Good morning, Dr.

Stevens.

And thank you for joining us on our podcast today, where we'll be discussing

male physiology and how to optimize it.

Um, briefly, would you just like to introduce yourself, who

you are and what it is you do?

Uh, yeah, I'm the medical director of the Men's Health Clinic.

Our clinic specializes in the diagnosis of testosterone deficiency.

I'm actually trying not to put you onto testosterone replacement therapy

unless you actually clinically need it, which is contrary to, uh,

what a lot of other clinics do.

Um, but yeah, if, uh, you are a candidate for testosterone replacement therapy,

then we've got a very novel but very logical microdosing TRT methodology

that's, uh, attracted patients from all All over the UK, obviously in 50

different countries, including the United States where TRT is everywhere.

Um, we've got a patient fly over from Hong Kong.

And I said to him, why did you come over to UK?

Do you know, because that's crazy, literally just Hong Kong.

And, um, he said, in one of your videos, you started speaking about Alan Watts.

And I said, and he said.

you're my man.

So I was like, wow.

Okay.

Um, so it's, it's, it's the, it's the medicine, but it's also the

philosophy that goes behind it.

So again, living more according to your physiology, which is obviously

something that we'll get into.

Yeah, definitely.

I think a great starting point in this regard is just briefly discuss,

I suppose, what testosterone is, uh, how it's produced in the bodies and

it's, and the physiological functions it performs, um, as a baseline.

Yeah.

I mean, traditionally, I mean, as a doctor, you don't really learn much

about testosterone at all apart from, you know, its primary role in development

of metal genitalia, uh, fertility, you don't really fully appreciate

testosterone's role in normal physiology.

Now we all understand that testosterone is this anabolic hormone, and obviously

there's that association with anabolic steroids and performance enhancement.

And that's true, but the premise behind testosterone in normal physiology is just

to allow for growth and repair, but it also has a massive impact on psychology.

Lots of our guys present with, well, they all present really

with an element of mental discord.

So when we talk about physiology, you can't separate physiology

and psychology and vice versa.

So if you positively impact physiology, you positively

impact psychology and vice versa.

So testosterone is obviously a hormone.

So what are hormones?

Hormones are essentially chemical messengers that help facilitate

the function of their target organ.

That's the textbook explanation.

But I, I like to look at hormones as, uh, describing them as, as, as a base.

So, when we think about hormones, there's a chronicity applied to hormones.

And, you know, whilst they're helping facilitate the function of their organ,

they allow for the nervous system to work appropriately, and then your conscious

brain to actually hopefully process all of that, and actually go forwards.

Again, we'll go Towards the light and away from the darkness, but that's

getting into the psychological part of it.

Very much a neuromodulater in that respect.

Yeah, absolutely.

And I think it's underappreciated.

And I think, unfortunately, testosterone has that rightly misassociation

with performance enhancement.

But it's just necessary for basic physiology.

And if you've got low testosterone, you know, with the best will in the world, you

know, you can't talk your way out of the psychological issues that you're having.

Um, because fundamentally you are your hormones.

Yeah, no, definitely.

And I think, uh, that's where maybe the traditional psychiatric system,

uh, sort of falls short as it's, they focus solely on neurotransmitters.

And if you present with any sort of, for the want of a better word, pathology,

you're instantly just going to be dosed up with, uh, well, maybe not instantly,

but the first port of call is always to just to look at your neurochemical makeup.

So look at serotonin and then as of almost as a first line of call

and then just put someone onto an SSRI without looking any further.

And I think again, as we were chatting about off air, that's what really, and

as you alluded to earlier, that's what really makes your practice unique.

The fact that you're sort of willing to look at all the the other

components that sort of help to develop an individual as a whole.

Yeah, I mean, listen, medicine has become incredibly specialized.

Um, and there's obviously a rationalization for that because you

want to be a specialist in an area of medicine so that you can offer the

best care and service to that patient.

But the person isn't just The gallbladder, the person isn't just the brain.

So you have to have that holistic approach.

Otherwise you're not really acting in the best interest of the patient.

So my, my real role is literally to normalise your testosterone level, to

allow you to do the necessary things.

But if you don't have a fundamental understanding of your own body and

your own physiology and your psychology and, you know, you're led by your

emotion, then you stand no chance.

So, so my, my role is rather perversely become a life coach, and I'm, and

I'm advising people about What they should be doing with regards to

the basics of life, stress, sleep, nutrition, exercise, and mindset.

The medicine's the medicine.

The medicine's pretty damn easy because, you know, our

practice started eight years ago.

It's evolved over the time to this microdosing methodology.

Through, through research, through clinical experience, and we now a

hundred percent know what's in the best interest of the patient, objectively, and

then your, your subjective experience.

is literally your subjective experience.

Now, we've seen 4, 000 plus patients from all different walks of life.

And so we now have that experience to say, you know, I know you want

to do this, but let's do this.

And we know we have that saying, trust the process because The process

has been done thousands of times before, but again, your subjective

experience is, is particular to you.

And if you've got dysregulated physiology, then you shouldn't trust yourself.

You can't trust yourself, because again, as you said, from a

psychiatric perspective, that they're focusing on the neurotransmitters.

They're having this sledgehammer approach to treating depression

by giving you an SSRI.

Now we are testosterone dominant, so we, we're not serotonin

dominant, so testosterone has a relationship with dopamine and

oestradiol, has a relationship with serotonin, but you need both.

And so you need both testosterone, oestradiol and dopamine and

serotonin but we're testosterone dominant, so we're dopamine

dominant, so we're chasing a reward.

So whilst you might have a temporary kind of effect from an SSRI, you're

not going to restore that person's drive and determination to be

the best version of themselves.

You're just keeping them away from the darkness, but you're essentially

numbing them down to this kind of like state where I'm better, but

I'm not, and it's uncomfortable.

And there's an understandable discord that patients have because

they can't do what they need to do.

They don't feel as bad as they used to feel, but they don't feel as good as they

want to feel because they cannot do it.

