Dr. Peter Attia

Yeah. Let's talk about the use of anabolic steroids. Let's talk about it more broadly with the three most commonly used approaches to testosterone replacement. The way I see it is the three most common approaches are using either clomiphene or enclomiphene, using HCG, or using exogenous testosterone in one of its derivatives. Would you agree that those are kind of the big three? Okay.

Yeah. Let's talk about the use of anabolic steroids. Let's talk about it more broadly with the three most commonly used approaches to testosterone replacement. The way I see it is the three most common approaches are using either clomiphene or enclomiphene, using HCG, or using exogenous testosterone in one of its derivatives. Would you agree that those are kind of the big three? Okay.

We'll just briefly highlight for everybody why each is a little bit different. Exogenous testosterone, you're just giving testosterone. The body senses it and immediately shuts down the hypothalamus.

We'll just briefly highlight for everybody why each is a little bit different. Exogenous testosterone, you're just giving testosterone. The body senses it and immediately shuts down the hypothalamus.

Yep. So LH and FSH will go to zero. Testosterone will be as high as you want it to be. There's no limit to how high it goes. I've had a couple of people on this podcast who have blown my mind with how much testosterone they've talked about taking. Not clear how that's possible, but nevertheless, they're doing it. HCG is synthetic luteinizing hormone.

Yep. So LH and FSH will go to zero. Testosterone will be as high as you want it to be. There's no limit to how high it goes. I've had a couple of people on this podcast who have blown my mind with how much testosterone they've talked about taking. Not clear how that's possible, but nevertheless, they're doing it. HCG is synthetic luteinizing hormone.

So you give a person HCG, they will make testosterone. So it's endogenously produced. But they're making so much of it that they'll also suppress LH and FSH. So LH and FSH will come down, testosterone will go up. And then clomiphene or enclomiphene block the signal of estrogen at the level of the hypothalamus. So the hypothalamus thinks- Doesn't see any. Oh my gosh, we need more testosterone.

So you give a person HCG, they will make testosterone. So it's endogenously produced. But they're making so much of it that they'll also suppress LH and FSH. So LH and FSH will come down, testosterone will go up. And then clomiphene or enclomiphene block the signal of estrogen at the level of the hypothalamus. So the hypothalamus thinks- Doesn't see any. Oh my gosh, we need more testosterone.

It ramps up FSH and LH production, which has the same effect as making more testosterone, but you'll now see high normal FSH and LH.

It ramps up FSH and LH production, which has the same effect as making more testosterone, but you'll now see high normal FSH and LH.

It's tightly regulated. So question one, if a guy is taking exogenous testosterone, and let's just say he's been on it now for a few months. Is he able to create sperm? 95% chance he's not. Wow. While he's on it. Yep, understood. But can he create it once he stops? And we'll definitely address that.

It's tightly regulated. So question one, if a guy is taking exogenous testosterone, and let's just say he's been on it now for a few months. Is he able to create sperm? 95% chance he's not. Wow. While he's on it. Yep, understood. But can he create it once he stops? And we'll definitely address that.

But just to be clear, even a couple of months on exogenous testosterone in any form, injection, topical, oral, whatever, You basically have shut off the ability to make sperm because your testes themselves have shut down. Right.

But just to be clear, even a couple of months on exogenous testosterone in any form, injection, topical, oral, whatever, You basically have shut off the ability to make sperm because your testes themselves have shut down. Right.

I don't want to go so far as to call it the marketing material, but for lack of a better term, the marketing material is suggestive that the more frequently delivered variants. So for example, the intranasal variant, which is delivered three times a day, the oral variant delivered twice a day.

I don't want to go so far as to call it the marketing material, but for lack of a better term, the marketing material is suggestive that the more frequently delivered variants. So for example, the intranasal variant, which is delivered three times a day, the oral variant delivered twice a day.

have less of a negative impact because they're producing far lower surges than if you did a weekly injection. Is that what you're referring to? Yeah, so they do more physiologic.

have less of a negative impact because they're producing far lower surges than if you did a weekly injection. Is that what you're referring to? Yeah, so they do more physiologic.

is too much. Yeah. So in your experience, has that borne out? Yeah. You've seen men taking Natesto three times a day, doing a nasal- Keeping their sperm count. Keeping their sperm counts. Okay. That's interesting to note. What about the oral testosterone, the twice a day? Love it.

is too much. Yeah. So in your experience, has that borne out? Yeah. You've seen men taking Natesto three times a day, doing a nasal- Keeping their sperm count. Keeping their sperm counts. Okay. That's interesting to note. What about the oral testosterone, the twice a day? Love it.