Why am I so tired even after normal lab results in perimenopause

Natalie Tysdal (00:01)

Doctor Mike, thank you so much for joining me today.

Mike Fortunato (00:04)

thank you for having me. It's my pleasure.

Natalie Tysdal (00:06)

So hormones are a big, big topic. It's one it's the most requested topic. The audience that listens here to the podcast, they're trying to figure out this hormone issue that they're told they have, they're not sure they have. So they go in for some lab work, they get it back, they make some adjustments and they still feel like crap. What how do you get the balance that we're all looking for to feel good?

Mike Fortunato (00:32)

Yeah, this is a this is a tricky thing in the sense that, you know, labs are they're built on the referen the so the reference range is based on the average of the population. So this is what what what's tricky with hormones is that

Since we're all being affected negatively by endocrine disruption, right? This is well known by the endocrine society. Since we're all being affected, we all move together. And so when we look at the reference ranges, and we look at them of the past, and we look at good studies on where patients should be to feel well.

They're always outside of the normal reference ranges. And so when when we're treating patients for hormones, we have to we have to first know that foundationally. And if we don't know that, and a lot of clinicians don't, like I was, I'm an I'm an MD by trade, I'm an anesthesiologist, we were taught reference ranges are normal, and that's where people are supposed to be. we weren't taught this nuance of hormones that have been happening over the last 30 years. So when I see patients and they're in the I know they're in the normal.

They don't feel well, but normal is dysfunctional. And that's the that's the crucial component of of what you need to know. And so when I see them, I listen to them because symptomatically that's how we treat hormones. We know this from all the research.

If patients are not improving and we're moving on the labs, but we're still not improving, the studies show conclusively you continue to increase the dosing until the patient's symptomatology gets better, or we're into ranges where patients are having side effects, right? But if you go methodically,

And at a nice pace, we always get to a range where patients feel better. And the funny thing is it's always outside, okay, not say always, the vast majority are outside the normal reference ranges.

Natalie Tysdal (02:18)

So you you mentioned something I want to go a little deeper into and that is this endocrine dysregulation or disruption, you said, right? And we hear that,

Mike Fortunato (02:24)

Disrupt. Mm-hmm. Yeah.

Natalie Tysdal (02:27)

but I don't think many people really know what it means. What what do you what do you mean when you say that?

Mike Fortunato (02:32)

Sure, sure.

so we live in a we live in an industrialized world, right? we're being exposed to things that we were not exposed to 30, 40, 50 years ago. And the endocrine society, which is a major medical society in this nation, has been documenting exposure and what it's doing specifically to the endocrine system. And so when we talk about chemicals.

We look on a box of our food and we look at all the things we can't pronounce. A lot of those are endocrine disrupting. We look at the stuff that they spray on, say, our crops to keep pesticides right pesticides to keep p the bugs around away. These are endocrine disruption. The things that prolong the shelf life of foods that they spray on them

The things in your clothing, right? The things in your skin products. The list is endless. We're constantly being exposed to this. Then we talk about EMF and exposure to these type of things. We're seeing more and more that everywhere we turn, our body's being disrupted by some form of endocrine chemical or

radiation. And so what this does is it mimics hormone hormones and it either blocks the receptors where hormones will bind and act, or it disrupts its production or downstream all the things that it's doing. So it can be difficult and the endocrine is doing a fantastic job. If you go there, they've been doing this since two thousand eight. They'll tell you these chemicals are doing this. These chemicals are doing this. And they're affecting us globally. So when I see patients I know

If they're not feeling well, they're disrupted. We know this. And it's it's from twenty year olds, it's as low as twenty year olds now. I think it's even it's gonna be lower in the next few years because they're finding that these things are being passed genetically. So your parents have better hormones than you do. And your children will have less than you because one, they're being exposed longer, and you're not passing on a hundred percent clean genes anymore. We're not doing that. Yeah.

