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Mitch: You're listening to "Who Cares About Men's Ìð¹ÏÊÓƵ," where we aim to give you some information, inspiration, and a different interpretation of your health. I'm Producer Mitch. Scot, Troy, and I are taking a little bit of a summer break, but we'll be back soon enough with brand new episodes I know you're going to enjoy. In the meantime, we've put together some best-of episodes highlighting our very favorite moments over the past 145 episodes.

Now, here on "Who Cares," one of the paradigms we try hard to shift is that health is more than just building muscles, attracting mates, testosterone, and what goes on below the belt. We subscribe to a more holistic, for a lack of a more macho term, approach to health.

And while we know that those types of topics aren't everything, they are concerns and they are part of our health. And as uncomfortable as it may be sometimes, we've got to talk about those things, which is why we bring on Dr. John Smith, a urologist and men's health expert, to help us talk about some of these more sensitive topics. He's our go-to expert for everything from hormones to sexual performance, to keeping a man's bits and bobs healthy.

Today, with the help of Dr. Smith, we're going to be talking about testosterone, or T, which if the advertisements on cable TV, men's health websites, and just about everywhere else on the internet, it's the one thing that can cure all that ails a man.

It's a hormone that I think crosses the mind of every guy at some point if he's not feeling 100% himself. In fact, questions and stories about testosterone are some of the most frequent messages that we receive in our inbox here at the show.

So we're going to take a deep dive today into testosterone, what it is, what it can actually do for a guy, and share some personal stories of how it may or may not work to improve a man's health.

To start, we've got to go back to Episode 102, part of our men's health essentials on testosterone, and have Dr. Smith give us some of the basics of T and what it can and cannot do.

Scot: Welcome, Mitch.

Mitch: Hello. Hi.

Scot: I think Mitch needs some testosterone. You can hear how low key he is.

Mitch: It's low T day. I mean, based on everything I see on the internet, that's got to be what's going on.

Scot: Well, yeah. I mean, you go to the internet . . . I'm going to do my impersonation of the internet. You ready for this?

Mitch: I love it.

Scot: All right. "You have low energy? You've got to get some T. You putting on a few pounds of fat? You've got to get some T. You having trouble sleeping? You've got to get some T." That's my impersonation of the internet. It's the answer to everything.

Troy: It is. It cures everything.

Scot: Yeah. So we're going to find out if that is actually true or not with Dr. John Smith.

Dr. Smith, what is the common complaint you get when somebody comes to you and they're interested in testosterone treatments? What problem are they trying to solve? What are they trying to cure? All the things I talked about? Something else?

Dr. Smith: Absolutely. I mean, I think the thing about testosterone is the symptoms are so wide-reaching. Fatigue, cognition, erectile issues. They've heard on the internet or they've talked to a friend who's on testosterone, and it's like, "Man, it just changed my life. It fixed everything," which in some people's cases, that may be true, but for most people, it definitely can play a role in helping them out.

But I don't think it's the cure-all that you're talking about that the internet shows. It's not making Frank Thomas who he is today.

Scot: And when you take a look at that test, it's a range, right? So a man gets the test done, and you've got some numbers, and there's a range. What does that tell you? Let's pretend I'm at the low end of the range, but I'm still considered normal. Is that somebody that you would suggest testosterone therapy for, or . . .

Dr. Smith: So I think a lot of it is the discussion that you have with the patient.

The range is huge, too. If you look at the range, most labs are between 300 and 1,000. Some are a little less, some are a little more, but just for intents and purposes of this discussion, about 300 to 1,000.

So let's say, Scot, you're at 350. Well, what does that mean? Insurance requirements say that we've got to get two tests that show a low value before 10:30 in the morning. So let's say we've done that. You come in, your first one was 350, and your second one was 340 or 338. What do we do from there? Well, then we have a discussion.

And I think in a lot of those folks, it is reasonable to discuss therapy. People outside the normal range, it's obviously okay to discuss that as well, but people tend to feel better in a range around 400 to 700. Sometimes, some people will say 600 or higher. There's a lot of different variability out there between who you talk to about it.

