The Missing Manual for Men's Health and Longevity with Dr. Myles Spar

Dr. Miles Parr, welcome to Well Beyond 40. Believe it or not, we like have never really talked about men's health on this show, which is a disservice since we all have men in our lives. And you are the perfect, perfect person to do this. So I am super excited to have you with us. And where I'd love to start with is one way I think we can get men inspired and motivated is to kind of relate it back to performance because I know you've worked with NBA players and executives. And when you look at any guy, especially as they're getting older, they worry about losing their edge and not being able to perform well. So what are some of the things that you've done with, say, NBA players and high performers that could translate over to everybody else?

Yes. Yeah. Well, I think part of it relates to asking for help. Every professional athlete I've worked with, has specialists that help them, right? They have coaches, they have trainers. They even have trainers for specific activities within their sport. So they'll have a— for basketball, they might have trainers that really work with them on doing jump shots and not spraining an ankle and knowing what's going on with their body at every point in time. And they'll have someone else that's working on other aspects of their body. They have ones that specialize in recovery, on supplementation, on nutrition. So again, looking for help, getting a coach doesn't mean you're weak. It means that you know that The best use of your time is not to do a deep dive in every single aspect of health and wellness. It's to find out who you can trust and then take advantage of that expertise and bring that on. And I think the other thing is an acknowledgement among every really successful person, whether it's a celebrity or a professional athlete, it's having kind of a holistic perspective. And I don't mean a woo-woo perspective. I mean, for example, We looked at professional NBA players and we found that their shot accuracy went down if they looked at social media before bedtime because it affected their sleep. If they were revved up looking at social media and that sleep affects their performance. So looking at all the aspects of your performance and what do you want to win at in your life? Maybe it's not being an NBA player, winning game, but maybe it's really winning at work or in your relationship with your kids, whatever. And then What needs to get you there? Not being distracted by things that are going to pull you away from that and understanding what all would contribute to you winning at that. It's looking at stress again with basketball players. We looked at if they weren't focused, they would have a much higher risk of having an ankle sprain, the number one injury in NBA players, because they didn't really think about how to do that jump shot correctly and land correctly because they were distracted. So it's about learning that you control your reactions, doing breathwork, meditation, doing work on really understanding yourself and knowing how to stay focused, working on sleep, working on nutrition, all these different pillars. So I'd say the two things are getting help when needed from experts and really having a very holistic understanding of what contributes to performance.

I love that you framed it in terms of winning. Yeah, because those are like— I did this study with Alison Armstrong and she talked about the different words that you would use for like asking a man how they feel and they're looking at you like, what are you asking me versus what do you think? You know, and framing things about winning, you know, it changes, changes the game. There's so much talk out in the world of women's health about cortisol. Yes. And you just don't hear it in the guys' world at all. Like, how, how does a man identify this as an issue for them?

Yeah.

And how do you make something like focusing on your sleep? Because I'll tell you, when I met my husband, he was sleeping 5 hours a night. I'm like, oh, this is not going to work, honey, at all. Now I've turned him into a major sleeper. Now he meditates. He does all the things. But none of that was— he slept 5 hours a night and he ran like crazy. And I'm like, okay, we're going to lift weights and we're going to meditate and we're going to get good sleep.

Nice.

Yes, right. Yes, yes. He wouldn't have done it on his own. I saved his life. I always remind him this.

