INTRO (00:01.134)
Thanks for tuning into Tier 1 Health and Wellness Podcast, the podcast that’s all about bringing you cutting-edge, evidence-based insights on all things related to hormones and how hormones can and do impact your overall health and well-being. And now, here’s your host, Dr. Keith Nichols.
Dr. Keith Nichols
Welcome to the Tier 1 Health and Wellness podcast, Home of Evidence-Based Medicine. It is my extreme excitement. I have to say I’m actually excited to Dr. Andrew Winge on our podcast today. I’m a huge fan of Dr. Winge. I’ve been following him for quite a while and I’m absolutely impressed every time I see him put out a new video or any information. He follows evidence-based medicine to the core. I’ve never been as impressed with any individual I’ve seen out there in the recent year or two that I have Dr. Winge.
So it is my extreme pleasure. He is the CEO of man medicine. It’s a telemedicine only practice for men where he runs the man medicine Academy. First and foremost, I want you to tell us about yourself and what brought you to the field and also your own personal experience of what you may have gone through. But also I want to thank you first and foremost for serving our country. cannot tell you how much it means to me and everyone else. So thank you very much. Thank you, Keith. Yeah, it’s a huge honor for me to be on your show.
Dr. Andrew WInge
You don’t know this, but I follow your content online for quite some time and I’ve learned a lot from you from a distance. So it’s a huge pleasure when that invitation came through my email. I was very excited about it too. So I appreciate you having me on here. But I got into this space through my own issues. think a lot of us as physicians that were in traditional medical specialties and then eventually transitioned into men’s health, bioidentical hormone replacement.
Many of us entered into this space because of some of our own personal issues. My medical background, just for the listeners, is I’m a traditionally trained MD. I went to the uniform services university, which is a military, I was military trained from day one. a full career in the Air Force. I’m board certified in family medicine and emergency medicine, employed on a number of occasions. And I still practice full-time emergency medicine as well. So I see the, know, the entire spectrum of the healthcare world, or I have at least in my career. And, and I continue to practice in that, that broken system. So, but as far as, how I got into this in my mid thirties, like a lot of men, I think I felt that something was, wasn’t quite right. And for a long time, I, it started in my second residency, my emergency medicine residency. And I attributed that to listen, we’re working 80 to a hundred hours a week. Emergency medicine is a shift work.
So the circadian rhythm is just a mess for all of us. But when I got out of training and things got a little bit better from a lifestyle standpoint, and I was still working a lot, still very busy deploying and had Air Force duties and things like that, but things were not getting better. was primarily just very, fatigue is a big one that men complain about. And I realize that’s, kind of a nebulous complaint, but I was not as sharp as I was on my shifts.
I was having difficulty remembering drugs and dosages and I found that the nurses were catching little mistakes that I was making. in a level one trauma center, which is where I was working, you can’t afford to have those kinds of mistakes. so I noticed things were slipping. While Obito was certainly in the toilet, it was affecting my relationship at the time. As a physician, you would think that I would have put two and two together and said, listen, I need to get this checked out. But I didn’t.
I didn’t. I should have known better, but I didn’t. But I had a colleague who was a urologist who said, listen, let me order a testosterone level for you. Yeah. And lo and behold, it was in the just right above 300. And for me, obviously, that was low enough to be to be highly symptomatic. And and the background to that also additional data point. I I was born I had bilateral cryptorchidism. which for the listeners is undescended testicles. And I was not born in the United States. I was born in Spain and it either was missed when I was born or they just didn’t really understand how important it was to correct that surgically, which we do now. And typically like when a baby is born with that condition, usually within about six months, they want to bring the testicles down out of the pelvis, you know, into the scrotum to prevent damage. Well, mine were not repaired till I was like three and half.
So I always knew that I would have fertility issues, but everyone that I had seen as a kid and even as a young adult said, you won’t have any issues with testosterone with that. That was what we thought at the time. Well, lo and behold, we know that that’s not true. That’s not true. So I presumably had pretty good testosterone levels as a teenager. I survive puberty. I was a competitive power lifter in my early 20s and completely natural. and was able to put up some decent lifts, put on a lot of muscle. So I’m assuming I had natural testosterone levels as a young man, but something happened in my mid-30s. And I know a lot of men have that story. so long story short, I got on testosterone replacement. And I’m the kind of guy that if I’m gonna delve into something like this for myself, I have to know everything about it. So I went down the rabbit hole. I took as many CME courses as I could.
