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.
Trend
recordings per month · last 12 monthsNo recordings in the last 12 months.Older appearances are listed below; set an alert to hear about the next one.
Appearances
Yeah. I'll tell you why I find that interesting, Paul. And I only learned that really in talking to bodybuilders who were taking 500 to 2,500 milligrams of testosterone a week. Because my initial reaction to that was you've already saturated the androgen receptor probably five logs. I mean, not five logs, but like at least one or two logs earlier. But they convinced me, no, no, no.
There is a real difference between 500 and 1,000 and 2,500 in terms of muscle mass, which it sounds like you agree with. And I don't understand the physiology of how that's possible. I don't, I mean, how many androgen receptors would you need? You'd have to upregulate them when in fact you'd be downregulating them. So I'm not sure, but the effect is indirect.
There's even studies that show, by the way, that high enough doses of testosterone will increase muscle protein synthesis absent the stimulus, absent the lifting stimulus. So it's the potential to recover that is improving.
All right. So now let's talk about the guy who comes to see you. He's been on exogenous testosterone for three years. So he was given poor advice three years ago. He went to some shady back alley website. He was 27 years old at the time. I mean, this is tragically a very common story by the way, right? So this guy has been on 200 milligrams of testosterone a week for the past three years.
He's now 30 years old. He's met the love of his life. Lo and behold, they can't seem to get pregnant. So he's in your office. During the history, you find out pretty quickly he's been on 200 milligrams of testosterone for three years. Tell me what his sperm analysis looks like. Presumably there are no sperm. I would bet 95% confidence that he would have no sperm in his semen. Okay.
So what are you telling him now? How are you going to solve this problem?
You always have to get it out of it. If they're super jacked, but then they have shriveled testes. Yeah. And they're zero. And they're wondering what, you know, right?
This is the same, by the way, as I'm sure you experienced as a resident in the ER. The people that come in with foreign rectal bodies and abdominal pain That's the one thing they emit from their history. They tell you, you know, this is the last time I ate. This is this, this is this. But then you get the x-ray back and there's like a candlestick in their colon. And then you say, yeah, yeah.
What about this candlestick? And they're like, oh, I totally forgot to mention that. Yes, yes. It was lit when it went in.
But not everything.
Either the ability to make sperm or the ability to make testosterone We typically tell men in our practice, two years would be the absolute ceiling. Are we too conservative? Maybe. Okay.
And then I usually check them at about six weeks. It's interesting. If you give Clomid, the pituitary will make FSH and LH? Yeah, it takes a while. Well, that's a way more cost-effective approach than giving, because synthetic FSH is pricey. Yes, a couple thousand a month in America, yeah. So is there any reason to do that over the Clomid approach, or is it just that it's faster?
I think you might gain a couple of weeks of time.
If they're in normal range. Oh, really? Okay. We want within a couple months to see them back to 600. 300 would be okay. To make sperm.
Now, I want to get onto some of the other topics here, but just to close the loop on this, do you ever advocate crazy ideas for guys that are using testosterone to use lower doses and then combine it with HCG, just as we were talking about the Clomid plus HCG approach? All the time. Okay. Not an unreasonable approach to combine Clomid with testosterone at low doses to preserve testicular function.
35.
Do you think that there's a difference between HCG and Clomid in that effect as the adjunct?
Outside of fertility, given the popularity of testosterone replacement therapy today, is there another advantage to just doing dual therapy? Obviously, for fertility, we wouldn't be talking about it. But can you think of any other reason why it might be advantageous if a guy can deal with the hassle and the cost? Yes, depends on the indication though.
Everything but fertility, like any other health benefit?
But I'm saying as opposed to just being on testosterone injectable to do the dual therapy versus just monotherapy. Oh, you mean if you're going to do some kind of therapy? Yes, if you've committed to doing therapy.
Showing 141–160 of 5,258 · page 8 of 263
← Previous
Next →