Endocrine Feedback Loop

EFL074 - Taking Levothyroxine Fasting vs. With Breakfast 18.06.2026 32Min.

For our 74th episode, recorded live at ENDO 2026 in Chicago, we review a recent JCEM study that addresses a common clinical question: does levothyroxine need to be taken on an empty stomach?This randomized clinical trial evaluates a dose-adjusted, non-fasting regimen and finds that a 15% increase with breakfast ingestion achieves TSH stability similar to that with standard fasting dosing. The results also suggest potential improvements in adherence and patient-reported well-being, while highlighting variability in dose adjustments and limitations in generalizability.Host Chase Hendrickson, MD, MPH, MHCC, from Vanderbilt University, is joined by regular contributor Andy Crawford, MD, from Dartmouth-Hitchcock Medical Center, and guest expert Matt Edelson, MD, from the University of Chicago. Together, they discuss “Fasting versus non-fasting dose-adjusted levothyroxine ingestion in hypothyroidism,” published in the April 2026 issue of JCEM, and consider how these findings may inform patient-centered approaches to medication timing and management.

EFL073 - Infrequent Zoledronate in Low Fracture Risk 21.05.2026 38Min.

For our 73rd episode and the start of the seventh season, we review a recent study examining the long-term anti-fracture efficacy of infrequent zoledronate dosing in women with osteopenia. While current clinical approaches typically focus on treating individuals at higher fracture risk, this study explores whether earlier intervention in lower-risk populations may help reduce fracture risk over time.This secondary analysis of a randomized clinical trial evaluates the effects of zoledronate administered at extended intervals, with outcomes assessed over a 10-year period. The findings suggest that infrequent dosing may be associated with meaningful reductions in vertebral, major osteoporotic, and overall fracture risk, particularly in the later years of follow-up. The study also examines how fracture risk relates to baseline risk factors and changes in bone mineral density, raising questions about the role of routine monitoring and the timing of preventive therapy.Host Chase Hendrickson, MD, MPH, MHCC, from Vanderbilt University, talks with regular contributor Amal Shibli Rahhal, MD, from the University of Iowa, and guest expert Thomas Weber, MD, from Duke Health. Together, they discuss “Anti-fracture efficacy of 5 or 10 yearly zoledronate in women aged 50 to 60 years,” published in the April 2026 issue of JCEM, and consider how these findings may inform decisions around early treatment strategies, risk assessment, and long-term fracture prevention in clinical practice.

EFL072 - Pre-Operative Use of Mineralocorticoid-Receptor Antagonists in Primary Aldosteronism 22.04.2026 43Min.

For our 72nd episode and the final episode of the sixth season, we review a recent study examining the perioperative medical management of primary aldosteronism, with a focus on the use of mineralocorticoid receptor antagonists before adrenalectomy. Primary aldosteronism is increasingly recognized as a common and clinically important cause of secondary hypertension, yet questions remain about optimal preoperative treatment strategies. This study explores whether pretreatment with mineralocorticoid receptor antagonists influences postoperative outcomes and longer‑term biochemical cure in patients undergoing surgery.Host Chase Hendrickson, MD, MPH, MHCC, from Vanderbilt University, talks with regular contributor Salila Kurra, MD, from Columbia University, and guest expert Jun Yang, MD, PhD, from Monash Health in Melbourne, Australia. Together, they discuss "Mineralocorticoid Receptor Antagonist Pre-Adrenalectomy in Primary Aldosteronism," published in the April 2026 issue of JCEM, and consider how these findings may inform perioperative management and surgical decision-making in clinical practice.

EFL071 – Taste Changes with Semaglutide 27.03.2026 30Min.

For our 71st episode, we review a randomized, placebo-controlled clinical trial that explores how semaglutide may influence taste perception in women with obesity and polycystic ovary syndrome. While GLP‑1 receptor agonists are widely used for weight loss, the mechanisms underlying changes in food preference remain less well understood. This study takes a multimodal approach to examine whether semaglutide alters taste recognition, tongue gene expression, and brain responses to food-related cues. Host Chase Hendrickson, MD, MPH, MHCC, from Vanderbilt University, talks with regular contributor Na Shen, MD, from UCLA, and guest expert Kalpana Muthusamy, M.B.B.S., MD, from Mayo Clinic in Rochester, Minnesota. Together, they discuss "Semaglutide and Taste in Women With Obesity and Polycystic Ovary Syndrome: A Randomized Placebo-Controlled Study," published in the January 2026 issue of JCEM.

