My name is Dr. Doug Lucas. I’m the chief science officer for PhD, weight loss and nutrition. This is our livestream talking about testosterone, exercise and weight loss, a super fun topic for me. I really like answering questions on this. Okay. So quick, disclaimer. I have to say this. So this discussion is not medical advice.

I am not telling you what to do for yourself. I am not your doctor, unless I’m. And I see a few of those. This ultimately is for educational purposes, only if you’re going to make any changes based off of this, please discuss it with your healthcare team. If you don’t have a healthcare team and you need one reach out to us and I’d love to talk to you about how we can potentially help.

But this does not create a doctor patient relationship. If you want to reach out to us, this will be at the end too, but this is our website, optimal human health.com. And then hello@ohamd.com is the best email. That’ll go to my team as well. And we’ll again, we’ll talk more about that. All right. So our goals today, I want to talk about testosterone deficiencies, something that is.

Really not talked too much about in, in the general circles of health and vitality and wellness. But it’s something that really needs to be talked about because it plays a huge role in so many factors that we’ll discuss. Because it’s not talked about in those circles, it frequently gets kind of swept under the rug and people that are struggling with.

We’ll tend to pursue avenues that maybe don’t provide the best quality care or maybe potentially products. They even actually are risky. And so I think it’s important that we have an open and honest discussion about what testosterone is, what the symptoms are and what they are not and how to manage it and how to mitigate the risks of if you’re replacing one, but you don’t necessarily have to replace it.

If it’s low, there are other ways that we can elevate it. I want to talk about weight loss and testosterone. There’s a lot of confusion. You know what weight loss does to your testosterone and vice versa, which we’re not going to talk as much about I want to talk about exercise and testosterone, because again, this is something where I think people will get, get misguided and go down the wrong exercise pathway and then find themselves not getting the results that they want.

And there are a number of reasons why that can happen. And then we’re going to chat a little bit about how to improve your testosterone leaning mostly on lifestyle, nutrition, supplementation. I find that you can make pretty tremendous improvements through those avenues and then ultimately replacement who should consider replacement and what that even looks like.

And I’m happy to answer more questions on that front. And then we’re just going to go over a few quick cases. Basically just some numbers from folks that I’ve worked with over the last couple of years. All right. So testosterone deficiency, like I said, this is everywhere. It is truly an epidemic in our country for a lot of different things.

It’s hard to identify because the definition of low testosterone actually only even exists for men. There is not a definition of low testosterone for women. And you’ll see when we get to the cases that the reference range for free testosterone, which is the level of testosterone that’s active in your body, actually go down to zero, meaning that if you have zero testosterone and you’re a woman that’s considered normal.

So the next time your doctor says your labs are. You may want to question what that means and is that an optimal range because zero is not optimal and it shouldn’t be normal. There’s a big discrepancy of numbers versus symptoms. If you look at the definition of, of testosterone deficiency in men, because again, there isn’t one in women, but if you look at the definition of men, what you’ll find is that there it’s a number, it’s a threshold of a number and it’s a really stinking, low number.

It has nothing to do with symptoms. And that’s a problem because I can’t diagnose somebody with low testosterone based off of symptoms. Let’s say a man’s testosterone is 350. Normal is kind of 600 to a thousand, their level 350, but they have all the symptoms of low T I can’t diagnose them with low T, which is extremely frustrating because then insurance won’t pay for the testing and they won’t pay for the medications to fix it.

So it’s, it’s a huge problem. Our definitions are. Way off base. They don’t include symptoms. And there isn’t a definition in women, which is mind blowing. So, what is testosterone specifically for men? Well, it’s a sex hormone, so it is a sex hormone that is made primarily by the testicles. It goes throughout the body and it has a number of effects.

It is not just about libido and erectile function. It has to do with your muscle mass. And we’ll talk more about exercise, but maintaining muscle mass as we age. Not just for cosmetics and aesthetics, but maintain the muscle mass. As we age is critical to maintaining our, our physiologic reserve our balance, our strength.

You know, if you fall down, you want to be able to get up, not break something when you hit bone quality on that same note, bone quality is also strongly directed by your levels of testosterone. As testosterone drops. Mostly important, important for both, but really important for women as your testosterone drops, as it will naturally as you age, your bone quality will start to get worse.

Your bone quantity will start to get worse depending on where you start. You may enter the zone of osteopetrosis. Really early on and be at risk for fracture. So this is something that’s critical for both muscle mass and bone quality, energy, strongly associated with testosterone. When you look at the studies on the benefits of replacement, which you can also then extrapolate to doing it naturally, if you look at the studies on replacement, people just feel better.

