Cushing’s Disease is common in dogs but rare and hard to diagnose in people. That’s why University of Georgia researchers are leveraging canine treatments to find new solutions to battle the condition in humans. This collaboration between veterinary medicine and human health care is just one example of how UGA uses a Precision One Health approach to find and tailor new medical treatments for people and animals.
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Imagine your body as a well-run newsroom. Each day, the editor-in-chief—in this case, the pituitary gland—provides assignments, keeping everything running smoothly. One day, however, the editor’s role is usurped by a rogue reporter who declares breaking news nonstop, flooding the newsroom with bulletins and sending everyone into overdrive.
This is a bit like Cushing’s Disease. The rogue reporter is a tiny, usually benign tumor, the stress bulletins cortisol. The newsroom—your body—responds with metabolic fluctuations, burnt out muscles, emotional distress, and more. Over the long haul, Cushing’s Disease can cause lasting deterioration of the body: osteoporosis, muscle weakness, high blood pressure and heart disease, diabetes, memory and mood issues, fatigue, and more.
It’s a common disease and easier to detect in canines. In people, however, it is rare and difficult to diagnose. University of Georgia researchers are leveraging canine treatments to find new solutions to battle the condition in humans.
This collaboration between veterinary medicine and human health is just one example of how UGA uses a Precision One Health approach to find and tailor new medical treatments for people and animals.
The landscape for compounded weight loss medicines is changing rapidly. Some availability depends on the state you live in. You may have heard that a U.S. federal judge has denied an injunction that would have allowed compounding pharmacies to keep making copies of Eli Lilly’s weight-loss and diabetes drugs Zepbound and Mounjaro (generic name Tirzepatide) in the United States. This was based on Lilly saying the shortage of Zepbound and Mounjaro has ended which most experts say is not true.
The Outsourcing Facility Association that filed the lawsuit said that the number of patients taking compounded GLP-1s as in the millions, so banning compounding pharmacies from providing these medicines will cause a shortage. This injunction does not current affect the Novo Nordisk’s drugs Ozempic or Wegovy (generic name Semaglutide), although it may in April 2025. Hundreds of Dr. Friedman’s patients have benefited from these compounded GLP-1s which are available in syringes allowing individual dosing that is not possible with the commercial medicines. Compounded GLP-1s do not require insurance pre-authorization and are much more affordable.
Compounding Pharmacies that Dr. Friedman works with
Dr. Friedman works with several compounding pharmacies to provide affordable and safe GLP-1 drugs that have improved patients’ health and weight. Dr. Friedman has communicated with representatives from the three compounding pharmacies he works with University Compounding Pharmacy (UCP), Strive Pharmacy and Empower Pharmacy and each pharmacy with each companies’ availability below. Dr. Friedman’s philosophy is that compounded pharmacies are supplying “Tirzepatide” and “Semaglutide” and not “Ozempic”, “Wegovy”, “Zepbound” and “Mounjaro” and that they are supplying customized dosing that are not available with the fixed doses supplied by the pharmaceutical companies.
According to the Wall Street Journal, Hims & Hers referred to a March 2 social-media post by Chief Executive Andrew Dudum saying the firm would stop selling commercially available doses in mid-May but would keep providing compounded versions if they have been getting a personalized dosing regimen. Thus, the personalized dosing regimen of GLP-1s (syringes that allow patients to adjust dosing) may allow them to continue to supply these compounds.
Legal Status as of April 1, 2025
Eli Lilly is suing two pharmacies for compounding Zepbound and Mounjaro, claiming the companies are skirting the Food and Drug Administration’s ban on the practice and luring people away from Lilly’s medicines. In lawsuits filed April 1, 2025 in Delaware and New Jersey, Lilly alleges the two companies — Strive Pharmacy and Empower Pharmacy — are falsely marketing their products as personalized versions of the drugs that have been clinically tested and are made using stringent safety standards. Lilly argues these claims are turning people toward compounded drugs and away from its FDA-approved treatments.
Tirzepatide versus Semaglutide
Overall, Dr. Friedman prefers Tirzepatide over Semaglutide as it gives more weight loss and less side effects but is currently available in CA only in the sublingual form. Dr. Friedman’s top recommendations are in red.
