Mark Bell's Power Project - EP. 527 - TRT For Men AND Women: Do's & Don'ts & Everything In Between

Episode Date: May 20, 2021

Jeff Wittmer is an Olympic Weightlifter and silver & double bronze medalist at the 2008 Pan American Games in Peru. Jeff’s father, Dr. Michael Wittmer, a former National level competitor himself, ha...d Jeff begin lifting weights to improve his ability in other sports. Since starting his practice, Dr. Wittmer, has helped thousands of patients and is committed to the best possible care for them. Dr. Wittmer has lead and assisted with continuing education seminars for Doctors of Chiropractors, athletic trainers, along with personal trainers. Book a Consult with Dr. Wittmer here: https://wittmerrejuvenationclinic.com/qrintakeform Jeff on IG: http://www.instagram.com/jeffwittmer/ NRC on IG: https://www.instagram.com/wittmerrejuvenationclinic Subscribe to the NEW Power Project Newsletter! ➢ https://bit.ly/2JvmXMb Subscribe to the Podcast on on Platforms! ➢ https://lnk.to/PowerProjectPodcast Special perks for our listeners below! ➢LMNT Electrolytes: http://drinklmnt.com/powerproject ➢Piedmontese Beef: https://www.piedmontese.com/ Use Code "POWERPROJECT" at checkout for 25% off your order plus FREE 2-Day Shipping on orders of $99 ➢Sling Shot: https://markbellslingshot.com/ Enter Discount code, "POWERPROJECT" at checkout and receive 15% off all Sling Shots Follow Mark Bell's Power Project Podcast ➢ Insta: https://www.instagram.com/markbellspowerproject ➢ https://www.facebook.com/markbellspowerproject ➢ Twitter: https://twitter.com/mbpowerproject ➢ LinkedIn:https://www.linkedin.com/in/powerproject/ ➢ YouTube: https://www.youtube.com/markbellspowerproject ➢TikTok: http://bit.ly/pptiktok FOLLOW Mark Bell ➢ Instagram: https://www.instagram.com/marksmellybell ➢ Facebook: https://www.facebook.com/MarkBellSuperTraining ➢ Twitter: https://twitter.com/marksmellybell ➢ Snapchat: marksmellybell ➢Mark Bell's Daily Workouts, Nutrition and More: https://www.markbell.com/ Follow Nsima Inyang ➢ Instagram: https://www.instagram.com/nsimainyang/ Podcast Produced by Andrew Zaragoza ➢ Instagram: https://www.instagram.com/iamandrewz #PowerProject #Podcast #MarkBell

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Starting point is 00:00:00 This episode is brought to you by Element Electrolytes. Now, Andrew, have you tried Element's new flavor? I actually have not tried it yet. I'm excited. I want to try it because I hear nothing but good things. However, what has been your experience? Dude, number one, I gave you two packs of it, so I'm kind of disappointed in you for not having tried it.
Starting point is 00:00:20 So get that in your mouth today. But dude, oh my God. It's okay. So my former flavor best flavor was orange before that it was raspberry uh watermelon by far is my favorite flavor really like it within my next purchase of element i'm getting nothing but watermelon boxes make jokes guys um but either way it is so good it tastes like um it tastes like sour patch kids oh but like not too sour.
Starting point is 00:00:46 We're like, you drink it and you're like, no, you do that thing. It's so good. They killed it with this one. Awesome. I'm going to have to check it out.
Starting point is 00:00:53 Um, look, I have two right here. No joke. He did give me two. Um, if you guys want to take advantage of this, you guys can head over to drink LMNT.com slash power project,
Starting point is 00:01:02 pick up a value bundle. That's buying three boxes. And then you get a fourth one free. If you can be like or you can be like in SEMA, grab all four watermelon flavors or you can get a variety of all the other ones. I've been having chocolate every single night. It's like my little like before bedtime snack and it keeps me hydrated throughout the entire night. Again, that's at drink LMNT.com slash power project. Head over there right now. What up Power Project crew? This is Josh Sutledge, aka SettleGate, here to introduce you to our next
Starting point is 00:01:31 guests, Jeff and Michael Whitmer. Jeff Whitmer is an Olympic weightlifter in silver and double bronze medalist at the 2008 Pan American Games in Peru. Jeff began Olympic weightlifting at the age of 10 in his home basement gym. Jeff's father, Dr. Michael Whitmore, a former national level competitor himself, had Jeff begin lifting weights to improve his ability in other sports. After a few months of training, Jeff decided to enter his first meet and from there, he continued his success by winning the first 50 competitions that he entered in. After winning multiple junior national titles, he accepted an invitation to train at the Olympic Training Center in Colorado Springs, Colorado. He continued to compete throughout his mid-20s with success in national and international competitions.
Starting point is 00:02:19 Jeff earned his bachelor degree in marketing and is currently working for Worldwide Technology on their Boeing program. His father, Dr. Whitmer, has been in practice since 1980 after receiving his doctorate degree from Logan University in St. Louis, Missouri. Dr. Whitmer has also been a faculty member at Logan University since 1984 and has also served as chief of staff from 2010 to 2015, educating thousands of physicians around the country along the way. He is also a certified USA weightlifting coach and has served as a valued member of the USA Weightlifting Board of Directors. Since starting his practice, Dr. Whitmore has helped thousands of patients and is committed to the best possible care for them. Dr. Whitmore has a lead and assisted with continuing education seminars for doctors of chiropractors, athletic trainers, along with personal trainers. His son, Jeff, has been recognized for supreme form and precision in the Olympic lifts and
Starting point is 00:03:16 has also been featured on the cover of the textbook Explosive Lifting for Sports by Harvey Newton. But that is a different story for a different time. Please enjoy our guest today, Dr. Michael Whitmer and his son, Jeff Whitmer. What do you think about Andrew being scared of butter? Butter's terrifying, right? Andrew has like issues with butter about how much fat's in there. Okay. It's a love hate thing. Okay. Because I look at the calories and I figure I can do so much more with that. But also, true story, not much change in my diet yesterday.
Starting point is 00:03:50 The only thing different was I added butter to my steak and I had a terrible blowout at night. I thought you were going to say a tent. I thought you were going to say you were pitching a tent. No. Blowout, okay. But I do feel really good today. I am full of energy and I am ready for today's podcast. What kind of blowout was it?
Starting point is 00:04:08 Was it one where you need to like run some forensic science on your toilet to figure out how it got sprayed so immensely? So it did defy gravity. It went upward somehow. On top of that, if I didn't have a bidet, I would have been in a lot of pain because it was spicy. Were there oil bubbles? I don't know. Y'all ever had that shit?
Starting point is 00:04:33 Oil bubbles in your shit? It's like the consistency of the buffalo wing sauce. Yes. It's the worst. It's got the little orange, like little orange dot in it or something. Oh my God. You're like, is that my kidneys? My liver?
Starting point is 00:04:45 Like what's, what's failing me? I'm so sorry, Jeff. Oh, you're good. You're good. I had In-N-Out last night. Yeah. I had a few triples. So, yeah, this morning, you know, in my own experience.
Starting point is 00:05:00 Yeah. Yeah. Quite the lewd. Yeah. So, it's been a while. No, it's been a while. You guys read my mind of what I've been thinking about what happened at the Holiday Inn. And you had to say load.
Starting point is 00:05:10 Dude. Now see what happened. Remember when we had to edit out of yesterday's show? We literally had to edit something out. But this show, I feel like this is more fitting for the topic of discussion. By the way, have you had In-N-Out quite a bit or no? What's that? Have you had In-N-Out quite a bit or no? What's that? Have you had In-N-Out quite a bit or no?
Starting point is 00:05:25 Oh, no. So I'm from Missouri. Gotcha. So only if I'm in Utah. And I think, are they in Texas? I think I've only had it in Utah and Arizona. And that's it. So, I mean, five times in my entire life.
Starting point is 00:05:38 There's something that you'll notice when you eat more and more In-N-Out. All In-N-Out blowouts smell the same. I don't know if you've realized that. No matter matter what your shit i can agree with that it's like when you pee it like after eating asparagus yes it's like it has a specific scent i don't know why that is it's happiness leaving the body yeah i guess it is it's not the onset of depression because you need more the only thing to cure it is more in and out. Yeah. I did have to Google how to look up to order.
Starting point is 00:06:09 I know there's a specific way. I did the three by twos with two pieces of cheese and you get the fries light well. Light well? Light well, I guess is a thing. A little extra crispier? A little extra crispier. And then someone ahead of me got cheese melted and I go go, let's go ahead and we'll do that. Did you ask for the happy ending as well?
Starting point is 00:06:29 I thought about it, but I didn't. Okay. That's the secret, secret menu with the secret, secret sauce. Cool. Okay. So it looks like Dr. Whitmer is ready to go as well. Where is he? So this is new for the podcast.
Starting point is 00:06:43 Is he in Missouri? I think so, yeah. There he is. Oh, snap. Here I am. There we go. Yeah, thanks for joining in. Sorry to hear that you got hurt.
Starting point is 00:06:57 You fell or something, right? Something happened? Something weird happened? Helping my grandma move over. I'm recovering. I'm alright. There'm recovering. I'm all right. There we go. Squatting before the end of the week. Jeff, you look like you're missing a few parts. What's going on?
Starting point is 00:07:14 Maybe you need to sit a little further away from those guys. I know. Jeff, did you get into lifting because of your pops? Yeah. Is that how this all started? How you guys because of your pops? Yeah. Is that how this all started? How you guys got into this mess? Yeah. So what was it?
Starting point is 00:07:29 When I started when I was 10 years old. But I remember my first sports were baseball and soccer. But I remember him having, we would do push-ups and sit-ups in the living room. I think when I was like seven. And I would go to the gym with him and his buddies, when we go to pro body fitness and I would be in the corner squatting with a broomstick while his buddies were lifted. And back then there was one platform for the power lifters and the Olympic lifters that lifted on.
Starting point is 00:07:55 Then I was a little kid in the corner squatting with the broomstick and he was showing me proper forms. I like to say I started a little earlier than any, but we started with, with kind of weights at, at 10 down in a, down in the basement. Doctor, the type of gym that you were at in the beginning,
Starting point is 00:08:16 was it, did it appear much different from today's gyms? Was it kind of like everyone had this, like it seemed like when I was growing up and I was in the gym, it seemed like everyone had the goal to be big. Everyone had the goal to be strong. There really wasn't this fitness component to the gym industry just yet. It was just like people wanted to lift heavy and they were either bodybuilding, powerlifting, Olympic lifting, doing those things. But it did seem like everyone just wanted to be like big and strong. Is that the way you remember about when I started lifting?
Starting point is 00:08:45 Yeah. Just maybe around the time your son started going to the gym with you to type thing. Ah, you're really, uh, the, the place I was working out at,
Starting point is 00:08:55 I wasn't competing that I was older and just lifting. Like that's what we do. And, uh, every once in a while, I'd bring him in there with me we'd have the training plates and you know the funny part is uh you know jeff would miss a lift and i he tried again he missed it he tried to get he missed and i'm like okay that's it that's enough and he'd start crying and i'd
Starting point is 00:09:23 we'd go back into the locker room and he's begging me to let him try it again and i'm like well he's not gonna hurt himself it's a snatch right it's up and down real fast so we go back out there he'd miss it and he'd start crying just one more time one more and i'm no no no that's good so we're this. And all these other guys at the gym are thinking that I'm this horrible father. My kid do this over and over and over. And here it was. I'm trying to talk him out of it. But I guess you can see behind me our family motto.
Starting point is 00:10:00 Yeah, it was really a good time. We really started in our basement. I worked out there, too. And I just showed Jeff how to pick up a weight, how to squat, how to put a weight overhead. He did some upright rows, maybe curls. A little bit. I had zero intention of him getting into weightlifting. He's just an athlete and athletes lift and the Whitmer family lifts.
Starting point is 00:10:31 So that's what we did. And he just took to it. The discipline that he had as a little kid, he always wanted to work out. I'd come home from work and eat dinner and he's like, let's go, dad. And my wife would say, let dad rest. Let dad rest for a while. He just got home. I go, oh no. We're going. Anytime he wants to work out, we're working out.
Starting point is 00:10:54 I hope this doesn't embarrass him but at one point he's doing 60 pound squats for 10 reps and he's smoking them. Just up and down, up and down, up and down and he's smoking them you know just up and down up and down up and down and he lost his balance and he pitched into the wall he's standing up against the basement wall he didn't
Starting point is 00:11:13 hit the wall but i just you know lifted the bar off his back and jeff you've got to maintain your tempo you go down under control you can come up as fast as you want but you've got to balance and keep control going down so all right so i put the bar back on the rack and i started loading it and he says what are you doing and i said let's go to presses that's your last set of squats anyway let's just go to press no i want to do it i said no no that's okay i want to do it yeah all right it's not 600 pounds, right? I could spot him with three fingers. So, okay.
Starting point is 00:11:50 I'm standing behind him to spot, and he's got his hands on the bar, and he's standing there going, I can do it. I can do it. I'm the man. He's 11. And I'm just going, oh, my God, what have I done?
Starting point is 00:12:09 But, yeah, he has always had that drive, whatever it is. He had it. You know, just a very mentally tough lifter. One time he was doing a jerk. I don't know if you remember this, Jeff. It was 85 pounds. I'm videoing him with back then one of those large video cameras. And he got under the jerk. He didn't have it. He got it up about three quarters. It wasn't going, but he didn't bail. He fought it. Next thing you know, it crashes on his chest and bam,
Starting point is 00:12:41 he's flat down on the floor. I did everything you're not supposed to do i dropped the camera rushed over picked the weight up off and grabbed him picked him up are you okay you okay he's crying a little bit and yeah okay i said jeff when those lifts aren't there you gotta know how to miss you know let it fall and he said we need to erase that tape so mom doesn't see it do you remember that jeff no i see i would think you didn't miss that many lifts so you should have remembered that yeah how'd you guys that's kind of how it got started uh jeff asked at one point if he could get into those competitions like I used to do. And, you know, I could see that he had the talent. He's extremely quick with exceptional flexibility.
Starting point is 00:13:35 Well, you know, you're born with that. Now it's just about getting strong. And he was doing a set of power cleans for five reps. And on the fifth one, he did a complete full squat clean. Never taught him how to do it. Never knew anything about it. He just totaled. It was actually better than any clean I ever did in my life.
Starting point is 00:13:56 You know, chest up, elbows up, perfect bottom position. Comes right out of it. I said, do you know what you just did? He said, I was tired. I couldn't get the weight all the way up, so I just went under it. And you know how some guys just can't do that. And they don't like dropping under weights or getting under a snatch. And this kid just does it naturally without even thinking.
