Women’s Health & Lab Testing

In a healthcare system that has often overlooked the unique biochemistry and needs of women, lab testing has changed everything. Join two leading experts as they explore how lab testing has empowered women to take control of their health, identify key biomarkers, and move from data to action.

• Panelists: Tiffany Lester, MD (Function Health) & Rose McKenzie (Mira Health)
• Key Themes: Empowerment and advocacy, hormonal and metabolic biomarkers, and the role of the health coach.

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Women’s Health & Lab Testing Panel:

Transcript

Dr. Sandi: I’m going to go ahead and introduce Rose while we wait for Dr. Lester. She’s amazing. You are amazing, Rose. I spoke with Rose at the Women’s Health Summit not too long ago and at A4M as well. So, Rose is the clinical manager at Mira where she assists healthcare professionals in effectively integrating Mira’s hormone monitoring tools into their practices. She’s well equipped to provide education and support to providers and fertility awareness educators. Additionally, she brings nearly a decade of experience as a natural family planning instructor specializing in the Marquette and Sympto-Thermal Method. So, welcome, Rose.

Rose: Yes, thank you for having me here. Happy to talk with you and Dr. Lester today.

Dr. Sandi: Thank you. And here is Dr. Lester. It is so great. And I know we got started a little earlier. So, it is great to have you here on our panel talking about women’s health testing at Function and Mira. And let me read to you about Dr. Lester. She’s amazing.

She is the Women’s Health Medical Director at Function, where she works with Dr. Mark Hyman to translate lab test data into personalized strategies that help women optimize their health at every stage of life. She’s a board-certified integrative medicine physician, educator, and advocate specializing in autoimmune conditions, hormone imbalances, gut health, and the effects of trauma and chronic disease on women. She is committed to advancing equity in care and expanding access to personalized health insights, which you get from Function and Mira. So, welcome, Dr. Lester.

Dr. Lester: Thank you. Thank you. Happy to be here.

Dr. Sandi: So, let’s start by talking about the sense of empowerment advocacy. How do you think the rise of direct-to-consumer testing has really changed the way that women advocate for themselves in a healthcare system that has historically dismissed their symptoms? So, whoever would like to take that and go first?

Rose: Yeah, I can go ahead and start. I will say that’s really where Mira came from. So, our founder was in her own fertility journey, and she did not have access to her own data. And she set out to change that, saying women and individuals, they should have the power to understand what their body is doing, what their own lab values are, and it should not be held against them or be restricted from them. And so that’s really where the foundation of our company came from.

And with that information, it’s really allowing the consumer, the individual, to now understand their own data and then advocate for themselves in a way that it’s not just, “I feel this way.” They can say, “I have these symptoms. My data confirms it with X, Y, and Z. And what are my options?” So, it’s much more of an advocating for themselves.

Dr. Sandi: Absolutely.

Dr. Lester: I totally agree, Rose, and I think we’re all on the same page and all want the same outcome for women. Can you hear me okay?

Dr. Sandi: Perfectly, yes.

Dr. Lester: Okay, sorry. So, yeah, I mean, I agree. I think that getting the data really helps to validate how women are already feeling and how they may have been dismissed at their doctor’s office or even family and friends. You’re like, “Oh, I’m tired.” And they’re like, “Oh, you’re just stressed. You have a busy life.”

And I think when women are able to get that data, especially the kind that we offer at Function that’s so comprehensive, it just validates what they’re already feeling, which is a huge part, I think, of the healing journey. And it’s just a start. But I think without that data, you can’t really move forward because you don’t know what’s wrong.

And I’ve learned this from Dr. Mark Hyman a long time ago is that you can’t manage what you don’t measure. And so once you’re able to know where you stand or where your body stands in this moment, obviously, it can change. And what I also love about Function is that it tracks those changes over time. So, you kind of know because as women, we’re different from day to day and we have menstrual cycles, and that’s the beauty, I think, of being a woman. But it also can… We just have this one snapshot of data. It’s like, “Oh, what does this really mean?” But even just that little bit of a snapshot can be helpful to validate how we’re feeling.

Dr. Sandi: That is so true. What do you see as some common blind spots in traditional women’s healthcare that you find out with this type of testing is bringing to light?

Rose: I’ll mention that hormones are something that it’s only looked at in a one-time… So, if the provider would order, let’s say estrogen, progesterone, it doesn’t actually make sense if you don’t know what part of the cycle they’re in. And so I can’t tell you how many times the provider is like, “Yeah, you’re within range.” But what does that actually mean, within range for what part of the cycle? Are you ovulating or not? You can’t answer those questions with just a one-time estrogen or progesterone.

And so often the patients are then even more dismissed because maybe they advocated for themselves to get a blood test. They get the blood test and they’re like, “But it doesn’t actually tell me anything.” And so a one-time blood test could say that you’re in range or you’re out of range, but if it’s not in context of the entire cycle, then really that data is kind of, I like to say, useless.

And I’ve actually seen where data was misinterpreted. So, I’ll give a real example. Some providers will do a cycle Day 21 blood test, which is a huge improvement over, “Just go get your blood drawn whenever you want,” right? It is an improvement. However, that blood work then came back saying the person’s estrogen was very high. And so the provider moved into giving them strategies to lower their estrogen. So, specifically giving them DIM.

And what ended up happening was this person had irregular cycles. And based on her next cycle, when she brought Mira in, we actually suspect that that high estradiol was when she was ovulating. So, you know, if someone ovulates around Day 21, that high estrogen is appropriate. And so they actually were giving her the wrong treatment. They lowered her estrogen, made it even lower, which then sent her into more irregular cycles. And so again, when we just having data not in context of what it means for the entire picture of the person, it can actually be quite dangerous.

Dr. Sandi: Yeah, thanks for sharing that story.

Dr. Lester: Yeah, no, it happens probably too common. And I know a lot of women listening will probably feel very seen. I share that story and they’re like, “Oh,” and it does matter when you’re checking.

And I think you brought up a good point on how everything is connected in our bodies. And sometimes we tend to isolate whether it’s vitamin D or TSH or hs-CRP, which is a marker of inflammation. And while all those individual values are important, they don’t give you the full picture, and our bodies don’t act in isolation. We’re all in this one body, and the systems are talking to each other.

