Sober But Still Not Yourself

 

You got sober. You did the work. And you still wake up exhausted, foggy, flat, and unmotivated — and everyone around you says give it more time.

Sometimes that’s the right answer. Sometimes something underneath is actually broken.

Dr. Amie Hornaman spent her twenties competing in bodybuilding and figure competitions. Then the scale started going up while she was training twice a day and tracking every macro. Six different doctors inside a major medical system looked at her labs and told her she was normal — eat less, exercise more. The seventh doctor was the first one to physically touch her throat. She found nodules, and a diagnosis.

Today Dr. Amie is “The Thyroid Fixer,” founder and CEO of the Advanced Thyroid and Hormone Clinic, host of The Thyroid Fixer podcast, and author of The Thyroid Fix.

In this conversation she makes a case our clients hadn’t heard before: getting sober is a physiological stressor, and stressors are exactly what flip thyroid and hormone problems from dormant to active. Pregnancy does it. Perimenopause does it. Divorce and grief do it. So does removing a substance your body has spent years adapting to. Which is why she argues thyroid and hormone testing belongs in early recovery — not eighteen months later when you’re wondering why you don’t feel the way everyone promised you would.

What we get into

• Why six doctors missed it, and what the seventh did differently
• Why TSH alone is not a thyroid test — and the full panel to ask for
• What long-term alcohol and substance use does to cortisol, blood sugar, liver detoxification, and sex hormones
• Why thyroid dysfunction looks almost identical to burnout, depression, anxiety, and post-acute withdrawal
• What alcohol does to estrogen in men, and why testosterone often can’t be fixed without addressing it
• SHBG, and why your hormones can test “normal” and still not be reaching your cells
• Why she says you can’t put hormone therapy on a dumpster fire
• The 30/60/90-day timeline for feeling different
• And why chasing every biohack can raise the same cortisol you’re trying to lower

Tim also shares his own experience — two to three years sober before anyone checked his thyroid, and what changed 90 days after they did.

FREQUENTLY ASKED

Can getting sober cause thyroid problems? Dr. Hornaman’s position is that sobriety doesn’t cause thyroid disease, but it acts as a major physiological stressor — and stressors are what activate a dormant autoimmune thyroid condition. She places getting sober in the same category as pregnancy, perimenopause, andropause, grief, and divorce.

Why do I still feel tired after getting sober? Persistent fatigue, brain fog, weight gain, low mood, and low motivation in sustained sobriety overlap almost completely with the symptoms of hypothyroidism and low sex hormones. Her recommendation is to test rather than wait it out.

What thyroid tests should I ask for? Dr. Hornaman names six: TSH, free T4, free T3, reverse T3, and the two antibodies — TPO (thyroid peroxidase) and TGA (thyroglobulin). She argues TSH alone is a pituitary measurement, not a thyroid measurement.

Does alcohol lower testosterone in men? In her clinical experience, yes — and it simultaneously raises estrogen, both directly and by burdening liver detoxification. She describes a case with an estradiol of 343 in a man in his fifties.

How long until I feel better? Her typical timeline: mental clarity and energy around 30 days, changes on the scale and early hair regrowth around 60 days, and the full effect around 90 days.

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Watch the episode here

 

Listen to the podcast here

 

Sober But Still Not Yourself

Fatigue, brain fog, weight gain, low mood and no motivation. It might be recovery. It might also be your thyroid — and almost nobody checks.

Dr. Amie Hornaman’s Journey From Medical Gaslighting To Advocacy

My guest is Dr. Amie Hornaman. She’s known as the thyroid fixer. She’s the Founder and CEO of the Advanced Thyroid and Hormone Clinic, a telehealth practice serving patients all over the country. She hosts a top-rated podcast by the same name. She’s the author of a book called The Thyroid Fix. Here’s why she’s here. Six different doctors told Dr. Amie her labs were normal. She was exhausted, gaining weight and her hair was falling out, and said it was normal.

She finally figured it out herself, then she built an entire career, making sure nobody else gets brushed off like that. Here’s the part that matters for this audience. A lot of people get sober. They do everything and they still feel terrible, still tired, still foggy, and still flat. Everybody around them says, “Give it more time.” Sometimes that is the right answer and sometimes it’s not.

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Dr. Amie, welcome to the show.

I’m so happy to be here. Beautiful intro, by the way, and that is so true. That is so true about getting sober and then, you’re like, “I thought this was supposed to be rainbows and butterflies. What the heck.”

I was probably 2 or 3 years sober before I finally had my thyroid checked and it wasn’t performing. I can relate to this. I know there’s lots of other people that are in recovery that their thyroid’s just not working 100%. They’re tired. I was tired. I’m grateful that I finally got it worked out.

I’m excited to unpack this for people because I understand the pressure and the stress that you’ve gone through. To get to the other side and say, “I thought this was supposed to make my life better and I’m still feeling this way.” I want to unpack this for people so that they can do something about it and live that life that they so deserve to have.

Six doctors told you that you were fine. Take me back to that. What were you feeling and what were they telling you?

This is in my twenties. I was competing in bodybuilding and figure competitions at the time. My diet was strict. My workout was strict. I was going to the gym twice a day sometimes. That whole process taught me how to get my body in the best of best shape. It was fun. It was a challenge. I’m a type A. I like the challenge. Except for this one show I was getting ready for and I’m working with a coach. I’m sending him my progress photos and all of that. The scales go up and not down.

Biologically, that doesn’t make sense. When you’re tracking your macros, counting your calories, going to the gym, expending energy, and building muscle. You should also be burning fat. Not putting more of it on your body. It didn’t even make sense. Everybody at the gym, and my coach thought I was cheating. Everybody thought I was sneaking in things behind their back and I wasn’t. I know that you understand when you’re doing everything right and people are accusing you of something you’re not doing, like, for the first time, I’m doing all the things.

