Men’s Health with Dr. Tracy Gapin: Rational Wellness Podcast 391

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Dr. Tracy Gapin discusses Optimizing Men’s Health with Dr. Ben Weitz.

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Podcast Highlights

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Dr. Tracy Gapin is men’s health optimization and longevity expert.  He’s the founder of the Gapin Institute for Precision Medicine and a board-certified urologist with over 25 years experience. He’s a best-selling author, TEDx speaker, and his website is DrTracyGapin.com.  He recommends going to GapinInstitute.com/launch.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

 

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Podcast Transcript

Dr. Weitz:  Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.

Hello, Rational Wellness Podcasters. Today we’ll be having a discussion with Dr. Tracy Gapin, who’s a leading men’s health optimization and longevity expert. He’s the founder of the Gapin Institute for Precision Medicine and a board certified urologist with over 25 years experience.  Dr. Gapin helps high performance entrepreneurs, athletes, and executives reach their peak performance through cutting edge, data driven health strategies. He’s a best selling author, a TEDx speaker, and trusted by top professionals to optimize their health and energy. Welcome, Dr. Gapin.

Dr. Gapin:  Oh, thanks so much, Ben.  Glad to be here with you.

Dr. Weitz:  Okay, good. So, I understand that you were a very successful conventional urologist and at some point in the recent past you switched over to an integrative medical model incorporating functional medicine into your practice.

Dr. Gapin: Yes, that’s one facet of what we do for sure. So, you know, as you mentioned, my background is traditional healthcare.  I was a urologist for 25 years and about halfway through that practice I, through my own health issues, came to really recognize how our healthcare system is failing. And we are, we’re missing the big picture. And, I woke up one day, I’m magically suddenly 25 pounds overweight, I am not sleeping well, I’m stressed, not eating well, not exercising, I’m a mess.  And here I am as the quote, men’s health expert, as a urologist. And my concierge doc wanted to simply put me on a statin.  And I, something got the better of me and I knew there was more to it than that. And so I started studying epigenetics and that’s really for me where it all started, epigenetics, science of how your lifestyle affects your, your genetic expression and ultimately how your body works.  That got me to really recognize… 

Dr. Weitz: Where did you study epigenetics?

Dr. Gapin: So I went through a Puron epigenetic certification program.

Dr. Weitz: Oh, okay.

Dr. Gapin:  And that was back in 2013 or so when it all started for me. It all turned around for me. It opened my eyes to how we were missing a lot and we were failing.  And here I was, as the mental health expert who’s supposed to be able to help you. And I didn’t know that the first thing about, Nutrition, Lifestyle, Sleep, Stress, and then I went through proper training in hormones and realized that as traditional medical doctors, we don’t even treat hormone therapy the right way.  And we don’t really know how to optimize testosterone and thyroid and we have 50 hormones we have to be looking at and most docs are not looking at any of them, let alone the ones that really matter. And then that got me looking at peptides and I got certified through peptide therapy, through SEADS, went through A4M for longevity training, went through Kailish and IFM for functional medicine.  

Dr. Weitz:  Okay.

Dr. Gapin:  And what I found from all these different angles, Ben, is that the magic is when you put it all together. It is like baking a cake. You’re making a wedding cake, if you can imagine. Multiple tiers of that cake, right? And guys would come to me and say, Yeah, I heard about this amazing peptide.  Can I just get this magic peptide? Well, what I’ve learned is you gotta bake your cake first. Before you can put the frosting on it, so to speak, right? You gotta get your hormones in. If your hormones aren’t dialed in, you’re not going to want to exercise like you’re supposed to, right? You’re not going to want to do the hard work like you’re supposed to.  And so it’s hormones, it’s nutrition, it’s gut, it’s sleep, it’s all the fundamentals that I know you talk about a lot in your podcast as well. It’s putting all those pieces together that that really is how I was able to transform the way I approach men’s health. 

Dr. Weitz: That’s great.  Absolutely. There’s, adding hormones, adding supplements.  If you don’t have the base, if you don’t have your sleep, your diet, your exercise, your stress management under control is not going to be effective.  Oh so why don’t we go into some of the diet and lifestyle factors that you consider most important. And maybe if you want to start with diet and what type of nutritional approaches you like to use.

Dr. Gapin: Yeah. And I’m going to pivot here for you because you’ve heard all this before. Your listeners have heard all this before.  They know what they’re supposed to do. They know what they’re supposed to eat. They know sleep, sleep hygiene kind of techniques. I want to come at this from a little different angle to give the listeners something different than they’ve always heard before. Okay. And that is that Everyone’s telling you what you should eat, right?

Everyone’s telling you’re supposed to eat this perfect diet, and there are some foundational, fundamental, you need enough, you need to be eating at least 0.8 to 1 gram of protein per pound of body weight, and eat organic, and fresh fruits and vegetables, and, grass fed organic meat.  We know all that, but what I really like to hang my hat on is the fact that One size fails all, and that there’s no perfect diet, and what’s right for you depends on a lot of things. So let me give an example. Genetics can help us really understand what’s right for us. For example, ApoE gene is a great gene that we know is the gene that regulates how our body processes saturated fats.  

