#149 - The No.1 Reason Men's Testosterone Levels Are So Low Today | Dr. Sara Amirmehrabi

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[SPEAKER_01]: the conventional primary care doctor made test your testosterone, and that's about it, right?
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[SPEAKER_01]: If they think it's above 300, this is your fine, I hear that a lot, and it's really sad because it's not fine, just because the entire population's testosterone is dropping doesn't mean that it's okay.
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[SPEAKER_01]: Exactly.
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[SPEAKER_00]: The people are suffering.
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[SPEAKER_00]: Exactly.
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[SPEAKER_00]: Now, so glad you bring this up because these ranges are out of control, I mean, a normal range being somewhere between 300 and 1,000, it's too broad for me.
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[SPEAKER_01]: Welcome to the Dr. Joy Kong podcast.
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[SPEAKER_01]: This is where I have a chance to share with you some of the latest developments in the space of holistic health, longevity, and wellness.
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[SPEAKER_01]: I've always honored intellectual curiosity and scientific rigor, combined with real world practicality.
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[SPEAKER_01]: My goal is that what you learn here will help you live longer and live better.
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[SPEAKER_01]: Hope you enjoy the journey with me.
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[SPEAKER_01]: Welcome back to the Dr. Joy Kong podcast.
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[SPEAKER_01]: Today, I'm so happy to have Dr. Sarah Amir Marabi back here.
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[SPEAKER_01]: Now we're going to talk about male hormones, which of course is equally important to female hormones, which we covered last time.
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[SPEAKER_01]: So Dr. Sarah is passionate about optimization of health, prevention, and longevity, and she specializes in hormone therapy.
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[SPEAKER_01]: So
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[SPEAKER_01]: I'm really looking forward to tapping into her expertise today, so you know how to optimize your hormones.
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[SPEAKER_01]: Okay, Dr. Sarah, so happy to have you back.
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[SPEAKER_00]: Hi, Dr. Joy.
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[SPEAKER_00]: Thank you so much for having me back.
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[SPEAKER_00]: It's a pleasure to be here.
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[SPEAKER_01]: Yes.
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[SPEAKER_01]: So are you equally passionate about male hormones as female hormones?
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[SPEAKER_01]: Oddly yes.
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[SPEAKER_00]: That testosterone is actually one of my favorite hormones on the face of the planet.
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[SPEAKER_00]: If it could be in the water, I would love that.
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[SPEAKER_00]: It's something very near and dear to my heart and just the way it makes people feel and the difference I see in my patients' lives.
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[SPEAKER_00]: Hmm, when did testosterone become an important hormone like in the medical world?
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[SPEAKER_00]: To testosterone, for men at the very least, this has been something at least for the past 40, 50 years that has been used in treatment to help men feel more optimal, prevent diseases
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[SPEAKER_00]: So it's been around for quite a while.
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[SPEAKER_00]: I know, you know, there is this whole camp where body builders were kind of abusing it, but even still there there are, there is that camp out there with the body builder group that we can learn a lot from them in terms of.
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[SPEAKER_00]: you know, how not to go to high, when to cycle off.
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[SPEAKER_00]: So they do know a lot, surprisingly, some of them are PhDs that have contributed a lot to the feel that's even surprising for me in a sense just because they didn't go to medical school doesn't mean that they're not aware of the benefits and how it can really help the recovery and performance and just overall mental well-being.
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[SPEAKER_01]: So I assume initially testosterone was used medically, right for people who are deficient.
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[SPEAKER_00]: Yes, yes.
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[SPEAKER_00]: So, you know, how do we know that a patient is deficient, right?
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[SPEAKER_00]: It's based on a collection of symptoms that the patient is coming in with.
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[SPEAKER_00]: And of course, biochemical lab work.
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[SPEAKER_00]: So we have to look at labs.
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[SPEAKER_00]: See what's happening within the body, but yes, initially it was for.
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[SPEAKER_00]: that in men, just to help with energy, mood, reducing belly fat, improving muscle mass, really helping with focus and concentration, libido and erectile quality, those tend to suffer as testosterone drops due to aging.
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[SPEAKER_00]: So lots of these factors came into play in order to start
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[SPEAKER_00]: somewhere between 700 and 1,000, that's where we like to see it.
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[SPEAKER_01]: And we're our most men at these days.
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[SPEAKER_01]: Let's say men between the age of 30 to 70.
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[SPEAKER_00]: Interestingly enough, the past, you know, 10 years, I've been seeing a drastic drop in over within 10 years.
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[SPEAKER_00]: Even within 10 years, especially the past five years, I mean, men as early as age 26 are starting to, we're starting to see lower and lower levels in the two,
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[SPEAKER_00]: Um, but on average, we want it somewhere between 700 and 1000 is where I like to see optimal levels.
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[SPEAKER_00]: Um, some other docs out there might drop down to 500 to 1000, but minimum on average 700 is where I like to see it.
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[SPEAKER_00]: And that's where men start to feel really, really.
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[SPEAKER_01]: I'm curious to see how was the proportion of men that actually meet that level that you like to see.
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[SPEAKER_00]: the 700 to 1000.
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[SPEAKER_00]: Yeah, yeah, you know, I think over the 10 years I've been doing this, I've I've maybe run into four, five men that came in without standing levels, without in clomophane citrate, without HCG, so nothing, nothing to boost their testosterone either exogenously or endogenously.
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[SPEAKER_00]: And that was surprising for me.
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[SPEAKER_00]: And I asked them, well, what are you guys doing?
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[SPEAKER_00]: And they're like, well, I don't need processed foods.
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[SPEAKER_00]: I make sure I get outside.
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[SPEAKER_00]: They monitor and manage their stress.
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[SPEAKER_00]: I think the latest guy that came in, his was in the thousand range.
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[SPEAKER_00]: He was actually one of your patients.
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[SPEAKER_00]: Wow.
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[SPEAKER_00]: Here at Chara.
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[SPEAKER_00]: And I asked him, what are you doing?
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[SPEAKER_00]: He's just like, well, I'm active.
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[SPEAKER_00]: I spent time with my family.
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[SPEAKER_00]: I spent time outside.
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[SPEAKER_00]: I regularly my stress and he was on some really good peptides, like, you know, some anti-inflammatory peptides, like a BPC-157, maybe a little bit of growth hormone stimulating peptides, CJC-1295, and EpoMoraline combination, not even kiss peptide to help
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[SPEAKER_01]: Yeah, so for men who actually had that kind of level, they are taking good care of themselves.
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[SPEAKER_01]: Very good care of themselves.
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[SPEAKER_01]: Yeah.
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[SPEAKER_01]: It sounds like it's probably less than 5% of this, which is very alarming.
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[SPEAKER_01]: Very alarming, because supposedly for every drop of testosterone level, there's a big
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[SPEAKER_01]: Big impact on their cardiovascular health and on their longevity, right.
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[SPEAKER_01]: Can you break that down a little bit about just what kind of degree of a reduction in what kind of consequences?
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[SPEAKER_00]: Yes, so with low testosterone and this is, you know, with respect to age related testosterone deficiencies.
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[SPEAKER_00]: not, you know, something going on with the brain or something going on with maybe like a varicoseal or some congenital defect in one of their, you know, in the reproductive organ.
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[SPEAKER_00]: So this is just age-related that I want to touch on.
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[SPEAKER_00]: But most men without the testosterone we start to notice insulin resistance, which we all know in terms of longevity and health optimization, we don't want too much sugar accumulated in the blood.
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[SPEAKER_00]: It can lead to
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[SPEAKER_00]: peripheral neuropathy, so numbness and tingling in the hands and feet, retinopathy, so problems with our vision, and just overall inflammation and really obstructing the microbasculture and the inner lining of our blood vessel, so the endothelium.
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[SPEAKER_00]: So we start to see damage there.
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[SPEAKER_00]: And so with that, at the very least insulin resistance is one thing that I'd like to use to
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[SPEAKER_00]: high cholesterol, low testosterone can oftentimes cause a skyrocket or or allow cholesterol the skyrocket in the absence of it.
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[SPEAKER_00]: So we see in studies profiling men who are on TRT or testosterone in a place in therapy three-year later follow-up study, we're seeing that total cholesterol reduced HDL or the healthy cholesterol improved and LDL or the not-so-healthy cholesterol also reduced.
