Speaker 1: Let's talk about it.
Speaker 2: Let's talk about the man. Hero.
Speaker 3: Let's talk about it.
Speaker 2: Let's talk about the man hero.
Speaker 4: Welcome to the man, Welcome back to the mail room.
Speaker 4: Jordan runs out, how in the hell are you? Did
Speaker 4: you survive? Santa Monica? I gotta let everybody know? So
Speaker 4: one of the they say, you never you never want to.
Speaker 3: Meet your heroes.
Speaker 2: But but Jordan and I actually, you know, he's not
Speaker 2: just sort of above the chest guy.
Speaker 3: I mean, he's living, walking human being, is.
Speaker 2: A three dimensional as delightful in person as he is
Speaker 2: on camera as well as behind the mic. And uh,
Speaker 2: this is humanism and radio right here. But so Jordan
Speaker 2: came out to Santa Monica a couple of weeks ago
Speaker 2: for the iHeartRadio Awards show out here. I believe, right,
Speaker 2: Is that what your thing was?
Speaker 3: Yeah?
Speaker 5: That was very fun. Yeah, we got to see I
Speaker 5: got to be a room with Taylor Swift, Travis Kelsey,
Speaker 5: heard of John Mellencamp doing his best. Would he got three?
Speaker 5: You would have loved it?
Speaker 3: Oh my god.
Speaker 2: I saw John Mellencamp in a what was it, Rock
Speaker 2: the Vote? That was one of his early political things.
Speaker 2: I saw him in La probably like an eighty seven.
Speaker 2: It was an amazing concert eighty seven eighty eight, and
Speaker 2: uh yeah, just what a performer, what a what a legend?
Speaker 2: Do you know?
Speaker 3: The cool thing about him?
Speaker 2: I just read the other day he's a big Indiana
Speaker 2: football supporter and also a chainsmoker, and so which is
Speaker 2: you know, not endorsed by the mail room until Big
Speaker 2: Tobacco wants to sponsor us. But but it's never gonna happen.
Speaker 2: I promise, I got my morals and ethics. But yeah,
Speaker 2: but they supposedly build a box for him in the stadium,
Speaker 2: like at the very top where you could go you
Speaker 2: can watch the game and smoke. I mean, that's that's
Speaker 2: a donor donor money going to good use. I think
Speaker 2: we just have to look the other way on that
Speaker 2: because he is John Mellencamp. But he's already survived heart
Speaker 2: attacks and bypass surgery. You know, maybe that's that nickedtine,
Speaker 2: that's you know, Actually, this is a strange tagaway as
Speaker 2: things always happen into what we're going to talk about
Speaker 2: on the show today, which is that individualized medicine and
Speaker 2: individualized results to medications is really important and not everybody's
Speaker 2: going to respond to the same drug in the same way.
Speaker 2: So you know, there are people that can smoke until
Speaker 2: they're ninety or one hundred years old, and they say
Speaker 2: their secret to longevity is a cigar, three cigarettes a day,
Speaker 2: and a shot of whiskey, and you can't take that
Speaker 2: away from them. Their genome is allowing them that kind
Speaker 2: of well, what's the word, I guess large, Yes, to
Speaker 2: let them live their best lives with tobacco and whiskey.
Speaker 2: But you know, the exact opposite of that is what
Speaker 2: you and I got to do when we were in
Speaker 2: Santa Monica.
Speaker 3: So tell tell me about our experience.
Speaker 2: Your kid in the candy storm moment, when this mythical
Speaker 2: place that also is real opened up your eyes to
Speaker 2: what Santa Monica is all about.
Speaker 5: I could believe it, folks.
Speaker 1: I finally went to Erwon, which if you're in the
Speaker 1: East Coast maybe you've never heard of.
Speaker 6: If you're on the West coast, you're laughing at me
Speaker 6: right now because I know that as a staple of
Speaker 6: your diet. I'm sure these smoothies they're they're they're magical.
Speaker 6: I've actually been craving smoothies every day since.
Speaker 1: It's ridiculous, right, Yeah, they're colors that don't appear in nature.
Speaker 5: Mine was like this blue one yours was I think
Speaker 5: pink or maybe around.
Speaker 2: It's some kind of algae and spiral leasion and ground
Speaker 2: up help. It does appear in nature, Drew And by
Speaker 2: the way, no sponsorship from Eriwan. Yes, but it's a
Speaker 2: good it's a I mean yet, that's right, it's a good.
Speaker 2: It's a good bit. But yeah, I mean it. It's
Speaker 2: so annoying to me because I have these very strong,
Speaker 2: farm rooted Midwestern sensibilities and to go in and drop
Speaker 2: twenty bugs in a smoothie, it just makes me cringe.
Speaker 2: It makes my I think of my grandparents in the
Speaker 2: throes of the Great Depression, you know where, where twenty
Speaker 2: bucks would get them through a year, and here I
Speaker 2: am dropping this on a Turmerican beat smoothie. But but anyway,
Speaker 2: I mean, it's real. We got to do it. That's uh,
Speaker 2: you know, that's living our best lives. And yeah, you
Speaker 2: know once a month or so ain't bad. That won't
Speaker 2: break the bank. But anyways, so good to see you
Speaker 2: and you made it back to Brooklyn and back in
Speaker 2: the studio and ready to lay down some tracks.
Speaker 3: I cannot wait.
Speaker 1: Actually, I have a question for you related to two
Speaker 1: things that we just spoke about, grandparents and individual response
Speaker 1: to what I'll loosely describe as medicine.
Speaker 6: I had a friend whose grandmother swore that her secret
Speaker 6: to longevity, and I believe she broke a hundred. She
Speaker 6: would fry bacon for her husband or eventually herself after
Speaker 6: he died, pour the grease into a little shot glass, into.
Speaker 5: A shot of bacon grease every morning.
Speaker 1: And she claimed that that was her secret to life.
Speaker 1: I would love to know what you think about this.
Speaker 2: Well. I think that the secret to life probably is
Speaker 2: these rituals that make you feel grounded every day, you know,
Speaker 2: like we ask all of our guests, you know, what
Speaker 2: do you do every day to make you you? And
Speaker 2: if we had her on, she would say, I drink
Speaker 2: bacon grease, Jordan and doctor Mills. That's what I do.
Speaker 2: I'm not gonna take that away from her. I don't
Speaker 2: think the health benefits are there, but maybe there's some
Speaker 2: meato privileged aspect of bacon grease. It's definitely not the nitrites.
Speaker 2: I think, you know, God bless her, you're not getting
Speaker 2: stomach cancer or something. But again you know, she didn't
Speaker 2: have the genetic predisposition to some kind of nitrite reaction,
Speaker 2: and therefore she can handle I imagine process bacon. Maybe
Speaker 2: it was organic, maybe it was from marijuana. Doubt it,
Speaker 2: doubt it. Oh there, it's been around a while. You know,
Speaker 2: it's not a new store by any means. Bacon smoothie,
Speaker 2: Bacon smoothie.
Speaker 3: Well there it is.
Speaker 2: Yeah, yeah, I keep pitching for my daily Sialis smoothie.
Speaker 3: You know the tadala field.
Speaker 2: Just grind it up, and you know that's your secret
Speaker 2: to nitri cockside boosting.
Speaker 3: So anyway, you know.
