The Ultimate Guide to Revamping Your Thyroid Health with Dr Amie Hornaman & Dr. Jenn Simmons

Hi there, it's Dr. Jen, and welcome to another episode of the Keeping Abreast podcast. I am delighted to bring you someone today who has literally revolutionized the world of thyroid of metabolism, and she is changing lives for so many people and solving problems. And it really started, like most of us, when she had to figure out how to solve her own problem. So I am talking about the great Dr. Amy Horneman. And Amy, welcome. And I'm just so excited to have you to have this conversation to talk about thyroid in a way that we're not talking about it because it is truly an epidemic to talk about testosterone because women are not talking about testosterone. And I don't know why they're not talking about testosterone, but we need to have the conversation around testosterone. So welcome, welcome. So happy to have you here.

Thank you. Thanks for having me. I know we had such a good time on my podcast with you and you're. Oh, my gosh, your message is such a hit. So I know that our audiences really resonate with all things women's health and hormones and thyroid and, and yeah.

So start us off by telling us how you got to be such an authority in this place. Let's. Let's hear your pain purpose story, because it's a good one.

And that's exactly what it is. It's. It's like so many of us in this space, when we go through something ourselves, then we realize, oh, there's a need. If I went through this, then other people are going through it too. So my story started back in my 20s and I was competing in fitness and figure competitions, doing fitness modeling, and I had done plenty of shows. You know, I always had to diet down for them. I always had to be really strict. The chicken, broccoli, asparagus, that whole thing, going to the gym twice a day. You know, I was not naturally skinny, but I. I knew how to get my body into shape.

You knew how to torture yourself temporarily.

I did. I mean, we got the results. Crazy. We're all a little bit crazy in that, in that arena, but no, you're right. Just, you know, just enough torture to keep my muscle, lose the body fat, step on stage in a bikini. I mean, it sounds absolutely ludicrous when you say it out loud, but. But I did it. It was that challenge and, and I had done plenty of them. I knew how my body should respond. You know, this was just another show. So I was getting ready for it, working with the coach, had to do my weigh ins, check ins every single week. And this particular show Every single time I got on the scale, the scale would go up and I'm talking 10, 20, 25 pounds. After 25, I stopped getting on it because I just didn't even want to know anymore. And, and I really fell into, you know, yes, I went through the frustration, I went through the questioning of like, okay, maybe I need to eat less, exercise more, maybe it's me, maybe I need to do more. But I also went through like the self blame and okay, maybe it is me.

And I felt, can we back up? Does eat less, exercise more work? I mean, could you have eaten less and exercise more?

No. I mean, it literally would have been impossible. But I mean, really, this is how women develop eating disorders is when their body is, you know, one of the reasons why when their body's rebelling against them, you just, you know, you get into this, what can I do? What can I do? I'll do more, I'll do more. And I mean, I even see that with my patients. They'll try every diet, every program, every Instagram promise under the sun and it doesn't work. So, yeah, I mean, I could have tried killing myself a little bit more, but it wouldn't have worked. It wouldn't have worked because at the end of the day, I had a thyroid problem. And that's really what six doctors misdiagnosed me with. I went to six different doctors after the scale was going up. I was getting fatigued. I was feeling the self blame, I was feeling judgment by people at the gym. And my coach, you know, he's thinking, oh, she's not following what I'm giving her. She's just not doing it. But I really was, I was doing all the things. And so I started going to doctors like we all do and there's something wrong. And six doctors misdiagnosed me. I heard you're normal, everything's fine. I heard it's all in your head. And one doctor, I kid you not, told me to eat less and exercise more. And I was like, dude, you have no idea. Like that's, that's going to be impossible. And I don't even think that the doctors believe me. I went in with my diet and exercise regimen written out with a couple of them. And I don't, I don't think they understood. I don't think they believed me anyways, so I was really, I was medically gaslit for, oh gosh, a good year bouncing from to all these doctors. And then finally seventh doctor diagnosed me with hypothyroidism and Gave me a pill. So of course, I'm pumped up. I'm leaving her office, excited that I had a name for what was going on with me. And then I had a pill that was going to be the magic pill to fix me, and it didn't. So that pill was T4. I now know, because back then, I obviously did not specialize in the thyroid. I Now know that T4 only does not work. And that's why I didn't lose any weight. I gave that five months, five more months of my life wasted as I'm waiting for this magic pill to kick in. And it didn't work. So I started doing my own research and see, oh, wait, this T4, that's inactive. It's an inactive thyroid hormone. There's an active thyroid hormone called T3. There's another one called T2. I mean, hey, why aren't we looking at these active forms of thyroid hormone? So I went back to my doctor and had the discussion like we all try to do. Brought her in, articles, the whole thing. And she's like, that's not standard of care.

So.

So I don't do that. And I said, well, I'm going to find somebody who does them. And that's what led me to functional medicine. I found a functional medicine practitioner. I kept hearing this guy's name over and over again. I'm like, fine, okay, I'll go. I'll go. And, you know, he sat with me for 90 minutes. I got five minutes from all the other doctors, sat with me for 90 minutes, tested everything under the sun, drew out this Venn diagram of how he's going to fix me. And it worked. I mean, because you're looking functional. Medicine is looking at every aspect of your life, as your listeners know. I mean, we're looking at hormones, we're looking at thyroid, we're looking at my supplements, we're looking at my nutrition. We're looking at how even my. My stellar nutrition plan and exercise plan was basically kicking up my cortisol. And. And we're putting all of this together. And then the weight started coming off. I started getting my life back. So after that point in time, and I was in. As you'll know, I was in a major medical system. Like, I wasn't in Podunk, you know, nowhere. I was in upmc. I mean, that's equivalent to Cleveland Clinic, Mayo Clinic, all the top doctors, right? The best medical system in the world. And I was misdiagnosed six times. So that really led me to think, like, you know, what if I'm in this major city in a major medical system. Oh, my God. Who else is this happening to? I mean, it's. It's like it really is a pandemic of misdiagnoses of hypothyroidism and this treatment. So even if you get the diagnosis, you might be stuck on T4 only. So that's why I'm doing what I'm doing now.

