SPEAKER_01: 0:00

Hi everyone, welcome back to Hashimoto's Nutrition RX. I'm your host, Natalia Sanzo, a registered dietitian and functional nutrition practitioner specializing in Hashimoto's hypothyroidism. If you have been wondering what you're feeling lately is just aging, or if it's actually your hormones changing, this episode is for you because so many women in their 30s, 40s, 50s find themselves tired, moody, gaining weight around their middle and feeling like something is just off. But when they go to their doctor, they're told that everything is normal, right? So today's episode is the must-listen because we're going to unpack one of the most confusing transitions in women's health, perimenopause and menopause. And it will help you finally understand what's happening to your body, your energy, and your hormones. And I'm joined by someone who truly bridges the gap between conventional and integrative medicine, Dr. Sean Tassan, known as America's Holistic Gynecologist. Dr. Tisson, welcome. Thank you. Okay, so before we get going with questions, I do want to give you an official introduction for people who don't know you yet, or for my audience that doesn't know you. Dr. Sean Tassan, MD PhD, known as America's Holistic Gynecologist, is the first physician in the United States to be double board certified in obstetrics and gynecology and by the American Board of Integrative Medicine. He holds a medical degree in addition to a PhD in mind-body medicine. Dr. Tisson is a practicing OBGYN in the Austin, Texas area, hormonal expert, author, speaker, highly rated patient advocate, creator of the world's first integrative hormonal mapping system, and host of the Confessions of a Male Gynecologist podcast. I love that name. In his 20 plus years of practice, he has listened to over 50,000 women's stories and is determined to remove the myths surrounding women's health. As an integrative health practitioner, he believes that you should have an active role in your care. His work includes studies and publications on hormonal imbalances, spirituality in medical care, whole foods to heal the human body, and integrative medicine. Dr. Tisson is featured in many publications, including The New York Times, NBC News Online, Stanford Medx, just to name a few. His latest book, The Hormone Balance Bible, published by Harper Collins, is available for purchase worldwide. Again, welcome to the podcast. Thank you. Yes, we're so lucky and excited to have you here. So let's start right where most women find themselves. That moment when they start to notice changes in their body, but aren't sure what's behind it? Maybe their cycle is shifting, their sleep feels often, or they suddenly cannot lose the weight the way they used to. How can a woman tell if what she's experiencing is perimenopause, menopause, or simply part of that normal aging process?

SPEAKER_02: 3:26

First of all, perimenopause is a word. And I try to convey that a lot when I talk about it. This is being thrown around now in a lot of marketing, a lot of books, this concept. And it's obviously as long as women have been alive, there's been perimenopause. Perimenopause is a word that simply in Latin means around menopause. So the word itself isn't really a diagnosis, it's more of a stage of life. So when I talk to women about it, I try to get them, instead of going into the doctor and saying, I have perimenopause, I would focus on the symptoms that you're having, like fatigue, insomnia, weight gain, hot flashes, irritability, anxiety, hair thinning, all those things are commensurate with the perimenopausal stage in varying degrees, depending on what hormone is usually the one that is off. Whereas menopause, pretty much most of the reproductive hormones are down pretty close to zero. And that's usually around the age of 51. So women even in their 30s can have perimenopause symptoms for sure.

SPEAKER_01: 4:36

Oh wow. That's such an important distinction to mention that how symptoms can overlap but still mean very different things. And I think many women need to hear that the changes are not all in your head, right? Because their body are truly responding to hormonal fluctuations. And when we understand that, we can support those changes through food, lifestyle, and integrative care that you provide. Now, that brings me to something I think so many women overlook. It's the timing. Because I often hear that women in their mid to late 30s say there is no way this can be perimenopause. Are there any signs that women are entering perimenopause earlier than they realize? And how early can they have perimenopause?

SPEAKER_02: 5:26

Like I said, perimenopause just means around menopause. So theoretically, I would say women in their 30s can certainly have perimenopausal symptoms. The big ones that I see tend to be insomnia, anxiety, maybe to a certain extent, fatigue, hair thinning is obviously very common even in younger women. And a lot of women don't realize that they can have those symptoms, even if they're on a birth control pill. I would never blow those things off, even though physicians may tell you you're fine. The point is that you know what's normal for you and what's not normal for you. So when you're having any of those symptoms, and I'm talking about symptoms that are not like, oh, last night I didn't sleep well, but if it's a persistent problem and it's starting to interfere with the way that you want to live your life, then that would be something to get checked out.

