Transcription
Welcome to our Testosterone Crisis episode, Dr. Mittal. The testosterone crisis in India is not just in India, it is in the entire world. Can you identify a man by looking at him and say that he might have low testosterone levels? Not having facial hair, having very feminine skin, or the body structure not being like a man's, there is absolutely no masculinity. I have friends who are dealing with ED already. Erectile dysfunction at 32. These sexual dysfunctions. If you don't have the right hormones, then a healthy sex life cannot happen. Erections are always linked to testosterone levels. Is that true? Testosterone has a role in desire. If the desire for sex itself is decreasing. That is a typical example of testosterone. I have heard that the size of the penis also becomes smaller. Yes, it can definitely happen. Testes do not develop in it. Along with that, the penis also does not develop. Sir, if someone doesn't have money, then what about taking Shilajit and all these bio-preparations? Nothing happens. The fact is that I don't think any food stimulates testosterone. No, taking Viagra can cause hormonal profiles to fluctuate. Steroids are the truth of Bollywood. I see so many people. Rockstars and all supplements have stopped. Everything is shrunk. His wife is threatening to leave him and it happened. The divorce happened. There is a burning question. Are there any three activities that you can do at home to boost your own testosterone? Welcome Dr. Mittal to our Testosterone Crisis episode. The testosterone crisis in India, sir, the testosterone problem is not just in India, it is in the world, the entire world. Okay, and as people are living longer, aging is increasing, and metabolic conditions are also increasing, diabetes, obesity, all these, so the testosterone problem is also increasing. But I wouldn't say it's a crisis. I would definitely say that its recognition has increased now. Okay, if you don't mind me asking, roughly what is your age? 67. 60. Wow. Okay. You are very young. But what would be your birth year? Then, something in the 50s. 58. 58. Yes. When you were my age, and men of your generation were my age, do you believe that all your testosterone levels were a bit higher than ours? It's possible. But testosterone studies happened later. Especially in India. Overall, yes, there is a trend of decline. But it's not like you get a definite trend like you get in diabetes or weight. Do you think that every man needs to know about testosterone? And this is something we ignore as men? Some knowledge is definitely necessary. Testosterone is one of our primary hormones. Look, there are testosterone problems that are major problems, which occur even in young age. But one that is lifestyle, as you said, this changing trend, after 40 or 50, then some knowledge should be there that testosterone has importance in many things. Okay. What kind of knowledge should there be? It should be about what symptoms can be caused by testosterone. Low testosterone. What can be the symptoms of testosterone deficiency? So, by testosterone deficiency, we generally understand that it will just cause sexual dysfunction, right? Erectile dysfunction, infertility, all these things we think. But testosterone is much more than that. There are many such symptoms that we don't connect with testosterone and keep facing them, keep living with them. And sometimes, if an endocrinologist advises, then we realize that these were symptoms of testosterone deficiency. What are the common symptoms? The initial symptoms, the very early symptoms, are very non-specific, very general symptoms. Feeling a little tired, feeling a little weak, feeling that I can't work out as much as I used to, or why do I get tired during the day? Earlier I used to work until 8 PM, 9 PM. So, all these things are initial symptoms of testosterone deficiency. So, no one pays attention to this because these symptoms can be of anything. So, testosterone often doesn't come on the radar. Meaning, you are saying that things that an ordinary person considers to be due to aging. Is this the story, what is the relationship between aging and testosterone levels? This is very important because there is a natural decline, a little bit, testosterone levels decrease a little bit with age. But is it responsible for those symptoms, or has it reached a level that can bother us? You will only know this when you get tested. Okay. A slightly random question for you. Okay? You are a top endocrinologist. I am sure so many men have come to you for testosterone treatment. So, as a doctor, can you identify a man by looking at him and say, yes, he might have low testosterone levels? In a particular type of testosterone deficiency where the deficiency is more severe, whether in younger age or older age, it can be identified by looking at them. Not having facial hair. Difference in skin texture, having very feminine skin, or body habitus, the body structure not being like a man's. An hourglass figure, such a shape, meaning overall, there is absolutely no masculinity. So, those are severe cases. We diagnose them from our training period. This is testosterone deficiency. Get treatment, get tested, get treatment. They are not that mistaken. Because they are clearly visible, and your physician, a general physician, will also doubt it and will refer you further. The problem is the other one. The problem is where there are subtle manifestations. It is decreasing slowly, slowly. In that, it is not known. But such severe cases are known just by looking, even in young age. In that, you also have to do a genital examination and a complete examination. But it is also known from the face sometimes. I assume that in genital examination, the size of the testes is smaller. The size of the testes being smaller is a very important thing. We are talking about severe cases here. The size of other organs can also decrease. It depends on at what stage it started, what happened, how it happened. Look, boys are watching this. Yes. That's why we will talk openly. Yes. I have heard that the size of the penis also becomes smaller. Yes, it can definitely happen. That is, especially if it started in early life, then the development does not happen as well. Because it can happen in childhood. Testes do not develop in it. Along with that, the penis also does not develop. And in others, where there is severe deficiency later, there is some shrinkage of the penis and testes as well. Some boys are like that, who don't take care of their own weight. They drink cola all the time, etc., etc. They drink cold drinks. Those who are excessively overweight and have an hourglass shape. Those are likely candidates for low testosterone. Right? Obesity and fitness play a very important role in testosterone levels. If we, like people who are fit and exercise regularly, don't let their weight increase, like you. Then their testosterone should be fine in the normal course. If your waistline is large, if you have metabolic derangements, metabolic problems, cholesterol, diabetes, blood pressure, all these at a younger age, then your testosterone is also more likely to be low. So, the point you made, if your lifestyle is unhealthy, then if you eat high-fat, high-carbohydrate food, then obviously you will have a higher fat proportion. And if the fat proportion is higher, then your overall metabolism will be poor, and that also impacts testosterone. Okay. Effectively, you are saying that if you are facing obesity, it is possible that your testosterone levels might also be a bit low. It can definitely happen. And people who are overweight, obese, or suffering from diabetes have more than double the chances of low testosterone compared to the normal population. What about those who are very thin? Even after being thin, you can have testosterone problems. It's not necessary that you will be saved. But there are multiple factors in everything. Got it. I want to deviate slightly. Yes. Okay? I regularly do blood tests for myself. And I am quite serious about my health because I have faced surgeries at a young age. I had gall bladder stones. I was unhealthy. Because of that, I woke up at age 16 and have taken great care of my fitness since then. Overall, I am 32 years old now. When I look at the boys around me, there are two types of boys nowadays: one who is health-obsessed, and one who is not. And this difference is very visible. Those who are health-obsessed often have good careers, often look younger, and look stronger. And those who have not been serious about health, other problems are starting to accumulate. Aging is happening rapidly. Obviously, stamina is low. I have friends who are dealing with ED already. Erectile dysfunction at 32. So, there are two points in this, Ranveer. First, health awareness and the adjustments we can make in our normal lifestyle for it, we should make them. For example, if you are a medical student, you cannot have an ideal lifestyle because your working hours are so long, so you have to adjust. But there is a basic lifestyle: maintaining your weight, maintaining your diet, eating on time, and getting enough sleep. If we maintain these, then we are good enough. So, I don't want everyone to be obsessed with gymming about their health, but precaution, awareness is very important. One, the other group is those who are not aware at all. They don't know. If you start talking to them, that