 Well, hello everyone and welcome to another episode of Dr. Jill live. I am so excited to have a recurring returning guest Dr. Pam Smith today We're going to talk about her new book and optimizing male hormones I don't talk a lot about this topic, but I think it's so relevant and I know from the feedback we got from already posting the poster on that this Is coming up that a lot of you are going to be listening or coming back to listen to sharing this with your partners or spouses So we're in for a real treat today Before I do that, I just want to remind you that you can listen to all of our other episodes on YouTube or iTunes or Stitcher or wherever you listen to podcast And I would love for you to subscribe on YouTube or give us a review those help to get more viewers so we thank you for that So today let me introduce Pam. I have talked to Dr. Smith before so you've seen her before but today super excited about the conversation Dr. Pamela Wharton Smith spent her first 20 years of practice as an emergency room physician in the Detroit Medical Center at a level one trauma center and then 28 years as an anti aging functional medicine specialist She's a diplomat at the board of American Academy of anti aging physicians and is internationally known speaker and author on the subject of anti aging precision medicine and Pam how many books have you written now 12 the 12 coming out this year. Yeah, so exciting as I said you are a pro at this and they are always such bestsellers I want to go on I'm going to make sure and include all the rest of the bio but I kind of want to get to our interview I will note the names of your books So she's been featured on the PBS series embracing of aging as well as online medical series awakening from Alzheimer's and regain your brain She's a founder of the fellowship in anti aging regenerative and functional medicine and the past co director the master's program in metabolic and nutritional medicine She has done so much and again 12 books the new book we're talking about is maximize your male hormones, it was just released and Dr. Smith, it sold out right It sold out in eight hours which I could not believe, because I actually had a hard time convincing my publisher for many years that men would read a book on hormones, and so we had a big discussion again and I said well, if men don't read it the women in their lives will So let's go for it and it sold out in eight hours so it's just being released again in the next printing. Amazing yeah we said today right it's available and it'll be available in this podcast is on so you can get your copy and links to all of that but it's called maximizing your male hormones and such a relevant topic because I'm sure like you in practice we are seeing more and more effects and we'll talk about all the details of male hormones being sabotaged by our environment by the chemicals by the diet by the lifestyle. So we're I'm seeing at least younger and younger men that are struggling with hormone levels many of them don't even know it they just know they don't feel well right. Let's talk about the big landscape first why is this such a big deal now versus 50 or 100 years ago. What are we seeing that's leading to more and more men that are struggling with optimal hormone levels. Well in July will be my 45th year of practice and you're right. It is totally different. When I was a young doctor we never saw men with testosterone levels that were low before the age of 42 45. Now we're seeing men in their 30s and sometimes even in their 20s with low testosterone levels. And there's a myriad of reasons why that happened. Certainly toxins are a big one stress is a huge one. We've talked before about the stereotype pathway, but pregnant alone the hormone of memory makes cortisol your hormonal stress, but it preferentially makes it pregnant alone also makes DHEA testosterone in the estrogens, but if you're stress long term, the body doesn't make a lot of So in today's world, honestly, who is not stressed in my personal practice I have one patient who has normal cortisol one. Wow. Wow. And I totally relate because it's the same with me it's either off the chart tie or nowadays after years and years and years and years of off the chart tie sometimes it's just flat line like low so we have these both extremes. And what you were just saying is that our body has to have cortisol to survive so it will do everything in its power to keep that flood of precursors going towards cortisol because we can't survive without it. And the innocent bystanders are testosterone in both men and women but today we're talking about men. So stress is a big one stress is probably the biggest factor what are their factors you see contributing to the decline of male hormones. Part of it is that some men actually have been using testosterone or its precursors at too young of age. And so then their body doesn't want to make any as they age. In fact, honestly, the newest addiction now is testosterone and men. It has become an addiction. People started too early. They take too much. The levels are are really, really high. And people do not realize the side effects. If you use