Hormone Optimization: When “Normal” Isn’t Good Enough
This is a segment of the conversation from the UnCut podcast, “Hormone Optimization with Dr. Alexandra Mayer”
Today, I have a very special guest, Dr. Alexandra Mayer of Ethos Integrative Medicine. I think that hormone optimization is a very overlooked part of the healthcare industry. And I’d love to just have you shed some light on that for people today.
Yeah, absolutely. I think it is very overlooked. And I think it’s something that a lot of patients know or have an inkling that they might need help with, but when they try to get help, it goes nowhere. And that’s the most frustrating part about hormones: you have to have somebody who knows what they’re doing and who actually is willing to take a look beyond the face of the issue in order to get the answers that you’re looking for. And it plays a role in everything. It plays a role in sports medicine, it plays a role in literally everything.
Absolutely. And there’s so many components to it and needing very comprehensive labs is a big part of that. Right? And a lot of people don’t get that that’s kind of the first step.
The Importance of Comprehensive Hormone Labs
Right, 100 percent. Comprehensive labs and run at the right time and on the right day. So if you’re postmenopausal it’s a little bit easier. But generally running hormone labs for women can be difficult. If you have a man walk in the office, you can run testosterone any day of the month, just please run it at the right time of day. With women, it’s this complicated process of counting back from your cycle and asking, “Are we here? Are we there?” And then the minute you decide to run it on that day, the cycle’s like, “Oh, this week, I’m going to be different. This is what I’m going to do this month.” You have to have it right. And I can’t tell you how many times I have patients come in with labs, sometimes even from an OBGYN who you’d think would get it right, and I have to say, “Cool. What day of the month did they run this on? Oh, any day? Okay, now they’re useless.”
There are obviously a lot of intricacies, which is what makes you the expert. So I’m excited to get into that with you today. You mentioned that one of the things that you love shedding light on is there’s a lot of people out there who are thinking or feeling like their hormones are off or that something’s off. What are the types of things that are happening to people who maybe have been led to believe are just “normal.” They’ve been told that everybody’s supposed to feel the way they do… until they come to you and find out that in fact those feelings are not normal. That these are things that can actually be addressed.
Yes. Whenever you go to a doctor, and a doctor says, “Well, you’re just–insert age here.” So something like, “You’re just in your 40s now, and this is just what it’s like to be in your 40s.’ As if when you hit 40, this button goes off and all of a sudden everything falls apart. That’s a lie. We don’t have to go down that path. For most women, it starts with low energy, low energy is the number one thing I see in my office. Weight gain is number two. I mean, the majority of women are coming in, they definitely are like, “Look, I’ve gained like 15, 20 pounds, I don’t know, I’m doing all the right things, but I can’t get it off.” Women don’t complain of this, but they often have decreased strength and endurance. It’s not something that they realize that they have until they’re like in the office, and we’re talking aboutit that they notice they haven’t been able to do as much lately.
Yeah, they can’t do as much or they just feel like like their muscle mass is declininga little bit, right, a little bit softer, getting softer like that.
Yeah, I always preface with something like, “Well, how’s your muscle mass?” And they’re like, “Well, it’s not very good. But you know, I’m not working out as much as I used to be,” and blah, blah, blah, blah, blah, all the things that we like, quantify our issues with, but in reality, it’s oftentimes hormonal.
And then there are hot flashes, night sweats, some of the menopausal symptoms. For those, women come in a lot faster because we’re conditioned to think, “Okay, this is a symptom that I don’t have to live with,” because we have enough education around that piece. But the rest of it, I think women are just told, “Well, sorry. That’s it.”
Like, “That’s your lot being a woman.” What are some of the cases that you can impact the most? Tell us about a certain individual or case that you love and how have you helped that person to live a more optimized life?
A Typical Patient Story
So my favorite patient is the patient that’s been to every single doctor, they have labs run and everything is, quote, unquote, normal. If you feel terrible, and you want to come to my office, and you have all the labs run, and everything is normal, you are like my favorite patient in the whole wide world. Because I can tell you that it’s not normal. I can’t count the number of women where they’ve come to my office, like I’m thinking of a specific woman. She had been everywhere. She actually had heard about me through multiple different people at this point. And I think it took her like six months to get to my office, which is pretty common.
