Hello, hello, and welcome to today's podcast. Today we need to talk about the midlife crisis. And we're not talking about the one where you buy a new sports car or you leave your marriage. What we're talking about is when your body stops cooperating. When you wake up one day and you don't recognize yourself anymore, not because you're unhappy with your choices, but because your energy is gone, your weight is shifting, your sleep is disrupted, and your doctor says everything is normal. That kind of midlife crisis, the health crisis. And it's real.
If you look it up online, the midlife crisis is defined as a period of intense psychological self-reflection and transition that typically occurs between the ages of 40 and 65. It's characterized by feelings of regret over unachieved goals, anxiety about aging or mortality, and the desire to make drastic lifestyle changes.
We want to clear up the fact that maybe some of these feelings and thoughts that people have are more biologically driven. We need to understand a little bit more about what's really under the surface here, what some of the root causes are, not just the idea that you're normal and it's part of aging. I cannot tell you how many patients come in daily talking about how it's all just getting older. I don't even like saying that word, so that's the O word in the practice. It's certainly something we can explain differently, because there are other options, other ways, and potentially ways you can improve your own health, your own feelings, and your own desires.
The Biology of Midlife
These are all things we've talked about in the past, and we have other episodes that go into deeper discussion. But we'll go through them to introduce what's biologically going on during midlife.
Hormone decline is a major driver of a lot of these problems people feel during this crisis time. For women, estrogen and progesterone are two big players. During perimenopause, there are significant fluctuations. One minute you're great, the next you're struggling. One minute you're having fun, the next you're crying. There's a lot of variety, a lot of ups and downs. Then when menopause hits, you have a drastic decline in estradiol, which is a big biological changer.
Men suffer decline just like women do, in testosterone, but it's a gradual decline, so it's often missed because it's not as drastic. We're talking about 1% a year starting at age 30. And testosterone and estrogen are just as important in men as they are in women. There are 400 different functions in the body that estrogen affects. It's significant. It's not just reproduction for females.
The other piece that often gets missed is thyroid. Thyroid function significantly declines too, and it's not necessarily that your thyroid level is low or dysregulated, but sometimes it's a hypofunctioning effect of the thyroid itself. Don't forget, thyroid is a hormone that affects other cells in your body. When those cells are affected, the hormone doesn't regulate that cell's activity well like it should. Growth hormone and DHEA are part of this hormone decline as well. And of course cortisol. Cortisol regulation also begins to break down.
The second thing is muscle loss, sarcopenia. This starts at age 30, and you steadily have a decline in muscle. The muscle itself becomes weaker and looks different. Think of it like a tenderloin with a nice thick muscle versus a ribeye with the fatty, fibrous parts in there. That's the difference from a visual standpoint. Muscle is your metabolic engine. It helps with glucose control and protects you during activities, which is why it plays a role in the biology of midlife. Less muscle means slower metabolism, more problems with insulin regulation, weight gain, weakness, and general frailty. There are also medications that can exacerbate that sense of frailty and muscle weakness.
That goes right into the metabolic shift. Blood sugar regulation, how our body handles fuel, this process changes. The same diet that worked in your 30s is now causing weight gain. It's that dysregulation that makes it a little trickier.
Sleep dysregulation is huge. When you're not sleeping well, you're not recovering or healing. Then you have sleep apnea, which is significantly on the rise, contributed to by weight gain and general anatomy. That rise in sleep apnea can be sneaky and not caught well. "My partner's just snoring. I have to nudge them every once in a while and it feels like they're not breathing." That affects your sleep, and your sleep affects a lot of patterns. You're not producing growth hormone, and when you can't produce growth hormone, you can't repair your muscles or regulate your metabolism as well.
Fifth on the list is inflammation, and this is huge. You hear people talk about "inflammaging" recently. That's essentially where inflammation in your body makes you age faster. A lot of that's driven by visceral fat and poor gut health. There are a lot of gut health issues these days. Stress is a big contributor, along with hormone decline. And we don't want to forget about processed food and lack of movement. There's a lot of sedentary behavior out there, so we try to get people thinking about movement throughout the day.
