Podcast
Clearly Hormonal
Hosted by Komal Patil-Sisodia, MD · EN
Have you ever wondered why your body feels like it's falling apart just as you're hitting your stride in other areas of your life? Join Dr. Komal Patil-Sisodia as she explores women’s metabolic health changes that start in perimenopause. The episodes center around educating and empowering women to have open dialogue with their doctors so that they can achieve their best metabolic health. Dr. Patil-Sisodia is board certified in Endocrinology, Obesity Medicine and Internal Medicine. She is also a Menopause Society Certified Practitioner. Any medical discussion on this podcast is purely for educational purposes and is not individualized medical advice. Please consult with your doctor to discuss any health concerns you may have.
33episodes
Episodes
Newest firstAll episodes
The Biggest Myths About Type 1 Diabetes (and the Truth Behind Them)
1w ago00:26:43Tap to summarize📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.Type 1 diabetes isn't just a childhood disease, and it isn't caused by sugar, weight, or lifestyle. In this episode, Dr. Komal Patil-Sisodia breaks down why type 1 diabetes is so often missed in adults, especially in people mislabeled as type 2, and introduces LADA (latent autoimmune diabetes in adults), a slow-moving form of type 1 that may account for up to a quarter of adult diagnoses. She walks through the clues that should prompt testing, the two blood tests that can change a diagnosis, and how perimenopause and menopause complicate blood sugar control for women living with type 1. The episode also covers pregnancy planning, the real (and often overstated) genetic risk to children, the underappreciated heart disease risk in women with type 1, and why needing insulin is never a sign of failure.In This EpisodeWhy type 1 diabetes has nothing to do with sugar, weight, or lifestyleHow adult-onset type 1 gets misdiagnosed as type 2, and whyLADA (type 1.5): what it is and why it hides in plain sightThe clues that should prompt a GAD antibody and C-peptide testHow perimenopause and menopause make blood sugar harder to controlPregnancy with type 1 diabetes: what's actually trueThe real genetic risk to children (it's lower than you think)Why heart disease risk is elevated and underdiscussed in women with type 1Why insulin is not a “last resort” and never a sign you did something wrongThe technology (CGMs and automated insulin delivery) changing type 1 careTimestamps:00:00 Why Type 1 Gets Missed00:30 A Misdiagnosed Patient Story02:52 Myth: Sugar Causes Type 105:31 Myth: Only Kids Get It06:29 Adult Onset and the Honeymoon Period08:41 LADA (Type 1.5) Explained10:13 Perimenopause Makes It Harder11:53 When to Test for Type 114:34 Pregnancy Myths and Facts16:41 Heart Risk in Women18:24 Insulin Shame and Stigma20:44 Tech That Changed Diabetes Care22:01 Perimenopause Management Tips22:49 Key Takeaways and Next Steps25:14 Final Thoughts and ShareResources Mentioned:GAD antibody test (glutamic acid decarboxylase antibody): the key immune marker for LADAC-peptide test: measures how much insulin your body is still producing on its ownContinuous glucose monitors (CGMs) and automated insulin delivery systemsMaternal-fetal medicine (perinatology) preconception counseling for planned pregnanciesDisclaimer: This podcast is for education, not personalized medical advice. Please discuss anything that resonates with your own healthcare team.Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.
