Ep. 243 Balancing your Hormones and Thyroid Health with Dr. Shawn Tassone

Connect with Dr. Shawn Tassone

• On his website
• On Instagram (Appointments: drshawntassone)
• Call Dr. Tassone’s office: 512 956029
• On Facebook

Documentary mentioned:

The Bleeding Edge

Books mentioned:

Eight Weeks to Optimum Health, by Andrew Weil 

The Hormone Balance Bible on Amazon

Transcript

Cynthia Thurlow: Welcome to Everyday Wellness Podcast. I’m your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent are to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

I’m joined again today by Dr. Shawn Tassone. He was one of our original podcast guests back in 2018, episode number four, he’s one of my favorite gynecologists and absolutely one of my favorite people to follow on social media. He gives you information in a really straightforward fashion. He is also the author of a book I recommend frequently The Hormone Balance Bible. Today we dove deep into the impact of the Women’s Health Initiative, the differences between bioidenticals versus synthetic hormone replacement therapy, contraceptive options for middle-aged perimenopausal women, the impact of Essure, a sterilization procedure, why so many OB/GYNs and other medical professionals are so burned out, different options for thyroid health, the basis for the hormone balancing Bible, the SHINE protocol, some of his favorite supplements, and those he thinks are terribly overused?

I’d also like to thank one of our recent podcast reviews. This is from emsgirls3 via Apple Podcasts. “This is such an interesting episode with Dr. Tan. I love Dr. Tan’s enthusiasm as well as how blown away I was from the information. I’m not only going to listen again, I’m sharing it for sure. Thank you, Cynthia.” Emsgirls3, thank you so much. We love this feedback. I truly, truly, can’t tell you how much I love and enjoy being able to share the brilliance of so many incredible researchers and healthcare professionals. I hope you will enjoy this podcast today with Dr. Tassone as much as I did recording it.

Well, Dr. Tassone, it’s so good to have you back. Some of my listeners may not know, you were one of the very first podcast guests on Everyday Wellness back when I was co-hosting it with Kelly.

Shawn Tassone: Oh yeah.

Cynthia Thurlow: And that was 2018 and I think you joined us from your bed. I think you were lying in bed and saying, “I’m joining you for my bed, I haven’t gotten up yet.” We just thought that was so cool. How are you today?

Shawn Tassone: Cooler stupid, I mean now look at me. I’m wearing my pink. I got all my stuff. I got my [unintelligible [00:02:41] now. I mean, it’s amazing. Doing good, busy for GYN, OBs. I don’t do OB, but for us end of the year is always busier because the doctor goals are met and people want their surgery and people get pregnant at Christmas time or a little after so they deliver their babies in October, November. So yeah, pretty busy right now.

Cynthia Thurlow: Well, good. Well, I’m glad that you’re joining us today and I’ve been really excited and looking forward to the conversation. And I think I really want to start, I would imagine that we both started in the medical field late 1990s, early 2000s. And what were some of the changes that you saw post Women’s Health Initiative? So, the listeners here are very savvy, but I’ve started asking more of the GYNs that come on to talk about the climate, you were pre-Women’s Health Initiative and then I’m sure that it influenced your practice. What are some of the things that you had to do differently or navigate differently? I know that, with your background, you’re very, very pro-women’s advocacy and helping your female patients have this ability to lean into understanding the role of hormone replacement therapy. Obviously, we know it was a completely junk study, unfortunately, that’s influenced an entire generation of clinicians and has made women very fearful about hormone replacement therapy.

Shawn Tassone: What I’m fascinated by– I thank you for making me younger because actually, I think I was in practice in probably mid-1990s, but the Women’s Health Initiative–. So, before that we used to prescribe when I was in residency and everybody got Premarin and Provera, like everybody you didn’t even get asked, you just were given it. And then the Women’s Health Initiative came out and basically said there was an increased risk of breast cancer, and everybody stopped it, but the risk was like one in a 1000, but I think it did a really– I did a podcast on my own a couple of weeks ago on this because it’s so prevalent to this day and it’s not just, I mean, how many patients come in and say, “Well, I started on the estrogen you prescribed and then my sister told me I shouldn’t take it because it caused breast cancer, so I stopped,” and I was like, “Do you honestly think I would give it to you if it caused breast cancer?” But it’s so prevalent that even doctors like you said, colleagues of mine won’t even prescribe it.

And it’s so ridiculous because if you do a deep dive on it, which is hard because it’s really complex, it wasn’t necessarily that it was a bad study, but what they didn’t tell you was bad in the sense that all the women in the study were over the age of 63. Well, they already have high risk of breast cancer. The medications used were a total synthetic, Prempro, but the Premarin only arm had no increased risk of breast cancers. So, the combination arm did but the estrogen arm didn’t and they kept that arm going. And actually, there was a 50% decreased risk of colon cancer and you don’t hear about that, you just heard about– and what’s funny is all the bad stuff that they said, was already in the package insert for that medication. So, it really wasn’t anything new, it is like somebody finally justified the package insert and nobody reads those obviously. And then can we even compare that to bioidentical hormones? I mean, Premarin, I just had a patient come in today this morning that was on Premarin and I couldn’t believe it because I didn’t even know people still prescribed it, to be perfectly honest. But I guess it’s still out there. But most doctors now use bioidenticals, I think.

Cynthia Thurlow: Well, and it’s interesting. I have a nurse friend, who was just placed on estrogen only despite still having a uterus and she came through a program of mine and we did a Dutch and sure enough, she was estrogen dominant. She’s predominantly metabolizing, estrogen down a nonbeneficial pathway. And so, we had this conversation, and then I referred her to someone in the state that she lived in because you need to follow up on this. And she said, I’m an ER nurse, how would I know that this is not considered to be a standard of care. So, well I’m glad that they’re talking to you about HRT. I just think that they’re certainly– and she’s in menopause, let me preface that. I just think it’s really important that women understand what their options are. And there are certainly many clinicians, many GYNs like yourself and others that are friends of ours that are prescribing bioidenticals. And I think it makes a big difference when you’re looking at that versus a synthetic hormone replacement therapy.

