Understanding Midlife Weight Gain, Obesity and Buzzy Weight Loss Drugs with Endocrinologist Dr. Rocio Salas-Whalen
We do a deep dive into midlife weight gain and the impact of fluctuating hormones on body composition and health with triple board-certified physician and obesity expert Dr. Rocio Salas-Whalen. Dr. Salas-Whalen walks us through the “perfect storm” that links roller coaster midlife hormones to weight gain, gives us a primer on popular weight-loss drugs like Ozempic, and catches us up on the latest thinking on obesity and new tools to measure healthy body composition (forget the BMI, think body composition scans). Plus, why it’s time to stop worrying about pounds on a scale and instead focus on muscle building and visceral fat reduction for optimal health, mobility, and longevity.
About Dr. Rocio Salas-Whalen: Dr. Rocio Salas-Whalen is a board-certified obesity medicine specialist and bestselling author of “Weightless.” A returning guest on A Certain Age, she cuts through GLP-1 hype and misinformation with real clinical guidance — from who's actually a good fit for the medication to muscle preservation and what your doctor probably isn't telling you.
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This is Dr. Salas-Whalen’s first appearance. Find her second episode here:
One in Eight Americans Is on a GLP-1 — Here's What Dr. Rocio Salas-Whalen Wants You to Know
Quotable:
“It's the changes in weight that really brings patients to the doctor's office. And midlife for many women is the scenario of a perfect storm. There are many changes that happen to a woman's life during midlife that are going to make it easier for a woman to gain weight, or very difficult for a woman to lose weight.”
Transcript:
Katie Fogarty 0:00
It targets the two reasons that humans eat. We eat for fuel, for survival, and we eat for the anticipation of reward. For the fuel part, these hormones increase your satiety hormones when you start eating — meaning you'll get full before you finish your plate, maybe with half or a third of what you'd normally need. Then, in between meals, they suppress your hunger hormones.
Katie Fogarty 0:31
Welcome to A Certain Age, a show for women who are unafraid to age out loud. Beauties, we have done 50-plus shows on menopause and easily 75 health shows overall, but we have not yet covered this topic or featured this type of expert. So make sure your AirPods and phone are charged, because you are not going to want to miss one word of this show. Today I'm joined by Dr. Rocio Salas-Whalen, who is triple board certified in internal medicine, endocrinology, and obesity medicine. Dr. Salas-Whalen is committed to changing the narrative around obesity, weight, and health, and to helping women navigate the hormonal changes that impact body composition. Body composition goes beyond pounds on the scale — it's clocked as fat versus non-fat, or muscle. An optimal body composition plays a key role in our health, mobility, and overall sense of well-being. We are diving into all things midlife metabolism, optimizing a personal healthy weight, and of course those buzzy, headline-making weight loss drugs like Ozempic — and we are doing it with an absolutely stellar guide. Welcome, Dr. Salas-Whalen.
Dr. Rocio Salas-Whalen 1:49
Thank you so much for having me.
Katie Fogarty 1:51
I am very appreciative of your time. I know how hard it is to get busy doctors on this show, and I'm thrilled that we've made this happen. And I want to kick off with a little stage-setting. As I said in my introduction, you are triple board certified. One area of focus is obesity medicine, and you don't need to be a doctor or have even gone to medical school to understand the term “obesity medicine.” But endocrinology is more of a mystery, at least to me. I would love to have you open by sharing what an endocrinologist is, and what it is that you do in your practice.
Dr. Rocio Salas-Whalen 2:24
So, endocrinology is the study of hormones. Basically, we specialize in the treatment and diagnosis of any hormonal problems or diseases, and this could be hormones in our brain, in our gut, in our reproductive organs — just any hormone throughout the body. That's what an endocrinologist does. We really span a person's entire lifespan when it comes to hormone production.
