 Good morning. Can you hear me? There we go. Men make no mistake about it. Our balls are under attack every day. Testosterone levels are plummeting at a population level and has become a crisis, a true epidemic. I'm here today to not only illuminate the problem, but also to hopefully motivate you and inspire you to do something about it and take the next step and make changes. Now to drive home how this is really affecting us, I want to share with you a patient who I saw recently who I think really is a good example of what this looks like. His name is Joe. Joe's a 49 year old executive who came to me for a low testosterone. He had just gone through a divorce and lost his job. He had been happily married with two kids and over the last ten years he notes that he had declining energy. He had fatigue. He had a change in his cognitive focus. He was having trouble working. He was depressed and he was uninterested in life to the point that it affected his performance at work so much he actually lost his job. He gained weight about 20 pounds and most importantly he really didn't even care. He didn't really seem motivated to do anything about it. It affected his relationship with his wife and his kids as well. He didn't want to play with his kids. He certainly wasn't interested in being intimate with his wife. This caused problems between them and he thinks this was actually one of the biggest reasons why his marriage fell apart after 16 years. He told me how his entire personality and mood changed and how he was no longer the man he used to be. As he sat there in the office in front of me, I was struck by how defeated he looked. I checked some labs on him. His testosterone was 280. 49-year-old guy with a testosterone of 280, his free testosterone was 30, which are both obviously very low. So this is a common story. I see this guy, a guy like Joe in my office every day. Even guys in their 20s and 30s and 40s, just like Joe with low testosterone. Low testosterone is not just about libido or sexual performance or building muscle. It's about a guy's life. It's about his quality of life. It's about his cognitive focus, his energy, his vitality. It's about his cardiovascular health, his bone density, his muscle mass, his longevity. The instance of low-teen young guys like Joe is increasing dramatically. I want to share a powerful study that really drives home what a big issue this is. This study was a Baltimore Longitudinal Aging Study. This is a prospective study of over 1,700 men that were followed longitudinally for 15 years. What they found was a substantial population level decline in testosterone. Medium testosterone levels dropped from just over 500 to under 400. That's a 22% drop, which is a 1.2% drop per year over those 15 years. And perhaps more importantly, the free testosterone dropped 45%. So the study showed that men were not just losing testosterone as they aged. This is not unexpected. But the same age men from later eras had substantially lower testosterone levels than their predecessors. So what I mean by this is this is very important. A 50-year-old guy today has a 22% lower testosterone level than a 50-year-old guy 15 years ago. Now, this study, it controlled for health and lifestyle factors like diabetes and obesity and smoking that are known to affect testosterone levels. So this dramatic decrease in testosterone levels persisted even after they corrected for those factors. So there's clearly something else going on besides just lifestyle. Problems not just in the US either. There was a 30-year study out of Finland, a longitudinal study that found that men had a lower testosterone level there as well, 37% over 30 years. A study at a Denmark showed free testosterone levels dropped by 45% there as well. So this is a global epidemic. This is not just here in the US. It's also not just testosterone. It's fertility, a sperm as well. You know, this study out of Israel followed men for 30 years and found a dramatic decline in fertility rates. They found sperm concentration dropped by 52% and sperm counts dropped by 59% over 30 years. Another study out of Spain looked at male college students and found the same thing. So again, this is a global problem and it's not just testosterone, it's fertility as well. You know, it's also no coincidence that these curves line up. If you look at this curve versus the testosterone one, it's not a surprise that they're fairly similar. So the big question here is why. Why are testosterone levels and fertility plummeting? You know, it's probably partially related to lifestyle to, you know, poor diet, the Western diet, obesity, metabolic syndrome, insulin resistance, chronic stress, lack of sleep. But there's clearly another insidious cause and that's where endocrine disruptors come in. So let's start with what is an endocrine disruptor. An endocrine disruptor is a chemical or toxin that interferes with normal hormone function. They could do this through four mechanisms. One is they can act like the natural hormone and over simulate or over increase the signal, if you will, to the body to respond. Kind of like turning on a light switch that never turns off. It can affect the receptor, the way the receptor responds to the hormone. It can affect the hormone from acting on the receptor as well. It can block it, so to speak. And then finally it can affect the actual production or metabolism of the hormone itself. Now, today I'm obviously going