40: The Most Misunderstood Hormone – How to Fix Your Thyroid, Fertility & Energy with McCall McPherson

So, friends, today we are going back to our Ask Me Anything episodes and you all submitted your questions on Instagram for me to answer. If you all follow me on other platforms, you guys know I love TikTok, but when I essentially ask my people for anything, like what is your feedback on this? What do you want to know about? Submit your Ask me anything questions. I always draw them from Instagram. So if you do not follow me on Instagram, please, please do. My username is McCall McPherson, PA. We also just overall get really personal on there and you guys learn more about my life, what's going on in my community, in my home, all the things, recipes, just stories that I don't necessarily share on other platforms. So if you want to get a little bit of a behind the scenes look or just want to deepen our relationship a little bit more, please head over to Instagram and follow me there and I'll be answering questions you all submitted on thyroid, on hormones, on weight loss, on GLPs, on random stuff that you guys want to know. So last time I did one of these episodes it was really, really popular. So I'm excited to do it again. Let's dig in. 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. I say, what do you guys think? Let's start with the tried and true thyroid questions. And if you all want to skip over this part, if you don't have any questions about that, you totally can. So let's dig in. And I'm sorry, if you see me reading, I'll literally be reading questions off of these lists. So please advise on how to check thyroid levels when on Armour Thyroid for twice a day. So armor is a form of what's referred to as natural desiccated thyroid. It is part inactive hormone or T4 and part active hormone or T3. Okay. It's called natural because it just comes from the gland of pigs. The thyroid gland of pigs. And desiccated. Desiccated thyroid. Specifically, armor is been around for a century, almost a half of a century longer than levothyroxine. So I use desiccated thyroid in my practice every day. I'm on desiccated thyroid. I use exclusively Armor and Ren thyroid, which is a new desiccated thyroid medication that is coming out and I am so excited about it for so many reasons. I'll have a Separate podcast episode on that. But. But y' all fingers crossed that I am hoping this will help drive the evolution of thyroid care forward. And I'm gonna do everything in my power to make that the case. So let's talk about it. So, armour, ren, thyroid, np. All of these have T3 or active thyroid hormones in them. T3 is short acting, guys. It peaks and it plummets in those meds every about six to eight hours. On cytomel leothyronine, that window is shortened. It peaks and troughs in your blood about every three to. In three to six. So if you're listening out there and you're like, oh my gosh, I'm on armor, I'm on NP. And every day at 3pm after my once a day morning dose, I crash. That is why, because most, not most people, in my belief, everyone on T3 base med needs to be dosed in the morning and in the late afternoon so that we occupy the bulk of your day with adequate thyroid hormones. Which is, which is what you need to like, thrive, survive, all the things. Right? So the question is, how do we measure these labs if you take it twice a day? And my answer is, I usually have people go three to four hours at the peak after they take their armor dose in the morning. Okay, so armor peaks at about the three to four hour mark. Lyothyrene cytomel peaks around two to three hours after you take it. And naturally, underneath this process of you taking medication, there is a natural rhythmic circadian peak of your own T3 that happens in the morning. So why do I time all of this in such a way? Because, one, I want to know what is your T3 look like at its highest? Okay, why do I want to know that? Number one, I always want to be able to protect you from over medication of T3 or active thyroid hormone. Number two, a lot of people are getting their labs drawn on these meds without taking them beforehand. And how are we making decisions on what to do with medication if we're not taking the medication before we get our labs drawn, how does that give us any information? So always after your morning dose, you don't like if you can't make it, you could theoretically go three to four hours after your afternoon dose as well. Either one. But generally speaking, a lot of times I also have my patients go fasting, so obviously that is easiest in the morning. So let's talk next. This next question bleeds into this. I started taking desiccated T3, but thyroid hormones then drop. You're probably getting your labs drawn off of your meds. So let's talk this through. T3, short acting. It peaks and troughs in three to eight hours, depending on which med you're on after you take it. Let's say you take it on a Monday. Let's say you even take it twice a day on a Monday. So the last time you take it is at 3pm on Monday afternoon. And you go get your labs drawn on Tuesday morning without taking your medication. Guess what? You don't have medication in your system anymore. So we're not going to Capture your. Your T3 that your medication is providing you because it's no longer in your system. Right? So that is the most common reason why hormones drop whenever you add meds and then you check them off meds because your body adapts to those medications. It's not compensating for them not being present. It can't do that quick enough for a day later after you take it. So you end up looking artificially low. And then guess what happens? People inevitably get their thyroid hormones increased, increased, increased after every lab draw they go to off meds. And that is how people end up dangerously over medicated. Okay? The other thing that can happen is let's say you're on armor. Well, when you're on armor or cytomel even, it sends a message back to your brain and it says, hey, guys, we have more thyroid hormones. Let's lower her TSH. And in turn, that will lower your T4. So everything creates balance from that. And so again, to complicate it even more, everything settles. Then you go get labs off meds, and everything looks lower. Inevitably, too, things settle as you increase thyroid meds. And then what that means if you're not in at an optimal level, is that you're not at your dose of medication that you need yet. Let's talk reverse T3. I feel like it's a hard and difficult topic to understand. I almost want to share my screen with you all and show you a little diagram. What do you think? Let's do it. Okay, let me get to my diagram that I want to show you. That tells you all about how your thyroid works. So if you're watching this on YouTube, you can tune in and see it. If you're on audio, you can go back at YouTube and watch it. So this is your thyroid gland. Okay. Or this is your thyroid function. Your brain sends a message to your thyroid via your TSH. Your thyroid produces this hormone called free T4. Largely, that T4 is then in Other areas of your body activated and converted to your active thyroid Hormone, your free T3, or it can shunt to an inhibitory hormone called reverse T3. Okay, for simplicity's sake, I want you to hold out your hands in front of you and imagine your left hand is your free T3 and your right hand is your reverse T3. These are the same shape but in an opposite orientation. Okay? Reverse T3 is the same shape as your active thyroid hormone, and it binds. It's able to bind to the same landing spot as that active thyroid hormone. But instead of activating that landing spot for something like your energy, your cognition, your metabolism, that reverse T3 sits there, binds, and doesn't let free T3 bind. So the higher your reverse T3 is, the lower T3 absorption you get. And your body uses reverse T3 on purpose, okay. When it wants you to go into recovery mode, when it wants you to lay down, rest, and recover, it increases reverse T3, therefore slowing the absorption of T3. So that you're tired, you're fatigued, you lay down, you're metabolically disadvantaged, so you're not burning through your fat. Right? So in part, we want to reduce lifestyle issues, stress, insomnia, inflammation, micronutrient depletion, severe caloric restriction over exercise, poor sleep. If I didn't mention that, one pregnancy. Although