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Speaker 1: Emily, I'm very excited for this episode about testosterone, as

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Speaker 1: you know, we you know, we just did the Hormone

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Speaker 1: replacement Therapy SOR for women episode last week, and honestly,

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Speaker 1: there is a vast deference between estrogen and testosterone, and

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Speaker 1: I'm excited to explore that. I think this is going

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Speaker 1: to be a seminal episode.

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Speaker 2: I can't even react to you, but I will say

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Speaker 2: that last week you gave a whole long open about

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Speaker 2: how you weren't going to talk about mint.

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Speaker 3: You weren't going a man's plain. You're working a blah

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Speaker 3: blah blah. I'm not giving that.

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Speaker 1: I am going a woman's plain all over.

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Speaker 3: I am a woman's plain. I'm not sorry.

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Speaker 2: I'm going to say all kinds of feelings I have

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Speaker 2: about testosterone and science, and even though I only have

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Speaker 2: a little bit of it, I assume.

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Speaker 1: I mean, Emily, I'm glad that you have the balls

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Speaker 1: to uh to really address this. Okay, I think I

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Speaker 1: have about eight more.

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Speaker 2: Yeah, you know what, I think that was three was

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Speaker 2: really good through vast Deeferens was.

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Speaker 3: Definitely the best.

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Speaker 2: The balls kind of is low, and so that's where

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Speaker 2: I think we should just move forward.

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Speaker 1: Okay, all right, Testosterone in a nutshell After the break.

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Speaker 2: I'm Emily Astro, I'm an economist and a data expert.

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Speaker 1: And I'm Perry Wilson, I'm a medical doctor.

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Speaker 2: It's Thursday, April thirtieth, twenty twenty six.

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Speaker 3: And this is wellness.

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Speaker 1: Actually, because you're getting a staggering amount of health and

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Speaker 1: wellness information nowadays from every source imaginable, and some of

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Speaker 1: it is awesome and some.

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Speaker 3: Of it is well actually both.

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Speaker 2: Fortunately, we're both people who know how to read studies,

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Speaker 2: how to parse the data, and can tell you what's

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Speaker 2: worth thinking about and what you can safely ignore.

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Speaker 1: But before we dig in, a note that this podcast

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Speaker 1: is for educational purposes and should not be construed as

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Speaker 1: medical advice. We don't know your unique situation, so talk

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Speaker 1: to your doctor for personal health decisions.

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Speaker 2: This week we're asking what's the deal with testosterone.

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Speaker 3: It's part two of our hormone two parter.

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Speaker 2: Perry and I will give the official smash or pass,

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Speaker 2: and then we'll get to your question of the week.

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Speaker 2: But first let's do the health news roundup after the break,

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Speaker 2: and now for the health news of the week, Perry,

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Speaker 2: no more flu vaccine mandates for military troops. The Department

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Speaker 2: of Defense Pete Hegseth has said we will not be

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Speaker 2: having required flu vaccines for the military.

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Speaker 1: Your thoughts, Yeah, this is weird when it comes to

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Speaker 1: combat readiness. You know, the military has long and in

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Speaker 1: multiple domains, had less freedoms than the public sector or

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Speaker 1: than the rest of us. Right, you know, think about

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Speaker 1: like free speech, even there are limitations on that in

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Speaker 1: the military because it is a job that has obviously

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Speaker 1: very specific risks and is so vital to national security,

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Speaker 1: and combat readiness is in part determined by the health

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Speaker 1: of the troops in terms of infectious diseases. I mean,

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Speaker 1: if you look at like the history of warfare, you

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Speaker 1: would find that infection has killed vastly more soldiers than

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Speaker 1: combat is often responsible for losing the war. I mean,

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Speaker 1: one of the reasons the Americans were able to hold

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Speaker 1: out during the Revolutionary War was because Washington made the

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Speaker 1: rather bold and somewhat risky decision to force smallpox vaccination

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Speaker 1: or inoculation really on all the Revolutionary War troops. It's

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Speaker 1: hard not even speaking of just about influenza's kind of random. Obviously,

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Speaker 1: there's a bunch of vaccines that the troops, get me

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Speaker 1: ninjaccle disease, have a hepatitis B, pertussis, diphtheria, so many

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Speaker 1: So I don't know why we're isolating influenza. And like,

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Speaker 1: let's not forget that the worst influenza pandemic in history occurred.

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Speaker 1: This is the Spanish flu so called Spanish flu influenza

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Speaker 1: pandemic occurred after World War One because a bunch of

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Speaker 1: infected troops brought brought the virus home. So a weird decision.

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Speaker 1: It feels completely like brazenly sort of political to me,

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Speaker 1: I see no justification for this in a rational society.

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Speaker 2: Yeah, I mean, I will say I think this feels

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Speaker 2: like just a complete political move to me, in the

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Speaker 2: sense that it's, you know, relative to other vaccines they

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Speaker 2: could have turned against. I don't know why it's they

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Speaker 2: chose this one, but it's one that you know, people

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Speaker 2: are having every year, and there's a lot of political

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Speaker 2: resistance too, and so it feels like it's this or

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Speaker 2: the COVID vaccine. I think they already don't require the

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Speaker 2: covid vaccine, so that's I.

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Speaker 1: Think that's that's correct. Two viruses, by the way, that

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Speaker 1: just really enjoys spreading in close quarter conditions. It's pretty random. Okay,

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Speaker 1: let's move on. We have some fish oil news today,

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Speaker 1: but actually some bad fish oil news. So fish oil

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Speaker 1: supplementation pops up every once in a while. It's a

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Speaker 1: wellness trend. Like many supplement trends. The data has been

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Speaker 1: rather mixed. But we've got some new headlines coming out

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Speaker 1: this week that actually suggests that fish oil might hurt

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Speaker 1: your brain. This is kind of the opposite of what

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Speaker 1: a lot of people think about fish oil, like it's

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Speaker 1: going to keep me smarter, right, probably because it has

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Speaker 1: so much dolphin in it, and you know how smart

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Speaker 1: they are. That's a joy. That's a Simpsons reference for

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Speaker 1: the very old people. And Emily, what's going on is

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Speaker 1: fish oil going to hurt my brain?

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Speaker 2: Fish oil is not going to hurt your brain, or

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Speaker 2: at least not. There is no strong evidence for based

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Speaker 2: on this new research. And this is an example where

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Speaker 2: the distinction between what the headline said, which was literally

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Speaker 2: fish oil might hurt your brain, and what the actual

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Speaker 2: paper said was really vast. So there is a piece

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Speaker 2: of new research in which researchers took mice with traumatic

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Speaker 2: brain injury, so they actually took some mice, they gave

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Speaker 2: them a traumatic brain injury and then they treated them

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Speaker 2: with fish oil, and they found that the treatment with

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Speaker 2: fish oil did not improve the traumatic brain injury in

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Speaker 2: the mice, which they had thought that it might. And

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Speaker 2: so that is interesting, I guess, from the standpoint of

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Speaker 2: thinking about how we treat traumatic brain injury, which is

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Speaker 2: an important question, and certainly, you know, early stage mouse

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Speaker 2: research might be helpful for that. To go from treating

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Speaker 2: mice with traumatic brain injury with fish oil does not

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Speaker 2: improve them to fish oil might hurt your brain. Feels

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Speaker 2: like we took not just one, but like several very

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Speaker 2: large leaps.

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Speaker 1: Yeah. Yeah, well, well, obviously the mouse traumatic brain injury

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Speaker 1: readership is not as large as the humans worried about

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Speaker 1: their brain readership.

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Speaker 3: No they're not, No, they're not.

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Speaker 2: But it's I mean, it's such a strong example here

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Speaker 2: of where there is a piece of evidence in data

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Speaker 2: that actually is kind of interesting and I think should

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Speaker 2: be something we should pursue and learn more about. And

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Speaker 2: then it gets turned into some clickbait headline, because of

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Speaker 2: course the headline you know, mice with traumatic brain injury

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Speaker 2: don't necessarily improve with fish oil is not click is

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Speaker 2: not clique, it's not okay, let's do some some good news,

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Speaker 2: at least what looks to me to be good news.

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Speaker 2: It seems like we have started to make a little

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Speaker 2: bit of progress on pancreatic cancer, a couple of new

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Speaker 2: treatments that maybe are working.

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Speaker 3: Did you see this and what'd you think?

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Speaker 1: So exciting? So preliminary data presented at a cancer conference

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Speaker 1: out in California, so not pure reviewed yet, but still

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Speaker 1: super exciting. Two new and completely different approaches for pancreatic cancer.

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Speaker 1: The larger trial that was presented was of a drug

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Speaker 1: that I have some difficulty pronouncing, but I'm going to

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Speaker 1: go for it. It is called deraxnracib dere sonracib. This

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Speaker 1: is This is a novel RAS inhibitor. It was trialed

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Speaker 1: in five hundred and one patients with fairly advanced late

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Speaker 1: stage pancreatic cancer. Many people know that pancreatic cancer, particularly

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Speaker 1: late stage pancreatic cancer, has a very poor prognosis, with

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Speaker 1: an expected life expectancy generally less than a year after diagnosis.

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Speaker 1: That mortality rate at the time that they cut this

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Speaker 1: data and presented it was twice as long in the

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Speaker 1: patients that were randomized to receive this new therapy compared

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Speaker 1: to those randomized to receive placebo, about an extra six months.

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Speaker 1: This difference in life expectancy, which is very significant in

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Speaker 1: a pancreatic cancer trial, and obviously that's an average, and

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Speaker 1: some people are living substantially longer. So super exciting that

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Speaker 1: there's that new drug. Potentially, you know, a much smaller study,

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Speaker 1: but potentially even more exciting insofar as it is a

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Speaker 1: totally new avenue for cancer treatment. Researchers reported on patients

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Speaker 1: receiving a customized mr ANDA pancreatic cancer vaccine. So this

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Speaker 1: is where you take out a piece of the actual

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Speaker 1: patients pancreatic cancer, you do some genetic sequencing on it

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Speaker 1: to figure out where the mutations are. You create an

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Speaker 1: mRNA vaccine much like the COVID vaccine that's directed against

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Speaker 1: those very specific mutations, and you give that back to

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Speaker 1: the patient. This was not a randomized trial. This is

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Speaker 1: phase one therapy really just testing safety. But what the

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Speaker 1: researchers reported that of eight patients whose immune systems responded

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Speaker 1: to the mRNA so they have signals that their like

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Speaker 1: immune system got revved up to the vaccine, seven were alive.

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Speaker 1: Six years or more after receiving the last treatment. So

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Speaker 1: this is not necessarily a miracle. You have to respond

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Speaker 1: to the therapy. There's no placebo control here, which we

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Speaker 1: always talk about, but in a situation like pancreatic cancer,

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Speaker 1: you know, these advances can be super promising. So phase

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Speaker 1: one study Phase two will get started and give us

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Speaker 1: some better efficacy data, likely with a placebo control. Yeah.

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Speaker 2: I mean, this last one was really very exciting, given

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Speaker 2: that six years in pancreatic cancer is really out huture

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Speaker 2: on the tail and the idea that it's a sort

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Speaker 2: of new approach to this. It's very cool. Hopefully hopefully

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Speaker 2: more science as we go.

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Speaker 1: Yeah, and just another place where mRNA technology is making

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Speaker 1: an impact, and we're going to talk about this in

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Speaker 1: a future episode. People know about mRNA technology because of

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Speaker 1: the COVID vaccine, but what makes it so flexible is

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Speaker 1: that it can essentially be programmed to do what you

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Speaker 1: want it to do and to attack the specific thing

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Speaker 1: you wanted to attack, whether that's a COVID spike protein

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Speaker 1: or a protein on the surface of pancreatic cancer. Very cool.

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Speaker 3: All right, that's it for the health news of the week.

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Speaker 2: After the break what's the deal with testosterone? All right, Perry,

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Speaker 2: So let's talk about testosterone. Although I said, I'm not

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Speaker 2: going to be careful if I do get really out

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Speaker 2: on the tail of woman's plaining, joxtrap is your safe word.

