Josh and Aaron talk about their professional and patient experiences with testosterone, dissect important medical terminology, and how hormones work in the body.
Josh works at Limitless Male Medical Clinic where he sees patients every day and understands their struggle with having Low T. He discusses common questions about how Testosterone Replacement Therapy works along with the benefits and side effects men can have.
If you believe that you could have symptoms of low testosterone, take the quiz today to find out if you could benefit from testosterone replacement therapy.
- Introduction to Men Explained
- Testosterone & Low Testosterone
- Hormones as we Age
- Symptoms & Signs of Low T
- Real life experience of being on Testosterone Replacement Therapy
- Side Affects & Misconceptions
- Myths and Stigmas
- What are Testosterone Levels
Aaron Tharp 0:00
The information provided in this episode is provided for informational purposes only, and is not intended to replace professional medical advice. If you have questions regarding your health, please contact your medical provider.
All right, we are live. And welcome to the very first episode here at the Men Explained podcast. I’m Aaron Tharp.
Josh Simms 0:25
I’m Josh Simms.
Aaron Tharp 0:26
And we were coming together to, to make this really cool opportunity for men to join a community.
You know, as Josh and I kind of came together, and we’ll get into how that happened. What we both have noticed is that it’s there’s not a lot of resources and a lot of places for guys to go to get good answers.
I think we all have, you know, a lot of questions, whether that be about our health, about our relationships, about different supplements, you know, we’re going to try and cover a lot of that here.
But, you know, the whole idea is, is to build a community, build a tribe, a band of brothers, and do it in a way that’s fun and engaging, and so that you get something out of it.
But I kind of want to, you know, know a little bit from you, Josh, tell us a little bit about you. And, and what brought you to Men Explained.
Josh Simms 1:19
Yeah, so, again, my name is Josh, Josh Simms, I, I’m a physician assistant by trade, but I think you and I, you know, we kind of sat down and had drinks one night, and kind of talked about how you had your own podcast, and you’re doing things, you know, for men stuff, lifestyle, fashion, datings, on so forth. And,
I think there was a desire to kind of branch that out and kind of bring somebody into that fold and make something a little more universal for guys. And I and I’m a big believer in, in that same, that same sentiment of community and a tribe. And I think that’s how people are successful. And there’s a few people who can do stuff by themselves. But like, Man, it’s science. It’s just, it’s hard. Sometimes you just live life on your own as a guy, and there’s a lot of expectations for men. You know, it’s always, there’s always that that myth of toxic masculinity and people, men aren’t toxic until you need them. You know, right. Otherwise, if you’re, if you’re doing your thing, if you go to the gym, and you work out, you take care of yourself, when you stand up for what you believe in, you’re toxic, and, and but until somebody needs you, right, so I think we’re here to dispel that myth of toxic masculinity, provide a platform to discuss a lot of things and bring some cool guests and to talk about that we’re not the experts on everything. That’s not what that’s not what we’re here for
Aaron Tharp 2:33
Far from the experts. So make that clear, I’m speaking for myself, Josh, way more than I do.
Josh Simms 2:38
Yeah, on a few things. And we’ll get into that. So but-but I think it provides a good place to bring people into grow, you know, kind of by yourself on your own, and then and then kind of develop that and join in with other people who are part of that community. And I think that’s, that’s a powerful thing. I think, you know, society that the more good men we have in society, the better society is, people were willing to kind of stand up, plant their flag, and move forward with what they believe in and be unwavering in that and refuse to be canceled by people for something that they did in the past and admit your mistakes. But then also say, I’ve grown, I’ve learned I’ve changed, and this is what I do with my life instead of just kind of cowering in the darkness and going away. Right. So yeah, that’s, that’s kind of what we want to do want to change that stigma? from a lot of different angles,
Aaron Tharp 3:20
We’re expected to have answers, right? And it’s, it takes a little bit of vulnerability to ask, right to kind of show up and not have the answers. Right. So, you know, as he mentioned, this is, you know, a place for men to be able to do that. And to feel safe doing that, that there’s nothing wrong with asking for help or just being curious about some different things. So, what we thought we would do is start off from a health perspective. [Yep.] So your physician’s assistant,
Josh Simms 3:50
yeah. Physician Assistant. People get very sensitive about that.
Aaron Tharp 3:54
How did I-How did I fuck that up?
Josh Simms 3:55
Physician’s assistant. Okay, so just so in the physician assistant community that people get very upset if your birth is physician possessed by a physician, [okay], I say when do you get upset about that, if you want to I don’t care.
Aaron Tharp 4:08
I stand corrected physician
Josh Simms 4:10
Because the eight people who are going to listen to this are going to be very, like two of them are going to be like, PA’s.
Aaron Tharp 4:15
okay, No, we won’t start off on the right foot. No, that’s good to know [Oh, man]. So, you see this on a daily basis, you work with men every day? [Yep.] You know, and I obviously have a good bit of understanding and knowledge of my own and health. We have a lot of we have a number of different systems like main systems, right, your cardiovascular system, your digestive system, and and those things you know, as you age, they begin to decline. There’s some things that you see as you age. When it comes to our hormones, the endocrine system is really where that’s that’s the motor, right? [Yes, it is.] So why, if I’m a man, why is that important? Why is that important system For me to look after,
Josh Simms 5:01
Because as you know, as we age, this is all people. This isn’t just men, this is women too, as we age are, well, the endocrine system is kind of the giant feedback loop of mechanisms that control hormones and metabolic rates, and which then affects kind of how we look how we feel our mood, so on and so forth. And as we age, those things start to kind of wear out, right? It’s just like, like anything, I mean, we get old, we die eventually, but the systems start to slow down and break down as we age. And that causes lots of problems. You know, commonly, hormones are mostly thought of in the arena of women, because they have very sudden and severe changes in their hormones, and it causes lots of problems for him. So there’s been a lot of research and money put into that deservedly so right. I mean, no one should have to go through what women go through when they go through menopause. And then after that, it’s a it’s a bad deal for them. But for men, as we’ve kind of, we’ve progressed through that everybody else, as guys get older, we can again, wait, we sat on the couch, you know, get a little more cranky, and you know, just kind of go to sleep at nine o’clock, and you know, wake up at four, take a nap at two. And it’s just guys getting older. Right? And that was kind of the stigma behind that. But you know what I do with men with men’s health? Not I’m not a man of urologist. We don’t work at a urology clinic. That’s not what I do. I do more hormone replacement therapy, erectile dysfunction stuff. And when we started looking, we look more and more every single day at guys that their testosterone specifically, that’s the hormone that makes men, right. And we’re finding that it’s widely low and a lot of men, and it’s not just age, I mean, we’ll, we’ll see guys who are 3035, who their testosterone is low. And if they’ve not been on testosterone in the past, it’s just, that’s the way that their genetics function.
