Mark Bell's Power Project - EP. 573 - Dr. Kyle Gillett TRT AND HRT for dummies and the importance of blood work

Episode Date: August 13, 2021

Dr. Kyle Gillett is the Medical Director and Head of Treatment over at Marek Health. We had an awesome conversation that covers everything regarding TRT/HRT, obesity and what is causing the sudden rise in infertility amongst men and women. Dr. Gillett earned his medical degree from the University of Kansas School of Medicine and completed a residency with Cox Family Medicine in Springfield, MO. He has training and certifications in obstetrics, emergency medicine, vasectomies, medical Spanish, obesity medicine, and other areas. Subscribe to the Podcast on on Platforms! ➢ https://lnk.to/PowerProjectPodcast Special perks for our listeners below! ➢Marek Health: https://marekhealth.com Use code POWERPROJECT15 for 15% off ALL LABS! Also check out the Power Project Panel: https://marekhealth.com/powerproject Use code POWERPROJECT for $101 off! ➢Eat Rite Foods: http://eatritefoods.com/ Use code "POWERPROJECT25" for 25% off your first order, then code "POWERPROJECT" for 10% off every order after! ➢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 $150 Subscribe to the Power Project Newsletter! ➢ https://bit.ly/2JvmXMb 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 ➢ https://www.breakthebar.com/learn-more ➢YouTube: https://www.youtube.com/c/NsimaInyang ➢Instagram: https://www.instagram.com/nsimainyang/?hl=en ➢TikTok: https://www.tiktok.com/@nsimayinyang?lang=en Follow Andrew Zaragoza on all platforms ➢ https://direct.me/iamandrewz #PowerProject #Podcast #MarkBell

having fun causing problems are you guys ready i'm ready we're rolling i'm ready i'm ready i'm not that gay and see my i just said i just i just thought that we should think if we were gonna start this podcast i mean i i don't know. I just think we should be together. I mean, it's a suggestion more than anything. This man sends me a voice note this morning. He's like, hey, man.

So next week, man, I'll say you should come up to my house in Bodega and we could go running and we could have some fun together running and maybe some more, but maybe just running. I'm like mad oh man i'm down to come run i'm down to come you're blushing i'm blushing a little bit man it worked it worked it worked i'm down to come run i'm down to come oh my gosh and whatever else happens and just whatever the phrasing. I'm down to come run. Yeah, the come run. The come run.

That'll be hard to figure out. We have no chill on this podcast, but we got issues. And let's start recording now. Yeah, for real. I was thinking, I'm like, okay, we got a dope guest today. Let's be adults. A doctor. And then we go and do this.

Yeah, we have Dr. Gillette. And totally redeem yourself. We got Dr. Gillette on the show today. He works with Merrick Labs and he has a background in obesity, which I got a background in obesity too, apparently. But he also has a background with family care, which I'm really interested in. Because, yeah, how do you help an entire family get healthier? Sometimes it's like one person just goes and starts to get their – they start to have a dietary intervention. Maybe they are getting their blood looked at and all different kinds of things, and

they're following like a protocol. But then maybe the wife's not doing the same thing, and maybe the kids are still eating pizza and macaroni and cheese and things like that. So it'll be interesting to dive in with him and to hear some of the suggestions because we've talked about many of these things on the show before. And it's going to be really cool. I'm really interested in talking about what makes these clinics different because you hear about a lot of people that go to TRT, HRT clinics and everyone gets the same thing. You hear that a lot.

You hear a lot of people be like, oh, I was getting this, but then he was also getting the same shit too and we have different levels like it's it's not standardized right and merrick apparently they're doing a lot of things on the back end to make sure that whatever you get tested the doctor will check it and they will let you know exactly you'll have a direct protocol for your specific situation so it's gonna be interesting to hear more about that because a lot of people are interested in it. A lot of people really need it. But I also want to know what like certain certain populations don't really need it.

And there are probably certain things that they can do as far as lifestyle and all of that's concerned to become healthier without that. I've been to like five different doctors over the last several years to try to figure out how to get my like hormones like optimized, I guess you'd say. And, you know, some some stuff like when I first started doing this, I was taking higher amounts, higher dosages than what the doctors were suggesting and recommending. and what the doctors were suggesting and recommending. But as I worked my way through it more and as I, the first couple of doctors that I worked with and the first couple of companies that I worked with, they wouldn't really have that much explanation on what was going on.

And so I didn't really, it was just like not great communication back and forth either. It was just like not great communication back and forth either. And so I was looking for a company that was going to just basically just help me feel better more so than anything. Like I don't really care that much about being as big as I was years ago because I was on a different drug protocol back then. That was just legitimate like steroid abuse. I can admit that. I got no problem saying that. That was to reach certain goals and it worked for certain things I was trying to do. But nowadays I want to be healthier. I want to feel better. I want to be able to move better like that. That's a huge goal of mine. And you know, part of that process is, you know,

leaning out and looking better and things like that too. But they're no bullshit. Like Merrick, I go back and forth with the doctor and they're like, well, we know you haven't taken the dosage that you're supposed to yet. And they check my blood again and they're like, okay, you're getting closer, but we still know that you're full of shit. Quit pulling back so far on that syringe. Yeah, yeah,

exactly. Um, it's just, it's just, it's what I'm used to, right? Wait, wait,

wait. I was used to, I missed the joke. Like, are you doing too little or you're doing too much? I'm doing too much. I was, I was used to it.

Cause if you're loading it and you're pulling back. Okay. Okay. Yeah. Just like, yeah, yeah. Like the, uh, pre-workout, uh, little commercials that everyone does, like just only have one scoop and then they have three and they go overboard.

But what happens is when you start to get outside the realm of TRT is like you start to cause a cascade of other hormones to move in directions that you might not want. So to Encima's point, some companies will, you know, automatically prescribe an anti-estrogen type thing to go along with your testosterone and things like that. And these guys are like, no, let's just watch your hormones. They'll balance out when you're on correct dosages. Because when you take testosterone, it is a bioidentical hormone that's already in your body. You're just taking to get a little extra boost. So, um, America has been amazing for me so far. I'm really, um, there's like one little piece of the puzzle that we're still working on, but they're, they're helping me with that. Any issues that you have from a health

standpoint, they'll work with you on anything. And I'm just trying to get a little bit more sleep. You know, that's kind of the only last mystery to kind of work on with me is to get that remedied, but they have all kinds of great suggestions. You know, talk to the doctor and the doctor's like, Hey, there's at home sleep studies you can get. And we know of a disposable ones that we could just have sent to you. And so it's just great to have just at your fingertips. It was simple email or a phone call at any time. I can communicate with them on any issues that I might have or anything that I want to maybe start to move towards. Yeah.

So for more information on the world's number one premium telehealth TRT clinic, like Mark said, they're not going to give you the old cookie cutter program that the guy next to you is going to get as well. Head over to merichealth.com slash powerproject. Now that'll take you directly to the Power Project panel. That's the most comprehensive panel that we were able to put together. But something awesome and brand new is that any lab that you can get at MerrickHealth.com is now going to be 15% off with promo code PowerProject15. So for some of you that maybe just want to get your test levels checked or you have certain, I don't know,

everyone wants to talk about their thyroid. So maybe you can just go get that lab done. You don't have to get the entire comprehensive panel. You can pick, you can select exactly what you want. And again, you can get that at 15% off. That's at Merrick health.com promo code power project 15. And you know, we're going to get into all kinds of labs today and figure out what panels are, are, you know, best for people wanting certain things, or they want to figure out certain, you know, issues that they have going on. So if you're not sure, please listen to today's episode. But also, don't forget MerrickHealth.com slash PowerProject for the most comprehensive panel

that you can get. And then just MerrickHealth.com and promo code PowerProject15 for 15% off all labs. I mean, that's literally unheard of. So every single lab, you can select one or select a ton you get 15 off links to them down in the description as well as the podcast show notes it's really cool like when i saw the results of my panel like this is why even if you like if you do want to get hrt or trt that's cool like it could be very beneficial for you but i'm i feel really good because the when i did the power project panel i got all those labs done,

I'm in good health everywhere, right? Like there's nothing weird going on with my cholesterol. There's nothing weird going on with anything. Um, and that gives me a lot of confidence in terms of what I'm currently doing. But before that, since I haven't had labs in years,

I wasn't necessarily sure, like I feel good, but you never know what you can find. Like they've mentioned how they've like screened people and found certain things as far as cancer is concerned, right? So, like, it's necessary to do this so you can see, is everything moving and working the way it needs to? They used to believe that you can only get fatty liver disease from drinking alcohol. fatty liver disease from drinking alcohol. But now we have so much processed food in our circulation that there's something called non-alcoholic fatty liver disease.

And many, many people have it. The percentage of the population that's getting that kind of stuff is going up all the time. There's people with all kinds of different issues that they might not be aware of, including insulin resistance. There we go.