your weight is high, your health is deteriorating, then they think, what are they talking about? It will be seen later. It will be seen when it happens. When you are young, if someone explains anything like this, if you are not careful, you will have a heart attack soon. No one understands that. You have to say that if you are young and you don't follow this, then you will have problems in your career. You will have problems with promotion. You will have problems in your family life. In the next few years. You talk about 20 years later, and everyone thinks, that will be seen. It doesn't matter to us. Okay. I will present two or three points to the audience. The first point is that I will just talk about myself and my friends around. We take strength training very seriously. But when we say very seriously, we mean we do it three times a week, that too for 40-40 minutes. So, 40 minutes * 3 is about 120 minutes. Which is 2 hours of your whole week. I think it's easy for any man to do this. Do it on Saturday and Sunday, and one mid-week. And I think just doing this, 120 minutes of strength training, gives you a pathway for growth. Because then you automatically start becoming serious about your diet, etc. Apart from that, I do 10-15 minutes of stretching every day, and I focus on my sleep. These are my three lifestyle pillars. Otherwise, it's fine. Sometimes the diet is set, sometimes the diet is not set. I try my best. But the attempt is what matters. This is the first point. The second point is that there is a longevity guru, Bryan Johnson, an anti-aging guru. He often talks about testosterone. People have very polarizing opinions about him. But I believe that he is actually affecting the culture, and many people worldwide are now thinking about longevity and anti-aging. Conversations about testosterone have also become more mainstream. And the third point is that Bryan Johnson himself always links erections to testosterone levels. Is that true? It's not that direct a link. Okay? If you ask 10 people who come for erectile dysfunction, maybe two will have testosterone deficiency. Okay? Because psychology plays a very big role in my dysfunction. Psychological factors. You are stressed. Your relationship is not going well. Your work is not going well. Your sleep is not good. A lot of psychology. So, testosterone alone is not responsible. In fact, testosterone does not have that direct a role in erectile dysfunction. Testosterone has a role in desire. If the desire itself is decreasing. If the desire for sex itself is decreasing. That is a typical example of testosterone. But even in that, all these stresses can play a factor. They can affect it directly without going through the path of testosterone. But the difference made by people like Bryan Johnson and others is that the importance of testosterone for older men has come out a lot, and addressing it will be beneficial. It is not just a sexual benefit. It is for health. Would you say that if your testosterone levels are high, obviously sexual health is improving, but besides that, your energy levels are also improving? Anti-aging also improves. And what else happens? High. I am against the overuse of testosterone, which some people are trying to do, that testosterone is fine, yet the gym instructor said, take a shot. Without this, muscles won't build. Patients come daily who are troubled later, that now they want to quit but cannot quit. That is a separate story. But to maintain optimal testosterone levels, good levels, normal levels, if you take testosterone or if yours is maintained, then your fatigue will decrease. Most importantly, our muscles. See, after a certain age, the strength of our muscles decreases. That is a natural process. But if the role of low testosterone is also involved, if your testosterone has decreased from what it should be normally, then definitely if you take testosterone, you will improve your muscles, you will improve your risk of osteoporosis, meaning the bones that weaken with aging, if that is happening due to testosterone deficiency, then you can stop it or fix it to a great extent. Secondly, testosterone is also important for our blood. It is important for our blood cells. So, if testosterone is taken in excess, taking another example, blood hemoglobin increases a lot. That can be a problem. It affects our moods. Testosterone. This is a joke. This is not 100% science. But people joke that CEOs become aggressive by taking testosterone. They acquire more companies. They fire more people, they hire more people. They are more proactive. So, there is a connection between male hormones and, you know, aggression with testosterone, but not as much as people think. But if someone is in a position where aggression is very necessary and he is not able to cope up, he is not able to do his work, he feels that he no longer has the desire for anything, then he should definitely get it checked once. It is possible that he has reached a stage of evolution where he no longer feels the need. At what age should it be? So, I think after 50, there is no doubt. You should get it tested. If you feel any symptom like fatigue, this should be tested. Otherwise, in a normal health check-up, you are also getting testosterone done. Many people say it should be checked after 40. Especially in Indians, everything happens a bit faster. So, it's good to check above 40. If there are clear symptoms, then you will check even at 25. But then there is no age. Clear symptoms of 20s. Low testosterone is... you said little feminine looking skin and lack of facial hair. And small testes and all that. That is, then it is clear. That is classic. I don't think that is missed. Because someone in the family or friends will notice it, or they will say, something is wrong. Go and get it checked. Or you should notice it yourself. Or the best is that. But I think if you feel that you are experiencing unexplained fatigue, then what are the reasons? Look, other than psychological stress and actual physical stress where you are not sleeping at all, or you are spending four hours commuting every day, then how can someone perform properly? Apart from that, there can be deficiencies in the body. It's not just testosterone. Your Vitamin D might be very low. B12 might be very low. Your protein intake might not be sufficient. All these factors are there. Iron deficiency, low hemoglobin. So, all these factors are there. There might be a thyroid problem. So, all these factors are there. We will break down each of these because we are going to have a whole section on diet. But what you said, if the size of the testes is small in the 20s, then please go and get checked. Yes. The question is for you. And please don't mind my language and directness. But what is the correct size of the balls? I mean, it's difficult for someone to just assess like that. You have to. Yes, there is a lot of variation, but above 12-15 ml volume, everything is good. So, you can measure its size. If you have doubts, look, if you try to correlate all testosterone deficiency just by the size of the balls, you will get troubled. It's not practical. Would you say, would you say that a big grape and a raisin? Yes, that's obvious. That's obvious. That's obvious. But does it shrink to the size of a raisin? No, normally it shrinks that much in those who have deficiency from childhood. They don't develop. They don't develop. And if it's because of lifestyle that you have got low testosterone, then the balls will shrink. Then how small they will be, you won't know. Judging it by the shrinkage of the balls is very difficult. It is difficult even for doctors. So, how can you do it yourself? Wow. Okay. Okay. Another question. My own muscle mass is fine, I think, and I feel I am relatively strong in the gym for my age. But I don't get much facial hair. My father also doesn't get it, my uncle also doesn't get it. And I am pretty sure my facial hair genetics are genetic. Yes. So, does this mean that lack of facial hair is also linked to low testosterone, or vice versa? So, good question, and I was going to say that. So, you asked the question: facial hair, body hair have a lot of role of genes. Yes. Now, if someone is from Western Punjab and someone is from the Northeast, their facial hair will be different, right? So, genes have to be considered. If you come from a family or an ethnic group where facial hair is less, then you judge it like that. You don't take it straight away that your facial hair is less. Okay? Beard has less to do with testosterone. If there is nothing like that in your family and your hair growth is less, then you should definitely ask a doctor. Meaning, if your father and uncle have beards and you don't, then you should definitely ask once, talk about it, and it is a common symptom. Like that, you come across guys with low so.
