33: The Truth About GLP-1s, Thyroid Meds & Hormone Therapy – Real Answers with McCall McPherson

Welcome to Modern Thyroid and Wellness, the podcast that explores the intricate dance between health, wellness and thyroid, unraveling the threads that weave our vitality together. I'm your host, McCall McPherson, and I'm so thrilled to guide you on this journey to optimal wellness. So today we are going to have a bit of a different podcast. So I asked if you all would like it if I simply answered your questions that you submit via Instagram and you guys said yes. So we're going to try this out for an episode. We're going to bounce around to various topics. I am 100% certain that one of them you will find interesting. You will have to excuse me. I have been sick and continue to be sick for the longest I've been sick in years, so I sound a little rough, but. But bear with me. We are going to have some fun today. So the first and most requested topic, generally speaking, is that of GLP1s. The new weight loss medication is taking the world by storm. These are things like Ozempic, Manjaro, Zepbound, et cetera. So we will just dig right in. Deal. The first question was, do we offer tirzepatide? We do. We don't know what the future holds with tirzepatide or even semaglutide. There is a lot of moving parts happening and things are evolving on almost a weekly basis. What I can say is we have honestly leaders in this movement and years ahead of what every we've been doing for years, what everyone is just now attempting to learn to do, utilize these medications in a progressive way that best serves people. And what I can say is no matter what we have seen firsthand how life changing they are, we will continue to find ways and strategies to offer these to people in whatever capacity is possible and legal and ethical. We are committed to staying ahead of that curve because there is little that can create this sort of impact in so many lives that I've seen. Another question is, do we offer tirzepatide or semaglutide microdosing for patients? We were microdosing patients before that was a thing. We've been microdosing people for probably two and close to two and a half years now. So the world is just now hearing about microdosing. We were doing it before it was called microdosing. So absolutely we do this. Not only, not only do we do microdosing dosing for 100% of our patients, we also offer tailored and unique dosing protocols, which is becoming more available or talked about now because of legal Infrastructure that's happening in the world of GLP1s. But we have been doing that since the very beginning. We offer, yeah, the next question was do we offer specific dosing? We tailor each unique person's dosing for them on up to a weekly literal basis. We will adjust people's medication according to their needs and responses. And I believe like a good, any other area of good practice of medicine, that that is what it takes. Can you main, can you come off of a GLP and maintain weight? So that is another unique aspect of our program that we've been working on since the very beginning is looking at data. We have honestly what I believe is the largest data set for people on GLPs with thyroid conditions in the world. I'd be shocked if someone else had more. So we have been analyzing data and collecting data on what improves outcomes and what lab markers look like when people can successfully come off of these medications. And with pretty good accuracy. We've been able to say we don't release this information publicly yet, but when someone's XYZ labs look like this, the likelihood that they can successfully come off these medications and maintain their weight with appropriate normal amounts of effort, the successes is pretty significant. So we have certainly been able to identify and analyze those patterns to predict success. If you come off of a GLP1, will the inflammation return? If so, how to keep the inflammation down? So this is actually the number one reason people do not come off of GLP1. In our program, GLP1s directly, very effectively, very quickly influence multiple inflammatory pathways of our physiology. I found four separate pathways in research that does not contain continue. When you stop a glp, there's not like a permanent anti inflammatory effect that goes on. Now if you lose weight, a significant amount of weight, and that weight was, you know, contributing to inflammation, an inflammatory response, you can maintain that improvement. But the miraculous reduction of inflammation that people experience who tend to deal with higher levels of inflammation, will not persist once that GLP is stopped. And that's just the facts of life, right? There's not a magic inflammatory bullet that's going to last forever 10 years after you stop it. So you can obviously work on inflammatory pathways, food, the air you breathe, micronutrients, antioxidants, detoxification, sauna, ldn. But if I'm being honest, even all of those, even a perfect lifestyle a hundred percent of the time pales in comparison to the anti inflammatory effects of a GLP1. And that's just, that's just the reality, sadly. Top tips for Avoiding glp. One, side effects. Starting microdosing next week and very nervous. The easiest way to avoid side effects with the GLP is microdosing. Is microdosing and tailored and unique dosing protocols for you. We have literally maybe 1% of the side effects that we had when we first started our program, when we started with standard dosing. The nightmares you hear online, all, most all of them in the media, are due to overdosing people on medication. We are trying to one, apply one size fits all dosing to every one of these medications and two, we are trying to apply diabetic dosing for non diabetic patients. And I just think it's overkill. So because of that, people are