Low Testosterone: Why It's So Common & Tips to Fix

it's not testosterone that's causing prostate cancer study came out about a year ago that they found that men with low testosterone had lower levels lower rates of prostate cancer but men who had low free testosterone had more aggressive prostate cancer so they put it into this whole group and they said well lower testosterone levels lower levels of prostate cancer okay I'm not concerned about prostate cancer odds are you and I by the time were 67 years old we may have some type of prostate cancer because it's so prevalent in men well every men eventually at some point have it yeah most men will die with prostate cancer rather than from prostate cancer so my question is is I don't care about the prostate cancer I'm concerned about the prostate cancer that will kill you I'm a girl concerned about the aggressive prostate cancers and then we get to this whole conversation of you know Gleason score and it hasn't metastasized and then you could do genetic testing to find out if there's actual mutations in the prostate tissue but we do know that when free testosterone levels are lower that there's a higher prevalence of aggressive prostate cancer and that's a prostate cancer that we are we have to be concerned about Ralph appreciate you coming on bud thanks man I really appreciate this this is gonna be fun a lot of fun yeah you know we've talked over the years a lot about women's health because initially we had a lot of female you know followers and stuff like that but lately a lot of men are getting on dakedo and things like that and a lot of men are emailing me and get direct messaging me about loti and things like that and so I think most traditional Doc's don't really know what to do I mean you know put you on oh you want 200 milligrams of tests and and date every other week like that's kind of the standard of care cookie cutter approach but um your in your practice you know and you're working with a lot of NGO Espinoza and whitey and so forth you see a lot of men come in with low testosterone and in your estimation there's a couple different ways in which we can get low tea from a brain kind of brain you know hormonal processing center and amp the testes what do you see most of like that where's the problem coming from and a lot of majority of people yeah most of the time so we know of that HPA axis dysfunction hypothalamic pituitary adrenal dysfunction or some people like to call it adrenal fatigue right and most people forget that there's an h PG axis hypothalamic pituitary gonadal axis in men and in women and I find that most male hypokinetic conditions are because of a central or a hypothalamic pituitary issue which you know a lot of doctors will say well you know I'm just gonna give you testosterone anyway yeah and my question is is well first let's figure out what's actually causing that so we can identify what we need to treat first because you know you have a young man who's 3040 years old maybe even 50 years old you put them on testosterone you can have to be on it for forever life essentially yeah for potentially for life and then if you do it for too long then you're shutting down their endogenous production and now they're they're just out of love if they really want to you know get off of it they notice that it's causing some trouble although that's also controversial because you know many Doc's will say yeah testosterone causes you know heart disease and prostate cancer and kidney failure liver failure yeah it's like actually no let's let's look at the data this look at the research must be evidenced about it and we're fine there that's actually not the case and then the other issue is you know a lot of doctors will miss hypogonadism they'll miss low testosterone because they followed the guidelines of the endocrine society which I respectfully disagree with and they're too low like their cut points are a little lower yeah so look I mean if you look at testosterone levels what most people look at a the average male will look at a testosterone level or get their labs back and say you know testosterone is at the ranges from 300 to 1200 and I'll say okay like all you do is like it's like throwing a penny in a pond it's like you're gonna hit the pond okay it's very hard to miss so what I like to look at is okay well the 300 would be the usually the 5th percentile which is when you take an average and then the the 95th percentile would be at the upper range of the of the average right so when when you look at a 300 to 1200 that's a huge range to try to identify what is can can be considered normal or not and what they do is they'll take a bunch of men they'll take a thousand men they'll average them out and find out exactly what is it going to be the average and then they plot that but if I told you hey your testosterone is at 300 that's still normal yeah you're okay like don't worry about it like your risk of Alzheimer's and low bone density and cardiovascular disease and actually prostate cancer yeah those are fine because your testosterone levels are at 300 nevermind not even paying attention to free testosterone levels so it frustrates me a little bit because I want to take a very personal approach with this like what is 300 to you what is 500 to you what is 700 to you so the endocrine society believes according to the research and you know rightfully so this is what the research shows is that if men are hypo gonna do which means a free testosterone below the lower range which is usually for nanograms per deciliter or lower than the total testosterone of 319 grams per deciliter and not or and also show symptoms of low testosterone then they're hyper Cornero they do not treat low testosterone levels without symptoms and they do not treat low testosterone symptoms if levels are within normal and the latter is usually when we noticed most of the issues like kind of like hypothyroidism sure yeah so many people exactly right like you see bunch of doctors saying oh yeah your TSH 3.5 4.0 like totally normal and I'm telling you no something is going wrong essentially the brain is not recognizing this thyroid hormone without even checking free t3 right which is actually responsible in that HPT access cycle so boy I could just like if you want to go down that rabbit hole tell me what closed down super interesting but I think for most men like if you were to rewind the clock or maybe look a ton industrialized people where is like a 40-year old man's free and total or do we know that like where should people be at and I know like you said there is subjective like some guys like to ride at 1200 total right and they're on juice and so yeah I feel normal that way right and like myself like I hover between like 4 and 600 unless I'm like in the juvenile the time right and everything like that taking herbs and things like that so I mean are we seeing a downward trend in in testosterone levels across the board and men yes we are actually there was a research study posted I believe it was in 2008 I can remember the exact statistics but over the past 30 years men's testosterone total testosterone levels have been slowly decreasing so technically my testosterone levels my generation testosterone levels are much lower than my grandfathers and great-grandfather's well why is that happening what is the issue going on and then that changes our lab values like what was low back then is super low now and what is low now is or I'm sorry what is low now would be part of an super low back then and what was normal then would be you know in a different range here right so you have to look at the thats why they do that's why they re-examine these testosterone levels based on your age so we are seeing we are seeing it drop now the question becomes what is what is actually the cause and I mean it's there's more stress in our lives and and you know a lot of doctors will say oh well you're stressed that's why you have low testosterone well which one which what stressor are we talking about psychological stressors are we talking about physiological stressors are we talking about social stressors are we talking about financial stressors like those are all need to be incorporated and involved in our decision-making so we definitely are seeing a lot of those levels drop and I think one of the biggest issues is environmental stressors which is probably easy to pinpoint we know plastics BPA xenoestrogens antibiotics in our environment changes in our microbiome like all of those things it has an impact on the total load that our body has to handle it's amazing so yeah I mean for men to have like a normal or high normal testosterone would be like an anomaly now like they get out layer because all these persistent organic pollutants like you mentioned the endocrine disruptors I mean if you do a random biopsy and our blood or a fat tissue most people have fairly high amounts compared to like you mentioned your grandfather a great-grandfather so that all those things are so are they and how are they affecting the HPA axis or are they antagonizing testosterone receptors like how are those compounds affecting testosterone event multiple mechanisms number one BPA well actually it's a xenoestrogen right it'll it can actually hyper activate estrogen receptor alpha or estrogen receptor yeah alpha of receptors right irrational receptor alpha compared to the estrogen receptor beta and the Alpha is more of a hyper proliferation hyper proliferation compared to the beta receptors so we know that we know that they're binding the receptors differently one thing that I think most people tend to overlook is these cytochrome enzymes and cytochrome one B 1 which is metabolizes ester own to four hydroxy ester own which is the four metabolites of ester own which you can test in a lot of tests like the Dutch test which I'm a huge fan of yeah it'll up regulates cytochrome one b1 and when you up regulate cytochrome one b1 you're gonna push more of that s drone to the four hydroxy which will then bind to the estrogen receptor alpha right and that can be more damaging but what is what is interesting is that most people don't pay attention to the DHT metabolites which nobody really talks about that like what okay so DHT we know we think DHT causes prostate I would say it take it a step further and at the beta and alpha metabolites of dihydrotestosterone that are binding causing problems and we do know we have research showing that the the three alpha and the 3 beta metabolites of DHT bind to different estrogen receptors so now you have somebody who has low testosterone an upregulation of 5 alpha reductase right making more DHT then making more of the three beta metabolites of DHT then also making more of the four hydroxy a strong estrogen metabolites all binding to these estrogen receptors over