TODAY'S AJENDA #99

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I’m going to say the quiet part out loud: I think the way we use the word longevity right now is mostly BS.

Not because living longer isn’t a good thing. Of course it is. But the way that longevity is marketed to women over 50 has drifted far from reality and very close to fantasy. And fantasy is expensive, exhausting, and not especially helpful.

Here’s the core problem. 

Much of the longevity conversation asks women to do uncomfortable, restrictive, expensive or time-consuming things today for a hypothetical payoff 40 or 50 years from now. Now, that framing might work if you’re 28 and optimizing a spreadsheet version of your future. It lands very differently when you’re 50 and over, juggling work, family, sleep disruption, joint stiffness, and a body that already feels different than it used to.

Most women I talk to aren’t asking, “How do I live to 110?”
They are asking,
“How do I feel better this year?”
“How do I wake up with energy?”
“How do I move without pain?”
“How do I think clearly and enjoy my life now?”

Longevity culture often skips right over that.

It’s also become a magnet for marketing hype. Supplements, stacks, gadgets, biohacks, peptide protocols that sound scientific but rest on very thin evidence.  There’s a lot of talk about pathways, molecules, and mechanisms, and far less honesty about what’s actually been proven in real humans over meaningful periods of time. Much of what gets labeled “longevity science” is either extrapolated from animal models, short-term surrogate markers, or observational data that can’t tell us what actually causes what.

That doesn’t mean the science is useless. (I find it interesting and potentially exciting, but I also often find it ‘not ready for primetime.’)  It means it’s being oversold. I also have a huge issue with health influencers who speak in absolutes. Science is almost never an absolute. It is nuanced, dynamically evolving, and ultimately may be slightly different for you than it is for a ‘study population.’ 

And here’s the other thing we don’t say enough: longevity without quality is not a win. Living longer while feeling weaker, foggier, more medicated, more restricted, and less joyful is not some gold medal outcome. It’s just more years.

This is why I prefer the terms "health span" or "vitality.”

Health span asks a better question:
How many of your years are lived with strength, mobility, cognitive clarity, independence, and resilience?

Vitality is even more grounded. It asks:
How do you feel in your body today?
Do you have energy?
Do you recover well?
Can you do the things you love without fear?

Ironically, when you focus on vitality and health span, longevity often improves as a side effect. 

• Exercise and physical activity improve healthspan by enhancing cardiovascular, metabolic, and musculoskeletal function, preventing or delaying many chronic diseases. Scientific reviews highlight exercise as the core of healthy aging and chronic disease prevention.

• WHO recommends even moderate daily activity, which is associated with lower mortality risk and fewer cardiovascular events.

• Research summaries note that maintaining muscle (“musclespan”) correlates with lower risks of chronic illness and premature death. 

But that’s not the sales pitch. It’s the byproduct.

The problem with the longevity obsession is that it can pull people away from what actually works: boring, unsexy fundamentals. Strength training. Protein. Walking. Sleep. Stress regulation. Purpose. Community. Social interaction. These don’t come with sleek branding or elite club vibes, and many of them cost nothing,  but they have the deepest evidence base we have.

I’m not interested in shaming anyone for wanting to live a long time. I’m interested in reality checks. If a recommendation makes your life smaller today in the name of a distant, uncertain future, it deserves scrutiny. And, if something sounds too good to be true, it usually is. 

For women over 50, the goal isn’t to optimize for a theoretical version of yourself at 95. (Though, full transparency: I am formulating my 80’s and 90’s style now, and I’m kind of excited about it! It involves platinum blonde hair or a faux-po, cool glasses, swaggy footwear, and oversized button-down shirts over cool leggings or pants!) 

The goal is to feel capable, clear, and alive now, and to stack enough of those good years together that you don’t need to chase the word longevity at all.

Call it vitality. Call it health span. Call it living well.

Just don’t let marketing convince you that suffering today or the latest trend is the admission price for a future that isn’t guaranteed.

What GLP-1 Medications Are:
GLP-1 medications (brand names such as Wegovy, Zepbound, Mounjaro, Ozempic) are prescription drugs that mimic a natural gut hormone to regulate blood sugar, reduce appetite, and slow stomach emptying, helping many people manage diabetes and weight when used properly. 