Can you hear us yet, Dr. Gillette? I can hear you loud and clear. Thanks for having me on today. Yeah, we really appreciate your time today. Can you give us a little background on your kind of medical history and kind of how you got into working with Merrick even? Absolutely. So I noticed that you were talking about insulin resistance as I joined

and that has a lot to do with it. So I've always kind of known that I wanted to be a family doctor. My dad's a family doctor as well. And what family doctors are supposed to specialize in is preventative medicine and then also connecting with the individual. So I've always had a passion for that. Through med school, I was a member of organizations like Food is Medicine and Exercise is Medicine, which have fortunately started to catch on as of recently. And I noticed that a lot of my colleagues had passion for similar things, especially during medical training, during med school, and even during residency, doing things like walk with the doc, where you'd walk with your doctor. And, you know, Saturday morning, you go and exercise together for health reasons. And we'd even write prescriptions

for it as well on a prescription pad, just like we would a medication. But somehow, transitioning to clinical practice that is lost to some degree. And that's how I ended up with Merrick because Merrick seems to emphasize the lifestyle interventions that are more powerful than any medication that we can prescribe someone. Yeah, that's amazing. You would walk with the patients? That sounds amazing. Yeah, it's definitely an interesting dynamic that you can't walk individually with all of them. Sometimes we'd have a group of several dozen

and we'd all do walks. I know that you guys like to do walks in between podcasts and after meals and nutrient partitioning and all this. And I think that's great that that's catching on as it's an extremely good thing to do for your health. I love what you said about a lot of, I was going to say, I love what you said about, you know, preventative. And I think that maybe sometimes these things are kind of lost. Uh, we're trying to prevent, um, you know, as we get older, um, you know, things accumulate in the body and over time you might end up with, uh, uh, plaque in your arteries. You might end up with some insulin resistance. You might end up, people sometimes end up with like fatty liver disease, or, uh, there's all these different things that people,

uh, could possibly, you know, end up getting even something like sleep apnea, which could be, uh, you know, correlated to a lot of the, a lot of your lifestyle choices. There could be other reasons, I guess, for it. But I think a lot of times we lose sight of the fact that like we want to try to do some of these things as preventative measures, but that's not very sexy or attractive to like do stuff in anticipation of something that hasn't happened yet. So it's sometimes hard to get somebody to, I guess, get on board with doing proper exercise and having a dietary intervention. Absolutely.

Logistically, it can be very, very difficult as well. So I understand the plight of many physicians these days, especially primary care physicians or anybody in primary care. We have all these wonderful programs that help incentivize people to do primary care, especially in underserved areas. But a lot of that is a stopgap for treating the untreated pathology because of an unhealthy population. There isn't really many programs to have true preventative care before the pathology happens because we're so busy treating pathology. And unfortunately, a lot of people that have health insurance, their health insurance doesn't want to cover what they might deem necessary.

And then for people that don't, it can be even harder. So those are two areas where Merrick excels at. A lot of people, maybe they have a job or maybe they have a lower tier high deductible insurance plan, which are becoming more and more common. And they work really hard. They don't have very much time to get healthcare and they might live close to a doctor, but they might not have good rapport with their primary care physician. And that's becoming more and more important as the population gets more and more unhealthy. As far as labs are concerned, let me ask you this, because most people, you know, first off, they don't even know what type of like labs to get, but what are the types of

difficulties that people with health insurance and people without health insurance, what type of difficulty do they fall into when they're trying to get labs done? Because I've heard people say, my doc says I shouldn't even get this done, or he thinks it's useless, et cetera. So what are like some pitfalls for people who are trying to do this just with their doctor? So if you're trying to use your regular doctor to get good lab workup, there's different levels of evidence for what we call screening labs. And each society in general has its own recommendations. So family doctors will have a recommendation. The urologist will have a recommendation, which may or may not be congruent. They all come together and there's something called USPTF, the United States Preventative Task Force, which is a

conglomeration of many different specialties and also brilliant statisticians. So they're making screening recommendations from a population-based standpoint. So it's not really an individual based standpoint. So they take into account the number needed to treat. So if you screen someone for, let's say thyroid dysfunction, how many people benefit from that? And then how many people are harmed? Because if you screen for things like thyroid dysfunction or prostate cancer, then you get false positives as well. So the difficulty in that is when those societies release their recommendations, the insurance company will choose usually based on those, whether they cover the test or not cover the test. For example, this summer, the screening

recommendation for most people for colon cancer, which is the highest level of evidence is either a fit test or a colonoscopy changed from 50 to 45. And most insurance companies are changing their coverage and they will now pay for people age 45 to 50 in general for colon cancer screening. In the case of something like insulin resistance, let's say that you see that somebody does have some insulin resistance on their labs. Insulin resistance, maybe for people that don't know, could lead to being pre-diabetic and can lead to being type 2 diabetic. I believe maybe you can clarify that a little bit more. some recommendations be for somebody that has some insulin resistance, both maybe a pharmaceutical and as well as maybe something over-the-counter that someone could utilize? So thinking about insulin resistance in general, the overarching term that I like to use for

it is metabolic syndrome. So it encompasses dyslipidemia. It also encompasses high levels of insulin, high levels of glucose in the bloodstream, intravascularly, and occasionally low levels of glucose in the cellular level. So it's also correlated with high body mass in the abdominal area, high visceral body fat, and thus fatty liver disease, which is fat accumulation in the liver. So just by looking at those different parameters, you can usually tell or infer if they have insulin resistance. However, the general screening labs do not, you know, they don't measure a fasting insulin. They don't measure the insulin resistance score based on your lipids. And many don't even include an A1C, which is basically a marker of

your average blood glucose in the past three months, assuming that you have a normal amount of red blood cells. Yeah, we hear all the commercials about all the time. It's going to lower your A1C. Yeah, but a lot of insurance companies don't recommend screening for diabetes or prediabetes or insulin resistance with an A1C. So it can be hard to know if you have insulin resistance. However, some of the best things that you can do for it is have a lot of healthy fiber in your diet, both prebiotic fibers and dietary fibers, which is soluble fiber. diet, both prebiotic fibers and dietary fibers, which is soluble fiber. Also doing a combination of anaerobic and aerobic exercise can insulin sensitize you as well. There's also lots of supplements. So inositol is a popular one. Many people know it for its fertility benefit because infertility is becoming more and more prevalent as well. So it's a B vitamin derivative, but it's also an

insulin sensitizer. So that's another good insulin sensitizer that you can take that's over the counter. Myo-inositol is one form of it. And that has more to do with the insulin sensitivity. There's also D-chiro-inositol, which is weak antiandrogen. So some people get a combination of both, especially women. Men usually go with the myo-inositol. Now, you asked about pharmaceuticals as well. So there's lots of different pharmaceuticals that can help insulin sensitize you. It kind of depends on what your personal situation is. you, it kind of depends on what your personal situation is. So some medications that we used to use for diabetes a long time ago are great when it comes to preserving beta cell function,

the pancreas. Beta cells is what secretes insulin. So when someone becomes diabetic, think of their beta cells as dying. So if we do autopsies on diabetics, oftentimes they have less than 15% of their beta cells left. So you want to preserve those, one, so you don't get diabetes, and two, so that you don't end up on insulin if you do get diabetes. So certain medications like TZDs or Actos are actually very good at that, but they have other detriments, especially when you use them in a long-term basis. So that's usually not a good long-term medicine. Some are good long-term, but they also have, you know,

metformin is an example of a very controversial one, which is one of the most commonly prescribed medications. In diabetics, it extends their life. So there's a mortality benefit. it extends their life. So there's a mortality benefit. However, it's not as strong as some medications at synthesizing you to insulin, but it has different mechanisms of action. So depending on the individual case, a short course of metformin could be indicated. And then also for life extension purposes, metformin potentially has some benefit as well. So the side effects of metformin, which is with long-term use, B12 deficiency, that's something that people bring up often. Also with long-term use, potential lowering of IGF-1 is another side effect.

Of course, those can be attenuated and taken into account depending on what your starting levels of those markers are. You know, having seen so many, I'm guessing, labs, you mentioned infertility being on the rise. And I'm just kind of curious about that. Like with everything you've seen, what are some of the big reasons why that's on the rise? I'd assume maybe it's something within lifestyle or are there deeper reasons why that's on the rise? I'd assume maybe it's something within lifestyle or are there deeper reasons why that's a problem? The answer to this one is all the above. So people have lots and lots of different theories of why infertility is becoming more and more prevalent. One of the easiest things to target is metabolic syndrome. So when you have different things that are inhibiting your

pituitary function, then spermatogenesis can be problematic and ovulation can be problematic as well. So insulin resistance is of course correlated with a condition known as PCOS, which is a continuum of androgenic activity and insulin resistance and polycystic ovaries. However, the same processes that are causing that can also cause infertility risk in men. So if you look at infertility risk and the rates of obesity in the United States, you can see that they're closely correlated, not necessarily directly causatory in some circumstances, but definitely correlated. And then, of course, you have the debate, which there's weaker evidence for, but theoretically could be playing a part, is toxins in the environment. What is polycystic ovarian syndrome? I hear it a lot. I've heard a lot of women in my life talk about it. And how can

someone potentially, I guess, rid themselves of this? I don't really know exactly what it is. I could be wrong too. I hear about it a lot amongst like really fit women. Yeah. Yeah, so do I. Yeah? Yep. Okay. Yeah. So PCOS is a group. It's really a continuum of many different conditions that often cause hyperandrogenic side effects. So in women, a lot of times this would be, you know, hair growth or even beard growth, acne, male pattern baldness, even uh and then high free testosterone low sex hormone binding globulin

often high lh to fsh ratio often greater than two um there's a couple different theories of why some people get pcos some people likely get pOS just because of a hormonal condition. For example, hyperthecosis, the ovary has specialized cells called beca cells that can secrete androgens. And for some reason, women have very high levels of this. I believe this has been talked about pretty often with the Olympics. There's several elite female sprinters, um, you know, XX sprinters, and they just have high levels. So, uh, that those people are very high risk of developing PCOS. So, uh, there's also other causes. Some cases of PCOS are likely just related to metabolic syndrome, excess calories over time causing hyperinsulinemia. So there's cases in between as well.

