How To Increase Your Testosterone Levels Naturally | Derek from MPMD

0:00 There's an array of things that are supported critically by testosterone.

0:06 I often hear from many people about testosterone levels

0:10 being lower now in men than they have ever been.

0:13 Is there a trend downwards?

0:15 I would say yes.

0:17 What are some of the major contributors?

0:18 Pollution, I think, is a big factor to be

0:20 chronically dealing with a toxic environment will inhibit broad systems.

0:24 If their libido is like totally down,

0:27 if they're having a harder time losing fat,

0:29 gaining muscle, losing fat, it could come down to this, right?

0:33 Bone integrity.

0:34 Almost bone integrity, right?

0:36 So, your top four supplements for testosterone would be

0:41 zinc, magnesium, vitamin D.

0:44 Not in order, just the top three, I would say.

0:47 And then, who should consider hormone replacement therapy?

0:51 Um, in general, I think

0:54 I'm sitting here with Derek from More Plates, More Dates.

0:58 You may know him from his very large YouTube

1:00 channel where he talks about all sorts of things.

1:04 Um, hormones, exercise, training.

1:07 I became sort of aware of your work

1:10 because you were on our mutual friends podcast,

1:13 Peter Aia, a couple of times.

1:16 super interested in, you know, your own personal experience,

1:19 but you also run a company that's a preventative health

1:22 company that helps people optimize their hormones, among other things.

1:26 And so, I mean, I'm excited to have a conversation with you.

1:30 You've got a lot of this experience, you know, personal experience,

1:33 but also experience just running this company where people

1:36 are coming to your company to help optimize their hormones.

1:40 And so, um, it's a a little bit of a different episode here.

1:45 As you guys know, I cite everything on the podcast and so I'm excited

1:48 to kind of dive in and talk about all things hormones with you, uh, Derek.

1:52 So, thanks for coming on the show.

1:54 Thanks for having me.

1:54 Really appreciate the invite.

1:57 Um, I'd love to kind of start.

2:00 I want to talk about testosterone as you know,

2:02 you know, kind of discussed this earlier.

2:05 Um, you're very knowledgeable in this area.

2:07 In fact, we had a conversation and I was asking you some questions and uh

2:11 your knowledge was very impressive in terms of um the scope and and depth.

2:17 So, all things testosterone kind of just wanted

2:19 to start with the role of testosterone in men.

2:22 I mean, it's obviously fundamental for male health,

2:25 but I'd love if you could kind of just

2:27 outline some of the primary functions of testosterone in men.

2:32 Yeah, I think at a basic level it is the primary anabolic

2:38 hormone men rely on for the sustainment or growth of muscle tissue.

2:48 Um bone health, bone integrity,

2:50 inhibiting degradation um indirectly through some

2:54 of those pathways as well like insulin sensitivity.

2:57 If you have worsened body composition,

3:00 it becomes more difficult to handle glucose adequately.

3:02 Um, neurological health or the aromatization

3:06 um in the actual tissues themselves.

3:09 Um, there's an array of things that are supported critically by testosterone

3:14 and its indirect metabolite uh activity

3:18 as well through its aromatization to estrogen.

3:20 And I guess notably, but often overlooked, it's easy to forget,

3:25 but in adolescence, the five alpha reduction to DHT,

3:29 so the conversion of testosterone to DHT is um necessary for full maturation,

3:34 sexual differentiation to basically reach full adult male maturity.

3:40 And there's a myriad of examples where if DHT is

3:45 either uh too low via genetic predispositions or through different

3:52 means then there is inhibited maturation and that's where you

3:56 get into some of these more uh unique interex cases.

3:59 But essentially at a base level this is the primary male

4:05 all but significantly impactful in females as well hormone that is

4:08 present at about 10x the concentrations in males and kind

4:12 of differentiates them in terms of uh sexual identity and male characteristics.

4:19 I I do we are going to focus a lot on the role

4:21 of testosterone in in in males and men but I do

4:24 kind of just briefly before we will eventually talk about females

4:28 and women but what what is the major role of testosterone in women?

4:32 I mean women obviously don't make as much as men

4:36 but they do make testosterone and it does play a functional role.

4:41 Yeah.

4:41 Yeah.

4:41 And like again it's a non-exhaustive list

4:44 that I just presented like the list extends beyond

4:47 into ariththropoesis the production of red blood cells

4:50 intrasticular testosterone production absolutely critical for fertility as well.

4:54 Um and women all but not directly

4:59 analogous introatalie but elsewhere in the body

5:01 the activity of testosterone is still necessary for a lot of the same things.

5:06 cognitive health, um some level of cardiovascular support,

5:09 bone integrity as anabolic activity and muscle tissue,

5:14 all of the same stuff is still the case in women,

5:17 just to a much lower magnitude.

5:20 So, but similar as you would expect, there's less of a concentration required

5:26 to sustain a female musculature than a male.

5:30 So, the concentration differential is about 10x.

5:33 But in women the main function of testosterone still overlaps with males

5:39 but intrainatal it is more to facilitate as a substrate of estrogen production.

5:45 So getting that sufficient amount of aromatization into uh

5:49 uh estradi but also the conversion into estrone

5:52 which then turns into estradile as well to facilitate

5:56 all of the uh female fertility facilitated processes.

6:00 So given the role of testosterone in all

6:03 these important physiological processes that you just described,

6:06 everything from muscle health, bone health,

6:09 neurological health, red cell production, um, etc.

6:14 What about trade-offs of testosterone?

6:17 And I mentioned this because of my interest in longevity,

6:21 my long interest in, you know,

6:23 life expectancy and looking at, you know, life expectancy between men and women.

6:29 And you really see amongst like pretty much

6:32 all mammal species that the females outlive the males.

6:38 Obviously, there's a lot of differences going on there,

6:40 but testosterone is al something that does, you know, differentiate.

6:46 There's a big difference between the levels

6:47 of testosterone between males and females.

6:50 So, I'm kind of curious.

6:51 I know you you think about a lot of these things and so I'm curious

6:53 what your thoughts are with respect

6:55 to the tradeoffs of testosterone with respect to longevity.

7:01 I think it would be highly speculative

7:04 because obviously I would love to just point

7:06 to some clear-cut literature that says based

7:09 on these studies on you know inhibiting IGF-1 or having

7:16 really low uh androgen levels equals lower body

7:20 weights equals longer lifespan or something to that effect

7:23 that could be a common kind of denominator but it's not as cut and dry.

7:28 I do think there is some level of metabolic uh resource demand that is needed

7:35 to actually support the infrastructure of a male

7:37 that is more intensive than a female.

7:39 So I would in general like larger humans are going to die

7:43 quicker than smaller ones at least from what I've seen trendwise.

7:47 And in supporting that it is something that requires more hormone

7:54 production in general which is also more uh intensive on all

7:59 organ systems accordingly to actually facilitate and get that hormone production

8:04 to the level it needs to to sustain that larger human.

8:06 So that's a highly speculative take on it, but that would be part of the reason,

8:13 but obvious at a high level if you wanted to extrapolate to, you know,

8:18 at higher levels, androgens will be neurotoxic

8:20 in a dose dependent manner past supra levels.

8:24 Um, it will cause uh cardiac remodeling in a negative manner.

8:28 Like all of the dysipidemia,

8:30 all of the negatives that you would hear about when it comes

8:33 to anabolic steroid use to some extent at supra levels are going

8:38 to be present from testosterone all but to a more muted extent because

8:43 it's not a synthetic drug that is manipulated in a lab to create,

8:47 you know, something that is not a substrate for aromatization

8:50 and some of the other stuff that is protective.

8:52 But that's a highle speculative take.

8:55 Yeah, I mean the it's kind of a loaded question because there's probably

8:58 a lot of factors that play here in terms of like the differences

9:02 in life expectancy between males and females and you're pointing out the size

9:06 difference is one one you know maybe it's the lack of estrogen right not

9:10 the presence of testosterone but not

9:12 lack of estrogen obviously men make estrogen

9:14 but not to the same degree as women um premenopausal women but have

9:19 you have you looked at any of that literature are you aware of it

9:22 the like the male castradi Like so the the men that are like yeah castrated like

9:29 they are osteoporotic as a consequence of a lack of sufficient aromatization

9:35 into estrogen and their growth plates

9:37 the epithesial growth plates don't close fully

9:40 because of that lack of aromatization

9:42 in adolescence which is facilitated essentially

9:46 entirely by testosterone as a substrate similar to what it is in women.

9:50 But if you castrate a male in adolescence

9:52 and he no longer has intraticularicular testosterone production,

9:54 he is now functioning off of solely adrenal production,

9:58 which is like a drop in the bucket to what

10:00 you actually need to function at a high level.

10:02 Like you're not going to have sufficient bone development

10:05 and you are going to suffer from osteoporosis inevitably.

10:09 And if those those who don't know what the castradi are,

10:11 it's really interesting.

10:12 So it's individuals who were had angelic singing voices.

10:16 And I'm not sure where the last who the last documented one was,

10:20 but it was actually more recent than many would probably think.

10:23 It's like within the last 100 to 200 years.

10:26 But anyways, you can listen to them on YouTube

10:28 singing and some of these old audios that were recorded.

10:32 And it's, you know, a youthful angelic singing voice

10:36 that comes across as somewhat in like androgynous to some extent.

10:41 And obviously going through male puberty and being subjected

10:46 to male amounts of testosterone and DHT would, you know,

10:50 like quote unquote wreck that voice because it's

10:52 going to be masculineized and get like fully,

10:55 you know, the deepening that would happen that's irreversible.

10:58 So the castradi were individuals that were castrated in order

11:02 to prevent them literally from going through puberty adequately.

11:05 So they would actually grow into men without the full

11:11 maturation that would come from androgen exposure and adolescence.

11:14 And as a result, you know, they would have a lack of adequate

11:18 sexual differentiation maturation and their bones

11:21 would reflect that as well via the osteoporotic outcomes they underwent.

11:26 Did you um happen to see that their life

11:28 expectancy was increased though compared to I mean

11:30 so I mean it's like you're you're living

11:32 longer but not necessarily the quality of life is

11:35 notably though their estrogen levels are in the ground.

11:37 say you saying a second ago about the estrogen, right?

11:40 So maybe I don't know.

11:42 It's it's interesting like what is it, you know?

11:44 Well, it's definitely lower capacity to build muscle and bone

11:49 which is less resource intensive and you're a smaller human.

11:52 So maybe as a result you are literally a walking

11:56 I don't know like shell of a man essentially.

11:58 So you don't require as much to sustain

12:01 but your quality of life is dramatically hindered, right?

12:05 Yeah.

12:06 So you live longer, but you don't necessarily want to, right?

12:10 Um, yeah.

12:10 So that's kind of interesting.

12:11 I just kind of want to get your perspective on that.

12:13 So, um, I'd love to kind of dive into an area

12:18 that I know you have a lot of knowledge,

12:20 you know, just based off of your your company, Merrick Health,

12:23 where you guys are really helping people optimize their hormone levels.

12:26 And so I kind of want to talk a little

12:28 bit about some of the best practices for measuring testosterone,

12:32 interpreting the results.

12:34 Um, could you kind of outline some

12:36 of the optimal best practices for actually measuring testosterone levels?

12:43 So, you know, optimal timing, repeated measures like free testosterone versus

12:49 um bound testosterone or total testosterone, right?

12:52 Like what's the difference here?

12:54 What what do people what should they like consider?

12:57 Mhm.

12:57 So total testosterone is the number

13:00 that most people are familiar with which reflects

13:03 the total production that can be detected

13:07 in your sample of blood that was taken.

13:10 So floating around how much testosterone is there

13:14 inclusive of the testosterone bound to binding proteins.

13:19 So just because it's in your blood

13:21 though it doesn't mean it's biologically active.

13:23 If it's bound to these binding proteins produced by the liver,

13:27 it could be either uh entirely inactive or like readily

13:35 available to be dissociated but not yet fully active as well.

13:39 So you have you know SHBG is the primary

13:41 one sex hormone binding globulin produced by the liver.

13:45 This acts as a regulator of androgenicity in the body which

13:48 is like how much androgen exposure systemically you would be exposed to.

13:53 And the body has this kind of regulating mechanism

13:56 to partly to make sure that you know females stay feminine,

14:00 males stay male and regulate which tissues get which hormones when

14:05 and transported around the body cuz these are um hydro uh

14:11 phobic like they're fat soluble and would not go through uh

14:16 the blood to where you want them without some sort of carrier.

14:18 So they have a um hydrophilic vehicle similar to like how cholesterol

14:23 would get moved around through its you know apo particles and whatnot.

14:27 Um and these binding proteins SHBG

14:31 and albumin comprise the vast majority of testosterone.

14:36 Um I think SHBG is about 60% of your total

14:39 tea will be bound by SHBG and then like 38% is

14:42 albumin and then 2% to 3% roughly depending on how

14:47 much SHPG produced and some other factors is actually free testosterone.

14:52 So the free testosterone number is just like freely circulating,

14:56 not bound to binding proteins,

14:57 and it's like ready and readily available to be used by target tissues

15:01 um should it bind to the androgen

15:03 receptor and cause the transcriptional activity.

15:06 But in general, the two numbers you care about

15:09 the most are going to be the total testosterone,

15:11 which is like total production reflection.

15:14 So like how much are you actually capable of making, which is important.

15:17 And a lot of people will just say just look at your free

15:19 cuz that's like the number that matters

15:20 cuz that's what's actually available to use.

15:22 And that's true, but it still doesn't

15:24 reflect total production capacity which is important

15:28 to assess the viability of the organ response

15:31 to the pituitary output a myriad of things.

15:33 So total testosterone total production including that bound

15:36 to binding proteins influenced by liver health diet bunch

15:40 of different factors free testosterone about 2 to 3%

15:44 in an optimally healthy male typically that is

15:47 just freely available to be used and then

15:50 as far as um measurement kind of like best

15:54 practices typically in the morning is the best testosterone

15:59 is kind of it's like a pulsatile secretion fashion.

16:03 So you would see in a dial rhythm

16:05 chart showing the secretions of testosterone throughout the day,

16:08 it kind of pulses out in waves.

16:11 So you would have like the biggest pulse early in the morning

16:13 and then it kind of like goes ac and flows throughout

16:16 the day until it reaches its uh low point later at night

16:19 and then as you sleep it starts to ramp back up again.

16:22 So typically the best way to assess peak levels

16:25 would be early in the morning and ideally you would

16:29 have um not taken certain confounding variable supplements like biotin

16:36 that can cross detect is you know estrogens and whatnot.

16:40 And typically labs will provide kind of like a a guideline of what not to do.

16:45 But in general the r rule of thumb is

16:48 you know go in fasted early in the morning.

16:51 Avoid uh your multivitamin probably if has

16:53 biotin in it or biotin containing supplements.

16:56 And uh be hydrated to reflect your actual uh hematology profile

17:00 correctly cuz some people incorrectly think they have a elevated you know

17:03 hematocrit level when in reality they're just super dehydrated when they go

17:07 in because they just got up rolled out of bed and are

17:09 you know dehydrated from hours of sleeping and you know not hydrating

17:13 properly when they wake up and they just roll in and think

17:15 that oh I'm gonna have a heart attack and then I

17:17 got to donate blood now which might not be the case.

17:19 So, I know that's a a mouthful, but early in the morning and ideally,

17:25 you would get a repeat measurement before you make any sort

17:27 of especially before you make any sort of choices on uh path

17:32 forward because you definitely want to get confirmation if you have

17:35 a low reading or even one that's like mildly concerning cuz again,

17:39 these things can be so variable depending on so many factors that you

17:44 might have a blip where it's a snapshot in time of your blood.

17:48 you see, you know, a 495 total tea.

17:51 And you think, well, that's not great.

17:54 It should be closer to a,000.

17:55 That's what I hear is good in, you know, all these podcasts and whatnot.

17:59 That's what my friends are at.

18:00 They're at 900.

18:00 Like, I only have 495.

18:02 I should have way more than that.

18:03 And some people haphazardly get on testosterone.

18:06 Shockingly, but it happens.

18:08 And there are a lot of clinics that will tell you like,

18:10 "Oh, yeah, you could get that up.

18:11 Let's get this up to, you know,

18:12 900." And that's all they need to give, you know, to justify it to themselves.

18:17 Um, so yeah, you definitely don't want to go off of one reading.

18:21 You want to go off of symptoms and repeat measurement

18:23 to confirm your findings before you even decide what the path

18:27 forward is for natural interventions and assessment of what is

18:31 happening at the organ level and at the hypothalamic pituitary level.

18:36 So, you sort of alluded to this, but like talking about reference ranges,

18:39 and I kind of want to get into that because like, you know,

18:42 there are these like reference ranges that you see,

18:45 and I'm just kind of like curious like how

18:49 does a man navigate where their testosterone should be,

18:54 what the reference ranges mean?

18:56 How do you look at this?

18:58 you how does like you know how do how does your company look

19:01 at this in respect to uh with respect to age with respect to like symptoms.

19:07 Let's say someone's on the lower end of the reference range,

19:10 but they have no symptoms.

19:11 Or someone's at the higher end of the range, but they have symptoms.

19:14 Like, how does one sort of interpret what their testosterone data shows?

19:23 And um how does the potential for someone who's actually hypogonatal,

19:28 so people that are actually not making testosterone, right?

19:33 How does that sort of complicate it?

19:35 Um, in general, I think, um,

19:39 it does get convoluted because people will see a reference range and assume,

19:44 and understandably so, like there's a lot of things that people will just say,

19:47 "Oh, target the top of the reference range.

19:49 This is where you should be." And in general, that's not a bad recommendation.

19:52 Often for things that modulate quality of life related outcomes,

19:58 you know, like even when we talk about vitamin D, it's like, you know,

20:01 you should probably be at like 60 even though the low end is like 30.

