Essentials: How to Optimize Female Hormone Health for Vitality & Longevity | Dr. Sara Gottfried
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health, and performance.
欢迎来到 Huberman Lab Essentials，在这里我们回顾过去的剧集，寻找针对心理健康、身体健康和表现的最有效、最可操作的基于科学的工具。
I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.
我是安德鲁·胡伯曼，斯坦福大学医学院神经生物学和眼科教授。
And now for my discussion with Dr. Sarah Gottfried.
现在我与莎拉·戈特弗里德博士进行讨论。
Dr. Gottfried, Sarah, welcome.
戈特弗里德博士，莎拉，欢迎。
Andrew Huberman:
安德鲁·休伯曼：
Thank you.
谢谢你。
So happy to be here.
很高兴来到这里。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah, I'm delighted and very excited to ask you about an enormous number of topics.
是的，我很高兴也很兴奋地向您询问大量的话题。
You are expert in so many things, female hormones in particular.
你在很多事情上都是专家，尤其是女性荷尔蒙。
Is it ever informative for a woman, regardless of age, to know something about her mother's, perhaps even her grandmother's experience, vis-a-vis hormones?
对于一个女人来说，无论年龄大小，了解她母亲，甚至她祖母关于荷尔蒙的经历，是否能提供有用的信息？
What sorts of conversations should women be having with themselves and with family members to get a window into what their specific needs might be?
女性应该与自己和家人进行什么样的对话，才能了解她们的具体需求？
Andrew Huberman:
安德鲁·休伯曼：
So my work is really at the interface between genetics and environment, and I think it's essential that you understand what your grandmother went through and especially your mother.
所以我的工作实际上是在遗传学和环境之间的交汇处，我认为了解你的祖母，尤其是你的母亲所经历的事情是至关重要的。
So I would probably start first with trauma and intergenerational trauma, because I think that affects the endocrine system so hugely, especially cortisol signaling.
所以我可能会首先从创伤和代际创伤开始，因为我认为这对内分泌系统影响很大，尤其是皮质醇信号传导。
And then there's certain female conditions that have a very strong component genetically, most of which run in my family.
另外，某些女性疾病具有很强的遗传因素，其中大部分是我家族遗传的。
So that includes endometriosis, fibroids, and polycystic ovarian syndrome.
这包括子宫内膜异位症、子宫肌瘤和多囊卵巢综合症。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Maybe we could march through and just say, for a woman in her teens who's already hit puberty, what sorts of biomarkers should those young women be paying attention to?
也许我们可以简单地说，对于一个已经进入青春期的十几岁的女性来说，这些年轻女性应该关注什么样的生物标志物？
Likewise for women in their 20s, 30s.
对于20多岁、30多岁的女性来说也是如此。
Maybe we could take it more or less by decade, starting at puberty.
也许我们可以或多或少地经历十年，从青春期开始。
Andrew Huberman:
安德鲁·休伯曼：
In your teenage years, what I think is really interesting is to look at cortisol.
在你十几岁的时候，我认为真正有趣的是观察皮质醇。
To look at the dance between estrogen and progesterone in those years is less helpful because I think there's a lot of variability due to the immaturity of the system.
观察那些年雌激素和黄体酮之间的舞蹈没有多大帮助，因为我认为由于系统的不成熟，存在很多变化。
If you've got someone who's got really regular periods, it's probably better to do some benchmarking at that age.
如果你身边有人月经非常规律，那么最好在那个年龄做一些基准测试。
But generally, I find that benchmarking is best performed in your 20s or 30s.
但一般来说，我发现基准测试最好在 20 多岁或 30 多岁时进行。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Are periods not that regular in terms of duration of the menstrual cycle when the menstrual cycle first sets in?
当月经周期开始时，月经周期的持续时间是否不那么规律？
Andrew Huberman:
安德鲁·休伯曼：
For a lot of women, they're not regular.
对于很多女性来说，她们的表现并不规律。
And then there's the whole piece of oral contraceptives and other forms of contraception where you have no idea what the normal cycle is.
然后还有整套口服避孕药和其他形式的避孕方法，您不知道正常周期是什么。
But getting back to your original question, which is about biomarkers per decade.
但回到你最初的问题，这是关于每十年的生物标志物。
In your 20s, that's when you want to do some base casing with estrogen, progesterone, and testosterone.
在你 20 多岁的时候，你会想要用雌激素、黄体酮和睾酮进行一些基础锻炼。
What happens a lot of the time is that estrogen dominates in that tango, and when that happens, it sets you up for greater risk of fibroids, endometriosis.
很多时候，雌激素在探戈中占主导地位，当这种情况发生时，你患子宫肌瘤和子宫内膜异位症的风险就会更大。
I'd want to know about DHEA and sort of the whole androgen pathway.
我想了解 DHEA 和整个雄激素途径。
I'd want to know about the metabolites of estrogen, because some of them are protective and very helpful.
我想了解雌激素的代谢物，因为其中一些具有保护作用并且非常有帮助。
Others are a bit like Homer Simpson.
其他人有点像荷马·辛普森。
I mean, they are just causing all kinds of problems in your body.
我的意思是，它们只会给你的身体带来各种各样的问题。
I'd also like to know about their stool, so I want to know about the microbiome.
我还想了解他们的粪便，所以我想了解微生物组。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
In terms of blood testing or various tests for these other biomarkers, getting estrogen, testosterone, and other ratios, women will need to do it at different stages of their menstrual cycle.
在血液检测或对这些其他生物标志物的各种测试、雌激素、睾酮和其他比率方面，女性需要在月经周期的不同阶段进行。
If they had to pick one, either in the follicular phase and/or in the luteal stage of their ovulatory menstrual cycle, when would you suggest they do that?
如果他们必须选择一个，无论是在排卵月经周期的卵泡期和/或黄体期，您会建议他们什么时候这样做？
Andrew Huberman:
安德鲁·休伯曼：
So if you forced me to pick one, I would say probably day 21 to 22 for someone in her 20s.
所以如果你强迫我选一个，我会说对于 20 多岁的人来说可能是第 21 到 22 天。
So for most women, they've got a menstrual cycle date that averages out at 28 days, so this is about a week before they start their period.
因此，对于大多数女性来说，她们的月经周期日期平均为 28 天，所以这大约是她们月经开始前一周。
For women who are more irregular, it's harder to do that.
对于性格比较不规律的女性来说，做到这一点比较困难。
As women get older, usually the cycle gets a little shorter, so as they start to decline in their progesterone production, their period gets a little closer together.
随着女性年龄的增长，月经周期通常会缩短一些，因此当她们的黄体酮分泌量开始下降时，她们的月经周期会变得更加接近。
At that point, you want to test sooner, like day 19, 20.
那时，您想早点进行测试，例如第 19、20 天。
Blood test is the cheapest thing.
验血是最便宜的事情。
It's usually what's covered by insurance.
通常是保险承保的范围。
But my preference would be to do dried urine so that I get metabolomics in addition to the levels of these hormones.
但我更喜欢做干燥尿液，这样除了这些激素的水平之外，我还可以获得代谢组学数据。
And if I'm forced to, I'll use blood testing.
如果被迫的话，我会进行血液检测。
It's not as comprehensive, and as you know, it's a quick little snapshot while the needle's in your vein for 30 seconds.
它并不那么全面，而且如您所知，它只是针在您的静脉中停留 30 秒时的快速小快照。
Let me go back and say one other thing about biomarkers.
让我回过头来谈谈关于生物标志物的另一件事。
A big part of the testing that I do in phenotyping my patients, I practice precision medicine.
我在对患者进行表型分析时所做的测试的很大一部分是实践精准医学。
I like to almost start with nutritional testing.
我喜欢几乎从营养测试开始。
That would be potentially a helpful thing to do in your 20s.
这对你 20 多岁的人来说可能是一件很有帮助的事情。
Becomes less important as you get older and you develop more micronutrient deficiencies, but micronutrients play a huge role in terms of hormone production.