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[SPEAKER_00]: So
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[SPEAKER_00]: very heart healthy in that sense, testosterone is also necessary for feeding the tiny vessels in the heart, so the microvascularity are oxygen and nutrients, so really also helping with heart muscle contraction.
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[SPEAKER_00]: And when that's optimized, we start to see a really nice pump of Venus return and arterial flow and we start to have blood flow to ourselves and the way we want them to and replenishing them with oxygen and nutrients, so they can function at their best.
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[SPEAKER_00]: So, that's more overarching as we kind of break down the rest of the benefits of testosterone.
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[SPEAKER_00]: We see a lot of the quality of life tends to reduce in men with low testosterone.
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[SPEAKER_00]: So, we start to see men feeling moody, maybe they're feeling a little bit depressed.
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[SPEAKER_00]: They're not as confident as they once were.
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[SPEAKER_00]: They're irritable and they don't know why.
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[SPEAKER_00]: They can't sleep, so the next day they can't function.
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[SPEAKER_00]: And then if you're if you're not well rested right the next day you're probably going to wake up just super bloggy can't focus on your work your hungry so now we start to see a little bit of waking That tends to collect around the midsection of the abdomen that spare tire.
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[SPEAKER_00]: And believe it or not, men care about their aesthetics and their appearance.
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[SPEAKER_00]: We start to see with their workouts that they're not able to recover as quickly and with muscle recovery.
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[SPEAKER_00]: We need that to happen in order to build muscle.
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[SPEAKER_00]: So it's not that testosterone directly stimulates muscle growth, but it does help in recovery and the ability to work out the next day.
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[SPEAKER_00]: So you can build more muscle mass.
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[SPEAKER_00]: So these men, when they're low, they just don't feel like themselves, and it starts to affect their personal life.
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[SPEAKER_00]: So the amount of energy they have to interact with their children.
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[SPEAKER_00]: That tends to plummet and, you know, I've spoken to men who do have families and that is a source of a little bit of regret for them that they can't spend time with their young kids and really nourish them through their young childhood and even adolescent years.
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[SPEAKER_00]: their libido maybe is a bit low and it's affecting their relationships, whether it's with you know, whoever partner they have or their marriage, you know, their partner might feel undesired or feeling like it's their fault.
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[SPEAKER_00]: And no matter what these men tell their partners, that it's not you, it's me that no one really wants to hear that, right?
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[SPEAKER_00]: So as much as they tell them this, it puts a strain between the interaction and a partnership and a couple.
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[SPEAKER_00]: So compound that with the emotional side effects of erectile quality issues.
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[SPEAKER_00]: So no man wants to walk around with the idea that they cannot achieve an erection.
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[SPEAKER_00]: It's just something, you know, the 10 years I've been doing this, I've heard it all, and it's a really a source of discomfort and a source of, I don't know, I put it like it's a hit on their masculinity, they just don't feel like the men that they're supposed to be, if they cannot achieve an erection, which I understand, I mean, there's that psychological component, so that really does testosterone actually affect the quality of the erection.
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[SPEAKER_00]: It can.
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[SPEAKER_00]: Okay.
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[SPEAKER_00]: It once we eliminate, okay, is there high blood pressure that's in the, in, that comorbid condition with the low libido?
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[SPEAKER_00]: Is it, you know, diabetes or blood sugar regulation?
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[SPEAKER_00]: That's also lending itself to a reduced or, you know, fall to your actual quality.
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[SPEAKER_00]: Once we eliminate that, then we can safely say, okay, maybe it was actually the testosterone.
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[SPEAKER_00]: So, lots of things that can affect men emotionally and mentally on that level, the confidence that the testosterone can bring.
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[SPEAKER_00]: A lot of men tend to lose a little bit of that.
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[SPEAKER_00]: that juice, so to speak, that they used to have in their 20s or 30s when they'd go out there, and nothing would bother them.
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[SPEAKER_00]: Problems would roll off their shoulders.
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[SPEAKER_00]: They can take on mountains of responsibility and chaos and show up the next day as if it never happened.
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[SPEAKER_00]: Also one of the
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[SPEAKER_00]: you can just survive.
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[SPEAKER_00]: Oh, it's not even surviving, it's you can push through your daily life.
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[SPEAKER_00]: And that's what you're talking about in the women, both men and women, yeah.
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[SPEAKER_00]: So all of these things compound and then all of a sudden you go from this man when he was in his 20s and early 30s, that felt unstoppable to this almost like fragile and kind of almost, um,
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[SPEAKER_00]: Loody, just not feeling like he can provide, and that's not what I want for our society, and that's not what these guys want for themselves either.
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[SPEAKER_00]: So that was my, I think in a way, this is my, my treating and, and, you know, using testosterone and placement therapy, and helping these men out, it's just my way of kind of helping society out a little bit.
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[SPEAKER_00]: Forging men, right, make better men, make out her men.
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[SPEAKER_01]: Yeah, exactly.
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[SPEAKER_00]: And what about the relationship between testosterone and cognition?
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[SPEAKER_00]: Yeah, I mean, without the testosterone, what we see is that the active receptors in the brain need testosterone.
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[SPEAKER_00]: There are energy receptors in the brain specific for testosterone.
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[SPEAKER_00]: And when levels are low, we start to see difficulty with focus, concentration, recall.
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[SPEAKER_00]: There could be a potential for as men age, especially in their 50, 60, 70s, without, you know, repleting the testosterone, we could be at risk for dementia and Alzheimer's disease as well.
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[SPEAKER_00]: I mean, this is more pronounced in women as estrogen drops, but there is a small effect with men as well, as endogenous T-levels do go down.
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[SPEAKER_00]: So what I have noticed after treatment in patients is that they are mentally more clear, they're endurance mentally increases.
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[SPEAKER_00]: And so maybe they've had a full work day.
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[SPEAKER_00]: And these, most of the men I've treated, they were corporate executives, high functioning, high achievers,
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[SPEAKER_00]: law enforcement firefighters.
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[SPEAKER_00]: So guys that are under a lot of stress, and then these high-functioning high achiever guys, and you know law enforcement and firefighters, they need to be on their toes mentally.
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[SPEAKER_00]: And so what we've seen clinically is at the very least that they're brighter, sharper, and they can feel like they can problem solve more readily versus has struggling prior to testosterone
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[SPEAKER_00]: to navigate through our crazy world that we have right now.
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[SPEAKER_01]: Yeah.
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[SPEAKER_01]: And testosterone really doesn't have to decline as we age.
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[SPEAKER_01]: I mean, we know there are people who maintain really good testosterone level, until they're in their 80s, 90s.
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[SPEAKER_01]: And they're all still having sex and having a good time in life.
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[SPEAKER_01]: So it's not an inevitability, but what do you think it's causing such sharp decline in men's testosterone?
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[SPEAKER_00]: What's happening right now is in our modern world, we have a lot of environmental pollutants, toxins, stress, has, uh, stress is the number one trigger that can plummet to testosterone levels.
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[SPEAKER_00]: And I see men that sometimes, you know, we put them on treatment and they're not really noticing a benefit and then I, you know, we deep dive a little further and realize that
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[SPEAKER_00]: They need to manage their stress a little bit better, whether that's going outside, getting fresh air, breathing, you know, spending time with their family, checking out of work for a little bit if possible.
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[SPEAKER_00]: So stress is a big indication, and the stress can be emotional, mental, environmental, a myriad of things.
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[SPEAKER_00]: There's also a lot of microplastics in our environment,
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[SPEAKER_00]: men's personal care products are contaminated in a sense with phallates, agents that basically can increase estrogen instead.
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[SPEAKER_00]: So Zeno estrogens, and when we see in men, especially with low testosterone levels, if their T is low and their estrogen is high, we start to see a lot more problems, and that's where the personal care products come from.
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[SPEAKER_01]: I don't think there's enough attention about these things because
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[SPEAKER_01]: The people just grab it.
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[SPEAKER_01]: They think it is sold on the market.
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[SPEAKER_01]: It should be fine.
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[SPEAKER_01]: And they, you know, they would rather not think about it, unfortunately.
