Articles
Evidence and practical answers, by condition
Each article answers a common question about the conditions we treat, with the numbers behind the answer.
Hormones & menopause
Estradiol Patch vs Gel vs Pill: Which Route Is Right for You?
Patch, gel, and pill all deliver estradiol, but the route changes your clot risk. Here is how transdermal estrogen compares to oral, and how to choose.
HRT Myths and the WHI Study: What the Trial Actually Found
The 2002 WHI study scared a generation off hormone therapy. Here is what the trial actually found and why the age-stratified reread changed the picture.
Is This Perimenopause? A Symptom Checklist for Your 40s
A clear symptom-by-symptom guide to perimenopause: hot flashes, sleep, mood, periods and brain fog, plus when to ask about hormone therapy.
The FDA Dropped the HRT Black Box Warning. Here Is What Actually Changed.
In November 2025 the FDA removed the boxed warning from menopausal hormone therapy. We break down what was removed, what stayed, and what it means for you.
Why You Need Progesterone With Estrogen (If You Have a Uterus)
If you take systemic estrogen and still have your uterus, you need progesterone to protect the lining. Here is why, and how micronized progesterone fits in.
Is It Too Late to Start HRT? The Evidence Points to a Ten-Year Window
Within ten years of menopause or before 60, HRT carries a favorable benefit-risk balance. What the WHI reread and the timing trials actually show.
Hot Flashes After Breast Cancer: Which Treatments Are Safe With Tamoxifen
Breast cancer treatment often brings hot flashes, and estrogen is usually off-limits. Here are the non-hormonal options that work, and why paroxetine is avoided with tamoxifen.
Hot Flashes When You Can't Take Estrogen: A Plain Guide to Your Choices
Blood clots, stroke, certain cancers or just a preference can put estrogen off-limits. Here are the non-hormonal hot flash treatments that work, and how to pick one.
Non-Hormonal Treatment for Hot Flashes: The Options That Actually Work
Three non-hormonal prescription options cut hot flashes by about half: venlafaxine, oxybutynin and low-dose paroxetine. Here are the numbers, the trade-offs and which fits.
Hair loss
Dutasteride vs Finasteride: When to Step Up
Dutasteride suppresses more DHT than finasteride, but it is off-label for hair loss with a smaller evidence base. Here is the data and the step-up logic.
Female Pattern Hair Loss: Your Treatment Options Explained
Minoxidil, spironolactone and why finasteride is restricted before menopause. A clear guide to the real treatment options for female pattern hair loss.
Finasteride Side Effects: The Real Numbers, Honestly
A straight look at finasteride side effects: the real trial rates, the post-finasteride syndrome debate and the 2025 EMA suicidality decision.
Hair Shedding vs Hair Loss: How to Tell the Difference
Sudden shedding and gradual thinning are different problems with different causes. Here is how to tell telogen effluvium from androgenetic hair loss, and when to worry.
Low-Dose Oral Minoxidil: Why Dermatologists Moved to the Pill
Low-dose oral minoxidil has become a go-to for pattern hair loss. Why dermatology shifted from the topical to the pill, and who it suits.
Finasteride and Minoxidil Together: Why the Combination Beats Either Drug Alone
Finasteride and minoxidil work on hair loss two different ways. A 5-trial meta-analysis (Chen 2020) found the combination beats either drug alone.
Ketoconazole 2% Shampoo: A Modest Add-On for Pattern Hair Loss
Ketoconazole 2% shampoo matched 2% minoxidil for hair density in one trial. The evidence, the right strength, and where it fits in a hair-loss plan.
How Long Does Finasteride Take to Work? Three to Six Months to See Results
Finasteride takes three to six months to show results and about a year to judge fully. The Kaufman 1998 timeline, early shedding, and what reverses if you stop.
Herpes
Daily vs Episodic Herpes Treatment: How to Choose
Daily suppressive antivirals and episodic treatment do different jobs. Here is how the two approaches compare on outbreaks, transmission, cost and who each one fits.
Herpes Transmission Risk: The Actual Numbers
Real per-year transmission rates for genital HSV-2 in couples, plus what suppression, condoms and disclosure each add. The numbers are lower than most people fear.
