Build Strength After 40: How to Future-Proof Your Body Starting Today

Summary

The Tamsen Show — Episode Summary

Episode: Build Strength After 40: How to Future-Proof Your Body Starting Today
Host: Tamsen Fadal
Guests: Will Harlow (Physiotherapist, author of Independence for Life), Dr. Kathleen Jordan
Date: May 28, 2026

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Overview

This episode is a comprehensive, hope-filled guide for women (and men) over 40 looking to build and maintain strength, mobility, and independence into later life. Tamsen Fadal speaks with physiotherapist Will Harlow about practical steps to future-proof your body starting today, explains why age is not a barrier to improvement, and busts widespread myths about "age-related" decline. Dr. Kathleen Jordan joins later to break down the latest on hormone therapy shortages, evolving menopause care, and the facts on testosterone for women. Audience questions on injury, stiffness, and real-world obstacles are answered, with actionable strategies throughout.

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Key Discussion Points and Insights

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Will Harlow: How to Build & Maintain Strength After 40

Will’s Story and Why He Focuses on 50+ Health

• Will originally trained to work in professional sports but found his true calling helping older adults regain mobility and independence.
• Realized that many physical complaints blamed on "aging" are not inevitable, but the result of deconditioning and misguided advice.

“Many of these problems that we see as aging are not. They're just a result of either deconditioning or people being given bad advice and told they have to accept it. And I knew that I could reverse a lot of that.” (Will, 06:08)

What Actually Happens to Our Bodies With Age?

• Two Buckets:
  • Physiological (body changes):
    • Sarcopenia (loss of muscle mass and, more importantly, strength)
    • Bone density loss accelerates, notably post-menopause for women
    • Joint changes (arthritis), but not always linked to pain
  • Lifestyle (how we move & live):
    • Daily movement tends to decrease
    • Regular activities (gardening, walking) are good, but usually not enough for muscle and bone preservation

“After the age of 30, not the age of 50, we lose between 3 and 8% of our muscle mass each decade, but we lose strength at a rate two to three times faster.” (Will, 09:17)

“If we know what we're doing, many of these things that we thought were inevitable are actually reversible.” (Will, 11:13)

The Two-Week Strength Gain Mindset

• You don’t need a gym or hours per week — two 20-minute home sessions using bodyweight or simple resistance are highly effective.
• Most people, especially those starting from less activity, see noticeable improvements quickly in strength and confidence.

“You can improve your strength in about two weeks... that confidence comes back because people don't feel like they're going to fall, they feel more capable. They can get up and off the floor, they can get out of chairs without using their hands.” (Will, 12:05)

The 3-2-1 Method for Efficient Home Workouts

• 3: Pick three compound exercises (e.g., squats, sit-to-stand, pressing overhead, push-ups or wall push-ups).
• 2: Do them twice per week (each session, use the same moves is fine).
• 1: Progress by ONE variable per session—either add a rep or a little more resistance.

“You can make considerable improvements with two 20 minute sessions per week if you choose the right exercises.” (Will, 14:13)

Age and Progress: Never Too Late

• Even people in their 90s have doubled leg strength in controlled trials.
• The less someone does before, the more dramatic their improvement upon starting.

“We've got people in their 90s who make progress... the average resident increased their leg strength by 175% in eight weeks.” (Will, 17:16)

Dealing With Recurrent Injuries (e.g., Back, Frozen Shoulder)

• Most recurring injuries are "mechanical" — muscles not protecting joints, stiffness, or weakness.
• Stopping rehab exercises too soon (when pain ends) is a key cause of relapses.

“Pain is actually a very poor indicator of how healthy your joint is.” (Will, 22:38) “As a golden rule, you want to keep working on those exercises probably eight weeks after the pain has disappeared to fully fix it.” (Will, 25:06)

• Frozen Shoulder:
  • Often follows menopause; not an injury, but severe inflammation and constriction.
  • Recovery is slow but inevitable; gentle movement plus PT accelerates.
  • Cortisone injections can help when pain disrupts sleep or daily life.

“It really can last. Now, the good news about frozen shoulder is it basically always gets better. Eventually.” (Will, 26:44)

The Four Pillars of Independence

1. Mobility (joint range of motion)
2. Strength (muscle mass and ability to resist)
3. Balance (key for confidence and fall prevention)
4. Skeletal Health (bone/joint health, prevent osteoporosis and manage arthritis)

“If you can tick all four of those boxes, it's like having a very sturdy table with four legs.” (Will, 30:44)

Practical Weekly Routine (for a 55-year-old woman)

• Mobility: 10 minutes a day on trouble spots (e.g., gentle stretches)
• Strength: Three compound moves, 20 minutes, twice/week (3-2-1 method)
• Balance: "Exercise snacks" during daily routines (stand on one leg, tightrope walk while brushing teeth, etc.)
• Bone Health: Resistance plus "impact" through simple heel drops (up on toes, drop heels)

“Just 20 to 30 minutes a day is enough to cover all these bases.” (Will, 34:00)

Exercise Snacks: The Single Best Habit Anyone Can Start Tomorrow

“If you can only do one thing... adopt exercise snacks. Just those tiny little and often bursts of exercise compound over time. And they do make a massive difference.” (Will, 45:49)

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Audience Q&A Highlights

Q1: “I wake up stiff and achy every morning—is it just aging?” (36:32)

• Not necessarily. Check for underlying issues (bloodwork/rheumatological), assess sleep, then look for lifestyle triggers. Stiffness for an hour+ is not just “normal aging.”

Q2: “Doctor says my knee pain is wear and tear; is surgery the only option?” (37:46)

• Absolutely not. 80% of knee pain is mechanical and often improves or resolves with strength and flexibility work. See a physical therapist—not a surgeon—as your next stop.

Q3: “I can’t get up from the floor without grabbing something—is it a big deal?” (38:43)

• A huge deal. This functional ability predicts real-world outcomes; not being able to get up puts you at serious risk if you fall. Practice daily if possible; address weak quads/glutes, tight hips/knees.

Q4: “Is walking a real workout?” (42:50)

• Walking is essential for metabolic and mental health, but not enough to maintain/build strength or rebuild bone. Combine walking with regular resistance training for best results.

Q5: “I fell playing pickleball—how can I avoid this again?” (44:09)

• Identify the cause (trip, weakness, joint give-way), but strengthening legs (quads, calves) and working all four pillars is protective for all sports as you age.

Q6: “What’s ONE thing to start now?” (45:44)

• Exercise snacks—mini bouts of movement throughout the day tailored to your needs (mini-squats, knee bends, one-leg balance). Six weeks of consistent snacks can yield significant improvements.

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Notable Quotes & Memorable Moments

“I like to say to people if you're looking to improve your muscle mass, it's going to take 12-16 weeks. However, you can improve your strength in about two weeks.” (Will, 12:10)

“The most dramatic changes come from the people who are starting from the worst positions.” (Will, 16:57)

“The earlier you start working on [balance], the longer you'll keep it for.” (Will, 33:59)

“We now know that muscle is your longevity organ. The more muscle you have on your body, the longer you live. It's as simple as that.” (Will, 29:35)

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Dr. Kathleen Jordan: Hot Topics on Menopause & Hormones (from 46:47)

Estrogen Patch Shortages (47:14)

• Demand has exploded because of new evidence for benefits (bones, heart, longevity) and broader recommendations to start earlier and continue later in life.
• Current shortages are due to supply not keeping up with demand, not manufacturing problems; may last for over a year.

“Manufacturers have not kept up… this is a lot more women coming to pharmacies with prescriptions. And manufacturers have not kept up well.” (Dr. Jordan, 48:04)

What to Do if You Can’t Get Your Patch (52:27)

• Ask your pharmacist about alternative brands/different dosages (once weekly/twice weekly/combined lower doses)
• Consider other forms: gel, cream, vaginal ring, or compounded formulations.

Evolving Evidence and Duration of Hormone Use (49:27)

• Research supports starting hormone therapy earlier (as early as late perimenopause), continuing well into later decades.
• Benefits for bone, cardiovascular health, and quality of life.
• Past caution about breast cancer risk was largely overblown with old formulations—modern formulations and evidence show the risk is lower than once thought.

