hol+ by Dr. Taz MD

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What Is PCOS in Women, How It’s Diagnosed? PCOS is not just a gynecology label, it is a whole-body syndrome that is widely missed in the exam room. In this episode, Dr. Taz explains why nearly seventy percent of women go undiagnosed, how PCOS often begins in the prenatal environment, and why it behaves like a metabolic and autoimmune condition. You will learn the signs most people overlook, the labs that actually matter, and a step-by-step plan that starts with the gut, supports the liver, balances blood sugar, and calms cortisol so real healing can begin.

Dr. Taz shares:
 • Why the old Rotterdam criteria miss metabolic, inflammatory, and immune drivers
 • How prenatal hormones, medications, and toxins can program PCOS risk
 • The role of hyperandrogenism in insulin resistance, inflammation, acne, and hair loss
 • Why PCOS looks different by life stage and race, and what that means for care
 • The exact labs to request: DHT, AMH, free and total testosterone, DHEAS, 17-OHP, fasting insulin, lipids, CRP and more
 • A holistic protocol that begins with gut repair and liver support, then adds androgen and metabolic tools
 • How daily stress and the cortisol hum keep PCOS active, and practical ways to turn it down

Whether you feel off but cannot explain why, are chasing a diagnosis, or want a long term plan for energy, fertility, and hormone balance, this episode gives you a clear roadmap to understand PCOS and take action.

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Chapters
00:00 The PCOS epidemic and misdiagnosis
00:27 Dr. Taz’s PCOS story
03:06 Why old criteria fall short
05:09 PCOS as metabolic and autoimmune
08:20 Why PCOS rates are rising
09:14 Prenatal and medication influences
11:05 Childhood and teen clues
15:44 Symptom checklist you can spot
18:42 Eastern medicine patterns to notice
20:32 What to test for PCOS
23:56 How presentation varies by race
30:03 Building a holistic plan
33:37 Gut and liver first
35:16 Androgen, metabolic, and inflammation tools
37:30 Managing cortisol and stress
39:13 Long term roadmap and next steps

Creators and Guests

Host
Dr. Taz Bhatia MD
Dr. Taz Bhatia is a triple-board-certified integrative medicine physician and founder of hol+, where she brings together science, spirit and the human experience to deliver holistic, whole-person care.
Producer
Pat Gostek
Founder of ClipGrowth.com - End-to-End YouTube, Podcast & Clips Management (you just record).

What is hol+ by Dr. Taz MD?

2025 Webby honoree and pioneering show, hol+ enters the next dimension of health-exploring where science and spirit converge to drive our human experience.

After three successful seasons and a Webby nomination, the hol+ show with Dr. Taz MD continues to lead pioneering and challenging conversations around healing, healthcare and the future of medicine. 

Recent guests include mental health advocate and author, Sophie Gregorie Trudeau, best-selling author, Katherine Schwarzenegger, Emmy-winning host, actor, and health enthusiast, Cameron Mathison, supermodel Carol Alt, veteran actress and sometimes medicine woman, Jane Seymour, author and journalist, Tamsen Fadal, wellness advocate and cancer thriver, Kris Carr. 
 
From cutting-edge and innovative experts to celebrities and thought leaders, veteran TV personality, author, and double board-certified physician, Dr. Taz MD, the host of hol+, leads game-changing conversations around health, healing, family and community.

On the heels of her successful 8-year-long podcast, Super Woman Wellness, which boasted over 1 million downloads, hol+ continues to be recognized as a show to watch, recognized in the same category as the Mel Robbins Podcast in the 29th Annual Webby Awards.

[00:00:00] Before we dive in, I just wanna say how much I enjoy hearing from you guys every week. Your [00:00:05] dms on Instagram remind me of why I started Whole Plus in the first place to [00:00:10] make health simple, human and personal again.
If you're listening right now [00:00:15] and something from this show hits home, please send me a message at Dr. [00:00:20] Taaz md. Your stories inspire what we talk about next, who we bring on, [00:00:25] and what we wanna dive into. Alright, let's get started with today's episode.