Shawn Tassone: I mean, the synthetics work, they just have, in my opinion, more side effects because they hit the receptor so much harder. I think, in general Premarin is probably seven times harder on your body than a bio-identical is. And it’s just because it’s a synthetic. It’s an endocrine disruptor just like plastics and things like that. So that’s why those have an increased risk of cancer because they don’t hit the keyhole, right? It’s like you unlock the door, but the key doesn’t fit and you ruin the lock because you’re turning so hard. That’s what the synthetic hormone does. Over time, it’s going to damage the DNA of that cell. And I think we also know a little bit more about dosing too. And I think oral estrogen metabolizes in a more negative way than a topical estrogen does and most providers, like you said, they just don’t know that. And I’m amazed that somebody in this day and age would even give unopposed estrogen in a menopausal woman with a uterus. That’s fascinating to me. But it just shows you there’s weirdness on both sides, not prescribing and then when they do prescribe, they don’t even know the protocols.

Cynthia Thurlow: Exactly, and I think one hot-button topic that I know we’ve talked about Sidebar consults many times, but came up in questions that listeners were submitting was, what are your thoughts on pellet therapy as an option? So, we talked about oral, we talked about transdermal, we talked about patches? What are your thoughts on pellets?

Shawn Tassone: I know you already know the answer to this [Cynthia laughs] but I have not pulled any punches on the fact that I hate pellets. And I guess, I’ll put this out there first. If I put in pellets, I would be rich because of the number of women that I see, “So don’t get me wrong, I’ve thought about it.” And I cannot ethically bring myself to do it because the things that I know about them. I have a blog post and there’re about 10 things that I don’t like, but the main things are– first of all, they’re bioidentical, which is good, but you can’t get a good dose. Most of the women if not all pellet, I just saw a lady this morning again, she’s six months post pellet with estradiol and testosterone. And her testosterone levels are still four times the normal level for a woman six months later. So, who knows what it was five months ago, I mean, Jeez it must have been through the roof. So, that’s it, you can’t control levels very well. It’s a minor surgical procedure. I mean you do have to numb the area, you got to dig a little pocket with this needle and you got to put it in. There are complications from that. If you don’t like the effect, you can’t take it out. The people that are putting them in, and I’m not trying to– I’m speaking in general terms because I have a friend that’s a GYN that puts them in and I’m sure he does a good job. But most people that put them in that will go to a course put on by one of the companies, and it’s a weekend and then they come back and what they do is they’ll draw the tests. They’ll put it into the formula that the company gives them and then they’ll come up with the dose and they buy the pellet from the company. The company is charging them $900 a month to be a part of the organization. So, it’s pay-to-play, and they pass that along to the patient who has to pay. I think pellets come out to probably $150 a month whereas a cream is 45 bucks. So, it’s more expensive in the long term. And there’s just no reason. I always say pellets are for animals not for humans, because they’ve been used forever in animals and they work, but we obviously aren’t animals. I just think that most women that go on them usually will go on them for a little bit and then they’ll go off of them because they just don’t like the effects.

Cynthia Thurlow: It’s been my experience. I’ve never myself had a pellet, just because of what I’ve discussed with colleagues and yourself and others. But I’m guessing that most people are getting pellet therapy because they want testosterone. And just seemingly from what I’ve read and what I’ve experienced, there’re so many other options. I know that, unfortunately, I was on another podcast and someone was saying, “Well, these two doctors I spoke to said that women don’t need testosterone.” And I said, “That’s interesting.” And so, we had a whole very interesting discussion where I disagreed with that. But I think on a lot of levels, it’s been my clinical experience that women, if they are in need of testosterone, especially in late perimenopause or menopause, whether it’s transdermal or subcutaneously, they feel a whole lot better.

Shawn Tassone: Yeah, decreased low testosterone in women I have called the plague of the 21st century. The problem is nobody’s talking about it. If you look at the FDA, there are 10 FDA-approved testosterone replacements for men, there’s zero for women, there have been five or six that have come up for FDA approval, they’ve all been shut down for the fact that they weren’t thought of that was necessary. And the interesting thing is there is a medication now called Addyi that is for sexual improvement, and it’s being promoted as the Viagra for women. So, we’ve approved that one and the interesting thing about that one is that it’s an antidepressant. So, we’re basically telling women that it’s all in their head, which we do all the time anyways. And what’s fascinating about it is you can’t drink when you take it now, what woman in this day and age, post COVID, isn’t having one glass of wine a day. And so, the problem is if you drink and you take it, you can have a super hypotensive episode and pass out. So, we just really do women a disservice in that area. And I do think and I hope that there are more people– what the problem is this, testosterone to me is a serious business. It’s a controlled medication, it’s a controlled substance, but you have people abusing it. And just like these prescribing those pellets, and I think my fear is, is that the FDA is going to glom on to that at some point, they’re going to try to take it away because it’s being overutilized and used in a bad way. And so, my hope is that that never happens. But they’re already after bioidenticals as it is.

I am on some committees, we’re trying to make sure that that doesn’t happen. They’re going after compounding pharmacies because big pharmacy wants it. And so that will be horrible if that happens, but I hope it doesn’t, I hope women will rise up and counteract that. And they are they’re starting to do that, because I think finally, to me it’s misogynistic to say women don’t need testosterone. And that’s like probably one of the most misogynistic things you can say, because you have testosterone your entire life, and then all of a sudden you’re not supposed to have it. Oh, granted, it’s eight times lower than a male’s testosterone, but you still got to have it. I can’t tell you how many women I have seen where have just had a complete turnaround from a little dose to testosterone. And we’re talking about taking them from the basement of the house to the main floor, a little bit right. When I talk about hormones, I always say, normal or abnormal first, so you’re in the house or you’re not in the house, but if you’re in the house, most doctors will just say,” Oh, you’re fine, you’re in the house.” Well, if you’re lying on the floor in the basement or just your nose is poking through the cement, and you’re in the house that might feel like complete shit, but let’s get you up to the middle of normal. And that’s still normal. But for testosterone, a 0.2 to a 3.2, which is the middle of normal, that’s like a 15-fold increase. And I told a guy, I’m going to increase your testosterone 15-fold, they’d be like bring that on, you know I take that any day. [Cynthia laughs] But for women, we don’t even consider it.

