hol+ with Dr. Taz MD | The Future of Medicine is Holistic

What happens when men’s health gets reduced to one testosterone number? In this episode of hol+, Dr. Taz sits down with Dr. Brandon Smith, MD, a conventionally trained physician practicing at hol+, for a practical and eye-opening conversation about men’s health, low testosterone, sleep apnea, TRT, GLP-1s, muscle, stress, hormones, and why so many men are waiting too long to get proactive about their health.

Together, they explore why men’s health needs a reframe, especially in a medical culture where many men are taught to only go to the doctor when something is clearly broken. Dr. Smith shares what he sees in the exam room, from younger men asking about testosterone before starting a family, to men in their 40s, 50s, and 60s realizing they have spent years pushing through fatigue, stress, brain fog, weight changes, low libido, poor sleep, or changes in performance without knowing where to start.

Dr. Taz and Dr. Smith also unpack why low testosterone is not always a simple testosterone problem. Dr. Smith explains the difference between total testosterone and free testosterone, why one lab number is only a snapshot, why testosterone can fluctuate throughout the day, and why morning testing matters. They also discuss why symptoms, context, body composition, sleep, stress, inflammation, chronic illness, and lifestyle all need to be part of the conversation before jumping straight to testosterone therapy.

This conversation takes a closer look at one of the most overlooked drivers of low testosterone: sleep apnea. Dr. Smith explains why disrupted sleep can create a stress signal in the body, why men may not realize they are waking up throughout the night, and why the body may lower reproductive hormones when it does not feel safe, rested, or recovered. They also discuss how fasting, chronic stress, high cortisol, poor recovery, and underlying medical conditions can affect hormone levels.

If you’re listening to this and thinking, “I know something is off in my body, but I don’t know where to start,” join the Circle here: 👉 https://holplus.co/circle

Men’s health is not just about testosterone, TRT, libido, or muscle. It is shaped by sleep, stress, metabolism, body composition, inflammation, blood sugar, chronic illness, movement, recovery, hormone signaling, and the way men are often conditioned to ignore symptoms until they become impossible to avoid. In this episode, Dr. Taz and Dr. Smith look at men’s health through a whole-body lens, where the goal is not just replacing a number, but understanding why the body is responding the way it is.

Learn more about support related to this conversation:
Men’s Health:
https://holplus.co/services/mens-health/
Hormone Imbalance:
https://holplus.co/conditions/hormone-imbalance/
Book a Hol+ Consultation: https://holplus.co/locations/virtual/

Dr. Smith shares why most testosterone deficiency is often secondary, meaning the issue may not start in the testes, but in the brain’s signal to the testes. He explains how sleep apnea, diabetes, kidney disease, heart disease, infections, stress, and poor recovery can all push testosterone levels down. He also explains why a more complete workup may include LH, FSH, sleep history, body composition, lifestyle patterns, symptoms, and a deeper look at what is getting in the way of healthy hormone signaling.

Dr. Taz and Dr. Smith also discuss the different approaches men may hear about, including testosterone injections, creams, pellets, Clomid, lifestyle changes, and GLP-1 medications. Dr. Smith explains why the right path depends on the individual, including whether the biggest barrier is sleep, weight, joint pain, libido, motivation, metabolic health, or body composition. They also discuss why strength training, muscle mass, and movement are essential parts of the men’s health conversation, especially for long-term resilience and aging.
If you are navigating low testosterone, low libido, fatigue, brain fog, weight gain, poor sleep, sleep apnea, high stress, low motivation, muscle loss, GLP-1 questions, TRT decisions, or the feeling that something is off but you are not sure what to test first, this episode offers a more complete way to understand what your body may be trying to tell you.

About The Guest:
Dr. Brandon Smith, MD, is a conventionally trained physician practicing at hol+. His background includes biochemistry, conventional medicine, integrative health, movement, fitness, and a deep interest in helping patients connect the dots between symptoms, lifestyle, labs, and long-term health. In his work with patients, Dr. Smith focuses on asking better questions, understanding the whole person, and creating practical, personalized plans around diet, sleep, stress, exercise, hormones, and metabolic health.

About Dr. Taz:
Dr. Tasneem Bhatia (Dr. Taz) is a triple board-certified integrative medicine physician,
bestselling author, and founder of hol+ a multi-location integrative medicine practice.
Learn more: https://doctortaz.com/about

Stay Connected:
Connect further to Hol+ at https://holplus.co/ - Don’t forget to like, subscribe, and hit the notification bell to stay updated on future episodes of hol+.

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https://www.instagram.com/liveholplus/

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Subscribe to the video podcast: https://www.youtube.com/@DrTazMD/podcasts

Host & Production Team
Host: Dr. Taz; Produced by ClipGrowth.com (Producer: Pat Gostek)

Chapters
00:00 Why Men’s Health Needs a Reframe
01:20 Why Men Avoid the Doctor
03:35 What Brings Men Into the Clinic
06:00 Why Younger Men Are Asking About Testosterone
07:25 What Testosterone Actually Is
09:15 Why One Testosterone Test Is Not Enough
10:10 The Best Time to Test Testosterone
11:15 Total Testosterone vs Free Testosterone
14:00 Is Testosterone Therapy Always the Answer?
15:25 Sleep Apnea and Low Testosterone
18:05 Stress, Fasting, and Hormones
20:05 Symptoms of Low Testosterone
22:15 When to Consider a Sleep Study
24:30 Why Most Low Testosterone Is Secondary
26:10 Cortisol, Stress, and Testosterone
28:20 Testosterone Shots, Creams, Clomid, and Pellets
32:20 Lifestyle Changes That Can Raise Testosterone
35:00 Why Muscle Matters for Men’s Health
40:00 How Often Men Should Strength Train
43:00 GLP-1s, Weight Loss, Muscle, and Testosterone
47:30 Why Men Need a Whole-Body Health Partner
50:20 What Makes Dr. Brandon Smith Feel Whole

Creators and Guests

Host
Dr. Taz Bhatia MD
Dr. Taz Bhatia is a triple-board-certified integrative medicine physician and founder of hol+, where she brings together science, spirit and the human experience to deliver holistic, whole-person care.
Producer
Pat Gostek
Founder of ClipGrowth.com - End-to-End YouTube, Podcast & Clips Management (you just record).

What is hol+ with Dr. Taz MD | The Future of Medicine is Holistic?

hol+ with Dr. Taz MD is redefining modern medicine through a comprehensive, evidence-based holistic approach; integrating functional medicine, integrative medicine, and time-tested healing systems to treat the whole human, not just symptoms.

Hosted by Dr. Tasneem Bhatia (Dr. Taz), triple board-certified physician in integrative, functional, and holistic medicine, bestselling Penguin Random House author, and founder of hol+; a comprehensive evidence-based holistic medicine platform with clinics in Atlanta, New York City, and Los Angeles, and virtual care available nationwide.

At the heart of hol+ is a revolutionary framework: the Five Body Map- physical, mental, emotional, energetic, and social/community bodies that create whole health. This whole-human approach connects hormone imbalances, gut dysfunction, microinflammation, cortisol dysregulation, metabolic disease, autoimmune conditions, perimenopause, and stress-driven illness to the full spectrum of who we are; body, mind, and spirit.

Each episode explores Dr. Taz’s original clinical frameworks ;The Cortisol Loop, Microinflammation, and The Invisible Load alongside conversations with leading experts, celebrities, and thought leaders including Sophie Grégoire Trudeau, Katherine Schwarzenegger, Cameron Mathison, Carol Alt, Jane Seymour, Tamsen Fadal, and Kris Carr.

Topics include hormone health, gut health, GLP-1 and metabolic therapy, thyroid dysfunction, weight loss, inflammation, autoimmune disease, mental and emotional wellness, energetic health, and the future of holistic medicine.

This is the show where science and spirit converge- driving health, happiness, relationships, and family ecosystems.

Want to go deeper? Join Dr. Taz’s private community, the hol+ Circle ; medicine beyond the exam room. (holplus.co/circle)

A 2025 Webby Award honoree, recognized alongside the Mel Robbins Podcast in the 29th Annual Webby Awards, hol+ is built on the foundation of Super Woman Wellness, which surpassed 1 million downloads over 8 years.

