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Why PCOS Patients Experience Gut Issues
Dr. Aliabadi explains that hormonal shifts and inflammation in PCOS patients often lead to gut issues like food sensitivities and bloating.
The Parallel Impact of High Androgens on Hair & Ovarian Follicles
Andrew Huberman points out an interesting parallel: just as high androgens miniaturize hair follicles in male/female pattern baldness, they also miniaturize ovarian follicles in PCOS, hindering their development.
Weight Loss as a Motivator: Regulating Insulin Dysfunction
Dr. Aliabadi explains how initial weight loss with GLP-1s motivates PCOS patients because it's the first time something has worked for them, leading to increased activity and improved self-esteem by addressing insulin dysfunction.
Menopause & Endometriosis: The Hidden Risk of Estrogen-Only HRT
Dr. Aliabadi explains that while endometriosis pain often subsides with menopause, reintroducing estrogen through hormone replacement therapy (HRT) can reactivate dormant implants. She stresses a critical, often overlooked point: even after a hysterectomy, endometriosis patients *must* receive progesterone alongside estrogen in HRT to prevent the stimulation of implants and manage other symptoms like anxiety and sleep issues.
GLP-1s & Compounding Pharmacies: Shifting the Narrative
Andrew Huberman discusses how the availability of GLP-1s through compounding pharmacies is altering the public and industry perception of these drugs, reducing prices and challenging the "big pharma" narrative.
PCOS: The Most Common Hormone Disorder in Women & Why It Goes Undiagnosed
This clip defines PCOS as the most common hormone disorder in reproductive-age women, affecting 15% in the US and over 20% in some regions. Dr. Aliabati corrects the misconception that 70% go undiagnosed, stating the real number is over 90%, often due to inadequate treatment beyond just birth control.
The Instagram Pushback Against Hormone-Based Contraception
Andrew Huberman notes a growing pushback, particularly on social media, against hormone-based contraception, with many women feeling it has negatively impacted their health.
Androgens as the "Tip of the Spear" in PCOS
Andrew Huberman and Dr. Aliabadi discuss how elevated androgens, while not the initial cause, appear to be the "tip of the spear" in PCOS, making them and insulin sensitivity key tractable targets for treatment.
80% of Women Get Fibroids: What You Need to Know
Dr. Aliabadi explains the high prevalence of fibroids (80% of women by age 50) and emphasizes that their location is key to symptoms and treatment. She differentiates between small fibroids causing heavy periods and infertility, and large ones causing pressure, outlining treatment options like myomectomy and hysterectomy.
The Hidden Truth About Endometriosis: Pain Doesn't Equal Stage
Dr. Aliabadi debunks the myth that endometriosis stage correlates with pain severity, explaining that even stage one can cause severe pain. She also reveals the challenge of stromal endometriosis, a type often missed on laparoscopy, which causes more inflammation and is resistant to progesterone, requiring surgical removal.
How Birth Control Helps PCOS Symptoms (Despite Mood Concerns)
Dr. Aliabadi explains the mechanism by which birth control pills can alleviate PCOS symptoms: they stimulate sex hormone binding globulin, which binds to testosterone, thereby reducing acne, hair loss, and regulating periods.
Slend: A Progesterone-Only Birth Control Option for PCOS
Dr. Aliabadi mentions Slend, a progesterone-only birth control pill that is very anti-androgenic, offering an alternative for PCOS patients who need contraception and symptom management without estrogen.
The Hidden Fertility Crisis: PCOS & Late Diagnosis
Dr. Aliabadi describes how women, often reassured by society in their 20s and 30s, discover fertility issues in their late 30s and 40s due to undiagnosed PCOS, despite potentially having a high egg count.
Why Pelvic Ultrasounds Should Be Mandatory in Well-Woman Exams
Dr. Aliabati passionately argues that pelvic ultrasounds should be a mandatory part of every well-woman exam, criticizing the current system where many gynecologists don't perform them. She emphasizes that without an ultrasound, proper diagnosis of conditions like PCOS is severely hindered.
Endometriosis Treatment: Pills, Surgery & When to Consider Each
Dr. Aliabadi explains medication options for endometriosis, including progesterone IUDs and estrogen-suppressing pills, their benefits for painful sex and periods, and their limitations (e.g., bone loss). She also details the surgical approach for pain relief and prevention of recurrence, especially for advanced stages.
Metformin's Role in PCOS: Boosting Insulin Sensitivity
Dr. Aliabadi explains that Metformin, commonly prescribed for PCOS, works by making the body more insulin sensitive, opening channels for sugar to clear the blood and convert into energy in cells.
Understanding Normal AMH Levels & Age-Related Decline
Dr. Aliabadi provides normal ranges for Anti-Müllerian Hormone (AMH) by age, noting that AMH levels typically drop precipitously after the late 20s, guiding fertility expectations.
IUDs and Egg Counts: Comprehensive Hormonal Suppression for Endometriosis & PCOS
Dr. Aliabadi recommends progesterone IUDs (Kylina or Mirena) for endometriosis and adenomyosis, especially for patients with mood disorders, due to their local suppression effects. She also emphasizes the critical importance of always checking egg count, even in young patients, to plan for egg freezing if fertility is at risk.
