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- [00:07]
A
Welcome to the observable unknown, where science meets the unexplained. I'm Dr. Juan Carlos Rey of crowscubboard.com and after two decades of working at the intersection of comparative religious studies, grief counseling, anthropology, quantum mechanics, and consciousness studies, I. I've discovered that our most profound human experiences often exist in the space between what we can prove and what we can perceive. In this podcast, we'll explore the measurable influences of immeasurable forces, those hidden factors that shape our reality, but often escape our traditional scientific frameworks. From the latest research in consciousness studies to the ancient wisdom that's now finding validation in neuroscience and quantum physics, we're here to bridge the gap between academic rigor and spiritual insight. Whether you're a skeptic, a seeker, or simply curious about the deeper mechanics of human experience, you're in the right place. Together, we'll examine the evidence, challenge our assumptions, and explore what happens when we dare to look beyond the obvious. In this episode, I am joined by Dr. Shireen Futemi, a distinguished endocrinologist whose vision of medicine extends far beyond lab values and prescriptions. Raised in a family that believed science should be blended with intuition, Dr. Fatemi brings a rare voice to the conversation about the body's most mysterious messengers, our hormones. Together, we explore how endocrinology illuminates not just physical health, but also mood, memory, and identity. From the impact of cortisol and circadian rhythm to the cultural over reliance on medication, to the uncharted mysteries of the pineal gland, Dr. Fatemi challenges us to see the human being as both rational and hormonal, balanced, interwoven, and profoundly alive. This is not just a medical conversation. It is a meditation on how hidden systems guide our choices, shape our stages of life, and even open questions of spirit and selfhood. So without any further ado, let's join the conversation.
- [02:37]
B
Good evening. Shireen, it's so good to hear from you again. It feels like just yesterday we were talking about equestrian theatrics in the park, and I'm always happy to really get down to the bottom of whatever it is you think and you see as the future of endocrinology. What first called you to endocrinology? And how has your upbringing shaped your approach to the body's hidden systems?
- [03:02]
C
Well, thank you first, Juan Carlos, for inviting me to speak with you today, because I just love to share, you know, my thoughts on endocrinology and everything else as well. But, you know, I have always been interested in medicine in general and just Service to humanity and medicine, I find, is always evolving. And so I just felt I always need to continue learning. And medicine, you know, is just the area where I can love what I do. Every single day is a new day. And I've been involved in research and just discovering new insights into medicine, as well as how hormones work, is something that keeps me alive. And, you know, hormones themselves, I think, 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. And we just really need to understand this whole interplay. And, you know, in order to be an endocrinologist, too, one of the things that I find is you really do need to understand the organ systems in order to diagnose and manage all of the varied endocrine disorders.
- [04:17]
B
Was there a moment or a challenge early on when you felt hormones were acting like hidden voices in the lives of your patients?
- [04:25]
C
You know, I think so. You know, I think as we go through life, really, hormones have such a profound effect, Whether it's adolescence and puberty and, you know, everything with all of that really kind of shapes our life and guides our behavior. And then, you know, as we get into our younger ages as well, when we're looking for a mate, all of those things, things are driven by hormones. And then, you know, as we age, I think that what happens is, you know, we felt not so long ago that women past a certain age did not need hormone replacement, or men as well, you know, for andropause. And I think that the times are different now, and we know that we have to approach each person a little differently and, you know, just help them in their own individual way rather than, you know, something we do as part of a guideline.
- [05:18]
B
How did your personal background, perhaps your childhood, inform how you listen to bodies beyond lab numbers?
- [05:25]
C
Yeah, you know, I think that I have an intuition, and a lot of that came from my mother, who I felt was very, you know, psychic, so to be. And I just feel that a lot of what I do, too. It's based on the science, but also I just get a feeling from. From people, from patients. And endocrine really resonated because it, to me, is such a mystical subspecialty that way.
- [05:54]
B
Do you ever see symbolic or archetypal echoes in cases you treat, tying your scientific work to this deeper intuitive lens?