I tried to block out the whispers and the judgments and just focus on me and my health because I needed to figure out what was going on with my body. My body was like a runaway train. I went to my doctor. I started with my PCP, like we all would. I’ll never forget, he looked at a piece of paper that was my labs. He looked at me and said, “You’re normal. Everything is fine.” I’m like, “Doc, I just put on 25 pounds in two months. My hair is falling out in clumps. I’m twenty something years old. I can’t even get through the day. You’re telling me that’s normal?” He said, “There’s nothing in your labs to see. I don’t know. Eat less and exercise more.”

 

I went on and I kept going. You hear about this second opinion thing. I went for a second opinion and then a 3rd opinion and a 4th and a 5th and a 6th. Six doctors in total, in a major medical system, by the way. I was in one of the best of the best medical systems that people flock to because they’re like, “That’s for sure where I’m going to get the best treatment.” Six different doctors, major medical systems, all of them told me I’m normal and I’m fine. It’s all in my head. Eat less and exercise more. Total medical gaslighting dismissal.

The seventh doctor, she diagnosed me. Now, the seventh doctor touched my throat and said, “Swallow.” The first doctor to lay hands on me, by the way. She said, “I’m feeling some nodules on your thyroid. Based on your labs, it looks like you have hypothyroidism. You have a problem with your master gland.” Tim, I was so excited. I left her office. I’m thinking, “I have a diagnosis.” I have a name now for what’s going on. I had an explanation, then she gave me a pill. She said, “This pill is going to fix you.” I’m like, “This is awesome. I’m going to lose weight. I’m going to get my life back.” It was fantastic.

Why Standard T4-Only Treatments Fail: The Active T3 Difference

That pill that she gave me was levothyroxine or Synthroid. I like saying the name because it used to be the number one prescribed medication. Now, it’s number two behind blood pressure. I know a lot of your audience is on it. That Synthroid, that levothyroxine, that T4 medication, I later learned is the inactive thyroid hormone. It doesn’t even do anything in your body. It does nothing in your body. It has to convert and become T3, the active thyroid hormone in order for it to give you a metabolism, grow your hair, give you energy, light your brain up and give you motivation.

I went back to her, I’m like, “I’ve taken this for five months. I haven’t lost any weight. I don’t feel any better.” I’m learning more and more about this active thyroid hormone T3. There are doctors that are putting the active thyroid hormone with the inactive. It makes sense to skip the middleman. Why are you giving me something that literally does nothing in my body? She said to me, “That’s not standard of care,” which I know a lot of people are standard of care.

Everything has to be under that umbrella of what insurance says we’re allowed to do. I said, “Thank you. You’re fired. I’m going to go find somebody else who will.” That’s what led me into the world of functional medicine. My functional medicine provider saved my life. Hands down. I wouldn’t be here with you if it wasn’t for him and if it wasn’t for me having hope and continuing to push, for sure.

I often think about, what if I would have stopped at doctor number 4 or 5? There are five medical professionals telling me that I’m normal. You wouldn’t blame me for stopping and accepting their diagnosis or lack thereof. I kept going and my functional medicine provider who became my mentor, changed my life and changed my career.

I can relate. I’m just thinking about my journey once I get sober. I saw a couple of functional health providers, but I didn’t hear anything about my thyroid until I finally came across one who said, “You have hypothyroidism. You can’t tell.” She gave me armour thyroid, which is T3 and T4. She said, “In 90 days, you’re going to feel better.” Sure enough, in 90 days, I felt better. I was like, “This is amazing.” It’s interesting that mainstream medical care or standard of care or whatever you want to call it, they don’t bring it up earlier. It’s interesting. I don’t understand. Why do they not bring it up earlier? It doesn’t make sense.

That’s a great question because it is the master gland. When I was writing the book, I interviewed my sister because she’s a doctor of osteopaths. I said, “Take me back to med school. How much did they go over the thyroid? It’s the master gland. You’re learning about blood pressure, cardiovascular disease, osteoporosis and gastrointestinal issues. As an internist, you’re learning everything. What about the master gland that dictates whether or not you’re going to have a heart condition or be able to poop every day or are inflamed in your joints or have a brain to even function and think?”

She said, “Not much.” They don’t spend that much time. What they learn in med school is you test one marker, TSH, which is thyroid stimulating hormone. Now, when we break down the piss poor testing of the conventional system, the problem with that is that’s a brain hormone. We’re testing your brain to check your thyroid. That’s like checking your tire pressure when your engine light is on. That doesn’t correlate. If you have a flat tire, your car’s not going to run anyways but the same thing.

 

If TSH is screaming high, there’s a thyroid problem but you have to look deeper. There’s a problem with testing and there’s a problem with what they teach in med school. They teach test TSH. If that’s high, give T4 only, Levo or Synthroid. Send that patient on their way. Wish them good luck. We’ll see you in six months. That’s when we’ll retest you. Not even asking, how do you feel? What are your symptoms? Maybe we need to look a little bit deeper since this is the master gland that runs your entire body maybe. It’s just not done. I wish I knew why. If we went down a rabbit hole, we’d be looking at big pharma and influence on medical schools and who knows, but just not taught.

Driven By Purpose: Dr. Amie’s Mission To Standardize Real Thyroid Care

Let’s back up a little bit. You could have gone a hundred different directions with your career. Why did you choose thyroid? Why has this become the thing that you’re just not willing to let go of?