Outpatient Laparoscopic Hysterectomy: A Game Changer for Women's Health
Dr. Aliabadi shares her unique expertise in performing laparoscopic hysterectomies, even for very large uteri (the size of a watermelon), as an outpatient procedure. She highlights how this minimally invasive approach, where patients go home the same day, should be the standard of care but is rarely available due to a lack of specialized training.
Insulin Resistance: The Core Driver of PCOS Symptoms
Dr. Aliabati explains that insulin resistance is at the core of PCOS, affecting 80% of patients, even lean ones. She describes how insulin resistance drives symptoms by increasing androgen production, blocking ovulation, and reducing sex hormone binding globulin, leading to more acne, hair loss, and irregular periods.
Theories Behind Endometriosis: Retrograde Flow, Immune Dysfunction & PCOS Link
Dr. Aliabadi explores the leading hypotheses for endometriosis causes, including retrograde menstruation (blood flowing back into the pelvis), immune system dysfunction (failure to clear implants), and chronic inflammation. She proposes a compelling link between the chronic inflammation seen in PCOS patients and the fueling of endometriosis implants.
The Hidden IVF Challenge: PCOS Egg Quality
Dr. Aliabadi warns that relying solely on high AMH or follicle count can be misleading in PCOS, as the quality of eggs may be poor, leading to suboptimal ovulation and IVF outcomes if PCOS is not addressed.
GLP-1s & Trulicity: Early Success for PCOS Patients (2014)
Dr. Aliabadi describes her early use of GLP-1 medications like Trulicity for PCOS patients starting in 2014, noting significant weight loss and improvements in periods and inflammation due to their impact on insulin.
Chronic Inflammation: A Key Pillar of PCOS
Dr. Aliabadi explains how chronic inflammation in PCOS patients stimulates androgen release, worsens insulin resistance, and affects gut health, leading to common symptoms.
Bourberine for PCOS: Short-Term Pulse Treatment Only
Dr. Aliabadi advises against long-term use of bourberine for PCOS because it lacks a cure and requires ongoing management. She suggests it can be used for short-term "pulse treatment" but prefers other long-term supplements.
How PCOS Pillars Interconnect & Affect Mood
Dr. Aliabadi explains that all the underlying pillars of PCOS work together, and the elevated androgens disrupt dopamine and serotonin, directly impacting mood and leading to feelings of unwellness.
Inositol: A Key Regulator for Insulin Sensitivity
Andrew Huberman and Dr. Aliabadi discuss inositol, particularly different forms like myo-inositol, as a well-known and effective regulator that can significantly improve insulin sensitivity, which is crucial for managing PCOS symptoms.
The Soaring Cost of Egg Freezing & Age Restrictions
Andrew Huberman discusses the escalating cost of egg freezing with age, noting that it becomes less financially viable for older women. He also mentions California's rule: after age 42, only embryos, not eggs, can be frozen.
Corporate Egg Freezing: A Smart Strategy for Employee Retention
Dr. Aliabadi notes that major companies like Google and Facebook pay for employee egg freezing, viewing it as a smart strategy to retain talent and allow women to delay pregnancy while focusing on their careers.
Adenomyosis: Endometriosis's Sister Condition Often Missed on Ultrasound
Dr. Aliabadi introduces adenomyosis, a condition closely related to endometriosis where uterine lining tissue grows into the uterine wall. She explains its symptoms, including heavy and painful periods and recurrent miscarriages, and highlights that it is frequently dismissed and misdiagnosed, even on ultrasound, despite being common.
The Hostile Environment: How Endometriosis Causes Infertility and Miscarriage
Dr. Aliabadi describes how endometriosis creates a 'hostile' inflammatory environment in the pelvis, which is a major cause of infertility. This hostile environment can block fallopian tubes, damage eggs, attack sperm and eggs, impair embryo formation, lead to ectopic pregnancies, and increase the risk of miscarriage.
The Genetic Link to PCOS: Don't Forget Dad's Side
Dr. Aliabadi highlights the strong genetic component of PCOS, emphasizing that insulin resistance and related conditions can be inherited from either parent, not just the mother.
The New Movement: Advocating for Your Own Health Post-Pandemic
Andrew Huberman acknowledges the significant shift towards individuals advocating for their own health, particularly since the pandemic, and notes that even government bodies like AHS listen to his podcast, highlighting its reach and impact.
How Dr. Aliabadi Discovered GLP-1s for PCOS in 2014
Dr. Aliabadi shares how she learned about GLP-1s (specifically Trulicity) for PCOS patients from a cardiologist in 2014, who encouraged her to use it for weight loss and improved metabolic health, even before wider adoption.
Beyond Weight Loss: GLP-1s Regulate Periods & Reduce Inflammation in PCOS
Dr. Aliabadi recounts observing that beyond weight loss, her PCOS patients on Trulicity experienced regular periods and reduced inflammation, attributing these benefits to the medication's regulation of insulin.
