Mind Pump: Raw Fitness Truth - 1607: How to Optimize Your Hormones With Dr. Rand McClain

Episode Date: July 29, 2021

In this episode Sal, Adam & Justin speak with renowned hormone specialist Dr. Rand McClain. Where did his knowledge and interest in hormones come from? (2:50) The first BIG misconceptions he learned. (8:14) What makes you an “expensive date?” (9:58) Why the stigma on testosterone replacement and is the pendulum swinging the other way? (12:36) What are the health risks of having low testosterone levels? (23:34) What are the health risks of having high testosterone levels? (29:33) His issues with the standard lipid panel. (32:17) Is testosterone anti-inflammatory? (36:22) What are the biggest mistakes that doctors make with TRT with their patients? (39:43) The ‘unknown’ anabolic steroids out there and the pros/cons of each. (44:25) His take on SARMS and their cellular impact on the body. (57:48) What is the BEST way to administer steroids? (1:02:05) The four changes in quality-of-life males on TRT generally see. (1:05:48) The stigma surrounding women on TRT. (1:11:45) What is the proper dose for women? (1:17:54) What does the process look like for someone interested in TRT? (1:21:19) Why he believes stress is the BIG driver for the decline in testosterone. (1:24:15) His reasoning behind ‘roid rage’? (1:35:50) Related Links/Products Mentioned Mind Pump Media x Regenerative & Sports Medicine Visit Super Coffee for an exclusive offer for Mind Pump listeners! **Promo code “MINDPUMP” at checkout** July Promotion: MAPS HIIT and the No BS 6-Pack Formula 50% off!  **Promo code “JULYSPECIAL” at checkout** Testosterone for Life: Recharge Your Vitality, Sex Drive, Muscle Mass, and Overall Health Oxandrolone Uses, Side Effects & Warnings - Drugs.com Anadrol - steroid.com Danazol : Uses, Dosage, Side Effects - Drugs.com Oranabol - steroid.com Dr. Rand McClain - YouTube Mind Pump Podcast – YouTube Mind Pump Free Resources

If you want to pump your body and expand your mind, there's only one place to go. MIND, MIND, MIND, UP with your hosts. Salda Stefano, Adam Schaefer, and Justin Andrews. You just found the world's number one fitness health and entertainment podcast. This is Mind Pump. Today is a special episode. We've waited a long time to partner with and work with a hormone therapy clinic or a testosterone replacement clinic. I'll say hormone therapy because they work with a lot more than just testosterone.

So it's been a long time. We've been looking around. We've actually flirted with other places. Nobody impressed us until we met the following guest, Dr. Rand McLean. He's the best in the business when it comes to optimizing your hormones and ways that improve the quality of your life. Adam is now a patient of his and was actually quite blown away. You're gonna love this episode. We ask him everything about hormones,

it testosterone in particular, how it affects the body, what it does, what it doesn't do, is it's safe, not safe, long term. You're gonna love this episode. Now, you can find them at Regenerative Sports Medicine, but we started working with them. And so, here's what we did for Mind Pump listeners. Head over to mphoramones.com.

If you feel you may have symptoms of low testosterone or hormone imbalances, fill out the form, If you feel you may have symptoms of low testosterone or hormone imbalances, fill out the form, they'll contact you, and you can get a consultation to see if this is something that'll work for you. Again, it's mphormones.com, and again, I want to stress, this is the one place that we back, that we've vetted, again, they're the best in the business.

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Great product, much smoother than regular coffee. I love their stuff, we actually all love their stuff. Go check them out, head over to drinksupercoffee.com, forward slash, mind pump, and then use the code Mind Pump and get 25% off your entire purchase. Also, there's three days left for our huge July promotion. Right? So, maps hit, that's high intensity interval training, is 50% off. And the No BS6 back form, this is a core training program, is also 50% off. Only 72 hours left for this particular

sale. After that, it won't be back for a very long time. Go check it out or just go sign up at mapsfitinistproducts.com. Just use the code July special with no space for that discount. Dr. Ant, I'm super excited to have you in studio today. I'm gonna give the audience a little bit of backstory on how I came across you and that was Sal actually introduced me to you. I was already doing hormone therapy through another company and I'd had a few months in and I was expressing to Sal,

like after I'd be like, you know, I'm not really impressed with these doctors. I'm like, I know that I don't have a lot of knowledge in hormone therapy, but I have enough to understand some things. And I'd be asking all these questions, the nurses that were talking to me. And just they seemed like they didn't have

any of the right answers for me. And so I was like, you know what? Let me do some research. Let me find out who's in the space, who's doing the best job at this. And he began communicating with you. And he says, yeah, I know you're set up with this other company, but I want you to meet Dr. Ran and have a discussion with him. And it was such a great conversation, the very first time that I talked to you. I mean, you blew my mind as far as your extensive knowledge on hormone therapy and I kind of want

to start there for the audience so they can get a little bit of background. Where does all this knowledge come from? When did you start doing this and when you learn all about hormone replacement therapy? Well, that's a good question and it kind of begs the question, how do you know I have all this extensive knowledge because there's so much ignorance out there, right? There's a lot of still questions that have to be answered because it's not really become as mainstream as it should be. A lot of urologists now are taken over thanks to Dr. Lipscholz and a lot of his fellows. I think urology will be the torchbearer,

hence Ford for testosterone replacement, and it makes sense, right? But I think we're probably 10 years off from that being in the mainstream because there aren't a whole lot of lip-sholtzes out there, and while his fellows are spreading around the United States, I still think we'll be in business at least for another 10 years because it's

just not everywhere. And boy, when you talk about the ladies, OBGYNs, I don't think have picked up the slack. So we'll be in business with them for even longer, I'm sure. But where it got started was really, I mean, in sport, I've always been fascinated by trying to be able to do better at sport and repair my body. I was kind of a sickly kid. They took out my tonsils when I was pretty young because that was the thing back then, if you're sick all the time. Well, must be those tonsils. So, the inked those early. You do, right? And I got into nutrition because I was fascinated by the fact that you could control a lot of how you feel and how you perform with the use of nutrition. And then you started reading about anabolic steroids, not so much article that 85% of the NFL players were on anabolic steroids.

So of course, you go, okay, yeah, I want to be bigger, stronger, faster. I had to pick aspirations. And so I was just telling you before, I can remember in high school, wrestling one season and being able to dishrag one of my teammates. And then after summary, he came back 30 pounds heavier and was tossing me around the mat like I was a dish rag myself so you know They're telling us that it didn't work was falling on deaf ears because clearly it worked and

You know that sparked my interest now smash cut to many years down the road. I got into medicine myself and It was easy to start practicing because one of the physicians I started with was already doing it. And with all due respect to him, I didn't think it was the best way of doing it. And I guess I skipped a long period of life where I was experimenting with these things myself, whether it be testosterone, but mainly, you know, anabolic's back in the day. And of course, we were doing it different too, not to start rambling on to another question here,

but you know, back in the day, stacks weren't the big deal. We couldn't afford them, they weren't available. So, you know, we got to know, for example, Deca de Roblin by itself, and what it would do. And just like, you know, maybe some of you guys could do, you could tell a Cuban cigar from a Dominican Republic cigar because, you know, had a different flavor because we were using them separately. We knew, okay, all this is definitely real daca because of the side effects or the things that came with it. This is real dannibal, etc., etc., but a lot of the knowledge to answer your question was picked up along the way from use.

And, you know, look, the gym and bro science has its negative aspects, no doubt about it. But it's also a great petri dish for what works. Now the explanations for why it works are often just to go, okay, you skip physiology class, I can tell, and some biology and other classes too. But again, it's one of the most stringent regulators of some of these things because either works or doesn't. You either pick up the weight or you don't, and or you lift it over your head,

heavy weight or not is what I mean to say. So the proof is in the pudding, and there are some of the harshest critics in the gym. So, you know, I learned a lot in the pudding and there are some of the harshest critics in the gym. So, you know, I Learned a lot in the gym from fellow athletes is what I'm getting at and and again for my own use What was your so as your journey into Educating yourself about this what were some of the first big misconceptions that you learned? Well, like I said earlier that it doesn't work that

You know you become impotent and your will is gonna that it doesn't work, that you know, you become impodent and your willy's going to fall off one day and all that kind of stuff. I mean, just some of the stupidest stuff you've ever heard. And then it's going to, you know, you're never going to come back once you use anabolic steroids, your own endogenous production will never return. These are the things that are still perpetuated. I mean, you wouldn't believe some of the things you can still hear from, and I don't mean to be picking on anybody, but at the same time, I don't want to let anybody off. There are no excuses anymore.

There's plenty of information published out there, even though it's not taught in medical schools as far as I know, to this day. It wasn't when I was in school. But doctors will still say that, for example, testosterone, just using testosterone in a replacement fashion will raise your hemoglobin hematocrit, and your red blood cell count. That's not true.

If you've got someone who might be an I call them an expensive date who has to use more than the typical amount of testosterone because they break down the ester, for example, and they metabolize it quickly, and we're using more than a typical replacement dose. Well, then you might spike your hemoglobin hematocrit by maybe a half a point. Oh, well, that's not a big deal. Well, this is what you said to me. I'll never forget when we had that first conversation, and you made that analogy to me. I thought that was really funny, because I thought the opposite was going to be true

with my situation. I thought that I would need more testosterone because I abused it so much in my 20s and that's why I'd be an expensive day and you broke it down differently to me. Explain what makes somebody a quote-unquote expensive day. Just the way you choose your parents. I mean, it's really just luck of the draw.

I've had guys that are, you know, we call them steroids for 30 years that come in for replacement therapy. And could really, if they wanted to, you probably get away with injecting, you know, 200 milligrams per amel of testosterone, sypine, it was a typical starting dose every nine or 10 days because they metabolize it very, very slowly. So it's not necessarily what you did before. Now, your liver can accommodate in certain ways and make more or less aromatase. That's more of a factor based upon prior use.