And so, you know, when we do our comprehensive testing at Function, we’re looking at each of those systems. And so we’re looking at metabolism and inflammation and thyroid and nutrient status and how those all interplay so that when you get your clinician note at the end, you’re able to take those insights and really act upon it and not just continue to guess.

Dr. Sandi: Yeah, that’s so important. Going back to the example I shared in the introduction, this was in the ’80s, so I was in my early 30s. One test, TSH, that’s it. And at the time, I was so clueless and not taking charge of my health. I was like, okay, the doctor says this is out of range. And he says that you really need this medication. Nothing was tested. Probably nothing else in the hormone panel.

And I also have to say that I was… I’m turning 76, and it wasn’t until direct-to-consumer labs that I started getting hormones tested because no doctor ever brought that up to test hormones through perimenopause, which didn’t have a name back then, basically, and menopause. Who knew?

Dr. Lester: Yeah, thank you for sharing that story. And it’s unfortunately common, and hopefully Function is a part of changing that so that women can, and everyone, but particularly women, can take ownership of their data and be able to bypass the doctor who typically has been the gatekeeper in terms of ordering tests and what you have access to, which has been in place for, I don’t know, probably decades, hundreds of years, way before my time.

But I think we’re in this really amazing shift in healthcare where people are able to, not that doctors aren’t important, as you said, we still need them, but you’re able to bypass making that appointment, having that conversation with your doctor, and then sometimes trying to convince them to check your full thyroid panel because you’re exhausted. You know that something is off, and TSH sometimes isn’t always enough.

And so that’s what I really love about Function is that it puts that ownership back into someone’s hands. Say, “Well, at least at the very least, I can check all of my numbers.” And then do something about it and take that to my doctor and have that conversation and collaboration. You want to be very careful when you’re in that visit, but I think that that’s a huge step.

And I remember one of our members… I got permission to share this story. One of our Function members who had a similar story to you, Sandra. And it was like she was 34, she’s an ER nurse, so she’s in the healthcare field, mother of two, and just exhausted. And to the point where she’s taking 3-hour naps every day just to get through the day, and went to her doctor, and she had to convince them to check her TSH.

And they checked it. It was a little high, but they were like, “Oh, you’re probably just tired. It’s postpartum. You’re fine.” And then she got her Function lab test, and it showed that her antibodies were positive and that she actually had an autoimmune thyroid condition that was causing her fatigue and brain fog. And then she took that back to her doctor and was able to get on medication, get on the right nutrition diet, and in a week she felt better.

Dr. Sandi: Thank you for sharing that. And I think that is not an isolated story. We see this all the time, unfortunately.

And something else we’re seeing is how difficult it is often to even get an appointment with your doctor. So, if you’re going that route, I had a friend who decided to see a cardiologist for prevention. And she said the first appointment was in 2027. Okay, this was a few months ago. This is often what is going on out there as we have doctors, older doctors are retiring, not enough doctors are choosing primary care, for example. And it is just getting… And it’s very frustrating.

And then when you do see the doctor, you have a short amount of time. You may have a lot of questions and you don’t feel understood or heard. So, we’ve talked about this, but perhaps we can go into a little bit more about this snapshot lab testing, right? Why is a snapshot lab result often misleading compared to tracking markers across a full cycle or life stage? Anything else you wanted to share about that?

Rose: I think we could come from this from so many angles. I know when some people do…they finally get that test from their doctor that maybe they’ve, again, like I said, waited for the appointment, then they advocated to get the blood work, and then they finally are like, “I can go do it.” And they’re so nervous to do the test because they’re like, “Is this going to be a good representation?” Like maybe they asked for cortisol, and they’re like, “I need this to be the perfect day to do this test so it actually represents what I want it to represent,” because they know it was so hard to get that one test.

And I’ve seen it with some other tests where they pay a lot of money to get it done, and they’re almost paralyzed to do the test because they’re worried that they’re going to do it at the wrong timeframe. And so not only break down the barriers to being able to test when you want but also when you want that it can be this longitudinal data. So, then you don’t have to worry about like, “I’m still seeing this cortisol test and then I got woken up in the middle of the night and now I can’t do the test again.” There are so many things that make that just very cumbersome and a burden for patients.

And so one thing that I like about hormone testing with Mira is there’s no barrier. So, no prescription, no doctor has to order it, direct to consumer. They just go and purchase it. But then there’s no requirement when you start testing. You can just start testing the next day. You don’t have to wait for a period. You don’t have to wait for the perfect situation. And then like I was mentioning before, it’s not about one single data point. It’s about the entire cycle.

And if you did happen to get one single data point, now you can make sense of… We like to… Dr. Carrie Jones and I joke about, “Mira gives you the forest, you see the entire cycle.” And then if you happen to do a test, let’s say the tree, looking at one tree within the forest, then it can make sense within the entire cycle pattern.

So, as I was describing before, you did that what you wanted to be mid-luteal test, 7 days after you ovulate. You can actually time that very easily on your own. And so one thing that people should think about is maybe you do ask your doctor for that blood test. They don’t need to know that you’re accurately timing it. You can time it for yourself, right? “I’m going to do this test 7 days after I ovulate.” And then the data that you’re then obtaining is much more useful. And you’ve done that all yourself. And again, we’re really trying to put the power back in your hands to make that single snapshot in time worth it for you.

Dr. Lester: No, I love that. And I think also just to add on to what you said, Rose, is that, you know, I think you often need more than one or two biomarkers. And traditionally, when you go to see your primary care doctor, it’s once a year, and maybe they’re new or they don’t really know you. And you feel like you have to explain your whole story again to this person.

And then at the end, on average, they only check about 26 biomarkers, to be honest. Yeah, yeah, which is a good start. You know, it’s better than nothing. But, you know, at Function, we test over 160 biomarkers in the first visit, and then you can recheck that at 6 months. And even in between, depending on what’s abnormal, it’s like maybe you’re fasting insulin, hemoglobin A1c, and you’re monitoring for type 2 diabetes and want to prevent that. And so maybe you want to recheck at 3 months, and you’re able to do that without having to go through a physician and really to monitor like, “Is the exercise changes I made, the nutrition changes I made, are they working in real time?” And not having to wait.

