In part two of this episode with Allison Cale, founder of The Confidence Clinic, they discuss a lesser-known but equally real side of PCOS—thin PCOS. While the common narrative links PCOS with weight struggles, Allison explains how lean women can experience the same hormonal chaos—irregular cycles, fatigue, anxiety, and insulin resistance—despite not fitting the “typical” profile. Together, they unpack the hidden hormonal dynamics that make PCOS so complex, including how cortisol, estrogen, progesterone, and testosterone interact to create a domino effect of symptoms. Allison shares her clinical insight on why stress, lack of sleep, under-eating, and overtraining all worsen insulin resistance—and how women can begin to break the cycle with small, sustainable changes. The conversation also explores the emotional and mental toll of being dismissed by healthcare providers simply because a woman “looks healthy.” Both Lindsie and Allison encourage listeners to advocate for themselves, track symptoms, and seek out practitioners who take the time to dig deeper into root causes rather than masking symptoms. This episode is a must-listen for any woman who has ever felt unseen or unheard in her PCOS journey.
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(0:02 - 1:35) Welcome back to PCOS Unfiltered, the podcast where we cut through the noise and get real about what it takes to heal from the inside out. I'm your host, Lindsie, and today we're diving into a conversation that I know some of you have been waiting for. When most people think of PCOS, they picture weight struggles. In fact, you've probably heard the statistic that up to 80% of women with PCOS are overweight. But what about the women who aren't? What about the ones who are thin, yet still dealing with irregular cycles, fatigue, hair growth, and yes, insulin-resistant? To unpack this often overlooked side of PCOS, I'm joined by Allison Cale, the founder of the Confidence Clinic. Allison specializes in helping women optimize hormones and blood sugar, and she brings a refreshing perspective on what's really happening beneath the surface when weight isn't the issue, but the symptoms are still very real. As always, the content shared on PCOS Unfiltered is for informational and educational purposes only. The views and opinions expressed by the host and guests are not intended to serve as medical advice. Always consult with a qualified healthcare professional before making any changes to your diet, exercise, or treatment plan. The information shared is based on personal experience and expert interviews, and is not a substitute for professional medical guidance. If you've ever felt dismissed because you don't look like the typical PCOS patient, this episode is for you. Now let's get into it.
(1:43 - 3:45) What role do hormones like cortisol, I mean, we've talked a little bit about cortisol already, of course, estrogen, testosterone, what role do they play in making insulin resistance more complex for women with PCOS? Yeah, sure. So cortisol, cortisol is sneaky because we all have elevated cortisol because we're all very stressed out and we live in a high inflammatory lifestyle right now. And so what happens when we are chronically stressed in our cortisol, which is produced in your adrenal glands, which sits on top of your kidneys, when that's high in the long run, it basically will always tell your liver to release glucose because your body's always in fight or flight. And so it doesn't matter if you're not eating sugar, like people will be like, I don't eat sugar. Okay, but you are stressed out all the time. Like you have a very high stress job. You have four kids, you're not sleeping. And so even though you're not eating the cake, high cortisol will still tell your body to release glucose to try to help your body get out of fight or flight. I will oftentimes put women on continuous glucose monitors and I can tell when their body is stressed out and you can see that their blood sugar is staying high and they haven't even eaten anything. And then they're like, oh, well, I was very stressed because of whatever. So that cortisol plays a huge role in that. Many women with PCOS, they already have what we call adrenal hyperactivity. So their adrenal glands are already producing more androgens, producing more cortisol, like they're already in overdrive. So you take PCOS and you pair it with high cortisol and it's literally like putting gasoline on a fire. Cortisol also suppresses progesterone and it blunts thyroid conversion of T4 to T3. So T3 is the active thyroid hormone cellularly in your body. When you have PCOS, you already have lower progesterone. So now not only do you have PCOS, now your cortisol is high, now you're suppressing your progesterone. (3:45 - 9:10) Progesterone is the calming female hormone. It is by far one of my favorite hormones. It helps women sleep, it takes the edge off, it regulates your cycle. And so we get a lot of women coming through. They're tired, they're anxious, their cycles are irregular and it is this very vicious