Yeah, they're essentially in an anhedonic state and it's definitely not my

wheelhouse, but the way I always look at it is that serotonin is this, uh,

there's, is this hormone that provides a sort of a relaxed and, uh, demeanor,

whereas, as you just rightly pointed out, dopamine is what drives human behavior

to a large extent, reward and motivation, and yes, even accounting for the type

of medication you would be prescribed by a psychiatrist, even if you are given

a dopamine reuptake inhibitor, you're not really solving the problem, are you?

At best, you're sort of masking it with another compound to try and increase

levels of a hormone that, excuse me, not a hormone, a neurotransmitter that

should be, uh, regulated by a hormone.

But it should fluctuate as well.

So, you know, you should raise the testosterone to raise dopamine,

but you should apply effort to achieve, to achieve a reward,

which will lead to more dopamine.

And that will give a positive reinforcement and feedback to

the brain to say, well, when I, when I do this, I get a reward.

Whereas.

If you give a drug that gives you a high level of dopamine or serotonin or whatever

chemical, it will by the very nature of downregulate because it has to because,

you know, if we think about consciousness, it's the subjective appreciation

of subtle changes in physiology.

So if you'll have a constant high level of something and, you know, I want to go

high but you don't, you, you want to, you want to feel change and whether it be good

or bad, you want to feel it so that you learn from it and then go, okay, I'm going

to adapt what I'm doing to chase this.

And again, it's path of least, least resistance, maximum reward.

And we're always seeking the path of least resistance because.

Paradoxically, obviously, that's a survival thing, but in this world,

it's wrong because we're not surviving, we're existing, and we're not actually

fulfilling our potential because we're lost in this perverse world.

Yeah, no, I agree 100%.

I'm going to bring us slightly back to centre, otherwise this is

going to turn into a conversation about drug addiction, I think.

Uh, but yeah, just coming back to the testosterone side of things, um, obviously

testosterone is the production of testosterone starts in the brain and in

an area of brain called the hypothalamus and through a system called the HPGA,

the hypothalamic pituitary gonadal axis.

Could we, uh, could you being the expert at this help us run through that and sort

of work through the mechanism of that particular pathway in the brain and body?

Yeah, I mean, essentially it's a negative feedback mechanism whereby your body

should be able to respond appropriately to what's going on both endogenously and

in the outside world to produce the right amount of testosterone for yourself.

So, you know, as, as you rightly said, the, the hypothalamus sends,

um, signals down to the pituitary and signals down to the testicles

that have a negative feedback.

So, it's gonadotropin releasing hormone that sends signals down to the pituitary,

pituitary sends down LH and FSH, and both of those hormones are necessary.

Really, the LH is obviously the primary hormone that's driving testosterone

production, and that's predominantly happening at night time, which is

why sleep is so super important.

And essentially, sleep is a superpower, irrespective of whether you're on

testosterone or whether you're not on testosterone, to produce good results.

Not only testosterone, but also you have a restorative effect on your body.

The testosterone gets produced and then it gets bound to a couple of

proteins that get produced by the liver.

Again, another rationalization, another need for a healthy diet

to optimize liver function.

But also that, the one that people don't fully understand is sex

hormone binding globulin, which is a fascinating glycoprotein.

And you need optimal liver health for that, but you also need stress.

And again, paradoxically as humans, we're always seeking comfort, but actually

we should be having, understanding the need for stress to achieve comfort,

but the comfort's the illusion.

So, sex hormone binding globulin binds tightly to the testosterone.

There's a fundamental lack of understanding around

SHBG and testosterone.

So we know now that it transfers into the cells and helps modulate anabolism.

But everybody wants to drive SHBG down, I want to drive it up drive it up.

Because, you know, it has a positive effect in whether it's just a marker

of improved insulin resistance, improved insulin sensitivity, or

whether it's correlation causation, we don't fully understand.

And then it's not weak.

Then the testosterone's weak bound to albumin, so it can be released on

demand and then you get about 2% of the testosterone that's actually free.

Kind of like people will say that it's the feel good part of testosterone.

So it's the bioavailable testosterone.

Now the testosterone can obviously just affect the target organ as testosterone,

but it also gets converted into a couple of other hormones, dihydrotestosterone,

which is more androgenic and anabolic.

And then obviously oestradiol, you know, when we traditionally thought

about these hormones, testosterone and oestradiol as being male and

female, but that's utter nonsense.

You know, we need testosterone and oestradiol.

Women need oestradiol and testosterone.

And interestingly, they have more testosterone oestradiol.

Because again, if you, if you understand the steroidogenesis

pathway, testosterone is above oestradiol in both male and females.

So, you know, we need to differentiate between calling one a male hormone, one

a female hormone and that's nonsensical.

So those hormones they go to their target organs and they also feedback to the

brain and it's predominantly oestradiol has a negative feedback mechanism on

the hypothalamus and pituitary and then testosterone and then to a lesser

degree DHT because DHT is more of a sort of an autocrine hormone, so it

has a more of a tissue specific effect.

And this is a bit of a problem in, unfortunately, the hair loss

kind of market, where everybody's measuring DHT levels, which

provides no information at all.

Because it has a tissue specific level.

And the hair loss thing is, is an absolute travesty from medical people

because of post Finasteride syndrome.

And you know, if you have hair loss, it's genetic.

So what are you doing?

Just do what you should be doing with regards diet and nutrition and

supplements and leading the best life.

Um, and people are worried about obviously image.

So yeah, this, this negative feedback mechanism should work and it would work

if we lived according to our physiology in a jungle, not a concrete jungle.

We didn't subject ourselves to all this chronic stress and you know the

cortisol will have a negative impact on testosterone and testosterone in elevation

will have a negative impact on cortisol.

So as we, as we spoke about earlier, you know, it's all literally yin and yang.

Um, and again, that negative feedback mechanism would work perfectly,

but we live in this perverse world.

Yeah, that's actually a perfect segue into sort of why.

We potentially seem to have the epidemic of low testosterone that we currently do.

