Joining me today is my longtime friend Allie Gilbert, she joined me during her bachelorette weekend to talk all about erections, testosterone, and all things male hormones and sexual potency. A two-time Golf Digest Top 50 Golf-Fitness Professional & Trainer, Ali has become highly sought after for her unique approach to training that combines nutrition, training, and lifestyle hacks to alter body composition and optimize metabolism.
Ali holds a B.S. in Exercise Science from Springfield College, and holds certifications through the Titleist Performance Institute (TPI) Certified Level 3 Fitness Professional, NSCA as a Certified Strength & Conditioning Specialist, FMS Certified Level II, CFSC, FRCMs & SFG 1.
Connect with Ali @thealigilbert
Connect with Jade @jadeteta
Learn more about becoming a Next Level Human at www.jadeteta.com
Jade: [01:17] Alright, what’s up everybody? Welcome to today’s show. I’m with my good friend Ali Gilbert. How long have we known each other now?
Ali: [01:24] Fuck. I think almost 15 years maybe? 12 years?
Jade: [01:27] It’s been a while.
Ali: [01:28] I feel old!
Jade: [01:29] Yeah. I feel old too. Man, we’re getting old. You don’t look it though.
Ali: [01:32] You’re all bougie, drinking LaCroix now. Look at this guy. Who’s he turned into?
Jade: [01:38] What are you trying to say, man? This is just sparkling tap water.
Ali: [01:42] Ew.
Jade: [01:44] Alright. So look, I’m so exciting you’re here. Ali rolled through Los Angeles. You’re here on your…?
Ali: [01:50] Bachelorette weekend.
Jade: [01:51] Yeah, this is a big weekend for you. But I grabbed her, brought her into the studio – a.k.a. apartment – and we’re going to talk…
Ali: [02:01] Boners.
Jade: [02:02] All about erections, testosterone, penis, all that kind of stuff.
Ali: [02:06] Our favorite topic.
Jade: [02:07] Our favorite topic, and we’re always laughing about it.
Ali: [02:09] Which so much that I learned from you.
Jade: [02:11] And vice versa.
Ali: [02:12] Yes.
Jade: [02:13] So, just real quick, let me give you sort of a little bit of an introduction. Most people know me – and this is what I’ve heard about you, actually, I don’t know if I’ve told you this, but it’s funny – people see me and they go, it’s so weird, you’re like the female metabolism expert and you’re like so… dude. You know what I mean? It’s like this big burly linebacker looking guy who talks about female hormones. Then, you got this little, cute, tiny thing, who her specialty, Ali’s specialty, is actually male hormones and testosterone. So, we’re kind of like alter egos in a sense, even though she does a lot with female hormones as well and I do a lot with male hormones. It’s just kind of what we’ve kind of been known for.
Ali: [02:51] Yeah, that’s funny. It’s funny.
Jade: [02:53] So, let’s actually get started, and I’ll just kind of get us into the discussion ‘cause I just figured we’d have a discussion around this, but let’s just get everyone up to date, and I guess we’ll talk to both the, you know, women and men who are interested in male hormonal metabolism and health. To get us started, what would you say would be the biggest things, biggest misconceptions, or pieces of information that people need to know sort of right off the bat about men and testosterone and all that kind of stuff. Like, what are your key points that you’re just like here’s where we really should start.
Ali: [03:30] I think that guys need to realize that number 1, it’s ok to want to know about it. As you know, men don’t go to the doctor, so they don’t really ask the right questions all the time, or it’s an ego thing or a pride thing, and I think that’s where being a female comes in handy because I’m not the wife or the girlfriend or whatever, I’m a woman who’s saying hey, it’s ok if you’re experiencing some erectile issues, it’s of if you don’t feel like yourself, or you don’t feel like the man you used to be. Just understanding that and being able to confront that, you know what, something’s wrong, I think is a great place to start because I think a guy doesn’t really know to start there. And it could be a testosterone issue, but the way our society is these days with stress and everything, like… it effects so much, as you know. So, I think getting past the myths and misconceptions, and not really taking what a GP doctor would say verbatim with the scare tactics of it causing cancer and all those things, I think understanding you know what, I need to ask more questions would probably be a good way.
Jade: [04:39] Alright, so let’s unpack this a little bit and basically start with this idea of how would a guy know that he potentially, at any age, really – you know, let’s say – because now we’re seeing people with low testosterone in their 20s that have come into my office, and you’re just like what is going on here. Actually, funny story about this, remember I had a guy late 20s, so mid to late 20s, probably 26, 27 if I remember correctly, and when I was in clinic, and his numbers on – just so everyone knows, typically labs will be a little bit different, but the low end of normal on a lab is 250; the high end of normal on a lab is usually around 1,000-1,200 – and so this guy was like in the 2s. And my father – I happened to have his testosterone level – at that time, he was probably – he’s 77 now, so maybe near 70 – and he’s up near 800.
Ali: [05:34] Wow.
Jade: [05:35] Right? It’s this really interesting thing that we – first point I’m trying to make is it’s not necessarily the age of the person, that very young men can have issues here, and also the symptoms can vary. So, based on a blood lab - obviously if you’re low, you may want to be looking at this – but I want you to walk us through how would you necessarily, like maybe they’re in that range of 400/500, low-normal on a lab, and maybe having symptoms. What would those symptoms be? Like, how would you sort of walk us through and say here’s what you need to look out for if you’re low testosterone as a man.
Ali: [06:11] I think, you know, most of the guys who would be low – and I think, actually 4-500 is like, if a guy in the 30s, 40s comes in with that, that’s pretty cool. That’s like, alright, they’re actually way higher than a lot of the kids that we’re seeing in the 1 and 200s. But if they’re low-normal like that and all of sudden they start to feel more lethargic than usual, and they’re gaining bodyfat in places they’ve never noticed, or they just don’t have the sex drive that they used to and maybe their erection strength isn’t the same, or maybe it’s not even as frequent, so, you know, morning wood could be an indicator of that, but it’s usually likely to be more of a stress issue in that sense. And I think guys just kind of overall feel this malaise of life where they just don’t feel like they used to and they had a ton of energy, and they maybe had more optimal testosterone levels. It’s kind of like a disinterest in the manly things.
Jade: [07:08] So, brain – what would be going on in their brain? So, you say lack of drive, lack of ambition, lack of interest in not just sex, but things in general, feeling like low energy, low vitality; and I think we usually think low ambition and low drive, because when I think of testosterone, I kind of think of it as sort of a dopamine potentiating hormone. Dopamine is a brain chemical that keeps us focused and kind of ambitious and sort of pleasure-seeking, and testosterone is known as a competitive sort of hormone. I often times say, and I know you said this too, that men want to WIN. That’s sort of like they have this drive to win, and when they start to lose that, we start to suspect maybe there’s something going on with testosterone. Then, where would be the areas that they would start to gain fat in particular? You know, walk us through that.
Ali: [08:02] Could be in the boobs, like man boobs, similar to the female fat storage pattern. So, around the hips, maybe the thighs. I’ve seen some guys who become more estrogenic or who are born that way have hyperextended knees. Have you seen that too? Then, around the stomach, obviously, and it kind of creeps up on them and they’re like ok, where did this come from; like oh, it’s my age, maybe I should do something about it.
Jade: [08:31] I love what you’re saying there. If you’re listening to what Ali’s kind of saying, there’s this really weird – and correct me if I’m wrong on this, Ali – but I’ve always seen sort of this really interesting thing; you’ll have men who are high estrogen, and men who are low testosterone, and sometimes those things go hand in hand, and sometimes they don’t. I tend to look at men and go ok, if they’re storing fat around the hips and butt – we’ve all kind of seen this on some men; it’s kind of like this pear-shaped man – you know, I’m thinking higher estrogen, man boobs, that kind of stuff. Then, if I’m seeing belly fat, I’m thinking low testosterone. And often times you see all of that come together, where it’s estrogen – higher estrogen and lower testosterone. But sometimes, you know, you can kind of tease that out, and it’s just dependent on the man, and I think you have to make that determination. Is this an estrogen related issue? Is this a testosterone related issue? Is it both? And this one of things in men where testosterone and estrogen – men need estrogen as well, both for health AND for proper erection – but it has to be in sort of a balance. Is that kind of how you see it as well?
