Testosterone Nightmare: Why Shots and Pellets Could Be Sabotaging Your Health (And What Actually Works)

Think testosterone shots are a magic fix? Dr. Ryan Partovi, JD, NMD, MIFHI, and Mrs. Madi Partovi bust open the myths, reveal why most men are missing out on better options, and explain how environment, diet, mold, and even your laundry choices could be tanking your hormone levels.

In this can't-miss episode of The Partovi Effect:

• Discover the four stages of hormone optimization most doctors never talk about.
• Learn what makes classic TRT risky—and why natural, bioidentical, and nutritional support can make a real difference.
• Hear surprising stories about sleep, diet, environmental toxins, and everyday products affecting men’s health.
• Get the inside scoop on how informed consent really works in hormone therapy (most clinics won’t tell you!).

Stop guessing and start getting answers. Pass this episode to every guy you care about, subscribe for more myth-busting wellness chats, and challenge the status quo with Dr. Ryan and Mrs. Madi Partovi—your guides to living well, informed, and empowered.

We love hearing from you! Do you have questions or want to suggest a future podcast topic? Email us today at office@drpartovi.com — your input helps us create content that serves you best.

Ready to take charge of your family’s health? Visit https://www.aspenwellnessinstitute.com to access personalized wellness solutions, expert guidance, and a community that supports informed, empowered health choices.

The contents of this podcast are for educational purposes only and do not constitute medical advice. Talk to your medical professional before starting any new treatment.

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Chapters

• 0:00 Introduction and Walmart's Food Initiative
• 0:50 Skepticism Towards Voluntary Regulations
• 3:10 Men's Health and Testosterone Therapy
• 13:11 Environmental and Lifestyle Factors Affecting Testosterone
• 37:44 Understanding Bioidentical Testosterone
• 40:29 The Four Stages of Hormone Optimization
• 46:54 Natural Medicines and Nutraceuticals
• 50:39 Advanced Hormone Therapies and Patient Choices

Transcript

 

Introduction and Walmart's Food Initiative

 📍 Welcome to this episode of The Partovi Effect. My name is Mrs. Madi Partovi. 

And I'm Dr. Ryan Partovi. 

And I'm sure that we've all heard in the news that Walmart is. Giving their word to eliminating,  um, synthetic dyes and 30 other chemical ingredients from their, their brand of food. If you're not watching on YouTube food in quotes, I mean, we'll by 2027, right?

So we'll, we'll, we'll see. And it still doesn't mean that their stuff is gonna be healthy.

Well, I'm just marveling at the fact you just launched right into that. Um, I did, but Okay. Um, yeah, I mean. Here's the thing. 

Skepticism Towards Voluntary Regulations

You know, as I've mentioned to you before, Hershey's, you know Mars, they've all said, oh, in years past, oh, in two years we're gonna have everything. In five years we're gonna have everything.

And then they, that that deadline goes by and they still have food coloring in their stuff. So to me, I am highly skeptical that this voluntary, you know, approach is gonna be effective. I think you have to regulate. You have to ban these things. I think that, um, I don't fully understand why RFK Junior is not willing to go that route because I feel like he knows better.

Um, but I think that there's like a knee fleck, a knee, uh, reflex kind of knee jerk. On the conservative side of things, like, oh no, we don't wanna ban anything. Oh no, we don't want to regulate more. And it's like, well, but you can't actually have a free market unless you have regulation. Because if you have unconstrained regulation, or if you have unconstrained markets, they're going to naturally co collude with each other.

They're naturally gonna be. You know what will ha what will develop is cronyism, right? You'll get crony capitalism, which frankly we see a lot of that today. So the only way you truly can maintain free markets is to have regulated markets. Um, and that is especially the case in the food and drug realm, in my view.

Mm-hmm. 

Yeah. So I don't hold out much, um, optimism when it comes to news like that. 

Yeah. I mean, I, I think that it's, um, it's good virtue signaling. Yeah. You know, it's like, Hey, come, come to Walmart. Right. But I mean, you know, Walmart has not, uh, been the friend, the friend of the people ever. So, um, I, I doubt they're starting now.

Yeah.

They had low prices though, that, that, that I think we can all agree on, 

but at what 

cost is what I would say. 

Yeah. Right. Ask yourself that. 

Yeah. Um, anything else you wanted to talk about? N 

no. 

Men's Health and Testosterone Therapy

Well, yes, and I, I really want to launch into, um, men's health especially, uh, particularly testosterone levels. Um, when you, when you open my world about it, you know, everybody kind of knows about.

Testosterone replacement therapy because it's widely marketed. Um, and I, I would assert that, you know, most people know that that is available for them, right? Mm-hmm. Um, what they don't know are the other levels of, uh, testosterone therapy that are available to them that may not have the, like reduced fertility or, uh, you know, the.

Testo or testicular shrinkage effects. Mm. Um, and the host of other effects, like loss of hair, um, sleep issues. Bless you. Bless you.

Bless you. 

Excuse me. Huh? 

And the host of other, um, side effects, you know, sleep issues and, um. I mean, you could eliminate, you know, most of them, but what, what are, what are the, but I think 

you've done a good job, actually. Thank you. Um, I think that certainly you can get a cholesterol increase, heart attack, a heart disease increase if you go too high, um, you can actually get over conversion into estrogen, which can cause gynecomastia, which is enlargement of the breasts, can increase your risk of, of male breast cancer.

I mean, there's all sorts of things that can happen with, uh. Testosterone injections, which are very common, uh, or even overdosing testosterone cream, uh, with the testosterone injections, which, um, I see this very often, people coming into the practice and, you know, the problem with the testosterone injection is it's, it's an injection.

So your, your level is basically going like this, and then it gradually goes down until the point that you get another injection and it, it's, then it's like this again. So you kind of get this pattern right, like. This is becomes your hormone pattern. And um, um, so the problem with that is that, you know, you get these highs and these lows, and at the high sometimes you get excess symptoms, and then at the lows, sometimes you get deficiency symptoms.

And so I prefer a more steady state, consistent level, which you get with. Uh, topical applications. And, um, the same of the, the same with the injections is true of the pellets. Some people do pellets, but you still, I mean, when you get the pellets injected, it's kinda like this, it's a maybe a little bit of a, of a low, slower curve, but then still there's this curve and then, you know, so the only way to really avoid that is by doing, um, the testosterone topical, uh, replacement.

Okay, so there's, uh, there's oral, there's, um, 

well oral really, you can't do oral. So oral is gonna get, um, pretty quickly conjugated by the liver and cause a lot of increased risk of heart disease. So you don't do oral testosterone. 

