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On Purpose with Jay Shetty

Dr. Sara Szal: Stop Ignoring What Your Body's Trying to Tell You! (THESE Are the Hormone Signals You Can't Afford to Miss!

with Sara Szal

Published October 27, 2025
View Show Notes

About This Episode

Host Jay Shetty speaks with physician and researcher Dr. Sara Szal about how hormones function as the body's messaging system, what hormonal imbalance looks like, and why stress and lifestyle are central drivers of issues like fatigue, weight gain, mood changes, and fertility challenges. They discuss cortisol, insulin, sex hormones, thyroid function, the impact of chronic stress and relationships, and practical ways to measure and rebalance hormones through testing, nutrition, sleep, stress management, and more informed choices about birth control. The conversation also covers life-stage hormone shifts, the risks and benefits of the birth control pill versus IUDs, natural family planning, and how integrating spirituality and self-awareness with medical science can prevent burnout and support healing.

Topics Covered

Hormones and metabolism HPA axis Stress management PCOS Perimenopause and menopause Endometriosis Endocrine disruptors IVF and fertility Women's health advocacy Trauma

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Quick Takeaways

  • Hormones are chemical messengers that help maintain homeostasis, and imbalances in cortisol, insulin, thyroid, and sex hormones can underlie many common symptoms like fatigue, weight gain, mood swings, and infertility.
  • Stress and cortisol act as central regulators that influence other hormones such as insulin, progesterone, and testosterone, so measuring and managing stress is a powerful starting point for rebalancing hormones.
  • Insulin resistance can appear years before blood glucose changes and drives fat storage and vascular damage, especially in women, making early testing and dietary changes crucial.
  • Women and men share the same hormones in different amounts, and both can experience deficiencies or excesses; for example, high stress can lower testosterone in both sexes starting as early as the late 20s.
  • Simple lifestyle shifts-like improving sleep, walking after meals, practicing breathwork and meditation, and spending a few minutes in nature-can measurably affect cortisol, insulin, and overall hormonal balance.
  • The birth control pill is widely prescribed not only for contraception but also for acne and painful or irregular periods, yet it can raise inflammation, deplete micronutrients, alter libido, and possibly persistently change sex hormone binding globulin.
  • Non-hormonal options such as the copper IUD and natural cycle tracking can provide effective contraception without the systemic hormonal effects of oral contraceptives.
  • Hormonal changes begin decades before menopause or andropause, so tracking markers like cortisol, thyroid hormones, sex hormones, and metabolic health earlier in life allows for earlier intervention.
  • People-pleasing and staying in chronically stressful dynamics can become a biological stress pattern (fawn response), so boundaries and choosing short-term guilt over long-term resentment can protect both mental and hormonal health.
  • Dr. Szal blends rigorous medical training with spiritual and relational awareness, emphasizing seeing patients as whole people and helping them activate their own healing capacity to avoid burnout and improve outcomes.

Podcast Notes

Introduction and framing of the hormone conversation

Why the episode focuses on hormones

Audience demand for information about hormones, birth control, emotional regulation, and fitness[2:29]
• Jay says listeners have had many questions about hormones, birth control, emotional regulation, fitness, and how they all connect
Introduction of Dr. Sara Szal and her background[2:43]
• Described as a Harvard and MIT trained physician, researcher, educator, and author of four New York Times best-selling books on trauma, hormones, and health
• Her book "The Hormone Cure" is highlighted as a key work for listeners who enjoy the conversation
• She serves as clinical assistant professor at Thomas Jefferson University and director of precision medicine at the Marcus Institute of Integrative Health
• Her work focuses on how personalized data and root-cause medicine reveal links between mental and physical health

Foundations: What hormones are and what hormonal imbalance means

Definition of hormones and body communication systems

Hormones as chemical messengers[3:53]
• Dr. Szal describes hormones as chemical messages in the body, likening them to text messages that tell different parts of the body to do something
Five ways the body communicates with itself[4:02]
• She lists five communication systems: hormones, peptides, proteins, nutrients, and the genome
• She emphasizes that we want to work with these systems, not against them

What is hormone imbalance?

