Dr. Peter Attia
speaker
5,258 appearances
36 recordings
6 series
first heard Jan 2024
last heard Jun 2025
Dr. Peter Attia’s voice in public audio — every appearance, attributed to the second.
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Do you prescribe it? Oh, yeah. I'd be interested to hear your experience with it. We have prescribed it now to maybe a half a dozen patients. One of the silly challenges we have with it is we actually have no idea if they're therapeutic because trying to get their blood drawn to figure out when to draw their blood to actually see the level.
For example, if a guy takes the drug at eight o'clock in the morning and then at one o'clock in the afternoon, which is sort of what we're told is a great window to take it so that you get that mid dose, mid dose, right? If he does his blood draw at seven o'clock the next morning, he's been 18 hours off drug. He has unmeasurable testosterone. He's going to show up at 200.
He's going to look like I did 50, 20 years ago. His LSH and FSH are still completely suppressed because that doesn't go away over 18 hours. But I don't know how to interpret what is he walking around at during the day, which is what I care about. It's hard to know.
And what are you dosing it at? It comes in 100 and 200.
Interesting. So this is not something you used when you're trying to get a guy from 300 to a thousand. You could, but probably not the first choice. Yeah. And now you're taking 500 twice a day or something crazy like that. Yeah. And twice a day is a big deal for men. It is. What about Natesto? How are you, are you using?
What's the experience like? We've never used it.
And do you find that the clot risk is proportional to hemoglobin hematocrit? Absolutely. At what level are you saying?
One of the things we do with patients who are injecting testosterone cypionate, and we have some patients who love doing this. I think it would drive me nuts if I were trying to do this. They inject it every day. So they'll do 10 to 15 milligrams every single day. And it actually produces the same effect, which is they don't have the polycythemia. Right. Because they don't hit the peaks.
They never hit these crazy peaks. 10 years ago, everyone I saw that was prescribing this was prescribing, the standard was 200 milligrams every two weeks, which was crazy. Highest risk. Yeah. Yeah. So what is your typical injection schedule?
Oh yeah, I do them all. The pellet also, I don't know the kinetics of it, but I would imagine you're pretty super physiologic for a month or so, maybe? Yep. So pellets are like the long-term contraceptives for women.
I really don't. So let's go back to the Clomid HCG route. What is the extent to which fertility is preserved when a man is on one of those agents? So Clomid is, we give it for fertility all the time. So it's very good.
And then your fertility is preserved. 1500 three times a week of HCG is a whopping dose. Mm-hmm. You're saying beneath that, you typically don't have issues with FSH and LH suppression? Right. LH you will, because it's LH, but not FSH. Maybe 1,000 to 1,500, you start seeing it. So that's the way you protect the fertility. And what dose of Clomid will you give on top of that regimen? Depends.
I mean, usually half a pill a day. Half a 25, half a 50? 50 milligram pills, yes. Usually half. You'd give 25 every day? Huh? These are staggering doses. How high are these guys' testosterone getting? The testosterone is driven mainly by the HCG.
Yeah, yeah, yeah. No, it's interesting. I mean, we don't like clomiphene at all. Just because, well, there are a whole bunch of reasons, but they have to do with kind of lipid stuff. Even when we would use it, we would probably use 53 times a week. So that's about the same, right? 25 a day. But for most guys, that would be sufficient alone, even without HCG.
So I think there's another reason, Paul, and it's everything you just said, but the HCG and testosterone are schedule four, which means you cannot prescribe them through these testosterone clinics that don't even see patients and are literally just not being doctors. They're just sort of giving it to anybody who shows up and pays. It's a coin-operated testosterone dispensary.
But Clomid, and I assume by extension, and Clomiphene are not scheduled. which means you can coin operate those. And my guess is that's probably why the FDA is saying what it's saying. It's already bad enough that the Clomid cat is out of the bag, but we don't want to put another one of these unscheduled drugs out there in the land of shady medicine.
The indications are pretty clear and they're really safe.
And what are the approximate levels for each of those?
So most guys that are having difficulty with erections are above 290. There's some other issue. Usually. Yeah. But you have to prove it to them. And I'm fine with that as long as it's safe.
You start seeing issues- With how much FSH and LH? I don't know. Okay. Obviously the other thresholds would be anabolic capacity, like muscle mass and things of that nature. And mood tends to be a lot more variable in my mind. Absolutely.
Showing 121–140 of 5,258 · page 7 of 263
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