Latest / The Dr Louise Newson Podcast / 44 - Testosterone and why the UK is falling behind

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44 - Testosterone and why the UK is falling behind · The Dr Louise Newson Podcast

0:00
So this is one of my most favorite podcasts.
0:02
We're talking about testosterone, such an important
0:06
hormone. And I'm talking with one of the
0:08
probably world's leading experts of testosterone in men and
0:12
women, Professor Mokira, who's come over from the US to be here
0:16
with me in the studio. In real life.
0:18
We talk about how low testosterone is a marker of poor
0:22
health in men and women and the role testosterone has in our
0:26
bodies. So listen carefully and enjoy
0:29
it. So, MO, you're in real life?
0:33
Love it. So you are a urologist and
0:37
you've been on my podcast before.
0:39
Some people will have listened to it, some people won't because
0:41
I've got lots of new followers, which is great.
0:44
My husband's a urologist. He sat in this seat with his
0:48
ridiculous long hair talking about urology.
0:51
But you're you're similar but different to him.
0:54
So just explain a bit about what you do.
0:56
If that's OK, your husband is a good friend of mine.
0:58
He's Paul Anderson, and we've traveled throughout the world
1:00
giving lectures. But my specialty is really
1:03
sexual dysfunction. So it started in 2007.
1:06
I finished my fellowship and I was really good at getting men
1:10
great erections and great libido.
1:13
And it was problem was these men would go home and these wives
1:17
would get very upset. They said, look, everything was
1:19
great until he met you, but now he wants to have sex every day,
1:21
and I don't want to have sex with him, right?
1:23
It's a problem. And so I quickly realized it's
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true. So I went out and did a
1:27
fellowship and started learning more about female sexual
1:30
dysfunction. So I started treating women in
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2008 because I really believe that sexual dysfunction is a
1:35
couple's disease. You can't just treat one without
1:38
the other. You really need to focus on the
1:40
couple. And part of sexual dysfunction
1:42
is hormones, right? You want to treat a woman, you
1:45
want to improve her sexual function.
1:47
It's the triangle or what you call pet, right?
1:49
Progesterone, estrogen, testosterone, and other things
1:53
that we can do to improve her sexual function.
1:55
So, but the pet not only improves her sexual function,
1:58
it's improves her quality of life.
2:00
So that's what all started in 2008.
2:03
It's interesting because it is quite binary with a lot of you.
2:05
I mean, I love urologists. Of course I'm a bit biased
2:08
because of being married to one. But urologists are quite open
2:12
minded, more than a lot of a lot of specialties.
2:16
A lot of doctors seem to have lost their professional
2:18
curiosity. They're sort of inquisitive
2:20
nature. They're sort of they do what
2:22
they've always done. Whereas urologists generally are
2:25
kind people. They like each other.
2:27
They're lifting each other up. They're not doing this pushing
2:30
each other down, which happens to not in medicine, but they
2:33
often treat men or they treat women.
2:36
Is is that fair to say? I I'd say most urologists treat
2:38
men. So the realities of men, right?
2:41
And, and most of the urologists treat men for sexual
2:44
dysfunction. But the problem is when you
2:46
treat a man for sexual dysfunction and you increase his
2:48
libido and you leave his partner's libido low, you've now
2:52
created a problem, a big problem.
2:55
It's OK to leave both libidos low.
2:57
It's fine, right? Or raise both of them, but don't
2:59
raise one without the other. And I'll tell you that when you
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have both the couple and raise both libidos improve both sexual
3:06
dysfunction, sexual function, you improve the quality of the
3:09
relationship that's been shown over and over again.
3:11
Couples that engage in regular sexual activity significantly
3:15
enhance the quality of their relationship.
3:18
I mean, that is facts, isn't it? And, you know, I've, you know,
3:22
I'm sure Professor Mike Kirby and Jeffrey.
3:24
Hackett Yes. I've known them for many years
3:26
and it's been great. Whenever I've lectured at the
3:28
British Society of Sexual Medicine, they are so forward
3:32
thinking and they talk a lot about sex, how important it is
3:36
actually. It's a physiological process.
3:38
It can help reduce anxiety, it can help improve mood, it can
3:41
help with cardiovascular disease, it can help with all
3:44
sorts. And when he's, when they've
3:45
lectured, the whole audience has been transfixed.