you don't want to influence that, you want to try to mitigate some of these reasons. Your body is shoving you into an elevation of reverse T3. The other thing that we want to do about reverse t3, y', all, we want to not over supply your body with too much T4. If the source of reverse T3 is T4, and you guys are taking a bunch of levothyroxine Synthroid T resent, guess what? If you're a poor converter, which most people are, you're creating a massive supply for this reverse T3. So anytime you're a little stressed or sick or not sleeping, your body starts dumping all of that crude oil into this inhibitory hormone and it really wrecks havoc. This is why having a balanced amount of T4, not too little, not too much, is very, very important. So I hope that makes sense. Perfect. Perfect. I have two questions about people who have had a thyroidectomy or a partial thyroidectomy. Does the blood test, info levels, treatment, does it all apply to them, too? And the answer is yes, largely, Absolutely. So with these people, we want. These people need more support than anybody, honestly, like when they don't have endogenous thyroid hormone production. But the only difference in my approach between people post thyroidectomy, partial thyroidectomy, or hemithy thyroidectomy and people with an intact thyroid gland is I like to keep those people who have had part or all of their thyroid gland removed at a lower level of tsh. I view your TSH as the energy your body's putting in to produce energy, or AKA thyroid hormones. When you're not able to produce your own thyroid hormones because you don't have a thyroid, I don't want you wasting energy trying to produce it. So I want to lower that threshold. And people I found absolutely clinically feel better in that case. How does methylation issues like MTHFR impact thyroid health and how best to support it? So, oh, goodness, we're back into the inevitable cycle of MTHFR in the media and in vogue. And here's the thing, guys. I started working with MTHFR in 2012. That was 13 years ago. And I did it for a long time. And you know how. What percentage of people got improvement when I worked on their methylation pathway? Not like, none. So can I find things in literature where methylation influences thyroid function? Yeah, I can. Methylation can influence a lot of things. My view on medicine, on my practice of medicine, is, hey, I will try, test, pursue, repeat, test, analyze, pull the data on just about anything at the same time. If I do that and it doesn't have an impact, I'm not going to continue. And that is my experience with methylation. The other thing that I want you guys to know about it is it is not casual people taking a lot of methylfolate, okay, Methylated folic acid to compensate for this. The vast majority of people that I have put on methyl folate, low, medium, high doses are all have had bad side effects, y', all, most commonly irritation. And it builds over weeks. So it's not, like immediate. So it can very much perplex people and they cannot realize that that's what's driving it. So in my opinion, the value level is low. And I know that it's in vogue because of one particular. I mean, you could call him a scientist, I'd call him an influencer, because he doesn't really hold a PhD or any degree that would make him a scientist and said it was all like, thyroid issues or all methylation. Total hogwash. Y' all basic. In that video that went completely insanely viral, the most basic physiological mechanisms and how the body works were completely inaccurately described. What does that mean? It means the foundational information that this person needed to Speak on this with knowledge wasn't even there. So they are very far outside of their scope and should not be talking about thyroid because they don't hold a medical license, they don't hold any formal training. It's just. And that was very clear in the video because they weren't calling the right things the right things. Anyway, I'll leave it at that. Let's see. How does emotional stress impact thyroid and what do you recommend for clients? It impacts in two different ways. One, the activation of your hormones, the conversion of T4 to T3, or inversely reverse T3. Right when you're stressed. That happens. Also, stress can cause Hashimoto's, it can worsen Hashimoto's, it can create flares, etc. Just to give you guys a little perspective, if someone experiences a traumatic event as a child, their likelihood of ending up with an autoimmune disease or chronic health condition later in life, not even way later, like early later is like over 85%. So how our emotions are not abstract. They impact our physiology. So I most of you know, went through an incredibly stressful and honestly like traumatic last year with the decline of my daughter's health and ultimately it resulting in me having to her going into cardiac arrest and me having to perform CPR on her to resuscitate her. And I don't really don't wish that on any parent. But anyway, over the last year I've been very much working on my stress because it dominated my whole life. Like, I don't think I ate or slept for four months straight, maybe even closer to six. So finding ways that you can mitigate that, going for walks. You guys can always tune into my content too, because I am forever trying to figure out these hacks. Okay. Like it's very high on my priority list. One other thing, Soma Vetic is something that I did really early on and was a big, big jumping point for me to be able to sleep specifically. You're. You're welcome to follow them on social media. I think I even have a discount code. I don't remember what it is. Maybe McCall or something, but that was a big launching point for me. Another thing that I do is called New Calm. This isn't sponsored. New Calm is an app. They don't even know who I am. But neither is Soma Vetic not sponsored. None of this is sponsored. I'm just telling you what I've done on my journey. Nucalm is great because I have a long a decade of experience meditating and when you're so stressed, it's very hard to meditate. So New calm is passive. It's an app on your phone. You put on headphones and it plays like music. Behind the music is something that takes your brain waves from like a fast frenetic stress state and it slows them down to a calm Zen state. And it actually works. I also use it on Rosie in stressful situations, so I hope that's helpful. Can high antibodies affect fertility? Mine were over 800 and I'm struggling to get pregnant. Yes, usually autoimmune disease impacts or Hashimoto's impacts pregnancy in a couple different ways. One, it can increase risk for miscarriage, so you want to lower those antibodies as much as you can. But two, more than anything, honestly, in my opinion, it impacts your thyroid hormones and nuanced thyroid issues long before medicine would ever diagnose someone with a thyroid issue. Impacts fertility. I've seen it over and over and over again. I've seen studies that state the same. Subclinical hypothyroid impacts fertility, subclinical hypothyroidism impacts everyone with it. I don't even believe in subclinical hypothyroidism. I would consider it to be overt hypothyroidism, but you need to get your thyroid optimized before trying to get pregnant. How to identify nutrient deficiencies with hashis so there's basic things that you can do in a lab. D B12 Iodine's not great to check in blood, but most people are not deficient in iodine anyway. Ferritin, all of these types of things you can b6 you can check on a blood draw. If you want to do a deep dive, there's something called a nutrival that you can check to look at really in depth. A lot of micronutrients and how well they're binding, etc. We don't do that at modern thyroid clinic. We refer out to it. We refer to alive and well for that. And I think they do a bit of telemedicine in other states as well, so that might be helpful. Can you dive into heart palpitations and why so many people with hashi have them? Sure. There's a few different reasons. Most commonly I would say when you're hypothyroid, your adrenals compensate and your adrenals are your stress glands. They pump out stress hormones, so they're pumping out epinephrine, norepinephrine, cortisol, and that causes lot of Palpitations. It's interesting, though. One of the defining things I see between a plain old hypothyroid patient and a Hashimoto's patient is