Aaron Tharp 6:39
What are what are some factors? Because we don’t we live in a very different time. Now then, you know, 1000s of years ago, you know, when it was probably more normal, because we were out hunter as hunters and gatherers, right? It’s feast or famine, live or die? So are there some environmental factors or like what, what can contribute to-to a lower or sub-sub optimal levels of testosterone?
Josh Simms 7:04
Yeah, that’s a good question. I think the number one thing I think the number one thing that you can always refer to back in anything when it comes to most of the problems is genetics, right? That’s probably the number one thing but there’s several environmental factors. Stress is probably the number one environmental factor we tend to live stressful lives were car jobs. not getting enough sleep is a big one poor diet, lack of exercise. those are those are probably the big ones substance abuse falls in there too much alcohol, smoking drug use, right? That really affects our hormones, too. But I would say like, high stress, lack of lack of sleep, lack of exercise and poor diet are kind of the main ones that a normal, healthy, adult male.
Aaron Tharp 7:44
We’re also a lot more sedentary I feel like then [big time], and that that equates to being you know, active or not. But [Yep], I just we’re more sedentary it’s more sitting in front of a desk or
Josh Simms 7:56
Your body doesn’t require you do not require your body to make as much testosterone [Right], right, when you just kind of pound away at a keyboard and you don’t really like your body has no reason to so it’s not going to waste energy making something it does not need. Right. It’s a very smart machine. Now we can improve that to a point right? I mean, some guys can diet and exercise and they can see their testosterone levels kind of come up a little bit but at a certain point you’re just you’re gonna run into a wall is right just cannot make more. Yeah, what you want it to.
Aaron Tharp 8:21
It’s exactly the case that it was for me. Yeah, I tried to sleep my way around it. Eat my way around it. Do sprints deadlifts, the pills a GNC. Maybe I’m not supposed to say GNC, but I guess I blew the can on that. You know, but yeah, have really done about everything I possibly could. And the reality was, is that it was just genetic predisposition, which is fine. It’s like that’s the reality so let’s just deal with it. Right? [Yep. Yep.] So, you know, I can speak from personal experience, but when when guys come in when they think that they may have subclinical levels, what are they experiencing what are they feeling? What are they going through on a day to day basis? That may trigger somebody that’s listening to Okay, maybe maybe I need to get my levels checked.
Josh Simms 9:06
Yeah, I think that’d be the number one thing is just day in day out fatigue right just tired from time to wake up tired of the time they go to bed and nap during the day on the weekends or they get 12 hours of sleep they’re still really tired. It might have a couple good hours here or there but for the most part they’re just exhausted Yeah. Less desire for sex which is pretty abnormal for men usually you know wives are saying we just get your hands off me you know, like enough’s enough but there is when we get a lot of guys who come in and their wives are like what’s going on like you don’t you know you’re not you’re not approaching it like the way you used to and so then that creates marriage problems cuz they think something else is going on or that I interested in them and it’s not the case. Weight Gain not sleeping very well. Those are kind of big ones to come mood changes a huge one right? People don’t think about it, but man when you’re tired, how do you feel? I mean, you want you want to get up and go out, hang out and do all this kind of fun stuff and be the guy and be chippy and have fun and now you’re miserable. You don’t want to do anything. So everything’s guys are great. Under mad and there are bad attitudes and stuff and we’ll start guys on therapy and within the first couple weeks that’s one of the first things I noticed. Like you know, my wife tells me that I’m a lot nicer now it’s like well yeah, man cuz you’re not just wiped out and exhausted all the time. You got a little more in the tank and you know, everybody feels better when they’re not exhausted and tired and
Aaron Tharp 10:15
Yeah, I would say the two the two biggest ones for me were fatigue. Like gap ago the gym at 1030 I’m like, I don’t know how the fuck to have brain fog. Yeah, 10 3036 years old. How, like, there’s I’m eating right, because this happened. And was really pretty irritable. Yep. Not short fuse. Were get, you know, start hitting things. And you know, like road rage, but just very irritable. Yeah. Why is this such a big deal? But dumb stuff? Yeah, real pissy?
Josh Simms 10:43
Yeah. And that’s the interesting thing, right? That’s one of the stigmas of testosterone replacement therapy is the roid rage when these guys roll bla bla bla, right. That’s it’s the complete opposite, right? We start guys on training. Tell me your story about that. Like, how did you how did that change for you when you started trying to give your personal testimony?
