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myths about men's testosterone replacement

What’s The Episode About?

In this episode,  I’ll be talking about testosterone and debunking the four common myths about testosterone replacement therapy in men. There’s been a lot of controversy about men’s testosterone replacement throughout the years and the myths have been found to be perpetuated by fear and lack of understanding among patients and medical providers. 

As a man, you really need to make sure you have the correct information and you aren’t putting something off just because you have been given incorrect information.

Tune in as I share all the right information about men’s testosterone issues so you can get the right treatment from your medical provider or avoid the dire consequences of low testosterone altogether.

Key Points Discussed:

  • Fighting misinformation with the correct information backed by studies (01:57)
  • What is total testosterone and free testosterone? (03:12)
  • The huge list of consequences of low testosterone (04:49)
  • The numerous myths we hear about testosterone (07:54)
  • Does testosterone cause strokes and heart attacks? (13:49)
  • It’s the lack of testosterone that is making you irritable (23:20)

Where Can You Learn More?


When Was It Published?

October 16, 2019

Episode Transcript

Disclaimer: The Transcript Is Auto-Generated And May Contain Spelling And Grammar Errors


00:00          To say there’s been a lot of controversy about men’s testosterone replacement throughout the years is an understatement. In fact, I would say it’s a huge understatement. I’ve been successfully treating low testosterone in both men and women for quite a number of years. This podcast episode focuses on men’s testosterone.


00:21          Here at The Optimal CEO Podcast, we help CEO entrepreneurs who love taking ownership of their wellness journey, but because they know it’s their most prized investment and when their state of wellness is at its peak, their income source. We want to help relieve CEO entrepreneurs from the pressure of unnecessary health exposure so they can be highly focused on growing their business and physically optimize for the journey so they can enjoy getting there.


00:56          Hi. I’m Dr. Brian Brown and I’d like to personally welcome you to today’s podcast episode. Thank you for joining me. To say there’s been a lot of controversy about men’s testosterone replacement throughout the years is an understatement. In fact, I would say it’s a huge understatement. I’ve been successfully treating low testosterone in both men and women for quite a number of years. This podcast episode focuses on men’s testosterone. We’ll be focusing on women’s low testosterone coming up, which will be equally as interesting. But, I have been treating low testosterone for a number of years, and these same myths keep coming up over and over, and over again. Sadly, I think the perpetuating of these myths is due to fear and lack of understanding on behalf of both patients and medical providers. What’s the answer? Well, I’m not really sure what the answer is, other than I always fight misinformation with information.


01:57          The correct information backed up by studies. And the studies are actually out there that support over… in fact, over 30 years worth of studies are out there to support the benefits of testosterone replacement therapy in men. It was only until recently, in recent years, that a study came out that through fear into everybody’s minds when it came to low testosterone and treating low testosterone in men. And, I’ll talk more about that in a minute, but that one particular study doesn’t negate 30 years of positive information and positive benefits for testosterone. So, let’s dig in. The first thing that you need to understand when it comes to testosterone and men, that as a man ages, starting around age 30, a man can expect to lose about one to 2% per year of his testosterone output, whether it be gonadal function in the gonads putting out enough testosterone, or conversion of that testosterone, total testosterone to free testosterone. And, you don’t need to get caught up in all the legal mumbo jumbo, or the technical terminology, when it comes to free testosterone versus total testosterone.


03:12          What you do need to know is that total testosterone is simply all the testosterone in the body, that… that’s free and circulating and ready for use, and that that’s not free and circulating and ready for use. The free testosterone, on the other hand, is that that is ready for use right now. That’s the one that we typically pay the most attention to when we’re looking at balancing a man’s testosterone. One of the problems we run into in primary care settings, urological settings, is that very rarely do you see medical providers check a free testosterone level. They typically only do a total testosterone level. The sad thing is, is that you can’t really treat a total testosterone. If you base your clinical practice off what research studies do in their study designs, they actually check free and total testosterone, and when they’re treating testosterone, or giving testosterone replacement to treat low testosterone, they’re actually treating.