cycle. Another thing would be estrogen. So a lot of times you've probably heard the term is estrogen dominance. And so people will come in and say, I think I'm estrogen dominant. Well, when you look at what is estrogen dominance, it's progesterone deficiency because progesterone offsets estrogen. And if you don't have progesterone, your estrogen rises and you get puffy and you get inflamed and you get sluggish and you get run down. So you really want to have optimal levels of all the hormones. You want to have your cortisol in check. You want to have normal, healthy progesterone, normal, healthy estrogen, same thing with testosterone. So testosterone is a really incredible female hormone too. So it is one of the largest in molecular size. It's not the most abundant, but it controls a lot of things for a female. It controls your muscle mass, it controls your energy, it helps with your libido. There's a lot of things that testosterone controls. So when you have PCOS and or you have insulin resistance and your progesterone is staying low, you get estrogen dominance. And then on the back end of that, more free estrogen and it frees up testosterone from your high insulin levels. Why? Because the insulin is suppressing the SHBG. So now all of your master hormones as a female, estrogen, progesterone, and testosterone are all out of whack. And so these are the classic hormone imbalance symptoms, water retention, bloating, mood swings, PMS, anxious, can't sleep. And they're depressed because they don't know what's wrong with them. And they go to their traditional provider and they're like, we don't know either. And so it's a very vicious cycle. And then they start medicating. Well, I take melatonin. Well, now I'm doing magnesium and it's not going to fix the root cause. Yeah. I need more coffee. And then, yeah. Oh, it's 2 PM. Let me get that coffee. Instead, it's 2 PM. Let me make that protein shake. Let me get that protein in. And so, I mean, these things can be adjusted with a few simple activities over time. And so I think a lot of people get discouraged because they're like, I don't have the time. I don't have the energy. When you realize how much better you feel by correcting your metabolic activity, you'll make the time. Yeah. Yeah. Oh yeah, for sure. I mean, and it just takes like one little thing to just break the cycle, like focus on one little thing for the week, like you said, maybe getting in some more protein, some added protein in there instead of going for the coffee, you know, and try to get a good, well-rounded just snack of some sort and having that prepared because that's going to break the cycle. And then yes, you're going to start feeling better, probably pretty quickly, not probably all the way better, but you'll notice some change. And then you can just kind of keep compiling, you know, from there, making some changes for sure. You focus a lot on a few different approaches at the Confidence Clinic, which can make the biggest impact for lean women struggling with insulin resistance would you say? Sure. So I think that for any woman who is struggling, like an in-depth blood panel can tell you so many markers that you're not going to feel, that you're not going to see. And so we will, again, typically do like an overall, a very deep dive into the hormone panel. We will do the very deep dive into the insulin markers. And then from there, you know, inflammatory markers and all that. And then from there, should we still not have our answers? We will deep dive into many functional medicine modalities or traits. I also do a lot of glucose monitors for people. So anytime I get a female patient who comes through, I'm putting them on a 15-day glucose monitor. I think this is really important. I've been doing this for probably close to three years now. And all the women that I see respond so differently to different foods. So like I have few females who will literally eat an apple and their blood sugar spikes to 180. Well, apples are considered a healthy snack. So it's not like they're doing anything wrong. So then on the flip side of that, say, okay, challenge dipping the apple and peanut butter and see what your blood sugar does, right? And so it's, I think the most in-depth look at cellular metabolism, cellular energy, and seeing how your body responds to things. I have a female patient who her sugar was actually spiking to 200 every night with her hot shower. Why? I guess the heat was stressing her body and creating inflammation. Wow. Yeah. So it's very good insight for females. So, you know, blood work definitely continues, glucose monitors definitely. And then from there, we just, I don't have any protocols. So I get a lot of females who will come through with literally shopping bags full of supplements. They're spending $2,000, $3,000, $4,000 worth of supplements at other clinics. It's like a very janky, traditional, you know, one size fits all protocol. I don't have any protocols because we literally just take each individual patient because everyone responds to things so differently. Yeah. Yeah.
