GLP-1 medications like semaglutide and tirzepatide have reshaped the way we approach women’s metabolic health. For many of my patients, especially those navigating perimenopause and menopause, these medications have been nothing short of life-changing. Women who have spent years feeling stuck — exhausted, inflamed, gaining weight without explanation, and disconnected from their bodies — are suddenly able to access their health again.
But with every new medical breakthrough comes an avalanche of misinformation. And one of the most common fears I hear is the alarming claim that these medications “cause blindness.” Before we address what is actually happening, it’s important to understand why these medications matter in the first place and why they are so transformative for women in midlife.
What most people think of as “menopausal weight gain” is actually a dramatic shift in metabolic biology. As estrogen declines, insulin resistance increases, cortisol spikes more easily, muscle mass drops, and the body begins storing fat differently — specifically as visceral fat.
Visceral fat is the deep fat wrapped around the organs. It is metabolically active and strongly associated with heart disease, stroke, dementia, fatty liver, chronic inflammation, and accelerated aging. It is not the fat you can pinch on your hips or thighs. It is the dangerous internal fat that quietly drives disease.
GLP-1 medications directly reduce visceral fat, which is something diet and exercise alone often cannot achieve in this stage of life. When visceral fat decreases, women experience improvements in energy, mobility, sleep, mood, cardiovascular health, and overall vitality. This is why I consider these medications longevity tools, not cosmetic interventions.
The eye-related headlines circulating online have caused unnecessary fear. The reality is far more straightforward and far less dramatic:
These medications do not cause blindness.
The rare cases mentioned in the media involved individuals with advanced diabetic eye disease whose blood sugar improved too rapidly. This is a known physiological response that can occur with any fast glucose correction — including insulin. It is not specific to GLP-1 medications and does not occur in individuals without diabetic retinopathy.
In a properly screened, monitored patient, this is not a meaningful risk. The actual danger for most midlife women is not these medications — it is unchecked insulin resistance, persistent visceral fat, and chronic inflammation.
The only consistent challenge I see with GLP-1 medications is that they reduce appetite so effectively that many women unintentionally undereat. If protein intake drops too low, or if a woman isn’t doing strength training, the body will break down muscle along with fat.
Losing muscle is one of the fastest paths to worsened metabolism, weaker bones, slower recovery, decreased hormone stability, and reduced longevity.
This is why in my practice, no one takes a GLP-1 medication without a plan for:
Adequate daily protein
Regular strength training
Supportive micronutrients
Monitoring for muscle mass, not just weight
Protecting muscle is the key to protecting long-term health.
Women feel best when fat comes off but strength remains.
GLP-1 medications work best when a woman’s hormones are in harmony. Estrogen, progesterone, and testosterone play enormous roles in:
Insulin sensitivity
Muscle preservation
Sleep quality
Metabolism
Mood
Motivation and energy
When hormone therapy is paired with GLP-1 treatment, the results are smoother, safer, and more sustainable. Many of my patients describe it as finally getting their body back after years of struggling against biology.
Supplements are not “extras” in this process. They support the metabolic and hormonal pathways that are shifting. Many women benefit from magnesium for stress and sleep, omega-3s for inflammation, creatine for muscle and cognitive support, vitamin D with K2 for bone health, and B vitamins for energy and neurotransmitter support. These tools help stabilize the system while fat and inflammation decrease.
GLP-1 medications are not shortcuts. They are a scientific, medically supervised way to reduce the dangerous visceral fat that accumulates with hormonal aging. When used carefully, with proper dosing, hormone support, muscle preservation, and targeted supplements, they can dramatically improve a woman’s long-term health and quality of life.
The goal is not to shrink women. The goal is to help them feel strong, healthy, and fully themselves again — with a body that supports them well into their later decades.
Used intelligently, these medications change far more than weight. They change lives.
For 24 years, I’ve cared for women through every stage of hormonal change — puberty, pregnancy, postpartum, perimenopause, menopause, surgical menopause, thyroid issues, adrenal fatigue, PCOS, and the metabolic shifts that come with each of these phases. One thing becomes very clear when you do this work long enough:
When a woman’s hormones are balanced, she feels like herself again.
When they’re not, every part of life becomes heavier.
This is why bioidentical hormone therapy has been one of the most important tools in my practice. Not as a trend, not as “alternative medicine,” but as real, physiological restoration that supports a woman’s brain, heart, bones, metabolism, mood, and long-term health.
Bioidentical hormones are structurally identical to the hormones a woman’s body makes naturally. Because of this, the body recognizes them. The receptors respond predictably. The metabolism processes them the way it was built to.
We aren’t overriding the body — we’re replenishing what’s missing.
And this matters because estrogen, progesterone, and testosterone regulate every single cell in the body.
Your brain, heart, bones, muscles, skin, immune system, gut, and metabolic pathways all have hormone receptors. This is why hormonal changes affect everything from sleep and mood to weight, memory, libido, and energy.
I say this to every patient:
Your hormones are unique to you — your treatment should be too.
In my own family, all three of my sisters are on hormone therapy, but each one is on a completely different regimen because their needs are different. Their biomarkers, symptoms, goals, and medical histories are not the same.
This is why personalized dosing matters. Route of administration matters. Timing matters. Monitoring matters.
Proper bioidentical hormone therapy is customized, thoughtful, and medically supervised. It is not a generic protocol pulled off a template.
The benefits are consistent and meaningful:
Starting estrogen at the right time reduces the risk of Alzheimer’s and cognitive decline by around 40%. Women often describe feeling clear and sharp again after years of foggy thinking.
When started in the first decade of menopause, hormone therapy can lower heart disease risk by up to 50%. It improves cholesterol, reduces inflammation, and stabilizes insulin sensitivity.
Hormones slow the rapid bone loss that happens in early menopause and help maintain muscle mass, balance, and strength — all crucial for healthy aging.
Better sleep. More stable mood. Stronger libido. Easier weight regulation. More consistent energy. These improvements are not cosmetic — they impact daily life.
Hormones do the foundational work, but supplements can make the transition smoother and strengthen overall health. In my practice, I use targeted supplements that support inflammation, metabolic health, detox pathways, brain function, and adrenal balance.
These aren’t random add-ons — they are strategic tools that enhance the benefits of hormone therapy and support stability over time.
I don’t recommend anything I wouldn’t support for my own family.
My mother stayed on hormone therapy when most women her age were told to stop, and today she has the heart, brain, and bone benefits to show for it.
My sister @farinamersi, one of the leading breast cancer surgeons in the country, also uses hormone therapy herself.
All three of my sisters are on personalized regimens.
Even my dog is on compounded thyroid hormones — because hormones matter at every level of physiology.
For far too long, women were told their symptoms were “normal,” “just aging,” or “something to push through.” Many were made to believe hormone therapy was dangerous, when the data simply didn’t support that.
Women deserve real information.
Women deserve individualized care.
Women deserve to feel strong, clear, vibrant, and fully themselves — at every age.
In my practice, bioidentical hormone therapy is approached with:
Precision
Safety
Ongoing monitoring
Deep personal attention
Targeted supplements
A long-term view of healthspan and longevity
When done correctly, bioidentical hormones remain the most effective and life-changing treatment I offer women who want to protect their long-term health and reclaim their quality of life.
Women do not need to settle for feeling exhausted, foggy, irritable, disconnected, or “not themselves.”
Hormones matter — and restoring them thoughtfully changes everything.
