Men’s Health with Dr. Myles Spar: Rational Wellness Podcast 83

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Dr. Myles Spar discusses Men’s Health with Dr. Ben Weitz.

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Podcast Highlights

1:22  Some of the ways in which men’s health is different than women’s, is that men die younger. They have higher rates of heart disease. They may have issues with erectile dysfunction, prostate problems, and low testosterone especially as they age. Men, on average, die five years younger than women.  According to the Harvard Health Blog, the reasons why men die younger are that: 1. men tend to take bigger risks, 2. have more dangerous jobs, 3. die of heart disease more often, 4. are larger than women, 5. commit suicide more often than women, 6. are less socially connected, and 7. tend to avoid doctors.

3:45  Dr. Spar said it appears to be masculinity that results in men dying younger than women. In countries where the masculine machismo is more prevalent and they engage even less in the behaviors we know contribute to longer life and healthier living, are countries where men’s health is actually worse.  Dr. Spar said that we need to figure out how to message wellness to men so that they respond, which is what his professional mission has been about.

4:31  Dr. Spar said that the five factors that most contribute to premature death in men are 1. lack of exercise, 2. drinking too much, 3. engaging in risky behaviors, 4. smoking, and 5. being overweight.

5:29  We need to message in a way that men will tend to respond. Talking about a prevention and wellness approach means a lot to us as practitioners, but it only resonates to someone who is fairly abstract thinking, while guys tend to be more specific results oriented. Dr. Spar explained that we need to message to what matters to that person, such as performance at work, losing weight, getting cholesterol down, sexual function, etc. Men tend to respond to a more performance oriented message. but there are also lots of women who also think in this goal oriented way of thinking. 

7:11  When working with men to lose weight it is important to measure not just weight but bodyfat percentage and setting goals and holding men accountable.  Dr. Spar finds that apps like Strava are helpful in using technology that helps with accountability and tracking improvement or not. 

9:25  Dr. Spar prefers to look at genetics to see if his patients have trouble with detoxification. He uses either Pathway Genomics or PureGenomics from Pure Encapsulations that allows you to put your 23and me raw data through. But he is concerned about a report that such programs that analyse genetic data tend to have up to 20% errors when reporting on the SNPs of these genes.

12:17  To help men reduce their risk of heart disease, men need to have an advanced lipid profile, since the tests that are run with the annual physical exam are inadeguate in assessing the risk for heart disease. Dr. Spar likes to use the Cardiometabolic Profile from Spectracell, which looks at LDL particle size and number and also at inflammatory markers like CRP. We also need to look at Lp(a), which is a huge risk factor for heart disease.  Take the case of Bob Harper, the trainer from Biggest Loser who appears to be in great shape, and had no risk factors except that he had a high Lp(a) and had a near fatal heart attack.  It will also look at homocysteine, which is a risk factor for heart disease and is easy to lower with the right supplements. And homocysteine is also an indication that you don’t methylate well, if you haven’t had genetic testing. Your primary MD will usually not order such an advanced lipid profile because it’s usually not covered by insurance and they usually avoid such conversations.  Dr. Spar also likes some of his patients to get a coronary calcium score to see directly if there is any plaque in their arteries, which is another useful test that is not covered by insurance. But despite some patients’ concerns, there is very little radiation associated with such a limited scan and there is no radioactive dye.  If he has a patient who has cholesterol problems and he has them on fish oil and plant sterols and he is deciding whether to place them on a statin, the coronary calcium scan can help him and his patient make that decision. 

17:08  Men tend to have lower testosterone levels today because of 1. stress and anxiety, since our bodies shut down reproductive drive if we are under stress, 2. environmental toxicity, which especially seems to affect free testosterone, and even lowers sperm count, and 3. opioids, which have been correlated with lower testosterone levels.  Testosterone should ideally be in an optimal range betweeen 350 and 900. Too much and too low can both be risks for heart health. Men should also have an optimal range of estrogen with an ideal estradial range of 15-30. Men who are taking a lot of estrogen blockers can be causing themselves harm with respect heart and bone health if they drive their estrogen down too low.

23:50  Natural ways to raise testosterone levels include: 1. zinc and chrysin are both natural aromatase inhibitors and will block the conversion of testosterone to estrogen. When you take zinc you should also take 1/10 as much copper. 2. Chinese panax ginseng, 3. Tribulus, 4. Maca root, 5. stress management techniques, including meditation, yoga, Tai chi, journaling, prayer, some breath work, 6. 7-9 hours of sleep per night is very important 

26:45  Free testosterone levels seem to be often very low, even more so than the total testosterone.  Some of this can be due to thyroid and liver problems, but most of this is probably related to increases in SHBG (sex hormone binding globulin), which may be related to environmental toxins.  Dr. Spar noted that when tracking men whom he has placed on topical estrogen supplements, he will track them with saliva free testosterone levels, which is more sensitive for this than serum. This is part of his tack180.com program.

