Dr. Keith Nichols Interview: Men's Hormone Replacement Therapy

This is episode 304 of the Empowered Team Podcast. Welcome to the Empowered Team Podcast, where we explore how to optimize your performance in career, sport, and life. And now your host, executive coach, and life strategist, Kari Schneider.

Welcome. Welcome to the Empowered Team Podcast. I have a brand new guest today, and this is so exciting for the men out there especially, but women, you know, ladies, you're going to be loving this too, as well. So I have expert Dr. Keith Nichols. And Keith Nichols is a medical director and CEO of Tier 1 Health and Wellness. It's a medicine clinic headquartered in Chattanooga, Tennessee. And he is. He and his wife Angie have founded this wellness center, and it's dedicated to promoting optimal mental, physical, and sexual health through the. The aging process. So from what I've gathered from Dr. Nichols is really that he's very, very proactive. This is about us living our best lives. And when I say us, I mean people, because we're talking about men today. We're talking about men's hormonal replacement today. So he's also an author and a speaker and has become one of the most recognized, foremost experts in testosterone replacement, testosterone replacement therapy. But specifically, Keith has become known for a specific testosterone cream with specific application that wasn't popularized before, wasn't used before. This is something that he's not only done the research and explored the research, but also takes a look at what the results are and what really, really works for people. So the other thing I'd like to point to is just how important this is now in our day and age. We're learning more and more. We're learning more and more what's coming into our systems, what's overloading our systems, what our hormonal needs are. And sometimes as men, I'm not a man, but the men that I serve and the women that are out there, we just don't know what we're supposed to do. We don't understand what. What is happening with our bodies as we age. And the men that I work with are high performers. These are people who love to perform mentally and physically. And when it comes to aging, they're probably not ready to slow down anytime soon. So welcome Dr. Keith Nichols. Thank you for being here. And I just want to lead you in that way and say, bring us. Take us to the water. We'll drink. So tell us more.

Thank you, Kari, for having me on. It's my pleasure. My pleasure. Look forward to doing it. And I admire everything that you do out there. I really appreciate what you do for men. And women all over this country. So thank you very much once again. My pleasure.

Thank you so much. Well, I, I went a little, I'm a bit of a keener and I want to serve my clients. So I went to a few of my clients and I asked the question, you know, I'm going to have an expert in hormone replacement therapy for men. What do you want to know? And they, they sent me a few things and one of the first questions was, what do you recommend to balance and optimize testosterone? Because some of the men over 40 are noticing they might, they might have less energy, they might have less arousal, they might have less, less of the, the tendency to hold muscle mass than they used to. So there's a number of things that they might point out. So if we start off with kind of a really broad general question. What do you, what do you recommend when it comes to testosterone and balancing? Or is it balancing? What do you do? Do you customize, start us off and educate the ignorant here?

Well, Kara, you're, you're 100% correct. And it's all about prevention. All right? Unfortunately, as we age, our hormones decline. And with that decline, so goes our health. They're tied intimately together. So what we really do in men 40 and above, women too, is we optimize their hormones. We'll talk about testosterone a day in men, because as we age, it does decline. It declines in everyone. So what we're trying to do is maintain the health span, that period of our life where we're independent. We're trying to prevent age related disease, disability, dependence, and more specifically, frailty. Now there is what I consider the trifecta of health, the foundation of health. And it's three things, and it's always going to be these three you're never going to get away from, you can't escape it. Number one, it's adequate nutrition. I don't really like the word diet, but nutrition, all right, Number two, it's coarse exercise. So those are, those are fundamentals that, that we need to have in our life for the daily, for the rest of our lives. But then after age 40, some may be younger when they develop symptoms of deficiency. But definitely after age 40, it becomes about nutrition, exercise and hormone optimization. So the best way to optimize hormones, of course, testosterone, is you're going to literally take testosterone. That's, that's how you optimize levels of testosterone. So those men out there, after age 40s, you're seeing that decline that you're talking about, the reduced sexual, reduced sexual Desire, the low libido, the decrease in the frequency of the morning erections, the erectile dysfunction, fatigue. And a lot of people with physical exhaustion, the irritability, the depression, the decrease in lean muscle mass, the increase in body fat, especially the visceral body fat, which is the dangerous body fat, which predisposes us of course to insulin resistance, diabetes, heart disease. So testosterone, healthy testosterone levels in middle age and older men provides us with all the same benefits that we had when we were younger. That's what hormone optimization is. It's maintaining healthy, robust levels of testosterone, for instance, as we age, so that we get the same benefits that we had when we were younger. Testosterone works in everyone, male, female, young or old. It works the same when you take testosterone and you tell me what other medication or drug out there in this world does what testosterone, for instance, does. It should be first line treatment in the aging process, especially for those with diabetes and insulin resistance and obesity. But it increases lean muscle mass, strength, endurance, exercise tolerance, bone mineral density, it decreases recovery time, it increases energy and motivation, self confidence and initiative. It improves libido and sexual function, it improves cholesterol, it improves memory and cognition, decreases body fat, both visceral and subcutaneous, prevents Alzheimer's disease, decreases fatigue, it prevents, in reverses insulin resistance and diabetes, it protects against prostate cancer, protects against cardiovascular disease, and the list goes on. Better the levels, the better those benefits. It's a dose response relationship with testosterone. So if you have healthy levels of testosterone, then you'll get all of those benefits from the testosterone itself. The problem that I see is men just don't get enough testosterone to maximize those benefits.

