175. The Hair Loss Conversation Your Doctor Should Be Having With You with Dr. Komal Patil-Sisodia

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As women, so much of our identity is tied to our hair. 

And when it starts to fall out, the internet will sell you a thousand solutions before anyone stops to ask why.

I recently sat down with Dr. Komal Patil-Sisodia — triple board-certified endocrinologist, hormone expert, and someone who has lived this firsthand. 

Stress-related shedding in med school. Postpartum loss. Genetic thinning. 

We got into the real hormonal and metabolic causes, the labs worth asking for, and why addressing the root cause will always matter more than the next serum, supplement, or device in your feed.

Your Symptoms Are Clues

One of the first things Dr. Patil-Sisodial wants you to know is that the pattern of your hair loss matters. It's not just about how much you're losing, it's about where, when, and what else is happening in your body at the same time.

Ask yourself:

• Is it sudden shedding or gradual thinning?

• Is it at the crown, or all over?

• Are you also losing eyebrow hair?

• Have you noticed more facial or body hair?
• Do you have heavy periods?

These details are clues. And they're exactly what a good doctor should be asking you about.

The Real Reasons Hair Loss Happens

Here are the most common hormonal and metabolic causes Dr. Komal covers in her clinic:

• PMOS (formerly PCOS) / High Androgens This is one of the most common culprits. Elevated testosterone and insulin resistance can drive thinning at the crown while simultaneously increasing facial and body hair. If you also have irregular periods, acne, or signs of insulin resistance, this is worth investigating.
• Thyroid Issues Both an underactive and overactive thyroid can cause hair loss, which surprises a lot of people. With hypothyroidism, you may also notice loss of the outer third of your eyebrows and brittle, cracking nails. With hyperthyroidism, the body is so hypermetabolic that maintaining hair growth simply isn't a priority.
• High Cortisol / Cushing's Less common but worth knowing about. Signs include fine peach fuzz on the face, scalp thinning, weight gain in the trunk, and muscle wasting in the arms and legs.
• Low Iron Especially common in women with heavy periods. Heavy blood loss means iron loss — and iron plays a direct role in hair follicle health. This one is frequently missed.
• Low Vitamin D or B12 Both have been linked to hair shedding. Low B12 is particularly common if you're vegan, have been on metformin long-term, or have had gastric bypass surgery.
• Stress, Postpartum, or Significant Weight Loss Shedding that starts a few months after a major stressor like a delivery, an illness, surgery, or significant calorie restriction  is your body's delayed response to that event. It's incredibly common and often goes unrecognized.

The Labs Worth Asking For

This is where a lot of women get let down by the standard system. A basic thyroid test and a CBC is not enough. Here's what Dr. Patil-Sisodia actually orders:

Thyroid

• TSH with reflex to free T4
• TPO antibodies — to check for Hashimoto's. Dr. Patil-Sisodia has noticed that her Hashimoto's patients tend to have worse hair loss, even when their other thyroid levels look normal on paper.

Androgens

• Testosterone and DHEAS — fasting, first thing in the morning
• Sex hormone binding globulin — because it affects how much testosterone is actually free and active in your body. Total testosterone alone doesn't tell the whole story.

Nutrients

• Iron studies — especially important if you have heavy periods
• Vitamin D — there is good data linking low vitamin D to hair loss
• B12 — particularly relevant if you are vegan, have been on metformin long term, or have had gastric bypass surgery

If Cushing's is suspected

• Dr. Patil-Sisodia will screen specifically if she sees the full picture — trunk weight gain, muscle wasting in the limbs, peach fuzz on the face, and blood sugar changes all showing up together.

If you've been told your labs are normal but something still feels off, push for this more complete picture. Print this list out if you need to. These are the questions worth asking at your next appointment.

Treatments That Are Actually Worth Your Money

Dr. Patil-Sisodia has been through every stage of hair loss herself and has tried virtually every treatment on the market. She's refreshingly honest about what worked, what didn't, and what she wishes she'd known sooner.

• Spironolactone This is a blood pressure medication that works as a diuretic, but it has a well-established off-label use for hair loss driven by high androgens. It works by boosting the body's own estrogen production, which in turn drives down testosterone levels. Dr. Patil-Sisodia finds it particularly effective for scalp hair loss and acne caused by high testosterone. One important note: it can help prevent new facial and body hair from forming, but it won't reverse terminal hairs that are already there.
• Birth Control Another option for high androgens. The estrogen in birth control increases sex hormone binding globulin, which binds up free testosterone and reduces how much is circulating in your system. Not the right fit for everyone, but worth discussing with your doctor.
• Treating Insulin Resistance This one doesn't get talked about enough. High insulin makes testosterone levels worse in two ways: it decreases sex hormone binding globulin, leaving more free testosterone in circulation, and it signals the ovaries to produce even more testosterone. Treating the insulin resistance directly — whether through medication, diet, or lifestyle — can meaningfully bring those androgen levels down. Dr. Patil-Sisodia is hopeful that GLP-1 medications will eventually be approved for PMOS, as she believes they could be a game changer for this group of patients.
• Metformin Has been used off-label for PMOS for decades and can help address the insulin resistance piece. It’s worth noting though that long term metformin use can deplete B12, so always check your levels if you've been on it for a while.
• Hair Vitamins and Supplements Dr. Patil-Sisodia's honest take? The best supplement is the one you'll actually take consistently. If you can't stick with something daily, it doesn't matter how good it is. I've been experimenting myself lately with Folly Nutrition Hair Health Gummies (Use code MATTHEA) and the difference I've noticed compared to other things I've tried has been hard to ignore. One thing I learned the hard way — take them in the morning. The B vitamins are activating enough that taking them at night had me wired!
• Rosemary Oil There is some data suggesting rosemary oil may act as a DHT blocker. Dr. Patil-Sisodia oils her hair once a week using a blend of rosemary, jojoba, and argan oil (something she learned from watching her grandmothers do it for years). She believes the scalp stimulation alone makes a difference.
• Laser Hair Bands Some white papers from device companies show an increase in follicle density per square centimeter with consistent use. Dr. Patil-Sisodia personally found a headband-style device more practical than a cap — it takes about 90 seconds per section rather than 20 minutes sitting still. Her dermatologist cleared it, and she's found it genuinely helpful. Not a cure, but worth considering as part of a broader approach.

