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Colin Renaud, PA-C explains why so many men over 40 are told their testosterone is normal and still feel exhausted, foggy and flat. The lab reference range runs from roughly 300 to 1200, so a man at the bottom of it is inside the range and told he is fine. Normal and optimal are not the same thing. What testosterone actually does, the markers that usually go untested, what drives levels down in the first place, and why testosterone therapy alone often falls short when nothing underneath it changes. Plus live audience questions. Functional medicine for adults in Maine and New Hampshire.
Colin Renaud, PA-C explains why so many men over 40 are told their testosterone is normal and still feel exhausted, foggy and flat.
The lab reference range runs from roughly 300 to 1200. A man at the bottom of that range is inside it, so he is told he is fine. Normal and optimal are not the same thing, and one marker on its own does not describe what is happening. Colin walks through what testosterone actually does, the markers that usually go untested, what drives levels down in the first place, and why testosterone therapy alone often falls short when nothing underneath it changes.
In this episode:
Med Matrix is a functional medicine practice serving Maine and New Hampshire. Learn more at medmatrixusa.com
This episode is for educational purposes only and is not medical advice. It does not create a patient provider relationship. Always talk with your own qualified healthcare provider before starting, stopping or changing any treatment, medication or supplement.
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Today's super exciting. We're going to be diving into testosterone, the low testosterone crisis. A lot of men think they have low testosterone. A lot of men do have low testosterone. We help a lot of men kind of optimize their testosterone, kind of get back on track with their health. So we're gonna be talking about that. I'm joined here by the brilliant Colin Renard. Colin, why don't you talk about kind of your licenses, your experience with functional medicine and all that while we wait for friends to roll in here. Sure, yeah, thanks, Cole. I'm Colin Renard. I'm one of the lead clinicians at MedMatrix. I have a pretty unique background in functional medicine. I have a degree in chiropractic medicine. I'm board certified in natural medicine. I practice as a PA at MedMatrix, and I am fellowship trained in functional medicine and hold multiple board certifications, including in anti-aging medicine. So I've been practicing this healthcare for a little over 10 years now, and testosterone is kind of one of my bread and butter things. I do a lot of testosterone optimization with men and with women. We can talk about that during the podcast. This is both, both sexes can benefit. So this is a really exciting topic. As you said, this is a bit of a crisis. Men need this, and they're not getting it. So that's what we're here for, so. Yeah, super excited to dive into that extent today. So before we get going, just want to let everyone know, this is not medical advice. This is for educational purposes only. If you want medical advice, you're welcome to go to MedMatrixUSA.com, become a patient, and we can help you from there. Otherwise today, this is just for education and making you more empowered as a patient. So got some notes here. Low testosterone has become increasingly common concern, right? We're going to talk about that today as like what shifted in like day-to-day life and like why testosterone is more of a problem. And then also there's a lot of confusion around like testosterone clinics. Like if you're a guy over 40, odds are you've probably got an ad talking about like some TRT telehealth clinic that'll kind of fill out a form and then you get testosterone shipped to your door. So there's a lot of misconceptions in this space. A lot of people, a lot of consumers and patients are confused. They go to their doctor, they're told, you know, they look fine when they don't feel fine and their testosterone levels aren't optimal, but what does that even mean? So that's what we're going to be talking about today. So when we talk about low T, low testosterone, what are we actually referring to? What are we talking about? So to give a little bit of a definition, testosterone is the male dominant sex hormone. It's what distinguishes a biological male from biological females because biological males have more testosterone. Women do have testosterone as well, but secondary sexual characteristics of muscle mass and the way our voice sounds and facial hair, all that is from testosterone. So testosterone is what drives, like I said, sexual function and all kinds of things for men. So when we talk about low testosterone, we're referring to sort of the technical low being below a certain reference range on a lab, but we in functional medicine and at MedMatrix, we talk a lot about testosterone as being suboptimal where you can see symptoms in men and in women too, where the testosterone is not necessarily below that reference range on a lab, but it's like right there, right? It's a couple of points above or 25 points above the reference range. And as you said, Cole, very importantly, that a lot of guys, their doctors will tell them that they're normal when it's really not normal, right? Because a lot of men are experiencing symptoms of low testosterone when their labs are quote unquote normal. And it's about how much testosterone the body's producing. It's about how much is available to use in the cells. It's also how the patient is feeling, right? Are there symptoms there? Can we correlate this with a suboptimal testosterone? So really, really important for guys to understand because like you said, a lot of people are misinformed by their doctor about what testosterone really means for them. So it's really important, the conversation, yeah. Gotcha, so you mentioned testosterone in the cell. So a lot of people think of testosterone, they just think of like sex drive and muscles. So like what does testosterone actually do inside of the cell when you say that? So yeah, stereotypically, testosterone is looked at as sort of like the beefy dude in the gym that's like taking steroids kind of thing. But that's really not what this is about. Testosterone affects a lot of things just beyond sex drive. That's an important part, right? We want our patients to have a healthy and appropriate sex drive and libido. But also muscle mass is important, strength, energy. Testosterone is really important for a man's mood and also how he feels cognitively. I see a lot of men with low testosterone that have like anxiety, depression. They just don't feel like themselves. They feel really run down, really low mood. And also it's really, really important for bone density. Like I said, muscle metabolism, body composition. If a man has lower testosterone, then he will be more in like a fat deposition mode where body fat will more accumulate than muscle mass. So a lot of my male patients will say, yeah, I just like I'm working out so much, but I can't build muscle. Or I've got like this extra abdominal fat that just won't go away. So really, really important whole body hormone for muscle, for brain, for sexual function, longevity, anti-aging benefits. It's not just a sex hormone, yeah. Right. So why like is testosterone become such a hot topic now? Like you can't go to Instagram without seeing something about like testosterone or Facebook. But like three years ago, even a year ago, like that wasn't as much the case. Like why is this more of a problem now than ever? And then also like why are you kind of like seeing things about testosterone everywhere you go? It's a great question because it is more of a problem now than it has been because testosterone deficiency is becoming much more common in men at even younger ages because of things we're exposed to. You know, poor food, plastics, a lot of endocrine disruptors, fragrances, chemicals. We've done tons of podcasts on this topic and you know, I'm sure we'll do a lot more. So there is a lot more low T that we're seeing but