Katie Fogarty 2:51
Okay, and so you also have this intersection with how hormones impact weight. I know that you're also board certified in obesity medicine. The very first podcast that I ever recorded, which was about 190 shows ago, was with a guest named Dr. Anita Sadati, who's an OB/GYN and integrative physician, and she shared with me on that show that the number one concern she hears from patients is unexplained weight gain. The number two was painful sex. But today we're exploring what, for many women, is a number one issue: unexplained changes in metabolism and weight. So let's start by hearing from you — how do changes in our midlife bodies, due to fluctuating hormones, impact our metabolism and result in what can be unexplained weight gain for women in midlife?
Dr. Rocio Salas-Whalen 3:43
And I'm going to have to agree with that OB/GYN, because that's the main complaint that patients come to see me for. And I would put changes in weight even higher than any menopausal or perimenopausal symptom that we're hearing so much about — it's the changes in weight that really bring patients into the doctor's office. Midlife for women is a perfect storm. There are many changes happening in a woman's life during midlife that make it easier for a woman to gain weight, or very difficult for a woman to lose weight. In our teens, 20s, and 30s, we have pretty much everything going for us hormonally speaking — we have estrogen at its full potential, and estrogen really impacts metabolism in a way that can change our body composition, positively or negatively. When there is estrogen in our body, we tend to have more subcutaneous fat, and more fat in our hips, thighs, and breasts — considered our fertile years. During perimenopause and menopause, when we start having drops in estrogen, our body composition changes. That subcutaneous fat starts to build internally — what we call visceral fat. Visceral fat increases insulin production; you get insulin-resistant hyperinsulinemia, pre-diabetes, metabolic disease. And then we lose muscle mass — lean muscle mass — as our estrogen drops. So estrogen drops, we increase our visceral fat, and we decrease our muscle mass. That's a bad combo right there. Now, for many women — and not just women, also men — there is a very strong genetic component when we're talking about obesity and being overweight. About 40 to 50% of somebody's weight is predetermined by family history. So what I see clinically is patients who weren't struggling with weight in their teens, 20s, or 30s, but who have a family history of obesity or being overweight — it starts to show up in midlife, when what they were doing to maintain a normal weight doesn't work anymore. So we have the changes in estrogen, and then family history starts kicking in during midlife, prompting weight issues a woman didn't have before. And then we add environmental causes or stress — aging parents. We're in midlife, we run into the aging or sickness of our parents, which adds stress. We have growing children — maybe teenagers leaving the house — which adds another stress. And then maybe professionally we're at our peak. So it's just the perfect storm for weight gain in a woman in midlife.
Katie Fogarty 6:38
Yeah, the perfect storm, as you called it — and I so agree. I found myself nodding along to all of that. I have children who are in their late teens to early 20s, and I'm helping them “adult.” I have a lot going on professionally, and I'm also helping manage my parents, and I know many of my listeners are as well. So I'm so thrilled we're exploring this together today. When we talk about obesity, when we talk about changes in weight, I would love for us to start with the definition of what obesity is, and then perhaps what a healthy body composition is, so we can have an understanding of the baseline.
Dr. Rocio Salas-Whalen 7:14
So obesity has been redefined over the last few decades, and we now consider it a true disease. Obesity is a chronic, multifactorial disease. Chronic, meaning it's not curable — the person is going to struggle with it long term. Multifactorial, meaning there's not one single cause that prompts somebody to develop obesity. We used to attribute somebody's weight entirely to lifestyle — either they're exercising and eating healthy, or they're not. Well, now we know that's not the whole equation — it's maybe one-fifth of it. Lifestyle contributes, yes, but then we have, as I mentioned, genetics; we have hormonal changes in perimenopause and menopause; then we have aging, where our metabolism starts to slow down naturally because we lose lean muscle mass; and then we have environmental factors — where we grew up, exposure to endocrine-disrupting chemicals, plastic toxins, stress at work, not sleeping, commuting, traveling for work. So all of that can cause somebody to gain weight or develop obesity. We say this not to make people feel bad that they have a disease — I think it's actually a positive way of seeing it, because it's not something the patient brought on themselves. And I feel like many times, when I explain this to my patients, they feel relief. You can almost see them take a deep breath, like, “Wow, it's not me causing it.” And I think once you relieve the guilt, you really open the door for improvement and change.
