Everything You Need To Know About Testosterone Replacement Therapy & Hormone Optimization, With Gameday's Dr. Evan Miller

My name is Ben Greenfield. And on this episode of the Boundless Life Podcast. When you see somebody or you hear somebody talking, especially a man, about what they're feeling, what are some things before somebody's even gone in for a lab test, if a guy is describing the way that he feels that you just know classically, "Yeah, this is for sure low testosterone." I'll tell you what it is at first.

So, if you ask 10 guys on the street, "Hey, man, do you have erectile dysfunction because that's a symptom of low testosterone?" Zero of them are going, "Yep, that's me. I got it." No. Yeah. So, very rarely are they going to lead with, "Man, I just can't perform." The biggest one, and it's the safest one really, is, "I just don't sleep well. You know, something's up with my sleep." Really? Yeah.

That's surprising that that's your top answer. Sleep, huh?

Sleep is the biggie. It really is. As you get older and as you take on more, right, as a guy, more stress, more responsibilities, certainly if you have family or kids, it all compounds. Your endocrine system takes a beating, and when your endocrine system takes a beating, the first thing that goes to sleep.

Welcome to the Boundless Life with me, your host, Ben Greenfield. I'm a personal trainer, exercise physiologist, and nutritionist, and I'm passionate about helping you discover unparalleled levels of health, fitness, longevity, and beyond. All right. My guest founded GameDay Men's Health but actually has a background in clinical psychology. His name is Evan Miller. Evan, where'd you go from clinical psychology to optimizing men's health?

Yeah, it's an interesting road. I opened an addiction treatment center when I got my PhD, kind of fell in love with that space. It was the first time I was practicing therapy, kind of sitting knee-to-knee with somebody. Quickly realized that I didn't want to do that for career. I just wanted a little more, you know, variety. Um, and so I said, let me start an addiction treatment center. And so started a center in Orange County. It was just a small 6-bed center, and we blew it up. You know, we were just doing really good work helping a lot of people recover from drugs and alcohol.

I was going to say, when you, when you say addictions, are we talking like hard stuff like heroin, cocaine?

You name it. Yeah, yeah, heroin, cocaine, meth, all the opioids, alcohol. You know, interestingly, the opiate and the meth detoxes are actually a lot simpler and straightforward than alcohol and benzos like Xanax. So, I don't know, most folks don't know this, but alcohol detox and then benzos, Xanax and Valium, those are the two most lethal drugs to come off because you can have seizures and all these things. So, we were taking folks straight off the street, helping them get better, and it was awesome. It was really rewarding work. But addiction treatment, dude, it's 24/7.

Ben Greenfield: I can imagine it's probably a little depressing too.

It is.

I mean, not that working with guys with low testosterone might not be depressing, but addiction sounds pretty depressing.

So I mean, the stats are pretty bad, right? So 1 in 10 are lucky to have a year of sobriety. But you know what's cool though, Ben, is like the ones that do, um, you've saved them, you've saved their family, and it's super transformative stuff. It's, it's— you see the light come back in their eyes. Um, there's really nothing more rewarding, you know, helping guys with low testosterone. Honestly, you know, someone on death's door that's significant. You know, revolutionizing men's health is massive, but it's different. You know, it's different in terms of like the lethality of it. Anyway, had the addiction center and then jumped into what I want to do next. So I was at a point in my life where, like I said, I was pretty burnt out, didn't know what I wanted to do. So I sold half the company back to a partner and went to Hawaii. You just got back from Australia, but I went to Hawaii. And if you spend any time in Maui, you know, there's healers all over the island, right?

Oh, yeah. Maybe not as many as Sedona, but yeah, there's a lot of weekend shamans, healers, invisible chakra energy quantum practitioners.

And Maui, for those of you who don't know, is one of the main chakras of the world. So, you can feel the vibrations and all that if you're into that stuff. Anyway, met him, his name was Magic. And, he's like, "Alright, we're going on a journey." And, it was just walking around these crazy part of like the backside of the north side of Maui. It was amazing. But I was one of those guys who was in Hawaii and I was depressed. I'm like, I don't do well when I've got nothing to do. I like to be busy and I like to be working on a mission or a project. And I had nothing at the time. And so I was— I thought of every idea you can imagine. I'm gonna— you name it, you know, it's just coming out of my head. And so he goes, uh, what are you gonna do next? And I was like, I have these ideas. He goes, dude, dude, dude, you know, you're thinking about it wrong. I was always thinking about what's the next biggest industry or what's the best exit or how can I make the most money? He's like, stop, bro. You need to start here. You start right here. What's in your heart? And if you do what's in your heart, the rest will flow from there, right? And it's the stuff that, you know, all the spiritual traditions talk about. But for me, it was men's health. I'm like, look, the part I loved about addiction treatment the most was helping guys recover. And I thought, how can I take like guys who are not just struggling with addiction, which is this like narrow segment, and make it to most guys throughout the United States? Dug into the research and low testosterone kept popping up. I'm like, huh, that's interesting. I was 34 at the time and went and got my levels checked. And not only, you know, I went to the doctor, I'm like, hey, I want to do a full panel. Can you check my testosterone? You're 34, you're fine. Come back in, you know, 10, 15 years. I'm like, no, please, can I check my testosterone? Fine. And came back 237 total T, which for those of you out there don't know, that's low. You know, I was 34 years old. It should not be that low.

And by the way, was this like the type of doctor who would do— like, was he looking at free T and DHT and estrogen, or was it just total T at this point?

