Friday Q&A: recurrent respiratory illness; hair loss after HRT; measuring blood estrogen levels; & weighted vests

Plus - join me & Emily Oster LIVE TODAY to discuss the USDA's new food pyramid 🥕🥗

Newsflash: Join me & Emily Oster LIVE TODAY at 4:30 pm ET to discuss THE NEW USDA FOOD PYRAMID: WACKY OR WELL DONE? Click HERE to join us. My opinion piece for The Free Press about the subject is here. Emily’s for the NYT is here.

ICYMI 👉

• Is Dry January Just Kicking the Can Down the Road?

• Why Is Everyone Sick Right Now?

• The Food Group You May Be Missing

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In this week’s reader-submitted Q&A, we’re tackling these questions:

• Why am I constantly sick with respiratory viruses and colds?

• Why am I losing hair after starting HRT?

• How do I know my estrogen patch is protecting my bones?

• Does a 5-pound weighted vest actually help?

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📣 Click here to send me your questions for future Q&As! ✍️

Photo by Kelly Sikkema on Unsplash

The following questions have been lightly edited for length and clarity.

QUESTION #1: PERSISTENT ILLNESS

Hi Dr. McBride, I’m constantly sick with colds and flu. For the last 2 years I’ve probably spent at least half my days sick with something. I think it probably has to do with having a young kid at home - he brings home germs from school. I do all the healthy things, like eat nutritious meals, get enough sleep and exercise, etc. But I feel like I’m in a vicious cycle where I’m too sick and tired to take care of myself well. I have missed a lot of work. I don’t know what to do. I just want to feel healthy. Any advice?

- Paige

Dear Paige,

So sorry to hear! Being constantly is indeed exhausting and demoralizing. And while having a young child at home is probably part of it, your pattern suggests something more is going on. Most adults with school-age kids get more colds than they used to, but spending half your days sick for two years is not normal.

First thing first: see your doctor to make sure you’ve actually ruled out other explanations for recurrent respiratory symptoms. Common causes include

• allergic stimulation of your sinuses and respiratory tract (from things like pet dander and dust to mold and certain foods)

• asthma (or it’s milder cousin called “reactive airways”) or

• gastroesophageal reflux, causing post-nasal drip and cough

Not only do these three underlying conditions predispose people to viral infections, they also can mimic infection, even without one. In other words, it’s worth getting evaluated to make sure you’re not treating the wrong problem!

Second, if you’re genuinely getting frequent viral infections, that raises the question of whether your immune system is compromised. Are you on any medications that suppress immunity? Do you have an underlying condition like diabetes or autoimmune disease? Are you extremely stressed, sleep-deprived, or dealing with poor nutrition despite trying? All of these can weaken your immune response. Ask your doctor about basic immune function testing—checking your white blood cell count, immunoglobulin levels, and screening for conditions that affect immunity.

Third, the vicious cycle you describe is real. When you’re sick, exercise and sleep suffers, stress increases, and your immune system gets weaker, making you more susceptible to the next virus. Breaking this cycle requires aggressive basics: prioritize sleep above almost everything else, even if it means letting other things slide (read my article on getting better sleep here); make sure you’re eating enough protein and calories to support your immune system; consider whether you’re over-exercising when you’re run down, which can further suppress immunity; and manage stress however you can, because chronic stress absolutely affects immune function.

A few other tips: Wash hands frequently. Keep your child home when they’re clearly sick to reduce the constant viral exposure. Get the vaccines you need. If basic strategies aren’t helping and your doctor hasn’t found an underlying issue, ask for a referral to an immunologist. You deserve answers. I hope you find some relief soon!

QUESTION #2: HAIR LOSS AFTER HRT

Dr. McBride, I started losing my hair AFTER starting HRT. I heard it is supposed to HELP!!! Is that normal? and also, what options do I have other than hair thinning shampoos?

-Geena

Hi Geena,

Hair loss after starting HRT is actually not uncommon, though it’s counterintuitive since low estrogen during menopause often causes hair thinning, and you’d expect HRT to help. Several things could be happening: the type of progestin in your HRT formulation might have “androgenic” (i.e., male-hormone-like) effects that can trigger hair loss, your body might be adjusting to the hormone changes and experiencing temporary shedding (which can happen with any significant hormonal shift), or the HRT might be unmasking an underlying issue like thyroid dysfunction or iron deficiency that was already affecting your hair.

First, talk to your doctor about your HRT formulation. If you’re on a combination therapy with a progestin, some progestins are more androgenic than others and more likely to cause hair loss. Switching to a different progestin or adjusting your dose might help. Also, make sure your thyroid function and iron levels (particularly ferritin) are checked—both are common causes of hair loss in women, and starting HRT doesn’t protect you from those issues.

Beyond adjusting your HRT, other options include minoxidil (Rogaine), which can promote hair regrowth and is safe to use with HRT, spironolactone, an anti-androgen medication that can help if your hair loss is related to androgens, and ensuring you’re getting adequate protein, iron, and biotin in your diet (though biotin supplements are oversold and rarely make a dramatic difference).

