I'm sorry, there are bullets flying at
you. Do you want to be normal or do you
want to be optimal? That's crazy. We
need optimized soldiers because every
life counts. Every decision counts.
Every stray bullet counts. And every
ability to be slightly more better at
your job absolutely counts. Do you know
why? Cuz it's important how our fighters
fight. Better fighters mean more people
come home alive.
Hey guys, Dr. Mike Israetel for RP
Strength. US Secretary of the War
Department just announced a very
important thing about testosterone and
our war fighters. So, is he cooking up a
crazy modified steroid army?
Scott five extra limbs, each one holding
a Glock. Yeah. Or is he saying something
substantially more rational? Let's take
a listen.
>> At the Department of War, we have the
most elite warriors on the face of the
Earth.
>> Gee whiz, he sure is handsome.
>> He is.
>> Every single day, you are pushed to your
absolute physical and mental limits to
master the profession of arms.
We demand your all and you give it.
But while we invest heavily in our
weapon systems, platforms, and gear, our
most decisive tactical advantage will
always be the individual warfighter.
>> This is super right on. The American
soldier is unbelievably well trained and
the American soldier is treated as a
very independent thinking unit compared
to many other armies of the world. And
so, making sure that the independent
thinking unit also has the highest
physical capabilities is absolutely on
message. It's spot on. It makes total
sense.
>> We have a sacred duty to maintain that
advantage, which is why we must
constantly look for for ways to optimize
your performance, your resilience, and
your long-term health.
>> Scott, doesn't this sound like the
preamble in a movie before they announce
a super secret super soldier serum?
>> X-Men.
>> X-Men or Captain America. I mean, god
damn, this is dope. I love it.
>> And to meet that commitment today, I'm
authorizing a new screening program for
testosterone deficiency for our service
members, ensuring you have the right
testosterone levels to operate at your
absolute best. Because it's
well-established science that as we age,
testosterone levels often naturally
drop.
>> Scott, are we supposed to be trusting
the science at this point?
Like, come on. I couldn't resist.
>> Is that true?
>> Let me hear what else he has to say. So
far, so good.
>> Under the supervision of our world-class
medical professionals, war fighters age
30 and older are going to be tested
annually as part of their periodic
health assessment. It's a health
assessment that happens every year.
We're just adding this test.
Those under 30 can voluntarily choose to
get the test as well.
>> This is really cool so far.
Testosterone absolutely meaningfully
impacts performance, especially in
military tasks, both physical and
cognitive. Testosterone levels at a
sufficient dose that aren't super high
actually give you a bit more of that
warrior spark, that decisiveness, that
aggression controlled. We're not talking
about super physiological doses here,
just normal ones, cuz if you have very
low testosterone, there's a warrior
like, "Ugh, I don't know, but it's so
hard." If you have more testosterone,
you can do cool robot cyborg shit, which
is awesome. It's also a really good
thing they're doing this for men over 30
who are at the higher risk of
testosterone deficiency, but I love the
fact that everybody else can volunteer
because sometimes you can have low
testosterone and be well under 30. So
far, so really good.
>> If treatment is recommended, it's
entirely your choice
to receive testosterone replacement
therapy.
>> Oh, Scott, this sucks. How are we
supposed to be pumping up warriors
against the role of psycho future drugs
if it's up to you?
>> Yeah.
>> I had faith in this department. God damn
it.
>> This initiative, it's not about
artificial enhancement.
>> Are we done yet, Scott? What is this?
Trolling me here. Where's the artificial
enhancement? I want nano test.
>> It's about restoring and optimizing your
natural capabilities, protecting your
longevity, and ensuring you have the
biological foundation required to
sustain the fight.
>> Everything's spot-on so far. Super
correct. It's not super serum, but
having people at healthy testosterone
ranges and giving them the discretion of
if they want an exogenous testosterone
TRT to see if they need to bring up
their cognitive and physical performance
is absolutely spot-on the money. It's
been said a long time by many people,
sometimes cynically, like why aren't we
giving steroids to our military? And
there's a lot of complexities to that,
but sort of finally we kind of are, and
that's a really good thing.
>> We owe our warriors the absolute best
medical care in the world.
And this program delivers on that
obligation.
Taking care of your long-term health
means ensuring you remain strong,
resilient, and capable. Not just for
your next deployment, but for the rest
of your life.
So you can thrive long after you take
off the uniform.
