Today’s hangout was a powerful Q&A session on TRT.
We answered questions related to beginning, currently undergoing and mastering Testosterone Replacement Therapy. We also had an awesome conversation with Joshua Smith who discussed his losing more than 100 pounds.
Dr Osborn‘s answers were awesome as usual.
Here’s what we covered with timestamps so you can jump to the section that most interests you:
(2:00) Joshua Smith’s story of depression and redemption in real estate and in life
(11:30) Steps Joshua took to change his habits and in turn, himself
(18:30) Dr. Osborne answers some questions about testosterone replacement therapy
(26:00) How to get a hold of Dr. Osborne to discuss your TRT needs
(34:30) The process of female hormone replacement therapy
(40:00) How to fight a biological war that you can not win and age gracefully
(45:30) How TRT figures into having children in your 30’s
(53:00) How our environment affects our hormone levels in today’s world
(58:00) Josh’s daily supplemental routine
(1:05:00) Dr Osborne’s suggestions for supplements to take for total health
(1:10:00) Why you should never need to cycle off TRT
(1:17:00) Dr. Osborne answers some questions regarding anti-aging treatments.
(1:24:00) Josh’s advice for staying healthy as you age, both physically and mentally
Here is the full hangout:
You can now read the full version of the transcript below. Check out Josh’s answers as they are AWESOME and worth using in your day to day life!
Here we go. Hey guys it’s Jay.
Hey it’s Monica!
And we are hanging out here in our studio in lovely southern California. Today the hangout is going to be a real Q&A on testosterone replacement therapy (TRT). I got a bunch of amazing questions that I’ve received from people that read our blog and watch our hangouts. We’re going to be joined (as always) by Dr. Brett Osborn and Dr. Brett Farber. But we also have a special guest in the show today. Josh Smith; he’s a very successful real estate team builder and also an entrepreneur. Make sure you watch his youtube channel for some amazing interviews and rants.
Monica and I were on Josh’s show last week (interview will be on youtube soon) and we had an amazing conversation more than 2 hours long about everything really: about the real estate business, about anti-aging, about hormone replacement therapy.
Josh has an awesome motto, it’s GSD, and I’ll let him talk about that. Josh, welcome to the show man.
Yeah, thank you guys for allowing me to be here.
Tell us about you.
OK, I don’t know how deep you want me to go into all of this.
Why don’t you start Josh with, how you got into real estate a bit, but take me to the place when you were at your bottom. I want to hear about how you were there and what you did to get out of that place.
Alright, dude. It’s almost easier to kind of reverse that right. Go down to that low point, how all of that started and how it transpired into real estate because it all built off of each other.
What’s crazy about it, I’ve done this with finances and my marriage. I didn’t start off obese and way out of shape. As a kid I was a wrestler. In high school I competed in bodybuilding. I was a very athletic guy. Then what happened is, I transitioned to college and it was a lot of things that just happens when you’re growing up.
But ultimately what it boiled down to was, I allowed myself to adopt this victimhood mindset. And I allowed myself to blame my circumstances, blame everybody else, and as I got into college it just kept progressing. I was lost for the first time in my life: when I was in high school, it was easy. I was going to become a professional bodybuilder and move out to Venice and live the dream like any young aspiring bodybuilder was thinking.
Then when I got into college, things started changing and for the first time in my life I lost all certainty. I ended up changing my major like 13 times and then dropping out. And then from there, things just kept spiraling. I kept allowing myself to adopt this victim mindset which led to this hardcore depression. And then from there, instead of working out and taking care of my body, I immersed myself into anything that was a temporary pain relief. Whether it was food, consuming a tremendous amount of alcohol.
It got to the point where I went from being in epic shape to my health deteriorating. And over about a 2 year span, I went from being about 175, 180 pounds very lean, to 276 pounds. I was very obese.
How tall are you?
5’10” So I’m not a super tall guy. Like right now, I’m at 162. That’s kind of my more natural weight.
So then things just kept getting worse with that. This story gets better, I promise. It got to the point where I was literally suicidal every day. I was thinking about committing suicide, to the point where I had picked out and kind of plotted it. At the point where I was plotting it, I had this internal conversation. Whether it was God or the universe or whatever it was. I had this internal voice that was like, “OK Josh you’re going down this path and this plan…it’s not working obviously, right? Let’s try a different path and if that doesn’t work you can always come back to this. If you want to end it at that point, then do it but let’s just try something different.”
So I did it, I mean I was at my lowest and that day I was going to take my life. And then I had that internal conversation and I decided to pull myself out of it. So that was kind of the lowest of the low.
Then, at the same time, I was actually working at a hospital as a nurse’s aide. This was actually back in Michigan. And I was float; what that meant was, I would be all over the hospital, different floors and stuff. But most of my time was spent on the hospice floor. So those of you who don’t know what a hospice is, it’s sort of the last resort before people expire and leave this planet.
So I’m spending a tremendous amount of time with people on their expiration date, right before they are going to leave this planet, and I’m having hardcore in-depth conversations with these people. And that experience, I’d just got done having this all-time low, and then coupled with this experience and one thing that always stuck with is that after having 1000s of conversations…I mean these were in-depth conversations. I was working 12-hour shifts. So I was spending more time with people on their death bed than their families were. And one of thing that’s always stuck with me, and I can still see the pain in these patients eyes, NOT ONE of them was like, “Life was epic. Life was amazing. I’m ready for the next journey. Whatever that is.”
Everybody had this laundry list of should of, would of, could of’s. So at that point I’m like, “If I really don’t wake up, I’m going to be that cat. So if I’m going to go down this different path and a different plan, I must wake up and get very clear and get that clarity that I used to have when I was younger. I better get that clarity back on what must happen.” So it was a journey. It didn’t happen overnight. I had to start immediately doing the work on it and spending the time getting the clarity on what I wanted for my life. And one exercise that I did (and I still do this every single day), but so today I’m 33 years old. So if I live to the average age of the average American which is 84 years old, that means that as of today I have 612 months left on this planet.
And I do this every day, I’m like, “What must happen now and between my expiration date, (because I’ve seen this in hundreds of people’s eyes)” Where all going to have that internal conversation when we’re at that point in our lives. “Did I piss away this life that God blessed me with or the universe or whoever it is that blessed me with life? Or was I spectator? Did I piss it away? Did I not go after my dreams, visions, and goals?”
You’re going to experience 2 things: the pain of discipline of living the life you want or the pain of regret. And after going through that experience, I made that conscious decision that I will never be that guy. Now I may not hit my dreams, visions, and goals because they are pretty damn big. But at least when I’m having that internal conversation that we are all going to have on our death bed, I want to be able to answer with full certainty in my own life that I wasn’t a spectator. That I got on the field, played ball, and went after my dreams, visions, and goals. That I gave it my all and operated at my full potential and left nothing else.
Of course I’ll have a regret that I wish I could spend more time with my loved ones which that I can’t control. But everything else, I want to know with full certainty that I can go out there and conquer. So ever since that point, I started living my life very intentional. And the sad part today, people spend more time today designing there grocery list than they do their life plan.
97% of people today on Earth live and die in mediocrity.
So that was the defining moment that woke me up to getting to the point where I was intentional about living my life intentionally with every aspect. So I got clarity with my health: “What do I want form my health? What must happen with my health?” “What exactly do I want with my relationship?”
And I’m asking myself these same questions every day: “What do I want from my business? What do I want from my health? What do I want form my relationship with my kids?” And I have such crystal clear clarity with that. And the cool thing about clarity is that life becomes so simplistic. A life of non-clarity becomes so chaotic.