Transcribe →Type 2 Diabetes Isn't a Moral Failing: Genetics, Hormones, Stigma, and the Truth About Insulin
2w ago00:26:04Tap to summarize📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.Type 2 Diabetes Isn't a Moral Failing: Genetics, Hormones, Stigma, and the Truth About InsulinIf you've ever been told — or told yourself — that your type 2 diabetes is something you caused and something you could fix if you just tried a little harder, this episode is for you.Dr. Komal Patil-Sisodia spends 17 years of clinical experience (and personal family history) dismantling one of the most damaging narratives in medicine: that type 2 diabetes is a lifestyle disease you can will your way out of. In reality, it's a complex, progressive metabolic condition shaped by genetics, hormones, sleep, stress, and — for women specifically — perimenopause and menopause.This episode covers the real biology behind insulin resistance and beta-cell decline, why stigma is measurably making patient outcomes worse, why so many people misunderstand what insulin actually does, and why "remission" — not "reversal" — is the accurate, honest term for what's possible.In this episode:00:00 — Welcome and Mission Introduction to Clearly Hormonal and why this particular episode is personal.01:00 — Diabetes Myths and Stigma The core myth — that diabetes is caused by bad choices and reversible through willpower — and the data on how stigma affects A1C, depression, and self-care engagement.03:18 — A Patient Story: A Midlife Shift A composite patient story of someone doing everything "right" whose A1C climbs anyway once perimenopause hits.04:15 — What Type 2 Diabetes Actually Is Insulin resistance, beta-cell decline, and why genetics account for 40–80% of risk.05:31 — Hormones, Sleep, and PMOS Estrogen as an insulin sensitizer, cortisol and chronic stress, the impact of poor sleep, and PMOS (formerly PCOS) as a major independent risk factor.08:52 — Type 1 vs. Type 2 Clarifier A quick, important distinction — type 1 diabetes is autoimmune and not the topic of this episode.09:15 — CGMs and the "I Can Feel It" Myth Why 64% of patients believe they can feel high blood sugar — and the story of using a CGM to show her dad he couldn't.12:48 — Insulin Fear and Complications Why so many patients believe insulin causes kidney damage, blindness, or amputations — and what actually causes those complications.15:07 — Diet Myths and Shame Vegetarian diets, "only sugar counts," and how internalized shame changes patient behavior.17:32 — Remission, Not Reversal The real data on remission rates over time, and why relapse is disease progression, not failure.19:59 — What Patients Deserve A call for full access to treatment — metformin, GLP-1s, SGLT2 inhibitors, insulin — without having to "earn" it first.22:38 — Menopause and the Diabetes Care Gap Why standard diabetes care ignores perimenopause and menopause, and what should be asked instead.23:48 — Key Takeaways and Share A recap and an invitation to pass this along to anyone who's been made to feel like their diabetes is their fault.Resources & Mentions:Continuous glucose monitors (CGMs) as standard-of-care discussionPMOS (formerly known as PCOS)Type 2 diabetes remission criteria (A1C <6.5% for 3+ months without medication)Disclaimer: This podcast is for educational purposes only and is not personalized medical advice. Please discuss anything you hear here with your own healthcare team.Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.
Transcribe →Thyroid Myth Busting (Part 2): What Actually Helps and What Doesn't
3w ago00:24:12Tap to summarize📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.Getting diagnosed with Hashimoto's can feel overwhelming, especially after spending five minutes online. Suddenly you're told to eliminate gluten, avoid broccoli, stop eating soy, buy expensive supplements, and ask your doctor for desiccated thyroid. But how much of that advice is actually supported by evidence?In Part 2 of the Thyroid Myth Busting series, endocrinologist Dr. Komal Patil-Sisodia separates fact from fiction using current medical research.You'll learn: Why cruciferous vegetables are not harming your thyroid When soy actually matters (hint: it's about medication timing) Who should—and shouldn't—consider a gluten-free diet Why iodine supplements can actually worsen thyroid disease Which thyroid supplements have evidence (and which don't) The truth about desiccated thyroid versus levothyroxine If you've ever felt overwhelmed by thyroid advice on social media, this episode is your evidence-based guide.Timestamps00:00 Welcome to Clearly Hormonal01:03 Why thyroid wellness advice can become overwhelming02:04 Cruciferous vegetables, iodine, and what actually affects thyroid function05:03 Soy consumption and levothyroxine timing06:16 Hashimoto's, gluten, and when celiac testing matters09:35 The dangers of iodine supplements and seaweed products13:08 Fact-checking popular thyroid supplements: Ashwagandha Vitamin B12 Low-dose naltrexone (LDN) Selenium 17:05 Desiccated thyroid vs levothyroxine: What the evidence says23:05 Key takeaways and what's nextResources & Links:Catch up on Part 1 (testing myths, TSH, subclinical hypothyroidism)Follow @drpatilsisodia on Instagram and TikTokDisclaimer: This podcast is for education, not personalized medical advice. Talk to your own healthcare team about what's right for you.Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.
