Hormones 101
In this episode we lay down all the basics of what hormones are and what they do. Co-host and endocrinologist Dr. Gillian Goddard walks us through the different feedback loops in our bodies, and how hormones are the instruction manuals for all our major systems. This episode includes fun facts about organs and glands, the placenta, your brain, how Tamoxifen works, diabetes, perimenopause, and the myth of the hormonal imbalance!
For a lot more on your hormones and women’s hormonal health from birth to menopause, check out Gillian’s forthcoming book, The Hormone Loop! www.thesavvypatient.com/book
We take a moment to remind you that while this is a medical discussion, it is not providing a diagnosis or treatment or any medical advice. The only way to get a diagnosis, treatment or medical advice for your particular condition is through a discussion with your doctor.
Please subscribe savvypatient.substack.com
Visit www.thesavvypatient.com/podcast for episode transcripts.
Watch full podcast episodes @TheSavvyPatient on Youtube.com.
Get your copy of The Hormone Loop by Dr. Gillian Goddard wherever books are sold.
Please subscribe savvypatient.substack.com
Visit www.thesavvypatient.com/podcast for episode transcripts.
Watch full podcast episodes @TheSavvyPatient on Youtube.com.
Get your copy of The Hormone Loop by Dr. Gillian Goddard wherever books are sold.
This episode was produced and edited by Erin Stein. Music: “All We Live For (instrumental)” by Wolfclub licensed through Audiio.com. Intro and outro edited, and video created, by Ian Mayer. The Savvy Patient logo by Amanda Spielman.
TRANSCRIPT
00:00 Defining Hormones
04:03 How Hormones Function in the Body
10:06 Exploring Hormonal Feedback Loops
15:59 The Lifespan of Hormones and Their Implications
20:45 Understanding Tamoxifen and Estrogen's Role
23:57 Estrogen in the Brain
25:18 Ongoing Research in Hormone Discovery
29:31 The Fascinating Role of the Placenta
33:16 Common Hormonal Issues
35:21 Hormone Balance is Not a Thing
Erin Stein: We’re going to let Gillian do a lot of the talking during this podcast because she
actually studied these things in medical school and has in fact written an entire book about it.
Maybe we’ll just let you start with trying to define what hormones are for those of us who did not
go to medical school.
Gillian Goddard: Sure, I actually think we should start even a little bit before that.
Erin Stein: Fair enough. In the beginning…
Gillian Goddard: So, okay, not that far back. We won’t talk single-celled organisms or anything.
The human body is really just a bunch of different networks or systems. We have the
cardiovascular system. We have the respiratory system. We have the nervous system. And all of
these systems actually work together and interact with one another to make sure that our bodies
function the way they’re supposed to. One of those systems is the endocrine system, my favorite
system. The endocrine system is made up of glands and those glands all make hormones. That is
sort of the framework that we’re talking about here.
Erin Stein: We often think of the human body as these discrete parts that we put together, like
building a Transformer or something. But I did take a class in neuroscience and read an entire
textbook about the brain. And the thing that I’ve took away is that our brain, while we try to label
parts of it, the entire brain works together in every system in our body. There is no real
separation that you can make. It’s just systems upon systems all layered all together. And so, the
way you’re talking about that makes sense to me because I read a whole book and was like, there
is no like one part does one thing. One part is a part of multiple systems doing multiple things.
Gillian Goddard: Yeah, we’re pretty complex. Yeah.
Erin Stein: Yeah, seemingly very complicated. Okay, so explain what a gland is.
Gillian Goddard: A gland is an organ that makes hormones. So, you have a bunch of them. You
have a pituitary gland. It sits straight back behind the bridge of your nose, just below your brain.
You have a thyroid gland, which is in your neck. You've got adrenal glands. They sit, they're like
three-cornered hats sitting on top of your kidneys. If you're a person with ovaries, you have
ovaries. And if you're a person with testes, you have testes. The liver, the kidneys are actually
making hormones. Fat. So fat cells can help produce hormones. There are cells in our stomach
that make hormones and cells in our gut that make hormones. The ever-present GLP-1 receptor
agonists, the hormone that that is based on is made in the cells of your small intestine. And so,
while we typically think of glands as being the main hormone-producing organs, and they are,
there's hormones coming from other places too.
