Being Well with Dr. Susan

This is my real, unfiltered mid-facelift journey — before, during, and after — with the gifted Dr. Fred Aguilar. As a physician myself, I've always believed in transparency, especially when it comes to choices that affect how we feel in our own skin. For me, this wasn't about looking younger — it was about alignment. About having my outer appearance reflect the energy, clarity, and confidence I've reclaimed in midlife. In this video, I take you through the full mid-facelift experience — from the decision-making process, to the operating room, and through recovery. Dr. Aguilar is a true artist. With over 35 years of experience and triple board certifications, he brings not only surgical excellence but also a deep respect for natural beauty and subtlety. Whether you're curious about facelift surgery or simply navigating your own evolution in midlife, I hope my story offers both clarity and encouragement. Thank you for being here. MEET DR. FRED AGUILAR Board Certified Plastic Surgeon Board Certified Facial Plastic Surgeon Board Certified Otolaryngology/Head and Neck Surgeon HPRS 1801 Binz Suite 300 Houston, TX 77004 713-521-4777 575 E Medical Center Blvd Webster TX 77598 281-282-9555 http://www.drfredaguilar.com/ https://www.myhprs.com/ https://www.myhprs.com/about/meet-dr-aguilar/

As many of you know, skin laxity on the neck is one of those things that can sneak up on us in midlife — no matter how well we take care of our skin. That's exactly why I wanted to share my own experience having Morpheus8 done right here with Dr. Leah. Morpheus8 combines two powerful technologies: microneedling and radiofrequency energy. By delivering heat deep into the skin while creating tiny micro-injuries, it stimulates collagen and elastin production, helping to tighten loose skin, improve texture, and create a smoother, firmer appearance — without surgery. For areas like the neck, where the skin tends to thin and sag over time, Morpheus8 offers a safe, effective, and minimally invasive solution to restore a more youthful contour. In this video, you'll see my real-time treatment and hear us talk through the process, the science behind it, and why this approach can make such a difference for midlife skin.

When it comes to midlife wellness, it's easy to get lost in complicated protocols, supplements, and conflicting advice. But the truth is: most of the real transformation happens when we focus on the simple things we can actually control. In this video, I'll walk you through the 4 key areas that build the foundation for lasting health: • Nutrition • Movement • Rest & Sleep • Hormonal/Lab Optimization If we consistently take care of these basics — what I often call the “low-hanging fruit” — we give ourselves the best chance at creating our Optimal Older Day in the years ahead. Let's bring it back to basics — and let's start here.

Resistance Training for Midlife Wellness – New Moves with Kelley Workman

Periodically it's important to revisit the topic of testosterone replacement for women, and to understand all the nuances regarding the options in delivery methods and dosing. Today I'll discuss options for testosterone replacement, including using 1/10 of an FDA approved male product, compounded creams and gels, as well as appropriately dosed hormone pellets. I'll particularly focus on how to safely dose hormone pellets, and will share the method which my office has used in many thousands of patients, and has been proven to reach safe levels. Appropriately dosed pellets should be thought of as a viable option for those who don't prefer to use a topical cream or gel. LINKS: The Truth About Testosterone For Women Over 50 https://youtu.be/LpG25EUvg-U Peter Attia - Episode 348 ‒ Women's sexual health, menopause, and hormone replacement therapy (HRT) https://www.youtube.com/watch?v=W0XW6av2wLQ

I'm often surprised how many of us were not taught about the anatomy of our external genitalia, so when we're talking about labiaplasty, many people are confused about what that means. Today I'm talking about the difference between the labia minora and the labia majora, and why some women might seek to surgically change either or both of these areas. This can particularly be an issue in midlife because of fat loss, as well as naturally aging skin. While no one needs a labiaplasty, it is a choice that many women make in order to restore their comfort and self-confidence. Having done hundreds of these surgeries, I cannot only confidently counsel you about the pros and cons of making this choice, but I can also provide the best outcome if you do decide to proceed.