And I think that’s the biggest thing that people lack today, and that they need to spend more time with is: “What must happen?”
Because we all have an expiration date right? So what must happen between now and then for you to know that you gave it your all? So that all happened. By this time I’m 23 years old. I decided to move from Michigan because I wanted to get away from the snow and gray days and get out to Arizona to further my opportunities. And I had just lost a lot of weight. I had lost 118 pounds and at that time I got really passionate into personal training. Before that I hadn’t been on the personal training aspect.
So I came out to Phoenix, started running a gym out here, became a personal trainer. And at 23 years old I realized that I’m never going to make money in the health club business, so I decided I wanted to start my own facility. When you’re a 23 years college dropout, with zero assets, it’s very difficult to get an $800,000 loan to open up a facility, right?
So my whole goal was to get into real estate as a stepping stone to go out there and bank some cash to go open up my own gym. So I got licensed, it cost me nothing, I got into the business thinking, “I’m going to out-work everybody, go hustle and I’ll go bank my 800 grand that I need and sacrifice 4 years of my life. Whatever it takes to get there. But then what happened with that journey was, health clubs were my passion and real estate quickly became my obsession and then it kept expanding from there.
That’s an awesome story bro, thanks for sharing that with us.
So you were going through this mental transportation of trying to live with purpose every day and clarity. What were some of the actual steps and things that you did every day to actually make the change? Because we know that you can think about all these things, but if you don’t actually change your habits, change your patterns, and change the things that you do every day, then you’re not going to make that shift. So what are some of the things you incorporated into your life to make those changes?
It’s the same steps that I take today, just at a different level. Life is about levelling up. To me, life is learning and life is growth. On this planet you are either growing or you’re decaying. Period. So it’s all about growth, but I hit this level and then I just have to take that growth to the next level. So step #1 is get clarity on the outcome that you want and the things that matter to you: whether that’s your business, your health, your relationships. Then identify “what are the problems and obstacles that are in my way that are locking this?”
So a great mentor of mine, I went to him one day and I was like, “Dude, what do I need to be doing to get to the point where you’re at?” He goes, “Josh everybody asks that question, but let me flip it around on you. Success is never an addition, it’s an elimination. What are the things that you must eliminate right now from your life that are holding you back from accomplishing your goals, visions, and dreams?”
For me it was giving up alcohol and other things that were holding me back. Also what I found out was that I was depressed to the point where I was ready to take my own life, and what I found through my own personal experience and I’m not saying this is for everybody, but for me, I knew that my potential was up here [raises hand], but I was acting down here [lowers hand].
I wasn’t living the life that I knew I should be living. I wasn’t operating at my full potential. I’m not even at my ankles as to what my potential could be but that’s what keeps me waking up every single day, but it’s know that every day I’m taking action steps to get better, to grow, and become the person I’m supposed to be.
So in the beginning it was…let’s take weight loss. I got up to 276 pounds, right now I’m 162. I got down to 158, so it was 118 pound weight loss. What was the outcome that I wanted? I got crystal clear on what I wanted. I’m a big meditation and visualization guy, so in my mind I’m visualizing. In my head, I was already visualizing what my body would look like, how my body would function, and how I would feel. And at that time, I couldn’t even get up a flight of stairs. It was that bad. So I got clarity on that. So then again, “what was the outcome that I wanted and what are the problems and obstacles in the way?”
And step 3 to that is, “What are the action steps I must start taking now to eliminate those problems and obstacles?” And I just started going to town on it. And then, here’s the cool thing I love about clarity, if people ever feel like they are pulled in different directions, it’s because they lack clarity. That’s it. Again, a life of non-clarity is so chaotic. A life of clarity is so simplistic. For me, I look at it this way: you’ve going to experience 2 pains in your life no matter what. So I looked at it like this, is the pain of being obese…does that suck more than this instant gratification fix of me eating taco bell. I used to be obsessed with Taco Bell, that was my vice.
One time when I was younger I had someone ask me, “Josh if you were on Death Row, what would your last meal be?” And I’m like, “2 burritos with guacamole and a nacho grande with guacamole, and a mountain dew. So I was addicted. I would literally crush Taco Bell 2 or 3 times a day. So I had that pain, I wanted that Taco Bell
I really think self-discipline is a fricking delusion. I lack self-discipline, you lack self-discipline, and we only have so much willpower. But we make conscious choices of what do we want more and what do we want less. So, “Do I want this body, do I want this energy? Do I want to have this tool that I’ve been blessed with, to operate a certain way through life? Do I want that more than I want this instant fix food that’s not going to serve me or my higher purpose?”
So I still go through it today. Every single day I get up at 3:30 AM. When that alarm goes off, I’m as pissed off as any human being would be when that alarm goes off at 3:30. But I have an internal conversation. “I can either lay my head on this pillow and dream or I can get my ass out of bed and go give birth to my dreams.” Those are the reality. The pain is going to exist. I used to have a really bad chewing tobacco habit. Started chewing Copenhagen when I was 12, so I chew Copenhagen for a good 10 years of my life, so the point where it got to 2 cans a day. I quit chewing about 4 years ago. I still crave it every single day today. I fricking love chewing. I love having a big dip in my mouth and spitting in a spit cup. I love it. The pain hasn’t went away, but it’s “What do I want more?”
Is that pain of not having that instant gratification…does it suck more or suck less than the negative consequences that come from that habit? And it’s operating with the right mindset. I operate with a domination mindset, not a competition mindset.
So it’s like, right now, I could go live in a huge fancy house. I could go do that because maybe that makes me feel good now. However, that’s a competition mindset: keeping up with the Joneses is competition. Domination is I’m going to go live frugal even though I’m banking cash, so I can acquire all these other assets so that then I could become truly wealthy in the future. So the pains all exist. I want things just like everybody else.
I desire things just like everybody else…I just choose which pain. That’s it. I just choose which pain on the outcome of things that I’d rather experience and which one I’d rather not experience. And it’s that simple.
Awesome. Scott you have anything else for him?
Nah, I love it. That’s what I wanted to get out of him so I appreciate you going through all that Josh.
I was telling Dr. Osborn earlier today, “You know Josh is one of people that has so much passion and so much energy that you can talk to him about a lot of different subjects. But now we’re going to segue and we’re going to talk about TRT.
So Doc, I’m just going to jump right in here, we have some really great questions.
Q1: My dad had 2 heart attacks from smoking. He’s 60 years old; his Testosterone is extremely low based on his blood panels. I’m his 28 year old son and I’ve read that often times TRT doesn’t cause heart attacks but that people who have suffered heart attacks should not use TRT. I don’t want my dad to suffer further, but higher testosterone would do him very well as he is exhausted all the time. What are Dr. Osborn’s thoughts?
Dr. Brett Osborn:
Jay, you and I have been through this numerous times and I liken this to the chicken or the egg phenomenon. So the data that has recently emerged is likely the product of a failed study design, as if often the case, unfortunately, in medicine. And to not be very long winded, because we know that testosterone unto itself does not cause coronary heart disease, and it is thought to be quite the opposite, in other words, it’s cardio protective. But the thought that I’ve had is that by putting somebody on testosterone by virtue of the fact that they have more energy during the day and feel better form a cognitive and a mental standpoint that essentially is an enabler. And it does enable them to get off their asses and feel motivated to get to the gym, and to feel that vim and vigor that they did when they were potentially 16 years old.