this is I think such a hot topic because I think we've reached a great place in our culture where men are, and I'm gonna generalize here, but men are more comfortable now expressing their health concerns. Generations past, you know, my grandfather's age say, men didn't really talk about their health concerns or if they had depression or anxiety or something like that. A lot of it was just kind of held in but I think more men are talking about how they don't feel well. And I think the advent of social media is showing men, other men that are performing at really elite levels, athletes, celebrities. I mean, that's a whole different ballgame but basically seeing a person of similar age, their body is totally different, right? How they're performing is totally different. It's like, what's going on with me? Like, why am I not at that level or something similar? So there is a huge push for men to want better out of the way they feel. Their libido is low, they're not motivated, they're not recovering in the gym and they're just feeling like they're aging faster than they should. So hormone optimization and like online TRT clinics and social media have just made T a huge part of public conversation. And I think we do a great job at MedMatrix optimizing men's testosterone because we don't necessarily just focus on the hormone but we're focusing on the longevity of hormone replacement, what that means with nutrition and optimizing diet and optimizing other things that need to happen to make the testosterone be most successful for a man's health. So it's a whole body approach really. It's not just the hormone. Totally, yeah. So obviously, we haven't reached the point of medicine where you can be 25, 30 years old forever, right? So testosterone, like things are gonna decline as time goes on kind of regardless, right? But there's clearly more to it, like you're saying. Like you see some guys in their 40s, 50s and they're just as inactive as a guy in his 30s. Yeah, they're killing it, yeah. Yeah, so it's like clearly there's a lot more longevity than you're being told, especially when you're like feeling like crap going to your normal doctor and they're telling you you look fine. So I guess like as a longevity provider, like what do you feel like the difference between like normal aging is and like testosterone decline versus like actual low testosterone being like a dysfunction and a problem, if that makes sense? Yeah, so testosterone for men does decline with age. So when we look at this as the difference between normal aging and then true hormonal dysfunction, it's sort of very similar because about one to 2% of testosterone decreases in a man every year till we die over the age of like 35 to 40. That's just typical normal aging process of men, right? We can't live forever, maybe someday we'll figure that out but I think we'll all be long dead before that when they figure it out. So testosterone does shift with age but symptoms should not automatically be dismissed as like just getting older. And I think a lot of primary care providers or internists or just family practice, whatever you wanna call it are telling men and women too that you're just getting older and the functional medicine perspective and really how we do things at MedMatrix is to look at whether the testosterone is truly low or whether other types of testosterone aren't working well. Right, as I mentioned before, you have different biomarkers of testosterone, different types of testosterone that are being used in the bloodstream versus in the cells by the body, what root causes may be affecting the production of testosterone, the conversion, the utilization of testosterone. It's a really big picture approach and I think, like I said, most conventional practitioners just don't understand the nuances and it is really nuanced and it's not just about giving a man testosterone and okay, we're done, that's it. I mean, that's a big part of it but there's a lot more to it than that. So yeah, it's a great question. Yeah, we're gonna really get into all that today for those who are watching, joining us live. And something I wanna do is we're gonna do Q&A later guys for all of you who are live with us, thank you again. So if you have any questions, pop them into the comments. We love to make this as interactive as possible and if you're thinking it, someone else is probably thinking it too so there's no stupid questions. So drop them in the comments. We can't always get to all the questions but if you commented earlier, odds are we will be able to get to it. So pop stuff, just put in the comments. Okay, so we're gonna get into the root cause stuff earlier that you were just talking about but let's talk a little bit more about testosterone and like why it matters. So like obviously short-term performance, right? Like you wanna look good, you wanna like be muscular, you wanna have energy, you wanna motivation, you wanna sleep well, you wanna have like libido, all these like short-term things but like what about long-term too? You know what I mean? Like what happens when someone has low testosterone and they're only 40? Like what are the long-term benefits of kind of having optimal testosterone? Yeah, it's a great question. So as you said, it's not just about short-term. So what are the long-term benefits of testosterone? Why does it matter? I mean, it matters because testosterone plays a role really as an anti-aging molecule. It plays a role in muscle metabolism, bone health, sexual health, mood, insulin sensitivity, body composition. So if we look at how testosterone might impact a man day-to-day, right? Fatigue or sleep or sex drive or motivation, physical strength, all those things as you mentioned, the short-term, the immediate kind of short-term performance things are really important but if we can use testosterone as an anti-aging molecule that supports bone metabolism, heart health, brain health, muscle metabolism, there's a very strong link between low testosterone and metabolic dysfunction, aka like a patient could be diabetic or pre-diabetic where low or suboptimal testosterone might impact the blood sugar control. I see that every day in my male patients where we get the testosterone optimal and they're no longer pre-diabetic or their diabetes gets much better controlled. So if we look at it from that type of perspective, right? If I improve a man's testosterone, number one, he's feeling really good day-to-day which is really important but then if we improve his body's ability to regulate its blood sugar, he's no longer pre-diabetic, we could potentially add a decade onto his life. I mean, that's amazing, right? So that's really where we look at this from a long-term benefit as a longevity intervention and not just, well, I wanna have more sex. The sex is important, we're not denying that but I always educate my patients on the long-term longevity pieces because I think they might not recognize it when they come to the clinic as one of their goals but then when we start talking about it, it's like, oh yeah, I wanna live a lot longer but I wanna feel healthy when I'm living longer, not living longer and being unhealthy. So it kind of puts some perspective on how people can start living healthier in later years versus some of the standard way of our culture now is you get old and you end up in a nursing home or something like that and it's not a great quality of life in your last maybe decade or so of life. That's not the goal, so. Yeah, totally. Well, let's talk about quality of life for a second because you hear it all the time where, it's just in culture, it's almost like, oh, I'm just tired, I'm just in that midday crash, I'm on my fifth cup of coffee, oh, I only get three hours of sleep. People have kind of normalized feeling not great even at like, oh, I'm getting old, they're like 40 years old. So why is there a problem when all these patients are just normalizing, kind of feeling weak and tired or brain foggy all the time, you hear it all the time, like, oh, it's my brain fog, you know what I mean? Just kind of like making it like some joke, but why is that actually a problem? Unfortunately, as a culture, we have