Latest / hol+ with Dr. Taz MD | The Future of Medicine is Holistic / The Testosterone Problem in Men: Dr. Brandon Smith on Low T, Sleep Apnea, TRT & What Men Need to Know
Transcript
- [00:00:00] Dr. Brandon Smith: 90 something percent of testosterone deficiency is this term secondary [00:00:05] hypogonadism, but just meaning, you know, it's not a problem with the testes making the testosterone, it's the [00:00:10] brain telling the testes to make the testosterone. That signal isn't there because there's something getting in the [00:00:15] way. [00:00:15] Dr. Brandon Smith: If I have chronic conditions, so heart disease, kidney disease, [00:00:20] diabetes, all those conditions will add on top of each other and will push my levels down. [00:00:23] Dr. Taz: Sleep apnea [00:00:25] is directly linked to low testosterone. Maybe explain that for just a second. If [00:00:29] Dr. Brandon Smith: you're [00:00:30] waking up multiple times or maybe you don't feel like you're waking up, but your brain does [00:00:35] overnight multiple times per hour, you're never getting that good deep sleep where your body's really [00:00:40] recovering. [00:00:40] Dr. Brandon Smith: We start to get stressed, we start to get sleep deprived, you know, maybe our diet's off or [00:00:45] maybe even we're doing long periods of fasting for our health for some reason. Yeah, those are periods of [00:00:50] stress and that'll hurt our hormone levels. You know, the hormone levels are an energy cost to the body and [00:00:55] when, you know, stress levels go up, our body's trying to put energy in other places [00:01:00] [00:01:00] Dr. Taz: This episode is sponsored by holplus, a holistic health platform built [00:01:05] around education, personalization, and integrative care. [00:01:08] Dr. Taz: holplus blends [00:01:10] holistic, integrative, and functional medicine clinics with learning resources like [00:01:15] blogs, YouTube videos, and of course, this podcast, so you're not just treated, you're [00:01:20] informed. The platform also includes holistic health quizzes and a curated wellness shop, [00:01:25] helping you make choices that support your body at the root level. [00:01:29] Dr. Taz: holplus [00:01:30] is holistic healthcare designed for real life. [00:01:33] Dr. Brandon Smith: Visit us at [00:01:35] holplus.co to learn more about the platform. Again, that's [00:01:40] H-O-L-P-L-U-S dot C-O. [00:01:41] Dr. Taz: Every week on holplus, we talk about different ideas, [00:01:45] different topics, really trying to push health forward and really trying to embrace this [00:01:50] holistic approach or the holistic model where we think about the whole body, all the different things involved.[00:01:55] [00:01:55] Dr. Taz: And one of the areas that often gets neglected is men's health. [00:02:00] I think that there has been so much attention on women's health, and r- rightly so, [00:02:05] honestly. I think we need the research, we need the clinical experience, we need all the things. [00:02:10] But men's health needs a reframe, too, just like pediatrics, just like so many [00:02:15] other aspects of health, that honestly are outdated the way they are conventionally [00:02:20] practiced. [00:02:20] Dr. Taz: That's why I brought in my next guest. So this is somebody [00:02:25] close to me, near and dear to my heart, who actually works in our clinics at holplus. [00:02:30] And ironically, a lot of the men have been signing up to see him. [00:02:35] So please join me in welcoming Dr. Brandon Smith to the show. I'm gonna let [00:02:40] Brandon tell you a little about, a little bit about himself, um, ultimately, as we go through the show, [00:02:45] but we're gonna jump right in, Brandon, with the first question. [00:02:48] Dr. Taz: And I'm sorry, I have to call you Brandon because [00:02:50] we know each other, and, but he is a doctor, he's a conventionally trained MD. He [00:02:55] is excellent. Our patients love him. But we're gonna jump right into the, to my very [00:03:00] first question, which is, what are we missing when it comes to men's health? [00:03:05] [00:03:05] Dr. Brandon Smith: So I think that's a really good question. [00:03:08] Dr. Brandon Smith: Um, the main [00:03:10] thing that I think when guys come in for the first time into the office, the mentality [00:03:15] seems to be, and if it's not broken, we don't have to fix it. And [00:03:20] that's the once a year annual physical model. Doesn't mean that it [00:03:25] couldn't be better, and I think that's my first visit with a guy is sitting down, [00:03:30] figuring out how their lifestyle is, un- like ultimately trying to get a good baseline on them [00:03:35] and figure out where are the areas that we could work on improving and where are they doing [00:03:40] well to figure out how do we move things, uh, I guess really move the needle in the right [00:03:45] direction so we're seeing metrics actually that matter improve. [00:03:49] Dr. Brandon Smith: So whether [00:03:50] that's, you know, on average, I think when I'm seeing guys, if things are running well, I'd like to see them [00:03:55] about twice a year. So maybe a little bit more aggressive than that once a year, you know, it's not broken, don't have [00:04:00] to fix it model. [00:04:01] Dr. Taz: I think I saw, um, a statistic recently that [00:04:05] said that only like 30 to 40% of men even make the annual physical. [00:04:09] Dr. Taz: The [00:04:09] Dr. Brandon Smith: [00:04:10] annual. Yeah. [00:04:10] Dr. Taz: So, so- [00:04:11] Dr. Brandon Smith: No, that's, to me, that's, that's the, that's the low bar. You know- Yeah ... that's the thing that, [00:04:15] you know, that's a population health level. How do we keep people in the country healthy? What is the [00:04:20] minimum that we need there? And that's that one year annual physical and, you know, that's [00:04:25] the sad reality is most people don't even make that low bar. [00:04:27] Dr. Taz: Do you think that just got baked [00:04:30] into our medical culture, so to speak, somehow that there's this like comfort zone [00:04:35] around like, "Okay, well, as long as I make that appointment, I'm fine"? Do you, do you hear men say that a [00:04:40] lot? [00:04:41] Dr. Brandon Smith: Um, I feel [00:04:45] like a lot of the times when I'm getting guys that are coming in just in our practice, it's, it's someone that's [00:04:50] coming in that's motivated or something has changed them to wanna change something else, whether someone [00:04:55] else in their household is getting healthy, um, you know, someone else in their family's coming into the [00:05:00] practice and I get to see the husband. [00:05:01] Dr. Taz: Yeah. [00:05:02] Dr. Brandon Smith: Um, someone is training for a new race or [00:05:05] event that they wanna really do well at. Something's really got them motivated. You know, maybe they have a parent that's [00:05:10] gotten sick, and they're looking, you know, into that crystal ball and seeing, you know, "What path, [00:05:15] you know, might I go toward? How can I change that path?" [00:05:18] Dr. Brandon Smith: So it's, it's people coming in pretty [00:05:20] motivated, I think, in general that, you know, we have in, in our clinic, which is, it- [00:05:25] it's nice w- working with patients. [00:05:27] Dr. Taz: Definitely. And I think we, we're sort of [00:05:30] blessed in the sense of, like, we have motivated people, people that want to learn more. We also [00:05:35] have the people that are sick, right? [00:05:36] Dr. Taz: The super sick that are coming in and are, and are trying to get answers. [00:05:40] But again, when we turn the lens back on men, what are they saying to you in the exam [00:05:45] room? Like, what are, what are some of the