getting side effects from too much medication at once, but also so much medication that they're not eating food and their appetite is overly suppressed and they're getting secondary side effects to over restricted eating. So another one is, you've opened my eyes to GLPs for hashis. How do I let go of the negative views out there? I would say I don't know if you mean of other people looking down at you or judging you for being on these medications. If so, who cares? Who cares? Like I guess when you turn like 40, you quit caring about other people's opinion. But. Or most of us do. But if it's like, oh, you're concerned about the negative side effects and things. I would say have conversations with people who are on these meds, not about weight loss, have conversations about all the other benefits they're experiencing and ask them about their side effects. And I encourage you to do that with people who are on a microdosing protocol because their experience is vastly different than people who are on a standard dose protocol. But that's my biggest advice. I. In medicine, everything is viewed as risk versus benefit in terms of analyzing the value of medications and treatments versus safety. Right. I have never seen a medication with so many benefits, full stop. I've also never seen a medication with so few side effects when it's appropriately used. And so you combine those two together and we have a pretty miraculous situation that's happening right now. GLP long term, if relieving all Hashi endometriosis symptoms lose effectiveness. So these meds are studied to be taken for life. So that's their indication is to be taken forever. So I know people get nervous about doing that, but that's what they're made to do. Most of our patients don't end up doing that, but that's what they're Made for. So if they're giving you huge benefits and they're studied for lifetime use, I mean personally I can't give you medical advice, but personally I sure would be open to doing that. Someone said, will semaglutide cause breast cancer? Someone said GLP1 for someone with hypothyroidism and breast cancer survivor, any research? So I found this study a while back. I talked about it in another one of my interviews with Sally, our health coach of our program, and found a study that GLPs reduce breast cancer by 13%. I'm not surprised, not surprised at all. In fact they have. So again, they have so many benefits and I go through them one by one in that interview. So try and link, try to find that one. It's again, it's one of the ones with me and Sally. And then when it comes to hypothyroidism, GLPs are incredible. I find that people need less medication long term, that we can reduce their medication over time. And two, I see consistently, almost ubiquitously antibody reductions for Hashimoto's across the board. Someone asked mimicking the quieting food noise achieved with GLPs. I would say that's not going to happen. You're not going to find something to mimic the food noise like glp. Just not realistic. How can we educate providers on microdosing GLPs? I think it is taking the world by storm at this point and what used to be unique to our program people are getting curious about now. So I do hope that maybe people will become curious about microdosing and learn. I don't think we can educate our providers. I think our providers honestly need to take that into their own hands, get curious, get invested and do that for themselves. So that was our GLP semaglutide topic. Let's move on. Thyroid medications, labs optimization, etc. I'm going to try to go through these kind of fast. Do any of my clients get off thyroid meds in time? I don't know what in time means. Generally speaking, by the time people come to us, they have had a very long chronic issue with Hashimoto's or hypothyroidism and they don't get off their medication, nor do they want to. Most of the people that come see us who are like I want to get off meds, I'm like, okay, well let's show you what life looks like when you're on the appropriate amount of meds first and then we'll go from there. And then if you ultimately want me to take you off. I'll do the best I can. Can't say that that would work because most of the time people are missing endogenous hormone production and they can't come off of meds. If people are selling you that concept, it is because they cannot prescribe medication. Let me repeat that. If you see people online, on social media, wherever, selling you the concept that, that you do not need thyroid medication and this is not a thyroid problem, it is because those people cannot prescribe medication. They are practicing medicine with a quarter of the toolbox and technically they're not really practicing medicine. Even if they're called doctor. You need to research them because most likely they're not a doctor. Most likely they're a chiropractor or some other specialty of medicine that can be very valued but should not be tricking people into thinking they don't need thyroid meds because they're not able to offer that. Most people that see us do not get off thyroid meds. And if they come to us wanting to after their thyroid is optimized, I couldn't pry their thyroid medication out of their cold, dead hands. They would never let me because they know what life is supposed to feel like. You're you like your labs drawn four to six hours after thyroid dose. Another specialist says 18 to 24 hours. You guys can find infinite other people that either A, don't tell you how to take your thyroid meds, B, tell you to skip it, or C, tell you to do some other thing. That is their deal. They can do that however they want. I think testing labs off meds is a very dangerous practice if you're on an active thyroid hormone. In fact, I know it's a dangerous practice. We check labs at the highest possible threshold that