← Biohacking Beauty: The Anti-Aging Skincare Podcast
Biohacking Beauty: The Anti-Aging Skincare Podcast
Dr. Jila Senemar, MD: How Early Perimenopause and Insulin Resistance Drive Skin Aging
00:51:01
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A
Foreign. Your Go to Anti Aging Skincare Podcast.
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We are your hosts Anesthesia Anna Mitai, the founders of Younger Skincare. And around here, we don't separate skin from hormones or beauty from biology because real skin health is systemic.
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A
Today's episode is all about women's hormones and not just the classic estrogen goes down, symptoms go up kind of way. We're talking root cause, bioidentical interventions and how to actually optimize your skin and your metabolism through the lens of hormonal change.
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Our guest today is Dr. Gilles Senomar, a board certified OBGYN certified menopause specialist and founder of GlamD. She's on a mission to change the conversation around midlife medicine and she's doing it with science, empathy and decades of clinical experience.
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A
If you ever wondered why your skin texture changed overnight, why perimenopause feels like a metabolic mystery, or what hormone trends are actually worth your time, this episode is for you.
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We cover everything from progesterone's role in collagen support to the truth about HRT, which lab tests every woman should run before her 40th birthday. And yes, we get into the hottest takes on what women should stop doing when it comes to viral hormonal trends.
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A
Whether you're in your 30s and thinking ahead or you're in your 40s navigating the shift, or in your 50s ready to optimize instead of just cope, this is the episode that will give you a new roadmap.
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B
Hormones drive skin, mood, energy and aging. And Dr. Gila is here to show you how to reclaim control over it all.
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A
And before we do all of that, every week we choose one of your you guys lovely reviews and gals lovely reviews and we read one aloud. Does it cringe me? Absolutely yes. That's why Anastasia does it. And if we read your review listen, it helps this podcast grow. Your reviews are important. We are on a mission to really support as many people in their journey to optimize their skin, optimize their health. It's important. I get it. And that's why if you leave a review and we're reading it, you're going to get a free product. We're going to tell you how to do it after we read the review.
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B
And I also want to say that Amitai reads your reviews at night on the couch and doesn't cringe him to read them. He just cringes him to read it out loud on camera. Just so you guys know. So this preview goes. Best Beauty and Longevity Podcast based on up to Date sub science, no hype, just straight facts delivered in an interesting way. Give amazing tips, easy to incorporate. Plus, the Yangoos products are actually highly effective. Thank you for continually educating people on skin. Debunking social media. Viral misinformation is also something this podcast does well. Tune in, you'll learn so much. Youngoos products are amazing and scientifically backed. I currently use three of them and can't wait to try more. And the handle is longevitytg. So thank you very much for this lovely review and please contact us either on instagram or email serviceyangoos.com and we'll send the product your way.
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A
Hey, man, I just want to say that I read the reviews to Anastasia, okay? Not to myself. I'm just saying that.
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B
Sure, sure.
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C
But he comes prepared.
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A
I read them aloud and she's there. How about that?
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B
He comes prepared. He's like, listen, look at the review we got. And yeah, sure. Just for me. Just for me. So selfless.
- [04:10]
A
Yes.
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B
I do my homework and thank you, thank you. I love hearing them.
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A
Great. So we're in agreement. It's all for you. Anyway, without further ado, please welcome Dr. Jilla.
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B
Well, Gila, it's so fun to have you here. Thank you so much.
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C
Thank you for having me.
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A
We should have recorded the podcast before the podcast.
- [04:35]
C
I know.
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B
We. We had our own podcast going on right now about motherhood and AI and I don't know, we touched on financing with entrepreneurship. We touched on so many things. But in this podcast, the theme, really, the theme is midlife. And it's something you took on as a mission to really prepare women when they get into midlife, support them through midlife. And my first question to is, is there a hormone that women like 35 plus should really obsess over?
- [05:08]
C
And that's a great question to start with because it's not the one most people would think to look at. And it's honestly insulin. Let me tell you why. Insulin plays a role in metabolism. Inflammation. And a lot of women in their mid-30s can start having inflammatory reactions going on on a cellular level that insulin resistance happening, and they don't realize it. A simple glucose or, you know, that isn't. Or a hemoglobin. A1C isn't going to pick it up, okay? And the way it presents in these women, they start gaining that middle body weight that they can't shed, and they get frustrated with it and they're like, you know, I'm working out, I'm eating the same, everything's fine. I Just can't shed the weight. And they become more restrictive, more cardio, things like that, which actually worsens the situation. So there are better tests that can be done, actually at that point to see if there is insulin resistance happening on a much lower level where they can then address it appropriately. So they would need something called a homa ir, which is a glucose insulin fasting, glucose fasting, insulin calculation that shows you if it's elevated, if that ratio is elevated, then there is some background insulin resistance already happening. And by changing some lifestyle, making some lifestyle modifications with the foods that you eat and things like that, you can actually help prevent prediabetes and diabetes 10 years earlier than it would be picked up on. A hemoglobin A1C.