I got as much training as I possibly could. And I continue to do it because I, you know, I learn new stuff every day in this field because it’s, I just find it so fascinating, but it, radically changed my life. I got the old me back, so to speak, and it may have been placebo. I’m fully willing to recognize that, but gosh, within seven to 10 days, I just felt like that fog had lifted and the clarity and the sharpness that I had intellectually was back. I was able to work more emergency room shifts. At my workload, I could handle it now. I just, you know, I not to make light of it, but I was, you men with low T are they get kind of bitchy and irritable, and they don’t handle adversity very well. And I and that was that’s not me. But that was definitely happening to me. And I noticed that corrected very quickly. Things that bothered me previously didn’t bother me. You know, I became you know, much better partner in my relationship. Now, you know, fast forward years later, I’m a much better father than I than I know I would have been. And I credit testosterone with all of that. So when I saw those, you know, when I saw what it did for me and I learned more about it, you know, I recognize what a huge problem this is. And of course, it’s only gotten worse. You know, in 15 years since I started treatment, you know, I wanted to help other men, you know, have those kind of same experiences because I
Once I started asking and once people kind of knew they heard me talk about testosterone, they just came out of the woodwork. And said, well, I feel exactly the same way. I would check some, I started with some friends and family, of course. And lo and behold, I was getting very similar, if not worse numbers than these guys. And then, you know, I was still on active duty at the time and I was, I was shocked by some of the low numbers that some of our deployed soldiers were coming back with.
And many of those guys had traumatic brain injuries and were being put on antidepressants and some of these atrial antipsychotics. I know you’ve seen this a hundred times and I know you’ve talked about it too, but many of those guys were suffering unnecessarily, found. And simply because nobody had ever thought to check the testosterone level, let alone the growth hormone, IGF-1 level, thyroid, let alone any of that other stuff. They were all being put on antipsychotics, antidepressants, and many times that was just making things worse. Fast forward to now, this is a huge part of my life. I’m still in the emergency room and I’m still taking care of critically ill and injured people. Emergency medicine is a young man’s sport, I say, and I’m not getting any younger, so I eventually will be transitioning full-time into this because it’s just so enjoyable. I feel honestly, people who don’t know medicine maybe can’t appreciate this, but I do more, I save more lives in my hormone practice than I do in the emergency department. I think I’ve made a bigger dent in the universe in terms of helping people by practicing this kind of medicine that I have in the emergency room outside of my military deployments. Of course, that’s a different story. Well, there’ll be a lot of cover the origin story. mean, that’s in a nutshell, how I got into this. Many of my own issues were solved by testosterone. So I’m a huge advocate.
And of course, once you learn about testosterone, then you start learning about the other hormones. I love what you have said in the past about the fact that we need to address all the hormones. We need to bring them all up to healthy, optimal levels and not just focus on testosterone or thyroid. You know, we need to look at things from a holistic standpoint, you know, and as a family med doc, that’s music to my ears, looking at the big picture. So I’m a big advocate of all of those things. All the things that you’ve talked about in this podcast are right in line with how I practice as well.
Dr. Keith Nichols (09:25.518)
Well, your history absolutely mirrors my own. It’s amazing to hear that story because that’s exactly what I went through. I tell my patients all the time. The reason I do what I do today is because I was mismanaged, misdiagnosed and mistreated by my own colleagues. And it wasn’t purposely. They just didn’t know better. And I also was trying to juggle two practices, a spine and sports practice along with home. But it just got so busy, but also so satisfying that ultimately had to give up one because I just couldn’t couldn’t manage them both anymore.
And so several years back, I, you know, went full time into, into the hormone field. And it’s been a, it’s been a godsend since then, because I people out there, they don’t really understand that from a clinician standpoint, what you do and what you get to do every day and what you’ve just outlined is what I get to see every day as well. You may think that what we do, we get to deal with problems all day long, like we did in the ER or like you do in the ER, like I did in spine and sports. Yeah. Look, what we get to deal with different from what you may think.
Because what you see in read on forums is we get to deal with success every day. It’s very rare that we run into any problems with what we do. And it’s just amazing that you just get to talk to man after man after man every day and talk about how much better they are. Much different than people may think. They may think that once again, that we are having to put out fires all day long or deal with the issues that you’ve had done podcast on for everything from gynecomast or this and the other. Well, we know we literally don’t have to deal.