Transcribe →Think It's Your Thyroid? Midlife Fatigue, Weight Gain, and the Myths Behind "Normal" Labs
Jul 100:36:06Tap to summarize📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.One in four women will have some degree of thyroid dysfunction after menopause — so it's not unreasonable to test it. But Dr. Komal Patil-Sisodia says the real problem isn't whether we test, it's what we do (or don't do) after the results come back "normal." In this episode, she breaks down the most common thyroid myths she hears in clinic: that fatigue and weight gain automatically mean thyroid disease, that everyone needs a full thyroid panel, and that a slightly elevated TSH always means you need medication. She walks through what TSH actually measures, when free T4 and T3 testing adds value, why antibody testing isn't a default screen, and the real risks of over-treating with levothyroxine. Then she dives into the part almost no one explains: how perimenopause and menopause change the way we interpret thyroid labs, why your TSH reference range shifts with age, and how starting estrogen therapy can change your thyroid medication needs.Timestamps00:00 — Welcome to Clearly Hormonal01:03 — Is It Really Thyroid?02:27 — Myth 1: Symptoms Automatically Equal Thyroid Disease05:22 — Myth 2: Everyone Needs a Full Thyroid Panel06:04 How TSH Testing Works11:18 — When Extra Testing Actually Matters (pituitary, pregnancy, illness, med changes)18:32 — Thyroid Antibodies: What They Are and When to Check Them19:45 — Myth 3: Subclinical Hypothyroidism Always Needs Treatment23:07 — The Real Risks of Overtreatment (and What the Evidence Shows)26:56 — The Menopause–Thyroid Overlap No One Explains30:51 — How Estrogen Therapy Changes Your Thyroid Labs33:37 — Questions to Ask Your Doctor35:21 — Next Episode Preview & Wrap-UpResources & Studies Mentioned2017 TRUST Trial (New England Journal of Medicine) — levothyroxine vs. placebo in adults 65+2025 Annals of Internal Medicine analysis of NHANES data on age/sex/race-specific TSH ranges2026 Hong Kong population study on age- and sex-specific TSH reference rangesKorean cohort study of 50,000+ women on thyroid dysfunction across the menopause transitionJAMA study on successful levothyroxine discontinuation in older adults on low-dose therapyConnectInstagram & TikTok: @drpatilsisodiaPodcast: Clearly HormonalPractice: eastsidemm.comIf this episode resonated, share it with a woman in your life who’s been searching for answers. Leave a review so more women can find this podcast.Disclaimer: This podcast is for educational purposes only and is not a substitute for personalized medical advice. Please discuss your own labs and symptoms with your healthcare team.Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.
Transcribe →Spit Happens: The Truth About Cortisol Testing
Jun 2400:25:00Tap to summarize📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.Picture three women. One is spitting into four little tubes throughout the day, mailing them off to a lab, hoping to finally get answers about her "adrenal fatigue." Another has been on a steroid inhaler for years, or just got a cortisone shot in her knee, and has never once had her adrenal glands checked — even though statistically, she has roughly a coin-flip's odds of an abnormal result if anyone bothered to look. And a third, in her late forties, is being told her exhaustion and brain fog are adrenal fatigue, when what she actually needs is a conversation about perimenopause.Same hormone. Same small gland sitting on top of each kidney. Three completely different ways we get this wrong — and in this episode, Dr. Patil-Sisodia untangles all three.She starts with the myth: why multi-sample "adrenal fatigue" saliva and urine kits run on real, legitimate lab technology in service of a diagnosis that doesn't medically exist — and why that combination is exactly what makes them so convincing. Then comes the plot twist she didn't expect to be making: that same multi-sample saliva format is actually a gold-standard tool, just for something else entirely — screening for Cushing's syndrome, when cortisol runs too high instead of too low. From there, she walks through the tests that genuinely work for Cushing's, the pseudo-Cushing's patterns (depression, alcohol use, obesity, PCOS/PMOS, illness, and more) that can mimic it on paper, and the condition she says gets missed more than any other: steroid-related adrenal insufficiency, which affects about half of long-term steroid users — inhalers, creams, sprays, and injections included — while fewer than 1% are ever tested for it.The episode closes on something close to home for this show's listeners: how easily perimenopause gets relabeled as adrenal fatigue, what that mislabeling actually costs women, and three simple questions you can run any cortisol test through before you trust it.Time Stamps:[00:00] Medicine Gets Cortisol Wrong — the three-part setup: wrong tests, wrong people, and the people who need testing but never get it.