Daniel Steinberger (5:50)

So to begin, tell us the Story of how you got involved in researching testosterone.

Dr. Abraham Morgentaler (5:56)

Oh, my God. So I had. It's an amazing story how life just goes full circle. I was 19 years old. I was an undergraduate at Harvard College, and I was lost. And I thought I was going to be a hockey player, and they were too good. And I played freshman, and that was it. And I was in Harvard Square, and I ran into one of my professors who was a biology teacher. And he asked me how I was doing, and I said, I'm kind of lost in college. He said, I want you to work in my lab. And I worked in his lab for three years studying testosterone in lizards. The little guys that are all around in Florida. And we would remove their. We would watch their sexual behavior. And if you remove the testicles of a male and you put them in it with a cage with a female, they don't do anything. Normally they got this bright colored flap of skin that comes out and the head bobs up and down really quickly, like the male's going, yeah, yeah, yeah, yeah, yeah. But if you castrate them, remove the testicles, which is the source of their testosterone, they don't do anything. And my project was to put testosterone in the brains of these lizards, in their sexual centers. And when I did, their entire sexual behavior came back. So that was amazing. Testosterone was a brain hormone. I published my first paper on this, 1978, that dates me. And so through medical school, through residency, we learned very little about testosterone, except it was important for male puberty and important for men to look like and behave like men. But that was it. The idea that men could have low levels of testosterone and could benefit from treatment was not taught, wasn't taught, and there wasn't even much awareness of it. And then during my residency in urology, we were the protectors of the prostate. We deal with prostate cancer. And the teaching was for 50 years that testosterone caused prostate cancer. But when I came out and started seeing my own patients, some of them were desperate with some sexual concerns. And they said Viagra wouldn't show up for another 10 years. And they said, doc, don't you have anything? I'll sign anything you want. My marriage is failing. And so I wondered whether the men might be like the lizards. And they were. And I gave the first few guys testosterone. They had these amazing stories. And not only were they better sexually, which is what they came to see me for, but they were better in other ways. They would say, my wife likes me again. I've never had so much patience for my children to play with Them I wake up in the morning with optimistic about my day. I haven't felt that way in years. I said, wow, this is something. But I was worried about prostate cancer. And so I monitored these men very closely and they weren't getting prostate cancer. The old teaching wasn't correct. And so I started publishing data on treating these men and their low prostate cancer rates. And that's how I got started.

Daniel Steinberger (8:59)

Interesting. May I digress just a moment. What was the professor researching the lizards for if not to figure out if they should be treating people? Was it just curiosity?

Dr. Abraham Morgentaler (9:13)

So lizards are really interesting in terms of evolution because the reptiles are a branch point, or at the time thought to be a branch point for the higher animals, which are considered mammals and birds. Today, the birds and the reptiles appear to have a closer relationship. But in biology and medicine we have often what's called conservation, which means the things in. People don't like the term lower and higher animals anymore, but I'm going to use it. The idea that biological processes that happen in lower animals are often the mammals and humans use many of the same processes, biological processes that happen in reptiles.

Daniel Steinberger (10:03)

So one thing that really interested me is I've been reading a lot over the last decade or so about declining testosterone levels in men. Something that's not happening over the course of 1000 years or even really 150 years. Something that's happened quite quickly.

Dr. Abraham Morgentaler (10:20)

Right.

Daniel Steinberger (10:20)

Can you tell us what we know about what's happened to testosterone levels in men?

Dr. Abraham Morgentaler (10:24)

Yeah, so the data are actually pretty clear that testosterone levels are declining over the last 50 years or so. And we know this because there have been studies where they've frozen blood under great conditions, they don't deteriorate. And you can look at average blood sample results for testosterone from 50 years ago, 40 years ago, 30 years ago, and they appear to be declining. Why this is is not well established, but there are a couple of things that could certainly be contributing to this. One is we've had an epidemic of obesity over that time. And if you're obese, it drives your testosterone down. Second, people talk a lot about what are called endocrine disruptors, things in our environment that appear to affect not just humans, but other animals in terms of their sexual development and things like that. And then the latest thing is we got plastics everywhere, microplastics, nanoplastics. That's so recent in terms of sort of general awareness that I don't think it's been studied with regard to testosterone. But nanoplastics and microplastics have been identified within the testicles of humans, and that's where the source of testosterone is. So there certainly could be a connection.