20:04 Typically, if you were at 40, people would be like,

20:06 you know, try and bump that up to 50 or 60.

20:08 With testosterone, people think similarly, and justifiably so sometimes,

20:13 but often what is overlooked is

20:14 the fact that the actual androgen receptor content,

20:19 which is like how many androgen receptors you have

20:21 in like a concentrated area or also the sensitivity of it,

20:26 like what kind of transcriptional activity do you get subsequent to binding?

20:31 Those things all factor into like how much

20:33 of an impact the androgen has after binding to the receptor.

20:38 So just because you have less testosterone than the next guy,

20:41 it doesn't necessarily even mean that you

20:42 have less muscle growth potential or less,

20:44 you know, you know, bone support capacity or less uh neurological support.

20:51 Like it's not guaranteed any of these things based on absolute values.

20:54 It should be a combination of symptoms as well as uh blood values.

21:00 But often times too,

21:01 the blood values should be superseded by symptoms in some cases

21:06 too because you'll have some individuals who have insensitivity at the AR.

21:09 So it's not just about how sensitive are

21:11 you and can you get away with lower testosterone.

21:13 Some guys need higher testosterone to be able to actually function well.

21:17 And they might otherwise be told, oh, you know, you don't need testosterone.

21:22 Your total testosterone is 900.

21:23 But they might have a, you know,

21:25 super high sex hormone binding globbulin that's gobbing

21:28 it all up and they have a low free

21:29 testosterone or their actual receptor activity after binding

21:33 is like subpar or they have a, you know,

21:35 gene mutation that inhibits the actual activity of it.

21:38 And that's where you get into some

21:39 of these convoluted cases with like you know the Olympic

21:41 boxer and like we're not going to go

21:43 down that road but some of these individuals who

21:46 like you know there's a spectrum of androgenic

21:49 activity that is influenced not just by the total

21:51 levels on paper but it is very much

21:53 dictated by your actual response to the hormone too.

21:57 C is that something that's measured readily like can

22:00 you measure your response to your androgen receptor activity?

22:03 Is that or is that something that's not really

22:05 known and you kind of have to do some

22:08 There are like proxies for it.

22:10 Um in general it's very uh crude the way they assess if

22:14 you are one of the individuals on this like spectrum of androgen insensitivity.

22:19 It's literally like manual assessment essentially of like

22:23 your gonatal development which is like kind

22:25 of uh you know demeaning potentially if you're

22:28 somebody who is like already obviously insecure about

22:30 what's happening and then you're just subjected

22:31 to some sort of like subjective analysis of like

22:34 an expert who determines if you've had

22:36 sufficient enough like male sexual secondary characteristic development.

22:41 But in general there are proxies for activity.

22:44 And you know if you're somebody who has like if

22:48 you if you looked at blood work for example some individuals

22:52 think oh the guy with a natural like 1300 total tea

22:56 that's probably great that guy is like an outlier genetic phenom.

23:01 Often times it's a reflection of some sort of problem

23:03 like they need to produce more to reach adequate activity.

23:06 So like sometimes the body is screaming at the testes

23:09 because it's not getting adequate production to do

23:11 what it needs to do and it's resulting

23:13 in you shooting out more gonadotropins to make more testosterone.

23:17 So typically you will see this reflected in some sort of symptom either

23:22 through actual development in adolescence being

23:25 not adequate or through biomarkers it becomes

23:28 pretty clear because you there will be other factors that are clearly outlier

23:34 uh oddities in blood work when you

23:37 see somebody who is not responding adequately.

23:40 What will you mentioned the gonut tropins like what would like

23:43 the lutein lutein lutin luteinizing hormone or follical stimulating hormone f

23:49 what would those kind of look like in in the cases

23:51 where it's kind of like a a red flag I mean is

23:55 like these are very outlier scenarios that I'd be deviating into where people

23:59 are like you know overshooting to try and meet some sort of physiologic

24:03 activity like most guys are going to be falling into the bucket of they

24:07 have low gonadotropens or low response respon to it from age related decline.

24:12 That's more of like you know what most people will find relevant.

24:15 So I'll start there.

24:17 Um in general the thing you would be looking to first is

24:21 okay like what are your levels your total and your free levels?

24:25 Are they do they look good?

24:26 Do you have any symptoms?

24:27 And let's just say you do have symptoms and you're

24:29 looking at these numbers and they look you know okay.

24:32 At that point you would be looking um the actual output from the pituitary is

24:38 going to be dictating what the signal

24:40 to your testes is to actually produce testosterone.

24:44 So the LH from the pituitary signals

24:46 to the light cells to make the intrasticular testosterone.

24:49 So is that signal adequate is one thing

24:53 to assess and that has a clinical reference range.

24:56 Um but also individuals who are primary hypoganatal

25:02 uh similar to what we talked about when

25:03 it comes to assessing you know when women

25:05 are hitting menopause like what kind of would you

25:07 look to in men if you are not

25:09 responding and producing adequate testosterone at in the testes

25:13 like you will be trying to make more

25:16 luteinizing hormone typically to try and push that signal.

25:19 So it's your body's going to recognize I'm not

25:21 getting enough testosterone out of this LH that I'm making.

25:24 So, the signal isn't sufficient.

25:26 I'm not getting enough testosterone and or enough

25:28 estrogen from that to provide the negative

25:30 feedback that tells me to stop making G&RH and the other the pituitary hormones.

25:37 So, I would just it would just keep shooting

25:38 and trying to like probably overshoot you into adequate territory.

25:43 So you would if you're primary

25:44 hypogonatal you would see the reflection typically

25:46 of high gonadotropens um or you would also see some sort of like structural

25:52 defects and that's where you would get into like you know ultrasounding for I

25:55 think the prevalence in males is like 15% of males have a varicus seal.

25:59 I don't know if you know what that is

26:00 but it's like varicose veins in your testes essentially and it

26:04 looks like like twisted kind of like the same

26:07 thing you would see in varicose veins in your legs.

26:09 that's like in the side of like the testes and it

26:13 uh inhibits thermmore regulation and significantly

26:17 impedes testosterone production locally and fertility.

26:21 So that often times well 15% of men

26:25 from what I recall is the number for prevalence.

26:27 Pretty significant though for something a lot of people don't know exists.

26:30 And if you are, you know,

26:32 doing all the lifestyle stuff and it's not working and you

26:36 think you're doing everything correctly and you must need testosterone,

26:40 sometimes it can be overlooked that there are structural defects.

26:42 So like typically the first thing you would look to is like am I capable

26:47 at the organ of responding to the signal

26:49 and like is the signal adequate to begin with?

26:51 Because if there's like a primary hypoganatal outcome,

26:54 it would be some sort of like

26:56 structural response problem in the testes themselves.

26:59 If that's not an issue and you've ruled out all structural problems, you know,

27:03 age related decline and is not a factor and you're,

27:06 you know, otherwise, you know, everything's all accounted for from that angle,

27:10 you would look upstream to the pituitary and it's like,

27:12 okay, well, at that point, am I producing enough LH and FSH?

27:16 And this is typically the outcome you would see in men uh not always,

27:22 but like a lot of men who are kind of like not sure if they need testosterone,

27:25 they'll have like a relative proportional inadequate signaling driven through

27:32 a myriad of factors including but not limited to lifestyle,

27:36 some age related decline, toxins, exposures, a myriad of things.

27:40 And that's kind of like where people have this uh opportunity to try

27:47 and incrementally maximize all the areas

27:50 in their life to try and improve the output.

27:53 Because if you have sufficient functioning

27:55 organs and your output is just insufficient,

27:59 you might be able to get that up to snuff

28:00 to where you need it just by getting leaner, losing body fat, fixing your diet,

28:05 addressing micronutrient deficiencies, um quitting smoking,

28:09 not drinking anymore, fixing your sleep,

28:11 you know, all the smorgesborg of uh things.

28:15 Yeah, we're going to that we're going to get into a little bit, but okay.

28:17 Um, what about the sexbinding globul globbulin hormone?

28:23 SBGH SHBG sex hormone binding globulin.

28:27 Sex hormone binding globbulin.

28:28 Um, what about the sex hormone binding globulin?

28:32 Like you're talking about like if if you have a lot if you

28:35 have a high level of that and it's bound up to your testosterone.

28:38 Um, so couple couple of questions here.

28:42 what regulates those levels and what regulates like how much

28:48 of that testosterone can then get away from that, you know,

28:51 binding protein and then be used to, you know,

28:54 obviously exert hormonal activity.

28:56 So, you know, h can you can you like dial in looking

29:01 at just that binding protein itself to help kind of solve some issues?

29:06 Yeah.

29:06 And it gets really complicated in this regard because

29:10 what a lot of people don't address is so DHT

29:13 dihydrotestosterone mentioned earlier how it's like the primary hormone

29:17 that will determine if you reach full maturity in adolescence.

29:20 Like you will still be markedly male probably if you

29:23 have adequate testosterone production but you won't get full maturation

29:26 if you have you know zero DHT from a defect

29:29 in the enzyme that encodes for five alpha reductase or something.

29:32 But that hormone, the most androgenic hormone in the body

29:35 that essentially determines if you fully masculineize or not,

29:39 where you end up, you know, with a micro penis,

29:41 that has a much higher binding affinity for SHPG than testosterone does.

29:46 And then testosterone has a much higher

29:47 binding affinity for SHPG than estrogen does.

29:50 So even though on paper we're talking about

29:51 the importance of free test versus total test which

29:54 is very important also very important which most

29:59 people aren't going to test in their blood is

30:01 the DHT level that males will rely on through

30:04 adolescence and to some extent in adulthood potentially

30:07 depending on their test levels that is going

30:09 to get gobbed up even more proportionally by SHBG.

30:13 So if you have high SHPG, not only is your free test

30:16 potentially inadequate despite adequate testosterone production,

30:20 proportionally your free DHT,

30:22 which is like the main androgenic hormone is like way more gobbed up.

30:27 And this gets really rough in females because they

30:30 a lot of them are using things like combined oral

30:32 contraceptives which crank SHBG through the roof through the liver

30:38 uh interaction with the oral combined oral contraceptive pills.

30:41 Depending on which drug they're using in general,

30:44 ethanol estradile plus some progesterine depending

30:47 on how androgenic the progesterine is.

30:50 It'll depend on how much the SHPG goes up.

30:52 But you'll see in uh adolescent women or women who

30:56 are you know in full adulthood that are taking combined

30:58 oral contraceptives their total testosterone will suppress upwards of 50

31:03 to 60% and free testosterone upwards of like 70 to 80%.

31:07 So they're walking around like borderline

31:09 asexual castrated by a pill essentially and that's only with oral.

31:14 That's with oral but like any sort of progesterine

31:18 that is synthetic will have negative feedback to some degree.

31:22 all but much lesser so via a localized IUD releasing a levonorest or something

31:27 and you're not having to take that supporting

31:29 estrog estradiol that comes compounded into it.

31:32 So it depends on the format but a lot

31:33 of girls are still using the combined pill.

31:35 So it's just worth noting nonetheless that when these SHBG levels

31:40 are skyrocketed or even like high on you know a clinical

31:45 reference range if you are somebody who is like moderate you

31:50 know tea production or low normal or whatever like the proportional hit

31:55 to your DHT getting gobbed up could be like the differential

31:58 between you being symptomatic versus not as well as your free

32:02 tea even though it's proportionally less gobbed up the DHT T

32:05 could be like nuked entirely essentially via the SHPG levels being high.

32:10 Since we're talking about the SP spghGH levels,

32:12 I kind of want to like what is there lifestyle?

32:15 So, does age regulate that and and also like lifestyle factors?

32:20 Yeah.

32:20 So, like a common thing that people hear is when you hit 30 years old,

32:24 your total testosterone will decline by 1% per year.

32:28 But the reality of what makes this even worse

32:31 is your SHBG levels will increase year-over-year proportionally faster,

32:37 thus making the velocity of free

32:38 testosterone decreases dramatically more so proportionally.

32:42 So even though total test decreases by 1% a year,

32:45 your free test will decrease by up to 2% per year.

32:47 And that's the one that you need to like

32:49 do stuff in the body through like freely circulating activity.

32:53 So, it's very important and very relevant for dictating

32:58 what activity you have in different tissues in the body

33:00 because it's ultimately the only one that can actually bind

33:02 to the receptor and do what it's supposed to do.

33:05 So, the SHPG levels will be dictated by age,

33:08 will be dictated by liver health to some extent,

33:10 will be dictated by other medications, especially oral formulations.

33:15 Um, insulenic signaling as well hugely implicated.

33:19 If you're on a ketogenic diet,

33:20 you can absolutely expect your SHBG levels to be through

33:22 the roof and your free test to be much lower.

33:25 So carnivore diet guys, there's a reason they eat fruit now.

33:28 It's because their free test levels are all[ __] and their total

33:30 test levels were high and they thought it was fine.

33:32 But in reality, they had like borderline hypoganatal free

33:34 test levels often because they were overlooking the fact

33:37 that insulenic signaling is needed to actually get

33:40 SHBG to a meaningfully reasonable level for a male.

33:44 So, and this is also something that would be relevant for females too, right?

33:48 Yeah.

33:48 And these binding proteins also exist for other hormones in the body cuz they

33:51 all function in similar ways through cargo

33:54 systems and transport mechanisms in the body.

33:56 Like you will have binding proteins for IGF-1,

33:59 you'll have binding proteins for thyroid hormones.

34:01 Like it's not uncommon to see people

34:03 with like normal on paper levels for certain hormones,

34:07 but then when you dig deeper,

34:09 all the free hormones are like proportionally horrible because

34:13 they're all bound like the the total production looks okay,

34:16 but it's cuz it's factoring in all these like

34:18 bound up hormones that are in use like unusable essentially.

34:23 Is that something that's common?

34:24 Like I mean would you say that's

34:27 uh it depends on the person and lifestyle.

34:31 So, but yeah, probably especially among women cuz I you know a lot

34:36 of them are you you only have so much androgens to work with to begin

34:40 with like your production is you know a tenth of males typically and then if

34:45 you are occupying all of your androgens

34:49 because you know essentially the SHBG is going

34:51 to with a much higher binding affinity mop up all your DHT and testosterone not

34:57 all of it but like a significant amount of it if it's high in any

35:01 like higher than it should be like

35:03 it will impact your like free androgenic signaling

35:06 so significantly that might put you into like

35:08 the you know female hypoganatal equivalent territory essentially.

35:12 So you could be like it's not uncommon for girls

35:14 to walk around borderline asexual or like literally no drive

35:18 throughout their entire adolescence 20s30s and think it's normal and it's

35:21 just not what they're supposed to be walking around like.

35:24 So, in other words, like if they have if their libido is like totally down,

35:28 perhaps like they're having a harder time losing fat,

35:31 gaining muscle, losing fat.

35:32 Um, it might it could come down to this, right?

35:36 Bone integrity.

35:36 All bone integrity, right?

35:38 Yeah.

35:38 So, that sounds like less a bit lesser.

35:40 So depending on if they're on like obviously you know if you're on a combined

35:43 roll contraceptive pill that has estrogen in it you know however much it does

35:47 that to what dose you know you can get into the nuance but ultimately like

35:51 you're inhibiting natural hormone production quite dramatically

35:54 through a myriad of means like think about

35:57 guys who are just like natural having to deal with what they deal with as is

36:00 you know the sleep impact the cortisol impacts the fat impact of being you

36:04 know obese and then if you have women who deal with all those same problems

36:08 you're going to have all the the suppressive

36:10 results of all of those lifestyle things,

36:11 the diet, the nutrition, the whatever.

36:14 And then you also factor in medications on top of that too

36:17 that maybe men don't typically have to take to, you know, achieve contraception.

36:21 Like, you know, that's typically like often I think

36:25 the final blow that will like push women into like,

36:28 you know, closer to low drive territory often and almost

36:32 certainly lower quality of life for a lot of them.

36:37 Now, that's not to say, because I think this gets misconstrued often,

36:40 is that's not to say don't use contraceptives at all.

36:43 Like, there are absolutely better ways to go about it.

36:46 I'm just giving examples that I see as common place.

36:49 No, no, it's this is great.

36:50 This is great information.

36:51 Um, you know, since we're kind of talking a little bit about symptoms,

36:54 let's kind of circle back to talking about

36:56 like what are the symptoms of low testosterone?

37:02 You know, we're talking about men here,

37:03 but like we talked about libido, muscle mass,

37:06 like what are what are like the classic

37:08 symptoms that men should be looking out for?

37:10 Is it something that's hard to differentiate between okay,

37:13 this is testosterone or other things?

37:16 It does get tough because as you would imagine a lot

37:20 of the lifestyle related things that lead to low testosterone will

37:26 come with the decrement to quality of life just via you

37:30 know if you have poor sleep like you're not going to feel

37:33 great because you didn't rest enough and then you add

37:36 that on top of the inhibition of you know your output

37:40 of ginadotropins pituitary hormones and response to them as well like

37:45 it's like a one-two punch off in a lot of this stuff.

37:47 So, in general, I would look to things like libido, um, erection quality.

37:55 Obviously, that's more, you know,

37:57 circulatory often, but still notable nonetheless.

38:00 If you suddenly, you know, if you don't have morning wood anymore,

38:02 like you got to look into it regardless if it's circulatory or hormone mediated.

38:07 Might be a combination of both.

38:09 Um, you no longer are able to hold muscle as easily or build muscle as easily.

38:14 you're, you know, losing strength in the gym,

38:16 your recovery capacity is inhibited relative

38:18 to what it was when you were younger.

38:20 um mood dysregulation,

38:24 um irritability and these are all like really general vague symptoms

38:29 and I would love to just say oh look at you

38:31 know the this exact thing will happen but in reality

38:35 it's often a constellation of things that comes as a vicious

38:38 circle effect of the you know factors that led

38:42 to that deterioration of testosterone to begin with or if you were

38:47 just you know never had reasonable testosterone to begin you

38:50 would have probably not gone through puberty adequately to begin with.