SPEAKER_01: 6:22

I think it's such a key message because it helps women pay attention earlier and take actions before things become overwhelming, right? Because I think early awareness can make such a big difference when it comes to supporting hormones, metabolism, inflammation through diet, lifestyle, or even hormone replacement therapy. Now, from the like nutrition side, I've noticed that women often start experiencing small shifts and blood sugar stability and energy in their mid-30s, like long before their periods change. And it's like their body starts whispering a little bit before it starts yelling. So I think what you do, you have an incredible platform throughout social media platforms, and you're doing such an incredible job bringing the awareness, talking about the topics, and not just seeing patients. And I know, trust me, I know I run social media platforms and it feels like a full-time job on itself. So I applaud you for being so active throughout all social medias. Now, we've talked about when changes begin, and I would love to dig a little bit deeper into what actually is happening hormonally. What are the top three hormonal imbalances do you see most often in women across different ages in your clinic?

SPEAKER_02: 7:48

When you talk about hormones, the hormones obviously fluctuate throughout the cycle. That's just what they do. And a lot of doctors will talk about this concept of imbalance being silly because they're always imbalanced because they're going up and down all the time. The problem is not that they get hung up on the word, but they forget about the fact that you might feel bad. Usually, what I see in my practice across the board is low to low normal testosterone, very common across the age groups. Low testosterone is fatigue, especially in the afternoons. You may want to take a nap, even though that's not your norm. Your hair thins because testosterone is responsible for hair growth. You'll have decreased drive, motivation, desire. I've often said in my posts that if it was a t-shirt, it would just say meh or blah. You feel blunted. You're not your same self. And when you don't have that drive and that desire and you're tired, then sex takes a back seat because those are two things you need to have. A sex drive is your energy and you want to care. So that would be one of the main ones. Another big one is a lot of women really struggle with sleep. They don't fall asleep, they don't stay asleep. And probably one of the more important things for your longevity is getting a good night's sleep. So progesterone is responsible. Women, when they're pregnant, they have great hair because progesterone stops hair from falling out as well. And it just gives you that kind of calm feeling that just life is good. And then on top of that, one, most of the time, if I'm looking at hormone panels, the third one I would see would be like a subclinical hypothyroid, meaning you meet the criteria for normal, but again, you're in the bottom 10 or 15 percentile. And you're having symptoms of hair thinning, fatigue, weight gain, brain fog sometimes can come in with that. So I would say testosterone, progesterone, and thyroid are the three big ones in younger women.

SPEAKER_01: 10:00

That aligns with what I see in my practice as well. It's amazing how connected all of those hormones are and how addressing one imbalance like progesterone through pills, hormone replacement therapy, or stress even, can start shifting everything else in the right direction. And in my work, I see patterns like you mentioned, like estrogen dominance or sluggish thyroid. Of course, I concentrate on Hashimoto's hypothyroidism. I'm patient myself. I have Hashimoto's, have had it for 10 years, and it has been a battle. And I'm I'm really curious to hear what you find most common in your practice. And it's interesting to see how it all overlaps. And when you mention about the sleep, how it changes, I started wearing Apple Watch to bed to track my sleep. And I learned that you're supposed to be in a deep sleep. There's a core sleep, right? There's RAM core sleep and deep sleep. You're supposed to be in deep sleep for about three hours a night. And on average, and that kind of goes across all of my friends that we talk to. We sleep in deep sleep, we sleep about 17 to 20 minutes. And that's where all the body repairs happen. So is this perimenopause or is this just bad sleep hygiene, being on the phone all the time, stress, not eating well? So it's interesting that you said that all those hormonal things happen. So, what are some red flags that what's going on is not just a normal aging, but actually deep hormonal imbalance that needs attention.

SPEAKER_02: 11:40

Like I said, I I think that most women don't have like a abnormal lab, like most women, with the exception of maybe testosterone, tend to have low normal labs. Like they may, and progesterone can be zero and be normal. That's how the lab is run. But you have to combine. See, I always say doctors who go purely based on symptoms and no labs aren't really getting the whole picture. And to go just based on labs and not the symptoms is going without the whole picture. So you have to combine those. And you have to look as the patient and say, this problem, whichever one it is, hair, sleep, energy, whatever it is, this is abnormal for me. This is something that I am struggling with. That even if the doctor tells you your labs are normal, which they may very well be, but I see a lot of women who say their free testosterone is in the fifth percentile of normal. I could multiply that by 30 and it would still be normal for a woman. But you might feel a lot better. And so that's where I think the doctors drop the ball in the sense that they just look at it and say it's normal because they're not listening to the symptoms that the patient's telling them. And I think that you have to just come to that realization: like, look, I just had a lady this morning who walks with her friends, and they all were saying they were doing their usual talk about how they feel this and they feel that. And they were saying they didn't want to go on hormones because they were afraid of them, because of all the fear that's out there. And then one of those ladies came to me and she feels so much better, and she was losing bone because she got a DEXA scan and she had osteoporosis, and that was a wake-up call for her. And so then when she started feeling better, this other lady called. And I think it's just when you see this person that you've known for years, and they just feel so much better, so much different, that you then start looking at it going, I've been told all these years that I'm just getting older, or I just need to exercise more, I just need to lose weight, or whatever you're being told. And it could be something as simple as a hormonal issue.

