Dr. Jacqueline Tolentino, of Parsley Health. specializes in hormone optimization. Having hormones balanced is extremely critical because when they're not in balance, we deal with a lot of frustrating and often debilitating symptoms and conditions.
We get to the bottom of how a woman, if she's suffering from specific symptoms, or has a condition that's been diagnosed, but it's really difficult to treat, how does she approach a clinician to be successfully treated, whether it's the symptoms, the condition, or both.
What we Discuss
How to properly understand the root cause behind your symptoms and whether these symptoms are due to a hormone imbalance
Signs and symptoms of hormone imbalance in females
What questions your doctor should ask you so they can best fix your hormone imbalance
What to monitor in your body to increase self awareness
The impact of quick fixes to treat your hormone imbalance
"If you want to really establish better foundations within an individual's body, they have to learn about their body. And they have to understand that these symptoms, if you are experiencing any sort of symptom, your body is talking to you and is telling you that there is something wrong." - Dr Jaclyn Tolentino
Women tend to do research based on symptoms unless they're already diagnosed with a condition. So I have found even when I'm engaging with the consumer, if I say, for example, “Tell me your greatest concern around your hormones,” silence. However, if I ask, “What's your greatest complaint,” and I post an Instagram poll, where you can only do an A or B….”Is it your low libido or lack of sleep?” People will respond because they get that. It's familiar.
What I thought we should do is focus on the symptomatology that happens and maybe talking about what that means from a hormone perspective and then potential solutions and considerations.
Dr Jaclyn Tolentino 03:58
Frankly, the way that I would approach it is if this was a woman or a man who was coming in with these symptoms is, “How do I explain it?” Say for example, it was fatigue, right? So there's just so many different possibilities there. And sure, there's absolutely some low hanging fruit from the surface that really could be contributing to somebody's fatigue. But then at the same time, on the other end of the spectrum, there's just a lot that really should be fleshed out. And if somebody says I have fatigue, I have so many questions for them as a practitioner.
When do you get it?
Is it worse in the morning?
Is it worse after eating?
Is it all day every day?
Is it just during your menstrual cycle?
Is it directly after you're working out?
Is it only certain meals that create it?
Starting to get intuitive about when people are experiencing symptoms, and how often they get them and what may also be associated. We teach that a lot. We really teach them to understand their bodies better so that they can also report some of these things to me and have more clarity and help them figure out exactly what's going on.
Georgie Kovacs 05:02
What I'm noticing is even like on Facebook, it's, “What do you do for getting to sleep? What medication do you take?” People are just giving their list. It's fascinating because I've been in this space long enough, and I've interviewed almost three dozen experts so far, just for the podcast. And here's what I will say. It's great from the perspective of before, there was nothing, no discussion about any of this, there wasn't an avenue like social media. But my concern is that, in this quick fix world we live in with social media, I think it leads to everything being a quick fix.
So someone comes in to visit you, what is your process, besides the questions that you ask, of really diagnosing? Maybe we can even do a case study here. If a woman comes in with a given symptom, what are the things you did, what were the things you uncovered, and how did she react to that? What was able to change in her life? I think women seeing this come to life might help paint the picture for what's truly possible outside of that quick fix.
Dr Jaclyn Tolentino 06:19
Oftentimes, the quick fixes may be short lived, right? One may say, “Oh, this girl was taking it, let me try it.” The next thing you know, it’s, “Okay, this doesn't work for me.” And so sometimes those lists can actually sabotage what you're really trying to uncover.
So crash course. If somebody was to be seen, virtually and say the issue, like you mentioned earlier with sleep, I think it's important to really dial back and think how long sleep has been an issue. So it's not just the question surrounding how that person is experiencing it on a day to day basis.
Are they waking up feeling refreshed?
Do they wake up feeling tired?
Is asleep really trickled down into the rest of their day?
Holistically, when we're looking at the human being, I'm also asking questions about work and work life balance; looking at micronutrient levels, hormonal function, and signs of excessive inflammation.
This is typically in that first visit to know that initial consult, really dialing all the way back:
Have you always had sleep issues?
Was it just after starting a certain medication? And how long have you been on that medication?
Has the sleep issues been like oh, ever since I was a teen or ever since college, and really pinpointing if there were specific turning points in somebody's life, where that really started to contribute to a lot of the sleep issues?
