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Last Updated: 12.06.23

Dr. Sara Gottfried: How to Optimize Female Hormone Health for Vitality & Longevity

In this episode, Dr. Huberman interviews Sara Gottfried, M.D., a board-​​certified gynecologist and professor specializing in hormone health and longevity. They discuss female hormone health, stress-​​related challenges, fertility, birth control, microbiome health, and actionable tools for overall health, vitality, and longevity in both males and females.

Key Takeaways

High level takeaways from the episode.

Omega‑3 fatty acids play an important role in managing female hormone health

  • Women have specific needs for essential fatty acids

Exercise recommendations:

  • Balance between resistance training and cardiovascular training for optimal hormone health

Women suffer from digestive issues at more than ten times the frequency of men. Overcoming digestive issues can help resolve related hormone issues.

Biomarkers for teens to consider: cortisol, estrogen, progresterone.

Biomarkers to consider in 20s and 30s:

  • Estrogen, progesterone, and testosterone (timed correctly)
  • DHEA (dehydroepiandrosterone) and androgen pathway
  • Estrogen metabolites (some protective, others problematic)
  • Microbiome (stool testing) — beta glucuronidase levels

For women in their 20s, best to test for biomarkers around day 21–22 of their menstrual cycle (assuming a 28-​​day cycle).

Preferred testing methods:

  • Dried urine for hormone levels and metabolomics
  • Saliva for cortisol (active cortisol)
  • Blood testing for a snapshot of hormone levels (less comprehensive

Nutritional testing:

  • Combination of blood and urine tests
  • Micronutrient testing to identify deficiencies (e.g., magnesium)
  • Helpful for teenagers to identify gaps and motivate healthier eating habits

Limited evidence from randomized trials to support the use of probiotics. Prebiotics and selective use of polyphenols have stronger evidence for supporting gut health.

80% of women experience constipation. Contributing factors: diet, stress, hormonal imbalances, thyroid dysfunction. Relieving constipation may help address other issues. Constipation could be a signal of dysfunction in the autonomic nervous system.

Ideal alcohol consumption: no alcohol or maximum of two drinks per week. Alcohol disrupts nighttime sleep patterns, particularly the first phase of sleep related to growth hormone release.

PCOS is not just a problem for reproductive age but also a massive risk factor for cardiometabolic disease as women get older.

Chronic cardio can lead to high cortisol levels

  • Marathon runners and those who do excessive cardio without resistance training are at risk
  • High cortisol levels can be buffered with vitamin

Hormone replacement therapy can be beneficial for vitality and health outcomes if started early enough.

Hormone therapy is safe when given judiciously within 5–10 years of menopause (around ages 51–52).

Women’s Health Initiative (WHI) study had flaws

  • Wrong study, wrong patients, wrong medications, and wrong outcomes
  • Study used synthetic hormones, which may have greater risk of breast cancer
  • Reevaluations of data show no increased risk of breast cancer
  • Women aged 50–60 within ten years of menopause had the greatest benefits from hormone therapy

Massive changes in female brain during perimenopause

  • 20% decline in cerebral metabolism from pre-​​menopause to perimenopause to post-menopause
  • Women with most symptoms have the most significant cerebral hypometabolism (low brain energy)
  • This may be a risk factor for Alzheimer’s disease

Hormone therapy in 40s and 50s may help reduce the risk of Alzheimer’s disease.

Ketogenic diet and intermittent fasting can increase cells’ sensitivity to insulin

  • Beneficial for brain health and reducing risk of dementia, especially in women
  • Pulsing between ketogenic diet and typical eating patterns may be more beneficial than staying on a ketogenic diet long-term

Coronary Artery Calcium (CAC) Score

  • Recommended for both men and women by age 45
  • CT scan of the chest, can be self-ordered
  • Provides insight into cardiometabolic health and potential risks

Adverse Childhood Experiences (ACE) Score

  • Essential baseline for understanding the impact of childhood trauma on health
  • Helps identify potential links between trauma and health issues in adulthood


Science-​​based tools and supplements that push the needle.

NuvaRing Alternative Contraceptive Method


Addressing Constipation


Oral Contraceptives


Dr Sara Gottfried’s Recommended Testing



We recommend using this distillation as a supplemental resource to the source material.

  • Dr. Sara Gottfried: How to Optimize Female Hormone Health for Vitality & Longevity

    Huberman Lab #111

    Huberman interviews Dr. Sara Gottfried, a Harvard-​​trained gynecologist specializing in hormone health and longevity. They discuss female hormone health, stress, fertility, birth control, microbiome, PCOS, and actionable tools for overall health in males and females.

Full Notes

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