You can't really talk about inflammation without talking about autoimmune disease, which is more prevalent now, or at least more diagnosed and caught. There are so many individuals we see who have different types of autoimmune processes occurring within them. We identify that because we draw the labs and look for it. If you're not drawing those specialized labs, you don't catch it.
The Patient Perspective
From a patient perspective, the types of things we hear are: "I used to sleep well, now I can fall asleep easy but I'm waking up in the middle of the night and I can't go back to sleep." Or, "I just don't feel like myself." That's something we hear quite often. A lot of people come in feeling like they don't have stress in their life, nothing to be stressed about. They feel very blessed for the life they have and don't understand why they feel this nervous system dysregulation. It's very common.
This may be the beginning of some metabolic changes, or maybe even the middle of it, but it's not the end. There are interventions that can be done to catch, change, and correct this course for people.
The Emotional Piece
Let's go into the emotional piece of midlife crisis, because it is very real. There's an identity crisis and loss of self. For these people who don't feel like themselves, it's not only biological. A lot of things happening in midlife create this identity crisis. Women are very attuned and aware of it, like, "Wow, things are just not what they used to be." Men may notice it, but they kind of just go on, or chalk it up to getting older. There's that line again: it's just getting older.
During this time, things are changing. You've got kids leaving home, aging parents, careers plateauing. There's a lot going on in our external world.
Another piece is that estrogen is so neuroprotective, and as it declines it can really affect our emotions. Progesterone too, but estrogen decline is very often related to feelings of apathy, which falls right in line with this identity crisis. When it gets down to low levels, women just feel like they're not themselves anymore. The brain is very receptive to estrogen, it's thirsty and hungry for it, and when you deprive it, these feelings tend to show up more. Men experience this too. Low testosterone is linked to depression, the inability to feel pleasure, and a loss of drive, motivation, and endurance.
The Stress Biology Loop
Stress is a real thing. Oftentimes this is the point where people feel they're using stress as an excuse. All these biological things are happening and they're told, "Oh, you're just stressed." How does this connect? Because it is all connected. When you've got your adult children, aging parents, and the financial stresses of paying for college, those are real, stressful things. What we hear very often is people feeling like they aren't as equipped to manage that stress as they were previously.
We're talking about chronic stress, not acute stress. There's a big difference. Chronic stress raises cortisol levels, which suppresses our sex hormones, breaks down muscle, disrupts sleep, and drives insulin resistance, which leads to a lot of the metabolic problems. Every conversation we have is a reminder that everything is connected and intertwined. You can't talk about one thing without talking about the trickle-down effect of everything else.
All this biology can drive behavior. Now you're talking about impulsive decisions, career changes, geographic moves, anything for meaning and purpose. A hormonally depleted brain is desperately looking for something. Is it estrogen? Is it dopamine? And now you bring dopamine into the picture, which is a whole other thing considering the technology in our lives now.
Not every midlife crisis is pathological. But it's worth asking what's going on. Are there biological changes, things I can fix or correct? And it may not be taking a supplement or hormone replacement. It could simply be lifestyle changes. It's really important to know there's no one-size-fits-all answer.
Gray Divorce
That brings up the whole thing of gray divorce. These are the surges in divorces occurring in people 50 and older. It's something that doubled since 1990. Is it part of an empty nest, growing apart, finding yourself? There's a lot of evidence showing many reasons this is happening: longer life expectancy, more financial independence. People don't feel like they have to stay married because there's more financial flexibility. That conversation really started around 2004, and since the recent uptick in conversation around perimenopause and menopause, they're looking at how this might be tied together.
One thing we haven't touched on much: during this time of changing hormones, there's more irritability and less filter. That ties into the apathy from estrogen decline. There are good things about not caring what people think, that's not all bad, but when we have increased irritability and this apathy, it can set us up to be less tolerant of those around us. When you're exhausted, irritable, disconnected from your body, and your libido is gone, intimacy starts to suffer. Communication suffers, and patience begins to suffer. It all boils over.
