“From DHEA To Melatonin: The Ultimate Guide To Hormone Therapy”

Keith Nichols MD (00:01.553)

Welcome back, Dave. Welcoming Dave back for a part two. We of course did a part one together. Recommend everyone go back and take a peek out. But as you remember, Dave is the founder of Advanced Fundamental Health. He is a holistic health coach that specializes in men’s hormone replacement therapy and testosterone replacement therapy. So welcome back, Dave. Tell me what’s been going on since we last met.

Dave Lee (00:24.362)

Well, thank you so much for having me, Keith, and thank you for having me back again. Since we last met, it hasn’t been too long, but what I’ve been working on is my third book in my series. It’s going to be called TRT 102, and it’s all the lost chapters of everything that I didn’t get to fill in for the first two books. One section that this book particularly focuses on, which I have a feeling we’re going to talk about shortly, is around the importance of looking at mental health regarding men’s health as a part of hormone optimization therapy.

And one thing that I like to look at is when we talk about TRT, meaning the second T standing for therapy is that a lot of the time the injections that someone takes or the cream that they apply or the pills that they take is not the entire, uh, gamut of the therapy that they need to receive. A lot of the time it’s exercise diet and sometimes mental health related as well. So I’m writing my third book on that. And I, uh, we’re just coming out of a very dark winter here in Lithuania. So I’m enjoying the spring sunshine that we had today too.

Keith Nichols MD (01:20.149)

Well, good. Well, good. Well, look, let’s get right into that, Dave. I had the pleasure of watching an Instagram feed you just did the other day, and I found it very prolific and it sends the right message to men. Now, look, we all know we need to get our foundation of health down. We need to, and that involves nutrition, exercise, and of course hormone optimization. That’s that for me is the trifecta of health. Of course, we need to reduce stress and get adequate sleep. But even when all that’s done, remember what we’re doing.

when we’re providing men with testosterone replacement therapy or even hormone replacement therapy for these older men and women. What we’re doing is we’re taking a set of symptoms that we feel may be related to low hormone levels and we provide them with adequate hormone levels to overcome the symptoms of the deficiency. And after we do that, whatever should be related to that hormone or hormones should improve, but it doesn’t always work that way.

As I’ve explained to many men before, there are symptoms that we want hormones to improve, and then there are symptoms that hormones are going to improve, and they’re not always the same. Just because you want it to be better on hormones doesn’t mean that it’s going to get better. And so when we talk about some of these mental health issues, there’s many men out there, and yes, they’ve read all over the internet and every forum that, man, testosterone can cause depression, testosterone can cause, low testosterone can cause anxiety and all these issues.

They have low testosterone, have anxiety and depression. They have optimal testosterone levels and still have anxiety and depression. So Dave, which is it? The low, the optimal, or is it not testosterone at all?

Dave Lee (02:56.37)

Yeah, this is such a good topic. And this is a topic that I inevitably transitioned to doing health coaching because this was the thing that the people needed, because as I’m sure you’ve experienced, there are so many guys who have the most perfect lab work that you could possibly get them and the most perfect protocol, but they still have these, what they would describe as negative symptoms. And a lot of the time it’s related to diet and lifestyle. But the other thing that we also have to take into account is that a lot of the time it’s to do with these.

maladaptive processes that have come and arisen or just the man turning into the being that responded to the low testosterone and the low hormonal environment that he experienced for many years. And I see this being particularly devastating for the younger guys who never had that optimal testosterone level to begin with. Not only physiologically did they not get this androgen saturation when they’re supposed to, but also in their early 20s, they didn’t get this.

sense of wanting to take risks and take on the world with courage and bravery and all of these things that testosterone is so important for. And as a result, they become meek and afraid and maybe involuntarily introverted, not because they prefer their own company, but because they’re so afraid of the world around them. And they develop this learned fear mindset. So they come in with this idea that, oh, once I get my testosterone levels up to the optimal masculine level that they should be, then all of a sudden I’m going to become that optimal masculine man.

And then when that doesn’t happen after 12 weeks, maybe six months, maybe a year, depending on the guy, they think, oh, well, I just must need more testosterone to be more masculine and manly. And I have found that that’s just not the case. It would be great if that’s how it works, but it doesn’t. And what’s very important that I like to explain to these guys and go, look, if I fix your car, it doesn’t make you a better driver. It might make it easier to become a better driver, but you’re still going to need to go and learn those skills. But…

Now that we’ve fixed the car and the car’s not malfunctioning, now you can go and learn how to become a better driver and it’s actually going to work. Same with diet, same with lifestyle. It’s like if we’ve, if we fixed the foundation for the house that kept falling down, you still have to go and rebuild the house. And I think the hard thing is that if you’ve tried therapy and you’ve tried diet and you’ve tried exercise and it’s failed 10 times because you had a low hormonal environment.

Dave Lee (05:08.95)

It takes a lot of courage and a lot of bravery to go, I’m gonna go try this thing again that didn’t work before, but this time I know it’s going to work. That is so difficult to do, but you have to do it. It’s like stretching, it’s like eating well, it’s like all of these things, it’s like, they’re difficult, but they’re doable, and you have to do them. And that’s the thing that I think is important, is that there’s this interconnected relationship between the biology and the psychology, and it’s much easier for us to come in and fix the biology.

but the client or the patient, they’ve got to go out and do the rest of the work and meet that medicine halfway. And I think that a lot of the time, guys are looking for the shortcut, they’re looking for the supplement, they’re looking for the magic snake oil thing that some guy on YouTube is gonna sell them, which is all just a load of crap. And at the end of the day, it’s stuff that they, we say TRT takes time to work, it does, but it also takes time to do the work that needs to be done. And if you’re particularly far off track, it’s gonna take you months, maybe years, to get to the point that you really wanna get to.

And all we can do is lay the foundation for you to do that.

Keith Nichols MD (06:09.045)

That’s right, Dave. I mean, what you’re saying is just music to my ears. I can’t put it any better. You’re right. It’s human nature for all of us to want an easy button, but this is not an easy button for everyone. We can provide the hormones, get levels optimal, and then as I tell them, you’ve got that box checked. Whatever’s not better, we need to address via other methods. It’s just that simple, and it should be that simple. It has nothing to do with not an adequate protocol or need to add.

You know, this other supplement to the mix, as you’ve mentioned, they have to put in the sweat equity and that’s, they have the hard work. These men have the hard work. We have the easy job. They have the hard job and those that are willing to put in that work and effort and sometimes have the strength to accept that, look, I may need counseling or, or other avenues, those are the strong men. You know, it’s not the strongest that they’re survive. It’s those that best able to adapt.

And so you’re completely correct. It’s not a quick fix. It’s not an overnight fix. We’ve talked about this before. It’s months and years. That’s what we need to be looking into. So that’s a very good point. And now that kind of leads us into kind of the different populations that you and I see. And what really the goals and the focus is in those different populations. So as everyone knows, I treat middle-aged and older men. I don’t treat men under 30 unless they have true hypogonitism.

And there’s a couple of reasons for that. It’s just that there’s so many older men that need it, that don’t know it. I treat a lot of men with prostate cancer and other issues. So I treat men basically 40 and above. Yes, I have some in their 30s, but for the most part, it’s an older age group, 40 and above. And what I do is bionidical hormone replacement therapy. Now there’s testosterone replacement therapy, which is just testosterone itself, which may be adequate for many men in their teens and 20s, of course. But when you get above 40, it becomes about

by identical hormone replacement therapy, meaning that we’re addressing all the hormones and we’re trying to address the age-related decline that occurs in all of us. It’s about prevention of age-related disease, disability, dependence, and frailty. It’s about never suffering the symptoms of a deficiency. It really is about prevention, but prevention is a hard concept, Dave, because we’ve all been taught from a very young age, we only go to the doctor, we only go when we’re sick, when we feel ill, we don’t go when we feel good. We’re not taught about

Keith Nichols MD (08:34.461)

prevention. But

Keith Nichols MD (09:04.965)

So we don’t wait for these older men 40 and above to get symptoms of a deficiency. We’re preventing the symptoms of the deficiency from ever developing. And that’s really what it’s about. It’s understanding that each and every hormone has beneficial effects, but they work synergistically. Now that’s a little different sometimes, and we don’t give contradictory advice. We are basically, we’re on the same page in literally every facet. So.

It kind of differs in the advice that you give these younger men that are less than 30. So why don’t you talk to us about how you kind of approach that age group of men since that’s not my age population that I treat.

Dave Lee (09:43.998)

Sure, absolutely. I like the way that you look at hormone replacement from just to touch on what you said. And the way that I use the analogy is that we again, I’m coming back to cars all the time, but we know that if your car needs a service, if you keep driving it, you’re going to make the problem worse. And if you know the wheels are going to fly off, and you know, you don’t need to wait for a massive crisis to happen before you go to the mechanic, you go earlier to prevent the bill from being huge. But in this case, we’re not talking about a bill for your car, we’re talking about your health, you only get one body. So

I really like this approach of focusing on longevity through hormone optimization, because you’re protecting against the diseases of aging, which are basically left to manifest. It leaves the body wide open, which is what we particularly, it’s not what we, but it’s what the medical industry has been much better at identifying in women, in menopause, all their diseases of aging risk goes through the roof.

