Prostate Health with Dr. Mark Stengler | How Humans Heal Podcast

Today I get to introduce you to Dr. Mark Stengler. He's a naturopathic physician in California. He's been practicing for 26 years and has written over 30 books, including his latest book on healing the prostate. So thank you so much for joining me, Mark. I'm so glad to be talking to you today about this really important subject for men and prostate health.

Oh, thank you. Great to be on your program.

Yes, yes. I mean, and I mean, the thing is, is that, you know, you've been doing this for so long, and I know you've written about a lot of different topics. What brought you to want to write about prostate health?

Well, the prostate health and men's health. You know, surprisingly, there aren't a whole lot of books out there in terms of integrative medicine. There's certainly a lot of books out there on prostate cancer, more of it from a conventional viewpoint, some holistic viewpoints, but very little in terms of just specifically focusing on men's health, prostate health, especially benign prostate hyperplasia, the most common prostate condition men have. Then there's prostatitis, where it becomes inflamed or infected, and then, of course, there's a prostate cancer. So there really hasn't been a comprehensive book written in terms of integrative medicine on the topic, surprisingly, being such a common issue with men.

It's so true. I mean, and that's the thing is it's, I think a lot of times it sneaks up on men. You know, like, I think a lot of times you're going, you know, men are going through life, you know, work and family and everything else they're doing. And then this seems like prostate issues kind of pop up out of nowhere. I mean, sometimes it's an infection in the prostate or prostatitis at a younger age or could be prostate cancer, usually a little bit older age. But talk us through that. Why is it that it's kind of something that is not really thought about until all of a sudden it's there?

Well, you know, we men kind of think we're invincible until something starts happening with our health. You've seen that with patients throughout the years. I mean, men, men, unfortunately, aren't as wise as women when it comes to health. The men tend to come in and get more serious things happening. You know, they've been diagnosed with a cancer. They. They've had a heart attack, a stroke. But the men do start to come in when they're having issues like frequent urination throughout the day. They're getting up Multiple times at night. Obviously it really interferes with having a good quality of life, which are symptoms of prostate enlargement. So that usually, you know, when their life's disrupted enough, they tend to come into the office and then we start finding out what's going on and start treating the men. So that just seems to be happening with most conditions with men. But because most men at some point in their lives do develop issues with an enlarged prostate, then it affects your urination. That's when men start looking for help.

And like you're saying, a lot of times it's waking you up in the middle of the night to have to pee and you're like, wait a minute, I don't want to get woken up every hour or two hours. And then you're trying to go back to sleep and then you're more tired and you're like, what the heck is going on here? And that's sometimes when the BPH or enlargement of the prostate is identified. Talk us through that a little bit more. Like, why does that happen and what's going on there from your perspective?

Yeah, absolutely. Well, there's some root issues going on with prostate enlargement. When you look at the literature, which I cite in the book, there's multiple things going on, but really one of the core things that's happening is hormonal changes.

And of course you talk a lot.

About hormone balance being so essential to good health. But with men, what's happening, typically you look at the literature. As men get older, the testosterone levels decline. So studies now show about 40% of men over the age of 45 have low testosterone. So a lot of people always associate testosterone with prostate problems. That really isn't the case. So it's more of the issue is as men get older, the testosterone levels drop. But there's an enzyme that converts testosterone into estrogen. That activity increases, so their estrogen levels go up as well as another hormone called dihydrotestosterone or dht, which is a metabolite of testosterone.

So essentially these two hormones that tend.

To increase as men get older and they fuel prostate cell growth, not the testosterone in and of itself. Otherwise of course, we'd have 20 year old men walking around with when their testosterone is high.