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B
Wow, that's fascinating. And you mentioned so the belly fat. Right. And then I remember I read that one of the other things that sometimes signals insulin resistance that some blood tests might not show is skin tags. Have you heard of that?
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C
Absolutely.
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B
Is that also one of the signs?
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C
That is one of them. And this little hump that some people get here, I've seen that. And darkening of the neck tissue right here. So what happens is this insulin resistance is something it's a component of also polycystic ovarian syndrome. And a lot of those women, they have insulin resistance happening in the background and elevated androgen levels. And that's where a lot of these little, you know, signals start happening in the body. And they need to be addressed rather quickly. And even the way we kind of approach polycystic ovarian syndrome and things like that, because it's an inflammatory metabolic disease that can lead to long term, you know, sequelae, chronic, you know, infertility, metabolic problems, prediabetes, diabetes, heart disease. So to avoid all of that, honestly, we used to just do birth control pills and metformin to kind of help improve this insulin resistance. But now we know better, and we need to approach those women differently. Even in their 20s and 30s with lifestyle modification, it is such a key factor in everything, especially with our environment. With the microplastics, the hormone disruptors that we are exposed to on a daily basis, making those changes really can help impact a woman's, you know, glucose and sensitivity.
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B
Yeah, absolutely.
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A
And of course, at the end of the day, you know, talking back about skin health, that's one of the biggest factors that we can control and that we can modulate as far as, you know, staving off or, you know, delaying the onset of the signs. Signs of skin aging, because that's a big Driver of glycation or. Or the apt name age is right.
- [08:54]
C
Right now.
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A
Yeah, yeah.
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B
So right now, on social media, at least in my algorithm, there is so much talk about perimenopause and myths and people debunking the myths and then people debunking the.
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A
Debunking response videos to. Response videos to. Reaction videos to.
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B
Yeah, but in your experience, because, yeah, definitely, you are an expert and we're so happy to have you. What is the biggest lie that women still believe about perimenopause?
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C
I get this. I don't know how many times a day where I have women sitting in front of me and they've been told, you still have your period, you don't have any hot flashes, hence you're not in perimenopause. And that is the biggest myth, lie, false statement, whatever we want to call it, because hormone fluctuations are in the background, the period changes. Those do not need to be a component of perimenopause. They typically aren't. They're not the most common symptom of perimenopause. They're more common with menopause or late perimenopause in early perimenopause, which can be a good 10 years prior to menopause. So now we're talking mid to late 30s. These are women who are still, you know, fertile. Technically, they can, they don't. They can have a regular cycle every month, not skipping any periods, not having a single hot flash yet. They can be full blown perimenopausal and not even realize it because the symptoms are completely night and day different.
- [10:36]
B
And, and there is so much like you were saying with the lifestyle changes and the information we have now, if you are, you know, told that you're not in perimenopause and you're therefore delaying acting on what you're feeling is happening with you, you will end up having worse menopause and just suffer through it. Yeah, it's heartbreaking really, to know that women are still told this every day.
- [11:00]
C
It's really. I have seen women lose between five to seven years of quality life because they were dismissed of their symptoms. And the thing is, they go in, they see their primary care doctor, their gynecologist, whoever have you. Once a year, they have 15 minutes with that provider, if that. And they're not even asked a lot of these questions. You're having your period. Yes. You feel good. Okay. All right, let's do your breast exam. Let's do your Pap smear. And they're out the door. No one is addressing how is your relationship with your partner? Are you sleeping at night, how are your moods, how do you feel? No one is talking about any of that. And that's where it's at. In perimenopause, one of the most common symptoms that women are dismissing of themselves as well, sleep disturbances. They're not sleeping at night, they're waking up, and they wake up in the morning, in the middle of night, 2, 3am, they wake up in the morning unrefreshed, yet they have a slew of things to do. They have kids to get ready, take to school, drop off, get to work, come back, do after school activities, then, you know, make dinner. They're not thinking about what is happening to themselves. And women tend to put themselves last because we're moms, we're providers, we're wives, you name it, we do it all. Yet we're not paying attention. So then all of this starts to build up on itself until the woman gives. Like it just something gives. They just can't take it anymore and they finally get to somebody. Now at this point, this is a, it could be a pivotal moment where someone's like, oh, I get you, yeah, you have your period, you're fine, but you're in perimenopause. Every patient I say that to, they're.
- [12:46]
B
Like, are you sure?
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C
Do you need to check a lab test? I actually don't because there is no lab test to tell me if you're in perimenopause. Yeah, right. The hormones fluctuate from day to day to day. But if you have enough symptoms where it's affecting your quality of life, that's enough for me to start some kind of treatment with you. Yeah, yeah.
