SPEAKER_00 0:00

Have you ever wondered should I get my cortisol checked? Should I get my testosterone checked?

SPEAKER_01 0:07

Babe. What? I'm feeling really inflamed right now and I've it's gotta be my cortisol. Can we can we quickly go to the lab and can I get drawn? Because my it my I'm feeling inflamed and my cortisol must be up.

SPEAKER_00 0:21

Well, let's have this conversation and then you can tell me if you think that would be a good idea.

SPEAKER_01 0:27

Okay.

SPEAKER_00 0:28

So that is what we are talking about today is hormone testing. And what are some of the myths and what are the truths behind different hormones? And should they be checked?

SPEAKER_01 0:40

I'm looking for those kinds of things. You ready for it? Because uh one of these on here is a conversation that we've had on previously, and it's uh and it's an important talking point. So awesome.

SPEAKER_00 0:51

Well, let's get started. You want to uh introduce number five?

SPEAKER_01 0:55

Number five, you know, I just you kind of already did. Yeah, I I feel inflamed right now, and I just feel like my because of my inflammation in my body and like just things aren't going well, I I've I must have high I'm tired, I must have high cortisol. Um can we get a cortisol check? Because I I've been told that with high cortisol, um you are fat and you are tired all the time, and I'm fat and tired, so it must be elevated cortisol.

SPEAKER_00 1:27

You're playing this role very well. Are we role-playing today? Um yes, I think cortisol is one of those things that I see on social media. I'm sure you see it on social media, people thinking, talking about how you should get it checked, how you need to get it checked, and how that could be the cause of all of your symptoms. Which what were the symptoms you listed for your uh role-playing self theory?

SPEAKER_01 1:48

Uh I the big ones was I was tired and I was fat.

SPEAKER_00 1:51

Okay, yes. And I think uh if you think about I have belly fat. I mean, a lot of the symptoms related to people's concerns for cortisol are very vague symptoms. And so cortisol excess is what people are worried about. But let's talk more about if that's something that should be done. Do you know what cortisol is, David?

SPEAKER_01 2:12

I do.

SPEAKER_00 2:13

What is it?

SPEAKER_01 2:14

It's a stress hormone.

SPEAKER_00 2:15

It is that I think is like the main thing people know about cortisol. And it is true. It is the uh principal like glucocorticoid hormone in humans.

SPEAKER_01 2:24

Okay. Correct me if I'm wrong. What? But it just isn't technically cortisol what makes you feel awake.

SPEAKER_00 2:31

I mean, I think it plays a role in that. I don't think there's one thing.

SPEAKER_01 2:35

I'm I'm speaking off the rip. We can plan this, but if I remember right, because cortisol levels spike in the morning because it helps you wake up.

SPEAKER_00 2:43

It does have a it has a very uh a circadian variability, but it's not the only hormone that does. So um, but yes, it does follow a what we call a diagurnal pattern, but it is uh produced from your um your uh derenal glands, and it is response to different stressors. And uh so why do people do you know why? I like I truly don't know. Why are people why do people talk about cortisol so much? Like, how did this become such a popular thing?

SPEAKER_01 3:12

Well, because diet, I think it all so much of stuff always stems from diet culture. And it's and it's like you being fat and tired is not your fault. It's actually this hidden hormone that you're not thinking about that's actually making you fat. It's always the one thing.

SPEAKER_03 3:27

Yeah, interesting.

SPEAKER_01 3:27

You went through the phase of it being insulin, or currently there's like this huge insulin spike insulin play before that. I believe it was cortisol. There's always something.

SPEAKER_00 3:36

Yeah. Well, and so there is a true condition that is cortisol excess. Do you know what it is?

SPEAKER_01 3:42

Cushions.

SPEAKER_00 3:43

Yes, cushing syndrome is a cortisol excess condition. Yes.

SPEAKER_01 3:47

You know a story behind that?

SPEAKER_00 3:48

Uh I don't know what you mean.

SPEAKER_01 3:50

You've heard this story before. Um, we have a cousin of ours who got married to a guy in Europe. Oh, I do remember this. We go to we're at the wedding. This guy was European. Uh, this is years ago, decade, like 15 years ago, maybe more than 15 years, long time ago. Um, we're at this wedding, and one of my cousins, cousins got married or whatever, and then dad and I see the groom, and this guy's got this just puffed out face. Everything else about him is relatively leaner, lean neck, lean, but just a really rounded, quote unquote inflamed face.

