43. Tracy Gapin, MD: Why Men Today Have HALF the Testosterone of Their Fathers

What if the symptoms you've been chalking up to aging, low energy, brain fog, stubborn belly fat, and lack of motivation, were actually signs of a deeper hormonal imbalance? The truth is, testosterone levels in men have been plummeting for decades, and it's not just about aging. Environmental toxins, chronic stress, poor sleep, and nutrient deficiencies are creating a perfect storm for hormonal disruption, affecting not only performance but long-term health and longevity. In today's episode, I sat down with Dr. Tracy Gapin, a board-certified urologist and expert in men's health optimization, to break down the science of testosterone, hormone balance, and high-performance living. We dive into why traditional medicine is failing men, how environmental toxins are silently crushing testosterone levels across generations, and the critical role of biomarker testing in personalizing health strategies. Dr. Tracy Gapin is a board-certified urologist with 23 years of clinical experience in men's health, functional medicine, and longevity. As the founder of the Gapin Institute and author of Male 2.0, he specializes in precision health, leveraging genetics, epigenetics, and advanced diagnostics to optimize performance and extend healthspan. We Also Discuss: 00:00 - Introduction to Men's Health and Hormones 02:15 - Significance of Testosterone in Men's Health 05:30 - Limitations of Traditional Healthcare in Addressing Men's Health Issues 08:45 - Understanding Underlying Reasons for Health Concerns 12:00 - Comprehensive Biomarker Testing for Health Optimization 15:20 - Impact of Lifestyle Factors (Nutrition, Stress) on Hormone Levels 18:35 - Effects of Environmental Toxins on Testosterone Levels and Overall Health 22:10 - Distinction Between Total Testosterone and Free Testosterone 25:45 - Relevance of Testosterone for Both Men and Women 29:00 - Various Methods of Testosterone Therapy (Injectable, Topical, Pellets) 32:30 - Management and Necessity of Regular Testing in Hormone Therapy 35:50 - Personalized Approaches to Hormone Therapy Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram: https://www.instagram.com/darshanshahmd/ Learn more about Dr. Tracy Gapin: Website: https://drtracygapin.com/ https://gapininstitute.com/start-here-gapin/ https://drtracygapin.com/ Instagram: https://www.instagram.com/drtracygapin/ Thank You To Our Sponsors: Deliverance: Give your liver the care it deserves! Deliverance is a powerful plant-based formula designed to support and restore liver health. Get 10% off your first order with code DRSHAH at loveyourliver.com https://loveyourliver.com Timeline: Upgrade your energy from within! Timeline helps power up your cells, supporting muscle strength, mental clarity, and overall vitality. Stay active, sharp, and strong at any age! Claim 10% off your first order now at timeline.com/DrShah http://timeline.com/DrShah

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 0:49Dr. Darshan Shah?

  What if fatigue, brain fog, stubborn belly fat, lack of motivation, all of these things that you've been blaming on aging were really signs of something deeper, like hormonal imbalances? The reality is testosterone levels in men and women have been steadily declining for decades in our population, and it's not because we're just getting older. Environmental toxins, stress, poor sleep, nutrient deficiencies are all causing a steady decline in men's and women's testosterone levels over time. And these disrupted hormones are impacting everything from our energy metabolism to our long-term health. In today's episode, I'm going to be sitting down with Dr. Jason Gapin. He's a board-certified urologist, and he's dedicated his life to helping men and women optimize their health

• 1:34Dr. Darshan Shah?

  and to unpack the science of testosterone, hormone balance, and high-performance living. We're going to talk and really break down why traditional medicine is really failing men, and how hormone levels, which are reported as normal, are really suboptimal. Biomarker testing is the key, and really understanding what an optimal level is, is what we're going to be talking about today. Dr. Gapin has spent 23 years helping men take back control of their health. He's the founder of the Gapin Institute, author of Male 2.0, and a pioneer in precision health using genetics, epigenetics, and cutting-edge diagnostics to help men optimize their longevity.

• 2:10Dr. Darshan Shah?

  Episode is important mainly for men, but also women should hear it, especially if you are living with a man or have a significant other that is struggling or could potentially be struggling with hormonal imbalance. It's starting earlier and earlier in a man's life now. I personally see in my practice, people as young as 30 years old have low testosterone levels. So let's dive in with Dr. Tracy Gapin on energy, focus, vitality and hormonal imbalances.

• 2:41Dr. Darshan Shah?

  I want to really focus in on what your expertise is in. And I know you're an expert at many things, but you've written books and one of them's right here, male 2.0 about hormones, right? And so tell me a little bit about your expertise and how you got to this place in the first place.

• 2:58Speaker 01

  Sure. Thanks so much. So I spent 23 years in urology as a board certified urologist doing robotic surgery. I launched the robotics program in my hometown back in Sarasota, Florida on the cutting edge of advanced prostate cancer detection and minimally invasive treatment. And I love to be on the cutting edge as a pioneer in the men's health field. And as I went through my career in urology, I got very frustrated disillusioned with how I had, first of all, so little time with men, again, six minutes per visit and we were not really solving anything. And it was, you know, great at fixing acute care. If you have prostate cancer, you have a kidney stone, if you need a vasectomy, I can do that. But if a guy comes to me and says, I want to have more energy. I want to feel like a man again.

• 3:40Speaker 01

  I want to be able to think clear and be more focused and be more productive and get rid of my belly fat and have great sex with my wife and play on the ground with my kids. I wasn't doing anything for them. And I realized that my own health challenges made me suddenly aware of that when I was struggling and I was 30 pounds overweight and I went to a doctor for my first physical ever and I was a mess. And I realized that I didn't have the solutions. And so I went back to school and I spent about 10 years studying and learning and engaging in, you know, how to do hormones the right way. Functional medicine, genetics, epigenetics, you know, the science of lifestyle and how our behaviors affect everything. And how can you interlay peptides and use wearable technology? And really this cutting edge of longevity that you and I are engrossed in right now.

• 4:24Speaker 01

  It's this amazing world of optimization that we can actually be our absolute best again with the right tools and strategies. And I realized that our healthcare system stinks. At giving people what they really want to need. And so after many years of planning and preparing and some procrastinating, I made the massive decision and I jumped off this figurative cliff and I left traditional healthcare. I left my practice, started from scratch, and I built the Gavit Institute. And that was about four or five years ago now and we are growing and we are focused on how do we help men? And men's health is my passion and focus, although we work with women as well, but men's health is where I live. How could I help men optimize their bodies to work like they're supposed to? How can I help them to really achieve peak performance?

