SMASHING Testosterone Myths with Hormone Optimization Expert Dave Lee

 Welcome to the tier one health and wellness podcast, the home of evidence based medicine. Our mission is to interview those that we consider leaders in the field of health and hormone optimization. It’s my pleasure to have Dave Lee on the podcast today. Now, Dave is the owner of Advanced Fundamental Health, and he is a holistic health coach that specializes in male hormone replacement therapy.

I’ve had the opportunity to follow Dave for several years now. And I’ve been impressed watching him evolve and develop into one of the top health coaches in the field. Dave’s desire to continually learn and follow evidence based medicine is what sets him apart from many others. As I’m sure he will tell you, when we follow evidence based medicine, it can be difficult at first because at times we have to unlearn what we previously thought we knew.

And we have to learn it all over again. We have to let go of any belief perseverance. our confirmation bias, and not everybody can do that. But when we follow evidence based medicine, we all speak the same language and send the same message. So it’s once again my honor to introduce Dave Lee to our audience.

So Dave, tell us about yourself and your practice and what led you into the field of hormone optimization.

Thank you so much for having me, Keith, and I’m very humbled that you have invited me onto your podcast and reached out to, to have me here today. What got me into this field personally is that I had, I had a brain injury and I was in a situation where I had to learn a lot of things myself to be able to understand that hormones were going to be a big part of getting my recovery on track.

And as I got further into my own hormone optimization journey, I found, similar to what you just alluded to, is that a lot of the information that was being reported and practiced was incorrect and it was doing more harm than good. And it seemed like there was a real lack of guidance for men to be able to get the knowledge that they needed to actually be able to get the treatments that were going to save their lives or improve their quality of life.

So, I dedicated my entire life and career to helping men. Get better access to information they could actually understand around how to do TRT properly and as you said That’s most importantly actually based in evidence that is going to give them the results they need and they deserve from their

treatment So we’re gonna dive right in Dave and I’ve heard you speak about this on many podcasts and and so eloquently So but let’s talk about what I consider the three pillars of health and that’s going to be nutrition Exercise and hormone optimization.

Now I know you know, I’m leaving out two things, which are, we all know, very important that is sleep and stress reduction. And we can talk about those, but the reason I refer to the others as our pillars of health is those are the three things that we are 100 percent in control of. We can control what we eat.

We can control whether we get up and move or not, and we can control whether or not we. undergo hormone optimization. We’re not always in control of how much stress we have. I mean, we have, they have family illness, we may be in a divorce or financial stress, and we’re not always in control of how much we sleep due to our job schedules and others, but we’re in control of those three pillars.

So let’s talk about nutrition first. And as you have said, once so many times before, most men really just don’t understand nutrition. So let’s help them out today.

Absolutely, Kate. I couldn’t agree more. I like to look at the body as a series of interconnected systems that is also sentient at the same time.

I like using the movie cars as an analogy, which are like the, it’s like the Pixar cartoon where the cars are alive. And I think that a. A machine that is experiencing itself being alive and interacting with the world around it is a really good way to look at the human body. And one of the most important things when it comes to cars is the quality of the fuel that you put in.

Um, and secondly, when it comes to movement is how you drive the vehicle. So when we’re looking at nutrition, I think this is something that is massively misunderstood. A lot of the time guys focus much too much on calories as the be all and end all of nutrition and body composition and body fat as the only end result of what we’re putting into our mouths.

And In reality, a lot of the low grade mental and physical health problems that guys experience, which then manifest into chronic disease over the course of a lifetime, comes from the, the, the kilograms of food that we’re putting in our mouth per week, rather than the milligrams of supplements or medications that we’re taking.

And nutrition is what forms each cell in our body. Like we are, we are what we eat. We’re made of the nutrition that we put into our bodies. And I think the most important thing that guys can understand is that if you’ve been eating a terrible diet for your whole life and you switch to whatever the best diet for you is tomorrow, You’re going to feel much better over the next few days acutely, but the real benefits are going to come when you’ve been consistently eating the right nutrition for a long period of time.

When you’ve been the person who had, who’s had their diet dialed in for a while, you’re going to be doing much better than if you’d only just recently changed your diet. And I think a lot of the time guys are looking for an instant result, being like, okay, well, I stopped eating junk food a week ago, and now I should feel fantastic.

So yeah, you should feel better, but this is a long term thing that you need to commit to. We don’t have the shortcuts, we don’t have the magic pill for this. We have something that, we have a model and we have a paradigm that guys need to understand how and what nutrition is. And I think that when we’re looking at nutrition, I think that a diet that is rich in bioavailable nutrients, that is low in inflammatory foods is important.

And I think the best way to look at that is going, what’s going to have the highest density of micronutrition in the most bioavailable format? In the smallest volume of of calories, because one of the issues that we have is that we’re eating too much nutrient devoid, hyper caloric foods, particularly the combinations of carbs and fats, which will override our satiety mechanisms.

So we’re over eating junk that the body is getting a bunch of dead energy from, particularly the high fructose corn syrup that’s in the United States. We don’t have that here in Europe. Um, and that’s causing a huge amount of inflammatory problems because we’re becoming overfat and undernourished. So I think the cornerstones of a good diet and nutrition is red meat.

As well as other nutrient dense animal based foods like eggs, good quality dairy if you tolerate it, and then using the rest of the plate to, you know, incorporate things like good quality organic vegetables, good quality organic fruits and ideally home prepared food that is not hyper processed and full of a bunch of emulsifiers, artificial flavors, artificial colors that we don’t really know what these things are going to do to us

long term.

Well, that’s why I’ve been so proud of you over the last couple of years and recently. Yeah, absolutely. Absolutely. listening to you preach just good old fashioned advice. I do believe you said is do what your grandmother said, correct? In other words, we should be eating nutrient dense, not caloric dense foods.

We should be aiming to achieve all of our macronutrients and micronutrients from the food that we eat. It’s very important. It’s just the good old fashioned healthy eating. You notice you’ve never used the word and I haven’t used the word diet. Every diet works initially. They all fail ultimately. You know, I went to the, all of these conferences on diets in the past and, you know, spend three days listening to all the various diets, which are usually just repackaged versions of a diet that occurred many years before, but ultimately, at the end of the conference, it really came down to what you just said, I could have just spent 10 minutes at the conference instead of three full days and that the best diet is that is, is a really adequate nutrition and it’s, um, A higher protein, lower type carb diet.

I didn’t say no carb diet. I said, lower carb, that higher lean protein type diet. So everything that you just described,

I think for people who are looking for a framework and exactly what Keith said, I think that what a lot of people would call low carb dieting is more like an appropriate amount of carbs because people will say, oh, you should, you should eat a low carb diet and say, well, how many carbs are we talking?

And they’ll go off. 100 to 150. And I’m sitting here being like, that’s not a low carb diet. That’s probably appropriate for most people’s activity levels. And then to be able to get a good amount of, uh, micronutrient dense fats, which contains, you know, vitamin A, E, D, K and cholesterol into the diet as well.

We have to have room to be able to get those fats in which are higher in calories than the carbs. So it’s exactly what Keith said. We want to have a higher protein diet. We want to have and focusing on when we are getting them. Okay. from energy, carbs and fats, that they are micronutrient dense. And I think that if people are looking for a framework for this, I think Mark Sisson’s primal blueprint is a pretty good place to, for people to check out.

I think that’s a good approach.

So, you know, I’m in, try to go on diets and they’ll get on these binge diets because they want to increase their testosterone levels. Now, when we look at weight loss and increasing testosterone levels, we can look at the European male aging studies and see that losing about 10 percent of your body weight.

We’ll increase your testosterone by about 85 nanograms per deciliter. And losing about 15 percent of your weight will raise levels about deciliter in some men. You know, of course it does this by decreasing the estradiol produced by the adipose tissue, which has a negative feedback on testosterone production in men not on testosterone.

But I think it needs to really be pointed out that it takes a sustained degree. and a large degree of sustained weight loss to really elevate T levels that are enough to be of any clinical significance. So I think men may be able to raise their baseline testosterone levels of some degree. But the real question, are they able to raise their levels enough to make a clinic, clinically significant impact on their health and resolve their symptoms?

Remember, we’ll say this Once we’ll say it again, raising testosterone a little bit results in a little if no clinical benefit. So that’s and I’ve heard Dave mentioned that raising testosterone with supplements, for instance, may work in the short term, but it won’t work in the long term because when you increase your production.

You will then have a negative feedback on your own production, correct, Dave?

I think that you have so many good soundbites that can just be clipped out that explain things so well. Like previously, you’ve done great ones with Jay on Estradiol, and that is something that me and my friend Ali Gilbert talk about all the time, is the importance of being lean and dropping excess body fat for the sake of health.

I didn’t come from a bodybuilding, health and fitness background, but I do come from Australia and Australia is very big on you want to have abs at the beach for summer, but winter doesn’t really matter. No one’s going to see that and one of the things that guys really need to get out of their heads is that being lean is really important for your hormone production.

Men are supposed to be much leaner than they think they need to be. And what guys think is Too shredded or unhealthy. I mean, if we’re talking about guys getting on stage at the Olympia, it’s like, that’s a different story. But when we’re talking about lean, you know, Brad Pitt in flight, uh, in fight club, this kind of like appearance where you’ve got visible muscle definition and you are sub 15 percent body fat.

And I think even close to the 10 percent body fat is actually healthy for bed is this is something that we see systemic benefits in reducing chronic inflammation from the body, not being over fat. And when the body has too much excessive inflammation from excessive fat, it’s no wonder that we get this negative downstream effect on endocrine function because the body starts to metabolize hormones very differently.

And then if we’re in a situation where we’re putting exogenous testosterone in, then it’s like we’re putting a sports car engine into not a sports car, and we’re wondering why we’re getting side effects. And it’s because one of the most important foundational points Is the outcome of diet and nutrition, which is a lean, healthy body.

And it’s not for the sake of vanity. It’s not for the sake of narcissism. It’s not for the sake of looking good with your shirt off. It’s that if you actually want to be feeling your best physically and mentally, you have to be lean. And if I sat here and I’m sure you would be the same and everyone else working in this field would be the same.