And one thing that we know for sure, I would hope most people know for sure, I know that you at tier one do, because your wife treats women, correct? Yeah. You don’t just treat one hormone in menopause, and it’s the same with age-related hormone decline in men. It’s not just testosterone, just like it’s not just progesterone in women, it’s all hormones that go down. And where there’s smoke, there’s fire. So if you’re old enough to have low testosterone from age, there is a very good chance, unless you’re an outlier,

Keith Nichols MD (10:43.125)

Mm-hmm. That’s right.

Dave Lee (11:04.482)

that you have also begun to decline in other hormones. It just wouldn’t make sense otherwise. I guess the thing that’s different when, and I also treat older men and I treat older men very similarly to how Dr. Keith Nichols does. But when I treat younger men, it’s a little bit different because they’re not dealing with age-related hormone decline. They’re dealing with what I believe, well sometimes it’s just poor diet and lifestyle. But a lot of the time we’re getting these younger guys who are coming up who are 21, 22, they’re healthy, they’re doing everything right.

to the point that it’s almost a bit weird. They’re doing everything perfectly. And they’ve got lower testosterone levels than you’d see in the average 65 to 70 year old. And I think this is a result of endocrine disruption, potentially unhealthy parents, exposure to all, there’s so many different things. It’s the perfect storm. But I haven’t found that those things are impacting the levels of DHEA, sometimes thyroid actually, thyroid’s very common, but.

Keith Nichols MD (11:56.435)

Yes.

Dave Lee (11:57.046)

The adrenal hormones, like pregnenolone and DHEA, I haven’t found to be too impacted in these younger men. I mean, when you get these guys come in with these really low levels of testosterone, sometimes they have even above range levels of DHEA naturally because they’re 21. That’s where they’re meant to be. But it would be very rare to get to the age of, let’s say 50 years old and have low testosterone and have robust levels of these other hormones. It would be very, very rare. So.

That’s the difference that we’re talking about here. And one of the things that I think is a bit of a myth in the space, and this is where people probably think we’re going to have a debate and an argument, but in fact, we’re just going to agree on it, is that a lot of the time these younger guys think that going on testosterone replacement therapy is causing their low pregnenolone and DHEA levels because they’ve disrupted this system. And while it does reduce the levels in the testicles or in the ovaries in a woman, when we’re looking at the knockout of luteinizing hormone activity,

The thing that Dr. Keith Nichols has picked up very well, and it’s why it’s so important, I actually referred a gentleman over to Keith this week who came to me who was on TRT, but he was in his 60s and the other hormones hadn’t been addressed yet. I was like, this is exactly what Keith talks about. Is that once you get to that age, the synergy between the hormones is so important. And I like to kind of, when Keith talks about how some of these hormones you feel, some of them you don’t, I referred them a little bit differently, kind of similar. I look at…

hormones like testosterone, DHEA, and thyroid as accelerators, and things like pregnenolone and melatonin as the brakes. And if you’ve got a deficiency in your brakes and accelerators and you come in and crank up one accelerator, you’ve now created a bigger discrepancy between all these hormones. You’ve created further, you’ve fixed a problem, but now you’ve created more because you’ve got further imbalance. And that’s why it’s so important, but not only just as important from like a pragmatic standpoint, but from an outcome standpoint.

If you take a gentleman who’s deficient in all these hormones and you just put testosterone in there, he’ll come in and think, Oh, testosterone is going to fix all my problems because it sounds cool. It’s marketable. It’s we, it’s like selling a thirsty guy, a glass of water. Everyone wants more testosterone, but in reality it’s pregnenolone, DHEA, thyroid, melatonin all together that actually do what guys are hoping testosterone will do.

Keith Nichols MD (14:12.065)

Well said. I tell my middle-aged and older men that look, when they come in, Dave, as you just made the statement, they’re all in on testosterone. All in. Hey, most of them, you know, hey, the more the better, but they’re all in on testosterone. And I tell these men that look, the way you win this mind game, this battle between your ears, is that you need to approach every one of those hormones as you do testosterone.

the better the levels, the better the benefits. That’s what this is all about. We’re trying to obtain optimal levels so that you obtain more benefit from each hormone and at the same time balance that against any unwanted side effects. And so that’s really the point that I get and men will say, well, I’ve been told that, you know, I don’t need these other hormones, especially if I got normal levels. And they’re at 40, 50, 60 years old. You realize that the normal levels for 40, 50 and 60 year old man, for like DHEA for instance, is a lot lower

than the normal range for a 22-year-old man that’s over 400. So the goal to what we’re doing is maintaining these levels as you age in your 40s, 50s, and 60s, just as they were when you were in your 20s, so an optimal level. And I’ll ask those men, so you’re okay with testosterone? Yep, that’s what I want. Well, your levels are normal. Why do you want testosterone if your levels are normal? Well, because I’ve read that it didn’t matter if they’re normal, I could still have problems. Well, that is correct, you read that correct.

But yet you’re willing to start testosterone at your age with a normal level, but you’re not willing to start any of your other hormones, foundational hormones, because you have normal levels. That doesn’t make sense to me. And the reason is, is because, you know, the two feel good hormones, the two that you can really base on symptomatic improvement, of course, they’re gonna be thyroid and testosterone. You know, I could literally base my adjustments really on clinical symptomatology and improvement. A lot of those other hormones, Dave,

Dave Lee (15:57.431)

Mm-hmm.

Keith Nichols MD (16:05.921)

you know, like the DHEA, the pregnenolone Limit, the vitamin D3, for instance, look, we really don’t notice it when we take it for the most part. Now look, let’s make sure we kind of set the grounds rules right here real quick. Dave, and I’m going to make a point by asking just a few simple questions. Dave, can you take Tylenol without any problems?

Dave Lee (16:13.41)

Mm-hmm.

Dave Lee (16:25.77)

Sorry, what’s the generic name for Tylenol? We don’t call it Tylenol in Australia. Can I take it without any problems? Yeah, in the short term, yeah.

Keith Nichols MD (16:28.209)

Acetaminophen.

Keith Nichols MD (16:33.024)

Me too. Okay. Can you take Advil? I’ll be….

Dave Lee (16:37.386)

In the short term, yeah.

Keith Nichols MD (16:38.557)

Yep, yep. And so, you know, so you can literally take certain medications, over the counter medications without any problems at all. Right? Now remember, there’s gonna be people out there that are going to say, I can’t take Tylenol. It makes me sick. It gives me a headache. I can’t do it. I can’t take ibuprofen makes me sick does this that other I can’t take, you know, Benadryl. Look, when we talk to these men about these hormones, we are talking to the 90

Dave Lee (16:45.974)

Yes, absolutely.

Keith Nichols MD (17:07.673)

99.5% of people that can tolerate it. Everybody out there, when they hear a video like you or mine, oh, I can’t take DHE, oh yeah, when I take DHE, I know it, it just, that’s okay, that’s good to know, but the majority of us can’t tell it, especially 40 and above, when we take these hormones like vitamin D3. Now you can know when you’re vitamin D3 deficient, when it’s been a long time, yes, it can cause fatigue and other issues, but the point is, is that I’m really trying to make is that

We’re not speaking to you guys that are the so-called 1% outliers that feel it when you take it or just have all kinds of issues when you take it. The majority of us, and when you look at the studies in older men and women that do take these hormones, they don’t have really many problems with it. All right. So the point is that these other hormones, since they don’t have tremendous feel-good effects, we do try to optimize levels. And that’s when we do maybe aim for levels with these other hormones, whereas testosterone and thyroid, I’m not aiming for a level. I’m treating for symptomatic improvement.

So I just wanted to make the distinction there and that they understand why we do what we do. And so the majority of us can take these without any problems, but if you can’t take it, if you can’t tolerate it, then either take it in a lower dose or don’t take it at all. Let’s don’t make something that should be very simple, more complicated than it is. We’re using bioidentical hormones. You are an advocate for, as we all should be, micronized, sustained or loose pharmaceutical grade hormones.

They work the best. You’ve said it over and over again. You’ve done a great job on all your information. So I just want to make sure that people do understand that that’s what we’re doing with hormone optimization, especially in my age group. We’re preventing age-related decline. We’re maximizing levels to maximize benefits. There’s a dose-response relationship. That’s all it is. Dr. Rouzier, my good friend and colleague, mentor, as he says, he wants his, on his grave, he wants it to say, what do you want your levels to be?

That’s all he wanted to say. What do you want your levels to be? So I’ll always ask him, these are what the hormones do. What would you want your levels to be? I can make them low so you get low effects of the hormone. I can give you mid range levels and you can have mid range effects. I can give you an optimal level so that you can maximize those benefits of that hormone. Which would you like? Oh doc, I wanna maximize it. So that’s kind of our take. That’s what.

Keith Nichols MD (19:24.721)

hormone optimization is in our world. It’s just that it’s not complicated. It shouldn’t be complicated. We’ll talk about all these other add-ons a lot of other clinics wanna do. And you know, you send an email to me whether it be HCG and these other things. And so it’s just, it just doesn’t need to be complicated. You’ve identified just how simple it should be. And it is, it just may not cure everything that man wants to cure. All right, Dave, so look, you are DHEA Dave.

So let’s go into the other hormones and how you like to utilize them and the men that you consult with, everything from DHEA and the benefits that it provides along with pregnenolone. Okay, those are all very important hormones. And of course, melatonin, one of both of our favorites. It just doesn’t get enough press. If melatonin got the press it deserved, people would just be begging for it. All right, so tell us Dave, let’s hear about the supplemental hormones that we utilize along with testosterone and of course thyroid.

Dave Lee (20:03.522)

Mm-hmm.

Dave Lee (20:07.657)

Mm.