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Speaker 3: Just say it and I will dial it right back in.

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Speaker 1: You got it. I appreciate it, thank you.

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Speaker 2: All right, So let's start with the big picture. What

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Speaker 2: is testosterone and what does it do for someone who

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Speaker 2: is totally unfamiliar.

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Speaker 1: So, testosterone is a steroid hormone. We talked about these

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Speaker 1: special types of molecules last week with the hormone replacement

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Speaker 1: therapy episode. But steroid hormones are unique in that they

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Speaker 1: act within the nucleus of the cell to change how

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Speaker 1: DNA is transcribed. So testosterone, estrogen, progesterone, some others all

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Speaker 1: work this way, and that's a function that really lets

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Speaker 1: them change how cells work. It can take a cell

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Speaker 1: that doesn't grow hair and change it into a cell

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Speaker 1: that does grow hair. Obviously, testosterone is the hormone that

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Speaker 1: makes men look like men. This is responsible for the

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Speaker 1: primary and secondary sexual characteristics of men. It certainly has

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Speaker 1: important roles in muscle growth. We'll get to that it's

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Speaker 1: necessary for sperm to be created. It has pretty significant

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Speaker 1: effects on erythropoesis or the generation of red blood cells,

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Speaker 1: and this is going to come up time and time again.

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Speaker 1: I don't know if we need an explicit warning on

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Speaker 1: this episode or not, but libido and sexual function is

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Speaker 1: clearly firmly within the testosterone wheelhouse.

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Speaker 2: Right, So if you're listening with your children, this episode

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Speaker 2: will discuss penises and sex, so.

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Speaker 3: Just be be aware, all right.

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Speaker 2: So when we start from the biggest picture here, there

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Speaker 2: are things which are definitely true, which is when boys

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Speaker 2: go through puberty, their.

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Speaker 3: Testosterone goes up.

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Speaker 2: And if that doesn't happen, if you have a medical

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Speaker 2: condition in which testosterone is lacking or is very low

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Speaker 2: for some reason, then you will need supplementation and that

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Speaker 2: that will affect the development of secondary sex characteristics. So

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Speaker 2: it's very clear that testosterone is important. Yeah, if we're

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Speaker 2: going to say, you know, smash or pass, like, do

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Speaker 2: we need testosterone as a species, like yes, yes, right,

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Speaker 2: It's not a useless peptide. It's an actual, important or important. Also,

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Speaker 2: some things that for sure are true, like if you

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Speaker 2: are a person doing sports and you give yourself a

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Speaker 2: bunch of extra testosterone. It will probably improve your sports performance,

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Speaker 2: but also.

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Speaker 3: That's cheating, so don't do that.

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Speaker 2: But I think there are a bunch of open, much

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Speaker 2: more interesting questions that relate to some of the wellness stuff,

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Speaker 2: which is, you know, how.

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Speaker 3: Much variation is there?

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Speaker 2: Does that variation actually matter, like within the normal range?

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Speaker 2: And if we supplement outside of a sports context, is

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Speaker 2: that going to improve our various sex activities and other stuff?

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Speaker 3: Are those for you the interesting sets of issues?

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Speaker 1: Yeah? Absolutely. I mean when people are asking me about

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Speaker 1: testosterone supplementation, they're not saying like I have a genetic

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Speaker 1: condition that prevents me from synthesizing testosterone, which will be

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Speaker 1: like one of the FDA indications for testosterone replacement. People

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Speaker 1: are asking, you know, these two things happen in parallel.

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Speaker 1: One men get older and two men's test osterone level

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Speaker 1: goes down a bit. And there's a natural question to say, like, well,

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Speaker 1: all these other things that happen when I get older,

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Speaker 1: like decreased energy, decrease libido. Maybe I feel like I'm

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Speaker 1: not quite as a top, quite as cognitively sharp as

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Speaker 1: I used to be, Like is that because of testosterone

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Speaker 1: or is it not? And if you go online you

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Speaker 1: will get plenty of people telling you absolutely it is

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Speaker 1: and please, you know, call this number to get testosterone

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Speaker 1: replacement therapy. But hopefully, if you're listening to the podcast,

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Speaker 1: that is not enough evidence for you. So I think

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Speaker 1: it's worth noting that the FDA indications for testostereplacement therapy

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Speaker 1: are quite limited. It is primary hypergonadism, which is like,

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Speaker 1: as you alluded to, like very rare genetic conditions that

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Speaker 1: prevent the production of testosterone in boys, you know, and

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Speaker 1: you need testosterone to grow into a man. The second

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Speaker 1: is pituitary hypogonadism, so your petuitary glands to creates a

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Speaker 1: substance that kind of tells the testes to produce testosterone.

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Speaker 1: If you have a tumor in your protuitary or you

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Speaker 1: had a stroke in a certain place, that's preventing that

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Speaker 1: from happening. Just the testes just won't produce testosterone. They're

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Speaker 1: not getting the message from the brain to do it.

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Speaker 1: Those are the only FDA approved indications, and less than

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Speaker 1: one percent of men with low testosterone have one of

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Speaker 1: those indications. So virtually everyone getting testosterone replacement therapy that

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Speaker 1: you hear about is technically getting it. Off label, which

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Speaker 1: is fine, it is legal to get drugs off label,

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Speaker 1: but I think it does lead to the question of, like, Okay,

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Speaker 1: why isn't there an FDA approval for age related low testosterone,

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Speaker 1: which is just the fact that testosterone slowly goes down

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Speaker 1: when you're aging. Caveat RFK Junior has said he wants

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Speaker 1: there the FDA to investigate this and maybe there will

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Speaker 1: be an improval in the future. So I think that's

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Speaker 1: where we kind of have to start, is like, what's

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Speaker 1: going on with testosterone in the life cycle? And it

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Speaker 1: is it is their menopause, right, Is there such a

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Speaker 1: thing isopause?

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Speaker 2: Is there a menopause? Okay, so so yeah, let's start there.

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Speaker 2: So let's start with how testosterone moves over the life cycle.

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Speaker 2: And if you look at a graph, and I think

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Speaker 2: I'm looking at the end. HAYNES, which is the National

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Speaker 2: Health and Nutrition Examination Survey, is a nationally representative survey

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Speaker 2: that the CDC runs. It's a really good source for

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Speaker 2: a lot of the biometrics that we have no value

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Speaker 2: over time because exactly like they they unlike many other surveys,

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Speaker 2: they actually test people. They bring them into these like

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Speaker 2: like drive around these mobile clinics and participants like come

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Speaker 2: to the clinic and have their blood drawn anyway, So

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Speaker 2: this will show you testosterone over the life cycle. And

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Speaker 2: there is one really striking thing in these graphs which

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Speaker 2: I'm looking at as we talk, which is, you know,

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Speaker 2: between the ages of like six and you know twenty,

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Speaker 2: your testosterone goes from more or less zero.

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Speaker 3: To like five hundred. And this is like in what

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Speaker 3: is it?

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Speaker 2: Is it nanograms for nanogrator for testolator. So at any rate,

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Speaker 2: you start with none, little kids have very little testosterone,

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Speaker 2: and then you go up a.

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Speaker 3: Lot during the period of puberty.

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Speaker 2: So it's very clear testosterone is very important for driving

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Speaker 2: the changes that we see in boys during puberty, the

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Speaker 2: development of secondary sex characteristics, the starting of supermato genesis,

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Speaker 2: et cetera. And then you see it over time. And honestly, Perry,

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Speaker 2: I'm looking at this graph and.

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Speaker 1: I knew you were going to say that when I

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Speaker 1: put the graph in our in our research document. Yeah,

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Speaker 1: you sort of. So this graph shows the uh sort

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Speaker 1: of variation in testosterone levels. And let's just put some

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Speaker 1: numbers on it because we'll kind of keep coming back

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Speaker 1: to this in adult males. So post pubescent males. Most

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Speaker 1: values tend to run between three hundred nanograms pertest leader

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Speaker 1: and one thousand. Most people would draw the line at

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Speaker 1: three hundred nanograms per test leader to be like low

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Speaker 1: testosterone or like lower testosterone. There is no cliff. This

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Speaker 1: is not estrogen for women going through menopause, which is

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Speaker 1: kind of up there, and just like tanks at menopause,

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Speaker 1: it is relatively flat. Now, if you mathematically model this

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Speaker 1: and account for things, and you know, you can show

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Speaker 1: in a large enough population that there is an age

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Speaker 1: related decline in testosterone on average, this is the same

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Speaker 1: and hates data using mathematical modeling, that kind of average

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Speaker 1: goes from about four hundred nanograms per test leader at

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Speaker 1: age twenty to about three hundred nanograms pertest at age eighty.

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Speaker 1: That's a change, but it's not dramatic.

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Speaker 2: So manopause, I just have to say, looking at this graph,

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Speaker 2: and this graph is so obviously this is like we

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Speaker 2: might need to take this out of the podcast, but

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Speaker 2: this graph is so obviously driven by somebody overfitting a

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Speaker 2: line to a very small amount of data on old

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Speaker 2: people that I can't even much confidence.

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Speaker 1: Interval.

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Speaker 3: For those of you who love and overfit. This graph is.

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Speaker 1: An Emily's not convinced. Okay, Emily's not convinced. How about

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Speaker 1: this data does suggest across multiple populations, both in the

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Speaker 1: US and abroad, that average testosterone levels in the population

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Speaker 1: have decreased over time. So not only as we've gotten older,

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Speaker 1: but like a fifty year old man today has a

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Speaker 1: lower testosterone than a fifty year old man in nineteen eighty.

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Speaker 1: Levels have been going down, they say by about one

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Speaker 1: percent per year, depends how you model it. Do you

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Speaker 1: buy that?

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Speaker 3: Yeah?

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Speaker 2: I think that's interesting and we should come and we

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Speaker 2: should come back to it, because I think it's part

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Speaker 2: of understanding why this has has declined. But I would say,

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Speaker 2: first if we ask the question like, are is this

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Speaker 2: like estrogen relative to estrogen where we talked about, there's

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Speaker 2: really this period in which it declines quite a lot

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Speaker 2: in which replacement is helpful.

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Speaker 3: We just we're not seeing that in testosterone.

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Speaker 2: So it doesn't necessarily mean you wouldn't get something from supplementation,

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Speaker 2: but it doesn't. It's not the case that there's some

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Speaker 2: period of your life when you're testosterone is just tanking.

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Speaker 1: That's right. You can be an eighty year old man

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Speaker 1: and have a testosterone level that a thirty year old

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Speaker 1: man has. But like, I challenge you to find an

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Speaker 1: eighty year old woman not on estrogen supplementation that has

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Speaker 1: an estrogen level of a thirty year old woman like that,

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Speaker 1: that does not happen.

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Speaker 2: Okay, So, but we also know from this amazing enhance

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Speaker 2: graph that there is a lot of variation within age. Right,

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Speaker 2: So if you look at like the tenth percentile of people,

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Speaker 2: say at forty to forty nine, they're at about two hundred,

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Speaker 2: Then ninetieth percentile is at about I don't know, six

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Speaker 2: to seven hundred, and so that's a really big range.

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Speaker 2: And I think that relates to the question of, like

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Speaker 2: what determines this? How do you get to be a

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Speaker 2: person of a testosterone level of seven hundred and realistically,

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Speaker 2: and I'm just going to channel the influencers here, how

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Speaker 2: do I get the seven hundred? What do I need

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Speaker 2: to do to optimize my testosterone? Parry, not me specifically,

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Speaker 2: I have only a small amount of time.

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Speaker 3: What do you need to do? What are you doing?

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Speaker 3: What do I need, Ferry to optimize your testosterone?

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Speaker 1: Yeah, And I mean they're like, all, I think.

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Speaker 3: You're not doing anything.

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Speaker 1: I'm actually not doing anything, but I'll give you some

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Speaker 1: things that you can do to optimize yourself. Or let

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Speaker 1: me let me phrase it this way. I will say

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Speaker 1: that before we decide whether we should make some number higher,

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Speaker 1: we should decide whether it matters to make that number higher.

