Keep Humans in the Loop: Prayer, Testosterone, Magic Shrooms, and Social Media Alert for Teen Health

[music] >> Hey! I just need to know where you got that chair. I mean, like compared to this compared to this [ __ ] >> [laughter] >> Your chair is so comfortable. >> I don't know, bro. Someone just ordered it for me. I'm I'm sure I asked for it. I was like, I need a chair. >> I mean, I need more details. I need to know who this someone was. I need to know where they ordered it from. And I mean, obviously it's like it's going to be super high-class.

So, I need to know how much of a bank loan I need to take to buy that chair because Jesus Christ. >> Yeah, I mean, you'll have to you'll have to save up some. You know, the orthopedic >> [laughter] >> salary might not be able to >> No kidding. I mean, I'm over here sitting in like this proletariat chair. You got your bourgeoisie little throne over there. Oh my gosh. The only reason we even figured out that Humayun's chair is so awesome. He's never let me sit in his chair before, by the way.

Is we just switched spots for a second cuz my video was lagging. So, we needed to go and check the other one. And I sat in his chair just to check and I just forgot we were even doing a podcast. I was like, dude, this chair is just like remarkable. Oh my god. I might take it home. >> Yeah, one day, bro. One day. >> Oh man. It's a nice chair, but then you know >> one day when Baylor's able to, you know, make some money off of Bento. >> Yeah, no kidding, right?

>> They'll get you the chair, but uh Yeah, you know, I have to sit here and do notes all day, so So, something has to be comfortable, right? >> There you go. Yeah, we'll get you a standing desk and I'll take your chair. >> Yeah, you know, I'll get one of those treadmill uh >> Didn't people do that? I remember doing med school we had like a bunch of those treadmill desks.

I mean I think we had like four of them in a row and kids would just like, you know, walk on the treadmill while reading a book. It was like a thing back I think it was like a fad cuz I haven't really seen very many people doing like treadmill desks recently. >> Yeah, I have I have it at home. >> Do you really? >> Yeah, my mom just my mom randomly just bought it. She was like she got excited and >> Does she use it or do you use it or it just sits there? >> Right now it's just sitting there.

>> [laughter] >> That sounds about right. >> Yeah, we were like oh yeah let's it's a walking pad and it comes with the desk and then you know, you can just the desk can go all the way up and you can just walk and do your work but how do you do like a medical notes and read echoes while walking? I don't know. >> I don't know either man. I mean maybe if you're dictating. >> Yeah, dictating or something but I can't think man. I can't I just have to I can't do stuff while walking. I don't know.

I don't know how to I can maybe study or think or like like you have to think about ideas or or or you know, reflect on stuff while walking but not like do productive work. >> Yeah, I guess that's true. I mean I guess if the work is also dependent on like computer it'd be weird to walk and try to input information into a device. Yeah, but I'll you know, I'll like walk and read every now and then like if you're holding a book like sometimes I don't know it's just annoying to sit for a long time.

I like walk like leisurely in the house and read. >> I can't do that. I I have to I have to sit there or lay there and be still but I can if I'm on a phone call I can't sit still. >> But yeah, I'm a I'm a walker when I'm a talker on the phone. I can't sit down and talk on the phone it's weird dude. >> Yeah, it's weird like people who just sit there and talk that's something it's weird.

I'll if I'm talking on the phone and even though I'm not on the phone as much I mean very few times I'm on the phone But if I'm on the phone, I'm just like walking around, you know, or I'm driving. Something has to be happening if I want the phone. >> Yeah, it just makes I don't know. It just makes more active process. >> Yeah, the things you do to kind of distract your mind, yeah. >> Yeah, man.

And that, you know, that kind of brings us to the first topic for today, like a theme, a loose theme of mindfulness, I guess, but a topic on how to distract yourself or maybe how to be more mindful of stuff is, you know, when we talk, which is common in medicine, talking about pain, a patient's perception of pain, and what are some methods to ameliorate that, to decrease their perception of pain and the pain scores on these patient-rated exams.

One of the topics we came across that I thought was interesting was the distinction and the comparison of prayer versus music and how each of them can decrease a patient's pain perception. I thought that was a pretty interesting study, especially how they especially the study design. You know, like the the catchphrase, "Oh my gosh, prayer versus music. Which one is better to help patients in who are having pain?" That's very broad.

And honestly, the way the studies are designed, they're not really going to be able to compare overall prayer versus music. There's so many different kinds of prayer and so many different kinds of music. You know what I mean? >> Yeah. I mean, the whole reason we started this podcast was, you know, we would see these random headlines, right? There there's all these headlines and they they catch news. Five, you know, crazy symptoms that all doctors missed.

And then when you read, you know, and then computer solved it. You know, you see these headlines and then, you know, you're like, "What the hell that is?" And you you most people never really read into it or read the article.

They look at the first paragraph, kind of see, "Oh yeah, doctors missed these diagnoses and AI found it." And you know, but when you read deeper into something and look more into it, you find the faults and why those headlines were more mostly for you know attention grabbing or click bait. >> Yeah, it's just click bait, right? >> Click bait and then you know as we saw this topic that you know music versus prayer which seems very interesting.