31:57  Dr. Spar does measure PSA levels in men, especially if he has placed them on testosterone.  We do know from the work of Dr. Abraham Morgentaler that testosterone does not cause prostate cancer, though if someone has prostate cancer, we don’t want to give them testosterone.  Dr. Spar will do a digital exam and if the prostate is enlarged he will also check a free PSA. If the PSA is elevated, will have the patient get a prostate MRI. If that is positive, only then he will recommend a biopsy.  This reduces unnecessary biopsies.

                                                                                          

 

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Dr. Myles Spar is a Medical Doctor who practices in Hollywood, California and he is a leading authority on men’s health. He is a co-author and editor of a comprehensive book on men’s health, Integrative Men’s Health. Dr. Spar provides a lot of useful information on his website, MDSpar.com where he offers his Tack180 program of comprehensive men’s care.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

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Podcast Transcripts

Dr. Weitz:            This is Dr. Ben Weitz with The Rational Wellness Podcast. Bringing you the cutting edge information on health and nutrition, from the latest scientific research and by interviewing the top experts in the field. Please subscribe to The Rational Wellness Podcast on iTunes and YouTube, and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.

Hello Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and leave us a ratings and review. That way more people will find out about the Rational Wellness Podcast. Today we are going to focus our discussion on men’s health, with our special guest, Dr. Miles Spar. We’ve talked in prior episodes about prostate health, and libido, with Dr. Geo Espinoza in episodes eight and number 48. These are important issues for men. But today, we’re going to talk about these and other factors in an overall approach to improving men’s health.

Some of the ways in which men’s health is different than women’s, is that men die younger. They have higher rates of heart disease. They may have issues with erectile dysfunction, prostate problems, and low testosterone especially as they age. Men, on average, die five years younger than women. What are some of the reasons for this? According to the Harvard Health Blog, men tend to take bigger risks, have more dangerous jobs, die of heart disease more often, are larger than women, commit suicide more often than women, are less socially connected, and tend to avoid doctors. As a chiropractor, I can definitely endorse this, because my practice, like most chiropractors, is 60% women, and a lot of the men who come in are only there because their wives or girlfriends pushed them to come in.

I’m happy that Dr. Miles Spar will be joining us today. He’s a medical doctor in Hollywood, California. He practices Functional Medicine, and he also directs the integrated medicine program at the Venice Family Clinics, Simms/Mann Health and Wellness Center. Dr. Spar is a leading authority on men’s health. His comprehensive book on integrated men’s health was published in 2014. When Dr. Spar sees patients, his consultations usually include an analysis of genetics, nutrient levels, hormones, and advanced cardiovascular testing. Dr. Spar is also an iron man athlete, and he works both with Hollywood celebrities, and professional athletes, including being a medical advisor for the NBA. I’m honored that you’ll be joining our podcast Miles, to speak about men’s health.

Dr. Spar:              Thank you. Thanks Ben. It’s great to be here.

Dr. Weitz:            Absolutely. So, do you agree with those reasons the author of the Harvard Health Blog wrote about why men tend to die younger?

Dr. Spar:              Yeah I do. I think it’s definitely proven at this point, that it’s not genetic, it’s not biologic. There’s differences in life expectancy between men and women, but those differences change over time, and across cultures. If there’s really biology, it would be a fixed difference or more close to a fixed difference. It really just seems to be, it’s more like masculinity is killing us, as opposed to being male. There’s a really interesting report, just a couple of weeks ago, the World Health Organization put out on the status of men’s health in Europe saying very similar things to what you quoted from that Harvard blog, that the countries where the masculine machismo is more prevalent, are countries where men’s health is actually worse. There are countries where they are engaging even less in behaviors we know contribute to longer life and healthier living.  Absolutely, I think it’s coming upon us to really try and figure out what are we doing wrong, and messaging wellness towards men. Why aren’t they responding? What can we do differently. That’s really what my professional mission has been all about.

Dr. Weitz:            Of those factors we mentioned, which ones do you think are the most important?

