THE HORMONE–LIVER AXIS

 

 Part 1

An Endocrine Perspective On Detox, Metabolic Disease, and Imaging In The MASLD Era

From a 2025 interview with Angela Mazza, DO – Integrative Endocrinology & Metabolic Medicine

The liver is one of the most metabolically sophisticated and hormonally influential organs in human physiology. While it is commonly viewed through the lens of detoxification and digestion, modern endocrinology now recognizes the liver as a critical regulator of hormonal balance, metabolic signaling, and systemic inflammation. Dr. Angela Mazza emphasizes that the liver and endocrine system are tightly interwoven, forming a functional network she refers to as the Hormone–Liver Axis.

When liver pathways become overwhelmed—from environmental exposure, nutrient deficits, endocrine-disrupting chemicals, chronic inflammation, or metabolic overload—the result is a predictable cascade: impaired hormone clearance, disrupted thyroid activation, insulin resistance, and mitochondrial dysfunction. This relationship is gaining urgency in clinical medicine due to the sharp rise of metabolic dysfunction–associated steatotic liver disease (MASLD/MAFLD), now the world’s most common liver disorder and a hallmark of modern metabolic syndrome.

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The Liver’s Endocrine Functions

Three endocrine pathways illustrate the liver’s pivotal role in hormonal homeostasis:

1. Estrogen Metabolism and Clearance
The liver performs Phase I and Phase II biotransformation to break down and neutralize estrogens before excretion. When these pathways are impaired, estrogen metabolites may accumulate, contributing to a clinical picture often described as estrogen dominance. Symptoms may include menstrual irregularity, fibrocystic breast changes, weight gain, mood fluctuations, or amplified vasomotor symptoms in menopause. Research confirms that impaired hepatic metabolism can meaningfully influence circulating estrogen levels and symptomatic expression (Liu et al., 2021).

2. Thyroid Hormone Conversion (T4 → T3)
Approximately 60% of the body’s active thyroid hormone (T3) is generated through hepatic conversion of thyroxine (T4) (Senese et al., 2018). When the liver is inflamed, infiltrated with fat, or burdened by oxidative stress, conversion efficiency declines. Patients may present with fatigue, constipation, cold intolerance, hair changes, or metabolic slowdown—despite normal thyroid bloodwork. This disconnect illustrates that hormone activation and utilization are just as essential as hormone production.

3. Glucose Regulation and Insulin Sensitivity
The liver stores glycogen, releases glucose, and is a primary site of insulin signaling. Hepatic insulin resistance is often the first measurable sign of future metabolic disease. Studies show that liver fat independently predicts insulin resistance and cardiometabolic risk, even before overt diabetes emerges (Bril & Cusi, 2017). This makes the liver central—not peripheral—to endocrine-metabolic dysfunction.

Together, these pathways demonstrate why hormonal symptoms frequently reflect underlying hepatic stress.

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MASLD, Metabolic Overload, and Endocrine Disruption

MASLD/MAFLD has reached epidemic prevalence, affecting an estimated one-third of adults globally (Eslam, Newsome, & Sarin, 2020). It is strongly linked to insulin resistance, visceral adiposity, and mitochondrial stress—suggesting that it is as much a hormonal and metabolic disease as a hepatic one.

The pathophysiology forms a self-reinforcing loop:

·        Insulin resistance drives hepatic fat accumulation

·        Hepatic fat worsens inflammation and oxidative stress

·        Inflammation interferes with thyroid conversion

·        Reduced T3 slows metabolism and mitochondrial output

·        Slowed metabolism worsens insulin resistance and fat storage

·        Impaired detoxification worsens estrogen imbalance

This cyclical model highlights why MASLD is not merely a liver condition—it is a systemic metabolic disorder with endocrine consequences.

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Detoxification, Nutrient Pathways, and Hormonal Balance

Effective hepatic detoxification depends on enzymatic pathways that require amino acids, antioxidants, and micronutrients such as selenium, B vitamins, magnesium, and sulfur-based compounds. When these nutrients are deficient, hormonal disruption is often an early clinical sign. Evidence shows that even mild micronutrient deficiencies can alter detoxification efficiency, oxidative stress, and metabolic signaling (Schmidt & Dalhoff, 2002).

Dr. Mazza’s integrative model focuses on:

·        Reducing toxin load

·        Restoring nutrient cofactors

·        Improving mitochondrial resilience

·        Enhancing insulin sensitivity

·        Supporting endocrine balance

·        Measuring progress rather than guessing

This final point—measurement—has become the missing ingredient in many detox or metabolic restoration programs.

