In This Episode
The Path to Intuitive Eating
Maintaining a healthy diet today seems nearly impossible. The built environment of modern day America makes it so easy to eat poorly. 100 years ago we had to work to get food and spend energy to get energy. Today there's no limit on the foods we can eat, and it's a little too easy to indulge in our built in biological drive to consume high fat and high sugar foods.
Dr. Alex Pastuszak has worked hard to become an "intuitive eater." He's practiced for years to get a good understanding of how much food and the types of food his body needs to stay healthy. He even finds himself looking forward to eating food that makes him feel good like a salad for lunch.
His secret is to make sure that he's never on a "diet." Diets are short term and focused on getting a person to lose weight or gain muscle. These quick-fix approaches to look better don't necessarily lead to good dietary habits. Dr Pastuszak urges people to focus on their health and forming good eating habits that can last a lifetime, rather than a fad diet that will help you lose a couple pounds for just a couple months.
Scot is working towards getting to a place where he can eat intuitively. He watches his diet closely and still weighs out his food. He hates weighing his food all the time, but is teaching himself what portion sizes should look like and how much he should be eating. He looks forward to the day he can stop weighing his food and eat intuitively.
Is Testosterone Therapy Right for You?
You may have seen the ads about testosterone therapy or "T" treatments. They make it sound like testosterone can cure just about anything that ails you. Have low energy? Testosterone is the answer. Putting on a few pounds of fat? Get T. Having trouble sleeping? Testosterone will help you sleep like a baby.
"In the right person, testosterone can help a lot," says men's health specialist Dr. Alex Pastuszak, but he admits that it isn't the cure-all the advertisements lead you to believe. Most of Dr. Pastuszak's patients will come in with complaints of low sex drive and general fatigue. They can't seem to power through a day and find themselves tired by lunch time.
The difficulty with diagnosing low-testosterone is that the symptoms are extremely non-specific. For example, if a guy is feeling fatigue, it can be caused by just about anything- lack of sleep, poor diet, depression, etc. Same goes for symptoms like low sex drive and insomnia.
The only way to know if a man is experiencing the symptoms of low testosterone is to get a testosterone level test.
What is a Normal Range for Testosterone?
A testosterone level test measures the amount of male hormones in the bloodstream. The results are measured in nanograms per deciliter. A healthy range for a guy is 300 to 1000 ng/dl, with around 600 being average. Anything around or below 300 is considered low by most physicians.
According to Dr. Pastuszak, most men feel better with a level of 600 or higher. Any man with a level below 600 will likely feel better with testosterone therapy and it's worth trying out. It's important to remember that testosterone therapy is typically considered a "lifestyle therapy" meaning you can use the treatment as long as you'd like if it helps you feel better.
Having a low testosterone level between 300 to 400 isn't dangerous to you health. However, if a man's testosterone drops below 300, there is an increased risk for osteoporosis and cardiovascular issues.
What Kind of Testosterone Therapy is Available?
Testosterone therapy can be administered in several different ways depending on the patient's needs, wants, and expectations.
The very first question Dr. Pastuszak asks is whether or not a guy plans on having kids in the near future. It may come as a surprise, but testosterone does not improve a guys fertility. In fact, testosterone does the exact opposite. After six months to a year of taking testosterone, most men see a dramatic drop in fertility.
Testosterone therapy is often made up of several different medications:
Testosterone
The basic form of the treatment is to add more of the male hormone to the body. This can be through injections, creams, pills, or even injections under the skin. These hormones aim to raise a man's testosterone levels to a more typical range.
Human chorionic gonadotropin or hCG
hCG is a drug that helps to stimulate the testes to produce testosterone naturally. It is prescribed with testosterone to prevent the testicles from shrinking during treatment. If testosterone is taken by itself, it interrupts the connection between the brain and testicles. The testes will stop producing testosterone and over time will begin to shrink. In some cases, the testicles will shrivel up to the size of raisins. hCG helps keep them the right size during testosterone therapy.
Clomid
Clomid is an oral medication that stimulates the brain and testes to make more testosterone. Clomid has less of an impact on fertility, but is less effective at raising testosterone levels as significantly as T creams and gels. It is often prescribed to men with slightly low levels of testosterone or men looking to have children.
There are many different testosterone treatments available. Work with your doctor to find out what type of therapy will work best for your situation
The Side Effects of Testosterone Therapy
Like any medication, testosterone therapy comes with its own set of potential side effects. The two major side effects are infertility and testicular shrinkage. Infertility can be avoided by taking a less intense treatment route like Clomid. Testicle shrinkage is prevented with hCG and should always be taken with testosterone.