Yeah, good on you and good for him. Um, yeah, I think so. You start out asking about cortisol, and so that does play into all this. I think one key point for listeners to understand is cortisol is toxic to your brain. Literally, it's toxic to your— toxic to your brain. It kills brain cells. It decreases something called BDNF, brain BDNF-derived neurotrophic factor that's very important in growing brain cells. We know, you know, when I was in med school, we learned, well, you're born with your brain, that's it. No, the brain continues to grow and you can continue to develop what's called neuroplasticity— more synapses, more pathways, hopefully in good ways and not in bad habits. But to do that, you need this BDNF. Cortisol is toxic to that. And the ratio of cortisol to a male hormone that women have as well, but are especially important in male, called DHEA, is actually very important. And DHEA is protective for those brain cells. So the first thing to know is if you have too much cortisol and not enough DHEA, both of which can be measured, then you need to adjust that by affecting your cortisol and getting it down by managing your stress better. Some guys mistakenly feel that, oh, when I'm really stressed, I'm really productive and I need that adrenaline. Guess what? No, nobody is. You may think you are, but you don't think creatively when you're in fight or flight mode. You think, how do I get out of this? And just get out of it and not think more broadly. So typically, if you think about it, sometimes you can't think of the most obvious— like an escape room. If any of your listeners did escape rooms, the people who are most stressed can't think creatively of how to figure out the solution, whereas the people that are just chill, we'll get this, we'll figure it out, they are able to think creatively. Because when you're stressed, that takes away brain energy. So It is a myth to think high cortisol is making you productive. It's like someone on crystal meth thinking they're getting a lot done when they're actually just running around not getting a lot done. So that's the first thing. And then I think what is contributing to high cortisol? It's not managing stress in a mature way. So looking at breathwork, looking at meditation or mindfulness, there are millions of great apps that can just help you tone down that stress feeling, which is cortisol. And measuring it. Everything's about measuring. That's— and we'll get to that, I'm sure. But part of this Medicine 3.0 is really measuring how you're doing, and that's where we should be in 2025. So you can measure something called heart rate variability, or HRV. You can measure that on an, on a smartphone or use a device like an Oura Ring or Whoop band or an Apple Watch. And that's a great measure of how your cortisol, your sympathetic nervous system is, and then you can try experiments to lower your nervous system, which is going to lower your cortisol. You can try sleeping more like your husband to see how that affects it. You can try breathwork, you could try journaling, prayer, you could try doing a sauna, try different things because it'll be different for everybody what affects it, maybe even supplements. But I think the key is assessing where you're at with your stress response and your cortisol. And then trying things out and you'll see how much more productive you are, not less productive.

And since you brought it up, Medicine 3.0.

Yes.

What, what is this?

What is that?

Yeah, what is it?

I think, I think it was Peter Attia that kind of made it famous, but it's become kind of the, the thing that we're all working towards now that are more cutting-edge, modern clinicians that are really trying to help move our field of medicine and healthcare forward. So Medicine 1.0 was kind of very early before we really even understood the germ cause of disease, right? Then Medicine 2.0 was like, oh, there are these things called bacteria, they cause disease, let's develop antibiotics. It was amazing in creating the ability to treat acute disease. All about treating disease though. And that's why we are great at treating acute disease, because Medicine 2.0 got us there. Intensive care units and emergency surgeries to open a blood clot and put in a stent and all these amazing, amazing developments, but there wasn't much focus on prevention and how do we participate more as individuals in our own health. So Medicine 3.0 is the evolution of that, saying, well, let's try not to need all those Medicine 2.0 interventions by actually looking at what can we do, how do we participate in our own health, by what we eat, by what supplements we take, by how we exercise, how we sleep, how we manage stress, in the name of prevention, and I would say in a proactive way, and then measuring it. So important in this Medicine 3.0 is using metrics. And that's a very guy thing. Again, stereotypically, with every man I work with, I have some metric tied to what their goal is, what's their individual goal they're trying to achieve, and how are we going to measure it, and how can we show where they're moving in that direction? And if they're not, then how do we hold ourselves accountable? So it's really looking at measurable goals, working a little bit to stay healthy. So that participation and being very preventive-focused.

So in Medicine 3.0, like, what are the labs and things that you're measuring and looking at to give you this information? I'm assuming it's not like the old stuff that they used to do, right?