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[SPEAKER_01]: And I see women do that all the time too.
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[SPEAKER_01]: Spraying all kinds of stuff on their hair, their face, and yeah.
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[SPEAKER_01]: And without realizing how that's really jeopardizing their health and their happiness.
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[SPEAKER_01]: So what can people do about this?
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[SPEAKER_01]: If they find out, I guess, if someone has little missection, energies not as good, maybe libido is dropping, maybe rain is not functioning as great as before, they probably don't know what's going on their heart.
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[SPEAKER_01]: That's usually silent until it's not silent anymore.
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[SPEAKER_01]: So but there are some other things that are a little bit more noticeable, a little bit moody.
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[SPEAKER_01]: That may be a good time to talk to your doctor and really get tested.
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[SPEAKER_01]: So, I know there are different kinds of doctors and probably run different sets of tests.
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[SPEAKER_01]: So, if a person goes to a primary care doctor, do you think that they get adequate testing?
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[SPEAKER_00]: Not necessarily, and this isn't to put anyone to shame.
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[SPEAKER_00]: It's just a primary care doctor.
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[SPEAKER_00]: If they're not in the niche of hormone replacement therapy, they may miss a few things.
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[SPEAKER_00]: I would really go to somebody who does this on a daily basis because it's not just about the low testosterone.
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[SPEAKER_00]: It's also about looking at the rest of the hormones.
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[SPEAKER_00]: Where is the estrogenat?
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[SPEAKER_00]: Where are the brain signals at the FSH and LH?
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[SPEAKER_00]: Where is the sex hormone binding Globulinat?
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[SPEAKER_00]: Where is even potentially albuminat?
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[SPEAKER_00]: So these are protein chaperones, essentially, that you have to have.
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[SPEAKER_00]: The lower the hormone levels, we have usually the lower the sex hormone binding globulin and albumin R. As we tend to ramp up in hormone of placent therapy, these numbers tend to increase.
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[SPEAKER_00]: So we needed before measurement of these parameters and also checking a chord is also it's multi-factorial.
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[SPEAKER_00]: I like to also check lipids and also check a hemoglobin A when seeing an insulin.
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[SPEAKER_00]: because if we're not looking at that complete profile we could be missing other things that are leading to these other comorbid conditions that could be causing inflammatory responses and stress in the body to lower the testosterone levels as well.
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[SPEAKER_01]: So it's a whole person approach, right, right, which the conventional primary character, they're not trained in it.
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[SPEAKER_01]: They made test your testosterone, and that's about it, right?
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[SPEAKER_01]: That's pretty much it says, well, if they think it's above 300, this is your fine.
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[SPEAKER_01]: I hear that a lot, and it's really sad, because it's not fine, just because the entire population's testosterone is dropping, doesn't mean that it's okay.
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[SPEAKER_00]: Exactly, the people are suffering.
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[SPEAKER_00]: Exactly, you know, so glad you bring this up because these ranges are out of control.
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[SPEAKER_00]: I mean, a normal range being somewhere between 300 and 1,000, it's too broad for me, you know, working in optimization and longevity and really wanting to get my patients, the healthiest that they can be.
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[SPEAKER_00]: I never want my patients in the lower or upper quartile.
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[SPEAKER_00]: want them somewhere in the middle and depending on how each person responds, we gauge the treatment accordingly.
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[SPEAKER_00]: Some men don't need a whole lot of replenishment and treatment.
18:27.113 --> 18:31.155
[SPEAKER_00]: I've gotten away with getting men to feel great with 40 milligrams twice a week.
18:31.255 --> 18:31.655
[SPEAKER_00]: That's it.
18:32.855 --> 18:34.856
[SPEAKER_00]: Some other men have needed to go a little bit higher.
18:34.996 --> 18:42.579
[SPEAKER_00]: So it really just depends on the blood work, what we're doing with the other hormones and proteins that we need to work with, how the cholesterol and blood
18:45.500 --> 18:45.700
[SPEAKER_00]: Mm-hmm.
18:45.980 --> 18:47.681
[SPEAKER_00]: So it doesn't have to be high.
18:47.701 --> 18:49.402
[SPEAKER_00]: It's just physiologic reformation.
18:49.462 --> 18:56.326
[SPEAKER_00]: And I think a lot of primary care docs scare men out of it because they're saying, oh no, you have a high cholesterol.
18:56.786 --> 19:01.088
[SPEAKER_00]: If you get on testosterone replacement therapy, you're going to throw a clot and die of a heart attack.
19:01.529 --> 19:02.069
[SPEAKER_00]: Well, yeah.
19:02.129 --> 19:06.631
[SPEAKER_00]: I mean, if we're not, if we're not looking at why is the cholesterol high?
19:06.711 --> 19:07.952
[SPEAKER_00]: Is this the stress response?
19:08.472 --> 19:12.134
[SPEAKER_00]: Because it can't elevate just from stress or is it dietary?
19:12.394 --> 19:13.835
[SPEAKER_00]: Do we need to intervene that way?
19:14.655 --> 19:18.477
[SPEAKER_00]: Or, you know, what's basically we have to look at the entire picture.
19:19.138 --> 19:27.963
[SPEAKER_00]: There are ways to go about repleting testosterone in a scenario where a cholesterol is high because it actually treats that after three years and morning to study.
19:28.003 --> 19:29.043
[SPEAKER_00]: So it will come down.
19:29.063 --> 19:34.666
[SPEAKER_00]: I think the one line I draw is if liver enzymes are elevated, so this is a new patient.
19:34.726 --> 19:36.127
[SPEAKER_00]: If liver enzymes are high,
19:36.907 --> 19:44.732
[SPEAKER_00]: And this is not because, you know, it was some sort of holiday and, you know, the patient's in, it's like, okay, I was with my family, you know, I had a few drinks, whatever.
19:44.812 --> 19:51.776
[SPEAKER_00]: But if somebody's a, you know, pretty much an alcoholic and is consistently drinking and it's affected as liver enzymes, we've got to cut the alcohol.
19:52.336 --> 19:58.960
[SPEAKER_00]: So I won't treat if we're not adjusting for that, or if we have uncontrolled high blood pressure, that's not something I like to play around with.
19:59.520 --> 20:02.002
[SPEAKER_00]: So we adjust for that first and then we move forward.
20:02.582 --> 20:16.086
[SPEAKER_00]: So I think in a primary care setting, the high blood pressure, the high cholesterol, setting in combination with testosterone is something that can be scary to the doctors and then that trickles down to the patient and then I have to damage control.
20:17.186 --> 20:23.368
[SPEAKER_00]: And tell them, no, it's great for you long term, but we just need to take some a few steps prior to treatment.
20:23.608 --> 20:23.948
[SPEAKER_01]: Mm-hmm.
20:24.429 --> 20:24.729
[SPEAKER_01]: Yeah.
20:25.009 --> 20:25.329
[SPEAKER_01]: Yeah.
20:25.449 --> 20:27.031
[SPEAKER_01]: So the cholesterol and blood pressure.
20:27.511 --> 20:34.456
[SPEAKER_01]: I mean, these are all kind of inflammation-based, which has a lot to do with toxicity and diet and lifestyle.
20:34.636 --> 20:34.896
[SPEAKER_01]: Yes.
20:35.016 --> 20:35.277
[SPEAKER_01]: Yeah.
20:35.597 --> 20:37.178
[SPEAKER_01]: Um, what they're doing with their body.
20:37.278 --> 20:38.439
[SPEAKER_01]: They're just doing some exercise.
20:38.499 --> 20:40.300
[SPEAKER_01]: Probably a lot of these things will get better. 100%.
20:41.401 --> 20:45.246
[SPEAKER_00]: exercise, you know, eating, eating foods that don't come in a box or a bag.
20:45.266 --> 20:47.970
[SPEAKER_00]: I mean, I think that's the most important thing.
20:48.050 --> 20:55.280
[SPEAKER_00]: Hydration and again, stress control being outside, interacting for for those men who aren't in a relationship, go out and meet women.
20:56.281 --> 20:56.842
[SPEAKER_00]: Interact!