And so I think that’s really the power of Function is that we give you that ownership back, so you can really become the CEO of your health as you should be, because you know your body the best. And I always tell this to patients like, yes, you’re coming to see me and I have my education and expertise. And I’ve been practicing for a few decades now, but you are living in your body all the time. And so I’m here to support you. I’m here to help collaborate with you and give you my advice and recommendations. And we are going to come up with a health plan together.

And so I think when you compare 26 to 160, sometimes it can feel overwhelming. You’re like, “Oh, that’s a lot. Do I really need all of that?” And I would argue, yes, you do at least once a year to really just see where you’re at. And I think that sometimes that is just like a snapshot. It’s one day you’re getting the blood testing, but you’re able to see where you’re starting and then able to determine with your doctor or health coach or with your healthcare team what’s the cadence of when you can track that longitudinal data that’s going to make sense for you.

Because we’re all individual, we’re all unique. And especially for women in the different stages that we go through and whether we’re trying to get pregnant, focused on fertility, or postpartum, or we’re having hormonal imbalances, you’re able to really decide for you what cadence of testing you want with Function, which I think is really powerful.

Dr. Sandi: Yeah, absolutely. It is so powerful. And talking about the restricted number of tests. So, my husband’s primary care doctor is very old school and still does like the… Now it’s not a postcard anymore, but it’s an email, “Everything looks good on your labs.”

And so my husband shared his… He did get a copy of the labs, and he shared with me. And I said, “Well, wait a minute. He didn’t test hs-CRP to measure inflammation. Did he do a fasting insulin?” “What’s that? No, he didn’t do that.” And so many things. “Beyond the standard lipid panel, was there an ApoB?” “No, none of that was listed on the lab results.” So, I think that that is absolutely what we’re seeing a lot in primary care still. And so it’s such a great step forward.

Turning to women’s health, so beyond the standard panels, which as I said, you get the lipid panel, the CBC, what are you finding specific biomarkers are really critical for women to monitor for hormonal health, for metabolic health? And what should they be talking about becoming the CEO of their health? What should they be asking for?

Dr. Lester: I think the most, if I had to choose, you know, because I love all of them. If I had to choose my favorite, I definitely, I don’t know, I think I just have a soft spot for thyroid. So, definitely like thyroid antibodies, so TPO antibodies, thyroglobulin antibodies, and then your TSH, free T3, free T4, like the full thyroid panel is really what you want to get as a woman to see where your baseline is. And then you can go from there depending on your symptoms.

Ferritin, probably my other favorite. So, ferritin is iron storage protein. And, you know, oftentimes you check a CBC, which includes your hemoglobin and hematocrit to monitor for signs of anemia. And that’s often normal, but women are still fatigued, they have brain fog, maybe their hair is coming out. And like, “I don’t understand. My doctor said all my labs are normal.” And then they get their ferritin checked and it’s super low. And that is the reason why they’re tired, why they may have exercise intolerance and can’t push it as hard in the gym as they want to, because we need… I mean, iron is a part of every cell in our body and carrying oxygen throughout our bodies. And it’s so critical. Or they’re having heavy periods and it’s because their ferritin is low and they don’t even realize because they’ve never had it checked. So, that’s another favorite of mine.

And probably fasting insulin that you mentioned. You know, it’s such an early indicator for metabolic disease that doesn’t get checked. And oftentimes hemoglobin A1C gets checked in those 26 biomarkers, which is important. And hemoglobin A1C, for anyone that doesn’t know, it’s an average of how your blood sugars have been managed over the last 3 months. And so it’s a good marker, but usually by the time that is abnormal, you have been having blood sugar dysregulation for decades.

And so that’s really moving from reactive to proactive care, and checking fasting insulin can be a first step in that. And often it is elevated before fasting glucose, before hemoglobin A1C. And so I would say those are probably my three favorites if I had to choose.

Dr. Sandi: Absolutely. That is so important. And health coaches can really provide that critical education to help people to become empowered to take charge of their health, to go to their doctor, to become a member of Function and help them if they don’t understand. So, just as you described what hemoglobin A1C is, that is something that health coaches can do. They can provide that critical information. And more and more, we are seeing the benefit of health coaches in this arena. So, I want to turn to you, Rose, in terms of response to the question if you want to share.

Rose: Yeah, I would say in general, of course, it’s for women, we know we have reproductive hormones that change. And so the reproductive hormones, of course, are going to be one of my favorites because that’s what I have all my experience in. And I’ll talk about that in a second. But some of my favorites that I don’t think I heard you say, fasting insulin, one of my top favorites as well. But cortisol as well, because often that can definitely disrupt the other hormones.

I like to say insulin and cortisol are kind of a little bit like bullies, and they bully around the other hormones. And so if someone is tracking their hormones with Mira, they are able to track their main four reproductive hormones. We choose to track LH, FSH, the main metabolite or breakdown of serum E2 in the form of E3G. So, it is, again, the main correlation between serum estradiol and then progesterone in the form of the progesterone metabolite, again, main breakdown of progesterone in serum.

And so with those four hormones, we can really graph out what is happening between the coordination between the ovary and the brain. And is the system being supported? Because we know ovulation is a sign of health, optimal health, because it’s technically not a requirement. It’s an extra that the body does, which it’s always seeking to achieve. But if it doesn’t have the right building blocks, if the body is under tremendous stress or the thyroid is very off, it’s going to disrupt the reproductive hormones.

And so tracking the hormones in themselves is very important, but it’s not everything. So, I’m very upfront with people. Testing with Mira is important, but you can’t just do that. And that’s where Function and Mira actually pair really nicely with each other because Mira can help you to track, “Am I ovulating? If I am, when?” And I like to be very clear with people, this is not just about trying to conceive. You should know if you’re ovulating because if you’re not, that means that, again, your body is not optimal at this point if you’re not ovulating.