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Elastography: A New Frontier in Endocrine and Detox Imaging

Ultrasound elastography provides a non-invasive method to quantify liver stiffness, allowing clinicians to identify fibrosis earlier and track changes over time. As a radiation-free modality, it aligns ideally with integrative and preventive care.

Emerging literature supports elastography as a reliable tool for staging fibrosis in steatotic liver disease (Castera, Friedrich-Rust, & Loomba, 2019). For endocrinologists, this offers transformative potential: instead of waiting years for MASLD to progress toward cirrhosis, practitioners can verify improvement or progression in real time, correlating fibrosis scores with metabolic or detox interventions.

Dr. Mazza believes elastography will become a foundation of imaging-validated metabolic medicine.

STRAIN vs SHEAR WAVE ELASTOGRAPHY Strain elastography evaluates tissue stiffness by measuring deformation when pressure is applied. The resulting color map is qualitative—blue tones represent softer, homogeneous tissue, while green indicates early fibrosis and red denotes firm, scarred regions. In one liver case, strain imaging showed homogenous blue echoes centrally with lateral areas of red scarring, prompting biopsy for confirmation. Shear wave elastography, however, quantifies stiffness in kilopascals. In a comparable case, homogeneous teal echoes with a mean value of 5 kPa confirmed normal tissue consistency—allowing the clinician to cancel a planned biopsy. This demonstrates shear wave’s precision and reliability in real-time liver evaluation.     Source: www.barddiagnostics.com

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Supplemental Insights: Additional Dimensions of the Liver–Endocrine Connection

While the liver’s role in hormone metabolism, binding protein production, and endocrine cross-talk is well-established, emerging research highlights several additional mechanisms that deepen our understanding of the liver–endocrine axis:

1. Sex Hormone–Binding Globulin (SHBG) as a Metabolic Signal: The liver synthesizes SHBG, a critical binding protein that modulates the bioavailability of testosterone and estrogen. Low SHBG levels are strongly associated with insulin resistance, metabolic syndrome, and MASLD, making SHBG not only a transport molecule but also a biomarker for endocrine-metabolic stress.

2. Hepatokines as Endocrine Messengers: The liver produces its own hormone-like signaling molecules—such as FGF21, fetuin-A, and hepassocin—that influence thyroid pathways, adipose tissue behavior, glucose metabolism, and systemic inflammation. These hepatokines act as messengers that allow the liver to function as an endocrine organ influencing distant tissues.

3. Estrogen’s Protective Effects on Hepatic Metabolism: Estrogen supports mitochondrial efficiency and reduces hepatic fat accumulation. This explains why MASLD risk rises sharply after menopause and why estrogen balance is tightly linked to liver health. Impaired estrogen clearance or low estrogen states may accelerate hepatic steatosis.

4. Cortisol and Stress-Driven Fatty Liver Progression: Chronically elevated cortisol—whether from stress, Cushing physiology, or sleep disruption—promotes gluconeogenesis, insulin resistance, and visceral adiposity. This creates a hormonal environment that accelerates fatty liver progression, illustrating how HPA-axis imbalance directly burdens hepatic metabolism.

5. Deiodinase Activity and Hepatic T3 Activation: The liver is a major site of deiodinase (D1 and D2) activity, driving conversion of T4 into metabolically active T3. Fibrosis, steatosis, or hepatic inflammation can suppress this conversion, reinforcing the clinical observation that thyroid-related symptoms often parallel liver dysfunction.

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Why These Concepts Matter

These additional mechanisms emphasize that liver health cannot be separated from endocrine health. SHBG, hepatokines, cortisol physiology, estrogen balance, and deiodinase activity all demonstrate a bi-directional, hormone-dependent feedback system. Recognizing these pathways gives clinicians more precise diagnostic insight and more therapeutic leverage—particularly in MASLD, metabolic syndrome, menopause, thyroid dysfunction, and stress-related disorders.

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Conclusion: Repair the Liver, Reset the Hormones, Restore Metabolic Health

The liver and endocrine system operate as a unified axis. MASLD has made that reality undeniable. By adopting an integrative, imaging-supported approach—targeting detoxification, insulin resistance, mitochondrial resilience, and hormone balance—clinicians can intervene earlier and more effectively.

In Dr. Mazza’s view, the clinical path forward is clear:
Support the liver. Protect the hormones. Break the metabolic cycle.

