← Biohacking Beauty: The Anti-Aging Skincare Podcast
Biohacking Beauty: The Anti-Aging Skincare Podcast
Dr. Jessica Shepherd: The Shocking Truth About Menopause & Skin Aging (Most People Get This Wrong!)
00:53:24
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- [00:00]
Amita Eshel
Foreign to another episode of Biohacking Beauty Podcast. The podcast where we break down the science of skin, longevity and youthful aging. I'm your host Amita Eshel and this show is brought to you by Young Goose Skincare, the leader in biohacking solutions for skin health and obviously the company that myself and my wife Anastasia have found it. Today's episode is really, you know, an incredible episode, a crucial episode for anyone interested in hormonal aging, skin health and longevity. We'll be breaking down how menopause impacts skin, why skincare is more than just aesthetics, and how to empower yourself with science backed strategies to feel confident at every stage of life. We're getting into hormones. It's going to be very, very interesting. My guest today is Dr. Jessica shepherd, an incredible human being. Jessica is an MD, a board certified gynecologist and chief medical officer of hers, a leading voice in menopausal health. Her holistic practice, Sanctum Med and Wellness in Dallas redefines aging through pre prevention and wellness, earning features in self and women's health magazines. Her book Generation M challenges menopause stigma, advocating for empowerment and science backed solutions. I really was very impressed by her knowledge. We've spoken many times before inviting her to the podcast and I couldn't wait to have her on. It took a while until we got it together again. Love her book Generation M. We talked about it today. You might have seen her in on Good Morning America today, cnn, msnbc, cbs. If you turned on the tv, you've probably seen her. But yeah, very excited for this. Without further ado, please welcome Dr. Jessica Shepherd. All right, Dr. Jessica shepherd, welcome to the Biohacking Beauty Podcast.
- [02:13]
Dr. Jessica Shepherd
Welcome. Thank you so much for having me. And I can't wait to discuss all the things beauty, but also in menopause, perimenopause and women's health. It'll be exciting.
- [02:24]
Amita Eshel
Yeah. I think this episode is crucial for anyone interested in hormonal aging, skin health and overall longevity. I would say absolutely. So maybe we can start by kind of you explaining why, like what made you passionate about. About women's health and wellness.
- [02:48]
Dr. Jessica Shepherd
Yeah, you know, starting out, you know, originally in OB gyn, a lot of it had to do with delivering babies. But I soon quickly realized that, you know, there's so much more to the lifespan of a woman, whether that's an adolescence, also through the reproductive phase. But a lot of what we see after that phase of reproductive phase in the perimenopause menopause space and in aging, that there wasn't much Research about that, but also from a healthcare perspective, not much that we could offer women. And I found that they were really needing this information, but not necessarily anyone to give it to them.
- [03:23]
Amita Eshel
Yeah, got it. Yeah, for sure. So maybe we can, you know, get into. What does it take then, to. As a physician, to get into the mindset of a provider of that information, or how do you procure that information past the point, you know, of, you know, graduating and obviously doing your. Your fellowship, et cetera? Like, at that point, you realize you want to give women a window to, you know, wellness, supporting them through menopause. How does one educate themselves on that?
- [03:56]
Dr. Jessica Shepherd
I think that starts, you know, fundamentally in our education throughout medical school is really looking at women's health as a very important part of what we learn. But also just aging in general, you know, whether that's men or women. I think just society has kind of put, you know, a dark cloud on aging, and something that people don't necessarily think that they want to do, will enjoy doing. And I think if we take the stigma away from aging, but also the beauty in what we can find from a longevity perspective in how you can not necessarily look at it from an aging perspective, because we'll all age. But how do I have Wellspan and in my aging process, even though I am aging to whatever age I get to, how can I do that in the best way? And I think that message is a little bit different than what we've seen in the past. And I do start to see that that message is becoming more kind of widespread, but we're not quite there yet, where the overwhelming majority of people truly understand aging as a process. But how we get to change some of those things in the aging process, where we can do it with a little bit more grace, with more substance, and with the tools and mechanisms to do it where we're comfortable and we don't have to be in an aging process where we're frail or ill. And what that means in a wellness perspective.
- [05:17]
Amita Eshel
Yeah. And when do hormonal changes kind of come into that conversation with you and a patient that you're. You're seeing through that process?
- [05:27]
Dr. Jessica Shepherd
Yeah, that kind of conversations starts all throughout their life, you know, their. Their time frames in life. But I think the messaging is just different. So in your 20s, you know, you're just kind of getting people around the idea of what's going on in their life right now, which typically will. Maybe they started their, you know, their cycles or menstruation in their early adolescent years and coming into their 20s, what that means for them as they start to make decisions, and, and then also into their 30s, where, you know, if you think maybe mid-20s to latter 30s is that childbearing age of someone decides to have children is that they should understand that part of it and how to do that in the best way. And then as they start to get towards their 40s and 50s, is this is where you start to see the hormonal shift in. We don't talk about it a lot. It is not the other end of the spectrum, which is adolescents and an adolescent. That's where you see that, the onset of menstruation. And we do talk a lot about that. But on the other tail end of that, where it's ending, we don't spend a lot of time there. And that's where a lot of women get very confused, don't understand what's going on with their body. And then there's not a lot of education behind that. So I think it's how we frame the message. To go back to your question. Yeah, I typically like to address it at all stages, but a lot of fundamental conversations start probably in the mid to latter 30s, then in the 40s, having more conversations because it's more relevant as far as they're starting to feel those changes. And then guiding them into their 50s as they really start to look at this next chapter of their life and how they can make the adjustments that they need.