If I took a hundred of my clients and put them in order from who feels the best to who feels the worst, just general day to day. And who’s got the best overall blood work from best to worst. We would be looking at in general, leanest to fattest.

That is correct. Couldn’t have been better said there, Dave.

So we all know that nutrition is one of the pillars of our health. So you have to have nutrition, adequate nutrition for testosterone to work. adequately in you. So the next is exercise. So Dave, give us your opinion on exercise and what type and how much?

More, more, uh, more, more is, more is, more is important.

I have met so many people who are worried about over training and I have met so few people who have actually over trained. The vast majority of people who I work with are training in a way that they’re trying to make a change. So they’re off track and they’re wanting to make a change, but they’re training with the load and intensity required to maintain.

So if you’re in a situation where you’re off track and you’re wanting to, you know, drastically drop body weight or build muscle mass, because not only is dropping body fat important, but actually having lean muscle tissue is extremely important. Generally people need to do about double the amount of what they think they need to do.

So. I’m a big advocate of of both cardio and resistance training. I think that there are huge mental benefits from doing cardio and activating the body’s natural endocannabinoid system, the endorphin system, as well as just improving cardiovascular health for health outcomes, um, as well as modulating blood pressure.

The amount of guys who I see who have hypertension because they just have poor cardiovascular fitness is through the roof. And I often say that one of the first front line interventions we should be making for hypertension is getting a cardio machine at home rather than going straight for the blood pressure medications.

We need to do more cardio. And if there’s a barrier to doing it, putting it in your living room will often increase compliance. So cardio is important. Lifting weights is important. And I’m a big fan of martial arts for the sake of learning skills and getting outside your comfort zone and doing something acutely difficult for the sake of.

Doing something acutely difficult in a life that is often too laden with the path of least resistance by default. But I’m a big fan of daily exercise and I think that mobility work is a great way to do it. And one thing that I’m a fan of is, you know, if you’re going into the gym and lifting super heavy weights and you’re taxing your nervous system and you know, you’re lifting really heavy, you need to find ways to be able to do more volume of movement.

throughout the day. So that might be adding in more walks or adding in some light cardio or adding in a 30 to 45 minute mobility session a few times a week. But so many guys have reduced their daily movement from working at home and you know, not just having the dawdling around the office and walking to get lunch and walking to get a coffee and staying inside the house.

And not realizing that we need to actually now make more of a conscious effort to get up and move. So I like daily cardio. I personally lift weights every day, but I do it in a way that I can recover from it. So I don’t lift super heavy anymore. And I program my split around that. But I think that humans are made to move every day and we thrive moving every day.

We always have. In my experience, I don’t know about yourself, but I’m sure it would be very similar. I see more guys with injuries from working office jobs than I do from working in trade and

construction. I would agree. Well, I follow more of a metabolic conditioning type of program myself, which is similar to evidently what you do.

You know, and I think there’s this big push recently. You’ll see people pushing. Well, you just need to lift weights. You don’t need to do cardio and nothing could be further from the truth. We need cardiovascular fitness for overall health. Everything that you just described. I mean, yes, we do need to have a component of resistance training to increase our lean muscle mass because 70 percent of our bodies insulin sensitivity.

Is accounted for by muscle tissue. So, you know, I think there’s a difference also. I’ve not heard you use the word exercise, but I continually hear you use the word train. There’s a difference between exercising and training. And so training is, um, we’re looking at an end result. We have an end goal. People are more motivated when they have an end goal in sight.

When you people that say people that just exercise every day, I exercise for one or two hours every day. And then you really look at. Are they really exercising? And you’d be surprised that, you know, we always say their perception is their reality. And I’ve heard you talk about this before. A lot of people don’t know how to eat.

healthy, but they also don’t know how to truly train or exercise properly to get the benefits from the exercisers. There was nothing more frustrating than me when I used to go to the local gyms and see that person that came into the same workout every day was on the treadmill or whatever they were on.

And over a period of year two and three, they looked the same. There was no change. In body composition, there was no visible evidence of the effort that they were putting in. So I think it’s important that just like you explained that men need to understand nutrition. It’s just, you know, it’s not so simple.

You need someone like yourself to explain to them how to eat healthy and nutritiously, but also how to train. How to train properly and when you’re training for mixed martial arts, which you did, which I did, I was a wrestler, you know, where, yes, we’re working out. We’re strong, but we’re not training just for mirror muscles.

We’re training for overall fitness and, uh, you know, we always say, and, uh, you know, when you’re wrestling or, you know, you leave it on the mat, you go in there and you give it all when you work out, but you probably as well as I, when you’re in the MMA training, you’re training for the fight. It doesn’t matter how much you can bench press.

You better be able to have both aerobic and anaerobic capabilities, or you’re not going to last very long. So, what say you on that, Dave?

That’s why, that’s why I got into doing more cardio, because I started to get into doing Muay Thai, and I was like, I, I, I’m big and, big and strong. I mean, I was 120 kilos and powerlifting, but I couldn’t get through five rounds to save my life.

I, I was, I was gasping for air in the corner. Um, so cardio is absolutely key, and I think that what’s the most important thing for guys to understand, and I would say it’s the same for mobility as well, is that if you hate doing cardio and cardio is very difficult for you, that’s an indicator that you need to do more of it, not that you need to avoid it.

Um, that’s the most important thing. That’s the reason I

get from all the guys. They say, well, I’m only, I’m 10 percent body fat, Dr. Nichols, and I really look good with my shirt off. I’m like, but can you run five miles? Can you mountain bike eight miles? Can you get into the MMA ring? Can we can we spar three rounds together?

The answer would be no, they couldn’t do it at all. But they and when you get to the nuts and bolts of it, as you just said, they don’t like to do cardio. It’s not fun. It’s painful in some instances.

I think that one of the most interesting things about cardio for me is As I made a really dedicated effort to get more into cardio and to see the outcomes of it, and one thing that I’ve done a lot over the recent years is I’ve, I’ve taken beliefs that I’ve held and held them to scrutiny and tried to prove myself wrong and cardio was a big one because I wanted to see if I was probably just doing like maintenance cardio, you know, 20 minutes on the elliptical a few times a week.

I was doing it, but I got to a point where I said, you know, what happens if I go all in on this? So I hired a coach to teach me how to run properly. I wasn’t a sporty kid, so I had someone teach me how to run properly. I started doing the Muay Thai and then I started doing enough cardio to be able to progress in Muay Thai, which was a lot more than I thought I would need.

And one thing that I think is really important is that if you have poor cardiovascular fitness, your body is getting stressed out just from going up the stairs, just from walking around day to day, just from carrying yourself around and becoming more mobile and more cardiovascularly fit. It, it makes the experience of just being alive so much less taxing and that way your body kind of gets out of your way so that you can have a much better quality of life just from a subjective standpoint.

And then when we look at the importance, the importance for cardiovascular health, we know that cardiovascular disease is number one killer and And as I said before, I have so many guys who will reach for things like telmisartan or other, you know, angiotensin receptor blockers before they’ll reach for going to the gym and doing more cardio because they don’t want to do it.

And I think that one thing that a lot of guys lack is the skill and the conviction to do the work they don’t want to do, but it’s the work that they need to do. And cardio is one of those things where, particularly if you work a sedentary job, and I really enjoy just going to the gym, putting my headphones on, and just lifting weights.

I really enjoy doing that. That’s a hobby for me. But one thing that I think is crucially important that I absolutely cherish, it’s one of my favorite things about living here in Lithuania, is that every week I go to Muay Thai and my coach pushes me to the point that I almost want to vomit. Because I can’t push myself to that point.

I can, but I, I don’t, I enjoy, you know, your training in a certain way. But the other thing that I really enjoy doing as I’ve gotten better at cardio is I love, you know, doing, you know, 10 sets of 10 sets of 10 burpees in the morning, you know, a few days a week, just getting that, getting to the point where cardio starts to feel good.

And when you can get to the point that cardio feels good, it actually starts to make you feel more invigorated and alive. You actually it’s like it’s like taking a sports car for a drive. It feels great to put your foot down. So if you’re at a point where doing cardio feels awful and stressful, that’s a signal that you need to do more.

And when you overcome that, you’ll actually find that now it doesn’t feel like a chore. It’s something that you actually look

forward to. Well, David, what you’re speaking of is discipline. It takes discipline and hard work, and you’ve got to get comfortable being uncomfortable. Once you reach that state, you’re doing pretty well.

All right, Dave. So those men out there are women that have, uh, you know, doing their nutrition and they’ve got that down pad and they’re exercising on a regular basis, both cardio and weight, weightlifting, but they still have. Symptoms of testosterone deficiency or they haven’t raised their testosterone levels enough to have any meaningful impact on their symptoms So let’s talk about the present normal range and and the decline that’s occurred over the last several decades

It’s horrendous and it drops every year doesn’t it?

We’ve just had another drop in Australia where the whether the top and the bottom of the range have moved down by about another 10 Or 15 percent across the board And it’s been every year since, and what we’re looking at is we’re looking at the average sick person who’s getting their testosterone level checked.

And now we’re at the point where even if you’re in the middle of the range, you could absolutely be hypergonadal. And the other thing that I think is important is that when we look at, you know, generally when women get their hormones checked, the reference range is adjusted based on when they are in their menstrual cycle, as well as if they’re menopausal or they’re not menopausal.

For men, it’s not adjusted by age. We’re using the same reference range for a 20 year old as we are for an 80 year old. And a doctor is looking at it and going, oh, well, you’re in the range. And then I think that’s one of the most damaging things that’s happening, particularly to younger men, is that they’re going to the doctor with symptoms of low testosterone.

The doctor’s running their lab work and they’re smack bang in the middle of the range. They’ve clearly got nothing wrong and they’re put on a necessary for their symptoms and everything gets a whole ton worse. And it’s because that reference range just means that they’re just as sick as everyone else.