Okay. So I know so many young men that are, are on this natural tea stuff that's oral.

Not, 

well, it may be not. It may not be testosterone, it may be something like, uh, an a botanical formula that boosts testosterone. Okay. And we can get into that. But that's, those, those do work. Some of 'em do work. And there are definitely herbs that increase testosterone level, either by increasing the signal from the brain to the testicles or by increasing the precursors to, um, the testosterone in the body, or by improving testicular function.

Or some combination thereof. Sometimes blocking the conversion of testosterone into estrogen or dihydrotestosterone, which are the two main metabolites of testosterone, the breakdown products of testosterone, and, um, yeah. So, 

okay. Testosterone 101 0 1, 1 0 1. 

Um, 

why is it important? 

Why is it important 

or why is the optimal function of testosterone important?

Yeah, so you're talking about men's health. Well, in men's health, having healthy testosterone levels help maintain muscle mass is, I think the biggest thing. And with muscle mass, you're able to do more. You're able to. You know, as you get older, you're able to con having higher function, you'd be able to get on and off the toilet 'cause you'll have good muscle muscle mass.

And so I think that um, you know, as people get older, they get tend to, their muscles tend to atrophy. They tend to have greater and greater mobility issues, greater and greater, um, uh, impairment in their functioning. Uh, you know. Harder time walking around, harder time running, certainly harder time lifting things, you know, as, as muscles atrophy.

Also, your basal metabolic rate goes down, which increases insulin resistance, increases risk of diabetes, increases weight gain, fat gain specifically. So there's metabolic consequences of low testosterone, um, you know, through the, the muscle mass atrophy. Um, those are the big things. I mean, certainly there's neurological benefits to testosterone.

It helps with, um, sex drive, it helps with confidence, it helps with sexual function. Um, you know, one of the, the main sort of underdiagnosed causes of erectile dysfunction is actually testosterone deficiency. Not that, oh, you have a Viagra deficiency, right? It's, it's that you don't have enough testosterone, and as a result.

You are not able to maintain your erection or maybe you have, um. Premature ejaculation. So a lot of, a lot of sexual dysfunction can be tied to low testosterone, um, or elevated estrogen. 'cause again, one of the most common things that happens as men get older, um, especially you know, over age 50, is that the conversion of testosterone into estrogen increases because the, um, activity of the, uh, enzyme aromatase, which is the enzyme that converts testosterone into estrogen increases.

So, yeah, I think that, um, you know, testosterone, other health benefits of testosterone, it, uh, helps with libido. We mentioned that, um, helps with, um, you know, drive, like ambition, uh, motivation, um, you know, mental fortitude, the ability to deal with stress and difficult challenges in life. Um, you know, people who go on testosterone therapy often feel like, oh, you know, I, I feel like I can do anything.

Right. Um, it, it kind of is the hormone that gives men that, that confidence and capacity, um, to. You know, really it, it's, it's a pro, I would say probably the most powerful anxiolytic, which is a anti-anxiety medication that we have available, um, especially for men, but even in low doses for women. Um, what else?

Um. It helps with chronic prostatitis so you have a lower risk of prostatitis, um, if you have good testosterone levels. Interestingly enough, uh, prosthetic hypertrophy is largely driven by the conversion of testosterone into dihydrotestosterone or DHT as well as estrogen. And so low relative levels of testosterone to estrogen and dihydrotestosterone can increase the risk of prosthetic.

Growth including prostate cancer. So, um, you know, if once you have prostate cancer, dihydrotestosterone and testosterone can potentially aggravate it. Um, but I think that for general prostate health, in the absence of prostate cancer. Keeping estrogen low, dihydrotestosterone low, and testosterone at a healthy level is, um, is the way to go and a healthy level.

So the normal range is gonna be, or the optimal range really, that we look for is 600 to 800 nanograms per deciliter, um, in a adult male. So, um, sometimes we can go a little higher or a little lower, but again, that's sort of the generally. I would say accepted amongst those of us who are testosterone aware.

Now you can go to some doctors and they'll say, oh. You know, a a 400 is just fine. I would say 400 is definitely borderline low, if not low. Um, and, you know, 400 to 600 is kind of suboptimal, but some, some men do well at that level. Um, below 400, you definitely need to be doing something to boost your testosterone, either to boost it or to replace it.

And then over 800. Um, you know, it just really depends on if the estrogen and the dihydrate testosterone are staying healthy. Some men can push it up to about a thousand, but anything over a thousand is an unhealthy level. So, um, unhealthily high level. So hopefully that's clear. Okay. Um, anything else on testosterone 1 0 1 that we, 

I would like you to speak on?

Um. 

Environmental and Lifestyle Factors Affecting Testosterone

What are the environmental things, um, that affect testosterone in 2025? Um, yeah, largely environmental, largely. I mean, there's the food and the products that we use and. Um, anything else that you think would, would cover that? 

Yeah, good question. That 

directly affect, uh, healthy testosterone levels. 

Yeah.

Well, there's a lot of potential, potential answers to that question. I would say that the first thing that comes to my mind is that we have a lot of endocrine disrupting compounds, mostly xenoestrogens and plastics and, um, in, um.

You know, things like BPA, bisphenol A, um, and parabens, which are found in a lot of like creams and over the counter. Cosmetic products, um, and you know, that are just pleasant pre present in like plastic food containers, which if you store your food in plastic, uh, and then there has any fat in the food at all, it will leach some of those, uh, into the food and then you consume them and then they get into the body and can wreck havoc.

And the, the way that they wreck havoc is that, um. In. So there's a hormone that your pituitary secretes called, um, gonadotropin releasing hormone and gonadotropin releasing hormone. It travels to the testicles and tells them the cells in your testicles that produce testosterone to make the testosterone.

Um, when. There the signal that tells the pituitary, there's been enough, we, we've had enough, uh, testosterone we're good is actually when the testosterone starts to spill into estrogen. Um, when that happens, uh, the estrogen signal is what lets the brain know, okay, well you have enough testosterone. Um, when.

There you have a lot of xenoestrogens. One of the things that's happening is that the, that those chemicals are able to activate the estrogen receptor and as a result they're telling the brain. We have plenty of, there's plenty of estrogen here. 'cause you know, you have this estrogenic. These estrogenic compounds that you're constantly being exposed to.

So the, it sends the signal to the brain, there's plenty of testosterone, meanwhile, there's not actually, right? So it gives this false signal of, of, of, um, sufficiency when there isn't, uh, sufficiency. Um, and then there's also directly cytotoxic effects, um, on the testicles.

