21: Breaking New Ground in Men's Health: Oral Testosterone with Shalin Shah

Today, we're diving into an exciting breakthrough in the world of men's health. Kaisertrex, a game changer in testosterone therapy. And I couldn't have a better guest to help us unpack it than Shalin Shah, the CEO of Marius Pharmaceuticals. Shailen has been instrumental in bringing kaisertrex to market, leading the company's strategy and operations with a unique blend of business acumen and healthcare innovation. With a background in investment strategy and operational leadership, he's helped drive clinical advancements and navigate the complex world of pharmaceutical development. His passion, bridging the gap between business and healthcare to create solutions that truly impact lives. Today, we'll talk about why testosterone health matters, what makes kaisertrex different from traditional therapies, and how it's shaping the future of men's wellness. Welcome to Modern Thyroid and Wellness, the podcast that explores the intricate dance between health, wellness and thyroid, unraveling the threads that weave our vitality together. I'm your host, McCall McPherson, and I'm so thrilled to guide you on this journey to optimal wellness. I am so excited for you to be here, Shalin, because I think we are beyond the cusp of very, very exciting things that are happening in the world of testosterone replacement for men, and I'm hoping women soon to follow as well. So thank you so much for being here, talking about Kaiser tracks and just unraveling some of the mystery around testosterone for our listeners.

Absolutely. No, thank you, McCall. I'm happy to be here, really excited to talk to your listeners and, yeah, help share and educate as much as we can. Yeah.

Tell me a little bit about how you ended up in the world of testosterone replacement and Kaisertrex. And obviously, I'm sure it's like a passion point for most men, but I'd love a little bit of your backstory.

Absolutely. The journey has actually been almost 10 years that I've been involved in Kaisertrex and in the testosterone space. It. It was. I mean, frankly, it was by chance in. In. In a lot of ways. So I have an investment background, looks at all sorts of different types of investments. We have spent time in health and wellness before, mainly in the supplement space. Kaisertrex came to us back in 2015, right around the time there was a lot of commotion around the FDA changing testosterone labels and this perceived cardiovascular risk, even though at that time we knew it was bogus. And then, of course, fast forward to today. We have the traverse trial that effectively showed this is safe. Unequivocally, this was around that time the asset was in phase two. The data looked really good, but again, there was a lot of question marks around the space given the. The change in tune from the fda. Historically, being a contrarian and thinking differently, we started to look closely at it. All the research pointed to the positive effects. All our discussions with global experts, not just us experts, but really important to look at folks that have been doing this for a long time in Europe and Australia, we were just scratching our heads and we said, testosterone looks like it is one of the most important molecules in the body. It's touching every organ because there isn't a androgen receptor on every organ in the body. So it did not add up. We really thought, okay, we can disprove this false notion around cardiovascular. And testosterone can sort of resume the growth that it was experiencing through Androgel. Right. So that product had done quite well. I think there was more awareness around testosterone. We just thought we had to fix the course and it would be back on track. Right. And we continued to pull back later. So we, we, we went in, we, we. We formed Marius. We started doing the phase 3 clinical trials, and again, producing some really compelling data. But I think as the journey continued, we pulled back more and more layers of this onion and really saw the effects not just from men feeling fatigue or having issues putting on muscle mass, but the role of testosterone in cognitive health or cardiovascular health, even all the way down to mitochondrial health. Right. I mean, if you want to have this longevity discussion, you frankly can't have it without testosterone or hormones. So it just became more and more compelling. And I think we're finally hitting a point where patients are understanding this and asking questions. And I think that's a great start when they're willing to ask questions and then learn and advocate. I think we're at the beginning of a renaissance for hormone therapy.

Absolutely. And my role at modern thyroid clinic, there's so many parallels between patient advocacy, like patients needing to be empowered and advocate for themselves, between testosterone and thyroid. It's so incredibly similar. Even this idea of, oh, I went to my doctor and my doctor told me, my testosterone's normal, so I don't need it. It's very similar to thyroid. In the realm of the normal level of testosterone goes down to levels of extreme dysfunction. I mean, often I see normal levels of testosterone for men go down to 200, 250. There's not a man on the planet that doesn't have low T symptoms with a testosterone level of 250 or 300. And so it is, it is, it's so important that people are informed and empowered to drive this conversation. That's why, again, I'm so excited to have this conversation today so we can inform and empower other people. I wanted to start by sharing some stats on testosterone and how it impacts people. The prevalence shows about 40% of men over age 45 experience low testosterone. That is enormous. 30% of men aged 40 to 79 have low T. This is all the way down to 200 or 250. In my clinical experience, the people that come to see me generally have thyroid problems. But I would say maybe 5% of men that I see from the age of 25 to 80 have normal levels of testosterone. 95% of them are low or at least minimally, significantly suboptimal. So it is certainly a pervasive issue. And then the second foundational piece I wanted to lay today is low T is so much more than sexual dysfunction. It leads to loss of muscle mass, increased fat. People are 33% higher at risk to develop type 2 diabetes with low T, and 24% increased risk in heart disease, which is the number one killer of men and women in our country. So I think it's an important, invaluable piece to our longevity, our lifespan, our health span. So I at least wanted to lay those foundational pieces before we dig in.

