Hello Menopause Episode 13: Dr Jessica Shepherd - Transcript

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Stacy (01:15)

StacyDr. Jessica, it's wonderful to see you. I am so happy to have you on the podcast, but I want to start by talking about your position as chief medical officer at HERS. What does that mean exactly for a company like HERS to have a chief medical officer? And how did you start that position?

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Jessica (01:34)

Yeah, I love how you stated it. And you're like, what does that mean? I love all of that. And so what that really means is when we think of like chief medical officer in any, you know, in any capacity, there are different ways that that can be visualized or executed. And specifically for him's and hers, know, him's and hers, an amazing company been around for seven, eight years started with him's right, right. And so a lot of that product went to

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the health care of men and what they were needing specifically started with ED. And as the CEO kind of moved into, we also need to provide the same capacity or care for women. And that's where hers came from. And so as we started to build more platforms and ⁓ in the way that we're gonna help women started with mental health, ⁓ birth control, contraception, and then weight loss.

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And weight loss probably was one of those categorical timeframes in which women really showed up for themselves in saying, is something that I want, this is what I want access to, and this is something in my life that is, you know, something that is an obstacle and is burdensome for me. And so was during that timeframe that there is a realization. Also, you know, we have a chief medical officer, Dr. Pat, who's amazing, is as we step into this, and if we're really going to embody it,

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we need someone who understands women's health and can relate to a woman. And then that's where that all started. And so me coming on pretty much a year ago to date is really the ability for a company to see vision, but also to hold it in the way of saying we want to be true to that. And so me coming on and being in the sense, how do we navigate through this women's health?

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kind of forum and what are women really looking for and what do you see as an OBGYN when you treat women? And so that's really my job is to make sure that on all levels, we really are embodying what the women's experience is and making sure in the ways that we do that through our telehealth platform is met in a way that a woman can feel safe seen in her.

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Stacy (03:55)

It's so funny to me, right? Of course, him started with ED. then of course, right? Of course, because we know that like, you know, women's health is the afterthought. But it is really interesting to me because I think bringing you on as a chief medical officer is actually very smart, obviously, because I know you, but also incredibly smart because you wrote Generation M. the menopause, perimenopause and postmenopause experience.

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And that to me, there's a real direct correlation in terms of weight loss. That's not to say that women don't want to lose weight after having a baby. I want to get to that in a second. I would guess, and you tell me if I'm wrong here, that a lot of the complaints or concerns that you must hear at hers are about that weight gain that people start to feel in midlife, right? mean, body weight distribution, I'm the same weight, but nothing fits, or.

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Why do I have a tummy that's turned into a shelf? I can put a Coke on my, you know, I can lean it. Is that what you started to see when, you when you first started to work with hers? Cause I'm curious. I understand obviously wanting to be a company that has an ethical standard around medicine, right? But when, you know, weight loss has become such a big topic of conversation in the past few years because of GLP ones,

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because menopause in the last few years has become such a cultural conversation. And that is one of the kind of, know, topics that we talk about most is that women start to feel unlike themselves because all of a sudden, 20 pounds just showed up on them.

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Jessica (05:39)

Well, the good thing is that we had statistics to back that, right? So as a tech company, one thing that we're really good is data. What's coming in, who's being impacted. And when you look at, again, when the weight loss feature was really being a hit for women is categorically, what do we see from a demographic standpoint, from age alone, is it is that true 45 through 55 year old timeframe. So there was no...

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way to deny that. And then when you really connect that with the, I guess, the underlying part of what goes on biologically with women as they enter this phase, it all made sense. And so again, it's something that we see in studies, but when we think of women's health, again, there's such a gap, right, between, I think, segmenting it is something that we've done that has not been helpful for women, is like kind of placing maybe weight loss over here.

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And then way over here in the other corner, have like when we think of hormonal health or mental health, right? Yes. What we start to do is create these categories. And when you really pull back from it, it really all goes together. And so making a concerted effort to address that gap in health care and access for women means you have to look at it holistically and everything together and not segmented.

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Stacy (07:06)

So, okay, about connecting those dots, how do you do that for women, right? If they come to you for weight loss, and let's say they're 50, what kinds of questions do you ask? more to the point, what kinds of questions should patients be asking when it comes to trying to understand what's going on with them holistically, right? Because for the most part, I find that even though we're seeing more more menopausal education, that people tend to focus on one aspect.

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I don't, I feel crazy. I feel like I'm raging. I'm so depressed. I'm so anxious." Or they're talking about weight gain or they're talking about joint pain, headaches, things that don't necessarily make sense to them together. What are the questions that we should be asking when we're coming to you and saying, hey, I don't know how this weight gain started, but what are the questions we should ask as well as?

