Ep. 282 Thyroid Health: Hormones, Medications & Weight Loss with McCall McPherson

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, is 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.
Today, I had the honor of connecting with a friend and colleague, McCall McPherson. She is the visionary behind Modern Thyroid Clinic, a thyroid centered functional medicine practice in Austin, Texas. She is also a former TEDx speaker and thyroid expert. She joined me today to dive deep into her background and spend a good amount of time differentiating between Graves’ disease and Hashimoto’s, how to address, treat, and provide lab work support for each of these diagnoses. We discussed specific treatment recommendations. We spoke about disordered eating, yo-yo dieting and the starvation diet mentality. The importance of metabolic potency, the impact of synthetic oral contraceptives, hormone resets, informed consent, as well as hormone replacement therapy. We talked about strategies including low-dose naltrexone, GLP-1 agonists, fasting, fear of food and over restriction, and the impact of weight loss resistance. I hope you will enjoy our conversation as much as I did recording it.

Welcome McCall, I’ve been so looking forward to this conversation. I think we’ve been trying to make this work for like, two years. [laughs]

McCall McPherson: I’m so glad we finally made it happen. We arrived. [Cynthia laughs]

Cynthia Thurlow: It was meant to happen. That’s the really exciting thing. So, share with my listeners a bit about your background. I think many people think about you in terms of focusing in on thyroid, but it’s my understanding that your medical career actually started in a different specialty. So how did you make your way to thyroid health?

McCall McPherson: Gosh. You know by way of a couple modalities. The first, I graduated PA school a long time ago, thought I had my dream job in neurosurgery and absolutely found myself unhappy in medicine. I literally told my parents at one point; I’m going to go become a general contractor–

Cynthia Thurlow: Oh, no. [laughs]

McCall McPherson: –and quit this whole medical thing altogether. So really quickly, I realized I would have to distance myself from my patients because I couldn’t handle the pain that people were dealing with. I wasn’t called to that. So, I’m like, either I have to create a barrier or I need to move specialties. And I moved specialties to psychiatry, I did that for several years and I loved it. Found myself in integrative and functional psychiatry, digging deeper into people’s driving root cause of psychiatric conditions. And then a few years into my practice, I noticed like, 80% of the people that were coming to see me were coming for thyroid disorders. And I was like, “How are you hearing about my thyroid treatment?” Like, I was never advertising myself as that. Over and over and over, I got the same answer, which was, I found your name on patient forums. I did a ton of research, and ultimately, I had treated enough people for treatment resistant depression that actually had a thyroid condition. That they took my information and they spread it all over the Internet and built an entire thyroid practice for me without me knowing. And I’m like, at that point, after my first out-of-state patient flew in, I was like, “Think I might be in the wrong specialty.” [Cynthia laughs]

I think falling is this whole other thing. I was in passion for it. I was a thyroid patient, which really is what started my journey to become a thyroid expert, because I couldn’t get my thyroid problem solved. And I was 27 and going to bed at 3:30 in the afternoon every day. So clearly this was my path, and now I get to give people their lives back after getting my life back from a thyroid problem. So, it’s a win-win for everyone, really.

Cynthia Thurlow: Yeah. I knew about the neurosurgery. I did not know that you were in clinical psychiatry for a period of time. That’s really interesting. And yet you were seeing refractory depression and realizing it was untreated hypothyroidism I would imagine. And it’s interesting to me because my listeners know me, my background is ER medicine in cardiology. I’m an adrenaline junkie. But how poorly we treated thyroid health issues, even in– well, in the hospital, it was either an emergency or it was just a stable, chronic health issue. But how insensitive I think many of us are to thyroid health issues until the pain to purpose. I developed Hashimoto’s, and it was very humbling when I would talk to practitioners and they were like, “Cynthia, you’re in your 40s. You put on five to ten pounds.” This is just the way things are. I think just hearing that got me so, I guess focused on ensuring that other people didn’t continue to hear that rhetoric, which I think can be very inflammatory and, in many ways, unmotivating for patients. When they hear that, they’re like, “Well, if my doctor, my PA, my NP are telling me this, then maybe this is just the way things are.”

As you made that kind of arc from clinical psychiatry to really this burgeoning thyroid practice, do you have an equal mix of patients with Graves’ disease and Hashimoto’s? Because this is like a personal statement. I just had a podcast that came out focused on Hashimoto’s. First one I’ve done solely focused on that. And I had so many women saying, can you please do a podcast talking about Graves’ disease? Because no one’s talking about it. And before we started recording, you admitted that it’s a really underserved. Like, thyroid disorders are underserved to begin with, but even more so for people that are dealing with an autoimmune hyperthyroidism, so an overactive thyroid. So, in your experience, is it an equal amount of patients that you’re seeing or do you see more Hashi’s over Graves or is it just an equal amount.

McCall McPherson: It’s 100 to 1, I would say. [Crosstalk] I see 100 Hashi patients for every Graves patient, which I think is why there’s a disparity in access to information and the progression of treatment in Graves’ disease. But the severity of these poor people, I mean, the severity of Hashimoto’s and hypothyroidism is absolutely debilitating. But Graves has just expanded exponentially on that and they really truly suffer. And the standard of care treatment lacks so much for them that they need access and information to help progression.

Cynthia Thurlow: Yeah. And so perhaps for the benefit of listeners kind of explaining what Graves is, it’s not just hyperthyroidism, but it’s kind of the extreme symptoms. So, these are people that could probably be treated for anxiety, they could probably be treated for chronic diarrhea, they could probably be treated for an inability to sleep, very likely with medications that are not helping the thyroid issue.