You know the study is it um in May or June of 2026 it was an open label randomized trial at one site where they enrolled 180 adults into into the study and 90 of them randomly got a music arm and 90 of them were assigned to um prayer arm.

The the prayer was you know with a person kind of you know it was it was described as a proximal intercessory prayer for 5 minutes versus 5 minutes of recorded music not an actual person playing the music or doing music therapy but recorded music that they're listening to. And that showed that people who underwent prayer had much lower pain scores after up to 6 weeks and a lower level of anxiety as well.

So patients who reported pain initially and anxiety initially uh people who used uh prayer had a much lower pain scale and much lower anxiety level in 6 weeks or within up to up to 6 weeks which is a >> Compared to the compared to the recorded music listening group.

>> line which is an interesting idea interesting thought that you know prayer but there's a lot of lot more into it that you know when you look into the study and see what happened and what it looked at and what it considered prayer what it considered music uh it's it's a very interesting idea yeah.

>> Yeah, even like so the to break it down a little bit like you know they the terminology like the vocab the proximal intercessory prayer like uh when I first read that I was like what the hell is that right? Um but you know they kind of try to parse this out so that you can distinguish different types of prayer and basically they broke it up into categories. So one type of prayer is you know someone far away from you.

Like some dude somewhere in Asia could be praying for you and your well-being. You don't even know they're praying for you. That is called distal intercessory prayer. Someone distal or far from you, they're interceding on your behalf via prayer, okay? Then there's proximal intercessory prayer, which is someone else still praying for you, but they're adjacent to you. They're next to you. Like it could be a priest, it could be an Imam, it could be a Rabbi.

Someone is guiding you in a prayer and doing it with you for you. So, that's really what this study looked at. And then obviously the most common type of prayer, which most people are familiar with, is personal prayer. Like I say a prayer for myself right now, or you say a prayer for yourself, right? So, those are different types of prayers, and you know, there's always this weird verbiage in these studies, but that's what the proximal intercessory prayer is.

And that's what it was looking at, and specifically it was looking at when someone like that, a spiritual guide, they didn't term them a priest or anything like that, but they did that prayer with the patient, the study participant. Um and it was specifically Christian prayer, and it involved, you know, touch.

Like you guide someone through prayer, touch is a part of it, just like you know, if you go to like a mass, for example, a Christian mass, there is touching when the the worshipers go up to the altar, the priest will, you know, do the sign of the cross or give them like Eucharist as an example. So, it's it's not uncommon that prayer is more than just words and thoughts. There's also a touch ritualistic aspect to it.

And that alone begs the question, how much of pain and anxiety decreasing is because of just human touch in a calm controlled manner in this prayer room versus just someone sitting there by themselves listening to pre-recorded music. Uh the patient population, too, it was very skewed. It was a very low-income population. They looked It was like between 20 to 30,000 dollar median household income, which is far lower than like population averages um in the United States.

and also it wasn't representative of the total US population large. It was much more I believe Hispanic and black population. So, how generalizable are the study results? You know, who who the hell knows?

But I just you know, more detail to break it down to make it a little more understandable I think is important because like you said Humayun, the clickbait and the catchphrases and reading just a headline or even just an abstract of a paper is very different than getting into the weeds of it and digging into like oh, so that's how they did the study. Well, okay, now I'm a little less excited about the study. >> Yeah.

Yeah, I mean, you know, the article would make you feel that there's some kind of divine intervention, right? That God came and you know, eased the pain because prayer is much more stronger than music, but if you kind of look more into it, you know, most of the studies that have been done with music and there's a lot more data on music alleviating pain and improve improvement in scores and anxiety with music.

And a lot of those are related to music therapy when there's a human in the room and actually doing music therapy, a guided therapy for patients, right? So, is it truly the actual prayer or the music or is it that human to human interaction? And I think that human touch in this age of AI is much more powerful than anything we can imagine, right?

I mean, just person sitting with you and praying for you has some very profound impact on your health and your well-being and your mental health and and you know, your mental health and mental well-being can have a lot of effect on your pain score and anxiety, right? Knowing that there's someone there uh you know, kind of wishing well for you. Sitting there with you holding your hand or you know, kind of praying alongside you um can be very encouraging for a lot of people.

Can be uh you know um can be kind of very healing as well. I mean um there's something to say that and and right now the mechanism is unknown, right? Why do these people with prayer have a much had a decrease anxiety and pain score? We have We can't say that and the only thing we can infer is it's that power of prayer, encouragement, and you know, some hopefulness that comes along with prayer that caused that, right?

So, I think uh I think your mental health and mental well-being has a lot to do with it and prayer obviously acts acts on that, right? >> Yeah, no, totally does. I mean and you know, like when I uh when I'm at the hospital, it's uh our hospital at St. Luke's, you know, obviously it's a religiously named hospital, but they they have a chaplaincy service. So, there's a chaplain in the pre-op area that comes and visits with every single patient um before surgery if the patient chooses to.