“We now know we sort of overreacted, but we had 30 to 40% on hormone therapy at that time.” (Dr. Jordan, 52:07)

Testosterone for Women (54:16)

• All women lose testosterone steadily from ~age 30; by 40+, levels are lower than in youth.
• Symptoms: low libido, fatigue, weakness, brain fog; not always aligned with "low" lab values.
• No FDA-approved testosterone for women in the US, making cost and access challenging (compounded creams/gels are best).

“The most studied [testosterone] benefit for women is libido... these other indications are less studied.” (Dr. Jordan, 56:51)

"[For] women who can’t take estrogen... some testosterone converts over to estrogen, so we proceed with caution." (Dr. Jordan, 59:41)

• Best starting delivery: daily topical cream or gel (avoid pellets due to inflexibility/side effects).

• If symptomatic, see a provider familiar with compounding and cautious hormone use for therapeutic trials.

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Useful Timestamps

• 02:37 — Will Harlow’s origin story and patient “aha moment”
• 08:41 — What happens to our bodies after 40? Sarcopenia, bone loss
• 12:05 — How quickly does strength and confidence return?
• 13:25 — How to start if you don’t want a gym or have much time?
• 15:00 — The 3-2-1 method explained
• 17:06 — Never “too late”; 90-year-olds seeing strength gains
• 21:31 — Recurring injuries, hidden mechanical problems
• 25:16 — Frozen shoulder, pain vs. true healing
• 29:19 — Four Pillars of Independence (mobility, strength, balance, bone health)
• 33:55 — What does a “real week” of movement look like?
• 36:32 — Audience Q&A: Stiffness, knee pain, getting off the floor
• 42:50 — Is walking a real workout?
• 44:09 — How to prevent falls/injury after 50
• 46:47 — Dr. Kathleen Jordan joins, hormone patch shortage explained
• 52:27 — What to do if you can’t get your prescription
• 54:16 — Testosterone facts for women, symptoms, access

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Final Takeaways and Resources

• Never too late: The biggest breakthroughs come from small, consistent steps — even at 80 or 90.
• Most physical decline is not inevitable: Strength can rapidly return, pain can resolve, and independence IS possible.
• Simple routines win: Two 20-minute weekly strength sessions, daily mobility snacks, and regular “exercise snacks” for balance change outcomes.
• Hormones: Menopause and andropause care is evolving; be proactive in seeking evidence-informed providers.
• See the experts: For persistent pain/injury, physiotherapy addresses root mechanical issues — don’t wait for problems to “just be age.”

Resources:

• Will Harlow’s book Independence for Life and YouTube channel ([search “Will Harlow”])
• Consult with menopause/hormone specialist providers (e.g., Midi Health)

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Notable Quotes for Sharing

• “Muscle is your longevity organ. The more muscle you have, the longer you live.” (Will, 29:35)
• “You can make considerable improvements with two 20-minute sessions per week if you choose the right exercises.” (Will, 14:13)
• “Pain is actually a very poor indicator of how healthy your joint is.” (Will, 22:38)
• “If you can only do one thing, adopt exercise snacks… they compound over time and make a massive difference.” (Will, 45:49)
• “We now know the benefits of hormone therapy extend well beyond hot flashes.” (Dr. Jordan, 49:00)

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Episode’s Tone

Encouraging, straightforward, no-nonsense, and deeply practical—full of hope, actionable advice, and myth-busting, delivered with warmth and empathy for anyone looking to future-proof their body and life after 40.

Transcript

[Tamsen]

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[Will Harlow]

Nope, I'm making dinner tonight.

[Tamsen]

You don't have time. Josh has practice.

[Will Harlow]

Oh, that's right.

[Dr. Kathleen Jordan]

I'll just get a salad and fries.

[Will Harlow]

No, just the salad.

[Tamsen]

But salad cancels. Fries.

[Will Harlow]

Salad only.

[Tamsen]

Fries.

[Will Harlow]

Salad, fries.

[Tamsen]

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[Will Harlow]

Hey, can I get the fries? Salad? Sorry.

[Tamsen]

Learn [e-mail] Mochi members have access to licensed physicians and nutritionists. Results may vary. Hey there. Welcome back to the Tamson Show. Well, if you are a member of this community, you already know I'm slightly obsessed with making sure I stay as healthy, strong and mobile as I can for as long as I can. My dad is 86 years old, and when I am that age, I want at least half the energy he has. Now I want to be traveling, hiking, walking. I don't want to be sitting there on the couch not being able to do anything or not interested in anything. And I know the women that I see who are active later in life did not get there by accident. They've been doing this work the whole time. So I'll be honest, I have good days. But then I have those days like last week when I pulled my back out, same injury I keep getting. And I'm lying there thinking, okay, this is that unsexy part that nobody talks about. The slow accumulation of things that we ignore. Stiffness we chalk up to a bad night's sleep, aches that we push through. Cause we're like, oh, we're so busy, we don't have the time to deal with it. But we're gonna take control. Today, Will Harlow is joining me. He's a physiotherapist and founder of HT Physio who specializes in helping people stay strong, mobile and independent as they age. And he has a new book out called Independence for Life and Stay Tuned Because I've collected all your questions, and he's gon answering those and giving us real solutions and tools before we get started. While you're listening, if you could please leave a review. It really helps this show reach more women who really need it. Okay, let's get this started. Will, I am so glad you're here.

[Will Harlow]

Thank you for having me on, Tamsen.

[Tamsen]

Yeah, I, you know, I'm excited because your story is just incredibly motivating. You shared a little bit of it with me, but I'd really love to dive into how you started working with people over the age of 50.

[Will Harlow]

Absolutely. So it's a. It's a weird story because I would say I kind of fell into it, but I feel like it almost discovered me. So, like many young guys, I spent my whole life obsessed with sports. So when I was growing up, I was either playing sports or I was watching sports. And I knew from an early age, like, I want to work in professional sport. This is what I want to do. I wasn't good enough to play it, so I thought the next best thing would be to get in there as, like, a support member of staff. And the best way to do that, I thought, was to become a physio. I was interested in the human body, and I thought, brilliant. This is going to marry up my two biggest things, sport and, you know, helping people with their bodies. And all the way through uni, I had this in mind, left university, and just a massive stroke of luck, I got an in with the club doctor from the football team that I'd supported my entire childhood.

[Tamsen]

Wow.

[Will Harlow]

And I called the guy, he said, great, come in for an interview. We'll see if you're any good. Met him, got offered the job, took it, and thought my dreams come true. However, started the job, and about six months in, I was like, this is the worst time I think I've ever had. I'm really not enjoying myself. The culture is wrong for me. Like, my personality is a bad fit for this. And this thing I'd built myself up for my entire life, it turns out it just wasn't what I thought it would be.

[Tamsen]

And you're young, right?

[Will Harlow]

I was 25.

[Tamsen]

Wow.

[Will Harlow]

And I had this moment where I was like, if I don't leave now, I'm just going to be stuck here doing a job I hate for the rest of time. So I made the difficult decision to leave. I didn't have anything else to go to. I didn't have any money saved. So I was like, I need to get a Job fast while I figure out what I'm going to do next. So I got a job in our corporate health care system called the NHS in England. And it's kind of like a mill, like physio clinic. You're seeing 15 patients a day. Most of them are doctor referrals, and about 90% of them were people over 50. So I did that for a few months. And I just remember one day I had a patient who came in who was. She was an older lady and she had been walking using two crutches for years because of bad knee. And I'd worked with her for a few weeks. We'd strengthened up her legs, and she came in one time and she was like, I'm not using the crutch.

[Dr. Kathleen Jordan]

And.

[Will Harlow]

And I remember watching her leave that day. And I thought, this is the most fun I've had in years. Like, I'm doing something that I actually care about. I never thought I would find so much enjoyment helping this group of people, but here I was having a great time, so that kind of ignited my. My passion for it. But I knew that the system I was in was not the right place to stay. We were very constrained as to what we could do with people in that setting. I was given a target of maximum 2.5 sessions per patient. That was our average to do.

[Tamsen]

It's basically. It's physical therapy. Is that what you were doing for everybody?