Yeah, it was a full panel, so I had to request total T. I think I was lucky if I got a free T in there or anything beyond that, or an estrogen or prolactin. But that was the number for me, was that 237. And so that's kind of when the light bulb went off. I went, huh, I'm— here's a guy like you, Ben, taking care of myself my whole life, played sports, know how to eat well, know how to sleep, know all this stuff, but still walking around at 237. And I went, okay, this is— there's something here. And so then I dug in and I'm like looking at the market and it was weird, dude. I remember back like 10, 15 years ago that the testosterone place was just sketchy and it was like the old man on the yacht with like the 18-year-old girlfriend and that was like the industry. So I thought there's something more to this. Let me dive in. And I thought, look, I'm going to create a model here for guys where they can come in and feel better fast. And I grew up an athlete. I'm like, let's put it in this man cave environment. We hate going to the doctor. If I tell you, Ben, I mean, you're probably different, but most guys here, Ben, go to LabCorp, get your labs done. You're going to go, "Okay, dude, maybe in a month." And, I'll have to call you, "Hey, did you go to LabCorp?" "No." "No. All right, you got to go." That's the average experience for most guys. I don't want to go to get my blood drawn because I hate needles. I'm a big baby and I don't want to spend all day at the doctor's office. So, that's where I started was like, how do I create a model that's comfortable? I mean, see we've got Kobe in the background. Place guys want to hang. Just like a lounge and then make it fast. And so, that's what we did.

Kind of reminds me a little bit of the Sport Clips for haircuts franchise where you go and watch a game and it's kind of like a manly man cave type of environment.

Yeah, a bit of that. I mean, certainly we get associated with them a lot. We're trying to honestly, and we'll get to this, but a franchise feels— there's like a cheapening when you think of it's a franchise, it's cookie cutter and all that, especially healthcare, dude. We don't want to be associated with that because that's not what we do. And I'm sure we'll get into this in the podcast, but what we do is pretty tailored specifically to guys. But the overall theme, yeah, was like, how do you create a model that like is mass appeal and it gets guys in and out fast? And so for us, I thought, I'm going to put a lab in every single game day, and that's what made the process just hit.

A lot of guys don't know they have low testosterone, and you certainly see, you know, reports that it's happening at a younger and younger age, this idea of andropause. You know, I hear some questioning that maybe it's different testing methods, or maybe are just identifying it and testing people at an earlier age, maybe. But regardless, people do test out with low testosterone. But, I often hear guys say things like, "Look, I've got pretty good libido. I don't have erectile dysfunction. I'm sure my testosterone is fine. Something else must be going on." But, when you see somebody or you hear somebody talking, especially a man, about what they're feeling, what are some things before somebody's even gone in for a lab test if a guy is describing the way that he feels that you just know classically, "Yeah, this is for sure low testosterone." That's the question right there.

So, I'll tell you what it isn't first. So, if you ask 10 guys on the street, "Hey, man, do you have erectile dysfunction because that's a symptom of low testosterone?" Zero of them are going, "Yep, that's me. I got it." No. Yeah. So, very rarely are they going to lead with, "Man, I just can't perform." The biggest one, and it's the safest one really, is I just don't sleep well. Something's up with my sleep. Really?

Yeah.

That's surprising that that's your top answer. Sleep, huh?

Sleep is the biggie. It really is. As you get older and as you take on more as a guy, more stress, more responsibilities, certainly if you have family or kids, it all compounds. Your endocrine system takes a beating. And, when your endocrine system takes a beating, the first thing that goes to sleep.. And so a lot of guys come indoors like, man, I haven't slept well in years. You know, I'm lucky if I get 3 hours and it's super bumpy and choppy sleep. That's a huge one. And energy levels. So sleep and energy. Once guys come in and start thinking, man, I just don't fit in, they go, I think it's because I'm not sleeping well. That's why I have low energy. Well, sure, but there's probably something else going on here. And those are kind of leading indicators of, you know, what's happening. But beyond that, you know, you're not going to know until you kind of do some labs.

Okay, so the labs, then somebody comes in, maybe they got the low sleep, they have low motivation. I know that recovery from workouts is another big one. Sometimes excess adiposity. You do the testing. What are you actually looking at? You rattled off some things. So did I, you know, like prolactin, total T, free T, etc. But walk me through the labs piece.

Yeah. So this is the kind of big differentiator for GameDay. So we take what's called a 3-step process and it's a free consultation. For every guy around the country. We believe it's every guy's right to know his levels. And so we don't charge for labs or the consult. So step one is you come in, free labs at every single game day throughout the country. We have 368 game days open today. We'll have 500 open this year. Uh, you're going to come in, we're going to do total T, we're going to do your, um, hemoglobin and hematocrit, which is your red blood cell count. And we're going to do your PSA, which is your prostate levels. And that's all done on site within 15 minutes. Um, total T is going to let us know what's going on with your testosterone. PSA lets us know what's happening with your prostate levels, and then your red blood cell count lets us know how thick your blood is, more or less. And it's a good baseline start. That step 2 is then meeting with our clinician. We have licensed clinicians. We have over 600 licensed NPs and PAs in our system that are supervised by another 600 MDs. So we're the largest network in the country in terms of medical oversight for what we do. They have a consultation with you. They're going through your history, medical symptoms, background, current medications, all the things you do at a normal doctor's office. Then they're looking at the lab results and then making a determination from there. We'll then send out that sample we took in the clinic for a comprehensive panel, which includes the more, you know, comprehensive stuff. You're talking estrogen, CBCs, prolactin, SHBG, LH, FSH, all the big hormone panel. And then, if you're qualified, we get you started. And this is all done within about an hour. So again, speed is the name of the game for guys, and that's what we've done really well.

