This is a segment of the conversation from the UnCut podcast, “Hormone Optimization with Dr. Alexandra Mayer” about how to know if you’re getting good labs.

If you feel like something is being missed, you shouldn’t brush that feeling off.

– Dr. Mayer

In this blog post, Dr. Tom and Dr. Alexandra Mayer of Ethos Integrative Medicine continue their conversation about hormone optimization. This is the second part of their conversation. In the first part, “Hormone Optimization: When “normal isn’t good enough,” the doctors discuss where lab work reference ranges come from and how getting “normal” results doesn’t mean optimal and that there’s nothing to improve. In this post, the doctors discuss how to find out if your provider is giving you the full story that your labs are telling and what to do if you’re still not getting better.

Dr. Tom

How does someone know [if their doctors are telling them that their labs are normal but aren’t telling them that they’re not optimal]? How does the everyday woman or everyday person know if they’re speaking with someone who is running the right labs? I think that’s a big part of it, right?  Do you have any advice for someone who might be in that situation where they feel like something’s being missed?

Dr. Mayer

I think if you feel like something is being missed, you shouldn’t brush that feeling off. Like if you are going somewhere and you’re like, hey, I still don’t feel very good. You shouldn’t brush that feeling off.

One of my patients who had been to a ton of doctors before showing up in my office had an inkling that she was being blown off to some extent. Or she wasn’t being told something. Sometimes you think, “Well it must just be me,” or “I’m crazy,” or “They all think it’s in my head,” etc. 

I’m not about just jumping ship to another doctor. I have a hard no poaching from other doctors rule. I just think that in medicine, that’s bad care for the patient. And it’s bad juju. 

However, I’m all about empowering my patients to have a conversation with their provider and say, “Hey, you know what, I still don’t feel very good.” And then if that provider comes back with a whole bunch of the exact same nonsense that they’ve been giving you, that, to me, is an open invitation to start to look for another set of information. If you’re not feeling good and your provider is just doing the same things over and over again, then it’s time to look for a different route.

Now, there are times where patients think that hormones are going to be the cure, right? Weight loss is a great example in my office. Patients want to get on thyroid, and then by next month be down 50 pounds. Yeah, I wish it worked that way. There’d be a line around the whole wide world if it worked like that. It doesn’t.

The way I explain it to my patients is basically like this: you’re walking down a path toward your goal, and there’s this big giant brick wall in front of you. Nutrition and exercise is what’s walking you down this path, your lack of hormone optimization is the big giant wall that’s in front of you. So you have two choices, you can either use nutrition and exercise to scale that wall, which is going to be way slower, and way harder, but you could do it. Or you can knock down the wall and continue walking. If you knock down the wall and don’t do the nutrition and exercise portion, you’re still going to be standing still in front of the wall that you knocked down. You’re not going to go anywhere.

There are times where patients will come in to my office, and they’ll be like, “Look, we did the hormone optimization and I’m not losing weight.” And I’ll say “Yes, because we haven’t done any of the nutritional piece that I’ve recommended. I have suggested this and this and this. And those are the next steps.” That is not the same thing as not giving the patient a next step. That’s not the same thing as giving you the same, “Oh, I just don’t know what’s wrong.” There is a different component to that. Because sometimes we stand in our own way, myself included.

Dr. Tom

How does someone even know when the experts are telling them something that’s incorrect, or how do they know that they’ve had good labs? 

Dr. Mayer

That’s a really good question. I think if you are looking at it from a hormonal perspective, so if I was not menopausal, I’m pre menopausal, i.e. still having a period and they ran estrogen or progesterone, I would ask these questions:

  • Did they tell you to run those on a specific day? 
  • If you’re on birth control of any type, did they tell you that it’s probably useless to run it? If not, then I would say you didn’t have good labs run. 
  • If you’re a thyroid patient, I would look and make sure that they ran more than just TSH. A good thyroid panel should have TSH, free T3, free T4 and thyroid antibodies as a bare minimum. If you’ve had thyroid antibodies run in the past and they’ve been normal, they might not include those, but they should at least include the other things. And then if you’re really the picture of thyroid dysfunction, and everything is quote, unquote, normal, then they should have added a reverse T3 in. 

So if you don’t have those things, you’re not doing very good. And then if you’re menopausal, you can run estrogen, progesterone at any point. But if you’re not on medication, there’s no point in running them. The definition of menopause is that estrogen and progesterone are low. That’s the definition. So we don’t run things that are unnecessary. 

Versus if you’re medicated, then they will run estrogen, progesterone, but they should be running a testosterone and a free testosterone because that really matters. The free testosterone is actually what’s active and available and ready to do the work. Your total testosterone, some of its bound up by sex hormone binding globulin and put into storage, so to speak. And then they should be running things like insulin, and hemoglobin A1C which is blood sugar regulation, they should be running things like a high sensitive CRP, which checks for inflammation in the small red blood vessels for cardiovascular disease, because all of these things we know as we go through menopause these things shift. Estrogen shifts, insulin tends to rise, abdominal weight rises, cortisol rises, thyroid dysfunction rises. So we need to start to look at the entire picture. Right? So it’s not about just one thing. And I think that too many patients are just like, well, I’m on estrogen replacement. So all the red is my estrogen.

Dr. Tom

You kind of just hit it on the head. You obviously have the background, and you know all the labs that are supposed to be run.

To learn more about the kinds of issues hormone optimization can treat, look out for the next and third installment of the UnCat Podcast episode, “Hormone Optimization,” or listen wherever you get your podcasts.