SPEAKER_00 4:32

So for everyone listening, that is a symptom.

SPEAKER_01 4:34

Dad look dad and I look at each other, and I go, Do you think he has cushions? And he's like, Dad's like, he looks pretty cushionoid. And then come to find out, about eight months later, he was diagnosed with a tumor on his pituitary, uh, benign, not non-malignant, and he had it removed, and all of a sudden, hom. His legs are normal, but he looks so different. That's crazy. He looked completely different, and you're like, we knew it.

SPEAKER_00 5:03

You should have told him. But um, do you know what the incidence of Cushing syndrome is? No idea. Any idea? So it is two to eight cases per million people each year.

SPEAKER_01 5:16

Damn.

SPEAKER_00 5:17

Yeah. So it's it's not a common condition.

SPEAKER_01 5:20

Wow. I I knew it was rare. I didn't know it was that.

SPEAKER_00 5:22

Yeah, and there can be like milder forms that turn up in different subgroups of people with different conditions, but in general, it is not a common condition. So the fact that so many people get worried about their cortisol, it's it's interesting because like we don't really need to all be worried about it.

SPEAKER_01 5:40

Well, yeah, but this but it but the classic is a lot of diet culture, your your pseudo medical professionals, they use one variable as a this is the reason why you're having these problems. So they can ultimately sell you something solution. So it's it just it is just such a common act that someone comes in with, well, this doctor on the internet or this whoever on the internet said that I must have high cortisol because I'm having these three vague symptoms. And it's like, well, that's not right.

SPEAKER_00 6:16

Um, I think, and this is like the case, I think, with a lot of the topics we talk about on this this podcast, is that I think where some of the beliefs about cortisol access come from come from that there is like small pieces of truth that kind of get twisted in in connection with the hormone. So cortisol does not make you fat per se, but stress does impact you and it does impact and activate your cortisol to some degree. So there is this, we call it in medicine the HPA axis, which is the hypothalamic pituitary axis, which is kind of how all your hormones from your brain kind of signaling to each other to produce other hormones. And so that's where cortisol gets it does get elevated in a stress response. And that can stimulate appetite, it can do different things that can make, say, weight an issue for somebody, but it's not cortisol. And it's not, you know what I mean?

SPEAKER_01 7:14

So what's yeah, and it's and and it's the call, like, yes, you could be stressed, which the stress is potentially elevating cortisol a bit. And people tend to use food to cope with stress. And so because they're coping with their stress by eating potato chips and pizza, their cortisol is maybe slightly elevated, thus it's cortisol causing it.

SPEAKER_00 7:38

Well, then that's it. You're like, it is so cortisol will go up, but it's not like if we check your cortisol level, you have like a cushionoid level of cortisol. Your cortisol is gonna go up during different responses your body's gonna make, but that doesn't mean you have a problem that needs to be checked.

SPEAKER_01 7:56

And just because you have a subtly elevated, just like um in so many things, there is statistical significance, but banana may not be clinically relevant. You may have a slightly above normal cortisol, or it's normal on the high end, but just because it's high normal doesn't mean you're having clinical elevated cortisol to the point where you're having cushionoid symptoms. Like that's those are two different things.

SPEAKER_00 8:25

I mean, I have s I've had many patients ask for a cortisol test and it's never positive.

SPEAKER_01 8:31

But well, I mean, statistically, based upon the fact that you said two to eight people per million. Statistically that makes sense.

SPEAKER_00 8:40

But I mean, if I have people that are really gung-ho about getting their cortisol checked, I who am I to stand in their way? Oh, we throw it on there sometimes. And I mean, then it's like a good piece of data. Say, see, look at this is not a cortisol problem that you are dealing with. So um anything else in cortisol?

SPEAKER_01 8:56

Uh I mean, that's a classic. I mean, that's I I love the fact that's at five because I would honestly put that at one.

SPEAKER_00 9:02

That one is so you know, it's funny because I think what you see you I think your list would be different than my list because I think what you see on social media is different than I see practically in the clinic sometimes. I can do that. Like people I think that people have the same questions, but I think their focus is in a different order.

SPEAKER_03 9:21

Yep. 100%.

SPEAKER_00 9:22

And just because we're doing it in this order does not mean we think one is more important. That's right. All right.