Dave Lee (20:13.325)

Mm-hmm.

Dave Lee (20:29.959)

Yeah, yeah,

Dave Lee (20:50.658)

Generally, the response with them when you follow up at 12 weeks is, how do you feel after taking the pregnenolone at DHEA? Uh, about the same, not really any different. Exactly. You don’t feel it. If people go, oh yeah, I think I might feel something this, no, it’s just, it’s like taking a sugar pill, but we know how important these hormones are for. And I like to look at pregnenolone and DHEA like yin and yang. Um, and they have a lot of, uh, yin and yang type of effects in terms of pregnenolone and its conversion to progesterone being

calming and acting like the brakes and DHEA actually sharing a lot of properties to caffeine, interestingly. So it’s like I like to describe it as your natural version of Valium and your natural version of caffeine, both important things not to be deficient in. Now, if I get a 23, 24 year old come to see me and he’s got a traumatic brain injury and he’s got undetectable levels of pregnenolone and DHEA and you restore them, he will feel it like that. And it’s a very different context when we’re talking about brain injuries versus

men who are aging. And that’s where I think some people can get mixed up and be quite confused about this. And one of the phenomena that I think is present here is that pregnenolone and DHEA as well as melatonin don’t seem to have a negative feedback loop like testosterone does. So we’re topping up levels. We’re not wiping them out and replacing them, we’re topping them up. And I think that that’s one of the reasons why I’m so encouraging and trigger happy for these older men to use these is that

Keith Nichols MD (22:08.521)

RET.

Dave Lee (22:18.09)

You don’t have to do injections. We’re not shutting down your natural production. I wish testosterone worked like this, that we could just top it up. That’d be fantastic. Um, and it’s something where there is so much benefit to be had from a subjective standpoint, because you might not notice what these things are doing, but it’s because they’re bioidentical hormones, they’re working with you, not on you. So if you take a drug, that’s not part of your operating system, you’re going to feel it, but a lot of the time when people go.

You know what? I don’t really feel the thyroid. I don’t think it’s doing anything. I’m like, stop taking it. And then they go, oh, that’s what that was doing. Now, that’s why I’ve felt so energetic lately, but because it doesn’t feel like caffeine or a stimulant because it’s part of you, you might not feel it. So I go, look, you might not think these are doing anything. Don’t refill your script and see how you go. And then they go, oh, that’s what that was doing. pregnenolone is why I’ve been sleeping so much better. DHEA is why I don’t need three cups of coffee. I only need one.

There’s these things that sometimes people don’t notice and that they’re so they’re so important and beneficial. And the thing that I like that you taught me in your old videos is the importance of not only using pharmaceutical grade products, but using a good pharmacy to make sure they’re actually good. I have seen so many guys come to me using brands like life extension or … or whatever, and they’re taking 50 milligrams of pregnenolone and DHEA. And sometimes their levels go down. They, they don’t work. And.

Keith Nichols MD (23:41.013)

Absolutely.

Dave Lee (23:43.446)

They come in or I have a guy and yeah, I have guys all the time and they swap over to the same dose of the pharmaceutical grade and they go, whoa, like, okay, this is a different thing altogether. And melatonin is particularly because if you want to get into high dosing, you have to get it compounded anyway. But

Keith Nichols MD (23:59.061)

Absolutely, absolutely. So what you’re saying, and I think it’s brilliant, is men, we can’t use these hormones as medications. I tell men all the time when it comes to thyroid, if you’re fatigued that we’re starting this for, if you’re fatigued, brain fog, lack of mental clarity, all these issues that you’re having, it’s not related to thyroid, it’s not gonna get better. If it’s due to sleep apnea, lack of sleep, working too hard, we all get tired if we work too much. So the point is, is that this is not gonna prevent you from being tired as a normal human being. We’re trying to improve fatigue-related.

to a thyroid deficiency. We can’t use thyroid as an amphetamine. And those are the exact words I use. We use amphetamines to wake people up that have narcolepsy and other issues. So you’re dead on point and I love every second of it. So yes, don’t use them as medications. So I mean, I think that’s just, people need to understand that they can’t be utilized that way and they shouldn’t be utilized that way. And the pharmaceutical grade is absolutely critical.

Understand that supplements are not regulated by the FDA. There’s no guarantee of purity or potency. There, you don’t know what’s in them. The only way to know if you’ve got a good supplement is either to send it out for independent testing or take it for a period of time and then measure your levels. If they come up appropriately, you got a good supplement. If you don’t, okay, then you know what you’ve got. So we’ve all been duped by the supplement industry. We’ve all been taken advantage of by them. So yes, we only use a micronized, sustained release, pharmaceutical grade.

Dave Lee (25:15.096)

Mm-hmm.

Keith Nichols MD (25:23.721)

hormone whenever we prescribe hormones concerning DHEA, pregnenolone, melatonin, of course, those are vitally important. You know, and so, okay. Yes, please.

Dave Lee (25:31.114)

I’m just, do you mind if I just chime in on this micronized point really quickly, because I have been such a stickler for this recently. And I remember when you first spoke about the importance of micronized sustained release hormones for oral hormones, I was probably like, yeah, maybe that’s important. Maybe not. I was wrong. And the reason why I was wrong is because when you go out and try, like, I work with clinics all over the world now, and it is so hard to find clinics that will do micronized sustained, or sorry, pharmacies that will make the micronized sustained release format.

but it’s so critically important that it’s micronized and sustained release because oral hormones have a half life of minutes and they’re not bound to an ester and they’ll all hit your liver at once. Whereas when it’s micronized, it will skip first pass metabolism and absorb gradually in the gut. And if you can combine that with a sustained release matrix as well, it means that you’re getting not only a sustained release into the body in terms of a steady release, but you’re getting it to release where it should actually be metabolized properly.

not via first pass in the liver. So if you’re taking 50 milligrams of pregnenolone from Life Extension or 50 milligrams of sustained released micronized pregnenolone from a good pharmacy, you’re taking two completely different products. Yep.

Keith Nichols MD (26:41.749)

Completely correct date. You’re dead on dead on man. Just so proud of you So when we talk about DHA and these older men and you know, we’ve established the fact that you’ve established the fact Thank thank God that you’d really can’t really tell it when you take it once again If we get symptoms of a severe deficiency one of these hormones We may feel that but that we may never want to experience that we want to prevent it So when you take it, you don’t really notice it, but well, what can it do for me then? Why am I taking it then if I can’t feel it? Well?

DHEA, as you know, Dave, and you add into this list, DHEA can stimulate your immune system. It can improve memory and increase energy, as you pointed out. It has anti-cancer properties. It can improve mood and help with depression. It can reduce your cardiovascular risk by decreasing visceral body fat. It can therefore lower hypertension and cholesterol in some people. It can reduce your insulin requirements. It can protect against osteoporosis. It can improve erectile dysfunction. It can protect against muscle atrophy.

Antiprotect skin’s inflammation, in fact, it’s been used to treat lupus, which is an autoimmune disorder. So look, those are some of the benefits of DHA. Most of those you don’t feel, but you want all those benefits. And the better the levels, the better the benefits, and whatever level you can tolerate, that’s your level. I’ll go on and say it online because it’s, you know, Neil Rouzier is the mentor, that look, whenever I’m treating an older man, typically an optimal level, will be around four to 600. Some men run higher than that.

Some men run lower, nobody’s saying you have to be there, but that was what we would consider a good optimal level for a 40-year-old or older man. So please add on to DHEA, Dave.

Dave Lee (28:15.166)

Yeah, absolutely. Couldn’t agree more. And the things that you’re talking about there are all the things that are going to prevent against the diseases of aging, which I typically look at dementia, cancer, obesity and heart disease. And all of those things are integral for preventing those at the root cause mechanism.

Dave Lee (28:41.07)

doing everything right and the HbA1c is not where it should be. They put the DHEA and then gradually over time that number starts to come down. Um, so I think the DHEA is very important, particularly for insulin sensitivity, as well as acting as a neuro steroid. It is extremely neuro protective. And when your DHEA levels are low, it’s, I like to call DHEA, the youthfulness hormone, I like to call it responsible for wellbeing and both of those things don’t objectively mean anything. But.

It’s just a good label to put on it because when you have the opposite of well-being and youthfulness, what happens is you’re more brittle, you’re more frail, your energy is lower, your immune system’s worse, and your brain doesn’t work as well. So all of these things are so, like it’s such an easy little thing to take. And this is the thing that we spoke about off air is that if we list out mechanistically all of the things that pregnenolone, DHEA, melatonin, all these hormones do, and then we look at all of the things that people are…

trying to achieve with hundreds or even thousands of dollars worth of buddy supplements every month. It’s these are the, these are like the, it’s like you’re downloading a whole bunch of stuff for your Windows computer off the internet and you’re missing Microsoft Office. Like these are like, I like to call them the Microsoft Office programs like Word and PowerPoint and Excel. They’re part of the operating system. They’re the first party applications that are meant to be there to do the things you’re wanting to do.

Keith Nichols MD (29:56.117)

Right, right.

Dave Lee (30:03.434)

And if you have optimal amounts of these hormones, you don’t need to try to take other stuff to try to do that because your body found, your foundation’s there. So DHEA, the other thing that DHEA is very important for is sexual sensitivity. One thing that I noticed a lot when, because in terms of what the main things that guys complain about are generally sexual things and then energy and performance and sleep. So when DHEA is low, the sensitivity of the penis goes down. So analgasmia is very common.