- [13:06]
A
I think again, I don't know, I think the same way where, you know, hormone replacement therapy was almost taboo to some extent in conventional medicine up to a few years ago. I think also the idea of true optimization is notable and what I mean by that, by the way, it could be for men and women, but obviously anything if men experience it within medicine, women experience it 10, 10x or 100x. And within that, I think it's very important to understand that most people who do you see trying to optimize their health, people that have a lot of money and a lot of time, normally that doesn't happen in your 20s. And maybe the unspoken idea behind optimization is trying to turn back the wheel. The news flash is that this is impossible or extremely costly and very extremely costly, both in energy and finances to do, but most of the time impossible to do at large scale. Real optimization is, as the word is, it's optimizing your performance right now, your body performs right now. So you can gain that five, seven years that you talked about before so you could delay the onset of menopause, or by the way, you can smooth out that transition. And that is, I think, someone such as yourself, I mean, we've, we've heard you talk. That's, that's how we, we, we've gotten to know each other. And that's something you touched on when you were talking, which I've actually never heard about before, is that the smoothness of the transition is one of the kind of the qualitative factors that you should be aiming at.4. And of course, from our vantage point, from the skincare vantage point, skin health, bad vantage point, we know that the two crises that we are called to serve are kind of end of late 30s and early 50s. And guess what happens in those areas or what can drop off a cliff in those areas. That's your perimenopause, menopause, hormonal violence, et cetera.
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B
Yeah, I mean, honestly, when you think about the fact that when you get to the last 3 or so percent of your eggs and that the collagen production drops by like 20%, I think 30%. It is, it's crazy that, you know, that our fertility affects so much of, you know, how it looks. And, and, and once that starts to decline, everything, you know.
- [15:44]
A
Yeah.
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B
Goes downhill. But with that, I think thanks to you and other women that are talking about this, there is a lot more awareness. And there are certain trends, viral trends online, including viral hormonal practices that trending out of those, out of what you see online. Is there anything that's really worth trying for our listeners that you see women start implementing in their perimenopause?
- [16:16]
A
Lemon in the morning. No, I'm kidding.
- [16:18]
B
And it actually, like, makes sense.
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C
Makes sense. You know, there's a lot of different things out there to employ. And I, I don't want everybody to think that they have to go to hormone therapy right off the bat, because that isn't the one fix. All for everything. It's not a magic bullet. It doesn't work like that. It's a, it's a part of the puzzle piece. You know, you got to put it all together. But in your 30s, if that's really what's happening, I would go for muscle building. You need that muscle. That's what's going to carry you through. Because Muscle is a metabolic organ in and of itself. Right. It helps with insulin balance, it helps with cortisol. It helps keep you strong, keeps your bones strong, and it's good for metabolism. And also testosterone plays a role in muscle as well. So if you're going to do anything, the most proactive thing I recommend to my patient, like start building muscle in your 30s, two to three days a week of strength training. But again, with somebody who knows what it is that they're doing, don't just go to the gym and start lifting heavy and doing deadlifts because you're going to hurt yourself. Okay. But really dedicate the time and the effort to doing the appropriate, you know, workout regimen for yourself, which could be a combination of things. It could be two, three days in the gym, and then the other days of the week you're doing Pilates or, you know, biking or swimming or whatever you like or enjoy doing because you're really only going to do it if you enjoy doing it.
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Yeah, yeah.
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If it's a chore, if you make yourself go, it's not going to work. It's not going to last long term.
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A
So your husband makes yourself, makes you go.
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B
Yeah. Amita has been trying to convince me to, to start lifting weights for years, and it was so hard for me because I'm such a, like, barre and Pilates girl. I just really enjoy bar and I see how it changes my body. It gets me to the, the shape of the body that I love seeing. And I enjoy Pilates as well. And last year, 2025 was the year of me actually being consistent with training with a personal trainer. Shout out to Jacqueline. Very, very well informed for perimenopause and, and in general. And yeah, that's, that's a habit that I got influenced last year and that's. I actually, yeah, for me, it was also trending. Like, I've seen women talk about it more and more and men also recommended that. And so, yeah, I think that's, That's a great one for sure.
- [18:45]
A
Yeah. I think, you know, where we are now is that we're. They're actually we, we are starting to understand, I mean, starting the last 20 years, we really are rediscovering the aging process of our bones or really, you know, if 20 years ago, it dawned on everyone that we need, you know, thicker or more robust skeletal scratcher as we grow older. Now, thanks to, very interesting, by the way, very interesting ways to measure or to spoiler alert, to measure the quality of bone. Right. We're starting to understand there's much more. There's. And it's not only, you know, it's not only the mass there, but it's kind of functional ability to bend, to stretch, to carry, load, et cetera. And one of the things that is becoming kind of more and more and more popular is its contributing ability to contribute to the organism as far as anything from energy from metabolic output from input to things like collagen production and hyaluronic acid production and things like that, and even, you know, releasing of bone of stem cells to the, to the, to the bloodstream and everything. And that is something I think is not, you know, not relate back to what people mostly, you know, care about, at least from our field is like how they look. And I remember I had, when I was, I don't know, 16, 17 years old, I went to the gym and all I cared about is the way that my body is. I don't have developed pecs, I don't have developed, you know, chest. That's what I cared about, you know, I wanted to have. And the guy said, oh, you should squat. Like my trainers. Like, I'm like, I. I don't get it. All I want is to have like a big chest. What does squat have anything to do with it? And back then, bro, science was like, hey, if your lower body is not going to grow, your upper body's not going to grow. So it's like, could understand there is a cap there. But we're starting to understand, like, hormonally there is something that's going on when you carry a lot of weight. And more than that, there is something that's got to do with bone density that you also want to preserve as you grow older. And your, and your bone density in your whole body is affected by the amount of weight you can lift. By the way, you're also exerting a lot of pressure on your jaw when you're lifting and exerting energy. There's even ways to expand that. We're maybe going to do it in a different episode. How to really, you know, kind of even, even do that more. But just to emphasize your point is that we, we want to lift weights because it does way more than give us a round shoulder or whatever or chiseled, I don't know, jawline. Jawline. Oh, yeah, that's the. Much more. But no, but that it does much more than just provide us that metabolic output that, that lifting weight does.
