Cleared Hot - Powered By BRCC - Dr. Wizz - Unlocking the Secrets of Anti-Aging

Episode Date: July 15, 2024

Dr. Anna-Marie Wysynski is at the leading edge of Anti-Aging Functional and Regenerative Medicine. As the first female physician in southern Ontario to become board-certified in this specialty, Dr. Wysynski, also known as Dr. Wizz, has made significant strides in advancing Bioidentical Hormone Replacement Therapy (BHRT) as a viable and effective treatment for anti-aging. Dr. Wysynski's academic journey, from earning a Doctor of Medicine degree at McMaster University to her Masters in Public Health from the University of Massachusetts, has equipped her with a unique perspective on patient care. Join us as we explore the science behind anti-aging, the benefits of BHRT, and how functional medicine can enhance overall well-being. The company I mentioned that I am working with for my blood panels is called Marek Health. If you are interested in checking them out, please use this link: https://marekdiagnostics.com/stumpf Marek has also provided me with a discount code, "stumpf". Full disclosure, I have no clue what the value of the code is, maybe it is 100 percent off, maybe it is 10. Some mysteries in life have no answers.

Good morning, ladies and gentlemen. Before the obvious comments, I know. I'm kind of decked out in camo here a little bit. This is a toehold hat. I don't even know if you can buy it. And this is an origin. Sun shirt is what I'm going to call it. It's part of their burr technology. And it's been fantastic. We've been having a little bit of a heat wave up here in Montana. And it's allowing me to stay not burned to pieces by the sun. This episode is brought to you by Black Rifle Coffee. Shall we go over to their website right now and see what they have? have to offer. My God, it's short shorts. Okay, so they're doing a summer tiger camo collection. Those shorts are showing more leg than I'm comfortable with. I mean, you go with whatever you want to go with. My lord, there's some thigh there. Moving along. As you go down, you can select whatever type of coffee you want from light to dark, apparel gear, coffee bundles, coffee sampler, follow them on social media, join their email list, or just scroll. scroll back up and look through the imagery of upper thigh.

Whatever floats your boat. They are an amazing brand, founded by amazing people, and I love what they stand for. Could not be more proud to be a part of it. My guest today is Dr. Wis. That is obviously short. Her first name is Anna Marie, and we talk about it. She is a Canadian physician who also holds a medical license here in the United States. I am going to speak for her a little bit. She does a great job of describing who she is and what she stands for. But optimization via hormones in both men and women. This is something that I've been very open with. In January, I started TRT. And I am slowly working my way through the treatment protocol. I'm using a company called Merrick. And I'm going to leave the link to it in the show notes that people have any interest. We went through my entire

treatment protocol. And this is something that I owed the listeners because they had asked about it. We go every medication, every dosage. But beyond that, we talk for two and a half hours about longevity, about improving your life if you want to go down this path. It is not consequence-free. There are side effects to everything, to include water and aspirin in the wrong dosage. So take it with, I was going to say take it with a grain of salt, but that's not the best way to go into this episode. educate yourself do research look at both sides make an educated decision that's what i'm going to leave it with so let's get into it amazing conversation with dr whiz enjoy okay coffee whiz to the smoke i'm looking at danger close now all right the request that you had just before we started is you

wanted to talk about black rifle coffee yes talk about whatever you would like to what is it about black rifle coffee you'd like to discuss well glenn and i were more glenn and than I was, we were looking for a opportunity to franchise in Canada. Okay. Because we are a childless couple, and as much as I am working towards hormonal therapy and designing programs, et cetera, as a legacy, one of the other things we were concerned about was, what do we do if we have a resident estate? We have no children, so the natural succession is gone, right?

It's not obvious to us. So of late, we bought a Belgium-Deneland. a dog, which I fell in love with. Named? Fury. F-U-R-Y? No, not Fury. Fury. Fiery is how some people say it.

Why would you make this a confusing name? Because it's her personality. Okay. And it's unique. You didn't know that when you named her, though. She's a male. Of course I knew that. Okay.

Yeah, it's a given. Fury? Fury. All right. It's your dog. Name it whatever you want. And if you say the first two letters of her name repetitively, it's F-F-F-E-F-E-F-E. which doesn't sooner at all.

What's her nickname? Does she have one? Fur. Fur. Okay. Yeah, it just seems to be shortened. Fur. I am actually not the person to talk to about that.

Although I joke about being the founder and CEO of Black Rifle Coffee. I'm not actually. Thank you. What I can say is this. I have known Evan for a good amount of time at this point. And I took the opportunity when he was in one of the phases where they, They were going to continue the franchising. They call them outposts.

And he was in a phase where they wanted to continue to do more. So I locked it in in that moment. And your facility is beautiful, by the way. Thank you. It is completely anxiety driving and stress riddled. But it's good. It's my first entrepreneurship. Yeah.

It's my first endeavor into that world. I have heard rumbling. that they may be looking at allowing some other outposts. Perfect. I can't confirm that, though, but what I can do is the next time I speak with Evan, I can ask him and maybe get a little bit of the sense of the blowing of the wind. Because honestly, like, I have no impact on it, and it's really a corporate decision. Of course. I get that.

The reason is that we've since had the dog. We've come up with this idea that we get really frustrated at the way military is treated. And unfortunately in our country, what's happened is when people are asking for things like aid dogs or service dogs or stair lifts to get to the second floor, they've been declined and offered medical assistance and dying instead. So that just infuriates us to know. Did you just say medical assistance and dying? Yeah, I did. Yeah. I was unaware until recently that Canada actually allowed that until I, I don't want to fuck this name up.

Jim Shockey, I believe, is his name. His wife chose medically assisted suicide, I believe, because of cancer. That's the correct last name, right? He's an incredibly famous Canadian hunter. Is that the right correct last name? Yeah, it's Jim Shockey. Okay. I wasn't aware of it until that in an article came across my attention.

Interesting. I don't know enough about, conceptually, I am not against allowing people to make that choice. I worry, and I'm sure there are safeguards in place, I worry about it not being used for the intended purpose. I agree. I think it's a little bit of a slippery slope. It is, and that's why I'm assuming there's got to be a control mechanism in there and reading that single article. My touch point on this is one single article, so I'm not an expert, I'm not all, but I believe there was multiple interfaces and interactions with, I believe, MDs and either a psych or shrinks. Right.

crazy people can do crazy shit and they can present themselves to be sane enough for long enough. Right. But, I mean, I don't know. I don't know how long the process was. Her issue was clearly diminishing in nature from a cancer perspective. I look at my own mom. And for anybody who's never been around, somebody who had died from cancer, fuck, it is rough. For the capital of.

It is horrible. She was an absolute shadow of the person that she was before. I could have put my finger around her leg. I don't know if she would have made that choice, but I feel in a situation like that, it should be available. Like abortion, as a medical doctor, I think it's important to have choices. Yeah. Everybody needs to use their own discretion as to whether they take that route or that choice,

but safe choices need to have happen. But when it comes to the military, and we see that they're being offered this option instead of a chairlift, which is a couple thousand dollars. Okay. Why would they even offer them that? That doesn't even make sense to me. They're asking for help and they're being offered medically assisted suicide?

There were two cases that were well published in the newspapers at home. And it really infuriated Glenn and I to no end. So what we've decided to do with our legacy is not only leave it to women and menopause, which is my goal, but also a foundation where we're going to start training dogs for service dogs with a finance option. We're going to create the foundation. so corporate and individual finance can be offered to the foundation to have these dogs housed and trained so that we can make them accessible to the military first. Okay, almost like a sponsor, a dog type program.

Exactly. And then Glenn had a great idea. He has got his own little entrepreneurial flare as well. He's going to start a coffee cart because we met on a gun range. And so bottom line is... I'm surprised you said that being from Canada. Well, it's not common... I feel like there's a lot of government oversight at that range.

Incredible. How did you get that feeling? Let me put my finger on it. You guys, you know, it's interesting. I love Canadians. I, you know, the Triple Seven expedition that we did, Glenn, the Glenn that was on our trip, not your husband, Glenn. It was so cool.

He was just like the nicest, happiest dude ever. He was one of my favorites on that trip. I worked with, or alongside Canadian soldiers. Like, I love Canada. I've taught a bunch of stuff up in Canada. But you guys are on the front leading. edge of some progressive shit. We are.

For better for worse. Well, for those of us and the countries that are a little bit behind, the answers to the tests are being displayed. And I don't know if people are paying attention. I don't think they are in my country. And I don't know if they are in other countries because they seem to be

diving headlong towards some of the policies that the current regime, I don't know what you guys would use as the term, is putting in place and driving at breakneck pace. I mean, it is what you vote for. It is what you vote for.

Unfortunately, sometimes you vote for the best of the worst. How could you dare talk about the current U.S. political environment like that? Rubber stamping. Did you guys happen to watch the debate? Not that it directly impacts what's going on north of the border? Well, it does directly impact north of the border. We say it doesn't, but it certainly does. Let's be honest.

You guys are the top hat of America, okay? In my mind, you're the 51st day. It's better than being the diaper. That's true. We have another country that's, handling that for us currently. But it's, you guys are the 51st state, as far as I'm concerned. Yeah, things that happen here directly happened there. The description of the best of the worst, Michael, would you agree? It aptly suits the presidential debate from what was it last Thursday.

Yeah, it was pretty bad. It was, I almost don't want to tell you to go watch it because my, I left with a few things. One of the things I left with was a question about, does the world think when they watch this? What did we just present as our best face forward to the global audience? And I'm not hopeful about the messaging we put out. The things that have happened in our country, too, of late, not that we should be talking about politics and religion generally, but really surprised me and worry me going forward. You know, people will be controversial all over the place. And Canadians are very too polite to express their real Canadian or the real held views. If anybody's really thinking about issues and controversies or if they're really

examining the issues to any doubt. But what's going on with censorship? I can't even get social media posts on my Facebook page from my friends in the U.S. So if they post a funny meme, they post a funny joke, can't see it. So it just doesn't even populate at all? It just says this content is not available this time. Blank. So you can see that they posted something, but not what it was. But I can't see what it is. If I do the same thing, it's taken down. That would drive me fucking nuts.

My nephew has a, or had a, what do you call it? Sorry, Glenn? Yeah, like a satirical swag company called Bad Government. He was making jokes about all parties in Canada. And as soon as our censorship bill got posted, the day after he got a cease and cisorder from the Canadian government. Hmm. This is not free speech. This is not the freest country in the world.

Who is the arbiter of what is okay and what is not in Canada when it comes to that type of language or sarcasm? It's now the liberal government. But who, though? Do they have a panel? Is it a person? Is there an organization? Do you know where that decision is actually being made? There has to be some organization within government, a think tank.

But it usually comes down to the CTC, the Canadian-touch. telecommunication company in the branch of government that governs broadcasting. I can't think of an example of when censorship was a net positive in the history of the world that I am aware of it. I agree. And it's generally not entered into with the benefits of the general public in mind. So I don't know why anybody in Canada would vote for that. There was no vote. That's the whole thing.

Well, they voted for the person. That's what I'm saying. They voted for the person who signed it into effect. Absolutely. Why would you do that? I don't understand that mindset. Do you think that they actually thought it would have a net positive? It would be good for them?

Or did they say this is the party I align with, so I'm going to agree with it and vote for it because that's what we do as good party individuals? I think the telltale was from a. entrepreneur who owned a little diner up in the northern peninsula of Michigan, where we ate when we came through Canada, went through Michigan to get to southern Ontario. And I asked her a question because we were there on a Friday. Everybody was wearing, you know, I support the military shirts. They had a Christmas tree still in the middle of the summer where they had different areas of the military, Christmas balls, et cetera, on there. They were really pro-military. And I said to her...

Christmas tree in the summer? Correct. They just left the Christmas tree up with all the... That's just called laziness. I fully support it. If my wife would let me, I would not take a Christmas tree down. There you go. Yeah, only because it's a pain to my ass. There you go. It is. It is.

And then a collect stuff and you need space to store it. But this was their thing. They just had a small Christmas treat at the front with different Christmas ornaments from different areas of the military, different branches of the military. And I said to her, as we were checking out, I said, interestingly, you see so many Canadians. I mean, half your business is probably Canadians. She said, you're right. And I said, what do you see is the biggest difference?

And she had clear insight. And without moments hesitation, she said, in America, we work. we work hard enough to take care of ourselves. In Canada, you work hard, but you expect the government to take care of you at the end. And I'm like, whoa. And I think people that vote for this type of legislation think that it's going to make our country into a kinder, more tolerant, nicer place to live, more inclusive, more – do we already say, I'm sorry too much already, so I don't know how they feel that they're going to be more complacent or acquiescing. but the bottom line being that I think the majority people who are in favor of these types of bills

think that it's going to help with respect to prejudice, oppression, name calling, increase inclusivity, but I'm not sure that that's the end that we're going to achieve. Does name calling really matter? You know, the saying of sticks and stones may hurt my bones, but worlds will never hurt me. Like, I get it, it's childish. And you say those things to young children in the hope of developing some resilience and the things that they may hear. Even the most horrendous things that somebody can say to you,

you're in control of whether or not you have a reaction to it, regardless of how bad they may be. I think most mature adults would see it that way, but I think most people in general... You would assume, but I'm not sure that that's true. I think the bottom line is the average human being still takes things personally and has a set of standards. It's okay to take things personally.

It really is more emotionally reactive. than logically assessing. Yeah. It'll be interested to see the trajectory that, like I said, Canada, you guys are ahead of us when it comes to a lot of those things that you're talking about, the censorship of language and information and a drive towards more inclusivity. And not that I'm against inclusivity at all. I'm against people driving for it for their own particular or political gain,

as opposed to what they are presenting. it. This will be better for everybody. I was like, I think you mean that this is going to be better for you. You guys are a little bit ahead. Your steam engine is a little bit ahead of ours. So I hope people are paying attention. I hope so too, because I'm not sure some of the changes or proposed ways of being are going to be adaptive. They're not going to be very inclusive after all. Because if we can't say what we feel, we can't have a dialogue, that's when things break down. It's not about being right or wrong. It's not about whose opinion matters more. It's about having a dialogue. and being able to say those things. Let's face it, most off-color, ethnic jokes, most jokes about sexual preference, et cetera,

are founded in some degree of truth. That's what stereotypes are built on. Or accuracy. For sure. Yeah. For sure. And without question, they can be hurtful. But, you know, you went back to the saying sticks and stones

that people teach your children. If we just went back to what our childhood taught us as well, if you don't have anything nice to say, maybe you shouldn't say it. And if we just practice those sort of clean your own doorstep first types of morals or approaches to life, maybe it would just be much more kind. It's very Jordan Peterson of you. That's a compliment. I know.

Make sure you have clean your own room before you go and talk and shit about somebody else's house. Oh, my. You got it. You got it. Yeah. I like a lot of what he does. Why? He seems like he might be a little bit crazy, but I like what he does.

Why do you like what he does? Because he stands up for what he believes in and he says what he thinks and what he means. does with conviction and without apology. And he'll stand there toe to toe and he'll argue if need be, but explain if asked why he believes what he does. And he's got quite an eloquent way of expressing himself, which stops to, it causes people to stop and listen. It's not just regular every old day language where people just fluff it off.

People have to stop and listen to him. His vocabulary is quite. Yeah. He could stop wearing multicolored suits. like the half, one color half the other is a little bit distracting. Wait a minute. We had a hockey announcer that wore colorful suits like that, though. Liberace, come on, some famous people.

The two examples you have just given are not actually arguing for what you want. Liberace did some gay shit. All right. So, I mean, have you seen the movie Under the Candlebra? Have not yet. Condalabra, however the fuck you say it. Michael is furiously Googling. I'm going to tell you right now, Michael.

This is not a movie that I want you to watch. First of all, it's behind the candelabra. Is it candelabra or candle bra? I don't even know now. Candelabra. Words I'm never going to use in my life again for 500, Alex. Yeah. Alex Trebek was Canadian, wasn't he?

Absolutely. Yes. You have a lot of Kenne expats here in the States that have done quite nicely. Yeah, given our proximity to the border. I think we're 60 miles away. I see the white and red license plates all the time. There you go. What's with the flashcards?

What's going on here? I just wanted some data. Just review. What type of data are we talking here? Studies, quotes, numbers. You want to dive right into it? Anytime you're ready. You realize, though, I'm warning you.

I'm passionate about this. We could talk for hours. I think you should be passionate about it. Why don't you describe what it is that you're passionate about? Explain to people why you guys reached out and what it is that you're passionate about. Because obviously it has a direct tie into my life very recently because I kind of went down this path. not too long ago as well. 100%.

What I'm passionate about, I've always been the type of person that thinks outside the box. So in medicine, we're taught the box, and it's very rigid. Here you would call it a board. In Canada, we call it colleges. The regulators are very rigid

about what's inside the box. Around the turn of the century, there was a report called the Flexner Report that basically promised in perpetuity funding to all North American medical schools if they taught pharmaceutical medicine.

There's so much more than pharmaceutical medicine. And if we make the box instead of rigid, we make it somewhat elastic. And we actually do critical thinking in medicine. I was a scientist before medicine. So I learned a lot about reading literature and looking at nuances and comparing and contrasting. And it's not okay, in my opinion, to just go with the standard of care because the standard of care doesn't really promote health. It treats illness. Has it always been that way or did it evolve into that? I think it evolved into that with pharmaceutical medicine to a great extent.

I was going to say who volunteered to pay for that North American medical school if they taught inside of the pharmacological system. I'm going to bet if you followed the breadcrumbs on that, we might have come back to Big Pharma. Absolutely. And it came back to Big Oil, Rothschilds. Really? One of the funders. Absolutely. So I think it wasn't the Sacklers.