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References

Bril, F., & Cusi, K. (2017). Management of nonalcoholic fatty liver disease in patients with type 2 diabetes: A call to action. Diabetes Care, 40(3), 419–430.

Castera, L., Friedrich-Rust, M., & Loomba, R. (2019). Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease. Gastroenterology, 156(5), 1264–1281.

Eslam, M., Newsome, P. N., & Sarin, S. K., et al. (2020). A new definition for metabolic dysfunction–associated fatty liver disease. Journal of Hepatology, 73(1), 202–209.

Liu, Y., Zeng, X., & Yan, Z. (2021). Estrogen metabolism and liver disease: From physiology to pathology. Frontiers in Endocrinology, 12, 1–12.

Senese, R., Cioffi, F., & de Lange, P. (2018). Thyroid hormone and metabolism. Thyroid Research, 11, 1–10.

Schmidt, L. E., & Dalhoff, K. (2002). Food–drug interactions and liver detoxification. Drug Safety, 25(9), 673–683.

 

SMARTER AGING (PART 2)- Fall Resistance & Life Extension

  SMARTER AGING – PART 2

THE LONGEVITY FRAMEWORK:

Building a Fall-Resistant Future

By Angela Mazza, DO – Integrative Endocrinology

Falls are not merely accidents — they are biomarkers of aging. A fall is often the first visible sign that inflammatory damage, hormonal decline, muscle loss, and metabolic imbalance have quietly eroded the body’s resilience. If we are going to talk honestly about longevity, life extension, and smarter aging, we must talk about fall prevention as a core component of that conversation. Preventing the fall is not just about safety. It is about lifespan, healthspan, and the body’s ability to sustain independence.

From an integrative endocrinology perspective, the path to a longer, stronger life begins at the cellular and metabolic level. Bones do not weaken overnight, muscles do not fail in a single season, and balance does not disappear without warning. These changes are progressive — and therefore, they are modifiable.

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THE INFLAMMATORY ORIGIN OF BONE LOSS

Chronic inflammation is at the root of many age-related disorders, and bone loss is no exception. Inflammatory pathways accelerate bone turnover and weaken structural integrity, setting the stage for osteopenia and osteoporosis. Once bone density is compromised, a simple misstep becomes a threat.

Inflammation also affects joints, connective tissue, and even neuromuscular communication, slowing reaction time and altering gait. This is why addressing inflammation through nutrition, sleep, stress reduction, and botanical or pharmaceutical support is not “general wellness” — it is structural preservation. It is fall prevention.

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HORMONES, METABOLISM, AND THE PHYSICS OF STABILITY

Hormones deeply influence bone strength, metabolism, energy, balance, and body composition. As estrogen declines — especially in midlife women — bone density drops and muscle mass becomes harder to maintain. Thyroid dysfunction can exacerbate fatigue, weaken muscles, and slow reflexes. Insulin resistance contributes to inflammation, weight gain, and loss of lean mass. Declining testosterone, in both men and women, accelerates sarcopenia — the age-related loss of muscle.

These are not cosmetic issues. They are mechanical ones. Balance, strength, and stability are endocrinological outcomes.

When metabolism is inefficient and mitochondria underperform, the body cannot generate the quick, coordinated response needed to correct a stumble. This is where fall prevention meets longevity at the cellular level: when we improve metabolic and hormonal health, we improve physical resilience.

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STRENGTH TRAINING, MITOCHONDRIA, AND THE ARCHITECTURE OF LONGEVITY

If there is one universal prescription for life extension, it is strength training — especially lower-body strength and impact-loading for bone. Muscle is metabolic currency: it stabilizes joints, protects bone, sharpens balance, improves mitochondrial output, and prevents frailty. Mitochondria — the energy engines of every cell — thrive on resistance work, movement, and oxygenation. Strong mitochondria mean faster reaction times, clearer cognition, and better neuromuscular control.

This is longevity in motion.

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RECOVERY IS PREVENTION

When a fall does occur, recovery determines the future. Too many adults treat a fall as an isolated event, when it should be treated as a diagnostic turning point.

Recovery should involve:

·        Rehabilitation and gait retraining

·        Strength rebuilding and neuromuscular conditioning

·        Balance, mobility, and flexibility work

·        Hormonal and nutritional evaluation

·        Bone-density assessment and inflammatory review

Recovery is not the end of the story — it is the beginning of prevention for the next chapter. A fall should activate a longevity plan, not a long decline. This is where smarter aging replaces passive aging.

