Low Testosterone in Men: Signs, Causes, and What to Do About It

All right, and we're live. Here we go. hear you. I'll be back. Hold on. Okay. Colin's having some difficulties. Well, I'll kick us off for the next minute or so, so I'm going to give people some time. Um, while we're doing that, see Colin's back here. Perfect. am. All right, welcome back, Colin. Um, yeah, I was just saying hi to everyone. Uh, we're going to wait like 30 seconds to 30 seconds here, wait for um, everyone else who registered to roll roll in. Um, today's super exciting. We're going to be diving into testosterone, the low testosterone crisis. Uh, a lot of men think they have low testosterone. A lot of men do have low testosterone. We help a lot of men kind of optimize their testosterone, um, kind of get back on track with their health. So, we're going to talk about that. Um, I'm joined here by the brilliant Colin Bernard.

Uh, Colin, why don't you talk about kind of your licenses, your experience with functional medicine, and all that while we wait for um, friends to roll in here. Sure, yeah, thanks, Cole. Um, I'm Colin Bernard. I'm one of the lead clinicians at MedMatrix. I have a pretty unique background in functional medicine. I'm um, I have a degree in chiropractic medicine. I'm board certified in natural medicine. I practice as a PA at MedMatrix, um, and I am fellowship trained in functional medicine and hold multiple board certifications, including in anti-aging medicine. So, I've been practicing this health care for a little over 10 years now, and testosterone is kind of one of my bread and butter things. I do a lot of testosterone optimization with men and with women. Um, we can talk about that during the podcast. This This is both both sexes can benefit, so this is a really exciting topic.

Um, as you said, this is a bit of a crisis. Men need this, um, and they're not getting it. So, that's what we're here for. So. Yeah, super excited to, um, dive into that extent today. So, um, before we get going, just want to let everyone know this is not medical advice. This is for educational purposes only. If you want medical advice, I welcome to go to medmatrixusa.com, become a patient, and we can help you from there. Otherwise, today this is just for education and making you more empowered as patient. So, got some notes here. Low testosterone has become increasingly common concern, right? We're going to talk about that today is like what shifted in like day-to-day life and like why testosterone is more of a problem. And then also there's a lot of confusion around like testosterone clinics.

Like if you're a guy over 40, odds are you've probably gotten an ad talking about like some TRT telehealth clinic that'll kind of fill out a form and then you get testosterone shipped to your door. So, there's a lot of misconceptions in the space. A lot of people A lot of consumers and patients are confused. They go to their doctor, they're told, you know, they look fine when they don't feel fine, and their testosterone levels are not optimal, but what does that even mean? So, that's what we're going to be talking about today. So, when we talk about low T, low testosterone, what are we actually referring to? What are What are we talking about? So, to give a little bit of a definition, testosterone is the male dominant sex hormone. It's what distinguishes a biological male from biological females because biological males have more testosterone.

Women do have testosterone as well, but secondary sexual characteristics of muscle mass and um the way our voice sounds and facial hair, all that is from testosterone. So, testosterone is what drives like I said, sexual function and all kinds of things for men. So, when we talk about low testosterone, we're referring to sort of the technical low being below a certain reference range on a lab, but we in functional medicine and at medmatrix, we talk a lot about testosterone as being suboptimal, where you can see um symptoms in men and in women, too, where the testosterone is not necessarily below that reference range on a lab, but it's like right there, right? It's a couple points above or 25 points above the reference range. And as you said, Cole, very importantly, that a lot of guys, their doctors will tell them that they're normal when it's really not normal, right?

Cuz a lot of men are experiencing symptoms of low testosterone when their labs are quote-unquote normal. And it's not It's It's about how much testosterone the body's producing. It's about how much is available to use in the cells. It's um also how the patient is feeling, right? Are there symptoms there? Can we correlate this with a sub-optimal testosterone? So, really, really important for guys to understand cuz like you said, a lot of people are mis- misinformed by their doctor about what testosterone really means for them. So, it's really important the conversation, yeah. Gotcha. So, you mentioned testosterone in the cell. So, a lot of people think of testosterone, they just think of like sex drive and muscle. So, like, what does What does testosterone actually do inside of the cell when you say that?

So, yeah, stereotypically, testosterone is looked at as, you know, sort of like the beefy dude in the gym that's like, you know, taking steroids kind of thing. But that's really not what this is about. Testosterone affects a lot of things just beyond sex drive. It's That's an important part, right? We want our patients to have a healthy and appropriate sex, you know, drive and libido, but also muscle mass is important, strength, energy. Testosterone is really important for a man's mood and also how he feels cognitively. I see a lot of men with low testosterone that have like anxiety, depression. They just don't feel like themselves. They feel really run down, really low mood. And also, it's really, really important for bone density. Like I said, muscle metabolism, body composition.

If a man has lower testosterone, then he will be more in like a fat deposition mode where body fat will more accumulate than muscle mass. So, a lot of my male patients will say, "Yeah, I just like I'm working out so much, but I can't build muscle or I've got like this extra abdominal fat that just won't go away." So, really, really important whole body hormone for muscle, for brain, for sexual function, longevity, anti-aging benefits. Um, it's not just a sex hormone. Yeah. Right. So, why like is testosterone become such a hot topic now? Like you can't go to Instagram without seeing something about like testosterone or Facebook. But like 3 years ago, even a year ago, like that wasn't as much the case. Like why is like Why is this more of a problem now than ever? And then also like why are you kind of like seeing things about testosterone everywhere you go?

It's a great question because it is more of a problem now than it has been because testosterone deficiency is becoming much more common in men at even younger ages because of things we're exposed to. You know, poor food, plastics, a lot of endocrine disruptors, fragrances, chemicals. We've done tons of podcasts on this topic and you know, we'll I'm sure we'll do a lot more. So, there is a lot more low T that we're seeing, but um, this is I think such a hot topic because I think we've reached a great place in our culture where men are and I'm I'm going to generalize here, but men are more comfortable now expressing their health concerns. Generations past, you know, my grandfather's age say, men didn't really talk about their health concerns or if they had depression or anxiety or something like that.

A lot of it was just kind of held in, but I think more men are talking about how they don't feel well. And I think the advent of social media is showing men other men that are performing at really elite levels, athletes, um celebrities. I mean, that's a whole different ballgame, but they're basically seeing a person of similar age, their body is totally different, right? How they're performing is totally different. It's like, what's going on with me? Like, why am I not at that level or something similar. So, there is a huge push for men to want better out of the way they feel, their libido is low, they're not motivated, they're not recovering in the gym, um and they're just feeling like they're aging faster than they should.

