đź’ˇ Episode Overview
In this no-BS crash course, the doctors cover testosterone. Testosterone is one of the most misunderstood and overhyped hormones in medicine today. Often labeled as a “male hormone,” testosterone actually plays a critical role in both men and women—impacting energy, mood, cognition, bone density, muscle mass, and metabolic health. Despite its importance, research shows a concerning trend: average testosterone levels have declined by 20–25% over the past few decades, even after adjusting for age. A man in his 40s today typically has the testosterone levels of a man in his 30s a generation ago. This generational drop is not simply a reflection of aging but a sign of broader environmental and lifestyle influences. Chronic stress, poor sleep, rising obesity rates, sedentary behavior, and widespread exposure to endocrine disruptors such as BPA and pesticides all contribute to suppressed hormone production and disrupted balance.
In this episode, Drs. Nisha and Vikas Patel take an evidence-based look at testosterone through the lens of longevity and preventive medicine. They discuss the physiology of testosterone, common symptoms of deficiency, and why so many people are being overdiagnosed or overtreated through aggressive testosterone replacement therapy (TRT) without proper evaluation. Many commercial “Low T” clinics skip essential lab work and fail to address the underlying causes of hormonal decline. This approach not only risks suppressing the body’s own testosterone production but can also lead to long-term dependency, infertility, and cardiovascular complications. The episode emphasizes that sustainable optimization starts with addressing foundational health behaviors—improving sleep quality, reducing visceral fat, managing stress, engaging in resistance and high-intensity interval training, ensuring adequate protein and micronutrient intake, and minimizing alcohol and environmental toxins.
Dr. Nisha and Dr. Vikas also share a real-life case study of a 45-year-old father who arrived at their clinic exhausted and convinced he needed lifelong TRT. Instead, through a structured plan focusing on exercise, nutrition, and recovery, his testosterone increased naturally from the low 300s to the mid-500s ng/dL—without injections or medication. This story illustrates that low testosterone is often a reflection of lifestyle dysfunction, not irreversible endocrine failure. The message is clear: before resorting to external hormone therapy, identify and correct the root causes of imbalance.
As Dr. Nisha explains, “You can’t inject your way to better health. Sustainable hormone optimization begins with the fundamentals—sleep, nutrition, exercise, and stress resilience.” For patients considering TRT, medical supervision and ongoing monitoring are essential to ensure both safety and long-term well-being. Ultimately, the goal isn’t just to raise a number on a lab report—it’s to restore balance, vitality, and functional longevity.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:03):
Welcome to MD Longevity Lab, where we're playing the long
game. This is a podcast where science
meets real life with expert insights, practical tips, and
real world tools to not only live longer, but live better.
Our aim is to radically change the way medicine is practiced
and enable individuals to age gracefully, maintaining health,
(00:24):
span and vitality well into their later years.
We're your hosts, Dr. Nisha and Dr. Vikas Patel, physicians
partners in life and parents balancing work, Wellness and
everything in between. Let's dive in.
(00:44):
Welcome back to the MD LongevityLab podcast playing the long
game. I'm Doctor Nisha Patel,
physician, mom of three and Co host of this Longevity podcast.
And I'm Doctor Vikas Patel, Yardock, Navy vet, and also
apparently the guy who keeps getting asked about testosterone
(01:05):
at our dinner parties. Today we are going to tackle a
topic that's everywhere right now and that is testosterone.
This is a good follow up to the podcast we did last week on
perimenopause, menopause and estrogen depletion.
I'm sure you guys have seen tonsof ads, clinics, and Instagram
(01:29):
reels about these hyped hormones.
And testosterone is definitely one of those most hyped
hormones. And ultimately, I think there's
a lot of confusion about who actually needs testosterone
replacement and who doesn't. So today's episode is really
your crash course testosterone one O 1.
(01:50):
We're going to cover what testosterone actually does for
men and women, why levels seem to be dropping across
generations, and how to tell if your symptoms might be linked to
low T, and also really the risksof chasing a quick fix at a
strip mall clinic and not havingproper monitoring.
(02:10):
Last episode, we explored one ofthe most vital hormone
transitions for women, and that was pairing menopause and
menopause, and how shifting estrogen and progesterone levels
affect everything from mood and metabolism to brain health.
Today we're turning the spotlight to a super powerful
hormone that doesn't get nearly enough attention for women, and
(02:34):
that's testosterone. Yes, men produce more of it, but
women have it too, and it's essential for both sexes.
Testosterone plays a key role inenergy, mood, muscle mass, bone
strength, libido and overall vitality.
We're also going to explain why starting testosterone can shut
(02:54):
down your body's own natural production.
Some of the lifestyle changes I can move the needle without
medications. And our favorite part, sharing
real patients stories. Recently I took care of a 45
year old dad of three who came in saying that he's exhausted
and really just he's ready to sign off for TRT because all of
(03:16):
his buddies were on it. We'll kind of walk you through
how we think through that process and how a few months of
some targeted lifestyle changes can make your testosterone go
from the low 2 hundreds up to really normal range in the five
hundreds naturally. Yep, and we're also going to
talk about some of the hacks that people try, like cold
(03:39):
plunges and even challenging your spouse to a foot race or a
table tennis competition. Some of these actually work to
naturally boost your testosterone level.
Others, not so much. So whether you're curious,
skeptical, or already I and yourbuddy's testosterone
(03:59):
prescription, this episode's probably for you.
Think of it as the evidence based, no BS guide to
understanding testosterone and how it might fit into your long
term health. Let's jump in.
All right, so first we're going to start by defining what
testosterone actually is. Testosterone is a sex hormone
(04:19):
mostly produced in the testes inmen and in smaller amounts in
the ovaries in women. The adrenal glands also produce
small amounts of testosterone inboth men and women.
So let's talk about testosteronefor men.
It drives puberty, sperm production, muscle mass, red
blood cell production, energy, mood, and bone density.
(04:41):
So it's really a vital hormone for men.
The role in women, it's responsible for libido, which is
our sex drive, energy, bone health, our muscle mass.
So it's also a vital hormone forwomen.
Equally, we have circulating forms in our body of
testosterone. So one of them is total
(05:03):
testosterone level, which is a metric that we test for.
We also have 3 testosterone floating around in our blood.
There's also something called sex hormone binding globulin,
and I like to think of that as acarrier, the transporter for
molecules like testosterone in the body.
(05:23):
So let's go through some normal ranges of testosterone levels
for men and women. For men, we consider normal
range to be about 300 to 1000. Again, 300 is on that low level
for normal. For women, we have testosterone
in much lower levels and those average ranges are between 15 to
(05:48):
about 90. And the lower that testosterone
is, the worse we can feel. So there's several hazards to
oversimplifying. The numbers don't always tell
the full story, right? Symptoms matter an enormous
amount, and that's what we take into consideration.
I think it's very difficult to just look at one of these
numbers by itself. So you can't just look at total
(06:11):
testosterone, you can't just look at free testosterone, you
can't just look at self sex hormone binding globulin.
You have to look at all all three of those to really be able
to determine whether somebody has a quote UN quote normal
level of testosterone. That's the nuance in this.
And I hear people say all the time my testosterone was 250.
(06:31):
Yeah. But OK, what does that mean?
Like where was your sex hormone binding globulin and where was
your actual free testosterone? So that it's not, it's not so
simple just to look at one number without having some
context. And then on top of that, these
are numbers and nanograms per deciliter.
The lab references from one lab to another are different, right.
(06:51):
And so at some labs and normal testosterone ends at 800 and
that on a different lab it couldbe ending at 1100.
So you have to also look at whatthe what the reference ranges
are. In sex hormone binding globulin,
we want those numbers in a decent range.
We don't want them too low or too high.
If that number is too low, that can be caused by obesity,
(07:14):
insulin resistance and metabolicsyndrome.
So even if we give a male exogenous testosterone and his
SHBG is too low, it's not going to drive up his testosterone.
So, Vikas, why don't you tell usabout some of the trends in
testosterone levels over the years?
Yeah. So this is kind of surprising
(07:34):
and at the same time alarming. Population wide studies have
shown that the average level fortestosterone for for the
population has been decreasing from 20 to 25% over the last few
decades, and that's even after adjusting for the normal
age-related decline. So historically in the early
(07:58):
80's the average testosterone total testosterone level for a
man in his 40s was somewhere around 500 to 5:50.
Today a man of the same age averages closer to 400 to 4:50.
So that's literally 100 nanograms per deciliter lower
than where they were just 30-40 years ago.
(08:19):
That drop has been reproduced inmultiple studies.
There's a landmark study from Massachusetts that found that
men in 2004 had about a 17% lower testosterone than men in
the same age cohort from 1987. Globally, we're starting to see
similar trends are being observed in Europe and Asia.
(08:41):
It's not just in our labs here, but this is truly a generational
decline. That age-related decline that is
supposed to happen falls in the range of about 1% lower
testosterone level per year after the age of 30 in men, and
there are numerous environmentalfactors that play a role into
(09:02):
why the rate of change can be greater than that normal 1%.
So let's talk about some of the environmental factors that
contribute to this decline that we've seen over generations.
Rising obesity rates, ultra processed foods, sedentary
lifestyles. We are moving way less than a
generation before core sleep habits.
(09:26):
There's a ton of endocrine disruptors, microplastics,
pesticides, BPA, chemicals that are much more prevalent in our
day-to-day items that we use than there were 30-40 years ago.
And add chronic stress to the mix and it's a recipe for
disaster. Yeah.
So now up to 40% of men over theage of 45 have low testosterone.
(09:47):
So that's nearly half of men that are entering into their
middle years are now having low testosterone levels.
So a little bit of real talk, right?
Basically your grandfather at 40had the testosterone of today's
average 30 year old and that's really how steep this drop off
has become. Let's go through some of the
(10:08):
symptoms of having low testosterone.
One of the most notable symptomsis fatigue and low energy level,
and another symptom is decreasedlibido.