So when there, there's so many things that you've pointed to here that I'm just, you know, eating up. And one of the first ones was the fact that you're not going to ignore that nutrition and exercise need to be in there and then, so that, so that people don't grab onto the idea that oh, testosterone's my solution. It's, it's nutrition, it's exercise, it's living a life that's got this whole picture and it's horrible hormone optimization. So then you dive into this hormone optimization and the list that you just gave. Honestly, I think people's minds will be blown because they're not going to fully understand how much it contributes, how much our hormones can contribute to such a vast, a broad spectrum of health, preventative, performance related, all of the things, and I'm talking thinking and feeling and energy and all, all of that never Mind the other things you're pointing to, like managing cholesterol levels or just having decent cholesterol or preventing prostate issues. So these are, this is really profound because I don't think that people fully grasp the spectrum. I think they think oftentimes what I hear is that they think, oh, well, is this what getting old is? Like, maybe my testosterone levels are down and maybe I need to do something about that. So if this is the case now, what I'm hearing, because if you think back in the day, some of the people that I knew three decades ago who were taking something like testosterone, they were doing it for anabolic reasons and trying to be a bodybuilder. You know, you're talking about a much different scenario than that. You're talking about, about, in my words, you can correct me here, you're talking about, about providing an amount that has been, that has been missing based on the aging process. And you're topping this back up to what would be within normal range ranges or optimal ranges for someone's ideal gender and age. Is, is that, I mean, I'm putting my words.

That's an excellent question. And you've opened up a very good can of worms that deserves to be talked about more often. I've tried to bring it up. One of the ones that, that does bring it up. You know, see a few things that I'm kind of known for. And, and, and let's talk about what you just mentioned, a few things. Number one, yes, testosterone will reward effort, but you have to put in the exercise, you have to have the adequate nutrition. But all three, there was a doctor by the name of Dr. Jeffrey Life Back in the day. And he was quick to point out that he didn't look like he did in his 70s. He looked very good for 70s. He would tell you, I don't look like I do because I eat right and exercise every day. And I don't look like I do because I take hormones. I look like I do because I do all three without. If you take away one or the other, I will not look like I do. I will not be as healthy as I am. So it does require all three for maximum health, middle age and on. There's no doubt about it now when it comes to levels, yes, once again, there is a dose response relationship with testosterone. Now, Kari, I can provide you with literally dozens of studies that shows that testosterone just doesn't work in men. You can give men testosterone and it doesn't work. That's why family doctors and internists will use those Studies to, to argue against utilizing testosterone in men. And there is one common denominator in every single one of those studies. They only gave testosterone to raise levels a little bit. If you raise levels a little bit, you either get no benefit or minimal benefit. And that's what happened in those studies. But when you look at the studies where they gave an adequate amount of testosterone, the men benefited in every way that you can. You know, you think that we would increase in lean muscle mass, decrease in body fat, improvement in lipids. All parameters of health improve with adequate levels of testosterone. Now, the can of worms that you opened is this. You mentioned the physiologic range. Unfortunately, men are producing less testosterone than ever. The new normal range is much lower than it was 20 years ago, for instance, because the normal range comes from an average of a population, and the average of the population now is for men that are producing less testosterone than ever. So the normal range is 264 to 916 presently at LabCorp and dropping in some areas. That is not a healthy normal range of testosterone. Not at all. In the early 2000s, some labs, the normal range went up to 1,593 in June of 2017 is when the normal range changed. And prior to June of 2017, the normal range went up to 1,197. After June of 17, it dropped to 9 16. When a study came out by Dr. Travison which provided us with these new normal ranges. So, for instance, if a man was being treated with testosterone by his family doctor and he had a level of 1100, let's say back in 2017, in June, that was normal. He was patted on the back. Levels are good, Bill, you look good. Keep going. If you went back to that same doctor three months later, the normal range is now 9 16. So Bill comes in feeling great. All his parameters of health have improved. But his doctor looks at him now and says, bill, your testosterone levels are way too high. It's dangerous because you're above 916. Well, nothing could be further from the truth. So it was healthy in June of 2017. Now it's unhealthy in October of 2017. It makes no sense because it shouldn't make sense. So there is no harm in testosterone even in, let's use the word, super physiologic level, a level above 916. What's most important that people need to understand is that whenever we treat, whenever the guidelines for treatment state to treat to the mid physiologic range, meaning the middle range between 264 and 916. There is no medical data to support aiming at a specific number in the mid physiologic range. None at all. That's just an opinion. Also, there is no medical data to support staying within the physiologic range while on testosterone therapy. In fact, I don't see many men improving from a clinical standpoint or women. When you stay within the normal physiologic range, what we found from a clinical standpoint is when you get outside that physiologic range, so called super physiologic, that's when you get the best, most robust clinical response. And we don't see any adverse effects with those levels. And there's a couple of reasons why we see this from a clinical standpoint. When we make testosterone ourselves, that's a very complex process. You know, there's a lot of physiologic events that go into steroidogenesis. But when men are given testosterone, which is literally just the end product, we bypass all those physiologic processes and we just get testosterone. So what we find from a clinical standpoint, if a man, if we could go back in time and if a man's Testosterone level at 600, he was completely asymptomatic and felt great when he made it on his own. But as he aged, that level dropped. Now it's 300. If we now treat him with testosterone, what I find from a clinical standpoint, it typically takes double what it would have taken if he could have produced it himself. So when I give it to him, it's different than if he produced it himself. He produced it himself. He would get asymptomatic and feel great at 600 in this specific man. But when I treat him with the end result, it typically takes a level double that. So around 1200, for instance. So there's no harm in a number outside of the normal physiologic range. And once again, think back on what I said earlier. The normal range went up to almost 1600 in some labs in the early 2000s. So it was healthy then, it was robust, it was good. Now all of a sudden it's considered dangerous, harmful and abusive. And that's just not the truth. That's not the truth.