This is medicine beyond the exam room. Welcome to hol+

[00:00:00] Dr. Brandon Smith: 90 something percent of testosterone deficiency is this term secondary [00:00:05] hypogonadism, but just meaning, you know, it's not a problem with the testes making the testosterone, it's the [00:00:10] brain telling the testes to make the testosterone. That signal isn't there because there's something getting in the [00:00:15] way.
[00:00:15] Dr. Brandon Smith: If I have chronic conditions, so heart disease, kidney disease, [00:00:20] diabetes, all those conditions will add on top of each other and will push my levels down.
[00:00:23] Dr. Taz: Sleep apnea [00:00:25] is directly linked to low testosterone. Maybe explain that for just a second. If
[00:00:29] Dr. Brandon Smith: you're [00:00:30] waking up multiple times or maybe you don't feel like you're waking up, but your brain does [00:00:35] overnight multiple times per hour, you're never getting that good deep sleep where your body's really [00:00:40] recovering.
[00:00:40] Dr. Brandon Smith: We start to get stressed, we start to get sleep deprived, you know, maybe our diet's off or [00:00:45] maybe even we're doing long periods of fasting for our health for some reason. Yeah, those are periods of [00:00:50] stress and that'll hurt our hormone levels. You know, the hormone levels are an energy cost to the body and [00:00:55] when, you know, stress levels go up, our body's trying to put energy in other places [00:01:00]
[00:01:00] Dr. Taz: This episode is sponsored by holplus, a holistic health platform built [00:01:05] around education, personalization, and integrative care.
[00:01:08] Dr. Taz: holplus blends [00:01:10] holistic, integrative, and functional medicine clinics with learning resources like [00:01:15] blogs, YouTube videos, and of course, this podcast, so you're not just treated, you're [00:01:20] informed. The platform also includes holistic health quizzes and a curated wellness shop, [00:01:25] helping you make choices that support your body at the root level.
[00:01:29] Dr. Taz: holplus [00:01:30] is holistic healthcare designed for real life.
[00:01:33] Dr. Brandon Smith: Visit us at [00:01:35] holplus.co to learn more about the platform. Again, that's [00:01:40] H-O-L-P-L-U-S dot C-O.
[00:01:41] Dr. Taz: Every week on holplus, we talk about different ideas, [00:01:45] different topics, really trying to push health forward and really trying to embrace this [00:01:50] holistic approach or the holistic model where we think about the whole body, all the different things involved.[00:01:55]
[00:01:55] Dr. Taz: And one of the areas that often gets neglected is men's health. [00:02:00] I think that there has been so much attention on women's health, and r- rightly so, [00:02:05] honestly. I think we need the research, we need the clinical experience, we need all the things. [00:02:10] But men's health needs a reframe, too, just like pediatrics, just like so many [00:02:15] other aspects of health, that honestly are outdated the way they are conventionally [00:02:20] practiced.
[00:02:20] Dr. Taz: That's why I brought in my next guest. So this is somebody [00:02:25] close to me, near and dear to my heart, who actually works in our clinics at holplus. [00:02:30] And ironically, a lot of the men have been signing up to see him. [00:02:35] So please join me in welcoming Dr. Brandon Smith to the show. I'm gonna let [00:02:40] Brandon tell you a little about, a little bit about himself, um, ultimately, as we go through the show, [00:02:45] but we're gonna jump right in, Brandon, with the first question.
[00:02:48] Dr. Taz: And I'm sorry, I have to call you Brandon because [00:02:50] we know each other, and, but he is a doctor, he's a conventionally trained MD. He [00:02:55] is excellent. Our patients love him. But we're gonna jump right into the, to my very [00:03:00] first question, which is, what are we missing when it comes to men's health? [00:03:05]
[00:03:05] Dr. Brandon Smith: So I think that's a really good question.
[00:03:08] Dr. Brandon Smith: Um, the main [00:03:10] thing that I think when guys come in for the first time into the office, the mentality [00:03:15] seems to be, and if it's not broken, we don't have to fix it. And [00:03:20] that's the once a year annual physical model. Doesn't mean that it [00:03:25] couldn't be better, and I think that's my first visit with a guy is sitting down, [00:03:30] figuring out how their lifestyle is, un- like ultimately trying to get a good baseline on them [00:03:35] and figure out where are the areas that we could work on improving and where are they doing [00:03:40] well to figure out how do we move things, uh, I guess really move the needle in the right [00:03:45] direction so we're seeing metrics actually that matter improve.
[00:03:49] Dr. Brandon Smith: So whether [00:03:50] that's, you know, on average, I think when I'm seeing guys, if things are running well, I'd like to see them [00:03:55] about twice a year. So maybe a little bit more aggressive than that once a year, you know, it's not broken, don't have [00:04:00] to fix it model.
[00:04:01] Dr. Taz: I think I saw, um, a statistic recently that [00:04:05] said that only like 30 to 40% of men even make the annual physical.
[00:04:09] Dr. Taz: The
[00:04:09] Dr. Brandon Smith: [00:04:10] annual. Yeah.
[00:04:10] Dr. Taz: So, so-
[00:04:11] Dr. Brandon Smith: No, that's, to me, that's, that's the, that's the low bar. You know- Yeah ... that's the thing that, [00:04:15] you know, that's a population health level. How do we keep people in the country healthy? What is the [00:04:20] minimum that we need there? And that's that one year annual physical and, you know, that's [00:04:25] the sad reality is most people don't even make that low bar.
[00:04:27] Dr. Taz: Do you think that just got baked [00:04:30] into our medical culture, so to speak, somehow that there's this like comfort zone [00:04:35] around like, "Okay, well, as long as I make that appointment, I'm fine"? Do you, do you hear men say that a [00:04:40] lot?
[00:04:41] Dr. Brandon Smith: Um, I feel [00:04:45] like a lot of the times when I'm getting guys that are coming in just in our practice, it's, it's someone that's [00:04:50] coming in that's motivated or something has changed them to wanna change something else, whether someone [00:04:55] else in their household is getting healthy, um, you know, someone else in their family's coming into the [00:05:00] practice and I get to see the husband.
[00:05:01] Dr. Taz: Yeah.
[00:05:02] Dr. Brandon Smith: Um, someone is training for a new race or [00:05:05] event that they wanna really do well at. Something's really got them motivated. You know, maybe they have a parent that's [00:05:10] gotten sick, and they're looking, you know, into that crystal ball and seeing, you know, "What path, [00:05:15] you know, might I go toward? How can I change that path?"
[00:05:18] Dr. Brandon Smith: So it's, it's people coming in pretty [00:05:20] motivated, I think, in general that, you know, we have in, in our clinic, which is, it- [00:05:25] it's nice w- working with patients.
[00:05:27] Dr. Taz: Definitely. And I think we, we're sort of [00:05:30] blessed in the sense of, like, we have motivated people, people that want to learn more. We also [00:05:35] have the people that are sick, right?
[00:05:36] Dr. Taz: The super sick that are coming in and are, and are trying to get answers. [00:05:40] But again, when we turn the lens back on men, what are they saying to you in the exam [00:05:45] room? Like, what are, what are some of the things that they're coming to you with, or maybe even some of the frustrations [00:05:50] of what might have kept them out of making that annual physical or even a baseline appointment?
[00:05:54] Dr. Taz: I mean, [00:05:55] I had a patient recently who had not seen a doctor in, like, a decade. You know what I [00:06:00] mean? And that happens a lot, where men are coming in and they, you know, work really hard, and they put their [00:06:05] head down, and they grind away, and they, you know, have a family, and then that gets foggy, [00:06:10] and there's a lot going on there, and then they look up and, and the years have gone by.
[00:06:14] Dr. Taz: You know, what are... I'm [00:06:15] curious what they're saying to you in the exam room.
[00:06:17] Dr. Brandon Smith: I think it probably-- Like, there's a few [00:06:20] different clusters of patients that I feel like I see, and it's probably easier to break them down- Yeah ... more by, like, the age [00:06:25] range. So when I'm seeing, you know, the 20, like late 20s, 30-year-old [00:06:30] guy that's coming in, maybe thinking about starting to have a family, you know, "Hey, I haven't been to the doctor in 10 [00:06:35] years," you know.