In this [00:00:30] next episode we are about to talk about a syndrome that is impacting millions of [00:00:35] women worldwide but is still misdiagnosed in the exam
[00:00:40] room every single day We're actually gonna spend the next few minutes talking about
[00:00:45] PCOS or polycystic ovarian syndrome
now I have a very deep personal [00:00:50] connection
to this particular diagnosis It is actually the diagnosis that led [00:00:55] me to this entire field of
holistic integrative and functional medicine back in my twenties [00:01:00] I was actually getting sicker and sicker as the years went by and experiencing all [00:01:05] kinds of strange symptoms
Everything from acne to hair loss weird [00:01:10] weight gain and
ultimately just
Achy not being able [00:01:15] to think clearly and honestly just a shadow version of who I originally [00:01:20] was It took a lot of coaxing for me to get into the doctor's
office but when I finally [00:01:25] did no one
Could diagnose me
now That was over 25 years [00:01:30] ago
And as we
sit today in our
clinics at Whole Plus unfortunately it's the story [00:01:35] that many of you tell us as well the story of having symptoms that no one [00:01:40] can put together Being told that you don't have PCOS because you [00:01:45] don't have cyst on your ovaries and nothing Could be further from the truth
I could [00:01:50] probably spend the entire episode telling you patient
stories and how they were told [00:01:55] they would never get pregnant that there was nothing wrong with them that they were simply anxious or [00:02:00] depressed and they needed to take a particular medication
And at the end of that story They [00:02:05] left our
clinics with a diagnosis of PCOS So needless to say this is a really [00:02:10] important topic and one that I
feel strongly we all need to
understand and [00:02:15] start to peel the layers back a little bit more
easily
Now
when we look at the [00:02:20] hard stats right when we
just go to the literature and we look at
What is the rate of PCOS? [00:02:25] At first it's like why is she making such a big deal about this? One in 10 [00:02:30] women are diagnosed with
PCOS but here's the here's the trick [00:02:35] Almost 70% of women
go undiagnosed When it comes to [00:02:40] PCOS so while one in 10 maybe get the official diagnosis we
have a huge [00:02:45] population millions of
women across the world who walk around not [00:02:50] knowing that this is
actually what's happening with their bodies
the misdiagnosis of [00:02:55] PCOS is rooted in a number of different issues First of all PCOS was [00:03:00] originally thought of as a purely GYN issue An issue [00:03:05] that comes up if you're trying to get pregnant but is not related
to anything else [00:03:10] And this is a problem we have in medicine in general right where we don't
understand that everything is
[00:03:15] interconnected and a hormone doesn't live in isolation but actually [00:03:20] interacts with other hormones Now traditionally the diagnosis of PCOS [00:03:25] was established by something called the Rotterdam
criteria The Rotterdam criteria was [00:03:30] established by different physician groups and essentially said you had to have two
of three [00:03:35] particular characteristics to have a diagnosis of PCOS
One of [00:03:40] them was that you had cyst on your ovaries Kind of a no brainer The second one was that [00:03:45] you had an overproduction of
something called androgens Now androgens are those hormones [00:03:50] like DHT free testosterone D-H-E-A-S These are the [00:03:55] hormones that we traditionally associate
with something like PCOS
And then the [00:04:00] third was that you were having an issue
getting your periods or anovulation where you were skipping [00:04:05] periods or not getting a period And if you had two of those three then yes you got the check [00:04:10] mark for you got PCOS
Unfortunately
the Rotterdam [00:04:15] criteria have fallen short and researchers and clinicians today [00:04:20] both are actually in agreement that we
need to find a better way For [00:04:25] example in this particular study this is from 2024 so recent right? [00:04:30] Evidence-based common standardized
guidelines for
PCOS diagnosis
and treatment
are [00:04:35] urgently needed
There is a problem understanding how
[00:04:40] women's health is getting impacted by this disease and that's in a study as [00:04:45] recent as just a few months ago So we have a lot to learn when it comes to PCOS [00:04:50] and we have a lot
to dig into and we need to start widening our ability
to [00:04:55] diagnose this disease And that's what we're gonna talk about a little bit here today and hopefully it's gonna be helpful for [00:05:00] you or for somebody that you love
When we think about PCOS what [00:05:05] most of the research and I'll quote some of it for you
shortly but what most of the research [00:05:10] seems to be pointing to is that PCOS is actually an [00:05:15] autoimmune disease and not just an autoimmune disease
It's a disease of
your [00:05:20] metabolic health Your metabolic health is closely tied to what is [00:05:25] happening with PCOS and the roots of it Go all the way back to your [00:05:30] prenatal
environment I want you guys to think about that for a second This is not [00:05:35] your fault In fact today even getting ready for this shoot the woman doing my [00:05:40] hair
said wait what are you talking about You're talking about PCOS What do we do about it? [00:05:45] I have
PCOS
I feel like I can't go anywhere without having a conversation [00:05:50] about this disorder because so there's just so much confusion around
it
But PCOS at
[00:05:55] the end of the day needs to be
rethought and rediagnosed In a much [00:06:00] different framework Let's look at what the research is starting to say
And I feel bad for so many of [00:06:05] you out there struggling to get
answers because this is such new research And what happens
with research [00:06:10] is it often doesn't translate into the exam room for another decade or even [00:06:15] sometimes for another 20 years Here's another article And I'm again I'm just gonna read it