things that they're coming to you with, or maybe even some of the frustrations [00:05:50] of what might have kept them out of making that annual physical or even a baseline appointment? [00:05:54] Dr. Taz: I mean, [00:05:55] I had a patient recently who had not seen a doctor in, like, a decade. You know what I [00:06:00] mean? And that happens a lot, where men are coming in and they, you know, work really hard, and they put their [00:06:05] head down, and they grind away, and they, you know, have a family, and then that gets foggy, [00:06:10] and there's a lot going on there, and then they look up and, and the years have gone by. [00:06:14] Dr. Taz: You know, what are... I'm [00:06:15] curious what they're saying to you in the exam room. [00:06:17] Dr. Brandon Smith: I think it probably-- Like, there's a few [00:06:20] different clusters of patients that I feel like I see, and it's probably easier to break them down- Yeah ... more by, like, the age [00:06:25] range. So when I'm seeing, you know, the 20, like late 20s, 30-year-old [00:06:30] guy that's coming in, maybe thinking about starting to have a family, you know, "Hey, I haven't been to the doctor in 10 [00:06:35] years," you know. [00:06:35] Dr. Brandon Smith: "The last doctor I saw may have been a pediatrician or someone that I saw when I was sick. I don't [00:06:40] think anything's wrong. Thinking about having a family, I just want to test hormone levels, see where my [00:06:45] testosterone is." These are the types of questions I'm getting. Um- [00:06:48] Dr. Taz: Oh. Uh-huh. [00:06:49] Dr. Brandon Smith: Even it-- [00:06:50] Uh, even in some of the younger guys, like, you know, 18, 19, 20, around college, a lot of [00:06:55] people are coming in and they've had their testosterone levels checked, and they just are asking questions and say, "Hey, you know, here's [00:07:00] my number. [00:07:01] Dr. Brandon Smith: What should we do about it?" [00:07:02] Dr. Taz: Yeah. [00:07:02] Dr. Brandon Smith: You know, whether we actually need to do anything about that or [00:07:05] not, you know, on a clinical level, you know, a different story, and how to even interpret that number is, you know, [00:07:10] that pathway that I have with that patient. And then, like you mentioned, you know, the person that is [00:07:15] finally putting their head up after working, you know, hit retirement age. [00:07:18] Dr. Brandon Smith: "Now I have all this free time. [00:07:20] Now I feel like I've got time to get caught up on all the things I may have missed out, you know, through that career [00:07:25] journey." I mean, I talk about it with those people hitting retirement age. It's such a big life [00:07:30] transition. It's fun working with them because it's almost like the, the reference I give them is like, "Remember when you went off to [00:07:35] college? [00:07:36] Dr. Brandon Smith: This is as big of a life transition- Yeah ... going from working to not working as it is when you [00:07:40] left your house to go to college." You have to think about it like that. [00:07:43] Dr. Taz: I remember I had, um... I [00:07:45] think this gentleman was in the financial services industry or in the sort of like, you know, the investment [00:07:50] banking world, and he's like, "Dr. [00:07:52] Dr. Taz: Taz, for 25 [00:07:55] years, I walked into a room with 15 different computers and [00:08:00] all of us, like, trading and competing against each other, and I'd go home after a [00:08:05] 12-hour day and I would collapse after having a meal and a few glasses of wine and maybe a few vacations." [00:08:10] He's like, "Twenty-five years have gone by doing that, and I'm looking up and [00:08:15] I'm like, 'Oh my gosh, there's sun and there's nature.'" [00:08:18] Dr. Taz: I mean, like, literally being in a [00:08:20] whirlwind. And I e- I know even my own husband s- just describes this fog, is what he talks about. [00:08:25] But one of the things that I have noticed is that the first question, [00:08:30] and I want you to set us straight on this, the first question, men of all ages, like you said, even the 18-year-olds, I [00:08:35] mean, my daughter's 18 and her friends are talking about this, like- Where, [00:08:40] where's my testosterone? [00:08:41] Dr. Taz: You know, what is an optimal level of testosterone? You know, [00:08:45] apparently, I found this out recently, that some of the guys in her grade, even as [00:08:50] young as like 15 or 16, were getting testosterone from somewhere and [00:08:55] injecting themselves until, until their parents found out. So, you know, help [00:09:00] everybody who's listening to this show, whether you're a parent of a teenager, or you're a young [00:09:05] man, or you're a man sort of in your 40s, 50s, or 60s, help us [00:09:10] understand testosterone. [00:09:11] Dr. Taz: We know it's important. We know it drives so many different, you know, really [00:09:15] positive things. But what should we really be thinking about when it comes to [00:09:20] testosterone? [00:09:21] Dr. Brandon Smith: Yeah. I mean, so first thing is, you know, just the definition. You know, it's a [00:09:25] steroid hormone. It gets inside all, all of the cells across the whole body. [00:09:29] Dr. Brandon Smith: And just trying to [00:09:30] give it some context, it's, you know, when we're looking at testosterone levels for the most part, unless you're doing [00:09:35] maybe like saliva testing for the hormones, then you're talking about a blood level of [00:09:40] testosterone. So we're just measuring what's, what's in the blood. You know, we're not talking about what's happening in the [00:09:45] brain, what's happening in the muscles, what's happening in the prostate, what's happening in the scalp, all these different levels of [00:09:50] detail that we can get down to. [00:09:52] Dr. Brandon Smith: Um, and so one is just, you know, okay, [00:09:55] what's the number? Two is trying to understand, you know, what is that [00:10:00] number changing throughout the day? You know, I think if guys had a testosterone monitor the same [00:10:05] way that we had a glucose monitor- [00:10:06] Dr. Taz: Wow ... [00:10:07] Dr. Brandon Smith: people would be shocked to see what their numbers would fluctuate [00:10:10] with across the day. [00:10:11] Dr. Brandon Smith: You know, if I didn't sleep the night before, maybe my testosterone is crashed whenever I [00:10:15] s- like woke up very early, came into my testosterone lab check that morning. [00:10:20] You know, I'm a fl- I'm a pilot. I, you know, got off of an overnight shift flying back from Europe, [00:10:25] and then I went in and did my labs that next day. [00:10:27] Dr. Brandon Smith: So the first question I always have is about the [00:10:30] context of those labs. What happened leading up to them? Where are they at? You know, one, [00:10:35] obviously, just getting, you know, like a physical exam on them. What's the body weight, body composition, all these other [00:10:40] factors. And then figuring out what happened even on that one particular day to really decide [00:10:45] what is that one number on that lab test from the testosterone out of the blood actually even mean for that one?