No, no. Yeah. I mean, honestly, the old stuff you get in your annual physical is actually based on what insurance reimburses, not on what would help you.. And I know that kind of sounds like conspiracy theories, but it's just the absolute facts. I actually have a TEDx talk on this that talks all about this, that it's all about what was done to see if you're really sick and need to get treatment right away. But if you're really looking at prevention and looking around the corner and staying well, you need to do a deeper dive. And it doesn't have to be crazy expensive, honestly. But there are certain labs, like for example, the number one killer of men and women is cardiovascular disease. A regular lipid panel is literally going to miss the majority of people who are going to have a heart attack. The majority of people who have a heart attack have normal cholesterol. So you need to dig deeper. You need to look at other particles that are like cholesterol that increase your risk. So these are called, uh, ApoB is a big one, or something called Lp, and then inflammation markers like CRP. So I would absolutely add those 3 to a cholesterol panel. ApoB is all of the particles that are dangerous for heart disease, that are like one of the things you see in your lipid panel called LDL, but much more expansive. And they're looking at the number of those particles and all of them all together, not just the one you see in that LDL that increase risk. Lp is a marker of genetic risk. I don't know if y'all— your listeners remember Bob Harper, who is the host of The Biggest Loser, fit guy, young, and had a heart attack. His cholesterol was fine, but his Lp was off the charts. And actually, I contributed to a New York Times piece on this of why aren't we all getting Lp? I mean, look at this. That would've identified him before he had his heart attack as being at risk.

Thankfully, it saved them a lot of money. I mean, here's the thing that, like, I'm, it's, I'm listening to this going, okay, if the insurance company is doing this because they're trying to do risk reward and save money, they actually are not saving money. No. By not looking at these things.

No, I know, I know. You can make yourself crazy trying to make sense of it. It doesn't make sense. But so getting that Lp, again, it's not crazy expensive, but ask for that, especially if you're over 40, for sure. And then also looking at—

well, you only have to do that once, right?

That exactly. I mean, you can follow it over time only if you're doing very aggressive interventions or some injectable medications to lower it. So, but other than that, you're absolutely right. And then inflammation. Okay, so we know most disease, including early cognitive changes and Cardiovascular disease is all related to inflammation. So you want to measure what is your inflammation like in your body. The best way to do that is through something called CRP, C-reactive protein. Again, not crazy expensive, really important because if you have, let's say, normal cholesterol and normal ApoB and Lp, but really high inflammation, you're still going to be at risk and you need to do that. And there's a lot you can do and we can talk about that if you want to. I'm sure you've had episodes on decreasing inflammation. And then the last thing I would say is for cardiovascular disease risk, looking at actually has that risk expressed itself by getting some kind of scan if possible, and if it's accessible to you, of the arteries around your heart to see if you already have blockages. So we can go into that if you want.

But then the scan you're talking about specifically is what, like a CT angio or what?

CT angio ideally, because that looks at what's called soft plaque and calcified plaque.

Can you talk about the differences between those? Because I think this is super important.

Yeah, sure. So yeah, so, you know, heart disease happens when you have a plaque in your vessel taking blood to your heart and it ruptures, explodes, and causes a blockage of blood flow. That has to do with inflammation and a plaque being there. That plaque could be hard or soft. So there are coronary calcium scores which are helpful that look at the hard plaque to see, have you had plaque buildup over years that's been there so long it gets calcified? And that's certainly helpful and good to get to see, have I had issues for a while that I need to make sure I address? The newer, even better, is one that looks not only at that hard plaque, but what's that soft plaque. So you can think of it as newer plaque. It hasn't been around long enough to get all calcified, but it's still there and can therefore rupture and cause a heart attack or stroke if it's in a blood vessel leading to the brain. So it's a more expensive and invasive test. But if you're at risk based on first doing those tests and then you see you're at risk, then investing in a test like that can be really helpful. To know where you're at. And I think what can help you decide what all testing you need is doing a genetics test. And that's kind of where I like to start, just to see where do I need to focus my attention? Do I have risk of diabetes and I need to test for that? Do I have risk for heart disease? Do I have risk for Alzheimer's? Where are my, my kind of weak spots genetically? Which doesn't mean I'm predestined to have a problem, but it means I need to work a little harder to attenuate that risk and do a little deeper dive in that direction.

So changing gears over to my favorite subject of all. Yes. And that is muscle.

Uh-huh.

You know, I'd love to address muscle and testosterone, those two things. Yeah. But where, where does muscle come into this? Because again, when I met my husband, he was— I'll tell you a little interesting story that you can unpack is he'd always been a runner. And a very tall, uh, lanky guy. You met him. And we went and did DEXA scans a couple years ago, and his DEXA scan for an athletic guy who eats healthy— and he would go work out, but I was like, I kind of felt like he was phoning it in, but I wasn't going to say anything, you know. It's like no profit in your hometown. But, um, his DEXA scan was 25% body fat.