[00:06:20] and I I know that's probably
boring but I'm just gonna read it out loud to you so that you understand what the research is saying
So [00:06:25] this is from the Journal of Assisted Re Reproduction and Genetics And [00:06:30] essentially it's saying hyperandrogenism remember that's the overproduction of those hormones that I was [00:06:35] talking about which was an which was a part of the initial Rotterdam criteria
[00:06:40] hyperandrogenism
Hyperandrogenism
Causes insulin resistance and [00:06:45] hyperglycemia high blood sugar And then that in turn leads to and I'm gonna use a lot of [00:06:50] big words but these are the things we dig
into and practice day in and day out It [00:06:55] leads to oxidative stress which is the ability of your cells to [00:07:00] withstand the environment other things that they're getting exposed to But [00:07:05] hyperandrogenism leads to more oxidative stress
It leads to Belly fat and [00:07:10] abdominal adiposity
and
it leads to and here's the big word [00:07:15] inflammation And over time those particular very functional medicine [00:07:20] ideas right of inflammation oxidative stress uh belly fat all of these [00:07:25] things Lead to
disease So there's a link for example between PCOS
[00:07:30] and many different diseases including mental health disorders cardiovascular [00:07:35] disorders autoimmune disease having additional autoimmune disease and of course
cancer[00:07:40]
It's all connected It's all linked up together
So
when we look at the research and when we [00:07:45] look in the exam
room and when we look at traditionally what's been happening we know [00:07:50] that there has to be a new way to diagnose and
understand [00:07:55] PCOS and simply using the Rotterdam criteria is not
enough and being [00:08:00] told that you don't have cyst on your ovaries therefore you don't have PCOS [00:08:05] is not the answer
Moving forward Let's dig a little bit now into [00:08:10] what we do need
to do to get a better understanding of PCOS When we look [00:08:15] critically at PCOS statistics and we understand that it is very underdiagnosed and that [00:08:20] so many women
today are walking
around with PCOS and are unaware of it even though the [00:08:25] stats have risen and they say one in 10 women today maybe one in 20 have a [00:08:30] true in the exam room diagnosis of PCOS we need to understand a little [00:08:35] bit better about why the rates of PCOS
Are increasing I get asked [00:08:40] this all the time What's happening? Why are we seeing so much PCOS? Is it simply [00:08:45] because we're more aware of it? And the answer is no Here is what's happening in [00:08:50] the exam room and also in research what we're actually seeing day in and day out [00:08:55] PCOS is increasing for a number
of reasons When I turn to the research [00:09:00] it's fascinating It's talking about the prenatal environment and how the [00:09:05] prenatal environment If for example your mom had high androgens or high [00:09:10] insulin you're predisposed to PCOS when you hit puberty
But
[00:09:15] here's the even more interesting piece of the puzzle Prescription medication [00:09:20] usage is tied to the development of PCOS
They're finding that [00:09:25] antidepressants anti-anxiety medications anti-seizure [00:09:30] medications are all linked to the development of PCOS because they are changing [00:09:35] the prenatal environment that maybe you or your child or your loved one was [00:09:40] exposed to right from
concept Yeah
this is
mind [00:09:45] blowing to me right?
Because for so long it's like oh we're stressed or we're eating bad food or [00:09:50] you know we're doing all these other behaviors and that's why we
have PCOS But it's [00:09:55] winding all the way back to what is
happening in your mother's
[00:10:00] environment
And
that's just the start
As
those androgens [00:10:05] continue to
build and you're exposed to androgens not just prenatally but now as you [00:10:10] go through life and you get them from processed food from the environment [00:10:15] again we've got studies talking about how BPA
endocrine disruptors [00:10:20] phthalates increase the amount of androgens circulating in the bloodstream[00:10:25]
We now need to think about this idea of the cumulative load right? I've talked about it in [00:10:30] reference to other conditions and
Other diseases I
talk to patients about it all the time [00:10:35] and I think one of the biggest challenges we're having in medicine and that's why this holistic approach I think is so [00:10:40] important is that oftentimes it's not a singular hit that is causing a singular [00:10:45] problem
It is a cumulative load that eventually is leading
people down a [00:10:50] particular path And same is true for PCOS So we've talked about the prenatal [00:10:55] environment we've talked about toxins exposed prenatally androgens exposed prenatally [00:11:00] high cortisol If your mom was stressed or if that stress continued [00:11:05] through your childhood home and as you entered
puberty you're more predisposed [00:11:10] to PCOS
We've talked about medication usage and one of the things we know for sure [00:11:15] is that the prescription medication usage amongst all of us has gone up over the last
[00:11:20] 50 years Young children today are put on many antibiotics right? They're put on asthma [00:11:25] medications They're put on A DD and A DHD medications
All of
these are [00:11:30] changing the microbiology and the environment of the cell and in turn [00:11:35] making the body more androgenic
We miss out
on the opportunity to [00:11:40] catch
this because We don't check these things in childhood right? We might check some of these [00:11:45] numbers in a woman trying to get
pregnant and we can start to understand if someone's got a very [00:11:50] high A MH
for example or the high DHT or the high free
testosterone
[00:11:55] Sure they're predisposed to PCOS but we're
not checking it in children before they hit [00:12:00] puberty so that we can prep them to maybe avoid
A-P-C-O-S [00:12:05] journey
Then