38:54 So like the genetic factors like some of these like more outlier cases become

38:58 a bit more obvious because it's like you

39:00 just never really like fully masculineized in adolescence.

39:03 You might have a higher voice.

39:04 You know you a lot of those things but are less relevant for the average person.

39:08 For the average person it's going to be more of these general symptoms

39:11 and it's warranted to get a test at that point and just see what's up, right?

39:15 Yeah.

39:16 So then that in combination with the test and the things

39:19 that we just talked about is kind of like where

39:21 you know like pre-diabetic you know progressing towards you know

39:24 pre-diabetes um insulin resistance a lot of this stuff is going

39:28 to be ultimately determined by blood work though because a lot

39:32 of people aren't going to be able to identify this autonomously reliably.

39:35 So that's kind of where I'd point

39:37 to the more vague stuff like the quality of life.

39:39 Like do you notice a blatant deterioration

39:42 with no other factors changed, erection quality,

39:46 you know, libido, uh vigor, muscle mass,

39:50 strength, fat, body composition, stuff like that.

39:53 So you mentioned the the by age 30

39:57 total testosterone decreases by about 1% per year.

39:59 And then you mentioned even in general in general, right?

40:02 Right.

40:03 On average like Yeah.

40:04 Exactly.

40:04 There's and that's where I ask

40:06 I've absolutely seen 70 year olds with you know 900 total te's.

40:10 So so the the question is then like there there are lifestyle factors

40:14 that really can sort of modulate that you know general decrease or not.

40:20 So maybe you can accelerate it or maybe can slow it, right?

40:23 And I kind of want to dive into some of that those those lifestyle

40:26 factors like what should men avoid or try to minimize in terms

40:33 of their environmental exposure or lifestyle factors

40:38 that are known to accelerate the decline

40:42 in testosterone and or increase the binding

40:46 protein so there's less free testosterone, right?

40:48 anything that's going to necessarily um regulate

40:52 the ability of testosterone to exert its, you know, its function essentially.

40:57 Mhm.

40:58 Um I would love to bang out an exhaustive list,

41:02 but forgive me, I guarantee we'll miss something, but like alcohol, you know,

41:07 the direct toxicity effects of that um does

41:11 inhibit actual uh steroidenesis in the testicles themselves.

41:17 It will also impact sleep dramatically which has

41:19 the vicious backhand effect of you know inhibited uh output

41:23 of signaling hormones which indirectly will also impact body

41:27 composition which you know the whole downstream cascade of that.

41:31 Um smoking obviously not helpful.

41:34 Um

41:34 how much alcohol is it?

41:36 Is it like any amount or like light drinking moderate drinking?

41:42 I think it like obviously the safe answer for me is to say no drinking.

41:47 I think it would be more like a dose dependent toxicity effect

41:51 and what is your capacity to handle it because ultimately the testes are

41:55 very uh affected by oxidative stress and if you're not capable of handling

42:02 that adequately like it will reflect

42:04 in your inadequate output of hormones locally.

42:08 So, I would love to give like hard and fast numbers,

42:10 but there are a lot of people who will be

42:11 able to get away with like murder and probably be okay.

42:14 There are some guys who like you might be low

42:17 normal uh function to begin with and like that, you know,

42:21 couple drinks a week like, you know,

42:23 throws off your sleep a bit and kind of pushes you over the edge.

42:25 Like it all depends.

42:27 Um it is very much a spectrum.

42:29 So, like going from like optimal

42:31 to like blatantly hypoganatal from a symptom perspective,

42:34 it's not like it's just on verse off.

42:36 like your way there is a you know it's it's transition

42:40 of you know shittiness as you arrive to that like worst case scenario.

42:44 Um so uh other things I could point to um if

42:48 you have a totally fat deficient diet I think that's you

42:51 know of a macro distribution that would be reflective of something

42:54 that's almost certainly going to hinder your capacity to produce hormones.

42:58 Um, also if you have a void of carbohydrate intake diet,

43:03 it would also be something that would

43:04 inhibit freely circulating hormones from liberating themselves.

43:08 Um, and lack of protein like you would not be able to produce, you know,

43:13 get as robust of a response recovering

43:15 from workouts and be able to build muscle,

43:17 which indirectly is going to improve body

43:19 composition and improve your hormones as well.

43:21 So, it's all kind of like balanced diet, don't eat bad.

43:25 Um, micronutrient intake.

43:27 I could definitely point to if you're deficient

43:30 and not every mineral or vitamin is going to be,

43:34 you know, gamechanging dramatic impact on your test levels,

43:37 but things like zinc, magnesium, vitamin D,

43:40 like these all have a marked impact on your testosterone either response to it

43:45 or capacity to produce it or even like like you mentioned in our podcast,

43:50 a conversion of vitamin D into active vitamin D.

43:53 like you might think you have adequate vitamin D status via

43:56 your dose you're taking that's super high but you're not actually utilizing it

44:00 but you think you are and that's that's impacting your testosterone production

44:03 and your response to it at the androgen receptor itself as well.

44:07 So I think from a minerals and vitamin standpoint,

44:09 the low hanging fruits are typically going to be like B vitamins,

44:13 but in particular like from a mineral side, you know, you have uh you know,

44:18 magnesium, zinc, and the vitamin D3 are going to be

44:23 three things that specifically on top of the minerals

44:27 and vitamins that everyone's familiar with from multivitamins

44:29 and whatnot are more difficult to get in adequate doses.

44:32 All but zinc is typically adequately in many multivitamins,

44:35 but the magnesium in particular almost never is because of the weight of it.

44:39 You would be having to take a multivitamin

44:40 that's like eight to 10 capsules otherwise, which just nobody does.

44:44 Um, and then the vitamin D, it's fat soluble.

44:47 Typically, you're going to have it in like a soft gel or something,

44:49 and it's not always going to be at the dose you need in the multivitamins.

44:53 It's just worth noting.

44:55 Um, so those are just some lowhanging fruits that are if you don't

45:00 look to those as part of your micronutrient

45:04 optimization strategy like you could be

45:06 overlooking low hanging fruit that like is a deterioration of you know 100

45:12 plus nanogs per deciliter per deficient micro

45:16 potentially depending on how severe the deficiency.

45:19 Um, other things I could point to, being obese,

45:21 like the worst one probably that I probably should have mentioned first,

45:24 but is like so dramatically impactful on your uh

45:30 negative feedback to the hypothalammic pituitary axis.

45:33 So, by that I mean men who are obese and women,

45:39 if you have uh a significant amount of fat,

45:43 it is going to elevate your aromatization, which is,

45:46 you know, your conversion of testosterone to estrogen.

45:48 And this is more impactful in males because

45:50 of how the brain gets signaled from estrogen,

45:54 not testosterone directly as significantly.

45:57 There's a bit of a nuance there, but in general,

45:59 like you need adequate estrogen to tell your brain, okay, we're good.

46:03 You don't need to make enough testo

46:05 more testosterone because I have enough estrogen.

46:07 Like that's kind of like the downstream cascade of these metabolite

46:11 conversions is you produce testosterone in order to produce other things, too.

46:16 And the estrogen is a very potent mediator of telling your brain we're good.

46:21 And if you have a significantly elevated amount of estrogen being converted

46:26 from your testosterone that you make because of how much fat you have,

46:30 you are basically achieving the proportional increase in estrogen that is much

46:36 higher than the amount of testosterone substrate that led to that conversion.

46:42 So you have that signal telling your brain, okay, we're good.

46:45 But the amount of testosterone you actually had to begin with was not good.

46:48 So that's problematic.

46:50 People who are obese have, you know,

46:51 upwards of I would love to give hard and fast numbers,

46:54 but it could be like significant like half of a reference range maybe,

46:59 you know, the it could be the differential between you being, you know,

47:02 the quality of life of you're fine

47:05 versus you're blatantly in, you know, severe deficiency.

47:10 And what else could I point to?

47:12 Um what does weight loss do to to the to those levels?

47:19 Like if you are someone that's obese and then you lose weight,

47:22 does that bring you back?

47:24 Yeah, as long as you are losing ideally like visceral

47:28 fat and like overall fat loss is going to be

47:31 very uh supporting of getting that ratio back into balance

47:36 of your estrogen and the amount that's converted to estrogen,

47:39 estradiol in particular.

47:41 And once that balance is favorable because you are leaner,

47:45 you will have a balanced amount of feedback to the brain

47:49 that then regulates like the perfect homeostasis between okay,

47:52 now we have adequate testosterone and estrogen.

47:54 So you will actually notice more testosterone being produced because

47:57 it realizes to get this signal that we deem adequate,

48:02 we had to produce more testosterone to get that amount of estrogen.

48:05 So there's a goldilock zone of course.

48:08 You can't just, you know, become, you know, a malnourished uh, you know,

48:12 low like bodybuilder shredded person and just

48:16 continue to get this elevation in proportion.

48:18 It's at some point you will end up essentially starving

48:22 your body of the nutrients needed to actually support hormone production.

48:25 But in general, you know, guys who are, you know, like 12,

48:29 like 12 to 15% body fatish will find that they have

48:33 a increase in testosterone dramatically relative to when they were obese.

48:37 And it's like super significant and how much it will improve uh hormone status.

48:42 So, and then the sleep.

48:44 I think I might have already mentioned that.

48:46 Yeah.

48:46 What I definitely want to dive into some of the diet things in a minute,

48:49 but I wanted to ask you about um a couple

48:51 of things for with respect to maybe factors to avoid.

48:55 Um what effect is like excessive endurance training have on testosterone?

49:00 Because I thought I came across some literature where it

49:02 was a negative effect and I wasn't sure like how robust.

49:06 I think it is pretty dramatic pending it exceeds your capacity to recover.

49:12 So that sounds like a weird way to answer the question,

49:15 but like some people have a higher tolerance for stress and that's, you know,

49:20 reliance on a bunch of different factors,

49:21 but if you are somebody who is not fueling

49:24 yourself correctly to handle that amount of endurance training,

49:27 like you were, let's just say you're in a calorie

49:28 deficit and you're trying to be like, I don't know,

49:32 six-pack shredded for the summer and like look as good as possible,

49:36 but also fuel your like endurance event efforts,

49:40 like you're probably like not doing two you're not doing two

49:44 birds one's don't stone like you're doing two things like inadequately almost

49:47 certainly and malnourishing yourself and ending up in a state of hormone

49:50 deficiency as a result probably like you see in studies all there

49:54 are uh cases that you can point to of what happened

49:58 to natural bodybuilders as they diet for a show and you can see

50:03 in like as they start to get closer to stage ready which

50:07 is like the most shredded basically any documented human gets essentially Okay,

50:12 the requirement to get there is a state of malnourishment essentially.

50:16 And at some point typically once you start

50:19 to cross into that like you know singledigit body fat

50:22 threshold you start to become so malnourished that you

50:25 are inhibiting your actual capacity to produce hormones adequately.

50:29 You almost enter into like you know preservation mode slash like

50:33 hibernation or something and it's kind of just like save yourself.

50:37 we're starving to death.

50:38 Like, how do I stop everything metabolically taxing from happening?

50:42 Let's shut down all systems.

50:43 Nor do we have the substrate to actually produce these hormones to begin with.

50:47 That's kind of what happens when you get like really really malnourished.

50:49 And with endurance running, like I've seen guys out eat, you know,

50:53 5,000 plus calorie per day diets when

50:55 they're doing like really intensive endurance activity.

50:58 So if you are not fueling adequately and with the right fuel,

51:02 micronutrient density,

51:03 macro aotment, the uh how much of it is like carbs versus fat versus protein.

51:09 Yeah, you could absolutely exercise yourself

51:10 into a uh state of hypoganism easily.

51:14 Um I kind of like I would I would caveat not easily.

51:17 It's hard to train that hard, right?

51:19 Yeah.

51:19 No, it's definitely not easily.

51:20 Like there's not a lot of people that are Yeah.

51:22 Kudos to the people mentally strong enough to do that, I guess.

51:25 Well, I I kind of think of the analogy here for women.

51:29 It would be like when women are excessively endurance training

51:33 and in a severe caloric deficit and they become a menoretic, right?

51:37 So, they're essentially not ovulating anymore.

51:39 And in fact, you mentioned like wanting to get shredded for the summer.

51:42 Well, I actually in my 20s

51:44 was was doing this very thing where I mean I was running like 10 miles a day

51:49 and I was eating like carrots and hummus and that's it, you know?

51:53 And it was like not fueling myself.

51:55 No, like hardly any fat, you know,

51:56 it was very like very sort of like low protein, you know, low-fat diet.

52:05 Yeah.

52:04 And I definitely got shreddedish,

52:06 but like I became a benetic for several months, you know,

52:10 where I just didn't get my period and I wasn't ovulating

52:13 and so I had to add back the calories in the food.

52:16 It was like and it took a while

52:18 before my body kind of like re-calibrated.

52:21 Yeah.

52:21 Yeah, but I feel like that's kind of like the analogy that like women it is.

52:26 It's like your body shuts down.

52:27 It's like, okay, I'm not getting enough calories.

52:30 Reproduction is not essential right now.

52:31 Survival mode, right?

52:32 Not reprod not reproductive like happy growth mode.

52:35 It's like survival mode.

52:37 And like some people might not even realize how

52:39 significant of a deterioration in hormone production I'm talking about.

52:42 Like to give context, men who are dieting for bodybuilding shows naturally,

52:47 it is not uncommon to see the end result of a hormone profile on like

52:52 the last week them to look more female on paper than like their girlfriend.

52:59 Like that's how low their testosterone levels are.

53:01 That's wild.

53:02 That's wild.

53:03 Um, just to kind of sum up the like factors to avoid, not always, but sometimes.

53:08 Um, I wanted to get your opinion on endocrine disrupting chemicals like

53:15 how how have you or has your um you know your company

53:20 looked or seen anything or do you have any speculation into like

53:24 what the scientific literature has shown

53:26 in terms of them affecting hormone levels?

53:29 Yeah, I think we're pretty convinced that there is an effect.

53:33 It's just the magnitude at which you often see hyped up.

53:38 I think maybe overexaggerated.

53:40 There are low hanging fruit things to absolutely avoid like don't use,

53:43 you know, plastic Tupperware and like heat it up and stuff like that.

53:46 Try and use glass when you can.

53:49 Um try and ensure you have like high quality air if possible.

53:55 like pollution I think is a big factor for like

53:57 your body's capacity to deal with stress and like

54:00 the allocation of resources to be chronically dealing

54:03 with a toxic environment will inhibit systemic like broad systems.

54:09 um water quality, like if you could make sure you have like decent water,

54:13 I think that'd be solid.

54:14 But as far as like the actual magnitude

54:17 of impact of those things for most people,

54:21 I think is going to be relatively negligible in contrast to like the obesity,

54:26 the diet, the exercise, the sleep quality,

54:30 the uh potential uh carcinogens they might be exposing themselves to.

54:36 you know, some of the lifestyle stuff is like way more important to be

54:41 addressing as like the base infrastructure

54:43 before you start thinking about like, oh,

54:45 it must be my like shower that is like shooting chlorine at me,

54:49 like it must be that or sure,

54:51 get a shower filter, but like it's not going to be the game changer.

54:54 I do think avoiding like the basics though, like you know,

54:56 switch to glass where you can, don't use plastic water bottles, stuff like that.

55:01 And there is blatant evidence showing

55:04 interactions with estrogen receptors with some

55:06 of these compounds as well as androgen receptors which in turn

55:10 will impede the ability of the actual hormones you produce

55:14 to bind to those receptors and do what it needs to do.

55:16 So you're like essentially competing with yourself for activity in the body.

55:20 like you're, you know,

55:21 competing with these like uh even if they're like moot activity compounds,

55:26 they still act as like anti-androgens

55:28 or anti-estrogens via their occupying of receptors.

55:32 So, to whatever degree they are,

55:34 doing it at all is not ideal because it's inhibiting like

55:36 space that could be occupied by actual endogenous hormones that you need

55:41 to produce and need to work properly and you don't want to be

55:44 competing with like environmental toxins to like do things in the body.

55:49 What do you you hear you like I often hear

55:52 from many people popular you know media as well as just people

55:57 I I speak to or comments that I read about testosterone

56:01 levels being lower now in men than they have ever been.

56:05 Mhm.

56:07 Um for one like is that true?

56:10 Do you think that's true?

56:11 And two like what are some of the major contributors?

56:13 Is it obesity since obesity is rampant?

56:16 I mean, or is it just like everything that you mentioned all sort

56:19 of like compounding together and not

56:21 necessarily just like increase in, you know, BPA and plastic, you know,

56:25 endocrine disrupting chemicals that are now a lot more prevalent than they were,

56:29 you know, 60 or 70 years ago.

56:32 Mhm.

56:33 I did a video a while ago on like the earliest finding I could

56:40 find of recorded testosterone levels in I

56:43 think it was like military soldiers or something.

56:46 One thing that I think is notable is the actual detection sensitivity of testing

56:51 is absolutely much different now than it was you know 60 years ago.

56:55 So to contrast like oh the total test of some

56:59 guy 60 years ago verse now is equivalent even

57:03 on like a testing methodology basis is like flawed

57:06 to begin with because it's probably not an accurate comparison.

57:10 But is there a trend downwards?

57:13 I would say yes.

57:13 And I think it is mostly dictated by the obesity, the diet, the lifestyle stuff.

57:20 So, you know, like you there's obviously things to deal with in the environment

57:24 that are less favorable and are not supportive and probably not benign,

57:29 but like in general, I think most people that worry about this stuff,

57:32 they would be put their mind at ease by dialing in everything else,

57:37 which is not that hard to do.

57:38 It's often free or, you know, cost less money.

57:41 You're eating less food, you know, go to the gym, etc.

57:44 I'm not saying that's easy to do, but like dial in your basics.