>> This is really cool. It's super spot-on.
I'll say testosterone levels are not the
only thing that lets you thrive for a
long time after you're done with service
or even in service. I mean, promoting
healthy eating, promoting regular
exercise are also really good things.
The military does those substantially
already as well. Sometimes they're much
more voluntary than gets people really
participating, but adding testosterone
into the mix to make sure those levels
are normalized are is just a really good
stand-alone idea.
>> As we know, the modern battlefield is
brutal and unrelenting.
It requires and demands maximum
psychological and mental readiness.
And by addressing these health markers
early,
we're keeping you on the leading edge of
lethality and giving you the same level
of support that you give this nation,
the absolute best.
>> This is a tough one because
the upside of TRT for folks that need it
is they get a higher performance
and better health and all that good
stuff. The slight downside is that it's
another drug that your people have to
take when they're down range. And then
it adds to the logistics burden. Not a
ton, but it does. Having to require
maybe oral supplementation, which
doesn't work that well, but clean
needles,
the ability to clean an injection site,
shooting regularly at least once a week,
but probably more like twice a week if
not more, that can really be strained
when troops are forward deployed,
especially into a combat zone. They get
the guys ammo, they get them fuel, they
get them food. It's a workable problem,
but that's one of the many downsides of
this whole situation is that if you are
on TRT and you can't get access to
resupply for 2 weeks and you don't have
2 weeks of injection and stuff like
that, after 2 weeks you're going to feel
different. If it lasts more than 2
weeks, then it's like 4 weeks, which is
very unusual, but possible, you're going
to be kind of cycling off of T cold
turkey and you're going to feel real
bad. Decision-making, sleep, cognitive
performance, physical performance,
recovery, acuity, those are all going
down the drain. Motivation and morale go
down the drain. So, this is definitely
something to keep in mind.
>> Godspeed, keep going.
And God bless.
>> So, we've heard from the Secretary of
War, Pete Hegseth, on his opinions of
this testosterone program, but there are
some folks that disagree. Let's take a
look at what they're saying and see what
I think about it. Dr. Celine Gounder,
CBS News medical correspondent and
editor-at-large for public health at KFF
Health News said testosterone in the
normal range is not a performance drug.
For a man whose level is genuinely low,
replacement can help libido and mood a
little. It has not been shown to sharpen
thinking, fix fatigue, or make a healthy
30-year-old a better soldier. This is an
interesting take. There are elements of
it that are true. You can't exaggerate
the benefits of testosterone to be
unbelievable. And if your normal
testosterone, remember guys, the normal
range is roughly 300 to 900 ng/dL
as measured. If you're normally at 500
and TRT takes you to 550 or 600 or 650,
this uh young lady, Ms. Celine here, is
absolutely correct that it's just not
going to be any kind of thing that that
you're going to be able to go and say,
"Wow, I'm a ton better."
However,
let's peel apart the statement a little
bit and see if we get under the cracks
to make some sense of some things.
The quote here is testosterone in the
normal range is not a performance drug.
Well,
regular fuel in a car
is not performance fuel, but if you're
low on fuel, what your car is able to do
is substantially hampered. Hey, want to
go out 2 hours to go picnicking on the
lake? No, because we only have an hour
worth of fuel. But I thought fuel wasn't
some super range extender, it was just
regular fuel. Well, that's where the
crux is. You guys understand what I'm
trying to say?
If you don't have testosterone in the
normal range, if it's very abnormally
low, then testosterone in the normal
range is absolutely a performance drug
because your performance when you're in
the low range is on average going to be
substantially
worse. That's why people take steroids,
you guys. It's not total rocket science.
Then she says, "For man whose level is
genuinely low, replacement can help
libido and mood a little bit. For the
average person who has true
hypogonadism, low testicular production
of testosterone below 300 ng per
deciliter, then that isn't just a little
bit of help with libido and mood, it can
be substantial and is often substantial.
A little bit is for the lowest rung of
responders. For most people, it's a real
legit thing.