Cynthia Thurlow: I think it’s a huge issue. The podcast that I was mentioning is the IF podcast and at the tail end, I was saying you’re never going to hear me say this, but I felt so impassioned to say, it’s the patriarchy, I said it’s two male physicians that told you that women don’t need testosterone and I’m here to tell you that every time I talk to a GYN, irrespective of their gender on my podcast, everyone talks about how important testosterone is and–

Shawn Tassone: Do me a favor.

Cynthia Thurlow: Yeah.

Shawn Tassone: Stop calling it patriarchy. [Cynthia laughs] I’m trying to change this.

Cynthia Thurlow: Yeah.

Shawn Tassone: Call it a doctorarchy.

Cynthia Thurlow: Okay, call it the Dr. doctorarchy.

Shawn Tassone: Because, who are the big people out there talking crap about hormones and bioidenticals. I won’t mention their names, but they’re all women, all of them. Well, there’re six of them. And they’re so brutal, I’ve had to block them because they send their armies after you. But it’s a doctor’s way of thinking, and it was patriarchy, sure and it’s filtered down. But it’s just that mindset that we’re smarter than you. We know more than you. You don’t know what you feel, you’re a woman and these are women telling women that, somebody tells me I used to think it was funny. But how women say to me, it hurts down there, I’m like, “Okay, I don’t know what it feels like and I don’t want to know to be perfectly honest. I don’t want to have a baby, but I know it hurts.” You know? And that’s the thing. I think you want to find that provider like you that doesn’t give you a hard time about ordering tests, because why? Why would I– I always love that when women go into get their blood tests or they have to– I want to do these tests and the doctors like “Nah, you don’t need those.” Why would you even who? just do it? I don’t lose money if I ordered tests and then just acknowledgment, we just don’t even acknowledge it, it’s just the same with thyroid. It’s the same.

Cynthia Thurlow: Ah, thyroid is a whole other bucket and I couldn’t agree with you more that, clinicians have to be open minded. We’re supposed to be lifelong learners. I certainly have learned a lot navigating middle age.

Shawn Tassone: Oh yeah, I still do.

Cynthia Thurlow: Yeah, I mean, I have a woman right now, I have a shared patient and she walked in and asked for fasting insulin, which is like a $12 test. And her doctor said, you don’t need this and she’s like, “Yes, I do.” And she explained why she needed it. And I said it’s a $12 test. I said if they don’t know how to interpret it, then I’m happy to look at if [crosstalk]

Shawn Tassone: You have to learn how to speak doctor, you don’t need it means, I don’t know what to do with it. That’s what that means. Like, I don’t want to order it because what if it’s abnormal, I don’t know what to do. So, that’s what doctors, it’s just deflection after deflection, it’s just like, they order TSH, and it’s normal. But I had a lady who had a normal TSH, which is for thyroid, but her free T3 was 2.0, which is hypothyroid. That’s actually hypothyroid, is the diagnosis. And they wouldn’t treat her because the TSH was normal. But she had every symptom in the book. And it’s like, so I give her thyroid and here’s what’s funny, “She thinks that I’m like this is genius and wonderful human.” All I did was listen to her and then replace what was abnormal. It’s not rocket science folks, but the doctor certainly make it out to be that way.

Cynthia Thurlow: Well, I think it goes without saying that a lot of patients are not feeling heard right now. If you have someone that listens to you, you definitely want to lean into that. Another area where there were a lot of questions were, “What do women do that are still technically fertile.” So, they haven’t gone into menopause. When they’re trying to navigate choices of contraception, let’s say they have a partner that’s not willing to have vasectomy. We’re going to touch on Essure, so don’t worry.

Shawn Tassone: Not if, not if, they don’t, men are babies.

Cynthia Thurlow: [laughs] So, what options are available? Because we just talked about how oral contraceptives are endocrine disruptors and I think a lot of women start oral contraceptives, maybe in their teens, early 20s. There’s a lack of informed consent. I certainly was on them for years. I had no idea what they were wreaking havoc on in my body, even down to impacting muscle development. I mean, there’s so many things or looking at lab work. And my women on oral contraceptives. They look like they’re in menopause. And so, they just don’t realize that’s what’s happening. What are some of your more common modalities or options you will offer women that are north of 35, not yet 50. They don’t want to run the risk of getting pregnant at that point in their lives.

Shawn Tassone: Well, I mean, first of all, I always go on record saying I’m not anti-birth control. I mean, I think for birth control they’re an option. I don’t like it when they’re used for everything else. Your car doesn’t start, here go on these birth control pills. [Cynthia laughs] But for birth control, but then like you said, let’s talk about what can happen to your thyroid, what can happen to your testosterone, blah, blah, blah, but that’s a woman’s choice and she should have that and there are options and there’re low doses. When I was in residency, they were 50 mcg pills and now they’re down to 10. So, they’re a lot weaker than they used to be. And there’s progesterone-only pills, Progestin, I should say. So, there’re options. I have a lot of women in Austin that don’t want birth control pills and that’s fine. I would always talk to them about IUDs. Now there’s only one that doesn’t have hormones and that is the Paragard, which is copper. Some women have a copper allergy or they have issues with copper. The problem with the copper IUD is that it’s bigger than some of the others. So, if you’re nulliparous and you haven’t had a baby or pregnancy, it’s harder to get that in sometimes. So, it may not be an option for some. There is Phexxi, which has been out for maybe a year and a half, two years. Phexxi just lowers the vaginal pH, which is actually an interesting way to do things. It makes it inhospitable for sperm and it’s not necessarily a chemical, it just lowers the pH.

Not as many women that use that, but I have some, the downside effect is you have to put it in about 30 minutes prior, it’s kind of a buzzkill. Condoms obviously, but they’re condoms that’s always an option. I always say the best form of female birth control is a vasectomy. But women don’t have control over that, per se, although they do actually have control over that, they just need to put their foot down on his penis [Cynthia laughs] actually that would be the best place to put it. And I just put this out there. I might sound like I’m a good partner, but I’ve been divorced. So, I’ve learned over the years, but this is if I’m being my patient’s advocate. And then finally, some of my favorite things out there are like, Daisy or iFertracker, those devices that actually– now they’re not technically for birth control, they’re for fertility tracking, but if you know when you’re ovulating, then you know when not to have sex.

