[Transcript] – How Low Testosterone Can Destroy Your Heart And What You Can Do About It.

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Podcast from:  https://bengreenfieldfitness.com/podcast/hormones-podcasts/testosterone-heart-attack/

[00:00] Introduction

[02:56] Jon Benson’s Story

[09:47] How Jon Found The Hormone Deficiency Link

[11:58] Heart Issues And Hormonal Status

[13:34] Forms Of Hormone Replacement Therapy

[16:18] Lowering Risk For Increased Clotting Factors

[18:50] Estrogen Conversion

[22:05] How To Go About Hormone Testing

[26:58] Testosterone Numbers

[34:25] When to Use TRT Versus Supplementation

[42:00] Going Off Testosterone Replacement Therapy

[46:57] What Our Ancestors Did

[49:52] Testosterone Supplements

[59:42] End of Podcast

Ben:  Hey, folks.  It’s Ben Greenfield.  And one thing I've noticed is that this year especially, popular media has been kind of blowing up the news with reports that, for example, hormone replacement therapy, like testosterone replacement therapy, could actually cause an increased risk of heart attacks.  But what they don't seem to be telling you is that low testosterone, whether you're a man or a woman, can actually decrease your heart health pretty big time.  And if you don't address low testosterone as you age, you can not only pile extra stress on your heart, but you can also get frail, you can lose muscle, you can gain fat, you can get impaired cognition and brain performance, you can get lower bone density, increased risk of diabetes, and the list goes on and on.  And there's been a lot of problems with the studies that suggest testosterone replacement therapy could hurt your heart, and hopefully in today's podcast we'll get a chance to talk about some of those problems and more importantly the really important link between your heart and your hormones.

My guest today is Jon Benson.  And Jon's going to tell a story to you in a little bit more detail, but 10 years ago he was a pretty typical American male who was overworked, and overstressed, and overweight, and he actually was in the obese category and had all the disease states you'd associate with that like high blood pressure, and high inflammation, high cholesterol, and high triglycerides, and the stress fat around the belly, and he also had some heart issues.  But he's managed to put himself back together, he's managed to fix himself.  He's actually now a four-time bestselling author on the subjects of fitness and nutrition.  He's got books like “Fit Over 40”, and “7 Minute Body”, and “The Every Other Day Diet”.  And the topic of testosterone and hormones plays a pretty big role in his story.  So we're going to delve into all of that today and John, thanks so much for coming on the call, man.

Jon:  Hey.  You're welcome, man.  It's great to be here, great to share this information with other people.

Ben:  So let's delve into your history of heart issues and kind of how you eventually came to find out this link between your heart and your hormones.  What's your story?

Jon:  Well, my story started when I was 25 years old.  I was feeling really drained and I didn't have any outward signs of hormonal decline, especially at such a young age, except for the fact that I'd go to the gym and I would be tired for about two or three days after working out, and I couldn't gain any muscle and I would just get really frustrated.  And what I ended up doing was, essentially later on I would get so frustrated even after looking at hormone replacement therapy that I just quit.  I just gave up, just thinking it's not going to happen.  But the irony was is that I went to an endocrinologist and he looked at me and said, “So why are you here?”  I said, “Well, I've been doing some research,” and back then it was in the library, “and I think I'm deficient in testosterone.”  He literally said, “You're not deficient in testosterone.”

Ben:  Just by looking at you?

Jon:  Yeah, yeah.  I might have had the worst endocrinologist ever because now that I've studied this for 15, 20 years, there's no way that you can look at somebody and know that.  But back then, there wasn't quite as much information.  It wasn't called HRT, these are relatively new terms.  So he ran all of these tests on me and he came back with a bunch of really bad news.  First of all he said, “Jon, you've got heart disease.  You have got crazy, blown out of proportion lipids.”  So he just ran a general blood test to find out what my lipids were, than he ran the endocrine test to find out if I was testosterone deficient or whatever.  So first thing he says, “Your cholesterol's over 500, your triglycerides are over 3,000.”  These are numbers that are absolutely off the chart high, and he said, “You really need to do something about this.”  But he didn't emphasize it enough for me to take action.  I mean back then when you're 25, you can kind of feel indestructible.  I was thinking, “Yeah, yeah, yeah.  Just get to the testosterone,” because I wanted to make gains in the gym.  I just was curious what, that's what I always wanted.  I always wanted to be a bodybuilder and I said, “Well hey, I don't want to take steroids, but I want to make gains.”

Then he said, “Well, your testosterone came back wrong.  There's no way this test is right, so we're going to have to retest.”  I go, “What do you mean?”  He goes, “Well, it came back 52.  And there's no way that your total testosterone is 52.  It's missing a zero and there's some sort of a lab error.  So I'm going to run it again.  So he ran it again and it came back 50.”  So at this point he said, he started calling me the freak 'cause he's like, “I've never seen anything this odd in my life.  He actually just ran the hormone test for testosterone first, and then he ran the entire endocrine panel on the second go-around, and we found out that I was not making any thyroid to speak of, my TSH levels were 14, which means my thyroid stimulating hormone was just being spurted out trying to please get more thyroid going on here.  And then I started suspecting, well after doing a lot of research that I may have, they nicknamed it Wilson's disease, which is where you don't convert T4 into T3.  So in other words 'cause we were seeing a lot of T4 but not any T3, which ended up being the case.  So I was severely hypothyroid, which can lead to heart disease.  They're both interrelated.  The IGF-1 factors were gone.  So basically all the hormones from the pituitary gland were deficient.  Severely deficient.  And so he suspected a tumor which got kind of scary.

Ben:  Yeah.  Like a pituitary tumor?

Jon:  Yeah, exactly.  And so we looked at the possibility of having a pituitary tumor and we ruled that out.  But he did notice that there was something really, really weird going on here with the pituitary gland.  So we tracked it back down to a fever I'd had the year before, a very high fever.  106, I was in the hospital.  And when you have that kind of fever, you can often have brain damage that we suspected some degree of brain damage.  My wife would agree with that assessment.  But we didn't know specifically what it was going to be.  I've lost a lot of, well, mid-term memory is very fuzzy for me.  Short term and long term is fine, but I never suspected that it could affect the pituitary gland, so that's our best hypotheses at the moment of what happened.  But the bottom line is I was making no hormones at all.  In layman's terms, your hormone gone, and I had this really strange heart disease, these heart disease factors that just were off-the-chart high.

