Body Aware Living Podcast

Insomnia, Depression and Healthy Testosterone levels. Full Body Wellness with Dr. Barry Rotman

• Margo Rose

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Today's Body Aware Living guest is my big brother, Dr. Barry Rotman! Medical topics we discuss include: healthy testosterone levels, insomnia and depression. Barry also shares wisdom from his 40+ years of medical experience as a primary care physician, medical acupuncturist, sleep specialist, concierge medical doctor and founder of his new Banner Peak health multi-doctor concierge wellness clinic in Walnut Creek, CA. 

00:00 Meet Dr. Barry Rotman

03:37 Testosterone: Myths and Natural Solutions

11:30 Sleep Quality and Insomnia Explained

17:03 Depression: The Mind-Body Connection

21:40 The Unhappy Triad

22:44 Light as Medicine

25:02 Personal Connection to Depression Prevention


Skillful Self Care Basics: https://bodyawareliving.com/skillful-self-care-basics/

Power and Wisdom of Women During Mid-Life: https://youtu.be/2MqViw8yC-Y


Guest Bio/contact info:

Banner Peak Health website: 
https://bannerpeakhealth.com/

Banner Peak Health articles: 
https://bannerpeakhealth.com/blog/

Margo Bio/contact info:
Margo Rose has been a personal trainer for over 25 years specializing in functional fitness. She has also written a book called
Body Aware Grieving; A Fitness Trainer's Guide To Caring For Your Health During Sad Times.
Body Aware Living is a new blend of these two systems of healing and self-care. On this website you will find: the Body Aware Living podcast, articles and videos about wellness in Margo Media section and description of her coaching services

Website:
https://www.BodyAwareLiving.com

Body Aware Grieving has been created to help you, or someone you care about, adjust to a loss or big life change. This link is one way to get the book quickly:
https://www.amazon.com/Body-Aware-Grieving-Fitness-Trainers/dp/0692459189

Also available from other vendors including this independent Bookshop organization:
https://bookshop.org/books/body-aware-grieving-a-fitness-trainer-s-guide-to-caring-for-your-health-during-sad-times/9780692459188

Follow Body Aware Living on Facebook  https://www.facebook.com/BodyAwareLiving

Speaker 1:

Hello and welcome to the Body Aware Living podcast. I'm Margot Rose and we are together today. We're looking for practical ways to get through difficult times and to celebrate our accomplishments, and I'm here today with an incredibly important man. Dr Barry Rotman also happens to be my big brother, so I want to thank you so much for being part of this interview.

Speaker 2:

Great to be here.

Speaker 1:

All right, let's get you in a little closer. Come on in closer.

Speaker 2:

Isn't that I mean?

Speaker 1:

All right. So, Barry, can we talk a little bit about? How many years have you been a doctor so far?

Speaker 2:

Yeah, I sort of started off being a new doctor before I knew it became the old curmudgeon. About 40 years has elapsed from when I started studying in medical school to where we are now, so that journey's covered a lot of different nooks and crannies along the way. Would you like me to go into some detail?

Speaker 1:

Well, I am curious about your medical journey, even though I was there for it. It's super impressive and our viewers might want to know. Our listeners might want to know whose opinion are we caring about? Whose opinion are we going to have in this podcast?

Speaker 2:

So you went to UCSF for medical school, university of California, san Francisco Medical School, for four years and then graduated in 1990. And then trained in primary care internal medicine in Sacramento at the UC Davis Medical Center and then actually was doing a health services research at Palo Alto, va, stanford, and then entered practice in the community in Walnut Creek, california, for about 10 years when I was with a large group practice Can.

Speaker 1:

I make sure I understand this. So you went to University of California, san Francisco. You also did some of your work at Stanford and then you became a partner at John Muir Hospital in Walnut Creek. Is that right?

Speaker 2:

John Muir Care Group. We were an outpatient group and practiced from 1997 to 2007 in a large group. I left to form a solo concierge medical practice in 2007. And then, along the way it started growing In 2023, we brought on a second doctor and a third doctor in the group in 24. We're now a third doctor has joined us in 2025. So we're now with primary care practices, banner, peak Health, and that brings us to present 40 years and 60 seconds or less.