Siblingual Tirzepatide atUCP– is an excellent choice. Patients pay UCP. Tirzepatide injections have been discontinued but they have sublingual (under the tongue) Tirzepatide (10 mg/mL). One can start with 2.5 mg (0.25 mL) twice a week for 2 weeks, then go up to 5 mg (0.5 mL) twice a week for 4 weeks and then go up to 10 mg under the tongue twice a week, which is the final recommended dose. The price for 10 mL (lasts about 2 months) is $199. The 20 mL is $299. It needs to be refrigerated and can be used for 90 days after opening the bottle. It comes with a syringe that can withdraw the liquid from the vial and put under the tongue, where it should be held for 1 minute and then swallowed. It is best to take with a “dry” mouth and not to drink/eat for 30 minutes after administration. Because the sublingual product is new, its weight-loss properties compared to injectable Tirzepatide are not known.
Compounded Semaglutide/ B12 FIVE is available from UCP until April 22, 2025, and is available in 44 states including Califormia. A 5 mg vial that last about 2 months is $299.
Strive Pharmacy Strive Pharmacy, which compounds Semaglutide (brand name Ozempic, Wegovy), and Tirzepatide (brand name Mounjaro, Zepbound) is a 503B compounding pharmacy that offers GLP-1RAs to patients at a low price in 31 states including California. For Strive pharmacy, patients pay Dr. Friedman directly. There are several options available at Strive Pharmacy, with the common 3 options seen in this table:
Strive
How to order
Mg per vial
Use for which dose
Theoretical doses per vial*
Cost per vial*
State
Semaglutide#
2.5 mg/ml – 2 ml vial
5 mg
0.25 mg weekly for 4 weeks, then .5 mg weekly for 4 weeks, then 1 mg weekly for 2 weeks
10
$299
CA
Semaglutide/Glycine/B12
5mg/5mg/1mg/mL 2 ml vial
10 mg
0.25 mg weekly for 4 weeks, then 0.5 mg weekly for 4 weeks, then 1 mg weekly for 7 weeks
15
$299
Out of CA
Tirzepatide/Glycine/B12
10mg/5mg/500mcg/mL 2 ml vial
20 mg
1 mg (0.1 ml) weekly for 2 weeks, then 2 mg (0.2 ml) weekly for 4 weeks, then 4 mg (0.4 ml) weekly
9
$299
Out of CA
Empower compounding pharmacy ships to all states but CA, WI and IA. Patients pay Empower directly.
Semaglutide / Cyanocobalamin Injection
1/0.5 mg/mL 1 mL $94.68
1/0.5 mg/mL 2.5 mL $118.96
5/0.5 mg/mL 1 mL $132.18
5/0.5 mg/mL 2.5 mL $219.49
Tirzepatide / Niacinamide Injection
8/2 mg/mL 2.5 mL $188.20
17/2 mg/mL 2 mL $308.53
17/2 mg/mL 4 mL $559.21
Zepbound Glass Vials For those patients who insist on non-compounded preparations, Zepbound Glass Vials from Lilly Direct are an option. The cost for the 4 of the 10 mg vials is $499 for the first vial and $499 if renewed within 45 days or $699 if renewed after 45 days. Patients need to register on LillyDirect.lilly.com and purchase syringes for a small fee. Each vial is 0.5 ml, so the concentration is 2 mg/0.1 ml. Although the company discourages using the vial for multi-dosing (it doesn’t contain a preservative), one option would be to inject 1 mg (0.05 mL) weekly for 2 weeks, 2 mg (0.1 mL) weekly for 2 weeks, then 4 mg (0.2 ml) weekly. The box of 4 vials would last about 10 weeks.
Because of the different options for compounded GLP-1s, Dr. Friedman is advising his patients to make a 10-minute followup appointment to discuss options.
For more information, please read about compounded GLP-1s, and listen to listen Dr. Friedman’s original GoodHormoneHealth Webinar on November 17, 2024 on compounded Tirzepatide vs Semaglutide for patients with endocrine problems
Dr. Friedman discussed the updated situation for compounded GLP-1s at his most recent GoodHormoneHealth Webinar on Sunday March 23rd at 6:00 PM after his talk on “How can Blue Zones and Maimonides’ principles be applied to lead a healthy life for patients with endocrine problems?”
It is available on YouTube:
Protect access to compounded medications — make your voice heard. Sign the Petition!
STORY: Could artificial intelligence be used to make brain surgery safer?
At this university in London, trainee surgeon Danyal Khan is taking part in a mock operation during which he’s assisted by a real-time video feed, as is typical in brain surgery.
But what’s new here is that the footage is being analyzed by AI to help Khan better understand what he’s seeing.
The AI system, which is under development at University College London (UCL), highlights sensitive or critical structures in the brain.
