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The Dr. Gabrielle Lyon Show
Why Men’s Fertility Is Declining: The Truth About Testosterone | Dr. Larry Lipshultz
01:47:11
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- [00:01]
Dr. Gabrielle Lyon
Have you ever thought about male fertility as a man's final frontier? Not just sperm count or testosterone levels, but how modern life is quietly dismantling men's ability to create life, sustain, energy, and age. Well, what if everything we thought we knew about male hormones and aging and virility was either outdated or flat wrong? Dr. Larry Lipschultz is one of the most respected male reproductive health experts in the world. For decades, he's been on the front lines of andrology, working with Olympic athletes, aging men, and everyday couples struggling to conceive. He doesn't just study testosterone. He wrote the rules for how it is treated.
- [00:51]
Dr. Larry Lipschultz
We are making such a advances in female fertility and ivf, and we have nobody to take care of the men. So a light bulb went off.
- [01:01]
Dr. Gabrielle Lyon
Is it true that male fertility is declining?
- [01:05]
Dr. Larry Lipschultz
For sure.
- [01:06]
Dr. Gabrielle Lyon
Today he breaks down the real cause of male infertility. The decline, how testosterone therapy impacts sperm, and what men can do to reclaim performance and purpose from shocking truths about how male fertility is tested or often ignored to. To why some of the most motivated men in the world are secretly burnt out, hopeless, or misdiagnosed with depression. Dr. Lipschultz exposes the blind spots in modern medicine that are quietly ruining men's lives and how we fix it. We talk libido, aging, legacy, and the emotional weight men often carry in silence. Dr. Larry Lipschultz, welcome to the show.
- [01:49]
Dr. Larry Lipschultz
Thank you so much.
- [01:50]
Dr. Gabrielle Lyon
I am very excited to have you on, and I'm gonna tell you why. Why right now? Well, for many reasons, but right now, when people hear men's health, what they often think about is testosterone. However, what I have learned from you is there's so much more to men's health, and you have been an innovator when it comes to many things, whether it's environmental infertility, erectile dysfunction. But I want to start with infertility, and I want to hear a little bit about your background, because at the time, I'm not so sure it was even a field.
- [02:29]
Dr. Larry Lipschultz
Male infertility, well, the whole thing wasn't a field. But should we go back to when this whole thing started?
- [02:34]
Dr. Gabrielle Lyon
Yes, sir, we should.
- [02:35]
Dr. Larry Lipschultz
So we go back to when I was an intern at the University of Pennsylvania and I was rotating on OB gyn and they had grand rounds, like all specialties. And I was sitting there and they had a lecturer, a PhD from New York whose basic science research was on sperm. And of course, it was obgyn. It was appropriate. And he started talking. It was fascinating things. I never even thought About. And at the end, the chairman, who was very early in the IVF world, said, you know, that is such a fascinating lecture. He said, we are making such advances in female fertility and ivf, and we have nobody to take care of the men. Right. So a light bulb went off. Hey, I'm an intern. I'm starting my residency. No one's doing infertility. What a great entree into an area that's been basically untouched.
- [03:28]
Dr. Gabrielle Lyon
Were you doing a residency? Was it obviously urology at the time, or was it.
- [03:34]
Dr. Larry Lipschultz
No, it was the internship. So then your PGY one year was called an internship, and then you went into your. But you were already in the residency program, so I was in the urology program.
- [03:46]
Dr. Gabrielle Lyon
You heard about this male infertility. You thought it was amazing. Very interesting. But you were only a PGY one.
- [03:53]
Dr. Larry Lipschultz
Right.
- [03:54]
Dr. Gabrielle Lyon
How did you then go on to create arguably the first fellowship?
- [04:00]
Dr. Larry Lipschultz
Well, the fellowship's way later. The thing we had to first create was the area, the focus. I mean, there was zero focus. So in my program, he did PGY1. PGY2 was a research, was a clinical year. PGY3, you went into the lab. So I had one whole year, and I decided I was going to devote that year to learning all I could about male infertility. So there were two urologists in New York who were doing nothing but fixing varicose veins in men's. Around men's testicles because that was felt to cause infertility, overheat the testicle, et cetera. So I went up and spend a day or two with them and realized it was very narrow. I then spent another day with a man in New York who was focused on antisperm antibodies, which was hot at the time.
- [04:51]
Dr. Gabrielle Lyon
Is it now?
- [04:52]
Dr. Larry Lipschultz
No, but it was then. But the whole idea was I was opening up all these doors, all these boxes of information I didn't even know existed. So I got back to Penn, and this is my research year, and I started setting up a lab to do semen analysis. They did not have a lab. So, my good friend, what year was this?
- [05:16]
Dr. Gabrielle Lyon
Give me a ballpark.
- [05:17]
Dr. Larry Lipschultz
I'm saying mid-70s. So a good friend of mine was then next to the top of the program, and he allowed me to use his nurse one week, one day a week. And I started a clinic. And I would. And we would develop. I taught her how to do semen analyses. So she, as an rn, had the job of doing a semen analysis. And since I was just fledgling, but yet the only person in the city, I started seeing men with fertility problems as a resident.
- [05:53]
Dr. Gabrielle Lyon
Wow. So you almost had your own clinic as a resident?
- [05:55]
Dr. Larry Lipschultz
I did have my own clinic, but. But I had to bill everything under my friend. Cause I was a resident. But the point was, I started learning as I was seeing these people. Cause each patient I learned something from. And that was the beginning of it. And so by the time I became a chief resident, I did have my own clinic. And I would admit people to the hospital under my friend who was a urology staff member, and we would operate on these people because no one else knew what to do. It was a great, fascinating time.
- [06:25]
Dr. Gabrielle Lyon
Did you. The landscape was when someone was struggling to get pregnant, it was really. They were focused on women, IVF and women, Is that correct? Yes, there were. From what I'm understanding, no clinics, no specialty focused on men and infertility.
- [06:44]
Dr. Larry Lipschultz
Correct.
- [06:44]
Dr. Gabrielle Lyon
Wow.
- [06:46]
Dr. Larry Lipschultz
And you say wow. Think about how long ago that is. And we're still struggling with getting to see the male patients. It's crazy.
- [06:54]
Dr. Gabrielle Lyon
What do you mean by that?
- [06:56]
Dr. Larry Lipschultz
As IVF has become gigantic and with venture capital and whatever, the move is to get the couples into IVF programs, obviously infertile couples, and to take them through the journey of ivf. And if the husband had sperm, any. That couple was with the IVF program until they released the patient to us. Because we did not have. We don't right now have the control now. Going back to when it all started, the women would go to the gynecologist, the gynecologist would send the man to us. So it was a much different paradigm of how the infertility was approached. I think it was much better because the men got better care.
- [07:47]
Dr. Gabrielle Lyon
Did you get pushback from whoever? What were they thinking? Oh, here's Dr. Lipschultz. He's kind of crazy back then.
- [07:54]
Dr. Larry Lipschultz
Yeah, no pushback. Very supportive. Because all the OB GYNs who were in the field realized there was a need. I mean, they knew there was a need. There still is a need. But the thing that changed was the ability to offer couples fertility care that is IVF with very few sperm. Remember, you only need one sperm for each egg that that woman produces. And then in the 90s, it was discovered that you could actually extract sperm from the testicle and use those sperm and inject a sperm into an egg and get a pregnancy. So then the number needed went way down, even to zero, because we could go in and extract the sperm.
- [08:38]
Dr. Gabrielle Lyon
How has infertility changed in terms of now versus then? And I'm going to ask this question differently. Is it True. That male fertility is declining for sure.
- [08:53]
Dr. Larry Lipschultz
So if you look at the data, I mean, and most of the data for some reason goes from 2000 to 220 or from 1980. It doesn't go back to 1950, 1960. But even if you just look 1980 to now, 50% drop. 50%, 50% drop in sperm density. And it's not just the U.S. it's Denmark, it's Finland, it's Israel. These studies are like, all consistent. It is frightening.
- [09:27]
Dr. Gabrielle Lyon
But why do you think that is?
- [09:30]
Dr. Larry Lipschultz
I think there's a host of reasons. I mean, people are not taking care of themselves the way they should. There's an increase in obesity, increase the use of illicit drugs. There's, of course, you cannot ignore the environmental factors which, you know, all these, you know, there's environmental chemicals, there's plasticides. I mean, there's. There's a chemical. I think it's either a phthalate or ethylenedibromate. I don't remember which one. That's used to soften up plastics. When people talk about not using plastic bottles, it leaches out of the plastic bottles, but it's essential to make the plastic bottles. But on the other hand, it can be an estrogen mimic. So you've heard of estrogen mimics? Of course, yes. So that is the problem with a lot of these chemicals is they make mimic estrogen, which is counterproductive to sperm production. And I think that's kind of globally what we see.
- [10:27]
Dr. Gabrielle Lyon
Because when you had mentioned these other countries, the U.S. we know that we have a massive obesity problem, But Denmark and some of these other countries, they seem to be very fit and not necessarily nearly as overweight or sedentary.
- [10:40]
Dr. Larry Lipschultz
Right. So we can check off no obesity, but we're left with everything else. We're left with all the estrogen mimics in the environment. They may be worse over there. I mean, I don't know. I don't know anything about what they do culturally, but they may have some habits that are actually not productive for helping sperm. I don't know. But there are so many things. Remember, sperm are being produced millions and millions a day, and anything that's produced so rapidly is more susceptible to environmental factors. Of course the cells are dividing. It's the same thing with, like, red blood cells, white blood cells, people getting chemotherapy. You know, it attacks these reproducing, rapidly reproducing cells.
- [11:26]
Dr. Gabrielle Lyon
I mean, that's very fascinating when you. Do you remember when you first really thought about environmental factors? Because I remember not even too Long ago, people would make fun of that idea. Oh, come on. It's not plastic. Doesn't create any estrogenic activity. Again, I don't know if you were so exposed to that because you really have had a academic legacy.
- [11:53]
Dr. Larry Lipschultz
No. But I'll tell you how it happened. It's very interesting. I got contacted in the early 70s because two very large chemical companies were producing a pesticide, a soil fumigant that they found was sterilizing the workers who were making it in the plant.
- [12:14]
Dr. Gabrielle Lyon
Sterilizing.
- [12:15]
Dr. Larry Lipschultz
Sterilizing. Zero sperm.
- [12:17]
Dr. Gabrielle Lyon
Wow.
- [12:17]
Dr. Larry Lipschultz
So I went out to California, where it was identified and got involved as an expert for the defense, which were these two or three large companies who were making this. And what we found out was indeed the men on the assembly line who were literally handling it or breathing it by either skin absorption or inhalation. They were sterile. And it was a big trial out in California. Very exciting because it's a very famous courtroom. Anyway, so obviously the men won. I mean, it was a lawsuit. It was settled. But then going forward, the plaintiff attorneys got wind of this. I said, ah, well, if the guys there are getting exposed, how about the men who were applying it in the fields all over Central America, in the banana crops and the pineapple crops? Because it was a soil fumigant. So then we started these lawsuits, massive lawsuits. And unbelievable. It's still going on today. We are still examining men for a lawsuit from a Central American country. These men are now 60. 60, and they're complaining about inability to have children. When you go back to when they were in their reproductive years, fully sterile. No, they're not. This is the issue.
- [13:42]
Dr. Gabrielle Lyon
They.
- [13:43]
Dr. Larry Lipschultz
Because they're now pulling these men out who just have a history of. Yes, I worked on this banana farm. Yes, I had difficulty having kids. Was I really exposed to something or were they really exposed? Because don't forget, you know, a large 2% of the world's population are sterile. Male population, naturally. Naturally. Well, you know, not because of external whatever. Yes. Not. Yes. More naturally than something like exposure to a specific pesticide.
- [14:14]
Dr. Gabrielle Lyon
And when you say sterile, does that mean they still produce sperm, but it's fragmented or something like that?
- [14:18]
Dr. Larry Lipschultz
No. I mean, they have no sperm in the ejaculate.
- [14:21]
Dr. Gabrielle Lyon
Okay.
- [14:22]
Dr. Larry Lipschultz
And maybe some of them, we can go in and find little pockets of sperm in the testis, but they could not naturally have a baby.
- [14:29]
Dr. Gabrielle Lyon
2% of the population.
- [14:30]
Dr. Larry Lipschultz
Naturally.
- [14:31]
Dr. Gabrielle Lyon
Yeah.
- [14:32]
Dr. Larry Lipschultz
So here you come up with the positive aspect of ivf, because now we can go. And some of these men extract sperm from the testicle, give it to the IVF programs. They can inject it into the eggs.
- [14:46]
Dr. Gabrielle Lyon
And they called you? Yes, they called you. And did they say, was the experience. Was it a known entity at the time, meaning that was one environmental factor in the seventies. Were there others?