Wow.

Okay, so normal weight, if anything a little on the light side, and you know, 25% body fat. I'm like, honey, you're skinny fat. Yeah. You know, he kicked it into gear. And what he did was his testosterone was sitting at around 300. He cranked it up to 900. And then we did everything else, like upped his protein, like added, like upped his weight training. Everything got him from 25% down to 10%.

Nice.

And what was cool was he dropped 27 pounds of fat and put on 24 pounds of muscle.

Amazing.

I wish we'd done one intervention at a time because it was 8 months. I always tell people testosterone had to do like a good part of that, right? Because there's no way you're putting on that amount of muscle and, you know, in 8 months unless your testosterone's really gotten kicked up. But I love, love you just to unpack that, talk about the role of muscle, because here's the thing that, that made me crazy about this. You go to the typical doctor's office, you step on a scale. He was normal weight. He looked— you would never have suspected this.

Right, right, right.

And, you know, the difference is insane. But no one would have ever known unless they were looking at body composition and, you know, and then unpacking. And again, they would have kept his testosterone at this lower level.

Yeah.

So insane. Have at it.

All right. I'm going to talk about muscle and then we'll get to testosterone. So Muscles hugely important, right? Especially in the last, I don't know, 5, 10 years, we've seen that loss of muscle mass, which is called sarcopenia, is correlated with early mortality.

Okay, but stop right there because here's my issue with sarcopenia. Yeah, we don't even have a really good clinical definition of it and no one's looking for it. Like, how are they looking for it?

Right? No, it's a great point. But in general, I would say doing like a DEXA scan and looking to see what is your muscle mass versus your fat mass. And for guys, it's different from women. They have a higher general fat mass. Um, under 15% is really— should be the goal. So your goal isn't just like your husband, not on the scale. That's not going to help you. It's what's your waist circumference. If you can't get a, uh, DEXA scan, or through a DEXA scan, or another— they have the dunking ways to measure your body.

Oh God, we had to do that in grad school.

Yes, exactly.

Horrible.

I know. So try to get— yeah, DEXA is the gold standard, and they're not that expensive. But yeah, under 15% is what you kind of want to go for. But the reason this is so important is That amount of muscle mass is number one, important for longevity. Number two, it's actually hormonally active. Muscle is not just blob tissue, just like fat tissue and just— but muscle actually makes myokines. They make hormones that affect your heart disease risk, your liver, your testosterone, your pancreas, insulin resistance. The big issue right now, we're all metabolically dysfunctional and we all have high blood sugar and insulin resistance. And the more muscle mass you have, the more insulin sensitive you are. The less muscle mass, the more insulin resistant. And that's directly related to things you've probably heard about on JJ's podcast here, AMPK and all of these, these inflammatory mediators that are actually favorably impacted by more muscle mass. So number one, it's not just about having your beach body, it's about your longevity and your health.

That's a side benefit.

That's right. Exactly. And that's why you need to work out your lower body and do your legs, guys. That's the thing, guys.

No, I know. Biceps and chest.

Yeah.

No, I'm like, come on.

Come on, you have giant muscles in your legs, and so you're not going to get all these benefits of muscle mass just from your chest and biceps, right? Back especially, and quads, and your glutes. Don't forget this. So anyway, so muscle mass is important for metabolism and for testosterone production. Okay, so it's, it's this like positive cycle. The more testosterone you have, the easier it is to build muscle. The less muscle you have, the lower testosterone, and then it's harder to regain that muscle. It's this kind of vicious cycle or positive cycle depending on which cycle you're in. So absolutely assessing where you're at hormonally with your testosterone and your estrogen are really important as you're trying to build muscle. Testosterone helps you build it. It's what's called androgenic. Estradiol, which we have as men, we have less than women, but we have some, should also be checked. The biggest mistake I see around testosterone is guys will get their testosterone checked and they'll say, oh, my doctor said it was fine, but all they had was just a regular testosterone check. So for Women listeners out there, if you're thinking about your husband, your father, your son, anybody, and you're wondering what's going on and their body isn't looking great and they're depressed and they're losing muscle mass, check a hormone level. But check not just total testosterone, check what's called free testosterone or bioavailable testosterone. Not that hard to do in addition to testosterone, but that's really, really important. And then also check an estradiol. Because a guy will have the same issues with high estrogen that he has with low testosterone. So we start with that. And then if it's in the 300s, like, husband, that's very, very low. What also makes me crazy is—

but here, Miles, I've heard this is normal. I can't tell you how many times I, I literally had someone DM me on Instagram. They said, my husband's testosterone is 300, and the doctor said fine.