AI & Chatbots: The Future of Women's Health Diagnosis?
Dr. Aliabadi suggests that artificial intelligence and robotic chatbots could become game-changers for women's health, potentially diagnosing and treating patients remotely, especially in areas with limited access to OB/GYNs.
Natural Origins of Pharmaceuticals
Dr. Aliabadi and Andrew Huberman discuss how many pharmaceutical drugs, often seen as distinct from natural remedies, are originally derived from plant compounds through a process called bioprospecting. This highlights the foundational role of natural elements in modern medicine.
AI vs. Expert Clinicians: Where Technology Excels and Falls Short
Andrew Huberman and Dr. Aliabadi discuss the potential for AI to surpass some clinicians in diagnosis, while acknowledging that true deep and lateral expertise, like Dr. Aliabadi's, remains irreplaceable by technology.
GLP-1s: The Importance of Behavior Alongside Medication
Andrew Huberman acknowledges the varied reasons for pushback on GLP-1s but stresses that while they help many, continued engagement in healthy behaviors like muscle resistance training, proper diet, exercise, and sleep remains crucial for overall success.
The Rise of PCOS: Potential Causes
Andrew Huberman and Dr. Aliabadi ponder why PCOS seems more prevalent now, discussing potential factors like increased insulin resistance from diet, chronic inflammation from visceral fat, and abnormal G&R neuron firing in the brain.
Ultrasound for Endometriosis: Don't Ignore the 'Smoke' of a Chocolate Cyst
Dr. Aliabadi explains that while ultrasound doesn't always diagnose endometriosis, detecting an endometrioma (chocolate cyst) immediately indicates Stage 3 or 4 endometriosis. She uses the analogy of 'seeing smoke' to emphasize that such findings should never be ignored, as they signify significant disease that is often dismissed.
Endometriosis Acts Like Cancer: Why Hormonal Suppression is Crucial After Surgery
Dr. Aliabadi explains that endometriosis implants, while not cancerous, behave similarly to tumors by forming their own blood supply and nerve fibers. She emphasizes that surgical removal (laparoscopic resection) must be followed by hormonal suppression to prevent recurrence, likening it to chemotherapy after cancer surgery.
The Slow Burn: How Endometriosis Pain Progresses to Chronic Pelvic Pain and Infertility
Dr. Aliabadi details the insidious progression of endometriosis, starting with painful periods that gradually worsen, disrupting life, leading to painful sex, and eventually culminating in chronic pelvic pain. She highlights how many women only get diagnosed after years of suffering or when they struggle with infertility, ending up in fertility clinics.
Beyond Lifestyle: Why "Perfect" Girls Get PCOS
Dr. Aliabadi acknowledges that while lifestyle factors like sleep disruption can contribute to PCOS, she also sees young girls with ideal upbringings and healthy habits developing symptoms, underscoring its multi-system nature beyond just stress.
Metformin Dosing for Lean Individuals & Managing Side Effects
Dr. Aliabadi suggests starting lean individuals on 500mg of Metformin at night to test tolerance, noting potential side effects like nausea and diarrhea, and emphasizing that blood sugar drops are less common at these doses.
OV Supplement Success: Addressing Hormone & Metabolic Health for PCOS
Dr. Aliabadi reiterates the importance of lifestyle and supplements, highlighting that many patients have successfully gotten pregnant by using her OV supplement, which targets hormone and metabolic health.
PCOS vs. Endometriosis: Contrasting Impacts on Egg Quality
Dr. Aliabadi contrasts PCOS, which often leads to many low-quality eggs, with endometriosis, which actively destroys both egg count and quality, highlighting their distinct impacts on fertility.
The Complex Reality of PCOS: Phenotypes, Ovulation, & Core Drivers
Dr. Aliabadi stresses the importance of understanding the four PCOS phenotypes, that most patients don't ovulate consistently, and that inflammation, insulin resistance, and the brain-ovary axis are the main drivers, compounded by genetics and epigenetics.
The 10-Minute Doctor Visit: Why PCOS Goes Undiagnosed
Dr. Aliabadi laments the severe time constraints in the healthcare system, where a typical 10-minute doctor's visit makes it impossible to comprehensively diagnose and explain complex conditions like PCOS, leading to inadequate patient care.
The "Thin End of the Wedge" for PCOS: Tackle Insulin Resistance First
Andrew Huberman emphasizes that for PCOS, the "thin end of the wedge" for self-management is to aggressively address insulin resistance through lifestyle (sunlight, stress reduction, sleep) and supplements, as complex medical interventions require physician guidance.
The OV Supplement: A Starting Point for Undiagnosed PCOS
Dr. Aliabadi presents her OV supplement as a foundational step for women unsure if they have PCOS or what to do, containing key ingredients like inositol, CoQ10, and Vitamin D to address underlying issues.
Freeze Eggs Before 30 for Future Fertility, Especially with PCOS
Dr. Aliabadi reiterates the critical advice for women, especially those with PCOS, to consider freezing their eggs before age 30, emphasizing egg quality over quantity for future fertility.