- [06:03]
C
Perhaps I do. I, you know, meet certain people that just have such an insight into life and into their own selves. And when I look at them and I, you know, try to piece out what's going on just with the science part. I find oftentimes that that doesn't solve the whole question. And sometimes I can just, you know, look at them and I'll just say, you know, I think something else is going on here and let's talk about it. And I think that happens when I do get patients that come to me and they really want to see endocrinologists and they, their hormones are all normal. So to spe. So a good example would be one of the most common ones is having a normal TSH or thyroid stimulating hormone, which controls, you know, our metabolism to some extent. And 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. And then when I start talking to them and asking them other questions and they tell me about their lives, I feel that oftentimes I can piece things out and help to guide them in a, you know, direction that will help their stress or their depression or their cognition or other things that are going on in their life.
- [07:25]
B
What do you believe is the reason so many patients are coming in with unfounded fears about their thyroids and how they're functioning?
- [07:36]
C
Well, I think it's more that what we do in standard science and medical practice isn't answering their questions as to why they're not feeling well. And I think that the way that we generally approach things are, you know, we do a battery of tests and if everything is normal, then we say everything is okay. When I think that there's a whole nother paradigm that, you know, we really need to explore that goes along with just. I don't think that, you know, we treat the whole person to the extent we want to, but I don't think that our society and the way that we practice in this day and age is set up to treat the whole person because it's time consuming. And I think that a lot of us default to take a medicine and, and that's, that's what many people are taught. That's just what you do as a physician. You know, you give them a medicine and if they don't improve on it, then meant there isn't anything else really to offer. And we talk about all the other, you know, lifestyle, diet, food choices, stress reduction. But I don't think that many, as many people have a way to really get a grasp on that. And they really need a life coach more than just one part of it. Physicians do a great job in what they do and what, you know, slice of the pie there. But I think really we need a different type of infrastructure to treat the whole person.
- [09:08]
B
Hormones are often called the body's chemical messengers. How do you think about them as storytellers influencing mood, appetite, metabolism, stress or identity?
- [09:19]
C
I mean, I think that obviously, you know, they control our whole entire system truly. And a lot of the way we navigate through life is, is hormonally based just with our various life stages. Those are all controlled by hormones. And you know, the choices we make in the direction of our life, the way we want to go at those various stages, they're all hormonally driven.
- [09:45]
B
Is there a single overriding influence, at least in the American lifestyle, that you see negatively impacting people's hormonal balances and therefore changing the outcomes of certain choices, certain decisions they might be making through different life cycles?
- [10:02]
C
I think the one thing is, is that many people think that with the medicines and the pills we have, you know, that's going to do it all. And, and I think that we really need to take more control over our life and, and how we approach it in a non medicine way. And I'm not saying by any means that we don't need all the modern medicines we have because I think that, you know, so many of them are life saving and you know, prolonging life and you know, certain types of diseases. But I think that the focus really needs to be on the whole system and all of those things we do to enable, you know, just, you know, our best life and that that's all the basics that haven't changed forever, I think.
- [10:49]
B
Which hormone do you personally feel is the most underappreciated in affecting behavior or mood?
- [10:54]
C
The most underappreciated? You know, I don't know if there is any one hormone, but I could say that, you know, a lot of work that's being done now with neurotransmitters, you know, serotonin, dopamine, etc. And the influence that those have on our lives I think is really, really important. One of the things that, you know, is very popular now are the glucagon, like peptide receptor agonists, which are your Ozempic or your, you know, all of the weight loss drugs, the GLP1 agonists. And we know what they do to decrease appetite and then cause weight loss because of decreased caloric intake. But these substances also affect the brain's dopamine reward pathway and then too much stimulation there can, you know, in some lead to depression. And I'm not saying that these drugs are quote unquote bad, but I don't think that, you know, as a weight loss agent, we've kind of all jumped on and, you know, here we are now we're using this and we don't know what the long term effects are. So to go back to your question, I think that some of the underappreciated, maybe I should say just the neurotransmitters that we are all, you know, unique in the way that certain neurotransmitters drive our own personalities and our makeup. And so some of us may be more of a dopamine type, you know, dominant person, others might need or have more serotonin, etc. So I think that this is something that really needs to be explored a lot more and we need to find a way that people can understand what that means for them and what we do in order to, you know, use them to, to have a better life.