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CONCLUSION: LONGEVITY IS OUR CHOICE

Longevity is not achieved by hoping we won’t fall — it is achieved by fortifying the body so that it doesn’t break when life happens. When we address inflammation, support hormones, train muscle, protect mitochondria, and approach recovery as prevention, we create a fall-resistant human structure.

Smarter aging means we do not wait for the crisis. We build resilience now. We choose strength now. We protect our future now. Because longevity is not merely about adding years to life — it is about adding balance, strength, confidence, and independence to every year we live.

 

 

Desiccated Thyroid Extract treatments - at risk

POINT BLANK: 

Five members of Congress are urging the FDA not to restrict Desiccated Thyroid Extract (DTE), warning that millions of patients who don’t respond to synthetic thyroid drugs could lose access to the only treatment that works for them. They’re demanding clarity and protection for continued patient access to this century-old, life-stabilizing therapy.

Dear Friends-

As a board-certified endocrinologist and dedicated healthcare provider, I am outraged at the FDA’s recent action against desiccated thyroid extracts (DTEs), a treatment that has been indispensable for over 1.5 million hypothyroid patients across the country.

I deeply appreciate the lawmakers who recently signed a letter urging the FDA to protect patient access to DTEs. Now, I call on the FDA to act responsibly and preserve this vital therapy option. As the medical director at the Metabolic Center for Wellness, I know the importance of DTEs. For over a century, some patients respond better to DTEs than other options. 

 

Relief from hypothyroid symptoms is transformative. Removing or restricting access to DTEs would cause unnecessary suffering for millions. I urge you to join me in thanking the lawmakers who are defending patient choice, and in demanding that the FDA protect access to this vital medication. For the patients who depend on DTEs, this is not merely a treatment option, it is a key to endocrine care and wellness. 

I appreciate your bringing attention to this matter.

Sincerely,

Angela Mazza, DO, ECNU and Medical Director at the Metabolic Center for Wellness

Office: (407)542-0661

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The Issue

In my clinical practice, I have witnessed how desiccated thyroid extract (DTE), or "natural" thyroid hormone replacement,  can be life-changing for individuals struggling with thyroid issues. Many of my patients, who do not achieve adequate symptom control with levothyroxine alone, report significant improvements in their quality of life when switched to DTE. The availability of natural thyroid hormone replacement is not just a matter of personal choice; it's a necessity for many who need an alternative to synthetic options.

Research has shown that thyroid hormone replacement isn't one-size-fits-all. While levothyroxine works for some, there are thousands of individuals who experience persistent symptoms like fatigue, weight gain, and depression despite being compliant with their prescribed synthetic treatments. DTE offers a more comprehensive profile of thyroid hormones, providing T4 and T3, mirroring what a healthy human thyroid naturally produces.

According to the American Thyroid Association's reports, the incidence of hypothyroidism affects nearly 5% of the US population, which translates to millions who could potentially benefit from alternative treatments like DTE. Despite these numbers and numerous patient testimonies, the FDA has been under increasing pressure to restrict access to natural thyroid options. This would severely limit therapeutic avenues for patients who have seen no improvement with standard therapies.

The decision to limit access to DTE could lead to unnecessary suffering for countless individuals whose only hope for relief may lie in alternatives like this. Ensuring these options remain available aligns with the ethical responsibility of patient-centered care.

We urge the FDA to recognize the importance of empowering patients and clinicians with diverse treatment options. The voices of those who have found relief through DTE must not be ignored, and their treatment choices should not be taken away.

Join us in advocating for the continued availability of desiccated thyroid extract as an indispensable option for thyroid hormone replacement therapy. Sign this petition today to help us protect the rights of patients seeking comprehensive care and ensure they continue to have access to all necessary medications. No need to donate! Just your show of support is all we need:) Sign the Petition

EMF: INVISIBLE EXPOSURES, VISIBLE EFFECTS

Electromagnetic fields and the Future of Hormone Health

By Dr. Angela Mazza

As a physician focused on hormones, resilience, and longevity, I am increasingly asked about electromagnetic fields—commonly called EMFs—and how they may affect our health. This is a complex and often controversial topic, but I think it deserves careful consideration, particularly when it comes to long-term endocrine balance.

What Are EMFs?

