Well, I guess we ought to stop prescribing TRT to women. Didn't you hear the news? According to a recent study that will be presented sometime this week via The Menopause Society, testosterone therapy has been linked to postmenopausal women with a higher risk of incident cardiovascular disease. Hmmm... I don't yet have the full study, but I'll be waiting with baited breath that's for sure. However, anytime I see headlines like these floating around, almost always when you dig into it, it's...
8 days ago • 3 min read
Have you heard some version of this in your office? “I’d like to feel better, but I’m scared of progesterone. Doesn’t it cause breast cancer?” It’s a fair question, and it's one that used to make me stumble early on. A lot of women were taught to fear it for many MANY years. But a 2017 paper by Zhou and colleagues found something many providers like you haven’t seen. When progesterone met one of the most aggressive breast cancers we know of, it slowed it down... See, triple-negative breast...
20 days ago • 3 min read
I want to run some startling numbers by you this morning. Mind you, I'm no Einstein when it comes to stats etc., but these will probably take your breath away... In the USA 6,000 women enter menopause every day. Menopause symptoms cost U.S. women an estimated $2 billion a year in lost work time. Fewer than 4% of women aged 50–60 use hormone therapy. Less than 1 in 10 OB-GYN residents (about 7%) felt adequately prepared to manage menopause. Nearly 4 in 10 men over 45 in primary care have low...
25 days ago • 2 min read
Your wish is my command. Many of you have asked, so this morning, I bring to you the case for checking ferritin levels. And yes, I believe based on the literature, that it's on of the most underrated and helpful markers when it comes to discovering iron deficiency. Let me make the case here. First of all, most iron-deficient young women aren’t anemic. In US females aged 12 to 21, 38.6% were iron deficient at ferritin <25. So only 6.3% had iron deficiency anemia. Put another way, just 16.4% of...
29 days ago • 1 min read
Have you ever considered using progesterone for TBI patients? We discussed this idea heavily during our annual HRTU conference last weekend. I spoke on the benefits of progesterone in men, and my colleague Jillian Martin (our lovely HRTU mentor) spoke on hormones in general for TBI. Now, before you jump ship on this email, I want to point out to you why this is so relevant to you. First and foremost, we all see patients with histories on TBIs. ALL THE TIME. In fact, its much more common than...
about 1 month ago • 2 min read
Boy oh boy did we have a heck of a weekend for HRTU. We just wrapped up our second annual HRTU Live conference here in my beautiful hometown of Cincinnati, Ohio. Over 120 providers from all around the country - literally. From Hawaii to New York, and from Utah to Florida. Every corner of our amazing country was present with a provider and clinic owner yearning for more then just the standard doll-drum education. These are movers and shakers, deep thinkers, and creative geniuses who really...
about 1 month ago • 1 min read
Morning everybody. I get some version of this question almost every week now. "Nico, what concentration of topical finasteride has the least systemic absorption but still works on the scalp?" It's a good question. But I want to tell you up front that I don't reach for this drug much, and I'm going to explain why. Especially orally, and especially in men. First, let me back up for anyone who doesn't prescribe this every week. Finasteride blocks an enzyme called 5-alpha reductase. That enzyme...
4 months ago • 3 min read
Morning friends. I'll tell you, at this point in my own research, the weight loss might be the least interesting thing GLP-1s do... I know how that sounds. Stay with me :) There's a new systematic review in the Journal of Clinical Medicine on GLP-1 agonists in hidradenitis suppurativa, and it quietly undercuts the story we've all been telling about this drug class. Quick background for those who don't see much HS. It's a chronic inflammatory skin disease, and a miserable one too. Painful...
4 months ago • 2 min read
Morning everybody! I had a great question land in the HRTU private community the other day. I'm paraphrasing, but it went something like this... "Nico, my patient's hematocrit is at 52. Should I do a therapeutic phlebotomy?" And here's my honest answer: no... but there's some nuance here. Let me explain what I mean. A paper just published in Endocrine Connections asked a question that the field has been quietly avoiding for years. Is therapeutic phlebotomy for TRT-induced erythrocytosis...
4 months ago • 4 min read
