It's Not "Just" Stress

Part of my work at Tia is listening to women talk about their health. This doesn't mean reading intake forms or symptom checklists - it's actual one-on-one time with our patients, where women can talk freely about what brought them to Tia, what they're looking for in a care experience, and how care needs to evolve for them. Over the last five years I've had a lot of these conversations, and a story commonly emerges. Here's how it usually goes:

"I've come to Tia on the heels of a bad healthcare experience… I do my annual physical, my blood work. I try to eat well and stay active (yes, I know there are things I can do better). And yeah, I have a lot going on [insert demands: caregiving, big job, just moved], but I've got it! But something has felt off, or I've had a symptom, and when I have gone to the doctor my labs are run, some tests are done, and then I get a nod of approval: 'Everything looks normal.' I push back - because I don't feel good in my body - and it was met with: 'It sounds like you're just stressed.'"

For some women, that was paired with "we can try X medication," or no solution at all besides "try to de-stress," or "yeah, it's tough getting older".

If any of this sounds familiar, you're not wrong, and your labs probably weren't wrong either. Both things were true at once, and the space between them is where a seismic gap in women's health has been hiding.

First and foremost: stress isn't the enemy

Stress isn't a character flaw, it's not a sign that you're failing to cope, and it’s emphatically not something to be ashamed of. Your stress response is one of the most elegant survival systems evolution ever built. It's what gets you out of the crosswalk when the car runs the light, what sharpens you before a big presentation, what floods you with the right amount of focus when you need it - it even helps you wake up in the morning! A short, sharp burst of stress that flares up and then resolves is your body working beautifully, and we'd be in trouble without it. So when we talk about stress doing harm, we're not talking about this type of stress.

We're talking about a different type of stress, a type that doesn't resolve, in part because modern life is filled with constant stressors, many of which don't resolve quickly (finances, relationships, tough jobs). Remarkably, your stress system doesn't need a predator or an event - it can be switched on by thought alone. Replaying a conversation from this morning, doing math on the mortgage at 3 a.m., bracing yourself on Sunday night for a week that hasn't even happened yet (Sunday scaries anyone?). This isn't a malfunction either; your body is fundamentally a predictive machine, which reads the situation, tries to forecast what you're about to need, and spends energy in advance to get you ready for it. (Sterling & Eyer, 1988)

All of that foresight is a gift right up until the moment there's nothing to get ready for - a worry without a finish line, a stretch of being high-alert demands without an end date, a background hum of "bracing" that you can't find the off switch for. Your body can't reliably tell the difference between a genuine emergency and an ordinary Tuesday, so it responds to both the same way, with the same neurochemical and physiological processes, for months on end. Which means that what separates the stress that keeps you alive from the stress that wears you down isn't necessarily the intensity, but whether it gets to end.

What bloodwork alone can't see

Bloodwork is amazing. However, in the last few years it's been positioned as a way to give you the full story of your health, and it can’t possibly do that.

Imagine a house that you're living in. Most of the work you do to keep your house maintained isn’t dramatic at all: it's the spring gutter cleaning, the occasional unclogging of a drain, the repainting of some floorboards that have been scuffed. Little moments of maintenance, but important to keep your house sound and cared for. Now imagine a pipe bursting and there's water everywhere. You don't stand there repainting the hallway while the basement floods; you shut off the water and deal with the emergency, and all the other house to-dos simply wait. That's great triage!

Your body does the exact same triage, and it's just as smart about it. When your brain registers a threat it fires off a fast, whole-body directive that you’re likely very familiar with. Your heart rate climbs, your blood pressure rises, your pain sensitivity decreases, your attention narrows and at the same time, it pauses some "upkeep" to turn that energy toward survival. Your digestion slows, immune function shifts, and the slow work of repairing and rebuilding tissue goes on hold, because none of that matters if you don't survive the next 30 seconds (McEwen, 1998). Skipping the bodily upkeep to handle an emergency is the correct decision; the house is fine, and you'll get back to that hallway next week.

But what happens to a house where there's just one emergency after another, and because of those emergencies the upkeep never resumes? Well, nothing dramatic at first. Your neighbors walk by and don't notice anything, sometimes for years. But the small maintenance that stopped happening slowly becomes something else: the seal under the kitchen sink that didn't get replaced, the tree that's gotten bigger and now cascading over the roof, the floorboards that never got attended to. The wear that could have been a 30-minute job three years ago isn't a 30-minute job anymore.

The accumulated cost of repair that never got done, because your body was too busy handling the emergencies to get to it, is what researchers call allostatic load (McEwen & Stellar, 1993). It's not debt you've racked up through poor decisions, and it isn't evidence you've done something wrong; it's simply what builds up when a system designed to pause maintenance for 90 seconds has to pause it for years instead. And this matters in a very literal, un-metaphorical way, because when your brain and body stay in that activated state longer than is healthy, all that deferred repair leaves you genuinely more susceptible to things like infections, high blood pressure, heart disease, gastrointestinal distress, sleep issues, and more. This is what people mean when they say chronic stress causes chronic disease.

Not every house weathers the same

We'll come back to the house metaphor, but we need to step out of it for a moment to talk about female biology - one of the many reasons women need a primary care home built for them, not built for the masses.

Women don't process stress the way men do, and it's not just a wee bit different; it's genuinely different circuitry in response to the same stressor. After a burst of acute stress, for instance, female brains show more of the receptors that respond to a key stress-signaling molecule than male brains do (Bangasser et al., 2010).