- [07:06]
Amita Eshel
Got it. Yeah, that's, that's, that's certain. And, and when do you feel that this is something that is directly linked with skin aging? In other words, what happens to the skin as, you know, estrogen declines during menopause.
- [07:26]
Dr. Jessica Shepherd
Yeah. So the first thing that I would say is that a lot of people typecast perimenopause and menopause to just the pelvis, because we relate it to the ovaries. And this is when you start to see changes in estrogen declining. And so then we'll then relate it to just a period stopping. But we have estrogen receptors all over our body, including the skin. And that is important because we see changes all throughout the perimenopause, menopausal phase that actually have to do with our entire body. So when we look at it from that perspective, which is why I always start there, that it's all body experience. Is that why it makes sense that you start to see some of these changes, you know, specifically for skin? But skin aging, you know, is something that is related to change in hormones, namely estrogen, which kind of Results in this skin change where it doesn't turn over. The skin cells don't turn over as much. You start to see changes in the keratinocytes where they not as vibrant, the melanocytes, where you start to see a little bit more changes, Whether it's dark spots or even lightening of the skin, or most importantly is the angiogenesis of skin, is that, you know, estrogens play a very important part in how the skin cells turn over, but the ability for them to receive blood flow, and when they don't receive blood flow, there's going to be changes in wound healing, immune responses, the oxidative stress that we just have from internally inflammation, but then external as well, you know, just like over environmental factors. So that's going to increase in dryness and reduce vascularity. So all of these protective functions that occur for skin are directly impacted by estrogen. And so when you start to see that estrogen decline, that's when you start to see skin responding in the way that it does in a skin aging process.
- [09:16]
Amita Eshel
Yeah, certainly. So you, you kind of alluded to collagen loss and dryness. But I think what, what was very interesting in what you said is that, that we also, because of that, you know, lack of, because of lack, lack of less circulation, whether it is lack of a proper response to damage, we're also getting a lot of times like increase in sensitivity. Right.
- [09:40]
Dr. Jessica Shepherd
And so sensitivity or the, the delay in response to something that happens to the skin. So you have this decrease, like you said, collagen content, but also the elasticity that decreases, which is going to increase wrinkling, increase the dryness, which you responded to. So the skin's ability to have hydration, hydration have better elasticity and thickness is the things that you see in youth. And then that changes over time. And I think take going back again to where we started is taking away the stigma of what starts to happen to our body and not necessarily fighting it in a sense, or being, you know, embarrassed or not liking it. It's how do we move with this time frame and aging, embrace it and then find things also that are going to help with the skin integrity and health and the proliferation of the actual layers of the skin. And that I think is the more important message to focus on rather than the appearance of or what's wrong with everything.
- [10:40]
Amita Eshel
Yes. Would you say that this is partially the reason why some women experience breakouts and rosacea in midlife?
- [10:48]
Dr. Jessica Shepherd
Yeah, so two different things, I think, you know, acne skin or changes in breakouts have a lot to do with the changes in hormones, whether that's a deep decline in the hormone that creates a fluctuation in the hormones, or for some, you know, even some who might do hormone replacement therapy, maybe because they were so low, and then now we're bringing it up with hormone replacement therapy, then their skin responds in a way because it's not the natural cyclic rhythm in which the hormones used to function before. And so again, it's that response. And then when you also look at inflammatory processes like rosacea, that again, has to do with estrogen actually is a very key component. It's very dependent on inflammation in the body. So it's kind of an inverse relationship. You have estrogen declining, which is now going to increase your inflammatory response, which then again, rosacea, when we think of it from an inflammatory process or a skin condition, that again, you don't have that protective feature of estrogen.
- [11:46]
Amita Eshel
Yeah, beautiful. So you've made the connection between, I mean, you've, you've, you've brought up hormone replacement therapy. Hormone therapy. We hear it more and more in the conversation around the appearance and whether it is around obviously, like the appearance of the body, muscle mass, et cetera, but also around the, the, the conversation of skin rejuvenation. So can someone that is undergoing hormone replacement therapy, can they actually improve skin.