How is it usually treated? Like, is there anything, is there like supplements or get more sleep or is there something you can do to kind of rewind the clock and not have it anymore? Yeah, so it's completely reversible in most cases. to kind of rewind the clock and not have it anymore? Yeah. So it's completely reversible in most cases. Some are significantly more resistant. The mainstay of treatment, so it used to be 10 or 20 years ago,

you'd go into your family physician and they'd say diet with caloric deficit and exercise. And that was pretty much the treatment. Metformin is used often for fertility. Fertility drugs are used often, for example, letrozole or Clomid. But if fertility is not currently desired, oftentimes different things that help increase sex hormone binding

globulin, because the more androgenic the uh steroid the endogenously produced steroid the more strongly it binds to shbg and this is where patients this is where trend comes in right well not treated with trend but uh oftentimes it is treated with um derivatives of androgens that are birth control pills. So, you know, synthetic estrogens and progesterones, and that synthetic estrogen will have an effect on the liver that causes the liver to secrete more SHBG, which decreases your free androgen index, decreases your androgenicity, and that's your symptoms. So it's symptomatically treated.

It's kind of the same concept. Sometimes they treat it with spironolactone, which is a diuretic. It's actually a mild antiandrogen as well. And again, that's a symptomatic treatment. Oh, go ahead. What about on the other side for male infertility? No, go ahead. mentioned i'm like hey well like bro science it's like hcg and clomid and you know a traditional doctor he's just like and no you know like don't do that um but i'm curious um what are what is some treatment that you can recommend or that maybe somebody should um kind of research and

kind of peek at when maybe their swimmers aren't as strong as they should be. Yeah, with men, it's situational. So as you mentioned, in some cases, HCG and or Clomid could be helpful. It's important to get a good diagnosis of why the infertility is happening. So in about one third of cases, it's what we call female factor. In about one third of cases, it's what we call female factor. In about one-third of cases, male factor. In about one-third of cases, it's combined or third factor. So basically work up to see is it mostly female infertility, male infertility, or just a combination of the two. So that includes lab work. Occasionally that includes imaging, whether it's ultrasounds or

HSGs, things like that. But often male infertility, you can find a cause and treat it. So there's several other things that you can do. And there's lots of studies, as I mentioned, with females, the myo-inositol or ovositol is a supplement that lots of them use with males. L-carnitine is because it helps with sperm motility is what many men use as well. So yeah, to answer your question directly, there's lots of different things that you can do, but it depends on the etiology of the infertility. You know, I know, I know all you listeners right now are probably waiting for us to talk about tests, and we'll get there at some point.

But I'm really curious, man, because this is important for men and women. So what kind of trends have you seen amongst young women as far as like, oh, this is something that we're continuing to see more of, just like you mentioned infertility, right? So with all the labs you've seen, you're like, wow, I'm seeing a lot of young women with these issues while going over a lot of these labs. What are,

what is, what is a common trend? And then also on the other side too, what is a common trend you're seeing amongst the labs of young men also? Because I think the reason why I'm asking for young people and we can, we can get to older individuals too, is because when you're young, you tend to think you're somewhat invincible.

Um, but you know, there's probably a lot of things that are going on that you don't realize. Like I was, like I was mentioning earlier before you came on, I'm super happy I got these labs done because it kind of gave me some confidence in what was going on. Like, I know that I'm kind of solid now, whereas before I was like, it's a drop. I could have some shit. I really don't know. So could you help us kind of like figure that out a little bit? Yeah, absolutely. So in the labs of both young men and young women,

often we see elevated prolactin and often that's due to lifestyle. So, uh, you know, whether that's certain herbs or supplements that are increasing your prolactin, or even something like a seizure disorder, or even a sex addiction, or just lots of gluten and casein intake. It's crazy what they can tell you about yourself.

Can you tell us what herbs, like, is it like weed? What are these things? Because when you looked over my labs, and you're like, you have elevated prolactin i'm like what does that mean is this dangerous yeah uh kratom can often cause elevated prolactin and any cannabinoid yeah i smoke a bit so yeah marijuana is obviously the common cannabinoid what uh what's the what does prolactin do and what's the dangers of having it maybe, you know, elevated out of the normal range? It does many ancillary functions in both men and

women. One of its main functions is helping with milk letdown. So it raises precipitously during pregnancy from a normal around 10 to 20, and it raises up to 200 or even 400 or 600 towards the end of pregnancy and helps with breastfeeding along with oxytocin. So that's its main function. It is actually possible for biological males to breastfeed as long as they have enough hypertrophy of their breast tissue for gynecomastia. Yes. And then with excess prolactin. Awesome news. There has been, yeah, there's actually been studies on the content, the protein and the nutrients in the, you know, in the lactational fluid of males. Is there anything of detriment to having high prolactin other than maybe like sensitive nipples or something

like that like does it do any like is there is there any harm and also i want to let it be known although my prolactin was elevated on my labs i do not secrete milk from my pecs you're not you're not tony nor do i have gyno and my nipples are sensitive to a normal degree so there's nothing weird going on here if you put your mind to it you could potentially produce some milk for us i don't know about that i've never tried but tony did that on there anyway yeah just kind of let it be yeah so often when your prolactin is really high you have a decrease in your follicle stimulating hormone and luteinizing hormone those are known as gonadotropins and when those, it can both decrease spermatogenesis

in the seminiferous tubules and in the testes. And then because of FSH and then with lower LH, it can decrease testosterone production from the latex cells. So it can affect your fertility. And then it can also affect something

known as a refractory period. So if you have very high prolactin, oftentimes your refractory period is longer. Oh, man, I thought you were going to say shorter. Yeah. Shit. How can we increase our refractory period, by the way? Let's just kind of shorten that time zone. Yeah, how could you get your prolactin in a better range?

That too, yeah. Yeah. So there's a few you get your prolactin in a better range? That too, yeah. Yeah. So there's a few ways to affect prolactin. High levels of estrogen increase the PRL gene or the prolactin gene, which increases prolactin production. So controlling your estrogen levels appropriately and in a healthy way. Also, anything that is a dopamine agonist, specifically D2 receptor agonist at the pituitary, that will also help. So people know of medications like

bromocriptine or cabergoline that you use in significant pathologic hyperprolactinemia, usually adenomas on the pituitary. But there's lots of other things that agonize that dopamine receptor. For example, P5P or pyridoxine 5-pyrophosphate, the form of vitamin D6 that often we give people to decrease nausea. Is that a supplement or is that a pharmaceutical? Yeah. It's a B vitamin. It's a supplement.

Vitamin E will do similarly. And that'll help lower the prolactin. Yes. And help you get it on quicker after you already got it on or got it in. Theoretically. Yeah, theoretically. Okay, what is this called again? I'm sorry, just really.

It's a B6 vitamin, right? It's a B6. P5P. P5P is the type of vitamin B6, yeah. Most people take 50 milligrams once or twice a day. 50, 5-0? Yeah. Okay.

Taking notes, Doc. You've got great information for us. I think I heard this, but even if, like during pregnancy, a man's prolactin will skyrocket for some reason because hers is. I might have got that loss, but if that's the case, why the heck does that happen? And maybe that would explain why my shit was through the roof as well. Yeah. Yeah. So the pathophysiology of the drop in testosterone, the postpartum drop in testosterone that many men have is not super well known. But we know that when two partners are together or physically touching often, that changes their levels of oxytocin and follicle stimulating hormone.

Whether that's through prolactin or not, it's not well known that I know of. But, you know, obviously in the postpartum period and even during pregnancy, the hormones that the women have will change how much and how she wants to interact with her partner what's the connection between a sex addiction you mentioned the prolactin levels being higher does prolactin like some like does it make you horny or something like that or it's more of the opposite though after orgasm prolactin will increase subsequently. All right.

So you were mentioning, um, the high, the high prolactin, uh, but you're also mentioning again, more trends. I don't know if you had more that you were, you were going to mention before I stopped you on prolactin. Yeah. Um, as far as young men, uh, a lot of times they have significantly high insulin. Sometimes they have low testosterone, but very seldom do they have pathologically low testosterone, true hypogonadism. You know, occasionally we'll find a case and usually we can find a cause for it.

Um, it seems like prolactin micro adadenomas are fairly common as a cause of secondary hypogonadism. But again, those are still relatively rare in younger males. Cannabinoids, marijuana is a pretty common cause of elevated prolactin. Kratom is a pretty common cause. Opiates are a pretty common cause as well. But we love kratom. Yeah. And opiates. Oh, wait. Yeah, and I don't mean to put all of those different substances or herbs on the same level.