Imbalance as disruption of homeostasis[4:18]
• Hormonal imbalance is defined as when the body's exquisite state of homeostasis gets out of balance
Examples of hormone imbalance in women and men[4:17]
• In women, imbalance can show up as endometriosis or polycystic ovary syndrome (PCOS), where there is too much androgen or testosterone
• In men, imbalance can show up as low testosterone
• Cortisol can be imbalanced in chronically stressed people who are not attending to their stress
• She notes there are ways hormones get out of balance, but also ways to get back to homeostasis

Major drivers of hormonal imbalance and why stress comes first

Stress and the stress-response system

Stress as the number one cause of imbalance[4:52]
• She calls stress the number one modern cause of hormone imbalance
Measuring stress objectively[5:09]
• She explains that stress is not just a feeling; you can measure it via cortisol levels
• Cortisol can be measured in blood in the morning or at four points during the day to assess the stress response curve
Genomics and sex hormones as other imbalance drivers[5:21]
• Some people have a greater genetic risk of PCOS with too much androgen/testosterone, leading to infertility, acne, and other problems
• Hormone imbalances can involve testosterone, estrogen, and progesterone in addition to cortisol

Access to testing and disillusionment with the medical system

Home versus lab testing for cortisol[5:49]
• She says you can measure stress at home, but prefers starting with a knowledgeable clinician so people know what to do with the information
• She notes a trend toward disintermediating the medical system because it has failed many people with hormone imbalances

Cortisol, DHEA, and the concept of optimal versus normal

Cortisol levels and daily rhythm

Optimal cortisol ranges by time of day[6:37]
• For a morning blood cortisol, she prefers an optimal range of about 10-15, which she distinguishes from the broader "normal" range used in mainstream medicine
• In the afternoon, she prefers cortisol around 5-10
Goldilocks principle for hormones[7:15]
• She states that for all hormones she can think of, you want a Goldilocks zone of not too high, not too low
• Her own cortisol in her 30s was about three times higher than it should have been, reflecting a pattern of being a "stress junkie"
• If cortisol is too high, it causes excessive wear and tear; if too low, it may indicate an exhausted stress-response system

DHEA and age-related variations

Preferred DHEA ranges[7:15]
• She says DHEA levels vary with age, but generally likes to see more than 100 in women and more than 150 in men

Metabolic hormones: Insulin, glucose, and weight

Insulin's role and insulin resistance

Insulin as the bouncer at the club[8:41]
• She likens insulin to a bouncer at a club deciding whether to let glucose into the cell (the club)
• With well-functioning insulin (fasting about 5-7), glucose enters cells to be used as fuel, you feel good, and you avoid excessive fat storage
Consequences of insulin resistance[9:04]
• When cells become numb to insulin, levels climb, leading to more fat storage and glucose remaining in the bloodstream ("streets full of glucose")
• High circulating glucose damages blood vessels; in women, prediabetic fasting glucose between 100-125 can set up high blood pressure and cardiovascular disease later
• She notes men tend to show vascular damage at higher fasting glucose compared to women

Testing for insulin issues and weight struggles

Two-hour glucose challenge test[20:39]
• She recommends a two-hour glucose challenge with 75 grams of carbs, measuring insulin and glucose fasting, at one hour, and at two hours to see how the body responds
• She explains insulin can change 7-14 years before glucose changes, so examining post-prandial insulin is important
Other hormones affecting weight[21:01]
• In women, excess testosterone can drive metabolic dysfunction, cardiovascular risk, fatigue, and mood changes
• She looks at androgens such as testosterone and DHEA when assessing weight issues
• Imbalances between estrogen and progesterone-especially too much estrogen (disestrogenism)-can cause mood swings, problematic eating habits, and structural body changes
• She names thyroid and cortisol as critical hormones in weight gain; high cortisol can increase belly fat, food cravings, and is elevated in about half of people with depression

Sex hormones, thyroid function, and early deficiencies

Shared hormone systems in men and women

Same hormones, different amounts[10:17]
• She stresses that men and women have all the same hormones, just in different quantities
• Women have about one-tenth the testosterone of men but are exquisitely sensitive to it, requiring a Goldilocks range
• Men also produce estrogen, and low estrogen in men can cause bone loss
• In women, estrogen has around 400 jobs, including brain health, memory, and growth of uterine tissue such as fibroids and endometriosis lesions