stimulating the body and thinking well okay because remember these receptors are mostly everywhere in the body but they're also central that's exactly why clomid works exceptionally well because it's a selective estrogen receptor modulator and you would think while blocking estrogen why would my body want to make more testosterone because it all feeds back in such a same loop so now I'm not saying that these four hydroxy and these DHT metabolites are binding that avidly to these receptors but you have to look at the river at a variety of factors and if you can reduce the load then the body can help recover better and that's why I think we're seeing a lot of these issues a min a lot of new stuff there which is awesome but I think just everyone the clock a little bit because there's so many these entrance tripping chemicals and you know estrogen mimetics and then the cytochrome p450 enzymes being upregulated yeah the the central hormonal processing in within the hypothalamus most likely sees there's a lot of it a lot of estrogen around so we're gonna suppress our own testosterone output because it thinks it's being converted right too much so that okay so that's interesting but then also there's we see higher levels of like breast cancer in men now prostate cancer is that from these you mentioned sip 1 b1 cytochrome p450 1 b1 the four hydroxy metabolite is that linked with prostate and breast cancer in men yes it's linked to certainly breast cancer in women there's more research and breast cancer in women because there's more problem I think one percent of breast cancer reports its prevalence in men so but we do know that those four metabolites because they're causing DNA damage they cause addicts and the DNA which is you know cancer is a metabolic disease but it's also a genetic disease as well and I think it's a it's a perfect storm of the two and the four hydroxy metabolites are contributing to that aspect when we're seeing it in prostate cancer there is a significant amount of research now we know that the the the dogma in medicine is testosterone causes prostate cancer that makes sense right because you give somebody a put somebody on androgen deprivation therapy like lupron which will shut down the hypothalamus and the pituitary from releasing at releasing LH and FSH completely chemically castrate smen and we see that prostate cancer PSA levels go down great that means we're treating the prostate cancer take off the Lupron and see what happens usually the prostate cancer sometimes comes back more aggressively and they can become resistant to it that's why they're combining lupron and other endrin deprivation therapies with radiation or they're combining it with other monoclonal antibodies or pi3 CKD inhibitors right so they're doing multiple different avenues because they're realizing that one approach is not working well we saw this with HIV therapy because HIV when it was first prevalent in the early 90s that they were using one therapy one antiviral and it wasn't working and then they put these cocktails together and now they know HIV is very well managed now you can get HIV titers very low also with hepatitis and we're seeing that with prostate cancer as well if you live like a hypo ganado male like little ADT wedding with Lupron and that I mean so so if a male gets it goes through this triple cocktail like you're mentioning yeah you're gonna run around with basically zero testosterone and high Astrakhan well I mean what kind of quality of life would that be they hate it sex drive goes down bone densities at a risk that's why they recommend weight training when Lupron which you would think would be the opposite right because you would say well you know i boned out she's going down I'm scared I'm gonna break a bone but actually it in Hans's improves bone density they'll have decreased libido one thing major thing is brain fog or decreased cognitive capability so they're just like men I just like I'm not on it like I used to be and we see that one androgen deprivation therapy which brings me back to my point is it's not testosterone that's causing prostate cancer in fact we found a study came out about a year ago that they found that men with low testosterone had lower levels lower rates of prostate cancer but men who had low free testosterone had more aggressive prostate cancer right so though so they put it into this whole group and they say well lower testosterone levels lower levels of prostate cancer okay I'm not concerned about prostate cancer odds are you and I by the time were 67 years old we may have some type of prostate cancer because it's so prevalent in men well every men eventually at some point have it yeah so most men will die with prostate cancer rather than from prostate cancer so my question is is I don't care about the prostate cancer I'm concerned about the prostate cancer that will kill you I'm a grocer concerned about the aggressive prostate cancers and then we get to this whole conversation of you know Gleason score and it hasn't metastasized and then you can do genetic testing to find out if there's actual mutations in the prostate tissue but we do know that when three testosterone levels are lower that there is a higher prevalence of aggressive prostate cancer and that's a prostate cancer that we are we have to be concerned about when PSA levels rise rapidly when PSA velocity goes up or PSA volume the PSA volume goes up or you do a 4k score are you familiar with the for case 104k score is a really it's it's actually the best PSA test that we have now it uses four different types of PSA total PSA free PSA intact PSA and something called hk2 and when you actually combine all four them and then you use other factors like is there a positive prostate exam do they have a family history all that goes into an algorithm and they'll tell you the percentage at which this PSA that you have is elevated the risk of it being an aggressive prostate cancer so if it's above 7.0 percent then the risk of it being an aggressive prostate cancer is more likely and that's what you need to do you know MRI and biopsy it's a it's a whole algorithm and and there's a lot of controversy because you know doctors will say I'm sure you've heard like don't test PSA it's not very specific what else do we do yeah I don't know what else there is what palpation right with the finger and that is highly insensitive it is I believe the sensitivity is perhaps 60 to 70 percent right but it's highly specific so if your doctor finds a nodule on your prostate you need to get checked but they found in research that the ability of a urologist to identify a nodule depends on their competency and their experience so I would trust a 30 40 year old experienced urologist over a newer practitioner who's been feeling you know I don't know I won't say a dozen but not as much as a guy who's been in it for thirty years there's so much Mike it's just it's I guess so I guess so worked up over because I want it I want everybody to know this I want everybody to know it that's really key for a lot of men but what about the low free testosterone is is how is that correlated with more aggressive prostate cancer okay great question dr. Abraham Morgan teller I believe he's at Harvard he's in Boston somewhere and he has a theory which I actually would agree with it's called the oaties the testosterone saturation theory and what he has found is that above a certain testosterone level prostate cancer does not grow more aggressively or more doesn't that proliferate proliferate a greater than it is at a lower level I believe that the cutoff is 250 nanograms per deciliter fact-checked me on that but what he had what they found was is that below that mark or below that threshold increasing testosterone level will cause prostate cancer cells to proliferate quicker so if you look at a graph the slope would be higher below that threshold why don't you get above that threshold it tends to Plateau but now look at think of a number 250 nanograms per deciliter that is below what is considered normal yeah right so and they've only did it with total testosterone levels I'm not sure if they did it with free testosterone levels but I would imagine that it's a very similar very similar trend so what happens is that these prostate cancer cells when they're not exposed to testosterone they might slow down and that's why we see androgen deprivation therapy work very well and then once they get exposed to more testosterone they get all excited and they start waking up and they start proliferating but above that point they're not so what does it really tell you is it the testosterone that's causing them to proliferate greater or is it because at these testosterone these prostate cancer cells have not been exposed to testosterone so the androgen receptors have become desensitized and once they be kind of like insulin resistance sure right make sense so when they're less exposed to that engine once they see it they get more excited and this actually comes to the conversation with you know you had a question earlier which was about you know testosterone levels in men like some met you said you hover around 4 to 600 sure right yeah and you might feel great at 4 to 3 at 600 and that's where I agree with the undercurrents society whereas where they say yes testosterone levels are moderately average at 4 to 600 they're not showing any symptoms no need to treat but why is it that some men at a testosterone level of like you were saying some that need to be at 1200 total total testosterone or free testosterone above 12 or 14 nanograms per deciliter why does some men need to be there and then other men are at 7 nanograms or 4 nanograms per deciliter of free testosterone and feel fine I don't think a lot of people are looking into this but my intellectual curiosity I just want to I just ask these questions all over again and I think it has to do with the androgen receptors and there is some research on the CAG repeats of androgen receptors which are the nucleotides that make up the engine receptive to testosterone receptors and what they see is that the more CAG repeats the more we call it testosterone resistant kind of like insulin resistant you are so you need more testosterone to activate the receptor and they've been doing a lot of this research on women with PCOS PCOS is typically a androgen dominant condition and women so they saw that women with higher CAG repeats were more resistant to testosterone levels which is why their testosterone would increase greater and that's what I think is going on with some men who you know they're like I'm on testosterone you know 200 milligrams of sippy 1/8 a week 300 400 whatever it is I'm not really feeling a big difference well maybe it's because of your receptors are just down regulate it or it's a genetic