Okay, so this opens up a real curiosity that I have, and maybe this is too big of a big picture question, and it's that, why are men's testosterone levels dropping? Why do you think?

Oh, that, that's easy. That's easy. It's the environmental toxins that we're exposed it, you know, and that's an interesting question. I'm glad you asked it. At baseline, meaning someone that's not on testosterone. When I see men in my clinic, when I see a 60 and 70 year old man come in that's not on testosterone, his levels are almost always higher than the 30 year old men that come into my clinic. Why? Well, those 60 and 70 year old men were not exposed to their environmental toxins, those plastics, those chemicals when they were younger. There were no plastics then. Right. They're just, they were not exposed to it. The younger men this day and age are exposed to it even in Euro. Okay. From the day.

Microplastics.

That's right. They're exposed to it from day one.

Yeah.

And it's in the news all the time now. You, you can't really open up a paper or, or, or get online and read, you know, any national news without this coming up. In the microplastics even found in, you know, men's testicles, which they're showing, that occurs now. And so, you know, that, you know, sperm has dropped 50% in men and they're intimately, you know, entwined. Testosterone and semen, they go together. You have to have high intratesticular testosterone levels in order to achieve spermatogenesis so that they are intimately intertwined. But it is the, it's the environmental toxins that are, that are wreaking havoc on both men and women's endocrine systems. And so we're just, we don't need less testosterone than ever. We're just producing less testosterone than ever. We need more than ever. And you know, it's something that I've been talking about for several years now, is those EDCs compete for the androgen receptor. So the only way that we can treat these right now because we can't limit the exposure, you cannot stop the exposure because they're ubiquitous. They're, you just can't, you can't get away from it. But what we can do is give the closest thing to an antidote that we've got, and that is testosterone. So you literally are trying to out compete these EDCs for the androgen receptors. And that's part of, you know, the thinking process that goes into a clinic like mine. We're treating these, these men. And what's most important for men to understand, and specifically your clients, is you can have completely normal testosterone levels, 3, 4, 500, and have significant symptoms of a testosterone deficiency. Having a normal level does not mean you do not have symptoms of a Deficiency. That is not how hormones work. Each man has his own normal level. And we know that from studies where men were given pellets that dissolve very slowly. And they compared men and as those pellets started dissolving, these men's would fill out, these men would fill out their symptom questionnaires and they found that for each man he became symptomatic at a very specific level. But what they also found out that there was a lot of inter individual variability, meaning that each man had his own number one man may become symptomatic if his level got below 400. Another might not be until his levels got below 300. So having a normal level, there's nothing more common than the question, here's my testosterone levels. Do I, do I do my normal, do I need testosterone? I'm in the normal range. Well, based on the guidelines, if you're above 264, mainstream medicine is going to tell you you didn't need it. Well, that happened to me too. The reason I do what I do is because of what I personally went through. My levels back then were 254 normal was 250 at the lab that the doctor went to. So you're normal, Keith, your levels are completely normal. You don't need testosterone. So went through a million dollar workup, they could have had cancer. Whatever else, you know, I was mistreated, misdiagnosed and mismanaged by my own colleagues. It's not their fault, they didn't know any better, but that's just what occurred. So once I was able to figure it out on my own and get it corrected, it literally changed my life, or what I used to say, it gave me my life back. And that's when I decided, you know what, if it can happen to me, it can happen to anyone. And that's why I do what I do today, because of what I went through. And so a normal level man out there does not mean you do not need testosterone. Nothing. It could not. That could not be more untrue.

And this is, this is across so many other areas that are, that are health based and preventative as well when it comes to hormones because, or even, even something as simple as vitamin D. I remember back decades ago working in high performance sport and our national level athletes were being tested for vitamin D and they were being compared to what was normal. And these athletes needed not only a higher level of vitamin D in their systems, but they also were, they're being compared to the regular population and there was no distinction between their Personal needs as a high performance athlete or their individual needs as an individual versus what the standard for normal or the range is out there. And then you've got the conundrum of going from country to country to lab to lab that have been different sets of ranges. So you're not even comparing apples to apples, you're comparing some other berry to some other citrus fruit. Because it's, it's so for the consumer. I love that you're explaining this so concisely because it's, it's clear as mud. It's just, how would they know? And especially for the physician who may not know either because their specialty is not in endocrinology, it's in general practition or whatever, then they don't know that if they're telling someone that it's in normal, that that may not be that person's normal. So we really are putting this, this, this is education for the consumer. So we can advocate for ourselves to be able to then go, okay, ask some educated questions. What might I need? What might I not need? So I have some more questions for you. And, and some of these revolve around, you're speaking of levels that basically someone has to figure out what is their normal. I'm gathering from what you're saying that they're figuring out by checking their symptoms.