testosterone when you don't need it, or if you have too high a dose. So let's talk about that. So let's take his average say the 32 year old male comes in his testosterone a little self optimal. And he asked me are you, you know, doc my testosterone is low I'd like to get a prescription. What would you caution them what would you say how would you, you know, tell them about the potential dangers of too much. Tell us a little bit about how we would look at this kind of a person, and it could be I would say anywhere from 25 to 45. That's kind of the range we're talking about right the younger men, before they hit the male testosterone decline. We really try not to give testosterone to men before the age of 42. There's other prescriptions we can give them. If they need to boost testosterone, depending on the state in which they live. There's climate, there's hcg. There's other choices than testosterone itself, because if you give too much testosterone, it doesn't stay testosterone. It converts to e one and e two, which are estrogens, and it converts to dihydrotestosterone. So men do need estrogen, commonly they're surprised, they need it for memory, they need it for bone structure. However, too much estrogen increases their risk of heart disease and prostate cancer. And of course, I know a lot of people know about dihydrotestosterone and hair loss. That's a big one that most people think about. But if you give too much testosterone, DHT will go up, and you can end up with too much testosterone with blood clots, you can end up with pulmonary heart disease, heart attack, stroke. I mean, the consequences actually are really large. And unfortunately, it can lead to your demise. So I want to talk about symptoms of testosterone or high, but let's first go down this path because I think this is important and very poorly understood by the average person. I'm not talking about testosterone or blood clots, like you and I know why, but many people listening are like, Oh, I didn't know about this. Tell us a little bit about what it is, how it affects the blood cells, and how they might even see it on the lab and then why that would lead to a clot like a stroke or heart attack or something. Well, when we order a test, when we look at giving hormones to men, we always order a complete blood count. That's a blood study that's done at any major lab. What we want to do that is we want to look at the red blood cells, the hemoglobin and the hematocrit. And we want to see where it's at. If you give too much testosterone, then all three of those can actually elevate. When they go up, then clotting can occur. And a lot of doctors that are not trained in this field, unfortunately, give too much testosterone, and then they tell the patient, Oh, just go donate a unit of blood. If you've been given too much testosterone, that is the answer. But it's not the answer every single month to go donate a unit of blood. The answer is to use less. We usually use testosterone transdermally, meaning on the skin. We used to use it more as an injection or shot. Very early on, we would do it twice a month. Then we started using smaller doses twice a week. But if you use an injection, it's certainly not wrong. But the first day, it's probably a little high. The next day is probably the perfect dose. And the third day is probably a little too low. When you put testosterone on the skin, it really mimics what the body does. Because a male's testosterone actually changes four to six times a day. And we want it to be natural. That really is God's plan for life is to mimic the perfection that God has designed for us. And so the other study that was really startling is not just about blood clots, but when it comes to I am testosterone versus on the skin, it has to do with erectile dysfunction. And this really gets a male's attention. If you put testosterone on the skin, it helps with ED erectile dysfunction, 83% of the time. If you use it as an injection, only 53% of the time. So ED is an issue with a lot of men for many reasons. But choosing testosterone on the skin, it doesn't take a lot. Men only make four to six milligrams of testosterone at their peak age at 25. So on the skin, we never give more than 50 milligrams of testosterone. There's honestly no need to do that. That makes sense. And you're giving it on the skin daily or intermittently? We are giving it on the skin daily. Men, at least at this point, we don't give them a hormonal holiday, like we do menopausal women. But it's not just sexual interest. Yes, I mean, that's huge. But testosterone lowers cholesterol, blood sugar, blood pressure, it's muscle mass, it's energy, it's bone structure. There's so many things that it does that is really, yes, sexual interest, it gets everybody's attention, but certainly lowering your cholesterol should and maintaining memory should as well. Yes. No, I love that because that's the big thing. And I'm talking to men and women all the time or women and their spouses or whatever about this, because I say testosterone for men is so, so important. Like you said, all those things and diabetes and all these what let's go back to just symptoms like say someone's