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Dr. David
Dr. David, Other
Category: Endocrinology
Satisfied Customers: 45195
Experience:  Experienced physician, undergraduate studies at MIT, studied Engineering, qualified to answer your questions.
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Any recommendations for my prev lean athletic teen daughter

Customer Question

Any recommendations for my prev lean athletic teen daughter who has had excess weight gain despite healthy diet (organic totally unprocessed foods) and minimum 60 min exercise including hiit and resistance training? Been trying to lose weight with gain instead. 45 pounds in a year. She has normal fasting glu, fasting insulin 5, normal FSH and LH. Normal ratio of lh/fsh. Normal tsh ft4. Normal tsh. Normal late night salivary cortisol. Shes late bloomer and menses at 15 with regular cycles. No signif hirsuitism. Has acne. Working dx is pcos but no response on metformin at all. Now on low carb but diet baseline already 100-150 carb. Now 50 net. Had us with follicles that could be pcos vs puberty (11 follicles and 12).
Im a doctor. But not peds endo. Im stumped.
Submitted: 6 months ago.
Category: Endocrinology
Customer: replied 6 months ago.
Have seen peds endo and awaiting referral to tertiary center.
Customer: replied 6 months ago.
She is 5'4". Was 110. Now 157. No obesity in family. She was 50th percentile all her life. Im 5'1" and 100 pounds. Husband 5'9" athletic 175.
Expert:  Dr. David replied 6 months ago.

This is Dr. David. I am reviewing your question now and will be with you momentarily.

Expert:  Dr. David replied 6 months ago.

she needs to get blood androgen levels checked and pelvic ultrasound scans to check for PCOS

she may need to go on birth control pills and metformin to help decrease weight.

she should see a dietician and work on optimizing her diet, cutting carbohydrates and increasing her protein intake and continue to exercise.

she may have to eat less than 50mg of carbs a day. does she drink soda? she should stop that.

she may benefit from adding weight training to her regimen.

she can have also blood test for ACTH and AM cortisol levels to check her steroid hormone levels.

Customer: replied 6 months ago.
Probably did not see my entire question. She has had all that done.
Customer: replied 6 months ago.
Testosterone total/free normal
Expert:  Dr. David replied 6 months ago.

at her age of 16, she is going through puberty and having increase of her estrogen levels which can cause her weight gain.

Customer: replied 6 months ago.
Normal estrogen levels. Normal FSH normal age. 40 pound to 45 pound weight gain is not normal for anyone in my family
Customer: replied 6 months ago.
It's not just the weight gain that's a concern… It's her inability to lose weight. She is already on Metformin 500 b.i.d. which has done nothing. She is eating under 50 carbs a day. She is eating under 1200 cal a day all organic lean meats, organic cruciferous vegetables. No grains no dairy no gluten
Customer: replied 6 months ago.
In my initial question I stated she is doing resistance training/weight training. She has a personal trainer 4 hours a week
Expert:  Dr. David replied 6 months ago.

at age 16, she should not be pushing so hard to loose weight.

she still has more growing to do.

she needs nutrition for her body at this point to grow and develop

her brain and body have not fully developed yet.

she could still grow in height

Customer: replied 6 months ago.
She is still gaining on this regimen. It isnt muscle.
Customer: replied 6 months ago.
She will be 17 next week. Not likely to grow taller
Expert:  Dr. David replied 6 months ago.

estrogen during puberty will cause her to gain fat weight, to grow breast, and to store more fat in her hips and thighs. this is very common during puberty as her estrogen levels rise

but she will continue to grow and develop

and this is not her final body shape

you should not put so much pressure on her to change her body shape

her biology is something she can not control.

her body's puberty and estrogen level is something she can not control.

she may not grow into a thin swimsuit model no matter how much she diets or exercise.

this is not because she has a medical problem

taking metformin most likely is not the right thing for her.

she most likely doesn't have pcos.

metformin can have side effects. and can cause upset stomach and gastritis.