And
it hasn't been shown to sharpen thinking
to some crazy extent, fix fatigue,
whatever that means, or make a healthy
30-year-old a better soldier. But
mechanistically, based on what
testosterone does, and based on the
reports of what happens to people when
they start really low and get to normal
levels, is that proper testosterone in
your bloodstream absolutely sharpens
your thinking compared to the dullness
of low testosterone in many people. It
doesn't fix fatigue, but let me tell you
this, fatigue management, your ability
to recover from high levels of fatigue,
are absolutely linked to your
testosterone levels in a very serious
way. Again, people take steroids, aka
extra testosterone, because they help
you recover a ton. If you're starting at
150 ng per deciliter, way below that
bottom end, and we get you into the
700s, you will almost certainly recover
better. Is it going to fix your fatigue?
There's no magic sensu being for that
yet that we have, but it sure as shit
helps. And if a healthy 30-year-old has
a very low testosterone levels, and you
get them into the normal or high normal
range by a small margin on aggregate at
a very low price and at a benefit to the
rest of their health, by the way, they
will become a marginally better soldier,
because they'll be able to think clear,
they'll be better motivated, they'll be
more aggressive, they'll have higher
morale, they'll be able to recover from
fatigue a whole lot better, and because
TRT introduces test all the time into
your bloodstream, it keeps the test
levels very, very straight and very
narrow and very level, it can result in
consistent performance even if during
combat operations, everything else in
your life is being turned upside down.
So, no, it testosterone won't make you
some kind of super soldier, but it will
make you marginally better at war
fighting. And to be honest, guys, when
you're fighting war, the margins matter
a shit load. Also weighing in is Dr.
Marcus Gunclavis, who is the director of
the Homan Division of Endocrinology,
Diabetes, and Metabolism at NYU Langone
Health. Hey, Scott. Hey, Langone.
It's perfect.
Hey, over there by NYU, pussy good
people.
Anyway, all jokes aside,
this uh nice doctor said, "Quote, the
normal range for testosterone is 270 to
900 plus." Which is roughly correct.
"Putting people on that scale has no
link to how masculine they are
or feel or look.
Somebody could be normal at 350.
Somebody could be normal at 650. So, I
would say the statement is almost
correct. It has only a very small
relation to how masculine they are or
look or feel.
The average person, if you take their
testosterone levels, whatever they are,
and you replace them with 270, and you
monitor them for several months,
or you replace them with 900, and you
monitor them for several months, they're
going to have known real differences in
how masculine they are, how they feel,
and how they look. These won't be
enormous differences, and in some cases,
they'll barely be differences at all.
But on average, there are differences,
guys. It actually does matter if you
have very low borderline hypogonadal
testosterone levels and if you have very
high normal testosterone levels, that's
why people take TRT. That's why so many
people experience the benefits. And so
there's sometimes a little tiny bit of
exaggeration and pretend in some small
segments of the the medical community
which are kind of doing this 1980s
steroids don't do anything sort of thing
to say like, "Oh, well, you know, TRT
doesn't really do anything." And it
comes to a crux in just a minute. Let me
show you guys another quote from this
article which this young man was quoted.
He said that the therapy, TRT therapy,
testosterone replacement, is known to
increase the production of red blood
cells. If levels of the hormone rise too
high, that can result in an increased
risk of blood clots. These clots can go
on to cause pulmonary embolisms and
kidney injuries. So, here's the thing.
If you're going to say that TRT is
bioactive enough to do all of this red
blood cell enhancement, which it does,
and increase on the margins the risk for
blood clots and potentially pulmonary
embolisms and kidney injuries, which it
does, how are you going to at the same
time say, "Oh, but it doesn't do
anything at all for any other body
system, cognitive, muscular, endurance,
fatigue, recovery." So, are we back to
1988 where steroids are all bad and not
good? Are we just fucking lying to
people again? This is tier one nonsense.
Yes, TRT does absolutely increase your
propensity to overproduce red blood
cells in some small segment of
individuals. That's a real thing, which
is why constant monitoring of your blood
work can address those changes. The
degree from slightly more red blood
cells to pulmonary embolisms and kidney
injuries, these things are unbelievably
rare. They're real, but they're insanely
rare. If you're going to talk about how
rare these events are, why don't you
talk about the marginal improvements in
ability that testosterone replacement
for people who really need it also have.
I just don't understand how we can be
all negative or all positive. You got to
take the good with the bad. All right.
And Dr. Gownder says one more thing that
really jumped out at me. She says, "For
most men over 30, we don't have evidence
that finding and treating a low
testosterone number makes them
healthier, stronger, or more capable. We
do have evidence that it carries risk.
Launching a mass screening program
anyway isn't following the science."