Here is the sixth video in our resistance training series with master trainer Kelley Workman, who shows us four exercises you can do at home in 30 minutes. Watch the first part here: https://www.youtube.com/watch?v=X_YMrHiz2ek Watch the second part here: https://www.youtube.com/watch?v=ma-osU7Bg9E Watch the third part here: https://www.youtube.com/watch?v=qD6Z89vAlqk Watch the fourth part here: https://youtu.be/zXNh5bb0lMo Watch the fifth part here: https://youtu.be/VhFKn5PGfRQ This week will be presenting four additional exercises that you could choose to mix and match with the others. You may choose to master these alone for a month before we continue to add more! The important thing is to be consistent and not get injured, and also provide variety that keeps you interested. Master Personal Trainer - Kelley Workman You can connect with Kelley at www.kelleymoves.com

After taking a short break to finish my second book, I'm now delighted to be doing what I'm most passionate about, which is seeing women one-on-one to co‑create a holistic health span and general wellness plan. I am licensed to practice medicine in both Texas and California, so if you live in either one of those states, or can come to either state, I can't wait to see you! Licensing laws say that if you are physically sitting in either one of those states for our visit, we are obeying all of the rules. (For patients in other states, you can absolutely schedule a visit with one of my providers in a coaching and education capacity.) With so much information available, it can seem overwhelming to try to optimize our nutrition, movement, hormones, cardiac and neurological wellness, body composition, sleep, emotional and sexual wellness... It can all seem like too much! In our series of three visits, we will create a manageable plan that you can move forward with confidently, and be successful in designing the life that you truly want for your remaining few decades. Here's how it works: First visit: A registered nurse will gather all of your data regarding your medical history, vital signs, symptoms, and wishes. She will also arrange for your blood to be drawn. Second visit: Once your bloodwork is returned, you'll spend 90 minutes one-on-one with me! Third visit: Six to eight weeks later, we'll check in to see how everything is going and adjust as needed. After the third visit, we will regroup and see if your plan is clear—or if you need more support—and my team is here for that too! Email appointments@completemidlifewellness.com, and I can't wait to see YOU!

This week, I'm talking to my friend Bria Gadd, host of the popular podcast "The Period Whisperer." Through her own perimenopause journey, Bria transitioned from being a fitness expert to becoming an expert in functional medicine and nutrition centered on the menstrual cycle, especially for women in those critical years prior to menopause. Bria and I are discussing how to listen to your body to feel better by reducing energy demands and increasing energy input throughout the various stages of our cycle. You can reach Bria through her podcast or via the following links:

I explored the power of choosing “yes” as a default mode—an approach that can open doors and spark transformation, no matter where you are in life. By intentionally welcoming challenges and unexpected opportunities, I discovered a sense of freedom and potential I hadn't tapped into before. My recent travels took me through the breathtaking wilderness of my birth country, New Zealand, but the real discovery was how much bigger life becomes when we let curiosity guide us. Saying “yes” doesn't mean agreeing to everything blindly; it's about giving ourselves the space to consider what might be possible. Especially in the second half of life, this mindset shift can lead to newfound joy, fulfillment, and personal growth. If you're ready for a change, try replacing that instinctive “no” with an open-hearted “yes” and see where it leads.

Here is the fifth video in our resistance training series with master trainer Kelley Workman, who shows us four exercises you can do at home in 30 minutes. Watch this video on Youtube today: https://youtu.be/VhFKn5PGfRQ Watch the first part here: https://www.youtube.com/watch?v=X_YMrHiz2ek Watch the second part here: https://www.youtube.com/watch?v=ma-osU7Bg9E Watch the third part here: https://www.youtube.com/watch?v=qD6Z89vAlqk Watch the fourth part here: https://youtu.be/zXNh5bb0lMo This week will be presenting four additional exercises that you could choose to mix and match with the others. You may choose to master these alone for a month before we continue to add more! The important thing is to be consistent and not get injured, and also provide variety that keeps you interested. Master Personal Trainer - Kelley Workman You can connect with Kelley at www.kelleymoves.com

If you're struggling with restless nights—or just looking to improve your quality of sleep—this video is for you. Today, we'll talk about why sleep becomes even more crucial in midlife and beyond, and explore how common daily habits and environmental factors can disrupt your rest without you even realizing it. We'll touch on broad, healthy approaches that can guide you toward more peaceful nights and help you wake up feeling refreshed. I hope this discussion sparks a renewed commitment to better sleep, because it's one of the most important things we can do for our overall well-being at any age. Let's get started!