Talk to me about the blood thickness part, the hemoglobin and hematocrit.

So, it's important to know what your HNH, hemoglobin and hematocrit, is at a baseline. And, normal levels should be kind of like hemoglobin below a 17. And, I'm saying this based on guidelines. I have to say I'm not an MD. We have 350 of them.. But the GameDay protocols are all based on Endocrine Society. So you want baseline level of hemoglobin below 17 means that your blood's kind of in that normal thickening state. What happens when most guys start testosterone replacement is the red blood cell count increases, and that's when you feel all those great benefits. Like, whoa, I mean, you're on a treadmill now, right? I can, you know, work out, walk forever. My strength is increased. I recover faster. All the benefits of higher red blood cell counts, more oxygenation to the muscles. If your blood becomes too thick, meaning that your hemoglobin levels become too high, you're talking over 19, over 20, you know, these are higher levels, then think about your blood going through your veins like it's like a pipe. It's, it's like sludge. It's harder to move through. And that's when you want to watch out for any of those adverse symptoms, right? Potentially a stroke. Um, because that's not, that's not, uh, it's not easily managed. And so you want to make sure on the front end that we know exactly where the levels are at.

Okay. So, help me understand this. If somebody gets on testosterone replacement therapy and let's say their HNH goes up, is the only option you have then decreasing the amount of testosterone that they're on or is there something else that you do?

Any case like that? Yeah. So, there's a few options. So, number one, and I say this kind of tongue-in-cheek, but a lot of guys who come in and their HNH all of a sudden skyrockets, it's Monday morning and they had themselves a weekend, right? And, they're super dehydrated and they're like, "Oh, man, I was in Mexico and we went hard." Well, dude, go back and drink a gallon of water. Oftentimes, that's all it is, is hydrating. And so, they'll come back, we'll check it again. And we do this all in the office, guys. It's all done in our clinics. You walk right in, know your levels fast, and the levels go right back to where they should be. So usually, dehydration is the culprit. If it's not and it is an elevated HNH level, then you can take a supplement that includes a grapefruit seed extract. Which is something you can get on Amazon that oftentimes helps lower the levels. And then number 3 is therapeutic phlebotomy, which, you know, guys don't like doing, but sometimes you have to have it done, which is where you go to like a Red Cross and donate, donate blood, and that'll bring the levels back down to normal.

What do you think about things like, um, or the two, two common agents that people tell you not to use or to stop using prior to surgery, fish oil and aspirin? What do you think about those as far as ways to kind of help keep the blood thin.

Yeah, I mean, some guys will take a baby aspirin as well every day. That can help. Oftentimes, you know, splitting the dose in half— and I'm saying this based on what all of our physicians do at GameDay— you know, if you do one big shot of testosterone a week, right, maybe it's 200 milligrams, that can, right, cause a big spike in your, in your testosterone levels but also your red blood cell count. Breaking that injection up into two separate injections per week. That also helps. So there's kind of, you know, an art to the science of managing your red blood cell count. So you have options beyond just, oh, I got to lower my dose and go donate blood.

I just got started working with GameDay 3 months ago, and so far it's been fantastic, by the way. It feels like really good concierge service. And I've been tested twice now. Is that an approximate frequency of testing? Is it like monthly, quarterly, or what do you advise as far as how often to check in on these values like HNH, total testosterone free, etc.?

So this is something we take a lot of pride in. The endocrine guidelines, and they're the gold standard, right? They're putting out what, how hormone therapy should be done. They say we want you checked for your labs every 6 months. What we realized early on at GameDay was that is not enough. It's not enough at all for a few different reasons. Number one, you know, here, Ben, here's some testosterone. I'll see you in 6 months. You know, let us know how it goes. Compliance is a problem. You might do too much one week and all of a sudden your red blood cell count does increase and you're walking around with too high of a blood cell count for months and months. On top of that, we want to make sure that you're feeling well. If I send you off in the wind for 6 months, how do I know that you're actually feeling better? We need more constant touchpoints. So, what we do at GameDay, and it's great you mentioned that you've been on 3 months, you've had 2 labs, that's the GameDay way. We do labs more than anyone else in the country. For what we offer. And they're done at least quarterly. So you're going to get that initial panel, and then we want you back within like 6 weeks, and then at 90 days, 120 days, and so on. Because it just helps, number one, create like a relationship with the patient. We really do want you to feel better, and with constant touch points, that's how we can get it done. And it helps you be more compliant. You know, you get— like I said, you give a guy a vial of testosterone and he's off to the races. And 6 months later, he walks in, his testosterone's at 2,000. And you're going, "Dude, what have you been doing?" So, 6 months is just not frequent enough in our opinion.

Ben Greenfield: Yeah. Okay. So, hopefully, you don't mind me just peppering you with all these logistical questions because these are a lot of the questions I get too from clients or friends. So, the delivery mechanism for testosterone, let's say you go in, you test, you're certifiably low, you need testosterone, but then, I mean, and I don't think the podcasting industry has helped this much at all because you hear about sprays and you hear about pellets and you hear about lotions and creams and injectables. Do you guys have like one specific method that you use at game day, or do you, do you tailor it according to the client, or how's that look?