And oftentimes, people don't really think about why do I have such bad sleep? Like what could be contributing to it? And when they read some of the checkoff list or some of the things that other people are doing, you really have to take a step back and really think about yourself like,
Am I staying up late?
Am I working, and not shutting off that boundary between work and rest?
What time am I eating dinner compared to what time am I actually sleeping?
What's running through my head at the time that I'm trying to fall asleep?
Do I really feel like I've put a lot of things on the back burner or am I wired and like bright eyed, bushy tailed that 11 PM because I just watched a drama show like This is Us, and I'm really torn up about what happened in that last episode.
Georgie Kovacs 08:32
I haven't watched it in a while. But yes, I can see that happening.
Dr Jaclyn Tolentino 08:38
Some people will choose to read, and then I also take into consideration, “What are you reading?” That really can propel some more thoughts rather than trying to calm your body down before you go to bed.
There's a book on trauma that I'm reading currently, it's called The Body Keeps the Score, recommended by a colleague. I really wanted to understand what the effects are over time and how that manifests. What I've learned about reading a book about trauma is that it's traumatic to read a book about trauma. So is that really the best thing that I should be reading before bed? Because then it has my brain thinking about the physiology of some of the things that these people are going through.
So there's just so many nuances, and over time, it could be layers and layers of things. It could be that the sleep issue had really been going on since college. But then a lot of the day-to-day habits haven't really been instilled. In order for somebody to really have consistent, good quality sleep that's restorative, maybe there is something physiologically that's contributing there.
And so part of uncovering it with just the basic labs is sometimes... we dig into specialty testing. Sometimes if I feel like I need to order diagnostics, I do, like sleep studies and so forth. Understanding it holistically versus just okay, you're having trouble sleeping here, let me give you this med, you really have to really take a look at the big picture to see exactly what's going on versus, “let me just give you this medication and see if that works.” That's just band aid. It's lots and lots of band-aids. Over the course of time, people think that that quick fix of getting used to taking the band-aids is the solution. Then they ask, “How do I get off of this medication? It has a slew of side effects, and I'm experiencing all of those, even though now I'm sleeping, but now I have 10 other problems?”
Georgie Kovacs 10:33
Let's talk about another symptom I see a lot is - anxiety is a big one, obviously, with COVID, and low sex drive. I'm curious what you're seeing as themes or is it, again, back to “it depends.”
I'd love for you to walk through when someone comes in with anxiety and maybe the low sex drive, which could be related. What you're seeing?
Dr Jaclyn Tolentino 11:12
Anxiety is a tricky one because every one of these symptoms is multifactorial, and so the causes are never just one cause. Usually, it's a combination of things or a layering of things.
Sometimes anxiety could just be from situational. And given this day and age with COVID, and what we're concerned about how we're internalizing some of these things, it really could be because of COVID. And the situation we're in with quarantine. I mean, who wouldn't be anxious at a time like this? It's also how our body is able to control some of the anxiety that we're experiencing, and whether or not we feel like we're able to continue our day to day and control some of that.
Honestly, Georgie I get a ton of patients that are experiencing anxiety that had not before. So they're not used to feeling these new sensations in their body because, prior to COVID, the anxiety was easily controllable. If there was a situation, they were able to handle it. Now, it's more like anxiety all of the time. It's almost like a blanket level of feeling nervous and anxious, just because of the situation that we're in, so all the more reason to really examine and really talk through with individuals about where it's coming from and exactly why they're experiencing it.
Are there certain triggers that are really adding fuel to the fire and making this worse? If we're anxious about things that we're hearing in the news, or what's happening politically, or what's happening with COVID, then adding fuel to the fire by opening up your phone and reading about it before you go to bed. Not a good idea.
I do see a lot of the anxiety and also the decreased sex drive because anxiety can also manifest hormonally and create a lot of problems with the hormones. We think of anxiety also being heavily tied to the cortisol and the adrenaline response that happens through the adrenal glands. So if somebody is super stressed out and anxious all of the time, that will manifest in the body. We feel it all the time. Humans feel it with a gut brain connection, cranial nerve from the brain that signals and innervates the diaphragm and the digestive tract. Sometimes that anxiety is manifesting in an upset stomach, nervous bellies, acid reflux, bloating, and so forth.
