Aaron Tharp 0:34
All right, welcome back. We are we are very pleased to be joined by a very special guest today. Dr. Steven Lapke. Who is the Medical Director here at Limitless Male Medical. Doc, welcome.

Dr. Steven Lapke 0:48
Thank you.

Josh Simms 0:49
How you doin’ Doc?

Dr. Steven Lapke 0:50
Great.

Josh Simms 0:50
Good to have you on.

Dr. Steven Lapke 0:51
Nice being here. Thanks for having me.

Aaron Tharp 0:54
Today’s topic is going to be around preventative medicine. So, you know, Dr. Lapke, he’s got a very, very credible, very impressive background, which I would rather have you, you know, talk about some of your background but, and a couple of things that that led you here, some of the, the, the ideas and goals that you had around your own medical practice over the years, and how that aligned with Limitless Male Medical. So we’re delighted to have you here and we’re gonna pick your brain on some things. And I wanted to kind of get a little bit of your background if you want to fill us in on where you came from. And absolutely, yeah, yeah.

Dr. Steven Lapke 1:37
I grew up on a large farm in Iowa, we raised a lot of cattle and, and then corn and hay, everything that we raise went to feeding the cattle, but it was just a great experience, great way to grow up, we ran it more like a rant. So genres I can remember, I was on horseback and work in Catalan. But my dad was I felt very influential in my life is one of those jack of all trades and, and could do anything. I mean, he, he was a mechanic, so he took care of all the mechanical work on the farm equipment. Construction guy, he built our farmhouse from the ground up, did everything himself and, and just had an incredible work ethic. And I think really instilled in me that blue collar work ethic. And so after graduating from high school, I moved to Omaha. And I wanted to stay home and farm but at that time, there was it was in the early 80s when there was a real farming crisis going on a lot of a lot of farmers not doing well bankruptcies and whatnot. So dad really encouraged me to go get an education. So off, I went, in my undergrad at you know, and then went to medical school at University of Nebraska Medical Center. And I think, my, here’s where my being raised on a farm and my blue collar mentality came in. I was just always wanted to be one of those doctors who could kind of do everything, like my dad be a jack of all trades. And, you know, I feel that primary care and ER, out of all the fields of medicine have that most blue collar, just hard working, get it done. And so looking back, I think that’s why I kind of went there.

Aaron Tharp 3:37
You get your hands dirty.

Dr. Steven Lapke 3:38
Exactly. Yeah, exactly. Very in the trenches.

Josh Simms 3:41
Yeah.

Dr. Steven Lapke 3:43
So, I did my residency at Clarkson Family Medicine, which is a private program. And at that point, that’s when Clarkson hospital was still a private facility. And so we were the only residents and a rather large hospital, so we got great training. Early on, as soon as I could, I took advantage of moonlighting and went out to a lot of the rural areas as even as a resident and worked long weekends in ERs and really got my hands dirty and really fell in love with the challenges of emergency medicine. So even though I trained in family medicine, right out of residency, I took a full time ER position at then Midland hospital. After a couple of years, I still had the desire to run my own practice. And so I did open my own primary care practice down in Bellevue and had no patients had to go the bank extra alone. Started out but in no time at all, we were full and I had just short of 4000 patients is all By 2007, I was still working ER as well, and really became frustrated with the business model. I mean, nothing like running your own practice to really, you know, see what works and what doesn’t work. I had multiple employees, I had my own in house billing, I think we have privileges at almost every hospital. So we’re doing around seeing patients in the clinic, in the hospital, etc. But really became frustrated with, with a whole, what I call insurance model of medicine, and where you have to have a lot of staff to, to manage a lot of different things to have contact with the insurance companies to get prior authorization for certain tasks to get approval for certain methods. And and just to help your patients understand and manage their insurance and what’s getting paid for and what’s not. So I felt that even though I had a big practice, I couldn’t spend the time with my patients that I wanted to. And I couldn’t affect them in the way that I really wanted to, which I would believe was spending more time really getting back to the basics of health care. And be able net, not to just throw medicine at him, and expect there to be great changes, I wanted to impact them in more meaningful ways. So out of that frustration, I did close my practice in 2007. And then just went back to full time ER, at that point, I started my own independent contracting business, then began contracting with really ours, I found out there’s just a huge unmet need. And it served me incredibly well to this day. I’ve worked at countless facilities throughout Iowa and Nebraska, really turned into a road warrior, putting on about 35 to 40,000 miles a year on my truck. But you know, just listen, some of the greatest communities might great people. I saw more disease, trauma, etc, in the real communities than I ever even saw normal. Really, and because you’re at, I mean, everything comes to you. Um, and there is no trauma team, or, you know, this specialty or that specially you’re at and you have to manage it, triage it. And you have to ship a lot of patients out, and you hope you do it well and, and do it in a timely manner. So, you know, it was a huge learning curve for me, and just a really good experience. But, again, and ER, it’s what I call sick care, which really is the mindset of health care in our country

Aaron Tharp 8:12
in general. Yeah,

Dr. Steven Lapke 8:14
it’s not, let’s take care of this beforehand, it’s, well, I’ll come see you when something happens. And really, I mean, the insurance reimbursement is set up that way as well, right? We don’t really get reimbursed for any kind of, of prevention, we don’t get reimbursed Well, for sitting and spending time with patients and sharing knowledge, we get reimbursed for doing things and prescribing things, right. And that’s not the best model. So while I was doing ER, my passion for a different type of medicine, I would say even grew more out of frustration of seeing how flawed the system is and how, you know, poor outcomes were etc. So, in 2019, my wife Brooke, and I broke had her training was she was an EMT in her earlier life, then went to radiology. School and became a radiology technologist, worked at Children’s and then worked up in Denison, Iowa and then manage the department up there. So she had a lot of just good general medicine experience and a lot of it and business. That’s big

Aaron Tharp 9:43
for business that’s running your own business brother. All right.