Common deficiencies and their symptoms

Stress-induced sex hormone changes[11:50]
• Starting around ages 27-28, high-stress individuals can experience falling testosterone, in both men and women
Thyroid hormone and symptoms of low function[12:01]
• She likens thyroid hormone to "gas in your body"; nearly every cell has a thyroid receptor
• Low thyroid function can cause fatigue, weight gain, constipation, low energy, loss of the outer third of the eyebrows, and hair loss on the head
• Low thyroid is 7-9 times more common in women than men, and the typical root cause is autoimmune Hashimoto's thyroiditis

Mindset versus biology and how fast hormones can change

Reframing fatigue and low energy[13:08]
• She notes many people feel tired and assume it is a moral failing or a mindset issue, but she urges starting with biology instead
• She recommends measuring hormones, especially the stress response (cortisol, heart rate variability) before blaming oneself
Time frames for hormone shifts[15:13]
• Insulin can change in as little as three days with food and exercise changes
• Estrogen and progesterone generally take about 4-6 weeks to adjust
• She cites a study in women with high testosterone showing that reducing dietary carbohydrates for seven days can change testosterone levels

Causes of hormone changes in 20s and 30s, and role of mitochondria

Estrogen, toxins, and premature ovarian insufficiency

Low caloric intake and estrogen[15:45]
• In women in their 20s and 30s, low estrogen often results from not eating enough calories or nutrients to support luteinizing hormone and ovulation
Endocrine disruptors[17:08]
• Exposure to toxins and endocrine disruptors can affect estrogen and thyroid levels and also testosterone
Premature ovarian insufficiency[17:19]
• Premature ovarian insufficiency is described as an autoimmune attack on the ovaries causing early perimenopause/menopause symptoms in women in their 20s and 30s (hot flashes, night sweats, mood swings)
• Diagnosis requires lab tests to confirm the cause of low estrogen

Testosterone, progesterone, and mitochondria

Stress, insulin, and testosterone[18:06]
• High stress and cortisol can rob the body of testosterone production, especially in women
• High insulin levels can dysregulate ovarian testosterone, often contributing to high testosterone in certain types of PCOS
Low progesterone and luteal phase issues[18:33]
• Women who do not ovulate every month may have late luteal phase disorder with low progesterone
• She suggests checking day 3 FSH and estradiol and day 21-22 progesterone; normal mid-luteal progesterone is about 10-15 or higher
Mitochondria in eggs and sperm[19:23]
• The cells with the most mitochondria in the body are eggs in women and sperm in men
• Sedentariness, high stress, and poor nutrition impair mitochondria and may first show up as egg issues like low progesterone
• She recommends supporting mitochondria with morning light, stress management, adequate nutrients, and possibly supplements like CoQ10

Where to start when overwhelmed: focus on cortisol

Cortisol as the great unifier

Why start with cortisol testing[23:36]
• She advises overwhelmed listeners to start with cortisol because it is involved in all the other systems and can affect insulin, progesterone, and testosterone, even in people in their 20s
• She emphasizes measurement as critical and links external life stressors with internal hormonal states
Befriending hormone signals[24:10]
• She suggests developing a sense of the inner terrain and treating hormones as messages and signals to be befriended rather than villains to blame

Reducing stress: measurement, practices, supplements, and relationships

Top strategies to decrease stress

Measure stress first[23:59]
• She says, "What you measure improves," and recommends establishing a benchmark for stress, including metrics like cortisol and heart rate variability
Meditation and breathwork[24:56]
• She began learning yoga at age five and meditation at 17 and believes nothing is more effective than meditation and breathwork for working with cortisol
Key supplements to support cortisol balance[25:19]
• She suggests phosphatidylserine at a dose of 400 mg to reduce cortisol
• Omega-3s from fish oil or plant-based sources are highlighted as critical for managing stress biology
• She cautions that you cannot out-supplement a bad diet or a very stressful life, but supplements can help
Relationships as regulators or stressors[25:39]
• She urges people to examine their relationships, which are often a common source of stress that people do not connect to their hormones
• A co-regulating relationship that calms the nervous system can reduce cortisol into the Goldilocks zone
• She references a preprint study about "hasslers"-people who provide some support but also a lot of hassle-who are associated with shorter life and higher cortisol