to focus on the effects of endocrine disruptors on testosterone as well as fertility, but I should briefly emphasize that there are numerous other physiologic effects from these exposures as well, including obesity, cancer such as thyroid, breast and prostate cancers, insulin resistance and diabetes, depression, immune dysfunction, and other developmental abnormalities. So where are endocrine disruptors? Well, unfortunately they're everywhere. We see them in our pesticides, herbicides and fungicides that are sprayed on the crops of the food that we eat. It's in the food coloring of the foods we eat. It's in our personal care items like fragrances and cosmetics and sunscreen and cologne and cleaning products and lawn care products. It's in industrial products like flame retardants and adhesives and detergents and in our cars. It's in plastics like plastic food containers. Plastic water bottles we'll talk about in a moment. Electronics. It's in pharmaceuticals, IV tubing, anesthesia tubing. It's in furniture. It's in clothing. It's ubiquitous. It's everywhere. Now, there are hundreds of endocrine disruptors that are known, but the EPA estimates that over 3,000 synthetic chemicals are produced in the US each year and over 90% of them lack any real data on their true health impact, so there are likely many more that are not known yet. I'm going to focus on some of the endocrine disruptors that have clear cut science showing how they crush men's health, testosterone and fertility. The first one is atrazine. Now, atrazine is a weed killer, an herbicide. It's the second most commonly used one here in the US behind glyphosate. Studies have shown high levels of atrazine in our lakes and in our drinking water. Our municipal water treatment systems don't adequately filter it out. Now, what's the problem with atrazine? Well, there have been studies that look at frogs who are exposed to very low levels of atrazine, and male frogs have been turned into female frogs. So think about that for a second. You have a male frog. You expose him to very low levels of atrazine, and he becomes a female frog who actually lays eggs and reproduces, simply from exposure to atrazine, the atrazine that we have in our drinking water. It's important to note that those frogs were exposed to only 200 nanograms per liter of atrazine, 200. Studies have shown 34,000 nanograms per liter has been found in our drinking water. So a little more than the 200 that affected those poor little male frogs. Now, Europe banned atrazine in 2004, but the EPA here in the US unfortunately has turned a blind eye, and it's still legal here. The next one was BPA. BPA is one of the most commonly known and discussed endocrine disruptors. BPA is Bisphenol A. Does anyone know here how many water bottles we use globally? Anyone have an idea? We go through a million water bottles a minute globally. A million water bottles a minute, and most of those are not recycled. So major problem with BPA. BPA is also in baby bottles as in plastic food containers and plastic utensils. It's in the lining of the cans of food products. The BPA is slowly leaching into our food and water from these products. It's also found in the coating of thermal paper receipts, and we're absorbing that through our skin. Like atrazine, BPA has been found in our drinking water as well. One study showed 93% of us have detectable levels of BPA in our urine, 93%. Studies have shown a dramatic effect of BPA on our testosterone. There was a great study out of Paris where they looked at male human fetuses. Now these fetuses were between 5 and 11 weeks gestation that were about to be aborted, but they actually took the latex cell tissue from their testicles before abortion. They bathed them in BPA in various concentrations, and they followed testosterone production from these latex cell tissues. What they found was in just three days, three days of BPA exposure, these latex cells produced 50% less testosterone. So a dramatic effect on testosterone production with BPA. Alright, birth control, fun one. How many guys here are on birth control? No? Actually, you all are. It was a trick question. All of you are on oral birth control. The reason is, is 100 million women worldwide are on birth control, and it gets discreet in their urine. It gets recycled back into our water system, because again, our municipal treatment systems are inadequate at filtering it out. You know, estradiol, the main component of oral birth control, is a very tough, resilient molecule, and it doesn't break down easily. It has a prolonged effect, kind of like that light switch example I was telling you, where the light switch turns on and never gets turned off. Estradiol has been shown, as we know, to lower testosterone and free testosterone levels, but it also has a dramatic effect on fertility, sperm counts, and sperm function as well. Some fish studies show that male fish become female fish, just like those frogs did with atrazine, with very low levels of exposure to estradiol. And again, we're drinking that on a daily basis. So I'm going to talk in a few minutes about how we can mitigate that exposure, hopefully, and reduce the effect. DDT, those are reason I have an alligator here. I'll tell you in a second. So DDT is an insecticide. It was banned here in the U.S. in 1972 because it was found to cause cancer, and it's been banned in most parts of the world, but it's actually still used in Africa to