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Dr. Jen
This is kind of in perimenopause. When women hit their late 30s, they go into their doctor and they're like, well, I'm gaining weight, I'm more anxious. Usually during that, you know, PMS week that we call the week before their cycle. And what does the doc do? They slap them on hormonal birth control, which is conjugated equine estrogen. It's not bioidentical, it's toxic. The liver has to process it and they give them an antidepressant. It's literally every patient that comes to see me that is not female feeling better. That is what they're getting with conventional medicine for their symptoms.
Host
All right, guys, we're here at a 4M with one of the speakers. She is speaking tomorrow. We got Jen here today. What are you talking about tomorrow?
Dr. Jen
Cycle syncing and perimenopause. How to optimize that?
Host
Yeah, cycle syncing. Is that when friends sync their cycles
Guest/Listener
with each other or is that something
Dr. Jen
else that happens too? And you can psych, you're sinko with your daughter if they live with you or something. But yeah, we see that on sports teams a lot. Yeah, but a lot of people are on synthetic birth control now, so that messes that up. But cycle syncing is working with the hormone fluctuation that women have during their menstrual cycle to their benefit instead of fighting against the biology because that leads to weight gain and anxiety and not good. So.
Host
Interesting.
Dr. Jen
Yeah, it's. It's really helpful when women understand their cycle and men, boyfriends, husbands, when they understand the cycle, because maybe you'll get in less fights, have more intercourse, you know, so if it's important for men too, to know what it is, I'm
Guest/Listener
actually learning about it now.
Host
She has an app.
Guest/Listener
There's certain days she's more fertile right of the month.
Host
So I'm learning, I'm trying my best
Guest/Listener
to learn it, you know?
Dr. Jen
Yeah. Are you avoiding fertility or Trying?
Host
We just got married, so we want to have kids soon. So we're just planning it and. Yeah, 28 day cycle. Right. It's crazy. Being a guy is so easy.
Dr. Jen
Oh, yeah. You're the same every day.
Host
Yeah.
Dr. Jen
So with women, we're. We're different every day of our cycle, but we can really hone in on that and make it better for the woman and for the man.
Host
Yeah. What are some things to keep an eye on when it comes to the woman's cycle?
Dr. Jen
Yeah. So the first half of the cycle is the follicular phase. So that starts with bleeding. Okay. So men kind of know, you know, the woman's like, oh, I'm on my cycle. So if they keep track of that, they can know a little better. But this. This is when estrogen is more dominant. So this is when you can do the hit workouts. You can push your body, go for the PRs, do the sprints, do the heavy weights, and you're less likely to get hurt, really? Because the second half of the cycle, the luteal phase, they did studies on soccer players in Europe, and this study team, they got injured. More soft tissue injury, joints, ligaments, in that second half of that cycle, that ludal phase.
Host
Seriously?
Dr. Jen
Yeah. And we're seeing with women, if they're entering in their 30s, late 30s, they're still doing the sprints, the hit workouts, all throughout their cycle to lose weight because they're starting to creep up in weight, and they're actually gaining weight because they're invoking a cortisol response. So their body's freaking out, and they're packing on the belly weight, and. And, you know, they're training for a marathon even. I had a patient train for a marathon, gained 20 pounds. Like, finish line was 20 pounds heavier. Yeah. My worst fear is when a patient's like, I'm going to train for a marathon, and they're in perimenopause, their late 30s, early 40s. I'm like, please don't. Yeah, it tanks their progesterone, tanks their testosterone. They gain weight. Their cortisol is jacked. Yeah.
Host
So don't run a marathon if you're experiencing perimenopause.
Dr. Jen
Right. Or you can sync it with your cycle. So you could do the harder training days, that first half of the cycle, the follicular phase, and maybe concentrate on more mobility and strength training that second half. So I think there's a way to do it. But all the training programs are usually designed by men for men, and women just are. Are jumping on to the running group. No, we have to do things differently because our hormones demand it.
Guest/Listener
Wow.
Host
I never even thought about that.
Dr. Jen
Yeah, it's. It's pretty cool when you look at the science and. And it's how responsive our cells are to insulin plays a role too. And cortisol influences insulin, because if we're stressed out all the time, we're pumping out that cortisol makes us more insulin resistant. So if you're pushing hard during that second half of that cycle, that luteal phase, you're. You're gonna have consequences. And we See that with irritability, blood glucose issues, because you think about it. So you guys are getting ready to have kids. That second half of that cycle is after ovulation. So what's happening you that egg is getting ready to fertilize and that egg wants to implant and make a nice home. So if we're stressed and trying to run from a bear or literally running, training for a marathon, our body is not going to react well and it's not good.