[01:07] Adrenal Fatigue Myth — why multi-sample saliva/urine kits use real lab technology to chase a diagnosis with no recognized normal range.[03:08] Real Use for Saliva — the plot twist: late-night saliva testing is legitimate gold-standard science, just for a different question.[06:19] Cushing Syndrome Basics — the three tests that actually work: late-night saliva, 24-hour urine cortisol, and overnight dexamethasone suppression.[07:34] Pseudo Cushing Pitfalls — how depression, heavy alcohol use, obesity, poorly controlled diabetes, PCOS/PMOS, illness, pain, eating disorders, and intense exercise can mimic Cushing's without being it.[09:19] Steroid Induced Adrenal Suppression — the condition affecting roughly half of long-term steroid users (inhalers, creams, sprays, injections, possibly Depo-Provera) while under 1% get tested.[12:57] Menopause Misdiagnosed — why perimenopause symptoms get scooped up under the adrenal fatigue umbrella, and what the research does and doesn't show.[17:06] Testing Adrenal Insufficiency — the real diagnostic pathway: tapering first, the 8–9 a.m. blood draw, and how to read the result range.[18:55] Cosyntropin Test Myths — the standard 250-microgram test versus the unvalidated low-dose version some sources still promote.[21:06] Recovery and Reassurance — why an abnormal cortisol number is far more common than a true adrenal crisis, and why recovery can take months to over a year.[22:21] Three Questions for Testing — what to ask before trusting any cortisol test: proven diagnosis, meaningful timing, gold-standard validation.[24:19] Final Takeaways and Outro.Key Takeaways"Adrenal fatigue" and "chronic stress" are not recognized medical diagnoses — there is no validated normal range for the multi-sample panels marketed to diagnose them.The same multi-sample saliva testing format is legitimate gold-standard science — when it's used correctly, at the right time of night, repeated 2–3 nights, to screen for Cushing's syndrome.About half of people on long-term steroids (any form — pills, inhalers, creams, sprays, injections) have some degree of adrenal insufficiency. Fewer than 1% are ever tested.Perimenopause symptoms (fatigue, brain fog, anxiety, low libido) overlap heavily with the symptoms marketed as "adrenal fatigue" — and that overlap can delay real menopause care.Before trusting a cortisol test: ask what it's proven to diagnose, whether the timing matches the question, and whether it's been validated against the gold standard.Resources & LinksFollow Dr. Patil-Sisodia: @drpatilsisodia on Instagram and TikTokSend fan mail / episode questions via BuzzsproutCatch up on the related myth-busting episode referenced in this one (adrenal fatigue supplements)Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.
Transcribe →6 Adrenal Myths: Why “Adrenal Fatigue” Isn’t Real and What Actually Matters
Jun 1700:20:29Tap to summarize📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.“My adrenals are shot.” If you’ve said some version of that sentence this year, Dr. Komal Patil-Sisodia believes that you feel terrible—she just wants you to know that adrenal fatigue isn’t a real diagnosis, a lab value, or something your adrenal glands can actually do. In this myth-busting episode, she takes on six widely held beliefs about the adrenal glands: from the supplement industry built around a condition with no validated test, to when an adrenal tumor actually needs surgery, to who really needs Cushing syndrome screening, to how peri-operative steroid dosing has changed. She closes with the myth she considers most dangerous—that real adrenal insufficiency is easy to spot—and explains why it’s so often missed for years, sometimes until a life-threatening adrenal crisis forces the diagnosis.Timestamps00:00: Welcome to Clearly Hormonal01:03: Setting up the adrenal fatigue myth02:17: Myth #1: “Adrenal fatigue” isn’t a real diagnosis04:47: Myth #2: Are adrenal support supplements safe and effective?06:18: Myth #3: Does every adrenal tumor need surgery?07:57: Myth #4: Should everyone with obesity or diabetes be screened for Cushing syndrome?11:00: Myth #5: Does everyone on chronic steroids need stress-dose steroids for procedures?12:38: Myth #6: Is adrenal insufficiency easy to diagnose clinically?15:58: Recap and what’s coming nextThanks for listening. Find more info about Clearly Hormonal on the website or Instagram.
