Episode 56: Unlocking Male Hormones Part 1 with Dr. Mark Holthouse, MD

Podcast Drop Date: 4/16/2025

In this episode of The Functional Medicine Foundations Podcast, host Amber Warren, PA-C, sits down with Dr. Mark Holthouse, MD, to discuss optimizing male hormones for overall health and quality of life. Dr. Holthouse shares the crucial relationship between testosterone and other hormones like DHEA and pregnenolone, and their role in addressing health issues such as obesity and metabolic syndrome. Tune in to Part 1 of this two-part series on men's hormones, and hear Dr. Holthouse’s approach to personalized treatment plans.

Transcript:

Amber Warren, PA-C: Welcome to the Functional Medicine Foundations podcast, where we explore root cause medicine, engage in conversation with functional and integrative medicine experts, and build community with like minded health seekers. I'm your host, Amber Warren. Let's dig deeper. Okay. Welcome back everybody. We're here tonight with Dr. Mark Holthouse to discuss all things male hormones and male hormone optimization, because we really haven't dedicated a podcast to this yet, which is kind of shocking.

Dr. Mark Holthouse, MD: Are you serious?

Amber Warren, PA-C: Yeah, so here we go. Okay. Doctor Mark Holthouse is the chief medical officer for FMC center for Optimal Health and Functional Medicine of Idaho. He graduated from Loma Linda School of Medicine and went on to his to obtain his family practice training at UC Davis Medical Center. While in the Air Force Scholarship program at David Graham Medical Center, Travis AFB. Dr. H has over 32 years of family practice experience and brings years of practice in the areas of functional and integrative medicine as part of the Institute for Functional Medicine Teaching Faculty. He has educated thousands of practitioners in hormone health across the nation over the past decade as an assistant professor of medicine. On the teaching faculty at Loma Linda University School of Medicine, he is an expert on cardiometabolic cardiometabolic disease prevention, reversing type two diabetes, heart disease, high cholesterol, obesity, and metabolic syndrome. In addition to his clinical and teaching experience, he has 30 years of owning his own private practice as Acting Medical Director, implementing strategic models in clinical practice and the business of functional medicine. Dr. Holthouse and his lovely wife Tammy enjoy photography, snowshoeing, skiing, sailing, hiking, kayaking and of course, great food.

Dr. Mark Holthouse, MD: I think you almost have that memorized.

Amber Warren, PA-C: I don't know why I still need to reference anything because I for sure have that memorized. I for sure know all of your hobbies and habits, and I feel like I could actually add.

Dr. Mark Holthouse, MD: I need to.

Amber Warren, PA-C: Add a much bigger list to what you enjoy doing. Yeah. So, um, this is so awesome. So yeah, no. Welcome back. We're so excited to have you. So, um, I think this this is 80% of the medicine we're doing, right? Men's hormone health and how it relates to cardiometabolic health in our nation. And it's such a big deal. So let's just just dive right in and say, okay, men, testosterone levels, why do we care? Um, how important is it and why is it so important?

Dr. Mark Holthouse, MD: You know, I'll start with just some ground. Ground rules, kind of the taxonomy. So many people go to their doc and they get a testosterone, total testosterone. And they say it looks great. Don't worry about it. It's within the normal range. I think the big thing to realize is that there's optimizing testosterone where you feel good, and then there's getting your insurance to cover your prescription because you've met a criteria where you're below a certain cutoff point. Um, we know from experts in this field, Abraham Montgentaler, the urologist from your Harvard, uh, and nine other countries put together a thesis of nine statements back in Mayo Clinic Proceedings 2016 that said, hey, a lot of guys, this is a real problem with quality of life. And regardless of knowing what the cause is and regardless of the reference range, a lot of people do better when you replace or give them a therapeutic trial. So we have really kind of fashioned our practice here around optimization, not just treating people with testosterone deficiency, which is what's recognized by traditional practices. And endocrinology is really the only thing to treat. Um, and so I'm following more what the studies are showing that the reference range is fairly irrelevant. Um, assuming they're a good candidate, there's no contraindications that it's safe. Um, I'm also a big believer, though if they don't respond, they don't feel better for the reasons you started them on it. In 6 to 12 months, you probably shouldn't continue. Yeah. You know, it's not necessarily worth the time and money. And there's so many ways to do testosterone, which we can talk about if you like.

