WEBVTT - Make America Hairy Again: The Truth About Post-Finasteride Syndrome 0:00:00.600 --> 0:00:01.680 Let's talk about it. 0:00:03.680 --> 0:00:05.400 Let's talk about the man. Hero. 0:00:08.840 --> 0:00:09.960 Let's talk about it. 0:00:11.920 --> 0:00:13.920 Let's talk about the man hero. 0:00:17.000 --> 0:00:20.720 Welcome to the man, Welcome back to the mail room. 0:00:20.800 --> 0:00:22.919 Jordan runs out, how in the hell are you? Did 0:00:22.960 --> 0:00:26.040 you survive? Santa Monica? I gotta let everybody know? So 0:00:26.400 --> 0:00:28.960 one of the they say, you never you never want to. 0:00:28.960 --> 0:00:29.560 Meet your heroes. 0:00:29.600 --> 0:00:32.000 But but Jordan and I actually, you know, he's not 0:00:32.400 --> 0:00:34.040 just sort of above the chest guy. 0:00:34.080 --> 0:00:38.360 I mean, he's living, walking human being, is. 0:00:38.320 --> 0:00:42.199 A three dimensional as delightful in person as he is 0:00:42.600 --> 0:00:47.080 on camera as well as behind the mic. And uh, 0:00:47.120 --> 0:00:50.080 this is humanism and radio right here. But so Jordan 0:00:50.200 --> 0:00:52.840 came out to Santa Monica a couple of weeks ago 0:00:53.200 --> 0:00:56.000 for the iHeartRadio Awards show out here. I believe, right, 0:00:56.080 --> 0:00:57.200 Is that what your thing was? 0:00:57.400 --> 0:00:57.760 Yeah? 0:00:57.920 --> 0:00:59.720 That was very fun. Yeah, we got to see I 0:00:59.800 --> 0:01:04.000 got to be a room with Taylor Swift, Travis Kelsey, 0:01:04.280 --> 0:01:07.600 heard of John Mellencamp doing his best. Would he got three? 0:01:07.640 --> 0:01:08.360 You would have loved it? 0:01:08.480 --> 0:01:09.160 Oh my god. 0:01:09.240 --> 0:01:12.880 I saw John Mellencamp in a what was it, Rock 0:01:12.959 --> 0:01:16.319 the Vote? That was one of his early political things. 0:01:16.319 --> 0:01:19.319 I saw him in La probably like an eighty seven. 0:01:19.720 --> 0:01:22.319 It was an amazing concert eighty seven eighty eight, and 0:01:22.600 --> 0:01:26.480 uh yeah, just what a performer, what a what a legend? 0:01:26.680 --> 0:01:26.959 Do you know? 0:01:27.040 --> 0:01:27.959 The cool thing about him? 0:01:27.959 --> 0:01:29.720 I just read the other day he's a big Indiana 0:01:30.000 --> 0:01:34.440 football supporter and also a chainsmoker, and so which is 0:01:34.480 --> 0:01:36.600 you know, not endorsed by the mail room until Big 0:01:36.640 --> 0:01:39.080 Tobacco wants to sponsor us. But but it's never gonna happen. 0:01:39.120 --> 0:01:42.360 I promise, I got my morals and ethics. But yeah, 0:01:42.360 --> 0:01:46.000 but they supposedly build a box for him in the stadium, 0:01:46.040 --> 0:01:47.800 like at the very top where you could go you 0:01:47.840 --> 0:01:50.880 can watch the game and smoke. I mean, that's that's 0:01:50.960 --> 0:01:54.440 a donor donor money going to good use. I think 0:01:54.600 --> 0:01:56.040 we just have to look the other way on that 0:01:56.080 --> 0:01:58.640 because he is John Mellencamp. But he's already survived heart 0:01:58.640 --> 0:02:02.360 attacks and bypass surgery. You know, maybe that's that nickedtine, 0:02:02.440 --> 0:02:05.040 that's you know, Actually, this is a strange tagaway as 0:02:05.080 --> 0:02:07.520 things always happen into what we're going to talk about 0:02:07.520 --> 0:02:10.840 on the show today, which is that individualized medicine and 0:02:10.880 --> 0:02:16.400 individualized results to medications is really important and not everybody's 0:02:16.440 --> 0:02:18.440 going to respond to the same drug in the same way. 0:02:18.520 --> 0:02:21.119 So you know, there are people that can smoke until 0:02:21.120 --> 0:02:23.280 they're ninety or one hundred years old, and they say 0:02:23.160 --> 0:02:27.320 their secret to longevity is a cigar, three cigarettes a day, 0:02:27.320 --> 0:02:29.480 and a shot of whiskey, and you can't take that 0:02:29.520 --> 0:02:33.160 away from them. Their genome is allowing them that kind 0:02:33.200 --> 0:02:35.920 of well, what's the word, I guess large, Yes, to 0:02:36.080 --> 0:02:39.000 let them live their best lives with tobacco and whiskey. 