someone's T3 gets in their blood levels. Why? Because I want to know the Highest level their T3 gets in their blood levels so that I can protect them from over medication of T3. I don't ever want to guess about the single most risky aspect of active thyroid medications, which is over medication of T3. These meds are very safe when you know what you're doing and you have the data. They can hurt people, they can kill people if you make decisions without proper data. So if someone is choosing to check your labs 24 hours after you take your thyroid medication and it has T3 in it. So these are drugs like Armour, NP, Ironine, Cytomil. They have no idea what your medication is doing and now they're basing decisions off how to dose your medication when they have no idea what it's doing in your blood, in your bloodstream, and what it's actually, how it's impacting your physiology, which is, to me, medically quite irresponsible, because that medicine, that active thyroid hormone, is gone from your bloodstream 18 to 24 hours after you take it. NP Thyroid. Can't seem to get my thyroid levels correct. Yeah. So I generally do not use NP with my patients. I have the same issue. I can't get things stable. I don't want to spend too much time digging around. But basically there's been multiple warning letters, multiple recalls for or too much potency of np, too little. I find that with my patients almost ubiquitously as well. And so I simply do not prescribe it. When my patients, historically, my personal experience is when they have asked to be moved to NP because it's cheaper, I say, absolutely, I can do that and I want you to let me know if you feel differently and you would like to switch back. A hundred percent of those patients have, have subsequently switched back to armour because they didn't feel as well. So that's enough information for me. So I don't use NP in my practice. Why is Sidemill making me more tired when I take it? My T3 is low. It's probably independent of Cytomel, but your thyroid's probably off and perhaps maybe when you had your last round of changes, they didn't do it in a way that's going to make you feel better and in fact did it in a way that's going to make you feel worse. I describe T3ALL and thyroid medications in general as needing to be the right medication at the right dose at the right time. And a lot of times people think, well, I'm on this T3, I should feel better. Right? Like I'm on armor, I should feel better, et cetera, et cetera. The reality is this is thyroid meds are like insulin, Right. Just because I put you on insulin and you're a type 1 diabetic, doesn't mean your blood sugar's controlled. The nuances very much matter here and it's the same with thyroid. So it's not as simple as getting on a certain kind of medication. It. You just need to. To go deeper with someone who can, who can take you there. What should you look at if thyroid levels are improved but you're not feeling your best? Absolutely. I wish that it was as simple as everyone coming to modern thyroid clinic. We just fixed their thyroid, sent them on their Merry way and everything was fine. By the time people come to see us, multiple issues are likely going on. Thyroid adrenals, almost always hormone dysfunction, inflammatory issues. All of these things have to be fixed to give women and men, but to give people their global health back, like what is the highest form of health they can achieve, we need to fix all of these things to get them there. Right. Can you level out thyroid, thyroid levels by taking medication for a time being or is it forever? That is kind of super unique. I touched on this a little earlier. Most people need thyroid meds forever. How long does it take to see improvement with T3 medication? So at least 90 plus percent of our patients feel improvement after their first treatment cycle. So what does that mean? The first time that they meet with their clinician and they start medication changes, they feel better. Often that happens in like days, can be weeks. But most people feel better extremely quickly. When you land in the right hands of the right clinician. What is an optimal TSH for a 24 year old male? My daughter and I have Hashimoto's. I always like TSH less than 1.8, ideally closer to 1. Do I personally take thyroid medication? Absolutely. So I ended up in this field by my own journey. I was 27 and was already had been switched from Levo to Synthroid and was bedbound. Like I was almost disabled. The only thing that I could do in my life was go to work and every moment I wasn't at work, I was in bed. And it wasn't until someone that actually knew about thyroid helped me and then became a mentor to me that I was able to get my life back. So. So I am absolutely on thyroid medication. I personally take armor, but I am switching to ren thyroid, which is a new form of desiccated thyroid that's coming out in the next few weeks. We're actually launching it within modern thyroid clinic. Do a little bit of, you know, beta testing, get things situated and then you guys will have it available to you as well. And it's an incredible medication. I won't talk too much about it, but I'm switching from armor to that. And in addition to that, I also take lyothyonine, which is the generic form of cytomel. About six years ago, my conversion could no longer handle just desiccated thyroid and I needed to also have a little extra T3 support. All right, let's talk about Hashimoto's autoimmunity antibodies diagnosis. Why do I also have TAB or antibodies? Interesting. So I'm making sure you don't mean thyroglobulin antibodies because those are just Hashimoto's antibodies. TAB antibodies are most commonly associated with Graves disease. T rab and or thyrotropin receptor antibodies and TSI or thyroid stimulating immunoglobulins are associated with graves. So