随着年龄的增长和微量营养素缺乏的增多，微量营养素变得不那么重要，但微量营养素在激素的产生方面发挥着巨大的作用。
Magnesium is hugely involved in the way that you get rid of estrogen, as an example.
例如，镁与消除雌激素的方式密切相关。
So micronutrient testing, what I usually do is a combination of blood and urine, and so I'm looking at all of the micronutrients that we can measure that have some clinical scientific basis behind them.
因此，微量营养素测试，我通常做的是血液和尿液的结合，所以我正在研究我们可以测量的所有微量营养素，这些微量营养素背后有一些临床科学依据。
Intake of vegetables, polyphenols, is such an important predictor of future risk of breast cancer, like when you're 50, 60 plus, and the most important time is when you're a teenager.
蔬菜多酚的摄入量是未来患乳腺癌风险的重要预测因素，例如当您 50 岁、60 岁以上时，最重要的时间是青少年时期。
If you have evidence that you could show a 17-year-old that they've got micronutrient gaps, I think that would be a motivator for them to eat differently at a time when it's so critical.
如果你有证据表明你可以向 17 岁的孩子表明他们存在微量营养素缺口，我认为这将成为他们在如此关键的时刻采取不同饮食方式的动力。
Even though it's 25 years in the future, that it's going to potentially change this arc that they're on
即使是 25 年后的未来，这也有可能改变他们所处的这条弧线
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I'd like to take a quick break and acknowledge one of our sponsors, LMNT.
我想稍微休息一下并感谢我们的赞助商之一 LMNT。
LMNT is an electrolyte drink that has everything you need and nothing you don't.
LMNT 是一种电解质饮料，拥有您需要的一切，没有您不需要的东西。
That means the electrolytes, sodium, magnesium, and potassium in the correct amounts, but no sugar.
这意味着电解质、钠、镁和钾的含量正确，但不含糖。
Proper hydration is critical for optimal brain and body function.
适当的水合作用对于大脑和身体的最佳功能至关重要。
Even a slight degree of dehydration can diminish cognitive and physical performance.
即使是轻微程度的脱水也会降低认知和身体表现。
It's also important that you get adequate electrolytes.
获得充足的电解质也很重要。
The electrolytes, sodium, magnesium, and potassium, are vital for functioning of all the cells in your body, especially your neurons or your nerve cells.
电解质（钠、镁和钾）对于体内所有细胞（尤其是神经元或神经细胞）的功能至关重要。
Drinking LMNT dissolved in water makes it very easy to ensure that you're getting adequate hydration and adequate electrolytes.
饮用溶解在水中的 LMNT 可以很容易地确保您获得足够的水分和电解质。
To make sure that I'm getting proper amounts of hydration and electrolytes, I dissolve one packet of LMNT in about 16 to 32 ounces of water when I first wake up in the morning, and I drink that basically first thing in the morning.
为了确保我获得适量的水合作用和电解质，当我早上第一次醒来时，我将一包 LMNT 溶解在大约 16 至 32 盎司的水中，并且我基本上早上第一件事就是喝它。
I'll also drink LMNT dissolved in water during any kind of physical exercise that I'm doing, especially on hot days when I'm sweating a lot and losing water and electrolytes.
我还会在进行任何体育锻炼时饮用溶解在水中的 LMNT，尤其是在炎热的日子里，当我大量出汗并失去水和电解质时。
LMNT has a bunch of great-tasting flavors.
LMNT 有很多美味的口味。
I love the raspberry, I love the citrus flavor.
我喜欢覆盆子，我喜欢柑橘味。
Right now, LMNT has a limited edition lemonade flavor that is absolutely delicious.
现在LMNT推出了限量版柠檬水口味，绝对美味。
I hate to say that I love one more than all the others, but this lemonade flavor is right up there with my favorite other one, which is raspberry or watermelon.
我不想说我比其他所有口味都更喜欢其中一种，但这种柠檬水口味与我最喜欢的另一种口味（覆盆子或西瓜）不相上下。
Again, I can't pick just one flavor.
再说一次，我不能只选择一种口味。
I love them all.
我爱他们所有人。
If you'd like to try LMNT, you can go to drinklmnt.com/huberman, spelled drink L-M-N-T.com/huberman, to claim a free LMNT sample pack with a purchase of any LMNT drink mix.
如果您想尝试 LMNT，可以访问 Drinklmnt.com/huberman（拼写为 Drink L-M-N-T.com/huberman），购买任意 LMNT 混合饮料即可领取免费 LMNT 样品包。
Again, that's drinklmnt.com/huberman to claim a free sample pack.
再次强调，请访问 Drinklmnt.com/huberman 索取免费样品包。
What do you do for a young woman who doesn't like vegetables or is not somehow able or willing to get those five colors a day of vegetable to help support the microbiome?
对于一个不喜欢蔬菜或无法或不愿意每天摄入这五种颜色的蔬菜来帮助支持微生物组的年轻女性，您该怎么办？
What other sorts of tools, behavioral or otherwise, are useful?
还有哪些其他有用的工具（行为工具或其他工具）？
Andrew Huberman:
安德鲁·休伯曼：
What I try to get them to do is to have a smoothie.
我试图让他们做的就是喝一杯冰沙。
If I could get them to have a smoothie three times a week and to throw some of these vegetables in, that makes a huge difference.
如果我能让他们每周喝三次冰沙，并加入一些蔬菜，那就会有很大的不同。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Hmm.
嗯。
Andrew Huberman:
安德鲁·休伯曼：
We know that makes a difference in terms of microbiome change.
我们知道这会对微生物组的变化产生影响。
I have them do steamed broccoli that's in the freezer because it's got very little taste.
我让他们做冰箱里的蒸西兰花，因为它的味道很少。
They could do that in a chocolate smoothie.
他们可以在巧克力冰沙中做到这一点。
They could add some greens.
他们可以添加一些蔬菜。
I like greens powders are super convenient.
我喜欢绿色粉末超级方便。
So that with a taste that they like, whether that's chocolate, which is what most of my clients want, or vanilla with berries and that sort of thing.
因此，他们喜欢的口味，无论是巧克力（这是我的大多数客户想要的），还是香草加浆果之类的。
So that can go a long way if you don't like vegetables.
所以如果你不喜欢蔬菜的话，这会有很大帮助。
And short of that, I would say some supplements, but I would say that's a distant second to making a smoothie.
除此之外，我会说一些补充剂，但我想说这与制作冰沙相比还相差甚远。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
What is going to be the best way to test the microbiome?
测试微生物组的最佳方法是什么？
Andrew Huberman:
安德鲁·休伯曼：
What I like to do with nutritional testing is run a panel that's looking at antioxidants, so vitamin A, vitamin C, alpha-lipoic acid, plant-based antioxidants, because you can measure that in the blood.
我喜欢做的营养测试是通过一个小组来观察抗氧化剂，比如维生素 A、维生素 C、α-硫辛酸、植物性抗氧化剂，因为你可以在血液中测量它们。
I like to look at some of the key vitamins, especially the B vitamin range, because as you probably know, if you've got particular genetic polymorphisms, you might be less likely to be absorbing the right level of vitamin B9, folate, vitamin B12, et cetera.
我喜欢研究一些关键维生素，尤其是 B 族维生素系列，因为您可能知道，如果您有特定的基因多态性，您可能不太可能吸收适当水平的维生素 B9、叶酸、维生素 B12 等。
I'm also looking, going back to the antioxidants, at glutathione, because I think that's such an important lever.
我也在寻找抗氧化剂，谷胱甘肽，因为我认为这是一个非常重要的杠杆。
And then I'm looking at some of the minerals.
然后我正在研究一些矿物质。
Magnesium is really the most important, and we know that somewhere around 70% to 80% of Americans are deficient in magnesium.
镁确实是最重要的，我们知道大约 70% 到 80% 的美国人缺乏镁。
That's the lowest hanging fruit.
这是最容易实现的目标。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I would be curious, for instance, with magnesium, if that number of people are deficient, does that mean that that number of people should be targeting their nutrition towards foods that contain magnesium and/or supplementing with magnesium?