Yeah.

Yeah.

Well, it's amazing. So I first want to talk about why, because, I mean, let's face it, we have an obesity epidemic, we have an overweight and obese epidemic in this country. Without question, we are actually infecting the world with it. Right. Because the more the rest of the world lives and behaves like Americans, the more they are suffering those consequences as well. And what we talk about a lot in my world is we know that there is a direct correlation to both the development and the progression of breast cancer and the recurrence of breast cancer. It's directly tied to adiposity, especially visceral adiposity, that weight that you're gaining around your waist, which incidentally is highly tied to cortisol. So can you talk a little bit about why eat less, exercise more, doesn't work. And what's that connection to cortisol?

Absolutely. So, you know, looking back at even pre issue, you know, pre expression of my hypothyroidism, even when I was competing and it was working, that kind of dieting is not good for your body at all. So ultimately, I was diagnosed with Hashimoto's, which is the autoimmune form of hypothyroidism. And we know that with any autoimmune condition, there's always a trigger and it's usually a stressor. So this is where we'll hear women say, you know, it was after my first pregnancy, it was after my second pregnancy, that's when everything went to hell in a hand basket. My symptoms came on. Yeah, because pregnancy is a huge stressor. If someone moves, gets divorced, all of that. A lot of times we'll see autoimmune express itself. So all the dieting that I was doing, which was essentially yo, yo dieting, I mean, yeah, we cloak it under, I was getting ready for a show, but you lose 20 pounds and you spring back 20 pounds heavier after the show because you basically plummeted your metabolism, deprived yourself for so long, crushed your body, killed your adrenals, and now, yeah, the weight's going to come back on. So I really, truly believe that it was the the yo yo dieting and all the shows that I did that flip that Hashimoto's switch to the on position. So number one, you have, you know, the excessive dieting of any kind. I mean, even if we're talking about, you know, a housewife that's trying to lose 20 pounds and she's doing every diet under the sun, that's a stressor. That is a huge stressor. And what we're seeing is people getting into these, these diet modes and really taking a toll on their body whether they lose the weight or not. I mean, some of them, some people are trying and depriving and intermittent fasting and doing every protocol out there that isn't working, but they're still adding to the stress of their body. So they're still taxing their adrenals, they're still pumping out cortisol for a short time until your adrenals absolutely shut down and then they stop producing cortisol, which we need cortisol. So we don't want that to happen. And all of that stress directly affects the thyroid. I mean, we know that there's an adrenal thyroid connection. And then I just explained how stress alone can flip the Hashimoto switch. So it's all tied together. It's like when we try to do these fad diets, long, intermittent fasts, it just, it ends up doing more harm than good.

Yeah. I mean, from an evolutionary standpoint, we are all designed to spend periods of time in a fasted state. There's no doubt that that's true.

Yeah.

What we weren't meant to do is cycle through fasting, you know, every month for a show or that kind of thing. Right. Like, we know that winter is coming and that there is going to be some point during winter where we feel evolutionarily ran out of food. And you know, that would be a very low caloric intake time for us that we would then replenish in spring and summer when food was plentiful, and even into fall. So we're all meant to have those periods of time, but we're not meant to do it every month.

Right. Every day. What about the people doing omacs every day?

Yeah, yeah, for sure, that's true. And so. And you can do it in the short term, right. Like your thyroid didn't quit on you when you, when you prep for one show or two shows or even three shows, but when you do this month after month, year after year, your body can only take so much. I was talking to a woman today and her Job requires her to be in at 6:00am, so you know, she gets up at 3:00am and she's been doing this for 12 years. And I said, yeah, you may think that you want to do this, but your adrenals do not. Your adrenals are like, I can't do this anymore. So we can only call on that stress response for so long and eventually it's gonna crash and there's gonna be ramifications. So I do want to move on though, to how. Why do you think we're having such a thyroid epidemic? I mean, I think I read it's one in four women now.

Oh yeah. Easily, easily.

What's happening there?

