November 25, 2025 • 52 mins
In part two of The Male Room’s deep dive on low testosterone, Dr. Jesse Mills and Jordan shift from diagnosis to what everyone really wants to know: treatment. Dr. Mills walks through the major options — gels, pills, injections, and long-acting pellets — breaking down how they work, who they’re best for, and how to choose a provider who’s not just pushing the product of choice. He explains when testosterone therapy truly makes sense, what happens if you over-treat, how and why it can act as male birth control, and the safest ways to come off therapy if you want to start a family or reboot your natural production. Along the way, he busts some of the biggest myths around “T boosters” and “roid rage,” and lays out the lifestyle levers — sleep, exercise, weight loss — that can raise levels naturally. It’s an empowering, no-BS guide designed to help guys ask smarter questions, avoid bad clinics, and use testosterone as one tool (and not a magic fix) in taking control of their health.
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Episode Transcript
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Speaker 1 (00:00):
Let's talk about it. Let's talk about a ma hero.
Let's talk about it. Let's talk about the man hero.
Speaker 2 (00:17):
Welcome to the man, Hey, welcome back to the mail room.
Jordan's great to see you again. We had such a
good time building a foundation for not only what we're
going to talk about with testosterone, but also just what
we're going to talk about with life. So so cool
to be back and getting into this again. I think
once you build that foundation of what is low testosterone,
(00:40):
then obviously it naturally follows into what are we gonna
do about it? Or should we do anything about it?
And I'm really looking forward to talking with you today
about just as a guy that would walk into a
doctor and talk about therapy. What are your questions, what
are your concerns, what are your thoughts about should I
be on testostro? What are the downside? What are the
risks to it? That's that's really what we're going to
(01:03):
focus the next half hour or so on is to
is to give a guy a tool so that he
knows a what to ask for b when to ask
for it, and see when to say okay, I'm good,
like I'm done. Man, I don't I don't want this anymore.
I don't need this anymore. Turn my life around. Thanks brother.
Let me get out back into the gym, or get
(01:23):
back into eating a salad and getting on with my life.
Speaker 3 (01:28):
Yeah, doctor Bill's I'm really excited to talk to you
about this. I've come armed with some questions, questions and
questions for me.
Speaker 2 (01:35):
Letter rip. I love it. Yeah, this is what it's
all about. It's a it's a pretty cool informal way
to just get some good formal science. We had a
good talk about what testosterone deficiency is, testosterone or hypogonatism
or however you want to categorize it. And I think
this should naturally follow to then how do I treat
(01:57):
it if I'm a physician and you're a patient. And
also I think what I want to do is empower
audience with how to select a provider to treat you
if you have low testosterone. So I'll sidebar for a
bit and just kind of think about how guys engage
in the healthcare system. So somebody has some of those
symptoms we were talking about, if they're libidos down, they're
(02:17):
not waking up with erections anymore, they're gaining weight around
the mid section, they just don't have that jois de
vive that they used to have. Then a lot of times,
you know, the traditional thought would be they'll go to
their primary care physician and maybe the primary care doc
makes the diagnosis is, well, hey Jim, your problem here
(02:38):
is your testosterone is low, and the primary care doc
may treat that, or I say, you know, I think
this is a nuanced approach. I'm going to send you
off to a specialist. And actually I think the big
thing is who you see will actually determine what kind
of therapy that you're going to get. And what I
want to challenge the audience with is that the right
(03:01):
therapy for you or is it the therapy that the
person that's writing your prescription has to offer you. And
some of this is if you don't go to a specialist,
they may only know a couple of things how to
treat this. Or if you go to a clinic that
purely sells testosterone, you know, whether it's in a gel
(03:22):
form or whether it's in an injection, then I guarantee
that that's how you're going to get it delivered. So
I want to arm our audience with the different therapies
out there and then I want them to choose what
their values are or what their situations are, and that's
kind of how we're going to we're going to shape this. So,
for example, testosterone therapy, as we talked about the last time,
(03:43):
is it's been around in some form or another for
over one hundred years, since we were grinding up guinea
pigballs and injecting them into veins and different injections and
the real synthesis of testosterone. What happened in the nineteen
thirties was the first time we actually had a pure
form and injections led the way. Since that time, there
(04:04):
have been everything from a pill that you can take,
to a patch that you can put on that absorbs
over time, to a gel that you put on, and
the gels or anything from on the top of your
thigh to your shoulders to under your arm. There's so
many different places that we can apply a cream or
a gel to absorb testosterone into the body. And then
(04:26):
there are injections that last day where from a week
to three months. And then lastly, there is a pellet
something that your doctor will implant, usually in your flank
or your backside, and the pellet dissolves over about a
three to four month period. So let's break it down,
because I think this is where guys will jump in
and say, oh, that makes sense to me. I can
(04:47):
put on a cream every day or ease. I already
know how to take pills, and we'll go to the
pros and cons of all of that. So let's start easy.
I think pills is a great place to start so
far making sense to Jordan. If you were in my
and I'm offering you different modalities or what's on your mind?
Just with that preamble, I.
Speaker 3 (05:07):
Mean, I guess my broader question is when is testosterone
therapy the right move and when isn't it? Is there
a risk of overtreating, like giving testosterone to someone who
doesn't really need it.
Speaker 2 (05:17):
The easy answer is that if you go and get
your blood levels drawn and there below a certain level,
which most guidelines and organizations say somewhere under three hundred
and fifty n yanagrams per desto leader for a total testosterone.
Some labs will also check a free testosterone, which I
think is important for men that are on the borderline.
(05:40):
So in other words, there's a couple of different ways
the body sees testosterone when it's in the bloodstream and
therefore a couple of ways that a lab will test testosterone.
The total is what we base all of our guidelines on,
and so I think it's probably easier for the scope
of our discussion to focus in on that and then
new on out to what free testosterone means and how
(06:03):
that can be effective. So if a guy has symptoms
of low testosterone meaning libidos down, corr erections, loss of
mood or unstable mood, frank depression, or muscle mass weight gain,
those are kind of the heavy hitters that would drive
somebody into the office. If he has symptoms of low
(06:23):
testosterone and his levels are below three hundred and fifty
or even three hundred to be stricter, then he would
benefit from testosterone therapy. What I just said there, I
didn't make up. That actually comes from the two big
professional society guidelines in ourt in the United States, which
is the undergrad Society and the American Eurologic Society, which
(06:46):
is what I'm a member of. And so that's it.
So who would benefit is if you're symptomatic and your
T levels are low below those thresholds, you would probably
benefit from therapy. That's the first part of your question,
second part is well, is there a risk of overtreatment?
Then what are the risks of that? And the answer is,
(07:06):
I don't really know. I think testosterone therapy in this
country has taken on this giant, multi headed beast of
where people are seeking it to optimize their health, thinking
that it's a cure in a longevity spectrum. And we
(07:27):
have some data dating back years that men that have
normal or good testosterone levels well into their sixties and
seventies do have longer longevity. But there is no paper
ever nor will there probably ever be that shows that
initiating testosterone therapy is going to cause a guy to
have a longer life. And the difference between that is
(07:49):
that we think that testosterone acts as a biomarker of
overall health. In other words, the extreme example is if somebody, normal, healthy,
twenty five to thirty year old guy gets in a
horrible accident trauma of some kind, motorcycle wreck, burn, whatever,
and he's in the intensive care unit. It doesn't take long.
(08:10):
We did these studies fifty years ago. A couple of
days before at his testosterone levels will plummet, and so
we know that the body has to be healthy. All
systems have to be firing for the body to make testosterone,
and so therefore, if a guy is kind of not
the healthiest and has a lot of bad lifestyle habits
and he's in his forties fifties, then the risk of
(08:33):
testosterone deficiency goes way up. And then it makes sense
then that what we're seeing is not necessarily something intrinsic
with test osma. What we're seeing is that this guy
isn't healthy in the testosterone is a biomarker of that
lack of health, which means that if I took that
same guy and didn't talk about reversing any of the
lifestyle habits smoking or obesity or diabetes, things that can
(08:57):
be controlled through change in life style, and I just
gave him buckets a testosterone, I would not expect to
see him when he's one hundred years old. In other words,
testosterone alone, by me giving that guy therapy is not
going to necessarily cause him a longer life. So that
becomes a difficult question to answer in terms of if
(09:18):
we're treating testosterone to improve somebody's longevity, we don't have
those data, so therefore we may be overtreating. But I
would argue, as I have many times in the past
in many forums, that the risk of overtreating testosterone is
not that extreme. In other words, if I give a
guy way too much testosterone, he's not going to drop
(09:38):
deut of a heart attack. He's not going to die
of prostate cancer. The worst things that happen when we
overtreat somebody that doesn't benefit is that we completely take
away this guy's ability to make his own testosterone while
he's on therapy. So to give you an example, just
real life example. This is a conversation I have multiple
(09:59):
times a week in my clinic. Is a guy comes
into me and says, Mills, I heard this podcast about guys.
They're all on TI your te they look jacked, they're
having great sex, their lives are fantastic. Test my testosterone.
I test it. It comes back at six hundred. That's great,
that's really well within the normal range. And I say, okay, cool,
So your tea is already really healthy. If I put
(10:20):
you on testosterone, what I'm going to do is I'm
going to take your normal production and take it almost
to zero. And then I've got to overcompensate for giving
you enough testosterone to get back to where you already
are naturally and put you up to that next level
and then we'll see if it works. And we don't know.
In fact, a lot of times when guys teas are
(10:43):
in that six hundred range and they feel fine and
they're trying to optimize, I'm actually doing them a pretty
big disservice. There's a quick, little interesting thought of behind this,
and this is some research that a lot of people
are doing. We don't have a great commercial available test
for this, but we know that all men metabolized testosterone differently,
(11:04):
and we talk a little bit about the range of normal,
and that range between three hundred and one thousand. Just
say is because you take one hundred blood tests from
one hundred guys that all have that feel great, they
have no symptoms of low testosterone, and the directions are
good and all the check all the boxes, and that's
where that range is. So the guys on the low
(11:24):
end that feel amazing, they're three hundred. The guys on
the high end that feel amazing are a thousand. But
essentially everybody feels fine in that range. So that means
you've got this huge range for where you fit in.
But we don't know in an individual person unless we
check their testosterone at eighteen when they were perfect and
(11:46):
know that, or twenty or thirty and we know that
their testosterone was at three hundred. That would be great knowledge,
right because then I could say, when he comes to
me and his testosterone is three hundred and he feels fine,
he's good. But what if that same guy comes to
me when he was eighteen and twenty five years old
and his testosterone was seven hundred, and he comes to
me and I tested, and he feels terrible and his
(12:07):
t is three p fifty. That's a guy I probably
need to pull back up into that seven to fifty range.