EFL070 – Dosing Strategies for Remission in Graves Disease 19.02.2026 35Min.

For our 70th episode, we review a paper that tries to improve our understanding of remission in Graves’ disease. Long-term thionamide treatment has long been the preferred approach internationally in Graves’ disease, and only more recently here in the U.S. So, the more we know about dosing and how that might encourage or predict remission, the better. This report is an observational study, as is often the case with the papers we look at, so we will discuss how these authors approach this question and share our thoughts along the way. Host Chase Hendrickson, MD, MPH, MHCC, from Vanderbilt University, talks with regular contributor Andy Crawford, MD, from Dartmouth-Hitchcock Medical Center, and guest expert Giuseppe Barbesino, MD, from Harvard Medical School in Boston. They discuss "Impact of Minimal Dose Strategy Before Antithyroid Drug Discontinuation on Relapse Risk in Graves' Disease" by Miyamura et al., published in the August 2025 issue of JCEM.

EFL069 - The Gut Microbiome in Type 1 Diabetes and Obesity 15.01.2026 41Min.

For our 69th episode, we review a paper in The Journal of Clinical Endocrinology & Metabolism on the gut microbiome of adolescents with type 1 diabetes, which hopes to understand differences between those with a normal body mass index compared to obesity. Studying gut microbiomes has been a “hot topic” for several years now, and we are excited to take the opportunity to unpack this work and see how it helps us better understand our patients. We both work through the challenges that come with any observational study and learn more about the specific techniques used by these investigators in this study. Host Chase Hendrickson, MD, MPH, MHCC, from Vanderbilt University talks with regular contributor Ashok Balasubramanyam, MD, from Baylor College of Medicine, and guest expert Åke Lernmark, MD, PhD, professor emeritus from Lund University in Malmö, Sweden. They discuss “Gut Microbial Changes Associated With Obesity in Youth With Type 1 Diabetes” by Ismail et al, published in the February 2025 issue of JCEM.

EFL068 - Hypocalcemia in CKD after Denosumab 18.12.2025 35Min.

For our 68th episode, we look at a paper in The Journal of Clinical Endocrinology & Metabolism that compares the effect on calcium of initial and subsequent doses of denosumab in people with chronic kidney disease (CKD). Though concerns have arisen over the years about the problems with stopping denosumab therapy, it remains an appealing medication for some of our patients with CKD. So we thought this report had the potential to change our practice and gave us the opportunity to delve into the challenges around osteoporosis in CKD. Host Chase Hendrickson, MD, MPH, MHCC, from Vanderbilt University talks with regular contributor Amal Shibli-Rahhal, MD, from University of Iowa Carver College of Medicine, and guest expert Kristin Clemens, MD, from St. Joseph’s Hospital and Western University in London, Ontario, Canada. They discuss “Dose-Specific Effects of Denosumab on Serum Calcium Levels in Patients With Osteoporosis and Various Renal Functions” by Sun et al, published in the July 2025 issue of JCEM.

EFL067 - Bariatric Surgery and Changes in Body Composition and Musculoskeletal Health 20.11.2025 43Min.

For our 67th episode, we look at a study in The Journal of Clinical Endocrinology & Metabolism that reports the impact of different types of weight-loss surgery on body composition, muscle strength, and bone density. Our patients frequently ask questions about these changes with surgical and medical weight loss, so we thought it highly worthwhile to review these findings with you all. Host Chase Hendrickson, MD, MPH, MHCC, from Vanderbilt University talks with regular contributor Andrew Kraftson, MD, from the University of Michigan, and guest expert Anne Schafer, MD, from the University of California, San Francisco. They discuss “One Year Changes in Body Composition and Musculoskeletal Health Following Metabolic/Bariatric Surgery” by Jassil et al, published in the May 2025 issue of JCEM.