When she sat down, she said to me, “Look, I’m gaining weight, I have low energy, I’m not feeling very good. My libido is crap. And I’m just not doing very good. But I’ve been everywhere and there’s no answers. I had labs run,” and she puts them down in front of me. These weren’t even good labs. I can’t even say they were comprehensive. I can’t say anything about them.
With the amount of labs that were run, I can say her TSH was abnormal. And immediately I said to her, “Has anybody ever mentioned your thyroid?” She looked at me, and she literally turned up and said, “I’ve been telling everybody about that. Nobody will listen.” And it’s because TSH, thyroid stimulating hormone, is a signaling hormone. It comes from the brain, and it signals the thyroid. So basically, the analogy I use with my patients is that it’s the brain telling your thyroid to do its job. So if you have a child and you’re telling your child to clean their room but they don’t listen, you don’t stop telling them. You’re not like, “Alright, cool, they didn’t listen.” You’re like, “Clean your room,” “Clean your room,” “Clean your room,” and your brain does the exact same thing. It says to your thyroid, “Hey, can you do your job?” “Can you do your job?” “Hey, dude, I still need thyroid hormone, can you please do your job.” And so TSH actually rises as your thyroid function declines, which confuses a lot of people. The conventional ranges go to 4.5. And I will tell you that conventionally, doctors will close their eyes to the problem until 4.5, when you’re officially out of the reference range, and then they’ll probably, maybe, start totreat you. This is opposed to trying to keep you within a good range.
So what I know is that with a TSH above 2.5, my patients start having symptoms. Above 3, they feel absolutely terrible. And doctors are going all the way to 4.5. We’re letting it get all the way to 4.5. We’re waiting. We’re making you wait. And with her, her TSH was 3.3. What I explained to her was that the research that I usually use with women actually comes out of fertility research. Because we know that a TSH above 2 greatly impacts your ability to ovulate and affects your fertility.
So what’s interesting is that in the metabolic world, we’re like, “Suffer. You’re good, right?” But then in the fertility world, anything above 2 and we will medicate you to get you below that level because we know that your outcomes are better. And so when I explain that to patients, patients are always like, “Well, that makes no sense to me.” And sure enough, she felt better by our second visit.
Since then, we’ve dove a little deeper into labs and we’ve run things like testosterone and her testosterone was completely in the tanks and this poor woman, she exercises three times a week, she actually strength trains and she was finding that she was like gassing out. The workouts that she should be able to do, she wasn’t able to do anymore. And so we’ve gotten her now to the point where she’s doing that. And then we added in a nutrition component, and she’s losing weight, and she’s feeling better. She’s feeling more confident. And I think those kinds of cases are my cases, because you shouldn’t have to suffer just because there’s, “nothing wrong,” quote, unquote, when there is.
Where “Normal” Hormone Ranges Come From
We’ve talked a lot in the past about having “optimal ranges” versus what Western med will call “normal ranges,” right? Normal versus optimal. They’re quite different.
It’s so different. So the way we get lab values in this country is that we take a subset of the population, and we get averages, we don’t actually know if they’re healthy, we don’t look at if they feel good, we don’t look at if they’re on additional medications, we don’t look at if they have like, for example, for testosterone, we don’t look into if you are a pre-diabetic. We’re not looking at the bigger metabolic disease picture, right? Or even, if you are the picture of good health at this level of testosterone. We don’t look at any of this.
Oftentimes, you have to go a while with testosterone outside the reference range. But with thyroid, you need to keep it really narrow in the reference range. Right where you want it to be. If you have somebody who doesn’t use the word optimal when they’re looking at your labs, you don’t want them looking at your labs. You don’t want them looking at the majority of it if they use the word “fine.” You should have optimal.
Listen to the full conversation Dr. Tom has with Dr. Alexandra Mayer on the UnCut podcast episode, “Hormone Optimization.”