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

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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
• 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 one 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
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  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 one 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? One of the more common
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  genetically inherited disorders amongst men is a
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  hemochromatosis, which is a form of iron storage disorder that
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  causes an elevation in the blood count in the iron level.
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  This type of excess iron can cause damage to your liver, to
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  your kidney, to your brain. It's quiet and it accumulates
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  over time. And because testosterone therapy
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  will stimulate the kidney to make erythropoietin, a natural
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  process that then stimulates the bone marrow to make more red
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  blood cells, you want to get your blood count evaluated.
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  The blood count going up is not a problem unless it goes above a
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  certain threshold. We call that erythrocytosis.
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  That's one of the potential consequences of testosterone
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  therapy, Blood count going higher.
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  In some cases, donating blood is recommended.
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  So we've got a few things we want to screen for, you know,
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  global health, cardiovascular health.
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  Now, what about that level? There are two forms, basically 2
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  forms of testosterone to test the total and the free.
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  I'm going to give you an example using a pen.
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  I have a prop, got a prop right here.
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  The studio comes fully equipped. OK, so here's a pen and here's
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  another pen. So if you said how many pens
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  does the Doc Pederudi have, the answer would be two.
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  But imagine that I am a sex hormone binding globulin, right?
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  And I am bound to this pen which represents testosterone.
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  Now you would say how many, how many pens are there in the room?
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  And the answer would still be two.
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  But only one of them is functional.
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  The other one is bound and can't work.
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  That's the difference between total testosterone and free
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  testosterone. It's the free testosterone that
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  does the work, a little bit harder to measure, not commonly
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  ordered, but worthy of acquiring.
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  So you want to look at total and free testosterone no matter what
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  the level is, if you're having symptoms and your age
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  appropriate. Age appropriate is a relative
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  statement. I've had men in their 30s with
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  symptoms of low testosterone respond to therapy.
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  So let's outline those symptoms so you know what to look for.
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  I mean, the most glaring loss of libido, erectile difficulty.
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  Those two oftentimes are triggers, more subtle symptoms.
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  Lost confidence, depressed mood, low energy, especially late in
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  the afternoon. I come from work and I crash on
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  the couch. Lack of motivation, lack of
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  initiative, difficulty recovering from workout.
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  You know, after the gym, skin quality loss, muscle loss, these
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  are all more subtle symptoms of low testosterone that are worthy
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  of evaluating and considering treatment.
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  So you have those symptoms, you're being evaluated.
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  By the way, make sure they check your thyroid because these
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  things can overlap and you decide to go on testosterone.
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  The next question, what kind of testosterone?
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  How should it be applied? There are pellets that can be
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  implanted, the topical creams, patches, there's a new drug out
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  that's an oral form and then there's injectable.
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  So let's review. I don't like the new drug.
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  Nothing. Well, I don't trust it.
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  The problem with oral testosterone historically has
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  been concerned about liver issues because it metabolizes
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  through the liver. Now, I talked to the Rep for the
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  company and they reassured me that it's totally safe for the
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  liver, and I absolutely don't believe that.
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  I don't believe it, no. It's a wrap, right?
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  They're selling stuff #2 you got to wait.
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  Let some other people try this, you know, maybe five years from
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  now I'll have a different opinion.
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  But it's also a proprietary drug, kind of pricey.
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  Topical creams, totally reasonable, a little sloppy, a
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  bit of a nuisance. The absorption can be somewhat
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  variable. However, it's totally cool to
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  use it, particularly if you don't mind applying it every day
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  and if you are not inclined to want to do any injection, which
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  is my preferred method for men. Many women as well, but it's a
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  once a week. Typically it's a once a week
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  self administered injection. The dose varies depending on
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  response. When it comes to dosing
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  testosterone, it is never judged based upon subsequent blood
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  level. So if a gentleman comes to me in
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  a follow up visit and says to me, thank you doctor, I feel
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  fabulous. My energy is great, libido is
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  back, my muscle mass is up, my fat mass is down, that's a
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  success. If the blood level comes back at
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  400 or 500, there's no value in pushing the dose higher just to
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  get to a different number. Now let's flip it around.