Katie Fogarty 8:58
Absolutely, I can only imagine. So when a patient walks through your door — I'm sure you see a wide variety of patients, and a wide variety of circumstances that add up. You said there are five different factors, and they're probably weighted differently in different people. But if somebody walks through your door and says, “I'm struggling with my weight, I am ready to tackle this, I want to feel and be healthier” — what is a starting point?
Dr. Rocio Salas-Whalen 9:24
So, a starting point is redefining weight loss. I think we're redefining obesity, but we should also redefine what it is to lose weight. We had associated weight loss with being skinny or thin — we think about BMI, we think about pounds on the scale. But really, what I'm trying to teach my patients when they come in is fat loss, not total body weight loss. Because when we concentrate on total body weight loss and don't take body composition into account, a patient could be losing muscle. We can end up making the patient “skinny fat” — lighter on the scale, yes, but because they lost a lot of muscle, they may still have a higher body fat percentage. So the starting point is redefining what weight loss is, to set expectations for the patient. Those of us who specialize in metabolism, endocrinology, and obesity are moving away from BMI — we know it's a very antiquated way to assess somebody's health status in regard to their weight. We use body composition now, which helps us see visceral fat percentage, body fat, and muscle mass. For me, those are the three most important components of somebody's body composition. Depending on what their numbers are, we set goals accordingly — some patients need to concentrate on body fat loss, and some need to concentrate on building muscle while decreasing body fat. That's how we're treating obesity now, and how we think about weight loss — or really, fat loss.
Katie Fogarty 11:04
Thank you so much — so interesting to hear about that shift. BMI is something I remember from doctor's appointments in my own past, and for my kids, so it's interesting to hear that the measuring stick is shifting. Dr. Salas-Whalen, we're heading into a quick break. When we come back, I want to talk a little bit more about visceral fat and how patients tackle it.
— BREAK —
We're back from the break. Before we went into it, you shared that BMI is considered an antiquated measuring stick, and that the medical establishment is moving away from that. You talked about how body composition is the newer rubric that we use to measure, and that it measures visceral fat and also muscle. So, if a patient presents to you with too much visceral fat, do you recommend lifestyle changes first? Are these new weight loss medicines the first line of defense? How do you begin to treat patients who are struggling with too much visceral fat?
Dr. Rocio Salas-Whalen 12:06
It really depends on the patient's own particular weight history — I like to call it a very thorough weight history. I want to know at what age the patient started struggling with their weight, or at what age they became conscious of it and started trying to maintain a normal weight, or had to be watchful. The earlier that becomes something conscious rather than something natural, the more likely it is to be chronic and long term, and more difficult for the patient to lose weight on their own. So I really want to get a sense of what the patient has done, has tried, and is currently doing, to help decide whether they'll benefit from weight loss medication. In regard to visceral fat — it's definitely an inflammatory tissue. We know it releases inflammatory chemicals that can promote insulin resistance, and can predispose somebody to more than 14 different types of cancer. So visceral fat is what we call the “bad fat,” or the dangerous fat. Treatment involves decreased caloric intake, diet modification, exercise, strength training, building muscle — and, more likely than not, the possibility of using weight loss medication.
Katie Fogarty 13:30
Now, if a person who's listening to this is thinking, “I don't feel that I probably qualify as being obese, but I'm worried about visceral fat” — short of seeing a doctor, is there any way that a listener could do a personal assessment of where they might stand on visceral fat versus muscle?
Dr. Rocio Salas-Whalen 13:46
Yeah — at home, we can use the waist-to-hip ratio, or just measure the waist. It's not a very exact science, but it's something a patient can do at home. And the patient will really notice the way that their body is shifting — maybe tighter at the center, tighter at the waist, and maybe weaker versus stronger. So the patient gets a sense of what's happening externally, too, reflecting what's happening internally.
Katie Fogarty 14:17
And how does the hip-to-waist measurement work?
Dr. Rocio Salas-Whalen 14:20
So a patient is going to measure their hip — that's at the top of the hip bone, going around the circumference — and then also the circumference at the waist, using the belly button as a guide. Then you compare the hip measurement to the waist measurement. For women, in regard to waist measurement, we consider below 35 inches healthy; for men, below 40 inches. If it's higher than that, it can indicate high visceral fat.
