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Testosterone, Aging, and Vitality: What Medicine Isn’t Telling You · Intellectual Medicine

• 0:00
  Your body is a self healing machine.
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  The mistake is to limit your body's potential for healing
• 0:08
  through your own and medicines bias.
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  The bias is well this is normal. Your brain fades, you have a
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  senior moment. Nonsense, your brain should
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  never wither. So one of the benefits of
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  testosterone, it is a neurotransmitter folks.
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  It's critical for good brain function.
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  It's critical for accelerating the movement of electrical
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  impulse from 1 neuron to the next.
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  Speed of transmission corresponds with formation of
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  new memory. Your testicles, like your
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  pancreas, like your thyroid, like your adrenal gland,
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  produces hormones. Now, if you went to your doctor
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  and you were feeling tired, constipated, gaining weight,
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  maybe a little depressed, and your doctor tested your blood
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  and said, well, you have hypothyroidism, your thyroid
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  gland is not producing adequate hormone, you would then expect
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  the doctor to address it by replacing what's missing.
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  Suppose the doctor instead said to you, well, your thyroid's
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  low, but you know what? For a guy your age, that's OK.
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  Not so cool, is it? Now let's flip it to the
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  testicle. What makes that glandular organ
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  so different from every other hormonal producing organ in your
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  body that medicine has collectively decided to ignore
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  it while it fades? It's a historical anomaly.
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  There's nothing normal about having your testicles wither.
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  It's a historically accurate fact, right?
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  Human beings, Homo sapiens, we're born, we grow to maturity,
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  we reproduce. Then what happens?
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  Yeah, we die. And before we die, we wither.
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  All right, so that's a historical arc.
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  From our Darwinian perspective, the world doesn't need us
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  anymore at this age. We can leave, but we'd rather
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  not. This is why we have a frontal
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  lobe, so we could think through things.
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  So in the next few minutes, we're going to discuss the role
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  of testosterone in your health, vitality, the role of
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  testosterone for the span of your life.
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  Should you do this? Why shouldn't you do it?
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  Should you ever stop it? What are the risks?
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  What are the benefits? So let's dive into this because
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  as you can tell, my advocacy is to live vitally in every regard.
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  Your body is a self healing machine.
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  The mistake is to limit your body's potential for healing
• 2:58
  through your own and medicines bias.
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  The bias is well you know this is normal.
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  Your brain fades, you have a senior moment.
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  Nonsense. Your brain should never wither.
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  So one of the benefits of testosterone, it is a
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  neurotransmitter folks. It's critical for good brain
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  function. It's critical for accelerating
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  the movement of electrical impulse from 1 neuron to the
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  next. Speed of transmission
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  corresponds with formation of new memory.
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  Word finding difficulty. Those hesitations.
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  They may be signs of inadequate testosterone.
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  Now I'm focusing on men. But ladies, you're equally at
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  risk. So brain function correlates,
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  immune function correlates. Testosterone has been known to
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  enhance immunologic function. How about preservation of muscle
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  yet? Can't grow muscle folks without
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  adequate testosterone. Y'all remember being 8910?
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  I do well scrawny kid. Can't wait for the day I can
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  actually grow muscle. I thought.
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  Didn't happen until puberty. Didn't happen until testosterone
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  came at the back end. As the testosterone leaves, you
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  can exercise all you want. You're going to slowly fade
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  unless you put back in what's missing.
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  This is so elementary to me that I have difficulty understanding
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  why medicine is so resistant. Maybe it's because it's largely
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  a generic pursuit. Maybe it's because there's not a
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  huge constituency benefiting from it, I don't know.
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  I think a lot of it has to do with a a bias against both
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  vitality, against sexual energy against anti aging.
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  The concept of aging as a normal process is a fallacy.
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  It is a variable dynamic. We need to age chronologically.
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  At some point we need to die. But everything about aging that
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  we consider to be normal as a part of it is modifiable.
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  There is no biological requirement to age in the
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  traditional manner before we die, and testosterone is
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  foundational to that. How about the fear factor?
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  This is buried in historical anomalies, misrepresentations,
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  paralyzed thoughts of prior concerns.
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  Prostate cancer? Nope.
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  Initially fearful that it would increase the risk of prostate
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  cancer. What do we know?
