EP 21: WTH ?!? Testosterone and Men's health with Dr. Sam Madeira

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Upsnap Mobile Contact Talk Radio. Welcome to what the Health an independent approach to your health span. Have you noticed how our healthcare system may not have your best interest in mind? Join Dr. Eckel in this fun and sometimes disturbing exploration of the state of healthcare and what it means for you. Now here's your host, Dr. Eckell.

All right, welcome back, everybody. This is what the health and I'm Dr. Greg Eckel and I've got my guest on today, Dr. Sam Madiera. He's got a big mission, passion and life work. It's to help you find the root cause of your health problems and your unique transformative path to healing and guide you to maintain a state of health and vitality throughout your life. We're really well aligned. He is a naturopathic physician. He's licensed in Washington state and in Montana. He doesn't just play an Internet doctor, he is an Internet doctor with two licensures. So welcome aboard.

Dr. Sam thanks so much for having me. Appreciate it.

You are very welcome. This topic is near and dear to me. You know, I kind of want to start out with saying what is going on with testosterone and men's health and the environment? You know, we're seeing the levels of testosterone plummet in the population in North America. What is happening here?

I think the biggest thing that people may not be aware of or we're just literally swimming in it, is xenoestrogens and the chemicals around us in our food, air, water, home cleaning products, sunscreens, what have you. We're literally swimming in it. And I like to tell a story going back to college where I was in a orientation course for three and a half weeks paddling on Lake Mead. And it's a giant man made lake. So they stock the lake with fish and they have to restock the fish every year. So this was almost two decades ago now. And the park ranger said that they have to redo this every year. And he thought at that time it was because of all the birth control metabolites from women's urine from the porter potties getting into the lake. So all the fish are turning male fish, turning female fish. And we know this from like amphibian studies, from different chemicals that are causing frogs, male frogs, to turn into female frogs. Obviously, we're not fish or frogs, but, you know, we have similar things going on with us where testicular size is shrinking from not sleeping enough. Same thing with ovarian mass shrinking with less than seven hours of sleep. So we have all this information now, and in some ways it's kind of like better living through chemistry that you can't get away from. You know, we have all these cleaning products and ideally, you know, hopefully while boys are going through puberty, they're not exposed to too many things and not having, you know, extreme like lead pain exposures and things like that that not only mess up hormone levels, but the brain and neurodegenerative development and stuff like that that you're an expert in.

Indeed. Yeah. And we. We are gonna. I'm excited to talk about this because that hormone component is huge in brain health in general, though, you know, we're seeing this component. I mean, that is like. Right there is a. What the health moment for everybody listening out there is. We are swimming in it and it is so ubiquitous that we don't even. It's. It's hard to believe it. Like you just. What you just said there. The water in Lake Mead is causing the fish to change genders. Right. I mean, that's pretty profound statement that we're. It's just a granted and forgiven. Like they've got to restock the fish every year. Well, we're eating those fish. We're swimming in the same sea of chemicals. You know, when folks come in, you've got your Apollo clinics, right? That's the name of your clinics, correct?

Yes.

And you're predominantly working with entrepreneurs and business folk really, looking for optimal performance. How do you couch this discussion of bringing up the hormone aspect? In addition to the environmental component that you just brought up there? How do you start this journey with people?

Yeah, well, I try to pre educate as much as possible, like all of us do, and explain that today we have so many more toxins we're exposed to. There's things like, there's other things that play into it as, you know, like head injuries, concussions, and I think the kind of the nature with both men and women today. Adults is that we aren't rewarded on being healthy. No one's going to reward you every day for getting eight hours of sleep at work by giving you, like, $10 more per hour, you know, and no one's going to, like, give you a high five in the hallway. If you work at a big corporation, if you're like, hey, man, I got eight hours of sleep, they're going to be like, you're lazy. You know, So I think part of it goes back to our innate reward system and we're rewarded with the holy dollar and with material things. And what we found is that that doesn't really work out for, you know, being happy and healthy. Like, yes, you need a certain amount of finances so you're not on the street panhandling or, you know, lying awake in bed every night wondering how you're going to pay your bills. But after that, you know, after the $75,000 or $80,000 income that they did in the happiness study, we find that more doesn't make us happier. And so how does that play into hormones? Well, people are working at these companies, they're working themselves, literally trading their health for their income. And that equates to not sleeping. That equates to using, you know, quick fixes, which usually equates to a lot of medications or at least one or two medications before age 45, and then wondering, okay, well, this didn't work. And I'm not going to go back now to my tech campus MD who I can literally see for nearly nothing or free because the insurance and the company has set it up so it's all paid for and it's convenient to, okay, well, now I'm going to invest out of pocket into my health. And what does that look like? So it is huge. Not just from, like a health point of view, but it's a huge educational point of view of, okay, this is a different kind of medicine. And we're not just going to put a bunch of band aids and duct tape over you and send you back out there to go do battle. And there's, you know, the archetype is of the, you know, the type a person who kind of sees himself like a warrior pushing through life. And I see this with women, too, especially the kind of type A mom parent complex. So. And what happens is eventually you just get your adrenal hormones crash, your, you know, go nadal hormones crash, and then you get symptoms of anxiety and add, and then you get those medications for those syndromes or diseases, which in my book aren't really Diseases like anxiety is not a disease, it's a symptom, for example. But it seems like everybody has been diagnosed or is being diagnosed with symptoms of adult ADD where they didn't. It's not like they were on the spectrum as a child, you know.