SPEAKER_01: 14:08

So that kind of brings me to a question. Why do so many people, women specifically, feel so dismissed when they bring hormonal issues to their conventional medicine doctor? And how can they advocate for proper testing? Because you just mentioned that the lady did a test to find osteoporosis. None of the doctors ever do that unless you are advocating. So how do we do that?

SPEAKER_02: 14:35

You ask and you see what your answer is. If the answer is we don't do testing here, then you're not going to change the way they do things. I've often said that you're not going to change how a doctor practices medicine. So if you meet resistance, then you need to just say thanks and go find somebody that does. And obviously, there's a bunch of us out there now that are talking about things and we're licensed in all these states, and we can definitely help. There's online companies, I'm not a big fan of those because it's more of a cookie-cutter approach. And the online companies, they kind of cherry pick the easy patients, and many of them won't do testosterone. So you're not, again, getting the full thing. But for some women, it's an entry point and they're affordable at a low price point. I think it's a$50 a month membership. I have so many of my patients come from those companies because they get started and they just can't get it right, or the hot flashes are gone and whatnot, but they're missing something. So you can get started many places. As far as what you really want, is you just really want somebody that listens, and that because I've often started probably 60% of my patients. I'll start them on something, and then I usually meet with them again in six weeks. Rarely is somebody a hundred percent better. It does happen the first time. Usually we have to tinker with the dosing, we have to change the way we deliver it, whether it's a cream or however we're doing it, because they may not absorb it. And you have to keep working with the patient, and then I follow up every six months because certain hormones you want to make sure they're at a different level to protect bones and things like that. And sometimes people will call me and say, I've been feeling great for a year, but now I'm having insomnia again or I'm having hot flashes again, and I want to check my lab. So it's constantly, as you change, as your lifestyle changes, things are gonna change for you. So you want somebody that's gonna be with you over time, not just somebody that's gonna put a band-aid on it, even. The short answer is you're not gonna convince your doctor to order labs, you're not gonna convince them to try testosterone, you're not gonna convince them to prescribe estrogen or progesterone if they don't want to. You have to do the research and find people that will do it.

SPEAKER_01: 16:56

That's such an empowering reminder because we really do have to be our own advocates. It doesn't matter what part of health we're trying to fix. And when women understand what to ask for, I think it changes the whole dynamic in the exam room. When they come prepared. Yes, doctors are an authority, right? But you have to come prepared. I always come with the list of questions because I don't know it all. I'm learning every day. So it doesn't matter if I'm coming to see a gynecologist. I Google the questions. I'm trying to figure out where my normal should be. And I love that you said that you take your patient's hand and you're walking them through this whole journey with them because it's not one and done. Yes, we as a medical professionals we have protocols, but that's where you start. We have to have guidelines, right? Where do you start? But then you taper things off or on or you're changing. So I love that you're really hands-on and really giving women exactly what they need. So this is a perfect lead-in to my next questions because I know you take a more comprehensive approach to testing. What are specific lab tests or markers do you believe every woman should ask for when they are investigating their hormonal issues?

SPEAKER_02: 18:20

I would say the basics are going to be estradiol, progesterone, free and total testosterone, DHEA, vitamin D. And then with thyroid, you want the TSH, the free T4, and the free T3. Those are your actual hormones. And then I also look at thyroid antibodies because I have picked up many cases of Hashimoto's that haven't been diagnosed in the past. Or I have a patient with Hashimoto's who might have super high antibody load, and we're really trying to get that down. That's what I run. I have patients that'll call and ask if they want to do a metabolic look like hemoglobin A1C or inflammatory markers. And I'll order those, but usually that's not my basic starting panel.

SPEAKER_00: 19:07

Mm-hmm.

SPEAKER_01: 19:08

And when we combine, like you said, when we combine functional laps with clinical symptoms, I think that's where the true healing happens. From my side, I always look at like how inflammation, blood sugar, and of course gut markers interact with hormones. And it's incredible how many answers show up when we look beyond this surface level, beyond just TSH, which most people work. So you mentioned that you work with some of the Hashimoto's patients. Are you doing anything differently for them as far as like a woman with Hashimoto's, is she different than a woman without Hashimoto's?