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  There's a higher incidence of prostate cancer in men with low
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  testosterone. Now that's not to say that
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  replacing it will lower that risk, but it is to say that
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  there's no correlation of enhanced risk.
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  Not only based upon observational experience, but
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  research studies. How about heart disease?
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  It's going to cause hardening of the arteries.
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  Nope. The best studies have not shown
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  evidence of increased heart attack and atherosclerosis.
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  One of the things are we fearful about blood clots?
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  Well, testosterone does transiently make the blood a
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  little sticky for the first couple of months, then it
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  stabilizes to a baseline. So the entry level into it may
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  have some mild increased risk, but it is quite rare to see that
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  manifest as an actual event. The fear factor about
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  testosterone is that it's going to make you aggressive.
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  Quite the opposite, the grumpy old man, or for that matter the
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  grumpy old woman, is an individual likely deficient in
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  testosterone. Testosterone has a calming
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  effect in the vast majority of people.
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  Irritability, depression, short temperedness, anger, these can
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  be symptoms of testosterone inadequacy and it's not an
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  absolute. You have to know the symptoms
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  you're pursuing and you have to discuss it in the context of a
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  clinician who's enlightened toward its use and that's not a
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  universal phenomenon. I'm of the opinion based upon my
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  research and I share this opinion with other like minded
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  colleagues in the space of anti aging therapy or human
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  andrology, the study of testosterone therapy, that every
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  man needs testosterone or they're going to suffer a
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  negative consequence. The only question is when to
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  start it. Now if you came to me and you
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  said, hey, I'm 60 years old, I feel like King Kong, I'm
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  awesome, erections are great, libido is great.
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  I'm killing it in the gym. I still put you on testosterone.
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  Why? Because it's anticipatory.
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  We know what comes next. Folks will say to me, but you
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  know my my father lived to be 90.
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  My grandfather lived to be 92. Granted, what do they look like?
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  Are they robust with a tall, with a muscular?
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  They likely shrank. They likely withered.
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  This paradigm, this perception of what aging should be, can
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  become a self fulfilling prophecy unless we break away
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  from that river of inevitability, the conventional
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  pathway. I'm embracing this for you, for
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  us, for all mankind, right. Let's live vitally.
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  My goal for you, all my patients.
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  I want to live with great energy, vitality, and then die
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  suddenly after a brief illness at an advanced stage while I'm
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  in good health. To achieve these goals, we must
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  maintain musculoskeletal integrity.
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  Most Americans spend roughly the last 10 years of their life in
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  some form of infirmity. A lot of that has to do with
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  musculoskeletal. So now we know testosterone
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  supports your brain. It supports your mood.
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  In fact, I've used it to treat depression and anxiety, men and
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  women, to good effect. What else can it do?
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  Bones and joints. If you have back pain, if you
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  have arthritic knees and arthritic hip, testosterone is
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  your friend. Muscle begets bone.
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  Health begets joint health. One of the most important
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  variables to keep your joints healthy is the power around that
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  joint. Now, I happen to have bone on
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  bone arthritis in my right knee and my right shoulder.
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  Yeah. Little reckless in my youth, got
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  smashed up a bit. All great fun.
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  Would not trade it for anything but the idea that my knee and my
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  shoulder need to be swapped out from metal.
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  Because they're bone on bone. By the way, bone on bone is an
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  absolute fallacy. How do I know that?
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  Well, because I can do this with my bone on bone shoulder.
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  Bone on bone implies petrified adherence of the joint.
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  If you can move that joint, it ain't bone.
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  On bone there is a microscopic layer of cartilage called the
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  articular cartilage still functioning within that joint.
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  Now it may look ugly on X-ray. My my knee on an X-ray looks
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  like somebody put a bomb in it but doesn't hurt.
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  I was at the gym this morning jogging on a treadmill because I
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  keep it strong. My point is that the
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  testosterone is critical for joint health.
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  So many of my patients report a decrease in their pain
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  syndromes, muscle pain, fibromyalgia, chronic back pain,
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  when hormones are supplanted, are replaced and at their
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  optimal levels. So bone health, joint health,
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  brain health, sexual vitality. Just did a podcast on that.
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  You could tune it in as well. It's a component thereof.