Well, you know, given what we're talking about, it could have been. I was just talking with my dad. And Michael, I'm going to need you to look this up to make sure I'm not completely full of shit. Because if I get data from my father, there is a chance that he is full of shit. He said he had just read that the Sackler family, the, I believe it was a high, an appeals court or the Supreme Court had just ruled that they cannot hide their assets through their bankruptcy filing, which would be amazing for people whose lives, friends and family and loved ones were destroyed by the opioid crisis that they held drive. Right. because the fucked up thing

and the documentary on Netflix I believe is called painkiller it's fantastic it's done by Pienerberg the fucked up thing is they made so much money and the agreement that they made with the U.S. government

it wasn't a one-time lump sum they could basically pay off their penalty with the compounding interest from the money that they had already put away so the penalty was about a day sales of narcotics so it might look huge but there was almost no impact

to the actual family, you know, air quotes itself. It's so fucked. And they were going to hide it behind a bankruptcy. Did you find any legitimacy of that, Michael? Yeah, I'm pulling it up right now. Okay. Let's see how accurate one Vaughn Stumpf is when reporting breaking news. The ruling upended a carefully crafted settlement worth roughly $8 billion in involving the Sackler family, which owns Purdue and all the individual states and local governments that had sued over harms from,

the opioid and a five to four decision damn almost right down the middle the justice is focused on the part of the Purdue bankruptcy the plan that shielded members of the sackler family from the future opioid related lawsuit so what was it hold on after the Supreme court's what was the title of this uh yes Supreme court overturns opioid settlement with Purdue pharma that shielded sacklers that's what I'm talking about yes that Netflix series if that doesn't piss you off. I don't know what else will. I don't know if you know this of me prior to medical school.

Well, we've only met for like 30 minutes, so I definitely don't know it of you. There you go. I was a bench scientist. So I was a pharmacology, toxicology, double major at the PhD level. Okay. So I was one of those geeks that stood at a scientific bench and tested drugs and help with drug development. So... Sounds not riveting.

Well, it is applicable, though, because in terms of my ability to understand medicine and my ability to understand drugs and physiology, pharmacology, and how everything interacts, gives me a little bit of an edge compared to somebody who's not had that experience. Oh, I'm glad you were doing it.

There needs to be people out there that have your level of intelligence and willing to do that, because if you were to give me, like, a pipette and some of that stuff, I'd spray it on Michael, I'd, like, squirt it on the floor. I mean, I would 100% not take it serious. Well, you might do that, too, and it's kind of fun, but when your thesis realized on it, you may not want to do that so often.

but so yeah my my background in pharmacology toxicology industrial hygiene what that means is that I bring a lot of experience in public health epidemiology pharmacology physiology biology biology biochemistry and it all is applicable to what we're going to talk about today so when we talk about my being passionate about hormone replacement therapy it really excites me because number one it's an application of medicine that's under undervalued we have a one-size-fits-all model in allopathic medicine. So allopathic being Western-style, you know, family doctor, regular medicine. And yet there's so many more ways to apply Western medicine to the health of the individual. And the healthy individual is not necessarily what is the goal at the end of the day of treatment.

We usually wait for symptoms to arise and then we start our pharmacological, you know, legalized drug dealing with a prescription pad. And I'm not here to bash my profession. I'm very privileged to have a degree in medicine and to have the ability to write prescriptions for patients and to treat patients. Concurrently, I also had a 20-year emergency medicine career. So, you know, do pharmaceuticals work? Hell yeah. If I'm in the middle of a stroke, give me the clot-busting.

For sure. If I'm in the middle of a heart attack, stop it in its tracks, right? If I have cancer, I don't know. That's a controversial one. That's an individual decision, but does it prolong life? Yes. Does it give quality of life in some cases, yes. And if you're the lucky one to get the cure, go for it, right?

Everybody needs to decide for themselves what their course of therapy is. but this particular area of longevity medicine, which the FDA actually hates that term, so does our colleges and regulatory boards, because they're not out in the business of making people live longer. They don't have an interest, and longevity is not an end point. And with testosterone replacement therapy, when we get into that,

that's a whole deal of why there's such scrutiny about this practice and replacing hormones for men and women, yet it could be so powerful, so powerful, and life-changing and rejuvenating for people that there's underappreciation in our medical societies of why that could be. When did it become a passion? I mean, obviously, you've talked about some of the things you did leading up to sitting here today, whether it's the bench testing or the emergency medicine.

When did the passion shift towards the hormone replacement therapy? About 2004-2005. Do you remember why that happened? Yeah, because the man that sent an email to you. Okay. So Glenn is largely responsible for my being introduced to. to this. So the story goes like this. I was finishing medical residency and didn't know what I wanted to do because I really don't like the practice of office family medicine. I think it doesn't

do well in terms of preventative care. It's very reactive rather than proactive. And so I really love procedures and working with my hands as well. So I was looking at a medispa. And we'd looked at for different places to practice and set up clinic. And in doing my research, I was looking to finalize a decision on a sunscreen. and the only place we can have that meeting was in our home. Glenn happened to be off that day. So not only did he make me lunch, as I sat spellbound at the woman who was talking to me,

representing one of the sunscreen lines that we were looking into, he'd never seen me this passionate and, like, riveted about anything in medicine before. And so he excuses himself and goes, excuse me, takes off for a few minutes. I'm like, yeah, yeah, whatever. Like, I'm just listening to this woman about this conference. And so he comes back down about 15, 20 minutes later and excuses himself again, whispers in my ear, can I borrow your credit card? Yeah, yeah, yeah, yeah, I don't care. I don't care.

I always say he could have been buying a ring for a flusy. I don't know the hell he was doing with my credit card, but I trusted him. I'm certain he wasn't. Yeah. But he comes down a little while later and enrolls me in an organization that trains around functional and regenerative anti-aging medicine and has my first course. Tuition says, make your flight arrangements. So several months later, I go down to Vegas for this course, and I had a flip phone at the time

with a, you know, $8 a minute charge to make. make a telephone call and I promised him that I would actually, that's how long ago it was, promised him that I would actually call and let him know how things were going. So I called on the first break, which was at about 9 a.m. And he said to me, so how was it going? And I held the cell phone up in the air with my hand and I came back and I said, did you, did you hear that? And he goes, no, I didn't hear anything. I'm like, yeah, that's about what I'm getting out of this too. Never even dawned on me to look at the biochemical pathways or anything. And it had been many years through medical school that we hadn't really looked at detail.

So I said to him, you know, I'm getting and and so, and because comes right off the back wall over my head a second time, and I could get that word. And then by noon hour, I called him back and he said, so how's it going now? And I said, oh, my God, I wet my pants. I have to do this. I'm so, like, enthralled with what's going on. And part of the, part of my interest, I think, and the passion is that I had done many years of graduate school training. My beginning of university to when I graduated from med school was just shy of 20 years. So I had looked at this and I had said to my hubby a long time ago, you know, I was really grieving in family medicine.

I don't use any of those background pieces of physiology, pharmacology, biochemical pathways. Could you if you wanted to or is there just not enough time working with people to do that effectively? I think the bottom line is when you get into a subspecialty of medicine, whether it be family or internal medicine or whatever, you just learn your approaches. Narrow tranche. Yes, the gestalt is back there, but you don't really have this stuff at the forefront. whereby if you're my patient, the way that I operate, I'm very visual in my head as well and very systems oriented. And so if you're talking to me about your signs and symptoms, the RAM is already going to tink, to tink, to tink, and I'm whipping through those pathways in my head thinking about what could be going on in terms of what is my approach. What do I need to ask you?

What do I need to rule out? So by noon that day of the first conference, I was hooked and just loved it and read voraciously around this area. So, for example, one New Year's Eve, I'd had a really hellacious shift, one of the worst shifts I've ever had in 20 years in emergency medicine. And it came home and I said, I'm fine. I'm not going to hurt myself. Bad day. I'm going to take a bath. So I drew a bath and, you know, he came up with a glass of water because he knew I would draw a hot bath.

And what am I doing? I'm reading functional medicine in the bathtub. He's like. Real page turners. Exactly. He's like, why don't you read a book? And I'm like, what do you mean? I am reading a book.

No, real book. I am reading a real book because I just find it so incredibly interesting and intuitive and everything based in physiology. And not everything we do in medicine is based in physiology. A lot of it is tradition. A lot of it is assumptions. How clear do you think doctors are about that with their patients? Not. I was going to say, I don't remember a lot of doctors I've ever encountered using terms like, I'm making an assumption here or we're doing this because this is traditional.

Right. A lot of it's based in the little. literature, and then the literature becomes the trend where they accepted standard of care, because the standard of care truly is defined as, quote, what the average reasonable physician in your community is doing, unquote. So for me, we have a large bridge connecting the peninsula of Niagara to the mainland in Ontario, and there's a bridge called the Burlington Skyway. If every menopausal woman was marched up to the top of the bridge with a rope tied around her

neck and a big anvil at the other end of the rope, and we throw the anvil in the, We threw the anvil and the woman off the bridge. And that's how we dealt with menopause. Should I be doing that too? No, and I'd like to believe that other doctors are not advocating for that. That's a horrible metaphor. But I get what you're saying. It is a horrible metaphor.

But, you know, people are told all the time, oh, you know, it's natural. Or you just have to suck it up and deal with it. Or here's your X drug. Or here's your next drug. Or here's your next next drug. And it doesn't really make much sense. And when we look at numbers. So, for example, let me give you a statin.

which is a cholesterol medication. The statistical term is numbers needed to treat. That means how many people have to take this medication for life to prevent one heart attack or stroke? And the numbers are 19. So you have an 18 at a 19% chance, which equates to almost 94% chance of still having a heart attack or stroke.

While having liver enzymes up to two and a half times higher than normal, which is acceptable, we don't do that in any other area of medicine. We don't let weight go up two and a half times. you don't let blood pressure go up two and a half times, who don't let cholesterol or insulin or sugars go up two and a half times before we say there's a problem. But yet this has become the standard of care,

and yet the numbers needed to treat are not that high. We learn those, but then that becomes what you do when somebody has XYZ pattern of cholesterol findings in their blood work, and so you just go ahead and you treat. So with functional medicine, I love it because it really goes on physiology. We really do base things in physiology. Now, is it perfect? Absolutely not, just like anything else.

And some of the studies that I reviewed, you know, to chat about hormones and men really say that there's a lot of discrepancy. And part of that is our regulators are so faction that they're all looking through their own set of eyeglasses and nobody really has a unified view of what this is. But as a practitioner, then that's my responsibility in my mind, just take that data and put it together and pick and choose. It's sort of the smorgasborg of, you know, functional medicine. Although functional really does give us guidelines or at least approaches that are based more in physiology sometimes than men. Madison. And as a bench scientist, I understand that. You know, we hone in on this little area of this, say, cholesterol. We look at the cholesterol path, and go, oh, look, see that little catalyst there that acts like a spark plug? What would happen if we block that spark plug? And we block that reaction or shoots and ladders.

If you can't go down the letter, then you would get this outcome. And so let's create a drug that targets that. And then when we look at the process of patenting drugs and whatnot, it really does drive North American Western allopathic medicine. I'm not always the type of person. I've never been the type of person that is always going along with the crowd. I'm always the type of person that stands up and says, the emperor has no clothes on. You're not always the most popular person when you do that,

but we need to start stimulating people to think, not just blindly follow what is going on. And if we can justify that the allopathic approach is the best approach, and by all means, let's do that. My favorite part about drug commercials are not the commercials themselves, but the... The 27 seconds of disclaimer? Correct.

Well, disclaimer and possible side effects. Right, of course. Possible side effects might include explosive diarrhea while driving your car, vomiting, you know, kittens. It's just ridiculous, you know. Your spleen may stop working. You might die of a sudden heart attack and excruciating pain. And it was a medicine for, like you said, cholesterol.

Right. Like, fuck. I did that to a patient once. Which part of that? Treated his gout really aggressively. and he went home and vomited all in the inside of his window. Hey, I've taken too much magnesium before just messing around. And that has the same result but a different ejection portal.

Absolutely. And just about as explosively. Same power of force behind it, right? So where do you start people when they come to you? With an extensive history. So my intake is extensive. Some people say, holy crap, you know, 26 pages. Mm-hmm.

So I want to know about you. So what I do is I fashion my intake form around an internal medicine, examination or evaluation or consultation. That includes everything from family history to reproductive history to meds. And then we include some of the, not some, we include many things from functional training that are also applicable to one's experience in hormone levels. So that includes traumas, toxic exposures, introspective practices like yoga or prayer, Pilates, stress reduction techniques, what their younger sexual function used to look like for men and women, because that's important.

If somebody, for example, never had a high libido, and then all of a sudden they come for TRT, and they're like, wow, you know, I'm not a raging tiger. Well, you never were a raging tiger. You were purring kittens, so I can't make you into something you're not. So that's always really important to really get a baseline of what people have had in their lifetime. Meds, allergies, surgeries, all kinds of things that really impact stress,

mental health issues, depression, anxiety, those all impact our ability to maintain and produce our hormones. Yeah. You know what has surprised me? Well, in December, I had a stomach surgery. In I want to say November, but just to be safe, it was either October or November, I went and finally got my first blood panel done based off a conversation that I had with a friend of mine who had talked about his own experience.

and I have just been transparent and super open and honest about it. And I'm glad that I have because the point I'm getting to is the number of people that have pulled me aside and asked questions or pulled me aside and said, hey, I'm glad that you finally were taking a look at that because that's a pathway that I went down years ago. For those people, it's like, hey, man, why are you doing this so quietly? Is there a stigma that you have put on this or somebody else has put on this? And the fact that people aren't being more open and honest about what it is that they are doing, I think it leads to more behind the scenes questions or people trying to be their own Google doctor. Right. And to try to just figure, well, I heard somebody's taking TRT, so I just need to find testosterone.

It's like, well, maybe somebody is taking only that, but that's probably one of 12 or 13 things that the company that I'm working with actually prescribed me. even though I don't think, I think the number of things they would actually need to prescribe is super low. A lot of it is over the counter like vitamin D3 because my vitamin D sucked. It's amazing how many people have come to me and said, what has your experience been? Because I'm suffering. My word's not theirs necessarily. But even Michael and I were just at a wedding and somebody there whose name I'll leave out of it. It was like, hey, weren't you saying that you started doing this about six?

months ago and I said, yeah. He goes, I just now I'm starting to think about it. Do you mind if I asked you some questions? I'm like, of course. Nice. And so that was my only, my only rule that I had. So the company I work with is actually called Merrick and they were founded by it or partially founded by a fellow Canadian of yours, Derek from more plates, more dates. Either has a founding rule or like an advisory role there. I don't know if he lives in Canada or not. But I told I'm like, I'm not going to do this unless I can talk completely openly and honestly about this and the feedback I'm going to give is going to be legitimately my experience because people think it's the fountain of youth.

And so far, I haven't found it to be that way. It's also, it's not like doesn't feel to me. And I mean, if you have any questions, trust me, I'll answer them. Michael's like, oh, fuck, here we go. Likewise. If you have any questions, I'll answer them too. Well, I'm a consumer. You are the person who's actually educated in this.

And I'm educating myself along the way because my experience hasn't been perfect. My body doesn't respond to, like as an example, I was taking IM shots. to start with. My body didn't feel like it liked it. So I switched to subcutaneous shots, a smaller dose, five days a week, Saturday, Sunday off. My body seems to tolerate that better. Right. It seems to be more consistent. Right. That was kind of a trial and error on my part. But people, it seems like some people think, like, hey, you just get on this TRT in your life. You feel like you're 18. It's like, either I'm taking the wrong stuff or. Or you don't remember what feeling like 18 was like. I definitely don't. It's not magic. It's helpful.

But it's not magic. Welcome to the world working with human beings with unique biochemistry. So that's the other thing that's really lovely, both functional. Even though we take population medicine, which is what allopathic medicine does, you know, we take a study, we look at the outcomes and we say, okay, people, blah, blah, blah, we use this drug for this reason. Okay, great. But that's a one-size-fits-all approach. And even in functional, you'll see varieties of what it looks like. Some people just have standardized dosing.

I just came across the company a couple weeks ago, brilliant business model, but definitely it's okay. What's your name? What's your age? We're going to plug you into an algorithm and here's your prescription and you'll get it by mail in a couple weeks. You never see somebody. I don't know what they're monitoring and their follow-up procedures are. I feel like that is irresponsible.

Again, I'm not here to... It's their business model. I'll be gracious. Well, I'm not here to be the arbiter of what is right and what is wrong. Another thing that I enjoy working with Merrick is if you don't go get your blood tested, they're not going to continue to work with you. That's how we did in my clinic. I think it's the only reasonable way to do it. Well, I look at it this way.

If you were a diabetic and I was prescribing you insulin and I never checked your blood sugars, would you think I was a responsible practitioner? No. Exactly. So just because we're used to giving birth control pills to women at standard doses doesn't mean, or we give one pump of androgel to antropausal man doesn't mean that it doesn't need monitoring. With those standard pharmaceutical doses in one size fits all, we've never been inclined

or encouraged or taught the need for monitoring. But in my clinic, a few years ago, we renamed the clinic to bespoke functional medicine. Dr. Wissonski bespoke functional medicine. The reason being everything, we stole that word from the tailing industry. Apparently Americans don't know that word very well. And it means custom-tailored. And everything that we do in the clinic, it's harder for me. It's a lot more brain power, but it's a lot more challenging and juicy and stimulating for me

to actually work with patients and customize their dose, customize their outcomes. It's beneficial for the patient, too. Absolutely. Absolutely. We know the part of the reason why people get side effects of drugs is that it's not an appropriate dose for them. They could be too sensitive or not sensitive enough. And it's really unfortunate because, for example, muscle spasm relievers, when we see patients with spastic CP or we see somebody with cerebral palsy or somebody with spinal cord injury and they've got massive muscle spasms, we say, oh, but I'm sorry, 40 milligrams is the maximum dose. I can't give you anymore. Yes, but I'm just starting to get relief. That person may need more for whatever for their body. biochemistry. So in biochemistry is highly influenced by everything. You know, and I'm really pleased to see your, your Q&A a couple of weeks ago that stimulated us getting in contact. Yeah. Because you're right. It is part of a package. I think hormone replacement therapy, whether it be for men or women, is about 50% maybe 60% of the package. But if you're not doing everything from the basics of food, food, rest, how you think, how you move, it's not going to work as well. Can it work? Sure. It could give somebody really great outcomes. You know one of the most impactful things that I've done, and it's been within the last 30 days? Drank more water.