Losing interest in sexual intimacy is very, very common. And then it creates also intimacy issues with their partner when they’re not able to actually achieve an orgasm. So when DHEA is low, I mean, that’s something that when you fix you go, ah, okay, that’s better. But all of these other benefits, you know that they’re things that are protecting you in the background from the things that are going to become more problematic. You’re going to increase your risk for as you get older. So you’re completely right. You wanna optimize, you wanna, with these hormones.

If you want to take as much of them as you can tolerate, you don’t want to take the minimal effective dose. You want to take the amount that you can tolerate to get the most benefits from them. Yeah. That’s for pharmaceuticals. Yeah.

Keith Nichols MD (31:08.049)

optimal dose. That is correct. The minimal effective dose. Yes, that’ll work for some, but you want to maximize the benefits. That’s right. And that is so Dave, from a clinical standpoint, it’d be very frustrating to us clinicians as it can be frustrating to you as a health coach. Just look, when you see some of these men, they first start out, they’ll do everything like they’re supposed to have great DHEA levels, great testosterone, you name it. And then

you’ll follow up with them a year or two, maybe three later, and then they’ll come in and they’ll have all these complaints they didn’t have, especially sexual dysfunction and issues like that. You’ll find that those men will maintain their testosterone. They’re all in on that. They just, they’re not gonna stop that. You can pry it from their cold dead fingers, but they’ll stop everything else and wonder now why they’re having problems that they weren’t having when they were doing everything else. It just doesn’t…

Dave Lee (31:38.32)

Mm-hmm.

Dave Lee (31:44.64)

Mm-hmm.

Keith Nichols MD (31:56.017)

You know, just doesn’t correlate with them. They just, they just can’t figure it out until it’s pointed out to them. Well, wait a minute. Your DHA was 550 and you were doing great. Now it’s, you know, 85 and you’re not doing so great, but everything else, you know, is, is okay. But look, you, why, why would you do that? And, and this is what happens when you do. So look, it’s about maintaining optimal levels of each. And, and you’ve touched on this recently because it is what aging is all about.

Aging is insulin resistance. Insulin resistance is aging. That’s what leads to all the complications that Dave just mentioned. 80% of age-related diseases are preventable, but they can all be traced back to insulin resistance. What happens to everyone as we age? Every single human being develops insulin resistance. They decrease lean muscle mass, they increase body fat, especially visceral body fat. They become in a pro-inflammatory state. So it’s about insulin resistance. So what do these hormones do? What’s the real end game? It’s preventing or reversing.

insulin resistance and they all work together to do that. So we think it’s vitally important at age 40 and above to optimize all your hormones to maximize those benefits. So Dave, a melatonin, it really is a miracle molecule. Now everybody knows I take 600 milligrams a night. Melatonin, as Dave has pointed out, does not suppress your own production because it is not regulated by a

Keith Nichols MD (33:21.861)

and jet lag. That’s not my primary motivation behind melatonin. Melatonin is a very potent antioxidant free radical scavenger and it’s free radicals that damage DNA and lead to cancer. That’s why melatonin can be used to treat and prevent cancers like breast, prostate, and colorectal cancer. It also protects your mitochondria. It does so many wonderful things that people just don’t know about, but like I said, if they did, it should be front page news every day. So I know you’re a big proponent of melatonin, so tell me how you use it in your population of Mende that you’re consulting.

Dave Lee (33:52.566)

Well, melatonin is just so damn good for you. That’s why it’s not front page news, right? There’s no money to be made in it. So melatonin is, is wonderful. As you said, melatonin is the body’s chief antioxidant. And I, for the last six months have been going on a deep dive down. Uh, is it Dr. Russell writer is his surname. Um, there’s also a guy, uh, Dr. John Lawrence, Lawrence. I’m probably pronouncing it wrong, but melatonin miracle. Yeah. Miracle. Yeah. Um,

Keith Nichols MD (33:56.569)

That’s right. Yeah.

Keith Nichols MD (34:15.409)

Yeah, yeah, he wrote them. A miracle molecule. Yeah, that’s right.

Dave Lee (34:20.658)

So I’ve watched all the content. I’ve got his book on the way actually. So I have gradually worked. Oh, fantastic, fantastic. I have gotten myself recently up to 120 milligrams of melatonin and I titrated up quite gradually. Not that gradually, I titrated up very gradually to about 20 and then I moved up in greater increments from there. And I think there are a lot of misconceptions around melatonin, particularly the idea that

Keith Nichols MD (34:25.717)

I’ll send it to you when we’re done. I’ll send it to you when we’re done.

Dave Lee (34:48.486)

You only want to take it in minimal amounts occasionally if you’re changing time zone or whatever. That was on this idea that melatonin has some kind of negative feedback loop like testosterone does. That was debunked a decade ago, thoroughly. It’s just that a lot of the people on the internet who speak very loudly about things who are often selling other sleep supplements, by the way, are saying you want to avoid melatonin for all these reasons, but you also want to take a whole bunch of other antioxidant supplements to do the same thing that melatonin does.

Keith Nichols MD (35:02.636)

Mm-hmm.

Dave Lee (35:18.758)

It’s ridiculous. So melatonin is fantastic. And I have found it to be particularly fantastic for people who have, basically the more stress the body is under, the more you can benefit from taking melatonin because melatonin is going to support the body being under stress. The thing that I have particularly found melatonin to shine for is intractable, um, chronic inflammatory conditions like autoimmune conditions, um, particularly, uh, endometriosis in women.

I don’t really work with women, but the other thing that I found it really useful for is people with spinal issues or physical pain that prevents them from getting comfortable at night and sleeping properly. Two birds, one stone. So melatonin is a profound antioxidant and a lot of the things that people are looking for antioxidant benefits for melatonin is wonderful for. We have incredibly high levels when we’re children and that’s why children tend to be more protected against these diseases of aging that we see in older populations.

But the other thing that we also have to consider is that when they’re looking at studies and saying to take three to five milligrams of melatonin because that restores natural production, restores natural production of older people who are living in a world that’s artificially lit 24 seven. That’s not optimal melatonin levels. So I think that you should take as much I think every single person should take as much melatonin as they can tolerate. I think a lot of people.

There’s a couple of theories as to why some people get that groggy morning after effect. One is that they metabolize it slowly and should take it before dinner. The other is they may be having a sort of detox reaction. I think both of those are viable, but I think the best way to do it is just titrate up gradually over time. Make sure you get morning sun, which you should be doing anyway. And I have only found more benefits have come from taking more melatonin. I do have two spinal injuries, which may be why I get so much benefit from it.

But every time I take more melatonin, my wife notices that my skin looks better. My wife notices that I physically look better. So melatonin’s wonderful. I highly recommend, like when people say, oh, I sleep well so I don’t need to take melatonin. No, no, no. Melatonin is, we’re looking at it like Pregnanolone and DHEA. We’re looking at it as an antioxidant protective, health promoting, health restoring agent. It’s particularly useful if you’re sick. And you want, even if you sleep great, you could still benefit from taking melatonin.

Keith Nichols MD (37:18.156)

Ah, there you go, there you go.

Dave Lee (37:34.974)

And you want to take as much melatonin as you can tolerate. And you also, you want to take a micronized pharmaceutical grade version of it so that it gradually gets released in the gut so you don’t get a big spike that’s just gonna throw your body’s rhythm out. And yeah, as you know, melatonin, wonderful.

Keith Nichols MD (37:51.093)

Yes, you’re

Dave Lee (38:07.118)

Mm-hmm.

Keith Nichols MD (38:20.461)

None of them hold a candle to melatonin. None of them. Remember hormones are bullets, supplements are babies. It’s just the way that it is. So I’m yes, you know, I’m a huge proponent of melatonin. I and now look, when you read the book by John, look, we’re not going to take it rectally. OK, we’re gonna take it orally like the study. OK, you can’t vet every book, you know, and there’s some good things in there. But, you know, sometimes, you know, there’s these books and you have to say, no, where did that really come from? So so no, let’s don’t take melatonin rectally.

Dave Lee (38:39.006)

Yeah, yeah.

Keith Nichols MD (38:49.437)

people if you read the miracle molecule by John is let’s take it orally like they do in the studies. So that’s important. You know, fact to point out. All right. So, you know, you’ve mentioned, of course, pregnenolone. Now, I’ll use it and older men and you know, to improve memory and help with neuronal repair. And of course, you use it as you as you stayed in these younger men that have had brain injuries. So tell us your feelings on pregnant on itself. It’s

pregnenoloneDave Lee (38:55.49)

Mm-hmm.

Keith Nichols MD (39:16.197)

to me, you know, if people, if people are like, I don’t want to take any hormones, I don’t want to take any hormones, I just want to do my testosterone, or I just, you know, I don’t have financial, I’m not financially able to do them all. And I said, which ones can I cut out first, I will typically say, well, if you’re going to cut out any hormone and not take it at all, I guess it would be pregnenolone on my list. But I’d recommend that you take them all because we’ve already talked about it working synergistically with all your hormone other hormones. But if Dave and I had to really throw it out there, the data

in humans and randomized control trials is somewhat limited in pregnenolone compared to the others, although there’s plenty of studies out there which I have, it’s just not as robust as our other studies, but I do use it to improve memory and help in a rural repair. How about you?

Dave Lee (39:53.858)

Mm.

Dave Lee (39:58.386)

Yeah, completely.

