Tired, Gaining Weight & Told Your Labs Are Normal? Here's What's Actually Going On

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You're exhausted. You're gaining weight. You've been to the doctor, had blood work done, and were told everything looks normal. So why do you still feel unwell?

In this episode, Jess discusses one of the most common and frustrating experiences she hears from women — and explains why the conventional medical approach so often misses the real picture. 

She shares her own story of being diagnosed with PCOS, hypothyroidism, and prediabetes at age 26 and handed a bag of prescriptions with almost no explanation. She breaks down why there is typically more than one reason or cause for symptoms like fatigue and weight gain. Then she walks through what a better, more holistic approach actually looks like — starting with the right data and asking the right questions.

 In this episode, she covers:

•     Why fatigue and weight gain are symptoms, not diagnoses — and why they're almost always multi-factorial

•    The normal vs. optimal problem: why "your labs are fine" doesn't mean you're thriving

•     Why the quick-fix, prescription-first approach misses the upstream cause

•     The questions a real root-cause approach asks that a standard 15-minute appointment doesn't have time to address

•     Why perimenopause and aging make all of this more important, not less

•     How to approach this like a detective: the right blood work to ask for, how to interpret it, and how to work through the hormonal hierarchy to find the real drivers

•     Why stress and cortisol are almost always a part of the bigger picture — and what to do about it

Connect with Jess:

• Instagram: @vitalbalancewithjess 
• Website: jessicatrone.com
• Email: vitalbalancewithjess@gmail.com

DISCLAIMER: The content shared in this podcast is for informational and educational purposes only, is not a substitute for the advice of medical doctors or practitioners and should not be used to prevent, diagnose, or treat any condition. Consult with a physician prior to beginning any fitness, health, or wellness regimen or routine.