If you’re a woman over 50 thinking about a GLP-1 medication for weight management (or even for prevention, though this is off-label at this time) and your doctor won’t prescribe it, you’re not alone. And before we turn this into a story about “a doctor who doesn’t get it,” it helps to know there are a few very real reasons clinicians say no. Some are appropriate. Some are fixable. Here is the calm, practical roadmap for requesting GLP-1 medication: 

Why a doctor might say no (and what it usually means)

1. You don’t meet FDA-labeled criteria (or they think you don’t). 
   For chronic weight management, both trizepatide (Zepbound) and semaglutide 2.4 mg (Wegovy) are indicated for adults with a BMI ≥30 or a BMI ≥27 with at least one weight-related condition (such as hypertension, dyslipidemia, type 2 diabetes, sleep apnea, or cardiovascular disease).  Off-label use for women who have gained 10-20 lbs during menopause, or for people at a normal body weight who want it for the brain/heart/kidney protective effects, is a much harder situation.
   

2. They’re worried about your safety or contraindications. 
   These medications have known risks and boxed warnings, and some clinicians are appropriately cautious. I was too, before speaking with Dr. Anne Peters (the world-renowned LA endocrinologist who has been prescribing these medications for 20 years and told me she has NEVER seen a case of thyroid cancer associated with GLP-1’s and that that risk was found only in lab rats. ) For example, if you have a family history of medullary thyroid carcinoma or MEN2, those would be a hard stop for this drug class.
   

3. They don’t have the time or the workflow for follow-up. 
   GLP-1s are not a “hand someone a prescription and wave” medicine. They require titration, management of side effects, and ongoing monitoring. Some doctors just simply don’t have the time to commit to proper patient management with this drug. It’s a good thing if your doc knows their limits. 
    

4. They aren’t current or comfortable. 
   Some clinicians simply haven’t incorporated obesity medicine into routine practice yet. That’s not a moral failure. It’s a systems issue, and I respect it.

Tackling barriers to weight-related medications is often more about communication, documentation, insurance, and logistics than it is about your body. Here’s a practical step-by-step approach that empowers you without guesswork. 

1.) Politely ask for the reason for “no” in writing

Don’t allow a vague “I don’t prescribe that” to be the end of the conversation. Ask your clinician to email or note in your record the specific barrier: eligibility criteria, safety concerns, experience, insurance, etc. 

Why it matters: Clear documentation enables you and your care team to address the real issue, rather than relying on assumptions.

2.) Bring a one-page safety snapshot to your visit

Make it easy for your clinician to assess appropriateness by providing them with the necessary clinical context to quickly evaluate eligibility and safety. 

Include:

• Your current weight, height, and BMI. (Calculate your BMI here.)

• Weight-related diagnoses (Blood pressure, prediabetes, type 2 diabetes, lipids, sleep apnea, fatty liver disease, cardiovascular history)

• Prior weight-loss attempts (your lifestyle, nutrition, medications, structured interventions)

• Relevant medical history (pancreatitis, gallbladder disease, severe GI motility disorders, personal or family history of medullary thyroid cancer or MEN2, pregnancy, or plans for pregnancy) 

Why it works: GLP-1 medications are indicated for adults with a BMI ≥30, or a BMI ≥27 with at least one weight-related condition. Summarizing this upfront helps your doc apply guidelines efficiently. 

3.) Clinician consideration

Studies show that clinician comfort and training strongly influence whether evidence-based obesity treatments are offered. Some clinicians are uncomfortable managing obesity pharmacotherapy, particularly dose titration, side effects, and long-term maintenance. If these are the issues, switch the clinician, not the goal.

What to look for:

• Providers with Obesity Medicine training (check ABOM.org to find one near you)

• Endocrinologists or cardiometabolic specialists

• Primary care clinicians who focus on obesity care

Why this matters: Provider comfort with dose titration, side-effect management, and long-term follow-up improves care quality and outcomes. 