and that's it like a snip right so they have a receptor snip or the prevalence of that ca ca P CAG CAG repeats right it's not a snip because it's not a single nucleotide I see it's it's a nucleotide repeat so I don't know of any tests that are doing this for consumer access but in the labs in DNA testing and research they could easily check that usually usually a karyotype or chromosome aspect yeah I can remember what chromosome it's on but if you look for CAG repeats for androgen receptor whichever chromosome that's on you'll be able to find it and I think that's what's happening interesting and that would give the subjective differences between people and you know some people maybe don't have anything to differentiate like if you asked a random person how do you feel that's it I feel pretty good because they don't really know what it really feels like to be totally well right so unless a man has taken anabolic steroids before or precursors or you know Columbian things like that you know because that I have experimented with that I've been pretty open about that you know on the internet and things like that I saw your post about it actually yeah yes I saw that which is which is a hard thing to do because everybody shuns it but let's be real yeah I think you know just to manage people's expectations on the internet because you look at Instagram like wow that dude is really ripped and then you're like well maybe you know the striated shoulders and veins everywhere there's a little bit more to the story and now we have peptides and GH are p6 and there's so many different things compared to even like 15 years ago yeah yeah but so so with men that have dabbled in either testosterone precursors like back and you grew up in like the 90s and so forth yeah yeah yeah so is popular like all the precursors and things and some of those I think were spiked with antibiotics we don't really push you mean stuff that you get at like some GNC like I think they would call them pro hormones I don't remember the names of all these different things but a member like VPX made one BSN made one yeah and that my school thought was like that's gonna shut you down anyway so why not just do the real thing which is what I did but with with men like that do you think that their HPA axis ever gets to back to a normal level or is it always kind of is there some variability there it depends on how long they're on it and that's the concern with men who are doing it like over-the-counter stuff typically and I'm gonna speak strictly from pharmaceutical II controlled substances we know that above one year I usually get nervous around six months of continuous testosterone Sippy innate use or test exogenous testosterone use whether it's topical which I am NOT a fan of pellets which are a little bit better or injections that after about a year to two years you will shut down the HPA HPG axis pretty permanently and it's going to be hard to resume it or revitalize it that's why a lot of men will go on testosterone stop take a break do a post cycle of HCG or clomid try to reactivate the HPG access get your testes to start making more of its own endogenous testosterone and then go back on the Sippy innate so yeah I have seen long-term use of that will shut people down and people come to me all the time like man I've been on testosterone and I I got off of it I feel like crap and I'm like oh how long were you on it for oh I don't know like you know eighteen months I'm like yeah it's tough and I feel bad because they're following like unfortunately like a lot of I caught him I call them experts right it's like guys who are in the gym like bro like you guys are going to do is what you do like you do the shots you stick a needle in your butt and you get better and you get gains and like all this other stuff not considering aromatization you have to check PSA levels you have if if you have prostate cancer and it's very unlikely in younger men but it it's just good practice it's it's good medicine I'm not you know I'm an addict physician an acupuncturist I practice functional medicine but I look at it all as medicine people say oh well you know he's an allopathic or he's a do or that's a nurse practitioner you're practicing medicine let's just practice good medicine and when we're finding is that over time they're not considering those things and they're just completely shut down now if the guy's 50 60 years old not gonna have kids not concerned about you know getting off of the testosterone then fine go ahead that's okay you need to manage it properly but for men younger men who were on testosterone and even stuff like over-the-counter it's much harder to reregulate the HPG access and then it can offset and throw off the hyperthyroid as well and your adrenals because the thyroid before I treat low testosterone I look at their thyroid first over anything because thyroid hormones t3 activates the lytic cells and it will it stimulate something called the star which is a receptor and your mitochondria which actually make testosterone so you need thyroid hormone to do that if your hypothyroid that activity is going to be suboptimal and that's where we get the local conversation of you know TSH is that's the only thing you look at and I'm just like okay let's sit down let's talk about this and that that's how I kind of approach things interesting so that I think that's steroid acute regulatory protein that you mentioned the star so that that's why this whole like you need to look at this through the functional medicine lens right I can't just say oh you've symptoms of low Chi it really could be hypothyroidism that was it and a lot of men are not really because I think the prevalence of hyperthyroidism it's more common in women to men don't really think about it as much or doctors don't maybe think to look beyond TSH and look at free t3 reverse t3 I didn't know that that's super interesting yeah it's essential and and you'll see amend you'll see symptoms of low thyroid be masked by or vice versa with low testosterone that's why brain fog well okay brain fog is low thyroid and low testosterone low bone density well that could be thyroid dysregulation or low androgens low libido well maybe it's just low energy in this guys not optimize difficulty with muscle gaining or fat loss oh I have a lot of central adiposity that could also be a thyroid dysregulation as well so if you don't address that or don't properly assess it TSH free t3 or verse t3 free t4 I like to look at sink RBC levels I look to like to look at selenium levels like a look at iodine levels I like to use the the iodine urine test to see a low test to see what their iodine load is because giving iodine can actually set off hyperthyroidism as well so I'm a little bit cautious with it so selenium and zinc are benign very effective and zinc is a 5 alpha reductase inhibitor so you can work by you know preventing DHT from going or the synthesis of testosterone to DHT so there's there's multiple different avenues to go with with it and and thyroid hormone is often missed totally and the dosages on zinc to to inhibit 5 alpha reductase yeah that testosterone a DHT conversion what's that roughly so typically the doses are 30 to 50 milligrams so it's not too high no yeah no they've gone up to 100 milligrams I don't necessarily need that much and you want to be careful with copper depletion if you go that high would zinc so typically I'll dose zinc with like 2 milligrams of copper and you'd be good that's awesome now which which form you talked about the alpha and beta form of DHT yeah did you and which form is linked with male pattern baldness the alpha pattern okay and and what can we do about that I mean if someone does he Islamic scum into play here and fortunately some people just happens in like the early 20s and so forth is there anything that you can do with that from a nutritional standpoint it's really hard it's a really hard Avenue to treat and I think the best approach is 5 alpha reductase inhibitors like finasteride or to testify which propecia and propecia right exactly or avodart the problem is is that the prevalence of high poka of of low libido associated with taking it or erectile dysfunction is actually pretty prevalent and i think i think that statistics say like 1 to 2 percent I think it's much higher I see it more prevalent in men so I would say that's the the most effective but topical actually can be effective as well so just putting topical 5 alpha reductase it's like topical finasteride on on hair would be a great way to prevent that there are some other herbs I can't speak to their efficacy a lot of people use zinc which can be helpful I haven't seen it to have a significant impact a lot of people use an herb called fo T or oh geez I can't remember the Chinese name of it we'll put in the show notes yes but that's another herb that's been used by in Chinese medicine to help improve or prevent hair loss I'm not sure if it exactly works on the reductase enzyme but it's a really hard thing to treat the other thing I would say is just making sure estrogen and testosterone ratios are optimal and you don't want to have I like to see estradiol levels no greater than 30 to 35 picograms per per milliliter because because actually above that benef above that level you have no additional benefit of bone mineral density so best Rijn is promoted as promotes bone mineral density in men and in women but in men above 30 to 35 we actually don't see any added benefit so if your estradiol levels are at 45 you could say oh that's better than 30 actually that's not the case and body composition in terms of reduced adiposity and increased lean muscle mass the optimum range is between like fifteen to thirty so that's my it's a really tight range but that's what I like to see it as and and that's why a lot of men would go like on aromatase inhibitors or or even some herbs that they can use to help inhibit aromatase but nothing beats like actual Arimidex or anastrozole mm-hmm things along the size what I've used for male pattern baldness does run in my family my D H my alpha D H she's not too high I've used topical keto cons all shampoo yeah and that I guess I haven't looked at the mechanisms or the research but it's more of a topical way to like kind of mimic or affect b5 out for a reductase so for guys listening I've recommended it to my brothers as well so I don't know and interesting they in Canada you can get a 2% ketoconazole to try to buy it online and get it whatever if you but over the counter here in the states it's just a one-percent Kiana's all and it works well yeah so I think it's you know it's benign its yeah exactly so it's not like the finish right or things like that which like you said I mean and you know Jeff Grimm he's a nurse practitioner in Portland he's friends with