What to Approach With Caution

• Minoxidil/Rogaine — Can be effective but comes with a significant caveat for women of South Asian descent specifically as there is around a 30% chance of increased facial hair with topical use. Dr. Patil-Sisodia experienced this herself. Oral minoxidil may have less of this effect, but results vary.
• Derma rollers — The idea is that micro-punctures increase blood flow to the scalp and stimulate growth. Dr. Patil-Sisodia learned the hard way that the roller can yank out hair. She now recommends a derma stamp instead, used gently — but always talk to a dermatologist first. Sanitation is critical or you risk infection.
• Biotin — Dr. Patil-Sisodia is very direct on this one: biotin does not help hair growth. More importantly, it interferes with lab tests that use a technique called radioimmunoassay — which includes thyroid tests, certain cancer markers like CEA for ovarian cancer, and cardiac troponin, the test used in the ER to diagnose heart attacks. A falsely negative troponin could mean a missed heart attack. You need to be off biotin for at least three days (ideally a week) before any bloodwork.

Before You Buy Another Thing 

No supplement, serum, or laser band will work if you haven't found the root cause first.

Dr. Patil-Sisodia's advice is clear: before you spend another dollar on a product, ask what is actually driving the hair loss. Get the full workup. See a dermatologist, even if you've already seen another doctor. And if you're not getting answers, keep pushing.

As she put it: you have to take the bull by the horns. One doctor might not have all the answers, and that's okay. What matters is that you keep asking because the answers are out there, and you deserve to find them.

And one more thing worth remembering: hair grows back slowly. Whatever treatment you try, give it at least six months to a year before you write it off. Track what you're taking and when you started. And most importantly, be patient with your body. 

Listen to the full conversation with Dr. Komal Patil-Sisodia on this week's episode of The Obesity Guide. 

Note: In this episode, I also mention I’ve been using Folly Hair Growth Gummies. I had been taking them in the evening, but realized the B vitamins were too activating for me that late in the day, so I moved them earlier. If you want to check them out, I’ll link them here:

 Folly Nutrition Hair Health Gummies (Use code MATTHEA)

Connect with Dr. Komal Patil-Sisodia:

Instagram/TikTok: @drpatilsisodia

Podcast: Clearly Hormonal

Practice: Eastside Menopause and Metabolism

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TRANSCRIPT:

Disclaimer: The transcript below is provided for your convenience and may contain typos, errors, or grammatical inconsistencies, as it has not been professionally edited or proofread. Please enjoy it as-is and read at your own discretion.

Please note: The content shared in this podcast and blog post is for informational and educational purposes only and is not intended as medical advice. Always consult your healthcare provider for personalized medical guidance.  