SPEAKER_02: 19:49

I think it shows inflammation load in the body. It also shows that if she has Hashimoto's, she's not optimally maybe converting T4 to T3, which is the active thyroid hormone. So I will talk to them about a good friend of mine who lives here in Austin, is Abella Wentz, who wrote Hashimoto's Protocol. I've learned a lot from her over the years as well, and another friend of mine, McCall McPherson, who is another thyroid person. And the thing that I always tell patients is you want to, and you do this, I'm sure, but you decrease gluten and dairy load. That alone sometimes will cut inflammation drastically. But then I will also rely on probably low-dose naltrexone. I may recommend a favorite supplement that I usually will recommend is Xyflamend, which is a holy basil rosemary turmeric blend that really also helps with the inflammation. And my goal is always to try and get the TPO antibodies under about 100. Because I find that when you decrease that load, it just helps the thyroid work better. It helps your body convert hormones a little bit better. But then it also depends on what their free T3 level is, because even if it's normal, it's a range. It's 2.2 to 4.4 and most labs. And a lot of these women are at 2.5, 2.6. They're in the bottom quartile and they have all the symptoms. So usually I would probably even consider treating them with an in or something.

SPEAKER_01: 21:22

Thank you for shining the light on how you work with people with Hashimoto's because I think it's it truly takes a village. And Dr. Isabella Wentz, I was actually on her podcast, and McCall McPherson, she's incredible. So you guys are all in Texas, I believe, right?

SPEAKER_02: 21:41

We're all in Austin, actually.

SPEAKER_01: 21:42

Yeah. Oh, amazing. I don't know why it's such a big concentration of incredible practitioners in Austin, but that's amazing. So I'm happy for people, the local people who are there. Do you take virtual clients? Because I saw that you're licensed in many states.

SPEAKER_02: 21:59

So I assume Yeah, I do in-office stuff on Mondays and then Tuesday through Thursday, it's mostly all telemedicine.

SPEAKER_01: 22:08

Fantastic. Now I know you've created a really unique system called the Shines Protocol that I know some so many women have found helpful. Can you explain what the this protocol is and how it helps women bring their hormones back into balance?

SPEAKER_02: 22:24

So when you write a book, you need to identify a problem, and then you have to solve the problem. So that's the formula. Um obviously there's tons of books out in the menopause area, and a lot of them are very similar. So what I did was I just basically distilled down the 50,000 stories or so that I've heard over the last 25 years. And what I found was if I talked to patients about their imbalance, they would get it. But if I talked to them about the stories of other women that I had, they really connected more with those, which is why I created the 12 archetypes, first of all, like low thyroid would be the underdog. And then in that chapter, I talk about the Shines Protocol, which is a six kind of pillared system to help you fix the imbalance. And only one of those six do you actually need me for, which is the H, which is hormones. So each of the 12 imbalances will have a spiritual practice, which is the S. And that could be something like just getting out and walking. It could be reading or meditating or things like that. The H is hormones. The I is what I call enthoceutical information, meaning I always want to include a little bit of what I call woo factor for people that like to do that kind of stuff. Things like essential oils, acupuncture, energetic work, and things like that. The N is nutrition, so there'll be nutrition advice in there, like about not eating gluten and dairy and some of the other things. The E is exercise. So each of the 12 has its own type of exercise that would probably work better. Because, like in women that are hypothyroid, they don't they may not want to go out and run because they just don't feel good. And then the last S is supplements. So each of the 12 archetypes would have something like Xyflamand or dihydroberberine or maca or something along the lines that I have found through the years that has a good profile at helping a majority of women.

SPEAKER_01: 24:33

And of course, for our people who are watching and listening, I'm going to provide all the links to your services, to the protocol, to your book so people can find it easily because I think it's such an incredible resource. Because when I read about your framework, what stood out to me was how personalized it is. There is no one size fits all approach, right? Which is exactly how I feel about nutrition too, right? We're talking about eliminating gluten or dairy.

SPEAKER_00: 25:03

And honestly, I'm not gluten-free. I'm not dairy-free. About 50% of my clients don't feel better over on the gluten diet. It doesn't affect their TSH, it doesn't affect their thyroid.

SPEAKER_01: 25:15

So it's such a truly personalized approach. But I do agree that when somebody just gets diagnosed with Hashimoto's and they get on the gluten and dairy-free diet, they feel better almost immediately. And I think it's partially because they eliminate a lot of processed foods that have gluten in them naturally. So that helps, but we do know there's studies that show that a gluten-free diet with selenium and vitamin D has been clinically shown to decrease TPO antibodies and improve uh improve TSH. So there's some truth to that. I don't recommend the gluten-free diet just across the border because I don't think it works for everybody, but I do think it's a great place to start. Of course.