Dr. Spar:              Basically I think there are five that are most important. There are five that are most likely to contribute to the decrease in mortality, the decrease in life expectancy, because they contribute most to the preventive causes of premature mortality. That’s basically lack of exercise. It’s a lot of what you mentioned, but I think … I can’t narrow it down to one. I think it’s lack of exercise. It’s drinking too much or not moderating alcohol. It’s taking risky behaviors. It’s smoking. I have a little thing here. It’s also maintaining a healthy weight. Men are more likely to be obese than women, and I think that may be the most important cause of it right there.

Dr. Weitz:            Yeah great. How do you address some of these issues in your practice?

Dr. Spar:              I think, first of all, like I kind of refer to we don’t message what we’re trying to do to men very well. We’ve been using this prevention and wellness approach, which is great, and it means a lot to us as practitioners, but it only resonates to someone who is fairly abstract thinking, able to put off things now for future benefit. By and large, guys are a little more result oriented. “What do I need to do now, and how is it going to impact me now?” It’s more about results, outcomes, specific goals, as opposed to broad ideas of wellness or prevention. I think part of what we need to is really think about messaging that’s directed at what matters to the person that you’re in front of. Is it about performance at work? Is it about losing weight? Is it about being more on mentally? Is it about getting cholesterol down? Is it about sexual function? Then making very specific recommendations that will impact that particular goal that’s of concern to that person. I call it a men’s approach, that it’s really about performance oriented, but it’s really not just for men.

I think that would help us in general, because there are a lot of people who think in this more stereotypical masculine way that’s result oriented, goal oriented that is more abstract and wellness orientated. By and large, that’s more men than women, but this is a caveat to our whole conversation today. When we talk about men, I really mean anyone who thinks in a stereotypical male way. It doesn’t have to be a person who’s a male in gender. That’s the first step, is really more goal results oriented way of talking about why it’s important to make behavior change.

Dr. Weitz:            You mentioned weight gain and obesity. How do you specifically deal with that with men, and how do you come up with more … How do you approach it in a way that’s more impactful than just making general recommendations, “You should lose some weight”?

Dr. Spar:               Yeah. Good question. I think it’s about measuring and holding patients accountable and having real milestones. As opposed to a general grid. “I have this great anti-inflammatory diet. Here’s what you eat. Here’s what you shouldn’t eat.” That doesn’t work as well as, “Okay, let’s look at specifically what you’re eating, meet with a nutritionist, and then let’s measure not just weight because with guys oftentimes they’re working out and then they don’t lose weight because they’re building muscle mass, so let’s look at waist circumference or let’s put you in a DEXA scan, which you can do now pretty inexpensively and check your body fat percentages. Whatever single measure can really be important to that guy, find that, and then check it periodically because guys like to compete even if it’s against themselves or against other people.  That’s the other part of that. I think physical activity is as important as diet. With guys especially trying to get them to engage. I love Strava, which is an app that’s like a social media/competition app or Weight Watchers even now has a great app. They’re using some kind of technology that helps have accountable measures. It’s all about having a measurement that you track and being able to show improvement or lack thereof and then figuring out where do we need to change our tactics.

Dr. Weitz:            Yeah, we use bioimpedance in our office, and that’s helpful.

Dr. Spar:              That’s great. Something that you use the same one each time, then it really is good. It’s showing changes, and then you know if you’re going the right direction or not. I think guys especially, everybody, especially guys like to feel like you’re holding yourself accountable. As a practitioner you’re going to say, “Look, I know this is going to work, and we’re going to show it’s working. If it isn’t, we’re going to change things. Then they like to see that they’re making improvements in black and white.

Dr. Weitz:            Do you ever look at toxins as a factor in having trouble losing weight or so many other health issues?

Dr. Spar:              Yeah. I like to do both looking at toxins and looking at genetics because sometimes people have genetics where they’re not detoxifying as well, so I like to do genetic testing to see if they need issues with detoxifying because it may be that they’re being exposed to the same amount as everybody else, but their hormones are getting messed up because they’re not clearing them out. Even if you do measure their testosterone, TSH and all that, it’s kind of okay, but their hormones aren’t operating as maximally because there’s so many toxins. Some of that is determined I think by how good their liver is at clearing things out. We can measure that through some of the genetic tests. They can tell us, “Oh, okay. This person really does have a propensity to not clearing stuff out, so let’s give him supplements that help boost whatever phase of detoxification they might need help with.”

Dr. Weitz:            What’s your favorite genetic panel?

Dr. Spar:              That’s a really good question. I play with all of them. Right now I’m using Pathway Genomics. It’s not really my favorite, but I like it for right now in terms of price and availability. I also like Pure Encapsulations products. It has this free if you’re one of their clients. It has this thing called PureGenomics, which is great. You can run 23andMe data for free through there. You get a great report.