That is correct. Well, let’s talk about when that was first recognized. So it was really in 2007 when Travis and published his study on the population level decline in serum testosterone levels in American men. What he looked at was testosterone levels in men born between 1915 and 1945. And over a 17 year period of time, he did collect three sets of data.

The first was in 87 to 89, the second 95 to 97, and then the third was 2002 to 2004. Now What he found was that the age match decline was 1. 2 percent per year in these men. So what that means is that a 60 year old man in 2004 had a testosterone level about 19 to 20 percent lower than a 60 year old man in 1988.

And this decline was independent of aging and was adjusted for health and lifestyle factors like smoking and obesity. I think it’s important to understand that it’s not just American men. There have been other studies published on Danish men and In 2007, I think, Finnish men in 2013, and then Israeli men in 2020, and we all see this same trend.

Men are producing less testosterone than previous generations. It’s not that they need less, but they are producing less. And our normal range comes from these men that are producing less testosterone than ever. So, the normal range Back before July of 2017 was 348 nanograms per deciliter to 1197 nanograms per deciliter.

Now, that was based on the Framingham heart study, but in July of 2017, it was changed. to 264 nanograms per deciliter to 916. Now, this new range was based on, uh, four studies being done in the United States and Europe, and it was men with a BMI less than 30 who were not tested for symptoms of low testosterone levels.

All right? But what is most amazing to me about that, the new normal range, Is that in June, let’s say, or in May of 2017, if you had a testosterone level of 1, 100, that was healthy, that was normal, everybody thought that was okay, the family doctors didn’t blink an eye. Then after July of 2017, when it was changed, Since the new normal range went up to 916, now all of a sudden, 1100 is so called super physiologic, therefore harmful and abusive.

It makes no sense, Dave. It makes no sense at all. Would you like to comment on that?

You’re right. It makes absolutely no sense. And at the same time, what does make sense about it is when you look out at the average man these days and see how much they’re sick and suffering, that part, as a reflection of society, I mean, it makes crystal clear that we’ve got a huge problem.

I primarily work with guys who are probably between 25 and 35. And one thing that I have found very interesting is that If I take a guy who’s let’s say 25 years old and he’s doing everything right, like eating right, sleeping right, moving right, everything perfectly. He generally has about the same testosterone level as a 65 year old who is not looking after himself.

That is great. That, that, that is great. It tends to, yeah, exactly. And, and. That I think is, is shaping and forming these guys in terms of not only that their physiology, but also their identity, but it’s also very much damaging their trajectory of life because now they don’t have this sense of bravery and courage and wanting to take a swing at life and, you know, wanting to be fearless young men, they’re wanting to be passive and avoidant and retreat inside.

And I would, you made a great comment before about how Testosterone levels are going down and it’s not because we need less testosterone. I mean, that’s completely ridiculous. And one thing that I know that you’ve spoken about before is, I think the argument could even be made that we need more testosterone now because of all the endocrine disrupting chemicals that we’re battling with.

We will talk about that. Absolutely. Thank you for bringing it up.

And

I think that that’s, that’s something that guys really need to understand is that I, I, I say very simply that testosterone replacement therapy. But 9 times out of 10 will be above the reference range because that’s the level that you actually need to be a healthy, thriving man.

I would agree with you. We’re going to get to talk about that as well. So Dave, there’s not a day goes by that you don’t see or I don’t see somebody right out there. These are my testosterone levels. Do I need testosterone? Let’s make it real clear to men out there that having a normal level does not mean that you do not have a testosterone deficiency.

And in fact, the guidelines on how we diagnose and treat testosterone is not based on the actual medical literature. Okay? There is no specific testosterone level that denotes a deficiency. Meaning that there’s no specific number like 264 or 300 for instance. Where you can say that every man below that number needs testosterone, and everyone above it does not.

That is not what the medical literature actually tells us. They’ve all gone on record to say this, and I’ll say it for the first time here. The new normal is to be deficient, in my opinion. The due normal So, you know, there was an interesting study that I’ve talked about on a couple of occasions done in 2004, and this is to help me and understand that each man has his own normal level.

So, what they looked at, you know, the development of testosterone deficiency symptoms at different serum testosterone levels in men. Now, what they did in this study is they inserted pellets in the men, and they would raise their testosterone levels. And then as the pellets dissolved, the testosterone levels, of course, go down and they would have them fill out symptom questionnaires as the testosterone levels declined.

Now, what they found out was that the return of testosterone deficiency symptoms were highly reproducible within individuals, indicating that each person had a very consistent level where he became symptomatic. But it also showed that this level varied markedly between men. So, there’s actually a great deal of inter individual variability with regard to what level a man will become symptomatic.

Some men are very symptomatic with below a level of 350, even 500 sometimes. Other men are perfectly fine. So, just having your, uh, a number on a piece of paper does not mean you do not have symptoms of a deficiency. Uh, you know, people need to understand why do we do this in medicine. Why do we hang our hat on a number?

It just makes it efficient, Dave. It doesn’t take long for a doctor to look at a lab and make a decision. It takes literally seconds versus sitting down and discussing potential causes of this man’s erectile dysfunction or poor libido, etc. What I think is interesting that people don’t talk about enough is that prior to the 1970s, before we had actual labs to test testosterone and thyroid, for instance, that testosterone and thyroid prescribed and dosed based on clinical presentation and their response.

Okay, medicine was patient centric at that time, not lab centric. We literally are giving men thyroid and women thyroid. We’re giving men testosterone for decades without any lab studies. And yet no harm was caused. No harm was caused at all. We can talk about it further. And in every one of those studies.

We’re raising men’s testosterone with no labs. They’re raising their estradiol as well, Dave. You realize that? So, uh, so look, so there is no specific level that denotes a deficiency. None at all. Every man has his own normal. That’s something very important to understand. And also people always want to quote the guidelines.

They, most people never read through the guidelines and, uh, and we can talk about the specifics of the guidelines. We talk about testosterone itself. But these, this is the disclaimer at the end of the Endocrine Society Guidelines. Have you ever read that disclaimer? Most people would never get to the end.

It’s in the fine print. But it states that the Endocrine Society’s clinical practice guidelines are developed to be of assistance to endocrinologists by providing guidance and recommendations for particular areas of practice. The guidelines should not be considered inclusive of all proper approaches or methods or inclusive of others.

The guidelines cannot guarantee any specific outcome. Nor do they establish a standard of care. The guidelines are not intended to dictate the treatment of a particular patient. Treatment decisions must be made based on the independent judgment of health care providers and each patient’s individual circumstances.

The Endocrine Society makes no warranty express or implied regarding the guidelines and specifically excludes any warranties of merchantability and fitness for particular use or purpose. They are not liable for direct, indirect, special, incidental, or consequential damages related to the use of the information contained within.

So, in other words, the guidelines are used to dictate care to physicians. But they should not be.

I love this topic so much. I’m so, and I love that you, you have been banging this drum since I first found your videos in like 2017 or 2018. This is, this is the topic that I’ve heard other people speak about, but not to the same degree that you’ve spoken about it in terms of Champion championing this perspective because it’s such an important perspective and the thing I made a video about this a couple of days ago in a similar vein where I said that if a man is not doing well and he’s at the point where he needs an intervention.

So we’ve already gone through the diet, exercise, lifestyle, etc. If he’s at a point in his physical and mental health that he needs an intervention and his testosterone is not optimal, it’s somewhere within the normal range. I think if we look at all the tools that we have in medicine, I mean, what do we have?

We’ve got pharmaceutical stimulants, we’ve got antidepressants, we’ve got antipsychotics, we’ve got all these different pharmaceutical drugs, or we’ve got bioidentical testosterone and potentially things like thyroid, pregnenolone, DHEA, vitamin D, melatonin, etc. I think that not only is the testosterone optimization a far better outcome for him just subjectively in terms of quality of life, but we’re going to be giving him side benefits, not side effects.

And this is something that’s so important is that if we’ve got a guy who’s, you know, if we’re using the, the units, you know, here in terms of the standard American units, if we’ve got a guy who’s got a testosterone of 400 or 500 and he’s not doing well, he may not meet whatever the criteria is for medically diagnosed hypogonadism based on whoever wrote that rule book.

But who is to say that he would not be doing significantly better with double or triple the testosterone levels that he has at baseline, because that could be the point that he should have been at if it wasn’t for the prolonged exposure to endocrine disrupting chemicals in the environment. And I know that you’ve spoken before at length about antigen resistance, and this is something that we can’t test for.

We can’t run a blood test to see, Oh, what’s your antigen receptor sensitivity? What’s your receptor availability? We can’t look at that. But what we can look at is This guy is not doing well, this guy has got symptoms, and this, this guy is, he’s, he’s going to, he doesn’t get to trade in his body and get a new one, he’s, he’s in this body for the rest of his life, and the quo, if, and if he needs an intervention, if he’s not going to use the testosterone, he’s probably going to reach for the SSRI or something worse, that’s not only going to make his symptoms far worse, but it’s going to cause more side effects and not solve the problem, and could also lead to a whole lot of problems.

deleterious health outcomes. We know that the monamine hypothesis of depression is bunk. It has been disproven for a very long time. But what we also know is that what testosterone does to the brain and the body is more of an antidepressant and pro life compound than basically anything else we have.

And it’s already part of your operating system. It’s working with you, not on you. And I think that when we have this amazing, powerful intervention that Gives guys. I mean, you’ve seen this phenomenally that the quality of life and the changes that you get. I mean, I get guys come back to me after three months or six months and They’re ecstatic, and they’re borderline unrecognizable in terms of how they’ve changed.

And you actually get to work with guys who get better. And then they, and the best part is not only do they get better, but you don’t have to keep seeing them every few weeks because they’re sick and struggling. You see them every 6 to 12 months to check in on them because they’re out there doing well and loving their life and enjoying their life.

And to deprive them of this treatment because someone drew a line in the sand and said anything below here is, is, is hypergonadal and anything above it is not. I, I think is, is, is a huge injustice to, to

people all over the world. I would agree. And so to summarize really what you said, you said anyone should be given a trial of testosterone therapy who has continued symptoms of a deficiency despite making every effort to raise levels with nutrition and exercise or the ways that naturally, you know, in my opinion, Davis should be frontline treatment for medical conditions like obesity and type two diabetes.