• 5:08Speaker 01

  And be able to live their best life? And you know, guys say, God, I used to feel great. I used to do this. I used to do that. Well, that's what I'm gonna help you do. And you know, every guy thinks of high performance differently. Some guys is, I want to be able to crush it in my business and I want to be able to scale and have this massive exit. And other guys, I want to be a leader in my community. Other guys, high performance means I can show up in the bedroom for my wife at night and be able to perform and be a loving partner. Others, it's like for myself, is I want to be the best father I can be. And that's what it's all about for me is I have these two beautiful kids at home. I have an amazing wife and how can I be the present and engaged husband, father and leader for them that I need to be, that I want to be? And so that's really the foundation. That's my purpose. That's my why. And so I bring that into everything I do when I work with men.

• 5:53Speaker 01

  And to do that, it takes a very different approach than what our crappy healthcare system is giving. And it takes, you know, we talked about lifestyle stuff, you know, nutrition and fitness and sleep. It takes optimizing hormones and doing the advanced diagnostic testing. You know, I know that we've talked about this a lot. How important is to find those blind spots that are getting in the way and holding you back? And how can you take a very integrated approach and coming at it very holistically?

• 6:18Dr. Darshan Shah?

  Yeah. You know, I love what you said about starting with the why. You know, you talked about that and you gave a few examples of some whys that men and you know, women do would have to do this. And I find that that's so powerful with my patients. It's like, I mean, like before I do a health history, I say, why are you here? Like, what do you want to achieve? Right? And they'll start talking about like, I need to lose some weight. I don't, you know, I don't feel like my testosterone is good. But I'm like, what's the real, like, why do you want to get healthy? And when you really frame it that way, it gets emotional sometimes, right?

• 6:48Speaker 01

  Yeah. I love that, you know, I, I, I love that you bring this up because there's, there's the why and then there's the why behind the why.

• 6:54Dr. Darshan Shah?

  Yeah.

• 6:54Speaker 01

  And I'll give you a great story. Uh, one of my clients came to us about three or four months ago and he's, he's older. He's in his, his mid to late sixties, older than the typical guy we tend to see come in. But his main thing was cognitive function and focus. I want to better focus. Okay. And, um, it took a little bit of pulling out of him, but what I finally come to find out was that a few years ago, he was a very competitive bridge player and he was winning tournaments.

• 7:18Dr. Darshan Shah?

  Hmm.

• 7:18Speaker 01

  And suddenly he found that his mind was deteriorating. He couldn't compete anymore. And that's all he cared about was that. And so for him, great example of it's not enough to help him think better and clearer. I gotta help him get back to playing competitive bridge.

• 7:30Dr. Darshan Shah?

  Sure.

• 7:30Speaker 01

  And that means there's a lot more to it than just thinking clearer. It's the, it's the focus. It's the energy. It's the concentration. It's the mental acute, all the details that make it so much more important. You bring up the weight loss thing. Guys will say, I want to lose 20 pounds. Well, why? Well, so I could fit my jeans. No, why? Why do you want that? And a lot of it may come down to they want to feel like a man again. They want to feel that their spouse is attracted to them. They want to feel powerful again. There's, uh, there's often an underlying emotional component that we have to get to. It's not just about the numbers. It's about the human behind the numbers.

• 8:00Dr. Darshan Shah?

  Yeah. It's so great to be at this point, like away from Western medicine. We never even got to ask a person why, because you had, like you said, six minutes. And now to have the time to spend with people and ask them the why, the why behind the why, the why behind that why.

• 8:15Speaker 01

  Right.

• 8:15Dr. Darshan Shah?

  And really, cause I think that's so powerful for anyone listening to this is like, why are you listening to this podcast in the first place? Right? And getting to that, getting really clear on that just makes it so much easier to focus in on that goal. Right? So I love that. So let's talk a little bit about hormones. And one of the struggles I have explaining to patients about hormones is I think a lot of people feel that the problems are starting with hormone deficiencies versus their routines and habits are probably a reason that they're in this hormonal state in the first place.

• 8:51Speaker 01

  Yeah.

• 8:51Dr. Darshan Shah?

  And so I know you and I talked about this in the past too. And I just was wondering like, how do you like parse through that with your patients? And

• 8:57Speaker 01

  Yeah.

• 8:58Dr. Darshan Shah?

  Why they're In a state of hormonal disruption in the first place.

• 9:01Speaker 01

  Yeah, great question. And this is, this brings back the point of, of having a very integrated understanding and approach to this because it's never just one thing, right? So when we see a, a man come in the office who has low testosterone, the question always is, you know, well, why? And you could look at things like poor nutrition and the quality of our foods has deteriorated. You know, increased stress, which drives our cortisol stress hormone, which caused a lot of other downstream consequences. We have a sedentary lifestyle, lack of fitness, lack of activity. All of that is true, yes. And one of the biggest factors that I don't think is really emphasized enough are the toxins in our food. The toxins in our water, the toxins in our personal care products that we are now seeing in, in the literature are crushing our hormones.

• 9:44Speaker 01

  What's even scarier is it has a transgenerational effect. What I mean by that big word is that our grandfathers were exposed to toxins. It's been shown to affect their sperm, which is then being passed down to our fathers, being passed down to us. And then we're passing it down to our children as well.

• 10:02Dr. Darshan Shah?

  So you're saying the toxins that I'm exposed to right now, it causes genetic epigenetic changes that gets passed on to future generations?

• 10:11Speaker 01

  Absolutely. That's right. And so a lot of the, the, the damage that we're seeing, unfortunately, the damage has already been done, so to speak. And I'm seeing men in their twenties and thirties coming in who have testosterone levels, half of what they should be. And there are three great longitudinal studies from the US and Europe that have shown that, that worldwide, we're seeing testosterone levels about half what they were 20, 30 years ago. And it's dropping by about 1% every year continually. And it's because of that compounding effect that.

• 10:40Dr. Darshan Shah?

  Through the generations?

• 10:41Speaker 01

  Through generations.

• 10:42Dr. Darshan Shah?

  Wow. Yeah, I was wondering like, why, why is this happening? And you're right, like it's all these reasons, right? And not enough movement or, or dietary choices, et cetera. But it's actually being passed down generations. So this is a compounding effect, generation to generation.

• 10:56Speaker 01

  That's right.