And then once you know you’re ovulating, then are the hormone patterns optimal? Because we know we should have a nice buildup of estrogen towards ovulation, then we should ovulate. Then we have a nice buildup of progesterone. And many of those things can be off. So, you could have low progesterone, you could have estrogen that’s too high at the wrong times. They can not be communicating with each other well. And all of those things we really need to know about. And if they’re off, then it says, “Well, why? What is causing this?” And then we can look at those other labs. So, is it your cortisol, your thyroid? What other pieces of your body is making your reproductive hormones not ideal?

Dr. Sandi: So helpful.

Dr. Lester: I think that’s so right. I was just thinking like, “Oh, I have another favorite.” I don’t know if you test this at Mira too, that a lot of women are curious about, is AMH as a check for fertility that’s included in our base membership at Function. And, you know, sometimes you have to beg your doctor to check it. And at Function, you just get it automatically.

Rose: Yeah, and I think when someone can get it more often, it’s much more eye-opening as well. For those that are not aware, AMH is not just a, I’ll say like, what do I say, law, like, “This is this, so this means you can’t conceive,” or “It is this,” and it comes with all these conclusions.

AMH can improve. Of course, AMH does decline as we age. And so yes, it’s often termed as the ovarian reserve. But if you don’t have good hormones and you’re not ovulating, your AMH can be lowered due to the fact that you’re not ovulating. And if you have PCOS, you can have really high AMH. And so it’s not a one plus one equals two kind of thing. AMH is much more dynamic than I think people realize.

And I’ve seen women improve their AMH and then go on to conceive. And I’ve seen women… So, I’d say that’s to improve their AMH, but I’ve also seen women with PCOS have really high AMH and improve it by lowering it. And so it is much more dynamic than I think people realize, AMH.

Dr. Lester: Thank you for explaining. Yes.

Dr. Sandi: So, let’s turn to the role of a health coach. I had a conversation with Dr. Mark Hyman. It was at a summit in October. And he came up to me and he said, “We really need an army of health coaches.” Health coaches are key to helping people become empowered to take charge of their health and to work intelligently with platforms like what the two of you are offering to consumers. Direct-to-Consumer is a movement that health coaches need to be a big part of. So, I’d like to hear your perspective. How do you think health coaches can help people, specifically women, move from fear of a bad lab result to taking the action of a lifestyle change.

Rose: It’s such a good question.

Dr. Lester: I love this question. You can go ahead, Rose.

Rose: Yeah. So, to me, I think of it as… The client and the health coach are a team. And data is of course very important for that team to function well. And many times patients don’t know how to track their own data well. They have symptoms and first and foremost, a health coach will teach them how to track their data well, whether that be tools like Function or Mira but simple like food diaries, symptom tracking, so then they understand themselves better so that it’s not just the health coach saying, “You should do this.” The actual client can look at it and say like, “Oh, wow, when I do x, y, z, I stay up too late, and I fall off my diet, and I stop exercising, I don’t feel well.” They connect the dots themselves because you’ve taught them how.

So, it’s a ton of empowerment that the health coach gives to a client. And then we take the step further. A health coach teaches them how to take that to the next level of, what are you going to do about it? Are you going to talk to a doctor about this or are you going to do something yourself or both? They have that conversation, and it equips the person to have a very informed, educated conversation with their provider in a way that usually leads to better action because they can say, “I’m concerned about my thyroid because…” And they can list out all their symptoms in, you know, what the doctor is wanting to hear. And they also can say a combination. My hormones are low. I’m trying to conceive. I’ve been trying to conceive for one year. My hormones are low on my Mira and my symptoms point to I have a thyroid dysfunction. And then they can hopefully get better action. So, I just see the layer of empowerment advocating just goes more and more and more when they have a health coach there to help them.

Dr. Sandi: A hundred percent.

Dr. Lester: Yeah, no, I love that answer. And I’ve had the great privilege to work with health coaches in a clinical practice and really be that partner with them, with the patient. And how I typically frame it is, you know, I’m in a visit with the patient, we’re going over their labs, they’re telling me their story, and then we come up with a plan. And I help them explain why their labs are this way and to make sure they have a good understanding of that.

And I think health coaches come in and really explain how to do it. Like, “My doctor gave me this diet to follow and I understand why I need to follow it, but how do I actually do this in my real life?” And that’s invaluable because we all know that we should exercise and eat well and we know to do all those things. But how many of us are actually doing it?

And health coaches, I think, are that really crucial piece in medicine that help people move the needle because behavior change is so, so hard. Even for me, with all that I know, I’m just like, “Oh, what do you mean? I have to eat vegetables every day?”

Dr. Sandi: So true.

Dr. Lester: Yeah, I know all the facts and information. Still, it’s a struggle sometimes. And so I think that health coaches can also, in this new transition that we’re seeing in health with direct-to-consumer testing and AI and people having more ownership and being empowered to take control of their health, but you still need people with health expertise and education to help frame that. And I really think health coaches can help people ask better questions when they’re in a visit with a doctor and where to focus because how doctors think, we think of symptoms and patterns and timelines, and people don’t necessarily think that way. And I think health coaches can help bridge that gap for a lot of people just to make their visit more powerful.

Dr. Sandi: Well, I love that. And that’s what we teach at FMCA, to become that behavior change specialist, to help people change when change is hard. And as you pointed out, lifestyle change is hard. And so partnering with a coach is increasingly important because as the medical system becomes increasingly impersonal and as we move to direct-to-consumer labs, you’re getting an email, you’re getting a report. But sharing it, who do you have to share it with, a human-to-human connection to then help you decide what steps you want to take next? And so it is just so critical.

We have many people. The old school model was thinking that you can be the one to interpret the labs and order the labs. But what I love so much about this movement with direct-to-consumer is it is empowering that consumer. They order the test and they get a printout. They can see everything is really there for you. And then you have the conversation with the health coach in terms of, “Are you understanding what this means? Where do you want to go for next steps? What about your doctor? How do you want to communicate with them?” So, that’s the critical piece. And that’s why I think health coaches are the most critical person in this direct-to-consumer lab movement.

Because working with doctors, as we’ve said, that can be challenging. What do you feel is the best way for a coach to help a client, let’s say, organize and present this data from their direct-to-consumer testing to their primary care doctor? Because my experience with many of them talking about my contemporaries, they’re saying, “We don’t want to do this because our doctor won’t understand it,” or that basically they’ll get mad at me. And many people do see the doctor as the authority figure and they’re afraid, “Well, maybe they’ll dismiss me from the practice,” for example. So, I’d like to hear your insights on this, how a health coach can help.