And certain variants of the ApoE gene have a markedly increased risk of heart disease. of Alzheimer’s disease, cognitive decline. However, we know by strategic [00:06:00] nutritional changes, by reducing sugar and specifically reducing saturated fat, you can eliminate that risk entirely if you have that variance. By understanding that, for that individual, the keto diet, for example, that is high potentially in saturated fats, may be the wrong diet for you.

The Plin1 gene is a gene that looks at how your body regulates carbohydrates. Based on your Plin1 variant, you may be one of those people where you can actually burn fat, lose weight, build muscle, with higher complex carbs. Which is way to Wait, what the hell? Wait, I’ve always heard Low carb diet, keto, that’s how you lose weight.  For some people, it’s actually the wrong freaking diet. We can look at supplementation like, looking at vitamin A, for example. The BCMO gene is the gene that regulates how our body processes vitamin A. Certain variants, beta carotene does nothing for you. It doesn’t convert into retinolic acid, which is what your body needs.  You need a specific form of vitamin A that your body can actually [00:07:00] use…

Dr. Weitz: So what’s the best way to test?  And so this is the power of testing, and specifically we’re talking here about genetics. our epigenetics?

Dr. Gapin: Yeah, so simple cheek swab. 

Dr. Weitz: What test do you like to use?

Dr. Gapin: So what we use is we use Gene Metrics and it’s one that it’s a provider based service and we look at 700, 000 genes, no lie.  700,000 genes that we look at with every client and we tailor them down. What’s comical to me is there are these Predators, if you will, online who are trying to sell you this magical kit for 900 with four genes and based on that here’s your supplement pack that you need to be taking for life now.

Excuse my language, it’s bullshit. Let me give you an example, the MTHFR, people call the mother effer gene, right? MTHFR is a gene that regulates methylation, but we know that if you can alter your diet in certain ways. Very high B complex vitamins, very high B12, very high folate. You can often overcome any of the challenges that people may have with MTHFR variation just by knowing that you can make these strategic decisions without having to buy a ton of supplements.  And so to me, genetics are a great foundational place to start. So when people ask me, what should I eat? It depends on genetics, right? It depends on gut testing. It depends on food sensitivities. It depends on a lot of that kind of stuff. 

Dr. Weitz: Now this panel that you like to run, if we were to run, if we were to take our patients, 23andMe or Ancestry and run that through some software, is that good enough?  Or this panel’s a lot better?

Dr. Gapin: Yeah, so it’s interesting. I get that question a lot. And there are maybe two thirds to three quarters of the SNPs that you can get off of that array. It’s basically an Illumina array. It’s the DNA array that you get, the raw file, if you will, from 23andMe. Right. That you can get some of [00:09:00] that data, most of that data, not all of it, though, because they just don’t, they’re not looking for that kind of stuff and, you bring up a great point that, I don’t know if you just saw on the news, it was I think Thursday of last week, how 23andMe is going through massive financial challenges, laying off a bunch of people, because they had a data breach that affected 6.9 million people last year to where your data is now exposed and is vulnerable. And so I really caution anybody against using those services because this big pharma GlaxoSmithKline comes up and buys 23andMe and next thing you know, your data is in someone else’s hands that you can’t control. So when we do genetics, and I would insist that any, you know, peak performance doc you work with, you need to be sure that it’s completely anonymous.

And so when we send off genetic report kits for testing to the DNA lab. It’s a barcode only. There’s no name on there. And so there’s no way that your data can ever get used and be correlated with you personally. So it’s a big deal in this day and age.

Dr. Weitz: I guess so. I’ve kind of given up the idea of ever having any privacy.  I figure everything is, every phone call, every email is being monitored. So I stopped worrying about it, but I can understand a lot of people do worry about it. I would, yes. So you, so if you wanted to determine if somebody’s going to do well on a certain kind of diet, is it better to run their genetics and then base it on that?  Or is it better to see what they’re doing, look at their biomarkers and see how that dietary pattern is expressing itself in their life?

Dr. Gapin: I always recommend starting with the diagnostics and what I mean by that is genetics

Dr. Weitz: first.

Dr. Gapin: Well, what I mean by that is blood testing, looking at key hormone markers, looking at biomarkers, looking at markers of inflammation, cardiovascular health, you know, lipids, for example, is a factor as well.

Looking at the functional testing like microbiome testing and food sensitivity [00:11:00] testing, organic acids can help us here as well. The genetics are a piece of that. We do metabolic testing as well, where you wear a mask, and based on your breath, we can understand how you’re metabolizing carbs and fats. When you put all of that together, now Ben, you can really understand what hormones do I need.

What supplements do I need? What’s the right nutrition program for me? How can I really focus on improving my sleep quality? And then, you know, how can I create a fitness program that is right for my body and my metrics and, you know, VO2 max testing to look at how your body is handling, aerobic capacity and recovery and fitness and performance.

Putting all that together, that’s when you can start to, you know, Make those recommendations. And so I like to give some basic fundamentals when it comes to nutrition, obviously, but you’ve heard all those before. I want to, you know, get the listener to think about this a little differently. Understand that every one of us is different.

One [00:12:00] size fails all, and you need to test not guess when it comes to knowing what’s right for you.