• 10:57Dr. Darshan Shah?

  So for our kids' sake, we gotta fix our testosterone.

• 11:00Speaker 01

  Yeah. Yeah. It's about cleaning up our, our food, cleaning up our water. And it comes back to, you know, the, these lifestyle choices that, that are so important. But I think that the point. Emphasize here is a lot of people want to fix the testosterone problem by just focusing on strength training and nutrition and sleep and and there's a lot more to it than that unfortunately.

• 11:16Dr. Darshan Shah?

  Right, absolutely. So on that, let's say um man comes into you and he's experiencing symptoms of low Well, first of all, why don't we go into what are some of the symptoms of low testosterone? How would this a listener know maybe testosterone is the issue?

• 11:30Speaker 01

  So some of the most common complaints men will have with low testosterone will be low energy, fatigue, you know, later in the day, it's three or four o'clock and they want to take a nap. That's not normal. That's not okay. That's not that's not optimized, man, if you're wanting to take a nap. Your focus isn't like it used to be. You can't concentrate. Um, you have brain fog. You can't quite come up with the word or your memory is off. Mood is off. A lot of men talk about just a lack of of of drive with low testosterone. They're moody, they're irritable. Belly fat. A lot of guys will carry like those, you know, those last five, 10, 15 pounds of belly fat that they can't shake, no matter how hard they're they're working out in the gym and trying to lose weight.

• 12:11Speaker 01

  They can't build muscle like they used to. Can't recover, you know, suffer from a knee injury, an elbow injury from tennis and it you just can't shake it. It's not healing like you used to. Poor sleep, loss of sex drive, poor function in the bedroom. I've had couples come in and the wife will say something's wrong with my husband because he used to chase me around the house and I had to, you know, bat him off with a stick and now I'm chasing him because he doesn't seem interested anymore. And some wives even think their men are cheating on them because they have just a lack of drive and and they don't care about sex and and they're they're different. And so it it changes. Sometimes it's very subtle over years. It changes in men that sometimes the wife will see it before the man can appreciate it.

• 12:54Speaker 01

  But what's important to recognize is that a lot of men have no symptoms at all. I have friends, colleagues, other doctors who who come to me asking me, you know, how do I deal with all this stuff? How do I correct all this stuff? And um they'll say, yeah, I feel fine, but people keep telling me I should check my testosterone. Be like, yeah, this is why, you know, because a lot of men have no symptoms and they'll check it and it's in the tank and they're like, I thought I was doing great. What do you mean? And so I want to emphasize that even if a man does not have any symptoms at all, they should get tested because you'd be surprised how low levels are.

• 13:23Dr. Darshan Shah?

  And what age does someone start testing their testosterone?

• 13:27Speaker 01

  I would say in your 30s. I've had so many men in their 30s and we'll talk about free versus total, but their levels were in the tank. And they did not even recognize that there was a problem.

• 13:36Dr. Darshan Shah?

  Yeah.

• 13:36Speaker 01

  And a lot of times, men will compensate for it until it reaches a critical threshold where suddenly they realize, holy cow, I need help.

• 13:43Dr. Darshan Shah?

  Yeah. So I know you, you treat mainly men, but you also have some women in your practice.

• 13:47Speaker 01

  We do.

• 13:48Dr. Darshan Shah?

  What are some, and testosterone, you know, I try to emphasize the women based on I see is just as important for women as it is for men.

• 13:54Speaker 01

  Yeah.

• 13:54Dr. Darshan Shah?

  So can you touch on that a little bit and what symptoms women would possibly experience?

• 13:57Speaker 01

  Yeah. And a lot of the wives will say, well, what about me? The wives, the men will come in and so we definitely, you know, we work with a lot of women as well. And hormones are so important. And I'm glad you bring this up because testosterone is an incredibly important hormone for women as well. And it's underappreciated. It's important for, again, energy, for sex drive, for building muscle. And especially, you know, pre-menopausal women, women in their 30s and 40s, a lot of them will have low testosterone. And they're struggling to, to optimize, they're struggling to burn the buttocks and the thighs. You know, they're trying hard to lose weight, if you will. You can't spot treat fat.

• 14:32Dr. Darshan Shah?

  No.

• 14:32Speaker 01

  But a lot of it is their metabolism is off and that comes back to hormones and testosterone is so important. The other point to recognize is estrogen, which women think of as their main hormone, comes from, is metabolized from, broken down from testosterone. And so you need optimized testosterone. A lot of couples will come in and the woman has no sex drive at all. And the man, now that he's been optimized, there's this disconnect. And a lot of times that's testosterone deficiency in the woman as well. So, so important for women. There's a lot of cardiovascular health benefits to optimizing testosterone in men and women as well. And so the earlier you start with that, the better.

• 15:07Dr. Darshan Shah?

  And I'm glad you brought that up because my next question to you was actually like, definitely low testosterone can cause symptoms. But even if you don't have symptoms, it's important to get checked. And this is why, you know, I'm a big fan of biomarker testing. I tell everyone when you're 30, even earlier, if you want, get a set of biomarkers done. Cause if we know what your testosterone level was in your late twenties, we can optimize towards that number later on in life. Right? So really important to get biomarker testing done as early as you can. But secondly, even if you're asymptomatic, there's a disease risk that is compounding year over year.

• 15:43Speaker 01

  That's right.

• 15:44Dr. Darshan Shah?

  By having low testosterone, right?

• 15:45Speaker 01

  That's right.

• 15:45Dr. Darshan Shah?

  So can you talk about that for men and women as well?

• 15:47Speaker 01

  For sure. So we know without question, the number one cause of death. In the US is cardiovascular disease, right? Cardiovascular disease in men and women is the most common cause of mortality. But what's important to recognize is that doesn't start when you're 50 or 60. That actually starts when you're a child and it's a process that develops over years and decades of time with plaque formation in the coronary vessels and the arteries that go to your heart. And that's dramatically affected by testosterone. So this is really a critically important point. I'm glad you're bringing this up because we know that testosterone, low testosterone is very clearly associated with increased risk of major adverse cardiac events, heart attacks, strokes, sudden death.

• 16:28Speaker 01

  We know that low testosterone is associated with worsened lipid numbers. Let me repeat that. Low testosterone is associated with worsened lipid numbers, LDL, triglycerides. Those numbers are much worse than with low testosterone, women as well. And so it's so important that we correct that testosterone deficiency as soon as possible because it has a lot of downstream effects on cardiovascular health, lipids. It affects blood sugar regulation. It affects inflammation. It affects cortisol, stress hormone levels. It affects so many downstream parts of our system, of our physiology. You have to optimize that first.

