How Total Weight Care Can UpLevel Your Fertility Journey with Dr. Catherine H. Toomer

If weight concerns on the fertility journey are taking up your mental space, do not miss this episode.

Dr. Toomer generously shares her own journey of navigating type 2 diabetes, an elevated BMI, and a potentially fatal diagnosis of heart failure early in her career.  She discusses how being an early adopter of a GLP-1 literally saved her life. She gives an overview of GLP1’s and shares her thoughts about when a patient with fertility struggles could consider starting one.

Even if you have not struggled with weight, this episode highlights many of the less talked about aspects of the fertility journey: stigma, unsupportive family members, and shame.

May this episode be a conversation started for many more impactful conversations!

Guest Links

Website: https://drtoomer.com

Youtube: https://youtube.com/@drtoomer 

TikTok: https://tiktok.com/@drtoomertalks 

Facebook: https://facebook.com/drtoomer 

As always, please keep in mind that this is my perspective and nothing in this podcast is medical advice.

If you found this conversation valuable, book a consult call with me using this link:

https://calendly.com/loveandsciencefertility/discovery-call

Also, be sure to check out our website: loveandsciencefertility.com

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Please don’t let infertility have the final word. We are here to take the burden from you so that you can achieve your goal of building your family with confidence and compassion. I’m rooting for you always.

In Gratitude,
Dr. Erica Bove

Transcript:

Hello, my loves, and welcome back to the Love and Science podcast. I have an esteemed guest today, a regal guest. Her name is Dr. Catherine H. Toomer. She is a colleague and a friend, and she is just an amazing human. I will share her bio. She is so much more than her bio, and I think you'll find that out very quickly. So here we go. Dr. Catherine Toomer is a family medicine and community health physician. She is the founder of Total Weight Care Institute. She's the host of the Dr. Toomer talk show, which is excellent, by the way, if you've not listened.

She is also a TEDx and keynote speaker, a certified hypnotherapist, an executive health coach, and a first creator. Now I did some digging, and on her website, she also has this beautiful aspect of her bio where she also admits that just to write words does not really capture the essence of who she is.

Words always have limitations, but she continues to say, "I'm a musician who hears life in chords and seeks to retune any note off key. I'm an artist who sees the world in color, moved to transform anything dull to vibrance. I'm a thinker who gets excited by taking complex problems and making them simple. I am a wife, mother, daughter, sister, friend, who is driven to create, grow, and maintain what connects us." And so I think that is really, really the sort of the vibration that we have as we go into this conversation today, and Dr. Tumor, it's just so lovely to have you.

Thank you. Thank you. Absolutely. And today we're going to be talking- And if you see me getting a little emotional because you just read that, that actually came from a letter my daughter wrote to me her first year as a freshman when she first left home, and she was like, "I've been thinking a lot about you and dad, and this is what I think of you," and she wrote that. Oh, wow. And so that's why I was like, "Now I'm getting all emotional because I think she had written it, and now I'm thinking about my daughter who's now 26 and an advocate and a policy." She's actually the national manager of policy and advocacy for a nonprofit. And she wrote that when she was like her first month of college. Wow. So that's why- Oh, wow. I forgot about that. Well, I had so much fun. I truly had so much fun because I know you as a human, and then when we meet people in these contexts, we can do some research and just sort of understand what's out there, and I had so much fun cruising your content, and that was on your website. And so I always say, "This is the same space. It's so great to have you here." Well, this is another aspect of me. I cry easily, I anger slowly.

That's a beautiful thing. And I will say, I mean, I hate people who know me. I did not cry for six years during training. Six years in a busy OB/GYN residency where we had maternal deaths, we had a fetal and neonatal death. I mean, there was so much going on and so much trauma all the time.

And I thought, "How in the world did I not cry for six years?" And so even though people here know, I really don't enjoy crying. When I cry, I'm like, "This is a sign of strength because I can access my emotions." That's what it's all about. So thank you so much for- It's funny because I rarely cry from sadness, but I mean, I can watch a commercial and start tearing up. That's just- Right, if you happen to be moved, right? To be moved.

I get very emotional about a lot of things, but- Yeah. And my listeners, I mean, my listeners, what did you say, Dr. Toomer?

I said, "It's usually soft stuff that makes me cry." That's right. Me too. I know, even yesterday and the day before, I think that would be.

But what I will say is, my listeners are mostly female physicians with infertility.

And I think the more people have a story, the more, I say in air quotes, street cred, we have because we aren't just saying, "Okay, this is what you should do. This is what is good for you." But it's saying, "I have lived the hard. These are my insights out of the hard. And how can we share our collective wisdom to help each other across?" There is no sparing the hard stuff in this life, right? There's just no sparing it. But I firmly believe if we can learn how to suffer well, if we can learn to share our stories in community, it just makes it so much better to be human, as I like to say. So, yeah. So that's the introduction. And I think, like I said, we're going to get into it. So this company that you've created in terms of the total weight care, tell me what that means and tell me why you do the work that you do.

Okay. Total weight care essentially means that it takes care of anything that weighs a person down.

It can be weighed in pounds. It can be whatever in life is weighing them down. It could be just the weight of the world, the weight of whatever. And so we care for that. And that because we take care of the whole person. So it's a biopsychosocial approach. So therefore, all things are interconnected.