- [12:16]
Dr. Jessica Shepherd
Quality as part of it with hormone replacement therapy? Yeah, yeah, I think, absolutely. When you do see women who, whether they're taking estrogen systemically or they're using it, you know, in, when we use our estriol face creams. Yeah, we do see a lot of women that have a positive kind of outcome and feeling how they look has improved because it has, again, a lot to do with the blood flow, decrease in inflammation, a little bit more plumpness. I always do tell my patients when they ask about estrogen, using it as a, as a face cream, namely, yes, it can be used, but that's not going to be your one tool wonder. Yeah, it's very helpful, you know, and so that's why, you know, looking into what actual products that you're using, what regenerative kind of processes you're using, and then also the use of devices like lasers and radio frequency. And then, you know, I always believe, you know, that even Botox and, you know, fillers are also a complementary way to kind of create something that feels good for some people, but also restorative. So I think there's a lot of modalities. Estrogen, I think, was not really given a strong pillar initially as one of those modalities. And now we are starting to see that which is. Which is a beautiful kind of addition to the toolbox when we think of skin health.
- [13:32]
Amita Eshel
Yeah, for sure. And you mentioned many different modalities that are meant, at the end of the day, to make people appear younger. And I think what is beautiful around your conversation, what you're kind of bringing up is kind of the balance between skincare is like a longevity practice mixed in together with aesthetics. And I think a lot of the times, you kind of need both. Right. Like, if you're going to have any stimulatory endeavor, whether it is lasers, whatever that is, you also want a skin that is youthful in the way that it responds to that. Right. So we kind of need both.
- [14:09]
Dr. Jessica Shepherd
Yeah, yeah. There's definitely a process in all of this which requires a controlled balance between what biologically is going on with the aging process, which obviously is going to be the breakdown or the degradation of the components of skin and the integrity of. But also the responsiveness in a controlled balance between how your body has the scaffolding to respond to something that's gonna help. So, for example, if you give someone, you know, a really good product to use, sometimes they can use that for some time. But because whether it's their nutrition, whether it's. They, you know, are not using other forms of modalities to kind of allow the skin to receive the product, well, then sometimes you won't see that outcome. As if someone who really truly understood how to use a product, but also how to. How to use some of these other modalities to get the best outcome is really. You can see that happen. And I've seen that happen in patients. For example, I have a patient who's on hormone replacement therapy, systemic, and does say, see esthetician. Right. So you would think that the integrity of the skin would be great because they see them very consistently. But because there is nothing that's really one product use, what is the product that's being used on the, you know, the topical form of the skin, but also what are they doing down to the deep levels and layers of their skin. To receive the product is also another part. And so you can have that kind of outcome that doesn't seem as heightened as it could be because it's not being reached by all modalities.
- [15:49]
Amita Eshel
Yeah, yeah, I agree. You mentioned estradiol applied topically. Would you say that's kind of what we have currently as a proactive skincare regimen to counteract hormonal shifts, or are there other Things we can look at combined together with it. When we are looking at kind of, you know, people, let's say, you know, people in their late 30s or early 50s that see a sudden decline in their facial, their, their appearance, assuming they didn't lose a lot of weight or anything like that. Normally we say, well, you probably had a hormonal shift. So is that kind of the end all, be all or can we do other things if we understand it's a hormonal issue?
- [16:30]
Dr. Jessica Shepherd
Yeah, I think the hormonal issue can be looked at different ways, whether it's topical, systemic, whether you use it for the systemic reason. But I also think, you know, in the skin kind of care industry, I think it would behoove, you know, people to consider estrogen, mixing it with say, you know, antioxidant enzymes or regenerative. A big fan of, of PRP use as well. Obviously you can't mix those two because it's, it's kind of something that's used at the time that it's prepared. But I do think that skincare for menopausal women combined with estrogen really has some really good Runway that we probably will see in the future. That it's going to be able to impact skin from a level of a hormone, but also additive things that can help with, you know, the free radical damage, integrity of the skin and oxidative stress that just comes with aging because there are estrogen receptors on the skin and so improving, you know, the receptivity to estrogen with the use of it topically. But also like you said, what are those other components in skincare that actually can either drive the product in which can allow for decrease in inflammation? I think there's so many ways that we can look at skin and help skin with the combination of hormones and other additives.
- [17:53]
Amita Eshel
Yeah. So what would you say are other additives? You know, you're a proponent of what is called like medical grade ingredients. Another kind of way to call it is, is results oriented skin care. Right. It's kind of means the same thing. What are some of the ingredients that you are, that you kind of are championing that you think are creating a change in people?
- [18:19]
Dr. Jessica Shepherd
Yeah. I'll start first with the issue in which I think can be addressed is decrease in blood flow. So what's going to increase, increase vascularity to that area is one important part. And then also the skin cell turnover. And so when you think of like skin cell turnover, obviously your, your retinoins are helpful, albeit with careful use and not too strong and not too much is one feature that I think that people are familiar with. So they're, you know, most people know what that is. So it's not intimidating. That would be something that's useful. I also think, gosh, there's so many that can be that. If I were to think, because currently what, what I do in my practice is use the, the difference of modality. So for example, we have a laser radio frequency. So that's one pillar. When people want estrogen, then I will, you know, prescribe them the estrogen. And then I also focus a lot on their diet and what they're putting in their body. That has a lot to do with the responsive responsivity as well. But one thing that I would say I don't really know outside of retinones, I mean you're more of the.
