Dismissed & Confused: Why Women Stop Trusting Their Bodies

Between trackers, lab tests, supplements, hormone experts, social media, and podcasts, women have more access to health information than ever before. However, despite (and sometimes because) of these resources, many women end up feeling confused and distrustful of their own bodies. 

In this episode, Dr. Komal Patil-Sisodia explores various factors contributing to the ambiguity, including long-standing systemic gaps in women’s healthcare. From “normal” lab results that don’t align with very real symptoms to a healthcare system built around specialties instead of whole-body care, women have been conditioned to push through pain and discomfort in order to adjust to everyone’s convenience but their own.

If you’ve struggled to find clear, conclusive answers about your health, this episode highlights why self-advocacy is essential in securing the individual care and comprehensive treatment you deserve.

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Audio Stamps :

01:06 – Why “normal” labs can often feel more devastating than reassuring 

03:35 – Why better access to women’s health information hasn’t created more clarity 

05:51 – Problem #1: How fragmented medical specialties leave women trying to piece together their own health story

09:23 – Problem #2: What “normal” lab results actually mean and why population-based reference ranges can miss meaningful hormonal and metabolic shifts

14:21 – Problem #3: How the “push through” culture discourages women from trusting themselves and engaging in self-advocacy

17:07 – Problem #4: Why the lack of understanding around the whole-body impact of hormones contributes to the general confusion  

20:40 – Problem #5: How the missing roadmap for midlife women’s health adversely impacts access to individualized care and effective treatment options

27:32 – How the ambiguity in women’s health is due to systemic weaknesses rather than personal ones