Speaker 2: Look out money on the table. Yeah, that's money at
Speaker 2: the table, that's right. Yeah, it's the it's the longevity
Speaker 2: over fifty smoothie. The geeze are smoothie. But I don't
Speaker 2: think it'll really sell now with an aim like that.
Speaker 2: All right, So here's the thing. There is a riddle.
Speaker 2: It's a rhetorical riddle. I mean, if I let the
Speaker 2: mic drop just long enough, you can try to guess.
Speaker 2: But what are the two things every guy is afraid
Speaker 2: to lose and thinks he has to choose between.
Speaker 5: I'm gonna say potency and hair?
Speaker 2: Damn I'll come on, you read the script that doesn't exist.
Speaker 2: That's right, his erections in his hairline, That's what I
Speaker 2: was going with. That exactly right. And I see it
Speaker 2: every day in my practice, and I see it also.
Speaker 2: I think because people are asking about it, there is
Speaker 2: this prevalence in the zeitgeist and maybe in our constant
Speaker 2: pursuit for more clickbait and content. We're revising something that's
Speaker 2: really been a debate for over thirty years, so this
Speaker 2: is not new. But what I'm talking about is finasteride
Speaker 2: and its cousin detasteride, and I'll think it's coming up for.
Speaker 3: A lot of reasons.
Speaker 2: And we're going to get into this because right now,
Speaker 2: I think the prevailing wisdom in the social media spase
Speaker 2: is that this is an evil drug and it will
Speaker 2: take away a guy's erections.
Speaker 3: Is libido his life?
Speaker 2: And I'm going to discount that because I do see
Speaker 2: guys in my practice that have these side effects from finasteride,
Speaker 2: and they're very potent and they can really wreck somebody's life.
Speaker 3: But we have to unpack it.
Speaker 2: We have to figure out what's real, what's mythological, And again,
Speaker 2: we want to be one voice above the din here,
Speaker 2: and that is our voice, maybe two voices, Jordan's voice
Speaker 2: of keeping me on task in my voice of saying,
Speaker 2: there is some medical basis to why it's such an
Speaker 2: amazing drug and why it does such good for the
Speaker 2: vast majority of guys that take it, but also why
Speaker 2: it could have a dark, ugly secret. And that's organ
Speaker 2: unpack today. So let's talk about this a little bit.
Speaker 2: What is fanaster, right, tell me what you're understanding is
Speaker 2: what's out there, and let me want to one this
Speaker 2: a little bit for our audience.
Speaker 6: I see that getting served up to me and a
Speaker 6: lot of guys my age or approaching their forties just
Speaker 6: on Instagram, ads and things through you know sites. I
Speaker 6: won't mention their names, but worked you can just kind
Speaker 6: of order it online with it, you know, a very
Speaker 6: hastily obtained doctor's note. Either spray or oral.
Speaker 5: My understanding of it is to kind of slow hair.
Speaker 6: Loss as opposed to any kind of regrowth's that's sort
Speaker 6: of the extent of my knowledge.
Speaker 5: I don't know too much about how it works.
Speaker 2: That was more well, and I ask you about but oh.
Speaker 5: Yeah, that was kind of more. My understanding was that
Speaker 5: it was either spray or an oral pill.
Speaker 3: Nice, let me do the heavy lifting again. I love it. So, yes,
Speaker 3: that is right.
Speaker 2: It is a hair loss drug, but it wasn't designed,
Speaker 2: you know, in the lab for that it was.
Speaker 3: It was actually a hormone.
Speaker 2: It is a hormone blocker, but it was designed to
Speaker 2: shrink a guy's prostate. And like all wonderful accidents in
Speaker 2: the world of pharmacology, guys were also noticing that their
Speaker 2: hair actually was getting thicker. So it actually can promote
Speaker 2: hair regrowth to a certain extent, but it does stabilize
Speaker 2: follicle degeneration. And so the guys that were saying, gosh,
Speaker 2: this is great. Not only am I being better because
Speaker 2: I'm on a drug to help my prostate, but my
Speaker 2: hair is coming back. So that sounds amaz and it
Speaker 2: is now. Unfortunately there was in the original studies. Now
Speaker 2: this is empty approved all the way back in the
Speaker 2: early nineties, so this is not a new drug by
Speaker 2: any means.
Speaker 3: But there was a certain.
Speaker 2: Subset of guys that in that early population, and this
Speaker 2: is where it gets a little bit fudgy, and where
Speaker 2: there may have been some trouble in terms of how
Speaker 2: the side effects were reported and may have been buried
Speaker 2: by some.
Speaker 3: Of the original studies.
Speaker 2: But the bottom line is, I mean, I remember when
Speaker 2: this drug came out and it was a oh yeah,
Speaker 2: this is a great drug for BPH benign prostact hyperplesia.
Speaker 2: It makes you urinate better, not get up at night,
Speaker 2: and also reduces your PSA, which we had the big
Speaker 2: episode series with Doctor Brisbane on in terms of your
Speaker 2: screening for prostate cancer. PSA is that blood test. If
Speaker 2: you remember that the higher it is, the more likely
Speaker 2: you have prostate cancer. And so you have a drug
Speaker 2: that actually reduces the PSA. And there was even some
Speaker 2: thought that finasteride at one point and detest ride might
Speaker 2: actually prevent prostate cancer that to never really hit. The
Speaker 2: FDA in fact looked at it and said, nah, we
Speaker 2: don't love it. And there's also a little bit of
Speaker 2: a nefarious side that maybe guys that are on long
Speaker 2: term finasteride, if they develop prostate cancer, it can be
Speaker 2: somewhat more aggressive than average because you're robbing the prostate
Speaker 2: of the hormone that it normally needs to grow and
Speaker 2: it's looking for alternative pathways to be bad. And so
Speaker 2: none of that really showed up either. But the bottom
Speaker 2: line is it does to dramatically decrease your prostate size,
Speaker 2: and it does dramatically lower your PSA and so if
Speaker 2: you're on it, this was that public service announcement another
Speaker 2: PSA from doctor Brisbane saying if you're on finasteride, tell
Speaker 2: your doctor, even if you're getting it online for hair loss,
Speaker 2: because we have to interpret your PSA in the context
Speaker 2: of if you're on it, you should at least double
Speaker 2: what the reading shows in the blood test, if not
Speaker 2: even go up from there.
Speaker 3: So super important.
Speaker 2: Just as another another shout out for anybody that is
Speaker 2: a screening age for prostate cancer. But yeah, I mean,
Speaker 2: all it is is it's kind of a cool, very
Speaker 2: specific drug in that it knocks out an enzyme. And
Speaker 2: I think if we talk about enzymes, which we've talked
Speaker 2: about before, and we'll do a lot, enzymes essentially are
Speaker 2: proteins in the body that make a reaction happen at
Speaker 2: a much faster rate. That's what it called it catalytic reaction.
Speaker 2: And so finasteride is an enzyme inhibitor. It inhibits something
Speaker 2: called five alpha reductase, and five alpha reductase takes a
Speaker 2: molecule of testosterone and it turns it into a molecule
Speaker 2: of dihydrate testosterone or DHT. That's very simple biochemistry and pharmacology.
