The Hormone Conversation Men Aren't Having

Speaker A: You are listening to Ms. For more on essential ingredients. I'm Justine Reichman and today I'm joined by a very Special co host, Dr. Lisa Brent, Naturopathic physician, founder of Blue Wall Natural Medicine right here in Mill Valley and one of the most thoughtful practitioners I know when it comes to the whole body experience of midlife. Lisa, I'm so glad to have you here today.

Speaker B: Thank you. I'm so happy to be here seeing you and it'd be great.

Speaker A: It is. And Ms. For more is about perimenopause, menopause, andropause and everything that happens to the body, the br in the relationships and the career. When hormones shift, we go where most conversations do not. Name what most people are only beginning to understand. And we do it with clinicians who believe you deserve the full story. Today we're going in deep on something that does not make the headline list of menopause symptoms, but absolutely should. We're talking about the heart. Heart disease is the leading cause of death in postmenopause women, not breast cancer. The heart. Our guest today is Drew Sinatra. He's a board certified naturopathic doctor and founder of Inspire Naturopathic Medicine. Drew co found founded his practice with his wife, Dr. Briana Sinatra, around the belief that the path to healing starts with feeling inspired. He carries forward a legacy his father, the renowned integrated cardiologist Stephen sinatra, built over 40 years. And he brings both the science and the wisdom to the lineage. Everything he does. Drew, thank you for being here.

Speaker C: Oh, it's great to be here. Thanks for having me.

Speaker A: Lisa, before we bring Drew into this conversation, can you set up for listeners why this episode matters so much you personally and clinically?

Speaker B: Well, I think as you and I both agree from different angles, we want to take the conversation around midlife health for women and men to sort of a deeper level. There is a lot of talk and buzz around the things that we should do for our menopause and also the andropause, maybe less buzz around that, but there it can be confusing and overwhelming about, you know, what's really real and valid, what's real medicine, and what are the important things I should be doing for my healthy longevity. So I think we both have an interest in taking this conversation around midlife, uh, health and beyond to a deeper, juicier level and get more action items for our listeners.

Speaker A: I would agree. And Drew, it's so great to have you here to be able to talk to this conversation, which really, I didn't even really know existed until not too long ago. I mean, it's not part of the conversation. It's not dinner conversation. I've spoken to so many men that are like, I don't know what you're talking about.

Speaker C: First off, the name andropause, or term andropause, is really like a misnomer because men, they don't all of a sudden lose their hormone production or testosterone. It happens very slowly and gradually. Right. So the name andropause doesn't really make sense to me. It's more of a testosterone deficiency syndrome. That's kind of how I look at it. Over time, their levels of testosterone decline and they start to feel symptomatic in their body, whether it's feeling fatigued or their muscles aren't as strong anymore, or endurance in the gym isn't as good. They, uh, might notice, like, mood issues where they're feeling low or just not as, like, motivated to do things. And of course, what people know most about is libido issues. They hear about this all the time where men are having erectile dysfunction or lack of libido. And that's when people tend to think of testosterone being low. But the reality is not every male goes through this syndrome, right? This andropause, as we like to say, it certainly doesn't happen to every male. And it's different within the different decades of a man's life. I mean, testosterone begins to decline technically in the 30s, but we don't really see symptoms show up in men typically till, like, their 50s or 60s.

Speaker A: Just so we can kick this off and really let people know, why should people be tuning in? Why should men and women be tuning into this conversation today?

Speaker C: Well, for men, this is something that is not necessarily talked about with either their doctor or their friends or their partners. And it should be. It should be something that is discussed openly. Contrary to women, men typically don't seek out medical help. They tend to kind of hide and deal with their issues on their own. And then unless they're part of a men's group or they have a really supportive, you know, men's network, brotherhood, so to speak, or community of men that they trust, they probably don't talk about these issues at all. But a lot of men are experiencing issues like this, and I feel like it needs to be spoken more of.

Speaker A: I couldn't agree more. And so the goal of this Ms. For more series that Dr. Brent and I are putting together is to define andropause clearly for people, establish the timeline and name it why it is so invisible, setting the stakes for the rest of the conversation. So most men have never heard of this, as we discussed, and most people listening to this have probably never heard it applied to someone they loved. Start us at the beginning. You know, let's. Let's just break down what is andropause. What is. What is actually happening in the body, and when does it begin?

Speaker C: Yeah. So andropause technically is defined as a lack of production of testosterone or a decline in testosterone over time. And like I said earlier, this can begin in the 30s, uh, but typically, symptoms aren't really showing up until late 40s, 50s, or 60s. And look, there's all sorts of different theories as to why testosterone may be declining in general in men, but really, a lot comes down to lifestyle habits where men are not sleeping as well as they should be or as long as they should be, stress levels are high. Um, a lot of people are dealing with being overweight or obese, which leads to, you know, a lack of testosterone production in the body. So there's all different reasons why this is happening. But now I feel like it's becoming more talked about, which is really good thing, as menopause is. Right. So we. We need to be having these conversations more because a lot of men are left in the dark, and they just deal with their issues on their own.

