Dr Felice Gersh: Could peptides help women through menopause?

Could peptides work alongside hormone therapy to help women through menopause?

Dr. Felice Gersh is an award-winning gynecologist, integrative medicine physician and bestselling author of PCOS SOS and Menopause: 50 Things You Need to Know. 

Estrogen is central to her thinking. It influences appetite, metabolism and many of the peptides your body makes. 

She explains why a GLP-1 injection differs from the hormone made in your gut, and why a peptide’s effects can reach beyond the problem you’re trying to solve. 

She also describes reports of peptide drugs being sold from coolers at gyms. Powerful medicines, treated like supplements. Her concern is what people are injecting, and what repeated use might mean. 

Her hopes for the future are clear: preserving muscle, supporting metabolism and controlling inflammation. She sees properly researched peptides working alongside hormone therapy to help women stay stronger as they age.

She explains:

■ Menopause, metabolism and a changing waistline
■ How estrogen influences your body’s own peptides
■ Why GLP-1 drugs differ from natural GLP-1
■ The unknowns of self-prescribed peptides
■ Where peptides could work alongside hormone therapy

Chapters

• (00:00) - Intro
• (02:25) - Why Dr. Gersh is cautious about peptides
• (04:14) - Peptides, supplements and GLP-1 drugs
• (07:26) - How peptides work in the body
• (09:25) - The risks of self-prescribing peptides
• (12:19) - The FDA and compounding pharmacies
• (15:45) - Supporting natural peptide production
• (17:19) - How estrogen regulates peptides
• (19:59) - Preserving muscle as we age
• (21:28) - Metabolism, inflammation and hormone therapy

Watch the full episode on YouTube

Further reading

Research: A longitudinal study tracking fat mass, lean mass and weight through menopause: Changes in body composition and weight during the menopause transition.

Research: A study in mice and human cells and tissues examining estrogen’s influence on GLP-1 secretion: 17-β Estradiol regulates proglucagon-derived peptide secretion in mouse and human α- and L cells.

The Menopause Society: Hormone therapy, its benefits and risks, and why treatment should be individualized: Hormone Therapy.

NIH: Why muscle loss matters for strength, mobility and independence as we age: Slowing Sarcopenia.

FDA: The role and risks of compounded drugs, and how they differ from FDA-approved medicines: Understanding the Risks of Compounded Drugs.

Books by Dr. Felice Gersh

Menopause: 50 Things You Need to Know
PCOS SOS
PCOS SOS Fertility Fast Track

Follow Dr. Felice Gersh

YouTube: @FeliceGershMD
Instagram: @dr.felicegersh
Facebook: @felicegershmd
LinkedIn: linkedin.com/in/felicegershmd/

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LinkedIn: linkedin.com/in/richardskaife/

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Peptide Show explores the science, medicine, business, and people shaping the rapidly evolving world of peptides.

Presented by Longr: longr.io

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This podcast is for informational and educational purposes only and does not constitute medical advice. Some compounds discussed in this episode are investigational, unapproved for the uses discussed, or subject to changing regulatory requirements.

Creators and Guests

Host

Richard Skaife

Entrepreneur, Venture Capitalist and CEO of Longr, focused on longevity, health technology and emerging science.

Guest

Dr Felice Gersh

Felice Gersh, M.D. is a multi-award winning physician with dual board certifications in OB-GYN and Integrative Medicine. She is the founder and director of the Integrative Medical Group of Irvine, a practice that provides comprehensive health care for women by combining the best evidence-based therapies from conventional, naturopathic, and holistic medicine. For 12 years, she taught obstetrics and gynecology at Keck USC School of Medicine as an Assistant Clinical Professor, and she now serves as an Affiliate Faculty Member at the Fellowship in Integrative Medicine through the University of Arizona School of Medicine. Felice is a prolific writer and lecturer who speaks globally on women’s health and regularly publishes in peer-reviewed medical journals. She is the bestselling author of the PCOS SOS series and Menopause: 50 Things You Need to Know.

Editor

Toby Sorabjee

Co-founder and COO of Longr, working across longevity, health technology, investing and media.

What is Peptide Show?

Welcome to the world of Peptides. New episodes every Tuesday.

When I give women hormones,

I'm not turning them 21 again.

