 Testosterone time! You're gonna love today's episode. This has taken us a long time to do. You know, we've flirted with a lot of TRT and hormone replacement clinics in the past. Talked to them. We're never really satisfied until we found Dr. Ran McClain. That's who we interview in this episode. By the way, we put something together with them for mind-pump listeners. So if you're interested in TRT or hormone replacement or want to see if you're a candidate, head over to mphormones.com. I know you're gonna love this episode. By the way, we're also gonna give away free access to MAPS PowerLift to one of you lucky viewers. You're so lucky. Here's how you can potentially win access, free access to MAPS PowerLift. Leave a comment below in the first 24 hours that we drop this episode. Subscribe to this channel and turn on your notifications. If we like your comment, if we pick your comment, we'll notify you and you'll get free access to MAPS PowerLift. Also, one more thing, 72 hours left for our huge July promotion. MAPS hit in the No BS 6 Pack formula, both 50% off. Again, there's only 72 hours left for that sale. Head over to mapsfitnessproducts.com. Just don't forget to use the code JulySpecial with no space for that discount. All right, enjoy the show. Dr. Ran, I'm super excited to have you in studio today. I'm gonna give the audience a little bit of backstory on how I came across to you, and it was, Sal actually introduced me to you. I was already doing hormone therapy through another company, and I'd had a few months in and I was expressing to Sal, like, after I was like, you know, I'm not, I'm not really impressed with these doctors. I'm like, I know that I don't have a lot of knowledge in hormone therapy, but I have enough to understand some things. And I'd be asking all these questions of the nurses that were talking to me. And just, they seemed like they didn't have any of the right answers for me. And so I was like, you know what, let me do some research, let me find out who's in the space, who's doing the best job at this. And he began communicating with you. And he says, yeah, I know you're set up with this other company, but I want you to, to meet Dr. Ran and have a discussion with him. And it was such a great conversation. The very first time that I talked to you, I mean, you blew my mind as far as your extensive knowledge on hormone therapy. And I kind of want to start there for the audience so they can get a little bit of background. Where does all this knowledge come from? When did you start doing this? And when did you learn all about hormone replacement therapy? Well, it's a good question. And it kind of begs the question, how do you know I have all this extensive knowledge because there's so much ignorance out there, right? You know, there's a lot of still questions that have to be answered because it's not really become as mainstream as it should be. A lot of urologists now are taking over thanks to Dr. Lipschaltz and a lot of his fellows. And I think urology will be the torch bearer, you know, hence forward for testosterone replacement. And it makes sense, right? But I think we're probably 10 years off from that being in the mainstream because there aren't a whole lot of Lipschaltz's out there. And while his fellows are spreading around the United States, I still think, you know, we'll be in business at least for another 10 years because it's just not everywhere. And boy, when you talk about the ladies, OBGYNs I don't think have picked up the slack, you know, so we'll be in business with them, you know, for even longer, I'm sure. But where it got started was really, I mean, in sport. I've always been fascinated by trying to be able to do better at sport and repair my body. I was kind of a sickly kid. And they took out my tonsils when I was pretty young because that was the thing back then, if you're sick all the time, well, must be those tonsils. So they yanked those early. You too, right? And, you know, I got interested in nutrition because I was fascinated by the fact that you could control a lot of how you feel and how you perform with the use of nutrition. And then, you know, you started reading about anabolic steroids, not so much testosterone back then that the hullablue was about anabolic steroids. In the 80s, I think Sports Illustrated came out with an article that 85% of the NFL players were on anabolic steroids. So, of course, you go, okay, yeah, I want to be bigger, stronger, faster. I had Olympic aspirations. And so I was just telling you before, you know, I can remember in high school, wrestling one season and being able to dishrag one of my teammates. And then after summer, he came back 30 pounds heavier and was tossing me around the mat like I was a dishrag myself. So, you know, they're telling us that it didn't work was falling on deaf ears because clearly it worked. And, you know, that sparked my interest now, smash cut to many years down the road. I got into medicine myself. And it was easy to start practicing because one of the physicians I started with was already doing it. And with all due respect to him, I didn't think it was the best way of doing it. And I guess I skipped a long, long period of life where I was experimenting with these things myself, whether it would be testosterone, but mainly, you know, antibiotics back in the day. And of course, we were doing it different too, not to start rambling on to another question here. But, you know, back in the day, stacks weren't the big deal. We couldn't afford them. They weren't available. So, you know, we got to know, for example, Decad Roblin by itself and what it would do. And just like, you know, maybe some of you guys could do, you could tell a Cuban cigar from a Dominican Republic cigar, because, you know, it had a different flavor. Because we were using them separately, we knew, okay, oh, this is definitely real decah, because of the side effects or the things that came with it, or this is real dynamite, etc., etc. But a lot of the knowledge to answer your question was picked up along the way from from use. And, you know, look, the gym and bro science has its its negative aspects, no doubt about it. But it's also a great Petri dish for what works. Now, the explanations for why it works are often just to go, okay, you skip physiology class, I can tell, and some biology and other classes too. But again, it's one of the the most stringent regulators of some of these things, because it either works or doesn't, you either pick up the weight or you don't. And or you lift it over your head, heavy weight or not is what I mean to say. So the proof is in the pudding. And there are some of the harshest critics in the gym. So, you know, I learned a lot in the gym from fellow athletes is what I'm getting at. And and then again, for my own use, what was your so as your journey into educating yourself about this, what were some of the first big misconceptions that you learned? Well, like I said earlier, that it doesn't work that, you know, you become impudent and your Willie's going to fall off one day and all that kind of stuff. I mean, just some of the stupidest stuff you'd ever heard. And then it's going to, you know, you're never going to come back once you use anabolic steroids, your own endogenous production will never return. These are the things that are still perpetuated. I mean, you wouldn't believe some of the things you can still hear from. And I don't mean to be picking on anybody, but at the same time, I don't want to let anybody off. There's no excuses anymore. There's plenty of information published out there, even though it's not taught in medical schools, as far as I know, to this day, it wasn't when I was in school. But, you know, doctors will still say that, for example, testosterone, just using testosterone in a replacement fashion will raise your hemoglobin hematocrit, okay, and your red blood cell count. That's not true. If you've got someone who might be an, I call them an expensive date, who has to use more than the typical amount of testosterone because they break down the ester, for example, and they metabolize it quickly. And we're using more than a typical replacement dose. Well, then you might spike your hemoglobin hematocrit by maybe, you know, half a point. Oh, wow. I think that's not a big deal. Well, this is what you actually, this is what you said to me. I'll never forget when we had that first conversation and you made that analogy to me. I thought that was really funny because I thought the opposite was going to be true with my situation. I thought that I would need more testosterone because I abused it so much in my 20s and that's why I'd be an expensive date. And you broke it down differently to me. Explain what makes somebody a quote unquote expensive date. Just the way you choose your parents. I mean, it's really just luck or the draw. I've had guys that are, you know, we call them steroids for 30 years that come in for replacement therapy and could really, if they wanted to, probably get away with injecting, you know, 200 milligrams per ml of testosterone, it was a typical starting dose every nine or 10 days because they metabolize it very, very slowly. So it's not necessarily what you did before. Now, your liver can accommodate in certain ways and make more or less aromatase. That's more of a factor based upon, you know, prior use. But even then prior use, we're talking about, you know, months ago, not years ago, because your liver will adjust to some of the, for example, foods you eat and some of your lifestyle factors to either produce more or less aromatase. But yeah, what you did before is not really as much a factor, certainly, as people think. And just to follow up on the testosterone thing, because I think it's important for people to know, you know, elevating your hemoglobin and hematocrit, what typically is the case is more times than not at sleep apnea. In other words, the testosterone can leverage hemoglobin and hematocrit production, right? Red blood cell count. You need it. People who come in with really low testosterone will often have low hemoglobin and hematocrit and can be even anemic because of it, which just means you're below normal hemoglobin. But it's not, testosterone in and of itself doesn't cause a problem unless you're going to really high dosages. It leverages it, though. So we see sleep apnea a lot, especially in, I mean, everyone in here probably got a mild form of sleep apnea. I'm looking at everyone's neck. We got it muscly guys in here. And typically a good ear, nose and throat doctor will look at you and go, oh, your neck is at least 17 inches. You probably have some obstruction there. And as you age, you know, things get a little, I don't want to say softer necessarily, but maybe looser. If you have a, you know, a drink or two before you go to bed or anything that might relax you, those muscles will relax more and collapse on the trachea. So you know, you'll find this. And of course, testosterone will leverage that. That's why guys, even the tour de France, not anymore, of course, but, but they might use testosterone not because they certainly don't want to get any bigger. They want to be six to 135 to be able to get up the hill, but they know it leverages the production of testosterone, which is the, sorry, leverage the production of testosterone, bigger part. Using testosterone leverages the production of red blood cells and hemoglobin, the oxygen carrying capacity of the red blood cell. So Dr. Anne, because you've been doing this for a little while, I wanted to ask you, because the attitudes towards testosterone really changed severely. And they seem to be, the pendulum seems to be swinging back in the other direction. Cause I know in the early days, testosterone, even anabolic, they were very easy to come by when I read stories about, you know, the 1960s and 70s, then steroids became kind of public enemy number one, which included testosterone. It was a scheduled drug, although I would love for you to correct me if I'm wrong, but of all the hormones you could potentially inject into your body, testosterone has to be one of the safer ones, especially if you compare it to like insulin and other hormones, but absolutely. So and in some countries, it's over the counter. But nonetheless, it became public enemy number one and doctors were afraid or couldn't prescribe. So if you were a guy and you go to your doctor in the 1980s or 90s, they test