0:02:39.040 --> 0:02:42.160 But you know, the exact opposite of that is what 0:02:42.360 --> 0:02:44.760 you and I got to do when we were in 0:02:45.080 --> 0:02:45.720 Santa Monica. 0:02:45.800 --> 0:02:48.600 So tell tell me about our experience. 0:02:48.600 --> 0:02:51.800 Your kid in the candy storm moment, when this mythical 0:02:51.840 --> 0:02:54.680 place that also is real opened up your eyes to 0:02:54.800 --> 0:02:56.320 what Santa Monica is all about. 0:02:56.880 --> 0:02:58.000 I could believe it, folks. 0:02:58.200 --> 0:03:00.440 I finally went to Erwon, which if you're in the 0:03:00.440 --> 0:03:02.600 East Coast maybe you've never heard of. 0:03:02.720 --> 0:03:04.280 If you're on the West coast, you're laughing at me 0:03:04.360 --> 0:03:06.160 right now because I know that as a staple of 0:03:06.160 --> 0:03:10.560 your diet. I'm sure these smoothies they're they're they're magical. 0:03:10.600 --> 0:03:13.080 I've actually been craving smoothies every day since. 0:03:13.280 --> 0:03:17.240 It's ridiculous, right, Yeah, they're colors that don't appear in nature. 0:03:17.480 --> 0:03:19.600 Mine was like this blue one yours was I think 0:03:19.639 --> 0:03:20.840 pink or maybe around. 0:03:20.960 --> 0:03:23.720 It's some kind of algae and spiral leasion and ground 0:03:23.800 --> 0:03:25.520 up help. It does appear in nature, Drew And by 0:03:25.520 --> 0:03:28.160 the way, no sponsorship from Eriwan. Yes, but it's a 0:03:28.160 --> 0:03:30.160 good it's a I mean yet, that's right, it's a good. 0:03:30.320 --> 0:03:33.200 It's a good bit. But yeah, I mean it. It's 0:03:33.320 --> 0:03:36.480 so annoying to me because I have these very strong, 0:03:36.760 --> 0:03:41.160 farm rooted Midwestern sensibilities and to go in and drop 0:03:41.200 --> 0:03:43.760 twenty bugs in a smoothie, it just makes me cringe. 0:03:43.800 --> 0:03:45.920 It makes my I think of my grandparents in the 0:03:45.960 --> 0:03:48.960 throes of the Great Depression, you know where, where twenty 0:03:48.960 --> 0:03:51.080 bucks would get them through a year, and here I 0:03:51.120 --> 0:03:55.280 am dropping this on a Turmerican beat smoothie. But but anyway, 0:03:55.360 --> 0:03:57.520 I mean, it's real. We got to do it. That's uh, 0:03:57.840 --> 0:04:00.800 you know, that's living our best lives. And yeah, you 0:04:00.800 --> 0:04:02.520 know once a month or so ain't bad. That won't 0:04:02.520 --> 0:04:04.840 break the bank. But anyways, so good to see you 0:04:04.880 --> 0:04:07.800 and you made it back to Brooklyn and back in 0:04:07.840 --> 0:04:10.200 the studio and ready to lay down some tracks. 0:04:10.400 --> 0:04:11.040 I cannot wait. 0:04:11.080 --> 0:04:13.480 Actually, I have a question for you related to two 0:04:13.560 --> 0:04:18.719 things that we just spoke about, grandparents and individual response 0:04:18.800 --> 0:04:21.520 to what I'll loosely describe as medicine. 0:04:21.560 --> 0:04:26.320 I had a friend whose grandmother swore that her secret 0:04:26.360 --> 0:04:30.520 to longevity, and I believe she broke a hundred. She 0:04:30.560 --> 0:04:34.200 would fry bacon for her husband or eventually herself after 0:04:34.240 --> 0:04:37.880 he died, pour the grease into a little shot glass, into. 0:04:37.720 --> 0:04:40.440 A shot of bacon grease every morning. 