EMFs are invisible areas of energy, sometimes described as radiation, that are produced by electricity. They are part of the electromagnetic spectrum. Importantly, the fields we are talking about here are non-ionizing, meaning they do not carry enough energy to break molecular bonds or directly damage DNA the way X-rays or CT scans can. Everyday EMF exposures come from sources such as:

·        Cell phones and smartphones

·        Wi-Fi routers

·        Bluetooth devices

·        Power lines and electrical wiring

These exposures are constant, low-level, and increasingly unavoidable in our modern world. By contrast, pulsed electromagnetic fields (PEMFs)—the kind used in clinical or therapeutic contexts—are highly controlled. For example, my colleague Dr. Robert Bard incorporates PEMF devices that deliver signals at specific frequencies and intensities designed to stimulate healing and recovery. That is very different from the continuous, background exposures of daily life.

Why I Care as a Hormone Specialist

My lens is always through the endocrine system. Hormones are exquisitely sensitive messengers, regulating everything from metabolism to mood, reproduction, and sleep. Emerging evidence suggests EMF exposure could influence:

1.     Melatonin and sleep rhythms – Several studies have shown that EMFs may reduce nocturnal melatonin production, which is critical for sleep and circadian regulation . Lower melatonin levels have also been linked to increased oxidative stress.

2.     HPA-axis function – The hypothalamic-pituitary-adrenal (HPA) axis orchestrates our stress response. Some animal studies suggest EMFs can dysregulate cortisol rhythms, though human evidence remains mixed .

3.     Oxidative stress and free radicals – A growing body of research indicates EMFs may promote oxidative stress, a mechanism relevant to aging, inflammation, and hormone balance .

From my perspective, even if the data are not definitive, the fact that exposure is so widespread—and cumulative over decades—warrants serious study.

Where the Science Stands

To be transparent, the human data are not conclusive. Some large epidemiologic studies have found no strong associations between EMFs and cancer or fertility issues, while smaller studies have raised concerns about sleep disturbances, sperm quality, and subtle neurologic changes . One challenge is that technologies evolve so quickly that long-term data often lag behind real-world exposure.

What we do know is that dose matters. Proximity, duration, and cumulative load all influence exposure. A cell phone against the ear for hours a day is very different from sitting a few feet away from a Wi-Fi router. Children may also be more vulnerable due to thinner skulls and developing systems.

Practical Risk Reduction

While we wait for stronger long-term studies, I advise my patients on a few simple, low-cost ways to reduce exposure without compromising modern life:

·        Use speakerphone or earbuds instead of holding a phone directly to the head.

·        Keep devices off the body—avoid storing phones in pockets or bras.

·        Turn Wi-Fi off at night or keep routers away from sleeping areas.

·        Limit unnecessary Bluetooth devices when not in use.

None of these require fear, just thoughtful choices to minimize unnecessary exposure.

The Question of Mitigation Devices

Many companies now market EMF “shielding” or “harmonizing” devices. One example is Aires Tech, which claims to reduce the biological impact of EMFs through structured fields. While intriguing, independent evidence is limited. At this stage, I cannot fully recommend these devices without more rigorous testing. Still, I am open to exploring whether such tools, if studied in well-designed trials, could play a role.

 

A Path Forward: Research and Collaboration

This is where I see an opportunity for integrative collaboration. What if we designed a pilot study that measured:

·        Baseline EMF exposures (from personal monitors or environmental assessments)

·        Melatonin and cortisol rhythms across day and night

·        Markers of oxidative stress

·        Sleep quality, measured both subjectively and with wearable devices

We could then introduce a simple intervention—perhaps EMF reduction strategies, or even testing a mitigation device—and track whether meaningful changes occur. Such work would help move this conversation from speculation to evidence.

Final Thoughts

As an endocrinologist, I do not view EMFs as an emergency, but I do see them as an under-recognized variable in our overall health equation. We live in an environment saturated with invisible signals, and while the technology itself is here to stay, we can still ask critical questions about safety and long-term adaptation.

Just as we learned over decades about the effects of diet, smoking, or environmental toxins, EMFs deserve the same scientific curiosity. For me, the most compelling lens is hormone health: sleep, stress, circadian rhythms, and oxidative balance.

In the meantime, I encourage patients to take small, sensible steps to reduce exposure while staying informed as science evolves. The answers will not come overnight, but by asking the right questions now, we can protect both present health and future resilience.

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References

1.     Burch JB, Reif JS, Yost MG. Geomagnetic disturbances are associated with reduced nocturnal excretion of a melatonin metabolite in humans. Neurosci Lett. 1999;266(3):209-212.

2.     Shahin S, Singh SP, Chaturvedi CM. 2.45-GHz microwave irradiation adversely affects reproductive function in male mouse through HPA axis. Prog Biophys Mol Biol. 2017;131:257-263.