your testosterone, it's in the floor. You're not doing very good. They're super reluctant to even prescribe it. Now we see TRT facilities are popping up everywhere. What changed in that? Like what happened to where it was like, you could not get any hormone replacement. And now it seems to be much more available. I got a few answers because you got a few questions in there. I hope we can keep track of this and come back when I get lost on a tangent here. But I mean starting with any of these substances were banned as of the 76 Olympics. That's where things definitely changed. Was that when the East Germans showed up and just crushed everybody? Okay. You can blame it on them, but how order was given special dispensation for his, I think it was his last Olympics because he had been on antibiotics for so long. And it was legal to compete on antibiotics. Again, prior 76 that the assumption was, okay, you use them, now you're dependent upon them. So it's my understanding you got special dispensation for his last Olympics. That might be a fairytale, I don't know. But again, the point is, it wasn't a problem until that point. And then yeah, everything changed. Now, why it became public enemy number one, number one, but it was up there at the top of the list, right? I couldn't tell you. I have no idea. Why has, and I don't mean to, I'm just picking one. And I don't have a special thing in my heart about marijuana. But we saw movies from, I guess what the fifties and sixties, you know, reefer madness. And I've never seen the movie. I've just heard about it where, you know, you smoke pot, it's going to lead to heroin addiction, and you're going to jump off a building one day and kill yourself. So why, you know, and we know better. Well, who dreams of stuff up with testosterone? Like you say, it's probably one of the safest hormones out there. It's definitely, you mentioned insulin. Insulin can kill you. No doubt. I've never seen a case where testosterone killed anybody. Estrogen, okay, can kill you. Okay, certain forms of estrogen are associated with prostate cancer and all kinds of estrogen sensitive cancers in females. So yeah, why it became such a, why it developed such a stigma? Was he a big part of that? I remember that. Yeah, they like, you know, pointed him as like, that was a big problem with, you know, his health was that he was a big steroid user. Yeah, I got to be careful here because of legal reasons, but I would argue that that was not the cause of death for Lausato. And I probably should leave it at that. But there are certain stigmas with certain diseases that I think, you know, he may or may want to, may or may not have, and I'm speculating here, must make it clear. So none of us get in trouble. But Lyle was a great guy. I knew him from Golds and he's super loving guy. But if you look into some of the things that were associated with his death, it might have been something else that caused him. I know of nothing that testosterone would have contributed to the things he died of. You know, what would that be? Brain cancer, I've never heard of a testosterone stimulating brain cancer or perpetuating it. I mean, it's just, like you said, it's a very safe hormone. So don't know about that. But then, okay, there was like three parts. Yeah. So it was so, because it became like this enemy drug and it was thrown in the category of steroids or testosterone being technically a steroid as well, it was impossible for men to get treated for low testosterone or even it wasn't even people weren't even aware that there could be an issue. Now it seems like the pendulum has kind of swung where, where it's people are more aware, there's more facilities available. Is this because of the, that there's so many men now with testosterone issues or have they changed the laws or what has caused this pendulum start to kind of swing the other way? Well, I think public demand. I mean, I can tell you that, for example, I had a young lady in my office who brought her mom in for whatever reason they only had one car and she was long for the ride. And she was probably, mom was in her 70s and this gal was probably in her early 40s. And she had low testosterone was complaining of all kinds of symptoms of low testosterone. And just out of politeness, I looked at mom and asked her how she was doing and she said, I'm fine. And I said, you know, nothing like your daughter here, none of these symptoms. No. Then 90 days later, daughter comes back with mom again for the follow up. And I being polite again, asked mom how she was doing and mom wasn't doing so well. All of a sudden she had all the symptoms that her daughter complained of earlier. My point being that, you know, humans are pretty phenomenal creatures in a lot of ways. If there's nothing you can do about it, if you've got an ounce of character, what do you do? You deal with it. You muscle up and deal with it, right? So mom had been doing that because her generation is, in my opinion, did not have these options, right? Like you said earlier, it wasn't really available. Certainly not to women as even more example, better example. And now she sees her daughter getting better. And all of a sudden, well, yeah, I'd like to get better too. It's probably going on at least subconsciously. And this is typical. And I think with guys now that we know, hey, it's not this public enemy, testosterone replacement. And my buddy down the street is using it, or my buddy in the gym is using it and doing so much better now. I can see it. That's how I found out about it. I asked him, I said, dude, what are you doing, right? And he found out about it. So public demand is leading that charge. Certainly. Okay. Also doctors. I mean, I got a lot of patients that are doctors. They're finding out about it and they're going, way, well, this is a great way to help my patients. This is a great way to make a living. And come on, I have a great job. I don't have people complaining about major problems. They're not on 26 medications. Typically they're people that are trying to get even better in terms of health and optimizing it. So what a great way to make a living. So more doctors are incorporating it into their practice. It's now being covered oftentimes by insurance. Even the HMOs of the world are sometimes covering it. The problem there is, to get to another problem, is before you have doctors looking at reference intervals. And those reference intervals for testosterone are very broad. Yes. Explain that reference. Because I know I look at the numbers and I'm like, it goes between 300 and 1200. That's a big difference. Well, that was another thing that you blew my mind and corrected me on, too, was the other place. We always talked about this generic range, right? They would tell me like, oh, 400, I think to 1200 of free testosterone is this kind of optimal or total testosterone is this optimal place to be. And I remember you telling me that, yeah, but there's other things, other factors I'm looking at on your blood work that are actually more important. Go into that a little bit. Remember that conversation? Yeah. No, because I have it frequently. Fortunately or unfortunately, first of all, I don't know where they're getting those reference intervals from. And I see it all across assays. Nowadays, for example, you can see a cholesterol reference interval that is nothing close to whatever they want to call it normal, because I see these assays day in and day out and zero to 99, I'm going to forget the units of measurement right now in terms of, say, LDL cholesterol, is not normal. Okay, so where they're getting those reference intervals, I couldn't tell you, unless you're on a statin or getting chased by lions on the Serengeti plane on a daily basis, you're not seeing somebody below 99 typically. When it comes to testosterone, again, I have no idea where they're getting those numbers from. They have adjusted them, by the way. Some companies from that, it was like 1197 LabCorp used to have as the top of the range. That's unusual. And now they've clipped it back to somewhere in the 900s, I believe. But the point is, it's your point. I think this is the question you're asking. First of all, even if that were normal, so what? As I like to joke with, but make a point with my patients, it's normal to get sick and die one day. Who cares about what's normal? One day, zero is going to be normal for you, because you're going to be six feet under, nothing's working, right? But we want to concentrate on, I would think in medicine, is what's optimal? What's the best thing for you? So if you see someone, and this is my typical patient, especially coming from an HMO, or a doctor that hasn't been educated in this yet, they look at your labs and they go, okay, for example, in your case, you're saying that the reference interval you saw was 400 and above was normal. Okay, you're at 450. Big whoop, right? At the end of the day, what do you treat? The numbers of the patient, if you're still having issues, complaints, then the numbers are to be used as guidance. If you had 1,100 total testosterone, and more importantly, by the way, your free testosterone was commensurate at, say, 22 pKg per milliliter, then you go, you know, probably not testosterone that's causing you the problem. Makes sense, right? Because that's pretty flush. That's a nice level of testosterone. You might look at other reasons for a lack of energy, a lack of libido, etc., or lack of body composition, you know, quit eating the cheeseburgers all the time with the milkshake and supersize and all that stuff. You get my point. Right. So, yeah, I mean, that's probably the other problem that has started to change is that doctors are realizing, oh, you know, the reference intervals are just that. They're there for reference and support or subtraction from a diagnosis rather than a rigid level. And one of the guys that helped that immensely was a guy named Abraham Wurgenthaler, who wrote a book, Testosterone for Life, I believe was the name of the book. And earlier in his career, he had set a limit, I think it was 450, as a matter of fact, for total T, did even concern himself with free T. And then finally, in an international consensus, I think from 2016, said, hey, it's not about the number. It's about the patient, which is kind of a duh, right? You would think. Anyway, things have changed because that's now published and he's a big shot in the industry. He's got a much better resume than I do. I think he's an associate professor with Harvard. And so that's helped things a lot too, I think. Yeah, I remember reading years ago, because obviously, I've been in the fitness space now for decades. And what we used to hear all the time were the dangers of high amounts of anabolic or high amounts of testosterone. And this is, of course, this is popular media, how bad it is for your heart, how bad it is for your health. And then I remember reading actual scientific articles, this was a little later in my career, and seeing, and I had no idea. I had no idea that low testosterone had severe health longevity effects. Can you go into that? Because I think a lot of us think high testosterone is really bad, but on the other end of the spectrum, and maybe we can get into that, like high testosterone, is that really bad? But let's talk about the low testosterone and what that could, besides feeling like crap, besides having low energy, low confidence, low libido, what are the health risks of having just low testosterone? Let's definitely come back to the risk of high levels, okay? But because first of all, definition of high should be defined or undefined, at least in terms of the reference intervals that we have currently. And there's other factors that come with high levels of testosterone use in the bodybuilding community. But to answer your question, absolutely. We have studies that go back, I think as far as the 1950s, showing a correlation between low testosterone and things like coronary artery disease, type II diabetes, colon cancer, prostate cancer, osteoporosis, okay? And that's other than prostate cancer in both men and women. Dementia and Alzheimer's too, I just read recently. Which adds up, right? I mean, you can start drawing all kinds of, and again, I use the word carefully, correlations, because look, if you had low testosterone, for example, given all the other things you do for your fitness and your health, more than likely, more than likely, you're not going to