So, um hormone optimization and like online TRT clinics and social media have just made T a huge part of public conversation, and I think we do a great job at Men Matrix optimizing men's testosterone cuz we don't necessarily just focus on the hormone, but we're focusing on the longevity of hormone replacement, what that means with nutrition and optimizing diet, and optimizing um other things that need to happen to make the testosterone be most successful for a man's health. So, it's a whole body approach, really. It's not just the hormone. Totally, yeah. So, um obviously, you know, we haven't reached the point of medicine where you can be 25, 30 years old forever, right? So, testosterone like Not yet. It's like things are going to decline as time goes on kind of regardless, right? But there's clearly like there's clearly more to it, like you're saying.

Like, you you see some guys in their 40s, 50s, and they like, you know, they're just as fit and active as a guy in his Yeah, they're killing it. Yeah. Yeah, so it's like clearly there's a lot more longevity than like you're being told, especially when you're like feeling like crap, going to your normal doctor, and they're telling you you look fine. So, I guess like as a, you know, longevity provider, like what do you feel like the difference between like, you know, normal aging is and that and like testosterone decline versus like actual low testosterone being like a dysfunction and a problem if that makes sense. Yeah, so testosterone for men does decline with age.

So, when we look at this as you know, the difference between normal aging and then true hormonal dysfunction, it's sort of very similar because about 1 to 2% of testosterone decreases in a man every year till we die over the age of like 35 to 40. That's just typical normal aging process of men, right? We can't live forever. Maybe someday we'll figure that out, but I think we'll all be long dead before that when they figure it out. So, testosterone does shift with age, but symptoms should not automatically dis- be dismissed as like just getting older. And I think a lot of primary care providers or internists or just family practice, whatever you want to call it, are telling men and women, too, that you're just getting older.

And functional medicine, the functional medicine perspective and really how we do things at Men Matrix is to look at whether the testosterone is truly low or whether other types of testosterone aren't working well, right? As I mentioned before, you have different biomarkers of testosterone, different types of testosterone that are being used in the bloodstream versus in the cells by the body. Um what root causes may be affecting the production of testosterone, the conversion, the utilization of testosterone. It's a really uh big picture approach. Uh and I think, like I said, most conventional practitioners just don't understand the nuances. And it is really nuanced, and it's not just about giving a man testosterone, and okay, we're done. That's it. Uh I mean, that's a big part of it, but there's a lot more to it than that. So, yeah, it's a great question.

Yeah, we're we're going to like really get into like all that today for those who are watching joining us live. And something I want to do is we're going to do Q&A later guys who for all of you who are live with us. Thank you again. So, if you have any questions, pop them into the comments. We'd love to make this as interactive as possible. It's And if you're thinking it, someone else is probably thinking it, too. So, there's no no stupid questions. So, drop them in the comments. We can't always get to all the questions, but if you comment it earlier, odds are we will be able to get to it. So, pops up, just put in the comments. Okay, so we're going to get into the the root cause stuff earlier that you were just talking about. But let's talk a little bit more about like testosterone and like like why it matters. So, like Sure. Um obviously short-term performance, right?

Like you want to look good. You want to have like be muscular. You want to have energy. You want to have motivation. You want to sleep well. You want to have like libido. All these like short-term things. But But like what about long-term, too? You know what I mean? Like what Like what happens when someone is low testosterone, you know, in their early 40s? Like how What are the long-term benefits of kind of having optimal testosterone? Yeah, it's a great question. So, the the As you said, it's not just about short-term. So, what are the long-term benefits of testosterone? Why does it matter? I mean, it matters because testosterone plays a role really as an anti-aging molecule. It plays a role in muscle metabolism, bone health, sexual health, mood, insulin sensitivity, body composition. So, if we look at how testosterone might impact a man day-to-day, right?

Fatigue or sleep or sex drive or motivation, physical strength, all those things as you mentioned, the short-term, the the immediate kind of short-term performance things are really important. But if we can use testosterone as an anti-aging molecule that supports bone metabolism, heart health, brain health, muscle metabolism, there's a very strong link between low testosterone and metabolic dysfunction. AKA, like a patient could be diabetic or pre-diabetic where low or sub-optimal testosterone might impact the blood sugar control. I've seen I see that every day in my male patients where we get the testosterone to optimal and they're no longer pre-diabetic or their diabetes gets much better controlled. So, if we look at it from some that type of perspective, right? If I improve a man's testosterone, number one, he's feeling really good day-to-day, which is really important.

But then, if we improve his body's ability to regulate its blood sugar, he's no longer pre-diabetic, we could potentially add a decade onto his life. I mean, who That's amazing, right? So, that's really where we look at this from a long-term benefit as a longevity intervention and not just, well, I want to have more sex. The sex is important. We're not denying that. But, um I always educate my patients on the long-term longevity pieces because I think they might not recognize it when they come to the clinic as a as one of their goals, but then when we start talking about it, it's like, oh, yeah. I want to live a lot longer, but I want to feel healthy when I'm living longer, not living longer and being unhealthy.

So, it kind of puts some perspective on how people uh can start living healthier in later years versus, you know, some of the standard way of our our culture now is, you know, you get old and you end up in a nursing home or something like that and it it's not a great quality of life in your last maybe decade or so of life. That's not the goal. So. Yeah, totally. Yeah. Well, let's talk about quality of life for a second because like Sure. it all the time like where and just in culture, it's almost like, oh, I'm just tired, you know, I'm just getting that midday crash. I'm on my fifth cup of coffee. Oh, you know, I only get 3 hours of sleep. Like, people have kind of like normalized like feeling not great even at like, oh, I'm just I'm getting old. They're like 40 years old.

So like um what like why is there a problem when you know like all these patients are just normalizing like kind of feeling weak and tired or or brain foggy all the time. You hear it all the time. People are like, "Oh, I'm just brain It's my brain fog." You know what I mean? Just kind of like making it like some joke. But like why is that actually a problem? Um Unfortunately, as a culture, we have normalized feeling tired and weak and foggy and disconnected. And I don't know why to be totally honest. I don't live my life that way. I never really have. I just can't understand accepting like oh, I just I'm going to feel like crap for I guess the foreseeable future. Oh, well. Um and many men uh push through symptoms for years and assume it's just getting older. And unfortunately, like I said before, in the conventional medical setting, a lot of times it's reinforced. Not always.

