A patient sat across from me last month holding a folder of blood results and one sentence. Everything's normal, but I feel awful.
She'd been tested. One or two markers, in range, and the conversation had ended there.
Normal and optimal are not the same conversation
In range is a population statistic. It tells you where most people sit. It doesn't tell you whether this person, with these symptoms, is where they should be.
Hormones also don't work in isolation. Energy, mood, libido, weight and the menstrual cycle all sit on top of thyroid function, nutrient status, insulin and stress at the same time. Look at one marker and you can miss the thing actually driving how someone feels.
The markers that get missed
Low iron stores without anaemia are a good example, because haemoglobin alone won't find them. A 2025 review of iron deficiency in adults reports that in wealthier countries roughly 38 percent of nonpregnant women of reproductive age have iron deficiency without anaemia, and that ferritin is needed to catch it.
Locally the picture is its own conversation. A systematic review of South African data found iron deficiency in women of reproductive age ranging from roughly 8 to 19 percent across the studies included.
Thyroid is another. A TSH inside the reference range, alongside real symptoms and a family history, is worth a fuller look rather than a discharge.
A short case
A male patient came in with very low testosterone, raised insulin and badly broken sleep. The straightforward route is testosterone replacement, indefinitely. Instead we used a low dose briefly while we corrected the sleep, the nutrition and the insulin, then stopped it. A few months later his own levels had doubled. We treated the drivers, not the number.
What a whole system assessment looks at
Thyroid function. Nutrient status, including iron and vitamin D. Metabolic health and insulin. Stress and recovery. And where it's relevant, the menstrual cycle. Then the picture gets read together rather than one line at a time. You can see how I approach integrative and hormone health if that's useful context.
For colleagues
If you work in general practice, gynaecology, nutrition or performance, you're seeing these patients too. The ones who benefit most from an integrative approach are usually the ones who've never been asked a joined up question.
I'd be interested in where you draw the line between reassurance and investigation when the bloods look unremarkable but the person clearly isn't well.