View the Show Notes Page for This Episode

Become a Member to Receive Exclusive Content

Sign Up to Receive Peter's Weekly Newsletter

Sally Greenwald is an OB-GYN who specializes in women's sexual health from a hormonal and physiologic perspective, with expertise spanning desire, arousal, pelvic floor function, contraception, and menopause care. In this episode, she explains why sexual health is a vital component of overall well-being, exploring topics such as the drivers of desire, the anatomy of sexual function, myths and realities around orgasm, and the role of hormones in perimenopause and menopause. She also covers vaginal and pelvic health, pain with sex, evidence-based therapies for low desire and arousal, how contraception and medications can affect sexual function, and practical strategies for enhancing sexual satisfaction and maintaining intimacy across life stages. This episode offers a comprehensive, evidence-based discussion with immediate real-world relevance for women as well as for men who want to better understand their partners.

We discuss:

• How sexual health influences physical health, emotional well-being, and relationships [3:15];
• Understanding the physiology of the female orgasm, sexual comfort and satisfaction, and the disparity between men and women [12:45];
• Foreplay, the science of desire, and methods to help women cultivate arousal and connection [19:00];
• The physiology and sources of female lubrication, the role of clitoral nerve anatomy in pleasure, and the use of lubricants and vibrators to enhance comfort and sexual health [23:45];
• Understanding female anatomy and what is needed for orgasm [31:15];
• Understanding sexual desire, how to cultivate it, the role of hormones, and testosterone therapy in women [41:15];
• Personalizing perimenopause care: how desire for ovulation guides the choice between contraception and menopausal hormone therapy [49:30];
• Considerations for choosing contraceptives and hormonal therapies during perimenopause [59:45];
• Factors negatively affecting desire, and why female libido persists with age and fluctuates across the menstrual cycle [1:11:00];
• How sexual trauma and physical pain can affect sexual health, and evidence-based strategies for recovery [1:15:15];
• Vaginal care routine: lubricants, moisturizers, topical hormones, and other approaches for vaginal health [1:19:15];
• Tips for sexually satisfying your female partner [1:25:45];
• The pharmacology of arousal: various treatments for low sexual desire in women [1:30:30];
• Sex during and after pregnancy: impact on arousal, safety of sex, and how to manage postpartum recovery and pain [1:37:45];
• How Sally would redesign sex education [1:42:15];
• Sally's optimism about a new era in women's sexual health [1:49:00]; and
• More.

Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode

Become a Member to Receive Exclusive Content

Sign Up to Receive Peter’s Weekly Newsletter

In this special episode, Peter provides a comprehensive introduction to longevity, perfect for newcomers or those looking to refresh their knowledge. He lays out the foundational concepts of lifespan, healthspan, and the marginal decade. Additionally, Peter discusses the four main causes of death and their prevention, as well as detailing the five key strategies in his longevity toolkit to improve lifespan and healthspan. Detailed show notes provide links for deeper exploration of these topics, making it an ideal starting point for anyone interested in understanding and improving their longevity.

We discuss:

• Key points about starting exercise as an older adult [2:45];
• Overview of episode topics and structure [1:45];
• How Peter defines longevity [3:45];
• Why healthspan is a crucial component of longevity [11:15];
• The evolution of medicine from medicine 1.0 to 2.0, and the emergence of medicine 3.0 [15:30];
• Overview of atherosclerotic diseases: the 3 pathways of ASCVD, preventative measures, and the impact of metabolic health [26:00];
• Cancer: genetic and environmental factors, treatment options, and the importance of early and aggressive screening [33:15];
• Neurodegenerative diseases: causes, prevention, and the role of genetics and metabolic health [39:30];
• The spectrum of metabolic diseases [43:15];
• Why it’s never too late to start thinking about longevity [44:15];
• The 5 components of the longevity toolkit [46:30];
• Peter’s framework for exercise—The Centenarian Decathlon [47:45];
• Peter’s nutritional framework: energy balance, protein intake, and more [58:45];
• Sleep: the vital role of sleep in longevity, and how to improve sleep habits [1:08:30];
• Drugs and supplements: Peter’s framework for thinking about drugs and supplements as tools for enhancing longevity [1:13:30];
• Why emotional health is a key component of longevity [1:17:00];
• Advice for newcomers on where to start on their longevity journey [1:19:30]; and
• More.

Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode

Become a Member to Receive Exclusive Content

Sign Up to Receive Peter's Weekly Newsletter

In this "Ask Me Anything" (AMA) episode, Peter revisits the "proven, promising, fuzzy, noise, nonsense" scale and applies it to a variety of popular topics. He begins with a refresher on what each category represents before classifying a range of interventions based on the strength of their supporting evidence. The conversation spans three main areas: drugs for geroprotection (including GLP-1 receptor agonists, SGLT2 inhibitors, methylene blue, and telomere-lengthening supplements), the use of low-dose aspirin for cardiovascular disease prevention, and strategies to improve muscle mass through optimal protein intake and follistatin gene therapy. This episode provides a clear, evidence-based overview for listeners seeking to understand where these popular health and longevity interventions stand on the spectrum of scientific credibility.

If you're not a subscriber and are listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #76 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

• A scale for evaluating scientific claims: proven, promising, fuzzy, noise, or nonsense [1:30];
• Strong convictions, loosely held: the mindset that separates great scientists from the rest [7:30];
• GLP-1 receptor agonists: are there benefits beyond improving metabolic health and promoting weight loss? [12:45];
• GLP-1 drugs and the brain: exploring the potential cognitive benefits [18:45];
• GLP-1 drugs and lifespan: examining the evidence for potential geroprotective effects [23:00];
• Rapamycin and geroprotection: why it remains in the "promising" category [25:45];
• SGLT2 inhibitors and their potential geroprotective effect [27:30];
• Methylene blue: examining the evidence of an anti-aging effect [34:45];
• Methylene blue's potential neuroprotective effects: limited and inconsistent evidence in humans, and the challenges of dosing and safety [41:15];
• Telomeres: what they are, how they relate to aging, and why telomere-lengthening supplements lack credible scientific evidence [43:45];
• Does the idea of targeting telomere length to extend lifespan have scientific merit? [50:15];
• Low-dose aspirin for cardiovascular disease prevention: weighing its clot-prevention benefits against bleeding risks across different populations [55:00];
• Rethinking the protein RDA: why most people need twice the recommended amount for muscle health [1:00:45];
• Debunking the protein–cancer myth: why higher protein intake doesn't promote tumor growth [1:06:15];
• The biology of follistatin and myostatin, and why follistatin gene therapy has become an emerging topic of interest for muscle growth [1:13:15];
• Follistatin gene therapy for muscle growth: state of the evidence in animals and humans, and the technical challenges and regulatory barriers [1:17:00];
• Why injectable follistatin is theoretically possible but impractical for real-world use [1:23:15]; and
• More.

Connect With Peter on Twitter, Instagram, Facebook and YouTube