Tailor it to the client for sure. Um, having said that, the injections, testosterone injections, those are the gold standard. They've been around forever. There's the most research around them. Testosterone cypionate is the testosterone that most offices use. The half-life is 7 to 10 days, so you take an injection and it's out of your system in week and a half later. So, it's easily managed. So, that's option number 1. The problem with option number 1, meaning injections, is guess what? Most guys hate injections, right? Who loves giving themselves a shot or having a shot? So, we have other options for guys who, for example, don't want to do injections and/or travel a lot, right? Imagine bringing around needles and syringes if you're always on the go.

Ben Greenfield: Well, that's my problem. I'm not on injections, by the way. I'm on a cream and I travel 14 days out every month easily.

So for you, injections would be super cumbersome. You're going through security, oh, you know, what is this guy, all these needles for? That's always the concern. So cream is a great option for someone like you. Cream has its benefits, which is easy to use, right? Put in your suitcase, off you go. One of the downsides of cream though is like you might not get the same, um, the same spikes week over week. There can be variability. And certainly if you, you know, you sweat more, or if, you know, you rub your cream on, you know, your clothing, you're not getting the same kind of absorption. So there's, there's a drawback there. The other option for guys who travel a lot like you is pellets. And so these are little— they almost look like little grains of rice, and they're testosterone pellets that are implanted under the skin, kind of in the glute area, and they last 3 to 4 months. So those are super effective as well. You know, they dissolve over time. One of the drawbacks of pellets though is once they're in, they're in, right?

You can't, you can't, uh, you can't adjust dosage, right?

No, no, you can't adjust. Once they're in, they're in, but they'll burn off in a few months. The final option is kind of a newer option that's come out, is oral. And so we've partnered with, with a company called Kaisertrex that offers the oral testosterone. They have a lot of positive research. It's still a newer form, but, you know, if guys were to say, hey, what I prefer is take a pill, it actually bypasses the liver, so there's not a lot of liver toxicity with it. And so we've seen a lot of success with that as well. Yeah.

And don't you have to take like metric crap tons of fat when you take the, uh, the testosterone oral, the pill?

Yeah, it's helpful. It's certainly helpful to eat a lot of fat.

Yeah, yeah, I made that— or I tried oral and I still felt better on the cream. But when I tried the oral, um, I for a couple of months wasn't consuming enough fat and didn't realize like how much, you know, almond butter and coconut milk and coconut, you know, all this stuff I had to put in my morning smoothie along with the testosterone. So to actually get the effects, the absorption Yeah, that's super important.

But I mean, to your point, yeah, it's tailored to the guy. I'd say the majority of the men at GameDay, and we treat millions of guys throughout the country, are on the injections.

Yeah, yeah. The things that you prescribe or use along with testosterone are obviously important. I'm on gonadotropin. It's this little, uh, little pill. I've been working with Judd and Nate up at the Coeur d'Alene GameDay. They have me on the gonadotropin to help out with maintaining ball size. I think a lot of times you'll do that for fertility also. What are some of the other things that you guys have access to or commonly use in conjunction with testosterone?

Yeah. So, testosterone, great question. Testosterone by itself causes your body to go, "Okay, I'm getting testosterone from an outside source." Your body's smart. It goes, "Okay, I guess I don't need to produce it myself anymore." And so, your testicles, right, they're obviously producing it. They're going to more or less shut down that production. And that's when you might see testicular shrinkage. Some guys really are upset by that. Other guys are like, who cares, it's cosmetic. It's really patient-specific. But in order to maintain testicular function, especially if, you know, guys want to still have kids at some point, there are some other options. Number one is gonadotropin, like you mentioned, Ben. There's another medication called HCG. And so both of those help maintain testicular function, maintain fertility and sperm count. While on testosterone sipping it.

Got it. And by the way, I think I said gonadotropin. It's, it's gonadotropin.

Gonadotropin.

And then HCG is human chorionic gonadotropin, right?

Correct.

Okay, so I misspoke. So it's gonadotropin is the little pellet that you just dissolve under your tongue. Yeah. And then HCG, is that usually an injection?

Injection.

You got it. Okay, got it. What about— because I did an interview last year on Men's Health and my guest was talking a lot about Clomid and enclomiphene. Do you guys use those at all?

We do, yeah, and they're awesome. And so there's kind of a tiered approach here, right? Think about it like, right, JV and then varsity. And clomiphene and Clomid, they're going to basically tell your body to produce more of your own testosterone. They're going to almost trigger it like a peptide would. Peptides are super popular right now. They're great for guys who still want to preserve 100% of their fertility because again, when you just use injectable testosterone, you're going to probably have a lowered sperm count over time.. And for those guys who are still wanting to have more kids, you know, you're going to have to get that sperm count back up at some point, which means getting off testosterone. And clomiphene or Clomid, these are, um, their pill form, and they help maintain your natural production of testosterone. So they're going to give you that bump, probably not as much as, you know, testosterone injections where they can get your levels much higher. But a lot of guys who are on Clomid, you know, say their levels started at a 300, they get them up to maybe a 600. And we have a ton of data around our patient base that shows this as well. So really great option, maintains fertility. It's the JV level of hormone replacement, and it doesn't impact your fertility like testosterone injections would.

Okay, so let's say I'm 34 years old, I'm not done having kids yet. I get on testosterone, I feel great. My wife and I have a chat, we want to increase fertility, have kids. You would cycle me off testosterone, transition me to Clomid or enclomiphene until I was past that, that fertility goal and then I could transition back onto testosterone, for example?

Nailed it. Bingo. Okay. Got it. Exactly. Happens all the time.