But even then, prior use, we're talking about months ago, not years ago, because your liver will adjust to some of the, for example, foods you eat and some of your lifestyle factors to either produce more or less aromatase. But yeah, what you did before is not a really as much a factor, certainly, as people think. And just to follow up on the testosterone thing, because I think it's important for people to know, you know, elevating your hemoglobin and hematocrit, what typically is the case is more times than not at sleep apnea. In other words, the testosterone could leverage

hemoglobin and hematocrit production, right? Red blood cell count. You need it. People who come in with really low testosterone will often have low hemoglobin and hematocrit and can be even anemic because of it, which just means you're below normal hemoglobin and hematocrit and can be even anemic because of it, which just means you're below normal hemoglobin.

But it's not testosterone in and of itself doesn't cause a problem unless you're going to really high dosages. It leverages it though. So we see sleep apnea a lot, especially in, I mean, everyone in here probably got a mild form of sleep apnea. I'm looking at everyone's neck. We got it muslyy guys over here. Typically, a good ear nose and throat doctor will look at you and go, oh, your neck is

at least 17 inches. You probably have some obstruction there. And as you age, things get a little, I don't say softer necessarily, but maybe looser. If you have a drink or two before you go to bed or anything that might relax you, those muscles will relax more and collapse on the tracheus. So, you'll find this and of course testosterone will leverage that. That's why guys, even the two are in France, not anymore, of course. But they might use testosterone not because they certainly don't want to get any bigger. They want to be 6'2, 135 to be able to get up the hill, but they know it leverages the production of testosterone,

which is the, sorry, leverages the production of testosterone, beggar part. Using testosterone, leverages the production of red blood cells and hemoglobin, the oxygen care and capacity of the red blood cell. So Dr. Anne, because you've been doing this for a little while, I want to ask you, because the attitudes towards testosterone really change severely and they seem to be, the pendulum seems to be swinging back in the other direction, because I know in the early days testosterone, even alabalus, they were very easy to come by when I read stories about the 1960s and 70s,

then steroids became kind of public enemy number one, which included testosterone. It was a scheduled drug, although I would love for you to correct me if I'm wrong, but of all the hormones, you could potentially inject into your body testosterone has to be one of the safer ones, especially if you compare it to insulin and other hormones. But absolutely. And in some countries, it's over the counter. But nonetheless, it became public enemy number one, and doctors were afraid or couldn't

prescribe. So if you were a guy, and you go to your doctor in the 1980s or 90s, they test your testosterone, it's in the floor, you're not doing very good, they're super reluctant to even prescribe it. Now we see TRT facilities are popping up everywhere. What changed in that? Like what happened to where it was like you could not get any hormone replacement. And now it seems to be much more available. I got a few answers, because you got a few questions in there.

I hope we can keep track of this and come back when we get lost on a tangent here. But I mean, starting with, you know, they would, the, any of these substances were banned as of the 76 Olympics. Okay, that's where things definitely changed. Was that when the East Germans showed up

and just crushed everybody? Because they, Well, okay, you know, you can blame it on them, but you know, how order was given special dispensation for his, I think it was his last Olympics because he had been on antibiotics for so long. And it was legal to compete on antibiotics. There is, again, prior to 76, that the assumption was, okay, you use them. Now you're dependent upon them.

So it's my understanding you got special dispensation for his last Olympics that might be a fairytale i don't know but again the point is it wasn't a problem until that point and then yeah everything changed now why it became public in any enemy number one in like one number one but it was up there at the top of the list right i couldn't tell you i have no idea why has uh... and i don't mean to i'm just picking one and i don't have a special thing in my heart about marijuana, but you know, we saw movies from, I guess, what, the 50s and 16s, you know, Refer madness. And I've never seen the movie. I've just heard about

it where, you know, you smoke pots, can lead to heroin addiction and you're going to jump off a building one day and kill yourself. So why, you know, and we know better. Well, who dreams of stuff up with testosterone? Like you say, it's probably one of the safest hormones out there. It's definitely, you mentioned insulin. Insulin can kill you. No doubt. I've never seen a case where testosterone kill anybody. Estrogen, okay, can kill you.

Okay, certain forms of estrogen are associated with prostate cancer and all kinds of estrogen-sensitive cancers and females. So yeah, why it became such a, why it develops such a stigma of mortality? Wow, was Aedo, was he a big part of that? I remember that.

Yeah, they pointed him, that was a big problem with his health, was that he was a big steroid user. I gotta be careful here because of legal reasons, but I would argue that that was not the cause of death for Luzano. And I probably should leave it at that, but there are certain stigmas with certain diseases that I think he may or may want to, may or may not, and I'm speculating here, must make

it clear, so none of us get in trouble. But Lai was a great guy, knew him from goals, and he was he's a super 11 guy, but if you look into some of the things that were associated with his death, it might have been something else that caused him. I know of nothing that testosterone would have contributed to the things he died of. What would that be? Brain cancer, I've never heard of a testosterone

stimulating brain cancer or perpetuating it. I mean, it's just, like you said, it's a very safe hormone. So don't know about that, but then, okay, there was like three parts to you. Yeah, so it was so because it became like this enemy drug, and it was thrown in the category of steroids, so testosterone being technically a steroid as well, it was impossible for men to get treated for low testosterone or even it wasn't even people weren't even aware that there could be an issue. Now it seems like the pendulum is kind of swung where it's people are more aware, there's

more facilities available. Is this because of the that there's so many men now with testosterone issues or have they change the laws or what is caused this pendulum start to kind of swing the other way? Well, I think public demand. I mean, I can tell you that for example, I had a young lady in my office who brought her mom in for whatever reason they only had one car and she was long for the ride and she was probably mom was in her 70s and this guy was probably in her early 40s. And she had low testosterone, was complaining of all kinds of symptoms of low testosterone. And just out of politeness, I looked at mom and asked her how she was doing.

And she said, I'm fine. And I said, you know, nothing like your daughter here, no, these symptoms. It's just, no. Then 90 days later, daughter comes back with mom again for the follow up. And I, being polite again, asked mom how she was doing and Mom wasn't doing so well. All of a sudden, she had all the symptoms that her daughter complained of earlier. My point being that, you know,

the humans are pretty phenomenal creatures in a lot of ways. If there's nothing you can do about it, if you've got an ounce of character, what do you do? You do with a muscle up and deal with it, right? So Mom had been doing that because her generation is, in my opinion, did not have these options, right? Like you said earlier, it wasn't really available. Certainly not to women, even more example. Better example. And now she sees her daughter getting better and all of a sudden, well, yeah, I'd like to get better, too, who's probably going on at least subconsciously. And this is typical. And I think with guys now that we know, hey, it's not this public enemy, testosterone replacement,

and my buddy down the street is using it, or my buddy in the gym is using it and doing so much better now. I can see it, that's how I find out about it. I asked him, I said, dude, what are you doing, right? And he found out about it. So public demand is leading that charge, certainly, okay. Also, doctors, I mean, I got a lot of patients that are doctors.

They're finding out about it and they're going, well, this is a great way to help my patients. This is a great way to make a living. And come on, I have a great job. I don't have people complaining about major problems. They're not on 26 medications, typically. They're people that are trying to get even better in terms of health and optimizing it.

So what a great way to make a living. So more doctors are incorporating it into their practice. It's now being covered oftentimes by insurance, even the HMOs of the world are sometimes covering it. The problem there is to get to another problem is, before you have doctors looking at reference intervals and those reference intervals for testosterone are very broad. Yeah, so explain that reference because I know I look at the numbers and I'm like,

it goes like between 300 and 1200, it's like that's a big difference. Well, that was another thing that you blew my mind and corrected me on too was the other place, we always talked about this generic range, right? They would tell me like, oh 400, I think, to 1200 of free testosterone is this kind of

autotal, or total testosterone, is this optimal place to be. And I remember you telling me that, yeah, but there's other factors I'm looking at on your blood work that are actually more important. Go into that a little bit. Remember that conversation? Yeah, no, because I have it frequently. Fortunately, you're unfortunately. First of all, I have it frequently fortunately or unfortunately first of all

I don't know where they're getting those reference intervals from and I see it all across assays, you know nowadays for example You can see a cholesterol reference interval that is nothing close to Whatever they want to call it normal because I see these assays day in and day out and 0 to 99, I'm forget to forget the unison measurement right now in terms of, say LDL cholesterol is not normal. Okay, so where they're getting those reference intervals, I couldn't tell you, unless you're on a statin

or getting chased by lions on their serengeti plane on a daily basis, you're not seeing somebody below 99, typically. When it comes to testosterone, again, I have no idea where they're getting those numbers from. They have adjusted them, by the way, some companies from that, it was like 11.97 lab core used to have at the top of the range. That's unusual.

Now they've clipped it back to somewhere in the 900s, I believe. But the point is, to your point, I think this is the question you're asking. First of all, even if that were normal. So what, as I like to joke with, but make a point with my patients, it's normal to get sick and die one day. Who cares about what's normal? One day, zero is gonna be normal for you,

because you're gonna be six feet under, nothing's working, right? But we wanna concentrate on, I would think in medicine, is what's optimal? What's the be normal for you because you're going to be six feet under nothing's working, right? But we want to concentrate on, I would think in medicine is what's optimal? What's the best thing for you? So if you see someone and this is typical, my typical patient, especially coming from an HMO or a doctor that hasn't been educated in this yet, they look at your labs and they go, okay, for example, in your case you're saying that the reference interval you saw was 400 and above was normal. Okay, you're at 450. Big whoop, right? At the end of the day, what do you treat? The numbers

of the patient, if you're still having issues, complaints, then the numbers are to be used as guidance. If you had 1100 total testosterone, and more importantly, by the way, your free testosterone was commensurate at say 22 p.m. from a later, then you go, you know, probably not testosterone that's causing the problem makes sense, right? Because that's pretty flush. That's a nice, nice level of testosterone. You might look at other reasons for a lack of energy, a lack of libido, etc., or a lack of body composition, composition, you know, quid eating the cheeseburgers all the time

with the milkshake and supersize and all that stuff. You get my point. Right. So, yeah, I mean, that's probably the other problem that has started to change is that doctors are realizing, oh, you know, the reference intervals are just that. They're there for reference and support or subtraction from a diagnosis rather than a rigid level.

One of the guys that helped that immensely was a guy named Abraham Wuergenthaler who wrote a book, Testosterone for Life, I believe was the name of the book. And earlier in his career, he had set a limit. I think it was 450 as a matter of fact for total tea. Did even concern himself with free tea. And then finally, in an international consensus, I think from 2016 said, hey, it's not about the number. It's about the patient, which is kind of a duh, right, you would think.

