Sara Szal MD
I had a dream a few days ago that is still with me. I was on a party bus with a group of women. We were running errands that mattered to everyone but me: skincare, small tasks, a strange small creature someone had put into my arms to look after. I kept trying to get home. The bus was too slow, and it never headed toward my house.
I woke up understanding the dream as a snapshot of how culture hands women vehicles that are never built to take them home. Follow the group, look young, be optimized, wait your turn. But if you stop believing that the body is a project to improve before you’re allowed to come home, you change which biomarkers you want to check.
You start to care more about sacred biomarkers that measure liberation.
I’ve been running lab panels on women for decades. I care about ApoB, estradiol, FSH, fasting insulin, DEXA, ferritin, hs-CRP, and VO2 max.
Yes, those biomarkers matter, but they don’t tell the whole story.
A woman can have an optimal blood panel and still be trapped in a life that doesn’t belong to her.
That got me thinking about a new framework that goes beyond biological age or how her organs are functioning.
It asks: Is she fully alive inside the biology we are measuring?
I call these the sacred biomarkers of female aliveness.
Can she stop saying yes before the burnout and without needing to over-explain?
A woman’s no is how her body states: this is where I end and the world begins.
When a woman has difficulty saying no, the body will say it for her, through fatigue, sleep disruption, resentment, cravings, pain, loss of desire, and autoimmunity.
Now I think of no as a functional biomarker, similar to how we measure intestinal permeability (leaky gut). Can she leave a meeting when her body says enough? Decline a business trip when she is depleted? Stop eating when full?
What did my body already say no to that my mind hasn’t yet honored?
The whole-body yes (WBY) is something I learned from my executive coach, Diana Chapman, via Katie Hendricks, PhD. WBY is a state of total alignment where mind, heart, gut (and I’d add, vulva) all agree on a decision. If anything less than all agree, it counts as a no.
WBY does not require you to perform or betray yourself in order to move forward.
Before I say yes now, I ask: Do I want the schedule that this yes will create, or only the ambition and identity that it gives me?
Aliveness is the capacity to come back. It’s not the discipline of never leaving.
Can she return after conflict? Poor sleep? After the relationship pulls her away from herself?
Heartrate variability (HRV) matters here as a clue.
The deeper question: what reliably returns me? Food, water, sunlight, movement, breath, solitude, touch? A smaller day?
True resilience looks like return more than toughness.
Living the first three biomarkers is important work. The next nine ask something harder. They want you to do the math that most women never get the time to do.
When you’re already carrying unseen labor, a career, aging parents, maybe children or a marriage, and then you get handed more to do, we need to be wary. Get your HRV up, track your glucose, train for strength, check your DEXA. Watch your toxins, fasting window, alcohol, and sauna minutes.
Each may make sense alone, but the totality can become another unpaid job. The longevity hacks can take over in such a way that it affects the HRV and cortisol that I already have you tracking. The cost can compound until the woman doing everything right no longer feels alive to her own unfolding.
What I was taught in my medical training: Be comprehensive, always, and give it everything you have. Rest is what you do after all the work is completed, if there’s anything left of you by then.
What I know now: I confused depletion for discipline for decades, and it cost me.
I no longer recommend a protocol that I wouldn’t run through that same filter myself: Is this optimization, or just another path to burnout?
The nine biomarkers below this paywall are the ones I use to hold that line with patients. They include what your 30s reveal about the mothering you did or did not receive, what your muscle is telling you, and the thing your desire has been noticing for longer than you’ve been willing to admit it.