Okay. Got it. Interesting because a lot of guys hear once you're on, you're on, and maybe you'd even take enclomiphene or Clomid simultaneous to the testosterone, but something like that would enable you to just stop, get fertility as high as you can, and then get back on whenever you want to.

Correct. Yeah, correct.

Okay.

Okay.

Got it. Now, that obviously I'm sure some people will wonder this, 34 sounds young. How often is it that a guy comes in, and I realize this might kind of sound like shooting yourself in the foot from a men's testosterone clinic standpoint, how often do you say, "Dude, you need to sleep more, stress less, get more sunlight, lift some heavy weights, get more vitamin D and fat intake." How often are you looking at these lifestyle factors before you just say, "Here's a needle." So, at GameDay, we say no much more than we say yes..

And for those reasons specifically, testosterone replacement is kind of the final solution for guys who've tried everything, you know. So guys, certainly we get a lot of younger dudes who are maybe in their 20s, you know, and, and it's like, hey, you know, let's focus on lifestyle first. You're going to want to have kids at some point, I'm sure. Most guys do. Uh, let's figure out, hey, how can you optimize what you're eating, your exercise, your sleep, your water intake, and then supplementation. That's the first start. If things are still not improving at that point, then we can look at the alternative options. Maybe it's a Clomid to start with, and then beyond that is testosterone replacement. So we actually have, you know, every single patient runs into our database. We have a huge data warehouse. The numbers we have are, you know, we, we do things by the book. We're not prescribing testosterone to young guys who are fresh out of the Marine Corps, you know. That's not That's not the vibe for those guys. It's just, you know, get in the gym, take care of yourself. You can lift your normal testosterone levels beyond what you would imagine. It's for guys who are a little bit later, right, in life, you know, not in life, but like guys who have tried those things. And sometimes it's in your 30s, like when I started GameDay, I was 34. Sometimes it's 40s, 50s, 60s. But it's for guys who have tried the lifestyle stuff, didn't really get the bump they wanted, and at some point they're weighing, okay, do I want to start a hormone replacement journey, but I want to maintain my current status quo. At some point in every man's life, you look in the mirror, right, Ben? And you go, "Just don't feel the same, dude. The light switch got turned off. I feel like crap." And, most guys go and their wives are usually the ones you tell them, they're like, "Babe, you're depressed. You need to go to the doctor and I want you to think about getting on an antidepressant because you're not the same guy. You sit on the couch, you have no spark, you have no joy." We will have one when his first thought or her first thought isn't go to the doctor and get on a pill, go to GameDayGetTested because oftentimes low testosterone looks just like depression.

Well, looks like or I would say even can be because if you have low testosterone, a lot of times you're not moving, maybe your relationship suffer, you're not having sex as much and you're not engaging in a lot of the things that would naturally fight depression. So, I think in some ways you could synonymize the two.

Yeah, yeah. And, there's tons of overlap. All the symptoms are the same: low energy, poor mood, decreased interest in life, poor sleep, poor sex drive. Those are all symptoms of depression. And so they certainly go hand in hand. The problem is, you know, a lot of guys go and they're getting on these antidepressants, and then we have to untangle them. They walk into game day, they're like, I feel worse, you know, I feel like, like I'm numbed out, I have no joy. Yeah, I'm not super depressed, but I'm also not happy. I'm just right here, zombie mode, zombie mode, dude. And we got to get them right off it.. And again, we'll work with, with their therapists and psychiatrists, but a lot of times those guys get on Tier 2 and they're like, oh, okay, got it. This is it. And it's cool, right? Because we're kind of— we're, we're the biggest in the country at GameDay. It's not by accident. It's because we do things the right way. We're almost 400 doctors supervising all of our offices, and we're helping guys like get educated, number one, on like, how can I feel better? And maybe it's not just a pill. Maybe it is a hormone deficiency.

Yeah, yeah. And I want to acknowledge, because I've had podcast guests on who have talked about this, that sometimes there is more than one way up the mountain. And I think, you know, more power to you if you are going to do like, you know, 3 or 4 cold plunges a day with the balls getting under, and, you know, heavy deads, and just the diet super dialed, and sunning your balls, and doing red light therapy. I think there's a way that you could to biohack all of this. But, there are people who realistically, including I would say I fit into that category. We're on a plane 14 days a month. We're in an office a lot of the time. We're relegated to what life has offered up to us as far as the blessings of living in an era in which we can be indoors working on computers, flying on planes. But, sometimes the whole cold bath, sunlight thing it doesn't quite fit the logistical bill.

Ben Greenfield: No. And honestly, you, Ben, and your audience, you guys would be considered the upper tier of kind of highly educated longevity, health-conscious folks. The majority of this country are not anywhere near that. Maybe they've listened to a little Rogan, maybe they listen a little bit of you, but beyond that, they're like, "I got my kid's soccer game this week." I got to work, I'm dad. And so they don't have the time to tweak out on like the latest stuff, right? Sauna, maybe cold plunge. Yeah, right. Those are the ones we want to reach, you know, because we don't honestly— at game day, we don't have to talk to the Rogan guys, the Goggins guys, the Ben Greenfield guys. They're already bought in. They know what's up. We're trying to reach the guy on the couch who's like, man, I just feel like shit. What do I do? You know? And he's got barely enough time to take a shit, let alone listen to a podcast.

Ben Greenfield: The pharmaceutical versus the compounding pharmacist thing, I think, confuses a lot of people. When someone goes and they get tested and they get on testosterone, are they getting a prescription that they bring to Rosar's or CVS or whatever and getting a bag with the name of a pharmaceutical company on it? Is this more of the compounding thing, which I think, again, a lot of people don't quite understand? I realize it's kind of a big question, but can you differentiate and walk me through how the pharmacy piece works for sure.