I would get a full antibody workup and just ensure that you don't have Graves disease and repeat your T rab as well. What is the fastest way to decrease antibodies? In my opinion, the fastest way would be low dose naltrexone or LDN or a GLP one another. Other great ways are improving gut health, reducing inflammatory foods. Sometimes maybe 20 to 30% of people see an antibody reduction with 200 micrograms of selenium every day for three months. But I would say quickest way is LDN. Why are there so many of us with Hashis? What do you think is the cause? So I think that we are in a time where our environment certainly primes us for autoimmune disease. We live in a society that's pretty inflamed. The access to food that we have, unless we're incredibly intentional, is highly inflammatory and processed. The air we breathe, our water quality, the products that we put on our body, in our body are just very often not clean drive inflammation, which drives up risk for autoimmune disease. Is it important to find the root cause of Hashimoto's to determine a treatment plan? So hypothyroidism in terms of a treatment plan for that is hormone based, medication based, independent of Hashimoto's is influenced largely by lifestyle. So nutrients, supplements, reducing inflammation, those types of things. And the reason it is important to try to influence your Hashimoto's levels is because the lower we can get your antibodies, even if you don't get into remission, the less of an attack that's happening on your thyroid gland, the less thyroid gland you'll lose. And additionally we can almost use that as like a risk stratification of your likelihood of developing another autoimmune immune disease, which if you have one, you're at an increased risk of developing another by over 30%. So if we can reduce those antibodies, we're inherently reducing your risk for other autoimmune diseases. Can you treat Hashimoto's without being on thyroid medication? I have high antibodies. So always the treatment for Hashi is not medication. It's always influencing inflammation that can lower your Hashimoto's antibodies. Now Hashimoto's over time leads to hypothyroidism so if someone's had Hashi for five or 10 years, in all likelihood they have hypothyroidism. That's not going to resolve simply because they stop because their antibodies go into remission. Those antibodies have already attacked their thyroid gland. They have eroded away our hormonal secreting tissue and replaced it with like inflammatory scarry tissue that doesn't secrete hormones as well. And so we still need to offset that loss with medication, if that makes sense. But I do want you guys to tease out those two things in your mind. Hashimoto and hypothyroidism are treated in two different ways. How to reduce thyroid fluid retention. This is my life's mission. I love this question. So one is obviously sorting out your thyroid, right? You want to solve that so that your lymphatic system starts to pick up the pace a little bit. But I almost view personally, but also with my patients, poor lymphatic tone. Almost like how? Well, think of your lymphatic system like a giant stocking over your body that sucks in everything and moves that liquid out. Right? I feel like when people. What I've noticed is when people have had thyroid issues for a long time, it's almost like that stocking is loose and saggy and it needs to be retrained. So I always encourage my people go get lymphatic massages, use dry brushing, use gouache. Asana is a great thing. I use lymphatic drops as well. I think you can find them in my Amazon storefront. But they're sold out right now under my favorite supplements. I take those every day. It's killing me that they're sold out right now. I love them and so I even do like an ice roller from Skinny Confidential. There's different things that you can do obviously as well, reducing inflammation because inflammation makes you puffy. But those are some of my favorite ways and I am a puffy, puffy person. I also love vibration plates, but I'm lazy about it and I don't do it enough. Okay, next topic. Hormones, women's health, bioidentical hormone replacement therapy. Progesterone makes me anxious instead of calm. What do I do? That's often seen in my opinion, when people are taking regular progesterone from Walgreens. Don't do that. Get a bioidentical form of progesterone that is sustained release and long acting from a compounding pharmacy that's made from like wild yams and things. And I find that it takes people from being Anxious to very calm. Does perimenopause affect thyroid levels? It absolutely can. So your hormones shift quite a bit during perimenopause and that influences downstream hormone transport that also transports your thyroid. So the two are obviously integrated very deeply. So yes, they have a give and take relationship. And then as we move closer into menopause and our estrogen drops, we are at an increased risk of Hashimoto's and thyroid issues as well. Why do I test hormone labs differently from Dr. Tassone? So Dr. Tassone and I, he's, he's one of our CMOs. Love that man. It's all about the tools that you have in your toolkit. Right. Like if I have tested hormones in a specific way for 12 years and I know what to expect with a nuanced level based on the methodology of how we test our hormones, I'm certainly not just going to go and adopt a new method and be operating with someone else's tools. Right. Like, so we have our own tools. Doesn't mean that one's right or wrong. It's that, hey, with intricacy we can understand what's going on in someone's hormone labs based on the tools that using that we have and the data that we've collected and that hundreds of thousands of pieces of this data that we've analyzed gives us a lot of knowledge and expertise when looking at data with the tools that we