391
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Speaker 1: But because we just talked about variation, I will tell

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Speaker 1: you what we know what correlates with lower levels versus

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Speaker 1: higher levels in the general population. Age is one. It's

394
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Speaker 1: not as powerful as you think, right, but there is

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Speaker 1: a statistically significant correlation between age. A history of smoking

396
00:23:06,119 --> 00:23:11,760
Speaker 1: lower's testosterone. Current smoking, which is really interesting, will actually

397
00:23:11,800 --> 00:23:17,360
Speaker 1: increase your total testosterone level by and this actually might

398
00:23:17,400 --> 00:23:20,680
Speaker 1: explain why total testosterone levels have gone down over time.

399
00:23:20,720 --> 00:23:24,000
Speaker 1: Can I detour for a second, because this is very weird. Okay,

400
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Speaker 1: So testosterone is broken down very quickly in the blood,

401
00:23:27,800 --> 00:23:31,000
Speaker 1: has a half life about ten minutes to maybe sixty

402
00:23:31,040 --> 00:23:34,560
Speaker 1: minutes depending, So it's carried around the blood by a

403
00:23:34,640 --> 00:23:38,159
Speaker 1: chaperone protein called sex hormone binding globulin, and that kind

404
00:23:38,200 --> 00:23:40,720
Speaker 1: of protects it. It like wraps testosterone in a little

405
00:23:40,800 --> 00:23:43,640
Speaker 1: hug and you know, keeps it safe from being degraded.

406
00:23:43,720 --> 00:23:46,120
Speaker 1: But it's also an active testosterone in that bound form

407
00:23:46,160 --> 00:23:50,760
Speaker 1: can't do anything. It has to be free. Free testosterone

408
00:23:50,800 --> 00:23:53,879
Speaker 1: is the active form that's about two percent of total testosterone.

409
00:23:53,920 --> 00:23:56,080
Speaker 1: But most people, if you're getting your lab test measured,

410
00:23:56,080 --> 00:23:58,439
Speaker 1: and all the numbers we've said so far are total

411
00:23:58,480 --> 00:24:02,160
Speaker 1: testosterone numbers, because free testosterone is a very difficult test

412
00:24:02,280 --> 00:24:05,880
Speaker 1: to run. It's expensive. There's a couple different essays, none

413
00:24:05,920 --> 00:24:08,800
Speaker 1: of them are FDA cleared at this point in time,

414
00:24:09,000 --> 00:24:12,760
Speaker 1: so most people are getting total testosterone. If you increase

415
00:24:12,760 --> 00:24:16,600
Speaker 1: sex hormone binding globulin, you'll increase total testosterone because you

416
00:24:16,640 --> 00:24:18,879
Speaker 1: just kind of have more that's out there stuck to

417
00:24:18,960 --> 00:24:22,240
Speaker 1: the chaperone protein, but it's not actually doing anything, and

418
00:24:22,640 --> 00:24:27,199
Speaker 1: current smoking does that. So there is some possibility that

419
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Speaker 1: the reason we see this generational decline in total testosterone

420
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Speaker 1: is actually because we're smoking less, which is a really

421
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Speaker 1: sort of paradoxical and fascinating finding.

422
00:24:39,880 --> 00:24:43,560
Speaker 2: Why would having a history of smoking make your testosterone lower.

423
00:24:43,800 --> 00:24:46,600
Speaker 1: I think that's just comorbidities. So the other stuff on

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Speaker 1: the list for making your testosterone lower is like higher BMI, depression, diabetes,

425
00:24:54,440 --> 00:24:57,719
Speaker 1: These are all things that kind of go along with smoke. Obviously, cancer,

426
00:24:57,800 --> 00:24:59,959
Speaker 1: right so I think the history of smoking is just

427
00:25:00,080 --> 00:25:01,960
Speaker 1: like you've kind of if you put your body through

428
00:25:01,960 --> 00:25:05,520
Speaker 1: the ringer. Testosterone also is a hormone that has a

429
00:25:05,560 --> 00:25:11,919
Speaker 1: pretty fascinating response to your psychosocial state. So there's a

430
00:25:11,920 --> 00:25:17,200
Speaker 1: well studied phenomenon that if a man wins something, their

431
00:25:17,200 --> 00:25:20,199
Speaker 1: testosterone level goes up. So if you like measure you

432
00:25:20,200 --> 00:25:22,679
Speaker 1: know soccer players before the championship game and you do

433
00:25:22,760 --> 00:25:26,600
Speaker 1: their their salary testosterone and then you you know, one

434
00:25:26,600 --> 00:25:29,280
Speaker 1: team wins, one team loses, the winning team will have

435
00:25:29,480 --> 00:25:32,560
Speaker 1: a significantly higher testosterone after the game. This doesn't last

436
00:25:32,560 --> 00:25:35,760
Speaker 1: for very long. This also carries over to men watching

437
00:25:35,760 --> 00:25:40,239
Speaker 1: their favorite sports teams. So if you are, you know,

438
00:25:40,400 --> 00:25:44,240
Speaker 1: an Eagles fan, Jalen Hurts runs it in for a touchdown,

439
00:25:45,000 --> 00:25:47,200
Speaker 1: your testosterone might go up a little bit. So it is.

440
00:25:47,320 --> 00:25:50,400
Speaker 1: It is quite a cerebral thing, don't you think.

441
00:25:50,240 --> 00:25:51,120
Speaker 3: That's a that?

442
00:25:51,160 --> 00:25:53,720
Speaker 2: I mean that feels like an evolutionary adaptation, right, which

443
00:25:53,760 --> 00:25:55,560
Speaker 2: is like the moment that I win the fight with

444
00:25:55,640 --> 00:25:58,360
Speaker 2: the other guy, that's the moment, and that a lot

445
00:25:58,400 --> 00:26:02,040
Speaker 2: of the lady animals, the lady monkeys want to have

446
00:26:02,200 --> 00:26:03,919
Speaker 2: sex with me, and so I want to be like

447
00:26:03,960 --> 00:26:07,080
Speaker 2: in a high like tsostne environment. So I'm like ready

448
00:26:07,359 --> 00:26:09,440
Speaker 2: for the lady monkeys after the soccer game.

449
00:26:09,720 --> 00:26:11,600
Speaker 1: I mean, yeah, I'll buy it. I'll totally buy me.

450
00:26:11,680 --> 00:26:13,280
Speaker 1: I don't know, I'm not an evolutionary biologist.

451
00:26:13,320 --> 00:26:15,399
Speaker 2: Makes sense, right, I know, But I think evolutionary bology

452
00:26:15,440 --> 00:26:18,159
Speaker 2: is just like telling stories like that, just some of it,

453
00:26:18,320 --> 00:26:20,880
Speaker 2: some of it, some hypothesis generation. There is that kind

454
00:26:20,880 --> 00:26:22,760
Speaker 2: of story, and I've asked the story I'm going with.

455
00:26:24,080 --> 00:26:25,320
Speaker 1: I totally love it.

456
00:26:25,840 --> 00:26:27,520
Speaker 3: Did you lose your trade of thought?

457
00:26:27,800 --> 00:26:29,600
Speaker 1: No, of course not, because I have one other thing

458
00:26:29,640 --> 00:26:32,800
Speaker 1: that has been shown to temporarily increase testosterone, which is

459
00:26:33,640 --> 00:26:39,640
Speaker 1: watching erotica or sexually charged visual imagery. Men are simple creatures, Emily.

460
00:26:40,160 --> 00:26:42,320
Speaker 2: You like to win soccer and watch porns, and those

461
00:26:42,320 --> 00:26:43,920
Speaker 2: are the activities that you enjoy.

462
00:26:44,080 --> 00:26:45,879
Speaker 1: As I was reading about this and comparing it to

463
00:26:46,000 --> 00:26:49,120
Speaker 1: like estrogen and women, and it's like so complicated and

464
00:26:49,200 --> 00:26:51,760
Speaker 1: like how you know what's what's going on? Men?

465
00:26:51,880 --> 00:26:52,639
Speaker 3: Soccer and porn?

466
00:26:53,520 --> 00:26:58,240
Speaker 1: Things we like, yeat, that's it doesn't take much. So

467
00:26:58,520 --> 00:27:02,719
Speaker 1: but but there is a lot of between person variation

468
00:27:02,800 --> 00:27:06,960
Speaker 1: and testosterone, and there is also within person variation in testosterone. Emily.

469
00:27:08,359 --> 00:27:11,000
Speaker 1: One of the things that came out when I was

470
00:27:11,000 --> 00:27:15,080
Speaker 1: looking at like how testosterone is measured, is this fact

471
00:27:15,200 --> 00:27:19,040
Speaker 1: that the coefficient of variation of testosterone measurement is fifty

472
00:27:19,080 --> 00:27:23,040
Speaker 1: percent or higher within a man. Can you, with your

473
00:27:23,080 --> 00:27:26,439
Speaker 1: data hat on, explain what coefficient of variation means?

474
00:27:27,119 --> 00:27:30,280
Speaker 3: So a coefficient of variation is it?

475
00:27:30,359 --> 00:27:33,800
Speaker 2: Technically it's the ratio of the standard aviation to the mean,

476
00:27:34,240 --> 00:27:34,920
Speaker 2: which is not that.

477
00:27:34,920 --> 00:27:35,840
Speaker 3: Helpful for people.

478
00:27:36,400 --> 00:27:40,400
Speaker 2: It's really a way to measure sort of how much

479
00:27:40,520 --> 00:27:45,120
Speaker 2: something is varying, in this case within a person scaled

480
00:27:45,160 --> 00:27:47,639
Speaker 2: to the means. So if something has a coefficient of

481
00:27:47,720 --> 00:27:54,520
Speaker 2: variation of fifty percent, it varies quite a lot within

482
00:27:54,560 --> 00:27:57,119
Speaker 2: a person over time. You know, many things would have

483
00:27:57,240 --> 00:28:00,440
Speaker 2: like you know, your weight within a time for does

484
00:28:00,440 --> 00:28:03,480
Speaker 2: not have a coefficient variation anything like that exactly.

485
00:28:03,600 --> 00:28:05,720
Speaker 1: And so you know, just to put like a number

486
00:28:05,760 --> 00:28:08,000
Speaker 1: on it, roughly, we could say, like, okay, if you're

487
00:28:08,880 --> 00:28:11,320
Speaker 1: testosterone is kind of on average is three hundred, you

488
00:28:11,359 --> 00:28:14,920
Speaker 1: get it measured one day, maybe it's four fifty, right,

489
00:28:15,359 --> 00:28:18,159
Speaker 1: maybe it's one fifty another day. Let me play you

490
00:28:19,280 --> 00:28:24,360
Speaker 1: an influencer that I think speaks to this potential problem

491
00:28:24,400 --> 00:28:24,960
Speaker 1: with testing.

492
00:28:25,280 --> 00:28:28,320
Speaker 4: I increase my testosterone by forty eight percent and only

493
00:28:28,359 --> 00:28:30,000
Speaker 4: twenty one days without medication.

494
00:28:30,320 --> 00:28:32,320
Speaker 1: Heer's out. I'm not even going to tell you.

495
00:28:32,400 --> 00:28:35,680
Speaker 3: How is it that he tested again? Thought right?

496
00:28:35,920 --> 00:28:38,680
Speaker 1: So that's the thing I want to get out. When

497
00:28:38,760 --> 00:28:40,880
Speaker 1: someone says, you know, my, my, whatever it is, my

498
00:28:40,920 --> 00:28:45,800
Speaker 1: testosterone might anything that went up dramatically, you have to

499
00:28:45,880 --> 00:28:48,920
Speaker 1: know how variable it is at baseline, and testosterone is

500
00:28:48,960 --> 00:28:51,520
Speaker 1: highly variable. We know for one thing. For example, it's

501
00:28:51,520 --> 00:28:54,360
Speaker 1: about fifteen percent higher on average in the morning than

502
00:28:54,400 --> 00:28:57,800
Speaker 1: in the afternoon. So like men's testosterone is just higher.