- [12:48]
B
That's very interesting. What you were just saying reminded me of the work of Dr. Helen Fisher, the biological anthropologist who put together, I believe it was something of a scale discussing personality types based on dopamine, serotonin, testosterone and estrogen. The same idea that obviously you have personality types that will range between obviously with dopamine, the explorer, serotonin the builder, testosterone the director and estrogen the negotiator. Really formulating that there were hormonal personality types, which is fabulously significant when we consider how much, as you've already pointed out, hormones get ignored as shapers of personality. That feels the most significant to me. Then we come into the modern age with some of these semaglutides that are really impacting, I believe, a lot of patients in ways that aren't being discussed with them necessarily, or at least not clearly discussed with them, not in a way that they can understand. Have you had a lot of patients who have suffered personality disruption or mood disruption after semaglutide had been prescribed that perhaps they weren't anticipating?
- [13:57]
C
I think in some I have and I think, and you know, it's not anyone, I should just say this, not any one brand of the GLP1 agonist or any one type. It's the whole class class in and of itself. And you know, we're still fairly new in its use now. So what we're seeing now are the early stages. And I have seen patients that overall initially, you know, they're very happy about their weight loss and things like that. But I Don't see them being exuberant. I haven't seen any people become enormously depressed. I think most of it has just been the side effects that, you know, we get from the gastrointestinal system. But the reason I say all this is that again, we haven't used it for a long period of time. So long term effects when one's using these are still, you know, yet to be seen. So I think it's, it's interesting and you know, you do ask about one particular hormone or whatnot that might, I might think is more important or not. I think that really they're all important and it's the interplay between all of them at our various stages in life that that is really the most important thing and focus that, you know, all of us need to pay attention to. That way, even if we are, you know, have a dominant personality type or neurotransmitter type, they all are important in the interplay, you know, for overall health, whether that's mental, emotional, spiritual, physical, etc.
- [15:27]
B
You've touched on this concept now a couple of times about life cycle and where we are at a specific phase.
- [15:34]
A
Do you care to elaborate?
- [15:35]
B
Obviously this is an important piece. You recognize the human body in a state of change as it ages. What hormones come to the forefront as personality modifiers?
- [15:47]
C
Oh, yes. Well, you know, I do think mainly it's estrogen and testosterone in males and females. And we see how the balance between the two in both males and females is, is very important. And you see when you have that imbalance initially in teenagers, how disruptive that is and you know, how, how hard it is really to, you know, stay, not stay afloat but, but, you know, maintain your aim and your direction in life when you're trying to grapple with all of these, these changes that are occurring very rapidly and how important socialization is when this is happening. And then as you go into your early 20s and then your 30s and then of making your way in the world and finding a mate. But these are all hormonally driven. And then the same is, is that when we get older too, and then we, you know, don't have that drive as much anymore. I think that those hormones are really important in us being, you know, satisfied with life. And it's there at a different level on a different, how do I say, it's not fluctuating as much as it, it is and the cycles aren't there as much and we have decreased amounts but still need them and, and that in and of itself, that way as well too, puts us into a different type of way that we see life and maybe a more comfortable way we see life for most people.
- [17:16]
B
Do you think overall, our Western culture underestimates how much we are in fact hormonal beings?
- [17:23]
C
I do. I think that we really say that we are rational beings, which is. Is correct. But I think that we overlook a lot of the horm. Hormonal influence than just our everyday lives.
- [17:37]
B
In the realm of diabetes, obesity, metabolic syndrome, what is a prevailing myth or misconception you wish every patient or clinician would unlearn?
- [17:46]
C
The one thing I think is that pills will not do at all. And I think that it's just so important, especially with all of the advances that we have in diabetes now and the type of medications we have that act at various organs and our, you know, monitoring systems. I think that we think that technology is going to be, you know, the one thing that's going to just fix us. And that's where we have to step back and say it's still the basics. When we're trying to treat a metabolic disorder like that or, or any of the others like PCOS or whatnot, it comes back to the basics. And I think the one most important thing is how do we make correct nutrit nutritional choices and lifestyle choices to manage our stress and to manage our, our attitudes, and how do we do cognitive therapy to address those things in ourselves that we might find are challenging and not where we want to be in life. It's just truly 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, you know, age and go through life.