Sometimes it may be the hormonal connection. Say it has to do with the way that the cortisol is elevated a lot more than it should be. We're not having this resilience in the way that our body can respond to anxious or stressful situations. The next thing you know, it's affecting their thyroid, and that may also affect the way that their sex hormones are working, not quite working regularly.
It's so strange, but when it comes to decreased libido, you would think that it's like heavily tied to testosterone. Right? So women that have high levels of testosterone, maybe they have like increased libido, or way more libido, than women that have low levels of testosterone, for example. I don't always see that in the lab work. You'll have women that have rock bottom, low levels of testosterone, their body is not producing enough, whether that's through the ovaries or through the adrenal glands (we get a little bit of testosterone from there), and also helping to build up lean muscle mass and focusing on muscle strengthening, and they'll have really low levels of testosterone. But guess what? Their libido is on fire, through the roof. That's not an issue. Not at all. That's strange, because we've always associated high testosterone with high libido and low testosterone with low libido.
There's that tie also between anxiety and decreased libido, or some of these other factors are at play. But then it could be situational. It could be intimacy. It could be a relationship. All of those things also need to be discussed.
So that just goes to show you that it's not always just based off of the labs. You're also thinking about relationships, social intimacy, all of these other components that may also be contributing to some of those symptoms. Lab work, I find it to be, again, one tool in the toolbox. Just like medications are one tool, but I really like fleshing out the details.
There's a craft to it. Are you asking the right questions? Are the patients intuitive enough to really give you some of the answers and understand holistically what's happening?
Dr Jaclyn Tolentino 16:03
For women with hormonal conditions? That's a big one.
Were you having hormonal symptoms prior to getting on your birth control?
Prior to getting off the birth control?
What has a pattern been throughout your life?
Does your mom have certain conditions that may also have a genetic related like genetic predisposition to that may be part of your issue?
How long were you on birth control what other things could be contributing to poor hormonal regulation or function?
Maybe we're eating junk, not eating well, not sleeping well, really fatigued throughout the day, micronutrients are super depleted. The poor eating also created a lot of gut problems, and now you're having symptoms here.
It becomes super complex, which is why it's never just one answer. This takes time for people to understand and also for us to educate them so that they really know the depths of how complex it is and how you really have to focus on it holistically.
Georgie Kovacs 17:11
I've had two journeys, when it comes to chronic conditions - with fertility, and now my son with potty training. He's five and still not potty trained, and I'm racking my brain over how to solve this. He's been to specialists and to different hospitals. I live in New York City. You’d think it's the best at trying to solve it, but it has been an absolute nightmare. During my fertility journey, I almost feel like if I'm not the expert already trained in this specific thing, I struggle with evaluating how to know who a good clinician is.
What guidance would you give women as they're assessing their clinician and their care? Even if the right questions are asked, they may still not get the proper recommendations.
Dr Jaclyn Tolentino 18:43
I run into that a lot because patients are seeing multiple doctors and specialists to get some of their preventive testing done. I think you have to find a doctor who's open minded and willing to listen, because oftentimes, by the time they come to see me, they've seen many doctors, and they never felt like anyone was listening to them. They've consistently reiterated that they're having some of these symptoms, and the doctor says, “That it’s nothing to worry about. I don't think that that's contributing to your issue.”
But oftentimes too, you have to think about the doctor's training and whether or not they're open-minded. We are learning so much about the human body every single day. And so there is so much more learning to be done. Rather than, “Oh, I went to medical school, I did all my training, then I did it all in residency, and there isn't more than I need to learn.” I've never felt that way about medicine. I've always felt like we should do our best to advocate and keep up with the times and learn about these new modalities and learn about things that we may not have known before.
So sometimes, it could be that doctors can be narrow minded. Maybe they just have no knowledge about it, and that can be scary because, as a clinician, and seeing patients, for your doctor to say, “Look, I really don't know about that.” It’s hard to say that you don't know and you're the medical professional, but all the more reason for doctors to be as open minded as possible and work together.