listening like, well, you know, I haven't tested first of all, let's talk about what do you do to test. And then second, what would be someone presenting with low testosterone, what would they symptoms, would they have because it's not like you said, it's not just libido. It's so much bigger than that. What would a male who presented with low testosterone maybe feel like a lot of men the first symptom they get is actually fatigue. It's not erectile dysfunction. In fact, if a man has erectile dysfunction, that means there's clogging of arteries and that part of the body. So we immediately send them to a cardiologist to see if there's clogging in the vessels of the heart and the carotids in the neck. So, Ed equals heart disease. So we back up a step and we want to really go back and see, is there erectile dysfunction because there's clogging, or is there because they're not enough testosterone, etc. Everything that I'm talking about is in my book maximizing male hormones, the references are online, you get a code for it and they're updated. So you get updated references all the time. And that way people can stay current. Another really important thing is diabetes. In fact, the American Endocrinology Society has come out now with an article that if a man has diabetes and it's new onset, meaning newly diagnosed, the first thing they should do is have their testosterone measured. Excellent. That makes so much sense, right, to you and I, but the people listening might be like, really? So yeah, because all of a sudden, because really it causes that adiposity around the organs, which is visceral. If you don't have testosterone, you get more waking in those visceral areas and those are very predictive of risk of metabolic syndrome, obesity, diabetes. So it's really, really important. I love that you're saying that too, because yes, erectile function, libido, all these things the males care about, but it's even bigger as far as life longevity. So we talked about young people and why they maybe should be more careful. Say you do have someone who is very appropriate, maybe a testosterone level below 200, which I'm assuming is kind of, what would you say cut off for too low? I might treat them a little sooner than that too, but what would your cut off be? Well, that's a great question on testing. Honestly, usually I do saliva testing and not blood. It's because I'm going to do saliva testing later on. If the hormones are put on the skin, they do not show up in the blood. There's three trials to show that one by David Zava and Israeli study and then one we're going to publish where we actually looked at it in both men and women hormones on the skin, any of the hormones, any age of the patient and none of the hormones showed up on the skin. If you look at blood testing. So if you're going to put the testosterone on the skin, you do have to do salivary testing. It is a, you actually spit. It's not a swab. People think they're just going to do this like a COVID test, but no, it's not like that. You actually spit it to the tube. Plus, when we measure cortisol, the stress hormone, there are six clinical trials showing the cortisol does have to be measured by saliva. That gives the most accurate method. Some people purport that you can measure by urine. It's important to do a urine test. It's really important because we want to see how testosterone is broken down and what kind of estrogens it makes because it makes the wrong ones. There's an increase in prostate cancer, but we don't dose off of urine. And the reason is it's a metabolite. It's actually a breakdown product. It's not the level of the hormone itself. And how I would break it down. You would break it down. Everybody else in the audience today would break things down is very, very different related to weight and age and genetics and medications, people around and a myriad of other things. That's, hey everybody, I just stopped by to let you know that my new book, Unexpected, Finding Resilience through Functional Medicine, Science and Faith is now available for order wherever you purchase books. In this book, I share my own journey of overcoming life-threatening illness and the tools and tips and tricks and hope and resilience I found along the way. This book includes practical advice for things like cancer and Crohn's disease and other autoimmune conditions, infections like Lyme or Epstein bar and mold and biotoxin related illness. What I really hope is that as you read this book, you find transformational wisdom for health and healing. If you want to get your own copy, stop by readunexpected.com. There you can also collect your free bonuses. So grab your copy today and begin your own transformational journey through functional medicine in finding resilience. That's so great to talk about because again, if you go to the average primary doctor, they're not going to even maybe know that saliva or urine testing exists. So if they are getting blood tests, maybe at the beginning, they're typically going to get estradiol, DHEAS, testosterone free in total, cortisol, AM, and then maybe progesterone or pregnant alone. You can get those in the blood. Would you say