Egg Freezing After 30: Quality Over Quantity, Even with PCOS
Dr. Aliabadi advises that freezing eggs is always worthwhile, even after 30, emphasizing that while PCOS patients have many follicles, the quality may be lower, so more eggs (e.g., 40) might be needed to ensure one good one.
Podcasts: Empowering Patients with Unprecedented Health Information
Andrew Huberman reflects on how podcasts have revolutionized access to health information, allowing for in-depth discussions like this one that were not widely available just a few years ago, empowering listeners.
Become Your Own Health Advocate: The Power of Podcasts
Dr. Aliabadi emphasizes the importance of self-education through podcasts like Huberman Lab and her own (GMD podcast) to empower women to become their own health advocates, especially when access to informed doctors is limited.
Actionable PCOS Summary: OVI Test & Insulin Sensitivity Control
Andrew Huberman provides a concise summary of immediate actionable steps for women: taking the free OVI self-test and actively managing insulin sensitivity through lifestyle (sleep, stress, diet, exercise) and potentially supplements like inositol or Metformin.
Lifestyle Pillars for PCOS: Sleep, Stress, Diet, & Exercise
Andrew Huberman outlines key lifestyle interventions for improving insulin sensitivity in PCOS: limiting stress, prioritizing excellent sleep, eating a low-inflammation diet (reducing processed foods and starchy carbs, increasing protein), and engaging in high-intensity and resistance training.
The OV Supplement: Comprehensive Support for PCOS
Dr. Aliabadi details the ingredients in her OV supplement, designed to address PCOS, including inositol, Coenzyme Q10, Vitamin D, and wild mulberry leaf, which can block carbohydrate absorption by 40% before heavy meals.
Diagnosing Endometriosis: Listen to the Patient, Painful Periods Are Not Normal
Dr. Aliabadi passionately explains that endometriosis can be diagnosed by simply listening to a patient, rather than relying on often inconclusive tests. She debunks the myth that painful periods are normal, highlighting this as a crucial indicator for self-diagnosis and medical attention.
Recognizing Endometriosis: When Period Pain is NOT Normal
Dr. Aliabadi provides a clear checklist of symptoms indicating that menstrual pain is beyond normal cramping and may signify endometriosis. These include pain disrupting daily life, painful sex, persistent bloating, painful bowel movements, and recurrent UTI-like symptoms with negative cultures.
The Criminality of Undiagnosed Endometriosis: Infertility, Chronic Pain & Opioid Addiction
Dr. Aliabadi highlights the severe, unaddressed consequences of undiagnosed endometriosis, which is a leading cause of chronic pelvic pain and infertility. She points out how many women, desperate for relief, are prescribed opioids by doctors who fail to diagnose the root cause, leading to addiction and suffering.
Male vs. Female Health: Why Endometriosis is a 'National Emergency'
Andrew Huberman and Dr. Aliabadi discuss the stark gender disparity in healthcare, arguing that if men experienced a condition as debilitating and widespread as endometriosis, it would be treated as a national emergency. They highlight historical biases in medical research and the accelerated approval of male-specific drugs like Viagra.
Endometriosis Destroys Egg Quality: Get Your AMH Checked, Even as a Teenager
Dr. Aliabadi emphasizes the critical impact of endometriosis on fertility, explaining how inflammation and endometriomas (chocolate cysts) can severely damage egg quality and count. She urges all endometriosis patients, even as young as 14-18, to get their AMH (egg count) checked to preserve their future fertility.
A Radical Solution for Women's Health: Separate OB from GYN
Dr. Aliabadi proposes a transformative solution for improving women's healthcare: a complete separation of Obstetrics (delivering babies) from Gynecology. She argues this would allow gynecologists to specialize, avoid burnout, and dedicate more focused, quality time to diagnosing and treating complex conditions like PCOS and endometriosis.
Boost Egg Quality with CoQ10 & L-Carnitine
Andrew Huberman asks about the benefits of Coenzyme Q10 and L-carnitine for egg quality (and sperm quality in males), which Dr. Aliabadi confirms, linking their efficacy to reducing inflammation.
The Diagnostic Challenge: No Single Test for PCOS or Inflammation
Dr. Aliabadi points out a major challenge in medicine: the lack of a single, reliable test for either inflammation or PCOS, despite impressive advancements in biomarker evaluation.
The Undiagnosed Infertility Crisis: Why 90% of Women Aren't Diagnosed
This moment highlights the shocking statistic that 90% of women with the leading causes of infertility go undiagnosed, drawing a stark contrast to easily diagnosed conditions like cataracts. It emphasizes the unique challenges and dismissals faced in women's health.
When Doctors Say 'It's in Your Head': The Dismissal of Women's Symptoms
Dr. Aliabati shares her frustration with how women's symptoms are routinely dismissed, minimized, or ignored by medical professionals, leading to millions suffering from undiagnosed conditions like PCOS and endometriosis.
