Fatigue, poor sleep, mood changes, declining libido, and stubborn weight gain are often treated as unrelated problems. But after age 40, hormonal and metabolic changes may be part of the bigger picture.
In this episode of the 1Optimal podcast, family nurse practitioner Marielle Elliot discusses her personal and professional journey into functional medicine and hormone optimization. The conversation explores hormone replacement therapy, testosterone for women and men, GLP-1 medications, peptides, gut health, and the importance of individualized care.
Key Takeaways From This Episode
- Hormonal changes after 40 may affect sleep, mood, energy, libido, and body composition.
- A laboratory result within a reference range does not always explain how a patient feels.
- Hormone treatment should be individualized and monitored rather than based on a standard dose for every patient.
- Testosterone is relevant to both women and men, but excessive dosing can produce significant side effects.
- GLP-1 medications can support eligible patients with weight management, but they work best alongside sustainable nutrition, exercise, and clinical supervision.
- Some compounded peptides have limited safety evidence and should not be treated as automatically safe.
- Patients should ask questions, understand the risks and benefits of treatment, and work with appropriately trained medical professionals.
Why Hormone Problems After 40 Can Be Overlooked
Marielle’s interest in hormone health began with her own experience. As she approached 40, she noticed changes in her mood, anxiety levels, and overall sense of well-being. When she asked her primary care provider to evaluate her hormones, she encountered a response familiar to many patients: she was considered too young, or her results were described as normal.
That experience led her to research hormone health more deeply and pursue additional education outside her original family-medicine training.
One of the central themes of the episode is the difference between being “within range” and feeling well. Laboratory reference ranges provide valuable clinical information, but they are only one part of an evaluation. Symptoms, medical history, medications, life stage, and potential alternative diagnoses must also be considered.
Hormone-related symptoms can overlap with depression, anxiety, thyroid disorders, sleep problems, medication effects, nutritional deficiencies, and other conditions. That is why a comprehensive evaluation is more useful than assuming every symptom is hormonal, or dismissing hormones entirely.
Testosterone Is Not Just a Men’s Hormone
Testosterone is often discussed as if it matters only to men. Women also produce testosterone, although normally in much smaller amounts.
During the episode, Marielle explains that testosterone may be relevant when evaluating concerns such as libido, energy, and overall well-being. She also emphasizes that treatment is not a substitute for addressing underlying relationship, psychological, or medical concerns.
A change in sexual desire, for example, can be influenced by hormones, stress, sleep, medication, pain, relationship dynamics, and several other factors. Hormone therapy may be one part of an appropriate treatment plan, but it should not be presented as a universal solution.
Why Personalized Hormone Monitoring Matters
Hormone therapy is not a one-size-fits-all process. Two patients with similar laboratory results may respond differently to the same dose.
Marielle describes an early personal experience in which she received substantially more testosterone than she believes she needed. Although she initially felt better, she later experienced unwanted effects, including hair loss.
Excess testosterone exposure in women can potentially contribute to:
- Acne or oily skin
- Increased facial or body hair
- Scalp hair loss
- Voice changes
- Menstrual changes
- Other androgen-related effects
Men can also experience problems when testosterone is used inappropriately. Potential concerns may include changes in blood counts, fertility, breast tissue, mood, or hormone balance, depending on the patient and treatment.
These possibilities reinforce the episode’s main message: hormone treatment requires appropriate screening, conservative prescribing, follow-up, symptom review, and repeat testing when clinically indicated.
Testosterone remains a Schedule III controlled substance in the United States, despite discussion in the episode about whether its regulatory status could change in the future. Any future change should be treated as speculation unless officially announced by federal regulators. (DEA drug scheduling)
Estrogen and Progesterone: Understanding the Balance
The episode also explores the relationship between estrogen and progesterone in menopausal hormone therapy.
For patients with a uterus who use systemic estrogen, clinicians commonly prescribe a progestogen to help protect the uterine lining. The exact medication, dose, route, and duration depend on the patient’s medical history and treatment plan.
The FDA explains that combination therapy involving estrogen and a progestogen is generally used for women with a uterus. Hormone therapy still carries potential benefits and risks, making individualized medical assessment essential. (FDA guidance on menopausal hormone therapy)
Patients should not start, stop, or combine estrogen, progesterone, or testosterone without guidance from a qualified medical professional.
GLP-1 Medications: A Tool, Not a Moral Failure
Weight management is another major focus of the conversation.
Marielle notes that many women experience changes in body composition and weight during midlife. When nutrition, exercise, sleep, stress management, and other interventions are not enough, prescription weight-management medications may be appropriate for some patients.
