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Mark Wulfe:
From The Aasgaard Company Studios in beautiful Wichita Falls, Texas... From the finest mind in the modern fitness industry... The one true voice in the strength and conditioning profession... The most important podcast on the internet... Ladies and gentlemen! Starting Strength Radio.

Mark Rippetoe:
Welcome to Starting Strength Radio, it's Friday, and as is true on every Friday, it is not Saturday. It's not Thursday. It's Friday. When it's Friday, it's Friday. And we're dead serious about that. I've always said Friday should be its own day, and here I'm Starting Strength Radio it is.

Mark Rippetoe:
And we're here this week with our our buddy Jay Campbell. Jay is the author of this very important book, Testosterone Optimization Therapy Bible.

Mark Rippetoe:
And yeah, we've had a bunch of requests over a very long period of time to deal with testosterone replacement therapy. And we have been looking around for somebody knowledgeable to talk to. And we we just asked ourselves one day last week, what is the bestselling book on this? And this is it.

Mark Rippetoe:
And therefore, we wanted to talk to the author of this book, Jay Campbell. And I discussed some stuff with Jay. And this is going to be a very, very good show. You guys are going to get a whole bunch of stuff. I'm going to learn a bunch of stuff and you're going to learn a bunch of stuff. And I appreciate Jay's time.

Mark Rippetoe:
And this is a fairly controversial topic in some quarters and in other quarters it is so fucking obvious that this is what we need to do as older guys that it's just odd that anybody could feel the other way about it.

Mark Rippetoe:
Jay, why do you think the medical community is so resistant to the idea of testosterone replacement therapy?

Jay Campbell:
Well, Mark, first off, it's an honor to be on your show here today, brother, I truly appreciate. I'm humbled, privileged at the opportunity, so thank you for having me here. This is going to be an amazing show and a lot of people are going to get clarification on what's really going on.

Jay Campbell:
But that's a great question to start the show off with, because truthfully, I could give you a bunch of different answers. You know, I could put my tinfoil hat on and tell you that, you know, over the last 30 years, testosterone levels have precipitously declined across the globe. And these are obviously numerous scientific studies that bear that out. But ultimately, and this is my personal opinion, the medical/ clinical community does not understand this.

Jay Campbell:
It's not taught from a medical school level. There's no standard care of practice applied through clinicians across the country on how to do this. Most of the physicians that are successful in prescribing testosterone therapeutically have used it on themselves and have actually also been given the runaround, you know, with other physicians who started them and screwed them up.

Jay Campbell:
So we're in this weird world where there's only a few people, both men and women, from a clinician standpoint that actually understand how to optimize, optimize a patient's hormone levels.

Mark Rippetoe:
Well, the interesting part of... The interesting thing and the most important aspect of that of the question about what is wrong with the medical community is, is that the vast, vast, vast majority of people who decide that they want to investigate testosterone replacement therapy are going to do it through a physician. And the first thing they're going to hear from their doctor is this big, long litany of bullshit that persists in in this topic.

Mark Rippetoe:
So. I guess a good place to start would be the list of bullshit. What is a guy who goes to his - oh God help him - his general practitioner, and asks about testosterone replacement therapy. What's he going to hear from these people?

Jay Campbell:
Well, first the first thing - it's a great question - the first thing he's going to push back, he's going to hear is like, oh, you don't need that. You're fine. Because the physician, again, knows very little about testosterone themselves. The average physician, general practitioner, you know, PPO provider, has nothing as far as a, you know, clinical background and understanding the difference between total testosterone and free testosterone or estrogen or any of those things.

Jay Campbell:
And so henceforth, when that, you know, middle age man or middle aged woman comes and asks about it, they just instantly push back because they're not technically qualified to have intelligent conversation. Obviously, I'm talking about GPs and PPO guys, but, you know, an endocrinologist and a urologist may not say you're fine, but they also may say to them, oh, you don't need testosterone because... And then that because is a litany of reasons that they don't want to prescribe.

Mark Rippetoe:
I have run into a lot of people who have heard this same litany of bullshit from their urologist. I've heard some urologists say some really, really stupid things. The urologist is much more likely than - it's been my experience - a urologist, much more likely to go ahead and do a test. Do a hormone level examination, lab tests on on a person that asked them about that.

Mark Rippetoe:
And then they go through the numbers. They see the reference range. They see that their patient is somehow within the reference range. And because you're in the reference range, you're just fine. And this is so frustrating.

Mark Rippetoe:
You know, 55 year old guy goes to his urologist, says, you know, I feel like shit. I'm kind of borderline depressed. You know, I haven't had a hadn't had blue steel in a number of years. And, you know, I'm I'm interested in my brain, but my body doesn't cooperate. I'm sore. I'm tired. I don't sleep good. Got no appetite. The whole list of things that indicate what is referred to as hypogonadism.

Mark Rippetoe:
And the guy says, well, we do a test. You know. Go ahead, we'll do a blood test and we'll see what, we'll send it to Lab Cor and and see what they say. And then it comes back and they're, you know, there they come back and and they're at 312. Their total testosterones at 312.

Mark Rippetoe:
And the guy says, well, yeah, you're within a normal range. You know, the reference range is 275 to 975 or whatever the hell they're saying it is this week. And and you're within that range. So there's nothing I can do for you, you know. And and the guys says well. I mean, after all. He is a doctor, you know.

Mark Rippetoe:
And and so he walks out of the office the same pile of shit that he walked into the office and nothing has been done to help the guy, because of this reference range thing.

Mark Rippetoe:
So, I think a wonderful place to start this discussion is to talk about the reference range. What is a reference range? Just in general, in terms of blood tests. What's a reference range? What's the reference range for CPK? How is it determined? What's the reference, for example, what's the reference range for free testosterone and how was that determined?

Jay Campbell:
So basically, those are all great questions and this is the story that you gave is exactly what happens in 95 percent, if not ninety nine percent of men across the country, and women for that case. But, you know, ultimately we're talking about men. But basically the standard range or the reference range for total testosterone free testosterone was established, you know, by the endocrine society. I don't know what it was, I think it was about 15 years ago. But as you said, it's moving every week.

Jay Campbell:
In fact, it's moved so far now that the high end of the range is 786 or 788. You can fact check me on that. And then the low end is one twenty five.

Mark Rippetoe:
125, for a male.

Jay Campbell:
Yeah. It's insane. I've been doing therapeutic testosterone for twenty years. Right. And when I first started, the high end of the range - just to give you this variability - was 1360 and the low end was four hundred plus. So now they've compressed the ranges to obviously - and again they call it or refer to it as the standard mean deviation. But now we're at seven eighty and one thirty or one twenty four, whatever it is.

Jay Campbell:
And they will tell you that the reason they're compressing the range is because of obesity in America. But you and I both know that that's not true.

Mark Rippetoe:
What does that have to do...?

Jay Campbell:
The top clinicians... Well, so they have they have an excuse, but the top clinicians will tell you that it's actually just them prescribing or further restricting the prescribing capacity of doctors. So they're basically eliminating the opportunity for men to get therapeutic testosterone. But they say that obesity, obviously, which is insulin resistance, metabolic disorder, lowers testosterone naturally, which of course, it does. Right.

Mark Rippetoe:
Of course it does. And the way we get rid of those symptoms is to raise testosterone.

Jay Campbell:
Exactly. Hello.

Mark Rippetoe:
What?

Jay Campbell:
Yeah, it should be frontline therapy. Yeah, it should be front line therapy for any man who walks into the office to get a bolus of testosterone in whatever delivery system. It will mediate, you know, short term memory. It eliminates depression, as you know. It increases energy. It increases dopamine signaling. I mean, it does so many amazing things and that's why it should be frontline therapy.

Jay Campbell:
I even have physicians that say psychiatrists should be using testosterone for an aging man as front line therapy over all the SSRI bullshit, you know, brain adjuvants, because all those do is create dependency.

Mark Rippetoe:
I've had that conversation so many times, Jay. It's... I've had the conversation with psychiatrists. I've had it with psychiatric patients. A guy... and it that is such an important thing that I think we'll go ahead and put this at the front of the show.

Mark Rippetoe:
My experience with this, my personal experience with it and the experience of lots and lots of my buddies, has been that if you are a little depressed, you know, like the kind of thing where you're you know, you're driving home from work at night, you find that you're crying for some bizarre reason because, you know. You find that you have a female reaction to an emotional situation, this sort of thing. And and you're getting tired of it and it's bothering you. You're not sleeping good. You're worried all the time about this this sort of thing and you take a big bolus of test cypionate. Two ccs, 400 milligrams, of test cypionate right in your left ass cheek. Because you listen to me and I, I decided that that I would tell you this and share this with you and you decided to go ahead and try it. And 72 hours later...

Jay Campbell:
It's a miracle!

Mark Rippetoe:
Your brain is back to normal. You can't I can't tell you how many guys have walked in the gym after trying this and said. You know, you were right.