And we don't know who those guys are. We do
know there is something called the antrogen receptor threshold where
testosterone is metabolized by the cells and by the organs
that testosterone fuels from your brain to your penis to
your testicles. It's governed by how many and trien receptors
(12:33):
that person has and how many of them have testosterone
molecules attached. And that's the science behind it. In other words,
if we had a commercially available test where a guy
would come to me and say, Mills, I feel terrible.
I'm not getting up in the morning of directions all
the stuff that you taught me, and my testosterone is
five hundred, shouldn't I get testosterone therapy? What if I
(12:53):
was at a thousand when I was twenty five, and
I'm in your office at fifty and I feel like stink,
and I said, well, great, yeah, I'm going to do
another blood test where I test your angigen receptor levels
and see and maybe your angigen receptor level test comes
back and it's a thousand and you're at five hundred,
then you're only fifty percent of the way you need
to be. That's a guy that I'd want to get
up to a thousand and see how he does. So
(13:16):
that would not be over treatment. Even though his testosterone
levels fall within a normal range, his levels are to
him intrinsically low. That's the silver bullet. That would be
the magic cure to knowing who would benefit from therapy
that falls within the normal range. So, in other words,
a guy comes into my office, it's a two minute discussion.
(13:38):
If he comes in with a testosterone of two hundred,
he's profoundly symptomatic. I know I can help that person.
I know because his numbers are low. But the guy
that comes in with a testosterone of four hundred and
it feels terrible, that's a much longer conversation. And that's
also where I have to put on my country doctor
white coat and say, let's treat the patient and let's
(13:58):
not treat the blood test And I think that's really
the critical part of testosterone therapy. So, boy, that was
a hell of a sidebar you put me on there,
But I think that was a great way to clarify.
What we're trying to deal with is not a condition
like diabetes, where if the blood sugar is too low
or too high somebody dies. With testosterone, we have to
(14:20):
figure out how to nuance it a bit more.
Speaker 3 (14:53):
And you're saying there are three ways to treat this generally,
do you have a preferred method.
Speaker 2 (15:00):
Whatever the guy wants? And so I think this is
so key because I tell everybody that walks on my clinic. Look,
I'm a professor at a major academic medical center. I
don't make any money different whether I write you a
prescription or I give you a shot or anything else.
I'm the guy that should be treating your testosterone. In
other words, you want to go to a physician or
(15:22):
a health care provider that is modality agnostic. In other words,
that they're not going to say, hey, I got a
trunk full of testosterone that I need to offload, so
we're going to do this for you. We're going to
do shots, or we're going to do pills, or we're
gonna do injections. So that's why I think that's number
one is choose the right physician. And if somebody comes,
if you go into an office and they tell you
(15:44):
here's exactly what you need, then that's what you have
to be a little concerned about. And I think again,
it doesn't mean it's the wrong therapy if you look
at my practice, which I look at a lot in
terms of what I book guys on. Interestingly enough to
mark leader for testosterone replacement right now remains a jail.
(16:05):
It's a transdermal jail. It's been on the market since
the late nineties early two thousands, and the reason for
that is not because it's better than any other thing.
It's because if a guy is coming through a normal
healthcare system, then he probably has insurance. He's going to
get whatever's on the formulary, and so most of the
people that I see in my clinic, they are going
(16:26):
to say, well, hey, Doc, can I get insurance to
pay for it? And say, of course you can. Your
testosterone is low, you're symptomatic on the rite your prescription,
we'll get the authorization, and you're going to have to
start with his jail. Now, not everybody that starts in
jail stays on jail. And for me, my biggest red
flags or things that I'm concerned about starting somebody on
jail is the risk of transference. And it transference is
(16:47):
when you're putting on an active product, whether it goes
under your arm or on your shoulders or on your thighs,
if you rub that body part against somebody, a spouse,
a kid, somebody that you really don't want to be
transmitting TESTOSTERONETO within a certain time period, usually within an
hour or so putting it on, you could rub testofsterone
(17:11):
gel off on that person. So that would be bad,
right if you had a young kid and a lot
of the gels. The most common gel is something you
put up on the shoulders. Then you know, you just
put it on and the kids crying. You're like, oh,
I've got to go change a diaper and then you
take the kid, you put them on your shoulder to
get ready to put them on the basinette to change
(17:31):
the diaper. Then you potentially have just transferred testosterone over
to that person, and that's been reported. So I do
worry about starting my young dad's on testosterone. That is
a transderambal. That's the plus in mind. It's a nice
thing about it is it's very easy to do. You
have to put it on every day, so it becomes
a part of the routine. So I tell somebody, you know,
(17:51):
maybe put it on after you shower in the morning
and you're shaving, or you're taking care of your hair,
whatever you're doing, put it on. It drives in two minutes.
You throw a t sh on and you go and
you're good, and after about two hours it's fully absorbed.
So you can jump in a pool, you can shower,
you can go to the gym, whatever. But during that
two hour window you have to be really careful that
you're not transmitting it to anybody else. That's the market
(18:13):
leader for better or worse. Pills have been around forever.
Jordan and pills have an interesting history. In the early
pill form of testosterone what happens you took the pill,
it would go into the liver, which is how all medications,
anything that you adjest through your mouth, it goes through
the liver and what we call in pharmacology the first
(18:34):
pass effect, meaning that the liver sees it before the
rest of the body sees it. The liver what it
does is it processes all the nutrients and all the
toxins and decides where to put it, whether into the
bloodstream or into the gut and into the stool. Eventually,
that's what the liver does. And so the early forms
of testosterone pills actually had a negative effect on livers.
(18:56):
It caused tumors of the liver, some of them even cancerous,
and so the FDA stopped approving pills years ago, decades ago.
They're still available in some other countries, but that gave
the oral form of testosterone really bad name. Now fast
forward to oh within the last five or eight years,
there has been a pretty clever way that we can
(19:18):
take testosterone pills and bypass what we call that liver
or first pass effect, and that's by attaching the testosterone
molecule to a molecule of fat that then the liver
it's too big for the liver to see it and
break it down into all of the different components and
get into the bloodstream, So it goes into the lymphatic channels,
(19:38):
and the lymphatic channels go all over the body, and
the lymphatic will then release it back into the bloodstream.
So you get a nice stained release from these new
lymphatically clear testosterone pills. So that's great. So that way
you have really zero concern about doing any liver damage
and the levels get pretty good. They're very comparable to
(19:58):
what you get from the gels. The downside to pills
is you have to take him twice a day, sometimes
even more, and you have to just the dosing to
get to the point where a guy feels good and
his blood levels are reflected that he's had in a
good therapy state. Second thing is especially true in Santa
Monica where everybody's wayfy thin that you have to take
(20:19):
you with a little bit of fat, and so if
a guy's on an intermittent fasting diet and he doesn't
start eating until four o'clock in the afternoon, your body
won't absorb that because there's no fat in your gut
to get into the lymphatic channels and actually get the
molecules started to be effective. So you have to have
a little bit of fat, not much, even a little
bit of cream in your coffee, little cream cheese on
(20:40):
a pagel something like that is enough. But ultimately there
are some guys that absolutely won't take the pill because
that's just not how they eat. So that's kind of
the downside to it. But otherwise very well tolerated. They're easy.
I've never seen levels go really really high in guys
and pills, and people feel pretty good. And there's about
three different companies that have a pill that's on the
(21:03):
market that is FDA approved, so that's you know, that's
another perfectly good way. In my practice, I do not
have a large percentage of guys on pills, partially because
it's hard to get authorized. There is a pill that
is that is a cash only model, so for about
one hundred and sixty five bucks or so a month,
if a guy is willing to pay that, then that's
a great system for getting good testosterone levels without really
(21:26):
any risk and not worrying about transference from jails or
the discomfort of injections. The wheelhouse, I would say of
my clinic, the number of guys that I see, especially
just because a lot of guys see me once they've
been to other clinicians and didn't get a good response
to testosteron or the person didn't feel comfortable treating them.
(21:46):
Is going to be either injections or the long acting pellets.
And the injections are great because they last about a week.
I can really predict where guy's levels are going to be,
and I can infinitely djust the dosing just by teaching
them how much to drop per injection. So that is
(22:08):
my guys that are super motivated. They don't have a
problem giving themselves a shot at home. They're also incredibly inexpensive.
I can send them to any pharmacy or any mail
order pharmacy and really get therapy for fifty bucks or
less a week, So even if they're paying cash, I
can find injections that are very cost effective for guys
if they don't have insurance coverage. And that leads me
(22:30):
I think to the pellets, which gosh, the pellets have
been around boo pushing fifty years, believe it or not.
But they come in two flavors. One is a compounded
pellet where you go through a compounding pharmacy and you
find a provider that inserts compounded pellets, and the advantage
to those is they tend to be very cost effective,
(22:52):
and the nice thing is that they last from the
insertion of the pellet. They last about three or four
months before you have to go back in for another procedure.
The other pellet is the only FDA proof pellet, so
I will say it by name because there is only one.
It's called Testa pel and it's been in production again
for decades, and the advantage of that is that it
(23:13):
is FDA proof, so you know that you're getting high
scrutiny of the lab. You're getting a pure product, and
most of the time insurance covers it. So that's the
downside is that if you're paying cash foroard, it's very
it's very expensive because it is a pharmaceutical. But most
of the time we're able to get insurance coverage for it.
And so for my guys that travel, I'm in a
(23:34):
city where people travel all over the place. Sometimes you
know they're going on set if they're a camera guy
or anything in the film industry, where they're going to
be in Hungary or Atlanta, or Turkey filming for three
months at a time. Those pellets are great. They don't
have to travel with any needles. They have to travel
with a couple of gallons with a testosterone gel or
(23:54):
bottles and bottles full of pills. They just come into
my office a couple of days before they head to
Laux and fly off to parts unknown, and they're in
great They're in great shape for three, sometimes even four
months in between the pellets, So that tends to be
a really a really popular form of testostering placement in
my practice.
Speaker 3 (24:14):
What is the process like of coming off a testosterone treatment?
Speaker 2 (24:18):
Why would you want to That's the question. Now I
sound like a cheerleader. I think the truth is that
most of the reason that guys discontinue testosterone one is
that it is a great form of male birth control.
So if I see a guy that is on testosterone
and wants to initiate a family or maybe have more
kids if he's in between, then we have to get
(24:41):
those guys off testosterone in order for sperm production to
pick up again. So let's talk about that first, because
that requires its own special treatment, and that is we
have to reverse the effect of testosterone that is prescribed
so ejected or swallow or gelled to on the pituitary gland.
(25:03):
So what happens if I put a guy on testosterone
therapy of any kind, his petutary gland will shut down
not only testostrum production, but sperm production. That's that's the
way it works. And so I've got to figure out
how to how to put jumper cables on the pituitary
gland and get it up and working again. And thankfully
there's a couple of different ways to do Weather's three,
(25:25):
and none of them, I should say, is FDA proved.
One of them is O natural, so therefore FDA agnostic.
