Why "Evidence-Based" Medicine Is Stuck in the Past

Dr. Meryl Kahan, MD, FACOG, MSCP is a board-certified OB-GYN and Menopause Society Certified Practitioner who spent nine years practicing full-scope obstetrics and gynecology before walking away from delivering babies to solve a different problem: the near-total absence of real menopause training in medicine. She founded SheMD, a solo direct-care gynecology practice in Manhattan focused on perimenopause, menopause, and hormone health for women in their 30s, 40s, and 50s. In this conversation with Dr. Amy Loden Tiffany, you'll learn why "evidence-based medicine" often means being stuck in outdated data, the real difference between bioidentical and compounded hormones, how one doctor uses FSH levels to know whether hormone replacement is actually working, and why waiting until 65 for your first bone density scan may be costing women their strength, independence, and years of healthy life. ⏱️ CHAPTERS 00:00 – Welcome to The Authentic Physician 00:23 – Who is Dr. Meryl Kahan? 03:31 – Who are you without your credentials? 06:25 – What does it really mean to be your own boss in medicine? 08:15 – Is independent practice still evidence-based? 11:06 – Does lack of evidence equal proof of harm? 12:25 – Why is there stigma around bioidentical hormones? 13:20 – Bioidentical vs. compounded: what's the difference? 17:41 – Should doctors test hormone levels or treat symptoms? 21:26 – How do you know when your HRT dose is right? 24:22 – What won't Dr. Kahan compromise on in women's health? 27:49 – Why did both doctors leave insurance behind? 30:40 – Is cash-pay healthcare actually cheaper? 35:13 – Why is waiting until 65 for a DEXA scan harmful? 37:01 – What did the HRT black box warning cost women? 39:08 – What is the osteopenia window — and why does it matter? Bioidentical hormones are structurally identical to the hormones the human body naturally produces. The average age of menopause is 51, yet standard guidelines do not recommend bone density screening until age 65 — a 14-year gap. Vaginal estrogen is now considered safe even for breast cancer patients. Compounded medications are prepared outside commercial pharmacies and often contain FDA-approved ingredients. 🎙️ ABOUT YOUR HOST Dr. Amy Loden Tiffany, MD, MBA, FACP is a triple board-certified physician (Internal Medicine, Lifestyle Medicine, Obesity Medicine) and founder of Vitality Medical and Wellness Consulting, a physician-led concierge practice in St. Louis helping women navigate postpartum, perimenopause, menopause, and midlife health. 🌐 https://vitalitymwc.org 👩‍⚕️ CONNECT WITH DR. KAHAN 🌐 https://www.shemdgyn.com 📸 Instagram: @shemd_ny