And so you can't leave any part out. So it's total, the total person. And then it's an institute in that it is not just one thing. There's lots of different components that address each and every part of who the person is. And depending on what they need, I'm a firm believer in adjusting care to the person. And so I make sure that there's lots of different components so we can make interchangeable parts. So I kind of say it's like kind of like a recipe and you have all these ingredients and you just don't know how many of those ingredients each stew is going to make to sustain that person. And so that's essentially what total weight care Institute is. That's beautiful.

I had not made that connection. And I think, you know, when I meet my clients, when I meet my patients who are struggling with infertility, that is such a tremendous weight and even a threat that, you know, somebody might remain childless, they might not be able to build their family.

And then it creeps into shame and affects other aspects of life. And so I think, and even the physical weight tends to creep on during the fertility process too. And so we can talk about the two, but total weight care, just this unburdening of all of life. I think that is so beautiful.

So tell us, so you pivoted from a career in family medicine in the traditional sense to, you know, working in this concept where you, in this, in this different context where you could really help people in the way that you knew best. So tell us a little bit about that, that pivot in your life. Okay. Well, it started because I had a pregnancy complication. Actually, I went into congestive heart failure a month after my last daughter was born. And at the time, I was given a 50% chance of living five years. I had a toddler and a newborn, and I had only been in practice right out of residency by a year and a half. And was just basically told, you can't practice anymore.

You know, it's like you, my whole world shifted from, you know, career building, family building to trying to stay alive. And so I focused. So what I did is I just took all the parts of my brain that I could and focused on the problem so that I didn't focus on what, what could happen. And I just started problem solving. That's my safe space. They give me a problem and I'll start planning. And that's where I kind of how I cope. And so I had a problem. I started planning. And that planning turned into a program for myself to stay alive. And then when I was able to go back into medicine, nine years later, I use that to help my patients. And it worked. At that time, I, the time I got ill, I was an insulin dependent diabetic, I was more than a hundred pounds overweight. And I had congestive heart failure. And so nine years later, when I was out of that five year, you know, scare time, I did come off insulin. I lost, I dropped about 100 pounds. Initially 60 stayed there for a few years, then dropped another 20 stayed there for each few years and dropped another 25. So total of over 100. And then took that program, applied it, but I found that when working for other people, I had a hard time having the time I needed to really sit with patients and listen. I've often said that, you know, when as physicians, when we really want to understand what's going on, we're not listening to what's said, we're listening to the whispers behind the words. And so I couldn't do that working for someone else. And so I just started working for myself. I opened my own practice. That's so beautiful. How long ago is that?

That was eight years ago. I opened officially, you know, my, my business officially started in 2016. I opened my doors to patients and January of 2017. Wow. You know, as, as you're talking, Dr. Toomer, it sounds very familiar to me because that's a, that was a big motivation for me to create love and science because I felt despite my best efforts in the clinical setting, that something was missing, was missing. And, you know, I would go through the, I don't want to say spiel because it's not a spiel. It's individualized, very patient that, you know, these are your options.

This is your diagnosis. This is what I think is best for you. And it was like deer in headlights, you know, and I'm like, okay, what am I missing? What, what, what am I not providing for this person to be able to get them to have making power choices, to really hear what's not being said.

And it was really the coaching tools and the time, right? That, that really enabled me to do that.

So I don't know. I just, I love hearing your story because it just, it reminds me, yes, yes, yes.

Like this is why we would do, we do what we do to be able to heal in the, in the most full sense possible. So, so tell me, are there any misconceptions for the work that you do? Like are there, I mean, there's always naysayers. I, I firmly believe when there's naysayers, you know, you're doing something right. Cause you know, you gotta be a little controversial. But what are some misconceptions about the work that you do? Well, kind of in understanding the, the, the misconceptions, we have to also understand the social construct around weight. The problem we run into is that being in a larger body, being overweight, being obese, unfortunately, it's, it's, it's an acceptable bias and prejudice to still have being the butt of jokes, being the, the, the, you know, being blamed, being shamed is very acceptable. It's one of the most acceptable forms of prejudice we still experience. And so when talking about weight loss, a lot of that, those feelings are, are imposed on the process. And so the process is treated as a superficial, it's treated as if it's vanity is treated as if, you know, it has only to do with how someone looks and how they want to look and not that it's truly a health process. Even if societally, and we've been ingrained to say, okay, I'm doing this because I want to look a certain way.

Ultimately, what happens is we start feeling better and that becomes the focus. And so health becomes the focus. When it is never, when it does not become the focus, however, the maladaptive diet culture things that happen provide enough for people to still latch on to their prejudice because they can point to say that's what's really what you're trying to do.

When most of the people who are trying to get healthy and trying to lose weight in a healthy way are not of that ilk. And it's just hard to separate them. So often with, and I suffered from this as well. I didn't want to be known as a weight loss doctor, because I too was like, you know, that's so superficial, it's just about vanity. And I don't want to just attract people who only want to get skinny. I want this to be about health. But then I realized that because of the way we've been ingrained socially, a lot of the problems we feel we have we tie to our weight. So in order for me to help people get over the other issues, their health and wellness issues, I knew that they were assigning their problems to their weight. So if I offered weight loss, I could get at the real problem. And that's what I do. That's fascinating. That's beautiful. I find that too in the fertility space too, I say fertility is just the access point, you think it's about fertility, but it's about so much more than that. And so I think that it's really important to believe in the work that we do and to understand what that context is. So that when the hard days come, when there's naysayers, when even like you talk about in some of your content, like those seeds of self-doubt, if there's ever a seed of self-doubt, it's like, no, no, I've already worked this out, not going there. I love it. And so it's clear to me why you do the work that you do. And I love that you're changing communities, not just individuals, you're really changing communities, which is so beautiful.

