Speaker: [00:00:00] Why is your testosterone lower than your father's was at the same age? And who can you actually trust to help fix it? If you want real answers to those questions, instead of quick fixes and spotty information, you're in the right [00:00:10] place.

Speaker 2: If somebody is marketing testosterone as a product rather than actually the condition that they're trying to treat, I would take a second look.

Speaker: I couldn't move in the [00:00:20] ways that helps me fight my depression, and it terrified me at the time.

Speaker 2: Your health is what's gonna empower you. Nobody owes you anything except yourself.

Speaker: My name's Tim Wienecke, and in our [00:00:30] 28th episode of American Masculinity, we're bringing on Dr. Hisham Valiuddin. He's a ER doctor who's seeing these problems so often that he's starting a secondary practice to help men with [00:00:40] them.

Speaker: He's here to help us get real information on what's actually happening within the science of these things, what we know and what we don't, and how to get competent care to help you should [00:00:50] you have a problem while you listen to the episode. Think about the ways you've been addressing your hormone health and where you got the information from.

Speaker: We'll talk about it more at the end.[00:01:00]

Speaker: Thanks for coming on man. I'm really excited to have the conversation with you.

Speaker 2: Yeah, [00:01:10] happy to be here and, uh, important subject deserves attention and love to talk about it.

Speaker: Yeah, it's been really interesting just in my practice around testosterone and what's been coming up, so I [00:01:20] think this is a pretty broad issue and I think there's a lot of bad actors taking advantage of guys' fear.

Speaker: And so I'm really glad there's guys like you in the space to give some clarity to this.

Speaker 2: Oh, [00:01:30] absolutely. It's at epidemic levels and testosterone levels have been lower ever in, in the history of testosterone level testing. It's a very important subject and [00:01:40] glad that there are clinicians that are starting to pick up on it, diagnosing it, and then starting to treat it.

Speaker: Well, so how does a guy go? Like you're an ER doc, right? You're already helping people. I imagine that's [00:01:50] some kind of fulfilling helping people on the worst day of their life. How do you go from that to engaging in hormone medicine?

Speaker 2: So we do, uh, personalized, uh, concierge [00:02:00] care. And so I'm a lifestyle physician and yes.

Speaker 2: Uh, so working in the er, definitely a, uh, satisfying experience, uh, fulfilling, uh, my life, [00:02:10] ambitions and passions of helping people on the worst day and, uh, being at our best, uh, when they're, uh, at the most vulnerable. And, um, I. Practicing over [00:02:20] years. Uh, I saw firsthand how many men let their health fall apart even before coming into the emergency department.

Speaker 2: Mm-hmm. Usually, uh, when you have an emergency, it's been building up for years. It's [00:02:30] people with chronic conditions that leave their bodies at risk for what's going to eventually happen. And so we stabilize in the emergency department, uh, but we can't undo the damage [00:02:40] that's been already done over the past decade.

Speaker 2: Concrete examples of that. One of the most, number one. Causes of mortality in the United States is acute coronary syndrome, uh, myocardial infarction, heart attack, [00:02:50] uh, in layman's terms, and, uh, heart attacks happen from cardiovascular disease. And cardiovascular disease is built up clogs in your coronary arteries, which is the piping system of your [00:03:00] heart, the smallest vasculature, which has been building up for years.

Speaker 2: And so getting ahead of it, uh, you know, launched 40 Health because, uh, I believe that men deserve proactive, [00:03:10] personalized stigma, free care. And, uh, we're starting to get more and more information out there about, uh, what testosterone can do and what's the impacts it has on the various [00:03:20] aspects of one's life.

Speaker 2: Personally, uh, I'm of the age demographic where it starts to affect people. So I started looking into it for my personal health, started talking to my friends and colleagues about it, [00:03:30] and I realized what a big problem this is in the community and at large. And so that's what inspired me to start to take this as a more [00:03:40] of my time in my day and starting to, uh.

Speaker 2: Guide my passions towards saving lives in a more proactive approach.

Speaker: Yeah. My experience of it is both very personal [00:03:50] and from my clinical area. Right? So, so many guys are struggling with their health over the long term and it usually comes from that idea that men, we shouldn't value [00:04:00] ourselves. Right? That it, that it's unmanly to like get ahead, to go to the doctor's appointment, to worry about your health, to get it seen to you should just be able to like put your head down and push [00:04:10] and.

Speaker: I wasn't any different until in my mid thirties after grad school. Depression's kind of been a struggle I've had most of my life, and because of that, I know what to do [00:04:20] with it, right? Like I'm effective adult, I'm a clinician. I figured out the ways that I need to hold that, that are gonna make me effective in my life.

Speaker: And all of a sudden, all the things I [00:04:30] knew that should work weren't. Like, I couldn't get the energy to exercise. I couldn't get the energy to cook, right? I couldn't move in the ways that helps me fight my depression. And it [00:04:40] terrified me at the time. And so I, I went in to get some mental health medication to try to take some of the, the edge off of this to get my, get my hands back under it.

Speaker: And luckily the nurse practitioner [00:04:50] also worked and moonlighted in a hormone clinic and was like, have you had your testosterone tested? And that's when I found out that I had the average testosterone at 38. [00:05:00] As a 72-year-old of the eighties. Uh, so that was great and, uh, kind of hit my masculinity pretty close to home, right?

Speaker: Feels, feels like you're less than [00:05:10] for a minute, and getting on testosterone. Absolutely. Turned all that around it. It. All the things that I know worked started working again. But there were also some real health [00:05:20] issues that no one, either people didn't tell me about or I was so worried about what was happening that I didn't pay attention to.

Speaker: And so later on when me and my now ex-wife [00:05:30] tried to have kids I was unable to conceive, and I'm pretty sure, and so is my urologist, that part of that is gonna be because of that being on the synthetic testosterone for so long. [00:05:40] And I don't think a lot of guys that go into these clinics to get this done, no one's telling them that.

Speaker: And I don't want anybody else to go through what I did. [00:05:50] So what are kind of the common things you are seeing and that you look for as a professional in this space that guys should be looking for, for red flags and what are the reasons why, even [00:06:00] if it's there, maybe they wouldn't wanna be on testosterone.

Speaker 2: Uh, the story that you shared about your personal story is not uncommon these days, but everyone's afraid to [00:06:10] talk about it, uh, because of a longstanding kind of culture. And then I'll bring the historic perspective to this and then also talk about where we're at today, and you're. [00:06:20] A hundred percent right.

Speaker 2: And, uh, you know, a couple dec decades ago, when you watch John Wayne on tv, when you watch the Cowboys, you know, they didn't talk, complain about much, and you just had grit and you just got through what you have [00:06:30] to get through when you were on your adventure in life. And, uh, so that part was true about masculinity and how you were supposed to approach life at that point in time.

Speaker 2: But [00:06:40] as time has been changing and, uh. Where we're at today, those same, they don't have the same environmental risk factors that we have been [00:06:50] predisposed to where our physiology is different. So the modern name today actually faces, uh, a lot of detriments to their health from [00:07:00] environmental factors such as BPAs, from frying pans, from, from what they eat, um, anti pesticides.

Speaker 2: You have chemicals and, and ultra processed foods. You have [00:07:10] seed oils. All of these things that didn't exist when we weren't such a successful nation, uh, exists today, which is actually starting to hold back men [00:07:20] from achieving their masculinity, achieving their physical health, their optimal health that they're supposed to be at.