Now the caveat is I’m concerned because I’m hearing that there is concern with some of these secondary data analyses from 23andMe data, that there have been found to be quite a bit of misinterpretation. I take it all as one piece of evidence. None of them is going to be a sole decision maker for me. It’s just if someone comes in with symptoms that could be relating to, let’s say, detoxification, then I look to see how are they detoxifying. How is their SOD? How is there MTHFR or some of these other genes? To see, okay, that could explain it or, “You know what? This doesn’t even make sense. I don’t really think this is significant.”  I mean I think hopefully whole genome sequencing will become more affordable, and that’s going to be a lot more reliable than any of these tests that look at individual SNPs.

Dr. Weitz:            What was that concern about the 23andMe?

Dr. Spar:              There are some just some studies that are showing that these Promethease and PureGenomics and some of these other programs that basically do secondary data analysis, they basically take the raw data from 23andMe and run it through their systems, that there’s a lot of error.  I forget the numbers now. I wish I could tell you. It was 20% or more were recording genes that were just inaccurate, that patients didn’t have those genes as it said they had.

Dr. Weitz:            Oh, wow.

Dr. Spar:              Yeah. It was really high rate of error. It definitely gave me some pause.

Dr. Weitz:            Interesting. Yeah, we’ve been utilizing that service as well. How do you deal with the heart disease risk that men have?

Dr. Spar:              Well, I think it’s important number one to look beyond just the general annual physical lipid panel. That’s a big thing. I think that just plain old cholesterol and LDL cholesterol is one part of the picture. You need to really look at these advanced VAP panels like Berkeley Heart Lab or I use SpectraCell, one of these advanced panels that looks, A, at things that go beyond the plain lipid panel. So they look at lipid particle number and particle size. Do they have a bad pattern of LDL or bad kind of cholesterol. You can have the worst pattern or the not as bad pattern.  Then especially looking at other markers because we know that heart disease number one is plaque and inflammation. Those are the two essential parts, right? We know that cholesterol can increase risk for plaque, but if their inflammation markers like CRP are really low, I’m less concerned. It’s really important to measure that. Then we know things like Lp(a), separate from cholesterol, a huge risk factor for heart disease. Bob Harper made that famous. He’s the guy that is a trainer on Biggest Loser, really in shape guy, had a heart attack or at least needed a stent placed emergently, and I think it was a heart attack.  Then there was a big article in the New York Times about the fact that his only risk was his high Lp(a) back in January or February of this year, your listeners can look that up, by this really good science writer for the New York Times. It really brought to light how important that marker is, which unfortunately isn’t always covered by insurance, but it’s a really important mostly genetically based risk.

Dr. Weitz:            I think that’s one of the big factors why when someone goes for their typical annual physical and they get this very limited number of blood tests, especially today, which when it comes to lipids is maybe going to be like LDL and HDL, total cholesterol, and triglycerides and sometimes even less because that’s what the insurance is going to pay. Unfortunately, most primary MDs are trying to stick with the insurance guidelines, and so unfortunately I think short changing the patients.

Dr. Spar:              Yeah. I mean there have been studies showing the annual physical as it’s currently done literally is a waste of time. It doesn’t provide any change in mortality or morbidity. There have been articles in the New England Journal of Medicine and JAMA and in very prestigious, very conservative journals about that. It’s because it’s all based on what insurance says as opposed to what is really optimal in terms of preventative medicine and evaluating risk, which is unfortunate because then it puts us in this position of saying, “You know, you really do need this test and this is how much it’s going to cost, and I’m not making money off of it, but you really need this.”  Patients who are low income, it’s not fair.

Dr. Weitz:            MDs rarely even offer patients that choice, though.

Dr. Spar:              Right because it’s a whole discussion that they don’t feel like to have. Either they don’t know about it because they don’t learn about it.  It kind of goes down they only learn about what’s in the annual physical or they’re like, “Okay, I know he needs this, but I got three patients waiting. Do I really want to go into ‘Well, you need this. This is why. Is it covered or not covered.'” They’re just like, “No, I’m just going to check off the lipid panel.”  It’s really unfortunate.

Dr. Weitz:            Yeah.

Dr. Spar:              Then the other marker I would say in there that I didn’t mention is homocysteine. That’s if someone can’t afford genetic testing that’s kind of a hint that they might have like an MTHFR, a gene where they don’t methylate their B vitamins well and don’t clear homocysteine.  Homocysteine is easy to lower, and it’s a very known risk factor for heart disease.  That’s part of it. And then imaging, I really think again is not covered by insurance but is not that expensive.  It’s like $200 for a coronary calcium score.