So in general, the opiates or abusing opiates is going to be a significantly more severe cause of hypogonadism. But we are in the middle of an opiate crisis. Kratom is actually a mild new opioid receptor agonist. So it stimulates opioid receptors just a touch. Obviously not near as strong as pharmacologic opiates. That brings me to a question for you. So if you do, if you are someone that uses a bit of Kratom, cause I don't like the cool thing that I like about it is that I don't feel a need for it. If I did,

that would be problematic for me. But if someone does like, like the way it makes them feel as far as like maybe when they're getting work done or whatever, how can someone use it in a, in a way that it like doesn't cause negative effects? Because as you, as you were going over my labs and I was like, okay, does this elevated prolactin, is it going to cause me any negative things? Do I need to really watch out for it? I want to make sure that there isn't going to be any potential

long-term problems or problems in the short term. Like I don't feel any problems as far as performance in the gym, performance, sexually performance in general, I feel okay, but I just want to make sure what is, what would be the best, safest way to use it, knowing what it can do.

With Kratom, a lot of that seems to depend on people's physiologies. So unfortunately, a lot of our evidence is anecdotal. I had one patient that had blood and urine and it would happen. And I tried to look in to see if it was caused by kratom and it ended up that it was not caused by kratom. So that was relatively reassuring. Some people seem to have severe withdrawing when they stop Kratom, and some people seem to be able to stop and have no symptoms at all.

So apparently there's something that has to do with physiology. It's kind of interesting because we do know that it's a weak mu opioid receptor agonist. And a lot of the weight loss medications we use, uh, especially for binge eating are similar. So there's a excellent medication called contrave, which is bupropion, well, butrin, and then naltrexone,

which is a partial agonist, partial antagonist. So perhaps Kratom has a similar mechanism of action to that. And that's some of the beneficial effects that people get. Um, obviously that's a relatively safe medication and we prescribe it fairly often. So a case could be made if you're not overly sensitive to it. Perhaps you could take it for a long period of time and have no negative side effects.

That being said, I've seen lots of cases and people have said kratom's, you know, been horrible for them. And they've withdrawn from it and they never want to do it again. What are some supplements that you personally take, and what are some that, you know, vitamin D or something that's heart healthy or brain healthy? Got any suggestions for anything like that? Yeah, vitamin D was my first suggestion. You know, as humans change and culture changes, we spend a lot more time sitting and inside like we are right now. So a lot of people have insufficient or even deficient vitamin D. And through this pandemic, I've seen more patients with lower vitamin D than ever.

So a vitamin D3 supplement is one of the most bioavailable ones. I got a question to pop in with on this. Is there any dangerous levels of vitamin D? Because years ago, I just started popping tons of it when I started to hear about the benefits of it. I've heard from some people that it might not be a good idea. I've heard from others that say it might even cause calcification and things like that. What's your take on that? What's the research show with that?

Yeah, absolutely. It is a fat soluble vitamin. So D, A, K, and E, cake with a D. Those are your fat soluble vitamins. And if you're taking almost all vitamin D and your fat's helping absorb that in the gut, perhaps you're absorbing less of your other fat soluble vitamins. In general, you want your level between about 30 and 100. So I have seen a couple patients with levels greater than 200, and it can build up in your liver. So that's where your body stores a lot of your fat soluble vitamins. That's why you don't want to eat an entire bear liver.

So next time you're out hunting for bears, only eat part of that liver. We got to remember that. Write that down. They have very high levels. They have essentially toxic levels of fat soluble vitamins. But no danger otherwise to taking like a decent amount. In general, if you don't go over a 100, there's no danger. There's actually good studies that the combination of vitamin D3 plus vitamin K2 helps prevent atherosclerosis or plaque in the arteries. Are there any other supplements that you usually suggest to most people? I suggest soluble fiber and prebiotic fiber to pretty much everybody. So the amount of dietary fiber

has decreased significantly. Dietary fiber or soluble fiber, for example, psyllium. And fortunately, dietary fiber is listed in nutrition labels too. So it's pretty easy to tell even if you don't want to supplement. You can get pretty much everything from whole foods that you can get from a supplement as well. But it helps raise your good HDL cholesterol and probably your apolipoprotein A1, which is kind of a good particle from HDL. It also helps with insulin sensitivity. And then it also helps decrease colon cancer risk, which is becoming more and more common.

There's a reason why they changed the screen from 50 to 45. So soluble or dietary fiber will help with that. And then the prebiotic fiber component, think of your body rudimentarily as a fish tank, your probiotics, which is the microbiome in your gut, as the fish, and then the prebiotic fiber, that's the fish food. So if you're just taking probiotics all the time, but you never eat any prebiotic fiber like

garlic, chicory root, anything with inulin in it, which is derived usually from chicory root, leeks, onions, things like that, or a prebiotic fiber supplement, benifiber is one of the most common ones. That's going to help actually feed the good bacteria in your gut because you have millions of species. So even if you have the best probiotic that you know, um, no, the,

uh, there's only going to be 40 or 50 strains in it at most. And even if you're, you know, eating kefir and kombucha and kimchi and all the other good, uh, probiotic foods, there's still only so many. There likely used to be, on average, a million species of unique bacteria. People that are 65 plus or older, a lot of them have 100,000 or more unique species.

And now a lot of kids these days, possibly partly due to diet and partly due to the antibiotic apocalypse, often they have less than 10,000 species. So the concern is that all these kids, when they're older, are going to start getting C. diff. Do you think something like a carnivore diet may not be a good idea with your fiber recommendation? fiber recommendation? And also, do you think that maybe the average person could utilize a lot of fiber because they aren't on such a great diet and it would be a nice replacement of some of their calories? Yeah, it depends on the situation. So I know that in certain situations, I think in your situation, you're an advocate of essentially a carnivore diet. The carnivore diet and ketogenic diet has become a lot more popular. And part of the reason is there's been some evidence that if you exercise and you're very active, there is a lot less deleterious effect from saturated fats.

So carnivore diet is not necessarily a bad idea. If you have severe insulin resistance, then it could actually be good in some circumstances, because a lot of times it's a low glycemic diet, right? However, if you're not going to be active, and if you're gonna have a very set and extremely sedentary life, then it is probably a very bad idea because it is very calorically dense. If you struggle with things like binge eating as well, or you just graze all day, it also might not be a very good idea. So some of the benefit behind it is it's very satiating. Now, I am curious about this. As far as I guess men are concerned, because a lot of people want to talk about this. And let's, because I think we're going to kind of...

It's not just men. It's not just men. Women too. Yeah. Yeah. I wonder if, do you ever prescribe testosterone for women? That's what you're going to get at, right? Testosterone? into testosterone and the main thing i wanted to start with here was um you see the prevalence of like first off it's great that a lot of this information is getting out it's great that there are clinics like this that are you know giving recommendations that aren't cookie cutter to everybody right but it does seem that like you mentioned um individuals who have pathologically

low levels like you don't see that often and a a lot of young guys, they do have low T because of things that they're doing within their lifestyle. If which they changed their testosterone would potentially get to a normal and potentially a very healthy range. Right. But because they're not dealing with these things, they want to get some tests because they see their favorite influencer doing it. Right. And again, I know this is necessary for a lot of people, right. But for you guys that are like 18, 19, 20,

21, what can they be doing so that they can get everything where it should be? Yeah, that's an excellent question. So to answer your, the first part of that question in general, I'm not a fan of testosterone in women. Often they want it for libido and there's just usually better choices with less side

effects. Um, but there's always exceptions, but, uh, 98% of the time it's very likely unnecessary. Uh, one of the first things that, um, you know, it's in the Hippocratic oath, first do no harm. And you want to make sure not to do any harm. If a woman doesn't want to be virilized, then you don't want to virilize them. And if you don't want to increase their chance of something like a blood clot, then you also don't want to do that. The kind of the second part of the question is the

prevalence of, you know, 18 to 30 year olds with low normal testosterone, again, some of its environmental and then some of its lifestyle related. And what I really emphasize in those cases is find the cause, because if they're really feeling terrible, maybe it does have to do with testosterone if they're very, very borderline. Maybe they have a total of 270 and a free key of, you know, eight or nine, which is borderline for a young guy. And perhaps it is playing a part. very often people come in the clinic and they'll have diabetes or they'll have a pituitary adenoma or they'll have a neurotransmitter imbalance or PTSD or sleep apnea or a whole host of conditions. Um, and I, uh, want to emphasize that people should find the cause first and then think about what treatment they need.

Blood work is just a snapshot as well, right? So like if you tested our blood today versus tomorrow, there'd be things that would be a little bit different, correct? Yeah, even lipids and cholesterol, even if you're fasting and you have a very similar diet, you can check it every day, seven days for a whole week. And there would be some pretty significant variation, perhaps even an outlier. So, you know, hormones are the same way. Testosterone, estrogen, there's lots of variations. If you have a cheat meal and you've got a cocktail hour, then you have a lot of fat. You're probably going to aromatize a lot that day. And it's going to look like your estradiol or estrogen level is quite high, but a different day, it could actually be quite normal.

