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Many people picture PMOS (polyendocrine metabolic ovarian syndrome, formerly known as PCOS) as a condition tied to weight gain. But the diagnostic criteria never mention body size at all, and a significant number of people with PMOS have a completely normal BMI. In part two of our PMOS Awareness series, Dr. Patil-Sisodia breaks down “lean PMOS”: what it looks like, why it is so often missed, and why the metabolic risk is just as real even when the outside doesn't show it.

In This Episode

• Why PMOS became associated with a specific body type, and why that picture was never the diagnosis itself
• The three actual diagnostic criteria: irregular or anovulatory cycles, elevated androgens (DHEAS, testosterone), and polycystic ovarian morphology on ultrasound
• What lean PMOS symptoms look like: irregular periods, acne, facial and body hair growth, scalp thinning
• “Normal weight obesity”: how insulin resistance and visceral fat can hide behind a normal-looking exterior
• The three-part pattern that causes lean PMOS to slip through the cracks in clinical practice
• Why an undiagnosed lean PMOS patient loses out on cardiometabolic monitoring, not just a menstrual explanation
• What needs to change: for clinicians, dropping body size as a screening filter; for patients, presenting symptoms as a pattern instead of one at a time

Timestamps

00:00 | Welcome to Clearly Hormonal
01:01 | Series Setup: Lean PMOS
02:09 | Why PMOS Has a Body Type
02:42 | Diagnosis Criteria, Not Weight
03:39 | Lean PMOS Symptoms
04:05 | Hidden Insulin Resistance
05:01 | Why Lean PMOS Gets Missed
06:51 | Why Diagnosis Matters
08:05 | What Should Change
09:24 | Wrap Up and Next Week
10:03 | Mini Course Announcement

Coming up next week: Episode three of the series looks at treatment, including where GLP-1 medications and other weight management tools fit into PMOS care, and who they actually make sense for.

Sign up for the newsletter at eastsidemm.com/newsletter, and follow along on Instagram or TikTok @drpatilsisodia.

This podcast is for education, not personalized medical advice. Please discuss anything you hear here with your own healthcare team.

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.

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PMOS Awareness Month kicks off with a reframe: PMOS is not a condition that resolves once your cycles regulate or once you're done having kids. It is a lifelong cardiometabolic condition that happens to announce itself first through reproductive symptoms. Dr. Komal Patil-Sisodia walks through the three diagnostic criteria (irregular periods, high androgens, and polycystic ovarian morphology) and explains why the biology underneath, insulin resistance, visceral fat, and unfavorable cholesterol, persists even when periods look normal. She unpacks what worsens in perimenopause, the clinical blind spot that causes PMOS histories to get dropped from the chart, and what she actually changes in her own practice: earlier and trend-based lab monitoring, a shift in treatment goals from fertility to long-term metabolic and heart protection, and more individualized hormone therapy decisions.

In This Episode

• Why the three PMOS diagnostic criteria are not the whole disease
• The underlying biology: insulin resistance, visceral fat, and cholesterol changes that often start in the teenage years
• What worsens at perimenopause: insulin resistance, LDL and triglycerides, and belly fat
• The missed clinical question that keeps PMOS histories from shaping midlife care
• Why 20+ years of a less favorable metabolic starting point matters for heart disease risk
• What changes in practice: trend-based monitoring, shifting treatment goals, and individualized hormone therapy
• A preview of the rest of the PMOS Awareness Month series

Timestamps

• 00:00 — Welcome to Clearly Hormonal
• 01:03 — PMOS Beyond Fertility
• 02:14 — PMOS Is Lifelong
• 04:05 — Perimenopause Metabolic Shifts
• 06:17 — The Missed Clinical Question
• 07:52 — Heart Risk Over Decades
• 09:38 — What To Do In Practice
• 11:34 — Key Takeaways & Next Episodes
• 12:46 — Mini Course Invitation

Coming Up in This Series

• Episode 2 — Lean PMOS (sometimes called "skinny PMOS") and why it gets missed
• Episode 3 — Where GLP-1s and other weight management tools fit into PMOS care
• Episode 4 — The long road to diagnosis and its toll on mental health

Links

• Join the email list for the PMOS mini-course: eastsidemm.com/newsletter

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.

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On Women's Equality Day, host Dr. Komal Patil-Sisodia revisits an idea from an early episode of Clearly Hormonal: the menopause penalty, the disproportionate income loss, leadership attrition, and career disruption that midlife women face. This episode goes past the data to ask what it actually feels like to lead through sleep disruption, cognitive overload, and hormonal change while carrying the weight of an executive role.