Hashimoto's. People tend to have more anxiety heart palpitations. So it is just a symptom that manifests as Hashimoto's. So that can be it as well. How long after taking thyroid medicine should you wait to eat breakfast? I would say 30 minutes if you're on a GLP, an hour to an hour and a half. You can have coffee and tea almost immediately after postpartum. Autoimmune thyroiditis. Research shows about 10% of women end up with this. It is a autoimmune condition that often manifests postpartum when we are at our highest risk for autoimmunity, as are. There's a lot of theories as to why this happens, but one that I certainly believe in is we are immunosuppressed during pregnancy and then as our immune system reactivates, it almost goes into a rebound and it's overdrive. And so that is a very common cause. Sometimes this is transient, meaning it will go away on its own. You need to be very diligent about checking thyroid function because even if Hashimoto's the antibodies and both need to be checked, TPO and thyroglobulin every time and a full thyroid panel. But this can go away but still leave persistent hypothyroidism because your body has attacked your thyroid gland, replaced hormonal secreting tissue with scar inflammatory tissue that doesn't secrete hormones as well, and that loss of hormones needs to be replaced. Can we drink lemon water or electrolyte water with heads? Yeah, you kind of can. If there's calcium in it, you want to keep it away. But most of them don't have any calcium and not enough to make a difference. But call me a realist, y'. All. I don't. I'm not an extremist. What can I take naturally instead of prescriptions for hypothyroidism and Hashimoto's? So here's the thing. I'm going to be real with you. You guys need to be real careful about people online that tell you that you don't need thyroid medicine. Those people don't have a medical license. They have no. They have no ability to actually prescribe medication. Even if they call themselves doctor. They're not a doctor. Like, they're not a doctor that can prescribe medication. They might be a doctor of chiropractic they might be a doctor of nutrition. They are not prescribing clinicians. And that is dangerous, dangerous rhetoric. Because the vast majority of people that have true hypothyroidism, meaning their thyroid gland is not producing enough hormones anymore, are medication reliant. Do not take supplements with thyroid hormones in them. Why would you do that? Like they are unregulated, wildly unstable, wildly unpredictable. Sometimes you will get no hormones, sometimes you will get crazy amounts of hormones. How do I know? Because I've tested people on these for so long. And why do that? Like that's cow thyroid gland. Why not just take a natural desiccated thyroid medication that is regulated, that is more predictable. Armor ren thyroid, it's pig thyroid gland as opposed to cow. The only reason they're giving you cow is because they're not legally allowed to give you pigs. So like, why even do that? Hashimoto's is always addressed from a functional medicine approach. It is a root cause resolution approach. It is looking at what drives inflammation, gut health, micronutrient deficiencies, stress, all of these things. But, but that is not the case with hypothyroidism. If you have half of your thyroid and Hashimoto's, would you only need T3 meds? No, absolutely not. So the only people that need T3 only meds, in fact, this would make you need T3 only meds less. Okay, because you're not producing enough of your own T4. You all need T4. T4 is the lowest level that your thyroid function gets on a 24 hour basis. And it can pull from T4 to create more T3. As your T3 levels, even if you take T3 are volatile, y'. All. They are up and down throughout the day. They are naturally low at night because you're not getting any T3. And T4 is extraordinarily important for hormone production. Digestion, skin, hair, libido, things that your body needs access to thyroid hormones on a long term basis. You need T4 4. So people post thyroidectomy, hemithyroidectomy, need T4 even more because you have less production of it. I do not buy into this rhetoric of suppressing T4, not giving people T4. That is so dangerous. And when it's done, most of the time, again, it's done by people who do not hold a medical license that are giving advice as if they do hold a medical license. And there are those people and it's dangerous. You guys need to be careful and it's deceiving. These people seem like they're actually a doctor and they're not Thoughts on Hashimoto's Estrogen Dominance Endometriosis symptom I'm going to leave that one for hormones. How important is finding a root cause when treating hypothyroidism? Hypothyroidism? I don't think it's really important. I think you need to offset the loss of hormones that you have now is important. As we reduce and reverse Hashimoto's your risk for other autoimmune diseases goes down. You preserve more of your thyroid gland as you age. You don't lose as much in real time. Hypothyroidism is different and I want you guys to tease those two things out of your mind with Hashimoto's. If it's super mild, it's less important than if your antibodies are crazy high, right? Because you're actually losing more thyroid gland. You can use that as a gauge for your severity of risk for other autoimmune diseases, et cetera. How can HRT affect the need for thyroid support and or medication? I did a post about this on Social like a week ago. HRT especially oral based estrogen birth control hormone replacement massively require require a shift in thyroid dosing because your sex hormone binding globule and your hormone transport increases often that creates hyper metabolism of your thyroid hormones and there are downstream effects. There still is some effect with estrogen. Testosterone especially at really high doses still can impact thyroid medication, need for dosing adjustments, et cetera. The more conservative and reeled in and the less oral estrogen you get the less need for those shifts. Key supplements for Hashimoto's and type 2 diabetes I would say zinc, magnesium, ferritin but you don't need to supplement that if you have enough of it. I do not supplement with iodine. Selenium is amazing. 75 to 200 micrograms of selenium can help reverse Hashimoto's. It can also help activate your thyroid hormones for diabetes. Berberine is great and we'll dig in more to like metabolic issues in the next kind of section of this root causes what to focus on for thyroid nodules Ways to avoid surgery so I am a big advocate for doing everything you can to avoid surgery for nodules unless you are pretty darn sure they're cancerous. Reducing antibodies can help reducing inflammation, low dose naltrexone even fixing thyroid hormones. I've seen help. Nodules are something that can actually fade away. Not always but they can. I think Dr. Alan Christensen even makes a nodule specific supplement. You all can try and monitor them like monitor, monitor, monitor. Radio frequency ablation or rfa. Of specifically only the nodules is also a great way to manage them. We recommend Dr. Jonathan Russell at the Russell center for this. He is probably one of, if not the leading expert in progressive ways of managing thyroid issues surgically. He is a pioneer in this field and an absolute angel human. So could not recommend him enough. All the patients we've sent there absolutely had a wonderful experience. I hear the same from my followers. Best way to support adrenals, having hashi and hypothyroidism, two things Ashwagandha and adrenal. Adrenal. Adrenal. Adrenal. Orthomolecular adrenal is freaking life changing, y'. All. It has nourishing nutrients and restorative things, but it also has cow adrenal gland in it, which makes you feel like you don't have an adrenal problem even though you do. And then also stress reduction, obviously salt, not over exercising, getting enough sleep, all of those things, of course. Is pregnancy possible on TRT and T3 T4 combo? Does it affect the fetus? So here's the thing. One, flat out, foundationally, we don't test drugs on pregnant women, full stop. Okay? So I can't say, oh my gosh, this has been tested for safety because no one's doing that. So number one, trt, testosterone replacement therapy is what we're referring to. Totally depends on what kind you're doing. Right? Would I go get a pellet and have them massively ramp up my testosterone before I'm planning to get pregnant? God no. I would never do that. That's not safe. Would never recommend one, it's stuck in there. Two, most levels are minimally, conservatively above 300. A lot of the times I've seen them over 2000 on a woman. A thousand in a man is a really high level, great level of testosterone. 