Starting point is 00:14:17 That's what I started thinking. You want to think you can do that again? Yeah. So he did it again. All right. Now I started teaching him how to jerk. We went on to the snatch. you want to think you could do that again yeah so he did it again well now all right now i started teaching him how to jerk we went on to the snatch and everybody thinks their kids the greatest in the world so i had some buddies of mine that i used to train with uh was still active and there were local meets and i said i want you guys to take a look at him you know weightlifting oh
Starting point is 00:14:44 yeah i know but you know i want some objective eyes on him. And that's when he went to his first competition. I think you were still 11, weren't you? Yeah, I was 11. I think I weighed 76 pounds in my first meet. My only deterrent from competing, I think, initially was the singlets they used to wear. Because I saw the pictures of him. They were the swimsuit ones, but they were, I mean, very revealing.
Starting point is 00:15:05 And I'm like, thank God they came out with the longer ones. And in my initial meets, you could wear the, I think I wore a t-shirt and shorts, and then they had the longer singlets. Now they even have the full body ones. But, I mean, I remember going, you know, when I was young watching him at meets, and I'm just like, I don't want to wear one of these swimsuit things. Why do I got to wear a leotard? I don't want to wear one of these swimsuit things. Why do I got to wear a leotard? Yeah.
Starting point is 00:15:26 That's so, so thankfully those, uh, those went away and never, never made a comeback. Yeah. Really? So how'd you guys,
Starting point is 00:15:37 Jeff told me that if I wanted to get in a master's competition, if I wore my old singles, he said, I'm going to quit. Thanks. How'd you guys get into, you know, what you're into now? How'd you get into, uh, you've been a doctor I'm sure for many, many years. How'd you get into, uh, HRT? Well, obviously I lifted in the seventies and the eighties. So we all know what that means.
Starting point is 00:15:57 Uh, the gym I started at Peoria Illinois was a good powerlifting, bodybuilding, anybody that was anywhere with there. In fact, you certainly have heard of Mike Bridges. Absolutely. Mike Bridges Trade. And, you know, we were all using anabolics. It was just part of it. So I always had an interest in it from that perspective. And then I got old and I'd been doing this as a patient now for about eight and a half years. My wife and I started it together and we were in our fifties. I'm 67. And so was I 59 and she was 56. So we, you know, kind of look at each other as we aged. And it's not like we're in our 20s. And we kind of laugh.
Starting point is 00:16:50 But the menopause that she was going through was really hard. And finally, we got to points that, yeah, we're not doing this anymore. And wound up taking this journey. And now this is what we do as a business and a practice. Jeff is heavily involved in it. as a business and a practice, you know, Jeff is heavily involved in it. To me, my thinking is actually my motto, zero frail old men. One of the things that just drives me crazy is when you see these skinny fat guys, they're fat, but they have skinny arms and skinny legs. And I'm like, good God, you know, you get off the couch, grab a barbell, put it overhead, put it on your back, do some squats.
Starting point is 00:17:29 Yeah, probably get out some testosterone. You know, it's hard as you guys aren't there. But as you get older, you know, you start looking around going, how am I doing? You know, yeah, I think I could kick his ass if I had to. And that's kind of what you do when you get older because what do you compare yourself to? Not when you were 20. So I think I'm doing okay for my age. But my weight class was 242.
Starting point is 00:18:00 And I usually weighed around 240 with a 33, 34-inch waist. And now I'm weighing 238 with a 42-inch waist, not now, but before I started. And one day, you know, I was kind of like, I'm all right. I have a gained weight. You know, I'm still in my weight class, for God's sake. But, yeah, everything that was up here moved down. Everything that was down moved up. It's all centrally located.
Starting point is 00:18:26 But, yeah, I was sitting on a toilet one day leading forward and i'm whoa what is this here and kind of i got some fat i didn't really and again i think i just kind of didn't focus on the truth because you don't want to and that's why yeah this has got to stop. And about two weeks after I started, and of course I knew what to expect. I'd done this stuff at a different level, of course, but I felt better in two weeks, just walking around. I felt better. And I was thinking, good God, I didn't, I didn't realize I wasn't feeling good. Yeah. I thought I'm okay. And you always get that qualifier, okay for your age.
Starting point is 00:19:09 But this was incredible. Of course, it just continued to improve from there. My lifting improved because my joints didn't hurt as much. I had more endurance so I could get more reps. Usually what would hold me back as I'm doing presses, I think my shoulder's going to explode. I better not do a rep. Well, now, dude, my shoulder's not hurting.
Starting point is 00:19:31 So I was able to train at a little higher intensity. I'm not doing the lifts, of course, but, yeah, I started gated muscle. Six weeks or six months, I'm sorry, I lost five inches off my waist, seemingly overnight. I used to joke around and tell guys, I'm spending more money on new clothes and alterations than testosterone. But yeah, now I wish and my wife and I were the same. We look at each other, wish we'd have done this 10 years sooner. So I bet if I'd have done it at 49, I'd go, God, I wish I had done this at 39, and to me, it's just maximizing your life. It's a lifestyle choice. I tell almost every patient,
Starting point is 00:20:13 you are not sick, and they're not, but they're 45, and they liked it better when they were 25. Well, we can do something about that, and that's what we do. And so rewarding. So when you got on testosterone, was it just testosterone and you felt all these benefits just from that? Oh, I was also taking anastrozole. And back then the most of the TRT doctors that I knew about and talked about or heard from, that was the concept that you want to manage estrogen and you want to keep it in that sweet spot. And I did that for three years.
Starting point is 00:20:54 Then I started going to Neil Rousier's program. I don't know if you guys have heard of him. Pretty well-known TRT hormone replacement doctor. And I went through all of his post-grad courses. I'm certified through him. And he's very much anti-aromatase inhibitors, let estrogen go. So I thought, well, I'm going to stop this and see what happens. And lo and behold, my cholesterol levels improved 20%.
Starting point is 00:21:27 My joints felt a lot better. I have pretty high estrogen, zero side effects. So in the office, we don't use the aromatase inhibitors very much at all. We've had guys that were able to go off a cholesterol medication and high blood pressure medication and even diabetes medication. Once they get their hormones optimized, get their testosterone up, they lose the visceral fat. And with it, their cholesterol markers improve. What's the worst thing in the world for somebody health-wise? Visceral fat.
Starting point is 00:22:07 It's that visceral fat. Insulin sensitivity goes down. So you can lose that fat. Now, obviously, I encourage everybody to lift. I think everybody should work out, do strength training. Most guys do, or at least a lot of them. But we have some that they don't. They just sit on a needle once a week and they get great results.
Starting point is 00:22:29 You know, it kind of makes me talk forever if you let me go. So just interrupt. Yeah, this makes me curious. Please. I'm serious. You mentioned that, you know, you started at 59 and you, you knew you'd start at 49. And if you knew earlier, you'd start at 39. Right.
Starting point is 00:22:42 and you knew you'd start at 49 and if you knew earlier, you'd start at 39, right? So it gets me curious, like when does a man, like when is the right time for somebody to start doing something like that? Like let's say, are there certain numbers he should be looking for? Like, oh, okay, I am too low. Or if his numbers are good,
Starting point is 00:22:58 is there even a reason to, you know what I mean? So like, what should he be looking for? Most of the guys we see that come in they're interested in testosterone because they're they're losing energy or lacking energy they're tired all the time they want to be more muscular they want to look better they're a lot more workout guys and they want to look like they work out and a lot of them poor libido so So pretty much for us, it's increased their sex drive or sexual function and gain some muscle, you know, look like they work out. So that's really it. We don't focus on numbers. I know I'm talking out of both sides of my mouth. So we look at these lab values. We look at reference ranges.
Starting point is 00:23:46 The testosterone, total testosterone range is 250 to 1,100 through Quest, the lab we use. The free testosterone is 35 to 155. It's a big range. Tell everybody we're looking at these numbers. We're using this as a marker to give us some direction as to what your options might be and as a reference point moving forward. Then on the other side, I go, I don't give a shit about these numbers. How do you feel? If your testosterone level is 700 and you don't have a sex drive, we're going to do something about that.
Starting point is 00:24:20 We're going to increase testosterone to get you feeling good. Next question is, well, where do you draw the line from? something about that. We're going to increase testosterone to get you feeling good. Next question is, well, where do you draw the line from? Now we're going from a testosterone restoration to the next step, and we're running cycles. I haven't had anybody, I think, really push that yet. We do have guys, I just got off the phone with one, his total testosterone was 1,500, and his free test is 260. So he's high, and he's been with us for a few years. And that's pretty much where he's been. I looked at his previous three labs, and very consistent.
Starting point is 00:24:55 He feels great. Everything regarding all his kidneys, liver function, lipids, his blood counts, everything was great. So we're good. He's happy, feels great. He's actually my age, exactly my age, almost a month apart on birthdays. He's like, you got my life back. So I don't know if that answers your question satisfactorily. We don't draw a line and go, well, when you go before 400, we take you, or 250. A very typical patient will be a guy in his 40s who's tired, got the bellies, gained weight, his sex drives down, his wife thinks he's having an affair because she's not seeing anything,
Starting point is 00:25:45 or maybe their marriage is just not what it used to be. They've been married a few years and she's looking at him going, you bastard, you've gained 35 pounds. I've gained five. You don't find me attractive? What's wrong here? Well, I don't know about you guys. I'd be depressed.
Starting point is 00:26:02 If I was fat and tired all the time and not interested in having sex with my wife, I would be very depressed. So they go to their GP. And even if they check their testosterone, well, 250 to 1100 is a big range. So they come back at, pick a number, 300, 400, 500. You're fine. You're normal. You don't need testosterone. Let me give you an antidepressant.
Starting point is 00:26:24 So they give an antidepressant and nothing changes except they're happy because they got a brain chemical screwing with their head. You know, their wife is still unhappy. He's not interested in sex with his wife. He's tired all the time. He's still fat. You know, he's not functioning at work. And that is a very classic presentation to see. The wife will come in with him because they want to make sure I get the full story. As soon as I see a woman in the room with the guy, I know exactly what's going on. And what often happens, I always tell the wife, I said, now, be careful what you wish for here. What often happens is five or six months later, the wife's in the office.
Starting point is 00:27:11 She's like, yeah, I can't keep up with him. I'm going to have to do this, too. So a good way to build a practice, right, Jeff? That's right. Jeff, how are you involved in this process? Yeah, so I'm one of the owners. And then I also handle some of the marketing and day-to-day operations. Then I'll see a patient myself as well. So, yeah, and I had a, you know, to the experience that he just mentioned as far as, you know, someone going to their GP for, you know, a lot of things that led me to get interested in this. And, um, you know, the first shift for me was,
Starting point is 00:27:46 you know, I was talking, I was talking to Chris earlier, but with watching bigger, stronger, faster, where I, you know,
Starting point is 00:27:52 coming from a sport that was drug tested sport, I was competed for 15 years. It was, everything was, anything on the band substance, the, um, you know,
Starting point is 00:28:00 band substance list. It goes, it was harmful for your health. You can't, you can't take it where, and even if two, if you go to the, you know, us anti-. It goes, it was harmful for your health. You can't, you can't take it where, and even if two, if you go to the, you know,
Starting point is 00:28:07 us anti-doping agency website right now, it says testosterone leads to depression, depression and suicide, which is, so I had spent 15 years eating all this, this false narrative kind of pushed to me and, you know, propaganda,
Starting point is 00:28:20 if you will. And so my mindset completely shift. And this was leading up to the, when I could be in the 2008 Olympic trials, when the movie came out. And so my mindset completely shift. And this was leading up to when I could be in the 2008 Olympic trials when the movie came out. And when I saw that, I go and all the facts he laid out and how he presented it. And I said, hold on, like some of this doesn't sound as bad. I think I've been getting a load of bullshit, you know, and I'm almost 37 now, became a patient myself at 32. And what led me to become a patient was I had, you know, transitioning out of a weightlifting career, false, you know, or, you know, failed attempts at the Olympics.
Starting point is 00:28:55 You're going through that, you know, trying to get out there in the real world. And I'm sure, you know, you know, plenty of people that can relate to that. And, you know, was just a little lost. And I was sleeping all the time. I was depressed and I go to my GP and, you know, they don't run a blood panel on me and say, well, let me, we'll put you on some SSRIs and we'll try those out. And, you know, I did those. I didn't like the way I felt on them. I didn't feel like myself. And kind of right when we opened the clinic, I was like, Hey, I might not need, my testosterone is probably not low, but let's go get it checked.
Starting point is 00:29:26 You know, obviously we have access. I go get it checked on 335 total nanograms per deciliter, just really low on the scale, especially for a 32 year old. My girlfriend, you know, at the time was not my wife thought she thought I had I was falling asleep at night and she thought I had a side piece, you know, so it was causing issues with our relationship. And then when I, you know, so when I started the testosterone, I got off the antidepressants because what was happening was I was, I was sleeping all the time and, you know, down, not so much from the, you know, wasn't a lack of serotonin in the brain. It was the lack of, you know, the hormone imbalances I was experiencing.
Starting point is 00:30:06 So for me, also within a few weeks, I had energy. I had a sex drive back because, you know, if you think, you know, how you'd feel without a sex drive, without being able to work out, having trouble getting up in the mornings, just not being able to do those things is going to make me depressed.
Starting point is 00:30:19 But all of a sudden I fix that. And then in turn, you know, it solves everything else with the depression. So that was when, you know, obviously I was, you know, firmly bought in with the research I had done before. And obviously from, you know, some of the stuff Chris had laid out as well. And so I was all in and I had tried to get him to start this sooner. And I was getting a little jealous when I started seeing like, you know, my almost 60 year old dad getting some chest veins. And I go, what the fuck? I go like, hold on, like maybe I need, it's like, so I was getting a little jealous. I was like, I maybe I'll,
Starting point is 00:30:48 I'll start. And then, uh, you know, after a few weeks to get the extra energy and, um, you know, that was, um, you know, so, you know, obviously I'm a good case study as well. So when I talk to patients can relate to a lot of things in that sense. Very cool. Is hrt is it something that you know after you do it for a while can you maintain some levels or is it something that like when you when you are on hrt you are on hrt for for as long as you want to be on hrt you could always stop. Your levels are going to drop down to around where they were when you started. And most of the guys we get that stop, they wind up coming back. A lot of them have unrealistic expectations. They think they're going to look like Sylvester Stallone or something. or Stallone or something. And when they don't, they're like, I'm not getting out of this what I want.
Starting point is 00:31:46 So they'll stop. And then six, eight months later, they call us up. Yeah, I'm really feeling bad since I stopped. So they're back. They say it's for life, and it doesn't have to be. It just has to be as long as you want to feel good. And there's a proper protocol, too, if someone does elect to stop, which is rare because normally people feel pretty good, but there's a proper protocol to follow to, you know, what to stop or you don't abruptly stop is what we recommend people not to do.
Starting point is 00:32:25 Or, you know, you can, you know, and I'll let him to speak to the protocol as far as adding HCGN to help, you know, kickstart your natural testing. So there's a right way and a wrong way to stop. So it's never advised for someone to abruptly stop. Yeah, it's my understanding too that testosterone is sometimes even, you mentioned depression. I've heard people suggesting testosterone for depression. Like it can really help a lot because for me, I've found it to be extremely motivating to be on testosterone. What have you guys seen as far as that goes? Mark, that's a great comment. I'm at a medical conference in Salt Lake City and there's all kinds of disciplines and specialists taking these programs, a hundred doctors in the room. There's a luncheon. I'm sitting next to a woman who's a psychiatrist.