have an issue with type II diabetes, for example, or coronary artery disease, okay? Although there are other factors that play in. And that's the thing, it's multifactorial. So we're always generalizing, which is important to include in the discussion in any discussion in this medical. Everything should be individualized. But going off in too many tangents, I apologize. No problem. We know generally speaking, though, that there is a correlation. And when we correct these things, life gets better, and the likelihood of some of these disease states decreases. That's a given, okay? So yeah. There have been some studies, so-called studies, that have raised the attention. And if you remember, maybe six, seven years ago, I'm terrible with time. But on ESPN, every 15 minutes, there was an advertisement for a class action lawsuit. If you or your loved ones have been involved or been prescribed testosterone, do you remember those? No, I don't remember that one, but I know the commercials. I do, because he didn't watch ESPN. What was based on, I believe, two studies, one of which I remember, it was a VA study, which I'll just stop there, right? But now going further, they used a cream. By the way, the upshot of this study was it increased the risk of heart issues, mainly coronary artery disease. So one of the knocks, and I'm not suggesting that this is true, necessarily, but one of the knocks on the VA system is there's very little follow-through, and in some instances, I mean, there's some great counter examples of this, but in a lot of areas of the country, the care is not that great. So anyway, you have a guy who jumps into this study and they give him a cream. There's no way to determine if the patient was compliant. So he might have said, okay, yeah, I'll do this and got his other meds that same day, but got maybe to the front of the line because he participated in this study. I don't know. I don't want to speculate any further than I am already. But then three months later comes back, applies the cream that day because he knows he's getting tested. Again, no assurance of compliance, but the treatment was ridiculous based upon what we know now. It was like, you know, some of these, and I won't name names, but some of these branded gels and creams that, you know, don't even have enough in them. The dosing is not even sufficient for a female in those cases. So they weren't being treated really. We can't be sure that even with the treatment they were given, they were compliant. And here's the kicker. These guys in the study were all in line for cardiac catheterization, meaning they were already hard patients. And yet it was published, okay, in peer-reviewed journals, a bunch of us got together. And of course, once we saw this, and it takes, you know, months, if not years to reverse some of the stuff, objected the study was retracted, you know, the journal was spanked for even publishing it. And, you know, there you have it. There you had people that were, and you know, this is, I called one of my best buddies in the whole world who happens to be a PI attorney. I said, and it happens to be on, I'm not going to name his name, because he happens to be on therapy. Excuse me. And I said, friend, what's going on here? And I went on off, I started off on a rant. He says, whoa, whoa, whoa, rant. He says, it has nothing to do with the medicine. It's a class action lawsuit. That's the brass ring for an attorney. Okay. They got a lot to win and very little to lose. So that's how these things get perpetuated. And, you know, patients of mine, either that we're already on therapy or that we're thinking about are coming in and going, what's going on here? I heard it can cause heart problems. And you got to back through, you know, over 70 years worth of research and undo, you know, undo all that because of one lousy, you know, irresponsibly published study. It's remarkable. And I say 70 years because we've known since the 1950s that this stuff is, it not only works, but it's very, very safe. We've got plenty of studies that go back that far. Wow. So, now let's go back to the high testosterone fears that were, it's dangerous to have too much or, you know, taking too much can cause problems. Let's talk about that. Maybe, I guess, paint the context. What would you consider too much? Would it be out of range or does it depend on the individual? There have been no studies that I'm aware of that use dosages that we might find in your typical bodybuilder program and, you know, prescribed if you will in a gym, right? So that's kind of hard to answer on one hand, but having seen all this, you know, go on in a gym, a couple of things come to mind. First of all, there's, you know, in terms of a, we don't have a formal study, but even in terms of analyzing this, we don't know what those guys are getting necessarily. This is all bootleg, pharmaceutical stuff, right? And based on what I've seen, a lot of the stuff is stepped on, because guys will come to me and say, Doc, you know, what comes here stays here, right? You know, they're afraid that I'm going to report or something like that, you know? Yeah, yeah, yeah. And they'll tell me what they're doing. I think it's impossible, especially based upon your laboratory assays. So there's definitely evidence that whatever they're getting in the gym is not necessarily what it's supposed to be. Interesting. So you'll hear about guys doing, you know, three grams of something a week. That's impossible, you know? It's just, it's just not going to happen. But even if they were, you know, back in the day, you hear stories of guys doing, and you know, how do you substantiate these stories? Guys doing a gram or two of something a week. Okay. Even if you were, you know, the risks of excess testosterone or certain antibiotics would be conversion to other substances like excess estrogen or dihydrotestosterone. And as you know, certain antibiotics will not convert to DHT or estrogen. So even those are limited. The other risks that most doctors will talk about, and this opens up a whole other can of worms is every, and it's rare you can say this in medicine, every anabolic steroid comes with side effects to raise so-called bad cholesterol, LDL, I say so-called for a reason, and lower so-called good cholesterol. And so that's a major reason why in practice, if some doctor were to prescribe an anabolic steroid, they will typically always weigh risks versus benefits, but pull you off after say three months and watch for your lipid profile to reacquilibrate. Why couldn't tell you? Unless you have established coronary artery disease, it makes no difference. And this goes off into another conversation about lipids and how we look at things for the last, again, 70 years incorrectly when we evaluate someone's lipid profile. If you wouldn't mind, let's get into that because you're saying so-called bad, so-called good. Why are you referring to them that way? Well, there's a lot of issues with the standard lipid panel. We're looking at LDL cholesterol and it goes well beyond that. But first and foremost, again, and it's a great timing because the people on the, what people call a dirty ketogenic diet where they're using a lot of saturated fats for their ketogenic diet, you see a lot of elevated LDLs. Well, and if that were killing people, we see people dropping dead left and right because I see people in my office on these diets that have an LDL over 200, right? LDL doesn't cause the problem. LDL comes in after the problem has started and the problem starts with inflammation. And I use the analogy of gasoline in your garage probably, if you still have an electric lawnmower, sorry, if you don't have an electric, you still have a gas-powered lawnmower, by five gallons of gas is pretty useful. Okay, cholesterol is useful. After all, it's how we make cholesterol. Sorry, it's how we make cholesterol-based hormones, okay? And so they are very important until you go on TRT, then it doesn't matter so much, right? But that five gallon gasoline can is not going to be a problem to you as long as you're not using your acetylene torch next to it, right? Now, if you are, then you might have a serious problem as well as maybe your neighbor. If you don't have inflammation, if you don't have an irritation inside the endothelial wall of your coronary arteries, then all the so-called bad cholesterol in the world is not going to start a problem. It will finish it for you. It will start you off. It will not start you off. It will finish off what you started with inflammation, okay? And then you go into the measurements. Do we really want to look at LDL or do we want to look at LDLP? Or do we want to look at LP, little A? These are other measurements that get into more of the brass tacks of your lipids that actually make a difference and are more correlated. So like these are the, are you talking about like the smaller or larger particle LDL particles? Is that what that refers to? More of the number with LDLP, the number of particles, and then LP, little A is another measurement altogether. And even those two are correlated somewhat. So you don't have to necessarily get both of them. You're in pretty good stead. I'm just being practical now as a physician, getting one or the other, but just getting a standard LDL is standard of care. And so legally, a lot of physicians are really, including me, are sort of forced to grab that. And okay, if I saw a guy the other day with 316 LDL, I go, okay, well, you're at greater risk than someone else if you have established coronary artery disease. So it might leverage me to go into recommending, say, you know, the starting course would be a bilateral carotid Doppler ultrasound where they just look at your carotid arteries to see if you do have any evidence of coronary artery disease in which the LDL would, again, make a difference. But if not, you know, you move on, there's a 95% correlation again between what we see here and what's in the heart. And this isn't me making this up. If you talk to the top cardiologists, say the top 5% of the cardiologists, they'll agree. You know, this is Stefan Ruhm over at UCLA, best in the West, has been doing this for 20, 25 years. And guys like Mark Penn, you know, formerly of Cleveland Clinic will agree because it's not a factor, just this cholesterol, unless you have coronary artery disease to begin with. So it's a good, what's your biggest risk for coronary artery disease? Like most diseases, age, right? So if you're 30 and you have an LDL of 200, am I really going to start worrying about it unless you have, you know, a first degree relative and other risk in your family that had coronary artery disease early in life? So you see, there's a lot of factors here. And again, the problem is, what we're talking about here is trying to do kind of paint by numbers medicine. We all do it. We generalize. That's how we move in the right direction with medicine. But you know, you still have to treat everybody individually. You brought up inflammation. Is testosterone anti-inflammatory? Because I've known people who, when their testosterone is low, they feel lots of aches and pains. They feel stiff. Then they get on TRT and all of a sudden they feel loose and not as much pain. Is that due to any anti-inflammatory effects? I wouldn't say in a direct way. I would say in an indirect way because you're healthier. And of course, even just for example, stability at a joint that might be already arthritic, if you've got some more strength, you know, put on a little muscle and because of testosterone use and combined with proper exercise, you strengthen the area, then you're less likely to have, when you don't want it to mobilize in the wrong directions, mobilize joint, it stays more stable and you have less pain. Definitely. I mean, I hear that all the time. Reduce inflammation for more strength, which we see as trainers all the time. Making someone stronger, less pain because they're moving better. Therefore, less inflammation. As with so many things, the poisons in the dose and arguably certainly when you move into anabolic steroids, part of the stimulation, sort of like the sand in the oyster to stimulate muscle growth is a little more inflammation. So, you got to be careful to say is it anti-inflammatory or not. I wouldn't say it's one way or the other, but with the example I gave you, I sort of skirted the answer to the question. Certainly, if you had an arthritic knee, for