The Ultimate Human with Gary Brecka

Episode 227: Menopause: Symptoms, Hormones, Tests & Solutions with Sage Workinger-Brecka & Gary Brecka
December 16, 2025

Episode Overview

This candid episode features host and human biologist Gary Brecka in conversation with his wife and life partner, Sage Workinger-Brecka. Together, they dig deep into Sage's menopause journey, exploring the symptoms, frustrations, hormonal imbalances, and practical solutions. The discussion spotlights the critical role of advanced hormone testing, why standard bloodwork often isn’t enough, the importance of understanding hormone ratios, and how a personalized approach can transform quality of life. The conversation aims to empower both women and men—offering guidance, debunking common myths (such as the link between hormone therapy and cancer), and encouraging open, supportive communication through the menopause transition.

Key Discussion Points & Insights

1. Early Signs, Surprises & Misconceptions About Menopause

• Perimenopause Can Start Early:
  • [00:00] Sage shares her disbelief at beginning perimenopause in her 30s, “Turns out you can be in perimenopause in your 30s. Like this shit. Probably. Sorry, language. But this stuff probably started happening a long time ago."
• Attributing Symptoms to Other Causes:
  • [00:21, 04:54] Both acknowledge how easy it is to explain away early symptoms such as mood swings, fatigue, and brain fog, often blaming stress, PMS, or sleep.

2. The Couple’s Personal Menopause Story

• Mood Swings, Brain Fog, and “Frozen Shoulder”:
  • [06:13] Gary describes Sage losing her edge: “She literally couldn't remember one thing. Not from one minute to the next."
  • Sage’s frozen shoulder was a catalyst, leading them to consider menopause more seriously.
• Impact on Relationships:
  • [03:38] Gary's advice to men: “As soon as you wake up in the morning, just say you’re sorry.”
  • [09:17] Sage talks about feeling like a “lazy piece of crap” because of persistent exhaustion.

3. Testing: Going Beyond “Normal” Blood Work

• Dutch Test as a Game Changer:
  • [00:51, 27:30, 28:34] Sage highlights the Dutch Test (24-hour urine hormone test) as a breakthrough: “Getting that test was a game changer. When it came back, it explained everything.”
  • [28:34] Gary details why Dutch Test is superior for women: “It looks at the ratio of hormones. The ratio is as important as your levels.”
• Standard Lab Panels Often Miss the Real Story:
  • [19:18, 47:39] Standard bloodwork can return as “normal” even when severe symptoms are present. Specialized tests are often needed for clarity.

4. Understanding Hormone Cascades and Ratios

• Types of Estrogen:
  • [07:23, 28:34] Gary breaks down E1 (estrone), E2 (estradiol - the most potent and critical for mood, skin, libido), and E3 (estriol). Postmenopausal women lack E2, causing most symptoms.
• Precursor Hormones:
  • [09:54, 28:34] Pregnenolone, DHEA, and testosterone are critical raw materials. When depleted, hormonal “construction” halts, amplifying deficiency effects.

5. Addressing Common Myths

• Hormone Therapy & Breast Cancer:
  • [11:44, 15:22, 28:34] Gary directly addresses a landmark study that wrongly linked hormone therapy to breast cancer, explaining the study was debunked: “Just because you are taking hormone replacement therapy does not mean you have an increased risk of breast cancer.”
• Bioidentical vs. Synthetic Hormones:
  • [13:09] Bioidentical hormones are safer and more effective than older synthetic forms.

6. Genetics, Methylation, and Estrogen Dominance

• COMT and MTHFR Genetic Mutations:
  • [22:23] Sage and Gary discuss how these common gene variants affect hormone clearance and contribute to anxiety, “worst case scenario thinking,” and sleep issues.
• Estrogen Dominance and Water Retention:
  • [26:03] Gary: “Women think they're getting fat, but they're not. They're getting water retensive… the estrogen band is that band right below your belly button…”

7. Symptoms Catalogued—Beyond Hot Flashes

• Common & Overlooked Issues:
  • [48:50] Itchiness, ringing in ears, brain fog, low libido, social withdrawal, and—uniquely—frozen shoulder.
  • [49:47] Sage: “I don't want to be in big crowds. I don't want to be around a lot of people anymore. I don't know. Just weird stuff is very different than I was before.”
• Sleep Disruption & Emotional Numbness:
  • [50:31] "There's no positive aggression towards life. There's no positive aggression towards working out. And stress causes the brain to release ACTH…"

8. Hormone Replacement Therapy: Practicalities & Solutions

• Restoring the Full Suite Matters:
  • [54:01] Gary: “Talk to Your ob GYN about replacing the entire suite of hormones including pregnenolone, testosterone, progesterone, E1, E2 and E3.”
• Different Delivery Routes:
  • [57:39] Sage chooses rapid-dissolve tablets over creams/pellets for adjustability.
• Timing & Circadian Rhythm:
  • [54:09, 54:17] Hormone doses are split between AM and PM, in tune with circadian cycles.
• Remarkable Turnaround:
  • [51:07] Sage’s frozen shoulder dramatically improved within weeks: “The fact that I got on hormones and three weeks later, I already was able to move up without pain is wild.”
• Emotional Impact:
  • [64:09] Sage recalls tears of relief upon getting clear test results: “You felt bad for me because you saw it finally. It wasn't just me saying, I don't feel good.”