Dr. Lester: Yeah, I can speak as a doctor. And the kind of joke when the patient comes in like, “I Googled this,” and now it’s like, “ChatGPT told me this,” and you’re cringing inside. You’re like, “I just spent thousands of dollars to get trained to interpret this for you.”

And so there’s a little bit of that, which I understand, but I also think that the best interactions and relationships that I have with patients are ones that are involved in their care. So, they’re taking that extra step to do that research and to come to a visit prepared.

And so I think some of it is on our clinician community to take a step back and maybe put our egos aside and be like, “Okay, they’re concerned. They don’t feel well. They’re trying to figure it out. And let’s be a partner with them in this.” And so I think that’s one step.

And then I think it’s coming with curiosity. And just because you have a lot, maybe your fasting insulin is out of range or your thyroid antibody or your ferritin is super low, and that feels validating for you but to come in with an open mind and to have a conversation and not a diagnosis.

So, I encourage people not to lead with the diagnosis, which is to say, “These are the symptoms that I’m having. These are the patterns that I’m seeing. They’re showing up on my labs. Can we have a discussion about it?”

Rose: And I think the health coach can help frame that for them. Again, a patient, a consumer may not know what the doctor is looking for, but health coaches do. And so they can say, not telling them what to say, but help give a framework or an outline of you can present your concerns very clearly if you say, “I’m concerned about, let’s say, my weight gain or weight loss because,” and you fill in the symptoms and the data that you have to support you for that. And then you can come with the request of, “I would be interested in X, Y, and Z.” And then the doctor can use their skill set, which is taking all that information in and then giving their professional recommendation.

Dr. Sandi: So important. And I think that leads back to where we started, and that is people can become the CEOs of their own health. And particularly for women who may have felt more dismissed than men in the medical system. Becoming the CEO of your own health, what does that really mean? It means that you, as the CEO, because I’m the CEO of FMCA, the CEO is I have a team in place and I trust my team.

And so for our health, we have a medical doctor, we may have specialists, we have our health coach, we may have a nutritionist, a mental health professional, whatever that might be. And now part of our team is our access to labs. We can get the data on our own, and it’s very empowering.

So, I would like to turn to the questions that have come in from our audience. Let’s see. We have a number that have come in. How do you think health coaching will change? Should we encourage our clients to work with these companies? And will things look different for health coaches with advances here? Yes, absolutely. I’m going to answer that, and absolutely. So, I see it as just an incredible opportunity for health coaches because now you can feel that as a health coach, unless you hold a medical license to interpret labs, you are the behavior change specialist, the lifestyle change specialist, the advocate for your clients. And so you can educate them about what’s available in the world of direct-to-consumer testing, help answer any questions they may have, and steer them in the right direction regarding the results.

Anything else either of you wanted to say about that?

Dr. Lester: Yeah, I agree with that. I think so many of us struggle with, “What should I be eating? How should I be eating? What timing should I be exercising?” Especially if my cycle is shifting and I’m going through perimenopause and I’m more tired, should I be doing more strength training? And even that can show up in changes in labs and improvements. And health coaches can help with that stuff even before they get to the doctor, such as if they’re waiting for an appointment with their primary care doctor or specialist. And maybe by the time they get to the doctor, they’re like, “Oh, I’m all better.”

Dr. Sandi: A question came in: are labs usually covered by insurance?

Rose: That’s kind of a landmine question.

Dr. Lester: Yeah, I was like…

Dr. Sandi: What do you see on the landscape? And what about health savings accounts? Anything that you’re seeing in the field of DTC labs?

Dr. Lester: Yeah, I think it’s kind of this push and pull, you know? And I think with Function, we have tried to make it as accessible as possible while still… We’re a company and running a business. And so our price is $1 a day, $365 for the year membership. And the answer is yes, you can use your HSA or FSA account to pay for that and get reimbursed. And there are many of the labs that we check within our Function annual membership that are covered by insurance, depending on your deductible and health plan. There’s so many different variables.

And so I think the great thing about Function is that there’s no surprises. And this is the cost at the end of the day, and you know you’re going to get the data, and you can take that back to your doctor.

So, some people use kind of a mix. They use Function to get those $365 a year. And then you get tests twice a year, six months apart. But say you want to recheck your hemoglobin A1C or your fasting insulin or your thyroid antibodies at 3 months, maybe you can ask your doctor for that and it goes through insurance. It won’t show up in our dashboard and how it tracks the changes over time, but that can be a way if someone is cost conscious to still utilize their insurance but still get the data that they need.

Rose: Mm-hmm. I just want to piggyback and tell a story about that. I myself, as a patient, trying to get my hormones tested, and I knew I had to time them correctly. And I was doing an every other day test to see my luteal phase where I had a history of low progesterone.

And I got the surprise from my insurance company that I got it drawn five times, and my insurance would only cover the same blood test done three times in a month. And so, you know, I got a bill for like $400 that I wasn’t expecting. And, you know, of course, I’m sure it was in the fine print somewhere, but how difficult is it to figure that out? What will be covered? What won’t?

And in my previous work in a doctor’s office, we would even tell our patients, we would say, “We’re not sure if this will be covered. Do you want to proceed with it? This self-pay will be $400 for one lab if you don’t get your insurance to cover it.”

And so I would say from an outsider’s view, what’s so beneficial to Function is you know what you’re getting, you know how much you’re paying for it, and you know you’re going to get the results. Whereas, again, you can do that hybrid, but you know you’re going to have to do a little bit more work to get it to be cheaper or get it more often, things like that. So, yeah, just from my own experience, I can see exactly why people are coming in droves to Function. For… Oh, sorry, Sandi.

Dr. Sandi: No, go ahead.

Rose: I was going to say, for those curious about Mira testing, Mira testing is direct-to-consumer, pay out of pocket. But you can use HSA if you have those accounts. We are covered by some fertility benefit coverages, so I think that as an insurance rider. So, Carrot, Maven, WIN Fertility, they will cover Mira products. So, we always encourage people check if you have those extra services or benefits from your employer, and then you may be able to have this either more discounted or be completely covered. But otherwise, it is direct-to-consumer. They, again, can use their HSA if they have it.