Let’s talk about what you just mentioned, what testosterone does. It increases lean muscle mass, strength, endurance, exercise tolerance, and bone mineral density. It decreases recovery time and improves healing. It decreases both visceral and subcutaneous body fat. It improves cholesterol. It increases energy, motivation, and self confidence.

It improves libido and sexual function. It improves memory and cognition. It improves mood and depression. It helps protect against cardiovascular disease, diabetes, and insulin resistance. It improves one’s overall sense of well being. Now, Dave, what other drug That doctor’s prescribed does all of that.

Name one drug. There’s not a single drug that does all of that. And as you alluded to, I tell men all the time, I can’t tweeze out the performance enhancement characteristics of testosterone from the beneficial effects with regard to your symptoms of low testosterone. They’re tied together, which is a good thing.

So when I’m raising levels to treat a man’s low libido or erectile dysfunction or fatigues, he’s also going to be able to increase his lean muscle mass, strength, endurance, and exercise tolerance. It’s, it’s just a wonderful hormone that no other drug, uh, has any effects like it does. Wouldn’t you agree, Dave?

Completely. I mean, there is absolutely nothing else that comes close to what testosterone can do. And. Everything else that does a small part of what testosterone does, or claims that it does, which in practice it actually probably doesn’t, also comes with a suite of side effects because One thing that I think doesn’t work well with the human body when you put these pharmaceuticals in is you try to push the body in a certain direction, but then it will work around you in other ways, or you’ll also cause unintended consequences because of how these pharmaceutical drugs interact with a bunch of different systems in the body.

I don’t think a lot of these pharmaceutical drugs are even well studied enough to be used in the way that they’re using, because we don’t have the long term studies that we have on them like we do have studies on things like thyroid. Testosterone or even things like metformin, which have been around for the best part of a century.

We don’t have enough data on so many of these drugs that people are taking. And one thing that we see in practice a lot is people come in who’ve been damaged from these medications that they’ve taken, and we don’t really know how to fix them. And it’s, it’s devastating for guys to come in to realize that maybe they should have taken testosterone all along, but One thing that I’ve seen that makes a huge difference is that when you optimize a man’s testosterone levels and he does everything right, you know, does everything he knows he should be doing and stops doing everything he knows he shouldn’t be doing.

It’s often that simple. And does that consistently over years? the epigenetic change that he experiences, he metamorphosis into a completely different version of himself. And that man is often someone who is much more robust and resilient, both mentally and physically. And one of the things I love about what testosterone does is that I got into hormones after dropping out of psychiatry because I was looking for the pill that did all this.

And then I was like, hang on. Testosterone does what we’re looking for from the best combination of all the psychiatric medications that don’t really work, but they’re a bit kind of these dirty drugs. And one thing that testosterone does is it increases your, your body’s dopamine transmission. So it means that you can make more dopamine and you can tolerate more dopamine, but it doesn’t give it to you for free.

So it means that the things that should feel good now feel better. But the other thing that it does as well is it antagonizes a lot of the effects of stress. So as you said, with exercise tolerance, I think a lot of guys who have low testosterone become overwhelmed by stress and anxiety because Their adrenal systems are often working in overdrive to compensate for the low energy testosterone environment.

And what they’re experiencing is that when they go to the gym or when they go into an uncomfortable situation, or they go into something that takes risks, it doesn’t feel good enough to overcome the thing that they need to overcome. They become avoidant and passive and they retreat and then they end up.

Being hard on themselves or seeing themselves as someone who’s wasting their potential and then that over a lifetime can lead to circumstances that are Horribly deleterious to his mental and physical health. So testosterone empowers men as a foundation to be able to Become the man that they actually want to be when they put the work in into you know Doing everything they should be doing on top of their treatment, but it gives them a chance And that’s the thing that I think is so important is that so many of these guys who have been bombarded with endocrine disrupting chemicals and they haven’t been taught how to eat well and move well, I mean, it’s, they don’t even have a fighting

chance.

Yeah, so brilliant. You said Dave. So let me address a few of the things that you that you pointed out. So sure, you know, they I tell everyone I have the easy job, you know, I can optimize your testosterone levels and other hormones. You have the hard job. You have to put in the sweat equity and that’s really what makes it work.

So that’s one thing. Number two, you’ll see many patients as do you that will be on a litany of drugs and not think a thing about it. But then have a fear of testosterone that’s not based on any medical data. You know, testosterone is characterized by an extremely high therapeutic safety. In fact, testosterone is the only hormone without a well defined, spontaneously occurring syndrome of hormone excess in men.

Now, we do see side effects, but I don’t see any adverse effects in men. None. Every year, tens of thousands of people die from taking medications like non steroidal anti inflammatory medications for their, you know, inflammation or their sports injuries. Tens of thousands per year, but yet nobody died from testosterone last year, but yet there’s still a fear of it.

Every week, I get an article or two sent to me from patients and other providers about what seems to be a mission now. To make sure that men do not get testosterone, that it’s harmful and dangerous despite 85 years of use showing no harm or danger. There’s a big push against men getting testosterone.

And I think that I’m fearful of that push and how it’s occurring in mainstream medicine. But we but we see it all the time. So with that said, you know, we do have side effects that you’ll get with, with testosterone that usually are easily treated, mitigated in the most common side effects that we see Dave are going to be what hair loss, acne, fluid retention, testicular atrophy, infertility, and, you know, and a secondary erythrocytosis.

But of course, the big fear that men have is gynecomastia. Now, from a clinical standpoint, glycocapacity is really uncommon, David, with testosterone therapy. I’ve seen two cases in the last 10 to 12 years. If you don’t have the genetic predisposition, you’re not going to get it. So most of these men are fearing a disorder.

that they’re not going to get and that drives them to unfortunately utilize AIs and things that we’ll talk about in a little while that are deleterious to their health. I just find that testosterone is a simple balancing act between raising levels to improve symptoms and avoiding any unwanted side effects.

So a person either has an adequate amount of testosterone for clinical improvement or they have symptoms of too much or symptoms of too little. Symptoms of too much, you lower the dose. Symptoms of too little, you simply raise the dose. You know, that that’s, that’s what I see. And I’ve heard you talk about this as well as the problem with some men is when they first start testosterone, they really just don’t give their body enough time to acclimate to the new normal.

They’ll start making adjustments at the drop of a hat, and that just leads to more problems and just this chasing your tail type mentality. So you tell me what you’re seeing as far as the guys out there. When they first start testosterone and the side effects they may see.

I have never seen TRT cause gynecomastia.

I have only seen it flare gynecomastia that was already there from them being androgen deficient during development. Um, when it comes to the side effects when guys start TRT. I think that it should be looked more at how we would address the side effect of a teenager going through puberty. If a teenager comes home and says, Mom, Dad, I’ve got some acne popping up, or they kind of get a bit moody, or you know, there’s a bit of mood changes, we just go, yeah, look, it’s just part of life, it’s what you’re going through.

And when it comes to testosterone, we’re inducing a big hormonal change in the body that takes time to adjust to. And it may take a bit longer than 12 weeks to adjust to it, just like our puberty takes a bit longer than a few months too. So, I think in terms of one of the issues that guys have with starting TRT, it’s I think sometimes they can get a little bit of a central nervous system overstimulation in terms of they subjectively feel overstimulated.

And if they are predisposed to being anxious, I think a lot of those guys can perceive that as anxiety. I see it as increased energy and I say you should just go move and get it out of the body because you’re used to being in such a low energy deprived state. And now when you’ve got a bunch of energy, now you’re complaining about it.

It’s like, well, what do you want? So I think it takes time to get used to it. It’s a big change and it can be a bit of a bumpy ride. And when I started TRT, I remember my doctor said to me, he said. You might get some acne, you might feel a bit funny for the first few weeks, but if you have any side effects at our first follow up, then we’ll talk about it.

And that was one of the best things he could have said to me because I just disregarded anything that popped up over the first 12 weeks as an adjustment phase. But now when guys, that’s exactly what I did. Yeah.

Yeah. Yep. Now in the first two weeks, three weeks, They’re just, you know, going to change something.

You’ve got to give your body time to acclimate. You know, if we, I’ve, I’ve said this before, that if you and I could go to deserted island, you and I could just naturally raise our testosterone. We had the best food, the best drink, you know, just living the best life. And we could naturally raise our testosterone levels.

That would occur over a period of many months to years. When we give testosterone, it goes up overnight, literally goes up overnight, and your body just does not have time to acclimate like it would if you could naturally do it on your own, which we can’t. So the guys just need to, you know, I hate to use the word weather the storm, but if they would just, you know, hold tight, most of these side effects that they see would improve with time.

And usually all of them, it goes away in every man. Every man, um, you know, with regard to what you’re talking about there. So let’s talk about, you know, men will talk about why some respond and others don’t. Uh, you know, I’ll say this, testosterone works in everyone, male or female. From a physiology standpoint, it does what it does.

It works in everyone. But you’ll find that men will say that it doesn’t work. And I find that there’s, there’s two, three, three main reasons. And I’ve heard you talk about these. Let’s talk about them now. The first being unrealistic expectations. Let’s talk about that, Dave. I find that men, That have the most difficulty with testosterone are those with very specific expectations on how it should make them feel and function.

And if it doesn’t live up to that, then it somehow doesn’t work. You know, it only improves symptoms related to the deficiency. I’ve heard you say those same statements. You know, there are symptoms we want testosterone to improve. And then there are symptoms that testosterone is going to improve, and they’re not always the same.

Some men have a difficult time accepting that all of their symptoms are not going to improve with testosterone. So many factors go into how we feel and function every day besides testosterone. And even with great testosterone levels, everybody’s still going to have good and bad days and good and bad weeks.

It’s not a panacea. And I know you agree with all of those

statements. I actually quoted you on a podcast earlier today where, and this was from a video you did a while ago, saying that If we optimize testosterone up past a certain point and you’re still not feeling good, the problem isn’t testosterone, it’s something else.