They have more energy, they want to go exercise. They want to get up and work. They have more vitality on these kind of general wellness scores. Feel better. Lavita goes along with that, it’s not just about libido, but libido goes along with it. And that’s a huge part of, a lot of people’s

lives. The sleep patterns are the same, but if you feel better in you’re more active during the day.

You’re going to burn up your energy and you’re going to sleep better at night. So you’re going to have these bigger highs and better lows and getting that good, good quality sleep at night is going to help secrete your growth hormone. It’s going to help with all of your just restorative, the restorative part of your day, which is a night so that you can wake up the next.

And be even better and get even stronger and tackling them more. And so you’ve got to have the ups and the downs in order to be able to to continue to improve day after day. People that are on testosterone, just have more of a competitive nature. And you kind of see this, you know, I look at my patients and people walking around and kind of get a sense of, you know, somebody that likely has lower testosterone.

There’s some clear things that we can discuss versus people that likely have higher testosterone. And you can just see it in the, in the competitive nature of folks that have higher testosterone. For some things is an advantage, not for all things. But for some things is an advantage. And when you replace it or increase it naturally, then that competitive edge comes back.

And that’s something that a lot of people are looking for. And this is a a controversial. Topic, but heart protection protection from heart attack and stroke. There’s an abundance of literature that suggests that low testosterone levels are associated with higher risk of cardiovascular disease and events.

So replacing. Should reduce those risks. And again, that’s controversial because there’s a lot, there’s a lot to that. But the association between low testosterone and events is very clearly demonstrated and really should be considered a risk factor for cardiovascular events. So all reasons to either keep it as healthy as you can naturally, or if you can consider doing something about it.

And when. It basically does all of those same things. One of the big differences I see with women is skin quality. So men normally talk about this as much. I think men don’t probably look at their skin in the mirror very much, but women do generally and women that have a testosterone deficiency tend to have.

Tend to have more wrinkles. It just looks, there’s just a certain look to a woman that has a lower testosterone. And when you increase it either naturally, and I’ll talk about how, or if your replacement, you can see that the skin just seems fuller. It just has that. It just has more of a, like a, a vitality to it.

And there’s a lot of reasons for that. But it just, if you think about its effect on lean muscle mass on protein balance on, on bone, that like all of those things kind of go together. I think women

just pick up more on the skin part of it. But all of the things are true across the board for men and women.

Now there’s a specific difference with women and we’ll talk about why this is really important, which is that in men I’ve mentioned, the testosterone is exclusively made in testicles and women. It is made in two organ sets. It is made both in the ovaries as well as in the adrenal. And so the ovaries, we all know as women go through menopause, the ovaries will kind of sputter and stop spitting out hormones.

So that’s true for both estrogen as well as testosterone and progesterone. Yeah. But the adrenal glands should be able to continue to produce testosterone. And that’s why when I see zero, well, let’s do it as a reference range for women. It drives me nuts because there’s no reason why women should have a testosterone level of zero even after menopause.

And yet we see this very frequently where women have extremely low levels. And we’ll talk about why that is, but essentially if your adrenal glands aren’t making it, we need to look at the adrenal glands and figure out, okay, why is that the case? And that’s not just, post-menopausal either that’s pre-menopausal and post-menopausal have a significant effect.

So testosterone with aging, we know that, like I mentioned in menopause women’s testosterone levels would drop because the ovaries stop making testosterone that is this graph here on the right. And what you can see testosterone is the pink line. And so testosterone just kind of slowly goes down and then it kind of flattens out.

Whereas estrogen and progesterone clearly have that clunk, that big drop, and that’s where you get the symptoms of menopause. And that’s sorry, I just saw a question about, can I move my image? I don’t actually think I can move my image. I think this is built into the system. So I’m apologizing. If it is covering something that you need to see And then for men, testosterone does decrease as we age, but it does it kind of more slowly, which is both good and bad.

There’s a threshold at which men will start to see symptoms. But because it happens so slowly it’s, they’re not going to get that. Clunk feeling women will get when after Jen drops, you know, you, most women know that they’re going through menopause men kind of just slowly changes, changes, changes.

Energy goes down and brain fog don’t feel as good, less competitive. And then, you know, something happens and they, they identify that they have a problem. Not only that, but what’s interesting and concerning is that the levels of testosterone are decreasing despite age, meaning that with age controlled, for the average level of testosterone, this study was in men.

The average level of testosterone continues to go down. And this study was studied looked at from 1987 to 2004. So over that time, The average level of testosterone in different populations drop, drop, drop, drop in a progressive nature. And we, we see this anecdotally in our patients because we test testosterone in everybody and we see it just is.