Daniel Steinberger (11:41)

What are the implications in behavior of the male American species? If testosterone levels have decreased that much over a short period of time, what do we expect to see in reality?

Dr. Abraham Morgentaler (11:53)

So the good news is that where we are, we're still okay. Because once a man has a certain adequate level of testosterone, he behaves normally, his fertility is adequate, it's fine. But if it continues and testosterone levels continue to decline on average for the American male or global males, we could have fertility issues for sure. We could have sexual problems that are more prevalent. And, and people don't often think about this way because human beings are so smart. But sex is actually about reproduction. Right. So that if people, if men can't perform sexually to a certain extent, that may affect birth rates, which are already going down in the western developed world anyway.

Daniel Steinberger (12:38)

Is the lowering of testosterone levels in men an American phenomenon or is this being observed in other countries as well?

Dr. Abraham Morgentaler (12:45)

No, it's been observed in other countries as well, in Europe, when we talk.

Daniel Steinberger (12:48)

About some of the potential causes, and you've mentioned a few, but the implication is, without studying it further, there are things in our food, our medicine, our water, our air, things like that that could be interrupting our hormone processes. If this is happening to men, is there something parallel theoretically happening to women? Women have some testosterone, right?

Dr. Abraham Morgentaler (13:11)

Women do have testosterone and it's important for them, just as it is for.

Daniel Steinberger (13:14)

Men, but also maybe their testosterone is interrupted. But number two is women's estrogen likely interrupted because the same process that's interrupting hormones in men could be interrupting hormones in women.

Dr. Abraham Morgentaler (13:26)

That's a great question. I confess I don't know the answer to that question.

Daniel Steinberger (13:30)

All right, so I'm looking from a societal level about potential implications if we continue along this path. I see there's great interest in treating what they call low T, which I guess is low testosterone, but without finding the cause. If you look at a population wide society of males that don't have what you would consider the normal amount of male hormones that make them behave a certain way, what are the potential implications of that for society?

Dr. Abraham Morgentaler (13:59)

Right. You know, I'm so glad that you're talking about this. This is such an important topic. And I've spent a couple of decades trying to inform both the public and the medical community about the importance of having a deficiency of testosterone. It's hugely prevalent, affects about one out of three adult men over the age of 40. And not only does it cause symptoms that make the men not feel so good, but it's associated with important health issues. So the symptoms, we may as well go through it. The symptoms tend to be in a few categories. In the sexual side that everybody thinks about first is true, can affect erectile function, libido or sexual desire and awakening with erections and the sensation. The non sexual symptoms tend to be fatigue. Not just everybody's tired, you know, but the guys who have this are tired in a way that makes no sense to them. It's out of proportion to what it is that they've done. Fatigue, lack of energy, lack of pep. You know, at the end of the day, people who are successful in whatever job it is they're doing or in their relationships, I attribute it to the extra 5%. Right? So if you lose 5% of your energy, you can still be amazing, right? But you won't necessarily, I don't mean about you, but a person isn't necessarily that makes that extra phone call right at work. They don't put in extra few hours or a few half hour at the end of the day working on whatever project they're doing, they lose a little bit of their edge and people notice it. So this lack of vitality, it's not okay, Joe, you're getting older. No, no, no. People lose a piece of themselves when this happens. So those are some of the other symptoms associated with depression and depressive symptoms. That's a lot. There also are what we call signs, not symptoms. Symptoms are things that we experience. Signs are things that you can measure. So the red blood cell count goes down. When it goes down too far, we call that anemia. Bone density goes down and it makes the bones more brittle and susceptible to fractures. And we've seen in some studies that men with low testosterone have higher fracture rates. Having a low testosterone is also associated with important health issues. So just by the fact of having a low testosterone puts a man at double the risk of later on developing diabetes, obesity, and what's called the metabolic syndrome, which is a set of things that predisposes to cardiovascular disease. It's a lot. And if we look at associations of low testosterone, we look at things like dementia, depression. Testosterone is the single, in my opinion, the single most important blood blood test that tells us about the health status of a man. But most doctors aren't aware of it. It's not a part of the routine blood test panel that doctors get. So what do they get? They usually get a glucose that's good for figuring out diabetes. They might get crp, which looks at general inflammation. They're going to look at cholesterol, which tells you a little bit about thickening of the arteries. Right. But testosterone tells you about obesity, muscle, bone, cognitive function, mood. It's unbelievable what it tells us.