So it really doesn't work that way. There's other issues of course too. From a naturopathic viewpoint, there's certainly very good research showing that when men are eating a healthier diet, they're less likely to have prostate enlargement. When men are overweight they're more likely to have prostate enlargement. There's some connection that's been studied with environmental compounds, the xenoestrogens, which I know you've talked about. So these estrogen like compounds in the environment from plastics and cosmetics and other things which mimic estrogen and will attach the cell receptors in the prostate. So really that's what it comes down to. Comes down to things such as hormone balance, weight, nutritional status. There are some studies done on nutritional deficiencies. For example, like men who are deficient in vitamin D are more likely to have prostate enlargement. They have studied that as well as insulin resistance, things like you get with pre diabetes and diabetes. Insulin resistance is one of the things which has been shown to increase the risk of prostate enlargement in men as well.

So does that mean then, if men start making these dietary changes and change their weight and their exercise, that they can then decrease the enlargement of the prostate?

Yes. I mean, you know what research has more shown is that when they change their diet, when they increase the exercise, they get a better body weight. Studies have shown that you can reduce the symptoms. I haven't seen studies actually where they've shown that the prostate size actually decreases. However, there are nutritional supplements which I cite in the book, which have been shown to decrease the size of the prostate. So a lot of doctors out there feel that once a man has prostate enlargement, only certain classes of pharmaceutical medications can shrink the prostate. But actually there are some studies out there with supplements like saw palmetto and nettles root. They actually have shown in published studies where they did before and after ultrasounds, you can get a decrease in the prostate. Now that's all within parameters. I mean, normally the size of prostate is the size of about a walnut, kind of a mild to moderate enlargement can get to the size of a ping pong ball. And then from there you can get the size of a tennis ball in really extreme cases, or you need surgery at that point. So you can kind of see the progression there. So natural medicine is excellent at preventing and treating cases of mild to moderate prostate enlargement, which is where most men fall into one of those two categories.

Yeah, saw palmetto is really an amazing herb. And we've known that. I think that research has been around for a couple decades at least. So it's, you know, it's like, hey, this is information we've had and we can use. And maybe some men are already looking for saw pal or taking saw palmetto products. What should they be Looking for in a saw palmetto product?

Yeah, thank you. That's a very good question because it is true when you look at the studies in saw palmetto, for example, I cite one here for men who have mild to moderate, you know, prostate enlargement symptoms of BPH, about 90% of men who take the right dose and concentration of saw palmetto actually get a significant reduction in symptoms. And we look at those studies and Those studies used 320 milligrams of an 85 to 95% what they call liposterolic concentration or standardization.

So one of the issues with saw.

Palmetto, when men don't experience good results.

From saw pametal, they've been on maybe.

Three months or longer, aren't noticing anything. One thing you have to look at, as with any type of product, are they using the right dose and the right type of concentration as the studies used? Certainly there's a lot of medical doctors out there who feel saw palmetto does not work based on certain studies. When you look at those studies, the studies weren't done where they were focused on again, having this exact type of concentration and dose which the positive studies use. So obviously if you're going to use something, you need to use it in the right dose which the positive studies use to get a similar type of result.

Yeah, that makes sense. And I would think, and I don't know if they've really studied it this way, but I would think that it would go along. It would only be synergistic or beneficial to have the diet changes and exercise and then other nutrients alongside the saw palmetto. Probably just enhances it is what I'm thinking. I'm thinking of cases I've worked on in my practice and it seems to me that in naturopathic medicine we're always working on the whole person, right. You know, are they getting good sleep, are they getting to, you know, do diet changes and so on. What are your thoughts on that?

I think it's necessary if you want to get the optimal results.

I mean, you know, in America people.

Are always looking for quick fixes. So sometimes people use supplements like you would drugs and they can work and often they do work, but you'll get much better results again if you address the diet, if you address the exercise, the weight, the stress and all that.

Absolutely, you'll get, you'll get much better results.

I that 100%. So always want to do a very holistic, well rounded approach in any type of condition, including for prostate enlargement.

Now here's the thing is, there's prostate enlargement, but what I think. And that can cause these annoying symptoms of waking you up and other pressure in the pelvic area. But then there's prostate cancer. And I think probably a lot of men have questions about what's the difference and what percentage of time does the enlargement become cancerous?