So I think with the autoimmune form, so we know that Hashimoto's makes a 95% of all hypothyroidism. So when we're looking at low and slow thyroid function, there's a really high probability, whether you've been told or not or diagnosed or not, that it is Hashimoto's or the autoimmune form. And that's when your body is essentially attacking your thyroid because it thinks it's a bad guy. Now from Alessio Fasano. Love this guy. He just puts it in such a comical way. But any autoimmune conditions, like a three legged stool, so you have the genetic predisposition, you have the stressor, like the trigger, and then you have leaky gut. So we all have leaky gut. And then if you have a genetic predisposition, you have autoimmune in your family, that's another leg of the stool, that third leg, that stressor, whether it's you're consuming gluten again, pregnancy, over dieting, whatever, even environmental toxins. So when we're talking about stress, we're not just talking about, oh, I have stress at work or stress in my relationship. Yeah, that, that makes a difference and can impact your health, obviously. But what about all of the, we'll call them unseen stressors, the toxic stressors, what you're putting on your face, what you're washing your body with, what you're washing your hair with, the lotion that you use, the cleaning products you use, the plastics in your house that are getting into your food and your water sources, the chemicals in your water, I mean, all of those actually are stressors on the body that we tend to kind of push aside and forget about. But this world has become way, way, way more toxic. Even from when we were kids. You know, you just look at the amount of chemicals that are being used. It's ridiculous. So I really believe that the environmental toxins are for sure contributing to the increased incidence of hypothyroidism and Hashimoto's hands down. And then I think there's just more awareness of it. So many women that I talk to or even patients, they'll say, we always do the health history. I'll say, well, my mom was taking Synthroid. I'm not really quite sure why. She never got thinner, she never felt better. She was just taking it because her doctor told her to take it. Right. Because back maybe in our, in our mom's, you know, day and age, if, if a woman got heavier. Oh, well, just part of being a mom. And they never really went deeper to find out what this thing is that's causing them to be tired, be overweight, not be able to lose weight, hair falling out. They just go, I trust my doctor. It's okay. But now we're moving into an age where you can find us talking about health. You can hear multiple podcasts, you can see YouTube videos, you can listen to summits, you can read articles. And it's out there to make women aware that, like, hey, I'm in this body that's rebelling against me, and that's not okay. And there are answers. So I think also the incidence of actual diagnoses that we're seeing are coming from women actually giving a crap what they look and feel like as they age. And kudos to us, but that's where we're seeing the increase numbers as well.

Yeah. So more people are getting diagnosed, less people are walking around symptomatic without. Without a diagnosis. But the. The mainstream treatment has not changed. And I don't know about you, I'm sure you, you're. You're feeling this too, but I am still very much battling the T4 is adequate treatment for hypothyroidism. So can you talk a little bit about what is T4 and why is that not sufficient?

So T4 is the inactive thyroid hormone. Our bodies produce T4 and T3. T4 is in. Well, our bodies produce T1, 2, 3, 4. But we're just going to talk about T4 and T3 because that's what essentially is in medication that your doctor would have to prescribe to you. So T4 is inactive and has to be converted over to become T3, the active form. And that conversion process, I liken it to running 10 tough mudders. It's actually not easy for your body to do, and a lot of things can get in the way. Genetic snips, insulin resistance, estrogen dominance, low magnesium, low iodine, all of those can interfere with that. That smooth conversion of T4 to T3. So what ends up happening if that smooth conversion does not happen? T4 gets converted into reverse T3, which I call that the antithyroid hormone. And it's like a bouncer outside of your cell door, literally blocking that active T3 from getting in. So it puts your body in survival mode, essentially, it shuts it down. And when you're in survival mode, you don't have to burn fat, you don't have to think, you don't have to have energy, you don't have to grow your hair. You just have to lay there and survive. But the problem is, if you're walking around in survival mode and you're trying to live life like you're not in the hospital, in the er, so you're just trying to live your life, but yet your body is basically shutting down.

Yeah.

That is the problem with T4. And just like you, Jen, I battle this every day. I mean, every day. And not just from conventional, from functional 2. I actually have a note over here to do. Do a post on functional doctors not knowing what the heck they're doing with the thyroid. I saw labs from a woman. She goes, oh, yeah, I see a functional doctor. I'm like, okay, I'm seeing one year's worth of labs and not one reverse T3 is tested, and you're on a boatload of T4. They're not functional. You might as well just be using your insurance with conventional medicine and stop paying this dude over here who's using the term functional because he's not functional at all. You really have to test thoroughly and treat outside of the standard of care box. And it's a shame that so many are in that box, but they are. And it really takes working with someone like you or I that knows what we're doing with the thyroid.

Yeah. So for the person that is listening, what. What kinds of things should they be thinking about? And. And what things should make them suspect that they're having an issue with their thyroid?

So the big ones, you know, right off the bat, symptoms, and I always say symptoms that you have are a gift by your body to let you know, hey, there's something going on that you might need to look a little bit deeper into. So if you are gaining weight and you're like, I'm eating all the right things, I'm doing. I'm doing my exercise, I'm Great. Like, my lifestyle, I'm sleeping all the things, and the scale just keeps going up. Or you can't lose weight no matter what you do. Constipation, brain fog, memory loss, extreme fatigue. I mean, the list goes on and on, even into, like, frozen shoulder muscle pain, joint pain. All of that can be thyroid related. So when you have those symptoms, then it's time to take that next step and really get tested.

Yeah. And I couldn't agree more. And oftentimes people are kind of barking up the wrong tree and they're not getting an adequate workup in that. Most people go to their doctor and they say, oh, well, it could be thyroid. I'm gonna order a tsh.

Yeah, yeah.

And then, you know, they meet with their doctor the next week, and they say that the TSH is within normal range. It's not your thyroid. What do you say to that?

Well, you have to look beyond that. I mean, TSH is a pituitary hormone. It's not a thyroid hormone. So, yes, standard of care says if TSH is high, then give T4, period, end of story. That's standard of care in conventional medicine. But we know in functional medicine, oh, there's so much more to it. There's so much more to get that full picture of your thyroid. Like, I don't know, let's actually look at the thyroid hormones instead of the pituitary hormone. So then we move down, because TSH could be. It can even be optimal. So optimal TSH and functional medicine, we like it less than 2. You could be coming in at a 1. I see this over and over again. And yet when we test the rest of your hormones. Oh, not good. So we test free T4. We test free T3, the active thyroid hormone. I want to know how much active thyroid hormone you actually have in your body. We want to test reverse T3 to see if that is blocking. So if reverse T3 is elevated, then it doesn't matter. You're on the wrong thyroid hormone replacement completely because you're in survival mode. We want to test TPO and TGA antibodies to see if you have Hashimoto's. And we want to test those multiple times because they often come back as a false negative. So it really is about doing all the testing, and then you pair it up with the person and that. How do you feel? You know, those four most important words that any practitioner or doctor can ask you? How do you feel? Because you're more than a lab value. The labs will absolutely give us some kind of direction. But then we have to pair that up with your symptoms and say, oh, okay, well, then let's. Let's address this. Let's do something.