Speaker 2: So we're starting to now catch up to, uh, it's [00:07:30] almost a, a twofold approach of trying to, uh, it's a, um. A vulnerability of our actual successes that we're having. Uh, so because we're a, [00:07:40] such a, uh, a successful nation and industrialized nation, we've solved the problem of hunger. But we've done it at the cost of ultra processed foods.

Speaker 2: That's easy to get convenient and [00:07:50] cheap, but then it's starting to affect our hormone levels. And with that actually has impacts on all aspects of our life. And, uh, exactly as you mentioned. So once [00:08:00] you're in your, uh, above your thirties. Forties. If you compare the average man today at 40, uh, with their testosterone level to what it used to be 20, 30 [00:08:10] years ago for an average man, 40 we're way below the norms of what it was.

Speaker 2: So our clinicians, uh, are starting to realize this is more of a problem. So just like the great clinician [00:08:20] that you went to that said, Hey, let's get this tested for you, that strung to be more part of the conversation. Now, why wasn't this part of the conversation five years ago, or let's say 10 years ago?

Speaker 2: It's because our healthcare [00:08:30] system is actually driven our healthcare decision making by health insurance payers. So there's no routine test, uh, routine screening tests, like there's a routine colonoscopy, routine, LDL [00:08:40] levels, routine triglyceride levels, which are. Supposed to be done for men as they age into their older age, which is above 40.

Speaker 2: There's certain screening tests. Testosterone isn't [00:08:50] on there. So if you're pri, if you have a primary care physician's, one thing, and if you do have a primary care physician, they frequently won't test for it because it creates a mountain load of paperwork that they have to then file with [00:09:00] the insurance company just to get that one test approved.

Speaker 2: And so most people. Don't end up getting their testosterone levels tested. And so, uh, today's a very [00:09:10] different dynamic as far as hormone health than it used to be 20, 30 years ago. Which brings to them the next question. Okay, you've gotten diagnosed, somebody [00:09:20] screens you, now you have a test. The blood test confirms you have low testosterone levels.

Speaker 2: Where do you go from there? As far as some of the most overlooked signs and symptoms of low testosterone, [00:09:30] uh, when you get tested is low energy brain fog. Fatigue. So if you are just drinking, having your everyday routine, but all of a sudden it seems that you're [00:09:40] missing an extra X in your life from the effort that used to put in the ambitions, that you have the motivations, essentially, imagine yourself when, if you ever did have a peak [00:09:50] testosterone phase in your mind, close your eyes and think about, you know, there was a time when I was just aggressive with life, or if I was more ambitious in my life.

Speaker 2: Usually for people, uh, their peak of their [00:10:00] life is at the age of 37. Uh, that's. These are all averages we're talking about, but from clinical physiology, people are at their peak, at their, their fine motor skills hand fine motor [00:10:10] skills are at their peak when they're 37 of age. Mm-hmm. And so think about twenties and thirties, how you felt compared to now.

Speaker 2: How do you feel today? And uh, that could be one of [00:10:20] the biggest signs to say, Hey, maybe I should have my testosterone levels tested. They're supposed to decline with age after you peak around your thirties, but sometimes that drop is very [00:10:30] drastic compared to everyone else. Which is kind of same thing with high blood pressure, right?

Speaker 2: Which is the most common chronic illness. Everyone's blood pressure goes up a little bit as they age, but other [00:10:40] pe other folks will have a higher pressure in their blood veins, and so they end up taking a hyper antihypertensive medication because they got screened for it, somebody managed it, someone [00:10:50] tested it.

Speaker 2: So just some people's bodies react a little bit more to the environmental factors than other folks do. So those are some folks that I'd highly recommend [00:11:00] getting tested. Uh, if you're above the age of 40, if you feel that, uh, something's off in your life and you quite can't put your finger to it and to exactly describe the [00:11:10] symptoms, uh, some of the f symptoms you can have is a loss of morning erections.

Speaker 2: If you, if you've never had a morning erection, if you're asking, wondering yourself, what does that even mean? Get your testosterone levels [00:11:20] checked out if you're having a decreased, uh, in your energy levels. If you feel, uh, you're not very focused in life, if you feel that your motivations are low, your ambitions [00:11:30] are low, and your body's just not moving, how it used to be or recovering how it used to be after workouts.

Speaker 2: These are all factors that play a role into it. So now you've gotten diag, you've gotten [00:11:40] tested, let's see, you get diagnosed with it and you get a prescription for testosterone. What are some, uh, red flags that you can think about that get often missed or [00:11:50] misattributed as far as, well,

Speaker: I want to pause for a minute as far as what guys should be looking for, because we know our testosterone is impacted by our social status and how the world engages us, as well as how we [00:12:00] engage the world.

Speaker: And so that guy that's depressed, that's super listless, that just isn't. Doesn't have the energy to move. It's a com. It's probably like a self perpetuating cycle at a certain point [00:12:10] with the testone stone, isn't it?

Speaker 2: Absolutely. Absolutely.

Speaker: And so how. If a guy's doing that and they can, what are things that they should be doing [00:12:20] before getting on testosterone to see if they can kind of jumpstart things again?

Speaker: Is that a possibility? Or once it's down, it's down and you really probably need the bump to go get some help?

Speaker 2: Uh, there's, uh, lifestyle [00:12:30] modifications are always the first line for pretty much many medical conditions, and this is one of them. You know, it's hard to pinpoint exactly what caused it, so never get to the root cause of why someone's [00:12:40] testosterone levels are low.

Speaker 2: But you can start to definitely take actions and starting to treat it. So once you start to, you know, one of the most frequent misconceptions that people have with diagnosis of [00:12:50] testosterone is that they think that it only deals with issues in the bedroom, uh, which isn't true. It actually shows up in less obvious ways, like fatigue.

Speaker 2: Uh, they don't feel restful after [00:13:00] sleep. Unexplained weight gain is a big one. Uh, if all of a sudden they're packing on pounds, or they're especially belly fat or abdominal fat, that's, uh, usually a red flag to get your testosterone [00:13:10] levels checked. But, uh, one of the, uh, there's a lot of talk online about boosting testosterone naturally with diet, exercise, and, uh, [00:13:20] supplements.

Speaker 2: And these things definitely do matter. Quality sleep, starting to have moderate exercise with weightlifting, stress control, having a high protein, [00:13:30] low sugar diet. All of these things definitely help with healthy tips. Increasing your testosterone levels and should be the first step, but these only move the needle so far.

Speaker 2: So depending on how [00:13:40] low your testosterone level really is, if you're too far off the curve, then no amount of lifestyle correction will get you the amount of correction that you need. You'll get the marginal [00:13:50] improve that you need. It's

Speaker: interesting, when I went in the first time and I advocated to get the test, my GP said that I was average.

Speaker: Within the average for my age, not [00:14:00] acknowledging that that has shifted over the last 20 years to detrimental levels are in your practice. Is that still what you're seeing the general medical industry doing is going off of the testosterone [00:14:10] averages of guys today versus our natural state of healthy testosterone?

Speaker 2: Yeah. You know, and, and so the thing is we use the thing, medical evidence is [00:14:20] usually 10 years behind from actual state-of-the-art research. And that's 10 years. And that's just how the way medicine's practiced at large. And that's because it takes that much [00:14:30] time to do some research, have randomized control trials, multiple level one, uh, a evidence, and then get that published, getting into textbooks, teaching those next.[00:14:40]

Speaker 2: Medical students that are then going to graduate in four years to actually practice a certain different way. So change, uh, they say some of the slowest industries to change are their practices are [00:14:50] medicine and in education. Uh, and so the range for testosterone, uh, the normal range is if you go to, uh, most labs to take, it's between [00:15:00] 200 to 1200.