SPEAKER_01 9:28

Number four, I'll let you do this one too, because this is this is the one we we've we've had uh other medical professionals on this podcast for this exact conversation. Low T does not explain everything, and TRT is not the end all be all fix. TRT being testosterone replacement therapy. Um we if you have more detailed questions on that, um we had a podcast with the medical director of Game Day Men's Health Clinic with Dr. Treesenberg, um, talking more of the details on that all. I'm on TRT myself. And I can tell you one myth off the rip that's always super important to know. Uh they think just because you're on TRT, which does help with main like increasing testoster increasing uh lean muscle mass when you strength train and do all these things, uh, I still eat plenty and I have not lost that much body fat. So this idea you're just gonna get jacked and shredded from being on TRT, not the case. You're like, shoot.

SPEAKER_00 10:32

But I do think um, I think a lot of men do think, well, I'm fatigued, my sex drive's not quite as what it was. Um yeah, my muscle mass isn't what I want. It must be testosterone. And it can be on the I what I find in those cases for all people, it's like on the lowish side of normal. And so a lot of times people are like, oh, see, it's the low side of normal, kind of like you said on cortisol. And then the then the conversation is, okay, if we replace replace that, is it gonna make any difference? Or are your symptoms because you're not sleeping well, you're stressed, your diet's not great? Like, are there other reasons for those symptoms?

SPEAKER_01 11:15

Well, it's it's like in my case, my scenario. Like, in general, I'm pretty compared to the general population, uh, the quality of food I'm eating, the sleep quality I'm getting, the strength training routine I have is better than most. And yet I was having these weird ten o'clock anxiety feelings. I was having these types of issues. Um the strength I was having in the gym was kind of meh. I was losing kind of that morning getting after it. Um and there's a lot of potential reasons why that's true. One of which I had been tracking my testosterone for three plus years and watching it drop considerably. Um and so there was the hypothesis, but even me, when I first uh got connected with Game Day, I didn't want to do TRT because like what that kind of equates to and all the long-term. Exactly, the the commitments and all this kind of stuff. And so I didn't want it to to make a difference, but I've noticed it to myself. The um one of the big ones is I don't have those weird anxious feelings I had at 10 o'clock like I used to. Um and it wasn't necessarily because of uh the the magic of TRT being like you're gonna be able to run through a brick wall, this kind of stuff. I mean, yes, my energy is better, my focus is better, but it's you're lifting stronger, aren't you? Yeah. Yeah. Yeah, my my strength's up. Uh but again, it's it's up, but it's not crazy. Like even then, I my my t my total test is sitting around right around a thousand.

SPEAKER_02 12:53

Okay.

SPEAKER_01 12:54

And so like I'm not these people, these these guys that are just absolute meat sacks and power lift, they're they're going way above clinical high physiological levels.

SPEAKER_00 13:04

Physiological levels and so I think um so I think it's reasonable if you're a male and you feel these symptoms, go get it checked. But that doesn't necessarily mean it's the problem. It doesn't necessarily mean replacing or taking testosterone is going to be the same thing.

SPEAKER_01 13:21

What? Uh I pushed dad years ago. Oh yeah, you just on it. Yeah. Um I will Dad, I love you if you're listening to this. I will argue his nutrition and fitness behaviors from a strength and conditioning perspective could be better. He does a lot more rehab focused stuff, which I totally respect. I'd love to him to to little a little more little more hypertrophy work. Yeah. Um and all this kind of stuff, but he uh he did two different but he's also a a science guy. So he's done two different um rounds of I don't know if he did more than 90 days. I can't remember. I think it was like 90 days, and he found no real feeling difference. The only thing that changed was his PSA went up.

SPEAKER_00 14:07

Well, yeah, that does happen.

SPEAKER_01 14:08

Yeah, but other than that, like he said I did it twice for 90 days or whatever it was, and he's like, I felt no different.

SPEAKER_00 14:14

So why continue it? So why continue? I mean, so he tried it and it didn't do anything. So I think that's fine. Do you know? Like, so true hypogonadism, so where it's someone's body is truly not making enough testosterone, do you know what the percentage is in in men?

SPEAKER_01 14:30

True hypogonadism is probably seven to ten.

SPEAKER_00 14:34

That is approximately what it's it's estimated like two to eight, is what I read. So um, so it's real and it's not, it's definitely more prevalent than cushions, but then I'll also be the first one to say of that two to eight percent, uh, when we get into all of this, the idea of TRT and replacement, I was hype, I would had low testosterone my entire morbid obese life.