[00:06:35] Dr. Brandon Smith: "The last doctor I saw may have been a pediatrician or someone that I saw when I was sick. I don't [00:06:40] think anything's wrong. Thinking about having a family, I just want to test hormone levels, see where my [00:06:45] testosterone is." These are the types of questions I'm getting. Um-
[00:06:48] Dr. Taz: Oh. Uh-huh.
[00:06:49] Dr. Brandon Smith: Even it-- [00:06:50] Uh, even in some of the younger guys, like, you know, 18, 19, 20, around college, a lot of [00:06:55] people are coming in and they've had their testosterone levels checked, and they just are asking questions and say, "Hey, you know, here's [00:07:00] my number.
[00:07:01] Dr. Brandon Smith: What should we do about it?"
[00:07:02] Dr. Taz: Yeah.
[00:07:02] Dr. Brandon Smith: You know, whether we actually need to do anything about that or [00:07:05] not, you know, on a clinical level, you know, a different story, and how to even interpret that number is, you know, [00:07:10] that pathway that I have with that patient. And then, like you mentioned, you know, the person that is [00:07:15] finally putting their head up after working, you know, hit retirement age.
[00:07:18] Dr. Brandon Smith: "Now I have all this free time. [00:07:20] Now I feel like I've got time to get caught up on all the things I may have missed out, you know, through that career [00:07:25] journey." I mean, I talk about it with those people hitting retirement age. It's such a big life [00:07:30] transition. It's fun working with them because it's almost like the, the reference I give them is like, "Remember when you went off to [00:07:35] college?
[00:07:36] Dr. Brandon Smith: This is as big of a life transition- Yeah ... going from working to not working as it is when you [00:07:40] left your house to go to college." You have to think about it like that.
[00:07:43] Dr. Taz: I remember I had, um... I [00:07:45] think this gentleman was in the financial services industry or in the sort of like, you know, the investment [00:07:50] banking world, and he's like, "Dr.
[00:07:52] Dr. Taz: Taz, for 25 [00:07:55] years, I walked into a room with 15 different computers and [00:08:00] all of us, like, trading and competing against each other, and I'd go home after a [00:08:05] 12-hour day and I would collapse after having a meal and a few glasses of wine and maybe a few vacations." [00:08:10] He's like, "Twenty-five years have gone by doing that, and I'm looking up and [00:08:15] I'm like, 'Oh my gosh, there's sun and there's nature.'"
[00:08:18] Dr. Taz: I mean, like, literally being in a [00:08:20] whirlwind. And I e- I know even my own husband s- just describes this fog, is what he talks about. [00:08:25] But one of the things that I have noticed is that the first question, [00:08:30] and I want you to set us straight on this, the first question, men of all ages, like you said, even the 18-year-olds, I [00:08:35] mean, my daughter's 18 and her friends are talking about this, like- Where, [00:08:40] where's my testosterone?
[00:08:41] Dr. Taz: You know, what is an optimal level of testosterone? You know, [00:08:45] apparently, I found this out recently, that some of the guys in her grade, even as [00:08:50] young as like 15 or 16, were getting testosterone from somewhere and [00:08:55] injecting themselves until, until their parents found out. So, you know, help [00:09:00] everybody who's listening to this show, whether you're a parent of a teenager, or you're a young [00:09:05] man, or you're a man sort of in your 40s, 50s, or 60s, help us [00:09:10] understand testosterone.
[00:09:11] Dr. Taz: We know it's important. We know it drives so many different, you know, really [00:09:15] positive things. But what should we really be thinking about when it comes to [00:09:20] testosterone?
[00:09:21] Dr. Brandon Smith: Yeah. I mean, so first thing is, you know, just the definition. You know, it's a [00:09:25] steroid hormone. It gets inside all, all of the cells across the whole body.
[00:09:29] Dr. Brandon Smith: And just trying to [00:09:30] give it some context, it's, you know, when we're looking at testosterone levels for the most part, unless you're doing [00:09:35] maybe like saliva testing for the hormones, then you're talking about a blood level of [00:09:40] testosterone. So we're just measuring what's, what's in the blood. You know, we're not talking about what's happening in the [00:09:45] brain, what's happening in the muscles, what's happening in the prostate, what's happening in the scalp, all these different levels of [00:09:50] detail that we can get down to.
[00:09:52] Dr. Brandon Smith: Um, and so one is just, you know, okay, [00:09:55] what's the number? Two is trying to understand, you know, what is that [00:10:00] number changing throughout the day? You know, I think if guys had a testosterone monitor the same [00:10:05] way that we had a glucose monitor-
[00:10:06] Dr. Taz: Wow ...
[00:10:07] Dr. Brandon Smith: people would be shocked to see what their numbers would fluctuate [00:10:10] with across the day.
[00:10:11] Dr. Brandon Smith: You know, if I didn't sleep the night before, maybe my testosterone is crashed whenever I [00:10:15] s- like woke up very early, came into my testosterone lab check that morning. [00:10:20] You know, I'm a fl- I'm a pilot. I, you know, got off of an overnight shift flying back from Europe, [00:10:25] and then I went in and did my labs that next day.
[00:10:27] Dr. Brandon Smith: So the first question I always have is about the [00:10:30] context of those labs. What happened leading up to them? Where are they at? You know, one, [00:10:35] obviously, just getting, you know, like a physical exam on them. What's the body weight, body composition, all these other [00:10:40] factors. And then figuring out what happened even on that one particular day to really decide [00:10:45] what is that one number on that lab test from the testosterone out of the blood actually even mean for that one?[00:10:50]
[00:10:50] Dr. Taz: How much can it vary in a given day? Like, you know, like- Hundreds of [00:10:55] points ... hundreds of points. Wow. So is there an optimal time to test [00:11:00] testosterone, or is there a guideline that we should be giving men as, as to when the best time is to test it? [00:11:05]
[00:11:05] Dr. Brandon Smith: So as far as the guidelines go, you really need two low morning time [00:11:10] testosterones to really confirm a diagnosis.
[00:11:12] Dr. Taz: Hmm.
[00:11:13] Dr. Brandon Smith: So in general, when I'm talking with [00:11:15] my patients and trying to look at testosterone, I'd like them to get it done before 10:00 AM [00:11:20] Yeah, I guess maybe some exceptions if someone's working different circadian rhythm schedules, like a [00:11:25] night shift worker or something like that, uh, we might have to interpret it a little bit differently.
[00:11:29] Dr. Brandon Smith: But morning [00:11:30] time, and typically at least two numbers that we like to see to really establish that pattern. You [00:11:35] know, one number is a, is a snapshot, two starts to tell a story
[00:11:39] Dr. Taz: So, [00:11:40] and where do you like-- I know a lot of men ask me, like, "Where's my free testosterone?" Right? [00:11:45] You know, where do you like total, where do you like free, and what's the difference between the two numbers?[00:11:50]
[00:11:50] Dr. Brandon Smith: Yeah, that's a really good question, and sometimes when you're looking at the numbers, uh, they don't always [00:11:55] match up. You know, someone looks good on a total, and then their low is free, their free is low, [00:12:00] uh, and they're really trying to figure out what are the tools that we can do to help that. So the first thing I like to, [00:12:05] you know, I, I guess I miss being in academics teaching- Yeah
[00:12:08] Dr. Brandon Smith: our medical students- Yeah ... so my [00:12:10] patients get to not suffer, but they get to learn with me. Uh, so I usually feel like [00:12:15] patients come away pretty educated after visits on, you know, what we're looking at, what we're looking for, [00:12:20] and how, you know, I'm really interpreting their labs. So the total-- So there's [00:12:25] really two-- I guess I'll back up even.
[00:12:26] Dr. Brandon Smith: There's two testosterone labs that we do. So one is [00:12:30] the ELISA, that's the standard one- Mm-hmm ... that comes back in a couple of days, very quick. For the most [00:12:35] part, it's pretty accurate. Uh, it's what we used to do. Uh, in a lot of the [00:12:40] older testosterone labs, when we compare, you know, testosterone levels from the '70s to the newer [00:12:45] testosterone averages and say, you know, there's decline in testosterone, some of that is actually due [00:12:50] to lab variability.
[00:12:51] Dr. Taz: Hmm.