And the chaplain, you know, he's Christian, but he he's very agnostic to a patient's religion. He just does a very generic prayer with them for their well-being, for their family, to decrease anxiety, they go through the surgical episode well, come out with a good recovery. It's a very very nice, very simple, but oh dude, like every patient loves that. Um even a patient that is like for sure the opposite religion. I mean, I have a lot of Muslim patients, like women wearing hijabs.

And if they ask them like, "Would you like the chaplain to come?" Dude, everyone says yes. I have Jewish [snorts] patients, atheists, Hindu patients. Everyone says yes, and everyone has a really positive experience with it. And the chaplain's great. I mean, I I know him very well. I I literally see him every day. And he's so polite, he's so kind, he's very respectful about boundaries, he's very aware of different religions and different cultures. He'll always ask, "Is it okay if I pray with you?

Is it okay if I lead the prayer? Is it okay if I hold your hand? Would you like me to?" You know, but it's patients across the board are like, "Yes." And you it's so relaxing to see that, you know, right before I go into a surgery, like even though I'm not really partaking in the prayer, I sometimes just watch, I actually just feel really chilled out and relaxed and like a a happy feeling.

Um so, I think there's something to it for sure, even if it's just people sharing an experience, you know, or sharing like a hope, um which is really what prayer is. A lot of prayer is hope. You know, you're hoping for something good, you're asking for something good, you're yearning for that. I I think that's a very positive thing. >> Yeah, it's interesting, you know, the chaplain Methodist was the hospital I go to. He's actually Muslim.

Uh and yeah, yeah, he's you know, there's a Muslim chaplain and he's actually going around and praying with um you know, people of all faiths cuz I think the whole uh field of uh chaplaincy or you know, a chaplain, they're they're not it's not a more of a it's it's it is more of a spiritual position, right?

You're there for all patients equally and it's not it's not specific to any faith, you're not you're not bound to any faith, you you don't have to do the Christian prayer, you don't have to do the Muslim prayer, you just have to do some kind of prayer where there's a divine being, divine intervention uh that's taking effect through that person and kind of helping you out mentally, right? And it's just someone a person that's there uh for the patients in in difficult times, right?

Especially when someone's about to pass away, they're transitioning to hospice. Um you know, they're towards the end of life. I mean, families love having chaplain kind of just someone to talk to and they have it's it's formal training program, right? I mean, they go through formal training how to help people with grief and and and helping with such big losses in life, right? So, I think prayer have has a big role to play in it.

If if a patient ever asked me to pray with them, I mean, I I'm always agreeable. I don't think there's anything you know, wrong with because as physicians our our our role is there to be for to be there for the patient, right? To be there for the patient to help them in any way possible and to to act as a vessel of healing. You know, if you if you're a religious person, a man of faith, you you believe that the healing that comes it comes through you.

You're a vessel and you know, it comes through a higher being and you're you're conduit uh for healing towards the patient and you know, you can kind of consider that and be there for the patient. If they're a Christian, they're Muslim, they're they're Jewish, whatever whatever their faith is, they're Hindu, you can you can partake in in prayer with them and I I personally believe there's nothing wrong with that.

I'm not my religion, my faith is not decreasing in any way if I pray pray with a Christian person or a Hindu person or a Muslim person or a Jewish person that that I'm just adding to their healing and there's something to that as well, right? I mean, just because we're physician and we have personal faiths and personal beliefs doesn't mean at that moment when you're supposed to help someone, you can't be there for them. >> Yeah, totally. Totally agree. But yeah, it was interesting.

I mean, I thought the main thing it was just interesting that they were trying to draw parallels that you know, something that is experienced like a prayer or music can both lead to decrease in pain and anxiety. Um I think it's cool. You know, what's funny is there's like so many different ways that people can address those issues of pain and anxiety in a patient whether it's from a medical condition, an injury, a post-surgical patient.

One one thing was the I think they did this at MD Anderson who I I'm not positive though, so don't quote me on it, but they used like VR headsets like the Oculus Rift thing and it was linked to a video game.

And when patients were undergoing a procedure, um if they had the headset on, you know, they were very immersed in the video and audio in the specials environment of the headset and had like a game controller or whatever and they were like in this fake little area, they actually needed much less pain medication. They were much less anxious. Uh that I thought that was really cool study, too.

I mean, in a similar vein as this, I mean, they're basically just you're forcing someone to partake in an experience and it kind of detaches them from experiencing pain when they're just like sitting there anticipating it. >> Yeah. Yeah, that's interesting because, you know, um there's been multiple studies like that where some kind of distraction and uh has some kind of distraction, something that kind of soothes you.

Not I think it was a game, but I think they've done studies where patients are just in a relaxing environment, you know, um either during an MRI they they were they were uh wearing like a VR headset where they were able to kind of just watch a movie or observe or be in the ocean and kind of have and they moved less, they had less anxiety, they didn't need medications.