Erin Stein: So, it's very messy is what you're telling me. Okay, so we have glands that are organs
and we also have some organs and we have fat all making hormones. While making hormones
all the time, it seems like we need them. Why do we need them?
Gillian Goddard: So, hormones are instructions that tell a part of our body what to do. To make a
protein, to open a channel, I mean, we're talking about things that happen on a really tiny level.
To grow cells to line our uterus.
Erin Stein: Hormones are all kinds of instructions. It's not like they only participate in one kind
of thing that's happening in our body. All kinds of things that are happening.
Gillian Goddard: All kinds of things.
Erin Stein: So how do we look at them? How do we organize them? How do you do what you
do, Gillian?
Gillian Goddard: Yeah, so usually we think of hormones and glands in feedback loops. So,
picture two people playing ping pong, right? Pretend they're good at it. So maybe not you and
me. One of them serves the ball and the other person moves and adjusts a little and hits the ball
back. And then the first person moves and adjusts to hit the ball back again and they keep the
ball going back and forth sort of easily. But they're sort of adjusting how hard they're hitting it
and where exactly they're hitting it from to try and keep the ball in play. So, the players in this
game are glands and the ping pong ball is the hormones. I think the easiest loop to think about is
the thyroid loop. It's the most sort of straightforward. And so why don't we start with that one as
an example?
Erin Stein: Okay, let's start with the easiest one.
Gillian Goddard: So, your brain, your nervous system is taking in all kinds of information. It's
taking in information like from your environment, from the outside world. Is it hot or cold?
It's taking in information from the rest of your body. And it synthesizes all of that in an area of
the brain that is also a gland called the hypothalamus. And the hypothalamus does lots of
different things with this information, tons of things. But one of the things it does is it makes
these little peptide hormones to tell the pituitary gland to do something. So, in this case, in the
case of a thyroid, the hypothalamus senses through all of its inputs that you need more thyroid
hormone. So, it makes a hormone called thyrotropin-releasing hormone. That hormone, TRH,
goes to your pituitary gland. Again, pituitary gland sits right behind the bridge of your nose, like
where my glasses are. It's tiny. It's the size of a jelly belly jelly bean. But it's super important. It
gets the signal from the hypothalamus and in response to that signal from the hypothalamus, the
TRH, it makes thyroid stimulating hormone, TSH. TSH then travels through the blood to the
thyroid and binds to receptors on the cells that make up the thyroid and tells the thyroid to make
and release thyroid hormone. Thyroid hormone is now circulating in your blood at appropriate
levels and it's doing all the things that thyroid hormone does. I like to think of thyroid hormone
as sort of like the gas pedal for the body. When you have more thyroid hormone, things happen
faster. And when you have less thyroid hormone, things happen more slowly. So, it's like
pressing on the brake or letting off the brake. But some of this circulating thyroid hormone
circulates back to your hypothalamus and pituitary gland and tells the hypothalamus and
pituitary gland that you have an adequate amount of thyroid hormone. So, then it will dial back
the amount of hormone, both the hypothalamus and the pituitary gland can dial back a little bit
the amount of hormone that they're making. They can adjust to how much thyroid hormone is
circulating in the body.
Erin Stein: Okay, so it's a super complicated text chain between multiple people that somehow
does not dissolve into a game of telephone. Although I guess that is something that may happen
with certain medical conditions. But I don't want to torture this analogy too much. Let's take one
step back because we've talked about hormones. They travel around, they go from place to place.
Gillian Goddard: That's right. That's right.
Erin Stein: In this case, one hormone made another hormone. It's a lot of hormones happening.
Gillian Goddard: It's like alphabet soup too, yeah.
Erin Stein: A little bit, yes, or a lot, a bit. So, the hormone goes somewhere, like the pituitary,
another gland, another organ, another whatever, but you describe the hormone as the
instructions. So, when the instructions get there, when the text message arrives, who is it talking
to? What then does something about it?