3:49
Like when you lecture, everyone's listening wants to do
3:51
more. And then a few years ago,
3:53
probably about eight years ago, I went to my first one of the
3:55
menopause society meetings. I've been to many over the years
3:59
and they started to talk about testosterone Now I've didn't
4:03
know. I feel really embarrassed to say
4:04
this. I didn't know women produce
4:05
testosterone until about 12 years ago because no one taught
4:08
me. So I went to a lecture and I had
4:12
just started using testosterone myself then.
4:15
So I'd understood about testosterone, I understood about
4:19
how it works on every cell in the body.
4:21
I understood for me personally, it stopped me thinking about
4:24
giving up my job because my brain had come back more than my
4:27
libido, but my brain, my ability to think and to just sleep and
4:32
to enjoy life was, was back. So I was feeling really, really
4:36
brilliant about testosterone as somebody was lecturing and
4:40
talking about sex and saying, well, there is some evidence
4:43
about sex and testosterone in women.
4:47
It can improve the quality of sex, it might increase the
4:50
frequency of sex. And the whole audience laughed
4:52
like it was almost like talking to teenagers about sex.
4:56
And I sat there really, really like crossed, but also
5:00
embarrassed that my colleagues thought talking about sex was
5:04
something that was funny. I.
5:06
Just yeah. But, you know, now it's not.
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I mean, it's become the mainstream.
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Think about this. Sexual health is the best
5:12
barometer of a man and a woman's overall health because it takes
5:16
into account their physical health and their mental health.
5:19
But you bring up a point about how people didn't realize that
5:23
testosterone helps with libido, and I have to tell you a story.
5:27
1935, testosterone was first synthesized 1935, and something
5:33
interesting happened in 1937. A few years later, a very famous
5:38
physician, he's a gynecologist, Alfred Lozier, who was a
5:41
gynecologist in London, was the first to start prescribing
5:45
testosterone women. And he gave it to these women
5:48
who started having mastitis during breastfeeding.
5:51
And he realized that women have high levels of testosterone in
5:54
the urine when they're breastfeeding and when they're
5:57
menstruating. So he said, maybe I'll start
5:58
using testosterone in these women.
6:00
In 1940, Lozier published his first paper.
6:03
In that paper, he talks about how women had significant
6:06
improvements in their libido, sexual function.
6:09
He also talks about how they significant improvements in
6:11
their mood, right? And then several years later,
6:14
Greenblatt, another gynecologist, starts talking
6:17
about improvements in libido. So this concept that tests also
6:21
improves libido is not a new phenomenon.
6:23
It is not it was 90 years ago all most people were talking
6:27
about this and it's just interesting that even today some
6:30
people still don't believe that it may not improve libido.
6:33
It's. It's madness, isn't it?
6:35
It doesn't make sense. It doesn't, it doesn't make
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sense. It really doesn't.
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And you know, reading those studies, like the 1 from 1940,
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looking at men and women together, I mean, that was quite
6:46
ahead of its timing for a start because women have been excluded
6:49
for so many years. But it's there.
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But also in medicine, if I ever get confused, I go back to basic
6:56
Physiology. It's like it's my comfort
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blanket really. You go back and work out what's
7:00
going wrong. So like, I know I admitted that
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I didn't know about testosterone in women till decade or so ago.
7:07
But testosterone as a hormone is biologically active.
7:12
It affects every single cell in the body.
7:15
There's been a lot more research in men than women, but most of
7:19
the drugs, certainly. I mean, I qualified in 94, and
7:23
it was only the year before that women were included really in
7:26
studies. Yeah.
7:27
So most of the medicines that I've ever prescribed as a
7:29
doctor, we've looked at male studies, and that's fine.
7:34
But somehow if I try and look at and extrapolate data from men
7:38
for testosterone, people say, no, you can't.
7:40
We haven't got enough data. Yeah.
7:42
So it's very sad, and I'll tell you that we spend only a
7:45
fraction of the money that we spend on men for women to study
7:49
testosterone. So I was involved in the
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Traverse trial. This was the largest trial ever
7:54
to look at testosterone if it increases cardiovascular risk in
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men. It took us six years to do this
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paper. We published it two years ago,
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but that study was over $500 million.
8:04
I can't imagine spending over $500 million on one study to
8:07
look at testosterone for women. It's not going to happen, right?