Ali: [09:37] Yeah. Like, Charlie and I go to Disney a lot, and Disney is full of shapes of people that you don’t know exist. I look at them and I’m like, ok, what hormone or hormones are off here? And I’m like God, there’s so much content for me, and he’s like don’t take pictures of people. But you do see that! You’re just like wow, there’s fat storage in places that, you know, and you see like ok, like obviously, low GH, and high insulin, and cortisol, those are another conversation. But you see these men, and from behind you’re like is this a man or a woman?
Jade: [10:12] Yep, yep.
Ali: [10:13] You know? It’s really, it’s sad, but it’s also this is the state of our society.
Jade: [10:17] And it’s interesting – that’s a whole interesting discussion, because a lot of us who work with hormones have hypothesized about that for some time. There’s not any great science on it. As a matter of fact, if you want to start looking at this, you can look at transgender populations who are basically male conversion of female and female conversion of male. That’s where a lot of the information will come from in terms of where we see these things show up, but it is a hypothesis we all talk about, but we don’t really have a good way to kind of prove it. Like, we can kind of say insulin and cortisol are sort of belly fat hormones. Testosterone tends to keep belly fat off of a male, but tends to actually mean a woman will have thicker, more belly fat. Human growth hormone tends to lean out the belly. There’s a synergy between estrogen and human growth hormone. So, when you start getting into this, it’s very difficult to tease apart fat storing patterns, but it’s funny because as you get good at it, you do start to wonder and hypothesize about these things when you look at individuals. And I know Charles Poliquin did a lot of that as well in his work. I think he had a whole entire course on that where he was looking at-
Ali: [11:23] Course on it.
Jade: [11:25] And I know he got a lot of flak for that because there’s not really any science on that. But it’s just this, sometimes in the clinical world, we tend to pick up on stuff like that and can use it sort of to judge. Ok, so we’ve talked about sort of the brain effects. we’ve talked about sort of the body storage effects. Obviously, walk us through some of the issues with the erections, because that’s the thing that most men are going to be most concerned about, and that’s going to be the first thing that makes them even – even if they’re feeling a little lethargic in the brain, once a male starts seeing issues with is an erection, the whole world, in his eyes, is blowing up. It’s like that’s when they start going uh-oh, something’s wrong here.
Ali: [12:08] Yeah, that’s when they might consider going to the doctor.
Jade: [12:10] Yeah.
Ali: [12:11] But, you know, I get it. It’s a scary thing to tell a doctor, like listen, I’m having erectile issues, or to even admit that, because as you know, depression is very commonly diagnosed when guys just need hormone testing. Doctors won’t do that, they’ll just be like here, here’s a happy pill. But with the erections, a lot of people are like oh, so do you like talk to guys about their erections on day 1, and I’m like no, it’s not like hey, I’m Ali, nice to meet you.
Jade: [12:40] Well, Ali texts me on the regular and be like Jade, how are your erections?
Ali: [12:44] Like, did you get morning wood today?
Jade: [12:46] I know. Any guy friend that’s a friend of Ali’s is like-
Ali: [12:50] But I actually-
Jade: [12:51] What’s Charlie, your fiancé, think about that?
Ali: [12:54] I know. I have progress photos of half-naked guys on my phone and stuff. But, it’s funny because I will have some of my guys, they’re like I got morning wood 4 days this week, and it’s similar to a woman’s period. It’s a sign of their health. So, when that, which is such a sign of the man being able to be a man, not only in bed, but to wake up like alright, I’m going to have a rock-hard erection. And if the body’s so stressed out, that’s not priority, like erections are not priority. Procreation, it doesn’t care about that.
Jade: [13:30] Walk us through the details on - because I know you talk about that – but walk us through the details, why is morning erection in a man so important to pay attention to. What should the morning erection be like, quality, quantity, that kind of thing. Walk us through some of your evaluations of that and why you see it as so important.
Ali: [13:50] So, from personal experience, Charlie? So, they’re actually – we should make the point, there are a handful of guys who don’t get morning wood and never have, and they always freak out and they’re like I never got that, should I worry about that? And maybe you can comment further on that, but what I tell them is like, you know, if it’s something you never had, not something to worry about, but if something you’re waking up with regularly and you have all your life and all of a sudden that goes away, then yeah, maybe we want to look at that. So, if a guy wakes up extremely hard, as he should, for him it’s a sign of like, yeah, ready to go, things are firing. You know that he got a good night’s sleep because you have to be very parasympathetic in order to achieve that erection. As soon as that kind of starts being less frequent, or the strength of the erection does not last, or he goes soft relatively early, that can really mess with his ego, and when something messes with your ego, that’s an automatic stressor. In essence, it’s kind of a vicious cycle that can make that get worse unless he addresses that problem. And as I’ve learned from you also, a lot of that has to do with how he manages stress the rest of the day, the other 23 hours.
Jade: [15:07] Yeah. And to me, sort of the morning erection, it’s really interesting – the theories on this, they don’t know exactly why this happens – partly, if a man has to urinate, one of the theories is that the morning erection is keeping him from basically peeing the bed because it is essentially pinching off, to some degree, the urethra. Any man will tell you, it’s very difficult to urinate when you have a very strong erection.
Ali: [15:31] I have a slide with all the different positions, actually.
Jade: [15:33] Yeah, right. It’s funny because I remember in college – this is just funny shit – but I remember we had one of these stand-up showers in college. Wake up in the morning and all the guys are basically using the shower because they don’t want to bend over, and it was disgusting. So, what they want to do, they go stand in the shower because they’re all like, have their morning erections, and they pee standing up in the shower rather than trying to pee in a toilet where you have to kind of angle yourself and put yourself down.
Ali: [16:02] Superman.
Jade: [16:03] Yeah, exactly. So, that’s one sort of potential theory. The other thing about erections too is they – it is exercise for the penis. So, one other interesting thing is just like we need to move our bodies, otherwise they’ll atrophy, so same with the penis. It’s a little bit different muscle, but it is exercise for the penis to push blood through it on a regular basis, and this tends to happen in the morning. So, these are some of the theories around this, and of course, testosterone’s really interesting because a lot of guys would sort of be like, well, is testosterone giving me an erection? No, what testosterone - what we believe it is doing is it is interacting with the penile tissue and enhancing certain receptors and certain muscle functions, and really sort of priming the penis for the other erection trigger. So, that’s one of the things why testosterone is important. I think what you’re alluding to, Ali, is the idea that if testosterone is not present, you may start to see this morning erection start to falter. But to answer your question about the men who don’t have it, it’s ultimately – in clinical practice, we’re always going what has changed. So, a man who doesn’t necessarily get erections, they probably do, they’re just probably getting it earlier in the night, because this is something that the body does to kind of theoretically exercise the penis; so, they’re probably just not noticing it first thing in the morning, maybe it happens earlier. But to your point, if they are responsive to sexual stimuli, and getting strong erections, that’s a good sign. The other thing about men, most men will tell you and most women know this about men, they have a special relationship with masturbation that women don’t necessarily have. So, again, one of the things I often times ask about with men is are you able to get and sustain strong erections with masturbation. What you’ll find is that that starts to fall off as well, so men will notice that, but to your point, they don’t always want to talk about that because it’s something that – women are more comfortable being “vulnerable” and open than men are with some of these sensitive things. So, that’s partly what we’re looking at, and actually, I believe now in the research – because they have all these scores, if you know, about like these erection scores and how to quantify and qualify erections – and one of the things they’re doing now is the masturbation erection scale, where they’re basically asking questions around that. And any good clinician tends to do that anyway – are you getting morning erections, how firm are they, have they changed; when you masturbate are you able to maintain an erection or not; with sex, how strong are your erections, how long do they last, and that kind of thing. We can certainly get into some of the discussion around, you know, some of this is overuse. I’ve certainly had many men who will, you know, who are masturbating and watching porn like crazy.
Ali: [18:59] Porn, yeah. That’s a big deal.