 Welcome back to another episode of the podcast. Friends, I have a real treat for you because I've brought back, I don't know, is this like the fourth, the fifth, the sixth time that I've had... It's a lot. I think it's probably the third, actually. But yeah, yeah. The third? It feels more. It feels more We talk a lot though. We talk a lot, so. Exactly. It's always a podcast when we're together. Exactly. I have brought back Dr. Komal Patel Sisodia. She is a triple board certified endocrinologist, does a lot in the metabolic health space and, today we're gonna talk about the hormonal aspect of hair loss. And so I was wondering if you can just start out introducing yourself, 'cause we have new listeners all the time. Yeah. And also, let me not forget, can you tell us about your podcast as well, just right from the jump? Yes. Because I love it. Okay. Oh, thank you. Yes. So thank you again for having me. I love being on your pod- I just love talking to you because we always have- Same ... like so many ideas we're exchanging. But for all of the listeners who have not heard from me before, I am Dr. Komal Patel Sisodia. I'm a board certified endocrinologist, internist, obesity medicine specialist, and a Menopause Society certified practitioner. Mouthful. But I am very passionate about endocrinology, metabolic health, women's health, and I have a podcast called Clearly Hormonal. I have a practice in Redmond, Washington called Eastside Menopause and Metabolism, and I am just super excited to be here. I love what I do. So yes. I love it. And hair loss is very personal to me because I have had several hair loss journeys starting from when I was in college to, different periods of my life. And because it's been so personal to me and I was listening to your podcast episode last week where you were talking about it and the association with weight loss, I've always been looking at what I can do from an endocrine perspective, and then experimenting with all the things that are out there on the market. You name it, I've probably tried it. Thank you for sharing your experience. Yeah. I don't know if you know this, but we did a conference however long ago here, like I don't know, a year or two, I can't remember at this point. Yeah. And you were talking about your hair journey and I was like... And then to myself, I was like, "Oh, Mattea, you need to go see a doctor." Like, there are answers, there are things, and I was like, it's because y- we were talking about it, right? Yeah, yeah. So it just, it always shows to me, it had been niggling in the back of my mind for a long time, but I was like, I don't wanna do anything. I don't wanna take anything. Yeah. I was very just, I don't know, h- like, in denial? I don't know what else to say. I just didn't want to address it. Mm-hmm. And so when you were talking about it I was like, oh, okay, I should look into this. Well, and denial is a big part of it, denial comes in strong because you don't want to acknowledge that there might be something wrong. Yeah. And the other thing is, is that as women, our identity is so tied to our hair. Yeah. And every time it's happened to me, I've been in denial the first time I had hair loss was when I was, I think, end of college, starting med school, and it was just- Oh, man ... a really stressful time. I think I was going through some personal stuff. I had maybe, there was a breakup in there, and then it was the stress of starting medical school. And I came home from summer break, and I think I'd lost a third of the hair on my head. And my mom, my sweet Indian mother, looked at me and goes, "Oh, my God, who is going to marry you?" Oh. And I was like, "What?" Like, "That's the reaction?" Oh, my gosh. Oh, my God. And, you know, like, understandable. Immigrant parents, anybody who's listening to this they have certain goals for their kids, which are, like, you're gonna get a good education, you're gonna get a good job and be financially independent, and then you're gonna get married and have grand babies for me those are the three expe- expectations of all immigrant parents for their children, right? So I was, like, working on the first two. The third one was in jeopardy, though. She was like, "Oh, no, we must fix this," so that four, six-week period I was home I got dragged to, her Eastern European hairdresser who gave me all sorts of concoctions to put on my scalp. At one... But, like, I was being force-fed protein. At one point she took me to our family doctor who's known us for years, and the funny thing is he- practiced, like I practiced at the same place as him, like the same hospital system later, and I was just like, "Thank you for dealing with me and my family's special level of crazy," right? Because I also had a doctor's appointment at this point, she takes me to the doctor, and she's like, "Dr. Chia will know what to do," right? And I was like, "Okay." So I was like, "Mom, I need you to stay in the waiting room, and I'm gonna go talk to Dr. Chia," because I'm in my 20s at this point, like I don't need my mom to come with me. And I'm sitting there, he's talking to me. We're talking about, med school, you know, touching on the hair loss. He's, like, trying to get to the r- and my mom bursts into the room. It could have been like a sitcom. And she goes, "Dr. Chia, fix her hair. Nobody will marry her." And I was like, "Damn, like this is the recurring theme." Nobody's gonna marry me with my hair loss. That's so funny that she came back. Oh, she totally did. I don't think they'd allow that nowadays. I don't think they would have. This was like early 2000s, and you have to... S- like smaller town, we'd gotten our healthcare in this particular clinic for a long time, it had been at least a decade at this point, so they all knew her and they let her back. Yeah. And that's what it was. It was like a very, I should write that in a sitcom episode type scenario. That- And Dr. Chia just looked at me and he goes, "Just eat more protein and work on your stress." And I was like, "Okay. Cool." Like, thank you. Okay you said there were other times as well or kind of- Yeah leading into now, what did you discover over time with yourself? So I think one of the things, and you know I've done a lot of content recently on PCOS or PMOS now. Yeah. For those who are listening, PCOS, polycystic ovarian syndrome, the name has been changed to polyendocrine metabolic ovarian syndrome, which is just a little bit more of a mouthful, but a little bit more accurate descriptor. One of the things that I've realized looking back was I probably started to have symptoms then, and that first round of hair loss that we attributed to stress was also probably the first signs of PMOS that I was having. Mm. Because I'd already had, like, the heavy periods and, the increased facial hair and things, and, I'd written that off 'cause I'm like, "I'm Indian," you know? Yeah. Indian women have hair. It's fine. Yeah. Right? So I think what we don't do is we don't do a good job of teaching women how to pay attention to their bodies when these things are happening. Yeah. Because I wrote the first one off to stress. I wrote the second one off to postpartum, and then, maybe five, six years ago, I wasn't even stressed yet because the pandemic hadn't started yet. It was, two weeks later the pandemic started, and I was having a flare of this rash that I thought was eczema for years. Turns out it was psoriasis. But I went in to see my dermatologist, and I love her. She is such a wonderful person. She's a friend and, but her delivery is very deadpan and very direct. So we're sitting there and we talk about the rash, whatever else, and I'm getting ready to leave, and she's like, "Are we gonna talk about the fact that you're balding?" And I was like, "Damn, girl." "I know we're friends, but damn," like- These are some direct conversations- You know? And- ... that you are having. Right. And I appreciated it, her MA was like, "I'm working on it. I'm working on her delivery." We're working on her soft skills. But I was so grateful, because at that- Yeah ... point, it really forced me to look at the fact that I had signs of androgenetic alopecia and she sat with me, and she was just, very logically walked me through it., "Okay, so, you had all your labs checked. They look okay." And at that point, I think my PMOS symptoms had been pretty well controlled. I didn't have elevated androgen levels that they could catch on labs.. All of that was really good, didn't have signs of insulin resistance. But