• 17:00Dr. Darshan Shah?

  Yeah, and like you mentioned earlier too, you said low testosterone causes brain fog, but over years, there's a higher association with Alzheimer's disease as well. So all of these symptoms kind of pile up over time and then become disease. So, you know, maybe you're unable to lose some belly fat, but that becomes metabolic disease 20 years later. So it's important to get to this early.

• 17:19Speaker 01

  Absolutely. And this is really, I want to emphasize, I love what you just said. This emphasizes what's wrong with traditional healthcare. Our healthcare system is all around, when you have a heart attack, you go to the hospital, then you're finally going to get treated. Or else your doctor may check your lipids, oh, you have high LDL, here's your statin, and that's it. And so taking a very proactive, intentional, personalized approach as early as you can is so important, and that's where our healthcare system is completely failing.

• 17:43Dr. Darshan Shah?

  Completely backwards. Just wait till you're in disease and react. Right, exactly. So, all right, so you've convinced everyone to get their biomarker statin, late 30s, maybe even early 20s. What tests are you doing, like the specific tests you're doing on men and women to check?

• 17:59Speaker 01

  So when we start working with clients, we have a huge biomarker panel that we look at. Advanced diagnostics panel has over 100 biomarkers to start. This is just the blood testing, having even gotten to the functional stuff that we'll talk about. And this panel is going to look at all the hormones. So, you know, we're going to talk all about testosterone, but I want to just emphasize, we have over 50 hormones in our body, right? And, and so many men focus on just T. And T is important, but you also have, again, over 50 other hormones that we want to look at. So we're looking at all the hormones, looking at markers of inflammation, we're looking at micronutrient levels, we're looking at markers of blood sugar regulation, markers of liver function, markers of advanced lipid function. And all of these markers are telling us a lot of different things that are important. And, and I call these blind spots with your health.

• 18:44Speaker 01

  And a great story I like to talk about Bob Harper. Bob Harper, he is on the TV show The Biggest Loser. He's that lead fitness trainer, right? And he looks great. He's like the epitome of good health and we all aspire to look like Bob Harper, right? And he's teaching people how to lose weight and get healthy. Couple of years ago, at the age of 51, Bob Harper had a heart attack that almost killed him.

• 19:04Dr. Darshan Shah?

  I remember that.

• 19:04Speaker 01

  Right, it was in the news. And fortunately, he recovered. And what he found afterwards were there are blind spots in his health that he didn't even realize were causing major problems just on the surface. He thought he was doing everything right, but yet he wasn't. And that's where the diagnostics are so important. For him, it was LP little a, lipoprotein A, which is a subtype of LDL. It's a specific LDL fragment that is inherited from your parents and has a dramatic effect on your risk of cardiovascular disease. And you would never know it unless you actually tested.

• 19:34Dr. Darshan Shah?

  No. And traditional healthcare doesn't test for that until it's too late.

• 19:38Speaker 01

  That's right.

• 19:38Dr. Darshan Shah?

  We test an LP little a on everybody because what I tell people is LP little a, you get, you get it done once, even if you're 30, and you know if it's high.

• 19:45Speaker 01

  For life.

• 19:46Dr. Darshan Shah?

  And then you know for life. It's like one of those like miraculous, like I think it's like 18 to 20% of people have LP little a. Like it's crazy how many people have this.

• 19:53Speaker 01

  That's right.

• 19:54Dr. Darshan Shah?

  And no one's ever tested for it with a traditional cholesterol panel.

• 19:56Speaker 01

  That's right. And a statin doesn't treat that.

• 19:58Dr. Darshan Shah?

  It doesn't treat it.

• 19:58Speaker 01

  That's right.

• 19:59Dr. Darshan Shah?

  Exactly.

• 20:04Dr. Darshan Shah?

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• 20:47Dr. Darshan Shah?

  So if you are looking to support your body and want to feel younger from the inside out, my friends at Timeline are offering you a 10% discount on your first order. Go to timeline.com/drsah to get started. That's timeline.com/drsah. Your future self will thank you.

• 21:10Dr. Darshan Shah?

  So on the hormone front, you're testing testosterone, free testosterone. You're testing estrogen and progesterone, estrogen in men and women.

• 21:18Speaker 01

  Absolutely.

• 21:19Dr. Darshan Shah?

  Progesterone in women, what other hormones are there? Chicks and THA?

• 21:22Speaker 01

  Yeah, and I want to emphasize that for estrogen, a lot of men try to get their estrogen as low as they can. And you know, I like to say estrogen is not the enemy and we need estrogen. And a lot of the benefits of testosterone are in reality due to the trickle down effect. Again, testosterone gets broken down into estrogen and a lot of the cognitive benefits you were mentioning are probably from estrogen. A lot of the cardiovascular benefits are likely from estrogen. So looking at estrogen levels, nitric oxide. Nitric oxide is a key hormone that is something that most doctors don't check or even know about, but it's a hormone that regulates our blood vessels and it's responsible for vasodilation, improving blood flow. Right? When you work out, you want to improve blood flow to your muscles. When you're in the bedroom, you want improved blood flow down there.

• 22:07Speaker 01

  When you need to think and have focus and cognitive, you know, clarity, crystal clear clarity when you're thinking. Thinking and concentration, memory, et cetera, you want blood flow to the brain. Nutrient oxide is in large part responsible for that. And, and so we can test for nutrient oxide and there are ways that we can help improve that as well.

• 22:22Dr. Darshan Shah?

  What tests are you using for nutrient oxide?

• 22:23Speaker 01

  So it's actually a, a saliva test strip. Exactly, yeah. Looking at thyroid, you know, most people think that thyroid is just important for women, but it's important for men as well. And it's important because it regulates mood and energy and metabolism. It controls your gut. And a lot of men struggle with something that they wanted mid, and that is stress. Right? High cortisol stress and, and it may be from stress of finances or marital issues or the kids or your business, whatever, or some guys will refuse to admit stress, but we're all dealing with stress, right? Our hormones, thyroid and DHEA and other hormone are responsible for regulating and balancing out cortisol stress hormone levels. And so thyroid is so important, it's also responsible for our gut health as well.

• 23:06Speaker 01

  And so for a lot of reasons, we want to be looking at thyroid hormone in men that is not just important in women.