Also, men can experience erectile dysfunction and for
women, they can experience vaginal dryness and low arousal
as well. In both men and women, low
(10:30):
testosterone can result in low muscle mass and increased body
fat. But this is also.
This is kind of a circular. Definitely a chicken or the egg
problem. Low testosterone means that it's
more difficult to put on muscle,but if you're not actually
moving, it causes you to have low testosterone, right?
(10:52):
So there's definitely this phenomena of like 1 causing the
other and vice versa. Yeah.
And for men that have excess body fat, but they're placed on
testosterone, they produce something called aromatase.
And this literally converts testosterone to estrogen.
So it's one of those catch 20 twos.
(11:13):
You really have to fix body fat.Just doing testosterone and
ignoring the body fat, you're setting yourself up for failure.
You're causing men to need a man's ear.
Yeah. Along those lines, low
testosterone is also very closely linked with depressed
mood, brain fog, and then ultimately it also causes the
(11:37):
same things that low estrogen causes, because when you have
low testosterone, you also have low estrogen, which means it
increases your risk for osteopenia and osteoporosis.
We know that estrogens are protective from the standpoint
of bone loss. Yeah, and that's a tricky part.
These symptoms overlap with stress, poor diet, sleep
(11:58):
deprivation, thyroid issues. So you can't just blame
testosterone without testing forit.
I want to kind of get into a little bit of this testosterone
replacement therapy explosion and the misuse, right?
This is really where it gets messy.
So TRT ads are literally everywhere and I I feel like
(12:20):
it's prescribed so often withoutreally following real sound
medical guidelines. Right there was Ava study that
found about 17% of men were prescribed testosterone without
ever having done a blood test tocheck their levels and only 3%
actually got the full evaluationthat they were supposed to get.
(12:42):
And another huge study found that 20% of men got TRT
testosterone replacement therapyeven though their testosterone
levels were completely normal. It doesn't stop there, right?
So the guidelines show that nearly 1/4 of men on TRT never
had a baseline test at all, and almost half never get their labs
rechecked once they're actually on therapy.
(13:05):
That's literally like prescribing insulin and never
even checking your your blood sugar to see whether you need
the insulin in the first place. Exactly.
And that's so dangerous because TRT is not candy.
It needs to be prescribed carefully with proper monitoring
or you can risk some serious side effects.
So how does TRT actually affect our natural testosterone
(13:31):
production? And this is kind of one of the
big questions that we get asked by patients all the time.
You know, if I start on TRT, is my body going to stop making
testosterone? If you're on it only for a
couple months, no, your body doesn't stop.
If you're on it for a couple years, yes, your body stops
(13:52):
making testosterone. So this is really why your brain
and your testes have this communication.
And within our brain your hypothalamus, pituitary and
gonadal axis are what determine your testosterone production.
So basically your hypothalamus sends a signal through this
gonadotropin releasing hormone to your pituitary gland also in
(14:15):
your brain that sends luteinizing hormone and follicle
simulating hormone to the testestelling the testes hey we need
testosterone. Is that what they say?
Hey, we need testosterone. Yeah, that's just like, I'm
like, hey, I need food, meatloaf.
I need meatloaf. Sorry, old school reference.
(14:36):
Your testes get the signal and they make testosterone.
But if we give you outside testosterone, your body says,
cool, we've got plenty. Your brain shuts down that
hypothalamic pituitary gonadal axis.
And if it's shut down for a longenough period of time, your
test, your testes become incapable of producing
(14:58):
testosterone again on their own.So that means your own
testosterone production can potentially slow way down, or
worse, just never reproduce again.
Over time that can mean testicular shrinkage,
infertility or full on dependence on TRT which means
you are taking this lifelong. Or small wrinkly balls.
(15:20):
Remember I referenced Big Daddy?Why?
Why are you obsessed with sayingsmall wrinkly balls?
It's just a movie. Oh my God, he keeps saying that
and our kids are going to start repeating it.
You need to cut it out anyway. And not everyone recovers from
natural production. If they stop.
Some men bounce back in months. I know you have some of your
(15:41):
patients and you tell them this is temporary and we need to get
the lifestyle modifications in order.
Others stay low and require lifelong replacement, and that's
why it's not a casual decision to go on TRT.
Generally speaking, if men stay on TRT for two years or more,
their ability to produce their own testosterone becomes
(16:03):
significantly impaired. Yeah.
And that basically means they'venow bought lifelong TRT at that
point. So if you're 70 and you're
buying lifelong TRT, not the same thing as if you're 35 or 45
or even 50 buying lifelong TRT. So there are some strategies,
(16:23):
right? So there are physicians who are
very well versed in how to do this, but it is a completely
unregulated Wild West when you go to a low T clinic because you
don't know whether they're goingto be employing any risk
mitigate risk mitigation strategies for how to manage
(16:44):
your natural production of testosterone.
When we are recommending somebody that might need
testosterone replacement, we're basically only recommending it
for two reasons. One, their body is incapable of
making testosterone. They have true hypogonadism or
two as a stopgap measure to get the ball rolling, to give them
(17:06):
that energy boost, to give them the ability to do a little bit
more in the gym. But the goal is to wean them off
of it well in advance of that period of two years where now
they've bought it for the rest of their life.
Yeah, so let's get to my favorite part, and this is how
to boost your testosterone naturally, both for men and
(17:27):
women #1 is going to be focusingon not just weight loss, but
your body composition. We do full body DEXA scan to
assess your body composition andthat's a gold standard of
dividing your body into fat, lean muscle mass and your bone.
So we can kind of breakdown whatyour body is made-up of.
(17:49):
If you are just carrying excess body fat, you are creating an
enzyme called aromatase. Aromatase converts testosterone
into estrogen. So just reducing your body fat
alone can reduce that enzyme that you may called aromatase,
which means you're not susceptible to that testosterone
(18:11):
being converted to estrogen. Visceral fat is especially
problematic. So visceral fat has extra
aromatase and that's something we always talk about.
That visceral fat is that inflammatory radioactive fat.
And if you're looking to optimize your testosterone
levels, both for men and women, you really want to make sure
(18:32):
that your visceral fat levels are in check.
Exercise is another big one here, right?
So resistance training, especially the compound lifts.
So these are the big ones, the squats, dead lifts, chest
presses. You may ask why compound lifts?
Well, they're engaging the largest muscle groups and
(18:54):
they're engaging multiple musclegroups as at a time.
This is providing the largest positive feedback loop to the
hypothalamus that hey, I'm stimulating a bunch of muscles
all at the same time. We need the, we need more
testosterone to to basically stimulate testosterone in order
(19:17):
to allow the muscles to repair themselves and grow because of
the amount of resistance training that I'm doing, the
amount of muscle groups I'm activating.
So just lifting alone can boost your testosterone level.
It's one of the best ways to boost your testosterone level.
Another huge one is sleep. Sleeping 7 to 9 hours can
(19:39):
increase your testosterone production and your testosterone
spikes during deep sleep and REMsleep, and that's often cut
short when we don't sleep correctly.
So even one week of sleep restriction can drop your
testosterone by 15%. That's crazy.
One of the largest causes of lowT is sleep apnea and now that so
(20:03):
many of us are overweight, I shouldn't say us, not you, not
me specifically. It's did you see?
These muscles. No, now that so many of us in
this country are overweight, obstructive sleep apnea has
become an epidemic. So if sleep apnea is left
(20:23):
untreated, you're not going through the normal sleep cycles,
right that those deep sleep R.E.M. cycles, your testosterone
levels are going to be low. So getting that sleep study done
and properly diagnosing obstructive sleep apnea with
treatment can restore your testosterone levels.
It's the one of the biggest reasons for low T in men is
(20:45):
they're not sleeping enough. Whether they're actually not
sleeping enough because they're only budgeting 5 hours of sleep
a night or they're actually in bed for 8 hours but the quality
of their sleep sucks because they're having acnic episodes
and they're never going into deep sleep and R.E.M. sleep.
The net is the same. Their body cannot produce
(21:05):
testosterone because it's producing it at night during
those deep and R.E.M. sleep cycles.
So if you don't, if you don't get to those cycles, you're
never going to produce a sleep. Sorry, you're never going to
produce a testosterone. Hence your levels are low.
I had noticed this in my in my lab work when I was still
(21:27):
working a bit more in the ER than I do now and working a lot
of late nights and overnight shifts.
My testosterone levels were in the three hundreds and and I
felt pretty much fine. I felt like I could put on
muscle when I was exercising regularly, but the lab values
(21:47):
showed that my actual testosterone levels were pretty
low. Just going to a little bit less,
working those night and evening shifts and having a little bit
more time in bed. That alone brought my
testosterone level up a couple 100 points without doing
anything else different lifestyle wise.
So let's move to stress management.
(22:08):
We know that cortisol, the stress hormone, suppresses
testosterone and the more stressed out we are, the more
cortisol we produce. It's one of the most futile
things when I tell patients like, hey, reduce your stress
because they look at me like I want to punch my face in because
yes, it's very easy for us as doctors to tell patients to
reduce their stress. How is a completely different
(22:31):
story. So we encourage our patients to
work on mindfulness, breath work, socializing and sharing
your life stressors with loved ones or therapists can certainly
help. Because we've evolved as social
creatures, we weren't designed to be isolated.
And this, the socialization, this connection is needed as
(22:53):
part of our stress management strategy.
So remember, reducing that cortisol level by reducing
stress can increase your testosterone levels.
I think for men especially, especially in current culture,
right, the the fixation is like,well, I can handle it.
(23:13):
I can take care of this on my own.
I should be able to just handle whatever's thrown on my plate.
That has led to people honestly having poor mental health, Men
especially, having poor mental health because they're thinking
that the normal is that they're supposed to be able to handle
whatever life throws at them on their own.
(23:34):
They don't necessarily share this with their friends or their
loved ones. That's not the way that our
species evolved. Our species evolved in these
social networks where it was completely normal to share life
stresses. All the things that are
difficult should be shared with other people, and that's how we
offload stress. You can't just take stress away
(23:57):
saying, well, if I've got 10 projects that I got to take care
of, you can't just make those projects go away.