例如，我很好奇，如果有那么多人缺乏镁，这是否意味着那么多人应该将营养目标转向含镁食物和/或补充镁？
And if so, what forms of magnesium?
如果是的话，镁有哪些形式？
Andrew Huberman:
安德鲁·休伯曼：
You have to measure red blood cell magnesium, whole blood.
你必须测量红细胞镁、全血。
And with deficiency, it's interesting with supplementation.
有了缺乏，补充就很有趣了。
For my patients who tend toward constipation, and that's frankly about 80% of the women that I take care of.
对于我的患者来说，他们有便秘倾向，坦率地说，这大约占我照顾的女性的 80%。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Really?
真的吗？
Andrew Huberman:
安德鲁·休伯曼：
Yes.
是的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Wow.
哇。
I'd be curious as to why that is.
我很好奇这是为什么。
Andrew Huberman:
安德鲁·休伯曼：
Patriarchy, rage, the PINE system.
父权制、愤怒、PINE 制度。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Right.
对。
Psychology, immunology, neural, and endocrine factors combined.
心理学、免疫学、神经学和内分泌因素相结合。
Is that-
难道是——
Andrew Huberman:
安德鲁·休伯曼：
Yes.
是的。
And then I would say there's another factor.
然后我想说还有另一个因素。
Being female is a health hazard.
身为女性会危害健康。
So we have twice the rate of depression, insomnia.
所以我们的抑郁症、失眠症发病率是原来的两倍。
We've got 3 to 4 X increased risk of multiple sclerosis.
我们患多发性硬化症的风险增加了 3 到 4 倍。
We've got five to eight times the risk of thyroid dysfunction.
我们患甲状腺功能障碍的风险是原来的五到八倍。
So if you just look at that and you look at subtle preclinical thyroid dysfunction, a large number of the women that I take care of have thyroid dysfunction that's contributing to constipation.
因此，如果你看看这一点，看看微妙的临床前甲状腺功能障碍，我照顾的很多女性都患有导致便秘的甲状腺功能障碍。
And if we go back to that control system, the hypothalamic pituitary adrenal thyroid canal gut axis, and they have a lot of perceived stress together with this borderline thyroid function that no mainstream medicine doctor has told her is a problem, and then she's got a problem with the tango between estrogen and progesterone, she's going to tend toward constipation.
如果我们回到那个控制系统，下丘脑垂体肾上腺甲状腺管肠道轴，他们有很多感知压力以及这种边缘甲状腺功能，没有主流医学医生告诉她这是一个问题，然后她在雌激素和孕激素之间出现问题，她就会倾向于便秘。
Women have a lot more constipation than men.
女性比男性更容易发生便秘。
The gut is about 10 feet longer in women compared to men, and they are much more likely to have a torturous colon.
与男性相比，女性的肠道长约 10 英尺，而且她们更有可能患有痛苦的结肠。
And the way you know that is you get a colonoscopy.
你知道这一点的方法就是进行结肠镜检查。
Women experience more trauma than men.
女性比男性经历更多的创伤。
This is well established.
这是众所周知的。
If you look at the ACE studies that were done by the CDC and Kaiser in 1998, we know that men, for the most part, middle-aged men, about 50% of them experience significant trauma as defined by the ACE questionnaire.
如果你看看 CDC 和 Kaiser 在 1998 年进行的 ACE 研究，我们就会知道，男性，大部分是中年男性，其中大约 50% 经历过 ACE 调查问卷所定义的严重创伤。
Women are at 60%, and that's pretty durable since 1998.
女性比例为 60%，自 1998 年以来这一比例相当稳定。
They have different forms of abuse, much more likely to have sexual abuse.
他们遭受不同形式的虐待，其中更有可能遭受性虐待。
They have a different HPA response than men.
她们的 HPA 反应与男性不同。
Their perceived stress tends to be higher, and I'm generalizing for a population.
他们感受到的压力往往更高，这是我针对人群进行的概括。
And so if you look at the physiology of a female, I think that constipation and that need to control and restrain and hold things in, I think that's part of the physiology.
因此，如果你观察女性的生理机能，我认为便秘以及需要控制、抑制和控制事物的需要，我认为这是生理机能的一部分。
So I'm veering away from the science, but I do think that It is a really important signal to pay a lot of attention to.
所以我偏离了科学，但我确实认为这是一个非常重要的信号，值得高度关注。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
What sorts of tools do you recommend people use to relieve constipation?
您建议人们使用哪些工具来缓解便秘？
Sounds like reducing stress is going to be a huge one.
听起来减轻压力将是一件巨大的事情。
Andrew Huberman:
安德鲁·休伯曼：
Yes.
是的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
What are your favorite stress reduction tools?
您最喜欢的减压工具是什么？
Things that can really lower the baseline.
真正可以降低基线的事情。
Andrew Huberman:
安德鲁·休伯曼：
So I'm not a fan of lowering stress.
所以我不喜欢减轻压力。
I'm a fan of lowering perceived stress.
我热衷于降低感知压力。
I think all of us need an à la carte menu of what is most effective.
我认为我们所有人都需要一份最有效的点菜菜单。
So what works for me now at my age is different than the TM I did as a college student, transcendental meditation.
所以现在对我这个年纪有效的方法与我在大学时所做的TM不同，那就是超验冥想。
I became a certified yoga teacher when I was in my 30s.
我在30多岁的时候成为了一名经过认证的瑜伽老师。
That is very effective for a lot of people.
这对很多人来说非常有效。
I do holotropic breathwork.
我做全息呼吸。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I think people are starting to appreciate that there are ways that they can relieve their stress that don't only fall under the categories of vacation-
我认为人们开始认识到，有一些方法可以缓解压力，而这些方法不仅仅属于假期类别——
Andrew Huberman:
安德鲁·休伯曼：
Right
右
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
and meditation.
和冥想。
But I want to say that meditation is obviously a wonderful tool.
但我想说，冥想显然是一个很棒的工具。
Andrew Huberman:
安德鲁·休伯曼：
Well, certainly it's a great tool, and it's got such a scientific basis behind it.
嗯，当然这是一个很棒的工具，而且它背后有这样的科学基础。
But there's so many things on this à la carte menu.
但这个点菜菜单上有很多东西。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Sex, orgasm, connection, feeling heard and seen and loved.
性、性高潮、联系、被听到、被看到和被爱的感觉。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I want to use this as an opportunity to, A, keep this in mind as we turn to a question that I didn't close the hatch on earlier, and it's my fault, which is I'm now clear on the fact that a woman in her late teens, early 20s ought to know something about her testosterone, estrogen, thyroid, cortisol levels.
我想利用这个机会，A，在我们转向一个我没有早点解决的问题时牢记这一点，这是我的错，我现在清楚地认识到，一个十几岁、二十岁出头的女性应该了解一些关于她的睾酮、雌激素、甲状腺、皮质醇水平的信息。
Should start at least thinking about her microbiome, should be thinking about how many bowel movements and the timing of those bowel movements per day, and I'm assuming that what I just described is also true for women in their 20s, 30s, 40s, 50s, on up to 100s.
至少应该开始考虑她的微生物群，应该考虑每天排便的次数和排便的时间，我假设我刚才描述的内容也适用于 20 多岁、30 多岁、40 多岁、50 多岁、最多 100 多岁的女性。
Is that correct?
这是正确的吗？
Andrew Huberman:
安德鲁·休伯曼：
That's correct, but I would say that there are differential opportunities by decade.
这是正确的，但我想说的是，十年间机会有所不同。
So I'm glad you circled it back to teenagers and testosterone, because I think if you know, for instance, in your teenage years that you have high androgens and that you've got this potential phenotype way into the future that you may not even notice.
所以我很高兴你把它带回青少年和睾丸激素，因为我认为，如果你知道，例如，在你十几岁的时候，你的雄激素水平很高，并且你在未来可能不会注意到这种潜在的表型。
Maybe you notice you've got a few extra hairs on your chin or something.
也许您注意到下巴或其他地方有一些多余的毛发。
If you know that your testosterone is elevated or some other androgen, it might change the arc of how you take care of yourself.