And that’s very common because a lot of the time guys with low testosterone levels have other problems. If you, if, if you were someone who was living the best life ever, And then you got a horrible testicular accident, and then we put the TRT in a few weeks later, then yeah, you’d probably just need the TRT.

But a lot of the time guys are pretty far off track as a consequence of being low testosterone for a long time, or Their low testosterone is a consequence of being off track for a long time. I think testosterone gives you the results of the work that you do. It gives you the results of you, that you deserve, but it doesn’t give you any more than that.

I think guys expect to wake up once they’ve got their optimal testosterone levels and their blood work completely jacked and masculine and all these different things that they’re wanting to achieve from whoever they look up to. And what they don’t understand is that those guys have done a whole bunch of work that they haven’t done.

And I think to have expectations that you deserve to have the results from work that you didn’t do, that’s called entitlement. And this can be a very difficult thing to break with guys, because a lot of the time they are sold this in the sales pitch from their windmill TRT clinic that gives them their TRT and the HTG.

Um, so I understand how they can get there and one thing I also understand from from a compassionate standpoint is that if someone isn’t into health and fitness or isn’t into science and they went, well, I felt terrible and then I took some testosterone and now I feel okay, so that should mean that if I take more testosterone, it should make me feel fantastic.

I get that logic. I get how guys can look at that. A lot of the time in life, the thing that took you from bad to good is not the same thing that’s going to take you from good to great in, in, in all things.

We’re going to circle, circle back to that. That’s a great point. We’ll circle back to that a little while later.

And I think it’s, it’s a really important conversation for guys to have to understand that this is a healing process. and healing takes time and it takes work and it’s not an overnight thing. But I think if we can measure our progress and how far we’ve come rather than how far we are away from our goal, then that’s when we can actually have the awareness of going, Oh, I actually am doing better.

And I say, look, if we get to our first follow up at, you know, 12 weeks and you’re feeling 10 percent better than you felt before you started, That’s a win.

Right. Well, you know, I think that it is oversold by many testosterone clinics and they’re told that you’re supposed to feel great all the time. No, you’re not.

That’s not what it does. Remember, we’re supposed to be using it to improve symptoms of deficiency. And some of those men like myself, yourself, and we had those, we did, we felt terrible. But when we got their testosterone back, we felt much better. Yeah, we’ll use the word, Hey, I was great compared to what I was.

But, you know, you’re not going to feel great all the time. It’s not normal to be happy all the time, sad all the time, feel great all the time. It doesn’t do that. It will improve the symptoms of the deficiency. That’s what it does. And that’s all that it does. All right. Once again, though, I can’t take out the performance enhancement characteristics.

They’re going to come in there with it. So yes, it’s going to do all those things, but we’re talking about treating the symptoms that you’re having of low testosterone. There’s not a year that doesn’t go by that I don’t get a phone call or two from a patient. And I, you know, I’ll say before I tell you the story is that low testosterone hormones, hormones in general will not overcome life.

They will not. So once or twice a year, I’ll get a call from a gentleman, Dr. Nichols. I feel worse than I did before I started. It’s not working anymore. Just doesn’t work. Uh, something’s wrong. Please do my lab work. Get my labs. Okay. Okay, Bill. I’ll be glad to get your labs and we’ll meet up. So we’ll get their labs.

And 100 percent of the time, this is what has occurred. I used to talk to the men first. And then I found that I just couldn’t get them to open up quite as much as when I did the lab work first. So I’ll do the lab work first. And it’s been 100 percent of the time in this, these men that I’ll call Bill up and say, Bill, got your lab work back and your levels are the same, if not better, Bill, than they were when you felt great.

I mean, when your levels were just this level, in fact, your levels are better than they were when you felt just the best you could ever feel. You didn’t have any symptoms at all. So now, why don’t you tell me what actually is going on? And these are the stories that I’ve gotten. Doc, my wife had an affair.

Doc, I’m getting a divorce. Doc, I lost my job. Doc, I’m working two or three jobs to try to make ends meet. We’re having some financial difficulty. Doc, one of our children is on drugs and had to go into rehab. Doc, my wife’s, a mother moved in, a mother in law moved in, and she has Alzheimer’s. There’s always a significant stressor.

And stress is the great equalizer. It doesn’t matter how great all of your hormones are. It doesn’t matter even if you’re exercising and eating right. You’re not gonna feel good. under significant stress. Dave,

I couldn’t agree more. I’m very big on the stress factor because before I did this, I used to teach mindfulness meditation and this is, you know, one of one of the things that we would look at is the Outcomes of chronic stress.

I mean, humans are meant to go through periods of stress. Life has always been hard, but what we want ideally is short bouts of acute stress that we can recover from and disconnect from, and you’re completely correct is that a lot of the time when guys have got something going on and everything else is dialed in on their blood work, it’s some form of stress, and sometimes it can even be perceived stress.

It could be programming in terms of guys lack the resiliency that they need to actually deal with the fact that Life is objectively difficult, and sometimes it’s more difficult than other times. And sometimes, you know, certain guys will get dealt a rougher hand than others, and you’ve just got to play the ball where it lands.

And a lot of the time, you know, when I’m working with my guys, I’ll, I’ll hear them, and I’ll, I’ll honor what they’re going through, and I’ll, I’ll give them props for, you know, getting as far as what they’ve gotten. But you’ve still got to play the ball where it lands. It’s life. We’ve all, we’ve all got that stuff to

deal with.

But they want that easy, they want that easy button, Dave. And what you’re telling them is that life can be hard, and you’ve got to deal with it. And, uh, and then unfortunately, there’s thousands, if not tens of thousands of men right now on forums around this country on social media, trying to find a way to tweak their hormones to address something that is not hormone related.

It’s not a stereo equalizer. You can’t, you know, when you get into the hard times, you can’t tweak these hormones to, to overcome that hard time. You’ve got to deal with it. It’s your norm. No amount of hormone is going to overcome stress. No amount at all. So we discussed the importance of, you know, unrealistic expectations and stress.

So. The other, Dave, is, and I couldn’t thank you enough for you sending this message out there. Alright? The other reason that maybe men don’t respond like they think they should is they did not get enough testosterone to exert a response, or they didn’t give it enough time to work. Thank you, from the bottom of my heart, for telling men out there, Dave, it’s a months and years long process, not days or weeks.

The number one reason that men and women discontinue their hormone therapy around the world is because they didn’t get the results they expected in the time frame they wanted. They expect a lot of results in a time, in a short time frame, and it doesn’t work that way. It takes time. So, um, you know, I can raise a person’s testosterone levels, and both of you and I can do as good as anybody, I guess, but once again, they’ve got to put in the sweat equity, and it takes time.

It’s months and years. Really, the, the physical, the sexual, the mental, those, those benefits really start coming together nicely. Within six to 12 months then improve yearly as you have also said Dave you couldn’t be more correct in that So, please explain to men that you’re not gonna feel better in days or weeks.

It’s a months and years long process

Absolutely, and thank you for saying that because I think it’s it’s one of the most important things that I’ve learned and I’m I’m seven Years into this now, so I’m coming up to my next milestone and I think that there are three milestones it’s eight weeks eight months and eight years and You’ll, you’ll notice big changes at those points.

I think that a lot of the, the needles start to move at about the six to eight month mark, but they don’t all resolve, but they all start to move. But I think that the most important thing that comes from testosterone, and this is what guys really need to understand, and you’ve been championing this for a long time, is the acute effects of testosterone are wonderful.

Great. They can get you out of a rut. They can give you a light at the tunnel. They can give you a a signal that we’re moving in the right direction and that we’ve used the right intervention. We’ve used the right tool for the job. But the main benefit that comes from testosterone replacement therapy, as well as diet and exercise and all the things we’ve spoken about, is chronic exposure.

Chronic exposure to androgens is what’s going to completely change not only your baseline mental state, and your, you know, your identity and who you are, but also it’s going to be impacting every cell in your body. Your body needs time to actually Change and evolve. I mean, puberty takes five years, and I think TRT takes even longer than that, particularly if you are hypergonadal for a long period of time.

I think it often takes much longer to get back on track than it took to get off track. And if I look at my progress with TRT, if I look at every year that’s gone by, I like to make, you know, reflections on my birthday and New Year’s every year. I know that It has huge benefits on me compounding every single year, even though I haven’t changed my dose in about six years.

My protocol has been exactly the same. And it’s an amazing thing to watch because the thing that I’ve learned more through experience, just in terms of my own journey over the last few years, is that testosterone acting as a multiplier for all the good habits that we’re doing day to day, because it makes those things work the way they should in the body and we get the results that we deserve.

But I think it’s very important for guys to understand that it’s, it’s exactly what you said. It’s a chronic exposure thing and the expectations of, I want it now, it’s not realistic and we don’t have a shortcut to give you what you want now. It simply doesn’t exist and the expectation that guys have when they go into groups is that if you take one guy and another guy and you put the same amount of testosterone into him, that’s the only thing that you guys have in common.

Is your testosterone protocol. If you’ve got two guys on 200 milligrams a week of testosterone, you have nothing else in common. So to expect that you’re going to get the same outcomes is ridiculous. And this is just a, an expectation that I understand how guys get here from looking at it from the outside in and having a simplified approach to it.

But it’s incorrect and I think it’s exactly what you said is so many people drop out of this therapy and they don’t see it through to the end because they don’t get the result fast enough. And it’s just a matter of being patient, putting one foot in front of the other and trusting in the process and I think also if, if guys can practice a degree of introspection and actually look within and go, hang on, I am doing better though, I might not be perfect, but maybe I don’t deserve to feel perfect yet because I haven’t been doing everything perfectly for a very long time.

I think that there has to be a degree of understanding with that. And I think that more and more guys are waking up to this because there are more guys who have gone through this and who are now sharing the story, which I think is great.

That’s great. Yes, it’s true. And Dave, you know what you’ll be shocked at.

