Testosterone cardiovascular risk: FDA update 2025

Meds
December 1, 2025

Testosterone therapy is receiving renewed attention, not only from patients but also from regulatory agencies. In recent months, the U.S. Food and Drug Administration (FDA) updated the safety information for testosterone products, reflecting new evidence on cardiovascular risk. This has generated understandable questions among men who are considering therapy and clinicians who prescribe it.

As a urologist, I frequently meet patients who are uncertain about the safety of testosterone treatment, particularly …

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Alcohol, dairy, and breast cancer risk

Conditions
December 1, 2025

Delta Airlines has been raising money for the Breast Cancer Research Foundation by selling cocktails and rosé on board flights for 20 years. This month, it’s Une Femme Sparkling Rosé. Delta also serves gouda and cheddar slices, along with chicken salad sandwiches topped with queso. Have a drink or two, snack on cheese, and feel good about sending money for research, a party for a cause.

Yet, studies have shown that …

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The erosion of evidence-based medicine: a doctor’s warning

Physician
December 1, 2025

Something unsettling is happening in medicine, and many of us feel it even if we haven’t said it out loud: evidence-based medicine is slowly being eroded, not just by outsiders, but from within our own profession.

Patients today are searching more than ever before for quick fixes, and physicians are increasingly stepping into the marketplace to meet that demand. Hormone pellets. “Longevity protocols.” Peptides that sound scientific but have no real …

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Infertility public health: the WHO’s new global guideline

Conditions
December 1, 2025

Infertility affects one in six people of reproductive age worldwide, yet it remains one of the most overlooked public health challenges of our time. For decades, millions of individuals and couples have navigated this journey in silence, carrying grief, stigma, financial strain, and deep uncertainty about their reproductive futures. Despite its prevalence, infertility has rarely been treated as a global health priority.

That changed this year when the World Health Organization …

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Imposter syndrome: a poem of self-talk

Conditions
December 1, 2025

Many of the physicians I work with live with a quiet weight of imposter syndrome. They show up every day for patients, teams, and families, yet doubt their own belonging.

I wrote a short reverse poem, “Worthy in Reverse,” as a way to explore how self-talk can shape that inner experience. This poem was inspired by “Worst Day Ever?” by Chanie Gorkin, which creatively uses structure to shift perspective.

It is simple …

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Modified DSM-5 opioid use disorder criteria for pain patients

Conditions
December 1, 2025

Two years ago, I asked, “Doctors diagnosing addiction: Are the blind leading the blind?”

The estimated rates of substance use disorder among clinical patients treated for pain vary greatly, depending on whom one believes. Studies also suffer from a widespread failure to address genetically mediated variability in minimum effective opioid dose between individuals. Thus, I have many times respectfully suggested that the entire body of literature on opioid …

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Rethinking opioid prescribing policies

Physician
December 1, 2025

As a pain management specialist, my intent is not to promote unchecked opioid prescribing or overlook the serious risks these medications pose. Instead, I advocate for viewing the full picture in patient care. Physicians, trained in medicine and its side effects, must be empowered to use their knowledge and direct observations, including subtle cues like body language and patient interactions during brief visits, to make tailored decisions. Documentation in charts …

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Understanding the deadly gaps in pediatric dental safety [PODCAST]

Podcast
November 30, 2025
YouTube video

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Pediatric anesthesiologist Irim Salik discusses her article, “The hidden danger in pediatric dental offices.” Irim reveals a terrifying oversight in ambulatory pediatric dental care: children are suffering neurologic injuries or dying during …

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A lesson in empathy from a young patient

Physician
November 30, 2025

Anyone close to me knows orthopedics has never been my cup of tea. I rarely studied it properly; somehow, my enthusiasm always remained low. No offence to the subject, but maybe it started the day I saw my best friend’s forearm break. Fractures have always made me uncomfortable. During one of our postings, we were asked to do a case presentation. A patient was assigned to us, and it happened …

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wRVU threshold risks in physician contracts

Finance
November 30, 2025

Many physicians do not seem to grasp the risks inherent in physician employment agreements that impose a minimum threshold of wRVU production. However, there can be many pitfalls in these agreements.

What is the effect of the threshold?