(9:10 - 9:59) Everybody's so different. I was going to say with the, with the continuous glucose monitor too, I mean, that's where you might discover like some sensitivities and stuff in there too. Right. That could be stressing the body out more. Right. Yeah. So I'm going to create inflammation. Now you have inflammation in your bloodstream, inflammation in your gut, and you can't, you can't survive like that. No, no. Yeah. I think the, I think the key honestly is like, we work closely with people like you, you know, so I don't claim to know it all. And I'm always referring my female patients to people who also specialize in nutrition because you have to have lifestyle plus you also have to have the medical side of it. And so I think that's where the real, you know, goal comes from for people. It's true. Yeah. Yeah. It does. It takes, it takes a team. (10:00 - 10:34) When you think about it. Yeah. Yeah. Cause I mean, even thinking back to my, my nursing education, I mean, I wasn't taught about nutrition like I am now. And so, yeah, but I can't, I can't do labs and I can't do, you know, other certain things. So, yeah. Yeah. I mean, nutrition is very surface level in traditional setting, you know, avoid carbs. Yeah. Yeah. Or this patient has diabetes. Like, you know, here's your metformin back in six weeks. Like, okay. Right. Yeah.
(10:36 - 11:07) Many women feel they're doing everything right. Specifically working out, eating well, it's a whole calories in calories out thing. I think that, that people tend to focus on, but they're still struggling. So what could be happening under the surface with blood sugar and hormones in those cases? Yeah. So I see this every single day, like females come, they're working out, they feel like they're eating right. And then we do the deep dive.
(11:07 - 11:48) And so I would say there are a few things that without fail always stick out. One of them is under eating. Females are afraid to eat like, girl, go get you a steak and some eggs. Like, do not be afraid to eat the protein, whatever, however that looks for people. But females will be like, well, I don't want to go over 1100 calories. And I'm like, okay, you just deadlift 200 pounds this morning. Like where are you going to feed your muscles if you don't eat under eating is huge. And not to any fault of their own, because there's a lot of coaches who will tell them to eat less. And that's not always the recipe for success.
(11:48 - 13:35) I'm back to like tracking blood sugars, so they could maybe feel like what they're eating is healthy, and it probably is, but maybe their body's not breaking it down like it should. Maybe it's creating more inflammation than it should. So figuring out how your body responds to the foods, it's definitely an eye opener. Lack of sleep, we're all like sleep deprived, unless you prioritize it. Because well, we go to bed at like 10 or 11 o'clock, then you might lay there on your phone, then your brain is stimulated, then the next thing you know, it's five o'clock and your alarms going off. So like, I will train people to create their bedroom into what we call a sleep oasis. And like, that is a bedroom is for sleep and sex. And that's it. Like, don't bring your phone in there, get yourself a secondary alarm, your phone stays in the other room, like it should be cool, it should be dark, there are many things, acupressure mats, we should be meditating, like, there's so many things to help lower stress inflammation and create better sleep. Overtraining, overtraining, I see a lot too, right? So females are just like, all right, well, you know, I'll just add on another day, or I'll just do two days, or I'll just do 75 hard, and that should do it. And like, it still doesn't do it. You can overtrain. What happens when you overtrain? You elevate your cortisol levels, your body is under stress, you're back in fight or flight, you're constantly in an elevated glucose state. So overtraining is not the answer. And then one other thing that we see happening under the surface is progesterone deficiency and PCOS and insulin resistance, raising your estrogen and you get that very estrogen dominance effect.
(13:36 - 13:58) Yeah, I think the overtraining, that was me in my 20s. But like, it worked. So I thought I could just do an extra workout or run some more. And I could still eat whatever I wanted. And now, of course, looking back, that's probably what led me down, you know, my own path, because I was just stressing out my body more. And I was doing fine until I wasn't.
(13:59 - 16:02) I think, you know, to your point, I have a lot of women in their 40s, 50s, 60s, 70s, my oldest patient's 94. I have female patients in their 20s. When you're in your 40s, you're in your 50s, you don't do what you did in your 20s. It doesn't work anymore. Your metabolism is different. Your hormones have shifted. Maybe you've had a kid, maybe you haven't, you have a lot more stress. And so I often see females resort back to like, well, when I was 20, I just trained for a marathon and that cut it. I'm not going to cut it now. It's a very different time when your body becomes a little bit older inside. Yeah. Yeah. Yeah. I mean, I think I even saw it in my 30s, but definitely now like 40s, I'm feeling it more. Same. And for myself, personally, like I work out like three or four days a week. Now I used to work out six days a week, but it's not enough recovery time. I need to listen to my body, do active recovery, Pilates, yoga, things like that. Instead of going hard for seven days a week. And I noticed a big change in my own body. And so sometimes it really just requires taking a step back and going, okay, I'm 45 now. Where do I go from here? What does my body like? How does it respond? And so I think there's a lot of things that women tend to do. Yeah. Yeah. And the, the under eating part is the, is the other big thing that I see a lot. Oh my gosh. Yeah. I mean, and, and that's like, even one thing with my program, people aren't tracking, like, but they still get into that mindset of being restrictive. And I'm like, no, I'm teaching how to eat all the right things. And when you eat all the right things, you don't have to track, you don't have to restrict anything. Like it shouldn't matter. You know, you eat till you're satisfied, you're fueling your body. But like you said, unfortunately, there's a lot of women out there that, that just, yeah, I feel like they shouldn't be eating, eating what they, you know, what they need to be.