Right.

So it's. It begs the question of do they really have ADD or do they just have a lifestyle deficiency where they have no dopamine, they have no serotonin, they have no, you know, acetylcholine in their brain, so they can't, like, hold a conversation and get their things done at work, but it really is that they can't sleep at night and they're eating the wrong things and they're using these household chemicals like Axe Guard spray for their deodorant, you know, so it's. It is a big kind of like, let's get you out of the matrix kind of moment without biting the hand that feeds them, because they got to keep their day job. And Dr. Bill Mitchell, who I was lucky enough to know of him and see him speak a bunch of times before he passed away, and he used to say to all of us naturopathic doctors, he was one of the co founders of Bastyr University. For those who don't know who Dr. Mitchell is, he would say, you can't just take away something and not replace it with something else. You know, we're not just going to tell everybody to like, stop drinking, stop smoking and go cold turkey and like, good freaking luck, you know. Right. So I hear. I recently heard some, like, prospective patients say, like, oh, I thought you're going to tell me, like, I couldn't have any alcohol. I don't know where you got that idea, but, you know, maybe cut back and see how you feel for a couple weeks, you know? Yeah. So I think, you know, you can't. You got to live in this world. We all live in it. We're all doing the best we can. And there's going to be nights where you don't sleep. There's going to be days where you don't have time to exercise or go outside. And we're all just doing the best we can in the end. But there's stark contrast to the person that is has very low testosterone and their lifestyle is a complete train wreck as well as their life. Otherwise they wouldn't be there.

Right. So what are you seeing for. What are common symptoms that you see coming in for low T. Right. I mean, you know, what gets advertised to us is it's all libido. And erection all the time. But you know, I think it's a lot more dynamic. Right. I think as a man I would like to say that, yeah, we're much more than just those two items. Those are quality of life issues. But, you know, what are you seeing with, what are you. What kind of the complex of symptoms that people have that they might not even be aware is a testosterone issue?

Yeah, definitely. I mean, I think the reason why those are the ones we hear about is that first of all, it's marketing. Second of all, from the Adult Aging Male Questionnaire, they call it like the ADAM questionnaire as the acronym is that the two top symptoms on there that from the research that have a strong connection in correlation to low T are low libido and erection issues. However, that doesn't, if you have those issues, it doesn't always mean that it's low testosterone or it could be. So the other symptoms that come up a lot are low motivation, just like lack of drive altogether. So sex could be part of it, but it could be, you know what, last year I got my promotion. This year I'm not going to get a promotion. And I'm actually kind of scared because I can't keep up. And I'm 42 years old now and there are people coming in who are 24 and I'm worried that they're going to take my job. And there's this ageism in tech right now that I hear from my patients where somebody will have the experience, they'll have all the credentials and they'll know more. But since the company can hire new blood and pay those people less to do pretty much similar work, it's very much a fear based kind of like lack of job security culture. And we have a lot of tech companies in Seattle. We have all the tech companies they have in Silicon Valley, pretty much like all the big ones, Google, Facebook, Amazon headquarters this year. And you know, they're making good money, but it's for them it's more about, well, I don't really have job security. And when you have that kind of fear, that monkey on your back all day long, you're not going to be making androgens, you're not going to be making adequate dhea. You're going to be in fight or flight every other minute with your manager or boss and kind of looking over your shoulder wondering like, is this enough? You know, And I've literally heard my patients say if I work 11 hours or less per day, I'm considered a slacker. So if that is the work climate or in the tech startup world, it's even, you know, that's the tech startup world. So if that's the expectation, then it's literally like performing like a Olympic athlete without getting the rest of an Olympic athlete, you know, and most Olympic athletes I just was educated by, I was just talking to Dr. Kirk Parsley, who's the sleep expert doctor, and he was saying most Olympic athletes get 10 hours of sleep at night roughly. So if you're going to be in this high performance demand work culture without a job security and with things in place that are basically there to make the company a lot of money but make you feel like you're expendable, and then it's not like my grandparents generation, like the World War II generation where they had a career for their whole life and they were like, you know, the mad season generation where they're like, given all these pensions and they have so much job security and they just keep going higher and higher and there's some comfort, you know, that's not the world we live in anymore. So where, where it comes into play is, I think a lot of it is just fight or flight, and people are kind of almost immune to it. And I literally hear men who are in this tech world say to me, I just want to go home, be in a quiet room with the lights off, no sound, nobody around me, and either like punch a punching bag or scream or just have no nothing, like nobody ask anything from me. I don't want to socialize. And I kind of see it like it's kind of like a work battle fatigue, you know, where there are these expectations from the top down. And ideally, you know, we would have work cultures. And there are some, you know, I think some great companies out there. I'm not going to name names or anything, but I think there are some great companies out there and great, you know, depends on your manager, some great teams and leadership, they're doing good things by people. But, you know, that's not what we're talking about. We're talking about people who come to see us who are struggling. So. And I also think it takes a lot of courage for men to say, you know what? This isn't working. I'm going to go ask for help. I'm going to go to this naturopathic doctor who I know nothing about their, you know, Dr. Madeira is not taking my insurance. Like, how the hell is this all going to pan out and how am I going to trust this person? I don't know them. I have no contacts. I'm just getting my buddy who I go and like, we go to Jinjitsu together and work out at the gym occasionally and have a couple of beers here and there and trusting, you know, and men and women definitely speak different languages as patients. So I think a lot of the low t going back to your question is about motivation and about what the man wants to get out of their improvement. So for some guys, that could be like, hey, I run a CrossFit gym and I'm an entrepreneur and I'm not getting the gains I used to get in the gym. And I'm actually, it's not going to look good if I can't teach a CrossFit class every night. So it really just kind of boils down to what's going on with them. So I do hear muscle strength and endurance being an issue, especially for men age 40 and older. And a lot of it is insulin resistance or the beginnings of insulin resistance, like pre, pre diabetes. So we can do these more kind of like advanced cardio, metabolic lipid testing. And there are these markers. They can find out, okay, you have the beginnings. You have the beginnings of insulin resistance and metabolic syndrome. And sometimes you can look at these people and walking in the door and you can say, oh, they definitely have insulin resistance or metabolic syndrome. So awesome.

