People should NOT be tested for testosterone levels unless they have overt symptoms and are evaluated by a qualified clinician first.
“Peptides”, by which I mean some currently popular, non-FDA approved dietary supplements, have no reliable laboratory or clinical evidence for benefit in human conditions.
And now military service members will be screened for testosterone levels starting at age 30 and an FDA committee has recommended that compounding pharmacies should be allowed to create peptide preparations for clinical use.
The CDC website now includes verbiage suggesting that vaccines may cause autism, that the data is ‘unclear’, when myriad high quality studies prove soundly that they do not. The single paper published in The Lancet decades ago claiming the relationship was retracted when found to be falsified, and the physician author sanctioned by his professional governing body.
These decisions and many others fly flagrantly in the face of decades of rigorous academic study and painstaking medical and public health stewardship on the part of researchers, educators, and clinicians who have dedicated their lives to understanding the science of medicine and collaborating to apply it for societal good through thoughtful, responsible, and accountable public health policy. The United States has led the world in that time with breakthroughs in basic bench science, revolutionary pharmaceutical discovery and development, and technical surgical advancements. Diagnostic and therapeutic innovations were vigorously tested and monitored for safety, efficacy, and harm. We have rightly enjoyed international regard and status as a nation where science is respected and done with integrity.
No more.
Including the one physician whose ethics and clinical credibility were also roundly denounced by his former academic colleagues, the men in charge of the governmental health and medicine decisions above are about as far from responsible and accountable public policy stewards as we have ever seen in the posts they occupy. I cannot state strongly enough what a national disgrace this is. The least qualified and competent people have been elevated to the highest positions of power and authority in our federal government. Their actions exemplify hubris, ignorance, arrogance, and an utter lack of integrity or intellectual humility. They are exactly the opposite of leaders we need at the front of public health policy and practices that affect the health and well-being of our military service members and population.
It absolutely exacerbates the situation that our healthcare system is so profoundly broken that most people don’t have enough of a relationship with their primary care physician (if they even have one designated at all) to get qualified, thoughtful, caring, and informed advice about all of the confusing and conflicting information they encounter on every media platform.
This post is a week late for various reasons (jury duty [fascinating—more on that soon!] and travel). I had intended to introduce two clinicians whom I strongly recommend to follow for reliable, evidence-based medical information, as well as education on how to think for ourselves when we encounter such information, how to vet it effectively. But apparently I had to rant first. Introductions forthcoming. Thank you for your indulgence.
OH YES, the doctors are angry. But we have not lost hope. Far from it. We persist and resist.
‘Curves’. I’ got more now then ever in my non-pregnant life, my friends.
Thank goodness for writers, actors, and advocates of body shape diversity and acceptance. The concept feels hard to integrate for a culture that pedestalizes Barbie, but we need to keep talking ourselves in that direction with our thinking brains, even if our feeling brains lag a far distance behind. Humans come in all shapes and sizes, and we change with age. The more we accept this fact, while executing the practices we know keep us healthy, the better we will all feel about ourselves, treat ourselves, and treat one another.
Subcutaneous fat is okay, protective, even. Visceral fat not so much. My ratio (as imaged by DEXA scan) is healthy overall, which is reassuring. But I still don’t like how I look a lot of the time in my middle-aged mom bod.
And yet, I am fitter now that at anytime since my 20s, and stronger by far than ever in my life. The leading indicators of my physical fitness land well in the optimal range. Eating indicators less so, but still improve incrementally these days with deliberate, conscious effort (so much effort–or at least mental load, if not consistent action!)
The ambivalence is so real—I’m doing the work, no question. The outcome falls short of desires, frustratingly so. I would like to have a smaller body by about 10 pounds. That was the set point for much of my adult life. About five years and ten pounds on today, I feel my age and family history creeping up on me, and wonder when/whether I will end up on medication for glucose control or other issues. It took me several months to realize that would not be the end of the world.