Dr. Weitz:            Right.

Dr. Spar:              To me, I love those because if somebody does have high cholesterol, but they don’t really want to go on a statin and I don’t really want to put them on a statin, we’re trying fish oil, we’re trying plant sterols. They’re watching their diet. The thing that will help me decide, “Okay, do we really need a statin or not?” is something like a phenotypic test. Is that risk translating into real disease? The way to look at that is something like a coronary calcium CT scan, which is only a few cuts, a couple inner bugs, and we can see do they have plaque or not, and if they don’t, then I know, “You know what? Don’t worry about it. You have some cholesterol, but it’s not really manifesting as plaque,” versus, “Ooo, you have a high calcium score of 100, we’re putting you on a statin.”

Dr. Weitz:            I think the reason why you mentioned that it’s just a few cuts is to point out that it’s not a lot of radiation.

Dr. Spar:              Right. Exactly. Some people get scared of having too much CAT scanning. This one, there’s no contrast dye that they’re injecting in you. It’s really limited to just looking at the arteries around your heart.

Dr. Weitz:            Right. Good. Yeah. Let’s bring up the testosterone topic.

Dr. Spar:              Yes.

Dr. Weitz:            First of all, we’re seeing lower levels of testosterone in men over the last several decades. Why is that?

Dr. Spar:              Good question. I don’t know that we know. I mean, I think the hypotheses that seem most likely are number one, anxiety and stress. There’s just more stress. There’s less time to do what we need to do. There’s less people unplugging and relaxing. We know that reproductive drive is completely directly correlated with or inversely related with stress. Women stop menstruating when they’re really stressed. Men stop making testosterone. It’s literally evolution protecting our progeny because if our bodies sense stress or crisis, and that can be emotional stress from work or from relationships just as much as being under attack from a saber tooth tiger, it’s going to say, “Whoa, we need to protect the home front. We can’t make progeny that we may not be able to protect. Let’s shut down reproductive drive and just focus on survival.”  It’s kind of hard where it ends. Stress lowers testosterone. I think that’s a lot of it.

I think some of it is environmental toxicity. We see that in to some degree this difference between total testosterone and free testosterone, which I know you were going to ask about anyway. Basically, some guys like their total testosterone is okay, but they have so much of this binding up protein called sex hormone binding globulin that their amount of testosterone available to really work is low. Some of that, I think, is due to environmental toxins that affect the liver and then the liver makes more of that protein.  I think between the stress and the toxins, those are probably the most likely. We see fertility going down. We see sperm counts going down. There’s something really affecting reproduction in general in men and women, but you can see a direct correlation in men.

Then opioids as well I guess would be the third one. We hear a lot of this opioid epidemic. Opioids are very directly correlated with lower testosterone, completely, even if you’re just appropriately taking them for a couple of weeks after having surgery or something. Your testosterone is going to go down while you’re on them.

Dr. Weitz:            Yeah. Opioids have all sorts of negative effects on the gut, every system of the body really. When it comes to testosterone levels, it’s interesting that really high levels of testosterone like professional body builders have will increase their risk of heart disease, while really low levels also increase their risk of heart disease. Then, yes, testosterone levels lower. A lot of times there’s higher estrogen levels, and it’s interesting that that’s a negative for men.  For women, higher estrogen levels are very protective for heart disease, which is one of the reasons why women have lower risk of heart disease.

Dr. Spar:              Yeah. I mean, I think there’s this whole controversy about testosterone, but it shouldn’t be a surprise that it’s not good if it’s too high or too low. I mean, we know with thyroid for example if it’s too high you can have problems. You can have palpitations and a risk of heart attack. If it’s too low, you get a wheeze and constipated, and you can even have all sorts of skin and other immune system conditions. All hormones are very finely tuned. They affect each other. It’s the same with testosterone. There’s definitely evidence too low testosterone affects increased risk for heart disease, increased risk for obviously osteoporosis and bone problems, and too high of testosterone increases it as well.  Really, it does need to be in the optimal range. I think that’s part of the issue with guys like bodybuilders that are taking too much of it. It’s not like … I don’t know if there’s any good example, but it’s not like more is better. You know? I mean, more is better if they’re low and they’re just getting it to the upper 25% of the normal range.  If they’re taking it over the normal range, it’s not good.