Yeah, it's a good question. There isn't necessarily a correlation between BPH or prostate enlargement and prostate cancer. However, the problem with prostate cancer is it is the second most common type of cancer in men behind skin cancer. About one in nine men do develop prostate cancer in their lifetime. Now, fortunately, most cases of prostate cancer are slow growing. So most men throughout their lifetime who have prostate cancer don't even know they have it. They have the slow growing type and they usually die of some other type.

Of disease at some point as they get older.

However, if you're a man who has a more aggressive form of prostate cancer, you need to know that so you can take more radical steps earlier on. You can't just wait and see what happens. So prostate cancer, it's definitely problematic. There's some, some very good research I talk about in the book. In terms of the type of diets people follow, which predispose them to prostate cancer, Vitamin D comes up. Again, there's research showing people deficient vitamin D are more prone to prostate cancer. So people or men can be proactive in reducing their risk for prostate cancer. That's why you just have to be prudent in terms of having a doctor evaluate you, monitoring you, checking you, not just for prostate diseases, but other health conditions, so that you can take action, hopefully holistically, if you're seeing signs of a disease starting to occur.

So what do you, after reviewing all the latest research on screening, what do you suggest for men? Should they be really getting in for a prostate exam once a year? Or what other testing do you suggest so that they know that they're on top of this and not letting it sneak up on them?

Yeah, it's a good question. I mean, when you look at the medical establishments out there who deal with.

This issue, you kind of get mixed.

Results or mixed answers on it. I mean, some still use the psa prostate specific antigen, a blood marker. It's kind of a generalized marker. It's not great. But for example, on a lab test, normal values basically between about 0.3 to 4.0. And if you're in that range, your chances of having prostate cancer, you know, it's possible, but they're mild. If you're between 4 to 10, you have a moderate likelihood of having prostate cancer. If you're over 10, a much greater likelihood to have prostate cancer. But it's not a great test. It can be a problem both ways. It can miss things, it can misdiagnose things. It's just one test that can be used. But essentially what we do with patients is we'll run that marker. We'll do a prostate exam. If there's a strong family history, we'll.

Check a patient once a year.

If there's not a strong family history, I think it's fine to check the patient every one to two years. If we're on the exam, we palpate a nodule. That's hard.

We're suspicious.

Then we go to the next step and you do imaging. You can do imaging with ultrasounds. MRI is even better. If you're still suspicious there's something cancerous.

The last step is a biopsy.

The trickier thing though, Dr. Donney, is that men over 65 and older, statistically, if they have prostate cancer.

Statistically, they're not likely to have any change in how long they live, whether they do something like surgery or not. Because again, most are slow growing. However, the problem you run into, again, if you have the fast growing type, you need to know that. And so that's where the testing comes in.

The biopsy can show you and then, and then you can decide, yeah, what do you, how do you want to treat it? Knowing that it might, is it going to, you know, be an issue quickly or is it more slow growing? And maybe because sometimes if you go through a surgery, then you have other side effects from removing the prostate.

Right, right.

And so fortunately, in terms of a man does. Well, first, I'll back up one step. There are some newer tests out like XOMD and some tests, urinary tests, actually, if a man has prostate cancer, you're kind of evaluating whether they need more aggressive type of treatment and stuff or even bopsy.

Biopsy of the prostate.

There's genetic testing do with urine testing, and more recent studies have shown that it's pretty predictive whether you have an aggressive type of cancer or not. So now urologists, integrative doctors are starting to use this genetic testing to find out, look, should this patient get a biopsy or not? So you kind of take all the information to their psa, your exam, this genetic testing due via urine testing, and it gives you a good assessment whether the patient probably should get a biopsy or not. Also combined with the imaging.