SPEAKER_01 15:00

Oh, yeah. And after losing 200 pounds, my tea, I don't have a baseline of what my tea. I'm sure this is pre-computers, so I'm sure my old endocrinologist, when I was 18, yeah. I don't have I don't know where it is, but I know it was low. Um and from that, losing the 200 pounds, my my nutritional behaviors, my fitness repair behaviors, my sleeping behaviors, my testosterone got back up to 660 almost 700, which is very middle of the road. No, it's very normal. Yeah, it's very normal. Oh, yeah, I guess it's normal.

SPEAKER_00 15:33

Well, do you know what is the single biggest reversible cause of low testosterone? No, it's actually abdominal fat and obesity.

SPEAKER_01 15:39

Okay, yeah.

SPEAKER_00 15:39

So I mean it makes sense.

SPEAKER_01 15:40

Well, because yeah, because because from the science side, yeah. Uh when you sleep is very high too. Sleep's high too. But from a science side, having having large visceral body fat in the stomach elevates estrogen. Elevating of estrogen decreases testosterone and it's a vicious cycle.

SPEAKER_00 15:58

Yep.

SPEAKER_01 15:59

So I I remember something.

SPEAKER_00 16:01

Good job. Anything else you have to say about testosterone?

SPEAKER_01 16:06

Um, no, I mean that's always a classic, which is like TRT and testosterone is not some friggin' hack that if your sleep quality sucks, if your nutritional behaviors suck, and just because you have a low normal T, like that that was like Dr. Treisenberg brought that up. Like it's fascinating what is you can't just treat the number. You have to treat the person and the symptoms. Some people that have a low normal feel completely fine and good. Some people who have a high normal go to mid, they feel like garbage. And so there is such a dance with this whole problem.

SPEAKER_00 16:40

I had a patient at residency. It was like an old man, and he had like legit hypogonatism, like he had multiple hormones that were low, and he had like a testosterone level of probably like 50. It was so low. And he was like, I feel fine. He had no concerns. Like, and I would always talk. I'm like, Do you want to like let's like work on these things? And nope, he he like didn't care. So fast. So it's like, you know, everybody's different. That's why you treat the person, not the number, David.

SPEAKER_01 17:06

Or or what is you do both?

SPEAKER_00 17:09

Well, I mean, yeah, but you get my point.

SPEAKER_01 17:11

I get 100% of your point. Like that was I was just like, wait, is that pivot to the other way? Yeah, that you probably treating the pure number to the optimization, and and it's like, well.

SPEAKER_00 17:25

Oh, that's funny. Um, okay, good on that one?

SPEAKER_01 17:28

Yes, and I think number three is up your eye.

SPEAKER_00 17:30

I'll take it because this is actually something that I feel like is becoming more talked about or more brought up by patients. And yes, you probably don't get fed this type of things. So um it is women in their later 30s, mid to late 30s, thinking they're in perimenopause. And now, when I say this, I am not saying you cannot have perimenopausal symptoms in your 30s or you can't go through menopause earlier than some people, but the percentage of people that are gonna have perimenopausal symptoms in their 30s is much lower than I what I see being promoted on social media. Gotcha. Um, so the average age of menopause is do you know what the average age of menopause is?

SPEAKER_01 18:10

We've talked about I just saw it 40 to 55.

SPEAKER_00 18:14

Yeah, and uh women have perimenopausal symptoms like for, you know, sometimes four, uh five to eight years. And so if you think average age is 51, eight years prior to that, okay, early 40s is a very common time uh to start perimenopausal symptoms. Now, there is uh a condition called primary uh primary ovarian insufficiency, which is when women start having um some of the menstrual changes of menopause earlier than age 40. And that is its own condition in and of itself, and that is treated in a specific way with hormones. But the vast majority of women are gonna go start going through perimenopause in their mid-40s. And so if you feel like you have some of these symptoms that you've heard are perimenopausal, I'm not saying don't go talk to your doctor about it. I'm just saying there are other sometimes other reasons for these symptoms. It's kind of similar to men, where it's a lot of these vague, like I'm fatigued, I've got brain fog, um, my energy levels are low, I'm not sleeping well. Could that be perimenopause? Yes, but couldn't that be how many other problems?

SPEAKER_01 19:24

You have family stressors, you have this, you yeah, like there's a million of things it could be.

SPEAKER_00 19:29

There's a lot. And so um just assuming or thinking it must be perimenopause, I wouldn't run to that initially. That's just what I have started seeing and I've had patients ask me about. And so I think it's important to know kind of some of the actual physiological, like what is a normal physiological change, and that will help you guide your conversation with your physician if you are listening to this and wondering about it.