Speaker 2: So as you can imagine, that's very. Broad range there to be considered normal and it's not age adjusted. That's the biggest problem because most [00:15:10] other tests, we've gotten sophistication to start to say, Hey, there's an age associated normal for a certain test, like a cardiac enzyme. But for testosterone, that hasn't been the [00:15:20] case.

Speaker 2: More and more talk is being done about it, but today you're a hundred percent right and if you go to any primary care physician to get a testosterone, if it's between the range of 200 to 1200, those [00:15:30] testosterones within their normal range, we can move on.

Speaker: I can say that when it was down around the two hundreds, it was not normal.

Speaker: That felt awful. The, the belly for [00:15:40] me, the, the weight gain was very clear. The energy level was really clear and I just, I couldn't recover from just minor hurts as well, like just [00:15:50] bruising and stuff took longer to heal. It was really surreal I felt. All of a sudden very old, is how I frame it. I guess with, with all this right it, the masculinity [00:16:00] conversation and having some kind of metric for it is, has been really important.

Speaker: It's informed a lot of my work I'm doing here on the podcast around how to socialize some of these things, but there's also just a lot of bad actors. [00:16:10] So let's say that a guy goes through, they get the test, they advocate, they're like, okay, I need to do some kind of treatment for this. And I know one of the options is actually [00:16:20] getting on testosterone itself.

Speaker: Uh, I use a medication instead, which works really well for me. And I imagine there are some that you'd talk about with different patients, depending on their needs. [00:16:30] What should they be watching for? Because I see a lot of really predatory actors in these health clinics.

Speaker 2: So testosterone, uh, is a, uh, substance, which is FDA [00:16:40] regulated means that it, you have to have a prescription for testosterone.

Speaker 2: So if anybody's selling you testosterone, synthetic testosterone, or any sort of a [00:16:50] testosterone supplement, which is not FDA approved or is, doesn't require a prescription means those are some, those are bad actors. [00:17:00] I would definitely stay away because, uh, some of that's the one, it's illegal. And number two, they're, uh, getting stuff and there've been multiple FDA arrests and, and [00:17:10] bust in this territory for people that get stuff from China and then they sell it, uh, on the internet or, or sell it in gyms, in locker rooms.

Speaker 2: Uh, someone who knows, a guy who knows a [00:17:20] guy can, can get a package, it,

Speaker: it feels very akin to what I used to think of as steroid culture.

Speaker 2: That's right. That's right. So anabolic steroids, some people use [00:17:30] testosterone, synthetic testosterone as a supplement to, for, for their goals of anabolic muscle growth, which is one of the benefits of testosterone.

Speaker 2: But [00:17:40] also, uh. That's exactly how they used to talk about the anabolic steroids. And so trend is the one that kind of frequently comes up online [00:17:50] or, uh, oxandrolone, which is frequently used in the muscle bodybuilding world. We don't recommend those things. And, and if anybody who starts off with that as their, [00:18:00] uh, testosterone treatment, uh, I would.

Speaker 2: Run, not, not even walk away. I, I would run from them.

Speaker: So if it's gonna be within the fitness space, you probably want to do a double or triple take on as to [00:18:10] whether they're doing it right. The place I went to ended up being a, um, it was a clinic and it was with a nurse practitioner, but they also seemed very [00:18:20] willy-nilly in their prescription.

Speaker: Like, I only needed the small pellet. I would get the pellet treatment, and they put in the larger one on accident and there wasn't a conversation about that being a bad thing [00:18:30] and it was. Like it was fundamentally different. All of a sudden I was angry all of a sudden. Wow. Different physiological symptoms that were not comfortable.

Speaker: And that was just from a [00:18:40] mistake because they're like, well, yeah, you got more. Isn't that good? And that was with a medical provider. They should look for if it's synthetic, if it doesn't have a prescription attached to it. [00:18:50] That's gonna be a huge red flag if it's kind of fitness related and gym related.

Speaker: Double check these things for sure. What are they looking for? How do they know if it's a reputable source for [00:19:00] care and somebody who's taking 'em through the best options instead of the easiest option?

Speaker 2: Well, one thing is the marketing messaging. If somebody is marketing testosterone as [00:19:10] a product rather than actually the condition that they're trying to treat, I would take a second look, meaning, uh, in order to regulate, uh, someone's hormones, which is going to [00:19:20] impact every facet of your life.

Speaker 2: You don't want to be injecting yourself with something cheap that they got from China that might be obtained illegally because you can imagine the type of effects it'll have on your [00:19:30] body, the person that you're talking to or the clinic that you're talking to. One thing is they should be having a real conversation with you about what symptoms, uh, you're having.

Speaker 2: What are your goals, what's your medical [00:19:40] history and, and how is your lifestyle fit, fit into play? Just from the, obtaining a history, a part of it. So the way they, whenever you go to any professional and talk to 'em about services, the [00:19:50] way they, uh, the questions that they ask you shouldn't paying attention to what they're paying, what they're asking you, and if they're getting a comprehensive picture, if they ask you one question, check a box and start to prescribe you stuff, likely [00:20:00] they haven't done their due diligence and, and maybe they're just making money off of giving you prescriptions.

Speaker 2: And the second thing is. Checking your, uh, testosterone levels. It's a whole [00:20:10] picture of within hormone health, there's various facets to your testosterone health and some of the most important to pay, pay attention to. It's not, it's not just your total testosterone levels. [00:20:20] You actually have to pay attention to your free testosterone level, which is your unbound component of testosterone.

Speaker 2: That actually is physiologically. The functions of how testosterone is in your body. [00:20:30] And then secondly, what are your estradiol levels, your sex hormone binding globulin, and your LH and FSH markers, the LH and FSH For me [00:20:40] as a clinician, I'll tell you, I'll tell you as a doctor, uh, that's the one that I paid attention for because not everyone checks your LH and FSH levels because they don't have to in order to prescribe [00:20:50] testosterone.

Speaker 2: If your testosterone levels. Levels are low if they can prescribe it to you. But any good clinician will first ask you about your LH and FSH levels because one of the [00:21:00] reasons you could have a low, and this is rare, but happens far enough that any endocrinologist that you go to would make sure to ask you this question is, uh, what's your LH and [00:21:10] FSH levels?

Speaker 2: 'cause if you have a prolactinoma, which is a small tumor in your brain, you that could be the reason for your low testosterone. So that, uh, it happens about one [00:21:20] in 1000 cases. But, uh, any physician would screen you for that and to say, Hey, if your testosterone levels are low, could it be a brain tumor? And that's causing your low testosterone levels.

Speaker 2: [00:21:30] And the reason they would ask that before giving you the testosterone is because if you just mask the symptoms by then increasing your testosterone levels, you'll never figure it out until it's, you know, 20, 30 years [00:21:40] later and you can't see out of an eye because of the, where the tumor would be, be near your hypothalamus pituitary gland.

Speaker: I love that you're, you're talking about this. I, I don't want everybody to think you have a [00:21:50] tumor because you have low testosterone, right? That's right. But the, the overarching point is clear. So many guys that I talk to and refer for hormone treatment and to get it [00:22:00] explored. The focus is on the symptoms and not the health.

Speaker: Like I have really have to pound on my guys that this is a predictor of your other health [00:22:10] issues. You need to incorporate a complete body health with this to make sure that it's what it seems like and that you live the life you want. I think that's a big part of what I [00:22:20] saw at the clinic I went to for that one.