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  How about skin quality? The skin is hormonally receptive
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  and testosterone maintains skin integrity and elasticity, both
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  for men and for women. So hopefully I'm getting you
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  engaged and you're going to talk to your doctor about
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  testosterone therapy. Now, unless your doctor has
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  advanced training and has confidence in regard to anti
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  aging modalities, this may be a little bit of a conversational
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  dynamic, right? Blood levels never determine
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  whether or not hormones are needed.
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  Never. The only reason that I get blood
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  at the beginning is to create a baseline and to make sure there
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  are no reasons to avoid testosterone therapy.
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  Now what might those be? If you have APSA that is above
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  10, in some cases 20, it's worthy of a moment of
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  reflection. Now I treat patients in my
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  practice with high PSA who want to be on testosterone.
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  There is a Safeway to do that, but getting a baseline has
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  merit. What else?
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  A blood count? 1 of the more common genetically
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  inherited disorders amongst men is a hemochromatosis, which is a
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  form of iron storage disorder that causes an elevation in the
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  blood count in the iron level. This type of excess iron can
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  cause damage to your liver, to your kidney, to your brain.
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  It's quiet and it accumulates over time.
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  And because testosterone therapy will stimulate the kidney to
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  make erythropoietin, a natural process that then stimulates the
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  bone marrow to make more red blood cells, you want to get
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  your blood count evaluated. The blood count going up is not
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  a problem unless it goes above a certain threshold.
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  We call that erythrocytosis. That's one of the potential
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  consequences of testosterone therapy, Blood count going
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  higher. In some cases, donating blood is
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  recommended. So we've got a few things we
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  want to screen for, you know, global health, cardiovascular
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  health. Now, what about that level?
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  There are two forms, basically 2 forms of testosterone to test
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  the total and the free. I'm going to give you an example
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  using a pen. I have a prop, got a prop right
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  here. The studio comes fully equipped.
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  OK, so here's a pen and here's another pen.
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  So if you said how many pens does the Doc Pederudi have, the
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  answer would be two. But imagine that I am a sex
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  hormone binding globulin, right? And I am bound to this pen which
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  represents testosterone. Now you would say how many, how
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  many pens are there in the room? And the answer would still be
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  two. But only one of them is
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  functional. The other one is bound and can't
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  work. That's the difference between
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  total testosterone and free testosterone.
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  It's the free testosterone that does the work, a little bit
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  harder to measure, not commonly ordered, but worthy of
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  acquiring. So you want to look at total and
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  free testosterone no matter what the level is, if you're having
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  symptoms and your age appropriate.
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  Age appropriate is a relative statement.
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  I've had men in their 30s with symptoms of low testosterone
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  respond to therapy. So let's outline those symptoms
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  so you know what to look for. I mean, the most glaring loss of
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  libido, erectile difficulty. Those two oftentimes are
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  triggers, more subtle symptoms. Lost confidence, depressed mood,
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  low energy, especially late in the afternoon.
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  I come from work and I crash on the couch.
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  Lack of motivation, lack of initiative, difficulty
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  recovering from workout. You know, after the gym, skin
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  quality loss, muscle loss, these are all more subtle symptoms of
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  low testosterone that are worthy of evaluating and considering
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  treatment. So you have those symptoms,
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  you're being evaluated. By the way, make sure they check
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  your thyroid because these things can overlap and you
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  decide to go on testosterone. The next question, what kind of
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  testosterone? How should it be applied?
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  There are pellets that can be implanted, the topical creams,
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  patches, there's a new drug out that's an oral form and then
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  there's injectable. So let's review.
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  I don't like the new drug. Nothing.
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  Well, I don't trust it. The problem with oral
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  testosterone historically has been concerned about liver
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  issues because it metabolizes through the liver.
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  Now, I talked to the Rep for the company and they reassured me
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  that it's totally safe for the liver, and I absolutely don't
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  believe that. I don't believe it, no.
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  It's a wrap, right? They're selling stuff #2 you got
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  to wait. Let some other people try this,
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  you know, maybe five years from now I'll have a different
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  opinion. But it's also a proprietary
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  drug, kind of pricey. Topical creams, totally
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  reasonable, a little sloppy, a bit of a nuisance.
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  The absorption can be somewhat variable.
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  However, it's totally cool to use it, particularly if you
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  don't mind applying it every day and if you are not inclined to
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  want to do any injection, which is my preferred method for men.
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  Many women as well, but it's a once a week.
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  Typically it's a once a week self administered injection.
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  The dose varies depending on response.