- [19:27]
Amita Eshel
No, but I love. At the end of the day, look, what we do, okay, is we take a very, an approach that says we will create the most youthfully functioning skin. That when they arrive to you, they can respond to whatever you are doing. Because I am, you know, I have been quoted many times saying that if you are a 50 year old and your tissue behaves like a 50 year old, the ability to create change with radio frequency, it's challenging. It's challenging. And there is a very, very high chance you're going to develop much more scar tissue than you're going to develop. The quality of collagen and elastin, by the way, which you mentioned, and I agree with you, is most of the time more important than the quantities. So on our end we need to make sure that you're getting a 35 year old scan biologically on a 50 year old ID. Okay, so. But I am always very curious as far as what we call boots on the ground, what you see making a difference. I love the fact that you mentioned on your own, the gut skin axis, in other words, is basically what you put in your mouth and how it affects the skin. Because I think obviously it's not, I think it's, it's any, any research into that would show us that this is where everything starts. And we're only starting to understand the, the relationship between, between those two barriers really. Because our gut is a barrier to what gets into our body and the skin is the barrier on the other side. So how does this conversation look like? And also, you know, kind of connecting to what I said a second ago. I'm wondering where are people right now? We live in an echo chamber. We go to a, we go To a longevity conference.
- [21:18]
Dr. Jessica Shepherd
Yeah.
- [21:19]
Amita Eshel
And everyone wants to talk with me about spermidine, but if I say spermidine outside, maybe I'm going to get arrested, you know. So the question is, when you, you're median person, where are they in the understanding of. Of gut and menopause and gut and skin? How does it start? What do you do with them? How do you get them to treat themselves like a temple or whatever? I don't know.
- [21:43]
Dr. Jessica Shepherd
How do you do. You know, I'm glad you brought that up. You know, that kind of is the fundamental foundation of my practice is really longevity and the things that patients have control over because as they live their everyday life, they get to control that part. And one of the things that we emphasize here is the collective of all of that and including gut health and maintaining a healthy gut microbiome and helping people understand that the digestive tract is really crucial for optimal health in all parts of your body, including skin. I would say that it is a very hard message. One there's, you know, it's not all the patient's fault. I do think in society we have a promoted, more unhealthy food kind of sentiments. And what we do with that relationship, our relationship with food, I would say, is poor. I think food quality is also poor. But what we do know is that again, in the aging process, we say that, you know, all of our organs or our body systems do start to take a shift. So now, as people are aging and biologically, their bodies are doing things that they have no control over. The gut health, you know, conversation is very new. You know, even in the world of gastroenterology, it is still very new in seeing just how it has impact on brain health, on skin health, and so much more is now delivering that message to so many people really is where we are. We are just at the tip of the iceberg. And, you know, as I discuss it, I absolutely know that it's something that I'll have to discuss repeatedly before someone truly understands how important their microbiome is to, you know, for this conversation, for skin health.
- [23:26]
Amita Eshel
Yeah, beautiful. And I think kind of presenting that and presenting, maybe changing the discussion from your general discussion around skin health and menopause and women's health and wellness in general. It's kind of, you know, following your practice and kind of what you're doing is definitely that screams through the. Your work. And what I'm interested is then why then if you're, if you are, you know, day in, day out having these conversations, how does a book come About. So you have a new book which, which we are very excited about. How does a. Which is called Generation M. How does a book come about? Do you feel like this conversation just needs to be kind of available out there? Like what is the idea around the book and what are you. What is the attempt to achieve with the book?
- [24:20]
Dr. Jessica Shepherd
Yeah, you know, in Generation M, I specifically wrote it in a way one where it would be a resource that people would want to come back to. And in order to do that, I, you know, really wanted to make sure it was written in a way where it was. Wasn't so highly medical that someone. It would be maybe overwhelming for someone or something that someone would not necessarily go back to as a resource when they have a specific issue because there's it. Menopause in general can be very overwhelming. And again, it's a all body experience. And so there may be certain points where you have a skin issue versus a gut issue versus a brain issue. And so it should be something that you want to go back to each and every time you are coming up with these kind of symptoms or signs or issues. I would definitely say that, you know, the book was looked at to be a medical resource, but also a longevity lifestyle resource. And really tying the two, which is how I practice in helping people truly see themselves as an advocate for themselves. So when they're out of my office and you know, the doctor patient relationship and what I tell them and what they should be doing and then also when they go home, what are the things that they can partake in that's gonna help them live that everyday life of the marathon of life? Yeah, because it's not gonna be fixed overnight by coming to my office. Actually more of the work is going to be done in those small incremental steps that you do every day in your life. The long term outcome is what I'm looking for.
- [25:54]
Amita Eshel
Hey there.
- [25:55]
C
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- [28:01]
Amita Eshel
And did you imagine more when you were writing this book, were you writing it more to a person that left your office or a person that picks it off the shelf in, you know, I don't know, New Jersey or wherever?
