Female Hormone Health, PCOS, Endometriosis, Fertility & Breast Cancer | Dr. Thaïs Aliabadi

女性荷尔蒙健康、多囊卵巢综合症、子宫内膜异位症、生育和乳腺癌 |泰伊斯·阿利亚巴迪博士

2025-11-24 | 官方页面 YouTube 官方音频

Thaïs Aliabadi: Every single ophthalmologist knows about cataract?

Thaïs Aliabadi：每个眼科医生都了解白内障吗？

Andrew Huberman: Yes.

安德鲁·休伯曼：是的。

Most common form of blindness.

最常见的失明形式。

Thaïs Aliabadi: So it would be rare for you to go to an ophthalmologist with cataract and not get diagnosed, correct?

Thaïs Aliabadi：所以您去看眼科医生却没有得到诊断白内障的情况很少见，对吗？

Andrew Huberman: Correct.

安德鲁·休伯曼：正确。

Thaïs Aliabadi: So why is it that the leading cause of infertility on this planet, 90% of women are not diagnosed?

Thais Aliabadi：那么，为什么 90% 的女性没有得到诊断，这是这个星球上不孕不育的主要原因呢？

Women's health is very different than other fields of medicine.

女性健康与其他医学领域有很大不同。

It's a different monster.

这是一个不同的怪物。

It's that cataract patient that goes to 20 ophthalmologists, and she keeps saying, "I can't see!" And the ophthalmologist says, "You're crazy.

就是那个白内障患者看了20位眼科医生，她一直说：“我看不见！”眼科医生说：“你疯了。

There's nothing wrong with you."

你没有什么问题。”

Andrew Huberman: Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life.

Andrew Huberman：欢迎来到 Huberman 实验室播客，我们在这里讨论科学和基于科学的日常生活工具。

I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.

我是安德鲁·胡伯曼，斯坦福大学医学院神经生物学和眼科教授。

My guest today is Dr. Thaïs Aliabadi, an obstetrician, gynecologist, and surgeon, and one of the most sought-after experts and trusted voices in women's health.

今天我的嘉宾是 Thaïs Aliabadi 博士，他是一位产科医生、妇科医生和外科医生，也是女性健康领域最受欢迎的专家和值得信赖的声音之一。

Today, we discuss crucial topics in women's reproductive and general health, including PCOS, endometriosis, breast cancer, perimenopause, and menopause.

今天，我们讨论女性生殖和一般健康的重要话题，包括多囊卵巢综合症、子宫内膜异位症、乳腺癌、围绝经期和更年期。

Dr. Aliabadi explains why so many cases of PCOS and endometriosis go undiagnosed, and how many physicians, unfortunately, write off things like pain, hair thinning, mood changes, and other symptoms as normal, when in fact, they reflect larger underlying issues that can impair fertility and lead to body-wide health complications.

Aliabadi 博士解释了为什么如此多的 PCOS 和子宫内膜异位症病例未能得到诊断，以及不幸的是，有多少医生将疼痛、头发稀疏、情绪变化和其他症状视为正常症状，而事实上，它们反映了更大的潜在问题，可能损害生育能力并导致全身健康并发症。

And she explains the key things to do to diagnose and treat PCOS and endometriosis, everything from how to adjust insulin sensitivity to hormone replacement, over-the-counter and prescription-based protocols.

她解释了诊断和治疗多囊卵巢综合症和子宫内膜异位症的关键事项，从如何调整胰岛素敏感性到激素替代、非处方药和处方方案。

As you'll soon hear, Dr. Aliabadi is incredibly passionate about women's health and has developed various zero-cost online tools that women of any age can use to assess their risk for things like breast cancer, PCOS, and endometriosis.

您很快就会听说，Aliabadi 博士对女性健康充满热情，并开发了各种零成本在线工具，任何年龄段的女性都可以使用这些工具来评估她们患乳腺癌、多囊卵巢综合症和子宫内膜异位症等疾病的风险。

I should also emphasize that today's discussion is relevant to women of all ages.

我还应该强调，今天的讨论与所有年龄段的女性都相关。

Many of the conditions we discuss are starting to show up in women, even in their mid-teens and 20s, and can carry serious health risks.

我们讨论的许多病症开始出现在女性身上，甚至在十几岁和二十多岁的时候，并且可能带来严重的健康风险。

Dr. Aliabadi makes very clear that often these issues can be resolved, but that it requires knowing the telltale signs and taking the appropriate steps.

阿利亚巴迪博士非常明确地表示，这些问题通常是可以解决的，但需要了解迹象并采取适当的步骤。

She explains that, alas, many doctors and even OBGYNs are unaware of those telltale markers.

她解释说，唉，许多医生甚至妇产科医生都不知道这些迹象。

So what you're about to hear is an extremely eye-opening conversation that, thanks to Dr. Aliabadi's passion for and expertise in women's health, could very well save someone's mental and physical health, their fertility, and in the case of breast cancer screening, even their life.

因此，您将听到的是一场令人大开眼界的对话，由于 Aliabadi 博士对女性健康的热情和专业知识，这场对话可以很好地挽救某人的身心健康、生育能力，在乳腺癌筛查的情况下，甚至可以挽救她们的生命。

Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford.

在开始之前，我想强调一下，这个播客与我在斯坦福大学的教学和研究角色是分开的。

It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public.

然而，我的愿望和努力的一部分是向公众提供有关科学和科学相关工具的零成本消费者信息。

In keeping with that theme, today's episode does include sponsors.

为了与这个主题保持一致，今天的节目确实有赞助商。

And now for my discussion with Dr. Thaïs Aliabadi.

现在我要与 Thaïs Aliabadi 博士进行讨论。

Dr. Thaïs Aliabadi, welcome.

Thaïs Aliabadi 博士，欢迎光临。

Thaïs Aliabadi: Thank you for having me.

Thais Aliabadi：谢谢你邀请我。

Andrew Huberman: Super excited to talk about today's topics, and there are a lot of them, because I think these days we hear a tremendous amount about how fertility rates are dropping.

安德鲁·胡伯曼：非常高兴谈论今天的话题，话题很多，因为我认为这些天我们听到了大量关于生育率下降的消息。

We hear that sperm counts are dropping.

我们听说精子数量正在下降。

We hear that things like PCOS, which you'll explain to us, are on the rise.

我们听说像多囊卵巢综合症这样的疾病正在增加，您将向我们解释这一点。

I'm curious if they're on the rise or they're just being detected or not detected as much.

我很好奇它们是否正在增加，或者只是被发现或没有被发现。

Let's start off quite simply and just bracket for people what the sort of standard trajectory of fertility looks like for the, quote, unquote, "average woman." I realize there's no such thing as an average woman, but I think we hear so much these days about people are waiting to have kids.

让我们从简单的开始，为人们列出“普通女性”的标准生育轨迹。我意识到没有一个普通的女人，但我想我们现在听到很多关于人们正在等待生孩子的消息。

Some people are freezing eggs early, all this.

有些人很早就冷冻卵子，这一切。

If we were to just march through and say, what fraction of healthy women are fertile in their, say, 20 to 25, 25 to 30, and march that forward, just to give people a sense of what the data and your experience really tell us.

如果我们只是问一下，20 岁到 25 岁、25 岁到 30 岁的健康女性中，有多少比例具有生育能力，然后继续前进，只是为了让人们了解数据和您的经验真正告诉我们什么。

Thaïs Aliabadi: First of all, before I go there, I want to tell you something.

Thais Aliabadi：首先，在我去那里之前，我想告诉你一件事。

I want to tell you how excited I am to be here today, and I'll tell you why, because I've been in women's health for 30 years, and one thing I learned is that women's symptoms get dismissed, minimized, or completely ignored, right?

我想告诉你我今天来到这里是多么兴奋，我会告诉你为什么，因为我从事女性健康研究已有 30 年了，我学到的一件事是女性的症状被忽视、最小化或完全忽视，对吗？

It's normalized.

它已经正常化了。

These women, every time they complain, they say, "It's in your head, you're anxious, you're stressed, it's normal, it's part of being a woman." And behind these dismissals are millions and millions of women suffering undiagnosed PCOS, endometriosis, chronic pelvic pain, infertility, which we're going to cover right now, and so many other issues, because no one takes the time to listen to them.

这些女性每次抱怨时都会说：“这在你的脑海里，你很焦虑，你有压力，这是正常的，这是作为女人的一部分。”这些解雇的背后是数以百万计的女性患有未确诊的多囊卵巢综合症、子宫内膜异位症、慢性盆腔疼痛、不孕症（我们现在要讨论这些问题）以及许多其他问题，因为没有人花时间倾听她们的声音。

And the reason I'm so excited to be on this podcast is I want to shed light on these topics, especially endometriosis and PCOS, because they're the top leading causes of infertility on this planet.

我之所以如此兴奋地参加这个播客，是因为我想阐明这些主题，特别是子宫内膜异位症和多囊卵巢综合症，因为它们是这个星球上不孕的主要原因。

Majority of these patients are never diagnosed, majority.

这些患者中的大多数从未被诊断出来。

And that's why I'm so excited to be here, and I love talking about fertility because the reason these women end up in a fertility clinic in the first place, majority of them have undiagnosed PCOS and endometriosis.

这就是为什么我很高兴来到这里，我喜欢谈论生育问题，因为这些女性最终来到生育诊所的首要原因是，她们中的大多数患有未确诊的多囊卵巢综合症和子宫内膜异位症。

So we are born with certain number of eggs, millions of them, and we don't make more eggs after we're born.

所以我们出生时就有一定数量的卵子，数百万个，而且出生后我们不会再制造更多的卵子。

And as we go through life, we start losing these eggs until, at about menopause, we have about a thousand of them left.

在我们的一生中，我们开始失去这些卵子，直到大约更年期，我们只剩下大约一千个卵子。

So as we get older, the number goes down, but the quality also declines.

因此，随着年龄的增长，数量会减少，但质量也会下降。

The issue is PCOS and endometriosis affect your egg count and your egg quality.

问题是多囊卵巢综合症和子宫内膜异位症会影响您的卵子数量和卵子质量。

So, because 90% of these patients are never diagnosed, what happens is they start losing their eggs.

因此，由于 90% 的患者从未被诊断出来，所以他们开始失去卵子。

Let's say, take an endometriosis patients, which we're going to get into it.

比方说，以子宫内膜异位症患者为例，我们将对此进行研究。

But they start losing these eggs.

但它们开始失去这些卵。

The quality starts shooting down.

质量开始下降。

Some of them, by age 30, they have zero eggs left.

其中一些人到了 30 岁时，卵子剩余量为零。

And these are patients who bounce from doctor to doctor, and their symptoms are dismissed.

这些病人从一个医生换到另一个医生，他们的症状却被忽视了。

They're being told that their painful period is normal, that their painful sex is in their head, that they're exaggerating their pain, and meanwhile, their ovarian reserve is completely depleting, and no one is addressing that.

她们被告知，她们的痛苦经期是正常的，她们痛苦的性生活是在她们的头脑中，她们夸大了她们的痛苦，与此同时，她们的卵巢储备完全耗尽，而没有人解决这个问题。

Andrew, I've always said this, and I really mean it: "If every 20-year-old in this country would go through my office once at age 20, I would shut down these fertility clinics, because where do these patients end up?

安德鲁，我一直这么说，而且我是认真的：“如果这个国家的每个 20 岁的人在 20 岁时都来我的办公室一次，我会关闭这些生育诊所，因为这些患者最终会去哪里？

In fertility clinics." That's why these doctors are so busy, and that's why these patients go bankrupt, selling their homes, selling everything they have to pay for an IVF cycle that could have been completely blocked had they been diagnosed correctly and treated at a very young age.

在生育诊所。”这就是为什么这些医生如此忙碌，这就是为什么这些患者破产，卖掉他们的房子，卖掉他们所拥有的一切来支付试管受精周期，如果他们在很小的时候得到正确的诊断和治疗，这个周期可能会被完全阻止。

And I'm talking, sometimes I treat 13-year-olds with endometriosis.

我说的是，有时我会治疗 13 岁的子宫内膜异位症患者。

I have, right now in my practice, a girl at 14 with endometriosis whose egg count is the egg count of a 40-year-old.

目前，我的诊所有一个患有子宫内膜异位症的 14 岁女孩，她的卵子数量相当于 40 岁的人的卵子数量。

That's why I can't sit here and generalize that if you're in your 20s, you're going to be fine.

这就是为什么我不能坐在这里概括地说，如果你 20 多岁，你就会没事的。

It's not true.

这不是真的。

You need to know at a very young age, every girl on this planet needs to be screened for endometriosis, for PCOS, and they need to know their egg count.

你需要在很小的时候就知道，这个星球上的每个女孩都需要接受子宫内膜异位症和多囊卵巢综合症的筛查，并且她们需要知道自己的卵子数量。

Egg count, AMH, anti-Müllerian hormone, is a simple blood test.

卵子计数、AMH（抗苗勒氏管激素）是一项简单的血液检查。

It's covered by most insurances.

大多数保险都涵盖它。

It needs to be offered.

它需要被提供。

If you don't want to offer it to your young patients, because teenagers are tricky because they have so many eggs.

如果您不想将其提供给年轻患者，因为青少年很棘手，因为他们有太多鸡蛋。

But if they're complaining of severe pain, if they're missing school...

但如果他们抱怨剧烈疼痛，如果他们缺课……

As a parent, you have to go pick them up from school, the nurse is calling you, they don't want to take their test because they're rolled up in bed from pain.

作为家长，你必须去学校接他们，护士正在打电话给你，他们不想参加测试，因为他们因疼痛而蜷缩在床上。

That patient, even at 14, deserves an egg count check, because for these patients, sometimes by age 16, I freeze their eggs.

那个病人，即使是 14 岁，也应该进行卵子计数检查，因为对于这些病人，有时到了 16 岁，我就冷冻了他们的卵子。

Andrew Huberman: Incredible.

安德鲁·休伯曼：难以置信。

So, now I'm going to reframe my question on the basis of what you just said and ask, is the typical plot that we see of this a X number of-- or X percentage of women of a given age bracket are this fertile or not fertile, meaning how many trials or times it would take in order to successfully get pregnant and carry a baby to term.

所以，现在我要根据你刚才所说和询问的内容重新构建我的问题，我们看到的典型情节是，给定年龄段的 X 数量或 X 百分比的女性具有生育能力或不生育能力，这意味着需要多少次试验或次数才能成功怀孕并生下婴儿。

Thaïs Aliabadi: Get pregnant.

Thaïs Aliabadi：怀孕吧。

Andrew Huberman: Should we either discard or think differently about the data that we see plotted out?

Andrew Huberman：我们是否应该放弃或以不同的方式思考我们所看到的绘制的数据？

Like, if I were to go into one of the AI platforms and ask, I'm sure it would generate a plot for me.

就像，如果我进入其中一个人工智能平台并询问，我确信它会为我生成一个情节。

What I'm hearing from you is that because PCOS and endometriosis are not taken into account, the textbook picture is a false picture of fertility as a function of age.

我从你那里听到的是，由于没有考虑到多囊卵巢综合症和子宫内膜异位症，教科书上的图片是生育能力与年龄关系的错误图片。

Thaïs Aliabadi: Correct.

泰伊斯·阿利亚巴迪：正确。

Correct.

正确的。

And that's why I have a patient who came to me.

这就是为什么我有一个病人来找我。

She was 24, severe pain.

她当时24岁，疼痛剧烈。

She said, "I listened to your podcast.

她说：“我听了你的播客。

I went to my doctor, and I asked her, my gynecologist, and I said, 'I have really bad, painful periods, and I think I have endometriosis.

我去看了我的医生，我问她，我的妇科医生，我说，‘我的经期非常糟糕、痛苦，我想我患有子宫内膜异位症。

Can you check my egg count?'" You know what the doctor told her, her gynecologist?

你能检查一下我的卵子数量吗？’”你知道她的妇科医生医生告诉她什么吗？

"You're too young.

“你太年轻了。

It would be malpractice for me to check your egg count, because at 24, you should not have any issues, and you have no problems getting pregnant." I operate on stage four endometriosis patients at age 18.

如果我检查你的卵子数量，那就是渎职，因为你24岁了，不应该有任何问题，怀孕也没有问题。”我在 18 岁时为子宫内膜异位症第四期患者进行手术。

That's why I'm here.

这就是我在这里的原因。

That's why I want to grab this mic, and that's why I want to just focus first on PCOS and then focus on endometriosis, because these two conditions, you don't need a doctor to diagnose you.

这就是为什么我想抓住这个麦克风，这就是为什么我想首先关注多囊卵巢综合症，然后关注子宫内膜异位症，因为这两种情况，你不需要医生来诊断你。

If you listen to this podcast, by the time you and I are done, whoever's listening, if it's a parent, if it's your sister, if it's yourself, if it's your daughter, you're going to be able to diagnose these conditions, the leading causes of infertility on this planet.

如果你听这个播客，当你和我结束时，无论是谁在听，如果是父母，如果是你的姐妹，如果是你自己，如果是你的女儿，你将能够诊断这些疾病，这是这个星球上不孕不育的主要原因。

It can be diagnosed.

是可以确诊的。

By the time we're done, you're going to walk on the street, and you're going to say, "I think that woman has PCOS." I'm serious, my patients are so smart.

当我们完成时，你会走在街上，你会说，“我认为那个女人患有多囊卵巢综合症。”我是认真的，我的病人都很聪明。

They literally send their friends.

他们确实发送了他们的朋友。

They're like, "I'm sending you my cousin because she has endometriosis." Patients are diagnosing when doctors are not.

他们就像是，“我派你去我的表弟，因为她患有子宫内膜异位症。”当医生不在时，患者正在诊断。

Andrew Huberman: Incredible.

安德鲁·休伯曼：难以置信。

Thaïs Aliabadi: That's why I'm looking forward to these robotic doctors.

Thaïs Aliabadi：这就是我期待这些机器人医生的原因。

I read that China has this robotic hospital.

我读到中国有一家机器人医院。

I'm like, "Praise the Lord!" These robots are not going to dismiss women.

我说：“赞美主！”这些机器人不会解雇女性。

If you tell a robot, "Sex hurts, I stay in bed.

如果你告诉机器人：“性爱很痛，我待在床上。

I end up in the emergency room every time I have my period," the robot will not call you crazy.

我每次来月经的时候都会进急诊室，”机器人不会说你疯了。

The robot will say, "You probably have endometriosis, but let's work it up."

机器人会说：“你可能患有子宫内膜异位症，但我们来解决一下吧。”

Andrew Huberman: Glucose is a key player in how our body functions, not just in the long term, but in every moment of our lives.

Andrew Huberman：葡萄糖是我们身体机能的关键角色，不仅从长远来看，而且在我们生命中的每时每刻。

That's because it is the major fuel for our cells, especially our brain cells.

那是因为它是我们细胞，尤其是脑细胞的主要燃料。

Glucose directly impacts our brain function, mood, and energy levels, and it may even affect our levels of tenacity and willpower.

葡萄糖直接影响我们的大脑功能、情绪和能量水平，甚至可能影响我们的坚韧和意志力水平。

This is why I use the continuous glucose monitor from Lingo.

这就是我使用 Lingo 连续血糖监测仪的原因。

I absolutely love it, and I'm thrilled to have them as a sponsor of the podcast.

我非常喜欢它，我很高兴他们成为播客的赞助商。

Lingo helps me track my glucose in real-time to see how the foods I eat and the actions I take impact my glucose.

Lingo 帮助我实时跟踪我的血糖，以了解我吃的食物和我采取的行动如何影响我的血糖。

When glucose in your body spikes or crashes, your cognitive and physical performance do, too.

当您体内的葡萄糖激增或崩溃时，您的认知和身体表现也会随之上升或下降。

In fact, large glucose peaks and valleys lead to brain fog, fatigue, irritability, and hunger.

事实上，大的葡萄糖峰值和谷值会导致脑雾、疲劳、烦躁和饥饿。

What you eat, of course, plays a major role in your glucose.

当然，你吃的东西对你的血糖起着重要作用。

Some foods cause sharp spikes and big crashes, and others do not.

有些食物会导致急剧的峰值和严重的崩溃，而另一些则不会。

But not everyone is the same in terms of how they respond to particular foods.

但并不是每个人对特定食物的反应都是一样的。

Seeing your glucose in real-time helps you build eating and other habits that support metabolic health, mental clarity, and sustained energy.

实时查看您的血糖有助于您养成饮食和其他习惯，以支持代谢健康、思维清晰和持续精力充沛。

Lingo has helped me to better understand what foods to eat, when to eat, and how things like a brief walk after a meal can help keep my glucose stable and much more.

Lingo 帮助我更好地了解该吃什么食物、何时吃以及饭后短暂散步等活动如何帮助我保持血糖稳定等等。

If you'd like to try Lingo, Lingo is offering Huberman podcast listeners in the US 10% off a four-week Lingo plan.

如果您想尝试 Lingo，Lingo 将为美国的 Huberman 播客听众提供为期 4 周的 Lingo 计划 10% 的折扣。

Terms and conditions apply.

条款和条件适用。

Visit hellolingo.com/huberman for more information.

请访问 hellolingo.com/huberman 了解更多信息。

Today's episode is also brought to us by Our Place.

今天的节目也是由我们的地方给我们带来的。

Our Place makes my favorite pots, pans, and other cookware.

我们的地方生产我最喜欢的锅、平底锅和其他炊具。

Surprisingly, toxic compounds such as PFAS or forever chemicals are still found in 80% of non-stick pans, as well as utensils, appliances, and countless other kitchen products.

令人惊讶的是，80% 的不粘锅以及餐具、电器和无数其他厨房产品中仍然含有 PFAS 或永久化学物质等有毒化合物。

As I've discussed before on this podcast, these PFAS or forever chemicals, like Teflon, have been linked to major health issues such as hormone disruption, gut microbiome disruption, fertility issues, and many other health problems, so it's very important to avoid them.

正如我之前在这个播客中讨论过的，这些 PFAS 或永久性化学物质（如聚四氟乙烯）与荷尔蒙破坏、肠道微生物组破坏、生育问题和许多其他健康问题等重大健康问题有关，因此避免它们非常重要。

This is why I'm a huge fan of Our Place.

这就是为什么我是《我们的地方》的超级粉丝。

Our Place products are made with the highest quality materials and are all PFAS and toxin-free.

我们的 Place 产品采用最优质的材料制成，不含 PFAS 和毒素。

I particularly love their Titanium Always Pan Pro.

我特别喜欢他们的 Titanium Always Pan Pro。

It's the first non-stick pan made with zero chemicals and zero coating.

这是第一个采用零化学品和零涂层制成的不粘锅。

Instead, it uses pure titanium.

相反，它使用纯钛。

This means it has no harmful forever chemicals and does not degrade or lose its non-stick effect over time.

这意味着它不含永久有害的化学物质，并且不会随着时间的推移而降解或失去其不粘效果。

It's also beautiful to look at.

看起来也很漂亮。

I cook eggs in my Titanium Always Pan Pro almost every morning.

我几乎每天早上都会用 Titanium Always Pan Pro 煮鸡蛋。

The design allows for the eggs to cook perfectly without sticking to the pan.

该设计使鸡蛋能够完美烹饪而不会粘在锅上。

I also cook burgers and steaks in it, and it always puts a really nice sear on the meat.

我还用它来做汉堡和牛排，它总是能让肉有很好的烤焦效果。

But again, nothing sticks to it, so it's really easy to clean, and it's even dishwasher safe.

但同样，没有任何东西粘在上面，所以它非常容易清洁，甚至可以用洗碗机清洗。

I love it, and I use it constantly.

我喜欢它，并且经常使用它。

Our Place now has a full line of Titanium Pro cookware that uses the first-of-its-kind titanium non-stick technology.

我们的地方现在拥有全系列 Titanium Pro 炊具，采用首创的钛不粘技术。

So if you're looking for non-toxic, long-lasting pots and pans, go to fromourplace.com/huberman and use the code Huberman.

因此，如果您正在寻找无毒、耐用的锅碗瓢盆，请访问 fromourplace.com/huberman 并使用代码 Huberman。

Right now, Our Place is having their biggest sale of the year.

目前，Our Place 正在进行今年最大的促销活动。

You can get up to 35% off all products now through January 12th, 2026.

即日起至 2026 年 1 月 12 日，所有产品均可享受高达 35% 的折扣。

With a 100-day risk-free trial, free shipping, and free returns, you can try Our Place with zero risk, and you can see why more than one million people have made the switch to Our Place kitchenware.

通过 100 天无风险试用、免费送货和免费退货，您可以零风险试用 Our Place，您就会明白为什么超过一百万人已改用 Our Place 厨具。

Again, that's fromourplace.com/huberman to get up to 35% off.

同样，来自ourplace.com/huberman 的折扣高达 35%。

Well, clearly, you're on an important mission, and clearly, it's good that we reframe the question that I initially asked and start with PCOS and then endometriosis.

嗯，很明显，你肩负着一项重要的使命，很明显，我们重新思考我最初提出的问题并从多囊卵巢综合症开始，然后是子宫内膜异位症，这是件好事。

Thaïs Aliabadi: Yeah.

泰伊斯·阿利亚巴迪：是的。

Yes.

是的。

Andrew Huberman: But before I do that, I just want to give a reflection, which is one of the takeaways from what you just said, and just one, there are many, but one of them is that most young women learn about the menstrual cycle.

安德鲁·休伯曼：但在此之前，我只想反思一下，这是你刚才所说的要点之一，只有一个，还有很多，但其中之一是大多数年轻女性都了解月经周期。

I think they also make an attempt to teach boys about the menstrual cycle.

我认为他们也尝试教导男孩有关月经周期的知识。

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: When we were in high school, they try to teach everybody.

安德鲁·休伯曼：当我们在高中时，他们试图教每个人。

Whether or not it sinks in to the males' brains is a question of debate, but most every woman learns at some point about the menstrual cycle.

男性的大脑是否会接受这个概念还有待商榷，但大多数女性都会在某个时候了解月经周期。

It sounds to me like female health education should also include education about PCOS and endometriosis at a very young age.

在我看来，女性健康教育还应该包括在很小的时候就进行有关多囊卵巢综合症和子宫内膜异位症的教育。

Thaïs Aliabadi: Mandatory.

泰伊斯·阿利亚巴迪：强制。

It should be mandatory.

这应该是强制性的。

Andrew Huberman: And currently, it's not.

Andrew Huberman：目前还不是。

In fact, many female listeners of this podcast, I believe, either suffer from or know somebody who suffers from PCOS or endometriosis.

事实上，我相信这个播客的许多女性听众要么患有多囊卵巢综合症或子宫内膜异位症，要么认识患有多囊卵巢综合症或子宫内膜异位症的人。

I know this because I get asked a lot to cover these topics, which is one of the reasons you're here.

我知道这一点是因为我经常被要求讨论这些主题，这也是您来到这里的原因之一。

And the other thing is that I'm certain that many do not, that many do not, because they came up through an education system where that just didn't happen.

另一件事是，我确信很多人没有，很多人没有，因为他们是通过一个没有发生这种情况的教育系统长大的。

So, we can start this important initiative now.

因此，我们现在就可以开始这项重要的举措。

What is PCOS?

什么是多囊卵巢综合症？

Thaïs Aliabadi: Very good question.

Thais Aliabadi：非常好的问题。

So PCOS is the most common hormone disorder in women in their reproductive age.

因此，多囊卵巢综合症是育龄女性最常见的激素紊乱。

The most common.

最常见的。

So we're not talking about some rare diagnosis, number one.

所以我们不是在谈论一些罕见的诊断，第一。

It affects 15% of women in this country.

它影响了这个国家 15% 的女性。

If you go to Middle Eastern countries, that number can go north of 20%.

如果你去中东国家，这个数字可能会超过 20%。

Studies show that 70% of these patients are never diagnosed.

研究表明，70% 的患者从未被诊断出来。

I tell you today that that number is over 90%.

今天我告诉大家，这个数字超过了90%。

Majority of these patients are never diagnosed, or even when they're diagnosed, they're not being treated correctly.

这些患者中的大多数从未被诊断出来，或者即使被诊断出来，他们也没有得到正确的治疗。

I listen to podcasts on PCOS, where doctors come, and whoever's interviewing them asks them, "So what do we do for PCOS?" And the answer is, "We give birth control." That's not true.

我听关于多囊卵巢综合症的播客，医生来的时候，采访他们的人都会问他们：“那么我们应该为多囊卵巢综合症做些什么呢？”答案是：“我们采取节育措施。”那不是真的。

Birth control is just one tiny little aspect of the entire treatment plan, and that's why patients get frustrated.

节育只是整个治疗计划的一小部分，这就是患者感到沮丧的原因。

So when it comes to diagnosing PCOS, right, you need to meet two out of three criteria.

因此，在诊断 PCOS 时，您需要满足三个标准中的两个。

The first one being symptoms of high testosterone or high androgens.

第一个是高睾酮或高雄激素的症状。

What are those?

那些是什么？

Facial hair, body hair, the most common, acne, oily skin, or male pattern hair thinning, which a lot of women complain of.

面部毛发、体毛，最常见的是痤疮、油性皮肤或男性型毛发稀疏，这是很多女性抱怨的问题。

Number two is basically ovulation dysfunction.

第二个基本上是排卵功能障碍。

These are women with irregular periods.

这些是月经不调的女性。

They'll get their periods over 35 days, it's not regular 28 days, or they get about eight periods per year.

她们的月经周期会超过 35 天，而不是正常的 28 天，或者每年大约有八次月经。

These are patients who usually come to the doctor, and when you ask them how your periods are, they can't really tell.

这些患者通常会去看医生，当你问他们你的月经情况时，他们并不能真正告诉你。

They tell you, "It's irregular.

他们告诉你：“这是不规则的。

I can't quite pinpoint when I'm going to get my period." And number three is PCOS, looking ovaries on ultrasound.

我不太确定我什么时候来月经。”第三是多囊卵巢综合症，通过超声波检查卵巢。

Polycystic ovary syndrome does not mean cysts.

多囊卵巢综合症并不意味着囊肿。

That's a bad name.

这是一个坏名字。

Andrew Huberman: Hmm.

安德鲁·休伯曼：嗯。

Thaïs Aliabadi: It's a very specific finding on ultrasound when you see almost 20-plus follicles in the ovary, and these are follicles.

Thaïs Aliabadi：当您在卵巢中看到近 20 多个卵泡时，这是超声波的一个非常具体的发现，而这些就是卵泡。

They look like a string of pearls.

它们看起来像一串珍珠。

It's very specific to PCOS.

它是针对多囊卵巢综合症（PCOS）的。

The issue is doctors don't recognize it, they dismiss it, and they look at the ovary, and they say, "Oh, you have so many eggs, you have no issues with fertility." So PCOS-looking ovaries on ultrasound does not mean cysts.

问题是医生不认识它，他们不予理睬，他们检查卵巢，然后说：“哦，你有这么多卵子，你的生育能力没有问题。”因此，超声检查中出现多囊卵巢综合症的卵巢并不意味着有囊肿。

To this day, doctors tell patients, "I don't see a cyst on your ovary, so you don't have PCOS." So, PCOS is an ultrasound finding.

直到今天，医生仍然告诉患者：“我没有看到你的卵巢囊肿，所以你没有患有多囊卵巢综合症。”因此，PCOS 是超声检查结果。

However, in 2023, they added another criteria to this third criteria, which is elevated egg count or elevated AMH.

然而，在 2023 年，他们在第三个标准的基础上添加了另一个标准，即卵子数升高或 AMH 升高。

So, women who have very high AMH, that is a telltale sign for PCOS, and that's what we were talking about before this podcast.

所以，AMH 非常高的女性，这是多囊卵巢综合症的一个明显迹象，这就是我们在本播客之前讨论的内容。

Andrew Huberman: Yeah, because so many women who are interested in and concerned about their fertility will go in and get their AMH measured, and so many just have in mind that you just want the higher numbers.

Andrew Huberman：是的，因为很多对自己的生育能力感兴趣并担心的女性会去测量她们的 AMH，而且很多人只是想知道更高的数字。

Higher is better, right?

越高越好，对吗？

Thaïs Aliabadi: The higher is better, but in case of PCOS, higher does not mean good quality eggs.

Thaïs Aliabadi：越高越好，但对于多囊卵巢综合症，较高并不意味着卵子质量好。

Andrew Huberman: I see.

安德鲁·休伯曼：我明白了。

Thaïs Aliabadi: We're going to talk about that.

Thaïs Aliabadi：我们将讨论这个问题。

So you need to meet two of these three criteria.

因此，您需要满足这三个标准中的两个。

Andrew Huberman: Only two of the three.

安德鲁·休伯曼：三个中只有两个。

Thaïs Aliabadi: Two of the three.

Thaïs Aliabadi：三个中的两个。

Andrew Huberman: You don't need all three?

Andrew Huberman：你不需要这三个？

Thaïs Aliabadi: No. So if you have irregular periods, and you have PCOS-looking ovaries on ultrasound, you meet the criteria.

Thaïs Aliabadi：不。所以，如果您的月经不规则，并且超声检查显示您的卵巢看起来像多囊卵巢综合症，那么您就符合标准。

If you have irregular periods and you have symptoms of high testosterone, you qualify.

如果您月经不规律并且有高睾酮症状，您就符合资格。

Now, let me tell you, you do not need to have a high testosterone in the blood to get the diagnosis of PCOS.

现在，让我告诉您，您不需要血液中的睾酮水平较高即可诊断出多囊卵巢综合症。

If you do, great, then you qualify for that high testosterone symptom or in blood, but you do not need to have a high testosterone in your blood.

如果你这样做了，那就太好了，那么你就有资格出现高睾酮症状或血液中的高睾酮水平，但你的血液中不需要有高睾酮水平。

And that's why a lot of doctors tell their patients, "Well, I checked your hormones, and your testosterone is normal." That's not one of the diagnostic criteria.

这就是为什么很多医生告诉他们的病人，“好吧，我检查了你的荷尔蒙，你的睾丸激素是正常的。”这不是诊断标准之一。

So if you're sitting at home, if you have an irregular period, if you have a daughter who constantly is lasering her face, she has acne, she's on spironolactone, she takes Accutane, these are criteria.

所以，如果你坐在家里，如果你月经不调，如果你有一个女儿经常用激光打脸，她有痤疮，她服用螺内酯，她服用维甲酸，这些都是标准。

She meets the criteria of PCOS.

她符合多囊卵巢综合症的标准。

PCOS patients have mood disorder.

PCOS患者有情绪障碍。

If you listen to them, they struggle with anxiety, depression.

如果你听他们的话，你会发现他们正在与焦虑、抑郁作斗争。

They're moody people.

他们是喜怒无常的人。

75 of them gain weight, 25% of them are very lean.

其中 75 人体重增加，其中 25% 非常瘦。

I see a lot of eating disorder or disordered eating in my PCOS patients.

我在多囊卵巢综合症患者中看到很多饮食失调或饮食失调的情况。

I would literally tell you that 60%, 70% of my PCOS patients have disordered eating.

我可以毫不夸张地告诉你，我的 PCOS 患者中有 60%、70% 患有饮食失调。

You want to find PCOS patients?

您想寻找 PCOS 患者吗？

Go knock on the doors of these eating disorder centers.

去敲这些饮食失调中心的门。

They're sitting behind those doors undiagnosed, and it's the leading cause of infertility.

他们坐在这些门后面而没有得到诊断，这是不孕的主要原因。

So this is the big picture of PCOS.

这就是多囊卵巢综合症的概况。

So, imagine these women who are walking around, they're gaining weight, they can't lose it, they're anxious, they can't get pregnant, they have acne, hair loss, facial hair, body hair, their periods are irregular.

所以，想象一下这些四处走动的女性，她们的体重在增加，她们无法减肥，她们很焦虑，她们无法怀孕，她们有痤疮、脱发、面部毛发、体毛，她们的月经不规律。

They go to the doctor, and what do they hear?

他们去看医生，他们听到了什么？

"There's nothing wrong with you.

“你没有什么问题。

Eat less.

少吃点。

You probably need to exercise more." That's all they hear.

你可能需要多锻炼。”他们听到的就是这些。

What do they do?

他们做什么？

They put them in eating disorder centers when they're a teenager, and they feed them pizza, and they say, "If you don't eat this pizza, that means your eating disorder is not better." I did a podcast with a patient of mine, Phoebe.

当他们十几岁的时候，他们就把他们送进饮食失调中心，给他们喂披萨，他们说，“如果你不吃这个披萨，那就意味着你的饮食失调并没有好转。”我和我的一个病人菲比一起做了一个播客。

She said in this eating disorder center, every day, they would put pizza in front of her, and she would say, "I'll eat this pizza, but when I eat it, I get sick.

她说，在这个饮食失调中心，每天，他们都会把披萨放在她面前，她会说，“我会吃这个披萨，但当我吃它时，我会生病。

I feel awful when I have this pizza." You know what they would tell her?

当我吃这个披萨时，我感觉很糟糕。”你知道他们会告诉她什么吗？

"See, you have an eating disorder.

“看，你有饮食失调症。

You're not ready to go." No, she had PCOS.

你还没准备好走。”不，她患有多囊卵巢综合症。

But at least if you diagnose and validate them, you can start helping them better.

Andrew Huberman: I have several questions.

安德鲁·休伯曼：我有几个问题。

You mentioned irregular periods, and I think to most people, that means that whatever cycle length they are accustomed to, 28 days or 30 days or even 22 days, that it's regular, and that if it changes by plus or minus five days or so for more than two or three months out of the year, then you would call that irregular.

你提到了不规律的经期，我想对大多数人来说，这意味着无论他们习惯的周期长度是多少，28天或30天甚至22天，它都是有规律的，如果一年中超过两三个月有正负五天左右的变化，那么你就会称之为不规律。

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: Okay, but given how young you're seeing PCOS in your clinic, and given that women start menstruating at, let's say, in their mid-teens, early teens, I know the age is getting pushed back, but it's going to vary.

Andrew Huberman：好的，但是考虑到您在诊所看到多囊卵巢综合症的年龄，并且考虑到女性在十几岁左右开始月经，我知道这个年龄正在被推迟，但会有所不同。

But I could imagine.

但我可以想象。

I've only lived as a male, so I'm really truly imagining here.

But I could only imagine that for a lot of women, cycle regularity is something that they're still figuring out at the stage when they could already have PCOS.

但我只能想象，对于很多女性来说，周期规律是她们在可能患有多囊卵巢综合症的阶段仍在弄清楚的事情。

Maybe not full-blown PCOS, but milder forms of PCOS.

And so, this notion of regular periods versus irregular periods could be quite confusing for someone to figure out if it's happening on a backdrop of PCOS.

因此，规律月经与不规律月经的概念可能会让人们很困惑，无法弄清楚它是否是在多囊卵巢综合症的背景下发生的。

And then that, of course, leaves aside all the stress and food-induced regulation of menstrual cycle length, et cetera.

So, it seems like a very difficult thing to identify.

Thaïs Aliabadi: Actually, you brought up a very good point, and I want to make that very clear.

Thaïs Aliabadi：实际上，您提出了一个非常好的观点，我想澄清这一点。

For teenagers, you have to be very careful, very cautious diagnosing them with PCOS.

Why?

为什么？

As you said, when you first start having your periods, your periods are irregular.

And if you do an ultrasound, these young ovaries have tons of follicles.

So, actually, the PCOS morphology is not used for teenagers.

For teenagers to get the diagnosis of PCOS, they need to have criteria one, which is the irregular period, and criteria two, which is the high androgen symptoms.

青少年要诊断多囊卵巢综合症，需要满足标准一，即月经不规律，以及标准二，即雄激素过高症状。

You do not use the AMH or PCOS morphology on ultrasound as a diagnostic criteria, number one.

Number two, you want to be very careful diagnosing these patients because you don't want to label them at a very young age.

So what I do with these patients, I do a hormone panel.

And these are patients who usually, at a very young age, they end up on Accutane for their acne.

You give them spironolactone, it's not working.

你给他们吃螺内酯，没有效果。

They complain of hair loss, they're gaining weight, they're showing signs of an eating disorder, they're anxious, they're not feeling well, they have really bad...

他们抱怨脱发，他们体重增加，他们出现饮食失调的迹象，他们焦虑，他们感觉不舒服，他们真的很糟糕......

I see a lot of PMDD with my PCOS patients.

我看到很多 PCOS 患者都患有经前抑郁症 (PMDD)。

So you look at the big picture, and I tend to not label them, but I will treat them.

And in 2014, I started using GLP-1s on my patients for weight loss, for PCOS.

In 2014, 11 years ago.

2014年，距今已有11年了。

Andrew Huberman: Yeah.

安德鲁·休伯曼：是的。

I think most people don't realize that these peptides were out there.

They weren't as commonly discussed.

它们并没有被广泛讨论。

They were sort of considered a little bit niche, a little bit, well, certainly cutting edge.

Incredible.

极好的。

Okay, a question that I just have to ask is, because PCOS is diagnosed, if it's diagnosed properly, by this kind of amalgam of different features.

好的，我要问的一个问题是，如果诊断正确的话，多囊卵巢综合症是通过这种不同特征的混合来诊断的。

And you mentioned by ultrasound, this kind of characteristic lining up of the follicles, I have to ask what might sound like a politically incorrect question, but I'm going to ask it anyway.

