Barbell Shrugged - Hormone Health for Sex, Fertility, Health and Performance: A Chat with Dr. Ralph Esposito — Muscle Maven Radio Episode #3

Episode Date: February 21, 2019

Dr. Ralph Esposito (@dr.ralphesposito) is a New York based naturopathic physician, acupuncturist and functional medicine practitioner specializing in integrative urology, men’s health and nutrigenomics. He has designed education modules for health professionals specifically on urological conditions, male and female hormone dysfunction, hypogonadism, exercise, men’s health and sexual dysfunction. He's an adjunct professor at New York University where he lectures on integrative medicine. Currently, Dr. Esposito serves as a medical consultant and research analyst.   This week we talk all things hormonal health: ways to increase testosterone in men and women, enhancing fertility, what certain symptoms can tell you about your hormone health, the key lifestyle factors for optimal hormone balance, and much, much more with functional medicine physician Dr. Ralph Esposito.   Enjoy! -Ashleigh   Minute Breakdown: 11-18: An intro to Dr. Esposito and his background 18–24: Importance of your history and ancestry as it relates to health 24-29: The biggest issues he deals with as a physician, the biggest issues his clients deal with regarding hormonal health, and the first things to address when dealing with hormone issues 29–33: Specifics on sleep, diet, and other lifestyle factors as the most crucial keys for overall health 33-50: Addressing men’s health and testosterone/ steroid use, and the complexity of manipulating hormones for performance, longevity, and even general health. 50-58: Specifics on lifestyle factors to address to improve healthy testosterone levels in men and women (there are different factors for both genders!) 58-1:25: Ways to tell your hormones are off, for both women and men 1:25: Acupuncture for treating sexual dysfunction and chronic pain and improving fertility ----------------------------------------------------------------------- Show notes: http://www.shruggedcollective.com/mmr-esposito ----------------------------------------------------------------------   ► Subscribe to Shrugged Collective's Channel Here http://bit.ly/BarbellShruggedSubscribe 📲 🎧 Listen to the audio version on the Apple Podcast App or Stitcher for Android Here- http://bit.ly/BarbellShruggedApple http://bit.ly/BarbellShruggedStitcher Shrugged Collective is a network of fitness, health and performance shows that help people achieve their physical and mental health goals.  Usually in the gym, but outside as well. In 2012 they posted their first Barbell Shrugged podcast and have been putting out weekly free videos and podcasts ever since. Along the way we've created successful online coaching programs including The Shrugged Strength Challenge, The Muscle Gain Challenge, FLIGHT, Barbell Shredded, and Barbell Bikini. We're also dedicated to helping affiliate gym owners grow their businesses and better serve their members by providing owners tools and resources like the Barbell Business Podcast. Find Shrugged Collective and their flagship show Barbell Shrugged here: SUBSCRIBE ON ITUNES ► http://bit.ly/ShruggedCollectiveiTunes WEBSITE ► https://www.ShruggedCollective.com INSTAGRAM ► https://instagram.com/shruggedcollective FACEBOOK ► https://facebook.com/barbellshruggedpodcast TWITTER ► http://twitter.com/barbellshrugged

Hey everybody, welcome to Muscle Maven Radio. My name is Ashley Denhouten and this week we are talking all about hormones. So key words here include testosterone, steroids, sex, testicles, fertility, you know all the interesting words. I'm talking with Dr. Ralph Esposito. He's a New York-based naturopathic physician, acupuncturist, and functional medicine practitioner specializing in integrative urology, men's health, and nutrigenomics, which I believe is just a smart way of saying he deals with hormone health. Yeah, so in addition to his other work, he's designed education modules for health professionals specifically on urological conditions, male and female hormone dysfunction, hypogonadism, which sounds terrifying, exercise, men's health, and sexual dysfunction. He's an adjunct professor at New York University, where he lectures on integrative medicine,

and he's currently serving as a medical consultant and research analyst. Dr. Esposito was also a guest speaker at an event that I held in New York in January called the Human Potential Party, where he had my guests learning and laughing in equal measure, because bottom line, it's always funny to talk about testicles, even though the conversation was relatively serious. Yeah, it's still funny. So in this chat, we talk about all kinds of stuff. So lifestyle factors that can contribute positively or negatively to hormone balance. We talk about steroid use, hormone replacement, what certain bodily symptoms can be telling you about your hormones. We discuss fertility and ways to enhance that and how different, and I'm going to use air

quotes here, natural and unnatural methods for raising testosterone can work very different in men's and women's bodies. So we do get into, um, testosterone and hormone health for men and women. So we're covering all the bases. Uh, and we even get into how cultural changes can be impacting our hormone levels. So this one is full of great, really useful information. And I highly encourage you to follow Dr. Esposito on Instagram at dr.ralfesposito. He's just a super smart, passionate guy, and you can just continue to learn from him there. So I hope you enjoy the episode. Dr. Ralph Esposito, thank you so much for taking the time to chat with me today. And I can't wait

to see where this conversation goes, because already it's like going in crazy places, which I love. But thank you. Thank you for taking the time to chat with me today. My pleasure. Anybody who's willing to listen to me, I'll talk. Let's do it. That's good to know. That's good to know. Well, we actually were connected through a mutual friend, Dr. Gabrielle Lyon,

who I really only recently met, but we had a really, really strong, quick connection. She's an amazing person. She told me through the course of our conversation and a podcast that I did with her that I have to talk to you. And she is extremely smart. So I just trust her. And it turns out, though, that I was actually already following you on Instagram, because I've got a lot of really cool information. And I mean, you talk about testicles a lot, which may be a big draw or a deterrent, depending on what you're into. But I'd love if we if you could just kind of start by telling listeners a bit more about your background and what you do and what you study

and what your work is based around. Sure, absolutely. So I'm probably going to downplay a lot of what I like to say about myself, or I'll say about myself, I'm not the best person at telling you how good I am. As you know, Dr. Lyon did a, I'm humbled by how she, you know, emphasize how, how she refers to me and asks me questions, which is, if you know Dr. Lyon, I mean, for her to ask me a question, like, whoa, you actually trust me and believe me. So that on its own is a honor. So I, where do I start? So basically my career started, I did my undergrad work at NYU, where I was a major in nutrition and dietetics, and I thought I was going to be a dietitian. And the reason why I want to go into nutrition is because when I was about seven years old, my father had two heart attacks, and two triple bypass surgeries. I mean, his he, it's like textbook cardiovascular disease to the, to the worst degree that you can experience. Right. And when I was even, um, when I was about eight years old, the doctor told my mom and said,

you know, your son's cholesterol is at 250 and he's eight years old. You know, if your husband had a heart attack at 47, your son's going to have a heart attack at 37. And I grew up thinking, geez, you know, these guys think I'm going to be unwell. And but, you know, they saved my dad and I saw my dad. They saved my dad's life many, many times and they still are. But then I started noticing, I was like, you know what? They're really not saving his life because he really doesn't have a life. You know, his health span has diminished.

And I always thought, well, if anything goes wrong, I'll be okay, because they'll have a pill or medicine for that. And then I started learning, well, that's not actually quite true. So I went into dietetics, I thought I was going to become a dietitian. And then I realized that I just had a hunger for more. So I was in one of my nutrition courses at NYU. And I just googled naturopathic medicine. And I was like, you know, who can I get connected with? And I found one of my mentors, Dr. Espinoza, he's at NYU. And he's like, why don't you come in and, you know, intern with me. So I interned with him from the end of my undergrad career to about two years after med school. And basically just doing research on men's health on urology on hormone health. And I really was just like, when I say the word geeking out, or, you know,

I'm sure your listeners are familiar with that word. I am like, I can geek out on hormones and men's health. And as you said, testicles and prostates, and I've probably seen more penises in my life than I probably would want to. There's the quote, there's the quote for this interview. Well, we'll get into all of that for sure. Yeah. And I, I just, you know, I was just so infatuated with it. And you know, people call this a job. And this is not a job for me. Even even friends were like, Hey, Ralph, I have this issue going on. And, you know, for most people, it's a task for me, I'm just intrigued. I'm like, okay, well, how can I figure out this puzzle now?