Starting point is 00:33:10 And you're like, what do you do? What's your backgrounds? And she's almost a psychiatrist. And she was very old. You know, it looked like she should have been on TRT or hormone replacement a long time ago.
Starting point is 00:33:23 But regardless, she tells, I go, a psychiatrist? You're at a hormone conference? Wow. So I'm looking at her and I said, let me guess. And I pretty much just ran the same scenario by her that I ran by you guys with that 45
Starting point is 00:33:38 year old guy who's fat, tired, out of shape, etc. Depressed, winds up in a psychiatrist's office. And now she's treating them. And now two, three years, I don't know, just at some point down the road, they're back in on a follow-up and they look different. They're in shape.
Starting point is 00:33:59 They're happy. Oh, yeah, I've been going to this TRT clinic. And that's usually what it is. That's a specialty clinic because this isn't taught in general medical school and GPs and even endocrinologists, they don't look at it the same way. But now they've gone to a testosterone replacement clinic and they're on test and they're doing great and they don't need the drugs. and they're on test and they're doing great and they don't need the drugs.
Starting point is 00:34:27 So I'm looking at her, telling her this story, and I said, and you're thinking I'm going to eliminate the middleman. So why should I give them these medications? I'm just going to check their hormones and give them hormones. And this is someone who actually got it. So, yeah, I don't know. You can't put everybody in the same box, but, my God, I would definitely look at my hormone levels before I went on some medications. The way I look at this is I know testosterone is a pharmaceutical product.
Starting point is 00:35:00 It's even a controlled substance in this country. We could discuss that, but that's another subject. But that's what it is. That's law. But it's not a drug. It's a hormone that was invented by God that we make naturally. It's not a drug. So if you could balance your natural hormones, something your body naturally had, instead of taking chemicals that are created by men and women who work for the pharmaceutical industry, there's nothing wrong with making money. I'm all for that. And that's what they do. Why do you think there's so much pushback with testosterone in our country? There's no money in
Starting point is 00:35:41 it. You can't patent testosterone. Well, you can patent these drugs. They've got to patent for 17 years after they get it through research and development and get it approved by the FDA, which isn't cheap. And it makes a lot of money for the government, too, because they have fees that these guys have to pay to get their stuff approved. To me, it's common sense, I think. their stuff approved uh to me it's common sense i think um so earlier uh you had mentioned that because one of my questions i had for you guys today was going to be like okay so then what is a proper level that somebody should be striving for but like you said it could be different for everybody so is it the same for um like um uh you know trt would 100 milligrams a week for one person work really well and then that not work really well for somebody else who has similar symptoms? Or is it pretty safe to say that like 200 milligrams a week is going to be fantastic? 600 is going to be really, really bad because
Starting point is 00:36:41 it's too much or you know what I mean? You get what I'm trying to say? You're talking more dosing levels. Correct. Yes. Sorry. Okay. Okay. Yeah. That's one of my favorite areas of discussion. This makes what we do challenging, fascinating, and frustrating. We're all different. And I've got guys that take less
Starting point is 00:37:10 than I do every week that have better levels than I do, significantly better. I don't know, go figure. That's just the way our body metabolizes it. We both feel good. So I'm good with that. it. We both feel good. So I'm good with that. But we've got, I've got a few guys taking 80 milligrams a week. A few guys taking 220. I've had a few guys go up to 250 for a while. I don't know off the top of my head if we have anybody still doing that much. Back to maybe your question, most of the guys take between 140 and 180. And depending on their level of patience, we may start lower and gradually titrate upward to effect. Some guys, I'm not patient. So I kind of tend to be a little overaggressive. When I do that follow-up with them in six weeks, I want to hear they're feeling great. six weeks, I want to hear they're feeling great. So I kind of will push it. But sometimes I don't know exactly why, but maybe going from 300 level testosterone to 900 is just a little too much too
Starting point is 00:38:16 fast that let their body gradually adapt to it and get used to the increased levels. Wasn't the case with me, but it is with some people, I think. I don't know. But I'll ask the patient, what do you think? How patient are you? Are you a patient person? Oh, yeah. Okay, here's what we'll do. We'll just gradually work upward if you'll be patient.
Starting point is 00:38:38 It may take us a while to determine what dose works best for you, but we can do that. Some are going, no, I want to go there now works best for you. But we can do that. Some are going, no, I want to go there now as soon as possible. I want an injection today. I want to go to the gym and I got a date after that. Well, it doesn't get in you that quickly, but it's a different approach. And the way I look at it is I'm working for the patient. That person is my boss.
Starting point is 00:39:06 And we're going to do what's healthy for them. We're not going to do anything that's not healthy or illegal. But yeah, I work with them. So I'm very flexible. We have guys that inject twice a week, three times a week. I've had a few guys try daily injections. They all went back to twice a week. We have most of the guys do once a week. Did that answer your question okay? Yeah, it actually did. But it does bring up another question that I just thought of. You had said, you know, we'll just take the patient person. You gradually increase it until they're satisfied or how does that work? Because I'm just thinking if it's me,'s like dude i feel good oh i feel better i this feels even better like doc let's keep going let's see where this uh you know where we could uh where this roller coaster will end up at so how
Starting point is 00:39:56 do you determine um responsibly what that level ends up being? One of the things I found from back in the day is there's certainly a point of diminishing returns. And then when you keep going past that, it even goes in the other direction. You don't feel as good. And so there's such a thing as too much of a good thing. And one of our favorite sayings was when I was competing was strength is a greedy mistress. There's always room for more weight on the bar. Some people have that mindset. I've got documentation of their progress over the last several months and how great they're telling me they're doing, and we get to a point where their levels are very good,
Starting point is 00:40:49 even a little over the range, that's where we're going to stay. And I pretty much tell the guys the same thing I just said to you. I said, you know, testosterone is really a good thing, but there's such a thing as too much of a good thing. How are you feeling? I'm feeling great. Then we're good. I want to feel greater.
Starting point is 00:41:07 Yeah, I really have not had patients push that. I tell them from day one, you know, this is not anabolic steroid cycles. You know, it's not performance enhancing drugs. We want to optimize your hormones to effect to address the symptoms and let you get the most out of your life you know we're not going to double their dose so they could bench press another 30 pounds don't do that not that i have a problem with that but this isn't the place for it god damn it you it. The amounts that we're talking about here, for anybody that's listening, that has used performance-enhancing drugs,
Starting point is 00:41:51 it's really, really small amounts. What are you guys allowed to prescribe? Is there certain rules or laws that you have to follow? Because 200 milligrams is about three times less than what someone would take to get big and strong. There really aren't rules. We don't use insurance. There you go. Kind of why.
Starting point is 00:42:18 For starters, most of our patients would not qualify for TRT because they're normal. Their levels are normal. Well, again, let's go back to that 250 to 1100 rates. A guy could be 300. That's normal. Another guy could be 1,000. That's normal too. I'm going to suggest that the guy with 1,000 is probably a lot happier than a guy with 300. So as far as rules, no. I guess if there was a problem with somebody that was overdosing, and I'm not really sure what that would be because I don't think there's any studies that I'm aware of. It's all the anecdotal stuff back with the PED guys
Starting point is 00:43:05 that hasn't really been studied. Yeah, I guess if you're subject to a lawsuit of some kind, there's no rule that tells you you can't only do this much. One of our patients is a surgeon, and he told me that 95% of what I do, there's no evidence in the literature for it. But he's found through his years of practice, this is what works.
Starting point is 00:43:31 And this is what I'm going to do, even though it's not a normal protocol. In fact, the guy that did Jeff's quad, didn't he do something different with that? He told you? He did. He said, as far as the way he tied it back down um yeah yeah i ruptured my quad tendon about a year and a half ago but he
Starting point is 00:43:51 took it in three spots tied it back down screwed it in he said tighter than he would have ever done for anyone else because he knew i was going to squat on it so it still kind of feels like i have a rubber band wrapped around it but uh yeah but i mean just to kind of add to that too as far as you know you asked some of the questions as far as like what we're prescribing and then outside of testosterone i mean we do have there's there's other products too with my you know with my knee recovery i did you know i used some peptides as well i used um went on and off we prescribed nandrolone as well so the proper doses you know and nandrolone can be very safe and effective with you know helping with joint pain which you may be familiar with if you've
Starting point is 00:44:30 taken before um it was key in my you know within a you know under a year i was back to i had full range of motion i was uh not to my best squats ever just because i'm a little old but i think if i needed to i could push it so it definitely helps speed up the recovery process as well. What's been some of your experience with, you know, seeing higher doses prescribed or hearing people, other people doing higher doses are either one of you aware of there being like some sort of dangerous threshold when it comes to. I guess it's hard to say with testosterone because most of the people that take quite a bit of testosterone will usually take other things, right? I guess I'm just basically trying to ask if you guys know or have seen or come across any research that shows, you know, somebody getting into the five, 600 to a thousand range of this, uh, having dangers?
Starting point is 00:45:28 And what are the dangers if you guys have seen any of those things? Yeah, I know with there's been, I mean, we've seen over 5,000 total nanograms per deciliter, but I'll let my dad kind of speak as far as what some of the other markers may have looked while they're taking that high of a level. Some people that were, you know, transitioning into doing therapeutic doses, but I know we've seen some crazy numbers over the years. In the office? Yeah. I'm saying as far as their other panels outside of just the testosterone,
Starting point is 00:45:53 if you saw anything in those that, hey, there are some additional health risks based on the blood work or other assessment. Not directly related to testosterone. Back when we were lifting, we never checked anything other than liver enzymes. We're using synthetic anabolics, so those are hard for your liver to break down because they're synthetic chemicals. That's all we looked at. The lipid testing that's available now wasn't available then.
Starting point is 00:46:23 Nobody ever dawned on checking hormone levels so why would you we we know what we're going to be really high we didn't care uh the guys i saw that were taking a lot and i thought i was taking a lot but it's all relative uh there were guys taking a lot more and you know we were pretty honest about it within the weightlifting community but uh powerlifting i don't know um some of these guys were back then what would seem like a crazy amount taking like 2 000 milligrams of tests a week i do have some friends and guys that i know of back from the day in st lou Louis that are not here anymore. You know, they wound up, now these guys, lifestyle.
Starting point is 00:47:09 They were drinking, they were smoking, they're using cocaine, you know, they're doing lines of coke before their workouts, they're taking all kinds of anabolics. Yeah, they wound up obesity, diabetes, wound up having strokes much earlier than 92 in their late 40s, early 50s. So I think there's a lot of moving parts there. And people that didn't know any better are going to say, well, I use steroids and about 19 other things that he should have been doing. I was at a powerlifting meet once and we all supported each other back then it was really cool community it's hard to get into the bodybuilding but powerlifting you know still you're doing it not looking good you're
Starting point is 00:47:57 doing good but one of the guys this guy was actually a patient of mine, and he was a pretty decent lifter, but he was like, oh, shoot, about 5'7", 5'8", 260, kind of a goo. And he had short arms and a thick chest, and he benched 500 pounds. Decent squat, not great, but not as good as his bench. Deadlift was a problem because he had a hard time with those short arms getting down to get them off the floor. So he's going out before his deadlifts, and what's he
Starting point is 00:48:31 doing? He's skin-popping epinephrine. This is a guy with high blood pressure. Really high. I mean, in the office, I said, John, you got to stop, man. You got to stop drinking. You got to stop smoking. You need to get off. Well, I got a meet coming up. You need to get off. So I'm, okay. It just really hit me. I remember this like it was yesterday. I'm thinking, my God,
Starting point is 00:48:57 somebody's going to die right on the platform someday. You've got a guy who is not cardiovascularly fit anyway, throwing the obesity and the smoking, and he's got hypertension and he's skin popping and has dealt epinephrine. Oh, come on, man. It's just crazy. So I,
Starting point is 00:49:21 I think some of the sideways things these guys were doing, you know, that's a lifestyle. That's not what we do. And even back with a lot of the Olympic lifters, we were pretty healthy. We ate good. We weren't taking what I would have considered crazy. With weightlifting, I think it's a little different. And you guys would probably know, probably know, Mark, you would. If your skill level is only here, it doesn't matter how strong you are.
Starting point is 00:49:51 I smoked some guys that were a lot stronger than me. And there were guys that were skinny and nothing near what I could squat. But they'd out-snatch me because they were better athletes. So I think with us you can take all you want you can get as strong as you want but there's going to be a ceiling there based on your athletic ability that really doesn't matter how much you're taking i think every time somebody gets beat they want to think their opponent has taken more well no maybe he's a better athlete than you you know know, this makes me curious.
Starting point is 00:50:25 I mean, I'm assuming that you guys like do online consults and stuff, but for somebody that they don't live in that area and they're, they're looking around and they're looking for an HRT doc, what are some things that they need to be looking for? What are some red flags that they need to take an account for when they do have their first consultation with said doctor? What questions do they need to ask to make sure that this person is going to give them the right things and not fuck them up do you want to take that one yeah i'll i'll jump in and take that one too so i i probably research more clinics and talk
Starting point is 00:50:58 to you know obviously people from that are switching clinics i mean definitely i mean i've seen clinics where they're not running any blood work panels on people. They're just signing them up and getting them started. Also, I think a red flag, too, is that some of the clinics, they will start people off on six different medications instead of focus on the bioidenticals first. They'll add in so you don't even know what's working. Bioidenticals?
Starting point is 00:51:24 As far as hormones your body's producing, so testosterone, DHEA, and looking at thyroid as well. So I would say making sure there's a complete medical panel, so not only just looking at the hormones, where some clinics we'll see will only test for, they'll do very simple, basic tests where it's a, they'll do the cheapest ones so they can make the most money, so testosterone, maybe free testosterone.
Starting point is 00:51:48 Sometimes they'll throw in sex, warm, binding, but it's very limited, cheap panel. They'll charge you a lot for it. You know, that would be a red flag. So, you know, limited blood panel or no blood panel, or trying to throw the house at you right from the beginning. So when you do start, you know, just like, you don't know what's really working and what's not, um, Hey, I feel pretty good, but what's actually doing it. So we take more of a phased approach where folks on the bioidenticals first, then it said, there are
Starting point is 00:52:12 other products we can add in. If you feel good, you don't feel greater. There's a specific goal or recovering from an injury. If we want to focus on that, um, you know, we can handle that as well, but you know, that would be a red flag. And, you know, as far as pricing goes to because obviously that there's a lot of scams out there. I mean, it is. That's why I think there's, you know, I think the industry is becoming less taboo. But I hear of, you know, one of what's happening was we have a lot of patients that were flying to us from California to Missouri to come see us because the prices were outrageous out here. I mean, it could be 10,000 plus a year. They're paying every follow-up consult a ton for blood work. And, you know, and so people would say, hey, I'll just go, I'll book a plane ticket for a hundred bucks. See you guys get established face to face. And I want the ability to do telemedicine.
