Health & Wellness

Dr. Sara Szal Breaks Down the Most Misdiagnosed Hormone Problems on ‘Treated’

August 16, 2025

You know that feeling when your labs come back “normal” but you still feel like trash? According to recent data, women are about 66 percent more likely to be misdiagnosed than men. That’s a real stat—and it explains a lot.

One person who’s trying to change that? Dr. Sara Szal. On Treated, she unpacks four hormone issues that keep getting misdiagnosed, brushed off, or straight-up ignored by many healthcare providers—and shares how to actually get the testing, support, and answers your body’s been screaming for.

PCOS

PCOS affects one in 10 women, but 70 percent of cases go undiagnosed. That’s not a typo. Szal calls it “the metabolic misread” because the symptoms are common and medical professionals often misdiagnose stress or mental health. “You show up to your doctor’s office with fatigue, acne, difficulty with managing your weight, maybe infertility and irregular period, and you leave with an antidepressant.” No one checks the right labs. No one even mentions PCOS.

Szal states that standard bloodwork is pretty useless here. What you actually need is fasting insulin, DHEAS, free and total testosterone, and maybe 17-hydroxyprogesterone. If insulin resistance is on the table, a continuous glucose monitor can be a game changer (you can buy them over-the-counter now).

If that sounds like a lot, Szal says it’s because most doctors aren’t ordering these by default—but they should be. PCOS can touch everything from fertility to mental health to metabolic health. This isn’t in your head. It’s in your hormones. And it’s worth pushing for the right tests.

Endometriosis

Endometriosis is the queen of medical gaslighting, and one of the most commonly misdiagnosed problems. Szal calls it “the eight-year delay” because that’s the average time it takes to receive a diagnosis.

Why? Because when you show up saying your periods knock you out, you’re often told “that’s normal” and handed birth control like it’s a cure-all. Or you’re told it’s IBS. Or stress. Meanwhile, the pain keeps coming—crippling cramps during your cycle, exhaustion that doesn’t quit, pain with sex, bloating, constipation, and sometimes even infertility. “The main clue with endometriosis is that the pain is real, recurring, and it worsens with the menstrual cycles, yet ultrasounds are often normal,” Szal says.

If you’re missing work or bailing on plans every month, that’s not just “bad cramps.” You need a full workup from a gynecologist trained in advanced excision surgery. Szal recommends labs for estradiol, progesterone, C-reactive protein, and CA-125 (not perfect, but it can be elevated in endometriosis). But even with those tests, she says, “Diagnosis usually requires laparoscopy.” In other words, you can’t just vibe your way into an endometriosis diagnosis—someone’s gotta actually look.

Hashimoto’s Thyroiditis

You’re exhausted, the scale is creeping up, hair’s thinning, you’re freezing in 70-degree weather—and your doctor says, “Your TSH is 3.2. That’s normal.”

Szal calls this “the thyroid trap.” With Hashimoto’s, one of the most misdiagnosed hormone problems, symptoms can show up years before standard labs do. It’s also autoimmune—and 90 to 95 percent of hypothyroidism is—so if no one’s testing antibodies, you’re flying blind.

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“Ask for a full thyroid panel,” Szal suggests. That means free T4, free T3, anti-TPO antibodies, antithyroglobulin antibodies, and reverse T3 if you’re fatigued, stressed, or not improving on meds. Then, track your own patterns—energy dips, mood shifts, temperature sensitivity, hair loss, cycle changes—and bring that to every appointment.

The right labs plus your symptom tracking can help you get past “you’re fine” and into actual answers.

Perimenopause

“You’re only 39. You’re only 43. You’re too young for perimenopause.” Szal hears it constantly and calls it what it is: “the dismissal and gaslighting of perimenopause.”

Symptoms can include mood swings, brain fog, irregular cycles, weight changes, sleep sabotage, and night sweats that make you Google bed cooling systems at 3 a.m. What gets mislabeled as anxiety, depression, PMS, or “just stress” can actually be your hormones entering a whole new era.

“Progesterone starts declining in your mid-30s,” Szal explains. “Estrogen may spike and crash unpredictably for years before it starts falling.” Yet most doctors aren’t trained to treat it, so you walk out with antidepressants or birth control instead of bioidentical hormone support—or even acknowledgement.

So, what do you do to avoid being misdiagnosed? “Track your symptoms by cycle phase,” Szal recommends. “Start noting your mood, sleep, energy, cravings, temperature shifts by the day of your menstrual cycle. Tools like a simple calendar can work great. We’re looking for patterns that show up before hormones start to change beyond the lab reference range.”

She also suggests asking for targeted labs like day-21 progesterone and day-3 estrogen/FSH, as well as finding a provider who understands progesterone deficiency and estrogen fluctuations. Because “73 to 75 percent of women who have perimenopause are not getting the care they deserve,” and if you ask Szal, “that has to change.”