In this video, I'll walk you through my daily protein intake routine—from breakfast to dinner (plus snacks!)—so you can see exactly how I hit my protein goals. Whether you're looking to build muscle, lose weight, or just stay healthy, understanding how much protein you need and how to distribute it throughout the day is key.

Here is the fourth video in our resistance training series with master trainer Kelley Workman, who shows us four exercises you can do at home in 30 minutes. Watch the first part here: https://www.youtube.com/watch?v=X_YMrHiz2ek Watch the second part here: https://www.youtube.com/watch?v=ma-osU7Bg9E Watch the third part here: https://www.youtube.com/watch?v=qD6Z89vAlqk This week will be presenting four additional exercises that you could choose to mix and match with the others. You may choose to master these alone for a month before we continue to add more! The important thing is to be consistent and not get injured, and also provide variety that keeps you interested. You can connect with Kelley at www.kelleymoves.com

Midlife is a time not only a hormonal change, but an incredible number of other transitions - including our own personal illnesses, children leaving, parents getting sick and dying, marriages and jobs ending…. sometimes it can seem like the world is colluding against you. Today I'm going to share how even these truly worst times can be catalysts to help you to grow into the best version of yourself, and I will share a simple understanding that has got me and my patients through. You got this.

Periodically it's great to talk about one of my favorite topics- sex! After many years of focusing on midlife sexual wellness, I can say with confidence that intimacy CAN improve with age if we approach it with an attitude of curiosity, self awareness and intention. Today I'm sharing REAL ACTIONABLE STEPS that have worked for me and my patients to revive our sex lives after 50, or at any age. Get my best-selling book, Sexually Woke: Awaken the Secrets to Your Best Sex Life in Midlife & Beyond: https://amzn.to/3rm47IU Join my Well Past Midlife Masterclass to gain a deeper understanding of how to optimize every aspect of your midlife wellness: https://www.wellpastmidlife.com/

This is the third in our resistance training series with master trainer Kelley Workman, who teaches us four whole body exercises that can be completed at home in 30 minutes. Watch the first part here: The 30-Minute Workout That Will Chang... Watch the second part here: The 30-Minute Workout That Will Chang... This week will be presenting four additional exercises that you could choose to mix and match with the others. You may choose to master these alone for a month before we continue to add more! The important thing is to be consistent and not get injured, and also provide variety that keeps you interested. You can connect with Kelley at www.kelleymoves.com Explore more resources: #1 Treatment For Bone Health video • https://www.youtube.com/watch?v=agW5ub-51XM&t=0s MUST-WATCH VIDEO - Queensland research helping osteoporosis sufferers - The Bone Clinic • https://www.youtube.com/watch?v=9EZw_wrFnmI&t=0s The LIFTMOR Randomized Controlled Trial https://drive.google.com/file/ d/1ZNh1...

Now a few weeks into January, it's good to reflect on the resolutions that we made on January 1 and consider how those are going. Today I'll be sharing some of my insights into how to regroup and reset to be successful in making long-term transformation based on what we truly believe is good for us, instead of focusing on what we “should” be doing. I'll also share some of my other favorite ways to regroup and return to our intentions for the year, including (not popular in the west, but it really works!) reflecting on death, and going back to the old favorites of generosity, gratitude, and forgiveness.

There's lots of discussion lately about using estrogen on your face to improve collagen and minimize wrinkles and fine lines. It's difficult to evaluate how well these products work because so far we have no standardization between studies, and different types of estrogen have been used as well as different mixtures of products like hyaluronic acid, vitamin C, and others. Most products use the weakest estrogen called estriol, but using the much more potent estrogen called estradiol is also another option- so long as the dose is very low. So far, no good studies can claim that estrogen is more helpful than placebo for the face, but more research needs to be done before we can state that it isn't beneficial. And at the appropriate doses, there is no scenario in which it would be harmful. Today, I'll be going over some different options and dosing protocols. At CMWC we offer no promises, but recommend you to try it and see!