Natalie Tysdal (04:33)

So okay, it scares me when you say things like that. And then you know, fear is a big part of how we change, but but short of moving to a remote

Mike Fortunato (04:38)

Yeah, but I I'll I'll I'll yeah, I'll explain how we could be optimism.

Natalie Tysdal (04:43)

island without all of those things that you talked about, how

do we reduce those problems?

Mike Fortunato (04:46)

Right. Okay, so there's

I look at it this there's t there's a problem, we have to identify it, we can't we can't bury our head in the sand, but we have to come up with solutions and we have we cannot lose hope in life. This is not what I'm trying to tell patients. right now we have good solutions. Good solutions are we replace our hormones currently.

I believe the body is an amazing instrument, right? Like you cut your finger and it heals. It's just phenomenal. We we often just have to give it basic resources and it will do what it's been God given to do, right? And being in medicine and being anesthesia for so many years, I know this. I believe we just we have to get to when this is we're talking a different spiritual level, I think we need to get to a a consciousness in this nation, in this world, where we start to say, hey, it's no longer okay that.

companies do this for profit. It's no it's no longer okay that we allow this type of thing for

these companies or said products. We have to figure out how we do these safely and benefit everybody. And I think until we get that consciousness, we're not gonna see much change. We're gonna have to just deal with the band-aid, right? So I you know we have a poison. When you have a poison you do two things. You remove the poison and then you give the antidote. and the patient will get better because you'll clear the poison and the body does what it's supposed to do. Work

extensively living in an environment that's constantly poisoning us. Every day we're getting it. So right.

Natalie Tysdal (06:14)

It's hard to remove it. You say remove it and we don't always know that it's even there.

Mike Fortunato (06:18)

It's very difficult. And so this is where when you replace your hormones though, it allows your body to come to a a a a state of

Healing. I've seen it time and time again. We're in a constant state of survival mode. We have a lot of stress, this is one aspect, and fear, that's another aspect that weakens the body. and then we have the disruption. When you heal the disruption, the body is able to handle a lot of these other things much better. Now I'm not saying it's ideal, but it's the best we have. And I see time and time again that patients not only get better, they start healing things that were ailing them for

Five, ten years. Because now the body's no longer in this state of survival. It's functioning like it's supposed to, and the body's amazing.

Natalie Tysdal (07:03)

Wow. Okay, so you talk about heat replacing the hormones. Tell me what specifically you're talking about with that.

Mike Fortunato (07:12)

when

s when we're talking about females and specifically, we're talking about things like progesterone, thyroid.

DHEA is another pro hormone. Vitamin D is not a hormone, or not a vitamin, it's a hormone. And then estradiol, which is what what everybody knows by estrogen, it's a version of estrogen, but it's the specific one we need, and then testosterone. So depending on what phase a female is in premenopausal, perimetapausal, or postmenopausal, there's some variations in things we do. It's mainly around estradiol.

But most most patients can get most of those things as early as their twenties now. It's becoming that n needed.

Natalie Tysdal (07:55)

Okay, I I want

to talk to you about that. That that's a really it's a big issue because a lot of women, myself included, and many listening, they think, Well, I'm not in menopause, I don't have to do that yet. So at what stage are you saying that, you know, we know perimenopause can go on for a long time. It could be quick

Mike Fortunato (08:11)

Yeah.

Natalie Tysdal (08:11)

for some people, it could be ten years. Most women don't even know they're in it. I just did an episode about that. But would you say you would be replacing those hormones slowly at a younger age to help balance that earlier?

Mike Fortunato (08:25)

think about birth control right we give birth control out so young and birth control the the main reason we're giving birth control is because the lack of progesterone it's a major dysfunction right and progesterone will regulate regulate the dysregulated menstruation this is why most women are put on birth control early on we're lacking these things very early so at the beginning you know we base it on symptomatology but if you're feeling tired if you're feeling like you just

have energy throughout the day. Thyroid dysfunction is happening globally. We're seeing it younger and younger and it's not being diagnosed, it's not being treated. That that we could start early. Progesterone in females, absolutely early. And then we're seeing that we're starting low dose testosterone in in women in their in their twenties. Yeah.