SPEAKER_01 19:52

Noted.

SPEAKER_00 19:53

So that sound good?

SPEAKER_01 19:55

I like it. David had little to ask about that one. I got nothing. I cheated on my own question.

SPEAKER_00 20:01

Yeah, you did. All right. Um, then moving on to the next one. This is also for me.

SPEAKER_01 20:07

Yes, actually, these last ones probably are all are but the third the the number one I can work.

SPEAKER_00 20:11

I know, I know, but more. Um, this is so common and this is controversial. Uh, so it is asking, make requesting, I guess it's more the need to have your hormones checked if you think you're going through perimenopause or menopause. So, and I was actually on a panel, a menopause panel uh two years ago, I think, that this question got asked by the audience. And so I was one of the physicians that talked on this, but there was a physician next to me who is a very um known functional medicine physician in the area. And she and I both gave our answers because I even said it when I started, we're gonna have different answers on this because uh functional medicine does not agree with me on this. But the thing with perimetopause is you're going to start having erratic hormonal fluctuations. It's not gonna be nice up and down like it had been for 30 years. Um, but if you are having erratic hormones, sometimes they're up, sometimes they're down, they're not in a great pattern. If you check hormone levels on a specific day, is that gonna give you much information?

unknown 21:20

No.

SPEAKER_00 21:21

No, because it could be completely normal or it could be way off the charts, but it's just one point in time and you don't know what's happening the rest of the month.

SPEAKER_01 21:30

That's always a very important argument in certain angles, which is remembering blood work is a snapshot in time of your body, of your blood in that moment.

SPEAKER_00 21:43

Well, I will push back on one point on that. There are some labs that give you a well like A1C. Yeah, that's the most common one.

SPEAKER_01 21:49

But yes, I beat your aha.

SPEAKER_00 21:52

But you're the one that said it. But yes, I think um, and here's the thing I this is the example I use. You're not Hi, girls. So I get that this is never something you've thought about. But for women, when they're 12 or 13 or 11 or whatever age, they start having menstrual cycles. Does their mom rush them to the doctor and say, She started bleeding? Can you run some hormone checks to make sure she's going through puberty? No, because she's 11 and this is normal. And so you're like, okay, this is what we expect. And that's that. So it's very similar at menopause that okay, your hormones, you're at the right age and your symptoms are consistent with perimenopause and menopause. Why do we need to check the levels? Now I'm not saying you can't ever check them. I actually have checked them for many patients that are, they really want to know their hormones. And I'm like, okay, here, I'm going to explain to you why I think this is or is not helpful in your situation. And then if they still want to proceed with it, okay, we can do it. Just they have to understand that the information may not be that useful. And sometimes we still do it. And a lot of times they're like, oh, I guess that makes sense. I guess I don't need to do it. That's most commonly what happens.

SPEAKER_01 23:07

So yes. Because like, because oftentimes from your standpoint, someone's having symptoms of perimetopausal metapuse. They're they fit the they fit the narrative. Their blood work, their estrogen and blood work comes back completely normal.

SPEAKER_00 23:22

It doesn't tell you anything.

SPEAKER_01 23:23

Doesn't tell you anything.

SPEAKER_00 23:24

No, and even if it comes like abnormal, you're like, well, you're probably in perimenopause. I mean, like, what else? Like, what do you I I guess I'm the people that do this more, like, what are they hoping to, I guess, find out from this data? I don't know.

SPEAKER_01 23:35

Well, it's like always the classic, it's very similar to the argument of I hurt my shoulder playing tennis. And now they're like, Well, I want an MRI.

SPEAKER_02 23:47

Yeah.

SPEAKER_01 23:47

And it's like the MRI is only going to tell you in a 99% certainty that 99 of 100 people, you're just going to have to go to do rehab because it's not surgically relevant. Right. And so why you might as well just do the rehab. And if it ultimately needs surgery, you cross that bridge where you get there, but nine times out of a hundred it doesn't. So save yourself the the three thousand bucks for an imaging scan. Or you can save about seven, you can save like a thousand to two thousand dollars by going to the imaging center, John Rumquist. Love you. Uh and but that whole thing, it's like just do the rehab.