Dr. Steven Lapke 9:46
So we have similar passes. So it’s like, you know, let’s start our own concierge practice and play and that’s a community we live in. And so she was my business manager. I was a doctor and the Justice Two of us were able to run that clinic and do it very effective.

Josh Simms 10:03
He cut the red tape cut all the red. I don’t think people understand like I tried to, you know, and I don’t mean to cut you off. But I know, like some of the some of the things that we think about the cost of health care, people are just so up in arms about the cost of health care. One of the things that people don’t understand sometimes when you talk to him about this, because I was comparing how much money doctors make, and Baba bots, it’s not the doctors. If you look at inflation, and the cost of health care, the wages of physicians are actually going down. While they make the same money, it’s not enough to keep up with with inflation, right? So they’re actually losing money year by year. But if you look at the bloat of corporate medicine, of administration, just in a hospital, which is the vast majority of the of the employees in a big hospital system, it increases. But the same amount of doctors that come in are the same doctors that go out the same amount of nurses that come in and the same amount of nurses that go out same with pa and NPS, right. So it’s just kind of a revolving door, you don’t get more doctors and more nurses and more nurse practitioners and PA is they’re all on the level, right? And we always talk about how there’s a shortage of all of them everywhere. Well, there’s not a lot of incentive to get into it because you just get drowned in the bureaucracy of medicine. And so the cost of health care could be cut dramatically if we had less regulation. And I don’t mean like, hey, let’s just go cowboy up and do all this crazy stuff to our patients. But there’s so much red tape from a medicare medicaid standpoint, they have to cut through and worry about and be concerned about that the people who really lose on the the patients, they don’t get the care that they deserve to get. And it’s super frustrating. I mean, you see that in the ER of people who just use the ER’s primary care because they don’t have insurance. But with EMTALA, you, you have to see him. So the concierge model is so attractive for doctors, because it allows you to charge a lower rate and you can help your patients get the medications and the treatment that they need. And they can reach out to at any time. And you can I mean coming from a small town they do. I mean, like, you probably saw the local doc at the ballgames and at the store as a as kids doing that, and they knew you they had a relationship with you, it wasn’t just like, Hey, how you doing? Okay, but personal care, good to see, you know, the nurse case managers could come in and take care of thing, and then we’ll see in six months, right, that’s a terrible way to do patient care. So sorry to go off on that. I mean, there’s probably gonna be eight other times we’re going to do that and those conversations.

Aaron Tharp 12:26
That’s exactly what he was talking about before we are recording because I was brand new to concierge, I explained, it’s a beautiful thing.

Josh Simms 12:32
And it’s a beautiful thing, you’d be surprised what you can accomplish. When you put a good doctor with a good analogy would say like a business manager. It’s more of just like a clinic oversee or to help with the day to day operations to make sure that he can do his job effectively. Whereas you get these big organizations that are like, well, how can we squeeze every single dime we can out of insurance companies to make a profit. Medicine is the biggest industry in the country. It’s bigger than tech. It’s it is massive, massive, massive, but there’s also hospitals that will sue their patients, if they don’t pay their bills, we’ll take them to court and sue them. You’re going down the street, right? You can’t afford insurance, you get hit by a car, they drag you into the trauma bay, they do $100,000 worth of work. And you’re like, why am I supposed to pay for this? I don’t care. He pays $1 a week for it until you die or we can sue you in some institutions will sue their patients, man. It’s incredible. Oh, yeah.

Dr. Steven Lapke 13:24
That’s been a I’ve read more articles about that in the last couple of years. It’s I mean, it’s it’s a huge issue. huge problem. And yeah, Josh, you’re exactly right. As I was saying earlier, I mean, consi. Here, the concept of it comes back to putting all the emphasis back on the provider patient relationship.

Aaron Tharp 13:48
That’s it. That’s what it’s about, which is likely why you got into it in the first place.

Dr. Steven Lapke 13:52
That’s why all of us got into it. Because we want to make a difference. We wanted to help people, you know, we wanted to have time to spend with our patients to do what, what we are best at. But when you’re limited on that, and you become almost robotic in nature, and cookbook like then that really robs you and the patient out of all the passion and fulfillment of the art of medicine is gone.

Aaron Tharp 14:25
And if I understand you right, the incentives that you were talking about in the in the in the in the model that we just went through, is that the incentive there is to go fast and see a lot of people and to also you’re incentivized to push products and to push drugs.

Dr. Steven Lapke 14:39
Absolutely. Well, our whole training is about pushing like writing scripts, ordering test, doing things to patients. That’s what most of the emphasis is, because that’s where the money is.