SPEAKER_02: 26:01

Yeah, I agree. And I think that most people want something easy, unfortunately, and there isn't always an easy fix. Sometimes you have to do the nutrition, sometimes it's always a good idea, and the proper exercise, but a lot of people want a pill. And sometimes there isn't one that can help. You know how it is. The exercise, the nutrition piece, does indeed take more time and more effort.

SPEAKER_01: 26:29

It takes more time, it takes more effort. It's very confusing because some social media brings out a lot of advices that are not personalized. And some of them are just made-up advices, some of them are just based on the study was done in 1986 that is no longer valid. So it's very hard. I feel like I'm fighting a lot. Like I spend a lot of time with my clients debunking the myths, and that's what you told me. You said, I want to debunk all the myths that go around, especially women's health. And that brings me into this hot topic that always brings a lot of confusion, is that hormone replacement therapy. And you already mentioned that people are afraid to get on hormone replacement therapy. So, how does hormone replacement therapy fit into your integrative approach and who is or isn't a good candidate for it?

SPEAKER_02: 27:28

Unfortunately, 20 years ago, when the Women's Health Initiative came out, it really scared an entire generation of women. And worse than that, it scared an entire generation of physicians around hormones. And that is still fairly prevalent even today. So doctors are really reluctant to prescribe hormones because they're still afraid. I feel like 95 to 98% of women are candidates for hormone replacement therapy. Some have a recent diagnosis of breast cancer or something like that, that maybe we want to wait a little while, or DVTs in the leg or something. There's serious things, but most women don't have those and are indeed people. And I know you've had folks on your podcast before that I have been blocked by, like Dr. Nadalski and a couple of others, because they are very traditionally based, very smart, and they use evidence, which is great, but they're really not open to thinking a little bit outside the box, like they won't compound hormones or they won't use testosterone in women. I'm not saying he does, I'm just saying that mindset. And then also you mentioned the frauds and the scammers out there because it's a big business. Anyone that says your doctor's not telling you this or your doctor doesn't know this, but somehow they do and they're a coach, that to me is a huge red flag. And so I've committed a lot of what I do to exposing that and just going through it logically, why it's silly, because there's a lot of money to be made with supplements. And I use supplements, but I might use four or five. I don't talk about detoxing and parasites and all that other stuff because I think 99% of the time it's a scam. And I just really would wish that women, instead of spending money on all that stuff, would focus more on like the hormones or the exercise or what they're eating. And again, it goes back to that kind of concept of false promises and vulnerable women. These patients are out there searching at midnight because they can't sleep or they feel miserable and they're on their phones and they're just getting deluged with all of this fairly worthless information, but it's very dramatic, very well done, and they fall prey to it. And they've probably spent hundreds and hundreds, if not thousands, of dollars on things that don't work when a simple Prescription to their local pharmacy would fix almost everything. Part of me feels like I need to do that to just show women what they're being sold. Like one of the recent ones I just did was Elle McPherson, who this is a new thing too, is celebrities are now getting into the space because they are now menopausal. And they've miraculously discovered this powder that they concocted that's got 51 things in it. When she said two minutes earlier in the video that she was already on a bunch of supplements that didn't work, but somehow magically this one does because she figured it out when for some reason none of us could figure it out, but she did. And it's just silly on its face. But when they're being sold to by Elle McPherson, who's gorgeous and 55, and she looks amazing, that's gonna sway people. Holly Berry or Drew Barrymore. There's all these people now that are getting into this space and they're really muddying the water.

SPEAKER_01: 30:56

Yes, and like Hailey Berry, they come up with supplements. They have no education. Probably a supplement company reached out to them and they were trying to make money on it. And the same with parasite cleanses and stuff. And people are saying that everyone has a parasite. Now, I do a stool test in my practice to screen for parasites if nothing else is working, if we have done lifestyle modification, diet modification, and all that stuff. And in five years of me doing the stool test, I think there was like two or three people with the parasite. And guess what they need to do? They don't need to buy a bunch of detox or parasite detox supplements. They need to go see a doctor because it can really be a problem because parasites do migrate. So you can't be treating them just over the counter. It can be a real problem.

SPEAKER_02: 31:47

Yeah, and usually it's a simple dollar prescription for something like Mebendazole, and the parasites are dead and they're gone, and you don't have to spend six thousand dollars on some cleanse or whatever. And I'm not saying that you might not feel better, but it's temporary and it's about 6,000 times the cost of a tablet that you would take.