• 23:11Dr. Darshan Shah?

  Yeah, that's such a great point. With the cortisol testing, are you doing saliva testing for cortisol? Four times a day kind of a thing?

• 23:18Speaker 01

  Yeah, exactly. So, yeah, so when we look at, you know, the, the second step of my, my process, the deep dive part of it, it is looking at, at advanced testing like cortisol. And a lot of high performing entrepreneurs and founders I work with will say like, yeah, yeah, I'm not stressed, I'm, I'm, I'm fine, I'm good, I, I, I compensate. But when you test for it, again, when you show them the data and, and a cortisol test is a great way to do that, just four saliva samples throughout the day, you can see how that, that is really coming out. And you'll find that typically cortisol levels are much, much higher than guys are thinking there.

• 23:48Dr. Darshan Shah?

  Yeah, yeah. So what I tell all my patients is that, you know, if you live in a chronically high state of cortisol, your body resets and thinks that's normal. So the next time you're stressed, it goes even higher and higher. And so it's really important to kind of cut out that stress cycle on a frequent basis. So let's focus back in on testosterone. Could you kind of explain the difference between free testosterone and testosterone? If you don't mind?

• 24:13Speaker 01

  Sure, yeah. So, great question. A lot of doctors will only look at total testosterone. And I want to emphasize that that's a fairly worthless number. Because for testosterone to do its job, for it to have any physiologic effect, for us to understand that it has to get into the cell, right? It has to get into the cell, it then binds to an androgen receptor, gets into the nucleus, and does all kinds of fun stuff in the nucleus, in the headquarters, the brains of a cell. That's muscle cell, brain cell, et cetera. For the testosterone molecule to get into a cell, it can't be stuck to other big fluffy proteins. It has to be free-floating, it has to be small enough molecule to fit through the doorway of a cell.

• 24:47Dr. Darshan Shah?

  Hmm.

• 24:48Speaker 01

  Ninety-nine percent of our testosterone, ninety-nine percent of it, is bound to proteins in our bloodstream, like SHBG and other proteins you may have heard about. Once it's bound to these proteins, it's worthless. It is ineffective, it cannot get through the doorway, it's this this big fluffy molecule now, it can't fit through the doorway, through the the the opening of a cell wall, can't bind to the androgen receptor, can't do anything downstream that that we want it to do, it's worthless. So the only testosterone that matters is free testosterone.

• 25:16Dr. Darshan Shah?

  Hmm.

• 25:17Speaker 01

  So free T is simply the amount of testosterone that is not bound to proteins in the bloodstream that's actually able to have any physiologic effect.

• 25:25Dr. Darshan Shah?

  Yeah, that's such an important point.

• 25:27Speaker 01

  Yeah.

• 25:28Dr. Darshan Shah?

  Because if a lot of people, you know, they're going online and getting these test kits with free testosterone and getting testosterone mailed to them, they have no idea what their sex hormone binding globulin is.

• 25:36Speaker 01

  That's right.

• 25:37Dr. Darshan Shah?

  What their free T is. And so, just emphasizes why you have to work with a trained practitioner. Oh, on that point though, okay, I wanna, I wanna mention something here. What do you think about, you know, who's the trained practitioner to help you with this? And I ask that because I see a lot of men, and women, go to an endocrinologist, get their hormones levels tested, and tell them, what are you on testosterone for?

• 26:00Speaker 01

  Yeah.

• 26:01Dr. Darshan Shah?

  I'm like, are you kidding me?

• 26:02Speaker 01

  Yeah.

• 26:03Dr. Darshan Shah?

  And so, talk about that.

• 26:04Speaker 01

  It's maddening, and and this is where our traditional healthcare system, again, is failing miserably. Urologists, my colleagues who I spent decades working with, they would would bash testosterone therapy and don't see the value of it, they don't recognize how important it is, or they would accept low levels. So, let's talk about numbers real quick, I think this will drive home the point you're making.

• 26:23Dr. Darshan Shah?

  Exactly, let's do that.

• 26:24Speaker 01

  When you look at a lab slip, there's this reference range on the right side of the page, right? And and people think that that's the optimal range. The scary part is doctors do as well, right? Our colleagues, our urologists, general surgeons, endocrinologists, who go through traditional healthcare training, they're taught that that's the normal range and that's where you want to be. Well, I mentioned earlier in our conversation that levels are plummeting by about 1% every year. They're about half what they were 20 years ago. That reference range is literally half what it was 20 years ago because that reference range is just simply the average of the population. So LabCorp will do a billion testosterone levels and the average becomes that reference range. And so the problem with other doctors like you're describing is they're just looking at that range, not understanding what are the optimized levels that you need. And so to answer your question,

• 27:09Speaker 01

  this is the 10 years of training that I went through. This is all the time, effort, sweat, blood, tears, money that I invested into learning how the heck do you do it the right way? And it's going back to school and going through training in longevity and optimization and, you know, reimagining how we approach men's health, women's health, population health, and take a much more personalized, much more direct proactive approach. And that's where we're going to make a real difference.

• 27:36Dr. Darshan Shah?

  Absolutely. So getting back to the levels. So what are you aiming for in your male patients for a good testosterone level? And I know that's a loaded gun question because there's things like free testosterone, this, what's your age? So let's talk about this.

• 27:52Speaker 01

  So what I tell guys is take your total and throw it away. It doesn't matter. It just doesn't matter because again, the concept of free testosterone is the actual testosterone that can actually do its job, right? And so the free testosterone, my target is around 20. Okay, 20 picograms per milliliter is the unit for those of you listening. So 20 picograms per milliliter is our target, understanding that for some men, 15, 16, 18 may be okay. For other men, they may need 25 or even 30, which most traditional healthcare doctors would cringe at and have some palpitations, chest pain thinking about that. But for some men, they need those levels that high to get the benefits that we talked about.

• 28:27Dr. Darshan Shah?

  Yeah.

• 28:29Dr. Darshan Shah?

  The reason some people's total testosterone does not translate accurately is because of sex hormone binding globulin and other proteins, right?

• 28:37Speaker 01

  That's right.

• 28:37Dr. Darshan Shah?

  Can you talk about SHBG a little bit and the importance of it and how you can modify that?

