/ Podcast / A Holistic Approach to Hormones and Intimacy, With Dr. Anna Cabeca

A Holistic Approach to Hormones and Intimacy, With Dr. Anna Cabeca

How are your hormones today? For many of us, the answer is “I have no idea.” Depending on your health, gender identity, and life stage, hormones may not be on your radar at all. But if you’ve experienced hormonal imbalances, especially due to menopause or perimenopause, you know that understanding and optimizing hormones can be a key to well-being. In this episode of Health Coach Talk, “The Girlfriend Doctor” Anna Cabeca joins Dr. Sandi to discuss hormones’ effects on sexual health, intimacy, and relationships and share her insights into a more holistic approach to hormone health.

Dr. Anna explains how our hormones impact everything from memory and mood to sex drive and motivation. These complex, intricate chemicals are connected to liver and adrenal function, circulation, lifestyle factors, nutrition, and age. Over the course of our lives, hormone fluctuation can have a considerable (and sometimes, a disruptive) influence on the delicate balance of our bodies. Hormone replacement therapy may be part of the solution, but it’s probably not enough on its own. That’s why Dr. Anna advocates for a holistic approach to optimizing hormone health by making intentional shifts in our habits, diets, and lifestyles.

“It takes more than hormones to fix our hormones…There’s so much empowerment through our body’s natural design that is even better than anything that I can write on a prescription pad.”

Dr. Anna Cabeca

Functional Medicine Health Coaches can help guide their clients through hormone transitions with expertise and empathy. Consider a client navigating menopause: they may be aware of hormone replacement as an option (and a good option!), but they probably don’t know that their work stress and the ultraprocessed foods they’re eating are impacting their hormones, too. They may not know that prioritizing sleep and gentle exercise is just as important as taking the right medicines, or that the best results will likely come from a holistic approach that takes all these factors into account. If you’re a health coach and your menopausal client comes to you asking, “What’s wrong with me?”, a conversation about hormones can be a great place to start.

Dr. Sandi and Dr. Anna share valuable insights and actionable advice, empowering listeners to take charge of their hormonal health and embrace a holistic approach to well-being. Their discussion underscores the importance of addressing lifestyle factors, optimizing hormone balance, and fostering meaningful connections to thrive in every stage of life.

Episode Highlights

  • Dr. Anna’s perspective on the power of hormones to shape our thoughts, behavior, motivations, willpower, and “every aspect of what makes us unique”
  • Understand how outdated fears around eating fat and cholesterol contribute to hormone imbalances
  • Hear why Dr. Anna believes bioidentical hormone replacement is the gold standard, but not enough on its own
  • Break down Dr. Anna’s “university” metaphor for hormone hierarchy and learn why the “love hormone” oxytocin is principal of the school

Meet the Guest

Dr. Anna Cabeca, DO, OBGYN, FACOG

The Girlfriend Doctor

The Girlfriend Doctor


Anna Cabeca, DO, OBGYN, FACOG, is best selling author of The Hormone Fix, Keto-Green 16, and MenuPause. A triple-board certified and a fellow of gynecology and obstetrics, integrative medicine, and anti-aging and regenerative medicine, she holds special certifications in functional medicine, sexual health, and bioidentical hormone replacement therapy. She lectures frequently on these topics throughout the world to large audiences and is known nationally as The Girlfriend Doctor (she’s also host of The Girlfriend Doctor show). Dr. Cabeca has personally developed natural products to help women balance hormones and thrive through menopause including the highly acclaimed Julva® cream for the vulva and MightyMaca® Plus, a powerful superfood blend. She now lives in Dallas with her daughters, horses and dogs.


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Episode Transcript

Dr. Sandi: Welcome to another episode of “Health Coach Talk.” One area that I find there’s great interest in, there’s also a lot of confusion regarding hormones, what are they, and how do they work together to balance once another. How do you control hormone fluctuations? Are there some natural ways that you can rebalance your hormones? And natural ways to rebalance your hormones, those are areas where health coaches are going to play a central role because it has to do often with lifestyle changes, those changes that may be very difficult to do.