Aaron Tharp 10:58
Yeah. So again, I had I’ll be totally honest, I fought against it for a long time. You know, probably my own pride gotten away. My ego. My pride was like, I got it. I don’t need to do it [We’re really good at that.] Yes. Yeah. Really good at that. Number one, I was just like, I’m not gonna let the guard down. [Yeah.] And the reality is, is that I was in my own way. And when everything else didn’t work, I thought, okay, what’s the worst I could do? My brother who’s four years younger than me actually went in? had his levels tracked, Oh, okay. He was, he was sub, he was sub optimal. Okay. And so I’m like, Okay, well, I went in a week later, I was too. Hmm. Now, when I started, I could tell physically, you know, my workouts are better. My reserves were better. My mood did improve, but the energy and the sustained that that come took a little bit longer. I’ve been on TRT now for I think, almost a year almost a full year. Okay. And I would say that from six months on the bigger benefits came from like the psychological side. Okay, so like my mental state, like I wasn’t, I wasn’t having those like, you know, ups and downs. I wasn’t crabby irritable. I mean, yeah, of course I am, but not to the extent so much more calm. copacetic. And for longer periods of time. I didn’t have you know, that up ups and downs. Outlook was a lot more positive. I was a lot calmer, too. That’s, that’s been my experience. Yep. On the psychological side, which, you know, if we can get a hold of our emotions as men, that’s, that’s really everything.
Josh Simms 12:44
Yeah, yeah, I think it’s huge. I think it allows, I mean, your hormones, I mean, if they’re not off, it’s everything gets thrown out of whack people will have really weird symptoms. It doesn’t. I mean, for guys, a lot of the time, it manifests as this kind of fatigue and irritability, and so on, so forth, right? But sometimes people they’re out on like, night sweats, and they’re, they’re gaining weight and losing weight at weird times, right? It’s, I mean, it’s like, it’s a really awkward situation, when you got to normalize things. It’s amazing how your body responds to it. And, and then kind of the psychological aspects can follow. Right? Because you were just feeling you’re feeling right. Physically, you were feeling right. And then you’re like, Okay, I have more confidence in my ability to go exercise and more confidence in my day to day work, because I my brain is functioning, firing on all cylinders, my energy is really good. And it can take some time to for that confidence to pick up and then all that stuff kind of can clear up afterwards, right? It’s not like instant change. Some guys expect that. And I’m like, Well, you know what, that’s not going to happen. So I mean, some guys will start my treatment and come back two weeks later, I’m a completely new man. I’m always like, take it easy, right? But then a lot of them do sustain that, but that’s not everybody. Again, just how your body processes, the medications and how it takes time sometimes for the body to respond to that. But it’s an interesting journey for everybody. Everybody’s pre tty unique when it comes to that. And it’s, it’s I mean, it’s good stuff, though.
Aaron Tharp 13:59
Yeah, they’re kind of hard to track because they can fluctuate
Josh Simms 14:02
throughout the day even Oh, yeah. Right. Like if you’re on if you’re on treatment, and you get a bad night’s sleep, or you tie one on. I mean, it’s not you’re gonna wake up and feel good. You know, it’s like, you still got to take care of yourself. You still have to do your part. It’s not a magic pill. It’s not a magic shot. That’s not the way it works, right. You still got to get yourself right. You can’t be sit at your desk all day long eating Twinkies and Burger King and like, Oh, I’m gonna start testosterone. I’m gonna be a new man.
Aaron Tharp 14:25
Oh, come on, man. [Yeah], look, come some Twinkies come over.
Josh Simms 14:29
And honestly, you can have them right. I’m just saying don’t come to me and tell me not to change. Yeah, no, I’ll give it to you straight.
Aaron Tharp 14:34
That’s absolutely right. You know? Yeah, no, that’s fair. And that’s it’s not what we want to hear but it’s the reality Yeah, right. It’s not a quick fix. It’s not just a pump and dump it’s it’s really not No. There are other factors that go into it that are that are contributing factors and that are direct result of diet and exercise and and lifestyle. So the I mean, if you if I, if I went out and I asked 10 people about getting testosterone, what are the myths, the stigmas? What’s out there?
Josh Simms 15:13
You know, it’s a it’s a good question. I think I think if you ask people in like a younger generation, like, you know, we’re bending your Verbal 37. Right. So we’re still relatively young guys. But the age that we grew up in, and the guys older than us, I mean, it was only related to kind of few things, right? bodybuilders and athletes like baseball players, like barry bonds and stuff and all those guys. And so there’s this cheating mentality behind it, there’s this meat meathead mentality behind it that that the whole that’s only for certain people like guys who want to get ripped big or guys who are athletes or guys who are cheaters are scumbags. And you’re gonna get all these other things. Like it’s an illicit drug, right? Like it’s taken, like meth or something like that. I think there’s, there’s stigma in that now younger people, their former open doors, I’ve just because they’re younger, and they’re a little it’s not, that wasn’t part of their life when they were growing up, right. So I think, you know, the big stigmas, obviously, that I get asked, When I start guys on it, they’re like, Well, you know, obviously, it’s the word rage thing. And I’m like, now you’re gonna have the exact opposite, right? Like, and, you know, the thing that I always I always circle back to guys on is like, we couldn’t do this on the scale, we do it if it caused all these problems, right? You know? And so that’s one of the things there’s, there’s questions about heart health and those types of deals. And I’m like, if I gave you something I was gonna give you a heart attack, you think the government would let me do that? You think I still have a job? Right? No. And actually, we see the opposite. And guys with low testosterone, we see an increased risk of diabetes increases heart disease, because your body doesn’t have the-the metabolic support from the testosterone to kind of burn off the sugars to support your muscles to to use those things as fuels, they just get stored. And then things go go sideways. And that happens.
Aaron Tharp 16:45
Your heart’s a muscle [100%] So if it does, well, if there’s if, if there’s information to support the fact that it is good for muscles, because even in the myths that says that that’s the case, your heart’s a muscle.