 So the, um, a lot of the toxins, especially the chlorinated pesticides and heavy metals, have direct cytotoxic effects on the late cells of the testicles, which is where the testosterone is produced. Um, and. So sometimes that can also, you know, by attacking at directly where the testosterone is produced, you can get a reduction in testosterone there.

Also, you can get auto autoimmune causes. Um, you can get autoimmune or where there's an autoimmune a. Basically attacking of the actual testicles. The immune system attacks its own testicular tissue, um, that usually gets provoked either due to an illness or a vaccine. We know that vaccines increase the risk of autoimmune diseases.

And, um, especially if you already have an autoimmune disease, your risk of a second autoimmune disease goes up substantially, um, with each additional vaccine. And there's also a phenomenon, and that's really because of the toxic elements in the vaccine. So the adjuvants, the adjuvant is the component that is increasing in immune response.

And if you have, have the, get the vaccine, you have an adjuvant. Then you're exposed to something that is similar to testicular tissue. Uh, it can then trigger a response to the, um, the, you know, the, the, the response to the vaccine ultimately is going to be, uh, autoimmune condition. And we see that, you know, the, the, the handful of studies that have looked at.

The long-term risks of vaccination have shown increased risk of allergies, eczema, atopic conditions, autoimmunity and neurodevelopmental disorders. So this would fall under that broader group of immunotoxicity because some of the elements of vaccines are toxic. Does that make sense? It does, yeah. Okay, good.

Um, and. I'm trying to think. Oh, mycotoxins. Yeah. Um, so mycotoxins are mold toxins and those have direct, um, effects on the, um, production of Melanocyte stimulating hormone, which, um, has, and I forget whether it's a direct, um, precursor to. G RH gonna add atropin releasing hormone or whether it has like a regulatory, I think it has a regulatory effect on G Rh.

Um, in fact, I wanna actually take a look at it because I think it's worth showing you guys, um, ox and pathway. So for those of you who are not on YouTube, I apologize, you have to go to YouTube if you're interested in looking at this. Um. So I'm gonna share my screen and we'll go ahead and, uh, I don't know how to make that full screen, but anyway, um, so the mycotoxins, uh, combined with HLA susceptibility, so this is a genetic susceptibility, which is present in 24% of patients, of people.

Um, and then you end up with, um. Basically cell surface receptors involved in the immune response that are gonna lead to increased cytokines, which, um, have an effect directly in the hypothalamus. A suppressing. MSH, that master regulatory hormone, melanocyte stimulating hormone, which then can lead to reduced androgens.

So reduced MSH can cause the pituitary to lower its production of sex hormones, particularly testosterone in men. So that's, that's the mechanism by which that happens. And obviously there's a lot more to biotoxin illness, but it's true that a moldy house can actually cause you to you to have low testosterone.

Um. Okay, let me stop the screen sharing, uh oh. Down there. Okay, great. Um, anything else that you wanted? Any questions about any of that or? No, I just wanted to summarize in a way that's super, super understandable. Sure. Um, so if a man is still while taking. Testosterone replacement therapy and living in a moldy house and eating at, uh, Jack in the Box McDonald's and Burger King and Wendy's.

Uh, and. Wearing ax cologne. Oh yeah, we didn't even talk about that. So, you know, fragrances are a big thing and actually fragrances are present not just in ax body spray, but um, probably shouldn't name any particular brands, but it's body spray, ax, body spray. Come get some anyway. No, um. The reality of the matter is, is that these, um, you, you know, these often contain parabens, uh, which as we mentioned earlier, are xenoestrogens and foreign estrogens that inhibit the signal, the feedback signal that tells your body to produce more to more testosterone.

Um, so whether it be. You know, scented dryer sheets, the fabric softeners, whether it be, you know, the other laundry additives you use that have scent to them, whether it be cologne, perfume, um, you know, scented soaps, scented air fresheners, scented cosmetics, aftershave, uh, body spray, deodorant. Um, those little tree things that hang in the car, other air fresheners that hang in the car or go over the blower in your car.

I mean, anything that's got a synthetic fragrance and synthetic fragrance is anything that's not, uh, an essential oil. Um, so it's, you know. It's made in a lab, um, is definitely, um, highly likely to have a xeno estrogenic effect, and as a result is going to potentially lower testosterone production. Yeah, that used to be a huge deal breaker for me long time ago, and I was in the dating world.

Um, what are you wearing? Oh, no, synthetic fragrance. Not a problem with me, I'm sure. Nope. It was so refreshing. You know, when I met you and you were just so, um, tuned into the world of, um, of healthy eating and genotype eating. Uh, and, um, I. Yeah, you didn't use any of that? Yeah, well, it's actually, I mean, it's a deal breaker for us in when we're hiring people to work with us.

I mean, you know, especially to take care of our boys. I mean, we have two boys and I don't want their testosterone inhibited at all, so well. Um, it's important that we don't have, or mine, frankly, for that matter. And so if they're around us and we're constantly getting exposed to those scents, it's a really, um, I mean, I feel it, I'm pretty sensitive to Oh yeah, I give me a headache, chemicals and stuff.

But yeah, it definitely makes a difference and it makes a difference staying away from that stuff. So, yeah, I remember you, um, you wanted to. Look for a, a Natural Pines saw. Oh yeah. The Pines saw. Yeah. And so I found like the original Pine saw, which they still sell, which is made with the Pinewood stuff, but apparently it's still, it, it's still, they put put a bunch of other stuff in it that synthetic.

And so I was still having like horrible headaches every day that the housekeepers would come and use that. And I would just feel sick for the entire rest of the day and we would like have to run the fans at maximum. And eventually, yeah, we switched to just totally all a hundred percent natural, you know, essential oil vinegar, peroxide, isopropyl, alcohol based cleaning.

Stuff. I don't, I mean, we really don't use anything. I mean, it's all like seventh generation or, or cleaner at this point, you know, which is, we are not this, this podcast not sponsored by Seventh Generation, which I believe was actually bought out by another company recently. But anyway, gotta look out for that.

You know what I mean? Watch out. Yeah. I'm laughing because I'm, uh, whenever we're over at your cousin's house, he, he messes with you and he, he busts out the, the radioactive Fabuloso. Can't believe he even has Fabuloso in his house. That stuff is so disgusting. I'm sorry. I wanna see whether seventh generation was purchased by, uh, another company because, uh, I don't wanna unfairly malign them.

Um. Okay, do, do, do, do, do. Some generation, let's see here, acquired Unilever u Unilever required them the Anglo Dutch Consumer Goods company for $700 million. Well, at least they got a good payout. So this is back in 2016. I mean, I still think they have, just based on the ingredients, I still think they have pretty good products.