- [28:14]
Dr. Jessica Shepherd
Absolutely both. I think that because I'm only, I'm AN N OF 1, right. So the people who get to see me or come into my office as a patient, whether it's virtual or in person, yeah. They have that ability to say, hey, I read your book or hey, you noted this. What does that mean? But for the person who may not know that I'm here in Dallas, Texas, have an office, may not see me, they still have a really good fundamental knowledge that they can utilize and also go long term with that. Right. It's this kind of ongoing process that they're taking part in and they get to refer back to it time and time again. But starting conversation, starting conversation, if they go to their doctor or how they interact with their friends and family about menopause and how they feel that it's interfering with their life, but also things that they're doing to make themselves feel better, I think is also part of this navigation in perimenopause into menopause, which again, for so long was so kind of put on the back burner, not talked about. And now we are starting to see that people are talking about it more and more.
- [29:21]
Amita Eshel
Got it. Yeah, I agree. So maybe I'm interested, like walk us through maybe kind of the breakdown of the book. Where does it start? I know in the beginning you are talking about a roadmap Right. So how easy is that to. To maybe like, even draw a roadmap to. To a person that. To an imaginary person you're. You're thinking of? Is it something that you've. You've. You already had from. From many, many, many conversations, and now you just are putting it on paper or you really had to put some thought into it?
- [30:00]
Dr. Jessica Shepherd
Yeah, I think it comes from being in this field and really taking on menopause. You know, I really. Because I did, you know, general gynecology and surgery for so long, and then about five to seven years ago, I kind of started shifting more towards wellness, longevity, and then the menopause space.
- [30:16]
Amita Eshel
Yeah.
- [30:17]
Dr. Jessica Shepherd
And what I. So more of my conversations were very focused because I was seeing these patients solely. And I realized that, you know, when we're giving a roadmap, you want to give someone, in any instance, you want to give someone a good sense of where they are and then also where they're going. And so with menopause, a lot of people did not understand it, but then they didn't understand that it's not just one time frame, you know, that could last five to seven years of symptoms?
- [30:46]
Amita Eshel
Yeah.
- [30:47]
Dr. Jessica Shepherd
It's menopause. Once you hit menopause, you're postmenopausal for the rest of your life. So I wanted them to take, like, ownership in. Oh, this isn't just for the symptom part of it. This is also for my longevity and how I'll show up when I'm 70, 80, and 90. And a lot of that starts if we take the opportunity to look at ourselves in our 40s and 50s and lay some really good foundation. So later we have some reserve. We have some. Some things that have been prepared for when we start to age.
- [31:20]
Amita Eshel
Great. And you are. You're talking about menopausal and postmenopausal, but you, your. You know, one of the first thing you're doing in the book is basically kind of describe perimenopause. Right. In your conversations, are you the person that lets people know, for the most part, that they are perimenopause? The ones who are. That they're perimenopausal or they come with that idea in mind? Like, is it. Is it very common to tell someone, by the way, you're perimenopausal, and they're surprised?
- [31:51]
Dr. Jessica Shepherd
I think, because of the way my practice is set up, obviously, I'm kind of the person they're coming to because they suspect that they're perimenopausal. But I still have some patients who are coming to me, you know, with just some vague complaints. And then when I'm tying it together and bringing the story together for them, it's then that I'm like, you may be perimenopausal. Let's explore this more or let's watch it and see what's going on. And how does that show up in your life?
- [32:20]
Amita Eshel
Yeah, yeah, interesting. But so when you are writing a book, does it change or you're going through the same guidelines you would have had in person?
- [32:30]
Dr. Jessica Shepherd
Yeah, roughly the same guidelines. I even have patients who have been seeing me and then when they read the book, they say it's very similar to how you consult us in the office or when we see you as a patient. So they feel as if it's a true kind of testament to what I'm doing here in practice versus for the book. And I'm that. That actually makes me probably very excited to know that there's a kind of consistency in the messaging of what I'm doing in practice versus what I can put out there for you know who. Anyone who picks up the book.
- [33:08]
Amita Eshel
Yeah. And that it, that it translates. Right. So you have a chapter about sleep.
- [33:14]
Dr. Jessica Shepherd
Yes.
- [33:14]
Amita Eshel
And I think it's funny because look, we have, maybe we had the same, the same idea behind it, but I think sleep is so, on one hand it's so simple. Right. Like sleep is good. Right. There's no debate there. And on the other hand, it doesn't matter how often we talk about it here on the podcast, it would really never be enough because it is such a big, I mean, Brian Johnson, who is now becoming whatever is saying you should structure your life around sleep. So was it, was it a no brainer to include a chapter about sleep or were you more like debating whether you should just mention it and have people like go on a journey? Like, was it pretty substantial as far as the pillars that you were. That you were structuring the book around?