I'm like, ah, no. Okay, yeah. So like, two things with that. One is, yeah, you know, for some labs it might be considered normal, but guess what? The normal range on labs it's about the average of the men who went there and got a testosterone drawn, which is not healthy and not optimal. You want what's optimal, not what's just normal by that LabCorp or Quest Lab. Okay. And so we know that 300, 350 is low. It is not optimal at any age. The other thing I would say is that that doctor probably told that person is, yeah, testosterone declines with age. You just deal with it. Well, that's like saying, oh yeah, you get a cataract when you age. Just deal with it. No. You get the cataract fixed, you get the cataract taken out. You don't just deal with it. You don't have to just deal with testosterone declining. Yes, age is the number one cause of lower testosterone, but it doesn't mean you just deal with it because it has impacts. In fact, low T is associated with mortality as well. So getting it treated and we can go into that if you want ways to treat it, but it's absolutely important in longevity, but also in muscle mass and in making sure you don't get metabolic syndrome and heart disease and all these other downstream effects.

And where are you trying to get it to?

Well, so that depends on— you aren't just treating a number, you're really, really treating the symptoms. So if you have a guy, symptoms of low T, for example, are obviously some sexual issues, low libido, sexual dysfunction, ED, erectile dysfunction. But it can also be things like moodiness and not able to put on muscle despite working out, gaining more fat mass. So fatigue. So you're looking at, at what point you get those symptoms better by giving T, but generally the upper third or so of the range. So we're talking like 700 to 1000. 1000 for total testosterone levels is generally good. You're not— if somebody still doesn't feel great at 1000, you're not going to make them feel much better at 1500. There's something else going on. I don't buy it that, that they would— they would have a testosterone issue if it's in that range. But typically the upper third— and I don't agree with labs that say, oh, a normal range for a 30-year-old is different from a normal range for an 80-year-old. No, optimal levels are optimal levels no matter the age. We— it's safe and it's big study just came out last year called the TRAVERSE trial. Very big study showing once and for all that even in older guys at risk on testosterone, there was no increased risk of using that testosterone if they needed it to get them into a normal range. It did not increase risk of cardiovascular disease. So it's safe and improves quality of life and improves exercise, improves bone health. A big cause of frailty in aging is bone issues in men, just like women, and low T contributes to that. So it's very important to normalize it.

You know, you look at this and it's the same with women and hormones. I go, but all of our health problems happen when these hormones go down.

Yeah.

So why are we sitting here afraid of this?

No. And for women, didn't we learn lesson with women? For years we made the mistake of trusting those trials that came out in the '80s that said, oh, don't use hormone, hormone is terrible and dangerous. And finally, in the last 10 years, we've realized, oh, we really did a disservice to women in poo-pooing hormone replacement. It has a lot of important effects, and if done correctly is really actually healthy. Same thing with men. Like, we don't need to relearn the same thing.

Now, I know that, that the guidelines have shifted a lot. Like, years ago, it was any man going on testosterone also needed to go on like something so that it didn't convert to estrogen. So where are the guidelines now with that?

