Hi, I am Dr. Beverly Ree. And I'm Dr. Amber k Clack. And we are two peak, two peaks in a pod pod. Well, welcome back everybody. We actually took a little break for the holidays, so this is our first podcast back from the holiday. Oh my gosh. Yes, I did. It was nice. This is always my favorite time of the year. I told you I get into like making vision boards and I have like, what's the new me gonna be? I know some people are like just not into that, but I'm fully into it. Are you into it? I can see that for you because I know, like I know your personality is all about goal setting. Yeah. And everything. I think I'm really bad about that. But I do like to reflect this time of year. So yes, yes, yes. Um, okay, well let's get to it. I've got a celebrity for you. I dunno if you're gonna recognize him. I'm gonna show you. We'll try to add the clip in too. But look at this handsome guy here. Play the clip. Wow. He sounds special. Who is this guy? I really appreciate the podcast. Is it a podcast news? It's a podcast. I appreciate the host. I mean, he's quite informed. Totally. And he's handsome. Who's that? That's right. Yeah. Um, no, I know. I so appreciated the discussion that he was trying to bring up. Um, and so I guess, so this guy's name is Harry. Now, I had seen him. For, um, because I'm a fan of Kristen Cavalier, who is a reality star, and I've watched her show, but I think the younger generation of people watch the reality shows that he's on. I had to ask the girls, they said he's on like, love island and things like that. Okay. So he's, I he's pretty cute, pretty handsome. Um, and so you're, this is the celebrity not podcast guy, okay. Correct. Okay. Although I'm, I need to look in the podcast guide too. I know. I dunno. But it really kind of caught my eye when I saw that because I'm like, this is such an important discussion right now because I think you and I are both seeing. Tons of patients. Mm-hmm. Who started testosterone and nobody ever discussed the risks with them. Yeah. And I just love how he even responded when he said, what are the risks? Yeah. No idea. Essentially he was like, I'm gonna get really strong. Like, no, there's some other things that Totally clueless. Yeah. Yeah. So I figured let's just talk all about testosterone and how it can affect fertility and all of that. So. If you have listened to this podcast before, sorry, you're gonna have to listen to me complain again about testosterone. Okay? And here's the thing. Dr. K and I are double board certified OBGYN reproductive endocrinology, and in fertility specialists, if anybody knows hormones, it is us. But what's interesting is right now we have. So many people coming to us excited to tell us about the hormones that they're taking and we kind of burst their bubble because we're like, you know, we don't support that. Absolutely. Yeah. So, um, first I think it's important to understand that right now. I feel like there's a big industry and I'm gonna call it big testosterone. So you know how they have like big pharma. Oh yeah. Big alcohol or like whatever it's supposed to represent that it's a business. Mm-hmm. And you know, I'm not saying that. The company that makes testosterone alone is the only kind of business here. But there are companies that make testosterone pellets that profit a lot from selling that product. And unfortunately, and I hate to say this, there are providers who also profit a lot from inserting these pellets. And so if they are gonna make a profit, both the company and the providers, they need to convince as many people as possible. That they need to take testosterone, right? Yeah. Yeah. And here's the thing, it's such an easy sell. Yes, totally. Right? Everybody wants testosterone. Yeah. And remember, if you even think back to like 10 years ago, people call this illegal steroids. Mm-hmm. Right? I think we've always all heard about it because you would hear about athletes who got in trouble because they took testosterone and that was illegal. And here's what has happened. It's now legal. Mm-hmm. Right? And so it's supposed to be through the judgment of your provider and you know, through the patient shared decision making of deciding who should get this medication or not. And in the past, doctors were very restrictive saying, really the only people who should have this are people who truly have low testosterone. But you heard from that little click we just showed you, even if you have normal testosterone. Someone's willing to sell it to you. Yeah. Scary. And the podcaster used an interesting word, hyperop optimization. I like absolutely think that he's spot on, right? Yeah. This he is saying this is above and beyond. Yeah. Normal physiology. Yeah. Does this young, healthy guy, yeah. You want to take these risks that, oh, lo and behold, he doesn't even know exists. Yeah. Yes, yes. And I think, honestly, it's so tempting. Like if I wasn't a. Wow. Do you wanna be strong and energetic and skinny? Mm-hmm. And you know, have no brain fog and all that. I'm like, sure, sign me up. That sounds amazing. Right? But here's the thing, again, hormones are complex. It's not that easy. You just don't take this and everything