I love to get into some of the information that we have and maybe don't have about the GLP ones. And like what we know, what we don't know, PCOS insulin resistance, like when people come to see me, like I said, my female physicians, they're like, listen, I wish I had paid more attention in medical school because I feel like I know nothing about this fertility stuff. And I say, don't worry, you paid as much as attention as you could, but like all the changes that happened in the last, you know, like there's been, even if you had paid attention, you wouldn't even know because these things didn't exist. So can you catch us up on the last five, 10 years, which is at least my perspective on these meds, maybe it's longer.

In terms of like, what does the person undergoing a fertility journey who may or may not struggle with their weight, may or may not struggle with type 2 diabetes, what do they need to know about these medications to be swimming in the water? Okay. So they're all inter our hormonal and metabolic processes are all interconnected. So you fix one, you automatically start fixing the others.

And so what we started saying, I've been actually been using GLP one medications for over 15 years.

They're, they've been out, they've been on the market for, you know, more than 20, about 20 years.

And so, and when I was using them initially, it was for diabetes. I started noticing that my diabetic patients were dropping weight. This was when we had Victosa, we had we've had others earlier, but I started with Victosa. And so I started noticing that my diabetic patients were losing weight.

I started, I knew my own weight loss was because I got my diabetes under control. So I knew the metabolic connection even before it became widely known. And so I started prescribing medication off label for my patients who were not quite diabetic, but were on their way, I could tell from their blood tests that they were on their way there. So I started treating them before they became diabetic and we prevented it. That then apparently, so many other doctors were doing the same thing.

And so it became a six end of Victosa then became, you know, FDA approved for weight management and became six under. But what we also noticed is that many of my patients who were having, were struggling with infertility. And we're just like, you know what, I, this is a struggle. I'm going to set this aside and just focus on my health. And so we focused on their health. And part of that was weight loss. And as their weight came down, their actually wasn't even their weight came down. Their metabolic dysregulation was corrected. Then their weight would come down and their fertility would go up. Now that's kind of widely known. They keep calling people, you know, ozimpic babies when really it's not that it's just that people's chronic metabolic conditions are being corrected. And that was the thing that was causing the problem. And so, you know, we see this in polycystic ovary syndrome. We've known this with polycystic ovary syndrome, for some reason, people never extrapolated out to the rest of the population.

And so funny, because it's 10 to 15% of women of reproductive age have PCOIs. So we're talking about a huge number of people with this. Exactly. Yeah, exactly. And so, and so with the GLP1 use, and then I was put actually put on a GLP1 as a diabetic because once a diabetic, always a diabetic, even though no longer on insulin, I was still diabetic. Sure. But actually, I was put on it to help protect my ejection fraction, my heart status. It's fast. Cardiologists have known for a very long time that GLP1 actually helped cardiovascular health. Wow. So I was put on big toes to help my heart. And my weight started dropping more. Interesting. And we thought, you know, and that was again, another indication that this is something more than just, you know, a weight loss medication. And then when ozimpic came out, that's when all the attention came.

Because ozimpic was a lot more effective in all that it did, including weight loss. What people don't seem to understand weight loss is just the side effect of the medication. The medication actually works on the brain. It works on metabolic systems. It works on the small part of it works on the mechanics of food digestion. But that's only the small part of it. And that's the small part that anyone can benefit from. So you might see someone who doesn't have a chronic metabolic disease, who still might lose weight on it, but it's only a small amount. When you're talking about 50, 60, 100, 200, I've had people who I know have lost over 400 pounds with the medication, it has to be an underlying disease being treated. And so ozimpic was better at treating that disease.

And then we got wagobi. And then manjaro, which is the diabetes version. And then zepboundar even more. And then there's another coming because you know, once people get money on one, they're going to figure out coming up with new ones. And so there's actually even better meds coming. Wow, that's really encouraging. So you were one of the pioneers actually, before it was the fad, you know, to then you were seeing this in your in your patients with infertility as well, which I think is really amazing. I was crazy. Honestly, I'm sure I was working in rural, I still live in South Carolina, I was working in rural South Carolina, where we were the only primary care physicians in the whole in like the whole county, pretty much. And so we were it. And so as patients needed help, we couldn't refer. I see there wasn't anyone so we had to learn what patients needed and then offer that service. And when with GLP once a lot of the disease processes that we were seeing were being treated, you know, autoimmune inflammation was suddenly stopped. And we're, you know, metabolic issues that were causing all sorts of problems, you know, quickening dementia, started slowing. Infertility, which you see, was suddenly being, you know, addressed, you know, weight gain, just so many different things that are also interconnected. And then you start talking about the psychosocial benefits of, you know, self esteem changing, their depression dropping, their anxiety being addressed there. And of course, you know, then there's relationship things that start shifting. And so it really just why just watch this positive snowball happen in people's lives. And so it makes me sad that there's such a stigma around them because once diet culture got ahold of it, they kind of tainted the good that it does.