This is all the same, Ranveer. These are all signs of severe deficiency. That is the thing, that is the issue. I am saying that severe deficiency is not that misdiagnosed. The change that has happened in the understanding of testosterone, which research has shown, is that even after these things seem normal, people can have testosterone deficiency. Which only becomes apparent through fatigue, lethargy, lack of muscle power, very low energy drive, reduced sexual drive, and fewer erections. What has happened to me? So if that is the case, testosterone should also be checked. So if we are talking about those symptoms, the clear-cut symptoms I mentioned, they will be quite apparent and someone will tell you, or you will notice yourself. They will not be ignored. They are not subtle. Catching subtle signs, that is the key. There is a burning question. This is a question that many men want to know, and I don't know how you will answer it, but let's try. Are there three activities that you can do at home to boost your own testosterone? Like you mentioned, do some aerobics, some strength training. 40 minutes thrice a day is very good. And don't let your fat increase. Body fat. You have to fight for your health. You have to fight to keep your health in order, which includes lower body fat, better muscle mass. That's all you can do. And sleep should be sufficient. That's what you should do. Okay, you don't have to be boring. You can indulge once in a while. But ensure your protein intake. Extra protein is not that necessary unless you are doing very vigorous workouts. But protein intake is a big problem in India. And from a normal diet, especially if you are strictly vegetarian, you should discuss protein sources with your nutritionist or doctor. I want to briefly talk about vegetarian and non-vegetarian food with respect to testosterone. But it's not like if you only eat non-vegetarian food, your testosterone will be high. I also believe that in today's non-vegetarian food, the animals that are slaughtered are often given steroid injections, hormonal injections. Obviously, those hormones are entering our bodies through their flesh. Does that play any role in affecting our hormonal profiles? So theoretically, yes, this is a concern worldwide, particularly in India, where it is sometimes difficult to regulate. Especially at the periphery, what is being given to the animals whose meat you are consuming is not clear at times. So it will have some effect on our bodies. Let's break down this entire question into two sections. Okay? First, tell me about a person who is purely vegetarian, then a person who eats quite a lot of non-vegetarian food, eating eggs, chicken, fish, mutton every day. And a third person who is sort of non-vegetarian, eating non-vegetarian food once or twice a week. Can you break down their testosterone profiles? It depends on too many other factors. But their direct correlation is with your overall protein intake. Our protein intakes are often insufficient. That's why in such a large country, we don't produce that many athletes. We should be doing that. We are doing a lot now compared to before, but still, the numbers are not that high. The reason for that is that our protein intakes are not that good across the system. And often people take offense. How can you say our diets, our grandfather's diet, father's diet were different. Theirs might have been different. According to today's environment, our protein intakes should be higher. At least 1 gram per kilogram. Very few of us will be taking 1 gram per kilogram. It's very difficult to achieve unless you are making a conscious effort. Our diet is carbohydrate-based. Because when civilizations are developing, societies are developing, where there has been deprivation for centuries, starvation has been there. So you have to feed a population. To feed a population, you cannot bank on non-vegetarian food. You need grains, cereals, so that everyone's starvation ends, there is no famine. So the effort made here, the green revolution happened so well, everything happened, with that, grains, wheat, and rice became our main grains. So our starvation reduced a lot, everyone started getting calories, for survival. But protein is not obtained from that. And our diets are mainly carbohydrate-based diets, which were intended for survival. And now you are talking about longevity. Now you are talking about testosterone, muscle mass. So if we continue with such pure low-protein diets, how will muscle development happen, and how will we become world-competitive athletes? It will be a challenge. So that is the main thing. You know, I have spoken to many doctors on the show. I have spoken to many dietitians on the show. I have learned that both non-vegetarian and vegetarian diets have their own challenges. The challenge with non-vegetarian is what we discussed. The vegetarian side of challenges is, I think, a lot of misinformation has spread in vegetarian circles that, oh, eat a bowl of lentils. That's your protein intake for the day. That's not true. In that one bowl of lentils, you are getting only two or three grams of protein. If you eat a bowl of paneer, that's at least say, 10, 12, 13. So ideally, every vegetarian in our country should be having paneer, tofu, etc., every day, or protein shakes, I believe. But we can't change the diet of the whole country. Look, changing diet is the biggest challenge, and it also has two parts. One part is economics. If healthy, protein-rich food is expensive compared to unhealthy fried food and Coke, Pepsi, or any cola, then naturally the population will gravitate towards it. Because economics is very important. Second is, whatever a person eats in their family from childhood, that's how their taste gets tuned. So behavioral change worldwide for diets is incredibly hard. I mean, it is very, very difficult. Some people can do it. You know, the problem in this is that you will have one Instagram influencer. They did an experiment on themselves, and everyone became a champion. They did well. They might be motivated. I have many patients like that. But if I look at the group of patients, how many can do that? Very few. So we need practical solutions. Therefore, vegetarian or non-vegetarian is up to a person. But the point you made is very valid and everyone should listen to it: if you are on a vegetarian diet, then definitely there are only two or three major sources of protein in vegetarian diets. Number one is dairy. Dairy is the main source of protein in vegetarian diets. Then beans and legumes, which are not that great, but they are good. You cannot consider just lentils in that way. Take soybeans, especially if you take them separately, it is beneficial. Nuts are also a good source. Nuts, especially almonds and walnuts. They are good sources of protein. But how much can you eat? You will eat just a handful. I am taking advantage of the fact that an endocrinologist is sitting in front of me. So tell me, sir, if I, as a vegetarian, eat tofu every day or soy chunks every day, will my estrogen increase? That can be an issue, with very minor. Very minor. Would you say it's safe? It's absolutely safe. I mean, there are populations that eat only that, like Japan, etc. Yes, yes. But look, there is a principle in medicine, and especially in endocrinology, that nothing should be in excess. I'll give an example. I had a patient who became vegetarian. Before that, he was non-vegetarian. Very fit, very, very fit. Like, couldn't be fitter. So he decided, I will now do this. Next time he came, his phosphorus was so high. What happened? He said, doctor, tell me what's wrong. He was eating only nuts, almonds and walnuts, from morning till night. So you have to balance it out. You have to. All the time he was eating that. He was still good, but his phosphorus and other things were all over the place. So, therefore, there should be balance in everything. You can eat tofu in both meals. No problem. It's okay. I believe that if we are looking for protein sources for the population, if you are an "eggetarian," as they say, vegetarian who eats eggs, that is the best possibility. Eating eggs is practical. This is what a top endocrinologist in India is saying. 100%. If you want to eliminate protein malnutrition from our children, if you want everyone's protein intake to be adequate, good, their muscles to develop, growth to happen, if vegetarians are willing to take eggs, then eggs can be a very good source. Of course, if there is a religious reason, that's a different matter. You have to then compensate if everyone has their own beliefs, faith. I am not saying that. But if that is not the case, then eggs are a good source of protein for our growing children, especially. Or as a podcast host, I would also say that almost every doctor has said the same thing on the show, and every dietitian too, that at least you should eat eggs. Absolutely, you should. If possible, if it's allowed by your family and faith, you should have eggs. If it's not allowed, if you are pure vegetarian, then as I said, take dairy, and with dairy, take tofu or these things. There is another category, that is vegan. South Mumbai, South Delhi. I am not saying anything against vegan diets. Again, everyone's choice, whatever they want to take. But protein has to be looked at separately. Where will good calcium come from? You have to take soy milk with added calcium. You can take soy milk. The regular Indians, the majority of vegans don't tolerate soy milk. They don't like the taste. You have to add calcium. If you take almond milk, then something else is added. It is fortified. Soy milk is fortified with calcium. Almond milk is sometimes fortified with protein too. Yes. So if you take these directly, it cannot match up to dairy. But with dairy, some people have intolerance, that's a different matter. So would you say that if someone is absolutely determined to be vegan, then perhaps taking supplements becomes even more