Absolutely. And in terms of these declining levels, what's scary is two, two fold. One, the need for patients to ask their doctors, can I have this test? Or can you run this test? And often be met with skepticism. A doctor might say, why do you need this? Or what do you want to know it for? But again, it's an important health marker. And then even when they do, you talk about these normal ranges, the lab values have come down so much over the years. What was normal 10 years ago or optimal is now moved so far down on the scale. So, like you said, you have folks in the 200s, two 50s. Now, a lot of lab reference ranges are citing them as normal, or even I've seen below that, given some reference ranges, it's a disservice to the patient. Then who's reading these labs thinking everything's okay?

Absolutely. Just to give people some perspective, my goal for my clinical treatment at modern thyroid clinic is ideally for men to be about 800, 900 of testosterone. Bare minimum is 600. So to have a man walking around with a level at 200 telling them they're normal is devastating for their quality of life. I'd love some foundation, a general practice of testosterone replacement before Kaisertrex, like injections they certainly have limitations of a very quick peak trough over the week. People feel good for a couple days and then they crash. Gel, which takes forever to integrate, has its own limitations. Cream, same. Right. I'd love for you to tell us a little bit about Kaiser Tracks, what it is, why it's such a significant development in the world of testosterone replacement. What makes it the game changing treatment that it really is.

Absolutely. So again, oral testosterone or testosterone capsules have, have effectively been a holy grail for development in terms of the pharmaceutical world for 20 plus years. Again, we've known injections have been around and gels have been around, but patients prefer pills. Right. It's just easier to integrate and we know that's when you have the highest levels of adherence. So the development of this was very, very critical. But really what makes this unique, it goes back to our body's physiological state. We produce hormones on a daily basis. When you're sleeping, that's when you have these secretions and you peak in the morning and effectively use them through the day. These other forms, especially injections, which is the dominant therapy 98% of folks are on, like you mentioned, they're kind of over the course of a week. So you have this big spike and then you're crashing later in the week. Whereas in Kaisertrek, since you're dosing this on a daily basis, it effectively is the most closely mimicking your natural circadian rhythm. And I think that's really where the magic starts to happen because your body is using it as it's meant to be used. Right. Testosterone, again, it's actually very different than a lot of, let's call them, quote, unquote, pharmaceutical products where they're sort of manipulating antagonists and so forth, this is replacement. So when the, when the molecule comes into the body, your body knows exactly what to do with, can bind to all of these receptors. By mimicking that daily rhythm, I think we achieve two interesting aspects, both on the safety side and on the efficacy side. But safety, actually I lead with that because we know testosterone has this checkered past. People are concerned about it or think steroids or bodybuilding and whatnot. So I think safety is paramount. If you look at Kaisertrex, one of the big issues you see in testosterone therapy is the elevation of hematocrit, or red blood cells, this blood thickening phenomenon. With Kaisertrax we see a sub 2% incidence rate of elevated hematocrit. To give you some comparison, when you look at literature, again, a number of years as injections have Been around. That rate can, can trend as high as 66% for injections, and that's a massive delta. And, and not only that, I think that's what has caused issues with patients then being adherent to therapy because they, it's a concern for them or they're often going to have to give blood on a, on a fairly regular basis. That can be disruptive to routines. But also providers. Right. If you think about providers, I told you to go and give blood because your hematocrit was running high. Did you actually do it? I don't know. Providers are worried about liability. So if that's gonna have to be my top concern with patients, maybe I don't wanna do this. And that has its own downstream effect. So I think that's a huge safety breakthrough that we're seeing with Kaisertrex. I think the second goes back to what I'm mentioning as it relates to the daily rhythm of the body. We don't see a full suppression of parameters called LH and fsh. So these, these are signals that the, the brain makes to make testosterone effectively in the body. Again, typically on injections, you'll see these go to zero. They'll be totally undetectable in patients. And that drives, again, a lot of downstream effects, including testicular atrophy. With Kaisertrex, given this daily dosing, most likely at night, the body's resuming its endogenous state without any external hormones. The pituitary is still active and sending signals to say, hey, body, we need to get back to work. Our levels are low. Let's produce what we can. Even though it may not be enough for that patient, that signaling process stays intact. So that's a really interesting feature that we're seeing in the real world, which has led us to do even more research. We have a pilot study going on as it relates to fertility and sperm counts in men.