4.) Treat insurance like a benefits problem

Coverage for anti-obesity medications varies widely across plans and often requires prior authorization with documentation of your medical history and comorbidities. This is important because denials are often overturned on appeal when prior attempts are clearly documented.

Why it matters: Insurance decisions are documentation-driven, not based on personal preference. 

Practical steps: 

• Ask if the office routinely submits prior authorizations. 

• If denied, appeal using documented comorbidities and previous weight-loss efforts. 

• If you have established cardiovascular disease and meet criteria, note that semaglutide has evidence for cardiovascular risk reduction in people with overweight/obesity without diabetes.

• Consider paying out of pocket (OOP); the prices for these meds have come way down recently. While not cheap, paying OOP could save you money long-term by improving your overall health.

5.) Understand “off-label” use

An off-label use means prescribing an FDA-approved medication for something not listed on the official label. 

Examples:

• Using Ozempic (semaglutide) for weight loss is off-label

• Zepbound is the FDA-approved version specifically labeled for obesity

Why this matters: Off-label prescribing can be appropriate, but it may affect insurance coverage and requires careful follow-up and monitoring.

6.) Be cautious with compounded or “unapproved GLP-1” products

The FDA has raised specific concerns about unapproved GLP-1 drugs, including the use of unapproved salt forms (semaglutide sodium/acetate), and reports of dosing errors and adverse effects, including hospitalization, linked to compounded semaglutide. 

While I understand that cost and access concerns drive people toward compound products, it's crucial to understand that safety issues are real. 

Why this matters: Since compounded products may vary in quality, potency, and dosing, they are not interchangeable with FDA-approved medications. Discuss risks and benefits with your clinician if considering any non-approved option.

What Good Follow-Up Actually Looks Like (Non-Negotiable)

Starting a GLP-1 is not a DIY situation. Obesity and the condition of being overweight are chronic conditions. Stopping medication without a plan often leads to weight regain. High-quality care includes an ongoing plan, clear guardrails, and proactive monitoring and/or maintenance.

At a minimum, a good follow-up should include: 

• A clear dose-escalation plan
  

• Defined nutrition targets, especially protein
  

• Monitoring for known risks
  

• A long-term maintenance strategy
  
  

Bottom line

You deserve an evidence-based care plan that is clearly documented and tailored to your health goals. If your doctor won’t prescribe a GLP-1, don’t default to panic or to sketchy workarounds. Instead, get clarity on why, document eligibility, and, if needed, transfer your care to someone trained and current in obesity medicine. That’s the safest, highest-return path for women over 50 who want results without chaos.

February is all about the heart, yes, but sexual health deserves some love, too. It’s a meaningful part of overall wellbeing, connection, and quality of life. 

Intimacy matters, especially in midlife. Yet for many women, the hormonal shifts of perimenopause and menopause can quietly disrupt it. 

As estrogen levels decline, vaginal tissues can become thinner, drier, and less elastic. This can lead to discomfort or pain with sex, vaginal irritation, and recurrent infections. 

The not-so-sexy facts: Research suggests that up to 50–80% of perimenopausal and postmenopausal women experience these symptoms at some point. NOT fun!

Add in hot flashes, fatigue, weight changes, and anxiety, and it's no wonder sex slips to the bottom of your to-do or wish list!

Alongside these physical changes, thanks to declines in estrogen and testosterone, many women notice shifts in libido, arousal, and natural lubrication. When sex becomes more uncomfortable and arousal is harder to achieve, desire drops naturally. These changes can erode confidence and pleasure, and they are still not discussed openly or honestly enough.

But this does not mean you're doomed to unpleasant sex the rest of your life!

Too often, women are told this is just “normal” and something to endure. But normal does not mean inevitable, and it certainly does not mean untreatable.

Caring for your sexual health is an act of self-respect and self-care. While sexual health is integral to overall well-being, studies also show that treatment has a positive effect on women who are not sexually active, too. Menopause.org suggests that treatment should be offered to anyone with symptoms, whether engaging in sexual activity or not, stating that “normalizing use of local low-dose estrogen therapy should be a thing.”