The Textbook Picture of Fertility is False: A Patient's Story of Dismissal
This clip reveals that standard fertility charts are misleading because they don't account for conditions like PCOS and endometriosis. It includes a striking anecdote of a 24-year-old woman whose gynecologist refused to check her egg count, deeming it 'malpractice' because she was 'too young' for fertility issues.
You Don't Need a Doctor to Diagnose PCOS or Endometriosis
Dr. Aliabati empowers listeners by stating that they can learn to diagnose PCOS and endometriosis themselves, highlighting the widespread failure of doctors to identify these leading causes of infertility. She even jokes about robotic doctors being better at diagnosis.
Genes Load the Gun, Environment Pulls the Trigger for PCOS
Dr. Aliabadi explains the role of epigenetics in PCOS, using the analogy that while genes load the gun (predisposition), lifestyle factors like stress, sleep, and diet pull the trigger for symptom expression.
The Hidden Trauma of a Young Girl with PCOS
Dr. Aliabadi vividly describes the emotional and psychological toll on a young girl suffering from undiagnosed PCOS, highlighting feelings of anxiety, body image issues, and frustration with ineffective treatments.
Why Dr. Aliabadi Advocates for Dismissed PCOS Patients
Dr. Aliabadi expresses her deep empathy and commitment to advocating for PCOS patients who are often dismissed by medical professionals, sharing how their trauma has become her own.
AMH to Follicle Ratio: A Quick Calculation for Ovarian Health
Dr. Aliabadi provides a simple rule of thumb for AMH: every 0.1 of AMH averages to one follicle. She then highlights how an AMH of 3 with 30 follicles at age 40 indicates PCOS, emphasizing the need for proper diagnosis.
The Misleading High Egg Count in PCOS
Dr. Aliabadi explains that PCOS patients often have a "falsely high" egg count and elevated AMH (anti-Müllerian hormone) because of numerous tiny, unovulated follicles, which can be misleading for fertility assessment.
PCOS & Egg Freezing: Why Earlier is Better
Dr. Aliabadi advises PCOS patients to consider freezing eggs by age 28-30, not due to low count (which is often high), but because the quality of eggs declines with age, impacting IVF success.
Shocking Truth: PCOS Often Undiagnosed by Fertility Doctors
Dr. Aliabadi reveals a concerning issue: many patients go through fertility clinics without being diagnosed with PCOS, even by their fertility doctors, underscoring a significant gap in medical care.
Egg to Embryo Conversion Rates: Age Matters for IVF Success
Dr. Aliabadi breaks down the significant impact of age on IVF success, explaining that at 25-28, three eggs might make one embryo, but at 40, it could take 10-15 eggs for a single embryo.
The Unjust Cost of Egg Freezing: Why Young Women Can't Afford It
Dr. Aliabadi criticizes the lack of insurance coverage for egg freezing, highlighting the paradox that young women with high-quality eggs often can't afford it, while older women who can afford it face lower quality.
The OB/GYN Desert: 50% of US Counties Without a Specialist
Dr. Aliabadi exposes a critical healthcare access issue: 50% of counties in the US lack an OB/GYN, forcing many women to drive hours for essential care, highlighting a systemic problem in women's health.
The Cataract Analogy: Why PCOS Remains Undiagnosed
Dr. Aliabadi uses the analogy of cataracts – a clear diagnosis in ophthalmology – to highlight the shocking reality that PCOS, the leading cause of infertility, is undiagnosed in 90% of women, pointing to a systemic issue in women's healthcare.
PCOS: A Complex Multi-System Dysfunction
Dr. Aliabadi clarifies that PCOS is not caused by a single factor but is a complex multi-system dysfunction involving the immune system, insulin resistance, the brain-pituitary-ovary axis, genetics, and epigenetics.
Why Birth Control Alone Isn't Enough for PCOS
Dr. Aliabadi emphasizes that a comprehensive treatment plan is crucial for PCOS, as it's a multi-system dysfunction, and simply "throwing birth control at all these pillars" without addressing the underlying causes is insufficient.
Why Birth Control May Worsen Mood in PCOS Patients
Dr. Aliabadi explains her reluctance to prescribe birth control as a first-line treatment for PCOS, noting that many patients, already prone to anxiety and depression, complain of increased mood issues, eating, or feeling unwell on it.
First Steps for PCOS Management: Lifestyle Interventions
Dr. Aliabadi outlines initial lifestyle interventions for PCOS, focusing on epigenetics: regular exercise (like walking after meals), good sleep, healthy non-inflammatory diet (avoiding processed foods), and stress reduction.
Insulin Resistance: The Main Pillar to Address in PCOS
Dr. Aliabadi emphasizes that insulin resistance is a primary pillar to address in PCOS, as lowering insulin directly reduces visceral fat, inflammation, and ovarian androgen secretion, improving overall symptoms.
Metformin Dosing & Managing Side Effects for PCOS
Dr. Aliabadi advises starting Metformin slowly, typically 750mg twice daily, to manage potential GI side effects like diarrhea and nausea, and explains how to gradually increase the dose if needed for ovulation and symptom control.