Amber Warren, PA-C: Well, and I like that you hit on, you know, what the conventional quote on quote insurance, how they approach testosterone deficiency. Right. It's also and I think it's still this this way. It's been so long since I've practiced in the insurance model. But you need two, two random blood draws, right? It's almost like they don't believe you. If you get one like, oh, he's not actually low. That was a mistake, right? Let's prove it again and have to spend another 300 bucks to get another, another draw, which always just seems so silly to me.

Dr. Mark Holthouse, MD: I mean, it does vary if you have an off day.

Amber Warren, PA-C: That's true.

Dr. Mark Holthouse, MD: You're not supposed to check it.

Amber Warren, PA-C: Later in the day.

Dr. Mark Holthouse, MD: Or, you know, later in the day is very different than in the morning, especially with younger guys. Older guys, it's a little more consistent. But it can vary 20 to 50% between the morning and afternoon. And guys under age 40.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: Um, but yeah, no, it's an expensive kind of lifetime commitment for them.

Amber Warren, PA-C: Absolutely.

Dr. Mark Holthouse, MD: So I think they.

Amber Warren, PA-C: Want to be sure.

Dr. Mark Holthouse, MD: Throwing up another hurdle. Why not?

Amber Warren, PA-C: That's true.

Dr. Mark Holthouse, MD: Take care.

Amber Warren, PA-C: So, um, how do how does testosterone and DHT and estrogen. We know, you know, we talked about it on our female podcast. Testosterone is really important in in a woman's body. So how do those three hormones play a role in a man's body?

Dr. Mark Holthouse, MD: First, a great question. Thank you for asking. Um, I mean, the first thing I want to go on record saying is testosterone is not a male hormone and estrogen is not a female hormone. We have different ratios of the two depending on the two different genders. But, um, you know, the most abundant, um, sex steroid in a female body is testosterone. And all estrogen comes from testosterone. It doesn't go back the other way from estrogen backwards. Um, you know, there is uniqueness in the roles that each of them play. Um, you could you could say DHEA, which is that androgen, male hormone, precursor from the adrenal gland, which basically leads to testosterone, which leads to estrogen. They're all important. They all have different receptors. They all have unique roles in the body. Dhea has its own mortality risk if it's low for cardiovascular and all cause mortality independent of testosterone. It works especially in women that have cognitive issues along with sometimes pregnenolone. It seems like better than in men in in my experience, that's what I've seen.

Amber Warren, PA-C: So pairing, sorry, pairing DHEA and pregnenolone.

Dr. Mark Holthouse, MD: Yeah you can actually I usually just do one or the other.

Amber Warren, PA-C: Okay. I thought you I thought you said using both.

Dr. Mark Holthouse, MD: You can use one or the other. Yeah. And I've seen people do both. I'm not sure I personally see the utility in that.

Amber Warren, PA-C: Yeah I agree.

Dr. Mark Holthouse, MD: Um, but these precursors, some, some providers feel have advantages over giving you the actual downstream.

Amber Warren, PA-C: Uh, but you don't know where it's going. You don't know exactly what direction it's going. So that's hard.

Dr. Mark Holthouse, MD: Exactly. And so there's this whole thing of giving seven keto DHEA, but that it somehow doesn't get aromatized. But there's really a positive data to support that. Okay. So if they're low or suboptimal on DHEA, I'll sometimes supplement them with that as an oral or sublingual, um, individually or if they've got ongoing brain fog, once estrogen and testosterone are optimal, they've got normal thyroid. Cortisol is not crazy, making them so they can't concentrate. Um, I can certainly look at pregnenolone and DHEA.

Amber Warren, PA-C: How about DHT?

Dr. Mark Holthouse, MD: Dht is just like another metabolite downstream of testosterone, right? It has a decision. It can either go to estrogen or it can go to DHT. Right. So only about 10% of circulating testosterone exists in the form of DHT because it's so dang powerful, right? Um, it's what causes enlargement of the prostate. Thinning of the male hair, scalp. And on women too. And acne if you get too much. So that can happen from just having too much 5-alpha reductase activity. A lot of these guys that are using topical testo cream on the scrotum, for example, tons of 5-alpha reductase enzyme there. So most of it's going to convert to DHT. These guys get DHTs in the three hundreds. And the problem with that is that they can get acne. They can get hair thinning, and they can have problems with urinary prostate enlargement and slow urine flow, things like that. Um, estradiol is as important as testosterone, I think, in men as testosterone is because of its role in preventing bone loss. So many of these guys come to me on testosterone or want to be on testo and their buddies are all on anastrozole, which is an aromatase inhibitor to block the T from becoming estrogen. And I want my guys to have an adequate amount of estradiol because it not only helps with preventing osteoporosis, but in many of the studies, we think that testosterones benefits to the brain, to pain management, to cardiovascular health is mediated through estradiol.