- [21:43]
B
Yeah.
- [21:48]
A
Let's take a second to talk about skincare during winter. Here's the part most people miss. Winter does not just dry your skin. It changes how your skin produces energy and repair itself.
- [22:01]
B
When temperatures drop, transepidermal water loss spikes, mitochondrial output slows and the barrier starts losing, losing ground faster than it can recover.
- [22:12]
A
This is why skin becomes reactive, inflamed and unpredictable in winter. Even if your routine worked perfectly all.
- [22:20]
B
Year, most people respond by adding a heavier moisturizer. That does not address the problem. So we built a system instead.
- [22:30]
A
The Winter Skin Protocol is how we protect the skin when repair capacity is compromised by cold, wind and low humidity.
- [22:42]
B
It is not a generic routine. It is tiered by metabolomic skin age, with clear guidance on when the priority should be protection versus repair and how to adjust when travel treatments or environmental stress push the skin past its threshold.
- [22:57]
A
Inside the protocol, you will find structured morning and evening rock routines, red and near infrared light timing and targeted strategies for the areas that break down first in winter, including the neck, chest and hands.
- [23:13]
B
If your skin becomes tight, red or reactive every winter, this removes the guesswork.
- [23:19]
A
If you want to go deeper, you can download the protocol and see the full system. The link is in the episode. So description. Your skin already knows winter is different.
- [23:31]
B
Your routine should reflect that. I have actually a question about testing. So you kind of mentioned talking to patients about the blood work results and Amitay and I recently went to do blood work and because of what we wanted to test, we actually opted for going like self paid and just, you know, like just give us all. We went to a functional medicine doctor and we tested everything that we want to test. And I was just talking to a friend about it yesterday and she's pregnant and she's 40 and she's like, oh my God, I think I'm going to need to go to this doctor that you went to see because my ob, you know, test suggests only this, I don't know, let's say four or five things. And I told her that I'm known to be very close to be anemic and I really want to test my ferritin iron, et cetera. And she's like, well, you don't have, I can't, I kind of can't test you for that because you don't, you know, I don't see anything alarming. So long story short, she basically told her, no, like this is what I can't have you test. I understand that she's paying with her insurance and it's very complicated. I guess the question I'm asking, if people really want to get a full picture and get like a really proper blood work. Can they ask it from their OB that they're seeing and it's up to ob or is it really that unfortunately the medical practitioners are very limited and yes, people actually have to seek help outside of their, the OB that they're working with.
- [25:07]
C
You know, that medicine is quite complicated, especially when there's insurance involved. You know, doing conventional medicine with insurance for the past 25 years, I can tell you even if the patient understands and wants everything done, you can still run it. There's a chance insurance is or is not going to cover it. And so as long as they're aware of that, I would run anything and everything that the patient wants in terms of pregnancy. Actually what I think may have been going on, I don't know. But normally we do a CBC looking for the hemoglobin hematocrit. That's one of the first things we check. And if we see an abnormality in that where it's borderline to the lower level, where we would think somebody may be anemic, then we would run the full iron panel to look for the ferritin and the, you know, other and the iron binding capacity and all of those markers to see because somebody can have a normal hemoglobin hematocrit but have iron deficiency still. So in women, especially in pregnancy, that can shift and change. So we do routinely run it if we see a problem. Now the woman comes in and tells me, I don't feel well or I feel dizzy or lightheaded, I would run both of those on her. Because there is a chance due to hemodilution of pregnancy, she can drop the hemoglobin and the ferritin enough where she's feeling it. So it is to our benefit. I tell a lot of patients, I'm like, listen, even if they don't cover it, it's worth it to get that test done. They're not thousands of dollars. These tests are not, you know, going to break the bank. Now you do a full genetic panel on a pronovo scan and add everything else on, we're talking thousands of dollars. But if you're just doing simple blood work, it's not going to be cost prohibited, prohibitive to do that outside of pregnancy. Like what I do now in my new practices, they get the full head to toe biomarker check once a year at least. And depending on what the results are, if there's something I need to follow up on, then I would repeat that incrementally as we go throughout the year.
- [27:18]
B
And with that in mind, is there anything in particular that you think women often don't know that they need to test? Like, what do you recommend any woman should test for before her 40th birthday?