Correct. We treat for systematic improvement, not aiming to a specific number. That is correct.

Okay, and then trial and error. You're going to start with a small dose, get you up to blank, whatever that next level is, and then recheck the symptoms and so on. Is that kind of the step by step?

Absolutely, absolutely correct. Spot on. That's exactly what.

And then is that a, and is that a. This is an exogenous hormone, meaning it's not made in their body. It has to be brought from an outside source. Now this outside source is likely a synthetic hormone. Correct.

Well, what we use is a bioidentical form of testosterone. Now, the injections are not bioidentical, so they have an ester attached. But the cream, for instance that I utilize is pure micronized testosterone. It's bioidentical. The chemical structure is identical to what men make on their own. The body doesn't know the difference.

So tell me why so many men have responded so well to the cream and why you like it so much.

Well, it's just as ease of use. Men do respond to injections as well, but the cream is just so easy to use. So it's when I provide men testosterone, I'll provide it two ways. There are other ways to get it. I just don't find them as efficacious. We could talk about those if we need. But injections and cream are the two most efficacious ways to provide testosterone to men. And I'll let a man decide how he would like to obtain is testosterone, whether it be via injection or via cream. But I find that a daily utilization of either injections or cream works the best. The truth is, most men are just not going to want to inject daily for the rest of their lives. But it's easy to apply the cream daily for the rest of your life. It's literally less than 11 seconds to apply that cream. I mean, I literally, I literally timed it. And the differences between the two are, you know, very, very easy to explain. Number one, yes, it's easier to take 11 seconds and apply cream and not worry about needles, syringes and vials. It's also going to be easier to travel with a cream than it is injections. Once again, traveling with needles, syringes and vials. The cream will not have a negative effect on a man's good cholesterol, the HDL cholesterol. The injections can have a little negative effect on some men's HDL cholesterol. All right? The cream also raises free testosterone levels better than the injections for any given total. So if you have a total of 1200 and the same man on injections or cream, well, the cream is going to raise free testosterone levels better. And it's the free testosterone that exerts the benefits of testosterone at the cellular level. Not total testosterone, but free testosterone. So those are really the benefits. And you do find that many men due to that increase in free testosterone over injections. And it's, and it's a consistent free testosterone because the cream typically is applied twice per day. So there's no significant peak or trough. Okay, so there's no. Men will say out there the slang, peaks or valleys. There's no peaks or valleys. So. So, so there's no peaks or troughs. And, but with injections, since most men are not going to do daily, then they're, there's going to have. Sometimes they can have significant peaks and.

Troughs because they just haven't been as consistent.

Well, yeah, just because they don't want to inject daily, it's just going to be a problem. So they can inject. They'll inject once or twice a week. But look, whenever you make testosterone yourself, whenever men make testosterone, the, the lady Cells and do not in your test. So the lady cells, they don't store testosterone. It's a constant release of testosterone. And there may be a diurnal variation, but it's still a constant release. And so with the cream it's, there's a constantly good level of minimal, minimal picot trough.

So this, this brings me to two other things. One is that if listeners aren't getting it, I'm going to be a little bit graphic here. When there's a cream, the guy is applying it to their scrotal area and that's what's going on every day, everybody. And away we go. Same for a woman if they were applying a.

Yeah, the testosterone for women is applied perivaginally. That's right.

There we go, applying a cream in that zone. So, and then that brings me to the next question, which now am I forgetting it because I was so visually impaired there?

Okay, well, men may want to ask why apply it. They, I mean, why? And that's. And let me explain that you can literally apply this cream anywhere that you have skin from head to toe. I've applied it on all body parts, measured levels. You can get good levels anywhere. But the reason we use the scrotal application for this cream is because, number one, we will typically get our best levels of testosterone applying it to that site because it's thin skinned and highly vascular. So you can typically use the least amount of testosterone to get the best levels. And number two, it reduces our risk of transference. Believe it or not, transference is transferring to someone or something. Now you have to have, yeah, you have in the skin contact for transference to occur. So with a scrotal application we should have literally completely eliminated any risk of transference to children or animals. So we're just talking about our, our sexual partners and there's easy ways to avoid transference to them.

Time between contact, hand washing, that kind of thing.

Well, yeah, specifically, yes, always wash your hands after you apply it. Okay. But yes, when it comes to the cream, a person can wait five hours or longer after they apply it to have sexual activity. Or number two, they could simply wait till after sexual activity to apply it. Or number three, at any time after they applied and they're going to have sexual activity that wasn't planned, they could simply go into the restroom, take a towel, soap and water, just wash off the application site. And then number four, many people are very scheduled with regard to their intimacy. If it happens to be that night or nights and it's always going to occur, you don't have to apply it at all. You will not notice any difference in how you feel or function by not applying it that evening.