example, strengthening the knee in most cases or even if it weren't arthritic, if it was a loose ACL or something like that, would make for less pain. What are some of the biggest mistakes that doctors make with TRT, with their patients that you see? Let me jump in here real quick and hopefully you can edit all this stuff and make it more flowing. But I wanted to touch on one thing about the excess testosterone. One of the things that comes with that, I harped on one about, okay, you're not really getting three grams equivalent. It's probably a tenth of that because they step on it just like any other, I know it's not a recreational drug, but things that are sold on the street, right? What people forget is the bodybuilders, and I'm not picking on everybody, but in general, the bodybuilders of old, what were they trying to do? They were trying to become as big as possible. And even if they weren't trying to become as big as possible, today's athlete wants to be leaner and more ripped, but what are they doing for a living? Typically, the top guys are not working a nine to five or certainly an eight to seven desk job under a lot of stress. They're working out, they're eating, and they're sleeping, and what else? And there's an expression, idle mind is devil's playground. The fact of the matter is, and I'm going to get a lot of flak for this, I know, but it's the truth. And if anyone's out in that field, they'll know. A lot of recreational drugs come in there. Guys are getting involved with, in my generation, we knew a lot of guys who were getting involved in New Bane was the drugs killer, right? Yeah. So it's the recreational drugs that are biting them in the butt, not the testosterone. Okay. Interesting. And again, you can do anything in excess. I'm not saying that's not the case, but really, you're probably more apt to harm yourself with excess aspirin used in excess anabolic steroid use. Okay. So back to the other question I had, which is, what are some of the mistakes you see in the TRT space where doctors are giving patients testosterone? Underdosing. So one of the first things doctors do is they go, okay, well, you know, This is what happened to me. You're at 400 and we're going to shoot for X. And whatever X is for that doctor, let's call it 800 nanograms per deciliter of total T. That's what we're shooting for. We're going to give you what we would consider the difference. Well, your body is working on like a thermostat and it'll just simply go, great, now I have to do even less work. And so initially you might get a bump and then your pituitary realize, okay, no need to send as much luteinizing hormone to the test schools and you drop back down to 400 again. Or sometimes even less depending on the results. That's what I want to mean. So I went lower. Right. Because you suppressed it. Yeah, they gave me, so that's what I thought was really fascinating. I think the first time I tested, I was like, I want to say 412 was my number. And they gave me 150 milligrams of testosterone. On day seven, when we would, we would retest, I actually fell down to 398, 406. And then they would just keep, they would then they moved me to like 160, then 170. And I was, and I think when they finally got me to 180, which was right before I met you, I was still four, I was still coming around 440 or something. But I was, yeah, they had, initially it was crashing me lower than what, when I even started. So it has to do with the dose, you know, and the timing of the dosing, of course, and you can imagine what I saw with like daily dosing of the gels and stuff, where it almost acted like hormonal oral birth control for females, where you've got a smidgen of something, but it's enough of a smidgen of estrogen, for example, that suppresses her endogenous production. That was what was happening to you. And it happens a lot with physicians who think that way. Okay, you have to again, think of it like a thermostat in order to dose properly. And then of course, you have people that as I said earlier, either, you know, a cheap date or an expensive date that might be metabolism more quickly. So that's probably the biggest mistake doctors make. And then the other one is, and it's part and parcel of that, shooting for a certain number that's within the reference interval, you're no longer normal once you're on TRT. Okay, again, who wants to be normal? But you know, those reference intervals are for people that are producing their own testosterone. We've known since the 1950s, and I'm certain of this, that in order to resolve the complaints that most people come in with, to get clinical benefit, in other words, you have to hit, and this is back in the fifties, they would use the total testosterone, at least 800 nanograms per deciliter, total T. Now, when I say hit it, I'm talking about maintaining a level above that. So that's the minimum above which you want to maintain. So that's the threshold, right? So if you're using sipionate, for example, on a weekly basis, that's the number you want to be at on day seven, or day one, however you want to call it, the day you're going to do your injection. But before you do your injection, okay, you don't want to drop below that. Now, I would argue that in today's world where we use free tea, which is roughly, especially on someone using TRT, 2% of total tea, I think you're shooting for, at least in my experience, for clinical benefit, the patient to be optimized somewhere around 28, maybe even 32 pika rounds per milliliter of free tea. And again, I'm just using numbers here, right? I don't care what the number is. If you come in and you say you're feeling great and you're free teas at 16 on day seven, I don't care to adjust it. Okay. But again, if we're using numbers, that's the number that seems to alleviate most of the symptoms that guys are complaining about. Now, again, I'm giving you guys numbers. And for guys, the total tea is probably going to be at least double high normal during the course of the week. Okay. For females, it gets even more interesting because they're going to be probably at triple high normal of that reference interval, right? To get to a therapeutic range. And it freaks physicians out, you know, primary care physicians who aren't in charge of this and patients themselves unless we warn them that, hey, this is the number you're going to see on your total. But again, their free tea females I'm talking about will be usually within the range, which is, you know, up to 4.2, say, p-grams familiar. And again, who cares about the number? But I'm just giving you the number. That's where they seem to, that's the sweet spot, the therapeutic threshold above which they have to maintain it to feel better. Now, I have a question. I'm probably the most ignorant out of the three of us in terms of like anabolic steroids and bodybuilding. And, you know, I come from a little bit more of a sports background when I was told to just avoid them completely, right? I was wondering just for myself and for the audience in terms of like what the options are out there for anabolic steroids and what each one has in terms of their characteristics versus, you know, you mentioned like DECA and testosterone and like, what are the other ones that are kind of out there? And, you know, what are sort of the pros or cons of all these things? Great question. So there's a bunch of great steroids out there, anabolic steroids. And before I go in any further, so people use that term loosely, right? Steroids. Well, testosterone, estrogen, DHEA, progesterone, pregnenolone, they're all steroids. Isn't cholesterol a steroid even? Well, cholesterol is the molecule from which we derive the word steroid, like cholesterol, like steroid, right? So all these hormones that we're talking about, yeah, are made from cholesterol. So that's different than an anabolic steroid to which you're referring, right? A molecule that usually is either a testosterone molecule or often enough a dihydrotestosterone molecule that's been jiggered in such a way by, you know, removing or adding a ligand along the molecule, so that when it goes into the cell, you know, it operates differently, we'll say, than a typical testosterone molecule. And what we mean operating differently is typically, you know, more of the anabolic properties will be emphasized, those that build muscle, accrete mass, rather than the androgenic side effects, the secondary male sex characteristics we call it, you know, that, you know, the accentuate, you know, the hair on the ears we get after we're in our 30s and stuff like that, you know, the weird stuff that none of us likes, balding and stuff like that. So there are a bunch of different antibiotics that have been developed. Unfortunately, we're limited as to what we can use in the United States. There are roughly, let's see, four that are used. There are more than that that are actually legal. For example, there's something called halitestin, which I have no idea why everyone, anyone would ever want to use it, a lot of bodybuilders do, because it makes you, and I'll put it mildly kind of edgy. And if you're power lifters like to use that one, I heard it makes them aggressive, ramps them up, right? So, you know, bodybuilders, power lifters is a great example, you know, though you smelling salts to perk themselves up, if you will, right before a lift. Same idea with halitestin, with bodybuilders it's more for, hey, I'm sucking wind here because I'm not eating prior to the show and they want anything to get them through a workout. It's unfortunately really rough on the liver. And again, I, you know, it can make you edgy and understatement, it can make you homicidal. So again, halitestin, I would say, hey, eschew that and have an extra espresso before a workout instead. But we have some good antibiotics that are useful for wasting disorders. I mean, that's what their standard, their indication is, right? Cachexia and wasting disorders, burn victims. So, oxandrolone used to be known as anivar is one of the best ones out there because not only is it anabolic in nature, it's also catabolic in nature. So, you can actually put on muscle and lose fat at the same time, sort of the holy grail of what most people in life would like. Yeah. Yeah. And it's, it can be used in females too. It's one of those that's a dihydrotestosterone derivative and it doesn't convert to estrogen, therefore. It doesn't affect the receptors, you know, for dihydrotestosterone. So, it's what we would consider a clean anabolic steroid. It's also, again, very useful for females because it doesn't convert to estrogen. So, if someone has had an estrogen-sensitive cancer, they can use it without fear of, of, you know, propagating cancer yet again, an estrogen-sensitive cancer. So, in that way, it's a wonder drug. A lot of bodybuilders use it prior to a show because that's exactly what they're trying to do. They're trying to lose fat and hold that muscle. There's one related to that called dustinazolol, which used to go by the brand name Winstraw. And that one is very similar to oxandrolone, except it also, one of the indications is for angiodema. So, it gets rid of the extra water, the third space water, the kind of water you don't want. Not the water that stays in the cell, but the one, the water that's in between cells. And so, bodybuilders like to use that a lot too or, or track athletes. That's a Ben Johnson got banned from the Olympics or whatever. He has gold medal taken away from the high. And it makes sense, right? You would use that one over anivar. Why? Because any athlete like that wants to carry as little extra as possible, yet still maintain the muscle mass and lose the fat, right? So, that makes sense for track athletes to use Winstraw. Plus, I think it tends to pep you up a little bit too. That's just been my experience. And that's a, that's a, that's, you can prescribe that in the U.S. Yes. Okay. You can prescribe an oral form. You cannot prescribe an injectable form. And I may not be the one to, to quote when it comes to the legal aspects of this because it might have changed, but that's my understanding is that, you know, you can't do the injectable for some, I guess that's only for animals or something. There's some rationale behind it. I don't know. And by the way, you can't get an injectable anivar either, which baffles me sometimes because I think it would be more useful in some ways for, especially if you ever had to use a higher