你通过超声波提到，这种卵泡排列的特征，我不得不问一个听起来像是政治不正确的问题，但无论如何我都会问。

Do you think that male OB-GYNs more often make this mistake than female OB-GYNs, or is this an equally distributed problem in the OB-GYN community?

您认为男性妇产科医生比女性妇产科医生更常犯这个错误吗？或者这是妇产科社区中同样存在的问题吗？

Thaïs Aliabadi: Equal.

泰伊斯·阿利亚巴迪：平等。

90% of these patients, let me tell you, are never diagnosed.

让我告诉你，这些患者中 90% 从未被诊断出来。

A, a lot of gynecologists don't do a pelvic ultrasound, which I want to change that in this country.

It needs to be part of a well-woman exam.

它需要成为女性健康检查的一部分。

Andrew Huberman: They don't do a pelvic ultrasound?

Thaïs Aliabadi: No.

泰伊斯·阿利亚巴迪：没有。

Andrew Huberman: I'm baffled.

安德鲁·休伯曼：我很困惑。

What is the reason for not doing it?

不这样做的原因是什么？

Thaïs Aliabadi: They're not trained to do it, or they have to hire an ultrasound tech to their office to do it.

But for me, in my office, if you come to my office and you say you can't do an ultrasound, it's just like me grabbing your glasses right now and say, "Read." How can I diagnose you?

但对我来说，在我的办公室，如果你来到我的办公室并说你不能做超声波检查，就像我现在抓住你的眼镜并说：“阅读”。我该如何诊断你？

Pelvic ultrasound should be mandatory, but that's another topic I want to cover with a what a well-woman exam should look like versus what women get when they go to their doctor's office.

盆腔超声检查应该是强制性的，但这是我想讨论的另一个主题，即健康女性检查应该是什么样子，以及女性去医生办公室时得到的检查结果。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: So, one of the issues is because women don't get a pelvic ultrasound, no one knows, one.

Two, a lot of doctors don't even know what a PCOS-looking ovary looks like.

They think polycystic ovary syndrome means cysts on the ovary.

Andrew Huberman: Yeah, the naming is really a problem, and this is true in science and very clearly true in medicine as well, that what things are named can be very useful, but it can also really limit understanding.

安德鲁·休伯曼：是的，命名确实是一个问题，这在科学中是正确的，在医学中也非常明显，命名的东西可能非常有用，但它也确实会限制理解。

Thaïs Aliabadi: Confusing.

Thaïs Aliabadi：令人困惑。

Andrew Huberman: Yeah, if anything, today's discussion hopefully will maybe even remove or put an asterisk next to the C in PCOS.

Thaïs Aliabadi: They want to change the name, but I personally am against it because I've spent 25 years saying, "PCOS, PCOS, PCOS, PCOS," and I feel like just in the past few years, more and more people...

Thaïs Aliabadi：他们想改名字，但我个人反对，因为我花了 25 年的时间说“PCOS、PCOS、PCOS、PCOS”，而且我觉得就在过去的几年里，越来越多的人......

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: Like, people didn't talk about menopause, now everyone's talking about menopause.

I feel like PCOS is the next topic, hopefully.

我觉得 PCOS 希望是下一个主题。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: And if you go and change the name, then I feel like I have to start all over again.

Andrew Huberman: No, but you make a very good point.

We don't want that to have to happen, and I agree.

Thaïs Aliabadi: But they're trying to do it.

Thais Aliabadi：但他们正在努力这样做。

Andrew Huberman: There's a strange thing in public health where there needs to be a ton of hydraulic pressure over time.

I guess today is my day to be only slightly politically incorrect.

Five years ago, if you said the word obese or you said, "This person has health issues because they're obese," it was considered...

I mean, people were losing jobs for making statements like that.

Now, we understand obesity can be a serious risk to brain and body health.

Thaïs Aliabadi: Is it?

泰伊斯·阿利亚巴迪：是吗？

Oh, my God.

我的天啊。

Yes.

是的。

Andrew Huberman: It's a medical condition, and I think the GLPs have kind of helped shift the view now because there's a medical treatment.

But it was always true that obesity was dangerous for people, but now you can say it.

So I do think that there needs to be a lot of hydraulic pressure behind that, and now you're doing the same for PCOS.

So I have a couple of questions about the thinning of hair, acne, and so forth.

I could imagine that a number of women listening to this are thinking, "Well, I've got a little bit of acne.

My hair is thinner than it was five years ago, but is this mild PCOS?

Is this indicative of PCOS?" I mean, everyone hopefully knows their body best, but how bad does the acne or the hair thinning have to be, how rapid, before you might say, "Maybe just the hair's seemingly thinner, there's a little bit more acne.

这是多囊卵巢综合症的征兆吗？”我的意思是，每个人都希望最了解自己的身体，但是痤疮或头发稀疏必须有多严重，有多快，然后你可能会说，“也许只是头发看起来更薄了，痤疮有点多了。

It's back acne, but..." And is it throughout the cycle?

Thaïs Aliabadi: Yes, it's throughout the cycle, and these are patients who usually come to the office asking for help.

They say, "I can't get rid of my acne." I always say, "If you're older than 25 and you're struggling with acne and you come to my office and you're asking for spironolactone and Accutane, something's not right," right?

他们说：“我无法摆脱我的痤疮。”我总是说，“如果你超过 25 岁，正在与痤疮作斗争，然后你来到我的办公室，想要螺内酯和异维A酸，那就有些不对劲了，”对吗？

If you have hair thinning, like you brush your hair and you lose tons of hair.

I mean, these are patients you can look at their scalp, and you know they're losing hair.

我的意思是，这些病人你可以看看他们的头皮，你就知道他们正在脱发。

I'm not talking about the hair loss that you get postpartum.

You know that's transitional, and it recovers in 9 to 12 months.

These are symptoms that persist, and as these patients get older, it becomes more and more and more significant.

But the reason I give that big picture is I always look at other factors.

但我给出这个大局的原因是我总是考虑其他因素。

Are they having a hard time losing weight?

他们减肥有困难吗？

Do they have mood disorder?

他们有情绪障碍吗？

Do they have any history of eating disorder?

他们有饮食失调史吗？

Have they been on Accutane?

他们服用过维甲酸吗？

Do they go and laser their hair twice a year because they can't get rid of it?

It's a pattern that you will know.

这是一种你会知道的模式。

It's not a little bit of this and...

这不是一点点，而且……

These are patients, patients who are listening right now to me, they're going to say, "Yes, I have this."

这些是病人，现在正在听我说话的病人，他们会说，“是的，我有这个。”

Andrew Huberman: Okay.

安德鲁·休伯曼：好的。

Thaïs Aliabadi: "I have every symptom, and I put a check in front of it." The problem with PCOS is there are four different phenotypes of PCOS.

Thaïs Aliabadi：“我有每一种症状，我都在它前面打了勾。” PCOS 的问题是 PCOS 有四种不同的表型。

That's why it's so confusing for doctors to diagnose PCOS.

这就是为什么医生诊断多囊卵巢综合症如此令人困惑。

The most common classic phenotype is a patient that has all three.

PCOS-looking ovaries on ultrasound, elevated testosterone symptoms or high testosterone or androgens in the blood, and irregular period.

超声检查显示卵巢类似 PCOS、睾酮升高症状或血液中睾酮或雄激素升高以及月经不调。

The second type B patients have the high androgen symptoms.

第二种B型患者有高雄激素症状。

They do have dysfunctional ovulation with irregular periods, but these patients have normal ovaries on ultrasound.

他们确实有排卵功能障碍和月经不调，但超声检查显示这些患者的卵巢正常。

In this group of patients, you can't do an ultrasound and say, "Your ovaries are not PCOS-looking, so you don't have it." Then the third phenotype is the ovulatory PCOS.

In this group of patients, you can't do an ultrasound and say, "Your ovaries are not PCOS-looking, so you don't have it."那么第三个表型是排卵型PCOS。

It gets very confusing.

这变得非常混乱。

This group of PCOS patients actually ovulate at least sometimes, because 70% to 80% of PCOS patients don't ovulate.

这组PCOS患者实际上至少有时会排卵，因为70%到80%的PCOS患者不排卵。

Andrew Huberman: ...

安德鲁·休伯曼：...

70?

70？

Thaïs Aliabadi: To 80% do not ovulate, even when they have regular cycles.

Thaïs Aliabadi：80% 的人不排卵，即使她们有规律的周期。

So, of the 20%, 30% who ovulate, you need to ovulate to get pregnant.

所以，在排卵的20%、30%的人中，你需要排卵才能怀孕。

This C phenotype, these patients are ovulating sometimes with regular cycles.

这种 C 表型，这些患者有时会按规律的周期排卵。

So these are PCOS patients who go to the doctor.

这些都是去看医生的多囊卵巢综合症患者。

They have PCOS-looking ovaries on ultrasound.

超声波检查显示她们的卵巢看起来像多囊卵巢综合症。

They have acne, hair loss, facial hair, body hair, mood, all of that, but their periods are regular.

她们有痤疮、脱发、面部毛发、体毛、情绪等等，但她们的月经很规律。

Even these patients, a lot of times, are not ovulating.

即使是这些患者，很多时候也没有排卵。

That regular cycle that you're seeing is estrogen withdrawal.

你所看到的规律周期就是雌激素的撤退。

It's not from the progesterone of ovulation, and we're going to get into all that if you want to.

它不是来自排卵时的黄体酮，如果您愿意，我们将详细介绍这一切。

And the fourth category, these are patients who basically don't have any elevated testosterone or androgen symptoms.

第四类，这些患者基本上没有任何睾丸激素或雄激素升高的症状。

They don't have acne, hair loss, facial hair, body hair.

他们没有痤疮、脱发、面部毛发、体毛。

They just don't ovulate regularly, and they have PCOS-looking ovaries on ultrasound.

她们只是不规律排卵，而且超声检查显示她们的卵巢看起来像多囊卵巢综合症。

So imagine these four phenotypes, right?

那么想象一下这四种表型，对吗？

And imagine all the insulin resistance and all these other underlying conditions.

想象一下所有的胰岛素抵抗和所有其他潜在的条件。

It makes the big picture, the image of these patients, so different.

它使这些患者的整体形象变得如此不同。

They all present differently to the office.

他们在办公室的表现都不同。

That's why doctors scratch their heads.

这就是医生们摸不着头脑的原因。

That's why doctors don't want to diagnose PCOS, because they really don't understand all these phenotypes.

这就是为什么医生不想诊断多囊卵巢综合症，因为他们真的不了解所有这些表型。

They don't understand that you can be completely thin and have PCOS, that not all PCOS patients need to have weight issues, that you don't have to have acne, hair loss, facial hair, body hair, that in some phenotypes, you don't need to have a PCOS-looking ovaries.

他们不明白你可以完全瘦并且患有多囊卵巢综合症，并不是所有的多囊卵巢综合症患者都需要有体重问题，你不必有痤疮、脱发、面部毛发、体毛，在某些表型中，你不需要有看起来像多囊卵巢综合症的卵巢。

There are some that have regular cycles, so that's why it gets so confusing.

有些有规律的周期，所以这就是为什么它变得如此混乱。

Andrew Huberman: It is confusing, and yet I think when one hears that there are different indicators, obviously, and it sounds like a skilled practitioner like yourself can see the contour of which ones fit together.

Andrew Huberman：这很令人困惑，但我认为，当人们听说有不同的指标时，显然，听起来像你这样的熟练从业者可以看到哪些指标组合在一起的轮廓。

I mean, it's pattern recognition, clinical pattern recognition.

我的意思是，这是模式识别，临床模式识别。

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Yes.

是的。

Andrew Huberman: Which is very difficult to do from an AI search or from a...

Andrew Huberman：通过人工智能搜索或......很难做到这一点

It's impossible, really.

这是不可能的，真的。

I mean, I think...

我的意思是，我认为...

I have a couple of questions.

我有几个问题。

One is just leap to mind as it relates to the mood disorders.

我突然想到一个问题，因为它与情绪障碍有关。

I could imagine that some of these disorders are treated or they attempt to treat them through antidepressants, SSRIs, and things of that sort.

我可以想象，其中一些疾病已经得到治疗，或者他们试图通过抗抑郁药、SSRIs 等药物来治疗。

Is there any indication that the drug treatments for these mood disorders interact with the hormones that we're talking about in a way that exacerbates the PCOS?

是否有任何迹象表明治疗这些情绪障碍的药物会与我们正在谈论的激素相互作用，从而加剧多囊卵巢综合征？

I mean, we know that serotonin and dopamine, all these things, have feedback and interaction with these hormones.

我的意思是，我们知道血清素和多巴胺，所有这些东西，都与这些激素有反馈和相互作用。

Or do you think that that's a separate thing entirely?

或者你认为这是完全不同的事情吗？

Thaïs Aliabadi: In order to answer that, I think it's better for me to tell you the underlying drivers of the symptoms of PCOS and how those can affect the mood.

Thaïs Aliabadi：为了回答这个问题，我认为最好告诉您 PCOS 症状的潜在驱动因素以及这些症状如何影响情绪。

And by treating the underlying conditions, sometimes you can address mood changes without having to give them a Zoloft or a Lexapro.

通过治疗潜在的病症，有时您可以解决情绪变化，而无需给他们服用左洛复（Zoloft）或来士普（Lexapro）。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: You might have to, right?

Thais Aliabadi：你可能必须这么做，对吧？

Andrew Huberman: But there's no evidence from what I understand that those drugs are actually causing PCOS.

Andrew Huberman：但据我所知，没有证据表明这些药物实际上会导致多囊卵巢综合症。

Thaïs Aliabadi: Yeah.

泰伊斯·阿利亚巴迪：是的。

No. No.

不，不。

Andrew Huberman: Okay, I just wanted to essentially rule that out.

Andrew Huberman：好吧，我只是想基本上排除这种可能性。

Thaïs Aliabadi: Right.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: Okay, good.

安德鲁·休伯曼：好的，很好。

I'm relieved to hear that, because those drugs are commonly prescribed.

听到这个消息我松了口气，因为这些药物是常见的处方药。

Thaïs Aliabadi: At least to my knowledge I've never experienced that.

Thais Aliabadi：至少据我所知，我从未经历过这种情况。

Andrew Huberman: Yeah.

安德鲁·休伯曼：是的。

My not-so-cursory web search on this said no, but I want to verify with you.

我对此的粗略网络搜索表明没有，但我想向您核实。

So, what is the cause of the mood disorders?

那么，情绪障碍的原因是什么？

You're talking slightly elevated testosterone, so all the males listening are like, "Ooh, sounds great." And, of course, supplementing with testosterone in women in menopause has now become kind of a trendy thing.

你说的是睾丸激素略有升高，所以所有听的男性都会说，“哦，听起来很棒。”当然，为更年期女性补充睾酮现在已经成为一种时尚。

Thaïs Aliabadi: And you can absolutely do that with PCOS patients.

Thaïs Aliabadi：对于 PCOS 患者，你绝对可以做到这一点。

We can get to that.

我们可以做到这一点。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: But is it okay if I discuss the underlying pillars?

Thaïs Aliabadi：但是我可以讨论一下基本支柱吗？

Because it's very important, and I think that's what people don't understand.

因为它非常重要，而我认为这就是人们不理解的地方。

And I think that's what I've observed, in my practice at least, over the past 25 years.

我认为这就是我在过去 25 年里至少在实践中观察到的情况。

And it's so important to understand it, because if you don't understand it, then you don't know how to treat PCOS.

了解它非常重要，因为如果你不了解它，那么你就不知道如何治疗多囊卵巢综合症。

Then you don't just throw a birth control pill at it, and that's why these patients don't feel better.

然后你就不能只是扔避孕药了，这就是为什么这些病人感觉不舒服。

So there are underlying pillars that drive the symptoms of PCOS.

因此，存在导致多囊卵巢综合症症状的潜在因素。

The number one issue is the brain-pituitary-ovary axis, which I'm sure you know it by heart.

第一个问题是脑-垂体-卵巢轴，我相信你已经熟记于心了。

But as you know, our hypothalamus releases a hormone called GnRH, it fires in a pulsatile fashion, and basically, it stimulates the pituitary gland to release this hormone called FSH, which stimulates the follicles in the ovaries.

但如您所知，我们的下丘脑释放一种称为 GnRH 的激素，它以脉冲方式激发，基本上，它会刺激脑下垂体释放这种称为 FSH 的激素，从而刺激卵巢中的卵泡。

One follicle per month.

每月一个卵泡。

As the follicle gets stimulated and starts growing, it starts releasing estrogen.

当卵泡受到刺激并开始生长时，它开始释放雌激素。

When the estrogen peaks really high for 48 hours, it stimulates that same pituitary gland to release a hormone called LH, and LH is responsible for ovulation.

当雌激素在 48 小时内达到峰值时，它会刺激垂体释放一种称为 LH 的激素，而 LH 负责排卵。

It comes, it basically weakens the wall of the follicle, it causes inflammation, it causes vascular changes, all of that, so the egg gets released.

它来了，它基本上削弱了卵泡壁，它引起炎症，它引起血管变化，所有这些，所以卵子被释放。

Once the egg gets released, whatever's left of that follicle is the corpus luteal cyst, which starts releasing progesterone to basically support implantation.

一旦卵子被释放，卵泡剩下的就是黄体囊肿，它开始释放黄体酮以基本上支持着床。

This is what's supposed to happen, and that's how people get pregnant.

这就是应该发生的事情，这就是人们怀孕的方式。

Andrew Huberman: It's such a beautiful mechanism, right?

Andrew Huberman：这是一个非常漂亮的机制，对吧？

Thaïs Aliabadi: It's so beautiful.

Thais Aliabadi：太美了。

Andrew Huberman: The very cells that are stimulated by FSH produce a hormone which feeds back to shut down the production of FSH and bring in the LH.

Andrew Huberman：受 FSH 刺激的细胞会产生一种激素，这种激素会反馈关闭 FSH 的产生并引入 LH。

I mean, it's a beautiful molecular set of gears, basically.

我的意思是，基本上，这是一组漂亮的分子齿轮。

Thaïs Aliabadi: It's beautiful.

Thais Aliabadi：很漂亮。

It's beautiful.

很美丽。

Andrew Huberman: I mean, not to make it too reductionist, but it's truly incredible when one thinks about it.

Andrew Huberman：我的意思是，不要让它变得过于简化，但当人们想到这一点时，这确实令人难以置信。

And as you mentioned, that it spans from the brain all the way to the ovary.

正如你提到的，它从大脑一直延伸到卵巢。

Thaïs Aliabadi: To the uterus, right?

Thaïs Aliabadi：到子宫，对吗？

Andrew Huberman: Yeah, it's a spectacular set of interactions, really.

Andrew Huberman：是的，这确实是一组令人惊叹的互动。

Thaïs Aliabadi: And that estrogen that the follicle is stimulating gets the lining of the uterus nice and juicy, ready for pregnancy.

Thaïs Aliabadi：卵泡刺激的雌激素使子宫内膜变得漂亮多汁，为怀孕做好准备。

And then when the egg ovulates, and now the progesterone comes, the progesterone stabilizes that lining, so the embryo can go and implant and turn into a beautiful baby.

然后当卵子排卵时，黄体酮就会到来，黄体酮会稳定内膜，这样胚胎就可以着床并变成一个漂亮的婴儿。

And usually, that cyst, the corpus luteal cyst, during the first 12 weeks of pregnancy, is helping release the progesterone to help the pregnancy really stick to that wall of the uterus, in simple terms.

简单来说，通常情况下，在怀孕的前 12 周，黄体囊肿会帮助释放黄体酮，帮助怀孕真正粘附在子宫壁上。

Andrew Huberman: Nothing wasted.

安德鲁·休伯曼：没有浪费任何东西。

Thaïs Aliabadi: Nothing, but women are incredible.

Thaïs Aliabadi：没什么，但女人是不可思议的。

Aren't we incredible?

我们是不是很不可思议？

Andrew Huberman: It's amazing.

安德鲁·休伯曼：太棒了。

I mean, indeed, they are.

我的意思是，确实如此。

It's like nothing's wasted.

好像什么都没有浪费。

The portion of the follicle that would otherwise be, quote, unquote, "discarded," is actually a source of critical hormones.

卵泡中本来会被“丢弃”的部分实际上是关键激素的来源。

Thaïs Aliabadi: Nothing.

泰伊斯·阿利亚巴迪：没什么。

Andrew Huberman: It's incredible.

安德鲁·胡伯曼：这太不可思议了。

Thaïs Aliabadi: It's incredible.

Thais Aliabadi：这太不可思议了。

Andrew Huberman: It's incredible.

安德鲁·胡伯曼：这太不可思议了。

Thaïs Aliabadi: But let me tell you what happens in a poor PCOS patient.

Thaïs Aliabadi：但是让我告诉你一个可怜的多囊卵巢综合症患者会发生什么。

That's the problem.

这就是问题所在。

The GnRH, remember, that secretes from the hypothalamus, it starts pulsating super fast.

请记住，GnRH 是从下丘脑分泌的，它开始超快地脉动。

By doing that, it shifts the FSH/LH balance.

So FSH goes down, and LH goes up.

所以 FSH 下降，LH 上升。

LH stimulates these cells in the ovary.

LH 刺激卵巢中的这些细胞。

I don't know if you remember, the theca cells in the ovary, and they start pumping androgens out, right?

我不知道你是否还记得，卵巢里的卵泡膜细胞，它们开始泵出雄激素，对吧？

When you have a lot of androgens in the ovaries, the androgens block the growth of that beautiful follicle that's growing to ovulate, so it freezes the follicle, and it prevents it from ovulating.

当卵巢中有大量雄激素时，雄激素会阻碍正在排卵的美丽卵泡的生长，因此它会冻结卵泡，并阻止其排卵。

The follicle is still secreting the estrogen, but it never gets to that peak high, right?

卵泡仍在分泌雌激素，但它永远不会达到那么高，对吧？

And it's still stimulating the lining of the uterus, but the ovulation doesn't happen.

它仍然刺激子宫内膜，但不会发生排卵。

So when the ovulation doesn't happen, polycystic ovary syndrome, you start seeing these follicles in the ovary.

因此，当不排卵（多囊卵巢综合症）时，您就会开始在卵巢中看到这些卵泡。

Andrew Huberman: So is it lack of sufficient LH?

Thaïs Aliabadi: It's too much LH.

Thais Aliabadi：LH 太多了。

Andrew Huberman: Too much LH.

Andrew Huberman：LH 太多了。

Thaïs Aliabadi: So in PCOS, the LH/FSH ratio flips, so the LH is twice as much as the FSH.

Thaïs Aliabadi：在 PCOS 中，LH/FSH 比率会翻转，因此 LH 是 FSH 的两倍。

So you have this constant secretion of LH that stimulates these theca cells to just pump androgens out, right?

那么 LH 的持续分泌会刺激这些卵泡膜细胞泵出雄激素，对吗？

So the follicle freezes, doesn't ovulate, the follicle stays in the ovary.

所以卵泡冻结，不排卵，卵泡留在卵巢中。

And one thing that they've noticed with PCOS patients, for whatever reason, their ovary is super sensitive to the LH.

他们在 PCOS 患者中注意到一件事，无论出于何种原因，他们的卵巢对 LH 超级敏感。

It's like adding fuel to the fire.

这就像火上浇油。

Andrew Huberman: It's like a positive feedback.

The reason I ask how LH is adjusted, the LH surge is what triggers ovulation normally, correct?

我之所以问LH是如何调节的，LH激增是正常触发排卵的原因，对吗？

Thaïs Aliabadi: Right.

泰伊斯·阿利亚巴迪：是的。

But there is no LH surge.

但没有 LH 激增。

Andrew Huberman: What I'm getting a kind of mental visual of is that the strong pull of the levers it's just a bunch of smaller levers being pulled repeatedly.

安德鲁·休伯曼：我得到的一种心理视觉是，杠杆的强力拉力只是一堆较小的杠杆被反复拉动。

But there's still shedding of the uterine lining, right?

但子宫内膜仍然脱落，对吗？

There's still menses.

月经还在。

Thaïs Aliabadi: It can be.

Andrew Huberman: So that's why it's probably very misleading for people who don't have extreme symptoms of PCOS.

Andrew Huberman：这就是为什么它可能对没有 PCOS 极端症状的人具有很大的误导性。

Because they think, well, if they're menstruating, then they assume that they're ovulating.

因为她们认为，如果她们来月经，那么她们就会认为自己正在排卵。

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

And 20% to 30% of them actually ovulate, right?

But they don't always ovulate.

That's the problem.

这就是问题所在。

And of the ones who ovulate, it gets worse.

Of the ones who, let's say, this brain pituitary ovary axis is just partially disrupted.

比如说，那些人的大脑垂体卵巢轴只是部分受到破坏。

Of the ones who ovulate, 40% of them, the embryo either doesn't form because the quality of the egg is bad, but also the environment is not ready for it.

在排卵的人中，有40%的人之所以没有形成胚胎，要么是因为卵子质量不好，要么是环境还没有准备好。

So the progesterone, the uterine lining, is not ready for it.

所以黄体酮，即子宫内膜，还没有做好准备。

That's why these patients don't get pregnant.

Andrew Huberman: What is thought to disrupt the hypothalamic GnRH neurons?

Andrew Huberman：什么会破坏下丘脑 GnRH 神经元？

Thaïs Aliabadi: It could be everything.

It comes to all the other pillars because they're all-

它涉及到所有其他支柱，因为它们都是——

Andrew Huberman: It could be the feedback?

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: But is there any evidence?

I mean, we don't want to attribute everything to psychological stress, but the more I learn about the brain and body and their interactions over the years, the more I'm convinced that psychological state does impact hormones and brain function.

我的意思是，我们不想将一切都归因于心理压力，但多年来我对大脑和身体及其相互作用了解得越多，我就越相信心理状态确实会影响激素和大脑功能。

Anyone listening will say, "Well, of course it does," but 10 years ago, there was this notion of psychosomatic illness.

任何听过的人都会说：“嗯，当然是这样。”但是十年前，就有了心身疾病的概念。

People would say, "Oh," they would say, "It's all in your head." We now know that stress is a powerful modulator of hypothalamic function.

人们会说，“哦，”他们会说，“这全都在你的脑海里。”我们现在知道压力是下丘脑功能的强大调节剂。

It actually comes from the hypothalamus in part.

So, is there evidence that this is preceded by stress or trauma, things of that sort?

那么，是否有证据表明在此之前存在压力或创伤之类的事情？

Thaïs Aliabadi: Partially, it can.

No.

不。

Andrew Huberman: It just sort of comes about.

Thaïs Aliabadi: Yes, it's genetic, and that's why I want to talk about it.

Thaïs Aliabadi：是的，它是遗传性的，这就是我想谈论它的原因。

This is just the first pillar.

这只是第一个支柱。

You saw just the first driving force is this brain pituitary ovary pathway that's completely disrupted, that most patients, 70% to 80%, don't even ovulate, and of the ones who ovulate, the environment is not really good for the embryo.

你看到的第一个驱动力是脑垂体卵巢通路完全被破坏，大多数患者，70%到80%，甚至不排卵，而在排卵的患者中，环境对胚胎来说并不是很好。

So that's just the first pillar.

这只是第一个支柱。

But at its core, PCOS has insulin resistance, and I'm sure you know all about insulin resistance, but I want to explain it to your-

但从本质上讲，多囊卵巢综合症有胰岛素抵抗，我相信你对胰岛素抵抗很了解，但我想向你解释一下——

Andrew Huberman: Please remind our audience because we have newcomers to the conversation, and I don't think we could hear enough about insulin resistance.

Andrew Huberman：请提醒我们的听众，因为我们有新人加入对话，而且我认为我们对胰岛素抵抗的了解还不够。

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Insulin resistance.

胰岛素抵抗。

Andrew Huberman: Yeah.

安德鲁·休伯曼：是的。

Thaïs Aliabadi: And as a gynecologist, I'll explain insulin resistance.

Thaïs Aliabadi：作为一名妇科医生，我将解释胰岛素抵抗。

So I'm sure you've had physicians who will probably explain it better, but I'm going to simplify it, because it's one of the biggest drivers of PCOS symptom, and it's extremely common.

所以我相信医生可能会更好地解释它，但我会简化它，因为它是 PCOS 症状的最大驱动因素之一，而且非常常见。

Even lean PCOS patients can have insulin resistance.

即使是瘦的多囊卵巢综合症患者也可能有胰岛素抵抗。

So, what is insulin resistance?

那么，什么是胰岛素抵抗？

The simple way of explaining it is when we eat carbohydrates and our body breaks it down into glucose, glucose stimulates our pancreas to release a hormone called insulin.

简单的解释是，当我们吃碳水化合物并且我们的身体将其分解为葡萄糖时，葡萄糖会刺激我们的胰腺释放一种称为胰岛素的激素。

The job of insulin is, it goes to the cells in our muscle and our liver, and it opens up the channels on these cells and pushes sugar into the cell, where it can turn into energy.

胰岛素的作用是，它进入我们肌肉和肝脏的细胞，打开这些细胞上的通道，将糖推入细胞，在那里它可以转化为能量。

So basically, insulin takes the sugar from the blood, pushes it into the cell, and turns it into energy.

所以基本上，胰岛素从血液中获取糖，将其推入细胞，并将其转化为能量。

PCOS patients, 80% of them have insulin resistance.

PCOS患者中，80%存在胰岛素抵抗。

It's not their fault.

这不是他们的错。

They're born that way.

他们生来就是这样。

What does insulin resistant do?

胰岛素抵抗有什么作用？

When they eat carbohydrate and their body breaks it down into glucose, glucose stimulates their pancreas to release insulin, but their cells are resistant, and I'll tell you why.

当他们吃碳水化合物并且他们的身体将其分解为葡萄糖时，葡萄糖会刺激他们的胰腺释放胰岛素，但他们的细胞具有抵抗力，我会告诉你原因。

Remember that androgen that I was talking to you about that gets secreted from their ovaries because of the first pillar?

还记得我和你谈论过的雄激素是由于第一支柱而从卵巢中分泌出来的吗？

Makes women more insulin resistant, so their cells don't respond well.

使女性更容易产生胰岛素抵抗，因此她们的细胞反应不佳。

I know.

我知道。

It's like, let me get there.

就像，让我去那里。

Andrew Huberman: The question I was going to ask was going to be a facetious one.

安德鲁·休伯曼：我要问的问题是一个滑稽的问题。

I was going to say, do androgens do anything good?

我想说，雄激素有什么好处吗？

No, of course, they do, but.

不，当然，他们这样做，但是。

Thaïs Aliabadi: Not the women.

Thaïs Aliabadi：不是女性。

No, they do.

不，他们这样做。

They do.

他们确实这么做了。

Andrew Huberman: Women need androgens, but they don't need this many androgens coming from the thecal cells.

Andrew Huberman：女性需要雄激素，但她们不需要来自膜细胞的这么多雄激素。

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Too much of it.

太多了。

Right.

正确的。

Andrew Huberman: Right.

安德鲁·休伯曼：对。

Thaïs Aliabadi: So, when their cells can't uptake this glucose, glucose bounces in the blood.

Thaïs Aliabadi：所以，当细胞无法吸收这种葡萄糖时，葡萄糖就会在血液中反弹。

You can't have glucose stay in your blood.

你不能让葡萄糖留在你的血液中。

You have to clear it.

你必须清除它。

So as glucose goes up, it pushes our insulin to go up.

因此，当血糖升高时，它会推动我们的胰岛素升高。

What does insulin do to PCOS patients?

胰岛素对 PCOS 患者有什么作用？

Number one, when insulin goes up, insulin stimulates our ovaries to push more androgens out.

第一，当胰岛素升高时，胰岛素会刺激我们的卵巢排出更多的雄激素。

How about that?

怎么样？

And it blocks the ovulation, it freezes that follicle, right?

它会阻止排卵，冻结卵泡，对吗？

And it causes acne, hair loss, facial hair, body hair, irregular periods, all of that.

它会导致痤疮、脱发、面部毛发、体毛、月经不调等等。

The other thing insulin does, it blocks the liver from secreting sex hormone-binding globulin.

胰岛素的另一作用是阻止肝脏分泌性激素结合球蛋白。

If you do a blood test on a PCOS patient, a lot of them, the sex hormone-binding globulin is low.

如果你对多囊卵巢综合症患者进行血液检查，很多人的性激素结合球蛋白都很低。

Sex hormone-binding globulin is a protein in the blood that grabs free testosterone from our blood, right?

性激素结合球蛋白是血液中的一种蛋白质，可以从我们的血液中获取游离睾酮，对吗？

When the levels go down because of high insulin, our free androgens and testosterone go up.

当胰岛素水平因高胰岛素而下降时，我们的游离雄激素和睾酮就会上升。

So more acne, hair loss, facial hair, body hair, all those symptoms.

所以更多的痤疮、脱发、面部毛发、体毛，所有这些症状。

Andrew Huberman: I see.

安德鲁·休伯曼：我明白了。

Thaïs Aliabadi: High insulin does one more thing.

Thais Aliabadi：高胰岛素还有另外一件事。

It basically tells your body, "Take this sugar, get rid of it from the blood, and store it as fat." How does it do that?

它基本上告诉你的身体，“服用这种糖，从血液中除去它，并将其储存为脂肪。”它是如何做到的？

It pushes our liver to turn it into triglyceride.

它推动我们的肝脏将其转化为甘油三酯。

The triglycerides can, A, go into our blood as a form of VLDL and go and attach themselves to the heart, and that's why PCOS patients, you have to screen them, their lipid panel, because of their cholesterol, risk of cardiovascular disease, risk of diabetes, all of that.

甘油三酯可以，A，以极低密度脂蛋白的形式进入我们的血液，并附着在心脏上，这就是为什么多囊卵巢综合症患者，你必须对他们进行血脂检查，因为他们的胆固醇、心血管疾病的风险、糖尿病的风险等等。

But what it does, it sends these triglycerides to our visceral organs, so these patients start having visceral fat.

但它的作用是将这些甘油三酯发送到我们的内脏器官，因此这些患者开始出现内脏脂肪。

Visceral fat is very different than the fat that you have under your skin.

内脏脂肪与皮下脂肪有很大不同。

Visceral fat actually releases cytokines, inflammatory factors that increases the inflammation.

内脏脂肪实际上会释放细胞因子，即加剧炎症的炎症因子。

Inflammation makes our insulin resistance worse, and inflammation, which is the next pillar, stimulates our ovaries to secrete more androgens.

炎症使我们的胰岛素抵抗变得更糟，而炎症是下一个支柱，它会刺激我们的卵巢分泌更多的雄激素。

It's vicious-

真是恶毒——

Andrew Huberman: So it's a vicious feedback cycle.

Andrew Huberman：所以这是一个恶性反馈循环。

And I think maybe if we just double-click on visceral fat a little bit.

我想也许如果我们双击内脏脂肪一点点。

We've never talked about it on this podcast, really.

我们从来没有在这个播客上谈论过它，真的。

Thaïs Aliabadi: And I'm not a visceral fat expert.

Thaïs Aliabadi：我不是内脏脂肪专家。

Andrew Huberman: All right.

安德鲁·休伯曼：好的。

No, well, nor do I expect you to be, but I think it's worth people just hearing twice that visceral fat is not subcutaneous fat.

不，我也不期望你会这样，但我认为人们只要听到两次内脏脂肪不是皮下脂肪就值得了。

This is why some PCOS patients can be lean.

这就是为什么一些多囊卵巢综合症患者可以变瘦的原因。

Indeed, many people, male or female, can be lean and have too much visceral fat.

事实上，许多人，无论男性还是女性，都可能很瘦，但内脏脂肪过多。

It's important to-

重要的是——

Thaïs Aliabadi: Correct.

泰伊斯·阿利亚巴迪：正确。

Andrew Huberman: You can now detect visceral fat in, I believe MRI will do it.

Andrew Huberman：你现在可以检测内脏脂肪，我相信 MRI 可以做到这一点。

Not everyone, of course, has access to MRI.

当然，并不是每个人都能接受 MRI 检查。

Thaïs Aliabadi: Or fatty liver, they call it.

Thaïs Aliabadi：他们称之为脂肪肝。

Andrew Huberman: Or fatty liver.

安德鲁·休伯曼：或者脂肪肝。

Fatty liver.

脂肪肝。

Thaïs Aliabadi: You know what I'm saying?

Thais Aliabadi：你知道我在说什么吗？

But it gets dismissed, but it's a very dangerous form of fat because of that inflammation.

但它被忽视了，但由于炎症，它是一种非常危险的脂肪形式。

Andrew Huberman: We've known for a long time that there are things that we can do to improve our sleep, and that includes things that we can take, things like magnesium threonate, theanine, chamomile extract, and glycine, along with lesser-known things like saffron and valerian root.

Andrew Huberman：我们很早就知道我们可以采取一些措施来改善睡眠，其中包括我们可以服用的东西，例如苏糖酸镁、茶氨酸、洋甘菊提取物和甘氨酸，以及一些不太为人所知的东西，例如藏红花和缬草根。

These are all clinically supported ingredients that can help you fall asleep, stay asleep, and wake up feeling more refreshed.

这些都是经过临床支持的成分，可以帮助您入睡、保持睡眠状态，并且醒来时感觉更加神清气爽。

I'm excited to share that our longtime sponsor, AG1, just created a new product called AGZ.

我很高兴与大家分享，我们的长期赞助商 AG1 刚刚创建了一款名为 AGZ 的新产品。

A nightly drink designed to help you get better sleep and have you wake up feeling super refreshed.

一款夜间饮品，旨在帮助您获得更好的睡眠，让您醒来时感觉神清气爽。

Over the past few years, I've worked with the team at AG1 to help create this new AGZ formula.

在过去的几年里，我与 AG1 的团队合作，帮助创建了这个新的 AGZ 公式。

It has the best sleep-supporting compounds in exactly the right ratios in one easy-to-drink mix.

它在一种易于饮用的混合物中以完全正确的比例含有最好的睡眠支持化合物。

This removes all the complexity of trying to forage the vast landscape of supplements focused on sleep and figuring out the right dosages and which ones to take for you.

这消除了尝试寻找大量针对睡眠的补充剂以及确定正确剂量和适合您服用的补充剂的所有复杂性。

AGZ is, to my knowledge, the most comprehensive sleep supplement on the market.

据我所知，AGZ 是市场上最全面的睡眠补充剂。

I take it 30 to 60 minutes before sleep, it's delicious, by the way, and it dramatically increases both the quality and the depth of my sleep.

我在睡前 30 到 60 分钟服用它，顺便说一句，它很美味，而且它极大地提高了我的睡眠质量和深度。

I know that both from my subjective experience of my sleep and because I track my sleep.

我知道这一点，既来自我对睡眠的主观体验，也因为我跟踪了我的睡眠。

I'm excited for everyone to try this new AGZ formulation and to enjoy the benefits of better sleep.

我很高兴每个人都能尝试这种新的 AGZ 配方并享受更好睡眠的好处。

AGZ is available in chocolate, chocolate mint, and mixed berry flavors, and as I mentioned before, they're all extremely delicious.

AGZ 有巧克力、巧克力薄荷和混合浆果口味，正如我之前提到的，它们都非常美味。

My favorite of the three has to be, I think, chocolate mint, but I really like them all.

我认为这三者中我最喜欢的是巧克力薄荷，但我真的很喜欢它们。

If you'd like to try AGZ, go to drinkagz.com/huberman to get a special offer.

如果您想尝试 AGZ，请访问 Drinkagz.com/huberman 以获得特别优惠。

Again, that's drinkagz.com/huberman.

再说一遍，这是 Drinkagz.com/huberman。

Today's episode is also brought to us by Joovv.

今天的节目也是Joovv给我们带来的。

Joovv makes medical-grade red light therapy devices.

Joovv 生产医疗级红光治疗设备。

Now, if there's one thing that I have consistently emphasized on this podcast, it is the incredible impact that light can have on our biology.

现在，如果我在这个播客中一直强调一件事，那就是光对我们的生物学产生的令人难以置信的影响。

Now, in addition to sunlight, red light and near-infrared light sources have been shown to have positive effects on improving numerous aspects of cellular and organ health, including faster muscle recovery, improved skin health and wound healing, improvements in acne, reduced pain and inflammation, even mitochondrial function, and improving vision itself.

现在，除了阳光之外，红光和近红外光源已被证明对改善细胞和器官健康的许多方面具有积极作用，包括更快的肌肉恢复、改善皮肤健康和伤口愈合、改善痤疮、减少疼痛和炎症，甚至线粒体功能，以及改善视力本身。

What sets Joovv lights apart, and why they're my preferred red light therapy device, is that they use clinically proven wavelengths, meaning specific wavelengths of red light and near-infrared light in combination to trigger the optimal cellular adaptations.

Joovv 灯的与众不同之处以及它们成为我首选红光治疗设备的原因在于它们使用经过临床验证的波长，这意味着特定波长的红光和近红外光相结合可以触发最佳的细胞适应。

Personally, I use the Joovv whole body panel about three to four times a week, and I use the Joovv handheld light both at home and when I travel.

就我个人而言，我每周大约使用 Joovv 全身面板三到四次，在家和旅行时我都会使用 Joovv 手持灯。

Right now, Joovv is having their biggest sale of the year.

目前，Joovv 正在进行今年最大的促销活动。

From now through December 1st, 2025, you can save up to 1,000 dollars on select Joovv devices during their Black Friday sale.