At the end of the day, we're all trying to do the same thing. We're trying to make this person well, and not just well in the short term, but in order for them to be well for the rest of their life. I'm sure a lot of doctors think this way, that if it's something that I'm not sure of, I usually will say, “Look, I'm really not experienced with that, but I'm going to look it up, and I'm going to do my research my due diligence and get back to you.”
One thing I love about the practice that I'm in is that if it's something that I don't know, or I'm not experienced with, I have a beehive of like more than 30 functional integrative doctors who are board certified and have all gone through their own journey as to the reason why they've chosen to work for Parsley and practice this kind of medicine - an integrative model. So in my eyes, our doctors have this added lens. It's never like we've never gone back to the grassroots of family practice and me knowing how to diagnose and treat conditions with medications if needed. It's really about how you can expand and open your mind to see that there's other possibilities for ways to support and treat people that are really looking to heal.
And it's not a short term fix. It's really like over the scope of time that really some of these things evolve. And as I'm sure you know, in your own healing journey, as is mine, it was never a quick fix. Even though in my head, I thought that was the answer.
Once I got sick, and really took a step back, I realized that there were so many things involved. And it wasn't just that I needed one medication, or I just needed one supplement. It was the foundation of my body that just needed so much work. That included mental health, stress relief, work life balance. Under the lens of those, that blanket of baseline labs, it also included:
How is my body holding on to toxins?
Am I detoxifying well or am I like recirculating some of these toxins back in?
What is my gut microbiome doing?
How are my cells working? Do my cells actually work really well? Are they efficient and working well or not.
I'm a breast cancer patient myself, and these we're not working well.
Getting that into better shape and figuring these things out, you realize that some of these underlying things like systemic inflammation, oxidative stress throughout the body, microbiome and balance, it's dependent on nutrients. It's dependent on stress. It's dependent on what kinds of foods I was eating. It's dependent on how I lived my day to day and what kind of environmental toxins were around me that my body wasn't able to get rid of that was, instead, harboring in my tissues.
To really understand that aspect of it, you need a doctor who is patient with you. Because we also have to be patient with patients, they're coming from so many different levels of education. Some really want you to explain things thoroughly, you need time, and you need a doctor who is open minded, who's really willing to listen to you and who's open minded about teaching you what you need to know, to really establish the best foundation for your body to move forward with. It's not easy to find that.
Thankfully, like I've joined the group where I feel like our doctors, that's our number one goal. And that means working with their primary doctors working with their specialists, and working together if we have to make phone calls so that we really feel like we're collaborating and on the same page, we really are. I would encourage all doctors out there to really have that open mind about healing and how some things we can't explain. There are some people, where they've gone through so much in their life and from a healing process, you might not be able to pinpoint exactly what the mechanism was. It may be that, holistically, they just did so much to revamp everything going on in their body and all of that synergistically created better health and better health outcomes.
Georgie Kovacs 24:37
One thing I would like to add is in my own journey specifically now with my son I took him to a specialist that I never even considered. It's a pediatric acupuncturist, I will tell you in this very long journey of potty training, I felt so different there. He made no promises. He said, “Give me eight weeks, weekly visits.” That first appointment, he gave me an action plan that didn't involve the typical “take Miralax and Exlax as if you're an adult.” It was a different plan. He said, “I'm not saying I'm going to cure him. You may still need to do the expensive diagnostic testing, but you probably don't need to rush because I have found enough that we can work with to see what potential next steps are.”
Like you said, he admitted he's not going to change the world. He acknowledged what he is knowledgeable about, and I felt that he would tell me what's next. My son let him do anything! The doctor was able to poke and prod him without complaint. It was just the most amazing appointment.
One thing I would say to women listening is, when you feel that, that's also when you know, because we do have our instincts, and we just have to create that space to listen to them. And I will tell you, with that appointment, I now know that when I feel this way, I'm at the right place. When I don't, I have to find another doctor.
Dr Jaclyn Tolentino 26:04
And the same thing goes for me. Look, I'm a patient myself. You really have to establish that trust, if you feel like there's something off or the energy isn't there, or it's just not the right fit, then keep looking. Be hopeful. You will find somebody that you click well with that is working synergistically with you; who you really feel on the same page with; who's going to collaborate with you.
Sometimes I think people have the wrong idea that doctors are up here and patients are down below. The model is shifting. We're actually on the same page trying to work together. The patient has all of the answers for me. You're telling me all of your symptoms. You're telling me how frequent you're having it. You're telling me your life story.
