagnosed diabetes and that's making them feel tired. But also: Are you under stress? Are you moving enough? When you're on a blood glucose rollercoaster for a lot of the day, you can have massive slumps that definitely feel like TATT.

The non-illness part…that's where the history is fundamentally important. When life is coming at us all the time, we've got no head space, we've got no rest space, we're not going to bed on time because we're trying to cram lots and lots of things into the evening because the day is so busy or we don't have enough help or problems within the family, difficulties at work and so on. But that shouldn't be our default assumption. You still have to be open-minded, that yes, you can have all that stuff going on, but there could be other things at play.

Often women go in and say they're feeling tired or not great, and it's like, oh, well, you're just getting older.

I push back on this assumption that as we age it's normal to feel under par. Because conversely, I look after some patients in their 80s and 90s and they're skipping into the consulting room.

I have a question about body fat and menopause. Why does our fat shift to the middle of our frame?

I think we become more insulin resistant, and that is the typical deposition — central adiposity. Insulin resistance becomes a problem through midlife, even if you're not carrying a lot of extra weight. It’s important to keep up resistance training. But even when we've got a good muscle mass, the body is much more insulin sensitive. 

What do you make about the hormonal zeitgeist we're in right now?

We’re very excited to watch Irving Berlin’s Top Hat tonight on Great Performances on PBS as part of The WNET Group’s Broadway and Beyond collection. Inspired by the 1935 film starring Fred Astaire and Ginger Rogers, this West End revival brings all the incredible dance numbers you want from a classic musical.

It features some of Irving Berlin’s most iconic songs, including “Cheek to Cheek” and “Puttin’ on the Ritz.” If you love classic musicals, beautiful costumes, and big Broadway performances, this is such a good one to put on tonight.

Watch free tonight starting at 9 pm. #partner

TO LISTEN Musical genius Linda Perry, formerly of 4 Non Blondes, just released a new album, Let It Die Here, and it is actually good. Not sure why we’re surprised; she’s had a long career as a songwriter. Also: There’s a new doc about her out in limited release.

TO TRY This groundbreaking vibrating ring for women helps boost arousal and natural lubrication during menopause and hormone shifts. It adjusts to your shape, magnifying sensations across the entire vulva. Even doctors recommend it. FDA-registered, FSA/HSA eligible, award-winning. And it’s 50% off today! Shop it here. #partner

TO WATCH The YA college hockey romance book series Off Campus has been turned into a TV series on Prime Video. It’s lightweight, somewhat formulaic, and will probably be a smash hit.

TO COOK This super-simple and straightforward miso chicken recipe was a weeknight hit. It comes together and cooks quickly; we ate it with rice and veggies.

This is a very moving essay about getting a wig for your mom who has cancer. • “The King of Pop and the boys around him.” • Inside the trial of a grandma who wore an inflatable penis costume to a No Kings protest in Alabama. • The quiet suffering of women married to men obsessed with AI. • A new study shows just how deadly osteoporosis can be. 

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