fight mosquitoes to prevent malaria. There's still a fair amount of DDT residue here in the U.S., especially in Florida. So a great study at the University of Florida where I actually did my urology training, they looked at DDT effects on alligators. Now Lake Apopka, which is a lake just near Gainesville, Florida, next to the University of Florida, it's known that there was a large chemical spill in 1980, so it's known that there are large quantities of DDT in this lake. So for this study, they got some lucky post-grad students, someone who drew the short straw, to go into this lake at night and capture 140 alligators. They also went into a nearby lake, Lake Woodruff, which was known to be clean and pure and did not have any DDT exposure. So this unlucky soul had to capture 140 alligators, press on their cloaca to figure out which one's male, which one's female, by the way, also. And then the male ones, they actually had to measure their penis size and draw blood and measure their testosterone. So the next time any of you want to complain about your job, think of these guys, all right? So what they found amazingly is there was a 50% lower testosterone level than the alligators in Lake Apopka compared to Lake Woodruff. 50% decreased testosterone level from exposure to DDT. And remember, this is DDT from exposure from 30 years ago. Okay, from the spill in 1980, it still continues to this day. Phthalates, phthalates is probably the most potentially disruptive one I'm going to talk about today. The problem with phthalates is they're everywhere. You know, they're chemicals used to make perfumes. It's a plasticizer used to make plastic look clear and makes it flexible. It's found in our personal care products like shampoo and soap and deodorant and cologne. It's using cosmetics, shower curtains, plastic toys, vinyl flooring, detergents, cleaning products, food packaging, adhesives, raincoats, paints, garden hoses, plastic bags. It goes on and on because phthalates are everywhere. Studies have found that 29% of our drinking water has phthalates at a detectable level in it. Several studies have shown a dramatic effect on testosterone production, on fertility, as well as reproductive cancers with phthalate exposure. So in your daily life, think of all of the chemicals, all of the products that have phthalates in them that you're exposed to on a daily basis is pretty scary. The next fun one is milk. Now, there was a powerful study with milk where they took milk off the grocery store shelf and they gave it to young boys and they checked their testosterone levels before and immediately after drinking whole milk off the grocery store shelf. They found in one hour, one hour after drinking milk, there was a substantial clinically significant decrease in testosterone levels in these young boys who drank the milk. Think about this for a second. Milk is stored in these containers, these boxes that are lined with plastic that's leaching endocrine-disrupting toxic chemicals into your milk. The cow that made this milk is given hormones that are estrogenic. The cow is eating a crop that likely has mycoestrogen, another endocrine disruptor. The crops have likely been sprayed with herbicides and pesticides as well that cause disruption. So think of the multiple layers and levels of endocrine disruption when you're drinking milk. So next time someone tells your kids to drink more milk because it does the body good, think about the multiple layers of endocrine disruption that is causing. Phytoestrogens, this is a fun one in the plant-based community but that's okay. I'll take it. This includes soy and tofu. Now, soy is the second most genetically modified crop only behind corn. In fact, 90% of the soy that's available here in the U.S. is genetically modified. Why is it genetically modified? To withstand glyphosate. What's worse is we're not actually eating the actual natural raw organic soybean. That might actually be okay. Here in the U.S. almost all of the soy that's available has been highly processed and what that does is it super-concentrates the phytoestrogen content which increases the estrogenic effect. There were several studies that have shown the effect on testosterone. One of them looked at animal study where they fed one group phytoestrogen-rich diet and one had no phytoestrogens in them. After five weeks, there was a 50% change in testosterone levels in the group that had phytoestrogens in their diet, 50%. There was a human study. They looked at young men who were doing weightlifting and they gave me their whey protein, soy protein, or placebo. They checked testosterone levels before, during, and after an intense workout. In the placebo and whey protein group, as expected, they had a spike in testosterone during and immediately after their workout. In the soy protein group, there was a decline. There was a blunted response to testosterone with exercise with soy intake. It's not just testosterone, we're also seeing an effect on fertility with soy. One very powerful study showed a 35 million sperm count decline in men who have chronic soy intake. So what do all these toxins have in common? It's that they're crushing us at an epigenetic level, altering our genes, and we've got to do something to start protecting ourselves. You know, we eat it, we wear it, we wash our clothes in it, we cook in it, we store food in it, we lather ourselves in it. It's everywhere. We are living in a soup, if