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  Suppose he's telling me how great he feels, and suppose the
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  threshold for my lab is 900 and his blood work comes in at 1200.
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  It's no harm in high levels. The lab parameters are a little
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  bit arbitrary as long as there's no negative effect.
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  We talked about elevated hemoglobin and hematocrit,
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  right? That can be monitored for
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  elevated estrogen. Some of your testosterone will
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  naturally convert into estrogen, which you must have.
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  If you have no estrogen, your bones can get weak and it can be
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  counterproductive to your libido and your energy.
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  If you have too much estrogen, yeah, you can grow man boobs and
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  that's not so cool and it'll undermine the benefit of
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  testosterone. So there's a sweet spot for
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  estrogen. Depending on the lab that is
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  utilized. My target zone for my patients
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  is between 20 and 40. It can vary depending on the
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  labs parameters, so that's something to be mindful about.
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  It would be one of the reasons to consider modifying the dose.
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  So testosterone injectable, we talked about topical creams,
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  pellets I almost never use. They work, they're safe, but
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  unlike women who do very well with one little tiny pellet, men
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  sometimes need a bunch of them. It's like buckshot going in the
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  buttocks. It's good if you have
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  limitations, cognitive impaired, or functionally just have
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  trouble keeping up with things. I have a few patients that
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  benefit from that approach as well.
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  How about preserving your testicle?
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  I get this question often. What if I decide to come off
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  testosterone? No problem, you just stop.
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  You won't lose value that you've acquired completely, but you
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  will go back to that which you were.
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  When testosterone therapy is being administered, it is
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  incumbent upon the provider to do things to preserve your
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  testicles. The testicles do more than make
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  testosterone, they make other supportive hormones.
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  They're a component of your health.
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  Giving testosterone without something to support the
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  testicle causes the testicle to shrink.
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  Over time will become completely atrophied, the size of a Raisin
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  and cease functioning by virtue of supporting testicles.
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  And that could be done with several different interventions.
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  There is clomiphene or clomid and oral capsule.
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  There is N clomiphene, A isomer that can be compounded.
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  Another oral agent. There is HCG, human chorionic
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  and adatrophen, which is an injectable.
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  There's gonadarellin, another compounded injectable.
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  How you preserve testicles is really incumbent upon the doctor
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  to guide you toward that. You preserve them, I think is
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  critical. So testosterone, absolutely.
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  Preserve the testicle. You bet.
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  Monitor estrogen, blood count, absolutely.
• 20:59
  How about other potential site? Can you lose your hair?
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  Oh yeah. If you're prone toward androgen
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  that is male pattern alopecia and you're on testosterone,
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  there's a risk of exposing the inevitable hair shedding that
• 21:16
  would that is destined to occur. Now there are things that could
• 21:20
  be done to try to balance that risk in some cases or topical
• 21:25
  creams. We have developed one in
• 21:27
  intellectual medicine. If you e-mail us, we can
• 21:31
  certainly consider it's a prescription compound that we
• 21:34
  made. It's a unique product, works
• 21:35
  great. What I like about it, and I do
• 21:38
  use it personally, is that it works on the hair follicle
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  without getting significant blood absorption.
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  You can use drugs like finasteride, Propecia.
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  These drugs block DHT, so some of your testosterone will go
• 21:56
  into estrogen and some of it will metabolize into DHT or
• 22:00
  dihydrotestosterone, a really potent form of testosterone that
• 22:05
  is helpful to libido, helpful to the beneficial effects, but also
• 22:11
  more stimulating to the prostate and hair follicles.
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  So going on a DHT blocking drug at the same time you're on
• 22:19
  testosterone to preserve hair if you're at risk for that is a
• 22:24
  reasonable combination to have. So here you are on your
• 22:28
  testosterone. I get another question.
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  How long should I stay on this dock?
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  And my answer until they close the lid.
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  Like why would you stop? The only reason to stop is
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  you're on the cusp of death or financially it's not sustainable
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  or philosophically you just choose not to do it.