Dr. Sandi: And I think the health coach can play a critical role here in having these conversations with people about what matters most to them, what they value their health for. And often they will have this “aha” moment, like, “Okay, maybe I don’t really need that new purse. Maybe I’m going to go for the testing,” or focusing on the value, how they value themselves. And that can be an “aha” moment where they are going to invest. And investing in your health is investing emotionally, cognitively, spiritually, investing in time, and often investing financially as well. So, that can be an important conversation.

I remember I used to have that with people back in the day. I did biofeedback as a health psychologist, and it was not covered by insurance. And often they would start to say, “No, I can’t afford it.” But when they realized what this could do for their health, they often changed their mind and made it work and found a way to pay. What about when lab results do not coincide with symptoms or how one is physically feeling, especially as they’re a snapshot in time?

Rose: I think for me, I think about have we considered the whole picture. So, the labs, again, Function labs are amazing in that it’s so many and then rechecked every 6 months. So, I don’t want to call those snapshots. They are but it’s not traditionally what we think of as a snapshot time. But we have to consider the interplay of everything.

And so have you actually looked at everything is what I would say. So, I’m trying to think of a symptom. Maybe a patient is entering perimenopause. And so they start having symptoms of perimenopause. And their assumption is, “Why am I feeling like this? I still have cycles.”

And then they get their blood work back and their blood work, again, may be within range. But what they’re feeling is that their hormones are actually shifting, which would be hard to see in a snapshot time. So, a perimenopausal patient may have shortening of cycles, or they may have lowering of progesterone, or they may have a misbalance between estrogen and progesterone. That would be missed by a snapshot in time.

And so again, the symptoms based on the snapshot don’t match. But when you see the longevity over it, then it does make sense. Or I would say something that’s gradually changing as well. So, you might be in range, but you’re on the low end. And then next time you check in 6 months, now you’ve fallen out of range. And so the symptom did match. It was just taking longer to see, I think, is what I think about for those.

Dr. Lester: I agree. And sometimes the reference ranges that are for labs are normal and not necessarily optimal. And so maybe you’re falling outside of the optimal range, but on a lab record, it says that it’s normal. And so you’re still having symptoms because you’re not in the optimal range for you or whatever is going on. And so that’s why some people can feel that discordance in their results and how they feel. And that’s where talking to a health coach or a doctor to explain those nuances can be super helpful.

Dr. Sandi: So Devon wants to know: as someone who wants to encourage Western medical intervention equally supporting patient empowerment and education, what about home tests to recommend to patients to test efficiency safely? And Mira is a home test, correct?

Rose: Mm-hmm. Yes, yes. So, I think if I’m understanding correctly, you want to know what tools are available to you that you could recommend to your clients and which ones should you trust.

So, of course, you have to figure out what you want to have them test. Are we looking at cortisol testing? Are we looking at hormone testing? So, I would say a well-rounded health coach knows what tools are out there. And the hard part about this is they’re changing rapidly. And then investigate that company, ensure that their evidence is there, they’re medically sound.

And then hear from the patients too. I can’t tell you how many patients, or I should say providers, come to Mira and they say, “My patients are showing me data and it was useful in my practice. Now I need to get on board. I need to get my dashboard and understand what the data is saying and to that next degree.”

And so what are the patients saying? Because consumers will do a lot of research before they buy something, and they’ll be quite critical as well once they start using it. And so you can learn a lot from what your clients are using and what’s working well for them and ensuring that it’s a safe plan for your clients.

Dr. Sandi: Yeah, especially things like… And coaches can play a key role helping people to understand and to prepare and that would be…especially home tests, you get this kit and how do I use it? And the instructions are really tiny. I can’t read the fine print and it’s complicated. And what if I do it wrong? And how do I mail it back? And there’s multiple steps in the process. Is it going to be accurate? So, it can generate a lot of anxiety and confusion, and health coaches can really be helpful with that.

And similarly, I just want to take this time to point out about how helpful coaches can be in preparing people for lab visits. If you’re going to Quest, for example, to get your Function test, there could be a lot of anxiety. And I will wear a CGM monitor and I see, “Oh, my blood sugar is really high,” about getting this draw. And so then when I get the lab test back and it was okay, well, this was stress because I can see on my CGM it’s not normally like this.

But often there will be anxiety. There’ll be fear about it or fear about the results. And health coaches can really be instrumental in helping people deal with those reactions and prepare well for it in terms of what you need to do. If you’re fasting, if you’re avoiding supplements, for example, to get accurate readings.

Okay. I just also want to remind everybody who is here that this is education, and we are not available or allowed to give personal recommendations. So, seek your own healthcare provider, your health coach, get your support. But we are not answering questions or giving any recommendations that are for any given attendee in their healthcare.

So, let’s see, we have one. What type of tests are important for women that are more than 10 years past menopause if considering starting HRT?

Dr. Lester: That’s a great question. I mean, I think comprehensive testing just to see where you’re at, but specifically, I would say checking your hormones if you’re 10 years post-menopause. They should be low. I think I really love… I don’t know if we can mention specific tests, but I think looking at your estrogen metabolism is really important, which certain at-home test companies do for hormones. And to see how you’re detoxing and going through phase one and phase two metabolism for estrogen, which is really important because if you’re adding on and taking HRT, but specifically estrogen and progesterone, then you want to make sure that your body is able to process that efficiently.

And so sometimes as we age, our liver and kidneys can have difficulty with that. So, I would say that’s important. Bone health, just in general, you want to check, which we do have those. It’s an add-on for a function membership, but we do have those biomarkers available. And cholesterol. You want to make sure that that is in a good place. And so we do an expanded cholesterol test, which is in the base membership for function that I think can be really surprising for people when they get their results, even though they’ve been told by their doctors that, “Oh, your cholesterol is fine.” And then they get the actual breakdown of small LDL, and medium-sized LDL, and LDL particle number and find that they’re more at risk than they thought they were.