But again, if you're feeling the symptoms of fatigue, decreased libido, decreased erectile quality, some of those things are really hitting you hard and you're like, "I'd love to try testosterone to see if it would help some of those symptoms," I think it's completely reasonable to do that.

Troy: I guess, John, I've seen all the stuff Scot mentioned, you see all these things on the internet, you see TV ads, etc. Yeah, I think I wonder myself, "Man, is my testosterone low? Should I be worried about this?" At what point do you tell people, "You should get your testosterone level checked"?

Dr. Smith: I think if you've looked at some of the other . . . If you've talked to your primary doctor and kind of gone over things and said, "Hey . . ." The usual suspects of a thyroid issue or vitamin deficiencies, things like that that they check a lot, if those are all normal, I think it's completely reasonable to look at it.

Some people say, "Well, my dad had low testosterone, and I got it checked in my 30s." But if you look at the facts of the matter, about 40% of people over the age of 45 have a testosterone level of 300 or less. And so that's a decent amount of the population that's out there.

And so I think if you have an interest in it, it's okay to ask to have it checked because it's better to know and to at least know what your options are where it may be of benefit to you.

Scot: And how do you do that then?

Dr. Smith: So your regular doctor can check it. You can make an appointment with a men's health specialist like we have at the Ìð¹ÏÊÓƵ of Utah. We have a men's health group with multiple different providers. We have nurse practitioners, PAs, and multiple MDs and DOs that can take care of your needs as far as checking the hormones. But that's the first thing that we do.

And hormones, ideally, should be checked before 10:30 in the morning because our bodies spike testosterone between the early hours of the morning. Usually, people will say between 4:00 a.m. and 10:00 a.m. in the morning. And so we want to check it to see what your body is actually doing.

If you're low in the morning, the odds that you're high in the afternoon are going to be really slim to zero because your body spikes it in the morning to give you that boost of the hormones that you need to get you through the day.

Scot: And of your patients that you start on therapy, you mentioned that the symptoms can be very broad, and be caused by a lot of different things. Maybe you're not getting enough sleep. Maybe you've got too much stress in your life. That's why you're low energy. Maybe you're not eating the right foods or exercising. That's why you don't feel good.

How many after they get testosterone that come in that have low testosterone actually go, "Yeah, that made a difference," versus, "Eh, I'm about the same"?

Dr. Smith: Majority of them, but that also varies via the route that they get testosterone. So I'll talk kind of a little bit about each modality.

Oral options, there's a medication called Clomid. A lot of people know it as a fertility medication. Women use it for fertility purposes. But what the medication does is it stimulates your body to produce more testosterone and more sperm. This is a very gradual improvement in testosterone. And a lot of times people don't feel that robust "boom," that jolt of energy and things because it's kind of a low key, slow rise of the testosterone back into the normal range. They don't have that big boost.

And most of the time when people have that boost, it's from the injection. They're injecting a bolus of testosterone that then is being absorbed into the body, and they have their levels shoot outside the normal range. So they feel like Superman. It gives them that rush of testosterone, which you don't get with topicals, the lotions, and you don't get with the oral because it's doing what your body normally did before you didn't create enough testosterone. And so you don't get those super highs that you would have before.

So a lot of patients know, "Oh, man, I do have more energy. I do feel good." The ones who do injections tend to come back and have more of a, "Man, that's great. This stuff is great," because they get that "boom," that rush, that spike of testosterone very quickly.

You really have to monitor things with testosterone. So testosterone can cause an increase in red blood cell mass. And that in and of itself isn't necessarily a bad thing as long as it doesn't get outside of the normal range too far. That puts you in an increased risk of a cardiovascular event like a heart attack or stroke.

Now, those incidents are rare, but it's something that we definitely keep an eye on. And that's a reason why we follow these folks with labs regardless of the type of replacement that we do.