I'm not giving them the same

exact hormones that they had

when they had 21-year-old

functioning ovaries. And of course,

in perimenopause,

women can be on the roller
coaster of estradiol.

It can go up and down, up and down.

So my goal is to try to regulate hormones,

because the hormones are the big master

of many of these peptides.

Like to see use of peptides
as pharmaceuticals.

These would be adjuncts to,
say, hormone therapy.

If we can control inflammation,

we can maintain muscle mass,

and we can control and modulate metabolism

through researched and
properly administered peptides,

two thumbs up. That would be my wish.

Welcome to this week's Peptide Show,

and thank you very much for joining us.

Before we begin, if you enjoy the episode,

please do like, follow, and subscribe.

It takes two ticks, and it
really makes a difference.

Now, on to the episode.

If you're eating well,

getting enough sleep, and exercising,

why does your body still
seem to have other plans?

Dr. Felice Gersh

has spent more than 40 years
helping women understand

how their body changes with age.

She's an award-winning gynecologist,

an integrative medicine physician,

and a bestselling author.

Her work explores how hormonal changes

affect women's metabolism

and long-term health,
often years before menopause.

In this conversation, she explains

how estrogen influences
many of the peptides

your body already makes, and what we

need to understand before adding others.

She sees enormous potential
in these treatments,

but she's asking

whether we're trying to
solve a hormone problem

with a peptide prescription.

But what could be happening to your body

before you feel a thing?

How could peptide therapies
help women preserve muscle,

regulate metabolism,
and control inflammation

as they age?

My guest today is Dr. Felice Gersh.

Welcome to Peptide Show.

Felice, thank you very much for
joining us on the Peptide Show

today. Well,

it's my pleasure, and we've
had some pre-recording,

you know, conversations
which have been really fun.

So it's been such a pleasure
just getting to know you.

A good preamble, and that kind of led to

my first question. You

would describe yourself as

someone who has a strong belief

in the potential of peptides,

but right now,

perhaps, I think, sort of peptide-cautious

would be a good way of
describing your position.

Well, I really understand the
critical functions of peptides

as essential signaling agents.

And as I mentioned to you earlier,

they're very much, not all of them,

but very heavily modulated
by my favorite hormone,

estradiol, in women,

and of course, through
different issues, testosterone,

which I don't deal that much with in men.

So I'm not in any way

ever questioning the essential

need and function of peptides.

But as pharmaceutical use,

which is really how I view them,

if you give them exogenously, they're

drugs. So I just have cautious,

you know, feelings about giving
anything without adequate

knowledge of, like, who's making them,

what is the formulation,
what levels are achieved,

what are the half-lives,
what are the interactions,

side effects, you know,

what's the best dosage?

So to me, it's like a huge potential,

but I'm just cautious
about giving peptides,

which I, you know,

I think of them as just
peptide-based drugs,

you know, pharmaceuticals,
to people without more

knowledge, because I'm
very cautious about how to,

you know, give things to my patients.

But I do understand the
essential nature of peptides,

and I would never talk, uh,

that you don't need to
have peptides in your body.

That's for sure. Absolutely.

And you used, I think,
two important terms there,

you know, drugs and medicine.

Um, and of course, in the United States,

you have very high-profile

figures in the administration

talking about the fact
that these could be looked

really as just supplements.

That, as a medical professional, must

give you cause for concern.

Yeah, I would not call
them supplements at all.

They, they, like, if you look
at the GLP-1 receptor agonist,

and that's, like,

a very important little

key group of words there,
because a lot of people say, oh,

the GLP-1s. Well,

that is really an
oversimplification of what these

particular molecules are.

If you gave shots, and the reason you have

to give shots, um, although

now they do have formulations
that can be given orally,

if you gave an actual, like, GLP-1,

it would be gone in a flash.
The half-life is very,

very short, and there's a reason for that

which I can come back to.

But when you give these as,
like, exogenously to people,

mostly as shots,

if you give it as the actual
molecule of the peptide,

then it's gonna be very
short-lived in the body,

you know, just minutes.

And so when they make GLP-1 drugs,

they call them receptor agonists.

So it's not actually the,
like, bioidentical peptide.

It's not bioidentical at all.

Because that's a common misunderstanding.

I think when you,

when you hear people who
are advocating for peptides,

and generally these are
not medical professionals,

but they will say, well,

these are just things which
occur naturally in the body,

so, you know, all we're
doing is God's work.