So what. And 40 years ago, average testosterone was, was much, much higher, you know, to see testosterone in a 40, 50 year old male, but you know, 800 900 was not normal. Now I don’t see that in 20 year olds. And there are a lot of reasons for this, but it’s concerning because as you, as that level comes down the starting point gets lower and it’s kind of, I think it’s similar to bone mass, particularly women where you reach your peak bone mass early in.

And then it slowly declines of your life. If that peak is lower than it’s, you’re going to hit symptoms earlier. So for bone mass, that’s osteopenia, osteoporosis, and fracture, but for testosterone in men, you’re going to start feeling symptoms of low T much earlier in life. And we see that early. I see it in, in 30 year olds.

I see it in certainly in 40 and 50 year olds. I’m not just talking about the 50, 60, 70 year old men that have natural andropause. This is a problem early on in men’s lives. So why is that? I think that the biggest one is stress. And we’ll talk a little bit more about stress, but stress is a huge problem in our society.

We are driven in so many ways and pulled in so many ways and distracted by so many things that we are chronically under an attack of stress from every direction. A lot of it’s internal too, and it’s just, it’s where we are in our society. And we are built to have a response to stress. You know, this has been developed over, over centuries.

And when there is an issue that we need to respond to, like, you know, 2000 years ago, it was generally an attack on us by another animal or another human. You know, we need to have this response of stress. But when it is chronic, if you are always being attacked by another human or another animal or another this or another, that we aren’t wired for that.

And we don’t really have a good coping strategy for that, unless you are actively doing it. Yeah. When you have chronic stress, it has a significant impact on your other hormones. And I’ll talk more about that. I think associated with that as poor sleep, I see poor sleep across the board and anybody that’s not actively working on it.

They’re not sleeping well, even if they think they’re sleeping. Well, we do a lot of tracking whether we use a whoop device or an aura, you know, all of these things, there’s a lot of ways to do it, but tracking and objectively measuring sleep. Is a way to understand, okay, you know, I’m getting, I’m not getting enough deep, or I’m not getting enough Ram.

I’m going to bed too late. Or I have to get up too early. Cause I’m trying to do this or do that. What’s the quality of my sleep. What’s the quality of my sleep. And I see sleep problems all the time. And we know that if you aren’t getting good quality sleep, then you will have an issue with your sex hormones, as well as other hormones, immune dysfunction.

This is an interesting one that goes along with it. So if your immune system is ramped up for any number of things, If your immune system is ramped up, your brain will suppress production of

sex hormones, your brain will worry, be worried more about whatever the insult is that your immune system is responding to.

Then it’ll be interested in keeping up your capacity to reproduce because your brain, if you think about what your sex hormones do, they. Primarily for reproduction, they have all these other good things, but your brain is going to very quickly shut them down in order to take care of elevated cortisol from stress or a an immune system that’s heightened for any number of reasons.

And there’s a lot of reasons why it would be heightened right now. One of those would be toxins. You know, we live in a very toxic world. It’s, it’s sad, but it’s true. And we have to protect ourselves from that and understand. What those toxins are doing to us, where they’re coming from and how to prevent them.

But when you have toxins, whether it be coming from plastic, whether it be coming from the water, the food, the soil, the air, the EMF, the whatever, you know, there are thousands and thousands of things that are assaulting us every day. Our body has the capacity to deal with

them. But at some point we can get overloaded and knowing how your body detoxes and knowing how to detox and having a plan for that is critical.

And we find that for people that are overloaded with toxins, getting rid of those things, we’ll make things like sex hormones, rebound without having to do anything. And then lastly, this real fat if your PhD clients, you have listened to your team, talk about visceral fat, visceral fat has its own interesting reaction to sex hormones.

I have a slide on that. But we know that the more visceral fat you have, even if you are making enough testosterone, then it’s going to be converted to estrogen in both men and women visceral fat on its own. Making your immune system dysfunctional and visceral fat on its own is causing you to have increased inflammation.

So visceral fat is kind of the, the triple whammy. And we’ll go through that here in a second. All right, so let’s go back to stress. So this idea of good versus evil, I mentioned, you know, our body. Our body is designed to respond to stress again in 2000 years ago, saber-tooth tiger attacks. You, you best be able to run or fight with an instrument.

You need cortisol in your system. You need epinephrin norepinephrine. You got to go. If we live like that chronically though, it’s like a saber tooth tiger is chronically on your tail. And that’s not a good way to live. It’s also not a good way to reproduce. And that’s why your brain will say, you don’t need to do this right now.