So, in this conversation, I think you are going to really enjoy, you’re going to learn a lot. We talk about hormones and intimacy, the role of hormones, and perimenopause, menopause, and what happens in post-menopause. We talk about bioidentical hormones. Are they something that you should be scared away from because of the Women’s Health Initiative study? We’ve talked a lot about that on this podcast.

So, today my very special guest is Dr. Anna Cabeca. Let me tell you a little bit about Dr. Anna. She is a bestselling author. Check out her books, The Hormone Fix, Keto-Green 16, and MenuPause. Dr. Anna is triple board certified, and she’s a fellow of gynecology and obstetrics, integrative medicine, and anti-aging and regenerative medicine. She holds special certifications in functional medicine, sexual health, and bioidentical hormone replacement therapy. She lectures frequently around the world on these topics, and she’s known nationally as “The Girlfriend Doctor,” hosts “The Girlfriend Doctor Show.” She has personally developed some great natural products to help women balance hormones and thrive through menopause, including her famous, highly acclaimed Julva Cream and her Mighty Maca Plus. This is a powerful superfood blend. She lives in Dallas with her daughters, her horses, and her dogs. I know that you are going to enjoy our conversation. Anna, welcome to the podcast.

Dr. Anna: It is great to be here with you, Sandi. Thank you for having me.

Dr. Sandi: I’m excited to get into this topic today, which I know will be of great interest to our listeners because we’re going to talk about hormones and not only talk about hormones, but hormones and intimacy, how they impact relationships. So, could you start out by talking about what is this effect of our hormones fluctuating all the time? Why is that happening? And how is it affecting our intimate relationships? How is it affecting our overall well-being and particularly people who are going into perimenopause, and menopause, and like me, postmenopause?

Dr. Anna: Yeah. Well, I always like to say, to be blunt, sexual health is necessary for optimal health and understanding how our hormones are changing and being able to optimize our hormonal transitions so that we stay as ultimately connected and turned on and receptive as we possibly can. Now, I think a lot of people don’t realize how strongly our hormones, our physiology, our hormonal physiology affects our thoughts, affects our behavior, affects our drive, affects our motivation, affects our willpower. I mean, really affects every aspect of what makes us unique.

So, in the perimenopause, the menopause, as our hormones are changing, then we start to get a decline in DHEA, which produces testosterone and estrogen, and that can lead to a decline in sexual desire for sure, right? Not to mention the physical changes that occur that can cause decrease in sensation or dryness and discomfort with intimacy. And so that’s one key area or function in both women and men. And the second key hormone that changes is progesterone. And that’s from our mid-30s to our 50s. We start to see a rapid decline of progesterone. Actually, the statistics show that there’s a 75% decline between age 35 to 50 of progesterone. So, it’s the biggest transition hormone. And because it’s one of our mother hormones, and it helps with our mood and our memory, and from there, we produce our other reproductive hormones, if we see a decline in that, it can be that simple physiology is changing and now we have less desire and less drive and a decreased function.

So, optimizing our hormones naturally through our body’s own natural production of hormones, as well as so we can use what our body’s making better, I think that’s the key thing, especially when it comes to functional medicine coaching, making sure that our livers are working, our adrenals are working well, and our circulation is optimum, all of these lifestyle factors and nutritional factors that move the needle the most when it comes to our hormonal health and optimizing the transitions in our lives.

Dr. Sandi: So, if I get this right and if you’re a coach wanting to explain it to clients, you’re going through this hormonal transition. And perhaps at the same time, if your lifestyle choices are subpar, if you are eating ultra-processed foods, if you’re highly stressed, if you’re not getting enough sleep, if you are experiencing, again, a lot of stress in your life and you’re thinking, “What’s wrong with me?” So, it’s this perfect storm of all these factors coming together. Would that be correct?