dose like for a burn victim. There's a lot of talk about how these are hard on the liver because they're oral steroids and they're alkylated a certain way. In my experience, I've never seen elevations in liver enzymes because of these when used the way they're supposed to be used. And this will be probably more helpful for the nerds out there, but AST and ALT are typically referred to as liver enzymes. And yet you can have elevated AST and ALT because of just muscle tissue breakdown. And so a lot of times people who are on hand block steroids have more turnover of muscles, certainly, right? And so, oh, look, that anabolic you're on is causing liver issues. No, it's not. And an easy way for physicians who are listening or anyone else to verify that is to get a GGT, which won't be elevated for muscle tissue breakdown. Okay. And it's specific to, well, the liver, but also pancreas, biliary tract, etc. So you use that to compare and go, oh, look, my GGT is well within normal limits, but my AST and ALT are mildly elevated. You can assume that things are safe. And there's other ways to prove that, by the way, you can do a liver ultrasound to make sure it's not too fatty, which, by the way, is one of the typical side effects. Probably the most dangerous thing about anabolic steroid is fatty liver, which tends to resolve after you get off the anabolic steroid. And all makes sense because what anabolic steroids do, they help pack glycogen into muscles, right, so that they become better later. But well, the next step up after, once the muscles filled for the moment, next step up is to store the energy in the form of glycogen in the liver. So you can build a fatty liver fairly early and I'll keep ramming here. Let me just ramble a little bit more, because this, I think your audience will appreciate this too. And I learned this from Franco Colombo way back in the day, God rest his soul. You know, bodybuilders, like I said, especially back in the day, used to just want to get big. So you do a lot of lifting, a lot of eating, and a lot of sitting around. Well, you could very easily develop a fatty liver. And so they all knew after an anabolic steroid cycle to use something called, back then it was just anositol and choline. They're nowadays still considered pretty much a B vitamin, although they're still arguing about how to classify them. Now we add another amino acid called elmethionine, and we call them midcaps. 30 days of these midcaps in a high dose, we're using 3000 milligrams of anositol and choline and 1500 of elmethionine every day for 30 days, divided all at once. And you get a squeaky clean liver. Oh, wow. Wow. Fascinating. And I say this because I mean, fatty liver, the latest estimates is that 100 million Americans, that's a lot of us, have fatty liver. And yet there's no pharmaceutical cure. I don't care what they market it as, and I'm not naming names, but I'm telling you right now, we don't have anything to compare to these two simple, excuse me, three simple ingredients. You can get over the counter. Yeah. Yeah. And not harmful. All right. Now, there are others. So back to your question, there's nandrolone, which used to be branded as decaduralin, which is an injectable steroid. Great for just putting on mass. It's essentially anabolic without being catabolic as well, like stenosolol and oxandrolone. And I use, for HIV patients, it's fantastic because you can put on 20, 25 pounds of extra weight in someone that, unfortunately, they can go through about a illness and that 25 pounds can be a lifesaver. I mean, it's a no-brainer. And very little risk with, I mean, what are the risks with nandrolone? I say very little. According to the medicine, that elevation in lipids, the bad lipids, the LDL is supposed to be a bad thing. But again, for reasons we talked about earlier, I would argue that's a bunch of bunk. And so it's a no-brainer for someone with HIV who's underweight or even mid-weight to put a few extra pounds on it, if it's not stressing the heart or something like that. And then the other one, which again, I don't understand why you'd necessarily want to ever prescribe it, is something called anadrol. Oxymethylone. Is that the name? Yeah. I've never written a prescription for it in my life. God, I heard that. That was referred to. God, this is back in the 90s. I had this bodybuilder that worked for me. And they called it guerrilla-roids. That was a nickname. Well, isn't that five? Did you say four? Or are they not five right there, right? There's the anadrol? That's five now, yeah. Oh, five. Because I said there's four that makes sense. Halitestin. This makes no sense to me. God, an anadrol makes no sense. And there are other ones that are legal. There's something called Danazol, which is called an anabolic steroid. But I don't see anything anabolic about it. What I use it for rarely, but I still use it as if someone's on TRT and their free testosterone is on the low side in terms of percentage. Like it might be one and a half percent instead of two percent. For some odd reason, I'll throw in a little bit of Danazol, which really wouldn't do anything except reduce SHBG, which is binding the total testosterone so that the free testosterone comes up. But anadrol, you said it was what did you call it? I call it dinosaur juice, man. I don't know why anyone would want to be on that. But for people that are really having a hard, hard time putting on weight, the indication I think is for, I want to say, pernicious anemia. And there's so many other ways to treat pernicious anemia than putting them on anadrol, which, by the way, has a major side effect for a lot of guys. It doesn't convert to estrogen, but it seems to activate the estrogen receptor somehow. It makes guys just absolutely crazy. The so-calledroid rays that people talk about, by the way, is typically not because of anabolic steroids. Now, how a testing can have that side effect to it, if you will, I'd say that has a profile that makes guys aggressive, no doubt. But it's really estrogen out of control that turns Dr. Jekyll into Mr. Hyde. The guy at the gym who puts on 30 pounds all of a sudden becomes really red-faced and puffy. And if the water fountain used to be a nice guy now, he's a jerk. That's typically because he hasn't controlled his estrogen properly, not because of the anabolic steroids. And think about it. The guys at the big yolk guys in the gym, they're doing it right. Don't look like that and don't act like that. And as guys, we can talk about, well, why would he? He knows he's huge. You can kick everyone's butt in the gym. Why would he get aggro over anything? He's like happy-go-lucky. testosterone makes you feel that way. But anyway, that's the answer to your question. I hope. I mean, those words... Yeah, we know I have a follow-up to that, but... Where does a boulder-on fall on that? Like, I didn't... Not as considered contraband for humans, anyway, in this country. The veterinary. Aggro-poise, yeah, is what it's used for. Just like the injectable windstraw is for... Would you compare that to, like, is it more like DECA or what would it be? It is. It's got a structure similar to DECA-derobler and nandrolone, but it can convert more easily. Everyone says nandrolone doesn't convert at all, but I think roughly 20% of it can convert to an estrogen. Bouldinone can convert more readily to estrogen, but it doesn't come with the side effect that everyone dreads with nandrolone. We haven't talked about that. Sorry, I skipped that side effect. DECA-deroblin comes with... Yeah, they call it DECA-dick. Erectile dysfunction, because for a lot of men, particularly the same ones that would react negatively to finasteride or dutasteride, pro-scar, propitia, and dutasteride goes avidart. They don't produce enough dihydrotestosterone and have erectile dysfunction, which, by the way, is not as prevalent as you would believe based upon all the press. But it does happen. And so with nandrolone, you get conversion to dihydronandrolone, which is very, very similar to... Well, it's very, very weak in effect. So it binds to the receptor that DHT would go to. So it occupies the receptor so DHT can't go do its job? Yeah. And so some guys will react to nandrolone with what they call DECA-dick based upon the old brand name to it. Yeah. So I've also seen this rise in SARMs. And I wanted to see if you could kind of go over that in terms of what you've seen, the reasoning why people use them, and also maybe some potential negative effects of that. SARMs are not my favorite. Now, I say that pleading ignorance because I can't keep up with all the SARMs. Guys are inventing these peptides more frequently than I can study them. And I knew this was coming because when I was still in, gosh, doing my pre-rex prior to medical school, I can remember walking down the building in the physics department, and physics department, mind you, in CSUN. And they had all these pictures of peptides on the wall, these different hormones and whatnot. Why is this in the physics department? Well, because peptides are made like Lincoln logs, I think they are, or not tinker toys, whatever. The one that you could put together different angles and all these things. And the sky's the limit as to what you can invent with peptides. And these SARMs that they're coming up with, all these peptides typically are going into the cell and doing all kinds of things. We haven't thoroughly tested them. So there's a reason right there where you go, hey, be careful, guys, with what you're buying out there. Not only have they haven't been tested, but who knows how they're being made and what's coming with them in terms of excipients and other toxic constituents. And again, I don't mean to wave the prude button, but be careful. Yeah, but a guy like you has got to get almost annoyed seeing that because I would think with all your extensive knowledge with hormones and knowing how much we've researched all these ones that you just talked about, there's so much more that we know about that compared to these SARMs. Not to mention what we know as far as side effects and stuff, but also how much more effective like regular hormones are. So like, why would you want to take more risk for less results? It doesn't make sense to me. Well, and that's really what I come to at the end of the discussion. Practicality rules. We did a study in a former partner of mine with some athletes that volunteered and a supplier of Osterine. And it was an IRB. It was just a voluntary deal where guys said, hey, let's try this. And it was, you know, the dose was by the manufacturer suggested at 25 milligrams, which I think is still what they use. And to your point, they had less result than even being on TRT and certainly than an anabolic. And the side effects were worse if you want to consider the effect on the lipids worse. So the HDL plunged even more. The LDL went up even more. And you don't get the same benefit. Why? Now I speculate it's because of good old American values of, hey, I don't want anybody telling me what to do and people and I get it. I'm a registered libertarian. Don't want to have to ask a doctor for prescription. And so they get these SARMs and the way they want to get them. And God bless them. But again, to your point, why not do what works? Okay, I get it. It's what we have to deal with. I make a living at it. You have to go through the gatekeeper and qualify to get this particular substance and all that. But yeah, when it's an inferior product, I argue, okay, this is not the right battle to fight. Go somewhere else. Now, with the new SARMs, though, that I'm ignorant of, there's a lot of them. Even things like Rad 140, they've been around for a while. I got people saying, wow, this is great. And I just don't have enough experience with them to tell you, oh, yeah, it is better than, say, oxandrolone or something. I will say that a lot of those guys that test out these SARMs, though, have never done an anabolic, the ones that I talked to. And also they're often stacking. So what was it, the Rad 140? Or was it the Rad 140 and the Ibutomoron and the BPC157 or better yet, the thymus and beta 4? What did what? And this is a big problem in the bodybuilding community because we're stacking now, unlike we used to in my era, where again, because we couldn't get it or we couldn't afford it, we did one thing at a time. Let's talk a little bit about how testosterone is administered because the old way, which is, from