Dr. Weitz: So your answer is to do the genetics and the biomarkers at the same time and combine those. Thanks.

Dr. Gapin: Absolutely. You know, I think the magic is when you do all the tests at one time to get a very clear blueprint and understanding of what’s working, what’s not, and what needs attention.  And everything is connected together, so let me give you an example. I work with a lot of entrepreneurs, a lot of founders, some NFL players, Olympic athletes, a lot of stress shit. People. Now, none of us will admit we’re stressed, right, Ben? We’ll say, no, that’s not, that’s everybody else but me.

I’m, I, it doesn’t affect me. I’m immune to that. Well, I call BS and the testing will show that. What happens when you’re stressed, and this often shows up with sleep issues, it shows up with poor quality sleep, what that does, it raises cortisol, it raises your baseline blood sugar, raises your insulin levels, it [00:13:00] makes you store fat, makes you, have a hard time building muscle, it crushes your hormones, and all this affects your gut, which leads to food sensitivities.

You see how everything’s wrapped together and how what you’re eating and your hormones and how you’re managing stress and your sleep, all of it connects together. And that’s the big picture that I think people need to, need to really honor. And people are looking for that one single hack. When I think you need your full custom stack of what’s right for you.  And that’s really how we’re going to change men’s health and, health in general.

Dr. Weitz: Yeah. That’s part of our approach too, is everybody’s an individual, and you’ve got to look at each individual to see what’s going to work for them. And that’s, I think, fundamental to a functional integrative medical approach.  Personalized medicine. For sure.

Dr. Gapin: Yeah.

Dr. Weitz: So, let’s see a couple of other diet and lifestyle things that we got from your… that I got out of your meal 2.0 book. Let’s see. You say that too much protein can raise cortisol levels and lower testosterone levels. Is that in the book?

Dr. Gapin: No, no. The challenge that most people have is not getting enough protein.  And you know, we, we think of, of energy systems. We think of, burning fat. When we think of longevity, we know that lean muscle is actually, the organ of longevity, if you will. And it’s tied to regulating blood sugar. And no, it’s the exact opposite. Most people do not eat enough protein.

And so, the metric we use For that is generally your target should be one gram of protein daily per pound of ideal body weight. And so for most guys, let’s just say it’s 160, 170, somewhere on there. That’s generally what we’d recommend knowing that you’re going to make it to about 0. 8 grams, which is really what most guys end up, reaching, which I think [00:15:00] is reasonable, but target would be one gram of protein per day that I think is really important.  Yeah, for sure.

Dr. Weitz: And you’re a big fan of intermittent fasting?

Dr. Gapin: There’s a lot of science around intermittent fasting and, uh, its benefits when it comes to reducing inflammation, when it comes to improving insulin sensitivity, which for the listener is blood sugar regulation, how you’re, you’re, you’re handling blood glucose.  It’s beneficial for hormone production, it’s beneficial for autophagy, which is how our body clears cells, and I know you’ve heard all this before in other episodes. I think what the studies really show is the most likely reason for that benefit is it comes down to caloric restriction. Because when you can create a narrow feeding window, what’s going to happen naturally on accident without your, you even trying to, is you’re going to reduce caloric intake.  And we know that from all the longevity studies looking at animals, when you can reduce calories, you’re going to burn fat and, lose weight, of course, and feel better, but you’re actually going to [00:16:00] live longer as well. And so that’s really what it comes down to is those benefits. You know, what’s it from?  It’s probably in many aspects from the caloric restriction.

Dr. Weitz: Okay. You also mentioned carb cycling. Is that something you like to recommend as well?

Dr. Gapin: Yeah. Carb cycling is a concept that, you know, when we look at your macronutrient intake, meaning carbs, fats, and protein. We know based on all the testing we do, based on metabolic testing, based on genetics, we can get a really accurate idea of what that ratio should be for you.  But then what we want to recognize is that should vary based on your workouts, based on your training. You know, I’m a big bull and again, this is where everything connects together. And we know that for most men over the age of 50, you need to be doing a lot more strength training than you are certainly a lot more than the aerobic work you’re doing.

Most guys tend to kind of flip flop. They get on a treadmill or they walk on the [00:17:00] neighborhood and that’s great. Zone one, zone two training is okay. We all need that. No doubt. But most guys are losing muscle. Mass every year by not doing strength training. The reason I’m bringing that up in this conversation is we want to pair our carb intake with those those sessions of strength training.

Meaning on the days that you’re doing strength training, your body needs that glycogen store. You want to be consuming higher. carb intake on those days and on days that you’re doing more of the low intensity the zone two or the, the recovery day where you’re just taking easy walking, doing yoga, stretching, et cetera.

Those are the days to really cut back on your carb intake. Now, again, that’s based on understanding where you’re, where you’re going. where your baseline is of those ratios. So you’re going to have a different starting point than, than, than other people, but that’s how you cycle your carbs, where you want to think of it as should not be static where every day you’re eating the exact same thing, the exact same amount.[00:18:00]

Dr. Weitz: Right. Okay. What are some of the other most important diet and lifestyle factors, if you wanted to highlight a few things for our discussion here that you think are really impactful?