In other words, I just say stop your tea and
come off it and give it a few months and
things will probably come back online. So that's not the
preferred method for me or my patients because they're not
(25:45):
going to be very happy. I mean, when guys come
off testosterone, especially if they're well into that normal range
and we start them on therapy for some compelling clinical reason,
then they're going to have to start making really high
numbers from zero to get back up to feeling well.
So what happens, So what's the withdrawal of testosterone look like, well,
(26:06):
it doesn't take long for testosterone to get out of
the system. So in other words, if it's an injection
and you miss a shot, after a week or two,
you're going to be well under the normal level. If
it's a pill, it'll happen after a day or two,
same thing with the gel. If it's those pellets, then
obviously it takes much longer because they last so long.
(26:28):
But eventually everybody hits bottom, and that bottom will look
like they might get some night sweats, feeling kind of hot,
cold intolerance, definitely, some grumpiness, probably loss of morning erections
that they were doing so well on for a while,
Definitely loss a libido, maybe even some weight gain if
they don't turn around very quickly. And on a global
(26:52):
physiologic health level, bone density will go down, their muscle
mass will go down, and all of these things take
a little while to read, and so those are serious deals.
And that's why I think your question at the beginning
of our chat today was very important, is that that
would be a real bummer if I took a normal
guy and overtreated him and he just said, I'm done,
(27:15):
I'm quitting for whatever reason, he's going to feel crappy
for quite some time, you know, maybe a couple months,
three months even, and he may even have actually some
medical concerning things happened to him during that time period.
So that's the cold Turkey method. I don't recommend it,
there's no need for it. There are different ways to
reboot that pituitary plant, and the two most popular are
(27:38):
a injection which is called hCG or human choreonic gonadotropin,
and it's been around again for decades, and what that
is is essentially a maternal testosterone. So anybody that has
ever been involved in a pregnancy and they do a
pregnancy test or they go to the hospital or the
(27:59):
lab and get a blood draw, that's what we're measuring
is hCG levels. And what happens is that when a
male fetus is developing, mom secretes hCG, which which the
male's body and testicles will recognize as testosterone. That allows
for testicular development and penis development everything. That's sort of
(28:21):
the beginning of differentiation of male into female phenotype or
body type in utero. So we've known about this for decades,
and so when we take somebody that's on testosterone. We
put them on hCG injections. What we're essentially doing is
we're inducing puberty again in these guys, and it's kind
(28:45):
of cool because they feel better almost instantly. So if
the testosterone is zero for whatever reason, whether it's from trauma,
from surgery, or from going off testosterone therapy, as your
question was saying, then we naturally stimulate their testicles to
make testosterone based on this molecule of hCG. It is
(29:06):
a peptide, and so your body will start to synthesize
testosterone based on that interaction from that molecule. So that's
pretty cool, and that works well, and it works within
a few months to actually get sperm production back online.
But testosterone levels go up almost immediately, so guys don't
feel quite so horrible as they're recovering natural function. And eventually,
(29:29):
if the goal is to get them to be not
on anything, we start to back off on the hCG
and see where their numbers really return to. The second
that is even more used because A it's cheaper, b
it's easier because it's a pill, is to take something
called chlomofin, and clobofin's a really fascinating molecule. We use
(29:50):
it in women all the time as a fertility drug,
and I use it in my mail patients to stimulate
sperm production. But that also works on the pituitary gland
to tell the petuitary gland to make more testosterone and sperm,
and it does so through this crazy molecular pathway called
selective estrogen receptor modulation. Many people have heard the term SERMs,
(30:14):
and that's what chlmaphin is. It's one of the early SERMs.
And the best way I can explain is that it
gas lights the peituitary gland. So what it does is basically,
you take this clmaphin and the petuitary gland thinks, oh man,
I'm not doing my job. I got to make more
LH and FSH, which is the only hormones that the
testicle recognizes to help me make more testosterone sperm. And
(30:38):
so basically, by blocking the estrogen receptor at that level,
the signaling to the testicle shoots way up, and that's
another great way to restart testosterone production naturally, and as
a side effect, it also restarts sperm production. Actually it
takes longer. Guys don't feel quite as good on it
for the most part. For some new wants to reasons
(31:00):
and hypothetical reasons and in terms of what estrogen does
in a mail, but for the most part, it's a
very effective way of restarting therapy. And I do something
called the Clomid challenge. Clomid is the old brand name
for this, but the Klonaphin challenge is to put them
on therapy. Usually after about three months, I stop it
and I see what happens, and if their numbers recover,
(31:23):
their pituitary gland wakes up and it's starting to produce
good levels at LH and FSH, then I hope that
their testicles start to produce higher levels of testosterone and
sperm production goes up, and everybody's back to where they
wear no harm, no foul after this sojourn on the
testosterone train. So that is why testosterone therapy. There's a
(31:44):
bit of a myth that I hear all the time.
It's not irreversible. So in other words, if I start
a guy in tea, a lot of guys say, Doc,
I don't want to do this, because you know what,
if I don't ever make it again, and I'm gonna
have to be on testosterone the rest of my life.
And I think I agree with you because I don't
have it in his hunt other than taking care of
you and making you better since I'm not profiting off
(32:05):
of your testoster and prescriptions. That makes me so happy.
If I can see a guy that, say, has a
low testosterone, but maybe is really overweight, or not exercising,
or not sleeping well in all of the classic eat
moose sleep paradigm of how to take care of yourself,
if he's failing in those and I can get him
on testosterone long enough that I can reverse that so
(32:28):
that then he actually is doing it on his own,
that's the best day in clinic ever, because what I've
done is I've empowered a guy through coaching on a
little bit of pharmaceutical intervention so that we can actually
eventually stop therapy. And that's a total win in the office.
Speaker 3 (33:06):
Speaking of myths about this that you're busting, here's another one.
It's a rookie question, but there's something I've wondered about,
and maybe listeners are too, and maybe people when they
come into your clinic ask you the same questions. Is
there a a psychological I guess I should say, negative
psychological impact of taking tesosterone treatment. I guess I'm thinking
about like essentially roid rage, oh something like that.
Speaker 2 (33:29):
Yeah, yeah, so bulking out right. So it's interesting, you know,
I say this a lot, and I've done some expert
witness work in the field too, but roid rage is
actually a legal diagnosis. It's not a medical diagnosis. So
in other words, like there's no level of testosterone that's
going to turn the guy into Lufarigno Circus at nineteen
(33:50):
eighty one or whatever. I was growing up watching an
incredible hope it it just doesn't happen. But the reason
that myth started really is because a lot of the
anabolic steroid rage that was going on in the eighties.
A lot of those guys, there's a couple of landmark
key cases of bodybuilders, professionals, wrestlers doing incredibly horrific things,
(34:13):
including murdering their families to get really dark, really fast.
Those guys were all on like crazy doses of cocaine
as well, and so like was it the coke, you know,
was it the Colombian marching powder or was it just
good old fashioned testoster? And so if you lay off
the blow, then you're probably not going to get roid rage,
(34:33):
but you do definitely have mood instability if you're not
doing testosterone therapy. Well, so, in other words, if a
guy is on super high doses and then he comes
off that grumpiness, yeah, I can see how it. Definitely
ment are much more irritable when their te levels are low,
but not so much when they're really high. It certainly
changed a little bit of our behavior, our prefrontal cortex,
(34:56):
which is where things like the libido come in and
decision making. So guys that are on testosterone tend to
be better, quicker decision makers. They get rid of that
brain fog, and so all of that is certainly part
of the psychological aspect of testosterone replacement is that a
lot of guys will say, I just don't feel like me,
(35:16):
or I've got this brain fog, I'm not thinking quite
as clearly. And I will tell you the reason urologists
know this really well is because one of the treatments
for guys that have advanced prostate cancer is to take
away all their testospel. We put them on pills and
injections that will take their T levels to zero because
(35:37):
that helps the prostate cancer or that stops the prostate
cancer from getting worse or growing. Is especially for combining
it with something like radiation therapy. And if you look
at those guys that have to be on temporary testosterone
ablation where they just you know, they get their teeth
thrown down to zero. They feel horrible when they're on
this therapy, but then thankfully, a lot of times after
(35:59):
six months to two years, depending on the treatment protocols,
they're able to come back off of the androgen blockers
or the testosterone of blaters, and man, they feel great.
And they were like, I don't know exactly what it was,
but I just felt like I couldn't quite even finished
sentences or thoughts in my mind was wandering. I was
so grumpy. I just didn't want to be around myself.
(36:21):
And so that's the extreme example. And those are great
people to learn from because you know, then when you
normalize their testosterone, either just through mother nature and they're
coming off that therapy, or we actually start them on
testosterone after their treatment, man, those guys are grateful and
all we're trying to do is get them back up
into a nice normal range. And so so yeah, I
(36:44):
would love to pretty well kill the roid rage. Myth
if we can today stops stops here at Jordan, stops
right now, stops right now. Roid rage is not real.
I can only imagine the people that are roll their
eyes at me and yelling at me right now. But
I just haven't seen it, you know. I think obviously,
(37:05):
if you do really good evidence based therapy, monitor your
guys really closely to make sure they're in a good range,
then I think that's the key and the same. So
if you're if you're the patient listening to this, then yeah,
you want to go to somebody that's keeping a close
eye on your levels and making sure they're right in
that wheelhouse of a good range.
Speaker 3 (37:25):
So those are all incredibly effective treatments for treating people
whose numbers are definitively low. I'm sure or I shouldn't
assume this, but I would imagine that there are edge
cases where you would give people a certain window of
trying to make certain lifestyle changes. What are some of
the most important things that people can do to try
to elevate their t levels naturally?
Speaker 2 (37:44):
First of all, what you can't do, which is take supplements.
So there are despite the gas station, yes, or even gosh,
I mean God bless. I love watching my Dodger games.
But I won't call out any necessary supplement company for
fear of defamation. But yeah, they there's really no clinical
(38:05):
evidence we've looked at this of going on things like
ashra ganda or fenogreek or maka or any of these things.
There There may there may be other reasons for those supplements,
and I certainly wouldn't want to step out of my
lane there. But in terms of if you take a
supplement and you look at serum testospe levels, nobody's ever
(38:26):
had a randomized clinical l simble controlled trial that shows
that tea levels go up. But are you ready for
this now? It just made me think of something else.