Dave Lee (40:28.434)

If I had an older gentleman who was like, what’s one hormone I could cut out if for some reason I couldn’t, I mean, yeah, I probably, if I had to, but I wouldn’t. But yeah, so when it comes to pregnenolone, pregnenolone exerts a lot of its effects in the body via conversion to progesterone and allopregnenolone. And these are where it has its calming effect. So it’s what’s called a GABA A receptor positive allosteric modulator, which is a fancy term for.

making the GABA-A receptor more sensitive, which is the same mechanism of action as benzodiazepines, Valium, Xanax, et cetera. So when someone is deficient in pregnenolone, what pregnenolone also does in the brain is it is very neuroprotective. So anytime someone takes anything that’s intoxicating, whether it’s caffeine or amphetamine or alcohol or whatever it is, the brain increases pregnenolone release to basically prevent your brain from getting too overexcited and going into an oxidative stress state. So it’s like a thermostat.

And it seems to have, as well as DHEA, have a lot of these thermostat properties throughout the body. It works on the endocannabinoid system. So a lot of these benefits that we see from cannabis are happening on the CB1 and CB2 receptors, which PregnantAlone also binds with. It’s technically a cannabinoid. So it’s like, it’s got like your own endogenous version of CBD almost as well.

Keith Nichols MD (41:45.638)

And that’s why you see it being used in all of these substance abuse disorders in this study. Absolutely, Dave, dead on.

Dave Lee (41:48.646)

Mm-hmm. And I often find that people who are pregnenolone, deficient, will self-medicate with CBD because it works on a lot of the same pathways. So, pregnenolone is very much, I like to call it the brakes. I do find that when people are deficient in pregnenolone, when you combine pregnenolone and melatonin, they sleep like a baby. It seems to massively reduce the baseline level of stress in the body. And sometimes this stress can be perceived mentally as anxiety.

If you’re constantly mentally feeling like there’s something wrong, maybe there is, and maybe it’s inside and maybe you’re reacting to that. It’s like a crying baby. It’s saying problem, problem. You don’t know what it is. So when I see younger guys who’ve got brain injuries, when they’ve got pregnenolone deficiencies, the main thing that you see pop up is anxiety and insomnia and being what I call wired and tired. It’s like being full of beans in a bad way. It’s like having, it’s like the bad part of having too much caffeine.

And the thing that I see, like when I, when I referenced this gentleman who I spoke about the other day, who I referred to yourself is that he had all these symptoms of, you know, low testosterone, which is low hormones at the age of 60. And the main thing that didn’t improve was the brain fog and the ability to articulate the ability to actually get the words out that you’re wanting to articulate. And I always stutter on this point, ironically, but it’s when you’re actually trying to articulate what’s on your mind and when you’re able to speak with good fluidity and speak well and confidently. And.

you know, not stammer over your words or lose your tongue. And I think pregnenolone makes your brain work better. It’s, it’s, it’s a very powerful neuro steroid and it’s very protective against cognitive decline. And it’s also like, as you mentioned before, insulin resistance is what I said, those four diseases of aging, they’re all insulin resistance at foundation, absolutely. And dementia is type three diabetes. So I think that when I look mechanistically pregnenolone and DHEA are very important for energy metabolism in the brain, which you can cognitively feel.

Keith Nichols MD (43:31.778)

That’s resistance. That’s right. That’s right.

Dave Lee (43:43.746)

but it’s also going to be the thing that’s going to protect you when you get older. And that’s what I think is very important is people want to get to 70, 80 years old. Everyone’s talking about longevity. It’s like, but you want to actually be doing well when you get there. You don’t want to spend the last 20 years of your life, you know, not being able to clean up after yourself. You want to actually be sharp and present and functional. And that’s what pregnenolone, DHEA, especially together are going to be able to facilitate for you. It’s just pregnenolone to the breaks and DHEA is more like the example.

Keith Nichols MD (44:11.689)

Everyone please listen to what Dave’s saying. I wish they could make a real on what he just said, which they will, I’m sure. In that look, you take them now, you optimize them now for what it’s gonna do for you 30 years from now. Not the way it makes you feel now. Do not get caught up into only the feel good effects. I’m not gonna take it if I don’t feel it. Understand that what you do now will have a profound effect on you 30 years from now if you will do it daily for the next 30 years.

It’s so hard to get people to understand that and do it. They’ll start for a while and then people get complacent and they just stop. And once again, they’ll just start looking for an easy button somewhere, but there is not one. There is not one. But for me and you, taking hormones is just so easy. It’s as easy as brushing our teeth. You know, it’s just as easy. So please, it is about prevention and do not wait until you get symptoms of a deficiency. Do not wait until you get a disease or disorder.

Dave Lee (44:59.055)

Mm-hmm.

Keith Nichols MD (45:10.793)

to start treating it because that’s how we’re trained in medicine. We’re trained to treat you once you get the disease, you’re trained to go to the doctor once you get sick of the disease. We’re trying to prevent you getting that age-related disease. We’re trying to prevent insulin resistance, we’re trying to reverse insulin resistance. So please listen to everything that Dave just said. So while we touched on some mental aspects of prenatal on the others, that’ll lead us into thyroid. So thyroid is probably the most controversial one of them all. It’s the one that creates ire with the family physician or internist because it is poorly understood.

just like testosterone has been for several decades. And I think what many need to understand out there is many men out there that get on testosterone and still have symptoms, you know, fatigue, brain fog, lack of mental clarity, weight gain, inability to lose weight, even erectile dysfunction, things such as that. A lot of times those symptoms are from thyroid. So low-acting thyroid in a man looks just like low-acting testosterone in many areas. And that’s why they don’t get better when they just get testosterone in some instances because…

Dave Lee (45:59.918)

Mm-hmm.

Keith Nichols MD (46:08.573)

the clinic is throwing testosterone as well as actually also a thyroid problem. So that’s why, you know, but what I found David in my practice is I used to teach about thyroid right off the bat, about optimizing levels in men, you know, understand that thyroid regulates temperature, metabolism, cerebral function, and energy levels. It protects you against cardiovascular disease, cognitive impairment, fatigue, weight gain, memory loss, decreases visceral body fat, and improves your lipids profiles. The better the levels, just like with testosterone, the better the benefits.

So I used to preach to the men that all the wonderful benefits of having optimal levels of thyroid, just like having optimal levels of testosterone. They can always understand testosterone, but inevitably they would call back a month or two later, many of them, why am I taking this thyroid again? I don’t wanna take it anymore, I just wanna take my testosterone. Then they’ll stop and they’ll start feeling bad or whatever, and maybe they won’t start feeling bad, but the point is then their thyroid labs are not optimal anymore, because that’s what hormonoptization is about, is maintaining optimal levels. And so,

What I have found that works recently best with men is men tend to typically do most of them, not all of them, some of them understand hormone optimization after 40. But what I found, Dave, is that it works best in them as far as them accepting it and understanding it. If I started, after I start testosterone and the other hormones, get everything out, it will give it time to work. And then if they have symptoms left over, still have persistent fatigue, brain fog,

Keith Nichols MD (47:37.981)

when they know exactly the symptoms they’re starting it for versus starting it and optimizing the levels and not waiting till you get symptoms of a deficiency. So if in a perfect world, if I went back to age 40, I would start all my hormones. Whether I had symptoms or not, I would start all my hormones. I maintain I had optimal levels. I would never want them to be anything but optimal. And that’s Neil Rizier’s perfect world too. And so that would be our perfect world, but we don’t live in that perfect world. So that’s kind of my approach to thyroid. It’s a vitally important hormone.

The two feel good hormones are testosterone and thyroid predominantly, you know, and that those are the ones that have the greatest impact on how you feel, function, perform and your overall health on a daily basis are those two, those are the biggies. And so Dave, you can tell us how you approach, you know, consulting men on thyroid, but that’s kind of the approach that I’ve taken after doing that for so long is I tend to get everything optimal first and then add thyroid, I kind of put it on deck for them, unless they want to start it off bad. They’re given the opportunity as every man is, just like with testosterone, they can not do it.

optimize it from the beginning, or just wait and start it later. There’s no wrong answer for that man. Whatever his answer is, is his answer. Okay. So tell us how you approach that and in your practice.

Dave Lee (48:45.291)

Mm-hmm.

Dave Lee (48:50.086)

Okay, yeah, so thyroid is a big one. Thyroid is also common in younger guys as well. Again, I don’t know what it is. Sometimes it’s Hashimoto’s, which is autoimmune. I think there’s also an endocrine disruption that plays into that too. I’m not sure.

Keith Nichols MD (49:03.173)

Military men especially, military men especially bad.

Dave Lee (49:06.338)

The thing that I’ve also found is it’s really rampant in the UK. Maybe it’s something to do with the pollution, weather. I don’t know, but very rampant over there. So yeah, if you take a list, if we imagine a Venn diagram that crosses over in the middle and you’ve got low testosterone symptoms on the side and you’ve got thyroid symptoms on one side, they’re all in the middle. They’re the same.

Keith Nichols MD (49:26.761)

They are the same. They are the same guys. You understand that they’re the same.

Dave Lee (49:31.034)

And this idea that if you’re you have to have like cold extremities to be hypothyroid, that’s nonsense. That’s nonsense. It’s I believe that maybe came from the fact that women run a little bit lower in temperature than men. So maybe that’s the first symptom they notice. But no. So. Extremes.

Keith Nichols MD (49:36.43)

That’s true.

