The first time I can remember hearing about microplastics and their negative effect on our health was during my pediatric endocrine fellowship, at least 15 years ago. In all honesty, at the time I was not very impressed. It seemed to me something that only the “crunchy” crowd was worried about. Well, I am here to admit, my instincts were probably wrong. Fast forward to 2024, and wow has the outlook changed. More and more research has been published linking microplastics with a whole host of adverse biologic effects, ranging from hormones and fertility to cancer risk and cognitive...

Undoubtedly, the most common question I get about hormone replacement therapy (HRT) for women is some version of: “What about hormones and breast cancer?” It’s a fair question. After all, for the past 20+ years there has been a dogma among physicians and the public alike that HRT causes breast cancer. What I hope to do in this blog is show that this belief is false. I will argue that the combination of bioidentical estrogen and progesterone not only does not increase the risk for breast cancer, but a strong argument can be made that it is actually protective against breast cancer. Now, if...

The impact of hormone replacement therapy (HRT) on cardiovascular disease (CVD) in menopausal women is one of the most fascinating questions in all of medicine. It’s an important question, because CVD is the number one cause of death for women in the U.S. And it’s a complicated question. It’s complicated for many reasons, not least of which is because the pendulum keeps swinging back and forth on what the medical community thinks about it.

Let’s spend a minute setting the stage. Women secrete three primary hormones from their ovaries during their reproductive years: estrogen,...

- Estrogen has been used since the mid-1900s to treat menopausal symptoms in post-menopausal women.

- In addition to treating menopausal symptoms, estrogen replacement therapy has been linked to a number of positive outcomes including reducing the risk of osteoporosis, cardiovascular disease (CVD), dementia/Alzheimer’s, and breast cancer. While there is strong consensus that estrogen is effective for increasing bone strength, the latter three outcomes remain controversial.

- For many decades Premarin – estrogen derived from pregnant horses - was the...

One of the most common questions I get is: what do I think about fill-in-the-blank supplement? I get where patients are coming from. If some major symptom or other problem could be treated with taking a supplement, I’m all in. But how do we wade through all the noise and figure out what might have a benefit, and what is just the latest fad?

Supplements can play a valuable role in our longevity goals. However, there is a potential danger as well, given that all of us have limited time, energy, and other resources. We have to be wise in how we spend those resources. We have to...

We expect testosterone levels to decrease as we age.

But did you know that testosterone levels in *age-matched* populations of American men have trended lower over the past generation?

Two landmark studies, one in older men and one in younger men, show that testosterone levels in American men have declined sharply over the past 30 years.

The first study was published in the Journal of Clinical Endocrinology and Metabolism in 2007 (Travison et al). They measured average total testosterone levels of different groups of men, aged 45-80, across three time periods:

...