Dr. Gapin: I think one of the key points that, that gets missed is how do I know if what I’m doing is actually working? So you’re hearing recommendations from me here, other episodes, you have other lifestyle recommendations and those are all helpful, but how do I know that what you’re telling me is actually right for me?

Well, the answer is you measure it, you test, and that’s where I really believe wearable technology is the future of healthcare and what’s lacking right now in most healthcare approaches. So what I mean by that is blood sugar tracking, for example, you know, CGM, Continuous Glucose Monitor, it’s blood sugar monitoring for the, average individual.

It’s not just for diabetics. We’ve always thought of these devices as [00:19:00] tools for diabetics, but we now know again, blood sugar regulation, metabolic health is, is the phrase that, that you may hear out there. That means how your body is regulating your blood sugar. That’s super important because we know that Blood sugar levels are directly tied to things like inflammation and visceral fat, which is the fat around your organs, which is tied to cardiovascular risk, cardiovascular disease, heart attack, stroke, blood clot, and sudden death.

And so we know how important blood sugar regulation is, so back to your question, how do we know what to do, is you simply track your blood sugars and you’ll find out. So, example, one of my clients, Claire, this was last year, she couldn’t lose weight and she swore she tried everything. I’ve tried everything.

Nothing works, Doc. I love when someone tells me they’ve tried everything, but they haven’t. If they tried everything, it would have worked. So, sure enough, we put a blood sugar monitor on her. And we find that at night, around dinner time, her blood sugar is spiking over 200, [00:20:00] now for the listener, it should never go above 140, or if it does, it should go very barely above 140, and it should come down very quickly, okay?

So you want short spikes, and you want brief spikes. She had a spike over 200 that lasted for 3 hours, and this happened repeatedly. And so, upon talking with Claire, we found out that the food that caused that blood sugar spike was sushi. Now, sushi, you think, well, wait a second. It’s just, fish and some vegetables and rice.

What’s the big deal? Well, for Claire, sushi was kryptonite. And so for Claire, what we figured out was that if she ate fibrous vegetables first, and then she ate the protein, salmon, chicken, whatever it may be, and then had that same white rice, she had a negligible protein deficiency. bump in her blood sugar.

And so sometimes the order matters when you eat the vegetables and the protein before the carb, it can often have a dramatic effect on blood sugar spike. And [00:21:00] sometimes food matters. Like for me, I’ll tell you what, when I drink red wine, my blood sugar goes freaking through the roof. I can have a baked potato?  Don’t touch it. White rice? It’s kryptonite for me as well. Yeah, there’s individual

Dr. Weitz: responses. And then of course, at sushi bars, they put sugar on the rice too.

Dr. Gapin: Well, it, even if it’s the cleanest food you can imagine, sometimes it’s the sequence of it. And for certain people, again, based on gut health issues, based on food sensitivities.

So when it comes to understanding what I should be eating, When you track blood sugar, you’ll be shocked to see how what you think you’re doing right is not necessarily right for you. I see a lot of high performers where they wake up with high blood sugar and you think, well, how is that possible?

Because I haven’t eaten. Well, the answer is, or sleep. crummy sleep raises your stress hormone cortisol, which raises your blood sugar. And you wonder why you can’t burn fat. You wonder why you’re not building muscle. [00:22:00] You wonder why you feel like crap and have low energy and have brain fog all day. It’s because you had poor sleep.

And so that helps us understand what exactly to focus on. And so this is why, again I hate the broad stroke general recommendations of this lifestyle stuff, which is, important and beneficial, but it’s in my opinion, better when we can tailor it based on the real data on wearable technology. I could track your sleep data with an aura ring.

I wear mine every night and I think it’s great for seeing not how long you slept, not the quantity of sleep, but the quality. And by that, I mean the deep sleep and the REM sleep, the stages that we know are important when it comes to repair and recovery. And if you’re not looking at that, you may sleep seven hours and feel great or seven hours and feel like crap.  And that may be simply because of the stages and the quality of Sleepy Gut.

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Dr. Weitz:  Do you prefer one of the CGMs over the other? You think they’re equivalent?

Dr. Gapin: Great question. So there are a number of them out there. We use, now I want to clarify, there’s the Dexcom, which lasts for 10 days at a time.  There’s the Freestyle Libre that lasts for 14 the two main

Dr. Weitz: ones that most people are using.

Dr. Gapin: But, but the key though is that the actual user interface, for them that comes with those devices is horrible. It’s awful. It’s not user friendly. Clients don’t know what the hell to do with it. So I use another company that has an overlay, has a user interface on top of that makes it so much [00:25:00] easier to put your food intake and your lifestyle and activities on top of that.

So you can, the numbers don’t matter unless you have context, right? Of what you did. So what company do you use? So T H E I A is. Thea is the company that I use and and I have functional medicine trained coaches who work directly with my clients looking at the Thea platform. We have a dashboard that integrates through API connections so that the client can see their data real time.

The coach can see it, the medical team, the concierge, and we can all see at the same time and be able to understand what the heck you’re doing every day and whether it’s working or not. And so that’s the power of wearables to start to really understand. What do I do with this data and how does it impact what I should be doing every day?

Dr. Weitz: You think the Dexcom and the Libre are equally accurate or you think one is better than the other?