But you venting to somebody and saying, Oh my gosh, I have all
of this to do. That alone takes off some of the
burden. Someone else is sharing the load
with you all. Right, so let's dive into
nutrition and how nutrition alone can increase testosterone
(24:18):
levels naturally. So there are some nutritional
things that we can do that can improve our testosterone levels.
One is having adequate protein, right.
So if we are getting enough protein in our diet, just the
act of having more protein in our diet can provide some
stimulus for us to increase muscle mass even without an
(24:41):
actual stimulus for building muscle, meaning doing exercise.
So if you have a very low protein diet, your muscles
aren't getting a stimulus to repair themselves and turn over.
If you increase the amount of protein and you're actually
getting 20 to 30 grams of protein in the meal, then your
muscles get the stimulus that hey, there's protein around.
(25:04):
Let me do some repair activity that is actually also tied to
increasing testosterone levels. Another thing is getting the
right fats. So hopefully you guys have heard
of omega-3 fatty acids. Those are the good fats for us.
Those can help to improve our testosterone because
testosterone is made partially of those fats.
(25:27):
And then there's also these micronutrients, right?
It's difficult to have very goodtestosterone levels if we don't
have high levels of vitamin D, magnesium and zinc.
And most of the time we don't suffer very much from low levels
of zinc, but we do sometimes seepatients with low levels of
vitamin D and magnesium. Even though this isn't
(25:48):
nutrition, one of the things that can increase your
testosterone is decreasing your alcohol consumption.
Heavy drinkers tend to have lower testosterone, and this is
not just from the alcohol itself, but a lot of this has to
do with impaired sleep quality. It goes hand in hand.
(26:11):
You know, we are not completely abstinent.
I know when we go on vacation orwe go out to dinners, we are
certainly enjoying ourselves. But I think it's always in the
back of our mind that health wise this is not a habit that we
can go head first in and expect to have good health.
And I think it's forced us to just kind of pick and choose
(26:34):
when we drink. Alcohol doesn't really have any
nutritional value in our body. Our body just stores it as fat,
right? So it is a pretty big caloric
load. We store it as fat.
And when we're drinking, we're not exercising right.
We tend to drink in the evening,which then impairs our ability
(26:55):
to sleep correctly and go through proper sleep cycles.
So if you're getting a fair amount of calories from alcohol
and you're not eating good quality food, the net is that
you're not providing the stimulus that your body needs to
be able to improve your testosterone or keep it normal.
(27:16):
Another way to naturally increase your testosterone level
is to avoid endocrine disruptors.
And I will say this is really hard.
I don't like to worry about the things that are out of our
control. Let's face it, in the last three
decades, there are so many toxins, microplastics that are
just, they're everywhere. They're in our blood right now.
(27:36):
There's literally microplastics in men's sperm.
So it's everywhere. I don't want to get too hung up
on this because you can either hide in a bubble and induce so
much anxiety over worrying aboutsome of the stuff that we can't
control, or you can kind of ignore some of the stuff that's
out of our hands and say, OK, I'm going to switch a plastic
(27:58):
container to a glass container. So there's some things that you
can do for yourselves and your kids that are in your control,
but we try not to get too hung up on all these giant
environmental factors that literally are anxiety provoking.
I don't think that this is the 90% either.
So the 90% is the other stuff. It's the poor body composition,
(28:24):
the poor sleep habits, the alcohol of the processed foods.
It's the other stuff that is making up to 90%.
Then you get in the single digits, which is this stuff like
the microplastics. Yes, in an ideal world like I
don't want any exposure to this,but I don't think it's what's
causing the majority of the problem.
(28:44):
Super good point, this is my favorite.
Of course, this is your favorite.
One of the natural ways to boostyour testosterone is by
competition. If anyone knows me, I love
competition. Anything it could be.
Who can eat this hot dog the fastest?
Who can beat me in a foot race? Right, You want to compete in
(29:07):
the Nathan's Staten Island Hot Dog Contest?
No, but I would. I love competition.
I want to see that. Yeah, well, maybe I'll add that
to my bucket list. And you're just going to fill
your body up with nitrates afterthis podcast.
Yeah, I mean, once in a while a hot dog is fine.
Chicago style. Yes for sure, competition is a
super important way that we can naturally boost our
(29:30):
testosterone. Simply engaging in competition
can cause a measurable short term testosterone boost and this
is irrespective of winning or losing.
Yeah, so basically what you're saying is pick the Bears, let's
go Ben Johnson and Caleb Williams.
But I shouldn't hold my breath because they typically lose and
(29:54):
I should just pick a better football team and cheer for a
team that's going to win. Well, you sitting and watching
football for three hours a day, yes.
Or 4 1/2 four. And 1/2 or six, we generally
have this rule. If you're watching sports longer
than you're playing a sport, it's probably too much.
So we try and keep that in check, but lean into those
(30:19):
competitive outlets. Pick up basketball, a 5K race or
challenging yourself with a new PR at the gym.
Right now, you're going to deadlift a certain amount of
weight. Any competition, whether it's
with someone else or yourself, is going to boost your
testosterone level. And I love that little tidbit
that it's irrespective of whether you win or lose.
(30:42):
I lose it everything. I don't care about winning.
He doesn't. I care about winning, but the
irony is that I'm one in 425 or maybe 4025 in competitions with
because he's beat me in tennis, ping pong, foot races, deadlift
competitions and it's usually mechallenging you to these
(31:05):
competitions. Why would I challenge you?
I know, but one of these days I'm going to win like I think
I've won one time in tennis and I think you were post night
shift. Ping pong.
Yeah, you beat me in ping pong regularly.
Yeah, but I feel like I'm still a winner when it comes to that
boost in testosterone, and I am.Absolutely.
(31:28):
Yeah. A few other things that I think
are important, sunlight and circadian rhythm.
So morning sunlight exposure helps to realign our circadian
rhythm and this is very closely tied with how our body is going
to then subsequently regulate our hormone cascade.
(31:49):
So if you have some sunlight exposure in the morning and your
circadian rhythm is is tied in into the clock correctly, then
our body gets the cues properly to produce testosterone when we
go to bed. And, and this is part of this
lifestyle modification that I think is very important.
I think it's important to know too.
(32:10):
I sometimes hear these Wellness influencers without children
that are like get 20 minutes of morning sunlight.
And if you have little kids, that's nearly impossible.
So things like just putting downyour phone and not looking at
the blue light and looking outside the window, that stuff
is going to help. But some of the goals are pretty
lofty when it comes to that morning sunlight.
(32:32):
This is all about whether you'resymptomatic or not, right?
So if you're symptomatic and youhave low T, then the natural
things that we can do, you have to start to prioritize.
And that's where I think it matters.
If you feel fine and your testosterone is low and you've
got screaming kids, why would you, you know, go outside and
(32:56):
sun your ass, right? There is also a little bit of a
transient increase in testosterone from ice baths and
cold showers. It could transiently increase
your testosterone and dopamine and that can indirectly support
a little bit of energy and drive.
But this isn't really a great long term solution to increasing
(33:18):
your testosterone because this is a very transient increase
that occurs. I something that's important to
note, expecting fathers and dadswith newborns tend to have lower
testosterone levels and that's anormal physiologic response.
So we get increased prolactin levels both in the mother and
the father when we have a baby and that's that attachment to
(33:41):
hormone naturally that triggers testosterone to go low.
So it is normal when you are expecting or in the first year
that baby's born libido goes down.
And that first year of having a newborn is not the best time to
get your testosterone check. You're not sleeping well.
(34:03):
You have this exactly what you're talking about, the
hormonal response, the normal hormonal response.
And there's a combination of factors.
This is not when you should be like, oh, let me go on
testosterone therapy because my testosterone low is low.
This is what's actually physiologically supposed to
happen during that period all. Right, So let's recap.
We touch on all the things that are naturally going to increase
(34:27):
your testosterone and that is weight loss and that reduction.
So reducing your body fat, exercise in the form of
resistance training, sleeping properly and addressing any
sleep apnea issues, stress management.
We talked about nutrition and protein, alcohol in moderation,
(34:49):
avoiding endocrine disruptors asmuch as possible, though we
emphasize that this is like one of the lowest on the totem pole
that competition effect. So competing with yourself,
family members, friends, that also helps getting some morning
sunlight which will support yourcircadian rhythm and cold
(35:10):
exposure. I think it's probably worth
talking a little bit about the quick fix trap.
We had touched a little bit on the TRT clinics and quite a bit
of aggressive marketing that goes into those clinics and the
low T commercials. What's really missing from this
approach is the discussion of why your testosterone is
(35:33):
actually low. And I'm not saying that there
are not clinics who do this correctly, but a lot of them are
run by people who are not necessarily qualified to do this
type of treatment. And there is no real discussion
on, well, what was it that caused your levels to be low in
the 1st place? Do you truly have hypogonadism
or is this that you have poor sleep and you actually have
(35:57):
sleep apnea? Or is your body composition all
messed up and you just don't have enough muscle mass plus an
increase in body fat percentage that's causing this?
Do you have impaired glucose tolerance or are they screening
to see? Is this really just that you
have your hypothyroid and you don't even have low
testosterone, you really just have hypothyroidism?
(36:19):
Yeah. So let's touch on the risk of
jumping straight into testosterone replacement
therapy. A lot of men that jump into TRT
prematurely can face fertility issues.
So there's sperm production can tank and they can also
experience testicular atrophy. You can get an elevated red
blood cell count with TRT therapy, and that can increase
(36:42):
your clot risk. Also, there's some
cardiovascular risk associated with TRT.
That's still kind of up for debate, but it's a possibility
that we keep in the back of our mind.
And emotional dysregulation, we call it roid rage.