what I've read, the best way, which is injecting. So you inject it intramuscularly. But then they've come out with creams that you rub on your skin. There's, I think they're called, I don't know if I'm pronouncing right, trouches. Am I pronouncing that right? Or pouches? They're like... I call them trokies or troches. Troches. There you go. Trokies, I think is actually the way people say it. But I think if you look it up, I think it's from the French. I think you're supposed to say... Trouche? Something like that. The common pronunciation is trokey. So let's just stick with that. So I guess it's like you put it in your gum and it absorbs through the mucous membranes of the mouth or whatever. There's tablets. What's the best form of administration from getting the testosterone levels where you want, getting people to feel the best type of contact and safest? Yeah. So as always, it's individualized. But in general, I would argue that for a male, the best way is through an intramuscular injection of a sterified form of testosterone, like a stipulate or an enanthate, which are pretty similar. It works out on a weekly basis. It just so happens it works out pretty well for most patients. So you just remember, okay, every Sunday I'm going to do my injection. We have another ester called undecanoate, which proven to be just a hassle to try and even try and even find it. But it's a much longer lasting ester. They also use them orally, but for the injectable, which would mean, okay, presumably you could maybe inject every three weeks instead of a week. You just can't get it. And I think it might have something to do with one of the warnings is that it can create, what's the word? I think the warning says it might cause a thrombus, which is going to scare a lot of people, including docs away. And I don't know why that's on there, because that opens up a whole other can of worms about testosterone. Because that's one of the things that a lot of doctors claim also that, oh, well, you can increase your risk of stroke. And this rise in hemoglobin hematocrit is evidence of that. If you talk to hematologists, they'll laugh, okay? Increase viscosity does not mean that you're going to get a stroke. And while we're on the topic, or I brought us on the topic, I'll say, two studies that I'm aware of will clearly show that, depending on the studies, either six months or nine months in for those six or nine months, if you have a preexisting issue with blood, a coagulopathy, an issue with clotting too easily, then it will exacerbate it for six to nine months, then it goes back to the normal risk of anyone else, right? So again, did testosterone cause that? No more than LDL causes coronary artery disease. No, it can contribute to it if you have a preexisting condition. But these are typically very rare. As a matter of fact, the standard human being has what we call is heterozygous for a clotting disorder, light and factor five. So it's normal for most of us to have one light and factor five gene and not. So the other coagulopathies are even more rare, okay? And those are the ones we're talking about. So my point is, the chances of you having an issue with clotting when you take testosterone are very, very low, such that anyone who administers it typically doesn't even test for these things, okay? You could argue that you should maybe because of the slight increased risk. But even then, those that have the coagulopathy, the increased risk of a thrombus forming at all is also very, very small. So again, I think that's why we ignore it. So let's talk about the change in quality of life that someone, a man, and we'll get to women because I really want to get to that because I think there's way more stigma with women using testosterone, of course, than men. But let's start with men for a second here. A guy comes and sees you, low testosterone, signs of low testosterone. He goes on therapy. What kind of changes in quality of life do you typically see? I know it's an individual, but what is typically seen with somebody who goes on tier two? The basics are, hey, doc, I've got low energy. And I shouldn't say low energy because the magic word is really decreased, whatever it might be. Because one of the reasons why we don't see patients as soon as we should is because we've all seen the guy who's bouncing around the walls, right, or off the walls. He's got natural high energy. Any figures, he looks at his buddy Ralph and goes, geez, man, Ralph's fattened out of shape on the couch. I'm still working out. I got tons of energy. Nothing wrong with me. It's just old age, right? He shouldn't compare himself to anybody else. You should compare himself to him and say, hey, man, how am I doing compared to 10, 15, 20 years ago? Do I have a decrease in my libido, my energy level, my sense of well-being, my ability to change my body composition, which the first three are personality traits, you could argue, right, and influence therefrom. But change in body composition, that's not, I mean, indirectly driven by your personality, do you get your butt into the gym or not, right? But that one, like you got a guy who, especially a successful athlete, who knows all the right things to do and just keeps saying, well, I'll just try harder. I'll do more of this. I'll do more of that. They're the last ones to come in. And really, they're the ones that would probably benefit more than anybody to come in sooner. So those are the, I guess I called them four things that most people complain about. Now connected to that though, you know, an increased sense of well-being, that can affect your sleep. When you wake up in the middle of the night and think about your 2.3 kids in a mortgage and go, oh my God, how am I going to get through this? You know, when things are going well, you go, shut up, brain. I'll handle it like I always do when I get up in the morning and kick butt because I feel good. I'm awake up feeling like I'm kicking butt. When you have the flu, for example, you don't wake up and think, I mean, the world becomes horrible place for 10 days, right? Why? Not because the world's changed. And when the flu goes away, the world's great again, right? It's because you don't feel well. And when you're off because of low T, you wake up and you start ruminating about that. Like, oh, yeah, you know, how am I going to make that car payment? And you think, hey, I got plenty of time to think about that. Why do I need to think about in the middle of the night? They're going to send me a nice little letter telling me that my car is going to be repossessed long before it happens. You get my meaning. I mean, these are the things that come along with low testosterone that people don't even think about. And once they start on therapy, they go, hey, by the way, I didn't talk about it the first time I saw you, but I'm sleeping a lot better now too. And there's things that come with that because they're working out more often. And of course, that helps you get into a deeper sleep, things we know that come with the other things that you're doing that can be indirectly because of the testosterone therapy. But those are those are the main things. So feel better, more of the higher libido, greater sense of wellbeing, confidence. Yeah. And again, compare yourself to yourself, not to your buddies. Think about it. I mean, when was the last time you played poker on a Saturday night with your buddies? The little things that start to go, you say, wait a minute, I'm doing fine. I'm keeping up with my business. I'm doing all the things I used to do. Oh, wait a minute. No, I am keeping up my business, but I used to be able to do that. And like I say, see my buddies for an occasion, you know, a monthly poker match. You know, those things start falling off. And again, it's for the people that tend to be tougher to begin with, that, you know, rationalize that stuff and probably postpone their. Oh, I was that guy. I was 100% that guy. You know, I waited, I waited longer than I probably should have because I thought, oh, I'll give myself more time to probably naturally bring it back up. Oh, I was still kind of working out and being somewhat consistent with that. So I'm doing better than this guy. Like I kept justifying in my head like that. But the two big things that I noticed that would finally kick me into gear to go finally do it was just my drive to even want to get in the gym. You know, for most all my 20s, I used to, I remember thinking about my workout the night before because I couldn't wait to go lift. I was, I was excited to train. I was in love with it. And I had lost a lot of that, you know, and yet I was still disciplining myself to come in and go my desire to do it. I had lost. And then of course, all the other ones you touched on, like I noticed all those things dramatically increased. The other thing that was really pushed me in that direction is as a trainer and doing this as long as I have, I know how I need to eat. I know how to need a chain, a train to change my body composition. And pretty quick too, I can get it in there. And that's what I was like really getting frustrated with was one, the drive to get in. And then two, when I was in and I was being consistent and I was eating the way my body just was not responding the way it had in the past. And that's what broke me down. If I'm okay, I think I need some help. I don't think I'm going to be able to figure this out myself. But what about the other thing I was talking about? Did you also look around and go, and I know you'll answer this, they'll all do humility. I'll, I'll tee that up for you. But you also, you look around and go, well, I'm still kicking ass here. I'm still way better than, you know, the 95, 99% of the people in there. So you go, and again, it's not to say I'm great, but just to go, okay, well, maybe it is just because I'm getting older, you know, or this is just what I'm supposed to expect. And to some degree, like we talked about earlier, it is normal. But it's not what you have to do. You have to suffer through, right? You're 100% right. That's exactly what I did was, you know, I'm approaching 40. I'm the youngest of my friends. So all my friends are in their 40s. And I'm looking at, even though I'm feeling all these things, not feeling great, not, I don't have the drive, not body's not changing. I'm still in a better position than all of them. And so I'm going, oh, okay, well, maybe it is, I'm just getting older. And all those things are just inevitably going to decline for me. Yeah. So let's get back, let's talk to women about women now, because I know women can also suffer from low testosterone and benefit from testosterone therapy, but is a huge stigma around, around treating women. They're afraid, of course, of turning into a man and growing a bunch of facial hair and all kinds of weird stuff. What are some of the symptoms that women go through and how do they feel afterwards? Is it very similar to what men will feel? Yeah, this is actually the status part. And we're actually making a very concerted effort to, to reach out and appeal to women more, because actually when I started, I had more women in my practice than men. But I think maybe because of the stigma that you refer to, you know, they just, they don't get the right push. They don't get the right answers. And they're kind of left in the lurch. The symptoms they suffer from are the same as for guys, that lack of libido, energy, sense of well-being, you know, call it joie de vivre, whatever you want. And the ability to change their body composition falls off the same way it happens with guys. The problem is, yeah, we were kind of reared to, to look at the hormones, the so-called sex hormones, right, as testosterone is male, estrogen is female, when in fact we both have the same hormones, okay, just different ratios. We men carry estrogen and testosterone in our bodies, just more testosterone than estrogen and the reverse for females. So that, that one, yeah, that one's very unfortunate. And like I said earlier, I see urologists picking up the ball for the men, but I don't see OBGYNs picking up the ball for females. And so like I said, they're kind of left in the lurch. And there's a lot of misconception out there. You know, oh God, I'm going to grow a beard. Oh gosh, I'm going to turn into Arnold Schwarzenegger in terms of my body composition, which, I mean, if you just think about how ridiculous that one is, I mean, Arnold, you