That was my next question.

Right.

I generally don't give testosterone replacement to men who are actively trying to plan a family. So I use things like clomiphene where it doesn't reduce that sperm count. I'm so excited to hear any initial findings we have.

It's a pilot study, so I want to caveat with that. We've had five patients data report through so far, and four out of the five maintained healthy sperm levels. So we saw that. And then also the rebound is a lot quicker. So you're seeing some suppression. Right. Given the daily nature of this, you can actually have a much quicker rebound. Based on the initial data, we're seeing. So we're excited for this study to play out. And again, we cannot advocate for family planning to be on external testosterone, but I think it really can be a step in the right direction. As we look at this issue of testosterone deficiency being more prevalent in the entire age spectrum.

I see low T in men in their 20s and 30s equally as often as I see it in men in their 40s, 50s, 60s. It's been a fascinating data point for me to monitor over the last several.

Years, hoping for that turning point. But I think we're firmly in this trend. So I think that non suppression or less suppression aspect is definitely interesting. And on the safety side, you don't see a significant amount of conversion to estrogen. So this whole concept of you have to be on estrogen blockers on testosterone therapy is effectively out the window. And estrogen is a good hormone for men. Right?

Right.

You don't wanna block it, you don't wanna create more than you need, but you don't wanna block it.

Right. Talk with me about liver toxicity, cardiovascular risk. It's like thyroid, right? It has such a bad rap for cardiovascular risk, prostate cancer, that kind of thing. But at least touch on a few of those and let's educate people and catch them up to date on more recent literature and research.

So on the liver side, this is an old notion with old versions of oral testosterone. We like to use next generation oral testosterone to describe Kaisertrex. It is. Kazotrex is lymphatically absorbed. So that means it's absorbed through your small intestine. And that's the, that's the way it's been formulated, tested and shown to be safe for the liver. In our data, there were no elevated liver enzymes or patients did not have to drop from the trial because of this. So I think it's really good for patients to know because of all the misinformation out there, that you do not have to worry about liver toxicity with this oral medication. And that's a huge positive in this being able to be a widely applicable therapy.

Absolutely.

On the liver side, on the cardiovascular side and the prostate side, I think this is again, Kaiser Trucks does carry a black box for blood pressure warnings. That's because this is a class label that the FDA mandated back in 15 when the studies that came out were so bad that the FDA themselves critically showed all of the flaws. It was actually a citizens petition that they responded to and outlined all of the flaws of these studies. It's a great piece to reference because you can see the history for whatever reason, they're, you know, again, they switched. There was an advisory committee and they slapped these, these warnings on and they asked the industry to do the traverse trial. So just for everyone's knowledge, that was a 5000 patient randomized placebo controlled trial. The, the largest one ever done in the testosterone space. They took men that already had pre existing cardiovascular conditions. These were men that had heart conditions in different ways. Still, at the end of that study, testosterone was shown to not cause an increase in cardiovascular risk.

Wow.

So huge data point back to the FDA as this was published in June of 2023. You would expect the agency to go back and revise the class labels. And that is something Marius is working on. And I have a nonprofit that we started that, the Testosterone Project. We're also working on this because it's again, it's just a tremendous implication to patients and providers for, for science. That is not true. The agency should be based in science. Right. So why have they not come back and done this yet? It's a really big question mark. The same thing goes for prostate cancer. The, the investigators in the trial who had been in the testosterone space for a long time understand this. They also powered it to look at prostate cancer because this has been a big, and it's been a big myth along the whole time. And everybody who's spent enough time understands it does not cause prostate cancer, but this has been then perpetuated. So traverse also looked at this and the same conclusion as the cardiovascular side. There is no increased risk of prostate cancer with testosterone therapy.