Not We We are very adamant at Men Matrix and on this podcast that we are not trying to shun our medical colleagues out in the world. They do amazing work. But and for something like hormone health and optimis- optimizing longevity, a lot of times people are just told, "Well, you're getting older. Oh, you're in your 50s now. Like it just kind of happens." Yeah. And if patients are told that over and over, then they're going to start to believe it. And someone like me will come along and say, "No. That's totally unacceptable. Right? You're only in your 50s. You're only in your 40s. You could live another few decades plus. And you're going to just feel like crap? That's not No. That's not fair." Um and then again, we start to see people in our culture in social media, television, movies who are older, right?

These actors, actresses, celebrities that are in their 50s, 60s, 80s, beyond that are performing at very high levels. Well, how are they doing it? You know, what am I doing wrong? So, um many men push through symptoms. It's totally unacceptable. Um and changes in libido, your mood, your fatigue, how your body recovers can be a sign that something is wrong. So, it's really worth understanding better. And if your doctors are telling you you're just getting old, uh maybe you need a second opinion, right? Yeah. Well, I think most people will kind of like obviously they don't feel great. They felt better. They don't They don't want to feel that way. So, a lot of them turn to like there's again, it's like these like online medication places are like a dime a dozen now. It's like everywhere you go. Like you can get hormones and weight loss drugs and like uh ED drugs again hair loss drugs.

Anything you want online now. Um like why is I guess cuz you know, you're like we talked for someone who just joined us who's who's known nothing about testosterone, they might think, "Oh, the solution's simple. I mean, just take testosterone and all my problems are fixed." And we're going to talk more about that later, but like why is testosterone not just something like they should just try to like hack on their own, go online, just like shoot themselves up with testosterone, and like all their problems are solved. Why is that like kind of problematic? Yeah, I mean, trying to hack your own testosterone health is problematic because testosterone is not a necessarily it it's very safe. Like testosterone replacement therapy is very safe, but it interacts with other things. It interacts with other hormones. It um can interact with your blood count. Uh it can affect your prostate.

It can affect cardiovascular risk and mood and metabolism. So, taking testosterone kind of on your own without guidance, to you are you doing the dose right? Are you monitoring the other biomarkers that need appropriate monitoring on the therapy? Are you um chasing something that may not even be the issue, right? So much social media now is trying to sell a product, trying to sell supplements, trying to sell some sort of like sex drive in a bottle. Like, okay, but you know, it's just not the health is just not that simple.

There are so many parameters that health revolves around, and that's why we pride ourselves at Men Matrix from a functional medicine perspective, where we do tons of blood work markers from the very beginning, lots of biomarkers to understand really uh what the root cause is, because if you're taking testosterone or hormone boosting products without proper evaluation, you could be creating a new problem or missing the whole problem altogether. Uh so it's not my favorite thing to see guys um succumbing to a lot of the social media advertising and these influencers trying to sell you their supplements and products, and these people have no licenses, they have no real experience, they're just trying to sell something, and it happens all the time. So, yeah. Yeah. Okay.

So, what um I know we talked about this a little bit, uh but like what symptoms should someone start to like think of like I guess when does it start? Cuz like quality of life like that goes on a spectrum, right? And uh for those listening, we're transitioning more into like kind of solutions right now. By the way, love the questions, guys. Keep them Keep them coming. Try to make them more specific. I see some questions in there that are like kind of vague, so the more specific the better. Not relating to you, we can't give medical advice, but uh statements are not really something we can work with. Um so yeah, what like what where does the scale start? Cuz if someone's like you know, like can't even get out of bed, that's a lot more extreme than like, you know, they wake up they don't have a ton of energy.

So, where like where in your like clinical opinion does should someone start kind of getting thinking about like their testosterone levels and like uh when their health is not optimal if that um kind of makes sense. Yeah, so men need to start considering getting their testosterone levels evaluated and thinking about hormone health when they start feeling off in any way. And to be totally honest, men women are the same. Men though are really, really in tune with themselves much more than I think we think they are. Um when I see my male patients, my new male patients, and they'll come in and they'll say, "I think my there's something wrong with my testosterone." That's kind of like what their chief complaint is. Yeah. And it's like 100% you're 100% right.

And they'll they'll talk about their low libido, they'll talk about erectile dysfunction, they'll talk about fatigue or um as I mentioned earlier, they're in the gym trying to work out, there's no muscle mass building, they still have a certain level of body fat that they're unhappy with. They're just not recovering, they're not motivated, they're feeling down, their mood is depressed. Uh a lot of brain fog, a lot of sleep issues. So men are really great at just coming in and saying something is off and I think it's my hormones. Like, yeah, you're totally right. It happens all the time. And I think there's just this switch that starts to flip for guys, and they just something happens and it's like, yeah, I just don't feel the same. You know, guys that have really physical lines of work or they're in the gym or something and it's like, uh it's just not the same, right?

The last couple years something's wrong. Um and the same thing happens with women, too. I mean women is uh testosterone is not just a male hormone, women have it, too, and it's really important for women's health from a physical perspective, mental health, sexual health changes. Um women will experience reduced sex drive and libido, difficulty achieving arousal, um vaginal issues like dryness, energy issues, mood and cognition, physical changes in the way their body composition feels and muscle tone and strength. So a lot of it is the same with women. Um but because women have dominance with other hormones beyond testosterone, it sometimes is not as obvious for women that the testosterone is an issue, but it's often a part of the puzzle.

Uh, so it makes women's health and women's hormones much more complex, but patients know, you know, with with testosterone being the male dominant sex hormone, they just know. And when you feel it, you got to express it. And like I said, if you are expressing it to your doctor and they're like, "No, you're fine." Or look, your testosterone's normal on the blood work, but if you look at it and it's only 15 points above the reference range of normal, you got to find another doctor to get better opinion on that. So, yeah. Hard. So, what are like you you see a lot of patients when it comes to um, so a lot of these symptoms we're talking about. What are like some of the most common root causes leading to lower testosterone other than just aging?

Like we know testosterone is going to decrease 1 to 2% per year after a certain age, but what are the causes that are like more in our control that you see kind of every day in your practice that are leading to this? Yeah, so some of the most common root causes of low testosterone are insulin resistance. So, the body's inability to control its blood sugar. And this could be expressing itself as like pre-diabetes or maybe the patient is already diabetic. Um, being obese, having a lot of fat around the midsection or predisposes you to low testosterone. Uh, poor sleep is a big one. Um, or like sleep conditions like sleep apnea where you're not oxygenating well overnight. Um, being chronically stressed. Um, the most common thing that I I educate patients on all the time is alcohol use. Alcohol is probably the one of the top re um, issues for low testosterone.