- [15:00]
Dr. Larry Lipschultz
Well, if there were, I was. I don't think I was involved with any others directly because this was known, because it had been demonstrated in the factory workers and the plaintiff attorneys were gathering these sugar cane workers, banana crop workers, to do these class action suits. So there was a tremendous amount of work to be done just on the one chemical. So I don't really think maybe I got involved with the second one, but I don't remember nothing like this.
- [15:28]
Dr. Gabrielle Lyon
How do you think about that for the modern day? Now we probably have more chemicals. We're trying to make things easier. We have a bigger population. That means we're mass producing foods. How do you think about fertility now and just the environmental exposures?
- [15:45]
Dr. Larry Lipschultz
Yes, of course it's a factor. I just wish that there were more people looking at what's doing it. But we go back to our initial discussion. They don't care about the men.
- [15:58]
Dr. Gabrielle Lyon
Only when the women fail well, and.
- [16:01]
Dr. Larry Lipschultz
Only when they present with zero sperm, then they call us. So I just think there's not enough focus on the why and not enough basic research on the why. It's interesting, but I have a former fellow who is at Stanford, Mike Eisenberg. His whole career, since he left me, primarily research wise, has been devoted to looking at fertility in males as a metric of men's health, I think it's a great idea. But his publications have been groundbreaking. Increase cancer, increase all types of health issues. Increase mortality in men who have no sperm.
- [16:45]
Dr. Gabrielle Lyon
Wow.
- [16:46]
Dr. Larry Lipschultz
And he could only follow them for, you know, eight years, 10 years. But it's really frightening.
- [16:52]
Dr. Gabrielle Lyon
Where do you start when you talk to patients about the infertility problem when it comes to environmental exposure? So someone is coming to you. They're young, they're 30, they can't. The wife checks out. How do you then go about approaching all of the. Is it just environment? What are the domains?
- [17:15]
Dr. Larry Lipschultz
Well, see, you can't, because there's no tests, there's no specific test. I think most important is what does the man do? I mean, you know, if he is a lawyer, he's unlikely to be overexposed to toxins that are not the same with somebody who, you know, is working in. We have huge chemical plants all around Houston. I see a lot of these guys.
- [17:37]
Dr. Gabrielle Lyon
Wow. So there's the chemical plants. What about.
- [17:40]
Dr. Larry Lipschultz
There's the petroleum plants? You know, because we do. We have so many refineries, but there's no real. No one has really gone into these places and done these type of studies that they did back when we were looking at the chemicals in California. And certainly it should be done, but it's very litiginous, you know, potentially. No one wants to get. I don't think anybody wants to really get. Go there.
- [18:07]
Dr. Gabrielle Lyon
So how do people protect themselves now? Do you say, don't drink out of water bottles, don't heat plastic. Have you thought about what we need to do? Just.
- [18:16]
Dr. Larry Lipschultz
I've thought about it. It's just onerous. I mean, how do you tell people to not drink out of plastic bottles when every time you ask for a bottle of water or you ask for water, you get a plastic bottle? Right.
- [18:28]
Dr. Gabrielle Lyon
Yeah.
- [18:28]
Dr. Larry Lipschultz
I mean, I don't think we can go back. I'm not sure. I just don't. I mean, do you think we could go back? What are we going to do to all the people who need water?
- [18:39]
Dr. Gabrielle Lyon
I think it's a really important discussion. You know, we. I have a. By the way, I have a clinic. I don't know if you know that, but I still see patients. And one of the things that we do is we do environmental testing in their blood and their urine.
- [18:52]
Dr. Larry Lipschultz
Right. Well, we're gonna have to talk about that because I don't even know where to send it.
- [18:57]
Dr. Gabrielle Lyon
Yeah, well, I can certainly help you with that. But then the question is there are things like Agent Orange. So once it's in the body, what are you gonna do? So you're gonna try to chelate it, but it becomes very challenging. And then if it's at this level that it's so.
- [19:13]
Dr. Larry Lipschultz
But we don't even know if that's what's causing the man's fertility.
- [19:16]
Dr. Gabrielle Lyon
That's right.
- [19:17]
Dr. Larry Lipschultz
So another whole area that we're just starting to look at is changes in their genome changes, genetic changes in men that may be causing problems with fertility and epigenetic changes. So the fellow who runs our lab also has an NIH grant to look at genetics of infertility. So if I see somebody now who has no sperm or hardly any sperm, we send over a blood sample, and he'll do their entire genome.
- [19:46]
Dr. Gabrielle Lyon
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- [21:37]
Dr. Larry Lipschultz
I know, but you get so many blips of abnormalities it's now like which one's really important. So that's a big job when you look at this whole genome to figure out which of the. There's a list of infertility genes that's been published and I don't, I think there's 140. So certainly that's the low hanging fruit. Do they have any of those?
- [21:59]
Dr. Gabrielle Lyon
But it doesn't make sense if, if it is true that male infertility is declining by 50%. Since when? Since the 80s.
- [22:06]
Dr. Larry Lipschultz
I'm looking at the 80s.
- [22:07]
Dr. Gabrielle Lyon
Yeah. I mean that is drastic and tremendous.
- [22:11]
Dr. Larry Lipschultz
But no, no, you have to differentiate between male fertility decreasing. We're talking about semen quality decreasing, right? It's just numbers of sperm. So is a man going to have infertility problems if his normally 100 million goes to 50 million? No. So the fact that these counts are dropping by 50% does not mean these men are ever going to show up in my office. It's just a metric of their health. Right.
- [22:40]
Dr. Gabrielle Lyon
Which is fascinating.
- [22:41]
Dr. Larry Lipschultz
It is fascinating, but it's not necessarily the reason why the couple's sitting in front of me.
- [22:48]
Dr. Gabrielle Lyon
What percent do you think? And I know you only see men, and this is probably a very difficult question. What percent is the woman typically versus the man?
- [22:57]
Dr. Larry Lipschultz
So, and I have. This is like one of my early slides when I give a talk. So the male just by himself 30% of the time. The woman just by herself 50% of the time and another 20%. It's both of them. So half the time the male should.
- [23:16]
Dr. Gabrielle Lyon
Be evaluated and it's not standard of care right now. Is that true?
- [23:21]
Dr. Larry Lipschultz
Correct.
- [23:22]
Dr. Gabrielle Lyon
Is there amount of time. So if someone is listening to this.
- [23:25]
Dr. Larry Lipschultz
Am I going to get in a lot of trouble with a gynecologist for saying this?
- [23:28]
Dr. Gabrielle Lyon
No, we love our gynecologist. Besides, you guys are looking. We're looking at different things. And also, at the end of the day, people want families.
- [23:36]
Dr. Larry Lipschultz
Right.
- [23:37]
Dr. Gabrielle Lyon
And if they have environmental exposures. And honestly, I don't know the answer to what to do about it, but it is. You know, I worry about my kids.
- [23:45]
Dr. Larry Lipschultz
Yes, but you do. I mean, you do focus on those type of healthy.
- [23:49]
Dr. Gabrielle Lyon
I do.
- [23:50]
Dr. Larry Lipschultz
And you measure things, and I think that's.
- [23:52]
Dr. Gabrielle Lyon
I'll send them to you.
- [23:54]
Dr. Larry Lipschultz
But what more can you do other than looking scientifically at what's going on with the individual right now? It's important to just gather data and look.
- [24:04]
Dr. Gabrielle Lyon
But then you think about things in terms of, for example, receipts, transactional receipts. These all have chemicals on them. The amount of exposure that we have is tremendous. And then the other question is, what are we doing to offset that? And I don't. I mean, you have to be really diligent. Is it that you have to sauna? Do you. I mean, you have to get rid of these toxins to the best of one's ability. Do they have to go to the bathroom and have good digestion? I mean, we have to be able to process it.
- [24:34]
Dr. Larry Lipschultz
Right.
- [24:35]
Dr. Gabrielle Lyon
I think it's a real. It's a real challenge.
- [24:38]
Dr. Larry Lipschultz
It is a challenge. It is. It's a huge challenge. And we're just scratching the surface of what these things are that are unhealthy.
- [24:46]
Dr. Gabrielle Lyon
There is the fertility aspect, which you define is infertility. What is the definition of infertility?
- [24:53]
Dr. Larry Lipschultz
It's a couple. It's a couple related phenomena. It's a couple who have tried for one year to establish a pregnancy with unprotected intercourse and nothing has happened. Or if the woman's over 30, five, six months.
- [25:08]
Dr. Gabrielle Lyon
Okay.
- [25:09]
Dr. Larry Lipschultz
And I cannot tell you how many women I see as I'm seeing their husbands. The women are there. They're 41, they're 42. And it's tragic because no one is talking to these women about the fact that they've got to think about maybe freezing eggs. If they're professional, something. Because after 35, it's not like their 35th birthday, something happens. But there's a gradual decline in a quality. And the guy can be borderline. And if his wife is 21, he may never have a problem. If she's 41, they're going to show up.
- [25:47]
Dr. Gabrielle Lyon
How does someone address sperm quality? For example, what are the things that a man could do to improve their sperm quality?
- [25:56]
Dr. Larry Lipschultz
Number one, get tested. Because if there's nothing wrong, don't worry about it.
- [26:00]
Dr. Gabrielle Lyon
Number two, what should they be looking for and who do they.
- [26:02]
Dr. Larry Lipschultz
They go to a. They go to a urologist. They go to their primary care doctor.
- [26:07]
Dr. Gabrielle Lyon
We do not sperm test.
- [26:09]
Dr. Larry Lipschultz
So let me tell you what happens. They go to the primary care doctor, he sends them to an IVF program, knee jerk. The IVF program, does his semen analysis. If it's low, the couple are shunted. I'm not saying every ivf, but in general, they are shunted into ivf. Because if you're selling Cadillacs, somebody comes into your showroom, you're not going to sell them a Ford or even a Mercedes, you're only going to sell the Cadillac. And that's what happens. Using our IVF programs as a clearinghouse.
- [26:44]
Dr. Gabrielle Lyon
For semen quality, what would you like to see happen?
- [26:48]
Dr. Larry Lipschultz
I would like to see more patients refer to their urologist. Doesn't have to be a specialized urologist. Any urologist knows how to get a semen analysis and then how to triage the patient.
- [27:03]
Dr. Gabrielle Lyon
Would it be safe to say that, I mean, a woman could go through IVF and that would be. I mean, that seems like it's really difficult, as opposed to a man getting a semen analysis and then treating it from the male perspective. Right.
- [27:20]
Dr. Larry Lipschultz
But the thing about it is, and I have to be honest, and that is the IVF programs can actually do something for everybody.
- [27:29]
Dr. Gabrielle Lyon
In what way?
- [27:29]
Dr. Larry Lipschultz
In other words, they can offer the couple the ability to at least put the sperm into the eggs, get embryos. But we can't treat a lot of the men we see, even though we identify the fact that they're not normal. But, you know, we have to. The message is, if a man is not normal, he's at health risk for other things. So at least get tested. Maybe you're not going to get cured, but you're going to know you have an issue. Because, you know, when we do our gene sequencing, we also look for what we call actionable abnormalities. Things that the man we may pick up, like a predilection to have cancer or a predilection to get diabetes. We pick these up in their gene screening.
- [28:18]
Dr. Gabrielle Lyon
Wow.
- [28:18]
Dr. Larry Lipschultz
And then it changes the way that man gets treated in his subsequent years of health. And don't forget, these guys are usually young, so it's better to know early than to know late.
- [28:31]
Dr. Gabrielle Lyon
Do you think that that could become a standard practice?
- [28:35]
Dr. Larry Lipschultz
No, it's too expensive. But I can tell you there, I've seen movements in some cities, in some countries to use a semen analysis as a screening tool for a man's health.
- [28:46]
Dr. Gabrielle Lyon
I mean, that is. That's incredible. And I'm. Pain.
- [28:49]
Dr. Larry Lipschultz
It's painless. You know.
- [28:53]
Dr. Gabrielle Lyon
I don't know. I don't know if it could be fun. But anyway. But the other question is, you said that sperm are produced very quickly, very often. That would make it sensitive to both environmental exposures, but also sensitive to positive things like diet, exercise, potentially.
- [29:14]
Dr. Larry Lipschultz
Exactly. But if somebody comes to me and I identify a problem and I treat it, we're not going to see an overall new community of sperm for three months. That's how long it takes a sperm to get from the baby, sperm in the testicle into the ejaculate.
- [29:35]
Dr. Gabrielle Lyon
So if I think about there's the good. The good diet, nutrition. Do we know, does diet and nutrition impact sperm quality? And when you talk about quality, are you talking about how fast it moves? What are the things?