normalized feeling tired and weak and foggy and disconnected and I don't know why, to be totally honest. I don't live my life that way, I never really have. I just can't understand accepting like, oh, I'm gonna feel like crap for I guess the foreseeable future, oh well. Many men push through symptoms for years and assume it's just getting older and unfortunately, like I said before, in the conventional medical setting, a lot of times it's reinforced. Not always, we are very adamant at MedMatrix and on this podcast that we are not trying to shun our medical colleagues out in the world, they do amazing work, but for something like hormone health and optimizing longevity, a lot of times people are just told, well, you're getting older. Oh, you're in your 50s now, like it just kind of happens. And if patients are told that over and over, then they're gonna start to believe it and someone like me will come along and say, no, that's totally unacceptable, right? You're only in your 50s, you're only in your 40s, you could live another few decades plus and you're gonna just feel like crap, no, that's not fair. And then again, we start to see people in our culture in social media, television, movies who are older, right? These actors, actresses, celebrities that are in their 50s, 60s, 80s, beyond that are performing at very high levels. Well, how are they doing it? You know, what am I doing wrong? So many men push through symptoms, it's totally unacceptable and changes in libido, your mood, your fatigue, how your body recovers can be a sign that something is wrong. So it's really worth understanding better. And if your doctors are telling you you're just getting old, maybe you need a second opinion. Right? Yeah, well, I think most people kind of like, obviously they don't feel great, they felt better, they don't wanna feel that way. So a lot of them turn to like, again, it's like these like online medication places are like a dime a dozen now, it's like everywhere you go, like you can get hormones and weight loss drugs and like ED drugs, hair loss drugs, anything you want online now. Like, why is, I guess, because you know, like we've talked for someone who just joined us who's known nothing about testosterone, they might be like, oh, the solution's simple, let me just take testosterone and all my problems are fixed. And we're gonna talk more about that later, but like, why is testosterone not just something like they should just try to like hack on their own, go online, just like shoot themselves up with testosterone and like all their problems are solved. Why is that like kind of problematic? Yeah, I mean, trying to hack your own testosterone health is problematic because testosterone is not necessarily, it's very safe, like testosterone placement therapy is very safe, but it interacts with other things, it interacts with other hormones, it can interact with your blood count, it can affect your prostate, it can affect cardiovascular risk and mood and metabolism. So taking testosterone kind of on your own, without guidance, are you doing the dose right? Are you monitoring the other biomarkers that need appropriate monitoring on the therapy? Are you chasing something that may not even be the issue, right? So much social media now is trying to sell a product, trying to sell supplements, trying to sell some sort of like sex drive in a bottle. Like, okay, but you know, it's just not, health is just not that simple. There are so many parameters that health revolves around and that's why we pride ourselves at MedMatrix from a functional medicine perspective, where we do tons of blood work markers from the very beginning, lots of biomarkers to understand really what the root cause is, because if you're taking testosterone or hormone boosting products without proper evaluation, you could be creating a new problem or missing the whole problem altogether. So it's not my favorite thing to see guys succumbing to a lot of the social media advertising and these influencers trying to sell you their supplements and products and these people have no licenses, they have no real experience, they're just trying to sell something and it happens all the time. So, yeah. Yeah, okay. So what, I know we talked about this a little bit, but what symptoms should someone start to think of? I guess, when does it start? Because quality of life, that goes on a spectrum, right? And for those listening, we're transitioning more into solutions right now. By the way, I love the questions, guys. Keep them coming. Try to make them more specific. I see some questions in there that are kind of vague, so the more specific, the better. Not relating to you, we can't give medical advice, but statements are not really something we can work with. So yeah, where does the scale start? Because if someone can't even get out of bed, that's a lot more extreme than they wake up, they don't have a ton of energy. So where, in your clinical opinion, should someone start kind of getting, thinking about their testosterone levels and when their health is not optimal, if that kind of makes sense? Yeah, so men need to start considering getting their testosterone levels evaluated and thinking about hormone health when they start feeling off in any way. And to be totally honest, women are the same. Men, though, are really, really in tune with themselves much more than I think we think they are. When I see my male patients, my new male patients, and they'll come in, they'll say, I think there's something wrong with my testosterone. That's kind of like what their chief complaint is. And it's like, you're 100% right. And they'll talk about their low libido, they'll talk about erectile dysfunction, they'll talk about fatigue, or as I mentioned earlier, they're in the gym trying to work out, there's no muscle mass building, they still have a certain level of body fat that they're unhappy with. They're just not recovering, they're not motivated, they're feeling down, their mood is depressed, a lot of brain fog, a lot of sleep issues. So men are really great at just coming in and saying something is off and I think it's my hormones. Like, yeah, you're totally right. It happens all the time. And I think there's just this switch that starts to flip for guys. And they just, something happens and it's like, yeah, I just don't feel the same. You know, guys that have really physical lines of work or they're in the gym or something, and it's like, it's just not the same, right? The last couple of years, something's wrong. And the same thing happens with women too. I mean, testosterone is not just a male hormone, women have it too. And it's really important for women's health from a physical perspective, mental health, sexual health changes. Women will experience reduced sex drive and libido, difficulty achieving arousal, vaginal issues like dryness, energy issues, mood and cognition, physical changes in the way their body composition feels and muscle tone and strength. So a lot of it is the same with women. But because women have dominance with other hormones beyond testosterone, it sometimes is not as obvious for women that the testosterone is an issue, but it's often a part of the puzzle. So it makes women's health and women's hormones much more complex, but patients know. You know, with testosterone being the male dominant sex hormone, they just know. And when you feel it, you gotta express it. And like I said, if you are expressing it to your doctor and they're like, no, you're fine, or look, your testosterone's normal on the blood work, but if you look at it and it's only 15 points above the reference range of normal, you gotta find another doctor to get a better opinion on that. So, yeah. It's hard. So what are like, you see a lot of patients when it comes to a lot of these symptoms we're talking about. What are like some of those common root causes leading to lower testosterone, other than just aging? Like we know testosterone's gonna decrease kind of one to 2% per year after a certain age, but what are the causes that are like more in our control that you see kind of every day in your practice that are leading to this? Yeah, so some of the most common