Mark Rippetoe:
You know, I... The last guy that did that, that I had to do this to me, I saw him walk in the door and I could tell by the way he walked in the door that things were better. It was... This is not confirmation bias. I've seen I've seen this a lot. And I could tell that his brain was...

Mark Rippetoe:
You've seen what I'm talking about, it's just your your attitude changes completely. And it doesn't... I don't know how you could convince a psychiatrist to try this, especially when there really, really isn't a downside to doing it. Because has anyone ever died from 400 milligrams of testosterone cypionate?

Jay Campbell:
Not provably.

Mark Rippetoe:
You can die from taking 40 aspirin, but you can't die from from 400 milligrams of testosterone cypionate. You could give your grandmother 400 milligrams of testosterone cypionate and she wouldn't die. She'd be a whole lot more interesting for about three weeks, but she would not die.

Mark Rippetoe:
And it's it just astonishes me that since there's no downside, why don't you just why don't you guys just try this as the as the frontline treatment for somebody that walks in the psychiatrist's office with mild depression? Why not? Why not?

Jay Campbell:
Because they don't make money, Mark. They make money prescribing SSRIs. You know, testosterone a generic.

Mark Rippetoe:
Goddamn that's cynical isn't it? But...

Jay Campbell:
It's the truth.

Mark Rippetoe:
It's true. It's the truth. It is, in fact, the truth.

Mark Rippetoe:
So of in fact, it's been my experience that the most profound effects of testosterone replacement therapy are psychological, not physical.

Jay Campbell:
Absolutely, yes, 100 percent no, you're actually right because it increases cognition and increases dopamine, signaling pathways in the brain. And as soon as dopamine receptors are turned on, it's like, whoa, I got a new lease on life.

Mark Rippetoe:
I feel better somehow.

Jay Campbell:
Exactly.

Mark Rippetoe:
Right. Exactly.

Mark Rippetoe:
So. This if you guys don't take anything away from our little discussion today, if you're having this, if you're 55 and you just feel sad all the time for no apparent reason... I understand current circumstances here in 2020 make any intelligent person sad, but if you can divorce the sadness that you're experiencing from current events and you find that you're sad all the time. Why don't you try this and just see what happens? Because the side the adverse effects of doing so are non existent. They're nonexistant.

Jay Campbell:
That's true, by the way.

Mark Rippetoe:
Physicians that tell you that testosterone replacement therapy is dangerous don't know what they're talking about.

Jay Campbell:
Walk out of the office.

Mark Rippetoe:
They they have no idea what they're talking about.

Jay Campbell:
No clue. No clue.

Jay Campbell:
Yeah, that's true. I, Mark, I talk about that all the time, you know, guys say that. I say there are no side effects if this is done correctly and initiated from a physician, you know, that understands what they're doing, there are no side effects. There may be a little bit of an adjustment dosage wise, but there's no side effect.

Mark Rippetoe:
Jay, even an... A physician who doesn't know what they're doing, that puts 2 ccs of testosterone in your ass, even if he doesn't even know how to administer the injection properly. There are no side effects. There just aren't any side effects. There's no reason to to talk about a disclaimer here. There are no there's no downside to this.

Mark Rippetoe:
I mean, I guess he could stick it in a vein, you know. He sticks 2ccs of oil in a vein because he don't know how to aspirate the needle correctly, that maybe that's a bad side effect, but that's not the testosterone's fault.

Jay Campbell:
Well, I mean, we should say there are delivery systems that are bogus, right? Like the pellets. Yeah.

Mark Rippetoe:
We're going to talk about all of that later because there's there's a lot of ways to waste money on TRT. Whole bunch of ways to waste money on it. And the the physicians that don't know what they're talking about are far more likely to waste your money than they are to kill you.

Jay Campbell:
One hundred percent.

Mark Rippetoe:
So what's the rest of the bullshit? What do we hear about heart attacks? We hear about heart disease associated with elevated testosterone. Let's just go through the list.

Jay Campbell:
Yeah, so for sure. So the two biggest side effects, you know, B.S. that you hear about prostate issues and then heart issues, right? Now, the reality of both is that and again, this is all substantiated with, you know, literally hundreds of clinical studies from the last ten years in the book in the TOT Bible.

Jay Campbell:
And by the way, anyone who listens to this podcast with me and Mark can get a copy of the books for free. The TOT Bible. It's a PDF, of course. All you have to do is go to J, C, Campbell dot com forward slash free books and Mark and put the put that in show notes.

Mark Rippetoe:
We'll put that up. That's awfully generous of you.

Jay Campbell:
Yeah. No, no, for sure man. I give back. I want men to understand what you and I are talking about because like you said, it's so important. But that to your question. You know, prostate, let's talk about prostate before we get to heart.

Jay Campbell:
So most doctors think that testosterone therapy or TRT or what I call it TOT optimization therapy can cause prostate issues. It's actually the inverse that's true. You only have a prostate issue if you have low testosterone because low pros...Low testosterone causes benign prostatic hyperplasia. And then over time it gets worse, which, you know, obviously it elevate your PSA, which, by the way, the PSA is a worthless measure anyway.

Mark Rippetoe:
Absolutely. We can talk about that as a separate issue. Oh, my God. There are so many people unnecessarily operated on because this PSA bullshit.

Jay Campbell:
Don't even get me going. Yep, totally.

Mark Rippetoe:
Oh, God.

Jay Campbell:
So so anyway, optimize testosterone, you'll never have a prostate issue ever.

Jay Campbell:
And then again you go going to the inverse again, heart disease or heart issues is also the inverse that... They now know that the majority of men who have a testosterone deficiency who have then suffered some form of heart, you know, atherosclerotic or, you know, vascular pathway issue, had a low testosterone level.

Jay Campbell:
And that the there was a study was called the Tom Study, and it was in, I think, 2011. And they had a patient population cohort of men who were basically dying. They were all sick and pre-existing conditions. And a couple of them had a heart issue when they were given therapeutic testosterone. And may I add, that therapeutic testosterone that they gave them was AndroGel, which, as you know, is worthless. So that was the study. Yeah, that was the medical study.

Mark Rippetoe:
Standard medical study.

Jay Campbell:
Yeah, that was the study. They extrapolated to say that it caused these heart issues, which we now know that is completely disproven. I mean, again, the opposite is true. If you are an older man and you do not seek testosterone therapy and you have the testosterone deficiency, you will have at some point a heart and a prostate issue. It's that simple.

Mark Rippetoe:
The prostate's an interesting thing. That's the first thing the doctors want to talk about. Well, would give you... Start taking a bunch of testosterone, you're going to end up with prostate cancer.

Mark Rippetoe:
All right, who has prostate cancer? I'm not asking, Jay, I'm asking you. Who has prostate cancer? Old men have prostate cancer. What is the testosterone level typically of an old man?

Jay Campbell:
Low.

Mark Rippetoe:
It's low.

Mark Rippetoe:
Why then would you associate high levels of testosterone with prostate issues when that's not what we see? The phenomenology is that old men with low prostate show up... With low testosterone, I'm sorry. Old men with low testosterone show up with prostate cancer. All right.

Mark Rippetoe:
It's it's this thing has persisted, this little nugget of bullshit has persisted in urology and in the GPs office for a long, long time when it should be obvious that that's that's absolutely not the case.

Jay Campbell:
Yeah, at 60 years. In fact, the top GPs, or not GPS, but the top oncologist now, Mark, use testosterone with their patients that have stage one and stage two prostate cancer because they know the testosterone is a therapeutic adjuvant for someone that has a prostate issue.

Mark Rippetoe:
It's protective.

Jay Campbell:
But there's only a small percentage of those guys.

Mark Rippetoe:
The story of PSA.... You know, I tell you what, PSA is such an interesting topic that maybe you and I will get together on another show and talk about the history of the PSA exam, what PSA is chemically, what it actually is, what it does, why it's secreted, why it occurs and and what is physiologic what that proteins physiologic purpose is in the body and and talk about this.

Mark Rippetoe:
Because I have a I had a good friend, mentor of mine, college professor that is dead now. And it's a sore spot with me. It damn sure is, and you and I'll get together and talk about that another time.

Mark Rippetoe:
Let's see... Cholesterol. It'll make your cholesterolgo up! Why it'll give you cholesterol.

Jay Campbell:
Cholesterol, I mean, just a quick conversation about that. You already know. But cholesterol is a meaningless topic in and of itself.

Mark Rippetoe:
Despite its dubious association with elevated testosterone levels. It does not elevate cholesterol.

Jay Campbell:
No.

Mark Rippetoe:
And even if it did, who gives a shit? OK, the bigger problem is statins.

Jay Campbell:
Oh yeah.

Mark Rippetoe:
Yeah, we do another show on that too. That'd be fun. Statins.

Jay Campbell:
Statins would lower your testosterone for sure.

Mark Rippetoe:
Well, they do all kinds of bad things, all kinds of bad things. And that's another that's another hour long discussion we'll have at some point.