0:04:40.560 --> 0:04:43.280 And she claimed that that was her secret to life. 0:04:43.320 --> 0:04:44.840 I would love to know what you think about this. 0:04:45.120 --> 0:04:49.800 Well. I think that the secret to life probably is 0:04:49.920 --> 0:04:53.479 these rituals that make you feel grounded every day, you know, 0:04:53.560 --> 0:04:56.040 like we ask all of our guests, you know, what 0:04:56.080 --> 0:04:58.120 do you do every day to make you you? And 0:04:59.080 --> 0:05:01.200 if we had her on, she would say, I drink 0:05:01.200 --> 0:05:03.479 bacon grease, Jordan and doctor Mills. That's what I do. 0:05:04.000 --> 0:05:05.760 I'm not gonna take that away from her. I don't 0:05:05.760 --> 0:05:08.360 think the health benefits are there, but maybe there's some 0:05:09.240 --> 0:05:12.920 meato privileged aspect of bacon grease. It's definitely not the nitrites. 0:05:12.960 --> 0:05:14.880 I think, you know, God bless her, you're not getting 0:05:15.040 --> 0:05:18.760 stomach cancer or something. But again you know, she didn't 0:05:18.800 --> 0:05:22.279 have the genetic predisposition to some kind of nitrite reaction, 0:05:22.360 --> 0:05:25.680 and therefore she can handle I imagine process bacon. Maybe 0:05:25.680 --> 0:05:28.200 it was organic, maybe it was from marijuana. Doubt it, 0:05:28.839 --> 0:05:30.760 doubt it. Oh there, it's been around a while. You know, 0:05:30.800 --> 0:05:34.200 it's not a new store by any means. Bacon smoothie, 0:05:34.400 --> 0:05:35.320 Bacon smoothie. 0:05:35.360 --> 0:05:35.960 Well there it is. 0:05:36.279 --> 0:05:40.200 Yeah, yeah, I keep pitching for my daily Sialis smoothie. 0:05:40.200 --> 0:05:41.200 You know the tadala field. 0:05:41.279 --> 0:05:44.080 Just grind it up, and you know that's your secret 0:05:44.120 --> 0:05:46.560 to nitri cockside boosting. 0:05:46.880 --> 0:05:47.680 So anyway, you know. 0:05:47.720 --> 0:05:49.680 Look out money on the table. Yeah, that's money at 0:05:49.680 --> 0:05:52.800 the table, that's right. Yeah, it's the it's the longevity 0:05:52.839 --> 0:05:55.200 over fifty smoothie. The geeze are smoothie. But I don't 0:05:55.240 --> 0:05:57.520 think it'll really sell now with an aim like that. 0:05:57.800 --> 0:06:00.920 All right, So here's the thing. There is a riddle. 0:06:01.320 --> 0:06:03.800 It's a rhetorical riddle. I mean, if I let the 0:06:03.839 --> 0:06:06.039 mic drop just long enough, you can try to guess. 0:06:06.080 --> 0:06:09.240 But what are the two things every guy is afraid 0:06:09.279 --> 0:06:11.600 to lose and thinks he has to choose between. 0:06:12.440 --> 0:06:13.960 I'm gonna say potency and hair? 0:06:14.480 --> 0:06:18.280 Damn I'll come on, you read the script that doesn't exist. 0:06:18.360 --> 0:06:21.920 That's right, his erections in his hairline, That's what I 0:06:21.960 --> 0:06:24.400 was going with. That exactly right. And I see it 0:06:24.480 --> 0:06:26.799 every day in my practice, and I see it also. 0:06:26.839 --> 0:06:29.440 I think because people are asking about it, there is 0:06:29.480 --> 0:06:33.279 this prevalence in the zeitgeist and maybe in our constant 0:06:33.279 --> 0:06:38.279 pursuit for more clickbait and content. We're revising something that's 0:06:38.320 --> 0:06:40.520 really been a debate for over thirty years, so this 0:06:40.600 --> 0:06:43.200 is not new. But what I'm talking about is finasteride 0:06:43.240 --> 0:06:46.320 and its cousin detasteride, and I'll think it's coming up for. 0:06:46.320 --> 0:06:47.080 A lot of reasons. 0:06:47.160 --> 0:06:49.800 And we're going to get into this because right now, 0:06:49.839 --> 0:06:55.000 I think the prevailing wisdom in the social media spase 0:06:55.080 --> 0:06:57.760 is that this is an evil drug and it will 0:06:57.760 --> 0:06:59.440 take away a guy's erections. 