SPEAKER_00 24:26

Like more testing and more imaging is not always the answer. But it could be. But it could be. Well, and I and also I'm not saying there's not legitimate reasons to test hormones. There certainly are. Going back to our last point, if you are having true peer menopausal symptoms prior to age 40, that is a legitimate reason to check. Um, but usually you need more than just one test as well. Um, and similarly, we don't check hormones to adjust hormones. So, what I mean is if we're giving women menopause hormone therapy or let's say birth control for their menopausal perimetopausal symptoms, we don't need to check their levels. I always hear that too. Like, I have a lot of patients that come in, my doctor put me an estrogen patch and they never checked the levels. And it's like we don't actually need to do that because we are using the hormones. What we're supposed to be using the hormones for is your symptoms, not the number. The only time we often will, or sometimes we'll check it is if we want to make sure their body is absorbing or getting the right amount. So Jana, interestingly enough, had a patient that had been on estrogen.

SPEAKER_01 25:34

Remember, I heard this.

SPEAKER_00 25:35

So she'd been on estrogen for a while from another provider. I don't know what type of uh I don't think it was a patch.

SPEAKER_01 25:41

I don't know what it was it was uh it was compounded pharmacy uh sub Q.

SPEAKER_00 25:46

Okay. So David has heard the story.

SPEAKER_01 25:48

So she was getting this and she just it was not sub Q, it was just that's subcutaneous. It was just on just Oh, like a a cream.

SPEAKER_00 25:57

It was just a code. Oh, okay. Yeah, I don't remember. But um and so Janna was working with her and she just didn't, she still didn't feel good. She had all these symptoms. So Janna was like, well, why don't we try the actual FDA-approved medication, not a compound aversion? Let's put you on a patch with a progesterone pill and let's see what happens. Um oh no, I'm getting the story wrong. Shoot. She started by first checking her hormones. So this was a legit, this is where this came from. This was a legit reason to check hormones. Like she's been on this estrogen, she's not feeling great, she's having these symptoms still. So let's check your levels. And guess what? Her estrogen level was non-detectable. She is taking estrogen. She should have detectable estrogen levels. Like that's the point of taking the hormone. And she wasn't. So Jana switched her to a patch, the FDA-approved patch. And guess what? She feels great now, and her hormone levels are up. Yeah. So that was a good use of that lab test.

SPEAKER_01 26:52

Yeah, and this is the classic practice, has a population of this, just because they people, for some reason, have this weird notion of being anti-establishment. Whatever the whatever the established process is, we don't want it. Like, we don't want it. So even though I want my estrogen, I it can't be in the patch format, the FDA approved. It has to be through this unique way that my functional doctor is doing it this way because he says it's better. Well, they always I would argue, where is their evidence to say it's better?

SPEAKER_00 27:24

Well, I know. Well, that's the thing. There isn't any. Um, and interestingly enough, a lot of those people are like, well, I'm getting it through my functional doctor, it's the bioidential type. And the funny thing is, there's a lot of FDA-approved bioidentical hormones that we use. Like that's what I typically use with my patients. So if you're out there thinking I can't get bioidentical hormones by going to my normal doctor, that's not true. You don't need to go to a functional or similar type physician.

SPEAKER_01 27:51

I don't want to sit here and just harp on only functional.

SPEAKER_00 27:54

No, I just, it's just they commonly do do that. So um yes. So I think that's plenty on hormone therapy.

SPEAKER_01 28:03

Noted.

SPEAKER_00 28:04

And women. So David's like, oh, okay.

SPEAKER_01 28:06

We got through the women stuff. I I can come back to the table. I was I was pretty I was pretty You did great.

SPEAKER_00 28:12

I was great.

SPEAKER_01 28:13

I was helpful.

SPEAKER_00 28:15

All right, number one. To me, this is my most common.

SPEAKER_01 28:19

Oh, 100%. I think I I think I can't tell you how many patients recently have been talking about this.

SPEAKER_00 28:24

I mean, patient, I mean, since I've been practicing probably in a residency, people were asking to have their thyroid checked.

SPEAKER_01 28:30

Which thyroid is the metabolism hormone. And if I'm fat, there's only one reason low thyroid. It's not because I eat too much fast food. It's not because I don't sleep sleep from 4 to 10 p.m. It's not because I drink too much alcohol. It's not because I my sleep quality sucks. It's because my thyroid.