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  When it comes to dosing testosterone, it is never judged
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  based upon subsequent blood level.
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  So if a gentleman comes to me in a follow up visit and says to
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  me, thank you doctor, I feel fabulous.
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  My energy is great, libido is back, my muscle mass is up, my
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  fat mass is down, that's a success.
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  If the blood level comes back at 400 or 500, there's no value in
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  pushing the dose higher just to get to a different number.
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  Now let's flip it around. Suppose he's telling me how
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  great he feels, and suppose the threshold for my lab is 900 and
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  his blood work comes in at 1200. It's no harm in high levels.
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  The lab parameters are a little bit arbitrary as long as there's
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  no negative effect. We talked about elevated
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  hemoglobin and hematocrit, right?
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  That can be monitored for elevated estrogen.
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  Some of your testosterone will naturally convert into estrogen,
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  which you must have. If you have no estrogen, your
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  bones can get weak and it can be counterproductive to your libido
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  and your energy. If you have too much estrogen,
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  yeah, you can grow man boobs and that's not so cool and it'll
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  undermine the benefit of testosterone.
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  So there's a sweet spot for estrogen.
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  Depending on the lab that is utilized.
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  My target zone for my patients is between 20 and 40.
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  It can vary depending on the labs parameters, so that's
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  something to be mindful about. It would be one of the reasons
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  to consider modifying the dose. So testosterone injectable, we
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  talked about topical creams, pellets I almost never use.
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  They work, they're safe, but unlike women who do very well
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  with one little tiny pellet, men sometimes need a bunch of them.
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  It's like buckshot going in the buttocks.
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  It's good if you have limitations, cognitive impaired,
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  or functionally just have trouble keeping up with things.
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  I have a few patients that benefit from that approach as
• 19:24
  well. How about preserving your
• 19:27
  testicle? I get this question often.
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  What if I decide to come off testosterone?
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  No problem, you just stop. You won't lose value that you've
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  acquired completely, but you will go back to that which you
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  were. When testosterone therapy is
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  being administered, it is incumbent upon the provider to
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  do things to preserve your testicles.
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  The testicles do more than make testosterone, they make other
• 19:58
  supportive hormones. They're a component of your
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  health. Giving testosterone without
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  something to support the testicle causes the testicle to
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  shrink. Over time will become completely
• 20:11
  atrophied, the size of a Raisin and cease functioning by virtue
• 20:16
  of supporting testicles. And that could be done with
• 20:19
  several different interventions. There is clomiphene or clomid
• 20:24
  and oral capsule. There is N clomiphene, A isomer
• 20:29
  that can be compounded. Another oral agent.
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  There is HCG, human chorionic and adatrophen, which is an
• 20:37
  injectable. There's gonadorellin, another
• 20:39
  compounded injectable. How you preserve testicles is
• 20:44
  really incumbent upon the doctor to guide you toward that.
• 20:47
  You preserve them, I think is critical.
• 20:50
  So testosterone, absolutely. Preserve the testicle.
• 20:53
  You bet. Monitor estrogen, blood count,
• 20:57
  absolutely. How about other potential site?
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  Can you lose your hair? Oh yeah.
• 21:02
  If you're prone toward androgen that is male pattern alopecia
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  and you're on testosterone, there's a risk of exposing the
• 21:14
  inevitable hair shedding that would that is destined to occur.
• 21:19
  Now there are things that could be done to try to balance that
• 21:22
  risk in some cases or topical creams.
• 21:25
  We have developed one in intellectual medicine.
• 21:29
  If you e-mail us, we can certainly consider it's a
• 21:33
  prescription compound that we made.
• 21:34
  It's a unique product, works great.
• 21:36
  What I like about it, and I do use it personally, is that it
• 21:39
  works on the hair follicle without getting significant
• 21:44
  blood absorption. You can use drugs like
• 21:48
  finasteride, Propecia. These drugs block DHT, so some
• 21:54
  of your testosterone will go into estrogen and some of it
• 21:58
  will metabolize into DHT or dihydrotestosterone, a really
• 22:03
  potent form of testosterone that is helpful to libido, helpful to
• 22:09
  the beneficial effects, but also more stimulating to the prostate
• 22:13
  and hair follicles. So going on a DHT blocking drug
• 22:18
  at the same time you're on testosterone to preserve hair if
• 22:22
  you're at risk for that is a reasonable combination to have.