Those issues, they’re very rare. you know, there’s a lot of talk about physicians burning out in medicine. And I understand that I’ve been burned out on more than one occasion in my career. But I think a lot of that burnout comes from this feeling like we all went into medicine to help people. if you’re practicing in the mainstream medical world, you know, whether it’s an emergency department, ICU, even in a regular primary care practice, you know, many times you I felt at the end of the day, like I hadn’t really helped anybody.
I was not making the world a better place. And I know again, that may seem kind of strange to people who are not in the medical system, but that’s not the case with this type of medicine. The radical changes when you have a patient buy into the things that you’re telling them and they trust you. And of course they’re willing to put in the work. I 100 % agree with Dave Lee. That was a great podcast that you had. I love how he talks about getting the results that you deserve.
Speaker 2 (11:52.408)
So when you have the right patient and the right treatment plan, the transformations are just radical. And there’s nothing better as a physician than you feel really good. I feel good about that. I don’t feel as good at the end of the day in the emergency room when I put a bandaid on somebody’s chronic problem or I send them to the OR to get their foot amputated. And I don’t feel good about that.
If I get a guy and I can get his human woman A1C from 10 to six and a half with testosterone, thyroid and some nutrition and training advice, I feel great about that. Right. Right. Well, there it is. Rewarding people need to understand that we’re human, We have feelings, too. You know, you know, our self-worth is defined by our success rate and it would be a tear. It’s you know, it’s it’s it’s terrible for those physicians that deal with disorders that never get better like.
You know, neurologist, for instance, you know, it’s very depressing, but you’re right. It’s just a six. And as you mentioned about the day podcast, everything, if a guy will put in the sweat equity, the results can be amazing and work amazing. I mean, testosterone real reward effort. I mean, what’s the saying? Don’t be upset by the results you didn’t get by the work you didn’t do. Well, if you put in the work, you will literally, it will, it will, you will be successful, but it does require quite a bit of a sweat equity. it does.
100%. That is the key. Yeah. Pistachio won’t, you know, it’s, is not a, it is not a panacea. And I know we were going to talk about that, but that’s, again, that gets back to what we talked about at the beginning here before we started recording about expectation management and, and men need to really understand that this is a partnership with the hormone.
and you will get out of the hormone what you also bring to the table, what you put into it. And if you don’t, if you don’t bring anything to the table and you’re not willing to make even these more basic changes, you get what you get. Right. And the men that don’t see results, I know you’ve had them too and I’ve had them. You get great levels of across the board, just really couldn’t be any better. Then they’re still gaining weight and still having these issues.
Speaker 2 (14:03.342)
And you’ll ask them, well, you you, you, you really need less evaluate the diet and exercise. Nope. got a perfect diet. You know, men that are most successful are going to be able to sit back and take a critical analysis of their life. They’re really, have, know, for instance, you know, that workout hard because you go to the gym for an hour. Doesn’t mean you’re working out hard. Does it mean what you need to do to literally lose weight, especially body fat, gain, that doesn’t mean anything while can go to the gym. And, know, because you’re a black belt and
and you did see which is which is also by the way, you know, I worked with MMA fighters. I was one of the ringside positions for UFC. And those are some hardworking guys. And people want to talk about working hard. Look, whenever they say they work hard, you can always work harder because when those guys are or fighting, when you’re out there training for for competition, that’s hard. Now, there’s there’s a little bit. Well, you can take it up a notch. So now that is the guys. Yeah, you can’t really.
I used the word you want to argue with them, but you do try to kind of help educate them. But some are amenable to the change and some are not. So there’s a lot of training. mean, when you’re training, you’re working toward it. Yeah, there are levels of training as well, for sure. And that could be a little daunting. know, I mean, I get guys like I’m sure just like you do who have made it into their late 40s.
and have never exercised. Those guys, start with, if you’re 450 pounds, we start with a walk around the block. That’s right. That’s where we start, right? Right. But my goal is eventually to get you to the highest level of intensity that you’re willing to tolerate and do that. So you have to meet people where they are, obviously. But again, it’s funny, know, the harder you work, the better the results. There’s no question. So Andrew, you’re obviously on testosterone. You’re in excellent health. We all know that.
black belt and jujitsu. So let me ask you this. Do you have an erection every morning? No, no, mean either. Do you feel like working out every day? No, not. get it? Do work out? Are they always good workouts? No, I never regret a workout, but they’re not. They’re not not always stellar. Right. It’s not. Does your libido is it just 10 out of 10 every day of every week? You know, it’s just like that. Okay.