Yeah. Are you using basal body temperature?

I do to a point. But, you know, really, I. I don't get into the vital signs as much until they start taking T3. So most people will come in on T only. It's like, go ahead and take your temperature, but you know it's going to be low. It's going to be low. But then when we start on T3 therapy, whatever that looks like, whether we're adding T3 to the T4, whether we're switching to armor, whether we're doing armor and T3 together or T3 only at that point in time, I say, well, yeah, go ahead and take your. Your basal body temp and your heart rate and your blood pressure, because we actually want to see those go up. And it's funny. I'm sure you get this, too. You'll have patients that are like, okay, my heart rate, I think it's going too high. I'm like, what are you. Like, it's a 60. I'm like, right, because you were like, 40 before because you were hypo low and slow, and you weren't 40 because you're Lance Armstrong. You're 40. 40 beats per minute with your heart rate because your heart literally wasn't working properly. So now you're coming into, like, normal range, and they'll feel like they're really amped up and jittery, but they're not. So that's. It's kind of a unique. It's a fun tool to use because people get to see, like, oh, these things are improving.

Yeah. And obviously, thyroid is a big part of our metabolism, and thyroid hormone is used by most of the cells of the body. Right. But as you said before, we are a symphony. And hormonal health is more than thyroid health. It's more than adrenal health. It's. It's overall hormone balance.

Right.

That comes from having a healthy gut, because there's lots of conversion of T4 into T3 into your gut. Right. It's having all the things. But I know when we were taught to optimize people's hormones, that we're looking at the adrenals first and then we're looking at thyroid, and then we're looking at the sex hormones. But what has happened over the last 20 years is the sex hormones have gotten kind of thrown out of the conversation. Right. Like, after the Women's Health Initiative, we're really not talking about hormone replacement. Definitely not in the breast cancer space. Like, I think I'm amongst the only person that's out there in the breast cancer world talking about hormone replacement. I know that there are some practitioners that are doing it, but in the breast cancer world, I'm kind of on an island here.

Yeah.

And that's okay because I don't mind.

That's why I love you. That's why we all love you.

But I would love to hear, because we haven't been having enough conversations out loud about hormone replacement over the last two decades. And certainly when we were having them, then we were talking about Prempro. We're talking about synthetic estrogen. Synthetic. I don't even want to use just synthetic because it was non bioidentical because everything's synthetic.

Right.

But we're talking about, you know, pregnant horse urine and progestins, not progesterone. And then the conversation stopped there. So I would love to hear your approach, your take on that hormone replacement and what conversation you're actually having, because I know that you're going for further.

Yeah, absolutely. So first of all, when, whenever we're dealing with the thyroid, the thyroid has control over the sex hormones. So listen, we know as we age, your sex hormones are going to go down. I mean, that's just what happens. And even before menopause now we're, we're seeing women in their 30s with declining progesterone and testosterone levels or even early menopause. So we know that the thyroid gland has, has an effect on the sex hormones. But independent of the thyroid, we have to also look at the hormonal profile of anyone, male or female, and say, okay, hormones give us life. So when we look at the, the animal world, we know that mammals will basically curl up and die after they lose their ability to procreate. Well, that's not the case for humans because we've found ways to extend life. But what about the quality of life and what about disease? And how do we prevent those diseases of aging that come on? We look at hormones and hormones give us life, and hormones ultimately protect us from many, many, many diseases of aging. So I have a theory in my practice, or just basically a saying that I came up with, which is both and meaning we have to treat both the thyroid and the hormones and your gut and your adrenals and your insulin resistance because we can't just do one. And I think, you know, far too often we see practitioners out there, I always, you know, call out the IG protocols and the Instagram practitioners that are like, I can heal your thyroid by healing your gut. I'm like, no, you're not, because you're going to heal their gut, and that's fantastic for their immune system and for conversion of T4 to T3, but you're not going to take an itty bitty thyroid gland where this person's had Hashimoto's for 20 years, and make it produce enough T3 to help run their entire body, give them a metabolism, grow their hair, let them poop every day, control their insulin, control their blood sugar, control their sex hormones. It's not going to happen. You have to look at everything all at the same time. Hormones are vital, really. I would put hormones above gut, above adrenal, because it doesn't matter. It doesn't matter how many gut food programs you do, adrenal programs you do. If your hormones are in the tank, you are going to be at an increased risk of cancer, an increased risk of Alzheimer's, an increased risk of heart disease, an increased risk of osteoporosis, and your quality of life is going to be in the toilet because you're going to lose your muscle, you're going to lose your libido, you're going to lose your hair, your skin's going to go to crap, your vagina is going to dry up. I mean, well, but I mean, even.

More serious than that is that you're going to lose the health of your blood vessels. So you're going to lose the health of not only the vessels of your heart, but the muscles of your heart.

Yep.

You're going to lose your mind, you're going to lose your mood, you're going to lose your sleep. And sleep is where the healing happens. So there's no. There's no repair happening if you're not sleeping. And you're going to lose your bone health, you're going to lose your joint health. And when. We all know what happens when that happens is people stop moving. And if you stop moving, you stop the ability to move. Right. Our body, if you don't move it, you lose it. We know that.

We know that.

