Almost everyone arrives with one of these — and almost nobody arrives with the right name for it. Find yourself below, then look at what I'd actually test.
"My thyroid is normal. I have every symptom of a thyroid problem."
TSH is in range. Your thyroid is fine. See you next year. Possibly a prescription for the fatigue or the mood.
TSH · Free T4 · Free T3 · Reverse T3 · TPO antibodies · Tg antibodies · Ferritin · Morning cortisol
Why it gets missed: a lone TSH can't see whether you're converting T4 into usable T3, can't see antibodies, and can't see the iron and cortisol that drive the conversion in the first place.
"I think I'm in perimenopause and nobody will engage with it."
You're too young. Your levels are normal for your age. It's just a phase. Here's something for the mood and the sleep.
Estradiol · Progesterone · Total & free testosterone · DHEA-S · Pregnenolone · Free T3 · Morning cortisol · Ferritin
Why it gets missed: "normal for your age" is a statement about other women, not about you. And where hormone therapy is genuinely indicated, I prescribe bioidentical hormones — with full informed consent and proper monitoring, which is the part that's usually missing.
"I'm exhausted all day and then I can't sleep at night."
It's stress. Try melatonin. Have you tried yoga. Everyone's tired — you have young kids / a job / a life.
Morning cortisol · DHEA-S · Pregnenolone · Salivary adrenal panel where indicated · Free T3 · Reverse T3 · Ferritin · Vitamin D · B12
Why it gets missed: "tired but wired" is a specific, measurable pattern — not a personality trait. Nothing on a standard panel is designed to find it.
"I've done everything right and the weight will not move."
Eat less, move more. Your glucose is fine. Maybe you're not tracking accurately.
HbA1c · Fasting glucose · Fasting insulin · Free T3 · Morning cortisol · Estradiol · Free testosterone
Why it gets missed: almost nobody runs fasting insulin. Glucose is what happens after your body has already been compensating for years — insulin is what shows you the compensating.
"My cholesterol is fine, but heart disease runs in my family."
Your lipid panel looks good. Keep doing what you're doing. We'll check again next year.
Apo-B · Lp(a) · Oxidized LDL · hs-CRP · Homocysteine · Fasting insulin · Free T3
Why it gets missed: a great many heart attacks happen in people whose standard cholesterol panel looked fine. A standard panel counts the cholesterol; it doesn't count the particles carrying it, and it can't see inflammation at all.
"Something is wrong with my gut and nobody can tell me what."
It's IBS. Try more fiber. It's probably stress. Cut out gluten and see how you feel.
Comprehensive stool analysis · Ferritin · B12 · Folate · Magnesium RBC · Vitamin D · hs-CRP
Why it gets missed: a gut that isn't absorbing properly shows up as everything except a gut problem — the fatigue, the hair, the immunity. (Stool analysis isn't covered by insurance and is billed separately — I'll always tell you the cost first.)
Go back and look at the gold. Thyroid conversion. Cortisol. Ferritin. Sex hormones. They turn up in nearly every one of those six lists — and that isn't padding.
It's because they are one system. Pull on any of them and the others move. Low iron impairs your thyroid. Impaired thyroid slows your metabolism and your gut. A slow gut absorbs less iron. Cortisol sits on top of all of it. None of that is exotic — it's just physiology that nobody has time to trace in twelve minutes.
So conventional medicine sends you to six specialists, each of whom sees one-sixth of you and none of whom talks to the others. You end up with six opinions, six prescriptions, and the same symptoms.
This is the alternative: one clinician looking at all of it at once — because the answer is almost always sitting in how they interact, not in any one of them.
I don't know what's happening in your body, and neither does any website. Everything above describes where I'd start looking and why — general patterns, not a diagnosis, and not a prediction about you.
Your biochemistry is yours. Two women with identical symptoms routinely turn out to have entirely different things driving them, which is the whole reason the workup exists and the whole reason I won't guess from a symptom list. The only honest way to know is to look.
And if what you need isn't something I can help with — or needs someone with hands on you — I'll tell you that on the call, not three months in.
A free 20-page preview of the Comprehensive Wellness Lab Guide: what these markers actually measure, and what optimal looks like — for results you already have from your own physician.