Uh so, there's a lot lot to say about the the the mental distractions we can create and kind of like our second topic, um you know, um there's a lot of discussions about psychedelics and magic mushrooms and psilocybin um improving mental health as well, especially for patients who have treatment uh resistant depression or they have cancer, they're towards end of life. You know, uh having some kind of a psychedelic experience has shown to have some improvement. There's some early studies, right?

There's some early studies that have shown that there could be some improvement in their symptoms, their depression, their anxiety um when they're going through that kind of experience. Um >> Yeah, and that's you know, that's what's interesting is like studying uh drugs like this. The studies are hard to do because all of these are classified as like schedule one drugs, meaning at least per the drug schedule that they have allegedly no medicinal benefit and they're simply drugs of abuse.

Um but obviously more recently a lot of these drugs like psilocybin like we're about to talk about, ketamine has been a big one, especially microdosing of ketamine for treatment refractory depression and anxiety has real evidence and the evidence has been growing. Um but also with that, you know, there's a bunch of like ketamine clinics that have opened up that there's a potential for abuse, too. Um So, I think it's very interesting. I mean, this is new stuff.

Um people have anecdotally touted these psychedelics and, you know, going on a so-called trip like a guided trip with a shaman or something that's common with DMT, ayahuasca. Or people will do that and they will almost unanimously talk about how it's a life-altering experience, you got in touch with yourself, things that held you back in life or traumas from your youth. You were able to shed them and move on.

So, I mean, that many people say that much stuff in a positive way about something, I I think there's got to be something to it. >> Yeah, for a long time, you know, these these were studies. They were They were small studies with with a small amount of populations and there a lot of the uh subjective evidence that came out of those studies were very positive, right?

But um recently when they moved on to larger studies, uh which were designed with certain doses and uh placebo-controlled to somewhat whatever they could do, uh the results were less promising than what they thought before, right? So, uh in theory, psilocybin is a prodrug, which uh it is converted to psilocin and that is a serotonin partial serotonin agonist. Uh you know, the SSRIs that are currently used to treat depression, they're selective serotonin re- receptor you know, reuptake inhibitors.

So, that they allow for more serotonin to stay in our neuro you know, the the synapses. But uh psilocin, which is a pro pro you know, which kind of comes from psilocybin, it just it's a activator of uh serotonin receptors. So, works in a very similar way. So, there is there is a case uh biochemically that it could possibly improve depression and anxiety symptoms, right?

Uh now, um a lot of people that went through those smaller studies and earlier phase studies, uh they went through life-altering experience. And sometimes when you go through something like that, you tend to over-exaggerate your symptoms as well. I mean, there's a Sometimes there could be a uh crazy placebo effect where you go through something profound profound like a trip, which was probably life-altering experience.

And after that, the euphoria from that uh kind of continues to stay with you for a while. And you you you feel like your mental health has improved. Uh how much of that was truly the experience where there was a human shaman uh human involvement that kind of created that environment for you to improve those symptoms and kind of go through that guided tour guided tour of your or guided trip per se, right? >> Yeah.

>> if you just were in a room by yourself and you did something like that, [clears throat] would that be the same kind of effect in that, right? Just like we we just talked about our first topic, the prayer, right? The prayer was a guided prayer with another person next to you. That human touch, the human in the room that that's there guiding you and kind of going through this profound experience with you. Um that that possibly had a lot to do with it as well.

Uh you know, that whole experience rather than just the isolated psilocybin uh trip itself. >> No, for sure. I think that's definitely the case. I mean, I think that's the case with anything, you know. You share this experience and you come out after you do something very positive or very negative or somewhere in between depending on the environment itself, who you're doing it with, right? Like for example, you could go and walk in the park aimlessly by yourself. You could do it with a loved one.

You could do it with your kid. You could do it with a friend you haven't seen in a long time, right? Those are very different experiences. The conversations you have, the things you see, what you stop at, what you comment on, and stuff like that. And it's basically you do the same walking path, but the experiences could be very different. With your son, you who's a little kid, you might stop and throw some rocks in the water for like 30 minutes and not really talk about much.

You're just enjoying doing that. Versus if you go with your wife, you may end up talking about a bunch of stuff, real life stuff, memories, plans for the future. You know what I mean?

So, like the same thing with drugs like this that are psychoactive, if you do it solo versus you're in college doing it with a bunch of buddies just goofing off versus you do it in a very planned methodical way with a so-called shaman who is an expert in leading people through these trips and through these substances to make sure you don't have a negative experience or a bad trip. I In the same way, they can be very different. And I think that also makes it hard to study, right?

Because if you as a study participant, you know, in these trials are getting a set dose in a controlled environment, it's with a so-called guide. And how well-versed is this guide in actual psychedelic experiences? You know, that is in the a clinical trial.

Versus is it just someone with a medical background who's making sure your blood pressure, your heart rate, your anxiety level, and all of those other vital signs remain at the normal thresholds and you're not having some, you know, psychoactive event. So, those are two very different things. Guiding someone through that and bringing them down or bringing them up if they're not having an appropriate experience versus just making sure they're medically okay. >> Yeah.