Amber Warren, PA-C: So interesting.

Dr. Mark Holthouse, MD: The guys we got to be careful with are the guys that have a lot of central obesity. They've got a lot of aromatase present and they will make a lot of estrogen when you give them testosterone. And these are the guys that will get the growth, you know the breast growth and the gynecomastia. Those are the ones you have to be careful of. And on the dosing initially until you fix their metabolic dysfunction and their their obesity, there.

Amber Warren, PA-C: Because we know those things stimulate that enzyme that then converts into estrogen. The aromatase.

Dr. Mark Holthouse, MD: Yes, yeah. The things that upregulate that aromatase enzyme are insulin and inflammation, cortisol. Stress, obesity, low zinc. Um, some of the endocrine disrupting chemicals that we see.

Amber Warren, PA-C: So it's so much more than just taking T.

Dr. Mark Holthouse, MD: Yeah, yeah.

Amber Warren, PA-C: Much more that plays into it.

Dr. Mark Holthouse, MD: It is a it is a not not to be seen as a silo. I love what I love about hormone health is that it is so intimately connected with insulin and cortisol and glucagon and ghrelin and incretins and, um.

Amber Warren, PA-C: Gut health, liver health.

Dr. Mark Holthouse, MD: Leptin. Liver health, fatty liver. They're all part of the same story. Yeah. Uh, we now know that guys that have low testosterone have a higher risk of fatty liver. Right. Who have a much higher risk of heart attacks? Diabetics with fatty livers. Metabolic dysfunction.

Amber Warren, PA-C: Guess what, guys? It's all related.

Dr. Mark Holthouse, MD: Yeah.

Amber Warren, PA-C: It is really all related. Back to your comment about the guys that are applying the transdermal cream like to their scrotums and the 5-alpha reductase. What would your argument be if someone said, well, then I'm just going to get on a 5-alpha reductase inhibitor?

Dr. Mark Holthouse, MD: And they can certainly do that. Yeah, yeah. My my advice would be if you're dead set against pellets, dead set against, you know, a gel just topically anywhere on the skin or a cream that's compounded and, and you like the effects you're getting there, then let's put you on.

Amber Warren, PA-C: The inhibitor.

Dr. Mark Holthouse, MD: Finasteride.

Amber Warren, PA-C: Okay. Okay.

Dr. Mark Holthouse, MD: Yeah. Usually Propecia which is the one milligram dose. And I usually do half to one pill twice a week because that if you drop that DHT too abruptly, that is a really powerful androgen receptor ligand that binds to that receptor and gives you the effects of the T. So I've seen guys with high DTS take too much finasteride and they're like, hey, my pellet doesn't work anymore. My injections not working. No you're on too much blocker.

Amber Warren, PA-C: Yeah. Here's why. Yeah. Okay. That makes so much sense. Um, so we talk a lot about, you know, sex hormones as it relates to just talking about hormones. But I think we forget that there's other hormones. You mentioned one, our stress hormone, cortisol, that play an intricate role in just how hormones are, how they function and are metabolized in the body. Thyroid health. Um, I think I'm not sure. And I know because statistically, more women are going to have, you know, Hashimoto's autoimmune, hypothyroid disease. But I'm not sure that I think that there's enough, um, attention given to thyroid health in the male population as it relates to hormones. Do you agree? I do disagree. Okay.

Dr. Mark Holthouse, MD: I do.

Amber Warren, PA-C: So why is thyroid health so important amongst this conversation?

Dr. Mark Holthouse, MD: Well, when it comes to secondary low T where it's coming from, the message from the brain not quite being right, telling the testicles to make T. One of the causes can be hypothyroidism, low T. So it's a direct cause of low T in some some guys. I think more importantly, um, though its effect on the liver and its production of something called sex hormone binding globulin. You know, we know that, um, hypothyroidism is associated with excess of this protein. And if you have more SHBG around, it binds up your testo making it virtually inactive. So you have less free hormone to do its thing. So when you've got a hyperthyroid situation that's important. Hypothyroid is going to do just the opposite. It's going to lower SHBG. You're going to have more free testosterone available. Now on the on the men's side of things, that's maybe a good thing. But when you're dealing with a woman with PCOS who's already got estrogen dominance, you don't necessarily want lower levels of SHBG to have more free estrogen running around, you know, creating more havoc with with their, uh, messed up menstrual cycle.

