A quick note: This episode was recorded just days before PCOS was officially renamed PMOS, polyendocrine metabolic ovarian syndrome, in a global consensus published in The Lancet in June. You'll hear us use PCOS throughout the conversation. Same condition, new name, and funny enough, we spend part of the episode talking about how much the old one never quite fit.

PCOS, now PMOS, affects 10 to 13 percent of women, roughly 1 in 8. It is the most common endocrine condition in women, and it is still underdiagnosed and often misunderstood.

Dr. Madeline Kaye is a board-certified OBGYN whose grandfather trained under Dr. Irving Stein, one of the two physicians PCOS was originally named after (Stein-Leventhal syndrome). Generations later, Dr. Kaye is doing the careful, comprehensive work this condition requires.

We cover:

• The renaming of PCOS to PMOS and what it reflects about the science
• What PMOS is and how it is diagnosed
• Why insulin resistance sits at the center of so many symptoms
• The hormonal dance of a normal menstrual cycle and what goes wrong in PMOS
• Irregular periods, acne, unwanted hair growth, hair loss, weight, sleep apnea, and mood disorders
• Why women with PMOS carry a higher premenopausal risk for endometrial cancer, and how to protect against it
• Birth control: band-aid or true treatment
• Lifestyle as the foundation: nutrition, exercise, sleep, and stress
• Supplements: what do we think about inositol (dose, ratio, what to expect), vitamin D, berberine, and spearmint tea?
• Metformin, GLP-1s, and the new oral options changing the game
• Fertility considerations and how to optimize before conception
• Spironolactone and the androgen symptom toolkit

Sign up for more at OffTheCharts.Health

The average woman with vulvar lichen sclerosus waits 5 to 15 years for a correct diagnosis. Most see three or more providers along the way. One in three women lives with a vulvar condition at some point in her life, and uncommonly is told what is really happening to the skin of the most sensitive area of her body.

Dr. Melissa Mauskar is a board-certified dermatologist at UT Southwestern, a leading vulvar disease researcher, and the founder of one of the few specialty clinics in the country dedicated to vulvar dermatology. She has built her career around finding the answers women have been told do not exist, and her work is changing what these women can expect from medicine.

We cover:

• Why the vulva is its own organ and behaves differently than skin anywhere else on the body
• Lichen sclerosus: who gets it, what it actually is, and the 1 to 3 percent prevalence that doesn't get spoken about enough
• The autoimmune debate and what the research is showing now
• Lichen planus, eczema, psoriasis, and Crohn's on the vulva
• Why the diagnostic delay is so long, and what is being done to close it
• Topical steroids: how to use them correctly, and the myth that they thin the skin when there is disease present
• Compounded and emerging treatments, including JAK inhibitors and the international clinical trial Dr. Mauskar is leading
• The vulvar microbiome and hormone research that may rewrite how we treat these conditions
• Surgical considerations and when to optimize before any procedure
• Vulvar irritants, allergens, and the over-the-counter products doing more harm than good
• Diet, irritants and allergens connection
• Vulvar cancer surveillance and what women need to know
• The new clinical trials and research consortium reshaping the field

Sign up for more at OffTheCharts.Health

Find Dr. Mauskar's work at melissamauskar.com

Autoimmune diseases affect roughly 5 to 10 percent of the U.S. population, and women carry about 80 percent of the burden. The science is clear that chronic stress and adverse childhood experiences raise the risk in a dose-dependent way, with each additional ACE increasing autoimmune disease prevalence by about 10 percent. A large Swedish cohort found a 36 percent higher risk of autoimmune disease in adults with stress-related disorders, rising to 46 percent for those with PTSD.

That's what the science says. Sara Hirsh Bordo went further. Filmmaker, founder of Women Rising, and author of Autoimmunity & The Good Girls, she funded the first survey at the intersection of female empowerment and autoimmunity in 1,000 American women and found a striking pattern: more than 6 in 10 with autoimmune disease were the eldest or only daughter, and more than half were raised as the family caretaker.

Her thesis: a self compromised creates immunity compromised.

We cover:

• The eldest daughter, only daughter, lifelong caretaker pattern
• How chronic self-betrayal correlated with Sara's own diagnoses and relapses
• Reframing self-prioritization as foreign, not wrong
• The little-T trauma of being raised to fear disappointing others
• Practicing safe disappointment as a muscle to rebuild
• The body speaks story, not just science
• Raising daughters who can fall, get dirty, and get back up
• Imperfection as the path forward
• Readiness, healing, and what it takes to live differently

Autoimmunity & The Good Girls is available now wherever books are sold. A portion of Sara's proceeds benefit the Society for Women's Health Research.

Sign up for more at OffTheCharts.Health

Dr. Tim Porter is a board-certified pediatrician and co-founder and Chief Medical Officer of Modern Pediatrics, a concierge house call practice serving Central Texas and the Dallas metropolitan area. Same-day messaging, in-home visits, someone always on call, and a model built around removing the barriers between families and their pediatrician.

Tim is also one of the country's most thoughtful voices on infant sleep, having worked with thousands of families navigating the hardest stretch of parenting.