Nope. I'm glad you said no.

It's man's work. So when
you give these medications,

they are receptor agonists.

So they're,

you can even think of them
as what they really are,

under the category of hormone

endocrine disruptors,

because basically an endocrine disruptor,

and many of them are pharmaceuticals,

we call them, for estrogens,

we call them SERMs,

selective estrogen receptor modulators.

So we have a whole bunch
of these kinds of drugs

that work on receptors for hormones or,

you know, and many hormones

are peptides. So that's just
the structure, you know.

You could have neurotransmitters
that are peptides.

So you have these, um,

hormones, we'll call them,
and they are basically,

you know, peptides, and
they are not identical

when you give them as a
form of a pharmaceutical.

They're modified, and they
work on the receptors.

And I think if you gave
the bioidentical version,

it would be very, very short-lived.

You'd have to have multiple
shots during the day.

I mean, who? No one's gonna do
that. That's why the original

GLP-1-related drugs had to
be injected on a daily basis,

right? And then they've
made them so they're weekly,

and some people are looking at monthly,

you know. So

there's different ways of
doing these kinds of things.

But I think it's really
important that people

recognize what peptides do in the body

as critical signaling agents,

and that they are, like, the same peptide,

which is just a chain of amino acids.

So that's, when you say peptide,

it's just a compositional,
structural thing.

It has nothing to do with the function.

It's just what it's made of, okay?

A chain of amino acids.

And that they are signaling agents,

and they have different
amounts of the same peptide

at different places in the body,

different amounts simultaneously. In fact,

even in the same organ,
like, say, the brain,

you could have a different
amount of, for example,

oxytocin, which is a peptide.

You can have totally
different amounts in the same

second in different parts of the brain

at the same moment of time.

So my concern is when you give, say, um,

say you gave someone oxytocin,

so where's it going? What's it doing?

Like, because we,

you know, we know it does
different things simultaneously

all over the body. So I think
of them as micromanagers,

you know. So you have a
little bit in this spot,

and it's like a flash,

and then another in this
spot, and it's a flash.

And they're all like micro, like,

like you have microclimates,

you have microenvironments of peptides.

So if you give a peptide systemically,

and it's going everywhere in the body,

that's where you can
get all kinds of, like,

we'll say, collateral issues
that you didn't expect,

because it's going to be doing things

that you don't necessarily
want it to be doing

at the same time. And it
could also have unexpected

benefits that you didn't
know about, right?

You just, so it's like an exploration.

But I don't want to turn my patients

into exploratory objects, you know,

where, oh, I wonder what I'm doing today.

I don't know. And absolutely, yeah.

And I think one of the fascinating and

quite scary things that we hear

when we're talking to
medical professionals is

how many of their patients or clients have

already started to self-prescribe

peptides. When we talk about any

other area of medicine,
it would be a really unusual

phenomenon. Uh-huh.

But is this something that you're

regularly coming into contact with, or

is that not sort of falling
into your practice, where,

you know, patient
conversations start with them

telling you what they want?

Yes, absolutely.

And they don't actually need me,

it seems. So

I've heard of stories in my local area

where there are people
selling, often through gyms

and just sometimes independently,

all these different peptide
drugs out of a cooler.

You know, they open the
cooler, and it's like,

what shall I? It's like,

excuse me, this looks like drug dealing.

Like, is this on a shady street corner?

Like, what is going on here?

And they're actually
distributing them to teenagers,

you know, like,

they're looking to build muscle

or have better recovery from exercise

and so on, and they're
just giving them out like,

like you said, like
they're a multivitamin,

you know,

even, like, with less caution
than taking a multivitamin.

And it's like,

really wild how they think
of them as completely safe.

They don't think, like, what
am I injecting in my body?

You know, that we worry about drug use,

that they're laced with
fentanyl or who knows what.

I mean, I don't know what
these things are laced with.

I don't even know what. In fact,

we don't even know what the molecule is,

because we know that they're
not the real peptide.

They're modified.

I don't even know what
people are injecting,

let alone quality or doses or anything.

But this is all over the place now.

It's like widespread, self-administered,

self-prescribed, or online,

you know, where people are
just getting stuff online.

And it's like, in California,

especially where I live,
all of this stuff is illegal.

But it doesn't, there's no enforcement.