Excellent. Excellent. And that brings me to something else you mentioned earlier, because this, so it sounds to me like if, if I'm picturing this scenario, whether it's my husband, clients, who, whoever's in this scenario, it sounds like there's probably a regular schedule of not only blood work and consults to make sure that they're on the right track. And, and then on top of that, if they stop taking the testosterone cream, then their levels are going to go back down. But, but are they going to go back down worse than they were before because their body isn't naturally making it as much because it's being provided externally? What, what is the. So, so then does that make them more dependent, if you will, on, on external testosterone for the rest of their lives? What does this all look like? Because I want to understand the bigger picture, but also understand drawbacks or anything that may come up.

All great questions. Let's see if I can cover all of them, starting at the last part and going backwards. Once you start testosterone, of course you're starting testosterone because you have symptoms of a deficiency. So you're already not producing enough. You should have already tried all other methods to raise levels on your own diet, exercise, you know, supplements, whatever. But that typically is not going to work sufficiently to raise levels significant enough to exert a clinical response. But nonetheless, so you've started because you weren't making enough already. So therefore you're on testosterone. If you start testosterone, no matter what the method of delivery, you're going to suppress your own production. And when you stop that method of delivery, yes, you're going to, your body is not, you're not applying, you're not applying it or you're not getting that injection. So therefore, yes, you will, you'll. Your testosterone levels are going to go down significantly and it takes around an average of about three months for your body to start producing back the testosterone level that it would have been producing had you not been on testosterone? The reason that we say it's lifelong is because you only get the benefits while you're on it. You can stop it at any time. Men and women all around this country stop their testosterone every day. They just go back to feeling how they did before they started. There's no, you know, there's no so called significant crash. And you know, nobody's ever called me because they're, you know, curled up in a fetal position in the corner that, I mean, for some people, some people view it as if it was, you know, you know, tapering off of, of a narcotic of some sort of, that this doesn't happen. You just go back to not feeling well. But yes, the cream, the reason that it works so well in mature, intelligent middle age and older men is because they can be consistent with it. The great thing about the cream is that it will raise levels on a dime. You can lower levels on a dime. It's just a matter of the application, adjusting the amounts. But if you don't apply it for a day, yes, your levels are going to be very, very low. All right, but if you apply it consistently, then, then you're, it's never going to be low. And I think men need to understand that missing a dose here and there is not going to change how you feel or function. For instance, when a man has really severe symptoms of a testosterone deficiency, he can get an injection or he can start applying cream and he's not going to notice any significant improvement in those symptoms in a day. All right, same goes for if a man is on testosterone and he doesn't apply it one day or misses his injection, he's not going to get symptoms of a deficiency in a day. All right, so a lot of misinformation out there on, on forums and social media. And you mentioned labs. Well, that, that's, that's a, that was a really good question. And let's talk about labs a little bit. The job from, for me, my, my job is to optimize men and test men and women's testosterone to the best of my ability. We can do that. They have the hard job, the sweat equity they have to put in the, the exercise. They have to, you know, get the adequate nutrition. I have the easy job, so we can optimize those hormones. Now, when it comes to labs, certain clinics use labs as an income generator. And that's kind of a red flag. A lot of times they'll have you sign up at maybe a lower rate, but it's all the little hidden fees that get to people. So if you're seeing a clinic and they want to do labs every three months or so because they want to main see if you're continuing to be optimal or whatever their reasoning may be. Those clinics are usually utilizing labs as an income generator. And people tend to love labs. They get kind of drawn into that. They, you know, that, that sales pitch of, man, we just need to make sure you're optimal. We just want to see those levels And I know you do too. Yeah, I do, yeah. Do, Doc. Well, yeah, it's just money and it's, and it's unnecessarily spent money. If hormone therapy is done correctly, typically only need 12 labs at most from the beginning to get people where they need to be, especially men with regard to testosterone. And then after that, if they continue to do it as prescribed and are consistent with it, their levels are amazingly consistent from year to year to year. So I only need labs once a year. I'll get labs. So I don't use, I do not use labs as an income generator. So there's no hidden fees there. I will get any labs that a, that a man or woman wants. It's their money to spend if they want to, if they want to order a lab, we can, we can order whatever lab they want. But as far as what I need, I only need them yearly. And that's really, when you, when you're been doing it for a long time and have a lot of experience, that that's all you should need. It should, it should be very simple for people, but it's made more complicated because unfortunately people view it as if it's more complicated. It must be better. When it comes to hormones, nothing could be further from the truth. It needs to be kept very. Because it is a simple process. We're taking an individual, male or female, that has symptoms of a low level of a hormone, testosterone, let's say, and we're raising levels to overcome those symptoms of inefficiency. That's all it is. It's that simple. And it should be that simple. People will fear hormones, but last year alone, over the counter medications like nonsteroal anti inflammatory drugs, ibuprofen, Advil, even hospital visits, they killed, they killed tens of thousands of people. It literally killed tens of thousands of people. And that's not even a joke. You can, you can.

Yeah, the people are quick to pop, they're quick to consume.