she was like, "Look at your, the scalps of the women in your family as they age. Do they have thinning hair?" And I was like, "Yes, they do." And she's like, "So there is a genetic female pattern hair loss that you're also dealing with," so I've been through the gamut of it. I've been through stress. I've been through postpartum. I've been through PMOS related hair loss, and then the realization that we have female pattern hair loss that runs in our family, and that I had to be proactive about it because I'd gotten lucky so far that it had come back each time. Yeah. And I wasn't gonna keep getting lucky if I didn't do something about it. That kind of Sent me down the rabbit hole of trying to figure out all of those things, so. Thank you for sharing all of this because again- Yeah ... I think the context, there's so much that I can relate to here, these different periods that you're talking about. Yeah. It's so incredible how the stories are so similar for many of us. Can you give us a little bit of a broader context? What are some of the endocrine factors that can play into- Mm-hmm ... hair loss? Yeah. Well, so the first one I mentioned, which is the polyendocrine metabolic ovarian syndrome, mm-hmm. That one we very commonly will see, androgenetic alopecia or androgenic alopecia, where you have that frontal hair loss on your scalp, but then increased facial and body hair everywhere else, and that tends to be a pattern. That's because of those elevated androgen levels, testosterone, DHEAS. The flip side of that is that you can also have that by itself, if there's an ovarian or an adrenal tumor that is producing testosterone or DHEAS, you can have similar symptoms without actually having PMOS, so there can be, ovarian or adrenal issues that happen there. There are other, things like thyroid disease, hypothyroidism and hyperthyroidism. So if your thyroid gland is underactive or overactive, it affects the health of your hair follicles. In hypothyroidism, because you have less thyroid hormone on board, and that's what regulates your metabolism, you actually get hair loss, but one of the hallmark features is you lose potentially the outer third of your eyebrows, And eyelashes. I have women coming and telling me, "I'm losing my eyebrows. I'm losing my scalp hair." We joke in endocrinology, you're not a real endocrinologist until somebody brings you a bag of their hair- ... to show you how much they've lost, to try and prove to you that they might have a thyroid issue, it's like a rite of passage, and I totally understand it because I've done it i've, not taken the bag of hair in, but I've, tracked my hair loss in my hairbrush or how much is clogging the drain and, it's really- Yeah ... hard not to freak out when you see that amount of hair coming out, right? Yeah. Because the true thing that I've found over the years is that you lose hair a lot faster than you can grow it back. Yeah. And ask me how I know from personal experience, right? It takes a while. And for my patients who have thyroid disease, with the low, thyroid hormone, they're losing the hair on their scalp, they're losing body hair, they're losing outer third of the eyebrows. They're getting brittle nails that are cracking. Mm-hmm. On the flip side, when you're hyperthyroid, because you're hypermetabolic, and your body needs to fuel its metabolism, you're also then starting to lose hair because it can't maintain the hair on your head as well, so people are like, "Well, I can't win if I have either thyroid condition," and the truth is yes, those are the two major things that can happen. And then the other place that I see it is when people get, uh Cushing syndrome. Mm-hmm. Cushing syndrome is where your pituitary gland, in your brain, that's actually Cushing's disease, has a tumor that's overproducing- the hormone that stimulates your adrenal glands to make cortisol. The end result is you have high cortisol, but it's because the brain is sending ACTH, which is that hormone that stimulates the adrenals. Or if there's an adrenal growth that is overproducing, cortisol, it, as a tendency, also tends to overproduce a little bit of DHEAS. And what I'll see in my patients with Cushing's is they will actually get, like, a fine peach fuzz on their face, but then they'll start losing their scalp hair, mm-hmm. So there's a lot of different flavors of it, but the really important thing is understanding your stressors, like what may have contributed leading up to it. I know we see in our weight management patients, that the weight loss and the calorie restriction, that can also really contribute. But then also, what are the other physical signs and symptoms on your body that you need to look for to know for a fact? And then my other subset of patients who have very heavy periods, whether that is from PMOS or from something like endometriosis, with all of that blood loss, they lose a lot of iron, and that iron deficiency, even though it's not a true endocrine, like directly endocrine, that iron makes a big difference. I love how you pulled that back because it's- Yeah ... people don't fully walk the dog all the way on it, yeah. So hair loss is happening- in your clinic. Yeah. Are there certain labs that you're always ordering? Oh, absolutely, first I, I sit and I talk with the patient. Like I said, I try and get an idea of, what are the stressors? How long has the hair loss been happening? Are there any other symptoms that are accompanying it? And then we go from there. But generally, I will always screen, TSH with reflex to free T4, and it's not standard of care to do this, but I do this because I'm a type A endocrinologist. I'll check a set of thyroid antibodies, TPO antibodies specifically, to look for Hashimoto's because I, for whatever reason, my Hashimoto's patients, in my experience, I don't know that there's actually data in the literature to back this up, they tend to have worse hair loss. I don't know why. Yeah. Interesting. So I will look for all of the thyroid studies. I will look and see if there are signs of hyperandrogenism, I will always check a testosterone and a DHEAS fasting in the morning to see what those look like. If I am seeing signs of Cushing's syndrome, which is very specific You get weight gain all through the trunk, you get muscle wasting in the arms and legs, and you have that pattern of soft peach fuzz and scalp hair loss. If I'm seeing that, then I'm going to screen for that, right? Because that's usually also accompanied by diabetes that's kicking up, things like that. And then with nutrient deficiencies, especially since I see some patients who are, post-gastric bypass or they have, some sort of malabsorptive thing, the i- and the heavy periods, the iron is gonna be, a big thing, so iron studies. Then I will check vitamin D,, because there is, there's really great data that shows that low vitamin D can be associated with hair loss. And then I've found that B12 also is a contributing factor, especially, I have some patients, and this is not very common, I have one or two in my practice who have a condition called pernicious anemia, which is an autoimmune thing where you just don't absorb the B12, and so I have them on, nasal spray B12, which works wonderfully. But that low B12 can do that, or if you have a patient who's, vegan or vegetarian, they may not be getting enough B12. Or if they're on metformin for a very long period of time- Wow ... metformin will deplete that B12, right? So I'm always looking for these little patterns, but those are really the main things that I try and rule out off the bat to know that, are we looking at all the potential medical things, hormonal medical things that are gonna contribute to your hair loss. Okay, this is a super comprehensive- Mm-hmm ... list. I'm so glad we went through this. Yeah. And can we... I wanna double back to you were talking about looking for, hyperandrogenic, manifestations- Yeah ... on the body. I know you said a few of them, can you name a few of them just so people know? Absolutely. So it'll be a pattern of scalp hair loss, so you'll see thinning a- across the crown, right? You will see increased facial hair, like those coarse what they call terminal hairs, like the thick ones. You'll see that on the chin, neck potentially. Some women have it on the chest and around their nipples. It will... You'll see increased, hair growth in the groin area spreading onto the thighs and up the stomach. Mm-hmm. And then increased just body hair in general, that can be a