Testosterone therapy can also lead to an elevated level of estrogen. It may be confusing that increasing a male hormone would also increase a female hormone. Biochemically, testosterone is a precursor compound to estrogen. The human body needs testosterone to create estrogen. Therefore, in some men, having too much testosterone can lead to the overproduction of estrogen. If a guy's estrogen levels are too high they can develop tender, sensitive nipples, and in extreme cases, begin to develop breasts.
Additionally, testosterone can lead to erythrocytosis, or a significant increase in red blood cells in the blood. If a person's red blood count gets too high it can increase cardiovascular conditions like heart attack and stroke.
If you're on any sort hormone management like testosterone therapy, it's important to maintain regular follow up care. The hormones can keep you feeling really good for a really long time, but it's important to keep tabs on how they're affecting your body with a professional. After first starting testosterone therapy, your doctor may insist on frequent visits and tests to track your treatment and adjust medication as needed. After you and your doctor get the treatments zoned in, you can expect to visit your doctor every 6 months or so to make sure everything is running smoothly.
Choosing to Stop Testosterone: Scot's Story
Scot has had his own experience with testosterone therapy. After not feeling his best for a while, he went to a doctor to test his testosterone levels. The results showed that while he was within the acceptable range, his testosterone levels were on the lower end of the range. His doctor prescribed him a testosterone cream that he rubbed on his chest. After using the cream for a while, he didn't feel like he was feeling better. For him, the testosterone didn't turn out to be the cure-all he had been led to believe. He stopped the treatment and started focusing on other aspects of his health.
Scot recognized that his lack of energy may have been caused by something other than low testosterone. At the time, he was only getting around five hours of sleep a night. He says he was a little overweight and wasn't exercising as frequently as he should. Those bad habits were probably the real cause of his low energy levels, and he felt that testosterone couldn't cure his lifestyle.
After focusing on improving those aspects of his health, Scot began feeling better. Even better than he did when he was on testosterone therapy.
Dr. Pastuszak agrees that testosterone therapy isn't the cure for everything that the commercials will lead you to believe, but for some guys, it can get them on the right track. For example, an overweight thirty year old with low testosterone levels may be suffering from extremely low energy. That low energy leads him to not exercise or eat as well as he should. He comes in. Get tested and finds out he has low testosterone. The low testosterone level may likely be caused by the extra weight and lack of exercise, but with how low his energy levels are, it's going to be hard to be active.
Dr. Pastuszak would put this guy on hormone therapy as a "lifestyle intervention." The treatment makes him feel better and improves his energy levels. He then has the energy to go to the gym and exercise, which will bring his weight down, and get his body producing testosterone again. In a case like this, testosterone therapy can break the bad health spiral long enough for a man to improve his health and eventually stop using testosterone.
Testosterone therapy is a deeply personal and complicated issue. If you have any questions about treatments or suspect you may have low testosterone, submit your questions to Dr. Pastuszak by email at hello@thescoperadio.com.
ER or Not: Food Poisoning
You've decided to eaIf you've had food poisoning, you know how terrible it can be. You've eaten somewhere that's not so great and now you can't seem to stop throwing up. Should you go to the emergency room?
According to Troy, you don't necessarily need to go to the ER for food poisoning. Food poisoning usually strikes six to twelve hours after eating contaminated food, and will last for about just as long. Over the counter anti-nausea medication can help with the symptoms, but it'll have to run its course before you feel better.
However, if you are vomiting incessantly and can't keep even liquids down, you run the risk of becoming severely dehydrated. In this situation, go to the ER. An emergency room will be able to put you on an IV drip and help keep you hydrated during the food poisoning. Most urgent care facilities lack the means to start an IV, so if you're at risk for severe dehydration, an emergency room will be your best bet for treatment.
Just Going to Leave This Here...
On this episode's Just Going to Leave This Here, Scot is thinking about the critters in his gut and how the microbiome could help your immune system stay strong and Troy is not ready for winter.
Connect with 'Who Cares About Men's Health'
Email: hello@thescoperadio.com
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Scot: You'll notice the host is taking steps now to establish trust with the guest which include deleting things that the guest might not want to be released in the public.
Troy: Thank you. Yeah. Do not release any of this to the public. It is entertaining though.