Do you think that that is just environmental or is there something more?

I don't know.

What's the correct word?

Not sinister?

Is there something more?

Yeah, just use that as a word, I suppose.

Um, what do you think is driving the this pandemic epidemic?

One of them, of low testosterone that we're currently facing as a society?

Um,

yeah, a lack of awareness of, um, what we should be doing as a human being.

Fundamentally, psychological chronic stress is is a massive issue.

I mean, you can just take the example of You know, these well to do couples that

have, um, chased a career as opposed to leading a more normal, natural

life, uh, who have obviously had a lot of psychological stress, uh, who are

desperately trying to conceive, and they struggle to conceive, and they go

through all these IVFs, and they stop trying, and then they suddenly conceive.

Because that, that psychological stress has been removed, and

they're actually just more at peace.

So we've, we've lost that semblance of peace.

It's all dictated by money, isn't it?

So everything that we do now is dictated by money.

So, uh, there's an epidemic of obviously obesity, which is not only obviously

creating the aromatase enzyme in the fat tissue to then negatively feed back

to the hypothalamus and pituitary, but it's also making people lazy and we're

all being told to save energy and take the escalator as opposed to the stairs.

So we're less physically active.

Um, we've got dysregulation, uh, of our hormone system as a result of plastics.

The, the nonstick frying pans leaching their chemicals into the water supply.

I've, I've got a fancy pants water filter and it's, it's glorious.

And it broke a few weeks ago and I had to revert back to tap water.

And it, you can, it's horrendous, you can just taste the chemicals,

you know, you've got women peeing the contraceptive pill down the toilet,

which is not only poisoning them.

Just think about that contraceptive pill, I mean, it's illogical

to dysregulate physiology.

So obviously the premise behind the contraceptive pill is to stop ovulation,

and that's normal physiological processes.

So it's that, that's what it's all about.

that dramatic for a female.

And obviously, if that's leaked into the toilet and the waterways,

that's going to have a negative impact on our endocrine system.

You know, you've got the demand for milk all year round.

So you've got cattle being fed oestrogen constantly, and it's

dripping into our waterways.

You know, it's an incredibly poisonous world.

So I think you need to then make the most.

out of a bad situation because again you can't escape this unless you know you go

to the country and you know you grow your own veg and hunt your own animals and you

don't subject yourself to social media but again leading nicely onto social media I

think that's utter poison because rather than getting the kind of the reward and

the calming effect that you're seeking as a human being All you're getting is

stress and more questions that can't be answered because there is no real answer

to the question that you're seeking.

Yeah.

Do you think then, sort of taking all that into account, that really

we can actually utilise lifestyle strategies to improve testosterone

production, especially as men?

Or has it gotten to the point where, for the most part, individuals

that you are working with do you find they just need to go straight

on to some sort of replacement?

Oh no.

So, 100 percent they need to be working on all the things that we talk about.

Psychological stress, sleep, nutrition, exercise, and mindset.

Um, before even considering testosterone replacement therapy.

But these are things that you should be doing as a human being anyway.

You know, you should be getting out into nature every day.

You should be considering doing like, grounding, or you should

be doing ice baths, you should be doing saunas, you should be doing

mindful, practicing mindfulness.

All of these kind of calming things to counterbalance the

chaos of the, the overstimulated, oversaturated world that we live in.

Yeah, it's, uh, it's, it's, it's, it's a scary world.

But you should be taking personal responsibility, and I think,

disappointingly, we, we've had a very paternalistic relationship

with, uh, our doctors, and I mean, I would also say the government, and

you know, let's not go into COVID, but kind of, let's not go into that.

But that's been an incredibly disturbing time, and it's created a

lack of, a massive amount of mistrust, and I think it's rightly placed.

. Um, I think we should mistrust, and I think we should be able to take

a step back and critically appraise ourselves the data and the information

and think, does this make sense?

Because I, I'm not, I'm not necessarily sure there's a, I would, I hope there's

not a Machiavellian plan here, but I think it's all motivated by this.

And I think whatever sells, we will be, we will be sold on that concept because.

Uh, there's, there's no carrot association promoting carrots to highlight the

importance of carotene and vitamin A.

It's, it's all sell, sell, sell.

And I, and I think that, that's fundamentally the problem here.

We lack that objectivity because we're oversaturated and

overstimulated with nonsense.

And again, taking that path of least resistance, maximum reward,

but realizing that maximum reward is not longstanding because You've,

you've missed some very vital steps to get to your perceived reward.

Yeah, no, I think, well, you've just said it all.

We really have sort of just, uh, gotten to the point where we aren't

almost able to make decisions anymore, I don't think, not without sort of

some sort of societal influence.

I'd love to just touch on diet quickly.

Some things I know you sort of talked about previously is the use of maybe

modulating carbohydrate intake.

Is this something you still talk about fairly frequently

with your patient population?

Do you feel that there is a place for moderation when it comes to carbohydrates

and helping to control things like SHBG and insulin as a baseline?

Yeah, 100%.

And I think, I think we need to appreciate why we have this

over reliance on carbohydrates.

And again, um, have you read Sapiens: The Brief History of Mankind,

where he talks about communities.

becoming too big to be self sustained and then the farming, um, of wheat, oats, etc.

became the predominant food source.

And then that over reliance came as a result of the fact that We lived in too

big a community to be sustainable with what we should be eating and that's

more of like that paleo style diet.

With regards to carbohydrates, I speak about low carbohydrate, high

fat diets as being the optimal diet.

Now, diet is incredibly particular to the individual and their needs.

So, again, you could go down the rabbit hole of saying,

well, you should do keto then.

Keto is a stress state.

So, Again, we quite like stress from the perspective it's going to help raise SHBG.

But I think keto is not sustainable from the fact that obviously you need

carbohydrates for brain function and then replenishing your glycogen stores

both in the muscle and the liver.

So, it's a short term fix, but you have to have that ability to understand

what you need as a human being.

So, you know, there's evidence to suggest that the ketones are actually

beneficial to brain function.