Katie Fogarty 15:03
Okay, great. And so, if somebody does have high visceral fat — whether they've done this test, worked with a doctor, or just know it from measuring, from the way they fit into their clothes these days, or from the way they see their body has changed over the years — and they're considering some of these new interventions... I'm not even sure if they're new interventions, but they're very newly buzzy. At least we hear terms like Ozempic, semaglutide, and GLP. I would love it if you could give us a quick primer on these weight loss terms that are all over the news, all over headlines, all over social media.
Dr. Rocio Salas-Whalen 15:37
Before going there, I want to go back a little bit to visceral fat. I think it's really important — now that we're advancing so much in regard to weight loss — that we move away from imprecise measurements. Body composition testing is more broadly available now, because we're learning more; there are more companies. Even some body composition websites let you put in your zip code, and it'll show you locations around you that have the machine — sometimes nutritionists, sometimes gyms, sometimes doctors' offices. So I really think we should become smarter about our weight and what we know about it, and truly, body composition testing is very helpful. Our gold standard is an MRI, which of course we're not going to do on every patient every time they come to see us. The second is a DEXA scan, which I see a lot of patients having done too. And the third is a body composition scan, which is the least expensive. So I just want to say that there's really no reason anymore why we shouldn't know our body composition when it comes to our health.
Katie Fogarty 16:52
Yeah, that is fascinating — I didn't even know that you could do that. So there are body composition websites where people can put their zip codes in and find assessment tools that will help them measure weight versus fat versus muscle. Question for you: I have had a DEXA scan, but when I hear the word “DEXA scan,” I immediately think of bone health. What role does it play in helping us identify a more accurate body composition?
Dr. Rocio Salas-Whalen 17:16
It's going to give you muscle mass, visceral fat, and percentage body fat. It's going to show muscle per segment in your body — very thorough, more precise than a body composition scan. But again, it's a little more expensive, and you do get some radiation with it, because it's almost like a CAT scan.
Katie Fogarty 17:42
Right, right — but it gives us another reason to prioritize a DEXA scan, because I've had a doctor who specializes in osteoporosis come on the show to talk about the importance of a DEXA scan at some point in a woman's life. Obviously, everyone's going to need to consult with their own healthcare practitioner, but these tests are worth doing, because now you can also learn the benefits we've just heard about in terms of body composition. So put this on your to-do list, listeners. All right — so maybe we could do that primer now on the weight loss terms you think should be on our radar.
Dr. Rocio Salas-Whalen 18:13
The weight loss medications, definitely — they're not new medications. The first of its kind was FDA approved — and we're talking about GLP-1s, also called incretins — first approved in 2005. It was first discovered in 1994 at Mass General in Boston, and the first one was isolated at the VA in the Bronx, here in New York. They were originally developed for type 2 diabetes — for the treatment of type 2 diabetes. But as a side effect, when we started using this medication — and I remember starting to prescribe it back in 2005, during my fellowship — patients were coming back not just with glucose control, but with weight loss. In the diabetes world, we didn't have any drugs that would improve your sugar and cause weight loss — it was always one or the other: improvement in sugar and weight gain. Most of the anti-diabetes drugs we had — insulin, sulfonylureas, Actos, and many others — would prompt weight gain in the patient. So this was the first time we had a drug that helped the patient both ways. Eventually, we started using the medication off-label for weight loss, because for it to work as a diabetes drug, your sugar has to be abnormally high. If your sugar is normal, it doesn't work as an anti-diabetic drug — so it doesn't cause hypoglycemia if you don't have diabetes. That's the reason we can use it in patients who aren't diabetic without any issues. In 2010, we got the first injection formulation, and in 2012 it was first FDA approved for weight loss. So, since 2012, they've been approved for weight loss; since 2005, for type 2 diabetes.
Katie Fogarty 20:12
Why do you feel they're so buzzy today, though? I feel like there are so many people that I know in my personal life, and that you see in the news, who are availing themselves of these drugs. It feels like this hasn't really been part of the zeitgeist since 2012 — when did it cross over and become more of a public phenomenon?