Daniel Steinberger (17:40)

Based on what you've described, I would say this sounds like a chronic, urgent health issue. Something that's not happening to just a couple of people, but something that's population wide.

Dr. Abraham Morgentaler (17:50)

Right. And where people are focused has been on testosterone as a treatment. And while that's really important and extremely useful for men who are deficient in testosterone, what's been ignored is having the condition of testosterone deficiency and how much it reduces the human condition. Men are not who they were. They've lost something. They lose their sense of humor, they lose their ability to be great partners. So I'm delighted to have the opportunity to talk to you about it, because it's not just about is testosterone therapy good or bad for you? It's about it's lousy to have a.

Daniel Steinberger (18:34)

Low level of testosterone without getting into debates over male versus female roles, which I'm not trying to do. But I would say it's believed that over time, men generally, through probably their natural testosterone and so on, take certain leadership roles or protective roles in a society. Could that be impacted? And do you see this being an issue on a level even beyond the individual man?

Dr. Abraham Morgentaler (19:01)

Yeah. So, hoo boy, we're going to get into some politically troubled waters here. But listen, I told you about testosterone and lizard research that I did, and the question was about how does this apply to men? What do we learn about that? All the vertebrates, anything with a backbone, fish, reptiles, birds, mammals, they all have testosterone. And we can see what the effect is on behavior in all of these animals. So we've been castrating, removing the testicles and the source of testosterone, domesticated animals for 10,000 years, right? We do it in cattle, we do it in goats, we do it in dogs, we do it in cats. And the observation is the same in every species, which is that the male tends to become more passive. They gain weight, which is good for meat and flavor of meat. Right. But in humans, it makes us a little bit obese, lose strength, lose muscle mass. And in terms of roles, that's where it gets a little tricky and hard to say, a one to one relationship. But certainly men who have low levels of testosterone don't have the get up and go to do often what they've done in their male positions, whether it's within a family structure, whether it's within a business organization or whatever.

Daniel Steinberger (20:24)

It seems to me again, just as an outside observer, as we've noticed the levels of testosterone going down in men, inexplicably there would be more urgent curiosity to try to identify the cause, not just to treat it, which would be important, but to identify what's causing it and try to stop that. Why do you think there hasn't been more focus on that?

Dr. Abraham Morgentaler (20:44)

Yeah, I couldn't agree with you more. I think that's a really important topic. The problem is that it's hard to make one to one correlations. Right. So while it's true that we've gotten more obese over the last 50 years, while it's true that we have more chemicals everywhere in our food system, water, air, whatever, while it's true that we have more plastics or at least we're more aware of it, it's hard to know how any one of those things impacts things. You know, there are some studies, there are people who are interested in exploring this, but that research is challenging and I'm looking forward to hearing what it will eventually show.

Daniel Steinberger (21:23)

I've read a couple of things that have quantified the amount of reduction or estimated. Can you give us in a timeframe of what we know or what the estimates are?

Dr. Abraham Morgentaler (21:32)

Well, it depends on the study and there have been several, but it ranges anywhere from 10 to about 20% of testosterone over the last 40 to 50 years.

Daniel Steinberger (21:39)

So what age? Let's equate that to a man. So a man who was 20 years old 50 years ago would have. What level? How do you measure?

Dr. Abraham Morgentaler (21:51)

So most of the studies are not in younger men actually, but middle aged men.

Daniel Steinberger (21:55)

All right, a man 45 years old.

Dr. Abraham Morgentaler (21:57)

Right. So today the average testosterone level is about 450 nanograms per deciliter. We say there's a lot of variation from one person to another, but that's an average of middle aged, relatively healthy men. So what was it 40, 50 years ago? Is probably around 500 or 550.

Daniel Steinberger (22:19)

Do you recommend men if they don't feel great, get tested and treated?

Dr. Abraham Morgentaler (22:24)

Absolutely. So listen, if there's a man that's watching this or listening and they feel like their energy is down, their sex drive has mysteriously disappeared, it's not from medicines, it's not because of a bad relationship, it's not because they're depressed and they just don't know what's going on, they've lost their moxie, they've lost who they are. And absolutely they should be asking their doctor to get a Testosterone level and.

