A Modern Pharmacist

lee

Most of what gets called healthy is just normal. Normal is not the same as optimal.
I am Lee, a prescribing pharmacist working in the NHS. I also live with diabetes, so this is not theory for me. Every week I break down the tests, numbers and decisions that actually move the needle on long term health. The biomarkers I run on myself. The tests I cannot order on the NHS but wish I could. What it is really like navigating the health system as both the person prescribing and the person managing a condition every day.
No fluff. Just evidence, from a clinician who holds himself to the same standard

Play

Open in

36 episodes
a few times a week
Avg 28 min
English

Episodes 36

Newest Oldest Longest

All20 Unplayed20 In progress0 Played0

Counted on this page — what you have heard stays on this device, so it is not something the list can be paged by.

Sunday · 25 min
The Rare Diabetes Doctors Miss Until It's Too Late
This episode is personal. I have GCK-MODY, a genetic form of raised blood sugar that’s often mistaken for type 2 diabetes or pre-diabetes, and in most cases needs no treatment. I share my own diagnosis and what the evidence says about living with it. I explain glucokinase, the enzyme that acts as your body’s glucose thermostat, and why in GCK-MODY that thermostat is simply set a little higher: around 6–7 mmol/L instead of 4–5. It affects about 1 in 1,000 people, most of whom don’t know they have it. I cover why HbA1c testing labels so many people with GCK-MODY as diabetic, why being called type 2 is the real problem, and how to get tested on the NHS. Then the evidence: when people stop treatment their blood sugar doesn’t change, and after around 50 years of exposure serious complications are as rare as in relatives without the gene, with mild changes in the eye the one exception. I also cover the first drug shown to reset the thermostat, and why in pregnancy it’s the baby’s genes that decide how it’s managed. Sources: Chakera et al. (Diabetes Care, 2014), Steele et al. (JAMA, 2014), Steele et al. (PLoS One, 2013), Stride et al. (Diabetologia, 2014), Shepherd et al. (Diabetologia, 2018), Stanik et al. (Diabetologia, 2014), Chow et al. (Diabetes, 2023), Caswell et al. (Clinical Chemistry, 2020), NHS Genomic Test Directory (R142), diabetesgenes.org. This is informational purposes only, not medical advice. If you can’t get seen by your own physician, by all means do so, but always speak to your own healthcare provider.
Thursday · 34 min
High Cholesterol on Your Blood Test? Here’s What to Do Next
ou’ve had a blood test and your LDL cholesterol has come back high, but nobody has told you what to do next. In this episode I walk through the steps I’d want anyone in that position to take. I start with why LDL rises in the first place: how much the liver produces, how much you absorb, and above all how well your LDL receptors clear it. Then the secondary causes to rule out, from an underactive thyroid to liver and kidney problems, medicines and diet. I explain how LDL is actually calculated, when fasting matters, and why ApoB and Lp(a) give you a much clearer picture than a standard cholesterol test. Next, lifetime risk. A 10-year risk score can look reassuring in a young person with high cholesterol, but the damage depends on dose and time, a bit like pack-years for smoking. I cover the evidence on “cholesterol-years”, how familial hypercholesterolaemia is assessed and tested for on the NHS, and what a calcium score really measures, including why a score of zero doesn’t rule out plaque. Finally, treatment: lifestyle as the foundation, and where statins, ezetimibe and PCSK9 inhibitors fit in. Sources: Khera et al. (JACC, 2016), Navar-Boggan et al. (Circulation, 2015), Ference et al. (JACC, 2012), Nordestgaard et al. (European Heart Journal, 2013), Patel et al. (ATVB, 2021), Burgess et al. (JAMA Cardiology, 2018), ESC/EAS dyslipidaemia guidelines (2019), Agatston et al. (JACC, 1990), NICE NG238 and CG71, NHS Genomic Medicine Service. This is informational purposes only, not medical advice. If you can’t get seen by your own physician, by all means do so, but always speak to your own healthcare provider.