Dr. Weitz:            Yeah, what bodybuilders are taking though is nowhere close to the normal range, you know?

Dr. Spar:              No, no.

Dr. Weitz:            They’re taking thousands of times above what the normal range is.

Dr. Spar:              Exactly. They get results in terms of muscle mass, but they also get dangerous side effects, liver, heart disease, all sorts of issues. I think the estrogen is the same thing. You want it in that what’s normal for men. That’s the other thing bodybuilders and some guys do. They’ll read it in Men’s Health magazine or these magazines to take all these estrogen blockers, and then they take too much, and their estrogen is unmeasurable. They think that’s great, but that actually puts them at risk for osteoporosis because you want between 15 and 30, if you’re measuring your estradiol level. If it’s much higher than that, no it’s not good. You can get breast tenderness and issues if you do maybe take a blocker a couple of days a week.  These guys who are taking blockers like every day, and they feel great that their estrogen is unmeasurable, are really in trouble.

Dr. Weitz:            You think 15 to 30 is the sweet spot for estrogen for men?

Dr. Spar:              Yeah, for estradiol specifically. Yes.

Dr. Weitz:            Estradiol. Yes. What about for testosterone? When you look at these testosterone tests, let’s start with the total testosterone. The range on some of these labs is 150 to 900, which is a big range.

Dr. Spar:              Yeah. I know. I think for a total really if it’s under 350, they’re likely to have symptoms.  First of all, with testosterone I rarely just treat the number. If it’s in the 100s, I will treat the number.  Even if they don’t have symptoms, that’s dangerous for bone and heart health and even diabetes risk. If it’s in the 300s, likely they’re going to have symptoms if it’s under 350. So the symptoms that a guy can have, they may not report sexual function issues, but they could have depression. They could even be put on antidepressants because nobody checked testosterone, but really they’re depressed because their testosterone is low.  They can have low energy.  They can just have lack of muscle mass or losing muscle mass or losing weight. Sometimes guys won’t talk about having issues with sexual function, but they’ll talk about these other things.  Those all can be improved if you get the testosterone normal.  I would say probably 350 is the lower limits of normal, optimal, and up to maybe 900, probably much above that you risk the blood count getting too high. You risk acne. You risk getting that kind of road rage kind of feeling.  There’s probably no extra benefit of getting it to 1,100 versus 900.

Dr. Weitz:            What are some of the strategies for helping to normalize or elevate testosterone levels besides taking testosterone?

Dr. Spar:              A couple of things. Number one, you can take some things that naturally do block some of that conversion of testosterone to estrogen, like zinc for example or there’s a natural herb called chrysin which you can even put into a topical thing. Those help a lot.  The conversion, you know we all convert testosterone to estrogen via this enzyme aromatase.  Those are natural aromatase inhibitors, so they will naturally boost testosterone a little bit.

Whenever you take zinc, you want to take a little bit of cooper with it in a ratio of about ten to one zinc to copper because they go together, so they are supplements that will have those combined. Those are kind of natural ways.  Other than that, there are other things that help boost libido and male energy, but they don’t boost testosterone per se.  Still, I think they’re worth using if testosterone is mildly low and somebody has symptoms.  For example, in Chinese medicine the ginsengs, we all know about, right? Especially Panax ginseng. In Indian medicine there’s Tribulus, which is kind of like the Ayurvedic form of ginseng. In South America, there’s Maca root, which is what they call Peruvian ginseng. Every culture kind of has their own male energy formula.  I really like Tribulus.  Maca has been really well shown to help with mood changes. There is a good study showing men on I forget if it was Celexa, Prozac, one of those SSRIs, which are known to cause sexual side effects taking Maca I think it was about two grams a day.  This was like a very well peer reviewed study.  They had a decrease in those side effects after they started the Maca, those sexual side effects.  I think that’s a great thing to try.  Those don’t raise T per se, but they do help some of the symptoms of low T.

Dr. Weitz:            Right. Tongkat Ali, have you tried that herb?

Dr. Spar:              No, I haven’t.

Dr. Weitz:            Yeah, check that one out. Look into the research on it.

Dr. Spar:              Okay. Great. Yeah, I definitely will. Obviously the other things we talked about that are real important. We talked about how stress lowers testosterone, so one of the most important interventions to increase testosterone is to find some stress management approach, whether it’s meditation, yoga, Tai chi, journaling, prayer, some breath work. I counseled a guy to do every day to really help decrease the impact stress has on the body. That’s probably the most powerful thing.

Dr. Weitz:            I found sleep to be really impactful as well. So many of us are sleeping four, five, or six hours a day.