Yes. I start every day now with two large glasses of water. And I started doing that because one of the, I don't want to say complications, and maybe you could explain why this happens. Sure. One of the first things that I encountered when I got on the Merrick Protocol was water retention. Sure. And of course, I go to the fucking Internet because it has the answers to everything. And what I found actually made me feel better, super common.

and it seems to work itself out in somewhere between four to six months. It seems like from the layman's perspective, your body is recognizing a difference because you're putting in substances that it's not naturally creating, responding to that, but it will find this place of homeostasis, work itself out. But one of the main things you can do is actually consume more water to induce your body to want to release some of that water, which, of course, I have to wait five months to do of trying to figure out what the fuck is going on because I'm a moron. It's been hugely beneficial. Absolutely. So detoxification occurs in five organs, your skin, your lungs, kidneys, your liver, your bowels, well, in your urinary tract as well, sorry, six organs. So if you're not flushing, your cells individually are going to look like prunes instead of plums. So when you get the adequate water that your body needs, and the rule of thumb of that is half your weight in pounds are the ounces of water one needs to drink in a day to maintain hydration. Half your weight in pounds. Okay, so call it for easy math, a 200-pound person, we need 100 ounces a day of water.

Correct. At rest, no sweating, no exercise, no caffeine, no alcohol. Would it be, if you were going to err on the side of that, is it better to be low or high? High. Okay. Is there any negative consequence at some, I mean, I'm not sure you could over,

you can actually kill yourself by drinking too much water. 100%. Let's put that on the extreme psychopath side of that house. Let's say somebody's getting 150 versus 100. Is there a risk associated with that? They could flesh out their electrolytes like sodium and then start feeling really weak. But generally people will know. But most of us run around dehydrated anyways.

Like you said, that was without sweat. Michael and I will go do jujitsu for two hours. Sure. You can wring your clothing out and sweat after that. Exactly. I almost think I cannot even like that much fluid volume. It's tough to, I think, tolerate the actual fluid volume that I need per day. If you're unused to it, yes.

And people can't go from drinking virtually nothing to everything. Because, again, you drop those electrolytes. You start feeling kind of weak. kind of red dollish. The first day that I started just trying to start with a big glass of water, it was not the easiest glass of water to finish. No, not at all. Because I wasn't really thirsty.

And now in the morning, it's like, boom. It's the first thing I do when I wake up. So thirst is a survival mechanism. When we feel thirst, we've gone beyond dehydration. And our body's saying, if you don't drink, bad things are going to happen. So, again, half your body weight in ounces is really important. And so you can flush out the other. toxic chemicals. Like basically our cells are like little powerhouses. We have a hundred trillion

of them. And they're excreting waste just like you would out of a smoke stack if you were an industry or a power generator or whatever. And so a hundred trillion of those making waste products every day need to go somewhere. And the problem is most people are not used to drinking. And so when they get the hydration, they start stimulating the excretion through the kidneys and then they have to urinate more, go to the bathroom more. And they don't like that. They think, oh, I'm peeing too much. No, that's not true. We have to eliminate. And so that'll help with sweating. A lot of people don't sweat. I'm not a big sweater. So when I get to altitude or when I get in extreme heat, then I third space it and I get puffy as well. So I've never been a big sweater. So I have to be really cognizant of making sure the electrolytes are there. The other thing is in medicine. We've scared everybody off the salt shaker. And table salt's not necessarily the best thing in the world for us anyways. And where we need to watch salt is not in high blood pressure. It's with people who are eating a lot of prepared, canned, packaged foods with Tons of salt is a preservative. And we know from Asian cultures, specifically China, high-salted foods increases the risk of stomach cancer.

But Himalian salt or well-balanced salt and salts that we need to maintain our hydration are really important. So when we talk about hormones, it's just not about testosterone. It's about a whole bunch of other hormones. And one of the ones that I talk a lot about will probably get into in a few minutes is cortisol or stress hormones. The adrenal glands that sit on top of the kidneys control salt and water. And so when we're not having great adrenal health, we're kind of burned out and we're stressed out and our stress hormones are going, we shift salt and water balance. And that could cause dehydration or it could cause water retention. And it can also make us feel weak.

Our muscles not work very well under stress, et cetera. So hydration is so key and that salt and water balance is really important. So is pH. So I just want to caveat that anything I say is not meant as medical advice because I can't be allowed to do that in this form. What I say is medical advice, because I'm a learned doctor. There you go. Perfect. I dubbed the a learned doctor.

Michael doesn't even know what movie that's from. Do you? No, I don't. Have you ever seen the movie Step Brothers? Oh, yeah, I've seen the stepbrids. God, how many times have you seen it? Actually, probably like three or four. They're laying in their beds.

This is a house of learned doctors. He's like, you're a curly-headed fuck. I remember that line. I was something like, when you go to sleep, I'm going to beat the shit out of you with soap and a sock or something. I love it. It's the best. Okay, so somebody comes to you, they do the questionnaire. I'm assuming there's going to be a blood draw in this.

You sit down with somebody for the first time. I'm like, where do you even begin? But yes and no. So there are different compartments. So when I was in graduate school designing my PhD thesis, somebody gave me the most poignant advice ever. And they said to me, if you don't want to be here for 10 years, if you want the answer to your question, being your hypothesis,

ask the right question. Because in research, we get a top of the question. kind of data, but it never addresses the real question. So I extrapolate that to medicine and hormone balancing. If you want to know your hormone levels, look in the right compartment. That makes sense. So hormones go in different compartments, and there's all kinds of controversy, and there's all kinds of debate about what is the best compartment. So there's blood, there's saliva, and there's urine. Blood is the compartment that we do all of our studies on because it's cheap, it's easy, send somebody to a lab, draw some blood, spin it down, do your analysis, whatever.

Yes, exactly. But unfortunately, it's not the most accurate component. Really? It is not. So what's passing the needle at the moment in time? So men, for example, create testosterone in their body and release it in little spurts, like air freshener commercials. And they release it about every 90 to 120 minutes. Hmm. So if you happen to get at 124 minutes when your testosterone might have just been released and you've got a high number, it's great.

But if you got it at, you know, 240 minutes, when it's about to be released again, you got a low. And you're talking about when the needle is literally in the vein pulling the blood out. Exactly. So we say it measured what passes the vein. So when I think of blood testing, for example, I think about it as your hormone savings account, right, or your bank balance. So you go online or your phone, you check and you say, oh, yeah, got money in the bank, going to go down and get gas. Except you left her wallet at the shop. So what happens when you get to the gas pump and you left her wallet at the shop?

Just use your phone. That's left there, too. That's your backpack. You left your backpack. I would just use my Apple Watch, which I don't have. I'm joking. You can't pay for it. You got to go back. For the average person, you're functionally broke. Yeah, you got to go back. So in that moment, you can't function if you've left a tool behind. So other compartments lend itself to different levels of testing and different levels of information. So saliva testing,

for example, is thought to be a proxy measure. And one of the things that does extremely well is measure cortisol up to 120 days earlier. So I can look at somebody's stress levels from three months ago and go, dude, this is what's going on. That's a hell of the history test. It is. And NASA uses saliva testing to measure cortisol in astronauts. So I think if it's good enough for NASA, it could be good enough for our patients. Probably.

However, there's controversy again as to how do you measure cell varie hormones or there's two different methods. So what is your lab using? Do you understand what the lab's using as a practitioner who's prescribing this? What are the outcomes? What are the drawbacks? And how do you interpret that? Right.

Then there's controversy as well. Saliva testing at baseline is fantastic. It is a proxy measure what's in one's cells. The blood has to go to the salivary gland, stimulates the salivary gland, the hormones are taken up through the salivary gland and excreted in the saliva. So that's similar to what happens in a testicle

or an ovary or a breast or a brain or bone, and it's really great for intracellular levels. Now, some labs and some providers of these tests say, yeah, but that's not so good. If you don't have topical applied hormones, you can't really measure the outcome in saliva. then you have to do blood or something else. Urine is fantastic.

I've used urine for decades. Well, decades. I've been practicing for decades, but I've used a urinary testing for breakdown products. When I want to look at metabolites or if I want to look at trends. What's coming out. Exactly. You can look at the metabolites and make some assumptions and go backwards.

And certain test companies say that, yeah, you can use this to dose on. But then it's kind of interesting to see the genesis of some of these urinary tests to now include a saliva panel as well. If I'm really stuck, I do do blood testing at baseline as well. So before a patient starts their hormones, they'll get a blood test as well. They get an extensive panel because I'm looking upstream for precursors to disease. I may have to go back to those blood levels if I'm, one, changing methodology, if I'm doing a different route, if I can't figure out Adam from Ursul about what's going on with this patient's hormones

and they just can't be balanced, and there are a small proportion of people who just have a difficult time balancing hormones for whatever reason, then I may go back at blood and look at some studies and compare, get some hints. It's rare, but it's valuable to have a little ticket in my back pocket that I can pull out. So for me, my patients usually start with salivary testing. Then they get their blood tests done as well, including their hormone levels, and other things like precursors to diabetes, heart disease risk factors, and ECG. and part of that is based on some assumptions and regulations in the trends as well. You know, there's a whole controversy. It is TRT or testosterone replacement therapy increase the risk of heart disease and stroke and men.

Or prostate cancer is another one you hear. Exactly. So I hope we can talk about those as we go forward because bottom line is there's an assumption that if you take TRT, you're more apt to have a stroke or heart attack. And that is actually the black box warning from the FDA on TRT, on testosterone products. My own research showed me that a low testosterone level actually put me at risk of some of those things at a greater level than actually taking the testosterone itself. 100%. To include dementia, Alzheimer's, heart.

And that was the balancing act that I had as somebody who was looking at doing this. So I started when I was 46 years old. Good for you. There are people. I started when I was 42. Okay. I'm going to say that you and I both know of some people who use, we're going to use the R.T. portion of the testosterone replacement therapy.

Okay. Yes. They are on what I'm going to call a sport dosage. They are not looking for anything therapeutic. They are looking for something that is superhuman in nature. And let me clarify something. I don't give a fuck what people do. If you want to do that, go do that and accept the consequences of your decisions. But please don't lie to everybody and tell them that you're doing a therapeutic dose of testosterone.

Right. Let's just be honest. Like, you can't tell me your... Could be therapeutic if you were an elephant. Sure. It's like you're eating waffles, but you're telling me that you're having sausage. Like, I can look at the fucking plate and see that you're eating waffles. Right.

Just be honest with me. I have no issue with people making the decisions that they want to. My issue is, I think it muddies the water for everybody else who is actually trying to make the most educated decision that they can. 100%. And I think some people fear that. Women and men, some men don't want to come in looking like Arnie in the day, you know? I don't think. Well, let's be honest, too, right, Arnie in the day, he was on enough shit to kill a horse, probably a stable of horses.

Go watch the documentary pumping iron and look at how he was training and how he was eating. All of those things are going to have to be present for you to look like Arnold. You're not going to jab a needle in any part of your body and wake up looking like fucking Arnold Schwarzenegger in the 70s. Unless you're the Hulk, and you can turn yourself around that quick. Well, the Hulk, Mr. Frignew, I'm pretty sure was a training partner of Arnold. And on, likely, hypothetically, the same program. And then there's a difference between synthetics. And there's a difference between natural hormones.

So all hormones are anabolic. They build. Testosterone being the most famous anabolic steroid. When we look at the risk factors for low T and men, it doubles the risk of diabetes, increases the risk of Alzheimer's dementia, increases the risk of, fatigue, falls, memory loss, cognitive decline, actual ability to do activities of daily living like dress yourself, feed yourself, go to the bank, pay your bills, make decisions. It's huge. So it's kind of interesting because one of the studies that I reviewed was a study by Schneider

and that was done around 2014. What they looked at was seven arms of a study. They did seven different outcomes within the study with small numbers of men, about 279 men per arm of the study. There were 790 total included in the study. And the men were allowed to participate in different arms of the study, which made for some really interesting statistics and criticisms of the study. However, what their goal was, their hypothesis was, is testosterone replacement therapy beneficial to men for anything other than... the effects of natural aging.

Was that not sufficient? When I started my business 20 years ago, my clinic, I wrote an article for the local paper that said, we would all love to live to be 100, dot, dot, dot. Unless we're in nursing home. Yeah. Exactly. So functional health is really important.

Now newer studies are talking about functional health, but the previous studies to about 2020 are really just talking about these risk factors that have become assumptions, myth in many respects, that is carried through as a tradition in medicine. So, oh, no, you can't have testosterone. And you're too young, 46.

No, no, no, no. Now, had you been wanting to conceive and procreate, then that's a whole different story. For sure, yeah, because it will drastically, for people who don't know, drastically decrease your sperm production, correct? About 20 percent. Yeah, in a younger man. Testicular size as well will testes shrink about 20 percent. But by time you're 50 anyways, you've lost about 30 percent, 40 percent of your natural,

endogenous, which is naturally made. levels of testosterone anyways. You know, on the corollary, if you lose 50% of your 40, 50% of your thyroid function of 50, do we hesitate to replace it? No. If you don't have insulin sensitivity at age 50 and you need a dose of insulin, do we hesitate to replace it? No.

Say it no, but we've got to look at your diet a little bit. Well, 100%. But in terms of the decision making, when it comes to replacing sex ones... It's almost binary, actually, for those ones you previously mentioned, it's like, hey, this is your number. We're going to do something about this right now. Exactly. It's almost automatic and yet replacing sex hormones and men and women is taboo. The other thing is talking about antropause, which is the male reduction in hormone

levels and the experience of symptoms that are concommonant with that or menopause and women is really taboo. Nobody talks about, oh, you know, you get to be 50. You're going to be tired. You're falling asleep. Like, we do talk about it, but we really don't talk about it. She did my dad. It's all he fucking talks about. I'm so tired. Yesterday was so hard. With respect, if you're 46, your dad may be having some fatigue issues related to home. He should be.

He's 76 years old. Good for him. The last time he was sitting in your chair, I think you were in the room, Michael. I'm like, I'm putting you in a home just so you know. I'm researching him now. And what did he say? He laughs at me. He knows.

See? He's asked me. He's legitimately asked me. He's like, hey, never let me get like that. I said, what do you mean? He goes, if I ever get like that, wheel me out into traffic. And Leah, my wife happened to be in the room. mortified at this moment.

And she asked me, would you ever do that? I'm like, fuck yes, I would absolutely do that. Because that's what I would want young Michael to do for me. You just throw them off the mountain. I feel like a wheelchair down an incline into oncoming traffic, so it's a maybe. See, you have an advantage. What's that? You could just, what do you call it?

Do a parachute with them? What do you call it with tandem? You'd tan to parachute with them. Just kind of. I don't know. my dad's cut from that cloth, to be honest. Yeah, but you can just cut them loose. It'll be quick. I don't know if you understand how a tandem parachute system works.

I don't. Because that is not how it works. Which is a good conversation because I want to jump with my dog. Connected, that would be easy. You're connected at four points. The upper points, I think, it's 5,000 pounds per connector and lowers are 2,500. You cannot remove. Well, you could, but it would be a monumental effort to unsnap all four of those and launch somebody. But see, you could be an entrepreneur. create that system. I'm not sure there's a market for that. There might be. I like the ideation,

but I think the size of the market that's going to buy that is super low. And we are so far off that. Well, you know, a lot of people go on cruise ships because they know they're dying and, you know, they want their last thrill. Here's an interesting question. Because my dad was with me, he went with me when I went down and got my initial blood draw. And he was asking me about it. So why are you doing this? And I was, and God, this ties in a few things. Again, I am, very surprised by the number of people who have reached out because I'm open about what it is that I'm doing, which I just feel like is the way that you should be. I mean, I'm not saying sheer intimate details of your marriage or whatever that may be, but I've been honest about my life up to the point, my physical experiences, my experience in the military, what I do from a recreational perspective physically. I've talked about the impact that it's had on my body. Why would I not talk about the other things that I'm doing to deal with those? I'm not like I hide my age. I'm like, I'm not the spring chicken that I used to be when I was 20, but so many people, you know, have questions. And the number one question I get is, how do I know if this is right for me?

And my response to that is, you're asking the wrong person because that's more of a question you need to have for yourself in the mirror. But then it ties into my dad. He's asking, okay, so why are you doing this? And I explained to him, you know, how I was feeling, which was not something that I arrived at overnight. You can feel things, whether it's like feeling like you're thinking through oatmeal, or starting to notice a little bit of your recall slipping or not recovering the way that you were. Just the physical. And again, a lot of that I just equate to every month, the calendar flips over.

It's not like it's not counting down. It's counting up. So I'm getting older. But my dad just recently, so I'm about six months into it right now. And he'd asked me. He's like, how am I feeling? And I've only had one blood draw since. It was a few months ago, so I'm almost due for another one.

Almost all the metrics moved in the right direction. The testosterone in my blood, and I know there's other metrics in this, was just a above three when I started 300 when I started not three three would be very very low. Three would be, uh, yeah, I'd be under this table. It's fucking dead. You got it. I think it's mid, sixes when, uh, I had my second blood draw. And I do feel better. So yours was just above three. Just above. At 46. Yes. Fit. Athletic. Works out. But at what cost? Like dragging. Right. Every day. But here you are somebody who other people might look from the outside in and go, hey, Andy, it's got it all together, right?