So after med school, I continued to do some medical internship at NYU. And then I went into private practice, was seeing patients. And then I took up a position as a medical consultant and a research analyst at a medical practice here in New York City with a medical doctor who wanted a naturopathic perspective and somebody who really understood the intricacies of hormones and endocrinology and other things that naturopathic medicine and integrative medicine offers, you know, microbiome assessment, toxicity, environmental toxins, the quote unquote, adrenal fatigue, which if you want to go into the weeds as to why I don't really like that word, we could totally go into that as well. So I now work as a expert in the practice in certain areas. And I do research and I consult with physicians and I basically do the digging on every single patient. So when other doctors, they look at your blood work and they say, hey, you know, your your ferritin levels are a little bit high, but

it's really not a big deal. You know, we'll continue to watch it. I'm on the other hand saying, why are your ferritin levels high? What could be causing this? Is it just iron? Are there other, you know, stressors or other factors? Like I go, actually, I'm telling you, I go deep into the research. It's like, I have to live it, which is fun. you who are willing to go that deep and geek out that much because not all of us can not all of us have the ability to do that or the interest to do that but that's why there are people like you who can sort us out um so that's cool okay so one question that I had from the background that you were giving me and it's it's relevant to something else that I'm kind of working on right now so it's in my head you were talking about the health issues that your father had and going back to sort of immigrant culture and mindset and also eating and lifestyle practices. So I'm writing the story currently for a magazine that I work for about a woman who is writing this health cookbook

about Korean food because she's Korean. She moved to the States from Korea when she was young. And she, as she grew up and got older and was going to restaurants and she would eat Korean food and she just feel really, really bad. And she's like, but this is my food. And this is my like ancestral food. This is what I'm supposed to be eating. Why do I feel like garbage when I eat it? And she determined through research and doing some work that it's because in sort of our fast food culture and processed food culture and things like that, the ingredients that are being used, the cooking methods that are being used, it's not the way that it is supposed to be done. And so she was eating quote unquote Korean food, but it was kind of these like terrible oils and like gross kind of processes and ingredients and it's making her feel bad.

So she ended up doing some research and kind of going back to traditional ancestral ways of putting together this food that was true to her culture and what she wanted to eat and was also healthy and good for her. So my question, bringing this back around to you is, and I have a pretty good handle. I have some Italian in my family. I have a pretty good handle on what Italian food Italian food is but do you think can you speak to that a little bit in terms of do you think there was any kind of like nutrition part of this for him that maybe he was eating either foods that weren't great in the name of this is what I've always eaten or you know newer kind of versions of traditional food that isn't as good for you. Is there an element of that to these kind of health issues that you're seeing for immigrants who are coming

to North America? Yeah, absolutely. And this is probably one of the biggest arguments that I have with most people on the Mediterranean diet is people say, well, you know, the best diet in the world is the Mediterranean diet. And then I asked them to go to Italy and look out to see what the Italians are eating, right? The Mediterranean diet, and well, not just Italians, right? Greece, other countries around that area, sometimes even parts of Northern Africa have a very similar to Mediterranean diet. So the question becomes is what is the Mediterranean diet in Italy and what is it here? And my father, when he was living in Italy, he lived on a farm, right? So he was living and eating off of the land.

But even then, he wasn't really eating a major, what we would consider the Mediterranean diet. His meat intake was higher because he was living on a farm. He wasn't eating much fish because he wasn't next to the ocean. And the food that he was, and they were very poor, so the food that he was eating was basically he was eating bread for breakfast so i think his nutritional issues stemmed from him being um from like the poverty type of diet that was occurring in italy in the 50s and 60s so that that is part of it but now we know better but when he came to the States, he went from a diet of very simple exposure to, I mean, although it wasn't great, great macronutrients, I guess you can say, because it was just a lot of bread and really just meat and bread, which is not the best

combination. But when he came here, he had exposure to a lot of other things, right? So then he started eating more of these Italian type of cold cuts, so capicola, right, and soppressata, and prosciutto, and combining that, and those are not things that he would, we say he was able to eat on a daily basis, that was a treat for him in Italy. And the same thing occurred for my mother, when, you know, she came to America, they said, wow, look at all this great food that we have access to. And they just started indulging in the American type of Italian diet. And that's the big difference. When most people tell me I eat, I'm Italian and I follow an Italian type of diet, I follow the Mediterranean diet, you know, chicken parmesan is not Italian,

right? That is what we have adapted to in the States. So I think there is a huge factor of nutrition there. Now, one of the things that he kept consistent was red wine. So we make red wine, my father makes red wine from scratch from the grapes and i've also taken on that tradition but even that's different right because now the grapes are coming from california or canada there's genetically they're genetically modified they're exposed to roundup in italy probably in a lot of cases right because we're making all of our fruit have way more sugar absolutely and the altitudes that they're grown is completely different. So it's a completely, the foods may look the same or may appear to be the same, but it's not the same type of diet. And

more so, the way that they're combining these foods is much worse, right? So if you want to have the argument on is fat bad or carbs bad, we can go on for days about that. And we may never find an answer, we'll always disagree with each other. But what we need to discuss is the context in which these foods are being eaten. So, you know, are you eating a are you eating, you know, low-carbohydrate diet? Or even more so, what are the quality of the fats that you're eating? And I think that even changed, right? Because olive oil in Italy is completely different than the olive oil that we have here in terms of ways being processed. So, yes, to answer your question in short, absolutely. Also to throw in the confounding factors of, you know, he also smoked, he did an exercise, and he worked, you know, 60 hours a week, where in Italy, they take a break from, you know, one o'clock to three o'clock every day. So that are your clients mostly? Who are the people that you're working with? And what are we can start like high level and work our way in? What are like the heart attacks although that that does happen um in most men so my specialties in men's health and urology and hormonal health you cannot

by any means ignore cardiovascular health and men because there's a very big connection there between cardiovascular health and um male health and hormonal health right so most men who have a cardiovascular disease oftentimes will be put some at increased risk of having either prostate disease or sexual dysfunction you can't dismiss those two and the reason why we're seeing that is because well heart disease is one of the biggest killers in this country so and i also think um it's a little bit of an emphasis in my approach because I don't think conventional medicine is putting a much emphasis on the actual data or the research behind cardiovascular disease. So they're just looking at LDL and they're thinking, well, if your LDL, your cholesterol is good, then your risk of heart disease is low. And that's not actually true.

And then, you know, the second, the second cohort is certainly hormonal dysfunction in both men and women. So women who are having, you know, perimenopausal symptoms, who are having PCOS, men who are having hypogonadism, low testosterone, sexual dysfunction, aka, quote unquote, adrenal fatigue, which is really hypothalamic, pituitary, gonadal, or adrenal axis dysfunction. Those are the two big cohorts that I would say are taking most of my attention. Okay. Right. I mean, there's a lot to unpack here. So again, I'm just going to kind of speak in general terms and we'll see where the conversation goes. But you talk about most of your clients are men, you're dealing with a lot of hormonal health issues. And that's a conversation, obviously, that comes up a lot in my world and health and fitness world and for athletes. And a lot of the men in my life tend to be like very sort of hard charging,

athletic type A type of people. So we're talking about military and first responders and athletes and people like that. And the conversation goes in a lot of different directions in terms of hormonal health, like things like we should be able to kind of fix these things naturally to, of course, men when they hit a certain age should all start supplementing with testosterone or different hormones to kind of bring you back up to certain levels that are appropriate. And it seems to me, you know, there's always this misconception that I think like women's hormonal health is so much more complicated. Maybe it is, but I mean, it seems like there's a lot of complexity and layers to, to figuring out how to address this issue with men too. So I guess, again, from a very general standpoint, we're talking about

healthy-ish men in their thirties and they're athletes, and they're just kind of maybe thinking ahead in terms of, I want to start looking at having a family and I want to continue to have high physical performance for all these goals that I have as I'm moving into my 40s. And should I start looking at my hormones? And should I start looking at taking things? And like, where do you how do you start addressing this issue? Yeah, that's a great question. And I really wish that there was just a simple answer. And that's probably why most people kind of asked me, you know, Ralph, what would you do? Because there really is no textbook, there really is no protocol, there is no algorithm to understand this. But I take the therapeutic order approach. And I try to go to least invasive approach to most invasive. So typically pharmaceuticals are the last option and then diet, lifestyle, and I would say the most important would be sleep. So if you had to really kind of target and focus, where do I look to try to address these issues

in men? And because everybody wants to know, what do I do? Right? They want to know what the plan is, what the what is going to be the game plan in terms of implementing all of this. And that's great, I could tell you what to do. But you really need to understand what is the cause. So what is the objective that we're trying to do? Let's try to identify what the strategy is going to be and then try to implement it. Right. So I try. I definitely you have to look at sleep. And and the reason why is because when we sleep, the there's deep wave sleep, which is a deep sleep, which is slow wave sleep.

