The guest
Dr. Sarah Gottfried: Harvard-trained OB/GYN and clinical professor of integrative medicine and nutritional sciences at Thomas Jefferson University, with 20+ years treating hormone health and longevity. Author of The Hormone Cure and Women, Food, and Hormones.
What this episode covers
Andrew Huberman interviews Dr. Sarah Gottfried about optimizing female hormone health for vitality and longevity across the entire lifespan, from puberty through perimenopause and menopause. They cover the gut microbiome and the 'estrobolome,' hormone and nutrient testing, cortisol and perceived stress, and the surprising prevalence of digestive issues in women. The conversation digs into PCOS, oral contraceptives versus copper IUDs, supplements for cortisol and inflammation, and the controversy around hormone replacement therapy. Gottfried repeatedly stresses precision medicine, the democratization of health data, and the underappreciated psychosocial drivers of women's health.
Recommended on this episode
BookRecommendedISBN verified
The Hormone Cure
Sarah Gottfried
“I read the hormone cure and found it to be tremendously interesting and informative... so I highly recommend the hormone cure”
“I read the hormone cure and found it to be tremendously interesting and informative... so I highly recommend the hormone cure for anybody interested in hormones”— Andrew Huberman
ProductRecommended
Copper IUD (ParaGard)
ParaGard
“I'm a huge fan... I love the IUD and I love it for younger women too... it's a really great choice”
“I like copper because it's non hormonal it's as effective as getting your tubes tied... I love it for younger women too”— Sarah Gottfried
ProductRecommended
Cortisol Manager
Integrative Therapeutics
“one supplement that I found to be incredibly helpful for people who tend to have high cortisol at night... it's so effective”
“there's one supplement that I found to be incredibly helpful for people who tend to have high cortisol at night and that's called a cortisol manager it's by integrative Therapeutics”— Sarah Gottfried
ProductRecommended
Rhodiola rosea
(generic herb supplement)
“rhodiola is very effective it's been shown in multiple randomized trials to lower cortisol”
“rhodiola is very effective it's been shown in multiple randomized trials to lower cortisol so that could be very effective”— Sarah Gottfried
ProductRecommended
Phosphatidylserine (PS)
(generic supplement)
“the other thing that I think is super effective is phosphatidylserine”
“the other thing that I think is super effective is phosphatidylserine PS for short fish oil also more modestly reduces cortisol”— Sarah Gottfried
ProductRecommended
Cleveland HeartLab
Cleveland HeartLab
“one of my favorite cardiometabolic panels is to do a Cleveland heart lab... they give me the most reliable information”
“one of my favorite cardiometabolic panels is to do a Cleveland heart lab so I think they give me the most reliable information”— Sarah Gottfried
The guest's own work
BookBy the guestISBN verified
Women, Food, and Hormones
Sarah Gottfried
“the two books that I'd like to highlight... are women food and hormones and the hormone cure”— Andrew Huberman
Also referenced (named, not recommended)
ProductReferenced
Genova Diagnostics (NutrEval / Metabolomix)
Genova Diagnostics
“for testing I do a lot of genova nutreval... they developed another test called metabolomix which does much of the same testing but it's a finger prick”— Sarah Gottfried
ProductReferenced
SpectraCell
SpectraCell Laboratories
“second lab is Spectra cell I use Spectra cell occasionally I find it not quite as easy in terms of fitting into my practice”— Sarah Gottfried
ProductReferenced
Ashwagandha
(generic herb supplement)
“with ashwagandha most of the data comes from thousands of years of using it in ayurvedic medicine and it's considered a double adaptogen”— Sarah Gottfried
ProductReferenced
OmegaQuant
OmegaQuant
“for you I would suggest an Omega Quant or one of my favorite cardiometabolic panels is to do a Cleveland heart lab”— Sarah Gottfried
ProductReferenced
Thorne Gut Health Test (Gut Bio)
Thorne
“a test by longevity... the test is under the umbrella of thorne and they used to call it gut bio... you get much more dense data”— Sarah Gottfried
ProductReferenced
Clomid
(clinical drug)
“if they want get pregnant then you help them get pregnant by addressing some of these PCOS issues like maybe you give them Clomid”— Sarah Gottfried
ProductReferenced
NuvaRing
Organon
“the so-called ring the... NuvaRing maybe that's a brand name... the ring is releasing estrogen locally as opposed to taking it orally”— Andrew Huberman
ProductReferenced
NordicTrack
NordicTrack
“do you remember Nordic tracks I had a Nordic Track in my house and that was that was like it”— Sarah Gottfried
ProductReferenced
WHOOP
WHOOP
“are you familiar with the whoop data with alcohol no but we have a collaboration with whoop through that paper”— Sarah Gottfried
Big reveals from this episode
- Gottfried calls oral contraceptives 'the number one endocrinopathy that is iatrogenic for women' and declares herself an 'IUD Crusader' favoring the copper IUD.
- Despite doing lots of microbiome testing, she admits science still cannot say what a healthy microbiome should look like ratio-by-ratio.
- She recounts her own age-35 hormone panel showing cortisol three times normal, fasting insulin in the 20s, and glucose at 105, after her doctor offered only a birth control pill and antidepressant.
- Claims oral contraceptives can shrink the clitoris by up to 20%, and the elevated sex hormone binding globulin may not fully reverse after stopping the pill.
- Argues the 2002 Women's Health Initiative was 'the wrong study in the wrong patients with the wrong medications,' scaring millions of women away from beneficial hormone therapy.
- Cites Lisa Mosconi's work showing a ~20% decline in cerebral glucose metabolism from premenopause to postmenopause, linking perimenopause symptoms to Alzheimer's risk.
- Her single biggest takeaway: every woman should get a coronary artery calcium score by age 45.
Worth remembering
- Women have roughly twice the rate of depression and insomnia, 3-4x the risk of multiple sclerosis, and 5-8x the risk of thyroid dysfunction versus men.
- The gut is about 10 feet longer in women than in men, contributing to far higher rates of constipation.
- Around 70-80% of Americans are deficient in magnesium, which is heavily involved in clearing estrogen.
- A retired UCSD physicist reversed his autoimmune disease by drinking a daily smoothie containing 57 different vegetables and fruits.
- In Gottfried's (Huberman lab) cell paper, cyclic sighing produced the greatest improvements in mood and lowered resting heart rate among breathing protocols.
- Women's testosterone declines by about 1% per year and can start dropping as early as age 28.
- She cites that roughly one in 12 people may carry a hypermorphic adrenal gene variant affecting cortisol output.
- Phosphatidylserine's effective dose is 400-800 mg, but in trials 400 mg was more effective than 800 mg.
- Taking oral contraceptives for about 5 years reduces ovarian cancer risk by roughly 50%.
- For cardiometabolic health, Gottfried recommends roughly one-third cardio to two-thirds resistance training at the population level.
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