we enter puberty and into puberty we go and there are all kinds of challenges [00:12:10] once we hit
puberty But what we are seeing now finally in puberty is the
[00:12:15] overexpression of these androgens
And they look different They look like severe acne [00:12:20] They can look like body hair in places where we
don't expect it They can look like hair [00:12:25] loss but here are some of the other manifestations that
we are missing even [00:12:30] in our teens
PCOS is
associated with mood disorders We have [00:12:35] studies again that show how the androgens and the cortisol in turn work [00:12:40] together to trigger things like depression bipolar disease and severe [00:12:45] anxiety
We even know that it's connected to a DD and A DHD
And
if [00:12:50] you have a child with a DD or A DHD I challenge you
to observe [00:12:55] them watch them see if their focus is different Especially in your girls it's a little bit more easy to [00:13:00] catch if their focus is different at different points in
their cycle And I [00:13:05] bet your answer's gonna be yes
I see that right here in our own home that again the two weeks [00:13:10] where estrogen is higher and those androgens
can't be over expressed We [00:13:15] see better focus But the second two weeks especially as the cycle approaches
[00:13:20] and those androgens are allowed to over express focus and concentration
[00:13:25] weakens So again there are all these different manifestations
of PCOS and [00:13:30] there are all these different
reasons why PCOS has become the
epidemic [00:13:35] that it is today We have to acknowledge that the environment has changed [00:13:40] toxins and your toxic load has increased the prenatal environment has [00:13:45] changed
and then
for our teens and for our young women in their twenties [00:13:50] Talk about stress and cortisol It's at a completely different level than it was even [00:13:55] 50 years ago We now have the added stress of connectivity and blue light [00:14:00] that actually triggers an inflammatory load
in the body And when we take that [00:14:05] inflammatory load and we combine it with all the hormones and all the environmental toxins and [00:14:10] all the epigenetic changes that's why
PCOS is an [00:14:15] epidemic today And unfortunately our medical models have not caught [00:14:20] up to what's actually happening to the chemistry in our
bodies
So
[00:14:25] PCOS is rising It is an
epidemic and it is something that we
need to think [00:14:30] differently about And sticking to old fashioned criteria like the Rotterdam criteria [00:14:35] is no longer gonna
be sufficient
What we are going to have to do instead is [00:14:40] screen for PCOS from early childhood through the history of our
hormonal [00:14:45] life because it actually presents in different ways at different stages
So what does that mean [00:14:50] tactically? Let's break that down for just a second So let's hopefully you're taking notes and hopefully you're saying [00:14:55] okay I agree with you but now what do I do?
Right? We need to make this tactical Here's what we [00:15:00] need to be thinking about
If
we're gonna change this conversation around PCOS and we're gonna [00:15:05] succeed in diagnosing PCOS earlier and being able to be maybe more [00:15:10] proactive around it and preventing stories like mine or so
many of my patients [00:15:15] then we really need a holistic approach and a
holistic
diagnostic approach We can [00:15:20] also use the word a functional approach or an integrative
approach Bottom line we need a new approach [00:15:25] So what I would like to see happen
is a couple of things no matter where you [00:15:30] are in your time span right? Whether you're a mom taking care of a child whether you're a young [00:15:35] woman really trying to get
pregnant or you're just not feeling right or whether you're in your thirties and [00:15:40] forties and you're noticing hormone changes associated with PCOS or even if [00:15:45] you're in menopause because there is a version of PCOS
for each of these stages [00:15:50] Let's first review the symptoms to make sure you know what
to dial into [00:15:55] Typically the most common loud you know speaker friendly symptoms are gonna be the [00:16:00] acne right the cystic acne that's typically on the jawline and usually on the neck [00:16:05] and
often on the back High androgen symptom you can't miss it
That one's super [00:16:10] obvious Symptom number two is the hair loss That's the one that
got
me and it's called [00:16:15] androgenetic alopecia And in that particular symptom you're losing hair but the way you [00:16:20] lose hair is very unique and that's where you can diagnose it differently from other forms of hair [00:16:25] loss When it's PCOS androgenetic hair loss here's what's actually [00:16:30] happening The hair is getting thinner and more brittle It's not coming straight out [00:16:35] It actually gets thinner and more brittle and it's almost like crunchy
You can hear like
paper sort of crunching in [00:16:40] your fingers when you go to rub it and that is because the hair follicle is narrowing [00:16:45] because of the androgen exposure
And over time that hair then falls
out [00:16:50] So hair loss is a symptom but that particular type of hair loss where the [00:16:55] diameter of the hair thins it falls over time It's almost not noticeable [00:17:00] until next thing you know you have this wide gap or part that you've never
had before and that's exactly [00:17:05] what happened to me when I was dealing with PCOS in my twenties
All right Those are two very obvious symptoms The [00:17:10] third is you're
skipping periods or you're not getting a period Another I would still put in [00:17:15] maybe the more obvious
bucket of PCOS but let's talk about some of the other ones Gaining [00:17:20] weight excessively especially
around the abdomen belly fat is often [00:17:25] a sign of
PCOS and here's why especially if you're having some of the hormone issues that go with
[00:17:30] it Because with PCOS there is this issue As the androgens go up the insulin
goes up [00:17:35] and we store