And so, I will often have women, especially if they’re very, like excited about learning more about their bodies, and especially those younger, like 25-year-olds they really learn “Oh, I’m having pain well, oh I’m ovulating. Oh, yeah, that makes sense.” And my daughter, she’s almost 29 and she uses birth control pills. And it’s just her choice. She’s busy, she’s got a job, and for her they work, but she did just recently call me and tell me that her– she’s having heavier periods and they’re more painful. So now we’re working on like magnesium and fish oil and a lot of other things to help her rather than go up, I don’t want her to go up on the amount because she could go from a 10-mcg pill to a 35. But then you’re going to have more problems. And she just lost like 60 pounds doing intermittent fasting, keto, and working on IF:45. She put in a lot of work and she doesn’t want to gain weight again. And so, but yeah, I would say those are your options. I think for women that are wanting to learn a lot more about their bodies, those fertility trackers are quite excellent.

Cynthia Thurlow: I think it’s really nice that there are emerging options beyond the conventional options that I had during times of my life where I needed contraception, I needed reliable contraception and didn’t know what I didn’t know but now I do.

Shawn Tassone: [crosstalk] the birth control pill. I remember going to Planned Parenthood with my girlfriend and that was the only option you had.

Cynthia Thurlow: Yep. That was the only totally reliable option. Now on the other spectrum for people, if they have a partner or significant other or husband that’s not willing to get a vasectomy, there was a form of permanent sterilization that got a lot of press and certainly got a lot of focus. And so, the Essure device, which I know you’ve been involved in helping women have theirs removed. Let’s talk about that. It’s interesting because I pulled my girlfriends, how many of them had an Essure. And sure enough, I had a few, mostly the friends whose husbands weren’t willing to get a vasectomy and it allowed them to have a permanent form of birth control, but not without side effects. And would you be comfortable talking about some of your experiences as a clinician helping women navigate choices after they’ve had this place when they come to you for support?

Shawn Tassone: So, how much time you got?

[laughter]

Shawn Tassone: Essure came out in 2002, it was FDA approved, basically consisted of a little inner rod, a straight rod with a coil around it that you would put into the fallopian tubes, but you did it, and this was the genius of it, was through the vagina, so there was no cutting. Before, if we did tubals, we had to either do it at a C-section or we would have to put a camera in the belly button and burn the tube. So, it was a surgical procedure. And this could be actually done in the office. And actually, for years, it was like the holy grail of birth control. So, we’d been waiting for something for decades and it finally came out. So, doctors were super excited and sure enough. The company that invented it was called Conceptus. They were bought out by Bayer and then they dissolved and went away. But the device is covered, unfortunately, with a lot of chemicals, polyethylene terephthalate, which is like polyester, Titanium, nickel, stainless steel, a couple of other things, and the reason that it worked, you put the coil in there, and then over three months, what would polyester do? Well, it causes inflammation, so it would get inflamed and your fibroblasts and your white blood cells would come in and that inflammation would lay down new scar tissue and it would close the tube over a three-month period. Okay, sounds amazing. And it was and the data that we had given to us by the FDA when it was approved, there were no pregnancies and very minimal complications. Now as I got deeper involved in the backstory and I’ve been to the FDA two times to speak against the product before it was removed from the market in 2018. I met a woman who was in that pilot study, so the pilot study comes before it gets approved. So, what they did was, this was back in the days when we didn’t have great computers, so it was all paper. She got the estrogen and she had to fill out, do you have side effects, heavy periods? Well, on pain and periods, she put yeah, 10/10 pain, 8/bleeding.

Through the Freedom of Information Act, she got back her results and the nurse on the phone wrote a line through the 8/10 and the 10/10 and put no pain. So, [unintelligible [00:25:19]. And so, it was basically fabricated, just like any– You got a medical device, they spend millions of dollars on this device, and then they do their own study to see if it works. That’s the major flaw with this, so they’re not going to say it’s horrible because they’ll lose all their money. So, and I’ll be perfectly honest, I probably put in about 100 over 2004 to 2006 and then I moved in 2013 to Austin and I had a patient. This was the last one I put in, I put one in. And about three months later, I had a doctor from Virginia call me and say “Hey, I just saw this lady, and she’s pregnant, and I was like, “I’ve never had that happen before.” You know you’re not supposed to have any pregnancies. So, I started looking it up and I found this Facebook page of like 4000 women that had Essure and they were having complaints, bleeding, pain, they were having autoimmune issues, they’re having joint aches and fevers, all this weird stuff, hives and all this stuff. Now I went in, I’ll tell you, I went into it skeptical and luckily, they didn’t kick me out of the group, now that group is like 50,000 women. And what happened was I took one out and then I took another one out and I started seeing these amazing results like a lady that had had six years of a body rash everywhere, she has had a biopsy, she seen six dermatologists, nothing helped. I took the coils out, 12 hours later the rash was gone and never came back.

I had a woman who had no platelets, was seeing an oncologist because they thought she had cancer. And the oncologist finally said to her, “Hey this was last year, why don’t you get these things taken out, we’ll just see platelets come back to normal.” I’ve just been seeing all these weird, amazing results. Some of them were put in wrong, they’re poking out. I had a woman come in and she pointed right here and she said it hurts way up here by her stomach and the doctors like oh, okay, she pointed to it and he did an x-ray and that’s where the coil was, it was way up there. And he still said, “Oh, that’s not causing you problems.” I mean it’s like she literally pointed to the spot. And so, I’ve probably taken out about 1000 now and it really opened my eyes to medical devices. This made me super skeptical about it and I was always not blindly following, but I trusted, you know, you have to, to some degree. And so, it really changed my mind. And it’s now gotten to the point where they pulled from the market in 2018, Bayer settled for $600 million which to them is nothing. And it’s no longer being put in, but because we put in over a million, there’re still women out there that are, I probably do 15 a month, I’ve to still remove, I’ve women come from around the country. And my thing is you can only have them removed the right way, one time. And what happens is doctors will cut the tubes open and they’ll pull them and they snap and they break. And so, I’ve had so many women come in with pieces. And now that’s what I’m seeing because doctors are trying to help which is great but they’re just doing what they think is best and they have never removed one. So, it’s been an interesting ride, I got fired from my job, basically, because of it. I was in a big group. And they were still putting them in and I was taking them out which I didn’t have a problem with. But they told me I needed to stop and I didn’t. I think it contributed a little bit to my divorce. But because she’s an OB/GYN and we were in the same group and it was causing a lot of strife. And I just saw the writing on the wall and I left, but to be perfectly honest, I’ve been in practice now since 98. And this by far has been the most rewarding thing that I’ve ever done. And that’s why I keep doing it because I’ve endured a lot of pain myself, but I see the result. It makes me feel good.

