The Observable Unknown
Episode: Dr. Shireen Fatemi
Host: Dr. Juan Carlos Rey
Guest: Dr. Shireen Fatemi, Endocrinologist
Date: October 5, 2025
Episode Overview
This episode explores the profound intersection of science and intuition through the lens of endocrinology. Host Dr. Juan Carlos Rey and his guest, Dr. Shireen Fatemi, delve into how hormones are not only physical regulators but also subtle messengers shaping mood, memory, identity, and even spirituality. The conversation challenges the medical status quo—questioning the overreliance on medication and advocating for a more holistic, individualized approach to health. Dr. Fatemi brings attention to the mysteries and misunderstood aspects of the human endocrine system, especially how cultural and technological changes are affecting our internal balance.
Key Discussion Points & Insights
Dr. Fatemi’s Background and Philosophy
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Early Influences: Dr. Fatemi was raised in a family that valued both science and intuition; her mother, in particular, modeled psychic sensitivity that influenced her medical practice.
“A lot of what I do, too. It’s based on the science, but also I just get a feeling from people, from patients.”
[05:25] -
Endocrinology as Mystical Science: She describes hormones as “profoundly mystical,” emphasizing their ubiquitous, often hidden sway over thoughts, behaviors, and spiritual experience.
“Hormones themselves... are just so mystical because there’s such a profound interplay, you know, with the body, in the entire body, affecting how we think and function physically, mentally, and spiritually.”
[03:27]
The Limitations of a Medication-First Approach
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Patients with ‘Unexplained’ Symptoms: Many patients present with normal lab results but persistent symptoms—a challenge she meets with intuition and a holistic inquiry into their lives.
“A lot of people think, oh no, when this patient comes in, it’s going to be really hard and difficult because these are hard people. There’s nothing quote unquote wrong with them... oftentimes I can piece things out and help to guide them in a direction that will help their stress or their depression or their cognition.”
[06:31] -
Cultural Expectations & Pill Reliance: The American medical system is structured for efficiency, often defaulting to prescriptions instead of addressing root causes or lifestyle factors.
“It’s easier to give a medication... we don’t for the most part in society [have resources for long-term modalities like psychotherapy]... medications are definitely the go to initially and the first trigger because it’s just easier to implement.”
[20:41]
Hormones as Storytellers
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More Than Chemical Messengers: Hormones are described as authors of life’s major transitions—puberty, seeking a mate, menopause, and aging—all largely hormonally driven.
“A lot of the way we navigate through life is hormonally based just with our various life stages...the choices we make, the direction of our life, the way we want to go at those stages—they’re all hormonally driven.”
[09:18] -
Underappreciated Influencers: Fatemi highlights neurotransmitters (serotonin, dopamine, etc.) as underexplored drivers of personality types and mood. She references popular medications (like GLP1 agonists for weight loss) affecting not only appetite but also the dopamine reward pathway.
“Some of us may be more of a dopamine type, you know, dominant person, others might have more serotonin, etc. So I think that this is something that really needs to be explored a lot more.”
[11:42]
Life Cycles, Gender, and Social Determinants
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Hormones and Life Transitions: Puberty, reproduction, perimenopause, and andropause are described as “disruptive” yet formative, affecting personality, drive, and satisfaction with life.
“When you have that imbalance initially in teenagers, how disruptive that is... and how hard it is really... maintain your aim and your direction in life when you’re trying to grapple with all of these changes.”
[15:55] -
Gender and Individualization: There’s a call to treat all cases individually, especially as gender identity becomes more nuanced (cisgender, transgender, non-binary, gender-fluid).
“You have to take each one case by case... It’s not a binomial now. It’s just many transitions in between... very complicated, as you can see.”
[36:52]
Metabolic Myths & Medications
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Overreliance on Pills: Modern technology and pharmaceuticals are invaluable but not a panacea; lasting change comes from fundamentals: nutrition, lifestyle, and cognitive therapy.
“Technology as we have it is not going to be, you know, the be all, end all in order to control, you know, the chronic diseases that we’re prone to have as we age and go through life.”