So we thought that maybe if we treated the hormones, the heart disease risks would decrease.  Well, it didn't happen.  It happened a little bit, but didn't happen enough.  So that's what got me into testosterone therapy.  So I've been on testosterone therapy since I was 26 years old.  And also with all the thyroid hormone, growth hormone, et cetera, 'cause I just don't make it.  I don't take anabolic amounts of it.  I think amounts that keep me normal.  And even to this very day, Ben, to be honest with you, I just, six months ago, or four months ago rather, I went to the doctor and my levels were off again.  My total testosterone was 96, my TSH was 17.  So it was worse than it was before.  And that was after just four months of laying off of these hormones just to see how it would feel.  Not a good idea.

Ben:  Wow.

Jon:  Your hormones are… they make you who you are and that's disturbing to a lot of people because they believe that they are something, they are their consciousness, they are other soul, they are their will.  I can make you into a different human being by using hormones, and that's very frightening.  But it's also, in my case, liberating because I was on a downward spiral for sure.  I wasn't going to be a young guy in my middle age.  I was going to be a very old middle-aged guy if I lived that long.  And then when the heart disease stuff really hit home, my doctor said, “You're not going to live past 35 if you don't do something about this.”  So I didn't, and that's another story.  I didn't do anything about it at all and I paid the price.  I'll tell you about that when we get to that point.

Ben:  So at that point, did you start digging into why or how something like hormone deficiencies could affect cardiovascular parameters like that? Had you made that link or had doctors made that link for you?

Jon:  No.  They didn't.  And honestly, like I said, I think I had the worst endocrinologist ever because he was a little bit of an alarmist, but he didn't really.  There was no bedside manner, there was no, “Look, let me help you through this.  Let's take this one step at a time.”  It was more like, “You better do something about this.  Nice to meet you.”  And that's a testament to our rather crappy medical community, in my opinion.  For the good doctor, I have a fantastic doctor now.  But for those of us who have had fantastic doctors, I think we're few and far between.  Medical [0:10:22] ______ has a lot to be desired.  So one problem is that I was ill informed.

The other problem is because of my age, I'm just being frank with you guys, I was like, “Oh, yeah, yeah.  Whatever.  I'm sure I'll be fine.  Just let me to get back to feeling good and let me get back to the gym and I'm sure it will take care of itself.”  I'm sure that 'cause I knew all about nutrition and I knew all about what I thought I knew about nutrition, I knew all about training, or so I thought.  I said, “I'll take care of that.  That's a diet thing.  That's for old people.”  And quite frankly, I literally just blew it off and I was more concerned with just getting into the gym.  And it wasn't until I hit just a total wall and I couldn't figure out why.  I mean I was not, even with testosterone therapy, I was getting more and more obese.  Well, I was overweight and I ended up obese, and then I just quit.  I literally said, “Just forget it.  I'm just going to be a workaholic and whatever.”  And that happened my late 20's all way through about 33 years old, I was clinically obese and that's probably where most of the damage was done heart-wise.

Ben:  So obviously there are a lot of guys out there who probably don't have testosterone that was as low as yours was, but who are walking around with suppressed levels, maybe a hundred, or 200, or 300, or somewhere around there.  Are you seeing issues in either men or women when it comes to their hearts and their hormonal status?

Jon:  Oh, yeah.  And there's a direct correlation and now it's well documented, and it's kind of a chicken-before-the-egg kind of thing.  We're not sure whether low testosterone exacerbates or causes heart disease, or if the genes that we know that contribute to heart disease just kind of come with the territory of autoimmune dysfunctions and things like suppressed testosterone, suppressed hormonal levels.  Whatever the case, we know that if you have low testosterone, your risk for heart attacks go up, your risk for heart disease goes way up.  And the studies that you mentioned earlier that talk about hormone replacement therapy and heart issues, they're almost always cardiomyopathy.  In other words, the enlargement of the heart.  That's usually where those come from.  The heart gets larger, the ventricles get larger.  And because of that, the heart loses some function and it starts to die.

Ben:  Yeah.  There are a couple other things I wanted to ask you about those studies too because I noticed in the big one in the Journal of The American Medical Association, they were using testosterone injectables.  Basically the ones that produce this huge peak in testosterone, then kind of drops back down pretty quickly, like way different than kind of your natural testosterone rhythms, and I don't think they were using bioidentical testosterone compounds.  Basically it was non-bioidentical stuff.  Do you have, for guys who you recommend use something like testosterone replacement therapy or hormone replacement, do you have specific methods or specific forms that you think are important versus others?

Jon:  My doctors, the ones that I've gone to and the one that I see right now are basically pretty much old school.  I mean it's injectable.  It's like testosterone cypionate, it's enanthate.  Some of the studies used enanthate, which is very dangerous 'cause enanthate can thicken the blood, and that right there will lead to issues.  So cypionate tends to be the safest of the kind and I honestly just inject once a week.  I did try a different way of doing that for about a year and a half ago that ended up working okay, but the more frequent and more, even with the bioidentical stuff, I ended up with some blood clotting factors I didn't like.  So the only way I was able to get my clot factors to where I liked it and where they were safe, and that's, look at fibrinogen.  That's a test that you run.  There's a few other tests that you run to look at how viscous your blood is basically.  To get those levels down for me, and this is probably true for any one that has such suppressed testosterone, that you would need to, I think the injections worked better.   Although some people do respond to creams and bioidentical stuff and you reduce some of the risks with that, but I don't think that's where the study had the problems.

I think the study had the problems because they were using the testosterone compounds that thicken the blood.  They were not doing any phlebotom at all.  So whenever you do have those risk factors and you know that that's part of the problem, that you need to be giving blood once every two to three months, that's a great way just to erase that problem right then and there.  They had no controls over nutrition, and there was a lot of problems wrong with that study, the two studies that I'm thinking of in particular.  But most of those studies render, they come back with with issues related to cardiomyopathy or the stuff that we're saying, these people had a higher risk for heart attacks.  Well, there's a lot of factors beyond heart attacks that are not, that's where the correlative isn't necessarily the causative.  And there's a lot of risk factors involved in that.  But I can tell you from looking at my blood, I'm very quite frankly anal about it that having my testosterone levels normal is always, always superior to having any issues with heart issues.