Yeah. Yeah. I mean, basically you want to measure your estrogen. So testosterone gets converted to estrogen. Via an enzyme called aromatase. And so some guys will need a blocker of that enzyme. This is where the genetic test can be helpful. It can tell you, are you a guy who's more prone to converting testosterone to estrogen? If I give you testosterone, you're just going to convert it all to estrogen, in which case I have to give you a blocker. Or are you somebody that doesn't overconvert that? So there aren't guidelines on, on testing for that genetic test, but that's where we can get to this personalized level, right? Where I can know for Jim, I give him testosterone with a blocker. For Ted, I don't need to, but it's so generally the guidelines are to at least test estradiol and then retest after you start testosterone to see if it's gone up. And if it's gone up, you block it. Some guys will make the mistake of blocking it too much. We do need some estradiol. We don't want zero. It's important for bone health, for heart disease. And some, like guys who get roids in the gym, frankly, that aren't as healthy and reputable, they might hear from other guys at the gym, oh, and take this blocker. You want to get your level down to zero. That actually isn't healthy. You want to get it down to a healthy level. So that would be between 10 and 40 for men for estradiol. If it's much over 40, you could have symptoms, but you don't want it under 10 because that actually is dangerous.

Now, you mentioned briefly about brain health. I don't know the statistics for men. I've been paying attention to the statistics for women and they're pretty high. I think women are a higher risk for dementia and cognitive decline. True. But what is the risk for men and what can they do here?

Yeah. Yeah. So of the top 10 premature causes of death, so preventable cause of death, men win at 9 of them, but women win at 1, and that's Alzheimer's. So Alzheimer's— die more often of Alzheimer's than men do. So that is true. But men do get Alzheimer's and they get early cognitive changes and the, The thing we know now is a lot of that is due to inflammation in the brain, and it has to do a lot with blood sugar in the brain. David Perlmutter talks about type 3 diabetes, and he's— he among others— looking at how blood sugar in the brain— getting rid of blood sugar— actually, the enzyme that gets rid of blood sugar competes with the enzyme that gets rid of plaque in the brain. And so if you're working on getting rid of blood sugar, you're going to have more plaque. We now know there's a lot more than just plaques that weigh into dementia. So there's a big tie-in with metabolic issues that we hear about with heart disease and risk of early cognitive decline. So what I would say to keep it simple is anything that's gonna help the heart is gonna help the brain because you're gonna help blood flow and you're gonna help inflammation. So I would really think of those together. If you want to get more kind of nuanced, there are some specific supplements and nutrition regimens that can really contribute if somebody already knows they have bad genes around Alzheimer's or if they're having some early cognitive changes. Even early Alzheimer's. There's Dale Bredesen wrote this amazing book called The End of Alzheimer's, how you really break down and see based on lab tests what particular issue does that person have contributing to their dementia and what should they be doing with sleep or stress or inflammation or blood sugar. But for the most part, anything that helps heart disease around blood flow and inflammation is going to help brain health. And one Quick, interesting thing, JJ, that I found out that I read about recently. So it used to be that guys' number one concern in terms of longevity and getting older was around prostate cancer. And now their number one concern is brain health and early cognitive decline, even more than prostate cancer.

Hmm.

So it is top of mind. No pun intended.

So should we— if someone did have, say, you know, the APOE4 genotype? Yeah. Should they be more proactive, or would it be that being insulin sensitive and exercise and sleep and all the things would be enough, or would they want to go farther than that?

Yeah, great question. Yeah, I would go farther. It depends to some degree if they're what's called heterogeneous or homogeneous, right? So you get two genes. I know your listeners know that one from mom, one from dad. If both are this E4 copy, then you're at about 10 to 12 times a risk of early Alzheimer's. So I get more aggressive with my patients like that, which basically means Absolutely. Dialing in sleep, dialing in stress, exercise, hugely important, but also looking at specific supplements and diet. So supplementation, there are supplements that really help boost what I just said earlier, this brain-derived neurotrophic factor, BDNF. There are supplements that can help things like, um, citrulline and phosphatidylserine. And I love mushrooms and not—

me too.

Right.

Yeah.

But especially like lion's mane. And these are called nootropics and they're absolutely shown to really help with cognition. The most important thing is to use your brain. And so learning a language, constantly doing something that builds those new pathways that I talked about, that's a huge one. But the exercise is a big thing. I think that we forget in people that are at higher risk because the more you exercise, like I said, you're going to promote growth factors all over the body and in your brain especially. So I think that's a big part to include and just being really aggressive with that.

Yeah. When you look at cognitive decline, the— and you could only pick one intervention, exercise beats everything hands down.

Yes.

Hands down.

Yeah.

Which makes me so happy. Yes. I was like, I finally feel like the exercise physiologists are getting their due here.