Natalie Tysdal (09:13)

Why are people afraid to take that hormone? And you say, I don't want you to give me testosterone. is it

Mike Fortunato (09:19)

Sure.

Natalie Tysdal (09:20)

are there natural forms of it? Are they synthetic? And what what's the fear and then how is it helping people?

Mike Fortunato (09:25)

Yeah.

Well, we have we have a lot of bad information over the years, right? First off, we know that hormones in the past have been touted as very dangerous, right? Especially for women. We were told, you know, breast cancer, uterine cancer, blood clots. And when you look at the research, this stuff and we're and we're starting to finally get this information out. most of all that research was based on synthetic medications, meaning they took the actual component, progesterone and estrogen, estradiol, and they and they synthetically made it.

And when they did this, they alter it because you can't Pfizer can't sell you progesterone and own it. They have to make it into progestin or provera, right? And in doing that, they changed the molecule. And that mimics

progesterone, but it doesn't act the same. When you give bioidentic, which is the exact component, you have to go to a compounding pharmacy. It's not a traded drug. They have to make it, but it's the exact thing that mimics your system. They studied the synthetic stuff because our system is based on pharmaceutical companies and HMOs. They're not based on compounding pharmacies. And so when they do the research they show now that the synthetic stuff we know is is actually dangerous, but the bioidentical is safe and effective.

So this is a huge issue that needs to be cleared up in in the psyche, but not just the patients, the physicians. They're still pushing this bad research, right? Medicine's very slow to react. and so that's one major issue. The other issue is I think

People equate specifically testosterone to anabolic steroids. Now it's an anabolic, technically, yes. But it's a hormone naturally in your body. And so when you're dysfunctional or deficient in it, just like insulin, you wouldn't tell someone they should take insulin because

Natalie Tysdal (11:14)

Right.

Mike Fortunato (11:14)

I don't want to be on it. Well, I know you don't want to be on it, but if you don't if you're not on it, you're not gonna be well, right? And so the same the same applies with hormones. and I think people, those are the main things I I think why people think they're not something I wanna be on.

And lot of people, to their great effect, they don't want to take things every day, right? Like people go, I don't want to be on something forever.

Natalie Tysdal (11:35)

Mm-hmm.

Mike Fortunato (11:36)

When we start hormonal treatment, it's not supplementation, right? We're so dysfunctional where we can't give you 25% hormones, right? Your body will slowly take in the hormone and your body will recognize it and say, hey, we don't need so much. We are making it. It's identifying what you're giving as its own. And so it starts to slow down your own production.

to

to get to the effects we need to, we surpass our natural production and so we shut down our normal response.

And that's called replacement, right? Because now you're dependent on what we're giving you because it's the doses needed to get your symptomatic relief. And a lot of people don't like that concept, I guess. But the reality is what you do get optimal, your life changes. Your body is is is running at a level you probably haven't seen in 20 years, 30 years, right? And you're you're mentally clear, you're more vigorous, and the and the reality is you're protected long term because hormones regulate insulin resistance.

They r they regulate inflammation. So we know it's protection for your heart and your brain and women for bones, right? When you when you get menopausal you lose bone health. Estradiol grows bone. It's the only thing that will grow back your bone. Yeah, so if you don't lose

Natalie Tysdal (12:48)

Wow. Wow.

Mike Fortunato (12:49)

it

That's why if you don't lose it, your risk of fractures later on in life become nil. But we don't do that. We give patients, you know, things that slow it down, right? Bisphosphonates and all these things that doctors will prescribe, but they don't solve the problem. having your natural estrogen solves the problem. We just don't do it.

Natalie Tysdal (13:08)

So estradiol

testosterone, those if you start supplementing when you have a little need, then by the time you're menopausal and y you have no energy and hot flashes and all these things, it's a it's an easier process.

