August 2025

Hi all,

Happy Summer! I really hope you are getting a chance to spend some quality time with your tribe, wherever that may be!

My tribe gathered in Brooklyn, NY, in June for my youngest daughter’s wedding. I was not prepared for all the emotions that filled me as I watched her walk down the aisle; a beautiful, competent, confident young woman who has found her “person” in a wonderful man. I couldn’t be happier for her, or prouder of the person she has become. What an amazing time!

Happy Birthday, Second Spring Midlife Women’s Health!

I returned to Napa, energized and ready to continue to grow my practice, which turned 1 on July 1st. I am always so inspired by the women I work with, striving to bring their best selves to their families, their work, and their community. To my patients, I have such gratitude for your trust and for allowing me to accompany you on your midlife journey!

I am also grateful to have had the opportunity to meet so many colleagues doing amazing work in the health and wellness space in Napa Valley and beyond. It has been a pleasure to get to know you, and I look forward to collaborating even more in the coming years.

I want to update you on a couple of new services that I have recently added to my practice.

Second Spring Medically Supported Weight Loss Program

I’m excited to announce that I’m adding medically supported weight loss to the services I offer! Why? Because weight gain is one of the things that many of my perimenopausal and menopausal patients are most concerned about. Sometimes it’s a new problem: weight is magically shifting to the belly, with no change in diet or exercise. Sometimes it’s a lifelong problem, but suddenly the repercussions have become serious (hypertension, high cholesterol, blood sugar approaching diabetes, arthritis/joint pain, sleep apnea). With my passion for holistic health, my first instinct is to always focus on diet, exercise, sleep, and stress management. But I know from personal experience that this is not always enough! Women deserve to have the full range of options available as we navigate these important years of our lives.

The health implications of living with obesity are tremendous. It is a leading contributor to most of the major chronic illnesses we face today. With hormone therapy or other strategies, I can help a woman address hot flashes, sleep problems, mood changes, vaginal dryness, bladder concerns, and so much more. But when she tells me about her desire to lose weight, I know that the likelihood of success for many women is lower than we like to admit, regardless of her commitment to lifestyle changes like diet and exercise, and her willpower. Finally, we have medication that addresses several of the complex factors in weight gain, and can contribute to more successful weight loss than many women have thought possible.

I understand that the genetic, biological, psychological, and social factors in each woman’s journey to this place of wanting to lose weight are complex and unique. I have been on my own health journey for the past couple of years, and last summer, I decided to try a weight loss medication called tirzepatide (Zepbound). This has been life-changing for me, and it seems appropriate that I share all that I have learned with my patients as well. I will continue to work to provide a truly holistic approach to each woman’s symptoms and priorities, and when her health priorities include weight loss, we can create a plan that addresses it in a meaningful and effective way. Contrary to what social media may have you believe, this is not an “easy way out.” While medication is an important tool, it is not magic! It is only with dietary changes and consistent exercise that weight loss can be significant and sustainable — so strategizing for and supporting those activities will be a big part of my program. See the link below to the new section of my website or a pdf flyer for more information.

If you’re a current patient and you’re curious about whether weight loss medication makes sense for you, make a follow-up visit with me to discuss this further.

If you’re not yet a patient, schedule a complimentary visit to meet briefly and see if my services meet your needs.

If you’re a professional colleague, I hope you will tell women about my services when appropriate. Below is a printable flyer you are welcome to hand out.

Another New Service: Testosterone for Low Libido (HSDD)

Testosterone is an important human hormone, with many functions in the female body. Some of them include contributing to sexual function and libido, maintaining muscle and bone health, supporting mood and energy, producing red blood cells, and promoting healthy breast and vaginal tissue. Unfortunately, testosterone became known as a “male” hormone decades ago and is only now being recognized as an important hormone in women as well. Our testosterone level is about 1/10th of the men’s level, and starts to decline gradually in our 30s. But throughout our lives, women have significantly more testosterone in our bodies than estrogen (three times or more). So it makes no sense to say that estrogen is “the female hormone” and testosterone is “the male hormone”; we need to stop thinking this way!

So many women report low libido in midlife, and this is an extremely complicated topic. Sometimes, what women describe as “low libido” is actually painful intercourse. It is a wise body that does not desire what it knows will cause pain! Many other things can contribute to a lack of interest in sex, like poor sleep, stress, medications (such as SSRIs, blood pressure meds, recreational drugs, and alcohol), depression and anxiety, body image, and chronic illness. But when all other possible causes have been ruled out, a woman may be diagnosed with hypoactive sexual desire disorder (HSDD).

It has long been known that low testosterone in men contributes to many problems, and testosterone products have been on the market for men since the 1940s; there are currently 12 products formulated for men for the indication of low testosterone (hypogonadism). Testosterone medication for women is much harder to access. It has been recommended by national and international guidelines for one specific symptom of low testosterone: hypoactive sexual desire disorder (HSDD = low libido), but the FDA has not yet approved any formulation of testosterone medication for women. So testosterone is considered off-label in women, but it IS possible for women to use a male product at 1/10th the dose, or to have it made at a compounding pharmacy in a dose appropriate for a woman. Another barrier to access: testosterone is currently classified as a controlled substance, meaning that the federal government and each state regulate specific requirements for prescribing it. Most insurance will not cover testosterone for women, but fortunately, it is not extremely expensive.

I am pleased to let you know that I am now able to prescribe testosterone for patients for the indication of HSDD. There are also other medications for low libido available, and there are non-medical strategies as well. This is an important topic that deserves attention! With a topic this complex, I decided to make another info-packed “toolbox” handout: DESIRE: Understanding & Supporting Midlife Libido. You can access it below and read more!

If you have concerns about low libido or other sexual health topics, you are welcome to make an appointment to discuss them further.

It’s harvest season in my garden, with loads of tomatoes, cucumber, eggplant, basil, and a few zucchini plants that want to take over Napa Valley. Here are my tomatoes (I sprinkled a few zinnia seeds amongst the tomatoes, and now I can’t even find the tomatoes!). I hope your garden is flourishing too (literally or metaphorically). Happy harvest!