So despite the recent data, because we know that the data is likely the product of, again, of a flawed study and there are plenty of flaws within that study, where not going to go into those now. I would encourage this individual, particularly if his other risk factors are being managed, i.e. his hypertension is being managed, he’s not diabetic or his diabetes or his insulin resistance is being managed either with exercise or metformin or the like, and his nutrition is optimized. This is sort of just another piece of a very complex puzzle.
It would be my recommendation, not as a cardiologist, but in conjunction with and under the supervision of, his cardiologist, to be on testosterone. So, I personally don’t have any problems. I have a lot of patients that I inherit from my neurology colleagues who have had strokes, etc. And a stroke is just a heart attack in another geography. So all these diseases are the same.
I have absolutely no reason why these patients should be precluded from reaping the benefits of testosterone. I aggressively put them on testosterone. And I will tell you to this day, out of writing hundreds and hundreds of testosterone prescriptions, I can’t tell that we’ve had any adverse events. If anything, these patients gain and new outlook on life by virtue of the fact that they have more vigor, their libido is enhanced, they are leaner. It’s a lengthy list of benefits, but the benefits far outweigh the risks.
That was a great answer, so I’m just going to summarize that for a bit because I know there are going to be a lot of people reading and watching this. If you are a man, and you’re older (meaning probably older than 60), you are technically considered high-risk from an age group standpoint and if you do have a pre-incidence of any kind of vascular events or heart disease or heart attacks, clearly if you’re going to use TRT you have to get the blessing of your doctor and as Dr. Osborn said you have to have your other risk factors managed. OK, let me jump into another question here real quick… So here’s a good one for you Doc, and I think this applies to both Josh and Scott.
Q2: Jay, I am a mid to late-30s male, who has been pretty serious into health and fitness my whole life, I have to admit that I started using TRT from the grey market about a year and a half ago. I’ve had really good results from it. I watch what I eat, I do blood work once a year, and I feel pretty well. However, I’m really considering using a doctor, what doctor other than Dr. Osborn would you recommend if any? I’m in the upper Midwest and also, what would I gain from enrolling on your SOAR seminar?
Dr. Brett Osborn:
Right, so that’s a good question. If an individual is either unable to get to me by virtue of the SOAR seminar or independent of the SOAR seminar, which is basically, as I’ve described it previously, the book “Get Serious” personified. Then what I would recommend doing, to be very short about it is, is to contact the A4M (American Academy of Anti-Aging Medicine) through whom I’m certified, they have a very robust web presence. They will actually be able to locate a doctor that is local to that individual and a doctor that is ported through them and very well versed in TRT and anti-aging regenerative medicine in general. That would be the route that I probably recommend that you go. A lot of doctors have started anti-aging practices, just by virtue of the fact that there is potentially money to be mad. Especially in this day of failing or faltering insurance reimbursements, so people have gravitated towards anti-aging medicine as a source of cash, akin to what pain management doctors have done as well.
I mean, let’s face it: who wants to be taking care of patients complaining of pain all day? One of the reasons why doctors gravitate towards that, particularly anesthesiologists and rehab doctors, is because there is a lot of money to be made in giving injections and there is very very little liability. It’s the same with anti-aging medicine. But just by virtue of the fact that someone has engaged themselves in that type of practice does not necessarily mean that they are qualified to be writing these medications.
Right. Good answer, real quick, just to recap: for the guys watching and listening to his answer, very diplomatic answer from Dr. Osborn. I pretty much know most of the anti-aging physicians and TRT reputable doctors in North America, and obviously I have a relationship with Dr. Osborn but I don’t know of anyone like him. I don’t know anyone who truly walks the walk and talks the talk like he does. Clearly his book is a personification of who he is, as both a man and a practicing physician. There’s no one better. There are some other doctors out there who do a great job.
You can go the A4M and find guys, but if you really want to work with Dr. Osborn, it’s not a problem, through SOAR (which we’ll we talking about in more detail later). You can come and listen to me, him, and some others on our team discuss anti-aging, strength training, applying optimizing your hormones, and understand better nutrition…all that stuff we will be talking about in the future.
But also, you can fly in to South Florida, either Fort Lauderdale or West Palm and make an appointment with his nurses and he can counsel you. He can look at your blood panels initially and then he’ll spend a good 45 to 60 minutes with you (maybe longer depending on your situation and your individual needs) and then you can work with him for life. And so for you guys in Texas or Seattle or even for Josh in Arizona, I mean you are making an investment in your health. There are a lot of doctors (And Dr. Osborn will tell you this) that are just making money on this, they really don’t have an interest in your health that they should, but if you work with a guy like Dr. Osborn, you’re not going to have an issue.
Josh, I’m putting you on the spot, do you use TRT and if so do you have a doctor that you use in Arizona?
You know, I do not. I do not use and I do not have a doctor. Now it’s something that I’ve been doing due diligence on after our 3 hour long crazy podcast. You know, I’m 33 so my whole thing was, “OK, maybe in my 40s or whatever,” but after a conversation with you, I’m definitely going to get some bloodwork drawn. Look at these, these are Gunner “eliminate the blue light” on the camera angle. Why? Because I want my eyeballs to operate at the most effective an efficient level that I possibly can. This is my tool [pointing towards his body]. This is my vehicle; my car’s not my vehicle. So I’m going to do everything I can to optimize my health and optimize the tool that I have. So if that is a tool that can optimize my health, give me the energy that I need, increase my experience of life, and the experience that I’m able to have, then absolutely I’m going to do it.
So it is something that I’m going to explore and check out, and connect with you and Dr. Osborn on. But here’s something that I kind of want to add with that: it’s crazy today that people will spend more time research the fricking new iPhone that they are going to purchase than they do their health. So my recommendation would be, go with the best. So if you have that mindset of “I can’t afford to get to SOAR. I can’t afford to work with Jay and Dr. Osborn,” figure out what else you could eliminate.
Go to the outlets, don’t go and buy $300 pair of jeans. Figure it out.
And when it comes to your health, go work with the best.
You only have one body and you can’t replace it. It makes sense to invest monetarily and to do the due diligence to make sure you’re maximizing it.
Awesome man. Thanks for that Josh. Get your blood work done; you’ll be really surprised when you look at your testosterone.
Dr. Brett Osborn:
Jay, if I may add to what Josh had said, and I think it was very well put. HRT and the various modalities that Jay and I (and all of us on the SOAR team) speak about, these are simply modalities through which one can better him or herself. They are not modalities unto themselves, which is the mistake that most people make in this regard. They think that going on testosterone or some other medical therapy is going to make or break their lives and it’s really not. It’s just something that could really enhance their lives and it’s just a piece in a larger puzzle. You can’t be on testosterone without practicing sound nutrition, it just doesn’t work. You can e on testosterone and expect results in the absence of training. It doesn’t work. You have to have the right mental attitude. Without these pieces together as an integral puzzle, you’ll lose everything. One piece does not operate in isolation.
This is a mindset. It’s an approach. Just like you have your approaches to the things that you do, we have our approaches as doctors. One thing is oftentimes interlinked with another and that’s just what this is.
Well said. Real quick, Scott…because I’m going to throw you on the hot seat right now. I haven’t had this conversation with Dr. Osborn because we’ve been so busy but Scott has low testosterone right? Scott what was your level it was like in the high 200s range, right?
I don’t know man. I have my blood work coming via mail from my doctor; I had to order it from him.
I looked at it, Brett, I think he was like somewhere between 270 and 290, as a 32 year old guy that’s suboptimal.