This is when we make most of our hormones. This is when we make men make something called LH, which stimulates your body to make more testosterone. It stimulates growth. This is when you make most growth hormone. And if this part of your health is completely off, then good luck trying to correct these things naturally. So you have to address the sleep factor first before looking at anything else. And if you take the therapeutic approach order, if you try to address these foundational things first, eventually the other things will fall into place. Now, actually, this is where the problem comes is people don't want to wait. Right. They're not feeling well now. So they don't,

they want to feel, you know, they want to correct it immediately. And unfortunately, what I tell them is if you didn't get sick overnight, and there's probably no way that you're going to get better overnight. But we need to work at this together, try to figure out how we can correct this. So and then the second thing that I look at is diet is so you have to look at somebody's nutrition and see exactly what they're eating. And I mean, your listeners are really, I would say the paleo or whole food based, low refined carb hydrate diet is probably going to be the best option for you in terms of improving your testosterone levels. So those are the two first places that I look. But, but that's really trying to identify what the issue is, right? Now,

what you really have to look at is why did this happen? And why did this happen? It also could be lifestyle. And as you mentioned, a lot of your listeners are type A driven men or women who are really just trying to get and push through and just be top performers. And if you want to be a top performer, you're going to have to sacrifice a few things. And one thing that's sacrificed is, you know, if you want to be the best, you have to do things that other people wouldn't normally do. And if you don't do that the right way, you can really burn yourself out. So those are my top three. And I'm not sure, it seems so simple. But it's so critical, you know, but it's also there's something empowering about that simplicity, because, again, from from the podcast interviews that I've done over the past couple years,

I've been so fortunate to talk to so many smart people and experts in so many different areas of health and wellness. And whether we're talking men's health, women's health, disease prevention, performance, anything, it's like these things keep coming back up. You got to get your sleep first. You got to figure out your diet. You have to manage stress properly. You have to figure out your diet. You have to manage stress properly. You have to figure out the workouts that are best suited to your lifestyle and your goals. I mean, they're simple. They're not easy necessarily all the time. But it's almost comforting for me to know that it's like no matter what your problem is, here are probably the top three to five things you need to sort out no matter what.

So there's no secrets in the world. It's like sort these things out and then we'll kind of drill down and talk about the details from there. One question, though, that I had because a lot of people that I deal with in the fitness world, a lot of men have already either used or abused, um, uh, let's say, I don't know, supplements, but we're talking about steroids and testosterone and things like that. And maybe they were doing it to just look better. Maybe they were doing it because they were into bodybuilding or performance enhancement or whatever. Um, but sometimes, and a lot of times, maybe they weren't doing it fully aware of the consequences or how best to incorporate it or what have you. So now maybe they're struggling with issues as a result of use of this stuff, you know, previously. So how does

your approach differ when you're dealing with someone who is maybe interested in looking at some of these things to sort out their health or people who are like, I was a bodybuilder for 15 years and I did a bunch of steroids and now I've got all these problems and I don't know what to do. How do you look at it from that angle? Boy. How long do we have? Right, Ralph? Yeah. It's like it's like okay so you oh man i just know that this is something that like i know people very personally because this and this is another thing that i feel like in this industry it's almost becoming less taboo maybe i'm wrong and maybe you know i have a background in competitive bodybuilding too so i just have been around a lot of people who are

like yeah i do steroids like what so does everybody else, and it seems like it's almost in the, even in the health and wellness world for men, it's becoming a little bit less taboo because it's more, it's getting more out in the open that, yeah, a lot of us have experimented with this. A lot of us have used it. And a lot of us can use steroids or different kind of hormone replacement or hormone supporting whatever in a way that is responsible and healthy and good for me. Because I think before it used to be like, oh, you do steroids, you're this or that, or you're, you know, reckless with your health. And that's not necessarily the case. So I think that it's a really, it's a big question. I get it. But it's also something that I think a lot of people are thinking about, because it's just it's a part of their life, they've used it,

or they want to use it, or they're interested in using it. And they want to know how they can either do it intelligently, or how they can kind of cycle off of it, or, you know, that kind of question. Yeah, it's an amazing question. I get it all the time. And I love answering this question. I get it all the time. And I love answering this question because, you know, people look at me and they think, well, he's a naturopath, so he's against pharmaceuticals. And that couldn't be farther from the truth. I think, you know, I don't see a big difference between a pharmaceutical and a nutraceutical because each one is intended to target a particular molecule or enzyme or any type of, you know, uh, target, right? It just depends on really the poison is in the dose, right? So, but when you start experimenting with exogenous hormones,

you're entering a completely different world. And the reason why is because you are trying to manipulate the body at something that it has been so intelligently designed to manage on its own. So when people try to manipulate hormones, they typically do it incorrectly. And I know that even most physicians who try to manipulate hormones don't know how to manipulate them correctly, whether they're for bodybuilding, whether it's for, you know, for longevity, or whether it's just for somebody who has hypogonadism, and they think that just giving them testosterone a shot once a week, or once every two weeks is going to do the job. Unfortunately, that's just not how simple it is. So when I look at people who have abused testosterone, and, you know, there's also different types of testosterone, and then people have abused HGH, insulin, fat burners like clonbuterol, right? What you really need to do is, number one, make sure that you're speaking with somebody who completely understands the hormonal system.

And unfortunately, I do see a lot of people who will tell me, yeah, I did testosterone, or I did HGH. And I'm trying to think, I'm thinking to myself, well, where did they get this? And they were working with a coach or working with a consultant. And that just tells me that number one, they were not getting their labs checked regularly. They were not they were probably not getting the advice from somebody who and I'm not being I'm not saying I know everything. Right. But there's certain people who know, they know their field and they know it very well. And then there's people who think they know their field and they think they know it very well, but really, really don't. And those are the people that I'm concerned about, because those are the people that think they know. And the people who are so confident in saying that something is true, like, look at me, I would say I'm very well researched, and I'm very well educated. And I still find myself thinking, wow, I don't know a damn thing about X, Y, and Z. And I really try to make sure that I understand everything completely. And I'll be the first one to tell you, I don't know everything. But the important thing is, I know what I know, and I know what I don't know.

And the thing that scares me is the people who don't know what they don't know. Right? And these are the people when they're just taking testosterone and then they just get off of it and they stop. So what you really need to do is make sure that you have somebody who's going to able to manage and look at your labs, um, either at the prior to starting during the cycle, after the cycle, and then also like weeks after the cycle. Okay. And, and you need to look at not just testosterone levels. So, so if we're talking just about testosterone replacement, right, because this is probably the most common. And the reason why, and I also want to make a point, the reason why this is not so taboo is because testosterone is not that bad for you.

Everybody and you know, their mother used to think, think well testosterone is really bad for you it causes heart disease and it causes prostate cancer and it causes you know it may it stops you from growing like that is all bogus it's not true and the research is pretty convincing evidence showing that testosterone actually is perfect perfect protective against cardiovascular disease protective against diabetes does not cause prostate cancer, and can actually improve health span. So just want to get that out there. The issue becomes is when people are abusing it and not using it properly, and then they're not checking their proper level. So, you know, looking at total testosterone, looking at free testosterone, looking at DHT, which is a metabolite of testosterone, and then looking at estradiol,

looking at your LH and FSH level. These are all things that you need to look at. And then I take it a step further, and then I look at the genetics of the person or their genomics. And then I look, okay, well, you know, do they have certain genetic, we call them SNPs, right, single nucleotide polymorphisms that impact their cytochrome 19A1 or aromatase enzyme, which will impact the way that they metabolize this testosterone into estrogen. Or maybe they have, and then I look into their urinary metabolites and I look at their Dutch test. Are you familiar with the Dutch test? No. The Dutch test is a dried urinary hormone test, which tests the hormones, testosterone, estrogen, and their metabolites in your urine.

And it also checks your adrenal hormones like DHEAS and cortisol. Now, a lot of people like to use saliva, and I'm not a fan of saliva because, number one, you can't check these metabolites in saliva. And what you get in the urine is you get the metabolites of DHT, and you get the metabolites of estrogen, and these are the things that you need to look at that are targeting and causing damage to cells. So when everybody says, you know, testosterone causes prostate cancer, what they're trying to say is DHT, the metabolite of testosterone, dihydrotestosterone is causing prostate cancer but there's a metabolite of dht called three alpha and three beta diols which can either be protective or um or or damaging

to prostate cancer cells and breast cancer so when you tell me you know testosterone is bad and when you tell me estrogen is bad my my next question is, which one? Right? And, and these are things that people and most, you know, general practitioners and even coaches, they don't know this stuff. So you really need to make sure that the person that you're dealing with, is completely in tune with every available tool that can be used to assess your risk. And there is no evidence, there is no research showing that supraphysiologic levels of testosterone is much better than bioidentical levels of testosterone. So what that means is having a level of, you know, 2000 of testosterone may or may not be better than having a 1000 nanogram per deciliter. And more isn't always better, right?