Speaker: And what I hear from a lot of guys that some of these, I wouldn't call 'em shady, but I'd say lazy is probably a better way. Just lazy providers. Is that Well. [00:22:30] My penis is hard again and I'm hitting the gym well again. Good. I don't have to worry about anything else. So we know like the brain tumors one way that this could go really wrong.

Speaker: I've read [00:22:40] that heart problems can be equated to also running your testosterone too high for too long. What are some of the other risks that you really watch forward with guys as you help them figure out the right [00:22:50] path forward?

Speaker 2: Yeah. So one of the things of getting your body ramped up again, uh, and functioning on high levels is you start to produce more red blood cells.

Speaker 2: [00:23:00] And, you know, it's a metaphor in life. You know, this guy's full of energy, he has more blood than the other guy, or he has red hot blood, you know? Mm-hmm. And it's actually physiologically there's some backing to that. And so once you [00:23:10] get to your testosterone levels higher, you start to produce more red blood cells.

Speaker 2: So your organs are more, well profused, uh, if there's the oxygen carrying capacity is a lot higher in your blood. [00:23:20] So you feel a lot more fresher. You feel a lot more youthful. You feel a lot more energetic just from your organs getting a better perfusion. But when it gets too high, there's a problem, right?

Speaker 2: So if [00:23:30] your red blood cells get too high, it can actually put you at rest for clotting. And so that's something to look out for by getting, what you're supposed to do is get a, [00:23:40] a blood test, a complete blood count that looks at your hemoglobin levels. And so that's a, a side effect, uh, that is to be monitored.

Speaker 2: And if it gets above. A certain [00:23:50] amount then you. Start to pay attention to how else do you manage your testosterone and what you should do about the right red blood cell count being too high. So it's the full picture [00:24:00] and uh, of the side effects and of the, uh, detriments that you can have with testosterone that need to be managed.

Speaker 2: And that's exactly why. Uh, it's a prescribed medication because [00:24:10] you're looking out for the risk and the benefits and in consulting with your medical provider and having that shared decision to say, Hey, these are my symptoms. How should we titrate it? And they have to give you a bigger pellet more than once [00:24:20] that there's an issue with it otherwise.

Speaker 2: And that's the response to that person said, Hey, aren't you happy? You're just getting more testosterone? And the answer is no, because, uh, you're putting me more at risk for side [00:24:30] effects without the actual therapeutic benefit for it.

Speaker: I, I think it's also really interesting that they don't have conversation with guys around what their goals for the future are.

Speaker: Yes. And I think it's because so many guys going in for [00:24:40] testosterone are older, so the assumption isn't that they're worried about fertility. But for layman, and I was certainly surprised by this when I found it out, you'd assume knowing nothing else, that if I get higher [00:24:50] testosterone, I'm more VR o, meaning I can probably produce more children.

Speaker: And in fact, the opposite is true. Can you speak to that?

Speaker 2: Yes, absolutely. So this is the biggest thing that's left [00:25:00] out from when people prescribe prescribed testosterone just online or from a non reputed clinic or, or non-clinicians, because you can get testosterone [00:25:10] prescriptions from, uh, mid-level providers, what we call 'em, which is nurse practitioners.

Speaker 2: Uh, physician assistants. Uh, these clinics are not run by physicians. And there's some, uh. The bigger players. [00:25:20] Actually, there's some big companies out there that are actually non-physician run, that are actually even owned by physicians, uh, to be frank. But one of the, we, we've touched on the subject a little bit, so when you have [00:25:30] testo synthetic testosterone, one of the biggest side effects of testosterone is that people see testicular shrinkage and which means, uh, decreased sperm production.[00:25:40]

Speaker 2: Your actual sperm count can go down to zero. To the point where they've been clinical studies where they've used testosterone as a birth control for men. Yeah. Women's birth control is actually [00:25:50] estrogen to take estrogen or progesterone as far as their homeless for birth control. They've even tried doing testosterone therapy to drop males rather than getting a [00:26:00] vasectomy, like a surgical approach, just taking testosterone in order to drop their sperm count so much that to use it as birth control for men.

Speaker 2: So that's. The impact that it has on your sperm production. And it goes back to the [00:26:10] conversation of LH and FSH and, and that's the reason behind it. We can talk clinically about it, uh, if you're interested, but it drops your LH and FSH, which is actually in charge of your, your sperm production. Well,

Speaker: [00:26:20] you, you're going through acronyms pretty fast, and I don't even know what they mean.

Speaker: And I'm, I'm pretty informed for a layman on this. Yeah. So let's say that I'm a guy and I'm gonna go to my gp mm-hmm. And I'm [00:26:30] gonna say, Hey, you know, I'm listening to these things. I'm worried about my testosterone levels. I'd really like to get them looked at and the doctor rolls his eyes and he's [00:26:40] gonna have to self-advocate a little bit here.

Speaker: Mm-hmm. Mm-hmm. What should he be asking that's gonna cue that doctor that he knows enough that he's actually gonna follow through

Speaker 2: If they roll their eyes, I'd [00:26:50] say just stop there because if your primary care doctor is going to give you a hard time about you being concerned about your health. You probably need another doctor.[00:27:00]

Speaker 2: Uh, you know, you should. I,

Speaker: I agree. And yeah, most of the guys I work with, they don't have a lot of options for what doctor they're going to. Yeah, they're on the insurance. They're on, they get to where they get [00:27:10] to and to get another provider's six to nine months. This is the access of care they have right now.

Speaker: And so if it's that person where, yeah, if they can afford to get a great [00:27:20] doctor, a concierge medical service, that's fantastic. I love it when my guys can get that. But so many of us barely have access to a gp.

Speaker 2: Yeah. And they're stuck. And they're stuck and, and you're totally right. So our [00:27:30] concierge service is exactly.

Speaker 2: Tailored for this problem. And one of the things is one, so you highlighted a big portion, you know, the primary care physician rolls your eyes. You're already feeling [00:27:40] vulnerable. You just brought up something and now they're not taking it seriously, which is only making this 10 times worse for you. And then number two is most of the primary care physicians in the US are [00:27:50] actually female.

Speaker 2: And so you have male patients that have been shown in literature, usually wait four to five years before they actually bring up their concerns about. Vulnerable conditions such as this, [00:28:00] because one, their p primary care physician, their gp, the general practitioner is a woman, so they feel kind of, uh, more vulnerable and don't wanna bring up something like this.

Speaker 2: And number two, maybe [00:28:10] their wife is also one of their patients or, or a community member. So they don't want to go to church or, or their, uh, community events and see this person that now knows that you have bedroom issues with, with you and your [00:28:20] spouse and, uh, have to be kind of worried about it. And so the, there's a.

Speaker 2: About four to five years before men actually even broached the subject, uh, with their primary care [00:28:30] physicians for all these issues. And that's exactly why we, uh, have this discrete private concierge type of approach to get these conditions addressed. But let's say that, okay, you get the [00:28:40] courage and finally ask them, and then they say, Hey, you know, let's start taking a look at, at your levels at that point.