Jade: [19:00] And that is going to impact their ability to keep the penis sensitive to stimuli and also responsive to erection as much as you’re doing that. So, that is – and even girlfriends will tell you that. It’s just like, what is going on? You’re masturbating all the time and that’s why you’re not able to achieve an erection. I don’t know if you have any thoughts about that, but I do think sort of quantifying erections and talking about that is important.
Ali: [19:28] Well, how much porn is too much porn? I’ve been asked that.
Jade: [19:31] That’s another interesting.
Ali: [19:32] You know, it’s how do you quantify? Ok, so how much are you watching? Because obviously, there’s the difference between a guy who maybe sits at home and watches it 6 hours a day, or there’s the everyday, or the guy who just travels.
Jade: [19:46] Yeah.
Ali: [19:47] And two part question – what are the effects of that with the constant hits of dopamine with porn and as it relates to erections; and then, how do we help guide those men who are able to achieve erection, because they do watch porn, but when they’re in bed with a partner, they can achieve erection, but maybe they go soft early, or they can’t get that same strength in their erection to be able to finish or please their partner.
Jade: [20:16] Well, a couple things with that. The research is mixed. You’ll find research saying that porn has no impact on erections, and it’s not addictive; and you’ll also find research that says it is. And usually, when you’re looking at research like that, usually what that means is that there is a population of men – sometimes they will be included in the studies and sometimes they won’t; remember, studies are a tool for averages not individuals – and so, probably whenever you see studies like that, you have to begin to qualify and say let’s look at men who are heavily involved with porn, let’s just focus on those, and let’s see if we can find effects. And right now, the research is kind of all over the place. I was just reading a study this morning because I tend to, as you know, I tend to be in bed in the morning-
Ali: [21:01] Oh yeah, everyday.
Jade: [21:03] -and reading research, at least reading abstracts, and then sometimes I’ll delve in. And they’re actually coming up with, again, a survey to essentially quantify these individuals and say who is porn-reactive and who is not. So again, the idea that porn is going to be bad for all men is not true, and we still don’t know what might be too much, and it’s probably very similar to people who do drugs. Some people can do it recreationally when they’re in their college ages and have no problems, some people get hooked on them, and it’s probably sort of the same sort of thing here. I will tell you this that’s interesting, watching pornography – from two studies that I’m aware of – watching pornography for men, where they masturbate or not, and either do or do not ejaculate, if you don’t ejaculate through masturbation, you’re actually stimulating testosterone production. So, that is probably a reliable way to increase testosterone in men. As a matter of fact, one really interesting study was they had men go to the gym and they had them watch erotic stimuli, motivational interviews - motivational stuff like maybe watching a clip of Conan the Barbarian, or like watching porn, watching two people have sex, and then they also had them watch things like comedy and stuff like that – then they’re measuring their hormonal profiles. What they found is watching something motivational and/or porn gives you the same kind of bump in testosterone as would a motivational thing. So, pornography certainly has, perhaps, a stimulatory impact in that way. But, if you’re watching it, masturbating, and finishing every time, you’re probably going to maybe have testosterone be low. So, that’s one way to look at it.
Ali: [22:57] So, what you’re saying is… like masturbate, watch porn, don’t finish, go to the gym.
Jade: [23:07] Based on this particular study, it may actually enhance testosterone production, absolutely.
Ali: [23:12] Interesting.
Jade: [23:13] We don’t know if that’s the case with women, but that kind of makes some sense, right? It’s like men are very visually sort of stimulated sexually, so they’re going to see that. That is a testosterone enhancer. So, the things that stimulate – competition stimulates testosterone in men. We now know sexual activity, watching sexual activity, may stimulate it as well. You might say, well, I think maybe the chronic effect of overly masturbating and finishing all the time with porn maybe – now, to me, it’s maybe, because you and I work in a very gray zone area now; we don’t know a whole lot about what this is – we know that testosterone is related for sure, but like we just talked about with the whole thing about body composition, fat storage, and stuff like that, there are other hormones and things involved.
Ali: [24:09] Correct.
Jade: [24:10] Anything that I missed there that you kind of want to make sure people understand? I think it’s important – what we’re basically trying to do for you all listening is help you quantify and qualify what things are going on with erections, and especially some of the stuff you normally won’t hear about that you’ll have Ali and I talk about. We don’t have these discussions [inaudible].
Ali: [24:27] Yeah, because there’s nothing that’s TMI in our world.
Jade: [24:32] Exactly.
Ali: [24:33] Because I’ve read also different studies where they will not allow men to finish for a number of days, and then testosterone jumps like 600%. But does that do anything circulatory-wise?
Jade: [24:47] Yeah, we don’t know, right? That’s the interesting thing. Theoretically, that should boost performance, and I think some of those studies have actually shown that there is a boost also in performance – and by performance, I mean performance in the gym, not performance in the bedroom. We will try to – as we have this discussion – try to distinguish between the two, but I would say for most men, especially if we’re talking about optimizing testosterone, anything you can do, especially as you age, that does that is probably a good idea. And I think that kind of goes into stuff we tend to – and I want to get your thoughts – but what we tend to do, I think, in this field a lot, the people who work with testosterone, we tend to always think that testosterone equals erection.
Ali: [25:38] Yeah.
Jade: [25:39] And it’s doesn’t, but clinically – and I’ll ask you this, but I’ll give you, everyone listening, my take on this – clinically, it’s a little bit more than related average. but it’s not a sure thing. For example, I was telling Ali before we got on, because we were talking about things, that I take testosterone replacement therapy. I was diagnosed, I was in the 200s when I diagnosed myself with low-T probably in my late 30s. At that time, I had no problems with erections. I had never had any issues with erections. It wasn’t until I actually went on testosterone replacement therapy that I noticed a change in my erections to a weaker erection, so it’s this interesting thing. For me, with that, going on testosterone replacement therapy, I probably over aromatized – which we’ll get to here in a minute – but for me, I feel so much better in the brain; the slight decrease in erection doesn’t bother me. Now, if I had lost my erections, I would get off TRT immediately. It’s a noticeable effect, not so much that I want to come off of it, because I feel so good everywhere else. But what I want people to understand is I’ve certainly put men on testosterone therapy where their erections got much worse; most of the time though, I think it gets better, and I want to hear your clinical experience for that as well.
Ali: [26:59] Is that acutely within the first couple months or until they are able to find a different dosage that works?
Jade: [27:05] You know pretty quickly. Then, of course, what we’ve all been fooling around with is – we’ve been fooling around with well maybe it’s this estrogen/testosterone ratio, which is still not clear, but I have had positive effects on that too where you put in where you put in an aromatase inhibitor or something like that and you’re like ok, well, that makes things a little bit better. Doesn’t really make a difference for me.
Ali: [27:27] Yeah.
Jade: [27:28] So, we don’t really sort of know yet.
Ali: [27:31] No, I’m glad you brought that up because I think initially when we first started talking about the erection and having it relate to stress, a lot of guys automatically just think testosterone. They think oh, my testosterone’s low, that’s why I’m not achieving erections, when theoretically, they could have testosterone 800 and have all this other stuff going on in their life, or maybe they just sleep like shit lately or something. So, it does not always equate to a hormonal issue as we know.
Jade: [27:57] Yeah, and actually here’s an interesting point for you. Now again, whenever you hear someone talk about their own case study, you gotta be very, very careful. That’s the biggest mistake you can make is to make judgments off of your own case study, and I have my own case study because I did have low T, and I also – I snore and I believe I have sleep apnea. I’ve never been tested for it, but I record my snoring. The other interesting thing about this is people who have sleep apnea tend to be lean towards diabetes, tend to have very poor erections, tend to have a lot of different things that look like the overfat, under exercised individual. You will see a lot of people who are sort of meathead bodybuilders and stuff like that, with these thick necks, who get sleep apnea, cannot sleep, and here’s the interesting thing – testosterone therapy as a physician is contraindicated in anyone with sleep apnea because it makes it so much worse. So, part of what I’ve always thought is that you have to be very careful about giving TRT to someone who has sleep apnea who may be dealing with this, because it can make it worse, and it certainly does with me. I can tell that my snoring goes through the – I use a app called SnoreApp, or whatever.