Josh Simms 16:57
Yep. And it’s not skeletal muscle, like it is like your biceps or your quads, right? So it’s not gonna, and that’s, and that’s a good thing that you bring up, right? Because then people think like, well, it’s gonna enlarge your heart. It doesn’t, you know, growth hormone like human growth hormone can, but testosterone doesn’t affected the heart muscle that way. Now, it can make your heart if you’re exercising your day and take care of yourself and make your heart and more efficient pump for sure. And that’s what you want, right? You don’t need a bigger pump, using a more efficient pump that works better. And that’s, that’s, that’s what it’s good for. And so another thing is, you know, all these myths that people see, it’s like, well, oh, there’s a bunch of 19 year old kids running around, like, they’re not running with prostate cancer, they’re not killing over heart attacks, and their testosterone is probably like, 1100, right? So I tell people that I’m like, you were that way once at one point too . And look at you now. Right? Are you better off then are you better off now? And most times, “well I was better off than when I was younger.” So, you know, it’s, there’s all these different kinds of things. And, you know, the acne is one of them. And that’s common, you know, that happens. It does. That’s what testosterone does, it can cause some acne, but it’s not like you guys are starting to get one or two sets here and there. It’s not like when they were 17 and a break and out or none of that stuff. You know, there’s there’s some of the things about the ball shrinkage stuff that testicular atrophy is the fancy word and
Aaron Tharp 18:12
so I want to stop. I want to stop you there. So because that ball shrinking balls is that’s a problem for every guy. That’s red flag. Yeah, that’s a huge that’s that’s we’re not looking for. Yeah, little trinkets. Little raisin? No, no, no, no, no. So how do you guys, how do you guys resist against that? How do you make sure because if I’m 37, and I still want to have kids, yeah, that’s important to me. Or if maybe I’m 25. I still want to have kids. Yep. Or even if I don’t, but let’s focus on on if I still want to have kids. Yeah. How are you protecting to make sure that I don’t end up with raisinets? Yeah, and I can still have kids?
Josh Simms 18:49
Sure. So let’s talk about kind of how that happens. Right? [Cool.] So there is testicular shrinkage associated with testosterone use. And the reason why that happens is because our brain specifically the pituitary gland produces two hormones that are kind of signaling hormones. And this is the way the whole endocrine system works, works in a feedback loop, sends out a signaling hormone to a signaling hormone to a target organ that target organ creates, the hormone wants it to make, and then that hormone accumulates in the blood, and then that signaling organ senses it, and then kind of says, okay, we either need to send out more of the signaling hormone or less, or just keep it normal, right? I know, it’s a little complicated, but it’ll kind of come together. So when we start guys on testosterone replacement therapy, the testicles are no longer making testosterone for them, right? Because the reason why that is, is we’re getting it from an outside source, you know, sitting such in this form, yep, the levels go up. And then that sensing organ that sends out the signaling hormones is like, Hey, I got a lot here, bro. Like, we don’t need to make any boys. So it starts to slow down. It’s, it kind of shuts those signaling hormones down because it’s like, Okay, I got these turned off, but I’m still seeing all this testosterone. Now those are also stimulating the testicles, right? So that’s where it’s like, it’s basically kind of like exercise. They’re not being stimulated so they kind of shrink and kind of just relax right? Now it happens to some guys doesn’t happen to some guys, it just kind of depends, it happens more often than not. So now, the way that we we work around that is we use HCG. And that mimics those signaling hormones. So once a week medication some guys use it twice depending on on if they need it or not. Now a lot of people that’s a red flag to some people, especially guys who use testosterone illicitly because they use that on their off cycle.
Aaron Tharp 20:24
HCG is-is a red flag you said?
Josh Simms 20:27
Yeah, cuz a lot of guys who do like who cycle steroids. Yeah. So use the HCG when they come off of it, because they’re trying to kickstart their body to make more. [Okay], that helps everything kind of go back to its base. [Okay,] now, we’re not doing that we’re doing medical therapy, right? That’s the difference who’s like, well, I heard about ABC. And I’m like, I don’t care what you read on some internet forum at some place. Like that’s not what we’re doing right? We’re doing medical therapy, we are actively treating testosterone, right. So we get them testosterone replacement therapy, and we’re being proactive about preventing potential side effects. So that’s why we give the HCG and we give another medication. Everybody’s heard about the bitch tits, right? Like as you start this and they don’t control their estrogen levels. That’s what causes that breast tissue growth. We give an estrogen blocking medication called an Anatrozol, it prevents the testosterone from converting from testosterone into estrogen. So again, that’s what I enjoy about what I do everyday is because I don’t, I don’t work in a reactive environment to hate reacting because you’re just waiting for bad things to happen. Right? So we approach it from a proactive standpoint, treating the testosterone preventing the side effects from human cropping up.
Aaron Tharp 21:28
Yeah. So in your opinion, what? What’s required, like when you when you say you monitor it, dive into that a little bit more. So if I’m thinking about going in, I’ve been sluggish. I’ve been tired and doing all the right things. I mean, but my testosterone levels might be lower. If I’m going to start working with somebody about my levels, what does that look like in a given week in a given month?
Josh Simms 21:51
Yep. So there’s a few ways that we approach it is we like to draw blood every single month and look at your levels. We don’t just look at testosterone, we look at your estrogen levels. We also look at your PSA which looks at prostate function. And we look at like your CBC your complete, complete blood count looks at red blood cell count, your white blood cell count count, hemoglobin, hematocrit. Hemoglobin is kind of the oxygenated portion of our blood cells that are inadequate is the percent of your whole blood that is red blood cell score. And that’s kind of the thickness marker that you sometimes hear us talk about, like how thick is someone’s blood, that testosterone causes our body to make more red blood cells so it can fit in the blood. So we watch that every single month to, but the goal is to make sure that your levels are where they need to be. And we’re not just treating that number though. So like if a guy feels really good, and his testosterone is like, 700. It’s like, man, I feel grateful. 100 times better. I want more. And I’m like, why? I’m not a drug dealer. That’s not what I’m doing here. I’m here to make you get medical therapy, right, guys require a little more 900, a thousand, it just depends.
Aaron Tharp 22:48
So can you can you widen a little bit? The discussion on the numbers? [Yeah.] Because I think that you can, you can probably focus too much on a number or you or maybe we’re both on it. And I know that Josh feels great at 1200. And I might feel great at 900. And knowing that you’re 300 more, should I ask for 300?