McCall McPherson: Yeah. It goes back to the same to the psychiatry piece. And a lot of thyroid patients do end up in a psychiatric office being treated for something that isn’t going to help them. So, Graves’ disease is an autoimmune condition where your body attacks your thyroid gland with different antibodies and it triggers a hyperthyroidism. But even more than that, so the symptoms are like anxiety, palpitation, sweating, weight loss, hair loss, sleeplessness, shaking, restlessness. It’s super common that I see postpartum for women especially, they go into this transient Graves state. So that’s definitely a time to be attuned. But the most difficult part about it too is it creates this instability where people will be really hyper and then they’ll crash and be hypo and they’re strapped into what I call this Graves roller coaster. So as soon as you finally might make it to the doctor to talk about your symptoms, they could have completely flipflopped and you’re just up and down. And it really does take an unique advocate for yourself, because the first line, the first thing that you’re getting worked up for will not be Graves’ disease. It’ll be one of the last.
Cynthia Thurlow: No. And so, in terms of a traditional allopathic lens for Graves, let’s talk about that combined or in contrast to a more functional, root-based approach, because they’re so significant. I saw a lot of Graves’ patients who, much to your point, they would be hyper and then the treatment for Graves would make them hypo. So, they would go from one extreme to the other. And I had patients, especially females, telling me, “I feel like I’m losing my mind.”

McCall McPherson: Yeah.

Cynthia Thurlow: Because they would go from one extreme to another. And it wasn’t because they weren’t being compliant with treatment. It was just the way that they go about treating Graves here in the United States.

McCall McPherson: Yes, absolutely. So that is the biggest struggle with Graves’ disease, is the standard of care approach is one, diagnostic, often, they just check some thyroid function labs, very limited ones, so they don’t get clarity if these people truly are hyperthyroid. They’ll check maybe TSH and T4, which again, paints this small picture that isn’t clear. I’ve seen people that transfer to me from an endocrinologist that say, “My endocrinologist told me I may have Graves’ disease, but they’re not sure.” Well, this is a finite differentiated medical problem that can be black and white diagnosed, and people need a full thyroid panel and then antibodies for Graves’ disease. So of course, I would categorize that as being in the allopathic model, but those are thyroid stimulating immunoglobulins and thyrotropin receptor antibodies. So, people need that full panel along with free T3, free T4, reverse T3, TSH. And so that is kind of the standard diagnostic approach with a more limited kind of algorithm. But the treatment is where it really starts to fail these people. And it is exactly what you said.

We really just want to make sure you’re not hyperthyroid. So, we are going to put you on methimazole, PTU, something to shove you down into a hypothyroid state because our priority in medicine is protecting people from acute medical issues like heart attack, stroke, that kind of thing. They have no problem allowing these people to be hypothyroid. And for all of you hypothyroid listeners out there, you know how miserable that is. And this is really where, in my opinion a functional medicine and integrative medicine approach shines. Especially, at Modern Thyroid Clinic, we have a super unique approach. So, in part similar to Hashimoto’s, we’re actually trying to reduce Graves’ antibodies measurably, with that takes the roller coaster from extreme swings of high and low to the lower their antibodies get, the less the swings and the less frequent, and severe the roller coaster up and downs are. So immediately people get relief from that roller coaster, but they also get to reduce their methimazole, they get to reduce their medication. But the coolest thing that I always tell Graves’ people on social media when they pick my brain, I’m like, “Listen, I have a couple of things to share with you that I want you to research.”

One is block-and-replace therapy. Life changing for these people. So, we block just enough of their thyroid function with methimazole to garner control, to stop the roller coaster ebbs and flows. And then we actually go in and we replace their missing hormones so that they too get to live a life of like perfect thyroid balance. They’re not stuck in one extreme or the next. And then the other piece of advice I always give Graves’ people that 100% of my patients on Graves with Graves are on at Modern Thyroid Clinic is LDN, low-dose naltrexone. Single handedly that will often help me completely get control so quickly that they need micro amounts of Graves’ meds, micro amounts of thyroid medication. It just really lowers their antibodies in a hugely significant way.

Cynthia Thurlow: It’s interesting. So, in prep for our conversation, I was down the TikTok rabbit hole because you have these really great vignettes. I was like, playing them while I was sitting at my counter last night, and my kids were like, who are you watching on TikTok? I was like, “This is the clinician I’m talking with tomorrow.” And I think you have a really unique lens because to me it is criminal that our standard of care is that we block and we’re not replacing. So, when I saw that, I was like, “Oh, that’s brilliant because no one’s suffering needlessly.”

McCall McPherson: Right.

Cynthia Thurlow: When you go from having too much and then having not enough, and you’re very symptomatic. The other piece is, are using synthetics like Cytomel or Synthroid? Are using Nature-Throid or using compounded thyroid replacement or is it dependent on the patient? I would imagine there’s a lot of bio-individuality.

McCall McPherson: Such a good question. So, my end goal and what I found, honestly, in my decade of thyroid care, is if I get people to narrow controlled margins of exactly what I dictate as perfect thyroid function, which is completely neurotic levels, just hyper focused ranges, they get their lives back. I find that irrespective of if it’s synthetic or natural in the form of desiccated thyroid, so I use both. The only thing I actually won’t use is compounded thyroid medication. The reason is because I stopped using it in about 2018, I believe. And I’ll give you analogy Dr. Alan Christianson gave me at one point, which is you know an analogy to baking muffins. When you’re baking muffins and you need to make an equal amount of blueberries in every muffin, you kind of can’t with pretty good accuracy. And that’s like when you’re dealing with milligrams, progesterone, estrogen, testosterone, when you’re dealing with micrograms like you are with thyroid medication, it’s like baking muffins and trying to get an equal amount of poppy seeds in every muffin, it’s impossible. And that’s what I would find. People that would be perfectly stable for months, years would all of a sudden swing. And the last time, I decided to stop using it, my stable patient swung to a TSH of 12-

Cynthia Thurlow: Wow.