57:47 And once you do that, you have like an incre you have your baseline.

57:50 Let's just say you get a blood test and you see where you're at.

57:52 From there, you can start doing some

57:54 of the minute changes like putting, you know,

57:55 a chlorine filter on your shower head,

57:57 do this, change your water source, whatever.

57:59 Do you notice an incremental uptick in your gonadotropen

58:02 output or your response to it at that point?

58:04 If yes, like okay, maybe it was a meaningful change.

58:06 But like until you do that, like you're kind of just taking shots in the dark,

58:09 assuming all of these things are,

58:12 you know, occupying your mental bandwidth and concerning you

58:15 that may not be worth your concern to that degree.

58:19 Does chlorine have an effect on testosterone?

58:21 I don't I don't like maybe.

58:23 Okay.

58:23 Yeah, I think I think more of like BPA, but um and consuming it like orally,

58:27 like you said, hot like heating up the plastic

58:30 or like hot beverages like going into like something plastic.

58:33 But um yeah, I I agree.

58:35 I think these lifestyle factors are are paramount and

58:39 I'd love to kind of get a little bit more into some of those particularly

58:42 like so you've already mentioned the diet and I'm kind of you mentioned protein,

58:46 fat, um carbohydrate, you know,

58:48 like so what what what are some of these important?

58:52 And so fats are important to make, you know, the backbones of of um hormones.

58:57 Maybe we can talk just a little bit about like why low-fat diets

59:00 and why people should be incorporating fat

59:02 into their diet to make sure that they're Yeah.

59:05 Like in general, it's not like if you have,

59:08 for example, if you ingest cholesterol,

59:11 it doesn't necessarily mean you're going to have like

59:13 a dose dependent elevation in your like serum cholesterol,

59:16 as I'm sure everyone knows here.

59:18 Um but there are like certain baseline requirements to serve as the substrate

59:23 for producing cholesterol derived uh steroids

59:28 in the body and these are all ultimately

59:30 derived from cholesterol and then get cleaved

59:32 and manipulated through enzyatic processes to make

59:34 all the hormones in your body including

59:36 but not limited to testosterone estradi etc.

59:41 So, in general, it does seem like having a sufficient amount of fat is

59:47 worthwhile and does seem to impact um

59:50 how much hormones you can actually produce.

59:52 Um, and the carbs for actually mediating uh,

59:56 and this is going to depend on, you know, activity levels,

59:58 how demanding of exercise you do,

1:00:00 if you burn through them versus not, if you're sedentary versus not,

1:00:03 but in general is going to be the insulinogenic signaling

1:00:07 is somewhat necessary to facilitate a balance of free androgens,

1:00:12 including free other hormones in the body that often

1:00:15 go overlooked to actually do what they're supposed to do.

1:00:19 cuz a lot of people won't even measure the free levels of, you know,

1:00:22 like the IGF-1, the, you know, the T3, like you'll,

1:00:26 you know, some of this stuff gets like hyper nuance when you

1:00:28 get into what hormones are actually bound up that you don't realize.

1:00:31 Um, estrogens, DHT, etc.

1:00:34 So, having a balanced diet and then the protein like you mentioned,

1:00:38 um, from like a mechanistic perspective, like I think in general,

1:00:44 these things all serve as building blocks is the simplest way I can put it.

1:00:48 and having a deficiency entirely of one or the other.

1:00:51 It's just like it's kind of the expected outcome.

1:00:53 Like it's often not going to be ideal to be

1:00:55 missing something entirely that your body utilizes for critical,

1:01:00 you know, structural things.

1:01:02 Well, I it's interesting.

1:01:03 I learned something from you because I, you know,

1:01:04 I was aware of the importance for, you know,

1:01:08 of of fat, particularly like, you know, a certain amount of saturated fat,

1:01:12 which is known to increase endogenous cholesterol production.

1:01:16 Um, but the carbohydrates and the insulin response and like

1:01:19 having that insulin action or response like and I didn't realize

1:01:22 that was also important and you know especially for the free

1:01:27 you know hormones like the act or the amount of free hormones.

1:01:31 So it's it's it's interesting to think about like a ketogenic

1:01:34 diet you know as you mentioned like some people can really be

1:01:38 um in in a problematic state if they're on a ketogenic

1:01:41 diet and their free testosterone just kind of tanks.

1:01:44 And it's not to say that it will absolutely happen.

1:01:46 Like I'm sure there are a lot of people that thrive

1:01:48 on long-term ketogenic diets or may even clinically require them.

1:01:52 So like I certainly don't want to come out here

1:01:54 and suggest if you're on a ketogenic diet, stop doing it.

1:01:57 Like talk to your doctor first.

1:01:59 Obviously, it's just like mechanistically this is what

1:02:02 happens if you have a lack of insulin signaling.

1:02:03 You will have less capacity to suppress the binding proteins.

1:02:08 Well, what you're saying is like get your hormones measured.

1:02:10 Measure them right and make sure that you're monitoring.

1:02:12 Yeah.

1:02:12 informed before you like freak out about anything, right?

1:02:15 Yeah.

1:02:16 Um, with respect to other sort of like

1:02:20 lifestyle factors that can maybe boost testosterone.

1:02:22 So, we're talking about dietary factors here.

1:02:25 What about exercise?

1:02:26 I, you know, resistance training is one that comes

1:02:28 to my mind when I think about trying to boost testosterone.

1:02:31 I mean, is there merit to that?

1:02:33 Is that something that moves the needle?

1:02:35 Yeah, I think it's kind of like in simplest way

1:02:37 I could put it is like descending order of intensity essentially.

1:02:40 So like you know weightlifting at the top and then

1:02:42 you have like um some of your more like hit

1:02:45 style workouts underneath that and then at the bottom of it

1:02:49 would be like the most basic of I don't know

1:02:52 barely exerting yourself but like getting out there and moving

1:02:56 that is going to have the least impact in general

1:03:00 and at the top it's going to be you know

1:03:02 the muscle building facilitating processes the things that build bone etc.

1:03:06 resistance training.

1:03:08 That's going to be the most directly impactful,

1:03:10 but ultimately it's also going to be what is the overall exercise

1:03:14 regimen that you adhere to because a lot of people the problem

1:03:18 is not even necessarily like oh what's the perfect thing like it

1:03:20 has to be something you enjoy enough that you'll adhere to it.

1:03:23 So like adherence almost trumps optim optimal in some capacity.

1:03:29 So like get the thing you can adhere to the diet model that you can adhere to.

1:03:34 Like a lot of people the the diet that on paper is the best

1:03:38 won't be the one that you stick to for more than like 6 weeks.

1:03:40 So like don't do that one if that's the case cuz you're not going

1:03:43 to stick to it and you're just going to end up where you were before.

1:03:45 So calories trump everything unfortunately you know or fortunately cuz

1:03:50 it gives you a lot more versatility with like your choices.

1:03:52 I think it's not like you're stuck in a myopic kind of, you know,

1:03:56 box of I have to be on like the Mediterranean diet or I have

1:03:58 to be on the carnivore diet or I have to be on the vegan,

1:04:01 you know, the whatever.

1:04:02 There are a lot of ways to skin a cat and ultimately it's going

1:04:05 to come in mainly from energy balance

1:04:07 and then also from there optimizing for, you know,

1:04:11 having adequate protein, fat presence,

1:04:14 carbohydrate balance to support your, you know,

1:04:16 whatever exercise you're doing and the intensity of it.

1:04:20 um and all the things underlying that.

1:04:22 Before we continue, I just want to mention something important.

1:04:25 If you're finding these episodes valuable,

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1:04:46 Now, back to the episode.

1:04:48 Um, with respect to some of the micronutrients,

1:04:50 it kind of this kind of gets into the the supplement area as well,

1:04:55 but you mentioned some important ones that I've also kind of like

1:04:59 come across in the literature and that being vitamin D, zinc, magnesium.

1:05:04 Can we can we kind of just dive a little bit into their effectiveness?

1:05:07 Like there's like is there human data on it?

1:05:10 Like do you know anything about how they're working?

1:05:12 I mean, I've seen I've read some of the the human studies particularly

1:05:15 on the vitamin D and like getting

1:05:17 like higher dose vitamin D supplementation improving testosterone,

1:05:20 but I mean, I'd love to kind of just take a moment

1:05:23 to kind of talk a little bit more about that if if you want.

1:05:27 Yeah.

1:05:27 Like in general, I think the most reliable things that move the needle if

1:05:32 you were deficient is I don't know if people are familiar with the ZMA.

1:05:36 It was like a the first like combo supplement that was sort

1:05:40 of seen as like a testosterone booster that was available on the market.

1:05:44 And it's, you know, like zinc, magnesium,

1:05:48 and I don't remember the the A was something else,

1:05:50 but vitamin D is the third thing you

1:05:53 I don't remember what the A stands for, but those were

1:05:56 the three things that move the needle most reliably that are natural you,

1:06:00 you know, otherwise would get through your diet, but likely not sufficiently.

1:06:04 Maybe zinc you might,

1:06:05 but like magnesium pretty difficult I would say for a lot of people.

1:06:08 They don't realize how deficient they are.

1:06:10 And then even like supplementing accordingly it's like you

1:06:14 know getting one that you respond that you tolerate well

1:06:17 with your digestive system has the yield that actually produces

1:06:20 enough magnesium from like the elemental weight of the supplement.

1:06:24 Um which is not that complicated.

1:06:26 I don't want to make it sound super complicated.

1:06:27 Like a lot of them are fine.

1:06:29 Rhonda has great articles on magnesium formats

1:06:32 that are bioavailable and yield more than enough magnesium.

1:06:35 Um, and yeah, the vitamin D having an adequate amount,

1:06:38 making sure you're converting it and actually getting the activity from it.

1:06:41 um mechanistically there is some level

1:06:45 of um like gene transcription capacity facilitated

1:06:50 through these like like vitamin D is a hormone for example and it does

1:06:53 also affect androgen receptor activity and some

1:06:56 like the capacity for androgens to do

1:06:58 what they do not just like the production of the amount of them.

1:07:02 So, similar to what I talked about earlier

1:07:03 where you have this kind of like receptor interaction,

1:07:06 how well can you actually utilize these hormones to do

1:07:09 the things it needs to do in the body,

1:07:11 some of this is going to be facilitated by the adequate

1:07:14 uh minerals and hormones for vitamin D supporting it.

1:07:19 And it's not necessarily measurable as much like directly,

1:07:24 but all you can really do is like back

1:07:26 fill accordingly to hit your needs and then assess

1:07:29 your kind of like proxies and your blood work

1:07:31 and your symptoms and kind of go from there.

1:07:33 In your opinion, like let's say someone is on the deficient range of vitamin D,

1:07:38 their inadequate magnesium, perhaps their zinc is, you know,

1:07:42 maybe okay or in the in the inadequate range.

1:07:46 Would getting to that sufficient status really

1:07:48 move the needle with respect to like testosterone?

1:07:51 I think if you were on the low end

1:07:53 of the reference range or literally hypoganatal and you were

1:07:58 clinically low or deficient for those depending if it's all

1:08:05 three or not because obviously there' be an additive effect.

1:08:07 Most of them are I mean at least

1:08:08 vitamin vitamin D and magnesium pretty common deficient.

1:08:11 Yeah, I would say like you're

1:08:13 looking at probably a potential incremental difference

1:08:16 of 100 to 150 total T maybe it kind of depends on the person

1:08:21 of course like I've seen more robust response in some studies but I

1:08:25 also don't want to like overexaggerate the expectations um but it is meaningful

1:08:30 like it's something that abs and some of it can't be directly measured

1:08:33 either like we're talking about the total tea number but it's like how

1:08:36 do you know how much deficient vitamin D is impacting your ability to like

1:08:40 use it correctly And then even if you had the sufficient vitamin D,

1:08:44 the magnesium impact on all that and the DNA interactions and whatnot,

1:08:48 it's like, you know, you would have you'd be speculating at best.

1:08:51 So, and then there are some other more like uh tangential

1:08:54 supplements that are not as like obvious no-brainers that are helpful.

1:09:00 They're just facilitating mechanisms that are not like this is a vitamin

1:09:05 you need almost regardless of what your test levels were kind of thing.

1:09:09 Yeah, I'd love to talk about those.

1:09:10 I mean you hear some of these herbal supplements

1:09:13 and like some of the ashwagandha fenugreek with tonga

1:09:15 ali I mean let's dive into that like are

1:09:18 they effective which ones are effective which ones are hype

1:09:21 yeah um I think one that I would would be

1:09:25 worth mentioning al but the literature isn't super robust it

1:09:31 is boron so that potentially has a suppressive effect

1:09:35 on SHBG levels there's some literature that looks promising saying all,

1:09:40 but I wouldn't hang my hat on and say it's a guarantee.

1:09:44 It's going to suppress your SHBG from like the high

1:09:46 end of the reference strains to something that's like much more,

1:09:49 you know, much better.

1:09:50 But like it may, it does seem to work for some people.

1:09:53 And in general, it can be a supporting adjunct that some people are,

1:09:58 it's not something you typically get through

1:10:00 your diet in like significant quantities anyways.

1:10:03 Like often people will it'll come into multivitamin typically

1:10:06 but the quantity that moves the needle for SHBG I believe was

1:10:10 like 6 to 12 milligs and can be meaningful for actually

1:10:13 liberating free testosterone not for actually producing more total tea.

1:10:17 Um the other one that's probably worth

1:10:19 mentioning ashwagandha specifically uh extract that is

1:10:26 standardized to a sufficient quantity of wthanol

1:10:29 and not just your standard run-of-the-mill generic ashwagandha.

1:10:33 You want to look for ideally a patented, you know, uh sensoril or a KSM66.

1:10:41 These are patented formats of ashwagandha

1:10:44 that are standardized to a um target yield.

1:10:47 So you know that what you're getting is what you're supposed to be getting

1:10:50 rather than relying on you know certificates

1:10:53 of analysis from China of a generic extract.

1:10:55 So I would what was that compound they're standardized to again with analytes?

1:11:00 Okay.

1:11:00 It's like the it'll show right on the label.

1:11:02 be like ashwagandha bracket standardized to x percentage

1:11:07 with with analytes and depending on if you have

1:11:10 ksm66 that's 5% sensor is 10% the difference between

1:11:15 why you would pick one or the other is

1:11:17 the actual total dose you could get away with using less milligrams of the ks uh

1:11:22 of the sensoril because it has more with analides

1:11:25 per milligram inclusion in your product but they're both like

1:11:30 impactful is that the active compound that affects testosterone or

1:11:34 it seems to be and when I say testosterone yeah clarify

1:11:37 it's like the indirect effect via suppressing uh

1:11:41 cortisol seemingly and kind of like the stress response

1:11:45 manipulations that it can induce which are favorable

1:11:49 for people who are anxious who have very stressful

1:11:53 lifestyles who could benefit from it but it

1:11:56 is not a catch-all supplement that will benefit everyone

1:11:58 and some people it will push them into anhidonia

1:12:00 territory which is like a numbing of emotion.

1:12:03 So you don't want to

1:12:05 really Yeah.

1:12:05 If you overdo it, it will like literally suppress your stress

1:12:08 response so significantly that everything's just like black and white.

1:12:12 What's what's So what what what's a dose that would be considered overdoing it?

1:12:16 And what's a dose that would maybe be effective for suppressing the cortisol

1:12:20 response and indirectly affecting testosterone by not

1:12:23 having the cortisol decreasing the testosterone?

1:12:26 like I would go with the clinically

1:12:29 like supported dose for something that's efficacious.

1:12:32 I wouldn't necessarily suggest somebody, you know,

1:12:35 take something that's lower than what I've seen to actually work.

1:12:39 But in general, it seems to be a cumulative effect over time.

1:12:42 Maybe there are some people who might push you

1:12:44 over the edge sooner and like certainly it's something

1:12:46 to be cautious of and be aware of as a disclaimer

1:12:49 before you jump on any testosterone augmenting supplements.

1:12:53 just be aware of the mechanism of how it works

1:12:55 based on your own individual biochemistry because this is not something

1:12:58 like a vitamin D that you can just sequester into subq

1:13:01 fat and just like get rid of at some point.

1:13:04 It's like it could impact your mood regulation quite significantly

1:13:07 for a bit depending on like what your neurotransmitter balances at baseline.

1:13:13 Like if you are already borderline like

1:13:16 emotionally numb as a person and you take

1:13:17 ashroandha like you might literally like cease

1:13:20 to care about anything for all I know.

1:13:22 That sounds awful.

1:13:23 Yeah, but I mean for someone who is more of an anxious phenotype like

1:13:26 600 millig I think is the dose,

1:13:29 but double check on that because I might be misremembering, but I'm pretty sure.

1:13:33 And that is impactful um to the tune of upwards of another 100 points seemingly.

1:13:40 I could be misremembering exactly,

1:13:42 but it's like I think it's triple digits

1:13:43 pretty reliably for those who can benefit from it.

1:13:46 And for some people,

1:13:47 it's like a gamecher supplement that really improves their quality

1:13:50 of life outside of just the testosterone enhancing capacity of it.

1:13:54 Because some people deal with a lot of stress in their life and need

1:13:57 that extra resilience or suppression of how

1:13:59 much it's affecting their mental state.

1:14:01 Like some people they can't even get

1:14:02 to sleep because they're ruminating and they're constantly

1:14:05 anxious and having that kind of suppressed uh

1:14:08 stress response can be very very net beneficial.

1:14:11 And then on top of that improves their sleep

1:14:13 and also improves their testosterone through the uh reduction

1:14:16 of the kind of like gluccocorticoid responses and yeah so

1:14:20 it's it works for sure the literature seems sound on it.

1:14:24 Um some of it is funded by some

1:14:26 of these companies that do have the patented extract so just

1:14:28 be aware of that but at least from what I've

1:14:29 seen in blood work anecdotally too it seems to work.