important? Then, I think, there aren't many choices left. It's very difficult. Either everything has to be fortified, like in foreign countries, where soy milk has calcium added, almond milk has some protein added. If you combine all that, then it might be possible. But to be strictly vegan, it will be a bit difficult to meet the protein requirement. Look, we are talking about testosterone here, but as an endocrinologist, I am sure you see all types of hormonal problems. Do you see a lot of vegans visiting you? You have already answered that yourself. Where do I practice? South Delhi? Okay. So, but these people who follow veganism, one by one. Everyone has their own choice. They, I don't want to food shame anyone. Food shame is the worst. Absolutely not. Don't food shame vegans either. Don't food shame non-vegetarians either. To each their own. But just tell me, what are the hormonal problems of vegans then? So vegans won't have direct hormonal problems. If, you know, the very smart vegans will compensate for everything. It's not a cheap diet to be on. My advice is that if you are so determined, then definitely talk to a nutritionist once, so that my entire intake is balanced. Nutrients are balanced. My own question, unrelated to testosterone. You are basically a hormone nerd. You love hormones, right? I am a biology nerd. I enjoy biology. Yes. You specifically enjoy the subject of hormones. Yes. What are the coolest hormones in the body? So you think, wow, this is absolutely magic. Cool or magic are different. If there are two answers, give two answers. Cool is like testosterone. What can be the coolest? Because you know it, it does things to you which probably no other hormone can do. But magic is cortisol. Magic? Cortisol. I thought cortisol was the villain hormone. No, that's the point. What? Cortisol is a life-saving hormone. Okay. Okay. One minute. There's a slight context. Yes. Almost every YouTube video says, please ensure your cortisol levels are not high throughout the day, etc. And there is something called baseline cortisol. Meaning, at rest, what are your cortisol levels? Like, for example, right now we are not working out. What will be the baseline cortisol level? So ideally, if it's lower, it's supposed to be better. This is my understanding. Please correct me if I am wrong. No, everything has a normal range. Cortisol is a life-saving hormone. It is not for making us what we are. The energy we feel when we wake up in the morning, start working. If there is no cortisol, you are gone. Look at cortisol deficient patients, how bad their condition is. What happens? Extreme weakness, no appetite, they slowly waste away, their weight decreases. Okay. So cortisol deficiency is a disease. So cortisol is very important. But hormones always have nuances. So if you are overstressed all the time, yes. And if your cortisol is elevated all the time, then it will harm the body. You have seen medicine. Cortisol is also cortisol, isn't it? So cortisol is also a life-saving medicine. Go to any ICU, everyone will be getting cortisol. But if everyone starts taking it, it has many side effects. So, therefore, cortisol is the most important hormone that gives us energy and gives us the capacity to deal with stress. If cortisol levels are low, you cannot run a physical stress marathon, or anything. Why? What will happen? Because when our body utilizes energy or is under physical stress, we have an adrenal gland. There is a gland above the kidneys that secretes cortisol. Cortisol gives us stress-fighting capability. It is a stress hormone. So normal stress also exists, right? We don't have normal stress-fighting capability, which we take for granted. And those who say this have directly correlated stress with cortisol, that if you do more, your cortisol level will remain high, your stress in the body will remain high. It is not necessary that it will always translate into cortisol levels. It's not that simple. So high stress is not always equal to high cortisol levels. High stress will equal high cortisol levels at that point. Definitely. Okay. But it does not mean that your cortisol level will be high. Supposing you measure cortisol levels around 24 hours for somebody. Yes. High stress, if it is that kind of stress where someone is very ill, their body is under constant stress, they are in the ICU. We say that everyone's cortisol levels are high in the ICU. But the day-to-day stress we consider, the stress of work and life, does it actually make a difference in measurable cortisol levels? It's not like that. Okay? It's not that simple. Loosely, I understand that every hormone has a certain amount in the body. If the amount of that hormone decreases, that can be a problem. If it increases, that can also be a problem. Absolutely. Do you mind me asking you all these questions? No, please. The question for you is, do you believe that meditation can change hormonal profiles? Logically, it should make a difference. Explain the logic. Logically, if you reduce your stress levels, the fluctuations in hormones will decrease. There will be more stability. There will be more, I mean, it's the same thing as you get with peace. When you are peaceful, your hormones are a little bit different. When you are agitated, your hormones are different. So, naturally, there will be some difference. Yes. As a health nerd, I'll tell you something I've discovered. When I sit for meditation, sometimes it takes me a little bit of duration to slip into a deeper state. Now, from the perspective of my consciousness, it's a deeper state. Actually, what is happening? It's kind of like sleeping, but it's not sleeping. Meaning, I am not falling asleep. I know I am meditating, but I go somewhere from consciousness. Now, when I look at these heart waves in my Whoop, it is very similar to the heart waves of restorative sleep, where stress levels drop completely. And like there is the concept of intermittent fasting, that if you don't put anything in your stomach for a long time, then your digestive system gets a break. Similarly, I believe that the brain also gets a break, and in that break, some kind of healing happens. That's what I believe. Could this be a reason that your hormonal system benefits from meditation? That it's just getting a break? See, it's absolutely possible. You are absolutely right. It can happen. Absolutely. One important point here is a hormone we haven't talked about, and that is adrenaline. Yes, catecholamines. What you described about the heart rate coming down and all that is directly linked to that. Less adrenaline in the bloodstream. Yes, because it is released from the brain. No, it is released from the hormone gland, from the adrenal gland, from where cortisol is. Right next to it, a part of the same gland releases adrenaline. So, what happens with adrenaline? That it is an acute response. Cortisol is a slightly slower response. So if a tiger appears in front of you, your adrenaline level will skyrocket. If someone points a gun at you on the street, the level will be very high, a sharp rise. Studies have shown that when surgeons are operating on complex cases, adrenaline levels really, really go up, and then it sharply comes down. At that time, when adrenaline increases, your heart rate will increase. Your breathing rate will increase. Adrenaline has all these actions. So managing adrenaline also, with lifestyle, with this kind of meditation, you are doing very well, because when you reduce that variability, with whatever it is, it will be a calm process, and you will have a better life. From a hormonal perspective, I will try to summarize what you just said. Okay? So, I am sitting here in front of India's top endocrinologist. But you have also explained life. You are basically saying that every hormone has a certain amount in your blood. You have to maintain that amount. If you are on the higher side, don't be too high. The base of all energy, whatever you are trying to do in life, especially for men, is testosterone. Maintain testosterone levels. Along with that, also remember that if you have too much adrenaline and cortisol in your blood, that is also a bad thing. It has bad effects. So try to keep them low, and how to keep them low, perhaps through meditation, brain exercises, or by spending time with family and friends. That's all. Absolutely correct. Absolutely correct. Okay. So you are also saying that people who are overambitious, who are obsessive, who take a lot of stress, their adrenaline and cortisol levels are often a little bit...