Guest Dr. Brooke Buckley traces her path from a punishing early surgical practice through hospital operations, an MBA negotiated into her first CMO contract, and a system-level leadership role she stepped into during the pandemic. She speaks candidly about infertility and loss, being the only woman in her surgical residency class, and the coaching and community that carried her through. The conversation moves into trauma-informed leadership, why physiology cannot be negotiated away, and the hard pivot Buckley made in walking away from the operating room to protect her own health.

00:00  Why Equality Still Lags

01:48  The Menopause Penalty

02:34  Meet Dr. Brooke Buckley

04:04  From Surgeon to Executive

07:32  Lessons From Organized Medicine

11:44  Midlife Friction and Storytelling

15:13  Boundaries as Superpower

18:07  Leading Through the Pandemic

21:29  Community, Coaching, and Accountability

27:20  Trauma-Informed Leadership

32:07  AI, Physiology, and the Future of Work

35:05  Hard Pivots and Closing Takeaways

Dr. Brooke Buckley is a board-certified general surgeon and physician executive, board-certified in lifestyle medicine, and currently serves as System Vice President of Medical Affairs for Henry Ford Health. She previously served as chief medical officer and holds an MBA from Johns Hopkins. She has held national leadership roles with the American Hospital Association and The Joint Commission and is a widely followed voice on physician wellness, trauma-informed leadership, and healthcare system transformation.

Instagram: play_your_story

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.

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Two women get the same diagnosis, PMOS (formerly known as PCOS), and end up with completely different symptoms. One has irregular periods, acne, and high androgens. The other has none of that, just an ultrasound finding. How can that be the same condition?

In this episode, Dr. Komal Patil-Sisodia breaks down the Rotterdam criteria, the three features used to diagnose PMOS, and explains why you only need two of the three to qualify. That single fact is the reason PMOS shows up as four distinct phenotypes (A, B, C, and D), each with its own symptom pattern and metabolic risk profile.

You'll learn:

• What hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology actually mean (without the jargon)
• The four PMOS phenotypes and which one carries the highest, and lowest, metabolic risk
• Why insulin resistance, not BMI, may be the real driver of your risk
• Why phenotype D ("the mild one") still deserves your attention
• Three questions to bring to your next appointment to get more personalized care

Whether you were diagnosed years ago or are newly navigating a PMOS diagnosis, this episode gives you language to better understand your own body, and better questions to ask the people caring for it.

Audio Stamps:

00:00 Welcome to Clearly Hormonal
01:03 Why PMOS Looks Different
02:43 Rotterdam Criteria Explained
05:15 Phenotype A: Full House
06:03 Phenotypes B Through D
08:27 Why Phenotype Matters
11:00 Phenotype D Still Counts
12:44 Three Takeaways and Next Steps
14:39 Recap and Final Message

This podcast is for educational purposes only and is not a substitute for personalized medical advice. Please discuss your own care with your healthcare team.

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.

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Perimenopause is having a cultural moment, and endocrinologist Dr. Komal Patil-Sisodia is glad it is, but in this launch episode of Clearly Hormonal, she pushes back on social media's habit of attributing nearly any midlife symptom to hormones. She defines perimenopause as the years leading up to menopause (recognized after 12 months without a period, average age ~51) and explains that it's marked by hormonal variability, not simply “low estrogen,” with menstrual-cycle changes serving as an important clinical clue.

She walks through why most women don't need single-point hormone testing, since levels fluctuate day to day, per current ACOG guidance. Using a composite patient example (“Jen”), she shows how fatigue, sleep issues, hair loss, and weight gain may reflect iron deficiency, thyroid disease, sleep apnea, nutrition, stress, medications, or life changes, not hormones by default.

She closes with a four-question framework for sorting it out: where you are in the reproductive transition, whether a symptom is plausibly related to it, what else could explain it, and whether treating perimenopause would actually help. Taking symptoms seriously, she argues, requires evidence and continued curiosity, not a single convenient explanation.