I'm speaking from the female perspective, but I believe men are going through all of this too. So both parties are less tolerant and more irritable. It's going to take some work and some questioning to get to the bottom of what's really playing the biggest role.
To be clear, we're not saying that optimizing your hormones will fix your marriage or make you love your job. What we are saying is that when your brain and body are working, you can make clearer decisions about your life. When they're not, things can feel impossible.
Why Conventional Medicine Misses This
Why does conventional medicine miss these things? There are several reasons, but the real problem boils down to three words: normal isn't optimal. Optimal levels are where we want to be. We don't want to be in the normal range. With reference range "normals," this is an average range of the population. What people don't understand is that 93% of these people are metabolically unhealthy. So now you have a group where you have to ask: do you want to compare yourself to 95% of people who aren't healthy, or do you want to be more optimal? Normal is not always best.
When you go to your primary care doctor, they're typically looking at normal ranges, not what would be optimal for you. That's just the way the model is set up. They're looking for disease, not for trends that show suboptimal function. Testosterone levels drop, TSH levels start to rise in some people, and maybe it's normal for age. But do you want to feel old or do you want to feel younger?
We hear a lot that people feel dismissed or unheard in discussions with their primary care. We can excuse a lot of things as stress or aging, and that's where dismissal comes in. Men with low testosterone are just told to exercise more and lose weight. That's one option, and you can't disagree with those things, but there's more under the surface. That goes back to normal isn't optimal. When you're operating from the lens that you need to fall in the normal range, then if you're in that range it must be aging or stress. That's where you have to flip the script. When you hear about fatigue, weight gain, brain fog, and low libido, that's not just part of our character. There are biological reasons for these things, and that's where you can dig deeper to find a true cause.
That leads to the seven-minute appointment blocks in traditional medicine. It really does take more time. You have to dig in and hear what's going on so you can connect the dots. Most doctors have about seven to fifteen minutes to diagnose a patient, write a prescription or give a plan, and move on. That's fatiguing from a provider standpoint, and it's not pleasant to sit in the chair trying to get your point across knowing your doctor wants to hurry up and get to the next room.
I always give the caveat that we're not saying there are bad providers out there or that this makes a provider bad. We're saying that provider is set up in a system meant to treat and diagnose acute illness, treating a disease process after it's already occurred, not necessarily a preventive process.
This leads to the difference in testing. In a prevention mindset, you're taking extensive tests. At primary care, you're getting a pared-down, focused, insurance-driven set of tests with diagnosis codes that go with them. Some of the more specific inflammatory tests or hormone level tests may not be covered by insurance, so they may not be done. When you're not testing, you can't diagnose. For instance, thyroid antibodies are very infrequently tested but could diagnose a thyroid issue way earlier in the process.
Lastly, from a conventional medicine standpoint, there's a fear of hormones, especially for women. The Women's Health Initiative of 2002 literally scared a whole generation of women away from hormone replacement therapy. We're not saying there aren't a lot of other options out there, but to have as many choices as you can have to make an informed, appropriate decision, you need them available. Not only are women scared, or have this misunderstanding of hormones, there's a whole generation of doctors who also have this misunderstanding. We've talked to so many people who went to their primary care, asked for testing, and were told they couldn't get it or there wasn't a reason for it. That study was flawed, and the reporting from it was not appropriately provided or looked at, which created a lot of the fear. You also have to understand that bioidentical hormones are not the same as synthetic hormones. There are differences, and there are plenty of studies on bioidentical hormone replacement and its benefits. Nobody needs to be scared about the big C word, cancer, or about blood clots and things like that. There are options, and if you have the information, you can make those decisions from an informed standpoint.
The Midlife Reset
So what is a good midlife reset, and how do you tackle this? In our practice, the "Reveal" is the biggest first step, revealing where you're at, which takes a couple of hours. It includes a comprehensive lab panel to look at metabolic markers, thyroid markers, inflammatory markers, micronutrient markers, autoimmune markers, and your sex hormones in full.