[00:12:52] Dr. Brandon Smith: So we used to use the ELISA, so the other sex hormones, [00:12:55] the estrogen, the DHEA, all might interact with that and typically make that number look a little [00:13:00] bit higher. There are some supplements that can interact with it, too. So just that first [00:13:05] ELISA test, you know, I don't, you know, put all my fish in that basket that that's exactly what's happening with [00:13:10] somebody.
[00:13:10] Dr. Brandon Smith: And that's actually measured. Uh, so the free testosterone is a [00:13:15] calculation, though. So I tell patients, "This isn't a real number." You know, it's us trying to estimate and figure [00:13:20] out how much testosterone is bioavailable, you know, dissolved in the blood, where it can actually get into the [00:13:25] cells and work. So most of that testosterone is bound to, for the most part, it's, [00:13:30] uh, sex hormone binding globulin.
[00:13:31] Dr. Taz: Yes.
[00:13:32] Dr. Brandon Smith: And then the bioavailable is bound to albumin, and then [00:13:35] actually the rest of it, a small percentage of it is just free, dissolved in the blood. So should-
[00:13:39] Dr. Taz: So
[00:13:39] Dr. Brandon Smith: those are- [00:13:40]
[00:13:40] Dr. Taz: Should folks be looking at the total or the free or both?
[00:13:44] Dr. Brandon Smith: So [00:13:45] my first question is always around symptoms that they're having. You know, really just trying to match up what symptoms [00:13:50] guys might be having to figure out, you know, with their levels where they're at.
[00:13:52] Dr. Brandon Smith: You know, you could have a guy with a [00:13:55] testosterone level, and so when I'm looking at totals, you know, mainly something north of three hundred and [00:14:00] fifty for a total- Yeah ... testosterone, uh, typically guys really aren't having very many [00:14:05] symptoms. Um, you know, it doesn't mean you couldn't still have a low free testosterone with a [00:14:10] low number and still get symptoms.
[00:14:12] Dr. Brandon Smith: Uh, but the first number I look at is that total and [00:14:15] then the free, and this is kind of how our bodies compensate. So, you know, if I have a [00:14:20] guy, one thing that happens is that protein that carries the testosterone, the sex hormone binding globulin [00:14:25] In overweight men, you'll see that number go up. Mm-hmm. Or actually, it, it does the opposite.
[00:14:29] Dr. Brandon Smith: [00:14:30] It decreases e- in extra body weight. So now we're binding less testosterone. [00:14:35] So even though a guy has a testosterone level 200, 300, they may feel fine. They still [00:14:40] have a good free testosterone level even with a lower total testosterone [00:14:45] amount. So it's our body kind of compensating and adjusting. We have all these adjustment mechanisms [00:14:50] and compensation, like for thyroid, the reverse T3.
[00:14:53] Dr. Brandon Smith: You know, we can- Yeah ... block.
[00:14:54] Dr. Taz: Yeah.
[00:14:54] Dr. Brandon Smith: [00:14:55] Yeah. Neutralize some, some of the hormone
[00:14:57] Dr. Taz: Yeah, so interesting with these hormones because [00:15:00] many people just wanna fixate on, and this is for men and women by the way, like they'll fixate on [00:15:05] a particular number
[00:15:06] Dr. Brandon Smith: The number
[00:15:07] Dr. Taz: But it's really like all of these [00:15:10] numbers play together in the sand, and understanding the whole hormone profile is just [00:15:15] important for men, you know, as it is for women.
[00:15:17] Dr. Taz: If we do see lower [00:15:20] levels, you know, and I know we've talked about this kind of in the hallway, but if we do see lower [00:15:25] levels of maybe a total and a free testosterone, is testosterone [00:15:30] therapy always the first option?
[00:15:33] Dr. Brandon Smith: The analogy that I like [00:15:35] to give patients is, uh, I know, you know, I'm staring at my computer monitor right now and we always [00:15:40] have them in the patient rooms when we're, when we're walking and talking about this.
[00:15:44] Dr. Brandon Smith: Um, [00:15:45] so you know, the analogy I give is, you know, if your computer monitor is out and it stops working [00:15:50] or, you know, you've got low testosterone, I can go to the store and I can just buy a new computer monitor. [00:15:55] You know, I can give you testosterone and I can put your number where we want it. You know, there's not really a [00:16:00] question about, you know, getting it there.
[00:16:01] Dr. Brandon Smith: It's just a matter of, you know, making that prescription and deciding to do that. [00:16:05]
[00:16:05] Dr. Taz: Yeah.
[00:16:06] Dr. Brandon Smith: Some people go that route. You know, they find a testosterone clinic and, you know, decide, [00:16:10] "Okay, you know, my system doesn't seem to be running. Let me just go get a new one."
[00:16:13] Dr. Taz: Hmm.
[00:16:13] Dr. Brandon Smith: Now it's, you know, it's, [00:16:15] it's outside the body.
[00:16:15] Dr. Brandon Smith: I'm either doing injections or maybe cream, and now, you know, that's my testosterone and [00:16:20] I'm, I'm able to replace it really pre- like pretty quick and easily. You know, that same afternoon I could [00:16:25] go get myself a testosterone injection if I wrote that script that day. Uh, I guess what I think [00:16:30] we're uniquely positioned to do is really getting to see people.
[00:16:33] Dr. Brandon Smith: You know, my, my [00:16:35] history is mainly kind of, "Talk me through your day. You know, what does it, like look like when you wake up in the morning? When are you [00:16:40] exercising? What's your diet like? How are you doing managing stress? What kind of coping mechanisms do you have [00:16:45] there? How is your sleep?" Um, sleep apnea is the number one reason where, you [00:16:50] know, people have lower testosterone levels.
[00:16:51] Dr. Brandon Smith: That's kind of the most misdiagnosis for [00:16:55]
[00:16:55] Dr. Taz: low test- I don't think people... I don't think... Uh, we're gonna say that again because I really don't think people realize that, that sleep [00:17:00] apnea is directly linked to low testosterone. Maybe explain [00:17:05] that for just a second because I feel like that gets missed all the time.
[00:17:08] Dr. Brandon Smith: Yep. I mean, main thing is [00:17:10] just it's, it's slight- like sleep deprivation to the body. You know, if you're waking up multiple times or, you know, [00:17:15] maybe you don't feel like you're waking up but your brain does overnight multiple times per [00:17:20] hour, you're never getting that good deep sleep where your body's really recovering.
[00:17:24] Dr. Brandon Smith: So [00:17:25] you know, when I tell people, you know, hormones are almost always the first thing to go You know, when [00:17:30] the body's in a good spot and it feels like reproduction is a priority, that's [00:17:35] when our body is doing well making hormones. You know, we start to get stressed, we start to get sleep deprived, you know, maybe [00:17:40] our diet's off, or maybe even we're doing long periods of fasting for our health for some reason.[00:17:45]
[00:17:45] Dr. Brandon Smith: You know, those are periods of stress, and that'll hurt our hormone levels. You know, the hormone levels are an energy [00:17:50] cost to the body, and when, you know, stress levels go up, our body's trying to put energy in other [00:17:55] places.
[00:17:55] Dr. Taz: If you're listening to this and thinking, "I know something is [00:18:00] off in my body, but I don't know where to start," this is for you.
[00:18:04] Dr. Taz: [00:18:05] That's why I created the Circle. The Circle is my private community where I and my team [00:18:10] focus on understanding your body from hormones and stress to metabolic health and [00:18:15] longevity with real-life guidance that you can actually use. This is about [00:18:20] clarity and consistency and support beyond the exam room and [00:18:25] maybe outside of all the different appointments and experts that you've been running around to.
[00:18:29] Dr. Taz: [00:18:30] You can try the Circle with a one-month trial using the promo code PODCAST at [00:18:35] holplus.co/circle. Again, that's holplus,
[00:18:39] Dr. Brandon Smith: [00:18:40] H-O-L-P-L-U-S, .co/circle. All right, let's jump back into [00:18:45] the episode.
[00:18:46] Dr. Taz: So many, so many experts have talked about that over the years [00:18:50] of just ... And it kind of goes back to sort of that Chinese medicine concept of chi or energy, right?
[00:18:54] Dr. Taz: [00:18:55] Like, if the energy is not there, the first thing sacrificed in all systems of [00:19:00] medicine is usually reproduction and reproductive hormones. That's the first thing kind of to, to [00:19:05] go out the door. So, you know, what would you tell men? Like, what is a [00:19:10] comprehensive workup for shifting testosterone levels, which is [00:19:15] now, it's not just a conversation for, like, men over 40 anymore, right?