know, like him or not, he had to work for that. You know, it's not going to happen overnight, man. You know, you got to put in some effort. Anybody builder will tell you that. And so, but you know, there are legitimate fears, because also there are, well, there are doctors that are writing protocols that are not aware of the potential side effects. And, you know, while men and women have hair in the same places, you know, women just a lot less of it typically, depending upon their phenotype, et cetera. You know, that's a fear because women don't want to have facial hair for now in this country. I don't think they ever have in the history of civilization. But I mentioned that because, you know, you look at, you know, what 16th century paintings and, you know, women were kind of books them back then, whereas today, you know, or just 20 years ago, Twiggy was supposed to be the ideal body type. So things changed. But anyway, as of today, women don't want to have beards, right? And so that's a fear. And while it will not cause a beard, it can, and it's by the way, it's not the testosterone that will facilitate this extra growth is something that testosterone gets converted into called dihydrotestosterone that it's the fly in the ointment. So if, and by the way, like I said earlier, you know, unless it's a very unusual female, she's got two or three somewhere on her face, right? Like grandma did, when she was 35, they appeared, but you didn't see them until at 75. She says, I just don't care anymore. I live long enough to take me as I am. Yeah, she stopped fucking. And then you notice them, right? Most of the females will have some of this, even if it's just sort of sideburns. My point being that it's driven by dihydrotestosterone, of course, first and foremost by the genes. And it's not the testosterone, but we can block the conversion from testosterone into dihydrotestosterone. You don't have to suffer from these side effects. And unfortunately, you know, yeah, we do fix a lot of bad hair cuts when it comes to female TRT, because they'll go to a doctor that hasn't really given it anything but short shrift in terms of study. And they put them on testosterone, like, oh, my God, that was a disaster. Yes, I love the energy. I love the libido. But my God, I got acne, which is also driven by dihydrotestosterone. And I don't think either sex likes acne. What about the low voice? What's the mechanism there? Again, dihydrotestosterone is what drives that. Dihydrotestosterone is two to five times more potent than testosterone in terms of potency and depending upon the receptor, right? It's a masculinizing hormone, essentially. Yeah, I mean, that's what we refer to it, the male secondary sex characteristics are driven by that particular hormone more than any other. It's an androgen. And yeah, I mean, that's an issue. So the good news is, for those that are on it and are not and are suffering with some of these side effects or those who are planning on getting on it and worried about them, we can stop that conversion and therefore prevent the side effects or you really kind of have about a six month window in which you can reverse them, I've found. So if someone's starting to notice, oh, my, my voice is getting deeper because of the thickening of the vocal cords, then we can put them on something to stop the DHT. And you got about a six month window. And by the way, this is what I tell all patients, you can stop and that extra hair growth will go away. Okay. And usually I'm stopped mid sentence ago. Yeah, you told me that, but never mind. I'll just get more laser. Well, okay, wait a minute. I also told you don't have to get the laser either. If we put you on a substance, it's usually finasteride or dootastride. The older docs used to use something called spironolactone, which is a diuretic, a potassium sparing diuretic. They used to use it ubiquitously for females and acne because they know that as a side effect of blocks and only works in females, by the way, dihydrotestosterone formation. I don't think any of anybody needs to be dehydrated necessarily. I mean, unless they have hypertension, and we can use it as an adjunct, but most athletes, yeah, that's one of your worst enemies is dehydration. So I don't use the diuretics anymore, but finasteride or dootastride even works great to block dihydrotestosterone. Again, people think of it as a male drug, but it works the same in the female. So a female walks in and she complains, similar to like maybe what my complaints were low energy, mood, libido all down, body composition, struggling to change. What does, and I know of course there's a variance, but what is kind of a normal dose of testosterone look like for a female to help her rebound through all those things? Roughly one-tenth the dose of a male is what it works out to, yeah. So like 20 milligrams or something like that, right? Yeah, we'll use a testosterone sipping at 20 milligrams per ml per week. That's a tiny amount. Yeah, well, and that's why we got to have it in a different strength because to be precise is difficult with 200 megs per ml. So we have to give them a different strength. And actually, we can get it, we can get away with 50 megs per ml and just use 0.4 ml. And it's precise enough to be accurate. So yeah, that's pretty much the secret there. And by the way, we were talking about the different delivery systems for men without a doubt. Clinically, you're going to see much better result with the injectable, anything that's asterified. With women, because it's a smaller amount of testosterone required is what I imagine part of the reason is anyway, you can get away with the creams and gels or even orals, yeah. Because again, the argument is that less stress on the liver, I don't think there really is. I mean, you could argue with methylated test, one of the original testosterone orals was hard on the liver. But any of the others, I don't think you have an issue with. But given that argument, okay, you want to select one of the others first. But there's still the drawback of you got to put it on, wait for five minutes for it to be to dry anyway. And then another 25, let's say to have it be fully absorbed before you can go swimming or exercising or whatever. I joke, I drop my candy by not investing in Sephora because my wife puts on a cream every day, several creams. I'm like, geez. And so, male or female, some are like, okay, what's another cream? Big deal. But there's some that say, no, hey, man, if I can avoid one more cream, I'll do the one sweet injection. But in terms of efficacy, I don't see much difference for a female, whether they use an injectable or a cream or a gel. So they're taking about 20 milligrams. And then what are you, what else are they taking in order to block the DHI? No, DHI, I thought testosterone, what'd you call it? DHT. DHT, dihydrotestosterone. Sorry, I'll stop with the abbreviations. No, it's okay. It's okay. I don't put them on a dihydrotestosterone blocker. We call it a five-off reductase inhibitor. Typically, unless they complain or they've had experience or they say, oh, I did it with this doctor, and man, I got acne, or man, I started getting hair in the wrong places, then I'll say, okay, well, we know that's in your genes. That's what's going to happen to you. Let's put you on from the get-go. But it only happens in about, say, 20, maybe 25% of the females or males, for that matter, that have side effects. So I don't put people on immediately, but we have a feature in the charting system, it's a patient health record, I think it's called, where we can message. So I say to patients, hey, as soon as you see anything, you even think as a side effect, communicate with us and we'll put you on right away. But if we start people on it, then based on what I just said, 75 to 80% of the people are taking it and don't even need it. So what does the process look like? Let's say somebody's watching this or listening and they're like, okay, I have some of those symptoms. I suspect maybe I have low testosterone. I'm eating right, exercising, getting good sleep, but I still feel this way. What does the process look like? They contact your facility and then what kind of testing do they need? What does that whole thing look like? Well, in order to get a prescription, first of all, again, fortunately, unfortunately, testosterone is considered a controlled substance. This is schedule three controlled substance. And so you have to have a prescription for it. In order to get a prescription, you have to have a relationship with a doctor and in the state of California, you have to establish a relationship with a physician, which involves a history and a physical exam. So those are the hoops you got to jump through. You have to see a physician. I say, see these days, you can get a surrogate physical exam from another physician called a surrogate. So that, you know, your primary care physician you could go into today and then I could use that physical exam tomorrow, trusting another fellow physician. And then you and I have to talk about what's going on. There has to be a reason for prescribing this. So we talk about the symptoms. Like I said, it could be that it has nothing to do with your testosterone. There's so many ways. I mean, there's tons of ways to get a headache. There's tons of ways to have low energy and low libido. So we got to look at typically some labs to help us guide the decision-making process, the evaluation. But it starts with, as I said, you and your symptoms. What's going on with you? What are your, what are your, we call them chief complaints? Awesome. So they do that, then they get on and then I imagine, I can only imagine that because I've, look, I've known several people who've gone on TRT and they're just rave about how they feel. I can imagine that the stick rate, in other words, the amount of people that work with you who stay on, it's probably through the roof. Do people tend to fall off or they tend to stick around once they feel the effects? Yeah, someone who was a crummy salesman because I hated rejection. This is a great profession to be in. Yeah, we have very few people ever drop off because, yeah, it works great, man. So I have a great, I have a great job. I really do. I don't see sick people, you know, I see people that want to optimize. I mean, sometimes we see people that need to be pulled out of a hole and that's very, very rewarding. I have a buddy, Joe Rivera, he won't mind. He put all this on, not Instagram, but YouTube. His mom came in on 26 meds, 26 medications. She was taking medicines for medicines. And we got her down to four, two of which were only temporary because of something else that was only temporary and we got her off. And she came in on a walker, you know, and then ended up, you know, doing the pool and hiking, you know, miles and stuff. It was really, really rewarding, not just because Joe's my buddy, but because you watch an individual who's being overly medicated. And that was an interesting conversation with her physician, too. I speculate you, your business to explode from this conversation because when I started talking about my journey on the show openly, and I started to get, and it was blown away by this, I told the guys this, that my entire career as a personal trainer in gyms, you know, this is 15 years ago, when I was working in gyms, I never met men under the age of 40 or 50 that would complain about low testosterone. When I started talking about it on the show, I was getting tons of DMs and from young men, from men in their 20s who went and got their blood work done and were telling me their, their total testosterone was 170, 205, like 25 years old, 23 years. I was blown away by how many young men with that. And then I, Sal talks about the studies that have been coming out about how much that's been declining. And I just, I find that really fascinating that you're seeing, I expect that in a 50 year old man, right? But not to see that in young men in their 20s. And so, and I've been telling them, listen, I'm not a doctor, I don't know what to tell you in this situation, but I do know that we'll be talking to one on the show about this. And so I know there's a lot of people who've been waiting for this conversation because I know it's helped me out tremendously. And I had no idea how many young men were struggling with this. What's interesting about that is, yeah, the age level has dropped for those that are definite