Jay Campbell:
It's medicine man, it's just insane what they do to people.

Mark Rippetoe:
Really is. It really is.

Mark Rippetoe:
Insulin resistance. That's all.... That's all that's interesting. Why would insulin resistance go up in the presence of a substance that increases muscle mass?

Jay Campbell:
Yeah, exactly. It's the dead opposite.

Mark Rippetoe:
It's like you're talking the Democrats, right? They accuse us of what they're guilty of. It's just exactly like that.

Jay Campbell:
Show me proof, Mark.

Mark Rippetoe:
Now, here is here is an interesting here's an interesting topic. This might actually apply to some guys of some... Of a particular age group: the lower age cohorts of people that actually might need to be on testosterone replacement therapy, might have their sperm count adversely affected by the administration of testosterone. Now, that has to be acknowledged. But how many fifty five year old guys do you know are trying to get the old lady knocked up? At the age of 55, I guess it happens every once in a while, but but this certainly doesn't apply to the population at large, does it?

Jay Campbell:
No, well, let's be honest, right, like just address that. Because guys will say, oh, well, I can't ever... I lose my fertility. Well, that's not true. You can use an ancillary medication like human menopausal gonadarophin or HCG human chorionic gonadotropin. And that keeps FSH and lutenizeing hormone high so that you do maintain motile sperm and you can still impregnate your wife or girlfriend or whatever. Right. So it's like it's not true that using testosterone will make you infertile. You just have to use testosterone intelligently.

Mark Rippetoe:
Mm hmm. But the fact remains that the vast majority of people who are symptomatic for hypogonadism are not... Those guys have long since given up on the idea, right? They're going to get the old lady knocked up.

Jay Campbell:
Correct.

Mark Rippetoe:
You know, a long time ago, I remember some discussions and I think these were primarily studies done on this were coming out of Europe of using Decadurabolin and which is an injectable anabolic steroid. It's not testosterone. It's a it's a testosterone analogue. It's an anabolic steroid and oil based anabolic steroid for birth control in men. And because it has the immediate effect of dropping your sperm count.

Mark Rippetoe:
And for a lot of guys, this is a this is a beneficial side effect. You know, I mean, guy's young and active and shit, you know, doesn't want to be in in a paternity situation. Right. You know, they're you know, a lot of people who would regard a lower sperm count as a as a benefit, as a beneficial effect of the therapy.

Mark Rippetoe:
So, but just to acknowledge the fact that that does take place, you know, in fact. Yeah. Testosterone replacement therapy can lower your sperm count.

Jay Campbell:
Yeah, for sure.

Mark Rippetoe:
Yeah, but what are the beneficial effects? Let's go through that list, shall we?

Jay Campbell:
Yeah, absolutely. So first off, you already said it right. The first noticeable effect on a person that, you know, optimizes their testosterone with a bolus of therapeutic testosterone is dopamine enhancement. Right. Which is going to increase well-being. You're going to feel better. You're going to have that like lethargy or that sadness as you discuss, you know, go away.

Jay Campbell:
So you're going to feel better. You going to have more energy. You're definitely going to have better cognition. Short term and long term memory is improved. And then, of course, energetically you're going to feel like you have more energy. Right. You know, a lot of guys think it's sexual function enhancement. That's the kind of like way down the list of all the things that it really does.

Jay Campbell:
Yeah, sure. If you have super super deficient testosterone levels, a bolus is going to increase, you know, sexual functioning. You're going to get better erections, whatnot. But most of this stuff is in, you know, in the brain, you know, it's going to be dendritic and synaptic pathway effects.

Mark Rippetoe:
Certainly been my observation is that the primary initial effect, the 72 hours effect is is psychological.

Jay Campbell:
Yeah, 100 percent.

Mark Rippetoe:
It's a it's a big gigantic effect for guys that are tired of being depressed.

Jay Campbell:
Sick and tired of being sick and tired.

Mark Rippetoe:
Sick and tired of it.

Mark Rippetoe:
And... Well, here's how you here's how you actually know what testosterone does: Listen to the ads on the radio for Andro 400. Listen to the ads for the for the oral testosterone boosters, Whatever they say that shit does, that's what testosterone actually does.

Jay Campbell:
I think Bo Jackson and Frank Thomas do commercials for that. Yeah, they do.

Mark Rippetoe:
Yeah, they do. There's several of these things. And that's a big giant ass market right now.

Jay Campbell:
Oh, yeah.

Mark Rippetoe:
Noticeably absent from any of their advertising, any of their claims, is the actual level of testosterone that got boosted.

Jay Campbell:
Yeah, exactly.

Mark Rippetoe:
You know, all you'd have to say is my testosterone went from 127 to 972 and I'd buy some of the shit. But they never say that because that's not what happens.

Jay Campbell:
It's so funny though, because we have a whole chapter in the book on, you know, investigating the science behind all the over-the-counter supplements and they're, as, you know, abject fraud.

Mark Rippetoe:
What do you think they actually do? What's in that shit?

Jay Campbell:
Well, some of them, you know, I can name a couple, but I won't. But some of them will increase...what's the word I'm looking for? You know, libido, it'll enhance libido, but nothing is going to increase free testosterone or total testosterone from anything beyond a transient level.

Mark Rippetoe:
Those things are primarily horny goat weed and other vasodilator chemicals. The same basic stuff that's inside Cialis. And one of the one of the interesting side effects of Cialis -a nd because it's got such a long half life in the body - and to a lesser extent, Viagra, is the fact that not only does it dilate the vasculature in the erectile mechanism of the penis, but it also dilates your lower esophageal sphincter.

Jay Campbell:
Yeah, it's absolutely true.

Mark Rippetoe:
It causes GERD - gastro esophageal reflux disease - or the symptoms thereof.

Jay Campbell:
That's correct.

Mark Rippetoe:
Those of you guys that are taking Cialis, taking Viagra, notice you've got heartburn, that's why. It's a trade off, you know. It's a trade off and depending on your particular situation, it may not be worth it, but be aware of the fact that it does that and the herbals does the same thing.

Jay Campbell:
To your point, Mark, guys should use it very surgical dose of Cialis so that they can minimize that. You know, but like you said, some guys are going to need a bigger dose to actually get the effect. But if you can use a very low dose of Cialis, you can minimize those effects. But you're right, some guys, they need a bigger dose. They just have much more issues. They have their endothelial function is very, very off.

Mark Rippetoe:
Yeah. And, you know, a lot of that has to do with the rest of their health picture. You know, are they training? How are, you know, what's their diet look like? All that other shit. Do they have accompanying type two? How much how much metabolic syndrome symptoms do they have? All of that will blunt the effect of those of those drugs and cause you to need to have more of them.

Mark Rippetoe:
What about what about all the other stuff that are claimed for the testosterone boosters -- body fat, stomach fat, muscle mass, all that stuff?

Jay Campbell:
So testosterone, as you already said, is lipolytic in nature. So that increases basal metabolic rate, you know, it uncouples - from thermogenesis standpoint. So basically, when you use testosterone, you are going to have an accelerated bodyfat loss because again, it's again, lipolytic, it increases all those things. But ultimately, too, it increases muscle protein kinase turnover and gives a person a positive nitrogen, you know, anabolic response signaling.

Jay Campbell:
So a person that's training, obviously with weights, which I hope you are when you're using testosterone, is going to be, you know, pro nitrogenice from a standpoint of they'll be able to put on muscle easier. Now a therapeutic dose versus, you know, a super physiologic dose - and obviously we're talking about therapeutic doses here, you know - is going to still allow a person to put on muscle mass a lot easier.

Jay Campbell:
Now, something else that testosterone does, which is huge, is for aging men, is improves bone mineral density. Right. So as a guy gets older, you know, the skeleton becomes more compromised if you're not supplementing with therapeutic testosterone in combination with doing, you know, bone resistance training or whatever, whatever you do from a resistance training standpoint.

Jay Campbell:
So, I mean, again, you already said it does so many things from a positive standpoint to help an aging man that it's almost insane not to consider using therapeutic testosterone once you get to an age where your levels are just not optimal. You know, not normal, optimal Big difference.

Mark Rippetoe:
Optimal is a... well, normal is once again a...

Jay Campbell:
B.S.

Mark Rippetoe:
...An interesting concept that's based on this wholesale swallowing of the reference range idea.

Mark Rippetoe:
So it's it's obvious at this point that - and you'd mentioned this earlier - that testosterone levels have dropped over the past decades. What's the what do you what do you think - And these are significant drops, 50, 60 percent in some studies, you know, from averages up in the nine hundreds to averages down in the 400s. What would be responsible for something like that?

Jay Campbell:
I mean, the answers are, you know, again, pretty, pretty explicit in the book. But, you know, the clinical community will tell you that it's just modern day living. You know, that essentially human endocrine systems are under assault now from the chemicals, from the air that we breathe, the food that we eat, the toxins that we take in, the blue light from the technology and our devices that are all over us, because that also reduces endocrine system response and biological system response. But, you know, ultimately too I mean, people just do not take care of themselves. You know, people are overconsuming fast food, drinking too much alcohol, eating too much sugar, you know, not exercising. Right. Like how many people are sedentary?