从即日起至 2025 年 12 月 1 日，在黑色星期五促销期间购买精选 Joovv 设备最多可节省 1,000 美元。

Just go to joovv.com/huberman.

只需访问 joovv.com/huberman。

That's J-O-O-V-V .com/huberman.

这就是 J-O-O-V-V .com/huberman。

Some exclusions apply.

一些例外情况适用。

Thaïs Aliabadi: So, the next pillar is chronic inflammation.

Thaïs Aliabadi：所以，下一个支柱是慢性炎症。

That's why PCOS patients have this chronic inflammation that they complain about.

这就是多囊卵巢综合症患者患有他们抱怨的慢性炎症的原因。

And this chronic inflammation basically stimulates their ovaries to release more androgens.

而这种慢性炎症基本上会刺激她们的卵巢释放更多的雄激素。

This chronic inflammation makes their insulin resistance worse.

这种慢性炎症使他们的胰岛素抵抗变得更糟。

This chronic inflammation can affect their gut.

这种慢性炎症会影响他们的肠道。

That's why PCOS patients come and say, "I don't feel good.

这就是为什么多囊卵巢综合症患者会说：“我感觉不舒服。

I have food sensitivities.

我有食物过敏。

I feel bloated," because these hormonal shifts and these inflammations do affect our gut.

我感到臃肿”，因为这些荷尔蒙变化和炎症确实会影响我们的肠道。

Then we go to the next pillar, which is genetics.

然后我们进入下一个支柱，即遗传学。

If you look in PCOS families, there's someone who's either diabetic, pre-diabetic, had gestational diabetes, is overweight, there's some form of insulin resistance.

如果你看看多囊卵巢综合症的家庭，就会发现有人患有糖尿病、糖尿病前期、妊娠期糖尿病、体重超重，还有某种形式的胰岛素抵抗。

A lot of times, you see these patients, and their dad is diabetic, so you don't have to look in your mom's side of the family.

很多时候，你看到这些病人，他们的父亲患有糖尿病，所以你不必看你母亲那边的家庭。

Andrew Huberman: This is a very important point.

安德鲁·休伯曼：这是非常重要的一点。

Thaïs Aliabadi: It's both sides.

Thais Aliabadi：双方都有。

Andrew Huberman: A lot of people just do the direct one-to-one, and they assume, "Well, if my mother had no fertility issues, and she wasn't overweight and wasn't diabetic, didn't seem to have type 2 diabetes, then it's not an issue." But yeah, dad's genetics are critical as well.

Andrew Huberman：很多人只是直接进行一对一的咨询，他们会认为，“好吧，如果我母亲没有生育问题，她没有超重，没有糖尿病，似乎没有 2 型糖尿病，那么这不是问题。”但是，是的，父亲的遗传也很重要。

Thaïs Aliabadi: Huge.

Thaïs Aliabadi：巨大。

And then the last pillar is epigenetics, which I know you talk a lot about it.

最后一个支柱是表观遗传学，我知道你对此谈论了很多。

But it's our stress, how much are we sleeping, what kind of food are we eating, right?

但这是我们的压力，我们睡了多少觉，吃了什么样的食物，对吧？

Someone said this to me, and I love this saying.

有人对我说过这句话，我很喜欢这句话。

They said, "Your genes load the gun, your environment pulls the trigger."

他们说：“你的基因给枪上膛，你的环境扣动扳机。”

Andrew Huberman: Mm.

安德鲁·休伯曼：嗯。

Thaïs Aliabadi: And I love that, because even if you're loaded with insulin resistance, all of that, you can suppress these symptoms.

Thaïs Aliabadi：我喜欢这一点，因为即使您患有胰岛素抵抗，所有这些，您也可以抑制这些症状。

But if you start eating unhealthy, if you're stressed out, if you're not sleeping, if you're just not exercising, right, you're pulling that trigger.

但如果你开始饮食不健康，如果你压力很大，如果你不睡觉，如果你只是不锻炼，那么你就扣动了扳机。

And that's why, Andrew, all these pillars work together, and that's why these patients present so many different ways, right?

这就是为什么，安德鲁，所有这些支柱一起发挥作用，这就是为什么这些患者表现出如此多不同的方式，对吧？

And when you were talking about mood, why does someone feel bad?

当你谈论情绪时，为什么有人感觉不好？

Why does a PCOS...

为什么多囊卵巢综合症...

First of all, the androgens do affect, disrupt the dopamine and serotonin in their brain.

首先，雄激素确实会影响、破坏大脑中的多巴胺和血清素。

That's a fact.

这是事实。

But put yourself in the shoes of a PCOS young girl, who lives at home with a thin, beautiful mom or a thin, beautiful older sister.

但是，请把自己想象成一个多囊卵巢综合症的年轻女孩，她和一个瘦弱、美丽的妈妈或瘦弱、美丽的姐姐住在家里。

She's overweight.

她超重了。

She doesn't eat anything.

她什么都不吃。

She's exercising every day.

她每天都在锻炼身体。

She's already a little anxious.

她已经有些着急了。

She has acne.

她有痤疮。

Her mom takes her in, and they put her on Accutane.

她妈妈收留了她，并给她服用了维甲酸。

She's constantly lasering her hair.

她经常用激光照射头发。

Her periods are completely unpredictable.

她的月经完全无法预测。

She's starting to have an eating disorder because nothing she does is working for her, right?

她开始出现饮食失调症，因为她所做的一切都对她不起作用，对吗？

And then you take this patient with everything I told you, with all these underlying pillars not working in her, you take her to the doctor, and she gets dismissed.

然后你按照我告诉你的一切带这个病人，所有这些潜在的支柱在她身上都不起作用，你带她去看医生，然后她就被解雇了。

That's why I'm here, to speak for them.

这就是我来这里为他们说话的原因。

I feel like over the past 25 years, their trauma has become my trauma.

我觉得过去25年里，他们的创伤也变成了我的创伤。

I literally can cry right now.

我现在真的可以哭了。

Andrew Huberman: It's clear how much you care about your patients and the ones that are not even your patients, just the women out there that are suffering in this way.

安德鲁·胡伯曼：很明显，你有多关心你的病人，甚至不是你的病人，只是那些正在遭受这种痛苦的女性。

Perhaps could we explore the possibility of a different, if I say phenotype, it sounds so clinical, but a different person who perhaps is only experiencing a subset of those symptoms that you just described.

也许我们可以探索一种不同的可能性，如果我说表型，听起来很临床，但一个不同的人可能只经历你刚才描述的那些症状的一个子集。

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: And on that note, I'm struck by the fact that what we know from male pattern baldness and female pattern baldness is that when androgens get too high, it miniaturizes the hair follicle.

安德鲁·休伯曼：关于这一点，令我震惊的是，我们从男性型秃发和女性型秃发中了解到，当雄激素过高时，毛囊就会缩小。

It's kind of interesting that when androgens get too high in the ovary, they miniaturize the follicle there, too.

有趣的是，当卵巢中的雄激素过高时，那里的卵泡也会缩小。

It seems that basically, excessive androgens are bad for follicle development.

似乎基本上，过多的雄激素不利于卵泡发育。

Thaïs Aliabadi: Stunts it.

Thais Aliabadi：特技表演。

Andrew Huberman: Yeah.

安德鲁·休伯曼：是的。

So two parallel pathways operating in the exact same way.

因此，两条并行路径以完全相同的方式运行。

It sounds like we're trying to make high testosterone the issue, but in some sense, unless we think back to the GnRH neurons firing too much.

听起来我们正试图让高睾酮成为问题，但从某种意义上说，除非我们回想 GnRH 神经元放电过多的问题。

The elevated androgens really seem to be the kind of tip of the spear in this whole thing.

升高的雄激素似乎确实是整个事件中的矛尖。

Not what initially sets off the cascade, but in terms of tractable things that good medications and good practices might be able to take hold of.

不是最初引发连锁反应的原因，而是良好的药物和良好的做法可能能够控制的易于处理的事情。

Thaïs Aliabadi: Correct.

泰伊斯·阿利亚巴迪：正确。

Andrew Huberman: Is that right?

安德鲁·休伯曼：是这样吗？

And certainly insulin sensitivity as well.

当然还有胰岛素敏感性。

So I'm imagining a bunch of different patient profiles here.

所以我在这里想象了一堆不同的患者资料。

I can imagine women in their 20s, in their 30s, who have been told by society, "Okay, you're still fertile.

我可以想象20多岁、30多岁的女性，社会告诉她们：“好吧，你仍然有生育能力。

You're good.

你很好。

You're going to be fine." These are the women that are showing up in clinics in their late 30s and 40s and saying, "Why is it that my egg count is so low?" Or, "Why is it that I can't conceive?"

你会没事的。”这些 30 多岁和 40 多岁的女性出现在诊所，她们说：“为什么我的卵子计数这么低？”或者，“为什么我不能怀孕？”

Thaïs Aliabadi: So, PCOS patients, their egg count is falsely high because of these tiny follicles that are frozen in the ovaries that never got to ovulate, they do secrete AMH.

Thaïs Aliabadi：PCOS 患者的卵子计数错误地偏高，因为这些微小的卵泡被冻结在卵巢中，永远不会排卵，它们确实会分泌 AMH。

So these patients, that's why in 2023, they changed that second criteria, the PCOS ovaries, to elevated or elevated AMH.

因此，这些患者，这就是为什么在 2023 年，他们将第二个标准（PCOS 卵巢）更改为 AMH 升高或升高。

Andrew Huberman: How high for AMH?

Andrew Huberman：AMH 有多高？

I mean-

我的意思是——

Thaïs Aliabadi: Sometimes like, let's say a young-

Thaïs Aliabadi：有时，比方说一个年轻的——

Andrew Huberman: What's a typical value for someone in their 20s and 30s?

Andrew Huberman：20 多岁和 30 多岁的人的典型价值观是多少？

Thaïs Aliabadi: So I would say up to six is normal.

Thais Aliabadi：所以我想说最多六个是正常的。

Andrew Huberman: And people in their 40s?

Andrew Huberman：那么 40 多岁的人呢？

Thaïs Aliabadi: Less than 1.0, 0.5.

Thaïs Aliabadi：小于 1.0、0.5。

Andrew Huberman: It drops precipitously?

Andrew Huberman：急剧下降？

Thaïs Aliabadi: Oh, yes.

泰伊斯·阿利亚巴迪：哦，是的。

Andrew Huberman: Where is the, I don't want to say cliff, because maybe it's more gradual than that.

Andrew Huberman：我不想说悬崖在哪里，因为也许它比那更渐进。

Thaïs Aliabadi: After probably late 20s, it starts declining.

Thaïs Aliabadi：大概在 20 岁左右之后，它开始下降。

Andrew Huberman: Okay.

安德鲁·休伯曼：好的。

Thaïs Aliabadi: That's why I always tell patients, especially PCOS patients, to freeze by 20 to 30, even though they have tons of eggs.

Thaïs Aliabadi：这就是为什么我总是告诉患者，尤其是 PCOS 患者，冷冻 20 到 30 个卵子，即使他们有大量卵子。

Listen, I get patients, they come to my office, they're like, "Doctor," new patient.

听着，我有病人，他们来到我的办公室，他们就像“医生”，新病人。

"I went to my fertility doctor.

“我去看了我的生育医生。

He doesn't know what he's doing." "Why?" A 40, 41-year-old.

他不知道自己在做什么。” “为什么？” 40、41岁。

"I put out 30 eggs, and he couldn't make a single embryo."

“我放了30个卵子，他却一个胚胎也产不出来。”

Andrew Huberman: Through IVF, yeah.

Thaïs Aliabadi: Through IVF.

You shouldn't put out 30 eggs at age 40.

40岁就不应该生出30个鸡蛋。

That's PCOS.

这就是多囊卵巢综合症。

Andrew Huberman: This is so important for people to hear because I think egg count and elevated or high enough AMH is sort of touted as the thing that people go and look at.

Andrew Huberman：这对人们来说非常重要，因为我认为卵子数和升高或足够高的 AMH 被吹捧为人们去关注的事情。

It makes sense, right?

这是有道理的，对吧？

I mean, they'll do an ultrasound, count follicles.

我的意思是，他们会做超声波检查，计算卵泡数。

Thaïs Aliabadi: It's great as long as you're not missing PCOS.

Thaïs Aliabadi：只要您没有错过 PCOS，那就太好了。

Because if it's PCOS, then the quality of the embryo is bad, then the ovulation is suboptimal, the environment is suboptimal, and everything else needs to be fixed.

因为如果是多囊卵巢综合症，那么胚胎质量就不好，那么排卵就不理想，环境也不理想，其他一切都需要修复。

Andrew Huberman: And this is perhaps why some people go in their 30s.

Andrew Huberman：这也许就是为什么有些人在 30 多岁时就开始了。

They might be doing IVF or something like that, and they actually have a relatively low egg count.

他们可能正在做体外受精或类似的事情，而且他们的卵子数量实际上相对较低。

They'll get maybe...

他们也许会得到...

It's always tricky what low corresponds with.

Thaïs Aliabadi: Yeah.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: But three and two...

Thaïs Aliabadi: Yeah.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: Three on one side, two on the other, but then the IVF works because you don't necessarily...

安德鲁·休伯曼：一侧三个，另一侧两个，但 IVF 会起作用，因为你不一定......

Thaïs Aliabadi: The quality profile.

Andrew Huberman: The quality of the eggs is higher.

Andrew Huberman：鸡蛋的质量更高。

Thaïs Aliabadi: Right.

泰伊斯·阿利亚巴迪：是的。

So, AMH, anti-Müllerian hormone, the easiest way to look at it is every 0.1 of AMH averages to one follicle.

所以，AMH，抗苗勒氏管激素，最简单的观察方法是每 0.1 个 AMH 平均对应一个卵泡。

That's an easy way to calculate it in your head.

Andrew Huberman: Okay.

安德鲁·休伯曼：好的。

Thaïs Aliabadi: So if you have an AMH of one, you should have about 10 follicles.

Thais Aliabadi：所以如果您的 AMH 为 1，您应该有大约 10 个卵泡。

But if you show up at 40 and there's 30 follicles in your ovaries, something's wrong.

但如果你 40 岁时出现，并且你的卵巢里有 30 个卵泡，那就有问题了。

That's PCOS.

这就是多囊卵巢综合症。

You have to make sure it's not PCOS.

You have to make sure that you're not missing PCOS because that's why this woman is not getting pregnant.

您必须确保您没有错过多囊卵巢综合症，因为这就是这位女士没有怀孕的原因。

And can I tell you, Andrew, how many patients come through fertility clinic and they are not diagnosed with PCOS, even by their fertility doctor?

安德鲁，我可以告诉你，有多少患者来到生育诊所就诊，但即使是他们的生育医生也没有诊断出患有多囊卵巢综合症？

Andrew Huberman: Well, the way you're describing the sort of standards in the medical profession, it's both not surprising and really disheartening.

安德鲁·休伯曼：嗯，从你描述医学界标准的方式来看，这并不令人惊讶，而且确实令人沮丧。

Thaïs Aliabadi: It's sad.

Andrew Huberman: Yeah, it's really sad.

Again, one of the reasons you're here today, I think this reframing of AMH and egg number or follicle number is very important for people to hear.

再次强调，您今天来到这里的原因之一是，我认为 AMH 和卵子数量或卵泡数量的重新定义对于人们来说非常重要。

Because I know a number of different people done IVF, do IVF, and this issue of AMH and follicle number is kind of held as the thing, right?

因为我知道很多不同的人做过IVF，做IVF，AMH和卵泡数的问题有点像问题，对吗？

Thaïs Aliabadi: Like, if you have , bravo.

Andrew Huberman: There's 12 and 15, oh, my goodness, someone still has 20 follicles at age whatever, 41 or something, and then they'll go through rounds of IVF, and it's just hopeless.

Andrew Huberman：有 12 和 15 个，哦，天哪，有人在 41 岁左右的年龄仍然有 20 个卵泡，然后他们会经历几轮 IVF，这是绝望的。

Thaïs Aliabadi: And, I mean, I'm not a fertility specialist, but I can tell you, if at age 25, 28, every three eggs make one embryo.

Thaïs Aliabadi：我的意思是，我不是生育专家，但我可以告诉你，如果在 25、28 岁时，每三个卵子会产生一个胚胎。

At 40, you might need 10 to 15 eggs to make one embryo.

40 岁时，您可能需要 10 到 15 个卵子才能形成一个胚胎。

So, if your AMH at 40 is 0.5, that means five follicles, so you might have to do two or three cycles of egg freezing or embryo freezing before you can hit that normal embryo.

因此，如果您的 AMH 在 40 时为 0.5，则意味着有 5 个卵泡，因此您可能需要进行两到三个周期的卵子冷冻或胚胎冷冻才能获得正常胚胎。

So that's why, unfortunately, insurance companies don't cover egg freezing, right?

不幸的是，这就是为什么保险公司不承保卵子冷冻的原因，对吧？

And I always say this when girls are young, and they have beautiful eggs, and their eggs are young and healthy, and you want to freeze them, they can't afford it, because it's very expensive.

我总是这么说，当女孩年轻的时候，她们有漂亮的卵子，她们的卵子年轻又健康，你想冷冻它们，她们买不起，因为它非常昂贵。

And then when they can afford it, they're usually in their late 30s or 40s, and the quality is down.

然后，当他们能负担得起时，他们通常在 30 多岁或 40 多岁时，质量就下降了。

So that needs to be fixed.

And we had this conversation, I think, in the Bay Area, a lot of these big companies, like Google and Facebook, these companies actually pay for their employees to freeze their eggs.

我们进行了这样的对话，我认为，在湾区，很多大公司，比如谷歌和 Facebook，这些公司实际上为员工支付冷冻卵子的费用。

They're smart, right?

他们很聪明，对吧？

They don't want their employees to get pregnant.

They're like, "I'll pay for your egg freezing.

Keep working." But most women, most women don't have access.

继续工作。” But most women, most women don't have access.

And let me tell you, 50% of counties in this country don't have an OB/GYN.

让我告诉你，这个国家 50% 的县没有妇产科。

Andrew Huberman: 50%?

Thaïs Aliabadi: 50% of counties.

A lot of these women have to drive two to four hours to see their OB/GYN.

许多女性必须开车两到四个小时才能去看妇产科。

Andrew Huberman: That's crazy.

Thaïs Aliabadi: That's why these podcasts are a game-changer, because if they don't have access.

Thaïs Aliabadi：这就是为什么这些播客能够改变游戏规则，因为如果他们没有访问权限的话。

That's why artificial intelligence, AI, these robotic chatbots, that hopefully can someday diagnose these patients and treat them from home without having them have to drive, I don't know, four hours to see an OB/GYN, who will then also dismiss their symptoms.

这就是为什么人工智能，人工智能，这些机器人聊天机器人，希望有一天能够诊断这些患者，并在家中治疗他们，而不需要他们开车，我不知道，四个小时去看妇产科医生，然后医生也会消除他们的症状。

Andrew Huberman: Yeah, like you said, in some cases, technology may be better than certain physicians.

安德鲁·休伯曼：是的，就像你说的，在某些情况下，技术可能比某些医生更好。

I don't disagree with you there.

我不同意你的观点。

Thaïs Aliabadi: By the end of this podcast you'll believe in the robots treating.

Thaïs Aliabadi：听完本播客，您就会相信机器人会治疗。

Andrew Huberman: Well, I'll believe in robots and technologies perhaps doing better than some clinicians and scientists, to be fair.

Andrew Huberman：好吧，公平地说，我相信机器人和技术可能比一些临床医生和科学家做得更好。

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Yes.

是的。

Andrew Huberman: But I do think that spectacularly good clinicians like yourself and in other fields.

安德鲁·休伯曼：但我确实认为像您这样以及其他领域的非常优秀的临床医生。

I mean, I know people in different fields of medicine.

我的意思是，我认识不同医学领域的人。

I'm fortunate enough, blessed, to know people in different fields of medicine for whom you can truly say that there's no world where a robot or even 15 doctors can compare.

我很幸运，很幸运，认识不同医学领域的人，你可以真正地说，没有一个世界可以与机器人甚至 15 名医生相比。

Thaïs Aliabadi: Incredible.

泰伊斯·阿利亚巴迪：难以置信。

Andrew Huberman: Because there's something about knowing the principles of something, knowing the principles below the principles, the principles below that, and then being a longtime practitioner in a given field.

Andrew Huberman：因为了解某件事的原则，了解原则下的原则，了解原则下的原则，然后成为特定领域的长期实践者。

Thaïs Aliabadi: Yeah.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: They're like what we call true expertise, deep expertise, and lateral expertise.

Andrew Huberman：它们就像我们所说的真正的专业知识、深厚的专业知识和横向专业知识。

Thaïs Aliabadi: No, I was going to say most fields of medicine, let's take ophthalmology, right?

Thaïs Aliabadi：不，我想说的是大多数医学领域，比如眼科，对吧？

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: Every single ophthalmologist knows about cataract.

Thaïs Aliabadi：每位眼科医生都了解白内障。

Andrew Huberman: Yes.

安德鲁·休伯曼：是的。

Most common form of blindness.

最常见的失明形式。

Thaïs Aliabadi: Thank you.

泰伊斯·阿利亚巴迪：谢谢。

So it would be rare for you to go to an ophthalmologist with cataract and not get diagnosed, correct?

因此，您很少会因患有白内障去看眼科医生而得不到诊断，对吗？

Andrew Huberman: Correct.

安德鲁·休伯曼：正确。

Thaïs Aliabadi: So why is it that the leading cause of infertility on this planet, 90% of women are not diagnosed?

Thais Aliabadi：那么，为什么 90% 的女性没有得到诊断，这是这个星球上不孕不育的主要原因呢？

Women's health is very different than other fields of medicine.

女性健康与其他医学领域有很大不同。

It's a different monster.

这是一个不同的怪物。

It's that cataract patient that goes to 20 ophthalmologists, and she keeps saying, "I can't see," and the ophthalmologist says, "You're crazy.

就是那位白内障患者去看了 20 名眼科医生，她一直说，“我看不见，”眼科医生说，“你疯了。

There's nothing wrong with you."

你没有什么问题。”

Andrew Huberman: Now, that's an excellent analogy.

Andrew Huberman：这是一个很好的类比。

Not just because it's vision, and that's my home area of science, but because I think humans are so dependent on vision, and just the idea of losing vision for people who are sighted is so challenging.

不仅因为它是视觉，这是我的科学领域，而且因为我认为人类非常依赖视觉，而对于视力正常的人来说失去视力的想法是如此具有挑战性。

I mean, the number of incredibly elegant feedback loops and the whole thing works like a beautiful symphony when it works, also indicates that small disruptions in these things can cause really downstream consequences.

我的意思是，令人难以置信的优雅反馈循环的数量以及整个事情在发挥作用时就像一首美丽的交响乐，也表明这些事情中的微小干扰可能会导致真正的下游后果。

I'm curious, why so much more PCOS?

我很好奇，为什么多囊卵巢综合症这么多？

Or is it like so many areas of medicine, where it probably was around a long time, but we just weren't aware?

或者它就像医学的许多领域一样，它可能已经存在很长时间了，但我们只是没有意识到？

And I can point to the insulin resistance.

我可以指出胰岛素抵抗。

Maybe it's how people are eating and the downstream chronic inflammation from the intravisceral fat.

也许这就是人们的饮食方式以及内脏脂肪引起的下游慢性炎症。

Thaïs Aliabadi: Yeah.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: Maybe it's the neuroscientist in me.

安德鲁·休伯曼：也许这就是我内心的神经科学家。

I keep thinking of these GnRH neurons in the brain that are suddenly start firing abnormally.

我一直在想大脑中的这些 GnRH 神经元突然开始异常放电。

Thaïs Aliabadi: Firing.

泰伊斯·阿利亚巴迪：开枪。

Andrew Huberman: I have all sorts of pet theories as to why that could be the case, but of course, I don't have any data.

Andrew Huberman：对于为什么会出现这种情况，我有各种各样的理论，但当然，我没有任何数据。

Thaïs Aliabadi: Stress affects it, for sure.

Thais Aliabadi：压力肯定会影响它。

Andrew Huberman: Disrupted sleep-wake cycles.

Andrew Huberman：睡眠-觉醒周期被打乱。

I always sort of default to that.

我总是默认这一点。

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

But then you see these young girls who grow up in amazing, loving families.

但随后你会看到这些年轻女孩在令人惊叹、充满爱的家庭中长大。

They've never had any stress.

他们从来没有任何压力。

They didn't have any trauma.

他们没有任何外伤。

Andrew Huberman: They're sleeping well, they're eating well, great nutrition.

Andrew Huberman：他们睡得很好，吃得很好，营养也很好。

Thaïs Aliabadi: And they're sleeping well, yeah, but they start having these symptoms.

Thaïs Aliabadi：他们睡得很好，是的，但他们开始出现这些症状。

The reason I'm saying this, I don't want people to get this message that stress is starting all this because it's a multi-system dysfunction.

我之所以这么说，是因为我不想让人们明白压力是导致这一切的原因，因为这是一种多系统功能障碍。

It's an immune system dysfunction.

这是免疫系统功能障碍。

It's an insulin-resistant dysfunction.

这是一种胰岛素抵抗功能障碍。

It's a brain, pituitary, ovary dysfunction.

这是大脑、垂体、卵巢功能障碍。

It has a genetic factor.

它有遗传因素。

It has an epigenetic, and that's why the treatment plan is so important.

它具有表观遗传性，这就是治疗计划如此重要的原因。

That's why you can't throw birth control at all these pillars and say, "All right, see you later."

这就是为什么你不能把节育措施抛在所有这些支柱上，然后说：“好吧，待会儿见。”

Andrew Huberman: Also, birth control means many, many things, right?

安德鲁·休伯曼：另外，节育意味着很多很多事情，对吧？

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: I mean, there's the estrogen.

安德鲁·休伯曼：我的意思是，有雌激素。

Thaïs Aliabadi: And I love birth control, but, you know.

Thaïs Aliabadi：我喜欢节育，但是，你知道。

Andrew Huberman: Yeah.

安德鲁·休伯曼：是的。

Well, nowadays, there's a bit of a pushback, I noticed, at least on Instagram, for what it's worth.

嗯，我注意到，如今，至少在 Instagram 上，存在一些阻力。

Sometimes we think Instagram is the whole world, and I'll tell you, everyone, it's not the whole world.

有时我们认为 Instagram 就是整个世界，但我告诉大家，它不是整个世界。

There are a lot of people who are not on Instagram all the time, but many are.

有很多人并不一直在 Instagram 上，但也有很多人在。

And there seems to be a bit of a pushback against...

而且似乎还有一些反对的声音……

And certainly hormone-based contraception.

当然还有基于激素的避孕。

A lot of women I hear from, are convinced that it somehow, they believe it damaged them, and I believe them.

我听到的很多女性都相信这在某种程度上损害了她们，我也相信她们。

Thaïs Aliabadi: That's when the topic of endometriosis will come up, and I would love to talk about that, but the reason birth control pills work for PCOS patients it's one of the aspects.

Thaïs Aliabadi：那时就会出现子宫内膜异位症的话题，我很想谈谈这个问题，但避孕药对 PCOS 患者有效的原因之一是它。

I don't like birth control pills for PCOS patients.

我不喜欢多囊卵巢综合症患者服用避孕药。

Remember, I told you they're moody patients, they have anxiety, they are depressed.

记住，我告诉过你他们是喜怒无常的病人，他们有焦虑症，他们有抑郁症。

It's hard for them to take birth control pills.

他们很难服用避孕药。

In my opinion, a lot of times they complain of, "I'm eating more," or, "I don't feel well," or, "I'm more depressed." So, it's not my first go-to treatment, but I will tell you why it works.

在我看来，很多时候他们会抱怨“我吃得更多”，或者“我感觉不舒服”，或者“我更沮丧”。所以，这不是我的第一个治疗方法，但我会告诉你为什么它有效。

Remember I told you the sex hormone-binding globulin goes down because of that high insulin?

还记得我告诉过你性激素结合球蛋白会因为高胰岛素而下降吗？

Birth control pills stimulate that sex hormone-binding globulin that starts grabbing the testosterone and helps with their symptoms.

避孕药会刺激性激素结合球蛋白，开始捕获睾酮并帮助缓解症状。

That's why if you go to the doctor and you say, "I have acne," they're like, "Birth control." "I have hair loss." "Birth control." "My periods are irregular." "Birth control." We use it for everything, right?

这就是为什么如果你去看医生并说“我有痤疮”，他们会说“节育”。 “我有脱发。” “计划生育。” “我的月经不规律。” “计划生育。”我们用它来做所有事情，对吗？

But it does work to treat the symptoms of PCOS.

但它确实可以治疗多囊卵巢综合症的症状。

It makes the periods regular, it helps with the skin, it helps with the hair loss, it helps with all of that.

它使月经规律，它有助于皮肤，它有助于脱发，它对所有这些都有帮助。

Andrew Huberman: This is estrogen-based or progestin-based birth control?

安德鲁·休伯曼：这是基于雌激素或孕激素的节育措施吗？

Thaïs Aliabadi: You can do both.

Thais Aliabadi：两者都可以。

Andrew Huberman: Uh-huh.

安德鲁·休伯曼：嗯。

Thaïs Aliabadi: Estrogen and progesterone, or there's a progesterone-only birth control pill now called Slynd that helps with...

Thaïs Aliabadi：雌激素和黄体酮，或者有一种仅含黄体酮的避孕药，现在称为 Slynd，可以帮助......

It's very anti-androgenic that I try for PCOS patients who need a method of birth control.

我为需要节育方法的多囊卵巢综合症患者尝试了非常抗雄激素的药物。

But when it comes to treatment, you have to hit the underlying pillars, right?

但在治疗方面，你必须触及根本支柱，对吗？

So, we talked about the epigenetics.

所以，我们讨论了表观遗传学。

I always start there with that.

我总是从那里开始。

Exercise, walking after each meal.

锻炼身体，每顿饭后散步。

Walk for 10, 15 minutes.

步行10、15分钟。

Make sure you're sleeping well.

确保你睡得好。

Make sure your diet is healthy, you're not eating inflammatory foods, you're avoiding processed foods.

确保你的饮食健康，不吃炎症食物，避免加工食品。

So lower your stress.

所以减轻你的压力。

So you deal with that, but that doesn't work for these patients.

所以你要处理这个问题，但这对这些病人不起作用。

That's why you need to address everything else.

这就是为什么你需要解决其他所有问题。

Insulin resistance is one of the main pillars that needs to be addressed.

胰岛素抵抗是需要解决的主要支柱之一。

You have to lower that insulin, because if you lower that insulin, you're lowering visceral fat, you're lowering inflammation, you're lowering the ovaries from secreting androgens, right?

你必须降低胰岛素，因为如果你降低胰岛素，你就降低了内脏脂肪，你就降低了炎症，你就减少了卵巢分泌雄激素，对吧？

So that insulin needs to be lowered.

因此需要降低胰岛素。

That's why a lot of PCOS patients get prescribed metformin, right?

这就是为什么很多多囊卵巢综合症患者服用二甲双胍的原因，对吗？

What does metformin do?

二甲双胍有什么作用？

Metformin basically makes us more insulin sensitive.

二甲双胍基本上使我们对胰岛素更加敏感。

It's opening these channels, so sugar clears the blood and goes into the cells, where it turns into energy.

它打开了这些通道，因此糖可以清除血液并进入细胞，在那里转化为能量。

Andrew Huberman: Is it high-dose metformin or sort of low?

Andrew Huberman：二甲双胍的剂量是高剂量还是低剂量？

Thaïs Aliabadi: No, high dose.

Thais Aliabadi：不，高剂量。

High dose, I mean, I start patients on 750 twice a day, but you have to start slow because PCOS patients, especially the ones with insulin resistance, which is 80% of them...

高剂量，我的意思是，我开始给病人每天两次750，但你必须慢慢开始，因为多囊卵巢综合症患者，尤其是有胰岛素抵抗的病人，占其中的80%......

I start with 750 because it can cause sometimes GI symptoms like diarrhea, and it can also cause nausea, so I start with 750 at night.

我从 750 开始，因为它有时会导致腹泻等胃肠道症状，而且还会引起恶心，所以我从晚上 750 开始。

Then if they tolerate it, I add the 750 in the morning.

如果他们能忍受，我早上就会加 750。

And for patients who are tolerating it and they still are not ovulating, their periods are still not regulating, and they still have symptoms, I might up it to 1,000 twice a day.

对于那些能够耐受但仍然没有排卵、月经仍然不正常、仍然有症状的患者，我可能会将其提高到每天两次 1,000。

But you see these patients who come in on 500 milligrams of metformin once a day.

但您会看到这些患者每天服用一次 500 毫克二甲双胍。

That's not going to touch these patients.

这不会影响到这些病人。

So, metformin is one, but before metformin, and I don't know if you know this, because of my passion for PCOS, I actually developed a calculator.

所以，二甲双胍就是其中之一，但是在二甲双胍之前，我不知道你是否知道这一点，因为我对 PCOS 的热情，我实际上开发了一个计算器。

It's a platform called Ovii.

这是一个叫Ovii的平台。

Women can go on it.

女人可以继续。

Obviously, I can't diagnose on any website, but I can tell them that, ask them...

显然，我无法在任何网站上进行诊断，但我可以告诉他们，询问他们......

It's my algorithm that I've developed over the past 25 years, and I can tell them very closely whether or not they have the likelihood of having PCOS.

这是我在过去 25 年里开发的算法，我可以非常准确地告诉他们是否有可能患有 PCOS。

Andrew Huberman: Hmm.

安德鲁·休伯曼：嗯。

Thaïs Aliabadi: So it's there.

Thais Aliabadi：所以它就在那里。

It's ovii.com, O-V-I-I.com.

这是 ovii.com，O-V-I-I.com。

It's free.

它是免费的。

Andrew Huberman: They answer some questions?

Andrew Huberman：他们回答一些问题吗？

Thaïs Aliabadi: Questions, and I tell them whether they have the likelihood or if they're less likely to have PCOS.

Thaïs Aliabadi：提问，我告诉他们是否有可能患有多囊卵巢综合症，或者他们是否不太可能患有多囊卵巢综合症。

And if they do, PCOS is one of the very few conditions in medicine where supplements make a huge difference.

如果确实如此，多囊卵巢综合症是医学上极少数通过补充剂发挥巨大作用的病症之一。

And these are for patients who don't have access to the doctor, and these are patients who basically go to the doctor, and they're being dismissed.

这些是针对无法去看医生的患者的，这些患者基本上去看医生，但他们被解雇了。

These supplements work amazingly well.

这些补充剂的效果非常好。

Why?

为什么？

Because the Ovii supplement I created, I literally did it.

因为我创建了 Ovii 补充，我确实做到了。

"Here, diagnose yourself, and if you're being dismissed, start with the supplement." They make a huge difference for these patients.

“在这里，诊断一下你自己，如果你被解雇了，那就从补充开始吧。”它们对这些患者产生了巨大的影响。

Why?

为什么？

Because they address the insulin sensitivity.

因为它们解决了胰岛素敏感性问题。

I'm sure you've heard of inositol, different forms of inositol, that work to increase sensitivity to insulin, and that's why these patients, when they take it, they say, "Oh, my periods became regular," or, "I took it, and I got pregnant," because it does address that.

我相信你听说过肌醇，不同形式的肌醇，它们可以增加对胰岛素的敏感性，这就是为什么这些患者在服用它时会说，“哦，我的月经变得规律了，”或者，“我服用了它，我怀孕了，”因为它确实解决了这个问题。

When it comes to this insulin resistance, they can either do the metformin, but what I like to do, I like to start them on supplements that have inositol in it and vitamin D.

当谈到这种胰岛素抵抗时，他们可以服用二甲双胍，但我喜欢做的是，我喜欢让他们开始服用含有肌醇和维生素 D 的补充剂。

Did you know that low vitamin D makes you insulin resistant?

您知道维生素 D 含量低会导致胰岛素抵抗吗？

Andrew Huberman: Well, I'm convinced.

安德鲁·休伯曼：嗯，我确信。

I was aware, but I think it can't be stated enough or emphatically enough, because I know I'm really bullish about the sunlight thing.

我知道，但我认为这一点怎么表述都不够，也不够强调，因为我知道我真的很看好阳光。

I'm always talking about sunlight.

我总是在谈论阳光。

I don't want people to get sunburned, and that's not what I'm talking about.

我不希望人们被晒伤，但这不是我要说的。

But we spend so much more time indoors now, under artificial lighting, where the short-wavelength lighting...

但我们现在在室内度过了更多的时间，在人工照明下，短波长照明......

Thaïs Aliabadi: Everyone's low.

Thais Aliabadi：每个人都很低落。

Andrew Huberman: It really disrupts how the mitochondria process energy, and the long-wavelength light from sunlight, the so-called red and infrared light, serves as a protective feature against the short-wavelength light.

Andrew Huberman：它确实破坏了线粒体处理能量的方式，而来自阳光的长波长光，即所谓的红光和红外光，可以作为针对短波长光的保护功能。

So we're not getting enough vitamin D, and we need that.

所以我们没有获得足够的维生素 D，而我们需要它。

That comes from the short-wavelength light.

那来自短波长光。

I do have a question about inositol.

我确实有一个关于肌醇的问题。

There are a couple different forms.

有几种不同的形式。

There's myo.

有妙。

Thaïs Aliabadi: Yes, myo, yes.

Thais Aliabadi：是的，myo，是的。

Andrew Huberman: Right.

安德鲁·休伯曼：对。

And we can explore those in more depth, but it is a well-known regulator and can improve insulin sensitivity, which is what you want.

我们可以更深入地探索这些，但它是一种众所周知的调节剂，可以提高胰岛素敏感性，这正是你想要的。

Sometimes people hear insulin sensitivity, and they think that's the bad thing.

有时人们听到胰岛素敏感性，他们认为这是坏事。

You want your insulin to be sensitive.

您希望您的胰岛素敏感。

Thaïs Aliabadi: You don't want it to be resistant.

Thaïs Aliabadi：你不希望它具有抵抗力。

Andrew Huberman: Right.

安德鲁·休伯曼：对。

Thaïs Aliabadi: Anything that will make you more insulin sensitive will help with symptoms of PCOS.

Thaïs Aliabadi：任何能让你对胰岛素更加敏感的东西都有助于缓解多囊卵巢综合症的症状。

So, you want to bring down these pillars, right, without even thinking about birth control pill.

所以，你想推倒这些支柱，对吧，甚至不考虑避孕药。

You want to lower your insulin resistance.

您想降低胰岛素抵抗。

So, whether it's metformin or supplements or exercise or low-carbohydrate diet or lowering your stress and lowering your cortisol, all of that, all of this system, that's why I wanted to explain all this, because they all work together.

所以，无论是二甲双胍、补充剂、锻炼、低碳水化合物饮食，还是减轻压力、降低皮质醇，所有这些，所有这个系统，这就是为什么我想解释这一切，因为它们都是一起起作用的。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: Then you want to bring your inflammation down.

Thaïs Aliabadi：那么你想减轻炎症。

You want to bring that visceral fat down.

你想降低内脏脂肪。

I don't know if you heard this, but in 2014, back then, I had Trulicity as GLP-1, and that's what I used to use for my PCOS patients, and they would lose 50, 60, 80, 100 pounds, and this is 2014.

我不知道你是否听说过这个，但在2014年，当时，我有Trulicity作为GLP-1，这就是我用来治疗我的PCOS患者的，他们会减掉50、60、80、100磅，这是2014年。

Andrew Huberman: What did your colleagues think at that time, that you were injecting patients with GLP-1?

Andrew Huberman：当时您给患者注射 GLP-1，您的同事对此有何看法？

Thaïs Aliabadi: I actually learned it from a cardiologist who I used to work with, Dr. Khorsandi, because I would screen for lipid panel on these PCOS patients, and they had high triglycerides, and they were overweight, so I would keep sending my patients to him, and one day he called me.

Thaïs Aliabadi：实际上，我是从我曾经合作过的一位心脏病专家 Khorsandi 博士那里学到的，因为我会对这些 PCOS 患者进行血脂检查，他们的甘油三酯很高，而且超重，所以我会继续把我的患者送到他那里，有一天他给我打电话。

He's like, "Listen, Thaïs, there is this medication called Trulicity.

他说，“听着，Thais，有一种叫做 Trulicity 的药物。

Stop sending your patients to me.

别再把你的病人送到我这里来了。

Treat them with this medication.

用这种药物治疗他们。

They will lose weight, and their cholesterol, everything will get better." So in 2014, I started putting these patients on Trulicity, and one thing I realized is their periods were starting to get regular.

他们的体重会减轻，胆固醇也会减轻，一切都会好起来。”因此，在 2014 年，我开始让这些患者服用 Trulicity，我意识到一件事是他们的月经开始变得规律。

Their symptoms of PCOS would get better.

他们的多囊卵巢综合症症状会好转。

And the first thing they would come and tell me is, "Doctor, I feel less inflamed." Why do you think?

他们过来告诉我的第一件事是：“医生，我感觉炎症减轻了。”你认为为什么？

Because you put them on these medications.

因为你给他们服用了这些药物。

First of all, PCOS patients chronically have this insulin firing, right?

首先，多囊卵巢综合症患者长期有这种胰岛素分泌，对吗？

And that's why this cascade starts.

这就是这个级联开始的原因。

What GLP-1s do...