Mike Fortunato (13:19)

Yeah. You sh you shouldn't have to deal with

yeah, you shouldn't have to there's there's women that we get you optimal during perimetopausal.

You don't have to suffer the symptoms that your mom suffered through, right? And then on the other end, the new normal. The new normal is no estrogen, no protection for your heart, no bone health, right? No no libido, no sexual function. These are things we've said, that that that's that's menopause. That's your new normal. you don't have to have that. You don't have to have that at all.

Natalie Tysdal (13:54)

So when you're talking about the endocrine system, how do these things work together? The endocrine system and then the hormones.

Mike Fortunato (14:00)

Yeah.

Think about hormones, they're communicators, right? They're very unique in that they they don't just go to one targeted area, they go throughout your whole body. So they're messengers in so many ways. Now they do specific things that we we associate them with, right? Your thyroid is metabolism.

thermal regulation, right? But energy, right? How we regulate your energy is so powerful through your thyroid. And when that's dysfunctional, every one of your cells is not running at optimal tempo, right? Because it sets the tempo for every cell. So if that's low, then everything's slow. And you can imagine if everything slows down, just theoretically, this is like an a nice way of explaining it. Things are more sluggish, right? And if things are supposed to clear things and and and help fight off infections and do

Natalie Tysdal (14:45)

Mm-hmm.

Mike Fortunato (14:45)

do all these things, deal with toxins, it becomes much less effective.

Right. And over time you can see how that compounds, right? Testosterone and energy and libido and muscle growth, right? And insulin resistance. They all commute they're communicating with each other and they work synergistically. So when you use one with an with the other one, it's one plus one is three, right? It's not two. And that's how you have to look at the entire system. A lot of clinics will just put patients because it's easy. we give guys all guys get testosterone. All women get XYZ.

But if you're not replacing everything in a holistic way, you're not optimizing them.

Natalie Tysdal (15:23)

Yeah. Well, I I started this interview talking about the blood work. So let's let's go back there quickly because

Mike Fortunato (15:27)

Yeah. Sure.

Natalie Tysdal (15:29)

for a lot of people they're they're seeing the doctor they've seen for many years and that might be the only doctor they're seeing and they might do a general set of labs. Is that enough that the average thing that's being done or is

Mike Fortunato (15:41)

No.

Natalie Tysdal (15:42)

it I mean I just did a big old lab and I got a lot more than I've ever had before, but I had to push because I'm kind of in this world and I know this

Mike Fortunato (15:50)

Yeah.

Natalie Tysdal (15:50)

stuff, that most people don't know what to ask for.

Mike Fortunato (15:53)

No, and here's the here's the thing. We're having two I think we have two systems, right? We have what I come from, the sick care system. We were taught, if you're sick, you come to us, we make you well. Back to your baseline. Back to your baseline. We never make anyone better than we found them. This is not what we did, right? This is not what medicine was. now people are going, Hey, I wanna prevent I see all the disease we've had for all these years. This is not looking good. I don't wanna I don't wanna go that route. How do I do that?

Well the primary doctors who taught in in the traditional system, unless they're educating themselves outside of it, they don't have a clue on how to do that. We weren't taught that, right? We were we were taught nutrition one class of all the years of medical school, one class. That's how we were taught prevention. We were taught, give me your symptoms, I'll look for the disease and I'll treat the disease. So, you know, I don't I I I don't fault them. I think we're looking in the wrong places, right? We we have to start to realize that that's a sick care system and most of your primary care doctors in the HMO system will

not know how to treat you hormonally. They will not. I'm not saying you need to have a thousand labs done, right? My lab work is pretty reasonable, but even still

you'd have to ask your physician for these for certain tests. You know, most doctors don't test testosterone at all. They've not looked at it for decades, right? We we thought it was a very rare disorder. So we'd never check testosterone. For women there's certain things that we would check, but again, we said, hey hormones were dangerous, so they weren't inclined to give you them even if they found a dysfunction, right? They'd Well no just wait it out. You'll you'll you'll get nothing

your hormones will crash and then you'll get used to living like that. That was the solution for even to this day some doctors will do that. so you have to have a physician who knows. So yeah, you know, there's there's certain tests you should check. You know, OB doctors are a little bit better, but they're still not doing it correctly for females.