- [29:50]
Dr. Larry Lipschultz
I'm talking about its ability to actually penetrate the egg and make a baby. And we do know that oxidative stress is bad. Oxidative. Increased oxidants in the individual can cause increased breakage in their DNA. DNA fragmentation causes poor fertilization, increased miscarriages. So, yes, there are things that you can do, and I'm sure you know how to treat excess oxidants in the individual.
- [30:19]
Dr. Gabrielle Lyon
I mean, yes. And are there supplements and things that you think have good evidence? When you sit down with a individual and you say, you know what, I need to improve your sperm quality or we need to do that. What are the domains and what are the things that you recommend that have good scientific evidence?
- [30:37]
Dr. Larry Lipschultz
So, number one, don't get into hot tubs.
- [30:42]
Dr. Gabrielle Lyon
Really?
- [30:44]
Dr. Larry Lipschultz
Yeah.
- [30:44]
Dr. Gabrielle Lyon
I mean, you're looking at me like I should know that. Well, I mean, I know if it's fake news or what?
- [30:49]
Dr. Larry Lipschultz
No, it's increased heat to the testicle hurts. Burn production now. Saunas, they're okay. You're not applying it, but hot water, you are applying it. So if I want to try to optimize everything, stay away from direct heat.
- [31:07]
Dr. Gabrielle Lyon
No hot tubs, no baths.
- [31:08]
Dr. Larry Lipschultz
Well, I mean, a warm bath is not going to hurt anything. Take showers, stay clean. But I mean, you know, we know that heat is bad. That's why the testicles are outside the body.
- [31:17]
Dr. Gabrielle Lyon
Because.
- [31:17]
Dr. Larry Lipschultz
Cause they're kept at a lower temperature.
- [31:19]
Dr. Gabrielle Lyon
What about cold plunging?
- [31:21]
Dr. Larry Lipschultz
You know, there's no data on it yet. I don't know. I could never do it. I mean, the idea is just. What?
- [31:29]
Dr. Gabrielle Lyon
It's a blast.
- [31:30]
Dr. Larry Lipschultz
I know, but everybody's doing it now.
- [31:32]
Dr. Gabrielle Lyon
I know, but you're not concerned about.
- [31:35]
Dr. Larry Lipschultz
Well, I mean, I think we need to look at the data. It could be bad, it could be a shock. Right.
- [31:41]
Dr. Gabrielle Lyon
What about drugs? Drugs, cannabis, use alcohol.
- [31:44]
Dr. Larry Lipschultz
Bad, bad, bad. Alcohol in moderation I don't think is bad. The other stuff, we don't have a no effect level. So I would say if you're trying to have a baby, stay away from drugs. Well, stay away anyway. But I mean, it really becomes important when you're trying to have a baby.
- [32:04]
Dr. Gabrielle Lyon
So you are not a fan of marijuana? It just seems that everybody's using cannabis nowadays. I mean, again, everybody might be a really large statement, but people are always talking about how it's good for this or that.
- [32:20]
Dr. Larry Lipschultz
What's it good for? Because I don't know.
- [32:22]
Dr. Gabrielle Lyon
I mean, from my perspective, I don't recommend it. I don't think it's a great choice. I don't care how you're getting it right. But I do know that people seem to like it and use it right.
- [32:33]
Dr. Larry Lipschultz
I actually do not see a lot of people who are using cannabis.
- [32:37]
Dr. Gabrielle Lyon
You don't?
- [32:38]
Dr. Larry Lipschultz
No, I don't think it's a. A big thing in Houston. I think maybe it's more bicoastal, east coast, West Coast. I don't, at least in the patients I see, I don't see a lot of it or they're not telling me, but you know, they're usually pretty honest.
- [32:51]
Dr. Gabrielle Lyon
Do. Are there certain kind of supplements you recommend? Would it be glutathione or vitamin C? Do we have data for this?
- [32:57]
Dr. Larry Lipschultz
They're both good. There are studies showing that the use of antioxidants can improve semen quality. So I mean, why not? Right? Why not use them? So we tried to make one, so we have one called you did.
- [33:12]
Dr. Gabrielle Lyon
You didn't even bring me any. Not that I have sperm, but still.
- [33:15]
Dr. Larry Lipschultz
No, but it just consists of a lot of antioxidants.
- [33:20]
Dr. Gabrielle Lyon
Okay. I think that.
- [33:23]
Dr. Larry Lipschultz
And we have one pharmacy that will make it for us because a lot of the pharmacies can't make over the counter as well as prescription. They can't do it in the same facility.
- [33:34]
Dr. Gabrielle Lyon
Do medications, depending on the kind of medication, affect sperm? Are there things where you say, okay, if. You know, like for women. When I think about women, for example, a woman. You don't want a woman on retinols for pregnancy, or Accutane. Sorry. Things of that nature are. There is thinking about male fertility through the lens of female fertility kind of the same. No, it's not good. Great.
- [34:06]
Dr. Larry Lipschultz
I say that flippingly, but I don't really know. I mean, I know that a lot of my guys go on Accutane, but they're not the infertility guys. They're the testosterone guys.
- [34:17]
Dr. Gabrielle Lyon
Well, we're gonna get to that. I know it's not your favorite topic.
- [34:20]
Dr. Larry Lipschultz
No, it is. I mean, I like it. I.
- [34:22]
Dr. Gabrielle Lyon
But you don't have concern about using, I don't know, antidepressants?
- [34:26]
Dr. Larry Lipschultz
Well, there's been a lot of data on finasteride, you know, which blocks dht. Yeah. And showing, but not fertility. Erectile dysfunction. I just don't see it very often. But in men who do experience that post finasteride syndrome, it can be devastating. And I do tell my patients, but I honestly, I've never seen it. And we see lots of people.
- [34:51]
Dr. Gabrielle Lyon
What are the biggest things that you think people are doing that are improving their sperm? I guess what I'm asking is how many. I've heard through the grapevine that you. There are days that you see 70 patients in a day. Is it 70?
- [35:09]
Dr. Larry Lipschultz
Maybe. But, you know, don't forget, my day goes till 7. 7:30.
- [35:13]
Dr. Gabrielle Lyon
Unbelievable. How long have you been in practice?
- [35:15]
Dr. Larry Lipschultz
I'm not gonna tell you. And.
- [35:17]
Dr. Gabrielle Lyon
And if I actually know these answers, But.
- [35:20]
Dr. Larry Lipschultz
And if. If the man is there just for refills right now, it's kind of like I see them on the way out because they don't want to wait just to get refills. Right. To see me.
- [35:29]
Dr. Gabrielle Lyon
I don't know. People have been with you for a long time. I do think that they want to wait.
- [35:32]
Dr. Larry Lipschultz
No. So some. You're right. Some people do. Just because they've become friends. Yes, but we see them because I have excellent, excellent help, like, as you do. I mean, I've got support. I've got a resident and I've got two fellows, so. And you know, and we often have med students, you know, and they're usually seniorish med students, so they know kind of what they're doing. And that really helps move the pace because for me to go in and have, you know, everything's typed, everything's on the computer, we use EPIC like everybody else, which, by the way, for those of you who don't know, is a system for seeing patients. And I typed very slowly. So for these people to go in and do all that, I can just go in and fiddle, but I can actually make the decisions regarding care.
- [36:18]
Dr. Gabrielle Lyon
But. And you see, the reason I asked you and kind of set you up is that you've seen thousands of patients and you've seen the landscape change. And I'm curious as to what the people are doing right that are becoming more fertile versus what they're doing wrong. And I do think utilizing things like testosterone. I'm really curious about testosterone use and fertility. And also age. A woman goes through menopause, she is not getting pregnant again. I mean, that would be that it just doesn't happen. Her egg quality, her ability to get pregnant is not there. Will not happen.
- [36:55]
Dr. Larry Lipschultz
Right.
- [36:56]
Dr. Gabrielle Lyon
Does a man go through a period of time where he has a equivalent to menopause?
- [37:04]
Dr. Larry Lipschultz
No. I mean, look at, look at unnamed movie stars who in the past couple years, over the age of 70 or 80, have had kids. So the problem is not that they can't have kids. The problem is they have genetic changes as they age in the sperm that can be passed on to the kids, you know, maybe increased autism. So, you know, I think men over the age of 60 have to be very careful. And it's especially bad if their wife's over 40.
- [37:37]
Dr. Gabrielle Lyon
And there's a risk. So the combination, it would be a risk for increased autism.
- [37:42]
Dr. Larry Lipschultz
Increased increased genetic abnormalities in the offspring.
- [37:46]
Dr. Gabrielle Lyon
Okay. But still viable sperm and viable pregnancy.
- [37:50]
Dr. Larry Lipschultz
The man does not stop making sperm.
- [37:54]
Dr. Gabrielle Lyon
Isn't that wild?
- [37:55]
Dr. Larry Lipschultz
Yeah, well, it's, you know, survival of the species. And, you know, you have a bull and all the cows, I mean, you know, it's the same thing. The men, sperm production goes on. And I think when you mentioned the woman, that's why it's so important that women think about this and freeze eggs if they're not. If they're going to postpone having kids. It's just men can't. Well, you can freeze sperm.
- [38:18]
Dr. Gabrielle Lyon
Do you recommend it?
- [38:19]
Dr. Larry Lipschultz
We don't. Because, you know, it's not the same thing where they're going to stop. You know, women are going to stop or their eggs are going to have increasing genetic abnormalities and they can change it much earlier than men.
- [38:30]
Dr. Gabrielle Lyon
When do you, would you say that? Around 60 is when that sperm quality changes for men?
- [38:35]
Dr. Larry Lipschultz
I think it starts over 50. I think it becomes a significant problem over 60.
- [38:40]
Dr. Gabrielle Lyon
What about erectile dysfunction and infertility?
- [38:43]
Dr. Larry Lipschultz
Right.
- [38:44]
Dr. Gabrielle Lyon
Are those related?
- [38:45]
Dr. Larry Lipschultz
Well, it's hard to have a baby if you can't have sex.
- [38:47]
Dr. Gabrielle Lyon
I know, I know.
- [38:48]
Dr. Larry Lipschultz
We're getting very basic here.
- [38:50]
Dr. Gabrielle Lyon
Yeah, but would that be. So if someone has erectile dysfunction, you would say that that's a marker of their health and probably an indicator of sperm quality?
- [39:00]
Dr. Larry Lipschultz
No.
- [39:00]
Dr. Gabrielle Lyon
Oh, good.
- [39:01]
Dr. Larry Lipschultz
Totally unrelated.
- [39:02]
Dr. Gabrielle Lyon
Great.
- [39:03]
Dr. Larry Lipschultz
You know, I think a lot of the time when we see problems with erectile dysfunction, it's blood flow problems. You know, when you look at the actual physiology of the erection and the blood flow problems to the testes are much, much different. Not that they're aren't some, but totally unrelated to the blood vessels that go to the penis. So we don't really think in this field, we don't think about the two being very closely related, except for the fact that it's very frustrating trying to have a baby if you can't get an erection, which does happen a lot of times just because of so much pressure.
- [39:42]
Dr. Gabrielle Lyon
Well, again, you've been doing this for a long time, so they definitely know to come to you to talk about that.
- [39:48]
Dr. Larry Lipschultz
But we don't have to keep emphasizing the long time.
- [39:50]
Dr. Gabrielle Lyon
Yeah, yeah, yeah, that's so true.
- [39:53]
Dr. Larry Lipschultz
That's okay.
- [39:56]
Dr. Gabrielle Lyon
What about when an individual uses testosterone? How does that affect testosterone? And or other anabolics? We have anabolics like Nandrolone. Anabolic agents like Nandrolone. What about things like Anavar? So number one, what impact does testosterone have on fertility? And then the follow up would be, what about other anabolic agents?
- [40:20]
Dr. Larry Lipschultz
So I think you have to just keep them all together. They're all going to do the same thing because what they do is they turn off the production of FSH and LH from the brain that are essential for sperm production. So, yes, it's a problem. And I tell men when I give them testosterone, regardless of their age, I tell them, look, this is going to lower your sperm count. Maybe it's going to make it go to zero. So I said, we can treat it. And I give them something called hcg, which is LH to take while they're taking testosterone. I offer it to every man because when you take testosterone, you turn off your own production and when you turn off your OR lower significantly and when that happens the testicles get smaller.
- [41:07]
Dr. Gabrielle Lyon
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- [42:33]
Dr. Larry Lipschultz
And a lot of men don't like their testicles shrinking, right?
- [42:37]
Dr. Gabrielle Lyon
Not a good look.
- [42:38]
Dr. Larry Lipschultz
Not a good look. So I tell them if they don't want that once a week give yourself a shot of hcg. It's not expensive.
- [42:47]
Dr. Gabrielle Lyon
Once a week as opposed to three times a week?