Other things that we follow. Your estrogen levels can rise because testosterone is a precursor to estrogen. There is a molecule called aromatase that actually converts testosterone to estrogen. Their chemical formula is very, very similar. Your body likes to keep a ratio of about 10-to-1 testosterone to estrogen, and so the higher your testosterone goes, the higher your estrogen level goes.

And some people will develop breast sensitivity, nipple tenderness, or breast growth from elevated estrogen if their bodies are over-converting to estrogen. And so we watch that closely because that can be bothersome too to folks.

And then a couple of the other things. We always monitor PSA in folks that are over the age of 40, or at least I do in my practice. There's not an increased risk of prostate cancer, but if you were to develop prostate cancer, testosterone would feed the prostate cancer.

It's kind of like if you have a match and it's lit, nothing happens. But if you have a match and you pour gasoline on it, you have a problem on your hands. And so the prostate cancer would represent the match and the testosterone would represent the gasoline. It would help it to kind of progress faster in a way.

And those are the things that we really kind of keep an eye on, especially people with family history or people who have had prostate cancer that we're treating with testosterone, which, yes, we do that quite frequently.

Scot: And that's dangerous, right? Because you can get testosterone without even having a face-to-face conversation with a doctor, right? You can essentially just order it online. Is that true, or is that overstated?

Dr. Smith: I think some of the newer companies you've got out there that are making things available . . . Hopefully, you're getting at least a video conferencing going over your medical history with someone who's a medical provider, whether it be a nurse practitioner or PA. Hopefully, you're talking with a physician. If they're not doing it that way, they're doing it wrong.

But testosterone is one of those things where it can be very helpful. I have quite a few patients that are on it, and I think it is one of those things that can definitely benefit people, but to the extent that it benefits them kind of varies between patients.

Scot: Testosterone, I get the impression that it's probably not a do-it-yourself sort of thing. It's not something you want to, as a layperson, just dive into on your own. Why is that?

Dr. Smith: Everything has a risk and a benefit, and testosterone is no different.

For people who have low testosterone, replacing it can really make a difference. It can give you that increased boost of energy, help you with weight loss, help you with metabolism, help with sleep. It can help with erections. I mean, it can help with cognition in people who have low testosterone.

However, it's not necessarily the thing that's going to fix all those problems. And oftentimes, I'll go through people's history and say, "Hey, man, your testosterone is normal. Adding more to the mix isn't likely to fix things. We should look at other issues."

And so I think really just taking that deep dive and seeing if it's something that is right for you is important.

Mitch: I'll just disclose now, I had my testosterone levels checked after we did a previous episode, and my number is right around 400. My primary care provider is like, "Oh, no, we don't need to. There's no need to talk about testosterone therapy." And so I've kind of put it in the back of my mind.

But then at the same time, you have the weird people on the internet that say you need to be 600 or 1,000 or above to be healthy. And it's just like if I'm right there, I'm at the 400, maybe it would be helpful. What would you say to someone in my situation?

Dr. Smith: So I think you've got to look at the whole picture, but I think it's definitely something that you could consider.

Again, most primary care doctors don't do a lot of hormone replacement, so they're going to say, "Hey, you're well within normal range. We're not going to touch it. We're not going to do anything," because that's their comfort zone.

This is the thing that I do every single day where I get people sent from their primary care doctor to talk about this stuff. And I think it's an in-depth conversation of, "Hey, let's look at the whole picture. Is there anything else going on that's a problem or could be seen as a problem? Do you have a thyroid issue? What is your BMI? How does your weight look? What's your exercise routine?" Things like that, because those things can be done before supplementing testosterone.

And there are some interesting numbers out there with diet and exercise. If people will lose weight of 10 pounds or so . . . You can increase your testosterone by 100 points by losing 25 pounds and getting diet and exercise.

But a lot of times, it's hard to get the motivation to go do diet and exercise when you're overweight and you're really lethargic. And so it's like, "Would testosterone help me get there?" and a lot of those things as well.