This is really like a team effort, a collaboration. The added layer that we've added at Parsley is to also include health coaching. That is such an important thing to help support patients all along that journey. Physiologically, I'm able to explain and spend time explaining what's happening to patients, helping them diagnose working through specialty tests, interpreting what I see from a data perspective.
When it comes to all of the lifestyle changes, consistency is key, and having a health coach to add that layer of care. This is why our team approach is really the wave of the future. So it's not just that you forget what your doctor had said, and you just forget it and move on to the next three months until your next appointment. But you're actually implementing a lot of those strategies consistently, and so health coaching is really great for that. I love our girls for that.
Georgie Kovacs 27:39
Tell us more about Parsley Health and how in your journey you made transformations and developed learnings. I know it also led you to the work that you're doing today.
Dr Jaclyn Tolentino 28:01
We're a functional integrative medicine practice. I personally practice in Los Angeles, and I see patients virtually in California and Florida. And right now Parsley is located in 45 of the 50 states. So we have doctors across the country that are also seeing patients with this whole person, holistic perspective that's really focused on prevention and whole body wellness.
We’ve got health coaching support doctors that have this added lens to really take a look deeper when it comes to somebody's health, looking at root causes of disease, the how and the why. So really more on the physiology and the mechanism of action as to why people have certain disease states, whether that's PCOS or endometriosis or whatever the case may be. Maybe it has to do with their headaches, maybe there's other diseases like even cancer prevention and support. We combine the cutting edge diagnostic tools, doctors and health coaches to support our patients with this really personalized holistic care.
We're able to see patients virtually across the country now. And we have different models and different types of services that we offer from a short program model, which is roughly around four months of really getting a baseline peek into one specific condition that a person is trying to understand better, to complete care models where patients see us year over year to really help maintain and manage their health. They focus more on the preventative model about what could happen or what can happen in the future and how you can lay down the best foundation for your body to establish itself and keep propelling forward.
I specialize in hormone optimization. Hormones were my first love. The reason why I felt it was so important was because no matter what stage a person was in in their life cycle, no matter what age, whether they were teenagers getting to know their body, trying to understand their physiology about what their hormones were doing, versus their 20s and 30s, or even fertility journey, or even when it comes to menopause. What exactly is my body doing now, and why is this happening? I felt that no matter what age somebody who is going to be dealing with these hormonal issues.
Little did I know that that was really one piece into the model of integrative and functional medicine care, because we don't just focus on hormones and functional medicine. We're looking at stress responses. We're looking at what's happening with oxidative stress in the body. We're looking at inflammation and what the immune system is doing. I've kind of just continued to gravitate through it, especially as I’m going through my own hormonal changes and the way that breast cancer really affected that.
I was originally diagnosed back in 2016, and I didn't get into integrative and functional medicine until after my diagnosis. I went through traditional routes to help to support my disease state with cancer and what I was going through, but then I wanted to do exactly that. I laid down the foundation for my life so that it wouldn't happen again, and in order to do that, you really have to take a look at everything deeper, not just that surface level of looking at the basic blood work, like physiologically, what wasn't working well in my body at the time that I was diagnosed.
The more research that I did, it really led me down to the functional medicine path. It's not like I ever forgot about the general Family Medicine care. It's very much rooted in the way that I practice today. It's just learning so much more. When you think about cellular health and mitochondria. What's going on from a DNA perspective. Trying to understand how my genes played a role there. What was my estrogen metabolism? What was my liver and my gut microbiome doing? And on top of that, how is I living at the time that I was diagnosed.
Hindsight is always 20/20, right? You look back and you're like, “I thought I was healthy.” I thought I was living the way that I was supposed to live. Oh, no! I ate horribly. I had work life balance issues. I was sleeping horribly and waking up feeling super stressed. I felt like my hormones were out of whack. I was on birth control for so many years. What impact did that have on the course of 15 years on my health and depletion of certain micronutrients? Was my thyroid up and running and working well? My metabolism was really slowed down, and I was having some constipation and the weight gain. I was eating horribly. So a lot of that journey for me.