8:10
So the reality is, is that sometimes we use the studies in
8:14
men for women, but doesn't really translate.
8:16
Maybe it's some, maybe it doesn't, but it's hard to say.
8:19
So I think that, you know, it's unfortunate, but we have to make
8:22
a push to study testosterone in women.
8:24
Look, I women make estrogen, they make progesterone, they
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make thyroid, they make cortisol.
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Whenever she's deficient in any of these hormones, nobody has
8:32
any problem giving it back to her.
8:34
These are hormones that she makes, right?
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But for some reason, if she's deficient in testosterone, we're
8:40
nervous giving that one back to her and no one can tell me why,
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you see? I can't understand either
8:45
because testosterone is aromatase into all the different
8:48
estrogens including estadiol. So you could argue, I don't want
8:53
to argue, but you could say that testosterone is more important
8:56
than estadiol. Do you know what's I mean?
8:58
Because you've got the aromatase enzyme throughout our body and
9:01
our brains and everything else. So we've got testosterone in our
9:03
brain. It it will some of it be
9:06
aromatase to estadiol. So it's almost a precursor to
9:10
the hormone that everyone's talking about.
9:12
So what? Why do you think we're so
9:14
scared? Oh, not we.
9:15
I'm not scared of it. But why so?
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Many people, I think the reality is that most of us are not
9:19
trained in it, right. We haven't got the education
9:21
there's in most countries don't have an FDA approved product.
9:24
So if you don't have an FDA approved product, you're going
9:26
to be writing it off label, right?
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There's some concern, and I think it's been dogma for
9:31
decades saying that it's dangerous to give it to a man.
9:33
But the reality is it just makes sense to me that if she makes a
9:36
hormone and she's deficient, I would be able to give it back to
9:41
her in the normal physiologic range, right?
9:43
That makes sense, right? And patients do better when you
9:46
put their levels back into the normal range.
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So it doesn't make any sense to me why we would withhold that
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medication. Now let's say you say I can't
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the benefit that I questioned the beneficial effects of
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testosterone. There are numerous studies
10:00
showing that combination estrogen plus testosterone is
10:04
better than estrogen alone in many symptoms, osteopenia,
10:08
osteoporosis, bone mineral density has been shown for one,
10:10
right. So you look at that, you just
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had a wonderful abstract that was presented.
10:15
We did it together. It was presented in the US
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showing that you look at women who are on HRT and you look at
10:21
adding T and the women, the HRT plus T do much better than THRT
10:27
alone for many areas like cognition.
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It was energy, right? So adding testosterone does make
10:34
a benefit, added benefit to your HRT program.
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So if you're getting, I think the take home message is this.
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If you're just getting HRT and not the T itself, you're missing
10:44
1/3 of the boat. Yeah, right.
10:46
I mean, that's important. I used to call it the triangle,
10:48
right? It's very important.
10:49
It is. I mean, I, I still use your
10:51
triangle analogy or sometimes I'll say to patients, it's like
10:55
a three legged stool. You can have normal, you know,
10:58
levels of two of the hormones, but it's still not going to be
11:01
right if you haven't got that third leg.
11:03
But also when I was reading, I'm very interested in history of
11:05
hormones. And one of the things is there's
11:09
always been concerned because there's not an absolute level
11:12
like a blood test and there's, there's big debate all the time.
11:15
How do you measure the level? Is it free testosterone?
11:17
Is it bound? Do you do 300 an index?
11:20
Do you use spectrometry? How do you do it?
11:22
And actually, like when I take a step back from all of this
11:25
discussion and noise, really, I think, well, not everything in
11:29
medicine, you have to have a blood test for, you know, I
11:32
could diagnose clinical depression or migraine in in, in
11:36
a patient. I don't have to do a blood test.
11:38
I don't have to do a scan. I take a really good history and
11:41
I work it out. So a blood test is a guide
11:44
rather than a panacea. And.
11:46
Yes, at least think about this. Let's talk about estrogen for a
11:49
second. OK.
11:50
A woman comes into my office. This is standard of care, and
11:53
she says, look, doctor, I'm start.
11:55
But we're now postmenopausal. I'm having vasomotor symptoms.
11:58
I'm having horrible hot flashes. Could you please help me?
12:01
I started on a semester in therapy and she comes back six
12:05
weeks later and she says I'm doing much better now.
12:08
Remember, I didn't check her estrogen before I started.