We’re going to reserve this energy from your testosterone production, and we’re going to shunt it towards your adrenal glands so you can make more epinephrine, norepinephrine, and cortisol. Chronic stress is a huge challenge now. There are other good stressors. We’ll talk about exercise exercises.

Right. Exercise is stress. Weightlifting is stress. Cardio is stress running on the treadmill is stress. We need stress in order to build and get stronger, but we have to understand what stress we’re talking about. Now. I will talk specifically about exercise because there’s some stress and exercise that will result in a lot of benefit, but both testosterone and weight loss and some that will, we’ll see that the research will say we probably should stay away from this because it’s not helping you.

I mentioned cortisol and testosterone. So cortisol being the hormone that’s secreted from the adrenal glands in response to stress, there is a directly. That’s it right. There was an inverse relationship between the two. So as cortisol goes up, testosterone, go down. This is proven over and over and over again.

If you elevate cortisol in any animal, the testosterone level will drop. So we know that if we’re living with chronic stressful environment and I have some slides on this, people that have elevated cortisol will have low T I don’t even need to test it. I just know it because we, we test cortisol and everybody we use salivary.

When we do that, we see this relationship time and time and time again, and the research supports it. So we know that if you have chronic stress in your life, you will not have adequate sex hormones. You just won’t. And then adrenal function. This goes specifically to women. As I mentioned with testosterone being made in the adrenal glands and women.

If you and I have a slide on this, but if you are shunting, all of what’s called DHA, the pre hormone to testosterone. It’s also the free hormone of cholesterol. And so if you’re under chronic stress, your adrenal glands will just suck all of that DHA and cortisol and you won’t get any testosterone. So I can’t emphasize this enough, having these tools to mitigate stress in your life and even understanding that you have it is huge.

And I see this a lot. Particularly in premenopausal women, they just don’t seem to feel that they’re stressed. And yet I get a cortisol curve and it’s like through the roof. And so while they may not feel stressed, they are stressed, their body’s stressed and that’s ultimately what matters. And so then working with.

Working with them to identify, you know, what does this even feel like? What does stress feel like to you? And that’s a huge thing, you know, understanding what that means. So these are celebrated cortisol curves. And so if you look at the one on the left, you can see that the, so this curve has kind of funky looking curve.

So there’s three lines. There’s a red line, the top on the bottom and a green line in the middle. We want these dots to line up on the green. What the dots represent are samples at different times throughout the day. And so we want this.to be on the green line, and this happens first thing in the morning.

So this sample was done a little after six o’clock in the morning. And this basically tests what, what cortisol was produced overnight. There’s a natural increase in cortisol in the morning. And in this sort of gets your, your body starts to creating cortisol around 4:00 AM. It gets you up going, and that should be, you should pop out of bed and feel rested and ready to attack the debt.

That’s natural. If you don’t, it doesn’t mean you’re not a morning person. It means you’re not getting enough sleep. You should be able to, if you’re not a morning person, get up, hop out of bed and feel great. You just probably need to do it later in the morning. I know that not everybody’s life allows for that.

But, but that’s how we should pop out of that. But then it should go down. You can see this normal curve at noon is much, much lower right than it is at say seven or eight o’clock in the morning. This curve is a much, much lower, and then it continues to decline throughout the day. And then it gets you ready for bed.

You can see this last.here is at nine o’clock. So this patient on the line. Has a reasonable response in the morning, but you see how it doesn’t go down. So throughout the day they had this tremendous cortisol surge all day long, and then it finally Peters out. And my guess is they’re probably getting to bed, but they feel pretty wired.

They’re pretty wound up at night. They need a really good routine to get them down. Now, what they really need is stress relief throughout the day. They need to work on their behaviors. They need to work on ways to mitigate stress what’s going on in your life, you know, adaptogens. We can talk about supplements that can help reduce these things.

But we ultimately need to get this down. Now, compare this to the one on the right. So the one on the right, you can see this first.is completely off the map. So what happened in this patient? Well, in this patient, they are not making cortisol in the morning. So this patient, when they wake up in the morning and it’s hard to get it.

And this is what they told me. This is what they tell me. They’re like, I am such a, such a night person. I can’t get out of bed. I mean, look at this, this is, this was done. It’s probably what seven, eight. This has done at eight o’clock. Okay. That is not that early. And so, you know, this patient is struggling to get out of bed feeling exhausted and then, you know, they get some stress.

And so now they’re kind of popped up around noon. They’re probably feeling a little wired. And then it starts to decline. Now this patient probably has no problems. Probably has no issues going to sleep. But this is what we call the flattened curve. And this is actually more dangerous than this elevated curve.