GLP-1 的作用...

People think it's an appetite suppressant, and that's how it works.

人们认为它是一种食欲抑制剂，这就是它的作用。

Well, that's a side effect of it, but what it does is it actually regulates that insulin, so when you eat, it spikes your insulin up and clears that sugar out of your blood, right?

嗯，这是它的副作用，但它的作用实际上是调节胰岛素，所以当你吃东西时，它会增加你的胰岛素并清除血液中的糖，对吗？

Andrew Huberman: It's like a scavenger, a glucose scavenger.

Andrew Huberman：它就像一种清道夫，一种葡萄糖清道夫。

Thaïs Aliabadi: Right, and it also makes you insulin sensitive, so again, clearing it, which is oxygen, really, for these PCOS patients.

Thaïs Aliabadi：是的，它也会让你对胰岛素敏感，所以再次清除它，对于这些多囊卵巢综合症患者来说，这实际上就是氧气。

That's why I get so upset when patients comment about these GLP-1s, because in this subgroup of patients with insulin resistance, who are overweight, who are not ovulating, and who have all these symptoms, these medications since 2014 have changed their lives in my practice.

这就是为什么当患者评论这些 GLP-1 时我会感到非常不安，因为在这个患有胰岛素抵抗的患者亚组中，他们超重，不排卵，并且有所有这些症状，自 2014 年以来，这些药物在我的实践中改变了他们的生活。

Andrew Huberman: The pushback on GLP-1s is...

Andrew Huberman：GLP-1 的阻力是......

There are a variety of reasons, probably a discussion for another time, but they've clearly helped many, many people as long as people still engage in the right behaviors, maintaining muscle through resistance training.

原因有很多，可能下次再讨论，但只要人们仍然采取正确的行为，通过阻力训练保持肌肉，它们显然已经帮助了很多很多人。

Thaïs Aliabadi: And it's not for an eating disorder.

Thaïs Aliabadi：这不是针对饮食失调的。

Yes.

是的。

Andrew Huberman: And people still need to take great care of themselves.

Andrew Huberman：人们仍然需要好好照顾自己。

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: Eat properly, exercise, sleep, et cetera.

Andrew Huberman：正确饮食、锻炼、睡眠等等。

You mentioned metformin several times.

您多次提到二甲双胍。

I'm aware of an over-the-counter version called berberine, which I believe comes from a tree bark, which is supposed to be a pretty potent glucose scavenger as well.

我知道一种叫做小檗碱的非处方药，我相信它来自树皮，它应该也是一种非常有效的葡萄糖清除剂。

Is there any reason why berberine is not advised?

有什么理由不建议使用小檗碱吗？

Thaïs Aliabadi: So, I think there are some studies that say long-term berberine is not advised.

Thaïs Aliabadi：所以，我认为有一些研究表明不建议长期服用小檗碱。

The problem with PCOS is it doesn't have a cure.

多囊卵巢综合症的问题是无法治愈。

You can't cure it.

你无法治愈它。

It's an ongoing issue.

这是一个持续存在的问题。

That's why you need to be on supplements that long-term you can stay on.

这就是为什么您需要长期服用补充剂的原因。

And like you mentioned, vitamin D, curcumin, chromium, inositol.

就像你提到的，维生素 D、姜黄素、铬、肌醇。

There are so many things we can do to increase that insulin sensitivity, lower the inflammation in the body.

我们可以做很多事情来提高胰岛素敏感性，降低体内炎症。

I don't usually give berberine long-term, but definitely short-term, you can use it as pulse treatment for these patients.

我一般不会长期服用小檗碱，但绝对是短期的，你可以用它作为这些患者的脉冲治疗。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

And metformin, it sounds like, is a relatively safe drug.

而二甲双胍，听起来是一种相对安全的药物。

Is that right?

是这样吗？

Thaïs Aliabadi: It's very safe.

Thais Aliabadi：非常安全。

Even for my patients who are not PCOS, I recommend metformin, let's say, perimenopausal women with hemoglobin A1Cs in the borderline range, 5.7, you fall into the pre-diabetic range.

即使对于我的非 PCOS 患者，我也推荐二甲双胍，比方说，血红蛋白 A1C 处于临界范围 5.7 的围绝经期女性，您就属于糖尿病前期范围。

I'm very lean, I've never been overweight, but I have a long family history of diabetes, and my hemoglobin A1C was 5.6 a few years ago, and I started taking metformin, and now I'm at 4.8.

我很瘦，从来没有超重过，但我有很长的糖尿病家族史，几年前我的糖化血红蛋白是5.6，我开始服用二甲双胍，现在是4.8。

Andrew Huberman: What dosages for people who are relatively lean or lean?

Andrew Huberman：对于相对瘦或瘦的人来说，剂量是多少？

Thaïs Aliabadi: I start with 500 a night just to see how they do.

Thais Aliabadi：我开始时每晚 500 美元，只是为了看看他们表现如何。

Andrew Huberman: Okay.

安德鲁·休伯曼：好的。

Thaïs Aliabadi: Metformin does have side effects.

Thaïs Aliabadi：二甲双胍确实有副作用。

Andrew Huberman: It drops your blood sugar, right?

安德鲁·休伯曼：它会降低你的血糖，对吧？

Thaïs Aliabadi: No, it's mostly the nausea, and some people really get really bad diarrhea with it.

Thaïs Aliabadi：不，主要是恶心，有些人确实会出现严重腹泻。

Andrew Huberman: Mm.

安德鲁·休伯曼：嗯。

Mm.

毫米。

Thaïs Aliabadi: That's why I start them on the supplements.

Thaïs Aliabadi：这就是为什么我开始服用补充剂。

If it doesn't work, I go to metformin.

如果不起作用，我就服用二甲双胍。

If that doesn't work, then I offer them GLP-1s.

如果这不起作用，那么我会向他们提供 GLP-1。

Andrew Huberman: I see.

安德鲁·休伯曼：我明白了。

Thaïs Aliabadi: Patients ask me, "Can I be on the supplement, on metformin, and on the GLP-1?" Yes.

Thaïs Aliabadi：患者问我，“我可以服用补充剂、二甲双胍和 GLP-1 吗？”是的。

You just don't want to start the GLP-1s with the metformin because they both cause nausea, and you don't know which one's causing what.

您只是不想同时服用 GLP-1 和二甲双胍，因为它们都会引起恶心，而且您不知道哪一种会引起恶心。

So, if someone's morbidly obese and they really want to lose weight, I start with the GLP-1s, and usually in about four months...

所以，如果有人病态肥胖并且他们真的想减肥，我会从 GLP-1 开始，通常在大约四个月内......

My average since 2014, I can tell you, four months of GLP-1s done correctly, patients lose 24 pounds.

我可以告诉你，自 2014 年以来，我的平均水平是，正确使用 GLP-1 四个月后，患者体重减轻了 24 磅。

That's my curve at my office.

这是我办公室的曲线。

Andrew Huberman: Of body fat and muscle, or?

Andrew Huberman：身体脂肪和肌肉，或者？

Thaïs Aliabadi: Probably of muscle, too, but these patients, a lot of them, are, like, 300 pounds, so it's hard to even assess that.

Thaïs Aliabadi：也可能是肌肉，但这些患者，其中很多人，大约有 300 磅重，所以很难评估这一点。

Andrew Huberman: They need to lose weight.

安德鲁·休伯曼：他们需要减肥。

Thaïs Aliabadi: But you know what?

Thais Aliabadi：但是你知道吗？

As they start losing weight, they become more motivated because it's the first time in their life that something actually works for them, because you're actually regulating that insulin dysfunction that they have.

当他们开始减肥时，他们会变得更有动力，因为这是他们一生中第一次真正对他们有效的东西，因为你实际上正在调节他们的胰岛素功能障碍。

And by supporting that, they become more active.

通过支持这一点，他们变得更加活跃。

Their self-esteem gets better.

他们的自尊心变得更好。

I had a 26-year-old in my office who I've been treating for many years for PCOS and these GLP-1s, and she came into my office a few months ago, and when I walked in, she was videotaping me.

我的办公室里有一位 26 岁的女士，我多年来一直在治疗她的 PCOS 和这些 GLP-1，她几个月前来到我的办公室，当我走进去时，她正在给我录像。

She looked so good.

她看起来很好。

She was so confident.

她是如此自信。

Her hair was done.

她的头发已经做好了。

She had a mini skirt with these boots, and she was always very shy, and she wouldn't talk.

她穿着迷你裙和这双靴子，她总是很害羞，不肯说话。

It was a different person that walked into my office.

走进我办公室的是另一个人。

And I started hugging her, and she started crying, and she looked at me, she said, "Dr. A, this is the first time in my life I know what it means to be happy."

我开始拥抱她，她开始哭泣，她看着我，她说：“A 博士，这是我一生中第一次知道快乐意味着什么。”

Andrew Huberman: Wow!

安德鲁·休伯曼：哇！

Yeah, I mean, it's very clear that these GLP-1s can help a lot of people.

是的，我的意思是，很明显这些 GLP-1 可以帮助很多人。

It's interesting, the pushback on GLP-1s now is changing a bit because a number of compounding pharmacies make them now.

有趣的是，现在对 GLP-1 的抵制正在发生一些变化，因为许多复方药房现在都在生产它们。

So, people tacked the GLP-1s to "Big Pharma." It was kind of a...

因此，人们将 GLP-1 归为“大型制药公司”。这有点像...

Thaïs Aliabadi: Yeah.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: And I understand people's gripes with Big Pharma, insurance, and things.

Andrew Huberman：我理解人们对大型制药公司、保险等事物的抱怨。

If everyone has been boxed out of access to a drug or something like that and had insurance issues, it can be very, very frustrating, even deadly.

如果每个人都无法获得药物或类似的东西，并且有保险问题，那可能会非常非常令人沮丧，甚至致命。

I mean, there's a whole discussion about this recently around cancer and cancer drugs.

我的意思是，最近围绕癌症和抗癌药物进行了全面的讨论。

But to stay on point, I think now that some of these GLP-1 peptides are available through compounding pharmacies, prices have come down.

但为了保持重点，我认为现在一些 GLP-1 肽可以通过复合药房购买，价格已经下降。

The big pharmaceutical companies don't like that, but it's also the case that people are "microdosing them." They're taking the GLP-1s at doses that are below the threshold that would give them nausea, so they're not losing weight quite as quickly.

大型制药公司不喜欢这样，但人们也正在“微剂量服用”。他们服用 GLP-1 的剂量低于会引起恶心的阈值，因此他们的体重减轻速度不会那么快。

Thaïs Aliabadi: I love that.

Thaïs Aliabadi：我喜欢这个。

Andrew Huberman: They're not going gaunt quite as quickly.

Andrew Huberman：他们不会那么快变得憔悴。

But nonetheless, they're benefiting from, I think, the appetite suppression, the improved insulin sensitivity.

但尽管如此，我认为他们还是受益于食欲抑制和胰岛素敏感性的提高。

Thaïs Aliabadi: And inflammation.

Thais Aliabadi：还有炎症。

Andrew Huberman: And reduced inflammation, yes.

Andrew Huberman：是的，还减少了炎症。

Thank you.

谢谢。

Thaïs Aliabadi: Huge.

Thaïs Aliabadi：巨大。

Andrew Huberman: And it also seems that they adjust something about brain chemistry that makes people feel better, separate...

安德鲁·休伯曼：而且他们似乎还调整了大脑化学物质的某些东西，让人们感觉更好、更独立……

It's impossible to separate it completely, but separate from a lot of the bodily changes.

不可能完全分开，但是和身体的很多变化分开。

There's a bit of an antidepressant function there.

那里有一点抗抑郁功能。

Thaïs Aliabadi: You know why?

Thaïs Aliabadi：你知道为什么吗？

Because that noise that says, "Eat, eat, eat, eat," which is an issue, like that binge eating.

因为那种声音说“吃，吃，吃，吃”，这是一个问题，就像暴饮暴食一样。

I'm just speaking for my PCOS patients, because I'm not an expert for obesity.

我只是代表我的多囊卵巢综合症患者发言，因为我不是肥胖问题专家。

But they have this voice in their head, and it's a constant battle from the minute they wake up to the minute they go to sleep.

但他们的脑子里有这个声音，从他们醒来的那一刻到他们入睡的那一刻，这是一场持续不断的战斗。

And it's not like they're crazy.

他们并不疯狂。

They're not.

他们不是。

It's not like they're being sloppy with food.

这并不是说他们对食物马虎。

It's just this brain dysregulation of dopamine and serotonin that causes this anxiety, constant anxiety.

正是大脑中多巴胺和血清素的失调导致了这种焦虑，持续的焦虑。

Andrew Huberman: Brutal.

安德鲁·休伯曼：残酷。

Thaïs Aliabadi: And every single one of them will tell me, "My brain is quiet." They're not drinking as much.

Thaïs Aliabadi：他们每个人都会告诉我，“我的大脑很安静。”他们没有喝那么多。

Andrew Huberman: Yeah, that's a clear "side effect," is people don't crave alcohol as much.

安德鲁·休伯曼：是的，这是一个明显的“副作用”，人们不太渴望酒精。

Thaïs Aliabadi: Don't crave.

Thais Aliabadi：不要渴望。

And I've said it for years, use it on alcoholics.

我已经说过很多年了，用在酗酒者身上。

Use it on alcoholics.

对酗酒者使用它。

I had a friend of mine who called me and said her son drinks a lot.

我有一个朋友打电话给我，说她儿子喝了很多酒。

The first thing I asked is, "Can he tolerate microdosing of Ozempic?" Because it shuts down their cravings.

我问的第一件事是，“他能忍受微剂量的 Ozempic 吗？”因为它可以抑制他们的欲望。

Andrew Huberman: Because it's, in some sense, a sugar craving.

安德鲁·休伯曼：因为从某种意义上说，这是一种对糖的渴望。

Thaïs Aliabadi: Yeah.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: It's a state craving of being under the influence of alcohol, but it starts with a craving of sugar.

安德鲁·休伯曼：这是一种渴望受到酒精影响的状态，但它始于对糖的渴望。

Those two things are very closely paired.

这两件事是密切相关的。

Thaïs Aliabadi: But that's why they feel better, right?

Thaïs Aliabadi：但这就是他们感觉更好的原因，对吧？

But even without GLP-1s, when you diagnose and treat these PCOS patients, their confidence comes back, they feel better, they know they're not crazy, which is why I'm here today.

但即使没有 GLP-1，当你诊断和治疗这些 PCOS 患者时，他们的信心就会恢复，他们感觉更好，他们知道自己没有疯，这就是我今天在这里的原因。

You are not crazy.

你没有疯。

If you're gaining weight, acne, hair loss, facial hair, body hair, if you're not getting pregnant, if you can't lose your weight, none of this, you're not crazy.

如果你体重增加、痤疮、脱发、面部毛发、体毛、如果你没有怀孕、如果你无法减肥，这些都不是，你没有疯。

These are the underlying conditions, and these vicious cycles need to be addressed.

这些是根本条件，需要解决这些恶性循环。

Andrew Huberman: And for people that want to get pregnant and treat their PCOS, what are the success rates that you've observed in your clinic?

Andrew Huberman：对于想要怀孕并治疗多囊卵巢综合症的人来说，您在诊所观察到的成功率是多少？

Thaïs Aliabadi: Very good question.

Thais Aliabadi：非常好的问题。

I'm not a fertility doctor, but I'm trying to take these patients out of the hands of the fertility doctors.

我不是生育医生，但我正在努力将这些患者从生育医生手中夺走。

So one thing I do, I put them on my Ovii supplement.

所以我做的一件事是将它们放在我的 Ovii 补充剂中。

I give them metformin, and I have them try.

我给他们服用二甲双胍，并让他们尝试。

And I try to see if I can regulate their period.

我试着看看我是否可以调节他们的经期。

Two things you can do easily, and doctors can do it in their office, one is a medication called letrozole, and the other one is Clomid.

有两件事您可以轻松完成，并且医生可以在他们的办公室完成，一是一种称为来曲唑的药物，另一是克罗米芬。

Both of those basically regulate that hypothalamus, pituitary, ovarian axis, and pushes these patients to ovulate.

这两者基本上都调节下丘脑、垂体、卵巢轴，并推动这些患者排卵。

With letrozole, 60%, 70% of them, I think, ovulate, and with Clomid, it's a little bit less.

我认为使用来曲唑时，60%、70% 的人会排卵，而使用克罗米芬时，排卵率会少一些。

So you can try those in the office for someone who wants to get pregnant.

因此，对于想要怀孕的人，您可以在办公室尝试一下。

What I usually do, I have them try on their own for six months to a year, depending on their age.

我通常会让他们自己尝试六个月到一年，具体取决于他们的年龄。

If they're above 35, I say six months.

如果他们超过 35 岁，我说六个月。

If they're less than that, and they're not in a hurry, and their egg count is good, and I know I've dealt with their PCOS and their inflammation and their insulin resistance, then I have them try for a year, right?

如果他们低于这个数字，而且他们不着急，他们的卵子数量很好，而且我知道我已经解决了他们的多囊卵巢综合症、炎症和胰岛素抵抗，那么我会让他们尝试一年，对吗？

Because if you take 100 couples, regardless of age, and you have them have sex, I don't know, three to four times a week, 50% of them get pregnant in the first six months, and 90% of them get pregnant in the first year.

因为如果你让 100 对夫妇，无论年龄大小，让他们发生性行为，我不知道，每周 3 到 4 次，其中 50% 的人在前六个月内怀孕，90% 的人在第一年怀孕。

But for patients with endometriosis or PCOS, I usually have them try for about six months and then check back in with me.

但对于患有子宫内膜异位症或多囊卵巢综合症的患者，我通常会让他们尝试大约六个月，然后再跟我一起检查。

You know, if letrozole, Clomid, trying on their own, everything fails, then you can send them to fertility doctors.

你知道，如果来曲唑、克罗米芬，单独尝试，都失败了，那么你可以把它们送到生育医生那里。

One thing that I want to bring up here, which is my observation, and it's nowhere in the literature, but I'm saying it today, and I know it's going to be published someday.

我想在这里提出一件事，那就是我的观察，它在文献中没有任何地方，但我今天这么说，我知道它有一天会被出版。

I strongly believe that over 50% of PCOS patients also have endometriosis.

我坚信超过 50% 的 PCOS 患者也患有子宫内膜异位症。

Over 50%.

超过50%。

And I've always said this, if you have a patient with PCOS, think about it.

我总是这么说，如果你有多囊卵巢综合症患者，请考虑一下。

PCOS is already one of the leading causes of infertility, and in my opinion, 50% of them, because I've seen it in my office, have endometriosis.

PCOS 已经是不孕的主要原因之一，在我看来，其中 50%（因为我在办公室见过）患有子宫内膜异位症。

And I have a path report, and I've done laparoscopic surgery to prove it.

我有一份路径报告，并且我已经做过腹腔镜手术来证明这一点。

If you only address PCOS and you're dismissing their painful period, then they're not getting pregnant.

如果你只解决多囊卵巢综合症并且忽视她们的痛苦时期，那么她们就不会怀孕。

That's why you have to make sure you put a check in front of all these underlying conditions.

这就是为什么您必须确保在所有这些基本条件之前进行检查。

Andrew Huberman: I'd like to take a quick break and acknowledge one of our sponsors, LMNT.

Andrew Huberman：我想稍微休息一下，并向我们的赞助商之一 LMNT 表示感谢。

LMNT is an electrolyte drink that has everything you need and nothing you don't.

LMNT 是一种电解质饮料，拥有您需要的一切，没有您不需要的东西。

That means the electrolytes, sodium, magnesium, and potassium, all in the correct ratios, but no sugar.

这意味着电解质、钠、镁和钾的比例都正确，但不含糖。

Proper hydration is critical for brain and body function.

适当的水合作用对于大脑和身体功能至关重要。

Even a slight degree of dehydration can diminish your cognitive and physical performance.

即使是轻微程度的脱水也会降低您的认知和身体表现。

It's also important that you get adequate electrolytes.

获得充足的电解质也很重要。

The electrolytes, sodium, magnesium, and potassium, are vital for the functioning of all cells in your body, especially your neurons or your nerve cells.

电解质（钠、镁和钾）对于体内所有细胞（尤其是神经元或神经细胞）的功能至关重要。

Drinking LMNT makes it very easy to ensure that you're getting adequate hydration and adequate electrolytes.

饮用 LMNT 可以轻松确保您获得足够的水分和电解质。

My days tend to start really fast, meaning I have to jump right into work or right into exercise.

我的日子往往开始得很快，这意味着我必须立即投入工作或立即锻炼。

So to make sure that I'm hydrated and I have sufficient electrolytes, when I first wake up in the morning, I drink 16 to 32 ounces of water with an LMNT packet dissolved in it.

因此，为了确保我有足够的水分和足够的电解质，当我早上第一次醒来时，我会喝 16 至 32 盎司的水，其中溶解有 LMNT 包。

I also drink LMNT dissolved in water during any kind of physical exercise that I'm doing, especially on hot days when I'm sweating a lot and losing water and electrolytes.

我还会在进行任何体育锻炼时饮用溶解在水中的 LMNT，尤其是在炎热的日子里，当我大量出汗并失去水和电解质时。

LMNT has a bunch of great-tasting flavors.

LMNT 有很多美味的口味。

In fact, I love them all.

事实上，我爱他们所有人。

I love the watermelon, the raspberry, the citrus, and I really love the lemonade flavor.

我喜欢西瓜、覆盆子、柑橘，而且我真的很喜欢柠檬水的味道。

So if you'd like to try LMNT, you can go to drinklmnt.com/huberman to claim a free LMNT sample pack with any purchase.

因此，如果您想尝试 LMNT，可以访问 Drinklmnt.com/huberman，购买任意商品即可领取免费的 LMNT 样品包。

Again, that's drinklmnt.com/huberman to claim a free sample pack.

再次强调，请访问 Drinklmnt.com/huberman 索取免费样品包。

Well, I definitely want to talk about endometriosis.

好吧，我肯定想谈谈子宫内膜异位症。

Before we move to that, it sounds like going after the insulin resistance first with metformin and inositol, the other things in Ovii.

在我们开始讨论之前，听起来像是首先用二甲双胍和肌醇（Ovii 中的其他药物）来解决胰岛素抵抗问题。

Well, first, people should go to the O-V-I-I site, and we can put it in the show note captions.

嗯，首先，人们应该访问 O-V-I-I 网站，我们可以将其放在节目注释标题中。

Thaïs Aliabadi: Take the quiz.

Thaïs Aliabadi：参加测验。

Andrew Huberman: Take the quiz, as it's a zero-cost platform.

Andrew Huberman：参加测验，因为它是一个零成本平台。

You get some feedback there about what might be happening, what's likely happening.

你会在那里得到一些关于可能发生的事情、可能发生的事情的反馈。

And then take care of the insulin resistance, which presumably also includes things you mentioned, trying to get best possible sleep, limit stress, exercise.

然后注意胰岛素抵抗，这可能还包括你提到的事情，尽量获得最好的睡眠，限制压力，锻炼。

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

And start with supplements first if your symptoms are not bad.

如果您的症状还不错，请先从补充剂开始。

I've had 50-some patients get off Ovii because they got pregnant.

我已经有 50 多名患者因为怀孕而放弃了 Ovii。

All you're doing is addressing their hormone and metabolic health.

您所做的就是解决他们的激素和代谢健康问题。

That's all we're doing with it.

这就是我们所做的一切。

But if it doesn't work, ask for metformin.

但如果不起作用，请服用二甲双胍。

If it doesn't work and you're having a hard time losing weight, ask for GLP-1s.

如果它不起作用并且您减肥遇到困难，请索要 GLP-1。

Ask your doctor for Clomid if you're trying to get pregnant.

如果您想怀孕，请向您的医生询问克罗米芬。

Ask your doctor for letrozole.

向您的医生询问来曲唑。

Letrozole first.

先来曲唑。

Clomid second.

克罗米芬第二。

And if all that fails, go see a fertility doctor.

如果这些都不起作用，请去看生育医生。

But before that, even if you're single and you don't have a partner, and you're in your late 20s, and you have no one, and having a baby is something that will probably happen a few years down the line, consider freezing eggs, not because of the count, because of the quality of the eggs.

但在此之前，即使你是单身，没有伴侣，而且你已经 20 多岁了，而且还没有伴侣，并且几年后可能会生孩子，请考虑冷冻卵子，不是因为数量，而是因为卵子的质量。

Because PCOS patients, again, have tons of eggs, but the quality is not that good.

因为多囊卵巢综合症患者有大量的卵子，但质量却不太好。

Endometriosis is opposite.

子宫内膜异位症则相反。

Endometriosis destroys your egg count and quality.

子宫内膜异位症会破坏您的卵子数量和质量。

Andrew Huberman: I've seen a few papers that suggest that coenzyme Q10 and L-carnitine might be beneficial for egg quality, and in males, sperm quality, but we're talking about eggs here.

Andrew Huberman：我看过一些论文，表明辅酶 Q10 和左旋肉碱可能有益于卵子质量，以及男性精子质量，但我们这里讨论的是卵子。

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: Do you include that?

安德鲁·胡伯曼：你包括这个吗？

Thaïs Aliabadi: Yes, and I would say it's probably because of inflammation, right?

Thais Aliabadi：是的，我想说这可能是因为炎症，对吧？

Andrew Huberman: We don't really have great tests for inflammation yet.

Andrew Huberman：我们还没有真正针对炎症的有效测试。

The number of tests that are coming online for evaluating biomarkers is quite impressive, but we don't really have a good test for inflammation.

用于评估生物标志物的在线测试数量相当令人印象深刻，但我们确实没有很好的炎症测试。

Thaïs Aliabadi: As we don't have a test for PCOS or endometriosis.

Thaïs Aliabadi：因为我们没有针对多囊卵巢综合症或子宫内膜异位症的测试。

Andrew Huberman: Wouldn't that be wonderful?

安德鲁·休伯曼：那不是很棒吗？

But it sounds like there's no single blood test that we do because it's a constellation of things.

但听起来我们并没有进行单一的血液测试，因为这是一系列的事情。

Thaïs Aliabadi: I want to see that day.

Thaïs Aliabadi：我希望看到那一天。

There's no single blood test.

没有单一的血液测试。

That's why patients say, "My doctor said I don't have PCOS because my testosterone's normal." False.

这就是为什么患者会说：“我的医生说我没有多囊卵巢综合症，因为我的睾酮水平正常。”错误的。

"My doctor said I don't have PCOS because I don't have any cysts on my ovaries." False.

“我的医生说我没有患有多囊卵巢综合症，因为我的卵巢上没有任何囊肿。”错误的。

"My doctor said I don't have PCOS because I'm not overweight." False.

“我的医生说我没有多囊卵巢综合症，因为我没有超重。”错误的。

"My doctor says my periods are regular, so I don't have PCOS." False.

“我的医生说我的月经很规律，所以我没有多囊卵巢综合症。”错误的。

There are so many myths.

有很多神话。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: That's why it's important to understand the four phenotypes and how they differ.

Thaïs Aliabadi：这就是为什么了解四种表型以及它们之间的差异很重要。

Understand that 70% to 80% of these patients don't ovulate, understand that the 20%, 30% who ovulate, ovulate sometimes, not all the time, and that's why they're not getting pregnant.

了解这些患者中 70% 到 80% 不排卵，了解 20%、30% 排卵的患者只是有时排卵，而不是一直排卵，这就是他们没有怀孕的原因。

And understand that inflammation, insulin resistance, and this brain-ovary axis are the main drivers, and then you add genetics and epigenetics, it starts a big chaos in the body.

并了解炎症、胰岛素抵抗和大脑-卵巢轴是主要驱动因素，然后再加上遗传学和表观遗传学，它就会在体内引发大混乱。

As a clinician, that's why it takes so much time, right?

作为一名临床医生，这就是为什么需要这么多时间，对吧？

In this healthcare system, when you get 10 minutes with your doctor, do you think your doctor...

在这个医疗保健系统中，当您与医生交谈 10 分钟时，您认为您的医生...

Everything we talked about, I teach all of this to my new patients with PCOS.

我们谈论的所有内容，我都会教给我的多囊卵巢综合症新患者。

How can you do that in 10 minutes?

你怎么能在10分钟内做到这一点？

And on top of that, do their Pap smear, check their hormones, talk about STD, talk about birth control, rule out endometriosis.

最重要的是，进行子宫颈抹片检查，检查荷尔蒙，谈论性病，谈论节育，排除子宫内膜异位症。

How are you going to do that?

你打算怎么做？

A, patients don't have access to doctors.

答：患者无法看医生。

B, when they have access, either the doctors are not well-trained, or they don't have time to spend time with these patients.

B，当他们有机会时，要么医生没有受过良好的培训，要么他们没有时间花时间照顾这些病人。

Even when they get diagnosed, they get prescribed a birth control pill, and off you go.

即使他们被诊断出来，也会给他们开避孕药，然后就可以走了。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Yeah, the thin end of the wedge in this case, really seems to be going after the insulin resistance.

是的，在这种情况下，楔形的细端似乎确实是在追求胰岛素抵抗。

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: At least in terms of what people can do for themselves without...

安德鲁·休伯曼：至少就人们可以为自己做的事情而言，无需......

Thaïs Aliabadi: Bravo.

泰伊斯·阿利亚巴迪：太棒了。

Andrew Huberman: Because people can't start injecting androgen blockers without the assistance and guidance of a physician.

Andrew Huberman：因为如果没有医生的帮助和指导，人们无法开始注射雄激素阻滞剂。

Thaïs Aliabadi: No.

泰伊斯·阿利亚巴迪：没有。

Andrew Huberman: So take care of your insulin sensitivity, enrich it, encourage it.

Andrew Huberman：所以要照顾好你的胰岛素敏感性，丰富它，鼓励它。

So sunlight, limit stress, sleep, et cetera.

所以阳光、限制压力、睡眠等等。

But these tools of inositol, coenzyme Q10, L-carnitine, these are in the Ovii supplement, right?

但是肌醇、辅酶Q10、左旋肉碱这些工具，这些都在Ovii补充剂里吧？

Thaïs Aliabadi: It is amazing, and not because...

Thaïs Aliabadi：这太神奇了，并不是因为……

I don't even have time, but I really created it for women who are at home, who don't know if they have PCOS, and they don't know what to do.

我什至没有时间，但我确实为那些在家、不知道自己是否患有多囊卵巢综合症、也不知道该怎么办的女性创建了它。

This is the least you can do: eat healthy, exercise, sleep well, lower your stress, take the Ovii supplement.

这是您至少可以做的：健康饮食、锻炼、睡眠充足、减轻压力、服用 Ovii 补充剂。

But before you do all that, take the quiz.

但在你做这一切之前，先做一下测验。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: And if you want future fertility, freeze, freeze, freeze before 30, and know your egg count.

Thaïs Aliabadi：如果您想要未来的生育能力，请在 30 岁之前冷冻、冷冻、冷冻，并了解您的卵子数量。

Andrew Huberman: What about for women who are older than 30 who want to freeze eggs?

Andrew Huberman：对于 30 岁以上想要冷冻卵子的女性呢？

Does it make sense for them to freeze at 35?

他们冻结在35岁有意义吗？

It seems to me the answer would be yes.

在我看来，答案是肯定的。

Thaïs Aliabadi: Oh, always.

Thais Aliabadi：哦，总是如此。

I always freeze, because you need one good egg, and you don't know if you're going to get it or not, but freeze.

我总是冷冻，因为你需要一个好鸡蛋，而且你不知道是否能得到它，但冷冻吧。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: And PCOS patients, the beauty of it is they have all these follicles, so we can pull out a lot of eggs.

Thais Aliabadi：对于 PCOS 患者来说，其美妙之处在于他们拥有所有这些卵泡，因此我们可以取出大量卵子。

Now, the quality might not be good, but keep pulling it.

现在，质量可能不好，但继续拉。

So for my PCOS patients, generally speaking, I always tell my patients, "Freeze 20 eggs," because 20 is safe.

因此，对于我的 PCOS 患者，一般来说，我总是告诉我的患者，“冷冻 20 个卵子”，因为 20 个是安全的。

But as you get older, especially if you have PCOS, I might want 40 eggs.

但随着年龄的增长，特别是如果你患有多囊卵巢综合症，我可能想要 40 个鸡蛋。

The more you have, because I know the quality's not that good.

你拥有的越多，因为我知道质量不太好。

Andrew Huberman: Well, and considering that you're going to get more the younger the patient is, and that freezing eggs is not a zero-cost endeavor, it starts to get more expensive as you get older, essentially.

Andrew Huberman：嗯，考虑到患者越年轻，冷冻卵子的成本就会越高，而且冷冻卵子并不是零成本的努力，本质上，随着年龄的增长，它开始变得更加昂贵。

Thaïs Aliabadi: Right.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: So, the incentive to do it younger is that it's going to be less expensive in the long run.

Andrew Huberman：所以，年轻化的动机是从长远来看成本会更低。

I mean, there are women in their late 30s, early 40s, who still try to freeze eggs.

我的意思是，有些 30 岁末、40 岁出头的女性仍在尝试冷冻卵子。

I think in the state of California, after age 42, you can only freeze embryos, not eggs.

我认为在加利福尼亚州，42岁以后就只能冷冻胚胎，不能冷冻卵子。

I think it...

我认为...

Thaïs Aliabadi: And I mean, it doesn't even make financial sense at that point to do it, to pay 10, 15, $20,000.

Thaïs Aliabadi：我的意思是，在那时支付 10、15、20,000 美元甚至没有经济意义。

I think in Northern California, it goes up to $35,000.

我想在北加州，它会涨到 35,000 美元。

I mean, imagine, for one cycle, to get two eggs out.

我的意思是，想象一下，在一个周期中，取出两个鸡蛋。

Andrew Huberman: Yeah, the probabilities are exceedingly low, but you can understand why people feel...

安德鲁·休伯曼：是的，可能性非常低，但你可以理解为什么人们会觉得……

Thaïs Aliabadi: Yeah.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: This kind of information, even just podcasts in general, weren't so prominent six, seven years ago.

Andrew Huberman：这种信息，即使只是一般的播客，在六七年前也不是那么突出。

Podcasts were around, but these sorts of discussions weren't happening.

播客已经存在，但这类讨论却没有发生。

Thaïs Aliabadi: No, this is amazing.

Thais Aliabadi：不，这太棒了。

What you're doing, you'll see, this podcast will make such a huge difference.

你会发现，你正在做的事情，这个播客将会带来如此巨大的改变。

And I want your male listeners to listen for the sake of their daughters, their sisters, their girlfriends, their wives, because this is so common and so dismissed.

我希望你们的男性听众为了他们的女儿、姐妹、女朋友、妻子而倾听，因为这种情况太常见了，而且被忽视了。

And I've always said this, you're going to laugh, but you know what my dream is?

我总是这么说，你会笑，但你知道我的梦想是什么吗？

You'll see I'm going to get to my dream.

你会看到我即将实现我的梦想。

I've always said it, I want the president of the United States to call for 15 minutes of silence in this country, and I'm really serious.

我一直这么说，我希望美国总统呼吁全国默哀 15 分钟，而且我是认真的。

And I want him to hand me the mic so I can tell women what they deserve to know.

我希望他把麦克风递给我，这样我就可以告诉女性她们应该知道什么。

To tell them that their symptoms are real, that their pain is real, that they're not crazy, that it's not in their head, that there is something really wrong that needs to be addressed.

告诉他们他们的症状是真实的，他们的痛苦是真实的，他们没有疯，这不是他们的头脑，有一些真正的问题需要解决。

And if they're being dismissed, they need to listen to podcasts like yourself.

如果他们被解雇，他们需要像你一样收听播客。

Come on SHE MD podcast.

来吧 SHE MD 播客。

I literally, just like you, take every single condition, and I teach them what to do with it.

我真的，就像你一样，接受每一个条件，然后教他们如何处理它。

Literally, they don't need to come to my office to see me.

从字面上看，他们不需要来我的办公室见我。

I'm telling them what to do.

我告诉他们该怎么做。

But you have to teach them to become their own health advocate.

但你必须教他们成为自己的健康倡导者。

Andrew Huberman: The new movement for people to advocate for their own health is a big shift, I think, since the pandemic, really.

安德鲁·休伯曼：我认为，自大流行以来，人们倡导自己健康的新运动确实是一个巨大的转变。

And I hear you loud and clear.

我听到你的声音响亮而清晰。

And also, folks at HHS, Health and Human Services, do listen to this podcast.

此外，美国卫生与公众服务部、健康与公众服务部的工作人员也会收听这个播客。

About 50% of our listenership is male, the other 50% is female.

我们的听众中大约 50% 是男性，另外 50% 是女性。

Thaïs Aliabadi: I love that.

Thaïs Aliabadi：我喜欢这个。

Andrew Huberman: It distributes differently across platforms, but that's basically the contour of things, and I have a feeling you'll get your 10, 15, hopefully more minutes of being-

Andrew Huberman：它在不同平台上的分布有所不同，但这基本上就是事情的轮廓，我有一种感觉，你会得到你的 10、15 分钟，希望是更多的时间-

Thaïs Aliabadi: I know!

泰伊斯·阿利亚巴迪：我知道！

This is my mic today.

这是我今天的麦克风。

I feel like I'm getting to my dream.

我感觉我正在实现我的梦想。

Andrew Huberman: Yeah, well, hopefully it's a large vertical step toward your ultimate dream of doing that at the national level.

安德鲁·休伯曼：是的，希望这是朝着在国家层面实现这一目标的最终梦想迈出的一大步。

Although we are now translated into other languages, so there is the potential for this to go extremely far, thanks to the information you're sharing.

尽管我们现在已被翻译成其他语言，但由于您分享的信息，这方面的工作有可能走得更远。

Okay, so I definitely want to talk about endometriosis, but before we do that, I just want to give people a summary reminder of the to-dos.

好的，我确实想谈谈子宫内膜异位症，但在此之前，我只想向人们简要提醒一下待办事项。

Women, basically, regardless of age, should go take this O-V-I-I test, the self-test.

基本上，无论年龄大小，女性都应该进行 O-V-I-I 测试，即自我测试。

Thaïs Aliabadi: Yeah.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: Zero cost, get some answers, get some feedback, and then really take control of their insulin sensitivity.

Andrew Huberman：零成本，得到一些答案，得到一些反馈，然后真正控制他们的胰岛素敏感性。

This is true for everybody, but especially for the people we're talking about here, women that might have PCOS, might not, interested in their fertility, or just broadly interested in their hormone health, regardless of age, even if they're perimenopause, menopause.

这对每个人来说都是如此，但尤其是对我们在这里谈论的人来说，可能患有多囊卵巢综合症的女性，可能不关心自己的生育能力，或者只是对自己的荷尔蒙健康广泛感兴趣，无论年龄如何，即使她们处于围绝经期、更年期。

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Bravo.

太棒了。

Andrew Huberman: Great.

安德鲁·休伯曼：太好了。

The actionables of limit stress, excellent sleep...

限制压力、良好睡眠等可采取的行动...

In no particular order, limit stress, get the best possible sleep, eat a low-inflammation diet, limited processed foods, maybe even cut back on starchy carbohydrates to improve insulin sensitivity, make sure you're getting enough protein, this kind of thing, exercise, including high intensity and resistance training, and then supplementation.

没有特定的顺序，限制压力，获得最好的睡眠，吃低炎症饮食，限制加工食品，甚至可能减少淀粉类碳水化合物以提高胰岛素敏感性，确保你摄入足够的蛋白质，诸如此类的事情，锻炼，包括高强度和阻力训练，然后补充。

Thaïs Aliabadi: Mm-hmm.

泰伊斯·阿利亚巴迪：嗯嗯。

Andrew Huberman: You've designed a supplement.

Andrew Huberman：您设计了一份补充材料。

I have no relation to it, so no, this isn't a designated collaborative promotional, but the point being that it has all the things in it that one would want.

我与它没有任何关系，所以不，这不是一个指定的合作促销，但重点是它拥有人们想要的所有东西。

It's inositol, coenzyme Q10.

它是肌醇、辅酶Q10。

Thaïs Aliabadi: It has vitamin D.

Thais Aliabadi：含有维生素 D。

It has actually wild mulberry leaf in it, which, believe it or not, if you take it before your heaviest meal, it blocks the absorption of carbohydrates in that meal by 40%.

它实际上含有野生桑叶，不管你信不信，如果你在最丰盛的一餐之前服用它，它会阻止该餐中碳水化合物的吸收 40%。

So all the things that PCOS patients really need for that insulin resistance, for their inflammation.

因此，多囊卵巢综合症患者真正需要的所有东西都是为了对抗胰岛素抵抗和炎症。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: We've had so many patients get pregnant on it.

Thaïs Aliabadi：我们已经有很多患者因为它而怀孕了。

I had a patient who called me and said, "My mood is better." Going back to what I was telling you, instead of just starting these patients on Zoloft and Lexapro, sometimes when you fix their underlying condition, you might make them feel better.

我有一个病人打电话给我说：“我的心情好多了。”回到我告诉你的，有时当你修复他们的潜在病症时，你可能会让这些患者感觉好一些，而不是仅仅让这些患者开始服用左洛复和来沙普。

Not to dismiss their symptoms, but you can at least start with the more natural ways and then prescribe them antidepressants or anti-anxiety medication.

