Research is always evolving.
But every so often, the evidence begins to converge - across disciplines, populations, and outcomes.
2025 was one of those moments.
Across hormone health, metabolism, movement, and longevity, several themes continued to surface consistently in the research. These were not trends or quick fixes. They were foundational principles that align closely with what we see clinically every day.
These are the insights we’re carrying forward - and the principles that guide how we practice at Shine.
Estrogen Therapy Requires Education - Not Fear or Guesswork
For many years, estrogen therapy carried a black box warning that understandably shaped both patient perception and medical training. As a result, many clinicians received limited education on how to prescribe hormone therapy thoughtfully as the science evolved.
Long-term follow-up data from randomized trials, including the Women’s Health Initiative, have clarified something essential: the effects of estrogen therapy are highly dependent on timing, formulation, dosing, and individual context.
When initiated closer to menopause and prescribed appropriately, estrogen therapy has been associated with improvements in bone health, favorable cardiovascular markers, and quality of life. In contrast, outcomes can differ when therapy is started later in life or without appropriate patient selection.
Importantly, the science has evolved faster than medical education, so despite the black box removal, we still have many practitioners that are not trained to properly prescribe and manage hormone replacement therapy. This helps explain why experiences with hormone therapy vary so widely - and why many women feel confused or under-supported when navigating these decisions.
Our Clinical Perspective:
Estrogen therapy is neither something to avoid categorically nor something to approach casually. Outcomes depend far more on how and when it is used than on the hormone itself. Finding a clinician trained in proper timing, dosing, and monitoring is critical to achieving optimal outcomes while minimizing risk.
Muscle Is a Metabolic Organ - Not Just a Strength Metric
Loss of muscle mass and strength is often framed as a mobility issue. In reality, it is deeply metabolic.
Large population studies consistently show that lower muscle mass and lower muscle strength - including grip strength - are associated with higher all-cause mortality, insulin resistance, and cardiometabolic risk, independent of body weight or BMI. Grip strength, in particular, has emerged as a simple but powerful marker of overall health and long-term survival.
Skeletal muscle plays a central role in glucose disposal, insulin sensitivity, inflammatory regulation, and long-term functional independence. As we move through midlife and hormonal transitions, muscle loss accelerates unless it is intentionally supported.
This helps explain why metabolic health often feels more fragile with age, even when weight remains stable.
Our Clinical Perspective:
Strength training isn’t about aesthetics or intensity. It is one of the most effective tools we have to preserve metabolic capacity and long-term resilience. Supporting muscle is foundational to healthy aging. This is a key reason that each of our patients receive an InBody scan so that we can quantify and track gains and losses in muscle mass.
Alcohol Is a Metabolic Stressor — With Important Sex-Specific Considerations
From a physiological standpoint, alcohol is not a neutral substance.
Large-scale analyses show that alcohol-related risk follows a dose–response relationship across populations, with higher intake associated with increased all-cause mortality and cancer risk. These effects are seen in both men and women.
That said, biological differences matter. Women tend to experience adverse effects at lower levels of intake due to differences in alcohol metabolism, body composition, and hormonal physiology. Alcohol places additional strain on the liver, interferes with glucose regulation, and contributes to systemic inflammation - processes that are relevant for everyone, but can be amplified in women, particularly during hormonal transitions.
Our Clinical Perspective:
Alcohol is not required for health. From a metabolic and longevity standpoint, lower intake is consistently associated with lower risk for both men and women. Many people notice meaningful improvements in sleep, energy, and recovery when alcohol is used less frequently or more intentionally.
Daily Movement Matters More Than Perfect Workouts
Daily movement remains one of the most consistently supported behaviors for long-term health.
Prospective cohort studies show a strong inverse relationship between daily step count and all-cause mortality, with meaningful benefit occurring well below the commonly cited 10,000-step target. Mortality risk reduction appears to plateau around 7,500–8,500 steps per day.
Physiologically, movement distributed throughout the day supports glucose regulation, cardiovascular health, nervous system balance, and metabolic resilience - benefits that cannot be fully replicated by long periods of sitting followed by a single workout.
Our Clinical Perspective:
Movement does not need to be complicated. Short “movement snacks” - walking, standing breaks, or brief body-weight movements - add up over time and meaningfully support long-term health, whether or not a formal workout happens.
Aerobic Capacity Is One of the Strongest Predictors of Longevity
Cardiorespiratory fitness - often measured as VO₂ max or exercise capacity - has emerged as one of the most powerful predictors of long-term survival.
Large cohort studies show that individuals with low aerobic capacity have a significantly higher risk of all-cause mortality, even after accounting for traditional risk factors such as smoking, hypertension, and diabetes. In contrast, higher aerobic capacity is strongly protective.
What makes aerobic capacity so meaningful is that it reflects how well multiple systems function together — the heart, lungs, blood vessels, and mitochondria. It is a true systems-level marker of health.
How aerobic capacity improves
Aerobic capacity improves through:
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regular lower-intensity aerobic work
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periodic higher-intensity efforts
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adequate recovery, fueling, and sleep
Precision matters. Guesswork often leads to under-training or burnout.
How aerobic capacity is measured
VO₂ max testing provides direct insight into aerobic capacity. Metabolic testing allows us to identify true training zones and understand how efficiently the body uses oxygen - replacing estimates with real data.
Tools like PNOĒ allow us to assess both resting and active metabolism, making it possible to guide training in a way that improves fitness efficiently and sustainably.
Our Clinical Perspective:
Aerobic capacity is one of the most impactful levers for longevity - and it is highly trainable when guided by accurate metabolic data and individualized programming. This is why almost every one of our packages include a PNOE analysis so that we can measure a patient's aerobic capacity and provide personalized plans to help improve these markers.
The Bigger Picture
None of these insights call for extremes.
They point us back to thoughtful, individualized care - guided by evidence, informed by physiology, and applied sustainably.
That is the lens through which we practice at Shine.
Want Support Applying This to Your Own Health?
The science is clear - but applying it well requires context, personalization, and the right data.
If you’re navigating hormone changes, metabolic concerns, or questions about how movement, strength, or aerobic capacity fit into your long-term health, our team can help you make sense of what matters most for you.
You can schedule a complimentary discovery call to learn more about working with Shine and whether our approach is a good fit.
References
Estrogen Therapy & Timing
Muscle Mass, Strength & Longevity
Alcohol & Women’s Health
Daily Movement & Mortality
Aerobic Capacity & Longevity