November 1 · 35 min
Who I Am and Why Prevention Matters
A more relaxed, conversational episode this week. I reintroduce myself, talk about my background as a pharmacist and why I started A Modern Pharmacist, and share my general thoughts on prevention, from why “normal” isn’t always optimal to why so many of us wait too long to look after our long-term health. If you’re new to the podcast, this is a good place to start. If you have a question for a future episode, send it to me on Instagram @leesmithhealth. This is informational purposes only, not medical advice. If you can’t get seen by your own physician, by all means do so, but always speak to your own healthcare provider.
October 29 · 30 min
How to Reverse Insulin Resistance: What the Evidence Shows
Insulin resistance can develop for years while your blood sugar still looks normal, quietly raising your risk of type 2 diabetes and heart disease. In this episode I focus on what actually reverses and prevents it, with numbers from the studies. I start with a quick recap: insulin resistance is largely a problem of fat building up in the wrong places, the liver and muscle, where it blocks insulin’s signal. I explain why that raises heart risk, through small dense LDL, ApoB and damage to the nitric oxide pathway, and how to test for it, including fasting insulin, HOMA-IR and the triglyceride-to-HDL ratio. Then the practical part. Losing just 5% of your weight cut liver fat by 40% in one trial. Combining cardio and weights beats either alone, and working muscle can take in glucose without insulin. Each 10% more muscle is linked to 11% lower insulin resistance. I explain what “low carb” actually means in grams, why a 2-minute walk every 20 minutes lowers your glucose and insulin by about a quarter, and why sleeping 6 hours instead of 7.5 raised insulin resistance by around 15%. I finish with stress, cortisol and the role of medication. Sources: DeFronzo (Diabetes, 2009), Magkos et al. (Cell Metabolism, 2016), Diabetes Prevention Program (NEJM, 2002), DiRECT (The Lancet, 2018), HART-D (JAMA, 2010), Srikanthan & Karlamangla (JCEM, 2011), Goldenberg et al. (BMJ, 2021), Dunstan et al. (Diabetes Care, 2012), Zuraikat et al. (Diabetes Care, 2023), Petersen & Shulman (Physiological Reviews, 2018). This is informational purposes only, not medical advice. If you can’t get seen by your own physician, by all means do so, but always speak to your own healthcare provider.
October 26 · 29 min
Sleep Explained: Stages, Efficiency and How to Sleep Better
Sleep takes up a third of our lives, and despite leaving us vulnerable for all those hours, it’s something we’ve never evolved our way out of. In this episode I explain why sleep matters and how to improve it. I start with what happens in each stage of sleep: N2 for skills and learning, deep sleep (N3) for long-term memory and physical recovery, and REM for dreaming, emotional processing and connecting ideas. I explain why sleeping 6 hours instead of 8 costs you far more than a quarter of your REM sleep. Then chronotype: whether you’re a morning lark or a night owl, how much is genetic, and how it changes with age. The second half is practical. I cover the difference between time in bed and actual sleep, what sleep efficiency means, and why falling asleep instantly can signal sleep debt. Then how to improve your sleep, from consistent wake times and morning daylight to a cool room and a warm bath, and what to avoid: alcohol, late caffeine, and relying on sleeping tablets instead of CBT-I. Sources: AASM sleep staging, Horne & Östberg (1976), Jones et al. (Nature Communications, 2019), Haghayegh et al. (Sleep Medicine Reviews, 2019), Kripke et al. (BMJ Open, 2012), NICE insomnia guidance, NHS caffeine guidance, The Peter Attia Drive #221. This is informational purposes only, not medical advice. If you can’t get seen by your own physician, by all means do so, but always speak to your own healthcare provider.
October 23 · 34 min
AMA: Statins, Creatine, Cholesterol and Protecting Your Heart
In this Ask Me Anything episode I answer seven questions on heart health, metabolic health, medication and training: the ones I get asked most often, plus two sent in on Instagram. I start with the vitamin stack question and why testing beats guessing, with one UK exception: vitamin D in autumn and winter. Then why being young and fit doesn't mean you can skip a cholesterol check, including ApoB and Lp(a), a genetic risk factor you only need to test once. I go through the evidence on statin side effects, including the SAMSON trial, where 90% of symptoms also appeared on placebo, and a meta-analysis of over 150,000 people showing only about 1 in 15 muscle complaints in the first year were caused by the statin. I also cover whether creatine is safe and why it can make your kidney blood tests look worse than they are, whether to prioritise cardio or weights if you only have three hours a week, and how to check your blood pressure properly at home. Finally, the big one: what you can do now to protect your heart for the future. Sources: CTT Collaboration (The Lancet, 2022), SAMSON (NEJM 2020; JACC 2021), StatinWISE (BMJ, 2021), EAS Lp(a) consensus (2022), HEART UK (2019), NICE NG136 and NG203, UK vitamin D guidance. This is informational purposes only, not medical advice. If you can't get seen by your own physician, by all means do so, but always speak to your own healthcare provider.