And so when someone is… You want to be safe with HRT, and obviously it’s a conversation and history and if you have history of specific cancers personal or family history, but I think to get a good snapshot of where you are to make sure that you’re doing it safely. And then also to track over time. And then once you’re on HRT, to track your estrogen and progesterone levels to make sure that they’re physiologic. And you still want to go by symptoms, but you just want to keep your eye on it so that you’re not going too high or too low.

Dr. Sandi: Thank you. And this is not for continuing education. We are talking about companies. And so it is okay. And I assume you’re talking about the DUTCH test. Okay. Rose, do you have any other comments about that?

Rose: Yeah. So, you mentioned that their hormones should be low once you’re post-menopausal, which is true. However, FSH is actually high. And so we end up with…

Dr. Lester: Yes, yes.

Rose: …a mismatch there. And so I typically tell people, Mira is the best use from puberty to menopause, who has ovaries that function. So, it doesn’t matter if you have a hysterectomy and IUD. If you have periods or not, hormone testing is important and just seeing what the hormones are doing.

When someone is post-menopausal, then again, we expect they’re… I like to say, it sounds kind of harsh, but your ovary has kind of failed. And so you’re not making estrogen anymore. And if you’re not ovulating, you’re not really making progesterone. And so those two hormones aren’t as useful to track in a longitudinal as they change, because they’re not really dynamically changing anymore.

But it can be helpful to still test FSH in someone who is post-menopausal, which I know this is kind of a newer space, but the research has been going on for quite some time, I would say about 10 years that we’ve been seeing that high FSH has its own risk factors independent of estradiol. And so someone who is going on estrogen, yes, it increases their estrogen, but it can also help suppress their FSH, which is a known independent risk. And so that’s one space where Mira is actually, again, very easy to get your FSH checked and see it as it’s changing.

So, if someone’s on HRT, we like to say there’s… It’s difficult to determine if HRT is therapeutic, but we have. Are your symptoms improving? Is your estrogen increasing? We know there’s that threshold in blood that helps with bone health, but we know that that’s not the end of the story. There’s more there that still needs to be developed and researched.

But have we looked at the FSH? Are we suppressing FSH? Because if you go on estrogen, your estrogen goes up, but it does nothing to your FSH, then we actually haven’t eliminated that risk yet. And so that’s something that’s currently not really addressed often is even getting your FSH tested throughout perimenopause and into menopause. And then seeing has that level been reduced? And again, it’s really looking at FSH as a risk factor that has kind of been overlooked in the research.

Dr. Sandi: That is really, really interesting. Sorry to interrupt. I’m going to check that out personally. And there’s the next… Yes, love it. If someone is going through a fertility journey and Mira is recommended, how would you go about talking to your doctor about results and all the things to test?

Rose: Yeah. So, if you have been testing Mira, I say you have a jumpstart because most conventional medicine doctors will say, “Try to conceive for 12 months and then come talk to me.” Well, if you already have Mira testing, you can come to your doctor and say, “Yes, I’ve been trying to conceive for 12 months, but I only ovulated three times in the last 12 months.” You can already advocate and say, “Yes, I’ve been testing, but I think I have low progesterone.”

And so it can be that conversation with your doctor to say, like, “I’m ready to move to the next step. I’ve already timed intercourse correctly. I know I’m ovulating.” And I actually encourage patients. If you have Mira data and you’ve been trying to conceive for six cycles, time intercourse correctly, you know you’re ovulating, I tell them, don’t wait six more months. I know your doctor wants you to. But thisthe stats really say that if you don’t change anything and you just keep trying to conceive for another six cycles, the outcome will probably not change and you probably will not conceive in the next six cycles either.

So, it’s really time that you start making actual changes to your lifestyle or your diet. And then when you go to your doctor, you can already say, “I know I’m ovulating. I know I’m timing intercourse correctly. I’ve already changed my diet. I’ve done, you know, X, Y, and Z.” And I’ll be very transparent. Some doctors are again, kind of resistant to seeing this data, but it’s usually because they don’t have time or they don’t have the skill to quickly interpret it.

So, if you write down notes for yourself, which again, your health coach can help you do to say, “My Mira data has helped me to identify again, that I do or I do not ovulate or I ovulate but my cycles are still irregular.” And then it’s not like handing a stack of papers to your doctor, “Here’s my Mira-generated report.” You can do that of course, but also have those bite size, ready to go things to, to show your doctor.

Dr. Sandi: Thank you. There’s a question about fasting insulin. So, let’s say it’s low, but then you get a glucose tolerance and it’s showing profound insulin resistance. So, any insights there in terms of those markers?

Dr. Lester: I would tend to believe the fasting insulin but also want to know what their fasting glucose is and hemoglobin A1c. And, you know, I think the oral glucose tolerance test is… It can be a great test, but in many ways, you know, tests can be flawed. And so it’s not necessarily the best indicator.

So, let’s say if you ever drank that solution. And if you’re not, it’s pretty terrible. And you know, if your body isn’t used to a lot of sugar, then it can have a high response that could be appropriate physiologically. So, it could just be an appropriate response. I love doing a CGM, as you mentioned earlier, just to track your blood sugars over time. And that can really give you an idea of how your body is doing and managing insulin levels. And do you really need to be worried about prediabetes or type two diabetes, or is it just kind of a one-off?

Dr. Sandi: Yeah, that’s a great point. And I think that’s another way that coaches can be so helpful, to help people track and get a CGM, for example, and use it well and get those insights. So, there’s been a lot of questions about postmenopausal, and I think we’ve answered that. Is there a guide available that defines each lab and its purpose?

Dr. Lester: Like explaining what each test is?

Dr. Sandi: Yeah. So, let’s say you get your results back. How do you know what this means?

Dr. Lester: We have on our Function website, we have a description of each biomarker, even the add-on. So, that’s a great place and great resource. And then once you get your test done with Function, you have even more information on the other side, not just in your clinician note but also under each biomarker in terms of what it is, why it matters, what are the reference ranges, and how that applies to you.

Dr. Sandi: Sounds great. Specifically, from Tiffany, do you invite the health coach into when you have a patient visit? How do you use your health coaches?