Natalie Tysdal (17:48)

So what are the questions

that you should ask and if you're not getting the right answer, go elsewhere?

Mike Fortunato (17:55)

Sure. do you prescribe compounded bioidentical hormones? Or is it just what's on the formulary for my HMO? So if it's through your insurance only, you're likely not going to be able to get treated. And that's why I don't practice within the insurance system anymore.

Right. This is there's there's the issue of the labs. Once I get patients to where I need to get them, they're all in the red. Now they're in the red. Now you get dinged, right? The insurance company says, Hey, you can't have the labs in the red. We're not gonna pay you. They'll remove the money from your bank account. They literally will do that. And so you go, Well now I gotta get the patient back into the normal ranges, but then the patient's not doing well. And so I don't wanna do that. they also have formularies where you have you have a you wanna give them extra dial? Well we have this. That's what you have to give.

Well no no no that's

Natalie Tysdal (18:41)

Mm-hmm.

Mike Fortunato (18:42)

not that's not what I want to use. the compound stuff is outside of the formularies. And so I think first and foremost, if you think you're gonna get hormone replacement done by your primary care doctor who's in an HMO system, it's not gonna happen.

Natalie Tysdal (18:57)

Yeah. So you need to start looking.

Mike Fortunato (19:00)

Yeah.

Natalie Tysdal (19:00)

If if you're not happy with that and you're hearing this thinking, okay, maybe I need to look, and you have the funds to do it, there's a whole nother issue because insurance

Mike Fortunato (19:07)

Yeah, for sure.

Natalie Tysdal (19:08)

isn't paying for it. is it I I'm guessing if you have an HSA, you can at least use those funds. Yeah. So it might not

Mike Fortunato (19:13)

Yes, HSA works, yeah, for sure, right?

Natalie Tysdal (19:16)

be might not be that you get your insurance to cover it, but you can use HSA funds if you have those. So then you start looking and and you're looking for

What, a a functional medicine type doctor?

Mike Fortunato (19:29)

yeah, I

mean there's there's hormone some functional medicine doctors are informed for sure. and then you have hormone like I'm a hormone specialist, so you have hormone optimization specialists now. They're on every corner, right? So this is this is a difficult time for patients. It really is. I do I went I went through as

Natalie Tysdal (19:44)

Yeah. Yeah. It is. It's confusing. That's why I do this. Yeah.

Mike Fortunato (19:49)

a doctor. I my colleagues told me because I I practiced because this is what I lived. I was dysfunctional.

ten years ago and they told me, you're fine. Your labs are normal. You're a doctor. You're gonna be tired. This is not unusual. You'll get used to it, right? even my friends and colleagues were telling me this. So I'm a physician. This is I I realize how difficult this is for just a lay person who's trying to to maneuver through this. And you have clinics on every corner that they know, hey, hormones are being trendy. we can make some good money, right? So they have paid you have clinics that do have good intentions but don't know what they're doing very well. You have ones that

Really are doing it well. And then you have those who just say, Hey, I can make some money, we'll give people a little bit of hormones, but you know, we'll keep them still in the normal reference ranges. I think it's important for patients to say, what's your philosophy on how we how how I'm gonna be treated, right? Am I gonna be on a set protocol or are we gonna is this individualized? Are you gonna adjust my dosings based on how I feel or reference ranges of the labs, right? If they're chasing labs for you.

you don't want to be there, right? Everything should be based on how you feel for hormones. And of course we use the labs to guide us, but we don't say, Hey, Natalie,

You're in this range and you're like, well, I just don't feel like we're we're we're improving yet. Well, that's you're in the range, you're fine, right? If if they're doing that, that's not the type of practice you want to be in. You you want more of a symptom base, okay, you're not doing well. Well, here's our options. We can increase this year, we just have to watch for X, Y, Z, but I think we'll go slow, I think we'll get you there, right? That's the type of relationship you need to have with your providers.