Nobody seems to really
be worried about it.

And I... Very, very limited.

Yeah, very limited.

Yeah, very limited enforcement or worry.

And it's not like people
are keeling over dead,

like, say, from fentanyl or something.

So it's not like, oh,

we're seeing a lot of acute problems.

I mean, so,

you know, realistically,

you know, people are using them,

and they see their friends,

and they may be building muscle,

because I'm not saying
they have no effect.

I'm not saying that at all.

But they'll, you know,

say, I feel better.

I mean, it's always,
because these are not studies,

you don't even know what
the placebo effect is,

because placebo effect is huge.

It can be, like, almost equal
to the drug in many cases.

It's so amazing what the mind can do.

It's not a fake effect.
It's a real effect.

It just shows the power
of positive thinking

and the brain.

The FDA, um,

have been looking at

adding additional peptides

to their compounding list.

There is an argument that they were

there before, and they've been removed.

Um, what,

where do you think that
sort of signals to,

to medical professionals in terms of their

willingness to work with peptides?

Would you be somebody who would still

be sort of advising a cautious approach?

Well, I have,

um, we won't get political,

but I have a grave concern

level with what's going on with that,

you know, concerning our FDA.

Everything's sort of different.

But if you go back to

what is a compounding
pharmacy supposed to do,

like, is it supposed to create
novel drugs that don't exist

in any pharmaceutical, you know, world?

No, that is actually

not the purpose of a compounding pharmacy.

It's not to create drugs that,

you know, don't exist, you know.

What it's supposed to do
is modify existing drugs,

so, to accommodate special needs.

So what they're not supposed
to do is take something,

a molecule that is not a drug,

it doesn't exist, it's
not an FDA-approved drug,

and then simply
manufacture it and sell it.

So basically, it's an
alternative to, we'll say,

all the different criteria that big, the,

the hoops of fire that Big
Pharma has to jump through

to get a drug on the market.

They're just sidestepping everything.

You don't need testing.
You don't need anything.

You don't need controls. You just make it,

you know. So

that's not really what a
compounding pharmacy is ever

supposed to do. That's
not why they're here.

They're here to just modify existing

approved pharmaceuticals. So no,

I'm not in favor of this, you know.

There's no one testing those batches

that's been recognized,

certified by, you know,

enough bodies of, you know,

certification qualifications. So,

you know, I don't know.

We are allowed, like, for example,

the GLP-1 receptor agonist drugs

were allowed to be compounded

when we had a shortage. Shortage, yeah.

And now they're ongoing,

being compounded by the truckload, okay?

Even though the pharmaceutical companies

that make the GLP-1 receptor agonist
drugs say, no,

we make enough, you know.

We don't need the assistance
of the outside compounders.

But those are officially approved drugs

that are now being compounded

widespread by the compounding pharmacy,

pharmacies all over.

There are concerns with them in
a variety of ways. Indeed, yeah.

I mean, quality concerns.

Well, yeah, because I personally,

would rather, when there's,

unless there's a reason
to use a compounder,

I usually use the standardized drug.

But I use compounding when
there's a good reason.

But

the main reason that people
are using the compounders

for the GLP-1 drugs is cost, okay?

So it's not because they need it.

It's because they want
it, because they're,

you know, lowering, the
compounding pharmacies in general

can undercut the prices.

So it's more of a price thing than it is

some other

typical reason for using a
compounded pharmaceutical.

But in any case, that's the one
peptide that is used that way.

But all the other ones
that we're talking about,

you know, there's so many peptides,

and that's another thing that's really

important for people to know,

that we know

there are at least 7,000 peptides

that are made in the body.

The number of peptides
that are currently sort of

recognized and turned
into pharmaceuticals,

although people think they're natural,

like vitamins, and they're not,

but, um, is a small fraction

of the number that are actually out there.

So why those? Why not others?

You know, like, you know,

and basically, it's so
important to know that peptides,

like I said it earlier,

are at different levels in the same organ,

even at the same instant in time.

So they're really

flashes that come and go in
different parts of the body

to create specific effects.

And so my goal is to try to macromanage.

I call peptide use
micromanagement of the body,

because you're trying to work,

to affect something independently,

you know, of the, what stimulates the
peptide to be made in the first place.

So you're trying to create these peptides

to create effects,

but you're doing it in a way that,

of course, is not physiologic at all.