Dr. Spar:              Yeah. That’s true. Most people do need seven to nine on average. You can get away with one or two less than that, but over time that absolutely decreases your ability to deal with the stress of life and then that’s going to cause a cascade of events. Yeah, that’s a really good point.

Dr. Weitz:            To bring up the free testosterone thing, I’ve noticed a huge percentage of men with low free testosterone levels. Even if their total testosterone level has sort of been normal or mid-range.

Dr. Spar:              Yes. Yeah, I don’t know that we know exactly why. Like I said some of that is from this increase in this binding protein, HDGN. We don’t know why that’s raised. We know thyroid disease and liver disease affects it, but it seems like more and more guys are getting a lot of testosterone gunked up with this SHBG, and I suspect myself, and I don’t have a lot of scientific basis for it, that it is part of this environmental toxicity affecting the liver and liver manufacturing more of this.

Dr. Weitz:            A lot of these environmental toxins are estrogenic substances.

Dr. Spar:              Exactly. The program I do called Tack 180, and in the show notes I’m sure you’ll have a link to that, it’s tack180.com that does a lot of this testing like we’ve talked about. I do saliva testing in addition to the blood. The blood is good for checking total, and you can check free as well, but the saliva is really good because it only checks the free really available testosterone and especially if I’m using topical testosterone replacement for a guy. Sometimes that salivary will really help me hone it in better because you can kind of overdose pretty easily a patient on topical testosterone just checking serum levels. The saliva will help you catch if you’re using too much or not.

Dr. Weitz:            Just in conversations with some patients who have used topical, they often feel like it doesn’t do much especially that AndroGel stuff.

Dr. Spar:              Yeah, it’s funny. You know, I think it’s like 50/50. I don’t know the percentage, but some guys it absolutely works, and it’s great. Some guys it does nothing. A, they don’t feel anything, and, B, it doesn’t even raise the level much. It must have something to do with the carrier and whether it gets absorbed or not. Just so your listeners know, bioidentical testosterone, it’s all the same. It’s much less complicated than with women, right? With women you can have all these nonbioidentical estrogens and progesterones, but, man, it’s all the same testosterone compound. It’s all pretty much bioidentical.

Dr. Weitz:            Yeah, there’s no testosterone coming from horses.

Dr. Spar:              Right. That would be right. I guess if they would take like stallions maybe they could get some or something.

Dr. Weitz:            Actually, that could be a big seller.

Dr. Spar:              As opposed to the mares, yeah. Okay. Let’s delete that. It’s going to be my patented thing. I don’t know how we’re going to collect it, but we’ll figure it out. Yeah, it is all the same. That’s why sometimes I like to go with compounded because you can put it in a carrier that might work better than whatever AndroGel uses. You can put it in a cream instead of a gel so it’s a little less sticky. You can use less volume and make it more concentrated so it’s less done. I’m using more and more of clomiphene, which is a pill so it’s easier, but it is off label. It’s not FDA approved for men. It’s approved for women. It’s safe. Urologists started using it a lot a few years ago, and so those of us doing men’s health started looking at that. It’s been out for a long time, so it’s available generically. It’s not that expensive.  It especially is good because it helps get the testosterone to be made by the patient themselves, so it stimulates their own testicle production so you’re not taking over completely the testosterone by putting it in either injecting it or topically. You’re just kind of fooling the pituitary gland into telling the testicles to make more testosterone.

Dr. Weitz:            Yeah. Dr. Elkin who’s in my office on Tuesdays, he’s an integrative cardiologist, he likes to use that in combination with HCG.

Dr. Spar:              Yeah. They work in a similar way, so it’s working on the level of the pituitary and hypothalamus. The other thing people don’t talk about when you use testosterone testicles shrink because you’re really taking over production. I don’t care with doctors say. You are taking over production unless you’re adding in HCG or clomiphene. As soon as the body senses you’re taking much higher doses of testosterone than you would make on your own, they’re like, all right we’re good. You’re just going to handle it through the shot or the topical. And the testicles stop producing and do shrink. That’s a concern for a lot of guys.

Dr. Weitz:            Over a period of time if men stay on that they may lose the ability to product their own testosterone, right?

Dr. Spar:              I don’t know if that’s true. I don’t think we know that.

Dr. Weitz:            I know it’s the case with former body builders because I used to treat a lot of these guys, and that was pretty common. They would take them in crazy excessive amounts.