root causes of low testosterone are insulin resistance. So the body's inability to control its blood sugar, and this could be expressing itself as like prediabetes, or maybe the patient is already diabetic. Being obese, having a lot of fat around the midsection predisposes you to low testosterone. Poor sleep is a big one. Or like sleep conditions like sleep apnea, where you're not oxygenating well overnight. Being chronically stressed. The most common thing that I educate patients on all the time is alcohol use. Alcohol is probably one of the top issues for low testosterone. It basically poisons the body and reduces the testosterone. So alcohol's a big one. When guys are athletic in some way, you know, they're in the gym or they're training for something, overtraining is a big one where you can reduce your testosterone level because you're doing too much. We're also on the flip side of that under recovering. You know, you're working out seven days a week, you're not giving your body any time to rest. That's a big thing too. And then there are certain medications that can lower testosterone. Having issues with your thyroid. Nutritional deficiencies are big. So there's quite a few things that we try to look for. And like I said, that's really where we pride ourselves at MedMatrix is really looking at the whole picture because if you're not identifying some of these issues and you're just blasting testosterone, maybe it'll work a little bit for a little while, but it's certainly not going to give you a long-term answer and it's not going to give you the longevity and the benefits that we're looking for long-term. So that's the really important distinction there, yeah. Yeah, for sure. So you said something that I feel like deserves to be kind of unpacked a little bit, which is that like insulin resistance and belly fat can really affect your testosterone levels. Like on a scientific level and in simple terms, that's when non-medical can understand like how does insulin resistance and belly fat lower testosterone? So belly fat and insulin resistance affects testosterone because when you have metabolic dysfunction, which is basically the body's not able to regulate its blood sugar very well, which can lead to obesity, increase in belly fat, abdominal fat, what happens is is the visceral fat can interfere with hormone balance. So visceral fat's the fat around your organs, right? The fat around your organs, right. Fat around your organs and then also having like a lot of belly fat, like forgive me for saying this for people listening, like the dad bod, right? If you're bigger around the middle, right? Like a pudgy or belly. That type of fat in those areas can interfere with the hormone balance and also the metabolism of the hormone. It can cause a lot of inflammation in the body and it can also interfere with the testosterone's availability in the blood to interact with the cells. So this is why it's so important for low testosterone and metabolic health to be evaluated together. And as I've said earlier, and I've said this on this podcast so many times, low testosterone is 100% needs to be evaluated in any man or woman that has some sort of metabolic issue. Pre-diabetes, diabetes. I've had patients, male patients, that can't get their diabetes regulated on tons of medication. We get their testosterone going, totally fine. Things get better in months. So they're hugely connected, hugely important. So interesting. And then another thing that needs to be unpacked is, sorry, real quick before I ask this question. Awesome questions, guys, who are with us live. Thank you so much. I think we'll try to move into Q&A like maybe five or 10 minutes earlier just because it looks like we have an awesome interactive crowd with us. So if you want a question answered, we already have a ton on the list. Just make sure you ask it now because otherwise I don't know if we're gonna be able to get to all of them. But yeah, great work, guys. Love it when we have interactive crowds. So, okay, you said stress. And in today's world with your phones and jobs, social media and TV, there's so much stimulus around us and stress, right? So you said stress can be a big driver to lower testosterone levels. So first off, how do you know when stress has gone too far? Like it's not good stress anymore. This is actually stress that's like kind of ruined your health. And then once you unpack that, how does stress actually lower your testosterone levels? So how do we know when we've gone too far with stress? I think that most people don't know because they're not very intuitive, unfortunately. And I think we live in a 21st century culture, and also depending on where you live in the country, right? If you live in New York City versus say in the Midwest where the lifestyles are different, people are pushing themselves beyond their limits and they know it intuitively because they're not sleeping, they're stressed, they're trying to balance a very demanding job, a spouse, a home, children, and they're doing maybe all of it a little bit half, not holistically, they're kind of, but I think a lot of people are pushing it way beyond their limits, they're just totally ignoring it. And what will happen eventually is eventually they'll become a patient of mine or one of my colleagues at MedMatrix where they'll say, I am just running so out of gas, 100% out of gas, I just can't do it anymore. But the problem is they've been doing it for so long and they don't know how to undo it. And it's like, well, the way you live your life, all your responsibilities and how much you push yourself in a career or other things you have going on in your life is not optimizing your health. So we have to not only try to change the health part, but you might have to change your whole lifestyle, you might have to change the way you live. COVID did that, I think, very well because we started to learn what the value of balance looked like, people working from home, they weren't commuting to work every day. It's like, oh, I have all this extra time and time to myself. So I think that was a really positive part of the pandemic, but people do, I think, know when they're running out of gas they just don't know how to intervene on it. So stress is such a major player when it comes to hormones, it can affect your sleep, it can affect hormone signaling and cortisol and your inability to recover. So it's a hugely important part of a man or a woman's assessment for hormones because it may not just be the need for testosterone, but as I said, it may be like a whole system recovery or a whole system reboot or total redo of something. So it's widely important, yeah. That's really interesting. Yeah, and that's something that's not really talked about like in conventional medicine, right? Like they don't even address that. No, no, I mean, the way people live, like I said, it does depend on where you live in this country. There's certain cultures, whether it's big city life or suburbia or country versus urban or whatever, but people push themselves so hard and I think that's an American thing, right? We're kind of brought up to like, you gotta hustle, you gotta work, you gotta do it 100 hours a week and make all the money and have all the things. And it's like, oh boy, is it worth it? Sometimes, but how much does it affect your health or how much does it affect your ability to have a balanced stress life? And it's hard, so. Totally. Yeah, yeah, right. Finding balance. Yeah, no, 100%. And that's why we're actually gonna transition to that right now, which is kind of how conventional medicine treats these things, right? And like, it's a full picture, right? It's like not just one thing if you've learned anything so far, I hope. So like, where does conventional medicine often like fall short when men bring up like low testosterone? Because I think it's in a couple of different ways. Yeah, I think so too. Conventional healthcare can often fall short when men bring up their testosterone symptoms because nine times out of 10, I would say that men will, it's not that their conventional healthcare provider might not test the testosterone. That might happen, it does happen. But