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Jessica (08:01)

You know, where I feel is, you know, when we think of a physician or a provider and the relationship they have with their patient, a lot of that has to do with, as a provider, how am I going to show up for my patient by helping them curate this conversation? And so I would even speak to providers first in being like, okay, how am going to start this conversation? So one, they feel safe addressing it. And one of those ways to do that is

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I always start with the reason why all of this may not make sense to you, but it really is all together the same is that we have estrogen receptors all over our body. In our brain, in our heart, in our muscle, in our bone. And then when you take that and then saying, now picture as you're going through your 40s into your 50s over a 15 year, maybe even more your time frame, then if we have a decline in estrogen, can you imagine for the receptors that are

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⁓ really relying on estrogen. And when I say estrogen, just so anyone who's listening, I really mean progesterone and testosterone as well, but I usually just kind of like ⁓ go to estrogen. Your body is really asking for this thing, which is estrogen. So if it declines, that's why brain fog might show up. If it declines, that's why cardiovascular health might take a hit, because there's receptors all over it. Our bone starts to get weakened.

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because there's estrogen receptors on our bone. So I think that when you put that in context, so we should be starting the conversation. So giving that framework then opens kind of the ability for women to be like, because that's usually the response I get when I tell my... It all makes sense.

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Stacy (09:46)

like aww.

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and by no means safe.

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Jessica (09:52)

Yes, and then the reassurance, I think stays so important, is you are not alone and this is not your

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Stacy (09:59)

Yes. ⁓ my God, this is not your fault. This is something else that I'm seeing a lot. ⁓ You know, with people who I just spoke with a dear friend and she was saying, you know, she had a baby at 43. She was diagnosed with postpartum depression, but even at five years later, she's 48.

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People were still saying to her, well, you have a small child. That's why you're depressed. Not one doctor, not an endocrinologist, not her OB-GYN, not her PCP said, maybe this is perimenopause. Have you started to see that there's confusion between women having children later, which hopefully biology will catch up to society and culture and it be such a big deal. But in the meantime, are you seeing these two things kind of come up against each other when you're seeing ⁓

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Jessica (10:51)

Absolutely. So take into context, you know, the life expectancy of a woman, early 1900s being like late 50s. And now we kind of surpass that with innovation, science, just taking better care of ourselves to roughly 78. That's like a 20 year gap. What we haven't accounted for is when the ovary declines and starts, you know, stops putting out estrogen, that it really is a death of an organ, if you want to say that. And so in that death means there's no estrogen.

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So the reason why we had a life expectancy of 58 is because that fertile time of a woman's life, whether you had kids or not is over, estrogen goes down and the body actually really responds to, there's no estrogen. So we've accounted for increasing life expectancy, but we haven't created something better for the gap and loss of estrogen. And so I think it's important for us to saying, even though we live longer, one, we're not living longer in better health. There's that.

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And the other part of that is now we've done another gap extension, which is women have kids later, which is great. But we've done that a lot through innovation, technology, blah, blah, blah. But now what we haven't accounted for is at the, now that we've increased that age, that doesn't necessarily mean that the ovary accommodated, I'm not, I'm going to go into menopause later. It's still going to do the thing that it was always doing. So the gap now becomes shorter.

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Stacy (12:10)

Mm.

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Jessica (12:15)

between what we've extended in fertility into the start of perimenopause. And so we, again, have to account for that in how we counsel patients, how we talk to women about, as you start to have kids later, you may kind of just really just very short timeframe before you start feeling these other issues, which really are the start of perimenopause.

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Stacy (12:35)

Is it true that some people think that actually the start of perimenopause is postpartum? Because I think that I've heard that once or twice and I'm like, I don't know. Is that real? Is that scientific?

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Jessica (12:47)

You know, Stacy, it's such one of those things that was coming up on it, like literal real time. Like this is not something that happened in the past. We studied it. We kind of like know everything that happens is we are saying women have children much later. Right now, postpartum hormonal fluctuations are also real, right? So even if you took like someone in their 20s or 30s, the amount of hormones are being percolated through that pregnancy. And after you have the baby, like it's coming.

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way down to get back to that normal level, that again, that whole fluctuation, anytime there's severe fluctuations in hormones, you don't feel your best or you're not working at the full functionality or capability that you were when it was in homeostasis. So again, there's this fluctuation and then homeostasis, same thing with perimenopause. Fluctuation throughout all your 40s. And then when you get to menopause, it's like kind of like that flat line.