Amber Warren, PA-C: So that's the link between I just always find this a fascinating SHBG is such a fascinating protein to me. But that's the link between hypothyroidism and breast cancer, right? If it's estrogen driven. Correct? Because you've got too much free estrogen doing their dance and, you know, rummaging around the body and wreaking havoc.

Dr. Mark Holthouse, MD: Yeah. And if you've got insulin, pre-diabetes or type two diabetes running around, insulin up regulates aromatase. Makes more of this of the estrogen. You add a little bit of central obesity more aromatase. Yeah. So it's just this vicious feed forward cycle. Um but insulin being a pro-growth hormone is very pro cancer in in excess. You know, we need it to live. But too much is so true with so many things. Oxygen, testosterone.

Amber Warren, PA-C: It is so true.

Dr. Mark Holthouse, MD: Insulin.

Amber Warren, PA-C: Fine symphony. The Goldilocks theory, right?

Dr. Mark Holthouse, MD: Yeah.

Amber Warren, PA-C: Which is why we test levels and we start low and go slow. And you have to check check levels after two. But I think I wanted to hone on that topic as well because I think there's so many men especially you guys are so targeted and you just want to feel better and you want instantaneous results that might do what we call point of care testing, right? You get an instant lab back. That's just total testosterone and nothing else, right? And it doesn't tell the whole story. Um, and so I just would encourage men to, to to seek out somebody who will run that full panel on you to really get the whole, the whole picture and therefore the whole understanding of what's going on with your system.

Dr. Mark Holthouse, MD: You bring up a good point, because if all you're looking at is total T.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: We were talking before we came out here. How so many guys that you start on testosterone therapy, your total T goes up like crazy and their free T sometimes doesn't budge. And there are these botanicals that you can sometimes add that will for whatever reason, I don't think anybody knows. Sometimes they're able to liberate and maybe it's working through SHBG. Maybe it's working through other liver, uh, proteins, I don't know. Um, but just like with, you know, selective estrogen receptor things in women, cohosh and, and, um, uh, many of the things that we use botanically, vitex, hops, red clover, rhubarb.

Amber Warren, PA-C: Yep.

Dr. Mark Holthouse, MD: You know, that are probably working through these other mechanisms that have hormone like effects that adaptogenic kind of help with the hypothalamic pituitary gonadal axis without being a hormone per se. So there's there are other things you can do besides the testosterone that can help support.

Amber Warren, PA-C: But are those are those going to get you optimal if we're truly looking at these optimal reference ranges?

Dr. Mark Holthouse, MD: No not usually. Yeah, this is going to be for people that are kind of, you know, mid normal range that are looking to get a little bit of a pop, you know, that can try or they're just opposed to or contraindicated. They can't,

Amber Warren, PA-C: They can't do it, right.

Dr. Mark Holthouse, MD: You know they've got breast cancer. They've got prostate cancer. Yep. That's not stable. And they can't really. Or an active clot.

Amber Warren, PA-C: Can't go feed that. Yeah. So what are the what's the average age where we start to see T levels really start to decline in our guys.

Dr. Mark Holthouse, MD: Uh let's see. So in guys it starts to go down by about a half a percent to about 1.5% per year after age 25. Uh, women, it's highly variable. Um, most of it's coming, I know, I can't resist, I gotta talk.

Amber Warren, PA-C: You always have to talk about. We already did that interview, Dr. Holthouse!

Dr. Mark Holthouse, MD: Um. You women, I mean, there are women in their mid 30s that start losing testosterone more rapidly. We know there's a sudden drop at menopause because a lot of it's ovarian. But the the ovaries continue to make a little bit of testosterone for the rest of their lives. As long as they've got ovaries. There's a little bit made obviously, by the adrenal as well. Uh, guys, we're we're pretty much a progressive slide. We don't have that sudden drop in T progesterone and estrogen at 52. So yeah, I mean it's it's fairly fairly common to see depending on the way you define low testosterone, what parameters you use. It can be as, as high as, you know, 30% by age 40 that have low levels.