如果您知道您的睾酮或其他雄激素升高，它可能会改变您照顾自己的方式。
So I think that could be very helpful in your teenage years.
所以我认为这对你的青少年时期非常有帮助。
In your 20s, for people who are a stress case like me, so age 27 on the wards at UCSF, if I had known that I was such a high cortisol person, I think I would've done things differently.
在你 20 多岁的时候，对于像我这样有压力的人来说，27 岁在加州大学旧金山分校的病房里，如果我知道我是一个皮质醇如此高的人，我想我会做不同的事情。
I would've changed my behavior.
我会改变我的行为。
Your testosterone can decline starting in your 20s, kind of depending on how much stress your matrix is under.
从 20 多岁开始，你的睾丸激素就会下降，这取决于你的基质承受的压力有多大。
So for women, that can start as early as 28.
所以对于女性来说，最早可以从 28 岁开始。
Usually, your testosterone declines by about 1% per year.
通常，您的睾酮激素每年下降约 1%。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
What level of testosterone do you like to see in a woman once she's sort of post, let's say after age 25?
当女性进入职场后（比如说 25 岁之后），您希望看到她的睾丸激素水平达到什么水平？
Andrew Huberman:
安德鲁·休伯曼：
So the way I tend to describe this on podcasts is the top half of the normal range.
因此，我倾向于在播客上描述这一点的方式是正常范围的上半部分。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I get a lot of questions about PCOS.
我收到很多关于多囊卵巢综合症的问题。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
So PCOS is one of those really poorly understood conditions.
因此，多囊卵巢综合症是人们真正知之甚少的病症之一。
It kind of flies below the radar until a woman wants to get pregnant or she's got some other issue that drives her to a physician.
直到女性想要怀孕或者有其他问题促使她去看医生之前，这种情况才会引起人们的注意。
The problem is that it is a syndrome, right?
问题是这是一种综合症，对吧？
So polycystic ovary syndrome, sometimes polycystic ovarian syndrome, and syndromes don't necessarily fit together into a really clear diagnostic criteria.
因此，多囊卵巢综合征（有时是多囊卵巢综合征）和综合征不一定符合真正明确的诊断标准。
So in this instance, there are three different criteria that we look for.
因此，在这种情况下，我们需要寻找三个不同的标准。
So cysts on the ovaries, having clinical manifestations of hyperandrogenism, so that could be hirsutism, acne, other things, and then usually irregular periods.
因此，卵巢囊肿具有雄激素过多症的临床表现，可能是多毛症、痤疮等，然后通常是月经不调。
And the way that that's defined, at least by the latest criteria, is having a period every 35 days or less.
至少按照最新标准，其定义是每 35 天或更短时间来一次月经。
So typical cycle length, 28 days, 35 days.
所以典型的周期长度是28天、35天。
You're skipping a period here and there.
你在这里或那里跳过了一个句点。
So those are the criteria that we use to diagnose PCOS.
这些就是我们用来诊断多囊卵巢综合症的标准。
There are about four different systems out there in the literature for diagnosing PCOS, which is where it starts to get confusing.
文献中大约有四种不同的系统用于诊断多囊卵巢综合症，这就是它开始变得令人困惑的地方。
So there's some women who have no cysts on their ovaries, but they've got hirsutism and they've got irregular periods.
有些女性的卵巢没有囊肿，但她们却患有多毛症并且月经不调。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Could you define hirsutism?
你能定义多毛症吗？
Andrew Huberman:
安德鲁·休伯曼：
Hirsutism is increased hair growth, usually in places that you don't want it.
多毛症是指毛发生长增多，通常是在您不想要的地方。
So for women, it can be kind of male pattern.
所以对于女性来说，它可以是一种男性模式。
They might notice it on their breasts, on their chest.
他们可能会在他们的乳房上、胸部上注意到它。
What we know is that PCOS is not just a problem in terms of irregular periods and then difficulty getting pregnant, so those are mostly problems in your 20s, 30s, early 40s, but it is a massive risk factor for cardiometabolic disease as you get older.
我们知道，PCOS 不仅仅是月经不调和怀孕困难的问题，所以这些问题大多是 20 多岁、30 多岁、40 岁出头的问题，而且随着年龄的增长，它是心脏代谢疾病的一个巨大危险因素。
So many people tend to pigeonhole PCOS as a problem of reproductive age.
很多人倾向于将多囊卵巢综合症归为生育年龄问题。
We have to be thinking of it over the entire female life cycle, and I would say it's even more important to consider it over the age of 50, average age of menopause is 51 to 52, because we know that that elevated testosterone, the high androgens, are probably the greatest cardiometabolic driver of disease for women with PCOS.
我们必须在整个女性生命周期中考虑这一点，我想说，更重要的是在 50 岁以上考虑这一点，平均绝经年龄是 51 至 52 岁，因为我们知道，升高的睾酮、高雄激素可能是 PCOS 女性疾病的最大心脏代谢驱动因素。
The thread we haven't talked about is the role of insulin and glucose.
我们还没有讨论的主题是胰岛素和葡萄糖的作用。
So for some of the phenotypes of PCOS, the problem is hyperinsulinemia, high insulin in the blood, is driving those theca cells in the ovaries to overproduce testosterone.
因此，对于多囊卵巢综合症的某些表型，问题是高胰岛素血症，即血液中的高胰岛素，正在驱使卵巢中的卵泡膜细胞过度产生睾酮。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Are you a fan of continuous glucose monitors?
您是连续血糖监测仪的粉丝吗？
Andrew Huberman:
安德鲁·休伯曼：
The hugest, most gigantic fan of CGMs.
CGM 的最大、最大的粉丝。
I've never seen any tool that I've ever used in medicine change behavior the way that CGMs do.
我从未见过任何我在医学中使用过的工具能够像连续血糖监测那样改变行为。
I think really understanding what the mediators are of your glucose control is essential.
我认为真正了解血糖控制的调节因素至关重要。
Now, that said, it's also kind of a later effect.
也就是说，这也是一种后期效应。
I'd rather know your insulin, and we know from the Whitehall study that Insulin, especially postprandial insulin, fasting insulin too, can change years and years before you get a change in glucose.
我更想知道你的胰岛素，我们从白厅研究中知道，胰岛素，尤其是餐后胰岛素，空腹胰岛素，可以在你的血糖发生变化之前多年发生变化。
So that's more for pre-diabetes and diabetes.
这对于糖尿病前期和糖尿病来说更是如此。
Third thing is it democratizes data.
第三件事是它使数据民主化。
One of the most hopeful and exciting things that I'm seeing right now in the health space is that we're going from this patriarchal relationship where doctors hold the power and are the gatekeepers of data, to patients and clients having much more access to that enchantment about their own chemistry and their own biology.
我现在在健康领域看到的最有希望和最令人兴奋的事情之一是，我们正在摆脱这种父权关系，即医生掌握权力并且是数据的看门人，患者和客户可以更多地接触到他们自己的化学和生物学的魅力。
Teaching the patient to be their own clinician, to me, that is a loop of benevolence and integrity that I think is essential to creating health.
对我来说，教导患者成为自己的临床医生，这是仁慈和正直的循环，我认为这对于创造健康至关重要。
We've got a disease care system.
我们有一个疾病护理系统。
We need the democratization of data to become a health-based system.
我们需要数据民主化，成为一个基于健康的系统。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I'd like to take a quick break and acknowledge our sponsor, AG1.
我想稍微休息一下并感谢我们的赞助商 AG1。
I'm excited to share that AG1 has just launched their newest formulation, AG1 Pro.
我很高兴与大家分享，AG1 刚刚推出了他们的最新配方 AG1 Pro。
AG1 Pro takes the clinically backed AG1 formula, which is a blend of vitamins, minerals, probiotics, and adaptogens, and adds three important new ingredients, creatine monohydrate, calcium HMB, and zinc carnosine.
AG1 Pro 采用经过临床支持的 AG1 配方，该配方是维生素、矿物质、益生菌和适应原的混合物，并添加了三种重要的新成分：一水肌酸、HMB 钙和肌肽锌。
Each serving has five grams of creatine monohydrate to support muscle strength and performance, as well as brain health, calcium HMB to support muscle recovery and reduce muscle breakdown, and zinc carnosine to support and improve the lining of your gut.