Gillian Goddard: Yeah, so the way that hormones act on other glands or other parts of the body
is by binding to receptors. Those receptors can either be sitting on the surface of the cell in some
cases, or in some cases, the receptors are actually inside the cell, inside the nucleus of the cell.
And basically, when a hormone binds to a receptor, it tells the cell to make a protein, do
something.
Erin Stein: He's the Homer Simpson at the control panel.
Gillian Goddard: And so it's really the receptor is like the guy at the factory pulling the lever to,
yeah. Right, exactly.
Erin Stein: The hormones are obviously the instructions. So they're super important, but for a
hormone to do its job it has to match up with that receptor.
Gillian Goddard: Yes, a hormone just floating freely in your blood is not doing anything. It's
when the hormone binds to a receptor that you get an action. So there's three other main loops
and then a bunch of hormones that are not sort of in these main loops. So, I like to think of the
four main loops as the reproductive loop, the growth hormone loop, the thyroid loop, and the
adrenal loop. And each of those loops has a sort of main effect. The reproductive loop is fairly
straightforward and obvious if you are a person with ovaries, if you are, it drives ovulation and
the menstrual cycle. If you are a man or you have testes, it drives testosterone and sperm
production. So, all the things we need to need as humans to make more humans. The growth
hormone loop is most active in childhood when we are in fact growing.
Erin Stein: Mm-hmm.
Gillian Goddard: And, but it has some effects, especially on blood sugar and body composition
and adults, although we don't have very high levels of growth hormone. We do have a little, the
thyroid loop, as we said, is the gas pedal for the body. It controls how quickly things get done.
And the adrenal loop is our stress response and controls our circadian rhythms. So why do we
wake up in the morning or when it's light out? Why do we go to bed at night? Why do we feel
like we need a cup of coffee at 3 p.m.? That's all the adrenal loop.
Erin Stein: You talked about the thyroid loop as a gas pedal speeding things up and that made me
think about like being stressed out or having my heart beat faster or something like that but then
you talked about the adrenal loop relating to stress so how are those two different?
Gillian Goddard: The thyroid loop is controlling things sort of on the like day to day and the
adrenal loop kind of revs up and breaks in when the situation is stressful. Does that make sense?
Erin Stein: I think so. So thyroid is more like, I got up in the morning, so now I'm moving around
and things need to start happening again.
Gillian Goddard: Yeah, like I need to, the food that I ate last night needs to continue on its way
through my gut so that I can get those nutrients. For example.
Erin Stein: Lovely thought. Okay. So those are the basic loops. And then you said there are a
bunch of random hormones floating around.
Gillian Goddard: Then there's a bunch of other hormones that are not part of those main loops
but are really important. So insulin, for example, from the pancreas. Yeah, it's pretty important.
I'm sure we'll be talking about it a lot here. Parathyroid hormone, which has nothing to do with
the thyroid whatsoever, except for that the parathyroid glands are next to the thyroid.
Erin Stein: Learn your Latin.
Gillian Goddard: Learn your Latin. And then there's many others for GLP-1 is a hormone, for
example, made in cells in the gut. So there are actually dozens of hormones and there's probably
many that we don't know about yet. GLP-1 was only discovered in the 80s and only really
understood in the 90s.
Erin Stein: You said fat is a gland. And I don't think people realize that. Explain that to me. So
we're always trying to get rid of fat. But how much of it do we need? And do we need the
hormone it's making? What's it doing?
Gillian Goddard: Yeah, so the short answer is we need some fat, but not too much. One of the
things that we will talk about a lot when we're talking about hormones is this Goldilocks idea,
right? Like you don't want too much and you don't want too little. You want it to be just right.
And fat is no exception. You need some. Fat does a couple of things. It makes some hormones
that affect our appetite and drives how we eat and what we do with the nutrients that we absorb
from eating. It also makes an enzyme called aromatase that converts testosterone into estrogen,
which is important both in men and women. For men, the aromatization of testosterone is the
main way that they get estrogen, which is important for their bones. In women, this is an
important factor in sort of how women experience menopause and perimenopause and can be a
really factor in people like yourself who have had breast cancer. The challenge is that there's
different types of fat. There's fat that's just underneath your skin called subcutaneous fat. And
there's fat that can build up around your organs in your abdominal cavity. That's called visceral
fat. And visceral fat has some added activity around making insulin not work as well in our body
and predisposing us to things like heart disease and diabetes. And so if we could pick where we
put our fat, we would want to put it subcutaneously and not put it around our organs and our
midsection. Unfortunately, that's kind of not the way our bodies work. We don't get to pick.