503
00:28:58,160 --> 00:29:02,040
Speaker 1: But that's like averaging a cross thousands of men within

504
00:29:02,280 --> 00:29:04,760
Speaker 1: a given man. If you test today and you test

505
00:29:04,800 --> 00:29:07,960
Speaker 1: a week from now, you're going to get very different numbers.

506
00:29:08,400 --> 00:29:10,800
Speaker 1: And that is going to have the effect because we're

507
00:29:10,800 --> 00:29:15,880
Speaker 1: all human, that you will start to assign causality to

508
00:29:16,040 --> 00:29:19,280
Speaker 1: things that you did to make that change when there

509
00:29:19,360 --> 00:29:23,600
Speaker 1: is in fact nothing. The recommendation from endochronologists is in

510
00:29:23,640 --> 00:29:26,920
Speaker 1: fact that you don't diagnose low testosterone without at least

511
00:29:27,200 --> 00:29:31,960
Speaker 1: two measurements temporarily separated that are both below three hundred

512
00:29:32,000 --> 00:29:33,000
Speaker 1: nanograms pertestlaer.

513
00:29:34,200 --> 00:29:35,960
Speaker 2: So one of the reasons to keep I mean, I

514
00:29:35,960 --> 00:29:39,959
Speaker 2: think that that influencer clip is you know, it's interesting

515
00:29:40,000 --> 00:29:42,640
Speaker 2: from the coefficient a variation standpoint, but it's also interesting

516
00:29:42,680 --> 00:29:45,479
Speaker 2: because of course this guy's on the internet saying how

517
00:29:45,480 --> 00:29:48,920
Speaker 2: great is testosteronis And that's like as a marker of

518
00:29:49,400 --> 00:29:55,400
Speaker 2: you know whatever, positive of manhood presumably, which gets to

519
00:29:55,480 --> 00:29:59,840
Speaker 2: the question of whether, in fact we see like are

520
00:29:59,880 --> 00:30:04,120
Speaker 2: the a symptoms of low testosterone either low or just intermediate?

521
00:30:04,200 --> 00:30:07,440
Speaker 2: Like if you told me I've been tested many times

522
00:30:07,800 --> 00:30:11,240
Speaker 2: at my testosterone level is five hundred, should I expect

523
00:30:11,280 --> 00:30:14,560
Speaker 2: you to be better on some dimension than if your

524
00:30:14,560 --> 00:30:15,760
Speaker 2: testosterone is four hundred?

525
00:30:15,840 --> 00:30:19,320
Speaker 1: Yeah, that's my guys, This is the question, okay, because

526
00:30:19,320 --> 00:30:22,760
Speaker 1: we're so tempted to look at numbers and be like,

527
00:30:23,680 --> 00:30:26,120
Speaker 1: higher number is better. And we do this with so

528
00:30:26,160 --> 00:30:28,320
Speaker 1: many things, right, We do this with like vitamins, we

529
00:30:28,400 --> 00:30:31,000
Speaker 1: do it with protein to some extent, right, Like we're

530
00:30:31,040 --> 00:30:34,120
Speaker 1: trying to max everything. Let me let me play another

531
00:30:34,160 --> 00:30:35,000
Speaker 1: influencer clip.

532
00:30:35,200 --> 00:30:38,200
Speaker 5: I'm ready, Oh, man, is normal in a three hundred

533
00:30:38,280 --> 00:30:41,400
Speaker 5: testosterone range? Your quality of life is gone. And it's

534
00:30:41,480 --> 00:30:44,240
Speaker 5: like you said, it's not just libido. You're not gonna

535
00:30:44,240 --> 00:30:46,200
Speaker 5: be able to lose weight, You're not gonna be able

536
00:30:46,240 --> 00:30:48,960
Speaker 5: to gain muscle. Just like you just said, you're gonna

537
00:30:49,000 --> 00:30:53,040
Speaker 5: be feeling like you can't focus on anything, brain fog

538
00:30:53,240 --> 00:30:56,200
Speaker 5: like to no end. You're also gonna ach. You know

539
00:30:56,240 --> 00:30:58,200
Speaker 5: that you're gonna ache, You're not gonna be able to

540
00:30:58,320 --> 00:31:00,600
Speaker 5: move well, every little thing you do going to hurt.

541
00:31:00,640 --> 00:31:06,080
Speaker 1: It's going to be painful. That sounds sounds terribly, It

542
00:31:06,160 --> 00:31:09,520
Speaker 1: sounds pretty bad. I don't want to have a testosterone

543
00:31:09,600 --> 00:31:15,840
Speaker 1: level below three hundred, so how but is it actually true?

544
00:31:17,520 --> 00:31:20,880
Speaker 1: Let's walk through the EMASS study from the New England

545
00:31:20,920 --> 00:31:22,880
Speaker 1: Journal of Medicine, because I think this is the one.

546
00:31:23,240 --> 00:31:26,200
Speaker 1: This is like how you would design a study to

547
00:31:26,200 --> 00:31:30,480
Speaker 1: assess what the effects of differing levels of testosterone are.

548
00:31:31,280 --> 00:31:35,120
Speaker 1: So, so this was a survey based study three three hundred

549
00:31:35,120 --> 00:31:38,840
Speaker 1: and sixty nine men ages forty to seventy nine in Europe,

550
00:31:38,880 --> 00:31:42,600
Speaker 1: and they gave them very long questionnaires asking about a

551
00:31:42,640 --> 00:31:51,400
Speaker 1: wide variety of symptoms depression, confusion, brain fog, fatigue, sexual symptoms,

552
00:31:51,760 --> 00:31:55,640
Speaker 1: on and on and on. After giving them all those questionnaires,

553
00:31:55,760 --> 00:31:57,880
Speaker 1: they measured their testosterone level. Right, and this is what

554
00:31:57,880 --> 00:31:58,440
Speaker 1: you would.

555
00:31:58,200 --> 00:32:00,920
Speaker 3: Want using like for real, using a blood test.

556
00:32:01,040 --> 00:32:04,400
Speaker 1: Yeah, so it's like, okay, this is you know, it's

557
00:32:04,440 --> 00:32:08,200
Speaker 1: one thing to say, like I measured my testosterone and

558
00:32:08,240 --> 00:32:11,360
Speaker 1: it was two hundred and fifty, and now I attribute

559
00:32:11,400 --> 00:32:14,160
Speaker 1: everything that's bad in my life to that to that number.

560
00:32:14,480 --> 00:32:16,520
Speaker 1: That's sort of like astrology, right, It's like it's like

561
00:32:16,560 --> 00:32:18,440
Speaker 1: I'm a Libra and like, so that's why you can't

562
00:32:18,440 --> 00:32:19,800
Speaker 1: trust me or whatever. I Actually, I don't know is

563
00:32:19,800 --> 00:32:21,040
Speaker 1: that true about Libra's.

564
00:32:20,840 --> 00:32:24,000
Speaker 3: I couldn't listeners? Not really my thing.

565
00:32:24,680 --> 00:32:25,880
Speaker 1: That's probably because you're a virgo.

566
00:32:27,760 --> 00:32:28,640
Speaker 3: I'm gonnaquarius.

567
00:32:28,960 --> 00:32:32,440
Speaker 1: Okay, should have known no with that, Okay. So this

568
00:32:32,480 --> 00:32:35,200
Speaker 1: study instead says like, look, there are gonna be people

569
00:32:35,200 --> 00:32:39,440
Speaker 1: who have depression, and are there more people who with

570
00:32:39,520 --> 00:32:41,480
Speaker 1: depression at a low testosterone or is it just something

571
00:32:41,520 --> 00:32:44,000
Speaker 1: that yes, of course people with low testosterone have depression

572
00:32:44,080 --> 00:32:48,240
Speaker 1: and people with high testosterone have depression. So, Emily, was

573
00:32:48,280 --> 00:32:50,719
Speaker 1: there anything that stood out to you and the results

574
00:32:50,720 --> 00:32:54,280
Speaker 1: of this study as like, what if anything? Is it

575
00:32:54,560 --> 00:32:59,760
Speaker 1: clear that lower testosterone causes symptom logically symptomatically?

576
00:33:00,680 --> 00:33:04,240
Speaker 2: So the statistics in this study are a little like

577
00:33:04,320 --> 00:33:08,480
Speaker 2: a little tortured for the sort of basic reason that

578
00:33:08,480 --> 00:33:11,640
Speaker 2: they're doing a tremendous number of different tests and running

579
00:33:11,680 --> 00:33:14,040
Speaker 2: them in various ways, so the like sort of some

580
00:33:14,120 --> 00:33:17,560
Speaker 2: of the key results that show up as significant. They're

581
00:33:17,640 --> 00:33:20,880
Speaker 2: kind of picking a threshold and then estimating the impact

582
00:33:20,960 --> 00:33:23,960
Speaker 2: as you sort of move below that that threshold. But

583
00:33:24,040 --> 00:33:27,640
Speaker 2: of course there's a tremendous amount of choice that goes

584
00:33:27,760 --> 00:33:30,920
Speaker 2: into like, well what is the threshold and exactly how

585
00:33:30,920 --> 00:33:32,600
Speaker 2: do you structure it? And if you're kind of like,

586
00:33:33,240 --> 00:33:36,880
Speaker 2: you know, messing messing around, you can get closer to significance.

587
00:33:37,720 --> 00:33:39,040
Speaker 3: And they're testing many things.

588
00:33:39,440 --> 00:33:42,560
Speaker 2: I will say, the thing that sort of shows up

589
00:33:43,240 --> 00:33:45,360
Speaker 2: most consistently here.

590
00:33:45,400 --> 00:33:46,640
Speaker 3: Is stuff about sex.

591
00:33:46,800 --> 00:33:53,560
Speaker 2: So sexual thoughts, mourning, erections, erectile dysfunction, those are the

592
00:33:53,640 --> 00:33:58,600
Speaker 2: key things. The effects are not that big, right, So

593
00:33:58,960 --> 00:34:02,520
Speaker 2: like it's a little hard to exactly translate their number

594
00:34:02,600 --> 00:34:05,920
Speaker 2: into something that would be meaningful for a person. So

595
00:34:05,960 --> 00:34:08,279
Speaker 2: it's like what's the odds ratio when you move one

596
00:34:08,440 --> 00:34:10,120
Speaker 2: animal per leader below the threshold?

597
00:34:10,120 --> 00:34:13,640
Speaker 3: Who knows what that number means? But the effects are

598
00:34:13,680 --> 00:34:16,840
Speaker 3: small and not very significant, is my read?

599
00:34:17,000 --> 00:34:20,720
Speaker 1: Yeah, I mean even it's very hard to actually assign

600
00:34:20,800 --> 00:34:24,200
Speaker 1: like good numbers to decrease sexual thoughts, right, It's like,

601
00:34:24,480 --> 00:34:27,200
Speaker 1: what how often you thinking about sex? Like there's all

602
00:34:27,239 --> 00:34:29,600
Speaker 1: those sort of urban legends and stuff like that. But yes,

603
00:34:29,640 --> 00:34:31,920
Speaker 1: to me, it's very clear they looked at, you know,

604
00:34:32,160 --> 00:34:34,960
Speaker 1: fifty different potential symptoms and the only things that sort

605
00:34:34,960 --> 00:34:38,440
Speaker 1: of withstood, however, torture, the statistics are the only things

606
00:34:38,480 --> 00:34:42,520
Speaker 1: that sort of stood out were things about sex. So yes,

607
00:34:42,640 --> 00:34:46,240
Speaker 1: it does seem like if your testosterone is lower, your

608
00:34:46,560 --> 00:34:48,960
Speaker 1: sex drive and things associated with sex drive is going

609
00:34:49,000 --> 00:34:52,680
Speaker 1: to be lower. But notably, the psychological symptoms had no

610
00:34:52,719 --> 00:34:55,960
Speaker 1: correlation with testosterone level. So these influencers who are like, oh,

611
00:34:55,960 --> 00:34:58,280
Speaker 1: if you're below three hundred, you're going to be essentially

612
00:34:58,280 --> 00:35:00,080
Speaker 1: on your deathbed. You're going to be in pain, and

613
00:35:00,120 --> 00:35:02,000
Speaker 1: you're going to be depressed, you can't think straight, you

614
00:35:02,040 --> 00:35:05,400
Speaker 1: have no energy, Like that is not born out in

615
00:35:05,920 --> 00:35:10,399
Speaker 1: the data where people are blinded to their testosterone level, right,

616
00:35:10,480 --> 00:35:13,840
Speaker 1: Like you can you can make the argument after the fact,

617
00:35:13,840 --> 00:35:16,200
Speaker 1: you can kind of attribute it, but you're probably incorrect.