Exactly. And, you know, I don't know, I've never been in the bodybuilding field, but because you've been in the fitness and bodybuilding arena, you know, are people asking these questions? Well, I think this is one of the, you're touching on one of the bigger issues here is it's kind of like with hormones, it's like enjoy responsibly because they aren't bad. They aren't unequivocally bad. They're just, you can abuse them or you can overuse them or you can use them improperly. And I think one of the issues, I think you're a hundred percent right. People just get a coach who's done some bodybuilding themselves and has taken a bunch of drugs. And that coach says, you should take these drugs because it'll work for you. And there

really isn't a lot of like aftercare issue going on at all. There isn't like post show coaching where people teach you how to cycle off things properly, or they teach you how to reverse diet, or they teach you even the kind of mental repercussions of coming out of a competition, all these things. But the issue with the hormone stuff may be an element of certainly it's human error too, but it's like how much is too much? Because if you, if you try, if you use HGH, if you use Anabar, all these things, and you're trying them and you notice a little bit of success, well, why wouldn't staying on it longer just make me more successful why wouldn't just doubling up the dose get me those results i want even faster and that's the part where even if there's like a common sense rational part of your brain that's telling you that isn't maybe the healthiest safest way to go you're going

to try to push those limits anyway because people again, again, who are in these, and this is a generalization, but people who are in these industries that are aesthetic focused, that are very competitive, that are, you know, really type A kind of people, that's, they might just be like, well, you know, screw it, maybe this is going to be dangerous, or I'll have to worry about the repercussions later, but I'm just going to double up on this shit now, because I want to get jacked. So that's the, that's the problem is even if they do have someone who's knowledgeable and maybe willing to kind of be reasonable and whatever with this stuff, if they don't understand the concept of less isn't always, you know, more isn't always better, that's the problem we're running into

because people are just crazy. Yeah, and this is the other thing is, you know, people take growth hormone and think that they're going to increase muscle synthesis, but the research is not even conclusive on that. Right. So, so, Anabar or other growth hormone releasing agonists or analogs, the benefit of them increasing muscle growth is dependent on the work that you put in. And it actually prevent is more important for recovery than it is for muscle synthesis. Right. And, you know, more testosterone may not necessarily be better. And again, it's not about how much testosterone that you have. It's about how much of the testosterone that you're making that is free is actually binding to the receptors and causing these um these uh intranuclear or the the changes in your nucleus to tell the cell to change and one thing that gets completely ignored right because we've spoken about testosterone we

we've spoken about post-cycle like arimidex right we've talked about growth hormone but what about thyroid hormone without your thyroid your testosterone receptors are pretty dull and um and low responsive and i know a lot of people who are in this bodybuilding um field or even into fitness they'll take their their thyroid hormone they'll doytomel because it'll improve their weight loss. But then you're completely messing up and throwing off this whole hypothalamic, pituitary, thyroid, gonadal, adrenal axis. And then what do you do when you're done? And this is the thing is, you know, I find the situations that you were mentioning with your, you know, these guys who just want to go hard go hard or go home, and when they're young, that's great. But the guys who want to do this correctly, and are the ones who are in

their 40s or 50s, who are less concerned about having six packs at six pack abs on Fourth of July weekend, and more concerned about living, you know, longer, because the name of the game is, you know, not to live as long as you can, but it's to live as long and as healthy and as well as you can. And that's what I really want to get across to your listeners. And that's why, you know, we opened up and I said, cardiovascular disease is the most one of the most important things that I talk about, because if your heart is not pumping, if your engine is not running, doesn't matter how much, you know, you could bench press or squat, you're done. It's not going to work.

Yeah, okay. So would we, is it safe to say then, and this obviously we can go down this rabbit hole, keep going down for as long as we want to. But is it safe to say that exogenous hormones kind of should be like a last resort. If this is something that's on your mind, it's something you're interested in, because it can, it is so easy, as you said, even professionals whose job it is to work with this kind of stuff, it can still be kind of a tricky, a tricky thing to work with, right? And so let's try to maybe do things as naturally as possible, or at least not dealing with exogenous hormones until we kind of feel like we have to. Absolutely. And again, that's part of the therapeutic order is, if you start mucking with exogenous hormones, my concern is not, you know, what is this hormone going to do to you? My concern is, what's the plan after? What are we doing after this? And, you know, people, you use the word naturally, right? And that's really, it's a really hard word for me to define,

because what does that mean? Right? What is, what does natural mean? And I'm not completely opposed to pharmaceuticals. So one of the pharmaceuticals that it's actually that's actually very effective is uh clomid or clomiphene which um it acts as a stimulus to the brain it's a serum uh selective estrogen receptor modulator which then tells the brain hey um you know i would make more uh gnrh which would then tell your your pituitary to make more l am i getting too too into the weeds tell me if i'm like too scientific okay okay you got to pause me because i get i'm still following yeah okay good okay good um so the the hypothalamus in the brain makes gnrh which then tells the pituitary to make lh and then that tells your testes to make testosterone so cl Clomid interrupts this pathway and says, you know, there's not enough messaging going back to the hypothalamus, make more LH. And that's a great way to kind of jump start the body to jumpstart really, it's, you know, what happens is, is there's primary and

there's secondary hypogonadism. Primary is your testicles are not making enough testosterone. And secondary is your pituitary is not making enough of a signal to tell your testes to make testosterone. So in primary hypogonadism, your pituitary is basically screaming at your nuts saying, hey, wake up, make testosterone, and your testes are not responding. And Clomid is a great drug to identify what might be the cause or contributor to why this person has low testosterone levels. So if it's the testes, right, and they're not making enough testosterone, and you give somebody Clomid, and that doesn't do anything, then you know that they're actual, you know, I call them the baby makers, the testosterone makers are not making the not making enough testosterone, and then your, your,

your cells are not going to be able to do it, right? So that at least we can rule out issues. So it doesn't necessarily mean I'm opposed, like, testosterone should not be the, the, I'm not saying that testosterone should be like a last resort, but you need to exhaust other options first to identify if testosterone will be effective. Now, you know, if I saw, if every man that I saw who had low testosterone, I said, okay, you need to be on testosterone replacement therapy, you know, that would probably be every single male patient. But there's many of them who recover just by fixing a lot of lifestyle, getting eight hours of sleep, making sure they're having a low sugar diet, weightlifting, lifting

heavy things and putting, you know, I lift heavy things and I put them down, like do that, high intensity exercises. And then you go to, you know, your herbs and the functional approach to try to understand, is this a functional issue or is this a structural issue? And then you go to the testosterone because then you could identify, okay, exhausted all options. You just can't make it, dude. Let's give you some exogenous testosterone and see if that helps. Yeah, let's get into, you obviously just mentioned some of the key lifestyle factors, but I want to talk more about like the food and the herbal stuff that can help maybe healthily raise testosterone. And also, does it work? Is it the same for men and women

in terms of like the free testosterone that actually can be can be used? Because I know, like, you know, as an athlete, and somebody who wants to be like buff and healthy like I want to get more testosterone too right like I I'm not concerned about growing a beard because I work out all the time and just to get the modest muscles that I have so I'm not really concerned about like I'm well past that like oh if I work out will I get bulky thing like you don't have to convince me of that but I think I believe that I want to get more testosterone probably right so this is probably applicable to women as well so it is but the mechanisms are completely different okay and the things that typically increase testosterone in men herbals work differently in women and it's because men have a Y chromosome and women do not. And that really can change the

game. But there are some that overlap. But most of the research on these herbals that help improve testosterone levels, very little of them have been worked on women to improve testosterone levels. And that's just because it's a different, um, we're dealing with a different species really. And in order to improve testosterone levels in women, there's a completely different approach to go through that. And we can go through each one and see how, you know, how does this work in women and how does this work in men? Um, this is getting like more and more complex for me because I've been, I've been told, I like to subscribe to, you know, you talk to Charles Poliquin and people like, like legendary strength and conditioning coaches. And they're

like, and I think you probably, I am sure probably feel the same way, but it's like men and women, our muscles are the same. Like women start out with a lot less muscle mass, especially upper body, but we don't have to like do different bicep curls to get muscles than, than men do. Like our muscles will react the same way. We can grow muscle the same way you eat protein and you lift heavy and you get good sleep and you're going to grow muscle, whether you're a man or a woman. So we're not that different in that respect. But now you're telling me that we, we, I guess the hormonal stuff is like super, super different in terms of how we're processing or using or getting testosterone.