It’s the pain to purpose story, my origin story. I was saying earlier, so major medical systems. When you look at Cleveland Clinic, Mayo Clinic, and UPMC Pittsburgh, which UPMC basically owns Pittsburgh, Pennsylvania. When you look at those major medical systems and you think, “Everybody is going there to get the top care,” and I didn’t. I was misdiagnosed six times. It was at that point where I’m like no. This is twenty some years ago. I made it my mission. I’m like, “I am in a major city in a major medical system. What about the woman or the man that’s in like Casper, Wyoming, or the middle of Pennsylvania? They can’t travel.”

They need help. I didn’t want someone that was in a different state than me to have a barrier. That’s where I made it my mission to build a team, to be able to prescribe in all 50 states because I wanted to be able to help people. The thyroid again, it’s the master gland. I was misguided. That’s the number one thing that they should be checking on everyone. That’s why I wanted to focus on the thyroid and obviously hormones play in the same sandbox as the thyroid.

I wanted to focus on the thyroid and focus on hormones, because that’s what gives us life. You start there and all the downstream issues do resolve. Even take something like mold. We have an entire mold community and I don’t want to piss off any mold people. The reality is, I always use the term shored up, like resilient. When your body is resilient, when your thyroid’s optimized, when you have a perfect hormonal balance, no matter what your age, by the way. We can replace those declining hormones. Your body is strong and resilient.

You get exposed to mold and it goes, “You’re going to suffer for like twelve hours or maybe a day.” You’re not going to suffer for the next six months to a year, and this is different if you’re living in mold. That’s a different conversation. I’m talking about these people that are like, “I was exposed to mold and now I have chronic mold disease. It’s ruined my life for the last ten years.” It doesn’t have to be. Instead of spending $10,000 on a mold protocol, fix your thyroid and your hormones.

Your body will be resilient. You’ll be able to withstand that mold exposure and you’ll be fine. You’ll also detox better and you’ll clear it out of your system. Detox. You can’t detox if your thyroid’s in the toilet. You just can’t. I don’t care if you do Beyonce’s detox or a $10,000 heavy metal detox from a functional practitioner. It’s not going to work. You’re going to waste your money. That’s a long answer to a short question, but I’m passionate about it.

That makes me think. I’ve had some issues. I’ve had some gut issues. I’ve had some blood pressure issues. I’ve gone through some of my issues. I had thyroid and I was talking with a doctor. He said, “Tim, people that are healthy don’t have SIBO. People that are healthy don’t have candida. People that are healthy don’t have high blood pressure issues.” It makes me think, we’ve got to figure out the root cause of these issues. To your point, mold or mold exposure.

If you’re a healthy person, that’s an issue, but you work through it. If you’re a healthy person, because look at me, I’m healthy. I’m fit. I ride my bike. I exercise. I eat healthy. I get enough sleep. I do all these things, but when it comes down to it, if I’m healthy, my body is going to be able to work through any of these issues. If anybody is not able to work through some of these issues, they have mold exposure from a year ago or five years ago. There’s something else going on.

 

Exactly, 100%. Something else that you mentioned earlier that I want to throw in because I’m always interested in saving people money and time. You had mentioned that you went to a functional provider or maybe a couple of them that never mentioned thyroid. It wasn’t until the provider said, “Tim, let’s check your thyroid. Here’s some armour thyroid,” and you felt better. It wasn’t until that functional provider who knew what they were doing with the thyroid helped you.

That’s another thing I talk about in the book. I call it a jack of all trades, master of none. I know functional medicine is on the rise, which is beautiful and amazing. We also have to caution people to not just buy into the functional medicine market. There’s a lot of conventional medicine docs that are just sick of taking insurance. They’re calling themselves functional and charging you money to come see them and they still treat you conventionally.

There are functional medicine practitioners that you’ll see on their site. They’re like, “We treat mold, Lyme, brain, gut, thyroid, hormones, your big toe and your hair.” It’s like, “What are you good at exactly?” I’m not going to hire a mechanic to build my house. I’m going to go with specialties. It’s like in the conventional world. You wouldn’t go to a gastroenterologist for a cardiovascular problem. Why are we going to these functional clinics expecting them to do everything for us? You have to go to someone that knows what they’re doing with thyroid and hormones.

You bring up a good point because I did see a couple of other functional medicine docs, but they weren’t specializing in the thyroid until I got with somebody that thyroid was her thing. She was the one that brought it up.

I’m glad you brought that up because as I said, I love saving people money. If I can save you $5,000 that you’re going to drop on that functional provider, then you’re welcome.

Sober But Exhausted: Distinguishing Post-Acute Withdrawal From Thyroid Issues

When someone stops using alcohol or drugs, but still struggles with fatigue, brain fog, weight gain, anxiety, depression, or low motivation. How can they tell whether that is just part of their recovery or whether something underneath is broken?

This is where I want to unpack. When you are going through recovery or you’re even on the other side, you can look back or look at your current situation. You can understand that that’s a stressor. It’s a stressor on the body. Let me back up and quantify that. Pregnancy that women go through. You go, “It’s beautiful. It’s natural. Let me get pregnant.” That is a huge stressor on a woman’s body. Her hormones are going crazy. Her body is changing. That’s a stressor on the body.

It’s natural, beautiful and great that it’s happening, but it’s still a stressor. When you are going through the process of essentially detoxing your body from years or decades of chemical substances. Whether it’s alcohol or drugs, it doesn’t matter. Your body has to process that, release it and adjust for the first time to that substance not being there. The body is like, “What’s happening?” Cortisol, insulin, blood sugar, hormones are wild. The thyroid’s a canary and the coal mine going, “What is happening in this person’s body?”