- [27:31]
C
Before the 40th birthday, I would say definitely you need a full blood work panel, all that. But I really love my DEXA scan, my bone dexaan going back to the bone density, back to the bones. Because based on recommendations by the US task force, we don't check a bone density till 65.
- [27:51]
B
Oh my God.
- [27:52]
A
Yeah.
- [27:52]
C
By 65, we're behind the eightball.
- [27:54]
B
Yeah.
- [27:55]
C
If you don't have osteoporosis, you definitely have some kind of osteopenia by that point. So, yeah, too little too late. So I've actually moved that it's not a recommendation by anybody but me based on my own research and knowledge that I have and based on what I've seen in my practice. Just by doing this. Over the last two years, I have picked up 40 year olds with osteopenia setting in already had I not done it. She's like, why did you do this test on me? I said, because I wanted a baseline. Because if it's perfect, then great, I will do lifestyle modification, supplementation, do all of that. And then, you know, repeat it at 50, let's say. Yeah, okay. But I have found more than I would have liked.
- [28:39]
A
Yeah.
- [28:39]
C
So because I'm like, everybody gets a bone density at 40, or if I see them like 45, they all get one.
- [28:45]
B
Yeah, yeah.
- [28:46]
C
And again, it's a hundred dollar test. Yeah, yeah.
- [28:49]
A
And there are other benefits. You know, you, you, you know, you can also find out that you need more muscle. Just saying, you know, there's, there's, you know, it's very, it's a very vivid test.
- [29:02]
C
It gives you a clinical picture that you didn't have. And again, remember, what is our goal with what we're doing? And this is really, you know, a lot of women think we're just trying to cover symptoms with hormone therapy. And yeah, that's goal number one. Obviously, they don't feel good. You want to make them feel better. Goal number two is longevity. What does that mean? It means you want to avoid that heart attack. We want to avoid that hip fracture. The silent disorders that are happening under the surface due to this drop in estrogen level that happens in midlife. And you know, I've had patients tell me, listen, I went through it pretty easily. It wasn't a big deal, I'm fine. But when I do testing on Them and I check their bone density and I do a calcium score on them. They're not that fine. And then they're surprised by that information.
- [29:49]
B
Yeah.
- [29:50]
C
And now we have to kind of re. Educate everyone from the start.
- [29:53]
B
Yeah. Like, thanks to the education that, that I've received over the last year, we had so many speakers and educators, I've learned that estrogen is actually a signaling molecule because we always think about it as a hormone, but it's like it basically signals our body to do so many things. Like I mentioned collagen production, but even like it has to do with the insulin and so many more things that, yeah, once it drops, we have to be prepared and we have to, you know, contract. What were you going to ask? I kind of interrupted you.
- [30:25]
A
God knows I know it's in the ether now.
- [30:29]
C
That's about right.
- [30:31]
A
Yeah, I think, you know, I'm always super curious. First of all, you know, you've opened your clinic almost a year ago, which is a clinic that really focuses on people once they. I loved how you called it off air. Once they're done having kids. First of all, I'm curious if you had to have an 8020 rule or 80 20, whatever. Splicing. 80% of people, like what are they coming with as they're burning might be physical, but how would they're burning? Desire or what's on their mind? What do you see a lot of. And then, you know, you did talk about hormone replacement therapy. What are some of your kind of STAR treatments, STAR approaches that you're taking and you're seeing profound change in those people. Not end case scenarios, but really that 80%. And then 80% of the things you're doing to them.
- [31:36]
C
So 80%, I would say, say what I see is they don't feel like themselves. Their quality of life, everything has changed and shifted to the point that they don't recognize themselves. And I feel terrible saying this, but they're at their wit's end. I'm like their last resort. They're like, I've gone. I had a woman drive down to see me from, I want to say, two, three hours north, almost by like Orlando area had been dismissed by, I don't know, a slew of doctors over the years. Seven years of struggling with symptoms that have worsened.
- [32:15]
B
And how old is she?
- [32:17]
C
She was 43.
- [32:19]
B
Wow.
- [32:19]
C
Okay.
- [32:20]
B
That's so sad. That's exactly what we said. It's such heartbreaking thing to know that these women are out there seeking help.
- [32:26]
C
And you know what gets better is she didn't want to come because she told her husband, what's the point? She's going to say the same thing. Everybody else has a reputable institutions and I'm not going to get anywhere. He drove her down. He said, you know what? We're going to go no matter what. I want you to go. Let her say the same stuff.
- [32:45]
B
And then at least a romantic for sure.
- [32:50]
A
Or he couldn't take it anymore.
- [32:52]
B
But yeah, I mean, I mean, isn't this is like the highest one of the peak times people get divorces, like when women hit their perimenopause and if the husband is not aware that this is not his wife gone crazy and he needs to go look for a new one or whatever.
- [33:10]
A
By the way, I meant he couldn't take it anymore that every doctor tells her the same.
- [33:13]
C
But sure, yeah, yeah, that too. It's a little bit of both. You know, it could happen both ways. I know we always look at things differently, but yeah.
