When my hunger returned, it felt as though my stomach was burning from the inside out. It was acute, painful, and very physical. I pushed everything else aside and concentrated on getting rid of it. There was no negotiating with…
When my hunger returned, it felt as though my stomach was burning from the inside out.
It was acute, painful, and very physical. I pushed everything else aside and concentrated on getting rid of it. There was no negotiating with hunger that intense. My attention narrowed to what I could eat to make it stop.
I am a registered nurse with more than thirty years of clinical experience. I have had bariatric …
About 80 percent of a diagnosis comes from the patient's story. The electronic health record has no place to keep it. I learned the first half of that in my second year of medical school, in a physical diagnosis lecture…
About 80 percent of a diagnosis comes from the patient’s story. The electronic health record has no place to keep it.
I learned the first half of that in my second year of medical school, in a physical diagnosis lecture by the late Dr. Arthur Aufses Jr., chairman of surgery at Mount Sinai for 22 years and a man of extraordinary skill and intellect. In that lecture, he said that about …
Most of us have a well-rehearsed speech for patients with elevated blood sugar. We talk about the heart. The kidneys. The eyes. The feet. We walk through the whole organ-by-organ checklist a glucose reading can quietly damage over the years.…
Most of us have a well-rehearsed speech for patients with elevated blood sugar. We talk about the heart. The kidneys. The eyes. The feet. We walk through the whole organ-by-organ checklist a glucose reading can quietly damage over the years. What most of us, myself included, haven’t been saying nearly often enough is anything about the brain, and a study published this summer in Molecular Psychiatry is a good reason …
If you take Ozempic, Wegovy, Mounjaro, or Zepbound, or you are simply trying to make sense of GLP-1s (glucagon-like peptide-1) and GIPs (glucose-dependent insulinotropic polypeptide), you may have seen a recent Medscape article asking whether GIP really adds any benefit…
If you take Ozempic, Wegovy, Mounjaro, or Zepbound, or you are simply trying to make sense of GLP-1s (glucagon-like peptide-1) and GIPs (glucose-dependent insulinotropic polypeptide), you may have seen a recent Medscape article asking whether GIP really adds any benefit in type 2 diabetes. It is a fair scientific question. The problem is that the headline makes the answer sound much clearer than it is.
Many doctors picture themselves practicing until the day they die. Andrea Hayes decided otherwise, and tells you what came next. She is a retired endocrinologist, author, and speaker. This episode is based on her article "From endocrinologist to writer: a…
Many doctors picture themselves practicing until the day they die. Andrea Hayes decided otherwise, and tells you what came next. She is a retired endocrinologist, author, and speaker. This episode is based on her article “From endocrinologist to writer: a doctor’s second act,” published on KevinMD. You will hear how …
A condition named for the ovaries turns out to run through the muscle, the liver, and the pancreas. Insulin is the signal connecting them, and different organs hear it differently. Oluyemisi Famuyiwa, reproductive endocrinologist and founder of the Montgomery Fertility…
A condition named for the ovaries turns out to run through the muscle, the liver, and the pancreas. Insulin is the signal connecting them, and different organs hear it differently. Oluyemisi Famuyiwa, reproductive endocrinologist and founder of the Montgomery Fertility Center, returns to walk through it. This episode is based on …
Picture a common follow-up visit: Six weeks into glucagon-like peptide-1 (GLP-1) treatment, a patient has lost weight and their glucose measures have improved. They describe the nausea as "manageable." Then you ask what they ate yesterday: coffee until noon, a…
Picture a common follow-up visit: Six weeks into glucagon-like peptide-1 (GLP-1) treatment, a patient has lost weight and their glucose measures have improved. They describe the nausea as “manageable.” Then you ask what they ate yesterday: coffee until noon, a few bites at lunch, half a dinner, and less water than usual because everything feels too filling. They’ve also stopped walking because they feel weak.
I have spent nearly twenty-five years treating osteoporosis. The drugs have gone from oral and intravenous bisphosphonates to several classes with better efficacy and, mostly, better tolerability. Their reputation has gotten worse. Some of that is a jaundiced view of…
I have spent nearly twenty-five years treating osteoporosis. The drugs have gone from oral and intravenous bisphosphonates to several classes with better efficacy and, mostly, better tolerability. Their reputation has gotten worse. Some of that is a jaundiced view of the pharmaceutical industry, some the internet doing what the internet does. But a meaningful share comes from the government. The Food and Drug Administration (FDA) prints warnings its own trial …
For nine months, I did not stand on a scale. I did not look at myself in a full-length mirror. I told myself I was busy. The truth was that I was frightened of what I might see. I had…
For nine months, I did not stand on a scale. I did not look at myself in a full-length mirror. I told myself I was busy. The truth was that I was frightened of what I might see.
I had reached my target weight, and my BMI had fallen below the range my prescriber and I intended. We discussed reducing my dose. Clinically, it was reasonable. Psychologically, it felt like a …
I have some version of the same conversation every week now. A patient is starting semaglutide or tirzepatide, and partway through the visit they ask the question I suspect most of us are hearing constantly: What happens if I ever…
I have some version of the same conversation every week now. A patient is starting semaglutide or tirzepatide, and partway through the visit they ask the question I suspect most of us are hearing constantly: What happens if I ever stop?