2000 in a woman is terrifying. So that I would never recommend or do, however, you can do like a dissolvable tablet of testosterone that leaves your system right away, right? And then if it's conservatively managed, like in a physiologically normal level, we're meant we have testosterone when we walk around naturally. Easy enough, right? Seems like in that situation wouldn't be an issue. I've never had an issue with that with my pregnant women. And I have had women get pregnant on testosterone replacement. Obviously we stopped it after. As far as the T3, T4 combo go, I have 00 issues with my patients being pregnant and on T3. T4. Why? Because I don't buy into the complete naivete of medicine and their approach to T3 with pregnant women, which is liter T3 does not cross the placental barrier. If you put your patients on T3 when they're pregnant, they're not going to have enough thyroid hormone for the baby, and the baby's not going to develop normally. Well, guess what, guys? Guess what does cross the placental barrier? T4. And guess what? We can absolutely measure on a lab anytime we want. T4. So there is this assumption in medicine that if someone's on T3, their T4 is suppressed. And that's not true. How do I know? Because we measure it every six weeks in our pregnant women and we adjust it accordingly. Obviously, the baby's health takes precedent over the mother. So we always balance T4 perfectly and we try to have them have enough T3 because that allows you to get pregnant and maintain pregnancy early on. But we would never suppress T4 so that the mom can have enough T3. But the problem lies in that medicine is checking what they're checking TSH, and they're, like, trying to magically infer what someone's T4 and T3 are based on their TSH, when, by the way, TSH is hyper suppressed in pregnancy, especially early on from HCG hormones. So it's like the blind leading the blind over here. And they're all up in arms because I'm using T3 with my patients. Meanwhile, I know exactly what every one of their thyroid hormones are. And by the way, we check it every six weeks. So there's nothing that's flying under our radar. We are crazy people when it comes to our pregnant ladies. We are psychotic. Like, we are relentless in our pursuit for perfect thyroid hormones, not only for the mother, but even more so for the baby. And it does nothing but improve outcomes, y'. All. Okay, we're going to switch over to the next category. Okay, we are taking a pause in the middle of this episode, and I'm asking you all for a favor. So if you could please, please, please, I have you here review our podcast on whatever platform you're sitting on right now. That would be incredible. And the other thing that I would love to ask you to do as a personal favor for me, is to subscribe and download these episodes. So the way that podcast value is measured is in downloads, not streams. And I know most people don't know that. And so good guests look at downloads to determine if they Want to come on a podcast? We are a new podcast, y'. All. We have under 50 episodes. So I would love nothing more than to serve extraordinarily valuable information to you to bring on extraordinarily valuable guests. But in order to do that, I need to show a lot of downloads. So please, if you could download every episode that you listen to or automatically download as them as the weeks go on and as they're released, that would be incredible. Share it with a friend. But the two biggest things that you can do to support our little podcast that is is freely giving you information is to subscribe and download and to review. Thanks, guys. All right, moving right along to metabolism, weight loss, GLPs, all the things. Let's do it. Okay. Where can I get a GLP if I don't have a weight problem for inflammation? So we totally do that at Modern Thyroid Clinic for our patients. I don't think we are taking any more new patients for weight loss alone at Modern Thyroid Clinic. But if you are a thyroid patient, a hormone patient, you can automatically participate in our weight loss program. Our sister company, Modern Weight Loss, can. Technically, we are aiming more for people that are trying to lose weight, but every once in a while, we are able to accommodate and I am trying to move things towards accommodating people for longevity reasons. So if it's not able to be facilitated now, I don't think it will be long, which is so incredibly exciting. But other than that, if you happen to become a thyroid patient, Sister, we got you. Can thyroid issues be the problem of why you don't lose weight on a glp? Absolutely. So thyroid issues are a very common problem for inability to lose weight in general, even with effort, for dysfunctional metabolism, all the things. But even the time, like if people compare, or if I compare people who come into Modern Thyroid Clinic and we start treating them with the GLP and thyroid at the same time, compared to people whose thyroid we've perfected and then we start them on a glp, the second class of people lose weight so much quicker because the thyroid issue is solved. So, absolutely. Can you be on a GLP1 forever? Yes. GLPs are actually studied and created for forever use. A lot of our patients are not on them forever because most of them are on it for weight loss, for metabolic dysfunction. Once we are able to repair that, most of those people come off. However, people that are inflamed want to stay on GLPs, and so they can. That's how they're meant to be used. Actually, I'M noticing vision problems after a glp. Can you talk about this more? Anything to do so in rare cases that vision change is due to naiom and that is likely not what's driving yours. That's more of an acute issue. It's often with people with blood pressure issues, severe diabetes, who are already prone to vision issues. In someone who is using a GLP simply for weight loss, that doesn't have metabolic syndrome, etc. I would say that's likely due to micronutrients depletion. So you need to solve for that. If you're over medicated, you're taking too much, you're not eating enough food, et cetera. Also be sure your blood pressure looks good. Often people who start GLPs are on a lot of blood pressure meds. They don't need them as they progress in their GLP1 journey and that is what drives a lot of the acute loss of vision. But if it's both eyes, it's likely not that it's it's most commonly micronutrient depletion. Can you get off metformin for type 2 diabetes if your numbers get down? I view that absolutely. I'm not a diabetes expert, but we treat people with pre diabetes early stage diabetes and very commonly we can reverse them out of that process, especially early on. How to fix the root cause of diabetes with hashi. Number one, fix your thyroid. So early indications of thyroid dysfunction are elevations in blood sugar, cholesterol, et cetera. You have to fix your thyroid to not have a blood sugar. Diabetes, et cetera. Issue hashis and now type 2 diabetes. What to focus on first, diet, GLPs, meds, exercise, always. Lifestyle first. Always, always, always. Because even if you get on a glp, you have to work on your lifestyle. Now you can certainly harness a GLP while working on lifestyle, but those two things go hand in hand. They are not separate. And always thyroid first. Immediately, immediately. Because that is the root cause of a lot of blood sugar dysfunction. Before starting glps, what are the big hitters for diet with hypothyroid? For me, for weight loss, for reversing blood sugar dysregulation. Number one, intermittent fasting. Incredible. I recommend my patients do it four to five days a week. I recommend a 16, 8 fast. You can start much slower than than that. You could start with an 8 hour fast and slowly build up. But very, very important for people who want to amplify their fast or people who maybe cannot intermittent fast ordering your food. So don't mean take out you order your food throughout the day in such a way that it keeps your blood sugar and insulin as low as possible as