Ali: [29:09] Oh, interesting.
Jade: [29:10] That records my snoring and I can hear when I stop breathing at times.
Ali: [29:13] Yeah.
Jade: [29:14] So, that’s another thing that I’ve often speculated on, that you don’t give TRT to someone with bad sleep apnea. That actually, if you make someone’s sleep apnea worse, it would make sense that you’re going to make everything worse, including erections worse, so you have to be careful about that. I don’t know if you’ve seen that as well.
Ali: [29:30] Not so much, but I’ve seen like with the sleep – and I say this every time I have a talk – it’s the most unsexy thing. Just like with diet, people just think that there’s this secret proprietary supplement that they’re missing out on that’s going to be the answer to everything. Nothing is going to help you, not any supplement, not no diet, no hormone therapy, if you’re not sleeping. And addressing it is very difficult with a lot of these guys because they want to be a hero, and I can function on no sleep; and I’ve had guys who walk off redeyes and they’re like yeah, I’m going to go train, and it’s like no, man. Like, you’re doing yourself a disservice, and I equate it to when we were kids and we would have sports practice. Whoever the first person was to get a drink, like you’re a loser. The same thing, like whoever’s the first person to admit, you know what, I’m not going to go to the gym the next day, I actually need to get another hour of sleep, they perceive that as being weak when it’s the one thing that’s going to save them. I’ve told fitness professionals in my talks, I’m like alright, if you really want to nail somebody, if you start to be able to try to feed them more carbohydrates to fuel their hard training and their body’s kind of rejecting it, and they’re retaining water, they don’t feel so good, have them do morning glucose; because if they’re not sleeping and they think it’s ok, and then all of a sudden, they’ve got 104 glucose in the morning because of that, then yeah, this makes sense, go get a sleep test. Usually it takes that data – or bloodwork – you know, if they have a heart issue or something, like dude, you’re going to die; ok, now I’ll do something about it.
Jade: [31:09] Yeah, it’s such an important thing, and the sleep part with men, I think, that’s one of the first things I would be looking at now because I saw it within myself and I’ve seen it with a lot of individuals. But it is sort of tricky in that regard. So, let’s pivot just briefly, because I’m not so sure a lot of people sort of understand – let’s talk a little bit about some of the things like how erection works, you know, some of the things that men can do beyond testosterone, and then, if you want, we can get into actual testosterone therapies and that kind of stuff, and a brief on TRT. I did this, by the way, those listening, in this podcast, there is an episode – I forget what episode it is that covers some of this information – but Ali has overlapping and other areas of expertise that I don’t have, so that’s why I kind of wanted her to kind of share this with us. So, anywhere you kind of want to start with that, let’s walk them through how this erection stuff works and… from a physiological perspective.
Ali: [32:14] So, I remember the podcast you did on that and the course you did on it. You laid it out very easily. If Jade does anything extremely well, it’s simplifying the science of a lot of this information. And the orchestration of all the hormones and everything involved in creating an erection starts with the guy being able to get into a parasympathetic state. That in itself is hard to get people to do lately.
Jade: [32:43] Absolutely.
Ali: [32:44] You know? Especially as it comes off of being able to sleep, and the Oura ring, I think, great tool to be able to assess that, because then if guys are not getting morning erections and you can’t qualify their sleep, because people will say, oh, I got 8 hours of sleep; yeah, you went to bed at 10, but you don’t know when you fell asleep, and the quality of your sleep, and I know I’m harping on this, but it really is that important, the time spent in deep and REM sleep, and how that can affect your erectile strength. So, from a stress standpoint, you know, what do you see when guys come in and they complain that they’re not getting this same erectile strength, or if they never experience premature ejaculation and now they are, or they just cannot finish for the life of them. Because yeah, sex is great if it lasts more than a minute, but not like 600 minutes. You know?
Jade: [33:39] Yeah, yeah. And the way that I often teach this to men, and it’s not my model, I picked it up – I think actually this is taught in my medical school, so whoever the doc was who taught this basic science-
Ali: [33:53] Point and shoot?
Jade: [33:54] Yeah, the point and shoot is a good way to sort of look at it. So, we talk about – Ali and I talk about parasympathetic/sympathetic stuff all the time – many of you listening, there’s a very savvy listener population on my podcast, but for those who don’t know, parasympathetic is just simply the relaxation response. You have - your nervous system can either be stimulated or relaxed. So, relaxed is parasympathetic. Stimulated is sympathetic. And when we think of erections, we tend to use the point and shoot way of thinking about it. In other words, point, P, parasympathetic; shoot, ejaculation, sympathetic. So, there’s this unique coordination between the parasympathetic and sympathetic, so in its perfect thing, as Ali was alluding to, think about this – and many women will know this – but think about a man who you have never had sexual intercourse with, you really love him to death, you guys are, you know - talking to women now, or anyone who’s had romantic interest in men – and he can’t achieve an erection. You know he likes you, he’s super excited, you get – what’s the deal? Well, that’s because he is nervous, so being super nervous as a man will result in lack of erection, or perhaps an initial response, and then the erection sort of falls off because this man is nervous. That’s because he can’t get into parasympathetic state. One of the things I often times say for men is one, you need to relax, and any woman who sort of has ever had this happen with her lover knows that this is where men can really benefit from foreplay. And men are also very visual creatures, so as long as the woman is relaxed and it’s not bothering her at all, she can easily pretty much turn that around for a guy that happens to. Same thing if a man overdrinks. Alcohol’s really interesting because alcohol, a little bit, makes you more parasympathetic and actually improve erections; but a little too far, it actually shuts down parasympathetic and pushes you into sympathetic. So, alcohol’s another interesting thing, and I would often times say people who respond to this or not can be a little bit more responsive to stress, so the erection sort of tells you. Likewise, someone who is, you know, kind of doesn’t get a full erection but ejaculates quickly is someone we can say is maybe more into a sympathetic state, so premature ejaculation falls into that. Then, to your point, someone who is rock hard and just going like crazy – this normally, by the way, for anyone whose lovers, men, who has seen this, this is often times, men, this is a good sign they’ve taken something before they got with you. This is a good sign they’ve taken like, you know, Viagra or Cialis.
Ali: [36:40] Cialis or something, yeah.
Jade: [36:42] Or something along those lines. But you certainly can get that sort of effect, and it is interesting because there is – at least when we’re talking about sex – women will often times say this and I think men don’t know, but I’ve heard this over and over again from women, they’re just like yeah, there is like too long.
Ali: [37:01] Yes.
Jade: [37:02] There is absolutely too long. There’s too short and there’s too long, and women, as amazing as they are in bed managing all the erections and all the emotions, there is like, you know, they don’t necessarily want to be doing that with you for 2 hours. So that whole thing – for you young men listening – I know you think that’s what it’s supposed to be, but it’s actually not. That’s sort of the issue there. Then, I think I’ll say one more thing and then get your take on this, those hormones – estrogen and testosterone in particular – prime the nervous system in the penis. We can talk about the nervous system and then the local innervation of the penis – part of what those hormones are doing are priming that parasympathetic/sympathetic balance. That’s where they become important. Those hormones simply prime the pump of the tissue, then the nervous system stimulation comes down and is able to do what it needs to do with that sort of sponge-like pressure effect of an erection and being able to maintain that. I think hopefully that helps people understand the mechanics of erection, and then we can get into some of the things that are helpful for that. By the way, high blood pressure, obviously because we’re dealing with the pressure system, is a huge issue with… that’s why metabolic syndrome, which has a lot of things with high blood pressure, that’s typically going to be one of the first things we look at if we start seeing these effects.