- [19:11]
B
In this discussion of technology, you're speaking more to the subject of chemical assistance. Obviously pharmacokinetic agents that modify hormonal output or regulate our hormones. Is this more, you think, a problem for Western civilization than an advantage? Or do you believe that it's necessary in some places and overused in others?
- [19:34]
C
Yes, I think that it is definitely necessary and it is a great help. I do think that a lot of our patients, though, what they really need more is more cognitive therapy and they need more lifestyle wellness coaching. Just something that encompasses more than just saying, here, you can take this pill and, and here's what you need to do, or even, you know, with nutritional support, just do this. And it's very hard for people to obviously change habits and change behavior, and many know what they need to do, but it's Making, you know, that leap to be able to consistently make that change and be, be consistent with it and, and have it become a permanent, you know, habit or change rather than something they start and then they lose track of what they were doing there.
- [20:34]
B
Why is the over reliance on medicine so persistent in medical culture or general culture by your opinion?
- [20:41]
C
I think it's easier, I think it's, it's, it's easier to give a medication and again, you know, we need medications, they are very, very important for disease, for disease management. But I do think that it's just easier to do. The other is more of a long term, it's the same as, you know, if you go into in depth psychotherapy, how long does that take and do we have the resources to give that to each person? And you know, we don't for the most part in society. And so I think that the medications are definitely the go to initially and the first trigger because it's just easier to implement than other long term modalities.
- [21:27]
B
When treating a population, how do you integrate social determinants, food, desserts, shift work, stress or environment into your perspective?
- [21:36]
C
I think it is so important when you're treating anyone to find out about them, where they work, what they do, what their living situation is, how much access do they have to healthy food. And I think that it's really important when you're talking to someone to do something to enable them to have some, however small, control on their own environment. And so if we start talking about their own individual situation, we say what is one thing that you might be able to do to, to help reduce your stress? Is there, you know, a self help app or is there a way that you could meditate a little bit every day? Is you know, are there sleep habits that we could try to introduce or dietary habits? And if one is food impoverished, is there any way that we can even make one small change a day to substitute a healthy food and, and even controlling our negative thought patterns and just our, you know, own mind. Is there a way that we can do that? When we do all of those things, we definitely lower our cortisol. And unless it's unhealthy effect, you know, on our thinking and the stre that you know, is posed on the body when you know it's out of control.
- [22:59]
B
Walk me through that. So cortisol as a hormone obviously is one that you recognize and calculate in your day to day treatment of patients and research projects you've been a part of. If you see it as, let's say, something potentially Negative in the lives of individuals? When have you seen it functioning positively? Where have you seen it changing lives for the better, if at all?
- [23:22]
C
Oh, yeah. Oh, well, of course, of course. If we didn't have anxiety in life, then we would never get anywhere in the sense that the performance usually won't be as good as if you had a little anxiety. You need that. If somebody was up there and completely paralyzed when they were in front of an audience, that's, that's way too much cortisol right there. So you definitely need a healthy amount. And, and that's why just our circadian rhythm, when we see cortisol's higher in the morning and lower in the afternoon, and, and that's because we need that, you know, when we're in a diurnal rhythm, when you have night shift workers, everything is just, you know, off the board there. That's, that's a whole different type of a situation. But so you need a healthy level of cortisol in order to give you the initiative to perform.
- [24:16]
B
Where do you see it having the most negative effect in contemporary lives?
- [24:20]
C
In contemporary lives, I think when we're just crazy busy, when we are all over the place, when. And we're going nowhere. One of the things I see is, you know, just the, the constant feed for stimulation and short sound bites by whatever modalities. We get them in our phones, our radio, our television are usually, you know, it's on social media, scrolling and, and whatnot. Just this constant, quick, repetitive motion there. I think that that's, you know, so hyper adrenergic. It's, it's a deterrent, you know, to our mental health, in a sense. It's a different type of addiction in one way.
- [25:05]
B
So in wanting to modify people's lifestyles to help them as a method of metabolic intervention, if you could make one change for Westerners in 2025, what would it be to improve their overall health from an endocrinological perspective?
