Newsletter

In my practice, few questions come up as often, or with as much genuine confusion, as the one that opens this article: Is tirzepatide or semaglutide the better choice? Two molecules from the same broad therapeutic family, both extraordinarily effective, both dominating headlines and patient conversation, and yet routinely conflated by patients and, I’ll say

A patient in her late forties came to me last year with the same story I hear almost weekly: disrupted sleep, cycles that had gone erratic, a new and unfamiliar irritability, and a heat that woke her at 3 a.m., drenched. She had already seen two physicians. Both had drawn a single hormone panel, pronounced

A primary care provider (PCP) is the licensed clinician who serves as your first and ongoing point of contact for most health concerns: managing preventive care, treating common illness, coordinating specialists, and holding the longitudinal record of your health over time. A PCP isn’t a one-time visit; it’s a relationship. That relationship compounds in value,

Most of the men and women who come to me about testosterone arrive with a legitimate clinical problem: persistent fatigue, low libido, cognitive fog, and unequivocally low serum testosterone on repeat morning labs consistent with testosterone deficiency. Along with that, they usually ask a fair question: what can go wrong? That deserves a clear-eyed answer,

In clinical practice, testosterone is among the most frequently misinterpreted values on a standard panel. A result within the reference range does not, by itself, confirm normal function. A result below it does not, by itself, confirm deficiency. Context determines both the interpretation and the appropriate next step. As an internal medicine physician who reviews

Testosterone replacement therapy (TRT) increases muscle protein synthesis, reduces nitrogen loss, and supports recovery. In men with confirmed hypogonadism, it can also produce measurable gains in lean body mass. That is the clinical reality. It is not a shortcut, and it is not the same as anabolic steroid use, whatever the internet forums suggest. In

In clinical practice, a heart attack is defined by what happens to the heart muscle, not by what the patient feels. A silent heart attack, or silent myocardial infarction, meets every physiological criterion of a heart attack: a blockage restricts blood flow, the affected heart muscle is deprived of oxygen, and measurable tissue damage occurs.

Add glucagon to a weight loss drug and you burn more fat. That is the pitch on every peptide forum I get asked about, and mechanistically it sounds reasonable: glucagon raises energy expenditure and drives fat oxidation, so retatrutide, which adds a glucagon receptor to the two that tirzepatide already hits, should strip fat and

Patients are often told they need a “cardiac CT” and leave unsure whether they are having a calcium score, a coronary CT angiogram (CCTA), or a different type of scan. That confusion can get in the way of informed decisions. Cardiac CT is not a single test. It is a group of related CT‑based studies

Most patients who come to me after a CAC scan have the same question. The number is higher than expected, and they want to know what to do about it. That question matters more than most people realize, because the answer is not what they expect. A coronary calcium score is not a countdown. It is