Speaker B: Yeah. And what I observe a lot because I see mostly women, you know, women in perimenopause through menopause, transition, and post. And, you know, yeah, you're right. More women do seek out ways to feel better, to move through this time, you know, feeling more vital to solve things that are in the way, like their poor sleep or low libido or weight gain. And, um, what I hear often, especially after women sort of feeling a lot better, is, do you see men? Right. Because she's starting to, you know, kind of feel like she's back to herself or she's in this new kind of phase and feeling good and noticing maybe that her partner is. Yeah. Maybe not able to keep up with her physically or isn't doing as well mentally or something. And I think there it can be, yeah, a bit of a, uh. It's a d. Desire for each person in a partnership or, you know, all the men that we know to feel good and age well. But I do think it is easier for women to talk about it.

Speaker A: Lisa, you get. You know, women like myself come in many times we're asking so about our partners, our husbands, et cetera. So from your perspective, you know, what does it look like when somebody. A man is going through andropause, and they've walked in your door, and then you're sending them to maybe somebody like Drew or you're talking to them. So I'd love to hear both from both of you what that looks like. Because, Lisa, you might be getting the people like me that are asking, right? And Drew, you might be getting more of the men. So I'd love to hear both perspectives.

Speaker B: So I could start just. Because sometimes it might happen that way, right? Like, uh, you know, I'd love to get my husband in here or my partner in here. And so first, where I might start is let's all. Let's find out what's going on. This. How he's feeling might have very little to do with his testosterone. There might be a lot of other things going on with his thyroid health or cardiovascular health or lifestyle or diet. You know, that's an important place to start. Even though the wife or the partner might think it's about that. We have to make sure, right from a fresh set of eyes and. And more, um, objectively what's happening and, you know, and then go from there. And some men, yeah, like, need sort of a deeper level of maybe hormone management, and that's a little bit out of my scope. So then I might refer to someone like Drew, you know, who kind of has a deeper grasp on that, or they need some other level of advanced care, or there's just some things we can do, and they start feeling better. And I'm sure that's the same for Drew. And then we keep building on that.

Speaker A: So when these people are coming in, what are they. What are the symptoms or what are they experience or what are they showing that we then are like, okay, I need to send this person to Drew to go discuss. Andropause, because potentially it's that it's not the thyroid, it's not cardiovascular, etc.

Speaker B: Well, it can look a variety of ways. I mean, some men come in and they're not sure why they're there. They're just like, their wife wanted them to come, right? And asked them to or made the appointment for them. You know, it could look a lot. You know, our screening as naturopathic doctors is pretty thorough, right? Like, how are you sleeping? How's your digestion? How's your mood as your energy, like, so we're looking at all of that and finding out for him which areas aren't feeling ideal is, you know, has your athletic performance, you know, declined, or you're having brain fog, whatever it is, we're just trying to assess what his, you know, concerns are. And then you, uh, know, probably run some labs and find out kind of. And, you know, some. What's going on. Where I might refer is, you know, a. Sometimes a man would prefer to work with a man, which I totally get. And that's, uh. Yeah, that's a very good reason to refer to a colleague. Or if, you know, I'm pretty comfortable with treating men using testosterone. But if it's getting to be like, a little more complex in the way that sometimes hormone therapy can get complex, then I would probably refer to Drew to manage kind of the more subtleties, because that's. I want it to go well for this man. And we often get less time with them. Women love to come back. We're seeing them pretty regularly. Right. We might just have a couple shots with the skin guy. Right. To start getting things to work before he thinks, this isn't going to do anything for me.

Speaker C: Yeah. I'll, uh, add that that one word that hasn't been used yet is, uh, or description is a lack of vitality. So a male may come in and they just say, well, you know, I'm just not feeling like I used to. I don't have the energy I used to have. I don't have the muscle strength. I'm lacking motivation, lacking drive. Oh, and by the way, I'm having libido issues. Right. That's kind of like how they may present, but really at a foundation. It's the. The male is not feeling as vital as he used to. And that's when I tend to think about, well, let's check your testosterone and let's see where you're at for your numbers.

Speaker A: So before we move on to our next section, as I like to call it, like act two, I just wanna take a quick pause because I wanna just talk to our listeners for a minute. So if you are listening to this and thinking of someone who needs to hear it, please share the episode right now. A partner, a friend, a brother, a colleague. This is the kind of information that changes how people understand themselves and the people they love. Send it. And if you want to keep going deeper, find us on substack. The link is in the show notes. The WTF community is waiting for you. Okay, so we're back now, and, um, we're here to talk about the symptoms. Nobody connects. So for me, this section goes deep on what andropause or what I hope this section will be. It's going to go deep on what andropause actually produces the symptoms, the misdiagnoses, the human cost of leaving it unnamed. Lisa brings her clinical and relational lens. And I'm going to try to keep perspective here. And Drew, I'm hoping that you can walk us through the full picture of what andropause produces, not just the libido. What are the symptoms men experience that they would never in a million years connect to their hormones?