Dr. Gapin: Yeah, I think that data is pretty similar there. I don’t know if there’s any major difference in the quality of the data Okay, Dexcoms [00:26:00] last for 10 days the Freestyle lasts for 14 days So I prefer the Libre for that reason, but I hate the user, the native user interface for either of them.  I prefer using one that’s really slick and easy for the clients to understand.

Dr. Weitz: Yeah, most doctors don’t seem to prefer one over the other, but one of the prominent doctors I had on, she was convinced that the Libre was not as accurate as the Dexcom, but anyway let’s go into hormones. Yeah. So I guess, how do we test for hormones?  What kinds of tests do you like to run?

Dr. Gapin: So, so I’ve talked about this ad nauseum about the testosterone epidemic. And we have massive studies, 30 year studies out of the U. S. and Europe that all show the same thing and that is that testosterone levels have dropped by almost 50%. Free testosterone, which is the active bioavailable form of testosterone, is 40%.

[00:27:00] 45 percent lower than it was 20 years ago if you look at the same age and what that means to be really clear for the listener is a 50 year old guy today has a free tea that’s about half of a 50 year old guy 20 years ago and that’s super important not just for sex not important for building muscle or you know having you bodybuilding competitions.

Testosterone we know is critically important for cognitive function, for focus, mental acuity, concentration, memory, important for mood, important for energy, and it’s important for endurance, it’s important for recovery, for bone muscle, muscle mass, burning fat, regulating blood sugar. Most importantly, testosterone is directly tied to cardiovascular health.

Meaning we know from dozens of studies that men with low testosterone have a 30 40 percent increased risk of developing a cardiovascular major event. Heart attack, [00:28:00] stroke, clot, death. 30 40 percent if you look at low T versus optimal T. What

Dr. Weitz: do we consider low T on a test?

Dr. Gapin: Great question. So if you look at the lab slip, this is, it’s kind of comical.

If you look at the lab slip, you’ll see this reference range on the right, right? And when I went to medical school back in the paleozoic era, They taught us this is, 30 years ago now, just simply look at the reference range. If it’s in that range, then they’re good. And if it’s not, they’re not. And so we’ve been trained, brainwashed to just look at that range.

Oh, that’s what it is. And for some labs like potassium and sodium, those numbers don’t change forever. And so that’s fine. But I just shared with you the published longitudinal studies, three studies, Tens of thousands of people showed the same thing, and that is that testosterone levels are half what they were 20 years ago.

So then, let’s ask ourselves, what is that reference [00:29:00] range on the lab slip? How did they come up with that? How does LabCorp decide? what the reference range is. It’s what

Dr. Weitz: the average American has, right?

Dr. Gapin: There you go. That’s the key. You’re right, Ben. Exactly. So that reference range is the freaking average.  And they take two standard deviations statistically above and below. It’s like a bell curve, like everything else in life. And that’s the freaking reference range. And so what’s maddening here, what drives me crazy is that reference range is literally half what it was 20 years ago because it’s just following the average.  And so we’re all stuck in this shitty average and being told that you’re quote normal.

Dr. Weitz: Yeah, no, same thing happens for other labs. You’ve got liver enzyme ranges going up as, everybody’s drinking more because of the pandemic and

Dr. Gapin: But, but those over generations, those don’t change, AST, ALT, Alkaline Phosphatase.

Those are fairly stable over decades and millions of people. That’s not changing. But hormones specifically, we need to [00:30:00] recognize that you cannot look at that reference range because it’s bullshit.

Dr. Weitz: It’s too big. I was just looking at a Vibrant America Labs test with a patient this morning and the normal range was 150 to 1300.

So,

Dr. Gapin: it doesn’t say normal, it says reference range, which is nonsense. Yeah, I ignore

Dr. Weitz: it anyway, we go by optimal ranges.

Dr. Gapin: Yeah, so, back to, now that I’ve went off on a tirade, I get all fired up about that. But the answer is, free testosterone is what you care about. So many doctors, they don’t check testosterone at all, or if they do, they’re only looking at total.  It’s important to understand that free testosterone is the only number that matters.

Dr. Weitz: It’s the only number?

Dr. Gapin: It’s the only number for testosterone that matters and let me explain why. Total testosterone is measuring all the testosterone in your bloodstream, right? It’s measuring all the concentration of testosterone, nanograms per deciliter, in your bloodstream.

Well, [00:31:00] 99 percent of your testosterone, give or take, is bound to proteins in the blood. that render it useless. So, sexual unbinding globulin is the most common protein. Albumin, Alpha 1, Anti 1, Cometrypsin. There’s other proteins as well, but what these proteins do is they’re these big, fluffy, cloud like molecules, if you can imagine.

They bind to testosterone. And now this big molecule, this testosterone bound to this protein molecule is too big, it’s molecular size is too big to get through any cell membrane, so it can’t get into any cell now. Therefore, it can’t bind to the androgen receptor that it’s looking for. Therefore, it can’t get into the nucleus of the cell.

Therefore, it can’t affect DNA transcription. Therefore, it can have no biologic effect. This is the key. This is why free testosterone is so important. That’s the only bioavailable form of testosterone that can actually get into a cell and do anything at all, have any physiologic impact. [00:32:00] And so when you’re looking at total testosterone, you’re looking at 99 percent of basically worthless T.