Josh Simms 23:09
Aaron Tharp 23:10
So can you kind of
Josh Simms 23:11
Feel a little small inside doesn’t it? A lot of guys do that. Well my buddy said he was 11 on mine. I don’t care. Yes, I got it. Like for me, it’s a case by case basis. Right?
Aaron Tharp 23:20
We’re very competitive, so I mean the numbers are important. Yeah. So can you flush that out?
Josh Simms 23:24
Yeah. So I think just as humans, we generally invest a lot in, in data and values and numbers, and more is always better. And that’s not the case. Specifically in medicine, it’s not the case. Like I’m not going to give you more of a drug. Like if you’re on a blood pressure medication and blood pressure is perfect. 120 over 80 take 20 milligrams of this drug, and “I want 40 milligrams, and more is better.” Yeah, next thing, you know, you’re gonna be face down on the ground pass out because your blood pressure’s bottomed out, right. So people don’t see it that way, when it comes to this, the testosterone cause, we kind of, and that’s where we have to do really good education on our part as medical providers is that we’re not chasing a high, because they get this bump, and they feel better. And so they’re like, yeah, give me some more man, give me something. I’m like, no, that’s not the way it works, right? You’re gonna fall into new normal, you’re going to kind of lose that honeymoon phase when you start the treatment. But but the numbers are there just as a marker to kind of track our progress and how we’ve done right now, we don’t want you to low but we definitely don’t want you to hide. And I always tell Guys, if if you’re at a certain point, you’re feeling good. We’re going to increase your dose, you’re going to kind of run into what I refer to as a law of diminishing returns. Right? Your your number might go up on this piece of paper, but you’re probably not going to subjectively feel better. You’re probably actually gonna have some bad symptoms, right? You’re probably gonna start getting more acne, you’re probably gonna start sweating at night, you’re probably going to start getting hot flashes during the day. Because, again, you came in because your hormones are imbalanced. Now we’ve overcorrected in your imbalances in another direction, and now you’re starting to have problems because you have too much testosterone. And you guys like oh, I don’t know. That’s right. And they don’t believe me, but I’m like I’m, well first of all, I’m not going to show you that. That’s not what I’m going to do. But just I just kind of again, put my put my flag in the ground and say this is not- We’re doing medical therapy and we’re not here to chase a high or do do A, B, C or D because you Dr. Google think that’s what we should do. Right? [Yeah.] That’s my favorite, though. Right.
Aaron Tharp 25:08
I have to say, when I first started, you know, you come in once a week, and I get the week’s worth on a Thursday is when I came in. And Friday. I was a beast. Yeah. In the gym, I would run for miles. I was like, untouchable. Yeah. In a good way. I mean, I wasn’t like, you know, barreling over people just because I could No. But yeah, you could really tell and then it would paid off. And I could tell Oh, yeah, it’s Tuesday. Yeah, I need to get back in there again, because I now understand that to be a very, not severe, but a pretty low low. I was up high. And then I was real low. Now. I split it up. Yep. And even if I don’t, when I come in for my drop shipping to get my do my blood draws, yeah. When they’ll
Josh Simms 26:04
Which means that you you do your treatments at home on your own? [Oh, right. Yeah.] So no, no, I just want to make that clear that we do in clinic treatments once a week or patients do their treatments at home come in once a month.
Aaron Tharp 26:13
Yeah, no. No, that’s, that’s, that’s, that’s a good distinction. I chose to have them, you know, have it shipped to me so that I could administer it myself?
Josh Simms 26:24
Yeah. Easy. It’s easier for a lot of guys.
Aaron Tharp 26:25
Yeah. Not that I don’t love coming in and seeing, you know, your beautiful smile, but it’s just easier on my day. But even when I do that, now. So when I come in and get a full week, while I’m waiting for my dropshipping stuff to come. It’s not nearly it’s not even really that at all. Yeah. So over time, I’ve noticed that what the ultimate goal was to just to be imbalanced, so that you feel better most of the time or to feel better more of the time. And that’s much more the case than it was in the beginning. Yep. Yeah. So it’s like it stabilized. Right. Yep. Which is what that’s the goal. I mean, that’s what you’re after any way rather than peaks and valleys?
Josh Simms 27:08
Yeah, for sure. And I think the split dosing is kind of a nice little kind of off off sheet to talk about the reason why we do that sometimes is everybody’s different, right? We’re just talking about that. Genetically. There’s a lot of cool research in genetics and pharmacology on how our body metabolizes drugs, some people are really quick metabolizer some people are slow metabolizers, you’re probably a quick metabolizer. So that’s when we split it up. So guys would be like, “well, coming out on Friday, and then by like, Wednesday, I feel like it’s worn off.” Right? And that’s because their body just it just metabolize the drug faster than guy B who’s like, man, I don’t notice a difference at all. We tweak, everything is good with just one treatment. Yeah. And so that’s when we do like what normally you’d say, let’s say you for argument’s sake do 200 milligrams of testosterone a week, that’s when we split it into 100. on a Monday, 100 on a Thursday, and it smooths that out, like instantly. You guys don’t notice that anymore as inconvenience, again, more injections. But, you know, sometimes we have to trade that for, for optimizing therapy.
Aaron Tharp 28:04
It’s, it’s in my opinion, and, you know, I don’t want to project here, but in my opinion, it’s a it’s a small price to pay. When the when the alternative is to feel as shitty as I was, before coming in, for [sure.] And then again, that was more of just me getting my own way. Just pride. Okay, great. So
Josh Simms 28:24
Sorry, a lil-little side note there. Why why we do that and how it can? Because if so some guys, you know if they guys have Why do testosterone but I feel good for four days? Yeah, well, that’s not something that we can change. Right. So there’s lots of tinkering. And that’s the cool thing about this is it’s not uncharted territory, what we do, but it’s I mean, it’s relatively new as a medical therapy, you know, we guys probably been treating patients with it for a while. But the more that we kind of dig into this, we realize how much we can really do move around and change things to to individualize it for patients, right? As ik Joe, I just put Bob, Rick and Gary on this one. You know, the doctor wouldn’t say that. But I’m saying in their head, they’re thinking that they’re like, well, it’s a one size fits all program. I mean, you know that it’s not right, I know that it’s not and that’s why I love being able to, I’m the guy that I don’t like a mile wide and an inch deep, more of the inch wide mile deep. And I get to do that with this. And it’s awesome. It’s fun. It’s a lot of fun.