Cynthia Thurlow: Well, thank you for the work that you’re doing with women, you’re helping to change lives and for anyone that’s interested in learning more, there’s a really great documentary called Bleeding Edge that I’ve now watched twice so that I could be fully informed and the amount of suffering that women have gone through in response to having this device put in, it was interesting. There were people that have perforated uteruses, chronic pain.

Shawn Tassone: I have tons of pictures. Yeah. Let me shout out Angie, Angie Firmalino, the lady that is the main lady in that movie. This all started because of one woman, she formed a Facebook page because she didn’t know what else to do, she had fibroids and an Essure and she had a hysterectomy. And when they did her hysterectomy, that was back when we were doing morcellations where we would put a device inside there that would cut the uterus up into small pieces, while they basically shredded the coil and spread it everywhere. So, it was kind of having just little pieces of metal all over your body. And at that point, nobody could fix it. And so, she just did this. I mean, just to show you the power of one person, she brought down Bayer and made them pay $600 million. I mean that’s pretty impressive.

Cynthia Thurlow: Pain purpose. And I think that on a lot of levels, it goes back to what we were originally talking about that, ultimately, we’re here to serve women, and we’re serving women in different ways but the power of one person is undeniable, and I’m so very grateful that it’s now off the market. And for anyone that’s listening to this, if you have Essure and you’re looking to have this removed, we’ll make sure that you can reach out to Dr. Tassone after this podcast.

Shawn Tassone: Yeah, because just like everything else, women do go to their doctors to this day and they’re told that doesn’t cause any problems. The gaslighting is still pretty impressive when it comes to Essure.

Cynthia Thurlow: Yeah, I think there’s a degree of cognitive dissonance in medicine that, this is the segue into talking about why are so many GYNs burned out or just healthcare professionals, especially given the pandemic. Why do you think so many GYNs in particular are not staying in their practices or they’re pivoting and doing functional medicine, integrative medicine, stopping the OB portion, probably because it’s hard to stay up 24 hours a day and deliver babies seven days a week.

Shawn Tassone: So, here’s the first thing, no doctors are starving to death. Let me just put that out there. However, it costs me, I don’t do OB anymore, it costs me $28,000 a month to just run my office, that’s not even paying myself, that’s paying my employees and running everything. And so, I’ve got to generate $28,000 a month to pay my bills. And then I got to make money on top of that for myself. So, the reason that I think a lot of people get burned out is because like, there’s a friend of ours in town here, and she’s functional medicine, and she obviously charges cash. And she will call me when she can’t figure out the hormones, and I’ll see the patient and I’ll get at $85 you know. So, it’s like, I got to see volume to pay my bills to cover that. And the problem is not only am I burned out, but my patients don’t like it either. They don’t like it. They want to spend time with me. So, it makes sense. And this has only taken me probably 10 years. But I’m starting to switch over to a hybrid model that will probably roll out at the end of the year. Because it’s not about greed, I want to spend more time with my patient, I would love to spend an hour with somebody, but I can’t bill for an hour, I can’t do that. There’s no insurance code for that. So, I want to spend more time but I’ll give people the option if you want to use your insurance and you’re okay with the 15-minute visit, then, by all means, let’s do that. But I also feel like me as a learner. If I learn some stuff, like right now for me, I’m just starting to get into– I’ve been in integrative medicine since 2007. But I’m still just trying to figure out gut testing and learning about that because it’s taken me a long time to go so deep on the hormones, but now I want to learn about gut and genetics. But in order for me to do that, I got to have time and I got to be able to spend time with patients coming up with plans and stuff. The burnout happens, my ex is 56 and she still does OB, she probably does, I think she sees 50 patients a day. I mean, it’s just, you can’t do that. It’s horrible and it’s not that she’s greedy, people want to be seen, they want to get in. I’m even booked out now for probably a month or two. And I always feel guilty about that. Like, I’d like to see more people and I think also I do feel like if people spend money and this is me included, I am the world’s worst patient.

But our friend, Tracy Gapin, he does men and so, I knew that if I paid him, that would leverage me. So now, I’m invested, so I think it’s part of it too. It’s like “Okay, I’m going to do this for myself” that’s self-care, right. But the docs are burned out, because, here’s the deal, I figured out if I charged what I bill insurance, so when we bill insurance, we don’t get paid that we get paid what they want to pay us. But if I just got paid what the insurance companies were supposed to pay me, I could see half as many patients and double the revenues to my office. Well, it’s not like I’m going to go by a yacht, I’m going to spend more time with patients. And so that’s the thing like I said, we’re not starving to death, I’m fine, but I could sleep a lot better, I could bring that– I had a patient say something the other day about how I didn’t seem like I was in a good mood. I think it was because I had a migraine or something. But yeah, we all have off days. But I think when you’re burned out, your off days probably are a lot more frequent than if you were happy and you enjoyed coming in. And you’re seeing it all the time. I think the reason doctors are going to functional medicine, integrative medicine is because they’re seeking for themselves. The brick on my head was my mom’s death and how I couldn’t help her as a doctor, I was like, “I don’t know how to help my own mom, for Christ’s sake, how am I going to help my patients?” And that pushed me. I think we all have some sort of catalytic event that moves us in that direction. And for some, it’s like, they wake up and they look in the mirror and they’re like, “Who the hell is that person?” I look 10 years older than I am, I’m eating crappy, I’m not working out. I’m a hypocrite because I’m telling my patients to do all this. And I think that’s sort of a– it’s not the money, for some it probably is.

But for most of us, like you said, we really want to help people. I don’t want to put women on birth control pills, if they’re bleeding, or if they’re having hot flashes, or their thyroid is not working, I want to figure out what the hell’s going on. That’s why we go into this. That’s why, you wanted to help people. And you have an investigative mind. It’s like a joke, it’s like NCIS for the body. It’s like we want to figure this out. But how deep can you go? Well, that just depends. I mean, okay, “You have abnormal hormones.” Well, what’s causing the abnormal hormones? Is it your genetics? Is it your gut?” I mean, so many options. And it’s fun, I think. I think it’s fun. For me it’s like, I feel so good when I learned something and then I translate it into my practice and people get better. That’s great. It’s so stagnant, I’m just thinking about the old ways.