We’re so used to these chemicals coming in and we adjusted to that. Now, they’re not there anymore and the person is stressed out. Maybe their heart rate’s up and then it’s down. That’s a stressor. The thyroid responds to stressors. The time in a person’s life where we see thyroid issues appear, maybe out of nowhere. It could have been dormant for years sitting, waiting, and then that stressor happens. Pregnancy, perimenopause, menopause, andropause after the age of 40, and any stress like death, divorce, loss of a loved one, sick child, or sick parent.

How about getting sober? Let’s face it. That’s a huge stressor on the body. It’s beautiful. It’s amazing, but it’s a stressor. I would say anyone getting sober needs to have their thyroid and hormones checked. Maybe even during the process too, because it could have easily been hit during the years of use, because that’s a stressor on the body too. Our body adapts to that chemical use, but during it, it still is freaking out a little bit.

Getting sober is a huge stressor on the body. It's beautiful, it's amazing — but it's a stressor. Share on X

I would say get your thyroid and your hormones checked because that could make this process so much easier. As I mentioned detox, you can’t detox if your thyroids are in the toilet. How much better will that process be if you can push these substances out of your body faster, if you can detox more quickly, if we can heal your liver and your whole phase 1, phase 2, phase 3 detox pathway? Let’s do it now instead of waiting until six months to a year or two years after you’re sober and you’re going like we talked about in the beginning, “Why aren’t I feeling as good as all these people talk about? I thought I was supposed to be living my best life by now.”

What I’m hearing or I’m just thinking about, it’s like any life change. It’s almost like if you go from eating junk food and you want to become healthy. Is that also a significant stressor? If you go from not working out to now, I’m working out. I’m exercising. I’m eating healthy. You’re eating different food. Everything changes. When someone gets sober, everything’s got to change, in my experience. New eating habits, new sleeping habits, and new exercise habits. They pray and meditate. All of these things have got to change. All of those things are going to take a toll on the thyroid is what I’m hearing. Is that accurate?

I would say yes/and. All of those changes are a stressor. Now, we could go one step further and say, if you’re sleeping more, reducing stress, meditating and eating clean, that’s only going to help support the thyroid. That’s what I tell everyone. We can test and treat your thyroid, but we can’t put thyroid or even sex hormones like testosterone, progesterone, estrogen for the ladies, on a dumpster fire. We can’t put thyroid hormone on a dumpster fire.

As you said even, whether you’re getting clean and sober and changing up everything or whether you were just eating like garbage. You’re changing up everything. You’re going to have a benefit from that in your health. There’s no question, but you’re also providing the foundation for the therapy to work, for that hormone replacement to work. It’s twofold. It’s a stressor, but it’s also building that foundation for things to get better.

Testing Vs. Guessing: When “Just Give It Time” Becomes Bad Advice In Recovery

When someone gets newly sober, we tell them, “It’s going to take a little bit of time before you start feeling better, 30 days, 90 days, or first year.” At what point do waiting for things to get better become bad advice?

First of all, no one has quite figured out how to age in reverse. I’m still waiting for that. They will be a billionaire when they do. I know Brian Johnson is trying.

 I feel pretty good at 50, though. I can tell you that much.

I do, too. I’m with you. I feel good, too, but that’s because of hormones. You’re on thyroid. I’m on thyroid. You’re on testosterone. I’m on all three hormones. If we weren’t, I don’t think we’d be having the same conversation. That’s the whole thing is, why wait to feel your best? Let’s test, not guess. Let’s treat what we see that matches up with your symptoms. I’ll give you an example. I saw your labs. They’re great, but I’m going to use you as a hypothetical.

Let’s just say you came to me and you’re like, “Amie, I want you to look at my thyroid and my hormone labs. I’m taking something, but it’s not quite hitting the mark. I put on a bunch of weight. I’m just feeling sluggish. Not motivated. It feels like when I wake up in the morning, I feel tired. I know I slept like seven hours, but I could go back to bed. I’m dragging myself through the day. I know I have to work out but I don’t want to work out. I don’t have the motivation to work out.”

I would say, “Let’s look at your labs because you just told me how you feel. I’m going to take those symptoms and overlay them on your labs.” Let’s now look at your labs, then I would go over here and I go, “That makes sense.” Again, all hypotheticals here. Let’s say, “I know you’re taking testosterone, but you must not be on the right dose because your testosterone is still like a 500. You should be like 800, 900, or 1,000. We got to adjust that dose. That will help. Let’s move over here, your thyroid. Your reverse T3 is elevated. I don’t think that armour thyroid is quite right for you. We’re going to add in some T3 to that. I’m going to lower your dose of armour. I’m going to add in some T3.”

That combination that works with your biochemistry is the sweet spot right there. Now we’re getting you optimized in both areas. You’re going to be like, “That was the issue. I thought it was just like my body was slow to respond to this recovery sober thing. I thought that maybe I had to do more. Maybe I wasn’t doing enough. Maybe I needed to meditate more, maybe I needed to detox more. I just needed to tweak and optimize my thyroid hormones. I get it.”

It’s overlaying your symptoms with your labs, and then we go, “We got this. We can fix this. It’s okay. You’re going to feel better probably in the same time frame, 30 to 90 days. At the 30-day mark, your brain is going to light up. You’re going to have more energy. Maybe your clothes will fit a little bit better, but you’re not going to see changes on the scale.” By 60 days, the changes on the scale are going to happen. Maybe you’re going to see some baby hairs growing in. Energy is definitely better. More balanced. Brain function is firing. You’re more motivated. By 90 days, you’re like, “The angels are singing and the heavens opened up. This is fantastic.”

