Bakhadirov Said Kamilovich — Endocrinologist at AKFA Medline, MD, PHD

With 17 years of clinical experience.

Diabetes, thyroid disorders, obesity and hormonal health.

Introduction

Endocrine disorders are among the major challenges facing healthcare today. They can develop gradually and remain relatively symptom-free for a long time, while affecting the cardiovascular system, metabolism, reproductive health and overall well-being.

According to the International Diabetes Federation (IDF), approximately 589 million adults aged 20–79 were living with diabetes in 2024. Of these, an estimated 252 million were unaware that they had the condition.

Obesity is another major public health challenge. According to the World Health Organization (WHO), 2.5 billion adults were overweight in 2022, including more than 890 million living with obesity.

Hormonal disorders affecting women also deserve particular attention. WHO estimates that polycystic ovary syndrome (PCOS) affects 10–13% of women of reproductive age, and many cases remain undiagnosed.

These figures highlight the importance of timely diagnosis, prevention and evidence-based treatment of endocrine conditions.

How can hormonal problems be recognized? Why do some people struggle to lose weight despite following a diet? Do thyroid conditions always require medication? Can type 2 diabetes be prevented?

We discussed these and other important questions with Bakhadirov Said Kamilovich, MD, an endocrinologist at AKFA Medline with 17 years of clinical experience.

13 Questions for the Endocrinologist

1. Diabetes and obesity: why is the number of patients continuing to rise?

Question: According to the International Diabetes Federation, almost one in nine adults aged 20–79 is living with diabetes. Why are endocrine and metabolic conditions becoming so widespread, and which factors increase the risk of developing them?

Answer: The growing prevalence of type 2 diabetes and obesity is associated with several factors, including changes in dietary patterns, insufficient physical activity, population ageing and genetic susceptibility.

It is important to understand that diabetes is not simply the result of eating too much sugar. Its development involves complex mechanisms, including reduced tissue sensitivity to insulin and a gradual decline in the pancreas's ability to produce enough insulin.

Some people remain at increased risk even when their body weight is relatively normal. Prevention therefore involves more than limiting sugar: it requires a comprehensive assessment of lifestyle, weight, family history and metabolic risk factors.

2. Persistent fatigue, sleepiness and reduced productivity: could these indicate a hormonal disorder?

Question: Many people experience chronic fatigue, daytime sleepiness, hair loss and changes in weight for years, attributing everything to stress. Which symptoms may genuinely suggest an endocrine problem, and when should someone seek medical advice?

Answer: Such symptoms can occur in several endocrine conditions, including hypothyroidism, diabetes and certain other disorders.

For example, an underactive thyroid may cause fatigue, intolerance to cold, dry skin and constipation. Elevated blood glucose can sometimes cause increased thirst, frequent urination and unintended weight loss.

However, these symptoms are not specific to endocrine disease. They can also occur with anaemia, sleep disorders, inadequate nutrition and many other conditions. Not every case of fatigue should be attributed to a “hormonal imbalance” or high cortisol levels.

The clinician's role is to identify plausible causes and select the tests that are actually appropriate for the individual patient.

3. Thyroid nodules: how dangerous are they?

Question: According to the American Thyroid Association, more than 90% of thyroid nodules are benign. Why do these nodules develop, which features require closer attention, and does finding a thyroid nodule always mean surgery is necessary?

Answer: Thyroid nodules are relatively common, especially with increasing age. Most do not cause noticeable symptoms and are discovered incidentally during an ultrasound examination.

When a nodule is found, it is important to assess its size, ultrasound characteristics and the functioning of the thyroid gland. In selected cases, a clinician may recommend fine-needle aspiration biopsy.

The presence of a nodule alone is not an indication for surgery. Many benign nodules require monitoring rather than active treatment. At the same time, normal thyroid hormone levels do not exclude a nodule that warrants further evaluation.

4. Can thyroid disease cause weight gain?

Question: Many patients believe that an underactive thyroid explains their excess weight. How much does hypothyroidism actually affect body weight, and is weight loss likely after thyroid hormone levels are normalized?

Answer: Hypothyroidism can contribute to weight gain, partly through fluid retention. However, substantial obesity cannot always be explained by reduced thyroid function.

When hypothyroidism is confirmed, appropriately prescribed thyroid hormone replacement can restore hormone levels and improve symptoms related to the deficiency. These medications, however, are not intended as weight-loss treatments for people with normal thyroid function.

Taking thyroid hormones without medical supervision in an attempt to lose weight can lead to heart rhythm disturbances and other complications. Treatment should be prescribed only when medically indicated.