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So both of those instances, it is hard sometimes to say, is this postpartum or is this early menopause? Because both of them are features of fluctuations in hormones. And so that's why there may be this, and I'm not saying it's great how this is done, is there is this kind of like, it's probably postpartum because it very well could be. The goal, I think, in that conversation is to saying,

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Because we're here, and this is specific to women who are having kids later. Later, yeah. you know what? Very well could be perimenopause, but it could be they're both kind of intersecting right now. Let's keep a close eye on it. Let's see how you feel. I want you to be part of this experience. So at some point, usually about a year after having a baby, is typically when we start to see kind of resolution of hormones of women postpartum.

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Stacy (14:38)

So that's

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Jessica (14:38)

So

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interesting to invite them back into the conversation and we're not.

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Stacy (14:41)

Yes,

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exactly. that's the first thing. And then I realized as I was asking that question that there are obviously women in their 20s and 30s having children that are not chronologically close to menopause at all. And that postpartum does resolve itself, whereas perimenopause can resolve itself, but it takes much, much longer. ⁓ So now that we're out of this kind of 20-year gap, we're no longer saying that

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hormones are going to kill you or give you breast cancer, know, that we're really, ⁓ MHT has entered the chat, so to speak. Do you think that that is something that will extend itself into postpartum care as well? Or is that something that we really need once our bodies are just no longer able to produce estrogen, testosterone, progesterone?

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Jessica (15:36)

Yeah, I think that we need to kind of look at them as separate entities, per se. And when someone is postpartum and maybe they do have a very short window before becoming perimenopause, that we still address it in the same way. Right. We've probably exited one phase and entered another, and we need to address it as such.

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Stacy (15:59)

Is it possible, ⁓ I know this is going to sound maybe like a naive question, but ⁓ can you start hormones while you're in peri as opposed to starting them after the one year anniversary of your past period menopause?

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Jessica (16:15)

No question is not a good question, Stacy. And that was a great question, actually, because I get that all the time. think even how we have historically taken care of women in this perimenopause-menopausal phase is very much used to say, until you can prove to me that you're menopausal, I will not start this hormone MHT discussion, period. Right. What we have seen in the last five years, and still very new, right? When you think of something

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that's new and in practice in what we're seeing, the wide landscape of it still hasn't hit, right, for both patients and healthcare providers, is the goal in the fluctuations of hormones in the perimenopausal phase, even though you're still having your cycle, the goal is I am seeking a little bit of stability with hormone fluctuations and ratios between estrogen and progesterone and declining testosterone, but more importantly, Stacy, quality of life.

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What is my quality of life and why are again going back to women's health, why should we have women suffer through the perimenopausal phase, which could last up to eight to 10 years until we're like, now you don't have your period and I will do something about it. So we are starting to see very much that shift into treating patients and women when they're in the perimenopausal phase.

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Stacy (17:32)

This is something else that you bring up that I think is so interesting. You talk about quality of life, right? And so many women say to me, oh, I had my hormones tested. I'm not perimenopausal or I'm not menopausal. And this idea that we're only going by tests, right, by Dutch tests. It's S-H tests, very hard for me to say. It's like a lateral lisp thing. F-S.

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Jessica (17:52)

Right.

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11 times fast.

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Stacy (18:01)

age. when you say quality of life, it one of the things that I think is so interesting when you're getting towards that age, let's say early 40s on, right, when you would chronologically, normally come to perhaps perimenopause, even early, know, premenopause. When you're talking about quality of life, is it that we are now looking really at treating symptoms rather than looking at test scores? Because

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It seems to me that that's what's driving women a little bit insane, right? They're getting mixed information and mixed signals.

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Jessica (18:35)

This is where it does get a little nutty, Stacy, because the fact is, because we said already, it's something that we do widespread, is you still have a lot of confusion. And with confusion, there comes chaos. And the conundrum is you might have very well-informed women who are like, I don't need a lab, I have symptoms. But you may still have a lot of women, and rightly so, because that's their understanding of it, is I feel I need labs to...

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diagnose what I'm going through, which is also very hard to do because their hormones are fluctuating because they have a cycle. Right. And then on top of that, you have the provider who may not even be in the mind of I'm going to treat you because your perimenopausal and have symptoms. And so you may have a block there. So there's all these areas where you can have obstruction. So, you know, in light of saying that and where those are.