Scot: You'll also notice the host smiles often at the guest to create a sense of comfort.
It's the podcast we like to call "Who Cares About Men's Health?" We have a simple premise. They say men don't care about their health. Maybe it's true, maybe it's not. But I think that there are a lot of men that do, and I think we can work hard to get those that don't care about it. My name is Scot Singpiel. I am the senior producer of thescoperadio.com, and I care about men's health.
Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.
Dr. Pastuszak: And I'm Alex Pastuszak. I'm one of the men's health urologists here at the U, and I definitely care about men's health.
Scot: So "Testosterone Hormone Therapy." That's the topic today. You see the ads on TV. You got low energy? Got to get some T. Putting on some weight? Got to get some T. Decreased sex drive? Got to get some T.
Troy: How many ads are you watching?
Scot: You must have TiVo. You never see these ads.
Troy: I've not seen these specific ads. I've seen the ads for low T, but not to that degree.
Dr. Pastuszak: He pays the low subscription fee. He sees all the ads.
Scot: It seems as though if you're a man and you have a problem, the answer is to get yourself some 19H28 . . . What is this? What's the chemical formula? I was going to just impress the hell out of everybody by having the chemical formula for testosterone . . .
Troy: For testosterone.
Scot: . . . and I forgot one of the letters.
Troy: Oh, no.
Scot: Dr. Pastuszak?
Dr. Pastuszak: I think testosterone is good. Yeah.
Scot: Yeah? I know there's 28 hydrogens and two oxygens, but I don't know what this 19 is for.
Dr. Pastuszak: No. And then they vary depending on the ester, but we're not going to totally nerd out on that.
Scot: Okay. All right. We'll get to that topic in a second. Going to start with this though. First of all, I was on Reddit the other day and saw a picture with some writing on it and I thought this was really an interesting take on health and I want to get your guys' thoughts on how you integrate this kind of a thought with your health. Person said down 30 pounds, gave up dieting/restricting and now engaged in intuitive eating and better coping mechanisms. How does this play into your life? How do you approach your nutrition? Do you write stuff down? Log stuff? Do you intuitive eat? What do you do?
Dr. Pastuszak: So now I'd probably say I'm more of an intuitive eater, but I just try and keep it clean and real. Meaning not too much of the processed stuff. And I exercise regularly. It's easy now because it's not a diet. As soon as it becomes a diet, then you become . . . I think people don't do well on diets. It has to be part of your lifestyle.
Scot: And you've developed a taste for clean eating. You enjoy it now?
Dr. Pastuszak: Yeah. I love it.
Scot: Which can take a while, but it does happen. And I know people that don't have a hard time believing that they'd ever look forward to a salad, but you do.
Dr. Pastuszak: Yeah.
Scot: I'm still at the point where I'm weighing everything and it gets tiring. I'd like to get away from that. I think it was a good tool at first to learn what size my portion should be and how much food constitutes what a normal meal size looks like because I think we all have a distorted view of that nowadays because our serving sizes are so huge, but intuitive eating sounds interesting. So, and then the coping mechanisms, we didn't talk about that, but exercise and those sorts of things as opposed to reaching for the food.
Troy: Yeah. Something to fill the time readily it's always the key. When you have a bad habit, find something to replace it. So rather than reaching for food, like you said, exercise or reach for a fruit or have those things readily available rather than the unhealthy snacks.
Dr. Pastuszak: I think we also just need to, and I know we need to keep going and then we need to give or credit, however you want to call credit to like, or discredit to the fact that we live in this built environment that is essentially 180 degrees from what people used to live in even 100 years ago. I think living a healthy lifestyle is different now, or it means something different than it did a 100 years ago.
Troy: Yeah. It's a battle. That's a bottom line.
Scot: I'm completely on board with that because think 200 years ago, in order to get food, you had to work to get food. It just wasn't served up at the grocery store or convenient. Right: So you had to expend energy to get energy and energy wasn't necessarily super abundant in the way that it is today. So we're at a place where we have excess amount of food and energy, where we have to expend little energy to go get it which just, like you said, from a structural standpoint, completely changes. We've never had to limit ourselves eating because, normally the problem is you didn't have enough food.
Dr. Pastuszak: Yeah.
Scot: And we're in a time and place now where you do have to actually control that. So you're going against all this biological programming in your brain that I need eat fat and sweets because those are the high caloric foods and . . .
Dr. Pastuszak: Access to high-quality food is expensive.
Scot: It is. And hard to do sometimes.