Understanding stress: eustress, hormesis, and the U-shaped curve

Healthy versus unhealthy stress

Eustress and hormesis[30:44]
• She distinguishes healthy stress (eustress) from harmful stress and describes eustress as hormesis, a positive intervention on the body's systems
Mismatch between ancient genome and modern stressors[30:57]
• She notes our genome evolved under infrequent stressors (perhaps monthly or quarterly) and is not designed for constant modern stressors like daily email overload
U-shaped curve of optimal stress[30:26]
• She describes a U-shaped curve where too little stress leads to under-contribution and too much leads to cortisol-driven dysfunction; the goal is the middle zone where productivity and resilience are highest

Meaningful stress and caregiving

How love and meaning buffer stress[32:04]
• In response to Jay's story about his wife caring for her dying grandmother, she says that serving from a place of love, even with sleep disruption, can offset extreme consequences of higher cortisol
• She clarifies that short periods (weeks or a month) of intense caregiving do not usually cause long-term bodily harm; chronic adaptation to stress over months to years is more problematic

After-work decompression, rituals, and avoiding maladaptive coping

Evening rituals and bookending the day

Need for transition between work and home[33:59]
• She recommends evening rituals to separate work from family and personal time, calling it a "bookend" similar to a morning ritual
Why alcohol is a poor decompression tool[34:04]
• She describes how she used to come home after seeing 30 patients and have a glass of wine, but now says it does not work as a healthy ritual
• Alcohol lowers testosterone, raises less favorable estrogens in women, is toxic to the brain, and shrinks the brain over time
• She notes people seek from alcohol the same state they should aim to create with a healthier ritual

Examples of regulating rituals and "menus"

Simple, low-energy regulation practices[34:50]
• She acknowledges not everyone can immediately meditate after work but suggests using "by whatever means necessary" including short breathwork and meditation
• She likes going onto her deck, looking at the view, and tracing the horizon to relax her eye muscles
• She enjoys reading something beautiful and meaningful and connecting with a loved one who co-regulates her
Movement, connection, and nature[37:12]
• Jay shares that playing sports like pickleball with friends in the evenings combines fitness, friendship, and fun and is deeply restorative for him
• He and his wife like to have dinner and then take a 15-20 minute walk, which supports connection and also helps insulin and glucose handling after a meal
• She notes that 5-10 minutes in a forest can regulate cortisol, adding to the benefits of walking in nature
TV, default habits, and variety in rituals[36:56]
• Jay admits some evenings he just wants to watch a show, but often feels it was not worth it afterward unless it truly engages and connects him with his partner
• They both emphasize the value of having a "menu" of options-some nights TV, other nights sport, walks, or connection-versus a single chronic pattern like nightly wine or TV that does not refuel you
Loss of commute as decompression and creating micro-commutes[38:49]
• Jay observes that commuting used to provide built-in decompression time; working from home removes that buffer
• He suggests creating a 5-10 minute decompression ritual alone-similar to old train or car time-to check in with body and mind before defaulting to evening habits
• She adds that decompression should be followed by regulation; both steps are important

Vibe checks and relational rituals

Partner vibe check practice[40:12]
• She describes a five-minute "vibe check" with her partner asking how their vibe is, what support is needed, and how she can be the best partner, which fosters giving and service

Family, divorce, and gendered hormone effects

Family as source of stress

Strong emotional impact of close relationships[45:41]
• Jay notes that family often causes some of the hardest emotions because they know us best and can say the most hurtful things