Erin Stein: We don't get to choose.
Gillian Goddard: We don't get to pick! Yeah, yeah.
Erin Stein: Okay, so one thing we didn't talk about yet is that I think is important for some of
these medications that we will talk about many, many times over and over again, perhaps, is
hormones don't last long.
Gillian Goddard: No. And how long they last is variable.
Erin Stein: Do any of them last long or are they're all here and gone in a moment?
Gillian Goddard: No, so there's kind of two subcategories of hormones. There are peptide
hormones. These are simple hormones and they're very short-lived. They often last on the order
of minutes. GLP-1 is a peptide hormone. All the hormones we were talking about in the
hypothalamus, those are peptide hormones. And the benefit of the fact that those hormones are
so short-acting, insulin also falls into this category. The benefit of these hormones being so short
acting is that the body can change course quickly if it needs to, right? Like if your blood sugar is
dropping and you need to keep it at a certain level, the insulin levels can drop quickly. And so
that's great. Other hormones last hours, some last days. The half-life of one form of thyroid
hormone is about a week. So, some hormones can last for very long periods of time. Most
hormones last on the order of minutes to hours.
Erin Stein: Which is why we need to keep making them all the time.
Gillian Goddard: It is, but it also is what gives the system its flexibility.
Erin Stein: I like that. I think that makes sense. Our bodies are doing all kinds of things every
second.
Gillian Goddard: Right, the challenge is, is one of the main things that I do in my job is give
people back hormones that they're missing. And when we're giving those hormones back, we
might want them to last longer than a couple minutes. Otherwise, you would be what, either like
popping a pill or having an infusion all the time. That's not very practical.
Erin Stein: Right. Right.
Gillian Goddard: This was a big thing that came up with GLP-1. They discovered GLP-1 and
they were like, this would be a great treatment for diabetes, but it only lasts six minutes. So like,
how are we going to turn this into a medication that can last long enough to be useful?
Erin Stein: Let's stick to GLP-1 since you brought it up because if it doesn't last very long, how
did they create a form that will last longer? How did we even figure out? I mean, this is, I guess
the question about all hormones. How do we figure out they even exist? How did they get
identified in the first place?
Gillian Goddard: The first way they identified hormones is they would do dissections and they
would look at the glands and the stored hormone in the gland. And that's kind of how they
discovered these things. I mean, the original treatment for hypothyroidism was to eat the gland of
either a cow or a pig. For example, because it has thyroid hormone in it. And we actually still
make, there still is on the market, desiccated porcine thyroid like in pills that I can prescribe to
people. I don't usually prescribe those, but you can and some people do take them.
Erin Stein: Huh. Science stuff.
Gillian Goddard: So yeah, I mean, it's funny, right? Because the thyroid's from the pigs are
actually like leftover after they like, it's kind of using the whole animal if you will.
Erin Stein: Okay, okay, yes, for meat eaters,
Gillian Goddard: So that's how we first learned about hormones. And then as we became more
sophisticated, we were able to start looking at oftentimes different receptors and cells and trying
to figure out what hormone went with that receptor and what that hormone must look like. But
GLP-1 is really fun because they knew we had this hormone. They were trying to figure out how
to use it to treat diabetes and then some scientists at the Bronx VA, which is like a few miles
behind me. They discovered that the venom of Gila monsters contains a very similar compound
called exendin that's very similar to GLP-1. But exendin lasts for hours. And so that was actually
the basis of the very first GLP-1 exenatide. But even that, compared to what we have now, didn't
last very long. Had to take exenatide twice a day. And so then we, now we have exenatide. We
look at that molecule. We look at the molecule of exendin. Chemists start, you know, changing
things about the molecule that affect how it's metabolized so it can act like the hormone without,
but can last longer in the circulation.