I’m sure you’re not shocked. You see it like I see it. It’s amazing how you can change a person’s life. They’ll eat right, they’ll start exercise, you give them testosterone, but when you see them years later, many discontinue the course. They’ll stop eating right, they stop exercising, they may or may not stop their testosterone.

But then they wonder why they don’t feel as good. Everybody out there needs to understand. It is difficult. To to long term eat right exercise consistently and maintain your hormones. It’s difficult enough. We all want an easy button There is no easy button. There is no special peptide. That’s gonna just circumvent you having to put in that sweat equity.

All right. So what you did mention is about two men may respond differently with the same dosage. We’ll talk about the last thing kind of quickly about why some men don’t respond to others. And of course it’s going to be androgen receptor sensitivity. So men need to understand that they have different androgen receptor sensitivities, and that’s dependent on the length of what we call the CAG repeat, which is a polyglutamine stretch that usually varies in length.

from nine to 37 or so, uh, men with shorter CAG repeats are more sensitive to testosterone and men with longer repeats are less sensitive. And I think what’s important to know, getting back to these normal levels, is that men with longer CAG repeats that are not sensitive to testosterone, there’s a compensation.

They have a higher LH concentration and higher total testosterone levels when you measure them. So they’re more likely to present with symptoms of a deficiency with normal testosterone levels. And these are the men that are going to be inappropriately denied treatment by the treatment guidelines. But when we do treat these men, Men with shorter CAG repeats require a lower dose of testosterone, and men with longer repeats require higher doses of testosterone.

So look, I’m always saying that some men are very efficient at utilizing testosterone. They can make a little bit go a long way, and then some men are very inefficient. It takes a lot to go a little ways. So I’m sure you see that as well, and that’s why we adjust dosages to treat symptoms and not really.

Uh, treat to a specific level. How do you feel about that, Dave?

It’s, it’s, it’s completely what you see in practice. And I think that, you know, as I was saying before, is that, you know, when you spend long enough in the trenches doing this and listening to your patients or your clients, you end up coming to the same conclusion because it just stares you right at the face.

The using the same number as a goal or a certain range that you’re trying to get a guy into for TRT or a certain range that you only start a guy on TRT on if he falls below a certain number, it doesn’t make any sense in practice, and that that is a definition of why that is, and it’s something that we’re trying to do.

You know, I wasn’t familiar with that as a concept, but I was familiar with the observation. Absolutely. And your age is a factor in things and health is a factor in things. And but also just individual variability is a huge factor of things. I’ve seen guys who are younger who just need to go just to the top of the reference range or maybe a bit above and they’re good.

And you get guys who are older and you know, they need to go to double or triple the top of the range just to even get a response. And I think that it can be a real crying shame that sometimes practitioners will write off guys as being like, Oh, you just want more testosterone so that you can put more muscle on or this or that or blah, blah, blah.

Whereas in reality, it’s guys are not going to respond in the same way. I mean, I keep my free testosterone at 50. Because that’s the level that I needed to get the proper response to therapy. And I, I kept my free testosterone at, you know, where my first doctor, who I saw when I first got on TRT, I mean, he would keep me at the top of the reference range, which, I mean, that was, you know, double or triple where I was at before I started.

I was doing much better than I was, but it wasn’t until I found, you know, your content and a few, you know, Neil Rousier’s content. And, you know, this was, you know, way back in, you know, 2017, 2018. Where I realized that, yeah, there was, there was more on the table and finding a practitioner who would work with me in terms of taking my levels up there and then not only did I get subjectively healthier, I felt better, but all my blood parameters improved every single marker that you want to be higher, went higher and every single market that you want lower, went lower.

And they’ve stayed that way. I’ve been on, you know, 250 milligrams a week of injectable testosterone for now coming up six years. And yeah. Everything just keeps continuing to improving. I have no negative side effects and I have more side benefits than when I was at 175 milligrams a week.

Absolutely. Of course, there’s a dose response relationship, which we’ll talk about.

Alright, so let’s uh, jump into the meat of the conversation when it comes to the testosterone. Method of delivery, Dave. Your preferred methods of delivery, and how often?

I think I’m a cream guy. I’ve swapped over. I’ve uh, swapped over to the, swapped over to the cream, and the reason why It sounds, uh, it sounds very arbitrary to a lot of people, but I’m sure you’d understand is in Australia.

We don’t have the toppy clicks. We’ve got these horrible pump pack things that you can’t adjust in a 0. 25 increment. And when you pump a bit out, air goes back in and it breaks the mechanism. It should be used for soap, not TRT. So now that I’m in Europe and I’ve been able to use the 20 percent transcortal cream, I’ve moved to that approach and I personally just put it on once a day.

Uh, for the sake of, and this is something that you’ve spoken about and I know Neil Ru Zi has spoke about as well, is that testosterone activates the receptor for longer than the half-life of testosterone itself. So once per day for me has actually been perfect in terms of improving my sleep quality and giving me more benefits and energy throughout the day.

So I’ve recently, within the last month, well actually only within the last few weeks. Up to four clicks in the morning of 20 percent cream. The majority of the guys who I work with are in Australia and we use primarily testosterone cipionate compounded in MCT oil. Most of the guys who I work with will do it three times a week because it’s easier than doing it every other day because the day stays the same.

Um, and some guys get away with doing it twice a week and I think that that’s great. If, if you can feel even keel twice a week, you know, the less time you have to stab yourself, the better. And But it’s primarily injectables because of what we have access to but if we had better access to creams I would definitely be using the creams because of the increased levels of DHT and also just the better subjective response that The guys get

right.

Well, I couldn’t agree with you more Dave. You know, I, I, I use two methods of delivery here in the United States is either going to be, uh, and I recommend either daily injections or daily creams. I don’t like big peaks and troughs. I like a nice sine wave of free testosterone. That’s really what it’s all about.

But let’s make sure people out there get the point that we’re trying to make today. Look, there is no single method delivery that everybody likes. 90, 95 percent of men that are on injections are fine with it. Five or 10 percent not going to like it for whatever reason. The same will hold true for the cream.

All right. Not everybody’s going to like it, but most of the men that I have on it, like it. Just as much if not better. So look, I just find that it is hard even for me when I was injecting a day. I don’t mind injections, but daily becomes a pain. So most people are not going to inject daily. They’ll maybe do it every other day, but I don’t recommend injecting less than 3 days a week.

So it’s daily as you’ve said every other day. Or at least three days a week. The thing about the cream is it’s so easy to do daily. I timed it the other morning. It literally took 10 seconds to apply 10 seconds. It’s in a vanishing cream. It goes right in and 10 seconds. So that’s something very easy to do daily.

All right. Uh, you know, I, I do like that about it. And I think the party line is this is that you see it all the time. Dave. Oh, you’ve got to do injections to get great testosterone levels. Uh, cream doesn’t work. Nothing could be further from the truth in good hands. All right? The cream works as good, if not better in many men, for testosterone therapy than the injections do.

It’ll raise testosterone levels just as good. But look, if somebody wants to abuse testosterone, for bodybuilding purposes, you have to do injections. Some of those guys are injecting grams per week. We just can’t apply that much cream. But if you’re looking for levels, let’s just say between 1 and 2, 000, It’s just as easy to get it on cream as it is injections.

So the take home message is just this. For men that don’t want to inject, there is another method of delivery that works just as well in most men. So there are two methods of delivery that I find work very well. There are other methods of delivery. I just don’t find them as efficacious. So I think we’ve covered the, the, the cream.

And yes, and so the question comes out there, Dave, that we see it all the time, that cream actually does raise. Free testosterone levels better for any given total in the same man. So if you get a man with a, let’s say, a 1, 500 level on injections and a 1, 500 level on cream, the cream will raise levels better, free testosterone levels better than the injection.

And there’s a physiology, there’s a physiology behind that. Yes, Dave just mentioned the cream when you apply it raises serum DHT levels. DHT has five times the binding capacity to sex hormone binding globulin than testosterone does. So when you increase that serum DHT, it’s going to bind up that sex hormone binding globulin, therefore freeing up testosterone.

So that’s why it raises free testosterone levels better for any given total in the same man. So that’s, so that’s really key. All right. So now Dave, we get into how much

that’s the how long is a string question, isn’t it? Um, I have found that on average, if we look at the average guy, and I found that when it comes to injections, there’s a, the majority of guys tend to respond within a ballpark that’s similar.

And then there’s a good amount of, Uh, outliers either side. I’ve seen guys take 10 mg a day, shoot their levels to levels you can’t even measure they’re so high and I’ve seen guys taking 300 mg a week and their levels are just above the top of the range and it’s all the stuff from the pharmacy. It’s they’re all doing it right.

They’re just the outliers. But I find that when it comes to injections, if I actually did this a while ago, I averaged out all of my clients and the average I think was about 180 a week, you know, divided up more often. And for me, as I said before, you know, for the majority of my treatment and I’ll most likely be staying on cream now because it’s more available here.

But You know, 250 a week was mine, and that was probably a little bit higher than the average person, but I needed my levels to be a little bit higher than the average person to get a good response. So I, when it comes to injections for me, for the majority of my clients, I start guys on 150 milligrams a week, split up into three shots, and then we look at adjusting from there.

And generally, it’s a process of titrating up gradually in increments of 20 to 30 milligrams per week, sometimes a bit more, sometimes a bit less, depending on what we’re doing until we can find the sweet spot. And when it comes to cream anywhere between, and we’re talking about a 20 percent cream that’s, you know, a click being 0.

25 of a mil. Anywhere between two clicks to four clicks a day on average, some guys needing one and some guys needing five or six.

You’re right. So we’re using a 200 milligram per gram concentration of testosterone in the cream. I would agree. So it wasn’t really a trick question, but I’ll just tell you that for me, I’ll say that the dosage is the dosage required to resolve the symptoms of the deficiency.

You know, Most of the guidelines, including the Endocrine Society, recommend raising levels to the mid normal physiologic range, which is around 600 nanograms per deciliter. The American Urology Association recommends that clinicians use the minimal dosing necessary, Dave. They say that you should raise testosterone levels to the normal physiologic range of 450 to 600.