- [42:49]
Dr. Larry Lipschultz
About three times a week. If you're trying to get sperm production for just maintaining size for some crazy reason, once a week does it because it only lasts for 48 hours. But that single pulse once a week does manage to obviate the shrinkage that you get from turning off gonadotropins.
- [43:10]
Dr. Gabrielle Lyon
What dose do you typically start?
- [43:12]
Dr. Larry Lipschultz
So I usually start 15 international units sub Q once weekly. 15 international 1500.
- [43:20]
Dr. Gabrielle Lyon
1500. When did you start utilizing testosterone therapy? So we had Abe Morgenthaler on the podcast and I mean it's not right now pretty much testosterone therapy is not off limits, but it seemed like it was for a very long time.
- [43:40]
Dr. Larry Lipschultz
Off limits or discourage? I mean, I don't know. I mean since I've been in the field, it's never been off limits. It's just been cautionary.
- [43:49]
Dr. Gabrielle Lyon
But did people believe that if you were to offer testosterone that it would give individuals prostate cancer?
- [43:55]
Dr. Larry Lipschultz
Yes, but, I mean, when I got involved in the field, first of all, the fertility was first. The testosterone and the erectile dysfunction came on later as patients realized that it was all kind of intimately related one way or another. So with the testosterone, when I started using it, Abe had already started publishing things like, you can take it and you're not going to get prostate cancer. But I'll tell you, there is a study that he and I did showing that you could take testosterone if you have prostate cancer and it's not going to get worse. And he and I just happened to be at a same course, and I started mentioning that I have these patients that I'm treating, and he said, oh, I have these patients that I'm treating. Let's publish it. So that was the publication showing that you could still take testosterone and not hurt your chances of your prostate cancer getting worse.
- [45:05]
Dr. Gabrielle Lyon
I mean, in my mind, that's landmark.
- [45:07]
Dr. Larry Lipschultz
Yeah. I mean, it was a really important finding. It was kind of serendipitous that we both did it at the same time and that we both talked about it at the same time. And that has led to many other publications that are similar.
- [45:21]
Dr. Gabrielle Lyon
You know, I'm really curious as to what you feel, and, you know, this is kind of a weird question, but, you know, I look at my longtime mentor, and his name is Dr. Donald Lehman. The individuals that listen to this know him very well. And really, his contribution, he's had many. But his biggest contribution was that determining leucine's impact, the amount of leucine's impact on skeletal muscle, which really shaped. Went on to shape how we think about nutrition and muscle mass.
- [45:50]
Dr. Larry Lipschultz
Right.
- [45:50]
Dr. Gabrielle Lyon
And I'm just curious, from your perspective as someone who has been very innovative in the field, what do you feel that your biggest contribution has been?
- [45:59]
Dr. Larry Lipschultz
Oh, I don't know.
- [46:00]
Dr. Gabrielle Lyon
I know it's a tricky.
- [46:01]
Dr. Larry Lipschultz
It's not tricky. It's just something I've never thought about.
- [46:04]
Dr. Gabrielle Lyon
I mean, you've trained fellows. I'm sorry, how many fellows have you trained?
- [46:09]
Dr. Larry Lipschultz
Over a hundred. That's not. That's like a side road.
- [46:15]
Dr. Gabrielle Lyon
I know. Again, we're just chatting.
- [46:17]
Dr. Larry Lipschultz
Yes, we're just chatting. But I mean, I think I'd have to think about what. I think my biggest. No, I think. I think you brought up something very interesting. I think my biggest contribution has been my fellowship because we've sent people out there now to all your major academic Centers who are now training their people. So it's been kind of like a family building type of thing. So, yes, let's go with training other fellows to carry on kind of the same message.
- [46:47]
Dr. Gabrielle Lyon
Right, Yeah, I like that. I think it's just really important, paying it forward. And, you know, you do publish quite a bit and you've published hundreds of papers.
- [46:57]
Dr. Larry Lipschultz
But.
- [47:00]
Dr. Gabrielle Lyon
I, I believe, and this is one of the reasons I was so excited to have you on, is the way that you think about things and then teaching that to the fellows and really thinking outside the box. You do teach a lot of your fellows about peptides and other anabolic agents, which I've been a physician for 20, almost 20 years, and I think that that is unusual. And what do I think is unusual about it? There is testosterone, which has, you know, really had this legacy. But peptides and other anabolic agents I think are very important. And I'll start with the anabolic agents, things like Winstrol, Nandrolone.
- [47:44]
Dr. Larry Lipschultz
But I think we have to preface this discussion with. With the fact that these are not FDA approved for the most part. Now, Anavar is.
- [47:53]
Dr. Gabrielle Lyon
Nandrolone is FDA approved.
- [47:54]
Dr. Larry Lipschultz
Yeah. So we're using. Some of the things we use are proven to be effective, but they're not proven to be 100% safe. Hence no FDA approval, if that matters to somebody. I mean, to me, as long as I am carefully monitoring the patient, you know, doing regular blood checks, looking at blood pressure, hematocrit, et cetera, I don't care that it's not FDA approved, because I'm doing what they would have done had they sent it out for some type of approval. But on the other hand, I think. I don't think you. I don't think it should be used without. Yes, cavalierly, I agree with you. Yeah.
- [48:37]
Dr. Gabrielle Lyon
When you. Do you remember when you started using other kind of anabolic agents? And how can we preface this? How can we bring the conversation to a place where we help people understand that anabolic agents, and we can decide whichever ones you would like to talk about. There are ones that are safe. They are very similar. For example, testosterone. We know pretty much what its safety side effects are. We do Nandrolone, FDA approved. We know what its safety profile is. There's still somewhat of a stigma, even though I think that these agents can be very valuable. I'm gonna pass it over to you.
- [49:23]
Dr. Larry Lipschultz
But I agree. I mean, I agree. I mean, I think they're useful and I think you have to be careful. So historically, what happened? I was treating men only with testosterone deficiency. Classically, the older man low testosterone satisfied the endocrine society and the AUA's criteria of lower than 300 nanogram per deciliter prior to 11am and following it by the book. And then I started realizing that, you know what, a lot of it didn't make sense to me. Why was I not treating a man whose testosterone was 200 in the afternoon if his testosterone was 400 in the morning, he was still low in the afternoon. I don't know how you feel about this.
- [50:11]
Dr. Gabrielle Lyon
I feel the exact same way.
- [50:11]
Dr. Larry Lipschultz
It just didn't make sense to me.
- [50:13]
Dr. Gabrielle Lyon
I feel the exact same way because.
- [50:14]
Dr. Larry Lipschultz
If they have classic symptoms of low testosterone and they have an afternoon 200, he should be treated. But that goes against the party line. So whoever is listening has to understand that that is not mainstream. But I would think it's becoming much more acceptable. And then as I got into that, I think I started attracting people who were fringy in terms of low T, for instance, athletes who were on testosterone, who wanted other things. And my rule is and still is, I'm not going to treat somebody who comes in on testosterone if they don't have historically a low testosterone. And I want to see that lab slip because otherwise I'm acting as a store, right? I'm selling. And I don't want to be a store for compounding pharmacies. So I'm very careful about who I treat. I'm not going to treat people just cause they show up. Having said that, the majority of these people that you see who look so healthy and so ripped in the gym will tell you at one point they had low testosterone and they'll show you the lab slip. So you can't just assume someone is taking something frivolously until you look at their history, because they may actually come from a low testosterone background.
- [51:46]
Dr. Gabrielle Lyon
And when someone comes, they have low testosterone, they're treated. And I am curious. You know, I have a former patient of mine, I think he listens to podcasts. Brandon, Amazing young man, low testosterone you could see in their 20s. But I will come back to the age at which you treat. When did you first start seeing other anabolic agents? Because in the HIV community they were using. Oh, they were using anabolic agents to prevent death from concussion, anemia and anemia.
- [52:21]
Dr. Larry Lipschultz
Muscle wasting. Yes, they were all being used.
- [52:24]
Dr. Gabrielle Lyon
So when did you start to use it in practice? Obviously very safely. And how do you administer it now? How long have you been using other anabolic agents?
- [52:36]
Dr. Larry Lipschultz
So I would say I've been Using them since I started working with compounding pharmacies because the compounding pharmacies were making them. Whereas if I just went to CVS Walgreens, I would never even have heard of them. And the compounding pharmacies I use are the best. I mean I've toured them. I'm thoroughly impressed by everything they do. And the thing that you don't realize.
- [53:02]
Dr. Gabrielle Lyon
I didn't realize empower is probably one we love. I mean empower them.
- [53:07]
Dr. Larry Lipschultz
So. But we'll get back to that. But anyway, these pharmacies who are compounding have to get their raw material from FDA approved facilities, albeit China and India.
- [53:20]
Dr. Gabrielle Lyon
Right.
- [53:21]
Dr. Larry Lipschultz
So it's not like they're getting bad drugs from Mexico and then selling them.
- [53:27]
Dr. Gabrielle Lyon
By mixing can be the alternative.
- [53:29]
Dr. Larry Lipschultz
Yeah, but they're using pharmaceutical grade materials or else I wouldn't use these pharmacies.
- [53:37]
Dr. Gabrielle Lyon
You started using anabolic agents when compounding became available. So how long ago was that? Is it recent?
- [53:45]
Dr. Larry Lipschultz
I'm trying to think.
- [53:46]
Dr. Gabrielle Lyon
20 years you've been using anabolic agents?
- [53:48]
Dr. Larry Lipschultz
Maybe 15 or 15 or 20. I started with Empower Pharmacy. Shout out to Empower Pharmacy.
- [53:54]
Dr. Gabrielle Lyon
We've had. Just so you know, I'm a huge. He's been on your podcast of Sean Norian.
- [53:59]
Dr. Larry Lipschultz
Has he been on?
- [54:00]
Dr. Gabrielle Lyon
Yes.
- [54:00]
Dr. Larry Lipschultz
Yeah. So I.
- [54:01]
Dr. Gabrielle Lyon
There was, by the way, I just want to say that there was. The mass media is talking about how they were getting rid of Ozempic and all of this stuff and none of that's true. I know, right. And that is why Sean and I spoke because. And again now you are coming on the podcast talking about the positives of a company.
- [54:20]
Dr. Larry Lipschultz
But let me tell you, I met. When I met Sean Nourian, he had a facility in a strip center. So that's. He could tell you when that was. That's what started me actually the first prescription I ever used from a compounding pharmacy was from him. And through the years they started adding more. As they added more, I used more because they became available. And I don't know whether you've ever toured their facility, but it is mind blowing the sophistication they have there. And the goal is to be at the level of a major big pharma company. I mean we're not talking about a little mom and pop shop. We're talking about really sophisticated manufacturing.
- [55:08]
Dr. Gabrielle Lyon
And is that what brought your interest in anabolics? Yes, I think it's a really. There is no one better to have this conversation with. Which is why I want to talk to you about. Is not commonly used in Andrology practices or urologist practices, not commonly used across the board. And I think that they are life saving and life changing. And you, from my perspective, have been one of the first doctors to use it.
- [55:39]
Dr. Larry Lipschultz
Well, I think they're one of the first to use it legitimately.
- [55:42]
Dr. Gabrielle Lyon
Yes.
- [55:42]
Dr. Larry Lipschultz
And carefully. I mean, every one of my patients, if they're on any of the. I don't know what you would call them. They're anabolic steroids, but so is testosterone. I would say the more. What word would we use, Andrew?
- [55:56]
Dr. Gabrielle Lyon
Anabolic. I mean, they're anabolic agents, but so is testosterone. Right, but it's more androgenic versus anabolic.
- [56:03]
Dr. Larry Lipschultz
No, they're more cutting edge. I don't know. But the point is, all those people are seen three times a year and every time at least. Yes, at least. If not four, it's three or four. And they get carefully screened every time. And for the ones that I have any concern for, they go to the cardiologist for a complete checkup before I continue treatment.
- [56:28]
Dr. Gabrielle Lyon
But is it fair for someone to come in and say, Dr. Lipschultz, I've had low testosterone. I can prove to you I've had low testosterone. I have been on testosterone. I feel good. Do they say, I'd like to improve my muscle quality? How does one go and for what reason? From testosterone to an agent that is anabolic, to build muscle versus cutting. Where do you think that it becomes? Okay and effective? And I'll give you my thoughts too.