They are high. Which is a pandemic for an entire generation in many ways right now. Stress levels have increased a lot. Therefore, mental health issues have increased. You would say that these things lead to a lot of other lifestyle problems, lifestyle diseases? Absolutely. See, ultimately, at one level, our hormones control everything everywhere. There are different hormones in the brain everywhere. There are different hormones in the heart. The kidney produces different hormones. So, earlier we used to think that hormones were only those that are formed from, as many viewers might think, those six or seven glands. The meaning of hormone was that whatever is produced somewhere, its action happens far from that place. Yes. So this is an important example. Like thyroid, everyone knows. It's an endocrine organ, you mentioned pituitary. I talked about adrenal, we are talking about testes. These are all glands. Endocrine glands. They were also called ductless glands at one time. Like when we used to study, ductless, ductless, meaning they don't have ducts. There was no tube, there was no pipe. They were releasing their products into the bloodstream. Okay? And the action was geographically in a different place. So thyroid hormone was released from the thyroid, and it was acting on the heart. Thyroid hormone released from the thyroid was acting on the muscles, on the bones. So that's why it was called endocrine, which are formed inside, and hormones mean those that have an action far from that side of origin within the body. Right? But that understanding has changed a lot. The understanding now is that at a micro level, every tissue has hormones inside that regulate it. So the understanding has become very different. Meaning, testosterone doesn't just come out of the balls. It only comes out of the balls. But small amounts of testosterone may be produced at other places not measured in the blood. We take blood measurements as sacrosanct. But my level is fine. That does not mean. Some people may have, as you said, less. Testosterone is the main thing that contributes to hair growth continuously. Testosterone, but their testosterone can be very good, so the local conversion of testosterone to another hormone, dihydrotestosterone, makes a difference. Testosterone is locally converted to estrogen in the tissue as well. It is produced from the testes, but it gets converted to estrogen. So because of that, boys get breasts. So local conversion of hormones, local action has been much better understood now than it used to be. Okay. Let's talk about man boobs. It is a very common problem, especially in teenage boys, because it is an insecurity for many young boys. There is a condition called gynecomastia. Where if you touch the nipple, there is pain. That is the symptom of actual gynecomastia, for which you might need surgery. But this happens in very few boys. The problem of normal teenage man boobs happens in many boys. It is effectively because during your teenage years, your hormone levels are all over the place. Right? So, as puberty starts in boys, testosterone production begins. Now, along with testosterone production, there is also a little bit of estrogen, and testosterone also gets converted to estrogen. In teenage years or throughout life? It doesn't happen, but at that time, the tissues are very sensitive to those hormones. At that time, when it goes up suddenly, you are at one level, and then it goes like this, and then it stays like this. So in that period, when it is increasing, estrogen production also happens, and local estrogen is also formed. At that time, you are saying that testosterone levels are very high in teenage years, meaning they are not higher than what they are, but they rise, right? Yes, the rise from pre-teen. Okay, okay. So estrogen also increases. So local production is a later thing, but the estrogen level itself is increased. The body gets shocked. So as much as testosterone increases, estrogen also increases. Similarly, through peripheral conversion, when you give testosterone injections to someone, estrogen also increases a little. So there is conversion. So one is that estrogen increases like this, then there is conversion of testosterone. When this happens, it is not predictable that some boys develop small breasts during puberty growth. Often it is very nominal and it goes away. But if it is beyond a certain stage, it doesn't go away, and especially in people who are overweight, obese, fat also accumulates there. So there is a little glandular tissue, a little fat. So both things together produce breast development. Sometimes it becomes so much that children get worried. So it is a combination of male and female hormone action that produces that. Let's take the case of normal boys. Guys who are not very overweight and who don't have a hormonal problem, but still are facing man boobs. At what age can they expect things to normalize? So after the entire puberty is over, after the teenage years are over, it should normalize. By 21-22. If it is still there at that time, and if it is significant and visible, then you should consult a doctor once. Yes, in that also, 90% will turn out to be nothing abnormal, but in some percentage, some actual hormonal problem might be found that is persisting. So what should the rest do, who have it and it is persisting, and who are otherwise normal? There are some medicines, but none are very satisfactory. If it is too much, then you have to get it fixed by talking to a plastic surgeon. In most people, it gets resolved. In a very small percentage, some disease is found that needs treatment. But there is still a chunk of people whose condition is normal, otherwise healthy, but that breast development, those breasts that have formed, are not going away. Firstly, do not consider it a disease. Yes, yes. It is not an uncommon thing. Talk to a doctor. If it is really bothering you a lot, then get it removed. Yes, yes. I would like to say a few things to the brothers. Please do. First, listen to the doctor's advice. Second, whatever the problem, even if it is actual gynecomastia due to some reason, everything can be solved. Everything can be solved. I have some friends who, even at the age of 27-28, had no problem according to me, but according to them, they were a little sensitive about the size of their nipples. They felt embarrassed that, "Oh, I can't wear tight t-shirts." So they got plastic surgery for their nipples. And it's become a common thing for guys, especially in Mumbai, Delhi, etc. So chill out. Second, wait for that age, 21-22. Often the problem resolves on its own. If you know that your fat level is a bit high, work on it from now. It's good. I made a small mistake when I was facing the same problem. I thought, "Okay, I'll reduce fat." I reduced fat and started doing a lot of push-ups, and it actually helped my chest. But the issue is, I didn't do back exercises. My posture got bad because the shoulders were getting pulled in front. It's a very common mistake. And obviously, because you are obviously insecure about the chest area, you start doing things like this. So it ruins your posture, and posture problems are then visible later, around age 30. So just avoid all these things and chill out. Meaning, having some breast development in essence, during puberty, growing age, teenage years, which is called, is not a big deal. Yes. And in 99% of people, it is not an indication of any disease. We should take it normally, it will resolve on its own, and if it doesn't, it can be treated. There is no need to stress about it. Okay, moving on. Does a healthy sex life have an impact on the hormonal profile, or an unhealthy sex life? No, see, a healthy sex life, or sex life in general, has an impact on hormones, or hormones have an impact on sex. Both. So a healthy sex life has as much impact on hormones as a good lifestyle does. If you have a healthy sex life, you will have more peace, more emotional relaxation, more physical relaxation, more happy hormones. So you are good. That's all. It will not increase your hormones. Okay? If you don't have the right hormones, then a healthy sex life cannot happen. If you are genuinely testosterone deficient, then how can there be a healthy sex life? It's impossible. But obviously, your testosterone levels won't drop overnight. They will drop gradually, right? They will drop gradually. Would you say that weaker erections are a sign of declining testosterone? The first impact of testosterone is on the desire. Not thinking about sex. Or rather, the desire itself is gone. You used to be with your partner three times a week. Let's say now you don't even think about it in a month. Rather than the process of erection, in which many other things, local hormones also are involved, prostaglandins, etc., and blood flow is very important. Vascular diseases, many things. Nerves are important. But the desire itself reducing, that is the first feature of testosterone deficiency. At what age does this often happen? It can happen at any age, but it can happen after 40. Is it almost a guarantee? After 40? No, not a guarantee at all. Okay. Or not at all. So there is some, see, everything depends on the overall picture. Because testosterone will decrease a little after 50, it will happen a little, but it doesn't happen like that. And generally, after 60, a clear decline is seen in testosterone. So roughly 20% of people over 60 will have low testosterone. But that may not mean anything much. 20% is a very large number. So many of them might not need testosterone. But it has gone down to a level where you may consider it. So the treatment given for testosterone, when treatment is given, it is not based solely on symptoms. It is based on blood levels of testosterone. So you have to have all of them. Suppose someone's blood levels are low. They have nothing else. Then nothing is given. We say, "Observe, let's see." But if there are also testosterone-related symptoms and the level is also low, when both things happen, then testosterone is given. So the benefit in that is that all these things can be reversed. Yes. If you have these symptoms, then you should definitely get your testosterone level checked. There are many caveats in that too. It's not that easy to get testosterone levels