This is this is a I love teaching this to
medical students and even other physicians. When we were talking
about the gel therapy, I just love this because because
(38:46):
I think this is why supplements work, and I think
everybody realizes this. So this is not earth shattering. But
when we looked at the original clinical trials, not the
original but the second formulation of gel therapy, which goes
back to I want to say, like the mid twenty
tens or so, and you we had two arms. We
(39:08):
had guys that went of the study that went on
transdermal therapy with testosterone, and then other guys that were
just smearing hand sanitizer on their shoulders every day because
they were in the placebo arm. So it feels like
hand sanitizer. Kind of smells like hand sanitizer. And so
you look at the guys that were in the treated group,
(39:29):
and the number of guys that had a really fantastic
response where their numbers went into the normal range was
I can't even tell you the number. Eighty nine ninety
percent of guys that were on testosterone therapy the treatment
arm had really good, appreciable improvements in the testosterone. So
here's do you know what the number is of guys
(39:52):
that were thinking they were getting testosterone, putting on hand
sanitizer with no testosterone and every day, do you know
how much their testo levels went up? Just give me
a guess. I can make a multiple choice if you want, Yeah,
you're so good thirty eight percent? Really yeah, So isn't
that crazy? So if I tell you guys like the
(40:13):
guy comes into my office and says, Mills, I need testostro, Like, ah,
I don't know this guy. I don't want to give
him testostra. He's fine, I'm gonna I'm going to give
him this hand sanitizer, tell him this testosterone. Then after
I lose my medical license for practicing and eficeal care,
the guy comes in. I'm like, guess what, you went
from three point fifty to four point fifty. Man, that's amazing. Congratulations.
(40:36):
So that's why supplements work a lot of times as
a pacbo effect is real. So that's why you can say,
guys clinically improved for this, this, and this perfect. But
give me a randomized trial where you show how much
more they they improved over pacebo. Nobody wants to do
that study, so anyway, that that's it. So so stay
(40:56):
away from supplements that say they're going to boost your
tea naturally because either they don't work or some of
them sneak testosterone into it and you're actually taking tea
whether you know it or not. So there's no regulation
at that level. The FDA doesn't get involved in supplements,
and that's a discussion for a whole other podcast that
I'm not sure I even want to do, but that
is the deal. So that's what you can't do. So
(41:19):
what can you do. So, there's a lot of great
evidence that weight bearing exercise and any good physical exercise,
if you stick to it and have a really good
routine where you're doing something at least five days a week,
can actually raise your testosterone upwards of about twenty five percent.
So again, you're empowering yourself. You're probably changing your metabolism.
(41:41):
And there's a really simple mechanism for why that works,
and that is that if you're overweight, then your body
will convert a reasonable proportion of testosterone to estrogen and
that lowers your total testosterone. Because what happens is that
pituitary gland that rate I said, this is going to
be said, I promise it will be that regulates testosterone production.
(42:04):
It responds to high levels of estrogen as well, and
so it shuts down and the signaling back that the
testicle goes down. So if you start to do physical
activity improve your your metabolism, then all of the testosterone
you are already making it gets to stay testosterone and
it doesn't go into estrogen and confuse the pituitary gland.
(42:25):
So good rigorous exercise, it combined with weight loss, is
a great way to naturally boost your testosterone. I will
tell you probably the number one thing that sounds so
easy and blissful and wonderful, but is probably the best
way to naturally raise your testosterone is sleep better. So
we know that when guys don't sleep, their petuitary gland
(42:47):
doesn't sleep, and when the petutary land doesn't sleep, it
stops sending the signal to the testicle to make testosterone.
And so by just changing sleep patterns, and we're going
to have to have some help teaching our audience how
to sleep better, because I as much as I love
it and learn about it, we're going to bring somebody
on that's going to teach us about that at some
(43:07):
point in the future. That is the key thing, because
when I look at a guy in my office, it
has low testoster and I'm not just looking at their testosterone.
I'm also looking at their petuitary levels. And the key
one for testosterone again is something called LH or lutinizing hormone.
And again, if you're going to your doc and you're
talking about symptoms of low testosterone, it's a reasonable ask
(43:30):
to say, hey, do you man, do you mind adding
on an LH to this, because that will be able
to teach us if it is the fact that the
petuitary levels are low. That's a reversible cause of low testosterone,
and one of the most common causes of that is
poor sleep. So that's the two big ones in terms
of all of the little clickbait about these foods can
improve your testosterone and all this nutrition, and really there's
(43:54):
not a lot out there. I think one of the
ones that I chuckled at the other day that I
clicked on because I'm a sucker just like everybody else,
and I'm a sucker with a high level of scrutiny,
so I feel as if I'm doing this for my
patients and my audience. But I clicked on it and
it was about sweet potatoes, and it's a really interesting
thing because when when you eat a sweet potato, your
(44:16):
body just converts all of that over to carbohydrate and
food and it's done. But the reason that that myth starts,
I think, is that the way that most testosterone is
synthesized is made in this country is through harnessing a
molecule in sweet potatoes that looks a lot like the
testostial molecule, but it still has to be chemically altered
(44:38):
to actually beat testosterone. So you can eat a thousand
sweet potatoes and you get a thousand of those molecules.
But unless you have the chemistry lab to convert that
to testosterone, your body's not going to But anyway, so yeah, there,
I wouldn't. I would stay away from foods that say
that's going to naturally boost your tea because it just
don't have a lot of data out there. So that's it.
But I think the most important, and in fact that's
(45:01):
part of our guidelines is is sure start with reversible causes.
So if a guy is not sleeping, if they're dramatically overweight,
they're not exercising, great. Here's where I differ from the
medical establishment to a certain extent is I don't know
why we have to just do one or the other.
Why can't we do both? And that's really how I practice.
(45:23):
So if somebody is coming to me with all of
the symptoms of low testosterone, and I know they have
reversible causes, I know that they need to sleep better,
I know that they need to have better nutrition to
lose weight and exercise more. But why can't I supplement
that guy and get them on the right path and
I've been successful over twenty or so years of being
in practice of meeting guys where they're at helping. And
(45:46):
I always say I'm halfway a coach and then halfway
an interventionalist. And the intervention is I will have no
problem helping a guy with a prescription with a testoster
management therapy as long as they are doing something to
reverse the underlying cause, let's do it both, man, it
doesn't have to be one of the other.
Speaker 3 (46:04):
Well, I think we got to get somebody a sleep
specialist on that sounds.
Speaker 2 (46:07):
Like the right. Uh no, I gotta gotta go after this, Yeah,
I gotta go. I think there's there's a lot of
really cool things that are simple, that are effective that
we can really get guys motivated to understand sleep and
sleep better for sure. And and then that's right, that
that would just be so amazing. And this is coming
from somebody that you know, did a decade of surgical
(46:29):
training and slept two hours a night for six years
in a row. And so so I'm still catching up.
I mean, I'm mid fifties, I've been out of training
for over twenty years, and I still am catching up.
And there's nothing as blissful of being able to sleep
in the night.
Speaker 3 (46:43):
Sleep debt is real.
Speaker 2 (46:44):
It's real, brother. But that's it. I mean, I think
so testoster therapy not that hard. The key take homes
are just make sure you go to somebody that is
treatment agnostic. It's okay if they have if they say, look,
I think you're going to be better with this and
here's why. Great, But if you're walking out of there
giving them a credit card and walking out with a
(47:05):
bag full of whatever, just you know, I'm cool with
that because they may in fact have exactly the right
therapy for you, and it may be the right therapy,
but just do your homework a little bit, make sure
that that, in fact is what is right for you
based on what we talked about today. But yeah, Jordan,
I think that's it. Just like everything is not that hard.
Let's keep it simple, be very mindful of your own health,
(47:28):
and make sure that you're asking the right questions.
Speaker 3 (47:31):
I guess before we let this topic go, do you
have a favorite success story involving treating low to a
patient who made big changes and really turned things around
in a remarkable way.
Speaker 2 (47:42):
Oh man, I can think of this one guy so many.
I can think of this one guy because the way
he phrased it. But he was a accountant, I believe,
a professional, but a sedentary job, but very analytical. Came
in with reams of blood work over the years, came
in with his diet, his sleep habits, he had everything,
(48:06):
and also that he was referred to me specifically for testosterone.
But he advocates, as I want to go see a
real specialist. So I knew his primary doc well, who
was a good doc. It probably could have taken just
to good care as I could, but you know, this
guy wanted to have somebody that really knows their tasagement.
So I saw him and we had the song. It
(48:26):
probably took an hour to just going through all of
the risks and the benefits and everything we just talked
about today. And we started him on therapy, and I
remember him coming back after three months. He had just
he lost about five pounds, but he had been going
to the gym. But the most important thing about this
man I remember so vividly is he said, Doc, you
got me out of the cave. I just felt as
(48:48):
if my body and my mind was in a cave
for years where I just it was just dark and sad,
and I didn't have the motivation to just get out
and start to really live my life and to feel
good about the next decade and the next twenty years
(49:09):
and the rest of my life. And I think what
that speaks to is, yeah, he did the physical things
that he was supposed to do, but the psychological impact,
the mental health impact of a guy that has low
testosterone and he doesn't know why that we can turn
around just with simple therapy. And in fact, I remember this,
he was just on the jel So after all of
(49:30):
the shenanigans, I just put the audience through about how
I can do injections and pellets and all this stuff.
I literally just wrote him a prescription and he went
to his corner drug store. But that got him out
of the cave. So that was exciting. And I followed
him for years and he just continued to get better
and better and good Bee gets better. And I think
that's the thing, is that that tustostra is not the answer,
(49:52):
and starting testosterone is really a fraction of what you
have to do to overall turn around your life. But
it's an amazing and it's an integral fraction. And again
I think it's you know everybody that comes in and says, well,
I want to look like that guy in the Marvel universe.
Well eight, you know, we don't know what his tstosterone
said is is, but b you know, you got to
(50:13):
spend some time in the gym and you got to
definitely spend less time in the drive through to look
like that guy. And so those are not the guys
that are going to be success stories. We have to
we have to break it down and build them up
and use nostalstra and as one tool in the box.
Speaker 3 (50:29):
It sounds like it's a good starting point, which is
why it was a great starting point for the series.
Speaker 2 (50:34):
Yeah, good start. It's just a great It's a great
entry into the conversation about about just how to optimize
your life and how to reevaluate where you are if
you're eighteen years old or if you're eighty eight years old.
There's always something we can do if you want to
do it to make yourself a little better than you
were the day before. Incredible, it's all good, all right, guys. Well,
(50:57):
this is another episode of the Mailroom to Jesse Mills here,
so great to join Jordan Runta again for a little
sojourn into the world of men's health and what's hot,
what's not, What you should be doing, what you shouldn't
be doing, who you should be listening to, who you
shouldn't be listening to, and everything in between. So have
(51:17):
a great time. I'll see you next time. Let's get
some learning done.
Speaker 1 (51:29):
Let's talk about it. Let's talk about the Maro. Let's
talk about it. Let's talk about the man hero. Let's
talk about it. Let's talk about the man Hero.
Speaker 3 (51:53):
The mail Room with Doctor Jesse Mills was a production
of iHeartRadio. It was executive produced by Jordan Runtog. It
was edited, mixed, and mastered by Beheid Fraser, and the
theme was provided by long Transit. If you like what
you heard, please subscribe and leave a review. For more
podcasts from iHeartRadio, check out the iHeartRadio app, Apple Podcasts,
(52:15):
or wherever you listen to your favorite shows. This program
is intended for educational and informational purposes only. It is
not a substitute for professional medical advice, diagnosis, or treatment.