Cynthia Thurlow: Well, and I think that lifelong learning, I think for any clinician is really critically important. I always tell my kids that I’ll be learning till the day I die, I think that innate curiosity is what distinguishes good clinicians from mediocre ones, wanting to learn more, to understand more, to evolve from where you are. Now, you touched on thyroid health and this is always a popular topic for us. In your clinical experience, are you using a lot of compounded thyroid medications? Do you feel like that’s more efficacious? I feel like the Nature Throid, Armour Thyroid, I’ve seen so many patients over the past two years that struggled to get pharmaceutical agents that are uniform and not having recalls. I know there are certainly people that do well on things like Synthroid and Cytomel. I know that bio individuality plays a large role, but are you using quite a bit of compounded medication or just the traditionals?

Shawn Tassone: I probably use about 90% NP Thyroid which is in that same aspect with Armour. The problem that you have with the desiccated thyroid products is they actually make good products. And part of that is they have to have consistency. So, if there are two standard deviations away from what it says is in the pill, they have to recall the law. I haven’t seen a recall in a couple of years but it happens every once in a while. And it’s usually because there’s not enough, it’s not because it’s over. It’s usually just it’s not enough. And so there wouldn’t be any harm in it, but they’re being open and honest with their patients. And I think that’s great. I find that a couple of them have gone off the market Nature Throid and WP Thyroid have disappeared, so you got Armour and NP. I’ve started doing the compounding, again compounding thyroid is a learning curve for a doctor and you have to figure it out. And it depends, it’s funny because NP Thyroid sometimes it’s 5 bucks, sometimes it’s 125 bucks. So, I have to play with the insurance. If it’s super high expensive then I’ll go compounded because it’s $45 somewhere around there and it’s the same stuff or I have used Synthroid and Cytomel for people that want to use their insurance. So, it just depends, but I’m a huge fan of the desiccated thyroid.

Cynthia Thurlow: Yeah, it’s interesting. I think fellow listeners are probably pretty familiarized, I was on Nature Throid for years. And then two years ago, they did away with my dose and then to never come back again. And so then started the journey of every other desiccated product, then on to synthetics, and then I started seeing a mutual friend of ours and he said you have the most interesting thyroid panel I’ve ever seen. I said I don’t want it to be interesting, I just–

Shawn Tassone: Sounds, like something Alan would say.

Cynthia Thurlow: Actually, it was Aaron Hartman.

Shawn Tassone: Oh, Alan, that sounds interesting but yeah, that’s good, somebody out there that’s helping.

Cynthia Thurlow: Yeah, so now I’m on compounded, but every two weeks I get labs drawn. So, the reason why I’m bringing this up is so people understand there are multiple options, but also understand that it can take a while to become therapeutic. Like I have not been therapeutic on medication for over two years. I’m hoping, I’m like crossing my fingers that my free T3 which is my active thyroid hormone will hopefully be within range. We’re getting very close, I’m like, this is good, I can sleep and my thyroid is finally [crosstalk].

Shawn Tassone: And how many women do you see that are on Synthroid?

Cynthia Thurlow: And they were so good.

Shawn Tassone: And I always say that’s like saying because T4 which is Synthroid is the storage hormone and T3 is active so having a nice T4 I always say is like, man, you got a million dollars in your bank account, but you can’t spend any of it. [Cynthia laughs] It looks good on paper, but you’re broke. And that’s exactly what it is. And so, what are we going to do? Well, let’s put more money in your bank and tell you still can’t spend it. I don’t understand the theory behind that. But that’s the endocrines notoriously don’t use T3, they hate the desiccated products. But luckily, I have a woman here in town that is endocrine and she’s all about it. So, I can refer to her sometimes. But I mean, how many times have you had it happen where you’ll get this patient happy on a desiccated product like Armour and NP? And then she goes to her endocrinologist and they take her off of it. It’s like six months down the tubes because they just didn’t believe in what is going on? And I am like, how can you not believe in it? It’s there. It’s real, it’s not like a ghost, you know? But it’s a weird thing.

Cynthia Thurlow: No, it’s interesting, that’s definitely one of the specialties that I would say when I talk to colleagues who are endocrinologists that they’re still focusing on studies from the 1950s with some concern about desiccated products, and I always say, the patient and how they feel is what’s most important, even if the labs suggest otherwise.

Shawn Tassone: I have a thyroid surgeon who is a friend of mine, drew her labs, same thing. TSH is fine, free T3 below normal. She said can you put me on NP Thyroid and I said, of course. And she said because I have two friends that are endocrinologists, and they laughed at me. And she’s a surgeon, she knows what she’s doing. So, I put her on it and she felt like a million bucks, and she’s like, I’m not even going to tell my friends that I’m on it because they’re going to give me a hard time. And I said that I just don’t understand that if you feel good why wouldn’t they say, “That’s amazing?” But that’s what we run into all the time.

Cynthia Thurlow: Yeah, it’s the cognitive dissonance that for a lot of medical professionals I personally find really frustrating. Well, let’s talk about your new book, Hormone Balance Bible. It’s definitely got a unique lens. I like the arc types. Let listeners know what was the impetus for your new book, which I really enjoy.

Shawn Tassone: I don’t have a poster, so I’m going to–

Cynthia Thurlow: [laughs] I have a poster.

Shawn Tassone: See, some people have cool posters, not me.

Cynthia Thurlow: No, you got the great, it looks very lush behind you, so tell me about your book.