October 18 · 29 min
Iron Explained: Why It Matters, Testing and Treatment
Iron is one of the most important minerals in your body, yet most people only find out they're low once they're anaemic, and that's one of the last signs to appear. In this episode I give a general overview of iron, from why it matters to how to test and treat it. I start with what iron does: 6.5% of the body's enzymes depend on it, it sits at the centre of haem in haemoglobin, and the body uses zinc instead when iron runs short. Then how much you need: we lose 1–2 mg a day and absorb only about 10% of what we eat, and needs differ for men, menstruating women and pregnancy. I cover the best food sources and the symptoms of low iron, including restless legs and craving ice. Next, testing: why a full blood count isn't enough, what ferritin, transferrin saturation and TIBC tell you, and why inflammation can make ferritin look normal. Finally, treatment: finding the cause first, why once-daily or alternate-day dosing works better because of hepcidin, why a 65 mg tablet is repaying a debt rather than overshooting, and when IV iron is needed. Sources: NHS iron guidance, NICE CKS, British Society of Gastroenterology guidelines (Gut, 2021), AGA guidelines (2020), Moretti 2015 (Blood), von Siebenthal 2023, The Peter Attia Drive AMA #58. This is informational purposes only, not medical advice. If you can't get seen by your own physician, by all means do so, but always speak to your own healthcare provider.
October 15 · 27 min
Is Microdosing GLP-1s Backed by Any Evidence?
Around 1 in 7 people on GLP-1s say they've tried microdosing, so in this episode I look at whether any of it is backed by evidence. I start with what microdosing actually means. There's no official definition, and I cover why it took off, from cost to side effects to claims about inflammation, longevity and the brain. Then how people do it: using the "golden dose" left in the pen, and stretching out the gap between injections. Next, the evidence. The lowest-dose trial we have used daily semaglutide, adding up to 0.35 mg a week, which gave 6% weight loss at 52 weeks vs 2.3% on placebo. That's still above the licensed starting dose. SURMOUNT-1 shows weight loss rising with dose, and SURMOUNT-MAINTAIN compares staying on the top dose, dropping to 5 mg, and stopping, along with what happened to side effects. I also cover EVOKE, where full-dose semaglutide didn't slow Alzheimer's. Finally, the MHRA warnings on fake pens, and why you can't know what's in an unlicensed vial. My verdict: below licensed doses, microdosing remains unstudied. Sources: O'Neil 2018 (The Lancet), SURMOUNT-1 (NEJM, 2022), SURMOUNT-MAINTAIN (The Lancet, 2026), EVOKE/EVOKE+ (Novo Nordisk, 2025), Eli Lilly UK Medical Information, MHRA falsified Mounjaro alert, STAT News (2026). This is informational purposes only, not medical advice. If you can't get seen by your own physician, by all means do so, but always speak to your own healthcare provider. New episodes every week.
October 11 · 27 min
Is VO2 Max More Important Than Strength?
I come from lifting, so I wanted the answer to be strength. In this episode, I go through the biggest studies on fitness, strength and mortality to answer one question: if you could only train one, which matters more for living longer? I start with what VO2 max really measures, and why a MET is based on the resting oxygen use of one man. Then the cardio evidence: the Cleveland Clinic study of 122,007 people, where elite fitness was linked to an 80% lower risk of death than low fitness, and why "being unfit is worse than smoking" misreads it. Then the case for strength, from Ruiz's bench and leg press data to grip strength across 1.9 million people. The UK Biobank head-to-head brings both together, and I finish with Generation 100, the largest exercise RCT on mortality, and why its result isn't as clean as it looks. My verdict: cardio edges it, but the lowest risk belongs to people who have both. Sources: Mandsager 2018 (JAMA Netw Open), Lang 2024 (BJSM), Ruiz 2008 (BMJ), García-Hermoso 2018 (Arch Phys Med Rehabil), UK Biobank 2018 (Eur J Epidemiol), Generation 100 (BMJ, 2020), Byrne 2005 (J Appl Physiol), UK CMO Physical Activity Guidelines 2019. This is informational purposes only, not medical advice. If you can't get seen by your own physician, by all means do so, but always speak to your own healthcare provider. New episodes every week.