[Will Harlow]

And in that time, they wanted us to assess the patient and get them better and discharge them. And it was like, that's, you know, I can do much better for people if I can see them longer. So I made the decision to leave that job and start my own business. And from day one, we. We boldly declared that we are here for people over 50. And I felt like this was an important mission because this group of people are just chronically underserved. And I mean, you write about this in your book from a. From a female point of view, but it's happening to all people of this age group. They're written off by the traditional healthcare system, told that it's just your age, what do you expect? Nothing can be done. And I knew from my training that wasn't true. And many of these problems that we see as aging are not. They're just a result of either deconditioning or people being given bad advice and told they have to accept it. And I knew that I could reverse a lot of that. So that's where I started. And it's just grown from there.

[Tamsen]

I think what's so impressive. Like, I wanna hit on so many things that you said, but the fact that you were half that age really like in your mid-20s, making a decision like that. But seeing that area of seeing those people that were getting no help at all and really needed it, were you seeing one thing over and over again with these people? Was it that they felt like they'd kind of given up or you knew that they were still pretty much young and could and could be so much better?

[Will Harlow]

Yeah, I think the thing I was seeing the most was what I call age related problems in brackets, because I don't think they are, but things like arthritis or, you know, various knee injuries or shoulder or hip injuries, and the pattern was always the same. The person would go to their doctor, the doctor would almost laugh and say, well, what do you expect? You're 65, you're 75, you know, your friends have probably all got this too. Like this is just the new normal. And something inside that person was saying, you know what? I don't think I have to just accept this. And, and I knew from my training that most of those problems are what we would call mechanical. So it's not because there's something wrong inside the body. It's because the muscles aren't supporting the area or the joint itself got a bit stiff. And if you loosen them up and strengthen the areas that are weak, quite often those symptoms just disappear. But people had just been almost living a lie for so long, being told that this is just what they have to expect. And yeah, righting that wrong really was kind of what motivated me.

[Tamsen]

I love the title of your book, Independence for Life, because that means so much. That gives people hope, gives people purpose, it gives people a mission so they don't feel like that, you know, you hit the certain age and all, all is done.

[Will Harlow]

Absolutely.

[Tamsen]

So I want to talk about people in this age group in particular, and especially women. You know, I talk a lot about women, but what is actually happening to our bodies, maybe between the ages of 40 and 60 that you're seeing primarily, is it that we're not working out the same way, is that we're moving differently, is that we've had an injury and that's what's caused us. Maybe we didn't even realize how badly it it hurt us.

[Will Harlow]

So I like to split what's happening with this age group into two buckets.

[Tamsen]

Okay.

[Will Harlow]

So the first bucket is physiological, so this is the physical changes the body's actually undergoing with age. And then the second bucket is lifestyle. So this is the changes to how we live our lives, which most people go through now in the physiological bucket, we do get changes to our muscle, in particular as we age and we develop something called sarcopenia. Most people develop this. And sarcopenia, we used to think was just a loss of muscle mass with age, but we now categorize it more broadly. It's not just muscle, it's strength and its function as well. And research shows that after the age of 30, not the age of 50, we lose between 3 and 8% of our muscle mass each decade, but we lose strength at a rate two to three times faster. So that's dramatic.

[Tamsen]

Very dramatic.

[Will Harlow]

So if you're losing 8% of your muscle mass, you might be losing 16% of your strength each decade. And we know that from grip strength tests over different age groups, we can see that happening. And grip is a great proxy for your overall strength. So that's one thing that's going on. Another thing, and I know you've dived deep into this in your book, Tamsin, is changes to our bones. And this is a big thing for the people I treat. So we, we lose bone at a similar kind of rate to the rate that we lose muscle. Unfortunately, for women who undergo menopause in those five years post menopause, that rate of bone loss can be as high as 2 to 3% per year in that five year period. And if that's not controlled, if nothing is done about that, then that can lead to osteoporosis, which can be catastrophic. And that can lead to fractures, and those fractures are serious risks to independence. So muscle and bone are the two things that I spend on lots of time helping people with. We also have changes to our joints. So everyone's heard of arthritis, which really is categorized by a progressive loss of cartilage in the joints. We used to think that everyone that had arthritis had pain. We now know that's not true. And many people have arthritis and no pain. And there's other people that have very mild arthritis, but lots of pain. So that's a complex relationship. But muscles, bones and joints, all of those things can change with age. However, if we know what we're doing, many of these things that we thought were inevitable are actually reversible. You can prevent them to an extent, and you can recover if you've had issues that have progressed over time to an extent. Now that brings us onto the lifestyle bucket. So we know from research that the older we get, we tend to move less.

[Tamsen]

Yes.

[Will Harlow]

It's not because we're lazy you know, energy levels change over time and sometimes people think they're doing enough because they're tending the garden, they're going out for walks and they think, well, surely that's enough to keep me healthy. But those things we spoke about there, that muscle, bone and joints, it's not enough to preserve them. Just doing your normal day to day life. So this is where I come in to try and show people what they can do in their lifestyle to improve those physiological things.

[Tamsen]

Do you see people change completely in terms of their, not just their body physically, but do you see a change in confidence? Do you see a change in motivation, in other things, in purpose? What do you see with all this?

[Will Harlow]

It's everything.

[Tamsen]

Yeah, I can imagine.

[Will Harlow]

So it often starts in the physical, but we see the gains in confidence happen so, so fast. And I like to say to people that if you're looking to actually improve your muscle mass, it's going to take you probably 12 to 16 weeks to see changes in the mirror.

[Tamsen]

So that's what we're talking about, 12

[Will Harlow]

to 16 weeks for muscle mass, okay. However, you can improve your strength in about two weeks because you can get a better connection between your brain and the nerves that lead up to the muscles very fast. That connection improves very quickly if you stick with it just for a couple of weeks. And with that, confidence comes back because people don't feel like they're going to fall, they feel more capable. They can get up and off the floor, they can get out of chairs without using their hands. And it really does unlock a new lease of life.

[Tamsen]

So we've got somebody listening right now and they go, okay, like a longer time, I know that's going to take, but in two weeks I'd love to, I'd love to have more strength. What do you have to start doing for that to happen? Because I know that, you know, when I was writing my book, I assumed that a lot of people were like, had gone to the gym, knew what to do in it. I put a little workout together and the woman that I was that was helping me with the book, she goes, I don't know what any of those exercises are. You can't put those out there and assume people are just gonna jump into the gym. And it really set me back for a minute. And I went, oh, we're all starting at this different place. So it can be intimidating, right, to be working out and starting something different. If there's someone listening right now and says, okay, I've got two weeks, tell me, well, what do I Do?

[Will Harlow]

Well, the first thing I'd say is it doesn't have to involve a gym. And I think this is the thing that puts people off because they think, well, I've got to go and join a gym. I've got to go and like pick up weights in front of those big guys that have been lifting for years. It's going to be super intimidating. I just won't do it. You can do the kind of training that I advocate from the comfort of your own home with stuff you've just got lying around.

[Tamsen]

And your YouTube channel.

[Will Harlow]

And my YouTube channel as well. So, yeah, all the exercises on my YouTube channel are done in a tiny little room inside our clinic. There's hardly any equipment and I do that on purpose to show people that you don't need a gym membership, don't need these expensive machines. They can help. If you like that environment, it's great. But you can do it all from home. And I like to get people started off in something I call resistance training. That's the term for it. But that doesn't mean they have to go and pick up anything heavy. Sometimes just starting with your body weight is enough. And the other thing I think that puts people off is the fact they think, well, it's okay for you. Well, maybe you can do five hours a week in the gym, but I don't have that much time. The research shows you can make considerable improvements with two 20 minute sessions per week if you choose the right exercises.

[Tamsen]

So you've saved, you've answered the two questions. I guess you got a lot of pushback, right? You're like, I don't want to join a gym and I don't have any time. And Will has changed.

[Will Harlow]

Let's see how many times I've had to overcome that.

[Tamsen]

You had to answer that so many times. But I love that. I think it's so important. I want to go through some of the different things that you recommend to people because I think that's really important, that we just kind of go a little granular with that.

[Will Harlow]

Yeah, yeah, definitely.

[Tamsen]

So if somebody has 20 minutes two times a week, what, what is the expectation that they would have of what they could do to actually start getting that strength back.