It basically poisons the body and reduces the testosterone. So, alcohol is a big one. Um when guys are athletic in some way, you know, they're in the gym or they're training for something, overtraining is a big one where you can reduce your testosterone level cuz you're doing too much. Or also on the flip side of that, under recovering. You know, you're working out 7 days a week, you're not giving your body any time to rest. That's a big thing, too. Um and then there's certain medications that can lower testosterone, having issues with your thyroid, um nutritional deficiencies are big. Uh so, there's there's quite a few things that we try to look for.

And like I said, that's really where we pride ourselves at Men's Matrix is really looking at the whole picture because if you're not identifying some of these issues and you're just blasting testosterone, maybe it'll work a little bit for a little while, but it's certainly not going to give you a long-term answer and it's not going to give you the longevity and the benefits that we're looking for long-term. So, that's the really important distinction there. Yeah. Yeah, for sure. So, you said something that I I feel like deserves to be kind of unpacked a little bit, which is that like insulin resistance and belly fat can really affect your testosterone levels. Like on a uh on a scientific level and in simple terms that someone non-medical can understand, like how does insulin resistance and belly fat lower testosterone?

So, belly fat and insulin resistance affects testosterone because when you have metabolic dysfunction, which is basically the body's not able to regulate its blood sugar very well. Um which can lead to obesity, uh increase in belly fat, abdominal fat. What happens is is the visceral fat can interfere with hormone balance. So, visceral fat is the fat around your organs, right? The fat around your organs, right. Fat around your organs and then also having like a lot of belly fat, like the like forgive me for saying this for people listening, but like the dad bod, right? If you're bigger around the middle, right? Like a a a pudgier belly. Um the the that type of fat in those areas can interfere with the hormone balance and also the metabolism of the hormone.

It can cause a lot of inflammation in the body and it can also interfere with the testosterone's availability in the blood to interact with the cells. So, this is why it's so important for low testosterone and metabolic health to be evaluated together. And as I've said earlier, and I've said this on this podcast so many times, low testosterone is 100% needs to be evaluated in any man or woman that has some sort of metabolic issue, prediabetes, diabetes. I've had patients, male patients that can't get their diabetes regulated on tons of medication. We get their testosterone going, totally fine. Things things get better in months. So, that they're a hugely connected, hugely important. So interesting. And then let's another thing that needs to be unpacked is um And sorry, real quick before I ask this question. Awesome questions, guys who are with us live. Thank you so much.

We're I think we'll try to move into Q&A like maybe 5 or 10 minutes earlier just cuz looks like we have a awesome interactive crowd with us. So, if you want to question answered, we already have a ton on the list. Just make sure you ask it now cuz otherwise, I don't know if we're going to be able to get to all of them. Um yeah, great work, guys. Love it when we have interactive crowds. So, okay, you said stress and like with in today's world with like your phones and jobs, social media, and like TV like there's so much stimulus around us and like stress, right? So, you said stress is a can be a big driver to lower testosterone levels. So, first off, like when it like how do you know when stress has gone too far? Like it's not good stress anymore. This is actually stress that's like kind of ruin your health.

And then once you unpack that, how does stress actually lower your testosterone levels? So, how do we know when we've gone too far with stress? Uh I think that most people don't know cuz they're not very intuitive, unfortunately. And I think we live in a 21st century culture and also depending on where you live in the country, right? If you live in New York City versus say in the Midwest where the lifestyles are different, people are pushing themselves beyond their limits and they know it intuitively cuz they're not sleeping, they're stressed, they're trying to balance a very demanding job, a spouse, a home, children. And they're doing maybe all of it a little bit half, you know, not holistically. They're kind of you know. But I I think a lot of people are pushing it way beyond their limits. They're just totally ignoring it.

And what will happen eventually is eventually they'll become a patient of mine or one of my colleagues at Men's Matrix where they'll say I am just running so out of gas, 100% out of gas. I just can't do it anymore. Um but the problem is is they've been doing it for so long and they don't know how to undo it. And it's like, well, the way you live your life, all your responsibilities and how much you pushed yourself like in a career or other things you have going on in your life is not optimizing your health. So, we have to not only try to change the health part, but you might have to change your whole lifestyle. You might have to change the way you live. Um COVID did that, I think, very well because we started to learn what the value of balance looked like. People working from home, they weren't commuting to work every day. It's like, oh, I have all this extra time and time to myself.

so I think that was a really positive part of the pandemic, but people do, I think, know when they're running out of gas. They just don't know how to intervene on it. So, stress is such a major player when it comes to hormones. You know, it can affect your sleep. It can affect hormone signaling and cortisol and your inability to recover. So, it's a it's a hugely important part of a man or a woman's assessment for hormones because it may not just be the need for testosterone, but as I said, it may be like a whole system recovery or whole system reboot or total redo of something. So, it's widely important. Yeah. That's really interesting. Yeah, and that's something that's not really talked about like in conventional medicine, right? Like they don't even address that. No. No, I mean, the way people live, like I said, it it does depend on where you live in this country.

There's certain cultures, whether it's big city life or suburbia or country versus urban or whatever, but people push themselves so hard and I think that's an American thing, right? We're we're kind of brought up to like you got to you got to hustle. You got to work. You got to do it 100 hours a week and make all the money and have all the things and it's like, oh boy, is it worth it? Sometimes, but how much does it affect your health or how much does it affect your ability to have, you know, a balanced stress life and it's hard. So, um finding balance. Yeah, no, 100%. That's why we're we're actually going to transition to that right now, which is kind of how conventional medicine treats these things, right? And like functional medicine like it's a full picture, right? It's like not just one thing if you've learned anything so far, I hope.

Um so, like where does conventional medicine often like fall short when men bring up like low testosterone? Cuz it I think it's in a couple different ways. Yeah, I think so, too. Conventional health care can often fall short when men bring up their testosterone symptoms because um nine times out of 10, I would say that men will It's not that their conventional health care provider might not test the testosterone. That might happen. It does happen, but a lot of times men will get their testosterone checked, and that's the only thing they get checked, right? Just a total testosterone. There's other markers that need to be checked that are really important, but they're told that quote unquote normal. As I said sort of at the beginning of the podcast, for example, testosterone on a lab range goes from 300 to 1200 on average.

Depending on the lab, there's different slightly different values, but if I'm a 47 52 something year-old male you know, year-old male, and I have symptoms of low testosterone, and I'm bringing it up to my doctor, and my doctor orders a total testosterone, and my total testosterone is 320, but the cutoff is 300. But it all it goes all the way up to like a thousand or 1100, and my doctor says, "Oh, look, you're it's normal. You're good, you know, sorry. Have a nice day. See you next year." And that's it. And then men are you know, it's like, "Well, my doctor said it's normal, so I I guess it's normal, right? But like I still don't feel good, and whatever." So, the problem here is that you're looking at one marker. You're looking at the marker from a quote unquote standard evaluation. You're not looking at optimal, you're looking at just normal. Is it in the quote unquote normal range?