EFL066 - Islet Autoantibodies 16.10.2025 35Min.

For our 66th episode, we review a recent Journal of the Endocrine Society (JES) article that looks at the frequency of positive islet antibodies in a population of adults without diabetes. While that may initially seem like an unusual article choice, we found it to be quite helpful in an era where we now have a therapeutic option to delay the onset of clinical type 1 diabetes when we can identify people early enough. That treatment option naturally raises questions about how we can find such patients and the risk of false-positive results with these antibodies. Host Chase Hendrickson, MD, MPH, MHCC, from Vanderbilt University talks with regular contributor Steven D. Wittlin, MD, from the University of Rochester Medical Center, and guest expert Raghu G. Mirmira, MD, PhD, from the University of Chicago. They discuss “Prevalence of Islet Autoantibodies in Adults Without Diabetes” by Pauley et al, published in the August 2025 issue of JES.

EFL065 - MACS and Vertebral Fractures 18.09.2025 42Min.

For our 65th episode, we return to The Journal of Clinical Endocrinology & Metabolism to look at a report of two different studies that investigate the relationship between MACS (mild autonomous cortisol secretion) and vertebral fractures. MACS has been of increasing interest to endocrinologists over the past few years, with a greater recognition of its health impact and new guidelines on its assessment and treatment. As this topic continues to evolve, we thought that this paper has a high likelihood of impacting our clinical care and so is well worth discussion. Host Chase Hendrickson, MD, from Vanderbilt University talks with regular contributor Jill Wagoner, MD, from the University of Nebraska Medical Center, and guest expert Oksana Hamidi, DO, from the University of Texas Southwestern Medical Center. They discuss “Adrenalectomy Reduces the Risk of Vertebral Fractures in Patients With Mild Autonomous Cortisol Secretion” by Morelli et al, first published online in JCEM in April 2025.

EFL064 - Subclinical Thyroid Disease and Cardiovascular Risk Factors 21.08.2025 49Min.

For our 64th episode, we return to The Journal of Clinical Endocrinology & Metabolism to review a recent paper that attempts to elucidate the connection between subclinical thyroid disease and cardiovascular disease. Any of you listeners who see patients with thyroid conditions likely frequently encounter people with mild thyroid abnormalities and need to figure out if those abnormalities may have a clinical impact. So, given the many unanswered questions in this area, we thought this article well worth discussing. Not only do these authors use an observational study design, but their work is a pooling of multiple observational investigations, necessitating a careful thinking through of the methodology. Host Chase Hendrickson, MD, from Vanderbilt University talks with regular contributor Anupam Kotwal, MD, from the University of Nebraska Medical Center, and guest expert Jennifer S. Mammen, MD, PhD, from Johns Hopkins University School of Medicine. They discuss “Associations Between Subclinical Thyroid Dysfunction and Cardiovascular Risk Factors According to Age and Sex” by Baretella et al, published in the May 2025 issue of JCEM.

EFL063 - Diagnosing Adrenal Insufficiency 24.07.2025 43Min.

For our 63rd episode, we returned to the Endocrine Society’s annual meeting and recorded before a live audience at ENDO 2025 in San Francisco. We look at a study from The Journal of Clinical Endocrinology & Metabolism that suggests that we can substantially alter our diagnostic approach to adrenal insufficiency. This study and others have already led to a shift in recommendations from some experts, so we thought it would be of great interest to you all as our listeners. Host Chase Hendrickson, MD, from Vanderbilt University talks with regular contributor Katie Guttenberg, MD, from the University of Texas Health Science Center at Houston, and guest expert Anand Vaidya, MD, from Brigham and Women’s Hospital and Harvard Medical School in Boston.They discuss “Performance of Dehydroepiandrosterone Sulfate and Baseline Cortisol in Assessing Adrenal Insufficiency” by Han et al, first published online in JCEM in December 2024.

EFL062 - Primary Hyperparathyroidism in Pregnancy 26.06.2025 48Min.