04:08          They’re looking at those free testosterone level numbers. So those are critically important to understand that we should be having those checked by our medical providers when we’re talking about apples to apples. Otherwise you’re comparing apples to oranges and there’s no comparison. So if you look at, by the time a man has a decade of hormone loss, if that starts around age 30 you’re looking at a 10 to 20% decline in his testosterone available testosterone by the time he’s 40 or 45 depending on when he started that decline. And by the time he’s 50 years old, I mean we’re looking at 20 to 40% deficit and testosterone. So what are the consequences of low testosterone with the low testosterone consequences, of course, or a reduced body hair, decreased libido, erectile dysfunction, and fertility. Osteoporosis. I mean this is a huge list. Depressed mood, increased risk of coronary artery disease, elevated blood sugars, increased cholesterol, and folks, this is all coming from the studies.


05:11          I pulled these from research articles that are out there, published in medical journals, increased risk for type two diabetes, decreased energy, decreased strength, stamina, endurance, decreased work performance, decrease hobby participation, decrease in home life activity, increased sadness and grumpiness. Believe it or not, one study talked about the grumpiness and sadness of men falling asleep easily if seated or sitting still for a short period of time. Changes in sleep patterns, emotional changes, irritability, depression, sadness, anxiety, decreased motivation, decreased self-confidence, reduced muscle mass, trouble concentrating, decreased sex drive, decrease intensity of orgasms, decline in erectile firmness and loss of morning erections. The list goes on and on and on. These are only a few that have the top clinical problems that we see with low testosterone, but these are things that men deal with all the time. Other things that men deal with are increased body fat, decreasing bone density, memory loss, brain fog, trouble concentrating, sore, achy muscles and our joints.


06:17          It’s really crazy. One of the questions that I ask when I do an intake on someone when they first come in is on a scale of zero to four, four being the worst symptoms, zero being no symptoms at all rate for me how achy your joints are. Then I asked the same thing how achy are your muscles and rate it on that same scale. A lot of times guys will come back and they’ll, they’ll write that at a zero Oh I’m not having any problem. And then when they come back for their follow up after they’ve been on testosterone for six, eight weeks, then they’re rating it at a three so they’re rating it as moderate, not severe, but moderate last time that was rated as no symptoms. And so I ask him to say, well, what’s going on there? Why all of a sudden did you not have this before the testosterone and now you have it after starting the testosterone?


07:05          And they say, well, I really didn’t realize how bad I felt until I got on the testosterone. And then I started feeling better. I guess it was pretty severe. And I think there’s a a degree of ego. Maybe. I don’t know that that’s the correct word. Uh, it’s definitely a degree of not wanting to admit that there’s a problem that we all do. I see this in both men and women where we minimize our symptoms and it’s not till after we get the symptoms treated that we realize, Holy cow, I feel so much better. So when we look at what primary care does, what specialty practice does, whether it be urology or whatever, when it comes to looking at testosterone, there’s some myths. So let’s go over those myths real quick. So one scenario plays out. You go into your primary care, your medical provider, whoever it is, your specialist, I don’t care.


07:54          And you say, doc, I’m feeling horrible. I have no energy. My mood is in the tank, my libido is shot. I’ve lost my zeal for a life. My stamina, endurance are gone. And I just don’t feel like getting off the couch to do anything. If I sit for more than five minutes, I’ll fall asleep. Well, your medical provider does due diligence and checks your hormone levels and comes back and says, you know your testosterone and the rest of your lab work is normal. You don’t need any testosterone right now. Let’s recheck this in a year and you’re left kind of holding the bag thinking, God, I just, I checked with dr Google. I just knew that dr Google had it right and it was my testosterone, my testosterone was low and I’ll come back and address that here in just a second as to why that happens or why I think it happens most frequently.