And so, again, exercise 15 minutes a day for six months of moderate intensity exercise will increase your testosterone by 22 points. And then if you're exercising for 30 to 40 minutes a day, you'll increase it by 50 to 60 points.

And so, again, there are things you can do other than testosterone if you're kind of in that range. And any of those things fit.

Now, Mitch, I know you're super fit, so that doesn't really . . .

Mitch: Yeah, I'm the fittest guy.

Dr. Smith: . . . matter for you. But if those are things that you can do, those are modifiable things you can do in your life to increase your testosterone naturally.

Mitch: So after we discussed testosterone and my sort of low levels on the podcast, I decided that it may be worth seeking a second opinion, and, of course, share it on the podcast.

And you know what? I'm so glad I did, because through working with a specialist, we found out my T levels were actually very low, and treatment was a real game changer for me. But that's not every guy's story. For guys like Scot, testosterone was not the magic bullet the ads make it seem like.

So on Episode 118, "Mitch and Scot's Tales of Testosterone," Scot and I share our very different experiences with hormone therapy and discuss the outcomes with Dr. Smith to help us understand why T works for some guys and maybe not so well for others.

Scot: There's kind of this implied thing . . . and I don't know, maybe it's just me, but I think it's a lot of guys . . . that testosterone is kind of a cure-all for men who are suffering from fatigue, or struggling to lose weight, or struggling to put on muscle mass, or their sex drive is reduced. So it's kind of like all guys should be on it, right?

But we've talked about testosterone on the show before and testosterone therapy, and it's not a magic bullet. The only time it's a magic bullet apparently is if you're Mitch.

Mitch: Yeah. So it was very interesting. The recording of that particular episode was smack dab in the middle of a year-long struggle with some really, really severe fatigue, right? And we're talking physical, mental. Every day, I was just tired. I was dragging myself, right? I felt it in my joints, I felt it in my brain, and it just kind of kept getting worse and worse.

We talk about on the show, "Oh, yeah, get more physical activity. Change your diet." If you're so tired all the time, the idea of getting up and running for 30 minutes, I'd be completely worn out for the rest of the day. I would just be that physically exhausted.

And it was even my therapist, my mental health person, who was saying, "Hey, you're obviously not doing the work that we're doing every week because you're so tired. You're so out of it. We can't help pull you out of whatever's going on if you're this out of it."

So after kind of talking through it and just struggling with all of this, I decided to go to my PCP, and I told him, "Hey, I'm dealing with some severe fatigue. It's been going for a very long time, blah, blah, blah." But I was like, "Hey, what could be wrong?"

And so he did a whole bunch of panels. We ruled out things like diabetes and all these other conditions. Took tons of vials of blood out of me, and they all came back normal. And he kind of said, "Well, why don't we try some lifestyle changes?"

So I tried. For months, I was doing healthy meals every day, I was going to bed at a certain time, I was trying to drag myself out of bed every morning just to go on a little jog or do working out. I was doing everything I possibly could, but I still was tired, and I was putting on weight.

And even when I went back and I said, "Hey, I've tried the things. I don't mean to backseat doctor, I'm just a podcaster, but I have a feeling that something else is going on. I'm not lying to you. I really am doing all the things I think I'm supposed to," the response was to prescribe me antidepressants.

There was such a confidence in my doctor that it must be something mental that's causing my exhaustion. And I took him at face value, so I went and I took the antidepressants. I tried it out and had kind of weird emotional swings for a week or two, and it still wasn't going away.

And about that time is when we recorded the episode. If there's any love letter to this show and the idea that talking about health can be a huge change for people, we had a conversation about this very thing, where it's like, "Hey, sometimes your PCP might not feel super comfortable giving you hormone therapy because they're not super trained in it."

After hearing that, I decided to reach out to Dr. John Smith. What better men's health person to talk to than someone I've already interviewed? We got the test done, and sure enough, my levels were pretty low. They were under 300. We took both of them in the morning to make sure we were minimizing any other potential things that were going on, but I had really low testosterone.