不要忽视他们的症状，但你至少可以从更自然的方法开始，然后给他们开抗抑郁药或抗焦虑药。

Andrew Huberman: Yeah, amen to that.

安德鲁·休伯曼：是的，阿们。

And it's interesting, this mulberry.

有趣的是，这个桑葚。

I think some people who are more from the traditional medical orientation think, "Oh, supplements," this and that.

我认为一些更倾向于传统医学的人会想，“哦，补充剂”，这样那样。

We've had a couple of scientists on this podcast, serious laboratory scientists, who work on things, everything you can imagine, from painkillers to things that are active in the brain to improve mood, regulate appetite.

我们在这个播客上有几位科学家，严肃的实验室科学家，他们致力于研究你能想象到的一切，从止痛药到在大脑中活跃的东西，以改善情绪、调节食欲。

Pharma and the drugs they make are derived almost always from plant compounds initially, right?

制药公司及其制造的药物最初几乎总是来自植物化合物，对吗？

They actually do what's called bioprospecting.

他们实际上从事的是所谓的生物勘探。

They go out and find plants.

他们出去寻找植物。

We rarely hear about this.

我们很少听说这个。

They find plants, and they isolate the alkaloids from plants that have potent effects on blood sugar, potent effects on mood, potent effects on pain.

他们找到植物，并从植物中分离出生物碱，这些生物碱对血糖、情绪和疼痛都有强大的影响。

And so, what we end up with when we talk about pharmaceutical drugs, most of them are derived from plants.

因此，当我们谈论药物时，我们最终得到的结果是，大多数药物都是从植物中提取的。

Thaïs Aliabadi: In the first place.

Thaïs Aliabadi：首先。

Andrew Huberman: In the first place.

安德鲁·休伯曼：首先。

So when you hear mulberry, you think, "Oh, is this like a berry?

所以当你听到桑葚时，你会想，“哦，这像浆果吗？

Is this a magic berry from the jungle?" No, these plant compounds contain very bioactive elements within them.

这是来自丛林的神奇浆果吗？”不，这些植物化合物中含有非常具有生物活性的元素。

The business of improving insulin sensitivity will lower inflammation.

改善胰岛素敏感性将降低炎症。

Thaïs Aliabadi: Right.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: Very, very important.

安德鲁·休伯曼：非常非常重要。

And then, of course, we can't control our genetics, but we've been talking about epigenetics.

当然，我们无法控制我们的遗传学，但我们一直在谈论表观遗传学。

And then, if one can, they should really evaluate their egg count, AMH, with the understanding that high egg count and AMH and regular shedding of the uterine lining, AKA menses, menstruating, does not necessarily mean that everything is reproductively normal.

然后，如果可以的话，他们应该真正评估自己的卵子数、AMH，并了解高卵子数和 AMH 以及子宫内膜定期脱落（又称月经）并不一定意味着一切都正常。

Thaïs Aliabadi: Bravo!

泰伊斯·阿利亚巴迪：太棒了！

Andrew Huberman: Okay, did I get it right?

Andrew Huberman：好的，我做对了吗？

All right.

好的。

Thaïs Aliabadi: You're the best.

Thaïs Aliabadi：你是最棒的。

Andrew Huberman: Okay, well, I just want to make sure that the audience really understands, because these are things that people can really take control of and do.

安德鲁·休伯曼：好吧，我只是想确保观众真正理解，因为这些是人们真正可以控制和做的事情。

Thaïs Aliabadi: Oh, my goodness.

泰伊斯·阿利亚巴迪：哦，天哪。

Andrew Huberman: Oh, and one other critical thing is listen to Dr. Aliabadi's podcast.

Andrew Huberman：哦，另一件重要的事情是听 Aliabadi 博士的播客。

Thaïs Aliabadi: SHE MD.

Thais Aliabadi：SHE MD。

Andrew Huberman: SHE MD, because there's a lot more information there as well.

Andrew Huberman：SHE MD，因为那里还有更多信息。

Okay, let's talk about endometriosis.

好吧，我们来谈谈子宫内膜异位症。

What is it?

它是什么？

What problems does it create, and what can people do about it?

它会产生什么问题，人们可以采取什么措施？

Thaïs Aliabadi: Devastating, devastating condition that affects, they say, 10%.

Thaïs Aliabadi：他们说，这是一种毁灭性的、毁灭性的状况，影响了 10% 的人。

I think it's north of 20% because they're not diagnosed.

我认为这个比例高于 20%，因为他们没有被诊断出来。

It's a condition where tissue similar to the lining of the uterus is outside of the uterus, around the tubes and ovaries, on the bladder, on the bowel, or inside the ovary, right?

这是一种类似于子宫内膜的组织位于子宫外部、输卵管和卵巢周围、膀胱上、肠道上或卵巢内部的情况，对吗？

What happens is, in simple terms, when every month, our ovaries are trying to get us pregnant.

简而言之，每个月我们的卵巢都会试图让我们怀孕。

They secrete estrogen, and estrogen stimulates the lining of the uterus.

它们分泌雌激素，雌激素刺激子宫内膜。

When we don't get pregnant, this lining breaks down and comes out as a form of period.

当我们没有怀孕时，这种内膜会破裂并以月经的形式出现。

10% to, I think, 20% of women have these cells similar to the lining of the uterus outside of the uterus.

我认为 10% 到 20% 的女性在子宫外都有与子宫内膜相似的细胞。

So once a month, when the follicle is secreting estrogen, these cells on the outside get stimulated, and when we don't get pregnant and the lining breaks down, these guys break down and bleed, but they're bleeding outside of the uterus.

所以每个月一次，当卵泡分泌雌激素时，外面的这些细胞就会受到刺激，当我们没有怀孕并且内膜破裂时，这些细胞就会破裂并出血，但它们是在子宫外出血。

Andrew Huberman: Oh, so it's a form of internal bleeding?

安德鲁·休伯曼：哦，所以这是一种内出血？

Thaïs Aliabadi: Correct.

泰伊斯·阿利亚巴迪：正确。

Andrew Huberman: So it's ectopic formation of uterine lining.

安德鲁·休伯曼：所以这是子宫内膜的异位形成。

It's in the wrong place.

它在错误的地方。

Thaïs Aliabadi: Correct.

泰伊斯·阿利亚巴迪：正确。

Andrew Huberman: Wow!

安德鲁·休伯曼：哇！

Thaïs Aliabadi: We don't know why people have it, but it's extremely common, and as I was telling you, I think more than 50% of my PCOS patients also have endometriosis.

Thaïs Aliabadi：我们不知道人们为什么会患有子宫内膜异位症，但它非常常见，正如我告诉你的那样，我认为超过 50% 的 PCOS 患者也患有子宫内膜异位症。

The problem with endometriosis is, in this country, it takes doctors 9 to 11 years to diagnose endometriosis.

子宫内膜异位症的问题是，在这个国家，医生需要9到11年才能诊断出子宫内膜异位症。

On average, patients see 5 to 10 doctors, and that's not an exaggeration.

平均来说，病人会看5到10个医生，这并不夸张。

I've had patients who've seen 50 doctors in this country to get the diagnosis.

我的一些病人在这个国家看了 50 名医生才得到诊断。

Majority of them go undiagnosed.

他们中的大多数人都没有得到诊断。

A lot of them end up in the fertility clinics.

他们中的许多人最终去了生育诊所。

If you spend a day with me in my office, you go home with a broken heart because these patients travel from all over the country to come.

如果你在我的办公室陪我一天，你会心碎地回家，因为这些病人从全国各地赶来。

They already know, right?

他们已经知道了，对吧？

Because of ChatGPT, they already know they have endo.

因为有了 ChatGPT，他们已经知道自己拥有 endo。

They just want a physician to validate them.

他们只是想要一位医生来验证他们。

So they will fly to come because they want someone to say, "Yes, you're not crazy.

所以他们会飞来，因为他们希望有人说：“是的，你没有疯。

You have endometriosis.

你患有子宫内膜异位症。

And yes, there's a treatment, and it's not in your head." The problem is, these patients talk about dismissal.

是的，有一种治疗方法，而且它不在你的脑海里。”问题是，这些病人谈论的是解雇。

I can't even tell you the devastating side effects of this prolonged dismissal, because no one wants to sit down and just listen to them.

我什至无法告诉你这种长期解雇的毁灭性副作用，因为没有人愿意坐下来听他们说话。

You do not need a fancy blood test.

您不需要进行花哨的血液检查。

There's no blood test for endometriosis.

没有针对子宫内膜异位症的血液检查。

You don't need an ultrasound.

你不需要超声波。

You don't need anything to diagnose endometriosis.

您不需要任何东西来诊断子宫内膜异位症。

You just have to listen.

你只需要听。

I met this gentleman in Paris who told me he has this blood test that's 95% accurate, that he's going to release it.

我在巴黎遇到了一位先生，他告诉我他的验血结果准确率达到 95%，并且他将发布该结果。

This was a few years ago.

这是几年前的事了。

And I was like, "Great, that's great, because we need a blood test." But then, when I was flying home, I was thinking to myself, "My accuracy is 99.9% just by listening to the patient." You don't need any fancy tools to diagnose.

我当时想，“太好了，太好了，因为我们需要验血。”但当我飞回家时，我心里想，“只要听病人说的话，我的准确率就达到了 99.9%。”您不需要任何花哨的工具来诊断。

You can self-diagnose yourself at home.

您可以在家自我诊断。

How do you diagnose?

你如何诊断？

The first thing I want to teach your listeners is painful periods are not normal.

我想告诉听众的第一件事是，痛苦的时期是不正常的。

One time for my 50th birthday, I wanted to get a...

有一次我 50 岁生日时，我想买一件...

What do you call it, on the freeways?

在高速公路上你怎么称呼它？

Andrew Huberman: Like a billboard.

安德鲁·胡伯曼：就像一个广告牌。

Thaïs Aliabadi: Billboards.

Thaïs Aliabadi：广告牌。

Andrew Huberman: Yeah.

安德鲁·休伯曼：是的。

Thaïs Aliabadi: I wanted to get 10 billboards for my birthday and just put, "Painful periods are not normal, #endometriosis." That was my birthday gift for myself.

Thaïs Aliabadi：我想在生日时获得 10 个广告牌，上面写着：“经痛是不正常的，#endometriosis。”那是我给自己的生日礼物。

I wanted to do that.

我想这么做。

But then my daughter, my second daughter, came up to me.

但后来我的女儿，我的二女儿，向我走来。

She's like, "Mom, okay, so you tell them painful periods are not normal.

她说，“妈妈，好吧，所以你告诉他们疼痛的经期是不正常的。

They go to their doctor, and the doctor says, 'Yes, it's normal.

他们去看医生，医生说：‘是的，这是正常的。

Don't worry about it.' Then what?" I'm like, "So maybe going down the freeway, the next one will say, 'If you have endometriosis, check your egg.

别担心。然后呢？”我想，“所以也许在高速公路上，下一个会说，‘如果你患有子宫内膜异位症，请检查你的卵子。

And 'If you have endometriosis,' on the third." And I was going to just treat them as they drive down the freeway.

第三个是‘如果你患有子宫内膜异位症’。”当他们沿着高速公路行驶时，我会好好对待他们。

That's how bad it is.

事情就是这样糟糕。

So, painful periods are not normal.

因此，痛经是不正常的。

Andrew Huberman: Could you distinguish between painful periods and premenstrual cramping?

安德鲁·休伯曼：你能区分经期疼痛和经前痉挛吗？

Thaïs Aliabadi: Correct.

泰伊斯·阿利亚巴迪：正确。

So, what do I mean by painful period?

那么，痛经是什么意思呢？

If the pain disrupts your life, if you're skipping school, if you're calling in sick and you can't go to work, if you're staying in bed, if you change your social plans around your periods, if you're ending up in the emergency room or in urgent care because your periods are painful, that's not normal.

如果疼痛扰乱了你的生活，如果你逃学，如果你请病假而无法上班，如果你卧床不起，如果你在经期前后改变了社交计划，如果你因为经期疼痛而被送进急诊室或接受紧急护理，那么这些都是不正常的。

If sex with deep penetration hurts, that's not normal.

如果深度插入的性爱会造成伤害，那是不正常的。

If you're constantly bloated, even during the month when your periods are painful, and after your periods, you eat, and you're constantly bloated, that's not normal.

如果你经常腹胀，即使是在经期疼痛的月份，并且在经期结束后，你吃东西，而且你不断腹胀，这是不正常的。

If when you have a bowel movement, your bowel movement hurts, that's not normal.

如果排便时感到排便疼痛，这是不正常的。

If you constantly end up in your GYN or primary care's office complaining of "UTI" or "bladder symptoms," recurrent bladder symptoms, and you're getting antibiotics three, four, five times, six times, ten times a year with a negative culture, that's endometriosis until proven otherwise.

如果您经常去妇科或初级保健诊所抱怨“尿路感染”或“膀胱症状”、反复出现的膀胱症状，并且您每年服用抗生素三、四、五次、六次、十次且培养结果呈阴性，那么这就是子宫内膜异位症，除非证明并非如此。

So, because these patients present differently, majority of these symptoms are chronic pain, though.

因此，由于这些患者的表现不同，因此大多数症状都是慢性疼痛。

It's the top cause of chronic pelvic pain in women.

这是女性慢性盆腔疼痛的首要原因。

It's the leading cause of infertility, right?

这是不孕不育的主要原因，对吗？

Over 100 years ago, they knew about endometriosis.

100多年前，他们就知道子宫内膜异位症。

100 years later, we're still not diagnosing these patients correctly.

100 年后，我们仍然没有正确诊断这些患者。

100 years later, these women go through life, they can't have children, they have chronic pelvic pain, they stay home, they get anxious, they get depressed, they get addicted to opioids because when they go to the doctor, they end up in these pain clinics, and someone starts prescribing them Norco or Percocet.

100年后，这些女性经历了一生，她们不能生育，她们患有慢性骨盆疼痛，她们呆在家里，她们感到焦虑，她们感到沮丧，她们对阿片类药物上瘾，因为当她们去看医生时，她们最终去了这些疼痛诊所，有人开始给她们开Norco或Percocet。

I have 25-year-olds who come to my office, they're like, "I know Percocet is not going to help me.

我有一些 25 岁的人来到我的办公室，他们说：“我知道 Percocet 不会帮助我。

I don't want to take this, but this is what the urgent care gave me."

我不想接受这个，但这就是紧急护理给我的。”

Andrew Huberman: That sounds like malpractice to me.

Andrew Huberman：对我来说，这听起来像是一种渎职行为。

Thaïs Aliabadi: But it is.

Thaïs Aliabadi：但确实如此。

But it is.

但确实如此。

And you know what?

你知道吗？

People think I'm crazy, but you know what I wanted to do, which I'm never going to do, but an intent to sue letter to send to all the doctors who've dismissed my patients.

人们认为我疯了，但你知道我想做什么，我永远不会做，但我打算向所有解雇我的病人的医生发送一封起诉信。

Because if you get one of those letters, maybe it'll wake you up.

因为如果你收到其中一封信，也许它会唤醒你。

We have to do something.

我们必须做点什么。

Can I tell you something, Andrew?

我可以告诉你一件事吗，安德鲁？

If men, think about this, had a condition that would cause them to have severe pain during sex, it would scar their scrotums, it would lower their sperm count, it would be the top cause of their infertility, that they would stay home two, three days out of the month in bed, they would end up in emergency rooms a few times a year, right?

想想看，如果男人患有一种会导致他们在性交时剧烈疼痛的病症，它会在他们的阴囊上留下疤痕，会降低他们的精子数量，这将是他们不孕不育的首要原因，他们每个月会在家里躺两三天，一年中会进急诊室几次，对吗？

They would get bloated, anxious, depressed from the pain.

他们会因为疼痛而变得浮肿、焦虑、沮丧。

Do you think majority of them would go undiagnosed?

您认为他们中的大多数人不会被确诊吗？

Andrew Huberman: No, the problem would be dealt with very differently.

安德鲁·休伯曼：不，这个问题的处理方式会非常不同。

Thaïs Aliabadi: So why?

泰伊斯·阿利亚巴迪：那为什么呢？

Andrew Huberman: And I say that with certainty, because if you look at just even the speed with which certain drugs have been approved in the medical community, like Viagra, for instance, one of the fastest approvals for new uses.

安德鲁·休伯曼：我可以肯定地说，因为如果你看看某些药物在医学界批准的速度，例如伟哥，它是批准新用途最快的药物之一。

I mean, some of those drugs were developed for other purposes, but male-specific health does receive a sort of acceleration.

我的意思是，其中一些药物是为了其他目的而开发的，但男性特有的健康确实得到了某种程度的加速。

Thaïs Aliabadi: Always.

泰伊斯·阿利亚巴迪：总是如此。

Andrew Huberman: And we know that in the research community, it started about 10 years back, there was a requirement actually to get grants funded, that people evaluate both sexes.

Andrew Huberman：我们知道，在研究界，大约 10 年前就开始了，为了获得资助，人们实际上需要对两性进行评估。

So, believe it or not, it was all done on male mice, largely male done.

所以，不管你信不信，这一切都是在雄性小鼠身上完成的，而且主要是雄性小鼠。

Thaïs Aliabadi: Of course.

泰伊斯·阿利亚巴迪：当然。

Right.

正确的。

Andrew Huberman: That changed, now with changes in the way that science is being done and funded, this issue has become prominent again.

安德鲁·休伯曼：情况发生了变化，现在随着科学研究和资助方式的变化，这个问题再次变得突出。

But everything I'm saying here is just in total agreement.

但我在这里所说的一切都是完全一致的。

Yeah, it would've been considered a national emergency.

是的，这会被视为国家紧急状态。

Thaïs Aliabadi: It would've been, right?

Thais Aliabadi：本来就是这样，对吧？

I mean, I have thousands of these stories.

我的意思是，我有成千上万个这样的故事。

Literally, I have trauma from it.

从字面上看，我因此受到了创伤。

I have PTSD from it.

我因此患上了创伤后应激障碍（PTSD）。

I saw a patient last week in my office, 50 years old.

上周我在我的办公室见到了一位 50 岁的病人。

The first thing she said when I walked in, she said, "I ask you a favor." I said, "What?" She said, "Don't call me crazy.

当我走进去时，她说的第一句话是：“我请你帮个忙。”我说：“什么？”她说：“别说我疯了。

I'm not crazy.

我没有疯。

And I didn't mark anxiety because I didn't want you to blame my symptoms or my anxiety." And I looked at her, I'm like, "I would be the last person standing on this planet that would do that to you." As I started listening to her, she's the classic endometriosis patient.

我没有标记焦虑，因为我不想让你责怪我的症状或我的焦虑。”我看着她，我想，“我将是这个星球上最后一个会对你做这种事的人。”当我开始听她说话时，她是典型的子宫内膜异位症患者。

She's 50 years old, painful periods.

她今年50岁了，月经很痛苦。

She said, "I've been to a hundred emergency rooms.

她说：“我去过一百个急诊室。

I know every emergency room in every country I've ever visited." She never got married because she had painful sex.

我知道我去过的每个国家的每个急诊室。”她从未结婚，因为她的性行为很痛苦。

She couldn't have sex.

她不能发生性行为。

She had severe pain.

她感到剧烈疼痛。

She would stay at home.

她会呆在家里。

She would lose her jobs, right?

她会失去工作，对吗？

Never had children, just chronic pain, completely anxious, guarded, right?

从未生过孩子，只是慢性疼痛，完全焦虑，警惕，对吧？

Shows up to my office.

出现到我的办公室。

I'm probably the 100th doctor she's seen, and all she wanted to hear me say is, "You have endometriosis." This is the story of these patients.

我可能是她见过的第 100 位医生，她只想听我说：“你患有子宫内膜异位症。”这就是这些患者的故事。

You can't even make these stories up.

你甚至无法编造这些故事。

Andrew Huberman: It's unbelievable and yet believable.

Andrew Huberman：这令人难以置信，但又可信。

And I don't want to sound like somebody who's super suspicious of the medical community or pharma.

我不想听起来像一个对医学界或制药公司超级怀疑的人。

I think most physicians have good intentions.

我认为大多数医生都是善意的。

I think that, like you said, the culture and climate within the field, the way insurances handle all these things, I think, railroad people into a kind of conveyor belt type of practice.

我认为，就像你说的那样，该领域的文化和气候，保险处理所有这些事情的方式，我认为，铁路人员进入了一种传送带类型的实践。

But I can also say, because I know some excellent physicians like yourself and some people I've known for a very long time in other fields, that really good physicians read the literature.

但我也可以说，因为我认识一些像你这样的优秀医生，以及一些我在其他领域认识很长时间的人，所以真正优秀的医生会阅读文献。

They integrate what they know from their clinical practice.

他们整合了从临床实践中获得的知识。

They talk to other physicians.

他们与其他医生交谈。

They're part of a community that's trying to evolve itself, but that's usually a subculture within the culture.

他们是试图自我发展的社区的一部分，但这通常是文化中的亚文化。

And most people don't know how to find the right people, although with podcasts, they're starting to.

大多数人不知道如何找到合适的人，尽管通过播客，他们已经开始这样做了。

Thaïs Aliabadi: The problem with endometriosis is it's so common, and we don't have enough doctors diagnosing it.

Thaïs Aliabadi：子宫内膜异位症的问题是它非常常见，而且我们没有足够的医生来诊断它。

And like I said, a lot of these women don't even have an access to an OBGYN, and when they go there, 95% of the time, they're not even diagnosed, and if they're diagnosed, they're not even treated correctly.

就像我说的，很多女性甚至没有机会去妇产科，95% 的情况下，她们甚至没有被诊断出来，即使被诊断出来，她们也没有得到正确的治疗。

So what happens, these ectopic implants, right, that are in the pelvis...

那么会发生什么，这些异位植入物，对，位于骨盆中......

It's very strange because, I mean, we don't know why some women have endometriosis and some don't.

这很奇怪，因为我们不知道为什么有些女性患有子宫内膜异位症而有些女性却没有。

It could be...

可能是...

There are so many hypotheses, but the most common one is probably retrograde menstruation, which a lot of women get, which means when we're having our periods, some of that blood goes through the tubes and out into the pelvis and implants there.

有很多假设，但最常见的可能是月经逆行，很多女性都会出现这种情况，这意味着当我们来月经时，一些血液会通过输卵管进入骨盆并在那里植入。

In a regular, healthy immune system, will get rid of those implants.

在正常、健康的免疫系统中，会清除这些植入物。

But for whatever reason, in this subgroup of patients, their inflammatory, their immune system doesn't work well.

但无论出于何种原因，在这部分患者中，他们的炎症、免疫系统无法正常工作。

It actually helps start an inflammatory process around these implants that makes it stick to the wall of the pelvis.

它实际上有助于在这些植入物周围启动炎症过程，使其粘附在骨盆壁上。

Andrew Huberman: May I ask, so I think I have the picture right, where the uterine lining either heads up the fallopian tubes as opposed to being shed outward out of the body, basically, and then it actually gets out into the extracellular space.

安德鲁·休伯曼：我想问一下，我想我的情况是正确的，子宫内膜要么向上延伸到输卵管，要么基本上从身体向外脱落，然后它实际上进入细胞外空间。

So would it be cleared by the lymphatic system?

那么它会被淋巴系统清除吗？

Thaïs Aliabadi: Yes, and by their immune system.

Thaïs Aliabadi：是的，而且是通过他们的免疫系统。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: They come there, eat it up, right?

Thais Aliabadi：他们来到那里，把它吃掉，对吧？

Andrew Huberman: The little macrophages eat it up.

Andrew Huberman：小巨噬细胞会把它吃掉。

Thaïs Aliabadi: Macrophage, yes.

Thaïs Aliabadi：巨噬细胞，是的。

Andrew Huberman: Yep.

安德鲁·休伯曼：是的。

Thaïs Aliabadi: But in these patients, not only they don't take them away, they stimulate them to stick to the walls of the pelvis.

Thaïs Aliabadi：但在这些患者中，他们不仅不会将它们带走，还会刺激它们粘附在骨盆壁上。

That's number one.

这是第一。

Then, these little implants need estrogen to grow, right?

那么，这些小植入物需要雌激素才能生长，对吗？

Remember, I told you the ovaries are secreting estrogen.

记住，我告诉过你卵巢正在分泌雌激素。

So, they start making their own estrogen.

因此，他们开始制造自己的雌激素。

Andrew Huberman: Hmm.

安德鲁·休伯曼：嗯。

Thaïs Aliabadi: Right?

泰伊斯·阿利亚巴迪：对吗？

So locally, they support themselves without needing systemic estrogen, right?

所以在当地，他们不需要全身雌激素就可以养活自己，对吗？

And then they increase vascularity to the lesion, and then they start growing nerve fibers around them, each lesion.

然后它们增加病变部位的血管供应，然后开始在每个病变周围生长神经纤维。

Andrew Huberman: It's almost as if everything you're saying resembles tumor formation.

Andrew Huberman：你所说的一切似乎都类似于肿瘤的形成。

Thaïs Aliabadi: I always say it acts like cancer, but it's not.

Thais Aliabadi：我总是说它像癌症一样，但事实并非如此。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: Let's say you have a patient with colon cancer.

Thais Aliabadi：假设您有一名结肠癌患者。

You go in, you resect the colon cancer.

你进去，切除结肠癌。

You'd never tell them, "Okay, sir, I'll see you in six months." He'll be back with colon cancer everywhere.

你永远不会告诉他们：“好吧，先生，六个月后见。”他回来时会患上全身结肠癌。

You have to give him chemo.

你必须给他化疗。

Endometriosis is not cancer, but you have to treat it the same way.

子宫内膜异位症不是癌症，但您必须以同样的方式治疗它。

What I mean by that is, once you go in laparoscopically and cut these lesions out, you have to give it hormonal suppression, otherwise, it comes back.

我的意思是，一旦你进入腹腔镜并切除这些病变，你就必须对其进行激素抑制，否则它会复发。

Andrew Huberman: I see.

安德鲁·休伯曼：我明白了。

Thaïs Aliabadi: So, we can get to that.

Thaïs Aliabadi：所以，我们可以做到这一点。

But these implants are self-limited, right?

但这些植入物是有自我限制的，对吗？

They basically have vessels that are feeding them.

他们基本上都有给他们喂食的船只。

They make their own estrogen.

他们自己制造雌激素。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: They start an inflammatory process in that area, and they start growing, right?

Thaïs Aliabadi：它们在该区域开始炎症过程，然后开始生长，对吧？

Every month, they progress more as we age.

随着年龄的增长，每个月他们都会进步更多。

That's why these patients' average age of diagnosis for endometriosis is 32, and it takes doctors 9 to 11 years to diagnose these patients, because it can start with, "Oh, my periods are painful." Then they get more painful, then you start staying home, then you have to call your mom to pick you up from school.

这就是为什么这些患者诊断子宫内膜异位症的平均年龄是 32 岁，医生需要 9 到 11 年才能诊断这些患者，因为可能会从“哦，我的月经很痛苦”开始。然后他们会变得更加痛苦，然后你开始呆在家里，然后你必须打电话给你妈妈来接你放学。

Then sex starts hurting.

然后性就开始疼痛。

Then you realize a week before it starts hurting.

然后你意识到一周前它开始疼痛。

Then you realize now a week after, the pain is still there, and eventually it turns into chronic pelvic pain.

然后你意识到一周后，疼痛仍然存在，最终变成慢性骨盆疼痛。

But these patients jump from doctor to doctor, doctor to doctor, until, A, they have chronic pelvic pain, and someone says, "Wait a minute, you have endometriosis," or, B, they can't get pregnant, and they end up where?

但这些病人从一个医生跳到另一个医生，从一个医生跳到另一个医生，直到，A，他们患有慢性盆腔疼痛，有人说，“等一下，你患有子宫内膜异位症，”或者，B，他们无法怀孕，最后他们去了哪里？

In the fertility clinics, for something that could have been suppressed years prior to that.

在生育诊所，一些几年前就可以被抑制的事情。

Andrew Huberman: Let's say they end up in an IVF clinic.

Andrew Huberman：假设他们最终去了 IVF 诊所。

They're able to create healthy embryos, they implant.

他们能够创造健康的胚胎并进行植入。

How does endometriosis impact the probability of carrying that embryo to successful-

子宫内膜异位症如何影响成功携带胚胎的可能性？

Thaïs Aliabadi: So it depends on the age, on the quality of the eggs.

Thais Aliabadi：所以这取决于年龄和卵子的质量。

One thing endometriosis does...

子宫内膜异位症会造成一件事...

So endometriosis is an inflammatory process.

因此，子宫内膜异位症是一个炎症过程。

It causes inflammation in the pelvis.

它会导致骨盆发炎。

That's why, as it progresses, it causes scarring in the pelvis.

这就是为什么随着病情的发展，它会在骨盆上留下疤痕。

It can cause scarring of the tubes.

它可能会导致管子留下疤痕。

That inflammation can affect your egg quality, can cause bowel adhesions, bladder adhesions.

那炎症会影响你的卵子质量，会引起肠粘连、膀胱粘连。

If it's inside the ovary, we call it endometrioma or a chocolate cyst.

如果它位于卵巢内部，我们将其称为子宫内膜异位症或巧克力囊肿。

That can destroy a woman's egg count and quality.

这会破坏女性的卵子数量和质量。

That's why sometimes you get a 30-year-old endometriosis patient who has zero eggs, or you can have a 14-year-old who has the egg count of a 40-year-old.

这就是为什么有时 30 岁的子宫内膜异位症患者的卵子数为零，或者 14 岁的子宫内膜异位症患者的卵子数与 40 岁的人相同。

So it is absolutely crucial, crucial for endometriosis patients to know their egg count.

所以对于子宫内膜异位症患者来说，了解自己的卵子数量绝对是至关重要的。

If they have no pain, get a baseline at age 18.

如果他们没有疼痛，请在 18 岁时获取基线。

If you have painful periods and you're 14, get an egg count.

如果您年满 14 岁且经期疼痛，请进行卵子计数。

Rule out endometriosis.

排除子宫内膜异位症。

You can have an eight-year-old with endometriosis.

你可能有一个八岁的孩子患有子宫内膜异位症。

Now, it's very rare, right?

现在，这种情况已经很少见了，对吧？

But as soon as women start menstruating, they can start complaining of these pains.

但一旦女性开始月经，她们就会开始抱怨这些疼痛。

Now, it's common for patients to have some cramps.

现在，患者出现痉挛是很常见的。

You might take a couple of Advils, and it's fine.

你可以服用一些Advils，就可以了。

But if pain becomes recurrent and it starts progressing, and it's disrupting their life, then it's absolutely not normal.

但如果疼痛反复出现并且开始恶化，并且扰乱了他们的生活，那么这绝对是不正常的。

It's endometriosis until proven otherwise, which takes me to my other discussion we were discussing, doctors don't do ultrasound.

除非另有证明，否则它就是子宫内膜异位症，这让我想到我们正在讨论的另一个讨论，医生不做超声波检查。

Not that you can diagnose endometriosis on ultrasound, but if you have an endometrioma or a chocolate cyst, which takes you to approximately a stage three out of four endometriosis, you can see it in two seconds on ultrasound.

并不是说您可以通过超声波诊断子宫内膜异位症，但如果您患有子宫内膜异位症或巧克力囊肿（这会将您带到大约四分之三的子宫内膜异位症阶段），您可以在超声波上两秒钟内看到它。

So, if you do an ultrasound and you see an endometrioma, I don't care how small it is, don't ignore it.

所以，如果你做超声波检查时发现子宫内膜异位症，我不在乎它有多小，也不要忽视它。

It's just like me saying, "I see smoke here, but I'm going to ignore it because I don't see the fire." Well, if you see smoke, you know there's fire.

就像我说的：“我看到这里有烟，但我会忽略它，因为我没有看到火。”好吧，如果你看到烟，你就知道发生了火灾。

Go check it out.

去看看吧。

And that's exactly what happens with endo patients because they go dismissed.

这正是内科患者所发生的情况，因为他们被解雇了。

They show up at age 30, they have no eggs, their tubes are scarred.

他们30岁时出现，没有卵子，输卵管伤痕累累。

And to answer your question, a lot of these patients, because of that inflammation, the environment is hostile.

回答你的问题，很多这样的病人，由于炎症，环境是恶劣的。

So the reason it's one of the top causes of infertility, yes, your tubes can get blocked, yes, your egg count and quality can drop, but the environment is so hostile for the sperm, for that little egg that's getting released that needs to be picked up by the tube that can get attacked by these inflammatory cells.

所以它是导致不孕的主要原因之一，是的，你的输卵管可能会被堵塞，是的，你的卵子数量和质量可能会下降，但环境对精子来说是如此不利，对于那些正在释放的小卵子来说，需要被可能受到这些炎症细胞攻击的输卵管拾取。

The embryo sometimes doesn't form.

胚胎有时不会形成。

If it forms, it might get stuck in the tube, and you might end up with an ectopic pregnancy, or if it goes into the uterus, all that inflammation increases the risk of miscarriage.

如果它形成，它可能会卡在输卵管中，最终可能会导致宫外孕，或者如果它进入子宫，所有炎症都会增加流产的风险。

And on top of that, a large percentage of endometriosis patients have adenomyosis, which is the sister condition to endometriosis, which is very common.

最重要的是，很大一部分子宫内膜异位症患者患有子宫腺肌症，这是子宫内膜异位症的姊妹病，非常常见。

Not all adenomyosis patients have endometriosis, but a lot of endometriosis patients have adenomyosis.

并非所有子宫腺肌症患者都患有子宫内膜异位症，但很多子宫内膜异位症患者患有子宫腺肌症。

And adenomyosis is when this ectopic tissue, the lining inside the uterus, are in the wall of the uterus.

子宫腺肌病是指这种异位组织（子宫内膜）位于子宫壁中。

So they do get stimulated, and they can cause heavy periods, they can cause recurrent miscarriages, they can cause painful periods, and it also gets dismissed on ultrasound.

所以它们确实会受到刺激，并且可能会导致月经量增多，可能会导致反复流产，可能会导致经痛，并且在超声检查中也会被忽略。

A lot of doctors depend on MRIs to diagnose adenomyosis, where, if you've done enough ultrasounds, you can start seeing it on a pelvic ultrasound.

许多医生依靠 MRI 来诊断子宫腺肌病，如果您进行了足够的超声检查，则可以开始通过盆腔超声检查来发现它。

But the problem is a lot of radiologists don't know how to diagnose it.

但问题是很多放射科医生不知道如何诊断它。

Andrew Huberman: I'd like to take a quick break and acknowledge one of our sponsors, Function.

Andrew Huberman：我想稍微休息一下，并感谢我们的赞助商之一 Function。

Last year, I became a Function member after searching for the most comprehensive approach to lab testing.

去年，在寻找最全面的实验室测试方法后，我成为了 Function 成员。

Function provides over 100 advanced lab tests that give you a key snapshot of your entire bodily health.

Function 提供 100 多项高级实验室测试，为您提供整个身体健康状况的关键快照。

This snapshot offers you with insights on your heart health, hormone health, immune functioning, nutrient levels, and much more.

此快照为您提供有关心脏健康、激素健康、免疫功能、营养水平等方面的见解。

They've also recently added tests for toxins, such as BPA exposure from harmful plastics, and tests for PFASs, or forever chemicals.

他们最近还增加了毒素测试，例如有害塑料中的 BPA 暴露，以及 PFAS 或永久化学物质的测试。

Function not only provides testing of over a hundred biomarkers key to your physical and mental health, but it also analyzes these results and provides insights from top doctors who are expert in the relevant areas.

Function 不仅提供对您的身心健康至关重要的一百多种生物标志物的测试，而且还分析这些结果并提供相关领域专家的顶级医生的见解。

For example, in one of my first tests with Function, I learned that I had elevated levels of mercury in my blood.

例如，在我第一次使用 Function 进行测试时，我发现我的血液中汞含量升高。

Function not only helped me detect that, but offered insights into how best to reduce my mercury levels, which included limiting my tuna consumption, I'd been eating a lot of tuna, while also making an effort to eat more leafy greens and supplementing with NAC, N-acetylcysteine, both of which can support glutathione production and detoxification.

功能不仅帮助我发现了这一点，还为我提供了如何最好地降低汞含量的见解，其中包括限制我的金枪鱼摄入量，我一直在吃大量金枪鱼，同时还努力多吃绿叶蔬菜并补充 NAC、N-乙酰半胱氨酸，这两者都可以支持谷胱甘肽的产生和解毒。

And I should say, by taking a second Function test, that approach worked.

我应该说，通过进行第二次功能测试，这种方法奏效了。

Comprehensive blood testing is vitally important.

全面的血液检测至关重要。

There are so many things related to your mental and physical health that can only be detected in a blood test.

有很多与您的心理和身体健康相关的事情只能通过血液检查来检测。

The problem is, blood testing has always been very expensive and complicated.

问题是，血液检测一直非常昂贵且复杂。

In contrast, I've been super impressed by Function's simplicity, and at the level of cost.

相比之下，Function 的简单性和成本水平给我留下了深刻的印象。

It is very affordable.

这是非常实惠的。

As a consequence, I decided to join their scientific advisory board, and I'm thrilled that they're sponsoring the podcast.

因此，我决定加入他们的科学顾问委员会，我很高兴他们赞助了这个播客。

If you'd like to try Function, you can go to functionhealth.com/huberman.

如果您想尝试 Function，可以访问 functionhealth.com/huberman。

Function currently has a waitlist of over 250,000 people, but they're offering early access to Huberman podcast listeners.

Function 目前有超过 250,000 人的候补名单，但他们正在为 Huberman 播客听众提供早期访问服务。

Again, that's functionhealth.com/huberman to get early access to Function.

同样，可以通过 functionhealth.com/huberman 提前访问 Function。

Can I ask a naive question about ultrasound and diagnoses and just women's health in general?

我可以问一个关于超声波和诊断以及女性健康的天真的问题吗？

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: And forgive me for not knowing the answer to this, but I don't, so I'm going to swallow my pride and just ask.

Andrew Huberman：请原谅我不知道这个问题的答案，但我不知道，所以我要放下我的骄傲，只是问。

What is the current state of medical care in this country for women, such that...

这个国家目前的女性医疗保健状况如何，例如......

Let's say a woman is in her, doesn't matter, 20s, 30s, 40s, 50s, whatever, and wants to go get a pelvic exam with ultrasound, a blood draw to look at AMH, and let's say, have a short discussion with a, let's say, marginally qualified physician about her own health.

假设一名女性，20 多岁、30 多岁、40 多岁、50 多岁，无论什么年龄，都想去做盆腔超声检查、抽血检查 AMH，并且与一位资质勉强合格的医生就她自己的健康状况进行简短讨论。

Thaïs Aliabadi: Endo, yeah.

Thaïs Aliabadi：Endo，是的。

Andrew Huberman: Is that the sort of thing that is just impossible for people to access who don't have insurance?

Andrew Huberman：对于没有保险的人来说，这是不可能获得的东西吗？

If they do have insurance, does insurance cover it?

如果他们有保险，保险是否承保？

Do they need to have a major problem to get a referral for that?

他们是否需要遇到重大问题才能获得转介？

I have no concept of this because as a man, we don't think about this, right?

我对此没有概念，因为作为一个男人，我们不会考虑这个，对吗？

Thaïs Aliabadi: Insurance will cover it.

Thais Aliabadi：保险会承保。

The problem is...

问题是...

So there are a lot of issues.

所以存在很多问题。

One, patients don't know that there's something wrong.

第一，患者不知道出了什么问题。

They think irregular periods are normal, they think painful periods are normal, they think it's just their nerves, because people around them, including their parents, their aunt, sister, everyone dismisses them.

他们认为月经不调是正常的，他们认为经痛是正常的，他们认为这只是他们的神经，因为他们周围的人，包括他们的父母，他们的阿姨，姐妹，每个人都对他们不屑一顾。

"Oh, it can't be that bad.

“哦，事情不可能那么糟糕。

Why are you being so weak?

你为何如此软弱？

Take some Advil and get up." No, this is really debilitating.

吃点止痛药，然后起床。”不，这实在是太伤人了。

Andrew Huberman: This is not premenstrual cramping, this is pain.

安德鲁·休伯曼：这不是经前痉挛，这是疼痛。

Thaïs Aliabadi: Right.

泰伊斯·阿利亚巴迪：是的。

Pain.

疼痛。

Andrew Huberman: This is abnormal levels of pain.

Andrew Huberman：这是异常程度的疼痛。

Thaïs Aliabadi: Pain.

泰伊斯·阿利亚巴迪：痛苦。

Andrew Huberman: And they don't have anything to check it against because it's, in some cases, all they ever knew.

Andrew Huberman：他们没有任何东西可以检查，因为在某些情况下，这是他们所知道的一切。

And it sounds as if people are very dismissive of women's pain, is what I'm hearing.

我听到的听起来似乎人们对女性的痛苦非常不屑一顾。

Thaïs Aliabadi: Period.

泰伊斯·阿利亚巴迪：时期。

Andrew Huberman: Yeah.

安德鲁·休伯曼：是的。

Thaïs Aliabadi: It's minimized, dismissed, or normalized, and there's no other way around.

Thaïs Aliabadi：它被最小化、被忽视或正常化，没有其他办法。

Those are the three options right now in the healthcare system, majority of the time.

大多数情况下，这是目前医疗保健系统中的三种选择。

So then this patient goes to the doctor, not knowing what's going on.