Today I'm revisiting the common idea that hormone pellets are somehow worse or more dangerous than other options for testosterone delivery. Derogatory language like “pellet pushers” is divisive and unhelpful, and suggests that all providers who prescribe pellets are practicing irresponsibly. While irresponsible providers exist in all fields, well educated menopause experts find that pellets are a viable option for patients who choose them, after being given the pros and cons of all available hormone delivery methods. Remember that we do not have an FDA approved testosterone product available for women, so all testosterone for women comes from a compounding pharmacy- and whether it is a cream, a pellet or a sublingual troche, it's exactly the same product, and the delivery method should be the patient's choice.

This is the second in our resistance training series with master trainer Kelley Workman, who teaches us four whole body exercises that can be completed at home in 30 minutes. On November 27, we posted our first video, and Kelley's suggestion is to master four exercises (3 x weekly for 30 minutes) for a month before adding more. Watch the first part here: https://youtu.be/X_YMrHiz2ek This week will be presenting four additional exercises that you could choose to mix and match with the others. You may choose to master these alone for a month before we continue to add more! The important thing is to be consistent and not get injured, and also provide variety that keeps you interested. You can connect with Kelley at www.kelleymoves.com Explore more resources: #1 Treatment For Bone Health video https://www.youtube.com/watch?v=agW5ub-51XM MUST-WATCH VIDEO - Queensland research helping osteoporosis sufferers - The Bone Clinic https://www.youtube.com/watch?v=9EZw_wrFnmI&t=0s The LIFTMOR Randomized Controlled Trial https://drive.google.com/file/d/1ZNh1GfV02RPVVpkGtkIwSbYvDaJ5vWlU/view

Most of us have heard that the lifetime risk of breast cancer for a woman in the United States is 1 in 8, which is alarmingly high. It's important to keep in mind that this is a population based risk, and that your own personal risk might be significantly lower or higher than this. Today I'm talking about a new FDA regulation requiring that mammograms assess our level of breast density, since this is one of the factors that can increase our breast cancer risk. For patients with high breast density (in the level C or D range), which is more than 50% of patients, the recommendation is to use a risk calculator and consider additional testing (with ultrasound or MRI) for a patient whose calculated lifetime breast cancer risk is greater than 20%. Anyone can do this risk assessment themselves using the link below. If your risk is 20% or greater you can talk to your physician about ordering additional testing. https://bcrisktool.cancer.gov/calculator.html

I am so excited to announce our new “Well Past Midlife Masterclass” being introduced in early 2025! Today I'm going to give you an exciting opportunity to be part of the first cohort of this eight week course, for a massive discount! I'll be discussing how the course will work, but in brief, you will receive two 30 minute videos a week, and join in a weekly 90 minute zoom meeting with me and 20 of your classmates, who will soon become your new best friends! This is not only learning about everything to do with perimenopause, menopause and beyond, including nutrition, exercise, sleep, lab, testing, sexual wellness and more….but it's also a genuine invitation to connect with other women going through the same struggles. Members of our online course will forever become members of our “inner circle” and receive early invitations to our retreats and events as well as a 10% discount for all in-office procedures. We will be announcing the dates of the first cohort early next year, and if you are interested in being first on the list, please send an email to MenopauseEducation@completemidlifewellness.com This program is open to anyone no matter where you live, since it is a coaching and education program, and it does not involve the practice of medicine. If you are a provider, we will be launching a simultaneous course for medical providers teaching you how to incorporate menopausal medicine into your practice, so we can increase education about this important topic throughout the world, and encourage more women to connect and not feel alone!

By now we are all aware of the countless benefits of resistance training, but it can be hard to know where to start. Today I will show you my real 30 minute workout with master personal trainer Kelley Workman. You can do this at the gym or in your own home with a few simple free weights. Studies have shown that 30 minutes of heavy resistance training twice a week reduces bone loss, falls and resulting injury, and every chronic disease including dementia. These four exercises use the entire body, and Kelley recommends doing these twice a week for a month before adding anything new. Next month we will be back with 4 additional exercises to mix it up a bit. With all of my ironman training I haven't lifted weights in a couple of months so I am starting along with you! You can connect with Kelley at www.kelleymoves.com

These recent times have left many of us feeling very unsettled and uncertain, and feeling like we have no agency to change things in the world. Today, I'll share a simple way to switch our mindset from feeling like the world is “happening to us” where we have no power, to a place of agency and choice. From this place we can move forward even in difficult times and make positive changes that affect us and all of those around us, moving towards creating the optimal older version of ourselves.