Right. And I've heard you talk about it as a tool. Like I love your analogy. You know, I heard you say, like, could you wash your clothes in a bucket? Absolutely. But if we have a washing machine, why would we not use the washing machine? And that just, that makes so much sense to my brain is like, we have this tool, you know, why don't we use it? And I will say, I have been doing this work exclusively for like graduated my fellowship about a decade ago. Right. And so the problem is getting worse. Like PCOS is not the same PCOS that I saw 10 years ago. It's getting worse. It's there is more insulin resistance. There's more oral medication resistance. I can't just give somebody let us all and have them ovulate. Like it doesn't work that way. Always.

You know, I had this huge population of people, no matter what we do, chlamyphine, let us all combined, you know, there's this resistance that's existing and it's like, how frustrating for not just me, but for the patient who's going traveling again, rural Vermont, like traveling to these appointments, missing work to all to find out, Oh, you didn't ovulate on this medication. You need more time. You need something else. You know, I see people who IVF, you know, even IVF, we say, Oh, you know, don't worry. And I'm cautious not to create this message, but it's out there. Oh, don't worry. If you can't get pregnant any other way, don't worry. IVF is going to help you.

Well, guess what? IVF does not help everybody. There's the same thing. There's resistance to those medications. There's anesthesiologists have BMI cutoffs and it's all kind of part of the same thing. If you're somebody who does live in a larger body, sometimes people do need to, they're not even candidates for IVF, which is, you know, its own particular problem. And so, you know, I think from that perspective, tell me how you today in 2025, how do you approach people who you see in your practice who have infertility are on the fence about that? Maybe they have that stigma in their brain somewhere. Like who's a good candidate, who's not a good candidate, and how do you approach that conversation? So you mean a candidate for a GOP one? Yeah, specifically.

Um, there are very few people who are not candidates.

The, um, the adverse reactions that we see on the box that scares everybody away from medications clearly have never read the adverse reaction of Tylenol before taking a breath.

Good point. Because every single medication put out by the FDA has said there's a list of things that could possibly happen. True. And most of us do not read them. And for some reason, when it comes to GOP ones, we all know them. And mostly because they have been weaponized.

They've been weaponized by the same people who didn't have GOP ones before, but were weaponizing the fact that you were in a larger body. People are always going to weaponize their prejudices. And that's just what they've done with these medications. And so, um, and, and so what I tell people is the benefits greatly outweigh the risks. I also tell people, um, you know, I find that, you know, we often were told in med school, don't talk about your personal stuff.

I find that ridiculous because the bottom line is I can't create a rapport with my patients with, by hiding. So often by sharing my story, I help people get to the point where they understand.

So people are like, well, I'm scared of the long-term effect of these medications. One, they're designed for long-term effect lifelong to I've been on a GOP one for 14 years.

I'm 60 years old, beautiful, obviously. And it saved my life actually. Um, so I'm, I'm obviously an advocate for a reason. Um, and then, um, once people are on them, I don't have to convince anyone because I mean, it's a slow process. As long as they ignore the TikTok stories that are unrealistic, some of them not true and, and, and, and made up or embellished. Um, if they understand that this is a slow and gradual process to reach the maximum health benefits of the medication, and when you reach those and really part of that is learning your body's cues and recognizing them for what they are. Once you get there, it is so obvious. It is like there's this golden spot.

And I always know when people reach that spot, because I get letters saying, thank you.

I have, I did not realize how badly I was feeling. I didn't realize that this was considered normal.

I didn't realize that this was a way I could feel ever in my life. How did I go 50 years not knowing that I could feel like this? I mean, I just letters after letter after letter. And I just, um, and so usually I share those stories in order to help people understand that, you know, this is not, I don't gain from the pharmaceutical companies. That's another misconception that some people get paid when we write prescriptions. We don't. In fact, it's illegal. Um, and so, um, so that's what I do. I just kind of really, I'm very patient. One, no judgment. Mm-hmm.

You know, we've been blamed and shamed and, and, and, and the fear tactics are intentional.

So when people say I'm scared, I don't get frustrated because I understand exactly.

All of us are scared by things that we don't know. And especially when we have people who are feeding us, you know, things to it, particularly, you know, exactly why they're feeding it to us is to make us scared. So I do understand that. And I just, I'm just very patient and I don't, and I just take time.

And that's another reason why I had to have my own practice. Cause I needed that time in order to really help people understand how something can benefit them and then give them time to process it. So, you know, sometimes they may take three, four times to hear the same thing before they're like, okay, I'm ready. Yeah. That makes total sense. I think one of the hard parts in our field right now is we don't have enough data. You know, it's like, you know, take this medication, but dear God, please do not conceive while you're on this medication. And we're just, you know, like you said, like what's happening is, is it's changing the metabolism people are doing, you know, they're starting to ovulate regularly. If they have a partner at home with normal sperm, then guess what, you know, we are seeing so many people come in and, you know, interestingly, the preliminary data actually looked pretty reassuring. You know, I did a PubMed search just before we hopped on just to make sure I wasn't missing anything, but you know, it's really, they even did like, it was a, it was a retrospective cohort study, of course.

