Dr. Tais Aliabadi is an obstetrician, gynecologist, and surgeon with 30 years of experience treating women's reproductive health. She joins Andrew Huberman to discuss the widespread misdiagnosis and dismissal of women's health symptoms, particularly PCOS and endometriosis.

The conversation reveals that 90% of women with PCOS go undiagnosed despite it being the most common hormonal disorder affecting 15% of women. Dr. Aliabadi explains how symptoms like irregular periods, acne, hair loss, and mood disorders are routinely dismissed as 'normal' when they actually indicate serious underlying conditions.

They explore the four pillars driving PCOS symptoms: disrupted brain-pituitary-ovary axis, insulin resistance, chronic inflammation, and genetics/epigenetics. Dr. Aliabadi emphasizes that endometriosis affects over 20% of women and takes an average of 9-11 years to diagnose, with patients seeing 5-10 doctors before getting answers.

The discussion covers actionable diagnostic tools, treatment protocols including metformin and GLP-1s, the importance of early egg freezing, and why every woman should know their lifetime breast cancer risk. Dr. Aliabadi advocates for separating obstetrics from gynecology to improve women's healthcare outcomes.

The PCOS Epidemic: 90% Undiagnosed Despite Being Leading Cause of Infertility

PCOS affects 15% of women in the US (over 20% in Middle Eastern countries) but 90% are never diagnosed, making it the most common undiagnosed hormonal disorder - Dr. Aliabadi

Diagnosis requires meeting 2 of 3 criteria: high androgen symptoms (facial hair, acne, male-pattern baldness), irregular ovulation (periods over 35 days apart), and PCOS-looking ovaries on ultrasound with 20+ follicles

PCOS has four distinct phenotypes, explaining why doctors struggle with diagnosis - patients can have regular periods but still not ovulate 70-80% of the time

"If every 20-year-old in this country would go through my office once at age 20, I would shut down these fertility clinics" - Dr. Aliabadi on early intervention

The Four Pillars Driving PCOS: From Brain Dysfunction to Insulin Resistance

Pillar 1: Disrupted hypothalamic-pituitary-ovarian axis where GNRH neurons fire too rapidly, causing LH to exceed FSH and stimulating excess androgen production that blocks ovulation

Pillar 2: Insulin resistance affects 80% of PCOS patients - high insulin stimulates ovaries to produce more androgens and blocks sex hormone-binding globulin production

Pillar 3: Chronic inflammation from visceral fat creates a vicious cycle, making insulin resistance worse and stimulating more androgen production

Pillar 4: Genetics and epigenetics - "your genes load the gun, your environment pulls the trigger" through stress, sleep, diet, and exercise habits

Actionable PCOS Treatment: Beyond Birth Control to Address Root Causes

Dr. Aliabadi created OVII.com, a free platform where women can self-assess PCOS likelihood using her 25-year clinical algorithm before seeing doctors

Treatment hierarchy: Start with OV supplement containing inositol and vitamin D, progress to metformin 750mg twice daily, then GLP-1s for weight loss if needed

"In 2014, I started using GLP-1s on my patients for weight loss for PCOS, 2014, 11 years ago" - Dr. Aliabadi on early adoption of these medications

For fertility: Use letrozole (60-70% ovulation rate) or Clomid to induce ovulation after addressing insulin resistance and inflammation

Endometriosis: The Dismissed Disease Affecting Over 20% of Women

"Painful periods are not normal" - if pain disrupts life, causes missed school/work, or requires emergency room visits, it indicates endometriosis until proven otherwise

Endometriosis takes 9-11 years to diagnose on average, with patients seeing 5-10 doctors before getting answers, despite being diagnosable through symptoms alone

The condition involves uterine-like tissue growing outside the uterus, creating internal bleeding, inflammation, and scar tissue that destroys egg count and quality

"50% of my PCOS patients also have endometriosis" - Dr. Aliabadi's clinical observation suggests massive overlap between these conditions

Fertility Preservation: Why Every Woman Needs to Know Her Egg Count

AMH (anti-müllerian hormone) blood test reveals egg count - normal is up to 6 for women in 20s/30s, drops to less than 1 in 40s

PCOS patients have falsely high AMH due to frozen follicles, but egg quality is poor - they should freeze eggs by 28-30 despite high counts

Endometriosis patients can have zero eggs by age 30 or egg counts of 40-year-olds at age 14 due to inflammatory damage to ovaries

"Freeze 20 eggs because 20 is safe, but for PCOS patients as they get older, I might want 40 eggs because the quality is not that good" - Dr. Aliabadi

Breast Cancer Risk Assessment: Every Woman Must Know Her Lifetime Risk

"If you know your first name, your last name, and your date of birth, you need to know your lifetime risk of breast cancer" - Dr. Aliabadi

Use the Tyrer-Cuzick Risk Assessment Tool (free online) - if lifetime risk is 20% or higher, breast imaging should start at age 30, not 40

Dr. Aliabadi discovered her own breast cancer through prophylactic mastectomy after calculating 37% lifetime risk despite no family history or genetic mutations

"85% of women who get breast cancer don't have it in their family, less than 5% have a genetic mutation" - most cases occur in average-risk women

Systemic Healthcare Failures: Why Women's Symptoms Get Dismissed

"50% of counties in this country don't have an OBGYN" - access issues compound diagnostic problems for women's health conditions

Most gynecologists don't perform pelvic ultrasounds during routine exams due to training gaps, missing obvious signs of PCOS, fibroids, and endometriosis

"Out of 100 gynecologists, one is trained to do laparoscopic endometriosis surgery" - and half would incorrectly tell patients they don't have endometriosis

Dr. Aliabadi advocates separating obstetrics from gynecology: "When you're busy running around delivering babies all night, how can you catch that endo patient?"