fat and we typically will first see that fat storage right [00:17:40] around the belly Maybe around the arms maybe around the back Those are classic hallmark [00:17:45] places where PCOS fast storage occurs So that's another way you can
tell
[00:17:50] Here's
another
symptom that we just talked about but it's the rise and fall of your mood and [00:17:55] emotions if you are having
extremes of depression or anxiety [00:18:00] especially as your cycle approaches it's another sort of whisper a soft [00:18:05] sign
that you may have PCOS And I'm gonna give you one more skin sign and here's what
[00:18:10] that one is
If you've got this velvety texture to the back of your skin that's called [00:18:15] acanthosis Nigra cans Fancy word I know I'm sorry but that's actually a sign [00:18:20] that you might be insulin resistant And in turn if it's coupled with hormone [00:18:25] imbalances you may have PCOS So that's a way to dial into your body and get a [00:18:30] sense of
what's going on
Now
when we flip the switch a little bit and we talk about looking [00:18:35] at it from the vantage point of other systems of medicine
right? If we're really gonna take this holistic [00:18:40] approach in Chinese medicine here's what they would actually say about PCOS
They didn't [00:18:45] diagnose it as PCOS right? But here's
what They did do They would talk about it as [00:18:50] liver qi
stagnation
meaning your liver for whatever reason is
[00:18:55] not able
to do the work your hormones needed to do So here's what you would see You would [00:19:00] see the dark circles right under the eye
If You stuck your tongue out and looked at it in the mirror [00:19:05] you would see that darkening kind of that
Purple purplish sort of reflection of the
tongue [00:19:10] That's liver cheese stagnation The other pattern of PCOS was actually
a gut [00:19:15] pattern believe it or not They had already connected the fact that the gut and the [00:19:20] hormones are interconnected and if we ignore that connection then in turn we're gonna have
[00:19:25] issues with overall balance in the body So the way you tell that this [00:19:30] time if your face was red or ruddy or you were getting a lot of rashes or you were itching a [00:19:35] lot and then your tongue had a coating whether it was a white coating or a yellow coating [00:19:40] you again should be thinking about something like PCOS So again these are [00:19:45] self-diagnostic
tools that you can use I would almost you know take a second to check in with [00:19:50] your body look at your face What's happening with your face? Do you have circles under the eyes? Do you [00:19:55] have a coating to your
tongue or is your tongue kind of that purplish color that we were just talking [00:20:00] about? Do you have a lot of cystic acne or is there acne on the neck?
Do you have hair loss or something that we
[00:20:05] need to be thinking about there? Do you have other rashes on your skin or your back your [00:20:10] legs your arms? All of these are a way to check in with your body Before you [00:20:15] even hit an exam room and start to understand that there is a connection between what your [00:20:20] hormones are doing and those androgens and maybe or maybe not your [00:20:25] ability or your risk I
should say for having PCOS
So that's a quick diagnostic [00:20:30] Tests that you can do Now what we do in the exam room is a little bit different If we [00:20:35] are suspicious of a patient having PCOS then there are a number of things that we actually [00:20:40] wanna look
at Once we've passed a physical exam Here's where we really start to [00:20:45] test and I hope you guys
have you know this is a resource that
you can use and even take into the [00:20:50] exam room with you but you should be testing and I've mentioned it a few times in
this particular episode we [00:20:55] should be testing A DHT an AMH
A free testosterone [00:21:00] a total testosterone A DHEAS and even a 17 [00:21:05] hydroxy pregnenolone Why? These are all androgens And again
in pulling the
[00:21:10] literature they talk over and over again about how a high a MH is [00:21:15] connected to having PCOS So when we look at all the androgens [00:21:20] together that's how we make the decision
Simply looking at a total testosterone And many of you have [00:21:25] said this
back to us in the exam rooms that well you know my testosterone is fine so I can't have [00:21:30] PCOS That is not
enough We have to look deeper and that's just the [00:21:35] androgen part of the conversation
Remember PCOS is a metabolic [00:21:40] autoimmune disease
so we have to check the metabolic markers too And what I'm talking about [00:21:45] here are things like a fasting insulin your triglycerides your lipids [00:21:50] even your blood pressure matters in this scenario because PCOS is impacted [00:21:55] by your metabolic state and your metabolic
state is impacting PCOS[00:22:00]
In
a particular study looking at PCOS they talked about something called advanced [00:22:05] glycation end products
Alright big words again What am I talking about? I'm [00:22:10] talking about foods behaviors Toxins [00:22:15] emotions that at the end of the day increase these molecules that [00:22:20] are basically high sugar or high glucose molecules and That's right Everything I just [00:22:25] mentioned can cause
that
So
when we're thinking about PCOS looking at the metabolic markers as [00:22:30] just as important as looking
as the at the hormonal markers they're [00:22:35] intertwined
Now there's one more set of markers that we like to look at before we put the whole puzzle [00:22:40] together and that's looking at inflammation markers So if you have a high [00:22:45] CRPA high SED rate a high TGF alpha a high interleukin six [00:22:50] these are all inflammatory markers that clue us into the fact that you are [00:22:55] dealing
with something like PCOS because it's not just a hormone but it's the hormone [00:23:00] symphony
that ultimately impacts you at the end of the day
So
the holistic [00:23:05] approach the functional approach to diagnosing PCOS involves looking at all the [00:23:10] hormones looking at all the androgens in their
