Zuranolone: What to know about the pill for postpartum depression

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In the year after giving birth, about one in eight people who give birth in the U.S. experience the debilitating symptoms of postpartum depression (PPD), including lack of energy and feeling sad, anxious, hopeless, and overwhelmed. 

Postpartum depression is a serious, potentially life-threatening condition that can affect a person’s bond with their baby. Although it’s frequently confused with the so-called “baby blues,” it’s not the same. 

The baby blues include similar, temporary symptoms that affect up to 80 percent of people who have recently given birth and usually go away within the first few weeks. PPD usually begins within the first month after giving birth and can last for months and interfere with a person’s daily life if left untreated. Thankfully, PPD is treatable and there is help available

On August 4, the FDA approved zuranolone, branded as Zurzuvae, the first-ever oral medication to treat PPD. Until now, besides other common antidepressants, the only medication available to treat PPD specifically was the IV injection brexanolone, which is difficult to access and expensive and can only be administered in a hospital or health care setting. 

Read on to find out more about zuranolone: what it is, how it works, how much it costs, and more. 

What is zuranolone?

Zurzuvae is the brand name for zuranolone, an oral medication to treat postpartum depression. Developed by Sage Therapeutics in partnership with Biogen, it’s now available in the U.S. Zurzuvae is typically prescribed as two 25 mg capsules a day for 14 days. In clinical trials, the medication showed to be fast-acting, improving PPD symptoms in just three days

How does zuranolone work? 

Zuranolone is a neuroactive steroid, a type of medication that helps the neurotransmitter GABA’s receptors, which affect how the body reacts to anxiety, stress, and fear, function better.

“Zuranolone can be thought of as a synthetic version of [the neuroactive steroid] allopregnanolone,” says Dr. Katrina Furey, a reproductive psychiatrist, clinical instructor at Yale University, and co-host of the Analyze Scripts podcast. “Women with PPD have lower levels of allopregnenolone compared to women without PPD.”

How is it different from other antidepressants?

“What differentiates zuranolone from other previously available oral antidepressants is that it has a much more rapid response and a shorter course of treatment,” says Dr. Asima Ahmad, an OB-GYN, reproductive endocrinologist, and founder of Carrot Fertility

“It can take effect as early as on day three of treatment, versus other oral antidepressants that can take up to six to 12 weeks to take full effect.” 

What are Zurzuvae’s side effects? 

According to the FDA, the most common side effects of Zurzuvae include dizziness, drowsiness, diarrhea, fatigue, the common cold, and urinary tract infection. Similar to other antidepressants, the medication may increase the risk of suicidal thoughts and actions in people 24 and younger. However, NPR noted that this type of labeling is required for all antidepressants, and researchers didn’t see any reports of suicidal thoughts in their trials.

“Drug trials also noted that the side effects for zuranolone were not as severe,” says Ahmad. “[There was] no sudden loss of consciousness as seen with brexanolone or weight gain and sexual dysfunction, which can be seen with other oral antidepressants.”

She adds: “Given the lower incidence of side effects and more rapid-acting onset, zuranolone could be a viable option for many,” including those looking for a treatment that offers faster symptom relief. 

Can someone breastfeed while taking zuranolone?

It’s complicated. In clinical trials, participants were asked to stop breastfeeding (which, according to Furey, is common in early clinical trials). 

A small study of people who were nursing while taking zuranolone found that 0.3 percent of the medication dose was passed on to breast milk, which, Furey says, is a pretty low amount of exposure for the baby. Ahmad says that “though some data suggests that the risk of harm to the baby may be low, there is still overall limited data.”

Overall, people should talk to their health care provider about the risks and benefits of breastfeeding while on the medication. 

“A lot of factors will need to be weighed, such as overall health of the infant, age of the infant, etc., when making this decision,” Furey says. 

How much does Zurzuvae cost? 

Zurzuvae’s price before insurance coverage is $15,900 for the 14-day treatment. However, the Policy Center for Maternal Mental Health says insurance companies and Medicaid are expected to cover it because it’s the only drug of its kind. 