So I'm a little bit sad, but I'm glad that you're telling me this because I did not know this. So please, I would really like to spend some time on this. I'd love for you to kind of walk through how it's different for men and women and how we respond to some of these things differently and how we can, you know, both sides can get their healthy kind of levels of testosterone. Absolutely. And just to kind of like break this down very simply into things that people can understand. And I like to use analogies. If you look at animals, okay, if you look at a rooster versus a hen, typically, we don't eat the rooster, right?

The hen is the type of chicken that we consume. And why is that? It's because the rooster has much more testosterone, and it changes the texture.. Like if you've ever eaten rooster, you know, it tastes different. It's much more lean. It's kind of more rough, right? Or even, you know, if you have venison versus a doe versus a buck, you can tell, you can taste the difference. And that's because the hormones are different. And estrogen allows the meat or the muscles to be a little bit more infiltrated with fat. Right. And we know that women have higher levels of body fat compared to men. Right. So we're more delicious. I get it. I love how you twist my words.

Well, I mean, I said it. I don't hate that. I don't hate that my words. Well, I mean, you know, I said it. I don't hate that. I don't hate that comment. But, you know, yeah, I have always been like kind of irritated again as like somebody who's like an athlete and just like likes muscles. I'm always like, why is estrogen? Why is my hormone the one that makes you like chubby and round and like emotional and sad? And the hormone that you guys get is the one that

makes you like want to go out and like crush things and like build muscles. It seems very unfair, but I'm starting to, you know, be a little bit smarter and wiser and know that they're both crucial for both, you know, both genders and they're important. Right. Well, if it makes you feel better, the one that you have tends to protect your heart a little bit better and your joints a little bit better. So you probably will outlast me. All right. Okay. I'll go with that. So you'll win. Okay. So that's just like a very simple comparison. And I'm not saying that that applies to everybody, but just to give you a little bit of an understanding as to what these hormones are doing and how we can apply it to our daily life. Now let's really look into it. So it's not so much of the amount of testosterone

that you have. It's that because men have a Y chromosome, they have more sensitive or more androgen receptors, right? And if they have more androgen receptors, and androgens, testosterone, androsenadione, DHEA, all these are androgens. And women have these too, but men have more of them. And then because women have more estrogen, they also tend to have more estrogen receptors compared to men. But then it works. Then you could flip-flop and say, well, men really have less total estrogen levels. So anything that will impact a male estrogen receptor will probably have a larger impact, right? Because they just have less total levels. And this is just because

of, this is genetics, right? This is just men are men and women are women because of these hormones and these receptors. So the things that will impact a, the things that typically improve male testosterone levels are things that will work on either on the androgen receptor or improving the building blocks to make these androgens or making testosterone. And then lastly, the things that help with at the brain level in terms of signaling the body to make more LH and FSH. So, you know, women, you don't have testicles. I'm sorry. So if you have an ex. Yeah, see, that's yoga pants are made for men. You're giving me more upsides every minute that you're talking to my cast. You know what? You intimidated me, Ashley. I'm like, I have to make sure this lady does not come after me. All right. That's the second quote of the podcast. Thank you for that. Love it. So where was I? Sorry, I got distracted by trying to... Women do not have testicles.

Yes, okay. So you don't have the machinery to make it as much as men do. Now, women can make testosterone from their arteries and their adrenal glands. So the adrenal glands are the major source of testosterone production in women, whereas in men, it's actually not so much a big source of testosterone production, but more of the precursor to testosterone, DHEA. And as we measure it in the blood, DHEAS. This also goes back into your earlier question as to, you know, men who are on testosterone, like, you know, they have to on testosterone, like, you know, they have to have a right coach and need to make sure you're also testing DHEA-S, which is the long lasting form of DHEA in the, in the blood.

Um, just a side note. So, you know, in women, you're making most of it from the adrenal gland and in men, you're making most of it from the testes. So that's, that's number one, a big difference. And then that impacts the approach that you'll take. So if you wanted to increase testosterone levels in women, DHEA actually works pretty well. And so well that I start compared to men, I start men at 25 to 50 milligrams a day, whereas women, I start them at five. Right? and that's a big difference because women will take that dhea

and they can convert it into testosterone fairly easily compared to men where it's only a precursor and your adrenal glands are not doing a great job at making testosterone that's a that's a that's a um a a job for the testes and the testes kind of are their own little machine. They kind of function on their own. And they have their own little internal factory. And they are self-sufficient in that they can make whatever they want from substrates on their own. it is so that giving men dhea might help improve their testosterone levels but don't think that it's a you know i wouldn't consider it like an anabolic hormone it's just a anabolic precursor which tends to actually work pretty well in improving testosterone levels in men so those are two two differences that you can see where dhea works completely different in women than it does in men and and the other thing you have to keep into consideration is in women, they're making a lot of their estrogen from their ovaries,

whereas men, they don't make it, they don't have anything to make estrogen. So they make it from their fat tissue or the conversion of testosterone to estrogen. So men can very well have very high estrogen levels relative to their testosterone levels. And then that is, you know, that's a big difference between men and women as well. So men with high estrogen levels compared to women who typically have high estrogen levels,

like your estrogen levels are higher than mine, but you could probably beat me up. All right. So we'll see when we meet in person later so you have to understand that women you guys women they utilize their estrogen very well and whatever testosterone that they do make they also utilize very well compared to men when they make a lot of estrogen um it has a big detriment on their health and it can have a downside on their

hormone synthesis, on their cardiovascular health, on their prostate health. It's just, it's so intricate. I really wish I could just give you a very simple answer. So for men who carry excess body fat, does that then translate to they are creating more estrogen generally? Typically, yes. Typically, yes. Alternatively, if that is where men create their estrogen, if you are super, super low body fat, like if you're one of those dudes that for whatever reason is walking around at like 6% year round. If you don't, if you don't have any of that adipose fat tissue, is there a risk of not having enough estrogen for men? It really depends on, so you can make adipose, you can make estrogen from visceral fat and also

subcutaneous, right? So any type of fat in the body, you can do it, but you also have this enzyme in your adrenal glands and in your testes. So you can, you'll be able to make it. Now the issue from when you bring that up, if a man's walking around with 6%, 6% body fat, you know, is he not, is he unable to make enough estrogen? My question is, is what's going on with this whole, like his whole hormonal system as a whole, looking at his thyroid hormone, his testosterone production. I mean, you do need body fat for, for general function. I mean, we make, you know, adipocytokines, which are basically molecules that our fat cells make that help control appetite, they help control the immune system,

they help, they have definitely have an influence on brain function. So those are the things that I look at more, more alarmingly than I would say just estrogen. But, you know, my target for estrogen, you know, when you look on and we can go into a we can literally talk hours on what is considered normal. But most doctors will say, well, if your testosterone is between, if your estrogen, your estradiol is between, you know, 20 and 60, then you're normal. Picograms per deciliter, milliliter, then you're normal. And I would say, well, you're completely off, right? So if they say, for you to say, say or men with high estrogen levels you know most people say oh above 60 and i say above 30 so we we can get into a whole conversation as to what's considered normal and then and then the research shows that you know men who have estrogen levels ideally between

