Sometimes in practice, I start to notice patterns.

I’ll have a stretch of a few weeks where multiple people come in, and somehow we keep circling back to the same topic over and over again.

Recently, it’s been bone health.

And I want to flag this, because most people still think of bone health as an “old person” problem.

It’s not.

Bone health is largely determined in your youth. What you do in your teens, 20s, and even into your 30s plays a massive role in what your bones look like later on.

And what you do in your 30s and 40s? That determines whether you maintain what you built or start losing it.

There has been a lot of media attention focused around being “skinny” again.

For a while, it seemed as if the heroin chic 90s were over, but it seems like they are making a resurgence. The skyrocketing popularity of GLP-1s like Ozempic is unfortunately not helping (no shade, just facts). And most recently, there has been a very big movie release with two very thin female stars, and I’ve had multiple moms discuss with me how triggering it has been to see that on the big screen.

Especially for women who have struggled with eating disorders, but also for those who now feel like they need to have conversations with their daughters about how being that skinny is not the goal.

And in my own practice, I see and hear this a lot - a real focus on thinness and a fear of gaining any type of size, even when it might actually benefit someone’s health.

At some point in their late 30s or 40s, many women begin to notice subtle - but persistent - changes.

Sleep becomes lighter or more fragmented. Anxiety appears where it didn’t exist before. Energy dips. Weight becomes harder to manage despite consistent habits. There may be joint pain, brain fog, or a general sense of “not feeling like yourself.”

These are often dismissed or treated as separate issues.
But in many cases, they are early perimenopause symptoms.

When we talk about hormones, most people think of estrogen, progesterone, or testosterone.

But there’s another hormone - arguably one of the most influential in the body - that often goes overlooked in everyday health conversations:

Insulin.

And yet, insulin plays a central role in metabolic health, hormone balance, and long-term disease risk.

An interview featuring Dr. Ben Bikman, whose work focuses on insulin and metabolic health, offers important context for understanding insulin’s broader role in the body. 

One key takeaway is that insulin does not only regulate blood sugar - it also influences hormone balance. 

Elevated insulin levels can interfere with the body’s ability to convert testosterone into estrogen by affecting aromatase activity, which may contribute to higher testosterone levels and downstream hormonal effects. 

The discussion also reinforces a consistent theme in metabolic health: common dietary patterns can contribute to chronically elevated insulin. 

Over time, this can occur quietly, often developing for years before changes appear on standard lab markers, while still influencing overall metabolic and endocrine function.