[00:10:50] [00:10:50] Dr. Taz: How much can it vary in a given day? Like, you know, like- Hundreds of [00:10:55] points ... hundreds of points. Wow. So is there an optimal time to test [00:11:00] testosterone, or is there a guideline that we should be giving men as, as to when the best time is to test it? [00:11:05] [00:11:05] Dr. Brandon Smith: So as far as the guidelines go, you really need two low morning time [00:11:10] testosterones to really confirm a diagnosis. [00:11:12] Dr. Taz: Hmm. [00:11:13] Dr. Brandon Smith: So in general, when I'm talking with [00:11:15] my patients and trying to look at testosterone, I'd like them to get it done before 10:00 AM [00:11:20] Yeah, I guess maybe some exceptions if someone's working different circadian rhythm schedules, like a [00:11:25] night shift worker or something like that, uh, we might have to interpret it a little bit differently. [00:11:29] Dr. Brandon Smith: But morning [00:11:30] time, and typically at least two numbers that we like to see to really establish that pattern. You [00:11:35] know, one number is a, is a snapshot, two starts to tell a story [00:11:39] Dr. Taz: So, [00:11:40] and where do you like-- I know a lot of men ask me, like, "Where's my free testosterone?" Right? [00:11:45] You know, where do you like total, where do you like free, and what's the difference between the two numbers?[00:11:50] [00:11:50] Dr. Brandon Smith: Yeah, that's a really good question, and sometimes when you're looking at the numbers, uh, they don't always [00:11:55] match up. You know, someone looks good on a total, and then their low is free, their free is low, [00:12:00] uh, and they're really trying to figure out what are the tools that we can do to help that. So the first thing I like to, [00:12:05] you know, I, I guess I miss being in academics teaching- Yeah [00:12:08] Dr. Brandon Smith: our medical students- Yeah ... so my [00:12:10] patients get to not suffer, but they get to learn with me. Uh, so I usually feel like [00:12:15] patients come away pretty educated after visits on, you know, what we're looking at, what we're looking for, [00:12:20] and how, you know, I'm really interpreting their labs. So the total-- So there's [00:12:25] really two-- I guess I'll back up even. [00:12:26] Dr. Brandon Smith: There's two testosterone labs that we do. So one is [00:12:30] the ELISA, that's the standard one- Mm-hmm ... that comes back in a couple of days, very quick. For the most [00:12:35] part, it's pretty accurate. Uh, it's what we used to do. Uh, in a lot of the [00:12:40] older testosterone labs, when we compare, you know, testosterone levels from the '70s to the newer [00:12:45] testosterone averages and say, you know, there's decline in testosterone, some of that is actually due [00:12:50] to lab variability. [00:12:51] Dr. Taz: Hmm. [00:12:52] Dr. Brandon Smith: So we used to use the ELISA, so the other sex hormones, [00:12:55] the estrogen, the DHEA, all might interact with that and typically make that number look a little [00:13:00] bit higher. There are some supplements that can interact with it, too. So just that first [00:13:05] ELISA test, you know, I don't, you know, put all my fish in that basket that that's exactly what's happening with [00:13:10] somebody. [00:13:10] Dr. Brandon Smith: And that's actually measured. Uh, so the free testosterone is a [00:13:15] calculation, though. So I tell patients, "This isn't a real number." You know, it's us trying to estimate and figure [00:13:20] out how much testosterone is bioavailable, you know, dissolved in the blood, where it can actually get into the [00:13:25] cells and work. So most of that testosterone is bound to, for the most part, it's, [00:13:30] uh, sex hormone binding globulin. [00:13:31] Dr. Taz: Yes. [00:13:32] Dr. Brandon Smith: And then the bioavailable is bound to albumin, and then [00:13:35] actually the rest of it, a small percentage of it is just free, dissolved in the blood. So should- [00:13:39] Dr. Taz: So [00:13:39] Dr. Brandon Smith: those are- [00:13:40] [00:13:40] Dr. Taz: Should folks be looking at the total or the free or both? [00:13:44] Dr. Brandon Smith: So [00:13:45] my first question is always around symptoms that they're having. You know, really just trying to match up what symptoms [00:13:50] guys might be having to figure out, you know, with their levels where they're at. [00:13:52] Dr. Brandon Smith: You know, you could have a guy with a [00:13:55] testosterone level, and so when I'm looking at totals, you know, mainly something north of three hundred and [00:14:00] fifty for a total- Yeah ... testosterone, uh, typically guys really aren't having very many [00:14:05] symptoms. Um, you know, it doesn't mean you couldn't still have a low free testosterone with a [00:14:10] low number and still get symptoms. [00:14:12] Dr. Brandon Smith: Uh, but the first number I look at is that total and [00:14:15] then the free, and this is kind of how our bodies compensate. So, you know, if I have a [00:14:20] guy, one thing that happens is that protein that carries the testosterone, the sex hormone binding globulin [00:14:25] In overweight men, you'll see that number go up. Mm-hmm. Or actually, it, it does the opposite. [00:14:29] Dr. Brandon Smith: [00:14:30] It decreases e- in extra body weight. So now we're binding less testosterone. [00:14:35] So even though a guy has a testosterone level 200, 300, they may feel fine. They still [00:14:40] have a good free testosterone level even with a lower total testosterone [00:14:45] amount. So it's our body kind of compensating and adjusting. We have all these adjustment mechanisms [00:14:50] and compensation, like for thyroid, the reverse T3. [00:14:53] Dr. Brandon Smith: You know, we can- Yeah ... block. [00:14:54] Dr. Taz: Yeah. [00:14:54] Dr. Brandon Smith: [00:14:55] Yeah. Neutralize some, some of the hormone [00:14:57] Dr. Taz: Yeah, so interesting with these hormones because [00:15:00] many people just wanna fixate on, and this is for men and women by the way, like they'll fixate on [00:15:05] a particular number [00:15:06] Dr. Brandon Smith: The number [00:15:07] Dr. Taz: But it's really like all of these [00:15:10] numbers play together in the sand, and understanding the whole hormone profile is just [00:15:15] important for men, you know, as it is for women. [00:15:17] Dr. Taz: If we do see lower [00:15:20] levels, you know, and I know we've talked about this kind of in the hallway, but if we do see lower [00:15:25] levels of maybe a total and a free testosterone, is testosterone [00:15:30] therapy always the first option? [00:15:33] Dr. Brandon Smith: The analogy that I like [00:15:35] to give patients is, uh, I know, you know, I'm staring at my computer monitor right now and we always [00:15:40] have them in the patient rooms when we're, when we're walking and talking about this. [00:15:44] Dr. Brandon Smith: Um, [00:15:45] so you know, the analogy I give is, you know, if your computer monitor is out and it stops working [00:15:50] or, you know, you've got low testosterone, I can go to the store and I can just buy a new computer monitor. [00:15:55] You know, I can give you testosterone and I can put your number where we want it. You know, there's not really a [00:16:00] question about, you know, getting it there. [00:16:01] Dr. Brandon Smith: It's just a matter of, you know, making that prescription and deciding to do that. [00:16:05] [00:16:05] Dr. Taz: Yeah. [00:16:06] Dr. Brandon Smith: Some people go that route. You know, they find a testosterone clinic and, you know, decide, [00:16:10] "Okay, you know, my system doesn't seem to be running. Let me just go get a new one." [00:16:13] Dr. Taz: Hmm. [00:16:13] Dr. Brandon Smith: Now it's, you know, it's, [00:16:15] it's outside the body. [00:16:15] Dr. Brandon Smith: I'm either doing injections or maybe cream, and now, you know, that's my testosterone and [00:16:20] I'm, I'm able to replace it really pre- like pretty quick and easily. You know, that same afternoon I could [00:16:25] go get myself a testosterone injection if I wrote that script that day. Uh, I guess what I think [00:16:30] we're uniquely positioned to do is really getting to see people. [00:16:33] Dr. Brandon Smith: You know, my, my [00:16:35] history is mainly kind of, "Talk me through your day. You know, what does it, like look like when you wake up in the morning? When are you [00:16:40] exercising? What's your diet like? How are you doing managing stress? What kind of coping mechanisms do you have [00:16:45] there? How is your sleep?" Um, sleep apnea is the number one reason where, you [00:16:50] know, people have lower testosterone levels. [00:16:51] Dr. Brandon Smith: That's kind of the most misdiagnosis for [00:16:55] [00:16:55] Dr. Taz: low test- I don't think people... I don't think... Uh, we're gonna say that again because I really don't think people realize that, that sleep [00:17:00] apnea is directly linked to low testosterone. Maybe explain [00:17:05] that for just a second because I feel like that gets missed all the time. [00:17:08] Dr. Brandon Smith: Yep. I mean, main thing is [00:17:10] just it's, it's slight- like sleep deprivation to the body. You know, if you're waking up multiple times or, you know, [00:17:15] maybe you don't feel like you're waking up but your brain does overnight multiple times per [00:17:20] hour, you're never getting that good deep sleep where your body's really recovering. [00:17:24] Dr. Brandon Smith: So [00:17:25] you know, when I tell people, you know, hormones are almost always the first thing to go You know, when [00:17:30] the body's in a good spot and it feels like reproduction is a priority, that's [00:17:35] when our body is doing well making hormones. You know, we start to get stressed, we start to get sleep deprived, you know, maybe [00:17:40] our diet's off, or maybe even we're doing long periods of fasting for our health for some reason.[00:17:45] [00:17:45] Dr. Brandon Smith: You know, those are periods of stress, and that'll hurt our hormone levels. You know, the hormone levels are an energy [00:17:50] cost to the body, and when, you know, stress levels go up, our body's trying to put energy in other [00:17:55] places. [00:17:55] Dr. Taz: If you're listening to this and thinking, "I know something is [00:18:00] off in my body, but I don't know where to start," this is for you. [00:18:04] Dr. Taz: [00:18:05] That's why I created the Circle. The Circle is my private community where I and my team [00:18:10] focus on understanding your body from hormones and stress to metabolic health and [00:18:15] longevity with real-life guidance that you can actually use. This is about [00:18:20] clarity and consistency and support beyond the exam room and [00:18:25] maybe outside of all the different appointments and experts that you've been running around to. [00:18:29] Dr. Taz: [00:18:30] You can try the Circle with a one-month trial using the promo code PODCAST at [00:18:35] holplus.co/circle. Again, that's holplus, [00:18:39] Dr. Brandon Smith: [00:18:40] H-O-L-P-L-U-S, .co/circle. All right, let's jump back into [00:18:45] the episode. [00:18:46] Dr. Taz: So many, so many experts have talked about that over the years [00:18:50] of just ... And it kind of goes back to sort of that Chinese medicine concept of chi or energy, right? [00:18:54] Dr. Taz: [00:18:55] Like, if the energy is not there, the first thing sacrificed in all systems of [00:19:00] medicine is usually reproduction and reproductive hormones. That's the first thing kind of to, to [00:19:05] go out the door. So, you know, what would you tell men? Like, what is a [00:19:10] comprehensive workup for shifting testosterone levels, which is [00:19:15] now, it's not just a conversation for, like, men over 40 anymore, right? [00:19:18] Dr. Taz: We're seeing this younger and [00:19:20] younger and younger. I mean, we're even seeing it in some of the teens and some of, some of the men in their [00:19:25] 20s. What's their starting point? Where would you have them start? [00:19:29] Dr. Brandon Smith: Yeah. I [00:19:30] mean, so the first question is, you know, looking for, like, just a self-assessment of, you know, "Hey, [00:19:35] do I think I'm having symptoms of low testosterone?" [00:19:37] Dr. Brandon Smith: You know, if you are, I think that's, you know, obviously a [00:19:40] good- [00:19:40] Dr. Taz: And what are some of the most common symptoms, just to educate everybody? Like, what, what is really- Yeah ... low [00:19:45] testosterone versus something else? [00:19:47] Dr. Brandon Smith: So the big ones that we're talking about [00:19:50] mostly that are more specific to testosterone because, you know, for-- so fatigue, you know, [00:19:55] is a list of a symptom, but it's, you know, can be caused by hundreds of other things too, as you know, [00:20:00] you and I know. [00:20:01] Dr. Brandon Smith: The-- So it's not really a specific symptom. But if I'm [00:20:05] seeing someone that's having decreased libido, they're having a difficult time with [00:20:10] erections, they're going to the gym and they're working out and their muscles are taking them days to recover after they've been [00:20:15] in, you know, a good workout routine, you know, instead of it's not the first time they went to the gym, now they're in a routine, but it's [00:20:20] still taking them days to really build back and recover. [00:20:22] Dr. Brandon Smith: Um, changes in, like, hair growth. [00:20:25] [00:20:25] Dr. Taz: Mm-hmm. [00:20:25] Dr. Brandon Smith: Were able to grow facial hair before and they can't, or maybe they're seeing a decrease of it on their [00:20:30] legs. You know, I mean, that could be circulation, but at the same time, you know, it could be changes in hormones. [00:20:35] Um, so those are kind of the more specific ones that I'm looking for. [00:20:38] Dr. Brandon Smith: So hair growth, [00:20:40] libido, erections, muscle recovery. And then everything else, you know, that [00:20:45] people hear about, talk about, you know, is really a little bit less specific to testosterone and [00:20:50] we need to kind of figure out what other things might I need to check if they're coming in with that type of complaint, like my [00:20:55] energy's dipping. [00:20:56] Dr. Taz: Right. [00:20:57] Dr. Brandon Smith: You know? Pretty big workup to figure- Yeah ... out what exactly is the root for that. [00:21:00] [00:21:00] Dr. Taz: And so, you know, I know that we do-- we're looking at nutrients, we're [00:21:05] looking at all the hormones, we're looking at inflammation and cellular function. One of [00:21:10] the things I'm curious with, like, are you asking them to do, like, a home sleep study of [00:21:15] some kind before you make a decision about testosterone? [00:21:19] Dr. Brandon Smith: Um, [00:21:20] I'm obviously asking about sleep habits. So first thing I like to ask is, you know, is it easy for you to [00:21:25] fall asleep? Are you staying asleep through the night? You know, are you snoring heavily or has that changed [00:21:30] recently? And then, you know, it's great if they have a partner, they can, you know, give us that other piece of [00:21:35] information. [00:21:35] Dr. Brandon Smith: Right. Yeah. It looks like they do look like they're choking in their own light. You know, it looks like they're-- stopped breathing for, [00:21:40] you know, seconds on, uh, uh. I'm worried about them when I see them sleep or, you know, they're sleeping in a [00:21:45] recliner because, again, laying flat, you know, they, they can't. [00:21:47] Dr. Taz: Yeah. [00:21:49] Dr. Brandon Smith: That person [00:21:50] obviously, yeah, needs a sleep study, yeah, before we decide to start giving them outside testosterone- [00:21:54] Dr. Taz: [00:21:55] Yeah ... [00:21:55] Dr. Brandon Smith: um, and see if we can't correct, you know, the reason for it. But, you know, there's so [00:22:00] many triggers for this and, you know, ninety something percent of