Keith Nichols MD (49:46.681)

They always have to describe the extremes, the extreme of true hypothyroidism. We’re not talking about subclinical hyperthyroidism or men with suboptimal thyroid levels. We’re talking about those true hypothyroid and hyperthyroid. So so yeah, that’s where that kind of comes from.

Dave Lee (49:52.427)

Yeah.

Dave Lee (49:59.518)

Yeah. So when it comes to the thyroid and you’ve said this before, like when you draw a line in the sand, let’s say hypothetically a free testosterone level of 50 and if you’re still wanting to throw more testosterone out at the chances are there’s something else going on. And the chances are if it’s clinical hypogonadism symptoms with optimal testosterone levels, it’s thyroid, but that should have already been checked and taken care of. But a lot of the time it’s not when they come to people like us because it gets overlooked all the time.

Keith Nichols MD (50:26.629)

right. And they’re afraid of it. The practitioners are afraid of it. That’s right. That’s right.

Dave Lee (50:29.634)

They’re afraid of it. They’re afraid of it and they don’t know how to do it. And there are so many men walking around with either undiagnosed hypothyroidism or damn hypothyroidism and they’re on T4 monotherapy. T4 monotherapy is like test a gel or pellets. It’s crap. It’s almost as good as nothing. The thing that breaks my heart is when guys say, oh, I had my thyroid removed and now I’m on a hundred micrograms of T4 and I’m obese. It’s like, well.

Keith Nichols MD (50:46.101)

Thank you.

Dave Lee (50:58.37)

You didn’t have much of a chance. So thyroid optimization gets a bad rap because a lot of the time people get put on T4 monotherapy, which is useless or it can make problems worse. And yes, there are outliers that do great with T4 monotherapy. But the vast, vast majority of people need T3 and T4 and natural desiccated thyroid just works better. I used to think, and I was wrong and I will eat my words on this. This is another one of those, you can say I told you so moments, because 100% sure is,

Keith Nichols MD (50:59.646)

No.

Keith Nichols MD (51:10.909)

That’s right, that’s right.

Dave Lee (51:28.426)

T3, T4, if you have the equivalent dose of NDT as synthetic T3, T4, it doesn’t work as well as the NDT does. One in 10 people won’t tolerate NDT for some weird reason, but the vast majority of people do much better on NDT. I’ve had guys be on the equivalent, like let’s say a two grain equivalent dose of T3, T4, and they swap to NDT and it blows the levels through the roof. Like it’s a much better medication. So.

Yeah, when it comes to thyroid, I like to think of thyroid as putting the wind in the sails of TRT. Thyroid is responsible for your metabolism. It’s your engine. I talk about thyroid being the furnace that sits in your, in your torso. And when thyroid function is low, it’s like when people go, Oh, I’ve just got a slow metabolism, you’ve got hypothyroidism. Um, or when you see those, like I used to know people when I was young, who would just eat everything and they’d stay stick thin, I’ve recently run their lab work.

Keith Nichols MD (52:12.806)

Mm-hmm.

Dave Lee (52:21.038)

They’ve naturally got a TSH of like 0.4 and a free T3 above the reference range. They’re just those outliers. So, um, you want to have optimal thyroid function one, because food is wonderful and being able to eat more nutritious food is wonderful for you. The more good quality emphasis on good quality, the more good quality food you put into your body, the more nutrients that you can assimilate and the more powerful of a vessel you can build. It’s like basically being a

It’s like being a more powerful car and going faster. It feels better to be alive when you’ve got good thyroid function. When you’re low in thyroid, everything feels like too much effort and the body constantly has to kick into adrenal hormones, cortisol and adrenaline to get things done, like a dirty backup fuel source because your body has to kick into fight or flight just to do basic day-to-day stuff. Thyroid is not amphetamine, like you said before. Thyroid’s not like you’re sitting down and being like, oh, I just wanna go take on the world now.

But what people do notice when they put the thyroid in is they go, Oh, now doing that cardio and abs at the end of my workout, it doesn’t feel like a chore anymore. I kind of look forward to it. Now I kind of want to go to the gym for as long as I can, rather than leave as early as possible. Now, all of a sudden, when I go for a walk, it doesn’t feel, I’m not always checking to make sure I’ve been going for long enough. I just want to keep going because it feels good to move and be alive. And I like to say to people that again, going back to the car thing,

If you were a car that had an engine that’s too small for the vehicle, which is what hypothyroidism is, you can still go down to the shops to get milk and bread. You can still get from A to B, but it’s going to feel terrible to drive. But if you’ve got a sports car with a souped up engine and it feels really good to drive it, not only is that experience going to be better, but you’re more likely going to go for a joy ride. So in your spare time, you’re more likely going to go and exercise and get off the couch and actually go and do the things that you need to do to achieve your goals.

And that’s what I love about thyroid so much. It’s giving people the energy that they need to put the testosterone and the other hormones to use. And the other thing that, we haven’t spoken about this before, I recently did a lecture on, maybe this term exists. I coined it subclinical Hashimoto’s. And this is where people have got elevated Hashimoto’s enzymes that are not above range.

Dave Lee (54:36.098)

but they’ve got symptoms of hypothyroidism, even when their thyroid panel looks okay. And these people benefit immensely. And these are often the guys who are, they’re incomplete from their TRT alone, and they’re 25, 26 years old, and they benefit from just boosting the thyroid up. Even if it’s only 30 to 60 milligrams of NDT, they do wonderfully with it. So it’s so important that people, even if you’re just going into this and you’re wanting to look at your hormones.

Get a comprehensive thyroid panel and look at your symptoms and don’t overlook it and go, oh, I’ve got a little bit of Hashimoto’s now, but let’s wait until I put on another 20 kilos of body fat and become insulin resistant before I fix the hypothyroidism. It’s nonsense. As we said before, the wheels are gonna fly off. So service it now.

Keith Nichols MD (55:21.405)

Or even better yet, Dave, I only need testosterone because my testosterone levels are normal, but they’re not optimal. They’re on the low normal. And my thyroid are totally normal. They’re normal. But your thyroid is no more optimal than your testosterone. In fact, when you really look at it, your free T3 is almost tanked. It looks worse than your testosterone does. Once again, men can buy into testosterone and start it with normal levels and realize that, hey, I can still be symptomatic with normal levels of testosterone and benefit from testosterone. They have a hard time applying that to thyroid.

Dave Lee (55:51.19)

Mm-hmm.

Keith Nichols MD (55:51.653)

Okay, and so when Dave mentions NDTs, talk about natural desiccated thyroid. And when we talk about T4 only, that’s a synthetic T4, and it’s T4 only. Desiccated thyroid is a mixture of T3 and T4. It’s 38 micrograms of T4 to nine micrograms of T3. So you’re getting both. The problem with taking T4 by itself for many people, as Dave has alluded to, is that T4 is not the active component of thyroid. It’s free T3. T4 has to be converted at the cellular level to exert the benefits of thyroid.

And for those people that take T4, you’re gonna kind of decrease your own thyroid production of T3 and T4. Thyroid produces just for lack of argument, say 75% T4, 25% T3. So your thyroid typically is gonna produce both, but 75% T4, 25% T3. When you take T4 by itself, you’re gonna shut down that production of T3, okay? And what’ll happen if you’re not converting your T4 adequately at the cellular level, you become very, you may feel worse because now you have no T3.

and you’re not converting adequately. When we take desiccated thyroid, we’re taking both T4 and T3. So, you know, we’re getting our T4 to be converted, and we’re also getting our T3 along with it, so that we’re never kind of devoid of T3. So those are the different streams of those two. The problem that the family physician has with it is that when they see us raise thyroid levels, when you take thyroid, what’s going to happen is when you look at your thyroid panel, there’s something called a TSH, thyroid stimulating hormone. That’s basically your little thermostat. The bigger that number,

that’s your body saying, I need more thyroid. The lower that number is your body saying, I don’t need to produce any, I don’t need to tell my body to produce any more thyroid because I’ve got enough. Free T3 will go up when you take desiccated thyroid. Now when you take T4, that might always happen, as Dave’s alluded to, but that’s the goal is to increase free T3. That’s really what we’re looking at. So when you take it, what’s gonna happen to your labs when you take thyroid is when somebody just looks at those labs,

Dave Lee (57:30.794)

Mm-hmm.

Keith Nichols MD (57:50.837)

they’re gonna think you’re hyperthyroid. It makes you look like you’ve got hyperthyroidism. Now hyperthyroidism is Graves’ disease. At baseline, they have a low TSH, they have a high free T3, high T4, so they have a lot of thyroid hormone. But here’s the issue. Graves’ disease is an autoimmune disease. It has an autoimmune component that does the damage. Yes, it causes cardiac abnormalities like AFib and other issues, but the literature is very clear on this.

Taking thyroid in somebody that is hyperthyroid or subclinically has subclinically Hashimoto’s or subclinical hyperthyroidism When they take thyroid in their labs move as we said TSH goes down T3 goes up It does not cause the same sequela as having Graves disease or hyperthyroidism It does not cause those adverse effects because there’s no autoimmune component and there’s plenty of data out there To show you that there’s some great people papers

written by Tomas Kelly on this very topic. And so what I would, he’s even written a book on it. So I’d recommend that, you know, but the family doctors, we were taught, I was taught that when you take thyroid, you’re gonna cause somebody to be hyperthyroid. Now, when you take thyroid, yes. Is it gonna increase your heart rate a little bit? Yeah. Is it gonna make you feel warmer? Dave’s already alluded to that, increases thermogenesis. It increases your metabolism. Yes, you’re gonna feel warmer. Yes, it’s gonna increase your heart rate. There’s no harm in that whatsoever. But if you’re one of those,

individuals that’s extremely sensitive to it, and you feel like you have an excessive heart rate, you feel like you’re having palpitations, or you’re having excessive sweating or heat intolerance, you can simply just lower your dose to resolve those symptoms. Once again, it’s always a balancing act between raising levels to resolve symptoms and avoiding any unwanted side effects, and sometimes it’s just lowering the dose and finding that midway point for you. So anything you wanna add to that there, Dave?