It's got his lifestyle together. I was doing the best I could to have it all together. But then who would have thought somebody looking from the outside end that you would have a testosterone level of 300? Well, they just don't live inside of my skin. Exactly. And yet, fatigue is the number one complaint to family doctors in North America. I would wake up feeling more tired than when I went to bed. And that is what kind of got me over.

That was like, okay, I'm going to crack this door. I did as much research as I could on low test. testosterone in men, what are the risks involved with that? What are the risk involved in going on hormone replacement therapy? It's kind of a Faustian choice because neither are without consequence. So what you're balancing is... Fair. You're balancing the consequences.

You could go one way and there's consequences. You can go the other way, there's consequences. Which one are you more comfortable with? Really? That's the way I describe it. And the way I view life is, you know, it'd be great to live to 100, dot, dot, dot. I agree with you, not if I'm a vegetable. I'd rather live to 80 and squeeze every drop out of the, you know, like when the race car does its one lap.

Like that old Neskath commercial? Yeah. When the race car does its one lap, it's like wheezing and coughing and every door is busted out. All the glasses. Like, I'd rather have that than get across it 100 and be pristine. So the functional ability to do things that I want to do in my life with my kids trumps adding additional years where I might be eating jello and watching Looney Tunes. So we say, do you want to add years to your life or life to your years? I mean, of course, the answer would be C, both, but if I had to choose, I'm going to add life to my years.

Most people would. Yeah. And so the approach that I take, I steal an adage from one of my friends who is very functionally oriented as well. And he says good, better, and best. So if people are making poor choices and they can make good choices lifestyle-wise or with therapies like TRT, then great. Then make that. That may be the one-size-fits. I'll go to your family doctor and get the standard dose and move on.

you may get some benefit good better and best how do we make somebody move towards better and best so if you don't mind you've you've loaded a hundred questions and points in there let me ask you one more thing so my dad just asked me does do i think and of course my answer was anytime somebody asked me i'm like listen i'm not an expert he said do you think there'd be any benefit for me getting my blood checked and starting great point he's 76 and i don't know good so let me appeal to some of the things that you brought up in your own story if i can't Please. So you were primed for low T at 46. Probably even just due to my operational career in the military as well. Concussoplast, exposure, all those things. Full stop. So, for example, if sleep disturbance, one week of sleep disturbance will drop your testosterone by 40%. Is that, you mean just like maybe even shift work or life experiences?

Exactly. Crying baby. Shift work. Which, by the way, it's one of the people who has asked. me recently about this was somebody who they rotate a month at a time, day, shift. And I'm like, hey, man, maybe you do more research on what that's doing to your body, you know, and stabilize that and then have your shit rechecked. I had a father who not only did shift work, he did it counterclockwise.

So he went from days to nights to afternoons. And he said that was more of a killer. He had done with the clock previously in his career. But the majority of his career was counterclockwise. The data is resoundingly back on what that does to the human body. Absolutely, and yet there are those of us that need to work shift work. When you're on a mission, you're on a mission, whether it's an emergency medicine shift. So many times my husband is like, text me, where the hell are you?

Why aren't you home yet? Yep. Somebody circling in the drain. I'll be home when I get home. You know, you just do what you have to do. And then that level of stress. So 40% just due to one week. 40% of one week having interrupted sleep, not even sleep less nests.

So can you imagine when people have to be hypervigilant for two, three days at a time, interns, residents, doctors, pilots. New parents. New parents, absolutely. I think it's insanity. You know, somebody has a new child and they're up every hour to two hours for months. No wonder why I don't understand why the prevalence of postpartum depression isn't higher. Or depression in men. We don't talk about that, right? Concussion blasts, so TBI and low T.

They go hand in hand. So when the pituitary gland, which is in the brain, which signals hormone production down the line, basically there's a talk between pituitary and gonads, which are testes and ovaries, when that is rattled, you know, on different shows, you know, in podcasts, I've heard you guys talk about what the effects are like shooting a 50-Cal. Are you kidding me? You rattle your brain like that. Rattle your ears. We should shoot them until your nose blade.

Absolutely. I remember you saying that on one of your podcasts. And I'm like, holy crap, are you kidding me? The percussion. Sounded super smart at the time. Well, it probably was a blast, literally and figuratively, right? The headache for the next two days isn't great, but yeah. Worse than a hangover?

Probably. No. No. No. Not when you drink like we used to. Well, fair. You counterbalance the concussion injury with the alcohol, right? Concussion is like, yeah, it's not too bad. I mean, I know some guys who went on fucking benders. So, yeah, it was probably magnitudes of order greater than the 50-cal concussion. And what's really interesting is the guys who can go on benders, the more muscular man is, the better he can handle his alcohol.

But then the more alcohol he drinks, the more testosterone, he turns into estrogen. Yeah, it becomes a self-licking ice cream cone. It's horrible. It is a self-licking ice cream cone. You're right. a good analogy. I like that. Not mine. I stole it from somebody years ago. So your, your, your military experience, for example, set you up for low tea. Modern Western life set you up for low tea. Having children, not the conceptual part, but the raising a children, hearing the child get up, the sleep disturbance, et cetera, et cetera. I can't imagine MREs. They're nutritionally balanced. No. No, they're not designed to be. R.M.E's, right? R. EMEs. Meal, ready to, no,

you'd think it'd be, the acronyms are always fucked up. It should be like, it's meal ready to eat. Sounds French. Sounds like it was developed in Canada. It's like the boats. Inflatable boat, small. It's always just, you know, it should be small inflatable boat,

but it's backwards. It is what it is. Okay. So meals, nutritionally balanced, but certainly not a variety of fresh nutrients in terms of fiber.

There's nothing fresh in there. It can't be. Exactly. It has to be able to be shelf stable for decades. Exactly. So when you've processed food, even though it's freeze dried,

mostly, you're still killing all the nutrients. Nobody's giving you a vitamin pill. You know, of multivitamin, and multi-mineral in the field, right? So stress, we burn iron, sorry, excuse me, we burn magnesium and we burn zinc under stress. All of us do, whether it's a common cold, whether it's worried about, you know, what you're

going to do tomorrow. And men, those nutrients are extremely important for testosterone production. So when men are under stress, whether it be common daily stress or extreme stress like sports or military service, you end up burning up key nutrients in a really fast time period, and that supports testosterone production. So, yeah, that you really got set up there, but who would think a 46-year-old would be prime for testosterone therapy? So when we look at these studies, the enrollment criteria for the studies are men over 65 years old with already established low-tee. I mean, I'd be shocked if you didn't have low tea at 65. Absolutely. So the

statistics go that about 50 years old, a man has lost 40 to 50 percent of his tea that he had when he was 18 to 25. Now, you've commented on, sorry, my brain is spinning because this is the way my brain works. You know, you've commented that people want to replace sometimes to 18 years old. Yeah. From age 17 to 19 is the highest production of testosterone in a man. However, it's not stabilized yet. They're just coming out of puberty.

And so they're getting their bones closing off. They're getting their maximum height. They're getting their muscle mass developing. We all come to hormone equilibrium where most amounts of hormones and men and women are produced at age 25. And then unfortunately from there, it's a downhill slide. But 25 is where you really like shelf stable? It's called the hormone prime. Shelf stable.

Absolutely like an memory, right? Not for decades, though, for only five years. By time we hit 30, women start having stepwise declines in their hormone levels. Men have a gradual decline towards older age. By time men are 60, they've lost about 70% of their testosterone. By time, they're 80, it's 80%. Now, if you think about the evolution of a man's physique at that point in time, usually men who are younger are slimmer and leaner.

And by time they're 60, 70, 80, they've got punch bellies, maybe man boobs, flabby skin, jowls, etc. Because they're losing a lot of their structural mass. And oftentimes lazy as fuck. Absolutely. But what comes first? The lazy is off or is it because they are low tea? I think that's a package deal. That's a self-looking, I think you're right, but that's a self-licking ice cream.

It is. Yeah, one can lead to the other, which can lead to the other, yeah. And most of the studies conclude that, well, we don't know whether antropos. and all these risk factors for heart disease, stroke, et cetera, because you've lost your tear, because you're aging. Well, does it really matter? Because here's the deal. This is so profound for me that I don't know why this is not taught in every medical school. We're going to talk about a couple of terms, and we'll put them together. Statistical significance. When we do a study, statistical significance has to be reached in order for your intervention to be deemed to be effective. So statistically significant means it does not

happened by chance. It happens because of the intervention that you're studying or some confound confounding factor. So when you set out to design a study, I had a little bit of experience with this, when you set out to design a study, you control confounding factors. That's why in medicine, male animals in animal research are used, because even though if you take a rack of rats in a cage and you put them in a rat room or a animal room, eventually they will coordinate their menstrual cycles called estrus cycles, it's still a confounder. So we actually eliminate female animals for the most part to prevent a confounder. All-cause mortality means dying from any disease you can think of.

All-cause and mortality being death. Yep. So now let's put that together. Statistically significant reduction in all-cause mortality is achieved with hormone replacement therapy in men and women when they need their hormones replaced. There's not a drug on the planet that can give you that benefit. So it is, it would be a benefit to my father at 76. 100%.

and yet we think that men over 65 should not have testosterone replacement therapy. We think that women five years or more out of menopause should not have hormone replacement therapy, and it's all bunk. It's all been discredited. And even the Society of Obstitians and Gynaecologists in Canada, even though this is a woman's statistics, say that even breast cancer survivors and women and menopause, the quality of life benefits from replacing hormones in women outweighs the risks. Okay. So what are the risks?

Well, let's talk about the risks of low tea. low T you've hit on many of them Alzheimer's disease low bone mass increased risk of fractures as a physician in emergency medicine for 20 years I saw innumerable patients with hip

femur and back fractures just from falling just from falling even from standing my dad fell the other day he's torn his ass muscle twice that's not good one was the last time you saw Michael this is a fantastic story it's been a while so he tore his ass muscle you weren't here for this story he was swinging a

golf club so hard that he tore his ass and ended up flat on his back. I got a spectacular chuckle out of this. I met his house the other day and he's limping around again and I'm looking at him like, what's wrong with you? He goes, a damn ass is back at it again. Apparently he was walking somewhere stepped into one of his wife's potted plants and was dragging it along trying to kick it off his foot as he took a header into the gate. And then my only question was, why the fuck do you not have ring camera? because I would 100% post that video for my own enjoyment. They fall down all the time. They can't stop falling down.

Well, the fact that they get back up and only tear their ass muscles are impressive, actually. And that's one of the things. The number one cause, or not a number one, a high cause of death over the age of 60. I mean, think about that, that's not far away. Yeah. It's falls and complications of falls. So when we look at the statistics around falls and hip fractures, falls, and fractures due to falls, 50% of people will die within a week of fracturing.

Wow. 50% of the remainder will die within one month of fracturing. 50% of those will die within one year of fracturing. That's not trending in the right direction. And of the 12.5% left, 50% will go to nursing home because they can't return home because of functional deficits due to a fracture. So the risk of fracturing and ending up going back to your own home after the age of 60s, around seven and a half percent.

It's not high. It is really rough. It's less than one in ten. It is. And so when we look at TRT specifically for men, case of your dad, TRT helps to encourage regeneration of tendons and ligaments. What helps us with strength? What helps us with balance?

It's not bones and it's not aerobic activity. What helps us with osteoporosis prevention? It's actually the tugging and pulling of the tendons on the muscles that stimulates the bone. So that's why weight-bearing activities are no longer high. recommended for men and women over 50 for prevention of osteoporosis. It's actually weight-bearing, weight-lifting activities because we want to pull and tug on those tendons and ligaments. And that's what stimulates bone growth. When you look at osteoporosis medications, they don't build the right kind of bone. So if you can imagine in your mind's eye, a big beef bone,

Montana, I think that's easy to find, you've got the big hard white bone on the outside. That's called the cortical bone. And inside is the spongy bone called the cancellous bone before you get into the marrow. What you want to build is that cortical bone. If one takes 200 tablets of calcium citrate, so here's where calcium and nutrient knowledge is really important as well, you have to take 200 tablets a day of calcium, a day of calcium citrate to get a thousand milligrams of elemental calcium. So when we talk about, you know, most of the calciums that are on the market, they're not the right form. And of that calcium citrate, it will build the little area of spongy bone inside the hard cancellous bone.

So even falling from a height or falling from standing will still cause a fracture. Calcium hydroxyapatite, on the other hand, will build the hard white bone that we need. But then if we don't have that advantage and you can't get calcium into the bones and you can't build bones without hormones, then what do we do?

We give osteoporosis drugs. What do they do? Well, on the outside of the bone is the old senescent bone, the old shedding bone. Slows down the rate at which the bone sheds. So really what you do is a mass old bone cells. They're not really functional and they're not really strong.

And then there is a huge risk. I think it's about 7% as well of what's called osteoenocrosis of the jaw. This is basically rotting of the jaw bone. And if that happens, teeth fall out. Jaw needs to be removed. The jaw bone needs to be removed and there's no repairing that. Awesome. That sounds super fun.

Doesn't that? Bring it on, right? So unfortunately, we have all these trials and, you know, we have injectable IV forms of these drugs as well now that are really popular at really high cost to the patient, to the facility, whatever. So when you look at fractures and people being hospitalized, institutionalized, the numbers are huge. And yet how can we reduce that? Well, testosterone breaks down in testosterone.

You knew about that. That's part of your research that you did around the bloat, right? It also breaks down into DHT, which also stimulates bone health. stimulates neuroplasticity in the brain. So in terms of memory, cognition, and Alzheimer's disease, DHG is really important. And yet, without those hormones, we can't build and maintain bone. In women, testosterone is also really important because it maintains a bone mass.

So without hormone replacement therapy, to me, taking all these nutrients, taking these drugs, it's like putting money into your pocket, coins, you have a hole in your pocket. You can't really retain anything. And so when we look forward about how do we maintain our, well-being, really there's three things we need to successfully age. Ice-aid, hearing, and mobility. And so we don't do well with the mobility part. We actually cause people to have increased risk factors for bone fractures and hospitalization institutionalization. And then if mobility is affected,

then the secondary factors of pneumonia, blood clots, etc., can set in. And then there's other causes and complications of fracturing a bone. Hip replacements, they don't come cheap, knee replacements, whatever we need to do, spinal fractures. I mean, somebody could fracture their spine and live the rest of their life in bed. That's not a quality of life for most people, not something they would normally choose. Yeah, my dad has a knee replacement, and my dad's wife has had a hip replacement. So they both have a little bit of the mobility issues already associated with that. I mean, great surgeries, but, you know, again, not without their complications, especially over the long run. And can be very life-changing for people who are immobile because of

chronic pain. And yet, that's a whole other, that's a whole other offshoot to get into, but there are therapies that can help without. replacing hips. There's prolotherapy. There's PRP. There's nutrients. There's anti-inflammatory diets that can help reduce pain and disability due to degenerative diseases like osteoarthritis or rheumatoid arthritis. So when we look outside the box and we see, you know, functionally outside of the allopathic box, that is, and we see what other options there are for people. They take work. And I think that's part of the other thing. You talked about people being lazy as F, right? Yeah. The bottom line is, yeah, it takes a lot of energy. And sometimes the natural methods work, but people,

don't adhere to the therapy or they don't want to take the effort of going through and maintaining. It's like weight loss, you know, people lose weight and then they have recidivism because the maintenance of maintaining that lifestyle is very difficult in most cases. So with respect to TRT, like I say, you were set up in some respects from your early career days. You're approaching 50. Just because 50 is the magic number, it doesn't mean that some men don't lose their hormones at age 42 and some don't lose them of 54. Or, you know, any other example in there, it is a range. The other thing that's really important is to understand how the normals come about. So how does that happen?

We take 1,000 people, regardless of what it is. You know, whether it's blood sugar levels, whether it's kidney function, whatever, we take 1,000 people. Not so much blood sugar levels, but like kidney function, liver function, testosterone levels. A thousand healthy men at age 50, whatever that means. Like if you're eating ding-dongs and you're having Wendy's every day, does that mean that you're healthy? I would say no. No, but appearingly healthy with no chronic disease or. medications is probably the criteria for inclusion. We take 1,000 people, measure their parameters,

testosterone, free testosterone, PSA, whatever, whatever, we apply bell curve to it. Top 5%, bottom 5%, get eliminated, that's your 95% confidence interval, and that becomes your norm or your range. Well, just because you're normal doesn't mean it's ideal for you. You were just above 300 in your testosterone levels. You were normal. Yeah, towards the lower end of normal. is what they said, yeah. Exactly. You're on the lower end of normal, but to diagnose gonad failure or andropause or testosterone deficiency, you have to be below 300, according to the three most guiding studies or

statements from the American Neurological Association, the Antocrine Society, and the Academy of American College of Physicians, excuse me, ACP, you have to be below 300. If you were thinking through quicksand, or you say oatmeal, I don't know. used to say quicksand if you were thinking through oatmeal feeling like you had lead in your shoes like you had a let up your arse no get up and go it already got up and went you can't problem solve concentrations poor starting to get moody and irritable starting to have decline in libido or desire for sex starting to have sexual dysfunction issues but you're at 300 or above or 320 or 323 does that make it normal it makes it normal because it fits into that bell curve but for andy that's not

optimal. Yeah. It wasn't where you were 10 years ago. Oh, for sure. Right. So why are we so resistant to restoring those levels of hormones, especially since we have statistical, significantly reduced all-cause mortality when hormones are replaced. And that doesn't mean they're replaced to ideal. It doesn't mean that they're replaced to the level of Pluto. Yes, we still want earthbound levels, but what does that mean? For each individual person, I think that's where the customization of this kind of therapy is really valuable. If not even customization, look at somebody's symptoms. Can we see and track or even measure or document a progression in symptoms?

Oh, you were fatigued and you were fatigued, you know, nine out of ten, six days of the week. And now you're telling me your fatigue is two at a ten, two days a week. Is that an improvement? Is that satisfactory to you? Because to me, it kind of matters what the medical studies say or the medical society. say, but really, what does it mean to you? Yeah. If 300 is not considered genital failure, the man who's functioning at 301 is considered normal.