This is kind of earlier stage adrenal fatigue. This on the right side is kind of end stage renal fatigue, and this will get flatter and flatter unless this is reversed. This is associated with immune

dysfunction, sex, hormone dysfunction. This will make you feel terrible and predispose you to a lot of diseases.

So I like to think of stress like this. This is my puppy about four years ago. And I, I love the way the dogs view the world because they kind of have four modes. They can either play with it, they can eat it, they can love it, or they can pee on it and walk away. And I feel like that’s kind of a, that’s a nice lesson, you know, and the way that we view our world, We really shouldn’t get wrapped up around things that have zero impact on our life.

I tried not to pay attention to things that I can’t have an effect on, and that ultimately don’t have an effect on me, but it’s really hard to do when everything is coming at you from every device talking about every catastrophe in the world so that they can make you feel like you’re stressed out stress and fear sells products.

So let’s talk about testosterone and obesity. So LBCT as I mentioned, especially visceral fat specifically with obesity and not all obesity to be fair has visceral fat, but the majority of it does. When you have visceral fat, usually people that have a lot of visceral fat have high levels of insulin.

And I would say almost all the time to be fair. So almost all the time you have high levels of insulin. Insulin is a hormone that helps your body to dispose of your blood sugar. It helps it put it away where it needs to go. We know that if your insulin levels are unnaturally high, that you will have low tests on.

It has to do with again, your body is, is dealing more with this crisis of this toxic of this toxin running around your body as glucose is it has to be kept low because in high levels it will kill you. So we know that that’s the case, but we also know that your testosterone receptors meaning that the binding sites for the hormone actually gets dysfunctional when you have high insulin levels too.

So it’s kind of a double whammy there with insulin. I talked about the fact that testosterone gets converted to estrogen. With visceral fat. So even if you had normal testosterone as a man, you’re going to feel like you have low testosterone because you are robotizing it into estrogen. And that’s why men, as you start to develop, you know, initially you have this beer belly, but then you kind of have these beer boobs too.

And that’s because you’re creating more estrogen than your body knows what to do with, and you start to kind of normalize into having more estrogen The increased inflammation. So this goes along with visceral fat too. It is increasing interleukin six, interleukin, 10 TNF, alpha, all these different cytokines that are increasing inflammation in your body.

They’re ramping up your immune system. So they are your immune systems already jive. That’s why we. That with COVID. If you get an infection and you have a lot of visceral fat on your body,

you are at much, much higher risk because your immune system’s already dysfunctional. You’re starting from a bad starting point.

And so getting your visceral fat down has this effect of reducing your inflammation. And we see it in labs all the time. When we receive these, the labs that we get that are markers for inflammation dropped, as people lose the visceral fat it’s really. Okay. So this is actually why probably most of you were here.

So what about weight loss and testosterone? If I lose weight, am I going to lose my testosterone? And the answer is maybe it depends on how you do it and it goes back to the stress part. So if you go on a program where I don’t know, I really despise medical programs for this, but you know, medical programs that I’ve seen a lot of, because I’m in the medical community, you know, 500 calories a day plus or minus HCG or whatever.

The new thing is. You will lose weight the first time for sure. And maybe subsequent times, but if you do that, your body is stressed out. Right. And if your body is stressed out, I already mentioned that if you’re under chronic stress, you’re going to see a reduction in your testosterone. So this first study of.

This was a not even tremendous calorie restriction. But these women they were under calorie restriction to lose weight. They lost, I forget what it was, you know, significant 20 pounds. And they had they saw a 10% reduction in their testosterone level. Not incredible drop, you know,

but, but enough, and in women, you know, these women, you know, their average starting was pretty darn low to begin with.

So to lose any, it was probably not good. Now the good news is, is that when they went on their maintenance plan and they did actually maintain their weight loss, but when they went onto the maintenance plan, they saw a 50% rebounder testosterone. It didn’t come back to normal and that was after 18 months.

So that’s a little concerning. Similar issues with basal metabolic rate and severe calorie restriction. But it looks like it does rebound some now look at this other study. So these graphs are from the other study. So this was not caloric restriction. This was backroom manipulation. So if you use the term carbohydrate tolerance level, right?

So shifting your macros around so that you’re eating more dietary fat, getting enough protein. And reducing your carbohydrates so that you’re bringing your insulin levels down the principles of PhD. Right? So if you do that, you will see that you’re in this study anyway, that your total testosterone increased over time.

Your free testosterone increased even more over time. So weight loss by itself does not result in testosterone to draw. But if you do it in a way that’s causing you stress, then it might. But the good news is even if that’s the case, it should rebound. And there are a number of other factors that could be contributing to it, not rebounding.