Conventional health care does not teach optimal versus normal. That's a functional medicine thing. That's what we do best. Um and oftentimes you're not being tested for really other important markers, free testosterone, sex hormone binding globulin, metabolic health, insulin, thyroid. Like you said, no one's talking about your stress, no one's talking about your sleep. So, that's where men um are getting the short end of the stick from the conventional health care approach. It's kind of sad uh cuz then they don't they might not know what else to do. If their doctors are saying, "You're normal." Okay, well, I guess I'm normal. So, I guess I'll just live like this. You know, they they might not have the health literacy to know to keep asking questions. And and Yeah. you know? Yeah, and hopefully hopefully now they do. Hopefully now they you You said like one level total testosterone.

Can you talk about kind of the other important levels that you look at when um evaluating a man's testosterone levels? Yeah, there's a lot of important labs that we look at to evaluate a man's testosterone and women. Um we look at the [clears throat] total testosterone which basically is a reflection of how much is floating around the bloodstream. We also look at something called free testosterone and bioavailable testosterone. Those are really really important markers because those are the markers that the cells actually use. And there's a question I'm seeing that one of our listeners has asked to basically say that the free testosterone um is most important, not the total. And I agree. Um these these markers of how the body is using the testosterone is really really important. So, um we also have to look at like estrogen or estradiol in a man.

Men do have estrogen even though it's the female dominant sex hormone. Um we have to look at markers of like sperm production and markers of insulin resistance and um markers for the prostate. So, it's a really it's a really whole person hormone evaluation, not just one marker. And that's where we differ at Mid Matrix is we do all that stuff right from the beginning with every patient. And that's how we can really start to identify what's going on and start coming up with treatment plans right away. Got you. Yeah, totally. So, okay, kind of going off that like what happens when let's say someone's someone gets testosterone online, they go to like one of these TRT clinics that'll just kind of give anyone TRT, or they um go to the normal doctor and they actually are slightly below in their doctor does prescribe them TRT.

What can go wrong when like just testosterone is prescribed without addressing all the other root causes, insulin resistance, their thyroid, their gut, their vitamins, like all these other things you've been talking about? Yeah, happens a lot. So, there it's not that things necessarily go wrong when TRT is prescribed without addressing root causes, it's just that the TRT is probably not going to give the man as much long-term or potential benefit as it could. Um a man may feel better temporarily, but still have insulin resistance, right? Still have poor sleep, still stressed to the max, inflamed, um nutrient deficient, uh thyroid is not optimal, and um there could be other lifestyle factors driving the problem. So, TRT is not this sort of one-size-fits-all fix for men. It is a tool that we use.

I I use the same analogy when we talk about the GLP-1 medications where oh, I'm overweight, here's a GLP-1, okay, bye. No, it's a tool. There's a lot of other things that you have to address. Uh one prime example of this in terms of TRT is if a man's nutrition is not in the right place, he's not getting enough protein, he's not getting enough uh nutrient-dense foods with vitamin B12, iron, um you know, vitamin D, there's going to be a suboptimal utilization of that testosterone. You really need stuff like good nutrition, good protein value good levels of protein to support the testosterone and what it's doing to the body. So, Yeah. the online clinics, the the you know, as you said, they're they're popping up all over the place. They're not doing all this extra work. They're just giving you T and sending you on your way.

And patients I have a lot of patients that have done that and they're really un- unimpressed cuz they really want the support. They really want to understand all the parameters so that they can utilize this tool for the future and for their future health and longevity. So, it's it's an important point, yeah. Totally. Yeah, so let's shift into kind of like how we approach men's health with functional medicine. So, um you talked about some, but I think we scratched the surface here. Like, what what are the other like lab markers that like you're really looking at when evaluating like a man's health and men's testosterone levels? Yeah, so there's a lot of lab markers that should be evaluated before considering TRT.

Obviously, all the testosterone markers we mentioned, the total testosterone, free testosterone, sex hormone binding globulin or SHBG, which is essentially a protein in the blood that attaches to testosterone and renders it inactive. Mhm. So, what it can look like is your total testosterone may look normal, but this sex hormone binding globulin is like deactivating that. So, something like a free testosterone or a bioavailable testosterone, which is what the cells will actually use, is very low. Um so, widely important to understand those those parameters. Um looking at, like I said, estradiol, which is estrogen, that plays a huge role in testosterone and also monitoring on testosterone therapy. Um we want to look at the thyroid markers cuz that affects testosterone.

We want to look at stuff like glucose and insulin, which is where we're getting our metabolic dysfunction and and blood sugar issues, A1C, which is a diabetes marker, uh and also things like cholesterol. And inflammatory markers as well as blood counts. Testosterone can affect your red blood cell counts. It can also affect the size of your prostate over many, many years. We check prostate markers. It's a whole hormone and metabolic biomarker pathway that we're looking at. And not just that, we're also looking at the body composition. That's a hugely important thing, too. When guys can see on paper that their body mass is changing. I mean, they feel it, but it's like, "Oh, you've lost 6% body fat in 6 months. Like, holy crap, that's amazing." So, it's really cool to start seeing some of those objective changes for guys, too.

And we monitor all that standard as a standard at Med Matrix with all our patients. Totally. Yeah, let's talk about the one that's the marker that's come up a couple times in this conversation, which is total testosterone. So, like, what's the difference between free and total? And why is total kind of the more important number? Yeah, free testosterone is so important when we talk about testosterone optimization and testosterone health because total testosterone, as I mentioned, just illustrates the overall amount of testosterone in the blood. But free testosterone helps show us what is available for the body's cells to use. So, a man may have a total testosterone that looks fairly normal. Maybe it's like 450, maybe it's 500. It's kind of It's fairly acceptable. But he has symptoms of low T.

So, if he goes to his doctor and his doctor runs his total testosterone and it's 500 or 450 or it's somewhat acceptable, "Nope, you're going to have low T. You're good." "Oh, but I have all the symptoms." "No, no, you're good. Bye." So, if they're not checking these other markers, you still have you could still have low available testosterone for your body to actually use. Which could depend on, like I said, the SHBG, that sort of binding protein that will render the testosterone more ineffective, um estrogen, which plays a role. So, the the total testosterone is kind of a guide for treatment, but it's not the most important marker or essentially for an evaluation. Yeah. Totally makes sense. So, um here's the kind of golden question is, um when patients come into MedMatrix, like we're we're not the type of clinic that's just going to put anyone on testosterone.