Join host Chase Hendrickson, MD, from Vanderbilt University Medical Center, in a discussion about a recently published article in The Journal of Clinical Endocrinology & Metabolism that investigates the impact of primary hyperparathyroidism on fertility and pregnancy outcomes. Those who take care of primary hyperparathyroidism will have encountered the challenge of managing it around pregnancy and will be familiar with how little data we have to guide us there. The authors utilize an observational methodology, so we will do our usual, careful walk through the study design to highlight those intrinsic limitations. Dr. Hendrickson talks with Alyson K. Myers, MD, from the Albert Einstein College of Medicine, and guest expert Shonni J. Silverberg, MD, from Columbia University. The article featured this month, by Sant et al, was published in the May 2025 issue of JCEM: “Fertility and Pregnancy Outcomes in Primary Hyperparathyroidism: Observations From a Large Insured Population.” Show notes can be found at https://www.endocrine.org/journals/endocrine-feedback-loop-podcast-series/efl062 — podcast home page: https://www.endocrine.org/journals/endocrine-feedback-loop-podcast-series

EFL061 - Effectiveness of Lifestyle Intervention in Preventing T2D Based on Genetic Risk 22.05.2025 42Min.

Welcome to our 61st episode and the beginning of our sixth season! Join host Chase Hendrickson, MD, from Vanderbilt University Medical Center, in a discussion about a recently published clinical trial in The Journal of Clinical Endocrinology & Metabolism that tries to understand the impact of genetics on the benefits of a lifestyle program in reducing the risk of developing type 2 diabetes. Personalized or precision medicine has been a hot topic for several years now, and this podcast has recently reviewed a few studies that fit that description. The authors of this investigation try to answer the question of how we can decide in advance which patients are particularly likely to benefit from a given intervention. Dr. Hendrickson talks with Ashok Balasubramanyam, MD, from Baylor College of Medicine, and guest expert Miriam Udler, MD, PhD, from Massachusetts General Hospital. The article featured this month, by Lankinen et al, was published in the January 2025 issue of JCEM: “Effects of Genetic Risk on Incident Type 2 Diabetes and Glycemia: The T2D-GENE Lifestyle Intervention Trial.” Show notes can be found at https://www.endocrine.org/journals/endocrine-feedback-loop-podcast-series/efl061 — podcast home page: https://www.endocrine.org/journals/endocrine-feedback-loop-podcast-series

EFL060 - Topiramate and Metformin for Weight Loss in PCOS 01.05.2025 34Min.

Join host Chase Hendrickson, MD, from Vanderbilt University Medical Center, in a discussion about a recent study in The Journal of Clinical Endocrinology & Metabolism that reports on the benefits of older weight-loss medications in a population of women with polycystic ovary syndrome (PCOS). Much of the attention today in obesity medicine focuses on GLP-1 receptor agonists. However, these medications are not treatment options for many of our patients, so we thought this paper asked important questions that we would want to know the answers to. Dr. Hendrickson talks with Na Shen, MD, from the University of California, Los Angeles, and guest expert Stanley G. Korenman, MD, also from UCLA. The article featured this month, by Bandeira Marchesan et al, was first published in JCEM in September 2024: “Topiramate Added to Metformin for Obesity Control in Women With Polycystic Ovary Syndrome.” Show notes can be found at https://www.endocrine.org/journals/endocrine-feedback-loop-podcast-series/efl060 — podcast home page: https://www.endocrine.org/journals/endocrine-feedback-loop-podcast-series

EFL059 - Testosterone Levels and Fracture Risk in Men 20.03.2025 34Min.

Join host Chase Hendrickson, MD, from Vanderbilt University Medical Center, in a discussion about a recent investigation in The Journal of Clinical Endocrinology & Metabolism that tries to illuminate the relationship between serum testosterone and fractures in men. Ever since the release of the TRAVERSE fracture findings last year, we as endocrinologists have been uncertain in how to think about testosterone and bone health, as that trial made us question what we thought we already knew. So we thought that this article would be an important one to review and are eager to discuss it. Dr. Hendrickson talks with Anna Goldman, MD, from Harvard Medical School and guest expert Peter J. Snyder, MD, from the University of Pennsylvania. The article featured this month, by Grahnemo et al, was first published in JCEM in October 2024: “Associations of Serum Testosterone and SHBG With Incident Fractures in Middle-Aged to Older Men.” Show notes can be found at https://www.endocrine.org/journals/endocrine-feedback-loop-podcast-series/efl059-testosterone-levels-and-fracture-risk-in-men — podcast home page: https://www.endocrine.org/journals/endocrine-feedback-loop-podcast-series

EFL058 - BMI vs Percent Body Fat in Defining Obesity 20.02.2025 43Min.