Speaker 2 (16:24.876)
All right. Interesting. So, do you get tired many days in the afternoon? You know, Keith, I do, I do get tired. Yeah. Well, Andrew, do you realize you are absolutely not dialed in? Right. People want to use these dialed in, then you should be adjusting your protocol. Neither one of us are dialed in despite probably having this optimal levels of hormones as you can have. Exactly. So, so men out there, that’s not what dialed in means.
We’re treating men with a testosterone deficiency. We’re treating men with symptoms of low testosterone. I made this comment, Andrew, I’ve never made it online before. I’m going to make it now. Everyone benefits from testosterone, male, female, young, old, but not everybody needs it. And so that almost sounds like, what do you mean, Dr. Nichols, if everybody benefits from it, why wouldn’t everybody need it? Well, because I can’t squeeze out the performance enhancement characteristics of testosterone.
The benefits when you take it and everyone are going to be increasingly muscle mass, strength, endurance, exercise, tolerance, bone mineral densities, healing capacity, recovery time. That’s why it’s banned in sports. That’s why young men probably can’t take it. But that doesn’t mean everyone needs it. The need comes from a person experiencing symptoms. They have symptoms of a true testosterone efficiency. And we give those men testosterone. We overcome those symptoms of deficiency and therefore make them a normal human.
of efficiency for that individual.
Speaker 2 (17:49.39)
subject to all the ups and downs that all of us normal humans have. It does not make us this. we do not live in a perpetual state of Nirvana every day and people can’t use hormones like a stereo equalizer. As I say, they’re having a bad week or a bad month. They just can’t make these adjustments and think they’re going to overcome life with hormones. We overcome your symptoms of a deficiency. As long as you continue to do what you’re doing, you will continue to resolve your symptoms of a deficiency.
You’re going to have good and bad days, good and bad weeks. You’re not going to have a rage in libido all the time. And I’m sure you see it all the time. I don’t have the libido. I think I should all the time, all the time, all the time. Well, can’t give you the libido. You think you should have your levels are off the moon. There’s about 14 other factors that go into libido. We all want certain things. That doesn’t mean we’re going to get it. mean, I hate, you know, it’s, know, life is not always fun. It’s not always that way. But we’re certainly
The bigger picture is that we’re using these hormones to overcome deficiency, to maximize health. Exactly. That’s really going to take on the expectations. And so please enlighten us on some of the things that you see and what you run into when it comes to men and their expectations. That was beautiful. That was far more eloquent than I could ever explain it. It’s absolutely right. Now, when a man comes to me and to any doctor, they
They’re typically coming in with a set of complaints, signs and symptoms that are bothersome to them. And so it’s up to us, as good clinicians, to take a good history, do a good physical exam, and then come up with a treatment plan to try to address those. Now, obviously, I do that, you do that, all good clinicians do that. I also have some things as a medical doctor, goals for them that perhaps they…
maybe are not their top priority. Things like, really want your cardiovascular risk factors to be as optimal as possible. I’d like you to have good blood pressure. I’d like your lipids to be under control. Your fasting glucose, all these sort of metabolic long-term health parameters. Those are many that that’s what I’m thinking about. In addition to, I would certainly like to help you with your libido, your mood, your energy, your brain fog, your body composition, et cetera. So I have my own little agenda that’s in
Speaker 2 (20:08.622)
in the background there that I work into, you know, my relationship with the patient. But you’re absolutely right. And, know, these misconceptions that guys have, think they come, know, social media is obviously a big part of that. It’s social media is such a double edged sword, obviously. I was just chuckling last night. I was just trolling through one of the forums before I went to bed. And there was at least two posts in there about guys that all of them had been on TRT less than four weeks.
and they were complaining that they weren’t getting, I don’t feel any different. What should I do? And thankfully most people on there were like, listen, buddy, you gotta give this, four weeks is not enough time to make a protocol change. But they were already looking. And I blame, obviously social media and things like that are partially responsible for that. But also it’s their clinician. It’s obvious that somebody, their doctor, prescribing, VITR, whoever the case is,
didn’t sit down with them and do some expectation management with them before prescribing to them. And that’s really key to kind of set the stage for expectations. know, erectile, many guys come in with erectile dysfunction and they’re under the mistaken belief that the only reason I have ED is because I have low testosterone. And so a week later after my first shot, when my levels are normal, I should no longer have ED.