• 28:41Speaker 01

  Yeah, so sex hormone binding globulin is the most common protein that I was talking about, the big fluffy cloud molecules floating around the bloodstream that will bind to testosterone and make it unavailable. So, most guys say, well, can I just lower my SHBG? So that means more of my testosterone is free-floating and available, and I wish it were that easy, right? But sex hormone binding globulin is affected by a lot of things. It's affected by metabolic health, it's affected by estrogen levels, it's affected by inflammation. A lot of different things can affect our SHBG levels. Unfortunately, it's tough to manipulate it. Things like boron may help a little bit, some micronutrients may help a little bit, improving thyroid health may help a little bit, metabolic health is directly tied to it. So those are all really contributing factors, and this is where I want to emphasize, there

• 29:24Speaker 01

  are a lot of biohackers out there who are relying on, you know, these companies, these direct-to-consumer products to help them. You need to be working with an expert, a doctor like you, like me, who understands all the nuance of this, because it's not as simple as just take this pill to lower my SHBG, which will then give me higher free T levels.

• 29:41Dr. Darshan Shah?

  Right, exactly. And so for people to understand kind of the flow from total testosterone, which you can improve with things like getting better sleep, weightlifting, there's some supplements maybe that can improve total testosterone, then you have more total testosterone, but if your sex hormone binding globulin is still off, due to all the different factors you said, you're still not going to get enough free testosterone. That's why it's so important to have your free testosterone number, which you say should be somewhere around 20.

• 30:09Speaker 01

  Exactly.

• 30:10Dr. Darshan Shah?

  And, um, once you, once you get this hormones levels, you get the paper in front of you and you see the free testosterone is low.

• 30:17Speaker 01

  Yeah.

• 30:17Dr. Darshan Shah?

  What's your conversation that you're having with your patients at that point?

• 30:20Speaker 01

  So this reminds me of Joe. Joe is one of my clients. He runs a online reputation company. And when he first came to see me, he's like forty pounds overweight and he looks like crap, feels like crap. And he's like, Doc, help me. And he told me how he learned online, you know, his free testosterone was four, by the way. Okay, and that's, that's very common. Most guys come in off the street, their levels are four. My doctor buddy, I mentioned, who thought he was fine, his level was six. Should be twenty.

• 30:43Dr. Darshan Shah?

  I would say eighty percent of the people I see, it's less than ten for sure.

• 30:46Speaker 01

  Yeah, four to six is very common. So Joe had tried all the, all the conservative lifestyle stuff, you know, the, the non-invasive, the natural approaches to boosting testosterone. He had been doing the, trying the strength training. He would try to eat well, although he wasn't doing a good job of it. He's trying to sleep better, trying to do all these things that you read about.

• 31:01Dr. Darshan Shah?

  I'm laughing because I see all these supplements, you know, on late night TV or online that pop up, boost testosterone. Almost everyone that's like notices their testosterone is low. The first thing they do is go for a supplement.

• 31:13Speaker 01

  A T booster.

• 31:13Dr. Darshan Shah?

  A T booster, right, exactly.

• 31:15Speaker 01

  Yeah. And the problem is, is honestly, those are not going to move the needle enough. Now, some guys, if you're religious about doing all this stuff, which no one is, of course, but if someone's religious about doing all the right things when it comes to lifestyle for six months, they may get that four to six number up to maybe ten. But again, you're only halfway there. And I find that it's an incredibly difficult job for any guy to do that religiously consistently for six months and see that little of a change. And they start to lose motivation, too. They start to lose drive. They're like, yeah, this isn't gonna work. Instead, if we can give them testosterone so that their levels are where they need to be, now they have the motivation, they have the drive, they have the energy to say, let's freaking do this.

• 32:00Speaker 01

  And they're more motivated to make the lifestyle decisions that are still incredibly important for a lot of other reasons. But it's this double-edged sword. It's this yin and yang. We have to start somewhere. And so this is where the benefit of testosterone replacement therapy is so incredibly impactful by getting them toward the, the momentum in the right direction.

• 32:21Dr. Darshan Shah?

  Yeah, you're so right about that. I think the, the main point there is you have to be working with someone that is equally focused on your lifestyle changes as you. Your testosterone number.

• 32:31Speaker 01

  That's right.

• 32:32Dr. Darshan Shah?

  Right? They they have to be a yin and yang that go together. If you're just doing one, you're going, in fact, I've seen people that don't do any lifestyle changes. In fact, they go even more sedentary and they get on testosterone replacement therapy. I've seen negative consequences to that as well.

• 32:46Speaker 01

  Absolutely. And this is why, you know, as amazing as as I may be when it comes to men's health and medical treatment and management and hormones, I have a team. And my team is is way more valuable and more important for my clients than I am because I have a team working with them on nutrition and on gut health and on sleep and on proper supplementation, all the testing and putting all those pieces together. And you need to program it together to really get those results. And, you know, I want to emphasize for anyone out there, testosterone is so important. And there's so much more you need to be doing as well. And I'm so glad that we're we're tying all this together.

• 33:20Dr. Darshan Shah?

  Yeah, absolutely. And you know, people also need to understand that testosterone is a hormone that your body makes. It's a really powerful compound.

• 33:28Speaker 01

  Yeah.

• 33:28Dr. Darshan Shah?

  You can't take it lightly, like getting like if you're gonna be on testosterone therapy, it has to include the full lifestyle change.

• 33:36Speaker 01

  That's right.

• 33:36Dr. Darshan Shah?

  And that's why I love what you're doing with testing all the biomarkers and tying in the nutritionist, the exercise therapy. All gut health, you mentioned a few times. I mean, that's so important. No one talks about gut health when they're on, when they're talking about their hormones. And so it has to be the the full solution. So someone comes to you, you got them into your program, they're on the program now, right? So how do you start managing their testosterone? What are the different options available?

• 34:00Speaker 01

  Sure. So when it comes to T, there are three main options we think about. First is injectable. Second is topical and third is pellets, right? And I typically recommend in that order. Injectable is is what I would typically recommend as a starting point for men when they start testosterone replacement therapy. And you could do sub Q, which is tiny little 30 gauge needle, you barely feel it. And that could be just under the skin, so super easy. Or you can use a big fat needle that goes into the muscle. Two different ways of injecting.

• 34:28Dr. Darshan Shah?

  Got it. So let's go into the nitty gritty of this a little bit more. So there's also another method, which is Clomiphene treatment and Clomiphene, right? And which is a pill that you can take that stimulates your natural secretion of testosterone. Where does that fall into your treatment algorithm? If you if you don't mind talking about that one a little bit?