Divorce and hormonal health

Patterns of divorce initiation and health outcomes[46:04]
• She shares that she completed her divorce a couple of years ago and has reviewed data on men and women
• Men tend to have adverse health effects sooner after divorce, while women's health effects often appear later
• Around 69-70% of divorces are initiated by women, most commonly women over age 40
• She says most divorced women she works with feel that autonomy and healthier psychobiology are worth the short-term dysregulation
Men's and women's post-divorce support systems[47:10]
• She recounts a meme from a Stanford psychiatrist: men's health benefits from being married to a woman, while women's health benefits from being with girlfriends
• She observes many men lack close community and rely heavily on their wives, whereas women more often leverage oxytocin networks and social support
• She notes that economic consequences of divorce tend to hit women harder, which can also affect health

High sensitivity, triggers, boundaries, and people-pleasing

Understanding sensitivity and triggers

High sensitivity and overstimulation[48:11]
• She says about 20% of the population is highly sensitive, while 80% is not, and our world is not designed for highly sensitive people
• Highly sensitive individuals may need extra tools to avoid overstimulation and manage triggers, especially around certain people
Triggers as opportunities for healing[48:19]
• She advises to "never waste a good trigger," viewing it as revealing an area where you still need to heal, a shadow side, or an old childhood wound

People-pleasing, trauma, and the fawn response

Prevalence of childhood trauma[49:06]
• She says about 60% of men and 70% of women experienced some kind of traumatic event as children
Stress responses beyond fight-or-flight[49:44]
• She explains that stress responses include fight, flight, freeze, and fawn
• People-pleasing is framed as a fawn response where you abandon yourself to stay in relationship, often learned in chaotic childhood homes
Boundaries, guilt vs resentment, and self-responsibility[54:02]
• She describes her 12-step work on food and how it taught her to look at and clean up her side of the street in relationships
• She shares a teaching: when choosing between guilt and resentment, choose guilt, noting that always avoiding guilt can lead to self-abandonment and long-term resentment
• Jay adds that many stay with stressful people out of guilt and people-pleasing, and advocates boundaries, accepting that some people will be disappointed or misperceive you
• He suggests for every one stressful person, having three people who lift you up, shifting the proportion of energy you are exposed to

Decade-by-decade hormonal shifts: puberty to menopause and andropause

Puberty (ages roughly 10-20)

Immature control systems and volatility[58:51]
• She describes ages 10-20 as a period of hormonal volatility where boys and girls go through puberty and hormone control systems in the brain are immature
• Key control structures include the hypothalamus and pituitary, which communicate with adrenals and gonads (ovaries in women, testes in men)
Critique of early birth control prescriptions[59:10]
• She is not a fan of giving birth control pills to girls with acne, irregular, or painful periods, preferring lifestyle approaches first
• She says millions of girls aged 10-20 are started on birth control pills and calls the pill the number one hormone disruptor in the country

Young adulthood (20-30)

Stabilization and peak performance[59:06]
• Between 20 and 30, hormone control systems stabilize; women often have more regular cycles and men reach peak testosterone
• She notes this is when many NBA players she treats are at peak performance and can recover well from exercise
Importance of habits in 20s[59:26]
• She emphasizes establishing habits around food and sleep in this decade, warning that poor sleep can trigger a "fall down a hormonal flight of stairs" later

Ages 30-40 and beyond

Early detection in 30s[59:54]
• She encourages people in their 30s to look for early signs of change by checking markers like day 3 estradiol and FSH, and testosterone in men
Perimenopause and andropause[1:00:42]
• After 40, women often experience perimenopause with more than 100 associated symptoms, including mood swings, irritability, sleep problems, and memory issues like losing phone or keys
• She debunks the myth that hormones only change at menopause or andropause, insisting they shift decades earlier
• She introduces the term andropause for male hormone decline, often called male menopause, which involves gradual testosterone decline and is appearing in younger men
• She cites stress and toxins like bisphenol A and "forever chemicals" as contributors to falling testosterone in men

Birth control pills: uses, risks, and alternatives

Expanded indications for the pill

From contraception to acne and painful periods[1:03:34]
• Originally developed for contraception and about 90% effective with perfect use, the pill later gained indications for acne and painful or irregular periods
• She says pharmaceutical companies broadened indications, especially after patents expired, and as an OB-GYN she was trained to prescribe it for multiple reasons