have. Dr. Tassona is the same with his tools. He's done it the same way that he has for even longer than we have. So everybody's got their own tools then make them right or wrong. It's just different. Recent hypothyroidism diagnosis. I've had long term PMDD symptoms. Will T3 resolve it? Probably not. But what often happens with PMDD in relation to thyroid is thyroid issues drive a lowering of progesterone which creates anxiety, irritability, agitation, insomnia, worsen leading up to your period. Sounds a lot like pmdd, right? Yes. So if we fix your thyroids, maybe slowly over time your progesterone can come back. But even better than that, we fix your thyroid and your progesterone to try to address pmdd. What is DHEA and how to lower it? I'm at 205. So DHEA is your adrenal hormone. It helps us look at overall levels of adrenal function over time. And honestly, depending on your age, it's different ranges. But I like DHEA around 180, 190. So that's close. I would take that and run with it and wouldn't change anything. Lastly, do I recommend pellets? So this is a bit of a difficult like black and white answer, right. But I will tell you this. Pellets need to be done carefully and conservatively. And I've had a hard time getting women that transfer into our practice that have been approached that way. And what often ends up happening is they end up over medicated on specifically testosterone, which can be permanent and disfiguring and change someone's the way that they look and sound. And once you get that pellet in there, you can't take it out. Right. And so if someone is over medicated, they're stuck with that over medication, often for like six months, Months. So it's not inherently that pellets are bad, it's just somehow we've adopted this mindset that it's okay to overdose women on testosterone with them. Like for example, a really robust man's level of testosterone is a thousand. Okay. I have had a woman come to me and it her level of Testosterone be over 2000. I've had another woman come to me over 1200. These are above the detectable threshold. So we don't even know what they are. Okay. Another over 800. So that's a really big deal. My range for Women's testosterone is 35 to 65. Could go up to 150. If people are really struggling with symptoms and we inch them up slowly. 150 is kind of my upper threshold. Imagine a woman over 2000. Like serious life altering side effects from that, like with estrogen. I don't really have an issue with it because I find that women do really well with pellets on estrogen. Even men on pellets do pretty well. It's specifically the women with testosterone. But sadly that's like the most common pellet treatment. Right? So yeah, mixed bag on that one. Okay, I am going to answer a couple more random questions. These are just random tossing them out. Can you speak to high CRP and how hard and easy it is to decrease it? So recheck CRP because it can acutely increase like after sickness, et cetera, travel. But if you have an elevated CRP over time, the fastest, most powerful, most potent way to reduce it in my opinion is a GLP. 10 times more effective than anything else. Those are the weight loss meds that are potent anti inflammatory agents. LDN can influence it some, obviously lifestyle modification can influence it some. But if I had a super high glp, I would be doing a microdose of a glp. What is the root cause of Everything else is normal. But I still feel bad. Normal doesn't equal all optimal. You need to get in the hands of someone that actually understands that and can look deeper at your labs and not just accept what the lab says is normal. What do I think about nads? I love nad. I have a separate podcast talking about it specifically with one of the lead researchers in the space. Very scientific, super valuable. I'd encourage you to go back and listen to the episode. I take true Niagen nad every day orally and then I do an NAD injection twice a week and feel so different when I do it. Some other random question. When is my book coming out? If you guys haven't heard, I sold a book proposal, or a book really to Penguin Random House and the Avery imprint. I am so incredibly excited. So excited. It will be out in spring 2027. Cannot wait. I'll share more as I can, but guys, I just can't wait. This is going to be such a movement. We are going to create a movement and we're all going to do it together. So I'm just thrilled that they're so excited that you guys are so excited. I am so excited. How's the dog? Rosie's seizure dog is doing pretty good. We she's been a little naughty lately. Like she's not been on her a game with seizure responses. So we're trying to like every day train her again, train her again more and more and more. Do you want to come say hi, Barbie? Come on. She's right here with me right now while Rosie's at school. Come here, come here, come here. This is Barbie, everyone say hi. Say hi, Barbara. Everyone wants to know about how you're doing. Everybody wants to know, have you ever thought about opening a clinic in Canada? I would love to expand access into Canada after we cover the us. This has been an incredibly rewarding and taxing workload to get into every state. It's not to be understated the difficulty, but I am hopeful that we'll expand into Canada next. And I can't wait. Do we work with patients in Europe? So we do non medical consults for people with Europe in Europe. Meaning you need to have a local doctor that's willing to implement the plan and we can edge in an educational manner, write up a plan for you or talk with your clinician or physician there. And that is how we currently do it. So I hope this was fun. If we like this, we'll do it again soon. It was fun, kind of bouncing around on topics and I can't wait to hear what you guys think. Tune back in next week for the next episode.