Amber Warren, PA-C: And what are the most common reasons to start having your testosterone drop earlier than others?

Dr. Mark Holthouse, MD: Some of the most common reasons are obesity.

Amber Warren, PA-C: Okay.

Dr. Mark Holthouse, MD: Uh, that's probably number one. Uh, for.

Amber Warren, PA-C: Some of the reasons you're already listed, right? Aromatizing.

Dr. Mark Holthouse, MD: Yeah, it's all about that. Um, there is a direct relationship, it appears, between obesity and your ability to make your brain send signals to the the gonads to make T. And as you lose weight, it's restored.

Amber Warren, PA-C: So with that. Sorry, I know I interrupted you because I know you're going to keep going, but is that an argument for the use of GLP-1s?

Dr. Mark Holthouse, MD: Absolutely.

Amber Warren, PA-C: Yeah, I figured it would be.

Dr. Mark Holthouse, MD: Absolutely. Yeah. I mean, there's data. There are studies now that are hinting at the idea more than just hinting. I would say there's a very valid hypothesis now that needs more randomized clinical trials to validate cause and effect. That would suggest therapeutically using testosterone to help reverse type two diabetes and prediabetes. Large trial January 21, Australia. Two year trial. Gel versus placebo. Couple hundred guys and they had newly diagnosed type two diabetes, or they were prediabetes. And at the end of the two years, both had same lifestyle interventions. Um, the thing the group that had testosterone over placebo had a significantly less, um, of of a incidence of um, type two diabetes and prediabetes compared to the controls, who got no T.

Amber Warren, PA-C: It wasn't that were not.

Dr. Mark Holthouse, MD: Yeah. They were both given, you know, dietary.

Amber Warren, PA-C: I was going to say I'm sure the lifestyle modifications were probably probably pretty significant.

Dr. Mark Holthouse, MD: Same program. So it was just the T and they were they were stratified uh, very well to look at other, other conditions that were confounders. So we're seeing testosterone moving from treating just sexual symptoms, preventing bone loss. Now to whoa, this might have something to do with helping reverse fatty liver, helping reverse type two diabetes. Pre-diabetes metabolic syndrome. And that's where it gets exciting because it's involved with that. And GLP-1s, you know, having that same effect of not just weight loss. Now we're looking at, you know, potentially helping dementia, AFib, cardiovascular protection. In addition to taking the food noise away, the neurotransmitter benefits the addictive dopaminergic hit we get from food. It takes a lot of that away. Kind of like our our smoking cessation meds do.

Amber Warren, PA-C: Right.

Dr. Mark Holthouse, MD: To give people a chance with some of these really hard to get rid of habits.

Amber Warren, PA-C: Yeah. Glp-1s, sorry guys. The the GLP ones we're talking about are these weight loss peptides. Ozempic, Wegovy, some of the compounded tirzepatide that we use and use at lower doses than Microdose here.

Dr. Mark Holthouse, MD: The stuff all your neighbors are on.

Amber Warren, PA-C: Yeah, exactly. Exactly. Yeah, that's a whole nother a whole nother topic on how to use and prescribe those appropriately. Um, but yeah, lots of lots of really interesting data coming out on on the GLP-1s again when they're used appropriately.

Amber Warren, PA-C: Are you looking for high quality supplements? Funmedshop.com is carefully curated by the wellness experts at Functional Medicine of Idaho. You'll find high quality supplements to support your health and optimize your body's natural functions. Rooted in responsible sourcing and utmost commitment to purity ensures that you're getting products that are not only effective, but also safe and reliable. Plus, you'll find our online Functional Medicine Foundations, which is carefully formulated using the best ingredients available so you can trust that you're giving the body the support it needs. Visit funmedshop.com today and take the next step in your health journey. That's funmedshop.com.

Amber Warren, PA-C: So intriguing. So intriguing. So what are let's let's talk through some of the most common symptoms we see as T levels start to decline in the male population.

Dr. Mark Holthouse, MD: So that's that's the that's the bummer is that not every guy has the same T that corresponds to the same level of symptomatology. It'd be so much easier if, like with an asthmatic, when we measure their spirometer to see how bad their breathing is getting air out of their lung, we kind of know how bad off they are. There's a cutoff with with some guys at 400 or even 3 or 2, 300, 200 low, low levels. They feel great.