[Will Harlow]

Yeah. The most effective approach I've found is something I call the three, two, one method. Okay, okay. It's very easy to do and it's easy to remember. So the three part of it is you're going to pick three exercises. Now when we're choosing these exercises, we want to choose exercises that are Compound movements. And a compound movement is anything that works multiple muscles and multiple joints at the same time. So to give you some great examples, things like any kind of squatting movement, a sit to stand from a chair, any kind of lifting from the floor, any kind of pressing overhead, any kind of lying on your back and pressing, or a press up or a wall press up, all of these things are great compound moves. An example of something the opposite to a compound move would be one of those bicep curls. Because it's just one muscle, they're not a bad exercise, but they're not very time efficient.

[Tamsen]

If you have two hours, you can go do your.

[Will Harlow]

Exactly.

[Tamsen]

Bicep curls.

[Will Harlow]

Exactly. But we're talking about 20 minutes here, so we've got to be efficient. So three exercises, you're going to do it twice a week. That's where the two comes from. You can do the same exercises and then the one that reflects how you're going to progress in one variable each week that you do it. And by variable, I mean either adding an extra repetition or adding a tiny bit of resistance to what you were doing.

[Tamsen]

Oh, wow.

[Will Harlow]

Okay. So if on the first week you did 10 squats and you felt, do you know what? That was enough to give myself a bit of an achy quad muscle. Next week try and do 11 or try and do 10, but this time hold a couple of pounds into your chest.

[Tamsen]

Are you seeing remarkable changes from people that do some of these things that are relatively organized, small amount of time, they can simplify the exercises without needing to join a gym, hire a trainer, do all these other things? Do you see a big difference in how they walk out?

[Will Harlow]

100%. And what I would say is the most dramatic differences come from the people who were doing the least before. So people who were already doing quite a lot, the differences are more subtle and you can still make progress, but the most dramatic changes come from the people who are starting from the worst positions.

[Tamsen]

So we're saying there's never too late. We use that word a lot. But let's talk about what that means. Are you seeing people that are 75 and 80 years old get into working out or strength training or grip strength for the first time and changing their lives remarkably?

[Will Harlow]

Yeah, not just 75 or 80 90s, we've got people in their 90s who make progress. And I mean, I can give you all the stories in the world from the clinic, but there was a wonderful paper that came out the other day that just proves this point brilliantly. So this research paper took A group of nursing home residents who are all over the age of 90. Okay. They put them through an eight week resistance training program which was really just those two 20 minute sessions each week and they were supervised by a physical trainer. Now in that eight week period, the average resident increased their leg strength by 175% in eight weeks. And these people were in their 90s.

[Tamsen]

And that helps because we're talking about balance, we're talking about not falling, we're talking about trying to prevent so many different things. Right.

[Will Harlow]

And can you imagine the difference to someone's life that more than doubling their leg strength would be if they start off hardly being able to get out of a chair? Suddenly they can get out of the chair without assistance. They can walk down the hall without being worried they're going to fall where they had to hold on to someone before. Like, we're talking life changing differences.

[Tamsen]

Yes.

[Will Harlow]

So we're not just talking about, oh, they're going to look a bit better in the mirror. We're talking about actual functional changes that matter for real life.

[Tamsen]

I'm so glad you made that decision so many years ago. That's really incredible to have the foresight to see that. I mean, most people don't do a career change until, you know, I did it mine at 50, you know, 52 years old. So kudos to you for that.

[Will Harlow]

Thank you. I appreciate that.

[Tamsen]

Oh, gosh, I love this time of year. There is something about this time of year where I just want to move, I want to walk, I want to get outside, I want to just get in motion. Long walks, workouts, being outside again, it makes me rethink the basics I'm wearing every day. I've been getting back into my lifting workouts and bomba sports socks have been such a game changer. They're cushioned where you need them, they're, they stay in place. And I'm not distracted by like adjusting everything all the time. I can just focus on moving. And you know, I love my morning walks. And you know what happens when I put my boots back in the closet. Then I'm all about comfortable footwear. Bombas has warm weather footwear and it's back in rotation. It's lightweight, supportive and perfect for travel days or for just running out the door. Especially when it comes to their sandals. Even their basic stuff has surprised me overall. The tees, the underwear, they're soft, they're breathable and, and they just feel like an upgrade from what I was wearing before. This is also a part that really matters. To me, for every item you purchase, an essential clothing item is donated to someone facing housing insecurity. One purchased, one donated. With over 150 million donations and counting, that is pretty amazing to me. Head over to bombas.com tamsen and use code TAMSEN for 20% off your first purchase. That's B O m b a s.com/tamsen. Code Tamsen at checkout. Summer's almost here, and I want to be thinking about where I'm going, what I'm packing, who I'm spending time with, not lying awake at night wondering, can I afford this trip? That's why I've been getting more organized with my money now, so I can enjoy Summer knowing it's handled. Monarch Core is the personal finance app. It tracks everything. I check it every day. Accounts, investments, saving goals, and spending. Get your first year of Monarch for half off just $50 with promo code Tamsen. Monarch monitors your money so you don't have to. I love seeing cash flow clearly because sometimes you don't realize how much lifestyle spending has crept up. It's so easy to spend, but then it's right there in front of you. It's like having a financial advisor in your pocket. You can ask the AI assistant, can I afford this vacation without touching my savings? And get real clarity before you book. Use code [e-mail] to get your first year of Monarch Care half off at just $50. That's 50% off your first [e-mail] with code TAMSEN. Something I thought that was really interesting in what I saw that you talk about is reoccurring injuries. And I want to talk a little bit about that because I have had one myself, and so I know that. I know when it's happening, it's getting ready to happen. Do you see that a lot in people over 50? And a reoccurring injury where it doesn't seem to get better and progressively goes back to the same injury over and over with what somebody's having?

[Will Harlow]

Yes, all the time.

[Tamsen]

What is that? Why does that happen? Is it because you've not gotten better?

[Will Harlow]

Yeah. I have a theory about this, and it's actually something I laid out in the book. So most of the problems we see in my clinic I would categorize as mechanical. So they're not necessarily due to changes to the tissues in the joint. They're due to funny forces acting on that joint. So the muscles around it are not protecting it or something's too tight or something's got very stiff. And when we Fix those mechanical problems, the pain usually gets better. So that's the theory of. Or the thesis behind all of the treatment we do in the clinic. Now, the problem is when people have recurrent injuries, what tends to happen is they start fixing the mechanical problem, it gets better to the point where the pain goes away, and then they stop treating it 100%, which maybe you've gone through yourself.

[Tamsen]

Yes, I feel like you're talking to me directly, but. Yes, but I thought. I'm thinking of it as you're talking about that.

[Will Harlow]

But pain is actually a very poor indicator of how healthy your joint is. And that's a really important thing for people to wrap their heads around. So we can have problems in a joint with no pain, and we can have a joint which has a. A lot of pain, which has just not fully healed, if that makes sense. So if we give up on treating those mechanical problems too early, what happens is the pain might have gone away, but before long, those mechanical problems will rear their ugly head, and then the pain comes back. So people end up in this cycle.

[Tamsen]

So what do you do, though? If the pain has gone away, how much longer do you treat that like? You know, I'm always excited when I can stop treating something because I think, wow, look what I beat the system.

[Will Harlow]

Yeah, absolutely. And I think that's different for everyone. This is why it's so important sometimes to have someone in your corner who is experienced in assessing these things. And sometimes it's not just the joint itself that's a problem. It's the areas above and below it. So I was speaking to a guy yesterday, and he was saying that he started off with some funny foot pain, then it worked his way up to his ankle, then his knee, then his hip, then his back. And there was nothing wrong with his ankle, his knee, his hip, or his back. It was just because the mechanics had changed because of his funny foot.

[Tamsen]

Wow.

[Will Harlow]

And he had pain all up here. But when he treated the foot, then all of these other problems got better as well. But if he gives up too early on that foot, then those problems tend to come back because that mechanic, that mechanical problem has never fully resolved.

[Tamsen]

Well, it was funny because I knew you were coming this week, and I read that. And then, I don't know, like two Thanksgivings ago, I hurt my back. I had frozen shoulder, which I'm sure that you hear a lot about.

[Will Harlow]

It's rough.

[Tamsen]

It's rough. It's no joke. And I'd love to hear your thoughts about that, because I know a lot of Women that I talk to are dealing with that. But I couldn't. I was doing a. I was squatting and I had my hands on one part of the barbell, and I was like, you know what? I'm okay. I can hold it with my shoulder. And I wound up crunching my back because I lost control of the weight and hurt my back. And it has come back, I don't know, once a year, twice a year for the last two years. And so it was funny, like, it started hurting again this week. And I went, will's coming, so he's going to come with all the answers. But the answer really, that it's a reoccurring pain that didn't get really properly treated is really the answer.