But I think that's only a temporary fix to allow you to then source carbohydrates

to then restore optimal physiology.

So I think it's a cheat, but the cheat isn't sustainable.

And again, when we look at carbohydrates, you know, we have that appreciation

that, you know, sugar's bad.

I mean, sugar's poison, but carbohydrates are necessary, but they're necessary

in the right amount versus with that over reliance that we've traditionally

had within Western societies.

And then just look at how fat everybody is.

I mean, you know, it, it's, it's plain to see that we're eating too much.

And again, if you're going to get that dopamine hit from the sugar

and simple carbohydrate, you're pre programmed to want more of that.

So you are going to have more of that because you've had a reward.

And I see these kind of like morbidly obese people and I understand how they

get there because essentially they get to that, that, that, that awful state

where the only reward that they get.

It's from that sugar hit and so naturally they go there, but they were never

told in the first place, don't do it.

And then if something's going wrong, then you're going to have to do this.

We'll resort to comfort eating.

I resort to comfort eating every once in a while.

I mean, but I have that awareness, understanding because I'm medicated

and I understand physiology to a reasonable degree, but the average

person's not educated in this.

Okay.

And they will naturally seek a reward and they will go towards it and they

will get to that stage where they're too fat to exercise, to then go, Well,

the only pleasure I get is from food.

And if you, if you speak to fat people, all they talk about is food.

It's like planning the next meal.

It's like, you know, it's eat what you need, not what you want.

You can occasionally have what you want.

But you need to eat what you need, and you don't need a

massive amount of carbohydrates.

You need carbohydrates for brain function and restoration of

glycogen in the liver and muscle.

But have you expelled, have you used that glycogen in the muscle?

And the answer to that question is normally no.

So why are you having that over reliance on carbohydrates?

Because it feels good.

Do you need it?

Differentiation that must be made, but it's not made, because

again, you're not taught about it.

Yeah, no, I agree 100%.

And again, um, I think we're turning into society that just seems to sort of

level polypharmacy and then subsequently as a result of people sort of eating

excess carbohydrates and becoming insulin resistant, they sort of end up on other

compounds like, uh, GLP 1 agonists, which are obviously making, uh, the rounds

at the moment and, It's just leading sort of further down the rabbit hole of

sort of drug induced dysfunction that's as a result of poor lifestyle choices.

Yeah.

The the GLP 1 agonist thing that is gonna be a a an A disaster zone in the future.

Mm-Hmm.

I'm a hundred percent confident.

Uh, one of my patients is a GP and he said that the NHS now is, is

allowing people with A BMI of over 35 to go on these GLP 1 agonists Wow.

And it's like, so number one is that's going to ruin the NHS from the fact that

the pharmaceutical industry is going to make billions and billions and billions.

Number two, I mean, I have a few patients on GLP 1 agonists and we have

a very serious conversation about the fact there's no long term data out

there about the long term effects.

And we also know that there's issues with the pancreas.

Um, but there's also, I'm confident there's issues with the reward system.

So the dopaminergic system.

So the guys that are on it under my, on my clinic have tried everything

and it's literally a last resort and they've had very positive effects.

But again, it's always a benefit risk thing, and the problem is, is nobody

really counsels you about the real risks, because the pharmaceutical industry is

in charge of the healthcare industry.

We've gone on a tangent again, which is my fault.

I'll take ownership of that.

Listen, I love tangents.

Fair enough.

Let's get back onto TRT, uh, well, testosterone and

talk about TRT specifically.

Now there are many ways of skinning this particular cat and A lot of, uh,

institutions, including NHS, obviously, as you know, will, uh, typically sort

of work with, uh, what's called a long form ester of testosterone called Nebido

and they'll give it to you once every four to six weeks, I believe.

No, no.

It's every, it's every 12 weeks and then they, they titrate, up, or

down according to your trough level.

Okay.

And this is obviously one way of.

Yeah, uh, running testosterone, uh, as a replacement therapy, I know you have

a very different way of running it, and this is micro dosing, uh, along with

the use of HCG, um, would you just like to elaborate on that and talk about how

you came across this specific, uh, this particular model or how you developed it?

Why use it?

And then, yeah.

I'd love to also dive a bit deep into the use of HCG as well.

Yeah.

I mean, so, so when we started the clinic back in 2016, we were, we

were quite wet behind the ears.

So w we again, as a, as a, as a doctor, I went by the guidelines.

Um, and so we adhere to the guidelines and we using Nebido.

Had very unsatisfactory results.

I think, you know, private care is one of those, those wonderful domains where

you can offer the best for the patient.

And not have to strictly adhere to the manufacturer guideline.

So we looked at this, the more American model and they were doing twice

weekly injections of medium chain esters, like cypionate and enanthate

and they were having better results, certainly anecdotally on the forums.

Uh, so we adopted them.

Sorry to interrupt, just a quick, uh, note on esters.

So, those are different, essentially, forms of testosterone with a

different half life, is that correct?

So, they last different amounts of times in the body.

Exactly.

So you want a medication that you can safely and effectively

titrate according to effect.

So one of the downsides of Nebido is it's got a massive half life.

So you give it, it has a massive peak and trough.

Um, and then obviously you measure in the trough to sort of see whether

objectively you need to adjust the dose.

But that's nonsensical.

So the reality is, is the NHS adopts Nebido because it's,

it's It's time effective.

So it's an injection that the GP or nurse will give every

12 weeks, so it's no big deal.

So we, we know that it's effective from, from up to a degree.

And I think the emphasis of the NHS is kind of disease prevention,

not health optimization.

Now that, that, that phrase is slightly bastardized by people who

are trying to manipulate physiology to, for performance enhancement,

but health optimization should just be restoring normal physiology.

. So we kind of moved to the sort of the, the medium chain esters and

injections every three and a half days.

And we have positive results from that.

But we had a, a certain cohort of patients who really did not do well

with twice weekly injections, and they were typically the low SHBG guys.

So going back to SHBG, that that helps, uh, it has a buffer

effect on, on the three hormones.