08:43          But the next myth that we have is you are speaking to a friend and it’s the scenario you go, Hey John, I’m thinking about getting on testosterone. I think I need some testosterone and replacement. I know Mike over here, he on testosterone replacement, he feels so much better. He’s doing great and I have a lot of same symptoms he had before he got on it and I think I just need to get some testosterone replacement. I haven’t been feeling right lately and I’ve been doing some reading and I just think that’s what it is. And your friend replies back to you, Hey man, you know, I’ve heard bad things about testosterone replacement. I’ve heard it can make you have a heart attack. I, I don’t think I would take the risk if I were you. You’ve got a wife and three kids and it’s just a risk that’s not worth it.


09:25          And the other myth that you hear plays out something like this. You go to your medical provider, you’d sell them that you’re not feeling well. Your medical provider does due diligence checks your testosterone, compares it to the number last year and says, you know what? Yeah, I think maybe there might be something going on here. So they go ahead and put you on testosterone replacement and then they follow back up with you and about a month and a half, two months and two weeks later, after you get that lab work drawn, you get a phone call from the office and says, Hey, this is Dr. Smith calling your testosterone level is super high. We need to decrease that dose ASAP. Also, one of your blood levels called a hemoglobin was increased and we’re going to need to send you over to the blood blank blood bank to get some blood drawn off.


10:17          So that’s myth number three. Myth number four goes something like this, doc, I’m feeling horrible. I don’t have any energy. My mood is in the tank, my libido is shot. I’m just not myself. If I sit for too long, I fall asleep. Your medical provider response like, well your testosterone is not normal. You have many of the symptoms of low testosterone. I would like to put you on a testosterone injections every two weeks. I’ll teach you how to do it here in the office or my nurse will teach you how to do it and Wilson at home with you so you can do self injections. And so I want to go through these one by one. Not all of them are bad. Not all of them are good either. So when we’re looking at the scenario number one where you go into your primary care provider, your medical provider and they tell you everything is normal.


11:03          Well the problem there is if you understand laboratory reports and this is critical to understand the laboratory report, the way they’re reported, every single laboratory in the country has a reference range for quote unquote normal labs on the right hand side of the page and every medical provider, well not every most every medical provider is going to look to see if that number that was reported from when they drew your blood fits within that reference range and if it fits within that reference range and they consider you normal. The problem with that is, I’ll use myself as an example, being 50 years of age, I turned 50 this year. I don’t feel it. I feel younger than I’ve ever felt. When you’re 50 years old and you have your lab work drawn, you’re compared to every other 50 year old male in that same pool of information at that particular laboratory.


12:00          Now if there’s a new laboratory that starting up, they’re going to use some standard numbers, but over time they will develop their reference range based on their pool of test specimens. That means your blood. So they will develop their own database of what’s normal. Well, I’ve gotta be honest with you, if you go back to the very first example where I said, you know, we have to understand that starting around age 30 35 we lose one to 2% per year of either hormone output or hormone conversion. Then by the time you’re 50 years old, you’re at 20 to 40% behind the eight ball and that means every other 50 year old, and that pool of data in that pool of blood samples is also 20 to 40% depleted. So my joke on that is I said, if you want to feel like a 50 year old yes, treats your, your numbers to normal reference range lab values, that will, the answer is you don’t want that.


12:56          You want to be optimized. You want to make sure that you’re at the level where you were. If I were to lie, which I’m not going to do. But if I were to substitute a data birth on your laboratory order sheet that said you were 25 years old, then that that testosterone level that came back normal, what actually flag out as too low. So we want that testosterone to be optimized, which means we really want that testosterone level to be somewhere in the neighborhood of where it was between to age 25 and 30 preferably closer to 25 so when you’re in functional and integrative medicine, you actually have those numbers in your head. You know it’s acceptable and you just shoot for those particular numbers. So myth number two, you and your friend or dialogue and you’re telling your friend you need to get on some testosterone because you’ve been doing a little research and Mike over there, he did so good with so well with the testosterone replacement.


13:49          And your friend says, man, I’ve heard it can make you have a heart attack. I don’t know that I would do that. So what I have to say about that is in 2013, a media outlets were overwhelmed with the information that testosterone replacement therapy or TRT for short, was found to cause strokes and heart attacks in men who took the hormone in mass attorney groups all across America started running ads on TV to recruit clients into this class action lawsuit who had been placed on testosterone. All of the hype was based on one erroneous article published by the journal of the American medical association siding one poorly designed observational study. Now you don’t need to know the ins and outs of what types of studies there are in medical journals. But an observational study says basically we look at a group of people and we see if anything abnormal happens that’s observational.