Mark Rippetoe:
Well, and I don't know much about the blue light or any of these other rather esoteric explanations for this, but I do understand that obesity is way up. Diet has become much more carbohydrate dependent because of our friend Ancel Keys many years ago, blaming carbohydrate ingestion for... or fat ingestion for heart disease.

Mark Rippetoe:
And, you know, of course, if we have to stop eating fat, we need to start eating Snackwell's cookies, you know. And the effect the effect of that on Type two diabetes would be hard to overstate. You know, as far as levels of Type two diabetes go up and levels of obesity go up, concomitantly we see muscle mass levels going down. A complete radical shift in body composition across across the world.

Mark Rippetoe:
We have far fewer men doing manual labor jobs, especially in this country. You know, farming is now machine based instead of instead of labor based. That these changes across society more than adequately explain. The change in most men's physical existence. Our physical existences are different now than they were 60 years ago.

Jay Campbell:
Dr. Anthony Jay wrote a really good book, too, that I think we could probably bring up real quick. It's called Estro Generation, and he's like the Mayo Clinic lead researcher on, you know, the anthropomorphic changes that are happening right now and like body composition between males and females. And he basically says that, again, it's just phyto estrogens are everywhere. They are in a food, the air. You know, obviously they're in the plastic and the water bottles, the PCB, the phylates. All that stuff contributes to, you know, second and third generational changes at the gene level. And that's why men are less masculine and women are becoming more masculine. You know, they're you take tests of 17, 18 year old girls, 17,18 year old boys and you see it. It's incredible.

Mark Rippetoe:
I kind of like masculine women. Does that make me bad?

Jay Campbell:
No. I feel you, brother. My wife is a beautiful woman, but she's she's got a masculine side to her.

Mark Rippetoe:
Well, I don't think there's anything wrong with it, but but I think that as a culture we have... Over the past 20 years, the pussifiation of popular culture with respect to male behavior is it's not it's it's a shameful, shameful situation. We remember the iconic pajama boy from the Obama administration's Christmas advertising that year.

Jay Campbell:
The soy boys.

Mark Rippetoe:
Yeah, these people are... You know, not all of them accept that, and a lot of them are trying to trying to undo this effect and and that's been good for our business here. But, the more popular culture tells men that it's OK to cry, you know, the more problems, men are going to have as a result of that, because, you know, men are not supposed to cry easily.

Jay Campbell:
Yeah.

Mark Rippetoe:
You know, that that's going to.... I don't think that a lot of people who watch this show would have a problem with that statement.

Jay Campbell:
But it's true.

Mark Rippetoe:
And if they do have a problem, a problem with that statement, you're probably crying right now because you're so upset that I would say that. Look, boys men are not supposed to cry all the time. When your dog dies, that's fine. OK? When your dog dies, you get to cry. When your mom dies, you get to cry. But when somebody tells you No, you don't get to cry.

Mark Rippetoe:
This is this is not the way your psychophysiology is supposed to function, and I think it's very important to think about that. Because throughout history, men are not known for crying just at random on the way home from work at night. That's not what we do. We're not supposed to do that. And if you are doing that, perhaps you have had your standards lowered, or perhaps your testosterone is low.

Jay Campbell:
You know, it's about the best way you could say it. You know, Dr. J in that book, estroGeneration did say too that - and again, there's proof of this now - that using birth control, you know, women started using birth control 30 years ago that washed off into the water supply. And now they see fish and all that becoming feminine.

Jay Campbell:
So I've heard that mentioned. Those those those compounds are rather stable. And and they do end up in the water supply, that's certainly true.

Mark Rippetoe:
You mentioned Alzheimer's in here.

Jay Campbell:
Yeah.

Mark Rippetoe:
That's an interesting that's an interesting topic. How do you think testosterone plays into the Alzheimer's disease question?

Jay Campbell:
Well, that's a great question. There's different differing opinions. But if you ask Dr. Mark Gordon, you know, who's probably one of the world's foremost traumatic brain injury, doctors working with a lot of, you know, ex military and law enforcement folks that have suffered TBI, as you know, he says that he can prove that, you know, testosterone deficiency of testosterone leads to amyloid plaque formation.

Jay Campbell:
And obviously with you know what for what we know of right now with Alzheimer's, you know, if you have amyloid plaque formation, which is really type three diabetes, by the way, because that's all.

Mark Rippetoe:
I've heard it called that for years. Yes.

Jay Campbell:
Yeah. So essentially, if you have that, you're going to get down that pathway. So as you are and you and I, Mark, have already discussed on this show, testosterone mediates type two diabetes, adult onset. Right. It's improving body fat loss, improving insulin sensitivity, increasing metabolic rate. So why would you not use therapeutic testosterone to also mediate/ mitigate any kind of neurodegenerative disorder, whether that's Alzheimer's or dementia?

Mark Rippetoe:
Have you seen any indication that women with Alzheimer's could beneficially respond to testosterone therapy?

Jay Campbell:
100 percent. I mean, there's a couple of studies in the book that lead down this pathway talking about that. But there's no question I mean, again, male and female physiology are essentially the same. The only differentiation is that men have more levels of testosterone. As you know, give a woman a super physiologic levels of testosterone, and she turns into a man.

Mark Rippetoe:
Well, she tries too. She doesn't quite get there, but she tries to.

Jay Campbell:
Almost.

Mark Rippetoe:
All right now that we kind of established, at least in our minds, hopefully years, that testosterone replacement therapy is a good thing for lots and lots of people, what is the best way to do this? What do you... I mean, if you go in to the to the GP's office, you go to your urologist, they're going to want you to use a patch or a cream or something like this. And for some bizarre reason none of them will just put a shot in your ass.

Mark Rippetoe:
I don't understand how they think they can deliver a precise dose of testosterone transdermally. It's as though they don't care about the level when they do it like this. What the hell is going on here?

Jay Campbell:
Ok, so again, great question. There's two delivery systems. There's really one, but there's one new delivery system that actually does work transdermally and I'll explain it in a second. But the tried and true method of testosterone replacement therapy is obviously an injection, right?

Jay Campbell:
Now. What we've learned in the last 10 years, really tweaking this is understanding that what you want to do as a physician and then, of course, a patient following along is you want to mimic the body's natural release, OK. The endogenous release and pulsatile diurnal release of testosterone through the body. So the best way you can mimic that with an exogneous external source of testosterone is by injection frequency.

Jay Campbell:
So the best way to really do this today, it really get as close as you can to the body's release of testosterone is to inject - some guys honestly right now, Mark, inject every day. You know, they use like a little HCG needle, you know, an insulin needle or whatever, and they just have a small little bolus every single morning and do that. But I found...

Mark Rippetoe:
And that's subQ.

Jay Campbell:
SubQ. Exactly.

Mark Rippetoe:
And subQ is a delivery bolus is just fine?

Jay Campbell:
Yeah, exactly. And then but I find from from an IM standpoint, so again, shallow muscle. Three times a week. So it's like basically every other day and taking the weekend off. Right.

Mark Rippetoe:
Now, some guys can inject twice a week and that's fine, you know, and a lot of guys don't want to inject themselves three days a week. Right. But again, if you want to mimic the body's natural pulsatile, release the injection frequency matters.

Jay Campbell:
And then the second format - and everything else is useless - is transdermal at the base of the scrotum. Now, the reason you can do it at the base of the scrotum is because the scrotum, you know, the epidermis, that skin level right there at the base of the scrotum is a it's so thin and so permeable that you get - and there's three studies on this right now out there. But there's you get eight times the best absorption or efficacy of the transdermal release right there than you would anywhere else on the body.

Jay Campbell:
So I would agree with you, if you put it on your arms, your forearms or your inner thighs, you're not going to get the absorption that you get on the base of the scrotum. So there's three doctors right now on the world that have really pioneered this and have really patented this. In fact, I switched after 18 years of injections to doing it that way. And honestly, it's the same, you get the same effects as you get injectable.

Jay Campbell:
The only difference that I feel - and again, it's my opinion. Right. But I've been doing it now for two years is you do get a little bit enhanced sexual functioning because when you put the proximity to the scrotum. Well you get dihydrotestosterone, so you're going to get a stronger DHT signal right there. And so that obviously is the primary anabolic hormone, you know, even more so than test. And so you will feel a little bit better sexual functioning, especially in guys in monogamous relationships. But beyond that, it's the same.

Jay Campbell:
So injections, cream on the bottom of your nuts, everything else is B.S. Everything.

Mark Rippetoe:
Right. The patch on the on the shoulder.

Jay Campbell:
Garbage. Totally worthless.

Mark Rippetoe:
And, you know, it gets on your wife and she may not like this.