Like it actually has to make sense. So, like when do you look at a patient that's like, "Okay, this is someone who there's a better root cause solution, maybe." Or maybe root cause isn't the right word for this, but there's something else that's causing low testosterone, and then this person might not necessarily need testosterone replacement therapy versus someone who uh kind of might need testosterone replacement therapy, and they're going to benefit from it for the rest of their life. How do you kind of distinguish between those two patients? Yeah, so how do we decide whether a man needs TRT or actually just more like root cause support or potentially both? And it really is very, very depending on the man and the objectives of the man. So, it depends on his symptoms, it depends on uh laboratory values. Age is a big one.

So, if I have a man that's say 27 with low testosterone, it's like, "Well, is it really at 27?" I mean, I I I am seeing low testosterone in younger men as my career progresses because as I said at the beginning of the podcast, there are so many things that are affecting testosterone levels and hormone levels in both men and women. We're exposed to so many things in the in the environment that's affecting our hormones younger and younger. So, it is getting worse, but we also have to consider um fertility, you know, if the man's in his early 30s or something, is he trying to have children? Is that going to affect things? What does does medical history look like? Um that's a big thing. If a man is, say, 29, 30, but he's morbidly obese, eats terribly, doesn't work out, right? Has nutritional deficiencies, very, very sedentary.

I mean, he's probably going to have low testosterone, but am I going to put him on testosterone? Well, no. Not that I wouldn't ever, but listen, dude, we got to totally alter your lifestyle, right? If you're 100 lb overweight, if you're horribly inactive, we got to fix that, right? That's really where the the important part is. So, some men need TRT, some men need foundational support first, but a lot of times men need both. Um, for a lot of our patients at Men Matrix that are guys in their 50s, 60s, they're trying really hard, um, but there's that natural decline with age, but they also need to lose weight, then it becomes a discussion of, okay, you have hormone deficiency likely related to age, but likely related to your lifestyle, so we got to do both, or this is not going to work. So, there's a lot of different variables there. Yeah, really important question. Yeah. Totally. Okay.

Yeah, no, great answer. So, um, all right, one last question here, then we're going to move into a case study, then we're going to do Q&A. So, uh, last question is, let's see, I have it written down here. Oh, just like with, um, like how like walk walk me through what it would look like for a patient, like if they want to help with Men Matrix. Like what does that look like? Like from patient comes in, patient sees you, kind of what, like what things are you looking at on the plan, and then what does that kind of like follow-up care look like?

Yeah, so, when a man comes to Men Matrix, um, and he has symptoms say of low testosterone or just a concern, a any type of concern, the process really begins with a full medical intake, symptom review, we go through a very in-depth health history, medication review, um, hormone history, has he been on hormones before, is this something he knows anything about. We assess lifestyle. And that includes diet, exercise. Do you drink alcohol? Do you smoke? Do you work out? How do you sleep? What's your stress? Uh, we do that for every patient right from the beginning. Uh, we do a full, uh, like I said, diet nutrition review. We discuss our body composition cuz again, as a new patient at MedMatrix, you're getting a full body composition on day one when you get your labs drawn.

So, we have information about how much muscle mass you have, how much visceral fat you have, your body fat percentage, um, and then we do a full comprehensive lab evaluation with, um, over 80 biomarkers, which include all the testosterone markers and hormone markers that we've talked about, but also full look at thyroid, cholesterol, um, inflam- inflammation markers, metabolic markers. So, that's really where the process begins and during the first visit, we have a very in-depth conversation about, uh, what the treatment plan short-term and long-term needs to look like around potential hormone replacement, foundational support, lifestyle support, all those things are addressed right away. Great. And then what is what is like the plan and then follow-up look like after that? What are you looking for? So, plans and follow-ups, uh, it depends.

So, plans and follow-ups can be really dependent on what the what the man needs, but typically, and again, I'm not trying to give medical advice here, but typically when we start hormone replacement, we want to give it a few months to see how it's working. Um, and then we would re-evaluate labs after that to see if we're in the right place. Are the hormone levels coming up? Are our blood sugar numbers coming down? Uh, we check in, how are you feeling, right? Talk about symptoms, talk about the chief concerns, are they getting better? Do you have any concerns? What's good? What's bad? Uh, so it's we got to give the the hormones a little time.

I always educate both men and women when we do hormone replacement that full effects of hormone replacement can take up to 3 to 6 months to be to get the full effects, maybe even longer, but men and women when they start hormone replacement, whether it's with testosterone or for women it's other hormones, you will start to notice some things after the first few weeks. Um but we I want to make sure that our my patients have their um their um their expectations in line with what's appropriate for their treatment. Totally. And then what are like some of the most important things you're looking up on the follow-up labs and follow-up visits with these patients? Yeah, on follow-up labs we're looking for is the is the testosterone getting better? Is it in a good physiological range? Uh in an in a in a range that is optimal.

Um are there issues with like estrogen becoming too high, which can happen on testosterone therapy, but not very often because we um we don't dose to places where that usually happens. Um we're looking at red blood cell cuz testosterone can over time increase your blood your red blood cell count, which we have to monitor and and treat accordingly. Um we're also looking at markers of the prostate. Again, testosterone can have an effect on the prostate. The literature says that testosterone replacement therapy does not cause cancer of the prostate, but over many, many years it could increase the size slightly, so we monitor all of that. Um and then monitor the subjective of the patient. How do they feel? What are you noticing? You noticing any issues, concerns? Are you having issues with how you administer it? How's that going? Um so it's a really deep dive in the treatment. Totally.

Great. All right, let's do a case study and then we'll answer the questions. Okay. So, case study that I had, I'll try to make this quick so we because we have a lot of questions. Um a case that I had uh maybe three or four months ago now of a um a man that was having all the classic symptoms of This sort of goes with what I've said throughout the whole podcast, but it it actually happens. So, he was or he is early 40s, I think, 43, something like that. Um had been to his primary doctor over concerns about uh he's got a physical job, works in construction. And like I said to you earlier, Cole, it's the guy is just like, "No. Like I I something's not right. My my performance at work has declined." That was sort of his chief concern. It's like, "Well, what does that mean?" "Well, I just like I'm in construction. I've got to be strong. I've got to move stuff all day.

I could fall asleep by like 3:00 in the afternoon. It's just not me." Okay, he's basically saying my testosterone something's wrong with my testosterone. So, um he went to his doctor, his testosterone measured at his doctor's office cuz he shared the results with me. Uh I think were 500 and something They were in the 500s. But it was just a total testosterone, like we talked about a few minutes ago. So, his doctor dismissed him. "Nope, you're in fine." So, he pushed back a little bit, rightfully so. So, um he got an appointment with a urologist who will often manage testosterone for men. That's a very appropriate specialist who would manage testosterone for men. Um maybe. That's part of what they do. Um same thing. "Nope, you're fine." But it was again, they repeated it. I think this was like 3 or 6 months later, repeated the total testosterone, still in the 500s.