- [57:02]
Dr. Larry Lipschultz
But okay, safe to use. Safe to use. If the doctor who's prescribing it understands what he's supposed to be checking. You know, it's. I think if we're giving out the message, it's safe for anybody to write this. These drugs. It's wrong. It's only good. It's only safe to write them if you understand what you need to be monitoring because they're potentially dangerous because of elevated hematocrit, changes in lipids, changes in estrogen. I mean, you really gotta watch that. So I rarely have a patient who come and uses the word I want to build muscle. They'll usually say, I'm trying to bulk bulk, which means they're trying to get bigger for whatever purpose. And, you know, everybody has their own reasons. And I don't want to get in. I don't want to personally with them, try to understand where their mindset is. But I don't have a problem with that. If they're doing it judiciously, if they're, if they're Healthy, but I don't want them taking up the room in my office of patients who are really hypogonadal. So you have to be careful when you get into this area that you don't open the door to patients who really don't need your care. I mean, I want my patients to be serious about their health because you can look great and be terribly diseased inside, you know, so my patients have to be really health oriented. I mean, don't you agree? I'm sure you.
- [58:30]
Dr. Gabrielle Lyon
I do. And I, I also believe that the, there should be an equal playing field. For example, if someone could come into my office or your office and say I want to lose fat, then they should equally be able to come into an office and say I want to build muscle. And I think there should be quite frankly a significant, significantly less stigma around these agents because I think that they are transformative for people if they are used safely. And you know, when there was, you know, when we talk about that, there are things like Anavar, which, you know, we personally don't use in the clinic, but I know that it has been FDA approved, does have some.
- [59:15]
Dr. Larry Lipschultz
Now, I, and I don't do it for this reason, but I know a lot of the, the doctors who treat women do use low dose Avivar for increasing lean muscle mass.
- [59:24]
Dr. Gabrielle Lyon
They do.
- [59:24]
Dr. Larry Lipschultz
But you don't.
- [59:25]
Dr. Gabrielle Lyon
I don't. Because, because again, you know, we could. But there are, you know, it's an oral agent. There can be changes in lipids. Not just lipids, but liver function.
- [59:39]
Dr. Larry Lipschultz
Right.
- [59:40]
Dr. Gabrielle Lyon
I think that.
- [59:40]
Dr. Larry Lipschultz
Interesting. I've never seen maybe one patient who had elevated enzymes from Anavar, but it has a bad reputation. But I just don't see it. And the other thing is, I'm not just trying to build muscle mass, I'm also treating the fat.
- [59:59]
Dr. Gabrielle Lyon
Oh, yeah.
- [59:59]
Dr. Larry Lipschultz
I mean, so we do a lot with the semaglutide and tirzepatide to try to get a balance. But if you want to look better, if you want to get leaner, let's get rid of the fat, not just look at building the muscles. So we try to do it all for these patients so they don't have to keep going from doctor to doctor.
- [60:20]
Dr. Gabrielle Lyon
No, absolutely. When, when will a patient. And how would you start?
- [60:25]
Dr. Larry Lipschultz
But I got to say, I don't like the reputation of being a doctor who can write anabolic steroids because you, you can attract a lot of people you don't want in your office.
- [60:35]
Dr. Gabrielle Lyon
Yeah.
- [60:36]
Dr. Larry Lipschultz
And so you have to be careful.
- [60:37]
Dr. Gabrielle Lyon
Be careful. But also, I mean, quite frankly, I would say you do not have that reputation.
- [60:43]
Dr. Larry Lipschultz
Right.
- [60:43]
Dr. Gabrielle Lyon
I mean, you have a, you come from an academic background.
- [60:45]
Dr. Larry Lipschultz
Well, I think that's what makes it different. Right. Because a lot of the things we do, we look at research wise and academically to make sure that what we're doing is not only safe but innovative.
- [60:59]
Dr. Gabrielle Lyon
Yes.
- [60:59]
Dr. Larry Lipschultz
And has positive outcomes.
- [61:01]
Dr. Gabrielle Lyon
Yes.
- [61:01]
Dr. Larry Lipschultz
So a lot of the, A lot of the patients we see the data, we use to actually write papers, give abstracts.
- [61:08]
Dr. Gabrielle Lyon
Well, speaking of that, you know, we're publishing a paper on muscle mass and sexual function.
- [61:14]
Dr. Larry Lipschultz
I heard that.
- [61:15]
Dr. Gabrielle Lyon
Yeah, I'm excited about that.
- [61:17]
Dr. Larry Lipschultz
Yes.
- [61:17]
Dr. Gabrielle Lyon
I'm going to be presenting it.
- [61:18]
Dr. Larry Lipschultz
Where?
- [61:19]
Dr. Gabrielle Lyon
At the Androgen Society.
- [61:20]
Dr. Larry Lipschultz
Oh, good.
- [61:21]
Dr. Gabrielle Lyon
Yeah, maybe you'll come to the talk, sit right in the front row. I'll be very nervous.
- [61:26]
Dr. Larry Lipschultz
Yeah, I'll be there.
- [61:29]
Dr. Gabrielle Lyon
Also, you know, you'd mentioned that you don't like this idea that they would come in and just say, hey, I want to bulk up or build muscle. But I would also argue, and I think you agree with this, that we have to protect muscle mass as they age. You have seen it.
- [61:46]
Dr. Larry Lipschultz
Oh, yes, for sure.
- [61:48]
Dr. Gabrielle Lyon
And I don't know a better way to do it. Yes, you can do diet and exercise, but from again my perspective, and I would love to hear yours, is you. It is nearly impossible to do with an aging individual without some kind. And again, unless they are a monster in the gym and have always been that it's not that these anabolic agents are just for aesthetics. That is absolutely not true.
- [62:16]
Dr. Larry Lipschultz
You know, it's so interesting you mentioned this because I saw somebody today who was like 56 and he was complaining about his inability even though he works out for five days a week each. Right. To put on muscle. And I'm telling you it is very difficult for men.
- [62:32]
Dr. Gabrielle Lyon
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- [63:54]
Dr. Larry Lipschultz
I don't know about women. Yeah, for men over 50 it is very difficult and speaking as one to put on muscle mass no matter what you do, it's just really, really hard. And you know, and I think, you know, you can do what you can, but you have to judiciously use anabolic agents.
- [64:15]
Dr. Gabrielle Lyon
Tell me about that.
- [64:16]
Dr. Larry Lipschultz
Well, you just can't go, you know, crazy like you could when you were 35, because your body, you have other things going on in your body. You have, you know, maybe borderline diabetes or blood pressure issues and you don't want to take in stuff that's going to retain water and bump up your blood pressure. And that's one of the problems with some of the anabolics.
- [64:39]
Dr. Gabrielle Lyon
Can we talk? I know you like to kind of bunch them together, but are you comfortable with us separating a few of those agents? So somebody, maybe.
- [64:47]
Dr. Larry Lipschultz
It depends.
- [64:48]
Dr. Gabrielle Lyon
Well, as your comfort is, how would you, what would you say the best choice would be? You've got testosterone on board. What would your next choice be for a man who wants to bulk because you don't see any women?
- [65:02]
Dr. Larry Lipschultz
No. Well, first kidney stones. But if he's already taking testosterone and he has a decent blood level and he's. I would really worry about his diet. I'm not so anxious to add a second agent, let's say his diet, until I'm sure. Well, how do we know that's the problem? Because the guy, and I'm telling these men, go get a trainer, go get someone who has a really good reputation as a trainer. Let him work with you on not only your diet, I mean, not only your exercise, but also your diet. If you're not eating right, you're not going to build muscle. Right. I'm preaching to the choir. You know, that is true, but I think that's a big fallacy. I think the over 50 year old male thinks they're going to come and get something magic and there is, there's nothing magic.
- [65:56]
Dr. Gabrielle Lyon
Ah, I see. Right. I actually, I see that in clinic all the time, that people will want testosterone and they believe that testosterone alone. I think we see this in the menopause community where they will Go on hormones. And they will expect a body composition transformation. That is not gonna happen.
- [66:12]
Dr. Larry Lipschultz
Right. And in the man they're gonna. They can, they think and I don't think it's. I think it's general, generally thought that testosterone builds muscle. Wrong. You've gotta do something. It's a building block. You've got to do something to make the wall your building blocks or else you're going to, you know, you can't take a shot of testosterone, sit on the couch and watch tv. Nothing's going to happen.
- [66:36]
Dr. Gabrielle Lyon
No increase in lean mass.
- [66:38]
Dr. Larry Lipschultz
I don't think so. Do you? I mean, I don't think so. And it may be different with men and women.
- [66:43]
Dr. Gabrielle Lyon
Yeah.
- [66:44]
Dr. Larry Lipschultz
But I don't think guys get a whole lot of positivity. Except now let me change that. If we're talking about libido, if we're talking about a sense of health. Yes. But not muscle mass. I think muscle mass requires exercise.
- [67:04]
Dr. Gabrielle Lyon
Yes, I would agree with that. What would you.
- [67:08]
Dr. Larry Lipschultz
So in answer to your question before I jumped to a second agent, I would want that individual to absolutely prove to me that he's doing everything he can to optimize his diet and his exercise. And then if still nothing's happened, then maybe add deca, which is nandrolone, Nandrolone decanoate because it's going to get those muscle fibers pumped up a little bit. I would also want him to do testosterone cypionate and not ananthate because I think the cypionate holds a tiny bit of water and it does give you that fullness that these people are looking for. That is a positive reinforcement when they work out.
- [67:45]
Dr. Gabrielle Lyon
I like that. Even if they're over 65. Because typically we change our patients to ananthate if they're older.
- [67:55]
Dr. Larry Lipschultz
I know, and it's probably smart. But depending what the patient wants, it's not going to give him, I don't think as big of a change physically as cypionate does. But if you look at the FDA, the FDA has approved testosterone ananthate at 0.5 in the Xiaosted injectable self contained agent. So that we know they are think and it's been proven to be safe and doesn't have age limit. Well, it could be 65.
- [68:28]
Dr. Gabrielle Lyon
So you're talking about the injection, you're talking about the auto injector. People are. They don't recognize that there is an auto injector of testosterone for those people that don't like to do intramuscular.
- [68:39]
Dr. Larry Lipschultz
And you never see the needle.
- [68:41]
Dr. Gabrielle Lyon
Yeah.
- [68:41]
Dr. Larry Lipschultz
I mean, you put it on and you don't even press a plunger because the pressure of putting it against your abdomen releases the needle. It's just.
- [68:50]
Dr. Gabrielle Lyon
Wow.
- [68:50]
Dr. Larry Lipschultz
Yeah.
- [68:51]
Dr. Gabrielle Lyon
That's amazing.
- [68:52]
Dr. Larry Lipschultz
It is.
- [68:52]
Dr. Gabrielle Lyon
And it's not for women. It's. From what I understand the doses.
- [68:56]
Dr. Larry Lipschultz
Well, it's 0.5. Oh, it comes less interesting. Yes. You can get 0.25.
- [69:01]
Dr. Gabrielle Lyon
Okay, we'll have to look at that. When someone comes in, do you have a starting dose of testosterone? And I. I don't want to ask questions that anyone could look up.
- [69:12]
Dr. Larry Lipschultz
And I also don't want to give information that someone's going to write down and go back and do it and that they have a problem. Well, Dr. Lipschold said there was.
- [69:19]
Dr. Gabrielle Lyon
So anyone listening to this, there are disclaimers everywhere. We are not giving medical advice. We are simply giving education.
- [69:27]
Dr. Larry Lipschultz
Okay.
- [69:28]
Dr. Gabrielle Lyon
Just so you know, we're not. People should not be taking this. People should be learning and thinking about how some of the best in the world.
- [69:36]
Dr. Larry Lipschultz
And I hope what we say creates questions in people's minds as well as knowledge. You know, the.
- [69:44]
Dr. Gabrielle Lyon
Again, that's one of the things that I really respect about you is I think that you are always learning. You, frankly, probably don't have to be in practice many. You could be like, golfing or something, but you're out there still contributing the.
- [70:00]
Dr. Larry Lipschultz
I don't know if I like that statement.
- [70:01]
Dr. Gabrielle Lyon
I'm sorry, but it's true. We're already BFFs. You love how I decorated this place. I mean, that's it. You're stuck with me. I know the anabolic agents. You start with DECA. My understanding that it's 50% the use the. So if testosterone is, for example, 200, nandrolone would be 100.
- [70:23]
Dr. Larry Lipschultz
That's my. That's my. That's how I do it.
- [70:26]
Dr. Gabrielle Lyon
I learned.
- [70:27]
Dr. Larry Lipschultz
Well, yeah, I always. Half the DECA for the testosterone.
- [70:31]
Dr. Gabrielle Lyon
Is there any evidence for.
- [70:33]
Dr. Larry Lipschultz
It's purely me, you know? Well, the evidence is. There's a. There's a. People have for a long time said that the use of nandrolone decanoate can cause erectile dysfunction. And I think it's the way it's metabolized and interferes with your dht. So what I like to do is to keep it lower than the testosterone to try to safeguard against any effects like that. And I've never had a patient complain of ED on deca, ever.