I think that was a term for it. But if you're on exogenous TRT,
you can get pretty angry. There is a difference that
(37:04):
occurs and there's a big difference between people being
on TRT and staying in the physiologic range versus people
going to these levels of, you know, occasionally I get a
patient, we check their testosterone level, they have
not disclosed that they're on TRT and their testosterone level
comes back at 2500. And you know, this will just be
(37:26):
a regular 5055 year old guy and physiologic range.
He should not be above 1000, buthis testosterone levels through
the roof. And I'm like, what are you
injecting in your butt, right? Like, And they'll be like, oh,
yeah, I forgot to tell you, I'vebeen on this for the last two
years, right? And I'm like, OK, does anybody
(37:47):
check it and see where your levels are?
Because you don't look like Arnold Schwarzenegger.
Why are your levels this high? Right.
So there are these side effects that can occur the longer that
you're on the medicine and we have to pay some attention to
where these ranges are supposed to be.
Yeah. And that there's that risk of
(38:07):
lifelong dependency, right? Once you're on it, a lot of
patients feel that they have to stay on it.
They're afraid to get off of it because they're not going to
feel well. But then we talked about that
negative feedback loop. If you're taking exogenous
testosterone, it's giving the signal to your body that your
own body does not need to produce it because hey, I've
(38:29):
already got enough. Yeah, I don't think that there's
a lot of, you know, there's a lot of anecdotal evidence on
bodybuilders that have been on testosterone for long periods of
time that have not suffered early death.
Most of those people were on relatively on the on the on the
(38:50):
how high is their testosterone. They weren't at these like 25103
thousand levels of testosterone for extended periods of time.
There are lower levels of testosterone.
If you're staying at the high end of the normal physiologic
range during TRT, you're not going to suffer the negative
consequences. The things that we're talking
about is what happens when you're outside of the normal
(39:12):
physiologic range and there are significant potential risk that
can occur when you're on those really supra therapeutic doses
of testosterone. So really what we're advocating
for is that there's a good medical approach to to TRT and
that really starts with identifying the reversible
(39:33):
causes first. Your physician should be looking
into taking a detailed history, taking baseline lab work and
saying, hey, wait, maybe this isdue to body composition.
Maybe this is due to, oh, you snore a lot at night.
Your partner says that you you keep waking up at night and
maybe you have sleep apnea. We need to order a sleep study
(39:56):
before we just throw you on TRT.So I think identifying those
reversible causes is the first line treatment.
Yeah, and let's be real, in thiscountry we love a quick fix.
We want to keep the same diet, skip the workouts, eat the junk
food and just inject our way to better health.
(40:18):
So it's no surprise that we see a lot of obese patients with
excess body fat being put on testosterone therapy, as if
that's going to magically melt the pounds away or improve their
health. It doesn't work like that.
We had discussed fat tissue actually contains that enzyme
called aromatase, which convertstestosterone into estrogen,
(40:43):
especially the visceral fat around your organs.
So if you're carrying extra fat,your body is literally turning
that extra testosterone, that you're injecting that expensive
testosterone into more estrogen.So the real issue isn't low T,
it's the obesity that's driving this hormonal imbalance in the
(41:04):
1st place. So you can't out inject a crappy
lifestyle. I mean, let's face it, this is
what causes man boobs, right? We mentioned this earlier when
you see a dude that needs a man's ear, right?
They have low T, they're overnourished, and the
testosterone that their body is making is being aromatized by
their fat tissue into estrogens,and they're actually growing
(41:27):
breast tissue. That's not what we want, right?
We want to reverse that process.And that is not as simple as,
hey, let me just inject some more testosterone.
That will not fix the problem. Can you get some sort of energy
boost out of injecting testosterone?
Yes. Are you going to put on muscle
just because you just inject testosterone?
(41:49):
Absolutely not. You still have to have the
training stimulus. You still have to actually put
in some work at the gym in orderto tell your body, let me use
the testosterone appropriately and put on muscle tissue.
Otherwise, if you're just overweight and injecting
testosterone, your man boobs arejust going to get.
(42:09):
Bigger. Yeah.
So This is why it's so importantto look at that root cause and
take that functional approach when it comes to your health.
We like to look at the full picture.
We talked about sleep, stress, nutrition, weight, alcohol and
other comorbidities and we also emphasize testing properly.
We test our patients for total testosterone, free testosterone
(42:33):
and we do not ignore that important hormone, sex hormone
binding globulin because remember that's like carrier for
testosterone. We also have to consider these
underlying medical conditions like sleep apnea that we've
emphasized, pituitary disease, metabolic syndrome, obesity.
And so looking at it from the longevity lens, testosterone
(42:56):
isn't just about performance, it's about maintaining function
and independence throughout life.
Yeah, You know, to really show what this looks like in real
life, we mentioned earlier abouta patient that I'd taken care of
not too long ago. So this 45 year old dad of three
(43:17):
who came in complaining of just feeling exhausted, just low
energy, even low sex drive and his testosterone levels were
borderline low. They were in that low 300 range.
And like a lot of guys, he came in saying I have a bunch of
friends who are on testosterone,just put me on.
(43:37):
And the conversation is difficult to have with patients.
But my preference is to say, well, I have no problem with
putting you on it if you need tobe on it, but let's just try a
couple lifestyle modifications first, see where you can get
with that. And then if that's not working,
(43:59):
certainly we can, we can put youon some testosterone
replacement. So he agreed after we had a, a
good discussion on this. And that's exactly what we did.
We worked on some of the fundamentals.
We worked on sleep, we worked onstress management, cutting back
on a little bit of alcohol and dialing in his nutrition and his
(44:20):
resistance training regimen. You know what?
After three to four months, whenwe rechecked his testosterone,
he goes from the three hundreds into the five hundreds and he's
reporting back that I feel like myself again.
And this was all done without having to put that needle in
your in your leg. And he felt alive again, right?
(44:41):
His energy was restored, his mood was better.
His strength was there. His libido came back in spite of
having 3 little kids. Because let's face it, that can
certainly take the wind out of your sails.
Yes. Yeah.
Yeah, he still had his own natural testosterone production
intact. So if he had just gone to AT
(45:01):
clinic, they would have put him on T and this poor guy at 45
would be stuck on this then depleting his own testosterone
production. So that's why it's so important
to go through the root cause. It is way harder to do the work
right. The easy thing to do is to take
the shortcut. But what we've learned is
shortcuts don't work. Where is no replacement for the
(45:25):
lifestyle modification. TRT should be a tool in order to
get your lifestyle modification in order.
So if your numbers are low and you feel like I just can't even
motivate to start this process, then TRT should be the bridge.
(45:45):
Assuming you don't have those other major issues like
hypogonadism or sleep apnea, like that's all been screened
for and you don't have these other problems, then TRT can be
the bridge to give you some of the stimulus to make it like I
have a little bit more energy now I can go to the gym, but
it's a bridge. That's it.
(46:07):
You cross the bridge and then you wean off of the TRT because
now you've implemented the lifestyle modification.
The lifestyle modification is what should be doing the bulk of
the work long term. Yeah, and that's why we
emphasize playing the long game.That's what that means, right?
TRT has its place, but it's not the first tool that we use out
of a bag. Sometimes your body just needs
(46:28):
the right conditions to be firing on all cylinders.
Again, we talked about HRT for women in our last episode and
compare that to power steering. You still have to drive the car
and know how to direct that steering wheel.
While HRT can be that power steering and really dial it in,
(46:49):
it's not a replacement for the lifestyle factors.
Exactly. I'm not against TRT and I think
it is a wonderful tool, but that's exactly what it is.
It is a tool and it needs to be used correctly.
So here's the take away. Testosterone, we've learned, is
critical for both men and women.And yes, levels are going to
(47:13):
decline with age, But lifestyle,environment and health choices
can accelerate that decline. And lifestyle, environment, and
health choices can also preserveyour numbers as well.
We can do a lot naturally, rightSleeping properly, lifting
weights, stress management, dietand all of this as well before
(47:34):
we get to the consideration of medication.
And if you do decide to look into testosterone replacement
therapy, please do it safely with a physician who looks at
the whole picture, not just a single blood test.
This is how we spend hours with patients, right?
In order to optimize someone's health and optimize their
(47:55):
hormones, you can't do it in a 15 minute visit.
This is not a one-size-fits-all.I think we have to spend time
with patients in order to get this right and make sure that
we're doing the right thing for the patient.
Really. Thanks for joining us today on
this testosterone one O 1. I think in a future episode we
are going to cover a little bit more and go in depth on what
(48:16):
testosterone replacement therapyactually looks like.
The goal here was just to give you guys the basics on the
things that go into low testosterone for the vast
majority of our population and and hopefully give you some tips
on how to increase your testosterone before jamming that
needle in your muscles in order to replace it.
(48:37):
If you found this helpful, please share with a friend and
maybe that guy from your group chat who just bought his third
bottle of Titan Testosterone Excel, but I hope you guys
enjoyed this. Until next time, keep playing
the long game. Thank you for playing the long
(49:00):
game with MD Longevity Lab. You can visit us at
www.mdlongevitylab.com to learn more about how we can support
you on your dream. Stay connected with us on social
media at MD Longevitylab for tips, updates, and behind the
scenes insights. If you enjoyed today's episode,
we'd love it if you subscribe, left us a rating, or shared it
(49:21):
with someone you know who's alsoplaying the long game.
Thanks for listening, We'll see you next time.
Welcome to MD Longevity Lab, where we're playing the long
game. This is a podcast where science
meets real life with expert insights, practical tips, and
real world tools to not only live longer, but live better.
Our aim is to radically change the way medicine is practiced
and enable individuals to age gracefully, maintaining health,
(00:24):
span and vitality well into their later years.
We're your hosts, Dr. Nisha and Dr. Vikas Patel, physicians
partners in life and parents balancing work, Wellness and
everything in between. Let's dive in.
(00:44):
Welcome back to the MD LongevityLab podcast playing the long
game. I'm Doctor Nisha Patel,
physician, mom of three and Co host of this Longevity podcast.