Anyway, things have changed because that's now published and he's a big shot in the industry. He's got a much better resume than I do. I think he's an associate professor with Harvard. That's helped things a lot too, I think. I remember reading years ago because obviously I've been in the fitness space now for decades and what we used to hear all the time were the dangers of high amounts of antibiotics or high amounts of testosterone.

And this is of course, this is popular media. How bad it is for your heart, how bad it is for your health. And then I remember reading actual scientific articles. This was a little later in my career and I had no idea. I had no idea that low testosterone had severe health longevity effects. Can you go into that? It's like, because I think a lot of us think high testosterone is really bad, but on the other end of the spectrum, and maybe we can get into that, like high testosterone, is that

really bad? But let's talk about the low testosterone and what that could, besides feeling like crap, besides having low energy, low confidence, low libido, what are the health risks of having just low testosterone? That's definitely come back to the risk of high levels. But because first of all, the definition of high should be defined or undefined, at least in terms of the reference intervals that we have currently. There's other factors that come with high levels of testosterone use in the bodybuilding

community. But to answer your question, absolutely. We have studies that go back, I think as far as the 1950s, showing a correlation between low testosterone and things like coronary artery disease, type 2 diabetes, colon cancer, prostate cancer, osteoporosis, okay? And that's other than prostate cancer and both men and women. Dimension Alzheimer's too, I just read recently. Which adds up, right? I mean, you can start drawing all kinds of, and again, I use the word carefully, correlations,

because, look, if you had low testosterone, for example, given all the other things you do for your fitness and your health, more than likely, you're not going to have an issue with type 2 diabetes, for example, or coronary arduous genes, okay, although there are other factors that play in. And that's the thing, it's multifactorial. So we're always generalizing, which is important to include in the discussion and any discussion in this medical. Everything should be individualized, but going off in too many tangents, I apologize. We know, generally speaking though, that there is a correlation, and when we correct these things, life gets better,

and the likelihood of some of these disease states decreases. That's a given, okay. So, yeah. There have been some studies, so-called studies, that have raised the attention, and if you remember maybe six, seven years ago, I'm terrible at time, but on ESPN every 15 minutes, there was an advertisement for a class action lawsuit. If you or your loved ones have been involved or been prescribed testosterone, do you remember those?

No, I don't remember that one, but I know the commercial stuff. I knew because he didn't watch ESPN. It was based on, I believe two studies, one of which I remember, you know, it was a VA study, which, well, I'll just stop there, right? But no, going further, they used a cream. And by the way, the upshot of this study was it increased the risk of heart issues, mainly coronary artery disease. So, one of the knocks, and I'm not suggesting that this is true necessarily, but one of the

knocks on the VA system is there's very little follow-through, and in some instances, I mean, there's some great counter examples of this, but in a lot of areas of the country, the care is not that great. So anyway, you have a guy who jumps into this study and they give him a cream. There's no way to determine if the patient was compliant. So he might have said, okay, yeah, I'll do this and got his other meds that same day, but got maybe to the front of the line because he participated in the study. I don't know.

I don't want to speculate any further than I am already. But then three months later, comes back, applies the cream that day because he knows he's getting tested. Again, no assurance of compliance. But the treatment was ridiculous, based on what we know now. It was like, you know, some of these, I won't name names, but some of these branded gels and creams that, you know, don't even have enough

in them. The dosing is not even sufficient for a female in most cases. So they weren't being treated, really. We can't be sure that even with the treatment they were given, they were compliant. And here's the kicker. These guys in this study were all in line for cardiac catheterization,

meaning they were already hard patients. And yet it was published, okay, in peer-review journals, a bunch of us got together, and of course once we saw this, and takes months, if not years, to reverse some of stuff, objected, the study was retracted, you know, the journal was spanked for even publishing it. And, you know, there you have it. There you had people that were,

and, you know, this is, I called one of my best buddies in the whole world who happens to be a PI attorney. I said, and it happens to be on, I'm not gonna name his name, because he happens to be on therapy. Excuse me, and I said, friend, what's going on here? And I went off, I started off on a rant, he said, whoa, whoa, whoa, whoa, rant. He says, it has nothing to do with the medicine.

It's a class action lawsuit. That's the brass ring for an attorney. Okay, they got a lot to win and very little to lose. So that's how these things get perpetuated. And you know, patients of mine, either that were already on therapy or that we're thinking about or coming in and going, what's going on here? I heard it can cause heart problems. And you got to back through, you know, over 70 years worth of research and undo, undo all that because of one lousy, you know, irresponsibly published

study. It's remarkable. And I say 70 years because we've known since the 1950s that this stuff is not only works, but it's very, very safe. We've got plenty of studies to go back that far. Well, now let's go back to the high testosterone fears that were it's dangerous to have too much or taking too much can cause problems. Let's talk about that. Maybe I guess paint the context. What would you consider too much?

Would it be out of range or does it depend on the individual? There have been no studies that I'm aware of that use dosages that we might find in your typical bodybuilder Program and it you know prescribed if you will in a gym, right? So that's kind of hard to answer on one hand, but having seen all this you know go on in a gym a on one hand, but having seen all this, you know, go on in a gym, a couple things come to mind. First of all, there's, you know, in terms of a, we don't have a formal study, but even in terms of analyzing this, we don't know what those guys are getting necessarily. This is all bootleg, uh, farm, pharmaceutical stuff, right? And, and that based on what

I've seen, a lot of stuff is stepped on because guys will come to me and say, Doc, you know, what comes here, stays here, right? And you know, they're afraid that I'm a reporter or something like that, you know. Yeah, yeah, yeah, yeah. And they'll tell me what they're doing out of the Simpossible, especially based upon your laboratory assays. So there's definitely evidence that whatever they're getting

in the gym is not necessarily what it's supposed to be. Interesting. So you'll hear about guys doing, through grams of something we can, that's impossible. It's just not gonna happen. But even if they were, back in the day, you hear stories of guys doing, and how do you substantiate these stories?

Guys doing a gram or two of something a week. Okay, even if you were, the risks of excess testosterone or certain antibiotics would be conversion to other substances like excess estrogen or dihydrotestosterone. And as you know, certain antibiotics will not convert to DHT or estrogen. So even those are limited. The other risks that most doctors will talk about,

and this opens up a whole other can of worms, is every, and it's rare you can say this, in medicine, every anabolic steroid comes with side effects to raise so-called bad cholesterol, LDL, and I say so-called for a reason, and lower so-called good cholesterol. And so that's a major reason why in practice, if some doctor were to prescribe an anabolic steroid, they will typically always weigh risk versus benefits, but pull you off after, say, three months and watch for your lipid profile to re-equilibrate. Why I couldn't tell you?

Unless you have established coronary artery disease, it makes no difference. And this goes off into another conversation about lipids and how we look at things for the last, again, 70 years incorrectly when we evaluate someone's liproprofile. If you wouldn't mind, let's get into that because you're saying so-called bad, so-called good.

Why are you referring to them that way? Well, there's a lot of issues with the standard lipid panel. We're looking at LDL cholesterol and it goes well beyond that. But first and foremost, again, and it's a great timing because the people on the, what people call a dirty ketogenic diet where they're using a lot of saturated fats for the ketogenic diet, you see a lot of elevated LDLs. Well, and if that were killing people, we'd see people dropping dead left and right, because I see people in my office on these diets

that have an LDL over 200, right? LDL doesn't cause the problem. Okay, LDL comes in after the problem has started and the problem starts with inflammation. And I use the analogy of gasoline in your garage probably, if you still have an electric lawnmower, not sorry, if you don't have an electric sub-gas powered lawnmower, by five gallons of gas, it's pretty useful.

Okay, cholesterol is useful after all, it's how we make cholesterol. Sorry, that's how we make cholesterol-based hormones. Okay. And so they are very important until you go on TRT that it doesn't matter so much, right? But that five gallon gasoline can is not going to be a problem to you as long as you're not using your Acid-Line Torx next to it, right? Now if you are then you might have a serious problem as

well as maybe your neighbor. If you don't have inflammation, if you don't have an irritation inside the endothelial wall of your coronary arteries, then all the so-called bad cholesterol in the world is not going to start a problem. It will finish it for you. It will not start you off. It will finish off what you started with inflammation, okay? And then go into the measurements. Do we really wanna look at LDL? Or do we wanna look at LDLP? Or do we wanna look at LPLililate? These are other measurements that get into

more of the brass tax of your lipids that actually make a difference that are more correlated. So like these are the, are you talking about like the smaller or larger particle LDL particles? Is that what that refers to? More of the number with LDL P in the number of particles and then LP little a is in another measurement altogether.

And even those two are correlated somewhat. So you don't have to necessarily get both of them. You're in pretty good stead. And I'm just being practical now as a physician getting one or the other. But just getting a standard LDL is standard in care. And so legally, a lot of physicians are really including me, are sort of forced to grab that. And okay, if I saw a guy the other day with 316 LDL,

I go, okay, well, you're at greater risk than someone else if you have established coronary artery disease. So it might leverage me to go into recommending say, the starting course would be a bilateral crotted doppler ultrasound, where they just look at your crotted arteries to see if you do have any evidence of coronary artery disease in which the LDL would, again, make a difference.

But if not, you move on, there's a 95% correlation again between what we see here and what's in the heart. And this isn't me making this up. If you talk to the top cardiologist, say the top 5% of the cardiologist, they'll agree. This is Stefan Roomb over at UCLA, best in the West, has been doing this for 20, 25 years. And guys like Mark Penn,

formerly Cleveland Clinic will agree, because it's not a factor just this cholesterol unless you have coronary artery disease to begin with. So it's a good, what's your biggest risk for coronary artery disease, like most diseases, age, right? So if you're 30 and you have an LDL of 200, am I really going to start worrying about it unless you have, you know, a first-rerelative and other risk in your family that had coronary artery disease early in life. So you see there's a lot of factors here and again the problem is what we're talking about here is trying to do kind of paint by

numbers medicine. We all do it. We generalize. That's how we move in the right direction with medicine, but you still have to treat everybody individually. You brought up inflammation is testosterone anti-inflammatory because I've known people who when their testosterone is low, they feel lots of aches and pains, they feel stiff, then they get on TRT and all of a sudden they feel loose

and not as much pain. Is that due to any anti-inflammatory effects? I wouldn't say in a direct way, I would say in an indirect way, because you're healthier. And of course, even just for example, stability at a joint that might be already arthritic, if you've got some more strength, you know, put a little muscle and because of testosterone you use AND combined with proper exercise.

