Sandberg described Greenwald to me as “brilliant, energetic, passionate,” adding, “She’s unafraid to broach topics in ways that other people, I think, have been afraid to do.” In the past few years, as her wait list blew up, Greenwald started jokingly referring to her practice as the B.V.C.—the Billionaires’ Vagina Club. Some patients found the name amusing, but the billionairesses apparently did not. Greenwald stopped using it.
Seated in Kordestani’s grand living room, the lunch guests told Greenwald about their frustration with their primary-care doctors, whom they viewed as old-fashioned disease chasers. “I like biohacking,” Kordestani said, but complained that her doctors were dismissive. The women wanted physicians who were disease preventers, and doctors who were attentive to the difficulties wrought by menopause, which have been increasingly found to leave women vulnerable to other ailments. (I first met Kordestani at a book group that was reading “All Fours,” Miranda July’s 2024 novel about a woman teetering on the estrogen cliff of perimenopause, ditching her husband and child in the process. The book-club members roundly disliked it, indignant that the character was being driven mad by perimenopause, as if hormone-replacement therapy didn’t exist. Did July just have a bad gynecologist?)
Outside Kordestani’s glass doors, a gigantic inflatable flamingo moved back and forth in an infinity pool. Inside, one young woman asked Greenwald, “How do I know when I’m in perimenopause?”
“My goal is that my patients never know,” Greenwald answered, segueing to her enthusiasm for hormones. She told the group that she had several Olympic athletes as patients. As soon as their schedules for the 2024 Paris Games were released, she used an ovulation medication to synch their cycles so that they would compete on days nine through fourteen—the time when estrogen peaks and women are suffused with energy. In perimenopause, she said, the pattern shifts: fluctuating hormones can cause days and days of angsty P.M.S., followed by spikes of anxiety. “Fortysomething women can get quite a reputation,” she noted. “These are badass women like yourselves, who run companies, run households with a lot of children, have M.B.A. careers and whatnot, and all of a sudden they’re freaking out at everyone.
“I’m super excited about using hormones, maybe forever,” Greenwald went on. “I will humbly bow my head when the data come out to prove the opposite, but I really think we’re onto something.”
When she is talking about scientific innovations, Greenwald warns her listeners that she is prone to “go super dorky.” Although the women she treats are data-driven, they are impatient—unwilling to wait a decade for randomized controlled trials, then years more for prescribing habits to change and insurance companies to catch up. She makes treatment recommendations based on a combination of what she calls “biological plausibility”—a theory of why something would work—and new data. “There’s a lot of cool new meds on the market that I’m super excited about that few doctors are using,” she said. “But I am!
“I want to be very clear about when I’m speaking as a U.C.S.F.-trained physician with lots of randomized control trials behind what I’m saying, versus when I’ve entered the ‘woo-woo’ world of concierge medicine and I’m going into anecdotal evidence and observational studies,” she said, fluttering her hands. “You guys are a very smart room here.”
A woman mentioned that some of her friends were paying for their young daughters to freeze their eggs, as a graduation present.
“Super interesting! That’s a great idea!” Greenwald said. “This is my favorite example of population-based health versus concierge health.” Research shows that most women who freeze their eggs before the age of thirty-seven don’t end up using them. “But suppose we don’t care what the cost is?” Greenwald asked. The calculus becomes simpler. Everyone knows twenty-one-year-old eggs are better.
Cori Bates, a trustee of the Asian Art Museum who is married to the C.E.O. of the software company Genesys, leaned forward. Bates was wearing a scarlet dress and kitten-heeled flip-flops, and she spoke up to say that, after learning that she was at a high risk for ovarian cancer, she funded a study to assess whether risk for the disease can be reduced by removing one’s fallopian tubes.
Greenwald praised the study, and Bates took the opportunity to ask if the doctor would take her as a patient. Greenwald beamed: “I’m so, so flattered. I would love to. But I’m completely full.” She promised to try to find room for Bates in the future.