Amber Warren, PA-C: Yeah. It's interesting.

Dr. Mark Holthouse, MD: It's it's insane. And then there's some guys at 6, 800 who we decide, you know, it's it's a risk benefit decision. Let's do a trial. See how you feel. And they're gaining more muscle mass. They've got better focus, stamina, endurance. Shorter recovery times.

Amber Warren, PA-C: Better sleep.

Dr. Mark Holthouse, MD: Better sleep is huge. This is when we hear all the time. All the time. Um, and they were at a dose where no one would ever have put them on anything. So it really brings home the point that there is really no normal level for which if somebody is having symptoms, it's not maybe worth trying a short trial. And that's true with men and for women.

Amber Warren, PA-C: How about guys with depression?

Dr. Mark Holthouse, MD: So that's a great question because so many of the depressive symptoms mimic low-T. And in fact it's not an SSRI deficiency an antidepressant. It's a it's a T problem. Yeah. And so many wives come to me afterwards and thank me saying he's less irritable. He's less grouchy. Um, there's this stigma about if you put guys on T, they become jerks and, you know, are aggressive and roid rage and, you know, cutting people off and giving them the salute on the road. I see that mostly with guys that are really overdosing on illegal, anabolic, androgenic stuff that they get out of their buddy's trunk at the gym parking lot, you know. And these guys are destroying their liver, you know, they're causing cancers. They're suppressing their hypothalamic pituitary gonadal axis, sometimes for life. And they're jerks. You can spot them in the gym. You can see who's juiced. They look like a tomato. They're like they've been bearing down. They got a red complexion and they're you know, they're just kind of angry and strutting versus guys that, you know, they're they look great and they're normal. Um, those guys on the synthetics don't have any natural metabolites, or I should say no natural enzymes that can handle those synthetic products. So they just build up in their system and that's why they behave that way. You can do the same thing if you overdose with bioidentical natural stuff, too. So there is there is a sweet spot, but symptoms typically are low sex drive, that's probably one of the most common. Guys, this is one we have to ask about because they're like, oh, yeah, that doesn't happen anymore. More spontaneous am erections. That's probably the most sensitive question that you can ask statistically that's going to identify a guy that's got an issue. It's hit and miss on erection issues. testo is not first line for treating erectile dysfunction. Only about there's only about a 19% prevalence of low T with guys that have ED.

Amber Warren, PA-C: 19!

Dr. Mark Holthouse, MD: And yet it's one of the things that brings a lot of them in.

Amber Warren, PA-C: Yeah, absolutely.

Dr. Mark Holthouse, MD: And then they find out oh I need Viagra or I need nitric oxide support because they've got vascular disease.

Amber Warren, PA-C: Yep.

Dr. Mark Holthouse, MD: So then that opens. Yeah. That opens up the conversation to say, hey, it's a bummer that you got ED and you can't get things to last as long as you need. But I'm now concerned about the fact that grandpa died of a heart attack at MI. You're 50 and you've got signs of low vascular NO, nitric oxide. That's not just a problem in the bedroom. That's a problem with, um, you know, developing vascular disease.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: Yeah. So symptoms, uh, really vary by by number. You just have to treat the guy as an n of one. A personal approach. But yeah, you'll see anything from those are the more specific low T, you know, um, decreased interest, um, decreased drive depressive symptoms, the ones that are a little more generic, that are harder to pinpoint to low T are things like fatigue.

Amber Warren, PA-C: Okay, yeah.

Dr. Mark Holthouse, MD: Poor sleep.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: Um.

Amber Warren, PA-C: Because that's so multifactorial. There's so many causes to that. Yeah.

Dr. Mark Holthouse, MD: Not able to build muscle in the gym. Putting in the time. That's another one. That's I hear a lot.

Amber Warren, PA-C: Body composition just in general. Right. Men and women?

Dr. Mark Holthouse, MD: Yes.

Amber Warren, PA-C: Just poor body composition. What worked five years ago is just not working anymore.

Dr. Mark Holthouse, MD: Yeah, exactly. Really delayed recovery. You know, it takes them a long time to recover from an effort of exercise.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: And, um, you know, this is not just for bodybuilders that want to work out every day insanely hard, right? Which we discourage because we want good recovery a day or two a week. Um, it's for the average, you know, weekend warrior and somebody who's out there three days a week going to the gym, it can really speed up recovery. So the results, especially if you're using peptides in conjunction, can be just logarithmic.