20:57.582 --> 21:04.187
[SPEAKER_00]: Even though, you know, that interaction with women, it's a 10-minute temporary boosted testosterone, but at least it's better Yeah, it's just 10 minutes.
21:04.347 --> 21:05.307
[SPEAKER_00]: Even post-quidus.
21:05.748 --> 21:08.189
[SPEAKER_00]: It's 10 minutes and then it fades.
21:08.449 --> 21:13.613
[SPEAKER_00]: So I was looking into the research and because I was curious I was like, oh, does this build over time?
21:13.673 --> 21:14.093
[SPEAKER_00]: It does it?
21:14.133 --> 21:23.099
[SPEAKER_00]: It's just for that moment, but it's better than nothing So at least these men can feel that drive in a natural way like a quick little boost
21:23.639 --> 21:33.286
[SPEAKER_00]: You know, direct exogenous treatment isn't the only way to go about this, so there's there's three major forms of of treatment to increase testosterone.
21:33.746 --> 21:39.730
[SPEAKER_00]: There's straight testosterone, which will give you numbers that, you know, you can only imagine.
21:39.750 --> 21:41.151
[SPEAKER_00]: You can go as high as you want.
21:41.191 --> 21:41.992
[SPEAKER_00]: There's no limit.
21:42.072 --> 21:46.795
[SPEAKER_00]: It's going to shut down your FSH and LH, so your brain signals, but you can go as high as you want.
21:47.055 --> 21:52.237
[SPEAKER_00]: Now, for men who are not looking for preserving fertility, that's great.
21:52.618 --> 21:54.759
[SPEAKER_00]: I mean, do we need to go in the high 3000s?
21:55.019 --> 21:55.279
[SPEAKER_00]: No.
21:55.999 --> 21:59.441
[SPEAKER_00]: But, right, we don't need to do anything excessive.
21:59.501 --> 22:02.042
[SPEAKER_00]: It's just a physiological inflation does, so what we're looking for.
22:02.382 --> 22:05.124
[SPEAKER_00]: But so that's the beauty of just straight testosterone.
22:05.204 --> 22:17.455
[SPEAKER_00]: Usually comes in a sippione or an ant they got a longer half life, you'll need to inject twice a week, smaller amounts, just to prevent oscillation of feeling gray, the testosterone metabolizing out.
22:17.975 --> 22:20.657
[SPEAKER_00]: and then not feeling so great when you need your next injection.
22:20.677 --> 22:22.979
[SPEAKER_00]: So that twice weekly is really nice for stability.
22:23.659 --> 22:27.682
[SPEAKER_00]: Then there's other delivery forms, like oral testosterone, like chisatrics.
22:28.723 --> 22:31.085
[SPEAKER_00]: This is, you have to take it twice daily.
22:31.425 --> 22:34.307
[SPEAKER_00]: Usually the dosage goes from 200 to 400 milligrams a day.
22:34.967 --> 22:37.569
[SPEAKER_00]: But I don't know any man that's going to take this twice a day.
22:38.390 --> 22:49.137
[SPEAKER_00]: So that compliance could be an issue, but it keeps you within that physiologic range and it prevents any spikes in the testosterone and that could preserve your fertility a little bit more readily.
22:49.577 --> 22:52.099
[SPEAKER_00]: You won't really get to above 600 or maybe even 550 with that oral version.
22:55.261 --> 23:01.545
[SPEAKER_00]: the other newer version out there is intranazel gel testosterone next and on, I believe.
23:02.025 --> 23:10.550
[SPEAKER_00]: So that one, we don't really see a lot of compliance with it because it is a gel substance, so it kind of gets a little sticky in the nose.
23:11.310 --> 23:14.252
[SPEAKER_01]: You're spraying your spray, you're spraying the gel.
23:14.672 --> 23:16.273
[SPEAKER_00]: It's 11 migs each and all.
23:16.333 --> 23:21.656
[SPEAKER_00]: It's three times a day, so you get, I don't know who's going to do this three times a day.
23:21.736 --> 23:23.838
[SPEAKER_00]: So most men, after a week, they're just done with it.
23:24.438 --> 23:28.985
[SPEAKER_00]: We find that women have an easier time dealing with this.
23:29.345 --> 23:31.949
[SPEAKER_00]: They're more apt to continue with the International Spray.
23:32.069 --> 23:33.231
[SPEAKER_00]: It's also three times a day.
23:33.391 --> 23:34.293
[SPEAKER_00]: The results are times a day.
23:34.393 --> 23:36.296
[SPEAKER_00]: Likely, it's going to be a lower dose for women.
23:36.356 --> 23:38.819
[SPEAKER_00]: Men have eight times more testosterone than we have.
23:38.879 --> 23:40.101
[SPEAKER_00]: We still need it as women.
23:40.742 --> 23:43.365
[SPEAKER_00]: But the men compliance is an issue with the intranese.
23:43.465 --> 23:44.967
[SPEAKER_00]: Also, like I said, it's a little gel-like.
23:45.147 --> 23:50.472
[SPEAKER_00]: If they can find a way to aerosolize it, more cleanly, I think that might be a really great route.
23:50.553 --> 23:51.774
[SPEAKER_00]: But we'll see what happens.
23:52.615 --> 24:00.083
[SPEAKER_00]: And then the other delivery form is, you know, if a man is looking to preserve his fertility and clawmafened citrate or clawmafened citrate.
24:00.463 --> 24:07.448
[SPEAKER_00]: Clomophine citrate, you have a potential of increase of triglycerides, which I don't really like to use that a lot.
24:07.469 --> 24:10.831
[SPEAKER_00]: I've seen it maybe a couple times and then there could be a side effect of blurry vision.
24:11.412 --> 24:21.760
[SPEAKER_00]: Mostly what we see is end-clomophine citrate being used and that will not shut down the message from the brain to the testee, your FSH and LH still remain, sperm count still remains high.
24:22.460 --> 24:26.844
[SPEAKER_00]: So that's an option for a man who are looking to conceive and want to maintain their fertility.
24:27.624 --> 24:34.646
[SPEAKER_00]: What's the mechanism of, so that, yeah, the enclimaphine and enclimaphine citrate, they block estrogen at the level of the hypothalamus.
24:34.706 --> 24:41.127
[SPEAKER_00]: So at that point, the brain is freaking assing, okay, whereas our estrogen, because in men, testosterone converts over into estrogen.
24:41.727 --> 24:49.809
[SPEAKER_00]: So when the brain senses that it sends out gonadotropin releasing hormone, which then sends out follicles stimulating hormone, FSH, and then LH.
24:50.289 --> 24:53.850
[SPEAKER_00]: That FSH and LH, the LH will give the testosterone,
24:57.751 --> 25:01.513
[SPEAKER_00]: So that's how the mechanism of action works there in a nutshell.
25:02.474 --> 25:04.475
[SPEAKER_00]: It's kind of similar to HcG.
25:04.575 --> 25:05.516
[SPEAKER_00]: Yes, okay.
25:05.556 --> 25:06.496
[SPEAKER_00]: And I was going to touch on that next.
25:06.536 --> 25:10.959
[SPEAKER_00]: So the HcG that is a synthetic LH or synthetic loonizing hormone.
25:11.299 --> 25:16.482
[SPEAKER_00]: And that will still, you can still get really high levels with just HcG if you dose high enough.
25:18.102 --> 25:25.145
[SPEAKER_00]: So, you're still risking suppression if you're dosing for example, you know, 1,500 megs three times a week.
25:25.225 --> 25:31.107
[SPEAKER_00]: That can be used, but you're still going to elicit enough testosterone to shut down the efficacy to an LH.
25:31.808 --> 25:40.571
[SPEAKER_00]: So, in that case, the chromophene or end chromophene is the better delivery form or the oral chisatrics just to maintain sperm count.
25:40.971 --> 25:45.533
[SPEAKER_00]: The other option, I think, of fermenter really think about in terms of fertility is
25:46.613 --> 25:50.116
[SPEAKER_00]: Just take it easy, don't stop.
25:50.616 --> 26:00.404
[SPEAKER_00]: Even if you're on exogenous, straight replenishment of testosterone because I have had patients conceive quite successfully with dosages of, you know, even 25 to 40
26:08.270 --> 26:11.711
[SPEAKER_00]: with small amounts of HCG concomitantly.