Starting point is 00:53:02 It, you know, that barrier of the flight and scheduling, we can do it while someone's on their lunch break at work. So it makes it much more convenient. But yeah, I mean, and I think too, also, if you see some of these places, we'll say there's a monthly membership fee. Then you pay your prescriptions on top of that. So we want, our goal too is where we don't want to treat just like some of these clinics, just the country clubbers. That's not us. We want it to be available to whether you be, you know,
Starting point is 00:53:38 a first responder. We ain't got affordable so anyone can get started. So, you know, that's, I think those would be the red flags, obviously with the price and kind of what I, what I mentioned as well in the consult times too. So one thing that, you know, when, when my dad is a consult, I mean, he blocks out an hour and a half of time. So sometimes he takes a full time,
Starting point is 00:53:53 but as you can tell, he gets a little long winded talking sometimes. So you can see why they could go, go an hour and a half, but it's an educational process where he gets to know them as a person. What's their lifestyle, go through their medical history. He's going to tell you every,
Starting point is 00:54:07 go through every blood marker in detail. And he's going to tell you what you're getting prescribed and why, where we'll see people will come to say, I don't know anything. So when you see those, you see a 10, they say, okay, you meet with the doctor from nine to nine, 10. Well, how are you going to know what the hell you're getting yourself into if they're only talking for 10 minutes. So that would be another red flag. So you're rattled off a bunch, but I hope that that's helpful for people. Those are the things to be on the, on the lookout for,
Starting point is 00:54:32 for sure. And one other thing to add too, and this is what I, you know, I was talking to with Chris about this earlier and it's, there's any time you see a place that's advertising a cookie cutter protocol saying, Hey, you know, one 99 a month, here's what you get dosage.
Starting point is 00:54:49 And okay. Hey, Scipion eight DHEA, uh, an Astrozole. Here's your set dose. Everyone gets that. Well, it doesn't matter where your blood work levels are at or what are your symptoms of our, why would they, so everyone's just getting that kind of compared to if you go to a supplement shop they'll say hey pre-workout protein um you know pre-workout protein and whatever and multivitamin which is pretty standard um which you know i would say for the majority people working out we probably all were on this similar page there but um yeah it it's treated
Starting point is 00:55:21 like that where i said there needs to be be a more thorough assessment with the blood work and consultation. How do you pronounce your name? Insema. Insema. Okay. I apologize. I want to make sure I got it. It's all good.
Starting point is 00:55:37 It's all good. I really don't get people that ask me questions. They, I think, are mostly referrals. So they've already got a level of confidence coming in and a level of trust built in because a close personal friend of theirs or family member is already, this is what you need to do. And they're already bought in. bought in. But to try to answer your question a little better, I would tell patients to ask around, you know, try to get a referral from somebody you know and trust. Jeff mentioned the cookie cutter approach that a lot of clinics use. And I don't know how a patient would necessarily know that's being done. Jeff knows some of these facilities in St. Louis. If I get a patient would necessarily know that's being done. Jeff knows some of these facilities in
Starting point is 00:56:26 St. Louis. If I get a patient that comes in from another place, I already know what they're on. I know what their dose is. I know what they're taking. I had a 60-year-old guy that had a vasectomy come in and he brought all his meds. He brought his testosterone, his HCG, and his anastrozole. And we had our labs on him. So I'm sitting there, and he was going to another facility. I said, okay, so why are you taking HCG? Are you still interested in having children? And he looks at me like I've got two heads.
Starting point is 00:57:01 I go, no, I had a vasectomy, you idiot. And I go, yeah, I know you had a vasectomy. I looked at your chart. But I was just wondering if you're thinking about a reversal or something at age 60. He goes, no. So why are you taking an Astrozole? They said I needed to keep my testicles going. I said, okay, why?
Starting point is 00:57:20 To me, the only reason to use HCG is because you don't want the testicular atrophy or you're actively trying to conceive. If estrogen is not a problem, why are we taking an estrogen? Well, they said it was part, just like Jeff said, it's part of the program. Well, when you buy a $100,000 Mercedes, there's things that are part of the price there too. But, you know, it's not $30,000 now. It's $100,000. I encourage everybody to get on the internet and read things. I do that a lot. I want to know what people are reading and be, therefore, better able to answer their questions.
Starting point is 00:57:58 I try to answer questions before they even come up with them. I just like this. So, you know, this is almost, what's fun to explain all this. I like to explain it. Here's what we're doing. Here's why, here's what your options are. You tell me. We have a patient who's a pulmonary oncologist at a major hospital here. And they had a hard time scheduling her because she kept rescheduling. And the medical assistant said, I think she works at a hospital or something. So we're like, oh, okay. Well, as it turned out, like I said, she was an oncologist.
Starting point is 00:58:36 And she comes in and, you know, I usually have a good idea where patients are coming from. And I asked her, so how'd you hear of us? And she kind of shrugged her shoulders. The internet? I go, the internet? I guess she stumbled across our website or something. And right away, I'm going, man, I wouldn't pick a doctor off the internet.
Starting point is 00:59:01 I know people do. But okay. So when I got to go over all of her labs with her, I said, I'm going to skip over a lot of this stuff because you probably know it. And she's like, no, no, no. Go assume I know nothing because we're not taught this. And I went, okay. But I think from my perspective, telling a patient what to look out for, how would you know? If you just walk into a place cold turkey, you don't know what's normal or not. I tell people, go ahead and do your research on the Internet if you want. Keep in mind that a lot of people put their anecdotal stories up there. And, you know, it's that one person with
Starting point is 00:59:45 their story. And that may or may not, probably not, you know, relate to you at all. So you have to take that with a grain of salt. I think it's interesting to read the stories and hear about them. But it probably shouldn't drive you in any particular direction. I think what I do, the feedback I get from patients that have gone elsewhere when i start explaining this thing well i didn't know that nobody ever told me this so i'd like to educate them and i don't discourage them from getting other opinions either you know if this doesn't make sense to you then you need to move on yeah um don't real quick uh you had mentioned a vasectomy so i'm curious uh does getting a vasectomy alter or impact your testosterone um at all
Starting point is 01:00:33 no okay cool that's plain civil cool great um so what if somebody's listening and they're like oh i didn't go to a clinic i got my testosterone prescription and um supplements or whatever you want to call it from my actual doctor so i should be okay right are they in our office no i'm just saying like in general they're somebody listening they think that they might be safe because they they went to like out here we have sutter we have kaiser because they went to, like, out here we have Sutter, we have Kaiser. They went to their regular doctor and they're getting a prescription from them. I can speak to a little bit of the Kaiser. I can just kind of fill in for you guys out here. Now, typically with Kaiser,
Starting point is 01:01:18 you know, they're looking for under 100 total nanograms per deciliter and they'll get prescribed, you know, if you're that low where you can get some coverage. I've seen some crazy protocols from people that have come over from Kaiser where the doctor, the GP is telling them to take two shots a month of 100 milligrams of testosterone sipionate. So with the half-life being seven days. of testosterone cypionate. So with the half-life being seven days, so they're actually almost doing more harm than good because of their levels are then crashing, then reaching back up. So I've seen some, some crazy protocols from some of the GPs since obviously they're not, they're not trained in it or what they'll do is they will only prescribe you with what is, what's going to be covered, covered through the insurance and dad i'll let
Starting point is 01:02:05 you add kind of on to that but i think that's a good example that can kind of resonate here just from knowing a lot of the california the californians that go through that experience well i would ask the patient you know how are you doing how are you feeling are you happy with whatever the endocrine society's recommendation is 200 milligrams of testosterone every two to four weeks. And a lot of GPs are going to look at, you know, if you've come back at four or 500, then you're good. Even though you may not be feeling that much better or better at all, your levels are fine. You don't need any more. The half-life of the various esters ranges around a week. So by the end of that second week, your levels have dropped pretty low.
Starting point is 01:02:57 And yeah, if that's something that really affects you, fine. And we don't do, we do maximum is every week. Nobody goes longer than a week between injections. But there are a whole lot of people in this country that go to their general practitioner for testosterone and they're happy. You know, they're happy. Now, maybe they'd be happier if they were doing a different protocol, but you know, they're happy. They're doing a shot every two weeks, which we go, that's crazy. Are you only doing 200 milligrams every two weeks? You shouldn't. But if it works for you, if you're happy with it, then yeah, fine. Just keep doing it. A lot of the guys we see that have been going through their GP or even an endocrinologist, they're not happy with the
Starting point is 01:03:43 results. And we look at their labs. We talk about ranges, talk about their symptoms. We go, yeah, guess what? We're going up. It's pretty simple, really. They just need more. But they go by the guidelines. And I'm friends with my general practice, my GP,
Starting point is 01:04:02 and standard protocol, 200 milligrams a week. And he doesn't even like to do that. But he'll give it to them, probably select the patients. But yeah, 200 milligrams a week is what, or I'm sorry, every two weeks. Yeah, I was just going to say. Every other week. Yeah, I said that wrong. Yeah, every other.
Starting point is 01:04:18 So that's what they're taught. That's what the Endocrine Society recommends, and that's what they read, and that's what the hydrocon society recommends and that's what they read and that's what they do cool and then uh you said that you wouldn't recommend to do it every other week um is there a certain sweet spot or is there a certain recommendation that you guys have how often to be um you know injecting testosterone individual uh i tell guys if you feel like you're running out of gas and you're hitting the wall before you get up to that next injection date, let me know. We have guys that do every six days, they do every five days, twice a week, whatever. That is based on how they feel. Now, some people are just much more sensitive to fluctuations.
Starting point is 01:05:07 They metabolize this differently. One of the best examples I can give you, this guy's actually a GP. And he comes in. He's on testosterone. He's taking 400 milligrams every two weeks. Okay, so 400 milligrams. Whoa, how are you doing? I feel great for like three or four days second week he's miserable a couple of our patients were patients of his and they were
Starting point is 01:05:32 telling him what they were doing and how great they were feeling so he's like shit i'm gonna call this guy so that's why he came in so i told him i said okay look here's what we'll do take your 400 milligram injection just like you always do. Go get your blood drawn in seven days. And let's just see. So in seven days, his total testosterone was 350, give or take a little. Seven days after 400 milligram injection? Are you kidding me?
Starting point is 01:06:03 That's impossible. That's the way he's metabolizing this. So I told him, it's okay. Here's what we're going to do. You're still going to take 400 milligrams every two weeks, but you're going to split it up into four 100 milligram injections. So next time we do labs, do it three and a half days after your injection before you take your injection. So that's what he did. And you already came back at 800.
Starting point is 01:06:32 Did he have a high sex hormone binding globulin? It was low, but I haven't found correlation there. There's a lot of theories and arguments over, you know, if you have low sex hormone binding globular, you need more frequent injections. If you have high, you don't. His was actually low. But I've got guys with low sex hormone binding globular that do once a week at 200 milligrams, and they're great.
Starting point is 01:06:57 But this guy, hypermetabolizer, whatever, and he's stuck with that protocol. Gosh, we're like over three years now. And, you know, he's just can't be happier. This is just what worked for him. Now, how can you take 400 milligrams and in seven days be down to 300, take 100 milligrams and you're at 800? I don't know what he would have been by day seven. He'd have to be down 300 or less, but okay. I don't necessarily understand what's going on, but I'm not questioning it. And we had a guy here that's feeling great. He's not doing anything crazy with that dose. Yeah. And I had tried splitting. I do one day a week, but some people were saying, I feel a lot better with the two. So I tried splitting it up.
Starting point is 01:07:41 Felt zero difference other than just the extra pain in the ass having to inject, which doesn't really bother me. But I was like, you know what? I'll try it for three, four months, see if I notice any difference. But I wasn't feeling much of a dip. I think what happens too is let's say someone injects on a Sunday or Monday and then they go, ah, by Friday I'm draining. What happens between Sunday and Friday? It's the fucking work week.
Starting point is 01:08:03 You're taking your kids around. So a lot of times it's just, it's kind of a false perception in their head that it's my tea drop. It's tea's dropping off too much, doc. It's like, well, no, like you finished your work week and you had all these other stressors involved, which is pretty, pretty standard.
Starting point is 01:08:19 I think for some people, depending on what their job is, you know, I feel all the days run together for me. So it's all pretty steady. Testosterone is really a tricky thing because, you know, I think, you know, when we use hormone replacement or use steroids, we'll just call them. Yeah. They can make you big, you know, and use a good amount of them. They'll give you some results.
Starting point is 01:08:42 You'll get big. You'll get strong. You know, and you use a good amount of them, they'll give you some results. You'll get big, you'll get strong. However, looking at someone's testosterone levels is not an indication a lot of times. If somebody's not symptomatic, if somebody doesn't have symptoms, they don't have a problem, they don't have an issue, they're not tired, their normal life is good, you cannot predict, you can't look at somebody who's jacked and be like, that guy's testosterone's through the roof.
Starting point is 01:09:08 So it's not apples to apples. And I found it interesting that estrogen is the same way. You talked about menopause. And I think that people think that that's because your estrogen goes through the roof. But my understanding is that it's your estrogen is going down is actually kind of more of what's happening. And a lot of times when it comes to testosterone, I think we just always kind of associate it with muscle or being
Starting point is 01:09:32 more motivated to go and do certain things, even in terms of sex. But sometimes you can inject a fuck ton of testosterone and not get any result from it that would... How do you guys kind of simplify some of this confusion? Is it because that once you bump up testosterone, there's 75 other things going on in the body? Is that kind of what's happening? What's your opinions of this?
Starting point is 01:10:00 Well, there's a lot of moving parts here. And lifestyle, I tell you with of moving parts here and, you know, lifestyle. I tell you with this last year with COVID, you know, a lot of our guys just weren't feeling as well. And we're having these conversations. Well, what's going on? They're working from home. They're eating crap. You know, they're off their routine.
Starting point is 01:10:18 The gym closed, which, you know, Jeff will tell you how it works in the whitmer family we are never without a barbell in our possession yeah i was like that before i went to college you know i i had two olympic sets and squat racks and there was a time where i had it set up in my living room in my apartment i obviously i couldn't drop weights they'd have gone into the basement but uh if the weather was bad if the car was broken down, and back in those days, the car broke down a lot, I could still train. These poor guys, you know, they go to a gym, the gyms were closed. They're gaining weight, they're lethargic, they're not happy. So yeah, there's a lot of moving parts here. And everybody's different. I think there's a,
Starting point is 01:11:11 think there's a i hesitate there's a lot of mental in your head stuff with this too and uh here's a good you guys could probably relate to this back in the day i wrote a lot of drug programs for guys i just knew more about it they all asked me for for help. And so I got this guy, he was a state champion and a shot put big guy wants to power lift 275 pound weight class. He's already strong. And, uh, you know, he's,
Starting point is 01:11:33 he wants to do steroids. So we got him on a program and, uh, he comes up to me several weeks into this and he goes, Mike, I'm really having trouble with this. What's the matter? He said,
Starting point is 01:11:44 the roid rage. Is that right? Rage. What are you talking about? He said, Mike, I'm really having trouble with this. What's the matter? He said, the roid rage. I said, roid rage? What are you talking about? He said, well, last week I took a shot. And I went out in the family room and my fiance had a movie on that I didn't like. And I blew up at her. And she said, you just took a shot, didn't you? You know, now you guys are all laughing.