long as possible. Think about it. Our longest time without food is overnight. Okay? So our insulin, our blood sugar go into arrested state within our control overnight. When we wake up in the morning, we can either spike that blood sugar and insulin with a bunch of carbs and sugar, or keep it as low as possible as long as possible throughout the day, which in turn reverses insulin resistance, leptin resistance, and can reset those cycles. So what that means is starting your meals with protein, then low, high fiber, low glycemic index veggies, and then you ideally do that for the first meal or two of the day. And you save carbs and sugar for your last meal of the day, which is the opposite of what people tell us. However, again, we're keeping our blood sugar as low as possible as long as possible throughout the day. If you can't do that, you save your carbs and sugar at the end of each meal so that you prime your body with protein and fiber so that your blood sugar and insulin response is not crazy peaks, it is slow, peak slow coming down. We don't want volatile blood sugar. That's what worsens insulin resistance, blood sugar dysregulation, riding the roller coaster of your blood sugar. So those are my biggest tips there. Let's see how to truly lose weight that if you have hypo hashi and your levels are in range. So the things that I just mentioned, also exercise fasted. As long as your thyroid, your adrenals are in good shape. Not crazy intense exercise. But hey, wake up, go for a walk, fasted, do some slow weight training, fasted. It's not going to kill us guys. And in fact, if you think about it, if you want to lose fat, what you don't want to do is drink a giant smoothie of 300 calories and then go work out and walk, run two miles, right? Like you're just burning the calories and the blood sugar from the smoothie you just ate. If you want to tap into your fat stores, harness exercise when you're already in a fasted state. It doesn't have to be crazy, it doesn't have to be super intense. In fact, some of the best exercise in the state are low stress exercise, like literally just walking. Your cortisol isn't raised, you're simply slow and steady in a sustained way, tapping into your fat stores and burning fat. Okay, I think those are, what should you do if you Tried GLP and you couldn't lose weight. Thyroid hormones address those. Sometimes I layer in metformin. Obviously we work on lifestyle. What are you eating? How are you exercising? It's not just this glp, that's a magic thing. And everyone loses weight. No. And in fact, what I want you guys to really understand is in an ideal world and in the real world, people do not start losing weight on a GLP for miles, months. They don't really lose weight until around month three. And that's on standard dosing. Which how I feel about standard dosing is it is way too high of a dose. These people are overdose, they're over medicated. It's driving bad things happening. So if that's how long it takes to lose weight on a standard dose, imagine how long it takes to lose weight on a microdose. So be patient, right? Be patient. Opinion on peptides on glp, peptides for inflammation. There is nothing I've ever seen that reduces inflammation more than a GLP. 1. No lifestyle, no diet, no supplement, not even LDN or Lotus naltrexone compares to the reduction in weight in inflammation from a glp. And here's two things that I want to debunk right now when I say this online, people come back and they're like, well, you're not figuring out the root cause of their inflammation, so that's not good. Well, here's the thing guys, and I am a perfect freaking example of this. Not everyone has a root cause that's controllable. My genetics are prone to massive inflammation. How do I know? Because I've had them run. I've looked at them personally on thousands of data points. And that's the fact. For me not to have inflammation in my life, I have to water fast my entire life, isolate every variable and live in a bubble. And even then, I am still prone to inflammation. So do people that are eating a bad diet and a bunch of processed food and crap need to fix that to fix their inflammation? Of course. Those are not my people, like the people that come to see us are not lazy. They're not trying to take the easy way out. They're not trying to just, oh, do this magic thing and pour zero effort into their lifestyle. That is not what's happening. These people are putting in tremendous efforts and they still cannot influence it in a way that's worthwhile. And people that aren't inflamed do not understand that. And there is a big difference. My husband and me. My husband has never been inflamed. A day in his life. He does not even cannot wrap his head around what that even means. I am the absolute opposite. 98% of the time, I am actively inflamed, trying my best to mitigate it by doing 1 million things. So it's not as simple as everyone thinks. The other thing is people say, well, you're not inflamed, it reduces inflammation because you lose weight. Bullshit. And I don't cuss often. That's not real. I could have told you this a year ago, but research even has come out that shows people's inflammation reduce on these meds long before they lose weight. One microdose injection measurably reduced a patient's CRP 65 plus percent. One microdose injection that is not able to be replicated again with diet, with lifestyle, with exercise, with Paleo, with whatever it is that you think that you have that's magic in your back pocket. That is this one size fits all for these people that can magically reduce inflammation with some lifestyle change. No, that is not real for a huge percentage of the population. And I it makes me infuriated that people demonize these other humans that are doing their best to live their healthiest life and you're constantly looking at them and blaming them as if they're taking the easy way out and it's not real, so quit saying that. And also it's not backed up in research, it's not backed up what I find in my own clinical practice. So there we go. If you want more information on GLPs and my viewpoint of them, Honestly now I'm hearing so much of what I've been screaming from the rooftops for three years out circulating in the world now. Finally. But I have a couple podcasts dedicated to this topic alone and I really encourage you to check them out. So the last major topic before we move into like all these random things is hormones. One kind of in between question is what are top nutrition and fitness tips for low thyroid function without messing up hormones, AKA thyroid or other hormones? So let's talk through this. It kind of also bleeds into the metabolism and weight loss piece. So this is a perfect bridge. We already spoke about diet, right? So ordering your food, intermittent fasting, high protein, super important. Getting enough salt, super important for adrenal health. And then the key here for exercise is a couple things. One, building muscle mass. So muscle mass is what is going to keep our blood sugar regulated, keep us metabolically advantaged, not disadvantaged. It also protects us from osteopenia. Osteoporosis risk of death from falls, sarcopenia, which means low muscle mass as we age, like muscle mass is huge. So lifting weights is very important, as well as eating enough protein to build muscle with weights with weightlifting. Now, the key here is finding a way to build muscle mass without taxing your body more than you're building an up. Right. We don't want to create unnecessary manufactured stress in people who are already stressed just from surviving. Right. And having the capacity to do what we need to do to survive. So the way that I recommend people do that is almost tease out cardio from weightlifting. Like, if you want to exercise fasted and you're not far along on your thyroid adrenal journey, exercise fasted while walking. Right. Don't go super hard at the gym and, and stress your body. The other thing is weight training can be done in a way that you don't mix cardio and weight training, not like circuit training. So when you lift weights, you take a lot of rest time between sets and circuits. Okay. So you allow your heart rate to completely come down and rest and recover before moving on to the next thing, especially when you're, you're working larger muscle groups, your legs, your butt, et cetera, things that can