You strengthen the area, then you're less likely to have, when you don't want it to mobilize in the wrong directions, you know, mobilize joint, it stays more stable and you have less pain. Definitely. I mean, I hear that all the time. So reduce inflammation for more strength, which we see as trainers all the time, making someone stronger, less pain because they're moving better, therefore less inflammation. Now that is with so many things, the poisons and the dose, and arguably, certainly when you

move into anabolic steroids, part of the stimulation, sort of like the sand in the oyster to stimulate muscle growth is a little more inflammation. So you've got to be careful to say, is it anti-inflammatory or not? It wouldn't say it's one way or the other, but with the example I gave you, I sort of skirted the answer to the question. Certainly, if you had an arthritic knee for example strengthening the knee in most cases or even if we're an arthritic if it was You know a loose ACL or something like that Would would make for less pain?

What are some of the biggest mistakes that they that doctors make with TRT with their patients that you see? Let me let me jump in here real quick and hopefully you can edit all this stuff and make it more flowing. But I wanted to think, I wanted to touch on one thing about the excess testosterone. Okay. One of the things that comes with that,

I harped on one about, okay, you're not really getting three grams equivalent, it's probably a tenth of that because they step on it just like any other, I know it's not a recreational drug, but things are sold in the street, right? What people forget is the bodybuilders, and I'm not picking on everybody,

but in general, the bodybuilders have old, what were they trying to do? They were trying to become as big as possible. And even if they weren't trying to become as big as possible, today's athlete wants to be, you know, leaner and more ripped, but what are they doing for a living? Typically, the top guys are not working a nine to five or certainly an eight to seven desk job

under a lot of stress. They're working out, they're eating, and they're sleeping, and what else? And there's an expression, idle mind is devil's playground. You know, the fact of the matter is, and I'm going to get a lot of flack for this, I know, but it's the truth. And if anyone's out in that field, they'll know.

A lot of recreational drugs come in there. Guys are getting involved with, in my generation, we knew a lot of guys are getting involved in new bane was the drug. The pink killer, right? Yeah. So it's the recreational drugs that are biting them in the butt, not the testosterone. Okay.

You know? Interesting. And again, you can do anything in excess. I'm not saying that's not the case, but really, you're probably more apt to harm yourself with excess aspirin used and excess anabolic steroid use. Okay, so back to the other question I had, which is, what are some of those mistakes you see in the TRT space where, you know, doctors are giving patients testosterone?

Underdosing. So one of the first thing doctors do is they go, okay, well, you know, this will happen to me. You're at 400 and we're gonna shoot for X and you know, whatever X is for that doctor, let's call it 800 Nantagrans predestinator And we're going to shoot for X. And whatever X is for that doctor, let's call it 800 Nm per desolate of total T, that's what we're shooting for, we're going to give you what we would consider the difference.

What your body is working on like a thermostat, and it'll just simply go great. Now I have to do even less work. And so initially you might get a bump and then your pituitary realize, okay, no need to send as much loot and I would want to go to the test schools and you drop back down to 400 again. Or sometimes even less, depending on the amount. That's what it means, so I went lower.

Right, because they gave me, so they gave me, so that's why I thought was really fast. I think the first time I tested, I was like, I wanna say 412 was my number. And they gave me 150 milligrams of testosterone. On day seven, when we would retest, I actually fell down to 398406. And then they would just keep in, then they moved me to like 160, then 170. And I was, and I think when they finally got me to 180, which was right before I met you,

I was still four, I was still coming around four, four to eat or something, but I was, yeah, they had, initially it was crashing me lower than when I even started. So it has to do with the dose, you know, and the timing of the dosing, of course, and you can imagine what I saw with, like, daily dosing of the gels and stuff,

we're almost actually like, hormonal oral birth control for females, where you've got a smidgen of something, but it's enough of a smidgen of estrogen, for example, that suppresses her endogenous production. That was what was happening to you. And that happens a lot with physicians who think that way. Okay, you have to, again, think of it like a thermostat in order to dose properly. And then of course, you have to, again, think of it like a thermostat in order to dose properly.

And then, of course, you have people that, as I said earlier, either a cheap date or an expensive date that might be metallic more quickly. So that's probably the biggest mistake doctors make. And then the other one is, and it's part and parcel of that, shooting for a certain number, that's within the reference interval. You're no longer normal

once you're on TRT. Okay, again, who wants to be normal? But, you know, those reference intervals are for people that are producing their own testosterone. We've known since 1950s, and I'm certain of this, that in order to resolve the complaints that most people come in with, to get clinical benefit, In other words, you have to hit, and this is back in the 50s, they would use the total testosterone, at least 800 nanograms per desolate, total T. Now when I say hit it,

I'm talking about maintaining a level above that. So that's the minimum above which you wanna maintain. So that's the threshold, right? So if you're using Cipunate, for example, on a weekly basis, that's the number you wanna be at on day seven or day one, however you wanna call that's the number you want to be at on day seven, or day one, however you want to call it, the day you're going to do your injection, but before you do your injection.

Okay, you don't want to drop below that. Now, I would argue that in today's world where we use free tea, which is roughly, especially on someone using TRT, 2% of total tea, I think you're shooting for, at least in my experience, for clinical benefit, the patient to be optimized, somewhere on 28, maybe even 32 pico rounds, familiar of a free tea. And again, I'm just using numbers here, right? I don't care what the number is.

If you come in and you say you're feeling great and you're free tea is at 16 on day seven, I don't care to adjust it. Okay, but again, if we're using numbers, that's the number that seems to alleviate most of the symptoms a guy's are complaining about. Now again, I'm giving you guys numbers. And for guys, the total T is probably gonna be

at least double high normal during the course of the week. Okay, for females it gets even more interesting because they're gonna be probably at triple high normal of that reference interval, right, to get to a therapeutic range. And it freaks physicians out, primary care physicians who aren't in charge of this, and the patients themselves,

unless we warn them that, hey, this is the number you're gonna see in your total. But again, their free tea, females I'm talking about, will be usually within the range, which is, you know, up to 4.2, say, pica ranch familiar. And again, who cares about the number, but I'm just giving you the number. That's where they seem to, that's the sweet spot, the therapeutic threshold above which they have to maintain to feel better. Wow.

Now I have a question. I'm probably the most ignorant out of the three of us in terms of like, anabolic steroids and bodybuilding and, you know, I come from a little bit more of a sports background where I was told to just avoid them completely, right? I was wondering just for myself and for the audience in terms of like, what the options are out there for anabolic steroids and what each one has in terms of their characteristics versus the other. You mentioned like DECA and testosterone and like what are the other ones that are kind

of out there and you know what are sort of the pros or cons of all these things. Great question. So there's a bunch of great steroids out there, anabolic steroids. And before I go in any further, so people use that term loosely, right? Steroids. Well testosterone, estrogen, DHA, progesterone, pregnant alone, they're all steroids. Isn't cholesterol a steroid even?

Well, cholesterol is the molecule from which we derive the word steroid, like cholesterol, like steroid, right? So all these hormones that we're talking about, yeah, are made from cholesterol. So that's different than an anabolic steroid to what you're referring, right? A molecule that usually is either testosterone molecule or often enough a dihydrotestosterone molecule that's been jiggered in such a way by removing or adding a ligand along the

molecule so that when it goes into the cell, it operates differently, we'll say, than a typical testosterone molecule. And what we mean operating differently is typically more of the anabolic properties will be emphasized, those that build muscle, a creed mass, rather than the androgenic side effects, the secondary male sex characteristics we call it, you know, that accent, the hair on the ears we get after we're in our 30s and

stuff like that, you know, the weird stuff that none of us likes, ball being and so on. So there are a bunch of different antibiotics that have been developed. Unfortunately, we're limited as to what we can use in the United States. There are roughly, let's see, four that are used. There are more than that that are actually legal. For example, there's something called halitestin, which I have no idea why anyone, anyone would ever want to use it. A lot of bodybuilders do,

because it makes you, and I'll put it mildly kind of edgy. And if your... Power lifters like to use that one I heard, I guess it makes them aggressive. Ramps them up, right? So, you know,gy. And if your power lifters like to use that one, I heard I guess it makes them aggressive. Ramp some up, right? So, power power lifters is a great example. Though you smelling salts to perk themselves up, if you will, right before a lift,

same idea with hal with bodybuilders this more for, hey, I'm second wind here because I'm not eating prior to the show, and they want anything to get them through a workout. It's unfortunately really rough on the liver. And again, you can make you, had Jesus an understatement, you can make you a homicidal.