So, we do have evidence that taking
someone from hypogonadal, which is the
purpose of this program, and taking them
into the high normal range, on average,
has an aggregate of benefits. That is
absolutely a real thing.
And apparently, again, we're at this
point where it's like it just it's just
downsides, but no upsides. If you talk
to real humans that have been on TRT and
been without TRT and really needed it,
they will almost all tell you it was
unbelievable life-changing thing. Is it
going to let you walk through walls and
eat tanks? No. Is it going to marginally
improve your ability to focus, be
determined, be physical, be aggressive,
and be well recovered, even in a really
stressful situation? Yes, it does have
those marginal benefits. So, this whole
idea of massive standard of evidence in
one direction and a couple of case
reports in the other is really gnarly.
It's just not doing anyone any good. And
I know news articles like this go out
and take strange opinions from folks
that are having a bad day and just
really biased, and most doctors don't
think this, but this is kind of classic
stuff that's just going to be looked
back at later, and it's just going to
age really poorly. It's age It's aging
already exactly as poorly as original
claims in the 1970s and 1980s. We told
athletes all the time that anabolic
steroids, there's no evidence that they
would improve muscularity or
performance, which just led people to
stop believing doctors as much, which is
terrible, because doctors, not idiots
like me, real medical doctors with a DO
or MD after the name, they are a massive
institution to be trusted, and takes
like this are not helping. So,
Dr. Gounder says something else, which I
kind of want to round out this episode
with.
She is claiming that
TRT prescriptions in the United States
have more than tripled, which is almost
certainly true.
And she said, "With many of those cases
involving men who were never properly
diagnosed." Many is doing a lot of work
there. Numerically, it's probably many.
Fractionally, I think the vast majority
of cases people actually get their tests
done with a doctor, and are properly
diagnosed with low testosterone, and
then prescribed testosterone. Dr.
Goncalves comes in and says something
that irked me a little bit. He said, "A
lot of the trend has been focused on
optimizing a normal body."
He said, "It seems like people are
taking it as a given that pushing your
levels higher and higher always leads to
a better result. And I think we have a
lot of examples in medicine where that
is not the case. So,
a lot of the trend has been focusing on
optimizing a normal body.
I'm sorry. There are bullets flying at
you. Do you want to be normal, or do you
want to be optimal? Do you want DJ
Shipley in the field doing his job, or
do you want my broad jump in the field
doing my job? I don't train for the
broad jump. I slacked off on the test. I
couldn't give a shit. You want me out in
the war? I sure don't. That's crazy. We
need optimized soldiers because every
life counts. Every decision counts.
Every stray bullet counts. And every
ability to be slightly more better at
your job, better at your job, absolutely
counts. In war, literal war, you guys.
This is what we're talking about. Sure,
TRT dad doesn't need a couple extra
milligrams to be able to pump mom out on
a Friday night when the kids are out
with the other kids at the mall, or
whatever the
But, for the love of God, these are
actual trained warriors we're talking
about. We want exactly optimization. And
then he says, it seems like people are
taking it as a given that pushing your
levels higher and higher always leads to
better results. I know a crap load of
people in the steroid community in
bodybuilding, and almost no one thinks
that more is always better. They think
more is on average going to have a
higher primary intended effect, and on
average have higher side effects, and
it's in the balance where you figure
that out. And then he says, I think we
have a lot of examples in medicine where
that's not the case. Well, of course
there are examples when you give someone
more of some drug and it actually has a
backwards effect on them. That happens
all the time. But we're beyond examples
and we're into statistical aggregations.
If you give a million people TRT, which
might happen in the army, what does the
average result show us? It's probably
going to show us that it's going to make
the average warrior, the average war
fighter, better at their job. And if we
find that's not the case, then with
proper blood work, their dose can be
either reduced or increased to get to a
testosterone dose that is optimized
because the assumption that the natural
amount of testosterone you have in your
body is the optimal amount for
performance is
dead on arrival. It falls flat on its
face. The human body did not evolve for
optimal integration into the US
military. It just didn't do that. With
TRT, and I'd say we should optimize a
whole
host of other variables, we can get our
soldiers better. Do you know why? Cuz
it's important how our fighters fight
for two reasons. One, we want to be
winning wars instead of losing them or
protracting them for longer. And two,
better fighters mean more people come
home alive.
I've been Doctor Mike. Shit gets under
my skin.
War fighters, thanks for keeping us
free.
See you guys next time.