Uh, and it looks like their, their CEO was still the same CEO, um, for the last 20 years, but then I guess he retired in 2021 and now we have. A new CEO. Yeah, I mean it's, they've still received a lot of good rewards for sustainability, but I'm sure that they're third party independent companies that are probably better.

You know, maybe we'll get one as a sponsor and then we can share all about how great their products are. Wouldn't that be wonderful? Hint, hint.

But yeah. Yeah, I mean, in terms of what's available at Target, you know, that's, that's probably the best brand that they have there. Actually, um,

I'd like to start addressing the, um, most people know that testosterone replacement therapy is available to them, right? And they, they don't know, um. Or they, they might or not, might not be aware of the side effects or the multitude of side effects, um, in and in our naturopathic integrative holistic approach.

Um, it is a rare case, like you, you, you, you talked about that 80-year-old patient, you know, who said, okay, I don't ha I had six months to me is like two years. Okay, just put me on straight on. He may have said 20 years. It was, it was like a lot, right? Yeah. Yeah. TRT. Yeah. All right. So a, apart from those kinds of kind, that kind of nuance, um, why would somebody start directly with.

Testosterone replacement therapy. And then I, I, I want you to talk about that and then what else is available, because you said there are three other levels that are available. Yeah. And then I recommend, frankly, starting with Yeah, right. Which people like, like in, in addition to just basic stuff like we've talked about with, um, removing the toxins from the environment.

And also, I don't know, uh, I don't think we discussed, uh. Um, obstructive sleep apnea. Obstructive sleep apnea is another big thing that can cause low testosterone, uh, because it actually deprives the, um, the hypothalamus and the pituitary of oxygen, and as a result, you can end up with. Decreased GnRH production.

So you have decreased testosterone production. Um, GnRH is that gonadotropin releasing hormone that tells the testicles to make testosterone. So, um, so is it sleep apnea can affect your testosterone or testosterone can affect your sleep. Well sleep, yeah. So, so sleep apnea can, can absolutely. Um, because of the oxygen deprivation can lower testosterone.

Um, and then having lower testosterone can make, for example, insulin resistance worse, which can cause you to gain weight, which can make sleep apnea worse. Okay. And the interesting thing about a lot of, I mean a lot of these things are mediated by insulin resistance and a lot of the, um. Yeah, I mean what you're pointing to is the fact that the body is a complex system with a complex interweb interconnected web of of different me metabolic processes.

And a lot of what's driving things like obstructive sleep apnea is inflammation, and a lot of that inflammation can come from the same sources that can affect testosterone levels. So there is a lot of overlap. Okay. Definitely with regard to. Did you have a question about that? No, go ahead, finish your thought.

Well, I was gonna say that basically with obstructive sleep apnea, you know, that can result, that can be more of a symptom, frankly, than a cause. I mean, it can cause things obviously, but it can also be a symptom of, uh, insulin resistance, pre-diabetes, diabetes. It can also be a symptom of, uh, mycotoxins the mold, toxins.

We talked about allergies. Um. Toxicants in the environment. You know, there's, there's volatile organic compounds that can cause, uh, reactive airway that can lead to, uh, obstructive sleep apnea. So, uh, or frankly, sleep apnea that maybe seems obstructive but may or may not actually be obstructive. But it definitely, you know, people can have apneic events because that, that airway gets inflamed and that inflammation can come from a lot of different places and.

That then leads to the low testosterone. And as then when you have low testosterone, it makes, it causes everything we talked about earlier about the muscles atrophy. And then as a result, you end up with a, a lower basal metabolic rate, uh, slower metabolism, and then worse insulin resistance, which then leads to.

Worse blood sugar metabolism, which then leads to more weight gain, which leads to more, you know, greater risk of obstructive sleep apnea. So, okay. It can definitely help to, to do the BiPAP and the CP Pap, that kind of thing. Um, and I'm not saying not to do those things, but I'm saying while you're doing those things, also find out what's causing your sleep apnea.

Okay, so lemme finish my, the, my thought, right? So if you, you're injecting yourself with TRT, you're still living in a moldy house and you're still eating junk food and you're still, um, wearing ax. And if you're still not addressing, you know, you're, you're slate, um, issues, um, then it's an uphill battle, right?

Given the whole intricate web of.

Well, it's not only an uphill battle, it's, it's like a canceling everything else. Yeah. You're, you're, if you're gonna be swimming upstream, so the point is, is that you have to deal with a lot of the environmental things. And there's also nutritional, dietary things, which I don't think we've mentioned yet.

Things like essential fatty acid deficiency. If you don't have enough Omega-3 fats, if you're not, you know, taking your fish oil or getting enough omega threes from the diet. Um, there's definitely, which is almost impossible to do these days. Um, if you're not getting, um, sufficient zinc, if you're not getting, um, you know, if you're being overly exposed to any heavy metals, um, you know, um.

If you're not getting, I mean, if you don't have enough fat in your diet in general, I would say, um, or if you're having too many Omega six fats and not enough omega threes, um, the ratio's off. So, you know, dietarily, if you're eating too many refined carbohydrates and sugars and so you have high insulin and so therefore with the high insulin, that's gonna also impair those late cells and you're not gonna get as much testosterone production.

So. You know, a lot of it does become like a, a vicious cycle where high insulin leads to low testosterone, which contributes to high insulin, which leads to lower testosterone, and it's like a downhill, you know, positive feedback loop. Okay. So I'm, I'm really getting that. Um, in, in our, um, impending testosterone program, it would be, it would have integrity to ask or have a questionnaire that lists all these environmental things.

Um, or just that kind of education. Yeah, like an educational document that kind of explains like, Hey, first thing you need to do is take care of these environmental things. And by the way, if you've, you know, if, if you have any concern that you might have sleep apnea, and we can list some of the symptoms of sleep apnea.

You know, please, uh, have yourself checked out by a sleep specialist and do a sleep study and find out, because if you do, then that's something that obviously also needs to be addressed and that in the meantime, um, there's, I mean, you don't have to go straight to A-C-P-A-P. There's also like a mouthpiece and some other devices that, that you can implant now, which I'm not crazy about those, but I mean, some people like 'em, um, inspire and stuff like that that help with sleep apnea, but those things can help.

Um. Honestly, I haven't seen those have a great effect on testosterone level, but I, I think that they can be helpful. Um, okay. Um, so by now, you know, we're, I, we're well aware of conventional testosterone replacement therapy. This is synthetic. Um, with the whole world of side effects, what else is available?

Well, I mean, I think that, you know, before we get into what else is available, we should talk maybe about where those side effects are coming from. We did talk a little bit about how, you know, mostly when you're getting testosterone, the levels are going. You know, if you're getting shots or pellets levels are gonna go up.