And, you know, it's. As I'm thinking this through from a perspective of a man, I mean, there's. Because either way, probably it also has to do with, you know, considering quality of life and symptomology. Right. Because even say we were talking about with the BPH affecting causing more frequent urination, and even with, say there's a tumor that could also affect urination or potentially sexual function, so can any potential surgery. Right. So this is. I'm thinking, I don't know if that's part of your conversation with men, is kind of weighing out how all of these different potential conditions and treatments could affect their quality of life.

Yeah, I agree.

I mean, that's one of the big concerns with prostate surgery. Definitely have problems with worsening of urinary symptoms. You don't have a good result with the surgery. Erectile dysfunction can occur. Pelvic pain, these things can occur from surgery. So that's why we like to make sure the other tests we do, in terms of the imaging, in terms of the new genetic testing via urine, possibly a biopsy, make sure that the men who need the surgery are getting the men that don't need it. You do more what we call the. In medical terms, the active surveillance. And that's basically where.

A man does not have a more aggressive type of prostate cancer. And so in conventional medicine, they just watch, you know, they just assess them through imaging and the PSA and stuff. Obviously, from a naturopathic viewpoint, we'd work on the diet, would work on the nutritional deficiencies, the immune system detoxification, and we're more proactive and so making sure that it's less likely they're going to get more advancement in their prostate cancer. Other men, there's some other good options out there. There's localized, what we call focal therapy. There's cryotherapy, where there's just a small section of the prostate that has cancer. It can be frozen. With cryotherapy, there's laser surgery for it. There's other conventional treatments like focused radiation. A man does not necessarily have to have surgery. If you've got this really localized lesion, there's other options out there for them.

Wow. And it sounds like whether either way, like whether you have a slow growing and you're doing more like prevention of growth, or if you have a procedure, then you're really in a place of wanting to prevent it from coming back again or advancing. Either way, taking this holistic view of your health is going to make a difference, because talk us through the studies on how naturopathic approaches can help with preventing prostate cancer or preventing the progression.

Sure. Well, in terms of nutrition, they definitely have done studies showing up men who get adequate amounts of plant foods in their diet. Like a lot of other types of cancers, it has a protective effect. They've done more research in terms of red meat and dairy products seem to be more problematic, especially dairy products. People with dark skin say, like African American men, it's more of a problem. Terms of the red meat, you could make the argument that it has not been teased out per se. Whether it's just red meat in general that's been grilled, we're creating the carcinogen, grilling. Or if men have like free range, let's say organic types of meat. If that's an issue, no one really has, like, teased out that type of information. Nevertheless, just erring on the side of caution. If there's a strong family history of prostate cancer, if a man has prostate cancer, we definitely restrict the red meat and dairy products and boost up the plant diets. Most of my patients, I use more of a modified Mediterranean diet, which I actually give a couple weeks of meal planning in the book. And that's the Mediterranean diet a lot of people have heard about. Rich in fish, fruits and vegetables, some beans, milder amounts of poultry, red meat. And it's modified because. Really cut back on the grains, because American grains, as you know, you know, the breads and the pastas and the crackers and all that, even the whole wheat one, they're just not the same as you'd find in Europe and other parts of the world. They really spike. Insulin aren't good for the immune system. We talk about. Insulin is related to prostate growth. So that's how we modify it.

Wow. Wow. That's. I mean, it's very, I think, can be very motivating to be like, hey, let me, you know, because sometimes it's hard to make these diet changes, but when you can see, hey, this could make a difference in your. Really the, Your longevity. Right. Based on. Because all of these same things are going to also help with preventing diabetes and heart disease and cancer and dementia. Right?

Yeah, that's a very good point. So more specifically in the book, I'm just looking at my list here, some things we talk about in the research.

You can lower your risk of things like prostate enlargement, even prostate cancer if you get more omega 3 fatty acids in the diet. Obviously, you got the cold water fish, you just want the clean fish. Human vegetables, ground flaxseeds organic flax oil lignans like you get in ground up whole flaxseeds. These are compounds which seem to help to remove the bad estrogens which fuel the prostate. There's been studies on garlic extract showing to help with bph. And then the phenols you find in fruits like cranberries, dark colored grapes and berries. Those actually been shown to help with urinary tract symptoms as you typically get with bph.