14:48          We’re observing for a change. And what they had noticed was that they, well, first of all, they ignored over 30 years of randomized controlled trials. These are studies that have a placebo group, meaning a sugar pill versus say testosterone. And uh, they were randomized in that they were blinded. People weren’t aware of who was getting what the study participants were, were not aware. And the people putting on this study were not aware, but, and those are the best studies by the way. But this observational study gets published in the journal of American medical association and it totally ignores 30 plus years of really good research related to testosterone. So needless to say with this media alarm, uh, ringing loud and clear throughout all media outlets that you can imagine, and every, not every attorney but a litigation hungry attorneys clamoring to make a quick buck by running these ads to recruit people into a class action lawsuit.


15:49          Patient stopped their testosterone on their own. Now saw men coming off testosterone left to right. They were worried, just come make me have a heart attack or stroke. I’ve got too much on the line. I’ve gotten too much at stake. And medical providers just kind of stopped prescribing it. On top of that, to make matters worse, the FDA also got involved and issued a warning for those taking testosterone, encouraging both patients and medical providers to stop testosterone. And this was all based on an observational study. See, there’s this, there’s a saying in research and in the medical field, observation does not mean causation. Just because you observe something happens doesn’t mean it caused it. If I hear a clap of thunder at the same time that my lights flicker in my home, do I make the assumption that it was a lightning strike or do I think, okay, there could have been a car that hit the electrical pole near my home.


16:44          Chances are we’re gonna associate it with what we think it is. And it was that, that clap of thunder. But it doesn’t necessarily mean that that was the cause. It just means it could have been a cause. And you had to look at the totality of all the information that’s out there in order to draw your conclusions. But again, that was not done. So, uh, when that, when the journal of American medical association article came out, like I said, it caused a mass outcry among of groups that were saying, Hey, we’ve got to get people off of this. Now, the interesting thing is it also caused a backlash, a outcry amongst specialty groups who said that, listen, no, this article needs to be retracted. This was wrong. There’s some really bad misinformation in here. The people that they looked at had known histories of cardiovascular and or cerebrovascular events, meaning they had had heart attacks or they had known issues with clogged arteries or they had had stents or they had had strokes in the past and over 130 medical researchers.


17:49          I mean top people in the world are petitioned the journal of the American medical association to retract the article. They requested that the retraction be based on numerous errors in the management of the data related to this study which rendered the article no longer credible. Interestingly, the JAMA, the journal of American medical associates did not retract the article and stand. They allowed the article to be corrected twice. Now for those of you guys who aren’t in the medical field allowing a journal publication, a professional journal, we call them peer reviewed mean and they’re supposed to be held to a higher standard. Never has that happen where an article was allowed to be corrected. Now, the crazy thing is at the end of the day, when they crunch the numbers correctly and looked at the data correctly, it actually showed the testosterone helped reverse the risk of cardiovascular and cerebrovascular disease.


18:49          Now, did that get published? Not in a separate article you had to dig, but typically when you search for that article, the first bad article comes up and that’s the sad thing about it, so that’s myth number two. Myth number three, he goes something like, you got put on the testosterone. Finally somebody recognized that it was wrong. Then you get your blood work checked and you get that phone call from the doctor’s office, the medical provider’s office saying your testosterone levels too high. We’re going to have to back off of that and Oh by the way, there’s this marker called hemoglobin and it’s elevated and we’re going to have to send you over to the laboratory to get blood drawn off because you’re going to be at risk for a stroke. Now I’m going to speak to that one first because this is really, really a hot topic of mine.