• 34:43Speaker 01

  Absolutely. So when we think about testosterone therapy, you can either give testosterone, which we're talking about with getting injectable topical or pellets. For some men, especially younger men, let's say he's 30, 35, 40, and he still wants to have children. For example, giving medications that can stimulate your body to make more testosterone may be a great option. So you mentioned Clomiphene. I find for some men, they have issues with mood from Clomiphene, mood disorders, mood can be impacted. So N Clomiphene, a variant of it, is another form of doing that. What you're doing with Clomiphene is you're telling the brain, there's not enough hormones floating around, make more. And that increases LH, which is a hormone made by the by the brain pituitary that goes down to the testicles and says, make more testosterone.

• 35:26Speaker 01

  And so the point of Clomiphene and Clomiphene is to stimulate the body to make more.

• 35:30Dr. Darshan Shah?

  Got it.

• 35:30Speaker 01

  We'll often pair that with HCG, which is an injectable hormone. It's actually just like the HCG you think of in women who are pregnant. HCG works just like LH from the brain. And again, it tells the testicles to make more testosterone. So that's an alternative. I find that much more effective for younger men, especially if you don't want to give them testosterone. You want to preserve fertility, that's a great option for them.

• 35:52Dr. Darshan Shah?

  Yeah, absolutely. But one of the problems with using that for someone who's maybe in their 50s is you just can't get the boost that you need.

• 35:59Speaker 01

  That's right.

• 35:59Dr. Darshan Shah?

  You kind of max out because your testosterone production over time actually decreases as well. The capacity to make testosterone.

• 36:06Speaker 01

  Yes, exactly right. I find most men, over the age of 50 or so, the Clomiphene and Clomiphene HCG option of stimulating your body to make more is just not nearly enough, not nearly as effective as we want. And so typically TRT replacement therapy is where I would generally steer those guys toward.

• 36:22Dr. Darshan Shah?

  Yeah. And with the TRT now, so I also recommend the injectable quite frequently. I find people love the subQ for the most part. There are some people that are just grown up with intramuscular testosterone, so they're fine with it. But with the subcutaneous one, just really diving in, how many times a week do you normally have them inject? And what are the dosages and where in their body do you have them inject?

• 36:45Speaker 01

  Oh, great question. So ideally it'd be every day, right? If we think about physiologic testosterone levels, the more often you inject, you'll have tighter regulator. levels and so ideally optimally it'd be every day no one's gonna do that unless you're a bodybuilder unless you're an insane biohacker who has no other responsibilities during your day so from most men answer question typically two or three times a week is ideal and it depends on compliance so if you can do it three times a week awesome if compliance may be a problem typically and that's the case for most guys twice a week is where I would I would direct them once a week is just not often enough and this goes back to my urology days where we were doing

• 37:25Speaker 01

  it every two weeks and now you know I learned through my 10 years of going back to school and training that that's just the wrong way to do it because you got these big peaks and valleys throughout that time period and you want consistent levels and you can't get that unless you're doing it at least two to three times a week

• 37:41Dr. Darshan Shah?

  yeah exactly and then the pellet therapy let's talk about that yeah cuz that's also one of my favorite ways of doing it I myself use pellets so I like it it's fits more of my lifestyle because for me you know I forget to inject I'm running around traveling a lot it's hard for me to carry this stuff with you especially internationally sometimes you know you can't bring it international so let's talk about pellets what are your thoughts on pellets

• 38:04Speaker 01

  sure so for the listener pellets are little tiny they look like rabid food right and we make a small puncture in the lower back or buttock and you numb it up so they don't even really feel it you make a small puncture and with a little metal trocar we can insert these pellets to slowly dissolve over time and I compare it to Depo-Provera in women right has a long-term treatment for testosterone replacement therapy that can last as long as four months or so for some men and so the beauty of it is it helps with compliance if you're traveling and if you're likely to forget I actually have an alarm on my phone to remind me the twice a week that I do it so that I don't forget because it's easy you know to get lost in your in your daily life and so pellets are a great long-term way to maintain optimal levels what I find for a lot of men when

• 38:46Speaker 01

  they're first starting testosterone replacement therapy is pellets can be a challenge because we don't yet know your body's needs how much testosterone do you need and so starting with injectable or topical for a while until we get to know you and understand what your body needs and then we can start to dial it in with pellets

• 39:04Dr. Darshan Shah?

  That's a great point. I like I like doing it that way. Um, there's some newer oral testosterone available now.

• 39:10Speaker 01

  Yep.

• 39:10Dr. Darshan Shah?

  Um, oral testosterone in the past was not used because it metabolized in the liver, could cause liver injury. These are some newer forms that are not metabolized that way. Can you talk about those?

• 39:19Speaker 01

  Yeah, so thi- this is a interesting development that we've always, you know, shunned the orals for the liver toxicity problems. Now that that has been solved, the orals is an option. The problems with it are, number one, is run through big pharma, it's run through the insurance companies. And so you gotta battle all the copay deductible nonsense, the the prior authorization nonsense that that is a big challenge on the administrative side. But the real problem with it comes down to levels. And what I find is with the orals, it's very tough to get the levels as high as you want them. A- again, the the reference range on the lab slip is what most doctors are aiming for. And sure, you can get to that level with the orals, but again, it's not where you wanna be. You wanna be optimized, you wanna be at, you know, to achieve peak performance.

• 40:04Speaker 01

  Free T of around 20 is our target, and I cannot get you to that level with the orals. Even if you're doing it, some guys are doing like three or four capsules a day over time, it's you just can't get there.

• 40:13Dr. Darshan Shah?

  Yeah, and I find like it's so variable with the orals, like what, how much is gonna go up from person to person. It has a lot to do with your gut health, your absorption of it as well, um, whether you took it with food or not. It's just so inconsistent. And like you said, like you need that consistency with your testosterone levels. So the more often you can inject it in a week is better, or the pellets could give you a consistent level. One other topic, bioidentical testosterone versus the chemically manufactured testosterone?

• 40:40Speaker 01

  Yeah, so the term bioidentical, you know, it came from the women's health world, like, right? So we know that for women's health, for estrogen, we know that synthetic estrogen and synthetic progesterone are massively night and day different than bioidentical true estradiol and true progesterone. So the term bioidentical came from the women's health world where you want the hormone to be the exact hormone in your body. When we use things like testosterone sipinate, testosterone propionate, or these other forms of testosterone that we're using. I wanna be clear that that that is bioidentical in the fact that it is the same testosterone molecule that our body has. It's just a buffer that's attached. And it's a way to regulate the release of that testosterone. How long, you know, the half life we talked about, which is how long does that testosterone last in your body before you need more?