Yeah, thank you for that. You know, it is, you know, a lot of times folks aren't thinking about that, but we've got heart health, brain health, in addition to the hormone balance. And it, like, you brought up the whole diet component and diabetes and insulin resistance tied in also to hormones. So it's not just. You're not just giving people testosterone. Right. You're probably right. If I guess what you're doing, you're doing full naturopathic care, like treating whole dynamic beings. And, you know, you're addressing their diet and their exercise and their sleep and their relationship, community aspect, in addition to the lab panels and, you know, all of the other components of testosterone as well. Is that right?

Very much so, yeah. Actually, I think a lot of people come to me because they think that we're going to just work with testosterone. And they're like, well, how much does the testosterone cost? I like to tell this story because it happened recently where it was probably one of the busiest days over the last month. And I had a gentleman call and then, and then text me because I, I text through an app on my phone and he wanted to get testosterone therapy. First of all, how do we know you have low testosterone? Do you have blood Tests. Do you have urine tests? You have a spider test. Did you self diagnose yourself on some quiz online? That's inaccurate. So second of all, you got to go with diagnostics first. You need basic blood work. You got to make sure before someone gets tested, testosterone, especially testosterone injections or pellets, that they don't have any clotting factors. And most doctors aren't doing this. They're not checking for prothrombin, they're not checking for factory late in five. And you get that person sewed up with some pellets in them, or you get them on injections, they're going to throw a clot, have a pulmonary embolism potentially, and end up in the ER and maybe die. So, yeah, that's genetic. And that person shouldn't be on testosterone therapy. Testosterone therapy, definitely not injections. And if they are, it should be a cream and they should be on warfarin or blood thinner. So we got to check off all the boxes. Like, your PSA isn't above 3. You don't have prostate cancer right now. You know, you're not about to, like, fall over and have a heart attack. You're not like stage four heart disease. So all those things got to be checked off along with, like, are you willing to do the lifestyle stuff? Are you going to go to bed, you know, at a decent hour and aim for seven to eight hours of sleep at night at least? Like, are these reasonable things for you to do? And then are you going to inject at the prescribed dose, you know, or use the cream at the prescribed dose? Or are you going to try to overdose and abuse this da Controlled medication? So actually, I would say I do probably more than most doctors as far as, like, making sure this person's not going to die with this prescription.

I'm sure they appreciate that, Doc.

Yeah, because then we're in another, what, the health moment. The patient's in the er, they got a pulmonary embolism, and they're like, what the hell? And then their ER doctor's like, give me your list of medications. And they're like, oh, well, there's the testosterone. So this guy who texts me, going back to my story, he said, well, how much does it cost? And I was like, I don't know how much it's going to cost. This is how it. This is how much it typically costs for everything for a year. I don't know what you need, though. And then he said, well, I'm a snowbird. I'm going down to California, Arizona, I Don't know exactly. I don't remember where he was going in a month and he's already there now and he said, I'll go to Mexico to just get my testosterone. So for the people listening, the reason why I tell that story is I hear a lot of guys saying, well, my personal trainer got me some testosterone in his gym bag. And these people are like making their own testosterone in their kitchens and stuff. And then.