Daniel Steinberger (22:50)

Is the basic treatment for what they call low T, what somebody would be given or what somebody would get for that.

Dr. Abraham Morgentaler (22:55)

There's a fairly standard way to treatment. We have an embarrassment of riches in a way which we have multiple ways to give testosterone. Now, it used to all be by injection. And then about 20 years ago came the creams and the gels that you can rub in your skin. Those are still around and they're all still good. Now we have little pellets that are like the size of a grain of rice. And we can put a few of those usually in the buttock area and they dissolve over a period of three to five months or so. And then they need to be.

Daniel Steinberger (23:30)

You mean implanted in the skin?

Dr. Abraham Morgentaler (23:31)

Little implants just underneath the skin. Office procedure takes five minutes. And then we have pills. There were pills many years ago, but they weren't good because they caused liver disease. We now have three FDA approved pills over the last, I don't know, five years or so that are safe for the liver and work very well.

Daniel Steinberger (23:49)

And Viagra, and those drugs do not treat testosterone levels exactly right.

Dr. Abraham Morgentaler (23:54)

So Viagra can help men with blood flow to the penis, which is what an erection is. But I had a patient some years ago who was on Viagra and he came to see me. I say, is the Viagra working? He said, yes. I said, what are you here to see me for? Then he says, because, doctor, I'm in the middle of the act with my wife and I'm saying to myself, why am I here? Why am I doing this? He didn't have drive. So testosterone helps with the drive, with the grr, baby, the hunger.

Daniel Steinberger (24:27)

And then a couple more questions. When is the peak levels of an average male? What age is their peak testosterone level?

Dr. Abraham Morgentaler (24:36)

So testosterone peaks in the late teen years, in the early 20s, and after about age 30, it's said to decline on average by about 1% per year. But if people. A lot of that is due to what we call comorbidities, other things happening, illnesses. Obesity is a big factor for healthy men. Can maintain a good testosterone level well into later life.

Daniel Steinberger (25:03)

What's the difference? Or does it matter if someone's experiencing lower testosterone as a natural course of growing older versus something that's more of a dysfunction? And should they get treated, would you recommend them seeking treatment for something that's actually kind of natural versus this syndrome we're talking about?

Dr. Abraham Morgentaler (25:21)

Right. There's a school of thought that says the decline in testosterone is so common as men age that it's just an aging phenomenon. And why should we treat aging? Maybe we shouldn't medicalize aging. But here's the thing. Almost every medical condition we treat in adults is age related, meaning it becomes more common as we get older. That's true, for we get what happens with aging. We get bad eyes, we get bad teeth, we get bad hearing, bad blood vessels, bad hearts, bad joints, and even cancer. Is age related? We treat all of those things even though they are naturally part of aging, because they improve the quality of life or even extend life. Testosterone deficiency is no different. The argument that maybe we should leave it alone because it's just a normal part of aging, when men are feeling the symptoms and aren't doing so well, when it's associated with various health conditions makes no sense to me.

Daniel Steinberger (26:25)

And then lastly, if we don't start to get at the root cause, as complicated as that may be, what do you foresee in the next 50 years? Based on what we've seen the past 50 years, what could happen?

Dr. Abraham Morgentaler (26:37)

Well, the doomsday scenario, if things continue the way they are, is not only the testosterone levels decline, but also sperm numbers. And there's evidence that sperm. Sperm numbers are declining too. They're both made in the testicle. And it's possible that whatever is causing one is causing the other. So I think it's possible, but I hope we never get there, that fertility will be reduced, that men will have more and more difficulty being sexual and active and physical, and that men will start feeling old before their time in society, will feel the impact of all of that.

Daniel Steinberger (27:16)

And last thing, this is probably not for the TV show, but for the podcast. I'm a 64 year old woman, and I will just say, observationally, this could just be that I'm older. Young men today, not all of them, but as a whole, seem more feminized to me than the men of my time. That could just be a behavioral thing or it could not be. What are your thoughts about that?

Dr. Abraham Morgentaler (27:40)

Well, first of all, you look fantastic.

Daniel Steinberger (27:43)

That's what I wanted to hear.

Dr. Abraham Morgentaler (27:46)

You know, it's.

Daniel Steinberger (27:50)

Do you think that ever, when you look at young people today.