And then they're gonna come down. And then they're gonna come up. So anytime you're going from here to here, you're gonna end up with excess. So if you were to basically get a testosterone shot, and then three days, assuming it was bioidentical testosterone, which I'll get to that in a second, but you get a testosterone shot, three days in, you're gonna check your testosterone, it's gonna be high, it's gonna be over a thousand.

Right. So given that, um. It begs the question of where, you know, are, are the side effects coming because of the, the testosterone or because the dose is too high? And then you also get at the bottom, you get low testosterone, and that's, those are some of the other, you know, essentially side effects. Um. And then the other question I have, uh, or the other point that's worth mentioning, um,

is that the, the form of testosterone, injectable testosterone, uh, they use predominantly. Um, testosterone cate, testosterone en enate and testosterone ecade. And you know, all of those forms are going to be not bioidentical. They're not gonna be the exact same testosterone that your body produces. These are forms of testosterone that are used in the shots.

Um, because they are typically slower, you know, they're, they're esterified, which means your body has to kind of metabolize them to turn them into testosterone. They're typically suspended in some sort of seed oil and, um, you know, they, they sort of gradually convert into natural testosterone. But the process of that conversion and the, the sort of.

I mean, I would argue unnecessary, um, uh, compounds that they're ba that, that they're bound with it are the primary sources. 

Understanding Bioidentical Testosterone

Those, those, those additional esters that they're bound with are the primary sources of the side effects in all likelihood. Um, whereas the bioidentical testosterone, which is exactly the same as the testosterone your body produces, typically you're gonna get that from a compounding pharmacy and typically.

Um, that's gonna be in a cream. So, or, or a pellet. Some of the pellets do use, in fact, because with a, with a pellet, the pellet structure is what's providing the time released component versus the fact that it's like this aster aside, asteroid, frank and testosterone. Instead with the pellets, they're like, oh, we're gonna put 'em in these little pellets and the pellets are gonna dissolve.

But still we see with that this sort of. You know, peak and trough, peak and trough pattern. Um, frankly, so, you know, I, there's not really a perfect method. Um. Because you know, it's not everybody likes the creams 'cause you gotta do it every day. But I mean, look to me, just make it part of your daily routine and there's so many things that people do every day.

Why not just, you know, put on a little testosterone cream. Uh, the key thing is to make sure you're doing it at a time where it's not gonna rub off on a loved one. You know, because you don't wanna do it right before you're gonna be intimate with someone because, um, you know, it, it can transmit with skin to skin contact if it's, if you apply it and then, you know, rub that particular body part on another person within about an hour, um, that's not ideal.

So. Um, yeah, so that's a lot of the side effects, I think come from the forms that get used in the shots and just that peak and trough that you see with both the shots and, uh, the pellets. Even though the pellets do often use bioidentical testosterone. Um. And that, you know, I mean, arguably I think the pellets may be better than the shots in that regard for that reason.

But I mean, you also have to ask yourself what's in the pellet, right? Uh, you know, what, what are they making these pellets out of that's causing them to time release over the course of weeks? You know? Hmm. You know, I mean, I, everything's a trade off, and so I would just evaluate it and use your own judgment and, you know, look up the ingredients, check their toxicity.

Um, I think some of those pellets may actually be like patented and so they may not even tell you what all the ingredients are to them, you know, which I don't like that either. I like knowing exactly what's in something, if I'm gonna take it or prescribe it to a patient. Um, okay. So what was the question you asked again?

'cause I think you asked a different question. 

The Four Stages of Hormone Optimization

Oh, you wanted me to launch into the four, the fourth stages that I go through with patients? Yeah. So the first stage I look at is precursors. So I'm gonna share my screen here. I want to go over, um, the, um, upload the, uh. This is the sex, this is the, uh, stick sex steroid synthesis cascade.

And you know, all the sex steroids, whether we're talking about progesterone or if we're talking about the estrogens, they all start with cholesterol. Cholesterol. That's one of the reasons why I think, you know, driving cholesterol down is such a problematic thing for so many people is not only because cholesterol makes up up to a third of our brain mass.

But also because it, it's the precursor to all the sex steroid hormones. So, um, you know, just sort of indiscriminately willy-nilly, assuming that, oh, um, lowering cholesterol more and more and more is not gonna have any negative effects on people, I think is problematic. And in fact, the rate limiting step in sex steroid synthesis, in other words, sort of the, the step that is the, the break on the entire rest of the cascade is.

This cholesterol side chain cleavage enzyme that converts cholesterol into pregnenolone. And so I found in many patients that even just optimizing pregnenolone levels will help bring cholesterol levels down naturally. 'cause then the body says, so I have enough pregnenolone. I don't need to make any more cholesterol.

Um, so then Pren alone. For Pernol alone, we get to go into 17 alpha hydroxy pregnenolone. And then, uh, now we get into the androgens. Uh, the first sort of androgen precursor is the Dehydroepiandrosterone, more commonly known as DHEA. And from DHEA, you can either go into Andros Diol, or Andros Dion. Both of those used to be available over the counter.

They're no longer available. They were taken off the market. Um, I think they were probably competing with testosterone prescriptions. And so doctors didn't like that. Um, and so they pulled, got 'em pulled off the market. Um, testosterone. Itself. Uh, the cool thing about Andros Diol, by the way, is that it would, it only converted into testosterone.

So it's kind of like the, the optimal precursor for if your goal is to just up your testosterone levels, but they took that off the market. Uh, androstenone was problematic because it can convert into estrogen, estro in particular, which is the pro proliferative precancerous. Estrogen that, that predominantly activates estrogen alpha receptors, um, which is the sort of pro proliferative precancerous estrogen receptor.

Um, so we don't really want too much estro, um, in, in men or women frankly. Um, but um, Andros diol, although was, was really nice 'cause it just went into testosterone. But as you can see here with the aromatase enzyme, which I talked about earlier. That can convert into, cause the testosterone to convert into estradiol, which is one of the two main metabolites of testosterone.

And, and as men get older, that or that level of aromatase goes up. So more on that in a minute. But, um, and then five alpha reductase is how we get from testosterone into dihydrotestosterone, which causes male pattern baldness. It causes, um. Prosthetic enlargement. Um, and it, it also causes you to literally, it literally puts hair on your chest.

So this is the, the, the predominant, uh, you know, cascade for the sex steroids. And what I would just say is that when we, when you come in as a patient in our practice, we often take a look at. Um, you know, certainly in our concierge practice, we're taking a look at all of these sex steroid hormones. Um, all of the major ones in this whole cascade.