Dr. Anna: That’s absolutely correct. It does. It becomes this perfect storm. And if you’ve got teenagers you’re raising at home, or your work stress, relationship stress, all of those things that add in, that adds to it. That adds to the hormonal imbalance that occurs too. So, real and perceived stress is a big hormone disruptor.

Dr. Sandi: So, when I learned about hormone production, I learned about the role of cholesterol. And yet I find so many people, women are freaked out about eating fat and they are afraid. And they’re often told, well, they have to have really low levels of cholesterol because they’re afraid of heart disease. So, could you comment on that where you might not be taking in enough fats or you’re not making cholesterol for other reasons as well? And then this is causing this downstream effect of perhaps if it’s all going to cortisol and your sex hormones are impacted.

Dr. Anna: Oh, my gosh. It’s such an important issue. And I see this every day too in my clinical practice where women have had their cortisol suppressed or from medications or dietary patterns. And we’re like, “Oh, wow, we’re just not going to get good hormones until we really increase your cholesterol or support your healthy levels of cholesterol—not too high, not too low.

There was a research that was published by an Italian group, Dr. Canonigo led this research, and he looked at actually cholesterol and statin medication in men and their testosterone levels. There was a direct correlation between the lower cholesterol and statin use and lower testosterone levels because cholesterol is a precursor for our sex steroid, so it’s so important. So, the answer, the long haul, when we look at longevity and quality of life and quality of muscle, it comes to having healthy, not too low cholesterol levels. So, that’s really a very microscopic view of a problem and not looking at the entire big picture. And I would just like to say to everyone. You guys got to do what Sandi’s doing because she’s amazing. She’s a rock star. She’s a role model for all of us.

What I learned as our physiology is shifting in midlife, that we need to optimize healthy fats and high-quality protein and lower but flex in some healthy quality carbs. So, we really want to modify our physiology so that we’re not just glucose-dependent. We’re able to flex into using ketones for fuel, because when we look at energy sources, glucose is an energy source as ketones are an energy source. But the use of glucose for fuel in the brain and in the muscle is dependent on our hormones, specifically estrogen and most likely progesterone. Whereas the use of ketones is not. So, glucose is to gasoline as ketones are to jet fuel.

So, understanding that and optimizing our physiology midlife to really empower fat burning becomes that much more important, especially in the society we’re living in, because we’re not pending… Most of us aren’t pending a famine, aren’t pending scarcity due to the season change and our crops aren’t growing. So, we have to really look at, in our modern society, how can we best optimize our physiology so that we have good hormonal production.

And when it comes to like sexual health and intimacy… And I just led two really amazing masterclass. We had over 6,000 people signed up on understanding about mastering your hormones and midlife transition. And a lot of the people were asking, “I’m really struggling with intimacy. I know I love my husband, but I don’t initiate relationships. I don’t initiate sex any longer.” Or, if I do, it hurts. And I’ve had clients tell me it feels like knives stabbing me in my vagina or burning needles, or I mean, just crisis situations that’s 100% avoidable and repairable. So, I want to say that again, 100% avoidable and repairable with understanding our hormones, healing our gut health, because the vagina is an extension of that, improving healthy fats, again, important for the cell membrane and the health of our cells, but also adding back hormone topically to the pelvic floor area, honestly, for both women and men can make a huge difference in the quality of our life and our intimate relationship so we’re able to maintain healthy relationships too and healthy intimacy, which is so critically important because with that, we produce other feel good and longevity hormones and chemicals that help our body regenerate and rejuvenate. So, continuing in this area, like not to give up on ourselves, especially in this area regardless of age.

Dr. Sandi: Oh, I love that we’re discussing this, and we also had Dr. Felice Gersh on the podcast, and we talked about bioidentical hormones. And I was that generation that was totally scared by the Women’s Health Initiative. That was the famous study and they traced… That was not bioidentical hormones that they were using, but we were scared and so many doctors just pulled people who were on it off of it. And can you comment… And then I would love to get into the role of what oxytocin is because I think our listeners will really love to have a conversation about that, love hormone.