Shawn Tassone: So, I mentioned it briefly. But after my mom passed away, I went on this little spiritual journey. I was 32, I was just barely into practice and I couldn’t, when your parent dies, you go, you know? So, I was on this little journey and as you do when you have a spiritual crisis, you go to Sedona. [Cynthia laughs] So, I went to Sedona and I was reading this book at the time by Andrew Weil called Eight Weeks to Optimum Health. And at the time he was talking about this crazy stuff like fish oil and CoQ10. And I was like, my mind was exploding. And luckily, his fellowship was in Tucson where I lived at the time. And so, I did the two-year fellowship and then just I had to go on even more and I did some mind-body medicine work and stuff. And I started reading a lot of Caroline Myss and Sally Hogshead and Archetype Jung. And I just found that stuff really fascinating. When I talked about hormone imbalances with women, sometimes I would just get that glassy look like, okay, whatever. But if I talked in stories, like, “Oh, your thyroid is low, well, that’s an underdog, you’re not living up to your full potential and I’d start describing it, they would be like, bam, bam and I was making this connection.”

So, I’ve been doing that for years. And so, I’d had the idea of trying to put the top 12 of those archetypes or storylines, hormone imbalances into a book, and I came up with a quiz. So, for women that are bored at midnight or whatever, they can take this quiz, and it just gives you a little bit of a starting point because nothing’s better than actual testing. But it just sort of happened. You know how we’re in that group, Mindshare, and I was out here in Austin, and one of the ladies in the group was out here and she said, “Hey, you want to grab dinner?” And I said, “Sure.” Can I bring a friend? And I said, “Oh, yeah, that’s great.” And so, he is a guy, he is sitting next to me. And she’s like, “Tell him about your book.” And so, I was like, “Well, you probably aren’t interested because you’re a guy.” But I told him about all the archetypes and said and he’s like, I want to buy it. And I said, “Well, I haven’t even written it yet.” And he’s like, “No, I’m an agent. I want to mark– I want to sell it for you.” And that started a year-long process. And so, then he got the book deal and then write the book as you’re well aware. And what I have found is that I’m meeting so many great people, yeah, it’s funny, because, you’ll get a couple of negatives here and there, but for the most part, so many women are just like, it’s weird when I was recognized at a restaurant the other day, I didn’t even know what to do. I was like, some lady came up, and she’s like, “I have your book and I’m like, Oh, my God.” Okay, what do I do? It’s like, you want me to sign your breasts? I don’t know what to do. What do I do? But no, it’s really been a great journey for me too because it has kept me in contact with my mom. It sounds cheesy, but every time I help somebody, I feel like I was able to help them because of her. And, it’s a lot of work. It took me 15 years to get where I’m at. But for me that’s why I think it’s especially rewarding is because– and it’s not like its junk science.

Our colleagues out there that are dyed in the wool, allopathic, whatever, they don’t think hormone imbalances even exist, which makes my whole book garbage because it’s called The Hormone Balance Bible. But if your doctor ever says to your hormone imbalance doesn’t exist but they give you a birth control pill for PCOS, what are they treating? And I always ask that question. Obviously, you’re treating hormones because you’re giving a hormone. And it must not be balanced or it shouldn’t be. So, it’s like, they just talk out of both sides of their mouths. And so, here’s the thing, hormone imbalances do exist. However, sometimes they’re normal. Puberty, pregnancy, menopause, sometimes in your menstrual cycle, they’re not in balance, but they’re supposed to be that way.

When I think that it’s a problem is when it’s interfering with the way that you want to live your life. If you are taking a nap at 4:00 o’clock if you are gaining 15 pounds that you just can’t get off. If you can’t sleep, if you’re sex drive is gone. Yeah, that’s a problem. It’s like blood pressure, it’s like we wouldn’t just tell you to leave if your blood pressure was high and we shouldn’t be ignoring this either.

Cynthia Thurlow: I think it’s really important for people to be reassured that there are a lot of things that impact hormone balance and your quiz is really fun. I took it through the lens of how did I feel before I started some hormone replacement therapy, and I ended up with a nun which I thought was hilarious.

Shawn Tassone: So, the nun has testosterone deficiency and obviously good nuns don’t have sex, [Cynthia laughs] but I also joke you don’t want nun and you ain’t getting nun.

Cynthia Thurlow: And so, from the lens of low libido, which is probably the most common symptom other than weight loss resistance. But your SHINE protocol is focused on spiritual practice, hormones, Infoceuticals, nutrition, exercise, and supplements. And this is my segue into, “Do you have favorite supplements you like to use in this protocol?” I know there’s a lot of bio-individuality, but I’m just curious as someone who recommends supplements on a nearly daily basis.

Shawn Tassone: I did a podcast on the top 10, but I think you know who’s going to buy 10 supplements. First of all, when I do supplements, I’m a person that likes to go– I’m not a huge proprietary blend person. I like just magnesium rather than a [unintelligible [00:47:39] formula, I’m more of a purist like that. But I think that if I had to pick three, I think most women across the board would benefit from, magnesium glycinate, a good fish oil, high-dose fish oil, or flaxseed oil if you don’t like fish, and maca. I think those three things are essential for even young women, women on birth control pills, women on hormones, women in perimenopause. Expanding from there, that’s when I get a little bit more into what is the problem like if it’s an issue with detoxification with your estrogen, maybe activated B complex vitamins. If it’s a progesterone thing, sometimes vitex or chaste tree, testosterone, boron, zinc, you can try things like Tribulus Terrestris or Yohimbine, but those you got to watch blood pressure and stuff like that. So, there’s always, always options. And for people, the Infoceutical I had to get an eye. Infoceuticals are things like what translates information to your body, acupuncture, essential oils, for those that like doing reiki or healing touch. I did some background on that. I’m a Level 1 Healing Touch practitioner, which I don’t know exactly what that means. [Cynthia laughter] But yeah, so there’re a lot of options and only for the hormone part, do you need a physician, the other ones you can do on your own.

Cynthia Thurlow: And I think that’s an important distinction because many people don’t actually understand there’s a lot of foundational work that you need to do in conjunction with considering hormone therapy with your healthcare professional. And what would you say– are their supplements or are there tests that drive you crazy? Like a patient comes to you and they’ve got a bag of supplements. It used to happen to me a lot, like patients would bring a bag in cardiology of 20 or 30 supplements that they were taking on top of their 20 to 30 medications, cardiology is not exactly the healthiest patient population, but there are ones that drive you crazy that are like button pushers?