[00:19:18] Dr. Taz: We're seeing this younger and [00:19:20] younger and younger. I mean, we're even seeing it in some of the teens and some of, some of the men in their [00:19:25] 20s. What's their starting point? Where would you have them start?
[00:19:29] Dr. Brandon Smith: Yeah. I [00:19:30] mean, so the first question is, you know, looking for, like, just a self-assessment of, you know, "Hey, [00:19:35] do I think I'm having symptoms of low testosterone?"
[00:19:37] Dr. Brandon Smith: You know, if you are, I think that's, you know, obviously a [00:19:40] good-
[00:19:40] Dr. Taz: And what are some of the most common symptoms, just to educate everybody? Like, what, what is really- Yeah ... low [00:19:45] testosterone versus something else?
[00:19:47] Dr. Brandon Smith: So the big ones that we're talking about [00:19:50] mostly that are more specific to testosterone because, you know, for-- so fatigue, you know, [00:19:55] is a list of a symptom, but it's, you know, can be caused by hundreds of other things too, as you know, [00:20:00] you and I know.
[00:20:01] Dr. Brandon Smith: The-- So it's not really a specific symptom. But if I'm [00:20:05] seeing someone that's having decreased libido, they're having a difficult time with [00:20:10] erections, they're going to the gym and they're working out and their muscles are taking them days to recover after they've been [00:20:15] in, you know, a good workout routine, you know, instead of it's not the first time they went to the gym, now they're in a routine, but it's [00:20:20] still taking them days to really build back and recover.
[00:20:22] Dr. Brandon Smith: Um, changes in, like, hair growth. [00:20:25]
[00:20:25] Dr. Taz: Mm-hmm.
[00:20:25] Dr. Brandon Smith: Were able to grow facial hair before and they can't, or maybe they're seeing a decrease of it on their [00:20:30] legs. You know, I mean, that could be circulation, but at the same time, you know, it could be changes in hormones. [00:20:35] Um, so those are kind of the more specific ones that I'm looking for.
[00:20:38] Dr. Brandon Smith: So hair growth, [00:20:40] libido, erections, muscle recovery. And then everything else, you know, that [00:20:45] people hear about, talk about, you know, is really a little bit less specific to testosterone and [00:20:50] we need to kind of figure out what other things might I need to check if they're coming in with that type of complaint, like my [00:20:55] energy's dipping.
[00:20:56] Dr. Taz: Right.
[00:20:57] Dr. Brandon Smith: You know? Pretty big workup to figure- Yeah ... out what exactly is the root for that. [00:21:00]
[00:21:00] Dr. Taz: And so, you know, I know that we do-- we're looking at nutrients, we're [00:21:05] looking at all the hormones, we're looking at inflammation and cellular function. One of [00:21:10] the things I'm curious with, like, are you asking them to do, like, a home sleep study of [00:21:15] some kind before you make a decision about testosterone?
[00:21:19] Dr. Brandon Smith: Um, [00:21:20] I'm obviously asking about sleep habits. So first thing I like to ask is, you know, is it easy for you to [00:21:25] fall asleep? Are you staying asleep through the night? You know, are you snoring heavily or has that changed [00:21:30] recently? And then, you know, it's great if they have a partner, they can, you know, give us that other piece of [00:21:35] information.
[00:21:35] Dr. Brandon Smith: Right. Yeah. It looks like they do look like they're choking in their own light. You know, it looks like they're-- stopped breathing for, [00:21:40] you know, seconds on, uh, uh. I'm worried about them when I see them sleep or, you know, they're sleeping in a [00:21:45] recliner because, again, laying flat, you know, they, they can't.
[00:21:47] Dr. Taz: Yeah.
[00:21:49] Dr. Brandon Smith: That person [00:21:50] obviously, yeah, needs a sleep study, yeah, before we decide to start giving them outside testosterone-
[00:21:54] Dr. Taz: [00:21:55] Yeah ...
[00:21:55] Dr. Brandon Smith: um, and see if we can't correct, you know, the reason for it. But, you know, there's so [00:22:00] many triggers for this and, you know, ninety something percent of testosterone deficiency is this, [00:22:05] the term is secondary hypogonadism,
[00:22:07] Dr. Taz: but just-
[00:22:07] Dr. Brandon Smith: Mm-hmm
[00:22:07] Dr. Brandon Smith: you know, it's not the problem with the [00:22:10] testes making the testosterone, it's the brain telling the testes to make the testosterone. That signal isn't [00:22:15] there because there's something getting in the way.
[00:22:17] Dr. Taz: Mm.
[00:22:17] Dr. Brandon Smith: So whether it's an infection, you know, if I [00:22:20] had COVID, my testosterone levels are gonna drop during that period.
[00:22:23] Dr. Brandon Smith: Uh, if I have, you know, chronic [00:22:25] conditions, so heart disease, kidney disease, diabetes, all those [00:22:30] conditions will add on top of each other and will push my levels down. So having, you know, any type of chronic condition [00:22:35] reversed. If I'm talking about, um, zinc deficiencies, probably a common [00:22:40] one. Uh, we'll see that occasionally, and that's pretty easy to correct.
[00:22:44] Dr. Brandon Smith: Uh, [00:22:45] but movement, you know, not sleeping enough, uh, stress levels just being really [00:22:50] high, which I find stress is to be the particularly hardest one to manage.
[00:22:53] Dr. Taz: It really is. I see so much high [00:22:55] cortisol and low testosterone, and then you're constantly like, "Okay, I'm gonna chase the [00:23:00] cortisol, but I know this person needs some testosterone too."
[00:23:02] Dr. Taz: And kind of again, that loop that I talk [00:23:05] about, like that cortisol loop getting stuck in there and trying to get somebody out of that. How do you handle that [00:23:10] patient?
[00:23:12] Dr. Brandon Smith: I mean, so stress, the hardest [00:23:15] piece of it is because it's outside our body. Mm-hmm. You know, our stress is coming from... Yeah. [00:23:20] I, I know you're my boss, but, you know-
[00:23:21] Dr. Brandon Smith: whether it's, you know, our boss or-
[00:23:23] Dr. Taz: From me. The stress is from [00:23:25] me. Yeah. It is. Yeah.
[00:23:27] Dr. Brandon Smith: Um, so whether it's, you know, coming from, you know, like a [00:23:30] work environment or- Yeah ... you know, a sick parent that they have to stay up and, you know, worry about or, you know, provide [00:23:35] for, all these other things come at us and, you know, at the end of the day, life, life happens and life [00:23:40] is going to happen.
[00:23:41] Dr. Brandon Smith: So there'll be periods where, you know, numbers are up and numbers are down based off of what type of [00:23:45] stress people are having. But figuring out, you know, when things get stressful, you know, what tools do I have to kind [00:23:50] of turn to? You know, if, if we're talking about stress as one of the main roots, you know, it might [00:23:55] be as simple as adding in, you know, a herb like ashwagandha to kind of help them.
[00:23:58] Dr. Brandon Smith: Ashwagandha. You know, it might be having them work on a [00:24:00] meditation practice. I just find all the, all the good stuff that we need, the [00:24:05] exercise as like a stress relief tool, the meditation, all the things that, you know, could [00:24:10] take five minutes to get a quick session in, you know, those are the things that we start to cut out when [00:24:15] things get stressful.
[00:24:15] Dr. Taz: Yeah. And they
[00:24:16] Dr. Brandon Smith: add- Those are the things we need the most.
[00:24:18] Dr. Taz: They... And even like little [00:24:20] small practices I think improve over time. When it comes to actually replacing [00:24:25] testosterone, do you like the shots? Do you like a cream? Do you like [00:24:30] Clomid? You know, what is your thought process there?
[00:24:34] Dr. Brandon Smith: [00:24:35] Um, I think everyone has their own strategy on this one.
[00:24:37] Dr. Brandon Smith: I mean, it, it's, it's very [00:24:40] personalized and it's very customized, and I like to kind of give patients almost like this multiple choice question in the [00:24:45] sense that, you know, working with them as a team, you know, my options are, "Hey, I think, you know, [00:24:50] this tool, this tool, and this tool are all good options for you."
[00:24:53] Dr. Brandon Smith: You know, if you're scared of needles, you know, I [00:24:55] think shots are off the table. Mm-hmm.
[00:24:58] Dr. Taz: You know, we should start with something else. Good