Feeling comfortable in your body, connected to pleasure, and supported in intimacy matters at every stage of life. In fact, regular sexual activity itself increases blood flow and helps maintain tissue health. Sounds intimidating? Do not worry. Amazing sex in menopause is possible. You just need the right support.

That’s why I love and partner with Alloy Health. Alloy offers doctor-led, evidence-based care and sexual health treatments* designed specifically for women navigating midlife changes. And because midlife health goes beyond one concern, Alloy also offers evidence-based solutions across skincare, hormone therapy, weight care, and more.

Their prescription-based sexual health treatments, including vaginal estradiol and the O-mazing bundle, are clinically proven options that help restore vaginal tissue health and improve comfort during intimacy, even in as little as 4 weeks! 

Research shows that local low-dose vaginal estrogen therapy is safe and highly effective at alleviating bothersome symptoms that contribute to pain and avoidance of intercourse. These products are designed to help you feel comfortable, confident, and connected again without waiting for an in-person doctor’s visit (because who has 8-12 weeks to wait to see a Gyn when her vagina is dry, and she can’t have sex?!)

What I appreciate most is that Alloy treats sexual health as healthcare, not as something frivolous or embarrassing. They make great sex and expert doctor guidance accessible. Their approach centers on dignity, science, and individualized care because they believe women deserve comfort, pleasure, and fulfillment in their bodies at every age.

Alternatives to vaginal estrogen therapy:

This depends on the severity of symptoms, but may include a natural oil (like coconut or sunflower) as a lube, or other prescription medications. For some women, this may be all that is needed, but these options don’t treat the root cause (which is low or depleted estrogen). Anything other than estrogen is like putting ice on top of a cracked driveway.  It might be slippery, but it is still cracked at its foundation/surface. 

So, don’t be afraid to look into treatment options in general, and vaginal estrogen therapy specifically. You deserve to have whatever level of physical intimacy you want, without pain! And there’s nothing sexier than that.

I am a huge fan of Lindsey Vonn. Her talent, her drive, her willingness to come back from setbacks, and the discipline required to compete at the level she has for so long are inspiring. She is extraordinary. Full stop. 

And precisely because she is extraordinary, moments like the one that happened in Cortina at the Olympics last weekend matter beyond the individual athlete.

Here is the perspective that no one is talking about:

When a world-class athlete competes with a known significant injury, especially something as fundamental to knee stability as an ACL tear, the message absorbed by millions of young (and pro) athletes is simple and dangerous: push through, suck it up, toughness equals worth, pain is weakness, don’t sit out.

We have spent decades in sports medicine trying to undo precisely that mindset.

We teach kids, parents, coaches, and professionals that playing injured changes mechanics, delays healing, increases the chance of additional injury, and can put others at risk. We try to create cultures where reporting pain is seen as intelligent, not soft. Where recovery is part of training, not an interruption of it.

Then a superstar shows up and does the opposite, on the biggest possible stage.

I understand the counterarguments. Elite sport is not normal life. The Olympics are once every 4 years. Athletes assume risk. Comebacks are part of legacy. Competitive fire is real. I respect all of that.  I know that Alpine Skiers have very specific training teams, and that it is intrinsically a dangerous sport.

But inspiration cuts both ways.

A recreational skier, a high school soccer player, a weekend warrior watching from home, doesn’t see that nuance. They see: she did it, so I should too.

As a physician (and an avid sports fan), that makes me uneasy.

In medicine, we think in probabilities, not absolutes. When the margin for error is razor-thin, any impairment becomes relevant. Could the injury have contributed to the crash? We cannot know that with certainty, and in fact, Vonn herself said her torn ACL had nothing to do with her hooking her arm by getting too close to the gate. 

Ski racing is inherently dangerous. Catastrophic falls happen even to perfectly healthy athletes. It would be irresponsible to claim direct causation, and Vonn herself said her torn ACL had nothing to do with her arm hooking the gate, and her practice runs were actually putting her in medal contention (unbelievably)!