The data is very clear on that, improved sustained improvements in erectile function can take months. know, it can take months. 52 weeks up to 52. Yeah, exactly. Exactly. And, you know, if you have a, if you have atherosclerosis in your pudendal and penile arteries, I’m sorry, but you know, now we have a mechanical flow issue that we need to address that testosterone will only partially address that. So that’s really important. And I, you and I both spent a lot of time, I think managing expectations and guys
because many times they’re unrealistic. I know you’ve talked about this. I see this all the time. Guys will have a fantastic result out of the gate. Six months, a year later, this stuff isn’t working anymore. obviously you peel that onion a little bit and then you realize it’s not, it’s not that it’s not working anymore. It’s your relationship is now you’re going through divorce, your relationships in the toilet. You know, you had some other really major life setback.
Speaker 2 (22:34.222)
You’re not sleeping, et cetera. It’s always that one’s hormones do not stop working. They’re always there. People will write. They don’t. OK. And that’s that’s also true. I’m so glad you see it. I’m so glad you brought that back. They just don’t stop working. That’s not how they don’t stop working. You know, I I’m 13 plus years into this. You know, I have an 18 month old. got up three times last night for that kid.
And and I’m tired. Right. You know, I’m probably less tired than I would be if I was still a hypergranatal. I think I handle it better. But, know, when it’s three, that’s a baseline fatigue being a baseline fatigue. And then, of course, but so you don’t have the baseline fatigue. I don’t have the baseline. I’d like a normal person would get that’s not a good.
Probably a little
Speaker 2 (23:25.696)
everything you’ve explained. Absolutely. But when it’s 3 a.m. in the in the emergency room and I’ve got four ambulances deep in the bay. Yeah. I mean, I’m tired and there’s not enough testosterone in the world to fix that. Or thyroid. Not enough. Or thyroid. It doesn’t matter. So that’s just super important for guys to understand. And also, you know, getting on TRT, for example, at age 50 isn’t going to undo 30 years of bad lifestyle choices. know,
the damage is done to a certain extent. And so it may take a long time to reverse all of those things that you’ve done to yourself. It’s not like if you quit smoking tomorrow, your risk of lung cancer goes down to zero. It takes many, years, over five years plus to do that. that’s a very important conversation to have with men. if it doesn’t happen, you end up with unhappy patients sometimes.
they will leave you to go to another practice that, you know, promises them better results. But the reality is they’re not going to get better results with them either. I’m so glad you brought that up. But look, I’ve said it before and I’ll say it again. There are, there are symptoms we want hormones to improve and there are symptoms that they are going to improve and they’re not always the same. Absolutely. We want it to improve. Doesn’t mean that it is. And once we raise those levels, they give you off the levels, give it time to work. Whatever improves. Okay. Was related testosterone.
Whatever it does not, then you need to look at other means. Exactly. That’s really a key part of that. probably probably get a little overboard right now with new patients about explaining what it doesn’t do versus just about what it does to try to try to temper down those unrealistic expectations because that can be a roadblock to efficient care and good clinical outcomes. So we’ve got to be realistic in what we’re doing. So, Andrew, you work in the ER, you still have?
you know, full time ER doc, which is, is, you know, admirable, of course. And I’m sure you see many people that come in on whether it be on a weekly monthly basis that may be overdosed on certain drugs and not just listed drugs. We’re talking about literally over the counter drugs or medications every day. Tens of thousands of people die every year from drugs like acetaminophen, Tylenol and anti-inflammatory drugs like ibuprofen and Advil. But yet
Speaker 2 (25:46.454)
I don’t know of anyone that died in the medical literature from testosterone itself. So we’ll see all our patients come in, you and me both, on multiple medications that have all these potential side effects and can cause potential harm. But yet there’s this so-called hormonophobia.
with hormones like testosterone. So would you like to kind of elaborate on what you see in that regard? absolutely. I’m so glad you brought that up. It’s a very specific kind of hormone phobia related to testosterone and steroid hormones. And I’m going to obviously lump estradiol in there too. The misinformation about female HRT is probably worse than it is for men. you’re absolutely right. In 24 years, I’ve never had a single maroon serum visit related to testosterone with one exception.