Dr. Pastuszak: So food stamps don't buy whole foods. Right?
Scot: Right. So, anyway. Yeah. I'm glad you brought that up because I think that is an important thing. People start to blame themselves for it. And I'm not saying use this as an excuse, I'm saying just be aware that this is the environment we're in nowadays, that you brought up. I love that point. I think that's such a great point.
Troy: Yeah. The simple statistic that sticks out to me, we talked about it recently was an article I saw that said most Americans are sick. They have some sort of illness, often related to obesity, there's diabetes, hypertension, some sort of chronic illness, the majority of Americans. So that's the battle we're facing now. If you're just going with the flow, that's probably where it'll end up. So it's a battle. It's really going against the tide to try and stay healthy.
Scot: And that's why we look at the core four: activity, nutrition, sleep, manage your stress. It comes back to those basic things. Yeah. You just get those basic things taken care of and you can go a long way to living a better and healthier life. So, you've seen the ads, right? People think if you have this . . . They talk about symptoms like low energy, putting on weight, decreased sex drive. What are some of the other symptoms that bring people into your office?
Dr. Pastuszak: You talked about decreased sex drive, poor focus, poor sleep, poor erections . . .
Scot: Boy, I guess . . .
Dr. Pastuszak: . . . weight gain, inability to gain muscle.
Scot: And testosterone can solve all those problems, right?
Dr. Pastuszak: In the right person, it can help a lot.
Scot: In the right person?
Dr. Pastuszak: And the right patient.
Scot: So, not unilaterally? That's not if . . . if I have those symptoms, that's not necessarily my problem is what you're saying.
Dr. Pastuszak: No, not at all.
Scot: Rats. I was hoping for a cure. All right. So we talked about some of the things that might bring a guy in your office for that. When they come in then, how do you sit down and make the decision if that's the right way to go? And then we're also going to talk about risks and benefits which is the important part of the conversation.
Dr. Pastuszak: Yeah. So there are a few things that you need to talk about with these guys because most of the time a guy will show up in your office saying, "Hey, I feel tired, my sex drive has gone down, stuff is not quite working. I used to be able to power through a day and all of a sudden one o'clock rolls around and I'm done." So, from a medical standpoint, the important thing to remember is that the symptoms of low testosterone are very non-specific. So fatigue. What causes fatigue? Troy, how many different things do you know of that cause fatigue?
Troy: Oh, the list is endless. And just as we're talking about this, so much of this could be psychiatric, it could be depression, it could be lack of sleep, just not eating well. All of these things could be contributing to all of these symptoms.
Dr. Pastuszak: The same thing with low sex drive. How many different things cause it? So point is until you actually do a test to show that somebody has low testosterone, you can't just assume. So that's an integral part. So you need to know what symptoms the patient is coming in with, and then you need to do a test to show that that person has low testosterone.
Scot: And so I went through this process and actually was on testosterone therapy for a while and I quit. And I'll tell you why at the end and you can tell me if I made a good decision or not. But I go and I get the test and there's a range of this is normal testosterone. There's a low end of the range, there's a high end of the range. I was not out of the range, I was just on the low end of the range. I went to a doctor that said, "Yeah. We can put you on therapy." Tell me your take on that.
Dr. Pastuszak: I think that's reasonable. It depends on what you mean by low end of the range because by the numbers, the insurance companies and most labs consider 300 to be the lower limit or normal. So, if you are at or below that you are considered low by anybody who, or I shouldn't say anybody, but a lot of people who aren't dedicated to this space.
But you can be low normal. So, 300 to 450, maybe even up to 500 because what we know is that guys who have testosterone levels above 610 tend to feel better than guys who have testosterone levels lower than 600. So maybe there is this impact of a range. So, if you're in that range, so above 300 but say less than 450 or less than 500, then it's probably reasonable to see how well you'll respond to therapy, especially if it's something that you would consider doing because it's a chronic therapy. You have to use the drug for as long as you want to use the drug.
And above 300, there probably aren't that many real physiologic issues that can arise because if your testosterone is too low, you can develop osteoporosis, you can potentially develop some cardiovascular issues and there are other sort of molecular level things that can occur in your body that contribute to poorer health. But then if you're above that range, it's dealer's choice. So it becomes a lifestyle decision.