So compounding pharmacies versus, you know, pharmaceutical grade. Compounding pharmacies are patient-specific formulations. So if you think about what you get at CVS, there's certain right manufacturers that have certain dosages and it's kind of this, hey, take it or leave it. That's what we offer. The beauty of compounding pharmacies, and this is what we use at Game Day and I'll explain why, is that we can go, hey, Ben Greenfield needs this. And we're going to formulate it specifically on Ben's labs. We're going to make it based on what is the best interest of him. And it might be, hey, there's testosterone with a little DHEA in it, right? We can do custom compounds specifically for you. Having said that, not all compounding pharmacies are created equal. And so I think this is where compounding gets a bad name, is the— they're called certificate of analysis. It's basically how much quality, how much control goes into your processes. This should be public information. Um, in most states, patients can require the certificate of analysis from a compounding pharmacy. At GameDay, we require every single batch of every single medication that goes to every single patient to have a COA, and our medical team reviews it to make sure it's the highest quality stuff. Oftentimes, compounding pharmacies, they can say, no, I'm not going to send it. If a compounding pharmacy is not sending you their COA, that's a huge red flag. So we, we go kind of above and beyond to make sure that standard is met similar to just pharmaceutical-grade manufacturer like a Pfizer or some of the big guys. We prefer compounding. We actually just acquired our own compounding pharmacy for this reason because it really is in the patient's best interest. You know, you're formulating it based on your body and what it needs.

Yeah, okay, that makes sense. What if you live in the sticks? Like you said, you guys are gonna have, I think, over 500 clinics around the country, which is great. But, some people are still going to be 2, 3, 4 hours out. Is there any space for teleconsultations, telemedicine, anything like that?

Yeah. So, we launched telehealth about 3 months ago and we can reach the rural areas, all the white space that we don't have a game day in and there's a lot of the country that doesn't have a game day and pockets of 4,000 people here, 10,000 people there. You can go online and complete the consultation process. We drop ship a lab kit to your house or you you can drive to the nearest lab. What we found with our telehealth model, it's kind of interesting, is patients go in and they, they want to do the telehealth and have a consultation online, get their labs done, and they realize, oh wait, there's a game day 20 minutes away or 30 minutes away, I want to go into the office. So we're seeing about large volume of telehealth, uh, interested patients actually convert to in-office because they want the custom feeling, um, and the, the real handholding. Now if they're 5 or 6 hours away from a game day, yeah, off they go with telehealth. It's important though with telehealth that, again, that lab interval is the same. And so we're not saying, here's your script, come back in a year, which a lot of these online guys do. And we are very wary, right? That's why they're charging $49 a month for your program. That's freaking crazy. You know, you think about what you get for $49, like, be careful of whatever you put in your body for that.

Yeah, especially, especially when you're dealing with the endocrine system. You know, back again to the idea of like the young person We did mention the importance of some of these lifestyle factors, but then the other thing that pops up a lot is how head injuries or even some kind of genetic condition could make it so even if you do all the right things, your testes aren't getting the signal to produce testosterone. Now, I think from memory, I could be wrong here, that's called primary hypogonadism and then secondary would be a problem with the testicles. But, do you see a lot of cases of primary where people will have a head injury or something something that's keeping them from producing enough?

Sometimes, and they tend to be like a lot of our military population that got injured or firefighters or police, first responders oftentimes have those kind of head injuries that can contribute to that. Mostly not though, but in those cases, it tends to be those guys.

And for those people, do you kind of use a similar protocol or is there other things involved that you'd use for head issues like hyperbaric oxygen or something like that?

No, similar protocols honestly. It's going to have the same bang for the buck at the end of the day in terms of outcomes.

Ben Greenfield: Okay, got it. Okay. So, we've talked about testosterone, HCG, Clomid, or enclomiphene, gonadotropin-releasing hormone. But then, you get into— and I've been hearing a lot more about this. I don't know if it's because of the Enhanced Games, which I'd love to hear your thoughts on, by the way, but I've been hearing a lot more talk about Deca, which I think is also known as Nando, Nandrolone. Which one is it, Nando or Nandro?

Yeah, Nandro.

Nandro. Okay. So, Nandro or Deca, I was watching a documentary on the enhanced games. The swimmer just blew up, looked like he was on way more than testosterone. I suspect he maybe was on that, EPO. I don't know, but what are your thoughts on enhanced games and also the use of Nandro?

So, look, at GameDay, we are for the average guy in the United States and now beyond once we were in Canada now and we'll be in multiple countries next year. I mean, England, we'll be in UAE, Dubai.

Oh, I didn't realize you were expanding internationally.

That's—

yeah, that's honestly, that's great because I have a ton of international listeners and followers who are constantly asking me, and usually most of the clinics I know of are US-based.

Yeah, no, we'll be everywhere, um, next year. Right now we're focused on, you know, North America, but next year we'll have many offices throughout the world. So that's coming. Um, having said that, We kind of stay in our lane, and I don't think any of our offices prescribe Nandrolone or anything beyond testosterone cypionate. Um, you know, we do a medication called Sermorelin, which is a peptide that tells your body to produce more growth hormone. That's a fantastic medication for anti-aging, energy, weight loss, etc. We don't really touch the anabolics much, and you know, we're guided by what our medical board kind of says, and we really take a lot of pride in trusting their judgment. We have the best of the best doctors involved. So, in-andro is an area we kind of go, "Eh, not for us." Maybe some of those more fringe concierge places. Seguing into the Enhanced Games, look, that's some entertaining stuff. I know the swimmer you're talking about. I'll certainly watch. I think, again, it's not to be taken lightly, a lot of the stuff that these guys are on. You can have a lot of complications. Yeah.