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I think the bigger goal is to how can we all align to understand that there may be at this point, we need a little bit of flexibility and fluidity in the ability to say, what can I do in the best interest of this woman who's sitting before me here with these symptoms? And so there's gonna be a little bit of butting ahead. So there's gonna be women who are gonna be like, you know, I need to advocate for myself in a better way. I'm gonna go to another provider. There may be providers who being like, there's something that I'm missing.

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I need to be more well-educated and I'm gonna go get that. So everyone needs to play these parts and how we can all get to this ecosystem in the end, helping women have a better quality of life, period.

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Stacy (20:13)

I mean, you we don't, it doesn't seem to me that we have enough knowledge just statistically. I mean, just in terms of data of the way women's bodies behave, right? You know, we, ⁓

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Jessica (20:23)

You

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know, I feel has done a really good job on the behavior physiologically of women throughout this phase? As physiologists. Because if you think of what they study, they study of how the body actually functions and manages, but many times they're doing it from a sport level, right? And how the body responds to stressors or an activity of some sort.

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But for years, you know, and a lot of my friends, and actually just kind of fun fact, that's what my undergrad degree was in, kinesiology and exercise physiology. So I was always very aware of what the body does in stages and phases and how it ages, but what it's able to overcome if you do, right? It's like this little puzzle of what your body can do. And so I feel like there's a lot of data already in that field of what happens with aging in a woman over time.

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and even to the level of hormonal as far as response and recovery. I think that there, obviously there's not a medical context to that, but we knew the medical side of it, of what's happening there. So now I see more of the fusion of bringing in the medicine or the hormonal kind of component of it to over here we have an aging process and what the body is doing. And until we can really come to an agreement of we can do this,

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with more people at the table, I think that's where, because the other part of that, Stacy, you know, as we really dive in and we see all this MHT and we see how it's so helpful, is the other part of that is we have to understand too that the body requires things that we're responsible for, nutrition, exercise, movement, because it can't be just a hammer approach. I have a hammer, it's gonna fix everything. It has to be a toolbox that has many tools.

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Stacy (22:11)

What's so interesting to me is that you say that and now I'm like, doesn't, why hasn't exercise physiology become part of menopausal education? Right? Because really to understand what the body needs as it ages is clearly why we have longer lifespans, right? We've said that GenX is sort of the healthiest and wealthiest of generations at this age that's ever been. And it would make so much sense to me. Now you're going to have to write another book.

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Because I do think that that makes so much sense. It's almost like the piece that we've been missing is what is our responsibility? What are the things that we know we can do, right? That trifecta of sleep and nutrition and exercise, as opposed to the medical toolkit, right? As opposed to, I don't know, ⁓ the meditation toolkit or the rest and relaxation toolkit. All of the other things that go into supporting a healthier life.

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So I wonder if I had to say to you, are the five top things that somebody who you have diagnosed as perimenopausal, either by symptoms or blood tests or whatever you deem to be enough for you to say as Dr. Shepherd, we're ready. What are the five things that we can do versus what a doctor can prescribe?

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Jessica (23:31)

Yeah, I like that you kind of pulled out the part of it, like what a doctor can prescribe, because that to me, and the way that we've built the medical system is the easy thing, right? Like it's the magic pill part of it.

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Stacy (23:42)

And certainly in mental health, Everything's like, throw an SSRI at it.

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Jessica (23:47)

Yes. And so I think that's where we have kind of missed the mark in creating a better reliance on ourselves as individuals. Also challenging the medical landscape to understand there's more than just medicine. Medicine is great. I'm a doctor. I love medicine, right? But have we maybe created that hammer, that hammer approach where it fixes all. So we've kind of taken power away from people for them to understand how can I

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be a part of this journey? And what do I need to do in my everyday life to obtain that goal? So I would go ahead.

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Stacy (24:24)

Sorry, no, no, I was gonna say, you think now we're seeing an over exuberance in terms of like, yay, we have hormones available to us again, let's just give them to everybody.

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Jessica (24:34)

I do and I think usually what we see is when there's something that finally, if you think about the 20 year gap that we've had since that study, you know, the WHI to being like, finally, we're at a place where we can talk positively about hormones is you want everyone in the effing world to know. You're like, so that comes with like anything new. We're like, my God, everyone should have had and just fine. But at some point I will, you know, we have to find some balance in there.

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so that we don't take away autonomy from individuals to being like, but what am I doing about my nutrition? And that would be, you know, on the list of five, probably one of the first things I would say is we have these beautiful machines that we own and are really responsible for, but how are we fueling it? And, you know, just alone in industrial revolution, in women going to work, we have seen more flexibility, which means over-processing of food.

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Stacy (25:16)

Mm.