0:06:59.480 --> 0:07:00.719 Is libido his life? 0:07:00.800 --> 0:07:03.200 And I'm going to discount that because I do see 0:07:03.240 --> 0:07:07.920 guys in my practice that have these side effects from finasteride, 0:07:08.640 --> 0:07:12.200 and they're very potent and they can really wreck somebody's life. 0:07:12.200 --> 0:07:13.080 But we have to unpack it. 0:07:13.160 --> 0:07:16.400 We have to figure out what's real, what's mythological, And again, 0:07:16.600 --> 0:07:19.600 we want to be one voice above the din here, 0:07:19.880 --> 0:07:23.440 and that is our voice, maybe two voices, Jordan's voice 0:07:23.440 --> 0:07:25.840 of keeping me on task in my voice of saying, 0:07:26.240 --> 0:07:29.080 there is some medical basis to why it's such an 0:07:29.120 --> 0:07:31.560 amazing drug and why it does such good for the 0:07:31.640 --> 0:07:34.080 vast majority of guys that take it, but also why 0:07:34.120 --> 0:07:38.440 it could have a dark, ugly secret. And that's organ 0:07:38.520 --> 0:07:40.720 unpack today. So let's talk about this a little bit. 0:07:41.480 --> 0:07:43.640 What is fanaster, right, tell me what you're understanding is 0:07:43.680 --> 0:07:45.920 what's out there, and let me want to one this 0:07:46.000 --> 0:07:47.400 a little bit for our audience. 0:07:48.160 --> 0:07:50.040 I see that getting served up to me and a 0:07:50.040 --> 0:07:52.920 lot of guys my age or approaching their forties just 0:07:52.960 --> 0:07:56.120 on Instagram, ads and things through you know sites. I 0:07:56.120 --> 0:07:58.640 won't mention their names, but worked you can just kind 0:07:58.640 --> 0:08:01.680 of order it online with it, you know, a very 0:08:01.680 --> 0:08:04.760 hastily obtained doctor's note. Either spray or oral. 0:08:05.080 --> 0:08:08.120 My understanding of it is to kind of slow hair. 0:08:08.000 --> 0:08:10.400 Loss as opposed to any kind of regrowth's that's sort 0:08:10.440 --> 0:08:11.760 of the extent of my knowledge. 0:08:11.920 --> 0:08:13.480 I don't know too much about how it works. 0:08:13.520 --> 0:08:15.800 That was more well, and I ask you about but oh. 0:08:15.640 --> 0:08:17.760 Yeah, that was kind of more. My understanding was that 0:08:17.760 --> 0:08:19.480 it was either spray or an oral pill. 0:08:20.120 --> 0:08:23.440 Nice, let me do the heavy lifting again. I love it. So, yes, 0:08:23.640 --> 0:08:24.400 that is right. 0:08:24.640 --> 0:08:27.160 It is a hair loss drug, but it wasn't designed, 0:08:27.640 --> 0:08:29.960 you know, in the lab for that it was. 0:08:30.200 --> 0:08:32.480 It was actually a hormone. 0:08:32.520 --> 0:08:35.600 It is a hormone blocker, but it was designed to 0:08:35.640 --> 0:08:38.319 shrink a guy's prostate. And like all wonderful accidents in 0:08:38.360 --> 0:08:42.280 the world of pharmacology, guys were also noticing that their 0:08:42.480 --> 0:08:45.480 hair actually was getting thicker. So it actually can promote 0:08:45.520 --> 0:08:48.880 hair regrowth to a certain extent, but it does stabilize 0:08:49.760 --> 0:08:53.400 follicle degeneration. And so the guys that were saying, gosh, 0:08:53.400 --> 0:08:55.360 this is great. Not only am I being better because 0:08:55.360 --> 0:08:57.760 I'm on a drug to help my prostate, but my 0:08:57.760 --> 0:09:01.520 hair is coming back. So that sounds amaz and it 0:09:01.559 --> 0:09:06.360 is now. Unfortunately there was in the original studies. Now 0:09:06.360 --> 0:09:07.959 this is empty approved all the way back in the 0:09:08.000 --> 0:09:09.880 early nineties, so this is not a new drug by 0:09:09.920 --> 0:09:11.000 any means. 0:09:11.440 --> 0:09:12.760 But there was a certain. 0:09:12.559 --> 0:09:16.120 Subset of guys that in that early population, and this 0:09:16.160 --> 0:09:18.840 is where it gets a little bit fudgy, and where 0:09:18.600 --> 0:09:21.199 there may have been some trouble in terms of how 0:09:21.240 --> 0:09:24.080 the side effects were reported and may have been buried 0:09:24.120 --> 0:09:24.560 by some. 0:09:24.440 --> 0:09:25.440 Of the original studies. 0:09:25.440 --> 0:09:27.080 But the bottom line is, I mean, I remember when 0:09:27.080 --> 0:09:30.080 this drug came out and it was a oh yeah, 0:09:30.120 --> 0:09:33.760 this is a great drug for BPH benign prostact hyperplesia. 