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Wow. Yeah. So it's so interesting, you know, and empowering when we can just go, oh let me choose these fruits or these oils or fish to help you know that it's going to make a difference in the long run. So. Oh my gosh. Well thank you for sharing that, that research and to bring it back a minute to testosterone because you were mentioning that testosterone is not what causes the BPH or it's not related to the prostate cancer, but it is, I think on men's mind, especially because it does reduce with age. So talk us through that. Like what is that effect of testosterone for men and what can they do about it to be able to benefit from testosterone later in life when it's decreasing?

Right, yeah. And we do have some chapters in the book just focusing on testosterone somewhat separate from the prostate, although the two can be connected in certain ways. As I talked about the metabolites of testosterone. But again, when you think about both, 40% of men over the age of 45 have testosterone deficiency, that's quite a few men. Obviously the older you get, the more likely it is to be a problem. So testosterone has many important functions in the human body, both men and Women actually many similar effects. So we need testosterone for proper muscle size and function. And by the way, that's not only just the muscles men you know are.

Looking at when they're working out, but.

Your heart, your heart's a muscle, too. So studies show if you have testosterone deficiency, you're more likely to have heart and cardiovascular problems. You need testosterone for proper bone mass and development. You need testosterone for property cognitive function. Men can be more susceptible to dementia if they have untreated testosterone deficiency.

And of course, we have all the quality of life.

Things such as libido is low. Typically, when you have low testosterone, you can get erectile dysfunction. Fatigue and depression are common symptoms of testosterone deficiency as well. We cite some pretty interesting studies in the book, and there's more than one where it has shown that men who have untreated testosterone deficiency are much more likely to die at a younger age than men who have normal levels, just because it affects so many systems of the body.

Wow. Well, that really. Yeah. Kind of is eye opening to be like, okay, this is because it doesn't always get tested. You know, it's not on the regular blood work. You'd have to specifically say, hey, I'd like to get this tested, or have your practitioner be more aware of those potential symptoms. So you might. Men have to. Might have to be a little bit more proactive, Right, to even find out that this is going on and to find a practitioner to help them with it.

Yes, absolutely. Matter of fact, you're right on that. The average doctor in America does not screen men typically for testosterone deficiency unless there's just some overt symptoms coming up or it's requested. So years ago, I changed that in my practice. A lot of us were trained. Once a man's perhaps 60 and older has testosterone deficiency symptoms, you start checking it more often. But I started checking men now around 40 years of age, because we do find a lot of men who aren't necessarily deficient, but they have low levels. In other words, they're in a normal range, but they're on the low end of the normal range, what we call the suboptimal level of testosterone. So we want to find these things and correct them so they don't need medications or more invasive therapy going on. You know, we're changing the diet, we're doing some detoxification, we're correcting the nutritional deficiencies. We know studies have shown things like zinc deficiency, vitamin D and magnesium. You need those to manufacture testosterone in the body. So we want to look at those things and Correct them while men are younger. So I do find a lot of men though around the age of 50 and older do have testosterone deficiency based on lab testing. And we walk people through the book, how to properly diagnose that. We always want to treat why a man has testosterone deficiency. A lot of doctors in America just instantly put men on testosterone. It's kind of the thing to do nowadays. But that can be a problem because you may be missing why they have the testosterone deficiency, the underlying disease or pathology. So is there a problem, for example in the pituitary gland in the brain? I mean, you know, there's, there's a small percent of men where they have a benign tumor of their pituitary gland and that's.

Causing problems with the messages from the brain to the testicles to manufacture the testosterone. We want to know that's an issue. We screen for that before using testosterone because that's a different treatment. You treat in a non surgical way that benign growth, the pituitary gland and then the testosterone levels come up. Plus, you know, you're saving perhaps some invasive surgery in the future if that tumor gets bigger. Fortunately that's a smaller percent of cases. But you know, we see men, men when they were younger, for example, they were messing around with testosterone use, just working out or sports. And that's thrown off the messaging system in their hormonal system. So there are ways naturally to bring back that messaging system. So their testicles are producing testosterone. Again, exercise. We talk about in the book that not only lifting weights can boost testosterone levels, but there's actually good research showing that even aerobic exercise in recent studies have shown increased testosterone in men.