618
00:35:16,520 --> 00:35:16,719
Speaker 3: Yeah.

619
00:35:16,760 --> 00:35:18,640
Speaker 2: I think the other thing about this trial and even

620
00:35:18,680 --> 00:35:21,000
Speaker 2: about these results is what they're looking at is sort

621
00:35:21,000 --> 00:35:23,680
Speaker 2: of what is happening as you're moving down below some

622
00:35:23,840 --> 00:35:26,920
Speaker 2: lower threshold. Right, So here we're like really very focused

623
00:35:26,960 --> 00:35:30,640
Speaker 2: on this question of if you are like these influencers saying, okay,

624
00:35:30,640 --> 00:35:33,720
Speaker 2: if you're below three hundred, what happens to you? Again,

625
00:35:33,800 --> 00:35:37,920
Speaker 2: there's no cliff But most of these trials are about

626
00:35:37,960 --> 00:35:43,200
Speaker 2: these lower like moving down within lower levels, not asking

627
00:35:43,239 --> 00:35:44,480
Speaker 2: the question of whether seven.

628
00:35:44,360 --> 00:35:46,040
Speaker 3: Hundred is better than six hundred.

629
00:35:47,239 --> 00:35:48,960
Speaker 2: And oh yeah, And for that I think we just

630
00:35:49,000 --> 00:35:51,800
Speaker 2: have no there's no evidence to suggest that's true.

631
00:35:52,080 --> 00:35:53,839
Speaker 1: Yeah, and I would be very honestly, I'd be very

632
00:35:53,840 --> 00:35:56,480
Speaker 1: surprised if it's true. And the variation within a person.

633
00:35:56,840 --> 00:35:58,759
Speaker 1: You know, if you're below seven hundred, if you're six

634
00:35:58,840 --> 00:36:01,279
Speaker 1: fifty today, you're seven fifty tomorrow, you're six hundred the

635
00:36:01,280 --> 00:36:04,399
Speaker 1: next day. Like, you know, you're only going to see

636
00:36:04,400 --> 00:36:07,440
Speaker 1: effects when things are low. And again it looks like

637
00:36:07,480 --> 00:36:11,040
Speaker 1: those effects are are fairly limited. But that was an

638
00:36:11,080 --> 00:36:15,560
Speaker 1: observational study, right, that didn't say anything about replacing testosterone.

639
00:36:15,640 --> 00:36:20,000
Speaker 1: So there's okay, if you don't have enough testosterone, all right,

640
00:36:20,040 --> 00:36:22,640
Speaker 1: you have decreased morning erections and a higher risk of

641
00:36:22,719 --> 00:36:26,120
Speaker 1: rectile dysfunction. Then the question is, okay, what if we

642
00:36:26,320 --> 00:36:29,520
Speaker 1: replace testosterone, do those things get better? Do other things

643
00:36:29,840 --> 00:36:34,240
Speaker 1: get better too? And in this case, we really don't

644
00:36:34,280 --> 00:36:39,520
Speaker 1: want influencers to tell us what their anecdotal experience was.

645
00:36:40,800 --> 00:36:43,440
Speaker 1: We want to hear in the form of randomized trials, right,

646
00:36:43,440 --> 00:36:46,640
Speaker 1: we want placebo controls where people don't know they're getting testosterone,

647
00:36:46,640 --> 00:36:49,000
Speaker 1: because we've said a million times, if I tell you,

648
00:36:49,040 --> 00:36:52,440
Speaker 1: I'm giving you testosterone, even if it's not, it's like

649
00:36:52,520 --> 00:36:55,840
Speaker 1: Felix fellicis in Harry Potter, right, You're just like you

650
00:36:56,040 --> 00:36:59,239
Speaker 1: feel good, and that's the power of place ebah.

651
00:36:59,239 --> 00:37:01,840
Speaker 2: And this is such a a classic place where the

652
00:37:01,880 --> 00:37:06,000
Speaker 2: placebo effect is going to matter, Yeah, tremendously because if

653
00:37:06,040 --> 00:37:08,040
Speaker 2: you tell somebody you know, I'm giving you something and

654
00:37:08,080 --> 00:37:11,720
Speaker 2: it's going to make you feel more excited about sex,

655
00:37:11,840 --> 00:37:12,680
Speaker 2: Like they are going.

656
00:37:12,480 --> 00:37:14,520
Speaker 3: To feel more excited about sex for sure. There's just

657
00:37:14,560 --> 00:37:17,359
Speaker 3: like no question. So much of this is in your head.

658
00:37:17,560 --> 00:37:22,640
Speaker 1: Yeah, yeah, yeah, that's how oysters work. So let's we

659
00:37:22,640 --> 00:37:24,560
Speaker 1: can't obviously talk about every trial, but I think there's

660
00:37:24,560 --> 00:37:27,680
Speaker 1: a couple that are are relevant to the discussion. The

661
00:37:27,760 --> 00:37:30,959
Speaker 1: testosterone trials. The te trials enrolled seven hundred and eighty

662
00:37:31,000 --> 00:37:34,360
Speaker 1: eight men above age sixty five who had total testosterone

663
00:37:34,480 --> 00:37:35,680
Speaker 1: less than to seventy five.

664
00:37:35,680 --> 00:37:37,680
Speaker 2: Can I just ask you before we get into the like,

665
00:37:37,760 --> 00:37:40,560
Speaker 2: what do you think about focusing only on old, older

666
00:37:40,760 --> 00:37:43,000
Speaker 2: men in this, do you wish that they had focused

667
00:37:43,040 --> 00:37:44,200
Speaker 2: also on people like you?

668
00:37:45,880 --> 00:37:48,479
Speaker 1: I think they would not find the signals that they want.

669
00:37:48,520 --> 00:37:50,560
Speaker 1: I think it would be very expensive. So you know,

670
00:37:50,680 --> 00:37:55,240
Speaker 1: the truth is, if you're enrolling people with normal testosterone levels,

671
00:37:55,760 --> 00:37:58,720
Speaker 1: you're not going to get any signal with physiological levels

672
00:37:58,719 --> 00:38:01,800
Speaker 1: of replacement. By the way, knows right that like antabolic

673
00:38:01,800 --> 00:38:05,160
Speaker 1: steroids that bodybuilders use are testosterone, right, or synthetic forms

674
00:38:05,200 --> 00:38:06,400
Speaker 1: of testosterone. People know that.

675
00:38:06,600 --> 00:38:09,000
Speaker 2: Yeah, I'm not sure if people know that, let's tell

676
00:38:09,040 --> 00:38:12,440
Speaker 2: them that anabolic steroids or a synthetic form of testosterone.

677
00:38:11,800 --> 00:38:14,600
Speaker 1: Yeah, they just happen to be given in like ten

678
00:38:14,640 --> 00:38:17,360
Speaker 1: times the dose of testosterone placement therapy, or even up

679
00:38:17,400 --> 00:38:19,560
Speaker 1: to like thirty times the dose. So these are crazy,

680
00:38:19,960 --> 00:38:23,080
Speaker 1: super physiologic doses of testosterone. And I think, in fact,

681
00:38:23,400 --> 00:38:26,080
Speaker 1: some of the hesitancy to get to your point, Emily

682
00:38:26,160 --> 00:38:30,440
Speaker 1: about testing and giving men testosteronal replacement therapy comes from

683
00:38:30,480 --> 00:38:33,239
Speaker 1: the complications that have been seen in bodybuilders, because we

684
00:38:33,320 --> 00:38:35,560
Speaker 1: know that when you're giving ten times the normal rate

685
00:38:35,600 --> 00:38:42,759
Speaker 1: of testosterone, you get infertility, liver failure, roid rage, baldness,

686
00:38:42,960 --> 00:38:46,560
Speaker 1: cardiovascular disease. Like all this bad stuff happens. But just

687
00:38:46,600 --> 00:38:50,319
Speaker 1: because that happens at ten x the dose doesn't necessarily

688
00:38:50,360 --> 00:38:52,480
Speaker 1: means it happens at one x the dose, right, like

689
00:38:52,480 --> 00:38:55,000
Speaker 1: like the dose is the poison, as the toxicologists like

690
00:38:55,040 --> 00:38:57,080
Speaker 1: to say. So I think that has you know, actually

691
00:38:57,160 --> 00:38:58,680
Speaker 1: hampered this research a little bit.

692
00:38:58,560 --> 00:39:00,759
Speaker 2: All right to getting back to this TESASA trials with

693
00:39:00,800 --> 00:39:05,640
Speaker 2: the older the older men, these focus on people who

694
00:39:05,880 --> 00:39:09,480
Speaker 2: have testosterone in lower levels. So I think the criteria

695
00:39:09,520 --> 00:39:12,280
Speaker 2: here was below two hundred and seventy five, So people

696
00:39:12,280 --> 00:39:14,200
Speaker 2: who were in the range of the you know, below

697
00:39:14,239 --> 00:39:16,640
Speaker 2: three hundred and you're basically dead.

698
00:39:18,320 --> 00:39:19,600
Speaker 3: And what happens.

699
00:39:20,840 --> 00:39:24,240
Speaker 1: What happens is your sexual stuff gets better. So these

700
00:39:24,360 --> 00:39:27,840
Speaker 1: older men that were randomizing, again placebo controlled randomized to

701
00:39:27,920 --> 00:39:31,320
Speaker 1: testosterone had a forty percent increase in sexual activity sexual

702
00:39:31,360 --> 00:39:35,080
Speaker 1: activity frequency, a twenty five percent increase in their libido scores,

703
00:39:35,080 --> 00:39:37,760
Speaker 1: and a thirty five percent improvement in a rectile function,

704
00:39:38,400 --> 00:39:42,719
Speaker 1: but no improvement in vitality or energy, and only very

705
00:39:42,719 --> 00:39:46,400
Speaker 1: small improvements in mood and walking distance. And this is

706
00:39:46,440 --> 00:39:51,400
Speaker 1: something that like gets repeated. I've seen this again and again,

707
00:39:51,520 --> 00:39:54,680
Speaker 1: Like if you look really at if you ignore the

708
00:39:54,719 --> 00:39:57,239
Speaker 1: influencers who say I started taking testosterone in placement therapy

709
00:39:57,280 --> 00:39:59,960
Speaker 1: and everything was a miracle. What you hear from men

710
00:40:00,640 --> 00:40:04,080
Speaker 1: is like sex sex sex. I am. I looked at

711
00:40:04,120 --> 00:40:05,359
Speaker 1: a Reddit thread in.

712
00:40:05,320 --> 00:40:06,280
Speaker 3: The ask Matrimonia.