Ali: [38:32] Yeah. And just like vascular health in general. I’m sure you’re aware guys are now taking Cialis daily, 5-10mg, just to achieve a better endothelial health or, you know, vascular, because you still need blood to flow in order to achieve that erection; and if blood’s not flowing very well, or if the body’s ability to have those systems clear, so to speak, is kind of compromised, it’s still not going to happen. So, this is why there’s so much that goes into being able to achieve and sustain an erection vs. just having high or low T. And as you mentioned with estrogen, like the bodybuilding world, I think kind of got everybody in the mindset of like oh, we have to suppress all estrogen, we have to lower it, eliminate it, get rid of it. When in fact, when guys do that and then drive it down too low, then they end up with the same issues, from low libido, low erectile strength, they’re more prone to heart issues. I think that’s where a lot of the complicated info of testosterone causing heart attacks and all that, that research that’s since been upended but many doctors still preach, came from the fact that they didn’t get the testosterone levels high enough and they didn’t manage estrogen, and then estrogen was either really low or super high, or the ratio was off.
Jade: [39:57] Yeah, when you’re looking at two hormones, like estrogen and testosterone and their relation, it’s very difficult to tease out those correlations or any sort of effect there, so I think that’s a big sort of piece of that for sure. I would say the other, the vascular health thing, let’s just give you guys some to-dos there. So, nitric oxide is the major sort of vascular event that is happening in the penile tissue to help blood flow sort of come in. There’s many things that we can do supplement-wise, exercise-wise, and exercise is definitely a nitric oxide potentiator. Arginine supplementation has been shown to raise nitric oxide and aid with erections, although there might be other supplements that are a little bit better than that like… it’s slipping my mind, it’s not… citrulline.
Ali: [40:51] Citrulline.
Jade: [40:52] I always go carnitine, carnosine, citrulline. I always gotta go all the Cs. But citrulline actually has been shown to raise arginine blood levels and nitric oxide blood levels to a greater degree than if you took arginine alone, which is interesting. That’s very high in the rind, the white part of the watermelon, actually. And then, obviously, nitrates and nitrites from food, which we’ve kind of been scared off by because, you know, people think bacon and nitrates – or nitrates or nitrites.
Ali: [41:22] Or ham, or whatever.
Jade: [41:23] But the interesting thing is there’s much, much higher concentrations of nitrites and nitrates in green vegetables, and beets, and things like that, particularly beets and arugula. When we eat these things, we have bacteria in the back of our throat that fix this stuff, we swallow it, it becomes nitric oxide, it can aid erections. Ali and I always refer to pee-pee greens – well, I refer to it as that; she makes fun of me – of arugula. I call it pee-pee greens because it’s like these things, literally salads, are erection food.
Ali: [41:52] Yeah, very inno – did I tell you what happened to me in England?
Jade: [41:56] No, no.
Ali: [41:57] So, I spoke in England in July, and we were eating lunch and I was talking about arugula and the pee-pee greens, and they’re like oh, you mean rocket.
Jade: [42:06] Yeah, that’s right.
Ali: [42:07] You call it rocket? I was like, what? I was like this is amazing.
Jade: [42:10] Yup. They have a much better name that says what it’s doing.
Ali: [42:13] Yeah! I was like rocket, that’s like genius! I thought that was hilarious and I made an instagram post about it, and literally it was just a guy’s boner through his shorts, they took it down. And I was like, you mean to tell me that these girls who wrap themselves around themselves with a thong on, and you see their birth canal, can get away with the instagram post, but a guy’s boner, you don’t even seen anything through the shorts, you talk about a food that can help – oh my God. But I was like, I remember I couldn’t wait to tell you. I was like rocket? I was like, shit, why do call that in America?
Jade: [42:44] Rocket greens, that’s right.
Ali: [42:45] Yeah!
Jade: [42:46] Yeah, no, and I think that’s an important thing. A lot of guys don’t, and dude’s don’t – again, women tend to be the ones who eat salads all the time.
Ali: [42:53] Yeah, yeah.
Jade: [42:54] But men tend to be the ones that eat burgers, and to me, I just go, like salads are definitely erection food. It’s really sort of true in that regard. Beets are another one.
Ali: [43:04] Tossed salads.
Jade: [43:06] Tossed salads. Yeah, exactly.
Ali: [43:10] Obviously erection food.
Jade: [43:11] And a couple of – I have my favorite supplements for this that I’ve had very good responses on, and actually, the one, like if you were like Jade, is there one supplement that you like to use that you’ve seen, and I’ve used it for a very long time, so I have enough clinical experience now, it’s just difficult to find, but Panax Korean Ginseng. 900mg daily in research has shown to be a really nice erection potentiator, and I have found that to be clinically – you don’t always find that, right? You don’t always find a study and go oh, this has been shown to work, and then use it clinically and see that it’s pretty effective. That’s one that I can kind of give people a tidbit with if you want something that is sort of like what can I take that will do me some good. Certainly, citrulline has been shown in research to be somewhat effective. I’ve seen clinically that the ginseng, Panax Korean ginseng, it’s that type of ginseng, which is actually difficult to get because there’s several different types of Panax. I wish my brother Keoni was here because he’s more an expert in this, but there’s one type of that ginseng that works really well. I don’t know the brand name, but I literally get it on Amazon. The brand name is… I can’t find it right now.
Ali: [44:28] Testosterone.
Jade: [44:29] Yeah, exactly. For me, it’s thyroid. It’s funny, morning sometimes like this, like my mind starts like oh, what was I going to say?
Ali: [44:36] Morning – it’s like 1pm.
Jade: [44:37] But anyway, I actually literally get this off of Amazon, and have my clients get it right off of Amazon, this particular one, and it works really well. Do you have any others that you love?
Ali: [44:48] The citrulline for sure, but also – I don’t want people to be confused, because I think people confuse with libido enhancing or erection enhancing supplements with testosterone boosting supplements.
Jade: [44:59] Good point, good point. Let’s go through that.
Ali: [45:01] Because I love to mess with the guys at Vitamin Shoppe and GNC. I just like walk over to the men’s health section, and it’s like, oh, wow, like ejaculoid and TestoboostRx. I’m like yeah, tell me about this. Even in my hotel room, they had a commercial for like GF9, which enhances growth hormones 600%. Ok, really, let me look this up. It’s all amino acids and then stupid stuff, so please don’t fall for those supplements that are on the shelf that cost $99, or that they’re locked up with a key, that claim to boost your testosterone. There are definitely things that can help your blood flow and that help enhance your life if you’re missing out on them, being magnesium, zinc – zinc working as a weak aromatase inhibitor in some senses – and sleep is a supplement. I mean, I’ll categorize sleep as everything, and I’m not going to stop shutting up about it. But I also find that electrolytes as well, because guys will drink water, or people will drink water – they don’t drink enough because they don’t like the taste, which I totally understand, so things like, if you’re traveling, Nuun tabs are great because it won’t set off the explosives on the carry-on bags, and making sure you’re getting in – like a lot of people are very deficient in potassium, if they’re over-salting their food, and a lot of people don’t salt their food. So, I think being able to be well hydrated from a cellular level is going to help them achieve better blood flow too. And electrolyte powder is actually something that I’ve had more people incorporate lately and gets them to drink more.
Jade: [46:36] Yeah, I love that. And I think it’s important to understand, I think what Ali’s rightfully pointing out is that something like citrulline, Panax ginseng, some of these things, they’re not enhancing testosterone. That’s actually pretty clear in the research. They’re not working by those mechanisms. Nitric oxide, the nitrate and nitrite rich stuff, they’re not enhancing testosterone. When we talk about enhancing testosterone – so she mentioned zinc and magnesium – the other one I’d throw in there is Vitamin D, as in David, these also don’t either unless you’re low, but I think Ali and I would tell you many, many men are low in one or more of those. So, that is really important. This is where off the shelf stuff like ZMA is a really just nice one that in some research has been shown to raise testosterone mildly. Vitamin D is very important, making sure you get that into the range of 50-100. Those are the ones that first come to mind when I think of supplements to enhance testosterone. Then, this one not a whole lot of people will like, and I don’t think Ali’s going to have a problem with it, but other people who are experts in this field – adaptogens in general can be very good for dealing with a parasympathetic/sympathetic balance, and helping the hypothalamus-pituitary-gonadal axis, and there’s many of those that I have seen in many ways that can enhance testosterone. One in particular that does have some research showing that it does actually enhance testosterone in many cases is ashwagandha, which also helps thyroid. So, adaptogens tend to – and by the way, Panax is also an adaptogen – so we tend to play with, those of us who do male hormonal health and working with testosterone, tend to play with adaptogens. I was going to ask you which ones of those do you like the best.