Ben:  Now for this clotting issue, like for fibrinogen like you mentioned, for athletes, some of the athletes I work with take, for example, proteolytic enzymes like trypsin, and chymotrypsin, and papain, and bromelain, and stuff like that to deal with fibrin build-up and fibrinogen from exercise.  Now in your case, when you're using testosterone replacement therapy, if you're worried at all about clotting factors, are you combining something with your testosterone replacement to lower your risk for that?

Jon:  Well, those are all excellent.  I highly recommend anything proteolytic.  It works great.  But in my particular case, again given the genetic structure that I have, we go the extra mile and I draw blood every 62 days.  So that's the best way to get your fibrin levels lower.

Ben:  So basically you just give blood?  Just donate blood or…

Jon:  Yeah.  It works like a charm.  So the good thing about that is you're doing a wonderful service for humanity and at the same time you're protecting yourself.  That's one of the healthiest things that you can do if you have issues with the viscosity of your blood.  And that's very common, clotting issues, viscosity issues are very common with people who have heart attacks.  In fact, this is not to scare someone into action or anything, but the vast majority of heart attacks happen with people that don't have blockages in their heart are more than 38%.  And they don't have elevated cholesterol levels.  Those are all myths.  Those were huge myths.  And we're just now finding out that not only are they myths, the whole concept of, “Oh, my arteries are clogged and therefore I have a heart attack.”  Your arteries can be relatively open and you can have a heart attack.  In fact that's the majority the time.

So there's a lot of things that you need to look at outside of testosterone therapy or those kind of suspicious causative agents which honestly, I mean I've just never seen it happen.  My doctor works specifically with hormone replacement therapy and we've never seen a problem with it.  One of the most conservative doctors in the world, I think he's very conservative, and the only time you see a problem with this or when people are doing testosterone replacement therapy and their testosterone levels were normal to begin with.  So that's the other thing, that when they talk about suppressed levels in those studies, one of those they started at a level of 220.  Well 220 is low and it's something I would certainly do, I would change nutritional habits before I would do anything else, but it's not caused by an endocrine failure, or rather it's not caused by a pituitary failure.  It's not caused by, it's probably not related to something that I'm going through.

Ben:  Yeah.  And I definitely want to talk about some of the lifestyle factors that people should do when they're kind of like not in that super-duper low category and maybe shouldn't be using testosterone replacement therapy.  But before we talk about some of that stuff, the other thing I wanted to ask you about because I know this can promote some abnormal clots formation and something like the blood thickening that we talked about is excess estrogen.  ‘Cause I know a lot of this testosterone, if you're getting injected, or using gels, or patches, or whatever, can't a lot of the get converted into estrogens if you're not careful?

Jon:  Oh, yeah.  Most certainly so.  And most progressive doctors will prescribe some sort of an estrogen blocker to help suppress it, to help the pathways do what they're supposed to do.  The bottom line is balance.  I mean some people can take testosterone and their estradiol levels remain totally normal, their DHT levels remain normal, that means they keep their hair.  Other people, their DHT goes crazy and I think that prescribing something like Propecia for controlling DHT, it is really problematic because those things can really mess with your sexual desires, so to say.  It can mess with your libido.  And it also just makes you generally just not feel that good.  But suppressing estrogen is usually a really good, estrogen in the male is important.  And don't get me wrong.  It's not like what people think, “Ah, it's a female hormone.  It's not important.”  It's important to keep it moderated and in balance with testosterone, which is usually in an 80:20 ratio, and that's not always, it's not clinically specific.

But if your estrogen starts going up, yeah, you'll notice a lot of bad side effects.  Gynecomastia is one of them, which is something that no one wants if you're a guy.  That's basically breast tissue growing.  And things of that nature.  But worse than that is your prostate cancer risk goes up three or four times.  So you really want to make sure that your estradiol levels are normal.  Which is why, by the way, for guys that are just injecting testosterone on their own or taking testosterone enhancing supplementation, most of them don't work, but the rare ones that do, you've got a real problem if you're not checking your estradiol levels because you're putting yourself at grave risk for stuff like that happening.

Ben:  Yeah.  I want to talk about some of those hard numbers too that folks would look at or some of the tests they should run.  But when you say estrogen blockers, are you talking about basically aromatase inhibitors?

Jon:  Exactly.  Aromatase inhibitors.  And there's quite a few that are prescribed routinely by doctors.  There's a couple supplements that work well.  Chrysin is one that some people swear by.  I just look at the blood.  I look at the numbers.  I am not a purist.  There are some people out there that are nutritional purists.  I am a nutritionist, I am from some kind of coming from that background, but I've never been a purist in anything.  I'm just a scientist.  I'm just a guy that likes to look at numbers and says, “Okay, this works.”  And I look at the data from a numerical point of view, I look at the data from an empirical point of view, and how do you feel.  How do you feel about X, Y, and Z? So if a natural supplement will do it, fantastic.  If it doesn't do what it takes to do it, the bottom line is getting those numbers into normal ranges and then assessing how you feel.  Because oftentimes normal numbers won't make you feel better.  Sometimes you need abnormal numbers to make you feel better.

Ben:  So let's kind of start down the path of somebody who suspects that they might have low testosterone.  Maybe they've got some of these issues that you were feeling, like the low cognition, or low libido, or not being able to bounce back from a workout as quickly as possible and they want to get test.  For starters, what do you recommend as kind of like the gold standard hormones to test or the best hormonal panel to run if you want to just check out what your testosterone is at?

Jon:  Well, most labs will have, in fact I use, if you don't mind me giving out a website, I'll just tell you the website, healthcheckusa.com, the reason I like them is because you can run a blood test without a doctor's appointment.  Now it doesn't mean you could read them.  I've had to learn to read them.  What it does mean is that you can take them into a doctor and say, “Hey, what does this mean?”

Ben:  Right.  So that would be similar to like a wholesale lab testing like, the other one that I've talked about before is Direct Labs.  Similar to that?

