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The Peter Attia Drive

The Peter Attia Drive

By: Peter Attia MD
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 The Peter Attia Drive will feature guests and experts that will offer advice and insight to help you optimize performance, health, longevity, critical thinking, and life. It’s hosted by Stanford M.D., TED speaker, and longevity expert Dr. Peter Attia, founder of Attia Medical, PC, a medical practice with offices in San Diego and New York City.Copyright © Peter Attia, MD Exercise & Fitness Fitness, Diet & Nutrition Hygiene & Healthy Living Physical Illness & Disease
Episodes
  • #348 ‒ Women’s sexual health, menopause, and hormone replacement therapy (HRT) | Rachel Rubin, M.D.

    #348 ‒ Women’s sexual health, menopause, and hormone replacement therapy (HRT) | Rachel Rubin, M.D.
    May 12 2025
    View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Rachel Rubin is a board-certified urologist and one of the nation's foremost experts in sexual health. In this episode, she shares her deep expertise on the often-overlooked topic of women’s sexual health, exploring why this area remains so neglected in traditional medicine and highlighting the critical differences in how men and women experience hormonal decline with age. Rachel explains the physiology of the menstrual cycle, the complex hormonal shifts of perimenopause, and the wide-reaching health risks associated with menopause, including osteoporosis, cardiovascular disease, dementia, and recurrent urinary tract infections. She also breaks down the controversy surrounding hormone replacement therapy (HRT), particularly the damaging legacy of the Women’s Health Initiative study, and provides guidance on the safe and personalized use of estrogen, progesterone, and testosterone in women. With particular emphasis on local vaginal hormone therapy—a safe, effective, and underused treatment—Rachel offers insights that have the potential to transform quality of life for countless women. We discuss: Rachel’s training in urology and passion for sexual medicine and women’s health [3:00];Hormonal changes during ovulation, perimenopause, and menopause: why they occur and how they impact women’s health and quality of life [5:30];Why women have such varied responses to the sharp drop in progesterone during the luteal phase and after menopause, and the differing responses to progesterone supplementation [14:45];The physical and cognitive health risks for postmenopausal women who are not on hormone therapy [17:45];The history of hormone replacement therapy (HRT), and how misinterpretation of the Women’s Health Initiative study led to abandonment of HRT [20:15];The medical system’s failure to train doctors in hormone therapy after the WHI study and its lasting impact on menopause care [29:30];The underappreciated role of testosterone in women’s sexual health, and the systemic and regulatory barriers preventing its broader use in female healthcare [35:00];The bias against HRT—how institutional resistance is preventing meaningful progress in women’s health [46:30];How the medical system’s neglect of menopause care has opened the door for unregulated and potentially harmful hormone clinics to take advantage of underserved women [53:30];The HRT playbook for women part 1: progesterone [57:15];The HRT playbook for women part 2: estradiol [1:05:00];Oral formulated estrogen for systemic administration: risks and benefits [1:13:15];Topical and vaginal estrogen delivery options: benefits and limitations, and how to personalize treatment for each patient [1:17:15];How to navigate hormone lab testing without getting misled [1:24:15];The wide-ranging symptoms of menopause—joint pain, brain fog, mood issues, and more [1:31:45];The evolution of medical terminology and the underrecognized importance of local estrogen therapy for urinary and vaginal health in menopausal women [1:37:45];The benefits of vaginal estrogen (or DHEA) for preventing UTIs, improving sexual health, and more [1:41:00];The use of DHEA and testosterone in treating hormone-sensitive genital tissues, and an explanation of what often causes women pain [1:50:15];Is it too late to start HRT after menopause? [1:56:15]; Should women stop hormone therapy after 10 years? [1:58:15]; How to manage hormone therapy in women with BRCA mutations, DCIS (ductal carcinoma in situ), or a history of breast cancer [2:00:00];How women can identify good menopause care providers and avoid harmful hormone therapy practices, and why menopause medicine is critical for both women and men [2:06:00]; andMore. Connect With Peter on Twitter, Instagram, Facebook and YouTube
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    2 hrs and 13 mins
  • #347 – Peter’s takeaways on mastering sleep, dealing with chronic pain, developing breakthrough cancer drugs, transforming healthcare with AI, advancing radiation therapy, and healing trauma | Quarterly Podcast Summary #5

    #347 – Peter’s takeaways on mastering sleep, dealing with chronic pain, developing breakthrough cancer drugs, transforming healthcare with AI, advancing radiation therapy, and healing trauma | Quarterly Podcast Summary #5
    May 5 2025

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    In this quarterly podcast summary (QPS) episode, Peter summarizes his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from his discussions with Jeff English on the journey to healing from trauma; Ashley Mason on improving sleep and CBT-I; Sanjay Mehta on misconceptions around radiation and its use in cancer therapy and treating inflammatory conditions (such as arthritis and tendonitis); Sean Mackey on understanding and treating acute and chronic pain; and Susan Desmond-Hellmann on insights from her extraordinary career that pertain to the use of AI in medicine, understanding cancer, and the development of cancer therapeutics. Additionally, Peter shares any behavioral changes he’s made for himself or his patients as a result of these fascinating discussions.