Um. And looking to see where the breakdown is. So, you know, if you have low cholesterol, the first thing we're gonna do is give you some cholesterol. We're gonna make sure your diet has more, more fats in it so your, your body can synthesize cholesterol. And believe it or not, we do see people who have low cholesterol and so therefore, their hormones are low.

So we start by getting their cholesterol optimized. If your cholesterol is below one 70, you have low cholesterol. Uh, if it's below one 50, your total cholesterol below one 50, you have dangerously low cholesterol. Um, so then we look at pregnenolone and if pregnenolone is, um, lower than 75, uh, really would like to see it between 75 and one 50.

And if it's below that, then I would say, um, you know, it's certainly suboptimal and we wanna optimize pregnant alone. And you know, then really give, you know, my philosophy, and this is pretty distinct. I mean, it's not how I think most doctors practice. Most doctors go straight for the estrogen or the testosterone or the progesterone kind of the end products and say, well, let's supplement those.

I do the opposite. And I think it, it absolutely works better with far, far fewer side effects. I say, look, let's give cholesterol if it's low, if it's normal, this pregnenolone is low. We'll give pregnenolone, see what the body does with it. Sometimes just giving pregnenolone is enough to get progesterone and, uh, DHEA, you know, and maybe even testosterone where we want it to be, let's say pregnenolone looks good, but DHEA is low, then we'll give DHEA an optimized DHEA.

And once DHEA is optimized. Then if testosterone is still low, uh, unfortunately we can't give Andros Diol anymore. So then what we have to do is move to the second, the second stage of, uh, what I do in the practice. So did you have any questions about stage one? Mm okay. So. Stage two. 

Natural Medicines and Nutraceuticals

Um, I think we can go ahead and stop the screen share.

I may come back to it in a minute, but stage two is when we are now looking at using natural medicines, uh, nutraceuticals, botanicals, herbal medicines, uh, food derived medicines to encourage. Like, we've got the precursors all on board. We've got the pregnenolone, we've got the DHEA. Everything is optimized, but testosterone is still low.

Well, one thing we can we wanna look at is sex hormone binding globulin. Sex hormone binding globulin is a protein in the blood. It's a form of globulin that binds your sex hormones. So that's gonna be your testosterone, your estrogens, um, and then maybe a few others. But those are the predominant ones that it binds.

And, um, if the levels of sex hormone binding globulin are high, then that can cause free testosterone to be low, even though testosterone itself is normal. So then what we want to do is work on bringing that sex hormone binding sex hormone binding globulin down. The main things that raise sex hormone binding loin are gonna be low thyroid function, um, elevated, uh, estrogen.

Um, as well as sometimes it's, it's actually pretty genetic. There's, there's a lot of genetic variability in SHPG production, but we have a few things like boron, um, like tica, diha, uh, root, which, um, will help lower SHPG levels in addition to addressing some of those other factors, if those are also. Like if the estrogen's high, we bring the estrogen down by blocking aromatase.

So, um, yeah, I mean, um, I think that there, and that's just like one axis of how we might address. For example, low free testosterone. If testosterone, total testosterone is low, then often we wanna work on stimulating the pituitary gland, um, and, and or the hypothalamus to produce more of that GNRH. But if, uh, or, and, and usually we're not measuring GnRH 'cause GRH levels fluctuate significantly throughout the day.

What we're gonna measure usually are like LH and FSH, the same kind of things we're gonna measure in a, a female, because those hormones will also be, those are part of the signaling pathway that signals the testicles to make more testosterone. And, and if the FFSH and LH are both elevated, then um, we know that the problem is testicular and we can address, focus on, on improving actual testicular function.

If the FSH and LH are low. And testo or normal, and testosterone is also low. We know the problem is in the brain, and so we can actually stimulate, uh, LH and FSH production or, and, and GnRH production through, um, use of herbs and that kind of thing. So, I'm not gonna get into too many details on that, but it's just, that's basically the, the second level approach is using the herbs, the botanicals, to figure, you know, to address.

Um, the particular causes of low testosterone, um, from, from whatever perspective is, is most indicated by the lab work. Um, any questions about stage two? No. Okay. I wanna have something to drink here.

Um, so what's stage three? 

Advanced Hormone Therapies and Patient Choices

Stage three is we start to use drugs. There's two primary types of drugs we use. One is actually an endocrine disruptor, which is kind of funny, but, um, the basic idea there is. There's a type of indicator disruptor that rather than acting, acting as a xenoestrogen actually blocks the effect of estrogen at the pituitary.

So what we're doing is we're blocking the estrogen that's in the system from binding to the pituitary and blocking the GNRH signal from coming to the testicles. And so as a result, you end up with more GRH production, so you end up with more, um. Uh, testosterone production, and that medication is called, um, Clomid, uh, or, uh, Clomophine.

Citrate. And Clomid is often used to stimulate, um, the ovulation in a woman. For someone who's, you know, trying to do IVF, they'll often do Clomid to kind of help. Uh. The follicles mature and kind of get, it's a, it's a fertility enhancing drug often used in women, but it can be used in men too for that very reason that it's helping to increase testosterone levels.

It also helps in through the same mechanism, the tuli cells that produce sperm. It helps improve their function as well, um, through that same mechanism. So it's, it's an interesting medication. It's frankly underutilized. A lot of urologists will use it that know about it, but. Excuse me. A lot of, uh, you know, GPS and testosterone replacement, people don't really know much about it.

Um, but it's a good way to encourage the body's own production of testosterone with once all the precursors are in place and you've dealt with things like high sex, her binding loin, and other things that can get in the way. Uh, that can be an additional tool that's really helpful. Um, and really I think in the case where FSH and LH are normal to low, should always be tried first before going to TRT.

Um, the other big thing is if someone has high estrogen, uh, and that can be estradiol estro. High estrogens period. Um, especially in a man. Um, blocking the conversion of, um, testosterone into estrogen is another good way to increase testosterone levels. And we can do that with herbal formulas and we can do it with a class of medications called aromatase inhibitors.

And usually I just give the aromatase inhibitors literally once a week is all you need to do. And, um, my favorite is Letrozole because that has shown to have the highest testosterone boosting effect and literally you give, um, I think it's, it's some ridiculously low dose of Letrozole and it's literally.

Once a week. Um, you might could give it twice a week, but I don't think that's gonna have that much of additional benefit. And, um, but yeah, I find significant, significant testosterone improvements, especially if you're overweight or obese, because what you have to remember is fat cells produce estrogen and so you're gonna automatically be making more estrogen because of, because of the fact that you have extra fat.

And so often using. Um, you know, even if your estrogen is even high normal, um, then it's often a reasonable thing to take some sort of a low dose of letrozole, uh, or other aromatase inhibitor to block that conversion of testosterone into estrogen. Um, I think that's all I had to say on stage three. Did you have anything else?