October 8 · 28 min
Heart Disease Starts Long Before the Heart Attack
Heart disease has taken another member of my family, and it's the reason I've put so much of my career into prevention. This is a more personal episode, but I didn't want it to be just my story. I wanted you to leave with something you can actually use. I start with why heart disease is still the world's biggest killer, and why most of the risk comes down to things we can change. Then I go through the autopsy evidence. Young soldiers killed in war, and teenagers who died in accidents, already had disease in their arteries. Early changes have even been found before birth. I explain how plaque builds up while the artery quietly grows outwards to hide it, which is why a normal test doesn't always mean you're clear. Finally, I go through what actually moves your risk: lowering LDL and blood pressure, getting fitter and stronger, losing weight, stopping smoking, and checking the things people miss, like family history and Lp(a). You'll leave with a simple checklist of what to know and what to test. Sources: INTERHEART (Lancet, 2004), BHF UK CVD Factsheet (2026), Enos et al. (JAMA, 1953), Bogalusa Heart Study (NEJM, 1998), PDAY (JAMA, 1999), Tuzcu et al. (Circulation, 2001), Ference et al. (JACC, 2012), CTT (Lancet, 2010), SPRINT (NEJM, 2015), Kodama et al. (JAMA, 2009), PURE (Lancet, 2015). This is informational purposes only, not medical advice. If you can't get seen by your own physician, by all means do so, but always speak to your own healthcare provider. New episodes every week. Follow so you don't miss the next one.
October 4 · 27 min
The Steroid User Waiting for a New Heart
At 41, after taking steroids continuously since he was 18, this patient has an ejection fraction of 15% and is on the waiting list for a heart transplant. In this episode I talk through his case and use it to separate two things that often get lumped together: anabolic steroid abuse and properly diagnosed, monitored testosterone replacement therapy. I cover how supraphysiological androgens damage the heart directly through androgen receptors on heart muscle, fibrosis, RAAS activation, fluid retention, raised blood pressure, crashed HDL and a higher tendency to clot, and why his high haematocrit was only part of the story. I go through the Baggish weightlifter study, where steroid users averaged an ejection fraction of 52% against 63% in non-users, and what the TRAVERSE trial does and doesn't tell us about TRT, heart attacks, stroke and prostate cancer. We also get into haematocrit monitoring, Virchow's triad, why testosterone switches off sperm production, and the dilemma of a man whose own testosterone is unlikely to ever recover. Sources: Baggish et al. (Circulation, 2017); Marsh et al. (Circulation, 1998); Fadah et al. (Front Cardiovasc Med, 2023); HAARLEM study (Smit et al., 2021); TRAVERSE (NEJM, 2023) and prostate safety analysis (JAMA Netw Open, 2023); Bhasin et al. (Am J Physiol, 2001); Endocrine Society guideline (JCEM, 2018); Ajayi et al. (Circulation, 1995); Travison et al. (JCEM, 2017). This is informational purposes only, not medical advice. If you can't get seen by your own physician, by all means do so, but always speak to your own healthcare provider. New episodes every week.
October 1 · 27 min
Does Omega-3 Reduce Inflammation?