McCall McPherson: -because she had a 90-day supply of thyroid medication that was not correctly potent. And so now I discourage the use of that in general, because eventually you’ll get a bad batch and 90 days is enough to throw off the course of a lot with thyroid.

Cynthia Thurlow: Yeah. I can imagine. And part of that question was just out of curiosity, I have been on all of those and finally there was a product I was on in 2000 and that was taken off the market and it’s taken two and a half years to get me therapeutic, finally, but on compounded because we had such small doses.

McCall McPherson: Yeah.

Cynthia Thurlow: But again, I completely respect the decision. If you can’t get consistency with medication, I can completely understand the desire to no longer facilitate that. Now, let’s talk about LDN, because LDN is really interesting. So low-dose naltrexone. I myself am taking this very small doses. Let’s talk about how it acts in the body, because this is not just for Graves’ patients. This can also be for Hashi patients and there’re a lot of different uses. But let’s talk about what it does for the thyroid patient that’s so substantial and significant.

McCall McPherson: Yeah. So, it’s a unique medication in that naltrexone in normal conventional doses is an opioid blocker. It will block pain medicine. It will block opioids. When you compound it and you make it into a microscopic amount, which starts at almost a 50th of the lowest traditional dose, it does something unique in our physiology, and it tells our body, “Hey, we’re a little short on opioids. We’ve blocked a little bit, we actually need more.” So, our body up regulates to surmount that depletion and we end up in a state of mild excess opioids. And what happens in that case is it lowers inflammation and therefore autoimmune disease of any kind. So, it takes the volume of whatever is driving your inflammation, whether it’s food, whether it’s your physiology, your genetics, your environment, it takes that inflammatory response and turns the volume down. And what you see in thyroid patients specifically, is a significant often reduction in antibodies. I’ve seen someone’s TPO antibodies, which is classic Hashimoto’s antibody, reduce over 500 points in three months with no other lifestyle changes, which it’s hard to mimic that any other way.

Cynthia Thurlow: Yeah. It’s pretty amazing. And what’s interesting is, when I brought it up with my functional medicine doc, I said, “I’m just reading a lot, seeing a lot.” And he just said, “Cynthia, I cannot predict who it’s going to work well in,” but he said, “It’s worth trying.” And he said, “But when it works, it’s miraculous.”

McCall McPherson: Yeah. And I tell people there is this idea propagated, I think, on forums, that LDN in a matter of days is going to make you feel so different and amazing. I see that maybe 5% to 8% of the time. I never aim for that to be my result. I aim more, especially in the realm of Hashi and Graves, I want to see that antibody reduction elicited, even if you don’t necessarily feel a world of change. And so, I always look for those objective markers. If they subjectively feel better, if their symptoms improve, all the better. But we are definitely aiming for long-term outcome improvement. And LDN has new studies coming out about that. I read one this morning about treating treatment refractory seizures with it like it’s just endless, the benefits of this medication so very powerful, for sure. I don’t even have Hashimoto’s autoimmune disease anymore. I haven’t had it for 15 plus years. I’ll take LDN forever myself. I make my husband take it. He’ll take it forever.

Cynthia Thurlow: Well, and it’s interesting. I was listening to a talk that a female physician was giving, and she was saying that 1.5 m of LDN can lower your risk of breast cancer, which I thought was really interesting. She’s in anti-aging. This is Dr. Pam Smith. I was at a talk that she was giving, and she has a very strong family history. So, she said, “I will take this till the day I die.” And she’s like, “1.5 mg is like nothing. It’s like breathing.” [laughs]

McCall McPherson: Yeah.

Cynthia Thurlow: So, she said, based on the research, this is certainly suggestive. And it’s one of those things, I think, that more often than not, if a patient or someone’s listening to this podcast, you’re very likely going to need to work with someone who has a functional or integrative medicine background. I would imagine that most traditionally trained allopathic providers are not offering that.

McCall McPherson: Absolutely. The one place I found improved access is AgelessRx, they really need to just hire me on their promotion team. [Cynthia laughs] They have no idea who I am, but I spread their information everywhere. They do, like, online consults, and they do LDN prescriptions. And so, I people [crosstalk] my followers, I’m like, “Listen, if you can’t have access to this, if you can’t find a functional medicine person to work with, there’re alternatives now.” Because really, the negative ramifications of it are little to none and a ton of health benefits, cancer just like you said, and so many other things. So, it’s something I encourage quite frequently.

Cynthia Thurlow: Yeah. AgelessRx was not on my radar. So, listeners, AgelessRx is someone that McCall works with frequently, recommends, check them out if you aren’t working with someone that is functionally or integrative medicine trained. So, let’s pivot a little bit and talk about– we had been touching base with one another before our conversation started, and let’s talk about what I see as an increasingly prevalent issue disordered eating. Obviously, in the intermittent fasting space, there’s a lot of people that hide their disordered eating under the context of intermittent fasting. But let’s talk about yo-yo dieting and starvation diet mentality, because I think for many women, by the time they probably come to you-

McCall McPherson: Yeah.