In my opinion, I hear a lot of people kind of misrepresenting what testosterone does in the body. And they routinely are saying like, how do I increase my testosterone? What are some, what are some ways I can, but, but like you pointed out, maybe they don't, maybe they're not even aware of whether the testosterone is a problem. Like maybe they never even got their blood work done in the first place. So you're just completely guessing. testosterone as a person can possibly handle over some periods of time. It doesn't like exponentially like, you know, the results of taking more and more testosterone, it causes a cascade of a bunch of other things that are negative towards your strength goals, towards your body transformation goals.

So just honing in on just the testosterone doesn't seem like it's not really the shortcut that people want to make it out to be. Now, a boost in testosterone and getting it to an optimal level that would allow you to gain more muscle mass and potentially through having more muscle mass, burn more fat and so on. It can have tremendous benefits. But I think people are kind of like misrepresenting it, thinking like if I really jack my testosterone up, this is going to be great. And this is going to do all these amazing things for me. I'm going to be a monster in the gym.

I'm going to be a monster in the bedroom. And you're going to be able to do all these miraculous things, but it doesn't really work that way. Yeah, absolutely. these miraculous things, but it doesn't really work that way. Yeah, absolutely. So there's actually not super strong correlation between testosterone level, uh, if you're a natural endogenous producer and how that will translate to body composition or even athletic performance. So, uh, it varies a lot individual to individual. Now, obviously if you're on exogenous testosterone, there's a pretty strong correlation within

the individual. Do you mind repeating that? So you're mentioning amongst, uh, natural athletes. Was that right? Yeah. So people will come in often and, uh, they'll, you know, a lot of people come to Merrick for hair loss prevention or hair and skin optimization, and they may feel totally fine, and they might have a very low testosterone level, like truly clinically hypogonadal and no symptoms at all. That actually happens quite often.

It's just we usually don't test those people unless we're testing them for hair loss prevention, trying to prevent something like finasteride syndrome. One of the biggest risks is a low free testosterone, which is an extremely easy test to test for. And most doctors would likely test for that before starting you on finasteride. However, some people come in and they think they have symptoms of low testosterone. And some of those patients

have had the highest testosterone I've ever seen. One guy had naturally, he just had over 50 free testosterone. The total was almost 1,500. Yeah, and he came in with symptoms of low testosterone. So there's, you know, some correlation, but it's not a super strong correlation. What does a boost in testosterone do for somebody that, um, you know,

is maybe getting older, maybe there's testosterone starting to go down. What are some of the positive benefits that you've seen happen in people? A lot of the positive benefits of, uh, testosterone, especially if, uh,

an aging male is truly hypogonadal, is it gives them back the tools to take their life and improve their lifestyle to the, they feel like they did when they were younger. That's what a lot of guys say. So they have the ability to have a healthy lifestyle to exercise like they did before. They have the ability to have a healthy lifestyle to exercise like they did before. Sometimes when, you know, it's always a risk and benefit discussion, right? So if there's an aging male that might have low testosterone, perhaps their lifestyle and diet and genetic factors have not been optimal and they reach a point in their life where testosterone replacement or exogenous testosterone would be too dangerous. And that's unfortunate because perhaps if they had addressed those

pathologies earlier in their life, then they would have been able to change their lifestyle, perhaps take some medications, change their diet. And then that wouldn't, the pathology wouldn't have happened. Can you explain that a little bit further i i don't know if i'm totally not getting this but you said there would be a point where like actually taking exogenous testosterone for an individual would be a dangerous thing to do what would cause that to be a dangerous thing to do for that type of person yeah so known coronary artery disease is one of the kind of strict contraindications to uh testosterone replacement so um if someone has something like uh you know several stints

in the past known significant coronary artery disease it it's more dangerous. And you might not want to start that patient on TRT, especially if they're not at a place, if they're so conditioned, perhaps they're not even a cardiac rehab candidate, which is the type of rehab that you do after, you know, you're in the cardiovascular ICU for a stent or a bypass. that person's not a very good candidate to start on DRT, a horrible one actually. So that's an example of one thing, but there's a lot of other risk factors as well. So blood clots is a risk factor if someone is very adamant about hair loss prevention and likely prone to it. If they're prone to prostate cancer or prostate issues, that's another one. If they're prone or already have gynecomastia and don't want

worse than the gynecomastia, that's another one. Liver disease, kidney disease, and then congestive heart failure. So there's a lot of contraindications to TRT. Interestingly, the American Academy of Family Practice, which is an organization, one of the largest organization of family doctors, mentions they have a recommendation as well. And I guess not too many, not all family doctors know about the recommendation, but they want you to do shared decision-making,

especially if there's an aging male with low testosterone that also has low libido. Because the AAFP recognizes that that part of quality of life is important enough to admit that there's some risks, but the benefits may be more. that there's some risks, but the benefits may be more. Now, also, I'm really curious about this because the cool thing about Merrick is that you guys don't give out just the same cookie cutter plan to everybody. And the things that you just mentioned in terms of reasons why somebody might not want to take testosterone, I'm curious what you've seen within that industry of HRT, TRT clinics, because there are some clinics that just, they see some numbers and they're like, take this, right? What are some things that you've seen that have been like, oh shit, that's actually, that's dangerous. This is why we don't do that. Yeah. We see a lot of new cases of diabetes. We see a lot of cases of pituitary adenomas,

people that are looking to get on TRT and people that have been on TRT, even people that have visual changes, you know, neurologic changes, even people that require surgery. That it would have been fortunate if they were checked earlier for things like that. things like that. But yeah, we see a whole host of issues, anything from hemochromatosis or iron overload to diabetes insipidus. Lots of interesting pathology comes in. And usually the patient population at Merrick, they're wanting to optimize their health. They're not just there to get a certain medication or treatment occasionally that is the case. not just there to get a certain medication or treatment. Occasionally that is the case. And we understand it if that is the case.

But most of the time when people come in and they get their labs checked and their hormone levels are fine and we tell them that usually they're happy to hear that. What does testosterone do for your brain? What does testosterone do for your brain? So testosterone interacts with neurochemistry in many different ways. So one way is that it activates your sympathetic nervous system or fight or flight nervous system. So your levels of, you know, catecholamines, your levels of, you know, like adrenaline will change. You know, catecholamines, your levels of adrenaline will change. And some people have trouble sleeping because they're just so sympathetically overdriven.

It also converts to estrogen. So during puberty, and I think Andrew Huberman talks about this as well, that helps develop the brain itself. So it helps mature the brain. Over time, it's theorized that the dropping of estrogen, not necessarily the dropping of testosterone, is why men and women tend to get dementia at different times because women tend to have very low estrogen levels after menopause, usually in the early to mid fifties. And then men tend to have lower levels of estrogen correlating to whenever their

age related hypogonadism onset is. So, um, some men with normal testosterone and estrogen levels could theoretically be less likely to get dementia. Um, that being said, there's more at play as well. So if your sympathetic nervous system is overdriven, then your levels of serotonin might be lower. So women tend to have higher levels of serotonin, and that helps with myelinization, the prevention of cerebral atrophy of age. So if you do a CAT scan or an MRI of someone advanced in age, 80s, 90s, almost all the time you'll notice that they have actual atrophy or shrinking of the brain itself and then more fluid, more CSF throughout the skull. So if you have not enough serotonin over time, that could potentially get worse. I noticed for myself that testosterone just seems to encourage effort,

you know, and especially once I already got going on something, then I feel even better. Like it just, it's compounded in some way. So yeah, a lot of that could be the dopaminergic or the increased dopamine activity during testosterone. So then what are some of the risks with low testosterone in young and old men? So if your testosterone is low and your estrogen is also low, theoretically, that could convey a card like almost paradoxically or ironically, so a cardiovascular disease risk. So a lot of times when women have premature ovarian insufficiency or early menopause, we are more we more strongly recommend hormone replacement therapy with estrogen to help prevent osteoporosis, to help prevent cardiovascular disease, and then theoretically to help dementia. But really, the first two are the main two reasons, osteoporosis and cardiovascular disease.

So theoretically, if a young male had very low testosterone and very low estrogen, it could convey the same risks. However, if that young man had low testosterone and very low estrogen, it could convey the same risks. However, if, uh, that young man had low testosterone and didn't address the testosterone level, but address the estrogen level instead, there would probably be a little to no risk other than the quality of life, which is very subjective. You know, we, uh, we had vigorous Steve on and when he of life, which is very subjective. You know, we had Vigorous Steve on, and when he came on, he spoke about how he got some labs done, so he's very good about getting his labs done. He found out he, did he have fatty liver disease, guys, or did he, was he getting it? Yeah, he was developing it.