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Transcript

Dr. Komal Patil-Sisodia 0:01

Welcome to Clearly Hormonal, the podcast where we stop googling our symptoms at midnight and actually start understanding what's going on in our bodies. I'm Dr. Komal Patil-Sisodia, an endocrinologist, internist, obesity medicine specialist, and a Menopause Society Certified Practitioner, which is really just a whole lot of words to say hormones are kind of my jam. I've spent 17 years watching women try to navigate their hormonal health without ever having been taught the language for what's happening in their own bodies, and then meeting clinicians who want nothing more than to help them figure it out, but are up against 10-minute appointments and a system that just wasn't built for it. This podcast is my answer to that gap. We'll cover menopause, metabolism, hormones, and everything in between with real evidence, not trends, and without the overwhelm. A quick disclaimer: I'm a physician, but this is education, not personalized medical advice. Take what resonates and discuss it with your own healthcare team. Now, let's get into it and talk about what's clearly hormonal and what's not. I want to start today's episode with a scene. Just picture it for a second. You're sitting in your car in the parking lot of your doctor's office. You've got the engine off. You're holding a piece of paper, or maybe you're staring at your patient portal on your phone, and every single line on it says the same thing. Normal, normal, normal. And you should feel relieved, right? That's what normal is supposed to mean. Everything's fine. You're fine. But you're not crying because you're fine. You're crying because you spent the last six months convinced something was wrong, and now you have a piece of paper telling you that nothing is. And somehow, that feels worse than if they had found something. Because at least then there'd be a name for what you're going through. At least then there'd be a plan. Instead, you have a normal lab report and a body that doesn't feel like yours anymore. If that scene felt a little too familiar, if you've ever sat in that exact car, in that exact parking lot, having that exact thought, I want you to know something before we go any further. You are not making this up. You are not being dramatic. You are not failing at being healthy. And you are very, very far from alone. Welcome back to Clearly Hormonal. I'm Dr. Komal Patil-Sisodia, and today we're going to talk about something that I think is at the root of so much frustration, the confusion, the exhaustion that women are bringing into my office every single week. We are going to talk about why women's hormonal health is so misunderstood, not just by patients, but by the system, by the culture, and sometimes, honestly, by us clinicians. And we're going to talk about it without me trashing medicine, because I'm a doctor, and I love my job. I love what I do. But we're also gonna do it without pretending the system is fine, because it is very clearly not fine, and it's very clearly broken, in my opinion. This is the episode where I want you to feel, maybe for the first time in a long time, like someone is finally naming the thing. Let's get into it. Here's what's strange about this moment we're all living in. Women have never had more access to health information than we do right now. Think about it. There are entire podcasts about hormones. There are doctors on Instagram explaining perimenopause. There's a TikTok hashtag for cortisol. There are books, there are summits, there are newsletters, there are influencers selling supplements, and there are clinicians selling courses. There is so much content, and women are consuming it. The patients I see every week have done the reading. They've listened to the podcasts. They walk into my office. They can talk about HRT and ApoB and continuous glucose monitors and progesterone and bone density. And yet, and this is the part that gets me, almost every single one of them sits down and says some version of the same thing."I'm so confused. I don't know what applies to me. I don't know what to do with all of this." So we have more information than ever before and less clarity than ever. And I've been trying to figure out why is that? Why has this explosion of women's health content not actually translated into women feeling like they understand their bodies better? And I think it comes down to something pretty simple. Information is not the same thing as a framework. Hear me out. You can hand someone every ingredient on the planet, but if they don't have a recipe, they're still not making dinner. What women have right now is a kitchen full of ingredients and no recipe. And I think that's why even the most informed, most engaged, most curious women I see are still walking out of appointments feeling lost. So today, I want to walk you through the four big reasons that I think this is happening. Because once you see the structure of the problem, I really do think it stops feeling so personal. It stops feeling like you've been failing, and it starts feeling like, oh. Oh, that's what's been going on. Okay. Problem number one, and this one is so structural that most people don't realize it's a problem until you point it out. Healthcare, the way that it's set up in this country, treats your body like a bunch of separate departments. Your OBGYN is in charge broadly of the parts that have to do with reproduction, your cycle, your pelvis, contraception, sometimes hormone therapy, depending on how comfortable they are with it. Your primary care doctor is in charge of the annual physical, your blood pressure, your cholesterol panel, your thyroid screen, your weight, the big chronic stuff. Endocrinology, that's my world, gets involved when something looks really off on a lab. Diabetes, thyroid disease, sometimes adrenal stuff, pituitary stuff. Cardiology shows up later, often after something's already gone wrong. And then mental health has its own separate appointment with a separate clinician, often in a separate building, who isn't talking to anyone else. And nutrition and weight management, those usually sit completely outside of the medical system. You have to find someone yourself. You have to pay out of pocket. You have to figure out who's