19:36          So the technical term for having blood taken out of your body and discarded because your hemoglobin hematocrit is too high. It’s called phlebotomist, a phlebotomist as one who draws your blood, but you got to go phlebotomist. I mean you have that blood drawn off. The sad thing is it costs about 400 to $500 to do that. It’s not like you’re walking into a blood bank to donate blood. Typically I do send you to a blood bank, but you have to pay a fee actually to give them your blood and they actually throw it away. They don’t use it. So why does this need to be done as the huge question? Well, it doesn’t really need to be done. It’s a misunderstanding on the behalf of the medical provider in relationship to a disorder called Polycythaemia Vera. And you don’t need to know that other than the Polycythaemia.


20:26          Vera is poly meaning many. It’s an elevation in all of your blood count markers, not just one like hemoglobin or hermatocrit. When we see people that live at altitude, like if you were to take people that live, the Sherpas that live in the Mount Everest and the Himalayan mountain range, uh, people that actually live in elevation, like say in Denver, Colorado, you’ll actually find that they have higher hemoglobin and hematocrit levels. The interesting thing is is that laboratories know this and based on that person’s zip code, they will actually adjust the normal ranges on hemoglobin hematocrit. And this is one time that I, they should adjust it and they do it well. And so it doesn’t flag this person out as having an elevated hemoglobin or hermatocrit because they live in an oxygen depleted environment. Their body naturally produces more hemoglobin and hematocrit and yet we don’t send these people to the blood bank to be phlebotomist or have blood drawn off yet that happens every single day, multiple times per day in this country because their medical providers are worried that this person has polycythemia Vera.


21:33          But the only thing I would petition that person to do is go back and look at your medical textbook. There’s a textbook that is, when I went to school, it was two volumes. Each volume was, Oh God, probably like 2,500 pages. And I mean, you couldn’t carry these books around. You’d had to get them home. You know, look, I’m in a wheel barrel. Get them home and sit them on your desk or your study area and use them as reference when you were studying, not the kind of books you pack in your backpack. And I would challenge you to go back and look at a Harrison’s taxed of internal medicine and look up the proper diagnosis of Polycythaemia Vera. It’s critical that that we as healthcare prem community health provider community, start understanding the difference between Polycythaemia Vera and just elevated hemoglobin or hematocrit from being on testosterone, which by the way, testosterone does elevate a hemoglobin hermatocrit but not to dangerous levels by any stretch of the imagination.


22:31          And it doesn’t cause polycythemia Vera. So the next one, the myth that I want to talk about is related to you going in and talking to your medical provider. You talked to your Merck, you tell them that you’re not feeling right, something’s off. I think it could be low testosterone. They check your testosterone and actually decide that yes, it is too low and they put you on injections every two weeks. Now, I don’t have anything against injections. I do think injections probably should be done more frequently than every two weeks simply because it creates a roller coaster effect and most men, most men, when testosterone is on the down slope, meaning it’s reached its peak and it’s coming down, but you’ll, most men will complain of actually being irritable. They’ll blame the testosterone on it and they’ll say, Hey, this testosterone is making me irritable.


23:20          No, it’s the lack of testosterone is making your irritable because what happens is, is when we add testosterone, we trick the natural production of testosterone to go down. That’s okay. We can overcompensate that by giving the right amount of testosterone, but in that one week where you spend time going up the slope and your level reaches its peak and then you spend another week coming down the slope. If you’re given this two weeks, then that last week typically is when men will notice that, Hey, their energy is off a little bit. There may be a little bit more moody or they may be more melancholy. You’re, we’re seeing the rise of pellet therapy these days. I’m not a huge proponent of pellet therapy for the same reasons I spoken about this in relationship to women, women’s health in previous podcast episodes, so I won’t bash a dead horse over again, but the bottom line is pellet therapy can have much the same effect as injections in that they create a yo-yo effect.


24:17          Another thing the pellet therapy does is you, you don’t know how it’s being absorbed. Yeah. You know how it’s supposed to be absorbed, but you don’t know how. For that individual, unique person who may be highly acidic or highly alkaline or dehydrated or over hydrated, poor kidney function and liver function or robust and metabolizers, great liver function, great genetics for metabolizing these things. You just don’t know and that’s why we will see and that’s why you get different histories. When you talk to people. How did you react to pellets? Well, it didn’t react well, and I jokingly say in my practice, we fix a lot of pellet messes because there’s a lot of over-medication that goes on and testosterone that’s too high can be equally as bad, if not worse than testosterone. That’s too low. So what’s the solution? The solution that quite frankly is simple.