sign. The other sign can be changes in the voice. If your voice is getting deeper- it can be a sign that you have excess testosterone. It's really interesting because, the voice literally changes octaves. And the sad thing is when it gets to that point, even if you treat the underlying condition, like say you find a testosterone-producing tumor, the voice doesn't go back, so- Wow ... at the first sign of those things, I'm always asking questions. And then some patients report clitoromegaly, which is another sign of having too much testosterone on board. They get, they have enlargement of the clitoris, and that can be, painful or disturbing or, very psychologically, distressing to people when they see- Mm-hmm ... changes like that in their body. We also see an increase in muscle mass, right? Because- Mm ... there's more testosterone, so you're holding onto muscle a little bit more. But that doesn't happen in everybody. But that's the general pattern that I'm looking for when I'm seeing somebody with high testosterone, or that I suspect- Uh-huh has high testosterone. What... And I'm jumping around a little bit just because I have- Yeah ... some questions as we're going through with the thyroid, if you treat those conditions- Yeah ... either hyper or hypo, does the hair, in the eyebrows and eyelashes, stuff like that, does that come back or does that continue to be- It, it usually does, but again, going back to what I said before, we lose it so much faster than we can grow it back My friend who's my dermatologist, she was like, "One hair follicle lives for three months. You have to go through two hair follicle cycles to even see, the little baby hairs sprout out. Then really it's gonna be a year before it comes back." And I think my the thing that people have the hardest time with is that duration of time where they are left feeling like they don't have a solution. And it also causes a lot of people to give up on stuff, they will try something- That's what I w- Yes. 100%, because- Mm-hmm ... and, I don't know how far we'll go on this episode 'cause- Yeah, yeah ... guys, we could talk for 10 hours. But I feel like I've tried some different products, and I know I'm not using them long enough. Like- Yeah ... fact. I, past three, four months, I'm like, "I don't know. Do I wanna spend 2, 300 again?" It's like it just feels like- I know ... am I getting had here? But, and then I don't think that enough of us keep good records, 'cause I don't know about you, I cannot- No ... remember when I started things. Mm-hmm. So now I'm getting a little bit better. Everyone, this is my tip for you. I have in my phone OneNote, and it has, It tracks my weights, it tracks, I don't know, if I am tracking blood pressure. Whatever it is- Yeah ... I have it all in one document. So- See, that's brilliant. I do the peck and hunt, and I look at my email to see when I ordered said supplement. That's true. And try and backwards extrapolate how I did, how long I've taken it, which is not useful. So yes, do Mattea's note method. I might have to start that today because like, oh, it, it feels like I did this for three months, but- Totally ... even that's not enough, truly you have to do something for six months to a year for it to be able to help and there are so many different treatments that are out... Well, not so many. There are different treatments out there, but if you're not giving them their full due, then You don't find out. You don't actually know We talk about lots of- Yeah ... conditions here, lots of reasons. Yeah. Let's assume that there is this androgenic pattern happening. Yeah. So this female pattern hair loss, again, all the things that you were talking about. Mm-hmm. can be done about that condition specifically? Yeah. Yeah, and I think that's a great question, first and foremost, if you are suspecting that there is a tumor that's producing it, because that presentation is much more, dramatic it will- That's what I was gonna ask. If that's- Yeah ... like, sudden onset, I mean, you're not gonna- It's very sudden. Yeah. It may not be sudden onset, but the presentation is dramatic, right? Like- Okay ... the facial hair is like a male beard. Oh, okay. Yeah. Yeah. There is truly, so much thinning on top that you can see scalp. There is that deepening of the voice that you will, notice right away when you're starting to talk to somebody. You can kinda see more of their muscle definition. They may have more acne. For those patients, I will, the ones that I strongly suspect I will do that workup to look at the ovaries and the adrenals, and we'll figure out what that looks like. And then if that's all ruled out and we think that this is just really severe PMOS that's causing this, there are a few different treatments, so in PMOS, one of the things that we see are the elevated androgens, and I'm hoping they incorporate this other one into the medical criteria, but it's the insulin resistance. And the two are interrelated, and I think it's really important for women to know this, because a lot of our treatment for a long time for PMOS was spent trying to lower the androgens. Yes. And you can do that with spironolactone. Spironolactone is a great treatment, it is a, traditionally a blood pressure medication that's a diuretic, but it increases the body's endogenous production of estrogen, which means it drives that extra estrogen derives down the testosterone, and that will improve your scalp hair loss. It works really well for acne that's caused by high testosterone. It also works pretty well for, preventing more facial hair from forming or more body hair from forming. Mm-hmm. To see the regression of that facial and body hair from, what the baseline is, that's not always successful because- Mm once those terminal hairs start to grow, you can't get rid of them with a medication. Okay. But that is a really great treatment because that works specifically on decreasing those. Some women will get prescribed birth control., Birth control has the ethinyl estradiol in it, which is really potent at suppressing the testosterone levels. And what estrogen does is it increases the sex hormone binding globulin, so more of the circulating testosterone gets bound up by that, and there's less free that's floating around in your system. In these patients, I'll look at both total and free testosterone to get an idea of how things are, playing out because the sex hormone And I also check the sex hormone binding globulin level because that'll, play into how I'm interpreting those labs. So that's another option. Now, where it gets interesting is the insulin resistance piece of it, because- Metformin has been used off-label for decades for treating it Mm-hmm And the data has shown that in patients who have insulin resistance and PMOS and elevated testosterone levels, the high insulin makes the testosterone levels worse twofold. It decreases the amount of sex hormone binding globulin that's there, so then there's more free testosterone that's circulating, and then the insulin goes to the level of the ovary and makes the ovary produce more testosterone. So you... I know, right? It's cruel, okay? You're like, "It's mean," right? Insulin is not so nice in this scenario. But it just goes to show that if you treat the insulin resistance, you can also help lower those levels. What this always makes me think of is when people are like, "Just eat less and move more," it's like, it's not... I know, you're rolling your eyes- Yeah ... everyone that's listening. It's not solving the problem, and it's like- Correct ... in how many ways can we say this? But when you just explained that- Yeah ... that's the little clip I wanna play for the person that's still stuck in the calories in, calories out. Yeah. You have to approach everything from a multifactorial view, because it is exceedingly rare that just one thing is playing into whatever your health condition is. Like, sorry, that, that is not very common at all. Most of the health conditions we treat that are chronic have so many different inputs that are plugging into it, yeah, so that's generally what I'll do. And metformin is great and all, but GLP-1s, if we can get those approved for PMOS, it will be a fricking game changer, that would change my life in clinic treating people. Yes. Let me just tell you. Yes. Yeah. And I'm hopeful that with this name change from PCOS to PMOS and we're acknowledging the gravity of these metabolic complications, that'll spur on more research to happen with GLP-1s- Yeah in this