Less than 1 percent of U.S. insurers have issued coverage guidelines so far, so it’s still unknown how much it will cost patients after insurance. Some insurers require patients to try another antidepressant first (like the more common SSRIs) before covering Zurzuvae. For uninsured and underinsured people, Sage Therapeutics said it will offer copay assistance

The hefty price tag and potential issues with coverage may widen existing health disparities, says Ahmad. “We need to ensure that we are seeking out solutions to enable wide-scale access to all PPD treatments so that people have access to whatever treatment may work best for them.”

If you or anyone you know is considering suicide or self-harm or is anxious, depressed, upset, or needs to talk, call the Suicide & Crisis Lifeline at 988 or text the Crisis Text Line at 741-741. For international resources, here is a good place to begin.

For more information, talk to your health care provider.

This article first appeared on Public Good News and is republished here under a Creative Commons license.

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    Shower vs. Bath: Our verdict is in – Showers win for cleanliness without compromising on potential mental health benefits, despite baths having their perks.

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  • Measles cases are rising—here’s how to protect your family

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    The U.S. is currently experiencing a spike in measles cases across several states. Measles a highly contagious and potentially life-threatening disease caused by a virus. The measles-mumps-rubella (MMR) vaccine prevents measles; unvaccinated people put themselves and everyone around them at risk, including babies who are too young to receive the vaccine.

    Read on to learn more about measles: what it is, how to stay protected, and what to do if a measles outbreak happens near you.

    What are the symptoms of measles? 

    Measles symptoms typically begin 10 to 14 days after exposure. The disease starts with a fever followed by a cough, runny nose, and red eyes and then produces a rash of tiny red spots on the face and body. Measles can affect anyone, but is most serious for children under 5, immunocompromised people, and pregnant people, who may give birth prematurely or whose babies may have low birth weight as a result of a measles infection. 

    Measles isn’t just a rash—the disease can cause serious health problems and even death. About one in five unvaccinated people in the U.S. who get measles will be hospitalized and could suffer from pneumonia, dehydration, or brain swelling.

    If you get measles, it can also damage your immune system, making you more vulnerable to other diseases.

    How do you catch measles?

    Measles spreads through the air when an infected person coughs or sneezes. It’s so contagious that unvaccinated people have a 90 percent chance of becoming infected if exposed.

    An infected person can spread measles to others before they have symptoms.

    Why are measles outbreaks happening now?

    The pandemic caused many children to miss out on routine vaccinations, including the MMR vaccine. Delayed vaccination schedules coincided with declining confidence in vaccine safety and growing resistance to vaccine requirements.

    Skepticism about the safety and effectiveness of COVID-19 vaccines has resulted in some people questioning or opposing the MMR vaccine and other routine immunizations. 

    How do I protect myself and my family from measles? 

    Getting an MMR vaccine is the best way to prevent getting sick with measles or spreading it to others. The CDC recommends that children receive the MMR vaccine at 12 to 15 months and again at 4 to 6 years, before starting kindergarten.

    One dose of the MMR vaccine provides 93 percent protection and two doses provide 97 percent protection against all strains of measles. Because some children are too young to be immunized, it’s important that those around them are vaccinated to protect them.

    Is the MMR vaccine safe?

    The MMR vaccine has been rigorously tested and monitored over 50 years and determined to be safe. Adverse reactions to the vaccine are extremely rare.

    Receiving the MMR vaccine is much safer than contracting measles.

    What do I do if there’s a measles outbreak in my community?

    Anyone who is not fully vaccinated for measles should be immunized with a measles vaccine as soon as possible. Measles vaccines given within 72 hours after exposure may prevent or reduce the severity of disease.

    Children as young as 6 months old can receive the MMR vaccine if they are at risk during an outbreak. If your child isn’t fully vaccinated with two doses of the MMR vaccine—or three doses, if your child received the first dose before their first birthday—talk to your pediatrician.

    Unvaccinated people who have been exposed to the virus should stay home from work, school, day care, and other activities for 21 days to avoid spreading the disease.