So my personal preference
is macromanagement,

so that the body will
make its own peptides,

all these thousands of peptides.

I'm not smart enough to
micromanage thousands of

peptides simultaneously all over the body.

Talk to me about the natural,

you talk about this sort of

natural production of peptides.

Can you give me some sort
of more color on? So many,

not all, but many,

many peptides,

and we don't even have
research on all of this stuff,

because it's like I said,

I mean, there's thousands.

But many of the most researched
peptides are modulated,

you could say regulated, by estradiol.

I call the master of
metabolic homeostasis.

And there are many peptides
that have to do with

regulating energy.

That's, like, a really
big thing in the body.

Energy utilization, energy storage,

energy creation.

So all these different aspects of energy,

you know, appetite regulation,

all these different,

like, all these different
peptides, and also inflammation,

regulating growth factors,

which are peptides,

like brain-derived neurotrophic factor

is a peptide modulated by estradiol. VEGF,

um, vasointestinal peptide, oxytocin.

I mean, we could go down
so many lists of peptides.

Um, the,

the ones that are the
melanocortin-related peptides,

all of these are modulated by estradiol.

You know, many,

many of the peptides are regulated.

The bone-growing peptides,

all these things are regulated

or modulated by estradiol.

And in men, testosterone
gets converted locally,

paracrine, we call it,

in many organs where the testosterone,

which has its own unique receptors,

but is also turned in
locally to estradiol.

So it creates these same effects

for creation and regulation of

peptide production.

So my goal is to try to regulate hormones,

because the hormones are the big master

of many of these peptides.

Other things can be,

like, exercise can change how peptides,

inflammation or lack of inflammation

can also regulate how
peptides are made or not made.

So by regulating nutrition
and sleep and exercise,

fitness, and reducing toxin exposure,

because toxins are so terrible,

they destroy,

basically, how

all the different hormone
systems in the body can work.

They're heavily endocrine disruptors.

Many of them are xenoestrogens
or receptor modulators,

in a bad way, of estradiol,

or alter how it's produced, distributed,

degraded, eliminated, and so on.

So reducing all these toxin exposures.

We have the same question for every guest,

and it's really to jump into the future,

sort of 10 years from now.

What are your sort of hopes
and wishes in terms of,

you know, peptides and where they're at?

What would you like to see happen?

Well, I'd like to see lots of
research and use of peptides

as pharmaceuticals,

manufactured in a safe and controlled way,

for specific uses, like,

that are age-related, you know.

So maybe we'll have the perfect combo for

reducing age-related sarcopenia,

which is a huge problem
that is not discussed.

And so everything that
we can do to manufacture

and maintain optimal muscle,

so that would be probably

a very important area for research.

Because in women, for example,

sarcopenia is huge, and muscle
is such a critical organ

that is not just about strength,

but it is also about strength.

But muscle is where we
burn most of our glucose.

So by losing our muscle mass,

which happens, and then becoming frail,

not only is there an
increased risk of falls

and fractures, which occur
in over 50% of women,

and can be not only
life-modifying in negative ways,

but life-ending.

So I probably, if I was
gonna pick one area,

I would pick researching peptides

for maintaining optimal muscle mass.

And then for, you know,

things like appetite control,

maybe getting some additional,

looking into peptides
for metabolic health,

you know, glucose regulation
in different ways,

and weight,

you know, getting into
other different peptides.

And also, probably,

the last one would be
controlling inflammation,

because we talk about
inflammaging as sort of underlying

the disabilities

and the degenerative diseases
associated with aging,

which a lot of these
things are modulated, yes,

by estradiol. But
recognizing that many women

didn't get proper dosing or regimens, and,

you know, men didn't
necessarily get proper dosing,

or they don't have the
opportunity to get testosterone,

or even if they do, when
I give women hormones,

I'm not turning them 21 again.

I'm not giving them the same

exact hormones that they had

when they had 21-year-old
functioning ovaries.

I'm not even really close.

I mean, the best I can give,

so these would be adjuncts
to, say, hormone therapy.

And so if we can control inflammation,

we can maintain muscle mass,

and we can control and modulate metabolism

through researched and properly

administered peptides, two thumbs up.

That would be my wish. Felice,

thank you so much for joining
us today on Peptide Show.

It's been a truly fascinating
conversation. My pleasure.