Aaron Tharp 29:16
Yeah, you’d see some real ease probably change lives change. Yeah. And honestly, relationships change, improve.
Josh Simms 29:22
Yep. And that’s the hard thing. So in medicine, and this, this the world, the information age we live in, we are so focused on data, right? Show me the data that it works. Well, it’s like, it’s a subjective change for guys, right? So I can’t provide you I can give everybody numbers that people’s testosterone came up, right, but I can’t give you a subjective study. That’s not helpful, right? No one will believe that. They’re like, well, he did you incentivize them to tell them that their interview went from a four to a 10? Like, well, no, I mean, but, but and that’s where, you know, as as a medical practitioner, I do, like seeing people so frequently, because then I know, I can see when they kind of have like an off an off week or they’re not gonna you know, man, I’m just not feeling very good this week. And then that’s where we can have the the lag, give us the data to show that Oh, yeah, your testosterone numbers, they’re like, three, four points lower than they were last month, like what’s going on and you didn’t miss a week or something like that. And we adjust their dose and then they feel better. Right? So it’s, it’s, there’s a lot more subjective and a little bit of objective data that we get, but I mean, I mean, I see, you know, I work at many clinics that probably house over 3000 patients, and you know, it’s kind of hard to make that up. Right. There’s just too many people to be able to be like, that doesn’t really work. Right. Yeah.
Aaron Tharp 30:30
You see patterns. Yeah,
Josh Simms 30:31
they just like to come in and you know, pay their insurance premium just for nothing, right? It’s, it’s fun and fun and games. So that’s, that’s kind of the stigma that a lot of primary care Doc’s will throw out, it’s like, “oh, well, it doesn’t really work in this what we refer to as senescence or the body kind of slowing down as a natural process. And we should just let that run” and I say, yeah, you you have fun with that. You go ahead and be that guy who’s who’s tired by 4:30 and wants to be in bed by nine, whose wife sitting on a couch wine and dinner
Aaron Tharp 30:58
To hell with 4:30. To hell with 4:30, 10:30!
Josh Simms 31:02
Yeah, I mean, it’s quick. I mean, some guys can’t do that tank real fast, man. So
Aaron Tharp 31:05
yeah, it’s brain fog. And, and, you know, fatigue at 10:30 in the morning, like, I’m just done with coffee. How am I tired?
Josh Simms 31:12
Yeah, that’s, that’s enough. Yeah.
Aaron Tharp 31:13
You’ve mentioned something about the primary care physician. [Yeah]. And about how he’s gonna kind of talk you off the ledge a little bit. It wasn’t terribly long ago. And correct me if I’m wrong, that it was kind of black market for them to even consider, like, what not really talk about it, but administer it helped me out here.
Josh Simms 31:31
Yeah, I think I think one of the things is we don’t get a very, our education on the male hormone system is not very, I wouldn’t say it’s bad. It’s just not very helpful, right? Because you don’t really I mean, they say, yeah, guy comes in you tested levels, and then you just give them to sastra. And that’s it. Right now we go into a women’s health section and man, I remember just like studying for hours, and hours and hours and hours, like trying to figure that out and, and birth control and how that affects hormones and hormone replacement therapy and women and all these, this that the other thing and it’s I mean, it was a library to an article and for men.
Aaron Tharp 32:05
Yeah it’s that cumbersome.
Josh Simms 32:06
Yeah. I mean, women. I mean, women are, it’s a it’s a very, they have much more complicated. I mean, I mean, as guy them were simple to the core, right? Yeah. I mean, I’m talking from just a mental to a complete anatomical standpoint. Like we’re in physiological. We’re pretty simple, right? Yeah. Give me Give me a couple beers. Give me a gym. And I’ll be pretty happy. Right? Yeah,
We’re not we’re not delicate flowers. And thank God for that. So, but
Aaron Tharp 32:28
It speaks to the larger the larger discussion about why they’re more on the emotional side? Yeah. I mean, if if you’re driven by a lot more hormonal changes, then yeah, that would make sense. Yeah. Cuz even I as simple as were built, when I didn’t have the right levels, I was a crappy little bitch.
Josh Simms 32:49
You know, like, because you’re, again, your hormones are out of balance. And that’s the thing that people understand when like women go through, when they go through their monthly cycle, man, their hormones are, they changed drastically, right. And so one of the things I always tell guys, and I love it, when like, a guy comes in with his wife, and we’re talking about, like treatment and stuff, and if they’re, like, get like a night sweater, like, Oh, yeah, I get a little bit more emotional, like, well, your estrogen levels too high for what your body’s normal. And I’m like, if we let your estrogen just run out of control, you can start, you know, you’re gonna get really emotional, you know, you might get some nipple sensitivity, you might put on some waterweight, and they’re like, oh, and now you know, what your wife goes through for three days, every month. Now you give them a little bit of a break, and the wife laughs and there’s, like, you know, so it, I mean, they go through those changes so frequently. But But guys, we’re, again, again, like I mentioned before, it’s a slow, steady decline into that. So we didn’t get we kind of got off track. So we’ll circle back to the primary care stuff. So we didn’t really we didn’t learn a lot about treating low testosterone we don’t get there’s not a lot of research on as I let a dad on it, there’s more of like trying people trying to say that it’s not helpful than it actually how it can help people. So a lot of primary care Doc’s who do venture into it, they’re very conservative when they do treat it, if they do do it. And I don’t want to poopoo primary care Doc’s I mean, they’re great. I mean, they have one of the most important roles in medicine, right. And I think the more ground that we gain as providers and what I do, we’re starting to find that a lot of primary care Doc’s so I’m glad that you go there because I, I don’t you’re like one of four patients that I have. And I kind of feel like I’m a little bit in the wilderness with this because I just don’t do it.