One of the studies that I alluded to before was by Snyder. Snyder had that seven components of the study. One of the things they looked at was walking distance and walking speed. Man over 65, could they walk six minutes? and could they add 50 steps to their six-minute walk with testosterone therapy? What 65-year-old man wants to concede and accept a six-minute walking duration as normal? Is that like from the handicapped spot to the front of the bank, but you can't get to the counter? I don't know.

I don't think that that's a reasonable parameter to think that that's a normal walking duration for any 65-year-old. Now, if those data are now applied to under 65, would you accept a six-minute walk? Like being able to just a walk for six minutes total? For six minutes. Yeah, that's ridiculous. Isn't that? Yeah. So when the bar sets a low and they say, oh, it didn't improve any walking duration, and they couldn't add 50 steps to their walk in terms of rapidity of walking during those six minutes, I don't think that's a phenomenal goal to shoot for.

No, that almost seems like a waste of time. Fair enough. And so bottom line is when we're looking at these parameters in the study and they're saying, oh, testosterone therapy doesn't improve walking distance and it doesn't improve walking speed. Therefore, it doesn't increase endurance and stability and endurance. It's not true. It's absolutely not true because we're not really giving, we're not really, first of all, looking at a population that's healthy.

I'm sure there are plenty of 65-year-old men who could go walk an entire golf course without a cart and do it with energy and feel great at the end of it. So when we're sort of looking at this debilitated population is our standard, we're really scraping the barrel at the bottom. Now, and these were men who took testagel, 1% testagel for a year. That was the only dose and the only method that was tested. We're not looking across different modalities of delivering testosterone. There are multiple ways to deliver testosterone, some better than worse. Now, you're injectable, it's very fashionable.

some of the objections about injectable are the on-off phenomenon. Yeah, I mean, two days a week, I don't have a shot yet. Often men will dose urine, smaller doses, so this is a more progressive style of dosing. But oftentimes what will happen is we'll dose men once a week or once every two weeks with higher dose. I feel like you're going to get a peek in a valley in that. Exactly. And that is the difficulty so that when they peak. Feeling fucking great for about four days. 100%. You know, Stelian, you know, they're off to the races.

They're the Cassanova on the market. Probably dragging by that two-week mark, though. Exactly. Or now there's a long-acting injectable that is dosed once a month. Now there's also controversy in our understanding about what happens. You ran into some side effects, you said, with bloat, water retention. That is usually the conversion of testosterone testosterone. And that can happen because the well was dry.

Now, all of a sudden, we're actually giving testosterone, and the body's like, yeah, let's put it into that pathway and let's shoot some ladders it down to the end goal here. Some people say you should be blocking testosterone conversion to estrogen in men because estrogen causes problems like weight gain, gynochamastia, which is breast development. But estrogen is also an essential hormone in men as well, right? 100%. So the other metabolite of testosterone that's really important is dihydro testosterone or Dht. Again, DHT was thought that we had to block that because it would cause prostititis or enlargement of the prostate. And then people would have, men would have lower urinary tract symptoms like urination, dribbling. retention. And that's not true. More advanced or modern day studies are showing that estrogen and

DHT are essential for men. They're absolutely essential. If you stop and block the estrogen, you have erectile dysfunction. If you stop the DHT, the prostate does not, it actually enlarges. It doesn't stay small and tight. Nobody wants an enlarge prostate. Urinary tract dribbling, urinary tract symptoms, not finishing at the end of urination, having to force uphill to get urination started, frequent urinations during the night, ergo sleep disturbance, lowers tea, and then it's just such a ball of wax. It's like this great big ball of yarn just wound up inside of each other and all intertwined. Hormones are like a spider web or a symphony.

You can't affect one without affecting the other. So one of my strengths is that I can see a bigger picture. Oh, I get it. So when it metabolizes and you get this little thing, it feeds in over there. and I can see those moving parts in my mind when I'm talking about hormones. And it's very surprising. I've actually changed my practice in the last year based on some newer data of not giving men testosterone blockers. So one of the things I used to use was topical testosterone, which is still favorable for men in terms of getting outcomes.

Why would you go that over injectable? I was curious what your preferred delivery mechanism. Absolutely. So the newer data, I use some injectable, but I've never liked the whole on-off phenomenon. and I've used microdosing more frequently. I usually dose my men twice a week because of the on-off. Looking at the half-life, which means how long does it take for half of it to get out of your system is about four to five days. So I usually dose my men twice a week on smaller doses so that they don't get this on-off phenomenon.

Because one of the things that we think as well is when we push the higher doses, it converts to estrogen really fast. And that could, in fact, increase belly fat. And visceral fat, the viscera are the organs within the belly. And we don't want fat around those organs because it increases the risk. of insulin resistance and diabetes. Okay. However, newer data says that that's not necessarily true. Insulin resistance is doubled.

Diabetes, the development of diabetes is doubled in men with low tea. And part of those effects are from estrogenic activity in the D.H.T. And so I've used a lot of topical creams, but I've also used creams with a compound, a natural compound called chrycin in it. Chrysin actually is a natural estrogen blocker. So it blocks the testosterone from estrogen. And since I pulled all my men off of chrycin because of the newer data around prostititis, benign prostatic hypertrophy, which is enlargement of the prostate without cancer,

because they need their prostates to be small and tight and hard. They don't need to be overgrown and, you know, like a rising muffin in a pan. So I've changed my practices based on newer data. And the advantage of that is studying what different organizations has taught me different things. And so when I look at different data, I can actually put it together in a really nice consolidated format and pick and choose the best of all evidence and practices to give the advantage to people. Now, testosterone is said to be best absorbed by being applied to the scrotum. And one of the things that's objectional to both men are, well, am I going to have shrinkage of my testicles or small balls? Yeah, but if you've lost your tea, you got the process starting anyway.

So if we're going to replace, unless somebody wants fertility in the groin on the scrotum, is said to be one of the better roots for topical testosterone. The reason being the absorption characteristics of that thin skin on the scrotum increases the uptake. And there's another scientific process or a physiological process called apoptosis or apatosis, depending on what side of the border you're on. Apoptosis is the programmed cell death that we all have genetically programmed into our cells. and what genitally applied topical testosterone has recently been shown to do is to increase the rate of apoptosis of visceral adipose tissue. So what does that mean in common terms?

It increases the rate at which cells naturally die in fat that accumulates around our organs. So decrease that fatty organ. Exactly. So when we talk about visceral adipose tissue, that's again, viscera are the organs adiposes fat tissue. we call it VAT, and VAT is angry fat. So angry fat makes for insulin resistance, increasing the risk of metabolic syndrome, which is a step towards diabetes, which increases and doubles the risk of heart disease and stroke. So if we're targeting anything concurrently with HRT or TRT, it has to be insulin resistance.

There's controversy. Does TRT increase estrogen increases belly fat in men? Maybe. But I think it's more related diet, dietary choices, stress, cortisol, sleep, sleep, So low testosterone is associated with increased risk of sleep apnea. Does it cause sleep apnea? We're not sure. But sleep apnea often results in people having disturbed sleep,

and refreshing sleep. And it results in low testosterone. So it's a chicken and an egg kind of situation. But really, you know, at the end of the day, doesn't really matter. If somebody's reported to stop breathing or somebody has heavy snoring, get them sleep study. Has to have happen. because without CPAP therapy, the risk of dying of a heart attack or stroke

and somebody with obstructive sleep apnea is 30%. Blow air into their airways that splints the airways open so they don't drop their oxygen, and then that reduces their risk to zero. This is truly a life-saving therapy, but we're not looking for it, and we're not monitoring for it. So in men with low T, if they develop more sleep disturbance,

are we really looking for sleep apnea? Maybe, maybe not. It depends on the practitioner. It depends on the availability of access to sleep studies as well because sometimes that's a little bit of a bottleneck as well as getting people into the system. Now, the other thing that's controversial, and a man with obesity, especially, you know, heavy belly fat,

hard heavy belly fat. There's a difference between subcutaneous fat, which is that soft, squishy belly versus visceral fat, which is that hard belly. You see that in the x-ray cross-section. Or maybe not x-ray, but like a... They'll take those cross sections, it'll show like an 80-year-old person who used to do marathons.

Right. And their muscle mass and an 80-year-old sedentary largely Western diet. And it's just, it looks like one looks like rib-eye, the other one does not. Exactly. Exactly. And that could be done on a body impedance analysis or body composition analysis as well. And so when we look at the use of testosterone therapy and men with obesity, it used to be said, quote, it is egregious and it is heinous to give a man with obesity, testosterone replacement therapy.

Well, one of the ways that we shift body composition is either you lose fat mass or you gain lean mass. If a man has low motivation, couldn't care less, it's sort of man-caving. Testosterone equals pro-social behavior. If a man doesn't want to go out, doesn't want to play sports, if that's his interest, doesn't want to do any exercise, doesn't want to make good food choices because he can't think as he has fat brain, how are you going to get him to lose weight? And that's what most doctors say, hey, you know what, go lose some of that belly fat, died and exercise. But what do we doctors get taught in general, unless you're seeking that information postgraduate? We're taught nothing about diet and exercise. Right?

So what do you do? You go to a dietitian, tells us about the, you know, the food guide, the pyramid food guide, which is the, very influenced by groups with special interests like the dairy manufacturers or wheat manufacturers, a lot of stuff like your little heart symbols that are on, you know, certain breakfast cereals are paid for. Yeah. Right? There's no accreditation or any kind of system that says, hey, yeah, you know, this cereal really

helps promote heart health. It's just a paid for advertising on a box. So nutrition and food choices are not necessarily very reliable either. But then the average family physician, cardiologist, internist, knows. nothing about diet and exercise. So what do we do? You go out and try and exercise. Well, if you have unbalanced hormones and you're pulling up your cortisol every day, which is your stress hormones, and women, I call this women being a menopausal women being a half-dead horse. But they also are the jockey on top of the horse. So antropausal women, men, or men with gonadal failure or hypogonadism,

are also half-dead horses and the jockey on the horse as well. And what do you do? Get the horse going out of the gate every day when the bell goes off, but the horse can't function very well, so you get out the women, come on, horsey, let's go, let's go, let's go. That can't be used for diet and exercise. It just doesn't work. It fails. We know that. So if we are able to control diet and exercise and give guidance in a very healthy way,

Mediterranean diet being one of the best ways to go, starting off with low carb, maybe even a carnivore diet to heal the gut, get the stress levels down. If we're recruiting in cortisol every day, it will put on belly fat. So get the stress levels down. give a man testosterone back so he can function, get his brain back, get his energy back, get his enthusiasm for life back. A lot of low testosterone, a lot of low hormones and women looks like depression. And if you give somebody an antidepressant when they're cortisol depleted because they've been

running on cortisol forever and they're low hormone, you'll actually flatten them like fly under flyswater. And yet, what do we do? Oh, you're really depressed. Here, take more antidepressant. It's not a cure. It's not a mental health disease. It has mental health features, especially in women.

Like it's clearly, but men also underreport mental health issues. The risk of depression in men with low T is huge. Yeah, that makes sense. The concomitant risk of suicide, suicidality. Men just kind of, you know, bye, honey, buy a rover, and they walk out the door and they keep going, and they never come back to their lives because they just can't cope. We don't hear a lot about that, but it's not unusual. We hear about people just walking out of their lives.

Yeah. What are the biggest risks associated with TRT or HRT? Aging? Aging, sure. Well, and I think it... Cost? I think it has to be clarified, too, that once you go down this pathway, to my understanding, it's a lifelong choice. It's not something that you...

It should be. Yeah. Well, yeah, I guess that would be ballsy. I'm going to go six on, six off for the next decade. That's going to be a roller coaster ride of epic proportions. But it's also not, hey, I'm going to hit this hard for 60 days, and I'm going to be okay. I want people to make educated choices and consider the totality of the path. This is what it could look like, but this is what is required.

Exactly. So again, you know, the societies like the American Neurological Society or the endocrine society say, oh, you know what, you stop testosterone therapy once the levels are within range and the symptoms are improved. And then what? You just filled up a depleted well. The well is going to get depleted again. And so why would we stop therapy? Ideally, hormone replacement therapy brings somebody back 10 years.

That's pretty usual. I can probably get somebody there pretty quickly. Do I want to get them back to 25? Do I want to get them back to 18? Theoretically, it couldn't happen. Does it need to happen to that level? Maybe, maybe not. Is that, in the case of men, just the addition of more and more testosterone to get them back to that level?

Exactly. And you know what? We're afraid of the doses. Oh, my God. You know, this guy's getting 100 milligrams five times a week. 500 milligrams a week. It's kind of a facetious dose and a higher dose. I was going to say, it sounds like it's high, but I don't know shit. It absolutely is. Most of the times you're prescribing under 100 milligrams a week.

But if somebody's well is really depleted and you can't move the marker. It's like if you step on the gas and the old-fashioned spedometer, if you can't, if you're hammering the gas and the speedometer is not going up. What do you do? You hammer on the gas harder, right? So the bottom line is you've got to figure out where your target levels are. Where target levels between 300 and 900 in general. Men's sitting around 7,800 generally feel well. However, if I've got a man who is, let's say, a 48 sports coat and he's six foot three and he's got Mickey Mouse hands and he's got a deep, baritone voice, I might want to correct him to 1,200. And yeah, there's an issue of, you know, sort of testosterone addiction. You know, you feel so great on it that you just

more and more and more. Sometimes with brain function, that may have to happen. If somebody can't get two and five together and calculate that, and they're really brain dead, and they're feeling like they're thinking through oatmeal, then the bottom line is, where is the patient most asymptomatic? Where is the patient most recovered from? And that, to me, is really important, not just some number on a scale. Now, having said that, the difficulty with that is as a prescriber, we have our regulators to answer to.

And so these fallacies still come through. Oh, you can't give the guy that high of testosterone. You'll make them addicted. Or you'll give him a heart attack. Or you'll cause prostate cancer. So bottom line is, where are the levels? You could go by a recommended range. And again, 300 to 900 is normal.

So if you were at 297 and I corrected you to 300, is that okay? No. You're not going to feel that difference. Exactly. But if I correct you from 300 to 600, you might feel better. Or if I correct you from 300 to 900. And it all depends. goal is to start a prejuvenation program for younger adults. And between age 25 and 30, everybody

come in and get their saliva test done. And that's the levels that you need when you're corrected. Baseline, yeah. Yeah. Nobody's thinking about doing baselines, right? Which, and if you're not, you're kind of trying to hit a moving dartboard. You don't know where it started from. 100%. And you're filling up a well, but you don't really know how deep the well goes and how depleted it is. You can get a gestalt and an idea. And yeah, do I stop my peeps at some point? Or You know, if I get these astronomical numbers, will I ask them to withdraw for a little bit? Maybe. Sometimes, too, testing is tough.

A little crystal of hormone that is on, let's say, a tablet, or if somebody has a drop of testosterone that they've cleaned up off, you know, they're dripped out of their needle. And they clean it up and don't wash your hands really well before they test can blow the numbers off the chart. Oh, really? You can have that much even just. Absolutely. Absolutely. I've got people who take progesterone at night and they've got a capsule. And sometimes there's residue on the cap.

capsule, we'll come in at 30, 40, 50, 50, 100,000 on progester. I'm like, that's spurious. And again, as a practitioner, the experience of learning how to read those numbers is really important, really important. So, for example, if somebody comes in with a testosterone off the chart, I'll do a blood draw. Let's look at your serum levels and let's look at your DHD. Or I'll repeat the test tube. Here, go home and spit again.

Go drizzle some spit. Let's just recalke your hormones. Make sure you wash your hands really thoroughly with a fresh facecloth and towel. And let's get the saliva test done again, right? So sometimes you just have to learn how to flag those things and not panic and things like that. But it's really quite incredible because sometimes I see people coming in like those Christmas ornaments you see on lawns. I don't know if they're popular here, but there are these inflatable Christmas ornaments or the little thing you see at car dealerships off and it's a little clown that weighs its arms. The wavy head man.

Exactly. The wavy hand man. So sometimes people come in and it's like somebody's turned their fan off and they come in crumbled and depleted. And it's quite a privilege to watch people become the wavy arm man again. Because they actually just rejuvenate. It's like they get more air and they function better. And, you know, modestly, you know, with modesty, I want to say that many of my patients say to me, Dr. Ways, you saved my life. No, I believe that for sure.

You saved my life. It feel, I mean, you feel different. Again, I don't feel like a new person, but I feel better. But I also don't think my goal, and I was telling the doctor that I was doing the appointment with, is I'd rather take a much lower trajectory to get to a stabilized place as opposed to a bolus dose up front and then be like, we're too far left. We've got to come right. We're too far. We have to come left.

So I don't know if the current level that I'm at is the right one. I feel better. You know, and I would love to continue to feel better. But again, it's not without complications. It's like one of the things, again, shocked. The number of people that were doing this stuff. I didn't know and still I started talking about it, which is great because I can talk to them about their experience. I think there's an element of shame because especially for a man to talk about low tea is sort of connotated to can't get it up.

I mean, I guess, I mean, we could all pretend that time isn't marching for us all and it's never going to happen. But, okay, I guess we can get into fantasy. But nobody wants to admit that, right? And so I think for men there's a stigma around. And that's not true. Low T doesn't always mean lack of erectile function. Yeah. But I think people assume that, oh my God, if I tell people I got low T, they're going to think that I'm going to think that I. I'm impotent, I can't get it up, and I can't, you know, get rock hard anymore and all those things that appeal to the male ego, right? Which is really important for survival and procreation. It's very important.

Yeah. But the larger data pool, you brought up Himalayan salt. That was one of the, because I was talking to him about water retention. He goes, oh, yeah. He goes, A, I dealt with that when I first started as well, too. And he talked about a year, essentially, of moving the stereo levers to try to find what works And what does it? Himalayan salt was one. That's called the art of medicine.