Dr. Rocio Salas-Whalen 20:35
I actually watched this happen, and it was during COVID. COVID really brought attention to obesity. Before, we used to tell patients with obesity, “If you don't lose weight now, in 10 or 20 years you may develop complications from your weight — you'll be at risk for type 2 diabetes, for cancer.” But then COVID came, and what happened was that patients with obesity were the ones with higher mortality — the ones who were sicker, who had more ICU stays. So people with obesity got the message very quickly with COVID: a virus out of nowhere showed that if you had obesity, you had higher mortality. You didn't have to wait 10 or 20 years to know your weight was causing a problem. I remember patients in my clinic saying, “I don't want to die from COVID — I need to lose weight.”
Katie Fogarty 21:35
Yeah, absolutely. So how do these drugs work? What is the mechanism by which they cause you to lose weight?
Dr. Rocio Salas-Whalen 21:42
So these drugs are hormones — actually, synthetic versions of hormones that we make in our gut. We have receptors for these hormones in many places in the body, and we're discovering more all the time as studies continue. But to circle back to how it causes weight loss — it targets the two reasons that humans eat. We eat for fuel, for survival, and we eat for the anticipation of reward. For the fuel part, these hormones increase your satiety hormones when you start eating, meaning you'll get full before you finish your plate — maybe with half or a third of what you'd normally need. In between meals, they suppress your hunger hormones, so you eat small meals throughout the day without feeling deprived, and without feeling starving before your next meal — that's what typically happens when somebody is dieting; it restricts how much you can eat. In the brain, we also have receptors for these hormones in the hedonic eating and drinking centers, where we associate reward, or the anticipation of reward, with food or beverages like alcohol. What these drugs do is block that reward system. So for somebody who has the habit of reaching for food because of anxiety or depression, or reaching for alcohol, when they're on these drugs, they don't get that feedback anymore. At the beginning, they may still reach for it, try it, and just not get anything back — so the behavior changes.
Katie Fogarty 23:22
That is the part I think is so fascinating. I have some women in my own life who've used some of these semaglutides, and at least two of them have told me that it cut down the “food noise” in their head, and that they no longer thought about food in the same way. One of them shared that she no longer even wanted to drink alcohol — that was an unexpected byproduct. She didn't begin using it to stop drinking; it just was something that went along with it. Is that a common experience for your patients?
Dr. Rocio Salas-Whalen 23:54
Definitely — the decrease in alcohol use, we see that a lot. In fact, there are ongoing studies for the treatment of alcohol abuse with these drugs. I have a mental health center that refers me patients — patients who have a history of drug abuse and obesity related to psych medications. Now those patients tell me they have fewer thoughts of abuse, even around drugs. So it's definitely that reward system improving with these medications. The potential and possibilities of these drugs just keep getting bigger.
Katie Fogarty 24:34
That's so interesting. So you mentioned that 2005 is when this became FDA approved for weight loss — is that correct?
Dr. Rocio Salas-Whalen 24:42
No, for type 2 diabetes.
Katie Fogarty 24:44
For type 2 diabetes — 2005.
Dr. Rocio Salas-Whalen 24:45
For type 2 diabetes, and 2012 for weight loss.
Katie Fogarty 24:49
Gotcha, okay. So since 2005, that's almost 20 years. Have there been any long-term studies regarding the safety of these drugs, and if so, what do they say?
Dr. Rocio Salas-Whalen 24:59
These drugs are very safe when they're used by somebody who has expertise with them. As with any drug, the benefit and the safety really depend on the experience of the provider giving the medication, and how they guide the patient. The typical side effects we can expect are nausea and some constipation, but they should all be tolerable enough to get through the day. When a patient is really struggling because of this drug, most likely either they're on the wrong dose, or the doctor isn't guiding them properly on diet or how to manage side effects. But generally speaking, they're very benign drugs — it really depends on how they're used.