[Will Harlow]

Yeah. Just because the pain's gone doesn't mean it's fixed. And this is a really important message to understand. And if you give up on fixing those mechanical problems too early, then that does leave the environment such so that the pain is likely to come back. This is why people are like, I keep getting this recurrent injury. The injury itself is probably there the whole time. It's just the pain comes and goes. So don't give up too soon. I usually say, as a golden rule, you want to keep working on those exercises probably eight weeks after the pain has disappeared to fully fix it.

[Tamsen]

That's a good. That's good just to have a timeline. So let's go back to frozen shoulder for a bit. Are you seeing more people aware of that term, I guess, coming in and saying, like, look, I don't know what's going on. I'm in menopause. I'm in perimenopause, I'm in post. I just. I don't know what I'm in, but I'm pretty miserable all the time.

[Will Harlow]

And first of all, I'm so sorry to hear you've gone through it, because I've seen how much people suffer with it. It really is one of the most painful conditions. And it's also quite a mysterious condition as well, because it isn't an injury per se. You haven't strained anything. You haven't lifted weights too heavy and hurt your shoulder. It comes out of the blue. And we know it can be triggered by changes in hormone levels, which is why it's so common in women in those postmenopausal years. Okay. We see it constantly now, what's usually happening. It's ironic that it's called a frozen shoulder, because actually it's a very inflamed shoulder. So if we were to scan it, it would look red. It would look. And basically what's happening there is you're getting an ingrowth of all of the blood vessels and the nerves to make it super sensitive. That's why it's so painful. The capsule, which is like the ligaments around it, they constrict and they tighten, which is why some people can't even lift their arm away from their side. And then it can stay like that for a very long time. And we've had patients that have had a fully frozen shoulder for as long as two years.

[Tamsen]

Wow.

[Will Harlow]

Yeah. And it really can last. Now, the good news about frozen shoulder is it basically always gets better. Eventually you just have to wait it out. But when I say wait it out, I don't just mean rest it. We want to try and keep it moving. Now, the thing to understand about frozen shoulder is just because there's lots of pain there when you move it doesn't mean you're damaging it further. In fact, it needs that movement to heal faster. And the people that guard it for a long, long time, they end up suffering for longer than the people that really try and get it moving.

[Tamsen]

It's ironic, though, because I did do that for a long time, which guard it and, like, I'll just keep it and let it rest. And that was the worst thing I could have done until, you know, I really was taught to, like, you got to get in there. I want to have to get a shot for it, which I know is not ideal.

[Will Harlow]

Sometimes they are really good, though, because they can just bring that inflammation down.

[Tamsen]

If you have somebody that's listening that. That's dealing with that right now, do you recommend PT for that or what? Do you recommend start getting it moving, at least in some way?

[Will Harlow]

100% physiotherapy. PT would. Would be a great place to start.

[Tamsen]

Okay.

[Will Harlow]

Now, the frozen shoulder tends to go through three phases. So we have what we call the freez stage, which is when it first starts, and that's usually the most painful stage. That's where it's agony to move it, and it's just starting to get stiffer over time. The second stage is the frozen stage, and this tends to be the stage where it's the stiffest. But the pain is usually not quite as bad. Okay. People have sort of learned to work around it. And then we have the defrosting stage, which is where it starts to get mobile again. And then you end up with your normal shoulder at the end of it. Now, the research is a Bit iffy on whether physio actually speeds it up. Now, from personal experience, it's impossible to say how long that person would have suffered if you hadn't intervened. But I think that when we start treating someone, we do tend to see that trajectory go much faster. So they improve quicker than I think they would have done otherwise. So it's certainly worth getting someone to have a look at it who's experienced in these things. But just some gentle movements anytime you can, that will help to loosen it up over time if you're really suffering and you can't sleep, because sleep can be a huge problem with this condition. For those people, sometimes getting a cortisone injection can be a good shout. But of course, it's a very individual decision.

[Tamsen]

Yeah, I didn't want to do it. I fought it. And then I was like, I can't anymore. I couldn't do anything. I was just, you know, I was the girl on the airplane. Like, can someone help me? So let me ask you this question. How do I become a woman strong hiking at 75. You know, the one that's lifting my suitcase on and off the plane? What do I need to know now that I might not know?

[Will Harlow]

Yeah. So in my eyes, you need four things to be able to do those activities for as long as you want. Okay. And I call these things the four pillars of independence. So the first one is mobility. And mobility just describes how well you can move your joints. We need to be able to move our joints through a full range of motion for us to be comfortable and to move well. The second is strength. We've touched on strength already. Strength is just how well you can move your body against resistance, but it's also how much muscle mass you have on your body, too. And that's very important just for your general health. We now know that muscle is your longevity organ. The more muscle you have on your body, the longer you live. It's as simple as that. The third thing you need is balance. So you need to be able to stay on your feet, not just because you want to avoid a fall, although, of course, that is something we want to avoid. But if you don't have balance, then you lack confidence. And we see people's world shrink very fast when they lose confidence in their ability to stay on their feet. They tend to stop going out the house. They tend to stop engaging with friends socially because they're worried that they'll be on uneven ground. So they just end up becoming quite isolated. So balance is vital. And then the fourth thing is you need skeletal health, so you need the health of your bones and the health of your joints. So we want to try and avoid osteoporosis, and we want to try and manage any symptoms of arthritis as well. And if you can tick all four of those boxes, it's like having a very sturdy table with four legs. If you lose one of those legs, the table's wobbly at best. If you lose two, the table's not standing anymore. Okay, so those four things are vital.

[Tamsen]

Has your goal in all this been to help people stay not just mobile, but very independent in their homes, in their environment, in their community? As you've gotten into longer, has your goal changed or has how you look at this change?

[Will Harlow]

Yes and no. So the mission has stayed the same throughout. It's to give people over 50 who've been traditionally let down by the healthcare system all the tools they need to stay independent for life. Because I don't know about you, Tamsen, but I massively value being able to do what I want, when I want, with who I want, for as long as I want.

[Tamsen]

I think we share that.

[Will Harlow]

And I hate the idea of having to rely on someone else to help me do various things. And I know that's one of the biggest motivators for the people that come and see me. They just hate the idea of having to depend on their family, not just because it affects their life, but it affects their family's lives as well. They don't want to become a burden. I hear this all the time. I get patients who come in and they go, my biggest fear is becoming a burden. And in. In some respects, it's such a, you know, a valiant thing to say because they're still putting other people before them, but it's heartbreaking to see that slip from people. So really, that's the motivation. Now, I don't like the idea of people needing these complex treatments and to be attached to a physiotherapist or a chiropractor for years and years and years to get this help. Because I know from helping people that most of the value I give them is what they do at home.

[Tamsen]

Yes.

[Will Harlow]

So if I can give people these tools, then. And, you know, it's low to no cost for them. It is sustainable and it's effective.

[Tamsen]

So when you brought all this online and decided to really, you know, I mean, your channel, I look at the comments, I see you're changing lives all over the world. What did you decide to do? Did you decide just make it accessible for people?

[Will Harlow]

Yeah. Definitely. So as time's gone on, I've had more of a focus on really simplifying concepts for people. Good, because I feel like the online health space has become overly complex and I get people coming to me all the time being like, I've been told this diet is going to kill me, but I've been following it for years. I've told I should do 100 jumps a day. Now this person's telling me I should never jump. Like, I'm completely overwhelmed. So my goal is to try and cut through all the noise and really simplify it for people and really give people a choice of like, if you just want to do the bare minimum for your health, this is what you need to do. If you want to go all in and really maximize your health, here's another path. And I feel like YouTube was the best place for me to do that.

[Tamsen]

I think it's been exceptional. When you look at a real week right in life, I'm a 55 year old woman. Aside from my back pain this week, I like to work out. I enjoy it sometimes. I'm not always motivated. But what does a real week look like? If you are saying, I want to work on all of those things, I want to make sure that I'm thinking about balance. Because truthfully, if someone told me about balance 25, I'd be like, man, I don't know, I'm fine. You know, mobility, I didn't even know what the word meant. What does a real week look like?

[Will Harlow]

Yeah, and I think balance is one of those funny things where we take it for granted until it's gone.