3.     Yakymenko I, Sidorik E, Kyrylenko S, Chekhun V. Long-term exposure to microwave radiation provokes cancer growth: evidences from animal studies. Exp Oncol. 2011;33(2):62-70.

4.     Röösli M, Frei P, Mohler E, Hug K. Systematic review on the health effects of exposure to radiofrequency electromagnetic fields from mobile phone base stations. Bull World Health Organ. 2010;88(12):887-896.

5.     Adams JA, Galloway TS, Mondal D, Esteves SC, Mathews F. Effect of mobile telephones on sperm quality: a systematic review and meta-analysis. Environ Int. 2014;70:106-112.

 

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PART 2:

Environmental Frequencies: An Invisible Problem
By Dr. Robert L. Bard

We live inside a sea of signals. Most are harmless background noise—useful, convenient, often life-changing. But there is an invisible problem here worth naming: the strength and frequency of those signals matter. As a diagnostic imaging specialist, I spend my days translating invisible waves into visible truth. That experience gives me a unique perspective on how frequency and intensity can mean the difference between healing and harm.

Diagnostic tools themselves illustrate this clearly. Ultrasound uses high-frequency sound to create real-time images of soft tissue; it is mechanical energy, safe when used correctly, and exquisitely useful for detecting structure and blood flow. MRI, by contrast, relies on very strong magnetic fields and carefully tuned radiofrequency pulses to map anatomy and physiology. Both are non-ionizing and clinically indispensable — yet both remind us that invisible energy, when controlled and harnessed, becomes information and healing.

Now look at the environment: today’s technologies emit continuous or intermittent electromagnetic energy at a wide span of frequencies. Cell phones and Wi-Fi operate in radiofrequency bands; smart devices, power infrastructure, and other sources add layers of exposure. The critical variables are not the label—“EMF” or “PEMF”—but the frequency, amplitude, duty cycle, and proximity. Therapeutic PEMF devices intentionally deliver pulsed signals at specific frequencies and dosages to stimulate biological responses. That controlled delivery is fundamentally different from ubiquitous, uncontrolled background exposures.

The distinction becomes starker when we consider directed-energy technology. Governments and militaries have developed devices that use concentrated electromagnetic or microwave energy for nonlethal crowd control or as tactical weapons. Those systems demonstrate, bluntly, that electromagnetic energy can be engineered to produce physiological effects. The difference between a clinical PEMF unit and a high-power directed-energy device is one of magnitude, focus, and intent — but the physics are related.

That reality calls for humility and prudence. In the clinic we control dose, duration, and targeting. In daily life, individuals often cannot. My concern — shared by many clinicians — is cumulative, chronic exposure and its potential subtle effects on sleep, inflammation, and systemic homeostasis. We need better monitoring, clearer exposure metrics, and translational research that links measurable signal environments to meaningful biological endpoints.

Practically, this means we should measure before we hypothesize. Environmental assessments, careful dosimetry, and integration with clinical biomarkers will allow us to separate signal from noise. As an imaging physician, I champion technologies that visualize the invisible. Now it’s time to apply that same rigor to the invisible signals that surround us — not to alarm, but to inform, mitigate, and responsibly innovate.

 

THE THYROID IN FOCUS (Spring 2025 podcast review)

Dr. Angela Mazza Brings Clarity to a Misunderstood Gland

From the Spring 2025 recording of the LEVELS podcast with Mike Haney

Few glands in the body spark as much confusion—and misinformation—as the thyroid. Sitting quietly in the neck, this butterfly-shaped organ influences nearly every cell through the hormones it produces. When it falters, the consequences ripple across metabolism, energy, mood, and long-term health. In a Spring 2025 conversation on the LEVELS podcast, integrative endocrinologist Dr. Angela Mazza explored this complexity with host Mike Haney. The discussion traced her journey into thyroid medicine, unpacked the physiology and testing of thyroid function, and outlined an integrative framework that blends conventional endocrinology with functional approaches.

 

 

A Career Rooted in Hormones and Whole-Person Care

Dr. Mazza entered endocrinology through a personal connection: diabetes runs in her family. But as her career unfolded, she found herself increasingly drawn to thyroid medicine. Early in practice, she became the physician handling ultrasounds and biopsies, naturally accumulating a large thyroid patient base. What she discovered disturbed her—patients were being missed, mismanaged, or left dissatisfied.