Well, I think that's part of the Enhanced Games is to compete, you have to pass certain health tests to make sure you're not destroying your body in the process.

That's good. Great. Yeah, I didn't know that because, man, you just start shooting up everything you can, not only physical issues but psychological. It's some dangerous stuff.

Yeah. I think the whole idea behind them is they won't test you for illegal performance-enhancing drugs because anything's fair game, but they will test you for health and wellness parameters. Okay.

Makes sense. Interesting. Yeah, definitely be a viewer, that's for sure.

Yeah. Yeah. So, the Semaralan, that'd be considered a peptide, right?

Yeah.

Do you guys do other peptides as well? Like, you know, because obviously that's a huge industry.

Yeah, peptides have exploded. So Sermorelin is the most popular. It's fantastic. You know, it's interesting, we have a lot of, um, a lot of the, the wives come in, right, with their husband. They're like, this guy is a new man, what about me? What do you have for me? Well, we have a women's brand. We have a women's brand launching soon. Um, but in the meantime, we say, look, um, what do you— what have you tried?. And a lot of women have been on the Wegovy, semaglutide, right, the GLP craze. All the latest research though shows, right, hey, maybe this isn't the best thing long term because muscle wasting, right, your digestive system slows oftentimes to levels that are really dangerous.

Wait, which one causes that?

The GLPs.

Okay, the GLPs.

Yeah, right. Okay. A lot of women are flipping over to sermorelin now because it has a lot of the similar benefits, but you're maintaining muscle mass. Not only that, you know, it's great for their hair, their skin, their nails, all the things that they really privilege and weight loss as well. So, sermorelin is great for men, it's been great for women. It's the hottest peptide right now for sure. There's some great ones as well. BPC-157, that's fantastic for recovery. I don't know if you tried that one, but a lot of the guys who are super active, that thing is—

I sprained my ankle a few weeks ago and that was one of my main go-tos.

Yeah. It's fantastic.

Literally, I didn't even go sub-q systemic, just jamming. I don't recommend this, but just jamming near the site of injury as close to possible every day.

Yeah. No, a lot of guys are doing that and a ton of success. And, they're like, "I don't need a cortisone shot. I didn't need surgery. My shoulder feels amazing or my neck pain is gone." So, it's really wild and awesome stuff. And then, CJC is another one. CJC is a big one for endurance. Yeah.

Growth hormone also, right? CJC usually get that with ipamorelin, right?

Yep, exactly. Yeah, so the peptides are, you know, they're, they're the new hot thing on the market. Um, certainly you want to make sure that they're coming from a reputable source. Right now it's kind of the Wild West in peptides, and a lot of the crap is, you know, research grade, which should scare anyone. If you see a peptide that delivers to your house and it says research grade, not for human consumption, that means it doesn't meet the rigorous standards it should.

Yep, a lot, a lot of lipopolysaccharide contamination. People having histaminergic reaction. I see all sorts of stuff now, people freaking out. Yeah, peptides. The Semarilan though is interesting. Um, you know, you hear about Tesamorelin, uh, Ipamorelin, and then you have this Semarilan. Would you say Semarilan's like top of the totem pole when it comes to growth hormone?

For sure. Yeah. Okay. Absolutely. Yeah, it's the safest. There's the most research around it. Um, you can be on it longer term, you know, sometimes 6 months. A lot of patients are on it. And the outcomes are fantastic. Number one thing folks feel on sermorelin is their sleep. They're like, "Oh, wow, I haven't slept that well in years." And, it's a game changer.

Ben Greenfield: Yeah. That's actually not one that I've used recently or I'm on, but way back in the day, I used to work when I used to race. This was like race Ironman 10 years ago. There was a company called Millennium Sports and they had not sermorelin but some kind of Cimarellan Precursing Agent. I remember I used to swear by that thing for sleep after a hard and heavy day of training. But, Cimarellan is an interesting one. I don't think a lot of people know about it. So, the women's piece, is it going to be Dame Day or different name, same name? Yeah.

So, one more thing on Cimarellan, it's about to be the hottest peptide in the country. It's about to blow up. Really? Wow. Yeah. And, we offer it at Game Day. It's an exciting time for sure with that peptide specifically. Yeah. So, HerWay Health and Hormones is the name of our women's brand. And, we have an office in Carlsbad. We're going to launch the franchise model around it probably early in 2026. And, it'll offer women's hormones, hormone replacement. If you talk to women who are on hormones, they're like, "I feel great, but I had to drive 4 hours to find the doctor," or there was a fixed 6-month waitlist. There's just not enough supply for the women who need hormone therapy. We also do sexual health, weight loss. Yeah.

Ben Greenfield: Yeah, that's incredible. I mean, my wife's been working with a practitioner for a little while and it's just been transformative for her. And, she was in great shape and slept well and everything before, but now, and her libido is off the roof, which I don't complain about. And, it's just transformed her being able to work on the endocrine system with somebody who knows what they're doing.

Is she doing creams or— What's she doing, pellets or—

uh, she's like a topical, and then, um, uh, everything for her right now is topical and oral.

Okay.