Many patients ask how to find a menopause provider and how to evaluate your provider's credentials and education. At Complete Midlife Wellness Center we are proud to have three Board Certified Ob/Gyn physicians who are certified through the menopause society, as well as nurse practitioners with menopause society certification. We are thrilled to announce that Dr. Hillary Boswell will be joining us in November to expand our services, and huge congratulations to Brandi, Hollie and Hayley who recently passed their menopause society certification exam! If you are a provider interested in joining our provider education program in 2025, please email PractitionerEducation@CompleteMidlifeWellness.com to be added to the first to know list. A link to our Menopause Education Platform will be provided as soon as possible, and no later than early 2025.

Reduction in bone density, which can lead to osteoporosis and increase our risk of fracture as we age is one of the most important goals of a healthy second half of life. We've talked extensively before about the benefit of menopausal hormone therapy for reducing the risk of osteoporosis, but today I'm going to focus on how important exercise is in the process of helping our bones to stay healthy and even to improve their strength. Traditionally as women age and develop low bone density, we were taught to stick with very low intensity exercises, but this has been shown to not only be incorrect, but also harmful. Strenuous exercise, including use of heavy weights is not only safe if monitored properly, but incredibly beneficial for improving bone density and reducing the risk of falling and fracturing, as well as improving quality of life! MUST-WATCH VIDEO - Queensland research helping osteoporosis sufferers - The Bone Clinic https://www.youtube.com/watch?v=9EZw_wrFnmI The LIFTMOR Randomized Controlled Trial https://drive.google.com/file/d/1ZNh1GfV02RPVVpkGtkIwSbYvDaJ5vWlU/view?usp=sharing

While knowledge about how to be healthier is skyrocketing, our health as a country is not improving. Knowledge alone clearly doesn't work. What's missing is the motivation to put our knowledge into action consistently, so that we can truly transform into a healthier, happier way of living. Today I'm sharing the work that I'm passionate about in the field of motivation; a passion that inspired my second book. After 25 years of helping patients create their healthiest life, I've observed 3 states of being; one of which leads to an almost effortless commitment to make healthy choices. For those of us who still feel stuck making choices that we know are not in our best interests, wondering "why did I do that again?", I'll share a system that works for both me and my patients, to finally make lasting change from a place of peace and ease. The best news is that we get to feel better now and improve our immediate health, while create the healthiest older version of ourselves. When you live in alignment with what you deeply believe is good, you will notice healthy choices naturally falling into place. I'll be sharing more as the book progresses!

Despite the numerous well known benefits of menopausal hormone therapy, it's important to talk about some common side effects. The most common frustrating side effect that we seen our practice is a new onset of bleeding, which affects about 5% of patients. The good news this is very rarely anything to worry about. It is certainly a major annoyance that needs to be addressed. Today I'll discuss why this happens in both menopausal and perimenopausal patients, how to evaluate it and most importantly how to make it stop!

During the last decades of confusion about menopausal hormone therapy, many well-meaning solutions were offered to patients claiming to be safer than the feared traditional HRT. These include combinations of estrogens, progesterone and testosterone in the form of topical creams and sublingual preparations. Now that we are emerging from this fog of confusion, and understand that estradiol, progesterone and testosterone are not only safe, but also provide numerous health benefits for women, it's important to reevaluate whether compounded estrogen products still have a place. Today I'm discussing the different types of estrogen that are available in compounded form, why progesterone cream is not a safe solution for patients who have a uterus, and why at the current time we need to rely on testosterone in compounded form, and how to ensure that we're getting the safe and most beneficial dose.

Managing the time leading up to menopause, known as "peri-menopause," can be particularly challenging due to fluctuating hormone levels and their often unpleasant side effects. These years can feel like an unpredictable roller coaster, making it difficult for both patients and providers to find balance. However, understanding what's happening in your body during this period is key. With the right knowledge, we can develop a treatment plan that includes effective options to alleviate symptoms and bring your life back into balance, helping you navigate through these challenging years with greater ease.