0:09:34.080 --> 0:09:36.320 It makes you urinate better, not get up at night, 0:09:37.080 --> 0:09:40.520 and also reduces your PSA, which we had the big 0:09:40.640 --> 0:09:44.360 episode series with Doctor Brisbane on in terms of your 0:09:44.400 --> 0:09:46.880 screening for prostate cancer. PSA is that blood test. If 0:09:46.920 --> 0:09:49.240 you remember that the higher it is, the more likely 0:09:49.720 --> 0:09:51.680 you have prostate cancer. And so you have a drug 0:09:51.720 --> 0:09:54.360 that actually reduces the PSA. And there was even some 0:09:54.400 --> 0:09:57.840 thought that finasteride at one point and detest ride might 0:09:57.960 --> 0:10:02.080 actually prevent prostate cancer that to never really hit. The 0:10:02.120 --> 0:10:03.840 FDA in fact looked at it and said, nah, we 0:10:03.880 --> 0:10:06.280 don't love it. And there's also a little bit of 0:10:06.280 --> 0:10:09.960 a nefarious side that maybe guys that are on long 0:10:10.040 --> 0:10:12.600 term finasteride, if they develop prostate cancer, it can be 0:10:12.679 --> 0:10:17.599 somewhat more aggressive than average because you're robbing the prostate 0:10:17.640 --> 0:10:20.920 of the hormone that it normally needs to grow and 0:10:20.960 --> 0:10:24.880 it's looking for alternative pathways to be bad. And so 0:10:25.600 --> 0:10:27.920 none of that really showed up either. But the bottom 0:10:27.960 --> 0:10:31.959 line is it does to dramatically decrease your prostate size, 0:10:32.000 --> 0:10:34.440 and it does dramatically lower your PSA and so if 0:10:34.440 --> 0:10:37.160 you're on it, this was that public service announcement another 0:10:37.200 --> 0:10:41.040 PSA from doctor Brisbane saying if you're on finasteride, tell 0:10:41.080 --> 0:10:43.920 your doctor, even if you're getting it online for hair loss, 0:10:44.320 --> 0:10:47.720 because we have to interpret your PSA in the context 0:10:47.720 --> 0:10:49.880 of if you're on it, you should at least double 0:10:49.920 --> 0:10:52.000 what the reading shows in the blood test, if not 0:10:52.080 --> 0:10:53.040 even go up from there. 0:10:53.080 --> 0:10:54.839 So super important. 0:10:54.880 --> 0:10:58.080 Just as another another shout out for anybody that is 0:10:58.080 --> 0:11:00.640 a screening age for prostate cancer. But yeah, I mean, 0:11:00.679 --> 0:11:03.640 all it is is it's kind of a cool, very 0:11:03.679 --> 0:11:08.120 specific drug in that it knocks out an enzyme. And 0:11:08.200 --> 0:11:11.200 I think if we talk about enzymes, which we've talked 0:11:11.240 --> 0:11:14.160 about before, and we'll do a lot, enzymes essentially are 0:11:14.440 --> 0:11:17.880 proteins in the body that make a reaction happen at 0:11:17.960 --> 0:11:20.760 a much faster rate. That's what it called it catalytic reaction. 0:11:21.360 --> 0:11:26.360 And so finasteride is an enzyme inhibitor. It inhibits something 0:11:26.440 --> 0:11:30.720 called five alpha reductase, and five alpha reductase takes a 0:11:30.720 --> 0:11:34.280 molecule of testosterone and it turns it into a molecule 0:11:34.480 --> 0:11:40.280 of dihydrate testosterone or DHT. That's very simple biochemistry and pharmacology. 0:11:40.320 --> 0:11:42.880 So if you knock out that enzyme, then your body 0:11:42.960 --> 0:11:47.400 ends up having more testosterone and less DHT. Now, the 0:11:47.720 --> 0:11:50.160 interesting thing about this drug is that nothing's ever for 0:11:50.200 --> 0:11:53.520 free in pharmacology. And as I always say too when 0:11:53.559 --> 0:11:56.959 we're talking about supplements, and if you say this is 0:11:57.000 --> 0:11:59.400 the most amazing supplement, it'll make your hair grow back, 0:11:59.480 --> 0:12:03.120 it'll make your penis longer, it'll make your boobs better, 0:12:03.200 --> 0:12:06.080 it'll make whatever supplement they're trying to