Speaker 2: So if you knock out that enzyme, then your body
Speaker 2: ends up having more testosterone and less DHT. Now, the
Speaker 2: interesting thing about this drug is that nothing's ever for
Speaker 2: free in pharmacology. And as I always say too when
Speaker 2: we're talking about supplements, and if you say this is
Speaker 2: the most amazing supplement, it'll make your hair grow back,
Speaker 2: it'll make your penis longer, it'll make your boobs better,
Speaker 2: it'll make whatever supplement they're trying to sell you, and
Speaker 2: there are no side effects, then you automatically know it
Speaker 2: doesn't work, because anytime you perturb anything in the body,
Speaker 2: you're gonna have some counter reaction somewhere else, and so
Speaker 2: f an astroide, it's a very simple counter reaction. Testosterone
Speaker 2: has two ways to be metabolized in the body, and
Speaker 2: one is through the DHT pathway we just talked about,
Speaker 2: and the other is through the estradal pathway. Sometimes in
Speaker 2: guys we use estrogen and estra dial interchangeably because there's
Speaker 2: really three iso forms of estrogen, but in a guy,
Speaker 2: estra dial is the most powerful one, so if I
Speaker 2: if I accidentally go between estrogen and estra dial, Any
Speaker 2: nitpicker indo chronologists out there, I love you all for it, but.
Speaker 3: Bear with me.
Speaker 2: It's really estra dial as the main molecule that we're
Speaker 2: talking about in guys in terms of the estrogen family.
Speaker 2: But testosterron can also metabolize into estradal through an enzyme
Speaker 2: called aromatase, So a romatase will convert to estrogen. And
Speaker 2: if that pathway is open and the DHT pathway is shut,
Speaker 2: then what do you think happens estrone goes up? Think
Speaker 2: of it as a big sink, right. Your body is
Speaker 2: a is a sink. You've got testosterone is a faucet,
Speaker 2: and there's two drains that testosrine can go into. There's
Speaker 2: the DHT drain and then there's the estra dial drain.
Speaker 2: And if those drains are equally open, then you get
Speaker 2: a pretty good ratio of testosterone degradation to DHT testosteron
Speaker 2: degradation to estra dial and your whole body is in homeostas.
Speaker 2: It's perfect balance, perfect harmony. So if I go in
Speaker 2: and I plug up that DHT drain, all right, you're
Speaker 2: ready for your quiz, what happens to estra dial levels?
Speaker 3: Then, Jordan, if that goes up?
Speaker 2: So if I block DHD and that drain is wide
Speaker 2: open for est dial, how much more estra dial is
Speaker 2: going to be made?
Speaker 5: How much sport it's gonna be made? I mean so
Speaker 5: if if the body is losing it more rapidly.
Speaker 6: I imagine that the much more is going to be made,
Speaker 6: because that's right to keep a homeasis exactly.
Speaker 2: Yeah, so you have higher levels of estra dial, So
Speaker 2: that's exactly it. So then you say, okay, well then
Speaker 2: finasteride detasteride. These drugs work by blocking DHD. Estra dial
Speaker 2: levels go up. So what's the baland what's the bad side?
Speaker 2: What happens if a guy's walking around with too much
Speaker 2: estra dial? You can you get asked me too, but
Speaker 2: what are your What do you think side effects could
Speaker 2: possibly be if we if a guy has an excess
Speaker 2: of estra dial because the DHT pathway is blocked with phanasteride.
Speaker 5: I'm actually not sure. I imagine that it would you
Speaker 5: would have disastrous effects to the sisostrail levels?
Speaker 2: Is that y? Yeah? Well so actually interesting. This is
Speaker 2: a great board question for urologists and In fact, the
Speaker 2: thought is the common wisdom, which is not right, is that,
Speaker 2: and it's understandable because some of the side effects will
Speaker 2: talk about our associated low testostrum, And the common wisdom
Speaker 2: is you put a guy in an asteroide, his T
Speaker 2: levels will go down. Actually they go up a little
Speaker 2: bit because we're blocking that part of the sink, and
Speaker 2: so not all that goes down. Estra dial tea levels
Speaker 2: are suspended a little bit longer. But the two big
Speaker 2: side effects that we know happen with guys that have
Speaker 2: too much as gen from say there I did estra
Speaker 2: dial from one of either an organic source like a
Speaker 2: guy has liver failure, smokes too much weed. Those are
Speaker 2: two things that can cause high levels of estra dial.
Speaker 2: They'll mention two things. One is they'll get breast tissue
Speaker 2: or what it's called guid in camasitia develop. Two is
Speaker 2: that they may have libido issues or mood swings. And
Speaker 2: it's not you know what you think is that estra
Speaker 2: dial is a moody hormone. It's just that our body
Speaker 2: and our brain isn't used to seeing such high levels
Speaker 2: of estra dial, and so it can change the way
Speaker 2: that we think a little bit, but also could be
Speaker 2: a libido killer. Now that's not universally true. In fact,
Speaker 2: there's some really interesting studies that show that some men
Speaker 2: are very ester dial dependent for libido, and so again,
Speaker 2: individual results may vary. It's just like cigarettes and whiskey
Speaker 2: and one hundred and two year old woman. Some do
Speaker 2: better with it than others, and so this is really
Speaker 2: the key to this individualized medicine. But that's one of
Speaker 2: the side effects that we know. So if a guy
Speaker 2: comes in and says, Doc, I want to keep my hair,
Speaker 2: and I say, great, you know, you just let me
Speaker 2: know if you get really moody, if you have any
Speaker 2: kind of libido shift, or if you start developing breast tissue,
Speaker 2: we need to know about it. We can stop it
Speaker 2: and then we'll get you back to that normal homeless stasis.
Speaker 2: So that's one aspect of it. The other aspect is
Speaker 2: that you do have other organs in your body that
Speaker 2: are DHD dependent. So the two that we know of
Speaker 2: and the reason finasteride works is the prostate, and it's
Speaker 2: also the hair and the hair follicles in the head,
Speaker 2: I should say, are very DHD dependent. They're also blood
Speaker 2: vessel dependent, and so hair loss is not just because
Speaker 2: our DHT levels kick in when we're in our early
Speaker 2: twenties or thirties whenever. Hair loss happens to guys, which
Speaker 2: also varies by age, but blood vessels are super important,
Speaker 2: so you have to make sure you have nice, open,
Speaker 2: healthy blood vessels. And so the other really big common
Speaker 2: cause of hair loss and guys women for that matter,
Speaker 2: is extreme stress where you're just not getting good blood flow,
Speaker 2: good nutrition to your scalp, and so hair falls out
Speaker 2: for that reason too, So we have to kind of
Speaker 2: tease out between those. But other than DHT being in
Speaker 2: the hair follicle and in the prostate, it's also in
Speaker 2: the brain. It's in the hypothalamus, which is kind of
Speaker 2: what we call our lizard brain. It's in the prefrontal cortex,
Speaker 2: which is most of the decision making aspect.
Speaker 3: Of our brain.
Speaker 2: So that says I'm hungry, I want to go have
Speaker 2: a hamburger, or I want to have sex now, or
Speaker 2: I'm going to run this red light and hope for
Speaker 2: the best. And so you know, as we talk about
Speaker 2: earlier signs of aging and twenty five being that time
Speaker 2: of sin essence, I think it's really important in the
Speaker 2: DHD story too is we'll get into so if you
Speaker 2: have other receptor mediated organs that don't see DHT, it
Speaker 2: may not just be the fact that estra dial levels
Speaker 2: go up. It also may be that what there's low
Speaker 2: DHT and those receptors that are DHD dependent changes can happen.