Ali: [48:25] The ashwagandha, because I think it can help you – it has a stimulatory and a calming property to it. The only issue that I run into, because I think maybe if – I’m not a medical practitioner or whatever – but people tend to think, they’ll equate nutrition coaching with supplement coaching, and they won’t do the foundational work for any of that to work. They think oh, I can just pop ashwagandha and I’ll get a 200-point test boost, and then I’ll be raging in the gym and I’ll drop weight.
Jade: [48:59] Oh my God, Ali, it’s such an important point. Actually, it reminds me of one of the key things that you and I need to talk about here that we would’ve been remiss if we missed it, so I’m glad you brought that up. But the other interesting thing about testosterone in general, and this goes for men and women – think about it, in a sense, our metabolism is one big stress barometer, and part of what it’s doing is saying is it good to reproduce, because that’s one of the primary directives of all of us and our species, is to reproduce. So, any kind of stress, especially over-exercising and under-exercising, or overeating and undereating, can impact, both in men and women, that hypothalamus-pituitary-gonadal axis, and impact our libido-enhancing sex steroids. So, you’ll often times see people who cut out macronutrients, you know, very low fat diets, very high fat-low carb diets – a lot of these people will often times come in if they’ve been on them for a while with low T. You used to see this, you know, when I was working a lot with fitness and figure competitors, women would come in without menses, estrogen and progesterone in the tank; men would come in, you know, they’re these big, muscular dudes with these great bodies, haven’t had an erection, their libido’s in the tank. So, any of these extreme dietary regimes on either side, what you find is very lean men and very fat men don’t get erections and don’t want to have sex. It’s a really interesting thing. You might see this guy, for example, who looks like the epitome of the leanest person on the planet, and what a badass and whatever on instagram, and he has no erections and no libido because his testosterone is in the tank, So, often times I think we see – when we see very lean, muscular men like that, we tend to think oh, that must be… testosterone probably helped them get there, but the leaner he gets, the more he’s probably becoming deficient in that. So, any extreme diets and balancing our macronutrient ratios are important, which alludes to what you’re essentially talking about.
Ali: [51:52] I see that so often, and I actually laugh at guys who say their doctor says to them, we don’t need to test your testosterone, you look awesome; and as you know, physique athletes on stage have the lowest levels, if they’re natural, have the lowest levels probably they’ll ever have. And at the end of a prep, a guy’s way more interested in a pizza than he is in having sex. That’s kind of like ok, now I know maybe I’m taking it to another level. And if any of you guys have seen me talk, a lot of you know that I talk from what I learned from Jade with the metabolic toggles – and my talk this year is called Toggling the Metabolism. How about that?
Jade: [51:30] I love it.
Ali: [51:31] And the biofeedback acronym that you came up with, SHMEC, I added an L for libido, SHMECL.
Jade: [51:39] I love it.
Ali: [51:40] So now it sounds like a Jewish word. So, understanding how – especially this time, because it is still January, even though it feels like March – people are still kind of into the whole new year, new me, slashing calories – and then I get these guys, and the magic number for women is 1,200 calories, and for men, it seems to be like 1,700; they’re eating 1,700 calories and they’re running everyday. All of a sudden, it’s been running – and actually, it’s not all of a sudden – every year it is, you know what, I gotta get in shape, I’m going to run; as soon as it’s nice out, I’m going to run. So, then they’re running, and then they add weight training on top of that, and Adam (Alan?) Cosgrove and I were talking the other day how a lot of people are coming to us doing mostly circuit, metabolic workouts only. And nobody is really sticking to the old school, straight set strength training to actually develop strength and muscle. It’s these high intensity cardio workouts, and as you know, the pendulum swings in the industry, and we went through this whole fuck cardio movement, and now it’s high intensity everything, all day every day, and depending on what diet and when keto was the rage, obviously, doing zero carb and doing glycolytic sports does not mesh very well. Anything that is taken to the extreme, which America loves to be about - because if 200mg of caffeine’s good, 800 is better - obviously is going to have ramifications, and one of those things, as Jade said, is procreation’s not on your body’s top priority list when it sense you’re in trouble. And you’re in trouble when you add a huge amount of stress to your metabolism, which is overtraining, and training all day every day, and then not eating enough to fuel that.
Jade: [53:31] Yeah, I love that. It’s this thing that if you understand – everyone understands what not moving and eating until your heart’s content does. We all know that’s a stress to the system. What people don’t understand all the time is that long term calorie deprivation, or carb deprivation, or fat deprivation, or protein deprivation, with this crazy exercise regime, can be a stress. And what I’d add to what Ali said is, here’s the part that gets confusing – this is more so with women, but it also happens with men – the degree to which the body fat percent, or the degree to which that becomes a problem, varies person to person. For example, in women who lose libido and lose menses, I’ve seen it happen in the low 20% bodyfat for women. I’ve seen some women get as low as 15%. After that, pretty much all women start to lose libido and menses. For men, it can happen as early as around 15% to 10%. 10%, you get there, you know, right around 6% you’ll start seeing a lot of dudes, I would say most of them start to see, perhaps, issues with erections and libido as well. So, it happens for some people when they’re a little heavier than what they think they should be, so the metabolism doesn’t respond to numbers on a piece of paper. The metabolism responds to its happy point and that is based on you as an individual. So, before we wrap up, I just want to see, do you want to talk a little bit about testosterone replacement therapy and sort of the pharmaceuticals that are available to people, and any sort of things there? Because we’ve kind of covered lifestyle, basic physiology, some supplements, and I know some people are going to be like alright, well, let’s say I’ve been doing all those things, I am low, I’m doing everything else and I’m thinking about potentially going on some kind of pharmaceutical. How do you walk your clients through that?
Ali: [55:31] So, I think it’s great since you’re a doctor, you can give the perspective of maybe some of the roadblocks that people experience when they go to somebody. The first suggestion that I would have would to not be going to a GP or somebody that would be an insurance-based doctor. This is about optimization, this is about something that has nothing to do with sick care, so it’s well worth the investment to find a practitioner - would you agree - that understands hormonal optimization, and with that comes asking how large of your practice is on hormone replacement, and how do they manage it and what is their preferred delivery method. Because there’s many different methods to acquire testosterone replacement, it’s not just injections. You can’t patent a hormone, so you have to have pharmaceutical companies create an alternative method via creams, and gels, and pellets, and a lot of these things are great moneymakers for certain practitioners, but maybe they don’t always get the job done the best way for a guy. You know, it starts with testing, and a lot of the times if they can get the proper testing, the standard protocol for a male being in – going on injections is 200mg every 10 days. A lot of my guys, if they’re able to get that, then they’ll ask their doctor, well, what about more frequent injections, and they say no. Where did the standardized protocol for 1 injection every 10 days come, because somebody of your size vs. somebody who’s 400lbs vs. somebody who’s 150lbs, why should they all be on the same amount?
Jade: [57:13] To be honest with you, it’s actually a matter of convenience and that’s it. It’s not based on anything else, so a lot of what you’ll find happen in clinical practice comes down to convenience and the ability to bill. What ended up happening is when these things were developed, we didn’t have – nowadays you can go down and get yourself your own injectables, you can find online, you can order 3cc syringes and all that kind of stuff, and have all that. It used to be you’d have to go in and get your injection from your doctor, so part of it was convenience. The other part is, even now, most men don’t want to do injections.
Ali: [57:50] Self-injection, yeah.
Jade: [57:51] That’s a big hurdle for a lot of people. The truth of the matter is, the way testosterone worked, the ideal way would be to inject every single day a small amount, because what ends up happening is you have testosterone in your system and we can’t really duplicate some of the biological rhythms. Testosterone tends to have a circadian profile, we believe a little bit, it tends to also respond to if you exercise, sleep; it responds to a lot of different things. We can’t reproduce that, but what we can reproduce is a daily sort of amount. So, when we give 200mg every 10 days, which was the standard, you get a huge spike in testosterone then it falls off, so you get this very a lot of testosterone effect, and probably a lot of aromatization, and then you get a fall off and symptoms come back. What most doctors do now is they basically teach their clients to do the injections themselves, and then they recommend 100mg and 100mg basically every 5 days.