- [33:25]
B
Anyway, so that was still very admirable that he drove her down and he was like, no, we're resolving this for you. That's. It was me like when it's Europe.
- [33:35]
C
No, but it was really, it was an impressive situation to see this happening. And you know, I spoke with her first, obviously, and I'm like, so tell me what's going on? And she gave me her whole story. And I looked at her, I said, and this is what we're gonna do about it. And she started crying because she said, you're the only one that told me that there's something to do and that there's nothing wrong with me. Because the last provider wrote in her chart needs a psychiatric evaluation.
- [34:02]
A
Wow.
- [34:04]
B
That.
- [34:04]
C
That's. And to your point where no, my wife's crazy. This is what we've been. What's been out.
- [34:11]
A
Wow.
- [34:11]
C
This is our culture, unfortunately. This is how women have been looked upon.
- [34:16]
A
You know, this doctor needs a psychiatric.
- [34:22]
B
Which used to be done to women for.
- [34:24]
A
Yeah.
- [34:25]
B
You know, and called hysterical.
- [34:26]
A
Yeah.
- [34:27]
C
Right. So with her, you know, then I spoke with the husband, obviously, and he was like, yes, this is kind of what we were here for, is to listen and see that there's nothing wrong and that there is a physiologic, biologic reason for this and how are we going to approach it? That's my 80%. So I see a lot of that. Not to that extreme.
- [34:51]
A
It's very well put. Very, very well put. You know, most of the people that you meet, I feel like they still think of themselves as like an 18 year old as a 15 year old.
- [35:02]
B
Really?
- [35:04]
A
Some child stuck in an old person's body or in mature body, if you would. Very true.
- [35:12]
C
Yeah, listen, this is a shift that we were never taught about. We know about puberty, we know about reproductive years. We're happy, we celebrate all of those. No one talks about this because it was a taboo. It was like the falling off the cliff component. It's like kind of put her to the side. It is what it is. We deal with it, we move on. But what did that look like? It didn't look too optimistic. If we remember, like our grandmothers were cute and all, but they would get shorter and smaller and frail looking. We're not looking like that. This generation of peripost menopausal women are not that. And with that, we're living longer, but we want to live healthier as well. This isn't just lifespan, this is all about health span. And if I can live seven, eight years longer but healthier, I'm all in with what we can do about it. So that's like the 80, the 20%, you know, where, you know, they're just kind of like, they don't. They, you know, what will we do and how do we modify things for women? I really like to like kind of break it down for them into like, okay, now we're going to do hand holding here. And a lot of what I pride myself on doing is really walking the patient through the next phase because you cannot give them a treatment plan and say, okay, go be on your way. They need hand holding because there's a lot of fear, there's a lot of misinformation out there. And so I can put them on a treatment plan and then they talk to a friend who says, are you sure you need that? I don't know. Did she look at your labs and maybe you don't need that. And no, she didn't tell me about my labs. Oh my God, what am I doing? This is where I come in. I'm like, give me a call, call me.
- [36:56]
A
They send them an Instagram reel.
- [36:58]
C
Yeah, exactly. And I get, it's funny, I get them on my social media, my dm, like, I saw this. I'm like, I did too. I'm on the same feed you are. And I know what's out there. That's why I, I'm not a social media guru by any stretch of the imagination. But I realized that's how people are getting their education and how misinformation is out there. I'm like, well, Let me get on there and put on, you know, the stuff I know that I know hopefully.
- [37:23]
B
Balance a little bit.
- [37:24]
C
Let me balance it out a little bit. But it's that hand holding. You need that guidance. And then once they're past the worst of it, they're great. Like, you have a new person in front. When I see them back in six to eight weeks, I have a new individual in front of me who's now, okay, I'm better, I'm not 100%, but I'm getting there. And. And we have something to work towards. So I think that's kind of how I approach things.
- [37:50]
B
Got it, Got it. One of the questions we received in preparation for this podcast was if there are any, like, let's say, one habit that you say it's really impactful for metabolism, which we know slows down. So is there anything that you saw really working? I know we talked about, you know, weightlifting and anything else, injecting GLP1s that.
- [38:15]
C
Is part of it in the right patient population. Yeah, I think a lot of it really has. It goes. I go back to lifestyle with all of this because they need sleep, they need quality sleep because that will help lower the stress on their body, which will then lower the cortisol level, which then will help with inflammation and kind of rebalancing their whole metabolism, insulin, all of that, they all go hand in hand together. You know, you mentioned it, estrogen. We have estrogen receptors everywhere, all over our body and so including our fat cells. So that's why you get this. You know, the lack of estrogen causes more fat to be kind of surrounding your organs. So the visceral fat rather than the subcutaneous fat, which we know that visceral fat is much more dangerous for us. So if you can rebalance all of that out, then you start to notice kind of the weight balances itself out. Not saying hormone therapy helps with weight, it doesn't. It doesn't make it go up or go down. So you cannot gain weight. You don't tend to lose. You don't tend to gain weight on hormone therapy, and you don't tend to lose on it either. But indirectly, it can affect metabolism because if you balance things out, then everything else downstream kind of falls into place.