Timestamps

00:00  Welcome to Clearly Hormonal

01:03  Perimenopause Everywhere

01:32  Why Nuance Matters

03:24  How Social Media Shaped It

05:22  Defining Perimenopause

07:51  Hormone Testing Reality

09:29  Patient Example: Jen

11:51  Fatigue and Weight Gain

13:58  Brain Fog and Mood

15:35  Hair, Sleep, Libido, Joints

18:54  When “It's Just Perimenopause” Becomes a Problem

21:38  The Four-Question Framework

23:33  Key Takeaways and Invite

25:26  Quick Question: 3 AM Wakeups

Key Takeaways

• Perimenopause is hormonal variability, not simply low estrogen: levels fluctuate rather than steadily decline in the early transition.
• Menopause is recognized after 12 consecutive months without a period; average age in the U.S. is around 51.
• Most women don't need a single hormone test to identify perimenopause: age, symptoms, and menstrual changes usually tell us more (ACOG).
• Common midlife symptoms (fatigue, weight change, hair loss, brain fog, mood shifts, low libido, joint pain) can have multiple causes beyond hormones.
• The four-question framework: (1) Where am I in the reproductive transition? (2) Is this symptom plausibly related to perimenopause? (3) Is there another explanation to consider? (4) Would treating perimenopause actually improve it?
• Taking a symptom seriously and attributing it to hormones by default are not the same thing.

Resources & Links

• ACOG: Do I need to have testing of my hormone levels during perimenopause? (acog.org)
• Follow along: Instagram & TikTok @drpatilsisodia
• Got a question for “Is This Actually Hormonal?”: DM @drpatilsisodia or send a note through the show's fan mail link.

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.

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Endocrinologist Dr. Komal Patil-Sisodia defines peptides as short amino-acid chains (with examples like insulin) and notes that any package or claim stating “contains peptides” is meaningless without knowing which peptide, how it was tested, and what it's proven to do.

She outlines the FDA approval pathway from preclinical work through Phase 1–3 trials and FDA review, then lists the FDA-approved peptides she prescribes for metabolic health (insulin analogs, GLP-1/GIP agents, glucagon, pramlintide), osteoporosis and calcium disorders (teriparatide, abaloparatide, palopegteriparatide, calcitonin), and reproductive/pituitary conditions (GnRH agonists, somatostatin analogs, vasopressin/desmopressin, cosyntropin, setmelanotide, bremelanotide).

She contrasts these with trending “gray market” peptides (e.g., BPC-157, TB-500, GHK-Cu), noting most lack published peer-reviewed randomized human trials and are often sold as “research chemicals” without purity oversight. Her key filter: ask what high-quality human evidence supports a claim — emphasizing informed choices, doctor-guided decisions, and evidence over hype.

In This Episode

• What a peptide actually is — and why the word alone doesn't mean anything
• The FDA's Phase 1–3 approval pathway, explained in plain language
• The full list of FDA-approved peptides Dr. Patil-Sisodia prescribes, organized by condition
• Why trending “gray market” peptides like BPC-157, TB-500, and GHK-Cu haven't cleared that same evidence bar
• The backlash from a recent social post — and what it revealed about asking for sources
• The one question to ask before trying any new treatment

Timestamps

00:00 | Welcome to Clearly Hormonal
01:03 | Peptides Everywhere Now
01:51 | Peptides Explained Simply
02:47 | How FDA Approval Works
05:13 | Peptides I Prescribe
08:42 | Social Media Peptide Hype
10:43 | My Viral Post Backlash
12:53 | Spotting Real Evidence
13:46 | Final Takeaways and Wrap

Connect

• Practice: eastsidemm.com
• Instagram & TikTok: @drpatilsisodia

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.

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Dr. Komal Patil-Sisodia explains that headlines claiming “FDA approves peptides” are misleading: an FDA advisory committee narrowly voted to recommend adding six peptides (BPC-157, TB-500, KPV, MOTS-c, Epitalon, Semax) to a compounding list, a step that is not FDA approval and still faces a formal FDA process. She notes FDA scientists opposed adding all six and that some voting members sell these peptides.

Reviewing the evidence, she explains that BPC-157 has only three small, weak human studies; TB-500 has zero human trials for the injury uses it's marketed for (while full thymosin beta-4 has some real human data); KPV has no human studies at all; MOTS-c has an unpublished Phase 1b trial and only observational, exercise-related human data; Epitalon lacks Western peer-reviewed human trials; and Semax is approved in Russia but with limited-quality stroke data.

She emphasizes that all six are synthetic despite being marketed as "natural," that marketing to midlife women is running well ahead of the evidence, that contamination and mislabeled dosing have been documented in online peptide products, that compounded drugs bypass typical FDA review, and that proven options already exist for symptoms like hot flashes, bone loss, and metabolic changes.