[Tamsen]

Absolutely we do.

[Will Harlow]

But the earlier you start working on it, the longer you'll keep it for. Now, in terms of what an actual perfect week looks like, it's probably less than most people think. Like when I talk about these four pillars, people are like, that's fine, Will, but I don't want a full time job. You know, I'm retired now. I've left those days behind. But I promise you, just 20 to 30 minutes a day is enough to cover all these bases. So I like to break it down into the four pillars. So with mobility, what I tell people to do is everyone's got a sticky area or a problem area for you right now it's going to be your back. As you've said, it's been sore. So 10 minutes a day focus on gentle mobility exercises. Just for that one area. That would be where I'd start. You personally came to me with back pain. Now we also Want strength. That's our second pillar. So that's where the three, two, one approach comes in. So that's 20 minutes twice a week, three exercises to build strength. Okay. Ideally, we can cover as many muscles as possible there for balance. I like something called exercise snacks. Now, these are super effective for balance. And research shows that people who do these short bursts of exercise little and often. They often outperform people in balance who go to these long, hour long classes. And it's much easier to do. You can fit it into your day anytime.

[Tamsen]

Can we do some of them after this?

[Will Harlow]

Yeah, let's do it.

[Tamsen]

Okay. Okay, let's do that.

[Will Harlow]

So these exercise snacks, this short burst of exercise, and you do them in otherwise dead time. So time like where you're brushing your teeth or you're waiting for the kettle to boil, or you're on the phone on hold to the bank, these are the perfect times to do little things like stand on one leg or try and pretend you've got a tightrope and you're walking the tightrope at home. Really narrow. That works super well. And over time, that improves balance massively.

[Tamsen]

Okay, we're doing some of these.

[Will Harlow]

Love it. And then the fourth thing is skeletal health. And this one is optional, but for women, I would say it's near enough essential. And for this, resistance training covers one of your bases. So if you wanted to skip this, if you're already doing your resistance work, you can. But for many people, impact training can really help. So jumping is obviously the extreme version, but I like to start people off with something called heel drops. Going up onto tiptoes and then just dropping the heels back down to the floor nice and briskly.

[Tamsen]

Is that an impact?

[Will Harlow]

Yeah. It sends a shockwave up through the legs into the hip, and that stimulates bone growth in that neck of the femur where the fractures happen.

[Tamsen]

I love how you make it so achievable. It feels good.

[Will Harlow]

Yeah.

[Tamsen]

It feels not overwhelming when I talk to you.

[Will Harlow]

Sure.

[Tamsen]

Okay. I have some questions. Because we asked people to send in questions. We've been collecting these all week long. Do you mind if I read some of them?

[Will Harlow]

Let's go.

[Tamsen]

All right. I think if you can give us kind of like the why, maybe a practical takeaway if there's something in there for it. All right. I wake up every morning feeling like I've aged 10, 10 years overnight. I'm stiff, I'm achy. I can barely move for the first hour or so. Is it just aging?

[Will Harlow]

No. And if someone came to me and they said that my first question to them would be, when was your last blood test? Because that can be the sign of something rheumatological, especially if it's lasting for an hour or longer. If they've been cleared for their gp, then the next thing I'd look at is what's actually happening at night. You have really poor sleep quality. Are you waking up a lot of times the night? Is it just because you're absolutely wiped, because you're not getting good quality? That would be where I would begin. And then if you're sleeping well, but you're still getting these symptoms, then I'd look at what was happening the day before. Are we doing anything that's triggering it? When people have got these overall body aches and stiffness and they feel like they can't move for an hour, there can be lots of things causing that. But that usually indicates to me that it's something systemic. Could be like some kind of allergy to a food they're eating or something else like that. But, no, I would say it's not just normal aging, and no one should expect to feel like that in the mornings.

[Tamsen]

I was just gonna say. And that's the question that you. That's the answer you hated hearing, right? Was it's just aging. From a doctor. My doctor says my knee pain is just wear and tear and I might need surgery eventually. Is that really my only option? That's interesting.

[Will Harlow]

This is a question I get probably every single day.

[Tamsen]

I can imagine.

[Will Harlow]

Yeah. So what I would say is, when I treat people with knee pain, about 80% of the cases of knee pain I see, I categorize as mechanical. So they're made worse because you've got weak muscles around them. The hips aren't doing their job. Something's become stiff or the muscles around them are very tight. And once you fix Those mechanical issues, nine times out of 10, the knee pain improves, sometimes disappears. So it's lazy medical work to say that it's just wear and tear without having checked all these other things. Perhaps the doctor's not the right person to do that. But the next port of call should certainly be a physical therapist, not the surgeon.

[Tamsen]

Not just run into surgery, please, No. I cannot get up from the floor without grabbing onto something. My kid pointed this out. Is it really a big deal?

[Will Harlow]

It's a huge deal because one of the biggest risks for people is not just falls, but what happens after a fall. Okay. And I've had many patients who've come to me who fell over at home they weren't injured, thank God, but they couldn't get up and they ended up on the floor for 20 hours, sometimes a whole day, until a family member came round and found them. And the damage from staying in that one position on the floor unable to move far outweighed the damage from the fall itself. So not being able to get up from the floor is massive and we need to address that without your hands. Right, well, if you can use your hands, then you're safer than people who can't get up at all. Yes, but ideally it would be good to be able to do it without your hands. Now, what I would say is you've got to start from where you are. And typically it's a combination of stiffness in the hips or knees or weakness in the quads or glutes that stops people from getting up. So we can often narrow it down as to what actually is the limiting factor that's stopping you from being able to get up from the floor. Once we find that, we can either strengthen it or we can loosen up those joints that were stiff.

[Tamsen]

Okay. Okay, good. I mean, I think that's a big one. It's funny, my dad's 86 and he can get up and down and I'm like, amazing. Oh my gosh, I hope I can do that at his age.

[Will Harlow]

You should keep practicing that. Like I tell my older patients, just do it once a day, really, just for the sake of it, Just if

[Tamsen]

you can, because it's so much easier,

[Will Harlow]

just so you know you can do it.

[Tamsen]

So a new season always makes me want to reset things, like a few routines. And lately I've been paying more attention to things that make me feel like myself again, especially hair and skin. And I'm so excited to share Irestore with you. I've been using Irestore at home and what I like about it is it's easy to use. It fits into my real routine. I don't have to like carve out this whole spa day for it. You can use Irestore Elite while you're working, while you're reading, while you're answering emails, or just winding down at night. And the Illumina face mask takes 10 minutes a few times a week. I'm telling you, I have seen a difference. The Irestore Elite is designed to support thicker, healthier looking hair, which is something so many of us start thinking about when we notice shedding, thinning changes in our hair. This uses advanced red light therapy with lasers and LEDs to support hair growth from home I've recommended it to a lot of people. And the Aluma face mask is lightweight, cordless, easy to use, easy to carry around. It uses red, infrared and blue light together to target the fine lines, dullness, breakouts, skin, health overall. And I like that. It's just, just so darn simple. Irisore is offering some huge discounts on the red light therapy devices right now. You can save on customer favorites like the Irestore elite helmet and the Illumina face mask. Just head over to irestore.com use code TAMSEN that's [e-mail] please support our show and tell you the Tamsen show sent you. Give your hair and your skin the upgrade they deserve so you can feel confident and refreshed. Let's talk a little bit about what spring means. Spring means more photos, more events, more moments where your glasses are front and center. Yeah, I realize I've been wearing the same frames for way too long. Warby Parker completely changed how I think about buying glasses. The virtual try on. Oh my gosh, it's so easy. It lets you see exactly how frames look on your face from your phone. And it actually works, which is more than I can say for every brand that has tried it. I got my current pair before Ira and I went away. And the compliments haven't stopped. Prescription glasses starting at $95. Contacts, sunglasses, online eye exams, over 300 stores nationwide. Quality and price. It's not even close. It is a perfect time to upgrade your glasses for spring. Buy one prescription pair and get 20% off any additional prescription pairs at warbyparker.com Tamsen that's 20% off additional prescription pairs when you go to w a r-byparker.com TamsEN this is a good one. And actually I did a. I actually did a video about this a little bit, but it comes from. From Renee. Is walking actually a real workout or are we just telling ourselves that?

[Will Harlow]

Great question.