Jay Campbell:
It is important to me to know that it's got to be two hundred milligrams per milliliter of the cream. If you're using anything less than that, like an AndroGel dosage, like ten milligrams or 30 milligrams, that shit's worthless. It's got to be 200 milligrams per milliliter because again, the cream has a different half-Life. It's much faster than an injection.

Mark Rippetoe:
Now, what about burying the ester with with frequent injections? I remember a long time ago, I remember a long time ago, testosterone propionate was available as a much shorter half life ester than either testosterone cypionate or testosterone enanthate. Enanthate is what's generally available in Europe. It's a long half life ester over there. And we use enanthate in the United States. But propionate was was available a long time ago. I haven't seen it available in a long time. What's the what's the thinking on propionate now?

Jay Campbell:
It's a great question. In my first book that I wrote in 2015, the TRT manual, which is like dead now, but still a very high selling book. We liked propionate due to the exact reasons that you spoke of. It is a shorter half life. The inter individuality of testosterone release is more noticeable with a shorter half-Life agent or ester like propitiate.

Jay Campbell:
But fast forward six years now and we've looked at testosterone, you know, under the microscope and we've looked at how it cleaves molecularly and at the bottom, at the end of the day, testosterone is testosterone, right? So if the propionate half life, which is somewhere between thirty six and forty two hours estimated and the cypionate is between say 56 and 72... Again, if you're doing injected, frequent injections, it's not going to matter, right?

Jay Campbell:
What matters is that you get a stable injectable solution. It's not full of cottonseed oil and other bullshit impurities that the pharmaceutical companies put in there. You need to get a stable carrier molecule like grapeseed oil or medium chain triglyceride oil or something that's not going to cause a histological response in the body.

Jay Campbell:
It is, as you know, a lot of guys inject the garbage pharmaceutical products and literally get infections or some sort of reaction. They get, you know, puffy skinned cellulitis. So that's the most important thing.

Mark Rippetoe:
Some of that is some of that reaction is is a result of the benzyl alcohol and the bezoic acid that are used as a sterilizers and stabilizers. And some people are real sensitive to that, but you think that there is a downside to the use of the of cottonseed oil as a suspension agent for the for the ester?

Jay Campbell:
Oh, absolutely. Yes. Full of GMO products. Yeah, no. I mean, they've seen now, like with the guys out there that do the prescribed the compounding pharmacy blends. They see with their patients, there's a much less issue with than just the cottonseed because again, the cottonseed oil is the old school pharmacologic big pharma usage. That's what they used as the carrier molecule. But there's just so many agents or additives in that it's just not as good as like a thinner oil that's more absorbed.

Mark Rippetoe:
I remember that Upjohn decades ago used sesame oil as their suspension agent.

Jay Campbell:
Yeah. And sesame oil is a lot better than cottonseed oil. But if you look at Big Pharma and you look at the main, you know, what do you call it, a generic providers of cypionate, that's going to be the main carrier molecule.

Jay Campbell:
Now, if you see the underground community, right, they're all using either MCT oil or grapeseed oil for the most part, or what you just said, what was sesame oil. So they're using three, you know, then whatever the solvent is, which will be like propylene glycol or oleic acid or whatever. But most men today, if they're inflamed and they inject cottonseed oil, they're going to have a reaction to it. I shouldn't say most, but a sizable number of men will.

Mark Rippetoe:
I've never had a reaction to, to an injection like that. Before, so I guess I'm probably OK, but you would say that if you've got injection site irritation than right then been probably it's the carrier oil that is the problem most of the time.

Jay Campbell:
Yeah, one hundred percent.

Mark Rippetoe:
If you're using sterile technique and you haven't screwed something up.

Jay Campbell:
Wll, some guys... That's a good point though, because some guys, as you know, also will respond to... If they're using propitiate because, you know, there's that agent is more water based, you know, whatever these whatever the solvent they use, that can burn, too. So some guys are a little sensitive to that, too. But they still... It's out there propionate's still prescribed.

Jay Campbell:
There's actually docs now that there's what do you call it, compounding pharmacies that use a combination of propionate and cypionate together. But to your question originally, because I didn't answer it, I don't think that there is that big of a difference. If you use a short acting ester with a longer acting ester, which, as you know, in Europe was Sustanon. That's what they do.

Mark Rippetoe:
Is that what Sustanon is? I've heard of that. But I don't know what it is.

Jay Campbell:
Yes, Sustanon is like four different esters. But again, at the end of the day, once it clèaves, right. It's still testosterone. Yeah.

Mark Rippetoe:
So let's talk about some of the other delivery mechanisms that you might be presented with if you go in for TRT. How many men are offered an implant pellet? I know that women are treated with a pellet, of subQ pellet real real frequently.

Mark Rippetoe:
And the pellet is typically - depending on the age of the of the female - it's a combination of estrogen and testosterone. And for older women... Or for younger women, it's just testosterone.

Mark Rippetoe:
And I have never heard of a male being offered a testosterone only pellet. I I'd be very skeptical of that myself because of the absolute defeat of the pulsatile mechanism of... That would have on the levels of testosterone. But, I mean, testosterone levels go up and down in a normal male. And if you've got a pellet that goes in. And erodes slowly over three months. I've never even heard of that. Is that actually going on?

Jay Campbell:
It is so incredible. It is the biggest replacement business going.

Mark Rippetoe:
I didn't know that.

Jay Campbell:
It's a billion dollars a year. And let me just say this right now. Obviously, I'm very anti that. It is proven unstable.

Jay Campbell:
Let's get the big picture of why it's garbage, right? As you just said, every person is biochemically unique. Right? So you implant, you know, basically a pellet of testosterone. And by the way, just you know, there's actually guys out there implanting pellets of testosterone and an AI together, which is absolutely a fiasco. But everyone's going to cleave that testosterone inter individually differently. Again, due to biochemically, you know, uniqueness.

Jay Campbell:
So some guys are going to cleave all that testosterone in six weeks and then be left to sit there and die for the next six weeks until they get to the next pellet insertion. Now, the other issue, which is the biggest issue that you're having a non-surgical doctor cut you open.

Mark Rippetoe:
Perform surgery, essentially because it is invasive.

Jay Campbell:
It's absolutely.

Mark Rippetoe:
It's far more invasive than a simple injection.

Jay Campbell:
It's absolutely invasive. I have a box, I have a folder on my desktop, which I can't show you, obviously for private purposes. But people send me emails all the time and they show me their their extrusions where they had a surgical implant.

Jay Campbell:
And it's the most horrific, God awful, you know, they're infected. They've got, you know, oh, dude, it's the worst thing you could ever possibly do. It doesn't make any sense. And Mark, by the way, it's literally between eight and 10 times more expensive than injection or cream. That's how expensive it is. It's insane.

Mark Rippetoe:
Well, I notice... Again, my experience with it has been they're offering it to girls.

Jay Campbell:
No, they offer it to men.

Mark Rippetoe:
But the boys, I've never I've never heard of anybody getting a testosterone pellet. That seems kind of stupid to me.

Jay Campbell:
Well, guess that's why they sell it?

Mark Rippetoe:
They make a hell of a bunch of money.

Jay Campbell:
And men are free to inject themselves.

Mark Rippetoe:
The pellet is three hundred and twenty five dollars if you have it done around here. For women. Are paying three hundred and twenty five dollars for a three month quote unquote, three month pellet. The pellet is probably worth about fifteen bucks. And so it's a it's a high markup item and that's I know why they're using it. But yeah, I do see a lot of reluctance among among men to give themselves a shot. Poor little guys, poor, poor little things. They just can't bring themself to give a shot. That that might hurt!

Jay Campbell:
It's huge, man.

Mark Rippetoe:
Oh, Jesus Christ.

Mark Rippetoe:
All right, let's let's pick up on something you mentioned earlier. A.I. is an aromatase inhibitor. Let's talk about aromatase inhibitors and what they do.

Jay Campbell:
So, man, this is a whole nother podcast, but I love talking about this, and quite honestly, I learned a lot about this in the last four years because when I first started writing about testosterone, you know, I was under the impression that you know, an AI, in a precise surgical dose was OK.

Jay Campbell:
But the reality is, is very simply this. You never, ever, ever, under the very most extreme circumstances for a guy that has or a woman that has, you know, some sort of genetic defect, you never want to prescribe an aromatase inhibitor because estrogen is actually at the end of the day, as important, if not more important than testosterone, because...

Mark Rippetoe:
Exactly what I wanted to talk about.

Jay Campbell:
So listen, so estrogen confers all the biological effects that a male and a female needs to grow. Bone mineral density, brain synaptic pathway issues, vascular issues. Estrogen is what prevents all the issues that you would have in your heart. Right. And in so many other things like fluid viscosity in the joints, in the soft tissues.

Jay Campbell:
So there's so many things that estrogen as a pleiotropic hormone must be allowed to do that inhibiting its formation - and obviously it's through the aromatase of testosterone - you are suppressing every biological system.