Ali: [58:46] Right.
Jade: [58:47] I like to do 100mg, 100mg, basically within 7 days. So, it’s like every other day, every 3rd day basically, you’re doing an injection. Part of that is though is because most men don’t want to do that injection. For me personally, because when I’m on TRT I use testosterone propionate, and I go everyday to every other day. I’m doing that to smooth out my testosterone curves and minimize some of the huge spikes and drops.
Ali: [59:13] Love that.
Jade: [59:14] But the 3 big ones typically, the one – you won’t find propionate, by the way, those of you listening, you won’t find… pretty much anywhere that you’ll get propionate – but you can find cypionate and enanthate pretty much anywhere. And the standard dose, in my mind, the way it works the best, is 100mg every 3rd day is a really nice dose. Then, you see where your response is, looking for a number somewhere between, in my mind, 700-1,200. And I like to tend to push up towards the higher end of physiological. There is some argument that if you look at – we probably had even testosterone levels way higher than what the average is – so some people would argue for optimal is around 1,600. I don’t, I kind of like it right around – if I was going to say what’s the perfect number, let’s just make it 1,000 is kind of where I like to kind of see it. Then, from there, you can kind of back off to other things. I have never found creams – now, truth be known, I used a lot of them, but when I did, I never found creams that effective. I know some MDs get mad at me when I say this because they’ve heard me say this, and they’re like, I get great results from creams. Fine. I certainly haven’t in a relatively small n for me, and now the whole new thing is sort of pellet therapies and things like that. Right now, most all the data and most all my clinical experience comes from injectables, and I like those and find them easy, but then again, I know some – I know there’s an awful lot of men – I know women might think men are – but there’s a lot of men that do not want to stick themselves. I have no issues with it and most of the clients I work with tend to be like ehh, no issue.
Ali: [01:00:47] What would be your go-to? What would be your go-to? If they don’t want to inject; what would be the next best?
Jade: [01:00:52] I have NO experience with pellets at all, so I can’t speak on that with any sort of-
Ali: [01:00:57] They’re not good.
Jade: [01:00:58] -with any level of – but I have had a few people who have been on them and seen sort of what I’ve seen with the creams. But I would probably go to sort of the creams, or to be honest with you, I always do – before I go to injections, I go HCG and/or Clomid, which both of those work really well, and I like that. If you want to know my clinical hierarchy, what I’d recommend, it’s diet, exercise, gotta get that, just like Ali said, you gotta get that in place; and then, adding in some adaptogens, see if we can bring this up – and by the way, the thing I’ve seen best for that is ashwagandha can bring that back in some men. So, making sure you got the ZMA on board, all that kind of stuff. Then, I like HCG or Clomid. I know some docs do both. I like HCG or Clomid, and I’ve moved more towards Clomid, and the reason why is it’s cheaper and it’s oral, so there’s no injection.
Ali: [01:01:50] Yeah.
Jade: [01:01:51] And you can see some really good effects with that. HCG tends to aromatize a little bit more in clients, so I don’t love it; plus, it’s still injection. So, Clomid is quickly become my first line of therapy, and those who are a little bit more savvy and want the background on this, it’s just the way – HCG is essentially an LH analog; it basically stimulates testosterone directly in the testes. Interestingly enough, Clomid is a selective estrogen receptor modulator, but a lot of people don’t know this, but estrogen feedback to the hypothalamus does impact testosterone production. So, Clomid blocks that, signaling the hypothalamus to be like oh, we better make some more testosterone; so Clomid can be very nice, and actually, there was a 52 week study on Clomid in men comparing it directly to injectable TRT; it was very safe and almost as effective. When I saw that study – and I think that study has made a lot of people go maybe just use Clomid. So, I would use those first. They’re easier to come off of, Clomid is cheaper, it’s pretty reliable in raising testosterone, we don’t see a whole lot of side effects. You still might get some of the estrogen effects with the HCG, less so with Clomid, so far what I’ve seen. Then, I go TRT injectables. I don’t know if you’re in alignment with that or not. I know you’re kind of – you’re not actually prescribing these, but you are watching an awful lot of men on them. What has been your perspective with creams?
Ali: [01:03:21] No, I like that protocol. Obviously, it’s having the conversation with guys about the sperm production suppression when you do go on injectables. So, understanding if they do want to have kids – now, testosterone’s not a guaranteed birth control method, but it does suppress it, and it’s not like you can’t get it back if you go off of it. Because you can go on HCG and/or Clomid concurrently, but it does have that effect on it, and I say, like a lot of guys don’t really want to endeavor in the injections because they’re like, I don’t want to do that the rest of my life. I think considering Clomid or HCG as a monotherapy, I think, is a great start point for them. I will say with the pellets, they are – from what I have learned and/or experienced with clients, and a doctor that I trained who gave them – it’s like CrossFit. You go to a 2-day certification, boom, you’re ready to go. You can go put pellets, and they’re the size of a grain of rice – they put in to your butt, and the problem is, you know, similar to a standard protocol of testosterone, so you’re going to give it to people of all different sizes and they’re going to metabolize it very differently. In order to tweak the dosage, you have to go back in, and it’s very invasive, whereas an injection or a Clomid therapy, or even a cream, you can kind of just mess with the dose right away. You don’t have to go back and do like some sort of little surgical procedure, and they’re so expensive. I think he was charging like $900 and it’s 15 minutes. Obviously, it’s a great moneymaker, but he would call me and be like, what do I do, this person’s like freaking out, he gained 15 pounds on the scale. Like water weight and stuff like that is a real thing no matter what the delivery system, but also, I just don’t think that pellets are really an optimal way to achieve for either men or women. I think women tend to do better on them, but I think for men they tend to be a disaster.
Jade: [01:05:24] Yeah, interesting. And of the things that we should also say is that one of the things that’s happened recently is a study within the last 5 years showing that testosterone injectable is very well absorbed, perhaps even better absorbed SubQ. So, what I’ve done for myself, and for a lot of the men that I work with, is just have them use insulin needles to both draw – the draw is a pain because it is a small needle, so it does take a little bit of time.
Ali: [01:05:49] It takes a long time.
Jade: [01:05:51] But you have way more sites, so I go shoulder, shoulder, right side of the belly button, left side of the belly button, left butt cheek, right butt cheek, right thigh, left thigh, and it’s a little tiny insulin needle. They’re very cheap, it’s just a pain to draw, but as long as you pump enough air into that, it gets easier as you go along and the injections become almost nothing now as far as that goes. Those are sort of the importance, I think, sort of considerations; and the other thing Ali brought up that I’ll just add to, is that what a lot of people don’t know is that testosterone therapy, especially as you push it up, if you’re doing TRT, and you’re not doing HCG, it is a fairly effective male birth control. People often times say, oh, we don’t have male birth control. Well, you kind of do when you’re using TRT. Now, I wouldn’t bet my life on it, but it dramatically will shrink the testicles. A lot of people say oh, testosterone shrinks the size of the penis. It does not shrink the shaft of the penis. It will shrink the testicles. That’s because the testicles don’t need to – they’re getting the signal not to produce sperm. Your sperm volume will often times fall down as well, and part of the reason is the feedback of testosterone. The hypothalamus shuts down, FSH and LH, which then, both of those play a role in sperm production and testosterone production, so you end up getting sort of this sort of shrinkage of the testicles and a very low sperm volume. A lot men don’t like that – one, because they want to remain fertile, and two, they want to have sperm volume. But for those men who want to use that as a birth control, it’s a fairly reliable birth control.
Ali: [01:07:29] Yeah.
Jade: [01:07:30] By the way, so is frequent masturbation a pretty reliable birth control too, because the more you ejaculate, the less sperm volume you have. So, those two together are – it’s just an interesting sort of thing to mention.