26:11.831 --> 26:13.631
[SPEAKER_00]: So it wasn't a standalone treatment.
26:13.831 --> 26:18.492
[SPEAKER_00]: It was not monotherapy, but dual therapy with testosterone and HCG.
26:18.652 --> 26:24.454
[SPEAKER_00]: That seems to be the chef's kiss to maintain sperm count and then also give these guys the tea that they need.
26:25.234 --> 26:27.875
[SPEAKER_00]: In a delivery form, that's easy for them twice a week.
26:28.855 --> 26:37.557
[SPEAKER_00]: The dosage with the HCG, I don't want to stick to anywhere from 250 to 500 migs twice a week to maintain the signaling from the brain to the testy and not shut that down.
26:38.157 --> 26:40.340
[SPEAKER_01]: And that's how I've always studied all these therapies.
26:40.500 --> 26:44.425
[SPEAKER_01]: Is it only testosterone that can have the potential of making the test these strength?
26:44.905 --> 26:48.950
[SPEAKER_00]: The testosterone and sometimes it in high doses the HCG.
26:49.070 --> 26:53.235
[SPEAKER_00]: But yes, that's a great clarifier because it's a particular atrophy is a thing.
26:54.096 --> 26:55.898
[SPEAKER_00]: I mean men really care about this.
26:56.518 --> 26:59.121
[SPEAKER_00]: I don't know any woman that cares or even looks.
27:01.483 --> 27:04.486
[SPEAKER_00]: I mean, you know, but it's for them.
27:04.586 --> 27:05.126
[SPEAKER_00]: It's a thing.
27:05.146 --> 27:07.629
[SPEAKER_00]: I know now there's fat transfer into the testing.
27:07.829 --> 27:08.890
[SPEAKER_00]: Yeah, Paul Trix.
27:09.190 --> 27:11.192
[SPEAKER_00]: He's created this technique.
27:11.312 --> 27:12.333
[SPEAKER_00]: This doesn't sound right.
27:12.793 --> 27:15.176
[SPEAKER_01]: I mean, why would you put fat where it doesn't belong?
27:15.696 --> 27:18.437
[SPEAKER_00]: It's almost like a Brazilian butlif for the testi.
27:18.617 --> 27:20.257
[SPEAKER_00]: Yeah, I just don't understand.
27:20.297 --> 27:26.339
[SPEAKER_00]: But it gives them the bulk, it gives them what they want in case, oh, for where I was listening out, their worst comes the worst.
27:26.859 --> 27:28.579
[SPEAKER_00]: But yeah, the testiography is a real thing.
27:28.619 --> 27:33.220
[SPEAKER_00]: So the guys on exogenous T. So maybe they're on the testosterone, sippione, or even the anathate.
27:33.240 --> 27:36.641
[SPEAKER_00]: The anathates more of a, you know, it's more readily available in Europe.
27:36.701 --> 27:40.782
[SPEAKER_00]: I know some guys can get it here, but the sippione is what we tend to have in the states.
27:41.282 --> 27:47.308
[SPEAKER_00]: So layering that with a little bit of HCG dual therapy is the one thing that's going to prevent some of that atrophy.
27:48.369 --> 27:50.792
[SPEAKER_00]: We've also found that it just helps men feel a lot better.
27:50.812 --> 27:55.917
[SPEAKER_00]: It mood-wise when that HCG signals a little bit of that natural LH release.
27:56.718 --> 27:58.539
[SPEAKER_00]: So they're happier, they're feeling better.
27:59.240 --> 28:07.082
[SPEAKER_00]: Um, we've noticed that with the addition of the HCG as well, they're able to maintain their lean mass a little bit more readily and reduce the body fat a little bit more readily.
28:07.182 --> 28:16.025
[SPEAKER_00]: So as far as the mood, that piece still needs some discovery in terms of what the HCG is doing there, but it's a it's a it's a benefit all take.
28:24.867 --> 28:25.047
[SPEAKER_00]: Yeah.
28:25.108 --> 28:28.653
[SPEAKER_01]: What would you think of that compared to the injections?
28:29.033 --> 28:30.095
[SPEAKER_00]: So the Android Jail?
28:30.235 --> 28:33.380
[SPEAKER_00]: Yeah, I like the Android Jail, but it's more of a daily thing.
28:33.500 --> 28:34.862
[SPEAKER_00]: So men need to apply a daily.
28:34.902 --> 28:36.945
[SPEAKER_00]: It's got to cover a large surface area.
28:36.985 --> 28:39.909
[SPEAKER_00]: So the problem with the gels is absorption.
28:40.570 --> 28:58.345
[SPEAKER_00]: if a guy maybe has a lot of hair and they haven't shaved it that we won't get the absorption onto the chest or wherever it is that they're applying so shaving is going to be key sometimes exfoliation if if the guy's just gotten out of the shower and he's still not dried off you know he needs to be careful of of when he's applying.
28:58.365 --> 28:58.405
[SPEAKER_00]: So
28:59.165 --> 29:00.365
[SPEAKER_00]: Absorption could be an issue.
29:00.385 --> 29:05.547
[SPEAKER_00]: I like to reserve the gels in cases of testosterone-induced polycythemia.
29:05.667 --> 29:12.549
[SPEAKER_00]: So testosterone will stimulate the kidney to secrete every ther proletin, which then tells the bone marrow, hey, make me some red blood cells.
29:13.049 --> 29:23.012
[SPEAKER_00]: So then the blood gets thick, and we see an elevation in hemoglobin, and also hematocrit on blood labs, which any doctor doing that should be following with blood labs, monitoring hemoglobin hematocrit every three months.
29:23.572 --> 29:31.039
[SPEAKER_00]: So I'd like to use the gel if I find that exogenous testosterone subunit has caused that increase in the blood cells.
29:31.940 --> 29:38.266
[SPEAKER_00]: And we see this elevated hemoglobin hermatter crit, then I'll drop down to a gel because it won't spike as readily.
29:38.406 --> 29:49.036
[SPEAKER_00]: We have a little bit more control with the topical to prevent peaks the way we see in the exogenous direct injection testosterone.
29:49.736 --> 29:52.239
[SPEAKER_01]: So because it's just not as fast release.
29:52.479 --> 29:55.722
[SPEAKER_01]: Yeah, is usually absorbed into the fat layer, right?
29:55.762 --> 29:57.744
[SPEAKER_01]: And then slowly, slowly release it.
29:57.824 --> 29:58.224
[SPEAKER_01]: It would.
29:59.265 --> 30:03.409
[SPEAKER_00]: So that's one thing I like, but again, compliance is a key.
30:03.509 --> 30:06.172
[SPEAKER_00]: I don't know any man that's going to really do that.
30:06.312 --> 30:09.275
[SPEAKER_00]: The only time I've released daily, daily application.
30:09.775 --> 30:33.797
[SPEAKER_00]: Okay, I always think that's a easy way, you know, just in the morning before you go to work, just it is right on it is just like you put moisturizer on it is it is for for a lot of people I mean, maybe we as women are used to it And I may you know, but for men who can't tolerate the injections for example, maybe they're getting well to maybe they're just they're just done with it and they don't want to feel like a pink cushion anymore than making transfer to a topical like a gel
30:34.817 --> 30:39.018
[SPEAKER_00]: to give them a little bit of a break, which is always nice, and that's why I love having these different delivery forms.
30:39.058 --> 30:44.859
[SPEAKER_00]: You can play around with it, and that's I think where the art of who's behind the replacement comes in.
30:44.959 --> 30:50.401
[SPEAKER_00]: So you gotta really find someone that knows what they're doing is in the know what the different forms, what the side effects are.
30:50.421 --> 30:54.722
[SPEAKER_00]: I mean, you mentioned atrophy, hair loss is a potential side effect as well.
30:54.782 --> 30:55.942
[SPEAKER_00]: So are these reversible?
30:56.642 --> 30:57.202
[SPEAKER_00]: Great question.
30:57.342 --> 31:10.308
[SPEAKER_00]: The atrophy is the atrophy is testicular atrophy is, you know, there are times where you can just take the testosterone away for a little bit, maybe add in some chromophene citrate, so the man doesn't crash, right?