We know that. And so there. There are huge ramifications. And you know, the people that argue, and God bless them, because some of them are really smart people, but the people that argue that menopause is natural and that we're not supposed to, you know, we're not supposed to overrule nature and things like that, you know, you have to remember that it's only because of modern medicine that we survive past menopause and, you know, thousands and thousands of years ago, when all of our mother, Sarah, she had Isaac when she was 90 years old, but she wasn't living in the toxic soup that we are living in right now. And so the toxic soup that we're living in has decreased our fertility, has decreased our years of ovarian function, but antibiotics allow us to survive a mosquito bite that we scratched and it got staph in there. And, you know, we would have all died either from being eaten by an animal or by overwhelming infection, and we're not doing that. But it is very unnatural to live without hormones. Yeah, very unnatural. Which is why your body literally starts to shut down in all the ways that you said.

Well, and to those people that say we should enter menopause naturally and just go with the flow, and that's how our bodies were made. How about we meet back when we're both 70 and we can compare the list of diseases that you have versus me. We can compare our body fat percent, our DEXA scans, our bone, our cardiovascular report, our lipid panel, and basically our appearance. Because I'm going to win. I'm going to win. So I'll see you when you're 70, quite frankly.

I mean, even for the people that go into menopause asymptomatically, and there are those, There are those that don't happen to notice the hot flashes or the night sweats or even sleep disruption. I mean, there are still some people that say, you know, I don't have problems sleeping and I have a libido. Or there are those that feel asymptomatic. And even those people need to know you're still undergoing brain deterioration. You're still undergoing deterioration of the quality of the vessels of your heart, the quality of the muscles of your heart, the quality of your bones, your joints, all of that. It's still happening. Whether you feel like it's happening or not, it's happening.

Yes, it is. So.

For those people, because I'm. I'm kind of someone that truly believes that it's the exception for me to not put you on hormones.

Yes.

That I have to have a really good reason why not. And even the reason that we were told why not turned out to not necessarily be true. Right. Like, you can't if you've ever had a blood clot before. Well, it's not exactly true. You just shouldn't be given oral estrogen. Right, Right.

You and I don't use anyways, so there's that.

Right.

Yeah.

And no one should be using.

No one should be.

Right.

Exactly. Exactly. Yeah. Or, you know, the only other case that I could think of is if a woman is just flat out refusing. Now, of course, you and I will have the discussion that we just had about, here's all the benefits, here's the. The downsides of not doing hormones, here's the diseases that you could be looking at and the quality of life. And ultimately, if she decides that she doesn't want hormone replacement, okay. But at least she's educated with the pros and cons, as opposed to being told by conventional medicine that she can't have it because of xyz, blood clots, previous breast cancer, whatever. Yeah.

So I want to. I. I know we've talked about a lot about T4 and T3. I want to talk about the big T. Yeah. Testosterone. Yeah. Because we really were not having that conversation for many, many years.

Yeah. It's. It's starting to come more into the conversation around women's health. I would say, you know, within the last five years, maybe ten, but much more so in the last five years. And testosterone. Oh, my gosh, I love it. It's. It's our. It's our get stuff done hormone. It's the GSD hormone. And without it.

I love that you call it that.

I know, right? And, well, it. It describes it perfectly. Without it, we're not motivated to get through the day, much less work out, much less have sex, much less, you know, go on a vacation or hiking trip or skiing. Nothing. There's no activity that you desire to do. When your testosterone is low, whether it's in the bedroom or out on the slopes, it's like you're in the gym. It's nothing. Like, you're just dead in the water. And then we get into all the health benefits again that testosterone gives us, I mean, protection against cardiovascular disease. Testosterone actually does play a role with our bones and osteoporosis combined with estrogen. Really? All the hormones have that effect? Our brain. Yes. Estrogen is touted as reducing your risk of Alzheimer's by 67%. But we tend to forget about testosterone and. And mood and cognition and memory. Classic for. For men, when their testosterone's low, they become, you would think, like, oh, they're going to become emotional. No, they become angry. They become angry jackasses. And that's when you're like, a woman will know, like, oh, honey, you need your testosterone because you're being a little bit of a dick. So let's. You know, let's give you some. I mean, it really is phenomenal when you look at the change in people's behavior and character when you replace their testosterone, both male and female. And everyone thinks that testosterone is a dude hormone. Everyone thinks that it's going to make you aggressive. Everyone thinks that it's going to make you big and bulky like a bodybuilder. And that's not the case because what we're talking about is replacing testosterone to optimal physiological levels, not super physiological levels like bodybuilders do.

Yeah, yeah. So are you considering it for everyone and when are you considering it? How are you doing that?

Yep, absolutely. Male, female, really all ages, except those women who are still in the, in the baby making years. You know, they're still planning on having more kids than, you know, we don't want to masculinize the baby girl that may be conceived. So, you know, we, we tend to totally avoid testosterone replacement in those cases. Now there's some instances where we will use it because it can help with fertility in very low amounts and all of that. But really after that, after, after a woman is done having babies, then it's like, let's go, let's do it. Let's give you that better quality of life plus all the health benefits surrounding it.

Yeah. So are you, what kind of testing are you doing with people and what should people be asking for from their practitioners?