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Jessica (25:30)

more availability of things that instead of like preparing foods. And so that has again, wreaked havoc on our bodies internally, that at some point we have to turn that clock back. And so each individual can own that and being like my body requires or this beautiful machine requires different things as I age and as I go through this depletion of hormones. So I need to pay attention to what those changes might be. The next thing I would say, Stacy is exercise.

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exactly why I had Dr. Stacy Sims, who is an exercise physiologist, contribute to Generation is because I knew that what she was able to provide from the juxtaposition of as women age, one, their physiology is different than men, but there is this complete shift because of the hormone depletion that I need to alert women to understand as they enter that phase, namely movement in general. Like I'm really trying not to dictate

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what women are doing in their movement, because I just want to emphasize and encourage to do it. But obviously, if you were to prioritize it, resistance training and weight training to build that muscle mass that we're already losing at three to five percent a decade. So there's that part of it. The other part is rest and sleep. I feel like I'm talking to myself for this specific step.

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Stacy (26:47)

You know

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what, I know that you are because I've also, if you have not seen Dr. Jessica Sheppard in person or looked on her Instagram to see what kind of muscle mass this woman has, you're missing out. So that's that you gotta follow her just to see. I saw you do that, that squat in the heels on one foot. I lost my mind. So I know that you're fine with exercise, but you're telling yourself about sleep.

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Jessica (27:16)

Yes, because as a doctor forever, we do not function on sleep. We're taught how good can you be without sleep, which is like a horrible message to send. Our training requires no sleep. And so you start to feel like, oh, you sleep when you die kind of thing. And that actually is the complete opposite of what our body requires, because it requires recovery and restoration, which is what sleep is. And also we now have so much data that shows the lack of sleep that you get increases your risk of

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cardiovascular disease, obesity, diabetes, start the list. So I'm like, how do I want to show up when I'm older? Is also another question everyone should ask themselves. Like you get to dictate what you want 30 years from now to look by starting now. Number three, number four.

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Stacy (28:03)

I just want number three, sorry, just to three B. Is that it's very hard for some people. mean, when we're really young, if you told me this in my 20s, I would be like, who cares? But we get to our late 40s, our early 50s, when we really start to see that if we're not paying attention, things could go awry. But even 30 years, 20 years can seem like a long time to people.

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One of the ways that I describe it is I say, you know, I want to be able to walk when I'm 85. And I know just from my family history that once you fall, the chances of you lasting much longer after that at a certain age is very low.

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Jessica (28:46)

at

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Millie Mill. And I wish you, like, people who are listening to you, listen, if there's one thing, if you say that again, Stacy, because say it again.

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Stacy (28:55)

Say it again, you wanna walk when you're 85, you don't wanna fall down. Yes.

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Jessica (29:00)

And when you fall, the likelihood of you having great recovery is really low. Right. Really, really low. So functionality, know, kind of putting that into that 3B is pretty important because you still want to be a functioning, vibrant 85, 90 year old. I want to be traveling to the Seychelles. Yeah. I want to taking my own luggage. I don't want assistance on the plane. I just want to be like, where are we going? Let's do this.

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Stacy (29:26)

Yes. my God. makes me think, mean, RIP Jane Goodall, when I think about, you know, 91, I mean, she was still traveling, advocating, doing all of these things. And, you know, she didn't even have that kind of information in her generation that we have now. you one of

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Jessica (29:46)

The

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impact of like her living the way she lived. She had more access to whole foods. She was, know, she was not going to McDonald's out there in the jungle. I'm pretty sure she was having to go through like fields and jungles and and then she had like great stress factors. Hi, you're ⁓ a chimpanzee or a gorilla. Like that's probably invoked her like physiology to being like, holy crap, holy crap. So all of those together, actually, she has like the perfect blend.

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of like what the body should be given as far as stressors, eating good food, movement. That's why she showed up like that. And her, the next one I was going to say, number four, her emotional state was on point. How she's showing up. What are the things that like bother her versus not? What's important versus not? What things am I going to tell myself that are good about myself? That is emotional resilience as number four, mind you.

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Stacy (30:29)

Your sh-

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Jessica (30:44)

that I think so many women who walk into my office and that when I see when I'm traveling, Stacy, is this emotional kind of downward spiral that occurs in midlife. And you and I even talked about that last year, you know, with your experience at the book launch in New York, was you were talking about like stressors in your life that almost took you out.

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Stacy (31:05)

Absolutely.