legit. There are some really great programs that are insurance-based. My partner, Dr. Sonia Hans, who's been on my podcast, runs one of those. But overall, access is just hard, and access is so fragmented. Now, think about what a forty-seven-year-old woman walking into a doctor's office actually looks like. She might come in saying,"I'm not sleeping. I've gained ten pounds without changing anything. My periods have gotten weird. My mood is all over the place. I can't remember the names of people I've known for twenty years. I'm exhausted." To her, that's one problem. That's her body, and something is happening to it. But the way our system is built, that gets routed to five different people. The OBGYN looks at cycle change. The primary care looks at weight and order some labs. If she gets a referral to me in endo, I look at her metabolic stuff. The mood goes to a therapist or a psychiatrist. People just shrug at sleep. Five clinicians, five fifteen-minute appointments. Nobody's looking at the whole thing. And here's the line I think is worth holding on to. Women experience their bodies in one integrated system. Healthcare often treats them as disconnected parts. And I wanna be careful here because I don't want to make this sound like clinicians don't care. We do. The vast majority of doctors I have ever worked with, n-nurse practitioners, physicians assistants, they're all working incredibly hard inside a system that gives them seven minutes per patient and rewards them for ticking boxes, not for connecting dots. The fragmentation isn't because individualized doctors are bad. It's because the system is built that way. Specialization is rewarded, and integration is not. But for the woman sitting on that exam table She doesn't experience her body in specialties. She experiences it as her. And when nobody is putting the picture together, she's the one stuck holding all the pieces, trying to figure out what they mean. On to problem two. And this one, I'm going to slow down here because this one I see hit women the hardest. Let's talk about the word normal. We started with that, so I want to circle back to it. When you get your labs back and they say normal, what does that actually mean? Most people assume it means I'm fine, like the lab looked at your blood and decided you're healthy. That's not actually what's happening. What's actually happening is your number got compared to a range, and that range was built by a bunch of people measuring their levels and figuring out where most of them fall. If you fall inside that range, you're statistically similar to most of the people in that group, and that's it. That's what normal means. You're statistically similar to a population. Now, let's pull on that thread for a second. Who was in that population? When was the range built? Were there enough women? Were there enough women in midlife? Were they in perimenopause? Were they in menopause? Were they on hormones? Off hormones? Were any of them you? And the honest answer for a lot of the reference ranges is we really don't know. The ranges were built for general use, not for nuance, not for life stage, and not for trajectory. So here's what that means in practice. You can have a lab value that falls perfectly inside the normal range, and the value can still represent a meaningful change for you. Let me give you a real example. Fasting glucose. The reference range says anything under a hundred is normal. So if your fasting glucose comes back at ninety-five, the report says normal. You're fine. Move on. But I say, let's pull up your old labs. Ten years ago, your fasting glucose was seventy-five. Five years ago, it was eighty-five. Now it's ninety-five. You haven't crossed any threshold. Every single one of those numbers on its own is technically normal, but the pattern is telling me something really specific. Your body used to keep your glucose at seventy-five without much effort. Now it's sitting at ninety-five, and the only reason it's not higher is that your pancreas is working harder. It's making more and more insulin behind the scenes to just hold that line. The climb from seventy-five to eighty-five to ninety-five isn't your fasting glucose drifting upwards by accident. It's your body losing ground. It can't keep your glucose at seventy-five anymore the way that it used to. That trajectory is an early signature of insulin resistance. It's your body warning you, sometimes a decade before anyone would ever say the word prediabetes, that the system is starting to strain. And you might feel that way too. Energy crashes after a meal, weight gain around your middle, cravings that don't make sense, workouts that just aren't doing what they used to do. The lab will tell you you're fine. Your body is telling you something has shifted. Both of those things can be true at the same time. The same thing happens with cardiovascular markers. The way we think about lipids in twenty twenty-six is really different than how we thought about them ten years ago. We used to focus a lot on LDL cholesterol. Now we have something called apolipoprotein B, or ApoB, which is essentially a count of the actual particles that drive plaque, and it's often a much better signal of risk of heart disease. And the threshold for what's concerning has come down. The most recent guidelines from the cardiology world this year flagged ApoB approaching one hundred as a meaningful number, especially for women who are going through the menopausal transition when cardiovascular risk genuinely does shift. But if you got your lipid panel last year, your report probably didn't even have ApoB on it, and if it did, the number that came back probably wasn't interpreted with menopause in mind. So here is the line. So here's something that I want you to remember Normal doesn't always mean informative. It means you've crossed a threshold designed for a population, not a portrait of where you are. And I want to say this part really clearly because I worry about it being misheard. I am not telling you that your doctor missed something. I am not telling you to mistrust your labs, and I'm not telling you to walk into your next appointment feeling angry. I'm telling you that the word normal tells you one thing, but it doesn't tell you everything. And if you're frustrated because your symptoms