testosterone deficiency is this, [00:22:05] the term is secondary hypogonadism, [00:22:07] Dr. Taz: but just- [00:22:07] Dr. Brandon Smith: Mm-hmm [00:22:07] Dr. Brandon Smith: you know, it's not the problem with the [00:22:10] testes making the testosterone, it's the brain telling the testes to make the testosterone. That signal isn't [00:22:15] there because there's something getting in the way. [00:22:17] Dr. Taz: Mm. [00:22:17] Dr. Brandon Smith: So whether it's an infection, you know, if I [00:22:20] had COVID, my testosterone levels are gonna drop during that period. [00:22:23] Dr. Brandon Smith: Uh, if I have, you know, chronic [00:22:25] conditions, so heart disease, kidney disease, diabetes, all those [00:22:30] conditions will add on top of each other and will push my levels down. So having, you know, any type of chronic condition [00:22:35] reversed. If I'm talking about, um, zinc deficiencies, probably a common [00:22:40] one. Uh, we'll see that occasionally, and that's pretty easy to correct. [00:22:44] Dr. Brandon Smith: Uh, [00:22:45] but movement, you know, not sleeping enough, uh, stress levels just being really [00:22:50] high, which I find stress is to be the particularly hardest one to manage. [00:22:53] Dr. Taz: It really is. I see so much high [00:22:55] cortisol and low testosterone, and then you're constantly like, "Okay, I'm gonna chase the [00:23:00] cortisol, but I know this person needs some testosterone too." [00:23:02] Dr. Taz: And kind of again, that loop that I talk [00:23:05] about, like that cortisol loop getting stuck in there and trying to get somebody out of that. How do you handle that [00:23:10] patient? [00:23:12] Dr. Brandon Smith: I mean, so stress, the hardest [00:23:15] piece of it is because it's outside our body. Mm-hmm. You know, our stress is coming from... Yeah. [00:23:20] I, I know you're my boss, but, you know- [00:23:21] Dr. Brandon Smith: whether it's, you know, our boss or- [00:23:23] Dr. Taz: From me. The stress is from [00:23:25] me. Yeah. It is. Yeah. [00:23:27] Dr. Brandon Smith: Um, so whether it's, you know, coming from, you know, like a [00:23:30] work environment or- Yeah ... you know, a sick parent that they have to stay up and, you know, worry about or, you know, provide [00:23:35] for, all these other things come at us and, you know, at the end of the day, life, life happens and life [00:23:40] is going to happen. [00:23:41] Dr. Brandon Smith: So there'll be periods where, you know, numbers are up and numbers are down based off of what type of [00:23:45] stress people are having. But figuring out, you know, when things get stressful, you know, what tools do I have to kind [00:23:50] of turn to? You know, if, if we're talking about stress as one of the main roots, you know, it might [00:23:55] be as simple as adding in, you know, a herb like ashwagandha to kind of help them. [00:23:58] Dr. Brandon Smith: Ashwagandha. You know, it might be having them work on a [00:24:00] meditation practice. I just find all the, all the good stuff that we need, the [00:24:05] exercise as like a stress relief tool, the meditation, all the things that, you know, could [00:24:10] take five minutes to get a quick session in, you know, those are the things that we start to cut out when [00:24:15] things get stressful. [00:24:15] Dr. Taz: Yeah. And they [00:24:16] Dr. Brandon Smith: add- Those are the things we need the most. [00:24:18] Dr. Taz: They... And even like little [00:24:20] small practices I think improve over time. When it comes to actually replacing [00:24:25] testosterone, do you like the shots? Do you like a cream? Do you like [00:24:30] Clomid? You know, what is your thought process there? [00:24:34] Dr. Brandon Smith: [00:24:35] Um, I think everyone has their own strategy on this one. [00:24:37] Dr. Brandon Smith: I mean, it, it's, it's very [00:24:40] personalized and it's very customized, and I like to kind of give patients almost like this multiple choice question in the [00:24:45] sense that, you know, working with them as a team, you know, my options are, "Hey, I think, you know, [00:24:50] this tool, this tool, and this tool are all good options for you." [00:24:53] Dr. Brandon Smith: You know, if you're scared of needles, you know, I [00:24:55] think shots are off the table. Mm-hmm. [00:24:58] Dr. Taz: You know, we should start with something else. Good [00:24:59] Dr. Brandon Smith: point, yeah. Um, [00:25:00] so it's, it's just really customized in a sense, or maybe they have a kid and, you know, the cream isn't an [00:25:05] option. Or, you know, they're, you know, traveling so much that, you know, traveling with the cream and [00:25:10] applying it every day isn't an option, but, you know, there's a, a stable dose that they could do, you know, once a week.[00:25:15] [00:25:15] Dr. Brandon Smith: Um, so it, it, it really depends. But, uh, what I like to do personally in my [00:25:20] practice is I- a Clomiphene challenge- [00:25:23] Dr. Taz: Mm-hmm ... [00:25:23] Dr. Brandon Smith: is what I like to give [00:25:25] guys. So I look and I'll see, you know, what their numbers are. So on the labs when I'm getting them, I'm looking at the LH and the [00:25:30] FSH to really see, you know, where the problem is. [00:25:34] Dr. Brandon Smith: Is it with the brain? Is it with the [00:25:35] testes? You know, and kind of making that diagnosis on that first set of labs. [00:25:40] Trying to figure out something in their lifestyle that we can work on modifying. Mm-hmm. If, you know, they haven't been [00:25:45] exercising, try to get them to get some type of high intensity exercise once a week. [00:25:48] Dr. Brandon Smith: If it's, you know, tackling the sleep, [00:25:50] you know, doing that for, you know, at least a period of two to three months and really making that one lifestyle [00:25:55] change a big priority. And if we can move that in the right direction and [00:26:00] we test and we see your testosterone is responding, you know, we'll just keep riding that wave in some [00:26:05] cases and see, you know, how high can we get your body to make your testosterone without adding any [00:26:10] prescriptions in at this point. [00:26:11] Dr. Brandon Smith: If- [00:26:11] Dr. Taz: I think that's the super exciting part about what we do, is that you can [00:26:15] see those levels go up with just making those changes. [00:26:18] Dr. Brandon Smith: Yep. No, that's... I mean, [00:26:20] I've seen a guy, he, he had, I think levels were around like 300, and all we did was get his sleep in a [00:26:25] good spot. Mm. Now he's double, up to 600. You know, [00:26:29] Dr. Taz: there, there's- [00:26:29] Dr. Brandon Smith: Incredible [00:26:29] Dr. Brandon Smith: it [00:26:30] depends on how bad the problem is for how much, you know, result you might get. [00:26:35] Um, so it's, it's interesting, uh, to really try to figure out- Do you have- ... [00:26:38] Dr. Taz: what's, what's gonna work ... and not to put you [00:26:39] Dr. Brandon Smith: on, [00:26:40] [00:26:40] Dr. Taz: on the spot, but do you have a thought about testosterone pellets? [00:26:44] Dr. Brandon Smith: [00:26:45] Um, uh, I don't personally, you know, prescribe or implant any pellets. [00:26:49] Dr. Brandon Smith: I just find that [00:26:50] the-- So some people, I think that might work in the sense that if you put them in, the levels [00:26:55] change, you know, over like maybe they go out after three to six months. [00:27:00] Um, I kinda like having, you know, shorter term dosing- Yeah ... in the sense that [00:27:05] we can really fine-tune things. You know, technically, guys' hormone levels, you know, they fluctuate [00:27:10] over the 24-hour cycle instead of like the 28-day cycle like