Erin Stein: Let's dive down into one specific example that relates to my life. Which is
Tamoxifen, a medication that I am now taking. I had breast cancer last year. I had surgery and
now to reduce my risk of recurrence. I'm on this medication called Tamoxifen, which I had
estrogen-positive breast cancer. So, this medication inhibits estrogen.
Gillian Goddard: Yeah.
Erin Stein: But they tell me that it only inhibits estrogen to my breasts. But there's other parts of
my body, right? That there's estrogen happening, I think. At least one other part.
Gillian Goddard: Yeah, so basically, so I think there's a couple things to think about here. So,
let's start from the beginning. What is estrogen-positive breast cancer? It is breast cancer where
the cells that make up that cancer have estrogen receptors in the cells. And when estrogen binds
to the receptors in those cells, it stimulates the cancer cells to grow. And so the purpose of giving
you a medication that blocks estrogen in the cancer cells is to stop any cancer cells that might be
in your body from growing.
Erin Stein: Right. That makes sense.
Gillian Goddard: Right. So, but you have estrogen receptors all over your body. They're in your
brain, they're in your bones, they're certainly in your uterus and your ovaries. And so then what
is happening in all of those places, basically, there are different types of estrogen receptors and
what tamoxifen is, it's called a, it's actually a selective estrogen receptor modulator. So what that
means is it binds to the receptors for estrogen and modulates them in some fashion. And the way
that, the reason they call them modulators is because they modulate different receptors
differently. So, it sits in the receptor and blocks estrogen from acting and blocks estrogen
function in some cells like the cancer cells. And it also acts like estrogen in other places like your
bones. And so the benefit of that is that you get the benefit of blocking the estrogen in the cancer
cells without making your entire body deplete of estrogen, which some of the other medicines we
use do. And so that means you don't have to worry about having osteoporosis, for example,
which is a nice benefit.
Erin Stein: Yeah, so that's kind of wild to me and amazing that it can target the receptors in
different parts of your body that the receptors are different enough for the different things that
hormone is doing in your body that they can target that specifically. It is pretty cool. I have to
admit I was like, I don't I don't really believe it.
Gillian Goddard: Yeah, it's pretty cool, isn't it? It's true!
Erin Stein: How can it only block the estrogen in one part? That doesn't seem possible, but...
Gillian Goddard: Well, it's binding to any estrogen receptors it comes in contact with. Effect it's
having on those different types of receptors is different.
Erin Stein: So, we don't know everything that our hormones do. You just mentioned, for
example, estrogen receptors in the brain. What, what's that? What does estrogen do in my brain?
I just don't know.
Gillian Goddard: Who knows? We do not have a good handle of all the things that estrogen does
in the brain. It probably changes how dopamine functions in our brain. So, there's a lot of
thinking that it potentiates dopamine. So what does that mean? Helps dopamine to work better in
our brain. We don't know exactly how it does that, but we think it does. Brain cells need glucose.
They can't run on anything else. They can only run on glucose. Estrogen seems to help the cells;
individual brain cells do a better job of metabolizing that glucose so that fewer free radicals are
released. That can damage the cells and cause cell breakdown. Again, we don't know how
estrogen does that. Clearly estrogen acts in the brain, but we don't understand a lot of the details.
This is what I will say. If there are receptors for a hormone in a tissue, that hormone is doing
something, whether we know what it is or not.
Erin Stein: Fair enough. Fair enough. How are we working on figuring that out? We don't know
about all the hormones we have. Are people still discovering new hormones?
Gillian Goddard: Yeah, I mean, every once in a while, you hear about a new hormone or a new
function of an existing hormone that someone has discovered. I mean, we do this in a number of
different ways. And this is how kind of all science on the human body is done. You start with
like cells in a Petri dish and you see how those cells react and you can sequence the proteins so
that you know exactly what the like shape of these different things are. You can do all of that like
as bench science. But then you've got to move into more complex systems than just like cells in a
Petri dish. So, you get to go to usually rats are a common one for humans. Yeah.
Erin Stein: Ye old rats.