Dr. Spar:              Right. Yeah, definitely if you’re using high doses like that. If you’re using just kind of therapeutic doses, I don’t know because the reality is guys are guys, right? No offense. They don’t use it all the time. Even guys on it for years are missing a lot of doses that are going on. They run out. They forgot how they felt off of it, so then they stop. It really ends up not being an issue. Most guys are not on it day in and day out for years unless they’re like you said body builders or something.

Dr. Weitz:            Do you use PSA to screen for prostate problems? I just recently had a physical with my primary care doctor, and he said, “I don’t believe in PSA anymore.”

Dr. Spar:              Yeah. No, I definitely do if they’re on testosterone. You have to. I do believe in annual exams.

Dr. Weitz:            But even if they’re not?

Dr. Spar:              Yeah. I mean, it’s really important. I mean, we know testosterone treatment does not increase risk for prostate cancer. That’s been proven. Abraham Morgantelar from NYU or Columbia proved that. If somebody gets prostate cancer, you don’t want to keep giving them testosterone. Yeah, I do screen for it with PSA. You know, in the other patients it’s tough. I will have the discussion. Basically I always do a digital exam and feel the prostate. If it’s enlarged, I will check it. I usually try and also check a free PSA. I think on one hand, yes, it’s like what do you do if the PSA is elevated. Half the time it’s just causing stress and worry, and it’s nothing, but the good thing is nowadays most men have access to a prostate MRI. That can really make the need to jump from a high PSA to biopsy much less likely.  They can instead have an MRI if the PSA is a little high, and if the MRI is fine, they don’t need to have the biopsy. If the MRI is not fine, they know exactly where to go for the biopsy so they’re not just doing a ton of random punches. The MRI helps me feel better about ordering a PSA.

Dr. Weitz:            Unfortunately, once again, we have another situation where you’ve got a procedure that’s not always covered by insurance.

Dr. Spar:              Right, right. Usually if the PSA is over 4, at least in my patients who are mostly PPO kind of insured, they’ve had it covered. Sometimes you have to go through the urologists, but usually they can get it covered.

Dr. Weitz:            Right. I think the big issue with the PSA test is that men who have positive PSA who show elevated PSA levels sometimes jump to biopsy and then just jump to surgery and then have a lot of side effects when maybe it was a slow growing prostate cancer that they could’ve monitored for years without any problems.

Dr. Spar:              Exactly. It’s heartbreaking. It really is. We’re trying to figure out. We need better tests to know which ones are just there and will never cause problems and which ones are scary.

Dr. Weitz:            Yeah. I think we’re doing a disservice though to not do the PSA. We just need to make sure that when they get it that they don’t panic and rush out and get a procedure that can cause incontinence and impotency when they might not need it.

Dr. Spar:              Right. Exactly. Yep. The free PSA even if there’s not access to the MRI it’s a little bit helpful. It kind of breaks out if someone has an elevated PSA into the percentage that is what’s called free, and that correlates with the likelihood that that elevated PSA is just enlarged prostate versus cancer.

Dr. Weitz:            Right. I think those are most of the questions that I had. Is there any other issue you’d like to raise?

Dr. Spar:              No, not really. I think it’s just important for listeners to know that, number one, there are ways to help men make behavior change, and I think it’s really, really important whether you’re a practitioner or patient to do that. It’s Movember right now. I’m not sure when this is going to air, but this is men’s health month. It’s literally life and death. I mean, it sounds like a hyperbole, but men are dying because they’re not resonating with the message you are giving. I just encourage listeners to really think about one step at a time. Don’t talk about big global prevention messages. Talk about one thing you or your patient can do to decrease the risk of getting some kind of problem. Make sure they understand how it affects something they’re concerned about. Make it goal oriented.

My whole tag line is when you’re healthy you can win. When you’re not healthy, there’s that saying, I forgot who said it. Somebody who is healthy has a thousand dreams. Somebody who’s unhealthy has one. That’s really something to think about.

Dr. Weitz:            That’s great. That’s a great note to end on. How can listeners get a hold of you and find out about what you offer?

Dr. Spar:               Sure. My website and blog and everything is at drspar.com. D-R-S-P-A-R dot com, and then the program I have for optimal men’s health is called Tack180, T-A-C-K 1-8-0, so Tack180.com. Really, I encourage you to sign up for my newsletter. It’s very brief. It’s once a week, just three nuggets of information that are germane to men’s health, and you can sign onto that right on the website.

Dr. Weitz:            That’s great. I’ll put links to that in the show notes. Thank you, Miles.

Dr. Spar:               Thank you. Appreciate it. It was a pleasure.

Dr. Weitz:            Yeah, excellent.