Speaker C: Yeah. So we'll go over symptoms again. So let's just say a male comes in and he's. He's 55 years old, and he says, I'm not feeling like I used to. And I say, what does that mean? They'll say, well, at the gym, I just don't have the muscle strength anymore. Um, I'm feeling more fatigued lately. I'm feeling a little moody. I'm a little irritable. I'm not connecting with my wife as well, my kids as well. There's these mood shifts happening, and then there might be some libido issues. Right. They might have lack libido, they might have erectile dysfunction, or they have difficulty getting erections, or maybe they're not waking up with erections in the morning anymore. And these are all the signs and symptoms that I'm kind of thinking about a low testosterone for a male. So really, the next step is, well, let's get some labs done, let's do some testing to figure out if you truly do have low testosterone or what Lisa mentioned earlier. Let's make sure your thyroid's functioning. Let's make sure you're not anemic. Like, let's do all the basic stuff to make sure that something else is not going on and that we're not just, you know, narrowly minded, focused on testosterone.

Speaker A: And Lisa, as Drew is saying this, and you see patients as well, you know, one of the things that. And I don't know that this is true, that I've heard people get diagnosed with depression and, you know, is this a misdiagnosis and a midlife? Uh, are men being diagnosed with depression and antidepressants when what is happening is really hormonal? How often are you seeing something like that? And, um, what does it cost men? And when it goes unaddressed, you know, what's at the root of this, I

Speaker B: think you've touched on. It's a really important paradigm to look for the root of all the things that happen to us. I mean, at any time of life. This seemed to be pretty pronounced around, you know, the 50s and beyond. You know, what are the downstream Consequences of hormonal changes from men and women. Right. Like changes in energy, changes in sleep, changes in mood, changes in cholesterol numbers. All of these things which tend to, in our conventional medical approach, get treated kind of in that whack a mole fashion, like, oh, you're depressed, oh, you have insomnia, oh, you have high, you know, like cholesterol. So we have a medication for that and that and that. And sometimes that is the right thing to do. Especially if somebody is suffering with a severe mood, you know, issue, or they're, you know, it's really getting in the way of their quality of life. There's. It's great that we can do sort of those fast acting things, but again, I think from our perspective, we want to step back and look at what's. What are the contributors that may be a part of every piece that's happening. So that if we treat more at the root, we cover a lot of bases in a, um, less invasive and less, yeah, ah, piecemeal kind of way.

Speaker A: Drew, did you have any additional thoughts you wanted to add to that?

Speaker C: No, but I will say just going back to testosterone and andropause. Right. It's like even the word andropause is going to deter a lot of men. They're gonna say, I don't have andropause. I don't want that. Right. There's a stigma associated with having low testosterone. So men may think, well, I'm weak or I'm not man enough, uh, if my testosterone's low. So already men are probably not wanting the diagnosis of a low testosterone. So we need to be mindful of that. And then on the, on the flip side of the spectrum is, well, I don't want to do testosterone or I don't, you know, I don't have low testosterone because I don't want to be anything like those gym rats who are using steroids. And so you need to kind of phase those things out because really, this is a real thing. But yet the testosterone that we're talking about today and we'll discuss, they're nowhere near the steroid levels that men use in the gym to get really buff and everything and really built up. So I think there's a lot of information out there that we need to discuss with our patients around testosterone, the safety of it, the prevalence of testosterone being low, how to use these m. You know, these, these hormones in a safe fashion. Like, there's a lot of discussions we have to have with our patients.

Speaker A: Yeah. And I've heard, you know, Men have concerns over testosterone, I've heard. And so it even begs a question for me for menopause, because if I'm going to take, you know, testosterone, what are some of the issues? And my understanding was they're actually very different for men and for women. And I would just love to hear a little bit from either one of you, from both of you, about some of the implications that, you know, whether we are correct, whether they're not. What people should be asking, what people should know about this.

Speaker B: Uh, I will say for the women, from a women's point of view, I think one of the biggest fears about testosterone, you know, supplementation, is. Yeah, the virilization. Like, will I grow a beard? Will I, you know, get big, you know, and bulky? Which is not at all the goal. I mean, the goal is to help our patients feel better. Right. It should be almost all benefit without harm. And so that has a lot to do with. Yeah. Appropriate screening. Like, is this an appropriate therapy for the patient? Say, if it's testosterone, appropriate dosing, which for women is, you know, a fraction of what the physiologic dosing is for men. And then the appropriate delivery system, which, as Juice said, is, you know, that's all part of, kind of the education of our patients so that they feel comfortable doing it and what to expect. And then also our job is to dose and monitor appropriately so that, you know, if someone. Yeah, if they. They want to look like a gym rat, that's a different. That's a different story. And they're probably not getting it from us.