15 to 25 they have the uh their their body composition tends to be correlated with that so the better we can control the estrogen levels in that range the more likely is that your body composition would be improved i'm going to say body comp i mean lower body fat increased muscle mass and aren't estrogen and testosterone levels also relatively dependent on the individual like some people are just naturally in a healthy way, going to have slightly lower testosterone than their friend would or whatever. So a lot of it is going back to, you were saying, doing regular proper testings that you have like benchmarks and you have precedents and you know what is normal for this person and within ranges, obviously,

right? Absolutely. And this is where I disagree with the endocrine society. And boy, Ralph, you got some cojones to tell people you don't disagree, you disagree with the endocrine society. Who am I? Right? How do you say balls in Italian? There you go. Yeah, I'll say it in that way. But see, this is part of being cultured in New York, man. Like, I know Spanish, Italian, English. Anywho. I love it. So what I disagree with the endocrine society is that they say that for a man to be diagnosed with their term hypogonadism or low testosterone, they need to have low total or free testosterone and also show the symptoms. Now, I'm really proud of them because they actually

extended that to free testosterone as well. So they said, if you have a low free testosterone and show symptoms, then you could be defined as hypogonadal. But then they said, you have to have both of them. And I say, well, there are men who are symptomatic of low testosterone and have quote unquote normal levels. And by the way, their normal for total testosterone is 300 nanograms per deciliter to 1000 nanograms per deciliter. It's like, you know, like those kids who like flip coins into the wishing well like a huge like water well like oh i want to make a wish like it's impossible to miss that thing right and that's exactly how i feel it's like okay let's just like throw a number out there and hope that it falls in this range well it likely will so for them to say that this is considered normal i completely

disagree with them right so number one i don't with that. And the same thing that goes for their free testosterone levels, they use a range from 3.9 or 4.0 nanograms per deciliter to like 15 nanograms per deciliter or no, 20. Right. So looking at that range, it's like, wow, you have to really try to not fall within that range. But I do agree that there are men who don't show symptoms and they have low testosterone levels. But does that mean you shouldn't treat it? And I would disagree. And I would say, no, you need to improve those testosterone levels because it does not necessarily mean that they're at risk now. I'm talking about their risk in 10, 15, 20 years. Their risk for low bone density, for Alzheimer's, for prostate cancer prevention, for cardiovascular disease prevention, for diabetes prevention, you know, looking at these

numbers and understanding what's normal for each individual is really important. So that's, that's where I would say you have to look at this per individual. And then you also have to, there's also something called CAG repeats, which are nucleotide repeats in the androgen receptor. And the more repeats you have, the less sensitive your androgen receptors are. So the more CAGs you have, the less likely your testosterone receptors will respond to testosterone. And that can explain why some men have a testosterone of, you know, 1000. And they're like, I still feel like crap. And you need to take it on a person by person basis.

So what are some high level ways that most of us can tell that there's something off with our hormones, and we'll speak just in this case to um testosterone and for men and women like i i've heard for men that it's you know if you're not getting your regular morning erections if you're a healthy man that's a that's a sign there's breast tissue there's like mood issues things like that but what about for women too like talk about both because i think it might be a little bit harder, like women don't generally know or taught, like, here's how to know if your hormones are off in terms of testosterone, not just estrogen, right? So I'd love to hear about both. I'll dive deep into the women aspect. But I just want to make a comment about what you mentioned about morning erections. If you want to research, it's called nocturnal penile tumescence. I'm going to not do that, but I think some other people might be interested,

but I'm just going to pass and have you explain. I meant to say is if you want to search in PubMed. Okay, there you go. Google might give you different answers. Yeah. But it's called nocturnal penile tumescence and really it's basically morning wood like how many times you wake up with an erection and it's a good sign but it's not very specific um to to a low testosterone although it is quite sensitive

so i mean if you're not getting morning erections then perhaps your testosterone levels are low but it doesn't mean that if you have if you don't get morning erections, then perhaps your testosterone levels are low. But it doesn't mean that if you have, if you don't get morning erections, that your testosterone is low. So I just want to make that clear, because some men are like, man, I haven't had an erection in two weeks, my testosterone is low. It's possible, but it could also be that you're just not sleeping or you're not noticing. Stressed out or whatever. Yeah. Yeah. That's usually the cause. Um, so for women, well, for women, um, low testosterone can certainly present as inability to maintain muscle mass or, or gain muscle. Uh, one of the controversial aspects is libido. And one of my best friends, Dr. Carrie Jones, kind of gave me a really good

picture. She said, you know, men's libido is a switch. It's on and off, right? If you have high testosterone, typically your libido increases. If low testosterone, your libido drops. Although not always true, but typically. For women, there's a lot of bells and whistles and dials and, you know, on off switches, medium switches, like that's how women work. Right. So to say that testosterone is a big contributor or factor in a female libido is not entirely true. And we find that if you correct testosterone levels, libido is does not always correct with women. And, you know, this is when people, you know, people argue with me, like, who's the smarter gender. And, you know, it's like, women have complete like their, their, their hormonal system works completely differently

than men are very simple. But women, their hormones are so intricate, and they connect with each other. So testosterone with libido, not a great measure for women. Other things that you want to look for in women with very low testosterone levels would be v, or varicose veins are typically common, because testosterone helps nourish the endothelial function of your endothelial cells of your blood vessels. So in women, they tend to have enough estrogen, which is protective against the blood vessels. But if their testosterone is low, you might want to, or if they have these, you know, vein issues, like, like varicose veins or hemorrhoids, then you want to pay attention to say, hey, maybe this is a testosterone issue, because perhaps this might be contributing to that. And then also, you know, cognitive function and mental

function and women, you know, if women have difficulty focusing, and you've, you've really ruled out, you know, other possible causes like adrenal dysfunction or overwork or caffeine excess or sleep disturbance, then looking at testosterone and say, hey, you know, testosterone really does have an impact on cognitive function. It might be helpful here. And then the last thing that most people don't tend to look at is your personality. And testosterone is responsible. And they did a lot of studies on this in men and women that people and men who have higher testosterone levels tend to make decisions much easier and much quicker.

There's less hesitation. It's very quick. It's very quick. It's like a go-getter type of response. Like, I gave you four options. I know what I want. That's what I want. And if you see a change in women where they're a little bit more hesitant, they're a little bit more resistant or more shy, then you want to also take a look at their testosterone levels. And it also depends on where they are in their cycle as well, which, you know, testosterone levels will typically

be higher in the either PMS period or as they, or as they ovulate. Interesting. Okay. This is all very interesting, new news to me. And I mean, some of these things, like you said, can be kind of like murky in terms of is this what's causing what? Or is it just a coincidence? Or is it stress? But I mean, some of these points that you're bringing up are not things that I would have thought to look at. So that's really interesting. Another thing that I wanted to bring up about testosterone is I've heard, maybe not on podcasts, but these kind of like horror stories about how it's this epidemic of lower testosterone in men and that, you know, men today have significantly less testosterone than say their grandfathers did at the same age. And is this like a complete myth, myth scary story or is there some truth to that and what do you think that means that testosterone levels are different now than they

were 20 years ago yeah that's true that's true yeah it's absolutely true and we have data supporting that um there i can't recall the numbers exactly right now, but there was a study published, I think, in 2013 or 2014. And they found that male testosterone levels now are much lower than they were three decades ago. And so is this like mostly lifestyle factors, do you think? Because we're not like working with our hands and we're sitting down and we're stressed out and we're eating garbage food and we're sleeping less like it's it's would you say that it's mostly lifestyle? Is there something else? uh these xenoestrogens these xenobiotics these environmental pollutants that are contaminating our waters our food supply uh they're finding their ways into our plastics into our water into our like food that you eat right poultry and are we talking like bpas and birth control yeah yeah we're talking bpa we're talking uh we're talking uh're talking polycyclic amines that are, you know, being the way we're cooking our food. We're talking about other xenoestrogens, we're talking about heavy metals, like lead and cadmium and mercury, these things completely impact or directly impact the brain. So it's not, it's not a surprise that these things are

starting to accumulate. I mean, this is just how this is basic ecology 101. Like this is the food cycle, you know, things are recycling and, you know, we eat food and then, you know, our, the food that we eat is eating smaller foods and then we're accumulating it. You know, um, you know, tuna fish, tuna fish is a great example. The bigger the, or, or mercury with other fishes, the bigger the fish, the more mercury they have. And then we consume that. And, you know, and then where are those, this is all just an ecosystem, you know, it's a, it's a food web and this is what's happening. I also think that, um, that the, uh, the culture is also having an impact in terms of you know men are they're

under a lot more pressure they're there's they're supposed to be defined to be you know macho and strong and less men are seeking out help less men are going to their doctor and saying i don't feel well and what do you think that is that really because i i think of like the stereotypical like 50s man you know who like had his job at the factory or whatever and he did it for 50 years and i it seems to me that he would have less opportunity to to express his feelings or tell people that he isn't feeling well than, than men today. But yeah, no, I would agree with that. And men back then, they definitely were, they had a more, a more macho approach. But, and likely so did not go to the doctor as much. But I also think that their exposure to these, um, these