SPEAKER_00 28:51

And I think the reason, I mean, I don't know why exactly, but in my mind, some of the reasons would that people want this check so much is for one, there is a lot of people with legit hypothyroidism. It's not an uncommon problem. And there's many people that have this and have to be on meds for. Um, and second, if you have hypothyroidism, it's very easy to treat. You take thyroid hormone and you're better. Now, a lot of and we know that hypothyroidism can lead to weight gain. And so it's not unreasonable to think if you're feel like your weight gain seems odd or unusual to get it checked. But the amount of people that think that must be the cause of my weight, it's it's always amazing. And I think it's a lot of people just it's an easy fix if that's the problem.

SPEAKER_01 29:37

I get it. I do the same thing with insulin back in the day. I die called it's it's it the people, I totally understand. Just like I can't tell you how many episodes we've we've had on this with finding the current vogue fear-mongering thing. Um if one thing is we have to understand about medicine and and the human physiology, it is ridiculously complex. We've learned quite a few things.

SPEAKER_00 30:05

It's very complex.

SPEAKER_01 30:06

This idea that's a w it's it's one thing. These grab bag of symptoms, it's your thyroid. These grab bag of symptoms, it's cortisol. This grab bag of symptoms, it's insulin.

SPEAKER_00 30:17

It's like Well, you know what's interesting is like all of these topics we've brought up and talked about.

SPEAKER_03 30:23

It's always the same symbol.

SPEAKER_00 30:24

It's always the same symptoms. It's the same thing for each. And so it's like you can have all these symptoms to be like, oh, it must be a grammar cortisol, have the same symptoms, oh, it must be my thyroid, same symptoms, oh, it must be my estrogen. So it that's so fascinating. Depending on who you're listening to, you're gonna think it's one problem. 100%. Or all the fixes are often the same, right? Sleep, stress, nutrition, exercise, as you've brought up multiple times. Let's focus on those.

SPEAKER_01 30:51

Absolutely.

SPEAKER_00 30:52

Not to say that you can't have these problems.

SPEAKER_01 30:53

And that's the whole thing. It's like it's this this whole the whole angle of this with the top five is not to say that none of these are problems.

SPEAKER_00 31:02

Where they should never have any of them checked.

SPEAKER_01 31:04

Correct. It's just that nine times out of ten, based upon I I didn't know cushions was that rare. I mean, it makes sense.

SPEAKER_00 31:10

I mean, I have never had a patient with cushions.

SPEAKER_01 31:12

Yeah. It's and so you sit there and go, is uh the odds that it's your c actually your cortisol is extremely low. We can do it. That's fine. But it's probably not. Yeah. Same thing with thyroid. What is the what is the uh prevalence of thyroid?

SPEAKER_00 31:27

That's a great question. I can find out in two seconds. Wait for it. Wait for it. Okay, it depends. Okay, are we talking the US? It is uh the cause of hypothyroidism is much different in other countries in uh other countries than in the US. Really? Because it like iodine deficiency is. Like that's not a big problem that we okay.

SPEAKER_01 31:56

In the United States, I've heard so many health gurus on the internet talk about how it's bad to have iodine salt. It's hysterical.

SPEAKER_00 32:04

I'm gonna keep using my iodine salt, but uh that's a topic for another day. Um, approximately 4.6% of the population over age 12.

SPEAKER_01 32:12

That's sick. I said seven. I'll respect that.

SPEAKER_00 32:14

I mean, yeah. So um so there you go. It does happen. And I mean, I have plenty of people on thyroid medication. Um, you know what I did that I thought would be kind of fun at the end of this? So I went to Instagram and for each of these points, I like wrote the main word down. It's like cortisol. Uh menopause hormone testing. Because I want to see like what is the first thing that the first reel, the first post that comes up. You want to know? Okay. So uh let me find it. Okay, cortisol. The first post that came up was a reel. Um, and it's uh it's telling you that cortisol is your natural stress hormone. Okay. Um, and it says point of view. You realize that being sleepy during the day and wired at night is the result of high cortisol, contributing to acne, anxiety, mood swings, and extra weight around your belly. And there's a fix.

SPEAKER_01 33:10

Oh, and I'm sure. The fix is buy my product.

SPEAKER_00 33:14

It was like DM me. Yep. And we'll talk more.

SPEAKER_01 33:18

Let me tell you these generic grab bag problems, and I'm gonna sell you a solution by saying one scientific word.

SPEAKER_00 33:24

Yep. So um, and that was um That was cortisol.

SPEAKER_01 33:29

That was cortisol. What was what was the what were they selling?