5. Diabetes can remain symptom-free for years. How can it be detected early?

Question: IDF estimates suggest that more than 250 million adults worldwide are living with undiagnosed diabetes. Why can the condition remain unnoticed for so long, and which tests can identify it at an early stage?

Answer: Type 2 diabetes often develops gradually. In its early stages, blood glucose levels may rise without any obvious change in how a person feels. Sometimes it is detected incidentally during a routine health assessment.

Diagnostic tests include fasting plasma glucose, glycated haemoglobin (HbA1c) and, when indicated, an oral glucose tolerance test.

According to American Diabetes Association criteria, an HbA1c value of 6.5% or higher may meet the diagnostic threshold for diabetes. In the absence of unequivocal hyperglycaemia, however, the diagnosis must be confirmed. HbA1c is also unsuitable for diagnosis in certain clinical situations.

Screening is particularly important for people with a family history of diabetes, excess weight, high blood pressure or other risk factors.

6. Prediabetes: is it possible to prevent type 2 diabetes?

Question: In the major Diabetes Prevention Program study, intensive lifestyle changes reduced the risk of developing type 2 diabetes by 58% over approximately three years. What does a diagnosis of prediabetes mean, and can blood glucose levels return to the normal range without medication?

Answer: Prediabetes means that blood glucose levels are above the normal range but do not yet meet the diagnostic criteria for diabetes. It signals an increased risk of type 2 diabetes, not an inevitable progression to the condition.

Changes in diet, increased physical activity and weight reduction when appropriate are central to prevention.

In the Diabetes Prevention Program, participants aimed to lose approximately 7% of their initial body weight and achieve at least 150 minutes of physical activity per week. The study showed that this approach can substantially reduce diabetes risk.

Medication may also be considered for prevention in selected patients. The key is to view prediabetes as an opportunity to address risk factors early, not as an unavoidable future diagnosis.

7. Insulin resistance: a real medical issue or an overused label?

Question: The term “insulin resistance” is increasingly used on social media. Persistent hunger, sugar cravings, abdominal fat and difficulty losing weight are often blamed on it. What is insulin resistance, and does everyone need insulin blood tests or a HOMA-IR calculation?

Answer: Insulin resistance refers to reduced responsiveness of the body's tissues to insulin. It can be associated with abdominal obesity, prediabetes, type 2 diabetes and polycystic ovary syndrome.

However, it cannot be diagnosed from physical appearance or symptoms alone. A raised insulin level by itself is also not a universally accepted diagnostic criterion for a disease.

Routine insulin testing and HOMA-IR assessment are not necessary for every patient. In most clinical situations, assessing body weight, waist circumference, glucose, HbA1c, blood lipids and other risk factors is more useful.

8. Why is losing weight so difficult for some people even when they follow a diet?

Question: According to WHO, more than 890 million adults were living with obesity in 2022. Why do some patients struggle to lose weight despite dietary restrictions and exercise? At what point does excess weight become a medical condition that requires specialist treatment?

Answer: Obesity is a chronic, multifactorial disease influenced by genetics, neurohormonal regulation of appetite, eating patterns, sleep, the environment and other factors.

After weight loss, the body can adapt: hunger, satiety signals and energy expenditure may change. These adaptations can make maintaining weight loss difficult, which is why simply telling patients to “eat less” is not always sufficient.

An evaluation should consider body mass index, waist circumference, associated health conditions and possible secondary causes of weight gain.

Treatment may include individualized nutritional care, physical activity, behavioural support and, when appropriate, medication or bariatric surgery.

9. Weight-loss injections: a medical breakthrough or a risky trend?

Question: GLP-1 receptor agonists have become one of the most widely discussed treatments in modern endocrinology. In December 2025, WHO published guidance on their use in obesity care. How effective are these medicines, who may benefit from them, and why should they not be used without medical supervision?

Answer: Medicines in this class affect the mechanisms that regulate appetite and satiety. Some are also used to treat type 2 diabetes.

Clinical trials show that, when appropriately selected, they can produce substantial weight loss and improvements in certain metabolic measures. However, they are not a universal solution for everyone who wants to lose weight.

Before prescribing them, a clinician must assess indications, contraindications, other medical conditions, possible side effects and interactions with other treatments.

Common side effects include nausea, vomiting and other gastrointestinal symptoms. More serious risks can also occur and require appropriate medical oversight.

Weight-loss medicines should not be started or used without a clinician's guidance. They should form part of a comprehensive treatment plan rather than replace healthy eating and physical activity.