Yes.

You know, you're always the low men and women on the totem pole. Now it's like every single longevity marker, we're like exercise Exercise, exercise.

No, it's true. And I would just say, just to clarify, to break it out into the various types, right? I know your listeners know this, but it's looking at not just the cardio, which a lot of people focus on, and that's hugely important.

That it's hugely— but I think it's actually the least important of all of them.

Yeah, I mean, I think strength training, like we talked about muscle and how you stimulate growth factors, how muscle is, is hormonally active, it will stimulate brain development. And then flexibility to prevent falls, and then core strength. So like, those are 4 really important pillars. And you could do some things that touch all of them. Yoga can touch a lot of those things, right? It's a little bit of strength, bodyweight resistance strength. It's certainly flexibility and certainly core. Pilates touches a lot of those, but you got to incorporate all those elements.

I love that. Yeah, that's why you could just do high-intensity functional training, you know, and get everything. Absolutely. And get the HIIT and get everything else. All right. So To put a bow on this, yes, you're going to give our listeners one thing that they could go back to their favorite man in their life and say, this is the one thing I would love you to do. What would it be?

I can only pick one. Oh my God. Okay, well, I mean, I think it's, it's, I would say measure. I would say measure is the number one thing. And then I want you to measure when you're going to start an exercise program, get your body fat down to 15%, measure your stress. So I think finding what matters to that guy and measure how it's moving and then coordinate interventions to move that mark.

I think that makes a ton of sense because first of all, I'm, I'm a big measure person. Like what you measure, monitor, you can improve, but especially in the male psychology.

Yes.

It's hugely effective. Yeah. And again, was the only way, like the way I got my husband to do, to, to get, you know, to get moving on this stuff was taking him to get a DEXA scan.

Yeah. And it incorporates this competition a little bit and gamification a little bit. Mm-hmm. Really respond to. Um, but the other last thing I just wanna say, and, and, and you can totally edit this out, but we didn't touch on it. It's so important is relationships and connection. And we don't talk about that enough with men. I think women talk about that. That's hugely important. We learned in COVID. And men didn't do well in COVID because we didn't have nearly the relationship.

What is up with you guys though? Like, here's the thing, I watch, I watched my husband, all my guy friends, and they just don't— like, women have such a different way with relationships and we'll sit and talk through all our stuff, and guys, like, they don't do it.

I know, I know. I, again, I think it's an embarrassment in front of other men, but that's why it's like a shoulder-to-shoulder thing with guys instead of face-to-face. So they're activities you do with a guy that will help you, then suddenly as you're helping him with, you know, with his deck, you can be like, hey, I'm not— speaking of wood, you know, as opposed to just confronting him with it.

It was funny when I had, you know, when I had people one-on-one, I would do all the nutrition and fitness stuff, but I would get them out working out and then it was like blah blah blah blah. Yeah, okay, all right, exactly. Yeah, none of the stuff you could ever ask them just flat out, they wouldn't tell you. But right then, you know, once they're ready to talk— same with my sons— once they're ready to talk, it's coming out. Yes.

You never know when it's going to happen, but you got to be there.

Now, you've written a book that's the perfect, like, manual for men. Tell us about it.

Sure. It's called Optimal Men's Health, and it's really an easy-to-read kind of list of things to look for, things to talk to your doctor about, what kind of labs, like we've touched on, you should be getting. And really, my toolkit around how, you know, because men love a toolkit, around what you can do to really get into this idea of how I stay healthy as long as possible.

Perfect. And the TEDx talk that you did, what's the title of it? Because I want to link to all of this in the show notes.

Oh my God.

Well, we can just look for Dr. Miles Barr again.

Yeah, I have to look that one up. It's been a while. All right. Change your annual checkup to a check-in and live longer. Oh, it's a horrible Catchy.

There you go. Catchy. Check up to check in. So, okay, we'll put both of those at jjvirgin.com/miles. M-Y-L-E-S.

Right.

Yes. M-Y-L-E-S. And thank you so much. All the women here, thank you for giving us the tools to get the men inspired in our lives. And just keep doing your stuff. We need you out there.

Thank you so much. I appreciate it. Great to talk.