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  By the way, that's totally cool too.
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  You know how you live as your prerogative.
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  My job is to educate and inform. It's not to impose.
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  Any doctor that attempts to impose a treatment, I think is
• 23:08
  deviating from the primary focus, which is you, right?
• 23:13
  Give me information, doc. Don't tell me.
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  I have to. I must.
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  That's required. You have to get your
• 23:20
  colonoscopy. You have to get your mammogram.
• 23:23
  You must get a prostate biopsy. There could be sound reasons for
• 23:28
  these recommendations, but they're never requirement,
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  right? Independent life.
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  That's most critical. The choices you make.
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  Most critical. You choose not to do
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  testosterone. Totally cool.
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  Doesn't make you a bad person. I want to age organically.
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  I want to do my best then do so. Can you do things to help
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  testosterone levels other than take testosterone?
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  Yes. Strength training, muscle
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  strength, weightlifting in particular and shown to have
• 23:56
  some value. Keep your percent body fat in
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  check, Shown to have some value. But even a lean man with optimal
• 24:04
  health habits is going to have his testosterone levels decline.
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  It's just inevitable. So you have options.
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  Now you know it's safe. Now, you know, you could do it
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  for the rest of your life. Now, you know, you don't have to
• 24:19
  fade. Now you can be confident that
• 24:23
  you're not going to harm yourself.
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  So, you know, my wife asked me a while back if I knew I was
• 24:30
  dying, would I regret anything? You know, and she's referring to
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  all the stuff I do. I do hormone therapy.
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  I do supplements, a bunch of other things we'll talk about
• 24:40
  over time. In a nutshell, if it's out
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  there, it's credible and safe and it has potential to keep me
• 24:47
  vital. Sign me up.
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  So yeah, I do testosterone therapy.
• 24:52
  The answer? No, I wouldn't regret anything.
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  We all leave the stage. How we live is what we control.
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  That we die is inevitable. How we die, not necessarily our
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  prerogative, but we can tilt the field a little bit, right?
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  Protect against dementia. Protect against withering.
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  Do not become disabled. One of the leading causes of
• 25:15
  disability is sarcopenia. It's a fancy word.
• 25:18
  It just means withered muscles. You got to get up and down
• 25:22
  stairs, people. You got to open a jar of people,
• 25:24
  you got to get in out of your car.
• 25:26
  These things matter. Think young, walk fast, lift
• 25:29
  weights, take testosterone. Nothing.
• 25:32
  I encourage my patients to do an occasional hormone holiday about
• 25:37
  every three weeks. You skip your testosterone.
• 25:40
  Why? Because it up regulates the
• 25:43
  receptors. We cannot test your receptors
• 25:47
  but they're there and by starving them a little bit, the
• 25:51
  theory goes you're going to enhance the receptivity.
• 25:54
  We got to think long term. I've been on testosterone for
• 25:57
  closing in on 20 years now. It is a sustainable approach.
• 26:02
  When you take that three-week holiday, you're going to feel
• 26:04
  fine. Maybe the third week you lose a
• 26:06
  little bit of juice, but it's barely noticeable.
• 26:09
  The body redistributes testosterone in a manner that
• 26:11
  keeps it around for quite a while.
• 26:14
  Another side effect worth mentioning, acne.
• 26:17
  If you're getting pustular corporeal acne on the chest, on
• 26:20
  the back, that's a sign of testosterone stimulated acne,
• 26:26
  you can lower the dose in some cases.
• 26:28
  I'll split how my patients split the dose into twice a week.
• 26:32
  Some people a lot more sensitive to testosterone than others.
• 26:36
  Testosterone for life, yes. Living more vitally, you bet.
• 26:40
  Testosterone for bodybuilding, not so much.
• 26:45
  You're 23, you want to grow muscles?
• 26:47
  Do not do anabolic steroids. Can it be any more clear?
• 26:53
  Right. Body dysmorphia is a horrible
• 26:56
  thing. Your biceps being an inch bigger
• 26:59
  is not going to change the arc of your life.