Consult your healthcare provider for any medical or other related
questions or concerns. The views and discussions aired on this
podcast with those of doctor Mills and do not represent
(52:37):
the official positions of UCLA or UCLA Health
Let's talk about it. Let's talk about a ma hero.
Let's talk about it. Let's talk about the man hero.
Speaker 2 (00:17):
Welcome to the man, Hey, welcome back to the mail room.
Jordan's great to see you again. We had such a
good time building a foundation for not only what we're
going to talk about with testosterone, but also just what
we're going to talk about with life. So so cool
to be back and getting into this again. I think
once you build that foundation of what is low testosterone,
(00:40):
then obviously it naturally follows into what are we gonna
do about it? Or should we do anything about it?
And I'm really looking forward to talking with you today
about just as a guy that would walk into a
doctor and talk about therapy. What are your questions, what
are your concerns, what are your thoughts about should I
be on testostro? What are the downside? What are the
risks to it? That's that's really what we're going to
(01:03):
focus the next half hour or so on is to
is to give a guy a tool so that he
knows a what to ask for b when to ask
for it, and see when to say okay, I'm good,
like I'm done. Man, I don't I don't want this anymore.
I don't need this anymore. Turn my life around. Thanks brother.
Let me get out back into the gym, or get
(01:23):
back into eating a salad and getting on with my life.
Speaker 3 (01:28):
Yeah, doctor Bill's I'm really excited to talk to you
about this. I've come armed with some questions, questions and
questions for me.
Speaker 2 (01:35):
Letter rip. I love it. Yeah, this is what it's
all about. It's a it's a pretty cool informal way
to just get some good formal science. We had a
good talk about what testosterone deficiency is, testosterone or hypogonatism
or however you want to categorize it. And I think
this should naturally follow to then how do I treat
(01:57):
it if I'm a physician and you're a patient. And
also I think what I want to do is empower
audience with how to select a provider to treat you
if you have low testosterone. So I'll sidebar for a
bit and just kind of think about how guys engage
in the healthcare system. So somebody has some of those
symptoms we were talking about, if they're libidos down, they're
(02:17):
not waking up with erections anymore, they're gaining weight around
the mid section, they just don't have that jois de
vive that they used to have. Then a lot of times,
you know, the traditional thought would be they'll go to
their primary care physician and maybe the primary care doc
makes the diagnosis is, well, hey Jim, your problem here
(02:38):
is your testosterone is low, and the primary care doc
may treat that, or I say, you know, I think
this is a nuanced approach. I'm going to send you
off to a specialist. And actually I think the big
thing is who you see will actually determine what kind
of therapy that you're going to get. And what I
want to challenge the audience with is that the right
(03:01):
therapy for you or is it the therapy that the
person that's writing your prescription has to offer you. And
some of this is if you don't go to a specialist,
they may only know a couple of things how to
treat this. Or if you go to a clinic that
purely sells testosterone, you know, whether it's in a gel
(03:22):
form or whether it's in an injection, then I guarantee
that that's how you're going to get it delivered. So
I want to arm our audience with the different therapies
out there and then I want them to choose what
their values are or what their situations are, and that's
kind of how we're going to we're going to shape this. So,
for example, testosterone therapy, as we talked about the last time,
(03:43):
is it's been around in some form or another for
over one hundred years, since we were grinding up guinea
pigballs and injecting them into veins and different injections and
the real synthesis of testosterone. What happened in the nineteen
thirties was the first time we actually had a pure
form and injections led the way. Since that time, there
(04:04):
have been everything from a pill that you can take,
to a patch that you can put on that absorbs
over time, to a gel that you put on, and
the gels or anything from on the top of your
thigh to your shoulders to under your arm. There's so
many different places that we can apply a cream or
a gel to absorb testosterone into the body. And then
(04:26):
there are injections that last day where from a week
to three months. And then lastly, there is a pellet
something that your doctor will implant, usually in your flank
or your backside, and the pellet dissolves over about a
three to four month period. So let's break it down,
because I think this is where guys will jump in
and say, oh, that makes sense to me. I can
(04:47):
put on a cream every day or ease. I already
know how to take pills, and we'll go to the
pros and cons of all of that. So let's start easy.
I think pills is a great place to start so
far making sense to Jordan. If you were in my
and I'm offering you different modalities or what's on your mind?
Just with that preamble, I.
Speaker 3 (05:07):
Mean, I guess my broader question is when is testosterone
therapy the right move and when isn't it? Is there
a risk of overtreating, like giving testosterone to someone who
doesn't really need it.
Speaker 2 (05:17):
The easy answer is that if you go and get
your blood levels drawn and there below a certain level,
which most guidelines and organizations say somewhere under three hundred
and fifty n yanagrams per desto leader for a total testosterone.
Some labs will also check a free testosterone, which I
think is important for men that are on the borderline.
(05:40):
So in other words, there's a couple of different ways
the body sees testosterone when it's in the bloodstream and
therefore a couple of ways that a lab will test testosterone.
The total is what we base all of our guidelines on,
and so I think it's probably easier for the scope
of our discussion to focus in on that and then
new on out to what free testosterone means and how
(06:03):
that can be effective. So if a guy has symptoms
of low testosterone meaning libidos down, corr erections, loss of
mood or unstable mood, frank depression, or muscle mass weight gain,
those are kind of the heavy hitters that would drive
somebody into the office. If he has symptoms of low
(06:23):
testosterone and his levels are below three hundred and fifty
or even three hundred to be stricter, then he would
benefit from testosterone therapy. What I just said there, I
didn't make up. That actually comes from the two big
professional society guidelines in ourt in the United States, which
is the undergrad Society and the American Eurologic Society, which
(06:46):
is what I'm a member of. And so that's it.
So who would benefit is if you're symptomatic and your
T levels are low below those thresholds, you would probably
benefit from therapy. That's the first part of your question,
second part is well, is there a risk of overtreatment?
Then what are the risks of that? And the answer is,
(07:06):
I don't really know. I think testosterone therapy in this
country has taken on this giant, multi headed beast of
where people are seeking it to optimize their health, thinking
that it's a cure in a longevity spectrum. And we
(07:27):
have some data dating back years that men that have
normal or good testosterone levels well into their sixties and
seventies do have longer longevity. But there is no paper
ever nor will there probably ever be that shows that
initiating testosterone therapy is going to cause a guy to
have a longer life. And the difference between that is
(07:49):
that we think that testosterone acts as a biomarker of
overall health. In other words, the extreme example is if somebody, normal, healthy,
twenty five to thirty year old guy gets in a
horrible accident trauma of some kind, motorcycle wreck, burn, whatever,
and he's in the intensive care unit. It doesn't take long.
(08:10):
We did these studies fifty years ago. A couple of
days before at his testosterone levels will plummet, and so
we know that the body has to be healthy. All
systems have to be firing for the body to make testosterone,
and so therefore, if a guy is kind of not
the healthiest and has a lot of bad lifestyle habits
and he's in his forties fifties, then the risk of
(08:33):
testosterone deficiency goes way up. And then it makes sense
then that what we're seeing is not necessarily something intrinsic
with test osma. What we're seeing is that this guy
isn't healthy in the testosterone is a biomarker of that
lack of health, which means that if I took that
same guy and didn't talk about reversing any of the
lifestyle habits smoking or obesity or diabetes, things that can
(08:57):
be controlled through change in life style, and I just
gave him buckets a testosterone, I would not expect to
see him when he's one hundred years old. In other words,
testosterone alone, by me giving that guy therapy is not
going to necessarily cause him a longer life. So that
becomes a difficult question to answer in terms of if
(09:18):
we're treating testosterone to improve somebody's longevity, we don't have
those data, so therefore we may be overtreating. But I
would argue, as I have many times in the past
in many forums, that the risk of overtreating testosterone is
not that extreme. In other words, if I give a
guy way too much testosterone, he's not going to drop
(09:38):
deut of a heart attack. He's not going to die
of prostate cancer. The worst things that happen when we
overtreat somebody that doesn't benefit is that we completely take
away this guy's ability to make his own testosterone while
he's on therapy. So to give you an example, just
real life example. This is a conversation I have multiple
(09:59):
times a week in my clinic. Is a guy comes
into me and says, Mills, I heard this podcast about guys.
They're all on TI your te they look jacked, they're
having great sex, their lives are fantastic. Test my testosterone.
I test it. It comes back at six hundred. That's great,
that's really well within the normal range. And I say, okay, cool,
So your tea is already really healthy. If I put
(10:20):
you on testosterone, what I'm going to do is I'm
going to take your normal production and take it almost
to zero. And then I've got to overcompensate for giving
you enough testosterone to get back to where you already
are naturally and put you up to that next level
and then we'll see if it works. And we don't know.
In fact, a lot of times when guys teas are
(10:43):
in that six hundred range and they feel fine and
they're trying to optimize, I'm actually doing them a pretty
big disservice. There's a quick, little interesting thought of behind this,
and this is some research that a lot of people
are doing. We don't have a great commercial available test
for this, but we know that all men metabolized testosterone differently,
(11:04):
and we talk a little bit about the range of normal,
and that range between three hundred and one thousand. Just
say is because you take one hundred blood tests from
one hundred guys that all have that feel great, they
have no symptoms of low testosterone, and the directions are
good and all the check all the boxes, and that's
where that range is. So the guys on the low
(11:24):
end that feel amazing, they're three hundred. The guys on
the high end that feel amazing are a thousand. But
essentially everybody feels fine in that range. So that means
you've got this huge range for where you fit in.
But we don't know in an individual person unless we
check their testosterone at eighteen when they were perfect and
(11:46):
know that, or twenty or thirty and we know that
their testosterone was at three hundred. That would be great knowledge,
right because then I could say, when he comes to
me and his testosterone is three hundred and he feels fine,
he's good. But what if that same guy comes to
me when he was eighteen and twenty five years old
and his testosterone was seven hundred, and he comes to
me and I tested, and he feels terrible and his
(12:07):
t is three p fifty. That's a guy I probably
need to pull back up into that seven to fifty range.
And we don't know who those guys are. We do
know there is something called the antrogen receptor threshold where
testosterone is metabolized by the cells and by the organs
that testosterone fuels from your brain to your penis to
your testicles. It's governed by how many and trien receptors
(12:33):
that person has and how many of them have testosterone
molecules attached. And that's the science behind it. In other words,
if we had a commercially available test where a guy
would come to me and say, Mills, I feel terrible.
I'm not getting up in the morning of directions all
the stuff that you taught me, and my testosterone is
five hundred, shouldn't I get testosterone therapy? What if I
(12:53):
was at a thousand when I was twenty five, and
I'm in your office at fifty and I feel like stink,
and I said, well, great, yeah, I'm going to do
another blood test where I test your angigen receptor levels
and see and maybe your angigen receptor level test comes
back and it's a thousand and you're at five hundred,
then you're only fifty percent of the way you need
to be. That's a guy that I'd want to get
up to a thousand and see how he does. So
(13:16):
that would not be over treatment. Even though his testosterone
levels fall within a normal range, his levels are to
him intrinsically low. That's the silver bullet. That would be
the magic cure to knowing who would benefit from therapy
that falls within the normal range. So, in other words,
a guy comes into my office, it's a two minute discussion.