The first pitfall is determining the effect of a threshold. Some agreements provide a salary “assuming a minimum threshold of” some number of wRVUs. I have reviewed many agreements with a provision like that …

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My late ADHD diagnosis in med school

Education
November 30, 2025

“When people with ADHD are able to get the treatment that they need as soon as they’re diagnosed as children, it gives them the best chance to realize their full potential.” These were the words that hit me like a ton of bricks one day as my preceptor was talking about his experiences treating adult patients with ADHD. I was soaking up every bit of information as he was teaching …

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How online physician reviews impact your medical career

Physician
November 30, 2025

Have you ever wondered how a single online comment might shape your reputation as a physician? I have, especially after reading a review that sardonically suggested I had earned my medical degree from Amazon (the company, not the rainforest). The jab was clearly meant to sting. Although I regret the dissatisfaction behind it, it gave me pause. How much weight do we give these offhand remarks, and what do they …

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Why is compression stocking compliance low?

Conditions
November 30, 2025

Every cardiology clinic has them: patients with swollen, aching legs and bulging varicose veins. We talk about conservative management: exercise, leg elevation, and, of course, compression stockings. And almost without fail, patients smile politely, nod, and then admit at the next visit: “I couldn’t wear them. They’re too tight, too hot, too uncomfortable.”

The paradox of a simple solution

Compression stockings are one of the most effective noninvasive treatments for varicose veins …

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Why modern dentists must train like pilots [PODCAST]

Podcast
November 29, 2025
YouTube video

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Dentist Lincoln Harris discusses his article, “How cloud-based simulation training is revolutionizing dentistry.” Drawing on his background as a pilot, Lincoln exposes the critical training gap in modern dentistry, arguing that dentists …

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Why you need a GLP-1 exit plan

Conditions
November 29, 2025

I’ve seen clients start GLP-1 medications full of hope, and stop them feeling betrayed by their own biology. Some reached their limit with side effects: relentless nausea, fatigue, or the quiet loss of joy in eating. Others simply couldn’t afford to stay on. A few never saw the promised results at all. But for nearly all of them, the story ended the same way: one step forward, five steps back.

We …

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Why midlife men feel unanchored and exhausted

Physician
November 29, 2025

Most midlife men don’t walk into our clinics asking for help. They walk in asking for labs.

They’ll tell us they’re “just tired,” “not as sharp,” or “feeling off.” They’ll blame work or age. They’ll ask for hormone testing or a quick fix. What they rarely say (and what most of us rarely ask about) is the deeper truth underneath the symptoms.

There is a silent crisis unfolding in midlife men, and …

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How medicine reflects women’s silence

Physician
November 29, 2025

My mother’s life was defined by silence. She was born in India. In a world where a woman’s worth was measured in duty: how well she cared for others, how quietly she endured. She was obedient. Her dreams were practical, her voice gentle. Never shared an opinion.

I used to think that by becoming a doctor (a woman with a career, a passport, a voice) I had escaped that silence for …

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Why not all ADHD generics are created equal

Conditions
November 29, 2025

A 2022 KevinMD article raised concerns about generic formulations of ADHD medications. The author described what many patients and families had already discovered: Not all generics are created equal. For those of us who lived through the substitutions, the difference was not abstract. It was a roller coaster that intruded on daily life, even on vacation.

The generic in question was manufactured by Mallinckrodt. Unlike Concerta, which uses an osmotic-controlled …

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Early Alzheimer’s blood test: Is it useful?

Conditions
November 29, 2025

In May, a published report indicated that changes indicative of Alzheimer’s disease (AD) were detected at age 24 via a blood test, which is increasingly available. These changes may begin earlier, but these were the study’s youngest participants. There are no medical treatments for these early manifestations, and aside from providing knowledge of a possible future and potentially causing anxiety, what value does the test hold? Unless a person has …

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How medical gaslighting almost cost a neurologist her life [PODCAST]

Podcast
November 28, 2025
YouTube video

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Neurologist Carolyn Larkin Taylor discusses her article, “How medical gaslighting almost cost me my life.” Carolyn shares her terrifying personal story of being dismissed by her long-time gynecologist, who labeled her cancer …

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