checked and interpret the results. Here you are giving guidance for blood tests. I am giving guidance for blood tests. Okay. Explain it from the very basics. What is this blood test guidance? See, you will do a normal blood test anyway if you are doing one, like blood sugar, cholesterol, etc. So you will give a fasting sample. Venous sample. For testosterone, there are specific instructions. Number one is that it should be a fasting sample and between 8 am. We tell the patient 8 am, it can be 8:15, 8:30, but not more than that. So it is very important because hormones like cortisol, like testosterone, decline rapidly in the body. So number one. Number two, the measurement technique for testosterone has undergone so many improvements and so many changes. It's unbelievable that the testosterone levels we were doing 10 years ago could sometimes mislead us. So constant research is still happening on it, and progressively, the methods have become better. So there is a method called LC-MS/MS, a technical term, tandem mass spectrometry. So if it is done using that method, you will get accurate results. So you have to check with your lab whether they are using the LC-MS/MS method or not. Wow. What is its price? Testosterone level measurement with this technique is not very cheap. It will be between 1000 to 2000. And should it be done once a year? If everything is normal, then nothing needs to be done at all? No, get tested. What is the healthy range? Above 300. If it is below 300, twice, they don't consider it in one go. Yes, yes, yes. Then the doctor might tell you something to do further. What is the unhealthy high range? Above 1000. Above 1000? Yes, people consider up to 1100 as well, there's no such thing. There is no unhealthy high range for testosterone. Unhealthy high range for testosterone means either you are taking testosterone from outside, or you have a testosterone-producing tumor, which is a very rare thing. So don't even go there. Unnecessarily people will get stressed. I think it's not that people don't get bothered by this. It's very important. It says your level is 400, and your friend's is 800, so you are not inferior to him. Brother, tissue responsiveness varies for everyone. So responsiveness can differ for the same level. If you are normal, healthy, have no problems, no extra fatigue, nothing, then don't worry about your testosterone levels. Okay sir, we have almost reached the end of this podcast. You highlighted some supplements a while ago. I think you spoke about Vitamin D and B12, if I am not mistaken. What should a supplement stack for an aging male look like, other than protein shakes? So you have asked my absolute favorite question. Sure, because I struggle with supplements all day. Okay. Those who should take them don't, and those who shouldn't take them take them excessively. So, not just from the perspective of testosterone, but what supplements are necessary for the Indian population for their health? Then everything will improve on its own. Yes. So the most common deficiency in India is Vitamin D. I have been involved with Vitamin D for 30 years, 35 years, in its research. What does Vitamin D do in the body? Why is Vitamin D important in the body? Because if there is no Vitamin D, calcium will not reach our bones. Number two, Vitamin D comes from sunlight. It is not in the diet. At all, minimally. Negligible. It's a little in eggs, a little in some kind of fish eaten in Finland etc., but not here. Okay. Plus, the biggest thing after this is that even where people go, the pollution is so much. Yes, yes. Because of pollution, our studies have shown that it gets scattered. The UV rays don't reach the skin. So anyway. So Vitamin D deficiency is common, but it's not a panic situation. I just want to say one line about Vitamin D supplementation. Low-dose daily supplementation is better than high-dose injections and supplements that are taken frequently. A big challenge in our country. Gross misuse. Exactly what was said, everything has a normal band, stay within that. So if you are taking 1000 to 2000 units of Vitamin D daily, and besides that, you are not taking anything weekly or monthly, then you will not have Vitamin D deficiency. Everyone should take it. Well, at least those who are leading an urban lifestyle. Meaning, if you live in cities, then you should take Vitamin D supplements. It's better. Definitely better for the elderly. Where it is very necessary for bones, for growing children, whose bones are forming. I would say it's good for young adults to take it too. But the dose should be this. Is there anything like excess of Vitamin D? Yes. That's why I'm telling you this. The injections you take, 1000 to 2000, are 6 lakh units. 6 lakh units? Yes. It's available at the chemist. Easily. And is it expensive? No. Sustainable. It can be sold. Okay. Two, three types. Meaning, not expensive. Not expensive at all. Okay. And not much difference in the brands. Now, I can't say this confidently, but generally, this is not a very difficult thing. So there shouldn't be much difficulty in brands. But this, this understanding, I will use this opportunity to give this message. We should take Vitamin D. Especially in the winter. Because in winter, the UV rays completely disappear. I'm talking about Delhi. They completely disappear. Yes, yes, yes. And low dose and daily. Got it. Any time of the day or does it matter? Because the Vitamin D that is formed in sunlight is formed around 12-1 pm. So who goes out in the sun at 12-1 pm? That's one thing. Second, the common deficiency is B12. B12 mostly has non-vegetarian sources. Some green vegetables, dark green vegetables also have it. Eggs? Eggs also have a little. Not much. Not too much. So the actual muscle of the animal. So, so yes. So there's a bit of an issue with B12. What does B12 do in the body? B12 is important for nerves. Most of all, nerves. If there is B12 deficiency, neuropathy and all that happens. Nerves, meaning if the deficiency is very severe, it can affect the brain and the blood. It can do many things. Okay. And is it a tablet or an injection? You should take a tablet. In this too, if you want to take it, take a multivitamin that has a little bit of B. The problem with B is also this. People are taking very high doses. Yes, 1500 micrograms or so. That's only for those who have a clinical problem. Otherwise, low-dose B12 is good. So effectively, anyone who is vegetarian, everyone should take it. There's a chance your B12 is low. Very high chances. Very high. So if you take a multivitamin-level B12, it won't harm you. It will only benefit you. So as an endocrinologist, you say that one should take a multivitamin every day? If you really want to be sure, check your levels. But in general, when you are asking which deficiencies are common, then those that you need to pay special attention to, because people are taking many supplements, and you don't know why they are taking them. So attention needs to be paid to D, to B12, and in India, there is often an issue with iron levels. So these three are the most common, other than protein, as you said, these are deficiencies. Yes. You know, there's something called the domino effect. You know those videos where one plate falls, and then everything falls. Effectively, today we have created a men's aging guide. I would like to ask you, sir, is there anything like testosterone-boosting foods? This is also a question asked daily. Meaning, to my knowledge, there isn't anything that really increases the level. Okay. People use a lot of things. This is a very big market. A whole huge market. I am dismissing it like this, but the fact is that I really don't think any food stimulates testosterone really directly. No. Let me tell you something random. In Bombay, for non-vegetarians, there is a culture of offal. Do you know offal? In chicken and mutton, you eat muscles. In offal, you eat organs. Kidneys. Okay. Okay. Yes, yes. So kidneys, liver, and kidneys. Yes, heart. One thing people say is that eating organ meat increases power. I don't know what it is. Probably actually linked to Vitamin D and B12 more. Meaning, how much iron will you get if you eat liver? A lot of iron. I think from organ meat, all that B12, D, iron, all that. But I'm not kidding about this. In Mumbai, goat balls are also eaten. It's a very common thing. And it's an urban legend that if goats, goat balls, could that be a testosterone booster? So if you are having testosterone directly, see, this has been tried from Roman and Greek times, eating testicles of animals to promote your vitality. This is a very old thing. Yes, yes.