Mechanism and impact on sex hormone binding globulin

Role of SHBG in acne and libido[1:03:37]
• The pill raises sex hormone binding globulin (SHBG), a "sponge" in the blood that soaks up free testosterone, which can reduce testosterone-driven acne
• She notes about 25% of women on the pill experience decreased libido or vaginal dryness due to lower testosterone
• A key concern is that SHBG remains elevated even one year after stopping the pill, though somewhat lower than on the pill, suggesting hormone balance may not be fully reversible

Inflammation, nutrient depletion, microbiome, and autoimmune risk

Increased inflammation[1:05:33]
• She notes the pill can double or triple levels of high-sensitivity C-reactive protein, a marker of inflammation
Micronutrient depletion and mitochondria[1:04:46]
• The pill can deplete nutrients like magnesium, CoQ10, and B vitamins (B2, B6, B9, B12), impairing mitochondrial function
Microbiome changes and autoimmune disease[1:05:16]
• She says the pill affects the microbiome and increases the risk of Crohn's disease, an autoimmune condition
• She points out that women diagnosed with Crohn's are often not asked whether they started the pill as teenagers
Informed consent and choice[1:05:16]
• She is not removing the pill as an option but argues that women rarely receive full informed consent about these risks before starting it

Painful periods, acne, and lifestyle-based alternatives

Myth that painful periods are normal[1:05:49]
• She states emphatically that it is not normal for periods to hurt and that the idea that pain is a normal part of menstruation is a myth that needs to be busted
Prostaglandins and diet[1:05:31]
• She explains that painful periods are often due to prostaglandins produced in the uterine muscle
• Omega-3 intake (e.g., from SMASH fish: salmon, mackerel, anchovies, sardines, herring) and anti-inflammatory diets can reduce prostaglandins and menstrual pain
• She suggests omega-3 supplements of 1000-2000 mg can help reduce period pain
Acne and inflammatory diet[1:07:10]
• For acne, she recommends identifying the root cause via hormone panels (e.g., PCOS) and using anti-inflammatory diets, cutting out gluten, dairy, and reducing sugar
Endometriosis, adenomyosis, and surgical options[1:07:25]
• About 10% of women have endometriosis as a cause of painful periods; adenomyosis occurs when endometrial cells grow into the uterine muscle
• She notes diagnosis and treatment can include lifestyle medicine, birth control pills, and laparoscopic surgery targeting the underlying pathology

Reversing pill effects and alternative contraception

Steps to take after long-term pill use[1:08:22]
• For women on the pill since adolescence who want to reverse some effects, she suggests starting with a multivitamin to address micronutrient depletion
• She recommends measuring inflammation and addressing it with anti-inflammatory diets
• Women with low-testosterone symptoms are advised to measure free and total testosterone and SHBG to see if they are affected
Clitoral size and patient decisions[1:08:54]
• She says the pill can shrink the clitoris by about 20%, which often convinces on-the-fence women to stop the pill
Copper IUD and satisfaction[1:09:24]
• She typically advises women wanting non-hormonal contraception to choose a copper IUD
• She states women with IUDs are more satisfied with their contraception than with any other method, citing ease (no daily pill), lack of systemic hormone effect, and symptom freedom
• Despite high satisfaction, copper IUD usage is low; she calls herself an "IUD crusader" seeking to increase awareness and use

Natural family planning and hormonal IUDs

Natural contraception via cycle tracking[1:09:57]
• Natural family planning typically requires a healthy, regular menstrual cycle and tracking basal temperature (possibly via wearables) to determine the fertility window
• Couples then practice outercourse during the fertile window
Hormonal IUD compared with pills[1:10:53]
• She personally prefers copper IUD over hormonal IUD, and hormonal IUD over oral contraceptives
• Manufacturers claim hormonal IUD hormones act locally in the uterus, but she notes that 5-20% of women still experience systemic hormonal effects

Managing IUD insertion pain

Pain control and supportive techniques[1:12:17]
• She has inserted about 5,000 IUDs and always does a cervical block, calling it "criminal" to insert an IUD through the cervix without pain medicine
• She encourages women to find a doctor who will provide numbing medicine and to use meditation, hypnosis, breathwork, and clear communication during the procedure to reduce fear and pain