Cynthia Thurlow: -they’ve been through a lot and they may be employing dieting strategies that can damage their metabolism or make it harder for them to maintain a healthy weight. And so, what has been your experience? I was actually looking at some statistics last night, and it was indicating that 9% of the population or 28.8 million Americans will have some type of a disordered eating pattern over their lifetime. The economic cost is 64.7 billion with a per year. And that was just this one ANAD website that I was looking at and that’s really sobering. I think a lot of clinicians don’t recognize the full ramifications of how many people are really struggling with this.

McCall McPherson: Yeah. And it’s such a multifaceted thing, especially for me. So, I’m in the business of women. I’m in the business of women aging with thyroid hormone issues. So, I have definitely a unique lens to this. And the people that come to see me, especially in Austin, Texas they’re health minded people. These are people who put a lot of effort into their health. And what ends up happening in the realm of thyroid hormonal disorders, which, in my opinion, will affect every woman at some point, essentially to a high degree, is you start to lose that metabolic potency over time and slowly as that potency erodes, you have to do more and more and more to maintain your weight, to not gain weight, even more to lose weight and it becomes this beast that controls you because you no longer have control over your outcome.

Women, especially in my opinion, are struggling with that. They’re not given answers to that, especially in the thyroid sector. Before they see me, they’re told repeatedly by their doctor that they need to diet more, exercise more, eat less, exercise more, and these women are already doing too much, and it ends up with a completely unhealthy pattern of eating. It ends up completely out of their control. Yet it’s so often this core physiological issue that’s driving it that’s not fixed and has caused so much of this damage, and they’re in a really, really unhealthy cycle with limited options at their disposal unless they’re really educated in this kind of sense of their health. So, it really is a huge issue.

Cynthia Thurlow: Yeah. It’s interesting because I’ve kind of fallen into this perimenopause/menopause space, initially not realizing that was where I was going to land when I transitioned out of traditional allopathic medicine. But I feel like in many ways, a lot of the information that we’ve given patients over the years is flatly wrong. We told them to eat to stoke your metabolism. Breakfast is the most important meal of the day. Eat all your heart healthy grains and carbohydrates, don’t eat enough protein. And I think that perimenopause for a lot of women is where this starts to manifest. And you talk about metabolic potency, which I’m going to assume is speaking to metabolic flexibility, metabolic sensitivity or insulin sensitivity, that loss of insulin sensitivity. And so, when you’re working with women in this age range, late 30s, early 40s that are kind of starting the early stages of perimenopause, what are some of the things that you’re thinking about beyond thyroid function that are critically important?

We were laughing about this before we started recording as well. I think that, again, goes back to your psychiatry background. This loss of progesterone that starts that women are put on anti-anxiety meds and they’re put on antidepressants and their sleep is terrible. So, they’re prescribed Ambien. Does Ambien still get prescribed? I’m assuming it does.

McCall McPherson: Yeah, it does.

Cynthia Thurlow: They’re prescribed sleep aids when what they really need is some progesterone that would really help them.

McCall McPherson: Amen. And that shift at that time is associated with, I think, on average, eight to ten pounds of weight gain because of that shift of hormones. So even just outside of thyroid, just reproductive hormones alone, then you have that mixed with this loss of insulin sensitivity. People have completely lost their metabolic flexibility because of the dogma that we’ve incorporated, especially women our age, because our dogma was so flawed that we have a lifetime on this. High grains, lots of meals, never let your blood sugar drop, calories in equals calories out. All of these flawed ideologies, and then we end up in our 40s and 50s, and we are just really in bad shape. And then we have to unravel all of the damage that’s been done over the last few decades, culminating with a potential thyroid and certain hormone dysregulation.

Cynthia Thurlow: Yeah, absolutely. And it’s interesting to me, working with thousands of women at this stage of life, that something as simple as encouraging them to eat more protein as an example-

McCall McPherson: Yeah.

Cynthia Thurlow: -can be life changing. They’re like, “I didn’t know what it was like to feel satiated between meals.”

McCall McPherson: Right. Just don’t be afraid of not eating six meals a day. Don’t be afraid of letting your blood sugar retrain itself to tap into your fat stores so that you can ever burn fat. These people who are so terrified of letting their blood sugar drop because of that lack of metabolic inflexibility or lack of metabolic flexibility, just get in this rat race of constantly keeping up their blood sugar. But of course, they can never lose weight and it gets frustrating for them, I think-

Cynthia Thurlow: Yeah.

McCall McPherson: – [crosstalk] and restricts.

Cynthia Thurlow: Well, and I think that’s– I call it the triad. That’s my working name for it. But it’s the over restriction of food because we’ve convinced people eat less, exercise more, so too much exercise, over restriction of food. And then if a little bit of fasting is good, more is better. And so, these are the women that I see that are doing chronic habitual OMAD, and they don’t understand that they are effectively, I hate to use this term, but breaking their metabolism to make it really clear that they are actually making it harder for their bodies to utilize stored fat as a fuel source because their bodies think they’re starving.

McCall McPherson: Their reverse T3, their thyroid inhibitory hormone is through the roof, and then they’re more restrictive to solve the problem.

Cynthia Thurlow: Yeah. And so, for an initial workup, so if a woman comes to you suspect there’s probably a thyroid issue. They’re in the right frame of range for perimenopause or even menopause. What’s a traditional? Again, we’re not giving medical advice, but like, 30,000-foot perspective on what labs are you thinking about ordering for these patients? So, if there are women listening that are saying, “Oh, that’s not a lab I’ve heard before.” So that they have some context. Now, obviously, if you live close to McCall, go to McCall directly. But if you’re trying to work with your practitioner and you’re trying to get a plan together, what are some of the common labs that you’re thinking about when someone comes to you with some degree of weight loss resistance or presumed metabolic inflexibility.