He was developing it, right? Now, a lot of that stuff can happen with people who are taking a lot of different compounds. So I'm curious, um, when you, with the, with the amount of labs you guys have seen, and obviously there's some of our audience that's already taking certain things or they're interested in that. Um, what type of things have you guys helped prevent? Because when you're using a bunch of different stuff, like what happened to Steve, things like that can can develop so obviously you screen for that but what kind of things have you guys helped literally just like stop or pause development of because people got the right labs done yeah a whole host of issues fatty liver disease is a common one a lot of times the what's prevented the most when it comes to

a clinic like Merrick Health is things that wouldn't develop for decades. So things that wouldn't develop for quite some time. For example, we found several cases of thalassemia. So and, you know, there is people that have thalassemia and sickle cell trait, hemochromatosis, And, you know, there is people that have thalassemia and sickle cell trait, hemochromatosis, and even, you know, blood clotting disorders. And the earlier you find them, the more you can specifically address the risks that come with those pathologies. So fatty liver disease is extremely common. Hepatic steatosis or non-alcoholic steatohepatosis or hepatitis probably about half of americans have some degree of fatty infiltration in the liver so if you've heard of visceral body fat that's just body fat that's in the peritoneal cavity

or uh inside the abdomen and that's the worst type of body fat it's correlated with again insulin resistance and it also leads to hepatic dysfunction and is a more and more common cause of cirrhosis so it used to be uh hepatitis like hep uh you know hepatitis c hepatitis b hepatitis b with d would cause cirrhosis but now fatty liver disease is causing lots of cases of cirrhosis as well. One thing Merrick has helped me with is just like inflammation. I remember getting my C-reactive protein, and maybe you can explain a little bit more what C-reactive protein is and why it's important.

And it was just some simple supplements. It was just over-the-counter. It was like alpha-lipoic acid and vitamin C and a couple other just small suggestions from Ben, I believe. And then the next time I got my blood work, my C-reactive protein was good. And these things that if they go undiagnosed or you're not paying attention to this inflammation that you might have going on in the body, like who the hell knows what it's going to result in. So I'm happy that like I can look at these things or we could look at these things together and say, hey, this is probably not a great idea for this to be, you know, out of whack. Let's figure out how to get it back on course. What's C-reactive protein?

let's figure out how to get it back on course. What's C-reactive protein? So C-reactive protein is a general or non-specific marker of inflammation in the body. So there's several markers and we usually refer to them as acute phase reactants. And whether you're inflamed from something that your body's allergic to or an autoimmune disease like Crohn's or lupus or an infection or a chronic infection, then oftentimes these are elevated. CRP we like specifically because it is one of the markers that we use to stratify your risk of heart disease. So you're considered low risk if you're below one, especially low risk if you're below 0.5, moderate risk one to three, and then higher risk three and above. So the reason why some people have different reference ranges, for example, if you're testing for an autoimmune disease or a rheumatologic disease, oftentimes the normal range will

go up to five or 10. But that's because you're not really looking to stratify your risk of heart disease or inflammation. You're looking to see how likely it is as a general screening for that, for you know, autoimmune or inflammatory disease in general. What are some measures that you might take if somebody comes in and they just maybe having like a lot of digestive issues? Like are there things you can look at in the blood that would identify, you know, how they can maybe course correct with their diet to, you know, have better digestion? You know, I hear people having like gluten intolerances and just a wide variety of things that

are kind of wreaking havoc on their body. How do you guys assist or walk somebody through that? Yeah, absolutely. So, uh, there's lots of GI pathology. We already mentioned, uh, some GI pathology, you know, the, um, extinction of the gut microbiome, things like that. But, uh, in general, when you have gut issues, even if you're relatively young and healthy, it's important to rule out inflammatory bowel disease. So if you've heard of IBS or irritable bowel syndrome, inflammatory bowel disease is IBD,

which is different. Examples of that would be ulcerative colitis and Crohn's, which are actually quite common pathologies. And then another pathology that we see quite often is celiac disease. So usually in Crohn's and ulcerative colitis, if you're having a flare, then your inflammatory markers are high, but the gold standard for diagnosis is endoscopy or a colonoscopy with biopsy. So oftentimes ruling that out is important if people have a severe GI issue. People in their 20s and 30s are relatively prone to it. And there's also a correlation with family history. With celiac, there's a genetic correlation. So a lot of people have different antigens or genes. DQ2 and DQ8 are two of them.

But you can test several different antibodies, which can be kind of negative, mildly positive, or positive. And the higher they are, the higher chance that it is celiac. But again, biopsy via endoscopy is the gold standard diagnosis for celiac. Again, biopsy via endoscopy is the gold standard diagnosis for celiac. That's a true allergy or IgA antibody that is formed against gluten. There's also gluten intolerance, which is somewhat harder to test for, and then a whole host of other pathologies of which blood markers and stool tests can help us in the diagnostic workup. You know, a lot of people are quite concerned because within the bodybuilding community,

right, with the amount of like steroid abuse that goes on, there are a lot of people who have get heart issues and have heart problems. And they're like, you know, people hear about Dallas McCarver, people remember that. And people hear about Dallas McCarver. People remember that. And you hear about a lot of those things happening, right? So for those individuals, what are some things that they can do to make sure that with whatever stuff that they're using, whatever all the compounds they're using,

they're not potentially risking their life. Yeah. Um, that's a very good question because when you talk about the bodybuilding community, uh, there's always a push for more and more. It's the same as any other sport or athlete. They're always trying to get the edge and get to that next level. And whether you're getting to that next level through like dangerous lifts, you know, oftentimes you hire a trainer or someone to help teach you how to lift, probably like yourself, and you can teach them how to do it safely. However, it becomes tricky

when you're talking about illegal substances. And depending on what country you're in, most countries, they're pretty illegal. Some of them, they're more lax, and a lot of them, they are. So because they're illegal like that, people will still find ways to get them. And unfortunately, there's a lot of different variables. So it might not be what you think it is. And then the solvent might be hyper-inflammatory or the solvent might be very caustic or even carcinogenic. And, uh, if you're talking about, um, steroids, usually it's in a carrier oil and that also

might be caustic or carcinogenic as well. Um, and also might not be sterile. So you see a lot of infections. Derek, who obviously founded and owned Merrick, he makes lots of videos about, you know, someone's leg has to get cut open. So there's definitely lots of side effects. It's kind of a tricky boundary

because you want people to have a good physician patient rapport and be totally open and truthful and honest. But then also you want to be able to be totally open and truthful and honest and tell them, you know, you got to stop doing this. Uh, this is something that's going to be detrimental to your health, uh, if not now in the future. And oftentimes if you can have that level of trust between the two of you, you can find them ways that they can more safely

and in a more healthy way maintain their performance. I know you have a history of working with families and we've talked on this show many times of how it's great that we're able to impact a lot've talked on this show many times of how, you know, it's great that we're able to impact a lot of people with this show and talk about diet and have people recognize like, oh, that might be a good idea for me to do some of those things. But sometimes even with our own family, you know, somebody that's like, you know, within arm's reach, they're not receiving the message the same way. So in some of your practice, how do you assist or walk a whole family through being healthier rather than just one individual

in the household? Yeah, it can be difficult to do, especially if some members of the family are totally on board and have lots of trust in a physician-patient relationship, and maybe some don't. So the classic example of this is for nicotine cessation. So when families attempt to have smoking or nicotine cessation together, they're significantly more successful. And when one or multiple people don't do it along with the others, then they're all more successful. And when one or multiple people don't do it along with the others, then they're all more unsuccessful. The same thing for diet and the same thing for lifestyle.

So, you know, whenever you get married or have a partner or moving together, usually it's the least healthy one that wins. So if your partner does not have as good of a diet as you, your combined diet is probably going to be the less healthy one, right? Same thing for lifestyle. So getting that commitment from all of them, it's very important for the health of the family. Now, when we're getting, or when we're kind of talking to a lot of i guess i want to kind of

go and focus on younger individuals again but when we're talking to them about uh getting extra sleep exercise etc um you see a lot of guess, individuals that make content around TRT, HRT, that type of stuff. And what I tend to see a lot now is 18, 19 year old dudes taking testosterone, talking about testosterone, like taking more and more, um, and talking about how beneficial it is for the gym workouts, et cetera. Um, now we kind of mentioned how with natural athletes, you don't necessarily see like increased levels of free and total. Like I think my total T or I think my total T is like six 40 and my free T is 16. I could have those numbers flipped cause I'm not good with that stuff. Um, but you tend not to see that you're like those numbers, those, those numbers are fairly normal. Right. So what I'm curious about

is we kind of talked about how you don't need or how like younger people can take, not they can take testosterone, but there are things that they can do as far as their lifestyle to increase their testosterone. Right now, what if a young guy does want to go that route and they do want to do those things? What should they be thinking about before they make that jump? Like, for example, Mark's talked and Mark's been open about his use, right? And he started when he was 25, right? But he's already been lifting for a long period of time before that. So for younger individuals who are thinking about going into that realm,

what should they think about before they do that? Yeah, that's a difficult question from a doctor's perspective. Obviously, ideally, then they don't do that. But what a lot of my colleagues advocate for is just learning as much as possible before starting. So Derek talks about this in his videos. Steve talks about this in his videos and different people who are affluent influencers, if you will. A lot of times just by telling both the good and the bad, because there is some good, as you mentioned,

but by also including that an honest assessment of the bad, because there is some good, as you mentioned. But by also including that, an honest assessment of the bad things that often happen, it convinces people not to. So that's almost more of a cultural change. So the same thing when it comes to any other substance that can be abused, whether it's alcohol or opiates or nicotine, is having an honest assessment of some of the negatives. So 70 years ago, pretty much everybody used nicotine, partly because we didn't know about the long-term detriments. And it took a long time for that cultural change to start kicking in and having a benefit. So hopefully as people are talking about it more openly, people will not be so aggressive to jump on in and recklessly

start. However, that being said, if you're going to start and you know that a hundred percent, then you definitely want to get good baseline labs. And that's not just your baseline testosterone level and baseline lipids and whatever else. Good baseline, all-inclusive, comprehensive labs. You mentioned to me on a phone call that you have a background working with a lot of people that are obese. Do you think that obesity is like an individual's fault, I guess you'd say. Like, is this something that they need to kind of shoulder and take full responsibility for and then try to work their way out of it? Or does it not do us any good to point a finger at anybody? Yeah.