"No, no, you're fine." Mhm. Mhm. "No, I don't feel fine. Something's wrong. Whatever." So, when he came to see me uh a few months after that, uh when I did his blood work, same thing, total testosterone was was almost the the as what it had been with those other providers, but the other markers we've been talking about his free testosterone, his um bioavailable testosterone was super low because his sex hormone binding globulin was on the higher side and that protein, which we talked about, does increase with age. So, um we started him as like a trial. It's like, "Okay, your testosterone's technically normal, but these other markers are suboptimal. So, we're going to use this as a trial for 3 to 6 months on testosterone replacement to see if it helps with your symptoms." And of course it did. So, that was that. [laughter] Okay, so what like what did he start? What happened?

It was within within like 2 weeks. It was like, "Yeah, I'm back to myself at work. I'm actually stronger in the gym. Um I'm I'm feeling like I can do my my full day of work uh on the job site and then go to the gym after and um it's funny because when men [clears throat] and women start certain treatment, especially hormone replacement, they'll comment to us all the time and say, "I had no idea I was feeling X, you know, insert whatever." And a lot of people will say, "Oh my gosh, since I started that like my brain fog is better or my memory's a lot better or I'm like cruising at work.

Like I get all my emails done and like I never have like the word finding issue and you know, I'm playing with my kids and like my sex life's better." And they don't often equate some of these other symptoms that they have as being part of the problem, but then when we start normalizing everything, it's like, "Oh crap. Like yeah, I I didn't realize that, you know, my headaches are better or like I sleep like so good now." So, there's all these trickle-down effects that will happen. It's really cool. So, great patient. I still see him. Yeah, he's a great guy. Yeah, I love hearing the patient stories every time. Yeah, it's really great. Yeah, let's get right to it. Let's start to knock out as many of these questions as we can. Um and then guys, if you hear us answer your question, you have like a follow-up, like try to do it quick cuz I don't know.

We're not We're going to We have another 7 minutes, so let's waste no time. So, um are there any concerning side effects of getting TRT? There we go. Um yes. Should I say what those are? Again, this is not medical advice, but there are some concerning side effects you do have to monitor for if the testosterone gets too high. It can affect estrogen levels, it can affect red blood cell counts, it can affect the prostate over time. So again, when men and women are on any type of hormone replacement, we do appropriate laboratory monitoring at least three or four times a year depending on the patient to make sure things stay really stable. Um so that's yeah, but but in terms of like a side effect, sometimes men will feel a little bit headachy at first, maybe like a little angry. Not very common though, cuz we do not overdose on men to start.

We start at more like a mild to moderate and increase from there. So it's very unusual to have really strong side effects. At least for us anyway, or for me. That's my style. Okay. Um I'm 75 going on 76. I have no diabetes and my blood pressure is quite normal. By the way, I walk three to four miles every day, but libido is so down. Should I be worried? And then also, if you can dive into just like this gentleman's age cuz I do know we have some patients who are in that in that age range and older. If you can talk about testosterone at that age as well, that would be pretty cool. Testosterone is appropriate for any man, well, no, take that back. Testosterone is appropriate for men as they age up until they die, essentially. I have men in their 80s on testosterone. It is not contraindicated with age.

There is no medical study nor any type of literature or evidence to say that testosterone is contraindicated or unsafe in older men over the age of like 70, 80. It's quite the opposite actually. Testosterone has protective benefits for men for their bone health, their muscle mass, their brain, their heart. So, testosterone optimization should be given to all men as they age so they're they're being protected from these things. So, in this particular instance, libido is down. Should I be worried? Well, worried is a I think a strong word, but if libido is down, it could be a sign that hormone optimization is a problem. So, I would I would get it examined. Yeah. How is TRT administered? Question mark injections or weekly? So, TRT is administered in multiple ways for guys. Some of the most common ways are injections into the muscle.

So, like into the top of your thighs or if you have a spouse at home that wants to learn how to inject you, you can do the side of the shoulder in the deltoid muscle. Um I don't recommend injections into the upper part of the butt because you have a lot of nerve endings there like the sciatic nerve that runs down the back of your leg that innervates your entire leg and if you're not skilled enough with injections, you might cause a little irritation there. So, it's not my favorite spot. So, usually I prefer the top of the thigh or the outer arm. Um you can also use testosterone topically. Um in my clinical experience, it doesn't work as well as the injectable because when you inject into the muscle, you get a lot of metabolism of the hormone in the muscle versus if you use it topically, it has to absorb through the skin and all of that. But topical is an option.

I do have some guys that are totally needle phobic and they're like absolutely not. Um topical testosterone is administered daily. Intramuscular injections are should be administered twice a week. Once a week is very old school. Um for people that are listening, for people that have had testosterone once a week is acceptable. It's very old school. The hormone only lasts about 4 days in the body, so if you're injecting it once a week, you will dip after like 4 or 5 days. You don't want any dips, that's why we do twice a week. That's preferred. Uh this one says Oh, yeah. I mentioned this is what I was talking about earlier. Yeah, Dr. Florence um Coleman, a renowned endocrinologist, thinks that free testosterone is the most important, not total or SHBG. Um I agree. So, I I I commented on this earlier.

I sort of answered your question, Ray, earlier um that total a free testosterone is what the body is actually using, and if you don't measure that, you could be under um appreciating a low testosterone or sub-testosterone in a male. Cuz if their total testosterone is normal or within normal range, but the free is low, then you have a sub-optimal testosterone picture there. So, I agree, very important. Great. Here's a fun one. I have a question. As a teenager, how could I ask my doctor about testosterone or figure out if I have low testosterone and how could I raise it as well? So, as a teenager, probably doctors are going to be very uh not not inclined to check testosterone, cuz it would be very unusual to have low testosterone in teenage years, but as we talked a lot about on this episode, a lot of things can affect low testosterone.

So, if there's weight issues, poor diet, um a lot of you know, like abdominal fat, um low uh physical activity, all those thing a lot of alcohol consumption, those are all going to affect testosterone significantly. So, you could certainly ask your doctor about it. They may or may not check it due to your age, but some of those lifestyle factors are probably affecting things um if those are applicable. So. Yeah, and if you're 18 or over, you could If you're 18 or over, we can see at MedMatrix, otherwise there are some direct primary cares or maybe naturopathic doctors in your area that could help you out. Yeah. Um and if you can apply this to men as well. Cuz [snorts] we there's there's a common question we totally skipped over, so.