Starting point is 01:12:04 I was laughing a lot harder i'm laughing at this guy said geez you're you're just a prick this is not an insulin ejection that gets in you now it's not a peptide this is a a steroid hormone slow long lasting. This doesn't turn you into the incredible Hulk in a minute. And if you want to go out there and be an asshole to your fiance, go ahead, don't blame the steroids. You're just an asshole. And there are things like that that we trade with that, you know what, they were assholes off steroids too. But when they get on drugs, they just thought, I got an excuse to be a bigger asshole. So with a lot of patients, and I go through these side effects and things to look for, some guys, they get a little emotional. They get a little edgy. They respond differently to
Starting point is 01:12:56 estrogen levels. I had guys with estrogen that's three times over the top into the range. They love it. They feel great. Other guys, it goes a little over. It's a problem. We address it on an individual basis. But I tell them, take your testosterone. Enjoy your life. Don't think about it. Just enjoy your life.
Starting point is 01:13:19 These guys will call me, my nipples are tender. Well, stop rubbing them all day. Rub them all day. Are my nipples tender? Are my nipples tender? Well, damn it. Now they are. Yeah, of course. If somebody runs you off the highway and you lose your shit, oh, my estrogen must be high. No, the guy almost killed you. You're supposed to be pissed it's all right but uh yeah i think that's a real issue with some they they just think about it too much and we got guys if their refill didn't come on time and they're a day late they're freaking out and uh yeah we'll we'll our our staff's really great they'll meet them somewhere with a syringe to accommodate them. And we just kind of, hey, you know, it's here, but that's okay. If it's in your head, it's still real to you.
Starting point is 01:14:16 You know, I'm really curious about this because it's like, we know that there are a lot of lifestyle factors that can influence a man's testosterone. He's not getting enough sleep. He's not exercising. influence a man's testosterone. It's not getting enough sleep. It's not exercising. It's not eating well. It's not getting outside in the sun. Like a lot of these things and added in with being indoors, watching TV, being on your phone all day. Like you're just going to be a weak dude, you know? Yeah.
Starting point is 01:14:39 Now, I was curious, is it a myth? Because we've heard this before of people saying that back in the past, like 50 years ago, a hundred years ago, um, male testosterone was higher than the average levels. Now, is that a myth or is that legitimate because of lifestyle factors? No, uh, I think there's something to that. If we think back even into, uh, if I want to say prehistoric times or the other caveman, you know, those guys look pretty jacked. But I think, well, if they didn't have really high testosterone levels, they were somebody's
Starting point is 01:15:12 dinner or they got beat out by their rival trying to get the woman. So it's a survival thing that if you didn't have high levels of testosterone, you're not going to survive. Nowadays, men aren't really men. You know, my grandparents, they worked. My one grandfather was a farmer. They worked construction. They worked in factories. You know, now we hang out all day and look at a computer and talk about hormones with guys. But guess what? We all go to the gym and we hit it hard.
Starting point is 01:15:51 The general public, not so much. So lifestyle changes, sedentary lifestyle, yes. I did see a study going past 30 years, three decades, testosterone levels have dropped 17% in the United States. Not so in other countries, but here. So also fertility has dropped. Sperm counts are down. A trend, I think it's disturbing, but there's a lot of theories. There's no real good evidence. Look at the pesticides, real good evidence. Look at the pesticides, chemicals in our foods, hormones
Starting point is 01:16:28 in our food, the plastics and the chemicals. You can't get away from it. When we go to Costco, we don't buy glass water bottles. You have a hard time lifting it. It's hard to get away from that.
Starting point is 01:16:46 What's that? I said, not us. We'd be good. Yeah. Well, you guys have better knees. Okay. Yeah. I think it's really hard to look at that.
Starting point is 01:16:59 To me, I think common sense would say, yeah, it was higher. Our quest, I was common sense would say, yeah, it was higher. Our quest, I was talking to somebody with Quest. They told me that the bottom end of the range used to be 350 for them. The high end was 1500. And it got lowered partly because Blue Cross Blue Shield negotiated that. Yeah, this is what this guy said. So if you're in network with an insurance carrier, you've got all your fees are negotiated.
Starting point is 01:17:38 We'll pay you this much for CBC. We'll pay you this much for CMP, whatever. So we'll pay you a little more for some of these lab tests if you'll drop this testosterone level. Because now what happens? Well, that guy at 300 is not below 350. He's above 250, and he's okay. I don't know. Then they don't have to cover him.
Starting point is 01:18:04 That's right. So we save money here because we don't have to cover them. That's right. So they save money. We save money here because we don't have to pay for treatments. We'll go ahead and pay out a little extra money here on your CBC. We'll give you an extra two cents. I don't know. That's one of the biggest questions I think I get when, you know, someone did get existing blood work and because, you know,
Starting point is 01:18:20 I call all the patient leads and talk to them and just say, why is the range so wide it's so i mean because you feel a lot different at 200 and then versus you know 20 somewhere you'd say it's 200 to 1200 is normal there's a big fucking difference in that and so i mean like the scam if you will what he just kind of went through is is part of it and there's even more to it you know than that so it's. So it's concerning. And I think it's only going to continue to get worse in that sense, in my opinion. You know, again, that's going back to symptoms and how you feel. Are you happy with your life versus a number? I had a 26-year-old guy come in. Actually, he didn't show up for his first
Starting point is 01:19:06 appointment, which really aggravates me because we block out a lot of time, which I could have been, so this guy just didn't show up. Okay. About a week and a half later, a woman calls and reschedules him with, and he will be there. So we're laughing at the officer. Okay, we know this story. So the guy shows up. I'm figuring we got a 45-year-old guy. His marriage is out in the rocks and so on and so forth. So I happened to walk by where I could see out to the waiting room, but this guy's in his 20s, a young guy. And the woman was with him, and she was wearing a yellow cocktail dress, which was just not necessary, and Cream Corps Missouri at 2 o'clock on a Monday afternoon.
Starting point is 01:19:57 So, you know, they come in, and they're sitting across the table from me, and she's looking at me, you know, with the look. And I'm looking at her, and I'm going, I know. It's not you. I know. It's not you. I can see. It's not you.
Starting point is 01:20:14 So here's the guy. So, all right, man, what's going on? And, again, I already know. This guy worked out. He's a meathead guy. He had muscle, a little doughy, but okay. Well, I've always worked out he's a meathead guy with he had muscle little doughy but okay well i've always worked out but over the last year even longer my lifts are down i'm tired all the time i gained 15 maybe even 20 pounds it's all fat and she's just staring a hole through him and uh then he says and i have no sex drive and she turns her head looks at me
Starting point is 01:20:47 i'm looking at her you know i'm thinking all right whitmer shut up you know you're professional here right because again i told you i said i said almost everybody you know you're not sick you know you're just not happy with the way you're feeling. So I'm looking at him. I'm looking at her, looking back and forth, going, I'm thinking, geez, this girl's here with you, and you don't want to. Because guess what? She could have a date before she hit our parking lot, but she's sitting here with you. So I look at him. I said, you know, I tell almost everybody that comes in here they're not sick. I look back at her.
Starting point is 01:21:28 I look back at him. I look back. I think you might be sick. Here is his story. And this is to our point. He'd been to his GP. You want to guess what his testosterone level was? 120.
Starting point is 01:21:45 It was 255. Oh, man. Come on. His GP told him that he was fine, that he was within the range. He was low normal, but he was fine. Now, I'm sorry. You got a heterosexual, 26-year-old guy that that lifts weight were your lifts going down when you were in your mid-20s no you know prime time ed he's got a girlfriend that looks like this and
Starting point is 01:22:15 he doesn't want to have sex with he's no i don't care what the numbers say yeah no, no way. But that's what they get because unless you're outside of those parameters, that's normal. I've been told they take 95% of the men and they put the top two and a half above and the bottom two and a half below. Everything else is normal. I don't know if that's true or not. But again, I don't care about the number. Certainly not to the point that I care about their symptoms. And that's what's going to direct us. I'm like, yeah, you're not normal. You're fat.
Starting point is 01:22:53 You're tired. You're losing strength. You don't have any sex with a pretty hot girlfriend. Extremely hot. You're just stressing this. Yeah. So, you know, this is called hormone replacement therapy what about some people that come to your office that don't really need the hormones to be replaced they just want to be enhanced we don't do hormone replacement we do uh optimization there you go yeah yeah yeah i think the industry
Starting point is 01:23:27 is kind of it was you hear trt you know and it's you know if you put like tot like people don't doesn't resonate with people so you have to do like hrt or trt even though you know obviously we're optimizing what you have like you know we legallyids. That's what you're trying to communicate to people. You know, yes, testosterone's an anabolic steroid. And I think testosterone gets a bad rap because of the
Starting point is 01:23:58 synthetic anabolic steroids, which, because they're synthetic, they have health issues. They'll screw with your lipids. You see guys their HD hdls drop their cholesterol goes up yeah whatever you're doing on a side man you need to stop because it's screwing with your lipids so yes there are health risks to synthetic anabolic steroids well testosterone is an anabolic steroid. So mainstream medicine has lumped testosterone in with Anivar, you guys, Dianabol, Maxabol, Winstrel, Nandrolone. So it's all bad.
Starting point is 01:24:35 Again, testosterone is a natural hormone that we make. So it's not the same. It's healthy. It's healthy to have better estrogen levels uh i already did the visceral fat thing and what have you guys seen what have you seen when uh somebody comes to you and they used to bodybuild they used to power lift and they did take some of these other drugs uh something like trend balloon or some of these other things so you know you hear so many people talking about trend all the time.
Starting point is 01:25:05 Because you're saying there is negative implications to those things. What are some of the negative implications that you've seen? It's lipidemia. Their own system may not recover well. Their FSH and LH, the pituitary hormones that stimulate the testicles are depressed. And now they're stuck with low testosterone because the extended use, you know, we used to cycle on and off. We somehow innately knew that we shouldn't do this without stopping at some point. But also, we didn't have enough money to go on year round.
Starting point is 01:25:42 And I think if we had the money, we might have gone on year round. But once I got towards the end of a cycle for a competition, I could tell I wasn't feeling good. I just kind of felt like I'm kind of looking forward to stopping. Of course, after six weeks, when you lose 15 pounds and your lifts start going down, you hurt all over, you're ready to go back. and your lifts start going down, you hurt all over, you're ready to go back. But I think guys that I've seen that started using Anabox steroids in their teens, I think that's really a bad idea. Yeah, I know Jeff and I, when I used to travel overseas with him when he was lifting at the world championships and, you know,
Starting point is 01:26:21 the junior worlds where you've got a guy in his weight class and that's 407 you know russian akayev and oh my god well what's he doing he's 19 years old i think when you start they caught him eventually i said they caught him eventually yeah he did get caught yeah when you have the juniors outlifting the seniors out the world records, I think sometimes it's suspect, especially if the... It's a lot of look and appearance, too. I think when you're young, you don't let your natural endocrine system
Starting point is 01:26:53 get established. So it's suppressed at a very young age versus a guy in his 20s who's had several years of building up their own natural levels. Okay, it's a little different. I also have a lot of guys, bodybuilders. Actually, every one of them is a bodybuilder.
Starting point is 01:27:12 These guys are in their 50s. They never stopped. They competed. They did their cycles, took anabox steroids. And then when they were finished competing, you know, they got to that age where I'm not competing anymore, they just went down to a TRT program. And they've been on TRT for
Starting point is 01:27:32 20 years or more, even. These guys, God, I wish I'd have done that, I think. Once I was done competing, I'm done. I'm not doing this. I think I wish I had gone right to TRT. These guys look extremely good for any age.
Starting point is 01:27:52 You don't want to go, man, you look really good for a guy in his 50s. You look really good for a guy that's 23, jacked. And they're not. They're just using a regular testosterone dose. But they maintain that level of fitness. And guess what? They're healthy. But now they're quite a few years down the road and who knows what they did earlier on,
Starting point is 01:28:10 but they didn't screw themselves up. Whereas some do. And I think now there's a lot more information out there from like the bodybuilders that I talked to when they're getting ready to retire. And there's, you know, like you had mentioned, they just abruptly stopped where i think now there's the awareness from a lot of the information out there to say it's okay to stay at this low you're better off staying at this low coasting dose moving forward than completely shutting it down um so like i think that's becoming more and more common what you mentioned uh real quick i love where the conversation is going because i do want to talk more about
Starting point is 01:28:46 the longevity but um you you said um you would prefer a teenager wait until they're in their 20s um i i'm curious uh why um why in their 20s i feel like that still seems like it's a bit young to even um you know kind of dive into something like this. Well, you know, you're 22, you're 23. I don't remember how old I was when I started. I was 22. And I'm competing and I'm getting better. And, yeah, I'm a decent athlete. And the only guys beating me were on.
Starting point is 01:29:28 I wanted to play in their sandbox and these were the rules i didn't have to play in their sandbox but i didn't want to keep getting fifth place i wanted to win i wanted to get to the next level so that's where i went to if you want to talk from just an overall general health standpoint, I would say, yeah, you should wait longer. We have very few guys in their 20s. These guys are sick. They have endocrine problems, pituitary problems. They're sick. They need to do this just for their health versus a normal, let's say, 26-year-old who just wants to jack it up a little bit. But yeah, I would tell that guy, yeah, wait, but I'm not sure if I'm answering your question. Is that where you are? I think just to add to that too, I mean, like the guys that we see in the, in their twenties that
Starting point is 01:30:17 come to us where, whether, Hey, there was previous abuse where they say they're in their mid to upper twenties where they're trying to address that. Or we may have someone where it's a former military member that suffered TBI or close to IED or there's a, like my dad mentioned, pituitary issue, pituitary tumor, things like that. I would say those are the outlier cases, but we are seeing it's more common. Like I said, I started at 32 when I thought I'd start to older, but I was really low. seeing it's more common like i said i started at 32 i when i thought i'd start to older but i was really low i would say it's rare but i mean there's those circumstances where maybe someone is in their mid to late 20s because of some sort of trauma or even a car accident because the pituitary is so sensitive um i would say in those scenarios that we we do see it and we've had you know obviously amazing results too from those people because they're you know obviously like
Starting point is 01:31:03 we had kind of mentioned earlier with the low levels and you combine that with um you know something traumatic or abuse they're you know mentally they're not in a good spot either so we can help get them back on track so i mean just adding context to it right that's really what i was hoping for not to just say like oh as soon as you hit your 20s like yeah you should probably hop on it's just certain case scenarios right yeah i would say those are the those are the outliers, you know, Andrew, for sure. But yeah, I would say most people are coming a little bit later to us in life. I would add to it as well and say, you know, somebody that's been training for a while already, somebody that, you know, maybe feels stuck, you know, they've been at it for a while. you know, maybe feel stuck, you know, they've been, they've been at it for a while.