Speaker 2: And that's where maybe, and we don't know, because nobody
Speaker 2: is gonna have an institution where review boards say we
Speaker 2: can take biopses of brains to look at DHD or
Speaker 2: androgen receptor levels.
Speaker 3: We have to rely on animal data. We have to
Speaker 3: rely on.
Speaker 2: Side effects and symptom monitoring. But that is where a
Speaker 2: lot of this lipido talk comes from. With phanastride, that
Speaker 2: if you put a guy in phanasteride and the main
Speaker 2: sexual side effects, one is almost a guarantee, which is
Speaker 2: seman volume reduces, which makes sense because we know that
Speaker 2: the prostate makes semen, and so if you have a
Speaker 2: smaller prostate, it's not going to make it as much semen,
Speaker 2: so ejaculate volume goes down. Most guys not bothered by that,
Speaker 2: but from a fertility perspective it can be an issue.
Speaker 2: And one of the things when I'm counseling my young
Speaker 2: guys that are on phanastride. Is if we may have
Speaker 2: to modulate or even stop your phastride while you're trying
Speaker 2: to initiate a pregnancy, if you're seeing a dramatic loss
Speaker 2: of ejaculate volume, again, that's reversible. You stop the drug,
Speaker 2: prostate grows back, seminal volume comes back, and you're back
Speaker 2: to baseline. So no harm, no foul along aside, Yeah, weeks,
Speaker 2: six weeks to eight weeks. Yeah, so not that long.
Speaker 2: I mean things bounce back. If you're on it chronically,
Speaker 2: then it can take longer. But it's a good point. Actually,
Speaker 2: if you look at the maximal effects of finastride from
Speaker 2: a urinary standpoint. We looked at those studies when it
Speaker 2: first came out, is it takes about six months to
Speaker 2: get the maximal amount of prostate reduction, and after two years,
Speaker 2: a lot of guys, even in my age, in their
Speaker 2: fifties sixties, we can stop fanasteride and actually still get
Speaker 2: a really long durational response because we really knocked that enzyme,
Speaker 2: you know, to the ground for so long, and so
Speaker 2: it's a much longer acting enzyme. Which also I'm glad
Speaker 2: you brought that up because one of the other things
Speaker 2: that finasteride we know happens is it's a dose responsive drug,
Speaker 2: and it's also a really long enzyme blocker. So if
Speaker 2: I give a guy prostate dose as a finasteride, that's
Speaker 2: five milligrams a day, seven days a week. If I
Speaker 2: give a guy a loss doses tends to be one
Speaker 2: milligram a day, seven days a week. Now, this is
Speaker 2: not a medical school approved podcast in that this is
Speaker 2: we're going to talk off label. But one of the
Speaker 2: things I'm super interested in in general as a clinician
Speaker 2: is this concept of microdosing, where you find a drug
Speaker 2: that works for a disease state and you use it
Speaker 2: at a much lower dose to prevent that disease from
Speaker 2: ever happening. And we look at it in cholesterol levels,
Speaker 2: and you know, one of the newest things in cardiology
Speaker 2: is to take guys at borderline high cholesterol and put
Speaker 2: them on low doses of statins where you mitigate side
Speaker 2: effects but you also prevent them. Why wait for a
Speaker 2: guy to get a heart attack before you treat them
Speaker 2: with a statin? So why wait for a guy to
Speaker 2: get full blown erectile dysfunction before you put them on
Speaker 2: low doses to dalipha.
Speaker 3: We've been doing that for years.
Speaker 2: Maybe it's the same thing with an asteroide in that
Speaker 2: instead of having to take even a milligram a day,
Speaker 2: what if you just took three milligrams a week, so
Speaker 2: you've cut that dose in half. And again off label,
Speaker 2: off label, off label. Just to banner scream that this
Speaker 2: represents only the opinions of doctor Mills and no other
Speaker 2: legitimate healthcare agency in the world. But I do think
Speaker 2: that microdosing is a very interesting strategy and it may
Speaker 2: in fact mitigate some of these side effects. But it's
Speaker 2: a long acting enzyme, so if I give it a
Speaker 2: guy a pill on Monday, it'll actually still be in
Speaker 2: a system by Friday. So we may in fact, at
Speaker 2: our FDA approved dosing that got these things to the
Speaker 2: market for hair loss and for prostate reduction, we may
Speaker 2: be actually overtreated, and that might be part of the
Speaker 2: issue as well. I have a side question for it, yeah,
Speaker 2: and no bring it.
Speaker 6: If this is a total sidebar, then we can circle
Speaker 6: back to it later.
Speaker 3: We'll fix it in post. You will face it. There
Speaker 3: is no post.
Speaker 1: The other treatment that I often see for hair loss
Speaker 1: is I'm probably gonna butcher the pronunciation monoxidil.
Speaker 2: No, it's good.
Speaker 1: Does that have a similar My very loose understanding just
Speaker 1: from researching for this episode is that the side effects
Speaker 1: for that is it's less of a concern than an asteroide. Yeah,
Speaker 1: how do you balance those two? What are the pros
Speaker 1: and cons of both?
Speaker 2: Weather synergistic because you don't have to balance in anything.
Speaker 2: I mean, so monoxidil is it was originally studied as
Speaker 2: a as a pertensive drug or a blood pressure drug.
Speaker 2: And so again it goes back to one of these
Speaker 2: great things where you know, we started taking monoxideal I mean,
Speaker 2: this drug has been around for forty years. I can't
Speaker 2: even tell you how long it has been around. But
Speaker 2: also we noticed not only did blood pressure go down,
Speaker 2: although not very much, but guys, you know, retaining hair
Speaker 2: and it's actually a very effective treatment by helping open
Speaker 2: up the blood vessels so that the hair follicle is
Speaker 2: seeing better blood flow, better nutrients, and so they actually
Speaker 2: can work synergistically. And there's a topical form of monoxidill
Speaker 2: that you put on like a moose or nobody uses
Speaker 2: moose anymore. It's what is it, nineteen eighty five mills,
Speaker 2: but anyway, you put it on as a hair accoutremole
Speaker 2: and you rub it in and it works. And there's
Speaker 2: also a pill form Modoxida comes in two and a
Speaker 2: half and five milligrams, and I think that actually has
Speaker 2: a very clean side effect profile from sexual side effects
Speaker 2: because it's non hormonal, you know, works on the blood
Speaker 2: flow system. And so if you came to a physician
Speaker 2: that was treating hair loss, then maximum medical therapy would
Speaker 2: be some combination of medoxidil and finasteride and usually orally.
Speaker 2: You know, there are sort of you know, potions and
Speaker 2: lotions and things that aren't really FDA approved where people
Speaker 2: will compound you know, an asteroid, put it in the
Speaker 2: hair follicle, never really study, don't there's no data that
Speaker 2: it works. May there may be some transdermal absorption, but
Speaker 2: for the most part, you know, you need a prescription
Speaker 2: to get both of these drugs, thank goodness. And actually,
Speaker 2: I think you know it's time to then, now that
Speaker 2: we have a little bit of a background on how
Speaker 2: these drugs work, hormone blocker pros and cons, it is
Speaker 2: to say, well, why is this becoming a thing again?
Speaker 2: I mean, first of all, because you know, we've worried
Speaker 2: as men for centuries, if not eons about hair loss.
Speaker 3: Why it's kind of you know, it's central to who
Speaker 3: we are.