I am not sure if it actually contains actual testosterone. I will have to check that. I don't know. But as far as because you can use testosterone extract from animals. But how much will go from eating actual testicles, I am not sure. But traditionally it has always been there in history. There was masculinity. For warriors, it was for them, you know, and most importantly, warriors, okay. Most people are troubled for sex drive. Yes. So they feel that it will help them. So as for foods, I, yes, yes, taking Viagra can cause hormonal profiles to go up and down. No, Viagra and testosterone combination is the thing that we use for people who are suffering. Okay, testosterone will increase your drive. Viagra will increase blood flow. They work in different ways. Okay, especially in the West, among white people, this has become a very common conversation. It's about TRT. Yes, testosterone replacement therapy. Yes, which actually, if there is a problem of low testosterone in someone's body. Yes, then I think there is a need to take TRT. But a culture has developed there that after the age of 40, many people have started taking TRT, and it has become a more common thing. But as far as I understand, I believe if you start TRT once in your life, you have to continue it lifelong. So this is a very important area because we have talked about deficiency, but we haven't talked about treatment yet. So if you are deficient, TRT is for whom, whose testosterone levels, measured by LC-MS/MS at 8 AM, come below 300 nanograms per deciliter at least twice, along with symptoms. Those are the people who should be given testosterone TRT. Testosterone replacement therapy. Replacement means you are replacing something that is low in the body. Out of 100 brothers, how many brothers will need to take it in life? If you only go by levels, then in my age group, 20% of people will need it. 20 out of 100. But it doesn't happen in youngsters. It's very rare in youngsters. Very, very rare. Okay. But typically 15-20% definitely. There are over 50 studies, over 60 studies. But it's not necessary that everyone has to take it. Is there any commonality in those 20 guys? Did they not take care of their health, or is it random? Some of it is random, and some is definitely those who have metabolic syndrome, who are overweight, whose waistline has increased with age. If all those things are present, then obviously you are at greater risk. These are risk factors. So, these white brothers of ours who are starting TRT after the age of 40, many brothers are doing it here too. It's not like that. It's becoming popular nowadays. But the science is weak. If you talk to your top endocrinologists anywhere, they won't say that. They will say only those who meet the criteria I mentioned should take it, those who have symptoms and are below 300. If you pick up an endocrinology book, read the guidelines of the American Endocrine Society or the European one, they will say the same. But nowadays, people do many things casually in the hope that it will help, and sometimes they over-interpret. They feel that if this happens, then maybe it will happen. So that's why to oversimplify a slightly complex phenomenon, this happens in every brother's life, in every person's life. When you are in your 20s, if you have taken care of your fitness, your body is fast, strong, has high stamina, etc. Roughly at around age 30, some drops occur. Yes. Same logic of athletes retiring in the mid-30s because your body is automatically getting slightly weaker. So it's nature's process. And I am sure that once you hit 40, once you hit 50, such drops will keep happening. I think because of these drops, all the white people are now thinking about TRT. Because there is that insecurity of youth. Just like many ladies go for cosmetic skin procedures. Fortunately or unfortunately, each to their own choice. But this has become the male equivalent. This culture hasn't reached India yet. I think it has started quite a bit. You are right, South Delhi, South South Delhi, South America. The core reason is that insecurity of youth, that I want muscles too. See, there are two things. One is this belief in people that we can live much longer. We can have a better health span, we can live much longer. Longevity. So why is aging happening? So people think of reversing the changes that happen in aging. Some through lifestyle, and some through medicine if it's not there. So that is a concept, but it's not proven that if you take testosterone, if your levels are not clearly low, you will benefit a lot. Like that. Okay. Hypothetically, I wouldn't do this. I think. But if I came to you 10 years later, at age 42, and said, Sir, please inject testosterone into my blood, what would you say? No, I would say, let's see your testosterone, man. Get tested properly, understand. But if I am sorry, I have to do TRT, sir. I miss my muscles. I would refuse. Why? Because nothing should be put into the body that can potentially have some harm. Okay? And this is an unknown zone. If the level of anything is normal, and we give extra, it's an unknown thing. Later, we will find out what the problem was. I am playing with nature. Exactly. But you of course play with nature when you understand that process. But where there is no understanding, there is no proof. All the studies that have been done, if normal testosterone is there and you give extra testosterone, no study shows that anyone has benefited from it. So we have to follow science, whether someone likes it or not. We will still have to follow that. Okay. Steroids are a truth of Bollywood and the modeling industry as well. As far as I understand steroids, they are synthetic compounds that mimic growth hormone and or testosterone. So, steroids are not growth hormone related. Growth hormone related are different peptides. Okay? And steroids are related to testosterone and cortisol. Yes, yes, yes. So, that's the same activity you are taking. So, let me tell you its story. I see so many people. Once a month, twice a month. Someone who has taken those steroids and walks like, you know. They don't even touch their body with their hands, they walk like that, so built up, and otherwise they were fine, but couldn't win competitions. Tried, did well, I mean, otherwise a healthy fellow. Now everything has stopped. Supplements, no problem. So now everything has shrunk. Hmm. His wife is threatening to leave him. I can't name them, but well-known rockstars and all, they have seen it, and it has happened. Divorce has happened. Oh. So what I am saying is, unapproved, unlicensed, unethical use of steroids for the sake of bodybuilding, you are doing it at your own risk. Yes. You know, sir, when I was in college, when I started gymming at age 19, there were many brothers who would just take injections on the advice of gym trainers. I have been a trainer myself. I am a fitness professional. And that's how my career started. In my opinion, that is also a very noble profession. Of course, the intention. Okay? You are trying to help others. But many gym trainers get lost in their own process. Because unfortunately, globally speaking, the gym environment is very insecure. And they get lost in this ocean of insecurity. And because they are lost themselves, they try pulling younger guys with them. I believe that if you are even less than 25 years old, don't even think of injecting yourself. Honestly, I am not a fan of that idea ever. See, two or three things are emerging from this. Sudden cardiac deaths in gym-goers. If you ask cardiologists, they will tell you they see many more cardiac events. Among people who take these drugs. Effect on kidneys. If we do anything in excess. This body is made for some normal purpose. If it comes into our mind, why should I weigh this much? Why should I weigh this much? Who said that? No, I want to. So, in today's society, this self-driven aspect is very high. So people end up harming themselves. In my opinion. And if you are seeing a young heart attack happen? My question is, is it worth the body that you are building in those years that you have lived? So, these things are very important. See, this is a psychological problem. Why would you risk everything? So, and some of them are not even professional athletes. Yes, yes. They just want to compete with friends. And it is our duty as doctors to explain that you are doing wrong for yourself. To their parents, family. But at that time, there is passion. People don't listen. And so many people are troubled later, and then it doesn't feel good to say, I told you so. I told you this would happen. Yes. I will use your good offices or good medium or huge reach to explain to youngsters that please don't take such steroids for bodybuilding. You have to pay a very heavy price. It's not a small price. For those who go to that level, it is almost impossible to come back and lead a normal life. You know, there is one the only counter-argument to this. And I have heard this from models and actors. And maybe it makes sense. In their professions, it's a professional hazard. That everyone is taking it, so I must take it. In Bombay, you hear this. And you know what, on some degree, I almost agree that okay, fine, it's your part of your job. But I would also like to say that as far as I understand steroid use, there is something called post-cycle therapy. PCT. Hmm. Basically, if you have taken steroids once, you need to take the help of a qualified endocrinologist to set your systems. Yes, yes, yes. That's why patients come. That's why they come. But I see, now this is everyone's personal choice. Again, it's the same thing. It's a personal choice. Yes, yes. All I say is, before you start anything like this, if you are thinking of doing it, see an endocrinologist. Yes, yes, yes. If the endocrinologist is willing to monitor you and feels that you are a candidate for it, then take it. But this whole process is expensive. So the cheaper way of doing it is doing it without an endocrinologist. Right? That's there. There will be a difference. Like only the rich can afford taking steroids in a slightly safer manner. But these injections are not cheap either. Injections are not cheap either. Gym is not