然后这个病人去看医生，但不知道发生了什么事。

The doctor doesn't have time.

医生没有时间。

You have 10 minutes with your doctor.

您有 10 分钟的时间与您的医生交谈。

He comes in, he's like, "Maybe she has endometriosis." Maybe even he or she is even thinking about this, but what do they do?

他进来时说，“也许她患有子宫内膜异位症。”也许连他或她都在思考这个问题，但他们会做什么呢？

They give birth control, right?

他们提供节育措施，对吗？

And the patient doesn't know why.

而患者也不知道为什么。

She goes home, and someone tells her, "If you take birth control, you're going to be infertile." So she doesn't take it, because her grandmother tells her that.

她回家后，有人告诉她：“如果你采取节育措施，你就会不孕。”所以她不接受，因为这是她祖母告诉她的。

And then she continues to have pain and starts bouncing from doctor to doctor.

然后她继续感到疼痛，并开始从一个医生换到另一个医生。

A lot of these patients, believe it or not, end up in GI offices getting colonoscopies at a young age.

不管你信不信，很多这样的病人在年轻时就到胃肠科诊所接受结肠镜检查。

If you have to do a colonoscopy for pain in a 22-year-old, make sure you're not missing endometriosis.

如果您必须对 22 岁的女性进行结肠镜检查以缓解疼痛，请确保您没有漏掉子宫内膜异位症。

So it's like you have to teach all these doctors.

所以这就好像你必须教所有这些医生。

So doctors don't have time, they don't diagnose these patients, and they start bouncing from doctor to doctor.

所以医生没有时间，他们不会诊断这些患者，他们开始从一个医生跳到另一个医生。

How can we fix this?

我们该如何解决这个问题？

And insurance will pay for these visits, but you need to be empowered, you need to be educated, and you need to be your own health advocate when it comes to endometriosis, on top of every other diagnosis.

保险会支付这些就诊的费用，但除了所有其他诊断之外，您还需要获得授权，需要接受教育，并且在涉及子宫内膜异位症时，您需要成为自己的健康倡导者。

Why?

为什么？

If I'm telling you all the symptoms of endometriosis and you have them, you already know you have endometriosis.

如果我告诉你子宫内膜异位症的所有症状，而你也有这些症状，那么你就已经知道自己患有子宫内膜异位症。

Go on ChatGPT, it will confirm it for you.

去ChatGPT，它会为你确认。

Andrew Huberman: So painful periods, UTIs.

安德鲁·胡伯曼（Andrew Huberman）：经期非常痛苦，尿路感染。

Thaïs Aliabadi: Painful sex with deep penetration.

Thaïs Aliabadi：深度插入的痛苦性爱。

Andrew Huberman: GI pain.

安德鲁·休伯曼：胃肠道疼痛。

Thaïs Aliabadi: GI pain, bloating, chronic pelvic pain, leg pain, just pain.

Thais Aliabadi：胃肠道疼痛、腹胀、慢性骨盆疼痛、腿部疼痛，只是疼痛。

Pain that comes with your period and eventually takes over your life.

经期带来的疼痛最终会占据你的生活。

Now, educate yourself, write down the questions.

现在，自我教育，写下问题。

I'm telling you, A, if you're young and you want a family, you need your egg count checked.

我告诉你，A，如果你还年轻并且想要一个家庭，你需要检查你的卵子计数。

So, write AMH on your to-do list before you go to your doctor's office.

因此，在前往医生办公室之前，请在您的待办事项清单上写下 AMH。

Two, ask for a pelvic ultrasound.

第二，要求进行盆腔超声检查。

I have a physical therapist, he said, "Every time my daughter goes to the doctor, I tell her to exaggerate her symptoms by 50%.

我有一位物理治疗师，他说，“每次我女儿去看医生，我都会告诉她将症状夸大 50%。

So if she has a 5 out of 10 pain, I say, 'Go tell your doctor it's 10 out of 10,' so they minimize it to 5 out of 10, so you can get your pelvic ultrasound." But don't do that, just ask your doctor.

因此，如果她有十分之五的疼痛，我会说，‘去告诉你的医生，这是十分之十的疼痛’，这样他们就会将疼痛降至十分之五，这样你就可以进行盆腔超声检查了。”但不要这样做，只需询问您的医生即可。

Say, "I have pain, and you need to give me a pelvic ultrasound order, and if you don't, I'm going to go do it somewhere else, or I'm going to go to another doctor." Most doctors want to help.

说：“我感到疼痛，你需要给我做盆腔超声检查，如果你不这样做，我就会去其他地方做，或者我会去找另一位医生。”大多数医生都想提供帮助。

They're not there to hurt you, they're there to help you.

他们不是来伤害你的，他们是来帮助你的。

Sometimes if they don't think of it, maybe reminding them that this could be an endometriosis is the first step.

有时，如果他们没有想到这一点，也许第一步就是提醒他们这可能是子宫内膜异位症。

They're your advocate.

他们是你的倡导者。

They want to help you, so guide them in the right direction.

他们想帮助你，所以引导他们走向正确的方向。

Ask for that pelvic ultrasound, ask for that egg count.

询问盆腔超声检查，询问卵子数量。

And when it comes to endometriosis, a normal ultrasound does not mean you don't have endometriosis.

当谈到子宫内膜异位症时，超声检查正常并不意味着您没有子宫内膜异位症。

A normal pelvic MRI does not mean you don't have endometriosis.

盆腔 MRI 正常并不意味着您没有子宫内膜异位症。

Endometriosis can be minimal, mild, moderate, or severe.

子宫内膜异位症可以是轻微的、轻度的、中度的或严重的。

And we stage it one, two, three, four.

The higher the stage, the more involvement, the more aggressive the endometriosis is.

阶段越高，受累越多，子宫内膜异位症的侵袭性就越强。

Endometriosis can be superficial.

子宫内膜异位症可能是浅表性的。

These implants can be superficial in the pelvis.

They could be in the ovary, called endometrioma, or they can be deep infiltrating, where they go deep, and as I told you, they make their own nerve fibers.

它们可能位于卵巢中，称为子宫内膜异位症，也可能是深层浸润，正如我告诉过你的，它们会产生自己的神经纤维。

And what happens, eventually, these nerve fibers start shooting, and our central nervous system starts going in overdrive and exaggerating those pains.

最终会发生什么，这些神经纤维开始放电，我们的中枢神经系统开始超速运转并加剧这些疼痛。

That's why the pain is so real and so debilitating, because their body, they get sensitization to these new nerve pains that are forming in their pelvis.

这就是为什么疼痛如此真实且如此令人虚弱，因为他们的身体对骨盆中形成的这些新的神经疼痛变得敏感。

The gold standard way of treating this is a laparoscopic resection of endometriosis.

治疗这种情况的金标准方法是腹腔镜子宫内膜异位症切除术。

Andrew Huberman: Surgery?

Thaïs Aliabadi: Surgery.

Andrew Huberman: There's no, like, a VEGF inhibitor or something of that sort?

Andrew Huberman：没有 VEGF 抑制剂之类的吗？

Thaïs Aliabadi: So, let's talk about that.

Thaïs Aliabadi：那么，我们来谈谈这个问题。

So you don't have to jump to surgery, but surgery is the gold standard way of diagnosing, A, to be 100% if you're not confident, and B, cutting these, excising these lesions.

所以你不必跳到手术，但手术是诊断的黄金标准方法，A，如果你没有信心，那就100%，B，切割这些，切除这些病变。

We used to burn them, but for the past 15 years, we've learned that you really need to cut them.

我们过去常常把它们烧掉，但在过去的 15 年里，我们了解到你确实需要砍掉它们。

You don't want to burn them, right?

Because burning them is just a band-aid, and the pain comes back.

因为烧伤只是创可贴，疼痛会再次出现。

Andrew Huberman: Peripheral nerves grow back very readily once they're there.

Andrew Huberman：周围神经一旦出现就很容易重新生长。

Thaïs Aliabadi: Very.

泰伊斯·阿利亚巴迪：非常。

Yeah.

是的。

Andrew Huberman: I mean, this is reassuring to anyone that has a peripheral nerve injury, it'll grow back, unlike a brain injury, where it's a variable outcome.

安德鲁·胡伯曼：我的意思是，这让任何患有周围神经损伤的人感到放心，它会重新生长，这与脑损伤不同，脑损伤的结果是可变的。

But when peripheral nerves want to grow, they grow.

但当周围神经想要生长时，它们就会生长。

Thaïs Aliabadi: They grow.

Thaïs Aliabadi：它们在成长。

Andrew Huberman: Yeah, they're very stubborn.

Thaïs Aliabadi: They're stubborn, and they're painful.

Thaïs Aliabadi：他们很顽固，而且很痛苦。

Here's the problem, Andrew.

Surgery is not first-line therapy, but it's gold standard if you have a patient in severe pain who's not responding to hormonal suppression, which we're going to talk about.

手术不是一线治疗，但如果您的患者患有严重疼痛且对激素抑制没有反应，那么手术是黄金标准，我们将要讨论这一点。

But here's the problem with surgery.

但这是手术的问题。

Do you know that out of 100 gynecologists, one is trained to do laparoscopic endometriosis surgery?

您是否知道每 100 名妇科医生中就有一名接受过腹腔镜子宫内膜异位症手术培训？

And then it gets better.

然后情况就会变得更好。

If you give 100 laparoscopes to 100 gynecologists, half of them will wake the patient up and say, "You didn't have it." Endometriosis, the typical endometriosis implants are glandular endometriosis, so when you look at it, they're blood-filled, right?

如果你给 100 名妇科医生 100 台腹腔镜，其中一半会叫醒病人说：“你没有。”子宫内膜异位症，典型的子宫内膜异位症种植体是腺性子宫内膜异位症，所以你看它是充满血液的，对吗？

They're these black spots, purple spots all over the pelvis.

它们是遍布骨盆的黑色斑点、紫色斑点。

But sometimes you really need to look for it, and you have to lift the ovary, look underneath, look at the bladder.

但有时你确实需要寻找它，你必须抬起卵巢，看看下面，看看膀胱。

Like, with the laparoscope, you have to go really close to find them.

就像使用腹腔镜一样，你必须非常靠近才能找到它们。

The problem is, a small subgroup of patients have stromal endometriosis.

问题是，一小部分患者患有间质子宫内膜异位症。

This stromal endometriosis is not as rare as what you read.

这种间质子宫内膜异位症并不像您读到的那么罕见。

It's actually very common.

这其实很常见。

In almost every endometriosis surgery that I do, my path report shows some stromal endometriosis implants.

在我所做的几乎每一次子宫内膜异位症手术中，我的路径报告都会显示一些间质子宫内膜异位症植入物。

So, stromal endometriosis, imagine those cells in the uterus.

因此，间质子宫内膜异位症，想象一下子宫中的那些细胞。

They have the gland, but they also have the stroma, the connective tissue around it.

它们有腺体，但也有基质，即周围的结缔组织。

Stromal endometriosis doesn't have the glandular lesions with it.

间质子宫内膜异位症不伴有腺体病变。

It's just these fibers that have nerve endings, and the nerves get squeezed, and actually, patients with stromal endometriosis tend to have more bloating, more inflammation, and more deeper pain.

正是这些纤维具有神经末梢，神经受到挤压，实际上，患有间质子宫内膜异位症的患者往往会出现更多的腹胀、更多的炎症和更深层次的疼痛。

But when you put a laparoscope, you only see these thin lines.

但当你放入腹腔镜时，你只能看到这些细线。

Andrew Huberman: Hmm.

安德鲁·休伯曼：嗯。

Thaïs Aliabadi: Sometimes it takes me 15 minutes to find it.

Thais Aliabadi：有时我需要 15 分钟才能找到它。

So if I put a camera and I look for these purple spots, I'm like, "No, you don't have it." So imagine, here you have a patient who's had 15 years of pain, ends up in the hospital, goes home, she lost her job, she's on narcotics, she's halfway addicted to these medications, she's depressed, she's anxious, and finally the doctor says, "I think you have endometriosis.

因此，如果我放上相机并寻找这些紫色斑点，我会说：“不，你没有。”所以想象一下，这里有一个病人忍受了 15 年的疼痛，最终住进了医院，回家后，她失业了，她吸毒，她对这些药物上瘾了，她很沮丧，她很焦虑，最后医生说，“我认为你患有子宫内膜异位症。

Let's take you to surgery." And then they wake her up and say, "You didn't have it."

我们带你去手术吧。”然后他们叫醒她并说：“你没有。”

Andrew Huberman: Oh, my goodness.

安德鲁·休伯曼：哦，天哪。

Thaïs Aliabadi: But that's what I see.

Thais Aliabadi：但这就是我所看到的。

Andrew Huberman: And they missed it in many cases.

Andrew Huberman：在很多情况下他们都错过了。

Thaïs Aliabadi: They missed it.

Thaïs Aliabadi：他们错过了。

But you want to vomit.

但你想吐。

You literally...

你从字面上...

I want to pass out sometimes when these patients tell me these stories.

当这些病人告诉我这些故事时，我有时会想昏倒。

I can write a thousand stories like this for you.

我可以为你写一千个这样的故事。

Andrew Huberman: Sounds like the field of which you're trying to fix is badly flawed in some sort of central, structural way.

Andrew Huberman：听起来你试图修复的领域在某种核心、结构方面存在严重缺陷。

Thaïs Aliabadi: It is.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: It just sort of feels like...

安德鲁·休伯曼：感觉就像......

And we could explore the reasons for that, but that comes clear in what you're saying.

我们可以探讨其中的原因，但这在你所说的中很清楚。

Do we know what causes endometriosis?

我们知道子宫内膜异位症的病因是什么吗？

Thaïs Aliabadi: The first one is this retrograde flow of the menstrual flow.

Thaïs Aliabadi：第一个是月经流的逆流。

Second is an immune system issue, right?

其次是免疫系统问题，对吗？

Which I told you, for whatever reason, their immune system cannot clear out these implants, which goes to the PCOS, right?

我告诉过你，无论出于什么原因，他们的免疫系统无法清除这些植入物，这些植入物会进入多囊卵巢综合症，对吗？

Remember, I told you PCOS patients have so much cytokines released from their visceral?

还记得我告诉过你多囊卵巢综合症患者的内脏释放出如此多的细胞因子吗？

It's my hypothesis that that's why I see so much endometriosis with PCOS, that this chronic inflammation that is caused in PCOS patients is fueling these implants from not being cleared, right?

我的假设是，这就是为什么我在 PCOS 中看到如此多的子宫内膜异位症，PCOS 患者中引起的这种慢性炎症正在加剧这些植入物不被清除，对吗？

That's why I see so much.

这就是为什么我看到这么多。

That's my hypothesis.

这是我的假设。

My problem is I don't have time to do all of this.

我的问题是我没有时间做所有这些。

There's so much I want to do.

我想做的事情有很多。

Andrew Huberman: You're too busy saving all these families and women and kids.

安德鲁·休伯曼：你太忙于拯救所有这些家庭、妇女和儿童了。

Thaïs Aliabadi: I would have done so much.

Thaïs Aliabadi：我会做很多事情。

I love women.

我爱女人。

I would have done so much for them if I could multiply myself to 5 more or 10 more.

如果我能把自己增加到 5 个或 10 个以上，我会为他们做很多事情。

But anyways, so inflammation is another theory.

但无论如何，炎症是另一种理论。

Then it's the metaplasia of this Müllerian duct, the Müllerian duct that forms the uterus and the fallopian tubes.

然后是苗勒管的化生，苗勒管形成子宫和输卵管。

Maybe embryologically, these cells are left somewhere in the body.

也许从胚胎学角度来说，这些细胞被留在体内的某个地方。

That's why we see implants sometimes by the diaphragm, or you can find it in people's lungs or very rarely in their brain.

这就是为什么我们有时会在隔膜处看到植入物，或者你可以在人们的肺部找到它，但很少在他们的大脑中找到它。

So you can't say that's retrograde menstruation, right?

所以不能说这是月经逆行吧？

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: The other hypothesis is through blood vessels from the uterus, that these cells get picked up in the vessels and implant in distant organs, like the lung or the brain.

Thaïs Aliabadi：另一种假设是通过来自子宫的血管，这些细胞在血管中被拾取并植入远处的器官，如肺或大脑。

Andrew Huberman: But was it always this common, or you think-

Andrew Huberman：但是它总是这么常见吗，或者你认为-

Thaïs Aliabadi: It's always been this common.

Thais Aliabadi：这种情况一直很常见。

Andrew Huberman: Okay, so it's not as if in the last 20 years we're seeing a huge increase in it.

Andrew Huberman：好的，所以在过去 20 年里我们并没有看到它的巨大增长。

I mean, it's difficult to say because, as you said, the diagnosis, the whole system is faulty.

我的意思是，这很难说，因为正如你所说，诊断，整个系统都有问题。

Thaïs Aliabadi: And you can't really study.

Thaïs Aliabadi：而且你无法真正学习。

That's why I'm telling you it's not 10%.

这就是为什么我告诉你这不是 10%。

I get so upset when people say 10%.

当人们说 10% 时我感到很沮丧。

I'm like, "It's not 10%!" Think about it.

我想，“这不是10%！”想一想。

15% of women have PCOS, which I think it's more, and I think half of those patients have endometriosis, so that's just the PCOS group.

15%的女性患有PCOS，我认为这个数字更多，而且我认为这些患者中有一半患有子宫内膜异位症，所以这只是PCOS组。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: And then I think in the general population, if I had to guess, I would say north of 20% have endometriosis.

Thaïs Aliabadi：然后我认为在普通人群中，如果我必须猜测的话，我会说超过 20% 的人患有子宫内膜异位症。

And I feel like with-

我感觉就像——

Andrew Huberman: That's a huge number.

安德鲁·休伯曼：这是一个巨大的数字。

Thaïs Aliabadi: It's huge!

Thais Aliabadi：太大了！

Andrew Huberman: 20% is an enormous number.

Andrew Huberman：20% 是一个巨大的数字。

Thaïs Aliabadi: It's enormous.

Thais Aliabadi：这是巨大的。

That's why I'm here to tell you, this is not some zebra diagnosis.

这就是为什么我在这里告诉你，这不是斑马诊断。

This affects every family.

这影响着每个家庭。

Every single person can think of someone in their life who either has PCOS, PCOS and endometriosis, or endometriosis.

每个人都会想到自己生活中患有多囊卵巢综合症、多囊卵巢综合症和子宫内膜异位症、或子宫内膜异位症的人。

There's no way if you close your eyes and think that you cannot think of someone like that.

如果你闭上眼睛并认为你无法想到那样的人，那是没有办法的。

There's no such human because they're everywhere.

不存在这样的人，因为他们无处不在。

There are millions of these women, but they are all dismissed, and they are told for years and years that they're crazy.

这样的女性有数以百万计，但她们都被解雇了，而且多年来她们都被告知她们疯了。

And that needs to stop.

这需要停止。

If I hear one more doctor or healthcare provider or physician assistant or anyone call a woman crazy, like, literally, I want to turn this world upside down.

如果我再听到一位医生、医疗保健提供者、医师助理或任何人称一名女性疯了，就像字面意思一样，我想彻底颠覆这个世界。

Andrew Huberman: Well, it seems like grounds for malpractice to call a patient crazy, even if they're a psychiatrist calling somebody who has a severe mental condition crazy.

安德鲁·休伯曼：嗯，称病人为疯子似乎是医疗事故的理由，即使他们是一名精神科医生，称患有严重精神疾病的人为疯子。

I think that what's becoming increasingly clear as we have this conversation is that, for these issues surrounding women's reproductive health and hormone health generally, because I realize not everyone wants to have kids, but many women do, but many women perhaps don't.

我认为，在我们进行这次对话时，越来越清楚的是，对于围绕女性生殖健康和激素健康的这些问题，因为我意识到并不是每个人都想要孩子，但许多女性想要孩子，但许多女性可能不想要孩子。

The core component seems to be that there's kind of a lot of overlap in the Venn diagram.

核心部分似乎是维恩图中存在很多重叠。

And so, while I'm not trying to get any physician a pass, it seems like the only people who really understand this are the clinicians like yourself, who've spent a lot of time with people with these conditions, and the patients themselves.

因此，虽然我不想让任何医生通过，但似乎唯一真正理解这一点的人是像您这样的临床医生，他们花了很多时间与患有这些疾病的人以及患者本身相处。

I think that one thing that I'm hoping will happen as a consequence of this conversation, as well as just the general theme around podcasts and public health communication, is that, in general, patients are dismissed as having important knowledge about their own health.

我认为我希望这次谈话以及围绕播客和公共卫生传播的一般主题会发生的一件事是，总的来说，患者被忽视，因为他们对自己的健康有重要的了解。

And I think that we put doctors on a pedestal because they are incredible healers, potentially, incredible healers.

我认为我们将医生推向神坛，因为他们是令人难以置信的治疗师，甚至是潜在的令人难以置信的治疗师。

No one knows more about their own body than oneself.

没有人比自己更了解自己的身体。

I will make the...

我会让...

Thaïs Aliabadi: Especially women.

Thais Aliabadi：尤其是女性。

Andrew Huberman: Especially women, I was going to say.

安德鲁·休伯曼：我想说，尤其是女性。

Yes, absolutely.

是的，绝对是。

And it's going to sound like I'm trying to grab political correctness points now, even though earlier I was saying politically incorrect things by saying this, but I firmly believe that...

听起来我现在正试图抓住政治正确点，尽管早些时候我这样说是在说政治不正确的话，但我坚信......

And again, I've only lived as a male, so I only know my own situation, but by menstruating, by having hormone cycles that across the month are more extreme typically than male hormone cycles, I think it's fair to say that, that women are much more in tune with changes in their underlying physiology and how they relate to their underlying psychology, and back and forth.

再说一次，我只是作为一个男性生活过，所以我只知道自己的情况，但是通过月经，通过整个月的激素周期通常比男性激素周期更极端，我认为可以公平地说，女性更能适应她们潜在生理的变化以及她们与潜在心理的关系，如此反复。

From a scientific perspective, you'd say, "Oh, they've experienced more variables and more outcomes.

从科学的角度来看，你会说，“哦，他们经历了更多的变量和更多的结果。

They've run more experiments, right?

他们进行了更多实验，对吗？

It's happening internally." Again, not to make it reductionist or overly intellectual, but I think that the first thing to do is to really give the statements that patients make, even if they're not technical, perhaps especially if they're not technical, an enormous amount of merit.

它正在内部发生。”再说一遍，并不是要让它变得还原论或过于理智，但我认为要做的第一件事是真正给予患者所做的陈述，即使他们不是技术性的，也许特别是如果他们不是技术性的，巨大的价值。

Thaïs Aliabadi: Right.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: Who knows more about their own body than the person experiencing something?

安德鲁·休伯曼：谁比经历某件事的人更了解自己的身体呢？

And women are in a position to know far more about their own changes within their body because they're always undergoing changes across the month.

女性能够更多地了解自己身体的变化，因为她们每个月都在经历变化。

Yeah, that's coming through very clearly.

是的，这一点非常清楚。

Thaïs Aliabadi: 100%.

泰伊斯·阿利亚巴迪：100%。

And I will tell you, 30 years in women's health, 25 years in private practice, when a woman tells you something's wrong, 99% of the time something's wrong.

我会告诉你，30年的女性健康经验，25年的私人诊所经验，当一个女人告诉你出了什么问题时，99%的情况都是出了问题。

Take them seriously.

认真对待他们。

The last thing they are is crazy.

他们最后一件事是疯狂的。

The last thing they are is stress-related or hormone-related.

最后一件事是与压力相关或与激素相关。

It's not in their head.

这不在他们的脑海里。

I had a patient once who told me, "Every time I go to the doctor, my doctor tells me my problem is between my ears."

我曾经有一个病人告诉我，“每次我去看医生，我的医生都告诉我，我的问题出在我的耳朵之间。”

Andrew Huberman: Oh, goodness.

安德鲁·休伯曼：哦，天哪。

I mean, unless they're a psychiatrist, and even if they're a psychiatrist, we now know that metabolic health impacts brain health.

我的意思是，除非他们是精神病学家，即使他们是精神病学家，我们现在知道代谢健康会影响大脑健康。

Yeah, that's criminal.

是的，这是犯罪行为。

I mean, honestly, what you're describing is criminal.

我的意思是，老实说，你所描述的是犯罪行为。

It's not a-

这不是一个——

Thaïs Aliabadi: But it is criminal.

Thais Aliabadi：但这是犯罪行为。

That's why I'm here, though.

但这就是我来这里的原因。

But it is, and it has to change.

但事实确实如此，而且必须改变。

Why do you think I want the President of the United States to give me that mic?

你认为我为什么希望美国总统给我那个麦克风？

But you did today.

但你今天做到了。

I don't think you're going to understand the impact of this podcast today.

我认为您今天不会理解这个播客的影响。

I don't think...

我不认为...

I mean, I'm sure you do because you're amazing and you have millions of followers.

我的意思是，我确信你会这样做，因为你很棒并且拥有数百万追随者。

Andrew Huberman: No, but the information is coming from you.

Andrew Huberman：不，但信息来自您。

Thaïs Aliabadi: I know, but women's health is very different than any other field in medicine.

Thaïs Aliabadi：我知道，但女性健康与医学的任何其他领域都非常不同。

Let me tell you what my solution is.

让我告诉你我的解决方案是什么。

You know what my solution is?

你知道我的解决方案是什么吗？

You literally need to separate OB, obstetrics, from gynecology.

您确实需要将 OB（产科）与妇科分开。

You need to separate it.

你需要把它分开。

Andrew Huberman: Tell me more.

安德鲁·胡伯曼：告诉我更多。

Thaïs Aliabadi: I think for doctors who want to deliver babies, great.

Thaïs Aliabadi：我认为对于想要接生的医生来说，这很好。

Go learn how to deliver babies.

去学习如何接生吧。

Take care of those women like they're your family members.

像照顾家人一样照顾这些女性。

Give them the time, have the energy.

给他们时间，给他们精力。

Don't run from your office to deliver them last minute.

不要在最后一刻跑出办公室去送信。

Hold their hand, don't dismiss them, and just focus on giving them the best experience they can possibly have, which women are not getting right now in this healthcare system.

握住她们的手，不要解雇她们，只专注于为她们提供可能拥有的最佳体验，而女性目前在这个医疗保健系统中还无法获得这种体验。

And then separate the residency, and for whoever does not want to deliver babies, teach them gynecology.

然后分开住院，谁不想生孩子，就教她妇科。

Teach them how to recognize PCOS, teach them what endometriosis is, teach them how to do a laparoscopic hysterectomy without cutting the patient from their belly button all the way down.

教他们如何识别多囊卵巢综合症，教他们什么是子宫内膜异位症，教他们如何进行腹腔镜子宫切除术，而无需将患者从肚脐处一直切下来。

Do you know that in Los Angeles, there are maybe two of us that can do a laparoscopic hysterectomy and take a uterus out this big, and I think I'm the only one that does it outpatient.

你知道吗，在洛杉矶，也许我们两个人可以做腹腔镜子宫切除术并取出这么大的子宫，我想我是唯一一个在门诊做这件事的人。

Andrew Huberman: Could you describe "laparoscopic"?

Andrew Huberman：您能描述一下“腹腔镜检查”吗？

For those of you who don't know, it's small incisions.

对于那些不知道的人来说，这只是小切口。

Thaïs Aliabadi: Minimally invasive.

Thaïs Aliabadi：微创。

Andrew Huberman: So you're not talking about major scar incisions, right?

安德鲁·休伯曼：所以你不是在谈论主要的疤痕切口，对吧？

Thaïs Aliabadi: Right.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: So coming in laterally and essentially doing everything from the camera.

Andrew Huberman：所以从侧面进入，基本上所有的事情都是通过摄像机进行的。

Thaïs Aliabadi: The camera.

Thaïs Aliabadi：相机。

So literally, a uterus the size of a watermelon, I take out laparoscopically outpatient.

所以从字面上看，一个西瓜大小的子宫，我在门诊进行了腹腔镜检查。

The patient goes home the same day.

病人当天就回家了。

Andrew Huberman: Amazing.

安德鲁·休伯曼：太棒了。

Thaïs Aliabadi: Yeah, but that should be standard of care.

Thaïs Aliabadi：是的，但这应该是标准护理。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: So these patients are still getting cut, because it's so big, from their belly button all the way down, a vertical incision, which is traumatic.

Thaïs Aliabadi：所以这些患者仍然会被割伤，因为它太大了，从他们的肚脐一直向下，是一个垂直切口，这是一种创伤。

It would be traumatic to me.

这对我来说会是一种创伤。

And these patients have six to eight weeks of recovery, have to stay in the hospital for two or three days.

而这些病人还有六到八周的康复时间，还得在医院住两三天。

I lost my outpatient privileges at Cedars because I haven't done surgery at Cedars.

我失去了在 Cedars 的门诊特权，因为我没有在 Cedars 做过手术。

I do it in the outpatient Cedars.

我在雪松门诊部做这件事。

So it's because, really, if you train these doctors well, they don't need to take their patients in the hospital, and quality of care will go up.

所以这是因为，实际上，如果你训练好这些医生，他们就不需要把病人带到医院，护理质量就会提高。

The problem right now is, when you're busy running around delivering babies all night...

现在的问题是，当你整夜忙着接生时......

I used to deliver 80 babies a month.

我曾经每月接生80个婴儿。

Andrew Huberman: 80 babies a month?

Andrew Huberman：每个月生 80 个婴儿？

Thaïs Aliabadi: When I was pregnant with my first daughter, Delara, who you met at Stanford, I delivered 82 patients when I was 34 weeks pregnant.

Thaïs Aliabadi：当我怀上我的第一个女儿德拉拉（您在斯坦福大学认识的她）时，我在怀孕 34 周时接生了 82 名患者。

Until one night, my husband used to drive me to the hospital, I had my pillow and a blanket in the car.

直到有一天晚上，我丈夫开车送我去医院，我在车上放了枕头和毯子。

One time, when I was running at 1:00 in the morning, I fell on the lawn, and my husband was like, “You can’t do this anymore," and that’s when I started cutting back.

有一次，当我凌晨 1:00 跑步时，我摔倒在草坪上，我丈夫说，“你不能再这样做了，”从那时起我就开始减少跑步次数。

But my point is, take that doctor, I was up all night, then I would come to my office the next day like nothing happened that night, and now I had 30, 40 patients on my schedule, GYN patients.

但我的观点是，以那位医生为例，我整夜没睡，然后第二天我会像那天晚上什么都没发生一样来到我的办公室，现在我的日程安排上有 30、40 名患者，妇科患者。

How can you catch that endo patient?

你怎么能抓住那个内科病人？

How can you diagnose PCOS patients?

如何诊断 PCOS 患者？

And let me tell you, you can't just diagnose in your head and throw a medication at them.

让我告诉你，你不能只在头脑中诊断并给他们用药。

Patients' compliance goes down when they don't know why they're taking a certain medication.

当患者不知道为什么服用某种药物时，他们的依从性就会下降。

But if you take the time and explain it to them, they’re going to go home and say, “This medication, I’m going to take.” So if you separate OB from GYN, then you empower gynecologists, A, to spend more time with their patients, to not be exhausted, to not run from the hospital into their office just completely burnt out, and then you can focus on women’s health.

但如果你花时间向他们解释，他们会回家说：“我要服用这种药物。”因此，如果你将妇产科与妇科分开，那么你就可以让妇科医生 A 花更多的时间与病人在一起，不会精疲力竭，不会从医院跑到办公室，完全精疲力竭，然后你就可以专注于女性健康。

And then we can also talk about well-woman exams.

然后我们还可以谈论健康女性考试。

I mean, I can sit here until tomorrow morning and talk to you about what a well-woman exam should all be about.

我的意思是，我可以坐在这里直到明天早上，和你谈谈健康女性考试应该是关于什么的。

Andrew Huberman: I love it.

安德鲁·休伯曼：我喜欢它。

Well, we can do multiple podcasts.

好吧，我们可以制作多个播客。

But you're also giving us tools for women to understand for themselves if they likely have endometriosis.

但您也为我们提供了工具，让女性能够自行了解自己是否可能患有子宫内膜异位症。

You know, the painful periods, UTI issues, GI pain, bloating.

你知道，痛苦的经期、尿路感染问题、胃肠道疼痛、腹胀。

Thaïs Aliabadi: Bloating.

Thais Aliabadi：腹胀。

Andrew Huberman: You mentioned earlier that with AMH, whatever units it's measured in, 0.1 of the typical units it's measured in corresponds to one egg, typically.

Andrew Huberman：您之前提到过，对于 AMH，无论其测量单位是什么，通常测量的典型单位的 0.1 对应于一个鸡蛋。

Ultrasound can be informative, but often, even with high-resolution ultrasound, it's not exhaustive.

超声波可以提供丰富的信息，但通常，即使使用高分辨率超声波，它也不是详尽无遗的。

Thaïs Aliabadi: You can miss it.

Thais Aliabadi：你可以错过它。

Andrew Huberman: It can be missed.

Andrew Huberman：可能会被错过。

Laparoscopic surgery, in and out the same day, no major scar, is the ideal way to go.

腹腔镜手术，当天进出，无大疤痕，是理想的选择。

Very, very few doctors are actually doing that.

很少有医生真正这样做。

But a number of the things we just listed off are actionable.

但我们刚刚列出的许多事情都是可行的。

People can think about them at any age.

人们在任何年龄段都可以思考它们。

I think that's one of the big themes coming through today, among others, is that if a woman is 19, 22, 42-

我认为这是今天的一大主题，除其他外，如果一个女人是 19、22、42 岁——

Thaïs Aliabadi: 14.

泰伊斯·阿利亚巴迪：14。

Andrew Huberman: Yeah, 14.

安德鲁·休伯曼：是的，14 岁。

Okay.

好的。

If some of these symptoms are occurring, they need to take them seriously.

如果出现其中一些症状，他们需要认真对待。

Thaïs Aliabadi: I know we talked about surgery when it comes to endometriosis, but endometriosis implants in general, not the stromal type, they grow with estrogen, but their growth slows down with progesterone.

Thaïs Aliabadi：我知道我们在谈到子宫内膜异位症时讨论过手术，但子宫内膜异位症一般是植入型子宫内膜异位症，而不是基质型子宫内膜异位症，它们随着雌激素的作用而生长，但随着孕激素的作用，它们的生长速度会减慢。

So if you have a young patient who you suspect might have endometriosis, and you can't really prove it, right?

因此，如果您怀疑一名年轻患者可能患有子宫内膜异位症，但您无法真正证明这一点，对吧？

You don’t have the experience, but you know they’re complaining of painful periods.

你没有这方面的经验，但你知道他们抱怨经期很痛苦。

And I’m talking to clinicians right now, or patients, then there’s nothing wrong with prescribing them some form of birth control or hormonal suppression that will suppress their symptoms of endometriosis.

我现在正在与临床医生或患者交谈，那么给他们开某种形式的节育或激素抑制药物来抑制子宫内膜异位症的症状并没有什么错。

What do I mean by that?

我这么说是什么意思？

You can use progesterone-only birth control pills, which that's what I would…

你可以使用仅含黄体酮的避孕药，这就是我想要的……

Remember, we talked about birth control, and I said I want to circle back with endometriosis.

记住，我们讨论过节育，我说我想回到子宫内膜异位症。

Birth control pills in endometriosis patients can be the difference of fertility and not having children.

子宫内膜异位症患者服用避孕药可能会导致生育和不生育的差异。

That's how amazing birth control pills work for suppression of endometriosis.

这就是避孕药抑制子宫内膜异位症的神奇功效。

Andrew Huberman: Would you recommend against estrogen birth control pills?

安德鲁·休伯曼：你会建议不要服用雌激素避孕药吗？

Thaïs Aliabadi: I do.

泰伊斯·阿利亚巴迪：我愿意。

Andrew Huberman: Because these implants, right, or tissues, these ectopic tissues, meaning...

安德鲁·休伯曼：因为这些植入物，对的，或组织，这些异位组织，意味着......

Thaïs Aliabadi: Implants.

Thaïs Aliabadi：植入物。

Or tissues.

或者纸巾。

Andrew Huberman: Sorry, ectopic, it's the scientist in me, these tissues that are essentially in the wrong place.

Andrew Huberman：抱歉，异位，这是我身上的科学家，这些组织本质上是在错误的地方。

They've migrated there or formed there.

他们已经迁移到那里或在那里形成。

They are sensitive to estrogen in the sense that they grow in response to estrogen.

它们对雌激素敏感，因为它们会响应雌激素而生长。

Does that mean that in the first half of the ovulatory cycle, the menstrual cycle, there's more pain at that time?

这是否意味着在排卵周期的前半段，即月经周期，那个时候疼痛会更严重？

Thaïs Aliabadi: No, they actually have more pain with the shedding of the lining, with the period.

Thaïs Aliabadi：不，实际上，随着经期的内膜脱落，她们会感到更加疼痛。

But some patients do complain of chronic pain because, remember, these implants eventually cause scarring and nerve pain, and those nerve pains start firing all month, and that's why chronic pelvic pain.

但有些患者确实抱怨慢性疼痛，因为请记住，这些植入物最终会导致疤痕和神经疼痛，而这些神经疼痛整个月都会开始发作，这就是慢性骨盆疼痛的原因。

Now, so you want to give it progesterone.

现在，你想给它注射黄体酮。

You can give this progesterone in the form of birth control, right?

您可以以避孕的形式给予黄体酮，对吗？

So if I have a patient who also has PCOS and has acne, hair loss, facial hair, body hair, irregular periods, painful periods, and their mood disorder is not that bad, I'm like, "Maybe I give her a Slynd, because I can kill two birds with one stone.

因此，如果我有一个患者也患有多囊卵巢综合症，并且患有痤疮、脱发、面部毛发、体毛、月经不调、经期疼痛，而且他们的情绪障碍并没有那么糟糕，我会想，“也许我给她一只斯林德，因为我可以一石二鸟。

I can suppress her PCOS symptoms, and I can suppress her endometriosis." But most PCOS patients, which is the crowd I see with endometriosis, have mood disorders.

我可以抑制她的多囊卵巢综合症症状，也可以抑制她的子宫内膜异位症。”但大多数多囊卵巢综合症患者，也就是我所见到的子宫内膜异位症患者，都有情绪障碍。

So one of the methods that I use to suppress endometriosis is actually a progestin IUD, like Kyleena or Mirena IUD.

因此，我用来抑制子宫内膜异位症的方法之一实际上是孕激素宫内节育器，例如 Kyleena 或 Mirena IUD。

Mirena IUD is the most common progesterone IUD used in this country.

Mirena IUD 是该国最常用的黄体酮 IUD。

It's a method of birth control, and it can last for eight years.

这是一种节育方法，可以持续八年。

Sometimes we use it for heavy periods, and you use it for five years.

有时我们用它的时间很长，你用它五年。

But I use it very often in my patients with endometriosis or adenomyosis.

但我经常在子宫内膜异位症或子宫腺肌病患者中使用它。

For young girls who haven’t had children, I tend to go with the smaller IUD because Mirena IUD is slightly larger than the Kyleena IUD.

对于还没有孩子的年轻女孩，我倾向于使用较小的宫内节育器，因为 Mirena 宫内节育器比 Kyleena 宫内节育器稍大。

So I love the Kyleena IUD, and I’m not advertising it, I’m just saying it because it really works.

所以我喜欢 Kyleena IUD，我不是在给它做广告，我只是这么说，因为它确实有效。

So for patients who have a lot of mood disorders, then I might go to these IUDs, which are more local in suppressing the endometriosis in the pelvis.

因此，对于有很多情绪障碍的患者，我可能会使用这些宫内节育器，它们在抑制骨盆子宫内膜异位方面更局部。

So I start with either a progesterone birth control or a progesterone IUD.

所以我从黄体酮避孕药或黄体酮宫内节育器开始。

And by the way, I always check egg count, always, because I want to make sure we're not low.

顺便说一句，我总是检查鸡蛋数量，总是这样，因为我想确保我们的鸡蛋数量不低。

Because if you have low egg count and you're 17, you're going to go freeze eggs.

因为如果你的卵子数量低而且你已经 17 岁了，你就会去冷冻卵子。

I'm not going to wait for you to be older to freeze.

我不会等你长大了才冻僵。

Waiting for that patient to be 30 or 35?

等待那个病人30岁或35岁？

You're done.

你完成了。

You know, they will have no eggs left.

你知道，他们将没有鸡蛋了。

So suppressed with progesterone birth control, progesterone IUD.

所以用黄体酮节育、黄体酮宫内节育器来抑制。

Then we have GnRH antagonists.

然后我们有 GnRH 拮抗剂。

I don't know if you've heard of these pills, Orilissa or Myfembree.

我不知道你是否听说过这些药，Orilissa 或 Myfembree。

These are medications.

这些是药物。

Remember, I told you you either give it progesterone or you take the estrogen away to treat endometriosis.

请记住，我告诉过你，要么给予黄体酮，要么取消雌激素来治疗子宫内膜异位症。

So giving it progesterone, you can do the progesterone IUD or the progesterone birth control.

因此，给予黄体酮，您可以使用黄体酮宫内节育器或黄体酮避孕。

I don’t like the implants because of the weight and irregular bleeding that comes with them, but you can also take the estrogen away.