environmental toxins. And also I hate, I mean, I don't know, I didn't live back then, but we live in a culture now where every, where we can work 24 seven, right. We can like, I don't work a nine to five. There's no way I've never finished work at five o'clock ever right it's it's always going on and exceeding and it also interrupts your lifestyle um and there is data from the cleveland clinic that is showing that men are less likely to speak to their doctor i think uh they're 40 more likely to speak to their partner than they are to speak to their doctor about their about their health so it certainly is an issue that men need to be aware of and say, hey, you know, I need more help here. Also, mental health, as you know, with a lot of

the issues that are going on in our society with, you know, gun shootings and mental disabilities in terms of, you know, men. Anxiety. Yeah, exactly. These are all things that men are not really wanting to talk to their doctor about because they think it's impacting them. Or they are, and the doctor is just putting them on an antidepressant, right? And that is having an impact. So antidepressants have significantly increased in their prescription rates over the past few decades. And if you want to turn off a man's

libido and turn off their testosterone production, give them an SSRI. Like that's really easy. And I think, you know, I think a lot of your listeners are going to listen to this and say, well, he said, you know, don't take an antidepressant. I am not saying that. Like, let's be clear, whatever your doctor says to do uh listen to your doctor because he knows you like i don't know who's listening i don't know who you are but when you take this is something called the allostatic load and it's a theory that i've adopted and really what it's saying is is if you have different uh if you have a threshold for where let's say you have a threshold at 100 just like let's just take a a number 100 and if your allostatic load the things that are causing pressure on you

exceed 100 that's when disease starts okay but if you never reach 100 then your body has an ability to uh equilibrate and and manage and what i I think is, when you take all these different factors, a variety of these factors, and you contribute, they all increase the allostatic load, they impair the body's ability to be resistant. And what happens is you actually get dysfunction, and you start experiencing poor health. So it's not just one thing. It's a combination of, you know, heavy metals, it's a combination of not sleeping well, it's a combination of, you know, antidepressants and poor mental health. And, you know, the, the, the idea of having to perform better. These are all things that contribute. And in the end that's how they manifest. Okay, that is very helpful.

I do want to go back to the comment about the heavy metals because that's something I hear over and over again and Dr. Lyon even was telling me like, come in, get your heavy metals checked and we should all be eating small little fish that don't eat other fish like sardines and stuff like that because they're delicious. But can you talk a little bit about what, if we're getting heavy metal testing, like how frequently we should be doing it? What metals we're looking for? Are there some general universal numbers that we should be like aware of or paying attention to? Talk about that.

Yeah. So the one metal that tends to impact men in terms of their hormonal influences is lead. And lead tends to accumulate in the testes, and it'll cause a dysfunction in your testes, and it'll also cause a dysfunction in your pituitary. So lead levels are something that you want to have checked, and you typically want to check urine lead and blood. So you want to check whole blood levels and also urine levels to see if they are similar. I don't, I can't. How are people getting lead in there? Is that again, like the water, the water supply? Yeah. Yeah. So it can be from a water supply. Have you ever, did you ever go fishing when you were younger? A little bit. So do you remember those little like pellets that you would put on a fishing line, those little lead pellets that you would put on?

I don't think we ever did that. We used worms. Oh, okay. So there's weights. There's stuff like old school. Oh, old school. We used rocks. There you go. Okay, you mean to weigh it down.

Okay. You kept it real ancestral yeah um but common sources of lead would be like artificial turf so i mean how many kids now are playing on turf not grass right uh toys from china uh water we know there's definitely lead in our water. I use a Berkey filter. I don't know if you're familiar with them. No.

Berkey filter. By the way, everybody that I'm mentioning, I have no affiliation. The Berkey filter is a carbon filter, which can filter out. It's a purifier, actually, and it gets rid of most metals and and antibiotics in your food so i i i just put a hunk of like japanese charcoal in my in my glass water bottle is that pretty much probably doing the same thing i mean charcoal carbon it's kind of like the same is it a filter it's literally a piece like a big piece of of um charcoal that is if you can get them on amazon i should put this in the show notes,

but it, yeah, it literally, you, you boil it like every couple of weeks to, to clean it out. But it's, it supposedly is drawing out the impurities from your water and it makes it

taste really good. That's pretty cool. I'm sure it's working very similarly, except this one is an actual filter. So the water you drink doesn't touch the, uh, the carbon. So pretty cool. But I'll definitely, I'll, I i'll i'll play with that i'll send you i'll send you yeah um it also just kind of looks cool

yeah what why are you drinking a black thing it's like does it turn the water black it's cool it doesn't no it doesn't at all and it's it's like yeah it's just um because i mean you know like charcoal is kind of like a new uh not new, but it's one of those sort of like supplements that's kind of like popular these days. I think Bulletproof came out with this charcoal pill and it's helping people because it's supposed to be like, if you take some, when you have one too many drinks some night, it helps like absorb the bad stuff in your gut and i've had i've actually had a lot of friends have very first-hand experiences where they're like i proactively took some charcoal pills when i was going out some night and i knew that i was going to kind of overdo it and it drastically reduced my hangover symptoms so i mean there's something to it oh yeah when i absolutely it's you know they give charcoal to people who have alcohol poisoning right yeah so it definitely works people are works. So I'm just asking what people are doing to themselves. They're like, I'm going to go out and alcohol poison myself tonight,

so I'm just going to take some charcoal pills before I leave because that's being responsible. That'll do it. Yeah. But other sources would be, you know, low-quality supplements. I see people buying stuff off shelves at, like, you know, like, local pharmacies and, like, dollar stores. And I'm like, you know, like local pharmacies and like dollar stores. And I'm like, what are you doing?

Like, or off of Amazon or eBay? Yeah, like China. Absolutely. And China is probably one of the most, I mean, Chinese herbs, because I'm also an acupuncturist and I do Chinese urology, traditional Chinese medicine. And the one thing is, you know, I don't, I want to make sure that these herbs that if they're coming, these Chinese herbs, I want to make sure that if they are coming from China, that they've been tested and purified and triple checked and

third party tested, like, you need to make sure that the stuff that you're taking is good quality. So those are... Okay, that's actually a really good, sorry, this is a really good segue. And I don't want to forget to ask you this because I don't want to keep you too much longer. We'll definitely have to do a part two because we can just talk forever. But I'm glad that you mentioned the acupuncturist thing because I really wanted to ask you about that. In addition to being a functional medicine practitioner and a hormone whisperer, you're an acupuncturist as well. And I'd like for you to explain kind of how you fit that into your methodology, how you fit that into your practice. Personally, I'm interested in that area of medicine.

I've never done acupuncture before, and for whatever reason, I'm not skeptical about it. I just feel like, yeah, it probably works for people, but I don't want to do it. And so maybe I'm just trying to convince myself to try it. So I'd love for you to kind of just talk about it a little bit and how that fits into the work that you do. Yeah. So there are things that conventional medicine has a very poor answer for. And one of them is sexual dysfunction, right? And one thing that acupuncture works really well for is for ED and also for prostatitis. So for pelvic pain, it works exceptionally well for pelvic pain. And that's something that a lot of men, you know, suffer with. And if you really want to

lower a man's libido and lower their testosterone levels and make them freak out all the time, then, you know, having a chronic throbbing pain in their prostate or their testes or their penis is definitely going to be the one way to do it. Yeah, I don't do it. Yeah. I don't put a kink on anybody's day. Oh, totally. You have no idea. Guys are just like sitting there and they're like, you know, they're like, oh my God, like, I feel like, like it's tingling and burning.

It's just, it's very uncomfortable. So it works very well for, for prostate pain or even pelvic pain. But how do I incorporate it? If you, so acupuncture can help regulate cortisol levels as well. And that's one thing, one aspect of conventional medicine that doesn't, that they don't do a really good job at managing is how do you manage your adrenal hormones? Like we can give you exogenous testosterone, we can give you birth control, we can give you growth, and we can give you all these things.

But when you have adrenal dysfunction, like how do you correct that? I'm not talking about, you know, adrenal atrophy. I'm talking about when your adrenal glands are not working very well, your cortisol is very high or your cortisol is very low. Acupuncture does a great job at doing that because it can help re-regulate the adrenal, it'll help re-regulate the HPA axis. That's one of the best things that I like to use acupuncture for. And other things are just for chronic pain. It works exceptionally well to reduce chronic pain and it allows people to function better without having the constant painkillers or, you know, it allows you to perform better.

