Alejandra Borensztein MD

There are two sets of rules here: the medical guidelines for who qualifies for weight loss treatment, and what your insurance company will actually approve. They’re not always the same thing.

I know so many of you feel frustrated. Abandoned by a system that’s supposed to help you. By doctors who don’t listen, or who refuse to even consider trying something new.

I get it. I really do.

But here’s the thing — that doesn’t mean alternative providers have it all figured out either.

I see so many patients who come to me with extensive lab testing that ends up being mostly unhelpful. Or on complicated, expensive treatment plans that were never optimized for them as an individual — and sometimes, honestly, not even safe.

We need to do better. We need to listen to our patients and build individualized care plans that actually fit their lives.

But we can’t disregard the extensive data we have pointing to what treatments actually work — and what doesn’t.

The best care isn’t “more testing” or “more alternative treatments.” It’s not “just follow the guidelines” either.

It’s somewhere in the middle: use the evidence we have, but never forget the person in front of you.

Progesterone side effects are one of the most common reasons women give up on hormone therapy — but a bad first try doesn’t mean it’s not for you. It usually means the dose, timing, or delivery method needs to change.

Here’s what we actually adjust in practice:

💊 Dose & timing — Lowering the dose or shifting it to bedtime (since the sedating effect is often the point, not the problem) can resolve grogginess without dropping progesterone altogether.

🩹 Vaginal suppositories — Oral progesterone is processed through your liver first, which drives a lot of the sedation and mood effects. A vaginal route bypasses that first pass, often meaning the same uterine protection with fewer systemic side effects.

🔬 Synthetic progestins — Not every body responds better to “body-identical” progesterone. Some women actually do better on a synthetic progestin — it’s not about which one is “more natural,” it’s about which one your body tolerates.

🌀 Progesterone IUD — A levonorgestrel IUD delivers progestin locally to protect the uterine lining, with minimal systemic absorption. This is an off-label use for hormone therapy, but it’s an option more women should know exists — especially if mood or bloating derailed oral progesterone.

🌿 Duavee — For women who can’t tolerate progesterone in any form, pairing estrogen with a SERM (instead of a progestin) protects the uterus through a completely different mechanism — no progesterone required.

The point isn’t that one of these is “the best” option. It’s that hormone therapy isn’t one-size-fits-all, and a rough first experience is data, not a dead end.

If progesterone didn’t work for you the first time, tell me what happened in the comments — I read every one, and it might be exactly what someone else needs to hear today.

Progesterone side effects are common — but most are fixable, not something you just have to push through. Part 2 coming with the fixes.

The hormone no one’s talking about in perimenopause? PROGESTERONE. 👇

Everyone focuses on estrogen — but progesterone is often the FIRST hormone to drop, sometimes starting in your late 30s. And when it does, it takes your mood, sleep, and mental clarity with it.

Here’s why:

🧠 Progesterone converts into allopregnanolone — a molecule that calms your brain through GABA receptors. Less progesterone = more anxiety, irritability, and emotional overwhelm.

😴 Progesterone has a natural sedative effect. When it drops, hello 3 AM wake-ups and racing thoughts.

🌫️ The hormonal chaos of perimenopause drives real, measurable changes in brain structure and function. Brain fog isn’t “just stress” — it’s neurobiological.

If you’re in your late 30s or 40s and your labs look “normal” but you feel anything BUT normal — ask your doctor about luteal phase progesterone levels.

You’re not losing it. Your brain chemistry is shifting. And understanding that is the first step to getting back to yourself. 💛

Save this for someone who needs to hear it 🔖

For years I thought a workout only counted if it wrecked me. Gym sessions, runs — always maximum effort. Half the time I dreaded even starting.

Then I started training at home and let go of the idea that intensity was the only thing that mattered. Strength training. Dance cardio. Sculpt. HIIT. Even a rebounder (yes, a mini trampoline — don’t knock it until you try it).

Some of these workouts are less intense than what I used to do. But I actually look forward to them. And that’s the part nobody tells you: consistency beats intensity, every time.

At 44, I’m stronger than I was in my 20s — not because I found the “hardest” workout, but because I finally found ones I’ll actually keep showing up for.

If you’re stuck in the all-or-nothing gym mindset, consider this your permission slip to try something different. What’s a workout you didn’t expect to love? Tell me below 👇

You didn’t fail your diet. Your diet failed you.

Rigid rules + banned foods + shame spirals = a plan that was never built to last. Add a stressful, busy, exhausted-by-6pm life on top of it, and it’s not a willpower problem — it’s a design problem.

And when you do lose weight, your body fights back by turning up hunger hormones like ghrelin. That’s biology, not weakness.

This is why I believe in weight loss medicine — as a tool that works with your body, not against it. You’re working hard. It’s okay to need help. 💛

Retatrutide showed up to 24% weight loss in trials — more than Ozempic or Mounjaro. But it’s NOT approved yet, and buying unregulated peptides online is genuinely dangerous (contamination with arsenic and lead has been documented). The science is exciting. The shortcut isn’t worth it.

What if one injection could crush your appetite AND burn fat directly in your liver? That’s survodutide. 💉

It’s a dual agonist — one molecule that activates TWO receptors:

✅ GLP-1 receptor → suppresses appetite, lowers blood sugar (same target as Ozempic)

✅ Glucagon receptor → fires up your metabolism and torches liver fat 🔥

The SYNCHRONIZE trial was just published in the New England Journal of Medicine. Here’s what happened:

📊 725 adults with obesity

📊 Once-weekly injection for 76 weeks

📊 Result: 16.6% body weight loss vs. 3.2% with placebo

📊 ~50% of participants lost 15% or more of their body weight

But here’s what makes survodutide DIFFERENT from every other weight loss drug out there 👇

In a separate trial (SYNCHRONIZE-MASLD), 84% of patients hit a meaningful reduction in liver fat — vs. just 24% on placebo. And the higher dose burned MORE liver fat than the lower dose even though weight loss was similar. That means glucagon is doing something to the liver BEYOND just weight loss. It’s directly switching on fat-burning pathways in liver cells. 🧬

Side effects? Mostly GI — nausea, diarrhea, vomiting — similar to other GLP-1 drugs but a bit more common. Not yet approved — still in phase 3 trials.

This is the glucagon paradox in action. The hormone that raises blood sugar is now being weaponized against obesity AND fatty liver disease.

Save this 📌 Follow for Part 3 — retatrutide, the TRIPLE agonist that hit 24% weight loss 🤯

The hormone that raises your blood sugar is now being used to help people lose weight. Sounds impossible, right? 🤯

Glucagon has always been known as insulin’s opposite — it tells your liver to dump sugar into your blood. But scientists discovered it does SO much more:

🔥 Boosts your resting metabolism by ~15%

🧠 Sends “stop eating” signals to your brain

🫁 Burns fat directly in your liver

The problem? Give glucagon alone and blood sugar spikes. The solution? Combine it with GLP-1 — the same hormone behind semaglutide — into one molecule.

The result: more weight loss than either hormone alone, PLUS liver fat reduction that goes beyond what weight loss can explain.

Drugs like survodutide and retatrutide are in late-stage clinical trials right now using this exact strategy. Retatrutide — a TRIPLE agonist — has already shown 24% body weight loss in trials. 🤯

The future of weight loss isn’t just about eating less. It’s about burning more.

Save this for later. Share it with someone who loves science. And follow for Part 2 — the survodutide deep dive 💊