Female Hormone Health, PCOS, Endometriosis, Fertility & Breast Cancer | Dr. Thaïs Aliabadi

**Thaïs Aliabadi** (0:00)
Every single ophthalmologist knows about cataract.

**Andrew Huberman** (0:03)
Yes, most common form of blindness.

**Thaïs Aliabadi** (0:06)
So it would be rare for you to go to an ophthalmologist with cataract and not get diagnosed, correct?

**Andrew Huberman** (0:11)
Correct.

**Thaïs Aliabadi** (0:12)
So why is it that the leading cause of infertility on this planet, 90% of women are not diagnosed? Women's health is very different than other fields of medicine. It's a different monster. It's that cataract patient that goes to 20 ophthalmologist and she keeps saying, I can't see. And the ophthalmologist says, you're crazy. There's nothing wrong with you.

**Andrew Huberman** (0:37)
Welcome to the Huberman Lab Podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Dr. Thaïs Aliabadi, an obstetrician, gynecologist and surgeon, and one of the most sought-after experts and trusted voices in women's health. Today we discuss crucial topics in women's reproductive and general health, including PCOS, endometriosis, breast cancer, perimenopause, and menopause. Dr. Aliabadi explains why so many cases of PCOS and endometriosis go undiagnosed, and how many physicians unfortunately write off things like pain, hair thinning, mood changes, and other symptoms as normal, when in fact they reflect larger underlying issues that can impair fertility and lead to body-wide health complications. And she explains the key things to do to diagnose and treat PCOS and endometriosis, everything from how to adjust insulin sensitivity to hormone replacement, over-the-counter and prescription-based protocols. As you'll soon hear, Dr. Aliabadi is incredibly passionate about women's health and has developed various zero-cost online tools that women of any age can use to assess their risk for things like breast cancer, PCOS and endometriosis. I should also emphasize that today's discussion is relevant to women of all ages. Many of the conditions we discuss are starting to show up in women even in their mid-teens and twenties and can carry serious health risks. Dr. Aliabadi makes very clear that often these issues can be resolved, but that it requires knowing the telltale signs and taking the appropriate steps. She explains that, alas, many doctors and even OBGYNs are unaware of those telltale markers. So what you're about to hear is an extremely eye-opening conversation that, thanks to Dr. Aliabadi's passion for and expertise in women's health, could very well save someone's mental and physical health, their fertility, and in the case of breast cancer screening, even their life. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public. In keeping with that theme, today's episode does include sponsors. And now for my discussion with Dr. Thaïs Aliabadi. Dr. Thaïs Aliabadi, welcome.

**Thaïs Aliabadi** (2:58)
Thank you for having me.

**Andrew Huberman** (3:00)
Super excited to talk about today's topics, and there are a lot of them, because I think these days we hear a tremendous amount about how fertility rates are dropping. We hear that sperm counts are dropping. We hear that things like PCOS, which you'll explain to us, are on the rise. I'm curious if they're on the rise, or they're just being detected, or not detected as much. Let's start off quite simply, and just bracket for people, what the sort of standard trajectory of fertility looks like for the quote unquote average woman. I realize there's no such thing as an average woman, but I think we hear so much these days about people are waiting to have kids. Some people are freezing eggs early, all this. If we were to just march through and say, you know, what fraction of healthy women are fertile in their, say, 20 to 25, 25 to 30, and march that forward, just to give people a sense of what the data and your experience really tell us.

**Thaïs Aliabadi** (4:00)
First of all, before I go there, I want to tell you something. I want to tell you how excited I am to be here today, and I'll tell you why. Because I've been in women's health for 30 years, and one thing I learned is that women's symptoms get dismissed, minimized, or completely ignored, right? It's normalized. These women, every time they complain, they say, it's in your head, you're anxious, you're stressed, you know, it's normal, it's part of being a woman. And behind these dismissals are millions and millions of women suffering undiagnosed PCOS, endometriosis, chronic pelvic pain, infertility, which we're going to cover right now, and so many other issues because no one takes the time to listen to them. And the reason I'm so excited to be on this podcast is I want to shed light on these topics, especially endometriosis and PCOS, because they're the top leading causes of infertility on this planet. Majority of these patients are never diagnosed, majority. And that's why I'm so excited to be here. And I love talking about fertility because the reason these women end up in a fertility clinic in the first place, majority of them have undiagnosed PCOS and endometriosis. So we are born with certain number of eggs, millions of them. And we don't make more eggs after we're born. And as we go through life, we start losing these eggs. Until at about menopause, we have about 1,000 of them left. So as we get older, the number goes down, but the quality also declines. The issue is PCOS and endometriosis affect your egg count and your egg quality. So because 90% of these patients are never diagnosed, what happens is they start losing their eggs. Let's say, take an endometriosis patient, which we're going to get into it. But they start losing these eggs, the quality starts shooting down. Some of them by age 30, they have zero eggs left. And these are patients who bounce from doctor to doctor and their symptoms are dismissed. They're being told that their painful period is normal, that their painful sex is in their head, that they're exaggerating their pain. And meanwhile, their ovarian reserve is completely depleting and no one is addressing that. Andrew, I've always said this, and I really mean it, if every 20-year-old in this country would go through my office once at age 20, I would shut down these fertility clinics. Because where do these patients end up? In fertility clinics. That's why these doctors are so busy and that's why these patients go bankrupt, selling their homes, selling everything they have to pay for an IVF cycle that could have been completely blocked had they been diagnosed correctly and treated at a very young age. And I'm talking, sometimes I treat 13-year-olds with endometriosis. I have right now in my practice a girl at 14 with endometriosis whose egg count is the egg count of a 40-year-old. That's why I can't sit here and generalize that if you're in your 20s, you're going to be fine. It's not true. You need to know at a very young age, every girl on this planet needs to be screened for endometriosis, for PCOS, and they need to know their egg count. Egg count AMH, anti-malarion hormone, is a simple blood test. It's covered by most insurances. It needs to be offered. If you don't want to offer it to your young patients because, you know, teenagers are tricky because they have so many eggs.