that's okay for a start if someone is not on therapy, just if their doctor is doing that as a screen to kind of see where they're at, and then you'd follow with saliva? You could do that, but then you're comparing apples and oranges because later on you're going to do saliva. You should also do E1, a stone. You need to do both of the estrogens. Men do make E3 as well, but we look at E1 and E2, and again, we don't want their estrogen to be high. Yes. Now my cut up on blood would be around 50, but what about saliva? Is there a cut off or a number or just a range or anything that would be? Dead center of normal. Okay, got it. Perfect. Dead center of normal. You can mention labs. Who is the lab that you like for salivary testing? Actually, right there, I was talking about ZRT for a great lab. There's other labs that do this testing as well. I mean, there's Genova, there's doctor's data, there is access medical. There's a number of labs, all of which are really very much clear approved and have the latest technology. Fantastic. So you can ask your doctor for these. And they're not super expensive. I mean, a few hundred dollars, most of them, they're not like off the charts, crazy expensive. Does that sound right to you? It is the only exception to that is pregnanolone, the hormone of memory. And pregnanolone is really important because not only is it the hormone of memory, and it makes the other hormones, but people make assumptions, like I will be 69 in July. And you would assume at this age that I have low pregnanolone, but honestly, I don't. My pregnanolone is still very normal. It has to be 50 to maintain memory. And my last one was a few months ago, it was 58. So do I take pregnanolone? No. This is why we met her because we don't want to give people hormones they don't need either. Right. So that brings me to a point that I think again, a lot of people maybe don't know that cholesterol is at the top of this whole cascade, right? Let's talk about men who are on cholesterol-lowering medications. What does that do to the hormones? And again, I'm not against it. There's very appropriate use to statin medications. So please hear me. But there are some men that are on those that get their cholesterol so low that it can affect hormones. Can you talk about that connection? Absolutely. Unfortunately, cardiologists, honestly, usually just look at the heart. Right. And they don't look at the whole body. And that's really why you should have an anti-aging functional medicine prescriber to see. Because they're really the people that have studied all of this. They've done a fellowship in this field so that they understand really the range of all this. So let me tell you a true story of one of my patients. 42-year-old male, dentist, he came in and he said the following. You know what? I think I'm going to quit practicing. And at that time, I was 10 years older than him. And I said, well, I don't feel like quitting practicing. Why? He goes, well, my dexterity is not there. My memory is not there. I don't have energy. I just don't see as well. I just don't feel as good. And then he handed me his labs from his primary care doctor. And there was the answer. His doctor had literally written a smiley face by the total cholesterol of 104. Yes, because it sounds great when it comes to the heart, but total cholesterol has to be 140 to make pregnant alone to make the other hormones. So I'm not anti-statin drug like you. I do prescribe statin drugs. They're great anti-inflammatories. There's many ways to lower cholesterol, but you don't want to get it too low. And honestly, we took him off of the statin drug because he really didn't need it. We gave him a little burberry and that was plenty to keep his cholesterol total at about 160. And in nine months, he felt great. And he's still practicing now because his memory came back as dexterity. People don't realize that men have testosterone receptors in their eyes. So testosterone helps prevent macular degeneration, glaucoma, cataracts. They have testosterone receptors on their heart. They have testosterone receptors on their colon. So testosterone being optimal helps prevent colon cancer. It's many, many things. Now hold up your book again because I want people to be sure and grab a copy of this because this is the one thing Dr. Smith does so well is you make things simple and easy. You've got lists, you've got protocols, you've got just the way you do things in your book, you're writing, you're teaching. It makes it simple and you've always done a great job at simplifying even for those of us other doctors that are learning from you. And the other thing that you do is you include references. Love that. So anyone who's like maybe going to their doctor and their doctor's not quite so sure they can find those references. So it's often said it's an online link so that it's continuously updated, right? It is continuously updated. We started doing that with the last two books. Right. Honestly worked out really well. Because by the time it goes to the publisher, we know it's out of date, right? It's just like things, it's changed though quickly. So that's even a better way to do