31:10.348 --> 31:19.733
[SPEAKER_00]: And then you can maybe after the chromophene spike the FSH and LH get them back on a regular kind of communication between
31:25.687 --> 31:29.291
[SPEAKER_00]: and then maybe go back to the exogenous testosterone.
31:29.311 --> 31:30.812
[SPEAKER_00]: I was saying you smile, I'm like, that's a lot.
31:32.795 --> 31:35.137
[SPEAKER_00]: I mean, this is a way to go around it, right?
31:35.157 --> 31:40.523
[SPEAKER_00]: To make your patient feel they're most comfortable, but yeah, it's reversible with their inclamation citrate and even some HDG.
31:41.704 --> 31:43.386
[SPEAKER_00]: So different ways to go about that.
31:43.426 --> 31:44.087
[SPEAKER_00]: But the hair loss?
31:46.346 --> 31:46.967
[SPEAKER_00]: The hair loss?
31:47.107 --> 31:58.433
[SPEAKER_00]: Yes, and if you catch your early enough and pull back on the dosage and then add some oral monoxidil and then use maybe some natural herbs like A combination of a saw pulmetonetal root pygium.
31:58.473 --> 32:10.060
[SPEAKER_00]: They'll work on both alpha and beta receptor of the five-alperary ductase enzyme and I use this often So we block that conversion to dihydrotestosterone, which is what's responsible for
32:10.920 --> 32:18.742
[SPEAKER_00]: thinning of not only the follicle, but then over time after we grow it becomes shorter and thinner, shorter and thinner, and then we start to see the baldness.
32:19.182 --> 32:23.523
[SPEAKER_00]: But I think the oral monoxidil is a great place to start, you know, just to prevent it.
32:23.883 --> 32:36.546
[SPEAKER_00]: And if men are a little concerned with, you know, I just got a hair transplant, you know, clearly I'm going to start a little bit on the air on the side of caution, and maybe do a topical gel, and then make sure they're on the oral monoxidil.
32:36.606 --> 32:39.087
[SPEAKER_00]: And definitely, you know, a five-alpha reductase blocker.
32:39.627 --> 32:40.047
[SPEAKER_00]: I see.
32:40.468 --> 32:44.450
[SPEAKER_00]: Doesn't have to be herbal, it can be a finasteride as well, or a do-tasteride as well.
32:44.950 --> 32:54.295
[SPEAKER_00]: So we can go far from a logical route as well, it just depends on how serious the condition is and how scared the man is that's right over here.
32:54.435 --> 32:55.556
[SPEAKER_01]: There are a lot of nuances.
32:55.576 --> 32:56.476
[SPEAKER_01]: A lot of nuances.
32:56.496 --> 32:59.798
[SPEAKER_01]: And so which brings us to side effects of
33:00.098 --> 33:01.099
[SPEAKER_01]: the hormone replacement.
33:01.179 --> 33:10.684
[SPEAKER_01]: So the testicular, after feed, the hair loss, and tell us a little bit about other potential side effects that people may end up noticing.
33:10.904 --> 33:16.247
[SPEAKER_00]: Yeah, so I mean, I think the biggest, biggest thing out there is got to come out to you.
33:16.307 --> 33:23.331
[SPEAKER_00]: So nipple tenderness, breast tenderness, and then eventually, if, you know, the estrogen goes uncontrolled, so that's how that got to come out to you forms.
33:23.391 --> 33:24.851
[SPEAKER_00]: It's too much faster than boobs.
33:24.911 --> 33:25.032
[SPEAKER_00]: Yeah.
33:26.112 --> 33:32.374
[SPEAKER_00]: So there's the man-boop situation and then how will you know, right, or how would a man know that this is what I'm going through.
33:32.474 --> 33:42.696
[SPEAKER_00]: So he might just be going through his day and then all of a sudden, you know, the brush of his t-shirt or a towel might cause some tenderness to the nipple that otherwise wasn't there.
33:43.976 --> 33:48.797
[SPEAKER_00]: The nipples can become pink, puffy and large and maybe pointing downward.
33:48.837 --> 33:50.898
[SPEAKER_00]: That's when we've gone a little too far in the game.
33:51.698 --> 33:56.323
[SPEAKER_00]: They're also maybe, you know, seeing water retention in the hands feeder phase.
33:56.943 --> 33:59.445
[SPEAKER_00]: Now, we're kind of getting outside the gynacomastia realm.
33:59.586 --> 34:03.269
[SPEAKER_00]: That's just more dealing with the man-boob situation, which is a result of high estrogen.
34:03.389 --> 34:06.212
[SPEAKER_00]: But they may also start to notice puffiness in the hands feeder phase.
34:06.272 --> 34:10.596
[SPEAKER_00]: They may notice feeling a little weepier emotional from triggers that normally wouldn't trigger them.
34:11.497 --> 34:14.360
[SPEAKER_00]: And then maybe a little bit of bloating in the abdomen.
34:14.800 --> 34:29.800
[SPEAKER_00]: And that's when we know, okay, our estrogen's at a control, let's dial it back, let's, you know, try to clear whatever estrogen is out of the way, I like to use herbs like, or supplements like diendol methane and endol three carbonyl, these are normally found in foods like,
34:30.300 --> 34:34.543
[SPEAKER_00]: Kale, broccoli, cabbage, bok-toy, cauliflower, brussel sprouts.
34:34.603 --> 34:42.848
[SPEAKER_00]: So if we can't use food as medicine or concomitantly use food as medicine with the dim i3c.
34:42.909 --> 34:47.311
[SPEAKER_00]: And then if I need to all throw in some anastrosal, that's the generic form of a ruminac.
34:47.371 --> 34:49.613
[SPEAKER_00]: So those are pharmaceutical estrogen blockers.
34:49.973 --> 34:50.994
[SPEAKER_00]: sometimes I use all three.
34:51.094 --> 34:52.795
[SPEAKER_00]: Just depends on how deep in the whole we are.
34:54.456 --> 34:59.139
[SPEAKER_00]: So that's kind of how the signs and symptoms of the gynecromascia, how we can mitigate for that.
34:59.719 --> 35:03.301
[SPEAKER_00]: The other is the hair thinning and hair loss, which we discussed.
35:03.381 --> 35:06.183
[SPEAKER_00]: The other is just feeling angry or irritable.
35:06.883 --> 35:12.467
[SPEAKER_00]: It's interesting that all these years, it's been to stastronism in the culprit.
35:13.187 --> 35:21.618
[SPEAKER_00]: and you know, for testosterone being so calming and so stabilizing and just the most magical hormone on the face of the planet to get through your life.
35:24.922 --> 35:30.369
[SPEAKER_00]: I have my favorite, it's just you can just feel like a superhero when when you have the right amount of testosterone.
35:31.010 --> 35:48.839
[SPEAKER_00]: But according to a 2023 meta-analysis, it's not really the testosterone, so it's the estrogen, because we have receptors in our brain, in that amygdala, which is our fear area, emotional control area, and the prefrontal cortex.
35:48.879 --> 35:50.640
[SPEAKER_00]: So our area of impulse control.
35:51.001 --> 35:54.222
[SPEAKER_00]: So what we find is that there's a ton of estrogen receptors in that area.
35:54.763 --> 35:56.443
[SPEAKER_00]: So if we're now all of a sudden having a
35:59.645 --> 36:02.366
[SPEAKER_00]: His brain in those areas are going to register that.
36:02.426 --> 36:04.387
[SPEAKER_00]: Those estrogen receptors are going to latch on.
36:04.427 --> 36:08.069
[SPEAKER_00]: This guy is going to start to become a little bit irritable, a little bit weepy, and a little bit aggressive.
36:08.129 --> 36:10.170
[SPEAKER_00]: Especially if he's at a history of it in the past.
36:10.911 --> 36:13.652
[SPEAKER_00]: So we're starting to see that science is a little more nuanced.
36:13.812 --> 36:19.535
[SPEAKER_00]: Now when it comes to otestosterone as the aggressor, not necessarily, could be the estrogen.
36:20.155 --> 36:23.137
[SPEAKER_00]: And so that's what we're seeing according to this 2023 meta-analysis.
