Long-form clinical reasoning on the problems that cross organ systems — written for clinicians, held to the evidence, and specific enough to use on a Tuesday afternoon.
Testosterone in women: what we can diagnose, what the evidence supports, and why the logistics are the hardest part.
From population thresholds to individual diagnosis in male hypogonadism — ten nuances, a staged workup, and what mass screening gets wrong in both directions.
The regression evidence, extreme LDL targets, safety concerns, and the data-driven case for putting clinical mythology to rest.
On labels, complexity, and the cognitive traps that cost patients the right diagnosis.
On very low LDL, the myth of “too low,” and what happens to patients when specialists can’t agree on the evidence.
The pursuit of your best possible biology — through rigorous evidence, systems thinking, and a clinical team designed to make improvement measurable.
Why weight loss alone is the wrong target — and why body composition matters more.
After years of concern about endocrine care access, an uncomfortable but unavoidable conclusion: the system is working exactly as it is designed to.
The essays describe the reasoning. These make it repeatable — staged workups that surface which step drove the conclusion, carry the evidence grade to the point of use, and are willing to answer “not yet answerable.”
Staged diagnosis for the man in the gray zone: assay check, binding correction, axis localization, reversibility, coherence read.
Complication-centric workup for adiposity-based chronic disease: staged by the complications rather than BMI, with driver review and pharmacotherapy selection.
DXA interpretation and treatment sequencing, including the sex-steroid contribution that standard reports leave out.
Which tests to order and how to read them — decision support that carries the evidence grade to the point of use and flags what a result does and doesn’t settle.
The reproductive–metabolic disorder formerly called PCOS: the self-perpetuating core loop you’re treating, the long-term diabetes risk it flags, and what the rename changes.
Menopause and postmenopause, staged: the timing hypothesis, where WHI does and does not apply, route–regimen risk, non-hormonal VMS options, and can’t-miss red flags.
Thread Medicine is the work of following the threads wherever they lead — across organ systems, across specialties that were never built to talk to each other, and across the boundary between the individual in the room and the population he belongs to. It rests on four commitments.
Applied systems biology. The mechanism has to be real, and it has to reach the exam room.
Held to an evidence standard. The grade travels with the claim, the uncertainty stays in the text, and “not yet answerable” is an available answer.
Delivered by a team. Most of what actually changes outcomes — sleep, load, intake, adherence, access — is not a physician task, and a clinic that can’t deliver it has only one lever, which is why the prescription gets written.
Fitted to a person. Guidelines answer questions about populations; clinics see individuals, and most of the difficult work in medicine happens in that gap.
Almost nobody writes down how that work is actually done. That is what this is for — see the method the tools implement, including what this is and isn’t funded to do.
Practice philosophy. Underneath the clinical method is something simpler: caring, and caring about caring — attention to the patient, and attention to whether the care actually lands. That second-order attention is what turns compassion into a systems discipline rather than a sentiment. It is grounded in some of the richest traditions of service — the Jesuit cura personalis, care for the whole person, and the Jewish tikkun olam, the duty to repair what is broken — and it resolves, in the exam room, into care that is personalized, patient-centered, and contextual. Empathy and honesty as defaults, professionalism as a discipline rather than a costume, evidence as the arbiter, and a deliberate distance from the profit motive wherever it would bend a judgment. These threads deserve their own essays; this is the short version.
Anthony Pick is a board-certified endocrinologist (internal medicine, endocrinology, obesity medicine, clinical lipidology) with certification in clinical densitometry and diabetes care and education, and a Menopause Society Certified Practitioner. See the full CV →