So you, you can have objectively healthy numbers with a low SHBG

and still feel rubbish because you, you don't have that buffer effect.

So then our thinking evolved, obviously did some research and it supported

the idea that obviously from a pharmacokinetic perspective, if you,

you, if you inject more frequently, you have more stable drug levels.

So it makes sense obviously to move to like more frequent injections.

And then with the obviously understanding of normal physiology and then a hold

on how does testosterone get released?

It gets released in a diurnal pattern.

So it's 24, 24, 24, 24.

So day, night, day, night, day, night.

So.

Logically, you know, the, the, the rationalization behind taking any

medication is either to correct pathology or to allow for normal physiology.

So we looked at the idea of microdosing.

So a daily injection to mimic physiology.

So you not only get stable drug levels, but you'd also get a peak.

By the very nature of injecting in the morning.

So then you've got a cohort of people who want to inject at night time.

There's a slight difference between normal physiological

processes and pharmacokinetics.

So injecting early morning is the most effective way of naturally

creating that peak and trough.

So that is gold standard.

So that works in 95 percent of people.

Now the only, the cohort patients were like, wait, I

was going to say 98 to be fair.

Um, there's a very small cohort of patients with super low SHBG who

can't even get stable with that.

And what we do with them is we actually do, we go back to

Nebido, which is kind of ironic.

So we do like a weekly injection because it has a longer half life.

So you can guarantee stable levels with that.

But what you can't guarantee is that sense of well being.

And everybody's chasing the sense of well being.

And again, Day, night, day, night.

So you wake up in the morning with a slight spike of testosterone and you

feel motivated to go and do something.

So you can paradoxically feel too stable.

So the, the low SHBG guys who need Nebido, and again, objectively, you

need to start with the microdosing, but if you do, then move on to the Nebido.

They need, they do need HCG.

So the HCG, uh, again, we like the concept of TRT not to really be

testosterone replacement therapy.

We like the concept to be hormone replacement therapy.

Now exogenous testosterone shuts down the natural production of luteinizing

hormone and follicle stimulating hormone.

Now does that matter because I don't want to be fertile?

Does that matter because I don't want my testicles to be the normal size?

I don't like the idea of something being suppressed by a doctor and

us not really appreciating the real need for that chemical or

that hormone or neurotransmitter.

So, the HCG mimics the luteinizing hormone, now it's got a couple of

subunits, one subunit is more direct towards LH, and the other subunits are

more towards TSH, FSH, and LH, and you can't really predict how much that's

going to be in a particular person.

So the HCG not only does it help preserve testicular size and fertility,

as we alluded to earlier, it also helps the neuroendocrine system, so

there are LH receptors in the brain.

So, with traditional testosterone therapy, whether it be testosterone

microdosing daily, or whether it be testosterone every two, every two,

three days, or longer, you're getting suppression of normal brain function.

So, the HCG.

Neurosteroids

yes, absolutely.

So, so, so, so, so that helps backfill those pathways and people tend to have

an improved sense of well being and libido with HCG in their protocol.

Now, there's always a caveat because there are a few people that

actually do, do quite badly on HCG.

Have you seen Spinal Tap?

No,

not that I know of.

No.

It's, it's, it, it's, it's, it's, it's an old film, so I figure you,

you, you'll be forgiven for that one.

Essentially, with testosterone replacement therapy, you're

always dialed up to the max.

Okay.

So in the film it's 11 and there's like a funny scene about kind

of like, why is it got to 11?

It's one.

louder But, with testosterone replacement therapy, you're, you're dialed up to 10.

With testosterone replacement therapy and HCG, you're dialed up to 11.

So it's the same, but it's one louder.

So again, watch this, watch this, if you didn't watch YouTube, then type it in.

But, if you have other things going on in your life that are causing a

negative impact on your psychology, The HCG can sometimes make that worse.

So if you have a background of anxiety as a result of something else going

on, disappointingly it can sometimes make that a little bit worse.

And again, we also know that the HCG has a relationship with S F M T S H.

So again, increasing metabolism, increasing anxiety.

It's a very small proportion of patients.

Now you go on the internet and you go, Christ, HCG is terrible.

But you have to, there's obviously massive amounts of bias there with 4,

000 plus patients and say 3, 500 are on HCG and they think it's the game changer.

So again, going on the internet is just the worst thing anybody can do.

The premise behind this is hormone replacement therapy, not testosterone

replacement therapy, because again, We don't have a full, full

understanding of normal physiology because, you know, science is ever

evolving, and our appreciation of science is always ever evolving.

A few questions, if you don't mind.

Just going back to the esters, you, I believe you use cypionate for

the most part, is that correct?

Yeah.

Um, that is a medium length ester.

Would it not sort of off the cuff be sort of more effective if micro

dosing to use a particularly a short ester again, something like

propionate, if you are looking at daily minute, uh, administrations?

In theory, yes, but in practice,

no, fundamentally because, uh, the T-max is, is too quick.

And when we, when we have high levels of testosterone,

The T-max being the half life.

Uh, no, the, the, the T-max is, is the, is the time to the maximum co maximum

concentration within, within the blood.

Um, when we spike testosterone, we drop SHBG, so we love SHBG 'cause

it, 'cause it has that buffer effect.

So, the time to T-max is, is too, too quick and, and too dramatic.

And then, obviously, in a, in any medication, you want to measure in a

trough, so before your next injection.

Now, we're looking at the numbers, and we're going, right, okay, well,

that, that number looks suboptimal.

And we're all chasing high normal as men.

Must be high normal.

Must be their 1, 200 nanograms per decilitre

Yeah, I mean, it's, it's absurd.

It's, but.

So you're going to react to that trough and you're going to raise the dose

because by the very nature of the fact that we must be in the optimal range.

But disappointingly, that's going to have a deleterious outcome.

And again, not only is it the SHBG, but you know, also when we spoke about earlier

that testosterone and dopaminergic effect.

And then you're going to spike oestradiol as a result of raising

the testosterone up even more.