Mark Rippetoe:
Let's not assume that's obvious. All right. When when you... Aromatization is that is the chemical process by which the precursor hormones are converted into the downstream versions. So we start with pregnenalone, right?

Jay Campbell:
Correct.

Mark Rippetoe:
Can we talk about the the the cascade there?

Jay Campbell:
Very good, Mark. Very good. You want me to talk about that?

Mark Rippetoe:
Yeah. Yeah I do.

Jay Campbell:
OK, so yeah. So essentially just big picture because I don't want to go too in the weeds for people, although I know you have a lot of smart guys on your show. When testosterone comes into the body, whether it's injected or through a cream, obviously it does aromatize into estrogen. And estrogen, there's a bunch of different.... you've got three different. There's three different hormones of estrogen.

Jay Campbell:
And again, I don't want to get into the weeds, but it's critically, critically important that estrogen is allowed to not be blocked. Because again, estrogen confers all of the biological benefits, heart protection, joint protection, bone mineral density protection, brain protection. I mean, so many things that, again, as you said, estrogen is doing downstream.

Mark Rippetoe:
And aromatizaton is the process by which one of the end groups is cleaved from the basic hormone molecule. Right? The steroid molecule.

Jay Campbell:
Exactly.

Mark Rippetoe:
And. Now, AIs, aromatase inhibitors, have a therapeutic purpose in breast cancer.

Jay Campbell:
And that's it. And even that's all that's debatable. 100 percent.

Mark Rippetoe:
But so so a cancer that is susceptible to the presence of estrogen in a breast cancer and ovarian cancer would benefit from the blocking of that at the receptor site with an aromatase inhibitor. In other words, if we can keep estrogen from being produced from base hormones, then we can prevent the the susceptible neoplastic tissue from reacting to the presence of estrogen and therefore manage those cancers more effectively. Right.

Jay Campbell:
Very awesome. You just said neoplastic.

Mark Rippetoe:
Yeah, I'm bright.

Jay Campbell:
You got this, brother. You know this.

Jay Campbell:
But no, it's true. But but just to that point, too, that's also that's also theoretic. Right? Because if you talk to the smartest oncologists today, they will also tell you that even a woman that has breast cancer or some form of metastatic tumor, you know, isolating, you know, with a medicine such as an AI is theoretical too. Because there's no way to know that it's going to be specific to that tissue or to that receptor. So, again, it's kind of like a shotgun approach.

Jay Campbell:
But anyway, let's go back to AIs and why they're in male.

Mark Rippetoe:
Right in our discussion today what's the problem with them? Why would somebody decide to use that and what's wrong with it?

Jay Campbell:
So, so so it's just real big picture. And by the way, you know, I'll give this guy credit. There's a physician. He's actually an ex-pro bodybuilder. I think he got his pro bodybuilder card, but his name is Dr. Scott Howl and he's in Chattanooga, Tennessee. And he helps pro bodybuilders now come off of super physiologic levels of testosterone and then also obviously AIs, right.

Jay Campbell:
Now, here's the thing. And I just want to glance over this and then we'll get into the conversation. We now know through Scott's work and researcher and by the way, he's an epidemiologist and he now knows that the issues that pro bodybuilders have guys are on massive amounts of gear and everything else, the issues that they're dying from are actually caused to the aromatase inhibitor. Because what the aromatase inhibitor does, obviously, is blocking estrogen, blocking aromitazation and the pathways. It causes micro seizures in the plaque and in the vascular networks which lead to heart attacks, MIs.

Mark Rippetoe:
Really? The absence of the estrogen affects the plaque structure itself?

Jay Campbell:
Exactly, exactly.

Mark Rippetoe:
Does he have an explanation for that?

Jay Campbell:
Yeah, yeah, I'll connect you with him. And I have a podcast and a couple of blogs, but he's the smartest guy on the planet with that. He just talked to Dave Palumbo about that. But it's very, very late stuff. But anyway, that's also in the book, and he's a good friend of mine.

Jay Campbell:
But at the end of the day, somewhere along the line, about 15 years ago, and I may be going back a little bit further than that, the bodybuilding strongman slash, you know, performance community saw or thought - and obviously the extended into the clinical world - that if you had high levels of testosterone, you need low levels of estrogen.

Jay Campbell:
That's what they thought. That's what they saw. And I think most people, including yourself, including me, who are trained in this somewhat, formally somewhat, you know, in the gym, had that same approach.

Mark Rippetoe:
It seems superficially logical. Right. That if you if you're trying to carry high testosterone levels, you don't want estrogen in there competing for the for the receptor sites. But that's probably not what's going on, is it?

Jay Campbell:
Exactly right. Right.

Mark Rippetoe:
Well, what's going on - and now and again, credit to Scott on this and he's taught me a lot - is that regardless of the level of testosterone that you use, whether it's you and me talking about therapeutic or it's a super physiologic bodybuilder or strongman, you must allow the testosterone to cleave through aromatization to its basic level based on your biochemical individuality.

Mark Rippetoe:
Because it's going to happen anyway.

Jay Campbell:
Exactly. So blocking it is the dumbest possible thing that you can do, because, again, you are literally stopping the pleiotropic effects of estrogen, which again is what confers all of the positive beneficial effects to a human biological system. It's insane that people continue to do it and doctors are out there, as I said, putting it in solutions. Mark.

Jay Campbell:
Imagine getting a testosterone bolus that has an AI in the oil. That's what's going on out there right now.

Mark Rippetoe:
Seems rather seems rather dumb, but, well, if the benefits of of estrogen - I guess we're talking about estradiol, is the ester - are obvious, do we supplement estradiol?

Jay Campbell:
Nobody's ever asked me that question, I got to give you a golf clap.

Jay Campbell:
Yes, for men that have genetically low levels of estrogen, which many do, and then they take therapeutic testosterone and there are number still only goes up just a slight smidgen. It's actually usually a really good effect. In fact, the top docs out there right now between oncologists and not what I call optimization doctors for men that have stage one prostate cancer, they're giving them estradiol. They're giving them two and a half to five milligrams of estradiol because, again, that is going to increase the aromatization that they genetically are not getting.

Mark Rippetoe:
So if you don't aromatize enough testosterone and testosterone to estradiol, it would be beneficial to take some estradiol too.

Jay Campbell:
Hundred percent. Dr. Neil Rouget, who's one of the top physicians, clinicians in the world that, you know, is talking about this, who I've been blessed to do a couple of podcasts with. That's what he does in his patients. I mean, he gives them estradiol.

Jay Campbell:
It's like tantamount. People are like what? But again, as you know, medicine is always, always learning and always evolving.

Mark Rippetoe:
Not all doctors are, though.

Jay Campbell:
No.

Mark Rippetoe:
Yeah. It's interesting that the aromatization of of testosterone to the to estrogen compounds is pretty well understood. And it's a it's a natural side effect of finding the correct dose of testosterone for the guy. That's part of the calculation. And I find it interesting that aromatase inhibitors are so popular.

Mark Rippetoe:
It's just, you know, you cannot.... one of the most important things that you that you understand when you start looking at this in depth is that you cannot manipulate any level on the on the hormone axis without impacting the other levels too.

Jay Campbell:
Correct, it's a downstream thing. Absolutely.

Mark Rippetoe:
But the important thing to remember is that if you stick a hormone in - all right - the tropic hormone above that is going to be depressed because you've already a level of the hormone it is trying to cause to be secreted underneath it. And all of those things are perturbed when you add a hormone. So you had better tread carefully.

Mark Rippetoe:
And when you start throwing in aromatase inhibitors and stuff, you're affecting things that you don't even know occur. And part of the, as I just mentioned, part of the part of the way you titrate up to the correct physiologic dose for testosterone optimisation therapy is to find out how much you need to achieve all of these effects, taking the aromatase process into into consideration. You're going to get some estradiol out of the end of this thing and it's supposed to be there.

Jay Campbell:
Well said.

Mark Rippetoe:
So how then do we correctly titrate the dose of testosterone replacement?

Jay Campbell:
It's a great question and, you know, one of my mentors taught me that the twofold goal of testosterone optimisation therapy is happiness and balance, right? So you are going to figure out how you feel good and you feel balance, right? Because some guys on a dosage that's too high are going to be a little bit irritable or have a little bit of mood and instability.

Jay Campbell:
And until you get to that level and again, you know, this year, your dosage is probably going to be you know, some guys have figured out in three weeks, some guys have figured out in six weeks. But ultimately, when you feel really good and smooth and cool as a cucumber, you're probably at the right dosage.

Jay Campbell:
Now, I tell guys, you know, and again, you know, there's obviously a lot of variability now, but I think that most guys do pretty good somewhere between two... Excuse me, one hundred and seventy five and two hundred and fifty milligrams a week. And again, the more frequent the dosage, the more frequent or the better they're going to feel.

Jay Campbell:
You know, biologically, they're going to mimic the endogenous release of testosterone. You know, some guys some guys need more. There's no question the best doctors know that it's not about measuring the levels and the standard deviation it to get about.