Speaker 1:

All right, well, and you also became a medical acupuncturist at one point, didn't you?

Speaker 2:

Good memory.

Speaker 1:

Yeah, I know A long way from about 2005 to 2015,.

Speaker 2:

I studied and practiced medical acupuncture a little bit of work with herbs, but mostly acupuncture and that was a great intellectual journey and learned a lot along the way with that one.

Speaker 1:

All right. Well, there's so much to know and your opinion's obviously very important. How many patients do you think you've sort of talked with all these years?

Speaker 2:

Somewhere in the thousands. Never kept score, but that's probably the size of the number.

Speaker 1:

Thousands of people so far. So I was reading through. I'm lucky enough to be on your newsletter for Banner Peak Health and I like your blog posts and three topics really caught my attention. Blog posts and three topics really caught my attention. One is you were talking about testosterone sort of artificial forms of testosterone versus some natural ways people could enhance their wellness. You talked about insomnia and how important sleep and quality sleep can be in ways to get better quality sleep, and you've written about depression and I thought those three topics would be interesting for us today. Is that okay to yeah?

Speaker 2:

it's a huge order. So you're the guide. Show us where we're going and I'll do my best to sort of help your listeners a little bit more on those really vital topics.

Speaker 1:

I appreciate that. I mean, first of all, let's talk about this testosterone thing. There are ads for testosterone and how to avoid seeing a doctor and directly prescribe yourself testosterone. There's ads for this stuff everywhere. What is going on, what are people complaining about and what are they trying to change, and how do you experience that in your office?

Speaker 2:

Yeah, before we get into the details of testosterone, I'll come right out and say I'm really not a fan of what's called direct-to-consumer advertising. I think that prescription medications should be the purview of a trained medical provider, in consultation with his or her own patient, not someone seeing an ad and want to buy it, as if it's like, say, coca-cola or a new ice cream cone. So that was my soapbox. For, briefly, why is testosterone so popular as an advertised product? The story begins with as we're all getting older, we all experience more symptoms and the symptoms that can potentially be attributable to low testosterone. The list goes on and on. Starting.

Speaker 1:

I'm sorry. Yeah, you are mentioning it. Yeah, I know, I'm so curious. What's on some of that list of what people are experiencing?

Speaker 2:

Right Anything from fatigue, loss of interest or desire in sex, difficulty maintaining muscle mass, difficulty with what's called central obesity, sort of that spare tire, distribution of fat, distribution of fat. It also includes poor concentration, lack of drive and other lab test findings that can include low blood counts, elevated cholesterol. So as we age, many, if not all, of us, at one time or another, have experienced one or many of those symptoms, the challenge being, yes, testosterone could cause that, but so could many, many other things in life, common things such as sleep deprivation, heavy alcohol use, lack of exercise. There's many other things that can cause the symptom constellation of testosterone, and you need to have a careful evaluation to determine one whether the testosterone is low, and we can get into this if you want. But if your testosterone is low, what are ways of correcting it and, naturally, raising it, before simply reaching for the shelf and taking a drug?

Speaker 1:

Well, that's what I loved about your article. You mentioned natural ways. Before taking some pill from some place that only really wants profit out of a person's experience, you were talking about natural ways people can begin to elevate their testosterone potentially.

Speaker 2:

Yes, just to be technical here, testosterone is really not prescribed in a pill form. People have to get it either transdermally with patches or gels, or intermuscularly with a shot. I believe there's a nasal formulation, but it's not really a pill. Just to be technical.

Speaker 1:

Yeah, I haven't bought any yet, but I just know that it seems to be a huge topic and people wanting a quick fix, and that's why I liked your whole health approach.

Speaker 2:

It sounded like Right, I know you liked the blog article that I wrote, and one of the metaphors I developed there, which I'm going to talk about right now, is you're inside a house and there's water dripping all over you. I think the instinct in the industry at large is to sort of sell people or tell people to put on a raincoat, which would be just giving them back the testosterone if they have not enough of it in their body. The route I propose is analogous to having to explore in that house and maybe get up on the roof and figure out why the roof is leaking. So, to continue the metaphor, you could have a leaky roof.