Jon:  Very similar to that, yeah.  They make it really simple.  They'll go, “Men's Hormone Panel.”  It just runs basically a male panel that looks at your testosterone, estradiol, looks at all the hormones that are related to those, the sub-hormonal structures and things of that nature, the pathways.  You want to make sure that, like for example, DHEA, DHEA is a precursor to testosterone.  So a lot of people take DHEA and [0:23:04] ______ or any other precursor and think that it's going to automatically turn into testosterone.  Well, it doesn't work that way.  But if those levels are off, if you have really high DHEA levels and you're taking testosterone supplementation, you can have a real problem.  So that's why again, I just reemphasized, having forbid taking anabolic steroids or something to that effect, just winging it, that's one of the worst things that you can do as far as for your health and for your hormone health.  Not because steroids themselves are so dangerous, but because of the interactions between the hormones and really some weird stuff.  So run the test through a doctor.  I personally run my tests through a doctor or I got to Health Check USA and run them there because I know how to read the labs.

Ben:  Okay.  Gotcha.  So you get the test and you want to look at testosterone, DHEA, your estrogens.  Anything else? What about cortisol? Should you look at cortisol?

Jon:  Cortisol is, first of all, it's a different test, as you know.  I think it's clinically iffy.  I'll put it that way.  Cortisol is one of those hormones that's up at anytime in the day and down at other times in a day.  It's very hard to test.  And it's also not consistent.  It's not consistently up in the morning and down at night, for example.  Cortisol levels, when they're high, people have heard that cortisol is the “belly fat hormone” and it stores belly fat, and that has a truth to it.  Also, cortisol is very important for keeping your… if you have a stiff neck, chances are your cortisol is too low.  So it's one of those hormones that's a little tricky where you have to, it's an anti-inflammatory hormone as well.  So you got to work within a structure of making sure that everything is in a balance.  So that's why I firmly believe in going to a hormone specialist.  I personally prefer working with guys that work with athletes.

Ben:  You mean physicians who are used to seeing athletes?

Jon:  Yeah.  My doctor is a physician, he's a medical doctor, but he's also someone who's used to seeing athletes.  In fact he was an Olympic athlete.  So, yeah.  So I go to guys like that who are used to seeing bodybuilders, athletes, and they're perfectly okay with making sure that your hormones are on the high side of normal, let's say.  And mine never are, by the way.  I've only had my hormones in the high side of normal once in my whole life.  You look at some of the pictures and you think, “Ah, yeah.  You're taking lots of steroids or something.”  And that's not true at all.  I mean it's very difficult for me to get my hormones even normal.  Even on injectables.

Ben:  And I want to ask you about what numbers people should be looking for as far as testosterone here in a second, but just to back up about what you said about seeing a doctor who's an athlete.  I went in and got my heart tested, I did a cardiac stress test and a stress echocardiogram at the hospital last year, and I actually called the hospital, or it was the heart clinic, and I asked them which of their doctors was an athlete.  They gave me two names.  They had a cyclist on staff and they had this guy who was into weighlifting on staff and I wound up hooking up with a doctor who is a cyclist 'cause I specifically wanted them to look at my heart in that context of athleticism and performance and not whether or not I was going to die or not.  I mean I would say to folks listening in, I mean you can figure this stuff out with a little bit of Googling, creative Googling or a few phone calls to find out if the doctor you're seeing really is tuned into performance.  So, numbers.  You mentioned numbers.  Let's say I get testosterone tested, we're talking about, at least in this case here in the US, what kind of numbers are you looking at as far as what you would consider to be good and what you would consider to be something that somebody should kind of follow up on to see if maybe they can improve?

Jon:  Well numbers, here's the deal with numbers.  You've got the lab numbers and then you've got the numbers that make you feel good.  So I really do believe you've got to be careful when you say, “This is always where you want to be.”  And also as you age, those numbers can tend to be lower, and should be lower to some degree, but not a great deal lower.  So the number I'd like to shoot for testosterone is, first of all, there's free and total testosterone.  So understand that if you've got a total testosterone level of 600, which sounds pretty good, and you're free is three, then you've got a real problem.  You're secreting a lot of testosterone, but your body's not uptaking that testosterone.  So you've got to make sure that those levels are well in balance.  So the typical levels range between 300 to 1200 nanograms per deciliter.  So that's ng/dl.  That's your typical range for testosterone.  And I personally feel better when my testosterone is around eight or 900.

Ben:  Got it.  So that's your total T?

Jon:  Yeah.  It's the total T.  Right.

Ben:  What about your free T?

Jon:  Free T ranges.  One thing I've noticed about free T is that the number for free T are probably the least accurate numbers on testing.  So I don't know what you've found on your test, but for mine it's, yeah, it just doesn't, sometimes my free T will test low and I feel great, and then sometimes it'll test high and I don't.  So I thought, “Okay.  Well, that's the answer.  I just want to explain for whatever reason, I do better with low.”  But the exact opposite will happen.  So I'm not really sure, to be honest with you, what the exact, why that's happening.  I have no idea why on earth that would be a thing.  But it is for me.  So for other people, it's testing.  It's really, really looking around and seeing what works best for you, how you feel better.  But yeah, the test levels, they're all, labs by the way are different by the way.  The numbers I threw out might be different in a different lab.  So it's just kind of crazy to get real specific.

Ben:  Yeah.  But what I've found personally is with the athletes that I've worked with and with myself, generally total's got to be at least above 500 to be able to perform and recover.  And usually free, between 10 and 15.  That's just personal experience, what I've found and what a lot of my athletes have experienced.

Jon:  So I'll take that same number and sometimes I'll get 5 and I'll feel… sometimes I'll get 20 and I'll feel bad.  It's really, for me, just for me, myself, and I, it's all over the map.  So what I've often heard to be a really, really good measuring stick for this is if you take that number, so in other words take your number and you divide, like if you've got a testosterone level of 500 and you want to get just a percentage of that.  So what's 1% of 500?  It's 5.  Then double it.  So that's the equation that I use that sometimes works.

Ben:  Okay.  So you take 1% of your total and double it.  So if it was at 500 for total testosterone, you'd be looking at free as being 10 as kind of a number that would make you feel pretty good.  That reminds me, by the way, do you get, when you go out and get a testosterone and a DHEA, are you getting a sex hormone binding globulin to see how much of that total testosterone is bound up?

Jon:  Yeah, I am.  And that's another very very important aspect of those tests.  Again, the binding up of that is, we're not going into a long scientific explanation of what's going on with that.  You've got issues with binding.  So the more that you bind, in many ways the better that it is.  So the problem is that it's the type of binding that's going on.  Again, there's all sorts of different hormonal pathways you're going to have to think about.  So sexual hormone is, that controls more of the feeling of libido versus the actual physical act of sex.  So a lot of people will get that level looked at and they'll think, “Oh, that's why I'm having poor erections or whatever.”  Just from my experience and from the people that I've talked to, and I don't work with people in this area, I just write about it.  So I can't say all the guys I work with in this area are doing this, but from what I know about it from chatting with my doc for many, many years about it, that's more of an action of how you feel toward it.  Not to get off the subject, but an ancillary note.  Remember when I was talking a little bit about DHT and DHT blockers?  So that's…

Ben:  You mean like what somebody would take if they were losing their hair?