magically goes away. Right. And again, it's important to even know what are your hormones to start with before you go adding on hormones that you may not need. So a couple of things that I just like to think about are, what does nature tell us? Okay? So first of all, I want you to picture my 9-year-old right now. Okay? She is a little ball of energy. She has no brain fog. She runs around like crazy and all the rest of it. Okay? And guess what her testosterone level is. It's zero. Okay. So it doesn't mean you have to have testosterone to be energetic. There are other things that probably really factor into this that maybe people aren't really telling you much about because maybe they don't make as much money off of it. Right. True. So that's number one. Okay. Number two, and maybe you can kind of share experiences about this. We know what happens when women have high testosterone levels, right? Because that is one of the most common conditions we see. Polycystic OV PS and Dr. Pe. I wanna know, do women with PCOS feel amazing and skinny and strong and No, I wish they did. And so if that's the case, you have to really wonder, okay, how can that make sense? On one hand, how could it be? That women with naturally occurring high levels of testosterone actually have trouble sometimes losing weight, or they often do report brain fog and all the rest of it. And yet this other salesperson is trying to tell you, if I give you testosterone, it's gonna solve all your problems. Both of those things cannot make sense together. And so these are things that we really. To sort out. Now will I say in the hormone field? Everybody completely understands it yet. Well, no, but I think that's my fear is the people selling it are trying to make it seem like, Hey, if, if you got low testosterone and these problems, that must be it. We give you testosterone, it's gonna make you better. Or even if you have normal testosterone, here's extra. Right? Yeah, yeah. Which is why I think it is really un. Important to understand what is normal. Yeah, and I think sometimes just getting a single blood draw right is not a good explanation. And I think for both males and females, it's important to understand why is this person drawing your testosterone? What is the goal for you? What. What symptoms are you you experiencing to even lead to this investigation, right? Mm-hmm. Um, and so we have to really take that for what it is and see what's their motivation, right? Are they really trying to help you figure out the source of a major health issue? Is it slapping a patch on something and, and kind of missing something else that could be going on with you? So you really wanna make sure that they have the proper motivation to investigate in the first part. Right. First place in our area we have what's called low T clinics. Right? And so you go to these low T clinics, no matter what you go in with, you're probably coming out with testosterone. Right? And I think these are fair questions to, you know, ask your provider is, okay, will you checked my pro my uh, testosterone level? It's normal. So why are you recommending I take this? Right? And usually they'll try to say, oh, but you're feeling bad. Okay. But then maybe you should say, but could there be other reasons that are feeling bad? And have you really done an intensive full body evaluation? And I would say probably not because they're low clinic, all they wanna do is give you testosterone. Right, right. Um, so. Interest. Testosterone is of course totally different in women and in men. So a normal for men is usually, and it depends on who you ask, what assay you use, somewhere around three to a thousand, which is a pretty broad range there. But I do have a lot of patients who come in and they say, oh, I got started on testosterone because I was on the low end of normal. And I say, okay, so I'll go look at his lab results. And I'm like, okay, your results were four 50 and okay. But their provider said, well, it's in the normal range with a low end of normal. And I'm like. No, they didn't even need to put you on this. And now look at the circumstance you're in, right? Yeah. Now, um, for women, this is kind of funny too because I'll say sometimes, guys, and I'm not saying I don't feel sorry for you, but sometimes y'all will come in, you'll say, oh, I feel so bad. My testosterone is low. It's three. I have no energy. I can't get through the day. So just, you know, my testosterone 30 and I've lived whole like this. Okay. So again, it can be right. I'm pretty energetic running, doing all stuff. And so, um. So, you know, not to say I don't feel sorry for them because sometimes it may just be that they've had a drastic dip. Um, but again, maybe there's more to it than just the level alone and maybe we need to be looking more into the root cause of why you could be feeling bad, um, as well. So those are kind of normal levels now. Um, even though that's kind of what we would just see in a normal person. What's interesting is some of the providers when they're prescribing testosterone, they'll kind of have their own made up range of what they have decided is hyper optimized, right? Yeah. And I