• 22:27
  So here you are on your testosterone.
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  I get another question. How long should I stay on this
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  dock? And my answer until they close
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  the lid. Like why would you stop?
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  The only reason to stop is you're on the cusp of death or
• 22:44
  financially it's not sustainable or philosophically you just
• 22:50
  choose not to do it. By the way, that's totally cool
• 22:53
  too. You know how you live as your
• 22:55
  prerogative. My job is to educate and inform.
• 23:01
  It's not to impose. Any doctor that attempts to
• 23:04
  impose a treatment, I think is deviating from the primary
• 23:10
  focus, which is you, right? Give me information, doc.
• 23:14
  Don't tell me. I have to.
• 23:16
  I must. That's required.
• 23:19
  You have to get your colonoscopy.
• 23:21
  You have to get your mammogram. You must get a prostate biopsy.
• 23:26
  There could be sound reasons for these recommendations, but
• 23:29
  they're never requirement, right?
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  Independent life. That's most critical.
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  The choices you make. Most critical.
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  You choose not to do testosterone.
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  Totally cool. Doesn't make you a bad person.
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  I want to age organically. I want to do my best then do so.
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  Can you do things to help testosterone levels other than
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  take testosterone? Yes.
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  Strength training, muscle strength, weight lifting in
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  particular and shown to have some value.
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  Keep your percent body fat in check, shown to have some value.
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  But even a lean man with optimal health habits is going to have
• 24:06
  his testosterone levels decline. It's just inevitable.
• 24:10
  So you have options. Now you know it's safe.
• 24:14
  Now, you know, you could do it for the rest of your life.
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  Now, you know, you don't have to fade.
• 24:21
  Now you can be confident that you're not going to harm
• 24:24
  yourself. So, you know, my wife asked me a
• 24:28
  while back if I knew I was dying, would I regret anything?
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  You know, and she's referring to all the stuff I do.
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  I do hormone therapy. I do supplements, a bunch of
• 24:39
  other things we'll talk about over time.
• 24:42
  In a nutshell, if it's out there, it's credible and safe
• 24:45
  and it has potential to keep me vital.
• 24:48
  Sign me up. So yeah, I do testosterone
• 24:50
  therapy. The answer?
• 24:53
  No, I wouldn't regret anything. We all leave the stage.
• 24:57
  How we live is what we control. That we die is inevitable.
• 25:02
  How we die, not necessarily our prerogative, but we can tilt the
• 25:05
  field a little bit, right? Protect against dementia.
• 25:09
  Protect against withering. Do not become disabled.
• 25:13
  One of the leading causes of disability is sarcopenia.
• 25:17
  It's a fancy word. It just means withered muscles.
• 25:21
  You got to get up and down stairs, people.
• 25:22
  You got to open a jar of people, you got to get in out of your
• 25:25
  car. These things matter.
• 25:27
  Think young, walk fast, lift weights, take testosterone.
• 25:32
  Nothing. I encourage my patients to do an
• 25:35
  occasional hormone holiday about every three weeks.
• 25:38
  You skip your testosterone. Why?
• 25:41
  Because it up regulates the receptors.
• 25:44
  We cannot test your receptors but they're there and by
• 25:49
  starving them a little bit, the theory goes you're going to
• 25:52
  enhance the receptivity. We got to think long term.
• 25:56
  I've been on testosterone for closing in on 20 years now.
• 26:00
  It is a sustainable approach. When you take that three-week
• 26:04
  holiday, you're going to feel fine.
• 26:05
  Maybe the third week you lose a little bit of juice, but it's
• 26:08
  barely noticeable. The body redistributes
• 26:10
  testosterone in a manner that keeps it around for quite a
• 26:13
  while. Another side effect worth
• 26:16
  mentioning, acne. If you're getting pustular
• 26:19
  corporeal acne on the chest, on the back, that's a sign of
• 26:23
  testosterone stimulated acne, you can lower the dose in some
• 26:27
  cases. I'll split how my patients split
• 26:30
  the dose into twice a week. Some people a lot more sensitive
• 26:33
  to testosterone than others. Testosterone for life, yes.
• 26:38
  Living more vitally, you bet. Testosterone for bodybuilding,
• 26:43
  not so much. You're 23, you want to grow
• 26:46
  muscles? Do not do anabolic steroids.