women. [00:27:14] Dr. Brandon Smith: So it [00:27:15] will peak in the morning, it'll drop toward the afternoon. So the, uh, the topical [00:27:20] testosterone, putting it on in the morning, you know, letting it wash out or dissolve out of the blood, you know, throughout the [00:27:25] rest of the day, that's kind of the most physiologic, you know, way to replace the [00:27:30] testosterone. [00:27:31] Dr. Brandon Smith: You know, putting it into the muscle or, you know, some guys do it in subcutaneous and it [00:27:35] trickling in slow, steady across the week, you know, their levels are up and they stay, you know, pretty high. They're not really [00:27:40] having a daily fluctuation. For the most part, it's more like a weekly fluctuation of, you know, they're [00:27:45] appreciating even, you know, a difference across the week. [00:27:47] Dr. Brandon Smith: Um, but I mean, my first [00:27:50] part is trying to figure out, you know, is there something that we could change in their lifestyle, you know, to look and see what's going on? [00:27:55] You know, looking to see, you know, a stressor factor, can we support that in any way? You know, their [00:28:00] diet. You know, for the most part, it's, it's, it's an obesity and body composition- [00:28:03] Dr. Taz: Man [00:28:03] Dr. Brandon Smith: problem that we're seeing. You know, [00:28:05] so helping to build up muscle, decrease body fat, working on that body composition tends to favor [00:28:10] higher testosterone levels. Um, you know, working on improving or just prioritizing the sleep, even [00:28:15] as just setting like a nighttime alarm on your phone. You know, instead of setting your bedtime, you know, your morning time [00:28:20] alarm- Right [00:28:20] Dr. Brandon Smith: to wake up, setting your bedtime alarm to go to sleep- [00:28:23] Dr. Taz: Yeah ... [00:28:23] Dr. Brandon Smith: you know, goes a long way to really make [00:28:25] it consistent. The body just loves consistency, and I think, you know, [00:28:30] that's why we're on a circadian rhythm and, you know, all these hormone cycles of, you know, cortisol and melatonin [00:28:35] for daytime sleep, then, you know, hunger hormones for when we wanna eat. [00:28:38] Dr. Brandon Smith: You know, we're just always on this type of [00:28:40] cycle. Our body's so smart. [00:28:41] Dr. Taz: It is so smart, but we do so much to it to throw it [00:28:45] off very quickly. You know, when we talk about muscle, uh, and, and [00:28:50] movement and its connection to testosterone, I know you have a big exercise [00:28:55] background. I know that you're pretty passionate about this stuff. [00:28:58] Dr. Taz: Uh, tell the audience a little [00:29:00] bit about you and how you really landed maybe first into [00:29:05] integrative and holistic medicine, but then also the movement and the muscle health part and how that fits [00:29:10] into this story. [00:29:11] Dr. Brandon Smith: Yep. So I grew up in Jackson, [00:29:15] Tennessee, and I went to Rhodes College. I kind of already knew that I wanted to go into med school at [00:29:20] that point, leaving high school. [00:29:22] Dr. Brandon Smith: So I picked my school to [00:29:25] decide, you know, how can I get into med school, and that was where I landed. Got into- Yeah ... biochemistry and, [00:29:30] you know, really liked the cellular pathways, mechanisms, and, you know, understanding that piece. [00:29:35] Um, it was an interesting overlap where I joined a club. It was a [00:29:40] CrossFit club, uh, in my first year of college, and I was lucky that a [00:29:45] doctor from my hometown, he actually came in, he was a family medicine doctor, but he had just started [00:29:50] doing... [00:29:50] Dr. Brandon Smith: Or I guess they've been doing CrossFit for a while. But, uh, Dr. Jeremy Draper, [00:29:55] he had- Mm ... uh, basically established a practice outside of his family [00:30:00] medicine group where he was, you know, I guess he was working as a family medicine physician, [00:30:05] prescribing blood pressure medications. You know, seeing people gain more weight, needing to prescribe more medications, and just [00:30:10] medication managing. [00:30:11] Dr. Brandon Smith: Um, then he took a weekend class as a CrossFit [00:30:15] instructor and started to see people lose weight in the gym and making progress and coming off of blood pressure medications, [00:30:20] and it made him question the reality of why did I go through years of school and dedication and [00:30:25] training to prescribe the medications when I could take a weekend class, understand about exercise, and help [00:30:30] these people actually get healthy? [00:30:31] Dr. Taz: Yeah. Yeah. Huge difference. [00:30:33] Dr. Brandon Smith: Um, so, so I [00:30:35] got into CrossFit, started coaching eventually, and there were some really, like, interesting [00:30:40] parallels. Uh, one of the things that they talk about is, like, a health wellness spectrum. [00:30:45] [00:30:45] Dr. Taz: Hmm. [00:30:45] Dr. Brandon Smith: So the idea is, um, I guess I'm trying to see on my screen, [00:30:50] you know, if this is the low side, you know, someone that's sick, and this side, someone that's pretty healthy.[00:30:55] [00:30:55] Dr. Brandon Smith: You know, you start out healthy. You know, over time, you know, maybe you get high blood pressure. Maybe [00:31:00] it goes on to develop, you know, some high cholesterol and some extra body weight, and then eventually [00:31:05] pre-diabetes. And then eventually, you know, you catch pneumonia- Lots of things ... and get sick, and now you're on this side of the spectrum. [00:31:09] Dr. Brandon Smith: What can [00:31:10] we do to actually push people higher up that side of the scale? You know, the, the more healthier, the [00:31:15] less chronic conditions someone has, if they get sick, you know, the less far down it knocks them. It's a [00:31:20] conceptual idea. [00:31:21] Dr. Taz: Yeah. [00:31:21] Dr. Brandon Smith: But it made a lot of sense. Uh, you know, the more [00:31:25] muscle I have on my body, thinking about saving for retirement is what I talk about with patients. [00:31:29] Dr. Brandon Smith: You know, it's like fighting gravity. Yeah, [00:31:30] yeah. Yeah. If I do my strength training, I can build up my bones, I can build up my muscle. If it's gonna decline over [00:31:35] age, I'm gonna have to work hard to keep it from dropping so fast. [00:31:40] So that's kinda the idea, you know, that's moving that person higher up that health spectrum, so when, you know, [00:31:45] they do fall, you know, maybe get injured, they don't lose as much muscle. [00:31:48] Dr. Brandon Smith: Or if they lose the same amount of [00:31:50] muscle, they're not to the point where, you know, they're immobilized or can't get up and, you know, manage at home by [00:31:55] themselves. [00:31:56] Dr. Taz: Do you think men today are good about building muscle and [00:32:00] being conscious of that? And is there a guideline you could give them, like, you know, [00:32:05] get in the gym X number of times a week for X amount of time, this is the right way [00:32:10] to do it? [00:32:10] Dr. Taz: I mean, you see guys in there, right? Lifting super heavy weights. Some are in there [00:32:15] not really lifting, walking around a whole lot. Some are in there lifting super heavy, and they're l- [00:32:20] I feel like they're in there sometimes even twice a day. You know, what is, like, a good [00:32:25] realistic way for any guy, any age, to really begin to build [00:32:30] muscle? [00:32:32] Dr. Brandon Smith: So I guess a c- couple different goals [00:32:35] with exercise. You know, I think I kinda break down movement into a couple of different pieces. I guess this [00:32:40] is