我不喜欢植入物，因为它们很重，而且会出现不规则出血，但你也可以去掉雌激素。

These medications work amazingly, especially for women who have painful sex, and usually by two months, they get relief from that painful sex and painful period.

这些药物效果惊人，特别是对于性交疼痛的女性来说，通常两个月后，她们就能从性交疼痛和经期疼痛中得到缓解。

The problem is, anytime you take estrogen away, what happens?

问题是，任何时候你去掉雌激素，会发生什么？

You can have hot flashes, and you can have all the symptoms, the mood-

你可能会出现潮热，你可能会出现所有的症状，情绪——

Andrew Huberman: It's like a pseudomenopause.

安德鲁·休伯曼：这就像假绝经。

Thaïs Aliabadi: Mm-hmm.

泰伊斯·阿利亚巴迪：嗯嗯。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: Correct.

泰伊斯·阿利亚巴迪：正确。

These pills are great because they're reversible, so if you don't like them, you can take them for a couple of days and stop, and they're out of your system in a couple of days, so it's not a big deal.

这些药很棒，因为它们是可逆的，所以如果你不喜欢它们，你可以服用几天然后停止，几天后它们就会从你的系统中消失，所以这没什么大不了的。

But it does make a difference.

但它确实有所作为。

The problem with these pills is that, because of the effect on the bone and the bone loss they cause, you can take them for up to two years.

这些药物的问题在于，由于它们对骨骼的影响以及它们引起的骨质流失，您最多可以服用两年。

So you can't take them beyond two years.

所以你不能让他们超过两年。

Usually, if I do a progesterone suppression and the patient has pain, I recommend surgery.

通常，如果我进行黄体酮抑制并且患者感到疼痛，我会建议手术。

Because during surgery, I resect the endometriosis, I cut all the adhesions if they have it, and then I put a progesterone IUD and I send them home.

因为在手术过程中，我切除了子宫内膜异位症，如果他们有粘连，我会切除所有粘连，然后我放置黄体酮宫内节育器，然后将他们送回家。

For patients during surgery who have severe disease, stage 3 or 4, then I also add these GnRH antagonists after surgery, depending on their stage or symptoms, from six months up to two years.

对于手术期间患有严重疾病（3 期或 4 期）的患者，我还会在术后根据其分期或症状添加这些 GnRH 拮抗剂，从六个月到两年不等。

Andrew Huberman: To suppress estrogen.

Andrew Huberman：抑制雌激素。

Thaïs Aliabadi: Suppress it and to just kill the endometriosis, because when it's advanced stage, even with surgery and an IUD, let's say stage 4, it can come right back.

Thaïs Aliabadi：抑制它并杀死子宫内膜异位症，因为当它处于晚期时，即使进行手术和宫内节育器，比如说第四阶段，它也可以立即回来。

So I really want to knock it out.

所以我真的很想把它消灭掉。

That's what I would do for endometriosis patients.

这就是我将为子宫内膜异位症患者做的事情。

And a very important point, the stage of endometriosis has nothing to do with the degree of pain, and this is very important for patients to understand.

而且很重要的一点，子宫内膜异位症的阶段与疼痛程度无关，这一点对于患者了解非常重要。

You can have stage 1 endometriosis and end up in the emergency room every month because of pain, or you can have stage 4 endometriosis, and you just have mild pain.

您可能患有第一阶段子宫内膜异位症，每个月都会因为疼痛而去急诊室，或者您可能患有第四阶段子宫内膜异位症，但您只有轻微的疼痛。

So pain, you can't say, "Oh, there's not much in your pelvis.

所以疼痛时，你不能说：“哦，你的骨盆里没什么东西。

I'm not going to worry about it." So that's one.

我不会为此担心。”这就是其中之一。

The other thing is, remember I told you stromal endometriosis, that doesn't have the glandular aspect of the tissue, it is missing the glandular aspect?

另一件事是，记得我告诉过你间质子宫内膜异位症，它没有组织的腺体方面，它缺少腺体方面？

It's mostly the fibrous part of it.

它主要是它的纤维部分。

These lesions are almost always missed on laparoscopy.

腹腔镜检查几乎总是会漏掉这些病变。

They tend to cause more inflammation, and they tend to be more resistant to progesterone, in my opinion.

在我看来，它们往往会引起更多的炎症，而且对黄体酮的抵抗力更强。

Andrew Huberman: Hmm.

安德鲁·休伯曼：嗯。

Thaïs Aliabadi: So those are the ones that you really need to cut out.

Thaïs Aliabadi：所以这些才是你真正需要删除的。

But then if you've never seen stromal endometriosis, you will not remove it during surgery, and you will wake your patient up and say you didn't have it.

但如果你从未见过间质子宫内膜异位症，你就不会在手术过程中将其切除，并且你会叫醒你的病人并说你没有患有它。

Andrew Huberman: So stage does not equate to pain, and vice versa.

Andrew Huberman：所以阶段并不等于疼痛，反之亦然。

Thaïs Aliabadi: Absolutely not.

Thaïs Aliabadi：绝对不是。

Absolutely.

绝对地。

Andrew Huberman: These days, it seems, at least in the United States, that women are opting to have children later or not at all.

安德鲁·休伯曼：如今，至少在美国，女性似乎选择晚生孩子或根本不生孩子。

We know that having children before age 40 is protective against certain cancers.

我们知道，40 岁之前生孩子可以预防某些癌症。

Thaïs Aliabadi: Breast cancer.

Thaïs Aliabadi：乳腺癌。

Andrew Huberman: Breast cancer in particular.

Andrew Huberman：尤其是乳腺癌。

Thaïs Aliabadi: Yeah.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: And if women have the BRCA mutations, then that number goes way up.

Andrew Huberman：如果女性携带 BRCA 突变，那么这个数字就会大幅上升。

So, is there any indication that pregnancy before a given age, successful pregnancy, or maybe just pregnancy in general before a given age, is protective against PCOS and endometriosis?

那么，是否有任何迹象表明，在给定年龄之前怀孕、成功怀孕，或者只是在给定年龄之前怀孕，可以预防多囊卵巢综合症和子宫内膜异位症呢？

Thaïs Aliabadi: For endometriosis, yes, because during pregnancy, your endometriosis is at bay.

Thaïs Aliabadi：对于子宫内膜异位症，是的，因为在怀孕期间，您的子宫内膜异位症已经得到控制。

Patients have no pain, right?

病人没有痛苦吧？

It all starts when the menstrual cycle starts again.

当月经周期再次开始时，这一切都开始了。

But what I do for these patients, as soon as they deliver, I put a progesterone IUD in them.

但我为这些患者做的事情是，他们一分娩，我就在他们体内放置黄体酮宫内节育器。

When they come postpartum, six weeks postpartum, and they're discussing birth control, I always recommend a progesterone birth control.

当他们产后，产后六周，当他们讨论节育时，我总是建议使用黄体酮节育。

Andrew Huberman: Do you think that...

安德鲁·休伯曼：你认为……

Well, these days we hear a lot more about postpartum depression.

嗯，这些天我们听到了更多关于产后抑郁症的信息。

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: And I'm very intrigued by this.

Andrew Huberman：我对此非常感兴趣。

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: Like any medical discussion, when you hear about something more often, you get two very polarized arguments.

安德鲁·胡伯曼：就像任何医学讨论一样，当你更频繁地听到某件事时，你会得到两个非常两极分化的论点。

One is, it's been a limited diagnosis, and this has been around a long time, and people have just been suffering in silence.

一是，这是一种有限的诊断，而且这种情况已经存在很长时间了，人们只是默默地承受痛苦。

You hear this about psychiatric conditions, childhood neurologic conditions.

你听说过有关精神疾病、儿童神经系统疾病的信息。

You hear about this with gut issues.

你听说过这个与肠道问题有关。

And then, on the other end of the spectrum, you often will hear, "Well, people are just sort of, like, they're just kind of fanatic about these terms, and then now people are paying attention to it." Do you think that postpartum depression is on the rise?

然后，在频谱的另一端，你经常会听到，“嗯，人们只是有点，就像，他们只是对这些术语有点狂热，然后现在人们开始关注它。”您认为产后抑郁症呈上升趋势吗？

And does it have any correlation with things like endometriosis?

它与子宫内膜异位症等疾病有任何关联吗？

Thaïs Aliabadi: Postpartum depression, I think, we see more in patients with anxiety, trauma, or PTSD.

Thaïs Aliabadi：我认为，我们在焦虑、创伤或创伤后应激障碍 (PTSD) 患者中看到更多产后抑郁症。

So, to answer your question, endometriosis and PCOS patients have anxiety, have depression, and have PTSD.

所以，回答你的问题，子宫内膜异位症和多囊卵巢综合症患者有焦虑、抑郁和创伤后应激障碍。

When you live their experience in their life and everything they've gone through in their life, they all have PTSD.

当你体验他们生活中的经历以及他们生活中所经历的一切时，他们都患有创伤后应激障碍。

So anyone with any history of anxiety, PTSD, depression, or PMDD, a severe form of PMS, all of these patients are at a higher risk of postpartum depression.

因此，任何有焦虑症、创伤后应激障碍、抑郁症或经前综合症（一种严重的经前综合症）病史的人，所有这些患者患产后抑郁症的风险都较高。

And to answer your question, because anxiety is on the rise, because depression is on the rise, postpartum depression is very common.

回答你的问题，因为焦虑正在上升，因为抑郁正在上升，产后抑郁症很常见。

It is very difficult, honestly, to navigate the different stages of life being a woman, you know?

老实说，作为一个女人，要度过人生的不同阶段是非常困难的，你知道吗？

Imagine when you're young, some of them with endometriosis and PCOS, they have all that struggle.

想象一下，当你年轻时，其中一些患有子宫内膜异位症和多囊卵巢综合症，他们经历了所有的挣扎。

Then they try to get pregnant, they don't get pregnant.

然后他们尝试怀孕，但没有怀孕。

They need to sell everything they have to pay for IVF to have a baby.

他们需要卖掉所有的东西来支付试管受精的费用才能生孩子。

Then they have a baby, and their body changes.

然后他们有了孩子，他们的身体发生了变化。

There is this giant drop in estrogen that puts them into these postpartum blues and then postpartum depression, and that gets dismissed by family members, by everyone.

雌激素的大幅下降使她们陷入产后忧郁症，然后是产后抑郁症，而这被家庭成员和每个人所忽视。

"Oh, you're not sleeping well, probably.

“哦，你可能没睡好。

Oh, it's normal, it's because you haven't had a child." No, these patients, even with PMDD, completely dissociate themselves from their environment, from their child.

哦，这很正常，因为你还没有孩子。”不，这些患者，即使患有经前抑郁症，也完全脱离了他们的环境，脱离了他们的孩子。

It's really heartbreaking.

真是令人心碎。

And then, once they're done with all this, in their early 40s, perimenopause comes, late 30s or early 40s, right?

然后，一旦他们完成这一切，在 40 岁出头，围绝经期就会到来，30 岁末或 40 岁出头，对吗？

Andrew Huberman: It's like wave after wave.

Andrew Huberman：就像一波又一波。

Thaïs Aliabadi: A wave after wave, and then perimenopause, which is, again, not diagnosed, right?

Thaïs Aliabadi：一波又一波，然后是围绝经期，这又没有被诊断出来，对吧？

Average age of menopause is 51 and a half, 45 to 55 is the range.

更年期的平均年龄是51岁半，范围是45岁到55岁。

Seven to ten years before menopause, women go through perimenopause, and during that perimenopausal time, their mood can go, they're not sleeping well, they have hot flashes, night sweats, irregular periods, they're gaining weight, their sex hurts, they have frozen shoulder, they start having hair loss, they have skin thinning, and all these things are happening.

更年期前七到十年，女性会经历围绝经期，在围绝经期期间，她们的情绪会变差，睡眠不好，潮热，盗汗，月经不规律，体重增加，性交疼痛，肩周炎，开始脱发，皮肤变薄，所有这些事情都在发生。

No one's diagnosing them, and no one's treating them with hormone replacement until they go through menopause.

在她们进入更年期之前，没有人诊断她们，也没有人用激素替代疗法治疗她们。

And then that's another chapter of life that just turns your body and your life upside down, and most men don't even know what menopause is.

然后，这就是人生的另一个篇章，它会让你的身体和生活发生翻天覆地的变化，大多数男人甚至不知道什么是更年期。

So imagine just the story of this one woman through her life, and then look how many times there are opportunities for this patient to get dismissed in the healthcare system.

因此，想象一下这位女性一生的故事，然后看看这位患者有多少次机会在医疗保健系统中被解雇。

That's why I have a broken heart.

这就是我心碎的原因。

Andrew Huberman: And you're also doing a ton of healing for people.

Andrew Huberman：您还为人们做了大量的治疗工作。

Thaïs Aliabadi: I know.

泰伊斯·阿利亚巴迪：我知道。

Andrew Huberman: But I hear you loud and clear.

安德鲁·休伯曼：但我听到你声音响亮而清晰。

What you described would cause most men, including me, to dissolve into a puddle of our own tears.

你所描述的一切会让包括我在内的大多数男人泪流满面。

That's my only response.

这是我唯一的回应。

Thaïs Aliabadi: But there's hope, though.

Thais Aliabadi：不过，还是有希望的。

I don't want to be all negative.

我不想一切都消极。

Andrew Huberman: No, that's why we're here.

Andrew Huberman：不，这就是我们来这里的原因。

We're here to-

我们来这里是为了——

Thaïs Aliabadi: I feel like it might come out negative, because that's what I see.

Thaïs Aliabadi：我觉得结果可能是负面的，因为这就是我所看到的。

Do you know what I'm saying?

你知道我在说什么吗？

I see my office, my waiting room is the waiting room of dismissed women in this country.

我看到我的办公室，我的候诊室是这个国家被解雇的女性的候诊室。

So I have a skewed view, but it's so real, and it's so painful to watch that, you know?

所以我有一个倾斜的观点，但它是如此真实，而且观看它是如此痛苦，你知道吗？

That's why I sound a little negative, but I'm not a negative person.

这就是为什么我听起来有点消极，但我不是一个消极的人。

Andrew Huberman: I don't think you sound negative.

Andrew Huberman：我认为你听起来并不消极。

If I'm honest, I think you sound very passionate about your empathy for the pain that you observe.

老实说，我认为你听起来非常热衷于对你所观察到的痛苦的同情。

And it must be...

而且一定是...

I'm realizing right now, it must be incredibly frustrating to know that there are solutions and to see so many people suffer.

我现在意识到，知道有解决方案并看到这么多人受苦，一定令人非常沮丧。

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: Like, I can think of almost nothing worse than having the solution to somebody's suffering and not being...

安德鲁·胡伯曼：就像，我能想到几乎没有什么比解决某人的痛苦而不是……更糟糕的了。

They don't know, and because they don't know, they can't access that solution.

他们不知道，并且因为他们不知道，所以他们无法访问该解决方案。

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: And as you've mentioned, it's a very tangled web of medical infrastructure and things like that, but what comes through is your passion and your care for people, for women.

安德鲁·胡伯曼：正如你所提到的，这是一个由医疗基础设施和类似事物组成的非常错综复杂的网络，但最终体现的是你对人们、对女性的热情和关怀。

Thaïs Aliabadi: For women.

Thaïs Aliabadi：针对女性。

Andrew Huberman: For women.

安德鲁·休伯曼：对于女性。

Thaïs Aliabadi: Mm-hmm.

泰伊斯·阿利亚巴迪：嗯嗯。

Andrew Huberman: Yes, it's specifically women, and also your desire to give them useful information that they can act on and better their lives and their health.

安德鲁·休伯曼：是的，特别是女性，以及您希望为她们提供有用的信息，她们可以据此采取行动，改善她们的生活和健康。

Fibroids.

肌瘤。

I hear about fibroids.

我听说有肌瘤。

Where does that fit into this picture, if at all, or is that completely separate?

如果有的话，它与这张图片的关系在哪里，或者是完全独立的？

Thaïs Aliabadi: Fibroids are very common.

Thais Aliabadi：肌瘤很常见。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: By age 50, 80% of women have some form of fibroids.

Thais Aliabadi：到 50 岁时，80% 的女性患有某种形式的肌瘤。

Like, if you stand at the side of a street and pull out 100 women, a lot of them will have fibroids.

就像，如果你站在街边拉出 100 名女性，其中很多人都会患有子宫肌瘤。

When it comes to fibroids, the location of the fibroid is very important.

当谈到肌瘤时，肌瘤的位置非常重要。

You can have a small fibroid in the lining of that cavity that we talked about that can cause you to have heavy periods, blood clots, you become anemic, fertility issues, all of that, or you can have a 10-centimeter fibroid outside of the uterus that can make you look like you're pregnant, but it doesn't do anything to your bleeding.

我们讨论过的子宫腔内壁可能有一个小肌瘤，这会导致月经量多、血栓、贫血、生育问题等等，或者子宫外可能有一个 10 厘米的肌瘤，这会让你看起来像怀孕了，但它对出血没有任何影响。

So when it comes to fibroids, the location of it is very important.

所以对于肌瘤来说，它的位置非常重要。

For patients who have small fibroids, it's away from the cavity, they don't have any symptoms, we just watch them.

对于肌瘤较小的患者来说，它远离蛀牙，他们没有任何症状，我们只是观察他们。

As they grow, you're more likely...

随着他们的成长，你更有可能...

You know, women in their 40s are very likely to have fibroids or develop fibroids, but if it doesn't bother them, we don't do anything.

要知道，40多岁的女性非常有可能患有肌瘤或发展成肌瘤，但如果她们不介意的话，我们什么也不做。

We operate on fibroids for several reasons.

我们对肌瘤进行手术有几个原因。

Number one, if it's inside the cavity and it causes anemia, infertility, or heavy periods.

第一，如果它在腔内并导致贫血、不孕或月经过多。

We operate on fibroids if they're extremely large and they cause bloating.

如果肌瘤非常大并导致腹胀，我们就会对其进行手术。

We go by weeks of pregnancy, and let's say you have a 16-week-size fibroid uterus, which is equal to a 16-week-size pregnant uterus, it starts putting pressure on the ureters that drain your kidneys.

我们以怀孕几周为单位，假设您有一个 16 周大小的肌瘤子宫，相当于怀孕 16 周大小的子宫，它开始对排出肾脏的输尿管施加压力。

So then you have to talk about either a myomectomy for women who want to get pregnant, when you go in and you remove the fibroids, or a hysterectomy for women who are done having children.

因此，您必须谈论要么对想要怀孕的女性进行子宫肌瘤切除术，当您进去并切除肌瘤时，要么对已经生完孩子的女性进行子宫切除术。

So fibroids are extremely common, but then again, if you don't do a pelvic ultrasound, just doing a bimanual exam will never tell you if these patients have fibroids.

所以肌瘤非常常见，但话又说回来，如果你不做盆腔超声检查，仅仅做双手检查永远不会告诉你这些患者是否患有肌瘤。

Andrew Huberman: Can a woman insist that she get an ultrasound?

Andrew Huberman：女性可以坚持要求接受超声波检查吗？

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Absolutely.

绝对地。

Andrew Huberman: Can she walk in and just say...

安德鲁·休伯曼：她能走进来说……

Maybe not have to exacerbate the pain from a 5 to a 10, unless she's already at a 10, of course, but can she come in and just say, "Listen, I absolutely want an ultrasound.

也许不必将疼痛从 5 级加剧到 10 级，当然，除非她已经是 10 级了，但是她可以进来说：“听着，我绝对想要做超声波检查。

I want you to look at fibroids.

我想让你看看肌瘤。

I also want you to do everything you can to determine if I have endometriosis."

我还希望您尽一切努力确定我是否患有子宫内膜异位症。”

Thaïs Aliabadi: Bravo.

泰伊斯·阿利亚巴迪：太棒了。

Andrew Huberman: "Here's what endometriosis is.

安德鲁·休伯曼：“这就是子宫内膜异位症。

I heard a podcast where a true expert in this described these things." How do you think a physician would respond to that?

我听到一个播客，其中一位真正的专家描述了这些事情。”您认为医生会如何回应？

I'd like to think that they would say, "Wow, this person knows a lot.

我想他们会说：“哇，这个人知道很多。

I better do everything."

我最好什么都做。”

Thaïs Aliabadi: There you go.

Thaïs Aliabadi：就是这样。

Bravo.

太棒了。

Empowered, right?

赋权了，对吧？

That's why I called my podcast SHE MD, Strong, Healthy, Empowered.

这就是为什么我将我的播客称为“SHE MD”，“坚强、健康、赋权”。

If you empower the woman to be her own health advocate, and she has that list, and she takes that to her doctor's office, 9 out of 10...

如果你授权女性成为自己的健康倡导者，并且她有这份清单，并将其带到她的医生办公室，那么十分之九......

Like I said, doctors are amazing humans.

就像我说的，医生是了不起的人。

They are there to help you.

他们随时为您提供帮助。

But if that doctor doesn't have a pelvic ultrasound in his office, which is probably very common, then ask them for an order to go to a radiology center or the hospital near you.

但是，如果该医生的办公室没有盆腔超声检查（这可能很常见），那么请向他们索要前往放射中心或您附近的医院的命令。

But every woman should have a pelvic ultrasound.

但每个女性都应该进行盆腔超声检查。

I think it should be part of the well-woman exam every single year.

我认为这应该成为每年女性健康考试的一部分。

Andrew Huberman: Yeah, why isn't it just part of the standard exam?

Andrew Huberman：是的，为什么它不只是标准考试的一部分？

Thaïs Aliabadi: It should be.

Thais Aliabadi：应该是的。

Andrew Huberman: Every male that goes in for a general exam has his testicles grabbed and is told to cough over the sink looking for a hernia.

安德鲁·胡伯曼（Andrew Huberman）：每个参加一般检查的男性都会抓住他的睾丸，并被告知对着水槽咳嗽，寻找疝气。

Thaïs Aliabadi: Yeah.

泰伊斯·阿利亚巴迪：是的。

Andrew Huberman: So it could be the equivalent of that.

Andrew Huberman：所以这可能是等价的。

Well, I mean, they just do it.

嗯，我的意思是，他们就是这么做的。

They do it no matter what.

他们无论如何都会这么做。

Thaïs Aliabadi: It takes me less than a minute to do a pelvic ultrasound, but then I've done it for 30 years.

Thaïs Aliabadi：我做盆腔超声检查只需要不到一分钟，但我已经做了 30 年了。

But that's how fast it is.

但就是这么快。

Andrew Huberman: But this is not an hour-long procedure, it's very fast.

Andrew Huberman：但这不是一个长达一个小时的过程，它非常快。

Thaïs Aliabadi: Oh, my God, no!

泰伊斯·阿利亚巴迪：哦，天啊，不！

And you know what?

你知道吗？

Let me tell you, I had a patient with a uterine septum.

让我告诉你，我有一个患有子宫纵隔的病人。

Do you know what that is?

你知道那是什么吗？

When the uterine cavity is actually divided in two because of this septum that was supposed to be absorbed, but it never did.

当子宫腔实际上因为隔膜而被一分为二时，本应被吸收，但它从未被吸收。

Unless you do a pelvic ultrasound, and unless you're a good ultrasonographer, you will miss this septum.

除非您进行盆腔超声检查，并且除非您是一名优秀的超声技师，否则您会错过这个隔膜。

And these are patients who have recurrent miscarriages.

这些都是反复流产的患者。

They don't get pregnant.

他们不会怀孕。

They sometimes come from fertility clinics, and they're like, "My doctor said I fall into the unexplained category." There's nothing unexplained.

他们有时来自生育诊所，他们就像是，“我的医生说我属于无法解释的类别。”没什么不能解释的。

So if you want to assess your fertility, I have buckets of it.

所以如果你想评估你的生育能力，我有很多。

One, female factor.

一、女性因素。

What is female factor?

什么是女性因素？

Check your hormones, make sure your egg count is normal, right?

检查你的荷尔蒙，确保你的卵子数量正常，对吗？

Make sure your prolactin, thyroid, everything's normal.

确保你的催乳素、甲状腺一切正常。

Do an STD check, gonorrhea, chlamydia, all of that.

做性病检查，淋病，衣原体，所有这些。

Next bucket, male factor.

下一个桶，男性因素。

What's the sperm like?

精子是什么样的？

Is your partner smoking weed every single day?

你的伴侣每天都吸大麻吗？

Has he had radiation because of testicular cancer?

他是否因睾丸癌接受过放射治疗？

Whatever, has he had fertility issues with his previous partner?

不管怎样，他和他的前任伴侣有生育问题吗？

Make sure the semen analysis is normal.

确保精液分析正常。

It takes one minute to check that.

检查这一点需要一分钟。

The third bucket is tubal factor, or anatomy.

第三个桶是输卵管因素，或解剖学。

Is the anatomy normal?

解剖结构正常吗？

Do we have fibroids in the uterus?

我们子宫里有肌瘤吗？

Is there a septum?

有隔膜吗？

Are the tubes open?

管子是否打开？

Have you had chlamydia?

你有衣原体吗？

Do you have any kind of adhesions?

您有任何粘连吗？

That's the next bucket.

那是下一个桶。

The fourth bucket is endometriosis.

第四个桶是子宫内膜异位症。

Are you missing endometriosis?

你还缺子宫内膜异位症吗？

Do you have painful periods, painful sex, bloating, everything we talked about?

您是否有经痛、性交疼痛、腹胀等我们谈论过的一切？

Rule that out.

排除这一点。

The next bucket, PCOS.

下一个桶，多囊卵巢综合症。

Do you have irregular periods?

你有月经不规律吗？

Do you have PCOS-looking ovaries on ultrasound?

超声检查中您的卵巢是否有类似 PCOS 的症状？

Do you have symptoms of high testosterone?

您有睾丸激素高的症状吗？

If you do, there's a 70-80% chance you're not even ovulating.

如果这样做，您有 70-80% 的可能性甚至没有排卵。

Boom, that's your problem, right?

繁荣，这就是你的问题，对吧？

If you have PCOS, then you have, in my opinion, that's Aliabadi diagnosis, a 50% chance of having endometriosis.

如果您患有 PCOS，那么在我看来，您有 50% 的机会患有子宫内膜异位症，这就是 Aliabadi 诊断。

Then go back to the other bucket and make sure you're not missing endometriosis.

然后回到另一个桶，确保您没有遗漏子宫内膜异位症。

And the last one is autoimmune for me, which is very important.

最后一个对我来说是自身免疫的，这一点非常重要。

These are patients who can't get pregnant, or when they get pregnant, they lose the pregnancy, especially my endometriosis patients.

这些是无法怀孕的患者，或者当他们怀孕时，他们失去了怀孕，特别是我的子宫内膜异位症患者。

Endometriosis is a form of autoimmune, and I always say, if you have one autoimmune condition, you probably have a 30% chance of having some other autoimmune condition.

子宫内膜异位症是一种自身免疫性疾病，我总是说，如果您患有一种自身免疫性疾病，那么您可能有 30% 的机会患有其他自身免疫性疾病。

Run this autoimmune bucket, because if someone has, let's say, antiphospholipid syndrome, and they're hypercoagulable, and pregnancy makes you more hypercoagulable, you can actually make blood clots in the placenta.

运行这个自身免疫桶，因为如果有人患有抗磷脂综合征，并且他们处于高凝状态，而怀孕会使您更加高凝，您实际上可以在胎盘中形成血栓。

These are patients who keep having miscarriages, and they don't know why.

这些患者不断流产，但他们不知道为什么。

Andrew Huberman: What about other autoimmune conditions, like psoriasis?

Andrew Huberman：其他自身免疫性疾病（例如牛皮癣）怎么样？

Thaïs Aliabadi: Lupus.

Thaïs Aliabadi：狼疮。

Yes.

是的。

Andrew Huberman: Even mild psoriasis is suggestive of overactive interleukins and things of that sort.

安德鲁·胡伯曼（Andrew Huberman）：即使是轻微的牛皮癣也表明白细胞介素过度活跃或类似的情况。

Thaïs Aliabadi: Yes, autoimmune.

Thaïs Aliabadi：是的，自身免疫性的。

Any autoimmune, I do a full autoimmune panel.

任何自身免疫，我都会做一个完整的自身免疫面板。

And for patients who I go through all these buckets...

对于我经历过所有这些痛苦的患者......

So these buckets that I told you, your listeners can do it at home.

所以我告诉你的这些桶，你的听众可以在家里做。

You don't need your doctors, because some doctors don't know what these buckets are, and they're not really putting a check mark in front of them.

你不需要你的医生，因为有些医生不知道这些桶是什么，他们也没有真正在它们前面打勾。

You can do it yourself.

你可以自己做。

You can ask for the first one, the first bucket, female factor.

你可以要求第一个，第一个桶，女性因素。

Ask for your hormones.

询问你的荷尔蒙。

Ask for a semen analysis, second one.

要求进行精液分析，第二次。

For the third one, ask for a pelvic ultrasound, and make sure there's no septum in that uterus.

对于第三个，要求进行盆腔超声检查，并确保子宫内没有隔膜。

Make sure there are no fibroids.

确保没有肌瘤。

Make sure there are no ovarian cysts or anything that would cause any problems.

确保没有卵巢囊肿或任何会引起任何问题的东西。

For the fourth bucket, ask for testosterone levels.

对于第四个桶，询问睾酮水平。

Rule out to see if you have PCOS.

排除一下你是否患有多囊卵巢综合症。

The next one, endometriosis, I taught you today what to do to make sure you don't have endometriosis.

下一篇，子宫内膜异位症，今天我教大家如何做才能确保自己没有子宫内膜异位症。

And if you have any family history of any autoimmune condition, if you have psoriasis, if you have Sjögren’s, if your mom has lupus, if you had recurrent pregnancy losses, if you have endometriosis, which is autoimmune, ask for a full autoimmune panel.

如果您有任何自身免疫性疾病的家族史，如果您患有牛皮癣，如果您患有干燥病，如果您的母亲患有狼疮，如果您经常流产，如果您患有子宫内膜异位症（这是自身免疫性疾病），请要求进行完整的自身免疫检查。

Because for patients who have an autoimmune panel, you can give them blood thinners like Lovenox in pregnancy, and it'll help bring that flow.

因为对于患有自身免疫性疾病的患者，您可以在怀孕期间给他们服用依诺肝素等血液稀释剂，这将有助于促进血液流动。

And I mean, you now have patients who come in...

我的意思是，现在有病人进来......

I haven't even gone into the room, and my medical assistant says, "Oh, this patient has had five miscarriages, but there's nothing wrong with her." I'm like, "There is no way this woman doesn't have an autoimmune condition." But that's pregnancy.

我还没进房间，我的医疗助理就说：“哦，这个病人已经流产过五次了，但她没有任何问题。”我想，“这个女人不可能没有自身免疫性疾病。”但这就是怀孕。

But can I say something?

但我能说点什么吗？

Andrew Huberman: Please?

安德鲁·休伯曼：请问？

Thaïs Aliabadi: I want to talk about breast cancer.

Thais Aliabadi：我想谈谈乳腺癌。

Can I?

我可以吗？

Andrew Huberman: Absolutely.

安德鲁·休伯曼：当然。

Thaïs Aliabadi: You know, my passions in life are PCOS, endometriosis, and the breast cancer calculator.

Thaïs Aliabadi：你知道，我对生活的热情是多囊卵巢综合症、子宫内膜异位症和乳腺癌计算器。

Do you know what that is?

你知道那是什么吗？

Do you know Tyrer-Cuzick?

你认识泰瑞-库齐克吗？

Have you ever had an episode on it?

你曾经有过关于它的情节吗？

Andrew Huberman: No.

安德鲁·休伯曼：不。

Thaïs Aliabadi: You're going to love this.

Thais Aliabadi：你会喜欢这个的。

So I always say, for women listening to this podcast, if you know your first name, your last name, and your date of birth, you need to know your lifetime risk of breast cancer.

所以我总是说，对于收听此播客的女性来说，如果您知道自己的名字、姓氏和出生日期，那么您需要知道一生患乳腺癌的风险。

It's mandatory.

这是强制性的。

Andrew Huberman: Lifetime risk of breast cancer?

安德鲁·休伯曼：终生患乳腺癌的风险？

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

Have you heard of that?

你听说过吗？

Andrew Huberman: I've heard that term, yeah.

Andrew Huberman：我听说过这个词，是的。

Thaïs Aliabadi: Good.

泰伊斯·阿利亚巴迪：很好。

So why is it so important?

那么为什么它如此重要呢？

I'm sure you know of someone in their 30s who ends up with stage-four breast cancer or advanced-stage breast cancer, and they die way before they get to their mammogram age, right?

我确信您认识一些 30 多岁的人，他们最终患上了第四期乳腺癌或晚期乳腺癌，并且在达到乳房 X 光检查年龄之前就去世了，对吧？

So the first message I want to say on this podcast is that the message of mammograms should start at 40 is misleading, and it needs to stop.

所以我想在这个播客上说的第一条信息是，乳房X光检查应该从40开始的信息是误导性的，它需要停止。

Mammograms start at 40 for very low-risk patients.

对于风险极低的患者，从 40 岁开始进行乳房 X 光检查。

An average American has a 12.5% chance of getting breast cancer.

美国人平均有 12.5% 的几率患乳腺癌。

Andrew Huberman: 12.5%?

安德鲁·休伯曼：12.5%？

Thaïs Aliabadi: Average American.

Thais Aliabadi：普通美国人。

Andrew Huberman: For women specifically?

Andrew Huberman：特别针对女性？

Thaïs Aliabadi: Yes.

泰伊斯·阿利亚巴迪：是的。

So pick your finger, go to a party in a room with 100 women, 12.5 of them, just on average, will get breast cancer.

举个手指，去参加一个有 100 名女性的聚会，平均而言，其中 12.5 名女性会患乳腺癌。

That's incredible, right?

这太不可思议了，对吧？

That's a huge number.

这是一个巨大的数字。

Now, the problem is, if you have a family history of breast cancer, or if you have a biopsy that shows atypia at some point in your life, that will significantly increase your lifetime risk of breast cancer.

现在的问题是，如果您有乳腺癌家族史，或者如果您在生命中的某个时刻进行活检显示异型性，这将显着增加您终生患乳腺癌的风险。

Why is that important?

为什么这很重要？

Again, there are three buckets for breast cancer risk.

同样，乳腺癌风险分为三类。

Low risk is less than 15%, intermediate risk is 15 to 20%, and high risk is 20% or more.

低风险为低于15%，中风险为15%至20%，高风险为20%或以上。

Why am I bringing this up?

我为什么要提出这个？

If your lifetime risk of breast cancer is 20% or more, you can start breast imaging at 30, not 40.

如果您终生患乳腺癌的风险为 20% 或更高，您可以在 30 岁时开始乳房成像，而不是 40 岁。

How about that?

怎么样？

Andrew Huberman: What does a doctor need to hear in order to put someone in that category?

Andrew Huberman：医生需要听到什么才能将某人归入该类别？

Thaïs Aliabadi: It's a very simple formula.

Thais Aliabadi：这是一个非常简单的公式。

Patients can do it at home.

患者可以在家中进行。

See, you don't need your doctor to do this for you.

看，您不需要医生为您做这件事。

Empowered, that's why women can do this at home.

赋予权力，这就是为什么女性可以在家里做这件事。

It's a formula called the Tyrer-Cuzick Risk Assessment Tool.

这是一个称为 Tyrer-Cuzick 风险评估工具的公式。

I have it on SHE MD.

我在 SHE MD 上有它。

It's free.

它是免费的。

You can literally go on there and calculate your lifetime risk of breast cancer.

您实际上可以继续计算您一生患乳腺癌的风险。

It asks you for your age, height, weight, density of the breast, which you can only get the density of the breast from your breast imaging, mammogram, or MRI.

它会询问您的年龄、身高、体重、乳房密度，您只能通过乳房成像、乳房 X 光检查或 MRI 获得乳房密度。

Usually, the radiologists make a comment on whether or not you have fibroglandular, fatty, heterogeneously dense, or extremely dense breasts.

通常，放射科医生会对您的乳房是否有纤维腺、脂肪、不均匀致密或极度致密做出评论。

The higher the density, the higher your lifetime risk of breast cancer.

密度越高，您终生患乳腺癌的风险就越高。

Patients who have children after age 30 are at a higher risk, women who haven't had children, women with a family history, women with genetic mutations.

30岁以后生育的患者、未生育过的女性、有家族史的女性、有基因突变的女性风险较高。

So you answer these questions, and at the end of it, it will calculate your risk of breast cancer over the next 10 years or over your lifetime.

因此，您回答这些问题，最后，它将计算您在未来 10 年或一生中患乳腺癌的风险。

If that number is 20% or more, you can go to your doctor's office for your well-woman exam, after you ask for your egg count and your pelvic ultrasound.

如果该数字为 20% 或更多，您可以在询问卵子计数和盆腔超声检查后，前往医生办公室进行女性健康检查。

You ask them for breast imaging, especially if you have a first-degree relative (mom, sister, or daughter) with breast cancer.

您要求他们进行乳房成像，特别是如果您的一级亲属（母亲、姐妹或女儿）患有乳腺癌。

That significantly increases your risk.

这会显着增加您的风险。

If that risk is north of 20%, you need to ask your doctor for breast imaging as early as 30.

如果该风险超过 20%，您需要早在 30 岁时就要求医生进行乳房成像。

That's why I had a girl on my podcast at 34.

这就是为什么 34 岁时我的播客上有一个女孩。

She has stage four breast cancer.

她患有第四期乳腺癌。

Had she been treated and diagnosed...

如果她接受治疗并确诊的话...

And I'll tell you her story, it's really devastating.

我会告诉你她的故事，这真的是毁灭性的。

So it's important to know your lifetime risk of breast cancer.

因此，了解一生中患乳腺癌的风险非常重要。

Patients who fall into the high-risk category, 20% or more, in addition to a mammogram, if they have dense breast tissue, they need to ask for an ultrasound of the breast.

属于高危类别的患者，20%或以上，除了乳房X光检查外，如果乳腺组织致密，还需要要求进行乳房超声检查。

And for high-risk patients, 20% or more, in addition to a mammogram and ultrasound, they need to ask for a breast MRI.

而对于高危患者，20%或更多，除了乳房X光检查和超声检查外，还需要要求进行乳房MRI检查。

Now, if your doctor writes for a breast MRI, it's probably not going to get covered by insurance.

现在，如果您的医生要求进行乳房核磁共振检查，那么保险可能不会承保。

But if your doctor writes, "Patient is high risk, lifetime risk is 28%," then your insurance company has to cover it, right?

但如果你的医生写道：“患者风险较高，终生风险为 28%”，那么你的保险公司就必须承保，对吗？

So that's how they test doctors.

这就是他们测试医生的方式。

They want to see that lifetime risk on the prescription order in order to approve it, but they can still not approve it, but that's another discussion.

他们希望看到处方单上的终生风险，以便批准它，但他们仍然不能批准它，但这是另一个讨论。

So it's important to know your lifetime risk of breast cancer.

因此，了解一生中患乳腺癌的风险非常重要。

For any woman with a family history of breast cancer, ovarian cancer, pancreatic cancer, prostate cancer, and the list goes on and on, they can ask their doctor to see if they qualify for genetic cancer testing.

对于任何有乳腺癌、卵巢癌、胰腺癌、前列腺癌家族史的女性，她们可以询问医生是否有资格进行基因癌症检测。

The company I use in my office, I've used for, I don't know, over 10 years, is Myriad.

我在办公室使用的公司是 Myriad，我不知道已经使用了 10 多年。

And the reason I use this specific company...

我使用这家特定公司的原因......

There are a lot of companies that check for genetic cancer testing, right?

有很多公司进行基因癌症检测，对吧？

They check 80, 90 genes.

他们检查 80、90 个基因。

I think Myriad only checks 63 genes, which is fine.

我认为 Myriad 只检查 63 个基因，这很好。

So not only Myriad checks you for the cancer-causing genes, but they also calculate your Tyrer-Cuzick for you so the doctor can see it.

因此，Myriad 不仅会检查您的致癌基因，还会为您计算您的 Tyrer-Cuzick 基因，以便医生可以查看。

But in addition to that, Myriad takes your Tyrer-Cuzick and also looks in the DNA for tiny little markers.

但除此之外，Myriad 还会检测您的 Tyrer-Cuzick，并在 DNA 中寻找微小的标记。

These are not main genetic mutations.

这些不是主要的基因突变。

They're tiny little markers that individually don't have that much power, but some women walk around with tons of these markers, and they add the Tyrer-Cuzick with these markers, and they give you a risk score.

它们是微小的标记，单独没有那么大的力量，但有些女性带着大量的这些标记走来走去，她们将这些标记添加到 Tyrer-Cuzick 中，然后给你一个风险评分。

Sometimes I have a patient whose Tyrer-Cuzick is 19%, but when you calculate their risk score, it jumps up to 34%.

有时我的病人的 Tyrer-Cuzick 风险评分为 19%，但当你计算他们的风险评分时，它会跃升至 34%。

So for patients who fall into the very high-risk category, north of 35%, those patients have the choice of either doing imaging every six months, alternating mammogram and ultrasound with MRI, or asking their doctor for a medication called tamoxifen.

因此，对于属于极高风险类别（超过 35%）的患者，这些患者可以选择每六个月进行一次成像，将乳房 X 光检查和超声检查与 MRI 交替进行，或者向医生询问一种名为他莫昔芬的药物。

Andrew Huberman: Estrogen receptor blocker.