- [39:36]
B
Got it.
- [39:37]
A
Do you think? Would you want to see, you know, talking about weight loss, hrt, would you want to see test, like, what do you think is the role of testosterone replacement therapy in women? Obviously, right now you need to have, like, a diluted form of men's testosterone Replacement products. Do you want to see a women's specific one? Are you comfortable with the way things are? Do you think it's unnecessary? Most people like, where do you stand on it?
- [40:05]
C
I love testosterone. Some women make, women make estrogen, progesterone, we all do. And as we go through perimenopause, it's actually really progesterone that starts to decline first, then estrogen, testosterone last. But we still need to be cautious and cognizant of that and replace it as needed. Because looking at a number doesn't tell you. Again, with a lot of blood work, what I try to relay to my patients is a number doesn't define what's going on. It's about optimizing that number so you can be within the normal range, but where in that range are you? And maybe for one individual being in the middle is good and for another individual they need to be on the upper end of normal to be optimized. So it's really about replacing based on what they're feeling. So I'm all about testosterone replacement. Some people depending on again symptoms. When they walk in to see me, we do it at the same time. So they get estrogen, progesterone, testosterone. Others I may hold off on it, do the estrogen and progesterone first and then later sprinkle in the testosterone depending on how they're feeling. We need a female formulation. The specific using the men's version is really not working. That it works but it's not amazing. I do two things. I can get a compounded version from a compounding pharmacy where they use like three or four clicks which is a lot of cream to be using every day and waiting for it to absorb. It's a lot of volume. So because that I've switched over to the male version, the testosterone gel. But even that can become messy and the patient's like how much am I really getting? I don't know. So we're trying to, okay, put it in a, you know, syringe and try and you know, use half an amount, pea sized amount. What does a pea size amount look like?
- [41:54]
A
You know, so again going buying peas in there in public, some comparing it.
- [42:00]
C
I have been. Doc, what do you mean? I'm like, like, like this much. Okay, like, like this much. I'm like, yeah, you know, back of your leg, you know, this and that. Make sure you don't. It doesn't get on anybody else. It's a little bit cumbersome to do something every morning and listen, we're Already having them, let's say, use a patch twice a week and a pill at night, every night. And some women need vaginal estrogen. So add that in. And now put a cream on your. Like, yeah, it's like, it's a mission. So really we need to make it easier. Easier. So I think that's the next thing for the FDA is to get us our own testosterone. Yeah, we need it.
- [42:34]
B
Amen. Yeah, Testosterone. Our own estrone for women. 2026. Let's go.
- [42:41]
A
So, you know, we talked about some of, some of the. Some of the hormones and their effects. I think estrogen does get a lot of. A lot of attention. Rightfully so. Am I correct to say, like, progesterone's not there yet? Even, like, looking at social media, looking.
- [42:57]
B
At, oh, I see progesterone all the.
- [42:59]
A
Time, so I'm incorrect.
- [43:01]
B
Videos I've seen, you're gonna be the expert. But this is what I heard. Probably that's what other listeners heard. I've seen this video where it basically goes, you are in your 30s. Would you benefit from progesterone? Yeah, actually you would. You're in your 40s. Would you benefit from supplementing on progesterone? Yeah, actually you would. And then they just go down, down and down in age. And it's like, unanimous. Everyone could benefit from progesterone. So I think that maybe it's brought.
- [43:33]
A
To you by Big Progesterone.
- [43:36]
B
Corporation. So that's the information I have. Do you agree with that?
- [43:41]
C
So it is. You know, it's interesting what you said is that estrogen gets all the crazy credit. Yes. Because there's a lot that goes on with estrogen, and we know it works everywhere, but so does progesterone.
- [43:51]
A
Yeah.
- [43:52]
C
Progesterone is the calming hormone of our bodily system. It helps with sleep, it helps with cognition, it helps with mood stability, anxiety. All of that is progesterone mediated. And to be honest with you, a lot of perimenopausal women, regular cycles, they benefit from the progesterone first. So we, you know, I tend to looking at a case by case situation, but I would, you know, be inclined to start them on the progesterone first, see how they do, and then add in the estrogen as we go, because, again, they may be okay on the estrogen side, meaning cycles are fine, nothing crazy, nothing else is happening. Okay, let's do some progesterone. Let's see how you do. And then as time comes by, then we decide to add in the estrogen down the road.
- [44:45]
B
Yeah.
- [44:45]
A
How common is it synthetic, like progestin? How common is it is. Is it right now to prescribe synthetic progesterone? Why would someone, you know, not do that? Why would someone should be aware of what they're getting and offer for bioidentical progesterone?