Speaker C: Um, I mean, I'll say that. So a lot of men. I shouldn't say a lot, but some men come in seeking testosterone, and they certainly don't need it. And so, you know, luckily we run labs and we figure out if their testosterone is low. And, uh, many times I'll say, listen, your testosterone's sufficient enough. You don't. You don't need it. Men, of course, don't like to hear that sometimes, but, um, that's the truth. In terms of, like, contraindications, let's say, if a male is presenting with these symptoms that we just talked about and their testosterone is low on their blood work, or at least their 3 testosterone is low, which we can get into. Um, you want to make sure that there's no active prostate cancer. That's kind of a big no. No. And really, there is some controversy around if a male has had prostate cancer before, can they or should they be on, um, testosterone replacement therapy? I refer out for That I don't deal with anything regarding the prostate in terms of prostate cancer, but that is a big contraindication is active prostate cancer. So you want to make sure you screen your patients for that. And then, of course, when you do blood work, you want to look into their RBCs, their hematocrit, their hemoglobin, to make sure that those levels aren't too high to start off with, which is very important because if you do run a CBC and their hematocrit is high, you need to ask the question, well, do you have sleep apnea? You know, are you smoking? Are you at high elevation? You gotta rule out some basic things before you do start testosterone, because testosterone will inadvertently raise these markers on someone. And so you do need to be careful that they're not already elevated. And there's other tests that we can discuss, of course, like measuring their estradiol or their sex hormone binding globulin or their free testosterone. These are all things, including the psa, looking at prostate health to make sure that testosterone is appropriate for them.

Speaker A: What I hear is a lot of blood work.

Speaker C: Yes. And, and regular and, and repeating labs too, uh, to make sure that once you do put them on testosterone, that you're following up to make sure that their hematocrit or RBC isn't going up too high, that their estradiol isn't going up too high, that their prostate, their PSA isn't going up too high. So there are some basic things you do need to run on a regular basis.

Speaker A: M. And the other thing that I, that was mentioned to me once and again, I don't know, this is a fiction or you know what, but I've heard that testosterone can have a negative effect on men's longevity. What are your thoughts on that? Have you heard this?

Speaker C: I haven't heard that. And okay, so. So there was a trial that came out two years ago called the Traverse trial. And this looked at like, all core, all cause mortality, cardiovascular mortality, and morbidity associated with testosterone use. And they didn't find any lessening of, you know, or at least any increase in morbidity, for that matter, in terms of cardiovascular disease. So what they did find was there a. What there was a small increased incidence of pulmonary embol. So that was good for me to see because now in my brain I'm like, okay, if someone has some sort of clotting disorder or they're, or they're at risk for clots, we need to be very careful with them going on testosterone. But ultimately, this trial A traverse trial did not show any, any decrease, let's say in longevity long term by using testosterone.

Speaker A: Well that's very good to know because I thought that was alarming when I heard that. So.

Speaker C: Mhm.

Speaker A: I want to continue our conversation as we were talking about mental health because mental health and suicide connection can, is a really important conversation. I think it's a conversation that people need to be willing to have. And in midlife, uh, oftentimes the male suicide rate peaks. Right. And testosterone declines. Depression, isolation and the cultural pressure on men not to ask for help. Not that I want to say that you wouldn't ask for help, Drew, but I'm just saying culturally speaking. So how do those things interact with. And what does early intervention with andropause actually look like?

Speaker C: All right, I'll, I'll take that. So there's, there's so many questions within that one question. Like Lisa said in the beginning, we need to be so very like comprehensive with our questions and ask about their sleep and their community life, their eating, their exercise. Like these are all such important things to be talking about because as a male becomes in their midlife, they uh, may be working more hours, not sleeping enough, eating crappy foods, not connecting with their partner or their male friends or their community as a greater, as a greater large. And really if all those things are off, they're probably going to feel isolated and depressed. And that's something to really look into. Testosterone is not the answer for a lot of men who are feeling very depressed and especially suicidal. So I want our listeners to know that, I mean you really need to seek help if you are suicidal. But make sure that when you're talking to someone that they, they were talking about their exercise, their sleep, their diet. I mean these are all very important things that in, in midlife.

Speaker B: Yeah.

Speaker A: Lisa, is there anything else you wanted to add or maybe things that you might want to, you know, your perspective that you might want to share?

Speaker B: Yeah, I mean, I think I, I agree. I mean we're, we want to look at again the whole system. Right. And, and you know, most patients show up in our offices with you know, at least one or two sort of primary drivers or the things that are really kind of, they're having a, ah, hardest time with. And so we do, you know, often start there. We want to help even while we're taking time to assess. Cause we want to try to give people some relief and help them feel better. So you know, there are say with mood, you know, issues if depression, uh, is really predominant, you know, There are some natural ways to address that, you know, that are probably pretty safe for everybody that we might be able to assess even in a first visit to get something started while we're looking at other contributors.

Speaker A: But could you maybe give us a couple examples of what those are, just so listeners might know what those, those kinds of resources might be or what they would look like?

Speaker B: Sure. I mean we use, we probably all have kind of our favorites. I know I use often an um, amino acid called 5 hydroxy tryptophan or 5 HTP, which is a precursor to tryptophan, which crosses over the, through the blood brain barrier and helps to make serotonin. So serotonin is the neurotransmitter that helps to regulate our mood and is often low in depression. That why SSRIs, serotonin reuptake inhibitors are, you know, the medications that are used. But if there's actually a lack of serotonin, then sometimes those medications aren't really going to uh, be as effective as they as maybe helping to promote serotonin itself, which we can, you know, so something like that. We use herbs like saffron or a supplement called Sami other ah, sorts of, you know, there's some great herbs that we consider kind of nervines that can help with sleep or if there's a lot of anxiety. So there's some tools right away if, you know, if it seems appropriate and we just need to buy a little time and help someone feel better.