We cover:

• Why Tim left traditional pediatrics to build Modern
• What concierge pediatrics looks like for a family
• The peace-of-mind piece: knowing someone is always there
• Why pediatrics is the perfect fit for the concierge model
• The science of infant sleep from birth through age four
• Why babies cluster feed at night (and why it happens with formula too)
• Avoiding the overtired state
• Sleep training: extinction, gradual extinction, what the attachment research shows
• Capping naps, drowsy but awake, feeding to sleep, holding babies to sleep
• The biggest infant sleep myths that need to go
  

Sign up for more at OffTheCharts.Health

Dr. Caitlin Giesler is a board-certified cardiologist, fellow of the American College of Cardiology, and founder of The Heart Center for Women in Austin. She left the traditional system to build a practice where women get an hour, get answers, and get someone who picks up the phone. Heart disease is the number one killer of women, more than all cancers combined. Women have been under-researched, over-dismissed, and misunderstood. Dr. Giesler does not stand for it.

We cover:

• Why heart disease is the leading cause of death in women but the message isn't landing
• How women's hearts are biologically different and why microvascular disease is missed
• Sex-specific troponin thresholds and the heart attacks women are sent home with
• Pregnancy as a cardiovascular stress test (preeclampsia, gestational hypertension, gestational diabetes)
• Perimenopause, menopause, and what estrogen loss does to the heart
• HRT and the heart in 2026: timing hypothesis, transdermal vs oral, the FDA black box removal
• Palpitations, chest pressure, anxiety in menopause and when to push for a workup
• Advanced labs: hs-CRP, ApoB, lipoprotein(a)
• Coronary artery calcium scoring, the mammogram of your heart
• Statins for women: muscle aches, brain fog, and the real conversation
• PCSK9 inhibitors and other options when statins aren't tolerated
• The statin-Alzheimer's connection and vascular health as brain health
• Calcium, vitamin D, K, omega-3s, CoQ10 and the supplement landscape
• GLP-1s and cardiovascular benefit
• VO2 max, weighted vests, strength training, and the Life's Essential Eight
• Oral microbiome, periodontal health and the heart
• Autoimmune disease, inflammation, and HSCRP
• Takotsubo (broken heart syndrome), MINOCA, ANOCA, SCAD: the female-predominant conditions you've probably never heard of
• Mental health, depression, PTSD and cardiovascular risk
• Warning signs of a heart attack in women
• What concierge cardiology offers women who want more than 15 minutes

Find Dr. Giesler at HeartCenterForWomen.com

Sign up for more at OffTheCharts.Health

What is normal for penis size? Why do most men seeking enhancement fall in the normal range? And do men talk about any of this?

Dr. Tyler McClintock is a board-certified urologist at Midtown Urology in Austin, and specializes in men's sexual health, including erectile dysfunction and penile enhancement.

We cover:

• Normal penis size: flaccid and erect measurements
• Grower vs shower: what the research shows
• Body image, locker room comparisons, and male insecurity
• Penile girth enhancement: what Phallofill is, how it works, who is a candidate
• Hyaluronic acid filler for the penis: procedure, recovery, results
• Do women report girth matters more than length?
• Erectile dysfunction (ED): prevalence, causes, progression with age
• Viagra, Cialis, and how these medications work
• Why only a very small percentage of men with sexual concerns seek help
• Use it or lose it: protecting penile length over time

Sign up for more at OffTheCharts.Health (http://offthecharts.health/)

Leaking when you laugh? Pain during sex? Pressure down there that won't go away? Told to just do kegels and it's not working?

Dr. Kimberlee Sullivan is one of the most respected pelvic floor physical therapists in the country. She's spent over two decades treating the conditions no one talks about and built her career making this care accessible to more people. She now leads clinics at Origin and still sees patients because she says it reminds her why she does this work.

We cover:

• What pelvic floor physical therapy actually is and what happens at your first visit
• Kegels: when they help, when they backfire, and why many people do them wrong
• Leaking urine, bladder urgency, and incontinence after pregnancy or with aging
• Pelvic floor exercises that can help
• Pain during sex, vaginismus, and conditions doctors dismiss as "all in your head"
• Postpartum recovery and how the U.S. is behind other countries
• Tight pelvic floor vs weak pelvic floor
• How to find a pelvic floor PT near you and what virtual pelvic floor therapy looks like

Sign up for more at OffTheCharts.Health

Find Origin at theoriginway.com

His brother was misdiagnosed for over a year while cancer spread. One blood test could have caught it. That experience pulled Jani Tuomi out of fintech and into healthcare, where he co-founded Imaware, one of the first companies to bring lab-grade autoimmune and cardiovascular screening to your home with a finger prick. He has since helped build companies across ALS therapeutics, neurotechnology, and physician workforce, including Coya Therapeutics, Coherence Neuro, and Matchday Health.

We talk about the difference between screening and diagnosing, what to look for before you trust an at-home health test, and why your doctor might throw out results that don't meet a specific standard.

Jani now invests in early-stage health tech founders in Austin, co-authors the Austin Bio and Health Report, and is working to make the city a national leader in health innovation.

If you have ever wanted more answers about your own health than you were getting, this one is for you.