Speaker 2: Uh, one of the things that you can say, uh, to them is, is bring [00:28:50] up, uh, the fact that the Traverse trial. And that's something I would drop in, in the con. Conversation. The Traverse trial is actually, uh, changed the whole paradigm [00:29:00] on testosterone health because there used to be a big black box warning on testosterone saying that, Hey, this can increase your cardiac cardiac risk due to hypertension.[00:29:10]

Speaker 2: And so most people didn't wanna talk about the testosterone prescribing testosterone. But if you, uh, traverse trial changed the game by FDA because they've removed that black box warning, and this just happened [00:29:20] last year, 2024. And most, uh, physicians, uh, won't be up to date about, uh, a year from now. But if you say, and, and so if you say Traverse, spell out [00:29:30] T-R-A-V-E-R-S-E.

Speaker 2: The traverse trial got rid of the black box warning. I'm really interested in the testosterone trout. They'll know that you're not just asking for some anabolic steroids or something [00:29:40] that that's shady or there's kind of peak, but that you've done your research, uh, you're asking them about some medical evidence and they'll take you a lot more seriously.

Speaker: Yeah, I think having that medical evidence in your pocket is [00:29:50] amazing too, and that five year stigma is just so consistent. And my practice and what I see with guys and, and it's why I tell my story about my testosterone, is I wanna get this [00:30:00] normalized. An epidemic problem right now, middle-aged men in this country are suffering with this, and some of it, like you said, is that there's female doctors in front of them and so they think they can't talk about it.[00:30:10]

Speaker: I can tell you there are wonderful female doctors that are absolutely informed and will help you if you open the door for them to do so, and if they don't, then yeah, like you said, you know, it's go through the process of [00:30:20] whatever that looks like to get to a doctor that you do feel comfortable with, but take your health.

Speaker: Seriously, what was the, there's a urologist that's on YouTube a lot, and I forget her name right now. I'll, I'll link her videos [00:30:30] because she's great. She talks about penis health and sexual health, but one of the ways that she framed it was is your penis is health, is the canary in the coal mine for other health problems.

Speaker: [00:30:40] Like one of the things I remember her saying was that within five years of having, uh, ed, a heart attack usually occurs. And so it goes back to that concierge service where you're talking about this [00:30:50] being a complete health. Focus and making sure that the testosterone is one piece of the equation. That's an important one.

Speaker: One that needs to be addressed, but it's also tied to all the other [00:31:00] ways that you're healthy or not and what your goals are. So coming back to those goals, we know that being on testosterone lowers virility. What [00:31:10] should a guy that has low testosterone but is still hoping to have children, they can't. If they're not gonna get on testosterone, what can they do?

Speaker 2: Yeah. You know, are you talking about Dr. [00:31:20] Rina Mulli, I think? Is that, uh, that sounds right. Yeah. Okay. Yeah. Yeah. Seems and yeah, I love that metaphor that she has and or, uh, you know, I like to say it's the tip of the spear, [00:31:30] right? There we go. That you have, and, uh, you know, you're talking to clinicians. I'm gonna get that real, real clinical on ya and mix.

Speaker 2: So the reason that [00:31:40] is, is because. Your arteries are the most tiniest when it gets to there. Uh, so the other second place where your arteries get really small, but supply a [00:31:50] very important organ is your heart. And, and so your penis in your heart are where you have your blood supply, uh, coming through the smallest of vasculature, uh, that is.[00:32:00]

Speaker 2: Most, uh, pronounced known to someone's health. So if all of a sudden if you're having erectile dysfunction, uh, you might have either a clotting disorder, you might have, uh, atherosclerotic [00:32:10] disease or coronary artery disease. And so yes, it's showing up as erectile dysfunction, which might be putting you at risk for exactly like you described in five years, having a heart.

Speaker 2: Because your other arteries then are gonna [00:32:20] start to also show symptoms. But app bath time is gonna be chest pain, so it's gonna be a whole different issue as far a yes. So the, the question that you were asking about the treatment options for someone [00:32:30] who is still, uh, trying to, uh, maintain their fertility or even to just testicular size, if they're just, you know, worried about their, uh, not wanting to have a decrease in [00:32:40] testicular size, volume, or if they're still trying to conceive or would like to conceive within the next 12 months.

Speaker 2: That's the important part. If you're trying to conceive within the next 12 months, you have to make [00:32:50] sure that do not be on unchecked testosterone or as a immunotherapy of just testosterone. Uh, there's two approaches to it. One is you can supplement it with [00:33:00] something that's similar to Incl Aine or, uh, or Clomid.

Speaker 2: They, or there's a couple different options, short and sweet of it, and clo enough go within Clomophine if that's what you're worried about. The, [00:33:10] so that. Boost your FSH lh, uh, that's your focal. They'll break down the, the initials, your, uh, follicular stimulating hormones, and you're luteinizing hormones.

Speaker 2: Those are in charge of your [00:33:20] sperm production. So what you do is you're taking testosterone, which is decreasing your F-S-H-L-H lh, but then you're taking the second medication, which is boosting your [00:33:30] FSH and lh. So then you have a balanced approach to your increasing your testosterone and making sure that you're still fertile.

Speaker 2: If you're still even more, a lot more worried, and you say, listen. [00:33:40] First thing first, I wanna have a kid this year, within the next 12 months, and I want my testosterone, but I'm not gonna sacrifice anything to make sure that I'm able to have a kid this year. Just [00:33:50] start off in the clomophine, don't do the testosterone because you still get that benefit of secondary testosterone increase with just in Clomophine.

Speaker 2: And many people choose to start off with that [00:34:00] as their first treatment. They go with Justin Clo Aine because that will increase your. FSH lh, which will increase your sperm production. So it's actually a treatment for men [00:34:10] if they're for, if they're having any infertility issues with a secondary benefit of Fs, increase in FSH and LH will increase your testosterone production too, while it's increasing your [00:34:20] sperm production.

Speaker 2: So many men, uh, actually choose to go with that option, which is a. Very good option as well.

Speaker: Well, so essentially it goes back to there are ways to mitigate [00:34:30] most problems if you and your provider are paying attention and talking through them and, and so like, I'm on chlo now. I don't do testosterone. I do ch clomid.

Speaker: And for [00:34:40] me, it increased my testosterone to the place I want it to be, and it doesn't feel synthetic. Like when I was on testosterone, I felt different than this. And [00:34:50] so me and my doctor, that's what we've chosen for my treatment and going forward, and we keep an eye on things, but that's probably just what I'm gonna be on for quite a while.

Speaker: And so it [00:35:00] sounds like when people think of low testosterone, they think of it as a singular problem, but it's our health and it's our hormone health, so it's gonna be complex. And so [00:35:10] anybody you're talking to about it that's treating it like a single point issue is doing you a disservice as a provider.

Speaker 2: Absolutely. You know, you wouldn't want to get your tire changed without them checking your fluids. Right. [00:35:20] We you to another, and that's very, this is your actual health, which impacts you every single day. And so you make sure they check their too.

Speaker: So we've got the fertility issue, [00:35:30] we've got some co cardiovascular stuff that apparently isn't as much of an an issue anymore.

Speaker: What are some of the other kind of things that people should watch for if they get on treatment that'll [00:35:40] let them know that their treatment isn't dialed in? Right.

Speaker 2: How your body feels, the symptoms and, and precision therapy is exactly that, is getting your symptoms under control. 'cause you don't also don't [00:35:50] wanna just treat a number, meaning getting a monthly, uh, testosterone test just to see what it does as far as increasing your lab value without you actually feeling different.

Speaker 2: Mm-hmm. And [00:36:00] so if you're not dialed into correct physiological testosterone levels, you're not gonna feel great. So start off there. The symptoms that you started off with in your follow-up visit, uh, [00:36:10] if you have one or just, you know, when you're talking to your CONSTITUTE physician, texting them, calling them, however, do you feel better?