Time Stamps:

00:00  Welcome to Clearly Hormonal

01:03  The FDA Vote Explained

03:09  BPC-157 Evidence Check

04:31  TB-500 vs. Thymosin Beta-4

06:01  KPV and Animal Data Limits

07:25  MOTS-c, Epitalon, Semax

11:32  Midlife Marketing Reality

13:37  What the List Means

14:23  Safety and Contamination Risks

16:06  Bottom Line and Next Steps

17:31  Wrap Up and Where to Follow

Resources & Mentions

• Follow Dr. Patil-Sisodia on Instagram and TikTok: @drpatilsisodia
• JAMA: “Under FDA, Unapproved Peptides Likely to Become More Widely Available” (Rita Rubin, MA, 2026)
• ABC News: “FDA advisers narrowly vote to add 6 peptides to a drug compounding list. What's next?” (July 24, 2026)
• Talanta (2018): impurity analysis of falsified peptide drugs seized from online pharmacies
• Expert Opinion on Drug Safety (2026): FAERS pharmacovigilance study on compounded GLP-1 receptor agonists
• Journal of Cellular and Molecular Medicine (2021): Phase I dose-escalation trial of recombinant human thymosin beta-4
• Zhurnal Nevrologii I Psikhiatrii (2018): Semax post-stroke rehabilitation study

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.

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Type 1 diabetes isn't just a childhood disease, and it isn't caused by sugar, weight, or lifestyle. In this episode, Dr. Komal Patil-Sisodia breaks down why type 1 diabetes is so often missed in adults, especially in people mislabeled as type 2, and introduces LADA (latent autoimmune diabetes in adults), a slow-moving form of type 1 that may account for up to a quarter of adult diagnoses. She walks through the clues that should prompt testing, the two blood tests that can change a diagnosis, and how perimenopause and menopause complicate blood sugar control for women living with type 1. The episode also covers pregnancy planning, the real (and often overstated) genetic risk to children, the underappreciated heart disease risk in women with type 1, and why needing insulin is never a sign of failure.

In This Episode

• Why type 1 diabetes has nothing to do with sugar, weight, or lifestyle
• How adult-onset type 1 gets misdiagnosed as type 2, and why
• LADA (type 1.5): what it is and why it hides in plain sight
• The clues that should prompt a GAD antibody and C-peptide test
• How perimenopause and menopause make blood sugar harder to control
• Pregnancy with type 1 diabetes: what's actually true
• The real genetic risk to children (it's lower than you think)
• Why heart disease risk is elevated and underdiscussed in women with type 1
• Why insulin is not a “last resort” and never a sign you did something wrong
• The technology (CGMs and automated insulin delivery) changing type 1 care

Timestamps:

00:00   Why Type 1 Gets Missed

00:30   A Misdiagnosed Patient Story

02:52   Myth: Sugar Causes Type 1

05:31   Myth: Only Kids Get It

06:29   Adult Onset and the Honeymoon Period

08:41   LADA (Type 1.5) Explained

10:13   Perimenopause Makes It Harder

11:53   When to Test for Type 1

14:34   Pregnancy Myths and Facts

16:41   Heart Risk in Women

18:24   Insulin Shame and Stigma

20:44   Tech That Changed Diabetes Care

22:01   Perimenopause Management Tips

22:49   Key Takeaways and Next Steps

25:14   Final Thoughts and Share

Resources Mentioned:

• GAD antibody test (glutamic acid decarboxylase antibody): the key immune marker for LADA
• C-peptide test: measures how much insulin your body is still producing on its own
• Continuous glucose monitors (CGMs) and automated insulin delivery systems
• Maternal-fetal medicine (perinatology) preconception counseling for planned pregnancies

Disclaimer: 

This podcast is for education, not personalized medical advice. Please discuss anything that resonates with your own healthcare team.

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.

📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.

Type 2 Diabetes Isn't a Moral Failing: Genetics, Hormones, Stigma, and the Truth About Insulin

If you've ever been told — or told yourself — that your type 2 diabetes is something you caused and something you could fix if you just tried a little harder, this episode is for you.

Dr. Komal Patil-Sisodia spends 17 years of clinical experience (and personal family history) dismantling one of the most damaging narratives in medicine: that type 2 diabetes is a lifestyle disease you can will your way out of. In reality, it's a complex, progressive metabolic condition shaped by genetics, hormones, sleep, stress, and — for women specifically — perimenopause and menopause.