particular space. So in this scenario of high testosterone, either due to the testosterone-producing tumor, which we talked about the first part, or PMOS, this is how I manage that bucket of patients, yeah. What about DHT blockers? You hear about this so much in the hair loss industry. You mean the minoxidils or the... Yeah. Like fina- even some, uh, finasteride. Yeah, finasteride and- Yeah. Yeah. So I'll say, and this is everybody has a very different experience with these. So when I saw my friend who's a dermatologist, she was like, "Spironolactone and topical Rogaine for you." And so I started that, and the interesting thing is that if you are of, South Asian descent, you have, a 30% chance of getting increased facial hair when you start using Rogaine- Mm ... to preserve your scalp hair, so it becomes a decision, and that's exactly what happened to me. I was like, "This is, what is all this peach fuzz? Do I have Cushing's?" No, I don't have Cushing's. Yeah. I have minoxidil, and it's causing me a problem, and there are some people who say that, it works better orally and you don't see that as much, but I did not have a great response to either one, and I have some patients who don't so at that point, you're left with spironolactone and treating the insulin resistance and trying to do all the other things. And this is where you go into that rabbit hole of,, what supplement is good for me, what, hair serum is good for me. Mm-hmm. Should I buy a laser cap or a laser hair band, right? And the thing is again, because I believe all of these things are multifactorial, I have tried all of these things. I think the only thing I haven't done is, PRP injections for my scalp. I- I'm not laughing that you've tried it all, but I'm like, I feel like I'm joining your band camp on this. Yes. I will s- and it, I will say, like, there's a few things. Like, right now there's this... Oh gosh, you've probably never heard of them, but they're at, the brand's called Folli, F-O-L-L-Y. I've been talking about it, like, internally. Yeah, yeah. Oh, have you heard of it? I, I heard about it on your podcast. Oh, okay. I was like Yeah. Oh my God, you're making me laugh. Anyway, but can I tell you what's funny about it? I think because of how they're doing the different encapsulation stuff- Yeah ... do you know, it seriously, it keeps me up at night if I don't do it in the morning. It's- Really? I've never taken vitamins and things where it had this much of an effect on me. Wow. So my conclusion is maybe other things that I've done in the past have not actually been effective- Okay ... because how do you feel so different with something, Yeah ... but my whole thing is I think it's really hard for people to understand what is actually- Yeah ... clinically effective as far as dose. Yes. And so when I was researching them, I was like, okay, they're on par with Nutrafol. Yeah. Nutrafol did this, they're that, right? Yeah. Like, I was looking into all that. Yeah. With you, do you, either did you find anything personally or do you see anything with patients in this whole land of, like red light bands and all the things? Do any of them help? That's a good question. So I'll say for me personally, what I found helped was actually, , the red- light hair band thing. I found one that's like a... One, I'm not gonna sit with a cap on my scalp for 20 minutes. I'm sorry, ain't nobody got time for that, that's, that was just a hard no for me. So I did a lot of research and into looking at it, and there's one, I think it's called, LaserMax or something like that, but it's literally, it looks like a headband, and you- Oh ... it's like 90 seconds on each section of your scalp as you just move the, like it buzzes and you move the headband back. Okay. That actually really helped. It's interesting, because it has, I think, m- the same amount or more than the caps of lights per area. Yeah. So I think that matters. The other thing is my hair is really dark, so how much that penetrates through that, do I follow the instructions exactly or did I make up my own regimen? I might do it a little bit more than what they recommend, right? Well, there's some nuance to this. Yeah. My sister does red light therapy,. like professional machine, that in the clinic. Yeah. And there's a little bit of nuance to, there's what's recommended, but then there's what actually works for the person, whether it be more or less- Yeah 'cause some of us are so sensitive- Yeah ... it needs to be less. So- Yeah ... I hear you with I don't know that it's bad to experiment a little bit with this. Yeah. And it's like I figure as long as I'm, like, not burning my scalp, it should be okay, right? So there, there's that. I've tried that. That's been really pretty good. I tried a new supplement recently that I'm halfway through, but it's called Xtrace. And so I'm like I think 45 days into this now because I- I'm halfway through the second bag. That's how I know. But I like it in that it's easy to take. Like the Nutrafol one, just like it was a lot of capsules- It's a lot. Oh my gosh ... and I couldn't, I couldn't... somebody described it to me as very earth forward. And yeah, and I just couldn't- And then, the regurgita- I mean, like, do you know what I mean? How, like, you, that, like- Yeah ... taste in your mouth- Yeah ... that you're like, "Ew- Yeah ... bad choices." Yeah. Yeah, yeah. That one just didn't really work well for me. And then, I think probably five or six episodes ago I interviewed this really incredible dermatologist, Dr. Sarah Stearman, on my podcast, and we talked a lot about biotin, and- Wow ... biotin is a freaking scam, let me tell you. Like- I know biotin does not do anything other than mess up your labs in my opinion, so she told this really interesting story about how the data for biotin came from a study on horses' hooves where they gave- Oh my gosh ... horses biotin to look at subjective thickening of the hooves, and then from that study decided it was great to recommend to women for hair loss. But you know what? This is happening right now- Yeah ... with, creatine If you actually look at the study, there was like, guys, I'm gonna be butchering this, I'll put the exact link below, but it was like maybe 20 dementia patients, and then they're like, "Maybe it didn't get worse." But it's not like- Yeah women cognitively getting better or, oh, all this stuff. Yeah. And it- it's subjective. Some of my patients, their brain fog gets better, but there's not amazing data behind creatine. No. No. Yeah. No. It- it's great for, I think, muscle. Yeah. But the cognition piece of it, it's like we ha- we have to be careful the way that the influencers are promoting it, I'm just like- Yeah ... this is wild that you're making these claims. Yeah. Well, and I think people also don't realize if they're not hydrating well, it's making your kidney function tests look funny- Oh, no ... or potentially even causing some issues so it's the same thing with the biotin. The biotin will mess up any lab that is done by a technique called radioimmunoassay because the biotin interferes with that. So your thyroid tests will get affected. The two scariest ones I heard, though, one, a gynonc surgeon told me that it messes with the CEA levels, the cancer markers for ovarian cancer. It can falsely lower those. And then I had a cardiologist tell me it messes with the troponin, which is the test- Oh ... they do in the ER to see if you're having a heart attack. Can you imagine somebody who has, no changes on EKG, but then their troponins are falsely negative and you miss a heart attack? That, to me, is terrifying. Oh my gosh, 'cause guys, that's a non-ST segment elevated, God, what's it called? Yeah. NSTEMI, where it's like- Yeah ... okay, it's very important and we keep people in the hospital and we know something's going on. Wow. I- That one I didn't know. Yeah. That one freaked me out. And so I, and like I talk very openly about the heart health history in my family. My mom, my husband are affected. That, to me, is terrifying, I told them, I was like, "Check all your supplements. Make sure there's no biotin in them," 'cause God forbid you go in, you have to be off of the biotin for a week for it to not interfere with your labs. Three- Three days minimum, but really a week. What this brings up for me though is that everyone's thinking, "Oh, AI's gonna take over everything." And I'm like, "Totally. It can look at a lab, it can say what it thinks-" Yeah ... "should be going on." But then we get