(13:38):
If he comes in with a testosterone of two hundred,
he's profoundly symptomatic. I know I can help that person.
I know because his numbers are low. But the guy
that comes in with a testosterone of four hundred and
it feels terrible, that's a much longer conversation. And that's
also where I have to put on my country doctor
white coat and say, let's treat the patient and let's
(13:58):
not treat the blood test And I think that's really
the critical part of testosterone therapy. So, boy, that was
a hell of a sidebar you put me on there,
But I think that was a great way to clarify.
What we're trying to deal with is not a condition
like diabetes, where if the blood sugar is too low
or too high somebody dies. With testosterone, we have to
(14:20):
figure out how to nuance it a bit more.
Speaker 3 (14:53):
And you're saying there are three ways to treat this generally,
do you have a preferred method.
Speaker 2 (15:00):
Whatever the guy wants? And so I think this is
so key because I tell everybody that walks on my clinic. Look,
I'm a professor at a major academic medical center. I
don't make any money different whether I write you a
prescription or I give you a shot or anything else.
I'm the guy that should be treating your testosterone. In
other words, you want to go to a physician or
(15:22):
a health care provider that is modality agnostic. In other words,
that they're not going to say, hey, I got a
trunk full of testosterone that I need to offload, so
we're going to do this for you. We're going to
do shots, or we're going to do pills, or we're
gonna do injections. So that's why I think that's number
one is choose the right physician. And if somebody comes,
if you go into an office and they tell you
(15:44):
here's exactly what you need, then that's what you have
to be a little concerned about. And I think again,
it doesn't mean it's the wrong therapy if you look
at my practice, which I look at a lot in
terms of what I book guys on. Interestingly enough to
mark leader for testosterone replacement right now remains a jail.
(16:05):
It's a transdermal jail. It's been on the market since
the late nineties early two thousands, and the reason for
that is not because it's better than any other thing.
It's because if a guy is coming through a normal
healthcare system, then he probably has insurance. He's going to
get whatever's on the formulary, and so most of the
people that I see in my clinic, they are going
(16:26):
to say, well, hey, Doc, can I get insurance to
pay for it? And say, of course you can. Your
testosterone is low, you're symptomatic on the rite your prescription,
we'll get the authorization, and you're going to have to
start with his jail. Now, not everybody that starts in
jail stays on jail. And for me, my biggest red
flags or things that I'm concerned about starting somebody on
jail is the risk of transference. And it transference is
(16:47):
when you're putting on an active product, whether it goes
under your arm or on your shoulders or on your thighs,
if you rub that body part against somebody, a spouse,
a kid, somebody that you really don't want to be
transmitting TESTOSTERONETO within a certain time period, usually within an
hour or so putting it on, you could rub testofsterone
(17:11):
gel off on that person. So that would be bad,
right if you had a young kid and a lot
of the gels. The most common gel is something you
put up on the shoulders. Then you know, you just
put it on and the kids crying. You're like, oh,
I've got to go change a diaper and then you
take the kid, you put them on your shoulder to
get ready to put them on the basinette to change
(17:31):
the diaper. Then you potentially have just transferred testosterone over
to that person, and that's been reported. So I do
worry about starting my young dad's on testosterone. That is
a transderambal. That's the plus in mind. It's a nice
thing about it is it's very easy to do. You
have to put it on every day, so it becomes
a part of the routine. So I tell somebody, you know,
(17:51):
maybe put it on after you shower in the morning
and you're shaving, or you're taking care of your hair,
whatever you're doing, put it on. It drives in two minutes.
You throw a t sh on and you go and
you're good, and after about two hours it's fully absorbed.
So you can jump in a pool, you can shower,
you can go to the gym, whatever. But during that
two hour window you have to be really careful that
you're not transmitting it to anybody else. That's the market
(18:13):
leader for better or worse. Pills have been around forever.
Jordan and pills have an interesting history. In the early
pill form of testosterone what happens you took the pill,
it would go into the liver, which is how all medications,
anything that you adjest through your mouth, it goes through
the liver and what we call in pharmacology the first
(18:34):
pass effect, meaning that the liver sees it before the
rest of the body sees it. The liver what it
does is it processes all the nutrients and all the
toxins and decides where to put it, whether into the
bloodstream or into the gut and into the stool. Eventually,
that's what the liver does. And so the early forms
of testosterone pills actually had a negative effect on livers.
(18:56):
It caused tumors of the liver, some of them even cancerous,
and so the FDA stopped approving pills years ago, decades ago.
They're still available in some other countries, but that gave
the oral form of testosterone really bad name. Now fast
forward to oh within the last five or eight years,
there has been a pretty clever way that we can
(19:18):
take testosterone pills and bypass what we call that liver
or first pass effect, and that's by attaching the testosterone
molecule to a molecule of fat that then the liver
it's too big for the liver to see it and
break it down into all of the different components and
get into the bloodstream, So it goes into the lymphatic channels,
(19:38):
and the lymphatic channels go all over the body, and
the lymphatic will then release it back into the bloodstream.
So you get a nice stained release from these new
lymphatically clear testosterone pills. So that's great. So that way
you have really zero concern about doing any liver damage
and the levels get pretty good. They're very comparable to
(19:58):
what you get from the gels. The downside to pills
is you have to take him twice a day, sometimes
even more, and you have to just the dosing to
get to the point where a guy feels good and
his blood levels are reflected that he's had in a
good therapy state. Second thing is especially true in Santa
Monica where everybody's wayfy thin that you have to take
(20:19):
you with a little bit of fat, and so if
a guy's on an intermittent fasting diet and he doesn't
start eating until four o'clock in the afternoon, your body
won't absorb that because there's no fat in your gut
to get into the lymphatic channels and actually get the
molecules started to be effective. So you have to have
a little bit of fat, not much, even a little
bit of cream in your coffee, little cream cheese on
(20:40):
a pagel something like that is enough. But ultimately there
are some guys that absolutely won't take the pill because
that's just not how they eat. So that's kind of
the downside to it. But otherwise very well tolerated. They're easy.
I've never seen levels go really really high in guys
and pills, and people feel pretty good. And there's about
three different companies that have a pill that's on the
(21:03):
market that is FDA approved, so that's you know, that's
another perfectly good way. In my practice, I do not
have a large percentage of guys on pills, partially because
it's hard to get authorized. There is a pill that
is that is a cash only model, so for about
one hundred and sixty five bucks or so a month,
if a guy is willing to pay that, then that's
a great system for getting good testosterone levels without really
(21:26):
any risk and not worrying about transference from jails or
the discomfort of injections. The wheelhouse, I would say of
my clinic, the number of guys that I see, especially
just because a lot of guys see me once they've
been to other clinicians and didn't get a good response
to testosteron or the person didn't feel comfortable treating them.
(21:46):
Is going to be either injections or the long acting pellets.
And the injections are great because they last about a week.
I can really predict where guy's levels are going to be,
and I can infinitely djust the dosing just by teaching
them how much to drop per injection. So that is
(22:08):
my guys that are super motivated. They don't have a
problem giving themselves a shot at home. They're also incredibly inexpensive.
I can send them to any pharmacy or any mail
order pharmacy and really get therapy for fifty bucks or
less a week, So even if they're paying cash, I
can find injections that are very cost effective for guys
if they don't have insurance coverage. And that leads me
(22:30):
I think to the pellets, which gosh, the pellets have
been around boo pushing fifty years, believe it or not.
But they come in two flavors. One is a compounded
pellet where you go through a compounding pharmacy and you
find a provider that inserts compounded pellets, and the advantage
to those is they tend to be very cost effective,
(22:52):
and the nice thing is that they last from the
insertion of the pellet. They last about three or four
months before you have to go back in for another procedure.
The other pellet is the only FDA proof pellet, so
I will say it by name because there is only one.
It's called Testa pel and it's been in production again
for decades, and the advantage of that is that it
(23:13):
is FDA proof, so you know that you're getting high
scrutiny of the lab. You're getting a pure product, and
most of the time insurance covers it. So that's the
downside is that if you're paying cash foroard, it's very
it's very expensive because it is a pharmaceutical. But most
of the time we're able to get insurance coverage for it.
And so for my guys that travel, I'm in a
(23:34):
city where people travel all over the place. Sometimes you
know they're going on set if they're a camera guy
or anything in the film industry, where they're going to
be in Hungary or Atlanta, or Turkey filming for three
months at a time. Those pellets are great. They don't
have to travel with any needles. They have to travel
with a couple of gallons with a testosterone gel or
(23:54):
bottles and bottles full of pills. They just come into
my office a couple of days before they head to
Laux and fly off to parts unknown, and they're in
great They're in great shape for three, sometimes even four
months in between the pellets, So that tends to be
a really a really popular form of testostering placement in
my practice.
Speaker 3 (24:14):
What is the process like of coming off a testosterone treatment?
Speaker 2 (24:18):
Why would you want to That's the question. Now I
sound like a cheerleader. I think the truth is that
most of the reason that guys discontinue testosterone one is
that it is a great form of male birth control.
So if I see a guy that is on testosterone
and wants to initiate a family or maybe have more
kids if he's in between, then we have to get
(24:41):
those guys off testosterone in order for sperm production to
pick up again. So let's talk about that first, because
that requires its own special treatment, and that is we
have to reverse the effect of testosterone that is prescribed
so ejected or swallow or gelled to on the pituitary gland.
(25:03):
So what happens if I put a guy on testosterone
therapy of any kind, his petutary gland will shut down
not only testostrum production, but sperm production. That's that's the
way it works. And so I've got to figure out
how to how to put jumper cables on the pituitary
gland and get it up and working again. And thankfully
there's a couple of different ways to do Weather's three,
(25:25):
and none of them, I should say, is FDA proved.
One of them is O natural, so therefore FDA agnostic.
In other words, I just say stop your tea and
come off it and give it a few months and
things will probably come back online. So that's not the
preferred method for me or my patients because they're not
(25:45):
going to be very happy. I mean, when guys come
off testosterone, especially if they're well into that normal range
and we start them on therapy for some compelling clinical reason,
then they're going to have to start making really high
numbers from zero to get back up to feeling well.
So what happens, So what's the withdrawal of testosterone look like, well,
(26:06):
it doesn't take long for testosterone to get out of
the system. So in other words, if it's an injection
and you miss a shot, after a week or two,
you're going to be well under the normal level. If
it's a pill, it'll happen after a day or two,
same thing with the gel. If it's those pellets, then
obviously it takes much longer because they last so long.