Dr. Brett Osborn:
Right. It absolutely is, particularly if your free testosterone, that’s really where your money is. But typically, as Jay was alluding to, when you have low total testosterone, very very very often you will have low or very low free testosterone. And one is sort of the function of the other and one has to do with how much of your testosterone is being bound up by plasma proteins by albumin and sex-hormone binding globulin. That said, you’re likely to have low free testosterone. And you’re exhibiting symptoms of hypogonadism already even in your 30s which is also quote typical.
So if exercise, optimal nutrition, weight loss, getting adequate rest etc., has failed you in the past and didn’t bring your levels up then potentially you would be deemed candidate for TRT.
One of the things that I always say, and obviously we write about this prolifically in the book that’s going to be coming out soon, is that the majority of men don’t even know they have low testosterone. Not only do they not know that they don’t have it, they don’t know how to go about figuring out how do they go about finding out if they have low testosterone.
Well, that’s the thing. I look at this blood work and I see all these things and I have no idea what any of it means and the Doc was just like, “Yeah you’re fine.” And I went, “OK.” Dr. Osborn, I want you to expound upon that in a second but, let me just say this: it’s unfortunate that in medicine in today’s society (especially when it comes to men) that almost any woman can complain about her hormones being suboptimal, having hot flashes, being pre- or post-menopausal and go to a doctor and have them write up a script for her and get whatever they give them.
But for a guy, it’s like this scarlet letter, this taboo thing. He feels shame; “What I am I going to do?” Scott your experience is what all too often happens, I mean that’s what they say: “Don’t worry about it.” Because they themselves don’t know jackshit about testosterone or enough about the male endocrine system and they don’t want to go down a path where they feel like they’re not going to be able to help you.
Dr. Brett Osborn:
Right. Jay that’s excellent.
And this point is harped upon in Jay’s book that’s coming out and I don’t want to sound like an advertisement but it really is a spectacular book.
And as a matter of fact, and I’m saying this with all honesty, not only every male that’s coming of age read it, but every doctor should read it.
Because as Jay had alluded to, I talk to my colleagues all the time, and despite going to medical school just like me, they have absolutely no idea what I’m talking about and they will look at me like I have two heads, literally. So again, the book is excellent, and it’s a must read for every male, and actually you know what? Every female as well. It goes without saying that women can go to the doctor and be put on estrogen replacement therapy in the context of decreasing bone mass, osteoporosis, and osteopenia. Hot flashes are another big indication for estrogen replacement therapy because these individuals are going through menopause or are post-menopausal.
But the name andropause, which we are now starting to hear more and more of as this normal process of aging being referred to as, is just, let’s face it a normal part of our lives. And we don’t need to be victimized by the aspects of it which specifically relate to our hormones because we have the ability and the science to be able to rectify the situation at least to some degree and really slow down the process of aging.
Not reverse, not to cure it, but to slow down the effects of it by keeping our hormone profile like what it was like when we were 16 year old men, when we felt our best. Or 18, or 20 when our libido was great. Or when we had a lot of lean muscle mass. When there was less adiposity. When we were less fatigued. When we felt like Superman when we woke up. Sort of like what Josh feels like when he wakes up every morning except he hasn’t felt what it’s like to be on testosterone, but probably by numbers, would qualify for it. So he would be waking up at 2AM instead of 3.
Josh, when you go on T, the GSD mode will be on T. It will be a difference.
Dr. Brett Osborn:
But anyway, it’s not something that’s even considered by a lot of doctors. And doctors just say, “Oh, you’re getting older.” Or, “It’s OK, it’s normal.”
We don’t want to function within the normal range. The normal range, as Jay talks about extensively in his book, is enormous.
You know, the normal range may be (and I’m talking about a total testosterone level) 275 to 1100. Well what kind of a normal range is that? You’re talking about a 900 point scale, that’s absolutely absurd. The genesis of that is that they assayed, I forgot what it was, people that were 18 to people that were 80. Well obviously the range is going to be huge. The thing about it is, if you look at the range where people were functioning optimally form a physical and mental standpoint, it’s where their testosterone levels were when they were 20 or 18.
So why wouldn’t you want to live where you are optimal? So why would you want to live where you’re at the very very low end of that range?
You don’t. You don’t want to have the testosterone level of a 90 year old. Why wouldn’t you always want to have the testosterone level of someone who is 18. And you can. It’s easy.
And essentially the side effect profile is negligible in my opinion. Negligible.
What I noticed too from having conversations with Jay, think about it, so many people have this negative connotation with TRT and they are like “You’re on steroids” Or, “You’re natural production of testosterone is going to diminish.” All these different things.
And what’s interesting is that so many people don’t realize, when you look at it, most people are addicted to the #1 drug in the world, which is food. That is way worse than working with TRT and we actually can see that there are improvements with it. And the sad part about it is, if you look back in the day, people probably didn’t need it because we didn’t have the exposure to the plastics like we have now, exposure to the environment that we live in now. There are so many other things that diminish the level and what’s sad is that people listen to uneducated people giving the information and then they are more or less, hypnotized. “Oh, I’m not supposed to be doing that.” And then you have a doctor, Jay, you have educated people who know what’s great, how to take it, and how to improve your life with it.
Great points Monica. The next couple questions are geared toward Scott and Josh. Guys (and Dr. Osborn already knows this), I have empirical data that shows in the last 20 years, globally, men’s sperm count have been reduced by half. So that’s not some random placebo nonsense, this is medical undisputed data, provided by the World Health Organization and why is that happening? Well lowered sperm count is also part and parcel to having lower testosterone, but it’s also because of what Monica just said, our endocrine systems are being bombarded and we are at war with our environment.
So not understand this stuff as guy in his late 20s, early 30s, or even in your early 40s. I mean listen, if you are in your early 40s and you have not investigated TRT, what the hell are you thinking? You’re not getting any younger, and he spends an amazing 20 minutes in the lecture on the components of aging and how fast everything declines after the age of 16, and I’m telling you, that part of the seminar is worth its weight in gold.
But you literally are fighting a biological war that you cannot win, as you age, without taking care of yourself, being in the gym, eating correctly, and optimizing your hormones. If you don’t do all of those things, as Dr. Osborn hit on, you are not going to age gracefully. And I’ll be honest with you, your aging is going to suck.
So let me jump into these questions. These questions are really good for you guys.
Real quick. Doc, I got my blood panels right here, I can screen share it live right here.
Sure, go ahead.
Alright, so I don’t know what any of this means.
Do you have your testosterone panel?
No just this picture.
Dr. Brett Osborn:
You’re looking at your metabolic panel, which is just your electrolytes, your liver function tests, and your renal function. All of which look normal upon first glance, but I saw it.
What you sent me Scott, had your testosterone on there, so there is a second or third page.
That’s the thing too, it says like…”On a scale from 2.0 to 8.0 ng/ml.” I mean, who knows what that even means? Why would I even know what that means?
Dr. Brett Osborn:
Scott, listen, you’re not supposed to know what these things mean. Jay knows because he’s very educated and he’s very well read and he understand more than 99% of the doctors that are out there. You can ask Jay, you can ask me, this is what SOAR is about, it’s not your job to know what these things mean.
But these are the things that are deciphered when you come to the lecture, when you sit and we talk about during the consultation. I don’t really go through the ins and out of these things during the lectures because to go through and start teaching basic biochemical to people who are unfamiliar, is just not worth. You’re going to retain zero. But if during a consultation that everybody undergoes during the SOAR seminars, I say, “Listen, this is a measure of your kidney function. These are your numbers, it looks good. Next.”