Speaker 2:

In the context of low testosterone, with a whole host of common things, I would say one of the most common ways to have a low testosterone is to not get enough sleep, and there's many ways to not get enough sleep, ways that you're aware of in terms of not devoting enough time to sleep, but there are a lot of ways that you might not be aware of, in particular, something called obstructive sleep apnea, where your airway closes off during your sleep and you're not getting enough oxygen, and this knock of oxygen creates a hormonal shift in your body with surges of adrenaline that keeps your body from truly resting.

Speaker 2:

This and other forms of sleep deprivation can lower your testosterone. Other common causes of low testosterone include just having too much fat mass. Unfortunately, in America, many of us have more fat mass than is healthy. It's a horrible affliction and it can have many, many bad health outcomes, including low testosterone. Testosterone could be low if we're couch potatoes. Lack of exercise can cause the testosterone to go. Just paradoxically, for those super zealous exercisers, overtraining can also cause low testosterone. You know, as I said again, as a nation I think we have more people who are under training than overtraining.

Speaker 1:

But just to be intellectually complete about talking about the list here, Can you just summarize super quickly what are some of the natural ways to raise testosterone? You mentioned some of them in your article.

Speaker 2:

So the natural way of raising testosterone is kind of to go the opposite of the list that causes it to be low. So, for example, there are a lot of common chemicals that people expose themselves to, for example, alcohol. Yeah, it's part of our culture, it's beverage, it's fun, but it is a chemical from outside your body and it really can have profound health consequences, including lowering your testosterone. So if we were to come up with a to-do list, as it were, to raise your own testosterone, naturally we're going to go back and explore that list of causes.

Speaker 2:

So I would say number one if you are drinking alcohol, see if you can drink less. If you are not exercising, see if you can exercise more. If you're unaware of any sleep impairment, you might need to talk to your healthcare provider about assessing for quality and quantity of sleep. Those are some of the biggest ones. I think the list goes on For a more detailed discussion. Please check out the blog. You do not have to be part of our clinic. Google Better Peak Health and you will find a section on articles. You'll find the articles and moving forward. Sign up. We'll send one to your email.

Speaker 1:

Okay, which is awesome. So two things that you mentioned were exercising too little or too much could also be a symptom of low testosterone, something that brings on lower testosterone and general well-being, and so finding that right happy medium of exercise is helpful.

Speaker 2:

I think people there are very, very small percentage of Americans who are overtraining. I think that would. People are spending several hours per day, day after day, without adequate attention to rest days and recovery. The vast majority of America is on the other side of the equation. They're never really getting even their minimum of 150 minutes of moderate exertion for their aerobic exercise and at least two 30-minute resistance training sessions. That's sort of the recommended bare minimum and again, only a very small percentage of Americans meet even the minimum. So I think for many people, getting more exercise is going to put them in a better position for raising their testosterone.

Speaker 1:

Okay, also. Okay, I want to get onto other topics too, but I am sort of curious as well when we talk about hormone changes in both men and women over time. A lot of the symptoms are talking about things that happen with libido and with interest in sex and function during sex. And, you know, because the erectile dysfunction or vaginal dryness, there's all these symptoms that relate to sexuality. How challenging is it to actually talk about sexuality when not everybody has access to the kind of sexuality that they might find most desirable to themselves? Whether people are married and the partnership is going through different kinds of challenges or limitations, everyone's busy or different health issues. People have diseases that can take a long time to, you know, affect a relationship. And then what about the single people? You know, what about the people who are single and trying to figure out what's going on with, like what would be an ideal style and what manner of sexuality?

Speaker 2:

There's a lot of things going on simultaneously in that question, right, I think. To parse that out, let's talk about desire for sex and let's talk about access for sex. Access for sex really is in the social realm. You're right. As we age, there are just demographically more women than men, so there could be a gender imbalance in terms of finding sexual partners and heterosexual relationships. So your right axis is an issue. The more medical side of it is libido or desire, and that is different necessarily whether there is a partner or there or not, and so you really have to parse your question out into the biology of desire and the social questions around finding a partner.