Transcript

SPEAKER_01 0:04

Welcome to Vital Balance with Jess, the podcast for women who want real life strategy, no BS conversations about women's health. I'm your host, Jess. While building my career as an attorney, I struggled with hormone imbalances, anxiety, metabolic dysfunction, and a healthcare system that left me with more questions than answers. So I took matters into my own hands. And here's what I discovered. The real magic happens when you get curious, start asking questions, and listening to your body like it actually knows what it's doing. This podcast isn't about weight loss, physical appearance, or rigid wellness routines. It's about agency. I want you to know just how much control you have over your everyday well-being. And I want you to experience stable energy, predictable moods, a sharp yet calm mind, and a body you can trust. Because when women are well, our homes and communities thrive too. Let's get started. Welcome to Vital Balance. I'm Jess. I want to start today's episode by asking you a few questions. And I want you to really sit with these and provide yourself with honest answers. Do you have a hard time getting through your entire day, especially the afternoons without tanking? Or maybe you just generally struggle to find the energy and the brain power to tackle everything on your to-do list without wanting to give up or at the very least take a nap? Are you gaining weight even though you haven't really changed anything about how you're eating or moving your body? Does something just feel off, but you can't quite put your finger on what it is? And maybe you've already gone to the doctor about one or more of these issues. Maybe you've had blood work done. And maybe you were told everything looks normal. Or that one marker is slightly off, but it's not a big deal. Here's a prescription. Consider scheduling a follow-up in six months. And you left that appointment with more questions than answers. And also now you feel a little crazy because you described your symptoms, but were basically told you're fine. So maybe it's all in your head. Well, I want you to know that you're not crazy and it's not all in your head. And normal blood work or test results doesn't mean optimal. Normal and optimal are not the same thing, but I'll get into that more in a few moments. First, I want to share something personal because I think it illustrates exactly what I'm talking about. In my mid-20s, I had recently become an attorney, I had a good job, and externally I appeared very healthy. I was thin and I didn't have anything appearance-wise to suggest that I was struggling internally. But the truth is that I didn't feel fine. I was anxious nearly all the time. My cycles were very irregular. My energy fluctuated pretty dramatically. Something was just off. I knew I had PCOS because I had been diagnosed with that endocrine disorder in college, but I wanted to know if it was something more than that. Or if not, how could I get my PCOS symptoms under control and minimize them? So I went to the doctor, she ran some blood work and she confirmed the PCOS diagnosis, but she also diagnosed me with two new conditions, hypothyroidism and prediabetes. She didn't really act surprised or concerned. She said these two new conditions were often par for the course with PCOS. Um, okay. So shouldn't we be looking further into the PCOS and how to better manage that? The prediabetes one really got me. I remember sitting there thinking, wait, I'm 26, I'm not overweight. How is that even possible? And she basically just said to watch my carb intake and handed me a prescription for metformin. No questions about my stress, my sleep, what my life actually looked like on a day-to-day basis. Nothing. Just here's a medication, good luck. It's almost as if she didn't even know that other conditions like stress greatly contribute to the development of these conditions she just diagnosed me with. Oh, she actually did say one other important thing. She told me these conditions would probably make it difficult for me to conceive. So I should come back when and if that is something I want to achieve, and we could talk about more medical interventions at that time. I left the appointment with three diagnoses, a few prescriptions, and almost no understanding of what was actually going on in my body. And it would take several years of my own research before I started making sense of it. And that experience, honestly, is a big part of why I do this. Because I've talked to so many women who have had almost the exact same experience. They know something is wrong, they've tried to get answers, and they've come away with medications, but no real understanding of why they feel the way they feel or what they can actually do about it. And today I want to talk about why that happens, what a better approach looks like, and why stress and everything it sets off hormonally is almost always a big part of the picture. Before we dive in any further, I want to emphasize that I am not a physician or a medical practitioner. So anything I say in this episode is for educational purposes only and is based on either my own research, the training I received upon getting my education, andor my experience. And anything I say should not be used to diagnose or treat any condition. So what's actually going on when you're exhausted and gaining weight and can't seem to figure out why? Here's the thing: fatigue and weight gain are not diagnoses, they're symptoms. They're your body's way of telling you something is off, that something's not right. And unfortunately, that something is rarely just one thing. And that's what makes this process so complicated. It takes time and effort, like solving a puzzle. And most physicians are not afforded the opportunity of time. Most medical companies are run by massive conglomerates who care about money, not patient satisfaction. Because if they own every medical facility in town, then people don't have options, so patient satisfaction doesn't really matter, does it? And these symptoms, the issues these women have, are often multifactorial. They're almost never a single cause. It's usually a combination of things: hormonal imbalances, blood sugar dysregulation, chronic stress, poor sleep, gut issues, nutritional gaps, and sometimes even emotional and psychological factors, all interacting with each other at the same time, which is exactly why the approach of running one standard blood panel and prescribing one or multiple medications so often falls short. It's only addressing one piece of a much bigger picture. The body is indicating there's a problem by manifesting as fatigue and weight gain. But like I said, those are symptoms of the actual issues, which could be elevated cortisol, low progesterone, a sluggish thyroid, insulin resistance, or maybe a nervous