really tax our physiology. So lot of weight, a lot of waiting between sets, et cetera, even. Yeah, so you get the point. One key thing that I drive home with all of my patients is if you leave the gym, if you leave a workout and you are left feeling more tired later that day or sick, or you need a nap, or you feel like you have the flu, you have overdone it, you should be equally as energetic later in the day or more energetic later in the day. You should not be more tired. This is important because a lot of people, especially like type A, motivated, driven people, will push through and say, well, I just have to keep working out at this level until my body adapts well, instead of adapting, it usually breaks down our physiology more and more. And instead of getting stronger in turn, a lot of people actually get weaker. And these are some of the sickest people that show up to my office. And honestly, some of the only people that I can't fix are people, by the time they show up to my office, they work out one day and they're in bed for five days. Like, that is very far along on the adrenal dysfunction scale. And it gets hairy and scary. So we don't want hairy and scary. You have to listen to your body, especially early on in the season, stages of recovery okay, Listen to your body. Another thing that kind of bleeds into the hormone aspect of this conversation is, hey, make sure you have enough testosterone to have endurance for your workouts. Appropriate levels of recovery needed that you can have enough testosterone to build muscle mass while you're working out. Okay? So ideal levels of testosterone for me are minimally between 35 and 65 for women, men at close to 800 to 1000. It can even be above 35 to 65 for some women. I do not advocate for women to have crazy levels of testosterone like 300, 400, 500, a thousand. I'm a no go for that. But I do believe normal, optimal levels of testosterone can be a game changer. And let me tell you, low testosterone is the first hormonal kind of secondary issue that I see with thyroid issues. First low testosterone, then low progesterone, et cetera. So it is very, very important to get your testosterone checked. I cannot tell you the percentage of women who are essentially undetectable in their levels of testosterone. What do I think about estrogen vaginal cream for ladies over 40? I love it. I love it. The downside about cream is women often don't like it. So they're a little non compliant. So I like vaginal trochees. They're almost like little waxy inserts that in your 40s and like perimenopause you can pop in a couple days a week. I do it personally. Really. As our hormones fade and wane, we need to be supplementing them. And symptoms of low estrogen in women are hot flashes, vaginal dryness, and then we have other sequela like hair and skin changes and abdominal fat deposits and osteoporosis, osteopenia. But some of the first things that we will notice as perimenopausal women, as our estrogen drops, hot flashes, vaginal dryness. Okay. Can progesterone, testosterone, LDN get rid of inflammation or why aren't they? So that's a very complicated thing that I honestly, I can't answer that question because that's a tough one because it's so bio individual. But I don't expect hormones to change inflammation. LDN certainly can in some people. I'm going to leave the LDN conversation for later because that is a conversation all of its own and we've got quite a few questions on it. Let me go back here. What did I do with all of my hormone questions? Darn it. I think I circled them with the wrong color, y'. All. Okay, how does MTC dose Sex hormones. I'm so terrified Sister had breast cancer. So our approach to hormone replacement therapy at Modern Thyroid clinic is conservative. That's it. Like we want to put you. It depends on what phase of your life you're in. But basically we want to put you in physiologically normal levels in perimenopause, meaning we don't want your hormone levels crazy high. So what would you be walking around with naturally at an optimal level? And that's where we want to put you, okay? Postmenopausally, we want to put you at the lowest possible level where you do not have symptoms of hormone deficiency, but still also get the benefits of hormone replacement. So that is tiny amounts of hormones, y'. All, okay? So for estrogen, for example, a great level of estrogen that we aim for conservatively is about 35 to 75. Postmenopausal women can walk around with a level of 25, even sometimes 30 of estrogen. Often it'll be lower, but like, that's not impossible. So baby levels, if you think about it, compared to women who ovulate, their levels of estrogen often go between 3 and 400 at peak. So I want you to conceptualize that we are giving a small amount testosterone same. We want to give you the amount of testosterone that you should be walking around with optimally as a woman, not a postmenopausal woman, where they'll say your testosterone should be zero. No, because you're going to have symptoms in long term health outcomes associated with low hormone levels levels. Same with progesterone. It is a tiny bit. So that is our approach. We do not, will not, do not advise over medicating women on hormones of any kind. Okay? So let's kind of dissect this a little bit further because for many women, especially women who are menopausal right now, they grew up and aged in a time where medicine repeatedly told them that hormone replacement therapy was dangerous. Dangerous and horrible. And you should be terrified. And here's the reality, guys, that was based on a study called the Women's Health Initiative that came out in the early 2000s, late 90s, somewhere around there. And that study has been single handedly debunked, ripped apart. The people that put on the study have came out and retracted it. It is not true. The data was not analyzed correctly. The study was not run correctly, and it has in turn cost millions of women their health, hormonal and otherwise, because of crappy data. Okay? In spring of 2024, the largest study ever conducted on hormone replacement for Women came out and looked at. I wish I had the exact stats in front of me. It was over a million women over I think 10 or 20 years. And it showed women who took hormone replacement, even estrogen, had less breast cancer risk, less ovarian cancer risk. Studies have shown less likelihood of death from breast cancer if you're on hormone replacement therapy when you get diagnosed. Less cardiac risk, less neurodegenerative or dementia, Alzheimer's risk, obviously osteoporosis, osteopenia. It came out that these hormones in fact were helping women tremendously in their long term health outcomes. And debunked again, the study that had already been debunked. So I would say big picture, too much of anything is not good. And it sadly, medicine is coming around to this idea of hormone replacement and it's not being done well. Often people are over medicated. Often there are whole organizations saying that we don't need follow up labs to even check what your levels are, which is insane. We absolutely do. That's ridiculous to put a woman on a hormone and not check her levels to adjust it appropriately. Anyway, here's the thing. Let's say you were taking estrogen and worst case scenario you ended up with a tumor on your breast that was estrogen receptor positive. I'm not speaking to you directly to the person that submitted this question. This is what I tell my patients. Okay. This is not medical advice. But let's say you were taking estrogen and your level was 45 on estrogen replacement. Okay. And your tumor specifically fed on estrogen. If your level is 45, that tumor might grow 2% more quickly. So estrogen replacement never causes breast cancer. That's never been the case. It is. Oh. If you have a breast cancer tumor that feeds on these hormones and you're taking these hormones, they're going to grow more quickly than they would if you weren't. Right. Which is an interesting concept because the people that get breast cancer the most are people that don't have hormones. Right. People that are postmenopausal are at highest risk for breast cancer. So again, it doesn't really make a lot of sense. But, but let's theoretically talk through this. Well, if your estrogen is very, is present but very conservative, it's almost a wash. Like the, the amount of increase in proliferation is so