- [34:10]
Dr. Jessica Shepherd
Yeah, absolutely. I think. Well, for multiple reasons. One, I'm one who sleep was. I had the wrong approach to sleep health in my personal life just because I'm like, have to do everything, can't sleep. And then also when we look at kind of the sleep health and sleep studies, we do see a strong correlation between poor sleep hygiene and comorbidities later in life, such as heart disease, obesity, sleep apnea, which really impact again, that longevity aspect of health. So, so I think it's important for people to truly understand how sleep impacts your health and Then. And then another reason was com complaints from women going through perimenopause and menopause because of that decline in estrogen and specifically progesterone. When we're talking about sleep was that they just started to really notice changes in their sleep, but we weren't really connecting the two to an experience that was hormonal. And so I think putting all three of those together, you know, when we were coming up with the chapters of the book, I was like, sleep absolutely has to be one of those chapters and giving them modalities. Whether it was hormone replacement therapy, but also the beauty of things that help our brain long term. So whether that's meditation, breath work, cognitive behavioral therapy. I do think that those things are so important to add on to whether you do, you know, CBD gummies. Great. Whether you take hormone replacement therapy, which is also going to help with sleep. But again, it has to be that cumulative impact that people get to choose how it fits into their life and how they get to see the pillars. Because I can prescribe all day long, but if they're not adding things that are gonna be helpful or, you know, some things just don't work as well for other people, then that's fine too. And so the more tools I can give, especially in the sleep chapter, I think that that was a way that people can see themselves and figure out what works for them.
- [36:12]
Amita Eshel
Yeah, I love it because, you know, in the early days of longevity, even research, but like, longevity literature, longevity books, we saw a lot of, you know, chapters and whole books about sleep. And it was mainly like, preaching the importance of being the importance of sleep or like, quoting studies of, you know, here's what happens to your. To your, you know, insulin response if you didn't get sleep or whatever. And what I love to hear is that newer books, such as your book, gives modalities, like tells people, hey, this is the right things, things to do right. Even, you know, you mentioned sleep hygiene. Like, I remember my parents coming to visit us and staying at our house and past sunset, I literally thought, my retinas are going to be burnt from all the light. They turned on the light like they were looking. I don't know. To be honest, I don't even have a good example. The brightest light. I thought, I'm being abducted by aliens.
- [37:16]
Dr. Jessica Shepherd
Maybe you were. That is hilarious.
- [37:17]
Amita Eshel
Maybe. But I think it's such an important conversation. And how do you, you know, how do you even start to talk about the importance of sleep without. Without.
- [37:30]
Dr. Jessica Shepherd
I think I'm still working on it, you know, personally, but I enjoy working on it and I think I've actually looked at getting better quality of sleep. I'm working on quantity, but I definitely improved when I'm sleeping. The quality that I get has improved greatly.
- [37:48]
Amita Eshel
Yes, I agree. First of all, we have a one year old. Believe me, I get what you're saying 100%. By the way, one of the best things for our one year old is sleep hygiene. It's incredible how it works on kids. And you mentioned still working on it. I think. I don't know if this is in the book, but I think the never ending process of working on it is the actual goal. That's the journey because it's. And you mentioned mindfulness. This is what mindfulness is. It's the dropping out of sync with meditation and getting back on it. That's the practice. It's not actually like being in no mind. Right.
- [38:27]
Dr. Jessica Shepherd
Yeah.
- [38:27]
Amita Eshel
There is no stopping to work on it. No one is perfect. Everything comes up all the time. And just when you think you have it handled, your wife gets pregnant, apparently so. Right, right. I think yeah.
- [38:39]
Dr. Jessica Shepherd
It's lifelong. It is lifelong work. Meditation is the practice of. Even in the chaos, your mind will still drift. Just like what you said, habits will drift. But how the mindfulness and awareness to bring it back. I think that that's what life is.
- [38:56]
Amita Eshel
Do you. Yes, a hundred percent. Do you also talk about as far as like hormone hormone replacement, interaction with the hormones and sleep. Do you also talk about growth hormone? Do you talk about growth hormone in general or is it something that you touch on less?
- [39:11]
Dr. Jessica Shepherd
I touch on less and I don't, you know, I actually don't think I brought it up specifically in the book. Those are one of those things I think is in the, the nice circle of longevity docs, which I am fully aware and love talking about growth hormone. But that would be, you know, in this, in the subsequent book say. Because when I think of. I wanted to, you know, I'm very longevity focused. But I knew in order to get people even to that level of that next kind of thought of how they see their lives, I needed to start with a good foundation and then build on that.
- [39:45]
Amita Eshel
Yeah. Yes. And I agree with that and I think it's correct. There is a limit to how much you know, if you start. There was a good analogy, I think like someone like Zig Ziglar or someone had like a million times a million years ago that if you got to meet people where there are like if you, if you start the race, you Know one step before someone, they're going to try harder to keep up. If you start the race like half a race forward, they're going to give up immediately.
- [40:11]
Dr. Jessica Shepherd
Yeah.
- [40:11]
Amita Eshel
So it's, it is, you know, a delicate dance to get people to kind of follow and follow through. So I do want to go over some, some of the questions I had.
- [40:23]
Dr. Jessica Shepherd
Yeah.