find it quite alarming actually. So listen to this in women. Some of these providers are saying they want your gold testosterone range to be 50. Wow. Wow. When we're used to like 30. Yeah. That's crazy. Crazy, crazy. Okay. Yeah, and here's the problem. When you first put a woman on it, she's gonna feel great. She's probably gonna be energetic and she'll build muscle and all the rest of it. But over time, and it does take time. You will start to see side effects. Okay? And probably how fast it happens does depend on the dose and your serum levels, and ultimately how long you're on it. But let's take an extreme CIR circumstance. If there's a woman who wants to transition to become a transgender man, how is she going to do that? She's going to take testosterone. Okay? And we know that if that person starts taking testosterone, it's not gonna happen in a month. It's gonna take some time, but then does it work? Oh, absolutely. Absolutely it works. Okay. So imagine if you're taking testosterone, you're on that spectrum somewhere. You may not have taken a high enough dose to completely transition to if you're, you know, to be a, but you can be on your way there. You can get deepening of your voice. You can get your hairline. I will see, I see all these people on social media selling testosterone, women, their hairline is getting further and further back. That's my nightmare. Yeah. Yeah. Right. Like, because women with P, they can't help us. Right. We're always trying to grow our hair up here. Yeah. Why are you intentionally doing this to yourself? Right. And sometimes it's not reversible. Um, cly, we as hormone doctors have seen this. I have seen patients who are growing essentially a little penis. You cannot get rid of it once you have it. So it's so important that you do not let a provider who doesn't have experience give you this kind of thing. So I would recommend if you feel like you need to have, um, testosterone supplementation, that you see somebody who actually is a hormone expert. So look at their credentials. How do they train? Are they board certified? And I would actually look for something called NAM certification, north American Menopause Society Certification to make sure this person has the proper training to be giving you, um, good advice if you're a woman. Um, for men, of course, you wouldn't necessarily have Nam uh, certification. Um, but still important to look at their, um, credentials as well. Yeah, and absolutely. You know, when we're talking about testosterone replacement in women, we typically see this in that perimenopausal and menopausal state, and so I do think that there is some interesting data and probably a role for replacing testosterone at that phase of life. But people who are doing this properly understand that you. Very low doses of testosterone replacement to get you back to a physiologic level, right? So there is a place for it, but it's in a, you know, controlled setting, right? Where you're making sure that you're not using way too much of it and having these side effects long term. Right. Right, exactly. So, um, and, and I think that's such a good point and important distinction you made. Um, our societies do support and say there is some evidence that postmenopausal women will do maybe better, a little bit better. Mm-hmm. Um, with a little bit of testosterone, but absolutely, just like you said, it's really just to get back, you back, get you back to what normal levels would be for a woman. Um, which might be maybe around 30, you know, maybe 30 to 50 ish range or something like that. So if your testosterone level is zero and you wanna go to 30 to 50, I think that's totally reasonable. Right? But don't let anyone put a pate in you because a p. Once you put it in, you can't get it back out. You cannot control how much it releases. We've seen so many times people's levels went way too high. They've got all these side effects. There's nothing they can do about it. Absolutely. So if you're gonna take testosterone, I think probably the best way to do it would be some topical gel and to have blood levels drawn. Now, here's the funny part. I say big testosterone. Okay, I'll admit it. I do prescribe testosterone for certain fertility purposes. This is a very small women that I do this for. I. It would be beneficial. But what I found is you can give, uh, two women the same dose and they will have totally different testosterone levels. I have to kind of adjust it based on their absorption level and, and all of that too. So, um, Steve, I just kind of veered off talking about women we're supposed Okay, but here's, um, here's what I. And I do kind of feel bad for these guys right now because the guys with the normal testosterone are kind of taking off, take away all your resources, right? They're cutting you in line to get testosterone when they don't need it. But some of you really do need it, right? And so, um, I do think it's reasonable to kind of ask yourself, Hey, what could be some signs of, um, low testosterone? Yeah, absolutely. So we have patients that will come and see us for this all the time, right? So perhaps you might be feeling low energy, low libido. Any type of