Mark Rippetoe:
The subjective effects because of the fact that the reference range is bullshit.

Jay Campbell:
Total bullshit.

Mark Rippetoe:
The guys I've talked to about this will all tell you that the reference range is meaningless. If you are having symptoms, then we treat it as a treat up to we titrate up totally symptomatic relief and whatever that is and whatever reference range, whatever level that generates in the patient is the level at which we're optimum.

Jay Campbell:
That's one hundred percent. And let me just add to that. There's a caveat to that, because I would have always said that that's exact right answer. But the caveat now is that the system, the medical system itself is starting to audit, you know, patient files. Right.

Jay Campbell:
And so if you see a guy that has a twenty six hundred level total testosterone, that guy might feel amazing. He might be exactly what you say, zero symptoms. He feels amazing. His life has changed. His sex drive is great, he's got blue steel. But if that you know, that state medical licensing board audits that position and they see that number, that physician is going to be called out on the carpet. And they're going to say, what the hell is this? And then that doc is going to be like presenting your case. Hey, this is this is normal.

Jay Campbell:
So it's important that we put that out there, that you got to work with a doctor that understands that because some doctors will see you at twelve hundred or fifteen hundred and say, oh, I got to lower your dose.

Mark Rippetoe:
Right. Right. They're there. They're afraid of their oversight in a situation like that.

Jay Campbell:
It's not they're fault either they're doing their job.

Mark Rippetoe:
You know. And I understand that. I understand that.

Mark Rippetoe:
But but I want to I want to pick up on something you said just a second ago that relates to the first topic we we talked about today on the show. You said happiness when we're talking about depression and I want to ask you about this, because I presented this question to a couple of psychiatrists I've had this conversation with and I want to see what you think about this.

Mark Rippetoe:
As a general, just as a general philosophical question, what is the opposite of depression? All right, now, stick with me here, is it feeling good? Is it happiness, is it joy or is it aggression? Now, by aggression, I don't mean want to be in a fight. That's not what I'm talking about, right. What I'm talking about is the fact that when a when a person is depressed. What do they typically do? They sit there with their hands in their lap and they stare at their hands and they don't do anything. They don't do a goddamn thing. Right. It's like waking sleep, right? Versus a person who is normal and in command of their situation. How do they feel, right? Happiness is a downstream effect of and I hesitate to use the term aggression, but I don't know of another word for it.

Jay Campbell:
I'll give you one. Strategically asserted.

Mark Rippetoe:
Ok, all right. That's assertiveness. What would be a good synonym for what I'm talking about? A person who is depressed is not assertive at all. No, a person who is depressed is not is minimally responsive to external stimuli. They're just they just receive things. They don't react to them.

Mark Rippetoe:
And. I think that if you look at the depression, aggression axis in this way, that the role of testosterone becomes rather obvious, and I think that's an excellent way to think about it. And I've mentioned this to a couple of psychiatrists and they say, well, you know, that's interesting. You know, it's interesting, I'll have to think about that.

Jay Campbell:
You know, Mark, if there was only testosterone in a pill.

Mark Rippetoe:
Yeah, yeah, it'd be better, wouldn't it would be better. I remember methyl testosterone used to be available in a pill. Is that still a thing?

Jay Campbell:
Well, so let's talk about that. So about three months ago, a company called I think they're Clarite Therapeutics. They have their own capsule now. And it's obviously just the old school andriol and it's called gitenso. So it's basically, you know, testosterone in a very low level in a capsule with oil based that you can take.

Mark Rippetoe:
But again, if you want to have another, it has to be in an ester form or it won't get through the stomach.

Jay Campbell:
Well, the reality of it is, is it I mean, it's in a very, very, very, very poorly solvent, ester. And so, again, there's no there's no hepatooxicity because it's not methyl alkylated, but you have to take a bunch of these during a day. So, again, it's another example of the pharmaceutical industry getting a man to bump up a little bit in the normal range. Right. But also costs a lot of money.

Mark Rippetoe:
That's not that I would be interested in doing injectable testosterone's auite inexpensive if you can use somebody to write you a prescription for it. So.

Jay Campbell:
Well, it's a it's a it's a it's a it's a cat. I mean, what do you call it, an insurance payment scam now, too, because they'll start offering that to men, you know, for a thousand dollars a month, you know. Yeah, it's crazy. And they won't even they won't even feel testosterone. It'll just be a slight bump.

Mark Rippetoe:
Right.

Mark Rippetoe:
Well, so having said all of this, and now we've got kind of a theoretical background for what we want to try to do, who are we going to get to do it for us?

Mark Rippetoe:
This is this is the biggest problem that most guys have got. They don't have access to somebody who has his head out of his ass to help them with this. This is a this is a giant problem. TRT clinics solve some of it. You know, those things have sprung up. And you know where you can go to your urologist and he's going to first tell you that you're normal at 271.

Mark Rippetoe:
And that second, yeah, he'll let you try some cream, you know, if you'll promise not to, you know, tell anybody you're doing it or whatever. And and then third, he's going to say, well, your levels back up to 475. So I'm now going to write you any more of the cream. Right.

Jay Campbell:
You're fine.

Mark Rippetoe:
You're fine now, you know, like you're going to stay that way.

Mark Rippetoe:
So that's what most people run into. So the way they fix that is they go to the TRT clinic and the TRT clinic will test you because that's just part of the formal thing they have to do. And then they're going to give you an injection and you go in every week and you get the injection.

Mark Rippetoe:
But your thinking on this is that once a week injection is not optimum and that every other day, Monday Wednesday Friday is a good ejection schedule. But in order for that to be the case, the guy is going to have to write you a prescription and send you home with the vial and the needles and and trust you to to do this the way he's telling you to do it. If you can find somebody that will do that for you and usually you can't.

Mark Rippetoe:
So we've got... We have the idea... We know what we need to do, you know, but how do we get it done?

Jay Campbell:
So it's a great question. Maybe the best question on the show, and I've told you this, like off air, there's maybe ten amazing hormone doctors in the world. Right.

Mark Rippetoe:
And I don't know any of them.

Jay Campbell:
Well, I know the best one. So, like, are you are you comfortable with me recommending a couple of people right now?

Mark Rippetoe:
If you think they don't mind.

Jay Campbell:
Oh, no, they don't.

Mark Rippetoe:
And if they will work with people in a remote setting. Yeah, sure.

Jay Campbell:
Yeah. Well, let's talk about that. So since covid, whatever that is. Don't say anything, Mark.

Mark Rippetoe:
OK, Jay. I won't.

Mark Rippetoe:
Oh yeah. Yeah. That, that's all. That's all gone. Right.

Jay Campbell:
So since covid or whatever it is they do now have they've, they've wacked telemedicine laws. So now anybody anywhere can work with the doctor remotely through Skype through Zoom.

Mark Rippetoe:
Really? Well let's have some more of that covid shit then.

Jay Campbell:
There you go. There you go.

Mark Rippetoe:
It's good to save a bunch of people a bunch of money in time, isn't it?

Jay Campbell:
So. So let me give you let me give you three doctors in the United States. They're amazing. There's one guy who's in Chattanooga, Tennessee, and his name is Dr. Keith Nichols. And I'll give his link out. tier1hw.com. That's the guy, Dr. Keith Nichols. And then his partner is Dr. Scott Howell. And he's the pro bodybuilder that now helps guys come off of super physiologic levels. Both of those guys are the best. They know more about this than Keith was like the doctor for the. Well, Nashville predators and then also the Tennessee Titans, and then he was also involved in MMA, you know, he knows Dana White and all those guys. So he is brilliant when it comes to this. And then, of course, Scott is the smartest guy on the planet with understanding the epidemiologist effects of estrogen.

Jay Campbell:
Another guy is Dr. Rob Kilmarnock, and he's in Dayton, Ohio. And his website is renuehealth.com also very close personal friend of mine, mazing, been prescribing hormones for twenty four and a half years.

Jay Campbell:
And then the other guy is Dr. Jim Meehan, and he is in Tulsa, Oklahoma, and also very advanced former opthamologist. I still an ophthalmologist, but, you know, it's his formal training. And then he was quacked and he went down this path and he learned everything. And now he's like one of the guys at lectures and talks.

Jay Campbell:
Now there's a lot of other guy's name, you know, big names in the industry. You know, I could say Dr. Mark Gordon, brilliant. But Dr. Mark Gordon doesn't take new patients and he's so overwhelmed with all the military and Joe Rogan and all that stuff. But there's a lot of other doctors I could bring up. But those three guys still have a practice that is thriving and they take new patients and they would love to work with men that listen to your show.

Mark Rippetoe:
Well, I'd like for them to do that,

Jay Campbell:
I don't make a cent recommending them just so guys know there's no they don't pay me.

Mark Rippetoe:
I understand. I understand that that's good of you to say that. But we don't want to give anyone the impression that we're we're fishing for commissions here because we're certainly not doing that because we got a you know, we we've we've got a whole bunch of people. People ask me this all the time. People ask us every seminar.