For a while I gave the honest-but-incomplete answer, that we’d cross that bridge when we got there. I don’t anymore, because I think the real answer has less to do …
Somewhere in a hospital right now, a physician is ordering a sliding scale of short-acting insulin to be given before a meal, at a dose set by the premeal blood glucose. Not a correction dose for hyperglycemia on top of…
Somewhere in a hospital right now, a physician is ordering a sliding scale of short-acting insulin to be given before a meal, at a dose set by the premeal blood glucose. Not a correction dose for hyperglycemia on top of a meal dose. The meal dose. Blood glucose before a meal describes what has already happened. It says nothing about whether the tray holds 20 g of carbohydrate or 90. …
I've been doing this long enough to have believed in technologies that failed, and doubted technologies that succeeded. That is a humbling education, and it is the one I trust most. I watched the Prostatron arrive, microwave thermotherapy that was…
I’ve been doing this long enough to have believed in technologies that failed, and doubted technologies that succeeded. That is a humbling education, and it is the one I trust most.
I watched the Prostatron arrive, microwave thermotherapy that was going to spare men the operating room for their prostates. It had its moment, and then the moment passed. I watched Computer Motion’s ZEUS, a surgical robot of real elegance (the …
She had five close friends. She told one. Not because she doubted the prescription. Her GP had raised tirzepatide after her bloodwork showed worsening insulin resistance, and the decision followed a real clinical conversation. She told one friend because she…
She had five close friends. She told one.
Not because she doubted the prescription. Her GP had raised tirzepatide after her bloodwork showed worsening insulin resistance, and the decision followed a real clinical conversation. She told one friend because she did not know what the truth might do to the other four relationships.
Would her weight loss still count? Would lunch become surveillance? Would every smaller portion be treated as evidence? Would …
On June 5, the American Diabetes Association called security and the police on some of its own members. Officers forcibly removed five prominent diabetes researchers from the ADA's 2026 Scientific Sessions for handing out copies of an editorial in its…
Testosterone is one of the most discussed and misunderstood tools in modern men's health. On one hand, it is portrayed as a remedy for aging. On the other, its legitimate clinical value is frequently downplayed. The evidence suggests a more…
Testosterone is one of the most discussed and misunderstood tools in modern men’s health. On one hand, it is portrayed as a remedy for aging. On the other, its legitimate clinical value is frequently downplayed. The evidence suggests a more nuanced view: Testosterone replacement can be life-changing for appropriately diagnosed hypogonadism, while many broader benefits remain evolving or indirect.
The well-known benefits are in hormonal and sexual health. For men with …
Men's health has often been limited to discussions about prostate, erectile dysfunction, and testosterone levels. This perspective is narrow. A more comprehensive model connects metabolic health, hormones, sexual function, mental well-being, and everyday self-care. These elements are interconnected and frequently…
Men’s health has often been limited to discussions about prostate, erectile dysfunction, and testosterone levels. This perspective is narrow. A more comprehensive model connects metabolic health, hormones, sexual function, mental well-being, and everyday self-care. These elements are interconnected and frequently influence one another.
Glucagon-like peptide-1 (GLP-1) therapeutics have accelerated this shift. Medications like semaglutide and tirzepatide have transformed obesity treatment from a focus on willpower to one based on biology, chronic …
A patient sat across from me not long ago and said, "I feel like I'm doing everything right, and still failing." She had lost weight. She was taking her medications exactly as prescribed. She had reworked her diet along the…
A patient sat across from me not long ago and said, “I feel like I’m doing everything right, and still failing.” She had lost weight. She was taking her medications exactly as prescribed. She had reworked her diet along the lines we’d discussed. Yet her glucose readings remained stubbornly elevated.
I’ve heard some version of that sentence throughout my career as a physician and clinical researcher studying metabolism and diabetes. This …
My wife answered our telephone. A representative of the state university asked her about my interest in participating again in her group's research project. She handed the handset to me. For several years, my name has resided in the database…
My wife answered our telephone. A representative of the state university asked her about my interest in participating again in her group’s research project. She handed the handset to me. For several years, my name has resided in the database of their Office of Human Research. My honoraria, when they offer one, have ranged from a crisp, minimally circulated $50 bill, to gift cards of $15 to 50, and an …
As a pediatric endocrinologist, I often meet families on one of the hardest days of their lives: a T1D diagnosis. I watch as the shock sets in. I hear their worries, their concern for the future, and the questions that…
As a pediatric endocrinologist, I often meet families on one of the hardest days of their lives: a T1D diagnosis. I watch as the shock sets in. I hear their worries, their concern for the future, and the questions that arise when I mention that family history can increase the risk of developing the disease by up to 15-fold. “What does this mean for our family? Could this happen to …
For millions of people living with obesity, FDA-approved GLP-1 medications have created new opportunities to improve health, reduce the burden of related chronic diseases, and receive evidence-based treatment for a condition that has too often been dismissed as a matter…
For millions of people living with obesity, FDA-approved GLP-1 medications have created new opportunities to improve health, reduce the burden of related chronic diseases, and receive evidence-based treatment for a condition that has too often been dismissed as a matter of willpower. At the same time, extraordinary demand for these therapies has fueled the rapid growth of compounded alternatives that are often marketed as less expensive, personalized, or equivalent substitutes. …