McCall McPherson: Yeah. So just that alone, absolutely, I’m looking at their fasting insulin. I’m looking at their hemoglobin A1c. Tertiarily, I’m looking at their fasting blood sugar but, in my opinion, that is third on the list for sure. I’m looking at inflammatory markers. I’m looking at hs-CRP, of course. I’m doing a full thyroid panel TSH, free T4, free T3, reverse T3, TPO, and thyroglobulin antibodies. And then we’re doing a full hormone panel too, so we can analyze, “Hey, where are you at in this process?” We’re looking at your sex hormone binding globulin, your progesterone, your estradiol, your testosterone, your DHEA, so we can look at your adrenal function. How is cortisol potentially rated into this? But definitely loss of metabolic flexibility, fasting insulin, hemoglobin A1c are top tier, and a lot of people have their hemoglobin A1c, the average blood sugar, but they don’t know how their insulin is relating to that blood sugar. And that’s an important piece of information.

Cynthia Thurlow: Yeah. It’s interesting, I oftentimes will tell people there’re now websites you can go to where if your provider is not willing to test your fasting insulin, which is cheap, I’ve seen as low as $12. I’ve seen up to $20. I get mine checked, like, every quarter because I’m a little obsessive [chuckles] about it. I’d like to know exactly where I fall. But having said that, I think it’s so helpful because we know that our fasting insulin will dysregulate 10 years before that fasting glucose or A1c. And so, we are missing opportunities with patients and that, to me, is really disheartening. How many women I’ve worked with that have said, “Get your fasting insulin tested and their fasting insulin is 20?” And I’m like, “Well, now we know why you’re not losing weight or this is certainly contributing to this.” So certainly, a very important piece of the puzzle.

And when we’re looking at women as an example, if they’re taking oral contraceptives, we know that that can make it harder to evaluate their sex hormones. How do you kind of work through that kind of low estradiol, low sex hormone state, trying to differentiate. And let me be clear, there are women in their peak cycling years, perimenopause and, yes, there are physicians and providers out there who still keep women on oral contraceptives in menopause, that’s something we could unpack for a whole other day, but important to just understand that the net impact of oral contraceptives, they are endocrine disruptors. If you need them for birth control, there’s no judgment. But just there’s not fully informed consent for a lot of these women. How do you unpack that? How do you help them understand their lab work.

McCall McPherson: You know that is such an educational piece? Because I sit down with them and I say, look, if this is working for you, of course this is such a personal decision, especially in the postmenopausal phase of things. But the necessity for this medication is not here. And not only is your birth control shifting your hormone transport for your reproductive hormones and shifting your hormones in general, it’s shifting it for thyroid, it’s shifting it for your testosterone. It is a downstream effect in pretty much every hormonal aspect of things. And so there are such better ways to support these women than to keep them on hormonal birth control in their hairy postmenopausal years. That most of the time they’ll let me just help them. The world of thyroid is complicated. It’s hard to have access to people that know what they’re doing. There are a lot of people that know good hormone replacement, so the access to that is so much more expanded. And so, I would encourage anyone that’s getting treated postmenopausally with hormonal birth control. To get a second opinion from someone that deals with bioidentical hormones and can really help support you, because it is life changing.

Cynthia Thurlow: Yeah. And it’s interesting, I would say most of us that are of a certain age, we at some point were on oral contraceptives and there’s no knocking that, it was a choice, but I don’t think most of us were fully had informed consent and I certainly didn’t. And so, at the time in my life when I should have been building my peak bone and muscle mass–

McCall McPherson: -you’re [crosstalk]

Cynthia Thurlow: Exactly. I said, “So why am I osteopenic at 51?” One of many reasons, I think, some of its genetics. It’s not because I don’t lift and I don’t have a pristine diet. I think a lot of is I missed out on opportunities to build my bone when I was younger. And so, if you’ve been someone that’s been on oral contraceptives for 20 years, the reality is that you are probably someone that low estrogen estradiol state for a period of time. Yes, it may be a help with contraception or addressing irregular periods or heavy periods or for whatever indication people took it, but also understand there are potential long term side effects. And that’s what I think is significant, because this is why I now speak out about this more frequently, is that if you’re a younger person and you have other options understanding the full ramifications of being on oral contraceptives, you know Felice Gersh talks about the endocrine disrupting properties of these synthetic hormones. It’s not progesterone, it’s progestin. It’s not estradiol, it’s a synthetic form of estrogen. Understanding with full informed consent that every woman deserves to fully understand what it is that they’re taking. And the sad thing about oral contraceptives and it’s sad because for most instances, people are taking them to ensure they don’t get pregnant. The joke’s on them because their testosterone is so low, they have no libido. So, yes, you can’t get pregnant, but then you don’t want to have sex.

McCall McPherson: Right. And I mean that’s so true. And then also when you come off of them and have this idea that you are immediately going to be able to get pregnant, I tell my patients, you need to give me at least 9 to 18 months because we are going to be doing some intensive hormonal resets over here. And women don’t realize that they’re actually walking around for years, decades, in a postmenopausal state for estrogen and progesterone, so that even the neuroprotection, the osteoporosis, osteopenia, the collagen, the hair, all the things that we need our hormones for in our prime hormonal years, decades, they are walking around below detectable level. There is not even an ounce of estradiol registering on your labs, 99% of you.