derivatives looking at inflammation markers and [00:23:15] understanding
what those markers are and then also looking deeply at all the [00:23:20] different metabolic markers and putting that puzzle piece together Because what was missing [00:23:25] in those Rotterdam
criteria is the fact that PCOS is a [00:23:30] metabolic disease is an inflammatory disease and is a disease of oxidative stress [00:23:35] influenced by the environment
toxins prenatal environment and so [00:23:40] much more As we dive deeply into PCOS and how to think about it and how do we reposition [00:23:45] it in the exam room so so many women don't walk around undiagnosed There's one [00:23:50] caveat that we're also not talking about today but the research is evolving and we are seeing [00:23:55] it partly in the exam room as well
One of the things that we understand about [00:24:00] PCOS is that
there's actually a different presentation of PCOS depending [00:24:05] on your race I'm gonna say that again Your race matters when it comes to what
[00:24:10] PCOS will look like Caucasians have a different presentation of [00:24:15] PCOS than South Asians South
Asians have a different presentation of PCOS than [00:24:20] traditional
Asians And they have a different presentation of PCOS
when compared to Hispanics [00:24:25] or when
compared to blacks And each of them have to be evaluated [00:24:30] a little bit differently and honestly treated differently as well Let me tell you what I mean Here In the [00:24:35] Caucasian population we actually do see what the Rotterdam criteria
initially talked about [00:24:40] skipping
of cycles more cyst on the ovaries higher
androgen levels [00:24:45] However when it comes to the Southeast Asian population
Those [00:24:50] criteria often don't apply and instead many of those folks are actually dealing with more of the
[00:24:55] acne or the hair loss component of it So checking their androgens becomes critical [00:25:00] to
understanding what's happening in their version of PCOS When we talk [00:25:05] about Hispanics and blacks we see a huge preponderance of the metabolic [00:25:10] component of it In fact blacks have actually higher triglyceride
levels when it comes to [00:25:15] their version of PCOS than maybe a Hispanic Caucasian or southeast Asian
patient [00:25:20] Blacks also have a higher level of blood pressure They
have more hypertension when it comes to [00:25:25] PCOS and They have more issues with weight Whereas a Hispanic patient [00:25:30] instead may have more problems
with something called hirsutism which is where you have a lot of body hair or facial [00:25:35] hair or hair in places where you really don't want it
So
there is a racial [00:25:40] component to PCOS when it comes to
presentation and that's another reason why [00:25:45] globally PCOS is often missed because the initial research was done mainly on a
[00:25:50] Caucasian population not really paying attention to many of these other
races [00:25:55] In fact when we look at India for example in people of Indian
descent which of course I am as well [00:26:00] there is some talk that the incidence of
PCOS among Indian women may be [00:26:05] closer to 70% So if you're Indian and you're watching this particular [00:26:10] episode it's not if you have PCOS it's more like you probably do have [00:26:15] PCOS and how do we treat it and how do we try to understand it?
So again there is [00:26:20] a racial undertone
when it comes to PCOS and this is something that we do need to [00:26:25] dive more deeply into as we move forward
Now as
we've talked about PCOS and [00:26:30] talked about the diagnosis conventional diagnosis the holistic diagnosis now we
understand the [00:26:35] racial component to this as well We need to understand that it's looking different when it walks [00:26:40] into the exam
room So some people may be walking in with new
onset [00:26:45] weight gain They can't explain that weight gain They've got belly fat They've got maybe [00:26:50] more more heaviness in general than they've ever experienced before and that's why PCOS [00:26:55] is not just a disorder of
women trying to get pregnant Again there's the childhood [00:27:00] version
If a child has high androgens and high insulin you are gonna see the distribution of [00:27:05] fat exactly the way
we've been describing it For somebody with high insulin Fat around the [00:27:10] belly fat around the chest fat in the back fat in the
arms If a teen has this [00:27:15] issue with metabolic syndrome right maybe you're seeing somebody who is African [00:27:20] American or a Hispanic
teen is having issues with weight gain
We need to be thinking about [00:27:25] PCOS because again that midsection weight
gain is
tied to this [00:27:30] hormonal imbalance
Now
what often happens people will sail through childhood
and maybe [00:27:35] through their teen years just fine and they'll even get through their twenties okay And not
[00:27:40] realize that they're having an issue with PCOS until they try to get
pregnant and then they go on an [00:27:45] infertility journey that can be devastating and heart wrenching
Whereas at the end of the day this was a metabolic
[00:27:50] issue and it's really about the insulin and the blood sugar And if they could correct that [00:27:55] and those n glycation products then
in turn
they would improve their hormone profile [00:28:00]
But
sometimes people sail through that too
and they hit [00:28:05] perimenopause and menopause but they actually have PCOS so they have A-P-C-O-S version of [00:28:10] this
Let me explain When you hit perimenopause and menopause and [00:28:15] estrogen levels decline guess what happens if you have undiagnosed PCOS? [00:28:20] Your
androgens are allowed
to overexpress themselves and [00:28:25] remember high androgens high insulin It means two things For a woman [00:28:30] in perimenopause and
menopause it means that now suddenly they're going through a second puberty
They're like [00:28:35] what just happened? They're getting acne They're experiencing hair loss [00:28:40] Many women