So I, to chat a little bit about exercise and testosterone, I think this is funny. I guess it’s not funny. It is interesting to me that, that this is such a debate when you step back and look at the big picture of these two athletes, for example. So I think we all know Dwayne Johnson, the rock, right?

Like he’s a big dude. He probably has high testosterone. I don’t know if he supplements testosterone. I have no idea, but clearly the dudes probably got some testosterone because I don’t think you can have muscles that big and not have high levels of testosterone. This other gentleman and the dimension data Jersey.

This is mark Cavendish. He is one of the, the most winning sort of France and professional cyclists in the world ever. He has muscle, right? He’s a little dude. He’s wicked fast and he probably doesn’t have high testosterone. We know that cyclist. And marathon runners and other chronic cardio people.

They have significantly lower levels of testosterone. Now there are, again, a lot of factors here, but we know that if the stress of training exist and your cortisol levels are chronically high and you’re chronically not getting the rest that you need, your body will shut its energy away from making sex hormones.

You’re running away from a tiger. You don’t need to have babies, right? Not a good time to have babies if you’re running away from tigers. Whereas the rock on the other hand, he’s working out in his, if you ever follow him on Instagram, he’s got this amazing workout facility. It’s probably the side of his house, but he, he has hard workouts, right.

But he’s dialing in this recovery cause he’s maximizing something other than chronic cardio. He doesn’t want to ride a hundred miles as fast as possible. He wants to gain muscle. And when you do resistance exercise, your testosterone levels will go up temporarily and then come back down. But we know if you do that time and time again, it’s going to be up, down, up, down, up, down, and eventually you’re going to see that your overall testosterone levels are higher.

Now, can you overdo it on resistance before? But you’re going to break down faster. You know, I see people that I don’t see as many people that overdo it on resistance training is I do that, overdo it on cardio. It’s much easier to overdo it on cardio because I think we’re just, it just in this mindset, like I got to run.

Five hours a week. I got to do this many miles. I have to spend this much time with like chronic cardio is really hard on the body. Lowers your sex hormones makes your adrenal glands dysfunctional. We’ll make sure that the thyroid glands is functional. They should feel terrible. And it makes me really hungry.

I think that’s true for others too. Whereas resistance training. Will increase. Your testosterone is not as stressful on the body and should elevate your testosterone over time. Now I tried to find

good studies that demonstrated this. The challenge here is that so many of the studies have multiple factors in them.

So I couldn’t even find a study that clearly demonstrated this, but we know that people that are building muscle mass, even without. I’m going to have higher levels of testosterone. Cause they’re anabolic people that are catabolic, people that are, are in chronic cardio state are going to have lower testosterone levels over time.

So choosing what kind of exercise you’re doing is correct. And understanding what your limits are and making sure that you’re getting the rest that you need based off of those activities. Again, I’m a big fan on tracking. So other devices that I wear the whoop for example, is really good at tracking.

What is your stress level throughout the day? It tracks how much energy output you have, and then it also tracks your sleep. And it actually gives you a recovery index. And it’ll tell you this morning, my recovery was 93% and I’m like, I can do whatever I want today. Right? But when my recovery is like 30%, I should, I should really pay attention to that and say, Ooh, my metrics don’t look good.

You know, something’s off. Or I just didn’t give myself enough time. You know, I need to back down today, focus on recovery. And so understanding that is really important and objective data can be. All right. So when people say, well, I lost weight in a tank to my T that’s totally possible, depending on how you do it, but I have a lot of questions for them, but they usually don’t have the answers to in one would be, is what, where was your testosterone before you lost weight?

A lot of times people are not paying attention to their health. They go through a program and then they check something and it’s wrong, it’s off. And they say, well, it was the program. Well, where’d you start from, you know, like where was it before you started? And so that’s really, really important. The, what other stress factors are going on in your life?

You know, we don’t lose weight in a vacuum. We don’t do anything in a vacuum. So what else is going on? Emotional stress, family stress, you know, all of these things job stress, a pandemic, right? A lack of Christmas presents for my kid. Like all of these things are really stressful and are going to have an impact.

What kind of exercise or activity are you participating in that could we just talked about. What’s going on with your immune system? Lots of reasons why you could have immune dysfunction, having extra visceral fat is one of them sleep. So sleep as we talked about hugely important. Are you getting enough protein?