[17:46] -
Lifestyle Change: The single most powerful intervention is conscious, mindful choice—especially regarding diet and managing stress. Processed foods and distance from whole sources are cautioned against.
“Absolutely what we put in our body... and second to that, I would think, how do we approach just wholeness and decreasing our stress?”
[38:28]
Technology, AI, and the Future
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Continuous Monitoring Technologies: Fatemi praises continuous glucose monitors but is excited about future prospects—wearables that track not just glucose but multiple hormones, offering real-time feedback.
“One thing I see exciting... is not just a continuous glucose monitor, but a way to continuously monitor all of our hormones throughout the day... that would be like the next frontier.”
[27:46] -
Algorithmic Pitfalls: AI isn’t ready to replace human judgment, particularly when it comes to holistic, individualized care.
“I don’t think it’s ready for prime time yet... I don’t think that’ll ever happen. But I’ve been wrong too.”
[30:13] -
Ethics & Access: Technology can exacerbate health inequities due to cost and accessibility, even as it offers new possibilities for self-understanding.
“These things are expensive... you have to be able to pay for it or have insurance to get that.”
[29:06]
Memorable Quotes & Moments
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On Hormones and Rationality:
“We have our hormone and you know, we can’t really control our hormonal being per se, but when we sit back and think about it... you need really a healthy interplay between the two, balance between the two.”
[26:40] -
On Cortisol’s Double-Edged Role:
“If we didn’t have anxiety in life, then we would never get anywhere... you definitely need a healthy amount [of cortisol].”
[23:22] -
On the Pineal Gland’s Mystery:
“One of the least understood glands, though, in the body is the pineal gland, which is very mystical… why was it historically called our third eye? There’s a lot more to it.”
[46:42] -
On Food and Health Disparities:
“The further you are away from the source has a lot to do with it... when you have people choosing a lot of processed foods... when you really look at ingredients, they’re not [healthy].”
[39:36]
Timestamps for Important Segments
- Dr. Fatemi’s Background and Mystical Approach: [03:01]–[05:53]
- Limits of Standard Medical Practice: [06:03]–[09:08]
- Hormones and Identity, Life Cycles: [09:18]–[15:46]
- American Lifestyle & Pill Reliance: [10:02], [17:46]
- Semaglutide, GLP1 Agonists & Personality: [12:47]–[15:27]
- Metabolic Disease Myths: [17:46]–[19:34]
- Social Determinants in Endocrinology: [21:26]–[22:59]
- Positive & Negative Roles of Cortisol: [23:22]–[24:20]
- Best Lifestyle Change Advice: [25:20]–[26:29], [38:28]–[39:17]
- Technological Innovations & Pitfalls: [27:03]–[30:13]
- Gender Fluidity & Endocrinology: [34:24]–[38:11]
- The Mystery of the Pineal Gland: [46:42]–[48:01]
Notable Moments
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On Clinical Intuition vs. Data: Dr. Fatemi describes the all-too-common scenario of middle-aged women reporting hypothyroid symptoms despite normal labs, ultimately finding perimenopause (often unaddressed) as the core issue.
“The one story that I repeat is not about just one patient, but about all the patients that I have come to me, and the most common one is normal thyroid function tests...”
[40:34] -
Third-Eye Speculation: Discussion of the pineal gland as a neglected but potentially central organ in consciousness, spiritual identity, and hormone regulation.
Summary
Dr. Shireen Fatemi’s appearance on The Observable Unknown masterfully bridges the analytic rigor of science with the deep knowing of intuition, calling listeners to see hormones as vital storytellers of human experience. The episode is a gentle but profound challenge to mainstream medicine’s quick fixes, advocating for a return to basics—mindful choices, food quality, and honest patient-clinician conversations. Fatemi sees a future where technology and self-awareness can help us appreciate, not override, our beautifully intricate internal worlds. For seekers of meaning and skeptics alike, this conversation is a call to treat medicine as both a science and an art of listening.