That’s where the studies come from. And that’s where it’s So that’s where the education comes from. Yeah,

Josh Simms 15:03
it’s tough man you get you get between a rock and a hard place really quick as a medical provider to. So there’s people who have like chronic back pain, and they’re like, Okay, well, we got to do an X ray first in, they’re never really explained clearly as to why that’s the first step. That’s not, that’s what I want to do. I know you need an MRI, I know you need an advanced image where I can see your radiologist and see your spine 360 degrees in in millimeter slices through the whole spinal column. But your insurance company wants to see if they could maybe find something on an X ray that we can use. So we can treat based off of that, instead of just cutting to the chase and getting to the MRI. So I’m going to make you come in and see me then and make you go get a separate X ray, and I’m going to make another doctor, look at that X ray. And then I’m going to look at it again and tell you Okay, great, now we need an MRI. Now you got to come in another week later, send an MRI machine for an hour, then that same radiologist will read that report again, right, then it’ll come back to me. And then I’ll refer you off to a neurosurgeon who may want to do more imaging after that. And then so then you’re you’ve had six different cooks in that kitchen, when you can just cut it out and say, Hey, I’m going to send you here, and then I’m going to send you to Dr. Rick, who’s the guy that I always refer almendros are like, you could cut out so much of that. But all that stepwise crap is for insurance companies. Wow. That’s Yeah, a lot of people don’t understand that. Yeah

Dr. Steven Lapke 16:17
Well I see happening now in the Emergency Room, and it’s rampid, that a patient will show up at their primary care office, they potentially have something significant going on. The primary care physician knows that he cannot get authorization to order set tests, let’s say it’s abdominal pain. Like I know this patient needs a CT scan, they can’t get prior authorization fast enough. So they go from their primary care office straight to the ER, strictly because they know, we can order the test without prior authorization. So it’s driving everything to the ER. So they can it’s it’s playing that game, and it’s how do we get around it. And that’s how much the insurance companies dictate care.

Josh Simms 17:10
And then the back end of that problem is his primary care doc says, Well, you know, let’s see if we can get the test tomorrow, we’ll try to get an ultrasound in a couple days. And that person has like a perforated bowel, and then they become septic and die. Guess whose fault it is. It’s the doc who said, well, I’ve My hands are tied, I gotta wait a couple times. I don’t want to send them to the ER, every single time. And so and so then doctors have to practice defensively. They don’t get to be I guess you’d say offensive or just practice the way that they believe they should be able to with patients. Because then they get defensive, and they get scared because they’re gonna get litigated upon us and the

Aaron Tharp 17:47
apple. Yeah, he’s in a rock and a hard place. Yeah, he’s in between I need to care for this person. And I see that there’s an issue, but I can’t have the delay occur, because there could be some potential hazard here. And reliability. Yeah, you’re right.

Josh Simms 18:03
I mean, the amount that like for me, as a PA, I generally get covered under the organization’s insurance. But doctors have to carry their own liability. It’s, it’s, it’s outrageous how much they have to pay for insurance, outrageous, just to protect themselves.

Dr. Steven Lapke 18:18
So, you know, because of all that, I mean, that, again, just drove my passion more for you know, there’s got to be a better way. We have a lot of ways in medicine, we got to get back to basics. We have to do more prevention, which I don’t necessarily like that word Josh and I were talking about this morning. I think, Josh, what was the term you had a better term?

Josh Simms 18:40
I don’t know. I might, I don’t know. Proactive care offensive man. I don’t know how you would put it because Progressive House. Yeah. So I think that’s probably the best term because preventative sounds like we’re not actually being, we’re not trying to make you a healthier person. We’re just trying to protect you from getting sick. I think the connotation there gets a little goofy, because then preventative, still implies that we’re going to just do stuff to you, instead of allow you to help yourself by doing the right nutritional and exercise and so on and so forth.

Dr. Steven Lapke 19:09
It’s like, yeah, let’s take you beyond prevention. And let’s get you so healthy, that, you know, that you’re not going to, potentially or your risk is so low to succumb to this disease or that disease. And you’re living the best life that you can be. It’s not just about, you know, like, like said preventing disease, it’s really about getting you to the healthiest place you can be and I don’t care if it’s mentally, physically. And that’s really what healthcare should be about.

Josh Simms 19:40
Yeah, it is. People don’t like that term, whole person or holistic sounds. So I don’t know. It puts kind of a new age twist on it, but it when you look at it, it’s just it’s the whole person. So if we’re focusing on a whole person, we’re looking at their mental health, their nutritional status, and what limited They can have within that and how we can potentially help with that. their physical lifestyle, their overall living situation, right. So if we don’t take all those factors into account, we can’t generally manage a full patient to make them healthy and whole. So it’s a, it’s a really interesting dynamic and an issue that doctors are up against, that they can’t, you just don’t have the time or you don’t have the time you don’t have the resources. Because you’re so boxed in. Yeah.

Dr. Steven Lapke 20:31
I’ve read studies. Yeah, there’s enough concierge practices out there. And enough patients now that they’re able to gather enough data, but studies have shown that patients have concierge physicians, they have less disease, overall, less hospitalizations, better outcomes. Why do you think that is? Yeah, it’s, it’s more integrated down there getting those doctors known more intimately, more time to spend with them, right? more time to really not just prevent disease, but make, you know, very positive changes, get them to their best.

Aaron Tharp 21:12
Yeah, and before, before we started recording, you were talking about getting back to the basics, you know, with nutrition and fitness, and he covered a little bit be more more comprehensive, being whole, you know, what are some other things that that are involved? I mean, cuz, you know, preventative medicine or preventative care, I guess, in some sense could be, can be pretty broad. Right. And, and that’s, that’s good, because it’s not so transactional, and just, you know, dealing with you, and then on to the next one, right. So, what are some? What are some other areas that that come up or that are important?

Dr. Steven Lapke 21:50
Well, I, I really believe you nutrition and exercise or activity are really at the core of keeping us at our healthiest. I mean, you think about it, you know, if we have a high performance vehicle, we’re not going to put you know, poor quality feel in that system, oil or gasoline, right? We’re going to we’re going to spend the money, we’re going to put the highest quality, are things going to get gummed up and not work properly. And it amazes me in our society, how little of emphasis there is on I mean, I can say from nutritional standpoint, like in my medical training, I got next to nothing.