Amber Warren, PA-C: Peptides! Like what kind of peptides would we want to use in conjunction with testosterone? Besides the GLP ones? We talked a little bit about some of the microdosing these GLP ones, but I know there's other great peptides out there.

Dr. Mark Holthouse, MD: Yeah.

Amber Warren, PA-C: That our guys love.

Dr. Mark Holthouse, MD: Yes yes. The GLP ones are, you know, your guys that have that belly fat that have got fatty liver really metabolically unhealthy. Who your I always say hey how much, how much weight. What's your goal? Even though I don't care about weight and BMI, I'm looking at comp.

Amber Warren, PA-C: But they care.

Dr. Mark Holthouse, MD: They care, they do. Yeah and they do.

Dr. Mark Holthouse, MD: And they usually have a number. I'm 285. Okay. How tall are you? I'm six two. Okay. Where do you want to be? I think 225. 230, let's be realistic. And you know, we'll do the the body composition. We'll look at that instead of their, their scale. Because that could be so deceiving. Yeah. But I think focusing on the body composition as opposed to weight loss, focusing on, hey, what is this particular hormone doing in concert with the symphony of all these others for your liver, your thyroid, your glucose management, your mood, your neurotransmitters? Um, you know, and we'll we'll look at probably weight is I'm going to say the low hanging fruit.

Amber Warren, PA-C: Okay.

Dr. Mark Holthouse, MD: Exercise number two. Both lifting and aerobic. Both resistance training and aerobic work.

Amber Warren, PA-C: Do both.

Dr. Mark Holthouse, MD: Um, you kind of need to do both. A lot of guys are just focused on resistance training only when you do your cardio. It's, I think, better use of your time to do high intensity interval training. You know, so 20 minutes, two, three times a week you can do some butt kicking intervals.

Amber Warren, PA-C: Yep.

Dr. Mark Holthouse, MD: This whole thing of slogging away on a Nordic track or a stair stepper.

Amber Warren, PA-C: Did you say nordic track?

Dr. Mark Holthouse, MD: I did that dates me. Huh? No one knows what that is.

Amber Warren, PA-C: I don't think those. They don't make them anymore.

Dr. Mark Holthouse, MD: They don't make anymore because they're just clothes hangers. That's all they became used for.

Amber Warren, PA-C: Nordic track.

Dr. Mark Holthouse, MD: Whether it's a peloton.

Amber Warren, PA-C: There you go. There you go. There he is. Um.

Dr. Mark Holthouse, MD: I can't remember. I believe I remembered. Nordic track. But yeah, these instruments of aerobic forever.

Amber Warren, PA-C: Fancy new treadmills and pelotons where you're hitting it hard. Or I shouldn't say hitting it, but you said slogging away 60 - 90 minutes.

Dr. Mark Holthouse, MD: An hour on that.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: You know, you go to the gym and you watch these folks hanging on to the handles.

Amber Warren, PA-C: Yes.

Dr. Mark Holthouse, MD: Their feet are on their phone. Not even their. Watch, but they're watching their their show.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: And they've been on there for an hour and a half.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: At 80% of their. Yeah.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: That's, uh, a lot of oxidative stress and really not going to get you very far.

Amber Warren, PA-C: Hard on your cortisol. Hard on your thyroid, which, as we just talked about, is kryptonite to T. So not really helping you.

Dr. Mark Holthouse, MD: So we want we want both types of exercise. Um, I think diet is a huge factor. Uh, everyone always wants to know what's the prostate friendly. What's the testosterone friendly diet? Well, it's organic. It's whole grains. It's whole foods. Um.

Amber Warren, PA-C: Omega threes.

Dr. Mark Holthouse, MD: It's not necessarily carnivore.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: It's not necessarily long term ketogenic. It's omega threes. It's plants. It's great sources of lean, clean protein. And, um, you know, not a huge fan of of dairy for my guys because of prostate data. Um, but I'd rather them do that than ultra processed foods. The what is the biggest killer? It's sugar.

Dr. Mark Holthouse, MD: Because we know that that arrow goes both ways. Giving testo Can optimize diabetes. But if you've got high sugar and really, you're spiking your insulin with your lucky charms, your Cheerios and your Chip Ahoy cookies. And you know what that is, right?