1:14:32 Tonat Ali another very notable one.

1:14:34 This is one that um works through a different mechanism.

1:14:38 It seems to be a bit more speculative how it works,

1:14:41 but it seems to do a few things potentially.

1:14:44 One being minor uh serum activity potentially.

1:14:50 And this is more speculative.

1:14:52 Serum is like a selective estrogen receptor modulator.

1:14:55 So something that binds to estrogen receptors and either

1:14:59 like positively or negatively modulates them in selective tissues.

1:15:03 So there are certain tissues where it would be more favorable to have

1:15:06 a selective inhibition of certain hormones

1:15:08 versus others who would be detrimental.

1:15:10 Like you wouldn't want to inhibit estrogen's activity

1:15:12 in bone for example because that would cause bone degradation.

1:15:16 Um having an inhibition at the hypothalamus level level may depending

1:15:21 on the person help increase testosterone

1:15:24 via the inhibition of that feedback loop.

1:15:26 Now I don't necessarily think it is a serum.

1:15:28 That's just like the tertiary potential mechanism and it is speculative.

1:15:32 the main mechanism that people seem to agree on that it

1:15:35 does do suppression of SHBG to some extent as well

1:15:40 as the uh upregulation of steroidenesis um intraesticularly so like

1:15:48 locally upregulating I believe it's

1:15:50 steroidogenic acute regulatory protein that basically

1:15:53 incorporates um cholesterol into the mitochondria

1:15:56 to actually undergo these enzyatic

1:15:58 cleaving uh sequences that result in the production of testosterone

1:16:02 locally So it seems to like help upregulate the process

1:16:05 that actually uh enzyatically spits out testosterone essentially uh locally.

1:16:12 So that one seems to work well for individuals who have

1:16:15 high SHG levels or um potentially higher estrogen levels than they,

1:16:21 you know, is otherwise fixable via basic lifestyle changes and whatnot.

1:16:26 Um because everyone has their own proportion

1:16:27 of metabolism at the end of the day.

1:16:29 it's not always going to be optimal even if you

1:16:31 have what is otherwise like a great diet and lifestyle.

1:16:34 Um but also it's just like I think it's

1:16:38 for people who have adequate everything looks on paper

1:16:42 to be sufficient but their SHPG might be a bit high or they could use a little

1:16:45 bit of a boost and it seems to work to the tune of 100 to 200 nanograms

1:16:50 per deciliter for some people and depends on how

1:16:53 potent of a standardized uh extract you get.

1:16:56 You want to look for one that is HLC tested for uricomone.

1:17:00 That's the active ingredient in tonad ali that actually

1:17:03 has the bioactive effect that you're looking for.

1:17:06 There are a lot of tonad ali supplements that just say tonad ali or it'll

1:17:10 say tonad ali like 100 to one or like 10 to one or whatever.

1:17:14 Like these are kind of meaningless numbers from what I understand.

1:17:18 Like you're not going to get a 200 to one version of a tonat

1:17:21 and even if you did there's no indication there's any uricomone in it.

1:17:25 So, similar to the Ashwagandha,

1:17:27 you want something that actually says this is how much of the literal

1:17:31 ingredient that does what you're looking to get out of it in it.

1:17:34 And here's a third party test to verify it.

1:17:36 So, and what was that ingredient called again?

1:17:39 Yurione.

1:17:40 Got it.

1:17:41 E U R Y A C O M A N O N E, I think.

1:17:47 Now, how does Tonat Ali compared to like boron?

1:17:51 Is it I mean it sounds like for men it might be like

1:17:54 you're getting a bigger bang because it's

1:17:55 doing it's working in two different ways.

1:17:58 Yeah, it's a good question.

1:18:00 Boron is a mineral that is um seems

1:18:05 to be something that is mechanistically I wouldn't be

1:18:10 able to say um for certain what the differential

1:18:14 is and how they affect the SHPG binding complex.

1:18:16 Like I would be trying to I might misremember and I don't want to misspeak.

1:18:20 I don't know.

1:18:21 Okay.

1:18:21 Well, yeah, it's just kind of interesting.

1:18:23 Would would would the tonat le work in women as well just through the SHBG

1:18:29 or maybe the B like I don't know which

1:18:32 just for off like off the you know topic here.

1:18:35 Boron has also kind of been thought

1:18:37 to potentially be a longevity molecule as well.

1:18:39 There's some evidence that boron may be involved in like improving aging.

1:18:43 So when you said boron I was like oh really that's interesting.

1:18:46 Um,

1:18:46 yeah, I feel like that's almost like a lowerhanging fruit thing

1:18:49 because it's just typically part of a multivitamin that may just

1:18:53 not be dosed high enough and you can just like stack

1:18:56 on top and see if it has an incremental decrease to SHBG.

1:19:00 And then the Tonkat is like more of a speculative one that you

1:19:03 don't want to just like take until you've exhausted some of the other options,

1:19:06 but is like the more exotic kind of like hammer that you might

1:19:10 want to take to the situation if it's like your last resort before,

1:19:13 you know, I've tried everything.

1:19:14 My lifestyle's perfect.

1:19:16 My diet's dialed, my micronutrients are accounted

1:19:18 for, my sleep is good, I don't drink,

1:19:20 I don't smoke, and my total tea is still inadequate and I don't feel that great.

1:19:24 Should I try some of this like one of these exotic things

1:19:26 that seems to have a reasonable safety profile and like an efficacious,

1:19:30 you know, um, you know,

1:19:32 impact in men and young healthy men at that like

1:19:35 there are literature showing the effects in young healthy men,

1:19:37 not just like age- related like declined men.

1:19:40 So notable.

1:19:41 Now, as far as its impact on women,

1:19:43 I would think mechanistically would do a similar thing,

1:19:46 but like I don't have a study I could point to that says it's the same.

1:19:50 So, I would think, but I don't know.

1:19:52 Are there are there any others?

1:19:53 You know, I hear about, you know,

1:19:54 the the fenugreek and then the some of these like deasper um aspartic acid

1:20:00 or are there any others that are notable or would you say more hype?

1:20:03 Um I think a lot of those have been disproven like tribulus,

1:20:07 daspartic acid, fenugreek.

1:20:10 Um, one that is notable that might do something is chiliget.

1:20:13 If you get a high quality chilleet, it may provide enough like the actual

1:20:19 capacity of your organ to respond to hormones

1:20:22 is partly conditional on its ability to tolerate

1:20:25 stress and reactive oxygen species locally too.

1:20:27 So if you have more than you can deal

1:20:31 with and you introduce a potent antioxidant to the equation,

1:20:34 you may be able to like attenuate and neutralize the kind of like

1:20:38 decrement to performance and kind of like net out more local hormone yield.

1:20:43 So, chiliget seems to be impactful on intesticular antioxidant activity,

1:20:48 but I wouldn't uh it's another one that requires like

1:20:52 careful sourcing and it's also one that's like more speculative

1:20:58 and indirect cuz like there are probably better ways

1:21:00 to manage your oxidant like your antioxidant profile I would think.

1:21:05 So,

1:21:06 so your top four supplements for testosterone would be

1:21:12 zinc, magnesium, vitamin D, not in order, just the top three I would say.

1:21:18 And then I guess for impact, I would probably say like tonat ali,

1:21:23 but probably boron would be my safer next choice just for like safety profile.

1:21:28 Okay, great.

1:21:29 Unless and and then if you're like the anxious person added Yeah.

1:21:33 and just be like cognizant of what it's how it works cuz

1:21:36 you you may be able to get the benefit at a lower dose.

1:21:39 You may be able to cycle it um depending on how you respond to it.

1:21:43 Like similar to you with caffeine like there's

1:21:45 no hard and fast rules on all this stuff.

1:21:47 Like there are studies you could adhere

1:21:48 to like the protocols designed but they're ultimately

1:21:50 just designed by you know scientists who thought this was the way to do it.

1:21:54 And like for you and your individual biochemistry it may not be the ideal way,

1:21:58 right?

1:21:58 I I mean I've been interested in ashwagandha.

1:22:00 I kind of experimented with it like half-heartedly like years ago

1:22:05 and I think I'm going to now bring it back into circulation.

1:22:08 Okay.

1:22:08 Um because

1:22:10 I do I am interested in in the stress management part of it like

1:22:14 lowering some of the the cortisol and stress although I do that with exercise

1:22:18 but um if there's like a side effect of like you know just

1:22:22 a little bit of testosterone boost like that would be great you know for me.

1:22:26 So, I think that's going to be another experiment of mine that I I try out.

1:22:31 Um, check your blood first, though.

1:22:33 Yeah.

1:22:33 No, I'm that's I already told you I want to get my my hormones.

1:22:36 It's I've had them measured, but like I don't feel confident.

1:22:39 I haven't had repeated measurements.

1:22:40 I

1:22:41 Once you got that blood test, you're going to be like, "Fuck,

1:22:42 I shouldn't have taken Astroghre cuz now I have no idea what this means,

1:22:45 what the what the baseline was." Yeah.

1:22:47 No, definitely.

1:22:48 For sure.

1:22:49 Um, but let's talk about like let's say people are, you know, trying

1:22:54 if you do assess your cortisol stress response,

1:22:56 I would highly recommend a Dutch test over a blood test.

1:22:59 Why is that?

1:23:01 Salivary cortisol levels uh are far more indicative of what's happening

1:23:04 from a stress response standpoint than

1:23:06 your like transient serum cortisol levels will be.

1:23:10 Oh, really?

1:23:11 Yeah.

1:23:11 And because this just like the snapshot in time and it

1:23:15 in the serum is just like not an accurate reflective measure.

1:23:19 Um the salivary levels will fluctuate and they get

1:23:22 like multiple readings and they create like an average curve

1:23:24 for you and they actually map out your day

1:23:26 as opposed to with blood you get like one big draw.

1:23:29 The cortisol is measured one time and it's like okay you're like

1:23:33 high end of normal like what do we do with that information?

1:23:36 The salivary one's a little bit more indicative of like here

1:23:38 are multiple time points of the day and like here's where

1:23:41 we'd expect you to be at these points and like

1:23:44 this is how you're responding to your day stressors kind of thing.

1:23:48 Cool.

1:23:48 All right.

1:23:48 Well,

1:23:49 and it's like less intrusive to like spit in a tube, you know, or whatever,

1:23:52 right?

1:23:52 And do they and do you usually you spit

1:23:54 in multiple times a day to kind of get that

1:23:56 I've actually not done a Dutch test personally,

1:23:58 but I'm pretty sure it's just you spit in a tube.

1:24:03 Yeah.

1:24:01 Yeah.

1:24:01 Okay.

1:24:02 Um, good information.

1:24:05 Let's kind of transition to like people that have, let's say, like we're,

1:24:09 let's get back into the men category here,

1:24:11 that have like exhausted these natural ways.

1:24:14 They've like, you know, perhaps lost weight or done all the lifestyle

1:24:18 factors that we've talked about to improve their testosterone.

1:24:22 They're both total and free, all all that above.

1:24:27 Who should consider hormone replacement therapy?

1:24:29 Like, how does a man identify whether or not they're a good candidate?

1:24:34 I mean, is it really just recommended for men with clinically low testosterone

1:24:39 and symptoms or like what we kind of touched on this a little bit earlier,

1:24:45 but I kind of want to just go

1:24:46 into this um area now of actual testosterone replacement therapy.

1:24:51 though um like there are definitely scenarios in which it's more

1:24:56 obvious because there is a structural issue that cannot be rectified

1:25:01 via any sort of lifestyle change or like sleep hygiene

1:25:05 manipulation or whatever like if you have primary hypoganism and you've

1:25:09 ruled out the ultrasound like varicusia there's no issues you're

1:25:14 not like cooking your testes in like a hot tub

1:25:16 every night you're not uh I don't know like your sleep

1:25:19 is dialed your micronutrient you know, intake is on point.

1:25:22 Also, satisfactory amounts of calories.

1:25:24 Like I think I might have probably indirectly touched

1:25:26 on this, but like via the getting to a good body

1:25:30 fat like you still need to have an adequate amount

1:25:33 of energy to actually meet the needs to produce hormones too.

1:25:37 So like adequate amount of calories, not overdoing it, not underdoing it.

1:25:40 Um, if you've done all the stuff that we kind

1:25:43 of like talked about and you've ruled out um pituitary adenoma,

1:25:49 you've ruled out any sort of like I don't know like uh um structural

1:25:55 defects and signaling is adequate or even

1:26:00 supra physiologic and you're just not responding.

1:26:02 Like at that point it's kind of like okay

1:26:04 you're we could try hammering you with some hCG

1:26:07 and see if we can stimulate a satisfactory response

1:26:10 with like a manual like extra push at the light cell.

1:26:14 Um or use some you know some of these other

1:26:17 like augmenting you know steroidogenic supporting things like tonat or whatever.

1:26:22 But if that's not working either like your your testes are cooked and you got

1:26:26 to be on test at that point because

1:26:27 you're just not responding to any natural stimulation whatsoever.

1:26:31 That is not typically the I the outcome

1:26:33 of a lot of guys who end up on testosterone.

1:26:36 A lot of guys end up on it through like

1:26:38 like secondary diet like hypogonatal symptoms through like the pituitary

1:26:45 either inadequate output or insufficient response to that output plus

1:26:50 an insufficient amount coupled with it coming out of the pituitary.

1:26:54 There's not a lot of people that are literally

1:26:56 showing up with like your testes don't respond whatsoever.

1:27:01 um in those individuals like it's app it's kind of like if you've exhausted

1:27:04 all resources you've tried the whole manual

1:27:06 stimulation directly because hCG is the way you

1:27:09 would actually test that out is you would actually look at okay if we

1:27:11 actually hit your lighting cells directly

1:27:13 with a signal and we escalate that to like

1:27:16 the maximum degree and we use FSH2 exogenous it's like if you're still not

1:27:22 responding to that like there's no saving it at that point unless you have

1:27:25 like such a significant amount of oxidative

1:27:28 stress that you're just like not dealing

1:27:30 with that would have been taken care of with the lifestyle stuff we mentioned.

1:27:32 So, primary hypogenatal like you're going to probably

1:27:36 be on exogenous testosterone and it's literally like testosterone.

1:27:39 You can't fix it with any clomophene.

1:27:40 You can't fix it with hCG.

1:27:41 You can't fix it with HMG.

1:27:42 There's no other way around it.

1:27:44 Like you're taking the literal hormone because it's

1:27:45 the only thing that will get you testosterone.

1:27:47 Like you can't produce it.

1:27:48 So, there's that.

1:27:50 Um, and there's different ways you can take it,

1:27:52 of course, which we could, you know, get into later.

1:27:54 But the next situation that's a bit more relevant is like the secondary

1:27:59 hypoganadism situation where somebody has pro like

1:28:03 testes that function just potentially to like

1:28:06 a suboptimal capacity and there might be some level of like low gonadotropen

1:28:12 output facilitate facilitated through some level

1:28:15 of like lifestyle or diet or whatever.

1:28:18 Um, like Peter for example,

1:28:20 like he's pretty dialed and like he did a lot of stuff

1:28:23 to try and like fix it before he went to any sort of replacement.

1:28:27 Sleep hygiene is on point.

1:28:29 Like the guy like what else could you do when you're him, right?

1:28:31 He's I think 50 years old.

1:28:33 So what he did was he used hCG which was

1:28:36 assessing okay like are the testes responding to like a manual

1:28:40 signal and they were and he's like replaced his hormones entirely

1:28:44 by using a manual LH mimic essentially why his pituitary wasn't

1:28:50 shooting out enough LH to hit the amount like the enough

1:28:54 stimulation he would need to produce the same amount of test

1:28:56 that would hit his like optimal variety of factors age

1:29:00 related decline who knows but probably a combination of multiple things.

1:29:04 And at that point, it's kind of like,

1:29:06 do you want to manually back fill with signal

1:29:08 or do you want to take hormones pending,

1:29:12 you've done all the exhaustive, you know, uh,

1:29:15 things to try and like check the boxes?

1:29:17 Cuz, you know, some people don't care as much and don't want to check the boxes.

1:29:20 But, like, in general,

1:29:22 I would say it would be worthwhile to learn why you have the problem,

1:29:27 even if your intention is to just end up on testosterone anyway.

1:29:30 Like I wouldn't I wouldn't delay treatment if you're

1:29:32 symptomatic and it's like hurting your quality of life,

1:29:35 but I also would like do some due

1:29:37 diligence to just like assess like what's happening.

1:29:40 And I think hCG for people who are like secondary hypoganatal is sometimes

1:29:45 a good middle ground of assessing like is this a testicle functionality problem

1:29:50 or is it like my pituitary output is not sufficient because at that point

1:29:55 you can kind of tell like which organ is it that's failing me here.

1:29:58 So there's that.

1:30:00 Um, and then like upstream to that, there's

1:30:03 the actual hypothalamus and the G&R output,

1:30:05 which is the thing that stimulates the pituitary to make the LH and the FSH.

1:30:09 And throughout that whole cascade, you could have insufficient signal

1:30:13 from that, insufficient response to that signal,

1:30:16 and then insufficient pituitary output from that weakened

1:30:19 signal and the response to it.

1:30:20 like it's a deteriorating thing that by the end

1:30:23 of it when it actually hits your testes may just

1:30:25 be like suboptimal for your response to be adequate through

1:30:30 often age related decline but it's a culmination of things.

1:30:34 So certainly back to the original question like how do you make sense of all

1:30:38 this and decide when is the appropriate time to be on hormones versus not?

1:30:41 That's where you'd have to work with like

1:30:42 a really highly educated medical professional in general.

1:30:47 Like I would not try and uh cowboy this yourself.

1:30:51 Um even trying to like learn it from, you know, online content, whatever.