Aaron Tharp 34:17
They don’t. I’ve never been through med school. You look closer. I don’t think that they, they don’t go deep with it.
Josh Simms 34:24
Yeah, I mean, cuz I gotta worry about the guy who’s got diabetes and heart failure and the next guy who needs a biopsy, isn’t that not the guy who’s just like, go fix my testosterone? I don’t I don’t want to minimize that portion of it. But it’s like, it’s such a it’s such a rare portion of what they look at, and what they treat, and they’ve got this whole thing where they got to take care of everybody from I mean, some dogs should go into like, you go into small towns. I mean, they’re seeing kids are seeing old people, they’re doing pediatrics to geriatrics and everything in between and doing call on Saturday night in the ER, right, like it’s, it’s one of those things where they’re like, okay, I don’t have a lot of time to sit down and look at this. And then if I have to see you every week to do real light, you see my waiting room, right like you’re gonna Coming, you’re gonna wait for an hour and a half to get a shot before you’re gonna get out of here like, do you want to do that? Or it’s just, it’s a very complicated thing for them just to throw into their practices they got to learn right in the process, all the while treating all these other patients. Right? So I don’t think it’s a I mean, they’re, they’re more than capable and smarter to do it. Right. That’s not the question. It’s just can they?
Aaron Tharp 35:20
It’s a bandwidth thing.
Josh Simms 35:21
Yeah. Can they fit it within their schedule? Right? And do they have the time to sit down and learn about it? Now? At some point, do I think that we’re gonna have dedicated people doing this in big primary care clinics? Yeah, I think so. Because I think we’re gonna see how pervasive this low testosterone issue is. And I think it’s going to be much more widespread. But I mean, you know, for me, we have to look at the medications that we’re using, how they work, and why we’re using them and, and making sure that, you know, as primary care, sometimes they’ll give a shot once a month, once every two weeks. And that’s not the way the drug works the last for seven days, that testosterone cypionate that we use. So you’re kind of doing your patients a little bit of a disservice, right? Again, feel good for four days, and then they’re not going to get a shot for another 10 days. Right. So you’re kind of given a little taste of it. And then you’re effectively suppressing their system, because they’re usually not getting the natural, which is the estrogen blocker, they’re usually not getting the HCG, right. Because those are we use those off label with the original intended for but they give us a results in the preventative treatments that we’re trying to achieve. Yeah, so it’s it’s it’s, it’s understandable why primary care Doc’s aren’t in it. But it allows us to do what we do. And then if we run into issues of week, because there’s plenty of patients who don’t have primary care Doc’s and we find stuff and I’m like, Hey, man, you need to go, right, go to ABC or D, right? My goal is to build to bridge that gap between us in the relationship with these people that are primary care doctors to allow us to work together. I have plenty of guys who are like, hey, my doc wants to my labs as your man just tell me what to do. And then they have a question just don’t call me more than one talk to them. Right? We don’t sit over here in our ivory tower where they’re in their ivory tower in in fire salvos at each other. It’s that’s not what we want, right? We want to work together with you. We want to work together because if we sit there and pissy pants with each other about this stuff, who loses
Aaron Tharp 37:01
Josh Simms 37:03
100% because it’s not about me.
Aaron Tharp 37:05
Yeah, man, well said I like that, that your approach is to take the, you know, the opportunity side of it to bridge the gap because guys are going in that they have, you know, hey, I’m tired. I’m moody. You know, the symptoms that we’ve gone through. And the first line of defense at primary cares, probably not going to be hormonal.
Josh Simms 37:28
No, they usually don’t look at it, right? You come in for a physical we look at almost everything but testosterone. In you know, in a defensive a primary care doc like man, like the majority of low testosterone symptoms are line exactly with where depression is. Right? Right. And so it’s like guys who are have little interest in doing what they enjoy before, they don’t sleep very well, or they sleep too much, or they don’t eat enough, or they eat too much, or they don’t have a lot of energy. They’re Moody, they feel bad, they feel sad, and so on and so forth. All those things, check those boxes, right now there are guys that will come in like that will start on testosterone replacement therapy, and they’ll see some gains, right? They’ll feel better, but they’re still having these issues. And I’ll kind of talk to him like what’s going on with what’s going on man? Like what’s going on your life everyday? Like, would you like to do? Are you doing what you like to do? Is that enjoyable for you? Right? kind of have that conversation right now. And I’m like, Well, you know what, man, there’s a lot of guys that will start on treatment, and then piggyback that wasn’t with an antidepressant. And you’ll be surprised how much better you feel. I mean, not everybody wants to take that because that’s this whole, like the mental illness thing is still for some reason, I can’t figure out why it’s such a stigma for people. But there’s this still component, right? We don’t i don’t ignore that. I don’t think testosterone is going to save the world, it’s going to fix every problem that we have, right? That’s not the way we don’t that’s just that would be foolish, right? But the good thing about seeing guys we tweak is we can have those conversations, right? It’s good to frequently see those guys, you know, every week or once a month. So again, it kind of helps us find find, I don’t wanna say an alternative treatment. But maybe there’s something else wrong, right? What if you What if you start the scanning antidepressant doesn’t feel better? Do we look at the testosterone then? Or do we do it? I mean, I think we do it before, it’s a better screening tool to look at it before. So that we can say, Okay, let’s, let’s try to stop. And if that doesn’t work, then we try medication that we add on,
Aaron Tharp 39:10
and you’re seeing them on a frequent enough basis where you’re going to be able to troubleshoot that pretty good. Whereas I’m just going to one primary care physician, I’m probably not going on a weekly basis, maybe not even a monthly basis. I’m going
Josh Simms 39:23
How often do you see your primary care doctor?