So the testosterone didn't kill anyone last year. But yet people fear testosterone.

So on that fear. No, what, what is, what is to be feared if something was over, over utilized or, or someone wasn't the right candidate for what. What is the uncertainty or what are any of the concerns that can come with testosterone supplementation or utilization?

Well, when I see a man that has low levels of testosterone and he's insulin resistant or he's low, even if he has normal levels, lower normal levels, but he has all the symptoms of a deficiency, then I will literally tell that individual that And I'll ask him the question. There is a, there is, you know, one potential risk or that, you know that, that you take with testosterone and that, you know for your health. And you'll say, well, what is it, doc? What is it? Not doing it. Your greatest health risk is going to come from maintaining those low levels that you've got because there's an increased morbidity and mortality across the board with your levels. So low levels of testosterone are terrible for men. Okay. That increases their, once again, morbidity and mortality across the board. Healthy, robust levels of testosterone have never harmed anyone. They only provide us with health benefits just like they did when we were younger. It should be no different than when we were younger. They didn't cause harm then, they will not cause harm now. We don't see harm from a clinical standpoint. There's not a single, not a single randomized control trial. Testosterone's been used for about 85 years. There's not a single randomized control trial, prospective study that shows any harm, such as heart attacks, strokes or blood clots in men on testosterone, but yet they fear it. It's the men with low testosterone levels that have all the problems not with the optimal levels.

So when I'm thinking about some of the demographics of the people that I know who could be candidates, if they're not already using testosterone, they're in lifestyles that are pretty demanding, their, their levels of stress might be high, they might be trying to do all the things. Are there, are there external factors that can impair the success of using testosterone? Are there some things that, that you find also support the success of using testosterone? So if somebody, you know, you've already mentioned nutrition and exercise, but let's say they're still working on their nutrition, they're still exercising, but there's a board meeting or a problem in the company or whatever that goes on or a family issue and their stress goes through the roof. Are there other factors like that that you see really confound the, the results or what, what happens with that?

Well, Carr, you ask such excellent questions. I really, I mean, I have to really give you credit there. I mean, if everybody out there, this, none of this was pre taped or none of, we talk about none of this. But what Excellent, excellent questions. I mean, just superb. All right, let's talk about that. Testosterone is not a panacea. Okay? Once again, we're taking an individual with symptoms of low testosterone and all the bad effects that causes and raising their levels to overcome the symptoms of deficiency that doesn't make us superhuman in any way, shape or form. Now, yes, a lot of people will say, well, Dr. Nichols, you missed several things that people have to have. You mentioned nutrition, exercise and hormones. But yeah, sleep and stress reduction. You're right, we do need sleep and we do need to reduce our stress, but we're not in control of that. We are not in control of that. Most of us are not in control of the amount of stress that we have or how much sleep we get. In a lot of instances, if your wife gets sick, child gets sick, you know, you're, you're not going to get much sleep and it's going to impair your sleep. So. But we are in 100% control of what we eat, whether we exercise or not, and whether we take our hormones. So every year I'll have men and their hormone levels will be just beautiful. And they're, we're eating right and exercising and I'll get a phone call from a couple of these men. Doc, it doesn't work anymore. I feel worse than I did before I started. Like, well, okay, okay, Bill. And so I used to really dive in right away, but I stopped doing that many years ago because I go ahead and get their labs because that's what they really want. All right? Just, you know, these hormones, can somebody sometimes be viewed as going to be an easy button for them? So we'll get those labs and then we'll meet. And in every instance, there's not an instance, this has not occurred. Now, these men were doing great the last time we talked. Levels are beautiful. Now all of a sudden it's just not working at all. And so I'll meet with Bill and Bill, your levels are the same. You know, in fact, Bill, your bit levels are better than they were the last time we talked and you felt great. So Bill, it's not hormones. They don't stop working. People stop working, but hormones don't. And I said, so, Bill, what else is going on? And these are the answers that I've gotten for these men. Doc, I'm going through a divorce, doc, My wife had an affair. Doc, I'm working two jobs and I'm just working myself to the bone. I'm not getting any rest at all. Doc, I lost my job, Doc, Our child, you know, unfortunately got on drugs in his rehab. And you know, doc, my mother in law moved in. She has Alzheimer's. It's just wreaking havoc in the household. So there's always one thing that enters their lives and it's significant stress. Stress is the great equalizer. It will make anybody feel bad no matter what their hormone levels are. So that was great that you brought up stress. Yep. That's the, you know, you. So when men, if you don't get enough sleep, if you have sleep apnea, if you're under tremendous amount of stress, then you're not going to feel as well, no matter how great your hormones are. I think whenever people see doctors, and I don't think it's done enough on social media or wherever else we. I spend as much time explaining what testosterone doesn't do as I do what it does do. Okay. It's not. Once again, it's not a panacea. Men think that they're going to get use these words so called dialed in. You'll never hear me use that word, but they will. That to them means that they just never have a bad day. They always have a great libido, they always feel good, they always want to exercise. They. That's not what testosterone does. Not what it does at all. It once again takes away those symptoms of a deficiency and makes you a normal man that's subject to all the ups and downs of all of us other normal men. That's all that it does. So, yes, it provides us with tremendous health benefits, but it does make us impervious to life and life events and people look at you. Literally look at you. I don't have any stress, doc. Not at all. Well, there's no such person. You know, I mean, I used to say, look, the, the richest man in the world is stressed over losing his money, and then the poorest man in the world is stressed over his next meal. So. And there's all in between. But stress, people always associate. They think stress has to be bad stress.