1:30:56 Like I think it's I think it's good to learn

1:30:58 how this stuff works mechanistically so you go in informed

1:31:00 and don't end up putting on a haphazard regimen

1:31:03 by a doctor who actually just wanted you on medications.

1:31:05 Cuz if you know this stuff,

1:31:07 it's pretty easy to identify who's like a shitty clinic who just

1:31:10 wants to like get you committed and stuck on lifelong hormone support.

1:31:15 and you can like weed it out

1:31:16 really quick even if the doctor seems well-intentioned.

1:31:18 He wants to help you.

1:31:19 He wants to, you know, support your quality of life,

1:31:21 says all the right things, seems professional, seems knowledgeable.

1:31:24 If you don't know this stuff, it's kind of like you would be going

1:31:27 in blind and assuming that's what you need to do.

1:31:29 And a lot of people just end up on hormones and that's it.

1:31:32 And sometimes there's nothing wrong with that.

1:31:34 Sometimes that might be what you need, but sometimes people want to know what

1:31:37 were the natural avenues I could have taken.

1:31:39 Could I have, you know, done something else?

1:31:41 Could I have maintained the signal from my brain

1:31:44 to my testies this whole time and I'm just missing something?

1:31:47 No, it's a really good point, you know, and also like talking about what any,

1:31:51 you know, key risks and side effects are as well.

1:31:53 So, I mean, that's that's kind of important, but like before we get to the risk,

1:31:56 like what kind of benefits for can someone who is,

1:32:00 you know, clearly like experiencing these symptoms

1:32:02 of low testosterone expect from, you know,

1:32:06 perhaps doing testosterone replacement therapy.

1:32:09 I mean, you mentioned HC, HCG, but I'm I'm kind of here directing

1:32:13 it more towards like actual testosterone replacement therapy.

1:32:20 Um, yeah, it would be in general if you are satisfactory in your replacement

1:32:26 of these hormones to a physiologic replacement level

1:32:30 like you should notice a ailaration of all symptoms.

1:32:34 That's the best way I could put it.

1:32:35 Um, now again, it's uh obviously you should not expect that you're going

1:32:42 to feel exactly the same as you did when you were like 20 years old.

1:32:44 Like I think some people think when they're 50, oh,

1:32:46 I'm going to get on TRT and it's going to be, you know, like being 20 again.

1:32:51 And like to some extent it could be because like

1:32:53 on paper like your test levels might be the equivalent,

1:32:56 but it doesn't mean the way you metabolize

1:32:58 the hormones into estrogen is going to be the same.

1:33:00 It doesn't mean that the way you respond is going to be exactly the same.

1:33:04 In general though, the target is to ameliate the symptoms

1:33:08 and then like dial in from there kind of thing.

1:33:11 So like I think what people should expect is like the intention of it is get rid

1:33:17 of your symptoms similar to like menopausal therapy like

1:33:20 you want to get rid of your hot flashes.

1:33:21 If you want to ensure that you are not uh like your bone

1:33:26 integrity is like actually supported like

1:33:28 all these things are like your baseline

1:33:30 requirements of why you're doing it is just to like get rid

1:33:33 of the negative and get to a baseline and indirectly you will feel much better.

1:33:37 So it's like you will feel better from the result of it

1:33:39 but like don't expect to be Superman unless you're you might

1:33:44 feel like Superman relative to your state just depends how deficient

1:33:46 you were to begin with and it's all contingent on multiple things.

1:33:49 So, it's hard to put hard and fast generalities on this stuff,

1:33:53 but like your target should ideally be symptom relief, right?

1:33:56 So, you're not like necessarily going to be shredded in a in a couple of weeks.

1:34:00 And exactly.

1:34:01 Um, yeah.

1:34:01 I mean, I think, you know, it's it's important to point out like some

1:34:04 guys might see that their testosterone is like

1:34:08 on the lower end of the normal reference

1:34:10 range and like want to do something about it.

1:34:13 like with respect to like not skipping over the lifestyle factors and just like

1:34:17 I'm going to go straight into like

1:34:18 I'm just going to take some testosterone, right?

1:34:20 And I think that would be the case to avoid, right?

1:34:23 If you're not especially if you're not really having symptoms,

1:34:25 but you're just kind of like freaked out by the numbers, right?

1:34:28 Yeah.

1:34:28 I definitely wouldn't make any rash decisions

1:34:30 based on numbers on a piece of paper.

1:34:32 Cuz I uh I know a lot of guys who like

1:34:36 the best physiques in natural bodybuilding

1:34:38 are like guys with 500 total testosterones.

1:34:41 Like I know guys with three times the amount of testosterone production,

1:34:44 much worse physiques.

1:34:45 Like it's not always the number on a piece of paper.

1:34:47 It's your genetics, your response to it,

1:34:50 literally how many muscle fibers you have at birth.

1:34:53 Like there are a lot of factors that determine what you're going to look like,

1:34:55 how you're going to respond,

1:34:57 the shape of your muscle bellies and how they appear to people,

1:35:00 your body fat level, especially like if you are leaner,

1:35:03 you will just appear more muscular, you know, stuff like that, right?

1:35:06 Yeah.

1:35:06 Um, okay.

1:35:07 So, let's talk about some of the important risks that, you know,

1:35:10 people should keep in mind when

1:35:11 they're going to start testosterone replacement therapy.

1:35:14 I know you've like talked about this, heard about it,

1:35:16 like the cardiovascular disease risk.

1:35:18 I mean, for a while it was a controversy, right?

1:35:20 Like doing testosterone replacement therapy is

1:35:22 going to increase your cardiovascular disease risk.

1:35:25 Um there's the the Trevverse trial that came that's kind

1:35:28 of we got some pre preublic like pre pre- data

1:35:32 here where it seems as though um this is a very

1:35:35 large trial placebo controlled where it seems as though men

1:35:38 these are older men that were at least it seems

1:35:41 to be hypogonatal like they were low testosterone and if

1:35:45 they were given testosterone replacement therapy to a normal like

1:35:48 physiological restoration range there's no

1:35:53 really adverse effects on cardiovascular outcomes.

1:35:56 What are what's what's the thought

1:35:58 here with respect to cardiovascular disease risk?

1:36:03 Um I think the only issue is like defining what

1:36:07 restoration of physiological testosterone production equates to is like when we

1:36:12 were talking about like coffee and like how much caffeine is

1:36:16 in a cup of coffee like it could vary so much.

1:36:19 like some guy's replacement to adequate physiologic

1:36:22 replacement what he was when he was younger highly variable and in that traverse

1:36:26 trial using andro gel to bump your total

1:36:30 tea from like hypoganatal to like 400 is not necessarily indicative of what I

1:36:37 would say a lot of people are looking to the data to see what

1:36:42 the results were of testosterone therapy because a lot of guys are on injectable

1:36:46 test boosting to 1,000 total tea

1:36:49 with a disproportionately high free testosterone cuz when

1:36:51 you inject infrequently too you drive your SHBG

1:36:54 down proportionally that is not the same

1:36:57 as a guy who's using an androgel to get to like 430 total T.

1:37:01 So taking that outcome and running with it as like

1:37:04 no cardiovascular risk like I think it's a bit haphazard personally.

1:37:07 Now it's obviously promising data and like it's great

1:37:10 that it came out like it's very very promising.

1:37:13 The only problem is it's like how many

1:37:15 guys are actually using that medium of therapy?

1:37:17 Like I don't know, none.

1:37:19 Like I don't know a single guy using androgel.

1:37:21 And that's fine.

1:37:22 Like it's still data and it's still worthwhile and it's still good.

1:37:24 It's just like not don't take that as like the the sign off that like

1:37:30 you're you know 200 milligrams of testosterone

1:37:33 and anth per week that you're like,

1:37:35 you know, more uh aggressive protocol has been designed

1:37:39 to do is like going to be the same outcome.

1:37:41 Like it's not.

1:37:41 You're going to have the ariththropo pois increase

1:37:45 that might not be reflected in the traverse trial.

1:37:46 You're going to have the disproportionately high energetic signaling.

1:37:49 Like you're going to have a lot of things that you would you looking to get

1:37:55 the reassurance that won't happen but you have absolutely

1:37:58 need to be cognizant of because will probably happen.

1:38:02 Um, still no this is this is so important and um that's

1:38:07 kind of why I was like these are hypogonatal and you

1:38:10 know it's like I guess their normal physiological range that's

1:38:12 not really accurate if it's only going to like 400.

1:38:16 So basically you're just making them non hypogonatal

1:38:19 but it is important because you mentioned yourthropesis and so

1:38:22 this is this is another kind of concern you

1:38:25 know with testosterone which does regulate red blood cell production.

1:38:29 it does increase you know the thickness of blood and polyythemeia

1:38:33 is a is a is I would say a risk factor right so you know how how substantial is

1:38:41 this um I mean I think I've read studies where it's

1:38:44 like almost 25% of men have thicker blood that are

1:38:48 on testosterone replacement therapy doesn't necessarily

1:38:51 mean it's like to the point where it has to be treated but it is thicker

1:38:55 right it is like the hermaticra is is it's thicker.

1:39:00 So um you know how how should men weigh

1:39:03 these risks for the cardiovascular disease risk the poly polythemia.

1:39:07 So for people like listening or watching

1:39:10 that isn't a concern because it increases you

1:39:12 know stroke risk it increases the the potential

1:39:16 for um you know cardiovascular events as well.

1:39:20 So like what are your thoughts on sort of weighing those risks?

1:39:24 Um to the opposite side of the coin on that androgel,

1:39:30 you know, like it's not necessarily physiologic replacement.

1:39:33 The thing to note is it it should be expected that if you use more testosterone,

1:39:39 you're going to have more thropoesis.

1:39:40 Like that's literally what it does.

1:39:42 So to think that it would be a net negative because you have

1:39:46 a 25% increase in that via

1:39:50 your testosterone administration if you were hypogonal.

1:39:53 to begin with, which presumably is the reason you're getting on TRT,

1:39:58 you know, depends on the person,

1:39:59 but like going from hypoganatal where you might be like borderline

1:40:04 like anemic for all we know and then having the 25%

1:40:07 bump like maybe you need that to actually like have

1:40:09 adequate oxygen carrying capacity and like actually sufficiently fuel your body.

1:40:15 So, it's not to say it's like net bad, net good.

1:40:17 It's all about where do you achieve like

1:40:19 the problem is is like the definition of symptom

1:40:20 relief too is so vague because you could

1:40:22 achieve simp symptom relief at you know 450

1:40:25 total t maybe depending on the person or it might be at like 800 or it might

1:40:30 have been like even if it was 450 like if you got up to 800 you're still

1:40:35 in normal on paper so like is that bad you know who's to say yeah I

1:40:40 think most people would say it's the high

1:40:42 of normal because that's literally what it is

1:40:44 on a reference range so it all is going to be just being cognizant of the fact

1:40:49 that androgens will do what androgens do which is

1:40:52 they will in a dose dependent manner drive ariththropoesis.

1:40:55 They will induce cardiac remodeling if you push it too hard.

1:40:59 Not necessarily within physiologic limits but like

1:41:02 these are things to be aware of.

1:41:03 Dysipidemia will become more of a concern at a higher

1:41:06 level especially depending on the medium of administration.

1:41:08 If you're dosing infrequently like once a week with a shot,

1:41:11 it's going to be a different outcome than if you're doing like daily,

1:41:14 you know, little pulsatile uh cream administrations or like micro

1:41:19 injections like subcutaneously where you're bleeding out the effect more.

1:41:23 It will all be impactful.

1:41:25 So I think it's more about there is a risk all

1:41:29 but there's not going to be data that says directly if you

1:41:33 replace the 800 total tea it's going to be dangerous nor

1:41:38 is there data that says it's safe either like you can kind

1:41:41 of take from the traverse trial what they found and extrapolate out

1:41:45 like what you know from graded dose response studies which do exist

1:41:49 and like realize okay like somewhere in the middle here if you're

1:41:53 one of those guys who like wants to hit that, you know,

1:41:55 high normal because I don't know, like who's to say you're in the wrong

1:41:59 for wanting to be like optimally vital, too.

1:42:02 It all kind of depends on the person.

1:42:04 You have to weigh the risk accordingly cuz it's not risk-f free.

1:42:07 Like you're still going to have to keep a an eye on your hematology panel.

1:42:11 Is it getting out of whack to a degree that is like unsustainable?

1:42:14 you're like looking at phabbotoies just to maintain something

1:42:16 that looks normal or is it like adequate slash like

1:42:21 optimal for you now to feel like you have

1:42:23 enough energy to not like faint when you get up?

1:42:25 I don't know.

1:42:25 It depends on the person.

1:42:27 Um yeah, it's just like an understanding of all

1:42:29 of the interplay of things and not taking the sign off,

1:42:33 you know, the one the traverse trial is like,

1:42:35 you know, your get out of jail free card.

1:42:37 Like it's just you're still going to have to keep an eye on your blood work.

1:42:39 You're still going to have to have like a doctor who knows

1:42:41 what they're talking about and is like very rigorous about this stuff.

1:42:45 You have to know how the different administration methods

1:42:47 and frequency will impact things cuz like you're probably

1:42:49 not going to be on androgel using a little

1:42:51 dose that gets you to 420 nanogs per deciliter.

1:42:56 You're probably not on that protocol.

1:42:57 And if you are like yeah okay look

1:42:58 at the traverse trial and like maybe you can get

1:43:00 like a bit more reassurance but like you're probably

1:43:02 not that guy and that's fine if you're not.

1:43:04 It's just like being very realistic about what

1:43:06 to expect and you know there is uh dysipidemia there

1:43:10 is an increase in uh blood viscosity to some

1:43:13 extent there will be a uh suppression of SHPG

1:43:16 if you're doing injections infrequently um which will elevate

1:43:21 your androgenic signaling beyond what is physiologic like most

1:43:24 people are supra at least transiently without knowing it

1:43:29 and by that I mean by supra I mean like

1:43:31 more than you would have produced physiologically because

1:43:34 it's not physiologic to have your hormones transiently shoot

1:43:37 to like I don't know 1,200 or 1500 total

1:43:41 tea with a disproportionately high free testosterone from administering once

1:43:46 or twice a week twice a week is a bit quite a bit better but once a week

1:43:49 for example and then it crashing back down before

1:43:52 you shoot again like that's not physiologic really at all.

1:43:55 So you need to be aware that's going

1:43:57 to cause more uh elevations in these like problematic

1:44:01 biomarkers than would be if you tried to maintain

1:44:04 what is reflective of like daily normal production.

1:44:07 So like the ideal protocol would be literally replacing

1:44:10 your daily testicular output which is adherence problematic for a lot

1:44:16 of people cuz not everyone wants to be using

1:44:17 like a scrotal application of cream twice a day.

1:44:21 A lot of people don't want to be injecting

1:44:23 daily subcutaneously with like a micro amount of testosterone.

1:44:26 They just want to be one and done, one shot a week.

1:44:28 Even some of the the problem too is like

1:44:30 the pharma pharma has set it up so you might be

1:44:33 forced to take it infrequently and at a high dose

1:44:37 because they have these auto injector pens that are pre-loaded.

1:44:39 So you like have to shoot it in one shot or you don't take it.

1:44:43 Yeah.

1:44:44 So like zestad is like the preloaded testosterone anantthate pharmagrade

1:44:48 that is often prescribed and it's like well you gota

1:44:51 you you either do the one shot one kill

1:44:53 and take the whole dose or you like don't take it.

1:44:56 So so the you're you're touching on an important point here that that supra

1:45:00 physiologic level like the amount that you

1:45:02 wouldn't necessarily have like a normal physiologically.

1:45:07 I mean, I read a study where it was like 25% of men have this and it

1:45:10 seems like it might be due

1:45:12 to this like dosing this injection, you know, protocol.

1:45:16 What what's what's wrong with the cream?

1:45:18 Like, is is that something that doesn't get your levels high enough

1:45:21 or is it just like annoying to have to do every day?

1:45:26 It kind of I mean,

1:45:28 it depends on the person because it would be personal subjective opinion

1:45:31 for me to say like why I wouldn't want to do it.

1:45:34 In general, the reason most people don't want to do it is adherence lifelong.

1:45:39 Like this is something you're going to do forever.

1:45:41 Typically, somebody going to apply a cream

1:45:45 to their scrotum twice a day, it's not that fun.

1:45:50 Like, it's like something that you have to go

1:45:51 out of your way to do wherever you are, you're traveling, whatever.

1:45:54 Like, you will go hypoganatal with pretty quick if you don't

1:45:56 get in the bathroom and wipe some cream on your balls.

1:46:00 Yeah.

1:46:00 That's not

1:46:01 I mean I I get that but like you know like stroke risk, cardiovascular disease.

1:46:07 Oh yeah.

1:46:07 If you want to be optimal, the problem is a lot of people will favor adherence

1:46:12 and sustainability similar to diet over optimal and that's fine.

1:46:16 It's just you have to be accepting of the risk profile that comes along with it.

1:46:20 Okay.

1:46:21 What about other like parts of the risk profile?

1:46:23 So like how does it affect the prostate?

1:46:25 Um I read about fertility.

1:46:27 I mean being a big one too.

1:46:28 It's it's suppressing fertility.

1:46:30 Yeah, sleep apnnea can be exacerbated as well.

1:46:33 I mean, these are all like part of the risk profile things to consider.

1:46:38 Yeah.

1:46:38 When it comes to prostate,

1:46:40 that is something that at least based on the most recent literature

1:46:44 that I'm aware of is Are you familiar with the androgen saturation model?

1:46:49 Basically, if you go from hyper Oh, yes.

1:46:51 Yes.

1:46:51 Yeah.

1:46:52 But go ahead.

1:46:52 Please, please explain it.

1:46:53 Yeah.