as they go
further into menopause will get that classic male pattern [00:28:45] baldness because they're having overexpression of androgens From undiagnosed [00:28:50] PCOS
They
also are gaining weight much more rapidly than their
[00:28:55] counterparts
If you take A-P-C-O-S woman and a non PCOS woman and put [00:29:00] them both through perimenopause and menopause those with PCOS are going [00:29:05] to struggle with weight gain and belly fat much more dramatically than those that
[00:29:10] don't have Because again remember those androgens are going up because [00:29:15] estrogen is going down insulin is being overexpressed or we're having an issue with [00:29:20] hyperinsulinemia and that in turn makes weight loss so so [00:29:25] difficult
And women in turn starve overexercise do everything they can do [00:29:30] but don't seem to see a difference So understanding the [00:29:35] racial undertones and how that's
presenting in each of these cases
of PCOS
is so [00:29:40] important and how the metabolic the hormonal
and the inflammatory part work [00:29:45] together is critical in putting the whole puzzle together for any
particular patient so [00:29:50] that they are not just having success hormonally but they're having success
with their overall [00:29:55] health
So now that we understand that PCOS is a truly autoimmune [00:30:00] Metabolic
syndrome not a hormone disorder We can actually build a holistic [00:30:05] plan and here's what's exciting and encouraging that we can actually do
something about all
of [00:30:10] this And here's where we really need to
start Once we've done the right testing and the [00:30:15] lab work and we can
really nail the pattern then we can build a
protocol around it [00:30:20] And the fundamentals of that protocol While they are nuanced for every particular patient
because [00:30:25] personalization does matter there are some general principles that work and I'm so
[00:30:30] excited to share some of those with you
In
all forms of PCOS whether we are [00:30:35] dealing just with the androgens with
the
inflammation or with the metabolic component we have to [00:30:40] start with the gut
the gut is ground zero of health
And managing that [00:30:45] microbiome and helping those gut bacteria metabolize hormones reduce [00:30:50] inflammation and even help regulate blood sugar is a win that allows the [00:30:55] rest of your
health
to come
back together
So
when we're talking about the gut with PCOS there's [00:31:00] some basic rules that you guys have heard before but I'm gonna reiterate 'em because they're so [00:31:05] important
when it comes to this disorder
An anti-inflammatory
diet right? Bringing [00:31:10] in lots of plant-based foods Clean foods and when you have a choice [00:31:15] choosing real food over processed food wins every single time We've talked [00:31:20] about that toxic load and how it helps
accumulate and drive the body [00:31:25] towards this sort of high insulin high androgen state So the gut is the first place to start [00:31:30] If you don't know where to start that's
where we begin And changing your diet helps and [00:31:35] changes the microbiome but also supporting the gut helps too And this is where doing things like [00:31:40] taking digestive enzymes
that help you metabolize your fats better adding in a [00:31:45] probiotic that's broad spectrum and has things like lactobacillus bifidobacteria bacillus [00:31:50] bacteria in it can help support the hormones
In addition to that [00:31:55] helping rebuild the
integrity of that gut lining I love using glutamine Some [00:32:00] people like collagen but these are things that make a difference when it
comes
to PCOS
[00:32:05] And sometimes over time if you just work on the gut
the [00:32:10] body starts to repair itself and the hormone profile starts to get better as well [00:32:15] I can share my own story with this right? A part of my journey was not [00:32:20] knowing that I had a gluten issue and the minute I took gluten outta my diet it's almost like [00:32:25] everything kind of fell into place Why? Because the integrity of my gut lining was right where it [00:32:30] needed to
be the bacteria got rebalanced and my hormones started to behave [00:32:35] and that's one way of bringing those androgens
down
If
we move on from the [00:32:40] gut the next place to go when we think
about a holistic approach to PCOS is looking at the liver [00:32:45] The liver is ground zero for your health and you
want to make sure you're supporting the [00:32:50] liver cleaning the liver just like you would
clean a room in your house the [00:32:55] way to do that is increasing your consumption of leafy greens herbs [00:33:00] like parsley and cilantro and oregano which help liver to detox very naturally
[00:33:05] And in addition to that Adding things like
dandelion tea or taking something called [00:33:10] milk thistle which helps the liver to flush clean rinse and repeat and do what [00:33:15] it needs to do We also know that the liver benefits when we reduce
its chemical [00:33:20] exposure So again back to the food we eat but even thinking about substances [00:33:25] like alcohol medications or even excessive supplementation [00:33:30] all of these are hard on the liver and make it difficult for the liver to do its [00:33:35] job to move bad hormones out and really regulate blood sugar the [00:33:40] way it
needs to be The gut and liver are ground zero and that's why those
Chinese [00:33:45] medicine and Ayurvedic medicine concepts of liver cheese stagnation or excessive yang [00:33:50] or too much PDA apply to something like PCOS Now moving on from the [00:33:55] gut and liver where would we go
next? Well once we're sure we've tackled that then [00:34:00] we have to decide This is where the road may diverge a little bit So if you have high [00:34:05] androgens our first response is to
put you on an androgen blocker There are some [00:34:10] natural androgen blockers that work beautifully
Saw Palmetto for example is one of my favorites [00:34:15] Anatol is another one that works beautifully to help bring