But there's one little caveat with that.

Men who over train, they tend to have lower testosterone levels. So there's always a balance.

You gotta get enough exercise, but not too much, right?

Yes. Over training can throw off the hormonal system, cause testosterone deficiency. And so then the men who need testosterone replacement, or you know, something beyond the diet and the supplements.

Although I'm sorry, I should back up one step.

What I do talk about in the book, which I think is very unique, is that there are certain herbal supplements shown to boost up free the active portion testosterone and total testosterone levels in both men and women. So you know, in years past you'd see articles on using supplements to boost testosterone, other supplements that would use them. I don't know about your experience. When I would test people, say men with low testosterone levels, the results weren't like great, they weren't consistent, they weren't Great. It was somewhat disappointing. Fortunately, in the last few years there's been some research that's come out and very specific extracts. For example, a certain type of ashwagandha extract, which of course you talked about for years in terms of adrenal health, but a certain type of ashwagandha extract shown to significantly increase free and total testosterone in men and women. We do see that in blood tests. It brings it up quite well. So that's one that we use with patients. There's another one called Tongkat. Ali is the common name and that's been shown to bring up testosterone levels as well. So men who are mildly deficient.

Low end of normal, we prefer, besides the diet and exercise and nutrients to use these supplements if possible and see if that gets them up to a mid range at least instead of going right to the medication because it's a lot simpler for the patient and it's always best. You can balance all the body's own hormonal system, obviously.

Yeah, I mean, all of this is making me really, I'm always relating it back to stress exposure. Exposure. And you know, it sounds like a lot of the, you know, the stresses we get exposed to, whether it's not getting enough sleep or being exposed to toxins or, you know, is what disrupts the hormone production, including the testosterone. And it's curious to me with the ashwagandha, I wonder if they, it makes me wonder if it's particularly helpful for someone who has elevated cortisol. You know, so say if the cortisol is high and the ashwagandha brings it down, then the testosterone production is going to increase. You know, so it's, it's. They don't always study it exactly that way. Right. They might just study. They may not be testing the cortisol levels when they run those studies, but, but I think that makes sense. You know, basically like the more we do stress recovery, the better our bodies can work. And how, like you're saying, better to have your own body making the testosterone for you versus relying on an external source if possible?

Yeah, I think that's a large part of it.

And that's true because they have shown in research, like you said, when the cortisol is high, it does at least block the free cortisol or the free testosterone. Of course, that's how available or active portion your cells. That is true. They have interestingly done some research.

In terms of this hypothalamic pituitary testicular access where, you know, these certain types of verbs, you know, like the ashwagandha, help to reestablish, you know, this messaging system. And you know, as you've written about, it's a very interesting system, this, what they call this HPA or HPG access, where you have this feedback mechanism, how the body, the different organs of the body communicate. But let's think about it. At the top of that system is the hypothalamus, you know, higher center of the brain. And so the information we get from the outside world, or at least how we perceive it, influences the messages from our brain to other organs in the body. So as you pointed out, many times the better you can handle stress on many different levels, you're going to create better hormonal messaging. So your hormonal glands are going to be in better balance.

Yeah, yeah, that makes sense. And I'm also thinking of how many men I've spoken with who have used, for example, the medications for preventing hair loss, which has been shown to disrupt these hormonal communication systems and disrupt the, for example, testosterone production. And I just like to mention it because I think a lot of times men are not aware that these. Right. They're more worried about their hair and they're trying to solve that, and it ends up causing hormonal disruption.

Well, it's a good point.