So we, I mean, just like you, we do the full hormone panel, I mean the whole shebang, but when we're looking at just testosterone free and total testosterone and dht, which is dihydrotestosterone. Because I want to know, especially as we replace the T, I want to know, are you pushing it to dihydrotestosterone DHT and is that contributing to any possible androgenic symptoms you might get, like the acne, the dark facial hair, the hair loss. Now I also have to say that not everyone with elevated DHT is not bad. It's kind of like it gets, it gets placed in that same category as, as cortisol. Cortisol. It's like, no, no, cortisol is not bad. You need it for survival. DHC is, is amazing because that produces a lot of the beneficial effects of testosterone. We just don't want it in abundance in a woman that, that reacts to it. So for example, I have high dht, I have no symptoms, none, like zero. So of the androgenic side. So it's not necessarily that elevated DHT is bad. We just use that as a, you Know again, kind of like you're more than a lab value. Okay, here's your elevated dht. Okay, Jen, are you experiencing acne or getting some cystic? Are you getting a little beard there? Going on, Getting some hair loss. Okay, then let's use saw, palmetto or anything else that we, we can use to help block that conversion of testosterone to dht. Not completely, not entirely. We don't want to block it off, but we want to maybe lower that dht.

Yeah.

Shbg, Sex hormone binding globulin. That's a sticky train. I love analogies. So SHBG is a sticky train that delivers your hormones and if the train gets too sticky, well then your hormones are going to stick to the train and not be able to get to the cell where they need to do their job. So obviously we want to look at that as well because a woman could come back with a beautiful total testosterone. And then we look at her free, it's like, oh, why is that up 0.6? Oh, because your SHBG is 120, that's why. So we really want SHBG. I like it. Between a 60 and 80, less than 60, we start to get into like the PCOS realm. So again, that's where we check back with the woman and say, hey, have you been diagnosed with PCOS? Are you getting too androgenic? Above an 80 though, we really see problems with the, the free testosterone. So we want to correct that.

Yeah. And this is why it's so very important to work with a hormone literate provider. And though they are becoming more prevalent, it's not everywhere yet. No, it's just not everywhere yet.

Well, and let's also warn the listeners of the hormone clinics that are on every stupid corner in every city and they will give you pellets that will jack your testosterone up to a male level. And then they are in you forever for. Well, not forever for, for the three months. You got to ride that out. You have to lose your hair, you have to deal with the acne because they're not coming out. And those clinics most of the time are not thoroughly testing. They're not doing the follow up. They're, they're literally handing out these hormones and be like, we'll see in six months. No, you have to, you have to test, you have to track these people.

Yeah. And to that point I have a friend who like swears by her pellets and she swears by them a little too much. And I know that there is such a thing as hormone euphoria. And I know she has it. And the only way that you know if the hormones that you're on are appropriate for you, because we're all going to be different, right? We're all going to have different hormone metabolism, we're all going to have different hormone clearance. The only way that you know if that dose that you're on is for you is to test. And if you are on pellets, there's no switching that dose, there's no adjusting. It is what it is. And people by and large who are on pellets are being overdosed. They just are.

Oh Yeah. I had one woman with a testosterone of a 900. I'm like, I have about 20 guys that would kill for your testosterone level.

Just, just to give people like a frame of reference. My 18 year old son, I hope he doesn't mind me saying this, I mean his testosterone is 600 like you, you should not have a testosterone of 900 as a postmenopausal woman. No, right. Like it shouldn't be anything like that. Anything like that. So it is so important to work with a hormone literate provider to make sure that you're testing to make sure that you're optimizing. Another thing that I wanted to focus on because we did talk, we did start this conversation with you saying that you had Hashimoto's, that Hashimoto's is an autoimmune disease where your body comes into contact with some antigen, either a virus or a food or something like that, it makes antibodies to it and those antibodies get confused with your thyroid gland. So it kind of matches up with your thyroid gland and causes tissue damage and destruction and you're left with dysfunction of the thyroid. That's one of the things that we call Hashimoto's. Hashimoto's is kind of diagnosed in this country and forgotten about.

Yeah.

And most women who come to me, they don't, if they've had antibodies measured, it was in the very beginning and they don't even remember having antithyroid antibodies measured. So I want to ask you, are you measuring antibodies on everyone and how are you following those antibodies?

Yeah, I mean we measure them on everyone because why not? It's just another test and it's, it's data, it's information. It's not going to change necessarily how we treat short of maybe the addition of low dose naltrexone, black cumin seed oil, which is fantastic for anti cancer. I mean those things will come into play with a positive antibody test. But it's not going to ultimately change how we replace your thyroid hormone, because that's just replacing your thyroid hormone.

Right, for sure.

Why we want to test them every single time is we're looking for trends. So I'm not going to panic if somebody's antibodies go for TPO. For example, let's say they're 200 and they go to 250. Okay, maybe you were gluten at a restaurant, maybe you were under a lot of stress, maybe you were exposed to a virus. I don't know. I'm not going to freak out. But if they go from 200 to 2,000, it's like, okay, what's going on?

What are we missing here?

Yeah, let's dig a little bit deeper here. So it's fantastic to test every single time. More so for us because, as you know, patients will look at it like my antibodies went up like, no, it's all right. That's not a, that's not, that's not a reflection of how well you're doing. Because I can show you someone with zero antibodies and their T3 is in the toilet and they feel like garbage. And I can show you somebody with 200 antibodies who's optimized in their thyroid hormone replacement, who's living their best life. I. So it's like, okay, ultimately we want to push them to zero. Ultimately, yeah, yeah.

And that, that's ideal to, to get rid of that autoimmune component. And I've had a number of practitioners say to me, well, I'm only using levothyroxine, which is synthetic T4, because when you put people on armour or nature thyroid or one of the combinations of T3, T4, it makes their autoimmune component worse. So where did they even get that?

I don't know.

I've heard that a number of times though. Have you not heard that?

I've heard that. The only. And I've only heard one explanation for it. This is years ago. The only explanation I've heard is that when someone is in that autoimmune state, since armor thyroid, MP thyroid is porousign derived, sometimes the antibodies don't like it for whatever reason. And people with Hashimoto's don't do well on armor. But anecdotally and in my practice, I don't see, see that thyroid hormone replacement is very individualized. It's very nuanced. It's very individualized. There is no one size fits all. When people ask me, what's your favorite thyroid medication and thyroid treatment? I Go. You know, the one that's going to work for you and whatever combination and dose that's going to work for you.