So there's limitations to that, but they looked at, you know, people who had type two diabetes and happened to conceive while on these men, and they looked at not just GLP ones, they looked at insulin and that was sort of the reference point. They looked at, you know, all the other different categories of medications and the GLP ones, and they looked at the outcome was major congenital anomalies, right? Because that's what people are really most concerned about. Is it tereogenic?

And they found that there was a 0.95 relative risk of being on the GLP one. So clearly not an increase, you know, and these were like, you know, millions of people in this population study. And so, and I've seen a lot of people come in, you know, of course it's always like, well, do we really need to pause the medication for two months before? Because that's when, in my world, my, you know, people wanted to be pregnant, like not just yesterday, like five years ago. And so if I meet somebody in my office and I say, Hey, you know, tell me about your weight journey. And I love to start there because it's usually been a journey for most people. And I'd love to know what they've tried, what, what, you know, what's, you know, worked, what hasn't worked, what their challenges have been, because I see the two as so interconnected. We really can't separate the two.

And it's, you know, it involves a self concept and shame, like you said, and depression and all the things. And so if I'm really going to get to the root of really helping them with their fertility, I say, I don't want you to just get pregnant either. I want you to have a healthy pregnancy.

I want you to deliver a healthy baby at term. I want you to walk home with a healthy baby in her arms, you know, 10 months from the time that you get pregnant. And, and I think that vision is helpful to people is easier for me to recommend a pause and a GLP one, you know, if they're 24, 28 or 30, and they, they have that sort of ovarian time, it's more tricky from my perspective, if somebody has diminished ovarian reserve or, you know, there are maybe they're 39 for me, maybe they don't have as much time as other people. So can you, I know once you're on these, people tend to stay on them, but what is sort of the typical timeline for how long it takes to see meaningful change? And what might you say to somebody who's in that 39, 40, 41 demographic where they're like, you know, I'd really like to do this, but I'm worried about the time component.

Okay. Part of that depends on their own history. It's different for every single person.

Most people who are taking, who, you know, are trying to lose weight, it's not their first time.

Particularly, you know, those of us in our forties, fifties, sixties, we really, you know, we live in a world of diet culture. So a lot of people, you ask them, they start dining when they're eight. They started watching what they ate when they were not even in their teens yet.

Makes me so sad. What that means is that in and of itself, apart from the psychosocial part, what that means psychosocially biologically, what that means is their muscle mass may have been affected. Muscle mass will determine what happens with the medication because it is our metabolic powerhouse. So if you have a large metabolic powerhouse and then you add this other metabolic corrector to it, it amplifies. But if you don't have that metabolic powerhouse to begin with, and you put in the medication, the medication has to do way more work and therefore it's not as effective. Add muscle work in and all of a sudden it amplifies again. And so, and also it's hard because when you do have a chronic metabolic issue, muscle work isn't as effective because now muscles fighting with the body trying to get the fuel out of glucose when the body's taking it to make fat. And so there's this battle. So when you correct, suddenly muscle work becomes way more efficient. So it really, muscle really determines how much happens. The next thing that other that affects is someone's emotional makeup. How stressed are they? How reactionary are they to stress to stressful situations? What are their coping mechanisms? Because cortisol will override the medications every single time. Most of my patients and clients are at an eight to 10 out of 10 stress. Yeah. And so, you know, so having some type of mechanism which drops cortisol, either through a yoga, meditation, hypnosis, that's one of the reasons why I became certified in hypnotherapy because really all hypnosis is a deep relaxation. You know, the stuff we see on TV in movies is not real. It just helps people deeply relax. And that, and so that helps drop cortisol.

And so therefore it improves their metabolic status. And so all of those things kind of come into play and, you know, of course, age, family history. So genetics, you know, what they've done in the past, food aversions, food preferences, you know, all those things play. And so, but everyone, again, you have ingredients, you have all these ingredients and you've got to find the stew that sustains that person. And each person has different ingredient amounts that go into that stew. And so it's just a matter of trusting the process, being patient. Patience is probably one of the most important emotional components to the process because unfortunately with the internet, we're being bombarded with these, you know, get rich quick stories basically, which are the weight loss equivalent of get rich quick. Especially when you consider thinness a social currency, it really is a get rich type stories. And they're not true. They're just simply not true. Some of them are physiologically impossible. Others, you know, for a fact, I can't tell you how many times it doesn't happen often, but it does happen enough where I've helped people lose a significant amount of weight. And then I see what they're posting about their weight loss and their enough blows to the stain. Like not even mentioning medication, Oh, I just been working out more and I've been eating a certain way. And I was like, but I've been prescribing for you for years.

But as a physician, of course, you know, confidentiality, you don't say anything.

And then some of it is I understand because of the stigma around the medications, people start attacking, you know, they use it like a weapon. Oh, I bet you've been using that, you know, those shots. Well, yeah. Nobody says that to the hypertensive who has high blood pressure, who's about to have a stroke that that you've got your blood pressure under control because you're taking hyper anti hypertensive. Who does that? No one, you know, it's so it's again, prejudice being superimposed on the process. And so, you know, to go, you know, back to what we were talking about, it is it's so multifactorial and trying to explain that there's some things that are basic and the same for everybody. It's just physiology. You can't get away from it. Some of his genetic, you can't get away from it, but there are components that are very specific and unique to you that no one else can tell you what's going to happen. Not even the physician treating you. So fascinating. And, you know, what's really interesting, like the antimularian hormone test is something that we kind of hang our hat on. Oh, you have a normal amount of eggs for your age or, oh, you're running out of eggs. Sort of how we explain it to people. It's interesting that, you know, so carrying a lot of additional adipose tissue, it lowers your AMH. And so I'd love to see a study like, Hey, look, people who go in GLP ones, you know, and we have to control for PCOS and things, but guess what? Your AMH actually might increase if you go on these, like you said, there's this factor. We don't know.