Katie Fogarty 25:50
And you shared earlier in the show that obesity is a chronic condition — it doesn't go away, it needs to be managed forever. So do patients who begin using semaglutide — is this something they're signing up for from now to the end of time, or is it something they do for a period of time, then get off, and maintain on their own?
Dr. Rocio Salas-Whalen 26:13
It's going to depend on the patient's weight history. If I have a patient who has struggled with obesity since childhood, then most likely this is a medication they're going to need long term. But let's say we have a patient who never struggled with weight, and then after pregnancy gained 30 or 40 pounds and wasn't able to lose it for whatever reason — that patient may not require it long term. So it really depends on what drove the patient to need the medication in the first place.
Katie Fogarty 26:44
That makes a lot of sense. And are there people who are not candidates for these drugs?
Dr. Rocio Salas-Whalen 26:50
I have yet to meet one — even patients with type 1 diabetes, we're using them very successfully. Patients with a family history of medullary thyroid carcinoma, we don't recommend this drug, because in mice it's been shown that it can cause medullary thyroid carcinoma, but we have not had a single human case reported — it's based on animal studies only. So that would be a contraindication we wouldn't start a patient on: a history of medullary thyroid carcinoma, or any other type of thyroid cancer — papillary, follicular, Hürthle cell. Thyroid cancer in general is not a contraindication.
Katie Fogarty 27:30
Thank you for that. So, for listeners who are sitting here thinking, “This sounds intriguing, I'd be open to exploring it” — is there a gold standard? Is it Ozempic, is it Wegovy, or is it case by case?
Dr. Rocio Salas-Whalen 27:44
I like to compare these drugs to the iPhone. They all work the same, essentially — the same underlying reasoning — but some are newer and improved. I like to say Ozempic is our iPhone 13, Mounjaro or Zepbound is our iPhone 15, and the iPhone 16 is still coming. Every time a new one comes out, it's improved — more effective, fewer side effects. But the way they work is very similar.
Katie Fogarty 28:14
That almost makes it easier — or maybe harder, actually. With iPhones, I never know which one to get. Which is why, I guess, if you get—
Dr. Rocio Salas-Whalen 28:22
—the 13, it still works. You're still making calls, you can still go on the internet. But if you get the 15 or the 16, your battery life is longer — small improvements, but the concept is the same. You can still make calls. You're still going to lose weight with the medication. A lot of times, patients ask me, “What's the best drug?” The best drug is the one you're going to be able to maintain long term, either through insurance or out of pocket — the one you have access to. I can tell you “this is the best drug,” but if you can't afford it, or there are shortages, or it's not available near you, then it's not the best drug for you.
Katie Fogarty 28:57
Absolutely, that makes a lot of sense. You used the phrase “small improvements” when talking about these iPhones getting better and better. So for listeners who are thinking this is all very interesting, but feel like it's not for them — what are small improvements women can make to deal with changes in metabolism in midlife that come from fluctuating hormones? Is it increased weight training? Is it just being more mindful of what you're eating? Are there other recommendations you can make to help women navigate unwanted weight gain, if they're not yet willing to try any of these more comprehensive medications?
Dr. Rocio Salas-Whalen 29:34
Definitely — the earlier you can bank muscle mass, the better. So, moving away from the excessive cardio that we used to do for weight loss — we need to shift the way we see exercise, toward more strength training, resistance training, and building muscle mass. Muscle is our calorie-burning machine — we don't have anything as strong or as potent as muscle for burning calories. The more muscle you have, the faster your metabolism; the less muscle you have, the slower your metabolism, and the more you tend to gain body fat. So strength training is something every woman should incorporate into her daily life, the younger the better. It's like a 401(k) — the younger you start banking it, the better, because in midlife it's a little harder to gain muscle. Not impossible, but harder than if you were in your 20s or 30s. So strength training is one thing. Then your diet — your protein intake should be higher than your other macros, fat or carbs, because we need protein to build muscle. Protein keeps us satiated and full, and it builds collagen and elastin. So definitely: strength training, and increased protein intake. Those are two things we can incorporate that make the changes we're all going to go through a little easier.