At the beginning, it’s like, let’s just get you on some armour or T3, T4, or whatever. We’re headed in the right direction. You got to tweak it and dial it in. Let’s go back. What exactly does the thyroid do? What is the thyroid responsible for people that don’t know?

Here is my saying about the thyroid. From head to toe, it runs the show. If you literally start at the top of your head, so hair growth. If your hair is thinning or falling out or breaking, the outer corners of your eyebrows are missing. That’s a classic hypothyroid symptom. Brain function, memory, mood, anxiety, and depression are very much linked to low thyroid function. Dry skin, dry eyes, even swelling of the throat, clearing your throat, blood pressure, heart rate, and body temperature. You’re cold when other people are fine, and normal.

From head to toe, the thyroid runs the show. Share on X

Even cholesterol balance, insulin resistance, glucose and blood sugar regulation is determined by the thyroid. We will often see if a person’s thyroid is low and slow. Let’s say they’re doing carnivore or keto. You would look at their blood sugar and think, “It’s got to be perfect. They’re not even eating carbohydrates to spike it.” I will tell you I have seen full-blown type-2 diabetes with elevated A1C levels, elevated glucose, insulin resistance through the roof, and this person is doing carnivore?

That shouldn’t even be, but it’s because their thyroid is in the toilet. Joint pain, frozen shoulder, migraines, bloating, and constipation. Literally go all the way down to your toenails. Your toenails breaking and ripping off is another sign of hypothyroidism. Dry and cracked heels. Dry and cracked elbows. It runs your entire body. That’s more the aesthetic view, but you have to think also of brain function. Low thyroid function is correlated to an increased risk of Parkinson’s disease, Alzheimer’s, and dementia.

We also see it correlated to cardiovascular disease, the number one killer of women and very common disease in men. If the thyroid is off, someone could have an ablation. They could be diagnosed with AFib, tachycardia. It’s not anything to do with the electrical system of the heart. It has to do with the fact that the thyroid is dictating that electrical impulse and that control of the heart. It’s dictating the blood pressure. It’s dictating the clearance of the arteries in your lipid panel.

Again, instead of putting you on metropolol, a statin and an antidepressant, let’s fix your thyroid. All of a sudden, your brain’s working better. You’re in a better mood and your heartbeat regulates. I’m not saying it’s the answer to everything. Maybe you do have a legitimate brain chemistry disorder that you need that antidepressant or that SSRI. Maybe you do have a genetic cardiovascular component that you need extra therapy for. I’m not saying it’s the be-all end-all, but I will tell you there’s a lot of pharmaceutical band-aids being written every single day for meds that people don’t need. They just need the focus on their thyroid and their hormones.

How Substance Abuse Disrupts The Master Gland, Cortisol, And Liver Detoxification

You may have already answered this. How does long-term substance use affect the thyroid, cortisol, blood sugar, liver function, and sex hormones?

It ties back into how we were talking about a stressor. Our bodies know how to adapt. Our bodies are just brilliant. In the beginning of substance use, we’re going to see changes in cortisol. Our stress hormone response from our adrenal glands. We’re going to see increased blood glucose. We know that. In the very beginning, or let’s say in the first 1 to 5 years, we’ll say of substance abuse.

That’s when the body is reacting to that because it’s like, “There’s chemicals coming in. We’re not used to this. We need to amp up the detox. We need to push this through the lip. We need to do all these things to take these, we’ll call it a foreign substance.” This weird foreign substance. Even when I talk about nutrition, I go, “There’s proteins, fats, carbohydrates, and then there’s alcohol,” which doesn’t fall into a macronutrient category.

It’s its own category of a weird, bizarre substance that our body doesn’t know what to do with. It comes in and our body just goes, “What are we supposed to do with this exactly?” It responds. Even an increase in cortisol or a stressor, like we talked about earlier can kick up the thyroid. I’ll get into a deeper explanation as to why in a second. That is where we see the body reacting and responding. Over time, the body adapts to that but so does the person.

Oftentimes, whether we’re talking about a person getting sober or in the throes of addiction or someone that’s never even touched a substance. The bottom line is, the body responds to stressors in a good and bad way. It adapts. The person goes, “This is just how I’m supposed to feel.” It’s almost like we medically gaslight ourselves. We’re like, “We’re this is as good as it’s going to get. I am in my 50s. I’m not supposed to feel my best. I’m getting older.” We tell ourselves these stories to make it okay that we feel like garbage, to normalize it.

We medically gaslight ourselves. We tell ourselves these stories to make it okay that we feel like garbage. Share on X

Maybe we even look at society and go, “If you go to the mall or go to Disney World, for goodness’ sake, 99.9% of the people are overweight, out of shape and unhealthy.” You go, “This is the norm. I’m just fitting in with the norm.” No. You have to realize that there’s better. You have to realize that there’s so much more to life and you can feel better. Don’t normalize your low mood or your excess weight or your fatigue. Don’t normalize that because that’s not how God made our bodies at all. That’s not how we were created.

We were created to be healthy and vibrant. The things in our world, unfortunately, tend to come in and break that down a lot faster than what they should. Now, we have the tools, i.e., thyroid hormone, bioidentical hormone replacement therapy, and all of this other functional medicine. These cool things that are out there. We now have the tools that we can improve life and we can have a better life literally until the day that we leave this earth. We can feel amazing and be throwing weights at the gym and skiing down the side of a mountain. Not sitting in a nursing home all crawled up. We don’t have to succumb to that.

I’m sitting here thinking about you are the average of the five people that you spend the most time with. If I hang out with unhealthy people that eat like crap, that don’t take care of themselves, the odds are stacked against me. If you look at a group of friends, typically their body composition is pretty similar. It’s hard. I don’t know why I thought of that. That’s a random side thing.