Everyone's heard the omega-6 to omega-3 ratio talked about like it tells you how inflamed you are right now. It doesn't — and the researcher who actually invented the real alternative test says so directly. This week I go through what the ratio actually measures, the real mechanisms behind omega-3's anti-inflammatory effects (including a gene-suppression pathway almost nobody covers), and then pressure-test the three major cardiovascular trials that somehow reached three different conclusions testing nearly the same intervention. I get into why REDUCE-IT's 25% risk reduction comes with a genuine, actively-debated methodological controversy, why the seemingly better-absorbed STRENGTH formulation failed completely while revealing a real atrial fibrillation signal, and how VITAL's "failed" headline buried a 28% reduction in heart attacks. I also walk through something genuinely uncomfortable: the original reasoning behind the 8-12% Omega-3 Index target hasn't held up as well under two decades of further research as most people assume. Finally, the practical part — what to eat, what to test, and the real gap between the UK's official guideline and what the research suggests actually matters. Sources: Harris WS, The Peter Attia Drive Ep. #83; Calder PC, Nutrients 2010; Bhatt DL et al., REDUCE-IT, 2019; Manson JE et al., VITAL, NEJM 2019; Marklund M et al., Circulation 2019; EFSA Scientific Opinion on EPA/DHA, 2010. This is informational purposes only, not medical advice. If you can't get seen by your own physician, by all means do so, but always speak to your own healthcare provider. New episodes every week.
September 27 · 25 min
The Growth Hormone Peptide That Got Shelved
Two growth hormone peptides, built by two companies in the same city, at the same time, for the same condition, using the exact same natural hormone as their starting point. In July 2006, one company's trial was halted after a participant died. The other company's trial, treating the same disease, kept going. One became an FDA-approved medicine. The other is now a research-chemical bestseller that a federal safety panel formally rejected for pharmacy use just last year. This week I walk through how these peptides actually work, why two companies took completely different approaches to stabilising the same fragile hormone, and why that one event in 2006 sent them down permanently different paths. I get into why one of them became a tightly-controlled "biologic" and the other never could, what HIV-related fat redistribution actually is and why a growth-hormone peptide made genuine medical sense as a treatment for it, and the part most coverage skips: even the approved drug doesn't protect you if what you're actually buying never went anywhere near the trials that proved it works. I also cover the real physiology of how raising growth hormone affects blood sugar, and what the evidence shows if you're already starting from normal levels. Sources: Falutz et al., NEJM 2007 & JCEM 2010; Ionescu et al., JCEM 2006; FDA Pharmacy Compounding Advisory Committee, December 2024; Stanley et al., Lancet HIV 2019; Baker et al., Archives of Neurology 2012; Rudman et al., NEJM 1990. This is informational purposes only, not medical advice. If you can't get seen by your own physician, by all means do so, but always speak to your own healthcare provider. New episodes every week.
September 24 · 22 min
The Peptide Safety Checklist Nobody Follows
Most people asking about a peptide want to know one thing: does it work. That's not actually the first question you should be asking — and this week I walk through the checklist that should come before it, the one almost nobody follows, including plenty of people already using these products. I cover the five questions worth asking before you put any peptide in your body, then spend most of the episode on what actually determines whether it's safe: how to read a Certificate of Analysis properly, why the two most-trusted names in peptide testing aren't accredited to any recognised standard, and why the pricing structure of this industry quietly rewards vendors for skipping the tests that matter most. I also get into a recent finding that changed how I think about sourcing entirely — some of the same manufacturers producing fentanyl precursors have been pivoting directly into the peptide supply chain. That's not a reason to panic about every vial, but it's exactly the kind of thing a purity percentage will never tell you. Sources: Peter Attia, MD, The Peter Attia Drive Ep. #387 (AMA #83); UKAS/A2LA/NATA accreditation standards; FDA 21 CFR Parts 210 & 211; ICH Q2(R2)/Q14; Axios, July 2026, on the fentanyl-to-peptide supply chain. Website for the testing I discussed- Janoshik.com This is informational purposes only, not medical advice. If you can't get seen by your own physician, by all means do so, but always speak to your own healthcare provider. New episodes every week.