Speaker 2: And it also is one thing we didn't talk about
Speaker 2: in our nitrogoxide episode, but it's one of the first
Speaker 2: signs of aging. And if you're nineteen years old with
Speaker 2: some men have very early male pattern baldness, that that
Speaker 2: can devastate us. Right, It's one thing, I mean, out
Speaker 2: of all the things I do urologically that guys are
Speaker 2: self conscious about. You know, you can hide that with
Speaker 2: underwear and a belt and a pair of pants, right,
Speaker 2: but you can't. It's very difficult to mask hair loss
Speaker 2: and nless you're wearing hats or wearing some kind of
Speaker 2: you know, hair accessory, and so it's front and center
Speaker 2: every day you wake up, brush your teeth, wash your face,
Speaker 2: and you look at your hairline thinning. And so it
Speaker 2: makes us very vulnerable as men and women too. I mean, obviously,
Speaker 2: female hair loss is a whole other thing which which
Speaker 2: is even less socially accepted and so therefore even more
Speaker 2: traumatizing to our women out there that may be listening.
Speaker 2: And interestingly enough, both monoxidal and finasteride can work in
Speaker 2: women as well, totally different side effect profiles, a totally
Speaker 2: different podcasts. We'll have to bring somebody on that is
Speaker 2: on that side of the treatment spectrum. But it's a
Speaker 2: devastating issue, right, and it has not had a lot
Speaker 2: of research into it. It's, as far as we know,
Speaker 2: not associated with any long term other health concerns, and
Speaker 2: so it falls into the category of cosmetics, which I
Speaker 2: would say is not true because anything that affects our
Speaker 2: psychology and our mental health is not a psychological problem.
Speaker 2: But it is a true mental health problem, and so
Speaker 2: we do need solutions for this, right. And the other
Speaker 2: thing is if there's a market for it, what do
Speaker 2: you think happens? Just like you said, I mean, so
Speaker 2: talk to me about you know, a day in your
Speaker 2: in your Instagram feeds and your social media feeds.
Speaker 3: What are you seeing?
Speaker 2: You know, I have the name companies, but the bottom
Speaker 2: line you mentioned it is that people are out there
Speaker 2: trying to sell you something to maintain that lustrous hair.
Speaker 3: You have.
Speaker 1: Yeah, I mean, I notice a lot of my friends
Speaker 1: are similar age to me.
Speaker 6: Just seeing it get served up more and more often,
Speaker 6: and it definitely puts the thought in your head.
Speaker 1: I mean, I've thought more about it in the last
Speaker 1: six months than I ever have, just because it's been brought.
Speaker 5: To my attention.
Speaker 1: You know, I find myself now at age thirty eight,
Speaker 1: you know, staring at the mara of thinking, wait.
Speaker 2: Is this is this then that it used to be?
Speaker 1: And my dad got blessed and always say, you know,
Speaker 1: his hair is thinning, and he would always say it
Speaker 1: just means it more highly evolved there.
Speaker 2: I always liked, that's right. Yeah, So somebody is trying
Speaker 2: to sell you something somewhere, and I think that's what
Speaker 2: has happened.
Speaker 3: I mean, we've known.
Speaker 2: About post finasteride syndrome, which we'll get into here in
Speaker 2: a sec for years, and what it is we'll talk about.
Speaker 2: But definitely the side effect profile has I think been
Speaker 2: buried a little bit because there's this rush to sell
Speaker 2: you something and there's multiple direct to consumer venues that
Speaker 2: the business model is if you don't log out without
Speaker 2: a prescription, then they're not going to make money off you.
Speaker 2: And so I think any listener that out there listening,
Speaker 2: I want you to make sure that the people that
Speaker 2: are prescribing you hair loss drugs at least have told
Speaker 2: you some of the side effects, and I think that's
Speaker 2: where this is making the news again, is that as
Speaker 2: these companies have higher and higher valuations, are becoming more
Speaker 2: and more part of our daily dinner table discussions, which is,
Speaker 2: you know, this is American capitalism. I cannot possibly say
Speaker 2: anything bad about it because we all live and breathe
Speaker 2: this every day. But I can say caveat emptor, and
Speaker 2: so I think I think that's what I want, is
Speaker 2: to make sure that people are informed before they make
Speaker 2: the decision, because, as I led this podcast off with,
Speaker 2: I think these are amazing drugs, and I think they're
Speaker 2: in general for most men, really are fantastic. I mean,
Speaker 2: it decreases a number of surgeries we have to do
Speaker 2: on men as we age for prostate enlargement.
Speaker 3: There's no doubt.
Speaker 2: So if you can take a pill to stay out
Speaker 2: of my operating room so I don't have to do
Speaker 2: some procedure to reduce your PROSTA side, then take a
Speaker 2: pill as long as it works for you, and eventually
Speaker 2: you'll probably end up in my o R.
Speaker 3: But that's okay. I got time.
Speaker 2: I'm busy, and so I'll wait patiently as you're taking
Speaker 2: that finasteride and do tasterhide But if I didn't have
Speaker 2: the conversation at the beginning and say, hey, Jordan, these
Speaker 2: are great drugs. But here's the deal. Let's just really
Speaker 2: break it down. This is what I've seen over twenty
Speaker 2: plus years of practice and treating thousands of men on
Speaker 2: an annual basis. If they come in asking for an asteroide,
Speaker 2: or if I notice that they are concerned about their
Speaker 2: rapidly thinning hairline or rapidly enlarging prostate, We're going to
Speaker 2: talk about it, going to say, here's the deal. I
Speaker 2: have no idea. I can give you this pill and
Speaker 2: I can get a spill to one hundred guys. And
Speaker 2: ninety eight of those guys are going to say, Mills,
Speaker 2: that was fantastic. I'm peeing better, my hair is thicker,
Speaker 2: and this is the greatest drug ever. And two of
Speaker 2: those guys are going to say, oh, man, like, I mean, yeah,
Speaker 2: prostates better, hair is thicker. But I have no sex
Speaker 2: drive anymore. I'm feeling kind of grumpy, moody, actually even
Speaker 2: feeling like I don't really have much reason to live.
Speaker 2: And I certainly have noticed that I'm not getting erections anymore.
Speaker 2: Those are the guys that very small percentage, And I'm
Speaker 2: not going to put a number on it because the
Speaker 2: number is very, very difficult to quantify. In the original
Speaker 2: clinical trials, even that was part of the problem, is
Speaker 2: that they excluded men early on that started to have
Speaker 2: severe symptoms and they sort of cast them aside to
Speaker 2: the point where they didn't want them to be in
Speaker 2: the cohort. So we don't actually know what that number is,
Speaker 2: but it's small. But if that guy comes into my office,
Speaker 2: then that is a life that we seriously affected, not
Speaker 2: for the better, and all the pursuit of and in
Speaker 2: most cases hair hair restoration or hair maintenance. And so
Speaker 2: that's a tough trade off, is that. You know, if
Speaker 2: I ask a guy like we led with, you know,
Speaker 2: can you keep your hair and your erections, the answer
Speaker 2: is most likely yes, and yes you're probably going to
Speaker 2: be Okay. If we start this medicine, you have those
Speaker 2: side effects, we stop it. So let's talk about postpinasteroid syndrome.
Speaker 3: Do you know about it?
Speaker 2: Have you heard this term before at all? Is it
Speaker 2: making it into the zeitgeist only recently?
Speaker 1: Actually I've heard it more sort of described as depression
Speaker 1: and brain fog.