Cynthia Thurlow: Yeah. It’s interesting because I think most of us don’t even realize that. I remember I thought I always had terrible PMS and I didn’t realize until I got married, went off the pill, had my first cycle, which took a while, much to your point about explaining to people, you may not get a cycle for a while. And I said to my husband, I had no idea I was going to get my period because I didn’t feel bad. And all those years I had been on the pill and it wasn’t even a real period. It’s a withdrawal bleed. I felt awful, like, horrible. And then I realized, “Oh, my gosh, I actually don’t have bad PMS.” It was a byproduct of being on the pill.

McCall McPherson: In my psychiatry practice, I had a patient diagnosed with bipolar disorder from birth control because she had so much mood dysphoria. She came off of her birth control and never had another bipolar issue again.

Cynthia Thurlow: That’s amazing.

McCall McPherson: Speaking to informed consent, it’s interesting in medicine, we’re supposed to give informed consent, but there’re these areas where we’re not held accountable or expected to, and birth control is one of them. I don’t even know if clinicians are trained properly in the long-term, short-term side effects, what to watch out for, or ramifications of these medications to even share with their patients.

Cynthia Thurlow: It’s a really good– and it’s not a topic that we’ve discussed at great length, but it’s one that I feel is important for younger women to be made aware of and even middle-aged women to be made aware of. I guess the other thing that I think about is synthetic hormone replacement therapy. Whether its people are taking oral progesterone, whether they’re using transdermal progesterone, whether they’re using bias or they’re using estradiol patches or testosterone. How do you start those conversations with your patients? Do you find that most people are receptive to hormone replacement therapy when they need it, or do you still feel like there’s quite a bit of fear or concerns? I think the Women’s Health Initiative, in many ways, which coincided when I finished my nurse practitioner program, had a whole generation of patients that were fearful to take them, providers that were fearful to prescribe them.

McCall McPherson: I absolutely still run into barriers that create an opportunity for education. And then those patients leave my practice, they go back to their GYN, and it is a complete dichotomy of approach of support or absolutely you’re going to get breast cancer. And the longer the Women’s Health Initiative studies go from being finalized, the more they are scrutinized and really debunked in such a significant way. And at the end of the day, I think it’s education and it’s need, not everyone needs hormone replacement. And I’m an advocate for, look, “We don’t need to fix this number if you’re postmenopausal, we need to fix your symptoms.” So, if your symptoms are bad enough, then let’s open this discussion. And the reality is they are so extremely safe when they are used appropriately. Can they be misused? Of course, absolutely like anything. Anything in excess is not really great. But women don’t need a lot of hormones to feel great to protect their health as they age. They need only just enough. And not just enough is, in my opinion, with negligible risk.

Cynthia Thurlow: Yeah. I think it’s important. There’re certainly differing opinions about hormone replacement therapy. I mean, there’s people that give very little, there are people that are kind of in the middle, and then you have extremes like The Wiley Protocol, which listeners may or may not be aware of, but protocols that give women back hormones to a super therapeutic level. Level to where they were in their peak cycling years. I’m not going to pass judgment. I’m just going to say that you have to be very aware of the potential side effects and whether or not that’s the right decision. I don’t see as much of that now as I did a few years ago. But certainly, those are the types of things that are out there and that’s an extreme. Like I always say, there’s outliers and then somewhere in the middle is probably more consensus. So, let’s shift gears a little bit and talk about some of the strategies that you use with your patients. We already talked about LDN.

McCall McPherson: Yeah.

Cynthia Thurlow: We’re going to talk about the big elephant in the room, the GLP-1 agonists, because I know that we’ve had conversations offline about some of the benefits that you’ve seen with your patients and how you think it really in many ways has been life changing for many of them.

McCall McPherson: Yeah. So again, it goes back to this loss of metabolic potency and the dysfunction that comes along with that, the over restriction, the fear of food that really spirals out of control with so many women. And let’s say magically, on day one, I wave a wand and I make someone’s thyroid function perfect, which ultimately is where we go. But even at perfect thyroid function, after years or decades of disordered function, that loss of metabolic potency, it is not fixed, it’s still there and it has to be repaired. And things like intermittent fasting within reason can help to repair that process. But it’s years and years and years that effort, and people become more restricted and more discouraged in that time. And where I found GLP-1 agonists, like semaglutide, Ozempic, Mounjaro to be exceptionally useful is in the specific type of person. Their lifestyle is good, they eat well, they exercise within reason, but they cannot lose weight. They cannot maintain their weight. And not only do these medications facilitate weight loss for these women or people, they improve their metabolic potency over time so that when they come off of them, they’re able to appropriately put effort in to maintain their weight.

They’re able to put appropriate effort into losing weight. And the biggest piece of feedback that I’ve gotten from my patients at Modern Thyroid Clinic, because those are the only people I treat with this, is the amount of food freedom that I now get to experience because of this is life changing. Because they no longer have to live in this tiny box of control all the time. And so, I think there’s so much dogma and politicized stuff about these medications right now. But for this, especially in other categories too, that in my realm, this specific category of person, it is life changing for their mental health, their physical health, their long-term health outcomes. The stuff that I’m seeing on these people with their lab follow ups over time is mind boggling too.

Cynthia Thurlow: And so, are you starting them at subtherapeutic doses, like smaller than, like, general– Because I guess some of what I’m seeing in the biohacking space is that you have very thin people that are taking semaglutide like once a week versus the dosing that I see that is more commonly utilized for men and women versus– let’s just start there. Are you at a subtherapeutic dose? Do you start with smaller doses than what’s conventionally used? How do you come to a determination? Because one of the things that I’ve realized talking to so many providers who do prescribe it, is there’s tremendous variation, and it’s very much based on you as a provider, knowing your patients, knowing how much you can push or sometimes how slowly you have to move to get them to the outcomes they’re looking for.