a lot of times, men will get their testosterone checked and that's the only thing they get checked, right? Just the total testosterone. There's other markers that need to be checked that are really important, but they're told that it's quote unquote normal. As I said, sort of at the beginning of the podcast, for example, testosterone on a lab range goes from 300 to 1200 on average. Depending on the lab, there's different, slightly different values. But if I'm a 47, 52 something year old male, you know, year old male, and I have symptoms of low testosterone and I'm bringing it up to my doctor and my doctor orders a total testosterone and my total testosterone is 320. But the cutoff is 300. But it goes all the way up to like 1000 or 1100. And my doctor says, oh look, it's normal, you're good. You know, sorry, have a nice day, see you next year. And that's it. And then men are, you know, it's like, well, my doctor said it's normal, so I guess it's normal, right? But like, I still don't feel good and whatever. So the problem here is that you're looking at one marker. You're looking at the marker from a quote unquote standard evaluation. You're not looking at optimal, you're looking at just normal. Is it in the quote unquote normal range? Conventional healthcare does not teach optimal versus normal. That's a functional medicine thing. That's what we do best. And oftentimes you're not being tested for really other important markers. Free testosterone, sex hormone binding globulin, metabolic health, insulin, thyroid. Like you said, no one's talking about your stress. No one's talking about your sleep. So that's where men are getting the short end of the stick from the conventional healthcare approach. It's kind of sad. Because then they might not know what else to do. If their doctors are saying you're normal, okay, well I guess I'm normal. So I guess I'll just live like this. They might not have the health literacy to know to keep asking questions. And you know? Yeah, hopefully now they do. Hopefully now they do, right. You said like one level, total testosterone. Can you talk about kind of the other important levels that you look at when evaluating a man's testosterone levels? Yeah, there's a lot of important labs that we look at to evaluate a man's testosterone. And women. We look at the total testosterone, which basically is a reflection of how much is floating around the bloodstream. We also look at something called free testosterone and bioavailable testosterone. Those are really, really important markers because those are the markers that the cells actually use. And there's a question I'm seeing that one of our listeners has asked to basically say that the free testosterone is most important, not the total. And I agree. These markers of how the body is using the testosterone is really, really important. So we also have to look at like estrogen or estradiol in a man. Men do have estrogen, even though it's the female dominant sex hormone. We have to look at markers of like sperm production and markers of insulin resistance and markers for the prostate. So it's a really whole person hormone evaluation, not just one marker. And that's where we differ at MedMatrix is we do all that stuff right from the beginning with every patient. And that's how we can really start to identify what's going on and start coming up with treatment plans right away. Gotcha. Yeah, totally. So, okay, kind of going off that, like what happens when, let's say someone gets testosterone online. They go to like one of these TRT clinics. I would just kind of give anyone TRT. Or they go to the normal doctor and they actually are slightly below and their doctor does prescribe them TRT. What can go wrong when like just testosterone is prescribed without addressing all the other root causes, insulin resistance, their thyroid, their guts, their vitamins, like all these other things you've been talking about? Yeah, it happens a lot. So it's not that things necessarily go wrong when TRT is prescribed without addressing root causes. It's just that the TRT is probably not going to give the man as much long-term or potential benefit as it could. A man may feel better temporarily, but still have insulin resistance, right? Still have poor sleep, still stressed to the max, inflamed, nutrient deficient, thyroid is not optimal, and there could be other lifestyle factors driving the problem. So TRT is not this sort of one size fits all fix for men. It is a tool that we use. I use the same analogy when we talk about the GLP-1 medications where, oh, I'm overweight, here's a GLP-1, okay, bye. No, it's a tool. There's a lot of other things that you have to address. One prime example of this in terms of TRT is if a man's nutrition is not in the right place, he's not getting enough protein, he's not getting enough nutrient-dense foods with vitamin B12, iron, vitamin D, there's going to be a suboptimal utilization of that testosterone. You really need stuff like good nutrition, good levels of protein to support the testosterone and what it's doing to the body. So the online clinics, as you said, they're popping up all over the place. They're not doing all this extra work. They're just giving you tea and sending you on your way. Patients, I have a lot of patients that have done that and they're really unimpressed because they really want the support. They really want to understand all the parameters so that they can utilize this tool for the future and for their future health and longevity. So it's an important point, yeah. Totally. Yeah, so let's shift into kind of like how we approach men's health with functional medicine. So you talked about some, but I think we scratched the surface here. What are the other lab markers that you're really looking at when evaluating a man's health and men's testosterone levels? Yeah, so there's a lot of lab markers that should be evaluated before considering TRT. Obviously, all the testosterone markers we mentioned, the total testosterone, free testosterone, sex hormone binding globulin, or SHBG, which is essentially a protein in the blood that attaches to testosterone and renders it inactive. So what it can look like is your total testosterone may look normal, but this sex hormone binding globulin is like deactivating that. So something like a free testosterone or a bioavailable testosterone, which is what the cells will actually use, is very low. So widely important to understand those parameters. Looking at, like I said, estradiol, which is estrogen that plays a huge role in testosterone and also monitoring on testosterone therapy. We wanna look at the thyroid markers because that affects testosterone. We wanna look at stuff like glucose and insulin, which is where we're getting our metabolic dysfunction and blood sugar issues. A1c, which is a diabetes marker. And also things like cholesterol and inflammatory markers, as well as blood counts. Testosterone can affect your red blood cell counts. It can also affect the size of your prostate over many, many years, so we check prostate markers. The whole hormone and metabolic biomarker pathway that we're looking at. And not just that, we're also looking at the body composition. That's a hugely important thing, too. When guys can see on paper that their body mass is changing, I mean, they feel it, but it's like, oh, you've lost 6% body fat in six months. Like, holy crap, that's amazing. So it's really cool to start seeing some of those objective changes for guys, too. And we monitor all that standard as a standard at MedMatrix with all our patients. Totally. Yeah, let's talk about the one that's, the marker that's come up a couple times in this conversation, which is total testosterone. So like, what's the difference between free and total, and why is total kind of the more important number? Yeah, free testosterone is so important when we talk about testosterone optimization and testosterone health. Because total testosterone, as I mentioned, just illustrates the overall amount of testosterone in the blood. But free testosterone helps show us what is available for the body's cells to use. So a man may have a total testosterone that looks