Speaker 1:

So moving on. So the other topic that you've mentioned a lot is sleep hygiene, and why is insomnia so common and why is insomnia so important.

Speaker 2:

I'm going to take a step back and just to define our terms. When I think about sleep, I think about lack of quality and quantity of sleep and as doctors, we think in terms of differential diagnosis list of things that can cause something. So insomnia is lack of sleep, given the ability to sleep, and it's just one category of a variety of impairments that could lead people to not have enough quality and quantity of sleep.

Speaker 1:

That could lead people to not have enough quality and quantity of sleep. Can you break that down a tiny bit for us simple people?

Speaker 2:

Right.

Speaker 1:

That sounded super impressive, but can you explain that a little bit more about? I didn't get all of that. Can you explain? It more for the rest of us.

Speaker 2:

Okay, why is sleep important? We need sleep for our. You know, almost every emotional, mental, physical aspect of how we live our lives is dependent on sleep and can be compromised without enough sleep. When I try to parse out the term not enough sleep, that could be not enough quantity of sleep, not enough quality of sleep. So not enough quantity of sleep is something. One example of that would be something we call short sleep.

Speaker 2:

In the slang people say burning the candles on both ends. Right, if you go to bed too late and you wake up too early and let's say you have six hours even available for sleep, you're going to be, you will have what we call short sleep, not enough hours of sleep, because you didn't devote on enough time. We talked about insomnia. Insomnia is not enough quantity of sleep. You will have allocated enough time for sleep, just you can't fall asleep, which is sort of the layperson's understanding of insomnia. Also, there are elements, different conditions, where you do not have enough quality of sleep. One of the most common that we're diagnosing more and more of as the sleep diagnostic technologies improve is something called obstructive sleep apnea.

Speaker 1:

Can you say that more slowly? Say it again.

Speaker 2:

Right Obstructive sleep apnea. Why don't we parse that out? Obstruction means blockage Somewhere in your airway. When you're in the deeper phases of sleep, your airway collapses and you can't get air all the way into your lungs.

Speaker 1:

Does that mean people are probably snoring?

Speaker 2:

Snoring is highly correlative. Not everybody who snores has obstructive sleep apnea. Not everybody who has obstructive sleep apnea is a snorer, but the birds of a feather do flock together. It's similar what that means? Apnea means the breathing is paused and you don't get enough oxygen in your body and the brain reacts by putting out that adrenaline, that fight or flight hormone, and it then not only disrupts your sleep cycle but changes all the autonomic nervous system. It puts stress on your heart, your blood vessels, your memory. So what I've given you is examples of not enough quantity of sleep. I've given examples of quality. We need to really take a look at all of that to make sure you have enough sleep to be healthy.

Speaker 1:

All right. Well, sort of like our previous topic, some of the things are what we would call purely medical, exclusively physical, and some are more in the realm of social or emotional, including, like anxiety, people who are awake because they're anxious. Because the other topic I know is super important is depression and anxiety. And how do you know people are struggling with depression or anxiety? What do you see? And does that affect sleep a lot?

Speaker 2:

Right. So basically, to the best of my knowledge, every single mental health disorder, whether it's PTSD, anxiety, bipolar affective disorder, depression, they all impact sleep and they're all worsened by lack of sleep. So you really cannot talk about mental health without addressing sleep. The two are inextricably entwined. It's part of the complete picture.

Speaker 1:

So how do you discuss what depression is and what do you wish more people knew about it?

Speaker 2:

Right Depression. At first glance the person on the street. When they think of depression, they think of that of an emotional disorder. Someone is sad and tearful. You know crying. You know crying and it's true. You know a constellation of. You know unwanted, unhelpful, negative emotions really are a part of depression.