So in theory, from a half life perspective, yes.

In practice, no, it's a terrible option.

It's only ever used by athletes and some crappy companies who

have access to propionate and they don't have access to a cypionate

okay, fair enough.

And the use of pregnenolone and DHEA in the place of HCG.

Is that something you've ever sort of experimented with?

Um, obviously DHEA can very quickly sort of go down the oestrogen route.

And I think that's generally the issue most men face when taking that

particular compound, but using that combination as an alternative to HCG,

do you have any thoughts on that?

Yeah.

I mean, we've played around with the idea.

Now, the only patients that we ever actually considered pregnenolone and DHEA

are patients with traumatic brain injury.

So, I'll give you a nice case example.

I had a guy, bilateral orchidectomy, and it's a no testicle, so it couldn't

produce testosterone naturally.

So, we tried him on the normal protocol.

So, we tried him testosterone cypionate HCG, didn't feel anything.

testosterone cypionate on its own, we, we tried other esters, we, we tried

adding in DHEA and pregnenolone and zero real effect, zero sustainable effect.

Okay, and again, they often, people often feel a slight improvement

initially because they get a drug effect from the DHEA and pregnenolone.

But the longstanding effects are normally deleterious because you can't effectively

titrate that dose according to response.

And the problem that we have with pregnenolone and DHEA is, is,

is the fact that you're going to have to take a dose with zero real

appreciation if that's the right dose.

And then you're going to feel subjectively a bit better, and then

you're going to go, I don't feel as good.

So, you know, as you know, cholesterol converts into pregnenolone.

Um, I don't, I don't think the HCG goes that far up to pregnenolone.

I think it's, it's the, the backfilling effect is, is, is

down further down the pathway.

It's, it's been disappointing.

It's, it's probably the summary.

So essentially you've got fewer variables contained with when you're

utilising the HCG and it's just more controllable in that respect.

Yeah.

A hundred percent.

Okay.

That's, that's interesting.

I did not know that.

Yeah, let's let's chat about Enclomifene and SERMs.

Enclomifene is obviously a SERM, and it's been making the rounds in TRT circles

in these cookie cutter clinics recently.

Obviously it is Clomid, which is, I believe, a compound that was originally

utilized in specific cancers in women.

Uh, to sort of, uh, block oestrogen.

However, it has off-target effects in men that result in increases in

LH and FSH signalling, which as we now know, increased testosterone.

But it's a pill form, and all it's doing is it's essentially increasing as I just

said, these signals that then increase testosterone and sperm production.

Do you have any thoughts on that as a potential treatment

option or is it more a no go?

Yeah, it's, it's, it is a no-go.

So, um, ch

Clomid, we, we, we, we do use it for male infertility, so as, as

we said, the premise behind TRT is HRT, so it's, it's normalizing

testicular function with the HCG.

The Clomid is,as you rightly said, it will stimulate the release of

LH and FSH down to the testicles.

But the problem is, is, we like oestrogen in the brain.

You know, it's neuroprotective.

And you cannot titrate the dose to the necessary level

with a crude drug like clomid.

And that extends into Enclomifene, so whilst there's two isomers in the

clomid, Enclomifene is touted as a more effective version because it doesn't

have the uh, the opposing effect.

But it's nonsensical.

It's okay short term because it does what it says on the tin.

It's gonna raise LH and FSH production because the brain is gonna think

it hasn't got any oestradiol.

But, we need oestradiol for neuroendocrine regulation and brain function.

So disappointing again, is that there's just a lot of

misinformation on the internet.

And unfortunately it's being used again, it's supply and demand.

But a lot of these things you'll, you'll hear some people saying,

well, this is the new drug and this is this it's because they've got

access to it or they've got it cheap.

And again, fundamentally TRT should always be either testosterone

cypionate or an enanthate and HCG, and then you move on from there.

And I think, I think it's just a marketing thing.

And it's going to yield disappointing results as a result of the fact that

it dysregulates a hormone in your brain that we know, obviously, when we spoke

about earlier, the relationship with oestradiol and serotonin, that you need.

And again, if you distort anything in the brain, it distorts everything.

Yeah, and I think ultimately there is going to be some receptor down

regulation with LH and FSH receptors when utilizing compounds like these.

And you probably, I'd imagine, just making this, thinking this

through mechanistically, you would ultimately end up with back at square

one with low testosterone again.

I suppose in a similar vein, uh, people who use HCG as a monotherapy.

Have you ever, uh, trialed that specifically in your practice?

Um, we, we have, again, same, same principle, downregulation.

The data, we don't have much, much data, robust data for 100 IU of HCG daily, but

anecdotally in my practice with 4, 000 plus patients, we have lots of anecdotal

data to support that is a very good dose.

Um, does not lead to down regulation.

And how do we know that we'll be doing it for eight years?

Does that mean 20 years?

I don't know, but I mean, in eight years, I would, I would think that

we would see some down regulation.

And the reason why we don't, we know there's no down regulation is because

the testosterone doses haven't changed and they've been with us eight years.

And the testosterone levels has remained, you know, practically the same, you

know, sometimes higher, sometimes lower because of other variables.

So I'm confident that a hundred IU of HCG does not down regulate.

the testicles.

I'm also confident that high doses does, because again, we have seen that.

So we've, some of these post finasteride guys are incredibly challenging to manage.

Now we always want to act in the best interest of the patient.

So again, disappointingly on the internet, it's well, it's HCG monotherapy worked.

Okay.

So you, so you try HCG monotherapy at a relatively high dose.

Um, and.

They yield positive results temporarily, but by three months, what we find

is the testosterone levels are dropping and they don't subjectively

feel as good as they want to feel.

Because again, if we think about comparing natural with pharmacology,

the LH is released down to the testicles in a pulsatile manner, isn't it?

So it's not released at a constant rate.

Now with the HCG you're constantly saturating that receptor.

And.

by that very nature, you know, again, normal principles, you are

going to downregulate that receptor.

So it's absolutely logical that, you know, you can't use something in this and

compare it with the naturally producing hormone because they're different.