1:46:53 So essentially from what I understand based on most recent

1:46:58 literature it shows that if you go from hypoganatal to yugenatal

1:47:03 or like the threshold of it which is like you know

1:47:05 on a reference range roughly like 300 plus nigrams per deciliter going

1:47:10 from hypo to that that differential will be positively stimulating

1:47:15 of like prostate growth you know PSA levels will go up etc

1:47:19 but beyond that you are not necessarily in a dose dependent

1:47:22 manner like a muscle or something going to be inducing size increases.

1:47:27 Like if you took even if that were the case,

1:47:29 you'd have bodybuilders who take, you know,

1:47:33 thousands of milligrams of steroids per week.

1:47:35 They would have prostates like busting out of their bodies at that point.

1:47:38 So, it's not necessarily the case,

1:47:40 but it's not like it's it's still worth monitoring your PSA for trends

1:47:44 and longitudinal patterns as you get older cuz like it will still have the same,

1:47:48 you know, susceptibility to things that happen as you age.

1:47:51 But the actual impact on prostate related issues

1:47:54 and like growing cancer from scratch if you

1:47:57 don't have pre-existing cancer cells like you're not

1:47:59 going to just like spawn cancer from taking testosterone.

1:48:01 So I think that risk is a little bit overblown.

1:48:03 Fortunately, we have data that seems

1:48:05 to be pretty strongly indicating that you're

1:48:08 not going to have to worry about that if you are somebody who is

1:48:10 otherwise healthy cancerree and you're just going from like you know like you

1:48:16 would probably have a small prostate

1:48:18 to begin with if you were hypogonatal anyways.

1:48:19 you're probably just going to where you would be if you had normal levels.

1:48:22 So, it's not like that growth is even bad either.

1:48:24 Getting to the yugenital state.

1:48:26 Um, so just keep an eye on the PSA and be aware of it,

1:48:29 but it's not something that seems to just like dose dependently escalate.

1:48:33 The other stuff is worth mentioning.

1:48:35 Um like you in general like when I said testosterone does

1:48:40 testosterone things in a dose dependent manner even if your protocol

1:48:44 is dialed in if you're producing more than you would physiologically

1:48:48 that your body can tolerate as well like you will have

1:48:52 the whatever backhand consequence of managing the extra estrogen the extra

1:48:59 DHT you know that could lead to extra acne hair loss

1:49:03 um gynecomastia If you have excessive aromatization locally in the tissue

1:49:08 that is not antagonized sufficiently by the DHT and testosterone signaling,

1:49:12 hair loss in the scalp, annoying body hair that sucks to get rid

1:49:16 of if you care about that sort of thing.

1:49:18 Um, more facial hair growth, deepening of the voice,

1:49:21 um, more than you already have as a male, surprisingly.

1:49:24 There's like often like if you're if you were

1:49:27 low te to begin with like typically guys who get

1:49:29 on and then like push their test levels up to high

1:49:32 normal especially will notice like a little bit of a deepening.

1:49:34 Um like these are all kind of like the ex kind of like

1:49:38 the maximization of the male secondary sexual

1:49:41 characteristics being like pushed to the nth degree.

1:49:44 um within physiologic parameters.

1:49:47 Um sleep apnea will get exacerbated pending your neck size increases,

1:49:53 muscle increases in size, things that are contributing to the obstructive nature

1:49:59 of your soft tissue falling into your airway

1:50:02 will get worse pending you are dosing in a manner that pushes you there.

1:50:08 So if you're physiologically replacing,

1:50:09 like a lot of this stuff is probably a moot point.

1:50:12 Um, but a lot of people won't be.

1:50:14 They'll be pushing to optimal optimal quote unquote, which is fine.

1:50:19 Just be aware that you will potentially increase your risk

1:50:22 of sleep apnnea and keep an eye on it.

1:50:24 I would absolutely recommend anybody even before they get on TRT

1:50:28 get their uh uh like a basic sleep study done.

1:50:31 Um, it's a lot less intensive than you might think.

1:50:33 And there are actually like pretty reasonable

1:50:35 at home devices that measure like uh uh

1:50:38 apnea episodes per hour that will like essentially put you on a chart of how

1:50:42 many um episodes of like ceasing breathing are you having per hour and you could

1:50:47 have a baseline there and see if that goes up when you get on TRT.

1:50:50 So it's not like this is a questionable like

1:50:52 what's going to happen in your sleep apnea susceptibility.

1:50:54 Like literally measure it like you have your baseline when you're not on it.

1:50:57 Now you're on it.

1:50:58 What's the difference?

1:50:58 And like you would see in real

1:50:59 time the literal diagnostic metric either going up

1:51:01 or not changing at all and then you would have your answer kind of thing.

1:51:04 But it is a possibility for sure.

1:51:06 Um just like any of the stuff is um

1:51:09 but if you're physiologically replacing like the risk is relatively low

1:51:14 unless we're talking about that super

1:51:15 physiological level where it seems as though

1:51:18 like one in four men don't even know they're in that level.

1:51:20 they are even transiently cuz I'm in blood work if you

1:51:24 for example if I'm on zestad and I'm shooting once a week an auto injector pen

1:51:30 and I'm checking on trough day which means like typically

1:51:33 you're a lot of physicians will say check your test levels

1:51:36 on like the day where your test levels are lowest based

1:51:40 on the pharmacocinetic profile of whatever

1:51:42 the format of testosterone you're using.

1:51:44 So if you're on a long estrotestosterone

1:51:46 formulation like a testosterone cipionate or an ananthade,

1:51:50 these are the typical prescriptions to make allow you to get

1:51:54 away with dosing only like once or twice a week for adherence.

1:51:58 But the reflection of that in blood work is you

1:52:01 would typically see because you're bless dosing it at once,

1:52:05 your blood work would shoot into supra

1:52:07 range depending on the total dose of course,

1:52:09 but like a lot of people this is what happens.

1:52:11 they shoot into like I don't know 13004 1500 1500

1:52:15 total T with the proportional five alpha reduction to DHT

1:52:20 suppression of SHBG disproportionate freeing of free androgenic signaling

1:52:25 via more DHT being free than would otherwise be normal

1:52:28 more free tea than is proportionately normal more aromatization

1:52:32 than would be possible if that dose was like even

1:52:34 spread out on an even curve throughout the week

1:52:36 on micro injections increase in ariththropoesis

1:52:39 acutely beyond physiological you know, capacity to, you know,

1:52:44 an unhealthy acute level at least for a periodic

1:52:46 period of time and then you're in like a slow

1:52:50 or steep depending on like the estester crash essentially

1:52:54 into like sort of normal looking territory until your next shot.

1:52:58 That's the reality for a lot of guys.

1:53:00 I think in Europe they do testosterone uh

1:53:04 undeanoate maybe or it's either a sustenon formulation,

1:53:07 maybe it's undocu like shot every like few weeks.

1:53:10 It's crazy.

1:53:11 So they'll like shoot their test into the stratosphere and then it'll

1:53:14 like crash into hypoganatal territory and then they pin again or shoot inject.

1:53:18 That's what I mean by pin.

1:53:19 Yeah.

1:53:19 My I mean you So it's like a roller coaster of like I can imagine it's

1:53:24 like the equivalent of what females deal with times like some magnitude.

1:53:30 I mean it it sounds they must be like

1:53:33 also just like they get aggressive and stuff and like

1:53:36 what irritable regulation would be like impossible to expect you know like

1:53:43 I don't know like I wouldn't want to wish that on uh anyone like that would suck

1:53:47 I mean to me so like let's say adherence like compliance that's a whole

1:53:54 issue right obviously but let's just like

1:53:57 if we're just talking about risk profile right?

1:54:00 Like you're not wanting to really get into that supra physiological level.

1:54:04 You're not like, you know, you're not like the bodybuilder.

1:54:07 You're not like, you know,

1:54:08 you're the person that just really wants to keep that risk low,

1:54:12 but you want to get the benefits.

1:54:14 Okay.

1:54:14 Like that's that's what you want.

1:54:15 You really don't want the risk.

1:54:16 Like you're just not not on the not on the table for you.

1:54:20 What would be the best There's the different methods.

1:54:23 You kind of mentioned a few.

1:54:24 Maybe you could kind of just go through them again briefly,

1:54:25 but like what would be the best method to get you to a more normal range.

1:54:33 Um maybe you're not someone that's totally hypogonatal,

1:54:35 but like you know, low tea symptoms, right?

1:54:40 Lower tea and symptoms.

1:54:41 Um what would what you're aging?

1:54:43 You're an aged, you know, like 50-year-old man or something.

1:54:47 What would be the ideal delivery method that would

1:54:50 really get you those benefits but lower that risk profile?

1:54:54 Yeah.

1:54:55 Um, and one thing just to add before we entered that subtopic,

1:55:00 I do want to clarify.

1:55:02 If somebody was to take an amount of testosterone,

1:55:06 even if it put them to like high normal of the reference range,

1:55:10 but it was something you tolerated in youth

1:55:12 and like your body was capable of handling, which a lot of people are.

1:55:17 if you do it responsibly, understand what you're taking,

1:55:21 know how to monitor your biomarkers, are lean, healthy, have a good diet,

1:55:25 lifestyle dialed in, you're aware of the risks.

1:55:28 Um, all that stuff is like overseen with a level of education,

1:55:33 some level of rigor,

1:55:34 and like obviously decreasing need over time as you start to dial it in.

1:55:39 It's not as like rigorous of an oversight

1:55:41 process cuz after you're in your dial protocol,

1:55:44 it's just kind of like living your life and you know what

1:55:46 to expect from your blood work at that point and how it affects everything.

1:55:49 You'll probably be fine probably.

1:55:52 It's just being aware is not zero risk.

1:55:55 Like it's just like that's the thing people

1:55:57 need to accept if they want to be pushing,

1:56:00 you know, to some level that is like just

1:56:04 in general like it's never going to be risk-free.

1:56:07 But I could still also say with certainty that if you're hypoganatal,

1:56:10 you're going to be healthier replacing to physiologic

1:56:14 than you would staying hypoganatal for sure.

1:56:16 Like you are a thousand% in cardiotoxic, neurotoxic,

1:56:21 uh, quality of life down the, you know,

1:56:23 the toilet territory if you're like in hypoganatal levels almost certainly.

1:56:29 So hopefully that's like somewhat of a consolidated

1:56:33 array cuz I don't want to like

1:56:34 sound too uh like it's worth being cautious and aware of all this stuff,

1:56:39 but like it's certainly not to don't dissuade

1:56:43 yourself out of like fixing your levels too.

1:56:45 Like it's critical that you have adequate

1:56:47 hormone production similar to women in menopause.

1:56:50 Like the the benefit outweighs the risk

1:56:54 like essentially every single time essentially.

1:56:57 And you just have to be responsible about your approach to what that is.

1:57:00 Listen.

1:57:01 Well, especially if you're you're monitoring biomarkers and we'd I'd

1:57:04 love to like talk about some of those in a minute,

1:57:06 but I think that's that's the key too, right?

1:57:08 Like monitoring, right?

1:57:10 Yeah.

1:57:10 Okay.

1:57:11 So, then circling back to administration, like the ideal way to go about it.

1:57:15 Um, I can say off the rip, I would not do pellets.

1:57:19 I would probably not do androgel if you're a male.

1:57:22 If you're a female, it's a bit different, which we can get into.

1:57:25 um the creams through compounding pharmacies.

1:57:29 That's probably the only like tolerable way you're

1:57:31 going to have something that you can apply scrotally

1:57:34 to get the ideal absorption and pharmaccoinetic profile

1:57:37 that would be reflective of something that's like more natural.

1:57:40 So like that is probably on paper arguably the best way to go about it.

1:57:45 It's just not necessarily something everyone wants to do.

1:57:48 But it it works well and it will get you to the levels that are great

1:57:53 and look pretty physiologic and like kind of reflect

1:57:57 the pulsatile dial nature of normal testosterone secretion.

1:58:02 And it's also converting like locally like

1:58:04 in the area you would actually be producing it too.

1:58:06 Like there is a local effect too through like

1:58:08 five alpha reduction in the skin and stuff like that.

1:58:11 um which can result in that's why monitoring like DHT and some

1:58:16 of this other stuff can be important but it's like a whole

1:58:18 more nuance discussion but in general the cream scrotally is reliable good

1:58:24 produces a very favorable outcome and a lot of guys will be quite

1:58:26 happy with that method the other method that I would say is

1:58:29 worth uh considering and like the typical one that most guys do is

1:58:33 injection which it's a bit more predictable typically in terms of like

1:58:38 what you're going to get out of it in terms of adher appearance.

1:58:41 It's a lot easier because you don't have to shoot it daily.

1:58:43 You can also modulate the release pattern of it through either the Esther.

1:58:48 So like you'll typically get prescribed like the longest bleed esther.

1:58:52 So, cypionate has a halflife of like I think it's like 10 days or something 8

1:58:56 to 10 days depending on how uh depending

1:58:59 on individual biochemistry and how you kind of like cleave

1:59:03 the esester but you can also change the way

1:59:06 it absorbs via injecting subcutaneously into stomach fat

1:59:10 or into any subq fat versus intramuscularly where

1:59:14 it's more quickly going to get absorbed and assimilated.

1:59:17 So you can also bleed out the effect even more

1:59:19 and make it even more stable in your blood levels.

1:59:22 And it's pretty easy to adhere to a TRT protocol of like micro injections

1:59:28 even on like a relative frequent basis

1:59:30 like every other day is pretty damn stable.

1:59:33 Subcutaneously is what a lot of guys do and works really really well.

1:59:38 And you know keeps a very stable uh hormone concentration curve.

1:59:42 It's pretty predictable and what's going to happen.

1:59:44 you just kind of like got to be aware of the you know how

1:59:47 hard you're pushing it and what that will do to your risk profile accordingly.

1:59:51 The other way that's promising that I would say

1:59:53 is uh oral testosterone undeanate lymphatic absorption patented format.

2:00:00 So there is three I believe tando um jatenzo and kaotrix

2:00:07 and they've basically managed to make

2:00:09 a lymphatically absorbed testosterone underway

2:00:12 you can actually swallow orally whereas back in the day they

2:00:15 would have had to make it hepattoxic to actually make it

2:00:18 through the liver um through a first pass metabolism and actually

2:00:22 like make it into circulation to any meaningful level they'd have

2:00:24 to like add like a 17 alpha alkalated group to it

2:00:28 and make it like a terrible for you oral steroid Essentially,

2:00:31 this does not have the same level of stress.

2:00:34 It's not stress free as far as I know,

2:00:36 but it's will get you the me a meaningfully significant like get you replacement

2:00:42 of total tea levels to like mid to high range depending on the person.

2:00:49 Likely achieve symptom relief for guys who are hypoganatal

2:00:52 and is pretty sustainable because you're just popping something.

2:00:55 So, some people prefer that.

2:00:57 pretty expensive though and kind of like

2:00:58 a newer medium of administration but promising nonetheless.

2:01:02 Um, typically what guys are doing though still

2:01:04 is the injections and the or the cream.

2:01:07 And the other method is intraasal,

2:01:09 which I'm sure you've probably heard of for like,

2:01:11 you know, hypoactive sexual disorder for women has a potential for that.

2:01:16 Um, as well as uh for men as like a different medium

2:01:20 of getting like an ariththro poising free version of test cuz it's so acute.

2:01:27 It's just like an unsustainable daily treatment.

2:01:30 Unfortunately, like it's okay if you're trying to have

2:01:32 like an ondemand libido boost as a female or something,

2:01:36 but for a guy using it like multiple times a day in snorting something,

2:01:41 it's like not something any guy I think would

2:01:44 want to do for and even if they think it's cool to begin with, I think for once

2:01:47 you get to like the month or couple month mark,

2:01:50 you the novelty would probably fade.

2:01:52 Um like a lot of guys are you know super excited when they start testosterone

2:01:55 injections like it's like this roster you're

2:01:57 using like this hormone and it's you know I'm replacing and it's you know it

2:02:01 feels like this big significant thing and then

2:02:03 you know a year in it's just like oh I got to do my injection.

2:02:06 So it's like whatever you can most sustainably adhere

2:02:08 to that is like the safest will achieve the outcome you desire.

2:02:11 The symptom relief is the one you should stick to.

2:02:14 And the cream, I guess I didn't mention the obvious,

2:02:16 but like transference, if you have children, you have pets,

2:02:19 like there are uh concerns with, you know,

2:02:23 like what you are going to rub it off on and like how like your hygiene with it.

2:02:28 So that's worth mentioning cuz like there are cases

2:02:31 of transference issues that have been noted in media.

2:02:35 You know, I think I did a video a while ago where some

2:02:38 dad accidentally was like wiping residue on his kid without even realizing it,

2:02:42 even after he like thought he cleaned it and his kid was

2:02:45 like starting to get masculineized

2:02:46 from the from the testosterone residue or something.

2:02:51 Wow.

2:02:50 Yeah.

2:02:50 Crazy.

2:02:51 Cuz it's like the levels are so low like any like significant amount will like

2:02:55 push things in like a significant incremental

2:02:59 direction that is like going to cause problems.

2:03:02 So that's a thing.

2:03:04 Whereas injection, it's like you're in the bathroom,

2:03:05 you do it and it's clean and done.

2:03:07 Totally sterile.

2:03:08 You don't have to worry about like are my hands fully clean, you know,

2:03:12 is somebody going to get into it like good luck

2:03:14 accidentally like breaking into like a multi-dosese vial or something.

2:03:17 It's not going to happen.

2:03:18 So, right.

2:03:20 Yeah, there's like different like logistical

2:03:22 advantages too to some of these administration

2:03:24 methods that probably should not be understated but are worth mentioning.

2:03:28 Um so yeah I think the three most viable cream

2:03:32 scrotal application injection intramuscular or subq if you want to bleed

2:03:37 out the effect or maybe the oral um all but I

2:03:43 want to see more of the literature as it evolves

2:03:47 right so it's kind of a newer thing and when it comes

2:03:49 to the injections it sounds like more

2:03:51 frequent subq is like subcutaneous is like where

2:03:54 you're going to get more less of the prob probability of having that supra

2:03:59 physiological peak versus like if you're just doing it once a week intramuscular

2:04:05 not bleeding out that like response or effect.