Troy: So, if those you're testing, there's so many other factors we talked about that could be contributing to these symptoms. So, when people come in they say, "I'm tired, I just can't put on muscle mass like I used to, I just don't have the energy." Maybe they're having issues with erections, whatever it might be. Of those individuals, how many have low testosterone versus how many of you saying, "Hey, your testosterone is fine, you don't need treatment?"
Dr. Pastuszak: Yeah. So believe it or not, in our clinics, most of the guys who come in tend to have lower testosterone.
Scot: If somebody has low testosterone, then what do they need to do about it? How do you help them evaluate if that's the right move for them or not? Because the commercials would have me to believe, "Yes, it is." If I have low testosterone, yes. Start rubbing that cream on your chest.
Dr. Pastuszak: Well, the good thing is that most of the time guys have a choice. And I'll tell you by the time they are coming to see you, they probably want something because they feel bad enough to come and see you. So, if there's reason to . . . If they have symptoms and they have low levels, then it's probably reasonable to offer them therapy. And so now the question becomes "What is therapy?" And probably the most important considerations there are, "What is this guy's medical history? How old is this guy? And does he want to have kids in the near or distant future?"
And the reason I say that is, and it's funny because a lot of docs think that testosterone is really good for fertility, but it isn't. It's actually an excellent contraceptive. So, if you don't want to have babies, get on testosterone. It's not as good as what we expect in terms of efficacy. So we want 99%, we get 95% with testosterone within about six to 12 months, but I digress. So treatment options for guys depending on what they want and what their expectations are over the coming six months to several years include testosterone, they include a drug called HCG or human chorionic gonadotropin.
So this is a drug that actually tells your testicles to make more testosterone naturally. So, if you give testosterone, it'll shut down the access from your brain to your testicles that makes testosterone or make your testicles shrink. If you give guys HCG on the contrary, it will actually stimulate your testicles to make testosterone and it'll keep them normal size.
The other treatment option is a drug called Clomid or clomiphene citrate. This is a pill that can also tell your brain to make more of the hormones that stimulate the testicles to make more testosterone. So there are a couple of ways to naturally stimulate your body to make testosterone. And then there's testosterone. So why would you use one over the other? So, that has to do with, again, what this guy wants.
So, if we've got a 25-year-old coming in with symptoms of low testosterone, bona fide low testosterone levels and saying, "Hey, I just got married, I want to have kids starting a year from now." You're not going to put them on testosterone, you're going to offer him clomiphene because it's going to probably do the job and it'll probably make them feel better. Because ultimately, these guys want to feel better.
Whereas if one of us walks into a clinic, we may still want to have kids down the road, but I know based on the literature that Clomid is not going to do much for us. It'll raise testosterone levels. It's not going to make us feel better. We don't know exactly why. So then the treatment options become testosterone plus or minus HCG. And you can use them in combination. But bottom line, there are a number of treatment options. They come in various forms from injections to gels and creams to, like I mentioned, Clomid is an oral formulation. Testosterone also has an oral formulation that's not yet approved in the U.S. but approved in Europe. There are pellets that you can put under the skin. So a bunch of different ways to skin the cat, all of which can work depending on what the desires of the guy are.
Troy: And what's your usual go-to? Are you usually going with testosterone with most people and tablets? Or what's typically recommended?
Dr. Pastuszak: Yeah. So it really does depend on what the guy wants, but in a patient who say is our age, so late 30s, early 40s who is no longer planning on children but doesn't want his testicles to be raisins in 10 years, typically I'll put them on a low dose of testosterone along with HCG because the testosterone will give him the symptomatic benefit that he's looking for and the HCG will work in the background to keep the testicles working and not shriveling down into peas. So that's like a typical regimen.
Troy: And you mentioned one of the side effects that doesn't sound very appealing, having your testicles shrivel down so they look like raisins. What are some of the other side effects?
Scot: I think that's a bit of exaggeration, isn't it?
Dr. Pastuszak: No. Seriously.
Scot: That small.
Dr. Pastuszak: So guys who with high testosterone . . .
Scot: At one point I'm like, "Well, we know if they were a little older or when you're running that would be good." But maybe running that would be good.
Troy: If you get kicked that would be good, but in other circumstances it might not be ideal.
Scot: Yeah.
Dr. Pastuszak: It's like, "Ha. You missed."
Troy: Yeah. You can get these.
Dr. Pastuszak: No. But seriously, when guys have been on therapy for 10, 20 years, you can barely find these things.
Scot: Wow.
Troy: That's a little scary. It seems like a major downside of being on testosterone.
Scot: It does.