cheap either. So it's just a way of thinking. Hmm. So my advice is, if it comes to your mind that you need something like this, there is some deficiency in your body, or whatever it is, then definitely consult an endocrinologist. Based on your own decision, not your gym instructor's decision. My advice is, don't take it, because the troubles later, we all see them. The highest quality of steroid use, where rich people or Bollywood actors are taking it. And suppose they come to you. I mean, you don't. Yes, doctor-patient confidentiality. Yeah. But you have treated a Bollywood actor? Not a Bollywood actor, but well-known people in Delhi? Okay. Yeah, who have taken steroids and you have been able to like just monitor their progress. There are side effects there too. Absolutely. It's a big challenge. Even in the world of the rich. Absolutely. So what are they? Prostate. If you overdose, the risk of prostate increases, right? Prostate problems. Cancer. Even cancer. But prostate problem means what? Prostate problem means that the prostate is a gland in our body that is near our urinary tract and controls the flow of urine. If we take normal testosterone, there is no problem. But if we take more, then if there are even one or two cells that are behaving a bit abnormally, they will grow, expand, and even cancer can happen. Enlargement will definitely happen, but even cancer can happen. So, I mean, I think that it is a serious thing. I don't think TRT is a casual thing. Yes. I do think it should be taken under supervision. Proper supervision, ideally of an endocrinologist. So, this TRT we talked about versus steroid use. They are different processes. So, sorry, I used the word TRT here. It's not a different process. Uh, it's basically giving the same hormone or something similar. TRT means calibrated correct dose under supervision. Steroid use means different steroids, different kinds of androgens, testosterone-like substances in random doses. So, basically, it's the same, but it's not TRT because that is TRT means testosterone replacement therapy. What is low in the body is being given from outside. Yes, yes, yes. Steroid therapy for bodybuilding means there is no deficiency in the body, but we are pumping it up to build our body. So, that's the difference. But the science is science. Same, same. Just do excess of it. Wow. So maybe what we said earlier, that white people are talking a lot about TRT these days. It's a friendly way of talking about steroid use. Yes, yes. Wow, wow. But it's not projected like that in their media. Because they, I think, are probably doing it in a very calibrated way, not letting levels rise, doing regular monitoring. Those who are doing it there are also the rich and the wealthy. Yes, don't think that everyone has testosterone. Yeah. The main side effect is lifelong. Because it won't be written in the university hospital. We write it privately. Okay. Sir, if someone doesn't have money for TRT, then what about Shilajit? So, everyone is taking Shilajit. Those who come to us, all these are Ayurvedic preparations, extracts. Nothing happens. The best is testosterone. It's not an expensive treatment. Yes, if you want to take TRT, then injections, anything, the price is less than ₹1. Okay. Once in two weeks. You know, I can check the exact price. Maybe 200, something in that zone. Different brands have different prices. So, taking one injection every two weeks or three weeks, what's the big deal? Nothing. So, testosterone therapy in India is not expensive. If you take gels and patches, they are a bit expensive. But injections are not expensive at all. What about Shilajit? I don't believe in all this. I don't believe in all this meaning. I don't believe in anything that has not been proven by randomized controlled trials. Whether it is Shilajit, whether it is TRT for normal level testosterone. Until it is proven by trials, anyone can take anything. So, okay, people take it. Okay. So, there should be trials on things like Shilajit. Yes, absolutely. Proper trials. So many people are taking it, have been taking it for generations, so do proper trials. Okay. And if you prove it, I will be very happy to use it. Hmm, hmm. But what is the understanding of Shilajit? What effect does it have in the body? All testosterone-like compounds. That's all. Meaning, thought to be, thought to be, thought to increase stamina. That is the logic. But as I mentioned, the problem with supplements for me now. Just last week, I saw someone taking 36 supplements. Of my age group. 36 supplements. Everything, Ayurvedic, this, Unani, Western, all are being taken. Brother, I, what can I do? Your choice. Long Island Iced Tea is your choice. Your choice. LIIT of supplements. The whole chemistry. Yeah, yeah. But there must be some side effect to doing that as well. I am pretty sure. Yes. But someone has to study that. When you are using things. See, it's funny. We question any new medicine so much, rightly so. There will be side effects. Yes. They didn't show side effects. This pharmaceutical industry is dishonest. They hid it from us. They did this, they did that. But we are ready to use something that has no published data at all. We use it with our eyes closed because, no, this is in our scriptures, or it is written in our old texts. It's a very good thing if it's written, then prove it in today's world. We also want to use it. But we are using it without proof. And for something that has so much data, where every side effect is reported, it seems like big side effects. So, it's a matter of ignorance. Ignorance is bliss, nothing else. Hmm. Okay. I think this is pretty much it, sir. Most likely, people have also learned about diet through this episode. You think we missed out on any point for men's aging guide? I think we talked about protein. Yes. We talked about supplements. Just an important point here to reduce refined carbohydrates in the diet. Last point that is very important if you are trying to maintain your metabolic health, increase fiber, reduce refined carbohydrates. Hmm. You know that you can always check, but it is very important. Like breads. Okay. You know, if refined carbohydrates increase in urban diets, which I talked about cereals, talked about the green revolution, it became refined. It wasn't refined before. It lost its fiber. It became very fine, shiny, easily digestible. So, this, along with protein, is also very important. Hmm. You know, let's simplify it slightly, and then simplify it further. The simplest way of explaining this is something that Sunil Shetty sir told me on the show, that he avoids all white things. It's a very easy hack. I was going to say it, then I thought, he must have said it. Avoid white things. Shiny white things are not good for us. What we think of as white flour. It's very good. Absolutely fine. Naan. Naan. These are classic examples. Meaning, its refined flour. Refined flour is poison. Yes. Refined flour in any form. So, instead of that, if you, you know, take whole wheat flour mixed with bran, flour mixed with bran. People used to take it in villages before. Or now, millets, jowar, bajra, ragi, or much better, kodo millets. These are better. Okay. I will say avoid sugar, avoid refined flour. 100% avoid anything that comes out of a packet. Chips, dips, noodles, bread. All these. As at some point, as your age increases, you have to stop eating processed food. Just for health, or your body will force you into it at some point. You should absolutely avoid processed foods. Their convenience is the challenge. Their convenience for anyone working long hours, for anyone working in an office. Or anyone studying at night. North in Delhi, there are services that provide food during the night for kids who are studying, and this is all that is in it. So, that's a problem. Yes, honestly, you know what I do? I always keep bananas with me. I keep a packet of protein shake with me. That's a meal. Fantastic. But it's about mental conditioning. Yes. You have to tutor yourself from a younger age. So, it's easier. You know, when I do any health podcast, it's usually a doctor or a dietitian. And you guys are used to dealing with the worst cases also. Worst case, meaning, a person who has never taken care of their body their whole life. Effectively. So, obviously, they are mentally weak. So, when I talk to people like you, you all talk with empathy. That, no, no, it's not as simple as eating clean. And I understand your predicament. But you know how I see this situation? In our generation, there is a pandemic of mental strength. It's about being mentally strong and mentally conditioning yourself to avoid such situations. Absolutely. You know, no one can question that. But yeah, you are right, baby, we deal with sickness all the time. So, you are very, you know, gentle, and you know, in every health podcast, I talk very strictly. And I talk lovingly to the person sitting in front of me. But I guess that's why these episodes work. It was fun talking to you, sir. But thank you. Just felt like talking to a big brother. So, thank you so much. Thank you. Yeah, I hope you had a really nice time. And yes. It's like a drawing-room conversation. Living-room conversation. Very nice. Thank you. Thank you, sir. If I ever need TRT, I will, but you guide me, and I think I will be in the 80% category, so I take good care. Will be good. Thank you. Had fun talking to you. Thank you so much.