I do. Yeah. I'm, I'm curious about, uh. So, oh, and by the way, some people, even when they're taking testosterone, need to be on some sort of aromatase inhibitor to help keep the testosterone from bleeding over into estrogen. So it's very common, and we can do that in one of two ways. We can either. Usually do some sort of, um, herbal aromatase inhibitor in with the testosterone that has, you know, varying effects I would say.

Or we can actually give a once a week letrozole along with the testosterone and then that helps keep the testosterone as testosterone. And you can also, for the people who have high, uh, five alpha reductase activity and elevated dihydrotestosterone and are getting balding or. You know, maybe their chest is too hairy or maybe their prostate is too large.

We can also give either pro proscar, Propecia, we could, Propecia is the lower dose. Proscar is the higher dose. And then we can also use ide, which is a more comprehensive, like, if you have a really large prostate, um, it's good to take, uh, do test aide or just totally blockade any DHT production. Um, just to keep all of that testosterone as testosterone.

Um. Go ahead. So if you were to evaluate, um, patients, um, how would you discern, you know, who's a great candidate for stage one? I think everybody should, you know, be filtered into stage two. But what's, what's the difference between like, okay, I gotta start this person on stage three or even stage four. And would you let them pick?

Right. Well, um.

We, we do believe in free choice, and I'm gonna answer that last question first. We believe in free choice in this practice. So, um, I am pretty flexible with patients and if they, they're like, Hey, I really want to go straight to stage, whatever, like that's something that I am almost always willing to.

Entertain, unless I think it's gonna be dangerous to them for some, for some reason. Um, so that being said, um, I almost always recommend that people start at stage one because I think that I've just seen it over and over again, that providing the right precursors will correct hormone levels without even having to worry about, you know.

Well, I mean, taking additional herbs or taking, taking drugs or taking testosterone replacement therapy. And the benefit of of stage one is you're giving the body the precursor. You're giving the body what's missing and then letting it decide how much to make and what to do with it. And. Often it does the right thing.

So, um, and I would just say that again, every single approach, you know, we're sort of gently encouraging the body. With stage two, we're encouraging the body a little more strongly. I would say in stage three and at stage four, we're giving up on the body. We're just saying. We're done, we're done working with you body.

You're obviously not able to do this by, by yourself. We're gonna just go ahead and prescribe, and we're going to, we're gonna give the body a certain amount of testosterone. And again, the problem with that is, is there's no feedback loop there. There's no, oh, the, the level is too high. You know, let's stop the production a little bit or, uh, this is kind of the limit.

Maybe we should back off a little bit. It's literally up to the patient. The doctor to some degree to be doing the checking every, you know, three to six months and evaluating the dose, and adjusting the dose as needed, uh, to get it and, and keep it where it needs to be. Yeah, that makes sense. Thank you.

Yeah. What was your question again? How would you know? Oh, that, that was, that was the second part of the question. Yeah, the first part of the question is how to know where to start. Right. And I think I didn't really quite answer that. So, you know, if you don't even know what your testosterone level is, I would always start with testing it.

And then typically starting with stage one. I mean, that just seems like a good starting point. Um, making sure your precursors are in place, checking the rest of the hormones, right. Checking the rest of that cascade. Um, I would say if you're younger, that definitely has me think more stage one and then work your way through.

Um, if you have. Um, but I'm also sympathetic to people. Don't, you know, I, it's tough, you know, I had a patient one time who was a young guy and he had like a wife and kid, but he had some sort of androgen, um, some sort of super active aromatase where his body was just way over converting his testosterone into estrogen.

And he was just like adamant that I prescribed him testosterone and I was like. It doesn't, I mean, it's just gonna make this worse bud. You know, like, um. You don't understand that, like you're gonna get worse estrogens. He was already getting gynecomastia and I was like, we have to put you on Letrozole. We have to put you on a tase number.

So I prescribed it to him and he left the door, he walked out and I don't think he ever, he never came back because I think he went and found somebody who would prescribe him TRT, which again, I mean, was just gonna make his problem worse, which was tragic, you know, because I really. Was very willing to work with him.

And if the Letrozole had not effectively re like, elevated his testosterone, which I, I mean the research shows that it will in people who have his condition. Um, you know, but he just didn't, for some reason, for him psychologically taken a drug. Was worse than just getting testosterone, I think. And the problem with that is, is that the testosterone was just gonna feed his estrogen machine and, and it was gonna make all of his symptoms even worse.

So, you know, there are times like that where, you know, I'm just gonna be straight with you. And if, if you have that kind of a situation, it just makes sense that you take the Letrozole. Um, and you know, at the dose we're using, which is again, it's like. Once a week, low dose. Um, there's no reason not to do it if you have super high estrogen.

So esp as a man, you know. Um, but yeah, I think that depending on what your labs show is, kind of also helps to orchestrate it. Like if your labs are way off and you know, your, for example, if your FSH and LH are real high. And your testosterone is real low, uh, and your estrogen is also real low and your dihydrotestosterone is real low, then it may make sense to go straight for stage four, right?

Um,

but if you're. You know, if, if, if part of the picture looks good, but some of the picture is off, you know, we may want to go at a different stage so I can, it's better to, like, I, it's easier for me to give certain examples clinically, like if I have that. I talked about that guy who really needed stage three, right?

I talked about what, who would need stage four. We talked about stage one. Basically as somebody who's like, I don't really know. You know, or I'm, I'm noticing that I have low precursors or my cholesterol's low. Um, stage two is interesting. I would say if someone's precursors, they know that their precursors look good.

Um, but some of the other labs are a little bit. You know, off, whether that be high SHPG, whether it be high test, high, high estrogen, high dihydrotestosterone, whether it be low F-S-H-L-H with low testosterone, right? Like those, all of those things we can help with herbs and nutrients. Um, a lot of people don't know.

Which herbs to take and at what doses and what the studies have shown. And they'll often take some random formula from some random website, which is not necessarily effective. Um, and you know, some testosterone boosting formula that's like some kitchen sink product that's got a proprietary formula where they don't tell you how much of each ingredient is in it, which is a huge red flag.

Um. You know, so really that's the benefit of working with a doctor is 'cause you're using products that have clinical validity, that have, you know, add doses that have been effective in clinical trials and we know how they work. Um, there have specified amounts of the, the actual ingredients in them.

They're third party certified to actually contain that amount of those ingredients because, you know, we don't have, um. Random spot testing of like the, the, the actual that the quantity is. They do with pharmaceuticals. They actually have like check the dose to make sure it's what it says on the bottle.