that. Amazing. So what about the, let's talk to the women who have men in their life that maybe have low testosterone real quickly. Because often the people listening are the women, you know, ages, my biggest audience is age 30 to 55 or 60 women. So if you're a woman listening and you think maybe your husband or your partner or your, you know, dad or son even has issues with testosterone. What would you tell them as far as either getting them in to get checked or give us a little spiel to the women out there? Absolutely. First of all, I would suggest this book is for women as well. It is just as much for women as it is for men because it's important to understand how the male body works and female body works. So that's the first thing. Number two, they really should see a prescriber who is fellowship trained in the field. There's actually in the book, there's a link to the American Academy of Anti-Aging Physicians. You can go right on that link and find a prescriber in your area. So someone that literally has done an entire fellowship in this field is really important. And also in the book, we go through other things. You know, we talk about cholesterol, but we talk about not just testosterone and DHA, which also lowers cholesterol. But we actually do give people some tips on other ways to lower cholesterol and triglycerides and risk for heart disease, etc. Fantastic. So it's a whole male, like everything you want to know about your husband as far as the medical facts and the testosterone and everything. That's fantastic because male hormones, like you said, way more than just do you go into insulin and some of the like metabolic stuff just briefly as well? Absolutely. Absolutely. Because it's just as important. It's part of the reason why we want men to be hormonally balanced. Yeah. So two other things that I think are important, DHA. People may or may not know what that is. Tell us about what is DHA? When would you use DHA in men? Well, pregnant alone makes DHA, which makes estrogen and testosterone. DHA can go down if you're stressed because it's a companion hormone to cortisol. Both are made in the adrenal glands that sit above the kidneys. DHA also declines with age. And so it's very variable. For men, we give them straight DHA. For women, it's a little bit different. If women have high testosterone, or if they're acne prone or normal testosterone, then we give them a special kind of DHA called fetal, K-E-T-O. So it doesn't make a lot of testosterone. But in men, we give them DHA, which makes estrogen and testosterone both. Beautiful. And then the last thing is, I know your book is for men, but because we have women listening, women can have low testosterone too. So is this something that you check? Do you ever replace this in women as well? And how would that look with that also be transdermal? Give us just a little bit of a snapshot on women. Absolutely. In my book, What You Must Know About Women's Hormones, second edition, which came out eight months ago. Basically, and it's double the size of the previous edition from 2010. Women are way more complex, right? Women are much more complex. Absolutely. And there's the misnomer now with testosterone. Again, testosterone, it really is the newest addiction. People think, oh, every woman needs testosterone. It gives her sexual interest. It gives her energy. But if you actually look at the numbers, only one fourth of women lose testosterone as they age. And for those that did not, if I haven't lost it by now, I'm not going to, minus dead center of normal, and we'll always stay there. If I use testosterone, then I would have an increased risk in heart disease and stroke. Also, blood sugar tends to decline. So it's important that women, if they are low in testosterone, they need it, sexual interest, lowest cholesterol, energy, they need muscle mass. Women do need all of those things, but we don't want to give them testosterone if they don't need it. Yeah, absolutely. Dr. Smith, this has been so fun as always. Where can people get your books? Where's the best place to find you? Give us a little bit of where we can find more about how to get the book and you've got all your books. So we want to promote those, but this new book is on male hormones. Absolutely. You can certainly go to Amazon and get my book, which is probably the best location for you to get it at the most cost effective. If you're going to buy it in bulk for all of your friends or people at your business, family members, and you can go directly to square one publishing to their website and you can get it from there. And then you can also go to drsmith.com. Any of those locations, you can get a copy of book. And I will include all of those links. If you're listening or watching wherever you're at, you will have those links down below as well. Dr. Smith and my friend, thank you so much for today. Thank you for bringing your wisdom. Thank you for continuing to publish great information and for continuing to be an educator, not only of the public, but of doctors like myself. We're very grateful for you. Well, thank you so much for the interview today. And you are a blessing to me very much.