problems with erectile dysfunction or sexual sexual dysfunction can be a symptom of that. Um, sometimes problem concentrating throughout the day. And so these things really need to be getting in the way of your daily functioning, right? Yeah. So they're prominent enough that you feel like you need to go and talk to someone about it. That might be a reason to. See a trained provider and get your testosterone level checked. Yeah. And I do wanna make a comment about erections. Mm-hmm. Awkward topic, I guess to talk about, but I think it's really important, right? So, um, we do get a lot of couples that'll come in and the guy they'll always embarrassed that I don't want be embarrassed about because we see it all the time, but they'll say, look, I do sometimes have trouble. Getting an erection, and there's kind of a cheating way for us to know, could this be more of a psychological issue or do we suspect that this is a testosterone issue? And so what we can ask is, okay, well when you wake up in the morning, do you wake up with an erection? If you do, it's probably unlikely that it's caused by hormone issues. If you don't and that is a change for you, then I am thinking more so. Okay. Is your testosterone low now? And then the other thing is, and when we see a couple for infertility, almost every time we'll get a semen analysis on the male partner if his firm number is low. Those are kind of the first things that are coming to our mind is could he have low testosterone? Um, and sometimes that semen analysis will then prompt us to, um, have them see a specialist to get their testosterone level checked too. Um, okay. But here's kind of one, one of my complaints is if somebody has low testosterone, okay? Then we're like, okay, yes, low testosterone. How can he be helped? Right? I hate how people just wanna give him testosterone, and they don't wanna try to help him figure out why does he have low testosterone, right? Yeah. Yes. So, you know, PSA, right? Mm-hmm. If you are found to have low testosterone, you might have an underlying, serious condition. Mm-hmm. That needs to be treated. For example, I have found a brain tumor recently in a patient that has low testosterone. Okay? So remember your hormone signal to talk to your testes to make testosterone and sperm. Come from your brain. Mm-hmm. So you can actually have some serious underlying conditions that are completely missed. And I think that is criminal. Yes. To just give someone testosterone and not find something like that, that could be going on. Percent percent. So whenever we see low testosterone, we know as hormone doctors, testosterone comes from the testicles. Okay. So if your testosterone is low, we think there's either a problem with the testicles. They're just not making it. Or there's a problem with the brain. The brain is not giving the testicles, the proper communication and stimulation to make testosterone. And so a great and easy way to to check that is blood work. Okay? So if you check your pituitary hormones, your Fs H, and your lh, and then also check your testicular hormone, then you're gonna be able to look at the pattern and determine, okay. Is my pituitary trying to do what it can to stimulate the testicles. Now I actually am feeling a little bit happier if the brain hormones are low and the testosterone is low, because I know in that case, oh, the testicles probably work just fine. They're just not getting the proper signal, and that's something we can easily help. Whereas if the opposite situation happens where the FSH and the LH are already really high. I'm more worried in that case because I'm saying, look, I can see the brain is working really hard to try to stimulate the testicles and they're not responding. And so then I worry that there's some sort of testicular failure going on there, right? And our medications that we can offer you to maybe hijack the system often employ your brain, kind of giving more signal. And sometimes if your brain's already working on overdrive, it's hard for us to do that. Um, okay. So let's kind of talk about some of the causes for low testosterone. So you mentioned brain tumor. Can you talk more about that? Yeah, absolutely. So sometimes you can have benign or maybe even, um, other types of brain tumors that can get in the way of the area that actually releases the signal to talk to your testes, right? Um, or it could be another, um. Tumor that's pushing on that area. And so sometimes these brain tumors are just benign little small tumors that really aren't much to worry about or and are just an explanation. It could even be treated with a pill sometimes. Um, or you could have a bigger mass lesion or something like that that's going on. I actually have not seen that. That's pretty rare, I think. Yeah. Okay. But most of the time it's a benign finding, but it's something that is easily fixable and you wanna be tracked and make sure that you're aware of it. Yeah. And this is definitely not. Scare anybody because again, it's not common, but also because it's such a big deal, somebody should be looking at this for you, okay? Mm-hmm. Um, so the ways to evaluate for this are again, number one, you