Jon:  Yeah.  Exactly.  Yeah.  So DHT has a way of really screwing up SHBG, which is the hormone that we're talking about.  It has a way of really screwing that up.  And if you are taking that, you might want to consider backing off of it.  I know it's a pain because you've got an old guy who wants to lose his hair.  But I ended up backing off of it and losing hair…

Ben:  I don't know.  I'd personally rather be bald and horny.  That's just me though.

Jon:  That's pretty much what I'm saying.  It's good that I can just cut to the chase like that.  So, yeah.  Bald and horny's always good.  So, yeah.  And so you want to do this to make sure that you really do keep that free androgen index where it needs to be.  And I think that really does interfere with it.  So, yeah.  And by the way, again a fall in testosterone will cause a rise in that sexual hormone binding globulin.  The problem with that, as I said, you want to make sure that when it's rising, what that level is rising, it's basically telling you that, “Well, there's not only something wrong with the testosterone levels, but there could be something interfering with the testosterone levels being utilized and absorbed properly.  And usually that comes from things like anything dealing with either DHEA being off or DHT levels being supressed.

Ben:  Got it.  By the way, when we're talking about testing, I should mention, I don't know if you've found this to be the case, but all these salivary and urine tests, like the ones you can get 20, 30 bucks off Amazon, that kind of thing…

Jon:  Worthless.

Ben:  Yeah.  I've found them to be extremely inaccurate.

Jon:  Yeah.  Worthless.  Blood is the only thing that you want to test, but there's a lot of testing for testosterone or for any hormone level.  It is nonsense.

Ben:  The cortisol and DHEA, there's one pretty good test called the adrenal stress index that will give you a daily run, but not for testosterone.  At least not that I've found.  I want to make sure that we get a chance to touch on kind of the difference between going out and getting testosterone replacement therapy or bioidentical hormones and when you would want to use something like that verses herbs, supplements, lifestyle factors, and things that might not be considered hormones for two reasons.  Number one, I know there can be some potential downsides to using testosterone replacement therapy, and number two, because I know we have some athletes listening in who simply can't do it because of World Anti-Doping Regulations.  So can you speak to when you think TRT is a decision that is good versus turning to more natural supplementation?

Jon:  Well, I think it's good when you know for a fact that your body has a serious problem producing it like I do.  In fact, it's not only good, it's mandatory.  I mean the options of living on low testosterone versus any risks associated with high testosterone are ridiculously skewed in my opinion.  I also think it's, personally I think it's okay to do this if you want to maximize your levels just to feel better.  If you're a competitive athlete, especially if you're being tested, and I personally get on a soapbox about this because, I'm going to bring up a really dirty name right now, Lance Armstrong.  Okay, Lance Armstrong.  Of course the guy lied through his ass and then, what are you going to do right? If anyone was wondering what his testosterone levels would be with one testicle,  and I wonder how that would affect [0:35:15] ______ .

Fortunately, I don't know the answer to that question.  But I'm kind of curious how it would be.  But let's say that someone came in like me that had a pituitary dysfunction and produced normal, less than a hundred on a free testosterone level.  Or a total testosterone level, rather.  To compete with somebody else, why is it not fair for me to be normal? So, yeah.  I personally think there should be a normal range rather than, “Oh, we tested this inside your blood.  And if it falls within a normal range, it falls with the normal range no matter how it's done.  But that's my personal opinion because I mean you've got the best athletes in the world who probably have great genetics and somebody can make a purity argument for, “Well, that's just it. That's great genetics.”

Ben:  It's such a blurry line.  I've definitely run into guys and I've coached athletes who have been living a lifestyle where they've got a ton of extra fat, a ton of aromatization and high amounts of estrogen, very low amounts of testosterone, and they can barely even get out of bed in the morning, but they could fix that all through lifestyle and nutrition adjustments versus other guys who seem to, kind of like you've been talking about, literally have pituitary issue to where no matter what they do, they're not going to produce testosterone or feel good when they train or when they race.  It's kind of two forms of testosterone being low that are both stemming from different issues, and I think that it's a tough call.  I think it's why a lot of times they have these pretty strict therapeutic use exemptions in place you know for something like the World Anti-Doping Association for really truly proving from a doctor that you really have a serious hypogonadal issue.

Jon:  Well, from a competitor's point of view, there is another problem and very few competitors are going to face this maybe until after the competition years.  But I know some of them that are basically during their competition years.  In fact I don't know if you know Peter Attica or not, but his stuff is pretty interesting.  If you don't know who Dr. Peter Attica is, check him out.  He's a cyclist as well.  But he found out that the only way he could get his body to cooperate, not only for fat loss but for performance, was on a diet extremely high in fat.

Ben:  Oh, yeah.  Peter Attia.

Jon:  Yeah.  Did I say Attica?

Ben:  He's been on this…

Jon:  We just watched a movie called Attica last night.

Ben:  He's actually one of my buddies.  He's been on this podcast four times.  So, yeah.

Jon:  I don't know him personally but I hear he's…

Ben:  Ketogenic man.

Jon:  So Peter's an interesting guy.  As you know, his diet's extremely high in fat.  Everybody's different, right? The same way they approach nutrition differently was my point is the same way they need to look at hormone replacement therapy or testosterone replacement therapy.  It depends on if you want to be a competitive athlete, if you're going into tested events of course.  Some people have an ethical issue with it, which I don't understand at all.  That doesn't compute for me.  Why would you have an ethical issue taking a polio vaccine?

Ben:  Or getting Lasik surgery like Tiger Woods.