Starting point is 01:31:48 I think one of the major things to consider, and this is something I share with people often is what Insima alluded to in the beginning of the show. Hey, like, do you get to take these? And like, they, you know, they somehow carry on after you're done using them. They don't. And so somebody that's thinking about using, uh, performance enhancing drugs or thinking about going and getting, uh, going to a clinic of some sort. You're only going to get the results when you're on when you're on the program. You know, that's that's it. You don't get to carry those results on. And if you do get to carry any of them on the gains that you may hold on to when you're not on performance enhancing drugs are going to be probably very little in most in most cases so it's just something to think about like if you're going to do them
Starting point is 01:32:29 whatever age you decide to do them if you want the same results of when you were actually utilizing them you will have to go back to them that's yeah i've never seen it work any different way than that yeah and that's yeah yeah i, that could be said as far as, you know, aesthetically as well as strength. And obviously I'm a way to use a weightlifting analogy. When you have, you'll see someone will hit really good numbers.
Starting point is 01:32:53 Then they, let's say they test positive. And then for, you know, they, you know, water gets more involved, starts testing that country.
Starting point is 01:33:01 And then all of a sudden, you know, once their bands up there, there's some guys where we're seeing that you know they can they're struggling um you know to clean and jerk weights they are snatching um you know where usually there's a significant spread there you know like so it's been it's fascinating but you're you know it's kind of back to square one almost if you will so um you know just to use a strength analogy to there, I said he could. You're absolutely right. And that's what we've seen. some HRT it kind of just makes sense but my question is like how like how long should one maybe wait like how do you know when you're starting to really
Starting point is 01:33:50 decline you know is it obvious just in the way you're feeling low energy etc or is there like just a good time to think about doing it because I want to put that off for as long as I can also because I compete in drug-tested sports. But with that being said, how long do you think something like that could be put off for the idea of longevity, holding on to health, etc.? I wouldn't put it off. I saw a study about a year and a half ago that looked at life expectancy and low testosterone. And they used 440 as the number, as the marker. And they found that guys with levels lower than 440 had decreased life expectancy compared to the guys higher.
Starting point is 01:34:41 Now, you know what they say about statistics? Lies, damn lies, and statistics. Or if you torture numbers long enough, they'll confess to anything. So as a testosterone guy, you know, well, yeah, you want, that's good, right? Well, wait a second. That's correlation or association is that doesn't necessarily indicate a causation that it's the low testosterone that is limiting your life expectancy maybe there are other health issues there that are causing the low testosterone you know the diabetes uh insulin sensitivities keep going out you know that you know the you know, the risks. So that you have low testosterone, you sit on your ass all day to eat shit, you smoke cigarettes and drink beer. So it's
Starting point is 01:35:32 really hard to say. I, I think it's really a very personal issue. There's not a right and wrong. And I really emphasize this to patients that I don't want to come across as really pushing this because I'm so into it. I think it's great. I know what it's done for my life and my wife and I, and then of course, other patients and friends of mine. This is awesome. I don't want to come across shoving it down anybody's throat yeah i want them to understand if you're not happy with where you're at then let's do something about it if you aren't that's fine i don't think i'm not sure you you want to push it off as long as you can because sport and partially like i don't want to start taking something that i don't like yeah and i also don't want to start something
Starting point is 01:36:24 that at the time i don't really need until I need it. You know what I mean? I'd like to ride the wave out as long as I can. Yeah. Yeah. You get to decide. Now you may go, well, you're done competing.
Starting point is 01:36:35 You're not going to get drug tested. Whatever reason your squat over the last couple of years has dropped 10% or maybe even more, or you're losing some muscle. You notice you're not as energetic. The volume, you've got to cut the volume on your workouts now. Your call. That's your call. When do you need it? Well, when my squat drops 20%, I need it.
Starting point is 01:37:03 I don't know. If you're good with 20% drop, okay, then wait until it's 30. If you feel, going back to the libido, how much do you need? I always tell people, if they're in a relationship, I say, how's your partner or your spouse with this? Because this is about compatibility here i've had stopped taking stop because their wife wasn't on board with it you know they go on trt they feel great and she's like yeah right uh you know twice a month is fine but this every other
Starting point is 01:37:39 day isn't going to work so get off me um so there's a compatibility issue there where there's no right or wrong. You need to decide. My wife has talked to people and women and, you know, roughly our age and some, you know, this is controversial and they know what we do. And, you know, she said, heard well who does it anymore anyway well if their husband's okay with that what do i care you know if if they're both happy that's not i think there's some people too though they give in to they say hey obviously we can't help aging every day we get older there's some people that just give into that or instead I said, Hey, there's actually something you can do about it where like, I look at,
Starting point is 01:38:27 you know, for me, I'm like, I feel, I feel just as good now as I did when I was 10 years ago, or even my mid to actually feel better because you know, I was coming off of a lot of heavy training, my joints hurt.
Starting point is 01:38:39 And so it's been beneficial in that way. But I mean, I think so in your scenario, they testing for jujitsu. Yeah. Yeah. I mean, I think for your scenario it's hey when you do know you're done competing and it's hey you know see how you're feeling get the blood work get to a blood work done if you know see where the numbers are at there and then you're very in tune with your body you're you're very structured in your regimen i heard quite a bit about it so i said so i you're, you're very structured in your regimen. I heard quite a bit about it.
Starting point is 01:39:05 So I said, so I, you'll know you're that in tune. You'll know something's a little bit off where I'm like, I knew it was like, as much as I had to, I was like, hold on,
Starting point is 01:39:13 I'm having to sleep so much more. I'm like, I'm having a little trouble getting it up. It's like, this is, it happens. And you're going to know, you know,
Starting point is 01:39:22 and you're, you know, educated to know kind of some of those symptoms, but that's what like my best recognition is when you know, you know, and you're, you know, educated to know kind of some of those symptoms. But that's what like my best recognition is when you get, you know, out of. And that was when I knew I was getting out of drug test support. That's why I said, I do know it. I'm curious at some point that this would be beneficial for me. But, hey, not in my late 20s.
Starting point is 01:39:39 But all of a sudden, when I hit my early 30s, I'm like, wow, like I that's when I was feared. I'm like, how the hell am I going to feel at 60? But I think that would be my best advice for you kind of going forward. And okay. And this makes me curious. This is like, this is partially why I'm so like worry about stuff like this, because it sounds amazing. And it is amazing.
Starting point is 01:39:59 It's like you, you, you can be 69 feeling like, you know, you're 40 something or 30 something. Right. like you you you can be 69 feeling like you know you're 40 something or 30 something right but i mean where's the where's the you know where's the issue here because i'm just like this just sounds too good that's why i'm wondering like you know the aging process we are supposed to age over time like test does go down is is there anything to just like be super careful about because it just it sounds so good and it is so good from what you hear about from so many people but it's just like is there something on the other side of that that people just should be thinking about
Starting point is 01:40:36 yeah this sounds too good to be true kind of yeah therefore something's yeah what's what's wrong with this right or yeah you know what my biggest fears is i'd have to stop testosterone for some reason i i and you're you brought up i know thinking back you guys got me thinking back of my life and uh as i started to age and and i'm you know i i knew i was getting older i didn't like it but yeah you know what are you going to do i'm in my 40s and uh and this wasn't such a thing then as it is now it's really exploding this was hollywood stuff you know this isn't new it was just for hollywood you know why do you think all those people in california are charging so much because they got all those wealthy actors and actresses that are paying 30 000 hours a year for this because they can well now this is available to
Starting point is 01:41:35 everybody else you know you don't have to be sylvester stallone to look good uh he's got enough money to buy all the hgh in the planet. But still, this is for everybody. And where do you want to draw the line? I think that's a very personal decision. And I don't think it's necessarily right or wrong. Yeah, and I think another point to add, too, is that with the, the obviously it's therapeutic doses but one thing that i tell people too is when you get on the regimen of one thing that people don't normally do is get regular blood work if you're going to be a patron with us you you get right or at most a lot of other
Starting point is 01:42:15 clinics too you do get regular blood work done so we're catching other things of other you know because we're not only running hormone panels we're looking at overall health so we're catching some other things in those panels. So it actually, from a lifestyle standpoint, health standpoint, we're monitoring that because a lot of people like they'll come to us and they've never had blood work done before. And he's caught some underlying, a lot of underlying issues, some crazy things into with blood count levels. Someone I know with, you know, stage zero cancer,
Starting point is 01:42:46 things like that. They caught up where they didn't come in. That would have kept growing. Cause they're, it's a battle. Sometimes they get a full extensive panel with your GP, get your insurance, cover it,
Starting point is 01:42:54 and then to get it done regularly. So I think that's one of the things that I look at where it was like, as far as a lifestyle goes, this puts you in a rhythm of monitoring your overall health on a regular cadence and have an interaction with the doctor. So that's why I feel like that's, that's, that's a good point. Even way more so than a regular person. I think, you know, uh, the, the topic gets to be a little confusing sometimes for people,
Starting point is 01:43:18 but we're trying to enhance everything all the time. I mean, you know, you have trouble seeing, you're going to get glasses or contacts or maybe LASIK eye surgery. You're not just going to keep bumping into the same fucking post every day. Eventually you're going to want to do something about not being able to see. Eventually you'd like to do something about not being able to hear. You want to try to figure out ways of making your life better, enhancing your life. And it's very normal for somebody to have an experience. Let's say you go out in a boat with some friends and you have a good time on a weekend. It's very normal to go out and enjoy yourself, have a great time.
Starting point is 01:43:57 And the next time you figure out, I'd like to enhance that a little bit more. So next time, rather than being a stiff and not drinking with every, you know, with everybody else, I'm going to fucking drink, you know, and, and you, you make these decisions and like, has anyone ever had bad experiences with drinking? Well, of course they have. And drinking can be really, uh, harmful in many, many different ways, but drinking can be spectacular as well. I mean, the drinking is, it can be a lot of fun. Uh you drink can you can you drink fairly often and have a great time and and cause no harm to your body i think you can you know but it's got to be like in a reasonable fashion and what you guys are pointing out is even safer because you're being walked through it by people that have experience i'm not trying to like sell people on and say hey
Starting point is 01:44:41 like go fucking do this stuff uh but at the same time, it's enhanced so much for me. I've seen what it has done for other people. The major drawback is that we love this shit. We love to lift. And for people that are listening, for people that are on the bubble, they're like, Oh,
Starting point is 01:44:58 I would recommend to go and seem as route and to push it off unless they have symptoms. If you don't have any symptoms, I don't think there's anything to really worry about. But if you have symptoms, you don't feel good, you feel miserable, you feel depressed about what's going on, then I would really look into the blood work. Then I would consider some of these things. But you have to understand if you are already an iron addict, as our buddy CT Fletcher talks about, this is going to be something that
Starting point is 01:45:25 you will do the rest of your life and you'll be trapped in it. And the pull towards taking more and getting a little more out of it, just like I talked about with the drinking, it's going to be sitting right there for you. It's going to be sitting right there for you in a box somewhere in your house, in a syringe, and it's going to be sitting right there for you talking to you saying, Hey, you should take a little bit like you're doing great. Fucking things are looking good.
Starting point is 01:45:50 Look, you look pretty jacked, but why don't we take this just a little step further and see what happens. And I'm not saying I even know what the detrimental things are to that. It's just that it's a long road. We'll be on them for a long time. There probably is some reason to consider what your life's going to look like when you're 70, when you're 80. And so that's the main thing that I usually try to communicate
Starting point is 01:46:12 with people. Just understand, this is not as simple as you going to the store and picking up some vitamin C. It's much different than that. Just like the doctor pointed out, go do your research. Go read up on it. Talk to other people. Communicate to other people. And listen to shows like this so you do have the information so you can make the right choices moving forward.
Starting point is 01:46:37 Yeah. Have you guys seen or are there such things as, like, diminishing returns on taking testosterone? And if there are are what are some of the things you can do to help aid it we haven't pushed anybody that high but there's certainly diminishing returns we used to talk about this all the time i'm sure mark you know what i'm talking about is well i i went on uh 30 milligrams of Dianabol and my lifts went up 10 kilos. Okay, so let's do 40 milligrams and 50 milligrams.
Starting point is 01:47:11 And at what point do you not get any gains out of it so that it's no more returns? And then at what point do you cross the line where you now are sick? You are not feeling good. I've done that about as far as you can take before the olympic trials in 1980 i was i stayed on longer than i ever did it was uh 18 weeks and usually i would do six to ten so these guys talked me into staying on I was going to go off and then go back and these guys I was training with we're really going to go hard we're all training together you can't do this you don't stay on some of my buddies were on nine months
Starting point is 01:47:55 time which was just unheard of back then so I okay about two to three weeks before, I actually had morning sickness. And of course, my estrogen must have been so high. And I'm not saying estrogen is bad, but mine must have been sky high. Yeah, I would get up in the morning and I couldn't throw up because there's nothing in my stomach, but I've got the dry heaves and I couldn't eat any food. I would choke down a protein shake, drink another one later in the day, maybe get a little food. And then when dinner would come around, I could, I need half my dinner.
Starting point is 01:48:33 I weighed in a full 10 pounds under my normal body weight at the Olympic trials. You know, like what the hell? I got my opening lifts and that was it. And I think I missed, actually, I missed both my openers. I had to repeat them on my second. I was lucky to do that. There's not diminishing returns, but negative returns. I did too much for too long.
Starting point is 01:48:55 So the point, you know, I'd have to look. I can't even remember everything I was doing back then. But for me, it was a lot. I'd also say the lifestyle is a huge part of that. You know, some people that might be listening that are into strength, that are powerlifting. I mean, powerlifters, strongman athletes, they're really at high risk because they're not eating well. And it may not necessarily be the various steroids that somebody's on, although they can contribute to a lot of different things. It's just the poor eating habits and the weight gain.
Starting point is 01:49:27 I mean, your blood pressure is going to go, you know, if you're, if you normally are, you know, six feet tall and you're normally 205 pounds and you're now 300 pounds, I mean, that's going to have, that's going to be stressful. And that's going to, that would be stressful no matter how you did it, no matter how you decided to gain that much weight. Your body's not used to lugging that kind of weight around. So definitely there's I know a lot of people that that are that are considering, you know, going on some stuff. dosages under the care of a physician, which is just in a completely different category than if you're trying to lift, if you're trying to utilize steroids for bodybuilding, if you're trying to utilize steroids for powerlifting, those are things that because
Starting point is 01:50:16 the amount that you may take, they could have more risk. And because you're not really looking under the hood to see what's going on, they could exponentially have even worse implications to them. So it's something that, you know, I don't think people should take lightly and they should pay attention to. Like if you don't have your shit together in terms of a nutrition plan and you think that you're going to hop on steroids and get in shape, I think that's the worst mentality that you can have. You should already have some of these disciplines intact. You should already be hitting the gym.