(16:03 - 18:01) Well, social media doesn't help always, you know, there's where there is an abundance of information and it can pull you in many different directions. And so you always have to go back and go, well, is this the healthiest, you know, back in the day, the diet that used to be popular was the HCG diet. What did they do? They put women on a, on a HCG, which appetites present, but also like an 800 calorie per day. Wow. Oh my gosh. I bet their metabolisms were a wreck. Did they lose weight? Yeah. Cause they were malnourished. Yeah. Yeah. Yeah. Yeah. And the social media thing. I mean, yeah, that can add to the stress and the increase in cortisol and like, yes, there's information out there that can be useful, but then just looking at it and looking, looking at some of these influencers, I think you have to be aware that these are not realistic. Like this is all these people do. They have the perfect lighting. They have the perfect filters. They have the perfect, everything to make it that way. Or like, and they're probably also being restrictive. I bet during the day, even though they might be preaching the opposite of that. So yeah, there's, we can go down that rabbit hole with social media too. We'll do that another day. How important is blood sugar tracking for women without weight issues and should lean PCOS women still be monitoring things like glucose, insulin, A1C? I mean, I feel like you've probably answered this, but yeah, I mean, I think absolutely. I think every American should be monitoring their, their statistics, their metabolic markers specifically for women, like tracking things like glucose, blood sugar, it's the core management for insulin resistance.
(18:02 - 20:00) Without it, you're never going to know how your body's going to respond because you respond differently than I do to stress, to life, to inflammation, to lack of sleep. Like you could go on and on. And so, yeah, I think it's definitely a core value for women to be tracking. Yeah, for sure. How does the invisible struggle of being a thin woman with PCOS affect confidence and mental health? And this is a good question. Yeah. So normally by the time women find me they're desperate, which I wish I could change that. I wish it didn't get to that point. And so by the time they find me, they are literally in tears. They have been denormalized by many, many practitioners prior to me saying, you look healthy. Your weight is good. I don't know why you feel so bad. You are anxious. Here's some Zoloft, here's some Wellbutrin because they don't know what else to do with them. And so I think more than anything, like being written off time and time again by medical providers, when you feel and you know there's something else going on, it leaves you tired, you are frustrated, and then you're just lost in your emotions. So then you start to question yourself like, oh my gosh, maybe I am anxious. Maybe it is in my head. Maybe it is depressed. So then you start to minimize how you are feeling. And then it is this very vicious cycle. So it definitely plays a big role in mental health. Yeah, yeah. I mean, I see it too. Same situation. Unfortunately, a lot of women that come to me are in that last ditch effort kind of mentality too, you know. But those are the ones I love also because if they feel like they've tried everything and or they have tried everything, then I'm like, let me pick you. What do you say to women who feel dismissed because doctors tell them, well, you look healthy, so you must be fine.
(20:01 - 20:17) So I think this goes back to a lot of what we said, and you have to advocate for yourself. And so you know, you don't have to settle for what anybody tells you. Like that just because you pay them a co-pay and you're there, you don't have to take that as your final, you know, answer.
(20:17 - 22:10) You just go, okay, you know, I'm sorry you feel that way. And you move on and you find yourself another provider who is willing to listen and take the time and educate and kind of do deep dives with you. I definitely empathize with these females for sure because they are written off time and time again. And over time, that really does a number to their mental health. And I feel so bad for what they have experienced in the past. I actually did a social media post about this recently, and it was like this sweatshirt. And it was like, let me guess, my labs are normal. I have anxiety, everything looks good. And like, I just want to print it for females and like PCPs, but you do have to advocate for yourself, you know, time and time again. And so I think like getting with untraditional providers and having your notes ready with you when you go, like, this is what I want you to do for me. They're going to be more willing to do it. Yeah, yeah. I know. I saw that post about the sweatshirt. You start printing those and having everybody go to the doctor. Like, I need this shirt. So if a woman listening today, and I mean, I have listeners, I've discovered like all over actually, in other countries, and yeah, all over. But if they suspect that they may have insulin resistance, but don't fit the typical PCOS profile, what are some first steps that you would recommend? So gathering their thoughts. So writing down the symptoms that they experience day in and day out. So I like to call it a symptom log. Because this is going to prepare you instead of when you get in front of your provider and you go, well, I have brain fog. Oh, my God. And I don't remember what else I have. Because now you're like stressed because you're pressed for time and your doctor's like, hurry up.