Dave Lee (59:44.422)

Exactly what you said about the TSH being a signal for the body wanting more thyroid. So I like to use the analogy. Usually I have a glass in front of me, but now I’ve just got the bottle. So it’s kind of like if you’re in a restaurant, basically the glass of water you have is like the T3 and then this bottle is you signaling to the waiter to say, hey, give me more water. That’s the TSH. So what you want is you want a full glass and you want you to shut up. And that means that TSH is generally under one close to zero point five, if not lower.

under one and people think, oh, that’s no, when you see people who are 23, 24, who are athletes with optimal thyroid function, they generally have a TSH of like 0.4, 0.5, and they have a T3 often above the reference range. And I tell them, I go, this is rare. This is optimal. And this is what we aim for with hormone replacement. Now, you find me a 50 year old who’s got a natural thyroid panel looking like that. And I tell you found Bigfoot. It’s, it didn’t exist.

Um, it would just, it would, especially if they have low testosterone as well, it’d be very unlikely. So when it comes to the thyroid, if that TSH is elevated to varying degrees, your body is signaling that it wants more T3 at the receptor level. And the problem is that there’s a whole bunch of chronic inflammatory conditions such as insulin resistance, which is this vicious cycle, right? Because insulin resistance reduces thyroid function, which slows your metabolism, which makes it worse. The body gets stuck in these vicious cycles. And this is where this

interventional hormone replacement therapy can break these vicious cycles so that people can get their health back, which is why it’s such a cool topic. But if your body is signaling that it needs more T3 at the receptor level, that means that your metabolism is suboptimal. If your metabolism is suboptimal, it feels better to have an optimal metabolism. You have more energy to do the things that you need to do to look after yourself better. People make bad decisions when they’re stressed because they go for the easy path.

The vast majority of people, even the vast majority of guys under 30, maybe not so much, maybe if we’re talking over 50, it would be 99% of guys would benefit from thyroid. In terms of under 30, I would still say 60 to 70% of guys would benefit from at least some thyroid. You do see the optimal guys every now and then, but you see a couple of them a week. The vast majority of younger guys, you see a bit of an elevation in TSH.

Dave Lee (01:02:02.91)

And it just might mean that they could benefit from a little bit of thyroid. But the cool thing about thyroid, which you’ve spoken about before is that, yes, this TSH feedback loop is active, but we’ve got a lot of research to show that people can withdraw thyroid medication after years and then natural production comes right back. So yeah, exactly. And that that’s the other thing as well, when it comes to this Graves and the hyperthyroid thing is that like.

Keith Nichols MD (01:02:20.193)

right back in your die if it didn’t. I mean basically yeah.

Dave Lee (01:02:28.498)

Yeah, so when someone has Graves disease, it’s got that autoimmune component. It just means that the waiters, they’re just pouring that water nonstop. That feedback loop is gone. And that’s why it’s so dangerous. If you take a little bit too much thyroid, your body’s natural production will just compensate by lowering. But I don’t know about you, but I have never found that someone continues to take medication that makes them hyperthyroid. It’s like coffee. There’s a certain amount of coffee that you drink in a day and you go, I’m not going to have any more.

If your dose of thyroid is too high, you’ll stop taking it before you end up in hospital.

Keith Nichols MD (01:03:00.573)

Exactly. Well,

Keith Nichols MD (01:03:28.029)

4.4 in some labs, you know, and I’m like, but okay, it’s 2.6, which is at the bottom of the normal range for a group of sick people. Is that where you really want to be? So if Dave and I were to be able to take these athletes that he’s speaking of and just get our normal ranges from them, it would be a much different normal range. And that’s what people need to understand that they, people don’t want doctors paying attention to labs and normal, but they themselves can’t break away.

from looking at labs themselves, if you know what I mean. It’s kind of a catch-22 for them. They’ll, once again, they can understand testosterone to some degree, but when it comes to the other hormones, they just can’t seem to make that next step to understand that it’s just like treating testosterone. And when we’re treating thyroid, it’s just like testosterone. We’re treating really free testosterone levels. And for thyroid, it’s about those free T3 levels. And yes, a suppressed TSH has never caused harm. You know, it’s the free T3 level that correlates best.

with clinical improvement, not TSH level. My TSH, for instance, Dave, last time it was tested, is.007. And you’ll see many people with a suppressed TSH, they feel great, they feel wonderful. So the takeaways here is the normal range is not for healthy people. You know, if we got them from the athletes, like Dave said, we’d have a much different range. And that’s the key there. And following free T3 and the fact that taking thyroid will not cause you to have hyperthyroidism or Graves’ disease.

Dave Lee (01:04:31.938)

Mm-hmm.

Keith Nichols MD (01:04:53.393)

You can have symptoms of too much just like you can with testosterone, you lower the dose. Remember, I try to point this out to people all the time, thyroids have been used for over 100 years. I think the first use of was in the UK around 1891. They used desiccated thyroid. There were no thyroid labs up until the 1970s, just like there were no testosterone labs until the 1970s, and testosterone was first used in 1935, the 1930s. So for decades upon decades upon decades, we have been treating men with testosterone, thyroid with no lapse, and it caused no harm.

Dave Lee (01:05:20.782)

Mm-hmm.

Keith Nichols MD (01:05:23.497)

Think about that for a minute. They literally treated their symptoms. If they had symptoms of too much, they lowered the dose. Symptoms of little, they raised the dose. That was a better way to treat. Now, clinicians for efficiency will just look at a piece of paper and literally ignore the symptoms or give you a medication for those symptoms and say you don’t need it because your levels are normal. Nothing could be further from the truth with hormones. That’s not how hormones work.

Dave Lee (01:05:46.678)

Oh, I couldn’t agree more. And you’re going to kick out of this. So in Australia, if you, and we talk about the importance of, so in Australia, we have something called, um, like Medicare, which is like the government subsidized health program. So if, if you, as a doctor order a thyroid panel for TSH, T three and T four, right, and you specify that you want that if TSH comes back below 4.5, they won’t run T three, T four. They’ll say, no, your thyroid is normal. And that.

drive me up one, we just get it all done privately because it’s not expensive and you have to get private care these days to get good care. But the amount of people who are walking into their doctor’s office with hypothyroid symptoms, who are getting diagnosed with chronic fatigue syndrome, adrenal fatigue, or just depression and anxiety would be astronomical. Um, and they’re just, it’s just going on detected, or even when the doctor does get a subclinical hypothyroid lab back, that’s obviously that they’ll go, Oh, it’s within range.

You’re just depressed. He is your SSRI. And that’s very sad.

Keith Nichols MD (01:06:45.813)

That’s right. That’s exactly how it works. That’s exactly how it works. And people need to understand why has it become so lab centric? Because in order to really treat people like we do, you know, you have to sit down with them and you talk to them and it’s going to take longer than six or 10 minutes, which is the average follow-up time in America for family doctors to see someone. You know, it’s just more efficient for them to look at a piece of paper, see that it’s normal, tell you they don’t need it, and then just go write a script for the symptoms that you’re having. It’s just the way the medical system is set up. Okay. It’s just, it’s not optimal in any way, shape or form. We all know that.

I never would believe I’d be talking about this, you know, 20 years ago when I was a good little soldier in that system. But now I understand that the shortcomings today, I mean, we’ve talked on a lot of topics today. I know, I mean, I know I’ve kept you for over your hour there, but look, I think it’d be important that, you know, there’s a couple of other topics that you and I should get together again and talk with it’s going to, it would require 30 minutes to an hour, just sit alone. And we both know that we do need to touch on estradiol and DHT. I would refer everyone to Dave’s book online regarding estradiol.

And DHT, I would go to his Instagram feeds as well, which have been very good. He’s done some really good ones on estradiol recently as well. He was on TRT and hormone optimization recently on estradiol, everything’s spot on. Okay. And so I think it would be nice if Dave and I could get back together for part three and just really take a little deeper dive into the estradiol and the DHT world. Okay. That’s the most controversial world. We understand it. But let’s, I think that if he and I could do that.

It would be a great service to most people. But Dave, I can’t compliment you enough about the knowledge that you have just obtained over the last couple of years. And I wish I had time to put out the work that you do on social media, but I just don’t have that amount of time. But I’m so glad that there are men like you out there that are putting out good quality. And the most important word I could use, the biggest compliment I could ever give you is evidence-based.

literature, you know, you do use it’s now evidence based and it’s just I can’t, I can’t disagree, would never argue with any point that you’ve made and anything that I’ve seen in the last year or two. So keep doing the good work. If people want to work with you, how do they get in touch with Dave Lee?