check your pituitary hormones, your FSH and your lh, your testosterone. You can also check a prolactin level that can help you look for one of those conditions. Speaking about, and then if you have low pituitary hormones and low testosterone, then you should maybe ask your doctor, Hey, do I need an MRI of the brain just to look and make sure that everything is good? Hopefully it would just be totally normal, but then you can feel reassured. Okay, let's talk about some other issues. Um, and, you know, here's another one of my soap boxes I love to talk about is alcohol. Mm-hmm. Okay. I also, I, we talked about big testosterone. I also think there's big alcohol, and I'll say big alcohol's in trouble right now. I just saw a news article that said alcohol companies are sitting on a lake of alcohol that has gone unsold right now because so many people are learning about the bad effects of alcohol and have stopped drinking. Oh my gosh. Well, it's dry. It's dry January too. Yes, that's, that's what they said. They said We still have a week left of dry January and it's stressing out the alcohol. C. So they're gonna be coming for you guys and trying to get you to drink. But alcohol in some ways for some people can lower testosterone. And we know alcohol's so bad for the sperm, so if you got low testosterone, I would. Stop drinking completely. See what happens. Yeah, absolutely. Yeah. Okay. What are some other process? Um, obesity I think is another one that you could look into and maybe offer even some other recommendations. Mm-hmm. So your fat cells actually have a hormone in them that converts, um, basically makes estrogen Right. Um, and. It's a important hormone in this pathway. And so the more fat cells you have that can actually lead to lower testosterone levels overall. And so just losing weight if you're overweight can actually help improve the production. Absolutely. Absolutely. That's great. Okay. Medications. Okay. This is something maybe you can blame doctors for too. Sometimes we give medications with good intent to help some other issue, but one of the most common medications doctors give steroids. Okay, they can actually lower your testosterone. Now, if you're just taking kind of a short course of steroids, it could just be temporary. But what if you just hadn't made that connection when you got your testosterone level check? Maybe you had been treated for a sinus infection a week before. Then you go get your level check. Your doctor says, oh my gosh, it's so low. Maybe just remember, wait a second, I did just get steroids. Maybe I should give my time myself some time to recover and recheck it in like a month or so. Mm-hmm. Yeah. And I, in going off of that, sometimes just a major illness can affect that. So I do ask patients if they had a real serious illness, um, recently when we're looking at these things. Yeah. Yeah. And then, you know, a lot of times when we're talking about age, we're talking about how much it affects us as women, but men. My dad told me can go through menopause. Not menopause, but menopause. Um, and you know, it's, as a hormone specialist, I'm kind of like, I dunno if I like that descriptor because I, you know. Sure. Do levels go down for men over time? Yes, but like, they don't understand for women, like they tank. When we go to mepa, they're like this and then down. Um, but for men, it just kind of gradually goes in. It doesn't, it's not as severe as it's for us. Um, but age is certainly a factor there. Um, I did have a recent one that I thought was interesting. He had previously had normal fertility, normal testosterone. We checked to see. All of a sudden his sperm was so low and terrible, his testosterone's low. And the urology fertility specialist finally made the connection and he did recover from it on his own, that he was training for a marathon. Mm-hmm. And she felt that it was just really stressing out his body and that the high amounts of cardio and maybe not enough calories at the time, was causing him to, um, have low pituitary hormones and not stealing the testicles properly. So I thought that was an interesting one too. That would've been kind of first, first come. So, yeah. Um, oh, and one more thing for medication too. Opioids. So pain pills, um, or even if you had some sort of pain pill addiction and now you're on methadone, methadone can really have a strong effect, um, on the pituitary as well, and ultimately cause low testosterone. I really feel like they need to tell people, um, this ahead of time. I don't feel like they're often told that. No, no, absolutely not. Yes. Um, okay. So let's say you are one of these guys, you found out you did have low testosterone. Let's say your doctor was great, did the full workup, but couldn't find a reason, but said, okay, we dunno the reason, but lemme give you testosterone. Okay? So Dr. K, can you explain to me why we tell patients you need testosterone to make sperm? But then if you give somebody testosterone, their spirit goes away. Yeah. So you can kind of imagine your body as a system, a loop, right? So you have little hormone signals that are always being released from your brain and talking to your testes. And