Now Dave, the problem that I see is that most men don’t improve to any significant degree when they aim for the mid normal range. In fact, I can present you and others with literally dozens of studies that shows testosterone doesn’t work in men. And there is a common denominator in every one of those studies.

In every one of those studies where testosterone did not work. They only raised testosterone a little bit. And if you raise testosterone levels a little bit, it either won’t work or it’ll work just a little bit. So that’s the problem that we see with the guidelines in raising testosterone levels to adjust a little bit.

I think what is also interesting, they’ve always liked to look at where the history of what we do comes from, you know, whether it be prostate cancer and testosterone or, you know, many other things. But do you realize there is no medical data That supports treating to a specific number such as the mid normal physiologic range and more importantly, there’s actually no medical evidence to support testosterone levels should be within the normal physiologic range when on testosterone therapy.

These are recommendations and purely opinions. You know, we’ve been doing this for decades because that’s the way we were taught to do it and we just really never questioned why we were doing it, but there’s no medical data to support that. So, what I have found, Dave, and I’m sure you have too, is that the most consistent benefits with testosterone have been when levels that exceeded the normal range and that the higher levels of testosterone have a greater clinical effect.

We’ve seen this in the vaccine dose response studies, remember, given 25, 50, 125, 300, 600 milligrams of testosterone. And those numbers that resulted outside the normal range in these men, they had a greater improvement in mood and cognition and libido and sexual function, as well as a greater increase in lean muscle mass and a decrease in fat mass.

So I really have to ask this question, and this is kind of new that we’re talking about this lately, and I’m sure you’re going to follow up with this and research it on your own, but is it correct, Dave, that we should be giving men a physiologic dose of testosterone that maintains their testosterone levels in the mid?

To the upper range of normal, or should we be using pharmacology, pharmacologic dosing for a physiologic effect like we use insulin and other drugs. In other words, should we be treating symptoms and adjusting doses to treat those symptoms and not focused on a specific level? I mean, we consistently see from a clinical standpoint that adjusting dosage based on symptomatic improvement and not a number results in levels outside of the normal range, which results in better clinical outcomes.

I’ll say it 100 times. Inadequate doses are ineffective, and the word supraphysiologic has been hijacked to mean harm and abuse. We talked about it earlier in our conversation that what was normal in June of 2017 became supraphysiologic. In July of 2017, I don’t find that once again, the new normal is deficient.

So when we’re treating these men, it’s, uh, you know, what it really comes down to Dave and I have, and I’m asking this question to myself, I’m asking it to you. Is that, could it possibly be that we are more sensitive and responsive to our own production of testosterone based on the complexity? of the physiologic events involved in steroidogenesis, as well as how it’s released and how it exerts its biological effects.

I mean, when we give testosterone and we bypass these complex physiologic events, does it have an effect on our response? Do we need more and higher levels when we give it exogenously than when we produce it endogenously? That’s the question that I’ve been asking because from a clinical standpoint, I see that it does require higher levels than what we would normally produce, and more specifically, I do not see men significantly respond to testosterone when I keep their levels between 450 and 700.

I absolutely couldn’t agree more. I often say that, I used to say that the therapeutic TRT range is the top of the reference range, the double the top of the range, but now it’s probably more like triple with how the range is dropping. Absolutely. Like, I only have a very small amount of outliers who get symptomatic resolution by staying within the reference range and the idea of bringing it up to those numbers would mean that we would be shutting down a man’s natural testosterone production to increase his levels by like 10 to 15%.

That’s a That doesn’t make any sense. And it’s, it’s definitely not going to actually resolve the symptoms that led him to seeking the treatment in the first place. So, absolutely. And one thing that I’ve, I’m glad you brought that up because it was something that I was speaking to a colleague about recently is that if we hypothetically took a guy who had a total testosterone of a thousand and they have the same binding proteins, so the same three, and a total testosterone of a thousand, but the first guy has got it naturally and the second guy’s on TRT, I think that the guy who has it naturally is going to be having better symptoms than the guy on TRT because I have found that the guys on TRT need to have higher symptoms, uh, serum levels, which are really just a snapshot of a proxy for overall activity.

We’re not really. That’s correct.

That is correct. That

is correct. And it’s, it’s something where. You know, when I see guys who are, who are naturally doing well, they don’t need to have the levels as high as the guys of TRT do to have the same effects when they’ve got, you know, their diet and lifestyle and all these other factors resolved.

So I, I completely agree. I think that we’re, we’re injecting something and I’m in the same camp as you. I think the cream is more of a resembling natural production than using the injectable, but I think the injectable is still a great way to go if that’s what’s available to you. And, but I completely agree.

I think that. where it’s a completely different process when we’re injecting it, you know, via an ester for circulation versus if it’s being made endogenously and circulating throughout different tissues in the body. And I think the idea that that means that we should be matching one for the other when we’re recognizing they’re completely different, it doesn’t make any sense.

So, I completely agree we need to take levels higher in serum.

It doesn’t work from a clinical standpoint to aim for the mid normal physiologic range that we would naturally produce. And we have study after study after study to show that. And once again, I need you, myself, and others to take back the word super physiologic to mean healthy and good.

Now, let’s don’t let you and I be misinterpreted here. We did not say that everybody should just keep driving their testosterone levels up and up and up and up with no end in sight. We did not say that. Dave’s already mentioned, and we’re going to talk about that now, that they’re actually is a plateau to the feel good effects of testosterone.

We’ll talk about why that occurs. And, and as David said, my free testosterone is in the fifties, Dave’s in the fifties, but men will say all day long, men out there in these forums and everywhere else, mainstream medicine, that you and I don’t need a testosterone, a free testosterone of 50. Nobody needs that.

No man needs that. Not true. And Dave and I have tried to explain we wouldn’t have needed it if we produced it ourselves. But when you take it exogenously, it just doesn’t work the same. Once again, we’re bypassing all those physiologic events that do have an effect on how we feel and function. And we need higher levels than we would naturally produce in order to get the same effect.

That is what we’re saying. So look, when it comes to the feel good effects Or symptomatic improvement of testosterone, yes, there’s a plateau. There is a point at which raising levels any further will have no effect on symptomatic improvement. And in order to know why that occurs, you really just have to understand two things, two saturation points.

The saturation point of the androgen receptor and enzyme saturation. Now, in order for testosterone and its active metabolites to exert its effects, in other words, to make us feel better, it has to bind to their receptors. And there’s a limited number of receptors available for binding. And once they’re fully saturated, then raising levels of testosterone and its active metabolites any further will have no further effect on how we feel.

It’ll just be excess. So for instance, you could raise serum DHT and estradiol to a certain point and you can measure it, but it doesn’t have any clinical effect because the receptors are fully saturated at a fairly low number, to be quite honest with you. So you know, the, the, the feel good effects do really come from estradiol predominantly, uh, and with increasing levels of.

testosterone, you’re going to increase levels of its active estradiol. And people think, well, I’ve got to block my estradiol because it’s just going to keep going to the moon. It’s just going to, as I raise my testosterone, it’s going to keep going up. It can’t, it can, it can only reach a point, a plateau.

It’ll reach a plateau. It’s called the VMAX kinetics. So once again, when it comes to the active metabolites, testosterone has to be converted in the cell to DHT or estradiol. There is a limited number of aromatase enzymes or 5 alpha reductase enzymes. And once those enzymes are fully saturated with free testosterone, you cannot raise DHT and estradiol any further.

And they have the feel good effect. So therefore, you can raise testosterone levels to the tens of thousands. Dallas Carver, in his, uh, autopsy, the bodybuilder that, that died, his level was 66, 000 of testosterone. He didn’t feel any better than you, than Dave or I do. A man with a level of 5 doesn’t feel any better than us.

He will have increasingly muscle mass because it works differently on muscle tissue, you know, the feel good effects come from the central nervous system and that’s where it comes and really there’s so much aromatase in the brain. Guys don’t understand the harm they’re doing when they’re taking aromatase inhibitor.

But nonetheless, once those receptors are fully saturated, keeping on raising testosterone, you can’t raise estradiol any further. It will have no further effect. The androgen receptors are also fully saturated. So there is a plateau to feeling good, but there isn’t a plateau that we found necessarily in medicine when it comes to increasing lean muscle mass.

Testosterone acts directly on muscle tissue. It doesn’t act through its active metabolites, estradiol or DHT. So it acts directly as testosterone. With increasing androgen levels, testosterone and anabolic steroids, there’s an upregulation of the androgen receptors. So you’re going to keep increasing lean muscle mass.

That’s why they’re so big. So we can keep increasing testosterone, increase our lean muscle mass and our strength, but we won’t feel any better. So the feel good effects have a plateau based on the receptor saturation as well as the enzyme saturation. So there’s just a plateau. So Dave and I are not saying raise your levels to 5, 10, 15, 000.

No, we’re not saying that at all. So I guess the question really comes down to Where’s that saturation point that I see from a clinical practice? I’ve heard Peter Atiyah and others, Huber and those guys, they’ll talk about a level of 700. Peter Atiyah did that the other week. If he has a guy who gets to 700, he doesn’t feel any better, he’ll take him off of testosterone.

I don’t see anybody getting better or not many getting better with 700. I may have a few. I don’t aim for a number. Dr. Nichols does not aim for a number, but when a man gets it and he feels great, everything that we can measure improves. That’s his number, whether it be 1200, 1500 or 700. Okay. So if you’re going to ask me from a clinical standpoint, at what levels do I see men improve most dramatically?

It’s going to be with a free testosterone of above 30, typically 30 to 50, 30 to 60. And that’s where I see the most clinical success. So there is a time if a man’s testosterone comes back and you start them on a dose and they really respond to it well, and their free testosterone, let’s say comes back 80 or 100.

We’ll lower the dose. That’s just excess at that point. Yes, he’ll get increase in lean muscle mass and strength and the performance enhancement characteristics, but that’s not why we’re prescribing it. So he will not feel any better with a free testosterone of 100 than he will with a free of, let’s just say, 50 or 54.