每份含有 5 克一水肌酸，可支持肌肉力量和性能，以及大脑健康；HMB 钙可支持肌肉恢复并减少肌肉分解；肌肽锌可支持和改善肠道内壁。
All three of these ingredients have compelling science to support them, and therefore, I love seeing them added to the existing AG1 formula.
所有这三种成分都有令人信服的科学支持，因此，我喜欢看到它们添加到现有的 AG1 配方中。
As most of you know, I've been taking AG1 every day for nearly 14 years now.
正如你们大多数人所知，我每天服用 AG1 已有近 14 年了。
I started taking it long before I even knew what a podcast was.
早在我知道什么是播客之前我就开始服用它了。
It's a great product, and it's now made even better with the new AG1 Pro formula.
这是一款很棒的产品，现在新的 AG1 Pro 配方让它变得更好。
If you would like to try AG1 Pro, you can go to drinkag1.com/huberman to get a special offer.
如果您想尝试 AG1 Pro，可以访问 Drinkag1.com/huberman 获取特别优惠。
AG1 is giving away a free bottle of omega-3 coenzyme Q10 with your first subscription.
AG1 首次订阅即可免费赠送一瓶 omega-3 辅酶 Q10。
Again, go to drinkag1.com/huberman to get a free bottle of omega-3 coenzyme Q10 with your first AG1 subscription.
同样，请访问 Drinkag1.com/huberman，首次订阅 AG1 即可免费获得一瓶 omega-3 辅酶 Q10。
If you had a magic wand and you could give two or three don'ts to maximize vitality and longevity, let's focus first on female patients, but if it extends to male patients as well, what would you like to see them not do?
如果你有一根魔杖，你可以做两到三个“不”，以最大限度地提高活力和寿命，让我们首先关注女性患者，但如果它也延伸到男性患者，你希望看到他们不做什么？
Andrew Huberman:
安德鲁·休伯曼：
So I would say sleep, alcohol, high perceived stress, eating the wrong foods, toxic relationships, and isolation, and then number six, not moving enough or not moving and exercising in a way that really fits with your body.
所以我会说睡眠、酒精、高压力、吃错误的食物、有毒的关系和孤立，然后是第六，运动量不够或没有以真正适合你身体的方式运动和锻炼。
So those-
所以那些-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Can we start with that one, actually?
实际上我们可以从那个开始吗？
Andrew Huberman:
安德鲁·休伯曼：
Sure.
当然。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Just because it's such a-- And then work backwards?
仅仅因为它是这样的——然后倒退？
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Well, I think for me, because I have a phenotype that produces a lot of insulin, kind of depending on how I'm on my game, I have a lot of glucose, so I have to exercise a lot more to dispose that glucose.
嗯，我认为对我来说，因为我的表型会产生大量胰岛素，这取决于我在比赛中的表现，所以我有大量的葡萄糖，所以我必须进行更多的锻炼来处理这些葡萄糖。
So I think you then have to move from medicine for the population or prescriptions for the population to what works for the individual.
所以我认为你必须从针对人群的药物或针对人群的处方转向对个人有效的药物。
One of the mediators that I think is important, especially for people who do what I call chronic cardio, which is what I did, is cortisol.
我认为重要的调节因素之一是皮质醇，尤其是对于那些进行我所说的慢性有氧运动的人来说，这就是我所做的。
So we know that runners, especially marathon runners, people who do a lot of cardio and don't do much resistance training, they tend to have much high cortisol levels.
所以我们知道，跑步者，尤其是马拉松运动员，进行大量有氧运动但不进行太多阻力训练的人，他们的皮质醇水平往往很高。
And you can buffer that with vitamin C.
你可以用维生素 C 来缓冲它。
Vitamin C can decrease the effect, but chronic cardio doesn't always serve people.
维生素 C 可以降低这种效果，但慢性有氧运动并不总是适合人们。
When I first started measuring hormone panels in myself, I went to my physician and I said, "I'm 35.
当我第一次开始测量自己的激素水平时，我去找我的医生，我说：“我 35 岁了。
I've never been so exhausted in my life.
我一生中从未如此疲惫过。
I just feel like I'm pushing a rock up the hill.
我只觉得自己就像是在把一块石头推上山。
I've got this belly fat that I don't like, and I don't want to have sex with my husband.
我有我不喜欢的腹部脂肪，我不想和我的丈夫发生性关系。
What can we do about this?" And he offered a birth control pill and an antidepressant.
对此我们能做些什么呢？”他还提供了避孕药和抗抑郁药。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Oh, goodness.
哦，天哪。
Andrew Huberman:
安德鲁·休伯曼：
So I left him and I went to the lab and I ran a hormone panel, and my cortisol was three times what it should have been.
所以我离开了他，去了实验室，进行了激素检查，发现我的皮质醇含量是应有水平的三倍。
My insulin was in the 20s.
我的胰岛素是20多岁。
I was fasting.
我当时正在禁食。
My glucose was 105.
我的血糖是105。
My thyroid was mildly abnormal.
我的甲状腺轻度异常。
My progesterone was low.
我的黄体酮很低。
And that set me on this course of realizing that what I was doing as a physician, taking care especially of women, was not getting to some of these root causes that are so essential.
这让我意识到，作为一名医生，我所做的事情，尤其是照顾女性，并没有找到其中一些至关重要的根本原因。
And I would say I had to start first with cortisol.
我想说我必须首先从皮质醇开始。
At that time, I was running four miles, three times a week, four times a week.
那时，我跑四英里，每周跑三次，每周跑四次。
That was just raising my cortisol further.
这只会进一步提高我的皮质醇。
So that was not the right exercise for me.
所以这对我来说不是正确的练习。
I needed more adaptive exercise.
我需要更多的适应性锻炼。
I started doing Pilates, more yoga.
我开始做普拉提，更多的是瑜伽。
That helped to lower my cortisol.
这有助于降低我的皮质醇。
It started me on changing the way I was managing perceived stress, and it also changed my supplement regimen.
它开始改变我管理感知压力的方式，它也改变了我的补充方案。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I'd like to make sure that we circle back to birth control, in particular, oral contraceptive birth control.
我想确保我们回到节育问题，特别是口服避孕药节育问题。
What are your concerns?
您有什么顾虑？
What do you like about oral contraceptives?
您喜欢口服避孕药的哪些方面？
What do you dislike about them?
你不喜欢他们什么？
Andrew Huberman:
安德鲁·休伯曼：
In terms of benefit, I think that, especially when they first came out and even now, it gives women reproductive choice, and that's essential.
就好处而言，我认为，尤其是在它们刚出现时，甚至现在，它为女性提供了生育选择权，这是至关重要的。
So I'm a big fan in that regard, and we've got a lot of data to show both the risks and also the benefits of it.
所以我是这方面的忠实粉丝，我们有大量数据来展示它的风险和好处。
So I'll speak first into the benefits because I'm going to get on a soapbox a little bit about the risks.
因此，我将首先谈谈好处，因为我将就风险进行一些演讲。
So we know that it reduces the risk of ovarian cancer.
所以我们知道它可以降低患卵巢癌的风险。
So there's something about this idea of incessant ovulation that is not good for the female body.
因此，持续排卵的想法对女性身体不利。
So if you look at, for instance, women who are nuns who don't take oral contraceptives, and they have a period every single month of their reproductive lives, they have a greater risk of ovarian cancer.
因此，举例来说，如果你观察那些不服用口服避孕药的修女女性，她们在生育期间每个月都会来一次月经，那么她们患卵巢癌的风险就更大。
So if you look then at women who have several babies, and they've got a period of time when they're pregnant that they're not ovulating, and then they breastfeed for some period of time, they have a lower risk of ovarian cancer.
因此，如果你观察一下生育多个孩子的女性，她们在怀孕期间有一段时间不排卵，然后母乳喂养一段时间，那么她们患卵巢癌的风险较低。
So Oral contraceptives help with reducing ovulation and reducing risk.