How to Tell a Partner You Have Herpes
Disclosure scripts, when to have the conversation, how suppression changes it and the legal facts. A direct guide to telling a partner you have herpes.
HSV-1 vs HSV-2: What Actually Matters
The HSV type matters less than where the virus lives. Here is how HSV-1 and HSV-2 differ by site, and why recurrence rates depend on both type and location.
Valacyclovir 500 mg vs 1 g for Suppression: Why Outbreak Frequency Sets the Dose
For daily herpes suppression, 500 mg and 1 g of valacyclovir are not interchangeable. Under ten outbreaks a year, 500 mg holds up; at ten or more, 1 g does better.
Valacyclovir vs Acyclovir: Which Herpes Antiviral to Take
Valacyclovir and acyclovir become the same active drug in your body. The difference is absorption, dosing frequency and cost. Here is how to choose.
How Common Is Herpes? About 1 in 8 US Adults Carries HSV-2
About 1 in 8 US adults aged 14 to 49 carries HSV-2 and most never know. What the CDC's herpes prevalence numbers actually say.
Migraine
How Triptans Work, and Why Painkillers Often Don't
Triptans target the migraine pathway through 5-HT1B/1D receptors. Here is the mechanism, why timing matters, and why ordinary painkillers fall short.
Medication-Overuse Headache: The 10-Day Rule for Triptans
Taking triptans on 10 or more days a month for over three months can cause medication-overuse headache. Here is the threshold, why it happens and how to avoid it.
Migraine Triggers: Which Ones Hold Up in Studies
Not every popular migraine trigger survives controlled study. Here is which triggers the evidence supports, which fall apart and the reverse-causation trap.
Migraine vs Bad Headache: How to Tell the Difference
Migraine is a specific neurological condition, not just a severe headache. Here are the ICHD-3 criteria in plain language and a validated 3-question screen.
Sumatriptan vs Rizatriptan: Which Triptan Works Better
Sumatriptan and rizatriptan compared on onset, efficacy data and formulations. Rizatriptan acts faster orally; sumatriptan has more delivery options.
Who Should Not Take Triptans: The Heart Conditions That Actually Disqualify You
The heart conditions that rule out triptans, the ones that don't and why a 63,575-patient study found no excess risk when prescribers screen first.
Skin
Azelaic Acid for Melasma and PIH: What the Trials Show
Azelaic acid 20% matched hydroquinone 4% in melasma trials and is one of the safest off-label pigment treatments for darker skin and pregnancy. A realistic guide.
Latanoprost for Eyelash Growth vs Latisse: An Honest Guide
Latanoprost grows lashes off-label, the same way FDA-approved Latisse does. Here is how the two prostaglandin analogs compare, what to expect and an honest section on permanent iris darkening.
Prescription Rosacea Treatment: Azelaic Acid and Doxycycline
How azelaic acid 15% and anti-inflammatory dose doxycycline treat papulopustular rosacea, which subtype you have and why ocular symptoms need an in-person exam.
The Tretinoin Purge Timeline: What to Expect Week by Week
A clinician-informed week-by-week guide to the tretinoin purge, why your skin can worsen before it clears, and when a flare means something else.
Tretinoin Strengths Explained: 0.025% vs 0.05% vs 0.1%, Cream vs Gel
How tretinoin 0.025%, 0.05% and 0.1% actually differ, what the photoaging trials showed and how to choose between cream and gel.
Doxycycline for Inflammatory Acne: Dosing, Duration and Resistance
Doxycycline 40 mg matched 100 mg for acne with fewer side effects (Moore 2015). Here is how it is dosed, how long to take it and how to limit resistance.
Tretinoin vs Retinol: One Acts Directly, the Other Must Convert First
Tretinoin is retinoic acid and acts directly. Retinol must convert in your skin and only a fraction does. Here is what that gap means for your results.
Women's health
Recurrent Yeast Infections: When One Fluconazole Dose Isn't Enough
Four or more yeast infections a year is recurrent VVC. A six-month weekly fluconazole plan kept 90.8% of women symptom-free at six months (Sobel 2004). How it works.
Why Fluconazole Needs a Prescription in the US When It Doesn't in the UK
In the UK, Canada and Australia you can get fluconazole from a pharmacist. In the US it still needs a prescription. Here is why, and how to get the one-pill yeast infection treatment online.