Dr. Smith: Mitch, I love your story because your PCP is awesome. The fact that he took the time to go through all of those things with you and make sure that it's not something else. I have a lot of people's PCPs who won't take that time. Not that they don't have the time, but sometimes PCPs are overwhelmed. But bless his heart, or her, for going through the time to get the blood work and make sure all those things are normal.

I've found plenty of folks who come in who have thyroid issues or other issues that are causing their fatigue. So I just wanted to put a plug in for your PCP and some kudos and a pat on the back for taking the time to really make sure that they covered all the bases.

Scot: Anything else to that part of the story, Mitch? You went through this.

Mitch: No, not really. I got on a cheap pill and things turned around. It was awesome.

Scot: Yeah, but drastically. The kind of drastic that we make fun of, like, "It's the silver bullet." We spent a lot of time . . . At least I felt like I did. Maybe Dr. Smith didn't. But upon reflection, I'm like, "I wanted to communicate this is not a silver bullet. You still have to do these other things, and you should try these other things." But for you, it was kind of a silver bullet.

Mitch: Yeah, it was night and day. It took me about a week to notice anything. So I show up to the pharmacy, I pay my $30, I get this big pile of meds, and I just start taking one. And after about a week, that weekend I woke up feeling like I had had the first full night's rest that I've had in years, right? I just woke up and felt amazing.

And it kept going. I could keep having energy. When I got done with work, I actually felt like I could do something in my evening, like I could work out or go for a walk or do a hobby or something, rather than just crash in front of Netflix and order Grubhub.

And it wasn't just that. I was suddenly able to work out without feeling completely wrecked, right? It used to be I'd do a hard set at a gym or something like that and it would drain the last bit of energy I had left in me. And so I just would crash.

It just felt good mentally. I was able to be sharper. I was able to focus on things. This brain fog and overall physical fatigue that was going on completely disappeared.

And then on top of that, I lost 25 pounds in a month.

Troy: Yeah, that was the crazy part.

Mitch: After years of struggling with weight and doing everything I was supposed to and never seeing anything, suddenly a month after getting on this medication, I lost all of . . . It's slowed down now, I'm not continuing to lose all this weight, but it's like something suddenly fell into place and my body worked.

Troy: And you lost weight and you also put on muscle mass, too, didn't you?

Mitch: Yeah, I did, but we don't know the exact numbers.

Scot: He's going to be honest about that.

Troy: You're just downplaying that part. "Yeah, I'm pretty ripped now."

Mitch: I am not ripped.

Troy: You probably are. I haven't seen you in a couple months. This was how long ago? When did you first start the treatment?

Mitch: This summer, actually. So a couple months ago.

Troy: So it's been a couple months. That's what I wondered too with treatment. Is there sort of this honeymoon phase where everything's great and you feel good and you lose weight, and then after a month, everything kind of levels off or maybe there's a little bit of a rebound? It sounds like in your case, everything is still good. Things are going well.

Mitch: I mean, I'm not still losing like two, three pounds a week, but I still have my energy. I still feel mentally sharp and good. And they're talking about maybe even minimizing and taking me off of some of my mental health medication I've been on because of how much better I'm doing. So, yeah, big change.

Troy: That's great. No, that's huge. John, is that typical? Is Mitch's experience typical?

Dr. Smith: I think Mitch is at the higher end of what people experience. I will say most people within the first year . . . The testosterone literature will tell you that you'll have a body mass change where you'll lose about 2.5 kilograms of body fat and you'll increase lean muscle mass. So that's something that you see across the board.

Mitch is probably someone who is in better shape than most of my patients. So folks who are a little bit more out of shape may not notice that muscle mass change as much as Mitch did, because Mitch has done a very nice job of staying in shape and taking care of his body and being in a good body mass to start. And that makes a huge difference for patients.

But I would say Mitch is on the higher end of people who have done very, very well and are very pleased with their treatment.

