The Dr. Z Journal
Thoughtful, evidence-led guidance to help you understand your body and make confident decisions about your health.
The best evidence says daily energy expenditure is stable from your twenties to your sixties. What changes in midlife is body composition, not metabolic rate, and that distinction matters.
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Clear answers for complex health questions, written with care.
An endocrinologist grades the popular hormone-balancing habits. What has real evidence behind it, what is reasonable but unproven, and what is marketing.
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Insulin, cortisol, thyroid and the sex hormones do not act separately. How they interact decides whether metabolic change holds, and which one to investigate first.
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Semaglutide targets one gut-hormone receptor. Tirzepatide targets two. Which matters more depends entirely on who is asking.
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Severe restriction lowers your metabolic rate by more than the weight loss predicts, and the tissue you lose first is not only fat.
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An underactive thyroid is a finding, not a diagnosis. Why the same TSH can mean two entirely different conditions, and the two questions standard bloodwork never asks.
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Eat less and move more fails predictably in insulin resistance, and the scale is the last thing to respond. What to measure instead, and why insulin is the starting point.
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Mouth hunger, stomach hunger, and heart hunger feel similar and need completely different responses. How to tell them apart in the moment, from an endocrinologist.
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Catching up on sleep at the weekend repairs less than it feels like it does, and the irregularity itself carries a cost. Why a fixed wake time may matter as much as hours slept.
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Two thirds of the weight lost on semaglutide came back within a year of stopping it. That is not drug failure. It is a missing layer of care, and here is what belongs in it.
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Women make testosterone too, and both too little and too much cause real symptoms. An endocrinologist on what the test can tell you, what it cannot, and what treatment the evidence actually supports.
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Sleep loss measurably reduces insulin sensitivity, raises cortisol, and increases hunger. Why sleep belongs in a metabolic treatment plan rather than beside it.
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Weight redistribution, insulin resistance, and muscle loss in perimenopause are hormonal, not a failure of willpower. What changes and what to do about it.
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Hashimoto's thyroiditis is the most common cause of hypothyroidism. What the antibodies mean, how the disease progresses, and what is worth doing early.
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Oral semaglutide 25 mg was approved for chronic weight management. An endocrinologist explains the trial results, the dosing rules, and who it suits.
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What metabolic rate really is, why crash dieting slows it, and the small number of changes that reliably raise daily energy expenditure.
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Many people have been dysregulated so long they mistake it for their personality. What a regulated nervous system feels like, and how it affects metabolic health.
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You can eat well, train hard, and still not lose fat if your body is holding a chronic stress state. How cortisol interferes with metabolism and what changes it.
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Some patients on levothyroxine with a normal TSH still feel unwell. An endocrinologist walks through absorption, timing, T3 conversion, and what else to check.
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A meaningful share of weight lost on GLP-1 medications is lean tissue. Here is why it happens, why it matters metabolically, and how to prevent most of it.
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Insulin resistance develops silently for years before glucose rises. Learn the early signs, the tests that catch it, and what actually reverses it.
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Most patients already know what to eat. An endocrinologist on why knowledge rarely changes behavior, and what sits underneath the habits driving metabolic disease.
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Polycystic ovary syndrome is driven largely by insulin resistance. An endocrinologist explains the mechanism, the correct workup, and what treatment should address.
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TSH is a useful screening test and a poor complete picture. An endocrinologist explains free T4, free T3, antibodies, and how to read a thyroid panel properly.
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The WHO now recommends GLP-1 therapy alongside intensive behavioral support. An endocrinologist explains what belongs around the medication and why.
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Standard blood work is built to detect disease, not early metabolic dysfunction. An endocrinologist explains what normal labs miss and which numbers actually matter.
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