Host
That makes sense. You mentioned birth control earlier. What are the stats on that these days? I know a lot of women are taking it well.
Dr. Jen
This is kind of in perimenopause. When women hit their late 30s, they go into their doctor and they're like, well, I'm gaining weight, I'm more anxious. Usually during that, you know, PMS week that we call it the week before their cycle. And what does the doc do? They slap em on hormonal birth control, which is conjugated equine estrogen. It's not bioidentical, it's toxic. The liver has to process it and they give them an antidepressants. It's, it's literally every patient that comes to see me that is not feeling better. That is what they're getting with conventional medicine for their symptoms.
Host
Geez. Yeah. There's so many women starting it at a young age too.
Dr. Jen
Yeah. And that's another problem because that's going to affect fertility and put them at risk. And really, when you're taking oral conjugated equine estrogen, it's gunking up that liver, so you're not detoxifying as well. And we live in a very toxic world, so it's just building up. And that can cause weight gain, energy loss, mitochondrial issues.
Host
What's going on with fertility these days? There seems to be a lot of issues. What do you think's the main driving factors there?
Dr. Jen
Well, metabolic health. So we are seeing a lot of polycystic ovarian syndrome, we're seeing a lot of insulin resistance and then that is stressing out the body, that is hurting fertility, ovulation, the cycle. So we're seeing a lot of shortened cycles. So women will start to say, oh, I have a 25 day cycle, I have a 24 day cycle. Well, that progesterone is either declining because of cortisol, stress on the body, erratic blood sugar, or we're having an estrogen dominance where we're not detoxifying the estrogen as well. So that's a shortened cycle and that is not good for fertility. So a lot of women, we work on fixing those root causes first. But more and more women need progesterone to support a pregnancy. A lot of women come to me with recurrent miscarriages and we test their progesterone and it's deficient.
Guest/Listener
Wow.
Dr. Jen
And yeah, we can try things like Chase tree Berry to support that and have the body make its own. But at a certain point we do give progesterone to support, support that pregnancy. But if you think about it, I mean, we're drinking out of plastic cups, everything's wrapped in plastic. So we have endocrine disruptors.
Host
Plastic all over this? Probably.
Dr. Jen
Yeah. Well, and then if it, if it's hot, you know, it goes up to the lid and touches the plastic.
Host
I love coffee.
Dr. Jen
Well, just, just bring your own cup.
Host
Yeah, bring my own glass bottle.
Dr. Jen
And see, there you go. You're good to go there.
Host
Yeah. Do you think fertility issues are mainly a female issue right now or do you think it's something men are dealing with too?
Dr. Jen
Oh, definitely both. Yeah, we know sperm counts are declining also, so men are at risk. But once again, testosterone, metabolic flexibility. So if men aren't going to the gym and lifting weights, then that's going to affect their testosterone and fertility. Cortisol is a big driver too, of infertility. If we're stressed in fight or flight all the time, you know, I know you have a lot of passionate guests that get all worked up about stuff like the one before me, like his cortisol, you know, you could feel it in the room.
Host
He's dealing with some problems.
Dr. Jen
He has some major stress right now, so that is gonna affect his hormones. So he has to figure out how to balance that with supplements with vagal nerve techniques. So it's all fixable. I think it's recognizing it, recognizing that we're running around in a sympathetic stressed out state all the time.
Host
You think that's why people aren't having as much sex anymore? People are just stressed all the time.
Dr. Jen
Yes. So everyone thinks that it's testosterone, right? Especially I hate to say male doctors think this, but I talk to them and like, oh, they need testosterone like women need testosterone.
Host
Crt, baby.
Dr. Jen
Well, they get it out, but they don't need it. Yeah.
Host
So I know guys in their 20s taking it.
Dr. Jen
Well, do they? Are they taking it with other things like omad. To preserve their fertility?
Guest/Listener
I don't think.
Dr. Jen
Do they know? Honest, they don't know?
Host
I don't think so. I think they're just taking it.
Dr. Jen
Okay. Well, that's scary. So you need to give them a heads up that it can affect their fertility if they're just taking testosterone. And then what if they meet the women of their dreams? They think they don't want kids, but then what if they meet her and she's like, I want kids and they can't.
Host
So that affects your fertility, fertility like abilities.
Dr. Jen
When you take trt, it affects the feedback loop. So if you're getting it, your body isn't going to make its own and that messes up that feedback loop. So for men that can be dangerous. Now women giving excess testosterone isn't going to affect that feedback loop as much, but they're going to get more manly. They can have. Well, if they have unopposed testosterone too, it can affect the heart.
Host
Yeah.