I had an elderly guy who developed necrotizing fasciitis from a dirty injection. had every risk factor in the book and he did not use sterile technique. But that wasn’t the testosterone that caused this problem, right? But I see, mean, just two nights ago, I put a guy on a helicopter dying of a GI bleed that was multifactorial, but it was also related to NSAID. So, most physicians, don’t think bat an eye.
about prescribing these drugs, prescribing dangerous opiates, that sort of thing. And in the hormone realm, you know, like I said, it’s focused much of the phobias and these steroid hormones. you know, insulin is a hormone and doctors don’t bat an eye at prescribing huge amounts of insulin. And if I had to pick one hormone where I see the most misadventures with and ER visits all the way up to including seizure, coma and death, it’s
insulin, yet it is liberally prescribed by physicians and most primary care specialties, endocrinologists, et cetera. The psychology, to is a little bit interesting because we all know about the Endocrine Society guidelines. tell you you have to target a specific number in the normal range. But those very same endocrinologists, Keith, if you came in to the emergency department hyperglycemic,
Speaker 2 (27:59.582)
If polyuria, polydipsia is thirsty and urinating excessively. Would you want me as your doctor to titrate your insulin levels to the high normal to keep you within the normal range? No, you want me to, I’m going to give you the amount of insulin that you need to correct your signs and symptoms of hyperglycemia and reduce the risk of hyperglycemic complications. And I don’t care what your insulin level is.
I might need to give you a hundred. I’ve given over a hundred units of IV insulin on many, many occasions, which is way super physiologic, but I do that because I’m looking for a clinical effect. I, and most, you know, 99 % of physicians don’t have an issue with that. They understand that concept, but with testosterone, for example, or thyroid hormone, all of a sudden, if you’re over 700, whoa, we need to drop your dose, my friend. I, I realize.
I realize you’re still symptomatic, but we have to keep you at 700 or whatever arbitrary number they decide. So it’s very interesting to me that it’s really certain hormones we can give wildly excessive doses, or not excessive, but they’re appropriate doses for the clinical effect. Yet others, which are actually far safer and have a much better risk profile, are treated like kryptonite. They’re dangerous. And it just doesn’t make sense.
It make sense to me at all. It doesn’t make sense because it shouldn’t make sense. And to all our listeners out there, what Dr. Wing is explaining is he’s explaining that in the ER with the insulin things and drugs like that, we are given a pharmacologic dose for a physiologic effect versus the way we’re trained in hormones. They want to give you a physiologic dose. What does that mean? That means they want to keep your levels in a so-called normal physiologic range or a very specific number in that physiologic range, such as
450th American Neurology Association for instance, or, you know, mid to upper normal range for the American neurology, I mean, the, integral society. So, so what we’re talking about is pharmacologic dosing with testosterone or thyroid for a physiologic spec, a clinical outcome, improving clinical symptoms, not giving us everyone a physiologic dose, which doesn’t work in most instances. So that kind of, and so I’ll say this one last thing about that is that look,
Speaker 2 (30:22.156)
The fear that they have of testosterone being outside that normal range. We’re not talking about bodybuilder levels. We’re talking about optimal levels, like you and I see in our practice. There is no harm in that only been about every parameter of health that we can measure improves in those men. So, so the ones that want to keep it in the physiologic range are afraid of a, they are, they, have a fear of something that doesn’t truly exist. I used to say this all the time. It’s a boogeyman that does not exist. Correct.
Absolutely. Man that doesn’t exist. So that leads us into the fact that so when you’re treating men there Andrew so we know that we’re trying to get optimal levels which we’re not following numbers. We are following numbers but we’re not aiming for number we’re for symptomatic improvement. Exactly. So when you’re when you’re treating those men I know you you know we’ll talk about your methods of delivery delivering how you go about that but so what are those levels that you typically say so I’m not going to ask like we usually get asked what numbers are you looking for I know you’re not looking for one.