So I was just talking about this with one of my colleagues who also treats obesity often. So there's a recent push to treat obesity as a disease itself, as a pathology, and you treat it before any of the other subsequent or secondary pathologies like diabetes or hypertension even present, which I'm absolutely on board with. But is it someone's fault? It can be. It's also possible for it not to be. For example, let's say that this arbitrary or hypothetical individual, their mother had gestational diabetes, or let's say that she was a type one diabetic and nothing that she could do about it. She was just a type one diabetic. She was relatively well controlled, but even for a type one diabetic, you're probably not going to have super, super strict blood glucose control. Unless you're just extremely adamant about glucose control during pregnancy, you have those epigenetic changes. And even because that

intrauterine environment, that individual is very likely to be obese later on in life. So it's that person's fault, probably not. But then that person's obese, let's say that they reproduce and have a child themselves. And that child is probably likely going to be obese. Is it that child's fault likely going to be obese, is it that child's fault? And then it just propagates. So it's like, you can't blame the child or the parents. Sometimes there is some pretty strong genetic factors. One thing that the obesity medicine advocates talk about a lot is the thrifty genotype hypothesis. So for the last 10,000 years, humans have been in a resource deplete environment and you're running from the tiger and the lion and you're running from the, you know, the dictator,

if you will, or just from a different clan or tribe. And it's beneficial to hang on to as much fat and have as low as a metabolism as possible. And now it's the opposite. What do you think is a good way to get somebody who is severely overweight, just to get them to take a step in the right direction? What do you usually recommend? Do you usually recommend walking or some sort of dietary intervention? What do you usually suggest? walking or some sort of dietary intervention, what do you usually suggest?

Walking and exercise is very beneficial for helping maintain or helping sustain weight loss after the weight loss period. So preventing yo-yo dieting, if you will. So for that reason, I'm a big fan of exercise. Doing it with someone else or doing it with a friend or a family member, that can help decrease the stress involved with it. Because by wanting to treat it, it's sort of admitting that there is a problem or something wrong. And that can be pretty disconcerting. So that's another benefit. Obviously, a caloric deficit, in one way or another, everybody is going to have a different optimal diet or lifestyle change, even better if they can continue that diet for the rest of their life. For some people, that's a zero liquid calorie diet. For some people, it's a low carb diet. For some people, it's a high protein, high fiber diet.

It just kind of depends on what they're going to be able to sustain and what they like as long as it's reasonably healthy even if so even if somebody's even if somebody's predisposed to being heavier um they can still lose weight though right like you you have a lot of experience with this um has there been people that just metabolically, they're just stuck, their body's literally stuck, and there's not much they can do about it? Some people are in a really difficult situation because they've dieted but remain sedentary, and their metabolism goes very, very low, even less than 2,000 calories a day. That's why it's very important to have a multidisciplinary team, you know, a dietician staff that's checking in care coordinators,

nurses, helping even potentially a bariatric surgeon. If someone's very morbidly obese, very high class of obesity because maybe they have some success, but they just need a little bit extra to get over that hump. So having that multidisciplinary team with all of those components involved is going to be most beneficial for the patient. But yeah, sometimes it, they use the term metabolic damage.

There's a lot of terms that are not true medical diagnoses, but we see them as real concepts like metabolic damage or adrenal fatigue or things like that. They might not be uh you know icd-10 codes or uh true accepted medical pathology but oftentimes people their metabolism is just very very low so it's hard for them to lose weight by going into even more of a deficit without becoming micronutrient deficient. Then you add into that factors or variables like leptin and adiponectins. So when you do go into that deficit, especially when you're already in a deficit, metabolically, you have a hard time rebounding from that or reaching a new normal or a new baseline. So it's very hard for a human to have a baseline eating 1,300 calories a day.

Have you seen some people that weigh 400 or 500 pounds have that low of a caloric demand? If they weigh 400 or 500 pounds, I have not personally seen it. I suppose theoretically it would be possible. But usually just having all of that tissue, and adipose tissue might not be near as metabolically active as muscle tissue, but it still is metabolically active to some degree. So, um, usually their caloric demand is, is higher if they weigh that much. Have you seen, um, I'm just curious, like what your, your take is on, uh, individuals that are obese utilizing fasting and what you've seen just because like dr jason fung he's a big advocate of

fasting uh to help his um his his uh patients as far as obesity is concerned and then there's who's the snake guy diet guy cole robinson cole robinson he's uh i don't know if you've ever heard or seen his content but um he's very big on that and he's had a lot of success utilizing that with individuals who are very very very overweight so what do you tend to see on that and he's had a lot of success utilizing that with individuals who are very, very, very overweight. So what do you tend to see with that? And then also, what would your suggestions be to an individual that is obese and they want to try doing some fasting? What are some things that you need to that you would tell them to be careful with? Because there's a lot of things to think about there.

to think about there. Yeah. So whether you're talking about a long or a prolonged period of fasting or intermittent fasting, both are very beneficial because it helps re-regulate your body's hunger hormones. So leptins, adiponectins, ghrelins, all of the above. And it helps teach the person as well. The, you know, they have a stronger willpower or they realize that they have had that willpower the whole time and they can unlock that potential. In addition, if you've been in a caloric surplus for a long time, you're very obese, have a very high body fat percentage. That leads to a lot of stress on your system, inflammation, oxidative damage, and you're hyper anabolic. So insulin is a very anabolic hormone. So that's why you're saying right there is exactly what happened to me in terms of the re-regulation of hunger hormones, because, I mean, we always talk about it. I could, in the past, eat and eat and eat, and when I'd get hungry, I would eat and

eat and eat. I didn't really have any control i would eat and eat and eat i didn't really have any control over that but that's exactly what happened when i started adding that into what i do i was able to gain control over my hunger hormones and um yeah it just it just made a massive difference as far as my habits as far as food so there's some really promising uh drugs these days to help people right right? Like with their hunger and at least from some of this information that I've heard, it doesn't seem like they have too many negative side effects. It seems like the effect of it assisting you to lose weight outweighs maybe some of the harm that it may do. I guess there's one more recently, I guess for some folks it was causing some

vomiting and some things like that, but it supposedly really crushes your hunger hormone. Are you aware of what the hell I'm talking about here? Yeah. So most weight loss medicines have an effect on hunger hormones one way or another. You're probably referring to the GLP-1 agonist or the Gila monster venom. So it actually has a lot more mechanisms other than just affecting your, other than just affecting your hunger. Why is it called that?

There's several of them. The GLP-1 agonist. Yeah, the Gila monster venom. So a researcher was looking to see why the Gila monster was never hungry it would just hang out in the desert and walk around and they took a bunch of proteins from its saliva and they isolated a protein and they found that it affected the GLP-1 receptor. So they essentially have a synthetic clone, exenatide, and they have two different drugs from it,

bieta and bidurion. They were kind of the first ones. And it's the, it's identical to the protein or the peptide that was in the saliva of the Gila monster. This is, this is amazing because this is why Cole Robinson calls his diet the snake diet because he says to eat like a snake.

And a Gila monster is also a cold-blooded creature. It doesn't need to eat all that often, right? Yeah, essentially the same. So you can eat like a Gila monster, eat like a snake. It does have a lot more mechanisms of action. It has four main ones other than just appetite suppression. It does cross into the central nervous system and cause appetite suppression, but it's also an insulin sensitizer and it has an increasing effect.

They did one study on GLP-1 agonists and they found that if you take it for 36 months, which is a long time, it has a legacy effect to help preserve the beta cells in your pancreas even after you stop it. I think a lot of this is really promising. getting themselves on track could get help and could potentially, I mean, turning it over to some doctors and some people that can help with physical activity, but also knowing that there are some pharmaceuticals that look like they hold a lot of promise. I mean, I think that's amazing. I think that's great. Yeah, it's definitely an exciting time for doctors who treat obesity medicine and also just people who want to cure their obesity as well, because it's one of the most true forms of preventative medicine that you can have. Are there any blood markers that maybe we're not considering when it comes to obese people?