The point being, spend time with people that you want to be like, that are living the life that you want to live and care about their health, their fitness, and their sleep and they’re doing all the right things to take care of themselves. If you want to be happier and you want to live a longer life, then spending time around those types of people is probably going to help you, in my experience.

I agree.

The Adrenal-Thyroid Connection: Why Cortisol And Blood Sugar Control Weight Gain

 Let’s talk about cortisol. How does the thyroid affect your cortisol levels? How important is it?

Thyroid and cortisol play in the same sandbox. Again, I’m going to save you all money. What I don’t want you to do is to fall prey to an IG influencer telling you all you need to do is take their adrenal fairy dust supplement or drink an adrenal cocktail or take their adrenal masterclass that will heal your thyroid, your life, your world, your dog and your marriage. Everything. The adrenals sit on our kidneys. They release a hormone called cortisol and respond to stress.

We want cortisol because cortisol is needed to survive. If you don’t have cortisol, you’re going to die, but we need it in the right amounts. When we’re super stressed, we tend to pump out more cortisol in response to that stress. That cortisol floods the body and creates an inflammatory response. We’re in an acute state. In a short term, that’s okay. We want that inflammatory response to our body so it can heal. When that cortisol is continuous and long-term and we’re inflamed long-term, that’s going to take a toll on the canary in the coal mine, i.e., your thyroid.

The thyroid is going to respond to that constant flood of cortisol, which, by the way, cortisol will then push up your glucose number, your blood sugar. Now, you’re running high, high blood sugar. Your body’s putting on weight because of the high blood sugar, because of the high cortisol. You’re inflamed. The thyroid is going to respond to that and basically be pulled down. It’s not going to produce the proper amounts of T4 and T3. It’s not going to convert that inactive thyroid hormone T4 to the active thyroid hormone T3 very well.

Don't normalize your low mood, your excess weight, or your fatigue because that's not how our bodies were created. We were created to be healthy and vibrant. Share on X

That’s where we’ll see elevated reverse T3. I know we looked at that at your labs and yours was fine, but we’ll see that elevated reverse T3 because the person is under stress. They’re pumping out cortisol. Their insulin and blood sugar is high. What happens over time is our body starts to crash. This is where you hear the term adrenal fatigue or adrenal exhaustion. Basically, the adrenal glands go, “We’re sick being under all this pressure all the time and pumping out cortisol. We’re out of it. We’re out of cortisol. We’ve used it all up. Thank you.” Now, we’re in this low cortisol. This is where people are like, “I can’t even get going in the morning. I have no energy whatsoever.”

Low cortisol and low thyroid overlaps. Now, you have a thyroid problem and low cortisol. You’re just dragging yourself through the day. What we do in those cases is we treat the thyroid and we’ll use T3, the active thyroid hormone strategically to get your cortisol up in the morning because technically, cortisol should be high in the morning and then go down through the day and bottom out at night to make you sleepy. It will strategically place T3 to get that cortisol bump in the morning and to help your adrenals out.

You can see how they all play together and how any stressor is going to come back and affect the thyroid. Let me unpack that briefly too, because I said that I would. When we’re looking at hypothyroidism, low and slow thyroid function. If you don’t remember the head to toe, the thyroid runs the show. Remember hypo, low and slow then think of every process in your body from your mood to your metabolism, to your digestion, circulation. It all slow down. Hypo, low and slow.

When we look at hypo, low and slow people, 95% of them have an autoimmune condition called Hashimoto’s. Ninety-five percent of all hypothyroidism is Hashimoto’s. It’s a very small percentage that a thyroid problem would be caused by chemo, radiation to the neck, eating disorders, and over-exercising. We see a lot in CrossFit and athletes because they just push their body to the utmost limits.

Ironman athletes.

It’s that autoimmune component that gets a lot of people. What do we know about autoimmune? It responds to a stressor. Whether we’re talking rheumatoid arthritis, celiac, Crohn’s, or Hashimoto’s, it’s like that autoimmune switches in the off position for a long time. Sometimes years or decades, then that stress happens, bam. Again, going back to our previous talk about pregnancy, perimenopause, menopause, andropause, death, divorce, getting sober. All of those, it’s all a stressor on the body that can just flip that switch to the on position.

Unmasking Hashimoto’s: How Stress Triggers Autoimmune Hypothyroidism

What is Hashimoto’s?

That is autoimmune hypothyroidism. Here’s the thing. How do we test it? We look at these two antibodies on your labs. They’re called thyroid peroxidase and thyroglobulin. We test those two antibodies to see if you have Hashimoto’s. Now, here’s the kicker. They often come back as a false negative. I’ve had plenty of patients say, “I don’t have Hashimoto’s. I just have hypothyroidism.” I go, “How do you know? We only tested one time. Let’s test it again and then we’ll test it again.” I’m like, “Here they are.” We’ll see the actual presence of antibodies on their labs because it was a false negative before.

We see people in early recovery with wild blood sugar swings and cravings that show up the exact same way every day. What is going on there physiologically?

That’s a great question and a perfect segue as well. Tying in what we talked about with insulin, blood sugar, cortisol, low thyroid function, and stress. We see that profile of that cortisol spike that rises the glucose, that pulls down the thyroid. It’s that profile that combination that basically works together. That’s where we see the issues. That’s where we see the stress come in and then people end up getting stressed about their health, which makes cortisol go up more.

There’s a little tangent, but I literally recorded a basically biohacking crap show and calling out. Biohacking has been great, but I don’t know about you, but I got into a cycle of getting stressed out about not doing everything. I’m like, “I got to get in the sauna. I got to get in the cold punch. I got to do my peptides. I got a mouth tape. I got to wear a CGM. I got to drink certain water. There’s the hyperbaric oxygen.”