And I'm Doctor Vikas Patel, Yardock, Navy vet, and also
apparently the guy who keeps getting asked about testosterone
(01:05):
at our dinner parties. Today we are going to tackle a
topic that's everywhere right now and that is testosterone.
This is a good follow up to the podcast we did last week on
perimenopause, menopause and estrogen depletion.
I'm sure you guys have seen tonsof ads, clinics, and Instagram
(01:29):
reels about these hyped hormones.
And testosterone is definitely one of those most hyped
hormones. And ultimately, I think there's
a lot of confusion about who actually needs testosterone
replacement and who doesn't. So today's episode is really
your crash course testosterone one O 1.
(01:50):
We're going to cover what testosterone actually does for
men and women, why levels seem to be dropping across
generations, and how to tell if your symptoms might be linked to
low T, and also really the risksof chasing a quick fix at a
strip mall clinic and not havingproper monitoring.
(02:10):
Last episode, we explored one ofthe most vital hormone
transitions for women, and that was pairing menopause and
menopause, and how shifting estrogen and progesterone levels
affect everything from mood and metabolism to brain health.
Today we're turning the spotlight to a super powerful
hormone that doesn't get nearly enough attention for women, and
(02:34):
that's testosterone. Yes, men produce more of it, but
women have it too, and it's essential for both sexes.
Testosterone plays a key role inenergy, mood, muscle mass, bone
strength, libido and overall vitality.
We're also going to explain why starting testosterone can shut
(02:54):
down your body's own natural production.
Some of the lifestyle changes I can move the needle without
medications. And our favorite part, sharing
real patients stories. Recently I took care of a 45
year old dad of three who came in saying that he's exhausted
and really just he's ready to sign off for TRT because all of
(03:16):
his buddies were on it. We'll kind of walk you through
how we think through that process and how a few months of
some targeted lifestyle changes can make your testosterone go
from the low 2 hundreds up to really normal range in the five
hundreds naturally. Yep, and we're also going to
talk about some of the hacks that people try, like cold
(03:39):
plunges and even challenging your spouse to a foot race or a
table tennis competition. Some of these actually work to
naturally boost your testosterone level.
Others, not so much. So whether you're curious,
skeptical, or already I and yourbuddy's testosterone
(03:59):
prescription, this episode's probably for you.
Think of it as the evidence based, no BS guide to
understanding testosterone and how it might fit into your long
term health. Let's jump in.
All right, so first we're going to start by defining what
testosterone actually is. Testosterone is a sex hormone
(04:19):
mostly produced in the testes inmen and in smaller amounts in
the ovaries in women. The adrenal glands also produce
small amounts of testosterone inboth men and women.
So let's talk about testosteronefor men.
It drives puberty, sperm production, muscle mass, red
blood cell production, energy, mood, and bone density.
(04:41):
So it's really a vital hormone for men.
The role in women, it's responsible for libido, which is
our sex drive, energy, bone health, our muscle mass.
So it's also a vital hormone forwomen.
Equally, we have circulating forms in our body of
testosterone. So one of them is total
(05:03):
testosterone level, which is a metric that we test for.
We also have 3 testosterone floating around in our blood.
There's also something called sex hormone binding globulin,
and I like to think of that as acarrier, the transporter for
molecules like testosterone in the body.
(05:23):
So let's go through some normal ranges of testosterone levels
for men and women. For men, we consider normal
range to be about 300 to 1000. Again, 300 is on that low level
for normal. For women, we have testosterone
in much lower levels and those average ranges are between 15 to
(05:48):
about 90. And the lower that testosterone
is, the worse we can feel. So there's several hazards to
oversimplifying. The numbers don't always tell
the full story, right? Symptoms matter an enormous
amount, and that's what we take into consideration.
I think it's very difficult to just look at one of these
numbers by itself. So you can't just look at total
(06:11):
testosterone, you can't just look at free testosterone, you
can't just look at self sex hormone binding globulin.
You have to look at all all three of those to really be able
to determine whether somebody has a quote UN quote normal
level of testosterone. That's the nuance in this.
And I hear people say all the time my testosterone was 250.
(06:31):
Yeah. But OK, what does that mean?
Like where was your sex hormone binding globulin and where was
your actual free testosterone? So that it's not, it's not so
simple just to look at one number without having some
context. And then on top of that, these
are numbers and nanograms per deciliter.
The lab references from one lab to another are different, right.
(06:51):
And so at some labs and normal testosterone ends at 800 and
that on a different lab it couldbe ending at 1100.
So you have to also look at whatthe what the reference ranges
are. In sex hormone binding globulin,
we want those numbers in a decent range.
We don't want them too low or too high.
If that number is too low, that can be caused by obesity,
(07:14):
insulin resistance and metabolicsyndrome.
So even if we give a male exogenous testosterone and his
SHBG is too low, it's not going to drive up his testosterone.
So, Vikas, why don't you tell usabout some of the trends in
testosterone levels over the years?
Yeah. So this is kind of surprising
(07:34):
and at the same time alarming. Population wide studies have
shown that the average level fortestosterone for for the
population has been decreasing from 20 to 25% over the last few
decades, and that's even after adjusting for the normal
age-related decline. So historically in the early
(07:58):
80's the average testosterone total testosterone level for a
man in his 40s was somewhere around 500 to 5:50.
Today a man of the same age averages closer to 400 to 4:50.
So that's literally 100 nanograms per deciliter lower
than where they were just 30-40 years ago.
(08:19):
That drop has been reproduced inmultiple studies.
There's a landmark study from Massachusetts that found that
men in 2004 had about a 17% lower testosterone than men in
the same age cohort from 1987. Globally, we're starting to see
similar trends are being observed in Europe and Asia.
(08:41):
It's not just in our labs here, but this is truly a generational
decline. That age-related decline that is
supposed to happen falls in the range of about 1% lower
testosterone level per year after the age of 30 in men, and
there are numerous environmentalfactors that play a role into
(09:02):
why the rate of change can be greater than that normal 1%.
So let's talk about some of the environmental factors that
contribute to this decline that we've seen over generations.
Rising obesity rates, ultra processed foods, sedentary
lifestyles. We are moving way less than a
generation before core sleep habits.
(09:26):
There's a ton of endocrine disruptors, microplastics,
pesticides, BPA, chemicals that are much more prevalent in our
day-to-day items that we use than there were 30-40 years ago.
And add chronic stress to the mix and it's a recipe for
disaster. Yeah.
So now up to 40% of men over theage of 45 have low testosterone.
(09:47):
So that's nearly half of men that are entering into their
middle years are now having low testosterone levels.
So a little bit of real talk, right?
Basically your grandfather at 40had the testosterone of today's
average 30 year old and that's really how steep this drop off
has become. Let's go through some of the
(10:08):
symptoms of having low testosterone.
One of the most notable symptomsis fatigue and low energy level,
and another symptom is decreasedlibido.
Also, men can experience erectile dysfunction and for
women, they can experience vaginal dryness and low arousal
as well. In both men and women, low
(10:30):
testosterone can result in low muscle mass and increased body
fat. But this is also.
This is kind of a circular. Definitely a chicken or the egg
problem. Low testosterone means that it's
more difficult to put on muscle,but if you're not actually
moving, it causes you to have low testosterone, right?
(10:52):
So there's definitely this phenomena of like 1 causing the
other and vice versa. Yeah.
And for men that have excess body fat, but they're placed on
testosterone, they produce something called aromatase.
And this literally converts testosterone to estrogen.
So it's one of those catch 20 twos.
(11:13):
You really have to fix body fat.Just doing testosterone and
ignoring the body fat, you're setting yourself up for failure.
You're causing men to need a man's ear.
Yeah. Along those lines, low
testosterone is also very closely linked with depressed
mood, brain fog, and then ultimately it also causes the
(11:37):
same things that low estrogen causes, because when you have
low testosterone, you also have low estrogen, which means it
increases your risk for osteopenia and osteoporosis.
We know that estrogens are protective from the standpoint
of bone loss. Yeah, and that's a tricky part.
These symptoms overlap with stress, poor diet, sleep
(11:58):
deprivation, thyroid issues. So you can't just blame
testosterone without testing forit.
I want to kind of get into a little bit of this testosterone
replacement therapy explosion and the misuse, right?
This is really where it gets messy.
So TRT ads are literally everywhere and I I feel like
(12:20):
it's prescribed so often withoutreally following real sound
medical guidelines. Right there was Ava study that
found about 17% of men were prescribed testosterone without
ever having done a blood test tocheck their levels and only 3%
actually got the full evaluationthat they were supposed to get.
(12:42):
And another huge study found that 20% of men got TRT
testosterone replacement therapyeven though their testosterone
levels were completely normal. It doesn't stop there, right?
So the guidelines show that nearly 1/4 of men on TRT never
had a baseline test at all, and almost half never get their labs
rechecked once they're actually on therapy.
(13:05):
That's literally like prescribing insulin and never
even checking your your blood sugar to see whether you need
the insulin in the first place. Exactly.
And that's so dangerous because TRT is not candy.
It needs to be prescribed carefully with proper monitoring
or you can risk some serious side effects.
So how does TRT actually affect our natural testosterone
(13:31):
production? And this is kind of one of the
big questions that we get asked by patients all the time.
You know, if I start on TRT, is my body going to stop making
testosterone? If you're on it only for a
couple months, no, your body doesn't stop.
If you're on it for a couple years, yes, your body stops
(13:52):
making testosterone. So this is really why your brain
and your testes have this communication.
And within our brain your hypothalamus, pituitary and
gonadal axis are what determine your testosterone production.
So basically your hypothalamus sends a signal through this
gonadotropin releasing hormone to your pituitary gland also in
(14:15):
your brain that sends luteinizing hormone and follicle
simulating hormone to the testestelling the testes hey we need
testosterone. Is that what they say?
Hey, we need testosterone. Yeah, that's just like, I'm
like, hey, I need food, meatloaf.
I need meatloaf. Sorry, old school reference.
(14:36):
Your testes get the signal and they make testosterone.