Aaron Tharp 22:34
I hear I hear that a lot. Actually, Josh? Yeah, that you

Josh Simms 22:38
would say the same? No, it’s a it’s a pretty low yield. I mean, I think we did maybe an afternoon on nutrition, and it was mostly in patient nutrition than it was actual, like, lifestyle. And I think the frustrating thing about that is is the society that we live in now is so obsessed with credentials. And if you say one thing that’s maybe not, that was true a year ago, but isn’t now you’re considered you’re obsolete, or you’re not credible. And so people are like, well, I go to a dietitian, and it’s like, well, I mean, that’s great. But like, I could spend a lot of time and teach you about nutrition on how to like, how to eat healthy. That regular intervals, intervals that work for your body, because that’s all not just one size fits all, not a high carb diet, when we talked about this man in our diet episode, refer back to that if you’d like to know more of how we feel about that. But there’s a reason why there’s 25 different diets out there. And there is a little bit of trial and error in that and I think people just need to know that like, okay, you don’t have to stick with this. This this. What if you feel like if you’re bloated, and you feel tired, and you feel foggy doing this diet? Well, it’s probably the food that you’re putting into your body. Like you said, You don’t understand that people have a tolerance to feel that way, right. But if they’re told by a dietician for 115 minute consultation, and I’m not trashing dieticians, I think they’re great. I think they need more time with people to write, they need more access and more time to be able to adjust people’s diets. And they’re a great part of an interdisciplinary team. But it’s, it’s it gets really frustrating when we can’t again, use that part of it. And it’s got to be so quick. And everybody wants a quick fix. And we fall into that habit.

Aaron Tharp 24:18
Yeah, if you’re going into if you’re going into people’s homes, you mentioned it, and that’s what you were talking about before you’re going into people’s homes, how they live, it affects their mental health. Obviously, that gives you an opportunity to see what their diet is like, what conditions that they’re living in. That’s a completely different experience. Patient doctor wise, then then is okay, I’m in here for a few minutes. And I know I got patients that are lined up out the door. So yeah, just watch your cholesterol. Yeah, it’s like that’s a very that’s a very narrow,

Josh Simms 24:46
I mean, it’s a totally different watch would eat because I hear that all the time in clinic. I’m watching my eat. I mean, I was like, shoveling into my mouth. Watch all the food that goes into my mouth or just

Dr. Steven Lapke 24:55
statements like we just need to eat healthier. What does that mean? Exactly? I’m sorry. I don’t have the time. To go over that with you, that’s hard. That’s our broken medical system. So when Brooke and I started our concierge practice, it was a priority for me. And I did a lot of research and a lot of interviewing and found a nutritionist that I felt had probably the healthiest approach to eating in nutrition that I’d found. And she was in our office and seeing patients, I recruited a strength coach who came in to the bay next to me and put up his own gym, and is working with adults and is very much into, you know, adult health and very knowledgeable in that aspect. You know, we are made to move as human beings were made to be active, and and we’re made to eat healthy, not eat a lot of the jump those and I’ve heard that.

Aaron Tharp 26:03
Right. And in, in our episode, we talked about that, that being unique to you. And that would be unique to me and unique to him. And you know, it’s not buying a box or fits in a box, right?

Josh Simms 26:15
Yep. I think the hard part about the diet portion, too, is that like what you said we’re made to eat healthy and made to move is that our evolutionary, evolutionary mind is, is in a mode of like, I need to consume, right? Our brain is designed to do that to say, food could be scarce for the next two weeks, so I’m going to load up. But then it’s like, I don’t want this to sound bad. But like the our access to food at any time is almost a bad thing. Well, probably is a bad thing. I shouldn’t be nervous about saying that. Because we shouldn’t have access to 1500 calorie meals three times a day, because our bodies just do not need that much food. Right? Unless you are like, I mean, even like it guess what we’re talking about just a base need, right? Olympic athletes need more calories, but like, you don’t really need that stuff. I mean, like, we don’t need that to live in to get by and to survive and be healthy. But I think the access and the ease of access to food to be able to drive through somewhere and get as many sugary calories as you can handle. It has caused a pretty big detriment to our society, and the fact that we just work jobs that we are encouraged to basically not move for eight to 10 hours a day.

Aaron Tharp 27:21
Yeah, fundamentally, it’s we’re wired, feast or famine. Yep, absolutely. Yes.

Josh Simms 27:26
Yeah, we have access to feast almost all the time right now.

Aaron Tharp 27:29
Yeah.

Dr. Steven Lapke 27:31
That’s crazy. But a on our current medical model. I know, keep going back to it. But we do not have the time to educate in that capacity. Yeah, that’s incredibly unfortunate. And you’re seeing the outcomes of it. It’s no coincidence that we have a epidemic of obesity in our country.

Josh Simms 27:53
And the time that and then when it comes to time, right. So the the issue of obesity leads to cardiovascular problems and diabetes and metabolic syndromes, which then lead to orthopedic issues. And like, right, it’s just kind of, it’s just this devolving problem, right. And it’s the same, it’s the same issue, like in a workplace as in like, you know, 10% of the people cause 90% of the problems at work. And same thing, 10% of our patients suck up 90% of our time. So if I have to see a patient who is, again, who is obese, with diabetes, who’s in heart failure, who’s who’s depressed because they are in that situation. So I’ve got 10 different things. I’ve got to spend time with this person. Aaron’s waiting for an hour and a half in the waiting room. He’s a young healthy guy who exercises who’s just here for his annual visit. But maybe he’s got a little bit of depression that he’s been dealing with. Or maybe he’s feeling really anxious, and he’s can’t really fight through it just through what he’s doing. And they come and talk to me here and Is everything going well, I got to go back to work in time as everything’s good, Doc, I’m getting my blood drawn blood pressures. Good. I’ll see you later. And so then again, that’s part of your holistic care that I completely whiffed on just because I didn’t have time to do it, or you didn’t think I had time or you had to be someplace else. Because the lack of ability to manage patients ahead of time again, the progress of medicine to prevent that patient from doing it sucks up so much time, energy and money, but it doesn’t allow for the people who, who kind of have these hidden issues that aren’t really at the forefront of mental health and other things which can devolve and lead to bigger issues down the road.