It's funny, I, I think sometimes people don't realize that in medicine, it's generational. We pass down myths to the next generation of clinicians from their preceptors, from their chief residents. It propagates for decades before that language, before that mindset will change. Research shows it takes an average of 17 years for new research to show up in everyday clinical practice. That is a, a lifetime of someone's years of thriving. Right. That's like your 30 to 50, some of the best years of your life. 20 to 30, that's a long time to be waiting for medicine to catch up. And so again, that's the importance of having these conversations for people to be able to listen to and, and get informed. In terms of cardiovascular disease, if you have low testosterone, you're at a 24% increased risk of cardiovascular disease. So what does that mean in reverse? It means if we can restore your levels to optimal, likely you're gonna see a reduction in cardiovascular disease risk. It's so great to have access to that more up to date progressive real information.

I think the stats are staggering. Right. And you mentioned low testosterone and cardiovascular risk in that that percentage. And there have been again studies that have looked at mass populations. I'm Talking about even VA studies with 150,000 people looking at all cause mortality. You're looking at cardiovascular risk, bone density or even tau protein accumulation. People. Alzheimer's and dementia are a huge topic today. And you again there's data that shows having testosterone deficiency is, is implicated in increase of these proteins. So again like you're saying by, by function of that and disclaimer these are not indications today and testosterone and Kaiser tract still have to be studied for them. But you can see the relationship and where the research needs to go. So I think we can put behind us a lot of these older myths. Cardiovascular, prostate and then let's focus on where can this be beneficial because we have an amazing tool in the toolbox that has been hampered. It's up to industry, patients, providers and even the FDA to work together to utilize this tool most effectively for you know, public health.

Absolutely. Tell me about who makes the best candidate for kaisertrex.

Good question. So we do see a lot of different avatars for therapy. I think the testosterone naive one rather has been an exceptional one for kaiserrex. And I say that for, for, for two reasons. One is as you mentioned in the beginning there's just, just this huge and increased prevalence of testosterone deficiency. So, so most people never have thought about it or been exposed to it and they are suffering. Those patients are really looking for help and they just don't know anything different even symptomatically. I've talked to a number of patients who thought their symptoms were relatively minor or this is really normal. I'm just again I'm just getting old and then obviously having a test confirm that. But then after being on therapy there the massive difference. Right. From their perceived non symptomatic state. Right.

Yeah.

Everything's okay. To how they should be feeling. It is so wide that, that I think that's why I mentioned the patients that are, that are naive have never started a therapy, have done so well on drugs.

I couldn't agree more. I see that in clinic literally every day, all day. People are like I feel better, I think I'm good. I'm like no you're not good. Like you're not done yet. We have to get everything perfect and then let's see how you feel because people lose touch. It's this slow Breakdown of the integrity of their vitality over time that they don't know what good feels like anymore. And so giving that back to people is such, like, it's such a sacred, special, amazing journey. For sure. It's so cool. But yeah, no, I completely see that every day. I agree. I should have asked you this in the beginning, but I want you to take me through symptoms of low T for men.

Broad in the sense so many men can qualify under symptomatics, but you'll have things like fatigue. This is often. Again, if you think about the way hormones produce throughout the day, it is often afternoon. Right. Your testosterone's peaking in the morning. So actually your low point is in the afternoon. And I think that's again, staying on that for a second. I actually equate this to a stress test. So even though it is recommended that you take a testosterone test in the morning to see where your levels are, I believe that taking it in the afternoon is the best barometer because that's when you're feeling this and not functioning. Same thing. If you look at a stress test, you're not lying on a bed relaxed and measuring how well your heart is doing. You're on that treadmill running as hard as you can for as long as you can. And that's why it's called a stress test. Does your heart perform under those conditions? Are you performing when you need to be performing? It can be any definition of that, but that's when it matters. General fatigue. Often libido comes up because it is an issue for males. That's when they'll actually go to the doctor because something's affecting them that they really don't want it to. And, and, and that's when they'll, they'll show up. But then you'll see an inability to put on muscle, which we know is a longevity organ, an increase in fat mass, bone density, loss, even cognitive function. Going back to research, I think we should, frankly, the NIH should be spending more, way more of their budget looking at this and look at. Understand what's happening to the brain when you have these hormonal deficiencies. These are tremendous public health epidemics that, that again, the research should. Relatively easy to do.

Yeah. And some other things that I see too in clinical practices, like depression, like, I mean, flat mood, sort of this apathy that people become adapted to and they just lose their edge of sorts, Poor exercise recovery, those types of things as well. I did want to read some stats on testosterone replacement. Generally, 70 to 80% of men report improved energy and mood. Within three to six months of TRT they gain an average of 3 to 5 pounds of lean muscle mass and lose 5 to 10 pounds of fat over six to 12 months. Metabolically, that shifts so much. 40 to 60% of men report improved libido and erectile function after starting trt. And again that's general trt. I want you to tell me what are, what are yalls findings on how quickly people start to notice some improvement, Specifically with Kaisertrax, if you have that data.