Katie Fogarty 31:07
Yeah, that's been a recurring theme on the show — we've heard it from people ranging from fitness experts to medical doctors: increased protein intake in midlife, prioritizing strength training and resistance training. So I'm delighted to hear you echo those recommendations. I've been practicing those in my own life as well, and I feel and see the impact of that. What role does hormone replacement therapy play in managing midlife metabolism? Does it play a role?
Dr. Rocio Salas-Whalen 31:37
Yes. Hormone replacement therapy will help a woman shift her body composition back toward pre-menopause levels — again, going back to that tendency to store body fat viscerally and lose muscle mass. By replacing what your body isn't making anymore — estrogen and progesterone — your body composition should shift back to where it was before. We don't like to say that hormone replacement therapy is a weight loss drug. We have weight loss drugs — the incretins, the GLP-1s. Estrogen is not a weight loss hormone. It will shift your body composition back to where it was, but it will also give you back your sense of quality of life — which may prompt you to sleep better, eat healthier, exercise, make it to the gym. Mood-wise, it's just an overall sense of well-being, when we give you back what you're not making.
Katie Fogarty 32:37
I follow you on Instagram, Dr. Salas-Whalen, and I saw you share something really interesting recently — that in your day-to-day work as an endocrinologist, your job is basically giving people back hormones that are missing from their bodies, causing all sorts of damage, impacts, and conditions. But for some reason, estrogen and progesterone have been so tied to reproductive health that people feel it's okay to let them disappear. I would love for you to expand on that thought a little.
Dr. Rocio Salas-Whalen 33:09
Yeah, it was like a lightning bolt — realizing that my job is to replace hormones, to replace what you're not making. With the exception of estrogen and progesterone, because we've minimized the function of those hormones to reproduction — “You're not fertile anymore, you don't need them, what do you need them for? You're not going to have any more kids.” But with any other hormone we replace, the reason is because we know that being deficient causes immediate symptoms and long-term consequences. That's the main reason we replace hormones — we want to treat, and we want to prevent. That's what we do with cortisol, with thyroid hormone, with testosterone in men, with insulin, with growth hormone — if it's zero, we give growth hormone; you should still have some, but if it's zero, you're a candidate to receive it. With estrogen, it could be undetectable, and we haven't had that teaching or that routine of replacing it, because the woman is in her 50s — she's not going to have any more kids, so who cares? But now we're realizing there are many other benefits of estrogen besides reproduction, and that's why we're seeing women have so many symptoms, and suffer, and see their quality of life decline after menopause, or during perimenopause, from the drop in estrogen. So we're really shifting to thinking of menopause as a hormonal deficiency that affects more than just reproduction.
Katie Fogarty 34:55
Yeah, absolutely — your bone health, your brain health, your—
Dr. Rocio Salas-Whalen 34:58
Your stamina. Your muscle mass, your libido, your sex drive — just overall, what makes a woman feel well, with stamina and a good quality of life.
Katie Fogarty 35:12
Well, I am a big fan of estrogen over here.
Dr. Rocio Salas-Whalen 35:15
Yeah, me too.
Katie Fogarty 35:16
In all seriousness, I've been using HRT for about a year — probably a year plus at this point, maybe a year and a half — and I've noticed a marked improvement across things I can pay attention to, and things I can't measure right now, like long-term impacts to my brain and bones. I feel like I'm banking healthy actions today that will serve me well when I'm in my 60s, 70s, 80s, and beyond. So that's my personal take on it — everyone needs to consult with their own doctor to figure out what's right for them. And I'm going to put in a plug for Let's Talk Menopause, the board of a nonprofit that I sit on, which is a menopause education and advocacy group. If you're still on the fence, and you're not getting information from your personal care provider, I would encourage you to go check out some of the organizations that can connect you with menopause-trained specialists who can help you make an educated decision. Dr. Salas-Whalen, this has been such a phenomenal conversation. I'm so grateful for your time, and for helping us leave with a better understanding of how hormones impact our weight and our metabolism, and why we need to prioritize a healthy body composition, and not just pounds on a scale. We're nearing the end of our time together, but I wanted to close with a speed round, if you're up for it.