Troy: Any other issues you're finding? Because HCG side effects from that. Any?
Dr. Pastuszak: Yeah. So the two that are really specific to testosterone have to do with infertility and testicular shrinkage.
Troy: Okay.
Dr. Pastuszak: Everything else can occur with all formulations of, or all drugs that raise testosterone levels. And the most common side effects include on elevation in estrogen levels. And the reason for that is testosterone is the precursor for estrogen. So, without testosterone, you can't make estrogen whether you're a guy or a woman. So the more testosterone you have, the more estrogen you're going to have. And if you have too much as a result of being on testosterone or having too high testosterone levels, you can develop nipple sensitivity, tenderness, you can develop breast growth which is the end result of elevated estrogen levels. And you can start feeling like you're not taking anything because elevation in estrogen levels in a guy will then suppress the positive effects of testosterone.
The most common what we call dose limiting side effect of testosterone therapy is what we call erythrocytosis. And what this means in plain English is an increase in the red blood cell count that are in your blood. And a lot of athletes would love that because it gives them an increased oxygen carrying capacity. But if it gets too high, there is this theoretical risk for increased cardiovascular conditions like heart attack or stroke. Hasn't been proven, but that's what the community thinks right now.
Troy: So you're monitoring people pretty closely after they start treatment and then once everything is looking good, you let them go or how do you approach that?
Dr. Pastuszak: No. So, Troy, that is such an important question and I'm glad you asked it because if you're on hormone management, you really do need regular follow-up. And I can't overstate that. These are very good drugs if you know how to use them. They can change your life and they can keep your life . . . they can keep you feeling really good for a really long time. But the side effects, we need to just keep an eye out for them. And we're not asking you to come to the clinic every two months or anything like that. We'll get you to the point where you're "cruising," then we'll see you every six to nine months or so, or six to 12 months. But that regular follow-up to just make sure that your hormones are in check and that your side effects are mitigated is really important to the longevity of your treatment and to the quality of your life on treatment.
Scot: So, if somebody is interested, they would come in and then you would work with them to come up with a specific plan of attack based on whether they want to have children or not, the age or what the levels actually are, I would imagine willingness to accept some risks, that sort of thing?
Dr. Pastuszak: Yeah. All of those things. And Dr. Google is really good at scare tactics. Granted, there are some good facts out there, but really talking to somebody who has been doing this as a clinician for a long time and is comfortable with the spectrum of it is probably going to be your best bet towards a long-term solution for what you need.
Troy: So perhaps avoid doing those ordering by TV things where you're getting minimal interaction with an actual doctor.
Dr. Pastuszak: Yeah. So, I think, absolutely. And the other thing is that there are guys out there, especially younger guys who want performance enhancement, right?
Troy: Sure.
Dr. Pastuszak: And no matter what, if you take testosterone, it's a performance enhancing drug, but the amount of performance enhancement you're looking for relative to the risk that comes with that is what's important to consider. So, in our practice, we're not judgmental. We see guys who have been on steroids or are on what you would consider steroids. And part of the reason they come to us, especially in their 20s is when they were 18, they were taking all these very harsh anabolic steroids that caused their testicles to stop working later in life. I think the message to guys like that is, "Look, we don't really care what you're taking. We would rather take care of you in the context of what you need and make sure that you're staying safe because those drugs can be dangerous if you're just using them on your own."
Scot: All right. My story. I was on, I guess I don't know exactly what I was on now.
Troy: [inaudible 00:18:57].
Scot: No. I was not on . . .
Troy: It was not bad.
Dr. Pastuszak: Or steroid?
Scot: I did actually go to a physician. My testosterone was at the low end of the healthy range, so I was not out of range. And I got a cream that you rub on your chest and it ended up just . . . I don't believe that I really felt a benefit from it. I think I felt later, a couple of years later when I improved my diet and my exercise, I felt a lot of those symptoms start to go away. I think I jumped on board just because I thought it would cure a whole bunch of problems where . . . I think some of my problems are actually elsewhere being on testosterone is not going to solve the fact that I'm only getting maybe five hours of sleep a night because I have poor sleep habits. It's not rectifying the fact that I'm not exercising as much as I should. Maybe I'm a little bit overweight. So that was my take. I figured I should do those things first.
Troy: Yeah. I'm in your camp too. It's great to hear that these are options and makes people feel better, but I'm more, I don't know, I come from a little more from the perspective of, "Hey, I'm going to do everything possible." I can do diet exercise, improving sleep, addressing . . . potentially there are issues with depression, maybe anxiety that could be contributing to these things as well to try and address those things before trying medication. But I'm not saying that's the answer for everyone. It sounds like there are various approaches and you've seen lots of success with people you've treated.