Speaker 2: Uh, if you're not feeling better, then start to go down the pathway to say, Hey, is there [00:36:20] something else that's going on that went unaddressed? But you should. This is a very exciting fear from men when they actually start treatment because they feel the impacts. I mean, you feel it emotionally immediately.

Speaker 2: You feel it [00:36:30] physically. It's, it's wonderful. I mean, it changes people's lives.

Speaker: It certainly did mine. It was, it was like waking up from a fog. Yeah. It was intense and I, I think that's part of, I [00:36:40] wouldn't be surprised if a provider had talked to me about the fertility issues. I was just so relieved to not be suffering the way I was suffering.

Speaker: Yeah. That I don't know that I'd have heard them in the first place. [00:36:50] I, I feel like we're, we're doing a good job of talking to guys in their thirties and forties that might be starting to struggle with this maybe into their fifties and sixties. What are things that you wish 20 something year old guys would be doing to [00:37:00] protect their, uh, health and their testosterone that maybe they don't know to do?

Speaker 2: You know, watch what you read in your twenties. You eat anything, right? Uh, chips and a soda. I feel personally

Speaker: [00:37:10] attacked right now.

Speaker 2: People will, convenience is the number one guiding factor for what people put in their bodies. The thing is, you're gonna have to undo some of those convenience factors [00:37:20] later.

Speaker 2: And so watch what you eat. Ultra processed foods, try to stay away from paleolithic diet or whole food diets. I mean, you know, it's far close to whole foods that you get. [00:37:30] It's a little bit more inconvenient, but you'll be more thankful for it for decades down the road.

Speaker: And I think one of the things that a lot of guys in their twenties don't hear is, I always like the the 80 20 rule [00:37:40] you get.

Speaker: T like 80% of the impact by 20% of the effort in a lot of cases. So what is it like taking a walk for a half hour a day gives you 60% of what going to the [00:37:50] gym an hour does. So even if it's just mitigating how much of the processed food you're having, that can make a positive impact. I'm, I'm kind of curious about this one.

Speaker: One of [00:38:00] the things I heard is not having your cell phone in your front pocket because of the heat and potentially like the Bluetooth and such. Is that real? Is that a thing?

Speaker 2: You know, it's tough to say, uh, it's tough to say [00:38:10] because, uh, I've heard both sides of the argument. I can't say we've been able to crack the code on it, uh, just yet to give hard evidence.

Speaker 2: And I like to speak from a place of, uh, [00:38:20] literature and, and research and, uh, practice, uh, when I can. But, you know, some of these things, there's no funding to get some of these stuff tested because big pharma doesn't wanna pay for it, or, you [00:38:30] know, uh, the communication services. Uh, and so there's no stakeholder that does the studies to, to figure out if this is a true issue or not.

Speaker 2: But, so, uh, jury's still out on that one,

Speaker: so [00:38:40] maybe just keep it in the back pocket because you don't know yet. Could be. Right.

Speaker 2: Or just in the car if you can, you know, 30 minutes there. Hey,

Speaker: get, get away from your phone, man. It's not gonna, it's not gonna do any [00:38:50] harm, right? There's diet. You talked a little bit about exercise, right?

Speaker: Keeping moving, keeping healthy. There's the adage, if you don't lose, if you don't use it, you lose it. Uh, so many young guys right now [00:39:00] are checking out and not pursuing sexual relationships. I believe the number is one in four. Guys from 20 to 30 are not seeking sexual [00:39:10] relationships. What's the long-term impact of that kind of celibacy and the movement within, uh, the different men's health things, advocating for full celibacy where you're not [00:39:20] even masturbating?

Speaker: How is that impacting our testosterone and penis health?

Speaker 2: There's a way your, your body's naturally programmed to do things and, uh, going against it is going to cause issues being, [00:39:30] uh, settled it for long periods. So there've been as far as impacts on testosterone health there. We have a great article on our website, which also talk, you know, talks about the what does no FAP November do for your [00:39:40] testosterone levels, because they used to be a, uh.

Speaker 2: If you watch the old Rocky movies or if you watch any, uh, sports type of, uh, movie, they used to talk about, Hey, there's a scene [00:39:50] where, uh, you know, he tells Rocky, then he has to stay away from his wife until his fight comes up so that, uh, he, he's more, uh, aggressive in the fight or his testosterone levels are higher.

Speaker 2: And if that's actually true or not, [00:40:00] about what kind of impacts. Just your testosterone level doesn't have, if you don't masturbate, if you don't ejaculate, if, if you stay away from, from your wife, and, [00:40:10] uh, you know, you'll have to go on the, uh, a website to take a look at, at what that, uh, more detailed version of that story.

Speaker 2: But don't believe, uh, everything that you, that you see online on TVs. [00:40:20]

Speaker: I will say that from a mental health standpoint, if it's a religious practice of some kind, where there's a purpose and a guidance to self-denial, that's very [00:40:30] different than pretending it's for health and, and so for all the guys I work with, one of the ways that I kind of check in on their health is how often they masturbate.

Speaker: And what's happening with that. [00:40:40] It's also really important as a metric to track as to how their relationship is. If they're, if they're in an intimate relationship, monogamously and their sex life is down, finding out how often they're [00:40:50] masturbating also informs how much of a difference there is between the physical intimacy they want to connect with their partner with and their physiological needs.

Speaker: So the way I always [00:41:00] encourage it is just, it's something to pay attention to. And it's something to do in balance, right? If you're a guy in, you're in your thirties and you're still like pulling one off three times a day, that's probably a [00:41:10] problem. That's a little much, right? Maybe, maybe don't go that far.

Speaker: But if you're a guy who's like, I'm gonna go six months and never do this, and there isn't some form of [00:41:20] meditation on it, something where you're, you're trying to do something to learn something about yourself, you're probably screwing up. Is that a, is that a reasonable statement, man? Am I misleading anybody here?[00:41:30]

Speaker 2: No. You know, uh, everybody's body's different. Uh, everybody's body's different. Uh, but, uh, I'll tell you the science on it, that the science on it is if you're not having, uh, warning erections when [00:41:40] you wake up. So, you know, we're not talking about voluntary kind of a practices, but just, uh, if you're not having erections, well, when you wake up in the morning.

Speaker 2: That's a physiological, uh, sign that the, [00:41:50] your, uh, pudendal arteries, which your arteries in your, in your penis, there might be something wrong with it. As we talked about tip the spear canary in the coal mine. Uh, that might be an issue. And so, uh, with [00:42:00] people think that with older age or with certain practices, you can change that, but this is actually a physiological response.

Speaker 2: Your body to waking up as the lights get clicked on in your body, [00:42:10] you're. Arteries, uh, dilate and, and you get morning erection. So if you're not getting morning erections, I would say get your testosterone level checked to, to take a look at, uh, which way [00:42:20] you might be headed.

Speaker: Well, and isn't it the, the, the, the same woman we were talking about, the urologist had a video on it and said the average.

Speaker: For most guys that are healthy is seven erections through the course of a night of sleep. [00:42:30] And that part of that is that your penis is literally cleaning itself and healing itself. 'cause blood flow is how we get oxygen to places. Blood flow is how we heal and that's the point [00:42:40] in which our body is making sure that that part of ourselves is being taken care of.

Speaker: Is that accurate to your experience and knowledge?