But if we give you outside testosterone, your body says,
cool, we've got plenty. Your brain shuts down that
hypothalamic pituitary gonadal axis.
And if it's shut down for a longenough period of time, your
test, your testes become incapable of producing
(14:58):
testosterone again on their own.So that means your own
testosterone production can potentially slow way down, or
worse, just never reproduce again.
Over time that can mean testicular shrinkage,
infertility or full on dependence on TRT which means
you are taking this lifelong. Or small wrinkly balls.
(15:20):
Remember I referenced Big Daddy?Why?
Why are you obsessed with sayingsmall wrinkly balls?
It's just a movie. Oh my God, he keeps saying that
and our kids are going to start repeating it.
You need to cut it out anyway. And not everyone recovers from
natural production. If they stop.
Some men bounce back in months. I know you have some of your
(15:41):
patients and you tell them this is temporary and we need to get
the lifestyle modifications in order.
Others stay low and require lifelong replacement, and that's
why it's not a casual decision to go on TRT.
Generally speaking, if men stay on TRT for two years or more,
their ability to produce their own testosterone becomes
(16:03):
significantly impaired. Yeah.
And that basically means they'venow bought lifelong TRT at that
point. So if you're 70 and you're
buying lifelong TRT, not the same thing as if you're 35 or 45
or even 50 buying lifelong TRT. So there are some strategies,
(16:23):
right? So there are physicians who are
very well versed in how to do this, but it is a completely
unregulated Wild West when you go to a low T clinic because you
don't know whether they're goingto be employing any risk
mitigate risk mitigation strategies for how to manage
(16:44):
your natural production of testosterone.
When we are recommending somebody that might need
testosterone replacement, we're basically only recommending it
for two reasons. One, their body is incapable of
making testosterone. They have true hypogonadism or
two as a stopgap measure to get the ball rolling, to give them
(17:06):
that energy boost, to give them the ability to do a little bit
more in the gym. But the goal is to wean them off
of it well in advance of that period of two years where now
they've bought it for the rest of their life.
Yeah, so let's get to my favorite part, and this is how
to boost your testosterone naturally, both for men and
(17:27):
women #1 is going to be focusingon not just weight loss, but
your body composition. We do full body DEXA scan to
assess your body composition andthat's a gold standard of
dividing your body into fat, lean muscle mass and your bone.
So we can kind of breakdown whatyour body is made-up of.
(17:49):
If you are just carrying excess body fat, you are creating an
enzyme called aromatase. Aromatase converts testosterone
into estrogen. So just reducing your body fat
alone can reduce that enzyme that you may called aromatase,
which means you're not susceptible to that testosterone
(18:11):
being converted to estrogen. Visceral fat is especially
problematic. So visceral fat has extra
aromatase and that's something we always talk about.
That visceral fat is that inflammatory radioactive fat.
And if you're looking to optimize your testosterone
levels, both for men and women, you really want to make sure
(18:32):
that your visceral fat levels are in check.
Exercise is another big one here, right?
So resistance training, especially the compound lifts.
So these are the big ones, the squats, dead lifts, chest
presses. You may ask why compound lifts?
Well, they're engaging the largest muscle groups and
(18:54):
they're engaging multiple musclegroups as at a time.
This is providing the largest positive feedback loop to the
hypothalamus that hey, I'm stimulating a bunch of muscles
all at the same time. We need the, we need more
testosterone to to basically stimulate testosterone in order
(19:17):
to allow the muscles to repair themselves and grow because of
the amount of resistance training that I'm doing, the
amount of muscle groups I'm activating.
So just lifting alone can boost your testosterone level.
It's one of the best ways to boost your testosterone level.
Another huge one is sleep. Sleeping 7 to 9 hours can
(19:39):
increase your testosterone production and your testosterone
spikes during deep sleep and REMsleep, and that's often cut
short when we don't sleep correctly.
So even one week of sleep restriction can drop your
testosterone by 15%. That's crazy.
One of the largest causes of lowT is sleep apnea and now that so
(20:03):
many of us are overweight, I shouldn't say us, not you, not
me specifically. It's did you see?
These muscles. No, now that so many of us in
this country are overweight, obstructive sleep apnea has
become an epidemic. So if sleep apnea is left
(20:23):
untreated, you're not going through the normal sleep cycles,
right that those deep sleep R.E.M. cycles, your testosterone
levels are going to be low. So getting that sleep study done
and properly diagnosing obstructive sleep apnea with
treatment can restore your testosterone levels.
It's the one of the biggest reasons for low T in men is
(20:45):
they're not sleeping enough. Whether they're actually not
sleeping enough because they're only budgeting 5 hours of sleep
a night or they're actually in bed for 8 hours but the quality
of their sleep sucks because they're having acnic episodes
and they're never going into deep sleep and R.E.M. sleep.
The net is the same. Their body cannot produce
(21:05):
testosterone because it's producing it at night during
those deep and R.E.M. sleep cycles.
So if you don't, if you don't get to those cycles, you're
never going to produce a sleep. Sorry, you're never going to
produce a testosterone. Hence your levels are low.
I had noticed this in my in my lab work when I was still
(21:27):
working a bit more in the ER than I do now and working a lot
of late nights and overnight shifts.
My testosterone levels were in the three hundreds and and I
felt pretty much fine. I felt like I could put on
muscle when I was exercising regularly, but the lab values
(21:47):
showed that my actual testosterone levels were pretty
low. Just going to a little bit less,
working those night and evening shifts and having a little bit
more time in bed. That alone brought my
testosterone level up a couple 100 points without doing
anything else different lifestyle wise.
So let's move to stress management.
(22:08):
We know that cortisol, the stress hormone, suppresses
testosterone and the more stressed out we are, the more
cortisol we produce. It's one of the most futile
things when I tell patients like, hey, reduce your stress
because they look at me like I want to punch my face in because
yes, it's very easy for us as doctors to tell patients to
reduce their stress. How is a completely different
(22:31):
story. So we encourage our patients to
work on mindfulness, breath work, socializing and sharing
your life stressors with loved ones or therapists can certainly
help. Because we've evolved as social
creatures, we weren't designed to be isolated.
And this, the socialization, this connection is needed as
(22:53):
part of our stress management strategy.
So remember, reducing that cortisol level by reducing
stress can increase your testosterone levels.
I think for men especially, especially in current culture,
right, the the fixation is like,well, I can handle it.
(23:13):
I can take care of this on my own.
I should be able to just handle whatever's thrown on my plate.
That has led to people honestly having poor mental health, Men
especially, having poor mental health because they're thinking
that the normal is that they're supposed to be able to handle
whatever life throws at them on their own.
(23:34):
They don't necessarily share this with their friends or their
loved ones. That's not the way that our
species evolved. Our species evolved in these
social networks where it was completely normal to share life
stresses. All the things that are
difficult should be shared with other people, and that's how we
offload stress. You can't just take stress away
(23:57):
saying, well, if I've got 10 projects that I got to take care
of, you can't just make those projects go away.
But you venting to somebody and saying, Oh my gosh, I have all
of this to do. That alone takes off some of the
burden. Someone else is sharing the load
with you all. Right, so let's dive into
nutrition and how nutrition alone can increase testosterone
(24:18):
levels naturally. So there are some nutritional
things that we can do that can improve our testosterone levels.
One is having adequate protein, right.
So if we are getting enough protein in our diet, just the
act of having more protein in our diet can provide some
stimulus for us to increase muscle mass even without an
(24:41):
actual stimulus for building muscle, meaning doing exercise.
So if you have a very low protein diet, your muscles
aren't getting a stimulus to repair themselves and turn over.
If you increase the amount of protein and you're actually
getting 20 to 30 grams of protein in the meal, then your
muscles get the stimulus that hey, there's protein around.
(25:04):
Let me do some repair activity that is actually also tied to
increasing testosterone levels. Another thing is getting the
right fats. So hopefully you guys have heard
of omega-3 fatty acids. Those are the good fats for us.
Those can help to improve our testosterone because
testosterone is made partially of those fats.
(25:27):
And then there's also these micronutrients, right?
It's difficult to have very goodtestosterone levels if we don't
have high levels of vitamin D, magnesium and zinc.
And most of the time we don't suffer very much from low levels
of zinc, but we do sometimes seepatients with low levels of
vitamin D and magnesium. Even though this isn't
(25:48):
nutrition, one of the things that can increase your
testosterone is decreasing your alcohol consumption.
Heavy drinkers tend to have lower testosterone, and this is
not just from the alcohol itself, but a lot of this has to
do with impaired sleep quality. It goes hand in hand.
(26:11):
You know, we are not completely abstinent.
I know when we go on vacation orwe go out to dinners, we are
certainly enjoying ourselves. But I think it's always in the
back of our mind that health wise this is not a habit that we
can go head first in and expect to have good health.
And I think it's forced us to just kind of pick and choose
(26:34):
when we drink. Alcohol doesn't really have any
nutritional value in our body. Our body just stores it as fat,
right? So it is a pretty big caloric
load. We store it as fat.
And when we're drinking, we're not exercising right.
We tend to drink in the evening,which then impairs our ability
(26:55):
to sleep correctly and go through proper sleep cycles.
So if you're getting a fair amount of calories from alcohol
and you're not eating good quality food, the net is that
you're not providing the stimulus that your body needs to
be able to improve your testosterone or keep it normal.
(27:16):
Another way to naturally increase your testosterone level
is to avoid endocrine disruptors.
And I will say this is really hard.
I don't like to worry about the things that are out of our
control. Let's face it, in the last three
decades, there are so many toxins, microplastics that are
just, they're everywhere. They're in our blood right now.
(27:36):
There's literally microplastics in men's sperm.
So it's everywhere. I don't want to get too hung up
on this because you can either hide in a bubble and induce so
much anxiety over worrying aboutsome of the stuff that we can't
control, or you can kind of ignore some of the stuff that's
out of our hands and say, OK, I'm going to switch a plastic
(27:58):
container to a glass container. So there's some things that you
can do for yourselves and your kids that are in your control,
but we try not to get too hung up on all these giant
environmental factors that literally are anxiety provoking.