Customer: replied 6 months ago.
Her peds endo prescribed it. Just increased dose. Ive not filled the rx though. And im not pushing her to change her body. Looking for weight stsbility. It is not usual to gain 45 pounds as a girl in puberty in my experience.
Customer: replied 6 months ago.
I guess you missed the im a physician part. But youre really just telling me things that I already know. But it's not really answering what could be causing weight loss resistance. She was very comfortable and 145 pounds. She is very not comfortable at 157
Customer: replied 6 months ago.
She is a muscular athletic girl who handles her weight very well. However continued weight gain despite healthy eating and exercise take a significant toll on her. And it seems excessive to me
Customer: replied 6 months ago.
I do question the diagnosis of PCOS myself Which is exactly why I thought referral to a more experienced pediatric endocrinologist was warranted it is pending But I thought it might be kind of fun to get someone's online opinion
Customer: replied 6 months ago.
She is tolerating the Metformin. But I'm not sure she should be on it at all Trying not to be my daughter's doctor I follow the recommendation of her pediatric endocrinologist
Expert:  Dr. David replied 6 months ago.

in your experience? what type of doctor are you? are you a pediatrician?

I don't see evidence of PCOS if she has normal testosterone levels and no ovarian cysts.

why did her pediatric endocrinologist put her on it if she has no diabetes and no pcos evidence?

have her go on birth control pills and see if that helps regulate her hormones better.

and have her continue to exercise and eat healthy.

Customer: replied 6 months ago.
she has "follicles" on ultrasound as mentioned in initial info. There were 11 in one ovary and 12 in the other. They said "consider pcos".
Customer: replied 6 months ago.
Im an emergency MD. My experience comment was in regard to it not seeming normal to gain 45 pounds as female teen in puberty.
Customer: replied 6 months ago.
I think her pediatric endocrinologist felt there was enough data to support PC OS with clinical symptoms of acne, weight loss resistance and ongoing weight gain as well as the ultrasound findings. However i'm not so sure she actually has PC OS… As you're saying as well
Expert:  Dr. David replied 6 months ago.

follicles are not ovarian cysts.

she doesn't have high blood androgen levels.

she doesn't have pcos.

this is spikes in estrogen levels during puberty which is causing weight gain, breast growth, fat storage in hips and thighs and butt.

estrogen does this.

your pediatric endocrinologist should have told you this about estrogen in women during puberty.

Customer: replied 6 months ago.
I am aware of the role of estrogen in puberty. Well anyway thx for your time.
Expert:  Dr. David replied 6 months ago.

you are welcome.

Customer: replied 6 months ago.
Btw where do you practice pediatric endocrinology
Expert:  Dr. David replied 6 months ago.

I don't practice pediatric endocrinology.

Customer: replied 6 months ago.
Expert:  Dr. David replied 6 months ago.


Customer: replied 6 months ago.
Are you an endocrinologist ?
Expert:  Dr. David replied 6 months ago.

no, but I work closely with endocrinologist.

I am a radiation oncologist.

I treat patients who have thyroid cancer dose with I-131 and have graves disease myself

Customer: replied 6 months ago.
This site says you are endocrinologist
Customer: replied 6 months ago.
I mean don't get me wrong… I don't think one has to be a specific specialty to be very educated or have an opinion And a lot of what you have said is what I have read as well. However I thought I was speaking with a pediatric endocrinologist
Expert:  Dr. David replied 6 months ago.

no, the site says you posted the question into an endocrinology/medicine category.

we don't have any pediatric endocrinologist on this website I don't believe.

Customer: replied 6 months ago.
Actually they had a picture of an M.D. from UCSF in the upper left-hand corner that said he was a pediatric endocrinologist. That is what prompted me to enter the site
Customer: replied 6 months ago.
under your name it says endocrinologist
Expert:  Dr. David replied 6 months ago.

you should take a screen shot of that and talk to customer service about it.

that is definitely false advertising.

Customer: replied 6 months ago.
I did do that
Customer: replied 6 months ago.
I have a friend who is an ER doc married to a radiation oncologist name David… Doesn't happen to be you is iT?
Expert:  Dr. David replied 6 months ago.

no. that is not me.

let me know if you have other questions.

if done for now, please leave positive rating of 3-5 stars so I can get credit for helping you today

we only get credit for helping clients after positive feedback

you can always reach me directly with "a question for Dr. David" in the medicine or oncology categories if you have other questions

here is my website if you need to reach me:

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