2:04:08 Um, but again it as you mentioned compliance is definitely

2:04:12 going to be better if you're doing it once a week.

2:04:13 But I mean twice a week, three times like every other day.

2:04:16 I mean, you know, for people that are

2:04:18 that are really concerned about risk profile, perhaps they have

2:04:21 already like, you know,

2:04:22 a family history of cardiovascular disease or stroke or whatever,

2:04:26 they probably are more incentivized to like

2:04:29 lower that risk for any potential side effects.

2:04:32 Yeah.

2:04:32 Like in general, I think or fertility.

2:04:34 What about men that are wanting men men that are wanting to reproduce?

2:04:38 Yeah, we gota talk about that too.

2:04:39 But one rule of thumb that's like to make

2:04:41 it as easy to understand, at least for me,

2:04:45 this was the easiest to understand like how I remember

2:04:46 it is the closer something is to what would be

2:04:51 equivalent to what you would naturally make should you have

2:04:54 had should you have healthy functioning testes producing natural testosterone.

2:04:58 that's going to be the one that has the least impact

2:05:02 on all of the un like intentional consequences of like spikes in hormones.

2:05:08 So like normally on a daily basis you would

2:05:11 pulse out like in es and flows multiple times.

2:05:14 So like the more you can get these like the more stable

2:05:17 you can get it with the more micro administration spread throughout the week,

2:05:20 the more stable everything will be and as a consequence

2:05:23 less spikes into the territory that would

2:05:26 produce things that are not representative of physiologic

2:05:30 and typically daily administration is the way to go.

2:05:34 Whether it's like cream is going to be twice a day at least,

2:05:38 but then for injection it's like every

2:05:40 day and every other day there's diminishing returns,

2:05:42 but you can kind of like we said bleed it out a bit.

2:05:44 So yeah.

2:05:46 So as far as fertility goes, yeah,

2:05:48 like you will absolutely crush your fertility pretty

2:05:53 significantly if not entirely depending on some things.

2:05:58 So intraicular testosterone is the significant mediator of spermatogenesis.

2:06:04 So it's not uncommon even for bodybuilders who are

2:06:08 on huge amounts of steroids to still accidentally get their wives,

2:06:13 girlfriends pregnant thinking that they're sterile when

2:06:16 in fact they have so much testosterone

2:06:18 in their body that it's like actually like

2:06:22 like producing the spermatogenesis effect via the exogenous hormone.

2:06:26 what that does to epigenetics, all that stuff.

2:06:28 No idea.

2:06:30 Would freak me out a bit, but like it's it happens and it's like

2:06:34 on paper these guys should be completely infertile,

2:06:36 but still see accidental pregnancies all the time in the bodybuilding world.

2:06:40 So, I wouldn't rely on that as a means

2:06:42 of uh contraception as a guy, first of all.

2:06:45 Um, but you will almost certainly have like inhibited to like

2:06:50 horrifically low if not auspermic level fertility if you were

2:06:55 on even just like baseline replacement because you are shutting down

2:07:00 the signaling from your brain

2:07:02 that otherwise dictates the intraesticular activity.

2:07:06 So by that I mean the hypothalamus releases the G&R,

2:07:11 the gonadotropen releasing hormone.

2:07:13 So it's the hormone that causes the release of ginadotropins, hence the name.

2:07:18 At the pituitary gland,

2:07:20 the pituitary responds to that G&R to then produce the ginadotropins,

2:07:24 which are the luteinizing hormone LH and the FSH

2:07:26 follicical stimulating hormone just like in women.

2:07:29 Goes down to the gonads and the thing that happens

2:07:32 is you uh produce intraicular testosterone at the litic cell.

2:07:37 Um and women do too.

2:07:38 It's just thea cells instead of you know lighting cells.

2:07:41 Um and that intesticular testosterone mediates

2:07:44 spermatogenesis in unison with the cerolei

2:07:48 cells which are also uh supported by follical stimulating hormone.

2:07:53 So if you have exogenous testosterone so like

2:07:57 you're administering it yourself synthetically you have basically told

2:08:01 your brain I have enough estrogen and testosterone

2:08:03 via this injection I'm doing or whatever it is.

2:08:07 So you cannot produce any more G&RH cuz like why would we need you to?

2:08:12 We have enough hormone.

2:08:12 It's like okay well let's turn that off.

2:08:14 Let's turn off as a result we have no

2:08:16 signal to produce pituitary hormones or the the ginadotropen.in.

2:08:19 So we turn that off and now you have no signaling to your testes.

2:08:22 So now you're just like literal organ uh

2:08:25 atrophy is occurring because there's no signaling happening there.

2:08:28 So the only thing you can really do at that point

2:08:30 if your HRT protocol is not built around replicating manual signal

2:08:36 because that is a means that some people do if you

2:08:38 have adequate organ function you could theoretically do that instead of TRT.

2:08:43 But if you're going to be on TRT,

2:08:45 like you either replicate that natural signal or you sustain

2:08:49 organ atrophy to the point of potentially some permanent likely deterioration,

2:08:55 all but likely not inability to restore fertility.

2:09:01 Like it's very rare that I see guys

2:09:02 who are actually like not truly fully hypogonatal, like their testes still work.

2:09:08 They just had inadequate signaling or something via like secondary hypogonatism.

2:09:14 If those individuals maintain the signaling

2:09:16 like you can retain the structural integrity

2:09:19 for the most part of the testes and then if you want to get pregnant

2:09:23 or whatever you are either currently fertile

2:09:27 still because you're manually stimulating it or you

2:09:30 could like you can basically manually manipulate

2:09:33 how fertile you are in real time essentially.

2:09:36 So you could fully retain all fertility parameters even

2:09:40 push them to super levels if you wanted to.

2:09:42 I don't recommend it,

2:09:43 but like you can maintain everything while you're on testosterone

2:09:46 via that manual signaling of hCG plus reccombinant FSH.

2:09:51 That's like the combo that basically replicates what would otherwise

2:09:53 be the LH and FSH from your pituitary to your testes.

2:09:56 You maintain structural uh the size,

2:10:00 the uh functionality, sperm production, etc.

2:10:04 But then you also have to account for the extra testosterone

2:10:07 you're producing because that's stacked on top of your exogenous test.

2:10:10 now.

2:10:11 So now your dose might have to change and the amount of estrogen.

2:10:16 There's like local activity in the testes

2:10:17 for how much aromatization happens and whatnot,

2:10:20 which is different than if you're injecting it like in your butt or something.

2:10:23 So you have to account for that differential, too.

2:10:25 Some people get highly estrogenic from hCG in particular,

2:10:29 which is like a female like literally

2:10:31 in pregnant women's urine to stimulate lighting cells.

2:10:35 That's what it's like purified from.

2:10:37 Um, and you know, there's some speculation as to if

2:10:41 HCG is like healthy to be on as a guy.

2:10:44 Like you're taking like an extract of like women's urine.

2:10:46 It's like a light cell stimulator similar to LH

2:10:49 and seems to mimic the effects of LH, but it's still not LH.

2:10:52 It's HCG, which like human corionic ginadropen isn't

2:10:57 what comes from your pituitary to your testes.

2:10:59 It's just something that stimulates the lighting cells significantly.

2:11:03 So, do we see any like notable effects on like

2:11:07 I don't know epigenetic modifications from hCG plus FSH mediated babies?

2:11:14 Like not that I'm aware of.

2:11:15 Not that I've seen any literature point

2:11:17 to, but it's worth noting nonetheless that hCG is not

2:11:20 like a bioididentical ginadotropen for men that you

2:11:23 would otherwise be using to shoot to your testes.

2:11:25 It's like a replacement for it.

2:11:27 And reccominant FSH is like it's FSH but it's still like grown in a lab.

2:11:32 it's not from your pituitary.

2:11:33 Does that matter?

2:11:35 I don't know for sure.

2:11:36 But either way, you can maintain your fertility metrics

2:11:40 to literal baseline if you had an adequate adjunct uh therapy.

2:11:44 It's just very cost prohibitive.

2:11:46 Like the cost of recompetent FSH is insane.

2:11:49 And hCG in itself is expensive.

2:11:51 And then you're stacking that on top of your testosterone that you're using.

2:11:54 It's not necessarily an affordable thing for everyone.

2:11:56 So, a lot of guys just let their testies atrophy because that's what

2:11:59 they can afford to do and they want to still get the symptom relief.

2:12:03 And then once it comes time to have a kid,

2:12:05 they have a bit of a more intensive protocol

2:12:06 ahead of them to restore organ size and functionality,

2:12:10 which is uh more intensive of a process than

2:12:13 if you just sustained like I'm sure like you could

2:12:15 speak to like it's easier to keep stuff where it

2:12:18 is than it is to try and like regain health.

2:12:20 So if you've literally atrophied an organ until

2:12:23 like you know a fraction of its functionality trying

2:12:26 to like bring it back from the it's

2:12:28 not it's not dead but it's like very compromised.

2:12:31 Um it's likely not going to restore to like full functionality

2:12:38 and the road to getting there will require more aggressive intervention.

2:12:42 You'll still probably get back to fertile but like it might not

2:12:45 be as good of uh health of the sperm for all we know.

2:12:50 um it might not be the same capacity to produce the same volume.

2:12:54 Who knows?

2:12:55 So, all that to say, yeah,

2:12:57 you should expect your fertility to go down the toilet and you should expect

2:13:00 that you have an adjunct protocol in place if you want to sustain it,

2:13:03 if you're on testosterone and you want to sustain the fertility,

2:13:06 but it's possible to sustain it.

2:13:08 A lot of people thought until like relatively

2:13:09 recently that if you're on testosterone, you just couldn't.

2:13:12 You were going to be infertile for sure.

2:13:14 And it's unfortunate because there's a lot of guys, especially bodybuilders,

2:13:18 who underwent severe atrophy and then had like really

2:13:22 more difficult roads to recovery because of just bad information.

2:13:27 Wow.

2:13:27 Yeah, I mean that's like imagine finding out like for 10 years

2:13:30 you've been on like hormone therapy and you could

2:13:32 have kept your testicles where they were the whole

2:13:34 time and now you just have like these shriveled,

2:13:35 you know, like raisins that you have to like restimulate

2:13:39 to baseline through like insane aggressive dosages of AC hCG and FSH.

2:13:43 Like not cool.

2:13:45 At what point does that atrophy start to occur?

2:13:48 I mean like how long do you have to be on, you know,

2:13:51 TRT before that really starts to happen?

2:13:55 Um it's pretty quick because like the suppression

2:13:58 of the ginadotropins happens like within days like once you start

2:14:03 to inject that hormone like you've introduced an amount that is

2:14:07 going to tell your brain we have enough don't make

2:14:10 anymore and once the ginadropins bottom out you have no

2:14:13 signal like you will atrophy over you know the next

2:14:16 months and get to some level of atrophy that is

2:14:21 variable depending on the person but regardless you're stimulating activity.

2:14:25 So even if like the structural size isn't like as significant of a drop,

2:14:29 like there's a lack of activity entirely.

2:14:32 So like, you know, it's all kind of individual dependent,

2:14:35 but like you should expect shrinkage within, you know, weeks to months.

2:14:39 Wow.

2:14:39 And so this is also kind of important

2:14:41 to point out for like guys that are, you know,

2:14:43 cowboying it and trying to like they want to they want to get

2:14:46 their tea up for like maybe some muscular effects or something, right?

2:14:49 and they're just kind of like maybe not hypogonatal but like lower range.

2:14:54 Yeah, I like doing this very seriously like it's

2:14:58 a you know that you want to be on it.

2:15:00 It's not something to experiment with.

2:15:02 Um, in my opinion, if it's like the route of hormone therapy,

2:15:06 like treat it as such, like you treat it like you are on it forever probably.

2:15:12 And biomarkers to monitor, right?

2:15:13 Let's say you are going to be on this.

2:15:16 And so some of the biomark you mentioned

2:15:18 like lipids and we're talking about hematocrit, right?

2:15:22 like some of these biomarkers are important like

2:15:25 what what would be or what are some of the ones that that your company measures

2:15:29 or what you think are important to measure PSA right?

2:15:34 Mhm.

2:15:34 Yeah.

2:15:34 I think uh um hematology you know this kind of like covers

2:15:40 the basics of you know red blood cell count hematocrit hemoglobin etc.

2:15:46 um metabolic parameters.

2:15:48 Um like there there's a lot of stuff you want to incrementally assess like

2:15:52 how well it's working too like how much more metabolically like fit are you

2:15:56 becoming in your blood work and insulin

2:15:58 sensitive and whatnot because these are metrics

2:15:59 of progress you can use to actually determine how well this is going for you.

2:16:03 So it's not just about like where did

2:16:05 your total tea and free tea end up on paper.

2:16:07 It's also about like the real health benefits that you're seeking not just

2:16:11 from a symptom relief aspect but also

2:16:13 from like you know what's your fasting insulin now?

2:16:15 Is it like way better cuz you have more muscle mass on your body?

2:16:17 Like if not like you know there there's things to be

2:16:20 had that are going to be net beneficial from a health standpoint,

2:16:23 not just like a cosmetic and like I don't

2:16:26 know sexual health standpoint that should be monitored regularly.

2:16:30 And I think one of the key things is just making

2:16:32 sure you have a good baseline cuz it's like once you

2:16:34 a lot of people make the mistake of like this is kind

2:16:37 of like mediated by default through us like you have to get

2:16:39 a baseline to even like see where you're at before you

2:16:41 would get even recommended to do anything but a lot of people

2:16:46 they get on hormones before they have a baseline and then they

2:16:49 just like don't know what they're looking at after they're on it.

2:16:52 Like if you have a problem and you've shut down your system via hormones

2:16:56 and you're trying to like retroactively figure

2:16:59 out what happened and what went wrong,

2:17:01 it's pretty difficult to see what like the change was that was

2:17:03 marked and like significant that led you to where you are,

2:17:05 that might be, you know, a problem.

2:17:07 So um if you have like a reasonably

2:17:10 comprehensive baseline that assesses the hematology um

2:17:14 a CMP that assesses your kidney uh status

2:17:17 via cystatin C estimated GFR or um a uh

2:17:23 SDMA which is like a uh uh symmetric um is it symmetric d uh it's another

2:17:30 marker more progressive marker for kidney function that is

2:17:33 a proxy for inulin clearance with relative accuracy,

2:17:37 which is like the gold standard of um

2:17:40 actual GFR for kidney for uh kidney filtration capacity.

2:17:44 Um I forget what it stands for, but you could just type

2:17:45 in ADMA and SDMA and you'll see what the acronyms stand for.

2:17:48 I think you've talked about on your show, too.

2:17:50 I don't know what they stand for either.

2:17:51 One of them is like asymmetric dimethylene and one's Yeah.

2:17:54 So, one of them assesses vaso dilation potential and one is more

2:17:58 of like a for cardiovascular and one is more of like a kidney marker.

2:18:02 um that is equivalent or slightly better

2:18:05 than cyatin C estimated GFR which is not

2:18:08 influenced by muscle mass creatine intake

2:18:11 or the array of things that can cause transient

2:18:14 complete like to the point of it being unusable uh changes in the marker

2:18:20 cuz creatinine calculated EGFR the amount of guys

2:18:24 I've seen think that they're on borderline like death store of kidney failure

2:18:28 from a creatinine that's high because they're you

2:18:30 know a muscle bound guy who takes

2:18:31 creatine and like works out harder or whatever.

2:18:33 It's like it's startling that this isn't more widely known.

2:18:37 So either of those two kind of like strong proxies for inulin clearance.

2:18:43 Um you have your kind of like

2:18:45 metabolic parameters to see your insulin sensitivity,

2:18:47 hemoglobin A1C, you know, all the kind of basics.

2:18:51 Um, I think uh the lipid panel definitely a baseline

2:18:55 HDL to see how much it gets lowered by the dose

2:18:57 of testosterone you're you're using because you will likely see a suppression

2:19:03 if you are elevating your testosterone beyond what you are at.

2:19:07 Doesn't mean that it's bad or good.

2:19:09 It's just worth noting like how much of a deterioration it has based

2:19:12 on your dose because it's one

2:19:14 of the proxies for kind of like androgenic activity.

2:19:18 SHBG and your binding proteins like what's your baseline relative to after?

2:19:22 Because if you are injecting infrequently

2:19:25 or a dose that is significantly suppressive like

2:19:30 it might otherwise be a proxy for like using more than you might need.

2:19:35 Not necessarily the case always, but SHBG will get suppressed dramatically

2:19:41 by exogenous androgens in a dose dependent manner.

2:19:44 So it's not uncommon to see

2:19:45 with bodybuilders who are using full-blown steroid cycles,

2:19:48 SHBG levels in the single digits, which is like you have essentially no

2:19:52 regulation of androgenic signaling at that point.

2:19:54 It's just like everything's flying around.

2:19:57 So with guys on TRT,

2:19:59 it's like worth knowing where you stood to begin with and then how

2:20:02 much it decrease because it's like if you didn't know the baseline too,

2:20:07 any of your diet changes at that point,

2:20:09 the carb manipulations, the exercise change,

2:20:11 the calorie intake change, the sleep,

2:20:13 like you would have no idea what the impact thing was

2:20:16 for sure that impacted the SHPG if you didn't have the baseline.

2:20:19 So um what else as far as assessing um

2:20:23 free tea and total tea measured through the accurate

2:20:26 assays which would be the gold standard for total

2:20:30 testosterone is liquid chromatography with tandem mass spectrometry.

2:20:34 If you use an equilibrium, if you use a uh immunoassay test,

2:20:39 which is like the cheaper version, often it will be relatively inaccurate.