candidates for TRT. Now, you know, you don't necessarily want to go out and check your testosterone levels. That's, that's kind of a no-no. I mean, an engineer would do that, but a doctor is counseled against that because you don't want to open up a can of worms that doesn't need to be opened because you don't treat numbers. But most of the time, people don't wake up and say, well, gee, I better check my testosterone today. They check their testosterone because they have some complaints. So, you know, it does kind of tie together that some of these 20 year olds do have low testosterone. And there's a reason why they, you know, they have symptoms of it. And there's a reason why they checked, et cetera. What's also interesting about that is, in my experience, it appears that stress is the big driver and it makes sense medically. You know, arguably, you know, 300 years ago, life expectancy on average was like 30 years old. Life was still different. And that average was driven down by, you know, infant mortality, early death, that sort of thing. But, you know, we're herding sheep for a living. Stress levels are pretty low. You're worried about an occasional wolf. And, you know, that's, if it does happen, it's, you know, maybe once a month or something like that. And that's what we're designed for, acute stress, not chronic stress. You wake up in today's world, and I'm not whining, but even my dad will say, you know, you know, your dad told you, I'm sure, same as mine, you know, he went up, he went to and from school uphill, uphill both ways, in the snow, ate dirt and lived in the shoebox, you know, for the first 20 years of his life. He'll say, yeah, you guys have it tougher than we do. And none of us here is whining, right? But it is a fact of life. And I see it in 20 year olds. I mean, just look at Hollywood, kind of maybe a funny side note. I got guys that are 20 years old with ED. It's not because of low testosterone oftentimes, because they believe what's on that stupid box that says that you're supposed to be able to, and pardon me if this sounds crass, but you're supposed to be able to take care of, you know, like Casanova, five women at one time and do so for five hours. And they're like, oh my God, really? That would freak anybody out. And so there's some mental stuff going on there that adds stress that can affect your ability to get an erection. It drives testosterone levels down. And so for in my early part of their career, I would say, well, you know, this is stress driven. You're 28 years old. This doesn't make a whole lot of sense. I do see this low testosterone at 28 year old. But why don't we think about some ways to lower stress? Well, that some in some people put even more stress on the situation. Because what do you do if you've already got 2.3 kids in a mortgage, you're going to go to Bali and become a beach bum? You know, to lower your stress levels? That's not an option. Now, the cool thing is that being said, in a 26, 28 year old, you have some other options besides TRT. So you can bring that 2.3 kids to a full three by preserving your fertility. In other words, you can raise your endogenous production because your testicles are usually still working just fine. It's just your brain, because it's stressed out, is affecting your pituitary, which is right below the brain, sending a signal to testicles to do their job. So we can give them something called ACG, human coriander going out of tropon, no more abbreviations. And other things like off-label use of clomid or better yet, enclomaphene, which indirectly gets your pituitary to send a signal to testicles to make more testosterone. So we have, you know, sort of a bridge gap there. So is that is that what's more common practice than for you? If you got a, say a 25 or 28 year old young man that came in complained of that before you would say, hey, let's do, you know, 200 milligrams of testosterone. Let's first see if we can get this up with HCG or clomid first. Well, that's what I used to do back then. I still do. I mean, I give them the option because, you know, it really gets down to practicalities. Medicine tends to want to let the body do what it wants to do. And again, the biggest argument I have there is, well, that's great, but eventually we die. So, you know, the whole anti-aging movement is, and gets sick in the meantime too, is to try and improve the quality of life and get the best of what mother nature gives us and get rid of the worst. So my argument is, look, by the time you're 50, certainly more than likely odds are you're going to be on TRT, right? If at 30, you're having issues already, I want you to have the options, even for some, it's just a mental aspect of, even though we are dependent upon air, food and sleep, and for some of us other things, to live an enjoyable life. For some reason, having to do testosterone once a week is something you go, wait, man, I wanted to be dependent on anything. And I get that psychologically. But to have a choice is nice, but I'm not going to necessarily counsel a 26 year old, hey, you have to do it this way. If they've got abnormally low T, I certainly will suggest to them, just because it makes life easier, not just mentally, but if they want to father children, it's easier to maintain fertility than to try and regain it if you lose it, you know? Even though I would argue, even that really, these days is not a consideration. It is, but I can say this for sure, I've never had anybody lose fertility, that didn't regain fertility for physiological reasons. I've had people for psychological reasons back in the day when we pull you off T and say, well, let's just hope it becomes back that, you know, after nine months and forget about it. But these days, even while on TRT, if someone, which doesn't happen that often, loses their fertility, they can regain it by just jumping on some HCG, for example, human koreanite, gonadotropin, to get the testicles to jump back online and get the sperm flowing again. Yeah, that's great advice, because I feel like a 25 year old, I think the fear that I would have if I was in your shoes of just right away prescribing him testosterone is, you know, that may mask all the other issues that he's got going on. Maybe he does have stress, maybe he does have a lot of other bad habits that are causing some of that too. And just by simply elevating those for him may make him think that he's better, but he's really not addressing all the root causes. Well, you bring up another issue that I wouldn't necessarily touch on, but since you bring it up, yeah, with those patients, invariably, what I'll do is recommend something called an MRI of the head. We want to see if the pituitary is damaged, has a tumor on it, is missing an empty cell, we call it, because that can be an issue. We can also do some other tests, because there might be an extra X chromosome, a client-felter disease. So we want to find all the possibilities, because again, at 28, it's unusual, although again, for stress reasons, we're seeing it way more often than we used to, even just 20 years ago. But in a 58-year-old, you go, well, okay, duh. And so you follow what's called a differential diagnosis, where if you see a hoof print, you look for a horse before you look for a zebra, you follow the things that make the most sense. But in a younger patient, you want to rule out some genetics, you want to rule out some enzyme issues where they might not be converting, I want to call it CAH, and then these issues with the pituitary. So that's part and parcel of evaluating someone who's a younger candidate, for sure. Now, that said, what happens if you do have a, it's called a pituitary microadenoma, it sounds scary, just a fancy way of saying you have a little small tumor on the pituitary, which by the way is rarely malignant, it's just a growth that's messing with your production of luteinizing hormone, right? What if someone says, well, okay, that's great, but I don't want you drilling a hole usually through the roof of the mouth and taking that thing off. I don't want surgery. Then you're still back to square one, but at least you have a reason. And I think that's to your point. But also to your point, are there things that are typically deadly that come with low T, meaning that they're driving it that you might miss? No. So it's again, pretty safe what we do with. Well, Dr. Rand, this is the first time we've wanted to or actually worked with any hormone replacement therapy facility. There's been lots of people who wanted to work with us, talk with us. We did our homework. We chose working with you because the information you already have out on YouTube, the way you talk about the way you do, we really appreciate it. So it's great. And we do get tons of questions and DMs on this. It's like a big thing, especially when Adam talks about this. I'm tired of trying to answer them. So yeah. So we appreciate you coming on the show and we appreciate this, you know, moving forward because we'd love to have you back on answering specific questions at some point and just talking to our audience because this is definitely a big issue, a quality of life issue. Well, I have a lot of fun doing it because, you know, as with anything, it's like, I don't know, when you, when you buy a new car, then all of a sudden you notice how many people have that same car on the road. Not exactly a good analogy, but you know, I just figured everyone knew this stuff, you know, more or less, you know, and then we got to talking about it like you said on some of those YouTube videos and you find out how many people go, wow, I didn't know that. I didn't realize that. So it really has been a lot of fun and doctors live, I don't care what anybody says, you know, doctors live for this, right? We want the pat on the back. Hey, thanks, Doc. I really feel a lot better. And so it's been a great source of pleasure for me and everybody works over on my team. I mean, it's a great job I have because you see a lot of happy patients, maybe not on first day, but 90 days in, you know, they come back and they go, Doc, you know, I feel so much better because of this, that and the other. And we actually do get Christmas cards, you know, every year. Hey, thanks. You know, I had another great year. Well, you did give a great analogy earlier about it being, you know, the stigma around it being very similar to the marijuana industry. I just think there's, there's still a lot of people around it. They think that it's, you know, testosterone is this scary hormone that, you know, you're doing drugs if you do it and only these bodybuilders. And of course, they attach it to the bodybuilders that died and think that it's because of that or that you're going to beat your wife because you take testosterone. I mean, there's just, there's these awful stigmas that have been around for a long time around it that are still there. So no, I think there's a lot more education that needs to happen around it. So I'm excited to have you come on the show. Well, to that end, just add another tidbit before we sign off. I mean, that, that, you know, the wife beater thing, the roid rage thing is really, like I said earlier, I think it has to do with excess estrogen, you know, making you moody and irascible rather than anything else. Excess DHT can make it edgy, but not that kind of roid rage type stuff. And that goes back to, you know, yeah, the problems with, like with so many things comes with mismanagement, not doing it the right way. As long as you keep the estrogen down, it's not going to turn Dr. Declan and Mr. Hyde. But what I tell people is, yeah, if you're already an asshole and I won't name names. Yeah, let's just use that. If you're already an asshole, just a bigger asshole. Exactly. Perfect. I couldn't have said it better. It's not going to turn you into one. So that's the only caveat I would say. For some people, maybe it's good that you let a little air out of their tire, but they were that way their whole life. In other words, don't call Dr. Rand if you're an asshole. Yeah, please refrain. Yeah. No, thanks again. Thanks for coming on the show. My pleasure. Really, my pleasure. Thank you. The fact that eating healthy is more expensive as a myth. This is largely due to people compare processed or fast foods in this category. And so they say, oh, if I eat at that healthy restaurant versus that unhealthy restaurant, boy, is that more expensive. Don't look at processed foods.