For women on TRT, um well, we I talked a little bit about women, but for women on TRT, can your body stop making you take testosterone One of the biggest complaints about testosterone is like if I take it, I'm going to have to take it for the rest of my life. Oh, right. Sorry, Cole. Yeah, I get what you're saying. Yeah, so for women on TRT, can your body stop making natural testosterone? So, I'll just use this as a blanket statement for both men and women. So, when you are on testosterone replacement therapy, yes, the body will stop making a certain amount of testosterone naturally. So, um but what I always try to educate patients on, especially men on testosterone therapy, is if your testosterone is low and it's like objectively low on a lab, then your body has stopped making enough of it to sustain your body's need.

So, while the testosterone replacement might reduce the natural testosterone production, your body's not making enough to keep you in good shape. So, that's kind of my work around for that. It's like, well, yes, but it's not making enough anyway, so you know, that's really where we try to educate on that. Yeah, good question. Uh hormone shots to kill testosterone during radiation treatment. Now PSA level is zero. Need testosterone again? Question mark. I don't really know what this is. he was on It sounds like maybe he had prostate cancer and treatment for prostate cancer. Yeah, PSA level is now low. Um [clears throat] there's a lot of variables with this.

Um if a if a male patient has had an undetectable PSA for I think it's 5 years post prostatectomy or um if there's just been radiation treatment, if there's just been radiation and not a removal of the prostate, most of the time testosterone therapy is not given if there's been prostate cancer. If there's been prostate cancer and the prostate was fully removed and there's been no PSA jumps in about 5 years, then it can be considered. Mhm. But prior cancer history is very tricky, unfortunately. Prostate testosterone does not feed prostate cancer or does not cause prostate cancer, but there's a thought that it could potentially make it worse if it's already there. Um since you mentioned alcohol, how much is too much? I have a can of beer Guinness really occasionally maybe once a week. So this is a very this is a very interesting question I get asked all the time.

Um my honest answer is alcohol of any amount is highly poisonous to the body. One of the number one carcinogens that humans ingest is alcohol. Um it's one of the number one cancer causing agents that we consume. So everything in moderation, I don't know. [clears throat] I don't necessarily agree with that, but if um if a patient has alcohol once a week and they have low testosterone, it might be something to consider reducing. Um it's it's a very case-by-case um answer. Yeah, but it does affect testosterone, but how much is too much? That's subjective. Oh, you're still there? There we go. Yeah, I'm here. Uh okay, so this question was asked by the same guy who asked about the prostate. So maybe talk about like how do you get um pros- how do you get testosterone level cuz it sounds like this may have affected his libido.

So how does how what are ways to get testosterone up um more naturally without TRT directly if he didn't get his prostate removed? Yeah. Yeah. Yeah. So if there's a history of prostate cancer and and testosterone cannot be initiated, then we're doing all the other things. We're talking about diet, we're talking about stress, sleep, alcohol consumption, um proper nutrients like vitamin D, zinc, magnesium, really really important to optimize testosterone levels. Um there's certain foods that can optimize testosterone. Uh so we're doing all that diet and lifestyle work, which can help a good bit, for sure. Um a question from Instagram, I'm taking testosterone, I am a female. I was very low and seem to be increasing my number, but what do you when do you feel optimal? I do feel better. I'm low in minerals and vitamins, working on T.

So I think so working on that, so what do you Working on the T, yeah. Um So [clears throat] Like I said before, hormone replacement can take many months to feel better, but um if there's for a female, testosterone is just a part of the picture. So most of the time for a female, there might be issues with progesterone and or estrogen and or the thyroid. So if it's just testosterone by itself, maybe there's something missing. If there's low levels of vitamins and minerals, that's another piece that's missing, foundational support that's really important, so that's definitely going to be in there, too. Female hormone health is much more trickier and complicated than men's, unfortunately. There's a lot more moving pieces, so um there's probably other things to consider here that need to be worked on. Mhm, yeah. Yeah. Um What Yeah, what causes high uh high sex hormone binding globulin?

So as I said, sex hormone binding globulin is um a protein in the body um that can basically render testosterone ineffective. So um age is the number one cause of elevated sex hormone binding globulin, but also if the estrogen is too high, if there's um, thyroid issues, specifically hyperthyroidism, where the thyroid is overactive, um, liver disease is a big is a big one, and then also extreme caloric restriction. So, people that might do like fad dieting or they're trying to lose weight, so they're eating like 500 calories a day or less. Um, so those are the most common things I see with that. A lot most often related to age, though. Okay. Sweet. All right, well, we'll we'll give Rick one more question cuz he was great. Hi Rick. So, can I bring my testosterone level up again after radiation therapy where PSA is zero now?

So, like like Cole was saying, there are it depends on it depends really on the oncology team and the urologist, um, if there was not a prostate removal, if there was radiation, excuse me, and the prostate is still there, it'd be very hard to get a clinician to prescribe you testosterone therapy. It's a little bit It's a little bit of a no-no, um, even though the PSA is is zero. So, to bring up the testosterone level would be working on all the other parameters of trying to increase testosterone around diet, lifestyle, physical activity, nutrition, all of that, really important. That's how I would do it, yeah. Great. Awesome. Yeah. All right, um, Colin, what should people do if they're they suspect they might have low testosterone and they live in Maine or New Hampshire?

Yeah, so if you're in our neck of the woods, um, and you're listening and you have questions about your testosterone, if you're a man or a woman, um, you can reach out, um, to MedMatrix, like I like Cole was saying, we do really comprehensive work with patients from the get-go. Um, we test over 80 biomarkers right at the beginning, including all the testosterone markers that we've talked about. Um, we do a full comprehensive health evaluation, talk about all the parameters of your life, your stress, your nutrition, your um your sleep, your uh everything. And um we really are trying to understand how we can fit something like hormone replacement into a treatment plan if appropriate. Uh of course, that's the that's the key. So, um yeah, that's that's my best takeaway and and low testosterone is real and it shouldn't be guessed, it should be treated.

Um you know, it's not a one-size-fits-all protocol, it's uh evaluating symptoms, labs, root causes, and really understanding how it can be utilized as a tool for a man and a woman in um appropriate cases to feel better. So, yeah. Fantastic. Awesome call. Thank you so much for your time. Thank you everyone for joining. You guys were wonderful crowd and uh yeah, we'll see you I think Tuesday's the next time we go live. All right. Bye, everyone. Yeah, thanks, Cole. Bye.