So we do. Well, we have it in multiple forms. If you look at our trials, we did look at patient reported outcomes and pretty much across the board statistically significant we saw increases in mood or sexual function. General well, being a lot of the symptomat that they're seeing and a lot of the reasons people start trt, we saw very significant improvements in terms of effectiveness or time to effectiveness. We encourage checking testosterone levels after seven days as a minimum. But anecdotally I've had folks that have come to us and said even in the first day they've actually asked their caretaker and said hey, am I supposed to be sleeping better on testosterone? And. And again there's data that shows yes and that patient felt it within 24 hours. Because again, you have this exogenous testosterone coming into your body. Your body knows what to do with it immediately. So there's really not a buildup period that needs to happen. So I think that's been really amazing to hear. Right. Obviously we have to be governed by large data sets and statistical significance. But the anecdotal stories are really the best because you just feel and you get to see patients clinically. So you gotta see this every day. But even from our end we had a long development road and now seeing the effect in patients is really awesome.

I think what's unique about Kaisertrax is it's a shorter acting form. You take it in the morning and then in the late afternoon, similar to thyroid medication. It kind of gets in your system, it integrates, it peaks, it troughs really quickly as compared to like a gel where I expect to see that slowly, slowly increase over weeks. And the feeling of clinical improvement is generally follows that timeline of it's very, very slow increase over time, which is a bit different than Kaisertrex. Is there anything else or you can generally speak to it too. But that's unique about the formulation of Kaisertrex that people should sort of know and understand.

I think a nice to know certainly on the formulation. Again, these development programs were increasingly Complex just to fine tune it. So it is actually going to work across broad patient populations. But in Kaisertrek specifically we use an excipient. They're called phytosterols. So plant sterols, this is a natural substance. They're used mainly in the supplement space or food space. For example Cheerios Heart Healthy claims come from the fact that they add plant sterols and have beneficial effects on the lipid panels. We actually use phytosterols to increase the bioavailability of testosterone and achieve the results we needed with Kaisertrax. This is very unique to the product. A pharmaceutical first and again I think driving a key part of this thing working well across a broad patient range.

Random question that just to follow up with that. Would Kaisertrex be considered bioidentical then if it's a phytosteroid, do you guys know the answer to that?

So we haven't. I, I don't think. And this has been tossed around quite a bit in, in the hormone space. Right. Bioidentical versus I think the synthetics and a lot came from WHI and some of those hormones that were used. So technically I, I wouldn't call Kazotrex bioidentical in that sense. Every. So all hormones are, are made through processes. The way most of our clinicians use Kazotrex when describing to patients is the phrase is it is the most bioidentical because you're mimicking your body's natural circadian rhythm.

Right.

That physiological mimicking drives what we say is from our perspective the most bioidentical bit of it.

How interesting. That's so true. Because it keeps your body in the same rhythm it would be with its natural supply of testosterone.

Exactly.

I love it. So I've heard Kaisertrex has an effect specifically on free testosterone. Can you take me through more information, go deeper on that?

Absolutely. As a primer, you have testosterone and free testosterone. Free testosterone is the testosterone in your body that's actually available to use. The rest of it is bound to proteins that make it unusable. So and, and this ratio is generally 2, 3% of your of your total tea is actually free. And that's really been coming down through the years. As you say these levels across the board have decreased. So has that free T ratio. The numbers are bad, but it's actually even worse when you start looking at the free testosterone levels given that decrease ratio. It's good that everybody understands that. And free testosterone is the one that we should really start checking all the time, because that's telling what your body can use. What we have with Kaiser Tracks is the unique ability to lower that protein that binds to testosterone and makes it unusable. And that protein's called shb, sex hormone binding globulin. So we're able to reduce this by around 30%. And in real world data, we've seen this up to almost 50% reduction of SHBG. What that means for free testosterone is we've seen free testosterone increase from two to five times. Staunton's effect, which is, is really a tremendous outcome for a patient. And this is again where you get into what, what modality works better and what, what are you actually aiming for? So use injections. Right? Obviously you're taking injections to restore levels, but often you're ending up shooting to a, a super physiological high. You get above where you want to be just because you're getting that one injection for the week. So you have a lot of time above average and a lot of time below average. That does help increase the free testosterone by sheer total testosterone. But then again, your, your, your levels that are, are often too high. So that, that's problematic for all the side effect reasons we know here. We can take patients to a normal adequate testosterone level, lower the SHBG significantly and then have a proportionately higher increase in free T. Again, that ratio I mentioned at the beginning of this part is going up. So instead of one and a half percent, you might be at two or two and a half percent, which is what you're really trying to unlock.