I’m increasing my cortisol trying to be healthier. That doesn’t even make sense. You got to look at the stressors on your body, in your body, in your mind, what you’re putting on yourself as a stressor and how that’s affecting your overall physiology. Sometimes, as we’re trying to get healthy, we’re doing more harm than good.

 

I was having some blood pressure issues and I know that my blood pressure is higher because I know that I’m checking my blood pressure. It’s the same thing. Why does thyroid dysfunction look so much like burnout, depression, anxiety, or post-acute withdrawal?

It’s the whole overlapping of symptoms. I’m not saying that post-recovery withdrawal and all of those symptoms that you just listed are not real. They’re real, but they overlap. This is where we have to go. This is where I would sit down with a person. We would do all of their labs. All of them. When we do that lab panel up front, working with someone in the clinic, we’re looking at thyroid, hormones, nutrients, glucose, A1C, insulin, CBC, CMP, and lipid panel.

We look at everything, including iron status. The whole deal, because all of that data allows us to paint a picture. When we’re sitting with you and you’re telling the story. You’re telling me your symptoms, then again, I go back. I can look at those labs and go, “This makes sense. Now, I think that some of this is post-recovery and some is whatever it is, be it thyroid, hormones, nutrients, or whatever we have to address.” You unpack it that way.

At the end of the day, we’re like, “Here’s a symptom that we’re not quite sure whether it’s correlated. It doesn’t matter. We’re going to treat you and optimize you. If that symptom doesn’t go away, then we look deeper.” For instance, frozen shoulders. Frozen shoulder is a classic hypothyroid symptom that often resolves when we optimize the thyroid.

However, if it doesn’t, then we go, “Maybe you need some stem cells and some PRP and some physical therapy, because it’s not thyroid-related. You still have to optimize. Let’s do it and we’ll see what symptoms are still there.” I would say the same thing of the symptoms that you listed off, unpack it, and let’s optimize you. We can have a discussion if something is still hanging out. We’ll look a little bit deeper and figure it out.

Men’s Health In Recovery: Restoring Testosterone And Lowering High Estrogen

For men specifically. How does substance use and early recovery affect testosterone, estrogen, SHBG, libido, and body composition?

You have such a special place in my heart. You do. My second favorite hormone is testosterone. Outside of thyroid hormone, I love me some testosterone for men and women. First of all, you get screwed over when we’re talking about the optimal testosterone number. That lab value range starts at a 250. Now, it gets cut off at 900. They don’t even let you go to a 1,000 or 1,100 on lab core because they would flag that as high. I’m like, “That’s where I want my guys.”

I want them at like 1,000 or 1,100 or 1,200. Right there, you’re getting screwed over in the testosterone area, but testosterone is so vital for both sexes, but obviously especially men, because it gives you motivation and drive. It keeps your organ of longevity, your muscle, sexual function, mood, cardiovascular protection, autoimmune protection against Hashimoto’s and other autoimmune conditions. That does take a whopping hit with substance abuse. We know that.

My partner was a former alcoholic and I tested him. I saw in this amazing 40 or 50 something year old, that he had very high estrogen because we know that alcohol, specifically beer, will jack up your estrogen. It’s like a Xeno fake estrogen that we’re taking in. Very high estrogen and very low testosterone. I was like, “Buddy, you’re looking like a female. I know you don’t want to be, but this is what it’s looking like. You have more estrogen than I do.”

His estrogen was like at 143. We know that any alcohol or substance abuse affects hormones. We know that. We know that hands down, especially for the guys. It just becomes, what are we going to do about it? You are going through the process of getting sober but, at the same time, we got to support your body. In his case, he did not have a thyroid problem. It was strictly hormones but we got him on hormone replacement, on testosterone, and added in an aromatase inhibitor to lower his estrogen.

 

The removal of alcohol also helped his body to lower estrogen over time because the alcohol itself is going to jack up estrogen. It’s going to impair liver detoxification. We detox our hormones through our liver and then out through our stool. If you’re not pooping because you have low thyroid function, that’s going to create a backup in the system of the detox flow. If your liver is overburdened, it’s also not going to detox. We often see estrogen dominance in an overburdened liver as well.

What should be evaluated before someone considers testosterone replacement therapy?

You had brought up SHBG as well. Let’s look at your whole hormonal profile. Let’s look at your testosterone, free and total. Let’s look at your estradiol number. Let’s look at your sex hormone binding globulin or SHBG. What SHBG is, it’s a little train that goes around your body that your hormones stick to. The testosterone, estrogen, your thyroid hormone all jump on this little train. The train has to be like the perfect amount of sticky so that the hormones will get on it and then get off at their stop to where they have to do their job.

The problem is, if SHBG is elevated, those hormones stick to the train and they never get off at their stop to go do their job. Whatever that hormone is supposed to be. We know that any substance abuse is going to increase SHBG. That’s definitely something that we have to test. We can basically your testosterone dose. I have a product in my line called SHBG Fixer that I created because we kept seeing all this elevated SHBG in the clinic. I’m like, “This is going to hinder what we’re trying to do here with hormone therapy.” You can also take supplements to help lower your SHBG as well.

Entering Optimization Land: How To Get Dr. Amie’s Full Thyroid Panel

I want to talk about what other questions I should have asked you that I didn’t ask?