因此，口服避孕药有助于减少排卵并降低风险。
We know that if you take the oral contraceptive for about five years, it reduces your risk of ovarian cancer by 50%.
我们知道，如果您服用口服避孕药大约五年，您患卵巢癌的风险就会降低 50%。
And that's significant because we're so poor at diagnosing ovarian cancer early.
这很重要，因为我们在早期诊断卵巢癌方面做得很差。
There's really no method that's really effective.
确实没有什么方法是真正有效的。
We use CA 125 and ultrasound screening, especially in women who are at greater genetic risk.
我们使用 CA 125 和超声波筛查，尤其是针对遗传风险较高的女性。
But even that, often we diagnose it in a later stage.
但即便如此，我们通常还是在后期才诊断出来。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Maybe just because that statement is going to highlight for a number of people the question of what are some of the earliest symptoms that people can recognize without a blood test.
也许只是因为该声明将向许多人强调这样一个问题：人们无需验血即可识别的最早症状是什么。
So is ovarian cancer, is it going to be pain?
那么卵巢癌的话，会痛吗？
Andrew Huberman:
安德鲁·休伯曼：
So the problem is the symptoms are so vague and they're so nonspecific.
所以问题是症状是如此模糊且不具体。
One of the most common symptoms is bloating.
最常见的症状之一是腹胀。
And we've already talked about constipation, we've talked about how women have this longer GI tract, and so bloating is a really common experience for most women.
我们已经讨论过便秘，我们讨论过女性如何拥有更长的胃肠道，因此腹胀对于大多数女性来说是一种非常常见的经历。
You can have bulk symptoms, feeling like your lower belly is kind of pressed out.
您可能会出现肿块症状，感觉下腹部有点受压。
The way that we inform women in terms of watching for this is to get regular gynecologic exams.
我们告诉女性注意这一点的方法是定期进行妇科检查。
For women who are at high risk where they have, for instance, an ultrasound for some reason, and it shows a mass that we're concerned about, there's a way to triage that in terms of what kind of evaluation that they need, and that's a situation where you might get a blood test called a CA 125.
对于处于高风险的女性，例如，由于某种原因进行了超声波检查，并且它显示了我们担心的肿块，有一种方法可以根据她们需要的评估类型对其进行分类，在这种情况下，您可能会进行称为 CA 125 的血液检查。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Taking estrogen and thereby reducing the frequency of ovulation lowers the risk of ovarian cancer.
服用雌激素从而减少排卵频率可以降低患卵巢癌的风险。
Should women that are, even women who are not sexually active, so they're not actively trying to get pregnant or avoid getting pregnant, but if they're not sexually active, would they be wise to suppress ovulation for periodically using hormone-based contraception just so that they can offset the risk of ovarian cancer?
女性，即使是性行为不活跃的女性，也不会积极尝试怀孕或避免怀孕，但如果她们性行为不活跃，那么为了抵消卵巢癌的风险，定期使用激素避孕来抑制排卵是否明智？
Andrew Huberman:
安德鲁·休伯曼：
That's a very rational question, and I would say that's what mainstream medicine has had at its back to recommend oral contraceptives, not just for women who are seeking contraception, but for acne, for painful periods.
这是一个非常理性的问题，我想说，这就是主流医学推荐口服避孕药的原因，不仅适用于寻求避孕的女性，也适用于治疗痤疮和经期疼痛。
For really kind of the drop of a hat, they're prescribing oral contraceptives.
他们确实开了口服避孕药。
That's what I was taught to do.
这就是我被教导要做的。
And I think a lot of that is pharmaceutical influence.
我认为其中很大一部分是药物的影响。
The oral contraceptive is two hormones.
口服避孕药是两种激素。
It's ethinyl estradiol, and it's a progestin.
它是乙炔雌二醇，它是一种孕激素。
So it's not the normal progesterone that your body makes, that your ovaries make, and your adrenals make.
因此，这不是您的身体、卵巢和肾上腺产生的正常黄体酮。
It is a synthetic form of progesterone, and it is the same progestin, similar, same class that was shown to be dangerous and provocative in the Women's Health Initiative.
它是黄体酮的合成形式，与妇女健康倡议中被证明具有危险性和挑衅性的黄体酮相同、相似、同一类别。
So I'm not a fan of progestins.
所以我不喜欢孕激素。
I do not recommend them for any woman unless it gives them some freedom in some way.
我不向任何女性推荐它们，除非它以某种方式给她们一些自由。
So like with almost any pharmaceutical, the oral contraceptive depletes certain micronutrients.
因此，与几乎所有药物一样，口服避孕药会消耗某些微量营养素。
Magnesium, there's certain vitamin Bs that are depleted.
镁、某些维生素 B 都被耗尽了。
It also affects the microbiome.
它还会影响微生物组。
That data is not as strong, but there seems to be some effect, and there's also an increased risk of inflammatory bowel disease, an autoimmune condition.
这些数据并不那么有力，但似乎有一些影响，而且炎症性肠病（一种自身免疫性疾病）的风险也会增加。
It increases inflammatory tone.
它增加炎症张力。
So the studies that I've seen increase one of the markers of inflammatory tone, high sensitivity CRP, by about 2 to 3X.
因此，我看到的研究将炎症状态的标志物之一——高敏感性 CRP 增加了约 2 至 3 倍。
It seems to make the hypothalamic pituitary adrenal axis more rigid so that you can't kind of roll with the punches and wax and wane in terms of cortisol production the way that you can off the birth control pill.
它似乎使下丘脑、垂体、肾上腺轴变得更加坚硬，这样你就不能像戒掉避孕药那样，在皮质醇的产生方面随波逐流、起伏不定。
It can affect thyroid function.
它会影响甲状腺功能。
Anytime you take oral estrogen, it raises sex hormone binding globulin.
每当您口服雌激素时，它都会增加性激素结合球蛋白。
And you've talked to other podcast guests about this, Kyle, I think.
我想，凯尔，你已经和其他播客嘉宾谈论过这个问题了。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Sex hormone binding globulin, I think of as a sponge that soaks up free estrogen and free testosterone.
性激素结合球蛋白，我认为是吸收游离雌激素和游离睾酮的海绵。
So when you go on the birth control pill, you raise your sex hormone binding globulin.
因此，当您服用避孕药时，您的性激素结合球蛋白会升高。
It soaks up especially free testosterone.
它吸收特别是游离的睾酮。
And for some women, it's not a big deal.
对于一些女性来说，这不是什么大问题。
They don't notice much of a difference.
他们没有注意到太大的差异。
But then there's a phenotype, maybe related to CAG repeats on the androgen receptor, who are exquisitely sensitive to that decline in free testosterone.
但还有一种表型，可能与雄激素受体上的 CAG 重复有关，雄激素受体对游离睾酮的下降非常敏感。
So this then opens the portal of talking a little bit about testosterone in women.
因此，这就打开了谈论女性睾酮激素的大门。
It's the most abundant, biologically, the most abundant hormone in the female system.
从生物学角度来说，它是女性系统中最丰富的激素。
It is so important for women.
这对女性来说是如此重要。
It is essential to so many things, not just sex drive and muscle mass and seeing a response to resistance training, but also confidence and agency.
它对很多事情都很重要，不仅仅是性欲和肌肉质量以及对阻力训练的反应，还包括信心和能动性。
And so those women who are so sensitive to their testosterone level, they've got this high sex hormone binding globulin, their testosterone declines.
因此，那些对睾酮水平非常敏感的女性，她们体内的性激素结合球蛋白很高，她们的睾酮水平就会下降。
What they describe is vaginal dryness, maybe a decline in sex drive.
他们描述的是阴道干燥，可能是性欲下降。
But there's also this bigger issue related to confidence and agency, even risk-taking from studies that we've done with MBA students that I think is a serious problem.
但还有一个更大的问题与信心和代理有关，甚至是我们对 MBA 学生进行的研究中的冒险行为，我认为这是一个严重的问题。
Maybe the most important out of all of these things is that it can shrink the clitoris by up to 20%.