12:11
That's not standard of care. Standard of care is to start her
12:14
on the estrogen without checking the levels and go ahead and
12:17
start it. She comes back six weeks later
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and she says I'm doing better, but I still have some hot
12:22
flashes. What's the standard of care?
12:24
It's not to check another estrogen level.
12:26
It's to give her higher doses of estrogen until the symptoms go
12:30
away. That's standard of care, right?
12:33
And so I, I, I look at, I don't other hormones like
12:36
testosterone. Yes, you should somewhat I do
12:39
think consider the levels, but symptoms are also very
12:42
important. A lot of people DM me on
12:44
Instagram or patients who come to the clinic this have been
12:47
told my testosterone levels normal so say well give me the
12:50
figure and it's something like 0.7.
12:54
I mean anything with A0IN front really is low isn't it?
12:56
And but the lab has been test, it's set up that it's only flags
13:01
as abnormal if it's raised. It seems madness, but also some
13:06
laboratories K the NHS laboratories that all the ones
13:10
that the NHS use, the level is actually quite low of the upper
13:14
limit of normal. So it will flag as high even if
13:18
it's like 1.6, which is in our sort of money is still quite
13:22
low. But they've reduced it recently.
13:24
And I was talking to the person who works in the laboratory that
13:28
we use and he was looking at the data to work out the normal
13:33
so-called levels for women. And it's done on a very small
13:37
rate number of women, like 20 women.
13:39
Like it's, it's appalling. I said, is there any other data?
13:43
Have you got any other data that you know, the, the, the
13:45
companies use who make the machines?
13:47
He said no, Louise, this is it. It's a joke, isn't it?
13:51
Because levels have changed all the time.
13:54
Even if you're not on testosterone, your body's making
13:56
testosterone at different rates, different amounts.
13:59
And I don't know that I showed you the graph, but I did my own
14:01
testosterone level like 8 times in a day and it's completely
14:06
different. At one time in the day it was
14:08
3.2, which you could say is slightly high.
14:10
Another time it was 1.2, which you would say is slightly low.
14:13
And I use the same dose. I've used the same dose for like
14:16
nearly ten years in the morning like but that's so any blood
14:21
test is it has to be interpreted properly doesn't.
14:24
It it's not just about the level.
14:26
So I'll give you the example I give in men.
14:28
So when I started my practice in 2007, I started a basic science
14:31
lab. In the lab, to this day, we
14:34
still take blood and we look at something called the sensitivity
14:36
of the androgen receptor. This is called the CAG, repeat.
14:40
What we showed many years ago was that those men with very
14:43
insensitive receptors need more testosterone.
14:47
Men with very sensitive receptors need less
14:49
testosterone. But we're all not the same,
14:52
right? And so there's going to be a
14:53
certain number where each man's going to feel better.
14:56
And it can't be 1 number fit all.
14:58
And right now it is 300. This madness is the.
15:01
Same concept goes for for women. We did the same thing.
15:03
We published this on CAG repeats in women and we also showed a
15:07
small series, 30 women. And we showed that in those
15:10
women, those with more insensitive receptors were more
15:13
likely in this case have the sibilitis, in other words,
15:15
problems with gynecological issues.
15:17
So every woman is different genetically and they may require
15:22
different levels to feel better. That's a very important point.
15:28
If you've ever felt confused, dismissed, or just left to
15:31
figure out your hormone health on your own, that's exactly why
15:35
I created my free Balance app. It's designed to educate women
15:39
about their hormones at every stage of life.
15:43
You can track your symptoms and periods if you have them, read
15:47
evidence based articles and connect with a community of
15:50
women who are asking similar questions that you might be
15:53
asking. I see everyday how powerful
15:56
knowledge is. When you understand what's
15:58
happening in your body, you can make informed choices about your
16:02
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16:05
when you speak to healthcare professionals.
16:07
If you want clear, trustworthy information without the noise or
16:12
the misinformation, then download My Balance app today.
16:16
It's there to educate, support and help you take back control
16:20
of your hormone health. I remember years ago, clinic
16:25
hadn't been known for very long and this lady came back with a
16:28
high raised testosterone level. And we, we, one of our weekly
16:33
meetings, we all went together with what are we going to do?
16:35
What are we going to do? And I said, well, the first
16:37
thing we need to do is phone the patient and see how she is.