Dr. Jen
So we also have to balance that out. But I'll check women's labs and I'm like, you don't need testosterone. So can you guess what their problem is?
Host
What is it?
Dr. Jen
Cortisol.
Host
Stress.
Dr. Jen
It's stress. Yes, sometimes. But stress can. Look, it could be, you know, poor metabolic profiles. So they're not metabolically flexible, so their blood sugar is bouncing up and down. They could not be sleeping. It could be a stress from like a stealth infection like mold or Candida. So it can be other things other than just, you know, emotional stress or working too much. It's, it's a lot of different layers but we need to correct that. So once we correct that, then their sex drive comes back.
Host
Really?
Dr. Jen
No testosterone needed.
Host
Stressing, huh?
Dr. Jen
Yeah, yeah, stress is, is a big one. But also keep in mind the cycle syncing. So if you're approaching your wife, your girlfriend and it's late luteal phase, right before they get their cycle.
Host
Yeah.
Dr. Jen
They're not going to be as into it.
Host
Really?
Guest/Listener
Yes, because so right before their period, they're not into it.
Dr. Jen
Yeah. That late luteal phase, they're like, don't touch me, I'm just can't focus.
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Dr. Jen
They might be. I mean, maybe if you incorporate a little more foreplay, it's going to take longer versus that ovulatory phase, their body. Because we're primed to make babies, we're primed to reproduce. That's what God said, you know, take dominion over the land and reproduce. So when we're in that ovulatory phase, that is when you just say, oh, hey, and we're going to be ready, we're going to be excited. So it's also playing into that because that, that late luteal phase, if you go there, you might look, look at your wife. Wrong. And she's just gonna be like, no, no. But, but also if your hormones are more balanced, you're not gonna have as much mood fluctuation.
Guest/Listener
Yeah.
Dr. Jen
But there's also fun things. Have you heard of PT141?
Host
Is that a peptide? What does that do?
Dr. Jen
It's a nasal spray. It helps with ar, so keep it in your fridge. Sometimes I'll bring it in my purse for date night with my husband. So I pair it with a little bit of oxytocin. So you can get PT141 with oxytocin. Both nose. My husband and I can both use it. It's male and female can use it. And 30 minutes prior to perceived intercourse and it helps. So the oxytocin helps with more of the intimacy. So that's why I like it with my female patients. And then the PT141 more for like the actual arousal. So it's. Oh yeah, it's great.
Host
You just buy that online or you need a prescription?
Dr. Jen
Prescription. So. But, but compounding pharmacies make it, it's pretty standard, so that's like a nice little one. Before diving into hormones, you can optimize the peptides. They have an injectable PT141 that's a prescription, but the side effects, nausea. So you're not going to want to like. It doesn't really make sense.
Host
It doesn't mix in the bedroom.
Dr. Jen
Yeah. So the intranasal is more well tolerated.
Host
Wow. What are some other things you're taking
Dr. Jen
for the bedroom for, for the bedroom. I mean, there's topical solutions that you can get like, called scream cream that sometimes I'll put patients on.
Guest/Listener
Scream cream.
Dr. Jen
Yeah. So basically what it's doing is it's increasing blood flow to the clitoris. So that is going to help women also when they're in perimenopause or even before that. So. And then also you want to look if they have any trauma, emotional trauma. I've had a lot of patients where they've needed pelvic floor therapy after having kids and then that helped their sex life. So if they're, you know, I know your audience is mostly men. Take some notes and work with your wife about this because it. There's a. We're a little more complicated than men. I hate to say that, but. But there's a lot more. It's more an emotional thing. So if you don't work on those other layers then.
Host
I have heard this though, when, when you have a kid and then you don't have as much sex afterwards.
Dr. Jen
Yes. Yeah. So it can be a traumatic situation. A lot of women have birth trauma.
Host
Right. From especially these days. I don't even blame.
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Dr. Jen
Yeah, yeah, it's pretty rough. So that pelvic floor can also get like tight in certain places. There. There can be internal trigger points. So you know how you get like sore muscle trigger points in the arm. So that can happen internally.
Host
Oh my gosh.
Dr. Jen
Yeah. So I'll have women with chronic hip pain and they have never gotten an internal vaginal exam by a physical Therapist to address those trigger points and then you release those trigger points and better and everything's better for them.
Host
Wow.
Dr. Jen
No back pain, hip pain. So pelvic floor health in general is ignored a lot by most physicians, even ob gyn. So that's another, another thing you need to check off for. For sexual health or just good physical health.
Host
Yeah.