Like, you know, we've been talking about like trends amongst young people. But how about amongst uh obese people if you know i don't know maybe you guys catch something early on maybe i don't know if that's even preventable but you know i mean like is there something that possibly we're not thinking of when it comes to obese people that their blood markers are usually you know through the roof or you know something like that yeah uh i mentioned the fasting insulin or even the non-fasting insulin to see their insulin response or even kind of like a glucose tolerance test so those are some things that we can look at obese people and obese people that have anemia or have hemolytic disorders and testing of fructosamine can also be reasonable. So those are some things that

you can look at. I wish that we could test neurotransmitters as well. So if we could test their serotonin levels easily or their dopamine levels easily, then it would really tell us a lot more about the pathophysiology of obesity because each case is unique. And in some cases it has to do with mostly binge eating and the treatment for that is different. So, uh, each case is a little bit different and we can't test for everything, but we can test for, uh, whatever we are able to, and then infer from the results. If there's an issue with, you know, their neurotransmitters or their serotonin level or their dopamine

level. If there were, because you mentioned binge eating there, so is there a, other than like habits, what would treatments for binge eating be? Oftentimes, it's different medications that help increase your dopamine or help decrease your cravings. So naltrexone or Contrave, which is naltrexone bupropion, that's kind of one of the main ones. Another new one is actually Vyvanse, which used to be an ADHD med. It's a controlled medication.

But the bupropion and the Vyvanse both increase dopamine in a different way that testosterone increases dopamine. But initially, Wellbutrin or bupropion was for smoking cessation or depression. And now we use bupropion and then also naltrexone for alcohol cessation. So naltrexone decreases cravings. cessation. So naltrexone decreases cravings. So whether it's being used in alcohol withdrawing or nicotine cessation or binge eating, it's going to decrease the cravings for that particular substance. A lot of times people are self-medicating when they binge eat because it increases their dopamine, similar to how exercise does as well. because it increases their dopamine, similar to how exercise does as well.

Why would you suppose that maybe something like Kratom assists with fasting? It's likely just the weak new opioid receptor agonism. Again, it's not super well known, but if those are agonized, then it's going to slow down your gut transit to some degree. GLP-1s also slow down your gut transit. And when your intestines are not moving as fast, you're less likely to be as hungry. So that could be one reason. Yeah, it's just something I noticed that it just assists with my fast. I don't have any proof or evidence or scientific research to

back that up, but it's just something I noticed in some of my friends and stuff like that. They're like, oh man, it makes the fasting easier. Maybe it's just because you're high. I don't know. Maybe that too. That doesn't hurt. Where can people find you? Thank you so much for your time today. Yeah.

Uh, thank you. You said, where can people find me? Yep. That's right. Yep. Yeah.

Uh, at Merrick health.com. And then you just started a, um, Instagram account. It looks like, Oh yeah. And I have a new Instagram.

Uh, please follow me. It at Kyle Gillette, MD, G I L L E T. Shave the E all. Yeah. Really, really appreciate it.

Um, great information and I'm sure we'll have you on again sometime in the near future. Have a great rest of your day. Thank you. Thank you as well. Looking forward to it. Awesome.

Thank you. Yeah, there was a lot there. He'll info. There was a lot there. Man, as we started going, Looking forward to it. Awesome. Thank you. Yeah. There was a lot there. He'll let info. There was a lot there. And as we started going, I was like,

damn, this guy knows everything. He really does. He had an answer. There's a little Joel Greenish over there. Yeah. He knew a lot of shit. Yeah. But like not too confusing.

Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah.

Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Sometimes with Joel,

I'm like, I don't know if he's speaking like something that we speak on this planet, let alone English. Yeah, Joel's like, you know, rehearsing shit that he read or something. Right, yeah. Damn, dude, could you spit it out so we can understand it? It's like a funny joke you've had in your back pocket. He's like, dude, I've been waiting for somebody to ask me about this coffee study 38 years ago. Right.

Exactly. Kyle was sick, dude. And he and he's i mean he's young right i don't know how old he is but i don't think he's super old no definitely can't be a real doctor right he's very wholesome he has a very wholesome vibe to yeah the show could use some of that sometimes really good oh god but at least um i know that i'm not going to be producing any milk anytime soon yeah right well gotta put your mind to it that's kind of that's kind of trippy yeah i didn't i mean he's the first person i've ever known that said like yeah you actually produce like some proteins out of that thing and it can feed somebody. Yeah. It's so funny, man.

When I had these labs done and he was going over them and he said it could also be caused by, you know, cannabinoids or cannabis or kratom. Andrew and I just laughed our asses off because we're like oh we'd use a little bit of that here and there you're like doc don't go any further into my personal life he's like oh my god you wipe your ass with your left hand huh you're like wait what he's like yeah your lab here shows that'd be super weird elevated something something but just real quick like that was a different case scenario where me and sema were both kind of hanging out with the doctor. Yeah. It wasn't something that you don't do a couple's lab reports.

Bring a buddy and make it cheaper. But no, it was a lot of good information, man. I think that especially for people because like this HRT stuff and this stuff's getting really popular. People got to be careful. People got to be careful where they go or where they go to get their medication or pharmaceuticals and like you don't want somebody

giving you the same exact prescription that they gave to a hundred other people because your situation is different that could lead to a lot of BS like we learned about in this podcast so just get to Merrick. If you need to get labs or any of that type of stuff done, go to them.

They'll get your shit handled the right way. We get a lot of questions about motivation. I think this is a great place to start. Look at your blood. You know, there could be that. That could be something that could be a factor because like with Andrew, they saw that your red blood cell count was high which is showing some issues potentially with sleep uh if your sleep is thrown off well of course you're

not motivated your fucking time you know so um and it could just lead to like hey let's let's look at let's consider you having a sleep study done or it could be that your testosterone levels are starting to get lower than they used to be or whatever it might be. But I think it's a great place to start is to, to look into that because it's going to give you an idea of all the different things that are going on in your life. They're all going to show up on this test. Uh, your stress that you have in your life, whether you're able to sleep, um, whether you're out partying into the middle of the night. And it's going to reveal a lot.

And I think it's just the way to go. I think it's the way to go. I think you're going to see more and more people jumping on board with this. So if you feel like you can't get out of your own way and you're kind of fucking stuck on the couch, use Merrick Health. Go get some blood work done. And then on top of the blood work, you're going to have somebody walking you through each and every panel that they went over, or that they drew from you. They're going to go over each thing, and then they're going to tell you how you can work on

having a better outcome the next time that you get your blood work done. Yeah, and we just had Lane Norton on, and he was talking to brian callan you know if if anybody has ever heard callan he's always talking about like i gotta get on trt i gotta do something like i gotta you know and if i mean just looking at that guy like he's always springy he's always full of energy it's like testosterone personified so lane was like dude just go get your labs done and sure enough he had high test. Like very high test. Yeah, yeah. So, you know, exactly what Mark's saying, like, just go get your labs done.

I never really considered it to be, like, motivating, but you're absolutely right. Like, yeah, I do got to get my hematocritin check and all that good stuff because, you know, that's dangerous. You know, some shit could happen down the road. that's that's that's dangerous you know some shit could happen down the road so having merrick take care of my my blood work and tell me what i'm doing or what what it's doing uh puts me in a better position to just get better learn about your heart you can learn about your digestive system i mean you can find out all kinds of stuff there's cancer screenings too i mean it's kind of heavy but that's something that you you want know, especially as you get older. Like, you want to make sure that you're not at risk. You don't want to, like, I think Mark Lobliner recently, he had something removed.

He just found it out, and he had it removed early. But you don't want to have a situation where something was lingering, and you could have found out about it three or four years ago, but you didn't. So just keep that in mind. Take us on out of here, Andrew. Yep. So again, we were just talking about labs, and Merrick is our lab company, and we highly recommend that you guys just start getting stuff done,

and we're making it a little bit easier for you because you can use promo code POWERPROJECT15 for 15% off all labs. Like I said, that's crazy. That's kind of unheard of. Or if you want to get the Power Project panel, that's also available. And when you get that and load that up into your cart

using promo code POWERPROJECT, we'll get you $101 off of that panel. Links to them down in the description as well as the podcast show notes. But if you're listening to this on the audio side only, while you're driving somewhere, somewhere exciting, hope you guys are having a great day. Just go to merrickhealth.comcom slash PowerProject for the PowerProject panel.

And then just MerrickHealth.com and check out all the labs. They have male panels, female panels. Again, hair loss treatment. They're a full-on telemedicine clinic. It's just really they are like the number one in the entire planet. Again, links to them down in the description as well as a podcast show notes. Please follow the podcast at Mark Bales Power Project on Instagram at MB Power Project on TikTok and Twitter. My Instagram and Twitter is at I am Andrew Z.

And Seema, where are you at? Seema Inyang on Instagram and YouTube and Seema Inyang on TikTok and Twitter. I saw a new review today on Apple. So go review us even more, guys, because I know you all love this podcast and it helps us out, so thank you. Mark, what color shorts are you wearing? I think they're like yellowish. Yeah, they seem yellowish. I've never seen them before.

Stop looking below my waist, bro. Chill! God, I'm just kidding. You guys flirting so much is... Andrew, you better chill too, Zaddy. Otherwise, you'll end up in the middle of this. Get that Congo over here and see what happens. Salted caramel, chocolate, some vanilla.

See where things go. It's a little tower, little waning tower of caramel. I'm at Mark Smelly Bell. Strength is never weak. This week, this is never strength. Catch you guys later.