Transcribe →When the Room Goes Quiet: Scientific Integrity, Political Pressure, & What Was Lost at the ADA Conference
Jun 1000:26:23Tap to summarize📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.Dr. Komal Patil-Sisodia records live from her hotel room on the final night of the ADA 86th Annual Scientific Sessions in New Orleans — still processing what she witnessed earlier that week. The NIH director didn't show up to his own keynote. A substitute speaker framed diabetes research under the MAHA agenda. And five physicians were escorted out of the conference by security for handing out a peer-reviewed article published in the ADA's own journal.This episode is her unfiltered account of what happened, what the science actually says, and why none of us — patients, clinicians, or researchers — can afford to let it quietly recede.In this episode:What the Kahn et al. Diabetes Care editorial actually arguesWhy an 89% drop in NIH funding notices is more alarming than it soundsHow a new policy is draining the research pipeline without a single congressional voteThe landmark diabetes trials — DPP, DCCT, TrialNet — that exist because of the infrastructure now being guttedA frank assessment of the ADA's official statementWhy diverse, long-horizon NIH research is existential for underserved populationsConcrete actions for patients, clinicians, researchers, and the communityTimestamps:00:00 Welcome to Clearly Hormonal01:03 Why This Episode Now01:38 My Diabetes Roots02:32 Keynote Cancellation Shock03:46 Editorial Handout Incident04:59 Inside the Kahn Editorial06:13 Funding Collapse Explained07:57 Oversight Councils Undermined09:02 Policy Loophole Chokes Grants10:24 Why NIH Research Matters11:40 Why I Stayed13:44 What the Keynote Said15:35 The Core Contradiction17:49 ADA Statement Breakdown21:22 Who Gets Hurt Most23:55 What We Can Do Next25:56 Closing and ResourcesResources mentioned:Kahn et al. Diabetes Care editorial (2026)ADA contact and advocacy toolsCongressional representative lookupHouse of Representatives lookupSTAT News coverage of the conferenceFind Dr. Patil-Sisodia:Instagram & TikTok: @drpatilsisodiaEastside Menopause & MetabolismClearly Hormonal is for educational purposes only and does not constitute personalized medical advice. Please discuss your individual health concerns with your own healthcare provider.Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.
Transcribe →PCOS is Now PMOS: What the Name Change Means for Every Era of Your Hormonal Life
Jun 300:22:30Tap to summarize📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.On May 12, 2026, The Lancet published the results of a 14-year global effort: Polycystic Ovarian Syndrome (PCOS) has been officially renamed Polyendocrine Metabolic Ovarian Syndrome (PMOS). For over 170 million women worldwide — most of whom have never received a correct diagnosis — this is not just a nomenclature update. It is a reckoning.In this episode, Dr. Komal Patil-Sisodia breaks down what changed, what didn’t, and why the new name carries profound clinical implications across every hormonal era: adolescence, the reproductive years, perimenopause, and menopause and beyond. She connects the renaming to the 2026 ACC/AHA dyslipidemia guidelines, the 70% undiagnosis rate, and the lifelong metabolic consequences that the old name made invisible.If you’ve ever been handed a birth control pill without a workup, told your symptoms were stress, or felt dismissed in a clinical setting — this episode is for you.Timestamps00:00 Welcome to Clearly Hormonal — Dr. Patil-Sisodia introduces the podcast and her clinical background across endocrinology, internal medicine, obesity medicine, and menopause care.01:08 PCOS Gets Renamed — The official May 12, 2026 announcement in The Lancet: PCOS is now Polyendocrine Metabolic Ovarian Syndrome (PMOS). Why one letter — C to M — changes everything.02:38 Why the Old Name Hurt — The 14-year global process led by Professor Helena Teede involving 56 organizations and 22,000+ survey responses. How the word “polycystic” misdirected care for generations and contributed to delayed diagnosis, stigma, and fragmented treatment.04:32 Breaking Down PMOS — Word-by-word analysis: Polyendocrine (system-level hormonal disruption), Metabolic (insulin resistance, cardiovascular risk as core features, not side effects), Ovarian dysfunction (still present, but no longer the whole story).05:48 What Did Not Change — The Rotterdam diagnostic criteria remain intact. If you were