GLP-1–based medications can affect appetite and food intake. Depending on the specific drug and dose, some are FDA-approved for type 2 diabetes, chronic weight management, or other defined indications.
The episode challenges the stigma surrounding these medications. Using medical treatment for obesity or metabolic disease is not a sign of laziness or failure. At the same time, GLP-1 treatment should not be promoted as an effortless or risk-free shortcut.
The National Institute of Diabetes and Digestive and Kidney Diseases notes that weight-management medications work best when combined with a lifestyle program involving nutrition and physical activity. Treatment duration varies, and some people may regain weight after discontinuation. (NIDDK weight-management medication guidance)
Protecting Muscle During Weight Loss
Rapid weight loss can involve loss of lean mass as well as body fat. This makes resistance training, adequate nutrition, and an appropriately paced treatment plan especially important.
Marielle encourages patients to remain physically active while using weight-management medication. That does not necessarily mean spending hours in the gym. Walking, age-appropriate resistance training, and other sustainable forms of movement can support long-term health.
A well-managed program should consider more than the number on the scale. Depending on the patient, clinicians may also evaluate:
- Strength and physical function
- Nutritional intake
- Medication side effects
- Hydration
- Sleep and recovery
- Changes in body composition
- The patient’s ability to maintain new habits
The goal should be improved health and function—not simply the fastest possible weight loss.
What Patients Should Know About Peptides
GLP-1 receptor agonists are peptide-based medications, but that does not mean every product marketed as a “peptide” has comparable evidence, approval, or quality controls.
The podcast discusses growing interest in peptides for recovery, joint health, and digestive concerns. This is an area where patients should be particularly cautious. Some peptide products promoted online are not FDA-approved, and evidence concerning their safety and effectiveness may be limited.
The FDA has identified potential safety concerns and insufficient clinical information for several substances used in peptide compounding. Compounded medications are also not reviewed by the FDA for safety, effectiveness, or quality before being marketed in the same way as approved drugs. (FDA peptide-compounding safety information, FDA overview of compounded drugs)
Patients considering peptide treatment should ask:
- Is this product FDA-approved for the proposed use?
- If it is compounded, why is a compounded version medically necessary?
- What human clinical evidence supports the treatment?
- What side effects or interactions are possible?
- How will treatment be monitored?
- Which licensed pharmacy will supply the medication?
Gut Health and the Bigger Clinical Picture
The host and Marielle also discuss digestive health and how gastrointestinal problems can affect a person’s broader health experience.
Symptoms such as persistent bloating, abdominal pain, changes in bowel habits, or difficulty tolerating medication deserve proper medical evaluation. However, broad commercial testing panels should not replace a conventional assessment or automatically be assumed to identify the cause of every symptom.
A responsible approach may involve reviewing diet, medications, medical history, warning signs, and evidence-based testing selected for the patient’s specific symptoms.
How to Find the Right Hormone or Functional Medicine Provider
Marielle’s closing advice is simple: become an informed participant in your care.
A qualified provider should be willing to explain why a test or treatment is being recommended, what alternatives exist, and how the patient will be monitored.
Consider asking a potential provider:
- What training do you have in menopause or hormone therapy?
- How do you decide whether treatment is appropriate?
- Which symptoms and laboratory results do you monitor?
- How frequently will we review progress and side effects?
- Do you begin with the lowest reasonable dose?
- What happens if I develop unwanted effects?
- Are the prescribed medications FDA-approved or compounded?
- How do you evaluate other possible causes of my symptoms?
- How will you coordinate with my primary care physician or specialist?
Be cautious of clinics that guarantee results, prescribe the same protocol to everyone, encourage supraphysiologic hormone levels, or minimize the possibility of side effects.
The Bottom Line on Hormones After 40
Hormonal and metabolic changes can have a meaningful effect on life after 40. Patients deserve to have symptoms taken seriously—but they also deserve treatment grounded in careful evaluation, realistic expectations, and ongoing monitoring.
The most valuable lesson from Marielle Elliot’s conversation with the First Optimal host is that better care begins with curiosity. Ask questions. Understand what is being prescribed. Know the potential benefits and risks. And choose a provider who listens to both the laboratory data and the person sitting in front of them.
Listen to or watch the complete episode to hear Marielle’s personal story and the full conversation about hormone optimization, GLP-1 medications, functional medicine, gut health, and the future of individualized care.
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Medical disclaimer: This article is for educational purposes only and does not provide medical advice, diagnosis, or treatment. Hormone therapy, weight-management medication, and peptide treatment may carry significant risks and are not appropriate for everyone. Consult a qualified healthcare professional before making treatment decisions.