September 21 · 29 min
The Weight Loss Drug Nobody Can Legally Sell
There's a weight-loss drug right now producing the biggest numbers ever recorded in an obesity trial. It hasn't been approved by a single regulator anywhere in the world. And it's already being injected by thousands of people, sourced from vendors who have no legal right to sell it for human use. This week I explain how that's actually possible — starting with a patent-law loophole that let an unapproved molecule's exact structure become public years before its own trials even finished. I get into why licensed pharmacies genuinely can't legally compound this drug, no matter what a website claims, and I walk through the actual pharmacology behind it: how GLP-1, GIP, and glucagon each work on their own receptors, and why building a weight-loss drug around a hormone that classically raises blood sugar is a deliberate, calculated trade-off rather than a mistake. Then I get into the real Phase 2 trial data — the actual serious adverse event cases, not just the headline weight-loss percentage — and what real-world users are self-reporting on forums like Reddit, which doesn't match the clinical trial data at all. That mismatch raises some uncomfortable questions about what's actually in these vials. Sources: Jastreboff et al., NEJM 2023 (Phase 2 trial); Coskun et al., Cell Metabolism 2022 (receptor pharmacology); Sanyal et al., Nature Medicine 2024 (liver fat data); Salhab et al., Endocrine Society 2025 (network meta-analysis); Sehgal/Tronieri et al., medRxiv 2026 (Reddit self-report study); Eli Lilly TRIUMPH-1 through -4 topline results, 2025-2026. This is informational purposes only, not medical advice. If you can't get seen by your own physician, by all means do so, but always speak to your own healthcare provider. New episodes every week.
September 17 · 29 min
BPC-157: The Peptide Everyone's Injecting, With No Real Human Data
BPC-157 is the poster child for the peptide boom, and I want to be upfront: I'm not against peptides on principle — insulin and GLP-1 medications are peptides too. What matters is how something's produced, how it's used, and whether the evidence actually supports it. This episode is me working through BPC-157 properly, using that exact standard. I start with how clinical trials actually work, since that's the real dividing line between a regulated medicine and everything else. Then I go into BPC-157's own origin story — discovered in 1989, first reported in 1993, with the discoverers' own patent filing admitting they may not have isolated one single pure compound. I cover both proposed mechanisms currently in the literature, which don't yet connect to each other, then the animal evidence, which is real but concentrated heavily in one research group. The human evidence is where this gets serious: three small pilot studies exist, all from the same investigator, covering roughly 30 people total, none controlled. I go through exactly what each one found, and why 87.5% and 80-100% headline figures don't mean what they sound like without a comparison group. Then I compare all of that to how people are actually dosing this at home, and where that convention really comes from — it isn't from any human trial. I finish with the July 2026 FDA advisory committee vote, what it actually changes and what it doesn't, and my own honest verdict on where this stands right now. Studies & Sources: Sikiric et al. (1993, original patent/Journal of Physiology); Sikiric et al. (1994, Life Sciences); Hsieh et al. (2016, Journal of Molecular Medicine); Seiwerth & Sikiric et al. (2021, Frontiers in Pharmacology); Vasireddi et al. (2025, Sports Health/HSS, PMID 40756949); Józwiak et al. (2025, Pharmaceuticals); Zhang, Liu, Ou et al. (2026, Cell Communication and Signaling); Lee & Padgett (2021); Lee, Walker & Ayadi (2024); Lee & Burgess (2025, Alternative Therapies in Health and Medicine, PMID 40131143); FDA Pharmacy Compounding Advisory Committee meeting, July 2026. Informational only, not medical advice. New episodes of A Modern Pharmacist drop weekly.
September 14 · 29 min
Magnesium: Do You Actually Need to Supplement It?
Magnesium supplements are everywhere right now, and I wanted to know whether I actually needed one myself. This episode is the result of about three months of genuinely digging into the evidence — not just repeating what supplement companies say. I start with why magnesium matters mechanistically: it has to be bound to ATP to function properly, and it plays a direct role in insulin signalling, which is what first got my attention. I explain why a standard blood test only reflects about 1% of your total body magnesium, and why that makes true deficiency genuinely hard to diagnose with any confidence. The centre of this episode is the absorption question. Supplement labels frequently claim up to 80% bioavailability for organic forms like bisglycinate — but when I looked at the actual controlled research, the real figures are dramatically lower, and I walk through exactly why, including a genuine flaw in how that research was conducted. I also explain "buffering" — why some supplements quietly blend in cheap magnesium oxide alongside the organic form you're paying for, and how to spot it on a label. I cover who's genuinely at higher risk of deficiency, why food supplements aren't held to the same manufacturing standard as medicines, and the one magnesium product that actually is a licensed medicine in the UK. I finish with exactly what I've personally decided to buy, and why. Studies & Sources: Attia's AMA #54 on magnesium (background source); Firoz & Graber (2001, Magnesium Research) on bioavailability; Pełczyńska et al. (2022, Nutrients) on magnesium and metabolic disorders; Nielsen & Lukaski (2006) on exercise and magnesium; Liu et al. (2016) and Zhang et al. (2022) on magnesium L-threonate and cognition; Held et al. (2002) on magnesium and sleep; UK food supplement labelling tolerance guidance (FSA); Magnaspartate SmPC (electronic Medicines Compendium). Informational only, not medical advice. New episodes of A Modern Pharmacist drop weekly.