Dr. Lester: I wish. I wish. That would be amazing. Yeah, I worked with health coaches in my previous practice and so they were separate visits, but we were always in communication. And if there are ever any questions, then we could go back and forth and answer them to help support the patient. But, yeah, I would love a group visit if we could figure that out with schedules.

Dr. Sandi: Yeah, okay. Yeah, totally. Okay. So, Devon says: yeah, this is something we’ve talked about. It’s very frustrating. You go to your primary care, you request the test, all these roadblocks. They can’t get an appointment. They have to refer to another specialist. How can a health coach help? So, I can speak to that. And that is that health coaches are helping people to become empowered to take charge of their health. And this is a perfect example where they can help that individual investigate direct-to-consumer testing. And they can also be the one who can make a connection because you have a team and, as a health coach, you collaborate with a provider. And so you may really be the one who intervenes.

And often it’s the office manager or that person, even like you get to know the person, if you are seeing a client and you have permission to speak with their provider, often you establish that relationship that could lead to referrals in many cases, but you are also informing you’re the bridge of communication. And so you can say, “Hey, Mrs. So-and-so, your patient is frustrated,” as you may say, even document some things that you’re noticing. And so you can bring that to the attention of the provider. So, I want to… And any other comments from either of you on that?

Dr. Lester: No, I agree. I think I’ve been loving all these questions.

Dr. Sandi: Okay. So, Dana says: as a health coach, what test panels should we share for patients to understand more about intercellular and intracellular? So, you can…

Dr. Lester: Nutrition?

Dr. Sandi: Yeah, I think she says for women, especially African-American, Latinas, what would help them to be more proactive with their health and empower them to improve from where they are?

Dr. Lester: I mean, I think, you know, getting nutrients and vitamin D comes to mind. That’s typically low, tends to be lower in Black and Brown people. And a lot of us have no idea. I know I certainly didn’t, but when I got my test, and I was like, “What do you mean it’s like?”

Dr. Sandi: Yeah. Absolutely.

Dr. Lester: Oh, go ahead. Go ahead.

Dr. Sandi: No, any other comments you wanted to share about that?

Dr. Lester: I think it’s just important to… You know, I can go on and on just about the disparities that exist in healthcare for women, especially for Black women. But I think this is so important that we can now get the testing ourselves. Yes, it might come out of pocket or we might have to get reimbursed, and you can get the testing yourself and have that baseline of what’s going on in your body. And then you can take that to your doctor and have that conversation. And that is incredible.

Dr. Sandi: Absolutely. Saoirse, you have a question about what training can licensed clinical psychologists and mental health coaches get to understand and interpret labs, especially given the interpretation of labs is variable and conservative and often aimed at optimization.

So, this is where I think it helps to look at having access to resources that are going to be able to provide interpretation that is beyond what any human being can. This is, again, referring to Dr. Mark Hyman. He talks about this a lot. He said, “You know, I’ve been a physician for many years. I can’t do what AI is now doing. I am in awe.” He said, “You know, I thought I was a good diagnostician, but what we are able to do…” And if we look ahead to the future, we have the ability now like never before to analyze data in a way that we have to… There’s caveats, which we are going to discuss later in terms of, you know, different labs may have different results, for example.

But particularly as a health coach, as a mental health, your critical role is helping your clients be empowered to get this test done and to understand that they are the ones who… So, you take the data. What you’re doing is interpreting it in lifestyle change. You’re helping them see, “Oh, I think I’m going to try and get to sleep earlier. Then I’m going to get tested again. Wow, it changed,” for example. That is the critical part because as human beings, we can’t keep up with the pace of what is now available and growing in terms of interpretation. So, any education you got about this would be obsolete, I would say, in a few months or a year. I’d love for you two to comment on that.

Dr. Lester: Yeah, I know. I agree. Things are moving so rapidly and I’ve played around with it even for my own patients and for myself. So, like, oh, what does this say about me? Because I know what the diagnosis is and 9 times out of 10, it’s pretty accurate, which is like scary. Am I about to be out of a job? But I don’t think so.

But I think it’s really useful to use these tools that we have and that are continuing to be created and perfected to help doctors to help health coaches because we can’t keep track of everything, even like the research that’s coming. You can use it to be like, “Are there any studies that came out this week that are pertinent to X, Y, Z, my areas of expertise that I need to know about? And can you summarize that for me,” even though you can always still go look at the paper, but we’re also I think limited in time. And so it’s like, how do we use these tools to help us help each other?

Dr. Sandi: Yes, absolutely. Rose.

Rose: Yeah. I think a health coach’s role here is ensuring that AI is used well, right? We know AI is advancing how labs are interpreted but also it can be very inaccurate if they’re going to the wrong places and they’re getting misinformation. So, health coaches are still very important with this new realm of AI and manually interpreting something is not bad. And so I can tell you from personal experience, there’s times when I’m looking at a mirror chart and even I’ll say our machine learning algorithm misses something that I still see.

And I’m like, well, I’ve seen thousands of charts at this point. And so until AI catches up to me, I still can manually interpret better. And so those are things that health culture, someone like me can look at that and say, “Well, when I look at your data and I understand that you have, let’s say, a history of this, when I look at your data, I do see, let’s say, that’s a shift and that’s an improvement.” Even though that let’s say got missed by… I have people say, “Well, I just fed all my charts into ChatGPT.” I’m like, “Okay, what did you learn?”

Dr. Lester: Yes, yes.

Rose: And we can shift that.

Dr. Sandi: Absolutely. This has been such an incredible conversation with the two of you. I admire both of you so much, the work that you are doing. And I think the best is yet to come, and we are really just at the beginning of what you can do. And I love that both of you are so committed to working with health coaches and the power that that has to help people become the CEOs of their health. So, thank you so much.

For those in our audience, stay with us. Everything is recorded. So, if you need to take a quick break, please do so. This will be recorded. And we are going to be talking… I know a question came in about GI tests, and we will be talking about that. And I apologize if we didn’t get a chance to answer all your questions, just so much engagement. But we will do our best to make sure we can help with that. So, reach out to us at FMCA.

So, thank you so much to you, Rose from Mira and Dr. Tiffany Lester from Function Health. Thank you so much.

Rose: Thank you.