you will, of endocrine disruptors. And they are attacking our balls from every direction. And also, each of these toxins don't act independently. You know, there's a cumulative effect as well. There was one study that looked at 20 humans, they biopsied their fat, and they found 19 different endocrine disrupting chemicals or toxins at a detectable level in every one of them. All 20 people in the study had 19 different endocrine disruptors in that fat biopsy. There are hundreds of endocrine disruptors, and combined exposure to these has a dramatic effect on our testosterone, our fertility, our health, our life. You know, it has a transgenerational effect as well. You know, many of these toxins are affecting germ cells and DNA methylation, and this persists for generations. There was one study that exposed fish to estradiol and BPA, and they followed these fish for five generations. And what was fascinating is they found an increasing problem over generations. Generations three, four, and five had worsened fertilization and survival rates than the first two generations. So we're not just talking about ourselves. It's our children, our grandchildren, and so on. So what's the answer? How do we protect ourselves? How do we get optimized? Well, there are two choices. You can keep doing what you're doing. We can be victims, or we can decide to make a change. So let's talk about the solutions, talk about what we can do that every man should be doing to get optimized and protect himself. It starts with mitigating exposure. You know, this is certainly not an exhaustive list I'm going to go through here, but this is just a start to give you some ideas of changes that you can make in your life every single day. Each and every one of these are small choices. Each one giving you just a little bit more control but have a dramatic effect over the long term. The first one I like to talk about is a charcoal water filter. You know, I should be a spokesperson for Berkey, the Berkey water filter, because I'm always talking about it. But you need to be filtering your water. And reverse osmosis does not get rid of endocrine disrupting toxins. You need a charcoal filter as well. Berkey's a great one. There are a bunch of other ones out there. You need to be drinking only from filtered water. You need to be using a stainless steel water bottle as well. So this is my water and coffee cup right here, stainless steel. You need to be eliminating highly processed foods. Focus on eating real, fresh food, organic if you can. You need to be looking at the ingredients of everything you eat. If you don't recognize or can't pronounce or don't understand the ingredients, you need to not be eating it. You need to be eating whole, fresh, real, organic foods. Grass-fed, organic meats and butter, wall-caught salmon. You know, your meats and your seafood should not be in a plastic package. They should never be wrapped in plastic. They should be in a butcher block. We should avoid any plastic contact that we can with our foods. We need to eliminate fast foods as well. Tons of endocrine disruptors in our fast food. There's a study that also showed that people who eat in restaurants have 35% higher levels of phalates in their urine from eating out. So, cooking at home means you know what's in your food. Limiting dietary grains, especially corn, especially processed phytoestrogen-full soy. We want to eliminate all plastics that have any contact with our food or drink. Especially if we're storing foods, especially if we're microwaving our foods, cooking our foods, we want to avoid foods in metal cans that are lined with endocrine disruptors. Plastic cups, plates, utensils that are in contact with especially hot foods is a problem as well. Good cleaning products, laundry detergent, dryer sheets. I'm going to talk about that in a second. How do you figure that out? We want to be really careful about anything that we're putting on our body because we are absorbing those toxins every day. You know, plastics are killing us through our coffee as well. So, when you're drinking coffee, think about that plastic cup that it's in and instead, stainless steel. Those K-cups, plastic. Your coffee is bathing in endocrine disruptors, especially as you're brewing it. Eliminating fragrances from all your personal care products. That's a big source of phthalates. You know, these candles, these scented candles that are a big deal now, think of the phthalates that are emanating from those as you're breathing them in. You want good quality personal care products including deodorant, shampoo, soap, sunscreen. I'm going to show you how you do that. These are two great apps that I like. Think Dirty is one and the other is Healthy Living. And Healthy Living is made by the Environmental Working Group and I love that one. I use it all the time. What you can do is when you're shopping, you can take this app on your phone and you can scan the barcode of any product that you're looking at and it will tell you the toxic ingredients in that product. So you can choose products carefully and know which ones are free of endocrine disrupting toxins. Every one of these things are choices. One little thing, one little change that you can make on a daily basis that over time when put together can have a dramatic effect on your testosterone levels. So these are all changes that everyone should be making, but we can go one step further. You know, we now have tools