I would say, overall, most people who get a benefit, they do maintain that energy improvement and things like that. On a caveat, if you have the desire to go to the gym and you're just too tired . . . The testosterone isn't going to make you want to go to the gym, but if you had that inherently before and the fatigue was impacting you, once you get that energy back, you're going to want to go back to those things that you enjoyed, if that makes sense.

Scot: Mitch also talked about how mentally he was feeling better. Is that common that the testosterone can help there? What do you think is going on with that, Dr. Smith?

Dr. Smith: So there is some debate on that, but overall, when you have more energy, you feel better, you're able to go and do the things that you like to do, you have the energy to go do the things you like to do, your mental health status changes, and you feel better. And I think that just stands to reason.

People who get a good result from hormone therapy of one reason or another, they tend to be happier. They tend to feel better. When you feel better and you're able to go and be active and do things and have energy to do things, overall, you do feel better. Things are just better.

Scot: All right, Mitch. Now the dark side. Are there any side effects?

Mitch: I guess, but they're all testosterone related. It's not the medication. I used to have to shave maybe once every week and a half. Now I'm shaving twice a week. So we'll see if I can . . .

Scot: A regular teen wolf.

Troy: So wait a second. You used to only shave once every week and a half? Was this because of you wanted to grow out a beard and then you'd shave it off, or just . . .

Mitch: No, I couldn't grow any facial hair. I've always been a little baby face. So, yeah, I'm having to learn how to shave all over again and more frequently.

Troy: But to say more frequently, it's just twice a week though?

Mitch: Yeah. That's a significant change.

Troy: From every week and a half, yeah.

Mitch: I'm doing that. I got a little bit of acne on the body. I've been zit free since I was 18, 19, and now I'm getting little bumps on my body every now and then. But nothing a little bit of special acne stuff or whatever won't help.

And after we chit-chatted last time, I'm growing my hair out. I got this awesome mane going these days, and I started to see it coming out in my comb. So went to Dr. Smith, was like, "Hey, I think I might be losing some of my hair." And he's got me on Propecia. Haven't had any side effects with that. I guess that'll help control any hair loss that might be involved.

But any of those changes I would not trade for the world, being a little hairier, a little zittier, and maybe a little thinner in the hair. I am fine. I would much prefer that than just being tired and miserable all the time.

Troy: So you're going to have this killer beard going on and shave your head, but you're going to feel good.

Mitch: Yep, 100%.

Troy: Take it. Yeah.

Dr. Smith: Mr. March of the "Who Cares About Men's Ìð¹ÏÊÓƵ" podcast, Mountain Man Mitch.

Troy: That's right.

Scot: I've been looking for a name for you. I think we might have had it there. Thanks, Dr. Smith. I like it.

Troy: Mountain Man Mitch. Triple M.

Scot: Yeah, that's good. Are there other side effects that some guys would experience in addition to what Mitch is talking about?

Dr. Smith: So those are very typical. Increased testosterone can increase male pattern baldness. You can get some acne, increased body hair, facial hair, those types of things. Kind of like when you're going through puberty, some of those similar things when the testosterone levels kind of raise like that.

We always watch the red blood cell count because it will stimulate that. Testicular size changes in the case of people who are on exogenous testosterone. It doesn't happen with the Clomid like Mitch is on. Those are the big ones that most people see.

The medication that Mitch is on, the Clomid, some people will have a little bit more of a moodiness or mood swings. They feel like they would cry during a Hallmark movie kind of a thing. Their emotions are a little bit closer to the surface.

I had a guy literally tell me that one time. He's like, "I feel great. I feel like I'm going to cry at a Hallmark movie." And I said, "Okay. So your emotions are a little bit closer to the surface." And he's like, "Yeah, that's kind of what's going on." And so that's the biggest thing with Clomid that people tend to see, but that's pretty typical.

Mitch: After discussing what specific medications and treatments I was taking and discussing the pros and cons of each, it was Scot's turn to share his experience with testosterone therapy, and why he ultimately chose to discontinue treatment.