This realization propelled her toward integrative endocrinology. By founding the Metabolic Center for Wellness, Dr. Mazza committed to merging traditional hormone science with functional insights into nutrition, gut health, stress, and lifestyle. Her philosophy is not about fixing numbers on a lab sheet; it is about helping people feel well now while preserving health decades down the road.

Why the Thyroid Matters

The thyroid produces hormones—primarily T4, which is converted into the active T3—that regulate metabolism at the cellular level. As Dr. Mazza explained, metabolism is not simply burning calories; it is the sum of thousands of chemical reactions occurring every second. When thyroid hormone levels tilt too high or too low, the imbalance reverberates through the cardiovascular, skeletal, neurological, and immune systems.

She describes the thyroid as the body’s thermostat: a regulator that sets the tone for countless other hormonal and metabolic processes. Dysfunction can therefore be both a cause and a consequence of disturbances elsewhere in the body.

The Two Extremes: Hyperthyroidism and Hypothyroidism

Hyperthyroidism, often triggered by Graves’ disease, places the body in a hypermetabolic state. Patients may feel anxious, shaky, or plagued by palpitations, sleep disruption, and gastrointestinal changes. Contrary to popular belief, weight loss is not inevitable; stress-driven cortisol surges can foster insulin resistance and paradoxical weight gain. Eye complications—from lid retraction to vision-threatening inflammation—can make the disease especially disruptive.

Treatment begins with stabilizing symptoms, usually through beta-blockers, and then choosing among anti-thyroid medications, radioactive iodine, or surgery. Yet Dr. Mazza’s integrative practice often allows her patients to avoid the latter two irreversible options. Stress management, gut health support, and antioxidant therapy form part of her toolkit, enabling many patients to discontinue medication over time.

On the opposite side lies hypothyroidism, most commonly associated with Hashimoto’s thyroiditis. Its symptoms tend to creep in gradually—fatigue, brain fog, constipation, mood changes, menstrual irregularities, high cholesterol, and visible signs such as dry skin and hair loss. Diagnosing hypothyroidism requires more than a single blood test. While the screening marker TSH is valuable, Dr. Mazza stresses the importance of looking at free T4, free T3, antibody profiles, and sometimes reverse T3. She also integrates nutrient testing, since iron, selenium, magnesium, and iodine deficiencies can mimic or exacerbate thyroid dysfunction.

Beyond TSH: A More Complete Picture

The conventional reliance on TSH alone as the diagnostic gold standard is, in Dr. Mazza’s view, limiting. TSH is an indirect measure reflecting brain-thyroid feedback loops. Optimal levels vary among individuals and may even shift with age. Some patients present with normal TSH but clear hypothyroid symptoms—a scenario where examining circulating hormone levels, antibodies, and nutrient status becomes essential.

She also defends the value of reverse T3 testing, once dismissed in training as irrelevant except in hospitalized patients. Elevated reverse T3, she notes, may indicate cellular stress, mitochondrial dysfunction, or overtreatment with T4-only therapy. For patients on thyroid replacement, this marker can reveal whether the therapy itself is inadvertently counterproductive.

The Role of Imaging

One of Dr. Mazza’s clinical hallmarks is her use of ultrasound imaging. While blood tests reveal biochemical function, ultrasound shows physical changes in the gland. With real-time visualization, she can distinguish between Graves’ disease, Hashimoto’s, and other thyroiditis patterns, or detect nodules that warrant closer scrutiny.

Nodules are remarkably common—up to half of adults harbor them, though the vast majority are benign. Size, composition, vascularity, and the presence of microcalcifications guide biopsy decisions. Even benign nodules, however, may cause cosmetic or mechanical problems, from visible neck swelling to difficulty swallowing.

Innovation in Treatment: Radiofrequency Ablation

Traditional surgical removal of nodules often creates more problems than it solves. Without a thyroid, patients face lifelong medication challenges, and not everyone converts synthetic T4 to active T3 efficiently. To address this gap, Dr. Mazza has championed radiofrequency ablation (RFA)—a minimally invasive office procedure that uses targeted energy to shrink nodules by up to 70% within months.

Patients remain awake, their vocal cords monitored in real time to avoid nerve damage. Compared with surgery, RFA preserves thyroid tissue, minimizes recovery time, and allows the gland to continue functioning. In cases of small, slow-growing thyroid cancers such as papillary microcarcinomas, RFA is emerging as an attractive alternative to both surgery and passive surveillance.

Personalization in Hormone Replacement

For patients who lose thyroid function entirely, hormone replacement therapy becomes necessary. The conventional approach relies on levothyroxine (T4 alone). Yet genetic variations mean roughly 15% of people cannot adequately convert T4 to T3. These individuals often experience persistent fatigue, mood issues, or metabolic challenges despite “normal” labs.