Speaker 2: Yeah, yeah, I think that's real. I mean, that's a
Speaker 2: pretty good description of what some of these men are
Speaker 2: suffering with. So it's twenty twenty six. I mean the
Speaker 2: first paper that came out on PFS was twenty twelve,
Speaker 2: you know, So it's not again overnight. It's been out
Speaker 2: for a long time. And it's a syndrome meaning is
Speaker 2: not a disease. Meaning a disease is you have appendicitis.
Speaker 2: If we don't take your mendex out and it ruptures,
Speaker 2: you're going to die. Syndrome meaning the constellation of symptoms
Speaker 2: doesn't have a clear ideology or a clear pathway for
Speaker 2: why it happens. And I think that's critical. And I
Speaker 2: think that any person that may be suffering from this,
Speaker 2: if you go to the doctor and they automatically discount you,
Speaker 2: which I see all the time, and say, you know,
Speaker 2: this isn't real, it is. It's real because you're feeling it,
Speaker 2: and there is enough of a mechanism that it may
Speaker 2: actually be something that is real that we have to address,
Speaker 2: and so let's talk about what it is.
Speaker 6: It's interesting to me, I'm just snaking right now. If
Speaker 6: there is any kind of diagnostic panel or something that
Speaker 6: you has done to kind of decide whether or not
Speaker 6: you would be somebody would be likely to be adversely
Speaker 6: affected by this.
Speaker 3: Yeah, you know, I mean we don't at this point.
Speaker 3: You know.
Speaker 2: One of the things that is kind of this new
Speaker 2: frontier in medicine is this personalized pharmacology where there are
Speaker 2: some available tests for certain drugs that you can screen
Speaker 2: to see if somebody is going to be a better
Speaker 2: responder or a worst responder. Usually has to do it
Speaker 2: the way liver metabolizes certain drugs, and there's enzomatic pathways
Speaker 2: that are upregulated or down regulated in certain people, but
Speaker 2: nothing yet for this.
Speaker 3: And so that would be amazing if I could say, hey.
Speaker 2: Look before I start you on this drug, which could
Speaker 2: be amazing for you, I want you to take this test,
Speaker 2: and if this test shows that you would be at
Speaker 2: risk for this, then you're not going to do it.
Speaker 2: And we remember we had doctor Sanloana a couple episodes
Speaker 2: ago and we talked about post vyseectomy pain syndrome. Again,
Speaker 2: another syndrome. We don't understand it, and we don't know
Speaker 2: who's going to get that and who isn't. And again,
Speaker 2: you take a very simple operation that six hundred plus
Speaker 2: thousand guys go through every year. The vast majority do
Speaker 2: amazingly well with it. And then every once in a
Speaker 2: while I gets this debilitating pain post vasectomy that we
Speaker 2: don't understand and we don't know. I don't know who
Speaker 2: that guy's going to be. It's just really is a
Speaker 2: roll of the dice. But I mean, thankfully, thankfully, thankfully,
Speaker 2: the dice are very loaded for a good outcome. But
Speaker 2: if you're one of those guys that suffers from it,
Speaker 2: you're one of those guys that suffers from it, and
Speaker 2: the goal for you out there listening is you're not
Speaker 2: suffering alone. There are resources and there are groups out
Speaker 2: there that can do some good. But I will say this,
Speaker 2: so one up your question Jordan and say that there
Speaker 2: are tests that if a guy comes in, and again
Speaker 2: I am not an expert in post finasteroid syndrome, please
Speaker 2: you know, find somebody that is. Although there are very
Speaker 2: few people out there that treat it. So if my
Speaker 2: office is flooded next week with guys that have this disease,
Speaker 2: I'm gonna I'm gonna work it up for you, But ultimately,
Speaker 2: just know that they're very As a urologists, there are
Speaker 2: very few things in my tool chest, but there are
Speaker 2: things that we're gonna look at. We're gonna look at
Speaker 2: a full hormone panel, right, because it does go back
Speaker 2: to the fundamentals that if if you started finasteride and
Speaker 2: you had any changes in your testoltram, maybe your testolstom
Speaker 2: is already low and it was inappropriately low for how
Speaker 2: high those DHT levels are yet at unfavorable ratio. Well,
Speaker 2: we're gonna at least look at that because I have
Speaker 2: had a little bit of success in treating guys hormonally
Speaker 2: in a couple of ways, either optimizing their testosterone or
Speaker 2: remember that other enzyme we talked about, aromatase and the
Speaker 2: estra dial pathway. There are blockers that we use mostly
Speaker 2: in male fertility to boost sperm function. But if I
Speaker 2: block eestra dial, then what do you think happens? The
Speaker 2: sink goes the other way and the drain goes down DHT.
Speaker 2: We elevate DHT levels and we see if that works. Now,
Speaker 2: what's the biggest downside to that hair loss? And so
Speaker 2: then you're back to this whole Gosh, dang it.
Speaker 3: I mean, like, I.
Speaker 2: Can't get out of this without the whole reason I
Speaker 2: went into this. In the first place, and I have
Speaker 2: treated some men, believe it or not. In fact, I'm
Speaker 2: thinking of one guy very recently who had a very
Speaker 2: low exposure to phanasteroide, and he had the effects, and
Speaker 2: yet he was willing to kind of dance a hormonal
Speaker 2: dance where he had a little bit of phnasteride side
Speaker 2: effects but able to stay on it maintain his hair
Speaker 2: by me optimizing testosterone. So again, there's not this binary
Speaker 2: world of where I have the worst symptoms of phenastoide syndrome,
Speaker 2: I have nothing going on at all. In fact, there's
Speaker 2: a spectrum where there may be an opportunity to optimize
Speaker 2: hormone balance. Let me throw someone else at there, at you.
Speaker 2: There's a guy, good friend and researcher, Erwin Goldstein, who's
Speaker 2: looked at ultrasounds of men that have purportedly have PFS,
Speaker 2: and it's seen that there are some structural changes in
Speaker 2: the penis of some guys where the DHT receptor there
Speaker 2: again is active until you know we're late in puberty,
Speaker 2: and then it shuts down. Therefore, you know your penile
Speaker 2: growth sadly for some of us, sutch down at some
Speaker 2: place where that's as good as you're going to get
Speaker 2: right whether you're nineteen or twenty two. But if those
Speaker 2: receptors are still open you hit them with an asteroide,
Speaker 2: then they may actually develop smooth muscle atrophy, which looks
Speaker 2: kind of like almost a Swiss cheese looking appearance on
Speaker 2: an ultrasound. And so there may be some data directly
Speaker 2: showing that an asteroid can be bad for penile health
Speaker 2: and development.
Speaker 3: There weren't controlled, in other.
Speaker 2: Words, they weren't blind did where you would take an
Speaker 2: ultrasound of a guy that doesn't have it and you
Speaker 2: look at that and you have to guess who's got
Speaker 2: phanasteroide syndrome and who doesn't. So it's interesting but not
Speaker 2: level one evidence. But the bottom line is again there
Speaker 2: may be anatomic issues with a very small subset of
Speaker 2: guys that take fanasteride.
Speaker 3: So then that brings us to the penis.