(26:28):
But eventually everybody hits bottom, and that bottom will look
like they might get some night sweats, feeling kind of hot,
cold intolerance, definitely, some grumpiness, probably loss of morning erections
that they were doing so well on for a while,
Definitely loss a libido, maybe even some weight gain if
they don't turn around very quickly. And on a global
(26:52):
physiologic health level, bone density will go down, their muscle
mass will go down, and all of these things take
a little while to read, and so those are serious deals.
And that's why I think your question at the beginning
of our chat today was very important, is that that
would be a real bummer if I took a normal
guy and overtreated him and he just said, I'm done,
(27:15):
I'm quitting for whatever reason, he's going to feel crappy
for quite some time, you know, maybe a couple months,
three months even, and he may even have actually some
medical concerning things happened to him during that time period.
So that's the cold Turkey method. I don't recommend it,
there's no need for it. There are different ways to
reboot that pituitary plant, and the two most popular are
(27:38):
a injection which is called hCG or human choreonic gonadotropin,
and it's been around again for decades, and what that
is is essentially a maternal testosterone. So anybody that has
ever been involved in a pregnancy and they do a
pregnancy test or they go to the hospital or the
(27:59):
lab and get a blood draw, that's what we're measuring
is hCG levels. And what happens is that when a
male fetus is developing, mom secretes hCG, which which the
male's body and testicles will recognize as testosterone. That allows
for testicular development and penis development everything. That's sort of
(28:21):
the beginning of differentiation of male into female phenotype or
body type in utero. So we've known about this for decades,
and so when we take somebody that's on testosterone. We
put them on hCG injections. What we're essentially doing is
we're inducing puberty again in these guys, and it's kind
(28:45):
of cool because they feel better almost instantly. So if
the testosterone is zero for whatever reason, whether it's from trauma,
from surgery, or from going off testosterone therapy, as your
question was saying, then we naturally stimulate their testicles to
make testosterone based on this molecule of hCG. It is
(29:06):
a peptide, and so your body will start to synthesize
testosterone based on that interaction from that molecule. So that's
pretty cool, and that works well, and it works within
a few months to actually get sperm production back online.
But testosterone levels go up almost immediately, so guys don't
feel quite so horrible as they're recovering natural function. And eventually,
(29:29):
if the goal is to get them to be not
on anything, we start to back off on the hCG
and see where their numbers really return to. The second
that is even more used because A it's cheaper, b
it's easier because it's a pill, is to take something
called chlomofin, and clobofin's a really fascinating molecule. We use
(29:50):
it in women all the time as a fertility drug,
and I use it in my mail patients to stimulate
sperm production. But that also works on the pituitary gland
to tell the petuitary gland to make more testosterone and sperm,
and it does so through this crazy molecular pathway called
selective estrogen receptor modulation. Many people have heard the term SERMs,
(30:14):
and that's what chlmaphin is. It's one of the early SERMs.
And the best way I can explain is that it
gas lights the peituitary gland. So what it does is basically,
you take this clmaphin and the petuitary gland thinks, oh man,
I'm not doing my job. I got to make more
LH and FSH, which is the only hormones that the
testicle recognizes to help me make more testosterone sperm. And
(30:38):
so basically, by blocking the estrogen receptor at that level,
the signaling to the testicle shoots way up, and that's
another great way to restart testosterone production naturally, and as
a side effect, it also restarts sperm production. Actually it
takes longer. Guys don't feel quite as good on it
for the most part. For some new wants to reasons
(31:00):
and hypothetical reasons and in terms of what estrogen does
in a mail, but for the most part, it's a
very effective way of restarting therapy. And I do something
called the Clomid challenge. Clomid is the old brand name
for this, but the Klonaphin challenge is to put them
on therapy. Usually after about three months, I stop it
and I see what happens, and if their numbers recover,
(31:23):
their pituitary gland wakes up and it's starting to produce
good levels at LH and FSH, then I hope that
their testicles start to produce higher levels of testosterone and
sperm production goes up, and everybody's back to where they
wear no harm, no foul after this sojourn on the
testosterone train. So that is why testosterone therapy. There's a
(31:44):
bit of a myth that I hear all the time.
It's not irreversible. So in other words, if I start
a guy in tea, a lot of guys say, Doc,
I don't want to do this, because you know what,
if I don't ever make it again, and I'm gonna
have to be on testosterone the rest of my life.
And I think I agree with you because I don't
have it in his hunt other than taking care of
you and making you better since I'm not profiting off
(32:05):
of your testoster and prescriptions. That makes me so happy.
If I can see a guy that, say, has a
low testosterone, but maybe is really overweight, or not exercising,
or not sleeping well in all of the classic eat
moose sleep paradigm of how to take care of yourself,
if he's failing in those and I can get him
on testosterone long enough that I can reverse that so
(32:28):
that then he actually is doing it on his own,
that's the best day in clinic ever, because what I've
done is I've empowered a guy through coaching on a
little bit of pharmaceutical intervention so that we can actually
eventually stop therapy. And that's a total win in the office.
Speaker 3 (33:06):
Speaking of myths about this that you're busting, here's another one.
It's a rookie question, but there's something I've wondered about,
and maybe listeners are too, and maybe people when they
come into your clinic ask you the same questions. Is
there a a psychological I guess I should say, negative
psychological impact of taking tesosterone treatment. I guess I'm thinking
about like essentially roid rage, oh something like that.
Speaker 2 (33:29):
Yeah, yeah, so bulking out right. So it's interesting, you know,
I say this a lot, and I've done some expert
witness work in the field too, but roid rage is
actually a legal diagnosis. It's not a medical diagnosis. So
in other words, like there's no level of testosterone that's
going to turn the guy into Lufarigno Circus at nineteen
(33:50):
eighty one or whatever. I was growing up watching an
incredible hope it it just doesn't happen. But the reason
that myth started really is because a lot of the
anabolic steroid rage that was going on in the eighties.
A lot of those guys, there's a couple of landmark
key cases of bodybuilders, professionals, wrestlers doing incredibly horrific things,
(34:13):
including murdering their families to get really dark, really fast.
Those guys were all on like crazy doses of cocaine
as well, and so like was it the coke, you know,
was it the Colombian marching powder or was it just
good old fashioned testoster? And so if you lay off
the blow, then you're probably not going to get roid rage,
(34:33):
but you do definitely have mood instability if you're not
doing testosterone therapy. Well, so, in other words, if a
guy is on super high doses and then he comes
off that grumpiness, yeah, I can see how it. Definitely
ment are much more irritable when their te levels are low,
but not so much when they're really high. It certainly
changed a little bit of our behavior, our prefrontal cortex,
(34:56):
which is where things like the libido come in and
decision making. So guys that are on testosterone tend to
be better, quicker decision makers. They get rid of that
brain fog, and so all of that is certainly part
of the psychological aspect of testosterone replacement is that a
lot of guys will say, I just don't feel like me,
(35:16):
or I've got this brain fog, I'm not thinking quite
as clearly. And I will tell you the reason urologists
know this really well is because one of the treatments
for guys that have advanced prostate cancer is to take
away all their testospel. We put them on pills and
injections that will take their T levels to zero because
(35:37):
that helps the prostate cancer or that stops the prostate
cancer from getting worse or growing. Is especially for combining
it with something like radiation therapy. And if you look
at those guys that have to be on temporary testosterone
ablation where they just you know, they get their teeth
thrown down to zero. They feel horrible when they're on
this therapy, but then thankfully, a lot of times after
(35:59):
six months to two years, depending on the treatment protocols,
they're able to come back off of the androgen blockers
or the testosterone of blaters, and man, they feel great.
And they were like, I don't know exactly what it was,
but I just felt like I couldn't quite even finished
sentences or thoughts in my mind was wandering. I was
so grumpy. I just didn't want to be around myself.
(36:21):
And so that's the extreme example. And those are great
people to learn from because you know, then when you
normalize their testosterone, either just through mother nature and they're
coming off that therapy, or we actually start them on
testosterone after their treatment, man, those guys are grateful and
all we're trying to do is get them back up
into a nice normal range. And so so yeah, I
(36:44):
would love to pretty well kill the roid rage. Myth
if we can today stops stops here at Jordan, stops
right now, stops right now. Roid rage is not real.
I can only imagine the people that are roll their
eyes at me and yelling at me right now. But
I just haven't seen it, you know. I think obviously,
(37:05):
if you do really good evidence based therapy, monitor your
guys really closely to make sure they're in a good range,
then I think that's the key and the same. So
if you're if you're the patient listening to this, then yeah,
you want to go to somebody that's keeping a close
eye on your levels and making sure they're right in
that wheelhouse of a good range.
Speaker 3 (37:25):
So those are all incredibly effective treatments for treating people
whose numbers are definitively low. I'm sure or I shouldn't
assume this, but I would imagine that there are edge
cases where you would give people a certain window of
trying to make certain lifestyle changes. What are some of
the most important things that people can do to try
to elevate their t levels naturally?
Speaker 2 (37:44):
First of all, what you can't do, which is take supplements.
So there are despite the gas station, yes, or even gosh,
I mean God bless. I love watching my Dodger games.
But I won't call out any necessary supplement company for
fear of defamation. But yeah, they there's really no clinical
(38:05):
evidence we've looked at this of going on things like
ashra ganda or fenogreek or maka or any of these things.
There There may there may be other reasons for those supplements,
and I certainly wouldn't want to step out of my
lane there. But in terms of if you take a
supplement and you look at serum testospe levels, nobody's ever
(38:26):
had a randomized clinical l simble controlled trial that shows
that tea levels go up. But are you ready for
this now? It just made me think of something else.
This is this is a I love teaching this to
medical students and even other physicians. When we were talking
about the gel therapy, I just love this because because
(38:46):
I think this is why supplements work, and I think
everybody realizes this. So this is not earth shattering. But
when we looked at the original clinical trials, not the
original but the second formulation of gel therapy, which goes
back to I want to say, like the mid twenty
tens or so, and you we had two arms. We
(39:08):
had guys that went of the study that went on
transdermal therapy with testosterone, and then other guys that were
just smearing hand sanitizer on their shoulders every day because
they were in the placebo arm. So it feels like
hand sanitizer. Kind of smells like hand sanitizer. And so
you look at the guys that were in the treated group,
(39:29):
and the number of guys that had a really fantastic
response where their numbers went into the normal range was
I can't even tell you the number. Eighty nine ninety
percent of guys that were on testosterone therapy the treatment
arm had really good, appreciable improvements in the testosterone. So
here's do you know what the number is of guys
(39:52):
that were thinking they were getting testosterone, putting on hand
sanitizer with no testosterone and every day, do you know
how much their testo levels went up? Just give me
a guess. I can make a multiple choice if you want, Yeah,
you're so good thirty eight percent? Really yeah, So isn't
that crazy? So if I tell you guys like the
(40:13):
guy comes into my office and says, Mills, I need testostro, Like, ah,
I don't know this guy. I don't want to give
him testostra. He's fine, I'm gonna I'm going to give
him this hand sanitizer, tell him this testosterone. Then after
I lose my medical license for practicing and eficeal care,
the guy comes in. I'm like, guess what, you went
from three point fifty to four point fifty. Man, that's amazing. Congratulations.