We can't predict. There may be benefits that we don't even, we can't even foresee. But you're right. I think what I'm hearing you say is a really individualized approach, right? To really look at, you know, yes, there's common elements, but who are you? When did your mother deliver her last child? You know what's in your soup of things, all the things, all the personalized medicine that we appreciate so much, which again takes time. And then also patients and really listening and you know, what are barriers? What, how can we support people in their journey?

I think that makes a lot of sense. So thank you for sharing that.

Cost is an issue. And especially when, I completely just lost my train. Oh, I know what I was going to say, especially when we're dealing with women's issues. Women's issues are historically and traditionally not well studied. And that's continuing to happen. And it's really becoming very obvious now, especially when the hormonal components that are being affected by GOP ones, we don't even have enough data to say what's happening. Cause we never studied the original.

It's like we didn't have a baseline. So we don't even know what's happening with, with the new, what's happening, you know, now. And so we're just kind of going based off of a conglomerate of anecdotal information, which has been extremely effective in the past, but it's also easier to distrust. Unfortunately, so a lot of sense in women's health research is getting rolled back and there's all those challenges too. You know, I, I had an insight as, as we were talking about, you know, people always say to me, Dr. Beau, what can I do? My REI tells me not to exercise all this weight's creeping up. You know, I'm, I'm doing my IVF cycle. I'm at the clinic every other day. And you know, as you said, that the muscle is the powerhouse that it's not easy to do to initiate a weight, you know, sort of a weight regimen, but it's a habit thing.

That is something that I actually think could really help my patients and my clients, because if they're being told you can't do vigorous exercise during all these different times, because your ovaries are big, you might twist and over retortion, all those things like, you know, weight, weight training is safe. No one's going to twist and over weight training, right? And, and that's a great way as people are doing this to really build their muscle mass so that their metabolism is better. It's a great stress, stress reduction too, especially if you listen to, you know, crazy music like I do. So I just know that's where Pilates comes in. Okay. Yeah.

Because that is a very gentle way of building muscle and lowering cortisol at the same time.

And one of the things that also does, depending on where you live and, and, and, you know, as long as it's not in the place where people just charge an arm and a leg for you for a studio, it also creates a community and accountability. And it just gives you a safe place to sort of get your focus, get your health in order without it being the whole focus of what you're doing.

That resonates so much. Go ahead. Keep going.

No. So that's why I always recommend Pilates. It is like the most gentle way of getting the muscle you need and getting all aspects. So it hits so many points in a person that, and that's why I love the fact that now they have home Pilates videos on YouTube where you can do home, you know, without machines, without anything. It's just, you know, exercises. Most of them are you lying on the floor doing stuff?

Amazing. I hadn't connected those dots, but you know, we, oh yeah, as you age, muscle mass is one of the important predictors of metabolism and, you know, ability to maintain your quality of life.

Like it just muscle muscle protein. But like for my patients in particular, for all you listeners out there, you know, focus on your muscle as you're undergoing this process. And a lot of things, it's like that efficiency, a lot of things will then get better. Right? That's what I'm hearing.

It's amazing. Well, muscle also determines your independence later. Yes, exactly. So, you know, I, you know, some of you who are listening or maybe don't know, but my mother's 95.

We just celebrated her 95th birthday. We're actually traveling to go see my, my daughter graduate and my mother will be there. Wow. And the only thing we were trying to decide is should we, should she use her walker or should we just in case she needs it, use the wheelchair that's collecting dust in her closet? Because she's still very active. She can bathe herself.

She doesn't, I mean, most of her activities of daily living, the only thing we don't have her do is cook because, you know, she needs kind of some stability. Other than that, she's very functional.

And I know it's mainly because she has a lot of muscle. She's just extremely strong and her recovery is, you know, she's had pneumonia. She recovered very quickly. She had other things happen. She recovered very quickly and she's defied all of her diagnoses and mainly because she's strong. And that is what, and I've seen it over and over again, even with patients, the most, those who need the most help in life later, who lose their mobility, who lose their interaction with the world, who lose their interaction with family are those who did not, who cannot maintain their mobility and muscle, muscle helps with that. Yeah. So, so we, we, we start these habits earlier on in our thirties and forties as we're undergoing this process. And then those are the same habits that are going to help us to, you know, be those parents who are running around chasing toddlers, to be those, to really age well. You know, I hit 40 and I was like, holy crap. What am I doing for my muscles? What am I doing for my strength? It was like all this knowledge that I hadn't really assimilated, but even today I'm going to go and do my orange theory. Cause I know I'm going to get my, you know, my muscle mass. Like I just, it's a focal point for me. And, and I'm thinking like, you know, when, when people are told not to do so many things during this process, it is one thing that people truly can do that can help them just immensely. So thank you for that insight. That's really going to help so many people. There's a question I've been dying to ask you. And you know, when, when you agreed to, to, to come and talk on the podcast, I was like, I have to ask her this question. Cause you mentioned so many parallels and overlaps in our two patient populations.