- [25:21]
C
More reflection. If one could incorporate even a short period of time, a half an hour a day hour a day of just mindfulness and, you know, reflecting on the basics, on where am I going in life, what am I doing even what's the day plan like now for me? How do I think I'm caring for my body, for my mind, for my spirituality, I think that would be profound if everyone just spent short period of time thinking about that and trying to make some positive changes with that, asking themselves their own questions and then answering it too. And sometimes what I think is very useful is to Pretend that you are somebody else answering the question for you that you're answering so, or asking. So if I asked a question about myself, then I'd put myself over in a different place here and say, okay, answer that question as if it were not you. What if you know somebody were asking you that, what would you say? And I think it's another type of practicing mindfulness that's very effective.
- [26:30]
B
So your model really is to convince patients that they ought to be more rational than hormonal beings, is that correct?
- [26:40]
C
I think that it's a balance. I think that the two are a balance. And so 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 and, and I suppose that is the rational part, I think you need really a healthy interplay between the two, balance between the two in order to be the.
- [27:04]
B
Most effective wearables Continuous glucose monitoring AI risk models what frontier technologies right now excite you and which do you see as being overhyped?
- [27:17]
C
You know, I think that the continuous glucose monitors and an AI to sometimes make diagnoses might be oversimplified because I still think that one still needs to think and so the glucose monitors are great, but one needs to wear them but also think about what the results mean for them. So it won't do it all for you. And I feel that some people initially think that that, you know, might be the case. I think that when we look at just the future, where things are going, I think if we. One thing I see exciting that can be on the horizon is not just a continuous glucose monitor, but a way to continuously monitor all of our hormones throughout the day. So if one war a monitor and I know these are things being looked at that are, you know, just in the research phase now looking at our diurnal and our, I mean our just 24 hour cortisol levels along with our thyroid levels and our glucose levels and, and other neurotransmitter levels. I think that would be like the next frontier for us to say, wow, then understanding how we are able to, you know, incorporate that for ourselves and how we respond as a hormonal being, then we can make some real changes in life about, you know, our innate responses and then we can rationally maybe modify them.
- [29:00]
B
What are the ethical or accessibility risks you worry about with any tech driven endocrine care?
- [29:06]
C
Well, I think accessibility, it's, it's very hard that in the sense that these things are expensive and so many people have you know, a lot of the technology that they wear, but you have to be able to pay for it or have insurance to get that. I think that any, anything that we wear or have now, from our phones to whatever else, there's always a risk of, you know, a lot of information out there. But I also think that most of the time I don't think that, that, you know, others are as interested in what's going on with our own health and sewing it for some reason then, then a lot of people might be worried about, unless it's to deny insurance to, you know, people. But I don't think that that's something that we really have to worry about.
- [29:57]
B
You mentioned earlier oversimplifying the way a health model might look based upon the results technology provides. But then that begs the question, how much should we trust algorithmic prediction when it comes to human bodies?
- [30:13]
C
Yes. Yeah, no, I, I don't think it's there yet. I think there are certain areas where we can use artificial intelligence to read patterns, such as reading radiological studies and things like that that's being investigated. And there's a lot of evidence to show that it's very helpful. But I don't think it's ready for prime time yet. I don't think that that's really something that we can, you know, lay our hat on and say, yes, I think this is a hundred percent, you know, risk free. Are there fewer errors with that now than when humans, you know, interpret or read or do this? That's, that's kind of up for grabs. You know, I, I just don't think that we have all the evidence yet to, to have, you know, a lot of faith in, in this taking over, you know, what a human would do. And I don't think that that'll ever happen. But I've been wrong too.
- [31:13]
B
DLP1 agents, new weight loss or metabolic drugs. How do you balance enthusiasm with caution in integrating them into long term patient care?
- [31:24]
C
Yeah, what I say is this is something here that, you know, can really help you and, but we also need to put work and effort into it in order for it to manifest itself. Its, its optimal effects. So here's what you have, and let's say if you're even just talking about a diabetes medication, all the studies done with those medications were on, you know, with patients that also were practicing all of the other, you know, lifestyle interventions that needed to be done as well. And that would be, you know, the appropriate type of a dietary intervention, exercise intervention or whatnot. And so I, I say that here's the hype, it's great. But here's, you know, the reality. What you need to do to get that outcome that you really want.
- [32:19]
B
What complications or unintended effects do you monitor most closely?