Gillian Goddard: And they're good for some things, but not good for others, but they're a place to
start. And then eventually you have to also try and do studies in people, which can be harder than
it sounds to design a good study that gives you the information that you want. And that's a topic
we'll be talking about a lot too.
Erin Stein: It's just so complicated because you are studying other kinds of creatures that we
might have some similarities to. Pigs have thyroid apparently. But like you're not going to get a
one-to-one comparison, but you have to start somewhere. Can't just randomly start
experimenting on humans. We generally frown upon that, although it has been done in history,
but
Gillian Goddard: We have organizations that prevent that.
Erin Stein: I think we agree that was bad. So then, you know, but you have to test it in humans at
some point. So then how to do it ethically and safely and all that stuff?
Gillian Goddard: Yep. And in a way that gets it the question that you want the answer to, which
is harder than it sounds.
Erin Stein: No, that's why I didn't go to medical school. We talked about pig parts and cow parts,
which is where we started with making synthetic hormones. Are we still there? Are we making
different kinds of hormones?
Gillian Goddard: In the vast majority of cases, we are not still using animal glands or extracts.
So, people used to use pituitary extract or bovine pituitary extract.
Erin Stein: Not the same as vanilla extract.
Gillian Goddard: Not the same. Not the same as vanilla extract, no. Now, because we know the
shape of these hormones, we can make synthetic forms of these hormones. In most cases, that is
what we are using. So, at this point, thyroid hormone, our replacements for cortisol, our
replacements for growth hormone, even the estradiol and progesterone that people take for
various things like hormone therapy. All those things are now synthetics. They're derived from
different things. Like the estradiol in an estradiol patch, which is identical to the estrogen that we
make in our ovaries, is synthesized starting with plant phytoestrogens that we modify.
Erin Stein: I've seen some things where they're like, we don't want to take drugs or fake things or
whatever. Like, are these natural or unnatural?
Gillian Goddard: I would say in general we have much more control over the amount of a
hormone in a synthetic product and we have much more data on how those synthetic products
work and, in many cases, those synthetic products are very close if not identical, like in the case
of estradiol, if not identical to the hormones that our bodies make. We can feel very small
differences in hormone levels very easily.
Erin Stein: Which we will also talk about. In this podcast, we will talk about feeling our
hormones all the time. Okay. We're going to, we're going to have an interlude because I'm going
to give a setup question to Gillian to tell us what her favorite. Just tell it, just say it. Just go ahead
and say it.
Gillian Goddard: My favorite gland is the placenta.
Erin Stein: Yes, so newsflash, the placenta is a gland.
Gillian Goddard: Among other things, but yes.
Erin Stein: Among other, well, like everything else, among other things. So, when you were
rattling off glands earlier, you did not mention the placenta. You're
Gillian Goddard: I was saving the best for last.
Erin Stein: Now I am not a person who has had children, so I have not grown a placenta myself.
So to me, I'm just like, ew. Isn't it just like a sack of goo?
Gillian Goddard: So, I have grown four. It's amazing. You grow a new organ from scratch for
every pregnancy. And it's the only organ in the human body that's made up of two separate
people. It's part mom and part baby. It's incredible. And it churns out tons and tons of hormones
in the 40ish weeks of it, not quite 40 weeks of its existence. It shuts the reproductive loop off and
pumps out estrogen and progesterone in huge quantities higher than we ever have any other time.
It's so cool. And then, baby is born, the placenta is delivered and they literally like throw it in the
garbage and the next time you get pregnant you make a whole new one.
Erin Stein: Well, what do you want to do? Keep it in a jar? On a shelf?
Gillian Goddard: I mean people do that but I wouldn't recommend it.
Erin Stein: So it shuts down your reproductive loop, but is it also then essentially functioning as
the hormone production factory for the fetus? At what point does the fetus grow its own hormone
production factories? I don't know. That's the thought that occurred to me. Like, is it pulling all
the levers? Is it getting all the text messages?