16:39
And so she was feeling absolutely fine.
16:40
She was feeling great actually. But the recommendation we
16:44
decided was just reduce the amount a little bit.
16:46
And then she came back literally, like just really
16:50
tired coming to the clinic. And they, she said, I felt awful
16:54
since she reduced my dose. Anyway, one of the other doctors
16:57
had seen her, but it materialized that she was an
17:00
Olympic swimmer and she used to swim across the Channel.
17:04
She'd done it like something ridiculous like 20 times across
17:07
the channel. And as she became older, you
17:10
know, her stamina reduced. Everything had just slowed down.
17:13
Giving back her testosterone, it made a huge difference.
17:17
But obviously reducing the dose had made it back to how she was
17:20
before and we all came to the conclusion she probably is when
17:24
she was younger had a higher naturally high testosterone.
17:27
Yeah, so remember that that more testosterone we give doesn't
17:30
keep doubling and tripling the improving symptoms.
17:32
In other words, if a man has a great libido at 500, giving him
17:35
1000 will not double Lib. We call it an inflection point,
17:38
saying with women. We, I know we've got studies
17:40
about libido in women, but we know naturally that testosterone
17:45
is very anti-inflammatory. Yes, it works on every organ,
17:48
every cell in our body. We know that it it helps as you
17:51
say, bone density, it helps with our metabolism.
17:55
So it will help reduce incidence of diabetes.
17:58
It will help it's it's cardioprotective as well.
18:02
It helps the mitochondria to function like it's really
18:05
important as a biologically active hormone isn't.
18:08
It to me, testosterone is probably one of the most
18:10
important hormones in men and women and it's probably one of
18:12
the best markers of a man or woman's overall health if you
18:15
think about it, because, you know, we think about low
18:18
testosterone. It's the single most important
18:20
test to me to, to predict what your current health status is
18:25
and what your future health status is going to be.
18:27
You know, So I can't think of another marker, a biomarker that
18:32
can give me a better indicator of someone's overall health.
18:35
So why is it so hard for men and women to access testosterone?
18:39
Do you think my? Well, I think it's based on the
18:42
country. I mean, in the US it's quite
18:43
easy now and a lot of the online pharmacies, most clinicians are
18:47
still nervous giving it to them. And there's still sub safety
18:51
concerns. With the Traverse trial, the
18:53
safety concerns and men have gone down.
18:56
We're not worried as much about prostate cancer and
18:58
cardiovascular risk, which is great.
19:01
So I do think it's country by country, UK still far behind us,
19:05
way behind us in terms of utilization and testosterone
19:08
from men and women, way behind. It's interesting that I mean
19:11
last year's figures show that for the male tests cause it
19:15
cause in the NHS the only way to have it is off license.
19:18
The male gel, yeah, that we can prescribe for women on the NHS.
19:22
We've got the cream that we can give privately, but NHS, so
19:26
looking at the NHS data last year there were more women than
19:31
men that were prescribed. I mean, it's unbelievable.
19:33
It's. Great for me as a woman, but
19:35
actually the the the figures are still really low.
19:39
And actually if you look at the data and tease out by socio
19:42
economic class, people from lower socio economic classes are
19:47
less likely to be prescribed testosterone.
19:49
And in my mind they would benefit more because often they
19:53
have a higher risk of heart disease and diabetes and mental
19:57
health. Yeah.
19:58
And one of the things that I've really learned in my clinical
20:01
experience is that testosterone can really improve mental
20:05
health. Yeah, a cognition.
20:08
We see that in men as well. And So what are the two big
20:12
mimickers of low testosterone? It's depression and
20:16
hypothyroidism. So you have to screen for both.
20:18
I tell that if a woman comes in and she has low libid, a low
20:21
energy, some depression, screen for the TSH and screen for maybe
20:26
she has depression. It's really important, right?
20:28
Those are two big mimickers. But it is true low T has been
20:31
associated with increased depressive symptoms and giving T
20:35
has been shown to improve depressive symptoms.
20:38
And we had a large study I published in 2011 where we had
20:41
almost 900 men and we showed that even if they were on an
20:45
SSRI, an anti antidepressant, adding testosterone in our trial
20:50
improved depressive symptoms. Maybe some synergy between
20:53
adding the two, you know, but it's really important because,
20:57
you know, a lot of these patients I think also are
21:00
suffering from clinical depression.