These are the things that we have to identify, I am looking to identify risk factors for disease, that’s what I’m trying to do. And in the context of the labs, I’m to get your internal chemistry through the various modalities Jay had just spoken about, to be normal, or even optimal.
So that’s what we’re trying to do.
We’re trying to get those testosterone levels to that high end of normal, not supraphysiological.
I’m not here to turn you into a bodybuilder, that’s not what we do here, OK? We just bring your levels to optimal.
If your triglycerides are high, we fix your eating. We get you exercising. We put you on high dose omega-3 fatty acids. We want those numbers to be right.
Because typically your physical mirrors your biochemistry. So you will look and feel better, I assure you, when your biochemistry is optimal.
If your biochemistry is lousy, you’re going to feel badly, and that’s conducive to sickness and accelerated aging. Period.
So it’s not your responsibility to know the ins and outs of these numbers. That’s what you have doctors for.
But unfortunately as Scott knows , we don’t have a lot of good doctors. That’s why you’ve got to use Dr. Osborn and come to SOAR.
Q3: So Doc, I’m 35 years old, I’m about to start TRT if I don’t use HCG (Human Chorionic Gonadotropin), and 5 to 10 years later I want to have a baby, can I then use HCG to increase fertility or do I have to use it from the outset of my TRT to allow for my sperm to remain mobile?
Dr. Brett Osborn:
So this is a question I get all the time, I actually just had a patient yesterday that I was speaking to specifically about this. So one of the first things that I make a mental note of when somebody comes to me for an anti-aging consult with the typical symptoms of hypogonadism, is I take a note of their age and then my follow-up question is, “Are you planning on having children?”
Some people say, “I’ve been vasectomized” and that’s the end of that. We don’t have to worry about it too much. I’m extremely cautious unless somebody is very symptomatic (and Jay we’ve been over this before) of putting somebody on standard doses of TRT if they are planning on having children in the future. Why? Because testosterone in a high percentage of individuals that are on it, can really knock down your sperm count and I’ve seen it happen. That said, one does not necessarily preclude the other.
So you can be on testosterone. I was on testosterone and HCG and we have a little 3 year old running around, Makenna. So it can be done. Bodybuilders do this stuff all the time and they are using all sorts of things. Bioidenticals, synthetics, and then they do what’s called rescue therapy because they are very very suppressed when they get off and they want to have children. So they use HCG as one of the medications that they want to use, in order to bring their sperm count up.
So one does not necessarily preclude the other. So you can father children even having been on testosterone, or even while on testosterone, but you’ve GOT TO use HCG. This is 100% using HCG. I would prefer to just wait, put the individuals on HCG, which by the way, augments your sperm count and brings your testosterone level up. But as Jay knows, it’s not nearly as robust of a response as if you are on exogenous injectable testosterone and HCG.
So I really try to dissuade individuals, and again, I live in Florida and I operate in a very malignant malpractice environment. So you have to be extremely extremely careful, if you’re going to do something like that (use testosterone in somebody that’s of child-bearing age). You’re going to use HCG as a backup in order to keep their sperm counts up and you’re going to have them sign a consent or a waiver that they are aware of the potential “hypospermia” if you will, that can result from TRT in isolation AND if you are using HCG.
There’s much much much less of a chance of you developing a problem if you are on HCG, but 100% if you are of child bearing age and you’re planning on having children and you’re not vasectomized, you’re going on HCG if you are my patient, period. There’s no choice. Otherwise you don’t get testosterone. You will not walk out of my office on testosterone alone if you plan on fathering children. Period.
My preference…and Jay and I did this for some of the guys who were at the beta test for SOAR…they were younger, they had some of these symptoms, they had numbers which paralleled their symptomatology and I put them only on HCG and a little bit of an aromatase inhibitor and they understand that they aren’t going to be running a total testosterone of 1100. They get it. That’s OK with them. Everything in medicine is a risk:benefit.
Just to recap:
- One doesn’t preclude the other. You can be on testosterone and HCG and have children. It’s fine I’ve done it.
- I would never recommend going on a testosterone or bioidentical testosterone and a synthetic like bodybuilders do without HCG and just relying on the HCG in isolation to rescue you because there are individuals (and this is unlikely too) who cannot father children because of chronic usage of synthetics and bioidenticals and just frank testicular atrophy. So it can happen. I wouldn’t recommend it.
No, it’s a great answer. The only thing I would add is, a lot of men (and Dr. Osborn and I definitely recommend this) if you are in your late 20s and you do have to start TRT because maybe you do even have damaged testicles, maybe you’re one of those guys who just naturally has a really low endocrine system and you need to go on, we would also recommend in addition to using Test with HCG, you should go to a sperm bank and have some of your sperm frozen. Have them kept there just in case in the event of, say 6 to 7 years later you go to have kids and it’s not working, well guess what? Now you got viable sperm.
Dr. Brett Osborn:
Very good point Jay.
So Josh, I wanted to ask you, I know you guys have 3 little kids, are you guys done?
Yeah, dude. Snip. Shop shut down.
[Laughs] Well man you definitely need to get a flight to Florida and go see Dr. O my brother. You have nothing to worry about. It’s funny because, most of the guys, Dr. Osborn knows this, and Scott is a perfect candidate because he doesn’t have kids. Scott’s about to get married by the way so congratulate him. It’s in the works.
But…most young guys are truly afraid of going on TRT because they have been misled and given so many bullshit myths and stereotypes that, “Oh my god, my sperm is going to die, I’m never going to have natural production ever again, and I’m never going to be able to father children.”
Listen, that’s complete bullshit. The book clearly points this out. Dr. Osborn just gave a really good 4 minute answer about using HCG concomitantly with testosterone, there’s no issue. There’s even other medications that we’re not going to mention right now, that are written about in the book, that are even stronger than HCG. There are doctors that use that as a form of therapy. Like he said, he calls it rescue therapy to restore bodybuilders who have had hypothalamic testicular axis problems for decades. So you can restore your ability to be a father. Do not think that that is going to happen because it is utter BS.
There are some guys that have really sensitive HPTAs and may have an issue, but if they do the things that we just recommended which is to have their sperm frozen before they start or initiate, and do the other things, it’s very unlikely.
Dr. Brett Osborn:
Right. You look at these bodybuilders who have been abusing their hypothalamic pituitary axis / adrenal axis…whatever you want to call it for years…decades. They go on rescue therapy that’s very very aggressive and they father children. Period.
Hey Doc, I have a question for you. We’re talking about elements that affect your sperm count and having kids and whatever. All the stuff that we’re putting in our bodies now like other drugs, booze, horrible foods…does that stuff affect it too?
Dr. Brett Osborn:
Absolutely. As Jay and Monica had alluded to before, we truly are in an ongoing battle with our environment. Jay had very very appropriately mentioned the fact that our testosterone levels are just plummeting when you look at these numbers pictorially. From 40 years ago to now, the numbers are like this [places hand in downward slope]. They are dive-bombing. And that is purely a function or a product of the fact that:
- We are poorly exercised individuals and
- Lack of sleep and all the stresses that are imposed upon us: psychological stresses etc., and
- All the garbage that we are eating.
These are all, one thing, one entity. But to sum up and be very simplistic about it, it’s just our environments that are killing us. These diseases, including hypogonadism because that is a disease or syndrome, or symptom of aging or whatever you want to call it, these diseases didn’t exist years ago.