- [45:06]
C
So there's a lot out there, but to be honest with you, like, most people will be getting bioidentical, especially in the perimenopause phase, as long as they have other forms of contraception, whether it's a vasectomy or tubal ligation or things like that. Now, the only time I would really need to use a synthetic version is if we need contraception, because, again, in perimenopause we're still fertile and can conceive and ovulate. So because of that, I would tend to go to like a, you know, progesterone only birth control pill to give them contraception from that angle. Or maybe even use a progesterone containing IUD to get the progesterone into their system. Helps with contraception. And then down the road, we look at estrogen and then add in the estrogen component bioidentical. And once they kind of graze into that menopausal phase, then you can switch them off of the synthetic in onto the bioidentical. But 90% of women will be on a form of bioidentical progesterone, which is either prom or micronized progesterone.
- [46:09]
A
Why would you opt for bioidentical? What are some of the issues that people might get with synthetic progesterone?
- [46:15]
C
So the synthetics are, you know, physiologically your body breaks it down completely different than a bioidentical. It's basically, it's chemistry. So the bioidenticals, again, it's a marketing term, by the way. It doesn't mean anything. You know, it just means the way your body recognizes that progesterone is the same as if the ovary was producing it internally. So, and the side, the byproducts through the liver are not detrimental, so they don't go back into the bloodstream and cause problems. The progestins, that's where we get into trouble, is the breakdown products then get into the bloodstream and they can cause anxiety, mood, other problems. And that's why you kind of want to stay away, steer away from them as much as possible in perimenopause.
- [47:03]
A
Got it. Interesting. Okay, you know, let's go, let's go. Some of the rapid Fire. Questions that.
- [47:14]
B
Okay. We always wrap up the episodes with the rabbit fire. Okay. What is one thing women blame on aging that is actually fixable on aging?
- [47:25]
C
I think it's weight gain.
- [47:29]
B
Like, do they wake up in the night?
- [47:31]
A
No, weight gain.
- [47:31]
B
Weight. Oh, weight. Gaining.
- [47:33]
C
The. Gaining the weight. The midlife in the middle. Higher that they call it. Or the metal belly they call it.
- [47:39]
B
Oh. Like they give up on being in shape because they're older.
- [47:42]
C
That also. And also the fact that now what used to work doesn't work anymore. So they used to do more cardio and eat less and they want to continue doing that regimen. And unfortunately it backfires in midlife because of the high cortisol and inflammation. You're only going to kind of get skinnier.
- [48:00]
A
Fatter.
- [48:01]
C
You're going to get fatter. So yeah, so it doesn't work for them. So they get, you know, they kind.
- [48:04]
B
Of give up on it.
- [48:05]
C
Skinny fat. Exactly.
- [48:07]
B
Okay, what is your hottest take on hormone replacement therapy?
- [48:12]
C
My hottest take on that is in the right patient at the right time. They should start definitely in perimenopause and not have to wait till they're in menopause to begin.
- [48:22]
B
Yeah, that's hot. That's hot. Okay, that's hot. What is one thing women should start doing in their 30s? If they want to age well in their 50s, they need to really pay.
- [48:33]
C
Attention to their lifestyle. Minimize the alcohol, improve their sleep habits, minimize stress and toxic relationships. Really. And listen to their body and their cycles and learn what their body's trying.
- [48:49]
A
To tell them and build muscle.
- [48:52]
C
And muscle.
- [48:52]
A
Obviously I learned well.
- [48:54]
B
Yeah, no, you passed the test. Well, I think that's a beautiful wrap up to this episode. You're such a wealth of knowledge. Thank you so much for coming.
- [49:03]
A
So I have a couple of questions. So first of all, how can people work with you? And then I don't know if you want to talk about the, the online educational platform.
- [49:13]
C
So thank you both for having me. It was a, it was so amazing to meet you both, you know, a few months back. And I'm glad we' kept. Kept the relationship going and conversing and seeing each other at other events and this was amazing. I loved this. You can find me on social media at my Instagram, Dr. Gila Senomar. The website is Gilamd. That's where they can sign up to be looked for as a patient and find an appointment there. And in terms of online platform education coming, launch will be in about two to three weeks.
- [49:49]
A
Wow. So this is gonna be by the time this is out, we're gonna be.
- [49:52]
C
We're gonna be launching.
- [49:53]
B
Yeah, so. So that's what we should do. We should. Yeah, we should air it when it's launched so we can have it linked in the show notes.
- [50:00]
C
Yeah.
- [50:01]
A
How do you know?
- [50:03]
C
I will definitely keep you posted. Yes.
- [50:06]
A
But how can. Do you have any information as to, like, what's going to be called. How do you, you know what's.
- [50:12]
C
There's going to be an Instagram page for it. It's going to be second Bloom Health and we will have all of that information on social media and I will pass it along to you.
- [50:21]
A
Amazing. So that's going to be in the show notes.
- [50:24]
B
I want to bloom.
- [50:25]
A
You want a second bloom too?
- [50:27]
C
Yeah, exactly.
- [50:28]
A
But that's going to be in the show notes and we're going to make sure to link to it. Yeah.
- [50:34]
C
I appreciate it. Thank you.
- [50:35]
B
Thank you.
- [50:37]
A
Good luck.
- [50:38]
B
Thank you.
- [50:38]
C
Yes.