Join host Chase Hendrickson, MD, from Vanderbilt University Medical Center, in a discussion about a study in The Journal of Clinical Endocrinology & Metabolism that reports the relationship between body mass index and percent body fat in terms of defining overweight and obesity. He talks with Andrew Kraftson, MD, from the University of Michigan and guest expert Beverly Tchang, MD, from Weill Cornell Medicine in New York City. The article featured this month, by Potter et al, was first published in JCEM in May 2024: “Defining Overweight and Obesity by Percent Body Fat Instead of Body Mass Index.” Show notes can be found at https://www.endocrine.org/journals/endocrine-feedback-loop-podcast-series/efl058-bmi-vs-percent-body-fat-in-defining-obesity — podcast home page: https://www.endocrine.org/journals/endocrine-feedback-loop-podcast-series

EFL057 - Weaning Glucocorticoids and HPA Recovery 16.01.2025 34Min.

Join host Chase Hendrickson, MD, from Vanderbilt University Medical Center, in a discussion about a study in The Journal of Clinical Endocrinology & Metabolism that gives insight into how we should wean patients off long-term glucocorticoid use and how successful that typically is. He talks with Salila Kurra, MD, from Columbia University and guest expert Felix Beuschlein, MD, from University Clinic Zurich in Switzerland. The article featured this month, by Arshad et al, was published in the November 2024 issue of JCEM: “A Retrospective Study on Weaning Glucocorticoids and Recovery of the Hypothalamic-Pituitary-Adrenal Axis.” Show notes can be found at https://www.endocrine.org/journals/endocrine-feedback-loop-podcast-series/efl057-weaning-glucocorticoids-and-hpa-recovery — podcast home page: https://www.endocrine.org/journals/endocrine-feedback-loop-podcast-series

EFL056 - Renin Measurements in Primary Adrenal Insufficiency 19.12.2024 35Min.

Join host Chase Hendrickson, MD, from Vanderbilt University Medical Center, in a discussion about a recent article in Journal of the Endocrine Society assessing plasma renin in the management of individuals with primary adrenal insufficiency. He talks with Jill Wagoner, MD, from the University of Nebraska and guest expert Irina Bancos, MD, from Mayo Clinic. The article featured this month, by Piazzola et al, was published in the November 2024 issue of JES: “Plasma Renin: A Useful Marker for Mineralocorticoid Adjustment in Patients With Primary Adrenal Insufficiency.” Show notes can be found at https://www.endocrine.org/journals/endocrine-feedback-loop-podcast-series/efl056-renin-measurements-in-primary-adrenal-insufficiency — podcast home page: https://www.endocrine.org/journals/endocrine-feedback-loop-podcast-series

EFL055 - T3 Replacement in the Treatment of Hypothyroidism 21.11.2024 39Min.

Join host Chase Hendrickson, MD, from Vanderbilt University Medical Center, in a discussion about a recent systematic review and meta-analysis in The Journal of Clinical Endocrinology & Metabolism about the role for T3 replacement in the treatment of people with hypothyroidism. He talks with Andrew Crawford, MD, from Dartmouth-Hitchcock Medical Center and guest expert James Hennessey, MD, from Beth Israel Deaconess Medical Center. The article featured this month, by Esberard de Lima Beltrão et al, was first published online in JCEM in September 2024: “Treatment Preferences in Patients With Hypothyroidism.” Show notes can be found at https://www.endocrine.org/journals/endocrine-feedback-loop-podcast-series/efl055-t3-replacement-in-the-treatment-of-hypothyroidism — podcast home page: https://www.endocrine.org/journals/endocrine-feedback-loop-podcast-series