也许所有这些事情中最重要的是它可以使阴蒂缩小高达 20%。
20%.
20%。
And if I've got a woman that I think should not be on the birth control pill, and maybe she's taking it for acne, or she's taking it because her periods were a little painful, what I'm going to do is say, "Let's leverage these other ways of making your period less painful.
如果我有一个我认为不应该服用避孕药的女性，也许她是因为痤疮而服用避孕药，或者她服用避孕药是因为她的经期有点疼痛，我要做的是说，“让我们利用这些其他方法来减轻经期疼痛。
Let's take the message of your painful periods and figure out, okay, it's at your inflammatory tone, and we give you some fish oil and ATMs, maybe a little aspirin when you've got your period.
让我们了解一下您经期疼痛的信息，然后弄清楚，好吧，这是您的炎症基调，我们会给您一些鱼油和自动提款机，也许在您经期时给您一点阿司匹林。
Let's find some other ways to deal with it than to take the oral contraceptive, which you have not received informed consent about, because it can shrink your clit by up to 20%." Now, that usually convinces most people to come off of it.
让我们找到一些其他方法来处理它，而不是服用口服避孕药，因为它可以使你的阴蒂缩小多达 20%。”现在，这通常会说服大多数人放弃它。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Is that reversible?
这是可逆的吗？
Andrew Huberman:
安德鲁·休伯曼：
The data that we have is limited.
我们拥有的数据是有限的。
There's one woman who, Claudia something something, who looked at sex hormone binding globulin a year out from stopping the birth control pill, and it was still elevated.
有一个女人，克劳迪娅什么的，在停止服用避孕药一年后，她检查了性激素结合球蛋白，结果仍然升高。
It wasn't as high as it was when they were on the pill, but it was still elevated.
虽然没有服用避孕药时那么高，但仍然升高。
So your question about reversibility, I don't know if we know the answer to that.
所以你关于可逆性的问题，我不知道我们是否知道答案。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I'd like to take a quick break and acknowledge our sponsor, Eight Sleep.
我想稍微休息一下，并向我们的赞助商“八睡”表示感谢。
Eight Sleep makes smart mattress covers with cooling, heating, and sleep tracking capacity.
August Sleep 生产具有冷却、加热和睡眠跟踪功能的智能床垫套。
One of the best ways to ensure you get a great night's sleep is to make sure that the temperature of your sleeping environment is correct.
确保您睡个好觉的最佳方法之一是确保睡眠环境的温度正确。
And that's because in order to fall asleep and stay deeply asleep, your body temperature actually has to drop by about one to three degrees.
这是因为为了入睡并保持深度睡眠，您的体温实际上必须下降约一到三度。
And in order to wake up feeling refreshed and energized, your body temperature actually has to increase by about one to three degrees.
为了醒来时感觉神清气爽、精力充沛，您的体温实际上必须升高约一到三度。
Eight Sleep automatically regulates the temperature of your bed throughout the night according to your unique needs.
八睡眠会根据您的独特需求自动调节整个晚上的床温。
I've been sleeping on an Eight Sleep mattress cover for nearly five years now, and it has completely transformed and improved the quality of my sleep.
我已经睡在八睡眠床垫罩上近五年了，它彻底改变并改善了我的睡眠质量。
The latest Eight Sleep model is the Pod 5.
最新的八睡眠型号是 Pod 5。
This is what I'm now sleeping on, and I absolutely love it.
这就是我现在睡觉的地方，我非常喜欢它。
It has so many incredible features.
它有很多令人难以置信的功能。
For instance, the Pod 5 has a feature called Autopilot, which is an AI engine that learns your sleep patterns and then adjusts the temperature of your sleeping environment across different sleep stages.
例如，Pod 5有一个名为Autopilot的功能，这是一个人工智能引擎，可以学习你的睡眠模式，然后在不同的睡眠阶段调整你的睡眠环境温度。
It'll even elevate your head if you're snoring, and it makes other shifts to optimize your sleep.
如果您打鼾，它甚至会抬高您的头部，并进行其他转换以优化您的睡眠。
If you'd like to try Eight Sleep, go to eightsleep.com/huberman to get up to $350 off the new Pod 5.
如果您想尝试八睡眠，请访问八睡眠.com/huberman，新款 Pod 5 最高可享受 350 美元优惠。
Eight Sleep ships to many countries worldwide, including Mexico and the UAE.
八号睡眠船运往世界各地的许多国家，包括墨西哥和阿联酋。
Again, that's eightsleep.com/huberman to save up to $350.
同样，访问八睡眠.com/huberman 最多可节省 350 美元。
What are your thoughts on menopause?
您对更年期有何看法？
When should people start thinking about it?
人们什么时候应该开始思考这个问题？
And I'm guessing, based on everything you've told me today, that there are women in their 30s that while they may be 20 years out from menopause, probably should be doing things now in-
根据你今天告诉我的一切，我猜测有些 30 多岁的女性虽然距离更年期还有 20 年，但可能应该现在就做一些事情——
Andrew Huberman:
安德鲁·休伯曼：
Yes
是的
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
anticipation of that.
对此的期待。
Andrew Huberman:
安德鲁·休伯曼：
The more you know about your phenotype, your hormonal phenotype when you're in your 30s, you're set up in terms of what to do in the future, especially things like your thyroid, your estrogen and progesterone levels, because you can replace to a state of euthyroid.
当你 30 多岁的时候，你对自己的表型、荷尔蒙表型了解得越多，你就会对未来做什么做好准备，特别是像你的甲状腺、雌激素和黄体酮水平这样的事情，因为你可以恢复到甲状腺功能正常的状态。
I don't usually go exactly back to where the estrogen and progesterone levels were, but we can get pretty close.
我通常不会完全回到雌激素和孕激素水平的水平，但我们可以非常接近。
So in your 30s, having a base case I think is really essential.
所以在你30多岁的时候，我认为有一个基本案例非常重要。
What's more interesting is to talk about perimenopause.
更有趣的是谈论围绝经期。
So perimenopause is the period of time before your final menstrual cycle, and for most women, depending on how attuned you are to the symptoms, it can last for 10 years.
因此，围绝经期是最后一次月经周期之前的一段时间，对于大多数女性来说，根据您对症状的适应程度，围绝经期可以持续 10 年。
So I'm still in perimenopause.
所以我还处于围绝经期。
It's been like 20 years because I've been tracking it so carefully.
已经过去20年了，因为我一直如此仔细地追踪它。
It usually gets kicked off by having your cycle get closer together.
它通常是在你的周期变得更接近时开始的。
So that can happen in your 30s or your 40s.
所以这可能会发生在你 30 多岁或 40 多岁的时候。
You go from 28 days to 25 days, that sort of thing.
你从 28 天到 25 天，诸如此类。
You may notice it as more anxiety, difficulty sleeping, and that probably is related to the estrogen receptor.
您可能会注意到它更加焦虑、睡眠困难，这可能与雌激素受体有关。
So there's this whole period of perimenopause, and what's most fascinating to me is that there is this massive, massive change that happens in the female brain that people are not talking about enough.
因此，在整个围绝经期期间，最让我着迷的是女性大脑中发生的巨大变化，而人们对这一变化的谈论还不够。
And so looking at the work of Lisa Mosconi at Cornell, starting around age 40, there is this massive change in cerebral metabolism.
因此，看看康奈尔大学丽莎·莫斯科尼 (Lisa Mosconi) 的工作，从 40 岁左右开始，大脑代谢发生了巨大的变化。
So you can do FDG PET scans.
因此您可以进行 FDG PET 扫描。
You can look at glucose uptake, and there's about, on average, a 20% decline from premenopause up to like age 35 to perimenopause to post-menopause.
你可以观察一下葡萄糖的摄入量，从绝经前到 35 岁左右，再到围绝经期到绝经后，葡萄糖的摄入量平均下降 20% 左右。
The women who are having the most symptoms in perimenopause to menopause, the hot flashes, the night sweats, the difficulty sleeping, those are the ones who have the most significant cerebral hypometabolism.