Dr. Anna: Absolutely. And when I was a resident at Emory University in gynecology and obstetric, I participated as a researcher in an arm of the HERS trial, which was one of the first large trials in women looking at hormone replacement and heart health. It, again, used substandard oral hormone therapy, which is at higher risk and detriment to our bodies, so it failed miserably. And one of the components that I had researched was how was your patient…talking to women in the study, did your doctor talk? How did they talk to you about hormone therapy? What other offerings did they give you? What other options?

It was very interesting, and the conversation was very little. I mean, it was very little and, again, in our infancy of knowledge. Then, in 2002, I was in private practice, and my own solo Marcus Welby type of rural health practice in Southeast Georgia. And that research was released from the Women’s Health Initiative study in 2002 and saying, “Stop your hormones. It’s going to cause breast cancer. We had to close down the study,” which was such a shame, which was such a shame.

But now in 2022, further retrospective analysis of the study has shown, well, okay, so we acted a little bit partially regarding the results of the study. Actually, the estrogen arm, even though it was oral and substandard estrogens because it’s conjugated equine estrogens, again, not bioidentical, did not show an increased risk of breast cancer. In fact, it did show a increased risk of stroke and heart attack because oral estrogens, especially conjugated equine estrogens, increase our inflammatory markers and can cause stickiness, so blood sticking, clotting, strokes, so that’s detrimental. However, the provera arm, again, a synthetic progestin, not bioidentical, progesterone, caused an increase in breast cancer. So, this is really important to understand. Now, way back in 2002, because I was a researcher, I looked at the data, and the same data was available then as is now.

So, it was very clear it’s the type of estrogen as well as the delivery mechanism—so, oral, not transdermal or vaginal—was the culprit in this and synthetic, not bioidentical. So, switching very… and always using bioidentical hormones as an advocate for what is God-given, what is natural by design seems like the best time tested first approach, not second approach, which is commonly approached in our modern medicine. But as a first-line approach seemed smarter and by far it is. There’s so much we can do healthfully to balance our hormones naturally, transdermally, regardless of our age. I say I don’t discriminate based on age or history of cancer to optimize your health and your hormones.

Dr. Sandi: Thank you for that explanation, and it is just so encouraging to see the scientific community going in this direction and looking at the value of bioidentical hormone replacement and increasingly look at the importance of hormones but not only for sexual health but for bone health, I’ve heard for dementia, and so many ways that those women were done a disservice in my age group. I was 52 at the time. You’re talking about 2002, so perfect age range, but of course I was so scared away from it. Let’s talk about oxytocin aka the love… Yeah, go ahead.

Dr. Anna: With that said, Sandi, because you’re proof that the lifestyle and environmental factors can trump, right? It takes more than hormones to fix our hormones. So, really recognizing there’s so much empowerment through our body’s natural design that we can do that is even, you know, as good as, most likely better than anything that I can certainly write on a prescription pad. So, I just want to emphasize that point.

Dr. Sandi: Absolutely. The important… it is always lifestyle first. And that’s why I say health coaches will be the new primary care. I’m not saying they want to replace or they should replace doctors, but what it means is that lifestyle is first and you always look at, well, what are you eating? What is your stress level? Are you getting enough sleep? What is your movement like throughout the day? I move throughout the day. I’m sitting on a bouncy ball. I have my hand grippers here. I’ve got a treadmill desk. I do weightlifting throughout the day as exercise. So, constantly moving, but also addressing stress and being able to let go of what I can’t control. And that’s what happens as you get older, you get a good sense of perspective. So, things that used to bother you don’t because you see that it’s meaningless in the long run and you want to generate that oxytocin. So, can you talk about this, about the love hormone and how we can get more of it?