So again, halitessen, I would say, hey, it's due that and have an extra espresso before workout instead. But we have some good antibiotics that are useful for wasting disorders. I mean, that's what their standard, their indication is, right? Cakexia and wasting disorders, burn victims. So, oxandrolone used to be known as anavar is one of the best ones out there because not only is it anabolic in nature, it's also catabolic in nature. So, you can actually put on muscle and lose fat at the same time, sort of the holy grail of what most people in life would like. Yeah, and it can be used in females too. It's one of those that's a dihydrotestosterone derivative,

and it doesn't convert to estrogen, therefore it doesn't affect the receptors for dihydrotestosterone. So it's what we consider a clean, anabolic steroid. It's also, again, very useful for females because it doesn't convert to etchion. So if someone has had an etchion sensitive cancer, they can use it without fear of propagating cancer yet again, an etchion sensitive cancer. So in that way, it's a wonder drug. A lot of bodybuilders use it prior to a show because

that's exactly what they're trying to do. They're trying to lose fat and hold that muscle. There's one related to that called dustinazol, which used to go by the brand name Winstrol. And that one is very similar to Oxandrolone except it also one of the indications is for angioidema. So it gets rid of the extra water, the third- third space water, the kind of water you don't want, not the water that stays in the cell, but the one, the water that's in between cells. And so bodybuilders like to use that a lot too, or track athletes like you heard. That's a Ben Johnson got banned from the Olympics or whatever. He has gold medal taken with him. And it makes sense, right? You would use that one over anavar. Why? Because any athlete like that wants to carry as little extra as possible,

yet still maintain the muscle mass and lose the fat, right? So that makes sense for track athletes to use wind straw. Plus I think it tends to pep you up a little bit too. That's just been my experience. And that's a leak, that's a, that's you can prescribe that in the US. Yes, okay. You can prescribe an oral form,

you cannot prescribe an injectable form. And I may not be the one to quote when it comes to the legal aspects of this, because it might have changed, but that's my understanding is that you can't do the injectable for some, I guess that's only for animals or something. There's some rationale behind it, I don't know. And by the way, you can't get an injectable anivar either, which baffles me sometimes because I think it would be more useful in some ways for, especially if you ever had to use a higher dose like for a burn

victim. There's a lot of talk about how these are hard on the liver because they're oral steroids and they're alkylated in a certain way. In my experience, I've never seen elevations in liver enzymes because of these when used the way they're supposed to be used. And this will be probably more helpful for the nerds out there. But AST and ALT are typically referred to as liver enzymes. And yet you can have elevated AST and ALT because of just muscle tissue breakdown. And so a lot of times people who are on handplugs steroids

have more turnover of muscles certainly, right? And so, oh, look, that anabolic urion is causing liver issues. No, it's not. And an easy way for physicians who are listening or anyone else to verify that is to get a GGT, which won't be elevated for muscle tissue breakdown, okay? And it's specific to, well, the liver, but also pancreas, bilirid tract, et cetera. So you use that to compare and go, oh, look, my GGT is well within normal limits, but my AST and ALT are mildly elevated. You can assume that things are safe. And there's other ways to prove that, by the way, you can do a liver ultrasound to make sure it's not too fatty, which by the

way is one of the typical side effects, probably the most dangerous thing about anabolic steroid is fatty liver, okay? Which tends to resolve after you get off the anabolic steroid. And all makes sense because what anabolic steroids do, they help pack glycogen into muscles, right? So that they become better. They also do it to the liver than I guess. Better later, but the next step up after,

once the muscles filled for the moment, next step up is to store the energy in the form of glycogen in the liver than I guess. Better later, but the next step up after, once the muscle's filled for the moment, next step up is to store the energy in the form of glycogen in the liver. So you can build a fatty liver fairly early, and I'll keep realm in here. Let me just ramble a little bit more because I think your audience will appreciate this too. And I learned this from Franco Columbo way back in the day.

God rest his soul. Bodybuilders, like I said, especially back in the day, used to just wanna get big. So you do a lot of lifting, a lot of eating, a lot of sitting around. Well, you could very easily develop a fatty liver. And so they all knew after an anabolic steroid cycle to use something called back then,

it was just an osteoctal and colon. Nowadays, still consider pretty much a b-vitamin, although they're still arguing about how to classify them. Now, we add another amino acid called elmethyneine, and we call them miccaps. 30 days of these miccaps in a high dose, we're using 3,000 milligrams of anostolin coalene and 1,500 of elmethyneine every day for 30 days, divided all at once, and you get a squeaky clean liver. Oh, wow. Wow, fascinating. And I say this because I mean fatty liver, the latest estimates is that 100 million Americans, that's a lot of us have fatty liver and yet there's no pharmaceutical cure.

I don't care what they marketed as and I'm not naming names but I'm telling you right now, we don't have anything to compare to these two simple, excuse me, three simple ingredients you can get over the counter. Yeah, and not harmful. All right. Now, there are others. So back to your question, there's a nangelone, which used to be branded as decadarolone, which is injectable sterograte for just putting on mass.

It's essentially anabolic, without being catabolic as well, like stenosolol and oxangelone. And I use HIV patients, it's fantastic. Because you can put on, you know, 20, 25 pounds of extra weight in someone that, you know, unfortunately they can get, go through about a, a villainous and that 25 pounds can be a lifesaver. I mean, it's a no brainer and very little risk with, I mean, what are the risks with, with an anjolone?

I say very little. You know, according to the medicine that elevation in lipids, how the bad lipids, the LDL is supposed to be a bad thing. But, you know, again, for reasons we talked about earlier, I would argue that's a bunch of bunk. And so, it's a no-brainer for someone with HIV who's, you know, underweight or even, you know, midweight, to put a few extra pounds on them,

if it's not stressing the heart or something like that. So, and then the other one which again I don't understand why you necessarily want to ever prescribe it is something called anodrome. Oxy methalone is that the name? I've never written a prescription for it in my life. God, I heard that. That was referred to. God, this is back in the 90s. I had this body builder that worked for me and they called it guerrilla roids. That was a nickname. Was that five? Did you say four?

Or did I five right there? There's the antirdrome? That's five now, yeah. Oh, five. I said there's four that make sense. Hellotess and uracus does make sense to me. And antirdrome makes no sense. And there are other ones that are legal.

There's something called danazole, which is called an anabolic steroid, but I don't see anything anabolic about it. What I use it for rarely, but I've still used it as if someone's on TRT and their free testosterone is on the low side in terms of percentage, like it might be 1.5%, instead of 2% for some odd reason. I'll throw in a little bit of dandasol, which really wouldn't do anything except reduce SHBG, which is binding the total testosterone so that the free testosterone comes up.

But, andadrol, you said it was, what did you call it? The real juice is what it really is. I call it dinosaur juice, man. I don't know why anyone would want to be on that, but it's for people that are really having a hard, hard time putting on weight. The indication, I think, is for,

I want to say pernicious anemia, and there's so many other ways to treat pernicious anemia, and there's so many other ways to treat pernicious anemia than putting them on anoderal, which, by the way, has a major side effect for a lot of guys. It doesn't convert to estrogen, but it seems to activate the estrogen receptor somehow. It makes guys just absolutely crazy. The so-called roid rage that people talk about, by the way, is typically not because of anabolic steroids.

Now, how a test can have that side effect to it, if you will, I'd say that has a profile that makes guys aggressive, no doubt. But it's really estrogen out of control that turns Dr. Jekyll into Mr. Hyde, the guy at the gym who puts on 30 pounds, all of a sudden becomes really red-faced and puffy, and then the water fountain used to be a nice guy now, he's a jerk. That's typically because he hasn't controlled his estrogen properly, not because of the anabolic steroids and think about it. The guys are the big, yo, guys in the gym,

they're doing it right. Don't look like that and don't act like that. And, you know, as guys, you can talk about, well, why would he? He knows he's huge, you can kick everyone's butt in the gym. Why would he get aggro over anything? You know, he's like happy, go lucky. testosterone makes you feel that way. But anyway, that's the answer to your question. Everyone's buttoned the gym. Why would he get aggro over anything? He's like happy go lucky.

Tissassemon makes you feel that way. But anyway, that's the answer to your question. I hope, I mean, those were, we're not, I have a fault of that, but. Where does Boulder on fall on that? Like I think we need to. Not as considered contraband for humans anyway in this country.

Equal coyes, yeah, is what it's used for. Just like the injectable wind straw is for, would you compare that to like deck, is it more like decker or what would it be? It is, it's got a structure similar to decker drop or an androle on, but it can convert more easily, everyone says an androle and doesn't convert at all, but I think roughly 20% of it can convert to an estrogen,

bold and own can convert more readily to estrogen, but it doesn't come with the side effect that everyone dreads with an angler. We haven't talked about that. Sorry, I skipped that side effect. Decaduralin comes with, yeah, they call it tecadect. Arachtol dysfunction because for a lot of men, particularly the same ones that would react

to negatively to finasteride or dutastride, proscar, propicia, and d do test ride goes avid art. They don't produce enough dihydrotestosterone and have erectile dysfunction, which by the way is not as prevalent as you would believe based upon all the press, but it does happen. And so with an angelone, you get conversion to dihydronangelone, which is very, very similar to, well, it's very, very weak in effect. So it binds to the receptor that DHT would go to. But it, but-

So it occupies the receptor, so DHT can't go do its job. Yeah, and so some guys will react to Nangelone with what they call call yeah, Dekka Dek based upon the old brand name to it. Yeah. So I've also seen this rise in Psalms and I wanted to see if you could kind of go over that in terms of what you've seen the reasoning why people use them and also like maybe like some potential you know negative effects of that. Psalarms are not my favorite. Now, I say that pleading ignorance because I can't keep up with all the sarms. Geyser inventing these peptides more frequently than I can study them. I knew this was coming because when I was still in, gosh, doing my pre-rex.

Prior to medical school, I can remember walking down the building in the physics department, in physics department, mind you, in CSUN, and they had all these pictures of peptides on the wall, these different hormones and whatnot. Why is this in the physics department? Well, because peptides are made like Lincoln logs, I think they are, or not Tinkertoy's, whatever. You know, you know, the ones that you could put together are different angles and releasing.

And the sky's a limit as to what you can invent with peptides. And these, these storms that they're coming up with, all these peptides typically are going into the cell and doing all kinds of things. We haven't thoroughly tested them. So there's a reason right there where you go, hey, be careful guys, you know, with what you're buying out there. Not only haven't been tested, but who knows how they're being made and what's coming with them,

you know, in terms of acceptance and other, you know, toxic constituents. And again, I don't mean to waive the, what the prude button, but, you know, be careful. Yeah, but a guy like you has got to get almost annoyed seeing that because I would think with all your extensive knowledge with hormones and knowing how much we've researched all these ones that you just talked about,

there's so much more that we know about that compared to these SARMS, not to mention what we know as far as side effects and stuff, but also how much more effective regular hormones are. So why would you want to take more risk for less results? Like this doesn't make sense to me. Well, and that that's really what I come to at the end of the discussion You know, it would practice how to rules We did a study an former partner mine with some athletes that volunteered and a supplier of Austrian

And it wasn't IRB. It was just a voluntary deal where guys said, hey, let's try this. And it was, you know, no, the dose was by the manufacturer suggested at 25 milligrams, which I think is still what they use. And to your point, they had less result than even being on TRT, and certainly than in anabolic, and the side effects were worse if you want to consider the effect on the lipids were. So the HDL plunged even more, the LDL went up even more. And you don't get the same benefit. Why? Now, I speculate it's because of good old American values

of, hey, I don't want anybody telling me what to do and people and I get it I'm a registered libertarian don't want to have to ask doctor for prescription and so they get these charms and the way they want to get them and I God bless them but again to your point why not do what works it's okay I get it it's it's it's what we have to deal with I make a living at it you have to go through the gate keeper and and you and qualify to get this particular substance and all that. But, yeah, when it's inferior product, I argue okay, this is not the right battle to fight. Go somewhere else. Now, with the new

charms though, that I'm ignorant of, there's a lot of, even things like Rad 140 that have been around for a while, I got people saying, wow, this is great. And I just don't have enough experience with them to tell you, oh yeah, it is better than say, Oxandrilo and or something. I will say that a lot of those guys that test out these charms though have never done an anabolic, the ones that I talk to.