But in your practice, what are the typical levels that you see in a bell shaped curve where most men get symptomatic improvement? Yeah, you and I, I think are pretty much on the same page with that. I have outliers, of course, where they get complete symptom resolution with numbers that are within sometimes even the mid normal range. Those guys are outliers. Typically, it is these guys are super physiologic, especially when it in terms of their free testosterone, 20, 30, 35. If a man is
getting above that level, 35, 40, and I’m really not making a dent in whatever symptoms he came to see me for. You sometimes it’s important to take a step back and just make sure I have the right diagnosis here and that I’m not missing something else. But what you said earlier was absolutely correct. With every incremental increase in that level, you just see more benefit. And that is supported in the medical literature.
You see improvements across the board. I see improvements in blood sugar control. I see improvements in lipids. I see improvements in well-being. I absolutely see improvements in visceral body fat, fatty liver disease. And you get those improvements with levels that are above what is considered to be the average or the normal reference range. And many times you won’t get those improvements until you reach those upper levels.
Speaker 2 (32:43.198)
That’s just the way it is there’s a dose response relationship response is related in this case what our listeners need to understand a dose response relationship meaning The better the dose the better the levels the better the response now We are both talking there’s a cutoff point for both of us and I’ve said before you know Like 30 to 60 is fine. Some of my men are lower than that. Some of them might be a little higher But that’s kind of that range that you see the improvement once you start getting above that Anything that’s not better. It’s just not testosterone. There is a plateau
to the right testosterone. There’s a point where those receptors are fully saturated and you’re just adding more is just excess and just going to, you know, increasingly muscle mass. That’s why bodybuilders do it. So, so certainly that that’s, that’s what we both see. And I’m glad to hear that now that’s unfortunately misinterpreted that my men out there that are not on testosterone. So when they hear us use these words, 30 free testosterone, 30, there’s probably not many men, if any men out there in the United States right now at baseline,
That’s not on testosterone that naturally has a free testosterone of above 30. I’ve never seen that man. I don’t, I really don’t know if he exists, but as you’ve heard me, maybe you’ve heard me do these podcasts recently about talking about that to get a good clinical response. It typically takes a level outside the normal range because when we take the end result testosterone, we’re bypassing all the events that occur in steroid genesis. And certainly those intermediate hormones have a role in how we feel and function. So when we make it ourselves,
We’re going to be more sensitive to it. see that from a clinical standpoint. So when a man’s out there that he’s in his early thirties, late twenties, and he gets his testosterone levels measured and there’s six or 700 friends just making up a number and that pre-testosterone, let’s just say 18, 19, maybe even 20. Everything’s really good. Look, you can’t look at the numbers for men on testosterone, that 30 to 60 and relate that to a baseline free testosterone level.
Because as I’ve also said, but they failed to hear this part of the conversations that look, if I could personally make testosterone myself to level a seven or 800 or whatever, and I had a free testosterone 18, 19, I would probably perfectly fine. Wouldn’t have any symptoms, but since I can’t, my levels are much lower than that. But if those are my numbers that made me feel better at baseline, then great. But when I get on testosterone, what I typically see is it takes a level, maybe
Speaker 2 (35:01.462)
twice what I could produce myself to get the same result. So instead of having a free of 19, I may need one of 40. So the take home message here is a lot of men out there are getting on testosterone that don’t really need to be on it because they’re aiming for these numbers for men on testosterone. And those aren’t the numbers are not the same. All right. I hope I’ve explained that in some degree and maybe you can help me kind of explain that in a little more detail to our listeners about the point that I’m trying to get across is that
Don’t look at that number if you’re 28 years old or 25 years old and it’s not 30 to 60 think that you need this pastoral. It’s not have the symptoms of an efficiency first and foremost. Precisely. Yeah, that that was perfectly said. Getting back to the insulin thing is it just as as a another way to think about this too. The reason that we have people with type two diabetes that are on super physiologic doses of insulin is because they have insulin resistance and you know, androgen resistance is a thing.
you know, we have these issues with, you know, endocrine disrupting compounds. Many of them interfere with the androgen receptor. You don’t have a nice clean androgen receptor these days. I don’t think anybody probably does. And so it’s, it’s not difficult to get a, a physician to understand the concept of insulin resistance and why you need to give big doses of insulin to control somebody’s blood sugar or their triglycerides or whatever. but for some reason it’s difficult to get them to understand the exact same concept.
with a hormone like testosterone, ethyl, thyroid, et cetera. Fundamentally, it’s the same thing. This person has resistance to the hormone for whatever reason. And so they’re going to require more unless we find a way to clean up your receptor and make it more responsive, which is not going to happen anytime soon. The answer is that we need to give more of the therapy. You increase the dose of the therapy and you achieve the result that you want.