Is there ever a circumstance where you would not recommend acupuncture? It's so harmless. I don't know of any instance where I would say, you know, acupuncture could be harmful for you. You have to understand it's a completely different philosophy and method of medicine where they use different theories in terms of understanding how the body works. So I can't think of a situation where I would say, you know what, acupuncture is not good here. I will say there are conditions where I would, where acupuncture, you know, may not be effective. Like it works exceptionally well for like hot flashes and fertility and hormonal imbalances. But for some things, like if you have cardiovascular disease, like I'm not, like, we're not going to, I'm not going to be able to help you with acupuncture. It's limited. Yeah, absolutely. I mean, I feel very strongly about finding the balance

between Eastern and Western medicine. I don't think we should forgo either one in favor of the other because they can coexist and work together. And ideally, functional medicine and holistic medicine and all of those things are about looking at not just your symptoms and putting band-aids on things and waiting until you're sick. It's about understanding your body and how it works and figuring out all of the different ways you can proactively, you know, maintain and encourage your health. So I think that all of these things have a place and can work together. It's kind of exciting.

But I'd like, can you, I don't want this to take like another hour of your time, but you said that acupuncture can help with fertility. Can you talk a little bit more about how that works for either men or women? Like say, you know, I'm looking to get pregnant and maybe we don't even have an issue. There's no issue that we are aware of yet but we're like trying to enhance our fertility and just be as as ready as we can be how is acupuncture going to assist with that it works best in women and what it can do it can stimulate ovulation so and it can actually help the uterus. And it helps to release up certain hormones that help stabilize the uterus and holding on to the egg, the fertilized egg.

So we see this most effective in people who've had failed in vitro. And then they do in vitro with acupuncture. And it's actually much more effective. I have many success stories where people were like i was never able to have a kid they told me i would never have a kid we've done three series of in vitro and you know now i'm having a baby in three months so it like i don't care what the research says it It works for that, and I've experienced it firsthand. So what it can do is it can help stimulate, number one,

it can stimulate the release of FSH and LH for women. And then also there's a few, there's an acupuncture point called Zigong's Wei, which is called the uterus point, and it's basically next to the ovaries, and you needle that area, and it can stimulate the ovaries to release an egg, so you have a higher likelihood of conceiving. Really cool. Okay. It's fascinating stuff. It's like magic. Yeah. Yeah. Yeah. Well, yeah, I guess it is. I remember I have a friend in New York whose grandfather was a Chinese herbalist, I guess, whatever. And he was one of those like cool old guys that you go to him and he kind of like looks at your face and looks at your tongue and looks at your hands and you're not feeling good. He tells you like, stop eating so much fried food or whatever like he'll like kind of look at you and be able to tell what's

going on and I remember I was really sick one day and it was just like a cold or whatever and he made some concoction for me and it was just and I can eat a lot I have like a really really um I think grown-up palate but this thing was like real hard to get down like to the point where I almost feel like it just like scared me into being healthy like I would rather die or be sick than drink this stuff again but it worked so like yeah you can't we have so much faith in like these white pills that are made in a factory and I think we need to have maybe a little bit more faith in in sort of just listening to what our bodies are telling us, but also practices that have been working for thousands and thousands and thousands of years.

And I think it's just cool to keep your mind open to all of it because it really is magic to those of us, especially who are not doctors and scientists who are studying. It's just, wow, you're going to poke me with some needles and I'm going to have a baby. It's amazing. All right. So Ralph, you've given us a lot of free information today.

And for that, I thank you. But if someone is listening to this podcast and is thinking, I want to work one on one with Dr. Esposito, I want to work with him, I want to ask him some questions. How do people go about like connecting with you and possibly you working? So right now, I'm not taking on patients. So I work exclusively with the medical practice in New York. So I work as a medical consultant. I just, I don't have the bandwidth to take somebody on and say, I want to be your doctor. I'm already managing, you know, a hundred other people very closely. My goal, my goal, and look on every podcast that i go on and people that i speak to like i just want to educate people and inform them so that we can just have better information

and make sure people understand these things because i don't really think anybody is doing an excellent job you know dr line is exceptionally really brilliant um who i would say you guys can definitely reach out to her. And her and I, we consult very often and we're in contact daily. So, you know, if you really need somebody to help manage your care one-on-one long-term, I'm not the person for that. I work more with physicians and other practitioners and give them input and insight as to, you know, how they can better improve their patient's life. And I just want, you know, more just basically like good medicine. That's like my agenda, good medicine for the world.

So people can find me, you know, on social media and, you know, my, my website. But unfortunately I can't say that i have the bandwidth right now to take on people for the long term okay fair enough you made us a little bit sad but i get it you're you're a busy man but i appreciate the concept too of like we're not holding any of these secrets close to our chest like we we just want to get the information out there to people and then the more educated and empowered we all are, we can make better decisions in terms of choosing a doctor, choosing who we want to work with, what kind of supplements we want to use, what kind of lifestyle we want to have. The more information that's out there for people to take in when they're ready, the better. So I appreciate you doing that and putting that out into the world because it's really important.

So thank you for that. And can you remind our listeners where they can go online to follow you? Sure. Yeah. Hear all your testicle news. If that's what you want to call it. Cool. Testicle news. Dr. Ralph Esposito. Hey, I've got all the one liners today. This is a goldmine of one liners. You can find me, my website is drralfesposito.com or my Instagram and Twitter handles are at dr.ralfesposito. So you can find me there. And yeah, I have all information there. You can message me there. And, you know, one thing I wanted to point out is I really hope that the listeners are listening to me and then questioning their doctor. And I'm not here to, like, you know, stir up any trouble. What I really want people to do is understand is that they have to be their own advocate.

And their doctor really needs, like, you need to make sure your doctor's on their game and um and that's kind of like what i'm like i would what i would love to see more of like stop using this word adrenal fatigue stop using these you know odd type of explanations of things and let's just get to the to the nitty-gritty of it and and start understanding things really really well and and if we could do that I think you know my work is a success awesome yeah and even knowing that you even feeling empowered enough to know that you can ask questions and discuss things with your doctor because I think so many of us grow up thinking like you go to the doctor and whatever he or she tells you is the thing that you do and knowing that you can ask questions you can get second opinions you can educate yourself first and bring that information to them and it doesn't have to be a confrontational

negative thing it's just a it's a learning and putting your health um first over you know just saying yes and making somebody else happy so i i completely agree with you and that's why things like the the work that you're doing and the podcasts that we're doing are important because it's just letting people educate themselves and just become aware. That's it. That's what we need to do.

So cool. Thanks, Rolf. I appreciate you taking the time. This was awesome. My pleasure. This was really fun. I love doing this kind of stuff. And we're going to do it again in person next time

because it's ridiculous. We're both stuck on this timing. Well, you're not quite, but we're both in very close geographic context. So we've got to do this, do part two soon in New York, and maybe we'll get Dr. Lyon to come and we'll just have like a geeked out nerd party. Oh, totally. We'll just geek out to the fullest. I'll bring my glasses.

Oh, me too, me too. All three of us, we can just be the three nerd musketeers. I love it. Down, 100%. Alright, Ralph, thanks so much for your time. I appreciate it. Thank you. Alright, everybody, thanks for listening. Next week is a really, really interesting

episode for me. On the surface, it's a conversation about women's bodybuilding. So we talk about the different categories and the mindset and the toll it can take on your body and the work and just from experience, because I've done it a little bit too. And I enjoy the sport. So I get into it with a friend of mine who is a quote unquote, a pretty big deal in the bodybuilding scene in Ontario, which is where I spend a lot of my time and where I competed and where they have a very, very big like meathead community there, which you may not, you might be surprised to know that Ottawa, especially there's just like a lot of bodybuilders there. So anyway, more specifically, though, I wanted to speak with her

about a specific experience in her life where a bodybuilding picture of her went viral on social media and was shared and commented upon literally tens of thousands of times. Some of it positive, much of it really disgusting and dehumanizing. And I think that any of us on social media, especially those of us in the fitness world, in that community that we sort of look at and consume on social media, we can get used to the harsh and frankly gross way that people judge and discuss people's appearance on social media. And while I like to think that most of us would never dream of commenting on or DMing a perfect stranger to tell them that we think they're disgusting, we see it a lot. And I think that for some of us, it barely phases us

because we think this is just what social media is now. This is what you expect to have happen. And this is what humanity is now. So I wanted to have a conversation with someone who actually lived this experience. So that's what I'm chatting about next week with my bodybuilding buff friend, former posing coach and all around beefcake, Coco King.

It's a really really interesting one so I hope you join me and until then have a great week everybody