    For more information, talk to your health care provider.

    This article first appeared on Public Good News and is republished here under a Creative Commons license.

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  • How anti-vaccine figures abuse data to trick you

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The anti-vaccine movement is nearly as old as vaccines themselves. For as long as humans have sought to harness our immune system’s incredible ability to recognize and fight infectious invaders, critics and conspiracy theorists have opposed these efforts. 

    Anti-vaccine tactics have advanced since the early days of protesting “unnatural” smallpox inoculation, and the rampant abuse of scientific data may be the most effective strategy yet. 

    Here’s how vaccine opponents misuse data to deceive people, plus how you can avoid being manipulated.

    Misappropriating raw and unverified safety data

    Perhaps the oldest and most well-established anti-vaccine tactic is the abuse of data from the federal Vaccine Adverse Event Reporting System, or VAERS. The Centers for Disease Control and Prevention and the Food and Drug Administration maintain VAERS as a tool for researchers to detect early warning signs of potential vaccine side effects. 

    Anyone can submit a VAERS report about any symptom experienced at any point after vaccination. That does not mean that these symptoms are vaccine side effects.

    VAERS was not designed to determine if a specific vaccine caused a specific adverse event. But for decades, vaccine opponents have misinterpreted, misrepresented, and manipulated VAERS data to convince people that vaccines are dangerous. 

    Anyone relying on VAERS to draw conclusions about vaccine safety is probably trying to trick you. It isn’t possible to determine from VAERS data alone if a vaccine caused a specific health condition.

    VAERS isn’t the only federal data that vaccine opponents abuse. Originally created for COVID-19 vaccines, V-safe is a vaccine safety monitoring system that allows users to report—via text message surveys—how they feel and any health issues they experience up to a year after vaccination. Anti-vaccine groups have misrepresented data in the system, which tracks all health experiences, whether or not they are vaccine-related.

    The U.S. Department of Defense’s Defense Medical Epidemiology Database (DMED) has also become a target of anti-vaccine misinformation. Vaccine opponents have falsely claimed that DMED data reveals massive spikes in strokes, heart attacks, HIV, cancer, and blood clots among military service members since the COVID-19 vaccine rollout. The spike was due to an updated policy that corrected underreporting in the previous years

    Misrepresenting legitimate studies

    A common tactic vaccine opponents use is misrepresenting data from legitimate sources such as national health databases and peer-reviewed studies. For example, COVID-19 vaccines have repeatedly been blamed for rising cancer and heart attack rates, based on data that predates the pandemic by decades. 

    A prime example of this strategy is a preliminary FDA study that detected a slight increase in stroke risk in older adults after a high-dose flu vaccine alone or in combination with the bivalent COVID-19 vaccine. The study found no “increased risk of stroke following administration of the COVID-19 bivalent vaccines.”

    Yet vaccine opponents used the study to falsely claim that COVID-19 vaccines were uniquely harmful, despite the data indicating that the increased risk was almost certainly driven by the high-dose flu vaccine. The final peer-reviewed study confirmed that there was no elevated stroke risk following COVID-19 vaccination. But the false narrative that COVID-19 vaccines cause strokes persists.

    Similarly, the largest COVID-19 vaccine safety study to date confirmed the extreme rarity of a few previously identified risks. For weeks, vaccine opponents overstated these rare risks and falsely claimed that the study proves that COVID-19 vaccines are unsafe. 

    Citing preprint and retracted studies

    When a study has been retracted, it is no longer considered a credible source. A study’s retraction doesn’t deter vaccine opponents from promoting it—it may even be an incentive because retracted papers can be held up as examples of the medical establishment censoring so-called “truthtellers.” For example, anti-vaccine groups still herald Andrew Wakefield nearly 15 years after his study falsely linking the measles, mumps, and rubella (MMR) vaccine to autism was retracted for data fraud. 

    The COVID-19 pandemic brought the lasting impact of retracted studies into sharp focus. The rush to understand a novel disease that was infecting millions brought a wave of scientific publications, some more legitimate than others. 