Yeah.

It does not. For instance, you preparing for a podcast or this stressful. There's. There's stress and you're getting ready for a wedding. Stressful. Just stress is stress. You have young kids, you're married, you got a house to take care of, got a job to go to. You may not think about it, but it's stressful. And that can impact how we feel and function. So, yes, stress is the great equalizer. It's great that you brought it up. So testosterone in general, the summary of all this, it doesn't make us feel great all the time. That's not what it does. Yeah, that's not what it does.

I, I really, I really appreciate that you said that, and especially in the context for men specifically, because men, I'm going to Generalize. Men are doers. They're, you know, there's, there are things to their conquests, there's things to achieve. And their health often gets put into that bucket of I'm achieving my health or I'm achieving my performance or I'm achieving. And I love that you as a physician have asked the question, well, what else is going on? Because we people and men, when asked, they have the answer. And sometimes I think physicians are not taking the moment to go and say, well, what is there for you? What's really going on? And then to be able to give the feedback of reasonable expectations. Because if there's a bunch of band aids being put on, no matter how wonderful the nutrition is or the exercise or the hormone replacement or the whatever, if there are these big life events or these, these other big elephants in the room that aren't being addressed, and it could be a major emotional thing or a major life catastrophe, those aren't being addressed. It doesn't matter how much we do in all those other areas. And that, I love that that message has been, has been addressed there, there.

Yeah. Hormones will not overcome life. They will not. They provide us with health benefits, but they will not overcome life's hardships. They will not.

Exactly. And, and if there was, there was a question that one of my clients asked and it was, it was, what questions must I ask when I'm with a doctor exploring this? So for those out there, the men that are going to approach you, your clinic or whatever, whatever they have access to, what should they be asking for themselves to really, to really support themselves and advocate for, for their best next steps?

Well, sure, I think that, well, we've talked about a couple of those things, but first and foremost, you'd want to know their, their personal experience with the use of hormones themselves. Do they have any personal experience with it? And number two, their, their training, of course. What is their training? How long have they been doing it? And then you want to get in some of the clinic specific questions, you know, hidden fees. We've already talked about labs and one question, especially for men, is that do they use what's called an aromatase inhibitor? Not do they block estradiol? If they do, then that's a clinic you should walk away from. All right, that's a, that's a whole nother topic for another day. But believe me, we don't want to block the beneficial effects of testosterone. That's what happens when you use an aromatase inhibitor. And if a clinic is following evidence based medicine, then they will Never do that. And I think it's important that there's really a. I call them a T meal. There's a testosterone meal on every core corner. Now you can't open up any social media without a mail in testosterone clinic. Don't fall prey to those clinics. If. One way to know if you're dealing with a legitimately good clinic or not is if they have a physician listed on their website. For instance, if you go to a lot of these T meals, there's no physician listed. What they typically do is they go hire some, we call them wounded provider that really just, they're just hired for their medical license and they will just write a prescription for anything. So you're not really getting any close supervision. But I think the most important aspect of any clinic is accessibility. How often can I talk to you? How available are you to answer my questions? And that's the key right there. Now that's where we try to set our clinic apart. I answer every single question every day. I never leave my office with any unanswered questions and I answer them on weekends as well. So they have complete access to me at all times. Now, every clinic doesn't have to be that way. I mean, that's just, I'm OCD about that. But nonetheless, I think accessibility is very important. And of course the training and it doesn't take long to figure out the good from the bad. 70% of the patients I see come from other clinics. You know, that's just, that's just the way it is.

And, and on a personal note, how old are you, if you don't mind me asking. And 58. 58. Amazing. And, and then how long have you been supplementing with, with testosterone? Because I'm imagining you are probably 15 years now. 15 years. And then for you personally, has, has the dosage changed a lot or do you find that you've just been able to maintain and it's been easy to maintain?

Yes, ma'. Am. It should be that easy. It should be that easy. Once again, you do things correctly, the hormones don't stop working. Once again, people will, they'll stop eating right, they'll stop exercising, but. And they'll literally stop their hormones and do it consistently. That's amazing. You know, people always want to get into the latest and greatest fads and that's what they really are. I always tell my patients that, look, do you know how difficult it is to maintain good nutrition, exercise consistently, and do your hormones for the next couple of decades? That is extremely difficult for most people. And most can't do it and won't do it. You know, I see people every week that have been doing great for years and they just get complacent and they're just outright lazy. And they'll admit it. I just got lazy, got complacent. Now I don't feel good. My levels are not good. Well, of course, you've got to continue to put that work in there for it to continue to work. So. But, you know, people do want that easy button. They'll look at all these new, you know, things out there, like whether it be peptides or they just want to get involved. And in so many even, which are research chemicals, most of them now. And what they're looking for is that, that easy button. There is no easy button. There is no easy button. And I tell, I'll tell people, look, you gotta, there's a financial decision to be made too. If you got on another substance that cost, let's just say you got on a peptide, whatever that costs $300 a month. Well, just like testosterone and the other hormones, it's only going to work while you're on. Also you're going to lose the benefits. Same thing with testosterone if you, if you're, you get the benefits while you're on it. So you always have to ask, if I add anything to my foundation of health, am I willing to make that investment for the rest of my life? Because it's only going to work if you do. So I'm not into the, you know, these, there's no, there's no quick fixes. There's no, there's no quick fix.