What do you do about the shame? What do you do about the shame that is so deeply embedded in so many humans? And I will say I, I listened to your TEDx talk on imposter syndrome. If you are listening to this, you know, please bookmark that and listen to it later because it is so phenomenal.

I find that the shame that is rooted sort of deeply rooted in humans who are undergoing the fertility process that is also there related to weight and body and all the things that, that takes time to address and melt and overcome and all the things like how do you approach that? And, and, and what have you seen in terms of people overcoming those initial limitations?

Unfortunately, the shaming starts really early, like way before we're even psychologically strong enough to resist it. So like four or five, six years old, unfortunately, especially when it comes to women, actually men are shamed too, but for different reasons, everybody gets shamed, unfortunately. However, the shaming in women is probably more internalized and we've accepted it. A lot of times we don't even recognize it for what it is. We get angry with other women and we don't realize it's because of our own shame. We get angry with situations because we don't realize we've been told that we're hope we're weak in that situation or we have no control. And so you, you react to that lack of sense of control when in fact you do have control, you just don't realize it.

One of the things that I've often said, and this is something that my mother has taught me, that I have experienced in myself, because one of the beautiful things about turning 50 is suddenly it's like all these things that used to matter, stop mattering all of a sudden. And so here I am about to turn 60 and I'm just like, wow, that was my best decade ever. I love my 50s and I'm just like, okay, if my 50s are this good and I've gained all this knowledge and wisdom, my 60s are going to be fantastic. So, and so that, some of that is just as you get older, you just sort of learn what's important and what isn't. But mainly the biggest lesson I've learned is don't focus on that.

Often focusing on something else grows what's in your periphery. So trying to say, I'm going to build my self-esteem. If you focus on your self-esteem, you're never going to build it.

But if you build something that makes you feel stronger, like your muscles, that confidence, that strength, that feeling gets transferred to your self-esteem.

So that focus, focus on the things you can actually do and build and strengthen, and it transfers to everything else. And that's kind of what I tell people, you know, you cannot get rid of shame by focusing on your shame. You cannot get rid of shame by focusing on the things that make you feel bad. Focus on the process that you can control that grows your confidence and then that confidence and feeling of accomplishment gets transferred. And that's basically what I tell people. That's what I've always done. It's what I've done in most situations.

It's how I got through med school. You know, it's like I, you never feel confident as a med student. So I stopped trying. And so I focused my competency on something else. And so I built my relationships during that time and actually met my husband and we ended up getting married in med school because that's where my confidence was with, with my relationship with him, not med school.

And so, and so that's how we do it. Now I was fortunate in that that relationship was a healthy relationship for me to help me grow. Now, of course, that's not always the case. And when it isn't the case, we have to recognize it and shift that focus to something else. And whatever that is, you just find that thing that you can control and grow and strengthen. And then that shame falls away. So understand though, that there are a lot of people who take advantage of our low self-esteem and our shame and do not like it. And they will resist that going away. And office is often it's those people that give us the hardest time and make it the hardest for us to grow and change. And one of the most important messages my mother ever gave me, and it was in the form of a book and it was called necessary losses. Wow. And essentially what it was, sometimes you have to lose people in order to grow and recognize when that is the case. And that was, I was 13 at the time.

Wow. Because I was bawling my eyes out because I guess a friend that I thought I had in lost and whatever, and you know, and she's not my friend anymore. She likes somebody else more, you know, that sort of thing. And she just handed me the book. She's like, you like to read, read this.

Changed my life completely, changed my perspective. And so now I don't see losses as, as losses. I see them as growth opportunities and that's actually how up. And that's exactly why I don't have imposter syndrome and why I can't think, you know, what is, like when I first heard the term, I was like, what is that? And when someone described it, I'm like, why would you have that? It's like, why would you say you have that if you don't have to? And so that's when I started diving into it and I realized it's a self-imposed description that we have to give ourselves.

That's true. And I think about it like for my patients and my clients, like I think that they're so focused on becoming parents because they're putting all this energy and money and all the things. I will tell you story after story. I have a client right now who decided to become a yoga teacher alongside the journey and she's almost done. And there she now teaches a regular class, a regular yoga class, which gives her something outside of this journey to focus on.

And she's helping other people and she's moving her body. And it's, you know, the identity perspective just widens out to be like, I am not just, you know, so-and-so the infertility patient.

I am so-and-so, and this is a part of my story, but I'm also a yoga instructor and a physician and all these other things. And I think that, you know, there's another one of my clients who is on Lupron, as people, you know, often do. And so she's just hanging out on Lupron waiting for her endometriosis to shrink until she can do another transfer. A lot of this is hurry up and wait. And she's like, well, why wouldn't I go to Paris and do a flower arranging course? Because one of my main values is beauty and I'm hanging out on Lupron anyway. And, you know, I think her timing's a little different, but, you know, she just said, well, what can I do? Right? How is this?