These are man-made diseases. Just like aging. Yes there are genetic components to aging, but we think that 25% of the aging process is genetic, and the other 75% or 80% is created. So just think about how much better we would be as a species, if you could eliminate all these environmental toxicities. And I’m not only talking about food, but all the mental and psychological stresses, etc. These are all one thing and we are constantly being bombarded with this.
Again, if you go to Monaco in the south of France, these people are living to 90 years of age on average. So how are we as Americans only living to an average age of 78.6 I think it is. They are doing something that is giving them nearly an extra 12 years. Well that’s called living just a cleaner lifestyle. But there is no reason why we can’t be living to a 100 OK? And you know what? As we get smarter and smarter, develop better drugs, and understand that we need to stay away from the processed foods, the sugars, etc. We’re going to live longer. It’s just a matter of time.
So real quick, Josh. The question is…but I want to know what you are doing…this is a question a lot of guys have been waiting for the answer for. Guys ask Dr. Osborn and I this question all the time, but I really want to hear what Josh is taking because Josh is fired up and motivated and has high energy. He’s probably going to say nothing, which is going to make me laugh.
So Josh, this is the question I want you to answer and then Dr. Osborn and I will elaborate.
Q4: What are the optimal supporting supplements when a man is using testosterone for both health and physique enhancement?
So before anybody answers, Josh will answer first…I wrote an article a little less than a year ago on the FabFitOver40 site called the TRT Diet. It’s been very highly indexed on Google, it’s an amazing article. It’s right before Dr. Osborn and I started our relationship and I hadn’t read Get Serious yet but his book also has amazing supplementation answers and you can actually download the supplementation chapter from his book from our website. It’s a free plug. Once you read this chapter you’ll buy the book for sure.
But you can go to www.FabFitOver40.com/supplements and you can download the chapter from Get Serious, Dr. Osborn’s amazing book on anti-aging and all the other things
All that said, Josh, what supplements do you take every day?
Here’s my daily routine.
Get up at 3:30AM, roll out of bed, go down and immediately I make my coffee. I operate 3 crazy businesses, I got 3 little kids…I got to go go go go, right? So, 6 to 8 hours doesn’t exist in my world. I’m lucky to get 4. But when I make my coffee I do it a certain way, I make black coffee and then I add the MCT oils and grass-fed butter in my coffee.
It energizes me in a different way, gives me that complete focus. I’ll also have a handful of almonds and from there, boom, I’m hitting the gym. So I hit the gym for about an hour. I’m home from the gym usually about
5:30 AM, and right from there it’s a cold-processed whey protein shake (2 scoops). Right now I’m taking Simple Truths protein shake. I buy a lot of the Simple Truth and Simple Organics products. So I take that along with some form of organic fruit. I don’t put anything in my body that’s not organic. You go to the grocery section and you’re like, “I’m buying this tomato it looks so good.” Well dude, that tomato wasn’t necessarily grown on the field, it was picked green and then ripened with gas. So we are putting all these crazy toxins in our bodies and we’ve got to be aware of it.
So this morning I had a little bit of pineapple and half a banana. I consume a ton of water. I drink about 2 gallons of water every single day. I track my water intake very heavily. I eat every 2 to 3 hours. So my next meal is 4 cage-free, vegetarian fed, omega-3 eggs with an avocado.
So for me, because everybody is different on this call, I don’t know everybody’s outcome that they are looking for. For me, it’s not aesthetics. For me, I don’t want to be fat. I’m 162, my body fat right now is probably 9%. I don’t care right now about having a dialed in 6-pack. What I care about is the ability to have optimal energy to grind 18 or 19 hours a day. I want to go hit the gym, work for 14 or 16 hours, come home, be an amazing father with my kids and not be a deadbeat that’s passed out on the couch. Then I want to put my kids to bed. Then I want to be an amazing husband to my wife and give her an hour of attention. And then boom after that, I go into self-development mode and stay up another 2 to 3 hours.
So for me, that’s what’s important. I don’t care what anybody’s outcome is, it’s just, “What’s the outcome that you want?” There is no right or wrong, it’s just what do you want. So for me again, it’s about energy management. So that takes me to about 8:30.
So today I had organic red kidney beans, and right before we got on this call I had another 2 scoops of cold processed whey protein, 10 almonds. After that I might have another coffee with MCT oils and grass-fed butter with that. Then at night, I have a protein of some sort. I eat a lot of grass-fed beef. So tonight I will probably have some beef with a big huge-ass salad.
And then before I go to bed it’s another cold-processed whey protein shake and 6 flax seed oil pills.
So you’re easily getting your bodyweight in protein per day, probably even more. You get about 175 to 200 grams of protein per day probably right?
Yeah, the hard part for me is that I burn so many calories. I can’t sit still dude. I just started tracking everything with Fitbit. So yesterday, and this is with zero cardio, but because I move and all my desks are standing up desks, I don’t moving…yesterday I hit 20,000 steps which is almost 9 miles, with just my normal events. Plus throw in an hour of gym time and I’m already sweating.
Are you wearing a fuel band…or how are you tracking?
So just a FitBit, the HR charge. I tracks my steps, my sleep patterns, diet, heart rate, all that.
So you don’t take any nutritional supplements at all, you’re not pounding any antioxidants or anything like that?
Nah, man I used to. I used to spend a decent amount of money on multivitamins and what not. I’m a guy that just pays attention to his body. I’m going to take this, and be the unemotional detached passenger, so I’m just kind of watching. So then I take this supplement, how did it make me feel? How did I respond? I’m journaling every single day. “I ate this. How did I respond?”
Because again, I’m very intentional about what I want. I need this tool to be optimized for the energy that I want.
Everything that I’m consuming, I’m asking “How did this make me feel?” Did it make me groggy? Did it give me brain fog?
I just did a 3 hour webinar before this call and then I’m going to be grinding at another call after this. So it’s go go go go, I can’t have brain fog in my life. So it’s “I consumed this, how did it make me feel?” But yeah, I cut out all multivitamins and antioxidants just because I do eat so clean. I do make up that nutrition that most probably lack.
Yeah man, your diet is way more dialed in that 99.9% of the American public for sure. Great answer. So for anybody watching the show or reading the transcript. If you’re going to eat like Josh and eat only organics, drink 2 gallons of water a day, and make sure you’re eating 200 grams of cold processed protein, and all the other things that he does to optimize his condition, you don’t need to take supplements but for the average person, Dr. Osborn has the supplement chapter which I highly recommend.
But to answer the question: optimal supporting supplements while on TRT. So again, that blog has a lot of good stuff but the book also, we have an entire chapter on fitness and nutrition. The one thing I learned from Dr. Osborn, amazingly, after being a patient on TRT for almost 15 years now, is stinging nettle root. For all you guys that are TRT, that is an absolutely must have supplement. It helps with free Test conversion. It also lowers sex-hormone binding globulin. It does so many different things it should honestly be a medication.
Just make sure that you’re getting a quality brand. They are on Amazon, with a high bioavailability. So again, that’s stinging nettle root or nettle root. I take it on an empty stomach in the morning and also before I go to bed at night. It will actually help you sexually too. Again, it increases free testosterone which will increase libido. Is there anything you want to add doc?
Dr. Brett Osborn:
No, I’m just going to make this one statement, when you are on TRT in addition to taking what I consider to be staple supplements that are mentioned in detail in the book, not in an order of important but my top 10 that I feel are integral for health across the board for everyone.