Dr. Jen
Because think about if you carried grocery, really heavy grocery bags for nine months straight in your arm. But, but think of that's what women are doing carrying these heavy babies. I mean, I'll have women come to me and they'll complain of like some low back pain or hip pain. I'm like, have you ever had pelvic floor therapy?
Host
I've never even heard of that. Pelvic floor therapy.
Dr. Jen
Oh, it's great. It's so helpful for women.
Host
Okay.
Dr. Jen
Yeah. Usually the good ones are cash pay. Sometimes there are some good insurance ones. But a lot of women actually have like high tone in the vaginal area. Yeah. So it causes, it's just they're always like clenched. So it affects.
Host
So it's like your teeth clench but almost your vagina.
Dr. Jen
Yeah, yeah. And then that's causing stress on the body. The cranial sacral axis. And it's really interesting once someone gets pelvic floor therapy, even going pee or poop the right way, you know, maybe they weren't doing that correctly. They're squatting and not sitting down and relaxing. They're not breathing properly. I even refer men to pelvic floor therapy too.
Host
A lot of people poop the wrong way. Actually.
Dr. Jen
Yes. How do you poop?
Host
I have the squatty. Potty.
Dr. Jen
Yes.
Host
That. That's the right way. Right. You're supposed to extend a little bit your legs.
Dr. Jen
Yeah, yeah, it was. It's funny, at the hotel, you know, you can flip over the garbage can and use that as a. If you run into. If you're traveling and running.
Host
Yeah.
Dr. Jen
But yes, I squatty potties. I feel like they should just come on the toilets automatically.
Host
They should be there. Yeah. I actually this might be tmi but like I sometimes I play chess on the toilet. So I sit there for like an hour. And that's like really bad for you, right? Yeah, I ended up getting. Fuck, I forgot the name.
Dr. Jen
Hemorrhoids.
Guest/Listener
Hemorrhoids.
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Guest/Listener
get to the gym?
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Dr. Jen
Yes, yes.
Host
Yeah, it was terrible.
Dr. Jen
Yeah, that is too much. You kind of want to go in and go out. Were you just sitting there for enjoyment or was it taking that long?
Host
I. So I play chess, but I don't stop playing until I end on a win. So like I would go on these losing streaks and then it'd be an hour on the toilet like every day. And then got a hemorrhoid. So I was like, yeah, I'm never doing that again.
Dr. Jen
Yeah, you gotta get in and get out. If you're spending too long on the toilet, then you need to start working on your gut health.
Host
I have some gut health issues too.
Dr. Jen
Oh yeah. So that would make sense.
Host
Yeah, but.
Dr. Jen
But the good thing is, is that stuff's reversible. Hemorrhoids and everything. So where do you play your chess at now?
Host
Not on the toilet.
Dr. Jen
Yeah.
Host
In bed or standing Now I'm walking actually a lot while I play.
Dr. Jen
Oh yeah, that's great.
Host
I have to double my step count according to my latest blood work. So.
Dr. Jen
Yeah, that's what we want. We want to have that the actual fidgeting is good for us. That non workout and moving in between.
Host
Because I sit all day. So in between episodes I try to get some steps on.
Dr. Jen
Yeah, because that's going to get that gut moving also. Yeah, that's great.
Host
Well, this was exciting. I can't wait to watch your talk tomorrow.
Dr. Jen
Thank you. Thank you so much for having me.
Host
Yeah. Anything else you're working on or planned or where can people find you?
Dr. Jen
Yeah, I have a book, the Perimenopause reset. And you can find me on Instagram. Integrative Dr. Mom. Integrative Dr. Mom. And I'm excited for you to start having kids.
Host
Yeah, I'll contacting you for advice, so thank you. Check her out, guys. Peace.
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Guest/Listener
Thank you.
Episode: Testosterone in Your 20s Could Hurt Fertility | Jen Pfleghaar | DSH #1847
Date: March 5, 2026
Host: Sean Kelly
Guest: Dr. Jen Pfleghaar (Integrative Medicine Physician, Author of "The Perimenopause Reset")
In this insightful episode, Sean Kelly sits down with Dr. Jen Pfleghaar to explore the intricacies of hormonal health, fertility challenges, and the often-overlooked topic of cycle syncing for women. They dive deep into how modern lifestyles, medical practices, and misunderstandings about hormones impact both female and male fertility and overall well-being. This episode is packed with practical advice, memorable anecdotes, and science-backed tips designed to educate and empower listeners, especially those considering starting a family.
Dr. Jen closes with encouragement for couples thinking about kids to be proactive and informed about fertility and hormonal health. The conversation is candid, practical, and packed with both humor and science—making it a valuable listen (or read) for anyone interested in optimizing hormonal health, fertility, and overall wellness.