As science progresses, it's so important to recognize when we got something wrong and tell patients that we have learned something new and better. Too often, doctors are stuck in their old ways and are not up-to-date in the latest science, and are continuing to practice out-of-date medicine without recognizing that they were wrong. Today I'm addressing the top five things that I personally got wrong, and I told patients these things for years before learning that there was a better way based on modern science. Even what we tell patients today no doubt will change as our understanding progresses, so it's important to see medicine (and science in general) as an ever-changing growing body of knowledge. As patients it's so important for us to stay educated and advocate for ourselves if we hear that our providers are giving information that is out-of-date or incorrect. If we learned anything at all from the debacle about menopausal hormone therapy, it's that we get things wrong sometimes, and we need to accept that, learn from it and move forward with a better way of practicing to take great care of our patients.

With metabolic dysfunction on the rise (including everything on the insulin resistance/pre-diabetes and diabetes spectrum) it's critical to understand how we are metabolizing glucose and carbohydrates. When you come to the doctor's office, we typically check glucose, insulin and other markers in a fasting state, but we have no idea what happens later in the day. Until recently, continuous glucose monitors have only been approved by insurance for diabetic patients and have required a prescription. Recently Dexcom released an over-the-counter continuous glucose monitor called Stelo, which measure is your glucose every 15 minutes, 24 hours a day. Today I'm talking about my experience with Stelo and why it might be something to consider, especially if you're struggling with weight gain or if you simply want to be educated about how different foods affect your metabolism.

Now that we are all aware of the multiple health benefits of taking menopausal hormone therapy, let's dig into some of the questions regarding timing, particularly for estrogen. There's no doubt that starting estradiol as soon as possible after menopause helps keep our blood vessels healthy, and reduces the risk of cardiovascular disease as well as multiple other diseases, including Alzheimer's. But what if you were not offered hormones and you are now more than 10 years past menopause? Today I'll be talking about what studies have shown regarding the possible risks of starting estrogen later in life, and why these risks may have been overblown and don't apply to everybody. I'll also talk about the myth that hormones should be stopped at some point, and discuss why this idea ever became popular.

This has been an exciting year with much more attention being paid to midlife women's hormonal health. Finally perimenopause/menopause is getting a voice, and the use of MHT (menopausal hormone therapy) is becoming widely accepted. Once we have decided to take menopausal hormone therapy, there are multiple options of products and routes of administration. Today I'll be discussing the different options for bioidentical menopausal hormone therapy, and the pros and cons of each. It's also important to understand why the doses are vastly different for the various different products, and why it's important to have your blood drawn to make sure that you are reaching optimal levels, because absorption is highly variable between patients. In the end, reaching the appropriate blood levels is much more important than the route of administration, which is really just a matter of personal choice and lifestyle. While the vital hormone testosterone continues to be controversial, in my practice we consider "optimal" for female testosterone to be in the upper range of what is physiologic for women (restoring levels to the high end of what they were when we were younger). Multiple studies have shown that these levels safely provide benefits for sexual wellness as well as muscle and bone conservation, sleep and mood. We recognize that long-term very high levels of testosterone put patients at risk of not only nuisance symptoms, but also irreversible masculinizing effects, which is why we never dose at that level, and why we have developed a novel dosing protocol which has proven to be safe and effective. Unfortunately, the practice of "Supra-physiologic dosing" continues elsewhere in the community, and is at the root of many people's misunderstanding about the safety of testosterone . We set ourselves apart from others who put their patients at risk with levels that are too high, and we pay the utmost attention to making sure we keep hormone levels optimal, without elevating risk.

Vitamin D is the subject of a lot of controversy right now after the Endocrine Society made new recommendations in June 2024 suggesting that routine screening for vitamin D was not necessary, and routine supplementation was not beneficial for the average person. Today I'm looking into how they came up with this recommendation and what hundreds of studies have shown over the years, to put this recommendation in context. Everyone agrees that vitamin D is critical for life and no one is suggesting that we don't need it, but questions remain around whether we need to take a supplement or if we can find it naturally, and if so, whether we need to measure blood levels and what the optimal blood level should be.