    Over time, the weaker studies were reassessed and retracted, but their damage lingers. A 2023 study found that retracted and withdrawn COVID-19 studies were cited significantly more frequently than valid published COVID-19 studies in the same journals. 

    In one example, a widely cited abstract that found that ivermectin—an antiparasitic drug proven to not treat COVID-19—dramatically reduced mortality in COVID-19 patients exemplifies this phenomenon. The abstract, which was never peer reviewed, was retracted at the request of its authors, who felt the study’s evidence was weak and was being misrepresented. 

    Despite this, the study—along with the many other retracted ivermectin studies—remains a touchstone for proponents of the drug that has shown no effectiveness against COVID-19.

    In a more recent example, a group of COVID-19 vaccine opponents uploaded a paper to The Lancet’s preprint server, a repository for papers that have not yet been peer reviewed or published by the prestigious journal. The paper claimed to have analyzed 325 deaths after COVID-19 vaccination, finding COVID-19 vaccines were linked to 74 percent of the deaths. 

    The paper was promptly removed because its conclusions were unsupported, leading vaccine opponents to cry censorship. 

    Applying animal research to humans

    Animals are vital to medical research, allowing scientists to better understand diseases that affect humans and develop and screen potential treatments before they are tested in humans. Animal research is a starting point that should never be generalized to humans, but vaccine opponents do just that.

    Several animal studies are frequently cited to support the claim that mRNA COVID-19 vaccines are dangerous during pregnancy. These studies found that pregnant rats had adverse reactions to the COVID-19 vaccines. The results are unsurprising given that they were injected with doses equal to or many times larger than the dose given to humans rather than a dose that is proportional to the animal’s size. 

    Similarly, a German study on rat heart cells found abnormalities after exposure to mRNA COVID-19 vaccines. Vaccine opponents falsely insinuated that this study proves COVID-19 vaccines cause heart damage in humans and was so universally misrepresented that the study’s author felt compelled to dispute the claims. 

    The author noted that the study used vaccine doses significantly higher than those administered to humans and was conducted in cultured rat cells, a dramatically different environment than a functioning human heart. 

    How to avoid being misled

    The internet has empowered vaccine opponents to spread false information with an efficiency and expediency that was previously impossible. Anti-vaccine narratives have advanced rapidly due to the rampant exploitation of valid sources and the promotion of unvetted, non-credible sources. 

    You can avoid being tricked by using multiple trusted sources to verify claims that you encounter online. Some examples of credible sources are reputable public health entities like the CDC and World Health Organization, personal health care providers, and peer-reviewed research from experts in fields relevant to COVID-19 and the pandemic. 

    Read more about anti-vaccine tactics:

    This article first appeared on Public Good News and is republished here under a Creative Commons license.

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  • The Checklist Manifesto – by Dr. Atul Gawande

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Dr. Gawande, himself a general surgeon, uses checklists a lot. He is, unequivocally, an expert in his field. He “shouldn’t” need a checklist to tell him to do such things as “Check you have the correct patient”. But checklists are there as a safety net. And, famously, “safety regulations are written in blood”, after all.

    And, who amongst us has never made such a “silly” error? From forgetting to turn the oven on, to forgetting to take the handbrake off, it takes only a momentary distraction to think we’ve done something we haven’t.

    You may be wondering: why a whole book on this? Is it just many examples of the usefulness of checklists? Because I’m already sold on that, so, what else am I going to get out of it?

    Dr. Gawande also explains in clear terms:

    • How to optimize “all necessary steps” with “as few steps as possible”
    • The important difference between read-do checklists and do-confirm checklists
    • To what extent we should try to account for the unexpected
    • How to improve compliance (i.e., making sure you actually use it, no matter how tempting it will be to go “yeah this is automatic for me now” and gloss over it)
    • The role of checklists in teams, and in passing on knowledge

    …and more.

    Bottom line: if you’ve ever tried to make tea without putting the tea-leaves in the pot, this is the book that will help you avoid making more costly mistakes—whatever your area of activity or interest.