It's also very hard to um kind of do a do a placebo control trial where there's no true placebo to a psychedelic trip, right? In a lot of studies that they did, they used niacin which kind of causes a flushing kind of effect or they used uh diphenhydramine which is um Benadryl, right? Or they used a 1 mg dose versus a 25 mg dose, a higher dose of psilocybin compared to a very microdose. >> Yeah.

>> to compare, but it truly doesn't substitute for that that trip that you have in >> Yeah, they they didn't give them portobello mushrooms. That's for sure. No real placebo there.

>> Yeah, and if you go through something like that there's a big uh kind of uh what I call like uh you know you feel like you need to feel better and you feel like oh yeah, I went through that so I have to feel better and you kind of have a self-fulfilling uh it's kind of like a self-fulfilling prophecy with cuz when you went go through something profound you're forced to kind of make yourself feel like yeah, there's something happened to me and I am better. >> Yeah, for sure.

>> How much truly is that the psilocybin itself is improving your depression or it's it's your mind telling you that you went through something like that and then uh you know, you're feeling better.

But you know, that it's going to be easier to monetize this because uh there's a lot of people that would now if this becomes it shows even little bit of data and the the government regulations slowly as we've seen from uh you know, the current administration at at Joe Rogan's encouragement uh you know, that they're changing [laughter] the the regulations on these drugs.

When it does become more more available, how many people will with no real qualifications and you know, or very minimal qualifications will try to get these licenses and open up like local clinics >> Dude, I can already see the headlines. New York Times, the number of mushroom farmers in America in 2027 has quadrupled. I wonder why.

>> Yeah, so I mean you know, people will find ways to kind of monetize and sell and and and even get people to to use these substances maybe in an unsafe manner when it's not really indicated, right? Uh and that's a lot already happening with a lot of other medications like like for example, testosterone therapy, right? Uh you know, I it's just been a crazy rise in the amount of people that are going to these low T clinics.

I know like 28-year-olds, 29-year-olds, 30-year-olds that are going to these low T clinics per se and getting shots of testosterone every every month. >> Dude, I feel like in Houston there's a low T clinic literally around every corner. >> Yeah. Yeah, I mean this is it's ridiculous, right? I mean and a lot of people do not do not understand the downsides and and the long-term effects of this, right? A 28-year-old going to a low T clinic, a 31-year-old going to a low T clinic.

Um a lot of these clinics are uh uh their main business model is selling you that medication, the testosterone replacement therapy, to make profits. So, when you go to them seeking care and asking them, "Hey, make this sound clinical judgment. Do I need testosterone replacement therapy?" They're never going to say no to you. They're not going to say >> they're just incentivized to hook you on it.

>> Yeah, the whole incentive is to hook you on it and and the data clearly shows that not everyone is is uh you know, eligible for testosterone replacement therapy. There's there's a lot of evidence showing that testosterone replacement therapy needs to be done in a in a in a indicated manner where you need to be examined by a physician, right?

A physician who first uh goes through your history, you know, and truly finds out what are what are the the symptoms of low hypogonadism that you're having. Are you having extreme fatigue, um you know, sexual dysfunction, you know, um weight gain, um you know, body dysmorphism, things like that. And then based on those, just that's not enough. You need to get testosterone you know, you need to get your testosterone checked first. The the levels of the testosterone level checked.

And not only once, you need to get it checked twice. And it has to be done um before 9:00 a.m. When I get patients who are on these testosterone replacement therapy and they have a hematocrit of like 18, 19 Uh and I asked them, "Hey, like you know, did you get your testosterone checked first?" And they're like, "Yeah, I went in." And almost every time I asked them, "Did you go before 9:00 a.m.

to get it checked?" And almost always it's like, "No, I just went in the middle of the day." And and and most clinics are not guiding their patients based on that cuz your testosterone levels are best checked before 9:00 a.m. Yeah, there's there's a cycle. They go up as the early in the day and then as the day goes on it goes down. So, if you get it checked in the afternoon, obviously your testosterone levels will be low.

So, the real way to do it is you have to get a extensive history, you know, truly see if they have symptoms of hypogonadism or low testosterone levels. Then you're supposed to check the testosterone level twice at two different occasions before 9:00 a.m. And if the levels are below 300 twice below before 9:00 a.m. along with the symptoms that they have and you think those symptoms are related, then they may be eligible for testosterone replacement therapy.

Otherwise, they're not It's truly indicated, right? And even if when you when you do testosterone replacement therapy and the testosterone level is low, the first thing to do is to look for secondary causes of it, right? Is it obesity? You know, significant obesity, insulin resistance can cause secondary hypogonadism.

And that's why you're supposed to check their FSH follicle-stimulating hormone and luteinizing hormone levels and you know, you're supposed to check for prolactin and make sure there's no pituitary dysfunction as well to make sure that it's not a secondary reason. Your pituitary is supposed to release hormones that that instruct the the testes to produce testosterone. Right?