• 27:02
  I get it guys, I've been there. Listen, I think I'd rather, I
• 27:07
  think I'd rather die than wither.
• 27:09
  And I've been in the gym since I was 16, and I like lifting
• 27:13
  weights and I like having muscle.
• 27:16
  But for God's sakes, don't crush your virility in the process.
• 27:20
  Anabolic hormones, these are the type people get off the
• 27:23
  Internet. These are the illegal type.
• 27:25
  These are the ones that stimulate incredible muscle
• 27:28
  growth at a price damaging neurologically damaging sexual
• 27:34
  vitality. And I've seen some of these
• 27:36
  patients in my practice years later.
• 27:39
  Sometimes recovery is not possible and they end up on
• 27:42
  testosterone in their 20s. How about things that stimulate
• 27:46
  testicles without using testosterone?
• 27:50
  They don't work. All right, that's a short
• 27:53
  response, but they generally do not work anything.
• 27:56
  I don't care what that baseball guy is telling you about, you
• 27:59
  know, T Rex, one O 1, whatever they're promoting out there.
• 28:04
  Look, it's placebo nonsense. If you're above the age of 40 in
• 28:09
  my vast experience and you're manifesting symptoms of low
• 28:14
  testosterone, almost always, you're going to need
• 28:18
  testosterone itself to get a remedy.
• 28:21
  In some cases, a testicular stimulant like clomiphene and
• 28:26
  clomiphene, gonadorellin, HCG in some cases you could try that
• 28:32
  and it may have value, but that's uncommon.
• 28:36
  Over the counter stuff It's it's a failure.
• 28:41
  Supplements have have value and I use them in certain settings
• 28:45
  but if you have issues with testosterone, testosterone is
• 28:48
  the remedy. So keep your money in your
• 28:51
  pocket. Do not do this people blindly
• 28:55
  over the Internet. It is worth the price to get a
• 28:59
  clinician who is progressive who can help guide you.
• 29:04
  Life vitality, anti aging, it's more than just testosterone,
• 29:09
  although I consider that foundational.
• 29:12
  The elements of vitality and anti aging control percent body
• 29:16
  fat replace hormones. The other pieces we'll be
• 29:21
  talking about in podcast includes protecting your brain.
• 29:29
  It's a whole nother topic. I'll defer to another podcast.
• 29:33
  Your brain gets protected by, ironically, being on hormones.
• 29:38
  Lower hormones correlates with increasing dementia risk.
• 29:42
  Women who've had hysterectomies, men who have had androgen
• 29:46
  deprivation therapy, Never. Let them castrate you guys.
• 29:50
  Never. I'd rather die of prostate
• 29:53
  cancer than invite dementia through testicular blocking
• 29:57
  therapies. That's a false choice.
• 30:01
  Mark yourself absent over 2 so maintaining percent body fat
• 30:06
  hormone therapy, lead reduction we'll talk about in future
• 30:09
  podcast. So I'll leave you with a story,
• 30:12
  one very motivational to me, one of my old patients, this is
• 30:17
  going back had to be 15, maybe 20 years ago now when I was just
• 30:21
  starting to develop my knowledge, capability and
• 30:24
  interest in hormone therapy. And I had a patient, he had
• 30:27
  stage 4 lung cancer and he came to see me and I asked him, how's
• 30:31
  your breathing? He said, well, doc, this is a
• 30:34
  guy I was treated with actually testosterone.
• 30:37
  It's great for cancer patients. How's your breathing?
• 30:41
  I said to him, he goes, well, doc, you know, dude's 85, said
• 30:44
  the only time I get short of breath, you know, when I'm
• 30:46
  having sex with my wife, I get a little breathless.
• 30:49
  Man, I was floored, impressed, motivated, right?
• 30:54
  Think about that, 85. Stage 4 lung cancer takes my
• 30:58
  breath away. He passed away a few months
• 31:02
  later, which is a beautiful exit for a wonderful life.
• 31:06
  The point of the story is vitality.
• 31:10
  Uber Alice. Hold on to that right gang till
• 31:13
  next time. Talk to you then.