For real?

Yeah. Yep. And then they're flushing the needles, are trying to flush the needles down the toilet, which is also pretty scary.

Wow.

Yeah, just some wacky stuff that I've heard and out there. So if you're doing that, just cut that crap out. Go get a medication that's from a compounding pharmacy that, you know, you can trace the lot number back and make sure that you're not going to get sepsis.

Yeah.

So yeah, it's a DEA controlled medicine for a reason. It's not something that you should just be treating like B vitamins, you know.

Well, I didn't realize people. So really that's like in gym culture or like in, in the culture people are just making like in their kitchens, making testosterone. I mean, how much does Testosterone, you know, 10 milliliter testosterone, cypionate, you know, 200 milligrams per milliliter. That is not a very expensive medication.

Less than $50, probably about $40 per.

Month for very well dosed, metered medication. Like, don't mess around with that.

Yeah, ridiculous. It's not worth. Worth getting sepsis and like getting part of your body cut off.

Geez. Yeah, no. So what, what do you see and what are the most common pitfalls? I mean, yeah, don't make it in your kitchen table, don't take it from your personal trainer at the gym. Um, let's go to a licensed professional and really get a proper workup so you don't die of a heart attack or throwing, you know, an embolism. What other? Like in the reasonable person's mind, what are the, and what do you see as like common pitfalls? Because this really is, I mean we get, you know, we're inundated in Portland, Oregon over the airwaves on all the sports talk radios about low T. And you know, you can order sildenafil on the TV now, you know, you go to the, you know, the men's clinic and get your testosterone and basically that's what they're doing. Right. So what are pitfalls? What other pitfalls are you seeing with this whole kind of hormone replacement Bioidentical hormone replacement, et cetera.