system that has been running in overdrive for years. All of those pieces are connected. And if you only fix one or two of them, you're gonna keep not feeling well. That's why I always say this requires a detective approach, not a prescriber approach. You don't just look for something to treat, you look for the whole picture, ask a lot of questions, and try to understand why things are the way they are, not just what they are. So why does the conventional medical approach miss so much of this? Well, like I said, a big part of it is the business side of things. One massive conglomerate owns every medical facility in town. But on a smaller, more nuanced level, it also comes down to how blood work is interpreted. When your doctor says your labs are normal, what he or she means is that your results fall within the standard reference range. But those ranges are based on population averages, meaning they reflect where most people fall, including a lot of people who aren't particularly healthy. So normal really just means you're not an outlier. It doesn't mean you're thriving, it doesn't even mean you're necessarily doing well. And because we're all different, different genetics, different histories, different stress loads, different lifestyles, what's optimal for one person might be suboptimal for someone else. Some women feel their best when their TSH is on the lower end of the range, while others can feel the same and have a higher number. Some women can have fasting insulin at a certain level and feel great, but others are symptomatic at the same level. The ranges are a starting point, but they're not the whole story. So when a doctor looks at your labs, says everything is fine, and you still feel terrible, that's not a problem with you. That's a limitation of the tool. Your symptoms are also real data. They deserve to be taken seriously even when the standard labs don't fully explain them. The other issue is that conventional medicine is really set up for quick fixes. And honestly, I don't blame the doctors. The system gives them maybe 15 minutes per patient. I don't know, maybe even less. And that's not enough time to really understand someone's full picture. So they just work within the constraints they have, and the fastest available option is usually a prescription. But here's the problem with that. A prescription addresses what's happening, not why it's happening. Metformin lowers blood sugar, yes, but it doesn't explain why blood sugar is high to begin with. Thyroid medication supports thyroid function, but it doesn't address why the thyroid is struggling. I am not anti-medication. And sometimes medication is absolutely the right call. I mean, I I went on some of the medications I was prescribed in order to help balance my hormone levels temporarily and get to a good place where I could have more minimal symptoms. But unless you want to be on a medication indefinitely, it's important to ask the question why. And like I said, some medications, there are people who have to be on medications indefinitely, and that's okay. But if you are on medications and you're still not feeling great, then of course you're gonna have more questions, right? A real detective approach asks a lot of questions that a standard 15-minute appointment can't cover. Things like, how stressed are you really? Not just right now, but even historically. What has your stress load looked like over the past few years? How are you sleeping? Not just how many hours, but are you actually waking up feeling well rested? What does your diet look like and how do you feel after you eat? Are you moving your body? What does your gut feel like? Have you been through anything significant emotionally? A loss, a period of prolonged stress, or maybe a trauma you haven't fully processed? I would argue these questions are clinically relevant because chronic stress, for example, elevates cortisol, and cortisol impacts almost every other hormone. It suppresses progesterone, disrupts thyroid function, drives insulin resistance, disrupts sleep, which then elevates cortisol further. It's a domino effect. I also want to take a moment to address the age factor. As women head into perimenopause, which can begin as early as the late 30s, but typically it begins in the in our 40s. Heading into perimenopause, this detective approach of asking questions and getting to the root cause becomes more important, not less. Our bodies naturally become a little less resilient over time. The things we could get away with in our 20s start to catch up with us. And in perimenopause, progesterone starts fluctuating, cortisol sensitivity changes, insulin sensitivity often decreases, and the thyroid can become more vulnerable based on these other changes. And the symptoms often get written off as normal based on age. Your doctor may tell you it's par for the course and that you should just expect to feel crappy because you're getting older. I have a big problem with that. Yes, health issues might get a little trickier as we age, but we were not made to just feel like crap once we hit the age of 40. I refuse to believe that, and honestly, evidence indicates that it just isn't true. But admittedly, aging does often require us to be more intentional, more aware, and more willing to dig into the full picture rather than just accepting that this is what life feels like now. So, how do we approach a situation like this? How do we get to the bottom of what is causing our symptoms? What do we do if we feel like our doctor is dismissing our concerns or not providing us with the full picture and the information we need to truly heal? Well, I've broken this down into a four-step process. Number one, start with the right data. Good detective work starts with evidence. And in this case, that means getting comprehensive blood work. Not just the standard panel most doctors run, but a panel that actually gives you a real picture of your hormonal and metabolic health. I'm gonna give you a baseline starting point and some suggestions of what to look and ask for. I would suggest making a list and taking it to your doctor and explain why you think you need certain markers drawn. Advocate for yourself. Now it is possible your doctor isn't running comprehensive testing because insurance might not cover it. So that is something to look into and consider before you have a bunch of testing done. But also, there are tons of companies now online that run very detailed medical testing, like hundreds of markers. So that's a consideration as well. The bad news is that you would likely have to pay out of pocket for those, but the prices have started to come down because there's more competition, and many of these companies will run sales and ordeals for first-time customers. So if you think you might have a thyroid issue, ask for a full