Is Your Metformin Dose Effective? & Discovering OV Calculator
Dr. Aliabadi warns that low doses of Metformin (e.g., 500mg once a day) are often ineffective for PCOS. She then introduces her free online platform, OV (ovii.com), where women can take a quiz based on her algorithm to assess their likelihood of having PCOS.
The Power of Supplements in PCOS Management
Dr. Aliabadi highlights that PCOS is one of the few conditions where supplements can make a huge difference, especially for patients lacking doctor access or being dismissed, by addressing insulin sensitivity.
Inositol: A Key Supplement for PCOS Insulin Sensitivity
Dr. Aliabadi explains that the OV supplement, containing different forms of inositol, significantly improves insulin sensitivity for PCOS patients, leading to regular periods and even pregnancy.
Vitamin D's Surprising Link to Insulin Resistance & PCOS
Dr. Aliabadi discusses the choice between Metformin and supplements (like inositol) for PCOS, and highlights a lesser-known but crucial fact: low vitamin D levels contribute to insulin resistance, making it a key factor in PCOS management.
The Crucial Role of Sunlight & Vitamin D for Mitochondria
Andrew Huberman emphasizes the importance of sunlight for vitamin D and mitochondrial function, explaining how modern indoor lifestyles and artificial lighting disrupt energy processing and the protective benefits of natural red and infrared light.
Insulin Sensitivity: Why It's a Good Thing
Dr. Aliabadi clarifies a common misconception: insulin sensitivity is beneficial, not bad. Increasing insulin sensitivity helps alleviate PCOS symptoms, contrasting it with insulin resistance.
Actionable Steps to Lower Insulin Resistance for PCOS
Dr. Aliabadi provides a comprehensive list of strategies to lower insulin resistance in PCOS patients, including Metformin or supplements, exercise, a low-carbohydrate diet, and reducing stress and cortisol.
The True Mechanism of GLP-1s: Insulin Regulation, Not Just Appetite
Dr. Aliabadi clarifies that while appetite suppression is a side effect, the primary function of GLP-1s is to regulate insulin, acting as a "glucose scavenger" to clear sugar from the blood and enhance insulin sensitivity, which is vital for PCOS patients.
GLP-1s: A Life-Changing Treatment for PCOS Patients
Dr. Aliabadi expresses her frustration with negative comments about GLP-1s, emphasizing that for PCOS patients with insulin resistance, overweight, and ovulation issues, these medications have been "oxygen" and life-changing since 2014.
Long-Term PCOS Support: Essential Supplements for Insulin Sensitivity
Dr. Aliabadi lists several beneficial long-term supplements for PCOS, including Vitamin D, curcumin, chromium, and inositol, all aimed at increasing insulin sensitivity and lowering inflammation, while reiterating bourberine's short-term role.
Metformin's Safety & Personal Use for Pre-Diabetes
Andrew Huberman shares his personal experience using low-dose Metformin for pre-diabetes, reducing his hemoglobin A1C from 5.6 to 4.8, highlighting its safety and effectiveness for those with a family history of diabetes.
PCOS Treatment Ladder: Supplements, Metformin, Then GLP-1s
Dr. Aliabadi outlines her preferred treatment hierarchy for PCOS: starting with supplements, then Metformin if needed, and finally GLP-1s. She advises against starting Metformin and GLP-1s simultaneously due to overlapping nausea side effects.
GLP-1s for Morbid Obesity: 24lbs Average Loss in 4 Months
Dr. Aliabadi shares her clinical experience with GLP-1s for morbidly obese patients, reporting an average weight loss of 24 pounds in four months when used correctly, which significantly motivates patients.
Microdosing GLP-1s: Benefits Without Nausea
Andrew Huberman explains that GLP-1 peptides from compounding pharmacies are allowing people to "microdose" at lower thresholds, avoiding nausea while still benefiting from appetite suppression, improved insulin sensitivity, and reduced inflammation.
GLP-1s: Beyond Body, Impacting Brain Chemistry & Mood
Dr. Aliabadi and Andrew Huberman discuss the "anti-depressant function" of GLP-1s, suggesting they adjust brain chemistry, leading to improved mood beyond just the physical changes, and quieting the "eat, eat, eat" noise.
The Constant Battle: Brain Disregulation & Binge Eating in PCOS
Dr. Aliabadi explains that the constant "eat, eat, eat" voice in PCOS patients is not a lack of willpower but a brain disregulation of dopamine and serotonin, causing brutal anxiety and a continuous battle with food.
Boosting Fertility in PCOS: Success Rates & Treatment Steps
Dr. Aliabadi discusses successful strategies for PCOS patients to get pregnant, emphasizing regulating periods with supplements (like OV), Metformin, and then trying medications like Letrozole or Clomid before resorting to fertility doctors.
Letrozole & Clomid: First-Line Fertility Boosters for PCOS
Dr. Aliabadi introduces Letrozole and Clomid as two effective medications doctors can prescribe in-office to regulate the hypothalamus-pituitary-ovarian axis and induce ovulation in PCOS patients, with Letrozole having higher success rates.