That’s a loaded question, Tim. You have covered so much. The message that we just keep weaving into this whole conversation is, number one, have hope. You have to start with hope. If you don’t have that, nothing is going to pull you through. I always describe optimization land. I invite everyone to join me. It’s a beautiful place to live. It’s where you have abundant energy through the day. Your brain functions. You don’t even know what the word brain fog is. You hear people talk about it, but you don’t know what that is.

You’re not gaining weight looking sideways at a brownie. You sleep well. You poop every day. It’s how life is supposed to be. You know exactly how that feels. You’re optimal. You know what it’s like to live in optimization land. That’s where I want everyone to eventually get to but it’s hard to tell someone in the throes of feeling like garbage that this life is possible. I even think back. Think about when you’re sick. When you’re really sick, you’re in that mindset of like, “I don’t even remember what it’s like to feel better. I don’t think I’m ever going to feel better again. It’s just going to be like this for the rest of my life.”

You know it’s not. You’re so sick, you’re like, “I can’t even lift my arm or get off the couch.” That’s where you need to either remember what it’s like to be vibrant, healthy and in optimization land, or you have to look to somebody that’s telling you it’s possible. You cannot lose that hope. If you’re going through hell, you got to keep going because you’re going to get to the other side. You got to keep going and have that hope. What I would say is, take all of this information that we said.

You can hear the passion in my voice. I’m passionate because I know it works. I’m passionate because I’ve been doing this for many years. I’m going to tell your audience, please trust me. Trust me on this one. I promise you that things can get so much better than they are now. Even if you think things are pretty damn good now. They can get better. Please let’s just test your thyroid and your hormones. Let’s look at it. By the way, on that note, one thing that we didn’t talk about is the testing.

Do not go into your doctor and say, “Doc, I just heard this lady on a show and I want to get my thyroid checked.” If anything, get a copy of my book or reread this five times and write these down, “TSH, Free T4, Free T3, reverse T3, TPO and TGA antibodies, test your thyroid.” Not just TSH and Free T4. You have to get the full panel. My rule of thumb is if a doctor says no to testing, it’s time to get a new doctor. If your doctor doesn’t even want to look at your entire profile, or look at everything that is going on inside of your body to better help you, how do you think they’re going to help you? I could rattle off the hormone list, too.

If a doctor says no to testing, it's time to get a new doctor. Share on X

You can go off and order your own test. That’s fine, but at the end of the day, you need somebody to do something about that. I’m begging everyone to get tested. Now, we offer because we realize this is a huge issue. You will run into resistance on testing. That’s why it’s a rule. Rules come up because it’s happened. My rule of, if your doctor says no to testing, it’s time to get a new doctor, is a rule because 99% of doctors are going to say no to testing. They’re dictated by insurance that tells them they can’t run those tests.

If you go to FixerPowerLab.com, it’s thyroid and hormone testing. We give you a lab order to go to Quest or LabCorp, then you get an hour-long interpretation with my team. It’s a test, plus a consultation. It’s like $249. Ultimately, it’s cheaper than what you would order your own labs for at Quest. You get the consultation with it, with the interpretation of what’s going on with you. If you’re just curious and you’re like, “I don’t know. Maybe this is thyroid and hormones,” then just do the test plus consult and see. If there’s something there, then we can talk about treatment.

That’s what I was going to ask. If people want to work with you, if they want to connect with you, or they want to start with that, the $250 test and consult, what does that look like? Give people that information.

If you want to start with the test plus consult, that is at FixerPowerLab.com. You just place your order and then we’ll send you the lab order and get you all scheduled. If you’re like, “I’m ready to go. I’m ready for proper care.” You can just go to DrAimee.com, and click that button that says Become a Patient. What we’re going to do is just set you up with a complimentary call because we want to know more about you. We want to know what you’ve tried, what you haven’t tried, or what are your symptoms. From there, we’ll put you in the best path that is right for you in terms of our different programs and protocols.

Dr. Amie, thank you so much for your time. I appreciate you. I got a lot out of it. I’m sure my audience got a lot out of it. That’s all we got for.

Thank you very much for having me. Thank you, everybody, for tuning in as well.

Everyone, we’ll see you in the next episode.

 

Important Links

• Dr. Amie Hornaman
• Dr. Amie Hornaman on LinkedIn
• Dr. Amie Hornaman on YouTube
• Dr. Amie Hornaman on Facebook
• Dr. Amie Hornaman on TikTok
• Dr. Amie Hornaman on Instagram
• Advanced Thyroid and Hormone Clinic
• The Thyroid Fix
• Fixer Power Lab

 

About Dr. Amie Hornaman

Dr. Amie Hornaman is a functional medicine practitioner known internationally as “The Thyroid Fixer.” She is the founder and CEO of the Advanced Thyroid and Hormone Clinic, a telehealth practice licensed to treat patients across all 50 states, built deliberately so that access to specialist thyroid care would not depend on where a patient happens to live.

Her work grew out of her own experience. In her twenties, while competing in bodybuilding and figure competitions, she gained twenty-five pounds in two months despite strict training and nutrition. Six physicians inside a major medical system reviewed her labs and told her she was normal. The seventh performed a physical examination, found thyroid nodules, and diagnosed hypothyroidism. When standard T4-only therapy failed to resolve her symptoms and her physician declined to adjust the protocol, she moved into functional medicine — and eventually built a practice around the specialty that had been missed in her own case.

She is the host of The Thyroid Fixer podcast, and the author of The Thyroid Fix: The No Nonsense Guide to Fix Fatigue, Fogginess and Fat That Won’t Budge. She created the Fixxr line of targeted supplements, including formulations developed in response to patterns she was seeing in her own clinic. She has appeared in the documentaries SHEALED (Amazon Prime), Ageless, and Hormones, Health, and Harmony, and speaks internationally on thyroid and hormone health.