Yeah.

So I don't care if that's armor and T3. Armor only, T3 and T4, the, you know, Synthroid and Cytomel. I don't care. It's about finding what is going to work for you.

Yeah, absolutely. And that's true of hormone replacement as well. Right. There's no one size fits all dose. That whole Premarin generation, though, in general, they did well. In general, they did well with one size fits all. But when you actually test people, there is a huge variation as to how people absorb, how people metabolize and what people's ideal levels are. And you can feel good and have appropriate levels, have levels that are too high and have levels that are too low. So how you feel doesn't always correlate with what your ideal dose is. And so we're always working towards that ideal dose and getting you in the most physiologically appropriate state we can. Because that's our goal.

Yes.

Right. Our goal is optimal function.

Yes.

So I want to just end on a couple of things. I want to talk about nutrients and I want to talk about diet.

Okay.

So, you know, you did mention that if your thyroid has been shut down for many years, like there's no, there's no gut detox that is going to allow you to have proper thyroid function again or adequate thyroid function again. But diet is still important.

Yeah, it is.

So what kinds of things are you telling people from a dietary standpoint? What is your general advice around diet? Understanding that there's no one right. Diet for everyone. And then I would love to hear what you're talking about in terms of supplements that support thyroid health.

Sure. So first of all, diet, I always say your labs tell us how you should eat if you're insulin resistant. And it's really going back to what you said in the very beginning of our conversation about metabolic health tied to cancer. I mean, if you are, if you're walking around with high glucose and elevated A1C, and I'm talking elevated in the functional world, not just flagged high on your labs for conventional medicine, but insulin resistance, type 2 diabetes, elevated glucose, blood sugar, dysregulation, that is absolutely going to contribute to increased risk of cancer, we know that hands down. Hands down. So keeping that in check and, and getting your, your glucose under control and your insulin levels in the optimal range below a 6 is where I like to see them. Then that's Going to have benefits that extend. I mean, yeah, you're going to have the, the, the immediate benefit of just aesthetically, you're going to lose body fat, you're going to feel better, you're going to be less inflamed, your thyroid is going to work better, your T4 to T3 conversion is going to look better. And then we have the long term ramifications of decreasing your risk of cancer, decreasing, increasing your risk of Alzheimer's, since we know that as type 3 diabetes. So in that case, when we see that on the lab, it's like, okay, you need to reduce your carbohydrates. So should all of us be reducing the bad seed oils, the processed foods, everything in a box, you know, cooks, cookies, cakes, all that? Of course, like, that's kind of a no brainer. Sugar, all of that. That's a no brainer. That's the no duh. Right?

Yeah.

But then we get into, okay, can this person handle maybe more fruit and some honey and some sweet potatoes? Okay. That person can, because they're not insulin resistant. This person over here, while those are good foods with high antioxidant value, they're gonna jack this person's blood sugar and insulin through the roof. So we have to, you know, eliminate or cut down significantly those foods for the insulin resistant person. So that's where it becomes very individual. And then we have the, the across the board rules of you have to be gluten free because gluten looks like the thyroid gland to those autoimmune soldiers. So every time you eat gluten, you're kicking up an attack. I mean, you are, you're spurring on that, that autoimmune attack. So we want to avoid gluten. And then there's the whole topic around.

Gluten is a factor even if you don't have autoimmune. Thyroid.

Yeah.

I have seen people without thyroid antibodies directly respond to stopping gluten 100%. And their thyroid starts to get better.

Yeah. Inflammation goes down, People lose weight, they're like, oh, my joints don't hurt anymore. Yeah. 100. I mean, nobody, no, none of us should be exposed to gluten. But I like giving the, the, the gluten gliadin mimicker analogy to really get the thyroid peeps to think like, oh, okay, I don't want my thyroid to keep getting destroyed.

Yeah.

So that's kind of universal across the board supplements. You know, we look at, I call them the no duh supplements. So we look at the new DUH supplements Like, duh, everybody should be taking magnesium and vitamin D. And honestly, I put black cumin seed oil in there, whether you have Hashimoto's or not, because of the anti cancer properties to it. I mean, crazy amazing. So when I, you know, I dove down that rabbit hole, black cumin, I put that in my Hashimoto's Fixer. And then I started going deeper and I saw all these other benefits. Like, like, it helps with your hair, it helps with weight loss, it helps with, you know, cancer. Then I'm like, oh, shoot.

Help with metabolism.

Metabolism. I'm like, I shouldn't have called it Hashimoto's Fixer. I should have called it like everything Fixer does. So much. So we have that. I love iodine.

I do.

I know, like the camps are split. We have the people that say, avoid iodine. We have the people that like myself that say I'm pro iodine. Because we know that every cell needs iodine. It helps with viral loads, it helps with our immune system. It helps convert T4 to T3, it helps reduce that reverse T3. So I'm a huge fan of iodine. And then, you know, then it gets more tailored. Like, are we going to use berberine for, for blood sugar control? Are we going to add in. I mentioned T2. That's over the counter. So T3 and T4 have to be prescribed. T2 is over the counter. And supplemental form. Are we going to use that to increase metabolism and help promote brown fat, you know, the browning of white fat. So then that's where it becomes more nuanced to the person.

Yeah. I'm glad you spoke about iodine because it is a controversial topic.

I know.