So, if if that's not happening, if that cycle is broken, testosterone replacement is not truly indicated because that's further going to suppress your pituitary function. Uh you're also supposed to check your prostate-specific antigen, the PSA level, because there is a possible risk of causing prostate cancer by by excessive uh uh testosterone replacement therapy.

So, there's a lot of things that a lot of nuances that go in there and and and the the number one side effect from uh testosterone replacement therapy that kills your sperm count. And pretty much makes you um infertile, right? I mean, a lot of these guys that are getting testosterone replacement in their early 30s, late 20s, mid 30s, they they eventually want to have babies. And this could possibly be very harmful to those plans, right? >> Yeah.

>> And and a lot of these low-T clinics are not counseling their patients in the right way, right? They may have them sign a waiver >> a consumerism model, right? Like same thing that the proliferation of these GLP-1 drugs that every Tom, Dick, and Harry is just prescribing them left and right, expanding the indications to basically the indication is do you want it or not, you know? I mean, that's happening everywhere and it's converting a patient into just a subscription-based consumer.

Because once you start a hormonal-based medication, like testosterone, [snorts] it's not just like you're correcting a lab value, like you go to the clinic, "Man, my calcium is high. Okay, I'll do X, Y, and Z. Now my calcium's fine. Okay." No, I mean, this is a thing you're on, you're cycling on, you need to have the appropriate dose, you need to have regular lab checks done, regular physical exams done. So, those it's now an annuity.

That client, that patient becomes an annuity for these low-T clinics. They're going to come in at set intervals, they're going to get X, Y, and Z tests, they're going to get X, Y, and Z labs, they're going to get the labs read. They charge cash only, so each time the patient comes in, it's ching ching ching. They're going to make money off of them.

And so every incentive, like you were alluding to earlier, is to get more people in the door, get more people to get on it, rather than turn people away. I mean, is part of you know, as one of the studies in this testosterone thing, it looked at what was called the secret shopper, that they had this one guy go to seven different um direct-to-consumer um models, these low T cash pay clinics. He went to seven different clinics. Six out of the seven didn't even ask about his medical history.

Like at all didn't even ask about his medical history. Didn't ask if he's ever had any cardiac events, any family history of cardiac issues, or anything like that. Didn't ask about his fertility history, plans on getting uh becoming a father, or anything like that. They basically just showed up. They're like, "Oh, do you have fatigue? Oh, okay. Let's go send you for some labs." And then they were just readily >> [laughter] >> readily give him give him testosterone just like that.

I mean, it's crazy, but that's literally how easy it is. >> Yeah. You know, a lot of the safety data around testosterone replacement therapy comes along the study called the TRAVERSE study. The TRAVERSE study was uh it's a great study.

I mean, it's it was done really well, and it was in patients who had either history of cardiovascular disease or or they were at high risk for cardiovascular disease, and they were studied and uh the it was and it was the endpoint was MACE, like a major uh adverse cardiovascular events. And at the end of study, it showed that testosterone replacement therapy was pretty safe for patients with cardiovascular disease or high-risk cardiovascular um you know, risk factors.

So, we know that testosterone replacement therapy is actually can be beneficial for a lot of patients, and it is safe to do in people who have heart disease. But that study was done in patients who were truly indicated for uh testosterone replacement therapy. These patients had hypogonadism, primary hypogonadism. They needed testosterone replacement therapy. They had all the symptoms. They had low T levels below 300, which were checked twice before 9:00 a.m.

So, it was done in the appropriate patient, and in those patients, it showed that the cardiovascular events were equal to people who were not taking testosterone. Um but most of the people the study was not done in in a 35-year-old with no real indication for testosterone replacement therapy. Their testosterone level may be 500 early in the morning, and when they check it at 2:00 p.m., it's maybe 200 now.

And those patients getting testosterone replacement therapy, we don't know how risky that could be and the how what kind of uh uh adverse events it could have because we have not done those studies. We haven't done studies of testosterone replacement therapy in young healthy individuals. And what that can do, right? We don't have those large-scale studies to show that. And the government just recently removed that cardiovascular um uh label from testosterone replacement >> box warning, right?

>> warning based on the study. >> [clears throat] >> It it it it added another uh um uh warning that it may cause hypertension. Now, if you're if you're if the news headline that you're showing is that, "Oh, yeah, there's no concern for heart disease with testosterone replacement therapy and go ahead and do it." Those getting unindicated testosterone therapy uh are not included in those trials.

And those who don't have hypertension and in whom uh these drugs may cause hypertension are not included and they may have adverse cardiovascular events. So, we have to be very careful in what is in the headlines and what truly the study says and most people are not looking at that.

They're they're listening to Joe Rogan, they're listening to all these guys that are promoting testosterone replacement therapy, but they're not closely looking at the studies where where where where it tells you the the real data is in the right patient and not just in every Tom, Dick, and Harry. >> Yeah, and I mean, it you know, just one extra safety data point doesn't change the fact that there are real side effects and real issues that come from this all the time.