sell you, and 0:12:06.120 --> 0:12:08.320 there are no side effects, then you automatically know it 0:12:08.320 --> 0:12:11.960 doesn't work, because anytime you perturb anything in the body, 0:12:12.360 --> 0:12:16.680 you're gonna have some counter reaction somewhere else, and so 0:12:16.800 --> 0:12:21.360 f an astroide, it's a very simple counter reaction. Testosterone 0:12:21.400 --> 0:12:25.440 has two ways to be metabolized in the body, and 0:12:25.640 --> 0:12:28.280 one is through the DHT pathway we just talked about, 0:12:28.280 --> 0:12:32.280 and the other is through the estradal pathway. Sometimes in 0:12:32.400 --> 0:12:35.360 guys we use estrogen and estra dial interchangeably because there's 0:12:35.360 --> 0:12:37.520 really three iso forms of estrogen, but in a guy, 0:12:37.679 --> 0:12:40.040 estra dial is the most powerful one, so if I 0:12:40.040 --> 0:12:42.600 if I accidentally go between estrogen and estra dial, Any 0:12:42.720 --> 0:12:45.880 nitpicker indo chronologists out there, I love you all for it, but. 0:12:46.120 --> 0:12:46.680 Bear with me. 0:12:46.720 --> 0:12:49.120 It's really estra dial as the main molecule that we're 0:12:49.120 --> 0:12:52.240 talking about in guys in terms of the estrogen family. 0:12:52.280 --> 0:12:56.520 But testosterron can also metabolize into estradal through an enzyme 0:12:56.559 --> 0:13:01.360 called aromatase, So a romatase will convert to estrogen. And 0:13:01.400 --> 0:13:04.720 if that pathway is open and the DHT pathway is shut, 0:13:04.840 --> 0:13:07.040 then what do you think happens estrone goes up? Think 0:13:07.080 --> 0:13:09.559 of it as a big sink, right. Your body is 0:13:09.679 --> 0:13:13.000 a is a sink. You've got testosterone is a faucet, 0:13:13.000 --> 0:13:15.520 and there's two drains that testosrine can go into. There's 0:13:15.559 --> 0:13:18.680 the DHT drain and then there's the estra dial drain. 0:13:18.720 --> 0:13:21.319 And if those drains are equally open, then you get 0:13:21.320 --> 0:13:25.000 a pretty good ratio of testosterone degradation to DHT testosteron 0:13:25.040 --> 0:13:29.120 degradation to estra dial and your whole body is in homeostas. 0:13:29.200 --> 0:13:32.200 It's perfect balance, perfect harmony. So if I go in 0:13:32.200 --> 0:13:34.920 and I plug up that DHT drain, all right, you're 0:13:34.920 --> 0:13:37.160 ready for your quiz, what happens to estra dial levels? 0:13:37.200 --> 0:13:38.880 Then, Jordan, if that goes up? 0:13:39.600 --> 0:13:43.520 So if I block DHD and that drain is wide 0:13:43.559 --> 0:13:45.520 open for est dial, how much more estra dial is 0:13:45.559 --> 0:13:46.160 going to be made? 0:13:46.280 --> 0:13:47.640 How much sport it's gonna be made? I mean so 0:13:47.720 --> 0:13:50.760 if if the body is losing it more rapidly. 0:13:50.400 --> 0:13:52.440 I imagine that the much more is going to be made, 0:13:52.480 --> 0:13:55.000 because that's right to keep a homeasis exactly. 0:13:55.080 --> 0:13:58.040 Yeah, so you have higher levels of estra dial, So 0:13:58.200 --> 0:14:00.480 that's exactly it. So then you say, okay, well then 0:14:00.960 --> 0:14:06.520 finasteride detasteride. These drugs work by blocking DHD. Estra dial 0:14:06.600 --> 0:14:08.720 levels go up. So what's the baland what's the bad side? 0:14:08.760 --> 0:14:10.360 What happens if a guy's walking around with too much 0:14:10.480 --> 0:14:13.440 estra dial? You can you get asked me too, but 0:14:13.520 --> 0:14:15.600 what are your What do you think side effects could 0:14:15.600 --> 0:14:18.040 possibly be if we if a guy has an excess 0:14:18.040 --> 0:14:21.280 of estra dial because the DHT pathway is blocked with phanasteride. 0:14:21.600 --> 0:14:23.960 I'm actually not sure. I imagine that it would you 0:14:23.960 --> 0:14:27.240 would have disastrous effects to the sisostrail levels? 