- [32:23]
C
Well, number one, definitely when we have people with diabetes that are on those agents to lose weight, we definitely need to watch out for low blood sugars. And so that's something that we must do real time, and that is adjusting their medications. When I have patients on GLP1 agonists for weight loss that do not have diabetes, I just caution about the gastrointestinal side effects that one could have. And if they do have those side effects, then we go down to a lower dose.
- [33:01]
B
In a world of inequitable access, how do you think about fairness and legacy of metabolic therapeutics?
- [33:08]
C
Oh, that's a really hard question. You know, I, I, I think that we really need to choose our patients well, or those individuals that wish to have the medications that will really follow through and make the best use of it, rather than handing everything out freely to many that just may not, you know, make the best use of it or adhere to a regimen and, you know, they would get the desired effects. It, it's really hard when you're trying to even kind of intimate we're rationing care in certain ways. But you definitely want to see your most, you know, highly committed people that really need it, whether they have advanced disease or they're the more, you know, obese or the more hormonally affected by the polycystic ovary syndrome, etc.
- [34:12]
B
That's a very good point for women or any gendered patients. Thyroid pcos, as you mentioned, perimenopause. What's an insight you wish more clinicians had about gendered endocrinology?
- [34:24]
C
Number one, you know, when you look at autoimmunity and endocrine disorders, just a broad brush, more women have autoimmune issues than men per se. But still, the most important thing to do with any individual is to, you have to take each one case by case. And so you can't treat all women the same and treat all men the same and treat, you know, younger women the same and older women. So you really have to individualize that way. And then when you talk about gendered endocrinology, then, you know, that's, that's one part of it, the cisgender individuals. But we're embarking on a new paradigm now where we have many transgender individuals and not just those that are going to transition from male to Female or female to male, but ones that are non binary, ones that are, you know, might not want to completely become one or the other gender, but a little of one or a little more, less of the other. There's all shades of gray with that. And so that's a different type of a understanding that physicians need to have, too. And then, you know, we used to. We were raised with, you know, 50, 60 years ago, transgender were those few patients that were born a man that really were a woman, you know, or. Or, you know, vice versa, a woman in a man's body. And now we know that the way that we see ourselves in society is just some people are gender fluid and others are just all of the other, you know, intermediate type of ways that they view themselves and want to be viewed than, you know, we had previously thought about.
- [36:24]
B
Obviously, I would imagine that complicates the outlook for an endocrinologist such as yourself. Are there ways of approaching this concept of misgendered endocrinology or perhaps gender adjustment within an endocrinological framework that you believe clinicians are not being trained on and physicians who are treating patients today don't have the right depth of awareness regarding.
- [36:52]
C
Yeah, that's absolutely true. And I think it's because it's a relatively new science. I mean, we've always known about transgender medicine where there were a few people that we absolutely. Or they absolutely knew that they were born into the wrong gender, and so had that change done. But now we find that there are so many types of, you know, again, just, you know, either they're gender fluid or they're not. Exactly. It isn't a binomial now. It's. It's. It's just many transitions in between that and so stages in between that where people are. It's really hard for me to explain this, this. But I think that it's hard because physicians don't understand that. And there are a lot of societal barriers. There are a lot of religious, you know, issues that come up with that too. And then you do have people that really do have other psychiatric issues that you have to make sure aren't causing these, These, these, you know, problems with them. And we're treating them appropriately. So, yeah, that's about. That's. It's very complicated, as you can see.
- [38:11]
B
It is a complicated topic, but it's.
- [38:13]
A
One that clearly is very much, I.
- [38:15]
B
Think, in our time. What's the single most powerful lifestyle change.
- [38:20]
A
That you can recommend to any patient.
- [38:23]
B
To support their metabolic health? And how would you choose that for them.
- [38:28]
C
Them, yeah, the single most is absolutely what we put in our body. And that would be, you know, the type of food that we eat, the type of just, you know, the chemicals we use. And second to that, I would think, how do we approach, you know, just wholeness and. And decreasing our stress? So I think it's. It's probably those two. That's not the single most, but I think, honestly, it's. It's truly making conscious choices for what we're doing and what we're taking into our body, and then the thoughts that we have about life and about, you know, what we're doing, I think has a lot to do with that.