713
00:40:06,880 --> 00:40:10,360
Speaker 1: It's a sex serment. Okay, there's a great reddit thread

714
00:40:11,200 --> 00:40:13,319
Speaker 1: in the ask Men's subreddit. It was like anyone taking

715
00:40:13,360 --> 00:40:16,080
Speaker 1: testosterone placement therapy, like, how was it for you? And

716
00:40:16,400 --> 00:40:20,319
Speaker 1: the basic breakdown is like twenty percent of people being like,

717
00:40:20,360 --> 00:40:23,440
Speaker 1: I took it, and actually I didn't feel much. Twenty

718
00:40:23,440 --> 00:40:26,239
Speaker 1: percent of people are like, I took it. My life

719
00:40:26,280 --> 00:40:28,360
Speaker 1: is great now, like I feel so much more energy,

720
00:40:28,440 --> 00:40:32,640
Speaker 1: I feel young again, great, And sixty percent of people

721
00:40:32,840 --> 00:40:38,719
Speaker 1: are exclusively talking about like the quality of their erections

722
00:40:39,000 --> 00:40:44,600
Speaker 1: and how horny they are, with one amazing comment blaming

723
00:40:44,640 --> 00:40:49,719
Speaker 1: testosterone replacement therapy for the failure of his marriage because.

724
00:40:49,760 --> 00:40:51,320
Speaker 3: He wanted more sex than she didn't.

725
00:40:51,760 --> 00:40:56,279
Speaker 1: Exactly. Yeah, something that that has has come up on

726
00:40:56,320 --> 00:40:59,359
Speaker 1: this odd podcast before. Emily has suggested that, you know,

727
00:40:59,480 --> 00:41:02,799
Speaker 1: women have a lower sex drive than men. And I

728
00:41:02,840 --> 00:41:05,520
Speaker 1: tried to be offended and I couldn't. And the data

729
00:41:05,640 --> 00:41:06,640
Speaker 1: tends to bear Emily out.

730
00:41:06,719 --> 00:41:08,960
Speaker 3: Data shows, data shows so be.

731
00:41:08,960 --> 00:41:11,040
Speaker 1: Careful if you're taking testoster replacement or you might want

732
00:41:11,040 --> 00:41:13,200
Speaker 1: to discuss it with your significant other.

733
00:41:13,280 --> 00:41:14,840
Speaker 3: You should always talk about this stuff.

734
00:41:15,040 --> 00:41:16,839
Speaker 2: Yeah, yeah, I mean, I think in a look when

735
00:41:16,880 --> 00:41:22,960
Speaker 2: you look the picture here feels very clear and almost

736
00:41:23,239 --> 00:41:26,440
Speaker 2: it's an example where you're in this rabbit hole of

737
00:41:26,480 --> 00:41:29,920
Speaker 2: influencers and if you just pull yourself out and you're like, Okay,

738
00:41:30,280 --> 00:41:33,080
Speaker 2: let me just think about, like what is likely to

739
00:41:33,160 --> 00:41:35,200
Speaker 2: be true based on what we know about this.

740
00:41:35,960 --> 00:41:38,440
Speaker 3: It seems likely that the thing that is going to

741
00:41:38,640 --> 00:41:39,799
Speaker 3: happen is about.

742
00:41:39,520 --> 00:41:42,240
Speaker 2: Sex, because that is and about feelings about sex, because

743
00:41:42,280 --> 00:41:44,000
Speaker 2: that is like the core.

744
00:41:45,400 --> 00:41:47,640
Speaker 3: Thing about disosterone is that.

745
00:41:47,560 --> 00:41:50,719
Speaker 2: It has all these things to do with how you

746
00:41:50,760 --> 00:41:52,319
Speaker 2: feel about sex and how much you want to have sex,

747
00:41:52,360 --> 00:41:53,839
Speaker 2: and your ability to have sex and all these other

748
00:41:54,360 --> 00:41:56,279
Speaker 2: all these other pieces. Just like it feels like that

749
00:41:56,400 --> 00:42:00,719
Speaker 2: is very sensible in contrast to a claim like you

750
00:42:00,760 --> 00:42:05,160
Speaker 2: won't be able to walk or move very well, which

751
00:42:05,239 --> 00:42:07,080
Speaker 2: is really no reason to think testosterone would have anything

752
00:42:07,400 --> 00:42:09,080
Speaker 2: to particular to do with.

753
00:42:09,360 --> 00:42:14,880
Speaker 1: Yeah, and I mean, insofar as mood maybe does improve slightly,

754
00:42:15,000 --> 00:42:18,880
Speaker 1: Like we can even draw a line between the sexual

755
00:42:18,920 --> 00:42:24,680
Speaker 1: effects and those subjective effects on mood and energy, and whatnot.

756
00:42:24,719 --> 00:42:26,560
Speaker 1: I mean, maybe not for the guy whose whole marriage

757
00:42:26,600 --> 00:42:31,080
Speaker 1: fell apart because of sexual incompatibility, but you can certainly

758
00:42:31,080 --> 00:42:34,560
Speaker 1: imagine that if all you do is increase sex drive,

759
00:42:34,719 --> 00:42:38,080
Speaker 1: like for many men, that might be enough to feel

760
00:42:38,480 --> 00:42:39,720
Speaker 1: a little bit better about things.

761
00:42:39,800 --> 00:42:45,800
Speaker 2: Right, totally, So if people are not interested in taking

762
00:42:45,840 --> 00:42:49,600
Speaker 2: exogenous testosterone, I mean, there are a couple of places

763
00:42:49,840 --> 00:42:53,600
Speaker 2: where it seems like there are small impacts of lifestyle

764
00:42:53,680 --> 00:42:56,680
Speaker 2: changes on testosterone, mainly around weight loss, is what I

765
00:42:56,719 --> 00:43:00,239
Speaker 2: would say, Like, there is some evidence of small all

766
00:43:00,280 --> 00:43:03,880
Speaker 2: amounts of increases in testosterone as a result of weight loss,

767
00:43:03,880 --> 00:43:06,520
Speaker 2: and similar with you know, GLP ones, which is presumably

768
00:43:06,600 --> 00:43:09,080
Speaker 2: for the same for the same reason. Those are again

769
00:43:09,160 --> 00:43:11,279
Speaker 2: like those are actually those effects are pretty.

770
00:43:11,000 --> 00:43:13,799
Speaker 3: Small, smaller than I might have thought that they would be.

771
00:43:13,800 --> 00:43:17,080
Speaker 1: Actually, yeah, me too. We usually see sort of better

772
00:43:17,160 --> 00:43:23,040
Speaker 1: effects with significant weight loss in other domains. Yeah, absolutely,

773
00:43:24,040 --> 00:43:26,080
Speaker 1: That is actually one of the reasons as I was

774
00:43:26,160 --> 00:43:28,720
Speaker 1: kind of looking through this and deciding what my feelings

775
00:43:28,719 --> 00:43:32,960
Speaker 1: were about testosterone replacement therapy, I tend to constitutively be like, oh, like,

776
00:43:33,120 --> 00:43:36,280
Speaker 1: let's find lifestyle things that can improve the thing first,

777
00:43:36,440 --> 00:43:40,120
Speaker 1: rather than just like supplements or you know, doing it exogynously,

778
00:43:40,920 --> 00:43:46,640
Speaker 1: And the truth is that there's not a slam dunk here. Again,

779
00:43:47,160 --> 00:43:50,359
Speaker 1: you're gonna see some people telling you that, like there's

780
00:43:50,440 --> 00:43:54,880
Speaker 1: really easy natural ways to increase your testosterone. Here's here's

781
00:43:55,000 --> 00:43:57,600
Speaker 1: a guy talking about zinc.

782
00:43:57,840 --> 00:44:00,399
Speaker 4: If your libido is gone and your energy is tank,

783
00:44:00,840 --> 00:44:02,880
Speaker 4: you might not have a hormone problem, you have a

784
00:44:02,960 --> 00:44:06,920
Speaker 4: zinc problem. Your body cannot build testosterone without zinc. Today

785
00:44:06,960 --> 00:44:09,520
Speaker 4: we're libido maxing at Whole Foods.

786
00:44:10,200 --> 00:44:12,239
Speaker 1: We're libido maxing. I love it.

787
00:44:12,320 --> 00:44:14,759
Speaker 3: Please don't do it at whole food So why I

788
00:44:14,920 --> 00:44:15,520
Speaker 3: know whole Foods.

789
00:44:15,560 --> 00:44:17,680
Speaker 2: I don't want a bunch of people libido maxing while

790
00:44:17,680 --> 00:44:18,719
Speaker 2: I'm just try chaper.

791
00:44:18,560 --> 00:44:21,440
Speaker 1: Just to buy the testosterone.

792
00:44:21,719 --> 00:44:24,640
Speaker 3: So is that true about the zinc? What what way

793
00:44:24,680 --> 00:44:25,480
Speaker 3: is zinc related?

794
00:44:26,080 --> 00:44:31,400
Speaker 1: This is like classic mechanism jumping to conclusion problem. So yes,

795
00:44:31,800 --> 00:44:35,560
Speaker 1: zinc is a cofactor in the synthesis of testosterone, as

796
00:44:35,600 --> 00:44:38,319
Speaker 1: like in the biosynthetic pathway of testosterone you need a

797
00:44:38,320 --> 00:44:42,640
Speaker 1: little bit of zinc. That does not mean that getting

798
00:44:42,640 --> 00:44:46,839
Speaker 1: your zinc level crazy high increases that. It's like it's

799
00:44:46,840 --> 00:44:48,680
Speaker 1: a vitamin, right, or it's a mineral, but like it

800
00:44:48,880 --> 00:44:51,360
Speaker 1: you know you need some amount or else you can't

801
00:44:51,880 --> 00:44:55,719
Speaker 1: synthesize testosterone, but having more doesn't mean you synthesize more.

802
00:44:56,440 --> 00:44:59,320
Speaker 1: About eight percent of the United States is zinc deficient,

803
00:44:59,360 --> 00:45:02,359
Speaker 1: but this is lar Argually, people with significant colmorbidities, who

804
00:45:02,400 --> 00:45:06,080
Speaker 1: are older and who don't have access to adequate nutrition.

805
00:45:06,239 --> 00:45:10,040
Speaker 1: Your you listener are probably not sync deficient, and pumping

806
00:45:10,120 --> 00:45:12,800
Speaker 1: up your zinc levels not going to really increase your testosterone,

807
00:45:12,880 --> 00:45:14,560
Speaker 1: although again, if you check it a couple times, you're

808
00:45:14,560 --> 00:45:16,040
Speaker 1: going to get numbers you like. It's like taking the

809
00:45:16,080 --> 00:45:17,239
Speaker 1: SATs over and over again.

810
00:45:17,280 --> 00:45:19,680
Speaker 2: Really, I was just thinking, it's like, and take it again, right,

811
00:45:19,719 --> 00:45:20,680
Speaker 2: they only count one of.

812
00:45:20,600 --> 00:45:22,520
Speaker 1: Them, and I will say that the more. If your

813
00:45:22,560 --> 00:45:26,480
Speaker 1: zinc is too high, then your copper metabolism can get

814
00:45:26,520 --> 00:45:28,520
Speaker 1: thrown off and maybe you don't get enough copper. I

815
00:45:28,520 --> 00:45:30,839
Speaker 1: don't know, So don't don't stress about stuff like that.

816
00:45:32,000 --> 00:45:34,200
Speaker 1: I think the real question for people when they're considering

817
00:45:34,200 --> 00:45:38,040
Speaker 1: testosterone real placement therapy is really quite simple. Is is

818
00:45:38,040 --> 00:45:41,080
Speaker 1: my indogenous testosterone low? And is it really low? Like

819
00:45:41,280 --> 00:45:43,719
Speaker 1: is not? Did I get one value that was low

820
00:45:43,760 --> 00:45:44,840
Speaker 1: and all the others are normal.

821
00:45:44,880 --> 00:45:47,400
Speaker 3: Consistently below three hundred on multiple tests.

822
00:45:47,480 --> 00:45:50,239
Speaker 1: And do I have sexual symptoms? Yeah, And if the

823
00:45:50,280 --> 00:45:53,200
Speaker 1: answer to either of those is no, like there's not

824
00:45:53,280 --> 00:45:54,120
Speaker 1: much to be done.