This episode covers the real biology behind insulin resistance and beta-cell decline, why stigma is measurably making patient outcomes worse, why so many people misunderstand what insulin actually does, and why "remission" — not "reversal" — is the accurate, honest term for what's possible.

In this episode:

• 00:00 — Welcome and Mission Introduction to Clearly Hormonal and why this particular episode is personal.
• 01:00 — Diabetes Myths and Stigma The core myth — that diabetes is caused by bad choices and reversible through willpower — and the data on how stigma affects A1C, depression, and self-care engagement.
• 03:18 — A Patient Story: A Midlife Shift A composite patient story of someone doing everything "right" whose A1C climbs anyway once perimenopause hits.
• 04:15 — What Type 2 Diabetes Actually Is Insulin resistance, beta-cell decline, and why genetics account for 40–80% of risk.
• 05:31 — Hormones, Sleep, and PMOS Estrogen as an insulin sensitizer, cortisol and chronic stress, the impact of poor sleep, and PMOS (formerly PCOS) as a major independent risk factor.
• 08:52 — Type 1 vs. Type 2 Clarifier A quick, important distinction — type 1 diabetes is autoimmune and not the topic of this episode.
• 09:15 — CGMs and the "I Can Feel It" Myth Why 64% of patients believe they can feel high blood sugar — and the story of using a CGM to show her dad he couldn't.
• 12:48 — Insulin Fear and Complications Why so many patients believe insulin causes kidney damage, blindness, or amputations — and what actually causes those complications.
• 15:07 — Diet Myths and Shame Vegetarian diets, "only sugar counts," and how internalized shame changes patient behavior.
• 17:32 — Remission, Not Reversal The real data on remission rates over time, and why relapse is disease progression, not failure.
• 19:59 — What Patients Deserve A call for full access to treatment — metformin, GLP-1s, SGLT2 inhibitors, insulin — without having to "earn" it first.
• 22:38 — Menopause and the Diabetes Care Gap Why standard diabetes care ignores perimenopause and menopause, and what should be asked instead.
• 23:48 — Key Takeaways and Share A recap and an invitation to pass this along to anyone who's been made to feel like their diabetes is their fault.

Resources & Mentions:

• Continuous glucose monitors (CGMs) as standard-of-care discussion
• PMOS (formerly known as PCOS)
• Type 2 diabetes remission criteria (A1C <6.5% for 3+ months without medication)

Disclaimer: This podcast is for educational purposes only and is not personalized medical advice. Please discuss anything you hear here with your own healthcare team.

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.

📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.

Getting diagnosed with Hashimoto's can feel overwhelming, especially after spending five minutes online. Suddenly you're told to eliminate gluten, avoid broccoli, stop eating soy, buy expensive supplements, and ask your doctor for desiccated thyroid. But how much of that advice is actually supported by evidence?

In Part 2 of the Thyroid Myth Busting series, endocrinologist Dr. Komal Patil-Sisodia separates fact from fiction using current medical research.

You'll learn:

•  Why cruciferous vegetables are not harming your thyroid 
•  When soy actually matters (hint: it's about medication timing) 
•  Who should—and shouldn't—consider a gluten-free diet 
•  Why iodine supplements can actually worsen thyroid disease 
•  Which thyroid supplements have evidence (and which don't) 
•  The truth about desiccated thyroid versus levothyroxine 

If you've ever felt overwhelmed by thyroid advice on social media, this episode is your evidence-based guide.

Timestamps

00:00 Welcome to Clearly Hormonal

01:03 Why thyroid wellness advice can become overwhelming

02:04 Cruciferous vegetables, iodine, and what actually affects thyroid function

05:03 Soy consumption and levothyroxine timing

06:16 Hashimoto's, gluten, and when celiac testing matters

09:35 The dangers of iodine supplements and seaweed products

13:08 Fact-checking popular thyroid supplements:

•  Ashwagandha 
•  Vitamin B12 
•  Low-dose naltrexone (LDN) 
•  Selenium 

17:05 Desiccated thyroid vs levothyroxine: What the evidence says

23:05 Key takeaways and what's next

Resources & Links:

• Catch up on Part 1 (testing myths, TSH, subclinical hypothyroidism)
• Follow @drpatilsisodia on Instagram and TikTok

Disclaimer: This podcast is for education, not personalized medical advice. Talk to your own healthcare team about what's right for you.

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.