Kerry Jones and so forth so yet the propecia finasteride things like that I guess there is some permanent erectile dysfunction and there's like a few genotypes or I don't know mechanisms but in some individuals it can suppress it so hard that you're kind of hosed and I don't know anyone that would want to be that person right so it's yeah they call it post finasteride syndrome yeah I think we're in a realm right now where post an asteroid syndrome is kind of like how we were with chronic Lyme it's like not quite sure if this is actually chronic Lyme I mean chronic Lyme like 20-30 years ago there was like oh there's no way fibromyalgia oh you just you know it's all in your head it's like don't let that's all I'm good like even in the past you know a reptile dysfunction it's like oh that's all in your head no there is a mechanism between testosterone and poor erectile function but there also is a psychosomatic aspect to it and I think with finasteride and you see this often it will cause it can cause low libido or erectile dysfunction and I think what happens in those individuals is that it causes a mental impact on them it kind of can once a man has erectile dysfunction once they it's like ingrained in their head they're like okay is it gonna happen this time it's gonna happen like what am I gonna do the best cause of erectile dysfunction is high epinephrine and alcohol they're anti erection chemicals so if you have a guy who's really like pumped up and really overworked and just went and had you know four beers after work correct erectile dysfunction is gonna be highly prevalent in him he has that one event in the future he's gonna think it's gonna happen to him again so I think the same thing is what we're seeing with post finasteride syndrome is yes it does cause that in men it does it happen over a long period of time after they stop I don't know there's enough research on it and I think it's coming out more now which which I'm excited to learn about but I can certainly not dismiss it it's a real thing yeah it's crazy I didn't realize epinephrine was involved yes that effect like nitric oxide production and things like that is that kind of what are the shuts down the power of the parasympathetic system I see because erections our autonomic in Mexico it is just a point and shoot so point do you remember that so sympathetic is shoot and then point is parasympathetic right and in order to get an erection you need to be in the proper parasympathetic state and epinephrine and adrenaline are actually the opposite of that right they up regulate the autonomic service of the sympathetic nervous system and that can shunt or shunt away or they would cause the vessels in the penis to state open and prevent constriction which will hold blood in the penile tissue in the corpus cavernosum and and spongiosum so that's exactly how it works when we see that with you know a lot of men who were just on like adderall or stimulants or amphetamine they just overworked and it's amazing do you recommend the Gaines wave and things like that for Edie I have I have read a lot of the research on gange wave I've never seen it in use I've never seen I've never had anybody who's used it a patient who's used instead a lot this was awesome I have seen reports online I think you looked into it right yeah yeah friend of mine Katherine retsoor she's been promoting it I mean quite heavily and stuff like that for some of her diabetic hypertensive now she said it's like been a life changer for the answer forth and and some of the the folks are pretty active on Twitter and the swingers that's like their weekly thing because they want to make sure they're in tip-top shape so yeah I think it's interesting I just didn't know if like obviously I think I gathered that you know from the everything from a biomedical standpoint that's what you'd like to address first and serve pretty well we know that the penis is a barometer of a man's health right so if a man has a reptile dysfunction the first thing I'm thinking about is his heart and a recent study came out maybe three weeks ago and said that erectile dysfunction in men is highly correlated with mace so major adverse cardiovascular events and the risk ratio was about two point one I believe which is significant risk I always get into this conversation of what's the correlation does correlation actually mean causation and it doesn't but when you have a relative risk ratio of 2.0 or above it sparks my attention and it gets my attention I'm like that's something that I need to pay attention to and we see that you know men with diabetes erectile dysfunction I believe it's 56% of men with diabetes have a rectal or 56 and Menem 56% of men with erectile dysfunction also have diabetes and it's damage to the micro vasculature of the penis I mean it it's a simple physiology as that so the gains wave which as I understand uses ultrasound waves to kind of break up plaque and induce nitric oxide synthase makes absolute sense and also you have to understand that nature has nitric oxide synthase there's neuronal and dental delial and if the nerves are not functioning like you can have as much blood flow as you want to the penis but if the nerves are not telling it to work that's also an issue and that's where you need to look at the neuronal and then the Leola nitric oxide synthase so for that I always advise on citrulline over arginine okay yeah yeah so just supplements over-the-counter people can get absolutely right it's super interesting going back to like the you know say like late 20s say mid 40s male loti they're doing estrogen detox eating clean diet exercising prioritizing sleep doing all kind of the basic stuff that we talked about on the channel and oh you talk about what next would you throw in there would you look at like clomid HCG people are talking about h MH human menopausal hormone this is something new someone idea i never heard about this I mean menopausal hormone yeah and it's like an h TG so it helps to kick-start the whole HPA axis interesting yeah I didn't even there's not much research on it yeah I shouldn't know about that yeah we'll talk about it after I could be mispronouncing one aspect of it but no it's not an image right anti-mullerian hormone it's not that oh yeah okay yeah I was never heard of it myself and so this was someone that a steroid user a nice guy after I posted that post on Instagram he said hey I've been on for like three years I want to have kids I'm not too worried about it should I think about cycling off and I was like yeah if you wanted kids you definitely should yeah and so he was gonna draw it he was inspired by the conversation so he's gonna reduce his test to like 75 milligrams a week that's good and then kick up the the Coloma and whatever but I think you know for a lot of guys that have been on gear you know they're psychologically addicted to their size and when the size comes down it's hard for them to grapple with that but anyway going back to that kind of young to middle-aged male you know from a natural standpoint you mentioned zinc and selenium thyroid yeah where else would you go like ashwagandha might go to KS m66 is a version of ashwagandha so it's a it's more that's been studied most with improving testosterone levels and Men improves motility sperm motility and men sperm morphology and men and can increase LH hormone in men at 300 to 600 milligrams per day I take 600 per day mostly to make sure I'm preventing lower testosterone levels life is stressful right I mean it's were specially Manhattan oh boy love it I wouldn't change it for the world I mean the best place in the world I mean I mean it's arguing with somebody in Seattle I live in Seattle for a year which was a nice break but I needed the concrete jungle but ashwagandha and create a tree regulating the HPG access and KSM 66 a particular version so there's sensor rule of ashwagandha there's KSM 66 and then there's just ashwagandha which they look at the with analytes in the astral and then they see those are the active constituents that are suspected to have the beneficial effects of ashwagandha so KSM 66 of the ashwagandha version that's what I like to use DHEA is pretty effective in supporting testosterone levels there is some research showing that men athletes even younger men in their 20s if they take DHEA and they get I believe it was about 50 to 100 milligrams a day will sustained testosterone levels after exercising so that could be a beneficial effect there is a limited amount of research on something called tongkat Ali Yuriko me along folia also called long jack or LJ 100 the studies were done I believe in Thailand but they were very impressive so I just tried to give it a shot the downside is it's pretty low and can be beneficial to try for certain men I've actually seen some men work really well with that there is some controversy over tribulus I know a lot of naturopaths like to use it I'm not a fan because a lot of the research has not shown that that it can significantly improve testosterone levels when you have a commence amount of conflicting research so I'm showing that it does improve testosterone levels and others showing that it does not I have to try to figure out what was it within these studies that caused these variations and there was one pretty large meta-analysis that's that could not that basically concluded said you know the benefits that we're seeing with tribulus terrestris may be unrelated to its increase in testosterone levels but might improve libido or sense of well-being so personally I never noticed a benefit from tribulus maybe because I wasn't hypo gonna do I don't know so I it's not I'm not a fan of it but I do know some men actually have some practitioners they're like man I put them on the tribulus and it works really well I'm like great awesome like that works not my go-to but you know more power to you so that's a great herb as well DHEA and one thing that we over or underestimated sleep sleep over everything and that's why you know the aura ring I think is a great you have one as I see is a great a tool there was one major study that tested groups of men and they sleep deprived these men and then they had other men who slept normal and they found that when they sleep deprived these men their testosterone levels decreased they when they were sleep deprived about four hours and when they lower their test and when they got their testosterone that was lower and then they actually returned them to normal sleep pattern seven hours and they found that by reprovingly r testosterone level are improving their sleep to seven hours was equivalent to giving them exhaustion as testosterone wow that's huge that's a huge deal I mean taking how many people do you know are like yeah I got four hours of sleep like I'm a machine yeah I don't need