Yeah, great question. I actually used to run a so called low T clinic. It was a men's clinic in western Washington. And I would drive almost, it felt like I was driving down towards you in Portland, Oregon because I would stop and work in Federal Way. So it's, you know, you're pretty far, you're past the Sea Tac airport from Seattle. And then I would go the opposite way two days a week to Lynwood. So I did that for a while. I was at that clinic for a year. And you know, I'm a loudmouth. So that's why I have a podcast. And I basically didn't agree with a bunch of stuff they were doing there. Uh, they were starting pellet therapies and I didn't, this was back in 2014 and I wasn't really down with pellet therapies. Still not really down with them. Um, and you know, I think it's great for maybe some people, like if you're just never gonna apply a cream and you're never gonna do an injection and you're just that kind of guy or too busy, they're probably good for you. But yeah, so the pitfalls being that I literally had to flip fight with one of the co owners of this clinic. A probably like a 45 year old man came in. I don't remember how old he was, let's just say he's 45 roughly. And he had great testosterone. Like his testosterone was like up in the upper quartile where you want it to be. And it wasn't too high, it was great. And he wanted me to give this man testosterone to make the clinic money. So I think that's the first problem with these clinics is that they are not geared towards your best interest. Where when you hire like a private doctor like myself or yourself or some of our colleagues, you're hiring somebody who is always going to have your best interest. And it's not so much like yes, obviously every business wants to make money to, you know, stay afloat. And we all deserve a certain, I believe we all, if we're going to work for it, we deserve a certain lifestyle after we work for it. But with that aside, these clinics I was rubbing heads with because I was in management, I was rubbing heads with the people running them and eventually I left, I was actually asked to leave because I wasn't falling in line with the company culture. Talk about toxic company culture. So I think that's the first problem with these clinics where you have People there that are getting paid to get you on testosterone therapy. Now think about that. Like, let's think about that. Where if you went to a hospital and somebody was always going, and this is actually how some hospitals are. They make money off of procedures. They make money off of procedures. So they're going to make money. They want you to get a procedure while you go in there. It would be like going to the dentist and being like, well, it looks like you're starting to get a cavity. Let's just drill like five of your teeth every time, you know, so that's the first problem. The second problem is they're not doing screening tests besides like a PSA and a cbc and they are doing, hopefully they're doing that, but there is a clinic up here in the greater Seattle area and they are just doing like one lab test a year or one or two a year. And that's dangerous because if their red blood cell count goes up, you don't know if they need to decrease their dosage. Usually cardiovascular exercise will help with that or potentially even donate blood, which some guys need to do. So. And it's genetic too, the way people's red blood cell count goes up with testosterone as a genetic thing. So basically, long story short, and the other thing is people are over prescribing anastrozole. So anastrozole is aromatase inhibitor at much higher dosages. It's used for women with estrogen positive breast cancers. So if you Google anastrozole or Remedex, you'll see. Oh, chemotherapy drug. It's not a chemotherapy drug. It's used when women are also on chemotherapy to block aromatase. So aromatase takes testosterone and it converts it to estradiol, estrogen, your most potent estrogen. And for men, when you're on testosterone therapy, if you take a man that has insulin resistance, they have that 40 inch plus waist, their BMI is really high and they meet all those parameters, they're automatically, most likely converting their testosterone to estrogen. And then there's genetics too, that push, push that pathway. So and you just give them testosterone at this low T clinic, they automatically give every single man aromatase and hcg. And the HCG I would argue is a good idea. But not every guy needs to be on it right away because it's basically replacing your luteinizing hormone by stimulating the testes to make testosterone inside the testes and prevent testicular atrophy the best they can. So not a bad thing. But it shouldn't be used all the time. So it should be taken away for a couple months or a month and then introduced again. So these low T clinics basically have this cookie cutter method. And that's what I learned. And then I started questioning things like, why are, you know, 30% or 20% of my men not benefiting from this after three months? That doesn't make any sense. Their labs look good. And I'm talking to this guy on the phone and he's saying nothing. I have no benefit. I'm right back to where I used to be. What the hell is going on? So I mean, you can have genetically hyper secretors of testosterone where they have like these genetics. I won't get into all the lingo because it gets pretty complex. But for the listener, basically you can have genetics that are, basically you could be synthesizing them enough testosterone. But the issue isn't synthesis from your testes and a little bit from your adrenal glands. The issue is that you're just getting rid of it really fast, you know, so you gotta work with somebody who's like willing to do that deep dive. And the other thing about testosterone therapy, even if it's low dose, eventually you're going to shrink the testes, you're going to decrease your ability to make enough testosterone. So if you start with bottom hormone replacement therapy in your early 30s, you and you do it for 10 years and you come off, it's going to be really hard crash if you're not working with somebody to say, okay, this is how we go off this. The, these are the herbs we need to replace things. You need to do HCG and maybe even consider Clomid for a while. So I just think that there's not in that model. We are seeing 30 patients a day sometimes. And if you're a health practitioner, I've talked to MDs and they're like, Sam, that's a lot of patience. So for the listener, that's a lot of patience. That's too much, I think, to give quality care. And you basically feel like you're throwing, throwing testosterone french fries at people in a fast food place. Yeah. So like they, they have the money to do the advertising and you know, I think it's dangerous to prescribe or let people buy sildenafil off the Internet or TV commercials. You know, why? Like my question is, why does this person have erectile dysfunction? Like may, like frankly, maybe they need a new job and a new wife. Like maybe there's no trust in the relationship anymore and they need to go see a sex therapist and figure out if that relationship is a toxic relationship or not. And maybe it's not about testosterone or. The other thing that I've seen more recently on the more physiological side is autoimmune diseases in men. So, like Crohn's disease, there's a lot of type 1 diabetes. But more shockingly, since it's statistically not that common is Hashimoto's thyroiditis in men. So we're seeing that, and I've talked to some colleagues around Seattle, and we're seeing that more and more with male patients. And it's like, man, if you're gonna want to chug IPAs four days a week or six days a week or eight days a week, and you're gonna eat whatever you want, and you're not gonna exercise that much or be a weekend warrior, and your gut health is crap. And you think, like, you have an iron stomach, but you don't. You know, like, having liquid bowel movements, dudes, is not healthy. I mean, I remember being even a student clinician, and I was amazed when talking to male patients, like, so, what's going on with my bowel movements? And they're like, it's all good, dude. I'm not going to talk about my poop with you. And it's like, well, no, we need to know about that. Like, I'm a naturopathic doctor. We're big on the. On the bms. But long story short, I think there's always room for improvement with men's health. And I think men are being disserved by thinking that they need to be like, a walking boner and just throw sidonafil or tadalafil at them and testosterone. And if they aren't producing dopamine, which has a strong correlation in connection with testosterone, Testosterone, the motivation neurotransmitter, then they're not going to be motivated to do the lifestyle stuff. Yeah, it's like you got to tune up in your. You're a brain doc, so, you know, you got to tune up the gut, brain access. You got to work on all things. And, you know, you have a hyperbaric chamber in your office. And I think that's awesome because there's so many guys that have had multiple concussions, whether they're playing high school football or. Or multiple car accidents, etc. You know, maybe they fell and slipped on something that didn't look like ice, and it was icy in the winter in Portland or Seattle and hit their head. So, long story short, it's like, what the heck is the root cause? You know, it's natural. Basic naturopathic principles applied to hormones. What is really going on here? Why does this person have no sex life? Why does this person have zero libido? Like, what is the, what is the climate, the environment that they're in every day? And would you want to be in that environment? Would anybody want to be. Could anybody be healthy in that environment?