SPEAKER_01: 32:09

I tell my clients who signed up with me, I said, I'm gonna save you money, even though you signed up with me, because when they come to me with 30 supplements, they take 30 supplements per day. We cut back by the time we finish working together, we taper off some. And I'm like, you need a basic multivitamin. If so, an iron pill, a vitamin D, whatever we deemed necessary based on blood work and symptoms. But it's really basic, not expensive supplements. So you do not need to be taking 30 supplements because it's bad for what? For your liver, for your kidney, that's your detox system. So I just love your perspective. It's reassuring for women to know that it's not all or nothing. It's about timing, context, and truly personalization. And from my experience, when women support their liver, their gut health first, they often tolerate hormone therapy so much better, I think. So it's really reinforcing the foundation, uh, that the foundation matters. Now I want to touch on something, on like some maybe lifestyle factors that play such a big role in this conversation. So, how does stress or how do stress, gut health, and sleep influence hormone balance during this transition to menopause?

SPEAKER_02: 33:27

I think it's which came first chicken or the egg. Was it the hormone imbalance that caused that stuff, or was it that stuff that caused the hormone imbalance? So it's hard to know for sure which is causing, if it was you not sleeping, I mean, you would know your lifestyle. So if you have a lifestyle where you're out partying and you're drinking and you're not eating right, that would be a good place to start. If you are doing, because I get a lot of women that are doing all the things that they should do and they still are having these issues, then that's probably more the hormones are off. It still could be lifestyle in the sense that you're pushing your body too hard in some of these women. They're they're working, they're CEO, they're doing work all day, they come home, they got the kids to take care of and run around. And by the time they go to bed, they're just burned out, and that could cause their hormones to be off, even if they're working out and eating right and doing all the things. So sometimes you have to parse that out, but you really got to sit with the patient and get a good medical history. Like when you sit down with them and get their background, what are you doing? What are you eating? And when I first sit down with a patient, my first question is always for them to tell me their journey. What have they done? What have they been doing? What are their symptoms? And then I will sometimes ask, what's your best day? What do you envision as being your best day? And if I can get you 80% of the way there, is that gonna be good enough for you? Because I you want to set expectations as well. I can't make you feel perfect. And I don't like when people say, I want to feel 30 again because you're not 30, you're 50. And so you can't feel 30 again. I'm sorry, it just doesn't work that way. That to me is also a marketing technique when people say, Oh, I'm gonna get your hormones back to where they were in your 20s. That doesn't mean anything. It's just marketing because you just want to know where your best is. And people will ask me all the time, what's an optimal level? And I feel like optimal levels is also a myth because optimal is where you feel best. I don't believe that you have to have your testosterone at a certain level because, as you might see with thyroid, I have women come in all the time that their thyroid's 2.7, they're free T3, which is around the 40, 35th percentile. And if I get them up to three, which is still isn't even in the middle of normal, they feel hyperthyroid. They have anxiety, they have heart racing. So for her, that 2.7 was normal. I could say optimal would be three and a half to four, but she would feel miserable. So that doesn't fly for me when you shoot for these optimal levels. I just want you to feel your best and the lady that's walking next to you to feel her best, and that could be a completely different regimen. So try not to focus on the numbers, try to focus more on how you feel.

SPEAKER_01: 36:22

I love that you brought it up because people reach out to me asking on Instagram all the time, what are you taking as a Hashimoto's dietitian? What is your T3? And I always say, it doesn't matter where my T3 is, don't shoot for my number because I'm gonna share it. My number is above five. So I am my free T3 is over the red line, but I feel the best on that dose. And as soon as it drops down to four, I cannot get out of bed. So now for most people, you mentioned your patient. As soon as she went above 3.5, and remember, I'm at five, she went above 3.5, she felt hyperthyroidism, right? Anxiety and all that stuff. So we're very different. How we metabolize the medication is different, how we convert T4 to T3 is very different. It's such a good message to say don't ask people what their numbers are, what are they taking. Find a doctor that listens to you, that's going to be your advocate, that's gonna be on your side, and let him be uh part of your team and figure out what the best dose and number for you. I think it's like the main message people need to take from this conversation.