Aaron Tharp 39:24
I mean, usually for if I if I need a physical Yeah, or if shit’s running downhill, like I find, you know, I got a problem. Yep.
Josh Simms 39:34
Yeah. And it’s so it’s, I mean, it’s like it’s so funny as a medical provider told guys like Oh, he’s had primary care doc, you go get you into physical and the only reason why I get an annual physical and this is so terrible is because my wife’s insurance requires it.
Aaron Tharp 39:47
Hey, at least you’re honest.
Josh Simms 39:48
I know. But I mean, it’s like, as I get older, right, and that’s what that’s what we have as they get rid of stigma. But as I get older, I do realize like, oh, maybe maybe I should go see like my doc and and just communicate with her. More and let her know like, hey, like, I need to see about ABC or D or whatever and just go in and like, Oh, she’s not like, so it’s it’s January 2021. I haven’t seen it since August of 19′. What’s going on about? Well, the insurance won’t be on that. So it’s [Yeah], you don’t want that. You don’t want that disconnect with your primary care, right? Yep. So yeah, I just, I try not to be hypocrites.
Aaron Tharp 40:38
No no I think you got a fair outlook on it so i mean we’ve covered a lot what i think i want to uh do is to kind of close out with a call to action about you know what we’re trying to
communicate what we want guys to be aware of uh you know if they’re if they’re feeling fatigued, lethargic, kind of having a little bit more of their emotional ups and downs, packing a little bit of weight, maybe not seeing the gains in the gym, anything along those lines. What do you recommend for them to do?
Josh Simms 41:13
Yeah i mean i think it’s it’s and this is uh it’s this is not like i think for guys over 40 right you said you’re 37 right i’m 37. we’re both on testosterone replacement therapy um it’s it’s a good it’s a good tool to at least investigate right i think it’s important As not just a human but as a man not to just ignore when things are going a little sideways i think it’s i think standing up and saying okay like there’s something going on here that’s not right i don’t feel the way i felt a year or
two ago like what can i do about that instead of just going like you said you had a lot of
pride about it uh and that’s good for a little bit right we can we can all feel on pride for a little bit until you run to the wall and i think it’s uh i think one of those the thing about that is is kind of setting that aside i mean i mean there’s a lot of times that when we do kind of put the ego and pride aside that we win and it’s not impressions that sometimes i say it’s pretty much most all the time right i mean it’s there’s very few people who just succeed based off of ego and pride right you should probably like an when you do that most you may not think you do but trust me you walk out there like you know so it’s uh i think kind of dropping that and going in and talking to somebody and and i i would recommend going and seeing somebody who specializes in it right it’s not and again what i do is not like this urological specialty or i’m not a cardiologist i’m not even endocrinologist i specialize in a very again one inch wide one mile deep area of men’s health which is testosterone replacement therapy erectile dysfunction and peptide therapy those are the big three things that i do yeah and i like doing that because i can sit around all day and read about that stuff and not getting the weeds on crazy stuff and then i can come and talk to a guy who comes in with those specific problems and feel like hey i am the
expert on this right and then build that relationship right so they they will know that hey
i’m coming to see josh today this is what he does right and if he but he’s got the education that if he sees anything wrong he’ll he’ll refer me to the right people and it just creates a good network for for patients yeah right and you can feel and i think doing that going to the right place you can feel confident in that that it’s like okay i’m not going to get recommended
something i don’t need i’m not going to get thrown something that i don’t want right i came here for this specific reason to find out if there’s a problem here yeah i mean if that’s it they’re going to treat me and if it’s not there then we move on to the next thing right so
Aaron Tharp 43:36
Yeah no well said man so yeah that’s the call to action man just pay attention to how you’re how you’re how your body’s feeling how do you feel on a day-to-day basis is it declining um and maybe it’s time to just admit that like hey i’ve done what i can do and and this is maybe outside of my control yeah so let’s do what we can within our control to feel better let’s go get our levels checked um so that way you can also establish a baseline right um and you get it from the people who study it who know it who work on a regular ongoing basis day-to-day basis with men every day.
Josh Simms 44:11
yeah and i think i think the other big thing is is that the value of doing it right then provides you’re you’re a resource for other people that you know right and as guys like some guys are
like well i’m uh i’m a ford guy or i’m a beretta guy from my guns right I only drink jack daniels all that other stuff is garbage right we’re very brand loyal as men to a to a fault of stupidity right but this can be like you know hey i you know i go to where you can go to where i go but just go see somebody man like i’m telling you I started this treatment three months i mean you can see it in me right right like you know yeah I you you i was doing the same thing you were doing three months ago now look at me i grind through the day and i and I get done and i go home and I hang out with my kids and my wife and and then i’m good yeah and you’re over there taking a break every 15 minutes like you know most guys will say like hey i know what you’re going through bro like i can relate to you i’ve got a resource for you that’s i mean huge i mean we can market all we want but nobody’s going to believe it until they know somebody who does it i mean some people will just going on their own accord but i’ll tell you what man if somebody comes up to me and says hey man like i know we talked about this i’m doing this you should go get checked out yeah i’ll probably rely on my friend more than about the radio ad right so that’s i think that’s huge
Aaron Tharp 45:20
yeah because you’re hearing it from somebody who’s experienced it yep yeah you’re good man no that’s awesome so uh yeah that’s the moral of the story go get your levels checked yeah and there’s nothing wrong with it it’s totally normal you feel a lot better so
Josh Simms 45:33
yeah natural process right again it’s natural it’s it’s not you it’s just the way that your body is designed that’s right so
Aaron Tharp 45:40
awesome cool well that wraps up episode one at men explained thank you so much for joining us we will be backum with another episode and we hope that you’ll join us thank you so much!