just my framework with it. [00:32:41] Dr. Taz: Mm-hmm. [00:32:42] Dr. Brandon Smith: But movement, mainly I'm talking about how is someone [00:32:45] moving throughout the day? You know, the person that goes to the gym and they exercise in the morning, but then they sit down in their [00:32:50] office, you know, all day, 8:00 to 5:00. [00:32:53] Dr. Brandon Smith: They finally get up, go home, you know, maybe they [00:32:55] put their head up and eat some lunch at their desk. You know, they're not really moving. They, they [00:33:00] exercised, but they didn't really move. [00:33:01] Dr. Taz: Right. [00:33:02] Dr. Brandon Smith: And then the other side I'll say is the person that's [00:33:05] moving, you know, maybe it's a stay-at-home mom taking care of the kids at home, someone that's working in retail on their feet all [00:33:10] day. [00:33:10] Dr. Brandon Smith: That person's moving all day, but they're not making that time to actually exercise. [00:33:15] So that exercise is that window of opportunity for, you know, basically either working on [00:33:20] cardiovascular health, you know, getting their heart rate up, or building strength and muscle. [00:33:25] So as far as... You know, that's how I like to divide up that exercise piece, whether it's in the morning- [00:33:30] [00:33:30] Dr. Taz: It's a good way to think about it, yeah. [00:33:31] Dr. Taz: Yeah. [00:33:32] Dr. Brandon Smith: Um, so as far as building up [00:33:35] muscle, you know, what I like for people to do is, you know, just as a simple guideline and framework is, you know, if you can [00:33:40] lift something heavy, that's the goal, you know? Heavy is relative. You know- Mm ... if I [00:33:45] can lift five pounds and it's, it's challenging, that's enough to build muscle. [00:33:48] Dr. Brandon Smith: If I can lift five million [00:33:50] pounds or I need five million pounds to lift, so be it. Uh, I'm not worried about the [00:33:55] weight, the number, what the exercise even really is, as long as I'm moving it [00:34:00] safely, not getting hurt. And then when I say heavy, you know, the challenge is something 10 reps or [00:34:05] less. So if I can do something in that range that's a challenge, you know, it's not doing the [00:34:10] 20, 30 sets of the light weight, you know, and then sticking with that weight for 10 [00:34:15] years. [00:34:15] Dr. Brandon Smith: You know, eventually my muscle's gonna be strong enough to- Right ... accomplish. I have to get heavier weight. [00:34:20] [00:34:20] Dr. Taz: And just gradually work your... And is it a couple times a week you think, or how, how [00:34:25] often should they be in there? [00:34:27] Dr. Brandon Smith: Kind of the, the minimum dose that I like to see people get, you [00:34:30] know, I always talk about things in doses and prescriptions. [00:34:31] Dr. Brandon Smith: Mm-hmm. Supplements, exercise, prescriptions. Uh, you know, [00:34:35] I think that's important to really define for people. So, you know, two 30-minute sessions a week [00:34:40] is where I like to get people at a minimum. So, you know, this is the person that's starting on [00:34:45] GLP-1, you know, if we're talking about really trying to protect their muscle, you know, my minimum bar is I want you to [00:34:50] get at least two 30-minute sessions a week. [00:34:52] Dr. Brandon Smith: You know, if it's doing 30 minutes upper body, 30 minutes lower [00:34:55] body to really focus on it or maybe, you know, 30 minutes full body and 30 minutes full body. [00:35:00] You know, that's, that's kind of my minimum goal for being able to maintain some muscle. [00:35:04] Dr. Taz: I [00:35:05] mean, I feel like I could talk to you about so many different topics for- [00:35:08] Dr. Taz: forever, and I know we're coming [00:35:10] close to time, but I... Can you kind of connect, and we probably need to do a [00:35:15] whole another session on GLP-1 and peptides and men's health and that stuff, but can you sort of connect [00:35:20] the starting of a GLP-1 with muscle [00:35:25] and with sort of just general testosterone, men's health, what your observation and philosophy [00:35:30] is? [00:35:31] Dr. Brandon Smith: It's a catch-22. [00:35:32] Dr. Taz: I know. And [00:35:33] Dr. Brandon Smith: it, you know this I know. [00:35:33] Dr. Taz: That's why I asked the [00:35:35] question. You know this. [00:35:35] Dr. Brandon Smith: I know. [00:35:35] Dr. Taz: I know. So... [00:35:37] Dr. Brandon Smith: So it's, you know, the person that's [00:35:40] overweight, you know, wants to be in exercise, um, you know, maybe not seeing the progress that [00:35:45] they want on the body weight or the body composition, and coming in with low testosterone levels.[00:35:50] [00:35:50] Dr. Brandon Smith: You know, the exercise is the thing that will, you know, hopefully help improve their body [00:35:55] composition but-- and also raise their testosterone. So, you know, that's the non-negotiable. [00:36:00] You know, whether it's at a point where, you know, they, "Look, I've been doing this for two years and I've not seen any [00:36:05] results. [00:36:05] Dr. Brandon Smith: You know, I'm at the end of my rope and I, you know, don't think I can keep holding onto this. You know, we have to do something. [00:36:10] We need to change it." That person, you know, talk with them and kinda figure out if it's [00:36:15] appropriate, you know, prescribing them GLP-1 or- [00:36:17] Dr. Taz: Oh, yeah ... [00:36:18] Dr. Brandon Smith: even testosterone. [00:36:20] You know, I, I usually like to go one step at a time. [00:36:23] Dr. Brandon Smith: Yeah. You know me, I, I, I like to try [00:36:25] to make it manageable and kinda bite-size- Yeah ... you know, steps and, you know, things to keep us on track [00:36:30] when there's so much stuff to look at. And in our space of whether it's labs [00:36:35] or their whole history, you know, at the end of the appointment, trying to narrow it down to one or two big changes that I think [00:36:40] is gonna push them in the right direction. [00:36:42] Dr. Brandon Smith: You know, I kind of offer it up as, you know, do you think, you [00:36:45] know, testosterone seems to be more of a problem, or do you think it's, you know, is it your body weight that you think is holding [00:36:50] you back the most? You know, if they're having knee pain and, you know, I- I've got a reason to push them in a direction or [00:36:55] the other, you know, their body weight's causing their knees to ache after they get done working out, and if I can get their [00:37:00] body weight down, they'll be able to move better, and that'll help their testosterone. [00:37:03] Dr. Brandon Smith: I might be biased to say, you know, [00:37:05] I think maybe GLP-1 first might be the right option. [00:37:07] Dr. Taz: Hmm. Interesting. [00:37:08] Dr. Brandon Smith: Or, you know, [00:37:10] my libido, my relationship with my wife, you know, is super bumming me out, and I don't feel [00:37:15] motivated to do anything. You know, exercise is really hard for me, but my joint's still fine. That [00:37:20] person might wanna start with testosterone. [00:37:22] Dr. Brandon Smith: You know, both things I think are gonna improve their, you know, body [00:37:25] composition, their insulin resistance, uh, move the needle in the directions that we wanna [00:37:30] go, you know, one step at a time. But usually just picking one or the other. So, you know, [00:37:35] I think both help, but trying to figure out, you know, which is one-on-one- What to do first [00:37:39] Dr. Brandon Smith: like which one [00:37:40] is the right option for them. [00:37:42] Dr. Taz: You know, you, it brings us back to kinda where we started, [00:37:45] where I, I think men need a whole body, a [00:37:50] holistic approach, right? 