more than that yeah I'm tough like I could do that like okay cool bro I mean like a whole power to you I can't function at four hours I mean I did during med school I mean there's no option but when you can improve sleep to that extent and get those benefits because and and it's not just sleep it's deep wave sleep all right it's slow way sleep and that is when LH FSH growth hormone releasing hormone ACTH all these secreted gags that's when their releases during deep sleep so people like oh I was dreaming last night I must have slept really well not necessarily you need to know if you were in deep sleep because that's when you're gonna make the most testosterone and most growth hormone and and that's really important so above all of others all the other things if your sleep is not corrected then all these other herbs and supplements and nutrients are might be less effective that's such a good point d aspartic acid do you see some research on that I know some people on the internet talked about it and yeah there is it there is a decent amount of research showing d-aspartic acid can help improve testosterone levels the exact Mac the exact mechanism I'm really not quite clear on and there is some like again like what tribulus there's some controversial research saying well yes this does help and then other research saying well you know it's really not that beneficial I haven't seen clinically I have not seen much benefit from it but perhaps the doses were not high enough I think it is like a 2 gram or over 2000 million like it's a pretty high yeah what about boron people talk about using boron yeah Munir was maybe 2 Studies on boron increasing testosterone levels I don't know what other confounding factors were involved in that study that could have contributed to why boy I don't I don't see a mechanism as to how boron could possibly improve testosterone levels so can it be working on the androgen receptors it's possible can it be working on correcting the HPG axis that's also possible but I've never seen I've never seen boron clinically work effectively it's kind of like you know it's not gonna hurt you get worth it a shot but would I put my money on it no like I'm all about probability right what is the probability that this is going to be effective I know Astrakhan the works because it's work than many men the research is pretty convincing DHEA I know it works because the research is pretty convincing and I have a mechanism as to how it may possibly work but in other aspects like boron or tribulus it's I'm a little bit confused other things like panax ginseng I love it Korean ginseng you know coming from a Chinese herbal perspective really warming improves Qi and can improve blood flow in the body the research shows that it may not actually improve testosterone levels but it does improve libido and it can improve energy levels and this ties in to the adrenals and if somebody's adrenals are for lack of better terms everybody says shot right and dr. Carrie Jones will talk to you about adrenal fatigue how that's a complete misnomer her and I whenever we cease whenever we see something on Instagram or social media I'll take a screenshot I'm like oh this person has adrenal fatigue she's like oh man we got to give them like cortisone just have to like throw it at them and it's it's not it's not a real condition right but I do have it people have it yeah like my doctor said I have like look at my cortisol levels they're really low Ralph I'm like okay well let's look at you or cortisone let's look at your metabolites let's just look at the whole picture was it saliva which is blood levels okay like your doctor said I believe you right you must know exactly what you're talking about but you know you correct the it cuz a lot of men they have the urge to have sex they have proper libido they have normal testosterone levels but they're just tired or they don't have the oomph to like get up and actually make a move or get the energy just the endurance and that's an adrenal problem and if your adrenal glands are tore are a worn out and I'm not talking about adrenal fatigue I'm talking about you know perhaps the cortisol ACTH maybe under immense amounts of stress so you're not releasing enough ACTH or perhaps you're converting you have hyperthyroidism or hypothyroidism and your metabolites are being shifted then you have to correct the adrenal glands first before you can go ahead and try to address the actual testosterone levels again thyroid and adrenal x' then testosterone levels and try to put the whole story together it's it's an art and a science and it makes it so fun which I love it's great because I mean it drives the whole lifestyle function medicine perspective because but if you go to it I went to an endocrinologist you know after at college and it was just like oh is loti doubt like it was so myopically focused on just testosterone but like you're talking about everything is connected and in all the different mechanisms feedback loops you know the same hormonal centers that turn on the adrenals turn on the thyroid and and gonads and so forth so yeah just the bro science the folks that are looking on the anabolic forums which i've been on and people just get all their information from there it's really just like again a myopic approach and so yeah I love this conversation any books or resources I mean and you have a great blog and you're pretty active on Instagram and things like that if people want to learn more what is there any books out there they kind of put this all together or it's it took I get asked this question all the time I write one I oh boy okay let's add a miler time thanks man all right Gabrielle doctor got realigned she's like me your book outline was due on Halloween I said okay it's coming next Halloween days you know I helped co-author a few chapters in a few textbooks one of them is the healing in Neurology which talks a little bit more about men's health and urology another one is the textbook us of integrative sexual medicine it's a dr. Andrew Weil series so I caught a chapter and they're on menopause or andropause there's a bunch of resources I think the best way to go about it is just look at major meta-analyses on PubMed and just make it your hobby I can't give you one source that says like look at this not even one person right like don't believe everything that I say Yeah right because I would tell you like everything that I've just told you go ahead look it up like argue with me tell me like I don't agree with you here because I would love to have a conversation not because you know I hate to be wrong and that pushes me to learn more but that's how we get better totally so I can't I really wish I had like a like a one-stop source I use you know examined comm they have a lot of good stuff there they do miss a lot of stuff or some herbs are not their natural standards are not natural standards up the natural standard comm or something like that yeah a complementary database yeah so I use that book really like PubMed is my best friend fortunately and unfortunately so I don't have I don't have a great do you I mean I don't know I know I don't I mean yeah you I think all of us are piecemealing all of this together whether it's keto fat loss and muscle optimizing hormones like we're all that's what these podcasts are for right exactly yeah hot castes are great funding you talk about fasting like what impact does fasting have on your thyroid what does it have on your testosterone on your engines it has an impact and actually can be a stressor so I'm glad I just want to make this point it's important there's Ramadan studies right and intermittent fasting time restrictive feeding is fairly it's a fairly new topic right like dr. panda who's doing immense amounts of work on this dr. Longo great works on fasting and intermittent fasting time restricted feeding but Ramadan studies which are kind of time restricted feeding studies are earlier and we've had these for multiple years and what we're finding and if you look at the research that meant to do Ramadan fasting by day 20 of that cycle their testosterone levels start to drop and fasting can be a stressor to the body and we know fasting will decrease thyroid levels we know that for a fact it'll increase adversity 3 and it'll shut down free to t3 levels well what is that going to do to your engines what is that gonna do to your adrenal glands what is that going to do you to your metabolism so now you're able to liberate less fatty acids you're not able to go into lipolysis as well right because adipose tissue is building up and now you're increasing aromatisse enzyme right so like and now when you go get out of fasting what is that going like how do you recover from that and carry dr. Jones and I we did this at the New York association of naturopathic physicians conference in October and it was was that I had and I said what's the quickest way to shut down your thyroid and it's like stop eating for three days that will shut down your thyroid so what impact does that have on your androgens I mean we're learning more about that now and I think it has to do with the allostatic load right the allostatic load has to how much pressure are you putting on the body to compensate and adjust and it's fasting as beneficial as it can be for metabolism and Altaf AG and longevity what is it doing to the body on an acute level if you're doing it incorrectly now a lot of guys are doing time restrictive feeding they're not eating for 16 18 hours drinking tons of coffee during that time because they're hungry as hell and then they'll go train lift really heavy and then eat and the body's like this is a lot this is pressure right and that's fine but if you're doing that daily that is a that's a physiological stressor to the hypothalamus and now you're talking about sleep deprivation what if they're not sleeping well so and then there's one study on time restricted feeding on CrossFit trainers and they show that their testosterone levels decreased after a 16:16 eight timesheet defeating was over four to six weeks but their lean body mass increased and their body fat percentage decreased so what is the trade-off there I don't know did they have symptoms of low testosterone I mean I would love I would love for people to just talk to me and say hey Ralph I want to run this study like what should I look for I'm like all right I have a list I do should look at this look at this do an IPSS score a shin score an atom score like like questionnaire it's really easy stuff but nobody's asked me guys dang it I'm gonna call Youm or ruff what's over there no I think you bring up a great point and and so many people are trying really hard and they're very vigilant about their workouts and their fasting protocols you know doing fasted exercise and like you