Natalie Tysdal (21:27)

Yeah.

one thing we started talking about before I hit record was finding someone that works for you. And I didn't realize that a lot of this, because it's symptom based, can be by phone or telemedicine.

Mike Fortunato (21:42)

Yeah. Telemetis. I do video, yeah.

Natalie Tysdal (21:45)

and that works for you did they someone would just order the labs and then you can read them and and prescribe and it shows up at their house. Wow.

Mike Fortunato (21:49)

Yeah. Precisely. So precisely. It's with

technology these days, we have nationwide labs, so patients

Natalie Tysdal (21:59)

Mm.

Mike Fortunato (22:00)

come in, we send them to LabRec, they go to lab core, lab core is almost pretty much everywhere or Quest, they're

Natalie Tysdal (22:05)

Yeah.

Mike Fortunato (22:05)

everywhere. you get your labs, they get sent to you and they get sent to me, then we do a consultation, I go through everything, we talk about your symptoms and see how it relates to your labs and then we come up with a plan and then when we

do move forward, everything gets shipped to your house.

Natalie Tysdal (22:20)

Wow, I I love the idea of that. So it well first it's just easier. You're not just running around town trying to find

Mike Fortunato (22:26)

Yeah.

Natalie Tysdal (22:26)

someone in your local area.

Mike Fortunato (22:29)

Right.

Natalie Tysdal (22:30)

but there's a communication to that that can be easier.

Mike Fortunato (22:34)

Yeah, 'cause and then I and my patients they have access to like a portal so you can send

Natalie Tysdal (22:38)

Hm.

Mike Fortunato (22:39)

in messages whenever you want. We're responding, our team's responding. You get more, you know, conscience care. And if there's an issue that we

Natalie Tysdal (22:45)

Yeah.

Mike Fortunato (22:46)

need to meet, then we meet and we say what's on the schedule the next couple days or the next week. How does it work, right? It's much better for both the patients and the providers, right? We're actually interacting with the patients, we're getting things done and everyone seems to be happy with it.

Natalie Tysdal (23:00)

Well, you you also mentioned and I wanted to talk about you moved out of this sick care model as an anesthesiologist for years of doing this thing you trained in to something completely different in medicine. And did that come from a place of your your own need? Or I mean that that's pretty big shift.

Mike Fortunato (23:18)

Yeah.

Yeah, it became it came through my own experience. I mean I love anesthesia. I did it for a long time. I was the chief of anesthesia at the local hospital, which is the head of the anesthesia department. And I do enjoy it. but my journey was

loss of my hormones and seeing the d just the dysfunction that I had to suffer through and my colleagues telling me it's okay, it's okay, you're fine and that would cost me three, four, five more years before I really hit rock bottom and said, No, no, this is not normal

I I shouldn't feel this way at thirty-five years old. I shouldn't have no libido. I'm married. I shouldn't not have any desire. I shouldn't have I shouldn't be tired all the time. This is crazy. so I went through the system that was available then and I saw how dysfunctional is. Even the clinics and the and the things that they were doing, giving me one shot a week and sending me on my way and giving me things to block estrogen. All of the things that

Could go wrong for the most part. I w I I I suffered through and my wife who's a physician, she's like, I don't think this hormone thing's for you. You should stop because I was having all these reactions. But but I felt I knew it was improving me from a deeper level. I could feel it. I felt the energy. I saw glimpses of it. So I knew this was the path. It was just being done wrong. And then once I educated myself, the more and more I did

I said, well, I could do this for patients. This is so rewarding. I see how much it changed my life and it changed my life entirely. I just said, you what, I'm gonna do that. I think I'm gonna do it. you know, medicine has become, you know, especially since COVID, it become very indoctrinated and very I would say we gave up the Hippocratic oath and I'm gonna like that. We started telling people what they have to do at all times and you do this or you don't do this. And medicine was supposed to be a

a a discussion with your patient.