0:14:27.320 --> 0:14:30.320 Is that y? Yeah? Well so actually interesting. This is 0:14:30.360 --> 0:14:33.600 a great board question for urologists and In fact, the 0:14:33.640 --> 0:14:38.000 thought is the common wisdom, which is not right, is that, 0:14:39.280 --> 0:14:41.280 and it's understandable because some of the side effects will 0:14:41.280 --> 0:14:43.800 talk about our associated low testostrum, And the common wisdom 0:14:43.880 --> 0:14:46.320 is you put a guy in an asteroide, his T 0:14:46.480 --> 0:14:48.640 levels will go down. Actually they go up a little 0:14:48.680 --> 0:14:50.840 bit because we're blocking that part of the sink, and 0:14:50.880 --> 0:14:53.480 so not all that goes down. Estra dial tea levels 0:14:53.480 --> 0:14:56.880 are suspended a little bit longer. But the two big 0:14:56.920 --> 0:14:59.360 side effects that we know happen with guys that have 0:14:59.440 --> 0:15:02.000 too much as gen from say there I did estra 0:15:02.080 --> 0:15:06.400 dial from one of either an organic source like a 0:15:06.480 --> 0:15:09.960 guy has liver failure, smokes too much weed. Those are 0:15:10.000 --> 0:15:12.240 two things that can cause high levels of estra dial. 0:15:12.720 --> 0:15:15.520 They'll mention two things. One is they'll get breast tissue 0:15:15.600 --> 0:15:18.720 or what it's called guid in camasitia develop. Two is 0:15:18.720 --> 0:15:21.600 that they may have libido issues or mood swings. And 0:15:21.640 --> 0:15:23.480 it's not you know what you think is that estra 0:15:23.520 --> 0:15:25.800 dial is a moody hormone. It's just that our body 0:15:26.000 --> 0:15:28.440 and our brain isn't used to seeing such high levels 0:15:28.440 --> 0:15:30.440 of estra dial, and so it can change the way 0:15:30.520 --> 0:15:33.760 that we think a little bit, but also could be 0:15:33.800 --> 0:15:37.760 a libido killer. Now that's not universally true. In fact, 0:15:37.760 --> 0:15:40.280 there's some really interesting studies that show that some men 0:15:40.880 --> 0:15:45.560 are very ester dial dependent for libido, and so again, 0:15:45.640 --> 0:15:49.440 individual results may vary. It's just like cigarettes and whiskey 0:15:49.440 --> 0:15:51.600 and one hundred and two year old woman. Some do 0:15:51.720 --> 0:15:54.440 better with it than others, and so this is really 0:15:54.520 --> 0:15:57.520 the key to this individualized medicine. But that's one of 0:15:57.560 --> 0:15:59.520 the side effects that we know. So if a guy 0:15:59.560 --> 0:16:01.840 comes in and says, Doc, I want to keep my hair, 0:16:02.240 --> 0:16:04.240 and I say, great, you know, you just let me 0:16:04.320 --> 0:16:07.680 know if you get really moody, if you have any 0:16:07.760 --> 0:16:11.400 kind of libido shift, or if you start developing breast tissue, 0:16:11.800 --> 0:16:13.280 we need to know about it. We can stop it 0:16:13.400 --> 0:16:16.920 and then we'll get you back to that normal homeless stasis. 0:16:17.440 --> 0:16:20.760 So that's one aspect of it. The other aspect is 0:16:20.840 --> 0:16:25.000 that you do have other organs in your body that 0:16:25.080 --> 0:16:27.560 are DHD dependent. So the two that we know of 0:16:27.600 --> 0:16:31.560 and the reason finasteride works is the prostate, and it's 0:16:31.600 --> 0:16:35.200 also the hair and the hair follicles in the head, 0:16:35.280 --> 0:16:38.600 I should say, are very DHD dependent. They're also blood 0:16:38.680 --> 0:16:42.720 vessel dependent, and so hair loss is not just because 0:16:42.720 --> 0:16:46.240 our DHT levels kick in when we're in our early 0:16:46.280 --> 0:16:49.080 twenties or thirties whenever. Hair loss happens to guys, which 0:16:49.120 --> 0:16:53.320 also varies by age, but blood vessels are super important, 0:16:53.320 --> 0:16:55.040 so you have to make sure you have nice, open, 0:16:55.320 --> 0:16:58.200 healthy blood vessels. And so the other really