Dr. Sara Gottfried strongly recommends a Coronary Artery Calcium (CAC) score, a CT scan of the chest, for all women by age 45. This simple, self-orderable test provides a critical assessment of cardiometabolic health, enabling early, personalized intervention for heart disease risk.

Androgen deprivation therapy induces metabolic syndrome-like effects, increasing cardiovascular risk. It is the medical oncologist's responsibility to perform a baseline CV risk assessment using tools like the STAMP questions and to engage cardiology partners when needed for risk mitigation.

While GnRH antagonists like relugolix show a potential cardiovascular advantage, this benefit may disappear when patients receive intensive, proactive cardiovascular management. A trial comparing degarelix to Lupron showed no difference in CV toxicity when all patients underwent rigorous CV assessment and optimization, suggesting proactive care is the most critical factor.

Focusing on building muscle is crucial for long-term health, particularly for women entering perimenopause. Muscle helps regulate blood sugar, reduces inflammation, and protects against osteoporosis, dementia, and heart disease, making it a vital health indicator.

Many chronic illnesses, including high blood pressure, cancer, and cognitive decline, are not separate issues but symptoms of a single underlying problem: chronically elevated insulin levels. This metabolic “trash” accumulates over years, making the body a breeding ground for disease.

When addressing hormone imbalances, start at the base of the "hormone pyramid." Optimizing foundational hormones like cortisol (stress) and insulin (blood sugar) is essential, as they directly impact thyroid function and sex hormones like estrogen and testosterone.

Early pubertal timing in girls—more so than the rate of development—is a strong predictor of future health risks, including mental health issues, earlier menopause, and a shorter lifespan. This suggests a deep biological trade-off between reproductive maturity and longevity, observed across species.

Focusing solely on LDL is a mistake. Even individuals with a genetic mutation leading to lifelong low LDL levels can still have cardiovascular events if they have other unmanaged risk factors like metabolic syndrome, obesity, or diabetes, highlighting the need for a comprehensive approach.

Contrary to popular belief, women's bodies contain substantially more total testosterone than estradiol. This misunderstanding arises because tests use different units (nanograms vs. picograms) or focus only on "free" testosterone, understating its overall prevalence and importance.