down to this, where if someone was in the ER in front of me and they had chest pain and they have, a history of high cholesterol, there's a certain- Yeah ... picture where you're like- Yeah ... "I really think something's going on," right? You would then do a stress test before you send them home, you would not... You would say, "My clin- my Spidey sense is up. I'm getting that, tingle in the spine-" Yeah ... "that we gotta keep going." So I remember I had a patient in clinic, this is when I was doing primary care, and- Yeah ... she was telling me about the worst headaches of her life. They were bitemporal, so both sides of the temples, guys. Worse with chewing, da, da, da. I'm like, "She has..." What are we calling it nowadays? Giant cell temporal arteritis or- I think so, yeah ... temporal arteritis. Yeah. Yeah. Anyway, so my point is I was like, " this is affected for her." So I got her as far as I did not care that the labs were not elevated, 'cause that's classic that the labs are elevated and then you give them steroids to help preserve vision. We got the biopsy. It was positive, and I was like, "If I hadn't kept going, she would've been blind within the next few weeks." Yeah. Hands down with how it was happening. Yeah. Yeah. And, and that's the, and that's the thing, and I totally agree with you. I'm not worried about AI taking our jobs because they're gonna miss stuff like that. Honestly, I think it has the potential to harm people. It actually really scares me when people come in and they're like, "I ChatGPT my symptoms. Let's go toe-to-toe for line-to-line and see how accurate you think it is." And I'm like, "Do we really wanna spend your appointment doing this? But okay if you want to, we can." If you want to, let's do it. But yeah, it's not really the best use of our time, but, I'm- We- ... I'm open. So back to this, the oral thing that you were talking about. So what, what exactly is it? Is it a capsule or? It's a, it's a gummy actually. Oh, a gummy. Okay, cool. Yes. Okay. Yeah, because I'm also, a child and I can't do pills. Like, I love gummy vi- It's like- I... No, me too. I'm obsessed with Gruns and Folly. The, the- Yeah ... the thing is, I always tell people is, "If you can't stick with it, I don't care how amazing it is. You have to be able to show up daily to do it." Yeah. "Otherwise you're not gonna do it." Yeah. And to be fair to Nutrafol, since I called it out by name before, it actually did help my hair. Yeah. Because it's got a ton of other stuff in it. I just couldn't swallow the pills. They made me- Totally ... gaggy, right? Totally. And- So again, it's, to your point, the best thing for you is the one that you can tolerate That, and I love that you're like, "'Cause we called called about by name." Different stuff's gonna work for different people, right? Yeah. So everyone do what works for you. Yeah. This is not like go it 100%, 'cause my clinical scenario, your clinical scenario, it's gonna be very different than- Yeah ... the person in front of us, that's why- Yeah ... it's so helpful to go see a physician, because we can- Yeah ... get to the bottom of what's happening for you. Do you use anything like serums or anything like that? That's a good... Yeah. I have not found one that I love, love, but what I've gone back to recently, and this is my grandmothers did this, my aunts did this, they oiled their hair, and then there's some data around rosemary oil that it may be a DHT blocker,? Yep. Yep. So I, I will oil my hair once a week, right? And I feel like that's actually made a difference for the strength of my hair. I think we also as a society got super into, the no wash washes, where we were not cleaning our scalps properly, and that's really bad for your scalp, right? Um I never got into that. Uh, but I, I remember- I'm so glad. I, I did it for a week- I feel like- ... and I was like, uh, "My hair is so oily. It's so nasty. I can't do this." Oh, yeah, 'cause I- I gave up. I, yeah, if I don't wash my hair daily it, it's so fine that it looks so nasty, and I'm like, "I'm not trying to look like I didn't wash my hair." Yeah. It's a no. Yeah. So I, I have, a concoction of, I think I bought them all at Trader Joe's, of, jojoba oil and argan oil and rosemary oil, and I'm, like, creating little tinctures in my bathroom and rubbing it into my scalp. But my grandmothers did that with different oils for years yeah. But I have intentionally put the rosemary in there just to see if it makes a difference. But I think just the act of, conditioning your hair, brushing through it, like stimulating your scalp. I bought one of those little, silicone things with the little prong things, and I try and- Oh, wow massage it into my scalp, very gently though. Yeah. I did have a near-death experience with a derma roller because I- ... I read this thing about derma rolling your scalp, and so I was like, "Oh, I'll do it." Did this, and then, yanked out, a chunk of hair, and then I was like, "Well, that was a stupid plan." But they have these- Wait, can you ex- explain what it is- Yeah ... to people? So- 'Cause I might might not be in this hair loss world at all. Yeah. For, like, some dermatologist is gonna listen to this and be like- ... "Dear God, get this woman-" You know what? If, if, like, contact me- "... to keep her safe from herself." We'll, we'll, we'll have you on the podcast. Yeah. Contact me. Exactly. No, but, derma rollers have these tiny, fine needles, and the thought is that, if you p- make micro punctures- Yeah ... it increases the vasculature to the scalp, and then you grow more hair, hmm. I did talk to a friend of mine who's a dermatologist. She's like, "Use the stamp, not the roller," right? So there are these- I've seen that. They're getting- Yeah. So the- ... advertised to me like mad. Yeah. And so I am playing with that. Am I consistent with it? No. Because it's a little uncomfortable and I'm a baby, so Again, can we stick with it? All roads lead to Rome. I know. Look, your doctors struggle too. Consistency is key. Do as I say, not as I do. Just kidding. It's... But it's hard especially when it's something that, you're wondering whether you have time for, and it just becomes a thing. So I haven't been as consistent with that. The other piece of it is that if you're gonna do that, you have to sanitize the heck out of it. Yes. Because then you are setting yourself up for an i- infection. So I know I have really moved away from that after my, initial incident. I did try the Stamper. It does work. It doesn't yank out my hair. But again, talk to a dermatologist about whether that's actually useful or not. There are some who say that it will, others that won't. I did experiment with a little bit of Latisse- Yes .. When I had, a kind of a bigger patch here in the front that was- Mm-hmm ... that had really thinned out. It actually did help, but you have to use it consistently, and the thing with Latisse is that it's not made to penetrate the skin on your scalp, so it's only gonna be as good as, you know... I don't know. I don't know that it works. Yeah. I've tried it- It's like- When I say I've tried it all, I've tried it all. What I often wonder too is, like, when, if you're using multiple things at the same time, is one contradicting the other? Mm-hmm. And I'm not talking about, I think the multivitamins and things like that, okay, that's the substrate, the building block, right? Yeah. Like the protein you're eating- having enough B vitamins, all that kind of stuff. But then it's if you're using multiple oral medications and topical medication and- Yeah like just at what point does one thing interfere with the other? And that, that's my thought, right? Like I don't have time to put all that stuff in my scalp at a regular cadence. Like I'm barely just trying to get my, the makeup off my face and skincare on, right? Like the scalp is a whole other story. I was trying this I forget... Oh God, I forget the name of the company. Yeah. Everyone was, "Oh, this is so incredible." Anyway- Yeah ... it left like white dandruff-y flakes in my hair, and I was like can you imagine during the day I'm seeing patients, there's just little flecks just like- Chunks like snow in the hair. Yeah. I'm like, I... This will not work. It's just interesting. And having darker hair, like that is an absolute no-go for me. Same. It's like- Right? Like that is just... Yeah, that's my worst nightmare. So I think that there are things you can try, but again, I will say consistency is key. The things I've been