- [71:10]
Dr. Gabrielle Lyon
How is it metabolized differently than testosterone?
- [71:14]
Dr. Larry Lipschultz
It's because I think the molecule. And I am not Good at this. But the way the molecule is constructed is very. Because it has a side chain that makes it act differently and makes it degraded differently. And it somehow interferes with dht, which is important for sexual function.
- [71:33]
Dr. Gabrielle Lyon
So it doesn't increase dht, it lowers dht.
- [71:36]
Dr. Larry Lipschultz
That's what I don't know.
- [71:39]
Dr. Gabrielle Lyon
It's fascinating.
- [71:40]
Dr. Larry Lipschultz
What do you.
- [71:41]
Dr. Gabrielle Lyon
So we see. Well, I use your formula. We use 50%. If not lower, I might even start lower. I do not have patients that come in with erectile dysfunction from that, nor have I ever had a patient that has it. But you will hear in sport performance realms that they. I don't even want to say it, what it's called. I know we're not even going to say it because we don't do jokes like that, but you know what I mean, it seems to. If used too high of a dose, it can cause erectile dysfunction.
- [72:20]
Dr. Larry Lipschultz
Right. So to me, I mean, if the theory is it causes too high dht. I don't understand.
- [72:26]
Dr. Gabrielle Lyon
Yeah.
- [72:27]
Dr. Larry Lipschultz
To low it would make sense.
- [72:28]
Dr. Gabrielle Lyon
Yeah. Yeah.
- [72:30]
Dr. Larry Lipschultz
So we need to fact check that. Do you have your people?
- [72:34]
Dr. Gabrielle Lyon
They could. Hey guys, if anyone wants to drop that to me, go ahead and look that up. So the question is, does nandrolone increase or decrease dht?
- [72:45]
Dr. Larry Lipschultz
Exactly.
- [72:46]
Dr. Gabrielle Lyon
And what would be the potential cause. Yeah.
- [72:50]
Dr. Larry Lipschultz
Uniquely related to erectile dysfunction.
- [72:53]
Dr. Gabrielle Lyon
Yeah, I think it's really fascinating.
- [72:55]
Dr. Larry Lipschultz
Now I can tell you all the bodybuilders in the gym know.
- [72:58]
Dr. Gabrielle Lyon
Right. I just, I know we don't know what would you be comfortable with for a dose. So if someone is thinking, I, you.
- [73:07]
Dr. Larry Lipschultz
Know, I think it's. To me my dosing is very age related. I'm not going to give somebody 60 the same dose. I'm going to give somebody 30.
- [73:14]
Dr. Gabrielle Lyon
But would there be a reason?
- [73:16]
Dr. Larry Lipschultz
I just think I just don't want to deal with the potential side effects in an older man of erectile. Especially water. That's mainly water retention, blood pressure changes.
- [73:27]
Dr. Gabrielle Lyon
What about effect of lipids? You know, I was talking to Nelson, Virgil and he was discussing, he was looking at, I mean this guy, he has all of the papers. I know you know Nelson very well. Just one. Wonderful. But it seems to not affect lipids in a negative way. Is that, is that true? Have you seen nandrolone?
- [73:45]
Dr. Larry Lipschultz
Which one? I don't know. But I can tell you for sure. Men on steroids have lower HDL and higher LDLs. And when I speak to the lipid specialists, they can't tell me why, but I know it and I, you know, I used to Say, well, maybe it's because they don't do enough cardio. Maybe because they don't take, you know, fish oil. There's something about the compounds that somehow interfere with cholesterol metabolism.
- [74:15]
Dr. Gabrielle Lyon
Do you have concerns about that? If you see that, do you take them off?
- [74:17]
Dr. Larry Lipschultz
Yes. I tell them, oh, I don't take them off. I said, look, I want you to increase your cardio, which a lot of them don't want to do. And I want you to start taking. I like krill oil because it doesn't give a fishy aftertaste, and I think it's more potent than fish oil. So that's what I like. And I tell them to get it and start it.
- [74:37]
Dr. Gabrielle Lyon
The. And do you see it improve, HDLs?
- [74:42]
Dr. Larry Lipschultz
I do see it improve. I don't always see it go to where I want it to go, but I've seen it in single digits.
- [74:47]
Dr. Gabrielle Lyon
Really?
- [74:48]
Dr. Larry Lipschultz
Yes.
- [74:48]
Dr. Gabrielle Lyon
Single digits.
- [74:49]
Dr. Larry Lipschultz
Single digits. HDL of nine.
- [74:52]
Dr. Gabrielle Lyon
No.
- [74:53]
Dr. Larry Lipschultz
Yes.
- [74:53]
Dr. Gabrielle Lyon
Okay. Why are we talking about this? Because both Dr. Lipschultz and I, with very careful monitoring, use very safe doses of testosterone and various agents. And we monitor the HDLs and there's an indication for use. I believe these agents can be used for sarcopenia, and they can be all used safely. How do you rectify that?
- [75:18]
Dr. Larry Lipschultz
Do you find those men? I have to decrease doses.
- [75:21]
Dr. Gabrielle Lyon
Do you find that it changes?
- [75:24]
Dr. Larry Lipschultz
Yes, it's only going to change for the positive. The thing that I can't control, and I'm sure you know this well, there are a lot of boutique drugs out there that I can't even tell you the names of that are primarily animal steroids. That these men.
- [75:41]
Dr. Gabrielle Lyon
Would that be tremblone or something like that?
- [75:43]
Dr. Larry Lipschultz
Well, I don't know if Tremblone, but I know Equipoise and maybe MasterOne, but I can't control what they take and I can't control the doses. But there's a philosophy amongst people who are trying to change their physique that if a little is good, a lot is great. And I have no idea what they're taking. I tell them, hey, look, you know, you got to tell me what you're taking, or I can't take care of you because, you know, I can't be giving you something when you're taking, right, you know, pounds of something else. But that's where I think the problem. Because the people who I think come in with These outrageously abnormal HDLs and LDLs are on a lot of things that we cannot control. The. I don't think you would see it in women as much, I think we don't see.
- [76:33]
Dr. Gabrielle Lyon
I mean, I, you know, frankly, I don't see really bodybuilding women and I don't see them using all kinds of things. But what I will say is that, you know, the men that I have seen, and I used to have more bodybuilders, we don't really so much in the practice. But what I saw was that they would be taking very, you know, before they were patients, really high doses of testosterone. And when I say high, let me qualify that anywhere between three and 600 a week.
- [77:04]
Dr. Larry Lipschultz
Oh, no, that's low. I would. They're taking a grammar. I mean, it's crazy.
- [77:11]
Dr. Gabrielle Lyon
And the question becomes when an individual. And see, this is amazing because nobody else sees patients that have been on that train. And when I say no, but, I mean, you are probably one of the only doctor. I mean, these guys are not going to the doctor.
- [77:25]
Dr. Larry Lipschultz
Yes.
- [77:26]
Dr. Gabrielle Lyon
When you see patients that are doing that and they've been on. Let's just, let's pick a moderate number. Let's say between three and 600, which, by the way, you and I would never prescribe that potentially, I don't know, but I would never. If they were taking 600 milligrams of testosterone a week, if they said, Dr. Lipschultz, I need you to take over my care. You measure their blood levels in a trough. They, I don't know or not. They have all the signs and symptoms of low testosterone. Would they then feel okay, close. Could you go from 600 for years and then now say, well, we're not going to go over 200. Will they still have the same effect? So what do you do?
- [78:10]
Dr. Larry Lipschultz
I mean, we compromise. So we have to go back to my basic philosophy, which should not be used by other people just because they hear me. And that is, I don't care that much what their serum testosterone is. I'm treating their symptoms. And I'm not talking about muscle mass. I'm talking about symptoms. Fatigue, I can't sleep. You know, I'm not building any muscle mass. I have no sex drive. It may take more than 200. It may take 400. I'm treating the patient. I'm looking at the side effects, but I'm not focused on their blood levels. I am for the things that can hurt them, for, for their hematocrit, for their estrogen, for their lipids. I'm not focused on their serum testosterone. I don't. That's important. I think that's unfair, but also important because everybody's different.
- [79:07]
Dr. Gabrielle Lyon
Meaning.
- [79:07]
Dr. Larry Lipschultz
And everybody's receptors have different sensitivity. Maybe this man has a very poor androgen receptor sensitivity and he can't utilize his testosterone as well as the guy sitting next to him. You know, we just don't know. We do measure androgen receptors now.
- [79:25]
Dr. Gabrielle Lyon
Is that the CAG repeats?
- [79:27]
Dr. Larry Lipschultz
Yes, CAG repeats. And I think that's going. If we did it on a regular basis, which we don't. We should because it would help us guide dosing. Right.
- [79:39]
Dr. Gabrielle Lyon
I think it would be really helpful because right now we. The standard of care is pretty much. You have to keep testosterone within, you know, 300 is low. You have to keep. Is there a number that you would feel comfortable. I mean, the lab value. If it's over 1200, you now of total testosterone, you are now outside the normal range.
- [79:56]
Dr. Larry Lipschultz
Right.
- [79:57]
Dr. Gabrielle Lyon
Free testosterone, depending on the lab, I don't know, could go. Where would you say that free testosterone is?
- [80:04]
Dr. Larry Lipschultz
Whatever my lab's range of normal is. I don't care. But I think the thing to realize is that these values about keeping it in with this. With this range are so arbitrary.
- [80:19]
Dr. Gabrielle Lyon
But what do we do? How do we close the gap between what is being done for people now and the gaps in care potential? And here's what I mean, because I know that's where you're going. See, we're like. We're on the same wavelength.
- [80:40]
Dr. Larry Lipschultz
Yeah.
- [80:40]
Dr. Gabrielle Lyon
That an individual, for all intensive purposes, is symptomatic on low test with testosterone. They have symptoms of low testosterone.
- [80:51]
Dr. Larry Lipschultz
Exactly.
- [80:51]
Dr. Gabrielle Lyon
Classic, however classic symptoms, which are fatigue, low libido, low energy, difficulty sleeping.
- [81:00]
Dr. Larry Lipschultz
Difficulty sleeping, mental fogging.
- [81:01]
Dr. Gabrielle Lyon
Keep going. What else you got for me?
- [81:04]
Dr. Larry Lipschultz
Muscle loss.
- [81:04]
Dr. Gabrielle Lyon
Muscle loss. What do you got? Hair loss on their legs. Is that one?
- [81:08]
Dr. Larry Lipschultz
Not with guys.
- [81:08]
Dr. Gabrielle Lyon
All right. Okay. Well, anyway, is there any other major symptoms?
- [81:12]
Dr. Larry Lipschultz
Not that I can.
- [81:13]
Dr. Gabrielle Lyon
Okay, but their total testosterone is 700.
- [81:17]
Dr. Larry Lipschultz
Yes.
- [81:18]
Dr. Gabrielle Lyon
Let's just say. And their free testosterone is. I don't know. We'll just say it's. What's a good number? 250? I don't know.
- [81:25]
Dr. Larry Lipschultz
I don't measure free. Unless the individual is borderline and their symptoms are out of line with his total.
- [81:33]
Dr. Gabrielle Lyon
But for the. You're saying the possibility of this conversation. Right.
- [81:39]
Dr. Larry Lipschultz
It's normal. You're saying it's free as normal.
- [81:40]
Dr. Gabrielle Lyon
It's normal or high. But they feel like crap.
- [81:43]
Dr. Larry Lipschultz
Exactly.
- [81:44]
Dr. Gabrielle Lyon
And you and I both know that maybe their androgen receptor density. They are someone who has. Would it be low androgen receptors?
- [81:53]
Dr. Larry Lipschultz
Right. Let me throw out something else as a possibility. So they have sleep Apnea. They're not sleeping, so they have fatigue. They can't put on muscle. They feel like crap. They don't have sex drive. Get a sleep study. We do a tremendous amount of sleep studies on my patients.
- [82:12]
Dr. Gabrielle Lyon
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- [83:29]
Dr. Larry Lipschultz
Okay, so, I mean, I don't think a man's symptoms with a normal testosterone makes. Makes it my responsibility to figure out why he's not responding, but rather what else is going on. What's his thyroid doing?
- [83:48]
Dr. Gabrielle Lyon
But let's say all that's perfect. And if we zone it.
- [83:51]
Dr. Larry Lipschultz
But are you creating an impossible situation?
- [83:53]
Dr. Gabrielle Lyon
No, because we have patients. We I and I. Because I don't measure CAG repeats. I personally don't feel comfortable going outside of the limits.
- [84:02]
Dr. Larry Lipschultz
I wouldn't either, but I would send them for a sleep study.
- [84:05]
Dr. Gabrielle Lyon
We do. We send all our patients for a sleep study.