How Long to Try for Pregnancy Before Seeing a Fertility Doctor
Dr. Aliabadi advises PCOS patients to try conceiving for 6 months to a year, depending on age and if PCOS is managed, before seeing a fertility doctor, noting general success rates for couples.
The Decades-Long Struggle for an Endometriosis Diagnosis
Dr. Aliabadi exposes the devastating reality that endometriosis patients face, often waiting 9-11 years and seeing 5-10 (or even 50) doctors before receiving a diagnosis. She highlights the profound emotional toll of prolonged dismissal and the desperate need for validation these patients experience.
Key Actionables for PCOS: Insulin Resistance & OV Test
Andrew Huberman summarizes the initial actionable steps for PCOS management: taking the free OVII self-test, and then focusing on improving insulin sensitivity through lifestyle (sleep, stress, diet, exercise) and potentially supplements like inositol or Metformin.
Women's Pain: Minimized, Dismissed, or Normalized in Healthcare
Dr. Aliabadi and Andrew Huberman discuss the pervasive issue of women's pain being minimized, dismissed, or normalized within the healthcare system and even by family members. This leads to debilitating conditions being overlooked, as women are told their severe pain is 'normal' or 'not that bad.'
The Flawed System: Why Endometriosis is Missed Even During Surgery
Dr. Aliabadi exposes a critical flaw in endometriosis treatment: only 1 in 100 gynecologists is trained for specialized laparoscopic surgery, leading to many patients being told they don't have endometriosis post-op. She explains how less obvious forms, like stromal endometriosis, are frequently missed by untrained surgeons, leaving patients in prolonged pain and despair.
Endometriosis: More Than 20% of Women Affected & Why It's a 'National Emergency'
Dr. Aliabadi strongly challenges the commonly cited 10% prevalence of endometriosis, asserting it's likely 'north of 20%' due to widespread underdiagnosis. She emphasizes that this makes endometriosis a condition affecting 'every family' and calls for an end to the pervasive dismissal of these millions of suffering women.
Bourberine: An Over-the-Counter Alternative to Metformin?
Andrew Huberman asks about bourberine, an over-the-counter supplement derived from tree bark, known for its potent glucose-scavenging properties similar to Metformin, and its advisability.
The Hidden Cost of OB/GYN Burnout: 80 Babies a Month & Missed Diagnoses
Dr. Aliabadi reveals the extreme burnout faced by OB/GYNs, recalling her own experience delivering 80 babies a month while pregnant. She explains how this exhaustion prevents doctors from taking the time needed to properly diagnose and educate patients on complex conditions like endometriosis and PCOS, leading to poor patient compliance and missed care.
Endometriosis Checklist: Key Symptoms & Actions for Women of All Ages
Andrew Huberman summarizes Dr. Aliabadi's crucial advice for women: recognize key endometriosis symptoms like painful periods, UTI issues, GI pain, and bloating. He emphasizes the importance of understanding AMH and ultrasound, and taking symptoms seriously at any age, from 14 to 42, to seek proper diagnosis and care.
Hormonal Suppression for Endometriosis: Progesterone Birth Control Can Save Fertility
Dr. Aliabadi explains that endometriosis implants thrive on estrogen but are suppressed by progesterone. She advocates for progesterone-only birth control pills as a powerful hormonal suppression therapy, stating they can make 'the difference of fertility and not having children' for endometriosis patients.
The 6 Buckets of Fertility Assessment: What Doctors Miss & How to Check Yourself
Dr. Aliabadi outlines her comprehensive "six buckets" framework for assessing fertility, which patients can use to advocate for themselves. She details female factors (hormones, egg count, STDs), male factors (sperm analysis, lifestyle), tubal/anatomy factors (fibroids, uterine septum, open tubes), endometriosis, PCOS, and autoimmune conditions, empowering listeners to ask for specific tests and avoid "unexplained infertility" diagnoses.
Beyond the Pap Smear: What a TRUE Well-Woman Exam Should Cover
Dr. Aliabadi contrasts her comprehensive approach to a "well-woman exam" with the inadequate standard practiced today. She details the extensive checks she performs, including fertility, endometriosis, PCOS, egg count, pelvic ultrasound, various genetic markers, hormones, bone density, and mental health screenings. She emphasizes that the current standard exam is insufficient and that pelvic ultrasound should be paramount.
Understanding PMDD: The Severe PMS That Destroys Relationships & How to Treat It
Dr. Aliabadi provides a thorough explanation of PMDD (Premenstrual Dysphoric Disorder), describing it as a severe, devastating form of PMS where women "destroy all their relationships" for two weeks a month. She highlights the high suicide risk and explains it's the brain's extreme reaction to normal hormonal changes. She offers specific treatment options including Yas birth control, pulsatile SSRIs like Prozac or Zoloft (taken only 10-14 days a month), and hormone replacement for perimenopausal women.
The Golden Rule for PCOS Fertility: Freeze Eggs Before 30
Dr. Aliabadi strongly advises single women with PCOS in their late 20s to freeze their eggs before age 30, not for quantity (which is often high), but for the crucial factor of egg quality, which diminishes with age.