consistent with are those hair vitamins and the oiling my hair and the using my little laser hair band that I really like. Uh-huh. And they go on and off sale. I've seen them at Nordstrom, I've seen them at Costco, I've seen them, all over the place. I just saw them marketed online y- like literally yesterday. Yeah. Yeah. Yeah. I mean, There is some data that shows that you see an increase, I think what, how they count it is like number of follicles per square centimeters or something like that. Oh, mm-hmm. So, there are some white papers by these devices that show that there is an increase in that but again, a white paper is not a randomized control trial- Uh-huh ... so you gotta take it with a grain of salt, because it's- Uh-huh ... not enough patients usually. But I figure it's not harming my scalp, and my dermatologist cleared it to try, so That's what I was gonna say, sometimes that's better than no- Yeah than nothing that they have behind them, and they're just, talking out of their behind. Yeah. I think what I like in the beginning, you just talked about such a breadth of different conditions that can be leading to this. Mm-hmm. And how if we don't actually treat the disorder- Yeah we know the hair loss will get worse, can it get better? Who knows. But it's just like we actually have to get to the bottom of that because I don't think that this whole workup's being done for everyone. I know it's a fact. No, it's not. Because it's not happening for my patients. It's not. And then I'm having to double back. And do you know that I, and this is... I mean, sometimes I have to write out the labs, "I want you to get this done," and let's say they're gonna go to the primary care doctor the next day, and they'll sometimes be like- Yeah ... "Well, is there anything else I should throw on?" And I'm like, "Okay, so here's what I want." I'm like, but then I also write the reason so that that doctor- Yes ... doesn't wanna punch me. And I'm like, "Hey, it's because we're worried about da, da, da, and here's what I would do with it." Yeah. And then they're, always okay, and they order it. Yeah. But if you don't explain it they think you're being a backseat driver. Yeah. Yeah, absolutely. And sometimes what I'll do, like I just have a, I created a panel of labs for hair loss in my EMR. I'll just be like, "You know what? I'm gonna order this. Take the sheet. It has the diagnosis codes and, the labs on there, so if your primary care doesn't feel comfortable ordering, you have it, you can just go get it and we'll talk about it, because it is hard to have that conversation sometimes. I would love if, you know how your course coming up here- Yeah. Mm-hmm ... with all the menopause and all that stuff. I would love- Yeah ... if you would throw that in there, 'cause I feel like- Yeah ... both clinicians and patients alike that are gonna be doing your course, like they- Yeah oh my gosh, would that be valuable to just- Yeah. It's like a- ... know actually what's correct. You just gave me a whole new module. I was like, "Please make it the hair loss module." Yes. Yes. Okay. So I, yes, I will add that in there for you. I know this is a very diverse topic. Do you think there's anything that we didn't talk about that's important to know in this area? Ooh, I think, let's see here. We talked about all the different endocrine conditions. We talked about, nutritionally, like what you need to be doing. Yeah. I think stress management and sleep- Yeah ... is a big one I feel like a broken record saying it over and over and over again, because I say it about every condition that afflicts- Yeah if you're not controlling your stress and you're not controlling your sleep, none of these things are gonna get better, right? I know. And so it's really hard to, to be able to make a functional difference if you're not, if you're not doing that. I would say that's my biggest thing. What I would recommend is, making sure that you're focused on that. The other thing is that if I cannot find anything medical, and even if I do, you should still go see a dermatologist. Yes. Preach. There's autoimmune scalp conditions that- No matter what I do, no matter what supplement you try or what- Right laser hair band you use, it is not gonna get better unless you treat the root cause of that. That and the time that we waste. Yes. I think that's the thing that people are missing, yeah. That let's say you're gonna see if that supplement works. Okay, you're gonna give it a year and miss something else during that time. Yeah. That is really what we're wanting to avoid as well. Yeah. And my derm colleagues are happy to see patients, because they, they get a... And I was listening to your last podcast about, going in and she did a really thorough evaluation of your scalp. That's kinda what happened when my derm friend called me out and she, took pictures of my scalp, and I was like, "How dare you?" I know, when she- How dare you show me that ... she's like- I came for a rash. She's like, "We're gonna document the beginning." And I was like, "Oh, stop." Yes, I know. It just, hurt my soul a little, but it was very necessary so I could actually see if things were working, right? Yeah. So that, that I think is, you know, don't sleep on a dermatology evaluation. Our derm colleagues are amazing at what they do, and it's really important for people to get that level of expertise when they are struggling with hair loss that's that severe. Yeah. We wanna blame it on so many things. I've heard stories, one of my patients a few weeks ago was like, "I stopped my statin because it's causing my hair loss." And I was like- Yeah, I've heard this. I've heard this with men too ... "Please don't do that." Yeah. So I sent them to derm. I was like, "Please don't do that. You're gonna mess up your heart to save your hair." I know. Yeah. Yeah. So. Yeah. But witness to anyone that's going through this, it is a hard experience. Mm-hmm. We both can speak to this, I think there, there are answers, there are things that can be investigated. Yeah. But you do have to a little bit take the bull by the horns here. Yeah. Because one person might not have all the answers for you, and I think that's a hard thing. You think, "Well "I went to the primary care doctor." Just knowing there are limitations to who you're seeing. Even me now, there's gonna be things I don't know, you need to make sure that you get the full whoever you think needs to see you, and probably dermatology is one of them. Yeah, absolutely. Absolutely. Yeah. I couldn't have said it better. Thank you so much for coming on again today. I always have the best conversations. Of course. And thank you for always sharing so openly with what's going on with you as well, 'cause I feel like we can just sit in these ivory towers and be, talking- Yeah about knowledge, but if we're not sharing some of the actual human experience as well, it's... I find it's just really hard to connect to the information. How can people find out more about you? Like, how can they follow you? What's your website, social, and podcast, just so people can- Yeah follow you with all the things? Yeah. Well first, thank you for saying that, and thank you for having me. I know you and I are very similar in philosophy that, you have to share those things because- Then it's just somebody talking at you. Totally. It's not a lived experience. And my hair loss journey and my crazy stories of, my mom busting into my doctor's appointment and being worried if I'll get married. By the way, I am, and I have a kid, so Fulfilled that duty. It all worked out. No problem. It all worked out. But, there, there's so... If we're not sharing those real stories, Life is too hard anyways. We can't- Yeah ... be so serious about, so precious about all of these things. Totally. People can find me on my socials @drpatilsasodia. That's the same on Instagram and TikTok. My podcast is called Clearly Hormonal. You can find it on anywhere that you stream your podcast. And my clinic, if you're in Washington State or California, because I have a license there, and I do some telehealth, My practice is called Eastside Menopause and Metabolism. It's located in Redmond, Washington, and you can find that at my website eastsidemm.com. Love it. And thank you again for having me. Yeah. This was so much fun. We're gonna link to everything underneath, the show notes underneath where you're listening or you go to redtailclinic.com. You can click on, podcast, and we'll have all of this. Thank you again.