I don't think that this is the 90% either.
So the 90% is the other stuff. It's the poor body composition,
(28:24):
the poor sleep habits, the alcohol of the processed foods.
It's the other stuff that is making up to 90%.
Then you get in the single digits, which is this stuff like
the microplastics. Yes, in an ideal world like I
don't want any exposure to this,but I don't think it's what's
causing the majority of the problem.
(28:44):
Super good point, this is my favorite.
Of course, this is your favorite.
One of the natural ways to boostyour testosterone is by
competition. If anyone knows me, I love
competition. Anything it could be.
Who can eat this hot dog the fastest?
Who can beat me in a foot race? Right, You want to compete in
(29:07):
the Nathan's Staten Island Hot Dog Contest?
No, but I would. I love competition.
I want to see that. Yeah, well, maybe I'll add that
to my bucket list. And you're just going to fill
your body up with nitrates afterthis podcast.
Yeah, I mean, once in a while a hot dog is fine.
Chicago style. Yes for sure, competition is a
super important way that we can naturally boost our
(29:30):
testosterone. Simply engaging in competition
can cause a measurable short term testosterone boost and this
is irrespective of winning or losing.
Yeah, so basically what you're saying is pick the Bears, let's
go Ben Johnson and Caleb Williams.
But I shouldn't hold my breath because they typically lose and
(29:54):
I should just pick a better football team and cheer for a
team that's going to win. Well, you sitting and watching
football for three hours a day, yes.
Or 4 1/2 four. And 1/2 or six, we generally
have this rule. If you're watching sports longer
than you're playing a sport, it's probably too much.
So we try and keep that in check, but lean into those
(30:19):
competitive outlets. Pick up basketball, a 5K race or
challenging yourself with a new PR at the gym.
Right now, you're going to deadlift a certain amount of
weight. Any competition, whether it's
with someone else or yourself, is going to boost your
testosterone level. And I love that little tidbit
that it's irrespective of whether you win or lose.
(30:42):
I lose it everything. I don't care about winning.
He doesn't. I care about winning, but the
irony is that I'm one in 425 or maybe 4025 in competitions with
because he's beat me in tennis, ping pong, foot races, deadlift
competitions and it's usually mechallenging you to these
(31:05):
competitions. Why would I challenge you?
I know, but one of these days I'm going to win like I think
I've won one time in tennis and I think you were post night
shift. Ping pong.
Yeah, you beat me in ping pong regularly.
Yeah, but I feel like I'm still a winner when it comes to that
boost in testosterone, and I am.Absolutely.
(31:28):
Yeah. A few other things that I think
are important, sunlight and circadian rhythm.
So morning sunlight exposure helps to realign our circadian
rhythm and this is very closely tied with how our body is going
to then subsequently regulate our hormone cascade.
(31:49):
So if you have some sunlight exposure in the morning and your
circadian rhythm is is tied in into the clock correctly, then
our body gets the cues properly to produce testosterone when we
go to bed. And, and this is part of this
lifestyle modification that I think is very important.
I think it's important to know too.
(32:10):
I sometimes hear these Wellness influencers without children
that are like get 20 minutes of morning sunlight.
And if you have little kids, that's nearly impossible.
So things like just putting downyour phone and not looking at
the blue light and looking outside the window, that stuff
is going to help. But some of the goals are pretty
lofty when it comes to that morning sunlight.
(32:32):
This is all about whether you'resymptomatic or not, right?
So if you're symptomatic and youhave low T, then the natural
things that we can do, you have to start to prioritize.
And that's where I think it matters.
If you feel fine and your testosterone is low and you've
got screaming kids, why would you, you know, go outside and
(32:56):
sun your ass, right? There is also a little bit of a
transient increase in testosterone from ice baths and
cold showers. It could transiently increase
your testosterone and dopamine and that can indirectly support
a little bit of energy and drive.
But this isn't really a great long term solution to increasing
(33:18):
your testosterone because this is a very transient increase
that occurs. I something that's important to
note, expecting fathers and dadswith newborns tend to have lower
testosterone levels and that's anormal physiologic response.
So we get increased prolactin levels both in the mother and
the father when we have a baby and that's that attachment to
(33:41):
hormone naturally that triggers testosterone to go low.
So it is normal when you are expecting or in the first year
that baby's born libido goes down.
And that first year of having a newborn is not the best time to
get your testosterone check. You're not sleeping well.
(34:03):
You have this exactly what you're talking about, the
hormonal response, the normal hormonal response.
And there's a combination of factors.
This is not when you should be like, oh, let me go on
testosterone therapy because my testosterone low is low.
This is what's actually physiologically supposed to
happen during that period all. Right, So let's recap.
We touch on all the things that are naturally going to increase
(34:27):
your testosterone and that is weight loss and that reduction.
So reducing your body fat, exercise in the form of
resistance training, sleeping properly and addressing any
sleep apnea issues, stress management.
We talked about nutrition and protein, alcohol in moderation,
(34:49):
avoiding endocrine disruptors asmuch as possible, though we
emphasize that this is like one of the lowest on the totem pole
that competition effect. So competing with yourself,
family members, friends, that also helps getting some morning
sunlight which will support yourcircadian rhythm and cold
(35:10):
exposure. I think it's probably worth
talking a little bit about the quick fix trap.
We had touched a little bit on the TRT clinics and quite a bit
of aggressive marketing that goes into those clinics and the
low T commercials. What's really missing from this
approach is the discussion of why your testosterone is
(35:33):
actually low. And I'm not saying that there
are not clinics who do this correctly, but a lot of them are
run by people who are not necessarily qualified to do this
type of treatment. And there is no real discussion
on, well, what was it that caused your levels to be low in
the 1st place? Do you truly have hypogonadism
or is this that you have poor sleep and you actually have
(35:57):
sleep apnea? Or is your body composition all
messed up and you just don't have enough muscle mass plus an
increase in body fat percentage that's causing this?
Do you have impaired glucose tolerance or are they screening
to see? Is this really just that you
have your hypothyroid and you don't even have low
testosterone, you really just have hypothyroidism?
(36:19):
Yeah. So let's touch on the risk of
jumping straight into testosterone replacement
therapy. A lot of men that jump into TRT
prematurely can face fertility issues.
So there's sperm production can tank and they can also
experience testicular atrophy. You can get an elevated red
blood cell count with TRT therapy, and that can increase
(36:42):
your clot risk. Also, there's some
cardiovascular risk associated with TRT.
That's still kind of up for debate, but it's a possibility
that we keep in the back of our mind.
And emotional dysregulation, we call it roid rage.
I think that was a term for it. But if you're on exogenous TRT,
you can get pretty angry. There is a difference that
(37:04):
occurs and there's a big difference between people being
on TRT and staying in the physiologic range versus people
going to these levels of, you know, occasionally I get a
patient, we check their testosterone level, they have
not disclosed that they're on TRT and their testosterone level
comes back at 2500. And you know, this will just be
(37:26):
a regular 5055 year old guy and physiologic range.
He should not be above 1000, buthis testosterone levels through
the roof. And I'm like, what are you
injecting in your butt, right? Like, And they'll be like, oh,
yeah, I forgot to tell you, I'vebeen on this for the last two
years, right? And I'm like, OK, does anybody
(37:47):
check it and see where your levels are?
Because you don't look like Arnold Schwarzenegger.
Why are your levels this high? Right.
So there are these side effects that can occur the longer that
you're on the medicine and we have to pay some attention to
where these ranges are supposed to be.
Yeah. And that there's that risk of
(38:07):
lifelong dependency, right? Once you're on it, a lot of
patients feel that they have to stay on it.
They're afraid to get off of it because they're not going to
feel well. But then we talked about that
negative feedback loop. If you're taking exogenous
testosterone, it's giving the signal to your body that your
own body does not need to produce it because hey, I've
(38:29):
already got enough. Yeah, I don't think that there's
a lot of, you know, there's a lot of anecdotal evidence on
bodybuilders that have been on testosterone for long periods of
time that have not suffered early death.
Most of those people were on relatively on the on the on the
(38:50):
how high is their testosterone. They weren't at these like 25103
thousand levels of testosterone for extended periods of time.
There are lower levels of testosterone.
If you're staying at the high end of the normal physiologic
range during TRT, you're not going to suffer the negative
consequences. The things that we're talking
about is what happens when you're outside of the normal
(39:12):
physiologic range and there are significant potential risk that
can occur when you're on those really supra therapeutic doses
of testosterone. So really what we're advocating
for is that there's a good medical approach to to TRT and
that really starts with identifying the reversible
(39:33):
causes first. Your physician should be looking
into taking a detailed history, taking baseline lab work and
saying, hey, wait, maybe this isdue to body composition.
Maybe this is due to, oh, you snore a lot at night.
Your partner says that you you keep waking up at night and
maybe you have sleep apnea. We need to order a sleep study
(39:56):
before we just throw you on TRT.So I think identifying those
reversible causes is the first line treatment.
Yeah, and let's be real, in thiscountry we love a quick fix.
We want to keep the same diet, skip the workouts, eat the junk
food and just inject our way to better health.
(40:18):
So it's no surprise that we see a lot of obese patients with
excess body fat being put on testosterone therapy, as if
that's going to magically melt the pounds away or improve their
health. It doesn't work like that.
We had discussed fat tissue actually contains that enzyme
called aromatase, which convertstestosterone into estrogen,
(40:43):
especially the visceral fat around your organs.
So if you're carrying extra fat,your body is literally turning
that extra testosterone, that you're injecting that expensive
testosterone into more estrogen.So the real issue isn't low T,
it's the obesity that's driving this hormonal imbalance in the
(41:04):
1st place. So you can't out inject a crappy
lifestyle. I mean, let's face it, this is
what causes man boobs, right? We mentioned this earlier when
you see a dude that needs a man's ear, right?