Back in 2003 I didn’t notice patients expressing shame about starting medications for blood pressure, cholesterol, or glucose. We talked about lifestyle and habit change then also, but when meds were indicated we simply initiated and followed up. It did not feel nearly as laden with social guilt as it feels now.
Today when medications are required to manage any of these medical issues, it’s too often seen as some kind of failure, and my patients ruminate if their ‘metrics’ are imperfect or ‘not at goal’, even a little bit. As if nobody should ever have any of these diagnoses if only we lived the perfect lifestyles; as if those lifestyles are so easy and accessible to us all.
What do our *systems* actually promote? How easily can we achieve 10K steps a day and a low volume Mediterranean diet with long mealtimes to enjoy our organic foods in the loving company of people who help us rest and digest? Who can reliably obtain affordable fresh produce and unprocessed protein, with time to plan, purchase, and prepare all of our meals at home? Who enjoys workplaces and jobs that give us autonomy, mastery, purpose, meaning, and psychological safety so our nervous systems can live not in constant fight or flight mode? In my observation only a privleged and elite few (and fewer of them, these days), and even they struggle with maintaining optimal health a lot of the time.
When the root causes of our dis-ease are systemic and oppressive and yet we blame individuals for failing to achieve ideal outcomes with no support, and the system additionally rewards those who prey on and profit from our fears and feelings of inadequacy and hopelessness, our lack of self-efficacy and self-compassion, then we get exactly what we have now: obsession over biometric minutiae without context, compulsion for more diagnostics that then drive oversimplified ‘solutions’ that don’t address root causes, an escalating disparity between those who can afford the quick ‘fixes’ and those who cannot, and pathologizing the normal, while we all lose sight of and connection to what gives life meaning and joy and ultimately makes us healthier.
All of that to say, I think I can be done with the self-judgment over my squishy parts. I have always been the chubby one in the family, I do a ton of work to moderate my indulgent tendencies, and I’m a middle aged, working woman in the urban West. I’m built to withstand famine and I train to withstand stress. I will continue to treat body and mind as the vintage vehicles they are, carrying me each day to meet my people, learn all kinds of cool new things, and live my best life, even if that means I’ got ten extra pounds on my frame. I will strive to get to bed on time, eat more colors, increase the intensity and frequency of my cardio, and revel in what my body can do now. Whatever it will be able to do in the coming decades will be the rewards of my efforts today. And I could still get smaller if I want. I’ got this.
So to all the curvy menopausal mamas out there, I see you. We’re all here doing our best. Let us cheer for and encourage ourselves and one another in our efforts, celebrate the wins (if not for all this work, I’d carry much more than these 10 extra pounds, I say!). What we do to take care of ourselves matters, even if we don’t always see the results we want.
From last week’s post: I hope to write here soon about Tea & Alchemy by Sharon Lynn Fisher. Another Shane East performance with Marisa Calin (they also narrate Kerri Maniscalco’s Prince of Sin series–“Think Bridgerton in Hell”–also among my favorites, see 31. Throne of Nighmares), this slow burn, low spice, heartwarming love story between a reclusive, benevolent ‘alchemist’ and a budding tea leaf reader points to all the ways we humans reject and harm one another by default, and how we can choose openness, generosity, kindness, and compassion to overcome those destructive tendencies and make a better world. I have connected with Sharon Lynn Fisher herself, and hope to interview her about the story’s inception and evolution, and what she wishes for the characters and us readers from it.
Thank you, Ms. Fisher, for your thoughtful and generous engagement with my questions! I listened to Tea & Alchemy again this past week, and ‘cozy gothic’ is the perfect description for this story. I love when Harker and Mina sit together thinking, exchanging, and connecting as they unravel dark, mysterious happenings in their community–that emotional connection born of collaborative, intellectual problem solving tickles something for me. That they each see in the other a worthy humanity beyond society’s expectations and stereotypes gives me hope that we can all practice this open, empathic, kind, and generous approach to our fellow humans. The love that grows between them through honesty, vulnerability, and each wanting to protect and care for the other, further lifts and deepens the romantic energy of this story.