Dr. Anna: Yeah. So, first I want to let everyone know, when we look at a hormonal hierarchy, our reproductive hormones, even our prohormone, vitamin D, melatonin, etc., this student body of hormones. If you think of a university or a school-type setting, it’s your student body of hormones. And then your professors or teachers of that student body are these regulator hormones such as adrenaline, insulin, and cortisol. So, when we want to work on hormones, we also have to address the leaders of those hormones. And I like to give the example of, if you ever have been in a situation where your teacher or professor comes in hungover, high, or whatever, and they turn out the lights of the classroom, flip on a movie, there is no order. There is no motivation in that except to get out of that environment as quickly as possible.

So, the same is true with our hormones. If insulin and cortisol specifically aren’t balanced and optimized and we’re not insulin-sensitive, there’s chaos in our reproductive hormones and there’s inflammation throughout our body. And then the overarching, like the principal of the school or the president of the university, we look at that as oxytocin, the most powerful, alkalinizing, rejuvenating, regenerating hormone. The hormone that we live life for. At the end of the day, it’s feeling connected, feeling loved and loving well that we want to have in our lives at every age and stage, especially as we get older, and that relates to the hormone oxytocin. Not to be confused with oxycodone, the pain-relieving drugs. So, oxytocin is a rejuvenating, life-giving hormone. And for every one of us produces this amazing drug in our own pharmacopoeia of our body. So, we produce oxytocin through laughter, through intimacy, orgasm, positive touch, through being and doing things that you love with people you love doing them with. Having a pet increases oxytocin. Healthy marriage, healthy community increases oxytocin. It has also shown that multi-generation households have increased oxytocin and also more longevity. So, this is critical.

And for many of you that you may realize that, okay, oxytocin is also an incredibly important part of childbirth. Without oxytocin, we wouldn’t go into labor and we wouldn’t feel that attachment to our body. As an obstetrician, we give Pitocin, which is oxytocin, during labor if we need to speed it up or make the contractions stronger so that many of you may have received exogenous oxytocin, but we make it through our thoughts and our practices in our lives. And research has shown that oxytocin, even in aged muscle, promotes regeneration and repair and that oxytocin improves our immune system so we’re able to incorporate this knowledge and science into our long-haul COVID or inject mRNA-injured individuals, so we can support the immune system with oxytocin as well.

And the practices that include oxytocin, it’s all part of my plan. When I give a lifestyle plan and before I give drugs, make sure you’re microdosing oxytocin with some OxyPlay every day. So, that’s how important it is. And it’s important to also to understand that when stress is high, we increase cortisol. When stress is high, oxytocin is low. And it makes sense. When you’re in a fight or flight situation or you’re scared or fearful, it’s not a time to hug your enemy, right, or hug the threat that you’re approached with. So, oxytocin is naturally suppressed. You’ve got the seesaw effect. When oxytocin is high, we moderate cortisol a lot better. But when we’re under chronic stress or chronic everyday stress, perceived or real, then the periventricular nucleus in our brain will suppress cortisol production. So, we get in this hypocortisol state, low cortisol, adrenal dysfunction state, but oxytocin stays low. And this exactly, when cortisol is low and oxytocin is low, we are in this state of burnout. It feels like, “I know I love my partner, I just don’t feel love for them,” or, “I used to love painting. I just haven’t picked up the paintbrush in years now,” or, “I used to love going out and meeting with friends, but I don’t want to now.” The physiology of depression, the physiology of burnout, the physiology of disconnect and divorce, oftentimes that state when these hormones, because physiology affects our behavior, it affects the way we think, how we feel, our receptiveness to others. And that’s what I’m so passionate about. I’ve written about it in my book, “The Hormone Fix,” and a little bit in every one of my books. But I think understanding this physiology is more important now than ever. So, my tangent on oxytocin.