- [39:17]
B
Are there foodstuffs that have become very popular or at least commonplace in the American diet that you look at and think, this is something that I would prefer for my patients not to be consuming because I believe it's going to promote metabolic disease or some level of endocrinological disruption?
- [39:36]
C
Yeah, I just think the further you are away from the source has a lot to do with it. And so. But you see, this is very expensive for people to eat organic foods and be as close to the source as possible is very hard. And so what I mean by that is when you have people choosing a lot of processed foods and things that look very healthy and they think are healthy, but when you really look at ingredients, they're not. And some of it, you can't even really tell what you're eating, I think that has a lot to do with it. And that's. That's the, you know, one of the single things I would say, try to get a handle on that.
- [40:15]
B
Get the patient's diet closer to the origin point of the foodstuff itself.
- [40:20]
C
Right, exactly, exactly.
- [40:23]
B
Tell me now of a patient encounter when the data said one thing, but your clinical intuition, you listening to them or your sense of humanity made the difference in diagnosis.
- [40:35]
C
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. And so they say I have all the symptoms of a low thyroid, of hypothyroidism. And my doctor's telling me that everything is okay. And then I'm talking to them. I say, you're fatigued, you have brain fog, you have this, you have that. And then if it's a female, oftentimes they're perimenopausal. And, you know, they just. Just. That was completely glossed over. And so we say, how do we. How do we help fix that. But that's one of the most common ones I see. And it's usually in women that are in their, their late 40s and early 50s struggling with that.
- [41:24]
B
Why in particular do you think this is getting ignored by physicians and clinicians? Why is the change of life something that doesn't calculate into what kinds of impacts we tell a patient they're suffering under?
- [41:40]
C
Yeah, I think that it just may be. Not that it's not appreciated, but it's the type of training that's gone on for years where it's a stage of life and you'll get over it and then you'll move on. And then, you know, years ago, estrogen and progesterone came under a bad rapid up because of some evidence. But looking at the evidence later on, we found that wasn't really you know, the most, you know, clear way to look at the evidence. And it was not quite as, you know, bias free as we used to think. And so I think that's happened too. And physicians don't want to even get into the conversation. And sometimes too when someone just overall they don't feel well and you're saying, oh, oh, well, it could be that, but oh, well, you'll get past it. It's easier to do that and less effort too, I think.
- [42:37]
B
Do you believe the gendered populations that service our patients are part of this conversation? Many women who are seeing male gynecologists might not get the sympathy that they would from a female gynecologist. Is that something that you think should be calculated into exactly what their patients are going through but not able to proper articulate?
- [43:03]
C
Yeah, that's an interesting question because I have seen both. And so we have many male physicians now that are very, very cognizant of, you know, the need for individualization and hormone therapy. And I've seen women that are adamantly against all of it. So I think it really depends on the physician. But I don't see it as, as it used to be. And I think as it used to be was, you know, more men may have not been aware of it in a different generation, but I do think that that's changed more now. I still say yes. I mean, you, you probably still need to be that, you know, sex or gender to really understand what's going on. But it doesn't mean that you can't have the empathy and initiative to help a patient that's telling you, you know, what they feel they need.
- [43:57]
B
Is there anything you can think of in terms of women specifically Going through their perimenopausal or menopausal symptoms that you believe in because clearly economy is driving so much of this.
- [44:11]
C
Yeah.
- [44:12]
B
Under serviced patients, because of their economic stratification, are there supplements you see them taking that are making the situation worse, or is there a reasonable solution to some of these endocrinological problems that can be aided not only through proper diet and through proper lifestyle, but possibly from supplemental options? Complementary medicine is what I'm talking about.
- [44:35]
C
No, I think that it's still available. I think, I don't think anything has happened to make, you know, the cost of the, that type of medicine we're talking about prohibitive. I, I think most of the cost is in the newer, you know, the technological advances we have and, and other types of drugs that way. But the basics are out there and still cheaper and which is what people, you know, generally need. So I, I think it's still not, you know, as prohibitive as we're thinking.
- [45:07]
B
Are you for or against hormone replacement therapy?