And so free T is what we care about because that’s the T that’s actually going to have any effect.

Dr. Weitz: Well, I hear you and I understand what you’re saying. The reason why testosterone is bound with these protein molecules is so it can be escorted through the bloodstream. So these binding globulins are needed, or the testosterone couldn’t get to those different parts of the body.

And then it has.

Dr. Gapin: Yeah, not quite. Yeah. So let me clarify for you. These proteins in the blood are needed, and sex hormone binding globulin has a lot of other key functions. So I’m not here to name the benefit of sex hormone binding globulin or aldehyde. Those are certainly needed proteins. My point that I’m getting at here, and this is scientific fact, that for testosterone to do anything, it has to get eaten.

into a cell. Bound testosterone cannot get into a [00:33:00] cell. And so most testosterone is bound to proteins, but the testosterone that’s going to have any physiologic impact by definition is the free testosterone. And so that’s the number that we care about. That’s the only T that is going to do anything for you.

Dr. Weitz: So you don’t even pay attention to the total.

Dr. Gapin: We look at it, but that’s not what drives any decisions for us. It’s the free. The free is what’s going to make a difference for you. And I’ll tell you, I see a lot of guys that may have a total of A thousand and have a free of three and they feel like crap, right?

And I’ve guys have a free of a thousand and have a free of 16 and they feel pretty damn good. And so the total just doesn’t matter at all. It’s the free that’s going to give you all of the benefits of testosterone. And so I urge any of the patients or people out there, make sure your doc is getting a free testosterone level because that’s really what matters.

Dr. Weitz: Now, when you’re prescribing testosterone, [00:34:00] how do you know, is there a way to specifically increase free versus total? Oh yeah,

Dr. Gapin: absolutely. Yeah, and what we find, interestingly, is that, you can look at the ratio of free to total and you know that SHBG is the, has the biggest impact on that ratio. Is there a

Dr. Weitz: number for SHBG that you like to see it below?

Dr. Gapin: Well, you cannot reliably, consistently lower sex homobotany globulin unless you’re using SARMs and other stuff that I don’t recommend. But the real point there is we don’t necessarily We’re not necessarily trying to lower SHBG. And I get this question all the time. Doc, how do I lower my SHBG? And the answer is, you just raise your free T to where you need it to be, and what you’re going to find almost every time is that lowers SHBG.

When you raise testosterone, it lowers SHBG, which is crazy. [00:35:00] And so what I do is understand the nuance of how those all interact. And SHBG is also related to to estrogen. It’s also related to blood sugar regulation. Insulin sensitivity affects SHBG levels. So there’s a lot of nuance involved there.

Yeah, but suffice it to say that what we want is a free tea where it needs to be. And so Coming full circle to answer your question that started this fun diatribe is we want a free testosterone of around 20. And 20 pg per mL. Now I want to clarify though that for Quest, it’s a different scale.

So 20 on LabCorp, 20 pg per mL is what you’ll want. Now what’s really odd here, and I cannot tell you why other than just the way they run their lab, is the Quest number is 200. So it’s a scale, a factor of 10, but the units are still picograms per milliliter, which does [00:36:00] not make any sense. And so, again, it’s 20 for LabCorp, it’s 200 for Quest.

But understand that some men may feel great and be okay at 15 to 16, or 150 to 160, or may need as high as 24, 25, upward of, mid 20s. It depends on the individual, but again, target is somewhere around 3T of 20.

Dr. Weitz: Does it make a difference if you prescribe bioidentical testosterone or non bioidentical?

Does that make a difference?

Dr. Gapin: There is no bio, there is no non bioidentical testosterone. So, To clarify, the phrase bioidentical was created in the women’s health space because they were given synthetic estrogen, synthetic progesterone, and they were having increased risk of cancers, and the WHI trial, which was a travesty, came out and said that women should not be on hormones at all for any reason because of this risk of cancer.

We understand [00:37:00] very clearly that estradiol is the natural hormone that our bodies make when testosterone gets converted into estrogen. That’s the estrogen, E two, which is estradiol, is how testosterone gets metabolized. And then our bodies need estradiol. Both men and women need estradiol, and then estradiol gets metabolized further into estro.

right? 2 Hydroxy, 4 Hydroxy, 16 Hydroxy, Estrone. It gets methylated and that’s how your body clears it, excretes it. And so back to the bioidentical comment, bioidentical refers to estrogen and progesterone. There is no non bioidentical. When we get testosterone, it is the exact same testosterone molecule that your body makes.

There is no other form of it. Now it’s attached to a buffer, So you may hear the phrase Testosterone Undecanoate, Testosterone Cypionate, Testosterone Propionate. That’s simply the testosterone that’s bound to a buffer that allows it to be released over time, so it can, it’ll have a half life that will allow it to be [00:38:00] given on a very infrequent basis.

So you can give testosterone, twice a week, three times a week, for example, because of those esters, is what they are technically but it’ll it’s basically the way your body metabolizes it.

Dr. Weitz: Yeah, I think some doctor was advertising that that using pellet therapy is better because it’s bioidentical.