But she doesn't even need to be on very much. Yeah. Um, so the, uh, the, the issue that I think some people might be thinking about is, okay, this all sounds great, but what if I get on this, like, the FDA cracks down and, you know, regulatory agencies start to restrict what a clinic like yours is able to do? What does the landscape look like as far as the regulatory conditions that, that you have to either battle against or work with?

So yeah, we feel very confident in what we're up, up to, you know, for a few different reasons. Number one, everything we offer at GameDay has, uh, a ton of research around it. Testosterone replacement is FDA approved. It has been for decades. That's not going to impact anything or go away anytime at all. So in terms of the treatment itself, good to go. Number two, we're the brick-and-mortar space leader, right? We've done the hard work. And not to talk crap on our telehealth competitors, but, you know, create a website, drive a bunch of ads to it, and then sign patients up— that's a lot simpler than building out an almost 500-unit retail model of medical practices throughout the United States that people still want to come in and feel trust. And so because we're on-site, um, you know, there's the Ryan Haight Act, which— not to get too deep in the weeds— but that basically allowed telehealth providers to prescribe controlled substances online, and it was waived during COVID because no one could leave the house, that there's the threat there, right? That if that goes back to where it was before COVID means now you can't get testosterone online. Well, guess what? GameDay is not only online, you could still just like drive to a clinic. So drive to a clinic, not an issue. And we believe in like the personal relationship piece. You know, um, number 3 is we are writing white papers. You know, we are literally— what my hope is, Ben, is that the industry follows us because there really hasn't been a truly kind of gold standard provider in this space that's done it at this scale. Maybe there's a great clinic in Tampa. Great. Well, guess what? I have 400, and every single one of them does things the right way. How do I know that? Because we have crazy compliance and AI built into every single office, and We want everyone to follow us so we can start giving this industry a better name.

Yeah, what's that mean, you're writing white papers?

We do studies. Yeah, we publish studies on our data. And, you know, we have patients, you know, millions of guys come in, the data pipes into our EMR, and we can look at trends. So number one, we can say, hey, here's what we're noticing. Number two, we can say, hey, let's take a group of, you know, former Marines, let's put them on testosterone replacement for a year and kind of follow them not only physically but psychologically. And so we're out there saying, here's the research, here's what we've learned. And then making it readily available. And so, we have a team of 350 doctors that have led our white paper team. So, we'll start getting those out here in the next 4 to 5 months.

Wow. Anything preliminary that you've found that's interesting or notable or—

Nothing yet. Right now, it's data compilation. Yeah. So, we can't really comment on results yet.

Yeah. Okay, got it. So, in terms of you know, what a guy— kind of coming back full circle to the symptomology idea— what can a guy expect if they get on testosterone? Like, you, you said light bulbs on, but let's get specific. Like, is it, do I build muscle faster? Do I get better erections? Um, am I hungrier? Am I not as hungry? Like, what are some of the common things that you see?

Yeah, so common things, and I think this is why testosterone replacement is so powerful, is because if I were to tell you, hey Ben, here's medication, you're gonna maybe feel better in 4 months. You're going to be like, yeah, not into it. I want to feel better in 3 weeks or in a month max. That's what TRT does. It's kind of like that, oh shit, okay, I feel something and I'm feeling better than I did 2 weeks ago. So it usually happens pretty quickly. Um, number 1 is usually kind of mood and energy levels. You're like, huh, I kind of feel, I feel happier. Nothing's changed in my life, but I just have more upbeat energy, upbeat attitude, and energy levels for sure.. So, hey, I don't need that cup of coffee or that Monster drink at 3:00 PM anymore. I can just get through my afternoon without any caffeine. And they start to notice this type of thing where like, I just feel better. I don't need as much support throughout the day with stimulants. I can get through my workout easier, putting a little more muscle mass. Whoa, I woke up and I'm ready to go. Hope my wife's around. Sexual performance is usually peaking as well by month 2. And certainly, hunger, that's a part of it. You'll probably be hungrier in the early days.

Mostly because you're more active or have put on more muscle mass, I'm assuming.

Yeah, exactly. I compare it to you kind of just want to go out and do something. What can I do today?

Yeah, I think it was— maybe it was Dr. Andrew Huberman who described testosterone as being something like a hormone of forward progress. It's kind of funny you said I'm walking on a treadmill during the podcast, but yeah, it is true. You have that motivation, that desire to complete another rep, complete another step, complete another task. Yeah, it's kind of hard to describe, but it literally— not like in a random distracted task rabbit mode, but you definitely feel almost like a greater dopaminergic response to any element of professional or personal progress.

Totally. Yeah. That idea that it rewards effort, effort you're giving, it kind of, "Okay, I want more of it." Yeah, yeah.

Well, this has been fantastic. Obviously, I'm sure there's guys listening in, maybe women eventually for this HerDay thing who are interested. I'm going to put all the shownotes in the podcast. I think you guys gave us some kind of a link or a discount that people can use for signing up. So, BenGreenfieldLife.com/GameDay Podcast. Again, you guys, I try everything that I talk about on this show. I've been working with Game Day for about 3 months. Super impressed with the professionalism and what they put together. So, I can stand by this. That's what I'm using now for my own hormone optimization. So, BenGreenfieldLife.com/GameDayPodcast is where the show notes are. You can leave your questions over there, your comments. I read them all. Evan, thank you so much, man. This has been super informational.

Thanks for having me, dude. This was awesome.

All right, folks, I'm Ben Greenfield along with Evan Miller from Game Day Health signing out from BenGreenfieldLife.com. Have an incredible week. To discover even more tips, tricks, hacks, and content to become the most complete boundless version of you, visit BenGreenfieldLife.com.

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