Scot: So after hearing Mitch's story, I got curious about testosterone again myself, because I feel like I kind of have the same things. I feel like I've been exercising and doing the right things, but losing body fat is difficult. I feel like I kind of have low energy and some of those things.

I had tried testosterone before, back around 2010, so 13 years ago. I had just turned 40. And it really didn't work for me. So I thought, "Well, I'll get my levels tested again and see how they look." And my levels came back right in the middle. It's 650. That's about as average as you can get, right, Dr. Smith? I am the most average man on the face of the earth. You ask me my skills and ability in anything, it's going to be average.

Anyway, with that number, I made the assumption that testosterone therapy is really not going to help me. Would that be a good assumption to make, that that's probably not the issue?

Dr. Smith: Yes. If you're asking me the question, I would say yes, because if you're in the normal range, there's not a lot of benefit to be had.

Now, some people may disagree, but I look at you have a certain number of receptors for testosterone. If you think about it like a parking lot, if you have 600 parking spaces and 1,400 cars, it really doesn't matter how many parking spaces you have, you're not going to be able to fit all the cars. And so, with a normal testosterone in a normal range, you're going to be saturating those parking spaces, aka those receptors, that the testosterone interacts with.

And so the benefit ratio of taking someone with low testosterone where there are too many open parking spaces, so to speak, to someone who's got almost all the parking spaces full all the time, you can see how the benefit would be there or wouldn't be there. And so normal testosterone, adding more doesn't necessarily improve things.

Scot: So I'm going to say, first of all, you have the best analogies of any of our guests ever.

Mitch: Absolutely.

Scot: Every single episode, you just nail it with an analogy. That was awesome.

Troy: Yeah, parking spaces. That makes perfect sense.

Scot: That was fantastic. So I'm going to try to keep my story short when I tried testosterone for the first time. I tried it for a couple years and really didn't notice any benefits, and it was a lot more hassle than it was worth.

So I had just turned 40, and I was working at a place and there was this guy that was really super muscular, and he was younger, and he was like, "Oh, man, as soon as I turn 30, I'm going to go to the doctor and get testosterone therapy." He is under this impression that you start losing testosterone as you get older, which is true.

And then you see the ads in the media, and there again, this seems to be recurring in my life. Low energy. I've always wanted to put on muscle, and I've always found it difficult even when I weight train. Losing the fat is difficult, even when I feel as though I'm doing things right.

So I had another friend who started testosterone, had some results like Mitch. It gave him this energy and drive again. So he referred me to this particular doctor. I got the test, they got the levels, and they put me on the cream. I did that for a couple years. After a few months, they ended up putting me on some pills to balance the hormones that the testosterone cream was causing.

And I also didn't like the fact that since I was using the cream, I had to be really careful my spouse didn't get near it. And I really wasn't noticing any difference, so I just ultimately kind of ended up quitting that.

Fast forward to the last episode we did, I thought, "Wow, I wonder if I could go back and pull those old labs and see what my testosterone levels were." And even back then, they were around 600 and 650. So what this physician and I were trying to do was we were trying to optimize, get at that upper level thinking that that's going to make me feel even better.

And after learning from you, Dr. Smith, and your awesome parking space analogy, it makes total sense why that didn't help me. So, in that case, testosterone really wasn't the solution for my problems or my perceived problems of energy and whatnot.

So, in a way, I'm kind of jealous of Mitch, but also in a way, I'm glad to know that everything is okay, and maybe now I can kind of be a little bit more honest with myself. Am I going to bed at a decent time? Am I eating the way I need to be eating? Am I getting enough calories? Could there be some other reasons why I feel like I'm tired, or is it just my perception?

So that was my story, which is very drastically different from Mitch's, but I think it really illustrates that if you don't need it, getting more is not going to necessarily help.

Mitch: So did you have any response to the treatment? Did you feel anything other than just kind of the same?

Scot: No, not really.

Mitch: Interesting.

Scot: I think at first I kind of thought maybe I did, but again, that could have been the placebo effect. I don't know. Ultimately, I didn't notice a whole lot of difference over the long term. And that in combination with the downsides is kind of why I just decided to stop.