So there's. So one of the things I'm hearing, we say often that, you know, it's, it can be easy to do and easy not to do. Just as easy to do and just as easy not to do. So when we keep that in mind, then we're not kidding ourselves into trying to make it one way, but it's just as easy to do as it is to not do. And on that note, for an investment, what is a typical investment for someone looking to do hormone replacement therapy? Are they looking at a few hundred dollars a month? Are they looking at $100 a month?

It depends on how they're set up. There are some that, that, that I couldn't afford. I mean, I'll just be honest with. There's some that just charge the exorbitant fees. And then you got your T meals that, you know are, once again, they're a dozen, dime a dozen. So they're not going to be very much, but they're not going to be around very long. Number one, once again, you don't have a real physician. And look, a lot of the younger guys are using it for performance enhancement. They're fine with that. It's not about health for them. I mean it's about just testosterone and performance enhancement. But for 40 and older, middle age and older people, they literally want adequate medical care. But the clinic price structures can be different for different clinics. But of course, but they can range anywhere from, you know, $100 a month to you know, some clinics charge $500 a month. I'm amazed at what they're charging out there and some even more than that with a yearly fee. There's also some of them have this tiered structure to them where for X dollars, for $2,000 you get so many visits and this. And for $4,000 you get, and then for $8,000 you'll get complete access to your doctor. Well, you should have complete access to your doctor no matter what. No matter what. No matter what. So I don't believe in the tiered access either. It just, you know, and you said it so brilliantly, it is, it should be very simple to do, you know, the goal for what we do is to get their hormones very optimal and then they don't have to worry about it anymore if they do it correctly. It's just something that, it's just like putting on your deodorant every day. When you're truly optimal and you really know that things are as good as they can be, then you don't, it doesn't cross your mind again. But so many men out there are stressing over their so called protocol and trying to mix and match this and make it more complicated than it, than it needs to be. Well, you're right. It's as simple as you want to make it and this should be a very simple process. But clinics can be very expensive or you know, down to the T meals that, that are, you know, charging. I don't know what they're charging. Maybe 89amonth, whatever.

So. Well, I love that information and I love just how clear you and your wife are with, with your objectives and your mission overall to provide this optimized health for people that otherwise people aren't, aren't aware of or they don't know how to advocate for themselves. And this is just one way you're allowing people to learn the information, they can make the decisions to empower themselves. And that's what matters to us. So I really, really appreciate how much you've shared. It's been so profound. Your knowledge, your expertise, your experience. This just opens the door for people to feel more confident in being able to make these decisions for themselves. So that's just amazing. And people can reach you in on Instagram at tier one hw. You are on YouTube as well. Tier one health and wellness. Wellness. You're on Facebook. Tier one health and wellness. And we'll put these links into our show notes so people can find you and look you up and reach out to you, all of those things. What would you like to share with people in imparting and just giving them this last bit of information that you wish everyone could know that maybe we haven't shared already or re emphasize something that we have shared?

Well, listen, it's really all about prevention. I was at a conference not that long ago with a cancer specialist up there talking and he pointed out very correctly that cancer, when a person's developed cancer in the 60s and 70s, it didn't start developing last year, even the year before that. It started decades before. 80% of age related disease, for instance, is preventable. The core of what hormone optimization is really about is about that prevention. It's not waiting until you get symptoms of a deficiency or a disease that you could prevent it before you start treating. So really in a perfect world, you could take everyone 40 and above and optimize their hormones because it provides us with tremendous health benefits and prevention against those age related related diseases. And that's the key. Focus on what it's going to do for you long term. A person that starts at age 40 versus a one that didn't. There's a tremendous difference between those that do. And you know, you can look around and look at some 60 and 70 year olds, it's not hard to figure out which ones are on hormones and which ones aren't. That's very easy if you just start taking a, taking a quick look. So the key about any good solid clinic is that they're going to teach you that it's about prevention. They will answer all your questions, even provide you with medical literature if necessary. So key is prevention. Don't wait until you get sick. Don't wait.

I am so grateful that you've shared that message because it's something that I wish more physicians were taking that attitude of prevention instead of treating symptoms. Not treating disease, not prevention, but treating symptoms. So I so appreciate your approach. I think it's, it's fantastic. And we will share this out to as many people as possible so that they can get in touch with you and understand a little bit more about how they can manage themselves from a proactive standpoint, a preventative standpoint, and living in their best lives, living the way that they want to feel. So thank you so much, Keith. It's been such a pleasure. This has been, it's been enlightening as well as fun and interesting because that's the, this is the stuff I love to learn about and I look forward to connecting next time and finding out more about what you're doing anytime.

Looks looking forward to it again too. Thank you so much K. Really appreciate you having me on.

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