say compressing that feeding window and because there is a lot of excited excitement about it it's it's not new to humans but it's new to us because we're understanding the mechanisms and the science and great people like you mentioned the works of Valter Longo and simeon panda and so on so I think it's it I love that you mention that and I think we're gonna get some people like they're gonna be kind of irritated at first yeah we're not gonna like what I'm not they're not going to want to change what they're doing but I'll just say personally like I spent two years in that world and I'm way stronger I'm a little carry a little bit more water weight which I don't really care about libidos way higher energies way better weight fasting with with not as tight of a fasting window being so your mood alone dose longer yeah having more carbohydrates still training hard but it is the life load like you mention because if I'm working hard trying to be the best parent I can and compressing the feeding window it's too many you're blowing all your matches at once absolutely people need to understand the life load in context of all these other stressors yeah so yeah I mean again it's all about the allostatic load what are all these variables that are impacting what what you can't look at one target it body doesn't where the body will outsmart you you cannot outsmart the body that's what fascinated me to get into medicine the Vinci was fascinated with the body and I'm not preparing myself to DaVinci no way the only comparison we have was were both Italian that's it but I'm fascinated and you can't outsmart the body it you won't be able to we can try and we'll do the best that we can and we can do that to improve longevity and health but you have to understand that you have to take a multiple a variety of angles in order to treat in order to help and like you were saying opening up that feeding window actually helped me as well I was very strict and then I was talking to Gabriele dr. Lyon and she's like no you need to eat and she's like a more protein and I was like all right like you got a boss I did it and I can't believe how remarkable I was feeling and it's just can't talk to yourself and you need to understand like what other stressors are coming along now if I lived in a cave and like didn't have anything chasing me and didn't have to worry about deadlines like yeah I probably cooked fast a little bit longer because nothing else was stressing me but when you have to look at it from an environment of living in New York City I'm exposed to environmental toxins like I know it give a Berkey filter we have another filter yeah it's a custom pure but yeah all the water filter yeah like my water filter is disgusting living in New York and like this is not the water that I want to drink so I I realize that there's other factors like those is the water causing you to have low testosterone no water tap water does not cause to have low testosterone but it can be a variable that must be corrected in order to address the whole allostatic environment which it's it's impossible but you know you have to take a functional integrative naturopathic approach to really to really get a hold of it such a great point can we finish up I'll comb it in HCG yeah sure when would you so we talked all about the ashwagandha and all your herbs and lifestyle steps sleep and so forth but when do you go down and thyroid adrenals all that when do you start to look at chromatin HCG for men yeah so I first look at LH and FSH levels if LH and FSH levels are below the 50 percentile I would suspect them to have a better response to clomid I prefer clomid over HCG mostly because HCG is not very stable it's a protein so you can't really travel with it if you don't if you kind of have a lot of trauma to the area it won't work very well so it can denature but HCG is a luteinizing hormone analog it binds to the same Aluna izing hormone receptor that's how it works so instead of giving LH to give HCG I first started combing and Coleman is a therapeutic intervention and it's a it's a diagnostic intervention so I have to identify is this primary or secondary hypogonadism if I suspect that it's primary which means that the testes are not making testosterone I suspect that the LH and FSH should be high right because that's a normal response testosterone glow testes are not responding the brain says make more LH make more testosterone if that if that's the case I could I could be pretty sure and say you know what LH oklahoman is not going to work here because the LH is really high it's already the the pituitary screaming at your nuts and it's like wake up they're not waking up clomid probably won't work there but if I see LH levels mid range 50th percentile usually like 5 I see testosterone levels in the lower range maybe at the 30th percentile I'll try Coleman and I'll say ok look that might be an option for you to look at clomid as an option to see if you can boost LH levels see if the testes respond if the testes respond robustly and your testosterone levels go up then we know that it was a secondary issue that the testes can respond the issues up here which then tells me I need to address the stressors that are causing this problem so that's when I would use call med or HCG also clomid and HCG should all be used between cycles of testosterone so if you're a younger male and you expect to have kids someday chronic consistent testosterone use will shut down your endogenous testosterone production your LH would I mean you look at LH levels on men on testosterone zero like zero point one it's super low so clomid between those cycles will help revitalize and get that cycle going again what's really good about clomid and i'm gonna get so much like kick back from this yes like it's a drug you can't just rug you only have two minutes you're a naturopathic doctor no drugs like dude if I have pneumonia and I'm nine years old you're getting an antibiotic like I don't care okay if you know if I know a patient whose needs chemotherapy and naturopathic approaches yes that's gonna happen I want what's best for the patient but clomid actually can I've seen the benefits of komen to be sustained so you don't have to do it forever I've seen increasing purses Nader testosterone levels in doubling it and then they come off a clomid for eight weeks I test house on those again and they're normal it's like wow we actually woke up the hypothalamus we we stimulated it and I think that's how adaptogens work but they're much more subtle and it takes a longer period of time but I think that exactly how they're working is they're they're they're desensitizing or resynthesizing these receptors so a clomid can be used to identify primary versus secondary hypogonadism can be used a post cycle of exogenous testosterone and and also it may not be for life so you can do that feel good you're done and you're sustained which is like that's perfect that's the goal yeah that that's that's because you have to look at the therapeutic order drugs should be a last option but if that is the only remaining option to identify then let's see what we can do best with that such a great tip and people on the internet talk about like every other day dosing every day dosing is there a moment yeah usually two to three times a week okay yeah two to three times will you post it in there yes yeah you don't need it every day because it has a long long half-life and the inhibition on the hypothalamus at the estrogen receptors is is long-standing so you know if what I would do is you know you test test test test social levels and even if they didn't take clomid for two or three days the effects are still withstanding so LH levels are still be high so you don't really need high doses by the way this is not a drug that has been FDA approved for hypogonadism so we know that I mean the research is coming out now on studies of komen being used for 10 to 15 years and it's it's benign except in men who have a suspected prolactin oma or a brain tumor or a tumor in their pituitary where they'll start seeing double vision like that's a warning sign stop and by no means am i saying everybody should go out and have clomid like this is not medical advice I'm saying you need to check with your practitioner and if your practitioner doesn't make sure that your prolactin levels are not elevated or you're not looking at the LH and FSH then there's a concern or something to be concerned about or aware of but yeah clomid not everyday HCG typically two times a week these are not everyday things but komen is a much easier drug and pretty benign – interesting yeah I've heard some potential long-term issues with because it's a selective estrogen receptor modulators well any cancer risk not that I've seen okay unless they're talking about risk of increasing testosterone levels and then we can go back down that rabbit hole again right right cancer risk again unless you have some type of malignant or benign growth in the brain that you don't want to stimulate more production again and then you also have to look at you know is there any type of neoplasm at the adrenal glands because you're increasing LH and FSH which can impact other organs as well we do know that the testes have receptors for ACTH which is a hormone released by the hypothalamus we're not really sure what it does but we know that there's some type of connect they're so interesting yeah really cool stuff but again we don't know exactly what it is used for and again it's a short-term drug you're not using this for life you should not and it's not used everyday and it's used in cycles and if you notice something that's going wrong estrogen levels jump tumor markers jump other other changes in vision then you have to be a little bit more alarmed but I'm not concerned about it a long-term use yeah interesting Ralph really appreciate talking with you and and folks listening we're watching right now on YouTube I feel want to connect with you best way to do that would be probably on Instagram oh yeah Instagram is probably the place that I'm most active I my Instagram is designed to put out information like I just I I want to help people learn more and then you can also check out my website dr. Ralph Esposito calm but those are the two areas where you can reach me all the views in my own eye I'm just here to educate the masses if I can help to people help a hundred people my work is done that's awesome that's really good yeah there's tons of great free tips for you guys so really appreciate you doing all the way through hit that like button share this with a young man or old man that is interested in learning natural ways to increase their hormone levels androgen levels tons of information really appreciate coming on but I like so much fun thanks so much I appreciate it


