Why Doctors Can't Fix Women in 2026

Dave Asprey

Apr 9, 2026

Episode description

Most women are suffering for years from anxiety, gut problems, low libido, and brain fog because no one is treating the real cause: their hormones. This episode is a masterclass in women's hormone optimization, covering everything from vaginal delivery of bioidentical hormones to why low estrogen destroys your gut, your sex drive, your mitochondria, and your marriage.

Watch this episode on YouTube for the full video experience: https://www.youtube.com/@DaveAspreyBPR

Host Dave Asprey sits down with Dr. Sarah Daccarett, MD, a physician, longevity expert, and the founder and CEO of Inner Balance, a modern women's health company redefining hormone therapy, sexual wellness, and aging. She has treated tens of thousands of women across all 50 states and is known for challenging outdated medical models and building science-driven solutions that reflect female biology rather than borrowing protocols designed for men. She created Oestra, a revolutionary hormone therapy delivery system, along with Libida, an on-demand libido solution that targets desire at the brain level, making her one of the most credible and innovative voices in functional medicine and women's longevity today.

Together, they expose why conventional medicine has failed women for decades, why patches and pills are nearly useless, and what actually works for anti-aging, metabolism, longevity, and human performance. Dr. Sarah makes the case that hormone replacement therapy is not a last resort for menopausal women. It is a foundational longevity strategy that every woman should consider starting in her 20s.

You'll Learn:

Why vaginal hormone delivery outperforms every other delivery method for women
How low estrogen destroys your gut lining, gallbladder, and immune system long before menopause symptoms appear
Why a carnivore or animal-based diet raises estrogen and why fiber lowers it
How progesterone converts to testosterone in women, and why you may not need a testosterone prescription
The real reason SSRIs get prescribed when hormone replacement therapy should come first
Why iodine is essential for breast health, estrogen metabolism, and thyroid function
How oxalates from "superfoods" like matcha, spinach, and almonds accumulate in your ovaries, uterus, and kidneys
Why both partners need hormone replacement therapy for a relationship to thrive
How hormones control mitochondria, dopamine, norepinephrine, and every system in your body

Thank you to our sponsors!

- Qualia | If you want to take the guesswork out of maintaining high NAD+ levels as you age, go to www.qualialife.com/daveNAD to

Mindsip insights from this episode:

Utilize vaginal progesterone to normalize testosterone levels

Giving a woman enough vaginal progesterone can naturally raise her testosterone to a normal range through bodily conversion, often eliminating the need for direct testosterone supplementation.

#progesterone

#testosterone

Apply scream cream for enhanced sensation and blood flow

Applying a small amount of testosterone cream, known as "scream cream," around the clitoris and labia can create immense blood flow and sensation for recreational use.

#protocol

#testosterone

Utilize vaginal hormone delivery for superior systemic effects

Vaginal delivery of estrogen and progesterone is superior for systemic effects as it's porous, bypasses the liver, and allows for first-pass metabolism through the uterus.

#estrogen

#progesterone

Recognize early signs of hormone loss to address issues promptly

In younger women, the first signs of low hormones are often anxiety, irritability, and gut issues, while hot flashes indicate you've waited about a decade too long.

#hormones

Synchronize hormone therapy in couples to balance libido and energy

If one partner in a relationship starts hormone replacement therapy, the other partner should as well to prevent a mismatch in libido and life force energy.

#HRT

#relationships

Fill hormone receptors with bioidentical hormones to resist toxins

Keeping your hormone receptors full of bioidentical hormones can make you more resilient against environmental chemicals, as it prevents toxins from binding to open receptors.

#hormones

#toxin

Supplement iodine to support estrogen metabolism and fibrocystic breast health

Iodine is essential for metabolizing estrogen in the breasts and uterus, and supplementing with at least 2000 mcg daily can help with fibrocystic breast disease.

#estrogen

#supplement

Address low sex hormones to combat leaky gut

The primary cause of leaky gut is often low sex hormones, which are needed to produce mucin and maintain tight gap junctions in the gut lining.

#hormones

#leaky-gut

Balance fiber intake to manage estrogen levels and constipation

Diets with excessive fiber (over 30 grams a day) can lower a woman's estrogen levels and contribute to constipation, which is often better addressed with estrogen replacement.