• 26:51
  Can it be any more clear? Right.
• 26:53
  Body dysmorphia is a horrible thing.
• 26:57
  Your biceps being an inch bigger is not going to change the arc
• 27:01
  of your life. I get it guys, I've been there.
• 27:05
  Listen, I think I'd rather, I think I'd rather die than
• 27:08
  wither. And I've been in the gym since I
• 27:11
  was 16, and I like lifting weights and I like having
• 27:15
  muscle. But for God's sakes, don't crush
• 27:18
  your virility in the process. Anabolic hormones, these are the
• 27:22
  type people get off the Internet.
• 27:24
  These are the illegal type. These are the ones that
• 27:26
  stimulate incredible muscle growth at a price damaging
• 27:32
  neurologically damaging sexual vitality.
• 27:35
  And I've seen some of these patients in my practice years
• 27:38
  later. Sometimes recovery is not
• 27:41
  possible and they end up on testosterone in their 20s.
• 27:45
  How about things that stimulate testicles without using
• 27:48
  testosterone? They don't work.
• 27:52
  All right, that's a short response, but they generally do
• 27:55
  not work anything. I don't care what that baseball
• 27:58
  guy is telling you about, you know, T Rex, one O 1, whatever
• 28:02
  they're promoting out there. Look, it's placebo nonsense.
• 28:06
  If you're above the age of 40 in my vast experience and you're
• 28:12
  manifesting symptoms of low testosterone, almost always,
• 28:17
  you're going to need testosterone itself to get a
• 28:19
  remedy. In some cases, a testicular
• 28:23
  stimulant like clomiphene and clomiphene, gonadorellin, HCG in
• 28:30
  some cases you could try that and it may have value, but
• 28:34
  that's uncommon. Over the counter stuff It's it's
• 28:39
  a failure. Supplements have have value and
• 28:43
  I use them in certain settings but if you have issues with
• 28:46
  testosterone, testosterone is the remedy.
• 28:49
  So keep your money in your pocket.
• 28:51
  Do not do this people blindly over the Internet.
• 28:57
  It is worth the price to get a clinician who is progressive who
• 29:03
  can help guide you. Life vitality, anti aging, it's
• 29:08
  more than just testosterone, although I consider that
• 29:10
  foundational. The elements of vitality and
• 29:14
  anti aging control percent body fat replace hormones.
• 29:19
  The other pieces we'll be talking about in podcast
• 29:24
  includes protecting your brain. It's a whole nother topic.
• 29:30
  I'll defer to another podcast. Your brain gets protected by,
• 29:35
  ironically, being on hormones. Lower hormones correlates with
• 29:40
  increasing dementia risk. Women who've had hysterectomies,
• 29:44
  men who have had androgen deprivation therapy, Never.
• 29:48
  Let them castrate you guys. Never.
• 29:52
  I'd rather die of prostate cancer than invite dementia
• 29:55
  through testicular blocking therapies.
• 29:59
  That's a false choice. Mark yourself absent over 2 so
• 30:04
  maintaining percent body fat hormone therapy, lead reduction
• 30:08
  we'll talk about in future podcast.
• 30:10
  So I'll leave you with a story, one very motivational to me, one
• 30:16
  of my old patients, this is going back had to be 15, maybe
• 30:20
  20 years ago now when I was just starting to develop my
• 30:22
  knowledge, capability and interest in hormone therapy.
• 30:26
  And I had a patient, he had stage 4 lung cancer and he came
• 30:29
  to see me and I asked him, how's your breathing?
• 30:32
  He said, well, doc, this is a guy I was treated with actually
• 30:36
  testosterone. It's great for cancer patients.
• 30:40
  How's your breathing? I said to him, he goes, well,
• 30:42
  doc, you know, dude's 85, said the only time I get short of
• 30:46
  breath, you know, when I'm having sex with my wife, I get a
• 30:48
  little breathless. Man, I was floored, impressed,
• 30:52
  motivated, right? Think about that, 85.
• 30:55
  Stage 4 lung cancer takes my breath away.
• 31:00
  He passed away a few months later, which is a beautiful exit
• 31:05
  for a wonderful life. The point of the story is
• 31:08
  vitality. Uber Alice.
• 31:11
  Hold on to that right gang till next time.
• 31:14
  Talk to you then.