[00:24:59] Dr. Brandon Smith: point, yeah. Um, [00:25:00] so it's, it's just really customized in a sense, or maybe they have a kid and, you know, the cream isn't an [00:25:05] option. Or, you know, they're, you know, traveling so much that, you know, traveling with the cream and [00:25:10] applying it every day isn't an option, but, you know, there's a, a stable dose that they could do, you know, once a week.[00:25:15]
[00:25:15] Dr. Brandon Smith: Um, so it, it, it really depends. But, uh, what I like to do personally in my [00:25:20] practice is I- a Clomiphene challenge-
[00:25:23] Dr. Taz: Mm-hmm ...
[00:25:23] Dr. Brandon Smith: is what I like to give [00:25:25] guys. So I look and I'll see, you know, what their numbers are. So on the labs when I'm getting them, I'm looking at the LH and the [00:25:30] FSH to really see, you know, where the problem is.
[00:25:34] Dr. Brandon Smith: Is it with the brain? Is it with the [00:25:35] testes? You know, and kind of making that diagnosis on that first set of labs. [00:25:40] Trying to figure out something in their lifestyle that we can work on modifying. Mm-hmm. If, you know, they haven't been [00:25:45] exercising, try to get them to get some type of high intensity exercise once a week.
[00:25:48] Dr. Brandon Smith: If it's, you know, tackling the sleep, [00:25:50] you know, doing that for, you know, at least a period of two to three months and really making that one lifestyle [00:25:55] change a big priority. And if we can move that in the right direction and [00:26:00] we test and we see your testosterone is responding, you know, we'll just keep riding that wave in some [00:26:05] cases and see, you know, how high can we get your body to make your testosterone without adding any [00:26:10] prescriptions in at this point.
[00:26:11] Dr. Brandon Smith: If-
[00:26:11] Dr. Taz: I think that's the super exciting part about what we do, is that you can [00:26:15] see those levels go up with just making those changes.
[00:26:18] Dr. Brandon Smith: Yep. No, that's... I mean, [00:26:20] I've seen a guy, he, he had, I think levels were around like 300, and all we did was get his sleep in a [00:26:25] good spot. Mm. Now he's double, up to 600. You know,
[00:26:29] Dr. Taz: there, there's-
[00:26:29] Dr. Brandon Smith: Incredible
[00:26:29] Dr. Brandon Smith: it [00:26:30] depends on how bad the problem is for how much, you know, result you might get. [00:26:35] Um, so it's, it's interesting, uh, to really try to figure out- Do you have- ...
[00:26:38] Dr. Taz: what's, what's gonna work ... and not to put you
[00:26:39] Dr. Brandon Smith: on, [00:26:40]
[00:26:40] Dr. Taz: on the spot, but do you have a thought about testosterone pellets?
[00:26:44] Dr. Brandon Smith: [00:26:45] Um, uh, I don't personally, you know, prescribe or implant any pellets.
[00:26:49] Dr. Brandon Smith: I just find that [00:26:50] the-- So some people, I think that might work in the sense that if you put them in, the levels [00:26:55] change, you know, over like maybe they go out after three to six months. [00:27:00] Um, I kinda like having, you know, shorter term dosing- Yeah ... in the sense that [00:27:05] we can really fine-tune things. You know, technically, guys' hormone levels, you know, they fluctuate [00:27:10] over the 24-hour cycle instead of like the 28-day cycle like women.
[00:27:14] Dr. Brandon Smith: So it [00:27:15] will peak in the morning, it'll drop toward the afternoon. So the, uh, the topical [00:27:20] testosterone, putting it on in the morning, you know, letting it wash out or dissolve out of the blood, you know, throughout the [00:27:25] rest of the day, that's kind of the most physiologic, you know, way to replace the [00:27:30] testosterone.
[00:27:31] Dr. Brandon Smith: You know, putting it into the muscle or, you know, some guys do it in subcutaneous and it [00:27:35] trickling in slow, steady across the week, you know, their levels are up and they stay, you know, pretty high. They're not really [00:27:40] having a daily fluctuation. For the most part, it's more like a weekly fluctuation of, you know, they're [00:27:45] appreciating even, you know, a difference across the week.
[00:27:47] Dr. Brandon Smith: Um, but I mean, my first [00:27:50] part is trying to figure out, you know, is there something that we could change in their lifestyle, you know, to look and see what's going on? [00:27:55] You know, looking to see, you know, a stressor factor, can we support that in any way? You know, their [00:28:00] diet. You know, for the most part, it's, it's, it's an obesity and body composition-
[00:28:03] Dr. Taz: Man
[00:28:03] Dr. Brandon Smith: problem that we're seeing. You know, [00:28:05] so helping to build up muscle, decrease body fat, working on that body composition tends to favor [00:28:10] higher testosterone levels. Um, you know, working on improving or just prioritizing the sleep, even [00:28:15] as just setting like a nighttime alarm on your phone. You know, instead of setting your bedtime, you know, your morning time [00:28:20] alarm- Right
[00:28:20] Dr. Brandon Smith: to wake up, setting your bedtime alarm to go to sleep-
[00:28:23] Dr. Taz: Yeah ...
[00:28:23] Dr. Brandon Smith: you know, goes a long way to really make [00:28:25] it consistent. The body just loves consistency, and I think, you know, [00:28:30] that's why we're on a circadian rhythm and, you know, all these hormone cycles of, you know, cortisol and melatonin [00:28:35] for daytime sleep, then, you know, hunger hormones for when we wanna eat.
[00:28:38] Dr. Brandon Smith: You know, we're just always on this type of [00:28:40] cycle. Our body's so smart.
[00:28:41] Dr. Taz: It is so smart, but we do so much to it to throw it [00:28:45] off very quickly. You know, when we talk about muscle, uh, and, and [00:28:50] movement and its connection to testosterone, I know you have a big exercise [00:28:55] background. I know that you're pretty passionate about this stuff.
[00:28:58] Dr. Taz: Uh, tell the audience a little [00:29:00] bit about you and how you really landed maybe first into [00:29:05] integrative and holistic medicine, but then also the movement and the muscle health part and how that fits [00:29:10] into this story.
[00:29:11] Dr. Brandon Smith: Yep. So I grew up in Jackson, [00:29:15] Tennessee, and I went to Rhodes College. I kind of already knew that I wanted to go into med school at [00:29:20] that point, leaving high school.
[00:29:22] Dr. Brandon Smith: So I picked my school to [00:29:25] decide, you know, how can I get into med school, and that was where I landed. Got into- Yeah ... biochemistry and, [00:29:30] you know, really liked the cellular pathways, mechanisms, and, you know, understanding that piece. [00:29:35] Um, it was an interesting overlap where I joined a club. It was a [00:29:40] CrossFit club, uh, in my first year of college, and I was lucky that a [00:29:45] doctor from my hometown, he actually came in, he was a family medicine doctor, but he had just started [00:29:50] doing...
[00:29:50] Dr. Brandon Smith: Or I guess they've been doing CrossFit for a while. But, uh, Dr. Jeremy Draper, [00:29:55] he had- Mm ... uh, basically established a practice outside of his family [00:30:00] medicine group where he was, you know, I guess he was working as a family medicine physician, [00:30:05] prescribing blood pressure medications. You know, seeing people gain more weight, needing to prescribe more medications, and just [00:30:10] medication managing.
[00:30:11] Dr. Brandon Smith: Um, then he took a weekend class as a CrossFit [00:30:15] instructor and started to see people lose weight in the gym and making progress and coming off of blood pressure medications, [00:30:20] and it made him question the reality of why did I go through years of school and dedication and [00:30:25] training to prescribe the medications when I could take a weekend class, understand about exercise, and help [00:30:30] these people actually get healthy?
[00:30:31] Dr. Taz: Yeah. Yeah. Huge difference.
[00:30:33] Dr. Brandon Smith: Um, so, so I [00:30:35] got into CrossFit, started coaching eventually, and there were some really, like, interesting [00:30:40] parallels. Uh, one of the things that they talk about is, like, a health wellness spectrum. [00:30:45]
[00:30:45] Dr. Taz: Hmm.
[00:30:45] Dr. Brandon Smith: So the idea is, um, I guess I'm trying to see on my screen, [00:30:50] you know, if this is the low side, you know, someone that's sick, and this side, someone that's pretty healthy.[00:30:55]
[00:30:55] Dr. Brandon Smith: You know, you start out healthy. You know, over time, you know, maybe you get high blood pressure. Maybe [00:31:00] it goes on to develop, you know, some high cholesterol and some extra body weight, and then eventually [00:31:05] pre-diabetes. And then eventually, you know, you catch pneumonia- Lots of things ... and get sick, and now you're on this side of the spectrum.