your testes actually talks back to your brain. Um, and the problem is, if you replace your testosterone and you gave yourself a lot of extra testosterone, that's the signal that's going back and talking to your brain, telling it, Hey. I'm good. I have plenty of testosterone. You don't need to release any more hormone because we're all filled up and it will eventually shut down your brain production to very, very low levels. And sometimes this can last forever. And I think that's a scary thing. And I think that's what that podcaster really was trying to tell this young, healthy guy. Do you know about the risks? The risk is are that. In the future, you might not recover from being on testosterone replacement therapy, so absolutely can shut down your own natural testosterone production, but also your sperm production. And yes, you can stop it. And we do see recovery for most of our patients, right? It can take a while, anywhere from three, six months, sometimes a year, but for some guys it might not recover at all. I do think what's challenging in those cases for men who never get sperm recovery though, is I have to say this is okay. Well, if you had low testosterone to start with, it could be your sperm was low at that time. Mm-hmm. We'll just never know because it was never checked back then. Right. Um, but, but what the body really needs is local production of testosterone from the testicles to make sperm. But you know what, if you take testosterone. Pure testicles shrivel up. They get really small and they just don't make testosterone. They don't make sperm anymore. So we call testosterone male birth control. Now, of course, I wouldn't use testosterone as contraception. Um, but actually you should tell the story if remember how you had the same analysis that you called. Oh yes. Yeah, this, oh, this was actually a great day for me because you were so stressed out about the phone call. Okay, so this, so this happens to me, and I've asked my husband about this'cause he says I'm the worst. Somehow. All of my semen analyses that have no sperm, it's called azoospermia, no sperm. Come, my results come to my inbox on Friday afternoon. Oh no. So you're gonna run weekend. And I, and I'm like, babe, do you think I should call these guys on Friday afternoon and ruin their whole weekend? Or should I just wait until Monday morning? Know And yeah, so and so, I'm always in this debacle, but you know, like sometimes like my consciousness gets the best for me. I'm like, I feel bad sitting on a result. Mm-hmm. You know, and not telling them as soon as I have it. So you ruined the weekend. Yeah. So I ruined their weekend. I know. I'm the worst. Okay. So I have one of these guys I call him and he starts cheering. When I tell him, he's like, oh, yes, I knew it. I knew it, I knew it. And I, I was like, okay. But like, what do you mean you knew? Apparently he did have a lady that was trying to con, big friend was trying to convince him that he had fathered a child. Mm-hmm. But he was like, I've been on testosterone for years. So I was pretty sure I don't make. For, so he was aware of the wrist. He's like, I'm not the father. Yes. Yeah. And he was like, can you please release a copy of that to me for my results? This is so great. I was like, I'm so happy for you. This is the best azo sperm analysis I've ever called. Such a relief. Because we know, usually when we make these calls, it's devastating. Devastating. It was so sad. I saw a patient the other day. And he was just, um, describing to me, he said it was October 6th, 2023, the day I got my, and I'm like, that was years ago. He knows the exact day. He found out about his looks perfect. It's so impactful and it did make me really just realize what big this deal, this is for the guys. And so that's why I just feel so bad when. Nobody ever told'em. So if you a provider who gets testosterone, you, you've heard I'm a little judgey, but please counsel your patients about that and just say, are you aware of the risk? Because the official guidelines say if somebody desires fertility, do not give them, um, testosterone. So, okay. If they can't take testosterone, are there any natural ways, you know, I love natural stuff. Are there any natural ways? Yeah, absolutely. Take testosterone. Yeah. And I think we work a lot with this, um, with our couples. Mm-hmm. So I think following a healthy lifestyle can actually help in several different ways. We just talked about how obesity can impact. So losing weight can really help abstaining from alcohol can help. Um, getting good sleep, right, having a regular sleep, sleep schedule, lowering those stress levels actually can improve your testosterone. Um. Production. So just stress management in general. I think all of those things can really help naturally increase it. Yeah. Okay. And then what if I've tried all the natural things, I'm a guy low testosterone, I've tried all the natural things not working. I do wanna have fertility. What kind of options can you offer me to increase my testosterone and normalize my S serum production? Yeah, absolutely. So there's kind of two tools in our toolkit that we'll use. We are mainly approaching