When you look at the inserts for those medications for hair loss, you'll find that they can create things like sexual dysfunction, for example. So it's showing that it is having an effect on that feedback system, the hormonal messaging system, resulting in side effects. A lot of people think, hey, I'm just applying this medicine topically in my scalp. It's not going to affect me systemically. But look, we found out 15, 20 years ago, things absorb through the skin and have systemic effects a lot more than we ever thought. So it's true. Even some of the medications used for hair loss, which, you know, primarily work on the dihydrotestosterone receptors in the follicles of the scalp, by blocking them, it can affect the rest, your hormonal system, systemically. So something, yes, people should be aware of.

And then.

Do you want to touch on testosterone therapy?

Sure. Yeah.

So.

So we do have men, you know, typically over the age of 50, where they just have overt, overt testosterone deficiency. You're just not going to bring it back with some of these other protocols. And they require testosterone replacements. We have a fair amount of men, my practice on testosterone replacement, and there's a couple different ways you can do it. You can do it as transdermal topical creams, reapply to the skin, absorbs through the skin, goes into the bloodstream. That's one. We don't like that approach. If you're gonna be around grandkids a lot, for example, or maybe you got younger kids and you're touching them a lot, you gotta be careful with that because you can contaminate, you know, other people, even your animals, you can contaminate, put it on, you know, your petting, your dog or your cat, whatever. So you gotta be careful with that. The other one we use a lot is testosterone injections. Usually men inject one to two times a week.

That can work very well. You're guaranteed to get a good blood level of testosterone. If you have a phobia of needles, then obviously it's not a good choice. There's also a testosterone pellet implant you can give a patient which will last for several months. That's my last choice with patients. Just because when you look at these patients, they get very, very high levels of testosterone, you know, for a certain period of time, then the levels drop and then you do it again. So it's not my primary choice.

Yeah, yeah.

Yeah. I think that's a lot of times the trick is how to get the right timing and dosing so you get kind of an even distribution of the testosterone.

Right, right. And so whatever method you do, you have to do with the patients, see how their symptoms are. Then we do lab testing to make sure they're at a normal level. Not too low, not too high. They're at a good level. Usually I shoot for, you know, if you have a reference range, let's say total testosterone. Most labs is 350 to 1100. I'm shooting for mid range, the three quarter range. But we gotta look at other things. You gotta. There's a certain percent of men where the testosterone stimulates the bone marrow to make more red blood cells. And then these patients end up getting thick blood. So we always are checking the red blood cells and hemoglobin, making sure their blood's not getting too thick. That does happen with some patients. And so for those patients, we get them to donate blood or we do what they call therapeutic phlebotomy, take some blood off about every three months or so. It's just their bone marrow is very sensitive to testosterone. We're looking at the metabolites, we're making sure. Let's make sure their estrogen and their testosterone levels aren't getting too high because some of the testosterone will be converted into Those other hormones, we already talked about how that can create issues with the prostate. And so we don't want to cause prostate problems as well. Men who have high dht, as you kind of allude to before, could cause things like hair loss. High estrogen in men causes low libido, causes fat accumulation. So we don't want that happening. So if those levels are too high, then we can use other things to help modify them. Like extra zinc will often bring those hormone levels down. There's some Chinese herbs that we can use. There's some good natural products you can use. There's also medications I have found throughout the years. It's rare that I need to use medications normally, just supplements for the people that are genetically predisposed to making too much of those other hormones. We can get them down into the normal range.

Yeah, that's so. But it is, it's helpful to be able to work with someone to help guide. You know, I'm thinking for men, you know, when you're on testosterone therapy, being mindful of doing the follow up blood work and making these tweaks to, to really help your body metabolize it optimally. Now, do you find that testosterone therapy, we talked about how it's gonna be beneficial to their whole health. But what about in terms of erectile dysfunction? Is that another thing that men have in mind with.

Yeah, well, yeah, A lot of men.

Are interested in testosterone because they've heard of the association between testosterone deficiency and erectile dysfunction. And it is true. I mean, it is one of the symptoms that can occur.