Yeah. And so in addition to the testosterone, you know, there's vitamin D3, K2, I think it is. I'm on a very high dose of vitamin D because my shit was almost didn't even look like. Really important. Vitamin D.T helps with the production of testosterone. Sure. DHA and Pregnantalone. Perfect.

But I don't think I respond well to the DHA. I think it actually makes me break out. It can. And that is exactly the advice that I had gotten from the, guy had just talked to. He said he had a horrible issue with it, so he stopped. What's your dose? I think it's, I'll pull up my treatment plan here and I can show you. Unfortunately for me. Oral or topical? Oral. Everything I take is oral. Over the counter or compounded? It's a, that comes from a compound pharmacy. Perfect. So the DHEA and the pregnant alone are in the same capsule.

Okay. Because what I want to do is I actually, and I stopped taking that capsule earlier this week to see how it affects the acne. And then what I'm going to do, because I do believe it is the D.E. What I'll do is I'll re-add in the pregnant-inelone. I'll just talk to them and have them split it. Yeah. Because I wish it came individually because then I could really do a stereo test. 100%. But right now I can't really do that. So my professional approach is I give everything separately to begin with for that exact reason.

I can titrate up. I can titrate it down. Sometimes taking it all every alternate day actually helps to moderate a dose and then you know what's working. Because pregnant alone turns into testosterone. And testo and dHIA can cause acne and facial hair. So in women, DHA is nasty. because it gives them mustache and witchy hairs, as I call them, as well as acne, and it depends on the distribution of acne.

So facial acne on the jaw is mostly testosterone. Facial acne on jaw, upper shoulders, backs of arms, and a man will be DHA. Okay. I'm trying to find, I'm just going to send this to Michael, and he could literally pull this up and we can go through it. Because that way, I know it's a 50 and 25, but I don't know what the split is, the DHA to the pregnant alone. It could go either way. I can't even hazard a guess on that. The other thing that's really important.

too, as you said, the long-term commitment to this. Yeah. Yes, can somebody use this for five years? You know, the old recommendations for women, for example, were five years post-menopausal to get symptoms under control and off. What does that look like when you come off of that, though? So your blood levels come out, your hormones come out of your blood in about 30 days. Okay.

They come off the receptors in about 90 to 120 days. And then you slowly, well, not slowly, probably about four to six months in, you revert back to the hormone levels that you had prior to the therapy. So really what you're doing is just reinstituting the problem that you sought therapy for anyways. Yeah, that's what I thought. And if you can enjoy a statistically significant reduction in all-cause mortality, why would you give that away? Yeah. Got an ease in your pocket.

Yeah. Did it come over, Michael? All right, so you can just pull it up. Take a, yeah, go ahead. Just pull it over. This is how little I care about being honest about what I'm doing. People be like, oh, my God. Hit the button, Michael.

Do the thing. Yeah, I'm trying. It's not working. Hold on. I feel like it's operator. So why did they think pregnant alone would be part of your regimen? Do you remember the... It's going to break it out here in this.

This is one of the things, it was like a huge document, 40, 50 pages, talked about everything from diet to sleep to... God damn it. Good, Michael. Now scroll down. Enhance. So I was at this conference one time, and this is very apropos. The presenter said, you know...

Figured out and pull it up when you're done, Michael. When you've got hormones or when you've got... A patient, what you want to do is sprinkle, put sprinkles on a cupcake. Right? He said, but sometimes patients bring you this and you're putting sprinkles on this and it was sprinkles on a pile of dog poo. Yeah. Right? So the basis, and I was really happy to hear you say this, that this is part of a package.

Oh, it's huge. Because if the diet is. Testosterone is like one of 12 things that they recommend. For sure. Yeah. Because if diet is not right, hydration is not right, sleep is not optimized, stress levels are not optimized, introspection, exercise. alcohol use, smoking, lifestyle habits, and our intake form deals with half of that. Like, probably five pages is medicine.

The rest of it is lifestyle and diet. There's another one that changed post-surgery. I have had just way less of a desire. Like, I've never been anything other than a social drinker. Never really, it never got its hooks into me. I turn it off for years, turn it back on. But after that surgery, it's far decreased desire to actually drink. My alcohol consumption is probably one to two percent of what it's been in the last six months

from that. Scroll down, Michael. It's fine. Why do you think that is? I have no fucking idea. It just didn't feel like having a drink. So anesthesia doesn't come out of your brain for probably about six months to a year. The old battle ax nurses will say that. The newer ones say, nah, you'll be fine. Since you wake up. This weekend, then I'll drink that shit.

So neurologically, what are you doing, Michael? You're going through all this shit. Okay. Keep, I mean, yeah, this shows the Let's just start. Actually, go down. Oh, good. They did the CGM. Okay, so here's the first thing. It was, I don't know the MGs or the units or all that stuff. I go to the five days a week at 1.1 on an insulin needle, which is, I think, the 40MG.

Right. Okay. And that's a reasonable starting dose. And it's the Cipionate. So skip that, Michael. I'm sure she understands that. These, the, you know, affect use. So this is a synthetic testosterone.

And this is a difference between what you're using here. We alluded to this a little bit earlier. The synthetic anabolic negatively affect your cholesterol. So they will drop your good cholesterol and raise your bad cholesterol. A bioidentical or natural hormone will actually support your cholesterol. Is that just a matter of a prescribing physician writing something different on a piece of paper? Exactly. Okay.

Exactly. But many people will take the injectable option. So for example, I've got... Oh, so the bioidentical is not injectable? No, it's usually cream. You could get it as a capsule, not advisable. Okay. You've heard there can be some stomach issues with the capsules?

It depends on the form. as well. So one of the things that I actually, here I am a pharmacologist, just learned or re-learned or whatever recently in a course was that micronized hormones are better, I knew this, are better absorbed. But the micronization process is different.

So think about a box grater and a piece of cheese. If you micronize it on the pizza side, it's not absorbable. But if you micronize it on the parmesan grading side, it's way more observable. So micronized hormones are not micronized hormones. They're not equivalent. The process of how

those are micronized is really important. So here in America, you have PCCA, which is professional compounding centers of America. They do a great job on compounding regulations, rules, acquisition of raw materials, protocols for how to mix, how to compound. And there's criticism. Most of the medical societies and some of the places like, you know, urological society or the endocrine society frown on compounds. They say, don't use compounds. But yet that's all we had before pharmaceutical medicine was compounded medication or homeopathics. So bottom line is if you've got a really excellent compounder, if they're under Medica or PCCA, Medica is the alternate to PCCA, and they're following the regulations on how to compound, they're very reliable. And if your lab is actually

sending out for third-party testing on occasion to say, hey, I made this, can you verify that that's what I made? And they're like, yeah, you've got a, you know, six degree of percent error. Then, and that's really funny, because we criticize the compounded medications, which by formula should be pretty standard. Yes, there's operator error, et cetera. You waste a little bit going from the scale to the mixer. But in your blood tests, there's up to 10% error, depending on the method in which it was evaluated.

So on one hand, we criticize the delivery method of the therapy, and yet we don't really criticize and acknowledge that there's a huge degree of error in our testing methods. Fair enough. All right, Michael, go down to the next one. Tedalafil. Tedalifil. This is brand name.

Cialis. Yep, one quarter of a pill sublingually every day. So the data on erectile dysfunction go like this. Testosterone replacement therapy may or may not solve erectile dysfunction. Which I had no complaint of. This was just something that they added, I believe, for other issues interfacing with the testosterone. It's not a bad deal because it increases nitric oxide, which relaxes your blood vessel. So this is really great for blood flow generally. This is also really great for lower blood pressure. So in the, in the penis, we have very small blood vessels. And when a man is starting to have erectile dysfunction, so not waking up with morning erections or failure to penetrate because firmness of erections are inadequate to penetrate in intercourse,

then the bottom line is that is a very early indicator of coronary artery disease or you call it here, yes, coronary artery disease or coronary heart disease. Bottom line is if the small vessels are being affected and they can't get enough blood flow to achieve temescence or hardness of an erection to achieve penetration, then a man needs a cardiac workup. Interesting. Did you write that down, Michael? Your inability to penetrate? Yeah.

That's something I've been struggling with for a long time. He's like fucking 14 years old. So this is like insurance. Yep. Okay. Go down, Michael. This is the one that I wish that I could split so I could see which one I, because I do believe it's the DHEA that is causing it, just based off conversations with other people in their experience.

So you've got 10 milligram sustained release DHA and 25 of pregnant alone. That's interesting because I start my man at 50 of DHA. And pregnant alone depends on what the situation was. I like pregnant alone in brain injury, traumatic brain injury, although there's not a lot of evidence for it. I like it in chronic pain. You don't always have to replace pregnant alone because the downstream harm. hormones of DHA and testosterone are being replaced. The role of pregnant alone is not really well understood, but it is an option. And you see there it may be protective against Alzheimer's disease. Well, testosterone itself is protective against Alzheimer's disease. Yeah.

So again, you know, this is all personal preference of the provider and how they like to practice. This is where we have our own personalized approach based on professional education and preferences. Yeah. I'm not going to criticize anybody with their pen. It's not my right to do that. Pregnant alone's not wrong. Next one, Michael. This is so important.

Yeah, I take a, there's a thyroid and another one that I take, which is like a daily support complex. Which thyroid are you taking? Is it the synthetic synthroid or althyroxine, or is it desiccated thyroid? I do not know. Would that be on the ingredients on the bottom there? It would be on your label. They just say thyroid support complex. Okay, this looks like this is a nutrient recommendation.

However, this is another area that's overlooked and overlooked by most physicians, including allopathic physicians. So what happens is in the brain, there is a hormone release called thyroid-stimulating hormone, and it talks to the thyroid and tells it release hormone. Depending on how the thyroid is responding, it either whispers or it shouts. So it's an inverse relationship. If you have to shout, something's not listening and not working well. In a u-thyrid situation where everything's working properly, the thyroid will then release

T4. There are four thyroid hormones that we know of. T1 and two are very poorly studied. We don't really know the rules of them, but T3 and T4 are really important. And so T4 is less active than T3. T3 is the most active in the functional form of thyroid. And when we have functional hypo or low thyroid issues, it impacts cholesterol negatively in that it will increase LDL cholesterol, which is what we treat with statins,

etc, etc. Increasing risk of heart disease and stroke as traditional risk factors. It also negatively influences things like apoprotein A and B and the ratio, which is also important for heart disease and stroke. And thyroid is thermostat to the body. Fat mass, body temperature. We know if you're hotter body temperature, you burn fat more easily. To burn fat, you get rid of it by releasing heat. Bowel function, cognition, mood. So low thyroid also mediates depression, can have some anxiety components, but mostly depression, hair, scalp density of hair on the scalp, thoughts. So I call it constipated brain. If people are having difficulty with thoughts, and more and more and more. So when thyroid is low, oh, I missed a really important one in men.

When thyroid is functionally low, erectile dysfunction is increased. So if we're not monitoring and supplementing thyroid, and again, our regulators have all kinds of controversy over this. So, for example, the lower end on our scale that I use at the lab is point three for the TSAH, which means that the thyroid is listening to that signal from the pituitary. If we drop that TSA by adding more T3 or more thyroid into the system, our regulators tell us that we're inducing hyperthyroidism. We are not. Hyperthyroidism is an, excuse me, hyperthyroidism is an endogenous disease.

you develop hyperthyroidism when your thyroid's working too hot and too fast. That causes a whole plethora of symptoms, insomnia, diarrhea, anxiety, sleeplessness, etc. Hair falling out. That sounds fun. Right? Not really. Low thyroid does the opposite. However, we can replace thyroid and drop that TSA low as an example and indicator of therapeutic outcome.

Because when the T3 is in the upper range or above the upper limit of the risk, range, you destroy visceral adipose tissue. So remember, DHA increases that apoptosis of visceral adipose tissue. So the cell death, so does thyroid. So does thyroid give you energy, ability to build muscle, cognition, memory. So it's really important that thyroid is taking care of. Here it appears that they're using a supplement that includes some of the precursors like zinc, selenium, tyrosine, et cetera. Tyrosine is the building block of thyroid hormone. And Bacopa is a really great one for energy. The botanicals like force glint and chemoforea also help to optimize thyroid function. Now, these are sometimes sufficient and sometimes they're not. And what some of these do,

like zinc and selenium, encourage the conversion in the body of T4 to T3. So you might pop your T3 levels up. I use a lot of natural thyroid, which comes from pigs. They desiccate the thyroid. They dry them up and they pulverize and they put them into capsules. And again, the criticism of that is, oh, well, there's no standardized dose, which I really laugh at, because if you ever look at your drug bottles, or you look at the medication, if it says USP, that stands for United States pharmacopoeia. And when it's USP pharmacopoeia, it's a standardized dose and tested for stability and reproducibility in the tablets. So somehow these pig thyroids have been able to be desiccated and pulverized into standardized doses. Thyroid can also be compounded. Again, the criticism of

compounding, oh, it's not very accurate. No, it's very accurate. In fact, when I was in residency, we used thyroid hormone to augment depression medications of people with refractory or untreatable depression. And there was a national shortage of pharmaceutical T3. So they relied on compounding pharmacists to create it in order that patients with psychological distress and depression could have their augmentation. It took about a year and a half for that thyroid to come back on the market. So we kind of swing with the wind like a flag.

You know, when it's appropriate, we'll go to compounding away. when it's not. So we just have to be careful to understand that compounding is very reliable. Now, not every pharmacy is reliable. For example, recently I had a woman's prescription be faxed back to my office and the compounding pharmacist did not have enough experience. They wanted to put her hormones in petrolatum, which is basically vaseline. I'm like, okay, we'll just like... We're talking about human beings. We're not all created equal. Some mistakes will be made. We'll recall that prescription and send it somebody who knows what they're doing.

So again, you know, patients need to ask questions. They need to ask about what kind of of experience the compounding pharmacist has. You know, if they follow PCCA or Medica guidelines, then those are really good reasons to think that your pharmacy is trustworthy. Now, within each compounding pharmacy, there's different practices, some of which I don't really agree with, where they compound high dose creams, for example, and then they spatula them off and mix it with a base cream to reduce the dose. I don't think that's as accurate as a pharmacy individually compounding each prescription by

hand. So just ask questions. It's really important. What's the next one, Michael? 100%. This is just information, essentially. So interestingly, insulin sensitivity, and I like the fact that they have berberine there, but berberine acts like metformin, which is one of the oral...

Just click it to the next one, Michael. Diabetes medications. Burbrine has the side effect like metformin of producing diarrhea in some people, so it may not be as tolerated in some people. I haven't had that issue yet. I'm happy to report to you. Well, and the nice thing with berberine, it's a one-two punch because berberine actually helps to reduce inflammation in joints. Really great for people who work out really hard,

people with early degeneration of joints, like early osteoarthritis, et cetera, knee pain, et cetera. So if you're taking enough burbreen, you might notice that it actually will cause some pain like in knees or hips, because now the tissues are being so stimulated that they can actually have a little bit of an achy

or throbbing type of sensation. So far, I haven't had either of those. So, I mean, maybe I'm right on the sweet spot from what I'm taking. Absolutely. Either of that, okay. Now with burbrine, the other thing that can happen, you're saying

$200 for 120-day supply, which really is about $50 a month, which is really reasonable. However, metformin can be used in place of burboreen. The problem with metformin, first of all, it's pennies produce. Many people who have drug plans will have it covered. The problem is every person who sees you in medicine

will assume you're a type 2 diabetic. And in some insurance policies, based on the day when diabetes was newly found and the therapies for diabetes were not as effective, some insurance policies are. are negated, especially home mortgage policies, mortgage insurance, are negated if you're type two diabetic. No shit.

Yeah, yeah. It's still on the books. Okay. Interesting. And an insurance company's job is to not pay out. But definitely collect. Oh, yeah, absolutely. But if they can find a little chink to put their finger in to not pay out, that may be a clause.

So if somebody wants metformin for anti-aging or insulin sensitivity purposes, it's really important to look at your insurance policy if you have mortgage insurance. For sure. God, I would never have thought to connect those to it. Yeah, it's kind of a crazy old thing that. still penetrates into the industry. I've never had anybody declined. Of course, I've known if patients die. Well, I do once in while patients die. Eventually they're all going to die. Yes, and they tell me I can't retire before they do, so I have a tall order there.

Next one, Michael. This is kind of the description. What's the, go to the next one? Omega-3. Can you go back, Michael, to the one I had? So at the bottom, it says, Goals, reduce APOB to below 70. I'm really glad to see that this organization is actually looking at APOB because cardiologists are only looking at APO A, and it's actually the ratio between APO B to APO A that's really important in terms of your cardiovascular risk. So this is a genetically oriented risk factor. This is not changeable. This is called a secondary risk factor. And then your triglycerides, triglycerides below 80. I would have to do a quick kelk to see what that looks like. C-reactive protein below, so ours would be seven, seven and a

Your is 0.75. I agree with that, so it should sit between 7 and 8. And limitation of oxidized LDL, you can get that marker done here in the United States a lot easier than I can, but it is really important to look at particle size and oxidation of LDL. So basically, LDL are smaller particles of cholesterol. So if you think about cholesterol, like sugar molecules, the HDL is like a sugar cube. It's really important because our arteries basically have these little pores inside of them. and the smaller the particle, the easier it is to get in the pores. So LDL would be more like table sugar,

and then you get other particles below that that are smaller yet. And so when the small particles of low-density lipoprotein, which is the bad cholesterol, get oxidized. It's like rust inside that little pore, and that starts intimal injury, so the intima is the inside of the artery. And so that starts to get irritated, starts to get inflammation,

and then you start having accumulation of cholesterol as a bandage, and then also platelets and fibrinogen, which increase clot size. Now, what's interesting, medicine is very interesting. We think that if you get a clog in this little pore, that eventually it's going to push out and clog an artery by just building up and becoming a physical road obstruction, right? So you've set up a barrier and blood flow can't get through. And that is absolutely wrong.