Aaron Tharp 29:22
And at a certain point, so you opened up that concierge practice in 2019. And at a certain point, I mean, that was that was very important to you that that was how things were structured, and it’s because it’s about the patient and doctor relationship, which of course, that’s the right way to go. I think we all agree on that one. But there was something that really aligned you with with Limitless Male and what they do with their patients. I’m presently a patient and I have been for a year and a half. I can attest to that. Personally, my brother would say the same thing. Josh sees a ton of patients. So it seems like this is his A real marriage of, you know, fundamental mission, right about helping men and getting them on the right path and doing it in a number of ways, because there’s a real care around that. And there’s time spent around them. So what does it mean to you to be here? And what are you most excited about, about what this clinic and Limitless Male is doing for, for men?

Dr. Steven Lapke 30:24
Well, when Dan Malloy first approached me, I was at my practice. And as I learned more, you know, what linen was smell was about, I did see, began to see a lot of similarities in the fact that their focus, our focus, now that I’m medical director, is on is on health, and not just prevention. It’s definitely on making men be all they can be, um, you know, we’re at our best. You know, we’re in our 20s 30s. And that’s, the reason for that is everything’s normally functioning quite well. And one of those most important things is our testosterone levels are at their highest. Although we’re seeing more and more gentlemen, in their late 20s, and early 30s, have very low levels. And again, I think that goes back to our society or eating or environment, etc. But they have a real passion for treating men and helping them to be at their best, you know, testosterone therapy, I call it a foundational hormone. It is what makes men men. And when it’s not, at its proper level, we start to have a breakdown of our system, then we get advanced aging, and a multitude of other problems. And, I mean, that whole philosophy certainly aligned with my philosophy of medicine, and how can you most impact people in the best way possible. And I felt that that’s what they were doing and doing it extremely well. And so to me, it seemed like just a natural progression for me of my medical career next step, and how I can impact the most people.

Aaron Tharp 32:29
One of the things that, that I know, this, this line of work is always up against is sort of the stigma around the business itself, which is that you know, okay, you see something like a commercial or, or an ad about, you know, male hormones and testosterone, almost instantly, there’s this knee jerk reaction, or there’s this perception that it’s a negative connotation, or that it’s, I don’t know, egotistical or maniacal or, or the the big guy at the gym. And it is so fundamentally flawed. Because just as you said, you know, when at a base level, the hormones are off, there’s a multitude of issues. You know, you’re gonna know, you guys would know better than I am. But you know, what, depression, lack of energy, lack of sexual performance, lack of sexual interest, your relationships, decline, your work, performance declines, these are things that we cannot afford to have happen, especially when we have families that are looking to us, or people that are looking to us to be relied upon, because we need to be outgoing and achieving your an entrepreneurial spirit guy. You know, obviously, this is probably something that was you were destined to find. So as you kind of like, look forward, and you know, the the clinics continue to open up, what excites you most about being able to help men. When,

Dr. Steven Lapke 34:05
you know, I’ve only been with linerless for three months. I mean, Josh could speak to this much better than I could. But I have been astounded at the number of men that I’ve seen already that come in, and I always ask them, How long have you been on therapy? And what do you feel that’s done for you? And I have heard some of the most inspiring stories I’ve heard in all of my medical career. Wow. And I graduated medical school in 95. We’re talking about I’ve had guys say it’s saved their life because they were having health issues. I’ve heard them say it has saved them financially because they were struggling so severely in their jobs and getting through the day. They felt like they could hardly function. I’ve had men tell me it saved their marriage. I have heard the most amazing story last week, 71 year old farmer from Iowa, who comes in to Josh his clinic every week. And he has been on testosterone therapy at least for a few years. He continues to farm full time. Plus he runs of other companies.

Josh Simms 35:23
And because of trucking business, I mean,

Dr. Steven Lapke 35:26
yeah. And he said, I am more in love with my wife today than I was when we were dating. And we have a more intimate and stronger relationship than we ever had. And I know, none of that would have been possible. Um, like you said, I know testosterone has gotten a bad rap. Because for years, obviously, it was a product that was black market, it was abuse. I mean, if you abuse anything, if you abuse Tylenol, you’ll go into liver failure and die.

Josh Simms 36:00
It’s better to go to, and, yeah,

Aaron Tharp 36:03
you know, that person?