They have low T, they're overnourished, and the
testosterone that their body is making is being aromatized by
their fat tissue into estrogens,and they're actually growing
(41:27):
breast tissue. That's not what we want, right?
We want to reverse that process.And that is not as simple as,
hey, let me just inject some more testosterone.
That will not fix the problem. Can you get some sort of energy
boost out of injecting testosterone?
Yes. Are you going to put on muscle
just because you just inject testosterone?
(41:49):
Absolutely not. You still have to have the
training stimulus. You still have to actually put
in some work at the gym in orderto tell your body, let me use
the testosterone appropriately and put on muscle tissue.
Otherwise, if you're just overweight and injecting
testosterone, your man boobs arejust going to get.
(42:09):
Bigger. Yeah.
So This is why it's so importantto look at that root cause and
take that functional approach when it comes to your health.
We like to look at the full picture.
We talked about sleep, stress, nutrition, weight, alcohol and
other comorbidities and we also emphasize testing properly.
We test our patients for total testosterone, free testosterone
(42:33):
and we do not ignore that important hormone, sex hormone
binding globulin because remember that's like carrier for
testosterone. We also have to consider these
underlying medical conditions like sleep apnea that we've
emphasized, pituitary disease, metabolic syndrome, obesity.
And so looking at it from the longevity lens, testosterone
(42:56):
isn't just about performance, it's about maintaining function
and independence throughout life.
Yeah, You know, to really show what this looks like in real
life, we mentioned earlier abouta patient that I'd taken care of
not too long ago. So this 45 year old dad of three
(43:17):
who came in complaining of just feeling exhausted, just low
energy, even low sex drive and his testosterone levels were
borderline low. They were in that low 300 range.
And like a lot of guys, he came in saying I have a bunch of
friends who are on testosterone,just put me on.
(43:37):
And the conversation is difficult to have with patients.
But my preference is to say, well, I have no problem with
putting you on it if you need tobe on it, but let's just try a
couple lifestyle modifications first, see where you can get
with that. And then if that's not working,
(43:59):
certainly we can, we can put youon some testosterone
replacement. So he agreed after we had a, a
good discussion on this. And that's exactly what we did.
We worked on some of the fundamentals.
We worked on sleep, we worked onstress management, cutting back
on a little bit of alcohol and dialing in his nutrition and his
(44:20):
resistance training regimen. You know what?
After three to four months, whenwe rechecked his testosterone,
he goes from the three hundreds into the five hundreds and he's
reporting back that I feel like myself again.
And this was all done without having to put that needle in
your in your leg. And he felt alive again, right?
(44:41):
His energy was restored, his mood was better.
His strength was there. His libido came back in spite of
having 3 little kids. Because let's face it, that can
certainly take the wind out of your sails.
Yes. Yeah.
Yeah, he still had his own natural testosterone production
intact. So if he had just gone to AT
(45:01):
clinic, they would have put him on T and this poor guy at 45
would be stuck on this then depleting his own testosterone
production. So that's why it's so important
to go through the root cause. It is way harder to do the work
right. The easy thing to do is to take
the shortcut. But what we've learned is
shortcuts don't work. Where is no replacement for the
(45:25):
lifestyle modification. TRT should be a tool in order to
get your lifestyle modification in order.
So if your numbers are low and you feel like I just can't even
motivate to start this process, then TRT should be the bridge.
(45:45):
Assuming you don't have those other major issues like
hypogonadism or sleep apnea, like that's all been screened
for and you don't have these other problems, then TRT can be
the bridge to give you some of the stimulus to make it like I
have a little bit more energy now I can go to the gym, but
it's a bridge. That's it.
(46:07):
You cross the bridge and then you wean off of the TRT because
now you've implemented the lifestyle modification.
The lifestyle modification is what should be doing the bulk of
the work long term. Yeah, and that's why we
emphasize playing the long game.That's what that means, right?
TRT has its place, but it's not the first tool that we use out
of a bag. Sometimes your body just needs
(46:28):
the right conditions to be firing on all cylinders.
Again, we talked about HRT for women in our last episode and
compare that to power steering. You still have to drive the car
and know how to direct that steering wheel.
While HRT can be that power steering and really dial it in,
(46:49):
it's not a replacement for the lifestyle factors.
Exactly. I'm not against TRT and I think
it is a wonderful tool, but that's exactly what it is.
It is a tool and it needs to be used correctly.
So here's the take away. Testosterone, we've learned, is
critical for both men and women.And yes, levels are going to
(47:13):
decline with age, But lifestyle,environment and health choices
can accelerate that decline. And lifestyle, environment, and
health choices can also preserveyour numbers as well.
We can do a lot naturally, rightSleeping properly, lifting
weights, stress management, dietand all of this as well before
(47:34):
we get to the consideration of medication.
And if you do decide to look into testosterone replacement
therapy, please do it safely with a physician who looks at
the whole picture, not just a single blood test.
This is how we spend hours with patients, right?
In order to optimize someone's health and optimize their
(47:55):
hormones, you can't do it in a 15 minute visit.
This is not a one-size-fits-all.I think we have to spend time
with patients in order to get this right and make sure that
we're doing the right thing for the patient.
Really. Thanks for joining us today on
this testosterone one O 1. I think in a future episode we
are going to cover a little bit more and go in depth on what
(48:16):
testosterone replacement therapyactually looks like.
The goal here was just to give you guys the basics on the
things that go into low testosterone for the vast
majority of our population and and hopefully give you some tips
on how to increase your testosterone before jamming that
needle in your muscles in order to replace it.
(48:37):
If you found this helpful, please share with a friend and
maybe that guy from your group chat who just bought his third
bottle of Titan Testosterone Excel, but I hope you guys
enjoyed this. Until next time, keep playing
the long game. Thank you for playing the long
(49:00):
game with MD Longevity Lab. You can visit us at
www.mdlongevitylab.com to learn more about how we can support
you on your dream. Stay connected with us on social
media at MD Longevitylab for tips, updates, and behind the
scenes insights. If you enjoyed today's episode,
we'd love it if you subscribe, left us a rating, or shared it
(49:21):
with someone you know who's alsoplaying the long game.
Thanks for listening, We'll see you next time.
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The Burden
The Burden is a documentary series that takes listeners into the hidden places where justice is done (and undone). It dives deep into the lives of heroes and villains. And it focuses a spotlight on those who triumph even when the odds are against them. Season 5 - The Burden: Death & Deceit in Alliance On April Fools Day 1999, 26-year-old Yvonne Layne was found murdered in her Alliance, Ohio home. David Thorne, her ex-boyfriend and father of one of her children, was instantly a suspect. Another young man admitted to the murder, and David breathed a sigh of relief, until the confessed murderer fingered David; “He paid me to do it.” David was sentenced to life without parole. Two decades later, Pulitzer winner and podcast host, Maggie Freleng (Bone Valley Season 3: Graves County, Wrongful Conviction, Suave) launched a “live” investigation into David's conviction alongside Jason Baldwin (himself wrongfully convicted as a member of the West Memphis Three). Maggie had come to believe that the entire investigation of David was botched by the tiny local police department, or worse, covered up the real killer. Was Maggie correct? Was David’s claim of innocence credible? In Death and Deceit in Alliance, Maggie recounts the case that launched her career, and ultimately, “broke” her.” The results will shock the listener and reduce Maggie to tears and self-doubt. This is not your typical wrongful conviction story. In fact, it turns the genre on its head. It asks the question: What if our champions are foolish? Season 4 - The Burden: Get the Money and Run “Trying to murder my father, this was the thing that put me on the path.” That’s Joe Loya and that path was bank robbery. Bank, bank, bank, bank, bank. In season 4 of The Burden: Get the Money and Run, we hear from Joe who was once the most prolific bank robber in Southern California, and beyond. He used disguises, body doubles, proxies. He leaped over counters, grabbed the money and ran. Even as the FBI was closing in. It was a showdown between a daring bank robber, and a patient FBI agent. Joe was no ordinary bank robber. He was bright, articulate, charismatic, and driven by a dark rage that he summoned up at will. In seven episodes, Joe tells all: the what, the how… and the why. Including why he tried to murder his father. Season 3 - The Burden: Avenger Miriam Lewin is one of Argentina’s leading journalists today. At 19 years old, she was kidnapped off the streets of Buenos Aires for her political activism and thrown into a concentration camp. Thousands of her fellow inmates were executed, tossed alive from a cargo plane into the ocean. Miriam, along with a handful of others, will survive the camp. Then as a journalist, she will wage a decades long campaign to bring her tormentors to justice. Avenger is about one woman’s triumphant battle against unbelievable odds to survive torture, claim justice for the crimes done against her and others like her, and change the future of her country. Season 2 - The Burden: Empire on Blood Empire on Blood is set in the Bronx, NY, in the early 90s, when two young drug dealers ruled an intersection known as “The Corner on Blood.” The boss, Calvin Buari, lived large. He and a protege swore they would build an empire on blood. Then the relationship frayed and the protege accused Calvin of a double homicide which he claimed he didn’t do. But did he? Award-winning journalist Steve Fishman spent seven years to answer that question. This is the story of one man’s last chance to overturn his life sentence. He may prevail, but someone’s gotta pay. The Burden: Empire on Blood is the director’s cut of the true crime classic which reached #1 on the charts when it was first released half a dozen years ago. Season 1 - The Burden In the 1990s, Detective Louis N. Scarcella was legendary. In a city overrun by violent crime, he cracked the toughest cases and put away the worst criminals. “The Hulk” was his nickname. Then the story changed. Scarcella ran into a group of convicted murderers who all say they are innocent. They turned themselves into jailhouse-lawyers and in prison founded a lway firm. When they realized Scarcella helped put many of them away, they set their sights on taking him down. And with the help of a NY Times reporter they have a chance. For years, Scarcella insisted he did nothing wrong. But that’s all he’d say. Until we tracked Scarcella to a sauna in a Russian bathhouse, where he started to talk..and talk and talk. “The guilty have gone free,” he whispered. And then agreed to take us into the belly of the beast. Welcome to The Burden.