    Click here to check out the Checklist Manifesto, and make fewer mistakes!

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Related Posts

  • The Real Benefit Of Genetic Testing
  • Singledom & Healthy Longevity

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Statistically, those who live longest, do so in happy, fulfilling, committed relationships.

    Note: happy, fulfilling, committed relationships. Less than that won’t do. Your insurance company might care about your marital status for its own sake, but your actual health doesn’t—it’s about the emotional safety and security that a good, healthy, happy, fulfilling relationship offers.

    We wrote about this here:

    Only One Kind Of Relationship Promotes Longevity This Much!

    But that’s not the full story

    For a start, while being in a happy fulfilling committed relationship statistically adds healthy life years, being in a relationship that falls short of those adjectives certainly does not. See also:

    Relationships: When To Stick It Out & When To Call It Quits

    But also, life satisfaction steadily improves with age, for single people (the results are more complicated for partnered people—probably because of the range of difference in quality of relationships). At least, this held true in this large (n=6,188) study of people aged 40–85 years:

    ❝With advancing age, partnership status became less predictive of loneliness and the satisfaction with being single increased. Among later-born cohorts, the association between partnership status and loneliness was less strong than among earlier-born cohorts. Later-born single people were more satisfied with being single than their earlier-born counterparts.❞

    Source: The Changing Relationship Between Partnership Status and Loneliness: Effects Related to Aging and Historical Time

    Note that this does mean that while life satisfaction indeed improves with age for single people, that’s a generalized trend, and the greatest life satisfaction within this set of singles comes hand-in-hand with being single by choice rather than by perceived obligation, i.e., those who are “single and not looking” will generally be the most content, and this contentedness will improve with age, but for those who are “single and looking”, in that case it’s the younger people who have it better, likely due to a greater sense of having plenty of time.

    For that matter, gender plays a role; this large survey of singles found that (despite the popular old pop-up ads advising that “older women in your area are looking to date”), in reality older single women were the least likely to actively look for a partner:

    See: A Profile Of Single Americans

    …which also shows that about half of single Americans are “not looking”, and of those who are, about half are open to a serious relationship, though this is more common under the age of 40, while being over the age of 40 sees more people looking only for something casual.

    Take-away from this section: being single only decreases life satisfaction if one doesn’t enjoy being single, and even then, and increases it if one does enjoy being single.

    But that’s about life satisfaction, not longevity

    We found no studies specifically into longevity of singledom, only the implications that may be drawn from the longevity of partnered people.

    However, there is a lot of research that shows it’s not being single that kills, it’s being socially isolated. It’s a function of neurodegeneration from a lack of conversation, and it’s a function of what happens when someone slips in the shower and is found a week later. Things like that.

    For example: Is Living Alone “Aging Alone”? Solitary Living, Network Types, and Well-Being

    What if you are alone and don’t want to be?

    We’ve not, at time of writing, written dating advice in our Psychology Sunday section, but this writer’s advice is:don’t even try.

    That’s not nihilism or even cynicism, by the way; it’s actually a kind of optimism. The trick is just to let them come to you.

    (sample size of one here, but this writer has never looked for a relationship in her life, they’ve always just found me, and now that I’m widowed and intend to remain single, I still get offers—and no, I’m not a supermodel, nor rich, nor anything like that)

    Simply: instead of trying to find a partner, just work on expanding your social relationships in general (which is much easier, because the process is something you can control, whereas the outcome of trying to find a suitable partner is not), and if someone who’s right for you comes along, great! If not, then well, at least you have a flock of friends now, and who knows what new unexpected romance may lie around the corner.

    As for how to do that,

    How To Beat Loneliness & Isolation

    Take care!

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  • Nasal Hair; How Far To Go?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    t’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝As a man in his sixties I find I need to trim my nasal hair quite frequently, otherwise it sticks out in an unsightly manner. But I’m never sure how severely I should cut the hairs back, or even how best to do it. Please advise.❞

    As you might know, those hairs are really important for our health, so let’s start by mentioning that yes, trimming is the way, not plucking!