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Jessica (31:07)

Can

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you imagine how many women are going through for multiple reasons at midlife? And you know what the crux of it is? Is they think it's their fault because they think that they've done something wrong. So that starts the spiral downward and then the hormones are shifting, which also impact the neurotransmitters. So they didn't even know that that's going on in the background. And then all of that is spiraling while their worlds are falling apart, whether it's career, whether it's relationships, taking care of older parent, kids leaving the house.

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So all of it together is like the perfect recipe for what we're seeing in emotional resilience. ⁓

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Stacy (31:42)

Resilience is such a great word too because you now ⁓ Now that I'm I can consider myself post-menopausal hopefully I do think a lot about the fact that one of the things that has been Really helpful to me in terms of that kind of emotional resilience is curiosity is is finding my ⁓ Ability to be interested in things again and not just checking out right this idea that

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I'm done with the acquisition of houses, cars, things, art, whatever. And I'm much more interested in being inquisitive. I'm interested in learning ⁓ and trying new things because that seems to also really affect my mood and my sense of resilience.

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Jessica (32:32)

Yes,

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I would say two important words that you said. One, resilience. Yes, I love that. And the way I like to explain resilience, because I do a lot of talks on emotional resilience, because even for myself, you know, in this last year, there's a lot of changes in my life from an emotional standpoint. It's just like, holy crap, so many women go through this like cruddy emotional down spiral. But the resilience part is think of your life and emotions as a rubber band.

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And that rubber band can be taught, it can be strong, you can pull it and goes right back to where it is. But as our resilience starts to decrease and we're not honing the skill of keeping it, it's just like that rubber band that's just like in the sun, has a few cracks in it and you pull it and it doesn't go back to what it used to be. And we are responsible for in many different ways. There's not one way to do it, is to how do I keep that resilience and curiosity is one of the curiosity breeds growth. I've learned that

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segue into my number five through, see how this like just blows, is the mindfulness behind who we are. And what we want our brain to capacitate in a way of restoration and relaxation recovery. Because we do often as women set ourselves on fire to keep everyone else warm.

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Stacy (33:54)

Yeah.

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Jessica (33:55)

And we have not learned how to place importance on how that brain runs, how we're going to let it rest for a bit in the form of mindfulness and meditation. Because the mind, I always say this, the body really is just like showing up to do the thing that the mind tells it to do. So if we're not allowing the mind, body, you know, and how I really wish medicine was practiced to be the overhaul of how we approach everything in our life.

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is that connection through mind-body. And when we can attune our minds to going through struggles, going through hardships, being happy but really happy, know, like when people say they're happy, I'm like, is that true happiness, right? Always waiting for someone or something to make you happy when really that should be within, is that mind-body and the capability to saying, I'm going to pay attention to my mind so my body can follow through with the mindset.

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Stacy (34:50)

It's so interesting that you say that because, you know, one of the things that I think ⁓ certainly women of our generation have been taught is that that mind-body connection was ever not actually ever connected for us, right? It was that they were very separate things for me growing up. And it's one of the things that I know, and I think we might've talked about this before, and I've definitely mentioned it on the podcast. There's a birth doula named Latham Thomas.

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And she once said to me, know, women don't feel safe in their bodies. They're always being told that it's not good enough or their pregnancy is imperfect or perimenopause is so, you know, you're past your prime or getting your period is so gross in a way that disconnects us from a, respecting and caring for ourselves, but also that we can trust our gut literally.

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that we can trust our own bodies and our own instincts to make good decisions for us, right? We stop relying on that connection because we don't even feel it anymore. And for a long time, I didn't live in my body at all. I did everything to go out of my way not to.

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Jessica (36:05)

And I don't even think I knew what that even meant, even though I thought I did, is really that deep inner work into feeling how to be embodied, one. And two, like when things don't feel great, that that's okay too. That is an emotional part of our journey. And how do we kind of carry through that emotion in our body and being okay with it. So we're always like, always trying to deflect and being like, everything's okay, I'm okay, I this is good, even though it's not.

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But yes, and that again is that disconnect. I'm not going to ⁓ really pay attention to what I'm really feeling and we're going to deflect that. ⁓

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Stacy (36:43)

We're going to deflect, we're going to keep going. Okay.

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So those are fantastic tips for us on our side of kind of being a patient and our autonomy. In terms of the toolkit, when we talk about weight loss, you know, what are your feelings about GLP-1s? Do you think that they are, you know, again, I'm nervous when anybody says anything is like a cure-all, you know, it's a miracle drug, it's going to change everything.

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What are your feelings about that in terms of weight loss? What are your feelings about MHT in terms of, you know, dealing with menopause and what we're losing after? And what other tools do you think will become available to us in order to combat what we're feeling?