围绝经期至更年期症状最多的女性，潮热、盗汗、睡眠困难，是脑代谢低下最严重的人群。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So it's almost like a, I don't want to scare people with this language, but it's a low level, or let's call it pseudo-dementia of sorts.
所以这几乎就像是，我不想用这种语言吓唬人们，但它的水平很低，或者让我们称之为伪痴呆症。
Andrew Huberman:
安德鲁·休伯曼：
Yes.
是的。
It seems to be a phenotype that you can then map to Alzheimer's disease because that's Lisa Mosconi's work.
这似乎是一种可以映射到阿尔茨海默病的表型，因为这是丽莎·莫斯科尼的工作。
She's looking at, okay, Alzheimer's disease is not a disease of old age.
她看着，好吧，阿尔茨海默病不是老年病。
It is disease of middle age.
这是中年病。
What are some of the biomarkers that we can define that can tell you what your risk is?
我们可以定义哪些生物标志物来告诉您您的风险是什么？
I've got a mother and a grandmother with Alzheimer's disease.
我的母亲和祖母都患有阿尔茨海默病。
You can believe I am all over this data.
你可以相信我对这些数据很了解。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
And insulin resistance-
还有胰岛素抵抗——
Andrew Huberman:
安德鲁·休伯曼：
Huge part of it
其中很大一部分
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
insulin insensitivity, as we talked about before, seems to be somewhere in there, which I think when that idea first surfaced, a few people were like, "Really?" But then, of course, right?
正如我们之前谈到的，胰岛素不敏感似乎存在于其中的某个地方，我认为当这个想法第一次出现时，有些人会说，“真的吗？”但是，当然，对吧？
I mean, the brain is this incredibly metabolically demanding organ.
我的意思是，大脑是一个代谢要求极高的器官。
You deprive neurons of fuel sources.
你剥夺了神经元的燃料来源。
Or you make them less sensitive to fuel sources.
或者你让他们对燃料来源不那么敏感。
They start dying.
他们开始死亡。
They certainly start firing less.
他们当然开始减少射击。
It makes perfect sense.
这是完全有道理的。
And I think now it's thanks to Lisa's work, work that you've done and have talked about quite a lot is in your books and elsewhere, I think has really highlighted for people that metabolism and metabolomics is going to be as important as genes and genomics when it comes to-
我认为现在这要归功于丽莎的工作，你在书中和其他地方所做的工作和谈论了很多，我认为这确实向人们强调了新陈代谢和代谢组学将与基因和基因组学一样重要——
Andrew Huberman:
安德鲁·休伯曼：
That's right
没错
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
dementia, perhaps especially in women.
痴呆症，也许尤其是女性。
Is it safe to say that?
这样说安全吗？
Andrew Huberman:
安德鲁·休伯曼：
I think so because we believe that the system is regulated by estrogen.
我这么认为是因为我们相信该系统是由雌激素调节的。
So the decline in estrogen starting around age 40, 43 is kind of the average, seems to be the driver behind cerebral hypometabolism.
因此，雌激素从 40 岁左右开始下降，43 岁是平均水平，似乎是脑代谢低下的驱动因素。
The way I describe it to my patients is it's like slow brain energy.
我向我的病人描述的方式是，这就像大脑能量缓慢。
So you walk into a room, you can't remember why.
所以你走进一个房间，你不记得为什么。
You just notice that you can't manage all the tasks the way that you once could.
您只是注意到您无法像以前那样管理所有任务。
Things are just a little slower, and I say that to women, and they're like, "I have that." Like, "Help me." We've got all of these women that are marching toward potentially a greater risk of Alzheimer's disease, and they have this opportunity in their 40s and their 50s to take hormone therapy, and they may not be offered it Because the typical conventional approach based on WHI is to say, "Unless you're having hot flashes and night sweats that are severe, I'm not going to give you hormone therapy." And I just want to call that out.
事情只是有点慢，我对女性这么说，她们会说，“我有这个。”比如，“帮帮我。”我们所有这些女性都可能面临更大的阿尔茨海默病风险，她们在 40 多岁和 50 多岁的时候有机会接受激素治疗，但她们可能不会接受激素治疗，因为基于 WHI 的典型传统方法是说，“除非您有严重的潮热和盗汗，否则我不会给您激素治疗。”我只是想指出这一点。
I would say, no, that is not the way to approach it.
我想说，不，这不是解决问题的方法。
The concept right now in conventional medicine is that hot flashes and night sweats are these nuisance symptoms that we will take care of temporarily.
目前传统医学的概念是潮热和盗汗是这些令人讨厌的症状，我们将暂时处理。
Doesn't matter that you're not sleeping anymore.
没关系，你不再睡觉了。
Turn down the temperature in your room.
调低房间的温度。
And that's not right because hot flashes and night sweats are a biomarker of cardiometabolic disease.
这是不对的，因为潮热和盗汗是心脏代谢疾病的生物标志物。
They are a biomarker of increased bone loss.
它们是骨质流失增加的生物标志物。
They are a biomarker of changes in the brain.
它们是大脑变化的生物标志物。
So many of these symptoms that occur in perimenopause are not driven by the ovaries.
围绝经期出现的许多症状并不是由卵巢引起的。
They are driven by the brain.
它们是由大脑驱动的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I just want to say you've taught me a tremendous amount.
我只想说你教会了我很多东西。
The amount of knowledge that you shared is immense and is going to be very useful and actionable for women in particular.
您分享的知识量非常巨大，尤其对女性来说非常有用且可操作。
Andrew Huberman:
安德鲁·休伯曼：
Can I just add one last thing?
我可以添加最后一件事吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Absolutely.
绝对的。
Andrew Huberman:
安德鲁·休伯曼：
Because I didn't talk about it since we didn't get to the 40s and the 50s and those lists of biomarkers.
因为我没有谈论它，因为我们没有到达 40 年代和 50 年代以及那些生物标志物列表。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Please do.
请这样做。
Andrew Huberman:
安德鲁·休伯曼：
If women went away with one thing today, it would be to do a coronary artery calcium score by age 45 and sooner if you've got premature heart disease.
如果今天的女性坚持做一件事，那就是在 45 岁时进行冠状动脉钙化评分，如果您患有过早心脏病，则更早进行。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
How is that taken?
这是怎么采取的？
Andrew Huberman:
安德鲁·休伯曼：
So it's a CT scan of the chest.
这是胸部 CT 扫描。
You can self-order it.
您可以自行订购。
It almost gives you this fork in the road in terms of how much you need to pay attention to cardiometabolic health as a woman.
作为一名女性，您需要在多大程度上关注心脏代谢健康，这几乎给您带来了这个岔路口。
It's so fascinating because there's some women who have a zero, so my score is zero.
这太令人着迷了，因为有些女性的成绩是零，所以我的分数是零。
But if you're 45 and you're starting to be elevated, or maybe you've got PCOS, or you've got some other biomarkers tending you in this direction toward the number one killer, that allows you to really start to make changes, and I think it's essential to know that data.
但如果你已经 45 岁了，你的体重开始升高，或者你可能患有多囊卵巢综合症，或者你有一些其他生物标志物引导你朝第一杀手的方向发展，这会让你真正开始做出改变，我认为了解这些数据是至关重要的。
Most conventional doctors are not going to do it.
大多数传统医生不会这样做。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So if I were to go to my doctor, and I just say, "I want a cardiac calcium score." That's what people should ask for?
因此，如果我去看医生，我只是说：“我想要心脏钙评分。”这才是人们应该要求的？
Andrew Huberman:
安德鲁·休伯曼：
Coronary artery calcium score.
冠状动脉钙评分。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Coronary-
冠状动脉-
Andrew Huberman:
安德鲁·休伯曼：
CAC.
CAC。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Okay.
好的。
There are certain people, they are exceedingly rare, but you are one such person that when they speak, knowledge just comes out of them, and it's incredibly useful and helpful knowledge.
有一些人，他们非常罕见，但你就是这样的人，当他们说话时，知识就从他们身上流露出来，而且是非常有用和有帮助的知识。
Andrew Huberman:
安德鲁·休伯曼：
Thank you.
谢谢你。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Thank you.
谢谢你。