[00:31:09] Dr. Brandon Smith: What can [00:31:10] we do to actually push people higher up that side of the scale? You know, the, the more healthier, the [00:31:15] less chronic conditions someone has, if they get sick, you know, the less far down it knocks them. It's a [00:31:20] conceptual idea.
[00:31:21] Dr. Taz: Yeah.
[00:31:21] Dr. Brandon Smith: But it made a lot of sense. Uh, you know, the more [00:31:25] muscle I have on my body, thinking about saving for retirement is what I talk about with patients.
[00:31:29] Dr. Brandon Smith: You know, it's like fighting gravity. Yeah, [00:31:30] yeah. Yeah. If I do my strength training, I can build up my bones, I can build up my muscle. If it's gonna decline over [00:31:35] age, I'm gonna have to work hard to keep it from dropping so fast. [00:31:40] So that's kinda the idea, you know, that's moving that person higher up that health spectrum, so when, you know, [00:31:45] they do fall, you know, maybe get injured, they don't lose as much muscle.
[00:31:48] Dr. Brandon Smith: Or if they lose the same amount of [00:31:50] muscle, they're not to the point where, you know, they're immobilized or can't get up and, you know, manage at home by [00:31:55] themselves.
[00:31:56] Dr. Taz: Do you think men today are good about building muscle and [00:32:00] being conscious of that? And is there a guideline you could give them, like, you know, [00:32:05] get in the gym X number of times a week for X amount of time, this is the right way [00:32:10] to do it?
[00:32:10] Dr. Taz: I mean, you see guys in there, right? Lifting super heavy weights. Some are in there [00:32:15] not really lifting, walking around a whole lot. Some are in there lifting super heavy, and they're l- [00:32:20] I feel like they're in there sometimes even twice a day. You know, what is, like, a good [00:32:25] realistic way for any guy, any age, to really begin to build [00:32:30] muscle?
[00:32:32] Dr. Brandon Smith: So I guess a c- couple different goals [00:32:35] with exercise. You know, I think I kinda break down movement into a couple of different pieces. I guess this [00:32:40] is just my framework with it.
[00:32:41] Dr. Taz: Mm-hmm.
[00:32:42] Dr. Brandon Smith: But movement, mainly I'm talking about how is someone [00:32:45] moving throughout the day? You know, the person that goes to the gym and they exercise in the morning, but then they sit down in their [00:32:50] office, you know, all day, 8:00 to 5:00.
[00:32:53] Dr. Brandon Smith: They finally get up, go home, you know, maybe they [00:32:55] put their head up and eat some lunch at their desk. You know, they're not really moving. They, they [00:33:00] exercised, but they didn't really move.
[00:33:01] Dr. Taz: Right.
[00:33:02] Dr. Brandon Smith: And then the other side I'll say is the person that's [00:33:05] moving, you know, maybe it's a stay-at-home mom taking care of the kids at home, someone that's working in retail on their feet all [00:33:10] day.
[00:33:10] Dr. Brandon Smith: That person's moving all day, but they're not making that time to actually exercise. [00:33:15] So that exercise is that window of opportunity for, you know, basically either working on [00:33:20] cardiovascular health, you know, getting their heart rate up, or building strength and muscle. [00:33:25] So as far as... You know, that's how I like to divide up that exercise piece, whether it's in the morning- [00:33:30]
[00:33:30] Dr. Taz: It's a good way to think about it, yeah.
[00:33:31] Dr. Taz: Yeah.
[00:33:32] Dr. Brandon Smith: Um, so as far as building up [00:33:35] muscle, you know, what I like for people to do is, you know, just as a simple guideline and framework is, you know, if you can [00:33:40] lift something heavy, that's the goal, you know? Heavy is relative. You know- Mm ... if I [00:33:45] can lift five pounds and it's, it's challenging, that's enough to build muscle.
[00:33:48] Dr. Brandon Smith: If I can lift five million [00:33:50] pounds or I need five million pounds to lift, so be it. Uh, I'm not worried about the [00:33:55] weight, the number, what the exercise even really is, as long as I'm moving it [00:34:00] safely, not getting hurt. And then when I say heavy, you know, the challenge is something 10 reps or [00:34:05] less. So if I can do something in that range that's a challenge, you know, it's not doing the [00:34:10] 20, 30 sets of the light weight, you know, and then sticking with that weight for 10 [00:34:15] years.
[00:34:15] Dr. Brandon Smith: You know, eventually my muscle's gonna be strong enough to- Right ... accomplish. I have to get heavier weight. [00:34:20]
[00:34:20] Dr. Taz: And just gradually work your... And is it a couple times a week you think, or how, how [00:34:25] often should they be in there?
[00:34:27] Dr. Brandon Smith: Kind of the, the minimum dose that I like to see people get, you [00:34:30] know, I always talk about things in doses and prescriptions.
[00:34:31] Dr. Brandon Smith: Mm-hmm. Supplements, exercise, prescriptions. Uh, you know, [00:34:35] I think that's important to really define for people. So, you know, two 30-minute sessions a week [00:34:40] is where I like to get people at a minimum. So, you know, this is the person that's starting on [00:34:45] GLP-1, you know, if we're talking about really trying to protect their muscle, you know, my minimum bar is I want you to [00:34:50] get at least two 30-minute sessions a week.
[00:34:52] Dr. Brandon Smith: You know, if it's doing 30 minutes upper body, 30 minutes lower [00:34:55] body to really focus on it or maybe, you know, 30 minutes full body and 30 minutes full body. [00:35:00] You know, that's, that's kind of my minimum goal for being able to maintain some muscle.
[00:35:04] Dr. Taz: I [00:35:05] mean, I feel like I could talk to you about so many different topics for-
[00:35:08] Dr. Taz: forever, and I know we're coming [00:35:10] close to time, but I... Can you kind of connect, and we probably need to do a [00:35:15] whole another session on GLP-1 and peptides and men's health and that stuff, but can you sort of connect [00:35:20] the starting of a GLP-1 with muscle [00:35:25] and with sort of just general testosterone, men's health, what your observation and philosophy [00:35:30] is?
[00:35:31] Dr. Brandon Smith: It's a catch-22.
[00:35:32] Dr. Taz: I know. And
[00:35:33] Dr. Brandon Smith: it, you know this I know.
[00:35:33] Dr. Taz: That's why I asked the [00:35:35] question. You know this.
[00:35:35] Dr. Brandon Smith: I know.
[00:35:35] Dr. Taz: I know. So...
[00:35:37] Dr. Brandon Smith: So it's, you know, the person that's [00:35:40] overweight, you know, wants to be in exercise, um, you know, maybe not seeing the progress that [00:35:45] they want on the body weight or the body composition, and coming in with low testosterone levels.[00:35:50]
[00:35:50] Dr. Brandon Smith: You know, the exercise is the thing that will, you know, hopefully help improve their body [00:35:55] composition but-- and also raise their testosterone. So, you know, that's the non-negotiable. [00:36:00] You know, whether it's at a point where, you know, they, "Look, I've been doing this for two years and I've not seen any [00:36:05] results.
[00:36:05] Dr. Brandon Smith: You know, I'm at the end of my rope and I, you know, don't think I can keep holding onto this. You know, we have to do something. [00:36:10] We need to change it." That person, you know, talk with them and kinda figure out if it's [00:36:15] appropriate, you know, prescribing them GLP-1 or-
[00:36:17] Dr. Taz: Oh, yeah ...
[00:36:18] Dr. Brandon Smith: even testosterone. [00:36:20] You know, I, I usually like to go one step at a time.
[00:36:23] Dr. Brandon Smith: Yeah. You know me, I, I, I like to try [00:36:25] to make it manageable and kinda bite-size- Yeah ... you know, steps and, you know, things to keep us on track [00:36:30] when there's so much stuff to look at. And in our space of whether it's labs [00:36:35] or their whole history, you know, at the end of the appointment, trying to narrow it down to one or two big changes that I think [00:36:40] is gonna push them in the right direction.
[00:36:42] Dr. Brandon Smith: You know, I kind of offer it up as, you know, do you think, you [00:36:45] know, testosterone seems to be more of a problem, or do you think it's, you know, is it your body weight that you think is holding [00:36:50] you back the most? You know, if they're having knee pain and, you know, I- I've got a reason to push them in a direction or [00:36:55] the other, you know, their body weight's causing their knees to ache after they get done working out, and if I can get their [00:37:00] body weight down, they'll be able to move better, and that'll help their testosterone.