The famous fight-or-flight story, meanwhile, was built mostly on studies of males, and researchers have proposed that women often layer a second pattern on top of it called "tend and befriend", an instinct under stress to connect (Taylor et al., 2000). Oxytocin, the bonding hormone, is central to that, and it tends to calm the stress response rather than rev it up, which is both remarkable and important to understand. If you're under stress and have an instinct to draw nearer to someone, that's your body trying to settle! But when you're isolated and depleted with nobody to turn to, that same pull toward connection has nowhere to go. Connection isn't merely a biological nicety for women; it's part of our physiology.

At Tia, we often speak with women incredibly frustrated to be eating well, exercising, and still fighting weight around their midsection. This is an important clue, not a personal failure, because in women, repeated stress-driven cortisol surges can push the body to store fat specifically in the abdomen (Epel et al., 2000) - which makes sense in an evolutionary way, given that fat around your organs protects them and gives them easy access to fuel in a crisis. Not so helpful for those of us at a desk job or not fighting a bear every day, but it can help us reframe the midsection as your body actively doing something to protect you, rather than something you failed to control.

On top of all that, women don't carry stress in the same way, which is why we've conceptualized Stress Signatures - the particular shape your stress response tends to take, built around how quickly your body mobilizes energy and how alert your nervous system tends to run. Some of us are Sprinters, up and going the second the alarm sounds, quick to mobilize but prone to running every cell in overdrive; some of us are Pacers, slower to build momentum, winning the slow-and-steady race when we're in rhythm but knocked off our game when a late night throws us off. On the other axis, some run Vigilant, always a little on watch and wonderfully perceptive under pressure but wearing down like a security guard who's never off the clock, while others run Reluctant, more inward and more contained, pulling into a shell until the thing passes. There is no bad or wrong or weird Signature - simply different ways of being under stress.

Which brings us back to our house, and a very important point. What all that deferred repair actually does to any one woman isn't a straight line running neatly from stress to sickness; it depends on a whole constellation of factors interacting together, including the nature and duration and timing of the stress, your genetics, your family history, your lifestyle, and your psychosocial factors - such that two women can have nearly identical stressors and still land in completely different places. Stress is one powerful input, but it's not, on its own, the whole story. And high-quality care is contingent on understanding the whole story.

Why this is getting missed

That word "just" – “it’s just stress” – gets used a lot with women, and it's accidentally harmful, especially in the context of our health. This isn't to say the person using it is careless or unkind; in fact, they're often trying to help. But they're working in a 10-minute window, in a system that rewards ruling out disease through a specific set of measurements, not preventing it from ever happening.

Just is a closing word, a conversation ender. And when women hear it enough times, something worse than a missed diagnosis can occur, which is that she stops trusting her own body. She comes to believe the tiredness isn't worth mentioning, that the brain fog is just from not taking enough screen breaks, that the tummy issues are just because she's not getting enough fiber. She comes to believe that her lack of feeling full and vital is a personal failure rather than a signal worth reporting.

The other problem underneath that one is bigger than any single appointment or provider: most preventive care simply isn't built to find the unattended maintenance before it becomes disease. It works like a smoke detector - genuinely excellent at telling you that you've overbaked the pizza, but blind to the gutters that never got cleaned. So it does its job correctly and reports back the only thing it knows how to say, which is that there's no fire. But if we wait for the smoke detector to go off, we've missed the critical window in which something might have been easier, cheaper, and kinder to fix. Prevention isn't a nicer version of cure; it's a genuinely different thing done in a different window, and you cannot do it with a tool that only speaks up once there's a fire.

A different standard for prevention

So if the smoke detector isn't enough, what is?

Not fewer numbers - more of them, read differently. Labs are genuinely useful and more information can help, because the right markers tracked over time and read together as a pattern, rather than as one-off values on a particular Tuesday morning, start to surface what a single snapshot often can't. Signals like inflammation, HRV, resting heart rate, and how your body is handling blood sugar mean far more as a trajectory than as an isolated dot (McCrory et al., 2023). One reading can only tell you where you are; a pattern can start to tell you where you're heading.

But numbers alone still won't get you all the way there, because the places where your health may be vulnerable don't always show up in your bloodwork. Oftentimes, these clues aren’t perceivable until hearing the words someone says, the shapes their bodies are holding, the look in their eyes and the sense of their energy. These are all important biomarkers in themselves, ones blood tests, body scanners and chatbots don’t look at – but that clinicians do.

That's why we care differently at Tia. We take your data seriously, your context seriously, and your definition of what makes you feel most alive seriously - and we put all of it together to build a plan with you (with you ultimately in the driver’s seat). It means reading your history, your environment, your lifestyle, what you're feeling in your body, and your biometrics as a single picture, in order to find the vulnerabilities that are specific to you while there's still a wide-open window in which to do something about them. You can't do that in 10 minutes with a stranger, and you can't do it with a mobile app and hundreds of lab values, which isn't a knock on anyone so much as it is just logic. Context requires a relationship: a team who has seen you across time, who knows what your normal actually looks like, and who notices when you seem off rather than only when a value crosses a threshold. The data can point the way, but the relationship is what makes sense of it.

The gap between “normal labs” and feeling well in your body

The accumulation of chronic stress, or the deferred maintenance we’ve been discussing is very real, but it isn’t your fate.

Some of what may be causing chronic stress can’t be changed. A parent who is dying; a separation you didn’t choose; a life season that’s simply hard. But how your body carries it, and everything around you that’s uniquely you, we can work with. Sometimes, the most empowering information is just understanding how chronic stress could be impacting your body, sometimes it means adjusting your care around a specific vulnerability, or actually changing your care plan.

So if your body has been raising a flag for years, it’s not overreacting and it’s not exaggerating; it’s doing exactly what it evolved to do, which is tell you something is off.

The space between “everything looks normal” and “I don’t feel alive and well in my body” is remarkable information. It’s your body keeping the score of what it’s carrying in the only language it has and we’re here to help you make sense of it.

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