I mean, in orthopedic surgery, we see patients a highly disproportionate number of patients that get pec tears, biceps tears, triceps tears, Achilles tendon ruptures, all of these musculo-tendinous, these myotendinous injuries, such a high percentage are in patients that are on high testosterone. I mean, it's almost like I would say in the last 4 years, pretty much 100% of the patients that I've treated with a pec rupture are men. No women. All men.

And like maybe I don't know, maybe 70, 80% of them are on some form of either testosterone, some steroid. I mean, I I just ask them. Like I just tell them like, "Listen, don't [ __ ] me. Like we're about to do a surgery together. You got to tell me straight up. Like this isn't a joke. Are you taking something or not?" And like they they are I mean, people are very honest when you know, they're agreeing to go unconscious and let you cut them open. They'll tell you whatever.

Um it's just crazy how many dudes are on this stuff. And >> We have the numbers, right? We have the numbers. It's There's a PDM P data from 25 participating sites. Uh It found that um um more unique testosterone recipients in 2022 than in 2018, which is a 27% relative increase uh from um 2018 to 2022, which is a huge amount of a huge >> It's a huge number in just 4 years. >> a huge increase in just 4 years. Yeah. Um uh the conventional increase from 2018 baseline is about 36%.

It was a total of 36% increase from 2018 baseline to 2022. >> I guess COVID and all of the people sitting indoors listening to podcast, they were like, "Yep, let's go get shot up with it." >> Yeah. Yeah, I mean, you know, after COVID there was a big push, "Oh yeah, like, you know, be healthy, take testosterone, take zinc, uh take your vitamins, you know." Uh >> Yeah. >> "Do not take medications." There's a that and we've talked about this.

There's a distrust in you know, mainstream medicine and what these scientific studies show. >> just like so stupid. I mean, I I still just can't get over the fact that these idiots, you know, like I I I Joe Rogan has some interesting stuff and I I do like some of his stuff but he was talking about it like when he had his ACL surgery.

I think I brought this up before but like he was like, "Yeah." So, he was talking about his surgeon who did his surgery who was a doctor and obviously you trust this guy to cut your leg open and fix it.

And then he's talk I think it was a segment with Mark Zuckerberg and he was talking about all these weird supplements to do to promote healing and Zuckerberg was like, "Oh, I don't haven't heard of that or my doctor didn't tell me that." And Rogan was like right after talking about how his surgeon did a great job. He's like, "Oh, yeah, don't trust doctors. They don't know anything.

You should be on this, this, and this." And I'm like, "What?" >> He's like, "Yeah, just cuz doctors cut your leg open but not to take a stupid supplement." It's just ridiculous.

>> Yeah, I mean but right now some of the some of the mistrust that we brought upon yourself by a lot of doctors just not really being showing the compassion or or just thinking that oh yeah, like you know, kind of looking down upon patients over the years especially during the COVID times though like yeah, you're dumb, you're not wearing a mask, you're not getting the vaccine, like stop doing that.

Like you know, kind of speaking down to patients and that kind of pissed off a lot of people and maybe that was the wrong attitude a lot of physicians and the scientific community took, right? This higher-than-thou attitude that for years doctors have had.

So, I can see why patients or people have had that mistrust but you know, the the data doesn't lie and scientific studies doesn't lie and the scientific process doesn't lie and that's something we we keep promoting through this podcast and for whoever few people that listen to us we don't have such a big following as as Joe Rogan does or or Andrew Huberman does but you know, what we can talk about is not a 25-person study in some obscure journal.

We we like to talk about studies with large human population that are randomized controlled and what the true data shows and what's practically doable for most people, right? >> There it is. Yep. >> Yeah, speaking of Mark Zuckerberg, you know, our last topic of >> Yeah, it is timely. >> Timely. Yeah, so it's interesting. I mean you're talking about mental health and and kind of having a human in the loop, right?

We've talked about human in the loop during prayer, during psychedelic therapy, having the doctor being the trustful person that you can go to for testosterone replacement therapy, but Meta is also kind of having a human in the loop when they're maybe monitoring younger adolescent you know, individuals chats and looking for any signs of mental health or suicidal behavior and they're sending alerts to parents that their kid could be in danger something harmful to themselves, which is a very interesting idea in this day and age because um uh >> Yeah, it's like a semi-controversial safety feature, I think, right?

Like Instagram And it's so there's two different ones. So Instagram has its own thing and then the Meta AI has its own thing. So Instagram will flag if it sees like a teenager who has a teen account on Instagram is searching suicide stuff, how to commit suicide, suicide-related content. It'll send an alert to the child's parent cuz that's how the teen accounts work. It's linked to a parent.

And then the Meta AI is if uh similarly a teen is interacting with it, asking it questions, having a discourse with it relating to suicide and it seems to get the gist that oh [ __ ] this kid may be suicidal or they're contemplating it, they're depressed, whatever, it'll similarly with a human in the loop it won't automatically give a message to the parent, it'll get flagged for whatever characteristics uh they deem are risky for suicide and it'll go to a human reviewer and then if it's confirmed and obviously it errs on the side of caution, it will send a message to the parent.