And also they are often stacking. So, what was it, the Rad 140, or was it the Rad 140 and or was at the Rad 140, and the Ibutamoran, and the BP C157, or better yet, the Thymus and Beta 4, you know, what did what? And this is a big problem in the bodybuilding community because we're stacking now,

unlike we used to in my era, where again, because we couldn't get it, or we couldn't afford it, we did one thing at a time. Let's talk a little bit about how testosterone is administered because the old way, which is from what I've read the best way, which is injecting, so you inject it intramuscularly,

but then they've come out with creams that you rub on your skin. There's, I think they're called, I don't know if I'm pronouncing right trouches, am I pronouncing that right, or pouch, they're like, they're, I call them trokeys or trotes. Trokeys, there you go. Trokeys, I think, is, excuse me, I think actually the way people say it, but I think if you look it up,

I think it's from the French, I think you're supposed to say frosh, something like that. The common pronunciation is trokey, so let's just stick with it. And I guess it's like you put it in your gum and it absorbs, you know, through the mucus, membranes of the mouth or whatever. There's tablets, like what's the best form of administration from a, you know, getting to the testosterone levels where you want, getting people to feel the best type of, you

know, context and safest? Yeah, so as always, it's individualized, but in general, I would argue that for a male, the best way is through an intermessure injection of an esterifoid form of testosterone, like a sippinate or an inanthate, which are pretty similar. It works out on a weekly basis. It just so happens, it works out pretty well for most patients. So you just remember, okay, every Sunday, I'm going to do my injection.

We have another ester called undecanoid, which proven to be just a hassle to try and even find it. But it's a much longer lasting ester. They also use them orally, but for the injectable, which would mean, okay, presumably, could maybe inject every three weeks instead of a week. You just can't get it. And I think it might have something to do with one of the warnings is that it can create to do with one of the warnings is that it can create what's the word I think that I think the warning says it might cause a thrombus. Okay. Which is going to scare a lot of people, including docs away. And I don't know why that's on there because that that opens up a whole other can of worms about testosterone because that's one of the things that a lot of doctors claim also that,

oh well, you can increase your risk of stroke. And this rise in hemoglobin hematocrit is evidence of that. If you talk to hemidologist, they'll laugh. Okay, increase viscosity is not mean that you're gonna get a stroke. And while we're on the topic, or I brought us on the topic, I'll say, two studies that I'm aware of will clearly show that depending

on the studies, either six months or nine months in, for those six or nine months, if you have a preexisting issue with blood, a quadrilopathy, an issue with clotting too easily, then it will exacerbate it for six or nine months and it goes back to the normal risk of anyone else. So again, did testosterone causeshron cause that, no more than it then LDL causes coronary artery disease. No, it can contribute to it if you have a preexisting condition, but these are typically very rare. As a matter of fact, the standard human being has what we call is heterozygous for what we call is heterozygous for clotting to sort of lighten factor five. So it's normal for most of us to have

one lighten factor five gene and not. So the other clogulopthes are even more rare. Okay, and those are the ones we're talking about. So my point is the chances of you having an issue with clotting when you take testosterone are very, very low such that anyone who administers it, typically they didn't even test for these things. Okay.

You could argue that you should maybe, because of the slight increased risk, but even then, those that have the coagulopathy, the increased risk of a thrombus form forming at all, is also very, very small. So again, I think that's why we ignore it. Let's talk about the changing quality of life that someone, a man, and we'll get to women. I really want to get to that because I think there's way more stigma with women using testosterone,

of course, than men. Amen. Let's start with men for a second here. A guy comes and sees you, low testosterone, signs of low testosterone. He goes on therapy. What kind of changes in quality of life do you typically see? I know it's an individual, but what is typically seen with somebody who goes on therapy? The basics are, hey, Doc, I've got low energy.

And I shouldn't say low energy because the magic word is really decreased whatever it might be. One of the reasons why we don't see patients as soon as we should is because we've all seen the guy who's bouncing around the walls, right, or off the walls. He's got natural high energy. Any figures, you know, he looks at his buddy Ralph and goes, he's man Ralph's fattened shape on the couch. I'm still working out. I got tons energy. Nothing wrong with me. It's just old age, right? He shouldn't compare himself to anybody else,

he should compare himself to him, and say, hey man, how am I doing compared to 10, 15, 20 years ago? Do I have a decrease in my libido, my energy level, my sense of well-being, my ability to change my body composition, which the first three are personality traits you could argue, and influence there from. But my body composition, which the first three are personality traits you could argue, right? And influence there from. But changing body composition, that's not,

I mean, indirectly driven by your personality, you get your butt into the gym or not, right? But that one, you got a guy who, especially a successful athlete, who knows all the right things to do and just keep saying, well, I'll just try harder, I'll do more of this, I'll do more of that. They're the last ones to come in and really they're the ones that would probably benefit more than anybody to come in sooner. So those are the, I guess I called them, four things that most people complain about.

Now connect it to that though. An increased sense of well-being, that can affect your sleep. When you wake up in the middle of the night and think about your 2.3 kids in a mortgage and go, my God, how am I gonna get through this? You know, when things are going well, you go shut up, brain. I'll handle like I always do when I get up in the morning and kick butt, because I feel good.

I'm wake up feeling like I'm kicking butt. When you have the flu, for example, you don't wake up and think, I mean, the world becomes a horrible place for 10 days, right? Why? Not because the world's changed. And when the flu goes away, the world's great again, right? It's because you don't feel well.

And when you're off because of low T, you wake up and you start ruminating about that. Like, oh yeah. You know, how am I gonna make that car payment? And you think, hey, I got plenty of time to think about that. Why do I need to think about it a million night? They're going to send me a nice little letter telling me that my car's going to be repossessed long before it happens. You get my meaning. I mean, these are the things

that come along with low testosterone that people don't even think about. And once they start on therapy, they go, hey, by the way, I didn't talk about it the first time I saw you, but I'm sleeping a lot better now, too. And There's things to come with that because they're working out more often. And of course, that helps you get into a deeper sleep. Things we know that come with the other things that you're doing that can be indirectly because of the testosterone therapy.

But those are the main things. So feel better, more higher libido, greater sense of well-being, confidence. Yeah, and again, compare yourself to yourself, not to your buddies. Think about it. I mean, one was the last time you played poker on a Saturday night with your buddies.

The little things that start to go, you said, wait a minute, I'm doing fine. I'm keeping up with my business. I'm doing all the things I used to do, well, wait a minute. No, I am keeping up with my business, but I used to be able to do that. And, like I say, see my buddies for an occasion,

a monthly poker match. Mm-hmm. You know, those things start falling off. And again, it's for the people that tend be able to do that and, like I say, see my buddies for an occasion, a monthly poker match. Those things start falling off. And again, it's for the people that tend to be tougher to begin with that rationalize that stuff and probably postpone their... Oh, I was 100% that guy. I waited longer than I probably should have because I thought, oh, we'll give myself more time to naturally bring it back up.

Oh, I was still kind of working out and being somewhat consistent with that. So I'm doing better than this guy. I kept justifying in my head like that. But the two big things that I noticed that finally kicked me into gear to go finally do it was just my drive to even want to get in the gym. From most all my tournaments, I used to, I remember thinking about my workout the night before because I couldn't wait to go lift.

I was excited to train, I was in love with it, and I had lost a lot of that. And yet I was still disciplining myself to come in and go my desire to do it, I had lost. And then of course, all the other ones you touched on, like I noticed all those things dramatically increased. The other thing that was really pushed me in that direction is as a trainer

and doing this as long as I have. I know how I need to eat, I know how I need to train, to change my body composition. And pretty quick too, I can get it in there. And that's what I was like really getting frustrated with as one, the drive to get in. And then two, when I was in and I was being, and I was eating the ways my body just was not responding the way it had in

the past, and that's what broke me down. If I go, okay, I think I need some help. I don't think I'm going to be able to figure this out myself. But what about the other thing I was talking about? Did you also look around and go, and I know you'll answer, there's the law of duty, I'll tee that up for you. But you also look around and go, well, I'm still kicking ass here. That's still way better than the 95, 99% that people in there.

So you go, and again, it's not to say I'm great, but just to go, okay, well, maybe it is just because I'm getting older, you know, or this is just what I'm supposed to expect. And to some degree, like we talked about earlier, it is normal, but it's not what you have to do, you have to suffer through, right? You're 100% right.

That's exactly what I did was, you know, I'm approaching 40, I'm the youngest of my friends, so all my friends are in their 40s, and I'm looking at, even though I'm feeling all these things, not feeling great, I don't have the drive, not body's not changing, I'm still in a better position than all of them, and so I'm going, oh, okay, well, maybe it is,

I'm just getting older and all those things are just inevitably going to decline for me. So let let's get back let's talk to women about women now because I know women can also suffer from low testosterone and benefit from testosterone therapy But is a huge stigma around around treating women They're afraid of course of turning into a man and growing a bunch of facial hair and all kinds of weird stuff What are some of the symptoms that women go through and how do they feel afterwards? Is it very similar to what men will feel? Yeah, this is actually the status part.

And we're actually making a very concerted effort to reach out and appeal to women more because actually when I started, I had more women in my practice than men. But I think maybe because of the stigma that you refer to, you know, they just, they don't get the right push, they don't get the right answers, and they're kind of left in the lurch.