SPEAKER_02: 37:38

Yeah, and I think the other thing is people asking you, you're gorgeous and you're thin and you probably do a lot of things. I've seen your Instagram page. Most women probably would die to look like you. And so you could use that and say, Oh, I do this and I do that. And you could make a lot of money off of that because you are who you are. But to tell them that I think is great because I have women that'll say, How come I'm on testosterone and my dose is two and my friends is four? And it's it's that very thing because she thinks because her friend is lifting weights and doing all this stuff, that her testosterone is too low, when in actuality it's great where it is. And I do have women that have T3s that are elevated like yours, and I don't change them because no, I did have a lady the other day that was at seven and a half, and that's to me too high. Even if she felt good, I just medically don't want her that high. But if it's like I said, if it's four to five, somewhere around there, that's mildly elevated. And if she's not tachycardic and has the issues, and I might say to her, let's go down, because if you don't feel any different on a different dose, the lower, then let's just do that. But if she calls me and says, We went down for two weeks and I'm I can't get out of bed, or something like that, then okay, you felt great on that dose. You don't feel great on this dose, let's go back to that one. So, yeah, it's about individuality. And that's the thing. I always talk to patients when you get a lab range at a lab, what they do is when they're setting up their lab, they'll get like a thousand people who are normal and they'll draw their labs and they'll take the top 5%, the bottom five percent, and then they'll just say, if you're in this 90th percentile, you're normal, and it's usually a bell curve, right? But where is your bell curve inside of that curve? See, that's what you have to shoot for. Most women, if they come in around that lower 20th percentile, they may not feel very good. I have some women that feel great there, but some don't. And you may feel better up towards the top of normal, like you do. So that's why I said it's not a one size fits all, and it's hard when you have patients that only want to be seen like one time, and you're gonna fix all their problems because it may take some tinkering around. You might have to do another set of labs. But if you stay the course and you stick with somebody for three to six months and they're working with you and looking at your lab and talking to you about your symptoms, chances are you'll find that dose eventually.

SPEAKER_01: 40:12

Absolutely. I completely agree. And I've noticed being patient myself and talking to other women, that the way you metabolize and how much medication you need changes with seasons. So I recommend seeing a doctor at least twice a year, like in the fall and the spring to get the blood work done, to adjust your medication even a little bit. I do. I adjust my medication seasonally, not based on seasons, but based on my blood work. I feel different. Sometimes I need a little bit more, sometimes I need a little less. So again, I love your approach. I love how hands-on you are with your patients. Now, I wrote something to myself as a reminder to ask you. I've read that people say that progesterone is the fountain of youth. Is that true? Is there anything to it?

SPEAKER_02: 41:02

To me, that in the sense that you sleep better, maybe, because we know that sleep patterns and stuff like that, you will you you have a shorter lifespan if you're not a sleeper. But it's not going to make you look any different, it's not going to make you lose weight or anything like that. So, again, when you hear things like that, it's probably coming from somebody that's got some program or something or a hot supplement or something that's going to potentially raise your progesterone. That to me, whenever you hear dramatic things like that, it's usually for marketing.

SPEAKER_01: 41:40

And that's why I'm asking you, because the functional medicine doctor said that he puts everyone starting at 30 years of age on progesterone because progesterone is fountain of use in air quotes. And I was like, huh, that sounds odd.

SPEAKER_02: 41:57

That's made up.

unknown: 41:58

Yeah.

SPEAKER_01: 41:59

Yeah, that's yeah. Okay, let's talk about non-made-up stuff. What nutrition changes do you recommend women focus on first? As soon as they suspect that they're entering this perimenopause or menopause, what should they do nutrition-wise?

SPEAKER_02: 42:16

I think it's pretty basic, you know, eliminate processed foods, uh eat enough protein. Most women don't eat enough protein. Try to stay away from gluten and dairy. And when I say you don't have to eliminate it, but try to limit the amount that you're consuming. Probably get somewhere between 100 to 150 grams of protein a day. And try to monitor saturated fats because I think the one the main killer of women is heart disease. And we really don't talk about the LDL part, is really the important piece nowadays where you have to get those LDLs under 100 or lower to prevent heart disease. And most women, especially in menopause, if they're not being treated with estrogen, will have the same heart attack risks as men because their LDLs go up, and that's what estrogen can help lower that. So I do think that it can be helpful to get rid of saturated or at least limit saturated fat. The problem is we now have this carnivore and keto push where everybody's eating all this meat, cheese, and butter. And I'm sorry, but it's gonna catch up with you eventually.

SPEAKER_01: 43:26

Yes, and it will catch up sooner than later, six months, maybe less, changes in your cholesterol levels. Your HDL goes down because you were not eating. Most people don't transition to eating avocados. Most people transition to eating a steak.

SPEAKER_02: 43:42

And there's a great Instagram account called Carnivore Cringe, and I would challenge everybody to follow it if they're carnivore, because what they do is they scour Twitter and all these platforms and they look for all these horror stories. And so many carnivores are now coming in with heart disease, strokes in their 30s and 40s, heart heart attacks. As a matter of fact, one of the biggest proponents for carnivore right now is Jordan Peterson, who's a very famous author and speaker, and he's been extremely ill now for about a month. And while it's a little cloak and dagger, I think people are thinking that he's having a problem because he's just been eating meat for the last three years. And it will make you feel better. I have no doubt. Carnivore and keto will help you because you're eliminating all the trash, and that's where you feel badly. And I would say fruits and vegetables are not your enemy. I would just eat clean fruits and vegetables and I would up your protein intake.