available to take a personalized approach with what we call cutting edge precision medicine. This is where I say you have to know your genes because your unique genetics allow us to identify how your body responds to toxin exposure and find blind spots. We can understand the efficiency of your detox pathways. We can understand if you're at risk for significant inflammation from your body's response to these toxins. And we can learn how to protect you at an epigenetic level much more so than simply mitigating exposures. So I work with guys directly. I help them understand specifically what their genetic blueprint is, what it looks like and how they can use that to optimize their health, which certainly includes endocrine disrupting chemical exposure. Now, Dr. Wood, it's great talk yesterday, and I just want to briefly comment on that because I think it's important that we have an open dialogue about this that there's a discussion of genetic data and how it's fairly useless, and I have to partially agree. This is partially true. You see, the human system is complex. It's dynamic. It's adaptable. It's rarely predictable. You know, there's a concept that researchers aren't able to necessarily always recognize unless you're actually dealing with it clinically, unless you're working with clients, with patients. You know, genetics is a great additional piece of data. It's a tool that could be added to the complex evaluation and management of human system. And, you know, yes, it's about probabilities. It's not absolute. I like to say that one gene does not equal one outcome. And that's why a lot of these direct-to-consumer products are fairly worthless, we'll agree, because it takes context. The key part here is you have to understand the genetics. You have to understand the client. And there's epigenetics, which means that your genetics are just a starting point, and your lifestyle and your exposures affect the expression. And so we need to understand that there's context, and, you know, we're not robots. We're constantly adapting. We have a genetic hardware that's the platform that we're operating on, but it's certainly not the end-all. It's not your destiny, and that's epigenetics. So back to Joe, the patient I told you about in the very beginning. We worked on his exposures. I worked with him closely to identify every toxin that he's exposed to on a daily basis, and we worked through coaching on eliminating those exposures, and we worked a lot on his diet and his lifestyle as well. I ran his genetic blueprint, and I found that there were several genes related to his detox pathways related to endocrine toxin exposure, and we worked on that. That's a personalized approach. That's precision medicine. That's a tool that's in our toolbox now that we should be using to provide a personalized approach to these guys. Joe's testosterone level came up dramatically over the six months after that initial visit. He never required testosterone injections. We were able to get his levels up to almost 600 with simply lifestyle maneuvers and working on his exposures and working on his personalized genomic approach as well with various supplements to help increase his detox pathways. So we need to understand that this is happening at an epigenetic level. Our environment that we're exposed to on a daily basis is directly affecting our function. Not just in ourselves, but in our children, in our children's children. Ancestral health is all about how our health challenges come from an evolutionary perspective. This is it. Okay, that's what we're talking about here. This is evolution happening. Unfortunately, the EPA has known for years what's going on, and they've really done very little to address this problem. We need to have a stronger voice and insist on better regulation. If we don't make a drastic change, guys, in 30 years, the entire male population will be hypogonadol and sterile. As I hope you can tell, I'm incredibly passionate about this, about helping men optimize their health and performance and longevity, and help them recognize their full limitless potential. And that includes optimizing their hormones by mitigating exposure to endocrine disrupting toxins, up-regulating detox pathways, and leveraging their genetics to take a personalized approach. Hopefully this morning, I've not only educated you and illuminated you, but hopefully motivated you to lock arms with me, get empowered, and take action. Thank you. That was awesome. I didn't say that genetics were useless. Just point that out first. Anyway, we won't get into that. I had a question about a specific scenario that I see fairly frequently, just because you talked about free testosterone or free Android index right at the beginning. And I often work with people who are... who do almost all the stuff that you talk about. They're super dedicated, super motivated. They want to optimize everything. And say, they're in. Maybe they're 40s or 50s. Testosterone looks pretty good. Maybe 6, 700. That's fine by me. But their SHBG is usually pretty high, like maybe 70, 80, sometimes higher. And if you look at the epidemiological data, SHBG pretty much is negatively correlated with insulin sensitivity or insulin resistance. So the more insulin resistant you are, the lower SHBG is. So I've stopped really worrying about free testosterone. There's calculated measures based on SHBG because these guys have no symptoms of testosterone deficiency. Their