Dr. Gapin: I will politely refute that and say that testosterone is testosterone. Now there are, when it comes to giving men specifically testosterone, and this applies to women as well because I want to briefly state that women need testosterone also, it’s incredibly important for energy and brain function and building lean muscle which you need, cardiovascular health and sex drive and so premenopausal women need testosterone also.

But for men you can give testosterone either injection, and that could be either sub Q or IM, intramuscular injection. You can do Topical, I have a lot of men on scrotal application of a Versa based cream [00:39:00] testosterone. You can do oral now, which I don’t love typically. And you could do pellets and they all have pros and cons, but to be clear, they’re all the same testosterone molecule.

It’s just different ways of absorbing it. And there are pros and cons of which way to go depending on the individual.

Dr. Weitz: I didn’t know there was a subcutaneous. I thought it had to be intramuscular.

Dr. Gapin: Yeah, in fact, most men are now on subcutaneous injection and small little 28 gauge needle in the belly, two or three times a week.

And the levels we get are absolutely consistent with when we were recommending intramuscular years ago. Yeah. There are a few, maybe two, 3 percent of men where they don’t get the same absorption subcube, but that’s very rare. Again, two, 3%.

Dr. Weitz: So is that the form you recommend the most? Yeah.

Dr. Gapin: It’s the form that I do personally myself as well, so yeah, I like it because you can get very solid, consistent [00:40:00] levels, stable levels.

that are reproducible over time and compliance does not become a problem. When you ask guys to do it every day, like the topical or the oral compliance becomes a problem. It’s not painful. You don’t even feel the injection. And two or three times a week is something that most guys can do. No pain.  You don’t even feel it and minimal negligible side effects.

Dr. Weitz: Now, I’ve read a lot about the benefits of estrogen and progesterone for men as well as women. And a lot of times I’ll look at labs and I’ll see sometimes a guy whose estrogen, estradiol is really low or their progesterone is low.  And I know that progesterone can be used after a traumatic brain injury and has all kinds of benefits. Is it ever appropriate to give estrogen or progesterone to a guy?

Dr. Gapin: No.

Dr. Weitz: Okay.

Dr. Gapin: Yeah. And, and there’s actually there’s no science on giving [00:41:00] progesterone to men now. Estrogen has been given for men for.

Actually, in my urology career, it was given in the remote past for prostate cancer because it actually had a castrating effect. So, when you give estrogen to men, I want to be clear here, estrogen is not the enemy for men. We need estrogen. Again, testosterone gets metabolized into estrogen, into estradiol, and we need estrogen for brain function, for sex drives, even sexual performance, we need estrogen, so it’s not the enemy, but when you give estrogen, very different story, because what it will do is it will suppress production of testosterone through negative feedback at the brain, and so we don’t want to give men estrogen.

Women giving estrogen is a very different story, but for men, we don’t want to give estrogen.

Dr. Weitz: So, if estrogen has brain protective effects you just mentioned, Yeah. and some men have low estrogen, is there a natural way to approach that?

Dr. Gapin: Great question. So [00:42:00] when a man has low estrogen, it’s because he has low testosterone.

So again, think of the steroid pathway, all steroid hormones start from cholesterol, it goes to pregnenolone, it gets broken down into testosterone, and then that gets broken down into estradiol. And so when men have low estradiol levels, they will typically have low testosterone levels as well by definition.

Now the real problem we see more often than that, the more common problem we see is low testosterone and high estradiol, right? You’re getting a lot of aromatization where your testosterone is getting converted into estradiol, and too much of a good thing can be a problem in that case. Your fat cells convert testosterone into estrogen, and when that balance is off, suddenly now you have that obese guy, has a lot of visceral fat.

A lot of subcutaneous fat. He’s converting all that T into estrogen. Now you get that [00:43:00] estrogen dominant sort of situation now where they’re insulin resistant. They have issues with blood sugar regulation problems. They have inflammation. That’s where you start to really get into trouble with, risk of cardiovascular issues.

That’s where you want to fix that balance of testosterone to estrogen.

Dr. Weitz: Do you recommend DHEA?

Dr. Gapin: I do. I love DHEA. DHEA is a key hormone. It’s actually the precursor to testosterone in that pathway I just mentioned. And DHEA is important because it helps regulate mood. It’s important for energy, for metabolism.

It obviously is a precursor to testosterone, but probably most importantly is we know that DHEA very nicely counteracts, regulates cortisol, our stress hormone. And in fact, when we do cortisol stress hormone testing, we’ll look at the ratio, the balance between the two, and we want to get those DHEA sulfate, the active form, up [00:44:00] high to help regulate cortisol and balance that out.

So love DHEA. And for men, typically levels I look for are 300 to 600 of DHEA. Almost every man is deficient, is low in DHEA. Women are typically low as well. We aim for 200 to 300 in women.

Dr. Weitz: The precursor to DHEA is pregnenolone. That’s right. Is that something that’s ever recommended?

Dr. Gapin: Yeah, for some situations, I think pregnenolone is a great supplement, for sure.

In what situations? So, again, going back to the cortisol issues, when I have someone who has and you look at, salivary cortisol testing to see the trends, when we have issues with either either high or even low cortisol, we can use pregnenolone to help support DHEA production to help, again, counteract and regulate the cortisol imbalance that you’re seeing.