They don't do that for nutraceuticals. Um, now there are companies who do that and you want to use those companies and not the other companies, but the vast majority of companies out there don't do that. Uh, and that's called third party testing. Um, the other thing is you want companies that use GMP certified manufacturing processes, so that's good manufacturing processes.

And, and you want Grade A, which is like the top tier, uh, which is basically the same practice practices they use for manufacturing drugs. Um. Again, the majority of nutraceutical companies don't do that. So look, I mean, I'm not saying that the nutraceuticals that we, that we, that I prescribe in our practice are the cheapest things in the world.

They're not. But you get what you pay for, right? So pharmaceutical grade, physician quality. Yeah. So versus some rando website or off of Amazon. Yeah. Testo Boost, I don't know. I don't even know if that's a real thing, so please don't come after me if, if your product is testo Boost. But I'm just like, there's so many of those out there and I'm just like, Ugh.

You know, because they all have a little bit, you know, like it'll have a little bit. And the thing is, when you have like a proprietary formula, right? It'll be like 2000 milligrams of a pro proprietary formula. It could literally be like, you know, 18 or like, like 19,000. You know, 990 of one of the products in that list, and then one, one milligram of each of the rest of the products.

And there's no way for you to know, right? So that's why proprietary formulas are almost always a scam. Um, you know, I, I say almost always because there are some super reputable companies who do have some proprietary formulas, but because it's like a rare thing. The rest of their product line are not that way.

They, I, and they do third party test their products. I might consider a proprietary formula from a company like that because it's like, hey, it's got a proven track record, especially if they've done a study on it and it's shown that it's effective. Um, that, that is where proprietary formula may in fact be helpful, but you know, that's.

Those are a few and far between. The, the intention, uh, of having you communicate with such thoroughness and comprehensiveness is to invite, uh, men of the world into true informed consent when it comes to, uh, testosterone, that you do indeed have choices. And, uh, you do indeed have the choice to be, um, be guided and,

what's the word I'm looking for? Guided. And also, I'm not sure, but I guess, um, you know, collected, I don't know, or, or supported. X masterly supported. Yeah. I mean, I guess what I would just say is most people don't even know that these options exist. Right? Like most people are aware of like option four. And, and that's it, right?

Because that's, and I think is, that's what is heavily marketed. And I think some people, that's all they want, and that's fair. I get that. But I think the vast majority of people who are dealing with either low testosterone or the symptoms that they think might be related to low testosterone probably would prefer option one, two, and three before going straight to option four.

If they knew that those were options. Yeah, if they knew that those options existed. Absolutely. And if you kind of pushed pause on the, you know, the instant gratification monster that you, um, I mean, I don't know how so many men are ready for those side effects, you know, benefits, but like massive side effects.

Yeah. Well, I mean, I think that the side effects vary, obviously. I think that for me, the biggest problem is with the different injectable forms because those have to be metabolized prior to, you know, becoming active. There is a potential for liver toxicity. And we do see that with testosterone, the injectable forms.

Um, and I, I was just looking about men who. Um, are great candidates for stage one, stage two, stage three. Sure. But we're that, that, you know that gentleman who walked out on, out of your office? Yeah. Said, yeah. I mean, I just, um.

It's, it's one of those things where I think people have to be open to it, you know, and then completely open, but re retrained, reeducated, you know, reprogrammed. 'cause there's this mass marketing everywhere. I mean, well, and I would just say that your body really is, is designed or evolved to produce sufficient levels of testosterone.

You know, if the, if the conditions are correct. And I think that that is something that we've lost sight of as a society. Now, testosterone levels do naturally go down as we get older. And I'm all for supplementing as an anti-aging strategy. And so I think that that's kind of where I say, you know, hey, when your levels start to really drop, and again, average 65 some minutes, 50 some minutes, 80, right?

But it's sort of like really does depend on the individual. That's why testing is an important part of it. Absolutely. Yeah. I mean, I'm, I, I drive by this, this spot where it says testosterone tirzepatide, you know, all these, yeah. I'm not quite sure about the level of testing or the, um, level of care that you receive in places like that.

Yeah. But yeah.

All right. Any other thoughts about that? No, I am, um, I'm excited to roll out a program that honors, uh, the individual and to present with, present to them, uh, these four options. Yeah. You know, and really educate people like reeducate people, um, and have it be known that, look, you know, you have choices. Yeah, yeah, yeah.

Look, and I think that that is, um, that is a distinct element and I think that if people were available, you know, there's gonna be a lot of people who, you know, there are people who are happy with the shots and happy with the pellets. I'm not saying that there aren't, but I would say that a lot of people, there are also a lot of people who either.

You know, either those didn't work for, or they were unhappy with the side effects or who just aren't gonna do that. 'cause they're just like, that's not me. I want to do something more natural. And I think that, you know, the approach that the approaches that I prefer typically are, you know, gonna be effective in those people.

And honestly, I mean, people who are rolling around with a 200 or 300, you know, testosterone level, I mean for them even sometimes bringing it up by a hundred points. Is enough is a game changer for them. And I think, and that's very easy to do with nutraceuticals. I mean, usually we can see, I mean, I would say a hundred points is easy, 200 points is definitely doable for most people.

Uh, using natural means and then bringing in the drugs, we can go up even further beyond that. And then of course, with TRT we can go dose it however we need. But I think the big message I would say is that for people doing TRT. You need to also be measuring your estrogen. You, you need to also be measuring your dihydrotestosterone to make sure that, that your testosterone is not over metabolizing into either or both of those.

You still need to have your GNA alone and your DHEA optimized, so just because you don't, you're not. You're not taking the precursors in order to up your testosterone. You still need to have those precursors because progesterone, sorry, pregnenolone and DHEA have separate physiologic benefits on memory predominantly, and longevity.

'cause we know that people who typically have higher levels of those hormones tend to live longer, and you need to have those in your system whether or not you're taking the TRT or not. So. You know, looking at the whole, the whole picture is really a big part of it. And, um, you know, ideally looking at the whole person.

But I would say even if we just focus on testosterone and there's obviously like this whole landscape that that can affect it. And I think that, um, by addressing, by looking at those different elements and addressing them, you're gonna get a much better, um. Side effect, profile, longevity, benefits, um, you know, ultimately consistent levels and, um, you know, everything in between.

You have a right to the whole picture. Yeah. Yeah, absolutely.   📍 Um. Is there anything else you want to talk about today? No, that was fantastic. Okay, great. Thank you. Well, I have, I'm Dr. Ryan Partovi. And I am Mrs. Madi Partovi, and this has been the Partovi Effect. Thank you for joining us this week, and until next time, be well.