and your labs aren't agreeing, that frustration is legitimate. It's valid. They're answering two different questions. The third problem, and this one is less about the medical system and more honestly about the culture we grew up in, women are praised for pushing through. Think about the language. She's so resilient. She's so strong. She handles so much. She never complains. She gets it done. She powers through. We grew up watching our mothers and our grandmothers do this. We absorbed it. We absorbed the idea that being a good woman means being a woman who doesn't slow down, who doesn't make a fuss, who keeps the house running and the kids fed and the meetings going even when she feels terrible. I have been guilty of this. And so what happens is symptoms stop being symptoms. They become personality. The exhaustion isn't just a symptom. This is just who I am right now. The brain fog isn't a symptom. It's just I'm so busy. The bad sleep isn't a symptom. It's just I've never been a great sleeper. The mood swings aren't a symptom. It's just I'm stressed. The weight gain isn't a symptom. It's I just need to be more disciplined. We minimize, we absorb, we adapt. And the thing I want to say about this, because I've been guilty of this too, by the way, this is not just me sitting in a tower judging everyone, is that this absorption gets really Sophisticated. Women don't just push through. Whatever we do, we do really well. We get really good at pushing through. And most women, become very skilled at functioning while unwell. You can hold a job, run a household, train for a half-marathon, show up for your friends, and be slowly running out of road, and the outside doesn't show it because you've gotten so practiced at it. And the consequence, the medical consequence, is that by the time a lot of women come into my office, they have been minimizing for so long that they don't trust their own signals anymore. They're not sure what's a real symptom and what's just life. They've been told for so long that they're tough, that they've forgotten that they're allowed to feel bad. Part of what I do, honestly, in a first appointment, is permission. Permission to take a symptom seriously, permission to say it out loud, permission to stop performing wellness when wellness isn't what's happening. If no one has given you that permission lately, I'm giving it to you now. Now, the fourth problem, and this one is a reframe that I think shifts the entire conversation when it lands. When most people hear the word hormones, they think reproduction, your cycle, your fertility, pregnancy, maybe acne, some PMS. The reproductive frame is so dominant that it almost owns the word. But your reproductive hormones, estrogen especially, are not just running your reproductive system. They're touching almost every organ system in your body all the time for decades. Let me walk you through what estrogen is actually doing. It's helping your blood vessels stay flexible. The lining of your arteries, the part that keeps the blood flowing smoothly and keeps plaque from sticking, has estrogen receptors all over it. When estrogen drops, your blood vessels change, and that's a cardiovascular, cardiology conversation, not a reproductive one. The estrogen is helping your bones turn over in a healthy way. We tend to think about osteoporosis as something that hits later, but really... We tend to think about osteoporosis as something that hits later, but the greatest loss of bone for most women happens in a pretty narrow window around the menopausal transition. That's a bone health conversation, not a reproductive one Estrogen also affects how your body handles insulin, how fat distributes, whether weight tends to sit on your hips or shift towards your middle, whether your metabolism is just humming along or it's starting to drag. That is a metabolic conversation. It's also affecting brain function. There are estrogen receptors throughout the brain, including in regions that handle memory, mood, and cognition. The brain fog and the mood shifts that you're experiencing that happen during this transition are not imaginary. Estrogen affects your sleep architecture, and by that I mean not just when you fall asleep but the quality of the sleep you get when you do. It's affecting baseline inflammation, your joints, your skin, recovery, all of it. So when we narrow the conversation about your hormones to just reproduction, we miss almost the entire story. Hormonal health is not just reproductive health. It's cardiovascular, metabolic, bone, and brain health. The reproductive system was just the loudest part of the conversation. This is part of why women in menopause transition often feel like everything is falling apart all at once. Because honestly, in a way that it is. Not in a scary way, but in the sense that one input is shifting and that one input is plugged into a dozen different systems. So when that one thing changes, it affects the dozen different systems. It feels like it affects the entire system because of course it does. And once you understand that, a lot of things stop feeling random. The sleep change and the weight change and the mood change and the cognitive change aren't five separate problems. They are one transition expressing itself in five different rooms of your house. All right, so I've given you four problems The system is fragmented, normal isn't always informative or helpful, women are trained to push through, and hormones touch a lot more than reproduction. But there's a fifth one, and this is the one I think nobody talks about enough, and it's the one that quietly makes all the other ones worse. There's no roadmap. Think about how we treat almost any other area of preventative health. Pregnancy has a roadmap. There's a schedule. There's an ultrasound at this week, this lab at this week, this milestone at this point. Pediatric care has a roadmap. Well-child visits at six months, twelve months, two years, vaccines on a calendar. What is the roadmap for a woman entering perimenopause? There isn't one. Not really. Not one that's been handed to her in a way that she can actually use. A woman in her forties is told, vaguely,"Take care of yourself. Eat well. Exercise. Maybe think about your bone health at some point. Maybe ask your doctor about hormones if your