that androgen load down [00:34:20] Or you may be someone who the metabolic component is the strongest and biggest [00:34:25] component And in that case thinking through things like
berberine which regulates blood [00:34:30] sugar adding in a good probiotic that also helps both the gut and the blood [00:34:35] sugar component of it
And here I'm talking about
something called akkermansia which we found is connected [00:34:40] to how the body uses blood sugar That's another way of helping and really [00:34:45] beginning
a holistic approach to PCOS And then finally if you have an [00:34:50] inflammatory
piece that really needs to be managed then we love bringing in high dose [00:34:55] Omega-3 curcumin boswellia
These are things that we have
seen work in practice[00:35:00]
But
sometimes you need a medication and medications aren't bad But what we don't wanna do is [00:35:05] the bandaid approach that you've got PCOS here's your birth
control and your spironolactone and boom you're done [00:35:10] What we wanna do instead is kind of build this plan so the body isn't necessarily always [00:35:15] dependent on this
particular prescription medication
So
this is where we've prescribed [00:35:20] as well spironolactone in very low doses and we're able to get away with low [00:35:25] doses because
we've done all this other work So you may only need 12 and a half to 25 [00:35:30] maybe 50 milligrams of
spironolactone in this particular scenario If you [00:35:35] have high androgens we've done oral minoxidil to help with the hair loss and it
makes a [00:35:40] difference
And then we've also done the medications like Metformin and even I'm [00:35:45] gonna say it even GLP one medications because they in turn help to [00:35:50] regulate the blood sugar and the hyperinsulinemia that's associated with
PCOS [00:35:55] And all of this is then in turn influencing [00:36:00] weight
gain adiposity hormone balance fertility [00:36:05] mood
and so much more
So again when you take this holistic approach [00:36:10] you're not band-aiding a myriad of different
symptoms right? When I went on my journey I was [00:36:15] handed an anxiety medication at one point a depression medication at another point a birth control [00:36:20] pill I was given spironolactone That's actually the medication
which I had a very bad reaction to [00:36:25] but it was a lot about just band-aiding every symptom
We wanna flip the switch really [00:36:30] when we think about how to care for our bodies and think about stacking and building it sequentially [00:36:35] starting with the gut moving to the liver moving to nutrients that optimize all the different [00:36:40] hormones and all the different cells of our body providing it with QE and energy that we [00:36:45] need to actually reproduce
and to
maintain our hormonal cycle
And then from there [00:36:50] moving into understanding that we have to regulate blood sugar And there are so many different ways to [00:36:55] regulate it There are some natural
remedies that work but if it's not working [00:37:00] then we move on
and that's the point of whole plus is that we have to move on some time and move [00:37:05] into medications that work but we can microdose medications and we can use less [00:37:10] of them for less period of time
when we've done this work So that's the holistic approach [00:37:15] Now I've left one really critical
piece out of this entire equation [00:37:20] and I did so on purpose because one other thing that we have to talk about that I've alluded
[00:37:25] to as we've talked about PCOS is the impact of cortisol and stress Right [00:37:30] Cortisol is the stress hormone and as cortisol ramps up right?
Should I be [00:37:35] surprised
that mine expressed itself after you know years of med school and residency and night [00:37:40] shifts and all that stuff? Probably not But as cortisol ramps up and we [00:37:45] go into high cortisol states We overproduce androgens and we overproduce insulin [00:37:50] and the body goes into this metabolic mode of
PCOS So managing [00:37:55] cortisol is really important too and there are a number of different ways to do that And I have so many [00:38:00] episodes and videos where we talk about that But in the context of PCOS [00:38:05] I wanna remind you all to have a plan to
bring your cortisol down
[00:38:10] because
that hum of cortisol that's coming from the pituitary
and the hypothalamus is [00:38:15] influencing your hormones So whether you do acupuncture Or yoga or [00:38:20] massage or you meditate or you go on a retreat or you sleep whatever it is you [00:38:25] have to have a consistent plan to start to calm those cortisol levels down
[00:38:30] And if you find yourself in a position like I was in my twenties where I didn't really have control [00:38:35] right? I had to do night shifts
you know I had to do residency These were not optional [00:38:40] Then you have to have a recovery plan that really works hard on bringing the cortisol [00:38:45] way down
And in that way you are protecting your hormones
but [00:38:50] ultimately you're protecting your
long-term health because every time these symptoms go [00:38:55] unchecked it's more inflammation
It's more metabolic
disease it's more [00:39:00] hormone
disruption And even though you may check off the goal Hey I got
pregnant Hey I
[00:39:05] lost weight Hey my mental health issues are
stable It's not over [00:39:10] until these things are balanced So a holistic approach to PCOS serves you well through your [00:39:15] decades and through your lifespan
And
avoiding doing this
work only leads
only leads
[00:39:20] to more heartache more medications more disease burden and [00:39:25] ultimately a you That's simply not
you
I hope this episode gave you something valuable [00:39:30] to think about or to even try this week. If it did, please leave a short review on your [00:39:35] podcast app.
It really helps us grow the whole plus community and reach more people [00:39:40] who need to hear this message. You can also connect with me directly on Instagram at Dr. [00:39:45] TAs md. Send me a DM and tell me what you'd love to hear about next.