The symptoms they suffer from are the same as for guys, that lack of libido, energy, sense of well-being, called a jua de vivre, whatever you want, and the ability to change their body composition falls off the same way it happens with guys. The problem is, yeah, we were kind of reared to look at the hormones, the so-called sex hormones, right, as testosterone's male, estrogen's female. When, in fact, we both have the same hormones, okay, just different ratios. We man carry estrogen and testosterone on our bodies, just more testosterone

than estrogen, and the reverse for females. So, that one, yeah, that one's very unfortunate. And like I said earlier, I see your all just picking up the ball for the men, but I don't see OBGYNs picking up the ball for females. And so, like I say, they're kind of left in the lurch. And there's a lot of misconception out there. You know, oh, God, I'm going to grow a beard. Oh, gosh, I'm going to turn into Arnold Schwarzenegger in terms of my body composition, which I mean, if you just think about how ridiculous that one is, I mean, Arnold, you know, like him or not, you had to work for that. You know, it's not going to happen overnight, man. You know, you got to put in some effort. Anybody, builder, will tell you that. And so, but we know that they're the legitimate fears because also there are, there are,

well, there are doctors that are writing protocols that are not aware of the potential side effects. And, you know, while men and women have hair in the same place is, you know, women just a lot less of it typically depending upon their phenotype, etc. You know, that's a fear because women don't want to have facial hair for now in this country. I don't think they ever have in the history of civilization, but I mentioned that because you know, you look at, you know, what, 16th century paintings and, you know, women were kind of books them back then, whereas today, you know, or just 20 years ago, Twiggy was supposed to be the ideal body type. So things changed. But anyway, as of today, women don't want to have beards, right? And so that's a fear. And while it will not cause a beard, it can, and it's, by the way, it's not the testosterone

that will facilitate this extra growth, is something that testosterone gets converted into, called dihydrotestosterone that's the fly in the ointment. So if, and by the way, like I said earlier, unless it's a very unusual female, she's got two or three somewhere on her face, right? Like grandma did when she was 35, they appeared, but you didn't see them until at 75, she says, I just don't care anymore. I live long enough, it's not fucking. Yeah, she stopped, I just don't care anymore. I've lived long enough to take me as I am.

Yeah, she stopped flukking. And then you notice them, right? Most of the females will have some of this, even if it's just sort of sideburns. My point being that it's driven by dihydrotestosterone, of course, first and foremost by the genes, and it's not the testosterone, but we can block the conversion from testosterone

into dihydrotestosterone, you don't have to suffer from these side effects. Unfortunately, we do fix a lot of bad haircuts when it comes to female TRT because they'll go to a doctor that hasn't really given it anything but short shrift in terms of study. They put them on testosterone and they go, oh my God, that was disaster. Yes, I love the energy. I love the libido, but my God, I got acne, which is also driven by dihydrotestosterone. I don't think either sex likes acne.

What about the low voice? What's the mechanism there? Again, dihydrotestosterone is what drives that. Dihydrotestosterone is two to five times more potent than testosterone in terms of potency and depending upon the receptor, right? It's a masculine rising hormone essentially. Yeah, I mean, that's what we refer to it. The male secondary sex characteristics are driven by that particular hormone more than

any other. It's an Androgen. And yeah, I mean, that's an issue. So the good news is, for those that are on it and are not, and are suffering with some of these side effects, or those who are planning on getting on it and worried about them, we can stop that conversion and therefore prevent the side effects,

or you really kind of have about a six month window in which you can reverse them, I've found. So if someone's starting to know, oh, my voice is getting deeper. Because of the thickening of the vocal cords, then we can put them on something to stop the DHT. That's interesting. And you got about a six month window.

And by the way, this is what I tell all patients, you can stop and that extra hair growth will go away. Okay. And usually I'm stopped mid-synth and go, yeah, yeah, yeah, tell me them, I never mind, I'll just get more laser. Well, okay, wait a minute. I also told you, you don't have to get the laser either. If we put you on a substance,

it's usually finasteride or deutastride. The older docs used to use something called Sparinal Actone, which is a diuretic, a potassium-sparing diuretic. They used to use it ubiquously for females in acne because they know that it is a side affected blocks and only works in females, by the way, dihydrotestosterone formation.

I don't think anybody needs to be dehydrated necessarily. I mean, unless they have hypertension, and we can use this as an adjunct, but most athletes, yeah, that's one of your worst enemies is dehydration. So I don't use the diuretics anymore, but finasteride or due-tastride even works great to block dihydrotestosterone. Again, people think of it as a male drug, but it works the same in the female.

And so a female walks in and she complains similar to like maybe what my complaint is with low energy, mood, libido all down, body composition, struggling to change. What does, and I know of course there's a variance, but what does kind of a normal dose of testosterone look like for a female to help her rebound from all those things? Roughly one-tenth of dose of a male. So what it works out to, yes.

So like 20 milligrams or something like that, right? Yeah, we'll use a testosterone-sypene, 20 milligrams per a mile per week. And for a tiny amount. Yeah, well, and that's why we gotta have it in a different strength because to be precise is difficult with 200 megs per email. So we have to get them a different strength. And actually we can get it, we can get away with 50 megs per

email and just use, you know, point four emails. And it's precise enough to be accurate. So yeah, that's pretty much the secret there. And by the way, we were talking about the different delivery systems for men without a doubt. Clinically, you're going to see much better result with the injectable, anything that's just terrified. With women, because it's a smaller amount of testosterone required is what I imagined, part of the reason is anyway. You can get away with the creams and gels or even orals. Because again, the argument is that less stress on the liver, I don't think that it really

is. You could argue with methylated tests when the original testosterone orals was hard on the liver. But any of the others, I don't think you have an issue with but Given that argument, you know, okay, you want to select one of the others first but You know, there's still the drawback of you got to Put it on wait for five minutes for to be to dry anyway and then another 25

Let's say to have it be fully absorbed before you can go, you know, swim in or exercising or whatever. You know, I joke, I drop my candy by not investing in Sephora because my wife puts on a cream every day, several creams, you know, I'm like, oh jeez. And so, you know, male or female, you know, summer, you're like, okay, what's another cream, big deal? But there's some that say, no, hey, man, if I can avoid one more cream, I'll do the once-week injection.

But in terms of efficacy, I don't see much difference for a female, whether they use an injectable or a cream or a gel. So they're taking about 20 milligrams. And then what are you, what else are they taking in order to block the, the, the, the D H I, D H I, I thought testosterone, what do you call it? D H T. D H T. I had to test testosterone.

Sorry, I'll stop with the, the, the, the, the abbreviations. No, it's okay, it's okay. I don't put them on a dihydrotestosterone blocker, we call it a five-offer ductase inhibitor. Typically, unless they complain or they've had experience with they say, oh, I did it with this doctor and man I got acne or man I started getting hair in the wrong places.

Then I'll say, okay, well, we know that's in your genes, that's what's gonna happen to you. Let's put you on from the get go. But it only happens in about, say, 20, maybe 25% of the females or males for that matter that have side effects. So, I don't put people on immediately, but we have a feature in the charting system. It's a patient health record, I think it's called, where we can message, so I say to patients, hey, as soon as you see anything, you even think as a side effect, communicate with us and we'll

put you on right away. But, you know, if we start people on it, then based on what I just said, you know, 75 to 80% of the people are taking it, don't even need it. So, so what does the process look like? Let's say somebody's watching this or listening and they're like, okay, I have some of those symptoms. I suspect maybe I have low testosterone. I'm eating right, exercising, getting good sleep, but I still feel this way. What does the process look like? They contact your facility and then what kind

of testing do they need? Like, what does that whole thing look like? Well, in order to get a prescription, first of all, again, fortunately, unfortunately testosterone is considered a controlled substance. It's a schedule three controlled substance. And so you have to have a prescription for it. In order to get a prescription, you have to have a relationship with a doctor

and in the state of California, you have to establish a relationship with a physician, which involves a history and a physical exam. So those are the hoops you got to jump through. You have to see a physician. I say see, these days you can get a surrogate physical exam from another physician, I call a surrogate, so that you're primary care physician, you could go into today,

and then I could use that physical exam tomorrow trusting another fellow physician. And then you and I have to talk about what's going on. There has to be a reason for prescribing this. So we talk about the symptoms. Like I said, it could be that it has nothing to do with your testosterone. There's so many ways, I mean, there's tons of ways to get ahead of you.

There's tons of ways to have low energy and low libido. So we got to look at typically some labs to help us guide the decision making process, the evaluation. But it starts with, as I said, you and your symptoms. What's going on with you? What are what are you, what are you, we call them chief complaints? Awesome. So they do that, then they get on and then I imagine, I can only imagine that because I look, I've known several people who've gone on TRT and they're just rave about how they feel. I can imagine the stick rate, in other words, the amount of people that work with you who

stay on is probably through the roof. Do people tend to fall off or they tend to stick around once they feel the effects? Yeah, someone who was a crummy salesman because I hated rejection. This is a great profession to be in. We have very few people ever drop off because yeah, it works great, man. I have a great job. I really do.

I don't see sick people. I see people that want to optimize. I mean, sometimes we see people that need to be pulled out of a hole and that's very, very rewarding. I have a buddy, Joe Rivera, he won't mind. He put all this on not Instagram, but YouTube. His mom came in on 26 meds. 26 medications. Joe Rivera, he put all this on not Instagram, but YouTube.

His mom came in on 26 meds, 26 medications. She was taking medicines for medicines. We got her down to four, two of which were only temporary because of something else that was only temporary and we got her off. She came in on a walker and then ended up doing the pool and hiking, my, and some stuff. It was really, really rewarding, not just because Joe's my buddy, but because you watch an individual

who's being overly medicated and by the housing and conversion with her physician too. I speculate you, your business to explode from this conversation because when I started talking about my journey on the show openly, and I started to get, and it was blown away by this. I told the guys this that my entire career as a personal trainer in gyms, you know, this is 15

years ago. When I was working in gyms, I never met men under the age of 40 or 50 that would complain about low-test australon. When I I started talking about on the show, I was getting tons of DMs and from young men from men in their 20s who wouldn't got their blood work done and we're telling me their their total test austro was 170 205 like 25 years old 23 this I was blown away by how many young men with that and then, Sal talks about the studies that have been coming out about how much that's been declining. And I just, I find that really fascinating that you're seeing.