Neurosurgeon Hani Marcus believes it has the potential to make brain surgery safer and more effective:
“So I’m very bullish that in the medium to long term, the A.I. will be helping lots of surgeons do lots of operations better than they otherwise can.”
Marcus says the AI system analyzed video of more than 200 pituitary gland tumor operations, and gained around 10 years-worth of experience in a fraction of the time.
That knowledge means the AI can now not only help navigate to the correct area of the brain, but also know what should be happening at any stage of the procedure, making it a valuable training aid.
“So, what we’re really trying to do is apply AI or artificial intelligence to support surgeons doing brain tumor surgery at the base of the brain. And what this practically entails is us training the AI with hundreds of videos, telling it, if you like, what structures are what and then at some point over that period, the AI becomes really good itself at recognising things, and able to support other surgeons who’re perhaps less experienced in advising them what to do next.”
Assistant Professor of Robotics and A.I. Sophia Bano explains how that might look in a real operation:
“There can be scenarios where clinicians, unintentionally, are very close to a very critical structure such as the optic nerve. This can have, any damage or a slight more pressure on the optic nerve, can have long term complications on the patient side. So, this whole tool will alert the surgeon during the procedure if there is any risk of potential complication so they can recalibrate themselves during the procedure.”
Khan, who was also involved in developing the software that is now helping him learn, says the A.I. system has been a valuable tool in his training.
It could also provide him with step-by-step guidance during a procedure, similar to having a senior surgeon standing over your shoulder.
“I think as I progress as a surgeon, there might be stages where I wonder, you know, have I done enough of a particular part of the procedure and should I move on? And actually having that sort of assistant in the background as a reassurance to look at and say, ‘well, yeah, actually, at this stage, out of the hundreds of videos of experts that this algorithm has watched, the experts would probably start moving on to the next phase’. It’s a useful double check.”
According to UCL, the system could be ready to be used in operating theaters within two years.
Dexamethasone, a cheap and widely used steroid, has become the first drug shown to be able to save lives among Covid-19 patients in what scientists hailed as a “major breakthrough”.
Results of trials announced on Tuesday showed dexamethasone, which is used to reduce inflammation in other diseases, reduced death rates by around a third among the most severely ill Covid-19 patients admitted to hospital.
The results suggest the drug should immediately become standard care in patients with severe cases of the pandemic disease, said the researchers who led the trials.
“This is a result that shows that if patients who have Covid-19 and are on ventilators or are on oxygen are given dexamethasone, it will save lives, and it will do so at a remarkably low cost,” said Martin Landray, an Oxford University professor co-leading the trial, known as the RECOVERY trial.
“It’s going to be very hard for any drug really to replace this, given that for less than 50 pounds ($63.26), you can treat eight patients and save a life,” he told reporters in an online briefing.
His co-lead investigator, Peter Horby, said dexamethasone was “the only drug that’s so far shown to reduce mortality – and it reduces it significantly.”
“It is a major breakthrough,” he said. “Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.”
There are currently no approved treatments or vaccines for Covid-19, the disease caused by the new coronavirus which has killed more than 431,000 globally.
Saving ‘countless lives’
The RECOVERY trial compared outcomes of around 2,100 patients who were randomly assigned to get the steroid, with those of around 4,300 patients who did not get it.
The results suggest that one death would be prevented by treatment with dexamethasone among every eight ventilated Covid-19 patients, Landray said, and one death would be prevented among every 25 Covid-19 patients that received the drug and are on oxygen.
Among patients with Covid-19 who did not require respiratory support, there was no benefit from treatment with dexamethasone.
“The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients,” Horby said.
Nick Cammack, a expert on Covid-19 at the Wellcome Trust global health charity, said the findings would “transform the impact of the Covid-19 pandemic on lives and economies across the world”.
“Countless lives will be saved globally,” he said in a statement responding to the results.
The RECOVERY trial was launched in April as a randomised clinical trial to test a range of potential treatments for Covid-19, including low-dose dexamethasone and the malaria drug hydoxycholoroquine.
The hydroxychloroquine arm was halted earlier this month after Horby and Landray said results showed it was “useless” at treating Covid-19 patients.
Global cases of infection with the novel coronavirus have reached over 8 million, according to a Reuters tally, and more than 434,000 people have died after contracting the virus, the first case if which was reported in China in early January.
In this “3 in 3” video, Ji Hyun (CJ) Chun, PA-C, BC-ADM, covers 3 types of pituitary disorders and describes useful workups for use by primary care clinicians.
Clinician Reviews’ “3 in 3” video series delivers 3 take-home points in 3 minutes—or less.
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