• 41:22Speaker 01

  And so for practical purposes, they're all bio identical in the fact that it is the same testosterone molecule as the one your body makes.

• 41:30Dr. Darshan Shah?

  Got it. Now with testosterone therapy, you've started it. Can you talk a little bit about your protocol for how often do you want to check labs afterwards? And I think every doctor has a different way of doing this. I like to check it more frequently upfront, but then I back off because most people, once you get them into a level.

• 41:47Speaker 01

  Sure.

• 41:48Dr. Darshan Shah?

  But then again, you know, I also find that like after travel or after a stressful event in life, things get kind of out of whack too. So talk about that a little bit.

• 41:55Speaker 01

  Yeah. So in the beginning, when you first start testosterone replacement therapy, it's very important that you're checking levels often.

• 42:00Dr. Darshan Shah?

  And I know that often is like how often?

• 42:02Speaker 01

  As in like six to eight weeks after they first start, I'll check the first level. And I'll probably do it again another six to eight weeks. A lot of guys out there, they're getting tested every six months. It's just not enough. You're missing a lot of variation that happens and dosing needs to be adjusted. This is again, the personalization that that is so important when it comes to testosterone to get that stable, steady level. You need to be checking and testing and tweaking and fine tuning. Things like, you know, body fat, you know, again, testosterone gets converted into estrogen in our body fat. As body fat levels change, that conversion can change. As stress changes, it can affect it. Gut health. All these things can affect our body's absorption and testosterone levels. And that's why you gotta constantly fine tune it.

• 42:42Dr. Darshan Shah?

  Yeah. So so six to eight weeks after you started, then another six to eight weeks. And then what about once you have them kind of stabilized? How often are you checking?

• 42:49Speaker 01

  Yeah. So if levels are are where we want them to be and they're consistent, you could probably then back off to maybe every three to six months at that point. But typically I find for men, that takes six months to a year to get there. It's not, it's not a quick process to find that optimal dosing. And there's constant refinement that's needed. And again, we take a very holistic approach when it comes to health, men's health optimization. And when you're putting all these other inputs into the system, things are changing. And your requirements for testosterone are going to change as well. And so it's so important that we're continually, you know, I like to say test, fix, repeat, test, fix, repeat. And continually optimize instead of just staying stagnant and complacent with where you are.

• 43:31Dr. Darshan Shah?

  I was really happy with that conversation with Dr. Gap and we took a deep dive into testosterone and how men can really optimize their lifespan and their health span by getting their hormone levels checked and optimized. So here are my 10 takeaways. Number one, the most important I feel everyone needs to know is that testosterone levels as a population are plummeting. Over the last 20 to 30 years, men's testosterone levels have dropped by about 50% and they continue to decline by approximately 1% per year. And that's important because the normal levels that are being reported on our blood test lab results are really not normal. They were much higher a few decades ago. And these are just showing us population-based averages

• 44:12Dr. Darshan Shah?

  versus what is really optimal. Number two, there's transgenerational damage. What does that mean? The toxins that our grandfathers and their grandfathers were exposed to are affecting their sperm. And this leads to lower testosterone levels in subsequent generations. This is a compounding effect that's going on with each generation and it needs to be turned around now. Number three, endocrine disruptors are actually a major culprit of hormone dysregulation. So there are many chemicals in our food, water, and personal care products, especially the amount of plastics and the plastics additives, the chemicals that are added to plastics, that are significantly lowering their testosterone levels. This is rarely discussed in mainstream healthcare and we all need to be very cognizant about

• 44:57Dr. Darshan Shah?

  how these chemicals are disrupting our testosterone levels. Number four, low testosterone increases your risk of heart disease, actually increases your risk. For a long time, we thought that low testosterone levels and testosterone replacement therapy could increase risk of heart disease, but the opposite is true. Having a low testosterone level that is not optimized can cause you to have a higher risk of heart attacks, strokes, and sudden death. Number five, low testosterone is also linked to Alzheimer's disease and cognitive impairment and brain fog, the whole spectrum of brain fog. There's a strong correlation between low testosterone and cognitive decline. Number six, many men have no symptoms of Low testosterone, but still have low testosterone.

• 45:41Dr. Darshan Shah?

  So this is what I always say with all chronic disease is that symptoms are the last thing that you will see when you're developing a chronic disease. The low testosterone is no stranger to this rule. When you have low testosterone levels, it can take sometimes years or decades to feel the symptoms of this. That's why it's so important to get checked with your biomarker testing. Number seven is traditional doctors misunderstand testosterone optimization. So many traditional doctors like endocrinologists and urologists rely on outdated information and reference ranges that were in place when they trained in medicine 30, 40 years ago. And there's so much new information out there that many of them are not privy to.

• 46:21Dr. Darshan Shah?

  So it's really important for you to have the newest studies and newest research and the newest thought process when you are looking into optimizing your own testosterone levels and to see an expert that's familiar with the new research. Number eight, testosterone does not cause prostate cancer. It actually prevents it. Contrary to old medical beliefs, men with low testosterone have a 30% increased risk of developing prostate cancer. So that's why we need to get out of our heads a testosterone replacement therapy can lead to prostate cancer. Number nine, at home testosterone tests could be very misleading. Many men are receiving testosterone levels from at home, direct to consumer testing kits, but you really need a full spectrum of hormone analysis to truly understand what's going on with your testosterone levels.

• 47:06Dr. Darshan Shah?

  You need to look at sex hormone binding globulin, free testosterone, LH, FSH. These are all important markers to check, and that's why it's so important to work with a true professional that not only is looking at all of these markers, but taking your overall health and other disease processes and chronic diseases into consideration before you embark on testosterone replacement therapy. And number 10, testosterone alone can't fix everything. So while TRT or testosterone replacement therapy can be life changing, it has to be paired with proper nutrition, exercise, sleep, stress management, and gut health optimization to get the real benefits and for maximum benefits. Those are my takeaways. It was a great time talking to Dr. Tracy Gapin about testosterone.

• 47:50Dr. Darshan Shah?

  If you know a male who is struggling with low testosterone levels, please send them this episode. I think it's important information for every man to know about as soon as you hit your late twenties or thirties to prepare. Thank you so much for listening to the Extend Podcast.

• 48:07Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.