Starting point is 01:50:48 You should already be eating properly. You should already understand some of these things. And then if you really feel like you're stuck and you're not happy with some of the things going on, then maybe you should look into it. You know, Mark, it used to piss us off when people would look at what you're doing. They look at you, well, you're you're on steroids say you know what i took a bottle of dianabol and i rolled it under the bar the bar then i took a bottle of testosterone and i rolled it under the bar still didn't move right so guess what i'm doing the damn work and everything else that comes with it we've got a few guys though and i think think Jeff might know at least a couple of them.
Starting point is 01:51:28 These are 320 guys. They're obese. Their idea of exercise is playing the guitar. One of them, in particular, I'm thinking about, he essentially sat on a needle once a week and he lost 65 pounds in six weeks. And still drinking his beer, zero exercise. I always tell him, there's a big picture here. You get more out of it if you put this into it.
Starting point is 01:51:57 I told him, I said, don't tell any of your fat friends. I don't want them all coming here thinking they're going to get the same result. Good for you. He's like, this is the best thing I ever did in my life. That's great. Was he able to figure out a way to eat less somehow through some of this process? He told me
Starting point is 01:52:17 he's a beer connoisseur. He knows all the ins and outs of making beer. I'm not a beer drinker, so I don't know mostly what he's talking about. I don't know the difference in the various types, but it's kind of a hobby of his. Okay. I actually was so wanting to help this guy, I set him up with a home gym. I took him to a place, told him what to buy, got him a squat rack, got him a barbell, got him some mats and a bench and some dumbbells.
Starting point is 01:52:50 And I had him over at our house showing him how this is a 40-something-year-old guy squatting an empty bar, which was about the limit. Did he end up exercising or eating any better at all? Or he just mainly took testosterone? He was very happy because he got his squats up to 105 for five. There we go. Nice. Progress. Well, you know what? We all start somewhere.
Starting point is 01:53:14 That's right. And I'm not, okay. But then what? He quit. He just got out of it. He didn't like it. It's uncomfortable, I uh yeah okay i think with him he's in that situation too where he he lost all that initial weight because his hormones were all out of whack
Starting point is 01:53:33 and then he was like i can get he goes like well he goes hold on i got a little lazier i drank a little more beer and like weight's going down this is great and he already i mean it's it's just i mean as far as physical movement and just being, you know, I didn't know who you're talking about. So I know he's more sedentary lifestyle, but yeah, I think where he's like, Hey, I'm going to keep going. Cause I don't want to gain that, you know, 50 to 60 pounds back cause this helps so much.
Starting point is 01:53:56 But we do get people like that where they say, Hey, I can, you know, not work out as much or not. He's good. I feel a little bit better, but to get the maximal benefits, you know, there's, you know, you know, not work out as much or not easy. I feel a little bit better, but to get the maximal benefits, you know, there's, you know, you know, it's, and I, this is how I kind of explained to people to where think about, you know, it's not going to happen suddenly to, if you take the testosterone, maybe after a few weeks, you get a little extra energy, then a little extra libido, then a little strength comes in.
Starting point is 01:54:21 And then later down the road, some fat loss and some body composition truly changes where it's a process. But I said, if you look at it where, you know, instead of doing the super physiological doses, but I said, think if you're in that 1000 to 1500 nanograms per deciliter range and you were down at like 300, I said, well, thank God if you train regularly at those optimal levels of what that's going to do for, for muscle development over the course of time. And that's how I try to explain to you, because this is,
Starting point is 01:54:49 it is not like you're going to go to the gym all of a sudden, going to have veins look like this in three. That's where, you know, they're going to think they're going to magically in three weeks look like this. I said, it's just not going to happen.
Starting point is 01:54:57 It's going to have to take some time. So I think, you know, setting those expectations is important. And what about how, how you've seen it potentially work for obesity? Like, have you guys seen, you know, a protocol of getting somebody on a specific program and optimizing their
Starting point is 01:55:12 hormones? Have you seen it help people quite a bit when you have someone that comes to you that's 300 pounds, 400 pounds? Yes. It's really, of course not. There's different results for different people, but you increase your testosterone, you increase your estrogen,
Starting point is 01:55:34 which improves insulin sensitivity. So you've got guys that are pre-diabetic that don't need metformin anymore and they lose that visceral fat their cholesterol levels drop estrogen is very cardio protective and i've had a few guys uh actually a cardiologist that referred a patient because one of our patients was going to him and this guy was on uh blood pressure medicine he was on his early diabetes he's just on metformin not on insulin and he lost a bunch of weight all he was doing was very by our standards very mild light weight
Starting point is 01:56:15 training workouts uh you know three times a week for 40 minutes kind of stuff and uh probably not squats but the leg press machine or leg curls or something like that. But it really, from a health standpoint, was incredible for him. And God, I wish when I see these guys walking around, I'm like, God dang it. You need to get on some tests, man. When you think of a 45-year- dead isn't a guy or a girl a guy almost always women don't have heart disease like we do until they get in their late 50s early 60s and they start catching up to us well so what's going on with a 60 year old woman menopause she
Starting point is 01:57:03 lost her estrogen 10 years ago. So now she's got the, what do they call it, muffin top. You know, the body changes. They don't have the figure. It's all this. And maybe they start heading towards diabetes. Their posture changes. Their skin looks dry.
Starting point is 01:57:21 You know, they're aging. They lost their hormones. And here they are now with heart disease. You know, when we start taking testosterone and increase estrogen, it helps with these other parameters and it's, it's very healthy. Now, again, some people, they don't handle it as well as others. Most of them do just fine. But I think that's a benefit going back to what you were saying, and Seema about starting at younger. Some of these guys, you bump up their estrogen. I think that helps a lot. It's good for their bones.
Starting point is 01:57:53 It's good for their joints. The bodybuilders guys we see, and these aren't, I say bodybuilders, they don't compete, but that's the mindset. They used to compete. Maybe they want to look shredded and they want to be ripped. You know, water retention and estrogens are mortal enemies. So these guys all want to use an aromatase inhibitor to keep their estrogen down. We talk about the pros and cons.
Starting point is 01:58:17 It's their decision. That's one part of evidence-based medicine is the patient gets to participate in this process. I know pre-comp, they like to start it to dry out a little bit more, but I know a lot of them don't want to go year round. Oh, we got guys, Jeff, that that's where they live. Okay. Really do. I'm not happy about it, but we do what we can to help them when we talk about it.
Starting point is 01:58:43 They're educated. That's their choice. What about thyroid medication and growth hormone and things of that nature? We do what we can to help them when we talk about it. They're educated. That's their choice. What about thyroid medication and growth hormone and things of that nature? Do you bring those things in occasionally? Thyroid, yes. Growth hormone peptides we use. Probably the biggest, most common is sermorelin.
Starting point is 01:59:11 But thyroid, we use a T3, T4 combination made in a pharmacy, so it's a custom-made bioidentical. I see a lot of patients that are taking Synthroid or just a plain levothyroxine as a synthetic T4, and they don't convert well to t3 but uh i don't know how much you guys want to get into this well i'm just kind of asking more so for like maybe some people that are that want to have like a body transformation you know that are thinking about you know considering getting into this and and maybe even the impacts and what you do for women, what that looks like. So yeah, maybe our patient base is, I would say about, we're like 40% women,
Starting point is 01:59:51 60% men. I know we talked a lot about testosterone so far, but we treat a lot of women. And then we do have people come to us specifically just for thyroid deficiencies as well, specifically. So as far as you can let him get in the women, the kind of the female protocols that we, that we look at along with the kind of add to the thyroid stuff but we just like with testosterone we optimize the thyroid so their levels might be within range
Starting point is 02:00:20 but they're tired all the time they get a good eight or nine hours sleep and they wake up, they still want to sleep two or three more hours. They want to take naps every day. Maybe their hair is thinning, their eyebrows are thinning, their skin's dry, their nails are brittle, hypersensitivity to cold, and they just can't lose that weight. Whatever diet they do, starve themselves, they still don't lose weight we look at their thyroid and we optimize their thyroid and maybe even then some you know back in the days before lab tests were available you know how they treated low thyroid i'm going to give you a little bit tell me how you're doing in a month i don't shit okay we're going to give you a little bit
Starting point is 02:01:01 more tell me in another month i still don't feel anything going to give you a little bit more. Tell me in another month. I still don't feel anything. We'll give you a little more. Well, at some point you're going to, Hey, I feel good. There's your dose. One of my best stories. This is a 38 year old woman. She had the gastric sleeve surgery. She was bumping up against 400 pounds and she's 190. When she comes in, you guys would love her. Mixed martial arts fighter. Yeah, that's her passion. Poor sleep, zero libido, tired all the time. So we gave her progesterone, testosterone, and thyroid. We check labs in six weeks, and she didn't get her labs done.
Starting point is 02:01:43 She ran out of her prescription. She calls for a refill, and she says, I'll go get my labs. Well, not now. You haven't been taking it. So just we'll get you the refill, take it. Long story short, it was seven months before she finally got her labs done. She kind of fell through the cracks. Her practice has expanded quite a bit.
Starting point is 02:01:59 We've hired more people now. But I get her labs back. The range for T3, free T3, is 2.3 to 4.2. She was 9.3. I, one of the, one of the signs of hyperthyroidism is heart palpitations. I started having heart palpitations when I saw that. And I thought, oh my God, you know, I'm killing her. And normally I just called her. I went to the office and saw she had an appointment for later in the week. And I thought, you know what? I'm going to see what she says.
Starting point is 02:02:30 If she was having problems, she would have called. She came in. She was 150 pounds. She said she did a fight in the 145-pound weight class. Never had this easy a time making weight. She never kept it off. She said, I have not felt this good in my entire life. And I'm sitting here, I'm fully expecting to drop her dose. And she was on an
Starting point is 02:02:52 average dose. We start people and we have to increase them to get them to four or five. She takes this dose and she comes back 9.3. How the hell does that happen? I don't know. makes this dose and she comes back 9.3. How the hell does that happen? I don't know. So here I pull her labs up. I said, well, you're really high with the free T3. It's way over. It's 9.3. And she almost got off the chair, got on her knee and begged me, please, please don't change a thing. I've never felt this good. So I ran through the symptoms of high thyroid and none of them, you know, none of them, I'm looking at this going, okay, well, that was three years ago. She's still doing awesome. So it goes back to optimizing based on patient response. Neil Rousier was explaining this once, a patient of his in a real high dose.
Starting point is 02:03:49 And somebody raised their hand and said, what were the free T3, T4 levels? He says, I'm not going to tell you. 1,500 hours a weekend for this conference here, man. What do you mean? There's 100 doctors and we're looking around. No, no, you have to tell us. It would scare you. And then he finally did.
Starting point is 02:04:07 But he made his point, which is kind of, I hadn't had this patient at the time. So I didn't necessarily relate to this. And it did scare me when I saw it. But then I went back and said, okay. So we just left it, and it's been great for her ever since. So thyroid is a big thing. Sometimes TRT doesn't work until you optimize the thyroid. A lot of low testosterone, low thyroid symptoms cross over. And low just means symptoms.
Starting point is 02:04:35 It doesn't mean numbers necessarily. What about the difference between men and women in terms of testosterone and estrogen? I mean, we both have both, right? and women in terms of testosterone and estrogen i mean we both have both right so what's a standard level for a woman versus standard levels for a male you're talking about the ranges i guess like normal ranges uh well quest let's go to free testosterone because that's what's bioavailable and actually working. And that number is more important than total testosterone. So for Quest, the range is 35 to 155 for men. And for women, it's 0.1 to 6.4, which is almost criminal.
Starting point is 02:05:22 Because a woman could have 0.2 and she's fine. And a woman with 6.2 is also fine. So those are the levels. And is that what you're looking for, a comparison? Yeah, and then what about estrogen? For estrogen, well, women, it fluctuates throughout the month. You know, they'll go over 100. They'll drop down into the 20s, or even well over 100. For us, there's different methods of
Starting point is 02:05:49 testing. Estradiol, the one we use for Quest is below 39, is considered normal. You know, women need testosterone just like we need estrogen. And a lot of the women, most of the women we see wind up getting testosterone. They're tired. They want muscle. They're workout chicks. They want to look good and be leaner, more muscular. And their libido isn't good. They don't like that.
Starting point is 02:06:24 So testosterone is right up their alley so they love it are there more wrinkles of complexity when it comes to um diet like giving them doses of hrt are there other things that they need to be looking into and then like how about women post-menopause is there a difference in how we treat them and how you treat them post-menopausal women are likely going to get estrogen you know we're looking at hot flashes uh you know their body changes so they're going to get estrogen if they're taking estrogen they must take progesterone and then maybe testosterone maybe thyroid dhea um some of the women uh yeah these are these aren't post-menopausal women i was going to say we've got some women that like the peptides these are younger 40
Starting point is 02:07:13 they're all into that youthful thing so they kind of max that out but there's more moving parts with women when you start throwing in estrogen and progesterone. So they can be more difficult. They generally are more difficult to work with. I think that's why primarily you see, I mean, there's a lot of men's low T clinics all over, and you see a lot of places will only treat men, or there will be a place that only treats women, they tie in the med spa services, because one, you make less money on women in the HRT industry. And then also, too, they're harder to treat. So that's why you'll see a lot of these places.
Starting point is 02:07:52 You'll see low T, low T, where they may be popping up every corner in some cities. But there's places to do both men and women. But I would say see a lot of only that will just focus on just the man would prescribing testosterone to a woman would that mess with their like birth control and that's a really weird question but we can get that all no it's a good question because with synthetic oral contraceptives sex hormone binding globulin is increased. And for women, the range will be up to 84 for younger women. I've seen them come in, they're like 250. So a real high sex hormone binding globulin, which means a greater percentage of their testosterone is going to be tied up by
Starting point is 02:08:43 that carrier protein. When that happens, it's done. It's out of the game until it gets excreted. So they may have a decent testosterone level, but their free testosterone is in the toilet. Then their sex drive is there too. So with that, that's why we want to look at sex hormone binding globulin because I know right away where her testosterone level is okay, but her free testosterone isn't, but we know why. So we're going to have to bump that total testosterone out of the range and get her free testosterone up to range or even a little higher, but it's going to be a disproportionate balance there because of that.
Starting point is 02:09:19 I always try to talk into getting off of it. In the amounts that they would take, does it change their voice and things amounts that they would take does it change their voice and things of that nature or no no uh but uh side effects with the women guys get oily skin maybe some get a little acne that subsides as they get used to the new hormone levels women might get the hertuism or facial hair uh your dark-haired Italian woman with that thick, coarse chin hair, they get those.
Starting point is 02:09:49 The blonder, it's more of a fuzz. Most of them don't have a problem with that, and if they do, we can drop the dose down a little bit. But yeah, by then, the ship has sailed, and they don't want to cut their dose. They're like, I'm just plucking them. I've got one, she's in her 40s. She says, I'm like a teenager again.