SHBG is super high, but I also know they're super insensitive, much more insensitive than the people that they use to generate the SHBG normal ranges. Do you have any thoughts? Have I missed something? Is there something in there that you'd think about? Yeah, so I'm not sure everyone can hear that, but the question is related to SHBG and basically do we care about free testosterone? And I would say that it comes back to working clinically with patients, with clients, working with them one-on-one identifying symptoms. A lot of guys will have low testosterone and they'll have no symptoms. Or they'll have normal testosterone and super low free testosterone and have no symptoms. And a guy like Joe, where the free in total is super low, is straightforward. He has clinical symptomatology of hypogonadism. He has low testosterone and he would certainly benefit from whatever we can do to boost it. But a great question is, what do we do with a guy who has no symptoms? And I think that's a personalized, individualized question. I like using genomics, personalized medicine in that situation because you can focus on other lifestyle factors. You can focus on different epigenetic maneuvers to help optimize other parts of their system. A big issue I see with these guys is sleep. Most guys with any questionable testosterone issues have terrible, terrible sleep. And so a lot of times optimizing their sleep, optimizing their response to stress, how they deal with stress, how they accommodate stress, their nutrition, their fitness, mindset, deal with all those other aspects of their health. And then a lot of times, it comes down to them making a decision how they want to deal with that. Does that answer your question? No? I think we're saying the same thing, that guys have a normal testosterone, super low free testosterone, they're asymptomatic, do you do anything about it? In general, no. The guy may want to do something about it, but I would not intentionally give him testosterone therapy or do something dramatic to that guy. Does that answer your question? Yeah, so when I see that kind of graph, and you show a big discrepancy in the drop between the free and the total, sorry, yeah, free and total testosterone, to me that really signals SHBG, because that's a classic signal, and you see this in women's hormones as well. And so the thing with SHBG is it's stimulated by estrogen, but it has a greater affinity for androgens. It's greater affinity, yeah. So I'm just kind of curious about the account you've given of the mechanisms of endocrine disruption. The account that you've given of the biochemical mechanisms of endocrine disruption being about lowering the testosterone, because my understanding is it's more about the binding of it and stopping it from okay, okay. So the question is the mechanism and it's understood that it's through multiple mechanisms. One is it has an anti-androgenic effect. One is it blocks receptors. One is it actually affects SHBG, which is more of the free testosterone, if you will. And then I think it's more so than that. I think we're also probably looking at an effect on testosterone production itself. So that was that one slide where I talked about the four different mechanisms. I think it's probably at least three of those that these toxins are working through. Are you aware of research on boron, through neuroboron, lowering SHBG? Boron, okay. Take a look. Okay, thank you. So one of the things that I often like to look at is what are the biggest levers and like the 20% that makes the biggest difference. And you mentioned that life cell factors like diet and other life cell factors, you mentioned sleep and stress just a moment ago too kind of a factor. As far as endocrine disruptors, how big a piece of the are they the majority of the cause of the testosterone drop, do you think? Or a small fraction or somewhere in between? Does that question make sense? Yes, the question is how much of an effect is endocrine disruptors versus lifestyle and other factors you're saying. I would submit that it's massive and it's the majority and I'll tell you why. I see guys in my office every day in their 20s and 30s they're working out. The guys who are very fit, they're playing tennis, their body fat very low, they're eating all the right foods and their testosterone levels are in the 200s. There's no lifestyle explanation for that. So I think that certainly when you see a 6 year old morbidly obese diabetic, there's an obvious lifestyle factor there, but most of the guys I'm seeing now is different. This is an epidemic among young guys who are otherwise fairly healthy. Of course everybody is individual and patients are individual etc etc. But in your experience and the group of many many patients that you see, where do men tend to become happiest as far as like total and free and SHBG and anything like that? Is there a range that you tend to see most people do the best in? And where do you find do you find a range that is too much and if so, where is it? Yeah great question. So testosterone levels, there's this clinical range that we've been given which is awful and that's generally 250 to 1000 or so give or take depending on which lab you're using. And that's awful and that's based, so you understand that's based on population level numbers. That range keeps dropping every couple years as a population level testosterone. It's just the, you know, we talked about the