SPEAKER_00 33:32

You know, some of these are like you had to like dig, and I didn't go that far. I respect it. Um, the next one, what was number four that we did? Yeah, low T cortisol. Oh, testosterone. Oh, I did these in the wrong order, but that's fine. Okay, uh, I did the parimenopausal symptom one. Yep. Um, and it lists all these symptoms, right? It's like feeling low, heart palpitations, 3 a.m. wakeups, unexplained weight gain, joint and muscular pain, loss of confidence, sudden rage, hair loss.

SPEAKER_01 34:01

Loss of confidence, okay.

SPEAKER_00 34:02

Yeah. So um if you have all those things, like obviously you must be paramenopausal, is what this woman is telling us. And guess what? You can join her masterclass to learn more.

SPEAKER_01 34:15

Yeah. So go and see a physician. Go on my online kid.

SPEAKER_00 34:20

And then it was like, look at all these ways you can work with me.

SPEAKER_01 34:23

Yep.

SPEAKER_00 34:23

And pay me money. Classic. Just you know.

SPEAKER_01 34:26

Rab bag of symptoms to pull people in, to hook them, and then to sell them on a product or whatever they're doing.

SPEAKER_00 34:31

Uh, for the thyroid one, this one wasn't all that interesting. It was like somebody talking about checking your thyroid. I it wasn't terribly awful. So that's good. Moving moving along from that one. Um, and then checking hormones in menopause. It was this like medical clinic in Ohio, it was the first thing that came up, and they're like, your doctor tells you they won't check your hormones, but we will, and we'll run this 68 hormone panel test.

SPEAKER_01 34:57

Oh, I'm sure they do. I'm sure you have to pay them for it.

SPEAKER_00 35:00

$17.99. I bet it's more than that.

SPEAKER_01 35:02

Oh, $1,790.

SPEAKER_00 35:04

Oh, okay. Yeah, more like that. Um, so that was that one. And then testosterone. Actually, the first thing that came up when I type in testosterone with a female talking about female related issues with low testosterone. So, um, because that can be a thing. But, anyways, so the first male one that came up was six signs your testosterone is dangerously low.

SPEAKER_01 35:27

Of course, I gotta use the word dangerously.

SPEAKER_00 35:29

And then he talks about a lot of the vague symptoms like uh hair thinning, can't build muscle, stubborn belly fat. I truly couldn't figure out what this guy was like the point of his Instagram page was because like he didn't really go anywhere. Hold on, I gotta, I'm actually not on it. He looks like he was like a physician from India. At least that's kind of what it appeared. Wait, I gotta pull it up again. This guy uh right there.

SPEAKER_01 36:02

Never seen him before. Interesting.

SPEAKER_00 36:07

So I don't know what his purpose is.

SPEAKER_01 36:10

I think it's just general medical content. Actually, honestly, he seems like a straight shooter.

SPEAKER_00 36:15

But what I don't like about his post is this the signs your testosterone is dangerously low. Like, men should be worried about dangerously low testosterone. Like, I have never been worried about dangerously low testosterone. Remember, I had a guy with a level of 50 that was coming along just fine. I'm not saying that was ideal, but I just think that's very fear-mongering. Oh, 100%. And I think that's where people get confused is all of this messaging.

SPEAKER_01 36:44

Social media sensationalizes data or sensationalizes narrative.

SPEAKER_00 36:47

It's sensationalizing, or it's trying to sell you something. And it's no wonder people don't know what they're supposed to be doing. Because this is where this phone is where people are getting information from. So I thought that was kind of fun.

SPEAKER_01 37:00

I love it. Well, hopefully you guys got some good context into the reasonable questions behind some of the main hormones. Um, if we didn't hit a hormone that you guys have questions on, there are more out there. Definitely more. And so if you guys want to comment down below or give us a uh a message, we would love to hear about it. We can do a future episode on it.

SPEAKER_00 37:18

Or if you're an endocrinologist out there that wants to come on and talk more specifically about one of these hormones, we would love to have you.

SPEAKER_01 37:24

I like that. And uh yeah.

SPEAKER_00 37:27

Love it. And remember, none of this is medical advice. Please seek the care of your own physician if you have questions.

SPEAKER_01 37:33

It's important. It's important to know that doctors are held to a higher level of medical legal ramifications than your fitness influencer on Instagram.

SPEAKER_00 37:43

Do remember that.

SPEAKER_01 37:45

You all have a phenomenal day, and we'll talk to you all later.