21:01
You got to screen for them. Yeah, and it's hard because
21:03
there's an overlap, but my problem or not problem, but one
21:07
of the things I worry about is women and men actually who are
21:11
misdiagnosed with mental health condition.
21:13
And once they're under psychiatrist, no one thinks
21:15
about hormones. And I see a lot of women who
21:18
have been under psychiatrist often for many years.
21:22
So they've been given antidepressants and
21:26
antidepressants can reduce testosterone levels.
21:29
They're given antipsychotics, which as you know, can push up
21:32
prolactin and then reduce testosterone levels and then
21:37
lithium, they're given ECT. So by the time I see them, all
21:41
their hormones are really low and I give them back the
21:44
progesterone, the estradiol, and it helps.
21:47
It helps with some of their symptoms.
21:48
Give them testosterone and weight and it can be
21:51
transformational. And as you know, some of our
21:54
deep prescribing data that we've just published show that women
21:58
can come off their antidepressants and
22:00
antipsychotics when they're on hormones, but it's higher, it's
22:06
up to 40% can come off when they, you add in testosterone as
22:09
well. And you have to do it very
22:10
slowly and carefully. And some women, as you say, and
22:13
men as well, need both, but they're not going to improve
22:16
their mental health if it's caused by a low hormone.
22:19
But. Remember, I treat sexual
22:21
dysfunction, right? So the last thing I want to do
22:23
is give someone an SSRI, right? It's going to shut down the
22:26
libido, right? It delays the ejaculatory time
22:29
or the orgasmic time for women significantly, right?
22:32
So that is my last pull. My first pull is to go with
22:36
what? Either checking the
22:37
testosterone, treating the testosterone and we hit them
22:40
hard, men and women on lifestyle modification, diet, exercise,
22:45
sleep and stress reduction. I don't have a pill on the
22:48
planet. Louise.
22:49
Stronger than diet, exercise, sleep and stress reduction.
22:52
And each one independently has been shown not only to improve
22:56
sexual function, but also improve testosterone levels,
22:59
right? We make testosterone when we
23:01
sleep. Exercise helps raise
23:03
testosterone. Reducing stress raises
23:05
testosterone, right? A proper diet can help raise
23:07
testosterone. So think about the natural ways
23:10
that we can do it. And if you improve the natural
23:12
ways raise your T, you're actually improving just your
23:15
quality of life. Yeah, just your health.
23:17
For sure. Your health span, right?
23:18
That's very important. Yeah, because it all is so close
23:20
together. But it can be very hard if
23:22
you've got low testosterone to do all those things.
23:25
And I found certainly my lifestyle was not as good when I
23:29
didn't have testosterone. And testosterone enabled me to
23:32
continue the lifestyle that I want.
23:35
And we've seen this in men and women as well.
23:38
And I I sometimes, you know, treat younger women with
23:42
testosterone on it, on the, on its own.
23:44
They've got regular periods of estadiol, progesterone is fine
23:47
but the testosterone is starting to decline.
23:50
But often when they have testosterone and then their
23:53
nutrition improves exercise and sleep, like you say, they don't
23:56
need as much testosterone. And it's I mean it's definitely
23:59
the same in men as well as an I agree. 100% and most people
24:02
would say, doc, I know what you're saying about diet,
24:03
exercise, sleep and stress, but also give me the tea.
24:06
I want both. I say fine, but what I don't
24:08
want to do is give you the tea and you don't do anything.
24:10
Just meet me halfway as the concept, meet me halfway.
24:13
I'll set. I will fine tune your hormones.
24:16
I will optimize your health, but you're going to give me diet,
24:19
exercise, sleep and stress reduction and then you are on
24:22
fire. The combination very, very
24:24
effective. It's favoured in medicine, isn't
24:27
it? It is, I mean, it's, it's the I
24:28
think it's a disservice many times just to hand in the Viagra
24:32
and let them go hand in the tea. You got to go deeper.
24:35
You have the opportunity to go deeper and this is your chance,
24:38
right? And so just say here's your
24:40
testosterone. We'll see you later.
24:41
No, here's your testosterone. And here are the things I want
24:43
you to do with your diet, exercise, sleep and stress
24:46
reduction to help raise your natural testosterone.
24:48
And in fact, if you do those things, you will make my
24:51
testosterone program even more efficacious because the outcome
24:55
will be greater than me just giving you T alone.