Solid plaques don't cause heart attacks and stroke. And LDL cholesterol, when you look at something called the Framingham risk score, based on a Framingham study, which is the most impressive and longitudinal, meaning going forward, study of a town in Framingham, Massachusetts. They had people recruit in, and they will follow them through their lifetime. Now, yes, is cholesterol an important risk factor? It's debatable. Are statins used in reduction of cardiovascular disease? That's also debatable. There's a fellow in England. His name is Dr. Assim Malatra. He actually has made his whole

career on debunking that statins or cholesterol medication are effective. So when we talk about cholesterol, there's something called the Framingham Risk Score, which will predict, give some predictability of the chance of having a heart attack or stroke in the next 10 years. Interestingly, that calculator takes into account total cholesterol. So cholesterol is like a family of all these little particles within it. So total cholesterol and good cholesterol. I don't believe. that LDL cholesterol is indirectly calculated in that, but LDL cholesterol does not appear in the Framingham risk score. Hmm.

So it's kind of interesting how we make these absolutes about, oh, your Framingham risk score, you know, Mr. Stumpf is, you know, 10.1 and 10 is a higher risk, so, you know, we've got to get your cholesterol down. But the other thing that we fail to recognize is testosterone actually prevents against heart attack and stroke, when testosterone is adequate and robust. And the bottom line is, what is testosterone made from? All sex hormones are made from cholesterol. So in our region, he's now retired, but there was a physician who made his career on cholesterol management.

Those of us who have never had a heart attack or stroke, he wants our total cholesterol below 2.5. Total cholesterol. Total cholesterol for us sits around up to about five and a half. So if your cholesterol is a 4.2 and you have no other risk factors, he still wants to get that total cholesterol down. And the problem with that is you stop making your sex hormones. When you stop making adequate sex hormones, you double your risk of heart attack and stroke. Oof, that's a tough bargain. So there's no clear-cut answer.

And what's happened with medicine is that it's exploded in the last 40 years to be so expensive that we basically have a microscope on our eye and we have this, I call it a rifle vision rather than a shotgun. Small focus, really deep penetrance for our rifle viewpoint. but sometimes you've got to sit back and take the shotgun approach because you have to look at the big picture. Yeah, I agree. So as my colleague in medicine that I trained with said, if you have a hammer in your hand, you see every problem is a nail. So if you're a cardiologist or a lipidologist and you're making your career on controlling lipids, you're going to want everybody's cholesterol low, but you don't really care about their sex hormones because that's not your, that's not your stick.

Yeah. Go to the next one, Michael. This one, it's just omega-3. Omega-3 is so important. Yeah. And so it's, what is it? I think two or three per day, something like that. Go to the actual Michael. Hard disease, I don't know how to say that.

Is it timibae? I don't know. Is that a mib? That is not how I said it, but I'm going to take your word for it. So yes, it'll affect your LDL cholesterol, apore protein B, and triglycerides. So again, LDL cholesterol is like table sugar. Triglycerides are like powdered sugar that you would get

on a donut if we're going to use that sugar analogy to explain molecules of cholesterol. Your triglyceride levels are way more important than your LDL cholesterol. Okay. Next one, Michael. And this is a statin. So interestingly, is etymab

is a statin. So you're actually not getting the health benefits from having a statin. So here's how this goes. If again, the numbers needed to treat are 19 to prevent one heart attack or stroke. So you're probably, just by statistics alone, one of the 18 out of the 19 that get no benefit from this. In addition, at two years after using a statin at therapeutic dose,

you will change five independent risk factors that double your risk of heart disease. Would you stop taking that? Absolutely. Okay. So those five risk factors are your aproprotein A and B will get deranged. Your fibrinogen will go up. Fibrogen breaks down into fibrin, which forms clots. Your homocysteine, which is that inflammatory marker, will increase.

your high sensitivity CRP, which is again another inflammatory marker, and inflammation suppress testosterone levels, it will also increase. And then COQ10, which is really important for the energy production in the cells, depletes a two years after statin. So you've changed one risk factor, which is LDL cholesterol. But fucked with five others. Exactly. You got the picture.

This is that vitamin D3, K2. Absolutely. And K2 is so important to direct calcium to the bones rather than to the arteries. Next one, Michael. I love this nutrient. Yep, magnesium. I tell people, go party with this one a little bit. Have a touch too much.

Have fun with that. It's really self-criticking. It is, isn't it? And there's a safety valve for it, isn't there? You've noticed. Yeah, you know, it's easy to find where the upper threshold is and just back it off from there. I would imagine. But when you find the upper threshold of magnesium need, it's really important.

So I have a protocol in my office where I have. ask people to increase their magnesium glycany to the point where they have mushy, porridge-like stools. Yeah, three in a row. And that is the upper limit. Push it farther, and you'll have those uncontrollably. Yeah, the stops on, your genetic signature on it in a couple of days. Then we back off until the stool is very toothpastey, consistency, snake-like and easy

to pass. The reason we go above that, again, we burn magnesium and zinc under stress. If you live in the world, you're burning your magnesium stores like crazy. And the bottom line is when you get those porgy stools, it means that your stores are saturated. You've actually got to your own saturation point, and that's a personal dose for everybody. When you back it off, that's your personal dose of magnesium. And then just watching the consistency of the stool. So if it becomes more constipated like or firm, then you can increase the magnesium dose.

But this will help most people sleep like a baby as well. Yeah, that's why they recommend it right at night as well. What else we got, Michael? Love this nutrient. This is like Drano for your arteries. How do you say that to, natokinase? Or natokinase. Okay.

Yeah, this is great. So natokinase is, like I said, like drenal for the cells, sorry, for your arteries. It's actually known to be as effective as a statin. That's why you don't need both. If you're on natokinase and you're investing the money into the supplement. And again, this is where personalization of everybody's program comes into play. If somebody doesn't have disposable cash to afford multiple supplements in a month, and they've got pennies on the dollar for a statin.

would you prescribe a statin? Personally, I don't think so. Personally, I think the numbers don't support statins. Personally, I think the risk factors of changing one for five is not worth it. But then if somebody has higher risk, how do you address that, right? Fair enough. Next one, Michael? All right, I say phosphatylcholine.

Phosphatylcholine. So I love this nutrient for sleep. This is a huge stress reducer. This is a huge fire hose for brain fire. So brain on fire. thoughts at night overactive brain not allowing people to sleep. But then in the second sentence to the right there, it says, coline deficiency can lead to non-alcoholic fatty liver disease.

And this is now becoming epidemic in North America. This is basically a nice marbled steak appearance of your liver. Which is not what you're going for, I believe. No, it is not. So a nice marbled steak on your plate at a steakhouse may be desirable. Yeah. But fatty liver disease most commonly. from alcohol, but now non-alcoholic fatty liver disease.

This is now called OFLD, obesity, fatty liver disease as well. So basically this is that visceral out of post tissue. It's around the organs. Those stores get saturated, and then there's nowhere else for the fat to go. So now infiltrates kidney and liver and can lead to cirrhosis of the liver and liver failure. For a non-drinker? 100%. Wow, that's crazy.

Usually you associate that with just an alcoholic. Exactly. So obesity can lead to liver failure. Okay. And liver failure usually means multi-organ failure because it'll affect the kidneys, which then will affect the heart, and then people generally die from multi-organ failure. All right. This is a nasty disease to have...

Oh, that sounds horrible. Death from cirrhosis. Yeah. What else we have, Michael? Methylation. 100%. So this is your B vitamins, especially B-12. Click the next one, Michael.

Oh, no, actually, it's right there. One more? Yeah, there you go. That's the support complex. Exactly. So homocysteine is really responsive to B-12. this will help you drink more coffee, especially a black rifle, but again, it's probably not the best choice of beverages if you overindulge, right? I actually, you know, when we first opened the coffee shop, I would lay in bed at night wondering why I couldn't sleep, and then I realized I was drinking coffee at like 4 or 5 p.m.

So I knocked that off. I try to kill it by about noon, and I do way better. So there's a couple of ways that I indirectly get to methylation support in people. Yes, I can measure it. And that urinary hormone test actually, usually the companies provide a measure of methylation because it's really important for estrogen detox. So when we talk about estrogen, estrogen is not a single hormone like testosterone. Estrogen is a group or a family of hormones. So really what you want in a man increasing is estrogenial to help with cardiovascular disease, bone health, brain health, and cholesterol and heart disease.

Bottom line is there are at least three estrogens that we know of, predominantly in women, one of which is called S-Tron, and it breaks down into toxic metabolites that can increase the risk of breast and uterine cancer. So methylation is a really important detoxification method, and people will know if they need meth support because if you eat asparagus and you have musty pee after eating asparagus or you get wired on coffee really easily, or Tylenol doesn't work for you, or coating doesn't work for you. So those are four tests of choice. Really simple questions to ask to know if somebody's methylating well. So your pee should smell weird after asparagus? Should not. So if you have a smelly pee, you don't methylate well, if you get wired on coffee.

If you choose Advil over Tylenol, because Tylenol doesn't really work, and if you've had a coating complex like Codian Cofsarebic Tylenol with codein, and it doesn't really relieve pain, you're not a good methylator. Okay, fair enough. Next one, Michael. Cats are great methylators. Yeah, five milligrams of, what is it? Yeah, five grams of creatine. Right? This can help with muscle building, so canel carnitine.

Yep. But then you see the memory parts of the benefits of having creatine. I just blend this in with one of the cups or glasses of water I drink in the morning. Pretty easy. Absolutely. You can probably use this with MCT and coffee as well. That's another one. You've got to be careful with the upper limit.

Oh, yes. Not magnesium with the upper limit and can MCT oil, right? Next one, Michael. The only thing with creatine is people with chronic renal failure or kidney problems can't always handle creatine. And so you just have to be making sure that somebody's done your kidney function. That's it. The rest of it, they ship the injection stuff as well, too. Okay, so the other thing is alcohol swabs.

Yeah. Okay, I'm just going to give a little advice here. I would like to see you change to chlorhexidine swabs. You write some stuff too. Yeah. I can write it for you later. Okay, let's just do that. The reason being, I do nutritional therapy by IV in my clinic,

and we were getting a lot of phlebitis, which is small clots in the veins. And it was pissing me off because I'm like, listen, I'm a really good operator. If I can make in my studies as a student, as a graduate student, I used to make RNA and DNA. And you have to be so sterile for that because if you get one little lens, I'm in there, choose the DNA fragments up and you've lost all your material. So you've lost, you know, day, day and a half of work. And for me, I was using a lot of DNA and RNA markers. So I learned such phenomenal, clean and sterile technique that I can translate into clinical practice. And so when I was getting these little phlebitis occurrences, I was really pissed up.

And then I actually contacted the gal who is like the world's authority on IV therapy. And she said to me, yeah, yeah, yeah. Bottom line is alcohol doesn't clean all the bacteria from the skin. Chlorhexidine does. Okay. So when you, and we've used that, we've switched from alcohol. Does it come to do the same thing to swab? Yeah, it's a little swabber.

You get a bottle of it and just put it on a cottonball. The reason being when you are doing testo injections for you a sub-Q is important, but intramuscular, even more important. One of the problems with testo injectables is abscess formation. And when we entrain bacteria on that needle, you have the cleanest technique you want. But if you're not cleaning the skin really well and you're just using alcohol, there's a possibility that you have alcohol-resistant bugs in there. And you entrain it into the muscle, and then you end up with a big infection. And that's disastrous.

I think that's basically it's, I mean, they send that along with it every time. Yeah, of course. What would you add? Is there any glaring holes that you would add to that? That's the current treatment protocol I'm on. Well, like you, I would like to see your pregnant alone split apart with your DHA. Which is solvable. I think I just need to ask for that.

Yep. And then the thyroid. I'd like to see what's happening with your thyroid numbers. And then I would see if I would add thyroid. Yeah, I'll send you my most recent blood draw. Yeah, I'd love it. I'd love to look over that. Was there anything else I would add? I would want to know what your E2 levels are, your estrogial levels and your DHT levels.

Those are really important for functioning. Will that be in the blood report? It would. Okay. And I'd like to see your cholesterol levels. So those are all things that I would look at. I would look at precursor diabetes as well. So one of the liver functions, I would like to see what you're free and,

and bioavailable testosterone. So that's the other controversy. What do you choose? There's different forms of testosterone. I remember both were in there. I just don't remember what the numbers were. So for people understand that, again, there's different ways of testosterone going through the body. There's just free floating in the serum.

There is bound testosterone, so the total testosterone includes everything. But most of the hormones are bound to proteins, usually albumin or other proteins on the body. And those are really not that available. The protein complex is bioactive as well. nobody's really studying what happens when protein is bound to testosterone what action does that do what happens when testosterone or other sex hormones are bound to something called sex hormone binding globulin well that's also a bioactive protein but nobody's really studying the effects of shbg testosterone complex or shbg estrogen complexes so what we really need to look at is the free testosterone

or the bioavailable most labs need to calculate the bioavailable by looking at the SHBG with the total and the free and they do some calculations and report the bioavailable. But bioavailable and free forms are really the most important metabolically active forms of testosterone. So if people are only looking at total T, then that's a problem. Yeah. Also prostate. PSA, total PSA is usually what we use for screening. If there's concern, then we also have to look at the free fraction of PSA and the ratio of those.

So looking at hormones is not just about looking in checking boxes. is okay, testosterone's an arrange, this isn't a range, that's an arranged. The ratios between certain things are really, really important, and knowing those outcomes to look for as a practitioner is really important. The forms that you're prescribing, are you giving somebody a synthetic antibiotic antibiotic being testosterone-scipionate? It lowers your good cholesterol, raises your bad cholesterol. Would you rather change to a bioidentical and then making sure that what's being used

at the compounding pharmacy is micronized in the proper way? What are your thoughts on the pellets for testosterone? Pellets are very interesting. I think that it is a not really understood mechanism. They say that it absorbs through lymph. Yeah, but how do they know how fast it's coming? You know what I mean? I had a doctor kind of pitched me on the pellets,

and one of the things he said was it was bioidentical, so it goes along that line of what you're saying. I just can't, I don't know, do they make the pellet in a certain way that it only releases at a certain amount? Like, how do I match via a pellet, a very precise injectable dosage per day. Right. Good question.

So the mechanism is not really understood, but the pellets are crystallized, and they're formulated to release slowly. So it's sort of like a slow release product, like your DHA slow release. Bottom line for that is it's inserted subcutaneously in the fatty tissue. It absorbs in the fatty tissue and is presumed to go through the lymph system and then disperse through the lymph glands, through the lymph system. Mechanism is not clear to me. the weight was pitched to me

there's only really one company that doesn't in Canada and a compounding pharmacist that makes the pellets it's not very popular in our neck of the woods it's also a surgical procedure so a lot of people don't like to be poked you know you freeze the area it's just a small incision insert them in

do they stitch it up or does it a small enough incision where you don't have to stitch it depends on the practitioner I prefer because of my experience with procedures you know in medical school before I graduated I'm like you know I think I better learn to close up a good wound right and have good cosmetic outcome. I prefer sutures or stitches in

most tissues. Face and anything on the face? Absolutely. Absolutely stitches. You've got a way better cosmetic outcome. And if you're going to get pellets every three months and have incisions in your butt and an interesting little, you know, farming

row of incisions along your ass cheek. Not all of us will be butt models and we're, you know, where G-strings or something, but bottom line is at some point you have to look in the mirror. or you feel the scar tissue. And then if somebody's opt to cheloid, which is one of those really high,

rolly kind of scars that looks almost like a caterpillar in the track of the wound, there's no way to predict. You know, we know that people of color, African-Americans tend to cheloid more. People with browner skin tend to cheloid more, but I've seen a lot of chelots and a lot of whites. Yeah.

You know, Caucasian-looking people, and that's not necessarily, who knows what your genetic background is if you haven't done a genetic analysis and what your propensity is. Fair enough. You know, you touched on something earlier, too, around heart disease. You know, they say with testosterone replacement that men are at higher risk of heart disease and stroke.

So there's a huge big black box warning from the FDA on any insert of any testosterone injectable in therapy. Have you looked at your package insert? On the Cipionate specifically? All of it. Any testosterone that is commercially available. I will have to take a second closer look at it. Yeah. So the black box warning says.

that there's a higher risk of heart disease than stroke in men. And that is absolutely not true. We know that testosterone favorably changes testosterone, changes cholesterol as long as it is not a synthetic brand. It can increase HDL cholesterol. We know that there is no higher risk of clots. That was one of the big issues. We know that in men, low testosterone can cause anemia

because the red blood cell count goes down. Red blood cells are called erythrocytesy. With testosterone therapy, you can map it. You can see the orthorocytes increase. And it's often transient. Often it'll come up and then go right down. But in some men, they make more red blood cells. And so the thought is more red blood cells, they're just going to stick together and cause a clot.

Well, that's not true. That is not true at all. For example, Calispell, 901 meters in altitude. Boston, 15 feet above sea level. Does that mean that more men of younger age with high. testosterone and Calispell are going to get blood clots? No. People who live at altitude tend to have higher red blood cell counts. Helps with the oxygen tension in the air, the lower oxygen, right? And so they adapt by having more red blood cells. Doesn't mean the more people in Calispell or people who live

at altitude, there are 500 million of them have an increased risk of blood clots. It's not true. And so there's this, again, myth of erythrocytosis or high red blood cell counts than people with testosterone therapy, developing clots and strokes and heart attacks. Again, heart attacks and strokes don't happen because usually of blood clots. They do exist. They're called thrombotic events. But going back to that cholesterol and plaques in the arteries, we talked about the pores in the arteries and the particles going inside. There are two kinds of plaques in our arteries. One looks like a jelly-filled donut and one looks like a cinnamon bun, a heart center or a liquid core. The liquid cores, like Vesuvius. And when those plaques explode, they create a localized cytokine storm.