How can I take back my agency? You're right. And that in and of itself brings back the joy, brings back the perspective. And it reminds us that we're a whole human being. It's not just this one aspect of ourselves. So I, gosh, you are so wise. And I know people tell you that- I honestly, I came, if I am wise, I came by it. Honestly, my mother is, when you talk about a wise woman, you look in the dictionary and it's her picture. I mean, I just really, I really lucked out with my mother. I mean, my mom, and she's just, she had eight children. I'm the sixth of her eight.

She's so unflappable. In fact, her cardiologist, I went to her last cardiology appointment and her cardiologist like how in the, she goes like, what if we could bottle you? What, you know, what would we have to bottle in order I can pass on to my other patients? And I said, and she, in my mom's like, I don't know. And so he asked me, what do I think it was? And I said, she's so unbothered.

Nothing bothers her. And she, she was like, and I said, I've always said my mother's the walking serenity prayer. It's like, God grant me the serenity to, you know, know the things that I can change and change the things that I can ignore the things that I can't and the wisdom to know the difference. And I've watched her do this. I can't do anything about it. So I'm not going to worry about it. Oh, I can, I can do that. Now I can fix that, but I can't fix it. I can't fix what other people do, but I can fix what I do. So that's what I'm going to focus on. And I've just watched her do that my whole life. And I, I'm so thankful that I absorb that a lot of that from her. And sadly, though, you know, like many women, we were growing up and we're like fighting against who we, who we, you know, we want to be, and I'm like, I don't want to be anything like her. She was like this, and she was like that. So I spent all my twenties trying not to be like my mother. And then I spent my thirties, 40 fifties and sixties trying everything I could to be just like, you know, and, and that is, um, and I think that one of the things that you said was very poignant is our identity. What do we use to identify ourselves? And if our problem, if what we perceive as a problem is our identity, then it grew, it amplifies it as a problem and not a process. And I think that is, um, that's key. That's right. We got to trust the process. That's, that's one of the things. So, gosh, and I'm so grateful that I'm so grateful for your mother. I'm grateful that for you, that you have that relationship that you have sort of adopted so much from her and, and made it real. I have a phenomenal mother as well. And I'm very similar story, you know, I'm like, okay. And she really loves the serenity prayer. So I'm like, okay, now I'm the one getting emotional. But you know, that's when you're hit your truth though. It's like, it's like, it's like our brain just knows when you really hit the truth in a place of honesty, it's like, it just kind of springs out from your eyes. That's right. So, so thank you for that. We've come full circle. So I would love to just invite my listeners to look you up and, and listen to your content, you know, and, and, and I would love for people to know where they can find you. So many people struggle. And I really think you've got the secret sauce, if you will, even though it's like 10 millions later, you know, we're complex than that, but you have what it is that leads to this meaningful life that leads people to really living their dream, their dream lives. So where can people find you, Dr. Tumor?

Well, if they want to contact me directly and make sure that their emails don't get lost, they can write to me at help@drtumor.com. If you watch any of my videos on YouTube, which is youtube.com/addrtumor, I respond. Any questions that go in there. In fact, at the first Tuesday of every month, I do a live into YouTube where that's all I do is answer questions. In fact, the one tonight at 6 p.m. Eastern is me answering any questions anybody has.

Wow. And because I love Q and A's and I figured out all these years of gathering this information, I feel very confident in either answering it or saying, I don't know, but I'll point you to someone who does. So, so that's what I do the first Tuesday of every month. And that is today at six. Yep. As of this recording, so then as of, oh, let's try it. I'm so used to doing lives. I know, I know. Okay. So apart from it being, you know, the first Tuesday of every month, I do a live in YouTube. I do lives every Tuesday at 6 p.m. But the first Tuesday is the Q and A and then others are rest of the topics.

Any video that's been done, if you write any comment, any question on those videos, I get notified and I will answer them. And they are so good. I will say, you know, I, as a physician, you know, it's amazing because you talk to such a broad audience, right? And I have learned every single time you do a video or live or a combination of two, I've learned so much about metabolism, about myths, about, you know, hormones, like you, you talk about it all. And so, like I said, find her, binge her content, listen to her videos, listen to the imposter syndrome TEDx talk. And I didn't mean to interrupt.

It was also on my YouTube.

On your YouTube, yeah.

So the other thing is you can follow me on Facebook. Unfortunately, Facebook only allows you to have a certain number of friends. And I think I've reached that limit. So, but if you, I do most things publicly. So if you, you know, follow me on Facebook, you're going to get all my information. And that's again, it's also Dr. Toomer there as well.

Beautiful. Well, thank you so much for your time, for your wisdom, for your friendship. I am just so honored to be in the space with you. I continually learn from you.

That's so, so much. And I love your podcast. I listen, because what's one of the things I think that people mistake, the mistake people make, if it doesn't, if they think it doesn't affect them directly, they may or may not listen, but there's lessons and things that may not be specific to your situation. Well, they're specific to your situation, even if the title is something else.

Yeah, you may be a man who may not be married to someone right now, but there are lessons in learning about how to cope with infertility that you can apply to other areas of your life.

That's right. And in life, I mean, who doesn't need self-compassion? Who doesn't need?

Exactly. You know, just emotional sobriety, as I like to call it in terms of feeling, processing emotions, all the things. So thank you for that. I, I, I look forward to future collaboration. So thank you again. Okay. Find her, please, people. And until the next time, you know, I love you. Bye.

Bye.