Mark Rippetoe:
We see guys that are in the in the seminar that are not on testosterone, that need to be on testosterone. They're asking me, well, what what do I do? And the only option I've got for them right now is to go to a TRT clinic. Most bigger markets have got at least one.

Mark Rippetoe:
And that's that's the closest you're going to be able to do that to a situation that makes any sense. Because if you approach your general practitioner about this, you're you're going to be dealing with somebody that doesn't know anything more about this than the girl at the cleaners.

Jay Campbell:
Or their receptionist.

Mark Rippetoe:
Yeah. I mean, you know, the the literally that they don't have the slightest idea what they're what they're doing. And it's it's it's it's harmful to ask them about it.

Jay Campbell:
Yeah. No, you're 100 percent right.

Mark Rippetoe:
You need to go to somebody. So in the absence of access to a guy that's got his head out of necessity, a TRT clinic is that is the most accessible option. But these four guys that you've mentioned today put that we have to show transcript with it and it'll be available and the names will be available to contact information in the transcript. So you guys are wanting to know what that was. Just look down in the transcript and it'll be there.

Mark Rippetoe:
What would you say, an optimum therapy program would look like for a guy that's that's into this, that still trying to find his level versus a guy that's been doing this for five years?

Jay Campbell:
Yeah, it's a good question. Let me let me go back to address something that you said, too, about the TRT clinics. You know, I call them windmill clinics. It's very important, especially, you know, and you're right. You said there's you know, every major city has one. I mean, if you're in a major city, you got hundreds to pick from there all over Google. It's very important. And you said this very early in the show, Mark, it's very important that men do this right from initiation, because if you go to a TRT clinic and they put you on 10 different things, there's absolutely no idea to know what the testosterone is doing molecularly in your body because it's not isolated.

Mark Rippetoe:
If you if you start up a therapy program and there are five variables in it, it is impossible to say which one of those treatments are responsible for what happens to you. You can't tease the effects apart.

Mark Rippetoe:
So if if they're doing cream, sublingual, injections, AI, if you got all of that shit going on yet, you have no idea what happened.

Jay Campbell:
It's insane. Yeah, it's literally insane. Plus, pregnenalone, which, as you know, is a steroid precursor and other hormone. And then they're given them melatonin and they're given an HCG. What, seven chemicals?

Mark Rippetoe:
You're you're what they're doing is they're they're trying to run up the bill.

Jay Campbell:
Make money.

Mark Rippetoe:
You want to go to a clinic that gives you an injection of testosterone cypionate and that's all.

Jay Campbell:
That's it. And then see how you fee.

Mark Rippetoe:
And then they can vary the dose, but if they're put in more than one thing and you go to another clinic.

Jay Campbell:
Exactly, yeah.

Mark Rippetoe:
So. So that's that's how you start. What does it look like five years down the road to it?

Jay Campbell:
Another good question. I mean, you know, you really once you get bounced and leveled out, you don't really have to increase the dosage. I mean, depending on what your lifestyle is and what your goals are. I mean, if you're a strong man or a professional athlete or power lifter or something, maybe you want to bump the dosage a little bit. Maybe you want to use peptides or consider human growth hormone or something. Again, it's all relevant to your goals, but you never have to tweak your dosage.

Jay Campbell:
I mean, I've been on testosterone therapeutically now for close to 20 years and my dosage never changes. I mean, eight years of injections and now two years of the cream on my balls. And, you know, it's the same thing. I wake up in the morning. I take, you know, after I get out of the shower, I just take a couple of clicks of the dispenser right at the base of my balls, wash off my hands. Good to go. Right.

Jay Campbell:
And if a guy's injecting. A guy's injecting. You know, again, I recommend that you do at least three times a week. And if you're needle phobic or you hate injecting yourself at least twice. And let's let's let's just talk about that for one second. You want frequency because again, the way that the ester cleaves in the system.

Mark Rippetoe:
It levels out the exact blood serum levels.

Jay Campbell:
You want to hit the nadir as it's coming down, you're hitting it, going back up again. So you're always kind of like this, right?

Mark Rippetoe:
Yeah, right, but at a TRT clinic, you're going to get one a week.

Jay Campbell:
Yeah, for the most part.

Mark Rippetoe:
For the most part. And that's better than nothing and none at all. It's better than none at all, especially if it is an injection of 200 mg test cypionate. And if that's what's available to you, then that's what you do.

Jay Campbell:
Exactly. Yeah. Testosterone injected once a week is better than none at all. Let's make that very, very clear.

Mark Rippetoe:
Oh, yes. I think it's important because that may be for most people, the only option they've got. If your option is is one is 200 mg a week test cypionate IM versus a transdermal patch there's no question, there's no question.

Jay Campbell:
It's useless. Go get go buy some pills or some androboost or whatever.

Mark Rippetoe:
Yeah, it's about the same thing. So just it's not exactly there's no question as to which one you do optimum would be more frequent. But if all you've got access to is one shot a week, then that's what you do.

Mark Rippetoe:
Now, it's also going to be important to understand that this is not necessarily cheap. It's very seldom cheap. How many insurance plans will cover testosterone replacement therapy?

Jay Campbell:
Good question. Now, with everything that's changed in the way they're coming down on the probably the state medical board, none

Mark Rippetoe:
I think they're probably all out of pocket.

Mark Rippetoe:
I think it's going to be all out of pocket. And really, Jay and really, that's the way you want it. I don't think you I don't think you want to be on record as being on testosterone. I think it's probably to your advantage that that all happens out of pocket and that remains the business of you and the guy that's doing it for you. And that's all.

Jay Campbell:
Right. That's right. And by the way, that's a good point, because you're, you know, from a life insurance actuary table...No.

Mark Rippetoe:
Because they don't understand it and I don't want them figuring it in is a variable and doing the math wrong because that's what they'll do. That's exactly what they'll do.

Jay Campbell:
Like prostate cancer or heart attack, cancer, a candidate now. You can never. You're right. Good point.

Mark Rippetoe:
No, you can't you can't tell them what you're doing on that. They just don't understand the data.

Jay Campbell:
No, no clue. They're years away from understanding that.

Mark Rippetoe:
Right. Right. If they ever do.

Mark Rippetoe:
Well, anything else you want to cover today? Jay, this has been real good. We need to get back in touch about the PSA thing. I want to talk about that. That's that's worth an entire show. If you get prepped up.

Mark Rippetoe:
Did we leave anything out today you want to talk about?

Jay Campbell:
Not really, man. I mean, it was phenomenal. You ask really good questions.

Mark Rippetoe:
Let me go ahead and plug the book again. So here it is, the testosterone optimization therapy Bible. It's about 600 pages, very dense information. Get it, read it. Make up your own mind. Do some research on your own and you guys that are that are in the situation where you need where you need this stuff. I think you know who you are.

Mark Rippetoe:
And if you don't know who you are, you need to think about it. It's not good for you 55 year old guys. And I keep saying 55. It might happen at 38. Yeah, you might be fine till you're 70. You know, it varies with the individual. All of this stuff varies with the individual.

Mark Rippetoe:
But if you're sitting around not feeling like, you know, you need to feel, why don't you consider this as a primary treatment for that? Because a. It doesn't hurt anything to try it. And B, it doesn't take very long before you know exactly whether it's going to work or not, these two things are very, very important.

Mark Rippetoe:
If if your doctor goes in and gives you a loading dose of 400 mg of testosterone. The worst thing that you could have happen to you would be you wake up every morning with steel. And it's not a bad thing. I think you'll agree that's not a bad thing. But if he had 72 hours, your outlook on life has radically changed, then I think you'll find that you're happy with this as an option.

Mark Rippetoe:
Jay, thanks for being with us today.

Jay Campbell:
Mark, man it's humbling, a privilege and honor. And let me just say again real quick, for the guys are too lazy to buy the book. You know, I give this out. It's just important for me.

Mark Rippetoe:
Give us the Web address again and we'll.

Jay Campbell:
Jay C. Campbell, Dotcom forward slas last free books.

Mark Rippetoe:
That's j-a-y c campbell dot com.

Jay Campbell:
Exactly. Yeah. And not only will you get the free book on the Bible, the PDF, you get download. It's got all, you know, the links from like the people like you that I have interviewed me that will go back and, you know, deep level detail. And obviously, I'm going to put your podcast when it comes out too there.

Mark Rippetoe:
Right.

Jay Campbell:
It's a very important topic, as you know.

Mark Rippetoe:
It is a very important topic to those of us in this business and those that are those of us that are in the business of being males at the age of 64. I think you'll find that this is this is an important thing that you can do and I want you to seriously consider it.

Mark Rippetoe:
Jay, thank you for being with us today.

Jay Campbell:
Thank you, Mark.

Mark Rippetoe:
And thank you guys for being here on Starting Strength Radio. We'll see you next Friday.

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