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Jessica (37:26)

that's all there

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Especially, you know, being chief medical officer at hers, those are kind of like, you know, coming up shortly as, you know, women's health platform with hormones. And then also we have the GLPs. So going back to GLPs, do I think, like you said, is it a one hit wonder? Absolutely not. Is it really great at what it does? Absolutely. And so I think there still needs to be context around when I look at all like in the past weight loss drugs, none have really

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emerged as strong as what a GLP is because it really kind of hits the crux of what the issue is, which is glucose and insulin. And that really is a lot of the reason why we may have increased inflammation inside our body or weight, you know, kind of redistribution, how our fat cells respond. A lot of that has to do with glucose and insulin, which is when we think of GLPs as a peptide.

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and how it responds to our body to allow it to do the thing that it needs to do. So there's that. Yes, I think it's a great mechanism of action of a medication. the flip side of that, it still requires, like I said, our beautiful machines that we take charge of that as well. So if I always tell, you know, people who are asking the same question you did is GLPs are great, but if you're not doing your end of the bargain, there's not a good ROI. And so

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It has to be this holistic approach to what am I fueling my body with? How am I making sure that I am having movement and exercise specifically resistance training? ⁓ For women specifically from a GLP standpoint, I think that there are a lot of glucose insulin shifts during this mid age in women because of estrogen, right? so estrogen plays a part in creating this machine of glucose and insulin to be very effective in how it works. So when you have a decline of that, it would make sense

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this machine over here is not running the way that it should or typically has. And so that's why you start to see that shift. And I think that women really should not be afraid of it to really look at themselves and being like, what am I trying to accomplish? Always start the journey there. What is my end goal? What am I looking for? I'm being honest with it as well. Like don't allow someone to dictate what your answer should be. What's your answer?

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Once you get to that, you can then allow for the multiple ways that GLP could be an effective tool for you. And also taking the autonomy to make sure that you're taking care of all the other things. Because if people use GLPs irresponsibly, which we do see this, you will always see that with any drug use, right? Someone will use it irresponsibly. As if you can use it responsibly, then you can attain your goal of weight loss come off.

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And then you can maintain because you've picked up the lifestyle portion of it. But if you don't, what do you think is going to happen? Just like any other drug, you're going to regain, you're going to... So don't create that wheelhouse for yourself. Moving to MHT and HT, women are given the option to decide for themselves if they think this is a good thing for them.

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always like just like we're talking today right now is the fundamental of education. What do you know about it and what are you trying to accomplish? Right? Set those things out first. And when you look at MHT slash HT, I always like give the whole thing. I know because there's so many acronyms is when you're coming to the table is curiosity, learn everything about it, figure out what you're trying to accomplish. And when we think of our bodies,

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of what we were born with, we were born with hormones. So I always take the notion off, it's not a drug. It's not a drug, folks. This is something your body had that now in the natural biological decline of it, you get to decide from a symptom perspective, do I want this taken care of? And then also we talked about it long-term, we're talking about Jane, right? What do you want to be like when you're 91 or 95? And hormones do play a big part in that.

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because they really are using this midlife portion in the decline to help decrease some of the things that may come later, because we're fortifying the machine. And so it's such a big conversation, it should never be looked at as when you walk in and you're like, I have a headache, okay, here's some Tylenol or Motrin, right? That's not the level of where we are with this type of work. It requires coming back to it. Which one should I start with?

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Do I take estrogen and progesterone? Do I take progesterone alone? Do I take it? There's so many ways to do it. And I think that we, I don't want it to be simplified in a sense where someone feels there's only two options on how to do this. And if I don't meet this criteria, then I can't take it. Everyone has the ability to do it.

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Stacy (42:12)

Agreed. Whether it's four or it's six and the things that the patient can do, ⁓ I think that research and education is essential, ⁓ especially because not all doctors are you and not all doctors are quite as informed or give you as many options. ⁓ But it does feel important to me to do your homework, whether it's read your book or read a book or do... There are so many telehealth

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platforms that have information about hormones that you can bring intelligent questions to your doctor and say, do I start with one? Do I start with all? Here are my symptoms. What's best for this? In a way that allows you to kind of co-create your health plan with your doctor.

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Jessica (43:01)

I love that, like a true health plan, not a health plan on an insurance payer. And you know what I love too, is with that health plan, like it should be kind of this flexible working document, some team members taking some off, bringing some on. We can't expect our health to flourish to be able to get through different decades because they present different things. We're paying attention to it.