small compared to those who weren't on it, that risk versus benefit, which is always what medicine is about, risk versus benefit. So my question would be, how bothersome are your symptoms of hormone deficiency? So I mean, progesterone I mean, progesterone is incredibly safe. I view it as protective against breast cancer, as do most clinicians who are progressively minded and up with research testosterone. I view it is independent of cancer in general. I think if people choose to be afraid of something, most commonly they're afraid of estrogen. But even looking at that and considering everything we just spoke about, I personally will be taking estrogen replacement. I already am taking estrogen replacement, and I'm 42 sporadically because I'm dipping below the threshold of symptoms. And so weigh the pros and cons. If it's protective against heart disease, that kills more people every year than all kinds of cancer combined. So we all tend to be so afraid of cancer, guys, we need to be afraid of heart disease. You can be afraid of cancer too, but heart disease is what really puts our lives at risk for the most part. So anyway, do you want to be afraid of that? Do you want to be afraid of cognitive decline, Alzheimer's, dementia and so everything is about risk versus benefit and your unique goals. Right. Do we not need a Dutch or similar prior to taking these hormones or a full picture? So I share this kind of openly with my patients. I do not believe in Dutch testing. Not at all. Not in the slightest. I think it's a total sham. I used to do Dutch testing and compared it to blood labs. So that's how I was gathering data to create the security and validity I needed to feel comfortable using it consistently every freaking time. It did not match to blood levels that I knew were factually true. And originally, when Dutch testing came out, it was marketed to people who could not order lab work, could not prescribe medication, people that did not have a license to practice medicine, so they couldn't order labs. So this was what they used adjunctively. And I think they did a really good job marketing it. And now it's adopted even by people who can order lab work. And frankly, I don't find it to be true or valid. And we do not use it at Modern Thyroid clinic. Full stop up. But we do follow up with blood levels, which is what. What's valid and what I know to be true and what I can actually believe in. Okay, let me make sure I'm not skipping any hormone pieces. I think I got them all. One random question is, can I talk about lipedema? I do not know about lipedema, though I'd love to bring an expert on the podcast. Okay, cool. Let's move into the random questions. Let's talk about ldn. I saw a really great question about LDN which was how long, how long till it works? I find LDN to increase in effectiveness slowly up to about 18 months before it levels off. So I think most people online like think it should take effect really quick in days, weeks or even a month. I don't find that to be true. And in fact what I tell people on LDN is don't actually expect any symptomatic improvement that you can feel subjectively. Let's check labs, let's check antibodies, let's check inflammatory markers and let's go by that because LDN is a tool for long term health and improvement. It's not a symptom based treatment. Also for ldn, I have an entire podcast episode to it dedicated to it. So please tune in. There is one of the earlier ones that I did. Let's talk other random stuff. I'm seeing a lot of ads for hair growth supplements. Do they really work? Work? Well, I think it depends which ones, but yeah, I mean so I approach hair loss in a multifaceted way and I should probably just do like a whole deep dive. Honestly. I'm going to write that down. I'm going to do a deep dive on hair loss on the podcast, but I absolutely use supplements with my patients. I mean think about it like we need certain nutrients to grow hair that compose our hair, that make us have healthy follicles and growth. So absolutely they are one of the first things I reach for for people often ask me, oh, do you really notice improvement with one skin hair loss drops? Yes, guys, y', all, I would never ever compromise the trust that you all have in me to schlep some product like that will never happen. So I probably get 20 to 40 maybe 50 offers a day on influencer marketing like will you rep our product? Will you promote y'? All? I take less than 1% of those, like.0001%. I am extremely particular in the the brands and products that I work with to share with you all and if I share them with you all it's because I actually 1 have used them, love them and 2 I think that you all would benefit and love them too. So I absolutely noticed improvement in the one skin hair drops. I it's on my social media if you want to find my before and after. I only used it for a month and I didn't even use it to the full way that they told me to because sometimes I'm a non compliant person and I live a real life and I can't revolve my whole life around growing my hair back. Right. So you can totally check that out. But know that I would never, never like overtly just tell you about a product that I don't know and love. Thoughts on peptides. They're all the rage right now. Can you help us sort out the hype? So I'm going to go on my own peptide journey again. I've done peptides as long as far back as 2018. I've had some great experiences with them, like with BPC157. I've had some horrible experiences with them with things like Sir Morland and Ipomorlin and everything in between. So let's take a pause on the peptide conversation. Let me dig in a little deeper personally, because that's honestly what I do before I recommend things to my patients as well. And I'm glad that they are all the rage right now. I believe that peptides are extremely powerful. Gcku. The, the copper peptide. I have not dabbled in that yet, but I am soon. I do not recommend that you guys buy peptides online on the gray market. Like, I just don't. You don't know what's in them. You don't know how much is in them. There is like replacement reports of sub potency, hyper potency additives, things that are not good. And you're injecting that, guys. So you need to be very, very careful in that regard. Can you talk about how you got rid of SIBO and what you do if you can't take Betaine hcl? So I don't know how you guys knew I had sibo, but I guess I told you at one point I had severe sibo. And I swear it was devastating for me. I absolutely hated it. It wrecked my entire life for like two years. I would get bloated if I even drank water. SIBO is small intestinal bacterial overgrowth. It's where bacteria that are meant to be in our large intestine end up making it into our small intestine. And they colonize that and we eat and they produce massive gas and they ferment, essentially our food. And gas comes up in the form of belching, burping. Our stomach goes out like we're pregnant. And that's kind of the symptoms of sibo. I took multiple antibiotics. I took Xifaxan. I took metronidazole. I literally. There was a time I had to go get colonics every week, guys, because I was in so much pain and discomfort. Awful. But I totally took antibiotics. I do not Think my SIBO is completely gone. I still think I have it. Like most people with sibo, it is extremely hard to get rid of. And yeah, so I would see a sibo expert that is not us at modern thyroid clinic. We are not sibo experts. So I would find one see them locally or via telemedicine. I would not hesitate in my case to take antibiotics. How do I get my beautiful tan glow? I fake it. So if you see me on a podcast, not this one, but other people's podcasts, like Josh Ax's podcast, which was great. You guys should check out that interview. I'm tan. I'm glowing. It's because I have a spray tan. If you see me on my Instagram stories, it's most likely because I have a filter on. So let's be honest, I don't. I mean, I do have some skin color, but it's not much. Guys, if I do an event, if I'm speaking, etc, I always get a spray tan first. So there you go. So I wanted to say thank you. You've made such a difference in my life. Oh, my gosh, Marcy, you are so welcome and deserving. My favorite concealer. I'm gonna post that on social because I do have a favorite. I think it's ilia and it is gold. But makeup and skin, I will post on social for you guys. Okay. I'm