    In an ideal world, we’d not trim them further back than the entrance to our nostrils, but given the constant nature of hair-growing, that could become a Sisyphean task.

    A good compromise, if you’re not up for trimming when you get up and having visible hairs by evening, is to put the scissors away (if you haven’t already) and use a nasal hair trimmer; these are good at a) trimming nasal hairs b) abstaining from trimming them too far back.

    By all means shop around, but here’s an example product on Amazon, for your convenience!

    Enjoy!

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  • The BAT-pause!

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    When Cold Weather & The Menopause Battle It Out

    You may know that (moderate, safe) exposure to the cold allows our body to convert our white and yellow fat into the much healthier brown fat—also called brown adipose tissue, or “BAT” to its friends.

    If you didn’t already know that, then well, neither did scientists until about 15 years ago:

    The Changed Metabolic World with Human Brown Adipose Tissue: Therapeutic Visions

    You can read more about it here:

    Cool Temperature Alters Human Fat and Metabolism

    This is important, especially because the white fat that gets converted is the kind that makes up most visceral fat—the kind most associated with all-cause mortality:

    Visceral Belly Fat & How To Lose It ← this is not the same as your subcutaneous fat, the kind that sits directly under your skin and keeps you warm; this is the fat that goes between your organs and of which we should only have a small amount!

    The BAT-pause

    It’s been known (since before the above discovery) that BAT production slows considerably as we get older. Not too shocking—after all, many metabolic functions slow as we get older, so why should fat regulation be any different?

    But! Rodent studies found that this was tied less to age, but to ovarian function: rats who underwent ovariectomies suffered reduced BAT production, regardless of their age.

    Naturally, it’s been difficult to recreate such studies in humans, because it’s difficult to find a large sample of young adults willing to have their ovaries whipped out (or even suppressed chemically) to see how badly their metabolism suffers as a result.

    Nor can an observational study (for example, of people who incidentally have ovaries removed due to ovarian cancer) usefully be undertaken, because then the cancer itself and any additional cancer treatments would be confounding factors.

    Perimenopausal study to the rescue!

    A recent (published last month, at time of writing!) study looked at women around the age of menopause, but specifically in cohorts before and after, measuring BAT metabolism.

    By dividing the participants into groups based on age and menopausal status, and dividing the post-menopausal group into “takes HRT” and “no HRT” groups, and dividing the pre-menopausal group into “normal ovarian function” and “ovarian production of estrogen suppressed to mimic slightly early menopause” groups (there’s a drug for that), and then having groups exposed to warm and cold temperatures, and measuring BAT metabolism in all cases, they were able to find…

    It is about estrogen, not age!

    You can read more about the study here:

    “Good” fat metabolism changes tied to estrogen loss, not necessarily to aging, shows study

    …and the study itself, here:

    Brown adipose tissue metabolism in women is dependent on ovarian status

    What does this mean for men?

    This means nothing directly for (cis) men, sorry.

    But to satisfy your likely curiosity: yes, testosterone does at least moderately suppress BAT metabolism—based on rodent studies, anyway, because again it’s difficult to find enough human volunteers willing to have their testicles removed for science (without there being other confounding variables in play, anyway):

    Testosterone reduces metabolic brown fat activity in male mice

    So, that’s bad per se, but there isn’t much to be done about it, since the rest of your (addressing our male readers here) metabolism runs on testosterone, as do many of your bodily functions, and you would suffer many unwanted effects without it.

    However, as men do typically have notably less body fat in general than women (this is regulated by hormones), the effects of changes in BAT metabolism are rather less pronounced in men (per testosterone level changes) than in women (per estrogen level changes), because there’s less overall fat to convert.

    In summary…

    While menopausal HRT is not necessarily a silver bullet to all metabolic problems, its BAT-maintaining ability is certainly one more thing in its favor.

    See also:

    Dr. Jen Gunter | What You Should Have Been Told About The Menopause Beforehand

    Take care!

    Don’t Forget…

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    Learn to Age Gracefully

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