(22:10 - 23:43) Why are you here? And so literally take a symptom log over like a four week period. What are you experiencing day in and day out? And then just be, you know, prepared with your notes. Like, here's what I'm experiencing based on my research. These are the blood work. This is the blood work that I'd like to have drawn. Here's where I, you know, would like to go from here. Sometimes you're going to have to guide that conversation because they're just not trained in it. And they don't know what to do with it. So typically they will give a prescription for metformin and say, okay, here you go. Like you said, back to, you know, the very beginning of this, this is forever. Stay on the metformin and you'll be fine. And so I think just educating yourself and being proactive and pushing for what you know is the best approach that you can take. Yeah, I love that. If listeners walk away with one key message about PCOS and insulin resistance today, especially for those in thinner women, what would you want that to be? Like, yeah, advocating for yourself, really. Knowing that even though there is a very classic presentation from the last 20 or 30 years of what PCOS might look like, that now today in 2025 is very far from the truth. Yeah. Thin PCOS is a real diagnosis. I'm sure by now it has an ICD-10 code. Be surprised if it didn't, but there's a lot of light being shed on it. And so you just have to know like, okay, my body doesn't feel right. I'm struggling.
(23:43 - 24:17) Here's what I'm struggling with. Could I possibly have PCOS? Don't let them write you off. Continue to do your research, continue to push for yourself and just know that now it doesn't have to be cysts on your ovaries. It doesn't have to be a high BMI. It doesn't have to be a woman with a beard. Like there are so many other things that PCOS can present as insulin resistance, high inflammatory markers. And then on the back end of that, like you set yourself up for health detriments later on if you let it ride. Yeah. So I think just know, like you said, knowing your body.
(24:17 - 25:27) Yeah. That's a great way to close it out. But last question. One more question. How can people connect with you and find you? Yeah. So we have one location. It's in Clearwater. So Clearwater, Florida on Belcher Road. We're getting ready to expand to a new location in Trinity. So we're going to hopefully be serving like the Odessa area, Trinity, Newport, Richey, places like that. Like I said, though, we do service all of Florida. So virtually on telehealth by phone, we can meet and connect on Zoom. We can draw your labs at any local lab core. There's one on every corner. So our office phone number is 727-435-7394. Our email address is info at my confidence clinic dot com. And then my website is www dot my confidence clinic dot com. And I am happy to literally chat with anybody to see if we would be a good fit to see if they need my services. I don't take people's money if they don't because that's not fair to them. So yeah, I love it. And I will, of course, link all of that stuff in the show notes as well.
(25:27 - 26:57) But I really appreciate this. This is so good. Definitely a great topic, I think. And you are so knowledgeable and all this stuff. So I really, really appreciate you being here. Yeah, no, thank you for having me. I really think I have finally found my passion in medicine. And that is literally to just help females get the results that they deserve and feel like themselves again. Because as we get older, you just lose yourself, you don't feel good, you don't look good, you don't feel like you look good. And I like to help women rediscover their confidence. And that's why I named it the confidence clinic. Well, thank you. Thank you for having me. Love that. Thank you. I hope today's conversation with Allison helps shine a light on a piece of PCOS that doesn't get talked about nearly enough. That lean women can struggle just as much with insulin resistance and hormone imbalances, even when weight isn't part of the picture. If that's you, remember, your symptoms are valid. You're not imagining things. And there are answers out there beyond the standard, just lose weight advice. You can learn more about Allison and her work at the confidence clinic. I'll link her resources in the show notes so you can connect with her. And as always, thank you for tuning in to PCOS Unfiltered. If this episode resonates with you, be sure to share it with a friend who needs to hear it. Until next time, keep nourishing your body, healing from the inside out and thriving. Unfiltered and unstoppable.