The Prepared Patient: When Influencers Fill the Gaps Medicine Hasn’t Closed
Why women turning to TikTok for perimenopause and menopause answers is a symptom of a deeper problem, and how to protect yourself in the in-between.
A 48-year-old woman opens TikTok to check on what her teenage son is watching. Within a few scrolls, the algorithm has pegged her demographic and starts serving her perimenopause content. Within weeks, she knows more about night sweats, brain fog, and hormone therapy than her own physician ever told her. She is far from alone. Videos under the menopause hashtag have racked up over a billion views, and Google searches for “perimenopause” have surged since 2022.
Here is the part that often gets framed unfairly. When these same women say “my doctor isn’t listening,” what is frequently happening is that the doctor is listening and simply doesn’t have an answer. Those are very different situations, and treating them as the same can lead patients into harm.
The gap is real, and physicians did not create it
Only about one in five OB-GYN, family medicine, and internal medicine residents reports receiving any formal menopause training, and just 6.8% of residents feel adequately prepared to manage menopausal patients. Stephanie Faubion, MD, medical director of The Menopause Society, has been blunt: “There is no room in the medical school curriculum for menopause.” Most practicing menopause specialists are, by their own admission, self-taught.
Layer on top of that a deeper truth. Women’s biology has been historically understudied. Hormone therapy guidance was thrown into chaos by the original Women’s Health Initiative reporting in 2002 and is still being re-litigated more than two decades later. Perimenopause itself, the years-long runway before menopause, has very little high-quality randomized trial data for many of the symptoms women actually experience.
So a patient arrives in clinic with brain fog, joint aches, rage, insomnia, and a heart that races at 3 a.m. She wants a diagnosis and a fix. Her physician, bound by an oath to do no harm, is genuinely listening. She also cannot in good conscience prescribe something for which the evidence is thin, the dose is unclear, or the risk-benefit ratio in this specific body is unknown. The patient hears silence. She interprets silence as dismissal. She opens her phone.
Enter the influencer, and “n of one syndrome”
Into that vacuum walks someone confident, charismatic, and often selling something (a supplement, a peptide, a compounded cream, a course). The pitch is almost always the same: this worked for me, and it will work for you.
I call this n of one syndrome. One person’s experience, however genuine and however dramatically transformative it felt, is not evidence. It could be regression to the mean. It could be the natural waxing and waning of perimenopausal symptoms. It could be a real pharmacological effect that genuinely works for that individual while lacking data on who else benefits, at what dose, for how long, and with what risks. Often it reflects some flavor of placebo response, which is powerful and real, and also a poor substitute for knowing whether something is actually safe and effective at population scale.
The harms here are not hypothetical. Clinicians are reporting patients with uncontrolled menstrual bleeding after using hormone products sourced from online providers, women taking herbal remedies like dong quai despite contraindications such as fibroids or bleeding disorders, and many people spending substantial money on unregulated compounded preparations marketed with promises no licensed physician could ethically make.
The testing trap
The other place I see patients harm themselves is in demanding tests that have no place in their workup.
Reproductive hormone panels in a still-cycling 44-year-old. Full thyroid antibody screens because an influencer said “everyone has Hashimoto’s.” Heavy-metal panels. Adrenal “cortisol curves.” Food sensitivity IgG tests. Many of these tests have no validated reference range for the question being asked, fluctuate so wildly day-to-day that a single value is meaningless, or yield results that no clinician can act on. A “positive” finding then triggers more tests, more anxiety, sometimes a biopsy or a scan, occasionally a procedure, while the original symptoms remain.
The data on this is sobering. Roughly 20 to 30% of commonly ordered tests are estimated to be unnecessary, and over testing is a recognized driver of misdiagnosis, false positives, overdiagnosis, and downstream overtreatment. Moreover, it adds financial costs to our system. Every test ordered without a plan for how to act on the result is a coin flip that can land on harm.
What about AI?
Patients are increasingly turning to large language models for medical questions, and the appeal makes sense. A good AI can summarize evidence, translate jargon, present questions worth asking your clinician, and do all of it without making you feel rushed or embarrassed. It can be a genuinely useful preparation tool.
AI shares the influencer’s core weakness, though. Confident fluency does not guarantee accuracy and suffers from a lack of context. AI models can hallucinate references, present contested claims as settled, and have no idea about your specific medical history, medications, or risk profile. The safest use is to generate questions and frameworks for understanding, then bring those questions to a clinician who knows you. Remember LLMs scrape their information from the internet and there's a lot of misinformation out there (e.g., like Reddit, TikTok, etc.).
Becoming a Prepared Patient
Empowerment and self-prescription are different things. The Prepared Patient does a few things consistently.
She tracks her symptoms with dates and severity, building a real data set rather than a vibe. She brings that log to the visit. She asks her clinician, “What is the evidence for this treatment in someone like me?” and accepts “we don’t know” as a legitimate answer when that is the honest one. She stays skeptical of anyone, credentialed or otherwise, who is selling the very thing they are recommending. She asks of every proposed test: what will we do differently depending on the result? If the answer is “nothing,” she skips the test. She treats AI as a study guide and her clinician as the second opinion. And when an influencer’s story resonates, she asks herself: is this evidence, or is this one person's opinion?
The frustration so many women feel right now is legitimate. The information gap is real. The training gap in medicine is real. The relative paucity of research into Women's health is real. The answer to a vacuum of evidence will never be a flood of confident strangers. It has to be a partnership between a patient who has done her homework and a clinician who is honest about what we know, what we don’t, and what we are working to find out.
That is the Prepared Patient. And honestly, she is one of the best things happening in medicine right now.
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The Prepared Patient: Your Guide to Surviving the Health Care System is available for preorder from Amazon or Johns Hopkins University Press