diagnosed with PCOS, you have PMOS. Your clinical picture is valid. What changed is the language — and what that language demands of clinicians.07:19 Adolescence — The Era of Missed Beginnings — How PMOS manifests in teenage girls, why it gets dismissed as normal puberty, and what’s at stake when early insulin resistance goes untreated. The window to act — and how the new name changes what clinicians look for.10:37 Reproductive Years — The Era of Diagnosis and Distraction — Why PMOS is most often diagnosed in fertility contexts, and why that misses the metabolic picture. The connection to gestational diabetes, preeclampsia risk, and the 2026 ACC/AHA dyslipidemia guidelines.13:58 Perimenopause — The Era That Intensifies — How declining ovarian function accelerates metabolic dysfunction in women with PMOS. Why symptoms quiet in the 30s and return louder in the 40s. The urgent research questions the new name demands.17:16 Menopause and Beyond — The Era the Name Change Protects — Why post-menopausal women with PCOS/PMOS history face the highest cardiovascular risk of their lives — and why no one is connecting the dots. Lp(a), ApoB, and what to ask your clinician today.19:09 What the Name Actually Changes — A clinical summary: how each word in PMOS shifts the posture of care at every hormonal era. One name. Four eras. A completely different approach.20:56 Takeaways and Call to Action — What to do if you have a PMOS diagnosis, what to ask your clinician if you’re post-menopausal, and a message to clinicians: the name changed. Now the care has to change with it.What We CoverThe official renaming of PCOS to PMOS (Polyendocrine Metabolic Ovarian Syndrome) in The Lancet, May 2026Why the word “polycystic” was scientifically inaccurate and caused measurable clinical harmWhat each word in PMOS actually means clinicallyWhy 70% of people with this condition remain undiagnosed — and how framing drives that numberEra-by-era breakdown: adolescence, reproductive years, perimenopause, menopause and beyondThe 2026 ACC/AHA dyslipidemia guideline connection: PMOS as a cardiovascular risk enhancerLp(a) and ApoB: why Class 1 universal screening now matters for your PMOS historyWhat to ask your clinician at every stageResources MentionedThe Lancet PMOS Renaming Paper — May 12, 2026Professor Helena Teede, Monash University — lead researcherRotterdam Diagnostic Criteria for PMOS2026 ACC/AHA Dyslipidemia Guideline (PREVENT equations, Lp(a) universal screening, ApoB targets)The Endocrine Society — one of 56 organizations in the renaming processConnectInstagram: @drpatilsisodiaPodcast: Clearly HormonalPractice: eastsidemm.comIf this episode resonated, share it with a woman in your life who’s been searching for answers. Leave a review so more women can find this podcast.Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.
Transcribe →Decoding the Risk: What New Cholesterol Guidelines Mean for Women with Dr. Harpreet Tsui
May 2700:58:31Tap to summarize📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.The number-one cause of death in women is still heart disease — and perimenopause is where your cardiovascular risk starts to quietly climb. This week, Dr. Komal sits down with Dr. Harpreet Tsui, an internist, obesity medicine specialist, and founder of Coronado Health (a direct primary care practice in Nevada), to break down the 2026 ACC/AHA Dyslipidemia Guidelines — the biggest update to cholesterol guidelines in years.This is a personal episode. Both physicians are Southeast Asian women with significant family histories of heart disease. Both are managing their own cardiometabolic health in real time. And neither of them is willing to accept "your numbers look fine" as the end of the conversation.They cover what's changed in the guidelines, which genetic cholesterol markers your doctor may not be ordering, why perimenopause can flip your lipid panel overnight, and the exact language to use at your next appointment to get the full picture.GuestDr. Harpreet Tsui, MD Internist | Obesity Medicine Specialist | Founder, Coronado Health (Direct Primary Care, Henderson, NV)📍 coronadohealthdpc.com 📱 Instagram & TikTok: @drharpreet.tsuiTimestamps[0:00] — Podcast intro and medical disclaimer[1:03] — Meet Dr. Harpreet Tsui: internist, obesity medicine specialist, founder of Coronado Health in Nevada — and why both she and Dr. Komal wanted to have this conversation as Southeast Asian women with significant family histories of heart disease[2:48] — Why direct primary