thyroid panel: TSH, free T3, T4, and thyroid antibodies, not just TSH, which is what most doctors order. For metabolic health, fasting insulin, and fasting glucose levels, not just A1C. Ask for your sex hormones to be tested. So estrogen, progesterone, testosterone, DHEA, cortisol, right? Our stress hormone. Ideally, this is done with a four-point saliva test rather than a single blood draw, though, because cortisol fluctuates in our bodies throughout the day. So one reading from one point in time wouldn't really provide an accurate picture of what's going on. You would also want a full metabolic panel, a complete blood count, and maybe even nutrient markers, right? To test things like your vitamin D levels, B12, magnesium, because mineral and nutrient deficiencies are pretty common, but oftentimes overlooked when it comes to health issues. Like I said, most doctors won't order all of this unprompted. Advocating for yourself really matters. And if the doctor won't do it, find a functional medical physician who will, or like I said, go through a third-party company. Number two, ask why. Once you have the data and you've assessed it, the next question to ask is why are these markers abnormal? If cortisol is elevated, why? This will require an in-depth examination of your stress levels or maybe even your circadian rhythm health. If progesterone is low, why? Is cortisol using up the building blocks to create enough progesterone? Because if your cortisol levels are dysregulated, that is gonna have a trickle-down negative effect on your progesterone. But if your cortisol was normal, then low progesterone would occur due to a different reason. Did your thyroid results indicate a sluggish thyroid? If so, why? Is it hypothyroidism? Or is it an autoimmune condition like Hashimoto's? Maybe you have a nutrient deficiency, or if you had dysregulated cortisol, that could be suppressing conversion of T4 to T3. Every abnormal result should produce a question, not just a thing to fix. And the answers are almost always somewhere in the full picture of someone's life, which again is why it can be complicated. Number three, work through the hormonal hierarchy. So when you ask why, how do you go about answering that question? I like to start with the hormonal hierarchy. I have a full episode dedicated to this topic, so I encourage you to check it out because I'm not going to do another deep dive on this episode, but I do want to briefly revisit it because it's a good place to start when you feel overwhelmed with test results or even symptoms like those that I've been describing. So if you receive test results that are either not in the normal range or they're near one end of the normal range, so they're not optimal, then like I said, you want to ask why. But a lot of times people are like, well, I can ask why, but I don't know the answer because I don't know what's affecting this particular hormone. And that is where you want to start with the hormonal hierarchy. At the top of the hormonal hierarchy is oxytocin, or what some people refer to as the love hormone or the connection hormone. Our relational and social health is foundational to everything else. Chronic loneliness and disconnection are real physiological stressors. If that's part of the picture for you, then you need to dive deeper into that issue. It might sound unimportant, abstract, or you might question how that could possibly impact your hormonal and metabolic health. But because it sits at the top of that hierarchy, that means it has a direct impact on the hormones that fall below it in the hierarchy. So below oxytocin is cortisol. And this is where most women dealing with fatigue and weight gain really need to focus first because dysregulated cortisol is very often part of the story. And typically it's a stress management issue. But it can also be triggered by circadian rhythm misalignment or sleep issues or even hidden issues like past trauma that you don't think are impacting your stress currently on a day-to-day basis. Below cortisol is insulin, which is a hormone that impacts our blood sugar regulation. Cortisol and insulin are deeply intertwined, so this is definitely the next layer to address. And below that are the thyroid and sex hormones, which would be estrogen, progesterone, testosterone. These are often the ones that show up abnormal on labs, but if you haven't addressed the cortisol and insulin picture first, you're trying to fix the downstream without addressing the upstream. Number four, look at the whole picture. Beyond the labs, a real detective approach looks at everything: sleep, stress, nutrition, blood sugar patterns, movement, gut health, emotions, and trauma, relationships, mindset, daily habits and routines. None of these are secondary factors. They are primary inputs into our hormonal health. And they are usually where the real answers are, not just what shows up on a blood panel. This is the work I do with the women I coach. We will start with data, but we don't stop there. We look at the full picture, ask the deeper questions, and figure out what is actually driving the symptoms. If you've been told your labs are normal, but you still don't feel well, I want to say this clearly. You are not crazy. Normal isn't optimal. And your symptoms are real data, even when a standard blood panel doesn't fully explain them. Fatigue and weight gain are not just part of getting older or being a busy woman. They're your body telling you something. And if you're willing to approach it like a detective, curious, thorough, looking at the full picture, there's almost always a story there that makes sense and that can be addressed. If you want assistance doing That if all of this sounds overwhelming, but it also makes sense to you, I would love to help. I would love to help walk you through the process. A free hormone clarity call is a great place to start. The link to schedule it is right at the top of the show notes. We'll discuss what you're experiencing, look at the bigger picture together, and figure out where to begin. Remember, be your own health advocate. You know yourself and your body best. You know when something isn't right. Don't dismiss your gut feelings. Thank you so much for being here. Until next time.

SPEAKER_00 22:39

If you enjoyed this episode, please leave my mommy a five-star review. And don't forget to hit the subscribe button.

SPEAKER_01 22:47

Thanks so much for tuning in to Vital Balance with Jess. If you loved this episode, it would mean the world if you would leave a review, share it with a friend, or hit subscribe so you never miss a dose of real talk on women's health. Remember, you have more control over your health than you've been told, and sustainable change is possible. Keep listening to your body and showing up for yourself. I'll see you next time.