Jon:  Exactly.  Lasik has given him a competitive advantage, and I do laugh at the Andy Pettitte I-took-one-injection-of-GH and he's thrown under a bus.  One injection of GH will do absolutely jack all for you.  It won't do a damn thing.  It's such a ridiculous, media has such a ridiculous view of what this really is and they confuse supplementing with hormone replacement therapy with steroid use.  In the  athlete's opinion, I mean.  Of course he was probably lying.  He did more than that.  But the point is to go apeshit over one injection of a growth hormone is a bit ridiculous.  So if could put this into a different perspective, and by the way, I want to come back to, definitely let's come back to the SHBG stuff because that's really, really important to go into that whole binding and something I kind of glossed over.  So I want to get back to the whole globulin versus the other bind.  So remind me to do that.

Before I go off into that [0:39:22] ______, there is this phobia around taking things that are “steroids” despite the fact that a lot women take the pill, which is a steroid.  And they don't link this to steroids.  But here's something that's probably interesting, I'm sure you know this, some of your audience may not, if you look at the ER list of causes of death, if you consider the outrage and alarm over even careless, which I would never recommend, careless steroid use.  It ranks slightly below deaths caused by aspirin and by L-carnitine.  It's 186th, I believe, on the level of ER deaths.  Alcohol, as you might imagine, is way up on the top five.

Ben:  Just to be fair, I don't hear people being as worried about, I mean we did open up by talking about testosterone replacement therapy and heart attacks, granted.  But I see people more talking about potential or fear of shutting down your endogenous production, or shrinking your balls, or having issues like that.  Those seem to be more of the concerns that people have compared to testosterone replacement giving them a heart attack.

Jon:  That is true.  And it's like, well let's put it this way: a lot of people have concerns over investment on “how much money will I make” when they should be concerning over “how long can I hold it”.  So using that parallel, just because their concerns are that doesn't mean that that's really the most major concerns.  Not that those are bad concerns or invalid concerns.  Yes, when you take testosterone you have an endogenous issue.  You're going to stop producing your normal levels of testosterone and your balls are going to say goodnight.  Don't worry, they'll still work.  They're just going to get smaller.  There's a way around that, if anyone's interested.

Ben:  Did you say there is or there isn't?

Jon:  There is a way around that, yeah.

Ben:  Okay.  Interesting.

Jon:  Yeah.  There is a way around that.  So, yeah.  It's HCG.  So HCG is well-documented for returning male testicles to their rightful, normal size even while taking exogenous testosterone.

Ben:  Interesting.  I didn't know that.  Now what about if you find that you have to start on testosterone replacement therapy maybe to jumpstart testosterone and then you get off it.  You hear a lot of people talk about fears, about feeling like crap for a really long time if they ever stop, like digging themselves into a hole always having to be on it.  What are your thoughts as far as that's concerned?

Jon:  If you tailor off of it, your body will start producing again.  And again, this is where I come back to HCG.  Forget the HCG diet, by the way.  That's complete and utter nonsense.  The only reason that diet works is 'cause it was 500 calories.

Ben:  And you're talking about HCG, like the human chorionic gonadotropin stuff.  Like they'll do the 40-day HCG protocol and mix that with a 400 calorie diet or whatever?

Jon:  Right.  Forget the 400 calorie diet part is what I'm saying.  Just look at HCG.  Taking that as you're coming off testosterone is what most, there's a lot of competitive bodybuilders who… so that they can restore testicular function and also so their body can kick back into normal production.  So if it's working for competitive bodybuilders who are taking literally 10 to 50 times the amount that anyone sane, anyone who's trying to just be healthy takes, then yeah.  That's the least of my concerns for a healthy male.  If you're content with having a 200 total testosterone level, great. Let's say that you have 400 right now, which is good, and you want to get to 800 as for a performance issue.  Then coming back down to 400 is pretty easy to do.  Most of the time, you just tailor off of it.  In other words, you just don't stop.  You just tailor off of it.  You do a three or four week tailor off of the cycle and your body will kick back in producing its normal hormones.  It may take the three or four weeks, but it will happen.  That's if you're healthy.  I think that's the least of the concerns.  The concerns need to be around balancing out the estradiol levels, making sure that the binding is correct.  In other words, the hormones are being used for what they're supposed to be used for.

So again, just look this up, SHBG, it's a lot easier to say for most people, that binds to testosterone and it prevents it from exerting effects on leading, whatever.  There's a lot of male physiology that that causes some bad stuff with it like gynecomastia, bad libido.  Sometimes it can do erectile dysfunction cause of that.  It can also be bound to albumin.  So the levels that you need to look at are how much is being bound to albumin and how much is being bound to SHBG.  So that's the kind of stuff that a doctor needs to look at with you.

Ben:  So that's not just like a standard SHBG test.  You would actually have to go in and dig deeper when it comes to what SHBG is actually binding to?

Jon:  That's exactly correct.

Ben:  Is there a name for that test?

Jon:  Not that I know of.

Ben:  Okay.  So basically when you go in and get an SHBG test, you need to actually ask your doctor what the SHBG is binding to and whether it's binding to, what now? Albumin or?

Jon:  Yeah, albumin.  So the reason why that's important is because, again, if it's binding, there's a lot of issues I talked about earlier with, I'm just going to call it SH.  SH being low or SH being high.  So SH levels are low, we now know that there is a profound amount of stuff that comes with this.  In other words, if the levels are low, which is basically indirectly looking at what is being bound to, what testosterone is being bound to, and it could actually become like a hormone in and of itself.  It's really that important.  Because if you look at what is being done to you, low levels that have been looked at have been directly related to metabolic syndrome.  I'm sure most of your listeners know what metabolic syndrome.  And if they don't know what it is, that's a combination of being overweight, hypertense, high triglycerides, and insulin resistance.  So not a good combination to have.  I had metabolic syndrome, so we get back to the ethics and who should be taking this, if you had metabolic syndrome and your testosterone is low, I think is almost a necessity to take testosterone replacement therapy.

Ben:  Got it.  Okay.

Jon:  That's my personal opinion on that.  Because without doing that, and then you have to play around to make sure that the levels are correct, estradiol is kept in check, et cetera, without doing that, metabolic syndrome is directly related to low testosterone levels.

Ben:  Okay.  So here's another question for you.  When we look at our ancestry and what people have been doing for thousands of years for example, is there evidence that folks in previous cultures have figured out ways to improve libido, make themselves stronger, fix some of these issues by relying upon some form of testosterone even if they didn't have our technology today like injectables? And the reason I ask this is I just drove through Montana and they had the Rocky Mountain oyster festival there where you go any cheap balls and the idea is that it's somehow supposed to increase your bioavailable testosterone.  How much of a cultural tradition is there with the use of testosterone as a performance enhancer, or as something to do like increase muscle, decrease body fat, et cetera?