Amber Warren, PA-C: Yes. That didn't date you, I think. Do they still make Chip Ahoy?

Dr. Mark Holthouse, MD: Okay, I think they. Oh.

Amber Warren, PA-C: Our producer said said yes.

Dr. Mark Holthouse, MD: Our producer says yes, so we'll go with it.

Amber Warren, PA-C: Yes, okay.

Dr. Mark Holthouse, MD: Um, so, you know, those things are going to spike your sugar, and they probably do a number on your T level.

Amber Warren, PA-C: Yeah. For sure.

Dr. Mark Holthouse, MD: So that goes both ways. So we're going to address diet.

Amber Warren, PA-C: Yep.

Dr. Mark Holthouse, MD: So what's that. That's weight. That's that's diet. Uh, manage stress.

Amber Warren, PA-C: Sleep and stress.

Dr. Mark Holthouse, MD: Cortisol is Kryptonite. I always say to my guys. And if you if you're stressed out, you're not going to want to have sex. You're not going to make T. Your body's trying to survive. And I don't care if you're 25 or 65. You takes away all of those normal functions. And until you deal with that, giving testosterone, it's kind of like going out here in the parking lot and flooring my car while I have my other foot on the brake.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: And, um.

Amber Warren, PA-C: So that's a hard one for guys. And maybe I'm wrong because I'm not a guy, but I live I live with a manly man and I'm raising two little men, but I feel like there's a lot of talk in our society about self-care for women and stress management for women. It is a hot topic, right?

Dr. Mark Holthouse, MD: Yeah.

Amber Warren, PA-C: But I don't think the guys talk about that. I don't think that's a thing for men. Right. These these, um, men that are, you know, raising their families and the sole providers or main providers for their family. And my husband doesn't have me time. Like, I think he'd, like, laugh at that. Right. So how do you encourage your guys to to manage their stress and manage their cortisol levels? What does that look like?

Dr. Mark Holthouse, MD: Having been at this a long time, guys have come a long way in that arena. Traditionally, historically, that has totally been true. I in the last ten years, even, you know, most of it being here in Idaho have seen a turnaround.

Amber Warren, PA-C: Good.

Dr. Mark Holthouse, MD: There are more men being proactive, probably because their wives are telling them and significant others to get their butt in there and fix what's wrong with you.

Amber Warren, PA-C: Totally.

Dr. Mark Holthouse, MD: You're 35 and you don't have any libido. And I'm driving all this initiation. Something's wrong here.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: Um, so some of it's that, um, some of it's fear of medical, you know, disease, diabetes and all these fatty liver things. I think, um, guys are not very good at networking. We're kind of used to being an island. And we just suck it up, and we don't talk and communicate like women do.

Amber Warren, PA-C: You guys don't. You don't engage in community like that. But that's also not how God made you, I get that.

Dr. Mark Holthouse, MD: It's. Yeah, it's.

Amber Warren, PA-C: You need that.

Dr. Mark Holthouse, MD: We need that. And I think where it's important in today's culture and this gets a little beyond T. But I'm going to share my my spiritual look at life. And that is guys need accountability.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: Um, men need to be trained and to watch by example. What meant what does a man do? What does a man look like? What is a good father? And if they don't have that in their friend group or their own father, their father-in-laws, it's really tough for them to know how to behave, especially in this culture where, you know, there's a lot of demasculinizing going on and, you know, it's almost like you got to apologize if you're a male.

Dr. Mark Holthouse, MD: Shame on you for being born with this thing hanging between your legs, because you are subpar and you have testosterone poisoning. Therefore you need to apologize. BS. Let's get real. There's, there's folks that are um, you know, divinely dedicating themselves and following a plan of action, whether that's God for me, that's God.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: Whether that's someone else's tradition. Um, find out why you're here. The bigger reason, and the context of what it means to be a fully functioning male, I think will be made clear to you. It will be revealed to you. So it's so much more than just four rings of carbon stuck together. Testosterone, steroid hormones. It's there's a spirituality about what it means to be male and to be a healthy male, not a compromised male, where the the poor female other half is, um, just has another kid on their hands, you know, as opposed to a helper.

Amber Warren, PA-C: Thank you for listening to the Functional Medicine Foundations podcast. For more information on topics covered today. Specialties available at the FMI Center for Optimal Health and the highest Quality of supplements and more, go to funmedfoundations.com.