36:23.298 --> 36:26.060
[SPEAKER_00]: And how does testosterone leads to elevation of estrogen?
36:26.560 --> 36:27.060
[SPEAKER_00]: Great question.
36:27.080 --> 36:35.887
[SPEAKER_00]: So yeah, in the body fat, we have an enzyme called the romatease and testosterone typically converts over into estrogen through that conversion.
36:36.487 --> 36:39.449
[SPEAKER_00]: So we call it testosterone aromatizes to estrogen.
36:39.469 --> 36:42.612
[SPEAKER_00]: So that's like a key phrase that, you know, our listeners can be aware of.
36:43.112 --> 36:46.975
[SPEAKER_00]: So the more body fat a man has, that's going to be a risk factor, the more
36:47.255 --> 36:48.536
[SPEAKER_00]: Alcohol heat drinks.
36:48.936 --> 36:52.258
[SPEAKER_00]: So I always tell my patients, cut the alcohol.
36:52.358 --> 37:00.944
[SPEAKER_00]: If you can or take it to a minimum, I'm talking about, you know, according to average healthy amount of drinks is wondering per week for a man.
37:01.084 --> 37:07.889
[SPEAKER_00]: I think that's still too much in the realm of testosterone replacement therapy and preventing that high estrogen surge.
37:08.369 --> 37:10.530
[SPEAKER_00]: So alcohol, reducing body fat,
37:13.232 --> 37:24.015
[SPEAKER_00]: in that man with the high testosterone, if he's sitting there on the couch not working out gaining weight, eating whatever he wants, drinking whatever he wants, he's going to be more at high risk to convert his estrogen over.
37:24.075 --> 37:26.875
[SPEAKER_00]: And so those are the things we need to watch out for.
37:27.095 --> 37:32.037
[SPEAKER_01]: Which means anybody who does all that could be having a lot more estrogen than you want.
37:32.317 --> 37:33.517
[SPEAKER_00]: Right, lots more estrogen.
37:33.577 --> 37:39.879
[SPEAKER_00]: Yeah, I mean, in their studies that have been done on alcohol induced aggression and the same logic kind of follows.
37:39.939 --> 37:41.239
[SPEAKER_00]: It's that estrogen spike.
37:41.719 --> 37:43.041
[SPEAKER_00]: That leads to their aggression.
37:43.141 --> 37:47.986
[SPEAKER_00]: It's not all of a sudden this guy's like drunk and his testosterone surging and now he's upset.
37:48.066 --> 37:58.118
[SPEAKER_00]: No, it's not that and then the personality type men who are prone to kind of that more strict you know, um, high dominance.
37:58.158 --> 38:02.262
[SPEAKER_00]: What does it call high dominance versus low impulse control
38:02.863 --> 38:07.105
[SPEAKER_00]: those guys are a little bit more at risk in terms of a psychological level.
38:07.586 --> 38:11.628
[SPEAKER_00]: So in my screening, I always kind of look for that.
38:12.008 --> 38:13.309
[SPEAKER_00]: Like, who is this man?
38:13.369 --> 38:14.590
[SPEAKER_00]: Like, what's the history?
38:14.610 --> 38:19.673
[SPEAKER_00]: I don't ask about, you know, history of like domestic violence or abuse, but you can kind of tell.
38:19.693 --> 38:22.514
[SPEAKER_00]: You can tell the guys that are in it just to be healthier.
38:22.534 --> 38:27.497
[SPEAKER_00]: And then you can tell, by the way, he talks to you, if he's going to be aggressive or not.
38:27.537 --> 38:29.718
[SPEAKER_00]: And that's just things you just pick up over time,
38:32.620 --> 38:32.960
[SPEAKER_01]: Yeah.
38:33.021 --> 38:34.162
[SPEAKER_01]: Yeah.
38:34.242 --> 38:37.925
[SPEAKER_01]: So some people may not want to do whammy replacement, right?
38:38.045 --> 38:45.613
[SPEAKER_01]: And there are men that really believe that they should be able to boost their own testosterone, just on his own.
38:45.713 --> 38:47.094
[SPEAKER_01]: How easy do you think that is?
38:47.795 --> 38:48.596
[SPEAKER_00]: How achievable.
38:49.176 --> 39:01.825
[SPEAKER_00]: So gosh, in the 10 years I've been doing this, I have yet to see, except for those three or four that I've mentioned earlier, I've yet to see a natural boost that can give me levels that exogenous testosterone does.
39:02.045 --> 39:06.068
[SPEAKER_00]: Not even, you know, just straight testosteronecipionate mixed with a little HCG.
39:06.828 --> 39:12.511
[SPEAKER_00]: I've yet to see levels rise to what I want them to be in terms of a 700 to a 1000 naturally.
39:12.971 --> 39:18.774
[SPEAKER_00]: But what we can try is, you know, a series of peptides like kiss peptin.
39:18.794 --> 39:22.716
[SPEAKER_00]: That's been shown to effectively raise testosterone levels.
39:23.196 --> 39:27.859
[SPEAKER_00]: So kiss peptin is one way to go about it indirectly boosting growth hormone.
39:27.999 --> 39:33.362
[SPEAKER_00]: So you can build muscle mass, so the more muscle we have, especially in the quads, the legs, and the glutes.
39:33.402 --> 39:34.702
[SPEAKER_00]: Those are our largest muscle groups.
39:34.722 --> 39:35.703
[SPEAKER_00]: Some of the muscles are the back.
39:36.604 --> 39:44.510
[SPEAKER_00]: As long as we grow those large muscle groups, the body will naturally request an increase in demand of production of testosterone.
39:45.071 --> 39:51.636
[SPEAKER_00]: So indirectly, if we use like a CJC 1295 EpoMorlin, you know, stack a Tessa Morlin on top of that.
39:52.096 --> 39:59.322
[SPEAKER_00]: If we can elicit that, get the guy working out, get the guy building muscle, helping with that recovery, we can indirectly boost testosterone that way.
40:00.043 --> 40:17.620
[SPEAKER_00]: And then, of course, in a stress reduction, as we mentioned earlier, and just clean eating up, go outside, you know, um, there's other herbs, for example, um, Ashwaganda, which is an adaptogen meaning that it helps your body respond to stress triggers.
40:18.580 --> 40:21.083
[SPEAKER_00]: Studies have shown that taking Ashwaganda daily,
40:21.643 --> 40:27.206
[SPEAKER_00]: can help with reducing cortisol, which can then help to increase testosterone.
40:27.786 --> 40:38.351
[SPEAKER_00]: Another herb, Tonga Ali, that's been studied not necessarily to increase testosterone, but to free your testosterone from sex hormone binding globulin.
40:38.851 --> 40:41.513
[SPEAKER_00]: So we have total levels, but we also want to look at free levels.
40:41.553 --> 40:47.538
[SPEAKER_00]: I forgot to mention this, you know, free tea anywhere from 5 to 25 is where we want to see.
40:47.598 --> 40:51.041
[SPEAKER_00]: I like to see it more in the middle, you know, 20 is a good range.
40:51.081 --> 40:53.302
[SPEAKER_00]: Or if I want to take a guide to its optimal.
40:53.342 --> 40:57.185
[SPEAKER_00]: If I can get it somewhere between 20 to 25 on a free tea, I would love that.
40:57.225 --> 41:00.148
[SPEAKER_00]: And that's I've done my mission in life for this.
41:00.188 --> 41:06.373
[SPEAKER_00]: You may be in terms of TRT, but the Tongat Ali will not directly increase the testosterone.
41:07.093 --> 41:19.302
[SPEAKER_00]: What it will do is free up your whatever you have in the total testosterone pool, so it'll separate your testosterone from sex hormone binding globulin and now you have more circulating free testosterone.
41:19.742 --> 41:26.587
[SPEAKER_00]: You need to have at least 26% euro peptide in that Tonga Oli preparation for any of that to even work.
41:27.347 --> 41:34.971
[SPEAKER_00]: Beta side of sterile also can be used to help free up some of that sex hormone binding globulin or free up some of the testosterone from sex hormone binding globulin.
41:35.351 --> 41:38.032
[SPEAKER_00]: And then let's say you have a high sex hormone binding globulin.
41:38.052 --> 41:39.053
[SPEAKER_00]: How do you bring that down?