Are you getting enough dietary fat? If you’re reducing your carbohydrate level to your carbohydrate tolerance, you probably. But this might be new to you, and this takes time to get the nutrients that you need. Are you inflamed? If you have this real fat still you are inflamed. But

what else? And there’s a lot of other stuff that can cause inflammation and even genetically you can have inflammation.

And then lastly, toxins, like we talked about getting as many of them out or testing for them and figuring out which ones are bothering you and getting those out. So how do we improve testosterone? I have everything listed here. Number one is working on. You know, I, I can’t emphasize this enough.

I like to test salivary cortisol, see where you are on that curve. If you’re high, we can deal with that. If we’re low, that’s a harder problem to deal with and deal with that too. But understanding where you are, especially for premenopausal women who feel like they don’t have stress in their life, but they have a full-time job and a husband and kids, and, you know, they’re just, it’s mind blowing.

That they’re not stressed out because they are stressed out. Immune dysfunction. Again, these are things that can be tested relatively easily. We don’t have to test them though. Just assume that you have toxins in your life and try to get them out inflammation is something that can be tested.

And I see it, it’s just high. I mean, it’s just high in everybody. So it got to get that down. And then obviously the visceral fat going through a weight loss program that will respect. Your calorie balance, understanding that it’s not a calories in calories out equation and working with macronutrients and micronutrients and behavior to help get you the results that you need.

And then finally lifestyle was sleep and resistance training. I’m not banging. Cardio is not great. There is a role for cardio and if you love riding bikes, that’s awesome. I love riding bikes too, but it’s not my, it’s not my training goal. And I know that actually. When I ride bikes hard. My health actually, it gets worse as a result of that, you know, I don’t I don’t fool myself to think that this is actually helping me achieve my goals because my goals aren’t to ride fast for long periods of time or to race anymore.

I did that and I was not in great shape, but I did that supplementation you know, again, these are not, I can not tell you what to take without you being my patient. These are what I tell people. In general. So zinc is great because it’s an aromatase inhibitors. So it’ll block that conversion of testosterone to estrogen.

And most people are zinc deficient, but you can take too much zinc and you have to balance zinc with copper. So take it carefully. I think with everybody taking huge doses of zinc right now, being worried about COVID, we’re going to see a really big problem of copper deficiency because you have to balance the two when you can’t take them.

This you’re a coma or Tongkat Ali is a popular supplement for weight loss, or many, many supplements that have this in it. The research behind it is pretty stinking. Good. Same thing with

cafeteria. Tribulus these are all these are all herbs that will increase your levels of total and free testosterone, both in men and women.

Dammit Vitex or are specifically for women and these can help both with increasing testosterone, but also with estrogen detox. So kind of balancing them. And so for women that are having pre perimenopausal symptoms, the biotechs in particular for, for women that have very heavy periods or significant kind of pre period symptoms Vitex can be really helpful.

Them is great for estrogen detox. But again, I like to test around these two because you can, some people don’t need them, some people do and then finally replacements, so who should get replacement. And the answer is this is a, a long conversation to have regarding the risks of benefits, because it is such a controversial field, but men can undergo replacement.

If I feel like if they’ve tackled everything and they’re still well, and that’s pretty common and we have a lot of patients that are on testosterone replacement different ways to do it. You can either just directly give testosterone. You can tell the brain to make more testosterone with Colombian.

You can Brock block testosterone to estrogen with Anastrazole. DHA is that, that pre hormone that goes to testosterone. And if that’s low, you won’t have enough testosterone. So lots of different ways to manipulate that premenopausal women. So. I find that there are generally making enough estrogen.

But if their adrenal glands are shot, their progesterone levels are usually low, but not always. And that’ll give them feelings of being estrogen dominant, even though they don’t actually have that much estrogen. Their testosterone levels are typically low. So these are our women that once we dial everything in a lot of times, they’ll end up on testosterone and progesterone.

If they’re not sleeping well at night, if they don’t have adequate levels of progesterone they need to balance out the estrogen that their ovaries are making. And then they feel, oh, a whole lot better on testosterone. And these are tiny dose, like with a dose is all they need. But if you’re a premenopausal woman and you have a testosterone level, you know, five you’re, you’re really at risk of, of losing muscle mass and losing bone quality.

It’s my biggest fear. Post-menopausal women. We talk about bio-identical hormone replacement. I mean, you, you, your ovaries just aren’t making it. And so you have to make a choice, you know, do you want to accept that and mitigate the, the risks and the, the symptoms of that over time and age naturally?

Or do you want to try to replace that for, you know, have that, that risk benefit discussion. And I think when it’s done well, women feel really well. And the risks can be mitigated. But the risks are real, but you know, there are risks to being alive. And so, you know, just having an honest conversation about that and what those risks are.