Josh Simms 36:04
I’ve seen it. I’ve seen it. But

Dr. Steven Lapke 36:07
what, what’s so frustrating, you know, there’s been, obviously an emphasis on women’s health for decades, what sir should be, and on menopause and hormones and the effect of them and the benefits of, but for a long time, Men’s Health, it was like, let’s just wait, that’s just aging, it was getting old. But it came out of high costs our society, and it still does. Because when, as you were saying, When our testosterone levels are low, the effects are profound, and from psychologically to physiologically, and it does it affects jobs affects productivity, it affects relationships of ex marriages, it affects families. And, you know, that’s a core of what makes us who we are and our country. And that’s how much emphasis and how important I think what we’re doing is

Aaron Tharp 37:06
the the the introduction for, or I guess the, the attention to the female hormones. I mean, they get introduced to, you know, sort of Doctor care, or I mean, much earlier probably in their teens, right? Absolutely. Yeah. So it’s much earlier where guys were like, okay, you know, unless it’s broke, or fallen off, or unless I’m bleeding or leaking somewhere, then maybe I’ll go and check out but other than that, I’m good. Well, that’s not super preventative, let’s say. And it’s also not really looking at maybe what may be boiling underneath the surface, because these things decline slowly over time. So

Josh Simms 37:49
sometimes rapidly, because we’re seeing younger guys come in with their own right. So it’s like, I think that was that was the thought. And I think kind of what our practices are allowed us to do is a little bit of a thought experiment, because we’ll have guys of all ages come in, and we’re not going to treat somebody who doesn’t need it. But I mean, you’ll see guys were 2728, and they’ll come in their testosterone is low. And we kind of investigate why, like, what are you doing is just something that you’re doing, they shouldn’t be so on and so forth. But and they’re like, Dude, it’s been like, a year, year and a half, like, everything was great, like last summer, or like, last Christmas, and it’s, and now I just, I’m tired all the time, miserable, it’s affecting all the things that we’ve kind of been talking about, I would really be interested to like, pull, pull that data, if we could, that would be a nightmare, and actually really kind of get an actual good range of normal testosterone levels and, and to see kind of, because I don’t necessarily know, because at first we were kind of taught, it was like about 40, things start to slow down. And now it’s more like, we know that it’s 30. But is that really true? Is it more like 25? You know, the societal pressures are much different now than they were even 30 years ago, on young people specifically? And how that how is that affecting our hormones? Remember, the production center is the brain or the the signal center is the brain. And so if we’re constantly under high stress and anxiety, or depression, or substance abuse because of those things, how is that affecting our hormones? So I think there’s kind of a dual approach that we can take when you’re talking about like, we see young girls, right, because they start their period when they’re young, right? And then they have it until they don’t, once they run out of eggs, and they go through menopause and they’re miserable. And then we kind of treat as we can from there. So there’s this kind of a lifelong theme that they’ve got to deal with guys is kind of like great, we got here my balls and then we’re gonna go go go and then my hair’s gonna swap my head and then I just keep getting fat, right? We’re just a little more I mean, we’re quite a bit more simple to the core, from our physiological standpoint as as men, but what can we do to stave off load has dosterone and hopefully get it back. Because I just think the generations before us are built a little different different challenges, different expectations. And I think just, it’s a really interesting kind of a wonder, really, if we could kind of figure that out if it’s much younger than we thought it was, and how we can, again, use our progressive medicine to prevent that, and then treat it when we need to.

Aaron Tharp 40:21
So beyond beyond the stigma that I mentioned, or the mountain, I guess that that business like this faces, you’re also faced with the admission of it. Right? So that that would be like, okay, yes, I, I’m going to admit that I have a problem. So I have to lay down my pride and, and go and admit that. So if you had a chance to, you know, to speak to a younger generation, about the importance of this, what would you tell them?

Dr. Steven Lapke 40:55
Number one, in regards to that? Yeah, there’s always been this kind of, it was taboo to talk about, you know, says hesitancy course, part of that has to do with us being men and our egos and our pride, right. Um, I do think I know, like, over my medical career, it has gotten significantly better because of the education that is out there. Now we have a long ways to go. Don’t get me wrong, but it has, it’s far better than what it used to be. And it’s, it’s more acceptable to talk about it. And there’s more advertisement about it and more education. That’s a great thing. But it’s like anything and health. As you were saying, absolutely. It’s very important to identify it at a younger age, because we don’t know for sure it was Josh was saying, When do you really start to decline, right. And it’s like anything else, you know, blood pressure disease, if you don’t catch it early on, it’s just kind of creeping up creeping up creeping up over years and decades. By the time you catch it, you’ve already got so much damage from it, or diabetes. Same with testosterone, as our levels are going down, then that’s causing advanced aging, advanced inflammation, advanced breaking down of certain systems, we lose, you don’t know how many years of productivity you lose, how that affects you financially, the quality of your relationships, I think it’s critically important to find out where your levels at when when you’re younger, I’ve told my sons and son in laws, who are in their early 20s, you know, like, go get a baseline, you know, you feel like you’re at your best, let’s get a baseline, see where you’re at. And so you have something to gauge it on. And then every few years after that, or you know, as symptoms arise, I think it’s just important to monitor testosterone levels as it is your lipid levels.

Aaron Tharp 43:06
Yeah, and the younger generation is going to be more prone to Oh, this guy at the gym so that he could get me this or I know, I can get these pills at GNC. But that that’s assuming that you know what the baseline is, and you don’t, you don’t, if you don’t know, what you have is there’s there’s a there’s an optimum level, or there’s a level that you should be at, or that is that you should hope to attain to be on a fairly regular basis, or that’s what you would be striving for, I guess. But if you don’t have any sense of that, you’re it’s a it’s a moving target. So you could be taking way too much. You could be taking some things that have adverse side effects that are not approved in any way or administered safely. So the baseline is huge. It is.