S1 · E19
September 9 · 29 min
Treating Hair Loss: What Actually Works
I'm going through my own hair loss treatment right now, so this episode is a bit more personal than usual. I walk through my own thinking on minoxidil and finasteride — the two main evidence-backed treatments — and why I've made the choice I have. Before we get to treatment, I cover what you need to rule out first: telogen effluvium from stress, iron deficiency, thyroid disorders, and B12/vitamin D deficiency. I also debunk the "check your mum's dad" myth for predicting hair loss — the real genetics are polygenic, not a single inherited trait. Then I get into the mechanisms: how minoxidil increases blood flow via vasodilation and why some people don't respond to it (a sulfotransferase enzyme issue), and how finasteride blocks the conversion of testosterone to DHT. I explain the genuinely strange DHT paradox — the same hormone shuts down hair growth on your scalp but promotes it on your beard and body — and why chasing a "zero DHT" target makes no sense clinically. Because this is a cosmetic rather than a life-or-death condition, I talk openly about how that should shift your risk tolerance around finasteride's side-effect profile, and why I've personally chosen to stick with topical minoxidil for now. Sources: Hamilton (1951, prevalence data via Endotext), Chumlea et al. 2004 (family history risk), Gupta et al. 2022 (minoxidil/finasteride hair count meta-analysis), Drake et al. 1999 (finasteride scalp DHT suppression data). This is informational purposes only, not medical advice. If you can't get seen by your own physician, by all means do so, but always speak to your own healthcare provider. New episodes every week.
S1 · E18
September 6 · 29 min
TRT: The Real Benefits, Risks, and When to Actually Use It
Testosterone replacement therapy is one of the most searched, most misunderstood treatments in men's health. I go through what the evidence actually shows: the genuine benefits, the real risks, the flawed studies that shaped 15 years of unnecessary fear, and exactly when treatment is justified. I start with the core diagnostic principle: the endocrine system is symptom-led, so a low number alone is never a diagnosis. True testosterone deficiency, once you require both a confirmed low level and real symptoms, affects only around 2% of men, mostly those over 60. I explain why free testosterone, not total testosterone, is the metric that actually matters, since only 1 to 4% of circulating testosterone is biologically active. On benefits, I cover the genuinely well-documented structural effects: lean mass gains, fat loss, and real increases in bone mineral density that surprised even leading researchers who assumed bone density couldn't be influenced this way. I also cover the metabolic benefits, including a 40% reduction in progression to type 2 diabetes in one major trial. On risk, I walk through the two badly flawed studies from 2013 and 2014 that wrongly linked TRT to heart attacks and strokes, including one that accidentally included women in a study meant to be all-male, and explain what the properly powered TRAVERSE trial actually found a decade later. I also cover the real prostate cancer picture, and go deep on fertility, including the mechanism behind why hCG and clomiphene work completely differently to preserve it. Studies and Sources: Prevalence and diagnosis: EMAS, the European Male Ageing Study. Structural and metabolic benefits: Amory et al., JCEM 2004, bone density; Page et al., JCEM 2005, body composition; Snyder et al., JAMA Internal Medicine 2017, bone density and strength; Cai et al. 2014, metabolic meta-analysis; Wittert et al., Lancet Diabetes and Endocrinology 2021, the T4DM trial; Yassin et al. 2016, continuous versus interrupted TRT. Cardiovascular controversy, the flawed studies: Vigen et al., JAMA 2013; Finkle et al., PLOS ONE 2014; Basaria et al., NEJM 2010; Xu et al., BMC Medicine 2013; Morgentaler et al., Mayo Clinic Proceedings 2015, critical re-analysis. Cardiovascular, the better evidence: Corona et al., JCEM 2018; Wallis et al., Lancet Diabetes and Endocrinology 2016; Lincoff et al., NEJM 2023, the TRAVERSE trial. Prostate cancer: multiple systematic reviews, 2004, 2008, 2009; TRAVERSE trial prostate sub-data. Fertility and HPG axis: classic hypothalamic-pituitary-gonadal axis physiology; intratesticular versus serum testosterone concentration data. Background and framing: Peter Attia, AMA number 28, All Things Testosterone and Testosterone Replacement Therapy, the Peter Attia Drive podcast, 2021. Informational only, not medical advice. New episodes of A Modern Pharmacist drop weekly.