[00:37:03] Dr. Brandon Smith: I might be biased to say, you know, [00:37:05] I think maybe GLP-1 first might be the right option.
[00:37:07] Dr. Taz: Hmm. Interesting.
[00:37:08] Dr. Brandon Smith: Or, you know, [00:37:10] my libido, my relationship with my wife, you know, is super bumming me out, and I don't feel [00:37:15] motivated to do anything. You know, exercise is really hard for me, but my joint's still fine. That [00:37:20] person might wanna start with testosterone.
[00:37:22] Dr. Brandon Smith: You know, both things I think are gonna improve their, you know, body [00:37:25] composition, their insulin resistance, uh, move the needle in the directions that we wanna [00:37:30] go, you know, one step at a time. But usually just picking one or the other. So, you know, [00:37:35] I think both help, but trying to figure out, you know, which is one-on-one- What to do first
[00:37:39] Dr. Brandon Smith: like which one [00:37:40] is the right option for them.
[00:37:42] Dr. Taz: You know, you, it brings us back to kinda where we started, [00:37:45] where I, I think men need a whole body, a [00:37:50] holistic approach, right? 'Cause they, there is so much out there. There's so many options, and what I [00:37:55] see a lot of men doing, you know, just when I'm eavesdropping or even if they're coming into our clinic, it's like, [00:38:00] you know, they'll ride a trend, and then they'll go order all this stuff, and they'll do all this, [00:38:05] you know, do all these things.
[00:38:06] Dr. Brandon Smith: For a couple months.
[00:38:07] Dr. Taz: But it might not be, like, the right [00:38:10] thing for them in terms of what their actual starting point is, and I think the only way to get this right [00:38:15] is to have a partner who can kinda be your sounding board. Well, like, w- even [00:38:20] if you took all our medical knowledge and dumped it out the door, but just someone to, like, [00:38:25] listen and be able to pinpoint, like, this is your biggest pain point.
[00:38:28] Dr. Taz: We need to start [00:38:30] here. You know, whether it's cortisol or muscle or energy or, or [00:38:35] testosterone, whatever it is, and then we're gonna move you through the rest of this plan. That's the [00:38:40] only way... You know, one of the big criticisms of our field is that there's just a lot to do, and there's so [00:38:45] much, and there's overwhelming.
[00:38:46] Dr. Taz: I think that only happens when, when you're not [00:38:50] able, you know, when you're in a relationship with a provider where you can't focus and kinda get, we [00:38:55] call it the core concept, right? Like, get to that, like, main idea and then build off that main [00:39:00] idea and keep creating a journey. So I think men need that honestly [00:39:05] just as much as women.
[00:39:06] Dr. Taz: So there's so much more I'd love to talk to you about. Like, we've [00:39:10] gone, we've gone past our time, which, but this has been an amazing conversation, and I really hope it [00:39:15] helps anyone listening, and I hope, you know, for, for any woman out there, you [00:39:20] send it to a man in your life because I think taking ownership of your health and being on the front end of it, the [00:39:25] earlier, the better.
[00:39:26] Dr. Taz: We're in an environment that's asking us to be more proactive with our [00:39:30] health, period. Dr. Smith, I know that you've got a fitness background, you've [00:39:35] got the integrative background, you've been seeing patients in our clinics at holplus. You know, what is [00:39:40] the one thing that you're the most excited about when it comes to our field, you [00:39:45] know, and you're thinking about men's health?
[00:39:46] Dr. Taz: What, what are you really excited about as you look forward? [00:39:50]
[00:39:50] Dr. Brandon Smith: I mean, I think just our practice. You know, I think the makings of [00:39:55] a good doctor, and I think you see this just through medical training, is like, you know, a good doctor asks the right [00:40:00] questions.
[00:40:00] Dr. Taz: Yeah.
[00:40:01] Dr. Brandon Smith: I, you know, am fortunate in the sense that, you know, our visits [00:40:05] aren't just eight minutes.
[00:40:05] Dr. Brandon Smith: You know, I get more time to ask more questions. So, you know, [00:40:10] maybe I'm not the best doctor, but at the end of the day, I get to ask more questions to be able to connect and find [00:40:15] those right pieces of information to link together to actually move people in the right [00:40:20] direction in line with their goals.
[00:40:21] Dr. Brandon Smith: You know, we talked about this, you know, talking about the evidence-based medicine- Yeah, [00:40:25] yeah ... or the patient preference, the knowledge that's coming from data research, and then our personal [00:40:30] experience in practicing. You know, putting it all together, you know, I don't think you get that just from like [00:40:35] an eight-minute visit.
[00:40:36] Dr. Taz: No. You know,
[00:40:36] Dr. Brandon Smith: or if you do, you know, it's, it's exceptionally, exceptionally difficult to [00:40:40] do that, you know, in the role of the doctor to kind of make the right question, get to the right answer, and fit it in [00:40:45] with the patient's values, you know, to move them in the right, yeah, direction. So [00:40:50] I, I don't know. I'm just excited working with patients.
[00:40:52] Dr. Brandon Smith: You know, no matter what the problem is that they're coming in with, coming up [00:40:55] with creative solutions. I feel like, you know, there's the cut and dry conventional where, you know, there's an [00:41:00] algorithm- Right ... and this is the right direction- Yeah, yeah,
[00:41:02] Dr. Taz: yeah ...
[00:41:02] Dr. Brandon Smith: and this is... And it's, it's [00:41:05] almost never that. You know, when patients come with us, we're in this, you know, fun space of actually talking about [00:41:10] diet, sleep, stress, and exercise, and whether they wanna do intermittent fasting or, you know, picking [00:41:15] another style of diet to work on moving them toward their goal.
[00:41:17] Dr. Brandon Smith: Like, you know, having that conversation with them and figuring out, you know, [00:41:20] okay, this is the parameters, where if that fits with your lifestyle, you know, perfect. 'Cause [00:41:25] this is a-
[00:41:25] Dr. Taz: I love- ... you know, it's their home ... I love that you answered, you answered with like the [00:41:30] practice of medicine and the relationship, not with like, "Oh, my gosh.
[00:41:33] Dr. Taz: Let me tell you all the biohacking- [00:41:35] Yeah ... tools that are coming up in the future." Yeah. I
[00:41:37] Dr. Brandon Smith: love
[00:41:37] Dr. Taz: that. Well- I think- Okay, go ahead ... I
[00:41:39] Dr. Brandon Smith: think [00:41:40] people, I think people that knew me, you know, would think, okay, I was, you know, into the biohacking space when that was, you know, very [00:41:45] trendy back when I was, you know, in college and- Yeah
[00:41:47] Dr. Brandon Smith: early in grad school. And, you know, it, [00:41:50] it's been around, but, you know, these like tried and true principles of diet, sleep, stress, and exercise aren't going [00:41:55] away- No ... you know, no matter whatever the latest fad is. No. So, you know, it needs to be sustainable, whatever [00:42:00] plan we come up with someone for.
[00:42:02] Dr. Taz: Amazing.
[00:42:03] Dr. Taz: Final question. Okay. [00:42:05] What makes you whole?
[00:42:07] Dr. Brandon Smith: Hmm. Um, I mean, I [00:42:10] think I, I think you know. My, my brain turns to fishing a lot, is my hobby. I'm [00:42:15] probably gonna go fishing after this. Amazing. So it's my time outside in nature and kind of my [00:42:20] crafting indoor hobby when it's not nice outside to be there. So just being outside in nature is [00:42:25] always a good way to make myself whole.
[00:42:28] Dr. Taz: I love that. Well, thank you so [00:42:30] much for taking time out of your day to join me on the show. And for everybody else [00:42:35] watching and listening. Dr. Smith does practice with us at holplus. And [00:42:40] remember, men's health needs attention in a different way than the conventional algorithms, [00:42:45] so please share this with the men that you love.
[00:42:47] Dr. Taz: And remember, we post new episodes every week. [00:42:50] We'll see you guys next time.
[00:42:51] Dr. Brandon Smith: Before you go, take a second to reflect on what stood out [00:42:55] for you today. Then, if you can,
[00:42:57] Dr. Taz: leave a quick review wherever you're listening. [00:43:00] It really helps other people discover holplus and start their own healing journey. [00:43:05] And don't forget to follow me on Instagram, @drtasmd.
[00:43:08] Dr. Taz: I love hearing how these [00:43:10] episodes are supporting you