Sure. Oh, I love that. So I'm going to take a quick station break. This is what the Health. I'm Dr. Greg Eckel. I've got Dr. Sam Madera on the line here. Am I pronouncing your name correctly?

Yeah, Madeira.

Madeira. Perfect. I got it. And we're talking hormones. And if you're just tuning in, go to Nature Cures Clinic, hit the podcast tab and listen to this show. It's great. Please share us with your friends and your family. You are getting information here that you aren't getting elsewhere. Dr. Sam is a hormone expert and a naturopathic doctor and he treats people, not just low tickets, not just a lab. And I think that really is the main. Just of the point that you're bringing up. There is, you know, a lot of physicians are just treating lab work. It's like, oh, well, what's your, what's your T level? And let's. That, let's get that there. Let's look at your estrogens. Maybe now you're on, you know, HCG and arimadax or dim or you know, something to stop the estrogenation, but they're not really addressing everything. The full completeness of a human in front of them. Right. I love that that is your approach. And so I want to unpack a couple of those things because you. This is like second nature to you. And so this is. The pieces that I want to start with are, okay, mode. You know, you talked about creams and you talked about injections and do you over your experience because you really are an expert on this topic. Do you have a preferred method? You mentioned a couple different reasons. If somebody has some clotting factor disorders or to maybe go on creams versus going on injections versus the pellets. It didn't seem like you were really into. So, you know, I will share in my practice. I started with just, I actually did never did bioidentical hormones. So I'm going to admit this on the air with you. Dr. Sam on. I would thought, you know, look, these are natural transitions in particular for women going through menopause. And I had Dr. Jonathan Wright literally kick me in the tuckus and said, do you promote death in your practice, Greg? And I thought he said, well that's a natural process. So you know what you're talking about. You know, we could really help quality of life. So two decades into practice we are supporting people. I've got 90 year olds that are healthier than when they were 60, so this is really a big deal. Like we're talking quality of life and longevity, so on. So that, that windup that I just gave you there, you know, have you found preferred methods and why of testosterone?

Definitely. So I guess my background started out mostly in injections and I do use cream and I have used cream here and there. Cream is, it's, I would say they're both a nuanced approach because if you're not dosing, if the potency of the cream isn't enough. So usually you want to see like 100 milligrams per like half milliliter or something like that for men. And getting them a dose of like 150 or 100 to 200 milligrams per per day in the cream has been shown actually out of Moses Lake compounding pharmacy. And keep in mind that they're a compounding pharmacy, they're not a large pharmaceutical company. So they did a study and it was an NM1 study. But they did take blood every so out, you know, a few hours. And they did see a good rise in testosterone that stayed steady throughout the day with injections. I usually recommend if somebody can do it every other day injection. However, if you think about that, who are the people that are coming in to our clinics? You know, usually these men are so busy, you know, kids at home or wife at home, you know, dog job where they're having to work 10 hour days or whatever, 10 to 15 hour days. They are not going to inject every other day, you know, no way. So I usually start people out at once a week and then at about four to six weeks in we switch to twice a week. And so you split the dose in half. We're not doubling their dose, that would be crazy. So we usually do injections every three to four days. So like a Wednesday, Saturday. So you'd inject Wednesday morning and again Saturday morning or like a Tuesday, Friday. So then they want to get their blood draw on the morning before they inject so you're not getting like a false spike. And then usually I pick the blood draw to be four days apart. Otherwise if it's three days apart, usually it's kind of like a false elevation. And then you're going to be decreasing their dose when you don't need to. And yes, they're gonna get a spike. They're still gonna get a spike in testosterone in the day they inject, and then they're gonna start decreasing in amount of testosterone. And what we're looking at is the lowest amount of testosterone that they're gonna be getting in that bucket. And you know, ideally someday we would have something like a testosterone pump. Like we have an insulin pump and technology where it would be, you know, like an implant or something, like a small implant. And then instead of pellets, it would be dose dependent on the person's, like, body weight, age, lab values over the. You know, maybe you would get like four blood draws over the course of like three weeks or something and then average out their total testosterone for that three weeks and then give them an implant or something. So if anyone is listening, wants to do that, just, you know, there's a market for it.

Yeah.