So then you have to adjust it accordingly.

And, uh, and we, and we've seen that, yeah, a higher dose of HCG

will eventually downregulate.

And again, we're not, that's not what we're trying to do.

We're, we're trying to give, That patient a protocol that's

going to be sustainable forever.

Yeah.

Not have to be adjusted.

And then what would you do if it downregulates?

Back to square one.

It's a disaster.

Again, let's try and replicate natural physiology as much as possible.

Yeah.

A hundred percent.

Cool.

You up for some quick rapid fire questions?

Uh, I'll say yes.

Okay.

Let's see how far we get with these.

Okay.

Prostate.

Um, often viewed as a stumbling block with age, uh, with TRT.

Do you ever find that to be an issue?

No.

Okay, that was nice and sweet and short.

Yeah, I mean, yeah, no, utterly no.

I mean, it's touted as being, uh, detrimental to prostate health.

If, if you, again, the problem is, is the data is based on crappy protocols.

If you've got a protocol that mimics natural physiology, obviously

healthy hormone levels are necessary for normal prostate function.

So it's logical if you've got a normal testosterone and a normal

oestradiol, and we know that oestradiol is probably more causative than

testosterone in prostate disorders.

And traditionally we've always thought it'd be a BPH.

Dihydrotestosterone.

Again, anecdotally, from clinical experience and more supporting

data is evolving, that oestradiol seems to be more causative.

And they don't look at

oestradiol.

So yeah, no, we normally see an improvement in LUTs.

Um, we've only ever had one prostate cancer and that was on pre screening, uh,

from a guy who'd been self medicating with massive doses of testosterone because his

SHBG was low, he kept on upping the dose.

And he had a subsequent oestradiol of 700.

Um, but yeah, yeah, yeah, yeah, yeah.

But, um, yeah, we, we, we, we don't, we don't see prostate problems.

Fair enough.

That perfectly, again, another perfect segue into my next one.

Do you ever use aromatase inhibitors, AIs?

What are your thoughts on them?

Yeah.

In principle, you shouldn't want to, or need to use an aromatase inhibitor, but

in practice, You, we do it, but, but just, just, just remember this, the, the

theme, it's a, it's a breast cancer drug.

Yeah.

So why are you using a breast?

It's the mechanism of action.

That's the reason why we use a drug.

I made that mistake earlier.

Hey?

No, I was just going to say, I apologize.

I made a mistake earlier.

I got my AIs and SERMs mixed up.

I was, I mentioned that.

Uh, Clomid was essentially an AI not a SERM.

So just to clarify that,

think you said SERM

I thought you said Clomid was a SERM

yeah.

No, but I mentioned that Clomid was utilized in breast cancer, not, uh, an AI.

Okay.

Yeah.

Um, so aromatase inhibitors, the issue with aromatase

inhibitors is irresponsible use.

Mm.

So it's, so again, if you carefully titrate the dose according to effect,

it's carefully titrated according to effect for safe practice.

The problem that you've got with AI is, number one, it's they're

prescribed by people who dunno what they're talking about and

irresponsibly when they are prescribed.

If you imagine the dose of dose of an aromatase in a female, you'd

say for, we, we use the Exemestane.

If, if, if we need to use it suicidal.

Yeah, it's much better from the, from, from the natural result from

the fact that that's a competitively, um, binds to the receptor.

We use a dose of, a starting dose of one milligram every three days.

So that's 0.

33 milligrams.

And that's normally effective.

And we titrate up sometimes to one milligram daily.

The dose that you get as a, as a female, that's commercially

available is 25 milligrams.

So that's a 75th of the dose.

Now you're going to imagine the internet's all going to be like, take a quarter

of a tablet, take a half a tablet.

You're absolutely comparing apples and oranges.

And, and again, the, the kind of one of the problems with an aromatase inhibitor

is you, you will yield a positive result by appropriate prescribing.

But it has to be monitored.

So say you lose 10 kilos or you say you improve your metabolic health and your

liver function improves, then your need for aromatase inhibitor will decrease.

So your dose has to be adjusted.

And again, we're always looking to put somebody on the minimum effective dose.

And because the aromatase inhibitor has a fixed dose response and perhaps the

testosterone and HCG is not going to have that fixed dose response because there's

going to be a variable on how much you utilize, how much HCG is going to produce

testosterone, that doesn't matter so much.

Whereas if there's a fixed dose response from a medication, that does matter,

which is why those patients are monitored regularly to go, do you still need it?

And often, yes.

But it has to be done safely.

Again, you know, the whole incentive for the fact that it's a breast

cancer drug is, it's absurd.

It's, it's, it's the mechanism of action.

But as with any medication, it has to be prescribed safely.

Yeah, it's just another tool in the toolbox and has to be utilised

in the right circumstances.

I'd imagine that you normally utilise them when you're dealing with an

individual who already has a high level of body fat and is likely to

sort of potentially overly aromatize the testosterone you then give them?

Yeah, I mean, we're always trying to motivate patients to

be better versions of themselves.

But as, as you rightly said, it's a necessary tool sometimes.

So in principle we say, right go.

listen, you're on testosterone now, you know, you've got high oestradiol

but you know you need to go and lose 10 kilos and you'll be golden.

But you try telling somebody with high oestradiol who feels like

crap to go do the right things

with low SHBG

. Yeah.

I mean, so, so you, you sometimes have to use these necessary tools.

to allow them to lose the weight, then not need the necessary tool.

Yeah.

Uh, that makes total sense.

Next one.

Let's go back to 5AR inhibitors.

I can, I gather you're not a fan.

These being 5 alpha reductase inhibitors.

It's scary.

I think the fact that you can open Instagram, scroll through your

feed and um, Yeah, you have four or five companies just selling drugs

like finasteride over the counter.

And there is no, you can just, again, there, there is no process

by which someone has to go through any sort of medical exam.

You can just get them.

So yeah, and they are incredibly, can be incredibly life altering drugs if

somebody does not react well to them.