- [40:23]
Amita Eshel
Around the book. So these are interesting to me. You have a chapter about libido.
- [40:31]
Dr. Jessica Shepherd
Yeah.
- [40:31]
Amita Eshel
And a lot of the times I describe the decline in skin health or the appearance of youthful skin as the body shifting with an understanding that it doesn't need to communicate sexual viability anymore, sexual virality. It does other things, it starts to do other things and may mainly preserves the, the knowledge base that is you as a person. You know, historically, as you grow older. And a lot of it, it's also, you know, through hormonal hormones and, and, and among other things, we get to want having lower libido first. First of all, a person with lower libido, does it bother them or are you kind of starting conversation telling them you don't know how good it's going to be when the libido is going to come back? I really am curious as to if it's something people feel is a problem before it gets fixed or fixed before it gets improved.
- [41:34]
Dr. Jessica Shepherd
Yeah, no, that's a great question. I think that there are many entry points to the answer of that. One of them being, I'll start with societal. I would say that most people are conditioned in the society that we live or the messaging that they received. And many times women have been subconsciously told that after a certain age they maybe shouldn't be thinking about that or because of the hormone decline that they will experience in testosterone, estrogen and progesterone. Is that when it's declining a little bit and they may have that decreased desire, that that's okay. And so I think that's where fundamentally what I've seen, that lack of interest can sometimes start from the messenger that you get. So then when it does start to happen, you're like, oh, this is expected and I'm not going to pay attention to it and I'm not going to think it's important, so I'm not going to talk about it.
- [42:28]
Amita Eshel
Right.
- [42:28]
Dr. Jessica Shepherd
And so a lot of that comes up when people are in my office and I do ask them specific questions about libido or intimacy. And as they're answering, we both notice that it has declined. And in that decline, then it's my responsibility then to share with them that that doesn't have to be that way. And so I think that's where that, that's one of the entry points that I would say. And then also just biologically, like we talked about aging, there's a decline in testosterone, which obviously has a lot to do with, you know, the desire and what that experience might feel like in a decrease in libido or sex drive. But again, going back to it doesn't necessarily have to be like that. And we have to find different ways. Just like we would approach gut health. Right. Just like we'd approach brain health as sexual health should be approached holistically, but also with the use of hormones or other medications. When we think of women's libido and desire, there's medications on the market or maybe two or three that again, that address that libido. So I think again, going back to starting with the messaging, why do they feel a certain way? How does that impact them? What do they think about that? Then going to, okay, now what are we going to do about it? And what are the tools that we can use? And then also the last part that I would say is it's not just all about the know, the actual organs or the decrease in hormones, but obviously our neurotransmitters and how our brain responds to intimacy. And that is something that is learned. And so there has to be a shift in a relearning in how we see ourselves as sexual beings and how we're going to respond to that as we start to age, because it, it actually requires a little bit of work. And so if you're not taught that, then you're not, you don't even know that there needs to be a shift. And I think that's an important message that we need to see more in women's health as well.
- [44:17]
Amita Eshel
And that is touched on in the book.
- [44:19]
Dr. Jessica Shepherd
Yes, absolutely.
- [44:20]
Amita Eshel
Fantastic. I do have a question that would actually take us a little bit back as far as age goes. But and if putting back like your longevity. Doctor, hat on, do you have anything to say, any opinions, any experience with fertility preservation and strategies for reproductive longevity? Is it something that you have discussions about with patients?
- [44:49]
Dr. Jessica Shepherd
Yeah, there's. There's two answers to that from a fertility perspective. So from a fertility perspective, I think we've made groundbreaking work in how to prolong that, preserve that. Depending on what the patient's looking for. If they're doing egg freezing at an earlier age, in order to use it later would be preservation. And then also prolonging would be for someone who does come at, you know, what we call advanced age in the fertility space is how can we use what they have at the time and utilize that in a way that can, again, we would say prolong fertility. And then the other side of that is just ovarian health in general, because we know that estrogen is such a big part of how our body responds. Inflammatory markers, I mean, everything really skin, is that. There is a lot of research. One who actually commented in the book, Dr. Pariah Byam, who is PhD and specifically devotes her time to looking at how to prolong the ovarian health. Because we know if we're able to prolong ovarian health, not necessarily for fertility, but just for ovarian health, then we can actually prolong and promote longevity because of the fundamental consistency of estrogen, testosterone and progesterone.
- [46:03]
Amita Eshel
To the extent, by the way, that we know that women who are able to become pregnant after 40, I think it's like almost like a guarantee centenarian right there. Right. Like it's.
- [46:15]
Dr. Jessica Shepherd
Yeah. I mean, and depending on how they got there, if they do it natural, it's like their phenom. But there are, you know, obviously we, because of science and technology, we do have women who are able to get pregnant, you know, with a little bit of assistance and help after 40. But yeah, you are seeing that a lot more. And it's not as obscure as, you know, what we used to see. Maybe before the. I would say Maybe the late 80s, 90s. Yeah.