And it's in the thyroid world and in the breast cancer world. And I have landed on being pro iodine mostly because for many years I wasn't supplementing. And I'm seeing such a dramatic improvement in overall health when people start to put iodine into. And I'm supplementing with pretty good amounts. I'm, I'm pretty much following Dr. David Brownstein's guidelines, which are, you know, if you, if you don't have any thyroid disease or breast disease, then you can wind somewhere around you know, 12.5 to 25 a day. And if you have any degree of thyroid disease or breast cancer, you should probably be somewhere between 25 to 50 milligrams a day. Bearing in mind that the USRDA recommended dose is 115 micrograms.

I know, I know. It's crazy.

It's crazy. Like that is the minimum amount that you need to not have a good goiter. I believe, I believe that that's what that recommendation is. And it all comes back to, at the end of the day, like, I'm not looking to fall into the standard deviation that, that the labs in this country are setting out for us. Right. That's where 95% of the population is going to fall. Well, at this point, like 92% of Americans don't have metabolic health. Why do I want to be in their bucket? I don't. Right. We all want optimal function, which means that we're not going to sit in their playground or in their swamp. Right. Like, we want to be so much better. We want to enjoy optimal health. My last question for you is, I have seen you wear a cgm, a continuous glucose monitor.

Yep.

Do you recommend them for everyone? And if you do, how long do you tell them to wear them? And what kinds of information do you, do you think people can get from those?

Yeah. You know, my approach to CGMs might be a little bit different than from the norm because I see practitioners or our colleagues wearing them all the time and I'm like, you know, I got enough data after two months that I really don't have to use it again. Unless, of course, my health was taking a turn or I was using it for some kind of, I don't know, health transformation or whatever. But when I wore mine, I used it. And the way I tell my patients to use it as well, collect the data on the foods that spike you, or look at the stressful day or the night of bad sleep. And where is your blood sugar then? Now, for me, what was interesting is I spiked the highest with things that you wouldn't think would spike me. So I bought some, you know, keto cereal and this is a message for everyone to not, not believe the marketing hype out there. I bought some keto cereal and my, my glucose went to 180. I had a, I had a, a latte with almond milk and I did one shot, I know I'm not supposed to. I did one shot of the sugar free vanilla and my, my blood sugar just jacked up so high. I don't know if it was hidden sugar in the almond milk or if it was the artificial sweetener of the sugar free pump of vanilla. But it was very interesting when I wore the CGM to get that kind of data because so many times, you know, when I use it with patients is when I'm running into the, I'm not losing weight I don't get it. I'm eating properly. Okay. Are you tracking your food? Are you looking at what you're eating? Now let's go to a cgm because something, whether it's stress or lack of sleep or what you're eating is spiking you. So let's figure out what that is.

Yeah, yeah. And I agree. And that's the same advice I give to people. I think everyone should wear a CGM for two months and learn what you can learn about yourself, learn about what exercise is right for you. I think a lot of people are out there doing exercise that they don't realize is too stressful on their body. And that CGM will tell you. Learn about your sleep and whether or not your blood sugar is because you're having disrupted sleep. Right. And the foods. The foods. Because sometimes it will surprise you and you learn a lot about yourself and then you can just apply it to the rest of your life.

Yep, exactly. Yeah, exactly.

So I know you have an amazing website and an amazing supplement line for people who are looking to up their game and up their health and increase their thyroid health, their hormonal health, their metabolic health. So can you tell us about a couple of things and where to find them?

Absolutely. So you can find me@dramyhorneman.com and the Fixer line of supplements is betterlifedoctor.com and that's where we have the Hashimoto's fixer. We have thyroid fixer metabolism fixer that contain T2, increases your basal metabolic rate a little bit of what we're talking about today. And then of course, all social mediactoramihorneman. And the podcast is the thyroid fixer podcast that Dr. Jen was on as well. You've been on twice and it's been. My audience just loves it. I mean, I can't even tell you how often, just like you said, you're the only one in the space talking about the correlation of hormones and cancer. So whenever I get that question, I'm like, send Jen's episode. I'm not going to even answer you. Just listen to this episode.

Yeah. Yeah. Well, I always love talking to you and hearing from you and you're doing really great things and helping people in and a space, space that we know now more than ever that we need to really know and understand and fix this space. And I don't think that the GLP1s are going to be the solution, although a lot of people are using them as a solution. And, and there is a time and a place for That I, I mean, I, I, I do believe that, you know, there is a group of people who really do, they are in dire straits and they really do need that. And I think the rest of us really need to become educated and learn and understand how physio physiology actually works and as providers, be educated, be literate, be hormone literate, because our patients need us. Just like you needed to find answers when you were struggling and doing everything right. And you know, you and I live in a space where a lot of people come to us, us and say, I'm doing everything right. And still, yeah, and still I'm gaining weight and still I have no energy and still I got breast cancer. Right? So it's so important to know and understand that hormonal dysfunction, at the end of hormonal dysfunction is going to be diagnoses like the ones that we deal with every day. But there is hope. There is hope because if you work with someone who understands how to restore function, then health can happen. And it is there and available to you as long as you can find your way to it and partner with the right person who can help you. So I'm so grateful to you and the work that you do. And you created some amazing products which I myself use. So I am, I am out there endorsing what she, what Dr. Amy does and what Dr. Amy offers. So make sure that you follow her. And if you liked this podcast, then please share it with a friend, make sure you like it and comment on it. And if you are on a health journey and you're on anywhere along your breast cancer journey, don't forget to pick up my book, the Smart Woman's Guide to Breast Cancer. And if you are on a breast cancer journey and you're trying to find your way back, make sure you pick up the 30 day breast cancer journal to help support you on your journey. And I will be back next week, same time, same place start. Jen, bye for now.