Speaker C: Yeah, and I'll add in that, I mean, Lisa, you know, said it right with all the supplements and herbs and such. And exercise, I think is just like absolute number one. It's like a medication for myself for a lot of men. And it's great at boosting mood, it's great to help men lose weight, to build muscle. All these things that are kind of associated with low testosterone. So I, I like exercise is one thing that I probably push the most in my practice to get people moving about, get out in nature, walking with a loved one, a friend out in the community, in the neighborhood, whatever it is, just to get outside and get some exercise. So key.

Speaker B: Uh, yeah, and I would like to just add on to that. I absolutely agree. I think it is like our most powerful tool for so many, you know, of our health goals and what can be sort of an interesting way to work with that, you know, because we might see somebody like someone, a man might say, like, yeah, I just don't even feel like exercising. Right. I don't have the motivation. I Don't, you know, have the stamina, the energy? I don't really want to. And we know that it will help them if he can. Well, that's where, again, coming back to like, checking out the biochemistry, because there might be some good reasons why he doesn't want to exercise. Maybe he's really hypothetical thyroid or anemic, or his vitamin D is low, or maybe his testosterone is low. And then if we support those systems, then often energy and motivation picks up. We want, you know, he wants to move more, work out more. The more he exercises, the more he's going to support his own testosterone production and, you know, feel better, probably lose weight or, you know, build more muscle, and then the ball gets rolling. And that's, you know, that's really what we want, is for people to take their own health in their own hands and use the tools available to them. And we're here to just kind of, you know, augment the pieces that might need a little kickstart.

Speaker A: So one thing that you were saying, you were talking about, you know, losing weight, you're talking about doing the exercise, but also being efficient by taking different supplements, depending on what the needs are, etc. Because it helps it be more efficient. Can you talk a little bit about that? Because I've heard so many people in midlife talk about the challenge that what they were doing before just isn't working anymore. Whether it's eating, even if they're eating right, whether it's working out, and it's just not the same.

Speaker C: Yeah, I mean, I think we're all dealing with this today. There's a lot of chronic illness and people aren't feeling as well and vibrant as they used to. So we almost have to up the ante, so to speak, in terms of exercise and supplements and lifestyle habits, making sure we're sleeping, et cetera. But, yeah, I think. And this is where you can measure testosterone and other hormones in a male who's starting to feel this way, because like Lisa said, it's a good kickstart. It's like a nudge that. That you can give a male along with what we just talked about, the supplements, the exercise, making sure they're sleeping well. And then it kind of just gives them that motivation and that drive to, like, want to do more things that are good for them, including eating well. And that's where I see testosterone shine, is that it gives men the vitality back that they've lost, improves their mood if they are feeling down, and gives them that motivation and that drive to

Speaker A: do More when you have somebody that comes into your office and they need to do a whole workup, what are some of the questions that you're asking or that you're sharing with them to ask if they're going to drew and vice versa? And what would that workup look like for them? Just so that people are educated enough to know what they should be looking for? I mean, I have to tell you, I never knew that I should look at cardiac health when I hit perimenopause. That was not part of the conversation. So I'm assuming, you know, the same goes for men, you know, as we talk about andropause.

Speaker C: Yeah, I think it's very similar to women. You want to make sure that you're measuring all the hormones. So we want to measure their. Their testosterone, their dhea, their cortisol, their estradiol, um, their thyroid, making sure their TSH is within normal range, making sure their nutrient status is sound. And. And really, it's. It's. It's just a matter of combining what you're finding on labs with how they're feeling. I mean, that is really a key element here is that making sure that things are overlapping, because sometimes you'll come in and a male is feeling this way where he's depressed, he's fatigued, and if you do a total testosterone, the total testosterone's low, but yet their free testosterone is normal. That may indicate that they may just need to maybe perhaps lose some weight, exercise more, uh, and do some other things to kind of get their free testosterone up. And it may not be necessarily like a testosterone issue, but more of like a metabolic type issue. So there's all sort of different, you know, paths to take here and levers to push and all that.

Speaker B: Yeah, I mean, as you know, Justine, we're very nosy, you know, in our world. And, you know, we ask, you know, our questionnaires are detailed and we ask, you know, we want to know your family history, what are your lifestyle stressors, what's a typical daily diet for you? You know, we want to know sort of a lot about you. And then, yeah, our lab testing, um, when we are able to do it, is pretty comprehensive and will sometimes even go outside of the regular, like, quest and lab and LabCorp kind of things. If we want to do some specialty testing, say on the microbiome or a specialty cardiovascular lab, you know, if we can do that, especially using the patient's insurance, or make it kind of accessible and affordable, then it gives us the most ways, sort of to be precise, with our patients and sort of like, where are the systems we need to support and what actually applies to them? Yeah, specifically.