Speaker 2:

I think what non-medical people are not as aware of is, unfortunately, depression has very profound cognitive impact. There's something we sort of shorthand call hopeless and helpless. There's a sense of futility. There's a sense of nothing's going to improve. There's a sense of can't concentrate. What's the point? And so not only do people with depression feel differently, they think differently. There's very much a cognitive component to the illness. There's also a third part which is perhaps even more hidden, and that is depression changes how we perceive the sensations of our body. In particular, there's tremendous overlap between chronic pain and depression in a very bad sort of feed forward or vicious cycle. There are emotional issues. Where we are in our head, our emotions, dictates how we perceive pain. That is, chronic pain can be made worse by our emotional state in depression. I know we wanted to talk about the unhappy triad.

Speaker 1:

Yeah, you mentioned the unhappy triad, and what is that? It's just ear-catching. It makes it sound like it's going to make it easier to understand this incredible, complicated constellation of physical ailments that we're trying to get better with.

Speaker 2:

We were sort of approaching that answer in the prior one. We were talking about two aspects of the unhappy triad. We're talking about two aspects of the unhappy triad. Unhappy triad is the connection between sleep impairment, chronic pain and depression, as we discussed in the last question. Depression can make chronic pain worse. Chronic pain can make depression worse. The third part of that triad, or triple, manifestations of disease is that of sleep impairment. If we cannot sleep, we become more susceptible to depression. If we cannot sleep, our perception of pain worsens as well.

Speaker 2:

The story I like to tell people to illustrate this is anyone who's raised or have been with a toddler to tell people to illustrate this, as anyone who's raised or have been with a toddler that at the start of the day, a young child could run around like crazy, smash into the bars and everyone is aghast at what it looks like, and a little kid will brush himself off and continue playing without being fazed. By the same token, the same child near bedtime or past bedtime will, you know, scrape a knee or barely injure itself will cry uncontrollably. What this illustrates where you are in terms of your fatigue and your sleep's ability to sleep and have sleep influences how we feel pain. Why is it an unhappy triad? Because there's a feed forward loop. Someone's in pain, they can't sleep.

Speaker 2:

Try it. Because there's a feed-forward loop, someone's in pain, they can't sleep, the depression gets worse, the depression gets worse, so it cycles. On the other hand, we could take advantage of this interrelationship in some of the ways in which we treat pain or depression. There are medications now, such as duoxetine and other drugs, that have an indication both for depression and chronic pain, sort of pharmacologically leveraging this connection such that if you help somebody's mental state, you then relieve some of their burden of pain. Sometimes we can work with different ways of getting more sleep for people to help both depression and pain management. So just giving you some examples of how that plays out therapeutically as well as diagnostically.

Speaker 1:

That's. I mean, I appreciate of the cities, on a ranch in New Mexico, which is sort of a place that's famous for having a lot of access to light. The light, the lighting, the sky, the big skies are a part of what people like being there. And you know I wake up to see the sunrise and then you know I love to watch the sunsets and in between I get to see the moon and the moon getting bigger and getting smaller and I was happier with all that experience and you came to visit me once there.

Speaker 2:

Yes.

Speaker 1:

And the first thing you said when you arrived was like I get it.

Speaker 2:

Right.

Speaker 1:

I get why you're happier here. So how is access to natural light and nature and in this case, animals as well a quick go-to that more people could use to look at exploring even beyond medical stuff and pharmaceuticals just access to natural light. How important is that?

Speaker 2:

Right, you've touched on a topic. The medical term is something called chronobiology, which I followed for almost 40 years. It has to do with our internal time clock and our circadian rhythms and how light then synchronizes that. So our ancestors did not have access to the incandescent light bulb, let alone a screen for a computer. We are designed to wake up with the sunrise and go to sleep with the sunset. That is how the light synchronizes our internal clock. What you were experiencing was almost a primordial reset for how we're designed to function. And you're right.

Speaker 2:

I've written on sort of non-pharmacologic or non-drug ways to augment depression. One of the lowest hanging fruits there is just to see light first thing in the morning. Augment depression One of the lowest hanging fruits there is just to see light first thing in the morning. I tell people go outside, you don't have to stare at the sun, that's dangerous. But I'm particularly concerned about people who use sunglasses. I say look, you may need sunglasses in bright light, just don't wear them for the first hour or two in the morning. Really take advantage of this sort of ancient antidepressant we all have access to in the form of sunlight.