So I think that the long story short, the technology for testosterone is. Is good, but it's. It could be improved significantly. Pellet therapy is a minor procedure, so you want to make sure you're going to somebody who knows how to do how to use a scalpel and that it's in their. Legally in their wheelhouse. Like they're allowed to do that with their license. So you. You make an incision. Usually ideally it's like, right. Kind of where on like a Levi jeans or jeans, the top of the pocket would end. So like that fabric ends. So obviously you're not going to cut there, but that's like the landmark. And then they would make a small incision that's like maybe a centimeter or so. And then you use a device to shove as many pellets as you're supposed to into that tissue. You're not supposed to bike, like road bike, mountain bike, run, no squats. So like, you can't go to CrossFit class. You can't do any Olympic lifting, no jumping jacks, no long periods of sitting. So if you have a desk job, that might cause some aches and pains there, and you can't be on a long flight because they could pop out and protrude. So we. There's a lot of kind of anecdotal stories where people have had infections. I have a colleague who does them in Seattle and Bellingham, and I've talked to him about it, and he said, I've never had anybody with an infection. So he's really well versed at this. So I refer people to him. And usually people get this training at a company down in Texas and they're I think they're like the gold standard. So they have doctors do these weekend trainings and then they start doing this. The reason why pellet therapy is so popular right now is that it's a procedure. So in medicine we, we are usually paid as clinics by procedure over our consult time over our brain, and then there's a time and place for all procedures. I think in medicine. So whether it's a surgery or IV therapy or hyperbaric chamber or pellet therapy, I just think that kind of similar to the low T clinics, that the pellet therapy is probably being overused. But I like the injections and creams and trans scrotal application for the cream. And then Jonathan Wright is really big on like applying like DHEA creams and testosterone creams to the anal mucosa because it's really easily absorbed there. So I usually say apply some to the scrotum, some to your butt right after you get out of the shower and then wash your hands and you're good.

Yeah, yeah. Cool. Well, and those are the predominant routes. Do you, do you have some cutoff for numbers for lab. Like, what's, what's a typical lab panel? Like you're doing extensive workups on your patients. Are you, what do you, what do you see? You know, do you follow like Terry Hertog's value numbers or do you have your own or, you know, what are you doing for, you know, we just recently, for folks that are watching, you know, testosterone levels in the major labs around the country just fell 300 points. Used to be 1200 on the top end. Now they're down about 900. That does normal common lab values. There's nothing normal about it, but wondering if you have some ideals doc on your panels, what you run and then your recommendations off of there, like whether it's herbal therapy or anything like that.

Sure, yeah. So usually I like to see people's testosterone 600 or 650 and above. And I'll say why in a second. I love Hartog's book and I've seen him speak at a 4m years ago, brilliant guy out of Belgium. And so he says 700. I think 700 actually is too low. Ideally it would be 800, but with lifestyle and diet you could get it up 200 points. So I don't want, if someone has like 650 or 600, I don't want to shut them down with testosterone yet. And you know, for the listener, when exactly you're saying, when I started in the, in 2013 doing, you know, ordering thousands of labs on men, seeing 15 to 30 patients a day, we would always test total free testosterone, sex hormone binding, globulin, psa, CBC and estradiol. And you know, I would say that's a bare minimum and I obviously do more than that now. But you want a certain amount, you want like at least 20 nanograms per deciliter free testosterone. 25, 20 would be great to 35, I believe that's hard dog's number. And then recently, you know, I would say 800 to 1100 would be like the golden ticket. You know, someone could get there. Most guys are not there though. And so once they fall below 450, then I say, you know, with lifestyle and diet, it's going to be unless they have sleep apnea. So if they have sleep apnea, then I say you need to get a sleep study if you haven't already and use a cpap. If you're not using your cpap, use your CPAP or you're not a patient because they can die and it happens. So I have seen, I had a patient who had undiagnosed sleep apnea. I said, go get a sleep study, got a sleep pap machine and they brought their testosterone. I don't remember the exact starting number. I think it was 350 to about over 800. So and that was about four and a half months with herbs because they didn't want to do testosterone therapy. And I was, you know, I wasn't 100% sure that that was the best thing for them anyway. So the herbs that I use are all medi herb. And I have a podcast where I interviewed Carrie Bone, who's written a lot of textbooks that we use in naturopathic medical school and well known internationally and in Australia. Medical herbal herbal products are reviewed and regulated by their version of the fda. And their version of the FDA is not nearly as corrupt as ours. So good for them and good for us because then we can use these products that have much higher standards than 99% of the stuff on the shelf out there, even the stuff that you can buy from practitioners. So I use medi herb tinctures or tablets if somebody or Gaia herbs. And those are the herb companies I like to use because of their quality. So basically herbs aren't being dosed high enough to move testosterone. So I have like an N of one study I did with a guy before we put him on testosterone therapy. He was, he was traveling every two months from India to Chicago, London, Austin, Texas, back Seattle. So multiple time zones, multiple continents. Low testosterone didn't completely change lifestyle. Still smoking, Couldn't stop smoking. Tried biofeedback therapy. That didn't help him. I guess it's a hard thing to deal with. But anyway, his testosterone went up about five 56 nanograms per deciliter. Total testosterone with multiple herbs, tonic herbs at pretty good dosages.

Cool.

So herbs can move it and. Yeah, so those are my numbers usually. Yeah.