  1. The number 1 thing. Number 1!!

    Lets not forget this or undermine this.

    Is : STRESS

    Reduce Stress = Increase Testosterone

  2. Good… I take Boron supplements 12mg daily…plus Keto and intermittent fasting… and yes I do cheat meals at minimum…

  3. Excellent interview. This is worth watching as an educational video for men that want to promote their hormone health

  4. Had it last year at 50. Doc said milk is a big feeder for it. Sugar. Was a hell of I ride. Coming back now. Ck your self long before 45. They said I had maybe 5 years to live. the left side was full. one more year it would have moved outside then ya done for.

  5. Not a single mention of the trace mineral BORON and it's role in creating usable Testosterone. Learn more here. https://www.youtube.com/watch?v=TJp7SW1pY2I
    Also men who have low cholesterol have low testosterone levels. The statin industry feeds the ED industry among others.

  6. I love when Mike talks with people who talk fast, much, and on point.

  7. Dr. Ralph Esposito?

    More like Ralph DESPACITO

  8. Can you take arimedex or clomid after being years off gear but nipples are still a little puffy but not sensitive?

  9. 6 weeks now taking ashwagandha ksm 66 and its working a treat for me in multilple ways.

  10. hello Mike, is there a functional MD in the southern ca. area ( rancho cucamonga) ?
    my endocrinologist sounds like all of the "other" drs you talk about.
    i have searched a few but get the feeling its not the norm for them.