Dave Lee (01:09:01.366)

Yeah, absolutely. Thank you. So yeah, that means the world coming from UK. Thank you. And all the video content that I make is very much inspired by the content that you’ve made. And I even made a comment the other day. I did like a reaction video to your cream, your cream video that you just did with Stevens just to kind of add my thoughts to it. And the point that I made in that I’ll make now is that like the videos that you put up that 20, 30 minutes long, they take me two hours to break down because there’s so much value provided in them. But the

There’s no one else online other than yourself and maybe me following in these footsteps, who’s just getting online and just educating people to go, this is how you do it. This is the secret sauce. This is how it’s done because we’re actually wanting more people to get better and get this treatment properly because there’s so much potential for this to be done right. And it’s getting bastardized and ruined all over the world in these clinics who were just doing it wrong. So yeah, I,

All the content that I’m putting up is very much inspired by the content that you made, which has just been so educational and well explained, like all those old videos you did with Stephen’s channel as well as Jay’s channel. So yeah, that means a lot. Thank you very much. The way people can get in touch with me. So my website is adva I do health coaching consults. I also have a partnered clinic in Australia. So if anyone is listening.

And once these kind of protocols, we can do similar protocols in Australia as well, finally. So I’m available on there for consultations. I’ve also written two eBooks, TRT 101 and Beyond TRT, which Keith referenced before. And I’ve also got a number of the lectures that I mentioned previously on the TRT and hormone optimization channel. And I’ve covered a bunch of these topics and many more.

Keith Nichols MD (01:10:42.089)

Well, excellent, Dave. Well, look, you need to get on the our TRT and optimization channel. The one just came out yesterday. That’s probably the most controversial one of all, which is super physiologic. And I would love for you to be able to view that. And then I would love to get back together with you. So we can discuss the details of that video and super physiologic along with DHT and estradiol. In fact, you need to watch that video. Look at the comments because there’s an Australian guy on there. He needs some help. He needs some help. All right, he does. He needs some help. He needs some help. So man, I really appreciate you taking the time once again.

Dave Lee (01:11:05.721)

I’ll check it out.

Keith Nichols MD (01:11:12.017)

big fan. That’s, you know, the biggest compliment I can give you. And so thank you so much for what you’re doing for this for this for this sphere. Okay. And I appreciate that very much. And so I look forward to working with you again. So

Dave Lee (01:11:21.506)

Yes. Thank you very much. I’d been looking forward to having a conversation with you about Pregnant and Alone in DHEA for about five years. So I’m very glad we got to have it.

Keith Nichols MD (01:11:28.213)

Well, there you go, man. You’re the man. You’re the DHEA Dave and pregnenolone Man. There you go, man. You’ve really done a great job with it. I really appreciate it. I will cut it off now. But hey, Dave, man, you did great as usual. What’s your… Listen, I’m not going to give compliments where they’re not due. I’m just not going to. I think you’ve done a fabulous job and I really appreciate it. So, you know, and look, I’m a… Look, Dave, you got to remember where I came from. I was a spinal sports specialist.

Dave Lee (01:11:35.772)

Thank you very much.

Dave Lee (01:11:49.066)

Yeah. No, thank you.

Keith Nichols MD (01:11:55.949)

And I dealt with pro athletes. That’s why I was a spot team physician for our national hockey league here, the national predators, the national football league. I was a UFC ringside physician, uh, and all the championship fights that occurred in Tennessee, you know? And the point is, is I dealt with men and they were accountable. Okay. You know, these coaches, these athletes are million dollar athletes, but let me, they’re, they’re held accountable. They’re expected to, to be a professional and to do their job. I don’t do well with little sissy boys.

And I’m sure you probably don’t either but you know, that’s I just don’t I hate I hate to I don’t know Whatever the word to use it I just thought if you want a lot of coddling and you know that I’ll tell you just I’m the wrong guy for that But if you want me to give it to you it isn’t and help you out and get your hormones off I can do that So I just wanted to kind of tell you where that kind of comes from is that I look out, you know I like a man’s man. I can respect a different opinion But but I these some of these guys out there Dave there. They can’t be helped

You know what they just they refuse to do what they need to do to be helped. Would you not agree? This is not on, it’s not going to be in the video of what I was ever.

Dave Lee (01:13:00.042)

Oh, yeah, completely. I look at it like, it’s like the role of a father, like it’s paternal, like paternal, paternal guidance is, is letting them hate you in the short term for telling them what they need to know, not what they want to know. I’ve had many guys cry on the call. I’ve had them say, I’ve had them, you know, swear me out and say these things, but then they come back six months later and they go, I needed to hear that. Thank you so much for that. That made a huge difference to me. And I’m very willing to be hated. Yeah.

Keith Nichols MD (01:13:05.454)

Yes.

Keith Nichols MD (01:13:26.642)

I’ve had the same thing. Guys come back, say, I really appreciate you being honest with me. But I use a different word. I say, look, sometimes I have to be a coach. That’s what I have to do. I just have to be a coach. I just have to tell you that, you know, something that you may not want to hear or like to hear, but I just have to tell you the truth because I have to look myself in the mirror tomorrow. So that’s the point. But look, I, uh, like I do, the reason I got you on Dave is because you of all people are putting out.

Exactly how Rouzier now exactly what we have been saying for years and it’s, and it’s the right message. So keep doing it. And especially, you know, the fact that it’s not a panacea, the things you’ve been doing that look, you know, sometimes once it’s all optimal, you’ve checked that box, it’s time to, to man up and check everything else because they just want that easy button I do, but, but look at my office is filled with guys every day that have these wonderful, beautiful, optimal levels and they’re doing so great and they tell you how they change their lives.

But you know, you can’t please everybody, nor can you. You know, I’m sure you’ve had people that, I went to Dave Lee and didn’t do anything for me. He told me to do this and felt like shit, but it only took it for two weeks. You know what I’m saying? You know those guys.

Dave Lee (01:14:33.094)

Yeah. They want, they want to blame you for every experience that they have in the world. Um, yeah. And all we can do is set up the foundation and show them the way and they’ve got to build on top of that. And yeah, I think, um, but yeah, this was, this was awesome. And, and as I said, it, it very much, uh, means a lot to me having these words of endorsement from you, because I’ve looked up to you in the space for a very long time. So I’m, uh, looking forward to this coming out. One thing that I, I suggested to Steven, if it’s okay with you is if we maybe take a few reels from this and put it onto his channel as well.

Keith Nichols MD (01:14:36.573)

Yes, yes, yeah.

Keith Nichols MD (01:15:01.041)

I was going to suggest that you and I get with him. In fact, I’m doing this, in fact, Sunday the 17th, he sent a message at 1 p.m. Sunday the March 17th at 1 p.m. I’ve got a set up with him. It would be nice if you wanted to be there. I’ll send him a message, can we add Dave Lee to that? So it’s Sunday, March 17th at 1 p.m. Eastern. And what we’re going to talk about was prostate cancer, DHT and estradiol, all those things.

Dave Lee (01:15:03.682)

Cool. Yeah.

Dave Lee (01:15:19.21)

Yeah, absolutely. I could do that.

Keith Nichols MD (01:15:30.729)

Seth Garrett, good erythrosis, things like that. Let’s do it then, let’s do it. Then I’m gonna send a message right now and you talk to him too. So I’m gonna send it right this second. Let’s add.

Dave Lee (01:15:33.547)

Yeah, I can do that, absolutely.

Keith Nichols MD (01:15:44.185)

to.

Dave Lee (01:15:44.226)

Cause I saw people were very happy to see your content back on the channel. And I think that Steven needs to do a few more of those reels, like the short ones. So I think that if we can maybe shoot him over a copy of this podcast and he can clip out a few things, I think people would very much. I know that there are a lot of people in that group and in my private group who have been looking forward to us having a conversation about breaking alone.

Keith Nichols MD (01:16:04.285)

good. I hope we you know, you can’t we can’t take too deep of it. I don’t just stop listening and get it. But I think we covered what we really need to cover. For sure. Sure. And the less add that I’ll look now look, what I want as soon as he finishes what he needs to do the editing or whatever, he should send it directly to you and you should have gotten the last one correct. So yeah, you could do of course do whatever you want to with anything and we’ll do the same with this one. So as soon as he sends me the I’ll send it to Stephen, I’ll of course he’s going to send it to you and then we can do whatever you want to with it. But

Dave Lee (01:16:10.198)

No, it was perfect. It was perfect.

Dave Lee (01:16:22.218)

Yeah, yeah, very quickly.

Keith Nichols MD (01:16:33.105)

But yeah, let’s do the March 17th at 1 p.m. and let’s do that, me, you and Steven, let’s just talk about it again, talk about a few things. Like I said, I think it’s about, you know, but it’s basically simple prostate cancer and secondary thoracitis, I mean, you could do E2 and DHT, all right? You did a really good video on that E2 video, by the way, just saying, look, you could take it long-term because you think it feels better, but it’s gonna trash you long-term. We’ve been saying that for years, you know? Yeah.

Dave Lee (01:16:33.347)

Perfect.

Dave Lee (01:16:52.887)

Perfect.

Dave Lee (01:17:01.898)

Yeah, yeah, all of the stuff that you’ve always said has aged very well. And I think that that’s the important thing in this space is what age as well. And yeah, I think that that’s the most important thing. So yeah, this has been awesome.

Keith Nichols MD (01:17:12.105)

Thank you, Dave. Look, Betty, you enjoy the rest of your night, man. I look forward to talking with you again. I hope you are as full as you can be, man. So thank you very much. You too, Dave. All right, then, glad we’re…

Dave Lee (01:17:20.662)

Beautiful, sounds good. I’ll chat to you on the 17th.

Dave Lee (01:17:27.39)

Absolutely. Thanks very much. Bye-bye.