For sex hormones, that's estradiol, progesterone, and testosterone, not just total but free, plus DHEA-S and cortisol levels. For your metabolic panel, in addition to the regular tests, we look at fasting insulin, A1C, a lipid panel with the addition of an ApoB level, and we determine HOMA-IR, an insulin resistance calculation. For thyroid, not only TSH but free T3, free T4, and thyroid antibodies. From an inflammation standpoint, we look at CRP, homocysteine, vitamin D, B12, and even an iron panel. Those are very important for micronutrients.
Then we go into lifestyle and body composition. A DEXA scan is the gold standard for body composition, but not everybody has access. They're pretty cheap and have a little radiation exposure, but there are other ways to look at body composition. If it's not convenient, it's difficult to get and to monitor, which is key. We use bioelectrical impedance, which is a good way to follow body composition because it's important to know where you're at as you go forward in your plan. We look at the trend. The trend is the more important thing, to see how much success you're having in your program. Sleep is also a big assessment in the Reveal section, taking a deep dive into sleep and screening for sleep apnea when indicated.
Then there's the "Rebalance" part of our health assessment. At the top is optimizing hormones. There are levels that need to be where they need to be to feel good. It's not about being at normal for your age, because normal isn't optimal. Sometimes you need levels where they need to be, not only for symptom relief but also for prevention, improvement, and avoidance of chronic disease later in life. And replacement isn't the only thing. There are a lot of things we can do to improve our natural hormone production without going down the road of actual hormone replacement, if that's what you choose.
Movement and building muscle is another big piece of Rebalance, getting it baked into our routines because muscle is so important to metabolic health. If we don't do anything, our metabolic health slowly declines. We want to get protein intake around 0.8 to 1 gram per pound of ideal body weight daily. That's a significant amount of protein. Another pillar is fixing our metabolism by addressing insulin resistance, reducing ultra-processed food, and prioritizing protein and fiber intake. We want fiber up to 25 to 35 grams a day for both men and women, though women need a bit less than men. This is another example of how things coincide, because increasing muscle also helps your metabolism. Then there's protecting your sleep. We talked about assessing where your sleep is, but then also protecting it. What do we have to do to optimize sleep, whether treating sleep apnea or changing sleep hygiene? Lots of things can be done. And stress is a big input in that.
"Revive" is building the long game. This includes some things we already talked about in Rebalance, but adds in relationships and community, setting yourself up to go through this process and maintain it, supported. It's a transition time, so we work on our attitudes and getting help through it. Sometimes you need therapy, coaching, or spiritual help, just something to help you navigate it. We see that as so beneficial. Retesting is something we try to stay ahead of. It's good to retest on an annual basis, certainly, and some things we do at six months, sometimes more often depending on how significant something is and how important it is to that person's goal. Your symptoms will dictate that too.
You want to build your team. You need a healthcare provider, ideally a functional healthcare provider, a trainer, the right community associations, and a therapist or mental health counselor.
Wrapping Up
That's it in a nutshell. It's a big nutshell, but people drive off of being motivated. If you see the weight come off, start to feel better, or have a better outlook, or maybe you have a better understanding that, "No, I see I'm going down this road of depression. What can I do differently?" If people can have that benefit of feeling more motivated and seeing results, they're a little more able to continue down that path. It's a process. It doesn't happen quickly. Just like we tell a lot of patients, hormone replacement therapy is not drive-through medicine. It takes a while. Your body took a while to get where it is, and it's going to take a while to get back, but it's certainly achievable.
One thing you really have to know is that you need to be heard. You are certainly a worthy person to be listened to. If you don't get answers, if you don't get what you feel you need, then you need to keep looking.
As we wrap up, we started with the midlife crisis and the midlife health crisis, looking at both, and just knowing that everything is connected. If you're having what feels like a mental health crisis, you might also start asking how your biology is playing into this. And vice versa. If you're having biological issues, maybe we have to ask how your mental health is playing into your physical health. It's not just one thing. There are a lot of spokes on a wheel, and if those spokes aren't the right length, the wheel won't turn well. So you have to keep looking.
Thanks for tuning in. We really appreciate you sharing your time with us. If we can help out in any way, please reach out. Until next time, have a healthy day.