I expect that in a 50 year old man, right? But not to see that in young men in their 20s. And so, and I've been telling them, listen, I'm not a doctor. I don't know what to tell you in this situation, but I do know that we'll be talking to one on the show about this. And so I know there's a lot of people who have been waiting for this conversation because I know it's helped me out tremendously.

And I had no idea how many young men were struggling with those. What's interesting about that is, yeah, the age level has dropped for those that are definite candidates for TRT. Now, you know, you don't necessarily want to go out and check your testosterone levels. That's kind of a no-no.

I mean, an engineer would do that, but a doctor is counseled against that because you don't want to open up a can of worms that doesn't need to be opened. Because you don't treat numbers. But most of the time, people don't wake up and say, well, gee, I better check my testosterone today. They check their testosterone

because they have some complaints. So, you know, it does kind of tie together that some of these 20-year-olds do have low testosterone and there's a reason why they, you know, they have the symptoms of it and there's a reason why they checked it, et cetera. What's also interesting about that is, in my experience, it appears that stress is the big driver and it makes sense medically.

Arguably, 300 years ago with life expectancy on average was like 30 years old, life was still different and that average was driven down by infant mortality, early death, that sort of thing. But we're herding sheep for a living. Stress levels are pretty low. You're worried about an occasional wolf and that's, if it does happen, it's, you know, maybe once a month or something like that, and that's what we're designed for, a cute stress, not chronic stress. You wake up in today's world, and I'm not whining, but

even my dad will say, you know, you know, your dad told you, I'm sure it's same as mine, you know, he went up, he went to and from school, uphill, uphill, both ways. In the snow, eight dirt lived in the shoebox, you know, for the first 20 years of his life. He'll up, he went to and from school. Up hill, up hill, both ways. In the snow, eight dirt lived in the shoebox, you know, for the first 20 years of his life. He'll say, yeah, you guys have it tougher than we do. And none of us here's winding, right? But it is a factor of life. And I see it in 20 year olds. I mean, just look at Hollywood,

kind of maybe a funny side note. I got guys that are 20 years old with ED. Yeah. It's not because of low testosterone, oftentimes, because they believe what's on that stupid box that says that you're supposed to be able to impart me This sounds crass, but you're supposed to be able to take care of you know like Casanova five women at one time and do so for five hours and they're like, oh my god Really? That would freak anybody out. And so there's some mental stuff going on there that adds stress that can Effect your ability to get an erection. It drives testosterone levels down.

And so, in my early part of the career, I would say, well, this is stress driven. You're 28 years old. This doesn't make a whole lot of sense. I do see this, low testosterone, a 28 year old. But why don't we think about some ways to lower stress? Well, in some people put even more stress in the situation, because what do you do?

If you've already got 2.3 kids in a mortgage? You're gonna go to Bali and become a beach bum. You know the lower your stress levels. That's not an option real pro Now the cool thing is that being said in a 26 28 year old You have some other options besides TRT so you can bring that 2.3 kids to a full three By preserving your fertility in other words You can you can raise your endogenous production because your testicles are usually still working just fine. It's just your brain because it's stressed out is affecting your partuitary, which is right below the brain,

sending a signal to testicles to do their job. So we can give them something called ACG, human coreana going out of tropin, no more abbreviations. And other things like off label use of clomid or better yet in clomophine, which indirectly gets your pituitary to send the signal testicles to make more testosterone. So we have sort of a bridge gap there that- So is that what's more common practice than for you? If you got a say a 25 or 28 year old young man that came in, complained of that, before you would say, hey, let's do 200 milligrams of testosterone, let's first see if we can get this up

with HCG or clomid first. Well, that's what I used to do back then. I still do. I mean, I give them the option because, you know, it really gets down to practicalities. Medicine tends to want to let the body do what it wants to do. And again, the biggest argument I have there is, well, that's great, but eventually we die.

So, you know, the whole anti-aging movement is and gets sick in the meantime too, is to try and improve the quality of life and get the best of what Mother Nature gives us and get rid of the worst. So my argument is, look, by the time you're 50, certainly, more than likely odds are you're going to be on TRT, right? If at 30, you're having issues already, I want you to have the options, even for some,

it's just a mental aspect of even though we are dependent upon air, food, and sleep. And for some of us other things to live an enjoyable life. For some reason, having to do testosterone once a week is something to go, wait, man, I want to be dependent on anything. And I get that psychologically. But to have a choice is nice, but I'm not going to necessarily counsel a 26 year old, hey, you have to do it this way. If they've got abnormally low T, I certainly will suggest to them just because it makes life easier not just mentally

But if they want to father children it's easier to maintain fertility than to try and regain it if you lose it You know, even though I would argue even that really these days is not a consideration. I mean it is but you know I I can say this for sure. I've never had anybody lose fertility that didn't regain fertility for physiologic reasons. I've had people for psychological reasons back in the day when we pull you off T and say, well, let's just hope it comes back that after nine months, I'd forget about it.

But these days, even while on TRT, if someone which doesn't happen that often loses their fertility, they can regain it by just jumping on some HCG, for example, human coriander going out of tropin to get the testicles to jump back online and get the sperm flowing again. Yeah, that's great advice, because I feel like a 25-year-old, though, I think that fear that I would have if I was in your shoes of just right away prescribing him testosterone is, you know, that may mask all the other issues that he's got going on. Maybe he has, have stress, maybe does have a lot of other

bad habits that are causing some of that too. And just by simply elevating those forum may make him think that he's better, but he's really done addressing all the root causes. Well, you bring up another issue that I wouldn't necessarily touch on but since you bring it up, yeah, with those patients invariably what I'll do is recommend something called an MRI of the head. We want to see if the pituitary is damaged, has a tumor on it, is missing an empty cell we call it is damaged, has a tumor on it, is missing an empty cell, we call it, because that can be an issue. We can also do some other tests because there might be an extra X chromosome,

a climb felt disease. So we want to find all the possibilities because, again, at 28, it's unusual. Although, again, for stress reasons, we're seeing it way more often than we used to, even just 20 years ago. But in a 58-year-old, we again, for stress reasons, we're seeing it way more often than we used to, even just 20 years ago. But in a 58-year-old, you go, well, okay, duh. And so, you know, you follow what's called a differential diagnosis, where, you know, if you see a hoof print, you look for a

horse before you look for a zebra. You follow the things that make the most sense. But in a younger patient, you want to rule out some genetics, you want to rule out some enzyme issues where they might not be converting. I want to call it CH. And then these issues with the pituitary. So that's part and parcel of evaluating someone who's a younger candidate for sure. Now that said, what happens if you do have a, it's called a pituitary micro adenoma. It sounds scary. It's just a fancy way of saying you have a little small tumor on the pituitary, which by the way is rarely malignant. It's just a growth

that's messing with your production of luteinizing hormone, right? What if someone says, well, look, that's great, but I don't want you drilling, you know, a hole usually through the roof of the mouth and taking that thing off. I don't want to, I don't want surgery. Then you're still back to square one, but at least you have a reason. And I think that's to your point. But also to your point, are there things that are typically deadly that come with low T, meaning that are, that are driving it that you might miss? No.

Okay. So it's again pretty safe what we do with. Well, Dr. Rand, we, this is the first time we've, we've wanted to, or actually worked with any hormone replacement therapy facility. There's been lots of people who wanted to work with us, talk with us. We did our homework, we chose working with you because the information you already have out on YouTube,

the way you talk about the way you do, we really appreciate it. So, it's great. And we do get tons of questions and DMs on this. This is like a big thing, especially when Adam talks about it. I'm tired of trying to answer them. So, yeah, so a lot of clarity for me. So we appreciate you coming on the show and we appreciate this moving forward

because we'd love to have you back on answering specific questions at some point and just talking to our audience because this is definitely a big issue, quality of life issue. Well, I have a lot of fun doing it because as with anything, it's like, I don't know, when you buy a new car, then all of a sudden you notice how many people have that

same car on the road, not exactly a good analogy, but, you know, I just figured everyone knew this stuff, you know, more or less, you know, and then we got to talking about it, like, you said on some of those YouTube videos, and you find out how many people go, wow, I didn't know that, I didn't realize that. So it really has been a lot of fun, and doctors live, I don't care what anybody says, you know, doctors many people go, wow, I didn't know that, I didn't realize that. So it really has been a lot of fun. And doctors live, I don't care what anybody says, you know, doctors live for this, right? We want the pat of them, hey thanks Doc, I really feel a lot better. And so it's been a great source of pleasure for me and everybody works over on my team.

I mean, I can say it's a great job I have because you see a lot of happy patients, maybe not on first day, but 90 days in, they come back and they go, Doc, I feel so much better because of this, that and the other. We actually do get Christmas cards every year. Hey, thanks. I had another great year. Well, you did give a great knowledge earlier about it being the stigma around it, being very similar like the marijuana industry.

I just think there's still a lot of people around it. I just think that it's testosterone is this scary hormone that you're doing drugs if you do it in only these bodybuilders. And of course they attach it to the bodybuilders that have died and think that it's because of that or that you're going to beat your wife because you take testosterone. I mean there's just, there's these awful stigmas that have been around for a long time around it that are still there. So no, I think there's a lot more education that needs to happen around it. So I'm excited to have you come on the show. Well, so that end just to add another tidbit before we sign off. I mean, the wife-beater thing, the road rage thing is really like I said earlier, I think it has to do with excess estrogen,

making you moody and arasable rather than anything else. XSDHT can make it edgy, but not that kind of road rage type stuff. And that goes back to, you know, yeah, that the problems with like with so many things comes with mismanagement, not doing it the right way. As long as you keep the estrogen down, it's not gonna turn Dr. Dekkel and Mr. Hyde, but what I tell people is yeah, if you're already,

an asshole, and I won't name names. Yeah, let's just use that. If you're already an asshole, you can use the bigger asshole. It's an exact, perfect that. You're already an asshole. He's an asshole. He's an asshole. Exactly. Exactly. I couldn't have said it better. It's not going to turn you into one. So that's the only caveat I would say. For some people, maybe it's good that you little air out of their tire, but they were that way their whole life.

In other words, don't call Dr. Rand if you're an asshole. Yeah, we're free. No, we're free. No, thanks again. Thanks for coming to the show. My pleasure. Really, my pleasure. Thank you. Thank you for listening to Mind Pump. If your goal is to build and shape your body,

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