But it is also very fair to say that ligament instability can alter proprioception, reaction time, and confidence in micro-moments that matter at high speeds (100 mph). Compensation for her torn ACL could have been subconscious, and could have affected the way her arm went into that gate, hooking it at high speed, and causing a horrible crash that led to a complex fracture of her tibia (among other serious injuries). Even Vonn may not have been aware that her ACL may have contributed in some way to her body mechanics, etc. 

There’s another layer here, particularly for women over 50 watching this story unfold.

Part of high-level athletics, just like part of life, is knowing when the cost of continuing exceeds the benefit.
Retirement is not failure.
It is often wisdom. It is an acknowledgment that the body has carried you brilliantly and deserves protection. That doesn’t erase ambition or competitive identity. It reframes them.  

I worry that what looked like courage may also have been denial. I wonder what the conversations were like with her personal training team. What did her orthopedist and sports psychologist advise her? Did they have the courage to say what she didn’t want to hear (that she shouldn’t race with a torn ACL)? Either way, the world lauded her for her toughness and courage and ability to ‘push through pain’ and race. 

I am not an orthopedic surgeon, a certified athletic trainer, an Alpine skier, or any of HER professional team. But I do know anatomy and physiology. And I covered stories like hers for 18 years as a medical correspondent, so I am familiar with the layers of complexity that lie within. Also, this has nothing to do with sex discrimination, at least for me. I would be thinking the same thoughts if she were an NFL quarterback playing in the Super Bowl with a known TBI, or traumatic brain injury/concussion.

Multiple Truths

None of these theories or issues diminishes what she has achieved. Lindsey Vonn is generally considered to be the GOAT of skiing. Her resilience, spirit, and athleticism have inspired countless people, including me. She is a massive role model for recovering from setbacks, injury and ‘falling down.’ Her mantra is ‘chase your dreams,’ and I am FULLY behind that. And… I can hold admiration and concern simultaneously. One feeling or thought does not negate the other.

Why discuss this?

To start, it is a global sports/medical story. She was airlifted off the mountain, had emergency surgery (and will need more), and was placed in the ICU. Also, it’s a ‘women power’ story, which you know I love. Vonn is an incredible figure of resilience, ambition, dedication, fortitude, and stamina. She gave her all, and I admire that. But because she is a celebrity, her decisions will always be scrutinized and debated, and that’s fine – that is the norm in sports. As long as there is respect, I am all for it. 

Uphill From Here 

I wish Lindsey a smooth and complete recovery, physically and mentally. I am heartbroken for her dreams and her severely damaged leg.
I hope she is surrounded by people who support healing, and speak to her with respect, and also have the courage to tell her what she may not want to admit to herself. 

The message behind the spectacle.

Strength is not only the ability to endure pain or the ability to get back up after being knocked down. 

Sometimes strength is the ability to step back before something worse happens, and listen to the body saying no, even when the mind is saying yes.

Last week, I asked whether you feel comfortable taking nutrition advice from your GP, who is not a certified Nutritionist.

The results are in, and I was a little surprised, if I’m being honest. The minority of you replied “yes,” and almost half of you, (42%) replied “it depends.” I wonder what it depends on. So few doctors have ANY formal education or credentials in Nutrition.

Nutrition is foundational to long-term health, yet many people are left unsure who to trust or where to turn for practical guidance. That’s exactly the gap we aim to fill by offering delicious, genuinely nutritious recipes curated by me, even though I really hate to cook!  No guesswork, no extremes. Just food that’s evidence-based, good fuel for your body, and designed to support real life.

Subscribe to my paid newsletter, Off Duty, where I step away from the doctor’s desk and television sets and share the info from my real life that nobody else has access to. Join now for $7/month, or send it as a gift to your Gal-entine!

Did you enjoy Today’s Ajenda? It would mean the world if you left us a testimonial!

ABOUT DR. JEN

In her former roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—”Dr. Jen”—has shared the latest health news and information with millions of viewers nationwide. As an OB-GYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She has authored several books, including the national best-seller, The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…

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^{This material is provided solely for informational purposes and is not providing or undertaking to provide any medical, nutritional, behavioral or other advice or recommendation in or by virtue of this material.  This newsletter is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this newsletter or materials linked from this newsletter is at the user’s own risk. The content of this newsletter is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.}