安德鲁·休伯曼：雌激素受体阻滞剂。

Thaïs Aliabadi: Mm-hmm.

泰伊斯·阿利亚巴迪：嗯嗯。

Andrew Huberman: Yeah.

安德鲁·休伯曼：是的。

Thaïs Aliabadi: That reduces the risk of breast cancer by fifty percent in the next ten years of their life, or ask for a double mastectomy, which is exactly what I did.

Thaïs Aliabadi：这可以将他们未来十年患乳腺癌的风险降低百分之五十，或者要求进行双乳切除术，这正是我所做的。

And I'm just going to end it by this: I was 48 and had no family history of breast cancer.

我想以此结束：我当时 48 岁，没有乳腺癌家族史。

85% of women who get breast cancer don't have it in their family.

85% 的乳腺癌女性家族中没有乳腺癌患者。

Less than 5% have a genetic mutation.

不到5%的人有基因突变。

Most Americans who get it are just like me.

大多数得到它的美国人都和我一样。

I had no family history.

我没有家族史。

I had no genetic mutation.

我没有基因突变。

I was never on hormones.

我从来没有服用过激素。

I was never overweight.

我从来没有超重过。

I never smoked.

我从来不抽烟。

I don't drink.

我不喝酒。

I've never done drugs in my life.

我一生中从未吸毒。

So I was the perfect example of someone who-

所以我就是一个完美的例子——

Andrew Huberman: You did everything right.

安德鲁·休伯曼：你做的一切都是对的。

Thaïs Aliabadi: I did everything right.

Thais Aliabadi：我做的一切都是对的。

At 48, I had a breast biopsy that showed atypia, and I asked my...

48 岁时，我进行了乳房活检，结果显示异型性，我问我的...

Obviously, I had to go in and do an excisional biopsy.

显然，我必须进去进行切除活检。

They removed it, and my doctor said, "Everything's good.

他们把它取下来，我的医生说：“一切都很好。

Go and come back in six months." I went to my office, and I calculated my lifetime risk of breast cancer, and it was the first time I did that because I had no reason to do it before, because I had no risk factors.

去吧，六个月后回来。”我去了我的办公室，计算了我一生患乳腺癌的风险，这是我第一次这样做，因为我以前没有理由这样做，因为我没有风险因素。

But when I calculated my lifetime risk, it showed 37%.

但当我计算我的终生风险时，结果显示为 37%。

So I called my doctor, and I said, "You tell me I'm okay, but this lifetime risk says 37%." And back then, I had my three daughters.

所以我打电话给我的医生，我说：“你告诉我我没事，但终生风险为 37%。”那时，我有我的三个女儿。

I had not adopted my little one.

我没有收养我的小宝贝。

"If you told me this plane had a 37% chance of crashing, I would never board that plane.

“如果你告诉我这架飞机有 37% 的几率坠毁，我永远不会登上那架飞机。

I'm very conservative.

我很保守。

Please take my breasts off and put implants in." I already had implants, I had augmentation.

请把我的乳房取下来，然后植入假体。”我已经做了植入物，我做了增强手术。

They called me crazy, paranoid, and anxious.

他们称我疯狂、偏执、焦虑。

I was told that because I didn’t have a family history, or because I looked the way I did and I was so healthy, that I was very low risk, yet my number was 37% until I found a surgeon who was willing to do it.

有人告诉我，因为我没有家族病史，或者因为我看起来像我的样子而且我很健康，所以我的风险非常低，但在我找到愿意做这件事的外科医生之前，我的风险数字是 37%。

She did it, and the day before surgery, she was very annoyed with me, and she said, "Why are you doing it?" I’m like, "Well, I don’t want it..." I said the boarding-the-plane example.

她做到了，手术前一天，她对我很生气，她说：“你为什么这么做？”我说，“好吧，我不想……”我举了登机的例子。

Andrew Huberman: That's not what you want your surgeon to say to you the day before surgery.

安德鲁·休伯曼：这不是你希望外科医生在手术前一天对你说的话。

Thaïs Aliabadi: Because she really didn't want to do it.

Thaïs Aliabadi：因为她真的不想这么做。

She really thought I was crazy.

她真的以为我疯了。

Andrew Huberman: Mm-hmm.

安德鲁·休伯曼：嗯嗯。

Thaïs Aliabadi: And I said, "Why?

Thaïs Aliabadi：我说：“为什么？

Why do I have to fight so hard to remove my breasts?

为什么我必须如此努力才能切除乳房？

This is my body, and I don't care about my breasts." It's very personal, but for me, it really didn't matter.

这是我的身体，我不在乎我的胸部。”这是非常个人化的，但对我来说，这真的不重要。

You know what she told me?

你知道她告诉我什么吗？

"We have really good chemo for breast cancer."

“我们有非常好的乳腺癌化疗方案。”

Andrew Huberman: Oh, my goodness.

安德鲁·休伯曼：哦，天哪。

Thaïs Aliabadi: I'm a women's health advocate.

Thaïs Aliabadi：我是一名女性健康倡导者。

Do you understand?

你明白吗？

This is how I'm being treated in the healthcare system, right?

这就是我在医疗保健系统中受到的待遇，对吧？

So she did it, against her advice.

于是她不顾她的建议，这么做了。

And a week later, I get a call that they found breast cancer in my tissue.

一周后，我接到电话说他们在我的组织中发现了乳腺癌。

That's how I diagnosed my breast cancer.

这就是我诊断出乳腺癌的方法。

So all this time, they were digging in the left, my breast cancer was sitting on my right breast at six o'clock.

所以一直以来，他们都在左侧挖掘，我的乳腺癌在六点钟位置位于我的右侧乳房。

Why am I saying this?

我为什么这么说？

I'm not saying this to scare people, but I'm saying this as a woman's health advocate, as a gynecologist, as someone who's...

我这么说并不是为了吓唬别人，而是作为一名女性健康倡导者、一名妇科医生、一名……的人这么说。

I feel like I'm extremely competent in my field.

我觉得我在自己的领域非常有能力。

If I had to fight so hard for someone to take me seriously, do you think other women have a chance?

如果我必须如此努力才能有人认真对待我，你认为其他女人有机会吗？

That's why they show up so late.

这就是为什么他们出现得这么晚。

That's why their genetic test is not done.

这就是为什么他们没有进行基因测试。

That's why, if you don't know your lifetime risk of...

这就是为什么，如果你不知道你一生的风险......

If I didn't know my lifetime risk of breast cancer, I would have never known to ask for these options.

如果我不知道我一生患乳腺癌的风险，我就永远不会知道要寻求这些选择。

That's why you have to empower women to be their own health advocates.

这就是为什么你必须赋予女性权力，让她们成为自己的健康倡导者。

Go calculate your lifetime risk of breast cancer.

计算一下您终生患乳腺癌的风险。

That's non-negotiable, and if that number is 20% or above, ask your doctor for breast imaging.

这是没有商量余地的，如果这个数字是 20% 或以上，请要求您的医生进行乳房成像。

I don't care if you're 34 years old, you need it.

我不在乎你是否34岁，你需要它。

And if you have family history, ask your doctor for genetic cancer testing.

如果您有家族史，请要求您的医生进行基因癌症检测。

That's not optional.

这不是可选的。

And if you do this, that's why...

如果你这样做，那就是为什么......

You know what, Andrew?

你知道吗，安德鲁？

I don't want to jinx myself.

我不想给自己带来厄运。

I've practiced for 25 years.

我已经练习了25年了。

I've never lost a patient under my care to cancer.

我从未因癌症而失去过我所照顾的患者。

Andrew Huberman: That's a wonderful thing to be able to say.

Andrew Huberman：能够这么说真是太好了。

Thaïs Aliabadi: Right.

泰伊斯·阿利亚巴迪：是的。

But it's not because I do some magic in my office.

但这并不是因为我在办公室里施展了魔法。

I'm hypervigilant with these patients.

我对这些病人保持高度警惕。

When you come for your well-woman exam to my office, I'm assessing your fertility.

当您来我办公室进行女性健康检查时，我正在评估您的生育能力。

I'm ruling out endo.

我排除内藤。

I'm ruling out PCOS.

我排除了多囊卵巢综合症。

I'm checking your egg count.

我正在检查你的卵数。

I'm doing a pelvic ultrasound, looking for cysts, fibroids, and septum.

我正在做盆腔超声检查，寻找囊肿、肌瘤和隔膜。

If you have PCOS, if you're young, I'm checking your ApoB.

如果你患有 PCOS，如果你很年轻，我会检查你的 ApoB。

I'm checking your lipoprotein(a) status.

我正在检查您的脂蛋白(a) 状态。

If you're perimenopausal, I'm checking your APOE4 to see if that increases your risk of dementia.

如果您正处于更年期，我会检查您的 APOE4，看看这是否会增加您患痴呆症的风险。

I talk about hormone replacement early during perimenopause.

我谈论围绝经期早期的激素替代。

I talk about bone density.

我谈论骨密度。

I talk about colonoscopy.

我讲的是结肠镜检查。

I talk about genetic testing.

我谈论基因检测。

Depending on your lifetime risk of breast cancer, I order different things, different imaging for different patients.

根据您终生罹患乳腺癌的风险，我会为不同的患者安排不同的检查和不同的影像检查。

I check your hormones.

我检查你的荷尔蒙。

I check your thyroid.

我检查你的甲状腺。

I check your prolactin.

我检查你的催乳素。

So I talk about anxiety and depression.

所以我谈论焦虑和抑郁。

I talk about eating disorders.

我谈论饮食失调。

So right now, a well-woman exam for a patient is: go to the doctor's office, get your Pap smear, get an STD check if you're asking for it, right?

所以现在，对患者进行的健康女性检查是：去医生办公室，进行子宫颈抹片检查，如果您要求的话，进行性病检查，对吗？

Ask for birth control, do a breast exam.

要求节育，进行乳房检查。

If you're 40, you get an order for a mammogram, and then you go home.

如果你 40 岁，你会收到一份乳房 X 光检查的订单，然后你就回家了。

That's not a well-woman exam.

这不是一个好的女性考试。

That has to stop, and pelvic ultrasound should be on top of the list.

这种情况必须停止，盆腔超声检查应该是首选。

Andrew Huberman: I greatly appreciate you telling us this.

Andrew Huberman：我非常感谢您告诉我们这一点。

I do believe that what you're saying will lead to change.

我相信你所说的将会带来改变。

It's going to take some time, but I'm going to encourage all the women listening to not just do what you suggest, but to also echo what you're saying to all of their friends and to all of their family members, the women they know, because I do think that that's the way things change, frankly.

这需要一些时间，但我会鼓励所有聆听的女性不仅要照你的建议去做，还要向她们所有的朋友、所有的家庭成员、她们认识的女性回应你所说的话，因为坦率地说，我确实认为这就是事情改变的方式。

I've never beat the drum of one particular health ailment or health practice, although morning sunlight.

尽管早晨阳光明媚，但我从未击败过某种特定的健康疾病或健康实践。

What I do is I give people information, and I try and distribute it so people can distribute it to one another.

我所做的就是向人们提供信息，然后尝试分发这些信息，以便人们可以相互分发。

But if ever there was a batch of information to come through on this podcast where it was absolutely critical that people do what the guest is talking about, and share that information and just keep pushing and pushing forward with this, it's the information you've been sharing.

但是，如果这个播客中有大量信息要传达给人们，那么人们做嘉宾所说的事情并分享这些信息并不断推动这一点是绝对重要的，那么这就是您一直在分享的信息。

So I can't say that enough times or emphatically enough.

所以我不能说足够多次或强调不够。

I do have a couple more questions, even though you've been incredibly generous with your time.

尽管您非常慷慨地花费了时间，但我还有几个问题。

Thaïs Aliabadi: No, of course.

Thaïs Aliabadi：当然不。

Andrew Huberman: But they are questions that come from the audience on social media that I've solicited for prior to the podcast.

安德鲁·胡伯曼：但这些问题是我在播客之前在社交媒体上向观众提出的。

So I'm going to just take a moment, grab my phone, which I keep out of the room for our discussions, but I'm going to grab it now and see if any of the questions touch on things that we haven't talked about this far.

所以我要花一点时间，拿起我的手机，我把它放在我们讨论的房间之外，但我现在要拿起它，看看是否有任何问题涉及我们到目前为止尚未讨论的事情。

Okay, some excellent questions from the general public.

好的，这是公众提出的一些很好的问题。

This first one is, "Are there any non-invasive methods for the diagnosis of endometriosis, like tests within from the menstrual blood itself?"

第一个是，“是否有任何非侵入性方法可以诊断子宫内膜异位症，例如从经血本身进行测试？”

Thaïs Aliabadi: They're doing a lot of research right now.

Thaïs Aliabadi：他们现在正在进行大量研究。

We don't currently have it.

我们目前没有。

Right now, non-invasive is, well, listen to your patient.

目前，非侵入性治疗就是倾听患者的意见。

That's 99% accurate.

这是 99% 准确的。

Do a pelvic ultrasound.

做盆腔超声检查。

Unfortunately, if you see it on a pelvic ultrasound, it's already advanced disease.

不幸的是，如果您在盆腔超声检查中看到它，那么它已经是晚期疾病。

Or do a pelvic MRI, because an MRI can actually, with an experienced radiologist, they can look at these specially infiltrating lesions.

或者做盆腔 MRI，因为 MRI 实际上可以让经验丰富的放射科医生检查这些特殊的浸润性病变。

They can see those on MRI.

他们可以在核磁共振成像上看到这些。

Andrew Huberman: Is endometriosis an autoimmune disease?

Andrew Huberman：子宫内膜异位症是一种自身免疫性疾病吗？

Thaïs Aliabadi: Yes, it is.

Thaïs Aliabadi：是的，确实如此。

We talked about this, absolutely.

我们绝对讨论过这个。

And that's why, if you have endometriosis and you're trying to get pregnant, or if you've had a miscarriage, ask your doctor for a full autoimmune panel, because when you have one autoimmune, you have a 30% chance of having another autoimmune disorder.

这就是为什么，如果您患有子宫内膜异位症并且您正在尝试怀孕，或者您曾经流产过，请向您的医生索取完整的自身免疫检查，因为当您患有一种自身免疫性疾病时，您有 30% 的机会患有另一种自身免疫性疾病。

Andrew Huberman: Is cognitive impairment in menopause an absolute occurrence?

Andrew Huberman：更年期认知障碍是绝对发生的吗？

Like, does it necessarily happen, is what they want to know.

比如，这是否一定会发生，这是他们想知道的。

Thaïs Aliabadi: Not always, but it's extremely common.

Thaïs Aliabadi：并不总是如此，但这是非常常见的。

I call it brain fog.

我称之为脑雾。

You know, women lose their concentration.

你知道，女人会失去注意力。

They don't remember things.

他们不记得事情。

You go into a room, you're like, "Why did I come in here?" And a lot of that is because of the fluctuations in the hormones and the drop in the estrogen.

你走进一个房间，你会想，“我为什么进来？”这很大程度上是由于荷尔蒙的波动和雌激素的下降造成的。

So by giving these patients hormone replacement, they feel like, "Oh, my God, I'm alive again.

因此，通过给这些患者补充激素，他们会感觉，“哦，天哪，我又活了。

I can see again.

我又能看见了。

I can think again." So it absolutely happens.

我可以再想一想。”所以这绝对会发生。

Most symptoms of menopause...

更年期的大部分症状...

Different women experience menopause differently.

不同的女性经历不同的更年期。

They all don't share the same exact symptoms, but a lot of women complain of brain fog.

她们的症状并不完全相同，但很多女性抱怨脑雾。

Andrew Huberman: Is inositol useful for PCOS?

Andrew Huberman：肌醇对多囊卵巢综合症有用吗？

Thaïs Aliabadi: Yes, absolutely.

Thaïs Aliabadi：是的，绝对如此。

Andrew Huberman: These are great questions.

安德鲁·休伯曼：这些都是很好的问题。

Thaïs Aliabadi: And I have it in Ovii.

Thaïs Aliabadi：我在 Ovii 中有它。

Andrew Huberman: What do you think is the most overlooked, missed cause of infertility by doctors?

安德鲁·休伯曼：您认为医生最容易忽视、遗漏的不孕原因是什么？

Thaïs Aliabadi: Everything we talked about, endo and PCOS, hands down.

Thaïs Aliabadi：我们谈论的一切，endo 和 PCOS，毫无疑问。

A lot of these patients who are "unexplained" are undiagnosed PCOS and endometriosis patients.

这些“不明原因”的患者中有很多是未确诊的多囊卵巢综合症和子宫内膜异位症患者。

Andrew Huberman: Suggestions for PMDD relief for somebody in their 40s.

Andrew Huberman：针对 40 多岁的人缓解经前抑郁症的建议。

Thaïs Aliabadi: Oh, I love that question.

Thaïs Aliabadi：哦，我喜欢这个问题。

Andrew Huberman: And could you explain PMDD?

Andrew Huberman：您能解释一下经前抑郁症吗？

I don't think we've defined that acronym.

我认为我们还没有定义这个缩写词。

Thaïs Aliabadi: Yes, PMDD is a severe form of PMS.

Thaïs Aliabadi：是的，经前抑郁症是经前综合症的一种严重形式。

Very, very common, devastating for these girls.

对这些女孩来说非常非常常见，也是毁灭性的。

The best way to describe it is these girls, two weeks out of the month, they're perfect.

描述它的最好方式就是这些女孩，每个月的两周，她们都很完美。

Two weeks out of the month, they destroy all their relationships.

每个月的两周，他们会破坏所有的关系。

They're depressed, they're crying, and they're unmotivated.

他们很沮丧，他们在哭泣，他们没有动力。

They don't want to go to school.

他们不想去上学。

They completely decline.

他们完全拒绝了。

They don't want to go out.

他们不想出去。

And two weeks after...

而两周后...

So I always say, two weeks out of the month, you destroy all your relationships, and then you spend two more weeks fixing it, and then the vicious cycle happens over and over again.

所以我总是说，每个月的两周，你会破坏你所有的关系，然后你又花两周时间修复它，然后恶性循环一遍又一遍地发生。

So, PMDD is a severe form of PMS, and what happens is it's not an abnormal hormonal condition.

所以，经前抑郁症是经前综合症的一种严重形式，它并不是荷尔蒙异常。

It's actually the brain's reaction, an extreme reaction, to normal hormonal changes in the body.

这实际上是大脑对体内正常荷尔蒙变化的反应，一种极端的反应。

So, PMDD symptoms usually start 10 days before the period and goes away two or three days after the period, and this vicious cycle happens.

所以，经前抑郁症症状通常在经期前10天开始，经期后两三天消失，形成恶性循环。

Believe it or not, suicide is really high in these patients during those weeks.

不管你信不信，在这几周里，这些患者的自杀率确实很高。

I'm actually seeing a patient from out of state on Friday after my surgery because her family is flying her in because she's not feeling well, and her diagnosis is PMDD.

事实上，周五我在手术后接诊了一位来自州外的患者，因为她的家人用飞机送她来，因为她感觉不舒服，而且她的诊断是经前抑郁症。

How do you treat it?

你如何对待它？

If you want to use birth control, there's one form of birth control, Yaz.

如果您想使用节育措施，有一种节育形式，Yaz。

I don't usually go to it.

我一般不去那儿。

It helps with the symptoms of PMDD, but these patients actually do really well if you put them on SSRIs or antidepressants for just 10 days during the month.

它有助于缓解经前抑郁症 (PMDD) 的症状，但如果您在一个月内仅服用 SSRI 或抗抑郁药 10 天，这些患者实际上会恢复得很好。

For these patients, you can prescribe 20 milligrams of Prozac 10 to 14 days before their period.

对于这些患者，您可以在月经前 10 至 14 天服用 20 毫克百忧解。

So they only take it 10 to 14 days per month.

所以他们每个月只需要 10 到 14 天。

After ovulation, they start taking it once a day, and they stop at the onset of their period.

排卵后，她们开始每天服用一次，并在月经开始时停止服用。

You can also treat them with 25 milligrams of Zoloft.

您还可以用 25 毫克左洛复治疗。

For some reason, their brain responds really well to this pulsatile treatment, and it's a game changer for these patients.

出于某种原因，他们的大脑对这种脉冲治疗反应非常好，这对这些患者来说是一个游戏规则的改变者。

PMDD patients, you do want to make sure they don't have a chronic underlying anxiety or depressive disorder, so I always refer them to a psychiatrist, but you can absolutely treat it.

PMDD 患者，你确实想确保他们没有慢性潜在焦虑或抑郁症，所以我总是将他们转介给精神科医生，但你绝对可以治疗它。

For perimenopausal women, you can also treat them with hormone replacement.

对于围绝经期女性，还可以通过激素替代治疗。

So someone in her 40s, I want to make sure if she didn't have it and suddenly she has...

所以一个 40 多岁的人，我想确定她是否没有这种症状，但突然她有了……

It's not like she hasn't had PMDD and suddenly she has PMDD.

她并不是没有患过经前抑郁症，而是突然得了经前抑郁症。

It's probably, it could be perimenopause, so you don't want to miss that.

可能是更年期，所以你不想错过这个。

Andrew Huberman: Great.

安德鲁·休伯曼：太好了。

It's the first time I've heard such a thorough description of what PMDD is and what one can do about it.

这是我第一次听到如此详尽的描述什么是经前抑郁症以及人们可以采取什么措施。

I think you just helped a ton of people.

我想你刚刚帮助了很多人。

A lot of questions about fasting and about low-starch, aka low-carbohydrate, diets.

关于禁食和低淀粉（又称低碳水化合物）饮食的很多问题。

Thaïs Aliabadi: I 100% say yes.

Thais Aliabadi：我 100% 同意。

A lot of us are eating...

我们很多人都在吃...

If you're waking in the morning and having bread, and pasta for lunch, and then you're having ice cream, and then you have rice and, I don't know, pizza for dinner, of course it'll start that process.

如果你早上醒来，午餐吃面包和面食，然后吃冰淇淋，然后吃米饭，晚餐吃披萨，我不知道，当然它会开始这个过程。

Diet is extremely important.

饮食极其重要。

One thing I try to stay away from is limiting these patients or telling a 22-year-old, "You are not to have any carbohydrates." That's not sustainable.

我试图避免的一件事是限制这些患者或告诉 22 岁的人，“你不应该吃任何碳水化合物。”这是不可持续的。

What I believe is, if you fix their underlying condition and address their insulin resistance and help them exercise and have healthy habits, you can fix these symptoms.

我相信，如果你解决他们的根本问题，解决他们的胰岛素抵抗问题，帮助他们锻炼身体并养成健康的习惯，你就可以解决这些症状。

Just cutting carbohydrates out, a lot of these PCOS patients are already doing this.

只是减少碳水化合物的摄入，很多多囊卵巢综合症患者已经在这样做了。

They're literally starving themselves, and they're exercising, and they're not losing weight.

他们实际上是在挨饿，他们在锻炼，但体重却没有减轻。

It's because their underlying condition has not been addressed.

这是因为他们的根本状况尚未得到解决。

So I would say, like anything else, add moderation, but you don't want to tell someone, "Don't eat carbohydrates." It's not sustainable.

所以我想说，就像其他事情一样，要适量，但你不想告诉别人，“不要吃碳水化合物。”这是不可持续的。

Andrew Huberman: Someone said that their estradiol patch is causing some hair loss.

安德鲁·休伯曼：有人说他们的雌二醇贴片会导致一些脱发。

Is there another option?

还有其他选择吗？

Thaïs Aliabadi: I don't think it's the estradiol patch causing the hair loss.

Thaïs Aliabadi：我不认为雌二醇贴片导致脱发。

Women who use estradiol patches are going through perimenopause and menopause.

使用雌二醇贴剂的女性正在经历围绝经期和更年期。

One of the issues with perimenopause and menopause is that a drop in estrogen does cause hair thinning.

围绝经期和更年期的问题之一是雌激素下降确实会导致头发稀疏。

So, for that reason, I would say I usually treat these patients with minoxidil.

因此，出于这个原因，我会说我通常用米诺地尔治疗这些患者。

You can either use Rogaine on your scalp, or you can take oral minoxidil.

您可以在头皮上使用落健，也可以口服米诺地尔。

The prescription is 2.5.

处方是2.5。

You can start with as little as 0.5 every single day.

您可以从每天 0.5 份开始。

The problem is, hair thinning is very common in menopause, and you want to hit it quick.

问题是，头发稀疏在更年期很常见，你想尽快解决它。

So if you start noticing that you're losing hair, take the minoxidil.

因此，如果您开始注意到自己正在脱发，请服用米诺地尔。

It doesn't work overnight.

它不是一夜之间就能发挥作用的。

You will probably start seeing results in about six months, but in two years, you'll see a huge difference in your hair.

您可能会在大约六个月内开始看到结果，但两年后，您就会看到头发的巨大变化。

But hit it early, and it's not the estrogen patch.

但要早点开始，而且这不是雌激素贴片。

I doubt it.

我对此表示怀疑。

Andrew Huberman: A number of questions about how to improve the quality of eggs after age 35, presumably by doing all the things that we already talked about.

Andrew Huberman：关于如何在 35 岁之后提高卵子质量的一些问题，大概是通过做我们已经讨论过的所有事情来实现的。

Thaïs Aliabadi: Everything we talked about for the past two hours.

Thaïs Aliabadi：过去两个小时我们谈论的一切。

Andrew Huberman: Yeah, lower intravisceral fat, lower inflammation, and improved insulin sensitivity.

Andrew Huberman：是的，降低内脏脂肪，降低炎症，并提高胰岛素敏感性。

Thaïs Aliabadi: Suppress endometriosis for sure, because endometriosis will go after those egg counts and quality.

Thaïs Aliabadi：肯定会抑制子宫内膜异位症，因为子宫内膜异位症会影响卵子数量和质量。

PCOS will go after your quality.

PCOS 会追求您的品质。

Andrew Huberman: Does endometriosis pain start to wane with perimenopause?

Andrew Huberman：子宫内膜异位症的疼痛会随着围绝经期而开始减弱吗？

Thaïs Aliabadi: Yes, it gets better.

Thais Aliabadi：是的，情况变得更好了。

The problem is, women in their 40s have a lot of adenomyosis, which mimics the symptoms of endometriosis.

问题是，40多岁的女性有很多子宫腺肌病，它的症状与子宫内膜异位症相似。

So these women actually do extremely well with the progesterone IUD.

所以这些女性实际上使用黄体酮宫内节育器效果非常好。

We talked about the Mirena IUD because it suppresses their pelvis and their endometriosis, and once they go through menopause...

我们谈论曼月乐宫内节育器，因为它可以抑制她们的骨盆和子宫内膜异位症，一旦她们经历更年期……

This is a very important point, and I'm so glad you brought it up, because doctors don't realize this.

这是非常重要的一点，我很高兴你提出来，因为医生没有意识到这一点。

For patients with endometriosis, menopause will make the pain go away, right?

对于子宫内膜异位症患者来说，更年期会让疼痛消失吧？

Because what happens in menopause, our ovaries are not functioning, and the estrogen levels drop.

因为更年期时，我们的卵巢不再发挥作用，雌激素水平下降。

However, you come and give these women estrogen, what happens?

然而，你来给这些女性注射雌激素，会发生什么呢？

You can stimulate these endometriosis implants all over again, and this is what happens.

你可以再次刺激这些子宫内膜异位种植体，结果就是这样。

So, endometriosis patients, in general, have a slightly higher increased risk of ovarian cancer, especially the ones with endometriomas or advanced disease.

因此，一般来说，子宫内膜异位症患者患卵巢癌的风险略高，尤其是患有子宫内膜异位症或晚期疾病的患者。

And postmenopause hormone replacement, the estrogen can still stimulate these implants.

而绝经后激素替代后，雌激素仍然可以刺激这些植入物。

Now, a lot of women in the healthcare system who have undergone a hysterectomy, meaning they remove their uterus, the doctor says, "You don't need progesterone," because we think we give the progesterone to protect the lining of the uterus from unopposed estrogen causing uterine cancer.

现在，医疗保健系统中的许多女性都接受了子宫切除术，这意味着她们切除了子宫，医生说，“你不需要黄体酮”，因为我们认为我们给予黄体酮是为了保护子宫内膜免受雌激素的抵抗而导致子宫癌。

Well, that's not true.

嗯，事实并非如此。

In patients with endometriosis, even when they undergo a hysterectomy and they're using estrogen patches, you always want to give them the progesterone because otherwise, you stimulate these implants again because of unopposed estrogen.

对于子宫内膜异位症患者，即使他们接受了子宫切除术并且使用了雌激素贴片，你也总是想给他们注射黄体酮，因为否则，由于雌激素不受对抗，你会再次刺激这些植入物。

That's one reason, and also we use the progesterone, micronized progesterone, in hormone replacement for patients who are anxious, who are not sleeping well, regardless of whether or not they have a uterus.

这是原因之一，而且我们还使用黄体酮（微粉化黄体酮）来替代激素，用于治疗焦虑、睡眠质量不佳的患者，无论他们是否有子宫。

But endometriosis patients, their hormone replacement should always be with progesterone.

但子宫内膜异位症患者的激素替代应始终使用黄体酮。

Andrew Huberman: Are there any natural ways to increase progesterone?

Andrew Huberman：有什么自然的方法可以增加黄体酮吗？

Thaïs Aliabadi: So, one reason our body doesn't...

Thaïs Aliabadi：所以，我们的身体不这样做的原因之一......

When we don't ovulate, we don't make that corpus luteum cyst, and we don't have that progesterone being secreted.

当我们不排卵时，我们不会产生黄体囊肿，也不会分泌黄体酮。

So in PCOS, let's say, by lowering your weight, by lowering that visceral fat, by regulating your insulin resistance, you can increase your chance of ovulation.

因此，对于多囊卵巢综合症来说，通过减轻体重、降低内脏脂肪、调节胰岛素抵抗，您可以增加排卵的机会。

And by ovulation, then you start releasing the progesterone.

当排卵时，你开始释放黄体酮。

So that's the best way of describing it.

这是描述它的最好方式。

But for perimenopausal women, then you need to prescribe them the micronized progesterone.

但对于围绝经期女性，您需要给她们开微粉化黄体酮。

Andrew Huberman: You already answered this earlier, but I think it's worth just briefly repeating.

Andrew Huberman：您之前已经回答过这个问题，但我认为值得简单重复一下。

How does diet affect female hormone health?

饮食如何影响女性荷尔蒙健康？

Thaïs Aliabadi: As we get closer to menopause, we become more insulin resistant, regardless of whether we had PCOS or not.

Thaïs Aliabadi：当我们接近更年期时，无论我们是否患有多囊卵巢综合症，我们都会变得更加胰岛素抵抗。

So dealing with insulin, almost all of us women deal with insulin resistance at some point in our lives at different degrees.

因此，在胰岛素方面，几乎所有女性都会在生命中的某个阶段不同程度地应对胰岛素抵抗。

But that goes to what I was telling you, when you load the gun with your genetics, and you pull the trigger with epigenetics, your diet, your exercise, your sleep, your stress, all of that will affect it long term.

但这就是我告诉你的，当你用你的遗传学装上枪，你用表观遗传学扣动扳机时，你的饮食、你的锻炼、你的睡眠、你的压力，所有这些都会长期影响它。

Andrew Huberman: What can women do to prolong their fertility?

Andrew Huberman：女性可以做些什么来延长生育能力？

I suppose everything you've already talked about.

我想你已经谈论过的一切。

Thaïs Aliabadi: But you see?

Thaïs Aliabadi：但是你看到了吗？

But now you know how to answer it.

但现在你知道如何回答这个问题了。

Don't dismiss your endometriosis.

不要忽视你的子宫内膜异位症。

Don't dismiss your PCOS.

不要忽视你的多囊卵巢综合症。

Know your egg count.

了解您的卵子数量。

Make sure you freeze your eggs early if you can afford it.

如果你能负担得起的话，请确保尽早冷冻你的卵子。

I mean, all the steps we talked about for the past four hours.

我的意思是，我们过去四个小时讨论的所有步骤。

Andrew Huberman: I could listen to you for many, many hours, and I know the audience can, too.

安德鲁·休伯曼：我可以听你很多很多小时，我知道观众也可以。

Several things.

有几件事。

First of all, thank you for coming here today to share with us a true treasure trove of information.

首先，感谢您今天来到这里与我们分享真正的信息宝库。

I mean, I have to imagine that most of what people heard, they have not heard before, and certainly not with the depth, rigor, and actionable items that you've suggested.

我的意思是，我必须想象人们听到的大部分内容是他们以前从未听说过的，当然也没有你所建议的深度、严谨性和可操作性。

So just thank you, thank you, thank you for taking the time.

所以谢谢你，谢谢你，谢谢你抽出时间。

Thaïs Aliabadi: Aw.

泰伊斯·阿利亚巴迪：噢。

Andrew Huberman: You're very busy.

安德鲁·休伯曼：你很忙。

You have four children, you're happily married, you run a very active clinic, and your story about running off to deliver babies at a rate of 80 or more per month while pregnant says it all.

你有四个孩子，你的婚姻幸福，你经营着一家非常活跃的诊所，你在怀孕期间以每月 80 个或更多的速度逃跑接生的故事说明了一切。

But that you would take the time to come here and share with our audience, the general public, that is, I'm immensely grateful.

但您能抽出时间来到这里与我们的观众、广大公众分享，我非常感激。

I know they are immensely grateful.

我知道他们非常感激。

We will put links so that people can find you and the various resources discussed, as well as another call to action to listen to SHE MD, your podcast.

我们将放置链接，以便人们可以找到您和讨论的各种资源，以及另一个号召性用语来收听您的播客 SHE MD。

I also just want to thank you for being you, which is sort of a funny statement on the surface.

我也只是想感谢你做你自己，这从表面上看是一种有趣的说法。

But truly, I mean, your passion for what you do, your passion for women's health, and again, the depth and rigor with which you approach these things, that, I think, for most people, they look up one or two things, see a few symptoms for this age to this age group, and you're giving people tools to potentially diagnose their own endometriosis, PCOS, and breast cancer, extend fertility, live life with far less pain, ideally no pain, and perhaps most importantly, to give them clarity and the sense that they are indeed sane in a world that basically is sending back the opposite message because it just doesn't understand what they're going through.

但说实话，我的意思是，你对自己所做的事情的热情，你对女性健康的热情，再说一次，你处理这些事情的深度和严谨性，我认为，对于大多数人来说，他们会查找一两件事，看到这个年龄段到这个年龄段的一些症状，你为人们提供了潜在的工具来诊断自己的子宫内膜异位症、多囊卵巢综合症和乳腺癌，延长生育能力，过着更少痛苦的生活，最好没有痛苦，也许最重要的是，让他们清晰和感觉在一个基本上发回相反信息的世界里，他们确实是理智的，因为它不明白他们正在经历什么。

So, words really can't say enough for how grateful I am to have you here and to share this knowledge, and that the audience is sure to glean from you.

因此，言语无法表达我对您的到来并分享这些知识的感激之情，而且观众一定会从您那里学到知识。

Thaïs Aliabadi: You're so sweet.

Thais Aliabadi：你真可爱。

Andrew Huberman: I would really like to have you back again to talk about where these things are going, because it sounds like the field is advancing very quickly, too.

Andrew Huberman：我真的很想让你再次回来谈论这些事情的进展，因为听起来这个领域也进展得非常快。

And everybody out there, head to the various resources that Dr. Aliabadi shared, and please share with me in thanking her through her social media channels, her podcast, and all the rest, and just really, truly, thank you, thank you so much.

大家请前往 Aliabadi 博士分享的各种资源，并请与我分享，通过她的社交媒体渠道、她的播客以及其他所有方式向她表示感谢，真的，真的，谢谢你们，非常感谢。

Thaïs Aliabadi: Aw, you're so sweet.

Thais Aliabadi：噢，你真可爱。

Thank you for having me.

谢谢你有我。

Thank you for giving me this opportunity, this mic, so I can take this time to talk about women and women's health.

感谢您给我这个机会，这个麦克风，所以我可以利用这个时间谈论女性和女性健康。

I love women.

我爱女人。

I'm surrounded by them.

我被他们包围了。

I have four daughters.

我有四个女儿。

I do this for them, for the world, and this world will be a better place if we take care of our women.

我这样做是为了她们，为了世界，如果我们照顾我们的女性，这个世界将会变得更加美好。

Andrew Huberman: Well, God bless you for doing it.

安德鲁·休伯曼：好吧，上帝保佑你做到了。

Thank you.

谢谢。

Thaïs Aliabadi: Thank you.

泰伊斯·阿利亚巴迪：谢谢。

Andrew Huberman: Thank you for joining me for today's discussion with Dr. Thaïs Aliabadi.

Andrew Huberman：感谢您参加今天与 Thaïs Aliabadi 博士的讨论。

To learn more about her work and to find links to the various resources we discussed, please see the show note captions.

要了解有关她的工作的更多信息并查找我们讨论的各种资源的链接，请参阅节目注释标题。

If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel.

如果您正在学习和/或喜欢此播客，请订阅我们的 YouTube 频道。

That's a terrific, zero-cost way to support us.

这是支持我们的绝佳且零成本的方式。

In addition, please follow the podcast by clicking the Follow button on both Spotify and Apple.

此外，请通过单击 Spotify 和 Apple 上的“关注”按钮来关注播客。

And on both Spotify and Apple, you can leave us up to a five-star review, and you can now leave us comments at both Spotify and Apple.

在 Spotify 和 Apple 上，您可以给我们留下五星级的评论，现在您可以在 Spotify 和 Apple 上给我们留下评论。

Please also check out the sponsors mentioned at the beginning and throughout today's episode.

另请查看今天节目开头和整个节目中提到的赞助商。

That's the best way to support this podcast.

这是支持这个播客的最佳方式。

If you have questions for me, or comments about the podcast, or guests, or topics that you'd like me to consider for the Huberman Lab podcast, please put those in the comments section on YouTube.

如果您对我有疑问，或者对播客、嘉宾有意见，或者您希望我为 Huberman Lab 播客考虑的主题，请将这些内容放入 YouTube 的评论部分。

I do read all the comments.

我确实阅读了所有评论。

For those of you that haven't heard, I have a new book coming out.

对于那些还没有听说过的人，我即将出版一本新书。

It's my very first book.

这是我的第一本书。

It's entitled "Protocols: An Operating Manual for the Human Body." This is a book that I've been working on for more than five years, and that's based on more than 30 years of research and experience.

它的标题是“协议：人体操作手册”。这本书是我花了五年多时间编写的，它基于 30 多年的研究和经验。

And it covers protocols for everything from sleep to exercise to stress control, protocols related to focus and motivation, and of course, I provide the scientific substantiation for the protocols that are included.

它涵盖了从睡眠到运动再到压力控制的所有协议，以及与注意力和动机相关的协议，当然，我为所包含的协议提供了科学依据。

The book is now available by presale at protocolsbook.com.

该书现已在protocolbook.com 上预售。

There, you can find links to various vendors.

在那里，您可以找到各个供应商的链接。

You can pick the one that you like best.

您可以选择您最喜欢的一个。

Again, the book is called "Protocols: An Operating Manual for the Human Body." And if you're not already following me on social media, I am hubermanlab on all social media platforms.

同样，这本书的名字是“协议：人体操作手册”。如果您还没有在社交媒体上关注我，我是所有社交媒体平台上的 hubermanlab。

So that's Instagram, X, Threads, Facebook, and LinkedIn.

这就是 Instagram、X、Threads、Facebook 和 LinkedIn。

And on all those platforms, I discuss science and science-related tools, some of which overlaps with the content of the Huberman Lab podcast, but much of which is distinct from the information on the Huberman Lab podcast.

在所有这些平台上，我讨论科学和与科学相关的工具，其中一些与胡伯曼实验室播客的内容重叠，但其中大部分与胡伯曼实验室播客上的信息不同。

Again, it's hubermanlab on all social media platforms.

再说一遍，所有社交媒体平台上都是 hubermanlab。

And if you haven't already subscribed to our Neural Network Newsletter, the Neural Network Newsletter is a zero-cost, monthly newsletter that includes podcast summaries as well as what we call Protocols in the form of one to three-page PDFs that cover everything from how to optimize your sleep, how to optimize dopamine, deliberate cold exposure.

如果您还没有订阅我们的神经网络时事通讯，神经网络时事通讯是一份零成本的月度时事通讯，其中包括播客摘要以及我们所说的一到三页 PDF 形式的协议，涵盖从如何优化睡眠、如何优化多巴胺、故意冷暴露等所有内容。

We have a foundational fitness protocol that covers cardiovascular training and resistance training.

我们有一个基本的健身方案，涵盖心血管训练和阻力训练。

All of that is available at completely zero cost.

所有这些都可以完全零成本获得。

You simply go to hubermanlab.com, go to the Menu tab in the top right corner, scroll down to Newsletter, and enter your email.

您只需访问 hubermanlab.com，转到右上角的“菜单”选项卡，向下滚动到新闻通讯，然后输入您的电子邮件即可。

And I should emphasize that we do not share your email with anybody.

我要强调的是，我们不会与任何人分享您的电子邮件。

Thank you once again for joining me for today's discussion with Dr. Thaïs Aliabadi.

再次感谢您参加今天与 Thaïs Aliabadi 博士的讨论。

And last, but certainly not least, thank you for your interest in science.

最后但同样重要的是，感谢您对科学的兴趣。

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