Shawn Tassone: Well, I think back in the day when Oz was really promoting stuff, like the green coffee beans and stuff. The Fly By Night supplements that, when the claims seem too big, they usually are. I think, testing there’s a few tests, when you get testosterone checked to make sure they get free testosterone, not just a total. And I would definitely– this is debatable, but I’m not a huge fan of testing reverse T3. It’s getting nitpicky. But I also think we shouldn’t be testing antibodies on the thyroid for most women. I don’t think we use FSH and LH enough, but those are your pituitary hormones. And we don’t look at prolactin enough either. But as far as supplements go, the problem that I have with supplements, you’ve just been going around the world, in a country like Germany or France, supplements tend to be prescription only, like it’s not like you can just go by them. And that just tells you they have powerful effects.

Cynthia Thurlow: But I think that using things as a guest or because it worked for your friend isn’t always the best way to go. The problem is and I know this is who you talk to, especially now, TikTok and all these trends and stuff, you never know what you’re getting into. And that’s why I think it’s good to have a few people that you follow, like you or me, or some of our friends out there that are really just talking about things on a level where, if there’s a guy, we both know, he cracks me up, but he’s just getting into this stuff. And he’ll talk about his supplement line. And I can tell he doesn’t know what he’s talking about. He wants to, but even I don’t, you got to know like, I like products out there called Zyflamend. It’s anti-inflammatory, curcumin, holy basil, rosemary, and stuff like that. But I can tell my patients why it works. Because I’ve had time now to dig into it. I just had a lady, well, “I need to be on B12” and I’m like “Why? And she goes “Because I’m tired.” Okay, well, “Where did you even hear that?” Because, oh, my mom does a B12 injection every month or something. Well, let’s figure out maybe you’re tired for another reason. But that’s the thing I think that bothers me the most is that people spend first of all gobs of money on supplements and a lot of those things overlap. There might be magnesium in four of the things you’re taking and you’re taking magnesium. So, that’s why I’m a purist rather than– the only supplement I use that has a lot of things in it is Zyflamend. Most of the others, like say a woman who has heavy periods. I always tell women that have heavy periods to get a product called Yarrow, which is a flower, Yarrow flower and it works like tranexamic acid, which is a prescription that has a lot of side effects but it really slows down bleeding. And it’s like $9 or for sleep, I like to use Hops. I’ve gotten women off of sleeping medication with Hops before. And so, I think my problem is multiple proprietary blends because the proprietary blend means they don’t have to tell you exactly like the amounts. And so that’s where I have a problem and mostly just knowing why you’re taking it not because your friends take it, but why are you taking it?

Cynthia Thurlow: That’s such a good point and it’s ironic that I take a couple of different things to help with sleep, magnesium, L-theanine, GABA, and they’re all by themselves and I agree with you. And sometimes when I’m making recommendations to clients, I’ll say to them, we’re going to use these separate entities because if something doesn’t work or something causes the side effect, I don’t know what’s causing a side effect if you’re on a blend– [crosstalk]

Shawn Tassone: So, try Nature’s Way Hops 600 mg. It’s like $12 on Amazon. I’m going to be so rich. [Cynthia laughter] $12. No, it works, it’s amazing, and it’s been used forever. But I don’t know, I can’t quote for you the exact mechanism of action right now but it does work. And I get women off Ambien all the time.

Cynthia Thurlow: It’s like talking about benzodiazepines like Valium, Ativan, and Xanax. How many of my patients are completely addicted to that or Ambien or both?

Shawn Tassone: Well, but they only take half of the pill a day, I hear that I’m only taking half, and I’m like, Okay. [Cynthia laughs] Only half as addictive, I guess, I don’t know.

Cynthia Thurlow: When I was a new nurse practitioner, I really struggled with sleeping because I was constantly worried, I’d made a mistake– [crosstalk]

Shawn Tassone: Oh yeah, that still happens to me.

Cynthia Thurlow: Yeah, yeah, imposter syndrome when you’re new at something. And I remember my well-meaning primary care provider gave me Ambien which didn’t help me sleep. It made me feel groggy.

Shawn Tassone: Let me show you the back of my computer.

Cynthia Thurlow: Oh, Imposter Syndrome, I love it.

[laughter]

Shawn Tassone: As you are speaking, I put that down there for a reason.

Cynthia Thurlow: Yes, now we are all constantly fighting those inner demons. Well, I could talk to you forever.

Shawn Tassone: Yeah, it’s been fun.

Cynthia Thurlow: I had a bunch of other topics that we could have touched on. Please let my listeners know how to connect with you, how to find your amazing book, how to find your new podcast, which I’ve been very fortunate to have been a guest on, how to connect with you on social media? And I always appreciate and value your transparency. I think that it’s so refreshing. There’re a lot of clinicians that aren’t that way. And I think it allows, potential patients or patients to feel like we’re real people.

Shawn Tassone: Well, thanks. I think that you and I have a really great connection and the fact that we are able to share, mastermind together and I’ve been able to watch you basically explode has been great. Instagram obviously @shawntassonemd appointments, Dr. Shawn Tassone or you can call my office at 512-956-0296. I still take insurance. But like I said, I’m going to be switching the model. I have a Facebook page, which is again, my name, you can see a consistent pattern here. The book is on Amazon, actually interestingly enough, the book is $28 but for some, I don’t know how, but the last month it’s been on sale on Amazon for $9.45 The Hormone Balance Bible and also with regards to fasting because that’s what you have in the background. I think every woman benefits from fasting. I don’t buy into this. It’s bad for some because like you say you’re talking about 12 hours a day. It’s not you’re not eating. And I have so many women that just get so much better, bloating, weight gain, pain in their pelvis. I mean it’s amazing to me what just not eating for 12 hours can do.

Cynthia Thurlow: Well, thank you. Ironically, I think we’re referring to a post that Dave Asprey had talking about women and fasting and there were the fearmongers kind of swooped in.

Shawn Tassone: I might have responded to a couple of them. But the more I do that the more haters I get, so I try to back off a little bit. But yeah, anybody, I’m around, I’m on the internet. I like to have fun and actually coming up because it’s Halloween, I’m actually going to be a female gynecologist.

Cynthia Thurlow: I love it.

Shawn Tassone: So, I’m going to dress up like a woman and I’m going to have all the makeup and everything and I’m going to interview some patients. So, we’ll see how it goes.

Cynthia Thurlow: Well, I think that’s fantastic. I can’t wait to see that. Thanks again.

Shawn Tassone: Thank you.

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