Fertility, preconception lifestyle, and early testing

Supporting fertility when coming off the pill

"Boring basics" for conception[1:12:56]
• She emphasizes sleep, stress management, and nutrition as foundational before trying to conceive
• She recommends getting 5-7 colors of vegetables and fruits daily to avoid micronutrient deficiencies
• She suggests starting a prenatal vitamin 3-6 months before attempting pregnancy
Cortisol's hierarchy over sex hormones[1:13:55]
• She notes cortisol sits at the top of a hierarchy: the body must make cortisol to survive, whereas estrogen and progesterone are not strictly required for survival
• Therefore, unmanaged cortisol can suppress production of reproductive hormones important for fertility

Early hormone testing and double standards

Don't wait a year to get labs[1:14:55]
• She urges women not to wait 6-12 months of trying to conceive before testing hormones; instead, test as soon as possible
Different treatment of fertility vs non-fertility patients[1:14:55]
• She points out that women trying to conceive get comprehensive hormone panels, while women who are not trying are often told hormones vary too much to test-calling this a double standard

Cycle syncing, evidence levels, and N-of-1 experiments

Scientific evidence for cycle syncing

Hierarchy of evidence[1:16:49]
• She references the hierarchy of evidence she learned at Harvard, with randomized trials at the top, but notes such trials are designed mainly for drugs, not lifestyle interventions
N-of-1 as ultimate personalization[1:16:49]
• She says the best evidence can be the N-of-1 experiment where you serve as your own control for interventions like cycle syncing
• She acknowledges limited data on cycle syncing and seed cycling but encourages trying such approaches for 4-8 weeks and seeing if they help

Adjusting behavior within the menstrual cycle

Fitness and carbohydrate timing[1:17:47]
• She notes there is better evidence for varying fitness goals and carbohydrate intake based on menstrual cycle phases and hormone fluctuations like estrogen, progesterone, and testosterone peaks around days 9-11

Testing, empowerment, and generational shifts in health ownership

Limits of mainstream medicine and need for personal data

Failures in early diagnosis[1:18:36]
• She says many people are failed by mainstream medicine, not receiving early diagnoses for autoimmune disease, thyroid dysfunction, or high cortisol
Importance of self-tracking[1:19:16]
• She argues you are your best doctor, spending less than 1% of your time in a doctor's office, so daily life and tracking should dominate health strategy
• She recommends tracking sleep duration and stages (deep, REM), sleep latency (normal 10-20 minutes; less than 10 suggests sleep debt), heart rate variability, relationships, and metabolic health

Younger generations changing the model

Millennials and Gen Z expectations[1:20:20]
• She contrasts Gen X and baby boomers, who often accepted dismissal by physicians, with younger generations who want to own their health and participate actively
• She mentions younger patients rejecting the idea that hormones "vary too much" to test and demanding more comprehensive hormone testing
• She notes that more than 93% of Americans are metabolically unhealthy, reinforcing the need for personal responsibility and tracking

Integrating spirituality and heart-centered care in medicine

Spirit as a throughline in patient care

From protocol-driven to heart-driven practice[1:33:25]
• She says spirit is a critical part of how she cares for patients, though it was more "repressed" when she worked in conventional systems
• Many patients arrive fearful and dysregulated; before cognitive strategies, they need to be met, seen, and heard
• She sees her job as serving patients, understanding their gifts and values, and helping activate their own healing capacity rather than imposing her values

Burnout, vacations, and rediscovering meaning

Pattern of burnout in her 30s[1:34:13]
• She had early childhood trauma before age 3, which she links to ongoing dysregulation and frequent burnout in her 30s, especially after having children
• Her former pattern was working intensely, coming home exhausted, using wine to cope, and planning increasingly elaborate vacations to escape burnout
Role of spirit in preventing burnout[1:34:45]
• She realized she needed spirit, meaning, purpose, and heart connection with patients-not just protocols-to avoid burnout
• Seeing each patient as a "beautiful person" and focusing on wholeness now helps her sustain her work without repeating past burnout cycles