825
00:45:54,680 --> 00:45:56,439
Speaker 2: I'm going to add to the to the last thing,

826
00:45:56,480 --> 00:45:59,000
Speaker 2: like do I have sexual symptoms that are a problem

827
00:45:59,040 --> 00:46:01,720
Speaker 2: for me? Because I think actually, when we talk about

828
00:46:01,760 --> 00:46:05,680
Speaker 2: sex here, it's like, you know, we're always talking about this,

829
00:46:05,840 --> 00:46:07,960
Speaker 2: like your goal is to want more sex, and like

830
00:46:08,000 --> 00:46:09,879
Speaker 2: maybe that is that is your goal or I'm being

831
00:46:09,920 --> 00:46:11,719
Speaker 2: bothered by not having.

832
00:46:11,480 --> 00:46:12,480
Speaker 3: The libido that I want.

833
00:46:12,560 --> 00:46:15,520
Speaker 2: I think that if that's true, that's absolutely a consideration.

834
00:46:15,640 --> 00:46:18,840
Speaker 2: I think people should ask always ask a question like

835
00:46:18,920 --> 00:46:21,440
Speaker 2: is this something that's actually a problem or.

836
00:46:21,680 --> 00:46:25,520
Speaker 1: Yeah not yeah, yeah, yeah, very important.

837
00:46:25,840 --> 00:46:29,959
Speaker 2: What about risks here at the kind of dosage levels

838
00:46:29,960 --> 00:46:32,640
Speaker 2: So we see, obviously at very high dose levels like

839
00:46:32,680 --> 00:46:36,400
Speaker 2: you would have in an anomolic steroid, there are many

840
00:46:37,239 --> 00:46:42,320
Speaker 2: issues acne, weird hair in different places, or not enough hair.

841
00:46:43,080 --> 00:46:46,640
Speaker 1: Strokes and heart attacks, strokes and heart attacks, liver failure.

842
00:46:46,840 --> 00:46:50,560
Speaker 2: Being caught by USADA for doping. But what about for

843
00:46:50,920 --> 00:46:53,160
Speaker 2: people outside of this in a normal dose.

844
00:46:54,520 --> 00:46:58,440
Speaker 1: Yeah, I mean, the major concern has always been cardiovascular disease. Again,

845
00:46:58,560 --> 00:47:02,000
Speaker 1: I think largely driven by the bodybuilding community in fact,

846
00:47:02,000 --> 00:47:06,600
Speaker 1: the FDA mandated a trial in higher risk older adults

847
00:47:06,600 --> 00:47:09,759
Speaker 1: of testosterone replacement to see This was a trial called

848
00:47:09,800 --> 00:47:14,040
Speaker 1: Traverse more than five thousand people randomized trial for testosterone

849
00:47:14,080 --> 00:47:18,200
Speaker 1: replacement therapy to look for cardiovascular disease as an important outcome,

850
00:47:19,200 --> 00:47:22,720
Speaker 1: and actually there was no difference in major adverse coronary

851
00:47:22,719 --> 00:47:26,719
Speaker 1: events in that trial. Again, you'll see influencers like who

852
00:47:26,760 --> 00:47:29,799
Speaker 1: are really pushing TRT being like afraid of the cardiovascular

853
00:47:29,840 --> 00:47:33,440
Speaker 1: risks the Traverse trial like repudiated this. But you know,

854
00:47:34,000 --> 00:47:37,240
Speaker 1: no one trial is perfect. I mean you'll hear Traverse, Traverse, Traverse,

855
00:47:37,520 --> 00:47:39,880
Speaker 1: No one trial is perfect. The follow up was thirty

856
00:47:39,880 --> 00:47:42,520
Speaker 1: three months in that trial, which is you know, almost

857
00:47:42,560 --> 00:47:46,480
Speaker 1: three years. But that doesn't mean that you know, stuff

858
00:47:46,520 --> 00:47:48,920
Speaker 1: can be going on that gets you ten years down

859
00:47:48,960 --> 00:47:51,359
Speaker 1: the line. And I will say, if you actually dig in,

860
00:47:51,400 --> 00:47:54,080
Speaker 1: if you actually if you actually read the Traverse trial,

861
00:47:54,280 --> 00:47:58,000
Speaker 1: what you'll find is that there was a higher rate

862
00:47:58,040 --> 00:48:01,600
Speaker 1: of atrial fibrillation, which is that abnormal heart rhythm that

863
00:48:01,719 --> 00:48:05,439
Speaker 1: actually endurance athletes like yourself, Emily are at higher risk

864
00:48:05,480 --> 00:48:10,799
Speaker 1: for thanks and blood clots in the testosterone arm low.

865
00:48:11,080 --> 00:48:12,920
Speaker 1: You know, the absolute risk was very low, but it

866
00:48:13,000 --> 00:48:16,600
Speaker 1: was higher than in the placebo group. Other risks that

867
00:48:16,760 --> 00:48:20,440
Speaker 1: I think are you know, worth considering. One is fertility,

868
00:48:20,239 --> 00:48:25,359
Speaker 1: So so testosterone supplementation if you are trying to not

869
00:48:25,400 --> 00:48:27,480
Speaker 1: become pregnant, get someone pregnant. If you're trying to get.

870
00:48:27,320 --> 00:48:29,880
Speaker 3: Someone pregnant, contribute positively to pregnancy.

871
00:48:29,960 --> 00:48:35,320
Speaker 1: Yeah, yeah, testosterone placement can decrease the production of sperm.

872
00:48:35,520 --> 00:48:38,160
Speaker 1: There are the issues with acne and hair loss, and

873
00:48:38,200 --> 00:48:42,200
Speaker 1: then prostate enlargement, but probably not prostate cancer, so benign

874
00:48:42,280 --> 00:48:44,880
Speaker 1: prostatic hypert refuge is just a benign enlargement in the

875
00:48:44,920 --> 00:48:46,480
Speaker 1: prostate can make it a little hard to pee. That's

876
00:48:46,520 --> 00:48:48,600
Speaker 1: been shown. And then I've got a fun bit of

877
00:48:48,680 --> 00:48:54,480
Speaker 1: chemistry for you, which is that testosterone is metabolized in

878
00:48:54,560 --> 00:49:01,320
Speaker 1: fat cells to estrogen to a stratiol via a enzyme

879
00:49:01,360 --> 00:49:06,279
Speaker 1: called aroma tase. And this is why people on very

880
00:49:06,320 --> 00:49:10,279
Speaker 1: high doses of men on high doses of testosterone can

881
00:49:10,320 --> 00:49:12,799
Speaker 1: develop kind of camastia, which is the development of like

882
00:49:12,960 --> 00:49:19,200
Speaker 1: glandular breast tissue as popularized by Robert Paulson in Fight

883
00:49:19,280 --> 00:49:24,160
Speaker 1: Club for the gen Xers, played admirably by meat Loaf.

884
00:49:24,760 --> 00:49:28,560
Speaker 1: So there is a risk of gind ofcomasia from testosterone supplementation.

885
00:49:28,880 --> 00:49:31,920
Speaker 1: And it is higher if you have a higher body

886
00:49:31,920 --> 00:49:36,200
Speaker 1: fat percentage, because that's where that conversion to estrogen takes place.

887
00:49:37,120 --> 00:49:41,920
Speaker 2: Okay, I have one last urban legend to discuss before

888
00:49:41,960 --> 00:49:44,920
Speaker 2: we smash our pass, which is the ratio of index

889
00:49:45,040 --> 00:49:46,000
Speaker 2: to ring finger.

890
00:49:46,600 --> 00:49:49,759
Speaker 3: So there's like this idea that if you have a.

891
00:49:49,920 --> 00:49:55,080
Speaker 2: Long ring finger, I think it's right that that indicates

892
00:49:55,120 --> 00:49:57,040
Speaker 2: a high level of testosterone.

893
00:49:58,200 --> 00:50:01,120
Speaker 1: Yeah, this is also all for Instagram. Take a listen.

894
00:50:01,400 --> 00:50:04,840
Speaker 6: Your finger length reveals how much testosterone you were exposed

895
00:50:04,840 --> 00:50:07,920
Speaker 6: to in the womb. Hold your right hand up. If

896
00:50:07,960 --> 00:50:11,560
Speaker 6: your ring finger is longer than your index finger, you

897
00:50:11,680 --> 00:50:15,880
Speaker 6: had high prenatal testosterone exposure. Is there the same length,

898
00:50:16,120 --> 00:50:19,759
Speaker 6: or your index is longer you had lower exposure. This

899
00:50:19,880 --> 00:50:22,279
Speaker 6: ratio is called the two D four D and it's

900
00:50:22,320 --> 00:50:24,719
Speaker 6: one of the most studied markers in human biology.

901
00:50:25,520 --> 00:50:28,520
Speaker 1: Okay, So, so I don't know that this is one

902
00:50:28,560 --> 00:50:32,520
Speaker 1: of the most studied UH mark markers in human biology,

903
00:50:32,840 --> 00:50:36,160
Speaker 1: but boy, if I didn't look at my own finger.

904
00:50:36,040 --> 00:50:38,440
Speaker 3: Yeah, you your fingers seem like you're in trouble.

905
00:50:38,640 --> 00:50:40,839
Speaker 1: Well, I feel like depending on kind of how I

906
00:50:40,880 --> 00:50:42,440
Speaker 1: hold my hand, I can kind of make it do

907
00:50:42,760 --> 00:50:45,800
Speaker 1: what now? I don't know. Maybe I didn't get enough testosterone.

908
00:50:45,960 --> 00:50:47,640
Speaker 1: What does that even mean? This guy goes on, I'm

909
00:50:47,680 --> 00:50:49,160
Speaker 1: not playing the whole clip, but he goes it's He

910
00:50:49,200 --> 00:50:51,399
Speaker 1: goes on to say, like, oh, then you know, if

911
00:50:51,400 --> 00:50:54,320
Speaker 1: you had more testosterone in the womb, you're like gonna

912
00:50:54,800 --> 00:50:57,720
Speaker 1: be more aggressive in life. And I don't know, Emily,

913
00:50:57,719 --> 00:50:58,880
Speaker 1: you were saying, there's.

914
00:50:58,719 --> 00:51:02,360
Speaker 2: Some amount of literature. This is just a bunch of bullshit,

915
00:51:03,120 --> 00:51:06,000
Speaker 2: But I like, so I happened. I'm looking at a

916
00:51:06,000 --> 00:51:09,560
Speaker 2: meta analysis of this, which here is the key statement.

917
00:51:09,920 --> 00:51:12,920
Speaker 2: We found no evidence of the relationship between the testosterone

918
00:51:12,920 --> 00:51:14,240
Speaker 2: types and digit ratios.

919
00:51:15,000 --> 00:51:15,920
Speaker 3: Furthermore, there was.

920
00:51:15,840 --> 00:51:18,200
Speaker 2: No evidence and very so this is uh, there is

921
00:51:18,239 --> 00:51:20,800
Speaker 2: no evidence of this. Maybe it is very highly studied,

922
00:51:21,280 --> 00:51:24,640
Speaker 2: but very highly studied to conclude that it is fake

923
00:51:25,120 --> 00:51:26,840
Speaker 2: that he should have added that he should have like

924
00:51:26,920 --> 00:51:29,520
Speaker 2: this is very highly studyed and we've concluded it's garbage.

925
00:51:29,680 --> 00:51:31,359
Speaker 1: I mean, even if true, I don't see just like

926
00:51:31,560 --> 00:51:37,200
Speaker 1: how this matters aside from I don't know, making conversation

927
00:51:37,280 --> 00:51:38,200
Speaker 1: of parties or something.

928
00:51:38,360 --> 00:51:40,960
Speaker 3: Okay, Perry, I'm gonna ask you a personal question. Do

929
00:51:41,040 --> 00:51:44,560
Speaker 3: you know your tesosterone level? No, you didn't even test

930
00:51:44,600 --> 00:51:45,719
Speaker 3: it for this episode.

931
00:51:46,320 --> 00:51:46,560
Speaker 2: I did.

932
00:51:46,680 --> 00:51:49,480
Speaker 1: I don't how much. I don't have what I know?