"The First Time in My Life I Know What It Means to Be Happy"
Dr. Aliabadi shares a moving story of a 26-year-old PCOS patient whose confidence and happiness were completely transformed after treatment with GLP-1s, highlighting the profound emotional impact of effective care.
Breast Cancer Screening: Why Mammograms at 40 is a Misleading Message
Dr. Aliabadi asserts that knowing one's lifetime breast cancer risk is mandatory for all women. She challenges the standard "mammograms at 40" message, explaining that it's only for low-risk patients. For women with a 20% or higher lifetime risk, or a first-degree relative with breast cancer, she advises starting breast imaging as early as age 30, citing cases of advanced cancer in younger women.
"They Called Me Crazy": A Doctor's Fight for Her Own Breast Cancer Diagnosis
Dr. Aliabadi shares her deeply personal and shocking story of having to fight her own doctors for a preventative double mastectomy despite having atypia and a 37% lifetime breast cancer risk. She was dismissed as "crazy" and "paranoid," only for cancer to be found in her removed tissue. This powerful anecdote exemplifies the systemic dismissal women face and underscores the critical importance of self-advocacy and knowing your risk.
Your PCOS Treatment Pathway: From Supplements to Fertility Doctors
Dr. Aliabadi outlines a clear progression for PCOS treatment, starting with the OV supplement, then Metformin, GLP-1s for weight loss, and if trying to conceive, Letrozole or Clomid, before consulting a fertility doctor.
The Hidden Link: Over 50% of PCOS Patients May Also Have Endometriosis
Dr. Aliabadi shares her strong, yet un-published, clinical observation that over 50% of PCOS patients also have endometriosis, emphasizing that dismissing painful periods in PCOS patients can lead to continued infertility due to this co-occurrence.
50 Years of Pain: The Patient Who Just Wanted to Hear 'You're Not Crazy'
Dr. Aliabadi shares a heartbreaking story of a 50-year-old endometriosis patient who, after decades of suffering, lost jobs, inability to marry due to painful sex, and countless emergency room visits, simply pleaded with her to 'not call me crazy.' This illustrates the profound trauma of medical dismissal and the desperate need for validation among women with chronic pain.
Dr. Aliabadi's Dream: A National Call to Validate Women's Pain
Dr. Aliabadi shares her powerful dream: to address the nation, telling women that their symptoms and pain are real, not in their heads, and that they deserve to be heard and treated.
A Call to Action for Men: Understand PCOS for Your Loved Ones
Dr. Aliabadi makes a passionate plea to male listeners to engage with this information for the sake of their daughters, sisters, and partners, emphasizing how common and dismissed PCOS is in women's health.
"You Are Not Crazy": Validating PCOS Symptoms
Dr. Aliabadi delivers a powerful message of validation to women with PCOS, assuring them that their symptoms – weight gain, acne, hair loss, infertility – are real and stem from underlying conditions, not their imagination.
Be Your Own Advocate: How to Get an Endometriosis Diagnosis
Dr. Aliabadi empowers women to be their own health advocates, urging them to educate themselves on endometriosis symptoms, write down questions, and demand specific tests like AMH and pelvic ultrasounds. She advises persistence, even suggesting to threaten seeking another doctor if dismissed, to ensure proper diagnosis.
"Wave After Wave": The Undiagnosed Struggles Women Face in Healthcare
Dr. Aliabadi passionately describes the continuous "wave after wave" of health challenges women navigate throughout their lives, from PCOS and endometriosis in youth to infertility, postpartum depression, and undiagnosed perimenopause. She highlights the pervasive dismissal women experience in the healthcare system and the emotional toll it takes. The host's powerful response underscores the gravity of the issue.
Debunking PCOS Myths: Beyond Testosterone & Cysts
Dr. Aliabadi debunks several common myths about PCOS diagnosis, clarifying that normal testosterone, absence of ovarian cysts, normal weight, or regular periods do not rule out PCOS.
GLP-1s: Quieting the Brain & Reducing Alcohol Cravings
Dr. Aliabadi highlights that a significant benefit of GLP-1s is "quieting the brain" for PCOS patients, reducing constant anxiety and also diminishing cravings for alcohol, which she links to sugar cravings.
When a Woman Says Something's Wrong: It's 99% True, Not 'Crazy' or 'Stress-Related'
Dr. Aliabadi emphatically states that when a woman reports that something is wrong with her body, it's true 99% of the time, and dismissing it as 'crazy' or 'stress-related' is 'criminal.' Andrew supports this by highlighting women's heightened physiological awareness due to their hormonal cycles.
"Every Woman Should Have a Pelvic Ultrasound": How to Advocate for Your Health
Dr. Aliabadi empowers women to demand pelvic ultrasounds as a standard part of their well-woman exams, likening it to routine male exams. She highlights that ultrasounds are quick and essential for diagnosing conditions like fibroids, endometriosis, and uterine septums, which manual exams miss. She encourages women to be informed advocates.