symptoms are bad enough. Maybe get your cholesterol checked at your annual visit." A woman in her forties is told, vaguely, to take care of herself, to eat well, to exercise, maybe to think about her bone health at some point, maybe to ask her doctor about her hormones if her symptoms are bad enough, maybe to get her cholesterol checked at the annual. Oh, and throw a mammogram in there. But no one is sitting down to her and saying,"Okay, here's where you are. Here's what changes between now and the next decade. Here's what we should be tracking. Here's where your personal risk lives. Here's what to watch for. Here's what to ignore. And here is the plan." The questions women want answered are really specific. What should I be tracking given my age and history? Which labs actually matter for me? What's a real signal versus a normal fluctuation? When does the math change? What's coming next? Should I take supplements? What should I do for my diet? What should I do for my movement? What should I do for my sleep? These are all different questions that come up, and the answer most women get to those questions is,"Well, it depends," or,"Your labs look fine," or the worst,"This is just what happens." And my favorite,"Talk to a different specialist." Women are expected to manage their health proactively without ever being given a clear framework for what proactive actually looks like. And that's not a knowledge gap. That is a structural gap, and I think that's the one that's been hiding underneath all of the others I want to slow down for a second because I think this is the part of the episode where the words actually need to land and not just be heard. If you have spent the last few years feeling confused about your own health, feeling like you should know more, or feeling like you might be missing something obvious, or feeling like other women seem to have it all figured out and you don't, I want you to hear me. You haven't been failing. You've been navigating a system that was never designed to give you what you actually need. Say that one again in your head. You haven't been failing. You've been navigating a system that was never designed to give you what you actually need. The confusion you have been carrying isn't a personal deficit, it is a structural one. It's not your fault that nobody handed you a roadmap. It's not your fault that your symptoms and your labs don't agree. It's not your fault that five different specialists gave you five different answers. It's not your fault that you've been pushing through for years because you didn't know what else to do. You are not the problem. The lack of a framework is the problem, and I think there is something genuinely freeing in being able to say that out loud. Because once you can name it as a structural issue, it stops being something you have to fix in yourself. It becomes something we can solve with a different approach. I'll tell you, honestly, this is the conversation I have thousands of times in clinic with women who walk in apologizing for taking up space, apologizing for asking too many questions, apologizing for not knowing things they were never told. And the moment I see most often, the one I never get tired of, is when their shoulders drop, when the apology stops, when they realize they are not crazy and they're not behind and they're not failing. They just need somebody to put the picture together. So where does this leave us? Honestly, this is where I have spent the last several months of my life. I kept seeing the same pattern: smart, motivated women coming in with the same five questions, the same confusion, the same frustration, the same sense of being lost in their bodies. And at some point, I stopped asking myself,"How do we educate women better?" Because I don't- actually think the answer is more information. We have plenty of information. The problem isn't that women don't know enough. The problem is that there's no structure to organize what they know. There's no way to take all of those individual data points and turn them into a picture for you. So I started asking a different question: What if women had a framework? What if there were a clear, organized way to look at midlife health that pulled all of the threads together, that made it easier to see where you actually are, what actually matters for you right now, and what to pay attention to going forward? That question, that's what I've been working on. And in the next episode, I'm going to walk you through what I've built. I'm not going to give it away today because it deserves its own conversation, but I will tell you that everything we've talked about today, the fragmentation, the limits of normal, the override habit, the bigger picture of what hormones actually do, the missing roadmap, every single piece of that shaped... every single piece of that shaped the way this thing was designed. So if today felt validating, next week is going to feel actionable, and I cannot wait to share it with you. If you take one thing away from this episode, I hope it's this: You are not confused because you haven't tried hard enough. You are confused because the system you're trying to navigate wasn't built to make sense for you. That's not a personal problem. That's the starting point for a better conversation. Care has been fragmented, normal hasn't always been informative, And we've been quietly trained to ignore our own signals. Hormones touch far more than we've been told, and nobody has handed us a roadmap. And nobody has handed us a roadmap. That ends. Not all at once, but it ends, and it starts with naming it. If this episode hits somewhere familiar, I would love if you shared it with a woman in your life who needs to hear it. The friend in the parking lot holding the lab report, the sister who keeps saying,"I'm fine, I'm just tired," the colleague who's been pushing through for years. Send it to her. This might be the conversation she's been waiting for. Subscribe to the podcast, to my newsletter so you don't miss next week's episode, because that's where we move from naming the problem to actually solving it. I'll be sharing the framework I've built, what's in it, and how you can use it, whether you're a patient or a clinician or both. Thank you for spending this time with me, and I'll see you on the next episode