So that’s been my clinical experience. That’s been Neil Rousier’s clinical experience. And I bet that’s probably been a lot of Dave’s experience as well. So, you know, what do you think about that, Dave? I mean, you’re running at 50. If you double that, you probably already know you’re not going to feel any better.

Your receptors are fully saturated, that’s why.

Yep, and I, I wrote a book, TRT 101, and I put in the book those exact numbers, which is, we, we run the, we have different units, but when we translate them, the, the recommend, recommendation I made for free testosterone was 25 to 50 with outliers either side. And I often say that guys will often max out their, their, one thing that I think is interesting when, when guys come to me in terms of their perception of things is that they, once they get to that free testosterone of like top of the range or above the top of the range, you know, 25 to 30, they don’t realize that the difference between 30 and 50 is just as big of a difference between 10 and 30.

So it’s going, oh, but I’ve already got my free testosterone up to the top of the range. It’s like, But what if you’re only halfway there and that’s the most important thing that guys need to understand is that once you get to the top of the range, it’s not like there’s diminishing returns past that point.

The diminishing return point is later. The saturation point is much later. And there are so many guys, and this is something that. You know, like I said, you know, when I first got into your work and I became a big advocate of it as well, is that I was seeing so many guys who were leaving so much on the table and they were trying, you know, that’s what was leading them to being like, Oh, maybe I need the aromatase inhibitor.

Maybe I need to take HDG. Maybe I need to take this, that. No, you, you actually just got halfway to where you needed to go and it’s because the range is misleading. And if the range actually went up to 50, then it would actually be a much easier thing to go. Oh, okay. You’re only halfway there and we need to keep working you up.

So those numbers that you quoted are exactly what I observe in practice as well.

Yep, and I’ve been attacked for years for, for saying that for, for years, but it’s what we see clinically. It’s what, uh, you know, whenever you look at some of the studies in women done by Rebecca Glasser, uh, treating women with testosterone that have a deficiency or even treating them with, uh, breast cancer, she finds that levels four to six times the normal range work for those women with no adverse effects whatsoever.

All right. So Dave, so look, uh, you’ve given some wonderful. Advice and information today and you know, it’ll be said that just because I give you advice Doesn’t mean that I’m smarter than you It means that I’ve already made the mistakes that I want to help you to avoid I know you’ve you’ve basically said that to so many men on previous podcasts So dave as I stated at the beginning of our podcast I’ve had the opportunity to watch you involve into the one of the leading health coaches in the field So if you could get someone one piece of advice or information that you wish someone would have given you when you first started testosterone What would that advice or information be?

That’s a tough one. I wish there was content like this out when I started. I really wish there was. There was, when I started, there was, it was, there was literally nothing. And now there’s so much information that people can have access to and they can educate themselves on and I think that that is, that is amazing.

But I think that that can also be confusing as well because then the space gets very noisy and you don’t know who to listen to. And When it comes to who I think people should listen to, it’s people who are following what is evidence based because that is objectively the best thing to follow. And I think a lot of people are experimenting and using their patients as guinea pigs for things that they’ve read mechanistically or on Reddit, rather than actually what’s in the studies and what actually makes sense in clinical practice.

And as we’ve spoken about this whole podcast, and I think, you know, one of the one of the main driving messages home is for guys to really understand that the reference range is not the range that you want to be sitting in for therapeutic testosterone interventions. It really isn’t if it was, and that was what led to clinical outcomes, then that’s what we would be saying, and that’s what we would be supporting.

But it’s not and. I have encountered so many guys and I know Keith has as well and as have so many of my colleagues who will fixate on numbers and will fixate on keeping numbers within a range because they don’t want it to go higher because they think that if the range goes up to this number that one number to the right of that means that they’re going to have a heart attack and they’re going to get prostate cancer and they’re going to drop dead and everything’s going to go Become terrible.

And that couldn’t be further from the truth because the vast majority of guys, and as I’ve said in my book, and as Keith’s been saying for years and years and years now, is that in general, because of how the range has shifted, the therapeutic range for testosterone replacement therapy generally starts when you go above the reference range.

So I would look at testosterone replacement as an opportunity to break out of the sick care range. Rather than thinking that we need to put a ceiling based on what lab corp or whoever your lab provider is, has arbitrarily defined based on the average sick care patient. So, as I’ve said, one of the biggest things when guys come to me to troubleshoot, because I generally get a lot of guys who come to me who’ve been to other providers and they’re trying to work out what’s going on.

And there can be all kinds of factors that happen and, you know, I’ve made YouTube lectures about it and written books on it, but one of the simplest solutions that guys need is they just need to take their testosterone up a little bit higher or sometimes quite a bit higher. And they need to focus on actually resolving their symptoms.

And it is very rare, it would be a statistical outlier on TRT to resolve your negative symptoms while staying in the physiological, which is not a representation of human physiology at all, a physiological range.

That’s correct Dave. Well remember, men are, don’t need less testosterone than ever. They’re just producing less testosterone than ever.

It’s my opinion that they need more because of the toxic environment that we’re in. But I think we’ve discussed this and I hope people will continue to listen, will continue to evolve our, our, our conversation when it comes to why men do need. Super physiologic levels in most instances for symptom resolution.

I think that if I could go back in time and, uh, you know, and somebody give me advice that I would actually follow from day one, it would be, you know, don’t fear that super physiologic number that that’s, that’s a, that there’s no harm in that number and every parameter of health that I can measure with a man with a level of.

1500, that’s doing great now. Every parameter of health that I can measure improves in that man. And you’ll see guys on forums either write, Oh my god, you’re running super physiologic levels. You don’t know what harm you’re causing that man. Well, I will tell them this. Let’s define harm. If every parameter of health that I can measure improves with that number, what harm would I be causing?

I think the harm is if I had his levels, half of that and every parameter of his health didn’t improve. That’s more harmful, number one. But if we go back in time, it would be that I would not fear a boogeyman that does not exist, a super physiologic number. And we’ve explained that you and I are not talking about raising levels to 3, 000 4, 000.

We’re not we’ve explained that there is a plateau. Okay. And that plateau for us is when that free testosterone is 30 to 50 or so. And once we get above that, it’s not testosterone. Okay. So I wouldn’t fear the number, um, that that would be 1 thing. Number 2, I would understand that it takes time that it’s a month’s process that you’ve, you’ve got to kind of weather the storm initially.

Some men do. And that you just don’t need to knee jerk and change everything just at the slightest little hint of something not going right because usually those things will resolve. Uh, those, those were, were important to me. So it’d be the levels, it would be the, uh, giving it time to work, not, not knee jerking, and I didn’t because Neil Rousier was, was of course my, my mentor and, and who was, uh, advising my treatment.

And then number three, it would be. I would not have used an aromatase inhibitor or prescribed them because I now know the harm that I would be causing using those long term. So I think Dave and I are going to do a part two and we’re going to discuss estradiol and DHT since they’re so misunderstood.

But men out there continue to think that testosterone does all the work. Testosterone is a three headed soldier, a three headed soldier. Yes, testosterone acts directly on certain tissues, but it also has an amplification pathway where it acts through DHT. And a diversification pathway where it acts through estradiol.

Estradiol diversifies how testosterone works and the majority Uh, the feel good benefits and the beneficial effects that you get from testosterone come from its active metabolite estradiol and we’ll talk about it in our part two about how measure measuring serum levels of estradiol for instance, uh, is really useless.

It’s not reflective of what’s at the tissue level. So Dave, you know, I’d really like to for sharing with your extensive knowledge today, sharing with us all of that. I’m sure, you know, we’ll be hearing a lot from you in the near future. I’d also like to thank our viewers for, you know, watching the Tier 1 Health and Wellness podcast and be sure to subscribe as well as to follow us on Facebook and Instagram, along with following Dave.

So Dave, how can listeners get in touch with you? How can they follow you? And continue to learn from your, from your, your brilliance.

Yeah, thank you. So I’ve written two books, uh, which are ebooks available on my website, advancedfundamentalhealth. com. Uh, they’re as affordable and easy to understand as I could possibly make them for, for people to have a guide to be able to refer back to on these topics.

And I’ve also done a variety of YouTube lectures and podcasts so people can look up my name with the search term TRT and you’ll find lectures and topics on, on just about everything. And I’m on Instagram as I’m Dave Lee. I’ve got a private Facebook group on a website that people can check out as well.

And, uh, I think it’s a fantastic Keith that you’re doing this podcast. I’m very great that you’re grateful now that you’re now hosting this podcast because the amount of knowledge and information that you have is just phenomenal in this field. And I’m looking forward to, uh, tuning into the rest of the episodes that you put out.

Well, thank you, Dave. And look, I can’t, I can’t appreciate what you do. Uh, I can’t appreciate it anymore. And I really have been, uh, thoroughly impressed and I love to see the evolution. I would have loved to have watched my evolution because, you know, I mean, we all are doing things differently than we did when we started, but see, I’ve been able to watch yours and it’s been quite impressive and so I’ll congratulate you, you know, over and over again.

And I thank you for the message that you’re putting out there, because once again, we’re speaking the same language. When I listen to some of your podcasts now, I’m like. That’s exactly what I would say or what I’m thinking. And so, uh, just, uh, once again, it’s evidence based medicine and we speak that way, we all hear it, right?

So thank you again. And I look forward to doing a part two so men can understand, understand the benefits. Let’s keep using the word benefits of estradiol. And there’s probably nothing that gets under my skin more than when they want to put that AI camp and the anti AI camp. There’s no such thing.

There’s either an evidence based medicine camp or non evidence based medicine camp. And when you get into the non evidence based medicine camp, you’re going to say a lot of things that are just untrue and misleading. But when you’re in the evidence based medicine camp, well, you’re going to do things quite differently.

Both Dave and I were in a non evidence based medicine camp before, weren’t we Dave? We used aromatase, I don’t know if you did, but I did, I used aromatase inhibitors to prescribe them. All right, I did things I do things much differently now than I did 15 years ago. So welcome to the club. I mean, I think you’re just a gold star member of the evidence based medicine.

So congratulations. Once again, I look forward to part two.