Natalie Tysdal (25:09)

Mm-hmm.

Mike Fortunato (25:10)

What's your issue? This is what I think. This is why I think it. We could do this or he could do this. This has this side effects. This has this. What what is your opinion? What do you feel? Dude You know what I mean? It was a it was a respectful thing and it was informed thing, right? It was informed consent.

COVID came and we threw all out the window and ever since then you just see how everything's very structured, everything is very protocolized. And that relationship, as everybody knows, they don't have a relationship with their providers anymore. That's gone. And if you don't

Natalie Tysdal (25:36)

Yeah.

Mike Fortunato (25:37)

have that, you lose so much of the ability to catch things and adjust things and and

Natalie Tysdal (25:42)

Yeah.

Mike Fortunato (25:43)

it's just it's it's I think we're moving into a new paradigm and I think optimization in that type of health space hopefully will change that relationship entirely.

Natalie Tysdal (25:52)

Yeah, it's it is a whole I've been covering health news for thirty years as a journalist and it's a completely different world of of of medicine than thirty years ago. well b ha partially because we know so much more. You know, the knowledge and and the science and what you're practicing now. Yeah.

Mike Fortunato (26:09)

Mm-hmm. We know so much more. But the but the machine becomes a monster because it's

now we have the most expensive healthcare system in the world

Natalie Tysdal (26:17)

Yeah.

Mike Fortunato (26:17)

practically, right? And and but if you look comparatively of how well people are doing, we have some of the sickest of the world.

Natalie Tysdal (26:24)

Yeah.

Mike Fortunato (26:24)

So you can't

say that we're winning at this. We're we're we didn't create this perfect system. And so we have to question it, but then we're at when we question it, they say you can't question this. You know what I mean? So it's so like

Natalie Tysdal (26:33)

Yeah, right.

Mike Fortunato (26:34)

I think that's why we see this other space opening. Because people are not, patients are not happy, providers are not happy, and we say there's something better. There's something better.

Natalie Tysdal (26:45)

Yeah. Well, I appreciate the knowledge that you shared with us today on endoc the endocrine system and hormones and and mostly just finding what you need as a as a patient. Go find the thing you need. Don't wait for it and

Mike Fortunato (27:00)

It's out there.

Natalie Tysdal (27:00)

don't expect that you're gonna just get it from the same doctor. Not always usually not the doctor's fault, as you mentioned. They just haven't been trained in that. And they

Mike Fortunato (27:07)

No, no. This is what they're trained to do. Yeah.

Natalie Tysdal (27:10)

only have a certain amount of time and each patient comes in and they get a certain slot and

Yeah. Well, thanks again. I appreciate it. Where can people find you? I'll be sure and put it in the show notes, but where can people get you? Mm-hmm.

Mike Fortunato (27:21)

Yeah, thanks for having me.

You can find me on www optimize md.health. That's my main my main site. You can you can i in interact with my AI and ask questions and it can guide you through the process. I'm also gonna be on a new a new podcasting system called Icon Streamer. It's gonna have community, it's gonna have a classroom where I'm putting up videos for people to get free education and stuff so that people can get informed about what what's happening and how and how they can go about improving their lives.

Natalie Tysdal (27:53)

Sounds like I need to know more about that. It's podcast streaming. Sounds fantastic.

Mike Fortunato (27:55)

Yeah. it's it's it's phenomenal. You should yep, we can talk about that.

Natalie Tysdal (27:59)

That's great. Well, it's so nice to meet you and learn from you. I there are a couple of other topics I'd like to come back to you on, because I think we can go deeper and help a lot of people by just informing them.

Mike Fortunato (28:11)

Absolutely love to.