care: Dr. Tsui on leaving the 15-minute appointment model to build a practice centered on women's health, obesity medicine, and actually having enough time to talk[4:42] — Guidelines confusion and statins: from the clear LDL targets of residency training to the ambiguous "lower it if you feel like it" era — and why statins have gotten an unfair reputation despite data showing they reduce heart disease, stroke risk, and even drive plaque regression[7:01] — Mistrust and culture around medications: immigrant family attitudes toward asking for help, the "I can do it on my own" mentality, and how even physicians absorb enough noise to hesitate — including Dr. Tsui, who prescribed herself a statin and left it on her nightstand for two weeks before she could take it[12:14] — Key update: risk-based treatment replaces number-chasing. The new PREVENT ASCVD calculator factors in HDL, triglycerides, family history, ethnicity, and even zip code — and gives you both a 10-year and 30-year cardiovascular risk estimate, not just a snapshot of today[16:11] — Perimenopause and lipid shifts: why cholesterol can change dramatically when estrogen drops, even when lifestyle hasn't. Dr. Tsui's LDL went from 77 to 177 in perimenopause. Dr. Komal's Lp(a) was normal before — and then it wasn't. Neither of them did anything differently.[20:59] — ApoB and Lp(a) explained: the two genetic cholesterol markers now in the 2026 guidelines as independent cardiac risk factors. Your standard lipid panel can look stone-cold normal while these are quietly elevated — and why both physicians now check them routinely on midlife women[23:28] — Female-specific risk factors are finally in the guidelines: menopause, PCOS, gestational diabetes, and preeclampsia are now formally recognized as independent cardiovascular risk factors. The gestational diabetes gap — including the postpartum glucose tolerance test that routinely gets missed — and why preeclampsia has lifelong cardiovascular implications[29:32] — Lower LDL targets and the case for being more aggressive: below 70 for high-risk patients, below 55 for very high-risk — and why vascular specialists have been pushing for LDL at or below 50 for years ahead of these guidelines[31:33] — Beyond statins: PCSK9 inhibitors, ezetimibe, omega-3s, and emerging Lp(a)-targeted therapies in the pipeline — what your options are if you genuinely can't tolerate statins[32:06] — Why guidelines change — and why that's not the same as being lied to: the science evolves, the tools get better, and the recommendations follow[33:13] — Pandemic messaging lessons: Dr. Komal on "flatten the curve," what it actually meant, and how the gap between what medicine knows and what gets communicated to the public continues to fuel mistrust[34:31] — Rebuilding trust in science: Dr. Komal's experience at her Washington hospital during the first COVID deaths in the country, the CDC arriving to learn rather than lead, and why uncertainty in medicine is not the same as deception[38:33] — Midlife women and heart risk: why cardiometabolic risk isn't discussed nearly enough in the context of menopause, and what Dr. Komal is doing in her own practice to screen every midlife woman proactively — before anything on the standard panel looks alarming[40:04] — Estrogen loss and metabolic shift: the mechanism behind why visceral fat increases, muscle mass drops, insulin resistance develops, and cholesterol climbs when estrogen declines — and why this is biology, not a lifestyle failure[41:09] — Inflammation markers and hsCRP: why both physicians check high-sensitivity CRP routinely, what Dr. Komal found when hers came back elevated despite well-controlled autoimmune disease, and the vicious cycle of visceral fat and cardiovascular inflammation[43:26] — Personal plans, statins, and GLP-1s: Dr. Tsui shares her own treatment journey — transdermal estrogen, a statin, and adding back a GLP-1/GIP combination — and how her LDL dropped back below 70 and her hsCRP normalized. The reminder that everyone's genetics are different, and so is the plan.