Ali: [01:07:42] I do have friends who are bodybuilders who’ve been on everything on the planet, and like 1000mg of test, and still had a baby; so, it isn’t-
Jade: [01:07:53] Yeah, it’s definitely not.
Ali: [01:07:54] Like 100%, but it is pretty effective for that. Where was I going with that? I want to know what your thoughts are, so for men who are on TRT who do decide, you know, I want to have a baby, or I want to be fertile. I’ve had a few clients that have gone on Clomid at the same time. Do you have a preference as to what’s more effective with the HCG or Clomid, and HCG will help bring back the testicular hypertrophy, but as a woman, I always tell guys like don’t worry, we don’t really care.
Jade: [01:08:23] Yeah, for me, it’s HCG. I wouldn’t use Clomid for that. I would go HCG, and typically, my standard, because I think it’s like, unless a man says, I typically want to have the HCG on board. And part of the reason I do that – I don’t do it with myself, actually, but I do do it with clients – it’s completely theoretical in a sense, but to me, those other hormones are doing other things. So, to me, I kind of want the HCG stimulating the hypothalamus sort of as well. I kind of want that LH sort of kick as well. Again, I don’t know – I don’t have any sort of science to kind of bolster that; it’s just that, to me, I want the testicles to be getting the signal and producing sperm. Because I guess being a naturopath, I feel like that’s the natural response. I don’t know that I want to shut that down.
Ali: [01:09:14] Yeah.
Jade: [01:09:15] So, for me, it’s HCG, and I’ve actually had no problem with pretty much any man that I’ve run into where coming off TRT, using HCG for a period of time – and actually, HCG-
Ali: [01:09:26] So, you have them come off and use it as a monotherapy, or do you have them use both?
Jade: [01:09:30] I don’t like any man coming off TRT unless they want to, and a lot of them do for many reasons, but a lot of it is the injectable. Which then you go, ok, well maybe I do want to move you to creams and pellets. Many men want to come off, and especially now, more recently now, because people go, I feel like my body should be able to do this myself. You used to get that a lot from women. You’re getting it more and more from men, and that’s just something that’s interesting. Unlike bodybuilders who do testosterone, very high super-physiological doses, and then give their body a break, once you’re on TRT – you’re not going super-physiological, this is within the normal limits – you don’t come off. You don’t need a break; you don’t want a break. You want that testosterone in your system, so you want it there all of the time. So, that’s one thing I’ll mention. Then, the other thing I’ll mention that, you know, I just wanted to make sure people understand, when we’re talking bodybuilders, that is a very different population, and when we’re talking anabolics, bodybuilders are taking a lot of “anabolics” that are not testosterone. They’re testosterone analogs, they look like testosterone, but when we’re talking today, me and Ali, we’re talking about testosterone replacement therapy, which means bioidentical testosterones. Those would be testosterone enanthate, testosterone cypionate, and testosterone propionate is the 3 biggest ones. Things like Trenbolone and Anavar and all of these kinds of things, I don’t consider those testosterone. To me, those are anabolics and a whole different deal, and I honestly – which I may get blowback on this – but I don’t think there’s any good medical indication for any of that stuff. Now, it’s used, obviously, in sport, but that’s where you’re getting a lot of the sort of downside. You’re just playing a game that we don’t know much about when you’re using that stuff.
Ali: [01:11:18] No, I’m glad you brought that up because there are – like it seems very basic to us – but there are people who consider TRT as steroids even though it’s a steroid hormone, but it’s not necessarily going on steroids.
Jade: [01:11:29] Yeah, it’s completely different things.
Ali: [01:11:31] Yes, it’s completely different. I mean, the max dose is what, 400mg a week somebody could prescribe?
Jade: [01:11:39] And that would be super, you know, sometimes it’s necessary, but you almost always can get the physiological ranges with 200mg. And I like to go as low as possible to get the effect.
Ali: [01:11:50] Right, yeah. I was going to say, sometimes if guys are injecting more frequently, you could actually lower the dosage, because that release pattern is more natural and aligned with the body’s natural release pattern. I always joke how a lot of the TRT clinics, like the starter pack is 200mg cyp, HCG, and Arimidex, without even doing any labs whatsoever, and they get sent out the door with that. It’s good that we can differentiate what does Clomid do, what does HCG do, why would you go on both at the same time. Would you think that there’s no need for a man to be on TRT injectable and HCG for any other reason other than if he demanded to have testicular fullness. Otherwise, some guys get side effects from both at the same time.
Jade: [01:12:39] I mean, my bias is to always use both as well. I don’t, though, put Anastrozole or Arimidex on board right away. I wait to see if someone is overly aromatized or they’re getting estrogen type effects. But yeah, I think that’s just clinical judgment at that point. I do like in my clinical, you know, if I’m working with someone – I don’t do it myself because I don’t mind some testicular shrinkage. I don’t mind, and to me-
Ali: [01:13:05] Right. No, and women don’t mind that.
Jade: [01:13:08] I certainly don’t mind, and –
Ali: [01:13:09] It makes your penis look bigger.
Jade: [01:13:10] Yeah, exactly. And I like the idea of, you know, I don’t want children, so I don’t mind having a little lower sperm volume, but that does bother some men. So, I use HCG and TRT together.
Ali: [01:13:24] Yeah. And one of the last things, like with the aromatase inhibitors, that’s gotten a lot of news lately because there’s a lot of research showing the DEXA scans of men who are on them long term being very dangerous for bone density, and how the massive suppression of estrogen can actually end up being more negative than doing positive. But what would you say – and I’ve heard both different ways, but I tend to err on the side of don’t suppress if you don’t need to – but men who do experience a little bit more water retention than they would like, some nipple sensitivity, and then it would be alright, maybe the lowest dose of Arimidex possible vs. these overly prescribed, like half a mg to a mg everyday or every other day.
Jade: [01:14:15] I mean, to me, I don’t just jump on Arimidex, but I definitely have it there because it’s needed in a lot of cases, and the lowest dose possible. I would start with 2.5mg for the week, and then if needed, you can go up to 5mg for that. And again, it’s going to be clinical – this is where a lot of doctors just have their thing that they like to do. I tend to, you know, I showed you my hierarchy, then I like to do HCG with testosterone. Then, I keep Arimidex in the bag, and often times I’ll use something like a Prostate Supreme from Designs for Health, which a lot of doctors who hear that, and they’re like that stuff’s not going to do much. I’ve seen it do, you know, I’ve seen it have a weak effects on labs, but typically, if you’re really aromatizing, unfortunately, the natural things are not going to keep that under control. But for someone who’s – it’s just very gentle – those things can be effective. Any final things that you want to make sure people know about this particular topic? It’s such a fascinating topic.
Ali: [01:15:18] It really is.
Jade: [01:15:19] We can go on and on, but I think we covered pretty much every area.
Ali: [01:15:24] Would you guys want a course for us to do on men’s health, because we’ve been only planning that for about 2 or 3 years.
Jade: [01:15:31] I know. Ali and I have been thinking about doing that and she’s just like, dude, what is wrong with you, because she also knows me really well, so she knows anything on my schedule stresses me out. Once it’s there, I’m fine, but getting it on my schedule is sort of crazy. So yeah, hit us up. Tell ‘em where they can find you and where you hang out the most. Go ahead.
Ali: [01:15:50] I’m on instagram. A lot of my content is on there. It’s @thealigilbert, A-L-I; and then my website is A-L-I dash Gilbert.com, and I do remote and local consulting. I live in Greenwich Connecticut, but we’re moving to Florida in May. But you can do a consult with me, and we can kind of go from there. Then, let us know when you want us to do this course, because I’m not going to stop.
Jade: [01:16:17] Yeah, exactly. And are you changing your name, by the way?
Ali: [01:16:21] I am. It will be Weingroff. I already bought the domain because I highly doubt there’s any other Ali Weingroff’s. There’s a lot of Ali G’s. So, I’ll still be Ali Gilbert professionally, but socially, I’ll be Ali Weingroff.
Jade: [01:16:37] Cool. I love you, buddy. Thanks for hanging out.
Ali: [01:16:39] You’re awesome, man. Thank you.