I think for a lot of practitioners that really look to a functional integrative model really came from their own health experience. I had been in my early 30s, never sick, never hospitalized, never saw doctors except to have my annual checkups. And then all of a sudden you’re hit with breast cancer, and you're making a decision within months to do a double mastectomy. It was a lot to take in. And really looking at the why was so important for me, because I didn't want to be one of those women who just listen to what people said.
The doctors told me that the cancer is gone. I'm feeling okay, I'm recovering, I can go back to living my life. If you go back to living that life, that life with such poor foundation, you're going to find yourself back in the same position. And my mom has had breast cancer twice. She had it 20 years apart. I didn't want to be put in that position. And so for me, it was so so important that I really swallow my pride, look back at how that life was at the time that I was diagnosed, and look at everything that was happening. And that meant doing additional testing so that I could understand my body better. And then that's why the trajectory of my family medicine career really just propelled itself more to functional medicine because of that feeling like I was giving patients enough to really get to know somebody in this capacity. You have to have time to do that to dedicate to each individual patient to do so.
Georgie Kovacs 34:31
Yeah, no, it is unfortunate that with the way doctors are reimbursed today from the traditional medicine perspective and how that impacts the time that they're able to dedicate to patients. It is frustrating because I have found that the ones I've been able to work with that have the time and dedication - it's out of pocket, out of network, cash paying. It's really frustrating and the way I just dealt with it is I feel a heck of a lot better than I ever have. I have a lot more awareness about my body.
All the different specialties or practitioner types serve different purposes, and I think we just have to keep creating awareness about that so that people can do right by their own health.
Dr Jaclyn Tolentino 35:21
Agree. I have some specialist colleagues, and they'll send patients to see me specifically for certain things that they're trying to deal with. I'll ask them why, and they'll say, “Because you have a lot of time that you can dedicate to really getting to know the full picture. I'm a specialist in this particular instance, whether it's GYN or urology, or whatever the case may be, and they feel like there's still limitations.
And we all do.
As doctors, there's always limitations. We're all always learning. Giving the time to just focus on the full picture versus just focused on one sliver of what's happening, in my opinion, I feel like that is a better model. And that's why I've chosen to practice it and really dedicate the rest of my career to practicing this way versus really just this narrow model of 15 minute appointments.
Georgie Kovacs 36:45
So if you were to give women one bit of advice, would you say to them?
Dr Jaclyn Tolentino 37:05
I want them to learn as much as possible, and never give up hope and have an open mind. As frustrated as you feel for some of the symptoms that you're experiencing, there are people out there that are really looking forward to helping you. And making those connections and listening to podcasts like this one, Georgie. You have so many resources that you've really provided for so many women, to be able to educate themselves with trusted practitioners, where they're really going to get to the depth and the root cause of what exactly is going on.
It's never been that we should just put a bandaid on. That's unfortunately the way that it has been, but that's not really where we want to go with health. If you want to really establish better foundations within an individual's body, they have to learn about their body. And they have to understand that these symptoms, if you are experiencing any sort of symptom, your body is talking to you and is telling you that there is something wrong. This doesn't seem right. If you're having frequent symptoms, learning and educating yourself on what those things could be, and finding trusted practitioners to really help you navigate the waters of the depths of what you need to know about yourself.
We're here. We're ready. We're looking forward to it. This is what so many of us have dedicated our careers to. And it's again, like you said, not bashing one type of medicine or another all types of medicine have a place, but for those that are really having these debilitating issues that they haven't felt like they found the answers to, there are doctors that are willing to listen to you. You may not have connected with them yet, but you can and you will.
And part of that really does imply that this is a team effort that patients have to understand and learn about their physiology. Know that there are warning signs. If you're having irregular cycles, if you're having any type of symptom that is having this frequency and severity, and you want to know why that is, you want to see doctors who also have the philosophy of understanding the why. Seeing doctors that really align with your philosophy and your beliefs, you will find us. We are out here.
Georgie Kovacs 39:20
That's wonderful. And I always enjoy connecting with you. It's always a soothing conversation and I certainly feel taken care of. So thank you for your time. And again, I'm sorry for the battle that you had with breast cancer, but look at the good that you're doing for yourself and your long term health as well as all the people that you're helping. So thank you for doing something with that journey.
Learn more about your Hormones and Menstrual Cycle.