[45:22] — Lifestyle first, medication timing: how Dr. Tsui structures the first conversation with patients — a deep dive on diet, body composition, schedule, and food access — and her three-month reassessment framework before deciding on pharmacologic intervention[47:47] — Calcium scores and hidden disease: the coronary artery calcium (CAC) score as a window into subclinical atherosclerosis — including Dr. Tsui's own score of 214 at age 43, discovered while trying to prove her heart was healthier than her husband's[50:12] — Statin side effects and PCSK9 inhibitors: managing myopathy, dosing strategies for women (who metabolize statins differently), and how Dr. Tsui gets about 75% of patients who need a PCSK9 inhibitor to actually commit to it[51:37] — Insurance barriers to care: prior authorization requirements for PCSK9 inhibitors, the specialist referral runaround, and what happens to patients when the system gets in the way of evidence-based treatment[52:31] — What to ask your doctor: specific language and specific tests — family history, the PREVENT ASCVD calculator, Lp(a), ApoB, fasting insulin, ferritin, GLP-1 conversations, and the "skinny fat" discussion that Southeast Asian patients in particular deserve to have[55:19] — Family history, kids, and screening: when to start checking cholesterol in children (as early as age two with significant family history), why puberty brings new risk considerations, and a message to primary care physicians and their own patients — including the data on female physician mortality that should make all of us pause[57:24] — Closing thanks and where to find Dr. Harpreet Tsui: Coronado Health in Henderson, NV | coronadohealthdpc.com | @drharpreet.tsui on Instagram and TikTokResources Mentioned2026 ACC/AHA Dyslipidemia GuidelinesPREVENT ASCVD Risk Calculator (American Heart Association)MASALA Trial (South Asian cardiovascular health research)Coronado Health: coronadohealthdpc.comClearly Hormonal Episode with Dr. Ambreen Mohamed (CT coronary angiogram and women's heart disease — coming soon)ConnectDr. Komal Patil-Sisodia Endocrinologist | Internist | Obesity Medicine | Menopause Society Certified Practitioner 📍 Eastside Menopause & Metabolism — Kirkland, WA | eastsidemm.com 📱 Instagram & TikTok: @drpatilsisodiaDr. Harpreet Tsui Internist | Obesity Medicine Specialist | Founder, Coronado Health 📍 Henderson, NV | coronadohealthdpc.com 📱 Instagram & TikTok: @drharpreet.tsuiThanks for listening. Find more info about Clearly Hormonal on the website or Instagram.
Transcribe →Why Women’s Heart Disease Gets Missed with Dr. Ambreen Mohamed
May 2001:06:40Tap to summarize📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.Heart disease has long been framed as a “man’s disease” – but women are being missed, misdiagnosed, and overlooked in ways that can be life-threatening, especially within South Asian communities where cardiovascular risk often develops earlier and more aggressively.In this episode, Dr. Komal Patil-Sisodia sits down with advanced imaging and preventative cardiologist, Dr. Ambreen Mohamed, to unpack the evolving science of women’s cardiovascular health, the hormonal shifts that impact risk throughout midlife, and why prevention needs to start far earlier than most people realize.Together, they explore the subtle symptoms women experience that are too often dismissed, the intersection of menopause, PCOS, pregnancy complications, insulin resistance, and heart disease, and why traditional risk calculators frequently fail to capture the realities of South Asian patients. Most importantly, this conversation reframes prevention not as fear-based medicine, but as empowerment: understanding your risk factors early enough to change the trajectory of your health before disease develops.Connect with Dr. Mohamed: LinkedInTikTokInstagramWebsiteConnect with me: LinkedInTikTok InstagramEastside Menopause & Metabolism Audio Stamps :00:00 – Dr. Komal introduces Dr. Ambreen Mohamed and sets up the conversation around women’s cardiovascular health, prevention, and South Asian risk00:00 Podcast Mission Setup01:05 Meet Dr Ambreen Mohamed04:38 Why Women Get Missed07:10 Women’s Heart Attack Symptoms11:18 Hormones Menopause PCOS Risk15:06 Pregnancy As Stress Test18:36 Menopause Hormone Therapy Debate25:59 South Asian Heart Risk Factors28:02 Advanced Lipids Lp(a) ApoB33:07 MASALA Study And Risk Tools36:27 Perimenopause Lp(a) Spike37:18 Estrogen and Lp(a) Research38:11 Who Counts as High Risk39:55 Doctors Still Learning42:12 Labs to Ask For43:31 Insulin Resistance Markers46:15 Beyond Labs and Blood Pressure47:52 Sleep Apnea and Heart Risk48:41 CAC Score When It Helps50:12 CT Angiogram and AI54:32 Lifestyle Changes to Start Now58:48 Advocating at the Doctor01:02:31 Wrap Up and Where to Find Her01:04:25 Final Takeaways and Call to ActionThanks for listening. Find more info about Clearly Hormonal on the website or Instagram.
Transcribe →