10. Polycystic ovary syndrome: why do so many women remain unaware of it for years?

Question: According to WHO, polycystic ovary syndrome (PCOS) affects 10–13% of women of reproductive age, and up to 70% of cases may go undiagnosed. Which symptoms should prompt further assessment, and how does PCOS affect metabolic and reproductive health?

Answer: PCOS is a common endocrine condition that can involve irregular menstrual periods, elevated androgen levels, acne, excessive hair growth and ovulatory dysfunction. Its presentation varies considerably between individuals.

Some women only seek medical attention when they encounter difficulties conceiving.

PCOS is associated not only with reproductive concerns but also with a greater risk of insulin resistance and type 2 diabetes.

Diagnosis is made using a combination of clinical and laboratory findings after other explanations for the symptoms have been excluded. Ultrasound findings alone are not sufficient to diagnose PCOS.

When recognized in time, management can be tailored to control symptoms, reduce metabolic risks and support reproductive health.

11. Can hormonal disorders cause infertility?

Question: WHO estimates indicate that approximately one in six people worldwide experience infertility at some point in their lives. What role do endocrine conditions play, and which hormonal problems are most commonly considered when assessing women and men with infertility?

Answer: The endocrine system plays an essential role in regulating reproductive function in both women and men.

In women, ovulatory problems may be associated with PCOS, thyroid disorders, elevated prolactin or other endocrine conditions. In men, certain hormonal disorders can affect sperm production and sexual function.

Infertility, however, is not always hormonal in origin. Anatomical, genetic and other factors can also contribute.

When pregnancy does not occur as expected, a comprehensive assessment of both partners is important. Ordering an extensive hormone panel without considering the clinical situation is not appropriate. Testing should be individualized.

12. Osteoporosis: why do bones become fragile, and how can fractures be prevented?

Question: Women face an increased risk of bone loss after menopause. Under the 2025 US Preventive Services Task Force (USPSTF) recommendations, osteoporosis screening is recommended for women aged 65 years and older. How do hormonal changes affect bone strength, and can osteoporosis be identified before the first fracture?

Answer: Osteoporosis is characterized by reduced bone strength and an increased risk of fractures. The decline in oestrogen after menopause is particularly important because it accelerates bone loss.

Age, family history, low levels of physical activity, certain endocrine disorders and long-term use of some medications can also affect bone health.

Bone mineral density can be measured using dual-energy X-ray absorptiometry (DXA). Decisions about screening should be based on age and individual risk factors.

Prevention includes adequate calcium and vitamin D intake, physical activity, resistance training and fall-prevention measures. The priority is to identify people at high fracture risk before serious complications occur.

13. Which hormone tests are actually useful for preventive care?

Question: So-called “hormone check-ups” that include dozens of tests — cortisol, insulin, thyroid hormones, vitamin D and more — have become popular. Which tests genuinely help detect endocrine disease, and why is testing “every hormone” not always beneficial?

Answer: There is no single list of hormone tests that every person needs to undergo regularly. Testing should be guided by age, symptoms, family history, medications and risk factors.

For example, glucose and HbA1c tests are used to assess disorders of glucose metabolism. When thyroid dysfunction is suspected, testing typically begins with thyroid-stimulating hormone (TSH), with further tests ordered when indicated.

Cortisol, prolactin, sex hormone and other measurements should be requested for specific clinical reasons.

Not every healthy adult requires regular vitamin D testing. International guidance does not support indiscriminate testing in the absence of appropriate indications.

Excessive testing can lead to incidental abnormal results, unnecessary follow-up investigations and inappropriate treatment. Good preventive care is about identifying genuine risks and conditions in time, not ordering the largest possible number of tests.

Conclusion

Endocrine conditions may develop quietly over time, gradually affecting metabolism, cardiovascular health, reproductive function and quality of life.

International medical statistics confirm that diabetes, obesity, thyroid disease and other hormonal disorders deserve serious attention from clinicians and patients alike.

Advances in endocrinology make it possible to identify many conditions earlier, manage them effectively and reduce the likelihood of complications.

Early diagnosis, evidence-based treatment and an individualized approach remain the foundations of modern endocrine care.

Persistent fatigue, unexplained weight changes, menstrual irregularities, excessive thirst and other new symptoms may warrant an assessment by a healthcare professional.

People should avoid taking hormone medicines on their own, undergoing unnecessary tests or delaying consultation when concerning symptoms occur.

Seeing an endocrinologist at the right time can help identify illness and preserve long-term health and quality of life.

At AKFA Medline, patients can consult an endocrinologist for an assessment of endocrine health, appropriate diagnostic testing and an individualized plan for further care.