Cool. The, you know, under all cause mortality under 300 is higher. So that for me that's like a critical motion of like, okay, we, we're not going to do botanical medicine at this point. We've got to go right to a bioidentical component. But up to about 450. I definitely recommend the lifestyle and in herbal support if we could do it that way. So that's really encouraging to hear. Like, very similar experience for you as well. On. So what about estrogen blockers? So what is happening there? Over prescribed, you said the hcg. You think that is a good move? Arimidex, dim pitfalls there. I mean, you know, what happens for me is my patients get online and they start getting into gym culture and weightlifter culture, which is not health culture. Right. And so they get skewed. And a lot of them know, like, okay, I know I got this from, you know, this weightlifting site and I know those guys are kind of doing weird doping stuff. But it is, you know, more and more a lot of men are turning to that. And that is not health promoting. But they're getting the information there. So what have you seen in your clinics? Or like some. Maybe give us some stories of some folks that you've seen some kind of, maybe some faux pas out there.

Yeah. For, well, bodybuilding. So bodybuilding is really bad for your testosterone because they're using multiple types of testosterone. They may be using a couple different bioidentical ones like testosterone, propionate testosterone.

They may.

And things like nandrolone. So nandrolone doesn't help the other cells in the body. It's just stimulating the, working on the receptors in the musculoskeletal system. So it's good for guys who want to get really cut up, but it has serious side effects. And the other thing with the gym culture is that they believe in cycling. So, so what that means is they'll do like three months on, three months off or like four months on, one month off or something. It depends on who you read and who you follow. And I'm obviously not into that culture, but I've worked with patients who were bodybuilders and then they came to the low T clinic and they were like 27, 28 at the time when they started coming. So I had to review their chart before they came in and they're starting testosterone as a less than 30 year old male who otherwise looked healthy and jacked was like 365 or something less than 400. And then the other thing is that there's research showing that at 450, even at 450 there can be the beginnings of destruction of the endothelial tissue in the penis. So the beginnings of like cardiovascular destruction in the penis causing irreversible erectile dysfunction. So the, you know, the vascular system and the hormones go hand in hand and testosterone is helps with vasodilation and things like that. So I think that the gym culture, the main thing with the gym culture, like you said, is the, that you either can have like a strong man or you can have a man that's going to live a long healthy life. So it's kind of like eventually in your adult male life or female life, you have to make a decision, am I working out for health or am I working out because I want to be the strongest guy in the gym and then compete and this is like my job or my part time job. And that's fine if you want to be like the next Arnold. But what we know from the research is that the longevity people are doing like fasting like crazy. Calorie restrictive diets, intermittent fasting, two days of fasting a month and they're living to like 100 or something. And then you have this guy who may die at like 60, but he'll be jacked. So you just got to decide like if that's what you want to do.

Right.

Do it safely though and understand what.

The repercussions are for long term. You know, I think most of the listeners here on what the health are into, longevity, they want to live a health span is the way that we're talking about. And you know, I'm really about promoting health care that gets us to thriving and you know that. So this bioidentical discussion is really key for, you know, longevity front. We're not, we're not going it for the Arnold Schwarzenegger or the bodybuilding culture. Just wondering though like what you've seen with the Remedex and, or dim any side effects or cautions for folks out there watching.

Yeah. So Arimidex trashes hdl. So I've seen it just tank hdl, total HDL cholesterol in the body. Also can. I've been on like webinars with doctors who are talking about it causing hip fractures and Otherwise healthy for 40 something year old men who are really like working out hard and doing all the right things. So bone mineral density issues. So those are the top two, HDL and bone mineral density. With Arimidex and then hcg there aren't really any side effects that I've ever seen except for like maybe if someone did the injection wrong. You should be using that off and on though. You shouldn't be using HCG like every week. And the dosage, you know, you only can utilize like 500 to max. I think 1000ius of it in your body at a time. But you could dose higher. So you're basically wasting it if you're dosing higher. So usually don't go too high on the dosage with that. And then Clomid has side effects because it stays in your body forever and it and it can trash your libido. So it increases sex hormone binding globulin and drives down free testosterone and that's your testosterone to use. So your cells don't get any testosterone even if it's increasing. It also works on your brain level. So any drug that works on receptors in the brain, I'm really skeptical of using too much. Absolutely necessary.

Yeah, that makes sense. Yeah, I like that and appreciate that caution. So last minute of the show, any final knowledge, bombs or insights that you'd like to share with the listeners of what the health.

Yeah, I think one that I learned from Carrie Bone on my interview with him that they've found in the research that 4 grams of ashwagandha withania sonifera is the Latin name can increase muscle strength. That's pretty cool.

That's awesome. Yeah. Love the herbal tip. Well Dr. Madera, thank you so much for coming on and sharing your information with our viewers and listeners. Again, this is what the health. Please share us with friends and family members. Go out, give me a five star review if you like what you're listening to here because this is how we get the word out folks. Thanks for tuning in. We are live every Tuesday from 2 to 3 Pacific Coast Time. So thanks again.