SPEAKER_01: 44:42

Completely agree. Nobody wants to hear these basic nutrition recommendations because they're not sexy. They're not fun. They're not gonna get you one million views. But this is the foundation. And if people are missing this foundation, nothing else will work. No supplements, no, of course, hormone replacement therapy, yes.

SPEAKER_02: 45:02

But if there's no foundation out of a bad diet, and you can't supplement your way out of menopause, I tell them that.

SPEAKER_01: 45:07

Exactly.

SPEAKER_02: 45:07

You can help actually maybe with perimenopausal symptoms sometimes, but menopause, no, you can't supplement your way out of it.

SPEAKER_01: 45:15

Agree. Now, this conversation has been hopefully so valuable to our listeners. If you can give one piece of advice to women entering their 40s or 50s about protecting their hormone health, what would that be?

SPEAKER_02: 45:32

Exercise, lift weights, eat enough protein, and get your labs checked at least once a year.

SPEAKER_01: 45:40

At least once a year. You know what I've done the first time I did a full blood work? I bought a full panel online that I went to a patient-oriented lab testing facility, and I bought that full panel as a birthday gift for myself.

SPEAKER_02: 45:56

If you can get it through your insurance, great. If you can't, those sites are great. What they do though is they'll say they have 100 tests, but the reality is they'll count one test like four times because there's four values that come back in that lab. And you're paying about 400 bucks. And the reality is I can order labs through my office if it's not covered by insurance for like$188. Those companies, it's a money grab. And the problem when you do those too is if you don't have a provider, they might give you the labs and then they'll give you an AI-generated thing that goes with it. Oh, you could try this supplement because that's what they do. But what do you do to interpret those labs? That's part of the problem. They don't have the knowledge base that you have. So they just get some red values and they don't, then they freak out and they don't know what's going on. So if you're gonna get them, at least if they're all normal and they look great, that's great. But if there's abnormalities, try not to freak out, but get with somebody. And I'm also a big fan of actual labs, these new companies coming out that have this thing you stick on your arm and it draws this little tiny tube of blood out of your arm. I don't know how accurate that is. I don't think it's what does that do? Does it get it's a patch and it's got a little needle on it, and you basically leave it on for 20 minutes and it just fills this little tiny tube up with some blood and you send it off, just like what you're talking about. But if you look at an actual lab panel, they usually have about five or six tubes of blood. So I just don't think that one's probably as accurate as if you're going to a physical lab to get your blood drawn.

SPEAKER_01: 47:30

I completely agree. Now, back then I did not have a PCP, so I just went and got my blood work done. Actually, I diagnosed myself with Hashimoto's, and then I went to endocrinologists with my papers and said, okay, I need to get on medication.

SPEAKER_02: 47:45

Yeah, and that's great. Yeah, I think being more proactive is a good idea and checking your lipids and all that stuff.

SPEAKER_01: 47:51

But of course, now all of my clients are they do go through their insurance, through their doctors, and of course, I work with doctors, we fax each other stuff. So I can refer people, I can order blood work, but yes, it's so much better with insurance, obviously. But yeah, if somebody's stuck and does not have a PCP, I think it's a good at least screening, maybe not a diagnostic tool, but definitely screening tool.

SPEAKER_02: 48:18

But definitely gives you, I always say more information is better.

SPEAKER_01: 48:22

Absolutely. As long as it doesn't overwhelm you and you don't start doing crazy parasite cleanses and stuff.

SPEAKER_02: 48:30

Yeah, fun people do that, but yeah, just take it to a physician or a nurse practitioner or somebody and have them look at it.

SPEAKER_01: 48:37

Now, Dr. Tesson, thank you so much for sharing your wisdom and expertise today. I know we're running close to the end of our podcast. I think this conversation will help so many women finally understand what's happening in their bodies instead of feeling confused or dismissed. And for everyone's listening, I really hope you walk away knowing that changes you're feeling are not just aging. Your hormones, your gut, your thyroid, of course, they're all connected. And when you start addressing the root cause with the right provider, your body can absolutely rebalance and heal. And guys, if this episode resonated with you, make sure you share it with another woman who needs to hear this message. Dr. Tishon, thank you again for your time. We're so grateful and lucky to have you here.

SPEAKER_02: 49:26

Thanks for having me on.

SPEAKER_01: 49:28

Thank you. We're looking forward to next episodes because I know we just talked about the tip of the iceberg here. So I would love to have you for another episode to maybe dive deep on Hashimoto's replacement therapy, or maybe dedicate a whole episode to just talking about treating Hashimoto's from a functional medicine perspective. So we'd love to have you back. Anytime. Thank you. Bye, everybody.