25:10          Just make sure you’re working with somebody who understands testosterone replacement, understands how to measure testosterone and diagnosed low testosterone. They understand what they’re looking at, make sure they’re checking free testosterone. You as a health consumer should know this terminology. You don’t have to get caught up in what all it means, but you do need to know enough to ask, Hey, did you check my total testosterone and free testosterone or did you just check my total testosterone? I mean, that’s a simple question you can ask and if they say a no, I didn’t check your free testosterone and say, well, why didn’t you do that? Because my understanding is is that that is the usable form of testosterone that we need to base this therapy all thought. And you’ll, you may get one or two responses, you may get a response that gives you the boot out the door and says, Hey, don’t challenge my ego.


25:59          Or you may get a response decision. You know what? You’re right. Why don’t we recheck that and see what your free testosterone level is. Again, you got to have somebody who knows how to interpret it because if they’re just looking at the normal reference ranges, not necessarily going to mean a whole Hill of beans difference because they’re gonna think you’re still normal. So just make sure you’re working with somebody who understands this and somebody that understands the literature and the totality of the literature when it comes to treating you, not just one erroneous study. When that causes him to blanketly say, no, no, no, I stopped prescribing testosterone years ago. It’s, it’s dangerous. I would never do that. For anyone that’s been following me for any length of time knows that, you know, I work with high achievers, I helped them move from great to greater by crafting a custom tailored wellness plan for them that helps them uncover hidden imbalances like low testosterone.


26:46          Just to name a few, I mean we look at everything from genetics to just preventative aging, nutritional markers and things like that. We look at everything, we look for, where the hidden imbalances are and then we craft a custom tailor plan that helps high achievers dominate at the peak performance level and optimize for life longevity so that they can make a bigger impact in their world. If you’ve been struggling with issues like fatigue, low energy, low libido, you just don’t feel right. You know something’s off, you’re a high achiever, high performer and you know you need to get this checked out but you’ve been put an awful long time. It may be as simple as doing a quick 15 minute phone call. I’m going to offer that to you so if you want to do a 15 minute strategy session with me, the only thing I ask is that you fill out a simple 23 question questionnaire.


27:35          As soon as you get that submitted and to us. We’ll review that and then we’ll set up a, I’ll have my administrative assistants set up a time to get you on the books and lets get that 15 minute strategy session done. If you want to just reach out to me for any questions, feel free to reach out to me on LinkedIn, Dr. Brian G. Brown on LinkedIn or on Facebook or Instagram at the optimal CEO. I’d like to thank you for joining me today. Stay tuned. Next time as we’ll be delving into female hormones and we are going to take several episodes to talk about female hormones and the boxes that women get put into because let’s face it guys, women get put into a lot more boxes than men do simply because there’s a lot more moving parts. No, I don’t mean that funny. There are a lot more hormones that women have to deal with than men have to deal with.


28:25          Men are actually simpler when it comes to managing hormone replacement. More complicated in other ways, because men tend to be a little bit more hardheaded. Women are much more proactive with their health and getting that help, but typically that’s what I see. And next time we’re going to be talking about women’s health. And, if you’re a guy, don’t tune out those episodes. It may actually be…., in fact, I can guarantee you there will be some information in there that will pertain to a significant other in your life, and you won’t want to miss it. Until next time. This is Dr. Brian Brown, the Optimal CEO, signing off. I hope you have an optimal day


29:00          Here at The Optimal CEO Podcast, we help CEO entrepreneurs who love taking ownership of their wellness journey, but because they know it’s their most prized investment and when their state of wellness is at its peak, their income source. We want to help relieve CEO entrepreneurs from the pressure of unnecessary health exposure so they can be highly focused on growing their business and physically optimize for the journey so they can enjoy getting there.

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