  11. What's the name of the shampoo?

  12. been waiting for this interview, Dr. Esposito is awesome

  13. I just finished a 3 day bone broth fast. I gained 1lb. After I broke my fast the next day I was down 3lbs. I'm never fasting again lol

  14. Great talk. Such a complex topic. I was with him until he mentioned time restricted feedings impacts. I understand that adipocytes signal an increase in aromatization… But dont understand how he draws the conclusion that TRF/fasting decreases lipolysis/fatty acid metabolism and increases adipose tissues when it appears to due the exact opposite for most who do it correctly.

    Ive noticed i store body fat really quickly once fed, but equally fast my insulin lowers and i wake up every morning leaner than the day before. To me it makes sense my adipose tissues grow more easily due to the increased insulin sensitivity but also break down even faster as a result of good sleep, clean nutrient dense food, regular exercise + a tight feeding window.

    Anecdotally, in my mid 30's… While not as big or strong as i have been in the past but im more ripped with a more muscular physique than when in my peak athletic prime. My pumps and recovery time following a work out are comparable to when i was 17-18, playing football, doing hardcore weight training (2-3 hrs 5-6 days a week) and taking 19-nor androstendione. After years of feeling tired week and sluggish, i now have the same energy & drive i had at 20 once again. Which i fully atrribute to my lifestyle changes of which TRF I feel is a crucial factor.

    Thanks for another informative deep dive into an interesting topic

  15. The real problem is if women wants estrogen it's "NO PROBLEM" hell they get get it for free. If a man wants testosterone it a highly-controlled drug — a toxic poison — and is expensively prescribed begrudgingly.

  16. I have a huge problem with anyone who says "we're much higher stress than our grandpraents' generation." They lived through the Great Depression, WWI, and WWII for Christ's sake.

    I'd say we deal with stress more poorly than they did for sure. But definitely not that we "have more stress."

    Could be the testosterone levels haha.

  17. Excellent Podcast 😋👍

  18. Mike, your arms are looking pumped! All kinds of gains!! 😬

  19. Okay, can someone clarify something for me? He says adrenal fatigue isn't real, but that the adrenals have to be fixed as a fundamental part of men's health. So, what's wrong with calling stressed out adrenal glands "adrenal fatigue", because it sounds like exactly what he's getting at.

  20. HMH ou HMG?

  21. I have heard that eating too much fiber (plant food ) can decrease testosterone?

  22. For someone that doesn't function well without a stimulant based ADHD medication, are there treatment options to correct the negative effects on the erection? I've only had an issue maybe two or three times in the years using these medications and it's always been within the first hour or two after taking my meds.

  23. Its cool this guy both knows a lot of science but also knows how much he doesn't know :p. It's easy to get cocky when you read a lot of pubmed, but knowing the complexity of the body is far more than you can ever know is so important. You can't outsmart the body!

  24. Great episode, thank you!

  25. Not good so me doing omad everyday can lower my testosterone???Sunday night makes the beginning of the keto community 3day water fast.Will I be impotent after this extended fast??I don’t have a lot of stress in my life and inflammation levels in my body are very low because of fasting..

  26. Anybody here get into the science of chronic masturbation and porn in reference to erectile dysfunction and prostate cancer? I liked the erection convo in this video regarding cardiovascular health, but I imagine some men these days are losing erections before their arteries calcify.

  27. Mike looking thicc

  28. Yea my professors who are also practitioners would say they are more apprehensive about doing hormone replacement in younger people. It's such a tempting thing though because hormones are so powerful, but short term thinking with any kind invasive drug will doom you to losing control of your body. I'm glad this guy awknowledges this and compliments it with lifestyle recommendations.

  29. “I don’t care about Prostate cancer”…. um are you crazy? Eat Brazil nuts for Selenium and take iodine drops… problem solved.

  30. Very interesting conversation

  31. Fasting should be treated like exercise with proper recovery & balance. Same with all other physical/mental life stressors.

  32. Mike do you know why your guest doesn't recommend testosterone cream? What's wrong with it for a 64 year old man?

  33. Eat meat.

  34. BOOM👊👊🔥 Love Dr Espisito

  35. I am 33 and have no testosterone or erectile issues. Despite this fact, this video is loaded with a treasure grove of great info. Mike is a great listener who asks thought provoking questions. Thank you Mike.

  36. A whole lotta info here….I don't even come close to having all the answers but I can tell you that Zinc & Sleep are 2 very positive things in my life. I've tried D-Aspartic Acid and noticed no difference positive or negative for me.

  37. Have had discussions with many compounding pharmacists, testosterone creams are the only way to go. At 55 years old, have been on testosterone cream for 10 years, and other hormone balancing forms like DHEA and Anastrozole. PSA levels have always been low, testicles have not shrunk, have a full head of hair and all hormone levels have been great! Get blood work done every 3 months. Pill form or injectables, always sky high levels of testosterone, followed by very low levels, because it's always in the body. Testosterone creams, 12 hours on, and 12 hours off. I give my body a rest every 12 hours, where it can still produce it's own testosterone for 12 hours a day.

  38. Anyone catch the name of the Shampoo he mentioned around the 30 min mark?

  39. As soon as I started doing that low carb life, I feel better, I'm more energetic, I can get up and go to the gym or make the bed, or cook. Doing Low Carb essentially was like taking a laptop that was pretty fast but had the slowest of hard drives, and putting in a brand new SSD. The difference in start up time, shut down time, rebooting time, application loading, everything got boosted. My floppy disk turned into a hard disk drive and the access time went up dramatically. Pretty sure that's a positive sign my testosterone levels are balancing out.

  40. How opinions vary–even among the MDs!

  41. High DHT, loss of hair. Agree, environmental issues regarding low testosterone levels. Please don't forget, soaps, lotions, plastics, animals eating grain, all have estrogen based products which lower your testosterone levels.

  42. What do you think of bio identical hormone pellets?

  43. Soooo glad someone is bringing plastic contamination into this conversation. I hear so many men complaining about the feminization of men, but most don't realize it's our very own environment that is responsible.

  44. * Note for growing Ashwaganda in warm/tropical climates – ignore the growing advice you see everywhere. Mine didn't thrive until I gave them a little shade and lots of water.

  45. (Note: Wiithaferin A comes from the Ashwaganda plant). Withaferin A Inhibits Prostate Carcinogenesis in a PTEN-deficient Mouse Model of Prostate Cancer12 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421823/

  46. That moldy looking wall in the background looks horrendous. Great guest.

  47. 1. Eat proper food, whether it's keto, paleo etc. I don't care – but stop eating sugars and processed foods.
    2. Get enough sleep – if you can't make it through the day without coffee you're not sleeping enough.
    3. Exercise.
    4. Meditate or do whatever else works for you to calm down and get better at dealing with stress.

    Congratulations. You've done as much as is humanly possible to maximize your time on this planet and to stay healthy and able-bodied while you're here. The rest is up to chance, the universe, God or whatever you choose to believe in. Don't worry about it – you can't affect it.

  48. Are you sitting on buckets? Seem to be low to the floor.

  49. Yeeeeah baby!!! Love the intro this is going to be good

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