Speaker 2: So if I can treat a guy from some of
Speaker 2: the libido issues, the depression issues with some other kind
Speaker 2: of pharmacologic or hormonal intervention, is everything we can do
Speaker 2: to the penis. And the one thing that we haven't
Speaker 2: talked about a lot, and it does fall into this
Speaker 2: newly approved, still not amazing data of something called low
Speaker 2: intensity shockwave therapy. And I'm throwing out all kinds of
Speaker 2: terms that people are going to have to look up
Speaker 2: and we'll have episodes on it. But shockwave therapy can
Speaker 2: help decrease the amount of collagen deposition in any structure,
Speaker 2: whether it's a penis or the joint. And what that
Speaker 2: does is it allows for better smooth muscle development, because
Speaker 2: one of the signs of atrophy anywhere is increase in
Speaker 2: collagen deposition, and in the penis that looks like where
Speaker 2: the smooth muscle becomes less elastic and more fibrotic and
Speaker 2: less able to trap blood in there and give us
Speaker 2: good directions. And so shockwave actually may be a reasonable
Speaker 2: adjunct to hormonal therapy to help reverse some of the
Speaker 2: effects at PFS. So again it goes back to you're
Speaker 2: probably gonna be okay if you have even the worst
Speaker 2: of this. There are therapies out there for you. And
Speaker 2: again the goal is to find people, physicians, providers, therapists
Speaker 2: even because you are going to need therapy for this.
Speaker 2: I mean, this is a devastating psychological condition that has
Speaker 2: physical manifestations, So you need a good team around you.
Speaker 2: And again, as I said, there are support groups out
Speaker 2: there to help people find people in your area that
Speaker 2: may be able to help. But I want to leave
Speaker 2: guys with and then obviously open up to all kinds
Speaker 2: of your questions because your brain, I can tell, is
Speaker 2: going into Jordan rapid fire question mode. But the bottom
Speaker 2: line is that this for the vast majority of guys
Speaker 2: is a you know, it's a really safe, really effective medication.
Speaker 2: But if you're one of those guys that has this
Speaker 2: effect in this PFS, it can be pretty rough, you know,
Speaker 2: and so we have to acknowledge that. But again, get
Speaker 2: the help you need. It's out there and most likely,
Speaker 2: you know, it's either, if not reversible, at least treatable.
Speaker 2: So that's my soapbox is, medicine has to be individualized.
Speaker 3: We're not all the same.
Speaker 2: This is not a new phenomenon by any means, just
Speaker 2: because it's making the social media rounds now, it's been
Speaker 2: around for thirty plus years. Papers have been out since
Speaker 2: twenty twelve. But I do have to say that if
Speaker 2: a guy wants to start this, if he clicks on
Speaker 2: one of those feeds and he's able to get finasteride
Speaker 2: delivered in a nice discrete envelope to his doorstep. Then
Speaker 2: bully for that company, but make sure you understand what
Speaker 2: you're getting yourself into. And I just don't recommend this
Speaker 2: is a drug that you should be ordering online. I
Speaker 2: do think you can find a physician to have the
Speaker 2: actual conversation with in person that can really help you,
Speaker 2: you know, navigate some of the downsides, because what happens
Speaker 2: if you do have an adverse reaction and you're going
Speaker 2: through an online company, You're gonna end up in my
Speaker 2: office anyway, and by that time, you know, damage has
Speaker 2: been done that we may have been able to thwart earlier.
Speaker 2: So that is my shout out to all of us
Speaker 2: hardworking brick and mortar physicians that are that are still
Speaker 2: punching a clock and taking care of guys when we're
Speaker 2: not podcasting in our oodles of spare time.
Speaker 3: Lay it on me, brother, what you got for me?
Speaker 6: I know you just did our patented You'll probably be
Speaker 6: okay segment.
Speaker 1: So I'm not trying to be a lot of us,
Speaker 1: but I we better should we should shout lawyers on that.
Speaker 3: Yeah, thank you.
Speaker 6: I wanted to put two points together and just explicitly
Speaker 6: ask you this we mentioned earlier. In the episode that within,
Speaker 6: you know, as little as six weeks after you stop
Speaker 6: taking the medication, a lot of the issues that you
Speaker 6: could have, a lot of the side effects will work
Speaker 6: their way out of your system.
Speaker 5: Is there a scenario where that's not the case?
Speaker 2: Yeah, oh yeah, yeah, so exactly. I mean I think
Speaker 2: that then. By the way, this is one hundred percent
Speaker 2: Mills hypothesis, right, and I alluded to it earlier, But
Speaker 2: what I've noticed in all my years of practice is
Speaker 2: that the younger the guy is when he gets his
Speaker 2: first exposure to finasteroid, the more likely he is to
Speaker 2: exhibit these symptoms that may not get better. And I
Speaker 2: think it goes back to this receptor activity in DHD
Speaker 2: that we know it turns off in the penis after
Speaker 2: a certain age. We don't know what's happening in the
Speaker 2: hypothalamus in the prefrontal cortex as much, because again, those
Speaker 2: are not areas that we can study except for maybe
Speaker 2: with you know, again, this would be a great study,
Speaker 2: which nobody would ever sponsor because these are all generic
Speaker 2: drugs and and I don't think any of the DTC
Speaker 2: companies are going to want to put forward eight hundred
Speaker 2: million dollars in a study. But imagine if you did
Speaker 2: a functional MRI study where you put two guys in
Speaker 2: an MRI, one on finasteride and one not that, then
Speaker 2: one that has potentially PFS, and then you know, you
Speaker 2: give them explicit material to look at or some way
Speaker 2: to stimulate them see what lights up in the brain.
Speaker 2: And my hypothesis is that guys that have the PFS
Speaker 2: or that early exposure that DHT part of the prefrontal
Speaker 2: cortex is not going to light up as much as
Speaker 2: to be like man, whatever, you know, I'd rather have
Speaker 2: a sandwich now, And I think that probably would be
Speaker 2: the only way to really study this to know are
Speaker 2: the guys that have a much more difficult time reversing
Speaker 2: this or the guys that are going to have to
Speaker 2: relearn neuropathways. I mean, one of the great things, you know,
Speaker 2: we we we're going to have some neuroscientists on this
Speaker 2: show in the next few weeks and also some therapists
Speaker 2: that talk about changing habits and redoing neural pathways, because
Speaker 2: there is this idea of neuroplasticity where if something gets
Speaker 2: knocked out, your brain can find other ways to make
Speaker 2: those pathways connect. And so maybe that's the direction we
Speaker 2: need with these guys that have the devastating psychiatric psychological
Speaker 2: complications at PFS. But I do think the younger the exposure,
Speaker 2: the more devastating it is. Now I've seen guys older
Speaker 2: guys that and I think one in particular is a
Speaker 2: very very prominent man that has a very healthy, wonderful
Speaker 2: sex life well into his seventies, who was started by
Speaker 2: his well intentioned neurologist on fanastride because he was having
Speaker 2: difficulty with his prostate, as happens to us as we
Speaker 2: age and immediately is like a switch turned off. He
Speaker 2: lost his libido, he lost his ejaculate, and it just
Speaker 2: erected him for a little while. But again he came
Speaker 2: to me, we stopped it, we rebalanced as hormones and
Speaker 2: all faculties came back online. I think by the time
Speaker 2: you hit seventy, you have compensatory mechanisms and altered pathways,
Speaker 2: and also your exposure may be a little bit more
Speaker 2: dose responsive as opposed to irreversible from something that's happening
Speaker 2: in the brain to younger brains. But I don't know,
Speaker 2: you know, there's never been That's my hypothesis. I don't
Speaker 2: think anybody else has shared that to my knowledge, because
Speaker 2: if you try to do a PubMed search on post
Speaker 2: fnasteroid syndrome, it'll barely fill a page. You know, there's
Speaker 2: not a lot of high research and certainly no level
Speaker 2: one research on it. There's no new randomized pacefical controlled
Speaker 2: trials putting guys on it and actually targeting those questions.