fairly normal. Maybe it's like 450, maybe it's 500. It's fairly acceptable. But he has symptoms of low T. So if he goes to his doctor, and his doctor runs his total testosterone, and it's 500 or 450, or it's somewhat acceptable, nope, you don't have low T, you're good. Oh, but I have all the symptoms. No, no, you're good, bye. So if they're not checking these other markers, you could still have low available testosterone for your body to actually use, which could depend on, like I said, the SHBG, that sort of binding protein that will render the testosterone more ineffective. Estrogen, which plays a role. So the total testosterone is kind of a guide for treatment, but it's not the most important marker, essentially, for an evaluation, yeah. Totally, it makes sense. So here's the kind of golden question is, when patients come to MedMatrix, like we're not the type of clinic that's just gonna put anyone on testosterone. Like it actually has to make sense. So like when you look at a patient that's like, okay, this is someone who there's a better root cause solution maybe, or maybe root cause isn't the right word for this, but there's something else that's causing low testosterone and this person might not necessarily need testosterone replacement therapy, versus someone who kind of might need testosterone replacement therapy and they're gonna benefit from it for the rest of their life. How do you kind of distinguish between those two patients? Yeah, so how do we decide whether a man needs TRT or actually just more like root cause support or potentially both? And it really is very, very depending on the man and the objectives of the man. So it depends on his symptoms. It depends on laboratory values. Age is a big one. So if I have a man that's say 27 with low testosterone, it's like, well, is it really a 27? I mean, I am seeing low testosterone in younger men as my career progresses, because as I said at the beginning of the podcast, there are so many things that are affecting testosterone levels and hormone levels in both men and women. We're exposed to so many things in the environment that's affecting our hormones younger and younger. So it is getting worse, but we also have to consider fertility, if the man's in his early 30s or something, is he trying to have children? Is that gonna affect things? What does the medical history look like? That's a big thing. If a man is say 29, 30, but he's morbidly obese, eats terribly, doesn't work out, right? Has nutritional deficiencies, very, very sedentary. I mean, he's probably gonna have low testosterone, but am I gonna put him on testosterone? Well, no, not that I wouldn't ever, but listen, dude, we gotta totally alter your lifestyle, right? If you're 100 pounds overweight, if you're horribly inactive, we gotta fix that, right? That's really where the important part is. So some men need TRT, some men need foundational support first, but a lot of times men need both. For a lot of our patients at MedMatrix that are guys in their 50s, 60s, they're trying really hard, but there's that natural decline with age, but they also need to lose weight, then it becomes a discussion of, okay, you have hormone deficiency likely related to age, but likely related to your lifestyle, so we gotta do both or this is not gonna work. So there's a lot of different variables there. Yeah, really important question, yeah. Totally, okay, yeah, great answer. So, all right, one last question here. Then we're gonna move into a case study, then we're gonna do Q&A. So, last question is, let's see, I have it written down here. Oh, just like with, like how, like walk me through what it would look like for a patient, like if they wanna help with MedMatrix, like what does that look like? Like from patient comes in, patient sees you, kind of like what things are you looking at in the plan and then what does that kind of like follow-up care look like? Yeah, so when a man comes to MedMatrix and he has symptoms, say, of low testosterone or just a concern, any type of concern, the process really begins with a full medical intake symptom review. We go through a very in-depth health history, medication review, hormone history. Has he been on hormones before? Is this something he knows anything about? We assess lifestyle and that includes diet, exercise. Do you drink alcohol? Do you smoke? Do you work out? How do you sleep? What's your stress? We do that for every patient right from the beginning. We do a full, like I said, diet nutrition review. We discuss our body composition because again, as a new patient at MedMatrix, you're getting a full body composition on day one when you get your labs drawn. So we have information about how much muscle mass you have, how much visceral fat you have, your body fat percentage. And then we do a full comprehensive lab evaluation with over 80 biomarkers, which include all the testosterone markers and hormone markers that we've talked about, but also full look at thyroid, cholesterol, inflammation markers, metabolic markers. So that's really where the process begins. And during the first visit, we have a very in-depth conversation about what the treatment plan short-term and long-term needs to look like around potential hormone replacement, foundational support, lifestyle support. All those things are addressed right away. Great, and then what is like the plan and then follow-up look like after that? What are you looking for? So plans and follow-ups, it depends. So plans and follow-ups can be really dependent on what the man needs. But typically, and again, I'm not trying to give medical advice here, but typically when we start hormone replacement, we wanna give it a few months to see how it's working. And then we would reevaluate labs after that to see if we're in the right place. Are the hormone levels coming up? Are our blood sugar numbers coming down? We check in, how are you feeling, right? Talk about symptoms, talk about the chief concerns. Are they getting better? Do you have any concerns? What's good, what's bad? So we gotta give the hormones a little time. I always educate both men and women when we do hormone replacement that full effects of hormone replacement can take up to three to six months to get the full effects, maybe even longer. But men and women, when they start hormone replacement, whether it's with testosterone or for women, it's other hormones, you will start to notice some things after the first few weeks. But I wanna make sure that my patients have their expectations in line with what's appropriate for their treatment. Totally, and then what are some of the most important things you're looking up on the follow-up labs and follow-up visits with these patients? Yeah, on follow-up labs, we're looking for is the testosterone getting better? Is it in a good physiological range, in a range that is optimal? Are there issues with estrogen becoming too high, which can happen on testosterone therapy, but not very often because we don't dose to places where that usually happens. We're looking at red blood cell counts because testosterone can, over time, increase your red blood cell count, which we have to monitor and treat accordingly. We're also looking at markers of the prostate. Again, testosterone can have an effect on the prostate. The literature says that testosterone replacement therapy does not cause cancer of the prostate, but over many, many years, it could increase the size slightly, so we monitor all of that. And then monitor the subjective of the patient. How do they feel? What are you noticing? Are you noticing any issues, concerns? Are you having issues with how you administer it? How's that going? So it's a really deep dive in the treatment. Totally, great. All right, let's do a case study, and then we'll answer questions. Okay, so case study that I had, and I'll try to make this quick because we have a lot of questions. A case that I had maybe three or four months ago now of a man that was having all the classic symptoms of, this sort of goes with what I've said throughout the whole podcast, but it actually happens. So he was, or he is, early 40s, I think, 43, something like that, had been to his primary doctor