Here, combination therapy—whether through synthetic T3 plus T4 or natural desiccated thyroid extract—can restore quality of life. Dr. Mazza points out that historically, thyroid extracts containing both hormones were standard until synthetic T4 took over mid-20th century. Now, the pendulum is swinging back toward individualized regimens tailored to patient response.

Hormones in Context: Women’s Health, Adrenals, and More

Thyroid function never exists in isolation. Adrenal health, sex hormones, and systemic inflammation can all alter thyroid balance. For women in perimenopause and menopause, shifts in estrogen and progesterone profoundly interact with thyroid physiology, complicating both diagnosis and management.

Dr. Mazza emphasizes that addressing thyroid health may require parallel attention to cortisol rhythms, reproductive hormone transitions, or insulin resistance. Her philosophy reflects the broader systems biology approach increasingly recognized in modern medicine: no gland or organ operates alone.

Tackling Misinformation and Myths

Social media and online forums abound with thyroid advice—much of it misguided. Among the most harmful myths Dr. Mazza counters are:

·        The “temperature method”: once popularized as Wilson’s Syndrome, it promoted titrating thyroid replacement based solely on body temperature. Patients often ended up dangerously hyperthyroid.

·        The “magic weight loss cure”: while thyroid dysfunction influences metabolism, hormone replacement alone rarely produces dramatic weight changes. Lifestyle, insulin sensitivity, sleep, and stress remain central.

·        The “subclinical” label: patients with symptoms and borderline labs are sometimes dismissed as having “subclinical hypothyroidism,” implying no intervention is needed. Dr. Mazza argues this ignores lived experience and the progression of autoimmune thyroid disease.

Her corrective is both practical and empowering: pair careful laboratory and imaging evaluation with open acknowledgment of patient symptoms.

Lifestyle, Nutrition, and Prevention

If there is a theme woven through Dr. Mazza’s teaching, it is agency. Patients are not powerless against thyroid dysfunction. Lifestyle choices can profoundly influence resilience and outcomes:

·        Sleep: A non-negotiable seven to nine hours stabilizes cortisol rhythms and supports thyroid function.

·        Stress management: Chronic stress distorts cortisol curves, undermining thyroid balance. Techniques that calm the nervous system are protective.

·        Nutrition: Micronutrients such as selenium, iodine, zinc, and iron provide the raw materials for thyroid hormone synthesis. Two Brazil nuts a day can supply selenium needs; pumpkin seeds add zinc. Whole, minimally processed foods protect against inflammatory triggers.

·        Detoxification: From household chemicals to plastics, endocrine disruptors are unavoidable. Supporting the body’s natural detox pathways—hydration, antioxidants, and even daily sweating—can lighten the load.

·        Movement: Exercise not only boosts metabolism but also improves insulin sensitivity, an underappreciated determinant of thyroid health.

These habits, she stresses, are not elaborate “protocols” but steady, sustainable practices that reinforce thyroid stability and long-term well-being.

Looking Ahead

Dr. Mazza’s voice on the LEVELS podcast carried both authority and humility. She blends rigorous endocrinology training with the openness of integrative medicine, recognizing that no single perspective holds all the answers. Her vision of thyroid care is deeply personalized, evidence-based, and compassionate, rooted in the conviction that patients deserve more than a prescription slip or a dismissive “your labs look fine.”

By educating audiences on the nuance of thyroid physiology and the promise of individualized care, she is helping dismantle misconceptions that have long hindered patients. From radiofrequency ablation to personalized hormone replacement, her clinical work demonstrates how innovation and empathy can coexist.

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Conclusion

The thyroid may be small, but its influence is vast. As Dr. Angela Mazza made clear in her 2025 conversation with Mike Haney, caring for this gland requires seeing the bigger picture: hormones in context, labs in conjunction with symptoms, and treatment integrated with lifestyle.

Her message is both cautionary and hopeful. Cautionary, because oversimplification—whether by clinicians or online influencers—risks leaving patients untreated or mistreated. Hopeful, because with the right blend of science, integrative strategies, and patient empowerment, thyroid disorders can be managed, and often improved, without compromising quality of life.

In the end, Dr. Mazza’s vision of thyroid care is less about chasing numbers and more about fostering resilience. It is an approach that reminds us that medicine is not just about glands and hormones—it is about people, their stories, and their capacity to thrive when science meets compassion.