(40:36):
So that's why supplements work a lot of times as
a pacbo effect is real. So that's why you can say,
guys clinically improved for this, this, and this perfect. But
give me a randomized trial where you show how much
more they they improved over pacebo. Nobody wants to do
that study, so anyway, that that's it. So so stay
(40:56):
away from supplements that say they're going to boost your
tea naturally because either they don't work or some of
them sneak testosterone into it and you're actually taking tea
whether you know it or not. So there's no regulation
at that level. The FDA doesn't get involved in supplements,
and that's a discussion for a whole other podcast that
I'm not sure I even want to do, but that
is the deal. So that's what you can't do. So
(41:19):
what can you do. So, there's a lot of great
evidence that weight bearing exercise and any good physical exercise,
if you stick to it and have a really good
routine where you're doing something at least five days a week,
can actually raise your testosterone upwards of about twenty five percent.
So again, you're empowering yourself. You're probably changing your metabolism.
(41:41):
And there's a really simple mechanism for why that works,
and that is that if you're overweight, then your body
will convert a reasonable proportion of testosterone to estrogen and
that lowers your total testosterone. Because what happens is that
pituitary gland that rate I said, this is going to
be said, I promise it will be that regulates testosterone production.
(42:04):
It responds to high levels of estrogen as well, and
so it shuts down and the signaling back that the
testicle goes down. So if you start to do physical
activity improve your your metabolism, then all of the testosterone
you are already making it gets to stay testosterone and
it doesn't go into estrogen and confuse the pituitary gland.
(42:25):
So good rigorous exercise, it combined with weight loss, is
a great way to naturally boost your testosterone. I will
tell you probably the number one thing that sounds so
easy and blissful and wonderful, but is probably the best
way to naturally raise your testosterone is sleep better. So
we know that when guys don't sleep, their petuitary gland
(42:47):
doesn't sleep, and when the petutary land doesn't sleep, it
stops sending the signal to the testicle to make testosterone.
And so by just changing sleep patterns, and we're going
to have to have some help teaching our audience how
to sleep better, because I as much as I love
it and learn about it, we're going to bring somebody
on that's going to teach us about that at some
(43:07):
point in the future. That is the key thing, because
when I look at a guy in my office, it
has low testoster and I'm not just looking at their testosterone.
I'm also looking at their petuitary levels. And the key
one for testosterone again is something called LH or lutinizing hormone.
And again, if you're going to your doc and you're
talking about symptoms of low testosterone, it's a reasonable ask
(43:30):
to say, hey, do you man, do you mind adding
on an LH to this, because that will be able
to teach us if it is the fact that the
petuitary levels are low. That's a reversible cause of low testosterone,
and one of the most common causes of that is
poor sleep. So that's the two big ones in terms
of all of the little clickbait about these foods can
improve your testosterone and all this nutrition, and really there's
(43:54):
not a lot out there. I think one of the
ones that I chuckled at the other day that I
clicked on because I'm a sucker just like everybody else,
and I'm a sucker with a high level of scrutiny,
so I feel as if I'm doing this for my
patients and my audience. But I clicked on it and
it was about sweet potatoes, and it's a really interesting
thing because when when you eat a sweet potato, your
(44:16):
body just converts all of that over to carbohydrate and
food and it's done. But the reason that that myth starts,
I think, is that the way that most testosterone is
synthesized is made in this country is through harnessing a
molecule in sweet potatoes that looks a lot like the
testostial molecule, but it still has to be chemically altered
(44:38):
to actually beat testosterone. So you can eat a thousand
sweet potatoes and you get a thousand of those molecules.
But unless you have the chemistry lab to convert that
to testosterone, your body's not going to But anyway, so yeah, there,
I wouldn't. I would stay away from foods that say
that's going to naturally boost your tea because it just
don't have a lot of data out there. So that's it.
But I think the most important, and in fact that's
(45:01):
part of our guidelines is is sure start with reversible causes.
So if a guy is not sleeping, if they're dramatically overweight,
they're not exercising, great. Here's where I differ from the
medical establishment to a certain extent is I don't know
why we have to just do one or the other.
Why can't we do both? And that's really how I practice.
(45:23):
So if somebody is coming to me with all of
the symptoms of low testosterone, and I know they have
reversible causes, I know that they need to sleep better,
I know that they need to have better nutrition to
lose weight and exercise more. But why can't I supplement
that guy and get them on the right path and
I've been successful over twenty or so years of being
in practice of meeting guys where they're at helping. And
(45:46):
I always say I'm halfway a coach and then halfway
an interventionalist. And the intervention is I will have no
problem helping a guy with a prescription with a testoster
management therapy as long as they are doing something to
reverse the underlying cause, let's do it both, man, it
doesn't have to be one of the other.
Speaker 3 (46:04):
Well, I think we got to get somebody a sleep
specialist on that sounds.
Speaker 2 (46:07):
Like the right. Uh no, I gotta gotta go after this, Yeah,
I gotta go. I think there's there's a lot of
really cool things that are simple, that are effective that
we can really get guys motivated to understand sleep and
sleep better for sure. And and then that's right, that
that would just be so amazing. And this is coming
from somebody that you know, did a decade of surgical
(46:29):
training and slept two hours a night for six years
in a row. And so so I'm still catching up.
I mean, I'm mid fifties, I've been out of training
for over twenty years, and I still am catching up.
And there's nothing as blissful of being able to sleep
in the night.
Speaker 3 (46:43):
Sleep debt is real.
Speaker 2 (46:44):
It's real, brother. But that's it. I mean, I think
so testoster therapy not that hard. The key take homes
are just make sure you go to somebody that is
treatment agnostic. It's okay if they have if they say, look,
I think you're going to be better with this and
here's why. Great, But if you're walking out of there
giving them a credit card and walking out with a
(47:05):
bag full of whatever, just you know, I'm cool with
that because they may in fact have exactly the right
therapy for you, and it may be the right therapy,
but just do your homework a little bit, make sure
that that, in fact is what is right for you
based on what we talked about today. But yeah, Jordan,
I think that's it. Just like everything is not that hard.
Let's keep it simple, be very mindful of your own health,
(47:28):
and make sure that you're asking the right questions.
Speaker 3 (47:31):
I guess before we let this topic go, do you
have a favorite success story involving treating low to a
patient who made big changes and really turned things around
in a remarkable way.
Speaker 2 (47:42):
Oh man, I can think of this one guy so many.
I can think of this one guy because the way
he phrased it. But he was a accountant, I believe,
a professional, but a sedentary job, but very analytical. Came
in with reams of blood work over the years, came
in with his diet, his sleep habits, he had everything,
(48:06):
and also that he was referred to me specifically for testosterone.
But he advocates, as I want to go see a
real specialist. So I knew his primary doc well, who
was a good doc. It probably could have taken just
to good care as I could, but you know, this
guy wanted to have somebody that really knows their tasagement.
So I saw him and we had the song. It
(48:26):
probably took an hour to just going through all of
the risks and the benefits and everything we just talked
about today. And we started him on therapy, and I
remember him coming back after three months. He had just
he lost about five pounds, but he had been going
to the gym. But the most important thing about this
man I remember so vividly is he said, Doc, you
got me out of the cave. I just felt as
(48:48):
if my body and my mind was in a cave
for years where I just it was just dark and sad,
and I didn't have the motivation to just get out
and start to really live my life and to feel
good about the next decade and the next twenty years
(49:09):
and the rest of my life. And I think what
that speaks to is, yeah, he did the physical things
that he was supposed to do, but the psychological impact,
the mental health impact of a guy that has low
testosterone and he doesn't know why that we can turn
around just with simple therapy. And in fact, I remember this,
he was just on the jel So after all of
(49:30):
the shenanigans, I just put the audience through about how
I can do injections and pellets and all this stuff.
I literally just wrote him a prescription and he went
to his corner drug store. But that got him out
of the cave. So that was exciting. And I followed
him for years and he just continued to get better
and better and good Bee gets better. And I think
that's the thing, is that that tustostra is not the answer,
(49:52):
and starting testosterone is really a fraction of what you
have to do to overall turn around your life. But
it's an amazing and it's an integral fraction. And again
I think it's you know everybody that comes in and says, well,
I want to look like that guy in the Marvel universe.
Well eight, you know, we don't know what his tstosterone
said is is, but b you know, you got to
(50:13):
spend some time in the gym and you got to
definitely spend less time in the drive through to look
like that guy. And so those are not the guys
that are going to be success stories. We have to
we have to break it down and build them up
and use nostalstra and as one tool in the box.
Speaker 3 (50:29):
It sounds like it's a good starting point, which is
why it was a great starting point for the series.
Speaker 2 (50:34):
Yeah, good start. It's just a great It's a great
entry into the conversation about about just how to optimize
your life and how to reevaluate where you are if
you're eighteen years old or if you're eighty eight years old.
There's always something we can do if you want to
do it to make yourself a little better than you
were the day before. Incredible, it's all good, all right, guys. Well,
(50:57):
this is another episode of the Mailroom to Jesse Mills here,
so great to join Jordan Runta again for a little
sojourn into the world of men's health and what's hot,
what's not, What you should be doing, what you shouldn't
be doing, who you should be listening to, who you
shouldn't be listening to, and everything in between. So have
(51:17):
a great time. I'll see you next time. Let's get
some learning done.
Speaker 1 (51:29):
Let's talk about it. Let's talk about the Maro. Let's
talk about it. Let's talk about the man hero. Let's
talk about it. Let's talk about the man Hero.
Speaker 3 (51:53):
The mail Room with Doctor Jesse Mills was a production
of iHeartRadio. It was executive produced by Jordan Runtog. It
was edited, mixed, and mastered by Beheid Fraser, and the
theme was provided by long Transit. If you like what
you heard, please subscribe and leave a review. For more
podcasts from iHeartRadio, check out the iHeartRadio app, Apple Podcasts,
(52:15):
or wherever you listen to your favorite shows. This program
is intended for educational and informational purposes only. It is
not a substitute for professional medical advice, diagnosis, or treatment.
Consult your healthcare provider for any medical or other related
questions or concerns. The views and discussions aired on this
podcast with those of doctor Mills and do not represent
(52:37):
the official positions of UCLA or UCLA Health
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As Director of The Men’s Clinic at UCLA, Dr. Jesse Mills has spent his career helping men understand their bodies, their hormones, and their health. Now he’s bringing that expertise to The Male Room — a podcast where data-driven medicine meets common sense. Each episode separates fact from hype, science from snake oil, and gives men the tools to live longer, stronger, and happier lives. With candor, humor, and real-world experience from the exam room and the operating room, Dr. Mills breaks down the latest health headlines, dissects trends, and explains what actually works — and what doesn’t. Smart, straightforward, and entertaining, The Male Room is the show that helps men take charge of their health without the jargon.