Speaker A: So I don't want to. Cause I don't want to call andropause or menopause, like, I hate to call it like something you're going through. I feel like it's part of the journey. Do you know what I mean? And you're not going to cure it, right? Like, we cannot going to cure. I mean, you can adjust it, but I feel like cure is the wrong word. And uh, uh, you know, so the conversation, it sort of goes in a variety of different directions when you're trying to solve a problem. Problem is really. So when I think about these words. So when we're looking at the actual treatment options and plans for our andropause, I'd love to have a conversation about what should happen between a man and his doctor before they start anything. What does an informed individual live care look like a care plan?

Speaker C: Well, I wanted to say that, uh, we're talking about health optimization here. We're talking about improved quality of life ultimately. Right. So that's important to bring out because, sure, aging happens in everyone. Andropause doesn't necessarily happen in every male. So you really need to figure out like, okay, what is your quality of life like right now? And how can we optimize that? How can we make that better? And so having that discussion around testosterone is one thing that I do on a regular basis. And it's like we've been talking about all today is it's not always the case, but it can sometimes be the case that that's something that we look at and treat.

Speaker B: As you said, menopause and andropause, these are not illnesses. Right. There's nothing to be cured. All women, as opposed to not all men, will have kind of what we call the andropause. But, you know, they're going to have changes in their health if they hang around long enough. And all women will have some version of menopause. And really what we. We don't need to treat that. Really. It's, you know, it's natural. What we're looking for are, or the reason we care is that it may change how a woman or a man feels in their body and how their optimal health is affected. Right. So that's what we're looking for. What's in the way of you feeling your best and, you know, and then we focus there. If, if you're, you know, if you're feeling pretty great, you're probably not in our office, which is great. It doesn't mean that at midlife, for both men and women, there aren't things that we should be thinking about to plant the seeds for our healthy aging. Right. So, you know, if. Even if you're not having overt symptoms, it is good, you know, after age 50, to start paying a little closer attention, getting thorough lab panels, going to see your doctor every year. Right. Like, just noticing even small changes, maybe wearing a device that rates your sleep or, you know, those kinds of things. So that we keep feeling well for as long as we possibly can.

Speaker A: Yeah, that's the goal.

Speaker B: Right, the goal.

Speaker A: Lisa, there's so many different studies that have come up. I'm curious about, you know, what you might ask Drew with regards to research on environmental estrogens, endocrine disruptors, and how they affect, uh, testosterone in men. So what questions would you ask him? Or would you, you know, talk to your clients about if you were sending them to him, to make sure that they could speak to that and, ah, that they, with their families, might get more educated, um, and might find ways to contribute to the decline beyond age?

Speaker B: Yeah, that's a really good angle. And, yeah, I am not expert in environmental medicine, Drew. I think you have better training in that area or maybe different ways you go about it. What I do know is that environmental toxins, such as mold or heavy metals, can be what we call endocrine disruptors. They can mimic hormonal disorders. So it is good to keep in mind, if someone's presenting with a hormonal imbalance of any kind, we can always assume, okay, it's just your age, but we shouldn't always assume it's just because of your age, especially if there are other kind of things going on that don't quite make sense, like they're getting sick frequently, or they're having some neurological issues or some constellation that's not easy to kind of wrap up. Then we want to know, like, are you having a mold exposure? Or have you. Do you work around chemicals? Are you eating organic food? Are you filtering your water? So if it goes beyond that, and you know my comfort zone, then I am referring to people who.

Speaker A: And that's. That's exactly what my question is. Like, so when you're going to refer to Drew, what are some of the things you might tell your clients to ask or investigate with him?

Speaker B: Well, I might just say, I don't really know. Please go ask him, because he's smarter than me, so I might just leave it at that. But I mean, I'll let Drew speak for his point of view. Like, you know, we all kind of have the environmental medicine lens now, but also, everybody does it a little bit differently. So I'll let you speak to how you approach that.

Speaker C: Yeah, I mean, I even have people that I refer to for severe environmental toxicity. I mean, there's all varying degrees that we're talking about here. But like Lisa said, ah, looking at all the basic stuff, whether it's, you know, toxicants and chemicals in the environment that you've had exposures to, or mold or metals and such, sure, those are great places to start. I will say that even if you correct those things, though, you. You're not going to see a big jump up in your testosterone. You might see a small increase, but really, this is where all these things are super important to look at and to address. But ultimately, if a male is having all the signs and symptoms of testosterone deficiency and their labs are showing it, they will likely benefit from going on something like testosterone or something that boosts testosterone or removing something in their life that is preventing the production of testosterone. So there's many ways to go about this, but, yeah, environmental medicine in general, very important to look at for everyone, not just, you know, aging men and women, but everyone. We're all living in a toxic soup these days, so everyone needs to detox at some point.

Speaker A: So, Lisa, uh, in your practice, I know you either you mostly see a lot of women, but you do see couples with their partners in some form of hormonal transition simultaneously. Simultaneously. And neither one sometimes even knows it. So the woman might be in perimenopause, the man is in andropause. Nobody has named either thing. What does that look like? And what changes when you actually name it?