standard deviation yesterday with Dr. Wood. So this clinical range is BS. I see so many guys with testosterone level of 400 who are miserable. Do you, do you not treat that guy because he's quoting the normal range? The answer is no. So the answer is every guy is different obviously. The free is way more important than the total in general. There are exceptions but most guys that I see, the free testosterone is much more valuable to look at. And I would say that for a young guy in his 40s, if your level is not around, you know, 7, 800 ish, total and you're free somewhere around 100 ish then you may not be optimized. Now I want to be clear though, if a guy has a testosterone level of 500 and his free is 80 and he feels amazing and no symptoms whatsoever, you don't necessarily need to do anything about that. But that's rarely the case that I see. I typically see guys who are symptomatic, they have very low normal testosterone levels, you know, 400, 500 and they're clinically symptomatic. They are subjectively hypogonadal. Okay. Thank you for your talk, Dr. Gavin, I appreciate it. I have a question. When you talk about this worldwide epidemic, the studies you brought up, you know, there's Denmark, Finland, Spain, etc, etc. But are these really universal? I see it as a European and their descendants problem. You mentioned Israel, but is there any epidemiological data from Africa or Asia, etc? Yeah, there are studies looking at various parts of the world that show this effect. They found whales in the Arctic ocean that had detectable levels of estradiol. They looked at lakes outside of Germany. I don't recall one specifically looking at Africa, but there are studies from all over the world that are showing this effect on our marine life, on our water, on our drinking water in lakes, in crops. What I found is pretty impressive how Europe has been much more progressive and much more had a much more regulatory perspective on managing this. Whereas the US has really turned blind eye and the EPA has done very little to regulate this. And it's a problem and hopefully public awareness, hopefully pushing with a voice to make change will help. But the fact that the EPA is still legal here in the US is crazy. Atrazine. It's crazy. Thank you for allowing me to ask this question. On the basis that everything is connected to everything, I find it interesting that you didn't mention anything about elevated aromatese activity and various environmental sleep causes driving up DHT eating up the forms of T. Is that another pathway for T to be low? Just coincidentally, I was a soy fed baby and found to have hypo T not too long ago. I'm on topical DHRT and I find I've got high DHT above the high range but my T measurements are okay and symptoms okay. Then additionally there's the things being taken intentionally that are estrogenic like Chinese herbs. Many of the things that are in the herbal environment are estrogenic. So multi part to take your pick what you'd like to answer. DHT first. So DHT I have not found a ton of data looking at specifically correlating endocrine disruptor exposure to effects on DHT but I will tell you that there's a lot of correlational studies that look at genetics. There are numerous genes that have been shown to correlate with a man's conversion of testosterone to DHT and so that's an individualized thing where a lot of guys may have a higher conversion than others. As for estrogen I think it's important for us to realize that estrogen is not the enemy okay. In men we need estrogen. Estrogen is important for cardiovascular health or bone health or sexual function for libido for cognitive state. It's different with these endocrine disruptors though. Estradiol and all these other toxins they're like a glue. They bind to the receptors and they don't let go. They cause a hyper aggressive response. They block receptors. They don't act like normal estrogen in our bodies and so the difference is with normal healthy estrogen in these toxins is the balance between testosterone and estrogen and for men we need a normal healthy balance between the two with endocrine disruption it completely alters that balance. Hi, I got here a couple minutes late so I apologize if you covered this. Since the effects of these endocrine disruptors are extremely complex that can act as agonists and antagonists and enzyme blockers and have a lot of regulatory effects I'm wondering when you're evaluating these men if you're looking at gonadotropins to see how the body is perceiving the endogenous and hormonal environment to see if they're higher or low in these men that are complaining about. Yeah, great question and it's basically a mixed problem so what I mean by that is primary versus second or hypogonitrism. In most of these men they have low testosterone and low free testosterone and their LH and FSH will be super low as well so their access is not responding appropriately. You would have higher levels of LH and FSH but we're just not seeing that. Oh yeah, and again this comes back to the fact that these disruptors are multiple different mechanisms to affect testosterone production and not just pituitary stimulation but testosterone production as well as at the receptor level so I think it's at least three different levels where this is happening. Great question. Thank you everybody, we've gone a bit over time but I'd love to put your hands together again for Tracy Gaffner who is awesome, thank you.