- [46:43]
Amita Eshel
Interesting. And what we hear from the circles that we sometimes visit, which are the really super bleeding edge longevity skin. Longevity circles. There. There is a lot of. When you start to talk about crazy things like gene editing and things like that. There is a lot of talk on the relationship between ovarian health and even. And even kind of rebooting the menstrual cycle or attempting to. And kind of restoring youthful skin. Yeah, Again, this is obviously like a little bit. It's not safe yet, 100% and et cetera. But there is definitely a very interesting connection there.
- [47:31]
Dr. Jessica Shepherd
Yeah, yeah, very. And I love to see the science behind it and it's fascinating and I can't wait to see maybe push that. Maybe what, 10 years from now what our conversation might look like.
- [47:42]
Amita Eshel
Exactly. It might not only be available in Tijuana then. Right, right. So what are emergent technologies and treatments for women's health that you are excited about or even trying out? Where is it going as far as you're concerned?
- [48:01]
Dr. Jessica Shepherd
Yeah, I'm really excited about. I Think three things. If I were to name three things, hormone replacement therapy, we're just starting back on that forefront, which obviously from 20 years ago was kind of annihilated by the WHI. So we're finally getting back to where people understand it, understand the benefits and safety of it. And then two peptides. Peptide therapy, I think, is something that can be utilized by anybody. But I start to, you know, research. I do think that when we think of maybe the governing bodies and looking at peptides in how they allow us to use it, I think, you know, that's where I would love to see more innovation or allowance, rather. And then the last thing that I would say is GLP, GLP1s, I think are kind of. Obviously, there's a weight loss component to it, but there's also a physiologic, insulin resistance, gut health, cardiac health that we're starting to see now in studies that there is such a benefit to the use of it. So I think, you know, whether someone uses them solely or, you know, in a combination, I think that when I think of it from a longevity standpoint, that's what I would love to see, you know, people talking about very freely and even from a physician standpoint is us truly understanding outside of the, you know, the box of, I guess you could say, pharmaceuticals and medications and drugs, what can be implemented because medications and drugs are needed. There's. There's no, you know, that. That is definitely a need and a necessity. But how can we now fuse the ability to use these other things, which aren't medications, to make a more robust experience for patients, decrease illness and death and, you know, seven out of 10 chronic diseases in the US can be controlled and prevented through exercise, food. And this is, you know, these are some of the ways that we can actually contribute to that and see a healthier aging population than. Again, where we started with this interview is aging is looked at as, you know, stigmatized. And. And then aging comes with just like, grief and frailty and falling down and just being stagnant. We need to move away from that.
- [50:16]
Amita Eshel
Yeah, I agree. Yeah. So, look, we spoke about today about many things. We started talking about how hormonal changes impact skin health, skincare and preventative wellness. We talked a bit about, like, empowering people through their journey with menopause. Talked about sexual health and reproductive longevity. We covered. We covered a lot. And. And I. And it was a very interesting podcast to. To have you on. I mean, it's. I'm very happy on how it turned out. I highly recommend we didn't cover everything that's in the book. I highly recommend going ahead and. And getting the book.
- [50:57]
Dr. Jessica Shepherd
I think you should just tell everyone to get it. That's.
- [50:59]
Amita Eshel
Yeah, yeah, yeah. That's my high recommendation. This is. Yeah. Anyway, so fantastic, fantastic conversation. Fantastic book. Generation M. We're going to have a link in the. In the show notes, in the podcast notes. And we are also. We have something cool. So anyone who comes to Dr. Jessica Shepherd's clinic, which is called. Wait, don't tell me. Sanctum Med and Wellness.
- [51:28]
Dr. Jessica Shepherd
Yeah.
- [51:29]
Amita Eshel
Is going to get a skin consultation if they free. If they mention the biohacking beauty podcast.
- [51:37]
Dr. Jessica Shepherd
Perfect.
- [51:38]
Amita Eshel
So I think knowledge is power and it's great to be able to collaborate and. Yeah. So, Jessica, I super appreciate this conversation. Is there anything else I missed and that people should know before we end up? Where can people kind of reach out to you?
- [51:56]
Dr. Jessica Shepherd
Yeah, I, you know, people can find me on Instagram. Probably the best place is Jessica shepherd md, which is S H E P H E R D M D And also Modern Menno, which is where I really strictly put a lot of my perimenopause menopause info on Modern Menno. And then of course, follow Sanctum Med Wellness on Instagram. So you can see everything that we're doing and how we really fuse medical with the ability for people to do their best work through nutrition and exercise and all of that and beauty. But, you know, I. What I would want to end on is that as we start this aging process, as we kind of define who we are as we start to get older, is that we really do have a lot of agency in how we would like to do that journey. And so I would, you know, encourage everyone to stay curious and continue to grow and find all of these different modalities that are going to only make your. Your journey more beautiful as you start to age.
- [52:54]
Amita Eshel
Amen. All right, Jessica, thank you very much and thank you everyone for, for listening.
- [53:00]
Dr. Jessica Shepherd
Thank you.
- [53:14]
Amita Eshel
Sa.