Speaker 2: There's something they used to do back in the day called a posted stamp [00:42:50] test. And, uh, 'cause nobody can measure, right? No one, they're actually having seven interactions throughout the night or anything like that. Or, so a posted stamp test is, uh, when you take a [00:43:00] roll of, uh, posted stamps and, you know, they're stuck together side by side, right?

Speaker 2: And, uh, you put it circumferentially around your penis and then you wake up in the morning to see if the role actually expanded. [00:43:10] Meaning if the poster stamp split up from one another, and, uh. So that'll be a telltale sign to say, Hey, jump out was a negative PostIt stamp test or versus a positive PostIt stamp test.[00:43:20]

Speaker 2: So that's, uh, one way that some people can 'cause people at home are on you. How the heck am I supposed to know how your reactions might be sleep?

Speaker: Yeah. I don't have the, I don't have the weird string attached to the electrode to let me know it's [00:43:30] happening here.

Speaker 2: That right to your light switch to see if the light white switch gets turned on.

Speaker: I just want to be on the wall as a fly, listening to the [00:43:40] clinician doing that study, talking to young guys about putting something on their penis before they go to sleep. I think that's gotta be hilarious. So

Speaker 2: would ask, what's a postage stamp? You know? [00:43:50] So

Speaker: now you know right now we got, now we got a thing.

Speaker: So I love that we are two clinicians that talk about this stuff regularly, and right now we're [00:44:00] making a little bit of discomfort, humor. Right. To me, that's what that felt like of like, oh man, we're publicly talking about something a little taboo. And so I imagine if it's two guys that are advocating for men's health having [00:44:10] this problem, that stigma's gonna be landing on so many of the guys listening.

Speaker: What would you say to the guys that aren't getting this looked at because they're scared to know?

Speaker 2: Your health [00:44:20] is what's gonna empower you and nobody is responsible for, and that's, you know, health in, in, in healthcare. I think this is something I spend quite a bit of my time talking to, to my patients about is nobody [00:44:30] owes you anything except yourself and your health.

Speaker 2: You have to feel empowered to ask questions the same way as you would as anything else in life. People ask 10 questions to buy a laptop [00:44:40] or a cell phone or a car. What kind of engine does it have? What, how much horsepower? How many times should I get an oil change? Does this take a premium? Just stay regular.

Speaker 2: What about your body, right? I mean, this is [00:44:50] your actual vehicle that will pay off dividends, but you'll drive every single day that, uh, you run. So, uh, asking questions about your body, about how does it work, uh, what [00:45:00] and what certain things supposed to be normal. What's it not supposed to be normal? Before, you know, YouTube and stuff was very hard to get this type of knowledge.

Speaker 2: The only way you could get it was go to [00:45:10] your. Primary care physician, you would get only 15 minutes once every six months or once a year to get your information. But now everyone has access to this and you know, Chad, CBT, large English [00:45:20] models. There's a lot of ways you can start asking questions just about your own personal health, so you feel empowered walking into a conversation.

Speaker 2: I know it's always daunting to go into a car [00:45:30] shop and ask something about a, a car park because he, you feel like you're gonna get scammed or you don't know what you're talking about. But, uh, watching videos online to learn about it, asking Chad CPT looking [00:45:40] at Google and then talking to a clinician will go a long ways to feel emboldened about your health and that, and, and questioning if something is going the right way [00:45:50] or, and you're always welcome to a second opinion and the same as you would for anything else in life.

Speaker 2: If, one, you've talked to one physician and you feel that. Something's not sitting right with you. Seek out a second opinion. Uh, you know, that's [00:46:00] totally okay. Yeah. Getting a second opinion and which is, uh, frequently, uh, much appreciated even to get a second opinion because something one person could have missed shouldn't impact you for the rest of your life.[00:46:10]

Speaker: Well, especially when it comes to a serious medical issue, it's just a good idea. I mean, at the end of the day, clinicians are people. We make mistakes. We know what we know, and I work a good amount with GPS as as [00:46:20] clients. And one of the main reasons they're struggling with mental health is because there is too much information for them to track.

Speaker: They literally like. I'm working with a 30 year clinician right [00:46:30] now who's a fantastic doctor who can't keep up with the flow of information in a way that he feels confident. He can catch everything that he's supposed to. As a gp, as knowledge [00:46:40] expands, it's getting harder and harder for these things to be found, and so getting that second opinion is so important just to make sure that you've got your basis covered.

Speaker 2: Exactly. And at 40 Health, uh, sometimes people just [00:46:50] send us their lab work to say, Hey, you know, can I talk to someone? And that is something that we offer, uh, that we'll talk to you. Uh, our, our, uh, concierge, uh, physicians will talk to you. Take a look at your lab work and just [00:47:00] if you need a second opinion even to say, Hey, you know, you're fine.

Speaker 2: Uh, you don't need something. Or say this. Did you get additional collateral information or to help guide your care? Because, uh, at the end of [00:47:10] the day, you know, one of the things that I think people should feel emboldened by is they're not alone. There's a reason why there's epidemic levels of low testosterone is because everyone stayed [00:47:20] silent.

Speaker 2: It wasn't because one person did, but every, a whole generation stayed quiet on it. Uh, a whole generation felt that they couldn't talk about it. So when you do talk about it and [00:47:30] you know, and your clinician, trust me, has heard. Ma many had those, many of those conversations probably, uh, about testosterone or sexual dysfunction or [00:47:40] hormone health, or any vulnerable condition because they're professional and they're supposed to.

Speaker 2: So feel okay bringing that conversation up and know that you're not alone. Uh, you just don't wanna fall into one of those [00:47:50] statistics at the end of the day and wait five years before knowing that you have coronary art, disease, or anything else, uh, that might be detrimental to your health. And you were just too scared to ask or feel too vulnerable to [00:48:00] ask, or didn't feel that it was masculine enough to ask.

Speaker: Well, I think this is where women can kind of lead the way a little bit, right? Women for the last forever have had to really [00:48:10] advocate against the medical system to get their needs seen, tuned and met. And a lot of how we've been informed on how to self-advocate comes from what women have had to go through.[00:48:20]

Speaker: And for me, what I always think of is that's the cost of patriarchy, right? The they're gendered health. Sucks because for so long it was about keeping men at the top and [00:48:30] ignoring women. Now that we're coming around, we're seeing what that's cost us by not having gendered information, by not having test results that are organized by gender and different lab results [00:48:40] as just consistent part of the process until very recently.

Speaker: These are where these problems are coming from. And so like you said, the other thing is fighting that silence. Showing up and [00:48:50] talking about it means that the doctor is more likely to ask the next guy about it. It'll remind them that this is an issue. So the other thing is, is anytime you're addressing a struggle for you within these systems, [00:49:00] you are helping all of us.

Speaker: So you step up where you can, guys, it, it's, it's a big deal. I know it's scary. I don't particularly like telling the world on a podcast that my [00:49:10] testosterone was low and. Hopefully it helps some of you guys get the testing that you need.

Speaker 2: Absolutely. You're not just saving your life. You might be helping to save the next guy's life, and it is that serious.

Speaker 2: [00:49:20] So please do speak up. Please do ask it. And one of my, my passions I'll tell you is, uh, birth rates in in America, in the United States are the lowest it's ever been. I mean this is effect, [00:49:30] this is gonna have impacts for centuries down the road. So if doing it for your life isn't good enough, doing it for a year, neighbor's life isn't good enough, do it for a hundred years down the road, uh, might be [00:49:40] the next generation and the next generation after that, that might be suffering because we didn't speak up when we should have, when it was our turn to.