Speaker 1:

Well, in winter as well, especially depending. It was a sad seasonal effectiveness disorder.

Speaker 1:

Is that what they call it? Seasonal effectiveness disorder? Right? So that's people especially. You know we're filming this in August. People might be hearing it in the middle of winter. They might be in a climate that's hard to have enough light or even get outside if it's super cold. So you know, everything could be its own show. Everything has so much depth. We could go into more, but I really appreciate that we touched on this one about depression. Are you willing for us to share our own personal sort of reason why some of this is so important?

Speaker 2:

to us, of course, depression is much more than a theory or a chapter in a textbook. It is a disease that has probably touched everybody on the planet, either them, he or she himself having suffered or known someone or a family member. It is, unfortunately, a very not rare problem.

Speaker 1:

Well, and our little sister, Shelley Rotman, died by suicide, and so this topic's really important to both of us. We've both devoted a lot of our careers in the 17 years since she passed away this week she passed away this week 17 years ago and we've both spent a lot of the past couple decades trying to help people not get that depressed that they don't feel like there's like you know, stay around a little longer, experiment a little more. We just really devoted this isn't this isn't theory, this is practice that we want people to feel like they have a lot of influence over their own life, that even when things are hard, you could try a couple new things that might not be so expensive and you can give them a try. And we really, professionally and personally, are very devoted that fewer people, you know, lose somebody that they really care about in a way that whether or not it could have been prevented, who knows? But it's not coming back and we don't want that to happen to other people.

Speaker 2:

So one of the things we think about in terms of the lethality of depression and suicide is it really gets back to that hidden aspect of depression, which is the hopeless, helpless, the cognitive futility of it all. And I think one of the biggest barriers for people who are at risk for suicide to not get the help they need is to not have the cognitive hope that their help exists. And I think that's where there needs to be a real awareness that the illness is potentially so dangerous and that the illness itself helps. The illness itself creates barriers for sufferers to receive adequate care because of that cognitive component, and I think both as health care providers, friends and family and loved ones, we need to really be vigilant and not let the sufferer give up on therapy, because that hopelessness is part of their illness and that too can be corrected.

Speaker 1:

Yeah, yeah. Well, thank you very much. I mean not to get too mushy, but on behalf of you know we've lost our mother, our father, our sister. So on behalf of all the family members currently alive and ones that are everyone's proud of you Everyone would be so proud of you I just appreciate everything that you're doing and I think this is a really special time together.

Speaker 1:

So if people want whether or not you're part of Barry's growing practice he's got other doctors he's working with now at Banner Peak Health, but bannerpeakhealthcom you could be part of the newsletter and read some of his articles. Even if that's not, you know where you're going to go for your medical care and I would really welcome people. Body Aware Living, you know, be part of what I'm doing now and next, bodyawarelivingcom, the website. I've been inspired by your newsletter. I want to start a newsletter so there's going to be a way to get updated with the BodyAwareLivingcom website. If you want to sign up for our email newsletter, I'm going to start it once a month. That's plenty. We don't need tons more email.

Speaker 1:

Body Aware Living podcast is available at all your different podcast locations and I have Body Aware Living on YouTube. We've got videos of the podcast like this will be there, but we also have lots of other videos and we're going to be growing Body Aware Living on YouTube, facebook and I'm also available via LinkedIn. If people want to stay more in touch, I am working on my next book, which will be coming out in January of 2026. So if you want to stay connected and see what I've been up to for the past 25 years of trying to invent practical healing ways to care for our health during the best and worst of times, and so those are ways to stay in touch with me as well, if you'd like to, as we have a really exciting next year professionally. I think we both have a really good year coming up professionally, so thank you so much. Any final words that you wish, any wishes or final words for the people listening and watching?

Speaker 2:

Well, I think if you're interested in improving your own health care, you're on the right track by listening to this video. Just keep up being proactive and actively investing time and energy in your own health. It's an investment that will pay dividends.

Speaker 1:

Thank you so much and best wishes to you all. We will see you again soon All right Take care, take care.