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Stacy (43:05)

No, exactly.

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Jessica (43:29)

And so the investment that everyone should consider when they're thinking of themselves and specifically women going through midlife is it's not just about medication. I think that that's really important, you know, from the hers perspective that we focus on. It's more about building and growing this healthcare system within yourself with a team that is aligned and that you trust to give you the care that you needed. And I think what we see in the, you know, the health, the traditional healthcare system.

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is that's where they became outdated. It became more about here's the medication, but I don't really know much about all the other parts that are going on in your life. And that gets kind of taken out of the equation. And in the end, if you look literally at where we are as a westernized country, far as, you know, kind of causes of death, all cause mortality, chronic diseases, we haven't done that well. So there's some...

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missing and I think that you know we really have taken charge of looking at the whole landscape and really the goal especially with me coming in is understanding that we want to transform that healthcare experience for women.

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Stacy (44:38)

Here, you know, I'm going to stop asking so many questions because you've been so gracious with your time. But I do worry about people who are not in a position to get the kind of medical care that they need and that we have not prioritized, you know, marginalized communities. And how do we get medicine to them? How do we get hormones covered by insurance? I know these are bigger questions than just, you know, the medical side that we're talking about.

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But it does concern me that it's become almost a privileged conversation to talk about our health, especially in midlife, when things get more complicated and do require different ⁓ techniques and methodologies. So what do we do? How do we?

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Jessica (45:25)

move

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forward? think the one, pro, the problem in totality is monstrous. Let's just start. It really is. I think one of the ways that we have really looked at and how to chip away at that is the access is the, we have done a poor job at in the healthcare system, traditional healthcare systems. What I'm alluding to is creating ease of access and

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Stacy (45:34)

Yeah.

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Jessica (45:54)

it actually has gotten more complicated. And even like currently you and I know that the current political climate that they're in has actually increased cost and decreased access. So the way that we have created a way to do that is we don't take insurance and people may be like, my God, you don't take insurance. That's horrible. And I'm like, actually, there are a whole of you to get direct. You don't need ⁓ a copay for someone to tell you where you can go and then having to wait months.

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Stacy (46:15)

You're better.

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Jessica (46:23)

to maybe get into the office, can you take off work to get it? We are 24-7 by reducing costs because we have created a way for us to have the tools, have the access ourselves. Like it's with us, so we have it. It's like it's right here. And so I think when we do take a step back to look at really what the conundrum of healthcare is today in an insurance payer world, how expensive it really is at the end of the day, and then looking from an individual standpoint,

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And I know this can't reach everyone in marginalized communities. understand that, but there are a lot of people once they do understand the investment of health and what's over here in this landscape, which they may never have access to because they may not have insurance, but even at cost, that model is still more expensive.

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Stacy (47:11)

It's also more expensive in terms of your time, correct? mean, just the paperwork, the...

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Jessica (47:15)

The months wait, it got canceled, all of that. I can only go in between the hours of nine and five. The only patience I had there, like, I can't make that appointment because I cannot take another day off of work. Versus, it is nine o'clock at night, I finally have gotten home, I've probably given my kids something to eat and they're settled. I can actually go on a platform that is available right now.

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And the other, the last thing that I would say about that, because we are a disruptor and we do things quite differently. And I think the way that the healthcare system is built is to oppose instead of being in collaboration with what we see in telehealth platforms is to oppose them. And so I always want people to be curious, to think about it in a different context. And those are two ways that they can even start that journey of being like, hmm, what does this, what does this all mean? This HIMS and HIRS platform.

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And then, know, another telehealth platforms as well is that's why midlife is like crucial. Biologically, our bodies take a hit, I think it's like 44, 45, and then later on in your 60s. Like there's this sharp physiologic biological shift where it goes towards like aging. It's like, it goes down and then it goes down again. Is we have that authority in our mid age to take the driver's wheel and being like, I see your alignment is off and you're trying to

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you know, bring me over here to the right, I would like to stay steady on course, and this is the time to do it. So once you put all those things together, I really feel like the, it has more of an understanding of why we need to think of things differently outside the box and invest in our health in a different way. ⁓

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Stacy (48:58)

Dr. Shepherd, thank you so much. I love talking to you. I love talking to you. And I miss you because I haven't seen you in person. And the other thing you have to know about Dr. Shepherd is she is so stylish.

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But I hope I get to see you soon. And this was so informative and so helpful. And I really appreciate the fact that we are discussing all of the ways that we can look at taking care of ourselves as well as possible.

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Jessica (49:25)

Thanks Stacy for having me.

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