But it raises big questions like what the hell do you do now? You know what I mean? Like obviously as the parent you should bring it up, but there's so many more questions that come up. I mean, what kind of home is the child in? Is it a single parent home, dual parent home? Is it a a happy home? Is it a broken home? Is it an abusive home? Is the caregiver/parent even going to care? Are they going to act in an angry way? Are they going to lash out?

Are they going to punish the child rather than actually, you know, connect and you know, discuss it? Um not everyone is able to have a discussion like that, right? Unfortunately, not all human beings can talk about things like potential suicide and and all of that stuff in a mature way and in a way that's going to make someone want to share.

So, I mean I I don't think it's necessarily a bad thing that there's this flagging process, but um there's not really like a set pathway to go about it once it is so-called flagged.

>> Yeah, it and it's a it's a sensitive topic as well to discuss as well and you got to be, you know, careful of what we say uh because a lot of people are going through a lot of mental health struggles and um but, you know, mental health is a huge issue and we we've talked about this in the past where people are using a lot of times uh ChatGPT, Claude, or Gemini as uh as kind of like their counselors, as someone they're talking to on the side when they're mentally disturbed and they can't really talk to another human.

Unfortunately, no one's using Meta's AI. Uh you know, [laughter] but uh >> Dude, when I read this, I didn't even know Meta had its own AI. I'm like >> have the Spark >> Now, who the hell doesn't have their own AI, you know? >> Yeah, they have a Meta Spark they just released and they're claiming it's going to be good eventually one day, but >> But, I guess, you know, if back in the day in the AOL Instant Messenger days, if Smarterchild existed, I mean, everyone can have their own AI.

Smarterchild was like the OG AI, dude. >> Yeah. Yeah. Yeah, but, you know, I think uh I think it's important cuz we've talked about this in the past, right? I mean, what if uh on ChatGPT, someone is going in and kind of um having these discussions and you know, the sycophant that ChatGPT can be it kind of agrees with it and kind of gives starts giving it ideas and you know, it has led to some people committing suicide in the past. Now, is there a way to safeguard against that?

And I think it's important to safeguard against that. It's it's safe just like you know, we're we're we're we're supposed to look through and I don't I think meta is supposed to look through Facebook and Instagram for people who could possibly be planning some mass shootings as well, right? They've they've kind of flagged those as well. Uh and it's mental health the same way if someone's is planning self-harm it should be flagged.

Now, where does that leave you know, privacy versus you know, preventing something harmful like that and I think uh it also doesn't account for people who are maybe talk in a certain way or joke around sarcasm or they're neuro divergent and they don't have know how to express themselves properly and they're they're just talking. How many times will meta raise false alarms to parents and every time a uh a kid says something odd online parents get notified.

Where will that leave a lot of these companies? And at what point it'll become like you know, um cried wolf uh kind of situation where >> Yeah. >> parents will keep getting alerts and they'll be like, okay, not this again. >> Yeah, it's like alert fatigue sets in and you just start ignoring the alerts. Kind of like an electronic health record. Like every patient chart you open there's like 15 alerts on the chart.

>> sepsis alert sepsis alert like every patient has sepsis alert and you're like, no bro, they're not septic. Like what are you doing? >> [laughter] >> This guy's here talking to me. So >> You're right. >> So you know, at what point the decision the the alert fatigue will set in but uh possibly alerts could lead to a catastrophic you know, if if they don't alert someone it could be more catastrophic where someone may commit suicide and all the signs and symptoms were there online.

So it's it's a hard discussion hard topic to talk about and I I don't know how I feel about it.

I mean uh God forbid if my kid was contemplating something like that having those thought I want to know right away so I can intervene and I trust myself to be there for them and intervene and you know show them love and encouragement and tell them I'm there and and seek out the right uh avenues for people who don't know and calling 988 if you're struggling with mental health is is is the number to call uh in the US or even 911.

But 988 is a mental health uh uh number to call but I could do that but uh not every adult in the household is a safe adult that and and some of these uh softwares may alert the wrong adult the parent that may not be the safe adult in the house and that could be harmful as well for the kids so >> Yeah and especially like I mean think about the reality that there's a lot of abuse and what if a child a teenager is becoming suicidal and depressed because of their parents and then those parents get that alert I mean they're going to be in that setting maybe even less likely to uh try to help the child.

I mean I don't know it's just >> [snorts] >> to have an alert about something so serious without like an actual pathway um I mean maybe it absolves the company now from possible litigation right because they have alleged they've taken a step they've sent the alert on to the responsible adult of this teen but what then? I don't know. >> Yeah. >> It just seems incomplete.

>> Yeah it's tough so but you know I think the key here is uh always keeping a human in the loop not depending too much on the AI not depending too much on the robot not depending too much on um you know uh psychophants or people who are trying to sell you things that are obviously harmful for you and having a trusted human in the room who you can trust, have a relationship with them.

And the human touch, you either being there in person playing music to you or praying with you goes much further than any robot or AI software that's there for you. All