Rapid-fire "Final Five" insights

Best and worst advice about health and hormones

Best advice received[1:38:10]
• Her best advice: "Get curious, not furious," which she implies applies broadly to health, relationships, and self-inquiry
Worst advice received[1:38:22]
• Her worst advice: that hormones can't be measured because they fluctuate too much and that testing is a waste of time and money

Recommended 30-day habit

Track stress response via HRV[1:38:47]
• If listeners adopt one habit for 30 days, she suggests tracking their stress response, starting with heart rate variability, and running small experiments
• She notes she has observed that certain Zoom meetings actually raise her HRV, and she wants more interactions with those people, echoing Jay's 3-to-1 ratio of uplifting to draining people

Belief she changed about health

From "suck it up and stay" to honoring health[1:39:34]
• She used to believe you should always "suck it up and stay," especially when you have kids, but now sees that this can have a significant health cost for some people
• She notes that sucking it up and staying can involve self-abandonment that is harmful to spirit and hormones

Law she would make for the world

Regulate before deciding[1:40:20]
• If she could create one law everyone must follow, it would be: regulate yourself and then decide; do not make decisions from a dysregulated, fearful state
• She encourages learning to recognize in your body when you are dysregulated or in fear and delaying decisions until you are regulated

Lessons Learned

Actionable insights and wisdom you can apply to your business, career, and personal life.

1

Before labeling fatigue, mood issues, or lack of motivation as personal failings, measure your biology so you can distinguish mindset challenges from hormonal and metabolic imbalances.

Reflection Questions:

  • • What recurring symptoms (fatigue, low mood, poor sleep, weight changes) have I been blaming on willpower that might instead be linked to hormones or metabolism?
  • • How could getting objective data on markers like cortisol, thyroid, or insulin change the way I interpret my daily energy and performance?
  • • What simple test or measurement (e.g., a basic hormone panel, HRV tracking) could I initiate in the next month to better understand my physical baseline?
2

Cortisol sits at the top of a hormonal hierarchy, so managing your stress response-through measurement, practices like meditation, and better relationship choices-can create leverage across many other systems.

Reflection Questions:

  • • Where in my day do I notice the biggest spikes in stress, and what patterns or people tend to be associated with those moments?
  • • How might a daily 5-10 minute practice of meditation, breathwork, or a walk change my stress levels over the next four weeks?
  • • Which relationship in my life consistently leaves me feeling more regulated and calm, and how can I intentionally increase the time I spend in that co-regulating environment?
3

Health interventions work best when they are personalized experiments: use general evidence as a guide, but treat your own body as an N-of-1 trial and keep what clearly benefits you.

Reflection Questions:

  • • What popular health advice or trend have I tried that clearly didn't work well for my body, and what did I learn from that experience?
  • • How could I structure a simple 4-8 week experiment (for example, changing my diet, sleep, or exercise around my cycle) and track its effects in a way that feels manageable?
  • • Which one area of my routine (food, movement, sleep, stress practices) am I most curious to fine-tune based on my own data rather than generic rules?
4

Chronic people-pleasing and staying in dysregulating situations can act as a biological stress pattern; setting boundaries and sometimes choosing short-term guilt over long-term resentment protects both mental and hormonal health.

Reflection Questions:

  • • In which relationships do I most often abandon my own needs to keep the peace or avoid disappointing someone?
  • • How might my body (sleep, digestion, energy, mood) change if I began setting one clear boundary in a situation that currently breeds resentment?
  • • What is one small decision this week where I could consciously choose a moment of guilt (for saying no) instead of carrying quiet resentment for days or months?
5

Integrating meaning, purpose, and a heart-centered approach into your work reduces burnout far more effectively than occasional escapes, because it transforms how you relate to daily demands.

Reflection Questions:

  • • Which parts of my current work feel most connected to my values and which feel most misaligned or draining?
  • • How could I bring a bit more intention and heart-seeing people as whole humans rather than tasks-into one recurring interaction or responsibility?
  • • If I stopped relying on occasional vacations to recover from burnout, what inner or structural changes to my work life would I need to consider instead?

Episode Summary - Notes by Rowan

Dr. Sara Szal: Stop Ignoring What Your Body's Trying to Tell You! (THESE Are the Hormone Signals You Can't Afford to Miss!
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