Yeah.

But you, you...

when you talk about anabolics, you're asking about specific ones, but the, but his point's well taken.

In general, all anabolics at high doses will start seeing changes in lipids, hypertension, cardiomyopathy, uh, you know, so, uh, uh, acute coronary artery disease, increased calcification.

So it's the d- the levels they go at.

You know, sometimes patients will come in, and they'll take... it's on a thousand milligrams a week and sometimes even higher.

Uh, and you have to ask yourself, "I mean, this is a significant amount, level." So, um, the levels are the problem.

You, this is your, Dr. Kara, Dr. Tatum, this is, um, this is something that's a labor of love, so hopefully it just continues that way.

Mm-hmm.

But it depends on what you're on.

But we first like to check everyone in four weeks just to see how things are going.

Do I need to titrate? Do I need to change anything? And then we will see them, if they're on a gel or a cream, we'll see them every six months for life, every six months for life, and make sure their levels are good.

I think waiting one year is a little too long, right? Um, if they're on a pellet, we see them every f- uh, four to five months.

If they're on an injectable, then it's really gonna be every six months for life.

So it really depends.

Yeah.

Mm-hmm.

And when you have no ability to compound 503A or 503 molecules, the underground just goes crazy like they are with peptides, but that's when you get, uh, unregulated bacteria, uh, heavy metals.

I mean, you don't even know.

Sometimes if they tell you this is the ingredients, this is the milligrams, it doesn't mean that's the milligrams.

It could be a variance of 50% to 150% or zero, and you have no way of knowing.

Right? And so that's a little risky, you know, uh, when you start using underground.

That's what we're using for peptides for most of the peptides now.

Yeah

But other experts think it's an entirely reasonable proposal, including Dr. Mohit Kara, a urologist at Baylor College of Medicine.

Men who have low testosterone levels will suffer from decreased energy, decreased muscle mass, some form of depression, and poor mood.

Those three in themselves, for someone who's in combat, is a significant disadvantage.

He acknowledges most men in their 30s will ultimately not screen for low T and require treatment.

However, we are seeing that younger and younger men are having low and lower testosterone levels because we're becoming more unhealthy as a general population.

What's the number? What's that cutoff threshold that at 30, and I know that number changes by year, that you would say, "All right, this needs some follow-up"?

Yeah.

So right now, in the United States, we use the number of 300, 300 nanogram per deciliter.

Now, some would argue that's a little low.

If you go to Europe, they use 346.

Other people use 350.

But that there is a number, and remember that in order to be a candidate for treatment, you have to have low testosterone, and you have to have signs and symptoms.

Speak to the risks of testosterone replacement therapy.

What's the number? What's that cutoff threshold that at 30, and I know that number changes by year, that you would say, "All right, this needs some follow-up"?

Yeah, so right now in the United States we use the number 300, 300 nanogram per deciliter.

Now, some would argue that's a little low.

If you go to Europe, they use 346.

Other people use 350.

But that, there is a number, and remember that in order to be a candidate for treatment, you have to have low testosterone, and you have to have signs and symptoms.

So I, I'm, I'm a proponent of screening, but if someone's low, and they don't have signs and symptoms, then obviously I would say you shouldn't treat.

Speak to the risks of testosterone replacement therapy.

But if a man comes in and he is the reason for the infertility in the relationship, in what percentage of cases are you able to get him to the point where they're able to get pregnant?

It depends on what the problem is, and fertility is so easy.

It's either he's not making sperm or he's blocked.

That's it.

Either he's not making sperm or he's blocked.

So all I have to do is figure out which side of the fence I'm, he's on.

If he's blocked, I can unblock him.

Um, biggest development in urology in the last 10 to 20 years that makes you very excited?

What is testosterone actually for? Who should be using it? And what are the most dangerous misconceptions out there on it?

All right.

That's a big question, but let me get started.

So first of all, realize that testosterone is a human hormone.

It is not just for men.

It is for women as well.

Realize that women make five times more testosterone than they make estradiol.

So with regard to men having their testosterone checked o- over the age of 40, g- and all these health, all these health benefits and so forth, let me ask the fir- I mean, the first question that pops to mind is, you're saying it is a predictor of future health, and is that because-- Why is that?

in obese patients?

I think it's two different topics.

So one topic is the sensitivity of the testosterone receptor, so it's called the CAG repeat.

So in Baylor, when I started with Dr. Lipshultz, we started this, doing this, we do it today.

We take the blood, we send it to the lab, and they give us the sensitivity of the androgen receptor.

If the CAG is greater than 27, the s- it- androgen receptor is insensitive, and we show that those patients need more testosterone.

Makes sense.

Those, uh, below 300?

Yeah,

but you know, now it's not.

I mean, it's become the mainstream.

Think about this.

Sexual health is the best barometer of a man and a woman's overall health because it takes into account their physical health and their mental health.

But you bring up a point about how people didn't realize that testosterone helps with libido.

And I have to tell you a story.

But why are so many people scared of it? I think the

How important is sex to the human body in terms of purely physically?

Yeah, it's extremely important.

So I want to just clarify one thing.

Erectile dysfunction is not a disease.

It's a symptom of other underlying diseases, right? So ED does not happen in healthy men as they get older.

If a man gets erectile dysfunction, it is a symptom of his diabetes.

It's a symptom of his cardiovascular disease.

You can't blame every one of them on testosterone.

So moving on from that, what are those simple measures that a guy could do to start improving his testosterone naturally?

Yeah.

So I have said this over and every time I've spoke about this.

I- there's the four pillars of health to me are diet, exercise, sleep, and stress reduction.

I don't have a pill on the planet stronger than diet, exercise, sleep, and stress reduction.

So when the patients come in, they say, "Just give me the pill.

Give me the testosterone," I say, "No.

... better trigger than, than some other metrics, 'cause guys are like, "I definitely wanna do that."

How important is sex to the human body in terms of purely physically?

Yeah, it's extremely important.

So I want to just clarify one thing.

Erectile dysfunction is not a disease.

It's a symptom of other underlying diseases, right? So ED does not happen in healthy men as they get older.

If a man gets erectile dysfunction, it is a symptom of his diabetes.

It's a symptom of his cardiovascular disease.

You can't blame every one of them on testosterone.