Dr. Pastuszak: And I think that one other thing to say to that is as far as general health goes, and this just contextualizes things is, let's say you have an overweight guy in his late 30s or early 40s who comes in with all the problems that we talked about. So trouble gaining weight, not gaining muscle, tired, low libido, etc., etc., etc. So, and he may have low testosterone because he's overweight and stressed and eats like crud, etc., etc., but all of this and the way he feels limits his ability to exercise and to lose weight.
So you put him on the hormone and again, this is a lifestyle intervention. You can stop whenever you want. Most guys continue, but there are definitely guys who stop. So my point is you put them on the drug, all of a sudden he feels better, all of a sudden he wants to get up and go to the gym, all of a sudden he's exercising, all of a sudden he loses weight, all of a sudden his natural testosterone production goes up, etc., etc., and all of a sudden he's better off for it because you were able to break that vicious cycle of . . .
Troy: Sure.
Dr. Pastuszak: This vicious downward spiral.
Troy: Yeah. That makes perfect sense. And in those cases, maybe he's someone who once he just gets that and going, he will not need to be on testosterone long-term. He makes the difference. That's an excellent point and that may just be what some people need.
Dr. Pastuszak: Right.
Scot: It's a complicated issue and it's a very personal issue. So I would say that there's no way that in one conversation we can cover all the questions that somebody might have or all the pertinent issues. So, if you do have any further questions, Dr. Pastuszak would be happy to answer them via the men's health podcast that we're doing here. You can just email us to hello@thescoperadio.com and perhaps what we'll do is we'll get an idea of what questions are out there and then we can do a follow-up episode with some specific questions that our listeners have.
Dr. Pastuszak: Yeah. This is a great topic and it's something that's not . . . it's not going away anytime soon. So get your questions in, we'll answer them.
Scot: All right.
Troy: Yeah. This is a great topic. My knowledge of this topic is limited to the same ads that Scot is watching and that is the extent of my knowledge of this.
Dr. Pastuszak: Yeah. You've got to pay your subscription fees.
Troy: Yeah. I don't know.
Scot: Get better cable.
Troy: I don't know what I'm watching but . . .
Scot: Maybe get Hulu and pay for the non-added version. Right?
Dr. Pastuszak: Exactly.
Scot: Dr. Pastuszak, thank you so much for being on the show and thank you so much for caring about men's health.
Dr. Pastuszak: Absolutely. Thanks, guys.
Scot: ER or not. That's where we throw out a scenario. You decide whether or not you think you should go to the ER for it or maybe the urgent care. And Dr. Troy Madsen tells us whether we're right or wrong today. ER or not? Food poisoning. So you know the classic thing you go to somewhere and then a few hours later you're not feeling so well and maybe you're throwing up. Is that a reason to go to the ER? ER or not?
Troy: Is not a reason you have to go to the ER. The biggest challenge with food poisoning is if you're just vomiting so much, you can't keep any fluids down and you're becoming very dehydrated as a result of it. So that'd be a reason to go to the ER, get an IV, get some IV fluids, get some medication. Most cases of food poisoning, they're going to hit you about six hours, maybe six to 12 hours after you eat something that's contaminated and it's going to last usually about another six or 12 hours. So you're going to get over it.
If you've got medication at home, maybe you have a prescription for some nausea medication or maybe you can try something over the counter like a medication like Meclizine, something that you can use for motion sickness can help with nausea as well. The biggest challenge though with severe food poisoning is you just can't keep that medication down. So, if you're not keeping stuff down, you're not keeping any fluids down, you're just vomiting incessantly. Probably a reason to go to the ER, get an IV for medication and for fluids.
Scot: Incessantly meaning?
Troy: Incessantly meaning like what I had experienced once after I ate some contaminated potato salad.
Scot: Okay.
Troy: It was horrible. I was on the bathroom floor. I could not lift my head off the bathroom floor without vomiting. It was just vomiting until there was absolutely nothing left in me.
Scot: And then still vomiting?
Troy: And then still vomiting. It was absolutely horrible. Now, me being the very good patient I am, I did not go to the ER. I probably should have, but I didn't even want to lift my head off the bathroom floor to try and get in a car and have someone drive me to the ER. So that's really . . . when you just have this retching vomiting, you just can't stop. That's just awful. It's the worst feeling.