9. Advice for Women & Men

• Don’t Suffer in Silence:
  • [69:18] Sage: “Do not let someone tell you you're fine. Don't let someone tell you nothing's wrong or it's all in your head…”
• Test, Don't Guess:
  • [28:31, 65:00] “Don’t just jump straight to hormones. Get your methylation in balance… raw material, simple raw materials might be missing.”
• Couples Need to Educate Together:
  • [04:47, 66:33] Gary jokes about forming male “support groups”; both agree men should learn and support.
  • [66:48] Sage: “Honestly, anything you can get through, anything with a good hug.”

10. Empowerment, Community, and Ongoing Support

• Community & Resources:
  • [71:07] Gary invites listeners to join his Ultimate Human VIP community for direct access to expertise, private podcasts, and protocols.
• Teamwork & Resilience:
  • [68:04] Sage: “We find that we are better together, no doubt, when we're a team. And that makes us the ultimate human, I really do believe.”

Notable Quotes & Memorable Moments

• On Early Onset and Misattribution:
  • “Turns out you can be in perimenopause in your 30s. This stuff probably started happening a long time ago.” – Sage, [05:42]
• Authenticity in Struggle:
  • "I remember, like, crying with you when we got all these results back, because you saw it finally. It wasn’t just me saying, I don’t feel good.” – Sage, [00:56], [64:09]
• The Impact of Knowledge:
  • “If you're not there yet, you're going to be there soon. So welcome to the podcast, Sage.” – Gary, [02:02]
• On Male Partners and Menopause:
  • “As soon as you wake up in the morning, just say you’re sorry.” – Gary, [03:39]
• Hormones as Biology, Not Weakness:
  • “This is not them breaking down, this is their hormones going in the tank and we don’t have to suffer like this. Women, you do not have to suffer…” – Gary, [40:25]
• On Community:
  • “You can get through anything with a good hug.” – Sage, [66:48]
• Expert Advice:
  • "Talk to your OBGYN about replacing the entire suite of hormones including pregnenolone, testosterone, progesterone, E1, E2 and E3." – Gary, [54:01]
• Empowerment:
  • “Don’t let someone tell you nothing’s wrong or it’s all in your head…” – Sage, [69:19]

Timestamps for Key Segments

| Time | Segment | |----------|--------------------------------------------------------------------------------------| | 00:00 | Opening remarks; realization perimenopause can start in 30s | | 04:54 | Difficulty distinguishing menopause symptoms from other causes | | 06:13 | Memory loss, mood swings, brain fog | | 09:17 | Shifting sleep patterns and daytime exhaustion | | 11:44 | Addressing hormone therapy and breast cancer myth | | 22:23 | COMT gene mutation, anxiety, and sleep disturbance | | 26:03 | Estrogen dominance, water retention, and “estrogen band” | | 28:34 | Detailed Dutch test results and hormone ratios explained | | 47:39 | Standard blood tests versus advanced hormone analysis | | 48:50 | Under-discussed symptoms and social withdrawal | | 51:07 | Rapid improvement in frozen shoulder after hormone therapy | | 54:09 | Timing and types of hormone administration | | 57:39 | Delivery methods: creams, pellets, rapid-dissolve tablets | | 64:09 | Emotional catharsis and feeling validated by test results | | 65:00 | Importance of correcting methylation and raw materials before/with hormone replacement| | 66:33 | Couples navigating menopause together—humor and support | | 69:18 | Sage’s advice: don’t accept being told you’re fine; advocate for yourself |

Final Thoughts

This episode stands out for its raw honesty, humor, and practical advice. By sharing their personal story—medical details, emotional battles, and triumphs—Sage and Gary offer validation, clarity, and hope. They urge women to seek comprehensive answers, remind men to be patient and supportive, and break the stigma around menopause symptoms and hormone therapy.

For anyone approaching or enduring menopause (or supporting someone who is), this discussion is both illuminating and empowering.

Find Sage on Instagram: @sageworkingerbrecka
Access more resources and the VIP community: theultimatehuman.com/VIP