Dr. Abraham Morgentaler (27:54)

Yes, but it's hard to separate out what's biological and what's cultural. Right, right. So, you know, guys are having a hard time now. It's hard for them over the last, I would say, 20 years to figure out what their role is in the world, what their role is in relationships. And of course, they're all stuck on their devices and instead of actually having interactions with other live human beings, they're having it with whatever it is they're seeing.

Daniel Steinberger (28:24)

By the way, the devices can be endocrine disruptors, according to some studies. So add that in.

Dr. Abraham Morgentaler (28:30)

Yeah. So, you know, it's impossible to get away from them completely or almost impossible. And there's obviously a lot that's good about having all that, the Internet and everything at our fingertips, but I think there's a social cost to it also.

Daniel Steinberger (28:45)

Any final thoughts based on what we talked about?

Dr. Abraham Morgentaler (28:48)

I think the most important point is that both listeners and viewers of your program and any healthcare providers that are listening really should be more aware of the impact of testosterone deficiency on the quality of life of men. And by the way, it also happens to women, especially after the menopause. And women get the same symptoms as men do with decreased libido. They get the same benefits of testosterone therapy. So many of the complaints that patients have that people have when they go see their doctors mood down, not feeling like themselves. Less drive and vitality in the world can be treated if it's related to testosterone deficiency. It's a simple blood test. Diagnose it and don't be afraid to treat it.

Daniel Steinberger (29:37)

Go to a urologist for that.

Dr. Abraham Morgentaler (29:38)

Urologists are the perfect people to go to.

Daniel Steinberger (29:41)

So for the podcast, we've turned the camera and audio back on to talk about one important thing we left off, which is risks. What do you want to say about that?

Dr. Abraham Morgentaler (29:49)

So one of the reasons there's been resistance amongst the mainstream medical community to the use of testosterone has been the fear that goes back to the 1940s that testosterone might increase the risk of prostate cancer. Cancer that has been overwhelmingly shown to be not true. We now have large randomized controlled trials that show no increased risk whatsoever. A more recent concern has been cardiovascular risks that came out of the Blue in 2013. We now also have large randomized control studies that show that that's not true. In many ways, where we are today is the safest period we've ever had where we know about what the real risks are of testosterone and what's not true about the alleged risks.

Cheryl Eckesson (30:44)

Sunday, April 6th. You can watch this interview, but I'll have a whole lot of other information about this subject on the episode of Full Measure. To find out where you can watch Full Measure on a station near you, go to cheryl Atkison.com and click the Full Measure tab for a list of stations and times. You can also watch online if that's easier, at FullMeasure News. FullMeasure News. The program feeds about 9:35am Eastern Time on Sundays and then it's posted thereafter. So if you miss the live feed or you don't catch it on television, that's not a problem. You can always see it online after the fact. That's at Fullmeasure News. You may have figured out by now I'm all about these medical establishment topics. How studies aren't done that should be done. How studies that are done can be corrupted. How establishment medicine has really let us down on some of the most vexing chronic health disorders in our society but for the chance to treat them. Too often, nobody's decided to look or pay for studies that would look for root causes so we could prevent these things from happening in the first place. There are reasons for that. Check out my five star bestseller Follow the How Big Pharma Misleads, Obscures and Prevails. That book is chock full of material that is sure to surprise, if not shock you, even if you think you're pretty up to date on medical scandals. My editor at HarperCollins said when he read the book that he considered himself very well informed on these topics and he said, wow, 80% of the people in this country won't have known about 90% of what's in this book. It's full of firsthand anecdotes from my time as an investigative reporter at various places, but also hard data, statistics and documentary evidence that leaves no doubt we are in a highly managed medical environment that is skewed by the pharmaceutical industry from the day that medical students enter medical school, all the way through the time that doctors, after they have their licenses and are practicing, all the way through the time they continue their continuing medical education classes. And lastly, if you would like to support this kind of independent journalism, you can go to Cheryl Akison.com and click the Store tab for some exclusive products designed for independent thinkers like you, with proceeds from the store as well as the book going to independent reporting causes like the Cheryl Echison ION Award to award independent reporting. Also the Brechner center for Freedom of Information at the University of Florida and other causes too. That's the Cheryl akison store@cherylakkison.com so many great products with slogans like I need to find some new conspiracy theories. All my old ones came true. And do your own research, make up your own mind, think for.