Speaker 2: In the initial clinical trials I got to market, you know,
Speaker 2: the sexual side effects were just kind of me you know,
Speaker 2: they weren't really the target end goal. It was much
Speaker 2: more you know, what's your hair production and what is
Speaker 2: your prostate scores? In other words, you know, your urination improvements,
Speaker 2: all that stuff. So yeah, so I mean we need
Speaker 2: to do that study, but it's never going to get done, Jordan.
Speaker 2: I mean, you know, with NIH funding at an all
Speaker 2: time low and no company wanting to take this up,
Speaker 2: it's just going to have to be trial and error,
Speaker 2: unfortunately for the guys out there. As sad as that
Speaker 2: sounds for somebody that may be suffering from this condition,
Speaker 2: but again, don't give up hope, because we can try
Speaker 2: a lot of things before we say there's just nothing
Speaker 2: else we can do. But it's not going to be
Speaker 2: from your urologist, it's going to be from a multidisciplinary
Speaker 2: group of people that are going to have to work
Speaker 2: together or at least in tandem to figure out how
Speaker 2: to to get you back to where you're feeling some
Speaker 2: degree of yourself. Again, a lot of considerations.
Speaker 1: So I guess the ending point is maybe don't click
Speaker 1: the Instagram ad and buy it from a doctor who
Speaker 1: maybe isn't even a doctor, could.
Speaker 5: Be chut GPT just setting you stuff in the discrete box.
Speaker 7: Yeah.
Speaker 3: You know.
Speaker 2: The other thing really bugs me about that is that
Speaker 2: that these drugs are you know, they're generic, and they're
Speaker 2: they're cheap as water, and so the whole business model
Speaker 2: of just having a telehealth visit where you know, you
Speaker 2: don't make money until you sell a drug, it just
Speaker 2: hurts a little bit. I've spoken about this before. Yeah,
Speaker 2: I've published on this in medical journals, about the fact
Speaker 2: that we lose something with this interaction. But I also
Speaker 2: understand the entrepreneurial spirit that made this country great, and
Speaker 2: so it's really a call to action for my other
Speaker 2: physicians out there to see these guys, make yourself accessible,
Speaker 2: come up with an algorithm, a pathway that you can
Speaker 2: see them and then be able to screen for these
Speaker 2: side effects and do something about it if they have it,
Speaker 2: because there's nothing probably more alone feeling and a guy
Speaker 2: out there that gets a prescription online thinking that it's
Speaker 2: going to change his life, because the guys on the
Speaker 2: sports commercials look amazing when they do whatever it is
Speaker 2: they're doing and taking and then realize they had a
Speaker 2: bad reaction.
Speaker 3: And what do you do. You don't go to the er.
Speaker 2: What do you call your primary doc and say, hey,
Speaker 2: by the way, I mean, you know, no judgment zone.
Speaker 2: I would say, yeah, you know, even if guys, you know,
Speaker 2: I have made a career out of taking care of
Speaker 2: guys that do things that they wish they hadn't. But
Speaker 2: we can still, you know, salvage a pretty down good
Speaker 2: life if we figure out how to break it down
Speaker 2: into the fundamentals and so so, yeah, don't give up, hope,
Speaker 2: And if you click on it, just know that this
Speaker 2: could be one of the bad side effects. Wow, dude,
Speaker 2: this was heavy.
Speaker 1: I was going to say, yeah, that's got a lot
Speaker 1: heavier than long luscious hair.
Speaker 2: Yeah, yeah, yeah, I mean it's important, I think is
Speaker 2: you know, there's a lot of times to have fun
Speaker 2: and make light of things. And I think this is
Speaker 2: one of these things that almost is more of a
Speaker 2: I don't want to use the word political, but at
Speaker 2: least something, oh Corona, that I had to talk about
Speaker 2: to say, look, you know what this is out there.
Speaker 2: You need to be armed as a consumer and as
Speaker 2: a patient with the knowledge that you can make really
Speaker 2: good healthcare decisions when sometimes you're not even having your
Speaker 2: doctor in the room to make those decisions for you
Speaker 2: or with you. And I think I think that's the
Speaker 2: TAKEO message, and that makes it worth it. I do.
Speaker 2: I'm not discouraging anybody out there from seeking treatment to
Speaker 2: keep that beautiful head of hair as long as you can,
Speaker 2: and seek alternatives too if you can as well. I mean, again,
Speaker 2: we meet people where they're at, and that's the goal
Speaker 2: of this whole venture in my practice as well as
Speaker 2: my podcast, is to meet guys where they're at, not
Speaker 2: be judgmental, figure out a solution that works for everybody,
Speaker 2: and deliver and deliver on the mail room an offline.
Speaker 5: I gotta ask you, what do you use here? Looks great?
Speaker 2: Oh yeah, I don't know. I have a guy for that.
Speaker 2: I can't remember. Honestly, it's a well, let me see. Well,
Speaker 2: we'll look at sponsorship for us. You know, that's right. Yeah, yeah,
Speaker 2: brill cream just to dabble, do you. You know, the
Speaker 2: girls will flock right to you. I don't even think
Speaker 2: brill Cream's on the market anymore. But by Talus talents,
Speaker 2: by Talas. Yeah, that in a and then a Burma shave,
Speaker 2: you know those are That's what I that's my go to.
Speaker 5: We're gonna be sponsored purely by companies that no longer exist.
Speaker 2: That's right, You're dang right, and I'm proud of it.
Speaker 2: That keeps it real too much fun. Well, all right,
Speaker 2: we we did it and uh and really I I
Speaker 2: hope everybody out there got a little bit of some
Speaker 2: out of this. That that if you're a guy or
Speaker 2: loves a guy, that's that that is having issues either
Speaker 2: with reactions to an asteroid ditasteride, or are interested in
Speaker 2: hair restoration. There's lots and lots of resources out there
Speaker 2: for you. Just vet them first, man, just like anything else.
Speaker 2: If it's too good to be true, damn it, it's
Speaker 2: too good to be true. Jordan Man, I'll see you
Speaker 2: next time.
Speaker 5: Brother, Doctor Milsey delivered, Thank you, sir.
Speaker 7: Hell yeah, let's talk about it.
Speaker 2: Let's talk about him, the hero. Let's talk about it.
Speaker 2: Let's talk about him, a man hero.
Speaker 7: Let's talk about it.
Speaker 2: That.
Speaker 1: The mail Room with Doctor Jesse Mills was a production
Speaker 1: of iHeartRadio. It was executive produced by Jordan Runthog. It
Speaker 1: was edited, mixed, and mastered by Beheid Fraser, and the
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Speaker 1: is intended for educational and informational purposes only. It is
Speaker 1: not a substitute for professional medical advice, diagnosis, or treatment.
Speaker 1: Consult your healthcare provider for any medical or other related
Speaker 1: questions or concerns. The views and discussions aired on this
Speaker 1: podcast are those of doctor Mills and do not represent
Speaker 1: the official positions of UCLA or UCLA Health