933
00:51:50,480 --> 00:51:51,480
Speaker 3: I know my testosterone.

934
00:51:51,560 --> 00:51:52,840
Speaker 1: Oh what's your testosterone?

935
00:51:52,960 --> 00:51:56,880
Speaker 3: Twenty five? Okay, it's like it's not it's below three hundred.

936
00:51:56,920 --> 00:51:59,080
Speaker 3: But yeah, I don't know. It's part of this blood panel,

937
00:51:59,520 --> 00:52:01,319
Speaker 3: part of some blood panel I've got. I don't know.

938
00:52:01,360 --> 00:52:02,960
Speaker 3: It said it was sufficient.

939
00:52:03,440 --> 00:52:05,000
Speaker 1: That seems that seems entirely normal.

940
00:52:05,120 --> 00:52:05,640
Speaker 3: Sufficient.

941
00:52:06,520 --> 00:52:09,040
Speaker 1: It would be low for me. No, I mean, I

942
00:52:09,440 --> 00:52:12,080
Speaker 1: haven't had it tested. It's one of those things where

943
00:52:13,040 --> 00:52:16,000
Speaker 1: I don't have symptoms that I would attribute to low testosterone.

944
00:52:16,040 --> 00:52:18,919
Speaker 1: And so even if I had it tested and it

945
00:52:19,080 --> 00:52:22,359
Speaker 1: was low, I don't know that I would necessarily want

946
00:52:22,400 --> 00:52:24,200
Speaker 1: to do anything about it. And that's always our threshold

947
00:52:24,239 --> 00:52:26,560
Speaker 1: for should I check something? Is the answer going to

948
00:52:26,600 --> 00:52:27,160
Speaker 1: make a difference.

949
00:52:27,760 --> 00:52:30,399
Speaker 2: I also feel like, what if you tested and it

950
00:52:30,440 --> 00:52:32,880
Speaker 2: wasn't like it was like four hundred, and then you

951
00:52:32,880 --> 00:52:34,720
Speaker 2: were like, ah, now I have to get tested again

952
00:52:35,400 --> 00:52:37,120
Speaker 2: so I can try to Because you're not really like me,

953
00:52:37,160 --> 00:52:38,600
Speaker 2: so you probably wouldn't do that. But I feel like

954
00:52:38,640 --> 00:52:40,440
Speaker 2: that's the reaction I would have. I'd be like, oh,

955
00:52:40,480 --> 00:52:41,040
Speaker 2: what can I do?

956
00:52:41,280 --> 00:52:45,440
Speaker 1: Yeah, I mean sometimes just like knowledge is your ignorance

957
00:52:45,480 --> 00:52:45,920
Speaker 1: is bliss.

958
00:52:46,560 --> 00:52:47,520
Speaker 3: Ignorance is bliss.

959
00:52:48,160 --> 00:52:51,920
Speaker 2: All right, Perry, testosterone supplementation smash your pass.

960
00:52:53,400 --> 00:52:57,640
Speaker 1: I'm giving this a smash for men with low testosterone

961
00:52:57,680 --> 00:53:01,560
Speaker 1: levels who have sexual symptoms. Otherwise it's a past. Emily

962
00:53:01,560 --> 00:53:02,200
Speaker 1: Smasher pass.

963
00:53:02,760 --> 00:53:06,520
Speaker 2: I concur smash if it is if you have low

964
00:53:06,600 --> 00:53:10,240
Speaker 2: levels and it is bothering you otherwise pass.

965
00:53:11,360 --> 00:53:14,520
Speaker 1: All right, That is it for testosterone. Your mailbag question

966
00:53:14,560 --> 00:53:16,439
Speaker 1: of the week after the Break.

967
00:53:21,480 --> 00:53:22,640
Speaker 3: Hi, Emily and Perry.

968
00:53:22,880 --> 00:53:27,640
Speaker 7: This is Emily, also from Baltimore. My husband is newly sober, so.

969
00:53:27,560 --> 00:53:28,680
Speaker 3: I kind of am now too.

970
00:53:29,200 --> 00:53:32,719
Speaker 7: My question is what is the health impact when swapping

971
00:53:32,760 --> 00:53:36,040
Speaker 7: a daily alcoholic drink for a daily soda and what's

972
00:53:36,080 --> 00:53:39,880
Speaker 7: the impact of soda versus diet soda? In other words,

973
00:53:40,000 --> 00:53:42,880
Speaker 7: if the choice is a daily drink of alcohol, diet

974
00:53:42,920 --> 00:53:46,400
Speaker 7: soda and regular soda, is there a clear winter health wise?

975
00:53:46,840 --> 00:53:49,239
Speaker 7: Love the show, Thanks so much so.

976
00:53:49,160 --> 00:53:52,200
Speaker 2: You're asking the question about alcohol, diet soda versus regular soda.

977
00:53:52,239 --> 00:53:56,279
Speaker 2: This feels like a fairly straightforward answer, which is, if

978
00:53:56,280 --> 00:54:00,840
Speaker 2: we're kind of thinking about some kind of optimizing diet

979
00:54:00,880 --> 00:54:03,120
Speaker 2: soda is the winner. It doesn't have the sugar, and

980
00:54:03,200 --> 00:54:05,640
Speaker 2: it doesn't have the alcohol. That's different from saying that

981
00:54:05,719 --> 00:54:08,640
Speaker 2: you can't have like a healthy lifestyle that incorporates alcohol

982
00:54:08,840 --> 00:54:11,239
Speaker 2: or regular soda.

983
00:54:10,960 --> 00:54:12,320
Speaker 3: In it in moderation.

984
00:54:12,560 --> 00:54:14,960
Speaker 2: But if you're telling me, like I'm a difference between

985
00:54:14,960 --> 00:54:16,719
Speaker 2: those three things, I'm going with the diet soda.

986
00:54:17,520 --> 00:54:21,480
Speaker 1: Uh yeah, I totally agree. I mean, there is a

987
00:54:21,520 --> 00:54:24,680
Speaker 1: lot of concern out there about artificial sweeteners. In fact,

988
00:54:24,880 --> 00:54:28,160
Speaker 1: that is on our list of upcoming episodes somewhere our

989
00:54:28,239 --> 00:54:31,680
Speaker 1: producer tomorrow can can tell us where that is happening.

990
00:54:31,719 --> 00:54:35,760
Speaker 1: But much of this, as you will see in that episode,

991
00:54:35,840 --> 00:54:38,840
Speaker 1: is really overblown or hypothetical concerns.

992
00:54:39,600 --> 00:54:43,840
Speaker 2: Whereas mice exclusively eats sycrilos as their entire diet forever,

993
00:54:43,960 --> 00:54:45,759
Speaker 2: that's not ideal, right, And.

994
00:54:46,360 --> 00:54:49,719
Speaker 1: You know, but the concerns we have about alcohol and

995
00:54:49,760 --> 00:54:52,720
Speaker 1: about like sugar or corn syrup as you would find

996
00:54:52,880 --> 00:54:56,960
Speaker 1: in regular soda is much better documented, much higher level

997
00:54:57,000 --> 00:54:59,640
Speaker 1: of evidence. So I think there's a lot of anxiety

998
00:54:59,680 --> 00:55:04,560
Speaker 1: about artificial sweeteners. Diet soda water is probably better for

999
00:55:04,640 --> 00:55:08,080
Speaker 1: you than drinking that stuff. But if you're purely talking

1000
00:55:08,080 --> 00:55:12,040
Speaker 1: about health risks, definitely diet soda over alcohol. If you

1001
00:55:12,040 --> 00:55:14,239
Speaker 1: get the same sort of amount of joy out of it.

1002
00:55:14,840 --> 00:55:16,520
Speaker 2: Yeah, I mean, I think that point about joy is

1003
00:55:17,000 --> 00:55:20,160
Speaker 2: important because they think, certainly, you know, I've spent a

1004
00:55:20,200 --> 00:55:23,040
Speaker 2: lot of time with the alcohol and health literature, and

1005
00:55:23,160 --> 00:55:27,239
Speaker 2: you know, occasional light drinking is I think the potential

1006
00:55:27,320 --> 00:55:31,200
Speaker 2: negative impacts are really quite small relative to some of

1007
00:55:31,239 --> 00:55:34,879
Speaker 2: what you hear. But again, if you're saying, like I'm

1008
00:55:34,920 --> 00:55:38,239
Speaker 2: totally indifferent, I think this is a clear call, particularly

1009
00:55:38,239 --> 00:55:41,000
Speaker 2: because this person has specified that like, this is what

1010
00:55:41,120 --> 00:55:44,520
Speaker 2: works for their relationship and is supportive of their partner,

1011
00:55:44,560 --> 00:55:46,640
Speaker 2: which makes it an even clearer no brainer.

1012
00:55:46,920 --> 00:55:50,000
Speaker 1: And also, have you tried diet doctor pepper? Amazing? It's great.

1013
00:55:50,920 --> 00:55:51,640
Speaker 3: It's too sweet.

1014
00:55:51,880 --> 00:55:53,920
Speaker 2: I find it too sweet, but diet like a nice

1015
00:55:53,960 --> 00:55:57,440
Speaker 2: diet coke. Like for me, that's like cannot be spot

1016
00:55:57,920 --> 00:56:02,920
Speaker 2: fridge cigarette. That's what gen Z calls that cigarette.

1017
00:56:03,480 --> 00:56:06,399
Speaker 1: Well, that's it for us today. Stick with us next

1018
00:56:06,400 --> 00:56:12,160
Speaker 1: week when we'll ask what's the deal with colostrum?

1019
00:56:12,280 --> 00:56:15,640
Speaker 2: Wellness actually is produced in association with iHeartMedia.

1020
00:56:16,200 --> 00:56:18,200
Speaker 3: Our senior producer is Tamar Avisheid.

1021
00:56:18,560 --> 00:56:22,200
Speaker 2: Our executive producer at iHeart is Jennifer Bassett. Our theme

1022
00:56:22,239 --> 00:56:24,880
Speaker 2: music is by Eric Deutsch. And our content is for

1023
00:56:25,000 --> 00:56:26,240
Speaker 2: educational purposes only.

1024
00:56:26,920 --> 00:56:29,200
Speaker 1: If you like the show, help other people find us,

1025
00:56:29,520 --> 00:56:32,319
Speaker 1: leave a rating and review on Apple Podcasts or your

1026
00:56:32,400 --> 00:56:35,160
Speaker 1: podcatcher of choice, and help us spread the word about

1027
00:56:35,160 --> 00:56:38,200
Speaker 1: the show. You can follow us on Instagram at Wellness

1028
00:56:38,239 --> 00:56:41,399
Speaker 1: Actually pod and don't forget We want to hear from you.

1029
00:56:41,840 --> 00:56:44,360
Speaker 1: Head over to Wellness Actually dot fm and leave us

1030
00:56:44,360 --> 00:56:46,960
Speaker 1: a question for our mailbag or suggest a topic for

1031
00:56:47,000 --> 00:56:47,680
Speaker 1: a future show.

1032
00:56:48,440 --> 00:56:50,279
Speaker 3: We'll let the influencers have the last word.

1033
00:56:50,719 --> 00:56:50,919
Speaker 1: Yeah.

1034
00:56:51,000 --> 00:56:54,960
Speaker 8: TESTOSTERM replacement therapy, hormone replacement therapy. Yeah, it makes a big.

1035
00:56:54,840 --> 00:56:56,240
Speaker 3: Difference, makes a big difference.

1036
00:56:56,320 --> 00:56:59,840
Speaker 8: Fuck Yeah, there's a stigma attached to that in a

1037
00:56:59,840 --> 00:57:01,520
Speaker 8: lot of people, like you know, where do you get

1038
00:57:01,560 --> 00:57:06,200
Speaker 8: your testosterone from? I'll get it from my balls. It's

1039
00:57:06,239 --> 00:57:10,200
Speaker 8: real simple. If you're fine with not feeling as good good,

1040
00:57:10,440 --> 00:57:11,880
Speaker 8: go ahead. Stick with that.