Yeah.

I have a very strong opinion about this because of, because I see guys.

Desperate guys with post finasteride syndrome.

Sometimes that desperate that they'll turn up to the new patient consultation

and I'll give them the appropriate counselling and we'll start them on

therapy and I never hear from them again.

They're in a state of absolute chaos and anxiety as a result of finasteride.

And again, it has to do with the fact not only does it reduce DHT but it also

has an impact on the brain function.

Not only does DHT obviously have an impact on brain function, But it's to

do with that neurosteroidal pathway, and essentially it's to do with the

negative impact it has on GABA, which is obviously an inhibitory neurotransmitter.

So, if you're dis you should never, ever dysregulate physiology.

It's, it's, it's an absurd concept to give a drug to dysregulate

physiology to preserve your hair.

When hair loss is genetic, and, you know, there are some dietary things that you

should be eating a healthy diet and eating the right micronutri micronutrients.

Thank you.

But it's genetic, and if your self esteem and self worth is based on having a full

head of hair, I feel very sorry for you.

Because, you know, your confidence and self esteem should come from

within, and you should be able to project that onto society without

the need for a Vidal Sassoon haircut.

We I'm I think it's utterly disgusting that it's even commercially available.

I mean, we obviously know that it was originally used for prostate

issues, benign prostatic hyperplasia, and obviously it's evolved into

this male pattern baldness cure.

Absolutely fucking disgusting.

Um, and I, I've been approached by big companies, probably one of the

companies that you, you, you, you be, you'll be thinking about as well to

say, would, would I like to head that testosterone replacement therapy program?

And it was just, uh, I, I gave him a real earful and I said, I

would never be associated with a company that sells finasteride.

Not only would I not be associated with a company that doesn't do testosterone

replacement therapy face to face, um, and provide the necessary support, but I

just said, I have nothing to do with you.

Yeah, no, it is.

It is another drug that I think definitely has its place.

And I think if you're one of the lucky individuals who doesn't

have any side effects, then great.

But you, for the most part, I think individuals, obviously men in

particular, are really playing with fire when they're sort of trying

to crush their, uh, 5AR enzymes.

And as you

It's, it's sometimes one dose.

Yeah.

They, they, they, they, they, they could say, I've just, I had one dose.

And then obviously everybody would say, well, it's because

you, you, you're mental anyway.

It's like, come on, I only took one dose of this drug.

And, and now I've got intractable anxiety, and I've got numbness,

and I, and I can't get an erection.

It's like, yeah, you're absolutely playing with fire, and I, and I

think, you know, as you said, the vast majority of guys are okay.

And so my, my opinion's very biased, because I'm, but I see

the arse end of this, and the arse end of this is dire Yeah.

So you can't predict who's going to, who's going to struggle with this.

Of course not.

And, uh, so essentially it's not the one to 5 percent of individuals

who may have side effects.

Do you think that's fairly underreported?

I don't know.

Um, again, the reality is, is, uh, is I'm obviously biased.

I only, I only hear the negatives.

But when I hear the negatives, I would steer clear.

I wouldn't be able to say one to 5 percent because I don't know how many are sold.

And I don't think we know at all really because of the online companies.

So I don't, I don't think we'll ever get proper statistics, but

when you do have post Finasteride syndrome, you're in trouble.

Yeah, no, it's, it's not a pleasant place to be.

Dr.

Stevens, I just want to sort of be cognizant of the time, but before we

go, I'd just love to learn how you incorporate all of this into your life.

I assume you're on TRT yourself, and I assume you practice what you preach, but

How are you incorporating all of this, all of these sort of, yeah, these tools,

these lifestyle strategies into your life on a daily basis to live your best life?

Yeah, and I think that that really is, I'm just, I'm smiling because I've, I've,

I was thinking in the gym this morning.

about a video, how to lead your best life.

So this is, this is quite poignant.

Um, I've been in a very privileged position.

So sat across me have been 4, 000 case studies.

My focus is, is, has, has been testosterone, testosterone, testosterone.

And as we alluded to earlier, it's not just testosterone.

And so what, so our thought and our, and our process has evolved into the idea.

The necessary idea that you have to encapsulate and incorporate everything

to be the best version of yourself.

So we, we live by the mantra, earn your reward.

So the more that we understand about this, this whole process is that

the testosterone is the foundation.

TRT is the catalyst for change.

Ultimately, you have to take personal responsibility to look at all the things

that you should be looking at, and that's reducing psychological stress.

getting good sleep, eating correct, engaging in physical exercise,

having the right mindset incredibly important because testosterone

is not going to do that for you.

Now we alluded to again earlier, testosterone has a relationship

with dopamine, so it's the reward hormone to allow you to feel good.

But you consciously have to put the effort in to do that, because

you can still sit there and eat McDonald's and feel like crap.

So it's about taking personal responsibility.

And again, the 4, 000 plus patients, the fact that this is all I do.

Has, has led me to understand that we are so far removed from nature

and we need the coping mechanisms in place to deal with the constant chaos

and oversaturation and assimilation.

So, how do I do it?

An ice bath every morning.

I used to do breath work, but I've been lazy, I probably

should go back to breath work.

Um, regular wood fire saunas.

Regular physical exercise.

Running the dogs in nature, regular expeditions to remove myself

from the stupidity of this world.

Which allows me, affords me the opportunity to go and earn my reward

in like just Machu Picchu and all the expeditions that we're, that we're

doing and have done and, you know, we're doing the fan dance in January just

to sort of create more of a community of positive, like minded people to

understand what you should be doing as opposed to what you have been doing.

That's amazing.

And where can people find you if they want to work with you?

Um, the menshealthclinic.

co.

uk.

Perfect.

Um, I do like YouTube channel where I sit in my Landie and talk

about testosterone related issues.

Um, I've got Instagram and stuff.

Perfect.

We'll link to all of those socials in the show notes.

Dr.

Stevens, thank you so much for your time.

I really appreciate it.

Learned a lot and yep, I look forward to hopefully doing this again soon.