it from a fertility standpoint. So I think if you're going to some of these. Centers, they often will offer HCG injections in my experience that I've seen, um, to their guys that are interested in increasing their testosterone, but ultimately might be thinking about their fertility in the future. So HCG is actually, uh, an injectable hormone that mimics a lot of your brain hormone and that actually. Does not suppress the testosterone and sperm production the same way. So it's kind of, again, trying to hijack your system, talking to your testes directly improving things. Um, the other one that we use a lot more, so infertility based things would be Clomid, same sort of thing. We're trying to convince the brain to release some of more of those pituitary hormones to increase sperm production mainly. Absolutely right. So I think that is the good news here is if you have low testosterone, we have medications that can not only increase your testosterone and get you feeling better, but also give you higher sperm and, and better fertility too. Um, but here's the problem. If I have somebody on testosterone, and this just happened to me the other day, I felt so bad because for the female partner, I said, oh, I need to give some fertility pills. We today. Oh, I'm on testosterone. I was like, oh, this is gonna be a setback, right? Mm-hmm.'cause how long does it take? Yeah. For a firm to come back if you're taking testosterone and then stop it. Yeah. In my experience, I usually won't even check another semen analysis for about six weeks. Mm-hmm. And I would say at least 50% of my guys have to wait another couple months before we see recovery. Mm-hmm. Mm-hmm. So because of the life cycle. Sperm, it can take about two to three months for the sperm to come back. Um, you just have to be super patient. But it can be frustrating if you're wanting to hurry up and get pregnant because you can say, well, what if it never comes back? You're, you know, 10 to 20% of the time it's not gonna come back. Right. But that does mean most of the time it will come back, but how soon? They say sometimes, even as long as six months. But I do think if you're willing and open to taking Clomid and or HG injections, it probably helps it come back. Faster. Mm-hmm. If it's gonna be amenable to, uh, treatment options like that. Now I do think it's important to say too, in a man who has tried all these treatments and nothing is working, you can still have a baby. We've got all the treatment options to help. If the sperm is just a little low, we can do insemination treatment. If the sperm is really low, even if you only have like 10 sperm or something like that, you can do IVF. And I will say that's probably where we also need to call out our own industry is sometimes men will come to an I VF clinic, they've got a low seen analysis, and the doctor goes straight to, you need IVF. Okay. But again, why is this sperm low? Has anyone helped you look into this? Are you interested in looking into it? Now, some, some guys say, no, I don't wanna know. I just, okay, fine. But somebody should at least give you that option to explore that further before rushing you into, um, a treatment when you haven't had, um, the time to, to discover why. The why and if it can be, um, fixed as well. Okay? And then finally, I think we need to start a new trend of like normalizing being normal, right? Oh yeah. Completely agree. If you ask these guys, why are you taking testosterone? Okay. I think like for this guy, Harry Jy, I saw him like flirting with Chris Capillary. I'm sure if you want like this beautiful starlet, it probably is a lot of pressure, right? You've gotta have big muscles and be very handsome and all the rest of it. Um, and like that's great, but like, are we expecting too much of these guys? Like, I dunno, like they don't have to all look like bodybuilders, right? No, definitely not. And I would say, you know, sexually performance wise, I don't think we need that. Like, I think it's us women, it's enough. Absolutely. So I do think that maybe just as women, we need to just like maybe encourage men, like, Hey, just be yourself. You don't have to be someone you're not. Right. And I would hope they would say the same back to us too. Unlikely. I feel like men aren't very picky actually. Like I do feel like women are more picky. Um, and, and so I said maybe as women we just need say, guys, you don't need to be a bodybuilder. Yes, we want you to be healthy, we'd love for you to work out, but you don't have to take testosterone and be some kind of like crazy mu guy. Um, either. So like for me personally, I always tell my husband a. Don't ever take testosterone. Especially too, because we see the mood effects. Foid rage. Oh my gosh. Oid rage is real. You guys, they're so mean. We see tons on testosterone and they're so cranky. Mm-hmm. So, yeah. Yeah. So, uh, just say no. Okay. Should we wrap it up? Yeah. Okay, good. Thank you guys. Have any questions? Let us know if you would be so kind to leave us a positive review for our podcast, um, on the website that you're listening to this on or the app. Um, or if you're watching on YouTube, like in subscribe. Bye bye.