Creatine is a naturally occurring peptide consistent of 3 amino acids, and has been widely studied for its numerous benefits and low side effect profile. In fact creatine is the most studied supplement in the world. Well known to improve muscle mass and sports performance, creatine is particularly relevant in midlife when losing muscle and bone accelerate, and gaining muscle can be more challenging. As well as the numerous health benefits related to muscle and bone, creatine also has important implications for brain health including improving memory, dementia risk and recovery from brain injury. In short, creatine is one supplement that I recommend for just about everyone!

Creatine is a naturally occurring peptide consistent of 3 amino acids, and has been widely studied for its numerous benefits and low side effect profile. In fact creatine is the most studied supplement in the world. Well known to improve muscle mass and sports performance, creatine is particularly relevant in midlife when losing muscle and bone accelerate, and gaining muscle can be more challenging. As well as the numerous health benefits related to muscle and bone, creatine also has important implications for brain health including improving memory, dementia risk and recovery from brain injury. In short, creatine is one supplement that I recommend for just about everyone!

Most of us have heard a lot about insulin resistance but many of us still don't understand why it should be considered a disease in and of itself, separate from diabetes. Insulin resistance affects more than 50% of our patients and causes weight gain around the middle, as well as increasing heart disease, Alzheimer's disease and of course, diabetes and its related complications. My hope is that with a better understanding of how this process works we can each get more involved in doing the things that are necessary to cure insulin resistance. This can almost always be cured with nutrition and exercise alone, without medications. Once we truly understand how the process works, we can become internally motivated with a clear reason WHY to stick to our healthy nutrition and exercise program.

Today I'm back with my partner, Dr. Leah Antoniewicz, discussing Nitric oxide. This fascinating molecule is made of one nitrogen and one oxygen atom (NO), and reduction in nitric oxide has been shown to be associated with an increase in multiple diseases as we age. Today, I'll be talking to you about the science of how nitric oxide works, as well as how to naturally increase it and some things to avoid that might be decreasing it.

Our understanding of the vital importance of the gut biome has skyrocketed in the past 10 years, yet we are still just beginning to learn all of the incredible functions of these healthy bacteria. Today I'll be reviewing the role of healthy gut bacteria in the prevention of multiple disease processes, including the most common diseases that affect American women- obesity, insulin resistance, diabetes and cardiovascular disease. I will particularly be talking about a really interesting key bacteria called Akkermansia, and a growing body of research suggesting its importance in weight maintenance and insulin sensitivity, amongst other things. Since learning about this, I have started taking the Pendulum brand Akkermansia product myself (I'll explain why I prefer this brand in the video though I have no affiliation with the company), and recommend it to many of our patients. I think after listening to this, you will consider it too!

Iron is a vital micronutrient that is sub-optimal in more than 50% of women. This is frequently missed because it masks as many other things, and most doctors don't check the labs that are necessary to evaluate this completely. Today I'll be talking about where we find iron in our diet, how to diagnose low iron and how to address it by evaluating our input, absorption, and ruling out any sources of blood loss. I'll also tell you about my own story with low iron, how I corrected it, and how both my patients and I feel so much better when our iron is optimized!

We all know that alcohol is a toxin with numerous effects on our health - from weight gain, to sleep and mood disruption as well as causing multiple cancers, diabetes, heart disease, gut dysbiosis, liver damage and dementia - even at "socially acceptable levels." Many of us drink in moderation and don't consider it to be a "problem"- but today I'm discussing an interesting way of reframing your relationship with alcohol and being very clear about where it might be causing problems in your life. I came across an amazing community called "One Year No Beer" (link and tag on social) and joined their 28 day alcohol free challenge. This challenge is supported with emails, videos and connecting with others on the same journey, and invites you to experience how you feel without alcohol for a prolonged period. Like me- a break from drinking makes most people realize that we are being held back by alcohol, and without it many things improve! My personal goal is to be someone who drinks "as much as I like as often as I like"- which will amount to very little, and not very often.