Troy: Scot, that's been a little while ago. Have you had your levels rechecked recently?

Scot: Yeah, I just had them rechecked after Mitch had such success with his treatment and found that they're just dead in the middle. That's that 650 level.

Troy: Okay. So still 650. Yeah, maybe I missed that. You were 650 years ago and everything has stayed exactly the same. Clearly no benefit for you to go on testosterone at this point.

Scot: Yeah. So what was the difference there between my experience and Mitch's experience, Dr. Smith? Do you have any more insight to that?

Dr. Smith: So we kind of talked about this a little earlier. Mitch had low testosterone, so adding more cars to the parking lot made sense. For you, you could make the argument that you may have even changed the cars in the parking lot initially, because when you start testosterone, your body is going to shut down your production. And so you're really just keeping yourself at that same level.

And I don't know what your labs looked like, if they rechecked your labs and things, but I've had people who've come into me from other outside places who've said, "Yeah, I've been on testosterone for about a year and a half," and they bring me their original labs, and they're kind of like yours. They're kind of in the middle of the range, 550, 600. I look at their numbers on testosterone, and they're like 720. And so, really, they didn't do a whole lot other than shut down their body's native production.

Now, I've had some people come in who were just being dosed up very, very high, who their testosterone levels were off the charts, and some of them said, "Oh, I feel great." And some of that, I'm guessing, is placebo.

But I've had some patients who, at a higher range, do say they feel better. I don't know that it's all placebo. And so there could be some benefit to that.

But being in the normal range, you're not going to get a ton of benefit. And so I think that's really where we look at it and we say there's not a whole lot more that you need to do.

And I would say that some of the patients I have that come in, they'll get sent by their primary doctor after they've had a couple of testosterone tests that are in the normal range. They'll come in, and I'll look at them, and their body habitus may be larger. I'll ask them questions like, "Do you snore?" I've diagnosed plenty of folks with sleep apnea where they get that treated and they feel like a million dollars. And it wasn't their testosterone. It's that they were waking up 30 times a night because they were having sleep apnea events during the night.

It's things like that that I've seen. You have to ask the questions around to get to the answer for some of those folks.

Some people may be on extreme diets trying to lose weight, and they're like, "I'm just tired." And I'm like, "Yeah, you're eating 500 calories a day. I don't know why you would be tired."

Things like that going on where you've got to ask the questions because you'll get to the answer. "Well, if you start eating 1,200 calories or 1,500 calories, you'll probably have more energy because your body is not going to try to store everything thinking that it's never going to eat again."

And so some of those things I see in folks where they have symptoms but their testosterone is in that middle of the road, kind of like yours was, Scot.

Mitch: And to wrap things up, Dr. Smith has this message for all men about advocating for their health.

Dr. Smith: I love it. I'm super happy for Mitch, and I'm also happy that you were able to kind of find your way. You mentioned it earlier about being an advocate. I tell patients all the time, "I get to see you for 15 minutes, and you know your body a heck of a lot better than I do. And so if you think something is wrong . . ." Like Mitch. He was like, "There's just something missing here. What is it?"

Be an advocate for yourself and find someone to have that conversation with about these things, because it can make the difference. Or it may not make the difference, but at least you'll understand the reason why, and you can then make the informed decision of which way to go.

So I think that for me was the take-home. You guys both did that in your own way, even though you ended up in two different places.

Mitch: Now, John talks about a lot more than just testosterone on this show. If you are interested in learning more about urological and sexual health topics, I highly suggest checking out our back catalog where you can find episodes of Dr. Smith discussing kidney stones, vasectomies, and answering listener questions about health concerns between the knees and the waist. We'll include a list of those episodes as well as the episodes featured today in the show notes.

And if you have a urology question you'd like to ask or a health story you'd like to share, don't hesitate to message us via email at hello@thescoperadio.com.

Thanks for listening, and thanks for caring about men's health.