Gillian Goddard: Yeah, that's a great question. So in the very early stages of pregnancy, so
during the embryonic stage, up to 10 weeks of pregnancy, and then sort of like through the first
trimester, it is running the show for fetus 100%. In fact, many of mom's hormones cross the
placenta to provide the hormones that the fetus needs. So thyroid hormone, for example, is super
important for early brain development. And the thyroid hormone that the fetus gets actually
comes from the mom in the very early stages of development. By the midpoint of pregnancy, the
baby is actually making their own hormones. It's amazing it ever goes right. So much has to
happen.
Erin Stein: Well, I mean that is true. First of all, growing a baby and then giving birth is not a
process that is just automatically going to go well. There’re so many teeny tiny factors that have
to go right for it to go right.
Gillian Goddard: I remember in med school hearing a statistic that said that like, it was a huge
number and I hate to misquote it, but like 15 % of people have a minor birth defect and 3 % of
people have a major birth defect. And I remember thinking that sounds insanely high.
Erin Stein: We all come out differently no matter what. But the fact that we come out at all,
think, I think is impressive. Yeah. Okay. So Dr. Gillian Goddard, you know a lot about
hormones. I think that's clear at the end of this. So as an endocrinologist in your day job as a
doctor, what kinds of hormonal things are you helping people with? Just to give some examples.
Gillian Goddard: I see a lot of women dealing with menopause. A huge portion of the population
has type 2 diabetes or some pre-diabetic process that can lead to type 2 diabetes. So I see a lot of
people with things like that. I see a lot of women on that same spectrum with polycystic ovary
syndrome. That is definitely something we'll be getting into. I see many, many people with
thyroid disease. And now increasingly I do a lot of medical weight loss.
Erin Stein: We are going to talk about a lot of those things, especially perimenopause and
menopause. Is there a way to generally speaking say, this kind of a thing might be a hormonal
thing?
Gillian Goddard: It's really tricky because your hormones literally affect your entire body and so
and some of the symptoms can be very vague. So, it can be really tricky to say this is a hormonal
thing. Certainly, if periods are irregular. It's probably a hormonal thing and it might not be the
reproductive hormones, but certainly if periods are irregular, it's probably a hormonal thing.
That's a good place to start if you're someone who gets periods. And then beyond that, I think
what ends up happening is people start with their primary care doctor, which is great. Primary
care doctors know a little bit about a lot of stuff. And so they're a great place to start. And they
can do some sort of baseline testing oftentimes and get you sent in the right direction.
Erin Stein: Okay, that makes sense and is very unsatisfactory, but that's fine because we will get
into much more specific scenarios in other episodes.
Gillian Goddard: Sorry.
Erin Stein: People who may think they have an issue with a hormone of some kind in one of
these hormonal loops that we talked about and they often refer to it as a hormonal imbalance.
And in fact, I was told that as a teenager that I had a slight hormonal imbalance. I started my
period very late. That was the reason given to me. I think you might want to address that phrase
in some way because I feel like that's what a lot of people hear, what they're told. And so, when
they go to seek help, they might be saying, I think I have a hormonal imbalance. I need to
balance my hormones. Can you?
Gillian Goddard: Yeah, it's not a thing. No, because at different times you need different
amounts of different hormones. And so, what you want is not so much to have your hormones be
in balance. You want the system, the feedback loop to be intact and functioning properly. So if
you go back to the ping pong game, you want the two players to be hitting the ball back and forth
and back and forth, you don't want the ball to be flying off and with a huge thwack flying off in
the wrong direction. And so, the goal isn't balance, but appropriate function of the whole of the
feedback loop that you're dealing with.
Erin Stein: I think of it as the ball needs to keep moving back and forth between these two
paddles and not, you know, some random third person who shows up or injuring someone in the
audience. Like you need the ball. Yes. Well, that is the hormone, right? So we need there to be a
ball.
Gillian Goddard: And you need the ball.
Erin Stein: Functioning in its loop. It needs to be in its loop doing its thing.
Gillian Goddard: Most hormone problems are problems where we have too much or too little of
a hormone at the wrong time.
Erin Stein: Right, timing. Timing is everything.
Gillian Goddard: Timing is everything.
Erin Stein: So many ways. All right, well, I'm not going to remember most of these things that
we talked about today, but I think through repetition, it'll start to sink in.