    If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the episode #347 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

    We discuss:

    • Summary of episode topics [1:45];
    • Jeff English episode: how trauma shapes behavior and identity, and the value of understanding personal adaptations and working through unresolved emotional wounds [3:45];
    • Practical behavioral changes and emotional tools Peter has applied since the Jeff English episode [13:00];
    • Ashley Mason episode: treating insomnia using CBT-I and practical behavioral techniques for improving sleep quality [19:15];
    • When to seek professional care for sleep issues [30:30];
    • Sanjay Mehta episode: radiation therapy’s evolution, its underused potential in treating inflammatory conditions, and the cultural misconceptions surrounding radiation exposure [33:45];
    • Peter’s predictions and insights for the upcoming Formula 1 season [43:15];
    • Sean Mackey episode: the neuroscience, classifications, and treatment strategies for chronic pain, and the importance of personalized care [57:45];
    • Susan Desmond-Hellmann episode: how AI is revolutionizing medicine through advancements in drug development, biomarker discovery, and the potential of training models on private clinical data [1:05:45];
    • More from Susan Desmond-Hellmann: why cancer is so difficult to treat with drugs, the promise of immunotherapy, and the long-term hope for systemic treatments [1:14:00]; and
    • More.

    Connect With Peter on Twitter, Instagram, Facebook and YouTube
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    33 mins
  • #346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.

    #346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.
    Apr 28 2025

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    Susan Desmond-Hellmann is a physician and scientist whose remarkable career has spanned clinical medicine, oncology, biotech innovation, and global health leadership. In this episode, Susan shares insights from her journey training in internal medicine during the early AIDS crisis, treating HIV-related cancers in Uganda, and developing groundbreaking cancer therapies like Herceptin and Avastin. She reflects on her leadership roles at UCSF and the Bill and Melinda Gates Foundation, offering lessons on guiding large-scale health initiatives, navigating uncertainty, and fostering scientific innovation. The conversation explores the promise of precision medicine, the integration of patient care and policy, and the evolving role of artificial intelligence in transforming diagnostics, drug development, and global access to care.

    We discuss:

    • Susan’s medical training, the start of the AIDS epidemic, and the transformative experiences that shaped her career [3:00];
    • Susan’s experience working on the frontlines of the HIV/AIDS crisis in Uganda [12:30];
    • Susan’s time working in general oncology and her transition to biotech where she helped develop taxol—a top-selling cancer drug [26:30];
    • Genentech’s origins, and its groundbreaking use of recombinant DNA to develop biologic drugs [33:45];
    • Susan’s move to Genentech, and her pivotal role in the development and success of Herceptin as a groundbreaking therapy in targeted oncology [44:00];
    • The rise of antibody-based cancer therapies: the development of Rituxan and Avastin [52:15];
    • The step-by-step drug development process and the scientific and strategic challenges involved [1:01:30];
    • The ethical and economic controversy surrounding Avastin’s high cost and limited survival benefit [1:12:30];
    • Susan’s tenure as chancellor at UCSF: leading during a financially strained period, and her strategic approach to fundraising and institutional development [1:14:45];
    • What Susan learned as CEO of the Bill and Melinda Gates Foundation: strategic processes and decision-making frameworks [1:26:00];
    • Susan’s philosophy of leadership and how she sought to build an empowering, values-driven culture at the Gates Foundation [1:35:15];
    • The erosion of public trust in science during COVID, the communication failures around controversial treatments like ivermectin, and the need for better public health engagement and transparency [1:39:30];
    • The role of AI in transforming medicine: from drug development to cancer detection and beyond [1:53:00]; and
    • More.

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    2 hrs and 6 mins
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The title of this review is not an understatement. Listening to Peter has transformed my life in all ways. I never really grasped the importance of exercise until Attia and have gone from being an exercise avoider to loving exercise and exercising for a minimum of 7+ hours a week. After a life time of serial yo yo dieting, I lost circa 45 pounds which I've maintained for over 2 years. I credit being weight stable at a very healthy weight to understanding it's exercise that is even more crucial to health than nutrition. Thank you Peter.

Peter Attia has transformed my life

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Excellent up to date content backed by solid research papers. Delivered in an informative manner but accepting that some content requires some chewing over and repetition to comprehend adequately.

Pushing Boundaries

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really loved the limitless series so listening to this podcast was great. getting more of Chris and peters insights was very interesting

loved limitless

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Important information that makes me reflect on my liffe and becoming more mindfully of the world around me that will make me live longer and learn.

Usefull insight on how to live a better life

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