The metabolic theory of menopause

What if menopause is one of the most important longevity events in human biology, and we've been ignoring it?

Dr. Matt Kaeberlein sits down with Dr. Jennifer Pearlman, founder of PearlMD and pioneer in female-centric longevity medicine, to unpack why women's health has been systemically underfunded, undertreated, and misunderstood and what a proactive approach actually looks like.

From the flawed science behind the Women's Health Initiative to the nuts and bolts of hormone optimization, testosterone for women, and the emerging field of ovarian tissue cryopreservation, Dr. Pearlman brings 20+ years of clinical expertise and a framework she calls FemSpan: harnessing the unique biology of female longevity while mitigating the risks most medicine ignores.

Timestamps:

00:00 — Cold open

00:47 — Welcome & Dr. Pearlman's origin story

02:33 — Why the medical system fails women

08:37 — How the women's health landscape has shifted over 20 years

09:26 — The Women's Health Initiative: what went wrong

13:07 — What drove the reemergence of menopause medicine

14:38 — Big Pharma, funding, and the micronized progesterone question

17:13 — "Medicine progresses one funeral at a time"

18:01 — From functional medicine to precision medicine

20:35 — Rebranding aging: from anti-aging to longevity

23:50 — Navigating the gray zone between frontier and fringe

27:46 — How to identify credible practitioners

33:32 — What every woman should know about the menopause transition

36:41 — Why take a proactive approach? Symptoms, disease risk, and aging

38:19 — The two simultaneous biology processes of menopause

41:46 — The role of FSH and hormone optimization

43:28 — Estradiol as the body's regenerative signal

47:24 — What to test and when

50:38 — The metabolic theory of menopause

55:08 — Visceral fat as an evolutionary adaptation

57:26 — How to navigate hormone therapy

01:00:24 — Bioidentical hormones: reclaiming the term

01:06:45 — Why route of administration matters

01:11:35 — Progesterone: the unsung hero of menopause management

01:23:19 — Testosterone for women: what the science actually says

01:34:25 — Introducing FemSpan: the female longevity framework

01:37:55 — The biological aging advantages women carry

01:46:46 — Can we close the healthspan gap?

01:53:05 — Could reversing menopause extend female lifespan?

02:00:29 — Regenerative medicine and the future of female longevity

02:03:10 — Ovarian tissue cryopreservation explained

02:10:39 — AI in women's precision medicine

02:15:50 — Medicine at scale: opportunity and risk

02:21:41 — Advanced cardiovascular diagnostics and the female gap

02:24:22 — Closing thoughts: your aging trajectory is more in your control than you think