Starting point is 02:10:12 My skin's oily, it's breaking out. I said, let me drop your dose. No, my boyfriend loves this. It's a choice. You can deal with it however you want. But rarely do we drop testosterone because once once they hit that they feel so good they don't want to go down they'll deal with you know plucking a few hairs off their chin and then a couple women stop because they didn't like that you know it's not for everybody it's
Starting point is 02:10:36 okay uh do either male or females become desensitized to you know once they find that optimal dosage does that occur over time or is it more they get older and then their natural production changes or something like that so if they're on let's just say guys if a guy's on testosterone there is no natural production
Starting point is 02:11:02 right the hypothalamus and the brain will see that you have plenty of testosterone and it's just gonna there'll be no gonadotropin releasing hormone stimulating the pituitary so there's no fsh or lh and your testicles aren't producing uh sperm or testosterone now that they're not sterile, it's not birth control, just takes one, but their sperm count will be suppressed. So that's long gone when they started testosterone. So to answer your question, no, you know, this isn't like a chemical, like alcohol or Oxycontin, whatever, a codeine, Vicodin type, where you build up a sensitivity to the chemical where you need
Starting point is 02:11:46 to take more and more to get the effect. It's just not that case with this. And for those that are looking to get pregnant, men and women, are there any considerations that they need to take into account before taking any of this stuff? Does it have any effect?
Starting point is 02:12:02 Yes. I talk to the younger guys who are interested in having children and we talk about the decreased fertility and what happens to the axis. We use HCG when they're ready to conceive
Starting point is 02:12:18 which mimics FSH and LH and stimulates the testicles to make sperm and testosterone. We can, we haven't because nobody's needed to. You can get injectable FSH itself and use that. It's more expensive, but we just haven't needed it. Everybody has been able to successfully conceive. Sometimes Clomid, we've used that as well.
Starting point is 02:12:48 So yeah, we'll alter their protocol when they get to the point where they want to start having a family. I think some of these guys, they were unable to conceive because their testosterone was so low. Their sex drive was in the toilet and they probably weren't making much sperm. So they needed the HCG to get things fired up down there. For women, I would pull them off testosterone if they're trying to get pregnant. I'm not sure at what level you start masculinizing the fetus. So at the end of the world, You can stop for a few months. You know, high testosterone levels or testosterone supplements can have an effect on the baby.
Starting point is 02:13:34 And how about like site and like the actual location of injections? Does that matter? I know there's like sub-Q and and then um i forgot whatever the muscle sorry i am yeah um we tell the guys they could use their out lateral thigh uh vastus lateralis or their glute i don't have anybody that does delts but that's fine we use between a half inch and inch needles. So it's either a shallow IEM or obviously intramuscular with a inch. There are some that advocate the sub-Q. I think that's probably fine with the lower doses. You can use a smaller, thinner needle. Those are the guys that are injecting, I say micro dosing every day, maybe.
Starting point is 02:14:30 Your labs will bear that out. If it's not getting absorbed because it's getting injected into the fat, your labs will show that. But it just doesn't. I've seen studies where the sub-Q was doing just fine. It's in your body. Eventually, it's going to get into the bloodstream and it's going to do its thing. So there's been some argument over the years, some very well-known, I think John Chrysler was one of the early advocates of the sub-Q protocol. And people are arguing back and forth. Hey, if you're injecting sub-Q and you feel great, then keep doing it. If you're not, well, maybe that's another thing we ought to think about modifying and try another route.
Starting point is 02:15:05 But I don't have anybody that does the abdomen. We do have guys that use the half-inch needle with anywhere from like a 0.3 to 0.5 milliliter dose and do just fine with that. I was curious because earlier in the conversation, you mentioned testosterone being a controlled substance. I was curious because earlier in the conversation, you mentioned testosterone being a controlled substance. And I don't know if you were mentioning how that's problematic or. I politically now, I don't think it's. Oh, God, I don't. Right. I get this right, wrong and legal, I guess. I think there was a kid in Texas, a high school kid who was taking steroids, wound up committing suicide.
Starting point is 02:15:49 And his boss got in on this cause and lobbied the politicians to start regulating antibiotic steroids. And John McCain was actually heavily involved in this. And the Congress, I can't remember what year it was. I want to say, oh, God, it had to be the second George Bush was president, but they passed a law that got signed that testosterone was a controlled substance. So now it's a felony. We can thank our current president for that as well. Was he voting on that too?
Starting point is 02:16:27 Yeah, he was involved, yeah. I'm stunned. I find that very difficult. He needs to be on now. Right. Or he might fall over again. But yeah, I don't think it should be a controlled substance. I think these things probably should be prescription, though, because of some of the intricacies involved. Do you guys remember when Donald Trump was elected?
Starting point is 02:16:54 They actually announced his testosterone at 492. Wow. I'm thinking, whoa, I would have bet $500 Trump was on TRT, you know, or 92. He must have gone off before the test or something. And the other side of me is thinking, I don't, it's none of my business what that is. You know, they didn't tell us Bill Clinton's testosterone levels. She was probably high. I don't know.
Starting point is 02:17:24 So why are they telling? But I'm sure he had to OK the announcement. Right. So they they tell you his height, his weight, his blood pressure. He's the president. That's none of my business. I guess you want to know that they're healthy. You're not going to die tomorrow.
Starting point is 02:17:37 If the president was in a coma, I'd be concerned. Well, I think the media was coming out with some things that he was unhealthy. So he's trying to combat that. And they did the full physical and release it. So shocker. But yeah, they were trying to say, you know, unfit health wise. So I think that's why he pushed out some facts. You know what I think?
Starting point is 02:17:55 I think there's guys like me that figured he was on testosterone and the liberals are all scared that he's on testosterone. He's going to start a war because he's aggressive. Yeah. And so they went ahead and put that number out there, which I'm not sure I believe. I'm. You know, it is.
Starting point is 02:18:15 I worked there. You know, this is a robust man. I suppose he's overweight, but he's not grotesquely overweight. Yeah. I should shut up. I figured he would have been doing like 150 a week at least. Right.
Starting point is 02:18:32 Yeah. You know what? I would hope so. I want the president maximized. Well, not this one. With testosterone being a Schedule II drug, it is important for people to understand that it is illegal you know so people just need to they just need to recognize that and uh you know that that brings up a whole other side of things you know that you you uh either got to get them in some shady way or you got to go uh visit guys like uh like you guys yeah. Or it's a controlled substance.
Starting point is 02:19:06 Or it's people mixing the, the order, the powder on the dark web, mix it in their garage and suspend the oil themselves. And, you know, I've heard some, you know,
Starting point is 02:19:16 as you have, I'm sure as well, I've heard some crazy stories where someone's thinking they're, you know, injecting a certain amount and it, their levels would indicate something really high or really low. I've seen and heard some crazy stories, and I don't know how sterile some of these people's garages are. I don't know if it's an ISO-certified facility.
Starting point is 02:19:41 Well, you know what? It's not that expensive. In fact, I know some of the guys that were getting it underground, our prices were cheaper than what they were paying for it. Getting there. But now if you want to take high level dosing, well, we were not doing that.
Starting point is 02:19:57 So I, and I know there's some guys that they're getting it from us and they're also getting it from their buddies. We had a guy about two or three weeks ago, come back. Are you guys sitting down? His testosterone level was over 10,000. us and they're also getting it from their buddies we had a guy about two or three weeks ago uh come back are you guys sitting down his testosterone level was over 10 000 damn yeah it was the little carrot above 10 000 because the lab couldn't even tell you how much it was because it was over 10 000 it was so high great look at that there's got to be a lab here no he was, he came clean.
Starting point is 02:20:26 I don't know. He told me he was taking 400 milligrams on top of ours. I'm thinking he was taking more than that. I just said, hey, look, you know, if you're going to do that, that's up to you. But don't do that and go get your blood drawn where now it's in our records. Because we're not giving you testosterone. So you need to stop. We're going to do another blood test and if the levels aren't down you know we won't prescribe you anymore because guess what your levels are way high you don't need it so you know but you
Starting point is 02:20:54 got to do that outside of us i'm not naive you know just being honest i know some do that so we i mean we've been talking about dosages even some of the locations of injections and then like this guy just seemed like he was probably pinning himself with a lot of stuff um but for some people like you know the whole thing of getting over the needles is like a hurdle in itself um how safe is it you know for like general i i mean i guess i'll say general population but i mean general population of people that are listening to this podcast um like have you guys seen anything where like somebody who's self-administering you know testosterone where they make a mistake and like have things gone bad because like that's yeah i
Starting point is 02:21:42 like i've said on a previous podcast where like i've heard like uh it was like almost propaganda like oh if you pin yourself and you accidentally hit like a certain nerve like you'll paralyze yourself and all kinds of weird like scary things like and seem was like cringing right now and i know now that that was like not true but you know are there anything that people are there any things that people really need to be careful of when it comes to self-administering some of these protocols? Well, obviously, you want to use sterile technique and needle placement. Our medical assistants will train you and show you how in the office and you can inject yourself under their supervision. We encourage everybody to do it on their own. I think a lot
Starting point is 02:22:27 of these clinics just want to get you back in there so they could charge you 35 bucks every week for an injection, to be honest with you. But maybe I shouldn't say that, but that's just my guess. And then for remote patients too, then we send them instructions. And we can even do FaceTime with the medical system walk through just like we do the consults and you know usually it's that first time once you do it you're just then after you know maybe the second time and there's a couple of certain techniques to use then it really honestly becomes like brushing your teeth that's pretty simple but like i even had a little phobia from like how am i gonna do this i push it all the way in and then once you get down like but it has not been
Starting point is 02:23:09 an issue and i i did think it was going to be at first because even in my mind i'm like a little hesitant driving this into you know hard muscle but it it becomes like second nature once you get used to doing it and so like i i thought it'd be an issue. Very rarely someone will say, I can't inject or whatever. It's kind of few and far between. Like you said, the key is obviously it's got to be sterile. We had a guy get a serious infection because he was injecting on his thigh a full CC sub-Q, just barely underneath the skin. We taught him how to do it i but anyhow
Starting point is 02:23:48 i for the guys that don't want to do injections and there aren't very many we do use scrotal creams kind of interesting uh it's a daily application or even twice daily the advantage of it is you get a very steady level, whereas with the ejection, you know, it goes up in a couple days. Over the course of the week, it drops. With this, you're steady throughout the week, even though naturally our levels drop and raise throughout the day. You know, at the end of a hard work day or a stressful day,
Starting point is 02:24:20 you're going to be lower than you were first thing in the morning. But some of the guys just don't want to do the needles and they use the creams. The disadvantage is transfer. You've got to let it dry. You can't get dressed, take a shower after putting them on and a daily application. About 70% of the creams are absorbed, and we all absorb those differently. Whereas with the injection, 100% of it is there. We may respond differently, but we know all those milligrams are there. With the creams, we're not necessarily sure how much of that gets absorbed. But it's an option. And most of the women use the creams, the transdermal.
Starting point is 02:25:04 Some do injections. I would say of our patient base, I'm the creams for men. Oh, very, very well. I mean, I think I could count on both my hands. That cream sounds nice. Yeah. You know, I don't know. I put it on like deodorant.
Starting point is 02:25:21 Yeah, I was going to say. Oh, yeah, under your balls. on that deodorant. Yeah, I was going to say. Under your balls. Yeah, I'd rather inject once a week than, you know, be digging down there. Fuck it, do both, man. Let's go. Yeah, keep that steady stream.
Starting point is 02:25:35 I don't have any, but there are some that do that. They submit their injections with creams. Wow, I like it. If you have something planned for later that day. You throw your cream on. Here at ST, instead of having the Lysol dispensers, we should just have that TRT
Starting point is 02:25:54 cream so when everybody walks in, they're just like, hey, you need a little boost today. Actually, that brings up a question. There's some great signs around, by the way. If somebody were to wipe this cream on their butt versus their scrotum, would it have even less of an effect? Or would it still have an effect but lesser than on the scrotum? Yes.
Starting point is 02:26:14 The skin is thinner there. It gets absorbed better. You may have heard of the gels, the Androgel, Testogel. to the gels, the androgel, testogel, those are about 30% absorbed and they seem to have different effects than what injections do. But those are the trademark pharmaceutical testosterone replacement preparations designed so they don't have to go to the office a couple times a month to get an injection. You can just do this on own you know those are rubbed all over it's a little sachet that there's a lot of gel it's alcohol-based it's not absorbed that well whereas the transdermal creams the versacream uh those are absorbed better but the scrotum because the thin skin is a lot
Starting point is 02:26:59 better the women we have them most of them use a cream but we haven't put it like inner thigh lower abdomen you know maybe upper arm not axillary area but up in here but we've had some women that didn't absorb the creams very well and i just have them on trilabias you know and they do fine there i mean the numbers bear it out we just switch location and now their levels go where they should be some women don't they they just don't absorb the creams, and they go to injections eventually. So put it on your scrotum. Yeah. On your scrotum.
Starting point is 02:27:30 Nope, no problem. Yeah, sorry, man. And you know what? They even recommend shaving it. Ooh. Oh, nice. You want to landscape. Yeah, you don't have the hair getting in the way.
Starting point is 02:27:40 Will your clinic shave it for you? Never mind. That's an additional California. Andrew, why don't you take us out of here, buddy? I will. Thank you, everybody, for taking out today's episode. Hopefully, we answered some of your questions about testosterone. We know we've been getting a lot of questions in the comment section as well as on Instagram.
Starting point is 02:28:02 So, if we did do that today, please hit that like button, hit the bell. If you guys haven't already, please subscribe. Of course, please make sure you find the podcast at Mark Bell's power project on Instagram at MB power project on Tik TOK and Twitter. My Instagram and Twitter is at,
Starting point is 02:28:18 I am Andrew Z and SEMA. Where are you at? I didn't see my Indian on Instagram, YouTube and see me getting on Tik TOK and Twitter, Dr. Whitmer and Jeff. I'm at Jeff my Indian on Instagram and YouTube. I didn't see me getting on Tik TOK and Twitter, Dr. Whitmer and Jeff. I'm at Jeff Whitmer on Instagram. And then the clinic is at national rejuvenation centers.
Starting point is 02:28:32 There you go. And I mean, I guess I can link stuff down below, but like you guys just, is that the website? Yeah. So the website, it's just,
Starting point is 02:28:40 you can go to NR centers.com or national rejuvenation centers.com. We'll do the same place. Dr. Whitmer. Thank you so much for your time today. You're welcome. Obviously, this was fun. I think I'm talking to the right crowd here. I told them it would be your crowd. Yeah, go hit up some deadlifts and squats for us.
Starting point is 02:29:01 All of you guys can outlift me, so that's great. Have a great rest of your day. I'm Mark Smiley-Bell. Strength is never weakness. Weakness is never strength. Catch you all later.

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