Speaker B: Most people are just relieved, right? Because I think we have this story, like, you know, you kind of peak in your 30s, and it's all downhill after that, right? You're not going to ever really have that same level of vitality or look as good and, you know, and feel as good. So I think what we probably both see a lot are, like, people, like, aren't feeling like themselves, and it's kind of confusing. And they're often, you know, I know. Especially women kind of blame themselves, like, I'm not working out enough or I'm not intermittent fasting or whatever. And so I think when we can identify, especially biochemically, like on labs, like, oh, this is actually like, you're really deficient in vitamin D or your thyroid isn't working well, or your cortisol is really disruptive, regulated. For men and women, I think it's a huge relief, like, oh, there is an explanation for why I feel this way and there's something we can do. And, um, then it's, you know, we all like a plan, right? We all like to have some steps. And I think, you know, we try to make our, our plan doable and sustainable. Just we're going to start here, you know, we're going to do these three supplements. We're going to make these changes to your diet or whatever it is. Um, we're going to add a little testosterone and then we're going to track. Right. See, you know, we should be feeling better in this amount of time and, you know, and then we're gonna keep building on that.

Speaker C: Yeah, I'll just add, Lisa said it very well there that sometimes giving a name to something can really help someone because then you have a plan, then you have a plan of attack and you can go forward and see changes. Um, and to know too, that there's not just something wrong with you, but you're, you're, you're suffering, uh, with other men and women in the same age group. So that is helpful to have sometimes.

Speaker A: And so as we talk about this in this series and we talk about the losses of hormonal transition, I want to end it here on something different. What do men describe when they get support, when they actually get treated and come through this? What changes for them and for the people around them, their relationships, whether it's work, personal, family.

Speaker C: Yeah, I'll start when men, let's just say a, um, male has now started testosterone replacement therapy, trt, and you follow up with him a couple months later. Generally speaking, they're going to notice a change in how they're feeling physically. They might notice more energy, uh, they might notice they can lift more at the gym. They feel like they have just more vitality. And then they might say, well, hey, I'm connecting more with people. I'm not as down. I'm more motivated to do things. Um, and then of course, they might say, well, my libido is starting to shift for, in a positive direction. These are all great signs and symptoms kind of pointing in the direction of like, this is working. Testosterone is working for me. I'll also plug too that, yes, like, testosterone certainly a part of the equation. But I encourage most men to join a, uh, men's group. I feel like it's incredibly important. I was a part of one for many years. And you go to A group with men who are in a similar life stage as you. And you learn that you're not alone with the stress we're under with our children and our work in this crazy world we're living in. And to be able to talk to men openly about stress in life and what's going on for you, I think is super, super important. And you, you also learn tools and how to move forward in life without being as stressed and reactive and angry as a lot of men deal with, you know, a lot of anger issues. Right. So it's just throwing it out there to your audience to, uh, if you're ever feeling alone, you want more male connection in your life, join a men's group.

Speaker A: Awesome. So I think that's great wisdom. I mean, I think that that's so great. You know, women connect all the time. We are, we're. We just always want to conn. And I think that it's not as common for men. Maybe. I don't know if it's harder. I don't know if it's less common. I have heard. I do have some friends here that belong to the book club. They don't discuss books. It's just a men's club. But, you know, it's kind of funny, right? So, you know, if every man listening walked away from today with one thing, one thing this week, what would you tell them?

Speaker B: Go talk to somebody about it. Right? Like, you know, get a referral from a friend or from your partner and just go see if there's some other stuff going on. You don't have to do anything. Right. Like we might recommend a whole plan for somebody. You don't have to do it. You know, it's just this is what we see would be good for you. Not going to be, you know, forced into some changes that you're not ready for or anything like that. But, you know, go, go check it out. Um, because there could be some very small tweaks to. Yeah. Either lifestyle or diet or a little supplement or a little peptide or something that could just up, like, you know, how you're feeling in the world and how you're experiencing your life. You know, we get. Not to be too, you know, philosophical, but we get one shot, you know, this is it. And most of us, after 50, we're kind of on the down, you know what I mean?

Speaker A: Right.

Speaker B: So, like, we want to feel good while we're here. So, uh, that would be my one thing. It's just, yeah, go run it past somebody, get some tests done and go from There.

Speaker A: So for you, Drew, if there was one thing that people that, uh, if every man listening today walked away from today and did one thing, if they did one thing, what would it be?

Speaker C: Tough to answer. But I will say that you can feel better tomorrow compared to yesterday, meaning you can feel better in your 40s and 50s compared to your 30s. There's so many different things you can do for yourself. So I'm all about health optimization. It's helping you feel better in your body, in your mind, and in your relationships, in your life. There's just so much, so much you can do. Testosterone is literally 5% of. Of that. What Lisa said. It's, it's. Don't be ashamed, don't. Don't feel anything. Know that there's people there to help you, to support you through this. And you're not alone. I mean, there's so many men and women that are going through this time mid life. That is a big change for them. So don't feel like you're the only one suffering or that there's so much we can do to support you. And you're not alone in this journey.

Speaker A: And so for those that are tuning in today, the partners that are listening, the women, the families, because andropause is so under the radar, should I say, not talked about, not popular, not common. What is the one thing you want them to know and do?