And the level will be the level. Well, you know, when you treat a normal man, my 50, 67 year old man that they, they, do so well clinically when we treat with a physiologic, I mean, a dose of physiologic effect. But the problem that we both run into Andrew, and you know it as well as I do is, is, is what everyone sees out there with regard to social media right now, the abuse of androgens, testosterone, anabolic steroids are glorified. It’s it’s, just, it, the social media platforms now are just full of those.
Speaker 2 (37:28.726)
And so that’s what our mainstream colleagues see. And that’s what they ask. Every man wants to do. They all think it’s going to be about sex and muscle. So when we’re treating them, these men outside the normal physiologic range, it is truly misinterpreted as those guys are abusing it for the wrong reasons. Unfortunately, so many people are out there abusing it for the wrong reasons. There’s so many of these misconceptions that originated in the bodybuilding world, even back from the seventies that have, they’ve spilled over into the.
consciousness of medical doctors and other medical providers and the general public too, of course. And it’s tainted this really valuable therapy. I do feel like things are slowly getting better with these new generations of physicians that are coming out of their training. at least not as, they may not be pro testosterone, but they’re at least somewhat neutral about it. But there’s a whole, your generation and mine of medical doctors that
We can show them a stack of papers and I’ve done this. put it, you know, please read these papers and they just, they go right, neither go right in the trash or they’re just unwilling to change their opinion. You know, perpetuating these misconceptions about heart disease, prostate cancer of all things. And still, mean, that’s been put to rest for more than a decade yet you and I, I still hear it. and, and it’s frustrating. So I think a lot of these old timers just need to retire.
Yeah. Well, we say it all the time and people ask, what’s the hardest part of your job? The hardest part of my job and Dr. Winge’s job is truly dealing with the family doctor, the internist or the ender. yeah. It’s truly the hardest part of our job. The hardest part of our job. So that that’s that it’s all true. I literally have told the story before and I’ve had I had two very specific. I used to try to provide information to information to local providers. I stopped doing that a couple of years ago because I literally had two women come back in in tears.
because they took the packet of information on estradiol and testosterone and women and progesterone took it to their family doctor and they both literally right in front of them. So they handed it to them. They opened it up, looked at it and put it in the trash can right in front of them. That is not a made up story. That is a true story. That’s how that’s that’s what they think of us and what we do. And I think all the time, I wish there was not a need for people that do what I do or for Dr. Winge does. I need for what we do.
Speaker 2 (39:51.712)
I wish it was accepted in mainstream. It would make the world a much better place. There’s no doubt about that. Yeah. So I have a, I have a patient who I’m, very proud of. He’s done really, really well that I have on T3 therapy. In addition to his T4, he’s done extraordinarily well on it. And, his, his primary got very angry at him and me through indirectly. and, said that the only people that should ever prescribe T3 or endocrinologist. That’s right.
That’s right. That’s the way they feel. And here in front of her was this guy who’s lost 60, 70 pounds, turned his life around every single health parameter that she had been harping on him about for years that she was not able to improve. I had helped him with his hard work, radically change. Yet she was she was angry about this T3. She completely ignored the clinical result. The fact that this guy
probably added 20 years to his life, not to mention his improved quality of life. She couldn’t get past the fact that somebody who wasn’t an endocrinologist had given her patient T3. And that’s just one story. I know you’ve got similar ones. It happens to all of us literally on a weekly basis and it’s just always best to never get into a dueling doctor scenario. I just try to tell them that maybe you should always tell them that I’ve got somebody else that manages and specializes in that so we don’t even need to measure or test it.
Thanks for listening to Tier 1 Health and Wellness Podcast. Don’t forget to subscribe to the podcast for free on Apple Podcast, Google Podcast, Spotify, and any other podcast directory of your choosing. By subscribing, this ensures that you don’t miss out on a single episode of the podcast. and please don’t forget to visit our website at tier1hw.com. Until next time, stay informed and stay healthy.