Jon:  Quit a bit.  I mean there's a lot of folklore about it.  Eating oysters for example.  But oysters are a known aphrodesiac, and so I'm sure there's like…

Ben:  There were Rocky Mountain oysters.  They're literal sheep testicles.

Jon:  Yeah.  They're bull balls, right?

Ben:  Yeah.

Jon:  So, yeah.  There's a lot of mythology around it and there's probably a little bit clinical science.  But the bottom line is this: if you have a normal functioning pituitary gland and your testosterone is low, there's nothing wrong with trying natural means to raise it.  And one of the best natural means for raising testosterone is grief intense exercise and a high fat diet.  There you go.  I mean a higher fat, moderate protein, low carbohydrate diet can do wonders for most people with testosterone.  There's a gentleman who, I don't recall his name, I can send you the link later, who blogged about this and talked about how he basically doubled his testosterone.  I'm not sure that everyone can double their testosterone, but he took his from 400 to 800.  And all he did was, he had a very rich diet in protein and fat, ate quite a bit of healthy fats, not a lot of carbohydrate.  He had actually more than what I usually eat, and ended up doing some really brief intense spurt exercises.

So if you go back in history, I mean Ben, you and I talked briefly about this before, there wasn't a great deal of endurance activity, at least at the levels that our endurance athletes are going through, in our evolutionary period.  There was lots of spurts, lots of sprints, lots of I've-got-to-lift-this-boulder-to-get-it-off-the-prey-that-I-just-killed.  That kind of stuff.  Which explains a lot of why we see sprinters, for example, look extremely muscular and fit, and we see extreme marathon runners, a lot of the times, they look unhealthy, they look anorexic, they look like they're kind of withering away.  Ben's kind of an example of how you could do both.  There's very few people that are out there that do both well.  And so my stance on that is when it comes down to increasing testosterone, brief exercise is usually better.  It depends on your genetic structure.  But normally if you've got the genes to recuperate from intensive exercise, you don't have the genetics to even worry about as far as testosterone.

Ben:  Yeah.  Interesting.  Man, there are so many little segues that we've created as we go through this discussion.  I'm going to have to get you back on the podcast, but I also can't let you go before asking you about the question I know folks are going to comment on.  You talked about exercise, you talked about high fat diet.  How about all these different herbs and supplements out there? We're got tribulus, and [0:49:37] ______, and Chinese adaptogens, and Maca root, and all this stuff.  Do you, or have you found any of those to be particularly efficacious or do you kind of roll with one specific form of an herb supplement when it comes to that stuff?

Jon:  They were never efficacious for me.  They never were.  But because, again, it comes back down to what's your pituitary axis is doing.  And in my case, I'm an unusual case I think.  For some people, they may work.  I don't think they're going to give you number that you're wanting.  And again, even if they do raise total and free, you've got issues with what it's binding to, you've got issues of the rest of the hormone panel.  So you got to be cautious with that.  I mean some people have to take an estrogen blocker, for example.  Your body just produces a lot of estradiol when testosterone raises.  You don't want that.  You just don't want that.

So there's nothing wrong with taking an estrogen blocker if, when your testosterone level is healthy, you're producing too much estrogen to the point where it's a legitimate cancer scare or a legitimate scare for gynecomastia if your start producing gynecomastia.  So my stance has always been “what's the most efficient way to get it done”.  If it's natural and it works, great.  If it doesn't work, go find the most expedient… sorry, I just fell out my chair.  Most expedient getting it done.  So that's where I'm coming from.  And also I'm coming from a position of safety.  In other words, I'm making sure that doctors are looking over this.  And granted, I mean when it comes down to heart disease, I had a cardiology, I just drew a blank here.  Austria.  The University of Austria.  In Austria, there's the University of, the major university in Austria, which I'm drawing a total blank on, he's the head of cardiology there and he teaches cardiology.  He was obviously a cardiologist for a long time, and we had a discussion at one of the Eben Pagan events and really hit it off well.  He said in his Austrian accent in about an hour into discussion, he said, “You know more about lipids than I do.”  I said, “I don't know whether to be frightened by that or not.”  Obviously, I can't chop open a chest and repair arteries and stuff like that.

Cardiologists don't spend a lot of their time studying the latest research on what helps manage lipids and things like that, let alone what naturally helps testosterone go up.  Endocrinologists don't do that either.  So that's my point.  You have to kind of do your own research, but be careful with it.  I would to conclude, if we had the time to talk about a little bit of the hard stuff because that's the stuff, the stuff we're talking about is going to make you feel better, but it's also going to lower your risk for heart disease if you do it right.

Ben:  Yeah.  Let's talk a little bit about that too, just because I want to make sure we kind of close that discussion and make sure that you've taught us what we need to know about that.  So, let's do it.

Jon:  Briefly, everyone over the age of 30 needs to go get a VAP test.  And even if you're not over 30.  Looking at a VAP, V-A-P, vertical auto profile test…

Ben:  Is that another one that you can order yourself?

Jon:  Yeah.  You can.  You can actually go to healthcheckusa.com and order that for yourself and find out if you're type A or type B, and I don't mean personality type.  What I mean is where is your small density LDL is falling into size.  So there's a lot that we now know that I'm going to be talking about in the re-release of Fit Over 40 with a cardiologist that we now know so much more about heart disease than we did just five years ago.  Let alone, 20 years ago.  We have completely dispelled the myths of fat being contributed to heart disease.  With the exception of this very bizarre, weird part of saturated fat or arachidonic acid that can cause some people who are allergic to have some issues, and certainly fats that are hormonal, that are out of balance with the omega-3, omega-6.  In other words beef that have been fed hormones or grains [0:53:34] _____ .  Certainly can cause a problem with heart disease.