Josh Simms 43:49
Yeah. And I would ask you like what, what do you think prevents primary care, doctors from doing those types of things and monitoring? testosterone levels? Because it’s a, it’s a dirt cheap pass? It’s like three bucks, three or four bucks. It’s not like it’s an expensive, you don’t want to talk about it? Well,

Dr. Steven Lapke 44:07
number one, it’s just a lack of education, lack of lack of knowledge, I mean,

Josh Simms 44:15
and not by any fault of their own. So I mean, it’s our medical says, I mean, think about when you went through training, how much education or emphasis was put on that we just learned the pathway with all the enzymes in the pictures in the chemical and the nightmare of trying to regurgitate that that was about it.

Dr. Steven Lapke 44:34
And I as well, I mean, there was just no emphasis put on, you don’t know what you don’t know. And I think it starts there with like I said, education is improve, but it has a long ways to go. And that starts with the medical community, not just even the general public. Yep. And then I think also stigma. You still see and hear physicians out there. I have patients tell me all the time I went to Dr. So and so you know whether it’s our primary care specialist, and they’re like, oh, you’re you’re on testosterone therapy. I wouldn’t be doing that. Yeah. dangerous. And I’m like, Did they tell you how they thought it was dangerous? Nope. They just said it was. Yeah,

Josh Simms 45:17
yeah. And because all your patients are well, my doctor says bad for my heart, or it’s can cause cancer. I’m like, okay, that’s a that’s a statement. Now prove it to me, right? We live in work and in an evidence based medicine society, right? If you make statements like that, without the ability to back it up, then you’re the fringe one, right? If you can’t bring because if somebody because that’s the things or if somebody brought me like a bunch of papers that said, like, Yeah, man, you’re putting your patients at higher risk for coronary artery disease, and cardiovascular events, and strokes. And in prostate cancer, like, first of all, when the FDA is allowing me to do this, that would be the first thing I would ask them. The second thing I would have to do is introspectively, ask myself if I’m going to continue to do that to people, right. So like, there is not really any good evidence that shows that those statements are at all true. Right? Now, there is some anecdotal stuff that says that, but let’s kind of dissect that really quick. So you look at old school body builders, a lot of those guys started dying because they were having heart attacks, right. And they do these autopsies and advanced cardiovascular disease and like an enlarged heart. Okay. So even with that, now, anybody who is worth their salt in dissecting data or anything like that, what else were they on? What dose were they taking? Was anybody monitoring that? How was their diet when they were on the treatments? Right? Because you know, a lot of these guys eat pounds of red meat and high carb diets when they’re trying to, they look great for about four days, and then go find them when they’re in their offseason. It just they look like a really big dude. Right? So if people don’t, I mean, that’s the problem when you just don’t want to peel back the second or third layer of that onion. And then oh, I guess that kind of makes sense? Well, yeah. And guess what, we’re not doing any of that. Right? We keep guys on one agent, right. And we give some stuff to prevent other side effects that help. We monitor their labs every single month. And we make sure that they’re squared away with their Doc, and they know about it. And if there’s anything that comes up, you’re done, go see your doc come back when they think it’s safe for you to get back on treatment, if there’s any other issues that arise. So it’s, that’s the other thing that needs to be done our due diligence as providers to make our patients feel comfortable that we’re looking at from end to loop their primary care doctor, or if they’ve had history of heart attack, or cancer to loop those people into it also, so that they are aware of what they’re doing. And then we get pulled in as part of an interdisciplinary team. Right. Right. So as to do the whole, exactly. The whole patient care?

Aaron Tharp 47:36
I would be, I would be willing to bet that that, that men come in and they’re on they’re on five or six, seven medications. Maybe that’s a little far north.

Dr. Steven Lapke 47:48
No, I mean, certainly there’s, there’s a number not far off. There’s a number of those out there. Right. And, you know, the older they are the more comorbidities absolutely, they can easily be on that menu.

Josh Simms 47:59
I mean, it’s also talk about a lot of the patients that we see, don’t go to primary care doctors, but they want to come and see us. So there’s that’s another window of opportunity for us as providers to do stuff to take care of them to help.

Aaron Tharp 48:12
So they’re there on basically what they’re getting meds for those seven, eight meds aren’t those like beep? Could they potentially be treating just a side effect of having an imbalanced hormonal? experience? Meaning, are we not D is not being treated at the at the base layer.

Dr. Steven Lapke 48:33
Now, now, I’m not going to go on record and say, Hey, come and get on testosterone, and you’re going to get off all your furniture. I’m not Yeah, that’s odd. But it does go back to if we are more aggressive early on, and in managing people more appropriately, the majority of the common diseases that that your most costly and hidden cause the most disability and death can be prevented, which is your diabetes, your vascular disease, etc. So and if testosterone is what it takes to keep your healthiest keep you active, keep you productive. There’s going to be benefits of that. I’ve read two studies lately. One looked at a large population of men, for men who had normal testosterone levels versus those who had low significantly increased risk for for all causes of mortality for the men who had low testosterone levels, all all cause. Well, that was in that was in the journal American Journal. And yeah,

Josh Simms 49:51
let’s make one by the way.

Aaron Tharp 49:53
That’s that’s what they do. Right? That’s COVID Of course, you know, big issue.

Josh Simms 49:58
This is a really interesting yeah. I’ve read the study,

Dr. Steven Lapke 50:01
the recent study, they looked again, at man, those who did well with COVID. me they stayed out of the hospital didn’t have any long term effects, versus hospital wise placed on a ventilator who had deaths from COVID. Again, a statistically significant difference. The men who had low testosterone had a much higher risk for hospitalization, ventilation and death from COVID versus those who had testosterone levels. It is a foundational hormone. And that affects us at the cellular level. When you talk about the weak, frail, crabby old man, and they have low testosterone, weak and frail, were susceptible to diseases, and disability and death.