Dr. Rocio Salas-Whalen 36:34
Definitely.
Katie Fogarty 36:35
Let's do it. Okay, so I know from following you on Instagram that you grew up in Mexico. You moved to the U.S. at age 25. Now you've got a medical practice where you treat patients in both Spanish and English. How does it feel to have built and opened your own practice?
Dr. Rocio Salas-Whalen 36:50
It was — I'm blanking on the word in English — but it was like a dream come true. I remember when I moved from Mexico to New York over 20 years ago, I used to walk the avenues here in New York City and see the names of doctors outside their offices, and I remember thinking, and dreaming, that I wanted that one day for myself. That's why I left my country — to do that here. And when I was able to do it, when I received my plaque, when I opened my office, it felt like all those sacrifices — it took me about 14 years — were worth it. And I would do it again.
Katie Fogarty 37:35
What a phenomenal accomplishment! I love it, I love it, I love it. You've also built a very active Instagram page — I think you've got about 100,000 followers — and you're committed to sharing information that advances women's and men's understanding of how to navigate hormonal changes. Because I follow you, I see that you do a lot of weight training. What's a favorite workout or workout tool?
Dr. Rocio Salas-Whalen 38:00
For me, it's legs — working out legs. I'm a challenge-driven person, so anything I feel like I can't accomplish, I want to try to do, and do well. Leg exercises — lower extremity and glute exercises — are very hard. They require a lot of concentration, all your senses. And I like how it feels to have strong legs. So it's definitely legs.
Katie Fogarty 38:28
Nice, nice, nice. What would you say to a weightlifting newbie, a beginner? Do you have a recommendation on how to get started?
Dr. Rocio Salas-Whalen 38:37
If you've never lifted weights, invest in a trainer, because the last thing we want is for you to get hurt — and you won't get hurt if you learn properly first. You need to learn how to do the exercises correctly before you start adding weight. I think when we start exercising, we want to move fast and jump straight into weight training, but you have to have a lot of patience. You'll get there — lifting heavy while still building muscle. But if you're starting for the first time, you need to know how to do the exercises to avoid injury.
Katie Fogarty 39:13
Smart advice. Okay, how about this one: this muscle-building superhero is always in your grocery cart.
Dr. Rocio Salas-Whalen 39:20
Eggs. Eggs!
Katie Fogarty 39:23
Oh my gosh, we go through so many eggs in my house. I have all three of my kids living at home this summer, and it's pretty astonishing. Eggs and yogurt, I'd say — I'm totally “the incredible edible egg.” And so, how about this one — finally, your one-word answer to complete this sentence: As I age, I feel…
Dr. Rocio Salas-Whalen 39:42
Stronger.
Katie Fogarty 39:43
Nice, nice, nice, nice. Thank you so much, Dr. Salas-Whalen. We're recording this on a summer Friday — I'm not sure when people will be listening to it, but I appreciate you carving out time before we head into the weekend, on a busy workday, to be with us and help educate and inform us. I'm very appreciative. Before we say goodbye, how can our listeners continue to follow you and your work?
Dr. Rocio Salas-Whalen 40:09
They can follow me on my Instagram page, which is @DrSalasWhalen, or on my website, NYendocrinology.com.
Katie Fogarty 40:19
Thank you so much.
Dr. Rocio Salas-Whalen 40:21
Thank you.
Katie Fogarty 40:22
This wraps A Certain Age, a show for women who are aging without apology. Before I say goodbye, a couple of quick favors: this was such a fantastic, informative show, I loved spending time with Dr. Salas-Whalen, and I know your friends will too. Please share the show with the women in your life. I would also absolutely love a five-star review or rating over on Apple Podcasts, Spotify, or wherever you listen. And finally, come hang out over on our sister podcast, The Midlife Book Club. You can find us on Instagram at The Midlife Book Club, on Apple Podcasts, Spotify, or wherever you listen, or you can sign up for our newsletter over at themidlifebookhub.com. Special thanks to Michael Mancini, who composed and produced our theme music. See you next time, and until then, age boldly, beauties.