- [45:10]
C
Oh, well, I, I feel the need to individualize and I definitely think that you have to look at the risks as well as the benefits. And I think the risks have only been what has been looked at. So I definitely give a balanced. I do prescribe a lot of hormone replacement therapy to patients, and that's men and women. So men with andropause on testosterone as well as women who need estradiol.
- [45:39]
B
The change that men go through is frequently overlooked in western civilization, largely because of the categories that we expect men to fit into. Is this something that you see changing as we move forward?
- [45:50]
C
Actually, I see that it was something that we didn't really look at in the past and it's looked at now. And I feel that men definitely are listened to when they feel that they need androgen replacement. And in some instances that may be even a little easier to give men the androgen replacement testosterone than women that might be saying, I want estrogen, you know, and, or progesterone. And that may even be a little bit harder just because of the literature that had been out there about the risks of, you know, cancers and, you know, other things that go on with estrogen replacement therapy.
- [46:32]
B
Looking forward, what is the endocrine mystery you most hope gets cracked in the next decade? And how would that shift our understanding of health, identity or choice?
- [46:43]
C
I think that may go back to our endocrine disruptors. I think we'll get a lot more evidence and information on the effect of the endocrine disruptors. You know, just in our system. And, you know, one of the least understood glands, though, in the body is the pineal gland, which is very mystical. And that's not really anything that anybody is looking at. I don't think is a. A research, you know, bull or something. But that would be really interesting to find out more about that. Just with its, you know, effect on melatonin and circadian rhythms.
- [47:22]
B
Now, the impact the pineal gland has on melatonin and circadian rhythms, beyond that, there an alternate role you've recognized impacting or regulating other glands. Does it have a communication channel that isn't getting recognized in the literature or the research that exists right now?
- [47:39]
C
Oh, I'm sure it does, but I don't know what that is. I. I would love to find that out, too. And why was it historically called our third eye? There's a lot more to it.
- [47:50]
B
Is this something that you believe gets any attention in any endocrinological research right now that you're paying attention to?
- [47:57]
C
To. Not at all. Not at all. No, I don't think so.
- [48:01]
B
What's your theory?
- [48:02]
C
Yeah, my theory is that, well, it's. It's there. I think it's more important than we have attributed. And it just, you know, needs to. To come to prime time. Somebody's got to do the research to look into it and see. But right now we say, yeah, it, you know, produces melatonin. That's it. But melatonin is very important, you know, know, for your circadian rhythm. And you almost think that that might be something that would be a controller for many other, you know, hormonal, you know, functions in the body.
- [48:34]
B
Fantastically insightful. And just as clearly, melatonin is necessary to regulate our circadian rhythm. As we close the evening, I want to say that I'm grateful for the richness you've brought to this conversation. It has been fantastic to really get some insight from a firsthand perspective into the matters that drive us in our behaviors and in our. But so rarely get a lot of public conversation. Thank you so much for joining me tonight. I certainly enjoyed our conversation. Shireen.
- [49:04]
C
Well, thank you, Juan Carlos. I was really happy to talk with you, too.
- [49:08]
B
Absolutely. Thank you so much. You have a wonderful evening. As we close, I want to thank.
- [49:14]
A
Dr. Shireen Fatemi for reminding us that hormones are more than molecules. They are storytellers, silent architects of our behavior, emotions, and our sense of self. Her perspective calls us to reimagine medicine not only as science, but as a practice of listening deeply to the whole person, to what data reveals and to what intuition illustrates before we part ways today. If this conversation starts something in you or offered a spark of insight, would you take just a moment to share that light back? Leave us a rating or review on Apple Podcasts or wherever you have listened to this episode. It's one of the simplest ways to help the observable unknown reach new seekers and fellow travelers. Your words matter more than you know and they help this circle grow. As always, I invite you to join the dialogue. Visit our website, WhatsApp channel the observable Unknown Email me your reflections at the observable unknown gmail.com or text me directly at 336-675-5836. And when you do, please share how did you first find out about this show? What's your favorite part or episode so far? What's one thing we could do to make the show better for future listeners, and what's one thing that you personally are struggling with right now? Until next time, remember, what appears unknowable often stands right before us, waiting to be observed through both the lens of science and the wisdom of spirit. This is Dr. Juan Carlos Rey of crowscubboard.com inviting you to look deeper into the observable unknown.