[Tamsen]

Yeah. Right?

[Will Harlow]

Yeah. Now, walking is not enough to maintain or build muscle, and it's not enough to rebuild bone.

[Tamsen]

Okay.

[Will Harlow]

However, it's fantastic for your health. It helps to maintain bone. It helps to maintain the health of your joints to a certain extent. It helps to preserve some of the strength and muscle mass. So do not discount it. It's also fabulous metabolic exercise as well. People that walk more, they just tend to have less body fat. They're more metabolically healthy, they have better blood sugar control. It's a brilliant form of exercise. So it should be walking and resistance training, not either or it's funny, I

[Tamsen]

think I grew up at a time where people were saying that walking is an exercise, but I always enjoyed it so much. But I think it's for my mind more than my family.

[Will Harlow]

Yeah, your brain is amazing. For the mind, I think, keeps you. Actually, there's some evidence to show it keeps the brain healthy as well. So people that walk more, they just have less. All cause mortality from any reason. They have less dementia, they have less depression and anxiety. Fantastic form of exercise. But for the things we're talking about today, on its own, it's just not enough.

[Tamsen]

Well, and you're here in New York now for a little while, so you just. You can walk as much as you want. It's like. It's the perfect city.

[Dr. Kathleen Jordan]

Yeah.

[Tamsen]

I fell last year playing pickleball, and it scared the hell out of me. I'm 54. How do I make sure that doesn't happen again? I feel like pickleball injuries are all over the place. Huh?

[Will Harlow]

Yeah. It's because the rise of pickleball has been crazy, hasn't.

[Tamsen]

I know. Especially in this age group. I think.

[Will Harlow]

I think it's fantastic. It's such an accessible sport. And I've got friends that have got into it and love it. I've also got patients who are in their 70s and 80s who've started playing it and love it as well. So I think it's just great for all ages. The question was about a fall, Wasn't they fell. Now, sometimes falls do happen, especially if you're playing sports. You know, it is slightly more risky environment. My first question to that person would be, what caused the fall? Did your knee give way? Did your hip give way? Did your legs just feel weak at some point and you just couldn't keep yourself on your feet? Or did you trip? Because all of those things have a different cause to address. Now, if we don't have the answer to it, then my general first place to start would be to build some strength back into those legs. And the two muscle groups I focus on with the quads, which are the muscles that live above the knee, and actually the calves, which live just below the knee at the back here. And research has shown that stronger muscles here and in the calves, they prevent falls in older people.

[Tamsen]

So go back to those four pillars.

[Will Harlow]

Four pillars again. So strength is basically the one that underlays all the other one. It's the most important one. If we had to pick one. And that helps people, particularly sports people, to stay on their feet when they get older.

[Tamsen]

One thing somebody could do tomorrow. No matter where they are in the process, whether they work out all the time or they're saying like, well, I'll do one thing because I feel guilty after I listen to this podcast and I feel like I should do something.

[Will Harlow]

Well, I never want people to feel guilty, but if you can only do one thing, I'll give you an easy one.

[Dr. Kathleen Jordan]

All right?

[Will Harlow]

All right. Adopt exercise snacks. Most people think of exercise snacks as just for balance, but you can do them for any attribute at all. So if you know that you've got a stiff knee every time you've got some dead time, just practice bending that knee 10 times. If you know you've got weak quads, just do 10 mini squats every time you get a few minutes. If you know you've got bad balance, Practice standing on one leg for 30 seconds every time you get time. And just those tiny little and often bursts of exercise compound over time. And they do make a massive difference. And we usually see people reporting back that they feel significantly better in about six weeks of doing this. So it happens quite quick.

[Tamsen]

I like that. Six weeks is good. Six weeks is doable.

[Will Harlow]

I think we can just about stick to it for six.

[Tamsen]

Well, where can people find you?

[Will Harlow]

So my new book, Independence for Life, is out in all major booksellers. Willharlow.com is almost like my hub that you can see everything else that we do. And then of course, YouTube is where most of my content goes. So just search Will Hollow and it'll come up.

[Tamsen]

Such a pleasure. Thank you.

[Will Harlow]

Thank you, Tamsen.

[Tamsen]

Dr. Kathleen Jordan, nice to see you.

[Dr. Kathleen Jordan]

So nice to be here. Thanks for having me.

[Tamsen]

Yeah, so it's been busy. So first of all, I want to talk about something a little timely right now that you and I have been a part of. We just came from a meeting with the FDA to talk about the estrogen patch shortage or unavailability for women. Hearing about this for the first time. What's happening, first of all, and why does it matter? Because I know this is so critical.

[Dr. Kathleen Jordan]

Well, we're finally getting women the care they need, and more women are having conversations and talking to clinicians about hormone patches. So more women are then presenting to pharmacies with prescriptions, and pharmacies are running out, and I think there's a bunch of things contributing. Right. So we just have more evidence that it helps more than just hot flashes. So that brings more women to the table. And then we now have evidence that you benefit from it longer. So people can start in perimenopause and they can take it well into their 70s and 80s, which is not how we used to do it. So we have more women with access to care, with companies like MIDI that take insurance. Right. So you have more women with access to care, more clinical indications. You start it earlier, you end it later. So this is a lot more women coming to pharmacies with prescriptions. And manufacturers have not kept up well.

[Tamsen]

So let me ask you this. Do you think they're just shocked by it? Do you think they're just surprised? Or do you, do you think we really moved a needle quickly?

[Dr. Kathleen Jordan]

Well, it was interesting when we talked to the fda, I thought one of their interesting comments was that typically a drug shortage is caused by some kind of manufacturing problem, like a tornado hits a manufacturing plant or you have a new drug that has pent up demand, but it's not very often that you have an old, tried and true generic drug that suddenly has this increase in demand. So I think we don't have a system that was set up for this. And I also, in talking, we've had other private conversations with manufacturers. I think they initially thought it was a blip or a fad and that there was just a bump from the FDA removing the black box label warning. But when we talked to them, we're like, no, these are, you know, the indication to take hormones longer. That changed in 2016. Right. And demand has been increasing now for many years. The black box label warning removal has helped because it stopped all the confusion to the consumer because they had experts telling him that it was safe and good for them. And then this black box label, which really wasn't relevant to the current formulations.

[Tamsen]

So talk about why in 2016 also that they had that indication that, that it could be long longer. What happened then?

[Dr. Kathleen Jordan]

Well, it's just more evolving evidence. Right. We didn't have a lot of studies in the prior decades that really said how long people could use it. Right. So we have, we have a lot of bone health studies that show that in when you enter actually now, it's late perimenopause and then early menopause, your bone loss accelerates and you lose almost 2% per year in those early years of your bone density. And then if you take hormone therapy that markedly slows down, you can even actually regain some bone mass. But if you stop the therapy, you kind of lose those gains. Right. And we know that women have fractures. 50% of women are going to have an osteopenia or osteoporosis related fracture. So that is a benefit that we probably know the most about, that's ongoing. But there's a lot of exciting stuff going on in cardiovascular health. And cardiovascular disease is what kills women. Right. So the mounting evidence around just vascular pliability, which means relaxed blood vessels around lipids. Right. We know, and we've known actually since the big trial around 2000, that estrogen impacts our cholesterol, it impacts our insulin sensitivity, it impacts our muscles and bones. Right. So those are effects that really benefit us as we age. So plus, I would say women feel better on it, so they don't want to stop. So we used to tell women actively to stop, and we now know that that was not the best advice because these benefits.

[Tamsen]

What was the amount of time between the.

[Dr. Kathleen Jordan]

What.

[Tamsen]

What was the number of years women were on hormone therapy then versus where we could be now? Was it 20 years back then or 10 years and now it could be decades.

[Dr. Kathleen Jordan]

Yeah. So it's funny, when I trained in the in, I won't even tell when was it you train? Over a bunch of decades. But, you know, over 25 years ago, we were told to put people, women on hormone therapy because it was good for their health, which is kind of what's happening now. And then there was a trial that sort of knocked everyone off that train, but we were reaching 30, 40% of women being on hormone therapy and loving it. It. And then there was a WHI trial that it had one of the arms, one of the six arms had eight more cases of breast cancer, which caused everyone to pause and take a look. We now know that with current formulation. So we used a synthetic progesterone back then that we don't use now. And we now know from national health data, we have European countries publish data that look at women on hormone therapy. Do all the women on hormone therapy in France, the uk, Denmark, did they have more breast cancer?