McCall McPherson: Yeah. So, our protocol is divided, and it definitely is individualized, but either they start at half of the normal dose or they start at the normal dose. We just don’t increase to ever increasingly high levels.

Cynthia Thurlow: Okay.

McCall McPherson: So, we kind of hit a threshold and we pause. We allow their body to become sensitive to the medication again, we use things like metformin during that time to continue our work, to create metabolic sensitivity, but without a GLP-1 agonists on board, and then we cycle them through again if they still have weight to lose. So, we kind of keep things on the low end. Research shows, too, the bulk of weight loss happens at kind of low, medium doses. And so, we want to harness that by building them up and then allowing them to pause and resetting and then recreating that period of time where most people lose the bulk of their weight on these medications over and over until they reach their goal weight. And their markers, their lab markers show that their metabolic sensitivity has been restored.

Cynthia Thurlow: And it sounds like your approach is pretty unique, which I think is wonderful to hear because I’ve heard from other colleagues that you can’t push too quickly, people get constipated, they’re nauseous. Those are the most common side effects and I do have some patients that are working with me that are working concurrently with other providers that are on it. And I think it seems like and again, small percentage of people, a lot of them struggle with the nausea, they struggle with the constipation. That can be a self-limiting and I would imagine if you’re using smaller micro doses and kind of cycling them on and off, you’re probably not seeing as many side effects.

McCall McPherson: Totally. And then ours is individualized. There’re so many workarounds for that, you split your dose, you do it twice a week, at half doses, you reduce down. Strangely, if you move your injection from your stomach to your outer thigh, reduces nausea. I know it’s strange, but consistently I’m getting that feedback. So, there’re so many workarounds for that. There’re very few people. I think I’ve had one person of a few hundred that couldn’t tolerate it for whatever reason their physiology didn’t agree with it. But most people, if you have an informed person that can really guide you with it, the side effects are minimal.

Cynthia Thurlow: Yeah. And are you seeing because I think this is one of the studies that just came out, it was saying most of what people are losing is muscle mass. And so obviously that would be a concern. Are you seeing that in your patients? But again, it sounds like because you’re being very conscientious using these subtherapeutic doses, cycling them on and off, they’re probably not seeing a significant amount of muscle loss. They might just be losing fat.

McCall McPherson: Yeah. I’m not seeing that now. I almost order their eating where they have protein first, then high micronutrients or green juice and then any filler foods. Because part of the struggle is these people are not getting enough protein and micronutrients. But it’s interesting because the original study showed about standard, where people lose two-thirds fat, one-third muscle, which is sort of what happens when you lose weight. So, I almost feel that there’s these smear campaigns coming out where, for whatever reason, these medications are being targeted and painted in a really negative light when that’s not the data that I’m getting.

Cynthia Thurlow: Yeah. But it’s helpful, I think, that we had Dr. Tracy Gapin, on earlier this spring, and you and I had a conversation in our DMs, and you had said to me, very transparently, that you had a very different experience, that there was another type of conversation that was worth having. And so, I’m always open minded. I don’t prescribe them because I’m not seeing patients face to face anymore, but I do see the utility. And certainly, when we’re looking at the bulk of our population that is not metabolically healthy, like 92% of us, we need to have options for people because it may not be that every person can just go low carb or keto and lose a bunch of weight and sustain that over time. So, when you’re doing these cycles, what’s the duration of time that the average person is utilizing the GLP-1 in conjunction with working with you?

McCall McPherson: Yeah. I would say the cycle goes on average from four to six months before they break. I’d say 80% or 75% break after four months because again two to three months in is when weight loss usually happens, but there’s still fear about stopping it. So, some of them will continue it for another two months because they think their metabolism is going to go right back to where it was before we started. And again, that is not what I’m seeing. And so, we’ll break somewhere around there and allow them four to six weeks to reset. Again, now, I use metformin during that time to continue the work to protect their metabolic function and then we restart again for another cycle.

Cynthia Thurlow: I love that perspective. And so, when we’re looking at kind of like broad reasons why women will be weight loss resistant, what are some of the most common reasons that you’re seeing this in your practice? This is a huge topic, one we could talk about for hours on end. But what are some of the less common or perhaps the things that women are doing that they’re not aware of are contributing to why they remain weight loss resistant?

McCall McPherson: Yeah. So obviously we know thyroid, 100% of my patients are thyroid, so we can definitely count that one in. Of course, that loss of insulin sensitivity and blood sugar metabolism, I think, is created by standard American living at this point. If you’re not working on it, you’ve got a loss of insulin sensitivity and blood sugar metabolic function, if you’re not intentionally dealing with that. I think lack of muscle mass to increase our basal metabolic rate is a big issue where people will do cardio, cardio, cardio but we never really build our muscle mass so that if we’re not doing cardio, we don’t have a metabolism. I think, too, one thing that I always see with my patients initially is people are afraid to work out while they are fasted.

Not to mean they need to go do 40-minute CrossFit workout five days a week fasted. But you can go lift weights fasted. You can walk, you can even go for a run if you are not doing that. And you’re waking up, you’re having a really great healthy smoothie, and then you’re going to work out, going for a run, you are burning off part of your smoothie. We are not tapping further into those fat stores. And then lastly and this is a big thing that I know you’re big on, too, is metabolic flexibility. Our body has to be able to switch from burning carbs and sugar to your stored fat. And if you’re not able to fluidly do that every day, if you are constantly burning your food, you can never burn your fat and you can never lose weight.