over concerns about, he's got a physical job, works in construction. And like I said to you early, Cole, it's the guy's just like, no, something's not right. My performance at work has declined. That was sort of his chief concern. It's like, well, what does that mean? Well, I just, I'm in construction. I've gotta be strong. I've gotta move stuff all day. I could fall asleep by like three o'clock in the afternoon. It's just not me. Okay, he's basically saying my testosterone, something's wrong, my testosterone. So he went to his doctor. His testosterone measured at his doctor's office because he shared the results with me. I think we're 500 and something, they were in the 500s, but it was just a total testosterone like we talked about a few minutes ago. So his doctor dismissed him. Nope, you're fine. So he pushed back a little bit, rightfully so. So he got an appointment with a urologist who will often manage testosterone for men. That's a very appropriate specialist who would manage testosterone for men. Maybe, that's part of what they do. Same thing, nope, you're fine. But it was again, they repeated it. I think this was like three or six months later, repeated the total testosterone, still in the 500s. No, no, you're fine. Mm, mm, nope, I don't feel fine. Something's wrong, whatever. So when he came to see me a few months after that, when I did his blood work, same thing. Total testosterone was almost the same as what it had been with those other providers. But the other markers we've been talking about, his free testosterone, his bioavailable testosterone was super low because his sex hormone binding globulin was on the higher side. And that protein, which we talked about, does increase with age. So we started him as like a trial. It's like, okay, your testosterone's technically normal, but these other markers are suboptimal. So we're gonna use this as a trial for three to six months on testosterone replacement to see if it helps with your symptoms. And of course it did. So that was that. Yeah. Okay, so what did he start, what happened? It was within like two weeks. It was like, yeah, I'm back to myself at work. I'm actually stronger in the gym. I'm feeling like I can do my full day of work on the job site and then go to the gym after. And it's funny because when men and women start certain treatment, especially hormone replacement, they'll comment to us all the time and say, I had no idea I was feeling X, insert whatever. And a lot of people will say, oh my gosh, since I started that, my brain fog is better or my memory's a lot better or I'm cruising at work. I get all my emails done and I never have the word finding issue and I'm playing with my kids and my sex life's better. And they don't often equate some of these other symptoms that they have as being part of the problem. But then when we start normalizing everything, it's like, oh crap, yeah, I didn't realize that my headaches are better or I sleep so good now. So there's all these trickle down effects that will happen, it's really cool. So great patient, I still see him. Yeah, he's a great guy. Yeah, I love hearing the patient stories every time. Yeah, he's really great. Yeah, let's get right to it. Let's try to knock out as many of these questions as we can. And then guys, if you hear us answer your question, you have a follow up, try to do it quick because I don't know. We have another seven minutes, so let's waste no time. So are there any concerning side effects of getting TRT? There we go. Yes. Should I say what those are? Again, this is not medical advice, but there are some concerning side effects you do have to monitor for if the testosterone gets too high. It can affect estrogen levels, it can affect red blood cell counts, it can affect the prostate over time. So again, when men and women are on any type of hormone replacement, we do appropriate laboratory monitoring at least three or four times a year, depending on the patient to make sure things stay really stable. So that's, yeah. But in terms of like a side effect, sometimes men will feel a little bit headachy at first, maybe like a little angry. Not very common though, because we do not overdose on men to start. We start at more like a mild to moderate and increase from there. So it's very unusual to have really strong side effects, at least for us anyway, or for me, that's my style. Okay. I'm 75 going on 76. I have no diabetes and my blood pressure is quite normal. By the way, I walk three to four miles every day, but libido is so down. Should I be worried? And then also if you can dive into just like this gentleman's age, because I do know we have some patients who are in that age range and older. If you could talk about testosterone at that age as well, that would be pretty cool. Testosterone is appropriate for any man. Well, no, take that back. Testosterone is appropriate for men as they age up until they die, essentially. I have men in their eighties on testosterone. It is not contraindicated with age. There is no medical study nor any type of literature or evidence to say that testosterone is contraindicated or unsafe in older men over the age of like 70, 80. It's quite the opposite actually. Testosterone has protective benefits for men, for their bone health, their muscle mass, their brain, their heart. So testosterone optimization should be given to all men as they age. So they're being protected from these things. So in this particular instance, libido is down, should I be worried? Well, worried is I think a strong word, but with libido is down, it could be a sign that hormone optimization is a problem. So I would get it examined, yeah. How is TRT administered, question mark, injections or weekly? So TRT is administered in multiple ways for guys. Some of the most common ways are injections into the muscle, so like into the top of your thighs, or if you have a spouse at home that wants to learn how to inject you, you can do the side of the shoulder and the deltoid muscle. I don't recommend injections into the upper part of the butt because you have a lot of nerve endings there, like the sciatic nerve that runs down the back of your leg that innervates your entire leg. And if you're not skilled enough with injections, you might cause a little irritation there. So it's not my favorite spot. So usually I prefer the top of the thigh or the outer arm. You can also use testosterone topically. In my clinical experience, it doesn't work as well as the injectable because when you inject into the muscle, you get a lot of metabolism of the hormone in the muscle versus if you use it topically, it has to absorb through the skin and all of that. But topical is an option. I do have some guys that are totally needle phobic and they're like, absolutely not. Topical testosterone is administered daily. Intramuscular injections should be administered twice a week. Once a week is very old school. For people that are listening, for people that have had testosterone, once a week is acceptable. It's very old school. The hormone only lasts about four days in the body. So if you're injecting it once a week, you will dip after like four or five days. You don't want any dips. That's why we do twice a week. That's preferred. My testosterone, oh, yeah. I mentioned this was what I was talking about earlier. Yeah, Dr. Florence Coleman, a renowned endocrinologist thinks that free testosterone is the most important, not total or SHBG. I agree. So I commented on this earlier. I sort of answered your question, Ray, earlier, that free testosterone is what the body is actually using. And if you don't measure that, you could be under appreciating a low testosterone or sub testosterone in a male. Because if their total testosterone is normal or within normal range, but the free is low, then you have a suboptimal testosterone picture there. So I agree. Very important. Great. Here's a fun one. I have a question. As a teenager, how could I ask my doctor about testosterone or figure out if I have low testosterone and how could I raise it as well? So as a teenager, probably doctors are gonna be very not inclined to check testosterone because it would be very unusual to have low