big common 0:16:58.240 --> 0:17:00.840 cause of hair loss and guys women for that matter, 0:17:00.880 --> 0:17:03.440 is extreme stress where you're just not getting good blood flow, 0:17:03.480 --> 0:17:06.480 good nutrition to your scalp, and so hair falls out 0:17:06.480 --> 0:17:07.879 for that reason too, So we have to kind of 0:17:07.880 --> 0:17:11.560 tease out between those. But other than DHT being in 0:17:11.600 --> 0:17:16.119 the hair follicle and in the prostate, it's also in 0:17:16.160 --> 0:17:19.119 the brain. It's in the hypothalamus, which is kind of 0:17:19.160 --> 0:17:22.040 what we call our lizard brain. It's in the prefrontal cortex, 0:17:22.080 --> 0:17:24.800 which is most of the decision making aspect. 0:17:24.440 --> 0:17:25.000 Of our brain. 0:17:25.119 --> 0:17:27.479 So that says I'm hungry, I want to go have 0:17:27.520 --> 0:17:31.000 a hamburger, or I want to have sex now, or 0:17:31.520 --> 0:17:33.240 I'm going to run this red light and hope for 0:17:33.280 --> 0:17:35.480 the best. And so you know, as we talk about 0:17:35.720 --> 0:17:38.720 earlier signs of aging and twenty five being that time 0:17:38.760 --> 0:17:40.520 of sin essence, I think it's really important in the 0:17:40.600 --> 0:17:44.359 DHD story too is we'll get into so if you 0:17:44.520 --> 0:17:49.760 have other receptor mediated organs that don't see DHT, it 0:17:49.760 --> 0:17:52.240 may not just be the fact that estra dial levels 0:17:52.280 --> 0:17:54.680 go up. It also may be that what there's low 0:17:54.760 --> 0:17:59.080 DHT and those receptors that are DHD dependent changes can happen. 0:17:59.240 --> 0:18:02.479 And that's where maybe, and we don't know, because nobody 0:18:02.520 --> 0:18:04.960 is gonna have an institution where review boards say we 0:18:05.000 --> 0:18:07.600 can take biopses of brains to look at DHD or 0:18:07.640 --> 0:18:08.919 androgen receptor levels. 0:18:09.119 --> 0:18:10.919 We have to rely on animal data. We have to 0:18:10.920 --> 0:18:12.120 rely on. 0:18:12.200 --> 0:18:16.439 Side effects and symptom monitoring. But that is where a 0:18:16.440 --> 0:18:19.639 lot of this lipido talk comes from. With phanastride, that 0:18:19.680 --> 0:18:23.040 if you put a guy in phanasteride and the main 0:18:23.119 --> 0:18:26.280 sexual side effects, one is almost a guarantee, which is 0:18:26.480 --> 0:18:29.440 seman volume reduces, which makes sense because we know that 0:18:30.000 --> 0:18:32.600 the prostate makes semen, and so if you have a 0:18:32.640 --> 0:18:34.919 smaller prostate, it's not going to make it as much semen, 0:18:34.920 --> 0:18:37.520 so ejaculate volume goes down. Most guys not bothered by that, 0:18:38.040 --> 0:18:40.399 but from a fertility perspective it can be an issue. 0:18:40.440 --> 0:18:42.000 And one of the things when I'm counseling my young 0:18:42.040 --> 0:18:44.240 guys that are on phanastride. Is if we may have 0:18:44.320 --> 0:18:47.000 to modulate or even stop your phastride while you're trying 0:18:47.000 --> 0:18:50.040 to initiate a pregnancy, if you're seeing a dramatic loss 0:18:50.040 --> 0:18:53.399 of ejaculate volume, again, that's reversible. You stop the drug, 0:18:53.920 --> 0:18:57.240 prostate grows back, seminal volume comes back, and you're back 0:18:57.280 --> 0:19:01.679 to baseline. So no harm, no foul along aside, Yeah, weeks, 0:19:01.720 --> 0:19:04.800 six weeks to eight weeks. Yeah, so not that long. 0:19:04.840 --> 0:19:06.960 I mean things bounce back. If you're on it chronically, 0:19:07.000 --> 0:19:09.760 then it can take longer. But it's a good point. Actually, 0:19:10.440 --> 0:19:14.520 if you look at the maximal effects of finastride from 0:19:14.560 --> 0:19:16.320 a urinary standpoint. We looked at those studies when it 0:19:16.359 --> 0:19:19.359 first came out, is it takes about six months to 0:19:19.400 --> 0:19:23.760