gonna try to do some rapid fire ones that came in late on social considering a breast dog. So much info out there. What is your honest opinion? My honest opinion is I have one. I'm not convinced that I don't have symptoms from it. I've had patients who have them who do great and have no issues. I have patients who have issues, they get them out and they don't improve. And I've had patients who have issues, they get them out and their whole life changes. So the jury's out, right? I mean, everything's about risk versus benefit. Personally, I don't regret it. I wish maybe that I had a fat transplant or fat transfer. Looking back now, I certainly wish that I had saline instead of silicone though. Dr. Whitfield, who has done a podcast interview with me, who's like a breast implant illness expert, said it didn't make a difference because the outside's still silicone anyway. Right? But I have mixed opinions about it and I think everything's about pros versus cons, and I think it's a super personalized decision. So I'm sorry, do you need to cut out caffeine to heal adrenals? In my opinion, no. Our bodies adapt to caffeine. We don't get the same response to caffeine as people who don't drink it. Our bodies very much acclimate to it. Also, I will never ask you to do anything that I'm not willing to do and haven't done myself. And I'm not giving up coffee and my adrenals are not in tip top shape so I'm okay with it in moderation but still working on your adrenaline function. I know it's personalized but do you have a go to thyroid medication or combo? I don't. It is very personalized. If someone comes in on Synthroid or a levothyroxine based med like Tyresin etc, I will never take them off and put them on desiccated thyroid unless they're on an extraordinarily low dose. I will simply add cytomel or lyothyrene to it. So that's probably as big as it goes. Everything else from there is too personalized. How long after having meds can you have coffee or half and half with whipping cream? I covered this earlier almost immediately. Best advice for setting time aside for yourself in a morning routine to do some self care at home too. So I would say it doesn't have to be in the morning, right? Like carve out time wherever you can. If it's before bed, if that's easiest for you so you get to sleep in 30 minutes, that's okay. If it's morning, do it. I think go easy on yourself. Try to start out like a few days a week and carve out whatever time you can. But having especially for moms, consistent support for child care pre planned in my opinion is key. Whether that's I drop my kids off at school in the morning and then I go for a walk or every Tuesday night I have a babysitter come over and do it that way. Also one little workaround that I do whenever I have Rosie is sometimes I schedule a mobile massage to come to my house at night while she's in bed. Like while I still am here I can still make sure she's okay. I don't need a babysitter, but I still get a little bit of respite and relaxation, which I think is key. Okay, a couple other questions. Grogginess in the morning with LDN normal, does it usually go away? It absolutely does. I usually have my patients stop taking it right before bed and push it back to dinner time. Best time to take glutathione orally is at nighttime eyebrow tutorial. I can totally do that on. On social. How to get the courage to start a social media influencer page. The whole video thing, I'm not a fan of. Oh, Sarah. So here's what I'll tell you. I had so much resistance in my being to start a TikTok page. You, probably so many of you are new here, but this whole thyroid journey thing with Modern, like, none of this is new. But there was a time, and I'm going to get a little personal for a moment. There was a time after 2020 where I was so burnt out, guys. Like, I went into deep hibernation. I didn't post on social. I didn't take podcast interviews. I just hibernated and, like, tried to keep my life together. And for so many years, I was seeing patients in clinic four days a week. So many patients every day back to back. Was most of the time not eating lunch. I. Everything was kind of dependent on me to keep this thing afloat. And eventually I got enough clinicians and we built a following under the name of Modern Thyroid Clinic. It wasn't just me anymore that I could share the workload, but I still was really reluctant to do that. And I had this idea that, oh, I've got to see all these patients. It's got to all be me. I've got to do this and doing that with a. Being a mom and having two young children. And for a long time I was a single mom and I have a disabled daughter. I have four step kids, like running a business. It was a lot, guys and helping this grow. And eventually in 2022, I made the decision and the promise to myself if I cut back some on clinic, that I would use that time to pour in back into Modern Thyroid Clinic in whatever way I could. But I promised myself that I would do it in a way that made me uncomfortable. And I resisted the TikTok thing for so long because I didn't want to do the video right. Like, I didn't want for. It felt so vulnerable. Eventually I made myself do it. And my first TikTok went viral. And I got like probably 30,000 followers from one, literally one video. And not only did I get those followers right, and then it spiraled. I mean, it really did. It took on a life of its own, guys. And people were ravenous for this information. I. I breaks my heart still that TikTok changed their algorithm from that because it's not nearly as rewarding from that standpoint. I don't Many people don't see the information I'm putting out, but get uncomfortable. And don't be afraid to be uncomfortable. Like in every season of your life, the way that you can up level your life is by making yourself be okay being uncomfortable. And now I'm so comfortable doing TikToks and things. Like I literally had like a TikTok person come over and film with me last week and she's like, you are so good at this. And it's practice, right? It's being willing to be uncomfortable until you're no longer uncomfortable. And now that I'm comfortable with that, you know what? I'm leveling up to my next uncomfortable thing, which is speaking in front of people and speaking engagements. I have a lot of them coming up, some of them in front of thousands of people, some of them in front of hundreds of other clinicians and doctors. And it is scary, but the reward is so great, right? Like when you're willing to put yourself out there and get, go beyond your comfort zone. What lies outside of that is completely untapped. Whether it's a community that you build on social media, and my community now on social media is, is incredibly rewarding. Whether it's partnerships with brands that I value as much, like the brands that I work with are just as much my community as the people that I'm serving this information and trying to help with information. It's just, it's so fun and it's so incredibly rewarding. And so if something is inside of you that's nudging you along to do that, just do it. Like, what's the worst that's going to happen? Like some random person from your high school is going to be judgy. Who cares? If there's anyone judging you in your life, it's because they are jealous of what you have. Your true people, your cheerleaders, your support network will never judge you. They will cheer you on, they will lift you up, they will hold you up. And if you don't have those people in your life and you're worried about the people in your life judging you, you need a new circle. Like you just need to find new people because there are friends, colleagues, acquaintances that will do nothing but lift you up. And I can't encourage it enough. TikTok has single handedly changed my life. Like it's changed my family's life, it's changed modern thyroid clinic. I would not be where I am today without having done that, without getting out of my comfort zone. I wouldn't have the book deal that I have, I can guarantee it full stop. Like, it wouldn't have happened. And because of what I've done, getting uncomfortable. Thousands of hundreds, honestly, hundreds of thousands of lives are touched because of my willingness to be uncomfortable. So do it. Do it. I can't encourage it enough. We'll close with that. This was the longest podcast episode I've ever done. I hope you guys enjoyed it.