24:57
No question, you know. Absolutely.
25:00
So before we finish, I want to ask you a question because I
25:03
think as you probably tell and about all sorts of things all
25:06
the time. And I was trying to think
25:08
recently which drugs in your medical career, my medical
25:12
career have made the biggest difference to patients or even
25:16
in the history of medicine. I can think about antibiotic.
25:19
Yeah, penicillin. Yeah, penicillin is a big one.
25:22
Yeah, huge. You know, I think statins came
25:25
out. Now there's some controversy
25:26
about statins, but when they came out and was a big thing and
25:28
drop dropping and reducing the risk of cardiovascular disease.
25:31
To me, testosterone is one of the biggest ones as well.
25:34
I mean, it really is a transformative medication that
25:37
made a big impact on numerous patients lives.
25:39
And it's not a sex drug or a quality of life drug.
25:42
I mean, it's not it is a true improvement in your medical
25:45
condition, right? To me, I'm very big proponent of
25:47
daily Cialis. Daily Cialis is one of those
25:50
magic drugs where it not only improves the quality of the
25:55
erections, it actually can improve the endothelial lining
25:59
of the blood vessels. A wonderful study that came out
26:02
with Doctor Cloner last year with a 13% reduction in
26:05
cardiovascular disease, 25% reduction mortality, and those
26:08
men taking tests off every to see it daily Cialis alone and
26:11
it's FDA approved for BPH. So you tell me, any man that
26:14
walks into my clinic, I can protect your penis, your heart
26:16
and your prostate with one pill. It is.
26:20
So this is tildanophil for those who don't know who's, which is
26:23
similar to Viagra, but it's, it's longer acting.
26:27
And I have done a podcast with Professor Mike Kirby talking
26:30
about this because it's really interesting.
26:32
So, so I agree these drugs and other hormones as well.
26:35
So thyroxine, insulin, but there aren't many other drugs that
26:40
have can really transform your patients sitting in front of you
26:45
as an improving the quality of their life, but also improving
26:48
their future health as well. Yeah, very important that we
26:51
said that. Your current quality of life and
26:54
your future health as well, because all of us, and I think
26:57
we talked about this before, all we care about is our health span
27:01
lasts as long as our lifespan. You and I don't want to live
27:04
till 90 but be healthy to 70. That is not what we want.
27:09
We want to be playing tennis the day we die, right?
27:11
In very, very good shape. And I think the same goes with
27:14
our sex span, right? Most people would say that they
27:17
want their their sex span to last as long as their lifespan,
27:20
right? It makes sense.
27:21
And in order to do that, you need to take care of yourself
27:25
and your partner. Yeah, right.
27:27
That's important as well. Absolutely.
27:29
I totally agree. And I feel very lucky that I
27:32
have a clinical job where I transform people's lives and
27:36
their partners and their families.
27:38
It all works together. It's great, but what that makes
27:42
me sad and frustrated is it's so difficult for so many women and
27:45
men to access their own hormones.
27:47
Yeah, but you're paving the way. Oh, thanks man.
27:49
Wow, I. Know you are.
27:50
We've. Got a lot to do, we've got a lot
27:52
to do, but it's, you know, it's education.
27:54
So before I end, I'm going to just have to ask you 3 take home
27:59
tips. OK?
28:00
Three reasons why testosterone or low testosterone is a marker
28:07
of poor house. I'll give you 5.
28:09
Yeah, we know that low testosterone, men, low
28:14
testosterone is a marker of cardiovascular events.
28:16
But men or in some cases even women with lower testosterone
28:19
levels, increased cardiovascular events.
28:22
Low testosterone is increased risk for depression, low
28:24
testosterone, increased risk for diabetes, obesity, metabolic
28:28
syndrome, right? And we know that other
28:30
testosterone is increased risk for also bone fracture, right?
28:33
So it's not about sex, it's about your quality of life.
28:38
Yeah, that's quite a depressing way to end, but replacing tests
28:42
let's. Make a positive.
28:43
Let's make a positive if. You.
28:45
Give it. If you give it back, you could
28:47
potentially improve these conditions, right?
28:50
And that's the important point. Perfect.
28:52
What a great way to end. Thank you so much and thank you
28:54
for coming from. The US, yes, great to be here.
28:57
Thank you. Thank you so much.