Several of the things that I would recommend fall into a category best known as “liver detoxification” supplements which helps the body deal with anything taken exogenous: testosterone, food stuffs, etc. and really bolster the antioxidant capacities of the body. So all those free radicals floating around in your body, all those bad metabolites of food that are generated just by living or various medications that an individual may take. One should bolster their antioxidant capacities by using liver cleansing supplements and I take several of them. I take silymarin if you want to call it that. There are other names. People call it Milk Thistle (it’s one of the active ingredients in milk thistle. I take a mushroom extract, and I also take something called N-acetyl-cysteine or NAC. That augments your glutathione production. Glutathione is a very potent bodily antioxidant, so it helps us deal with some of the stresses, whether it be exogenous substances that we’re putting into our bodies, medications etc. and some of the bad foods that we eat because we all don’t eat like Josh. So that would probably be my one other supplement group that I would recommend using in addition to those mentioned in the Get Serious book.
Again, this is all discussed on his book and my book. There’s a really good one that has all those liver constituents, it’s called Tyler’s liver detox. Tyler’s is a company run by doctors so it’s really high quality. It’s actually hard to find and it’s super expensive, but if you want to get all the things that Dr. Osborn just said, and honestly if you live in a large coastal population center or a big megalopolis, it’s really good to take a liver detox supplement even if you’re not on TRT. For sure when you’re on TRT it’s much better, especially if you drink alcohol.
So Scott, here’s the question:
Q5: I’m 32 years old and I have been on supplemental T for 2 years due to serious physiological issues I suffered in my late 20s. I love the way I feel on it but I feel I’ve become dependent on it. What’s the best way to come off? What ancillary medications would be optimal to restore my natural production?
Jay: What the F*ck? Why do you want to come off? Laughs.
Dr. Brett Osborn:
[laughs] That’s the most important question.
You’re 32, been on supplemental T, you probably feel great on it, but you feel dependent on it. What does that mean, “You feel dependent on it?” Do you feel like someone conditioned you or brainwashed you to believe that your natural production is more important and you need to be on your natural production than supplemental form? I guess it’s hard for me to understand that question because there is no reason to come off especially if you’re not suffering. Why would you want to disrupt your endocrine system after you’ve been on exogenous supplemental testosterone for 2 years in the hope that you’re going to restart your natural production? And even if you do restart your natural production, which clearly you can, you’re not getting any younger.
As you age, your natural production is lessening by the day, by the second. Living in a big city, in a large coastal population center or a big city, you are under bombardment. Your natural testosterone is not going to get better. The mindset that people have of, “I need to be off. I need to be relying on my natural production, I need to not be dependent on a chemical.” It’s all mindset and psychological warfare. It’s media manipulation, as Dr. Osborn knows. IT’s the demonization of using testosterone. It’s all these things that are making people think, “Oh I can’t be on it, I got to get off. I got to let my natural production take over.”
It’s ridiculous. You don’t even have any natural production. You’re 32 years old, you’re Scott and you have 275…who knows what his free test is, but we can assume it’s not great. That’s not natural production. If you’ve been on for 2 years and relying on exogenous supplemental form and you want to stop that because you feel guilty or whatever other nonsense is affecting your opinion…it doesn’t make any sense to try and restart your natural production when you probably are never going to get back to where you were when you went off and started relying on the outside. I’ll let doc answer the questions as far as what ancillaries would be optimal from a medication standpoint to restore. My answer is, there’s no point in coming off so why should you?
Dr. Brett Osborn:
Right. I get this question all the time. As a matter of fact, just yesterday with another individual, his wife was there and asking the exact same question. And my answer was, “Well why would you consider doing something like that?” These medicines, these bioidenticals (these are not synthetics like anavar, winstrol, anadrol, Deca-Durabolin). I’m not going to condone their usage [synthetics], but bodybuilder use them and they need to be cycled. Why? Because a lot of the more “powerful” ones have very malignant side effects particularly on the liver and other organ systems.
And they need to be cycled because it lessens their toxicity. Bioidentical testosterone does not need to be cycled. There’s absolutely no reason you need to be worried about putting testosterone in your body because if high levels were toxic, every 16 year old male would be dead from testosterone overdose, and they’re not. So that’s bunk as far as I’m concerned.
It [Test] does not need to be cycled, there is no reason to be coming off. Many many people have been on lifelong testosterone without a single adverse event. Nothing. Nothing at all. So there is no reason you should come off of testosterone or feel guilty on exogenous testosterone. You should that, “Oh I should just sort of age gracefully without any chemicals in my body.” Because I’m going to tell you one thing: if you don’t have health (and I talk about this in Get Serious) in the supplement realm, if you don’t have health with hormonal optimization…if for some reason you cannot get your hormones up by optimal nutrition and exercise, you will not age gracefully.
So you do need health. So it’s OK to ask for help and to have help in the form of using exogenous testosterone. You do not need to come off your supplements OR testosterone. There’s absolutely no reason to do so. That said, if somebody needs to come off testosterone. Say as an example, and this is going to open a whole ‘nother can of worms but…say as an example you got diagnosed with prostate cancer (not because of testosterone use), but you did get diagnosed with prostate cancer. Yes, prostate cancer is a hormone sensitive cancer, so you would have to come off of your testosterone in that context.
If you did, and you didn’t want to feel the lag that going to be associated with the relative loss to testosterone relative to where you were a month prior, what you would do is you would slowly taper yourself off and at the same time you might consider going on slight touches of beta-HCG so you don’t feel that lag and ultimately re0establish your normal hypothalamic pituitary testicular axis so that your body is making the nominal amounts of testosterone that it was making before and you won’t feel that “withdrawal.”
And there are other medications that you could go on as well to help establish your normal testosterone to estrogen ratio, but it’s something that’s not necessary. It’s something that’s talked about a lot in Jay’s book in another context, but these are the medications that you can use. These are the medications that bodybuilders use when they are coming off…but again, what I want to stress is just what Jay had stressed, THERE IS NO REASON EVER TO COME OFF THIS STUFF unless there is some sort of condition that mandates you get off the medication.
Right. Only if you have a medical condition. He’s absolutely right. I could go on and on. I could talk about this subject for days. This whole cycling thing…even doctors are f**king confused. It’s absurd that they believe you have to cycle off of testosterone. It is a joke. There is no reason, it’s a fallacy, and it’s a complete misunderstanding of the male endocrine system. Coming off is just as disruptive as being on. It’s absurd. I don’t want to talk about it anymore.
Scott two more questions and we’re out. And Josh I really appreciate you staying on, I’m going to try to tie you in here really quick in a second. So this is for someone who has never done testosterone before, they are in their early 30s, the question is:
Q6: How long does it take to reach the proper level? How much blood should I expect to have drawn in the first 30 to 90 days? What should I expect to experience? Will I have mood swings? Will I have irritability? Will I have water retention or puffiness? And as a follow-up to that: are aromatase inhibitors absolutely necessary if, after 60 days, I have no elevated estrogen symptoms?
Dr. Brett Osborn:
Okay, I’m going to make this really quick because I know we’re short on time. The answer is no. Okay, I rarely let individuals who are on exogenous testosterone out of my office without some form of aromatase inhibition. That said, okay, patients will often times exhibit extremely high sensitivity to aromatase inhibitors. So I’ll put them on testosterone and their estradiol will be about 25. I like to run my men at about 20 because we believe that’s the optimal number. But that’s not necessarily the case.
And they’ll come back to me in 6-12 weeks with repeat labs or whatever it is, and their estradiol levels will be zero. I’ll stop the aromatase inhibitors. They’ve proven themselves unworthy of the medication. I myself need the inhibition – it’s a genetic thing, it has to do with your fat, etc. etc. But the answer is no, you don’t need to be on aromatase inhibitors. A lot of people of people are, and their dose is different from you. It can be different between siblings, it’s going to be different from your friends.