But the traditional low fat diet almost killed me.  So I just want to share that with people.  I mean I did a blood to blood test with no factors changing and I looked at a low fat, medium to high carbohydrate, medium protein diet, what most people would look at as a healthy hard diet, very low fat, 10%.  And I compared that hormonally and with my lipids against a high fat, 65% fat diet with very little carbohydrate, 10 to 15% carbohydrate, most of that coming from vegetables.  And the latter increased my HDL by 25 points and decreased my LDL by 60 points, and it decreases my small particle LDL which is what's causing you the most amount of problems when it comes to heart disease by a factor 600%.  These are not numbers that I'm making up.  These are like…

Ben:  I've seen the same thing.  ‘Cause I do a lot of blood and biomarker checking with WellnessFX and I look over a lot of the results of both high carb and low carb folks, and I did a console with a vegan athlete today, triglycerides through the roof.  And their VLDL particles through the roof.  LDL and HDL actually weren't that high, like his cholesterol was not high, which technically isn't necessarily a good thing.  But his trigs were way high and, yeah, that small oxidized cholesterol particle was super-duper high and he was kind of like the wheat, soy consuming kind of vegetarian diet type of person.

Jon:  Yeah.  He's going to die.  He has to change this or he will die of a heart attack.  It's not like an if, it's when.  And then it's like, I hate to be so brash about it, but I've deconverted a lot of adamant vegans.  Some of them can handle it just fine, by the way.  Their genes are fine.  They can eat a vegan diet 'cause they're great.  A lot of people can't and a lot of people can't do vegetarian because it's just slowly killing them.  It sounds counterintuitive, but what I want to get across to the listeners is most of science is counterintuitive.  I'm a science geek when it comes down to physics and astronomy, and I certainly don't know nearly as much about those subjects.  But what I do know is that when you look at what the laws of physics, just a little bit of quantum mechanics [0:55:52] ______ the fact is certain things work and they're just completely the anti-common sense.  I mean when you look up in the sky, it certainly looks like the Earth is standing still and the sun going around us, but that's not what's happening.  The same thing is true when you think of what causes heart, well it seems like it's common sense that, “Oh.  Well since I have fat on my body, I shouldn't eat dietary fats.”  That's not true at all.  So the same thing is true of your heart, which by the way is mostly comprised of fat.

Ben:  But we get this panel, we want to check out our lipid particle size.  Anything else that you would recommend to folks from the heart health standpoint?

Jon:  By all means, don't confuse normal cholesterol levels with being healthy.  You really need to look at the ratios and you need to look at the size of your VLDL.  That's extremely important.  One of my good friends had a massive heart attack, quadruple bypass surgery.  His cholesterol was never over 120.  It's not a number that means a damn thing.  It doesn't mean a damn thing.  I heard people come back, “Oh, my cholesterol's great!  It's 165!  I eat Cheerios.  That's why.

Ben:  Well it does mean something once it gets to a certain amount, right? ‘Cause like you mentioned, yours was up around 500 or something like.  When we're talking about way out of whack values, that's when it matters, right?

Jon:  I've seen healthy people with 300.  In other words, the ratios are fine.  But, yeah.  It's over 300, then it's just a sign, because the cholesterol's antioxidant defense, it’s like a sign that “Whoa.  Something is really going on in the body.”  And usually a sign that you're not eating enough cholesterol because it's trying to overproduce the 75% that's produced in your liver.  Your body has a way of when you eat more cholesterol, it stops producing so much, which is kind of interesting.  So don't be afraid of fat.  I don't know if you should be afraid of anything, but there are certain foods that in me, trigger my VLDL through the roof, and those foods are all carbohydrate foods.

Ben:  Yeah.  Absolutely.  Carbohydrates and vegetable oils as well when it comes to the heart health standpoint, just from the triglycerides view.  Man, so many things we can talk about here but we're running up against time.  And speaking of blood and biomarker testing, I'm actually now a few minutes late for a consult I'm opposed to have with one of my clients to go over their labs so I'm going to have to start to close this one up.  But folks listening in, I know that we probably opened up a bunch of cans of worms from everything from the Lance Armstrong discussion, to testosterone replacement therapy, herb supplements, heart health, all that stuff.  So I would recommend that you head over to the show notes bengreenfieldfitness.com, if you have thoughts on this discussion, I'm going to put them at bengreenfieldfitness.com/heart.

So go to bengreenfieldfitness.com/heart and you can pipe in on this discussion, and I'll put also resources to some of the stuff that Jon and I talked about like the hormone testing, and cardiovascular testing.  And if Jon has other resources that he shoots over to me after the call, I will be sure to add those as well so that you can go and look into some of this stuff as well as some of Jon's books, and programs, and the things that he's doing now.  So that's all going to be over bengreenfieldfitness.com/heart.  So Jon, thank you so much for your time, man, and for coming on the call.

Jon:  Oh.  My pleasure, Ben.  I appreciate you having me.

Ben:  Alright, folks.  Well this is Ben Greenfield and Jon Benson signing out from www.bengreenfieldfitness.com.



This year, popular media has been blowing up the news with reports that hormone replacement therapy like testosterone replacement therapy could cause increased risk of heart attacks.

But what they don’t tell you is that low testosterone (in both men and women) can actually decrease your cardiac health, bigtime. And if you don’t address low testosterone as you age, you not only pile extra stress on your heart, but you also get frail, lose muscle, gain fat, get impaired cognition, experience lower bone density, increased risk of type II diabetes, and many more serious issues.

There were also many, many other problems with the JAMA study that suggested testosterone replacement therapy could hurt your heart. And you’ll learn about those problems – and much more about the link between your heart and your hormones – in today’s podcast episode with Jon Benson.

Ten years ago, Jon Benson (pictured above) was a somewhat typical American male: Overworked, over-stressed, and overweight. Benson’s weight put him officially into the “obese” category and brought with it all the associated disease states such as high blood pressure, high inflammation, high cholesterol, high triglycerides, massive amounts of “stress fat” around the belly and chest region, and some serious heart issues.

But he’s fixed himself. Jon is now a 4-time bestselling author on the subject of fitness and nutrition, including “Fit Over 40”, “7 Minute Body”, and “The Every Other Day Diet” – and testosterone plays a big role in his story.

Today you’re going to learn all about Jon, and the crucial link between your heart and your hormones. During our discussion, Jon and I cover:

How increasing testosterone improve cardiovascular health…

The best way to test testosterone, and other hormones to test…

What kind of total and free testosterone numbers you should look for…

What to do about excess estrogens and aromatization…

What the best and safest methods are for testosterone replacement therapy…

The ideal herbs and supplements for increasing testosterone…


Resources we discuss in this episode:

Thorne Hormone Test (check on your testosterone, cortisol and much more)

Thorne Cardiovascular Risk test

Aggressive Strength herbal testosterone booster (that Ben takes)

Ask Ben a Podcast Question

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