Dr. Sandi: This is such important information. And I love how you said our thoughts can control this, because that’s what I have taught for so many years, that we can change that. And we can also… There’s a heartwarming exercise that comes from HeartMath, where you take a breath, you feel the warmth and you feel the warmth flowing through your heart. And then you imagine that as love and you send love out. Whoever needs it or to yourselves, give them some love, and that power of generating this but also how you could be engaged in activities that could be pleasurable. Even sex. There’s a famous movie. It was an old movie called “Klute” with Jane Fonda. She’s a sex worker, and she’s having sex, and she’s looking at her watch. Many people do that who are not sex workers, but they’re like, “Oh, get this over with so I can get on to get to bed or do the dishes or whatever.” So, it is not the actual act, but it is actually how you’re experiencing it and what you’re telling yourself about the pleasure of it. So, it’s so important.

So, let’s turn to hormone fluctuation. So, how can we naturally rebalance these hormones, up our level of oxytocin? What are some ways that we can do that and lower cortisol? Can you just comment on…? And I know there’s a whole encyclopedia of things that we could be touching on, but what are some of the things most important for you?

Dr. Anna: So, for me and the method that I teach in my Magic Menopause program that I write about in my books is I call it the Keto-Green Way. And it’s the lifestyle approach which is 90% of it. And I only say 90%. It’s really 99.99%…okay, 100% but because I’m an egotistical physician still, I want to claim some credit for what I can do for my patients. So, this is the concept of… If you think of our hormone bucket as a bucket, we first need to fill the holes in the bucket where we’re just losing energy. Hormones are energy or energetic molecules. We have to seal where we’re losing them. Then we have to replenish our hormones. And from a natural approach and a lifestyle approach, our first step is, what are our thoughts? How are we talking to ourself? How are we thinking about ourselves? Are we in the present moment and are we grateful? And so that goes a long way to sealing these holes in the bucket, right? And then removing toxins.

So, part of my method is a Keto-Green hormone detox. So, working with adaptogens and medicinal foods and menus that I’ve created to help support your body’s natural anti-inflammatory process and hormonal production, specifically with our adrenal glands and thyroid gland and our ovaries or testes in men. So, we want to produce our own natural hormones as healthfully as possible by reducing the strain, how quickly our hormones are being emptied out, by reducing the strain on them, and improving the detoxification pathways. So, their body’s able to receive these hormones better and use more of them efficiently as well as make. We know our ovaries are making hormones way past age 65. So, we have studies that showed we have our ovaries still. They’re still making hormones. And when we don’t, the adrenal glands are going to pick up the slack if they’re given the right nutrients.

And so for me, part of that is the medicinal foods is my adaptogenic blend, which is called Mighty Maca Plus. And then using bioidentical progesterone, pregnenolone, and specifically for sexual health and function, DHEA or my product, Julva. So, to help maintain the condition, the skin of our delicate female parts too, I think that’s part of optimizing. And then everything like always focusing on, if I can move the needle quickest most, it’s to make more oxytocin. So, reducing cortisol, focusing on the ways that we can make more oxytocin naturally as much as possible and having fun, laughing at ourselves and others like to do a lot. And so things like that can really make a big difference in our hormone balance. It just changes my programs in just a few weeks. We see an incredible transition. Not just feeling healthier but happier.

Dr. Sandi: It’s so critical. And all of these areas that you mentioned, these are things that health coaches can work with clients on. They can inspire them on ways to produce more oxytocin, to recommend your books, which are so fabulous, beautifully written, beautifully illustrated. I love your books and your product. That is such a good product, by the way. I highly recommend it. I have used it. It is wonderful. And your Maca Green’s as well is a staple in my kitchen when I make my smoothies. So, this has been such an enlightening conversation. Dr. Anna, where can people find you?

Dr. Anna: Oh, thank you, Sandi. I talk to you all the time. Again, you’re so inspiring. So, to find me, it’s easy at dranna.com and on social media @thegirlfrienddoctor.

Dr. Sandi: Remember that because she is truly The Girlfriend Doctor. You are making such a difference in the world in the health of women and so I applaud you and we’re here to support you and your important work. So, thank you so much.

Dr. Anna: Thank you.