Speaker: That's thinking about it's, uh, and [00:49:50] depressing. So thank you. Thanks for that. I think it's a real issue. The, the birth rate thing is something that's on a lot of people's minds and I think this is [00:50:00] a healthy and effective way to have that discussion is around our health more than blaming women, blaming careerism, whatever else.

Speaker: I think this is something that we can concretely do for [00:50:10] ourselves and take leadership in our own health to address. So that's a great point. I wanna be respectful of your time, right? We, I know you've, you gotta try to get some rest between these ER shifts and running a business. The next [00:50:20] set is literally just to get to know you.

Speaker: And the reason why we collect these stories is to just like we were talking about, normalizing some of these things for other guys. And so every person that's answered [00:50:30] these questions has. It's been about them. It's been about their experience with their gender, their masculinity. This doesn't need to be about everybody else.

Speaker: It's gonna give us a chance to get to know a very [00:50:40] effective man who's running a business, who's an ER doc, and what his experience with his masculinity has been. So the first question is, what's a rule about masculinity you learned before you were [00:50:50] 12 that's remained true today?

Speaker 2: One of the rules that, uh, I learned about masculinity when I was young was, um, don't be afraid to ask for help.

Speaker 2: And, uh. [00:51:00] A team, uh, is actually stronger, uh, than a singularity. And I think that's still true today. I think, uh, if you, something that one of my favorite athletes, uh, says is, [00:51:10] uh, if you wanna go somewhere fast, go by yourself. But if you wanna go somewhere far, go with someone else. And that's very true. You masculinity, when you think about long term, when you think [00:51:20] about achieving your goals, ambitions, and what it means to be a man, uh, being successful, uh.

Speaker 2: Don't be afraid, uh, to actually go as a team, uh, and ask for help because [00:51:30] other, other people that are gonna have skill sets, which will help you out down the road.

Speaker: Yeah. I always get very upset at the idea of people achieving things alone. That's just not how [00:51:40] humanity works. If nothing else, you drove a car somewhere and someone built a road, man, we, we don't do anything by ourselves.

Speaker: That's right. That's great. But, and who, who was kind of instrumental in you learning that? [00:51:50]

Speaker 2: Oh my father. Uh, yeah, I'd say, yeah, you know, he's been, uh, my role model in life and, uh, has taught me, uh, a lot about life and, and that's, uh, one of his pieces of wisdom. [00:52:00]

Speaker: Oh man. I'm so glad that you had him. He sounds like you did a good job in a lot of ways.

Speaker 2: Oh, I appreciate it. I'm sure he'd appreciate too.

Speaker: So, uh, the next one [00:52:10] is, tell us about a time where pursuing men had hurt you.

Speaker 2: Pursuing manhood. Uh, where it hurt me was I always felt the need to, uh, felt the pressure to have the answers. Mm-hmm. You know, to be the [00:52:20] decision maker, the fixer, uh, the rock for everyone else.

Speaker 2: But I internalized that idea to say that asking questions or slowing down, uh, was a weakness, [00:52:30] but it actually led words slowing of things, you know, less efficiency, uh, because, uh, physically, mentally, and emotionally. When you're chasing a [00:52:40] particular version of something, trying to be somebody, it adds an undue pressure on you so you don't move as fast.

Speaker 2: It's not about just getting to the destination, but uh, you're trying to control the perception [00:52:50] of things. But, uh, it's okay to not have the answer at a certain time. Wherever you're getting to, whatever you're trying to accomplish in life, realize that it's always just one step in front of the other. And if you don't have the answer to [00:53:00] something, say, I don't know.

Speaker 2: And that's okay. You know, as a professional, as a doctor, you always feel you have an answer, especially when patients ask you the very tough question. What's wrong with me, doc? And I'll tell you, a lot of times they [00:53:10] say. I don't know. We don't know, but we know what's true right now, which is the certain things that we check, which is what your body's telling us today at this moment.

Speaker 2: But that doesn't mean that things can't [00:53:20] change, aren't going to change that there are other factors that we didn't consider. And so to say, I don't know, is, uh, something that I came to of reality with, uh, which I'd say that changed [00:53:30] my perception on how I pursue things.

Speaker: It's, it's funny, I think almost every provider I've talked to has had some kind of experience with the pressure to have an answer.

Speaker: Yeah. And [00:53:40] that being intrinsically tied to being a man. Right. The expertise, the, the status that we get from being the person in the front with the answer matters and. [00:53:50] People can see you fix ignorance. They can't see you fix bluster and ego.

Speaker 2: That's right. That, that's a great way of putting it.

Speaker: So we always like to go out on a high note with this.

Speaker: Uh, tell us [00:54:00] about a time when pursuit of your manhood empowered you.

Speaker 2: It comes down to exactly, you know, there's reason for this podcast, uh, today and, and this episode. Uh, you know, when I started focusing on optimizing my health, [00:54:10] uh, and not just what my perception was of, of true health is what really empowered me.

Speaker 2: I started taking control of my body, uh, of my per my [00:54:20] outcomes of my actual long-term planning, when with my life as it comes to health, energy, mental resilience of leadership. Start trying to say that, Hey, I can't just say, Hey, you know, it's a [00:54:30] certain day of the week, or if it's Sunday, or if it's uh, Friday that my body's gonna feel a certain way.

Speaker 2: Or if I didn't have coffee, I'm gonna feel a certain way. But to actually take ownership to say, this is my health, I'm gonna keep [00:54:40] it on a certain line, certain bandwidth, and I'm gonna pursue my goals with my health, uh, to, which gave me ultimate confidence and, and empowerment to say, Hey, you know, I can change things not only [00:54:50] for myself, but also how not let life dictate me, but, uh, rather, uh, me dictating the way my life's conducted.

Speaker: Yeah, so by leaning into your own efficacy and what [00:55:00] you can do for yourself, life got better.

Speaker 2: Game changer. Game changer.

Speaker: Well, is there anything else that you want people to know before we let you go for the day?

Speaker 2: Make sure you pay [00:55:10] attention to what your body's telling you, and if you're worried about it, 40 health.com.

Speaker 2: Check it out. Just browsing the website. Even just take a look at, uh, what we're. If you need some more education on [00:55:20] the topic, uh, great blogs, great clinicians on our team board, certified physicians. Happy to talk to you and if anybody wants to shoot me an email after listening to this, happy to answer some [00:55:30] questions as well.

Speaker: Oh man. That's really kind to you. I'll make sure to put that in the show notes so that guys can get those questions to you. 'cause I think it's so important to have an avenue for some of those answers, and it's really wonderful that you're providing that for [00:55:40] folks. Thanks so much, and that's our conversation with Dr.

Speaker: Va Hoon. At the beginning of the episode, I asked how you're handling your hormone health, what's changing for you? Now that you've listened to this episode, leave it in the comments so we can [00:55:50] normalize men changing their minds with new information. I know for me, I'm less worried about where my cell phone goes.

Speaker: As always, we like to fact check here. The one thing that needs a little bit of nuance [00:56:00] is the Traverse trials absolutely changed how the FDA regulates these things. But as the good doctor kept reminding us, A complete picture of your health is required for [00:56:10] competent care for hormones, remember, go to a provider that cares about that, not somebody who's gonna give you a single blood test and put you on a hormone right away.[00:56:20]

Speaker: I'm Tim Winkie. This is American Masculinity, and as always, thank you so much for listening. We'll see you next time when we talk about men in the Me Too [00:56:30] [00:56:40] movement.