Be patient—hair grows slowly, so even if you make changes now, it can take 3-6 months to see improvement. Also, keep in mind that some hair shedding is normal (we lose 50-100 hairs a day), and what feels like dramatic hair loss might be within normal range, especially if you’re noticing it more because you’re worried.

If the hair loss continues or worsens despite addressing these factors, consider seeing a dermatologist who specializes in hair loss. They can do a scalp examination and potentially a biopsy to figure out what’s going on and recommend more targeted treatments. Wishing you a fuller head of hair on the horizon!

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QUESTION #3: MEASURING ESTROGEN LEVELS

I have osteopenia. How do I know my estrogen patch is protecting my bones when estradiol levels are not monitored by my primary care? I did self order tests from Sonora Quest a couple times and compared levels before and after starting the estrogen patch. They have gone up, but I don’t know what level they should be at.

-Audrey

Dear Audrey,

This is a great question, and I understand why you’re concerned about whether your patch is actually protecting your bones. Here’s the reality: estrogen does protect bones by slowing bone loss and helping maintain bone density, but monitoring estrogen (i.e., “estradiol”) levels isn’t standard practice (or even necessary!) for confirming bone protection.

The research shows that systemic estrogen therapy (like your patch) reduces fracture risk and slows bone loss in postmenopausal women, but those benefits don’t depend on hitting a specific blood level. If you’re on an adequate dose that relieves your symptoms, that’s usually sufficient for bone protection too. The fact that your self-ordered tests show your levels have gone up is reassuring—it means the patch is delivering estrogen and your body is absorbing it—but you don’t need to chase a particular number.

Most doctors don’t routinely monitor estradiol levels because the levels fluctuate and don’t correlate perfectly with tissue-level effects. What matters more for bone health is directly measuring your bone density over time with DEXA scans, typically every 1-2 years for someone with osteopenia. That’s the gold standard for knowing whether your current treatment is actually protecting your bones.

A DEXA scan will show whether your bone density is stable, improving, or declining, which tells you directly if your HRT (along with weight-bearing exercise, adequate calcium and vitamin D, and other factors) is working. If your DEXA scans show stable or improving bone density, your patch is doing its job.

That said, checking estradiol levels occasionally can help confirm your dose is appropriate. If your doctor isn't ordering regular DEXA scans or discussing your bone health plan, that's worth bringing up. You deserve a clear strategy for managing osteopenia, not just a “slap-on-a-estrogen-patch-and-hope-for-the best” kinda plan. I hope this makes sense!

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QUESTION #4: WEIGHTED VESTS

Thank you so much for providing such clear, thoughtful and balanced advice. I always look forward to reading your newsletter. I am a relatively fit 61 year old woman and recently purchased a (light) weighted vest. Although it is only five pounds, I enjoy wearing it and it seems to make my daily 4 mile walks a bit more strenuous. I am trying to add more weight bearing exercise to my routine and this seemed like a good first step. Am I kidding myself in thinking such light weight can make a difference?

-Sally

Hello Sally,

Thank you for your kind words! It’s funny: this topic has become kind of a lightning rod for some odd reason. (Just ask my friend Dr. Mary Claire Haver, MD whose advice to wear a weighted vest has been unfairly poo-pooed in my opinion!). But here's the deal: wearing a weighted vest during your walks absolutely can make a difference in your bone health, even at just five pounds. To what DEGREE will it help? Who knows. But we know that adding weight to weight-bearing activities like walking increases the load on your bones and muscles, which is exactly what you need to maintain bone density and muscle strength as you age.

The benefit isn’t just about the amount of weight—it’s about the fact that you’re adding resistance to an activity you’re already doing consistently. That extra load signals your bones to maintain or build density and challenges your muscles more than walking without it. Studies show that even modest increases in load during weight-bearing exercise can improve bone health, especially in postmenopausal women who are at higher risk for osteoporosis.

Starting with five pounds is smart—it lets your body adapt without risking injury. As it gets easier, you can gradually add more weight. Many people work up to 10-15 pounds or more, depending on their fitness level and goals. Just make sure the vest fits well and doesn’t strain your neck, shoulders, or back.

That said, weighted walking is a great addition to your routine, but it shouldn’t be your only form of strength training. To really protect your bones and maintain muscle mass, you’ll also want to incorporate resistance training—using weights, resistance bands, or bodyweight exercises that target major muscle groups. (See more ideas for types of resistance training you can do here!) But as a first step and a way to make your daily walks more effective? You’re doing the right thing. Keep going!

Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.

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ICYMI, check out my recent Q&As on:

• Ozempic and alcohol; when to stop HRT; too much protein?; & what supplements to take

• Post-holiday detox; peripheral neuropathy; HRT for hip pain; & leaky gut syndrome

• Heart rate variability; testosterone therapy for men; zinc for colds; & optimizing for longevity