And just a couple of cases here. I know I’ve been talking your heads off. Nobody leave time for questions. This is a 41 year old male. So this is a guy who was complaining of just fatigue and it wasn’t feeling like he had the muscle mass that he did in his thirties and twenties. Getting fatter, despite being pretty dialed in on nutrition brain fog, trouble thinking and decreased libido, maybe a little erectile dysfunction.

And these are, this is testosterone. Obviously we get more than this, but this is a testosterone talk. So his total testosterone 4 58. So for someone who’s 41, and you can see this reference range that goes from 2 64 to nine 16, you know, it’s right. It re. No, I mean, this is pretty darn low. And then this study didn’t have free tea, but it’s free tea was really low.

And so we said, okay, well, before we jump on the bandwagon of replacement, let’s dial some things in for you. So working on his lifestyle, working on sleep detox we actually did put them on thyroid for a little bit, and he came off of it after his adrenals healed and supplementation, you know, this was him about a year later, so almost 900 total testosterone.

And now you can see us free tier. And it’s actually off the chart high. So it’s, it’s 25 when the top of the range is 21. So it feels good. All right. So it feels good. We don’t have to worry about testosterone replacement for him. And he’s very happy with this implementation and he takes two different supplements with those things that I mentioned.

And he’s, he does not need testosterone right now. This is a 63 year old post-menopausal. Kind of similar symptoms, right? Fatigue, brain fog, loss of muscle mass. She actually was on HRT at one point. And so you can see in her labs, you see this 1 29. So this is from January of 2020. And I don’t see the date on this, but it was probably 2021.

But anyway this is like 1 29 is really, really high. And I know on my pictures covering up the reference ranges here, but we really want this to be around 60. And again, this free. Reference range goes down to zero. So this is normal. But a total of eight and a free of 2.2 is very, very low. So her adrenal glands are making some testosterone, but not enough.

Now she did not feel good with the testosterone 129 and that’s way too high. And so I’m not surprised she did. So this is a different kind of test. So this is a urine metabolite test. And I know this is a busy slide and I don’t expect you to understand how to read all of it. But what I want to point out is that this is three months later and this is how we do testing.

So we. Test, initially we initiate and then we retest and we retest and we retest until it’s dial event both from an objective perspective and symptoms. And so you can look on here, testosterone’s right in the middle. And this dial is kind of like a it’s like a speedometer. We want this little triangle to be kind of right above the star.

And that’s going to kind of core, let’s say the correlate around a 60 on a serum panel. And so she’s about half. Okay, so she’s probably around 30, so she needs more. And so we increased it

and we’re about to retest. I don’t have those numbers yet. You can appreciate her progesterone is probably not quite there either.

So we needed to increase that. And her estrogen actually needed a big bump. And so you know, start slow, start low, go slow. That’s a good policy. And then, yeah. Well, keep increasing her and she feels great. So hopefully we’ll be where we need to be objective. Like this is that premenopausal picture I mentioned.

So again you know, speed dials. So this patient, you can see her estrogens is a younger patient. Probably in her thirties. You can see that her estrogen is kind of right at the star. So it’s for, for premenopausal woman, that’s low, but it’s, it’s doable. It’s fine. It’s okay. Progesterone. But later testosterone it’s like bonked out.

I just know what testosterone so this is that picture that I’m talking about. This is actually your cortisol curve slightly different because it’s in urine, but you can see it, like it’s flat. She doesn’t make it into this curve. And then she just sort of glides along the love, but then, oh, look, it happened at night.

At night. It starts to go up, you know? So this is ruminating thinking, maybe difficulties falling asleep. So this is that epidemic I’m talking about that I see in premenopausal women, that’s really kind of challenging. Yeah. Okay. So in conclusion this is a big problem. We are in a testosterone epidemic for a lot of reasons, high insulin, dysfunctional cortisol, high inflammation, immune dysfunction, and the solution really is lifestyle.

It’s weight loss, it’s managing your stress. It is getting good sleep. It’s not just throwing testosterone at it. Hmm. I think a systems approach is important because you have to take a big picture, not only to understand where the problem is coming from, but also to understand the risks of potentially fixing it.

I’m a big fan of lifestyle and supplementation as the, the initiation and then replacement for those that need it. I think that we shouldn’t shy away from it, but it should be done correctly and safely. Otherwise you do potentially put yourself in a more. And that is it. So thanks so much everybody for your time.

This was hopefully really helpful. It’s a topic that I really liked talking about. So I hope you found it educational and, if you have any questions, again, reach out to us and we will answer as many of them as we can. And thanks again for your time.

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