- [84:07]
Dr. Larry Lipschultz
Pick up stuff.
- [84:08]
Dr. Gabrielle Lyon
Yeah.
- [84:08]
Dr. Larry Lipschultz
Okay.
- [84:09]
Dr. Gabrielle Lyon
And. Or this would be a case of an individual that has poor androgen receptor density. And the point I'm making is that how do we manage that? And you know, because we have very clear guidelines. This is. The testosterone that you can treat is 300. This would be considered high testosterone. This would be considered an elevated hemoglobin. Hematocrit. You send them for blood draw, but they don't feel good getting 200, 250 milligrams of testosterone. Everything else checked out because that is someone.
- [84:46]
Dr. Larry Lipschultz
Do they feel good getting 400 milligrams, probably.
- [84:49]
Dr. Gabrielle Lyon
Let's say they do. So let's say they do.
- [84:51]
Dr. Larry Lipschultz
I would go to 400. I would not bother me.
- [84:53]
Dr. Gabrielle Lyon
It would not bother you. But for everybody, every other physician who was not a. I'm not saying that you've been in the game long. Og. Well, I'm sorry, we'll edit it out. But how.
- [85:05]
Dr. Larry Lipschultz
I was precocious.
- [85:07]
Dr. Gabrielle Lyon
But how do we. How do we rectify that?
- [85:12]
Dr. Larry Lipschultz
We don't. I mean, we come to grips with the fact that everybody's level of normal is not the same, that some people require more, and that as long as they don't have any side effects that are concerning, why not go higher? Why not follow them closely? But see, this is a bad message to people who are watching the podcast.
- [85:36]
Dr. Gabrielle Lyon
No, it's not.
- [85:37]
Dr. Larry Lipschultz
But I think it is.
- [85:38]
Dr. Gabrielle Lyon
It's a conversation. And here's why is that there are. There's more to this story than just the testosterone given at X, Y and Z is what it should be. And it's not the message. I think this is a really important conversation because I think the science can evolve.
- [85:57]
Dr. Larry Lipschultz
And I also think that we've been boxed into a corner by existing guidelines, and I really do. And I don't think the guidelines are based on taking care of patients. They are based on avoiding problems. You know, and there's a big difference. You know, you have patient safety, but you also have patient care.
- [86:19]
Dr. Gabrielle Lyon
Yeah.
- [86:19]
Dr. Larry Lipschultz
I mean, what if you're. If your patient is suffering and you can make them better safely, why don't you make them better?
- [86:26]
Dr. Gabrielle Lyon
I know, I know. And, you know, I feel this way about the use of these. And to be clear, the conversation is. My intention was to talk to you about things that nobody else would see, have answers to, or talk about their.
- [86:43]
Dr. Larry Lipschultz
Fear of getting in trouble.
- [86:45]
Dr. Gabrielle Lyon
Right. But, I mean, these are your unique gifts and skills that I think, again, this is the whole goal of.
- [86:54]
Dr. Larry Lipschultz
But I think it's an. What I have is an evolving philosophy on care tempered by what works in patients and the lack of serious side effects.
- [87:05]
Dr. Gabrielle Lyon
That's.
- [87:05]
Dr. Larry Lipschultz
That's how I got to where I got.
- [87:09]
Dr. Gabrielle Lyon
I think it is extraordinary, and I think it's important. And the message isn't, okay, take a whole bunch of steroids. That's not it. It's understanding that perhaps we are not where we need to be in the realm of understanding hormone replacement. And this is beyond hormone replacement.
- [87:37]
Dr. Larry Lipschultz
Right. And the other thing I want to bring up before I forget, perhaps this individual would do better with microdosing.
- [87:43]
Dr. Gabrielle Lyon
Tell me about that.
- [87:44]
Dr. Larry Lipschultz
So I just see fewer side effects. Let's say I'm going to prescribe one cc, that's 200 milligrams. But if you take that 200 milligrams and divide it by seven and have that patient inject whatever 0.15 sub Q daily, I don't see as much rise in hematocrit and I don't see as much change in lipids. But you have, there's this critical mass when these oil based drugs can't be injected every day because you get too many blebs. So you have to keep the dose low.
- [88:19]
Dr. Gabrielle Lyon
What I'm hearing you say is that if you dose, would you say how many days a week?
- [88:26]
Dr. Larry Lipschultz
It depends. Whatever they five days, seven days, three days, whatever they want to try, I couldn't do it seven days a week. I think three days is reasonable, maybe five.
- [88:37]
Dr. Gabrielle Lyon
Do you prefer the sub Q dosing as opposed to im?
- [88:41]
Dr. Larry Lipschultz
No, I don't prefer it. I think it's an alternative. It's patient choice.
- [88:45]
Dr. Gabrielle Lyon
But if someone does a IM injection, they have more. There's a bump in hemoglobin, hematocrit because there's a greater response for there's a big peak. Right.
- [88:55]
Dr. Larry Lipschultz
So if the individual comes back and says, you know, at 1cc and we see this with elevated hematocrit, try sub Q because you may not have to deal with it. And again, it's an individual response.
- [89:13]
Dr. Gabrielle Lyon
That is fascinating. I typically, you know, I would just have them go donate as opposed to, which is, you know, perhaps you can.
- [89:21]
Dr. Larry Lipschultz
Change and you can do both.
- [89:22]
Dr. Gabrielle Lyon
Well, no, I mean, I don't. Number one, how is the science on elevated hemoglobin, hematocrit causing an issue? I mean if it's, do you think the science is there that it really is an issue?
- [89:34]
Dr. Larry Lipschultz
So I keep all my patients, I try under 50% hematocrit and everybody we see we send in at the first visit a donating slip to Gulf coast blood bank and tell the patient if it gets above 50% they've got to donate. But we see them regularly so we know when they need to go. And the other thing is, because elevated hematocrit has symptoms, the patients start feeling fatigued. They do and they feel draggy and they get headaches. So you know, you got to keep them. Now if you speak to the hematologist, they say 54%. We like them under 50 just to be safe.
- [90:18]
Dr. Gabrielle Lyon
And I know you don't treat women, but I will say there's no guidelines for females that are on testosterone and their hemoglobin, hematocrit for them, that would be higher, would be different, right?
- [90:31]
Dr. Larry Lipschultz
You know, Yeah, I would. You know, I think it's safe to use the same guidelines.
- [90:35]
Dr. Gabrielle Lyon
And that is, that is certainly what I hear. The other agents. Do you want to talk about them? Because you also, when I say agents, you know, you are a scientist. I have to be very particular. You almost feel like I'm talking to my mentor of 20 years. He's very particular. He's like. What do you mean? What exactly? I mean, he will call me out. Doesn't matter. We could be on stage and he's busting my job. Doesn't matter. Other agents, we can continue on the Anavar discussion if you would like, because that is unusual how you see individuals dose it, if you have interest. Or we could talk about peptides.
- [91:19]
Dr. Larry Lipschultz
I would rather go to peptides.
- [91:20]
Dr. Gabrielle Lyon
Okay.
- [91:21]
Dr. Larry Lipschultz
But I will, I will give an intro that. I don't know as much about peptides as I want to know. I have not used them that long and I have not used a lot of different ones as long. So let's. I would rather in depth revisit peptides in a year only because. But having. Saying that I don't want people listening to think it's something to be avoided. I mean, I think they are potentially great additions to better females regimens.
- [91:54]
Dr. Gabrielle Lyon
What do you think they work? Yes, you do? I mean, well, I mean, listen, I was at. I. I don't know if you know this, but I go to the. What is the bark meeting.
- [92:07]
Dr. Larry Lipschultz
Yeah, I see you there.
- [92:08]
Dr. Gabrielle Lyon
I know. I'm joking. Of course. We have like tacos or something. So it's the. What does it stand for? The Baylor.
- [92:16]
Dr. Larry Lipschultz
Baylor Andrology Research Group. Yes, consortium.
- [92:23]
Dr. Gabrielle Lyon
Yes, consortium. I attend that.
- [92:27]
Dr. Larry Lipschultz
We don't talk about this at the end.
- [92:28]
Dr. Gabrielle Lyon
Yeah, we did.
- [92:29]
Dr. Larry Lipschultz
Remember, we didn't know.
- [92:30]
Dr. Gabrielle Lyon
One of the fellows presented a paper and it was looking at. You guys were talking about the data of. The collected data of peptides and if it was effective on testosterone. Do you remember that? You went back and you looked at the big data set and you did group all. You guys grouped all the peptides together and basically you didn't find an increase in testosterone.
- [92:52]
Dr. Larry Lipschultz
And I never thought it would increase testosterone.
- [92:55]
Dr. Gabrielle Lyon
Okay, but do you think that there are peptides that work, for example, MK677.
- [93:02]
Dr. Larry Lipschultz
So interesting enough, the M stands for Merck.
- [93:06]
Dr. Gabrielle Lyon
Really?
- [93:07]
Dr. Larry Lipschultz
I did not know that it was being developed at Merck simultaneously with Celebrex. They both came to fruition about the same time Merck went with Celebrex shelved MK677. My friend was the one that discovered it while he was there and he discovered it by looking at whatever the ligand is that is useful for it.
- [93:36]
Dr. Gabrielle Lyon
But it never came to market.
- [93:38]
Dr. Larry Lipschultz
That never.
- [93:40]
Dr. Gabrielle Lyon
Can you tell us a little bit about MK67? 7? I can give you.
- [93:44]
Dr. Larry Lipschultz
I, I. You can be what?
- [93:46]
Dr. Gabrielle Lyon
A little bit of my experience, but it's much less interesting than.
- [93:48]
Dr. Larry Lipschultz
Give me your experience.
- [93:49]
Dr. Gabrielle Lyon
MK677, I believe is a ghrelin agonist.
- [93:53]
Dr. Larry Lipschultz
Yes.
- [93:53]
Dr. Gabrielle Lyon
Makes people extremely hungry.
- [93:55]
Dr. Larry Lipschultz
Yes.
- [93:57]
Dr. Gabrielle Lyon
It causes a significant amount of water retention.
- [93:59]
Dr. Larry Lipschultz
Yeah.
- [94:00]
Dr. Gabrielle Lyon
And when I say significant, I mean.
- [94:01]
Dr. Larry Lipschultz
We'Re not in men. I mean maybe women more so maybe 10 pounds.
- [94:07]
Dr. Gabrielle Lyon
We don't really use.
- [94:07]
Dr. Larry Lipschultz
Oh no, I never, we never use.
- [94:09]
Dr. Gabrielle Lyon
It a lot for women.
- [94:10]
Dr. Larry Lipschultz
I've never seen £10.
- [94:12]
Dr. Gabrielle Lyon
And the reason individuals use it is they want to put on weight.
- [94:15]
Dr. Larry Lipschultz
Yeah.
- [94:16]
Dr. Gabrielle Lyon
I couldn't tell you the mechanism of action.
- [94:18]
Dr. Larry Lipschultz
Ghrelin.
- [94:19]
Dr. Gabrielle Lyon
Oh, that's right. Above and beyond that. If there was some other.
- [94:23]
Dr. Larry Lipschultz
I think that's the main.
- [94:24]
Dr. Gabrielle Lyon
So you just eat more, you're just more hungry?
- [94:26]
Dr. Larry Lipschultz
Yes.
- [94:28]
Dr. Gabrielle Lyon
Yeah. So that, that's pretty much it. But it doesn't uniquely put on skeletal muscle.
- [94:34]
Dr. Larry Lipschultz
No, you have to. Well, I mean it's just like any other substance we've talked about. If you take it and don't do anything, doesn't matter, it doesn't make any difference. But if you're trying to put on size and you just. Some guys just can't eat and some guys are so ectomorphic that you see them when they walk in the door. I think it helps. And it also helps because we take it at bedtime, they sleep better and they wake up the next day hungry. And then if they, if it doesn't last all day, I'll give them a second dose early afternoon.
- [95:11]
Dr. Gabrielle Lyon
What else do you use? What other peptides?
- [95:13]
Dr. Larry Lipschultz
BPC157. The patients love it.
- [95:16]
Dr. Gabrielle Lyon
They do.
- [95:17]
Dr. Larry Lipschultz
It's an anti inflammatory available as injectable and oral. And the oral, apparently I haven't used. It is really good for people who have bowel issues, inflammatory bowel disease. But the injectables, to a man, they swear by it.
- [95:33]
Dr. Gabrielle Lyon
Do you think it's placebo?
- [95:34]
Dr. Larry Lipschultz
No, I don't.
- [95:35]
Dr. Gabrielle Lyon
Because you can confidently say that it's not placebo.
- [95:38]
Dr. Larry Lipschultz
Yes. They could also inject it like if their elbow in the fatty tissue near the joint and massage it in and they could get a local response as well.