I love that. And what's really fascinating to me about Kaisertrex, when I first heard about it, is oftentimes oral hormones like estrogen. For example, if you put a woman on oral estrogen, her sex hormone binding globulin, her SHBG skyrockets, it absolutely increases to wildly unreasonable levels. And instead of oral testosterone following that same process, which is what I would honestly clinically expect, it does 180° opposite, which is so fascinating.

As I mentioned, we are peeling back these onion layers and I love conversations with providers like yourself and strive to have as many as I can. We peeled back that layer and I just said this is really interesting because you have a whole generation of females that have been on birth control with elevated SHBG levels. What are the implications here? I was mind blown when I found that out.

Yeah, me too. And what I think other people should know is when that sex hormone binding globulin skyrockets, it doesn't just impact Your testosterone or your estrogen, it impacts your thyroid, it impacts your progesterone, it has this downstream impact on many of your other hormones and processes. So the ability to effectively influence hormone levels without shifting that is extremely valuable. So thank you so much for clarifying. Tell me a little bit too like people that are listening to this. I know Modern Thyroid Clinic is working on getting Kaisertrex available to our patients, but tell me how people can generally get access to Kaiser tracks if it's covered by insurance, kind of the pricing points if possible. For anyone listening, women or who might want to talk with their husbands about this, how could they take next steps to get access to this life changing treatment?

Absolutely. Just again as a preface, what we did when we launched Kaisertrex as, as a drug and this is, this is probably a whole separate podcast in itself. We, we are really focused on increasing health access. We knew this is game changing but we saw how the typical pharmaceutical system works, how insurance works in terms of pre authorizations or the forcing of genetic generic step throughs and so forth. We didn't want to be a part of that. We said this needs to be in the hands of patients and providers and have access. So we decided to make kaisertrex a cash product. We said we're not gonna go through insurance because then nobody's gonna get it. We tried to make it as affordable as possible so as many people as possible can get it. The way it works is through clinics like Modern Thyroid, Other wellness concierge, even your regular prescriber can have access to Kaisertrex. Just because it's not covered by insurance doesn't mean that regular traditional providers that you go see for your annual physicals or your endocrinologist or your urologist can't, they do get it and are already prescribing it. Kaisertrex is used in major hospital systems like ucla, Sloan Kettering, Cleveland Clinic. So we've been very good about making sure that this is a broad access thing. So again, I think talk to your provider. There's a lot of information on our website on kaisertrex.com you can find a provider. We're working with a whole spectrum of folks that understand hormone therapy. And so, so hopefully yours today, you know, already does. We are working with a number of telehealth companies. So again they're also on kazotrux.com if you don't, you know, again our goal is access and unfortunately with the healthcare system today, you know, doctors just don't, or providers just don't have the time to, to go through this. So this is a typical problem. You go to your primary care, they may not want to deal with testosterone therapy. They send you a referral to your specialist, maybe an endocrinologist that has a three, four month wait time and, and then they, again, it's a 50, 50 chance that they're going to be clued in. That patient just gets bounced around and loses hope. I think with the right guardrails, there's a role for telemedicine in today's world. It's better than ever. Patients can get their own labs done and take them to providers. We've tried to put this in front of all the right places that practice medicine well so patients can access it and typical, sorry, typical price points. We, we generally see anywhere from, you know, 200, 250 bucks a month is, is where we're, we're seeing kind of average.

Yeah, I love it. That is such a foundational piece to longevity, health span and lifespan. It's an investment in your health, your cardiovascular health, your bone density, your mental health, your relationships. And I think I'm, I'm encouraged because I think people are finally ready and willing to invest in their health. Not just fixing band aiding acute medical issues, but actually being well. And I think Kaiser tracks can be a huge part of that movement. So thank you so much for the work that you all do. I am so excited to use this product myself with my patients. I'm so excited that maybe that'll happen in the future because, gosh, we need it so badly.

Would love to come back in six to eight months and talk about it.

It's, let's get it on the books. Thank you so much. It was absolutely insightful having you here today.

Thanks for having me.