Interestingly enough, if you look at the medical literature on it's not the primary cause. The primary cause of erectile dysfunction in men actually has to do more with circulation. We know that men who have erectile dysfunction, the first thing we think about as doctors is always look at worst case scenarios. We know that the literature shows it's a red flag. It's a warning sign by the body. For men who has erectile dysfunction, could it be related to testosterone deficiency? Absolutely. But we know more commonly it's related to their circulation. And so the research has shown these men are at much higher risk for heart disease. Like a heart attack, it's a sign that they may have atherosclerosis or plaque buildup in arteries. And so you want to take this into account. We do more advanced lipid testing on these men. We'll often do.

Ultrasound testing of their carotid arteries, arteries that feed the brain, see if there's any plaque in there. Studies show if you have plaque in your carotid arteries, you're more likely to have plaque in your heart arteries. The other test you may do is a coronary calcium score, which is a specialized 3D CT scan of your heart arteries, see if there's plaque in there. So we want to make sure, you know, this, this man isn't prone to be having a heart attack or stroke because his arteries are all plugged up. But with the circulation, it certainly could just be due to the effects of stress because as you know, releasing these stress hormones, it often causes your arteries to constrict.

Periods of time. And so again, it may be stress related as well. We can of course, use natural things to help with stress. We can use natural things like arginine pycnogenol, which I talk about in the book and the published studies have shown to be pretty effective for mild to moderate erectile dysfunction. But yes, for some men, the testosterone replacement works very well. And then there's a small percent of men, we've got to go beyond that. We have to use, you know, the, the medications to help them. Things like the Cialis or the Viagra, things like that they need to use.

But I think you're making a really good point that, you know, it's a sign, another sign from our body, a signal that, hey, we better look at your whole body and see what's going on. Why is this happening? Is there something else that needs attention in terms of blood flow and blood vessel health? So I think that's a really good point. I'm glad you mentioned kind of another motivation to investigate further. And again, it's amazing to me always how when we can make changes, dietary changes and lifestyle changes, that it ends up benefiting our whole health, you end up improving.

Preventing heart disease while at the same time preventing prostate issues and improving sexual function all in one. I'm sure you do a lot of that with your patients. I know you have an amazing clinic there near San Diego, but you're also now seeing people virtually. How can people find you if they want to learn more and find out how you could help them?

Yeah, sure, thanks. Just at my website, Mark stengler.com S T E N G L E R.com and there you can learn about our practice and what we do. And yeah, you know, we do offer inpatient visits even during this Covid time. Got the telemedicine and we got phone as well.

And then the book, the Healing the prostate book, where can they find that?

Yeah, it's all the regular places. So of course, Amazon, Barnes and Noble, all the regular booksellers do carry it.

And then audible too, right? So if you're better to listen to it.

Yeah, that's right. It's available in soft cover, it's available in an audio book, and it's also available as an ebook, say on Amazon or Barnes and Noble.

Awesome. Well, I mean, what a great resource for men because, you know, to be able to just get all of this information in one place and not have to be scrambling and wondering and searching, you know, you've got other things to do better to just, you know, come to your resource that you put together based on the research and your experience and just say, okay, here's what I need to know so that I can make decisions from here. Is there anything else you would want to share with, with men or listeners that might, you know, be inspiring to them or different than they have heard elsewhere?

Well, sure, yeah, I would just say in summary, in healing the prostate, basically what we've done is we've taken the most up to date literature and what men can do integratively without more of a focus on natural medicine, of course, diet, exercise, supplements, how to balance your hormones to help all the hormone related things men experience like the low testosterone and the adrenal imbalance and things like that. But again, very specific protocols they can follow and also follow with their local holistic doctors for the common problem of prostate enlargement, prostatitis and even protocols they can use along with their oncologist for prostate cancer for better prevention and outcomes.

Amazing. Wow. Well, thank you so much for being here and sharing with us. I really appreciate it. Thank you.

Oh, thank you.

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