[Tamsen]

Cancer?

[Dr. Kathleen Jordan]

They don't really. So we now understand that we sort of overreacted, but we had 30 to 40% on hormone therapy at that time.

[Tamsen]

Yeah, it's re. It's incredible. So. So real fast to just wrap this part up because I want to get into testosterone for one currently on the patch and cannot find it at her pharmacy. What should she do?

[Dr. Kathleen Jordan]

Okay, so talk to the pharmacist because they do have some leeway in changing brands. If you're getting a specific brand brand prescription, you can also find out what they have in stock. So there can be instead of twice weekly patches, sometimes they have once weekly patches. They can sometimes put together two lower dose patches. Right. So find out what they have in stock and then I know at MIDI we can call in a new prescription to get those covered. In addition, now they're starting to run out of those because the patch shortage is getting a little bit broader and impacting even those secondary patches. So sometimes you can change formulations, you can do a gel, you can do a cream, there's a vaginal ring that emits estrogen, or you can do compounded if all else fails and you need a unique formulation.

[Tamsen]

And then with the fda, how long do we think it's going to take to fix this or manufacturing? Do we have any idea what we're looking at right now? I know that we didn't get it. You know, they've got to review everything. But do we know how, how long we're talking about or it's still kind of open ended. Right?

[Dr. Kathleen Jordan]

Well, I was, I was heartened by the FDA that they actually KN about the issue and had already been talking to manufacturers. But they did comment that we are going to be playing catch up for a while. Right. And then when we've talked independently to manufacturers, they have said that it takes a year after they decide to increase manufacturing, it takes a year to get a new manufacturing line up and running. So what they're doing in the meantime is they're sort of improving importing, you know, sort of moving what they have around. But it is going to take a while to ramp up manufacturing and we don't actually have commitments or transparency into how much they're wrapping up and if they're ramping up enough. So I think we're in this for a little bit at minimum, potentially much longer.

[Tamsen]

So let's talk about testosterone because that's the real reason we're here. But I needed to get the FDA timeliness in there. I think it's one of the most misunderstood hormones in this conversation right now. So when it drops and I went to the doctor and they said to me, like, you don't have any testosterone, so whatever that means. I had none at one point. What does that feel like for women when testosterone drops?

[Dr. Kathleen Jordan]

So all everyone's testosterone drops, men and women. So from the time we're around 30, maybe a little bit earlier for women, you're slowly decreasing your testosterone over your lifetime. So I would expect anyone over 40 to have, have markedly decreased testosterone than what they had in their 20s. That's true for men and women. So it doesn't parallel perimenopause and menopause exactly where you get dramatic drops. So typical Menopausal hormone therapy is going to be estrogen and progesterone because those sort of drop more precipitously. Testosterone's on its own sort of declining over time. But you do sort of many women hit critical levels also in perimenopause, menopause. So that's one. The other thing that's interesting is that for women is the lab values don't tell you if you're going to have symptoms. There's some women with low levels that don't have symptoms. There's some women with sort of modest, modestly decreased. They're definitely decreased from when they were 20 and they have a lot of symptoms. So the lab value isn't going to tell you whether you're going to benefit from testosterone therapy. Your symptoms are going to tell you if you're going to benefit from testosterone therapy.

[Tamsen]

Mood, energy, fatigue. What would be some of those symptoms?

[Dr. Kathleen Jordan]

Well, and ironically. Right. The greatest studied symptom is libido, both for symptom as well as impact from taking exogenous testosterone or extra testosterone. So libido for sure, arousal, fatigue, people are coming in with weakness or sort of vague symptoms of brain fog. And unfortunately it's not studied that well in women. It's much more studied in men and some of it translates over, but some of it's different in women. But definitely we see women coming with decreased libido, fatigue, weakness, brain fog and they're wanting to try it for all these reasons. But what I tell them is the most studied for taking extra testosterone is libido. So you most experts will agree that there's enough studies, robust placebo controlled, that it can improve libido for women. And these other indications are less studied in women. Right.

[Tamsen]

Well, and so there's also no FDA approved testosterone products for women in the US So can you sum up what that means practically a woman who says like, look, I want to, I want to take testosterone, there's safe places, there are safe sources for that. What, what should they do?

[Dr. Kathleen Jordan]

There's definitely safe sources. Unfortunately, the biggest problem with being no. Having no FDA approved formulation for testosterone is that it's not on any insurance formularies. So it's not covered by insurance. You know, when we order estrogen, progesterone, it's largely covered by insurance. You get it from your local pharmacy, it's super easy. But because there is no formulation for women, there's two issues. One, they have to pay cash for it. Now you can get your visit covered. It may. Right. But you still have to Pay cash for the fill on the prescription. You can use hsa, fsa, but that makes a financial barrier for many women to not be able to access it. One but the second thing is to really do it right for women, they need about one tenth of what the men get, right? That's really hard. So you can't really buy the men's formulation. And then people have tried like you cut these little things into 10 pieces or you, you trying, you try and sparse out a little packet. Think about like a little packet of ketchup and trying to measure it into tenths, except it's smaller than that, right? So it's difficult. So really the best way to treat women is to get these compounded formulations. And those are not your local pharmacies. So there's mail order ones, there are ones in major metropolitan areas. So we work with compounding pharmacies and send in for a compounded formulation that's easy to apply and you can get it. And you know, we find there's different types of compounding pharmacies and they go through different sets of rigor. So we use highly vetted, accredited, certified pharmacies that you can definitely get reliable sources. It's just a little bit expensive and it might be a little bit less convenient because you can't get it from your local pharmacy and it's not covered by insurance.

[Tamsen]

What do you recommend as a starting point for delivery options? I know that a lot of women talk about pellets and then there are creams and there are gels. What do you suggest?

[Dr. Kathleen Jordan]

Well, I mean, if I'm going to start a drug, I probably am not going to go to a pellet. I mean, a pellet means you put something inside your body, you go through a procedure, and then once it's in, it's in. There is no getting it out. So you have the delivery of testosterone going on for months. So if you have a side effect, you're stuck with it. Right? So generally it's also a procedure and it's, it's many hundreds of dollars, right, to get it. So I think the best way and the most accessible way is really just to start with applying a daily topical cream or gel.

[Tamsen]

And then what about women who have been told they can't take hormones? Is testosterone off the table?

[Dr. Kathleen Jordan]

So we proceed with caution there because one thing I think you may not realize, or women don't realize, is that some testosterone converts over to estrogen. So if you have a contraindication and you're trying to avoid estrogen, you're going to get a small percentage of testosterone that turns into estrogen. So typically we'll look for other ways to get to your clinical needs. So if arousal is your issue, there's other things you can do. If libido is your issue, there's other FDA approved indications. Right. So I think I would check in with the specialist and really talk about. And you can do that at midi, talk about what your health goal is and see if there's other more studied and slightly safer ways to get there.

[Tamsen]

All right, one more question, I promise and I'll let you go. If a woman is symptomatic right now and doesn't know where to start, what's the most important thing she can do today after she listens to you say it?

[Dr. Kathleen Jordan]

Okay, so if she's postmenopausal or perimenopausal, so generally women, 40 plus, I can tell her that her levels are lower than they were in their 20s. I don't even need a lab test for that. I'm going to get a lab test for safety reasons because it helps me figure out your dose. So I will get baseline and follow up. But if you're basically, if you're over 40, perimenopausal, postmenopausal, and you have symptoms, you can try what we call a therapeutic trial of testosterone. You can see if it actually alleviates your symptoms. Right. So I would see a specialist and someone who knows how to write for compounding and knows how to support you in this way.

[Tamsen]

Wonderful. And of course, you know, we're huge fans of Mitty myself personally, and I'm so happy to have you here. Thank you so much.

[Dr. Kathleen Jordan]

Thanks for doing all you do with educating women on this.

[Tamsen]

Thank you. All right, all right, we'll talk to you soon.

[Dr. Kathleen Jordan]

Take care.

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[Will Harlow]

Monday.com AI agents took over my work and I absolutely love it. Chasing deadlines, writing status reports, updating stakeholders, holders, agents handle the daily grind. Now I stay in the loop only when it matters. Create your own AI agent in minutes. On Monday, combination.