Dr. Weitz: Cool. Great. Um, so I think those are the main questions. Any other topics that you wanted to discuss for a few minutes? [00:45:00]

Dr. Gapin: Yeah. I think that, when it comes to hormones, it’s funny, every conversation I have around hormones, it always goes to testosterone. It’s such a fun, lengthy, bulky, which is great.

And it’s the most important hormone, but I’ll really emphasize for the men out there that there are a lot of other hormones you need to be looking at as well. I’m glad you asked about DHEA. Growth hormone. We know over the age of 40, it declines about 1% every year. So, get your level check there.

IGF one is one of the best ways to use as a surrogate for measuring your IGF one, or excuse me, your growth hormone production. Nitric oxide is a key hormone IGF one. Is

Dr. Weitz: there a level you like to see?

Dr. Gapin: Yeah, typically we look for, you know, around 150, maybe even up as high as 200 the older the man, typically the lower it is, I see a lot of older men where it’ll be 80, 70, somewhere in that range, which is much lower than you want, and, and it’s an important hormone because it’s beneficial when it comes to recovery, when it comes to repair from [00:46:00] injury, when it comes to repair from heavy exercise, from illness, etc.

It has a very anabolic effect. Effect when it comes to building muscle as well. And again, muscle is the key to longevity. And so, growth hormone, I don’t typically ever recommend giving you growth hormone. There are a lot of potential negative consequences, side effects, and suppressing your own production of growth hormone.

But I do like to really emphasize the benefit of having optimal growth hormone levels. And this is where peptides can be very helpful at boosting that without suppressing your own internal production of growth hormone.

Dr. Weitz: Yeah,

Dr. Gapin: unfortunately, some of the peptides have been banned, right? So interesting you say that.

So they were not actually banned. So I like to clarify this, that what happened is the FDA, in their wisdom, They took a bunch of peptides that were in class 1 and they moved them into a different class 2. Now, that doesn’t mean they’re banned. What that means is they cannot [00:47:00] verify the safety or the efficacy of these peptides.

Okay? Now, I’m not going to get on my Big Pharma soapbox right now, but I will simply state that Big Pharma controls everything the FDA does. Thank you very much. What we know is if you go to PubMed, publish studies on any of these peptides, you’ll see thousands of published studies. Someone just asked me on YouTube this morning about BPC, about published studies.

I looked it up. There are 1416 studies published on PubMed on BPC and the benefits of it. Nonetheless, they moved it into Category 2, which simply means they cannot confirm the safety because You need a 10 year clinical trial from Big Pharma to meet their standards of, quote, safety, which because peptides are by definition a simple sequence of pept, of amino acids, which cannot be patented for the most part, there’s not a drug company that’s going to, that’s going to do those clinical trials.

And so you can’t meet [00:48:00] the benchmark that they’ve set. It’s an unfair standard, and so what that meant by putting it into category two is not that they were banned, it’s that therefore the compounding pharmacies would not take the liability, the risk of producing them, knowing now that suddenly they’re vulnerable.

to really lawsuits malpractice because of that classification. What has happened since, however, in the last month, most of those peptides from September of 23 that were put on that class two have been taken back off of it actually. Really? The amazing work that we’ve been doing, the lobbying that we’ve been doing, and so most of them are actually available again now.  There are very few that are not available anymore still not available. Most of those ones that they Quote, took away from us. We actually don’t have access to yet again. Like

Dr. Weitz: some of the growth hormones, secretogogs, are they back? Yeah,

Dr. Gapin: most of those are available. BPC injectable, Thymosin, Beta. I love Epidilon.  It’s a great peptide when it comes to longevity and actually has anti [00:49:00] cancer growth benefits. So there are a lot of amazing peptides that that we now have available again. But there’s continually new ones evolving and coming out and this is the amazing, it’s the fast world and the fast science around peptides that we’re continually innovating and researching and testing and there’s science being published every week on new cutting edge peptides and how can we use them.

Dr. Weitz: Cool stuff. Interesting, cool. Good news to hear about the peptides being available again. So, I need to wrap how can everybody find out more about you and your practice and your books, et cetera.

Dr. Gapin: Thanks so much. Yeah. So, um, my website is gapininstitute. com, G A P I N institute. com. And if you’ll go to gapininstitute.com forward slash launch, I have a bunch of gifts for the listeners. I have a copy of my Ultimate Peptide Guide, which goes into detail a lot more about what we just talked about. I have my High Performance Health Handbook, which has 15 strategies and tactics you can start using today to have more energy, [00:50:00] better focus, burn fat, have better sex, live longer.  I have a copy of my best selling book, Male 2. 0. I have a digital copy and a guide that goes along with it. I have a Amazing masterclass that I put out as well, and you’ll also get a a link there if you want to reach out to my team to learn more about what we do, be happy to share that as well. So gappininstitute.com forward slash launch, L A U N C H.

Dr. Weitz: Excellent. Thanks, Doc.

 

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Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review.  As you may know, I continue to accept a limited number of new patients per month for functional medicine. If you would like help. overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310 395 3111.  And we can set you up for a consultation for functional medicine. And I will talk to everybody next week.