We all heard about cytokine storms now with recent events, right, in public health. That cytokine storm brings in platelets, which are clotting factors. That fibrinogen that you have increased with a statin over two years, it breaks down into fibrin, forming a fibrin net. So it catches the platelets, almost like fish netting and catching fish. And that starts accumulating the blockage that occurs in a heart attack or stroke. Certain hormones can change that jelly-filled donut into the consistency of a cinnamon bun. Hard plaque, no explosion.

It's not true that when the particles get inside the pores, that they keep building up and building up and building up until the artery blocks. It's not true. Exploding plaques cause heart attacks and strokes. And to date, there's no evidence that testosterone therapy causes plaques to explode. In fact, the astrodial component

is likely what's responsible for changing the center of a plaque from liquid to solid. And I can't say that with certainty, but that is the mechanism in women who have esteridal replacement. It actually shrinks the plaques into hard cores, reducing the risk of explosion, therefore reducing the risk of heart attack and stroke. That makes sense. Fuck, you're talking well over my head. Michael, do you feel like an idiot yet?

That's not the point. Sorry. Yeah, but I felt like an idiot before we walked in here. I did, too. I'm just a moron. No, I like the explanation. When you stop and you think about the common sense of that, people at elevation don't have. There's no evidence in the literature whatsoever.

The people who live at elevation who knowingly have higher red blood cell counts have increased risk of heart attack or stroke. So what's happened is in medicine we mince words, but we don't mince words. And what that means is that we use our terminology inaccurately. And if we, there's a whole move towards patient-centered care in the last 20, 25 years, which is important. Patient is the center of the care. We need to have the patient understand what's going on and speak their language instead of this high-flutant Latin-based terminology. But even in the literature, we use things erroneously. So there is a genetically derived disease called polycythemia vera.

This is a condition that is genetically determined in those patients have high red blood cell counts, high white blood cell counts, high platelets. Platelets are your clotting cells. they have a higher risk of clots, DVTs, pulmonary and bliss, strokes and heart attacks. High red blood cell count called erythrocytosis is not polycythemia vera, but we kind of use them interchangeably like, oh, they're going to get polycythemia on testosterone, so you can't give that because you'll increase heart attack and stroke. So the FDA warning is also erroneous because it makes assumptions on a disease that's genetically based. Additionally, when we look at, if you look at testosterone,

cypionate in the big Bible of drugs, and you look at testosterone, the same warning for synthetic testosterone is rubber stamped into natural testosterone. When men have high testosterone at their prime, age 25 to 30, do you see people having fractures, heart attacks, stroke, prostate cancer? No. No, just poor decisions in behavior. Absolutely, which is natural, which we would expect, right? testosterone driven, right?

Yeah. But the bottom line is if you took 25-year-old man and you lined 100 of them up, you had them bend over and drop their drawers and took samples of their prostate, they already have what's called neoplastic cells. Neoplastic cells are abnormal cells. They're not prostate cancer. They could progress to prostate cancer and they're pre-cancer cells. But why don't 25-year-old men have those neoplastic cells turn cancers and have prostate cancer?

Because testosterone suppresses growth of neoplastic cells. And that was demonstrated by Abraham Morgan Teller in his, I think, 2008 book called Testosterone for Life. So Morgan Teller is a faculty member at Harvard University. And Harvard has this fantastic archive collection of just about every published study in the world, somewhere in the bowels of Harvard University. So Morgan Teller takes the risk and the time to go down and look at these studies, because we also assume that if you give a man with prostate cancer testosterone, that would be like gasoline to a fire.

And there's this natural assumption. You asked about PSA and prostate cancer before, and we never talked about it. But the bottom line is, Morgan Toller actually proved that 100% wrong because that study on which, and the data on which that assumption came was based on three men. The old therapy for prostate cancer was orchidectomy, which is basically cutting off somebody's testicles. Thank God that is changed with some modern medicine. So see, Big Pharma has its advantage. in some cases. When he looked at these three people, only one man was intact with prostate cancer. The other two had orchidectomy. And the data show in prostate cancer that if you deplete testosterone

in a man, it not only increases the risk of metastasis or distal development of prostate cancer elsewhere, bone, brain, whatever, it increases the velocity or how fast that metastasis goes. So why are we withholding testosterone from men with prostate cancer? Like I said, one of the things that got me across the threshold, if not the thing that got me across the threshold of being willing to go down that path, was researching the risks to men from having low testosterone. The risks are huge of low testosterone. To me, they far outweigh the risks involved in going into a path of TRT or HRT or HRT. And the collateral risks. So let's take a man who's got low T. Let's say he's 50. maybe still has a mortgage, maybe still has teens or young family, if that man falls into depression and suicidality and commits,

and men commit more violent suicidal acts, and they usually finish their acts. Women don't. Women have less violent and often have more impairment if they have an incomplete act. But the bottom line is the risk of suicide with depression is 30%. That's incredible. If we can actually reduce depression and suicidality, in men by giving testosterone when it's needed. And we need to be looking younger and younger. We assume that it's this magic age of 65 that men need testosterone. They don't.

They actually need it earlier. You said you started at 46. I started at 42. No. I was not menopausal, but I certainly had some symptoms. Absolutely. Has it made a change in my life? I'd say if people, I would be in jail if there was no progesterone.

Because either I'd kill somebody. or kill somebody to get it. One way or the other, I'm going to jail. So bring on the progesterone. I'll just be a nice, tempered, polite woman and not kill somebody. And, yeah, it makes a huge deal of difference. Huge deal of difference in how I function, how I think, how I sleep, what I can accomplish, the brain power, other risk factors for men with low T.

Chronic pain. How many vets do you know with chronic pain? Quite a few, but oftentimes that's just tied to, you know. wearing tear the job. Absolutely. Narcotics or opioids. How many people are treated for chronic pain with opioids? To the vast majority.

Absolutely. And they're effective. There's a rule for opioids in our regimen of chronic pain treatment. I just did an update a couple weeks ago on chronic pain. Did a seminar. And there was a, okay, let's just face it. We started this conversation off with, you know, the whole opioid crisis. And that was a fabricated.

not fabricated as a not real, but it was actually perpetuated by the makers of the opioids, right? Oh, for sure. Yeah, they were looking for ways to make that shit more addictive. Absolutely. Well, at least sell more. Yeah. You know, I can't say that they were looking for addiction. They were certainly looking for greater sales. They did greater usage. Absolutely. More consumerism, right? Yeah. And so the bottom line is, yes, it has its dangers, but narcotics actually knocked testosterone down like a bowling ball. So there's a whole contingent of men out there, whether it's osteoarthritis, rheumatoid arthritis, chronic pain, back issues, whatever, whatever, who are treated with narcotics, who are actually becoming sarcopenic, which is the technical term for loss of muscle.

And the number one biomarker of aging is loss of muscle. And nobody's looking at the rule of sexual hormone replacement in testosterone replacement therapy and chronic pain patients, be they male or female, because females need their testosterone too. And if you're low tea, you're going to ache more. If you're low tea, you're going to have more aches and pains because ligaments and tendons are going to be weak. You can't build muscle. Stamina is going to be down. cognition is going to be down, mood is going to be down, sexual desire, performance,

actual function of sexual organs is going to go down. Loss of secondary sex characteristics. So men feminize as they get older. They lose her facial hair. They lose her hair under their arms. They hair in their legs. Genitals shrink. Why are we doing this?

Again, it's a rhetorical question. I'm just grateful that I can actually, you know, I've been doing this for 20 years. Are you allowed to, you're only allowed to practice in Canada, though? I'm assuming you're limited by the border to be able to treat people. I am not. I am licensed in the U.S. Oh, sweet.

You know you're based in Canada? Absolutely. I guess it, 51st state based. Absolutely. All right. Our boards will not recognize. There's not a lot of reciprocity, so I've had a license in the U.S. for a while. Okay.

Well, I mean, that is one way to get around it. It is. We have been at this for two hours and 35 minutes. I warn you. I'm passionate about this. I can talk forever. Well, it's not good to talk much longer than we have been. I got it.

For digestibility. but that just means that we can link up again for a secondary episode at some point. Sounds lovely. What are we leaving out? And let's end with, if people are interested in what you're talking about, how they can pursue getting in touch with you. But is there anything else that you would want to add, anything that we're leaving out? Absolutely. You know, again, my legacy that I want to leave, I was never blessed with children.

So my legacy that I'm leaving for the world is for menopausal and perimenopausal woman, a program in which they can manage menopause. because not everybody has the means or the availability or their accessibility to bioidentical hormones. Ask a lot of questions. Ask about what you're being prescribed. Know some trends. Like put some, you know, we used to say put that in your pipe and smoke it, right?

So put some of these data points in your pipe as an individual and as a viewer as a consumer. Ask the questions. Am I getting synthetic hormones that can negatively affect my cholesterol or am I getting micronized bioidenticals? And bioidenticals are not equal either. You have synthetic bioidenticals like, testosterone and you have natural based from plant-based sources that look exactly like our biochemistry.

So if you want to open the door tonight to your car, if you still have a key to your lock in the car or to your home, do you want something that truly fits with the tumblers or do you want something that sort of fits and still has an action? That's the difference in a natural bioidentical hormone versus a synthetic. Scipionate is said to be bioidentical, but it can't be. It has a functional group added onto it. So that's like me wearing gloves right now. You know, I haven't worn gloves through the whole show, but if I now put on gloves, I'm not identical to how I appeared at the beginning.

Correct. So hormones are not hormones or not hormones. So ask. Ask about the training with your physician. Ask about their experience. Yeah, was I crapping my pants the first year or so when I did all this? Even now, if somebody comes in with symptoms, the first question I ask, because I am who I am, is like, holy shit, what did I do with the, what did I do wrong?

Well, let's look at the prescription. What did I do wrong? What are they on? What did I do wrong? And oftentimes it's not what I've done wrong. It's just that it's a titration. You're right. Hormones come to equilibrium around 12 weeks for every dose change.

Give a time. Do you have a time? You're not going to feel fantastic overnight, but I can usually get people, women, specifically, and men, symptom-free in about six weeks. You should start feeling some benefit. And it's easier to go from lower doses to higher doses than be overdosed and then have to withdraw.

Garden hose to the face or fire hose, I should say. That's nasty, drinking from a fire hose, absolutely, right? So that's really hard. The other thing is, you know, you alluded to this earlier, do what your mama told you. Get to sleep on time. Don't burn light. I mean, Alexander Graham Bell, great. Thanks, buddy, you know, Canadian inventor.

Fantastic. But you know what? Turn the lights off. Get off your tack. One hour free of blue screen free time before bed. Quality of sleep is important. We know that it reduces testosterone by 45%. You know how people get around that bullshit?

They wear like blue light blocking glasses or they get these filters on their phones. They do help. But the brain stimulation is interesting. You know, just as a crazy aside, sometimes I have crazy data in my head, in order to control the flicker of the screen on electronics, whether it be an iPad, a phone, or your computer, it stimulates the same area of the brain in order to see a static picture. It stimulates the same area of the brain as ADD meds do. So you're getting a dose of ADD meds before you go to bed for on your tech, right?

Doesn't help. Each are vegetables, especially your green leafy vegetables, especially as a man. You know, the XX chromosome is female, the X, the X, Y, chromosome. If I could prove this, I think on that little stick that is absent to make the Y chromosome from an X is eat your green leafy vegetables, put the toilet seat down, pick up your socks off the floor, all the things that we bitch about men about. But eat your green leafy vegetables are really important. Vegetables at every meal. Why do you guys bitch about putting the toilet seat down? Have you ever fallen in the middle of the night when it's up? Yes.

Sucks. There's a nice water seal. Let me ask you this. Do you lift it when you're done? No. Why isn't it one lifting event each? Because I prefer to put the lid down. Okay, you could, I mean, you could do that if you want to.

But so guys, of course, lift, live when you pee, right? Yes. And then. Unless you sit. Which sometimes in the middle of the night, maybe you should. But, you know, put it back down. But how come ladies you go, why can't you lift it up for us? We could.

I'm just saying, where's the equality at in that in Canada? Put the lid down and neutralize it. Trudeau. I'm going to get a hold of him. Okay, you do. that this shit is... Where can people find you? Where can they find your practice?

People can find me at Dr.wiz.com. Okay. Two Zs, I'm assuming? Two Zs or two Zeds, depending on what side of the border you're on. So, DRWIZ dot com is my office. We're in Burlington and licensed in Michigan, soon to be Ohio. If they decide to go down this path with you, What can somebody expect as initial contact?

What is it actually, like walk me through what a treatment protocol, not like what the prescription would be, but like a timeline of how things would work. Sure. So basically if somebody's interested in pursuing care with me, they will need to sign an electronic communication form. We don't have encrypted email, so that just gives me permission based on my college,

which is Ontario. They have the strictest requirements for that. Then they will get their questionnaire, their 26-page questionnaire that they'll fill in electronically in a financial consent form. And then if they're testing by saliva, the kit is done in home so we could ship them a saliva kit. Really easy. Labs, that gets a little bit trickier.

We will have a third party to provide lab work for United States patients. Merrick does the same thing. I'd go to Lab Corps. Exactly. But I can't write a prescription for Lab Corps, so I'd need a third party for that. So we'll just get somebody getting their lab work there. And then I have connections with compounding pharmacies here in the United States. Interestingly, if they come to Canada,

Hormones are cheaper in Canada, dramatically cheaper. We're talking like 30 to 50%? Probably at least 50%. No shit. I had some patients here who were snowbirds or who have worked in the United States for a period of time and went back and forth. And pretty much our hormones run between $30 and $50 per hormone per month. Okay. And in the U.S., you're talking anywhere from $100 to $200 per month per hormone, so it's dramatically different.

That is a pretty dramatic cost savings. Okay. Mm-hmm. It is. So we're allowed to treat out of country, out of province patients. Sometimes that's a nice way to get that done. And then they're monitored every three months. You know, in the monitoring, again, by these governing bodies and regulators who give these guidelines.

Some say don't even test until a year out. Well, yeah, hormones do take a well to come to equilibrium. But periodic checks are really important because shit does hit the fan in people's lives. Cortisol thyroid, cortisol, block thyroid. There's so many interactions that happen between the things. the hormones, dietary changes, especially if you're in a place like we are where, you know, I have snow for seven months and all the food is trucked in. That's a lot of nutritional depletion in terms of core nutrients that we need. That's wild. A year is a long time to go,

kind of shot in dark. I agree, because things change. Yeah. Things really change. I mean, maybe six months on the outside. Don't be afraid of things that we've scared you off of. Don't be afraid of Himalayan salt. Don't be afraid of eggs. Don't be afraid of meat. These are nutrients that we need in our body. Like you talk about coline. That was one of the things that they gave you, phosphatititoline. Highest nutrient of coline is an egg yolk. Don't be afraid to eat whole foods and get rid of the junk. If it comes from a package or a box, you know, it takes a lot of effort to cook from home.

We do, and we still struggle. Like this last year's been brutal for me. I had a leg injury. They told me a tore my meniscus and actually turned out to be a horrible IT-Ban syndrome. So after rounds and rounds and rounds of physio and chiro and other things, still disabled. So I spent a lot of my 20-24 in my... mobilized and, you know, barely off on my feet. So I'm feeling the hormone changes. I'm watching the sarcopenia. I'm watching the body fat composition change. And I'm like, holy crap, got to put a lid on that.

So being proactive for me is really important in my practice and really important in my life. And I really treat my patients with proactive care and outcome-based medicine. We want outcomes. We don't just want to palliate symptoms. We want to not have a pill for every ill as, you know, I was taught in medical school. I want to really get down to the core issues. Work with you. You your practitioner, I've open conversations, ask the hard questions. Don't be afraid to talk about erectile dysfunction or use the terms of anatomy for men, a penis testicles. Like, let's just take the stigma away from all of that and let's be really frank. My guys get asked about, are you having difficulty with how hard are your erections? Are they frequent? Are you waking with morning

erections? Those for men are really important in terms of cardiovascular and cerebral vascular disease and that'll kill you faster and it's a more prevalent cause of death than prostate cancer. And despite the guidelines, like our guidelines now say, don't test for PSA until people are 70. Seems like a little late. A little. And men get overlooked in terms of breast cancer, bone mass. So make sure that you're getting complete examination so that you determine if you're at risk

because sometimes the first sign of bone fracture, osteoporosis is the bone fracture. Yeah. Right? It's a little late. closing the barn after the horse has gone out. So be proactive. Read. There's tons of information out there, good and bad, unfunctional medicine, on hormone replacement therapy. It's not the scary monster that we make it out to be. And I think it's really important for not only overall well-being, proactive health. Our regulators in the FDA won't let us prescribe this for the purpose of

longevity because life is not a medical outcome. Longevity, wellness. Again, all of us would want to live to be 100, dot, dot, dot, unless we're in nursing home. It's preventable. Only 20% of our disease expression is genetically based. The rest is environment, and environment includes our hormones. Again, going back to the beginning of our talk, there is no drug that we have available to us as physicians that causes statistically significant reduction in all-cause mortality. If you want to control what you're going to die from, optimize your hormones. Replace them.

And not just to some textbook level to what works for you. That's a perfect ending right there. Until next time, I feel like we're going to link up again. Thank you for making the drive down. I know it wasn't a short trip for you guys. It's my pleasure. Yeah, it helps me with a greater understanding. And I think that'll help answer a lot of questions for people out there who are,

there's a lot of people on the fence and also a lot of people trying to solve this silently. Oh, absolutely. There's so much shame around sexual. medicine. There's so much shame around aging. We're all going to age. I mean, that's the goal. It's not the goal to get old, but aging is inevitable. So we might as well age with grace and have some control about what we're doing and be able to function. Listen, I drive a yellow-a-tetee, man. I want to reg top something or other in candy apple red by time I'm 88. I'm not going to grow up till then, okay? Perfect. Thank you.