- [95:52]
Dr. Gabrielle Lyon
And you Feel like those are.
- [95:53]
Dr. Larry Lipschultz
I'm afraid I sound like a snake oil salesman.
- [95:56]
Dr. Gabrielle Lyon
No, we actually covered BPC 157 here. It'd be great to see some data about it. We've used it, actually, frankly, in the clinic for 10 years for a lot of the military operators. I just don't. From my perspective.
- [96:09]
Dr. Larry Lipschultz
Well, if you used. Must have worked.
- [96:12]
Dr. Gabrielle Lyon
I mean, I don't use it so much anymore. People ask me about it all the time. But again, as physicians, we get really interested in certain things and then potentially we move to other things. What about an individual that has been on t. What should I call it? I didn't say testosterone therapy, but not replacement therapy.
- [96:34]
Dr. Larry Lipschultz
Well, you're not replacing anything, are you?
- [96:36]
Dr. Gabrielle Lyon
Okay, no. Well, that's not true.
- [96:39]
Dr. Larry Lipschultz
What do you mean? What are you replacing?
- [96:40]
Dr. Gabrielle Lyon
Testosterone.
- [96:41]
Dr. Larry Lipschultz
But you haven't lost it. You're not making it. Maybe, but the whole thing came from hrt, right?
- [96:51]
Dr. Gabrielle Lyon
Yeah.
- [96:51]
Dr. Larry Lipschultz
So remember when Susan Summers and all the business about, you know, hormone replacement therapy and HRT and it has to be bioidentical and women were taking Premarin and it was horse made from horse urine.
- [97:09]
Dr. Gabrielle Lyon
Yeah, that was great.
- [97:10]
Dr. Larry Lipschultz
It was.
- [97:10]
Dr. Gabrielle Lyon
Yeah, yeah, yeah.
- [97:11]
Dr. Larry Lipschultz
So then they switched and now they're using bioidentical for testosterone for estrogen replacement because they don't have any estrogen. They're menopausal women.
- [97:20]
Dr. Gabrielle Lyon
You know what? That is a really good point. Nobody has a testosterone of zero.
- [97:24]
Dr. Larry Lipschultz
Right?
- [97:25]
Dr. Gabrielle Lyon
Yeah, that's my point.
- [97:27]
Dr. Larry Lipschultz
I mean, they call it replacement. You're inferring that they don't have any.
- [97:32]
Dr. Gabrielle Lyon
That's actually very smart. So you call it testosterone therapy.
- [97:35]
Dr. Larry Lipschultz
Now let me tell you something. I got the word testosterone therapy from a morgenteller, but I still think he does TR says trt. But at that time, we just, we had this discussion and I thought it made so much sense not to use trt. And then they have. Now they have TRT clinics.
- [97:53]
Dr. Gabrielle Lyon
And, you know, do you get worried about people getting care from those kind of things? And I'm sure. And listen, I'm not. You know what? I'm not even asking that question because you probably think there are good doctors everywhere. You just have to be careful.
- [98:07]
Dr. Larry Lipschultz
I don't like TRT clinic. I don't like testosterone clinics because, number one, they make people go in and get their shots there and they tiny increases in doses to make the patients think it's going to do something and they overcharge with the testosterone. It's just a moneymaker. It's not patient care.
- [98:29]
Dr. Gabrielle Lyon
I don't like you are very big into patient care. Speaking of patient care, is there an age? And I actually, I'm curious because again, I'm gonna bring up Brandon, and I wish I had known you back then. I had a young guy come in. I want to say, when I say young, he was probably late 20s and he had low testosterone. He had low free and low total. I measured him.
- [98:54]
Dr. Larry Lipschultz
Oh, we see it, we see it.
- [98:55]
Dr. Gabrielle Lyon
But I was very early on in my practice and I knew that he needed it. But here I am. I might be a fellowship trained doctor, but I wasn't trained in andrology. I didn't have an andrology mentor. Now I do, but I sent him to endocrinology and they felt uncomfortable treating him because of his age.
- [99:18]
Dr. Larry Lipschultz
So nobody treated him.
- [99:20]
Dr. Gabrielle Lyon
I mean, he was treated then, but how do we think about those, especially with these environmental exposures from an age point perspective? One is too young to begin testosterone replacement therapy. Yeah, I'm sorry, testosterone. Well, his was pretty replacing, but therapy, testosterone therapy.
- [99:41]
Dr. Larry Lipschultz
Well, I mean, you know, if they need it, we got to think about what we can do to make them feel better. So certainly in adolescents who don't yet have closure of their long bones, we don't want to give them testosterone because they're going to be short. So, you know, we'll give them maybe low dose hcg.
- [100:00]
Dr. Gabrielle Lyon
So in high school, these kids that would be using testosterone, that would close their bone plates, growth plates, if they haven't closed. Kids, you hear that? And that means also probably in college, their plates might not be closed. I don't know if people are still growing.
- [100:16]
Dr. Larry Lipschultz
College? I don't think so. 18 and up, I don't think so.
- [100:18]
Dr. Gabrielle Lyon
Okay, so you give HCG to jumpstart.
- [100:22]
Dr. Larry Lipschultz
Their own, or Clomid and Clomiphene, something to stimulate your own production to make it more physiologic.
- [100:30]
Dr. Gabrielle Lyon
If someone has abused anabolics or been on testosterone for a very long time, is there an ability to recover, to come off recover, like a reboot protocol, some way to reboot their own production of testosterone?
- [100:46]
Dr. Larry Lipschultz
But I would think HCG would. I mean, I have not seen somebody on it who wants to come off it, but there's no reason if they.
- [100:52]
Dr. Gabrielle Lyon
Want to get someone pregnant.
- [100:53]
Dr. Larry Lipschultz
Well, then that's totally different. If you want to talk about that, that's a totally different issue. Right. And we can talk about it. I think it's very interesting.
- [101:02]
Dr. Gabrielle Lyon
Yes.
- [101:02]
Dr. Larry Lipschultz
I'm gonna first get some water.
- [101:04]
Dr. Gabrielle Lyon
Yeah, we've been going for. It's 4:30 already.
- [101:07]
Dr. Larry Lipschultz
Yes, I know. Can I?
- [101:09]
Dr. Gabrielle Lyon
Yeah, you can stretch your legs. You can tell me that you want to quit too, but I would have to bring you back for a part two.
- [101:15]
Dr. Larry Lipschultz
You would have to what?
- [101:16]
Dr. Gabrielle Lyon
You are so. I mean, I'm learning so much.
- [101:19]
Dr. Larry Lipschultz
Because you know what you're learning. My. A lot of my stuff is opinions. It's not published science.
- [101:24]
Dr. Gabrielle Lyon
But Dr. Lipschultz, you have done something that very few people do, and I hope you understand my appreciation for that, because I am a science communicator, which means I look to see what everybody is doing. And you've provided really meaningful innovation. No other doctor is doing this or talking about it or willing to think about it.
- [101:51]
Dr. Larry Lipschultz
Right. But it's also open to criticism.
- [101:54]
Dr. Gabrielle Lyon
Do you care?
- [101:56]
Dr. Larry Lipschultz
No.
- [101:57]
Dr. Gabrielle Lyon
Exactly.
- [101:58]
Dr. Larry Lipschultz
You have to be careful, though, in academics.
- [102:01]
Dr. Gabrielle Lyon
Yeah.
- [102:01]
Dr. Larry Lipschultz
Maybe less so in academics and private practice because, you know, we are doing things that are very academic way. We're just not throwing stuff against the wall and seeing if it sticks.
- [102:12]
Dr. Gabrielle Lyon
Of course not. Nor would you. I promise I'll let you out of it. Are you good for just a couple more minutes?
- [102:18]
Dr. Larry Lipschultz
Yeah, because I have to go to the doctors.
- [102:19]
Dr. Gabrielle Lyon
You do? Okay, so let's just wrap up on your discussion on. You said it was important to reboot too.
- [102:29]
Dr. Larry Lipschultz
It is.
- [102:30]
Dr. Gabrielle Lyon
So let's just mention that if you just want to finish that, then we can run through scripts, we'll have Mia come down and we'll like, knock out some scripts.
- [102:37]
Dr. Larry Lipschultz
Do you have enough intro to go right to it?
- [102:40]
Dr. Gabrielle Lyon
Yeah, we just have to end it appropriately.
- [102:42]
Dr. Larry Lipschultz
No, this talk about the HCG and the.
- [102:44]
Dr. Gabrielle Lyon
Oh, yeah. Well, I'll ask you the question. Talk to me about individuals that have used anabolics. And I'm saying anabolic testosterone, which is an anabolic or other agents that now want to regain fertility.
- [102:58]
Dr. Larry Lipschultz
Right. And this is a very common problem. So what we do. First of all, we've changed our paradigm. Now, anybody in their reproductive years who comes in complaining of low T, we get a semen analysis because, you know, sperm production, when it's impaired, is often associated with poor testosterone production.
- [103:19]
Dr. Gabrielle Lyon
Sperm production that is impaired is often.
- [103:22]
Dr. Larry Lipschultz
Okay because the testicle is just not working well. Right. So if someone's starting out with low semen quality, we don't want down the road try to re stimulate and get to a level where that individual never started. What do you mean?
- [103:39]
Dr. Gabrielle Lyon
What do you mean?
- [103:40]
Dr. Larry Lipschultz
In other words, I think people who come in with low T when they're young are at risk for also having poor sperm production. So I want to know what they are before I give them t. Okay. So when it comes time for them to have a baby re establish, I want to know what my target is. I mean, if their production is 10 million per mil, I don't want to try to stimulate them to 30 because they weren't that way to begin with.
- [104:04]
Dr. Gabrielle Lyon
I see, I see.
- [104:05]
Dr. Larry Lipschultz
So that's what we're doing now. That's different.
- [104:07]
Dr. Gabrielle Lyon
Okay.
- [104:07]
Dr. Larry Lipschultz
But before we did it, you know, when people come in now, they haven't done that. The old technique was to take them off testosterone originally. Just take them off testosterone. Well, that was terrible because they had no testosterone. They were miserable. They wouldn't stick to no testosterone. So what we then started doing is adding HCG with Clomid and then later, which is what we're doing now, HCG with fsh. Because we found those two hormones, which are the essential hormones for sperm production, we can give parenterally, we can give from the outside, you can purchase them, and then we can bypass the issue of trying to restimulate them so the individuals will get pregnant faster. In addition, we found out we can also add back or allow them to stay on their testosterone because when you think about it, testosterone is bad for sperm production because it turns off FSH and lh. Right, Right. Well, if I'm giving the individual FSH and lh, why do I care if they're taking testosterone? Right. And we've published this and shown that it works. So now our individuals can stay on their testosterone. They don't have to go through any of the symptoms they came in for initially of low testosterone. And yet they can reestablish sperm production back to their baseline.
- [105:36]
Dr. Gabrielle Lyon
That is innovative. Do you then need to lower the testosterone dose? You just give them LH and FSH and they're able to maintain fertility?
- [105:45]
Dr. Larry Lipschultz
Yes.
- [105:46]
Dr. Gabrielle Lyon
Wow. Dr. Larry Lipschultz, I could talk to.
- [105:50]
Dr. Larry Lipschultz
You all day and I would love to, but we all have other things to do.
- [105:54]
Dr. Gabrielle Lyon
Well, I don't know. This is pretty important. But you know what?
- [105:58]
Dr. Larry Lipschultz
We can come back again.
- [105:59]
Dr. Gabrielle Lyon
We'll come back for.
- [106:00]
Dr. Larry Lipschultz
We can have part two.
- [106:01]
Dr. Gabrielle Lyon
We'll have part two. And you know. Yes. I am so grateful to you and the way in which you have really led the charge on a lot of this innovation. Really extraordinary.
- [106:13]
Dr. Larry Lipschultz
Yeah. Well, I appreciate your appreciation. Well, and also, you're a great interviewer. Very comfortable. Thank you so much.
- [106:20]
Dr. Gabrielle Lyon
I appreciate that. And till next time. Yes, till then, we will not call it testosterone replacement therapy.
- [106:27]
Dr. Larry Lipschultz
Never again.
- [106:29]
Dr. Gabrielle Lyon
Dr. Lipscholz, thank you so much.
- [106:30]
Dr. Larry Lipschultz
And thank you.
- [106:32]
Dr. Gabrielle Lyon
Thank you so much for tuning into this powerful conversation with Dr. Larry Lipschultz. If today's episode challenged what you thought you knew about men's health and fertility, share it with someone who needs to hear it. Partner, brother, friend. And if you're ready to take your health seriously, make sure you're subscribed so you never miss an episode. I'm Dr. Gabrielle Lyon. See you next time. And remember, strong bodies, strong minds, strong future.