Speaker C: The women. You're saying, what do you want the women to do?

Speaker A: The women, the partners, the families, the people that are surrounding. They're, you know, the people that are experiencing at this time of life. Andropause.

Speaker C: Well, with what Lisa said, I mean, someone has to be ready. Uh, we don't want to, like, push them, right? And say, well, you need to go do this. This is what you have to do. They have to be ready to make any sort of change or want to do a change, for that matter. But if there's any level of curiosity there, sure, bring it up with your partner or a loved one or family member, whoever it is, that, hey, maybe, maybe there's something going on for you that you could improve by seeing a doctor that knows something about hormones or health optimization. So, yeah, don't be afraid to ask that question. But also, don't push someone. You don't want to push them. They need to walk through the door themselves.

Speaker A: Yeah, I agree. It's a hard conversation, and I think it's uncomfortable as anything is. And I think that, uh, because it's also so new and not widely talked about as much, I Mean, menopause is only beginning to have, you know, be part of people's everyday conversation.

Speaker B: Now, I think I just add on because I think you and I had this conversation at one point, Justine. I think there's also that perspective that can be helpful, especially if you're in a partnership, you know. You know, say, a man and a woman or, you know, any combination, right. Who's moving through a transition. What I do for my health is good for me, but it's also good for you. Right. If I help myself, age well means you're less likely to have to kind of take care of me, and we're going to have a better time and vice versa. Right? So. And that doesn't mean you use guilt to get your partner to go in, but it just also to point out, like, you know, like, I want to enjoy this time for you with you. And, you know, we're moving through a more, you know, where things are going to change in our bodies. And so, you know, this can be something we do together and support each other. And, um, so, you know, that can be another way to come at it. It's like, I want us to travel more. I want to, you know, hike or whatever. Like, let's work on that, or. And I want to support you in feeling your best.

Speaker C: Well, sadly.

Speaker A: And I want to thank you both for joining me today. And I want to thank Lisa for organizing this and help facilitating this conversation. So, Lisa, uh, in one second, I'm going to ask you why you thought Drew was such a great fit and how, you know, and all the things that he brought to the table. For the moment, I just want to thank Drew. This is a conversation that needed to happen, and, uh, that most platforms are not willing to have it. So you brought the science, you brought the clinical reality, and you brought genuine compassion for the men and the families navigating this without a roadmap. So I love what you and your wife are building at Inspire. It's exactly the kind of medicine this moment calls for. So it's super exciting to see. So, Lisa, I'll let you share your thoughts here.

Speaker B: Well, I've known of Drew and known Drew for many years. Uh, I know he's really, really smart. We've shared some patients over the years. We've done IVs for his patients because he's outside of the area. And I've known his wife a long time. Brianna is a really good, great naturopathic doctor. I tried to get her to come and work with me, but then they, you know, for their own reasons, decided to move elsewhere, which I have to let. Let that go. So, yeah, when we were thinking about who we would have come on to talk about men's health, Drew, you came to mind right away because I. I like how you've taken care of your patients over the years. I really admire that.

Speaker C: Appreciate it.

Speaker A: So, to everyone listening, I hope you'll share this one, especially with the men in your life. Text it to a partner. Send it to your brother, your father, your friend, who has been quietly disappearing for the last two years and does not know why. This information can change what happens next to them. You can find Dr. Drew Sinatra at Inspire Naturopathic Medicine. He's seeing patients in California and Idaho in person and via telemedicine@drdru Sinatra.com you can find today's guest co host, Dr. Lisa Brent at, uh, Be well Natural Medicine in Mill Valley of Be well Natural Medicine and come find us on Substack. The link is in the show notes. The WTF community is where we keep the conversation going and we want you there. If today brought something up for you or for someone you love, come find us. We want to hear from you. I'm Justine Reichman. My guest co Host today is Dr. Lisa Brent. And uh, this is Ms. For more. And we're just getting started.

Speaker D: Awkward time to ask this, but.

Speaker C: Hey, did you download the trail map?

Speaker B: Yeah.

Speaker A: No, I don't need to.

Speaker C: I don't understand.

Speaker D: You're trusting your signal out here?

Speaker A: I'm trusting T Mobile. They have the best network. And if we end up in bumtots nowhere, well, we've got T satellite for backup.

Speaker C: Whoa.

Speaker D: I don't trust my carrier that much.

Speaker A: We'll just use your phone as a flashlight.

Speaker D: With America's best network and T satellite, we're keeping you connected in places you never thought possible. And if you switch today, you get free phones for zero down and only 2025 bucks a month per line for four lines. Find out more@t mobile.com or visit your local store. Best Mobile network Based on analysis by Ooglo speed test intelligence data 2H 2025 with 24 monthly bill credits and 4 eligible port ins on essentials for well qualified customers with auto pay taxes, fees and 35 connection charge per line credits and imbalance due if you pay off earlier. Cancel Contact Us Finance Agreement example 299.99 Moto Edge 5G required T Satellite available with compatible device in most outdoor areas in the US where you can see the sky included with experience beyond or $10 a month. However, news monthly cancel anytime. Visit t mobile.com.