Cynthia Thurlow: Yeah. It’s really important and it’s always helpful for listeners to hear this from multiple practitioners because it reinforces that these are foundational principles that are so important. A couple of listeners questions. One asked, do you have supplements that you– so, again, 30,000, you’re not giving medical advice, supplements that you tend to utilize for your thyroid patients, whether it’s micronutrients, whether it’s fish oil. I mean, are there supplements that you use with some consistency for these patients where it kind of fills in the gap? Maybe they’re not getting enough from their nutrition. Maybe depending on what medication they’re taking; they may have gaps in their needs.

McCall McPherson: Yes. So, I like thyroid blend supplements. Designs for Health has one. Xymogen has one. Xymogen’s is called MedCaps T3, I forget the name of the Designs for Health, but Xymogen has iodine, Designs for Health doesn’t. So, I try to stick with Designs for Health for people that have Hashimoto’s. And then my favorite, honestly, is almost 100% of my patients have adrenal dysfunction, and that will keep you from feeling the improvement in your thyroid. And so, I am a huge advocate for adrenal support in my population of patients and really anyone with a thyroid disorder, my very favorite is Ortho Molecular Adren-All. It’s life changing. I tell people for people that need it, it’s equally as life changing as thyroid medication.

Cynthia Thurlow: Wow, that’s impressive. And it’s interesting to me that the adrenal piece gets overlooked. The concept of adrenal fatigue has gotten patients thinking that’s what it’s about. It’s really the hypothalamus-pituitary-adrenal axis. So, it’s really talking about your brain’s perception to what you’re going through. But I can’t think of anyone that’s north of late 30s that doesn’t need some degree of adrenal support.

McCall McPherson: Amen. At least for a season and I find I can repair their adrenals and they can go on and be fine without it. But most people in their 30s need some adrenal restoration to get them through the rest of our lives.

Cynthia Thurlow: Yeah, absolutely. And then lastly, I was going to ask you about the iodine piece. Do you have a perspective? Because I know Alan Christianson is not pro iodine. I’ve had other thyroid experts on who use it judiciously and carefully and cautiously. Are you in one camp or the other? Or again, do you go back to the bio-individuality piece, because I had multiple people asking about iodine and I was like, “That’s very bio-individual.”

McCall McPherson: It is, so definitely it is individualized. I do not use it in people with Hashimoto’s, Graves, a history of autoimmune thyroid issues. I am not anti-completely iodine, but I use it in small, small conservative amounts if I do and I will tell you, there is a subset of my patients who went through Dr. Alan Christianson’s book and did the removal of iodine. And I tell you, their antibodies consistently dropped over time in a predictable way and it was pretty impressive.

Cynthia Thurlow: That’s amazing. It’s interesting. You probably also have patients who have Hashimoto’s but have negative antibodies, but their thyroid is that subtherapeutic. They’re very symptomatic. What do you do with those patients? Are these patients that depending on their symptoms, are you starting them on medication? Again, not medical advice. I’m just asking at a generality because I feel like this is a subsect of thyroid patients that conventional allopathic medicine will probably not treat. And then, on the other hand, functional or integrative medicine will very likely treat because they’re so symptomatic, but they have negative antibodies whether they have suspected Graves or suspected Hashimoto’s.

McCall McPherson: Yeah. In that case, I treat on thyroid function alone. It’s interesting 100% of my patients at Modern Thyroid Clinic have been dismissed by at least one, usually five doctors and told that everything’s fine and they don’t need treatment. And those are the people that really have a life-changing experience, because when things are deviated just slightly, it goes back to our initial part of this conversation. The severity of patient’s symptoms with hypothyroidism and Hashimoto’s is wildly underestimated in medicine. And they’re dismissed over and over and over. And the reality is these people are suffering incredibly with an extraordinarily fixable problem that no one is offering or equipped to fix them and so those are my people. Those are like, those are my people. And so, we rely on thyroid function alone at that point in time, and we can always work on inflammation and try to reduce Hashi antibodies, while not measurable, but those people benefit hugely from getting their biochemistry outlined to a nuanced degree.

Cynthia Thurlow: Well, I’m so thankful for this conversation. I’m glad that were able to make it come to fruition. Please let my listeners know how to connect with you, how to view your TED Talk, how to find you on TikTok that’s where I loved. And you have a YouTube channel, but how to find you, how to connect with you, and if they want to work with you, how they can go about doing that.

McCall McPherson: Oh, I’d love to. So TikTok is my place. You can find me on Instagram @mccallmcphersonpac. TikTok @mccallmcpherson is where I spend the bulk of my time. I love my TikTok community. Also, YouTube, you can find my practice at modernthyroidclinic.com, my website is mccallmcpherson.com. Currently, there’re a few ways that I am offering to help people, mainly driven by the demand from my TikTok people asking me over and over. One is I’ve created a course, Thyroid Empowered, that really takes people through all the information and demystifying the complexities of thyroid over time. And it culminates with a group console where we all go through your labs, we talk about what they mean, what I would do. We learn from each other. It’s really been an amazing experience and I launch them every month or two so you can find that at mccallmcpherson.com/courses. And then two, we have a waitlist. We are working to expand nationwide right now to massively increase access to thyroid people everywhere. So, you can find that on any of my social medias. You can sign up for the waitlist to be notified when we make it to your state.

Cynthia Thurlow: That’s awesome. I’m so excited for you. Thrilled that you are working in this space and grateful for you to be a friend.

McCall McPherson: I know, same sister. Thank you for your work and thanks for having me.

Cynthia Thurlow: Of course.

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