*See my own comments in response to Ms. Fisher’s answers below. I’m so grateful for this little interaction! Maybe I’ll be able to do this again with another author; I’ll start a list now.
1. What was most meaningful to you about this story–its inception, emergence, development, evolution, and publication?
I think first it’s that I’ve always wanted to write a vampire novel, but I never very seriously entertained the idea because I wasn’t sure how I could make it feel fresh. Then one day it struck me that simply framing it in my own voice and brand would result in a unique story.* A cozy vampire tale packaged in folklore, cottage witch vibes, and Victorian themes. And it meant the world to me that my publisher believed in me enough to let me have a go at it!
I’m also a huge Daphne Du Maurier fan and have for a long time wanted to set a book in Cornwall. When I visited there a few years ago, Roche Rock struck me as the perfect setting, and its history and gothic broodiness contributed so much to the story’s development.
2. What thread, if any, wends through your writing? Or, how would a reader recognize your work from its nature?
I’ve always loved including fairy and folklore, cozy elements, and gothic drama. And below the surface of that, I find it so interesting to use the Victorian setting to show women who were very much constrained by society growing into their strength, voice, and truth. And part of that comes through the romance, because my male main characters always support and encourage this growth.**
In the past I have written bigger stories, including a fairly epic fae series set in Victorian Ireland (The Faery Rehistory). But I am very much enjoying this smaller-story niche, and how it allows me to really focus on character.
3. What empathy do you feel for the various characters in this story? What are your greatest wishes for them?
The women in my stories often start out doubting themselves, and not truly understanding that their gifts are worthy and needed in the world. I have grappled with this myself in my writing career. I have felt at times that I’m not good enough, or that it’s no more than a self-indulgent hobby. As my books have found more readers, I’ve begun to see how much stories can mean to people, and how people can be comforted and even healed by them. As a reader myself, I know this, of course! But imposter syndrome can really mess with your head.
I write love stories, so of course I wish my female main characters to find men who see them and value them and adore them. Men who help heal them and whom they help heal in return. But I also wish them to find purpose in life and learn to believe in themselves.
Reading back over this, I realize I slightly misread the question and answered more generally, but I think it does apply to Tea & Alchemy. Also, that book in particular was about healing, and what I wished for both Mina and Harker was for their love to be a balm for their deep pain, and to move them both out of their “stuckness.”***
4. What do you most want to share about this story; what do you wish most for readers/listeners to get from it? 5. Anything else you’d love to share about this story?
I think only that it was a joy writing it. Creating stories always begins as a curiosity journey for me. I do a lot of research, and finding little bits that help me define my characters (like Harker’s alchemical theory about vampires) is akin to finding buried treasure. For my readers, I hope the stories will pique their curiosity, too. I hope they will feel they’ve gone on a worthwhile journey. One that reminded them to believe in themselves, to be their own champions, and to love. And especially at this time, one that brings comfort. That feels like a hug.xo
*OH I feel this. As a conventionally trained internist I have often felt constrained and unremarkable in my medical practice from an early stage. Every time I have allowed myself authentic expression, without sacrificing professionalism, the rewards are clear and fulfilling: deeper understanding and connection with patients, and broader learning and reinforcement that everything is connected and we are healthiest when our relationships thrive.
**I think this is something I also appreciate about historical romance, and it applies now. Society today still sets implicit expectations and norms for both genders, and navigating them as mutual allies makes it easier for us all. Regency and Victorian romance heroes use their money and influence to validate and elevate their heroines’ talents, voices, and contributions. Isn’t this what we all wish for modern day men in power to do for women and other marginalilzed groups? The active, loving allyship in these stories gives me hope.
***YES! Both main characters bear their deep, respective loneliness with courage and some stoicism, and find their ways to each other similarly. The cautious yet compelling emergence of their abiding love speaks, to me, of their intuitive mutual empathy and understanding of that innate human need for connection, something that they both long for but had all but lost hope of finding. That they find it in each other is just the sweetest gratification.
Healing Through Connection 