Your reliance on that or whatever your need for it, is going to be completely different from another individual, even if he is related to you. So one thing has nothing to do with the next and it’s really a trial and error.
So the answer to that is no. Okay, something just so that, I want to throw it out there – a natural aromatase inhibitor, which is a little more gentle than say using anastrozole, which is what I use in my practice. Some people use tomoxifen, which is a receptor blocker – is just Zinc, okay.
You can use something called Chrysin, okay, which is a transdermal cream. They’re a little bit more gentle, and they’re less likely to put you into so-called “menopause.” Because I do have people call me on occasion, saying “I’m having hot flashes, blah blah blah.” And I usually tell them to stop the anastrazole, it’s unnecessary. Next question, um the question about hematocrit or hemoglobin, whatever you want to call it. That is also, I would say about 5% of my patients have on testosterone replacement therapy require phlebotomy. My cutoff is somewhere around 50 or the low 50s. You don’t want to put somebody into the mid to high 50s because then they are at elevated risk for “sludging.”
When blood is “sludging,” it becomes more like mud, if you will. And then you can run the risk of developing blood clots etc etc, because it’s just more and more red blood mass, which is one of the dangers of epogen. So there’s an epogen-like effect. So my threshold is 50 or the low 50s. If somebody starts drifting up that way, I’ll say “listen.” I’ll have my nurse get them on a phlebotomy schedule. And they’ll be phlebotomized until they’re around a hematocrit of 4, which typically translates to a hemoglobin of about 15 or so. So, just because you’re on testosterone doesn’t necessarily mean you’re going to be phlebotomized. I would say one out of 20, maybe one out of 10 require phlebotomies. It’s not a big deal. It’s a natural sort of side-effect of testosterone. It’s not dangerous as long as it’s watched, okay. And that’s why these things need to be done under the supervision of a physician, period.
You got to have a good physician, guys. I’ve been using him for almost 15 years. Um, always with a doctor. And my level’s never been higher than 47.
Dr. Brett Osborn:
I run similarly, Jay.
But 46 – 48, I’ve never in 14 years, been phlebotomized, other than getting my blood drawn a couple times a year, getting a full metabolic panel or the anti-aging panel where they take out four vials, twice a year…
Dr. Brett Osborn: And it’s OKAY. It’s okay not to be phlebotomized. It doesn’t mean you’re a failure, or that testosterone is doing something badly – It’s normal.
It’s totally based on your genetics. Some guys I talk to – and Dr. Osborn knows this – some guys literally have to get phlebotomized 5 times a year to stay on TRT, okay.
I’ll add this – and I have no clinical proof or empirical data to prove this, okay – but the more cardiovascularly conditioned you are, meaning the better the blood is being delivered through your system systemically, it’s less likely that you’re going to have vascular issues or blood pressure issues that are going to make you do that.
So again, as we always say, you cannot think that you’re going to do TRT and be a fat fuck that goes to McDonald’s and slams beers every night. If you do that, you’re not going to get the benefits of TRT. Now if you want to use TRT, and you want to exercise, you want to be like Josh, and be very very serious about your diet, and drink water, and make a commitment to minimizing, if not eliminating alcohol, then TRT can be the greatest life-enhancing supplement/medication/drug/hormone – whatever you want to call it that you have ever seen.
I tell most guys, when they ask me this question: “How do you measure your life before TRT and after?” And I say, that’s the answer to the question. You will measure your life before you started, and after you started, because it’s that big of a difference – if you’re willing to put in the work and do all the other things that are mandatory to make TRT work. With that said, Scott say something, and then Josh, I want you to have the final word.
Dr. Brett Osborn:
You know, Jay, that was a perfect ending to this conversation. It is truly um, and I tell this to my patients all the time, family, friends- it is a life-changing medication/hormone/supplement – whatever you want to call it, okay. And you can feel it. It’s unlike some of these other supplements/medications – you take an aspirin a day and it’s almost like on blind faith. You’re going by the data. You take omega-3’s because Dr. Osborn or Jay Campbell says take high doses of omega-3. This is something that you can feel. And it’s not just a physical thing, it’s a mental think as well. Josh, it seems like you’re a very, very clear individual. From a mental standpoint, you seem to be firing on all cylinders – overclocked, ok.
Testosterone gives you that feeling of mental clarity. It’s not a stimulant but it’s conducive to all aspects of your health – not just physical, but mental as well. It’s a life-changing drug.
No doubt about it. Scott, anything you want to say?
I mean, the doc blows my mind. Doc you’re amazing.
Yes, all the time.
Hey Josh, man, I just want you to know dude that last week was amazing for me. The 2 ½ hours that we spent together were like life changing. I want to do this again. I want to have you back on the show another time when I can have more input from you. And of course, Monica. Today was kind of an esoteric subject. But I’ll free up some time on the calendar and we’ll get you back in pretty soon, so…
He’s the expert on TRT, not me.
Dr. Brett Osborn:
That he is.
Josh, you still there brother?
Yeah, I’m here, man. I appreciate it. Any time you want to rap, I love rapping with you.
I would just say to anybody that’s listening: don’t follow the path that society follows.
Right, like you don’t want to fit in, you don’t want to be average. Seventy-five percent of people are overweight, 40% are obese.
I consider myself a polite, open-minded skeptic. And I’m questioning everything – why is it this? What am I consuming in my body? What is it, if it’s got 20 different ingredients that I can’t even pronounce? That’s a red flag, right? What is it? Is it good for me – yes or no. And why or why not? And just research, and do that due diligence. It’s your one tool.
And like I said with Jay, and I say this a lot, I’m not utilizing TRT yet, but it’s something that I’m looking very very heavily into right now. Because I’m going to optimize this tool that I have, and Jay and I, we went deep last week. It’s not that you’re trying to be a bodybuilder or a pro-athlete on all these hormones, it’s bringing your body back to homeostasis, to that midline.
Because all these other environmental factors – your dashboard on your car – the sun hits it, and it releases these chemicals that screw us up chemically. And we’re just talking about bringing yourself back to that midline homeostasis path. So your body should function the way that it should.
So be an open-minded skeptic – be a polite open-minded skeptic, do your research, do your due diligence.
Aww, you’re very polite…I want you to break out in song.
Monica wants to meditate with you now. You resonate with her so much.
Do you ever go into the tank – do you ever do sleep-deprivation tanks? Or sensory-deprivation tanks?
No, I know people who do it. Doc have you ever done that?
Dr. Brett Osborn:
I haven’t. I’ve read a lot about it. But one of my friends has done it and he says it’s quite the experience.
That’s what I’ve heard too…
Every week, dude…
So, what’s your experience of that, real quick?
It’s been amazing, dude.
Meditation’s been a game-changer for me.
Companies are making billions of dollars just to distract us, and that again, just brings us back to our midline.
So yeah, the tank has been, for total body healing, any chronic pain and body aches, it’s been absolutely amazing. But the medication, the mindset areas that it takes you to is mind-blowing, so it’s definitely an experience that everybody should try.
You’re the man, dude. That was an amazing show. Scott, thanks for staying over. Everybody, I’ll have the transcript for the show on the blog within the next 3-4 days. And the next time, we’ll talk SOAR.
Yep and then we’ll be back here in 3 weeks, not 2 – 3 weeks.
Yep, so we’ll be back in early May, exactly.
Dr. Brett Osborn:
Good talking to you and meeting you guys.
Be the BEST YOU EVER!