S1 · E17
September 3 · 29 min
Statins, Diabetes, and Your Brain — What the Evidence Actually Shows
Statins are the most prescribed and most controversial medication on the planet. I am not debating whether they work, the evidence there is unambiguous. Instead I go deep on the two concerns patients raise with me most often: do statins cause type 2 diabetes, and do they harm your brain? On diabetes, I walk through a genuinely new mechanism discovered in 2024: statins alter specific gut bacteria, which reduces a bile acid called UDCA, which in turn lowers GLP-1 and worsens glucose tolerance. There is already a trial underway testing whether supplementing UDCA can fix this without losing the cholesterol lowering benefit. I also cover the real numbers, how many people develop diabetes per statin users treated, weighed against heart attacks and strokes prevented, and why higher intensity statins carry more risk than lower doses. On cognition, I explain why the brain being cholesterol rich does not mean statins starve it, since the brain has its own separate, protected cholesterol supply, and where the 2012 FDA warning about cognitive impairment actually came from versus what the trial evidence has consistently shown since. I also bring in the STAREE trial, published just days before recording this episode. Finally, I explain why this question just became more urgent: 2026 guideline changes now make statins a consideration from age 30, and what that means for an evidence base built on trials lasting a fraction of that exposure window. Studies and Sources: Mechanism, diabetes: She et al., Cell Metabolism 2024, 36(2), 408-421. NCT06684106, ongoing UDCA plus atorvastatin trial. Nature Reviews Endocrinology 2015, the diabetogenic action of statins. Diabetologia 2006, statins and adipocyte GLUT4. J Clin Invest 2011, adiponectin and AMPK pathways. J Cell Physiol 2019, mechanisms of statin induced new onset diabetes. Outcome evidence, diabetes: Sattar et al., Lancet 2010, 375, 735-742. Preiss et al., JAMA 2011, 305(24), 2556-2564. IPD meta-analysis, Lancet Diabetes and Endocrinology 2024. Ridker et al., Lancet 2012, JUPITER post-hoc analysis. Cleveland Clinic Journal of Medicine review 2023. NICE NG238 evidence review. Benefit versus risk: CTT Collaboration meta-analysis, 26 trials, over 170,000 patients, Lancet 2012. TheNNT.com, statins in low cardiovascular risk primary prevention. Collins et al., Lancet 2016, interpretation of statin efficacy and safety evidence. Outcome evidence, cognition: Cochrane review, statins for the prevention of dementia, HPS and PROSPER pooled. Zhou et al., JACC 2021, ASPREE trial. Ott et al., J Gen Intern Med 2015. Observational meta-analysis, European Journal of Preventive Cardiology 2022, 29(5), 804. Westphal Filho et al., Alzheimers and Dementia TRCI 2025. GeroScience 2026, brain, benefit or burden. STAREE trial, NEJM and ESC Congress 2026. PREVENTABLE trial, ongoing, Duke Clinical Research Institute. Guideline context: 2026 multi-society dyslipidaemia guideline, ACC, AHA and nine other societies, March 2026. Eligibility study, JAMA, July 2026, Pittsburgh and VA, NHANES data. LDL cumulative exposure hypothesis paper, 2024. Brain cholesterol mechanism: Tom Dayspring, Peter Attia podcast episodes 334 and 395, brain lipidology and cholesterol homeostasis. Informational only, not medical advice. New episodes of A Modern Pharmacist drop weekly.

Showing 1–20 of 36 episodes