The most common killer of both men and women is heart attack, so understanding how to reduce our risk could not be more important. Since the 1980's, studies have consistently shown that menopausal hormone therapy (particularly estrogen) reduces the risk of heart disease in women. The now infamous Women's Health Initiative study surprised the medical community in 2002 by suggesting that hormone therapy increased the risk of heart attack in a small subset of women. After 22 years of gathering more data, multiple large studies have now confirmed what we previously understood, which is that estrogen has a highly beneficial effect for the heart if it's started in the first 10 years after menopause, and benefit seems to be negligible if it's started later (but not harmful). We no longer recommend taking the lowest dose for the shortest time, but rather suggest starting menopausal hormone therapy as early as possible and continuing it long term. For the great majority of patients the benefits far outweigh any potential risks.

Many people have strong opinions about compounding pharmacies, although few people know what they really are, how they are regulated and what the difference is between one type of compounding pharmacy and another. There is a perception that compounded drugs are not FDA approved, not regulated or somehow not safe or reliable. Today I'm going to explain what these pharmacies are, why we might choose to use them (or not) and why the perception that compounding is inferior or not safe is quite inaccurate.

This past two decades has brought so much confusion about menopausal hormone replacement and breast cancer risk, but we now are entering a modern time with a much better understanding of how all this works. Today I'm going to review how this controversy ever started and what the modern understanding is regarding estrogen and breast cancer. You may be surprised that we are now flipping the script and realizing that estrogen not only has no effect on increasing breast cancer risk, but actually reduces the risk of dying from breast cancer if it's started early. Not only that, but estrogen also undeniably reduces the risk of colon cancer, osteoporosis, and particularly cardiovascular disease when it is started shortly after menopause. We no longer recommend taking hormone replacement only for treatment of hot flashes and night sweats, or stopping it after any defined time period. The health benefits of starting it as soon as possible after menopause and taking it for life outweigh any risks for most women. ~ Dr. Susan

While the safety and benefits of menopausal hormone therapy (MHT) are becoming widely accepted, hot debate continues around dosing, delivery methods and how to monitor levels. Advisory boards including the American College of Ob/Gyn and the Menopause Society support the use of (MHT), but much confusion continues regarding ideal blood levels, whether to check blood levels at all, and optimal route of delivery. The dosing of both estradiol and testosterone varies 5-10 fold between methods such as patches, gels, sublingual methods or pellets. Both doctors and patients need to understand the dose that they are prescribing to make an educated decision. Today I will help to shed light on the differences between these options, and why my strong opinion is that blood levels are critical to ensure that levels are not too high or low for your optimal health.

Sometimes we have to be our own advocate and ask for the tests that we need since many doctors don't offer very high-level labs that can be critical to maximizing your healthspan and helping you to feel great. Today I'm going to go through a real patient's lab panel and show you what we look for in our office during a hormone consultation. I'll be discussing the difference between "reference ranges" and "optimal ranges" so that you can interpret your own lab values with a critical eye and make sure that you're not missing any opportunities for wellness. I'll include an actual copy of this patient's labs so that you can ask for exactly the same thing when you go to your doctor and you'll be empowered with everything you need to start on your wellness journey! LINK - https://completemidlifewellnesscenter.com/private-practice/womens-fasting-panel/ If you do get these labs done, we can also discuss them with you virtually -or in person if you find your way to Houston!

So much has changed in our understanding of cholesterol and how it affects our risk for heart disease since I was in med school! Until recently we talked about "good cholesterol" and "bad cholesterol" with very little understanding of what those words actually meant. Today I'll attempt to unwind a little bit about what cholesterol does in our body, how to test for the particular lipoproteins that put us at highest risk for heart disease, the importance of ApoB, and most importantly what we can do to reduce our risk of heart disease based on this information. While this is often a largely forgotten subject for women, it's important to remember that the number one killer of both men and women is cardiovascular disease, and it is critical that we understand our own heart health, and how to optimize it!

Have you been as confused as me about all the controversy that you hear about which fats are the healthiest? Which ones we should avoid and which we should consume more of? What does MUFA, PUFA, trans fat or saturated fat mean? Is a low-fat diet healthy or should we aim for 30% fat or higher? Today I'll go through a basic introduction to the types of fat that are available in foods, which ones appear scientifically to be the most healthy, and which ones we should avoid.