'Cause they, there is so much out there. There's so many options, and what I [00:37:55] see a lot of men doing, you know, just when I'm eavesdropping or even if they're coming into our clinic, it's like, [00:38:00] you know, they'll ride a trend, and then they'll go order all this stuff, and they'll do all this, [00:38:05] you know, do all these things. [00:38:06] Dr. Brandon Smith: For a couple months. [00:38:07] Dr. Taz: But it might not be, like, the right [00:38:10] thing for them in terms of what their actual starting point is, and I think the only way to get this right [00:38:15] is to have a partner who can kinda be your sounding board. Well, like, w- even [00:38:20] if you took all our medical knowledge and dumped it out the door, but just someone to, like, [00:38:25] listen and be able to pinpoint, like, this is your biggest pain point. [00:38:28] Dr. Taz: We need to start [00:38:30] here. You know, whether it's cortisol or muscle or energy or, or [00:38:35] testosterone, whatever it is, and then we're gonna move you through the rest of this plan. That's the [00:38:40] only way... You know, one of the big criticisms of our field is that there's just a lot to do, and there's so [00:38:45] much, and there's overwhelming. [00:38:46] Dr. Taz: I think that only happens when, when you're not [00:38:50] able, you know, when you're in a relationship with a provider where you can't focus and kinda get, we [00:38:55] call it the core concept, right? Like, get to that, like, main idea and then build off that main [00:39:00] idea and keep creating a journey. So I think men need that honestly [00:39:05] just as much as women. [00:39:06] Dr. Taz: So there's so much more I'd love to talk to you about. Like, we've [00:39:10] gone, we've gone past our time, which, but this has been an amazing conversation, and I really hope it [00:39:15] helps anyone listening, and I hope, you know, for, for any woman out there, you [00:39:20] send it to a man in your life because I think taking ownership of your health and being on the front end of it, the [00:39:25] earlier, the better. [00:39:26] Dr. Taz: We're in an environment that's asking us to be more proactive with our [00:39:30] health, period. Dr. Smith, I know that you've got a fitness background, you've [00:39:35] got the integrative background, you've been seeing patients in our clinics at holplus. You know, what is [00:39:40] the one thing that you're the most excited about when it comes to our field, you [00:39:45] know, and you're thinking about men's health? [00:39:46] Dr. Taz: What, what are you really excited about as you look forward? [00:39:50] [00:39:50] Dr. Brandon Smith: I mean, I think just our practice. You know, I think the makings of [00:39:55] a good doctor, and I think you see this just through medical training, is like, you know, a good doctor asks the right [00:40:00] questions. [00:40:00] Dr. Taz: Yeah. [00:40:01] Dr. Brandon Smith: I, you know, am fortunate in the sense that, you know, our visits [00:40:05] aren't just eight minutes. [00:40:05] Dr. Brandon Smith: You know, I get more time to ask more questions. So, you know, [00:40:10] maybe I'm not the best doctor, but at the end of the day, I get to ask more questions to be able to connect and find [00:40:15] those right pieces of information to link together to actually move people in the right [00:40:20] direction in line with their goals. [00:40:21] Dr. Brandon Smith: You know, we talked about this, you know, talking about the evidence-based medicine- Yeah, [00:40:25] yeah ... or the patient preference, the knowledge that's coming from data research, and then our personal [00:40:30] experience in practicing. You know, putting it all together, you know, I don't think you get that just from like [00:40:35] an eight-minute visit. [00:40:36] Dr. Taz: No. You know, [00:40:36] Dr. Brandon Smith: or if you do, you know, it's, it's exceptionally, exceptionally difficult to [00:40:40] do that, you know, in the role of the doctor to kind of make the right question, get to the right answer, and fit it in [00:40:45] with the patient's values, you know, to move them in the right, yeah, direction. So [00:40:50] I, I don't know. I'm just excited working with patients. [00:40:52] Dr. Brandon Smith: You know, no matter what the problem is that they're coming in with, coming up [00:40:55] with creative solutions. I feel like, you know, there's the cut and dry conventional where, you know, there's an [00:41:00] algorithm- Right ... and this is the right direction- Yeah, yeah, [00:41:02] Dr. Taz: yeah ... [00:41:02] Dr. Brandon Smith: and this is... And it's, it's [00:41:05] almost never that. You know, when patients come with us, we're in this, you know, fun space of actually talking about [00:41:10] diet, sleep, stress, and exercise, and whether they wanna do intermittent fasting or, you know, picking [00:41:15] another style of diet to work on moving them toward their goal. [00:41:17] Dr. Brandon Smith: Like, you know, having that conversation with them and figuring out, you know, [00:41:20] okay, this is the parameters, where if that fits with your lifestyle, you know, perfect. 'Cause [00:41:25] this is a- [00:41:25] Dr. Taz: I love- ... you know, it's their home ... I love that you answered, you answered with like the [00:41:30] practice of medicine and the relationship, not with like, "Oh, my gosh. [00:41:33] Dr. Taz: Let me tell you all the biohacking- [00:41:35] Yeah ... tools that are coming up in the future." Yeah. I [00:41:37] Dr. Brandon Smith: love [00:41:37] Dr. Taz: that. Well- I think- Okay, go ahead ... I [00:41:39] Dr. Brandon Smith: think [00:41:40] people, I think people that knew me, you know, would think, okay, I was, you know, into the biohacking space when that was, you know, very [00:41:45] trendy back when I was, you know, in college and- Yeah [00:41:47] Dr. Brandon Smith: early in grad school. And, you know, it, [00:41:50] it's been around, but, you know, these like tried and true principles of diet, sleep, stress, and exercise aren't going [00:41:55] away- No ... you know, no matter whatever the latest fad is. No. So, you know, it needs to be sustainable, whatever [00:42:00] plan we come up with someone for. [00:42:02] Dr. Taz: Amazing. [00:42:03] Dr. Taz: Final question. Okay. [00:42:05] What makes you whole? [00:42:07] Dr. Brandon Smith: Hmm. Um, I mean, I [00:42:10] think I, I think you know. My, my brain turns to fishing a lot, is my hobby. I'm [00:42:15] probably gonna go fishing after this. Amazing. So it's my time outside in nature and kind of my [00:42:20] crafting indoor hobby when it's not nice outside to be there. So just being outside in nature is [00:42:25] always a good way to make myself whole. [00:42:28] Dr. Taz: I love that. Well, thank you so [00:42:30] much for taking time out of your day to join me on the show. And for everybody else [00:42:35] watching and listening. Dr. Smith does practice with us at holplus. And [00:42:40] remember, men's health needs attention in a different way than the conventional algorithms, [00:42:45] so please share this with the men that you love. [00:42:47] Dr. Taz: And remember, we post new episodes every week. [00:42:50] We'll see you guys next time. [00:42:51] Dr. Brandon Smith: Before you go, take a second to reflect on what stood out [00:42:55] for you today. Then, if you can, [00:42:57] Dr. Taz: leave a quick review wherever you're listening. [00:43:00] It really helps other people discover holplus and start their own healing journey. [00:43:05] And don't forget to follow me on Instagram, @drtasmd. [00:43:08] Dr. Taz: I love hearing how these [00:43:10] episodes are supporting you