Scot: But it's been more common food poisoning, maybe two, three times.
Troy: Exactly.
Scot: And then you're done.
Troy: I think most cases is going to cause some belly upset and maybe some vomiting, maybe some diarrhea, but it's maybe a couple times. It's not super severe like that.
Scot: Urgent care?
Troy: No. Urgent care could give you a prescription for medication, but most urgent cares aren't going to do IVs and do fluids. Maybe some will, but most cases they're not. So probably the ER.
Scot: All right. Time for " Just going to leave this here" might have something to do with health, it might not. I'm going to start with my "Just going to leave this here." The role in the microbiome fighting off colds, flus and other illnesses. I noticed, personally, a huge difference when I started eating more vegetables. I eat a couple, maybe three servings of vegetables in the morning. I make a full omelet and then I usually have some vegetables in the afternoon. And ever since I've started eating better in that respect, I've noticed that my immune system seems to be able to ward off colds and flus and stuff which I used to get a lot.
So I wanted to look this up a little bit and I didn't have a ton of time, but the Seattle Times had an article from a nutritionist that said, "About 80% of your body's immune cells live in your gut or your intestine." And then it goes on to say, "The population of bacteria and other microbiomes that make up your gut microbiome play a big role in the strength of your immune system." And then they talk about the types of foods that will help strengthen your microbiome. And you're never going to guess what types of foods, Troy.
Troy: Fruits and vegetables.
Scot: You talk about it all the time.
Troy: There we go.
Scot: More specifically.
Troy: That's the key.
Scot: So, first of all, yogurt has that in it, fermented foods has stuff that the microbiome likes, but a plant-based diet with lots of fruits and vegetables along with beans, lentils, whole grains, nuts, and seeds will give your friendly microbes plenty to eat apparently.
Troy: Did you just cite the Mediterranean diet?
Scot: Sounds like as I did.
Troy: This is like recurring theme.
Scot: It is. So, once again.
Troy: Yeah. It's amazing. Fights colds, helps your heart. All the above.
Scot: Yep. So it just comes back to our core four plus one more. How important nutrition is. I have experienced this myself. There might be more robust research out there, but anyway, it's worked for me. So I love it.
Troy: I'm just going to leave this here. Scot, are you ready for winter?
Scot: No.
Troy: I am not. I'm not either.
Scot: My wife and I were talking about this just the other day. We're just not even ready for it.
Troy: I'm so not ready. I went running this morning. And running at 6:30 in the morning and I was running back home in a blizzard. It was just snow coming down and I . . .
Scot: It was snowing on you.
Troy: Yeah. It was snowing. I had a headlamp on. I couldn't see anything on because it's like driving with your headlights on, it's just like white out. And it just came out of nowhere. And I said, "I am not ready for this." I don't know. I used to love winter because it's ski season, you're getting out in the snow and that's fun. But I don't know. I've gotten to the point where I just don't know that I'm ready for winter. I'm trying to get excited for it. I think this last winter was just so long and so much snow, which was again, great for skiing or snowshoeing, but I'm trying to get myself psyched for winter. So I'm just going to leave this here. I'm not ready for winter.
Scot: Well, you ain't got no choice. It's coming whether you like it or not.
Troy: I know. What can you do?
Scot: All right. Time to say the things that people say at the end of podcasts. So let's try to split this up this time. Troy, you've been bogarting the whole thing.
Troy: So I've just got my list in my head and once I get going on the list, I'm just like, "I've got to hit all these things."
Scot: Like a freight train. Yeah. So be sure to rate and review our podcast. Give us an honest rating and review if you liked it. It helps other people find this podcast. We're wherever podcasts can be found. Spotify is one of the most popular places people are listening to "Who Cares About Men's Health?" But we're also on iTunes and Stitcher and the other places as well. To find out where, you can go to whocaresmenshealth.com.
Troy: Also, we'd love to hear from you. I don't know if anyone's actually contacted us yet with questions, but we would love to get questions. Don't hesitate it. hello@thescoperadio.com. You can check us out on Facebook, facebook.com/whocaresmenshealth. Our website is, whocaresmenshealth.com. We'd love to hear from you. Get back with us. Feedback would be great. I'd love to get some health questions, topics, anything like that.
Scot: It's all very helpful and it can ensure that we are talking about the things that matter and you care about. Thank you very much for listening and thank you for caring about men's health.