testosterone in teenage years. But as we've talked a lot about on this episode, a lot of things can affect low testosterone. So if there's weight issues, poor diet, a lot of abdominal fat, low physical activity, all those things, a lot of alcohol consumption, those are all gonna affect testosterone significantly. So you could certainly ask your doctor about it. They may or may not check it due to your age. But some of those lifestyle factors are probably affecting things if those are applicable. So that's a good question. If you're 18 or over, we can see a med matrix. Otherwise, there are some primary cares or maybe naturopathic doctors in your area that could help you out. Yeah. If you can apply this to men as well. There's a common question we totally skipped over, so. For women on TRT, well, I talked a little bit about women, but for women on TRT, can you find something to go? If you take testosterone, one of the biggest complaints about testosterone is if I take it, I'm gonna have to take it for the rest of my life. Oh, right, sorry, Cole. Yeah, I get what you're saying. Yeah, so for women on TRT, can your body stop making natural testosterone? So I'll just use this as a blanket statement for both men and women. So when you are on testosterone placement therapy, yes, the body will stop making a certain amount of testosterone naturally. So, but what I always try to educate patients on, especially men, on testosterone therapy is if your testosterone is low and it's like objectively low on a lab, then your body has stopped making enough of it to sustain your body's need. So while the testosterone replacement might reduce the natural testosterone production, your body's not making enough to keep you in good shape. So that's kind of my workaround for that. It's like, well, yes, but it's not making enough anyway. So, you know, that's really where we try to educate on that, yeah. Good question. Hormone shots to kill testosterone during radiation treatment. Now PSA level is zero. Need testosterone again, question mark. I don't really know what this is asking. I think he was on, it sounds like maybe he had radiation treatment for prostate cancer. Yeah, PSA level is now low. There's a lot of variables with this. If a male patient has had an undetectable PSA for I think it's five years post-prostatectomy or if there's just been radiation treatment. If there's just been radiation and not a removal of the prostate, most of the time testosterone therapy is not given if there's been prostate cancer. If there's been prostate cancer and the prostate was fully removed and there's been no PSA jumps in about five years, then it can be considered. But prior cancer history is very tricky, unfortunately. Prostate, testosterone does not feed prostate cancer or it does not cause prostate cancer, but there's a thought that it could potentially make it worse if it's already there. Since you mentioned alcohol, how much is too much? I have a can of beer, Guinness, really occasionally maybe once a week. So this is a very interesting question I get asked all the time. My honest answer is alcohol of any amount is highly poisonous to the body. One of the number one carcinogens that humans ingest is alcohol. It's one of the number one cancer-causing agents that we consume. So everything in moderation, I don't know. I don't necessarily agree with that, but if a patient has alcohol once a week and they have low testosterone, it might be something to consider reducing. It's a very case-by-case answer, yeah. It does affect testosterone, but how much is too much, that's subjective. Oh, still there? There we go. Yeah, I'm here. Okay, so this question was asked by the same guy who asked about the prostate. So maybe talk about how do you get testosterone level? Because it sounds like this may have affected his libido. So what are ways to get testosterone up more naturally without TRT directly if he didn't get his prostate? Yeah, so if there's a history of prostate cancer and testosterone cannot be initiated, then we're doing all the other things. We're talking about diet, we're talking about stress, sleep, alcohol consumption, proper nutrients like vitamin D, zinc, magnesium, really, really important to optimize testosterone levels. There's certain foods that can optimize testosterone. So we're doing all that diet and lifestyle work, which can help a good bit for sure. A question from Instagram. I'm taking testosterone, I am a female. I was very low and seem to be increasing my number, but when do you feel optimal? I do feel better. I'm low in minerals and vitamins, working on T, so. I think still working on that. Working on the testosterone, yeah. So like I said before, hormone replacement can take many months to feel optimal. To feel better, but if there's, for a female, testosterone is just a part of the picture. So most of the time for a female, there might be issues with progesterone and or estrogen and or the thyroid. So if it's just testosterone by itself, maybe there's something missing. If there's low levels of vitamins and minerals, that's another piece that's missing, foundational support that's really important. So that's definitely gotta be in there too. Female hormone health is much more trickier and complicated than men's, unfortunately. There's a lot more moving pieces. So there's probably other things to consider here that need to be worked on. Yeah. Yeah. Yeah, what causes high sex hormone binding globulin? So as I said, sex hormone binding globulin is a protein in the body that can basically render testosterone ineffective. So age is the number one cause of elevated sex hormone binding globulin, but also if the estrogen is too high, if there's thyroid issues, specifically hyperthyroidism, where the thyroid is overactive, liver disease is a big one, and then also extreme caloric restriction. So people that might do like fad dieting or they're trying to lose weight, so they're eating like 500 calories a day or less. So those are the most common things I see with that. A lot most often related to age though. Okay, sweet. I will give Rick one more question because he was great. Hi, Rick. So can I bring my testosterone level up again after radiation therapy where PSA is zero now? So like Cole was saying, it depends really on the oncology team and the urologist. If there was not a prostate removal, if there was radiation, excuse me, and the prostate is still there, it'd be very hard to get a clinician to prescribe you testosterone therapy. It's a little bit of a no-no, even though the PSA is zero. So to bring up the testosterone level would be working on all the other parameters of trying to increase testosterone around diet, lifestyle, physical activity, nutrition, all of that really important. That's how I would do it, yeah. Great, awesome. Yeah. All right, Colin, what should people do if they suspect they might have low testosterone and they live in Maine or New Hampshire? Yeah, so if you're in our neck of the woods and you're listening and you have questions about your testosterone, if you're a man or a woman, you can reach out to MedMatrix. Like Cole was saying, we do really comprehensive work with patients from the get-go. We test over 80 biomarkers right at the beginning, including all the testosterone markers that we've talked about. We do a full comprehensive health evaluation, talk about all the parameters of your life, your stress, your nutrition, your sleep, everything. And we really are trying to understand how we can fit something like hormone replacement into a treatment plan if appropriate. Of course, that's the key. So, yeah, that's my best takeaway. And low testosterone is real and it shouldn't be guessed. It should be treated. You know, it's not a one-size-fits-all protocol. It's evaluating symptoms, labs, root causes, and really understanding how it can be utilized as a tool for a man and a woman in appropriate cases to feel better. So, yeah. Fantastic. Awesome, Cole. Thank you so much for your time. Thank you, everyone, for joining. You guys were a wonderful crowd. And, yeah, we'll see you, I think, Tuesday is the next time we go live. All right, bye, everyone. Thanks, Cole. Bye.