41:39.193 --> 41:39.833
[SPEAKER_00]: Not a root.
41:40.853 --> 41:41.854
[SPEAKER_00]: Can do that not the leaf.
41:41.994 --> 41:46.576
[SPEAKER_00]: Just the root about 500 milligrams twice a day for a few months can really be beneficial.
41:46.656 --> 41:52.359
[SPEAKER_00]: So lots of ways in terms of using herbs, herbal medicine to also help
41:56.821 --> 41:57.762
[SPEAKER_01]: Yeah, that's great.
41:58.342 --> 41:59.403
[SPEAKER_01]: What about other hormones?
41:59.623 --> 42:07.848
[SPEAKER_01]: Because men, you know, as women is estrogen progesterone, but for men, I mean, these other hormones are important too, right?
42:08.648 --> 42:10.970
[SPEAKER_01]: Do you check men's progesterone as well?
42:11.370 --> 42:11.890
[SPEAKER_00]: Yeah, I do.
42:12.010 --> 42:14.312
[SPEAKER_00]: I do check progesterone just to be thorough and complete.
42:14.392 --> 42:15.732
[SPEAKER_00]: I'm just a little bit like that.
42:16.994 --> 42:21.800
[SPEAKER_00]: I do check progesterone, especially if the man is having issues sleeping or if he's super anxious.
42:21.840 --> 42:26.947
[SPEAKER_00]: He doesn't need a lot, just maybe two mugs a day, but that progesterone can also be very calming.
42:26.987 --> 42:31.834
[SPEAKER_00]: It's gabinurgic, so it attaches to our gaba neurotransmitter, which is very calming to the brain.
42:32.194 --> 42:33.755
[SPEAKER_00]: So I will check the progesterone.
42:34.016 --> 42:45.645
[SPEAKER_00]: I also love to check a cortisol just to see where his cortisol is at and then that's when I'll add some of the herbal components, you know vitamin B6 B5 are also great to help with some of the with cortisol as well.
42:45.705 --> 42:47.767
[SPEAKER_00]: So we'll do some nutrient therapy as well.
42:48.047 --> 43:02.729
[SPEAKER_00]: And then I'll also check for like as an insulin level just making sure you know insulin is a hormone in and of its own right so make sure that's normal their hemogloin A when C's not above 5.7% and if it is we need to adjust for that.
43:03.069 --> 43:21.371
[SPEAKER_00]: So those are a prostate specific integer, not necessarily a hormone, but a lab marker that I always want to make sure I address because there have been times where, you know, with testosterone replacement therapy, it can potentially lead to what's called benign prosthetic hyperplasia or BPH where the prostate is enlarged.
43:21.851 --> 43:29.713
[SPEAKER_00]: The good thing is now we have studies that have refuted the whole connection with, you know, testosterone replacement therapy and prostate cancer.
43:29.813 --> 43:33.174
[SPEAKER_01]: It does not cause that's an important part to talk about.
43:33.214 --> 43:39.876
[SPEAKER_01]: Because I still have, you know, not too long ago a patient was diagnosed with a testicular cancer.
43:40.576 --> 43:44.877
[SPEAKER_01]: And the doctor told him to absolutely get off the testosterone.
43:45.337 --> 43:53.724
[SPEAKER_01]: And he was, that was the hardest thing because everything plummeted and yeah, he had miserable miserable months.
43:54.064 --> 43:56.346
[SPEAKER_00]: Yeah, I feel bad for him.
43:56.786 --> 44:00.950
[SPEAKER_00]: Yeah, to to cold turkey, any type of testosterone placement therapy, it's tough.
44:02.110 --> 44:09.056
[SPEAKER_00]: But in an active state of prostate cancer, yes, I don't recommend, you know, taking any type of testosterone.
44:09.376 --> 44:17.141
[SPEAKER_00]: during, you know, a recent diagnosis or it's been debunked as far as causing prostate cancer.
44:17.522 --> 44:25.087
[SPEAKER_00]: But just, you know, for my mental well-being and peace of mind, I don't like to administer testosterone, you know, if I've just found out my
44:25.508 --> 44:27.610
[SPEAKER_00]: patient as prostate cancer.
44:27.670 --> 44:34.635
[SPEAKER_00]: I'll wait a little bit on that and then we'll resume after he's spoken with his urologist and try to figure out and then I'm on board with the urologist.
44:34.655 --> 44:38.138
[SPEAKER_00]: If urologist is on board, I'm on board and we'll go ahead and you know start.
44:38.158 --> 44:44.343
[SPEAKER_01]: So you would taper off whilst probably supplementing with other herbs and other lifestyle changes.
44:44.683 --> 44:52.369
[SPEAKER_00]: Yeah, yeah, but the I was really happy to read in the studies that you know that has been debunked in terms of testosterone and prostate cancer and even you know 10
44:54.771 --> 45:03.058
[SPEAKER_00]: So wait a second, you know, men have, there are incidences of prostate cancer and men who have never been on testosterone replacement therapy.
45:03.638 --> 45:10.324
[SPEAKER_00]: So it was a little bit iffy from day one, but I'm glad that at this point we can definitively say, nope, it does not cause prostate cancer.
45:10.724 --> 45:11.705
[SPEAKER_00]: That was a major win.
45:11.805 --> 45:12.746
[SPEAKER_01]: Yeah.
45:13.006 --> 45:13.206
[SPEAKER_01]: Yeah.
45:13.286 --> 45:13.747
[SPEAKER_01]: Wonderful.
45:13.827 --> 45:15.688
[SPEAKER_01]: I think we covered a lot of ground.
45:16.989 --> 45:19.912
[SPEAKER_01]: It's as people can see, the body is a symphony.
45:20.632 --> 45:24.536
[SPEAKER_01]: and the hormone replacement is an art and is a complex matter.
45:25.677 --> 45:36.626
[SPEAKER_01]: So being with somebody that's really experienced and really understand the whole scope of how these hormones work in the body and affect each other as well.
45:37.126 --> 45:40.569
[SPEAKER_01]: So what Dr. Sarah, what's the best way for people to actually get help from you?
45:41.450 --> 45:43.151
[SPEAKER_00]: Well, definitely confined as a child health.
45:43.771 --> 45:46.613
[SPEAKER_00]: Um, we do, I will do all, I do all of those things here.
45:46.633 --> 45:53.576
[SPEAKER_00]: And we'll need some labs first, uh, and then we can get started on whatever delivery form is appropriate, uh, for that patient.
45:53.776 --> 45:55.257
[SPEAKER_00]: You can just give our office a call.
45:55.677 --> 45:55.978
[SPEAKER_01]: Right.
45:56.278 --> 46:01.200
[SPEAKER_01]: And you are, you're trusted, not only among our patients, but also among our staff.
46:01.740 --> 46:10.305
[SPEAKER_01]: Many of us have gotten to help from you and you're being so kind and so generous and and doesn't miracles for for some, some of them that are we're suffering.
46:10.685 --> 46:11.385
[SPEAKER_00]: I appreciate that.
46:11.405 --> 46:13.227
[SPEAKER_01]: Yeah, so, so great to have you.
46:13.607 --> 46:19.870
[SPEAKER_01]: And thank you for sharing your wonderful and vast knowledge in this subject.
46:19.970 --> 46:22.452
[SPEAKER_01]: So, I'm, I hope this is super helpful for people.
46:22.692 --> 46:28.615
[SPEAKER_01]: And really give you a good understanding of the complexity of, of, of male hormone.
46:28.776 --> 46:30.276
[SPEAKER_01]: So, there's a lot to consider.
46:30.296 --> 46:32.738
[SPEAKER_01]: So, I hope you, um, get the right help.
46:33.158 --> 46:39.740
[SPEAKER_01]: Thank you for listening to this episode, hope you enjoy the content, and if so, please rate and follow this podcast.
46:40.020 --> 46:45.862
[SPEAKER_01]: To reach me, you can contact uplift longevity center, that is uplift with a why.
46:46.102 --> 46:49.863
[SPEAKER_01]: You can also subscribe to my YouTube channel Joy Kong MD.
46:50.283 --> 46:51.003
[SPEAKER_01]: See you next time!