Josh Simms 50:51
Yeah, and I think one interesting thing that I always kind of bring up to patients when I’m when I’m helping them out, and we’re talking and treating and talking about what we’re doing, why we’re doing it, if you look at, if you take a side by side comparison of low testosterone symptoms, to depression symptoms, they’re almost the inexact mirror, they’re almost the exact same thing, there’s, in fact, there might be pretty darn close, lack of energy, lack of interest, and things that you use to find joy in, you’re not sleeping well, or you’re sleeping too much or not enough, you’re irritable, you are depressed, right more days, often than not. I mean, that’s, we see patients like that all the time, right? Every single day, we see patients who come with those exact same complaints. And we’ll see patients who are on antidepressants with the exact same complaints, right? And so I’ll tell guys, like, hey, like, we’ll start the testosterone, we’ll see how you do and then go from there, right? Guys who aren’t on antidepressants would come up with that, I tell them, hey, this, this could potentially perhaps have a depression aspect to it, right? You’ve been feeling like this for the last four years, someplace, you’re going to get into deep dark hole, we’re going to start the testosterone. Now, if things aren’t getting better, or we’re getting marginal gains, right? Then we’ll talk about do we need to maybe add an antidepressant I’ve done that for a few guys, and it takes them over the top, you fix that you fix the hormonal imbalance, when you fix the brain chemical imbalance, and guys get significantly better. There’s a place for all that stuff, right? I just think that the hormones are the first place to look rather than starting as on something that’s going to

Aaron Tharp 52:19
tinker with the brain. Right? That was my point about, are we digging at the fundamental or the foundational level? Are we just kind of like, you know, popping balloons that are basically side effects of what’s actually happened? Yeah,

Josh Simms 52:30
right. And it’s so easy to treat, right? Like, usually in that old model. Yeah, by the way, oh, yeah. But you start guys on testosterone in within, let’s say, like three weeks are feeling significantly better. That’s not everybody. But that’s a significant part. But sometimes you start putting patients on antidepressants. And that doesn’t work, because a bad side effects, you guys switching to another one, and then that one didn’t work. And then we got to add a second drug because we’re not kind of like, it gets into this. Okay, we’ve been at this for six months, we haven’t looked at people’s hormones, right hormone is a base level thing we should be checking, like you said, that’s a part of our body, it’s part of our physiology. I can measure serotonin levels, I can’t measure how well they’re being taken into neurons and, and the effect on that, and I can really do functional MRIs and spend 1000s, and 1000s and 1000s of dollars when I can do a $4 test. Holy crap, man, your testosterone was 180 Oh, my goodness, well, maybe we should do something about the holy Doc, I feel so much better. Can I get out because I’ve had guys get off antidepressants and all that stuff, because we fixed I mean, any imbalance in our body causes us to go haywire. And I don’t think people will appreciate that really, until I feel it. So

Dr. Steven Lapke 53:35
there’s I don’t know what you think, Josh, but exactly where you’re talking about the psychological component and mood and their improvement in their life. enough emphasis is not put on quality of life. In our country, and particularly in medicine. Yeah. Yeah, it’s, it’s like, it’s easy to poopoo that, well, that’s just subjective. But I’m telling you, we have patient after patient after patient after patient who comes in and tells us how profoundly this has affected the quality of their life. There has to be evaluated.

Josh Simms 54:13
If you can’t just sit in it. I mean, like, you see patients who are old and frail, in the hospital, who are 83 it’s like, great, you take your coverage. But like, how you doing like, you’ve been like this for the last seven years. Is that worth? Like? Is that worth it? And I guess like if you had a candid conversation with some of the people they probably tell you, no, but our guy who’s 71 who’s out there still planting and harvesting and he’s he’s weaning, he tells me I got wheat calves today. I got to get in and get out of there fast man, and it’s just like the greatest thing ever. I’m like, Man, I wish I hope I’m I’m hope I’m you and I’m 71 if I could do right now he’s a machine he I mean those just again, I think it’s just he probably lost a little bit of that. And we got to back for him. I mean, that’s I mean, me cuz he’s out there with this Son, and his grandson. Right on the family farm. And he’s still kicking 71 not just like, I’m just kidding. He’s working with those guys. He’s living. Yeah, yeah. I mean, that’s a great. I don’t know,

Dr. Steven Lapke 55:13
I just existing. Yeah, that’s a quality of life.

Josh Simms 55:15
He’s 71 years old farming and the middle of the country in Iowa. 20. I mean, that’s, that’s a great, that’s awesome. I love hearing that stuff.

Aaron Tharp 55:25
I think we’ve only scratched the surface here, Dr. Lapke. And obviously, we’re gonna have you back on. We really appreciate you coming on today. There’s no reason to suffer in silence. Men, just just grab it by the horns, like, lay down the pride, go get a baseline, go check it out. There’s nothing wrong with it. There’s actually millions of people that have the same issue. And you would be better if you were in the camp that would just deal with it. There’s no reason to suffer in silence at all. So I’m deeply grateful as a patient of this place to what you guys do and what you what really brought you here, which is the patient and doctor experience. So thank you so much for your time, I hope. I hope you’ll be back we’re gonna have you back on definitely. appreciate you having me. Yeah, absolutely. Well, that’s gonna do it fellas. But thanks for listening and we’ll catch you next time. Cheers. Hey guys, thanks again for joining us another episode here at Men Explained podcast. If you’re watching this on YouTube, go ahead and hit that subscribe button also the bell icon as well so you can be notified when we push out new videos. If you have any questions, comments or concerns go ahead and drop them at hosts that’s plural h o s t s at Men Explained podcast calm or just visit our website Men Explained podcast calm thanks again.