Prostate Care, Hormonal Balance and Men's Mental Health with Dr Ralph Esposito (podcast #44)

November 12, 2019 51 mins read

Prostate Care, Hormonal Balance and Men's Mental Health with Dr Ralph Esposito (podcast #44)

We've got Dr Ralph Esposito (or Dr Espo as we like to call him) back on the pod today. We're stoked to have this legend on the show with us again, especially as we're celebrating the bro's this month for Brovember. Today Dr Espo shares his insights on men's health, particularly in areas of prostate care, men's hormones and men's mental health. With his extensive experience as a naturopath, licensed acupuncturist and functional medicine practitioner, Dr Espo is an absolute weapon of knowledge in his field of expertise, so strap yourself in and enjoy the ride. 

Mason and Dr Espo bro down on:

  • The link between cortisol and prostate health.
  • High insulin as a driving factor of dis-ease.
  • The risk factors involved in prostate cancer.
  • Keeping up to date with your GP for regular prostate exams. 
  • The male hormonal cascades.
  • Testosterone and oestrogen.
  • How the liver supports hormonal balance.
  • The diet and lifestyle interventions a man can embody to prevent testosterone aromatisation.
  • The importance of men's mental health and the shame that often surrounds it.
  • Male "man-o-pause, aka andropause.

 

Who is Dr Espo?

Dr. Esposito is a naturopathic physician, licensed acupuncturist and functional medicine practitioner specializing in Hormones, Integrative Urology and Men's Health. His precise and personalized style embodies a progressive approach to medicine. He has been published and is a peer reviewer in well-respected medical journals. Furthermore, Dr. Esposito has authored several medical textbook chapters and has designed education modules for health professionals specifically on urological conditions, fertility, male and female hormone dysfunction, Low Testosterone, exercise, fitness, men’s health and sexual dysfunction. He has trained at NYU Integrative and Functional Urology Center. Dr. Esposito also holds a position as adjunct professor at New York University where he lectures on integrative medicine.

 

Resources:

Dr Espo Instagram 

SuperFeast Deer Antler 

SuperFeast Ashwagandha

 

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Check Out The Transcript Here:

 

Mason:  Dr. Espo, welcome back, man.

Dr. Espo:   Wow, thanks so... I can't believe I'm back for almost, what is it, a third time?

Mason:   Yeah.... I've never said this before, but you're a friend of the show.

Dr. Espo:  Yes. [crosstalk 00:00:19]... I'm the best friend.

Mason:  Was it three years ago when we first had our chat over on my old podcast? Yeah, a second time having you here, and we're recording a little bit before, but now we're in Brovember. We're celebrating men's health, I was going to talk to you anyway, but one of the reasons I really wanted to have you on again is because in the last year for Movember... I don't know if everyone knows Movember. I think it's pretty synonymous with November now, you shave off, you grow Mo, and it's all about raising awareness and money for prostate health essentially. Is that right?

Dr. Espo:  Yeah, for cancers that impact men. So testicular cancer, prostate cancer, and also male mental health.

Mason:  Yeah. Nice. But I'm really awesome, and I learned a lot from you, so if you're not on the Instagram we're doing a lot of sharing of Ralph's posts especially through that last year, November and all the way up until currently. So get over there and look at those because there's heaps of juicy stuff, but we're going to be going into it today as well. And with Brovember, of course, we are going to be focusing, yes, and including those particular cancers that are affecting men, especially going to be looking at prostate health, but we're blowing it out into men's health.

Mason:  We're going to be of course talking about mental health as well, but blowing out into like all areas of health that are affecting men. So bro, let's start diving in. Now, of course, prostate health is something that is... I feel we just had a little conversation before about how you're still working in that clinic that you mentioned in the last podcast, which is awesome. And we were saying how, it's a little bit easier for you to get the patient's history, but often it's so incomplete and just how it's one of those things where when you're a bit younger you just don't value your medical history and how it's like, you don't value getting your taxes and finances in order until stuff starts hitting the fan. You go, "Oh shit, yeah, I really got to get on top of this."

Mason:  I mean, it's like that with prostate health is one of those things. All we need to do is just get a little bit of insight now, especially if you're a bit older, but when you're young, ideally start really understanding your physiology in your anatomy. So let's dive into prostate health. Do you want to just go start with just jamming with us about what it is and its function?

Dr. Espo:  Yeah. So the prostate is a gland that sits beneath the bladder. And if you're a man over the age of 40 or 45, sometimes 50, your doctor has probably stuck his finger in your rectum and did a prostate exam. And it's probably one of the most exciting things that men love to look forward to once they reach 50. But no, and in all honesty, it's an important test to get done because the prostate has... its primary function is for sexual function. It creates a fluid that allows your semen and your sperm to survive to inseminate or to impregnate an egg.

Dr. Espo:  Now, it's there your whole life, but as you get older, your prostate can start to enlarge and it also is susceptible to cancer. Now, the great thing about prostate cancer is that most men will die with prostate cancer than from prostate cancer. And the great thing is that it's also typically a very slow growing type of cancer. So what I usually tell men is by the time you're 65, 70 years old, you probably will have some type of prostate cancer cells in your body. That doesn't necessarily mean that they're going to kill you and it doesn't necessarily mean that they're going to be a malignant.

Dr. Espo:   But I want to make sure that I'm protecting my body and preventing any type of cancer cells, especially prostate cancer, but any cancer from growing, because it seems to be one of the most prominent cancers in men. So it's a really important cancer to get on top of. And also it's easily to, well I don't want to call it easy, but it's one of the cancers that can be treated rather well compared to other types of cancers like pancreatic.

Mason:  And especially, just with lifestyle you mean?

Dr. Espo:  Yeah. So for prostate cancer, prostate cancer is largely a cancer of lifestyle. So there are genetic causes that contribute to it. So there is the BRCA gene, which is often associated with breast cancer, but in fact there are individuals who do have a BRCA mutation that can increase their risk of prostate cancer. So whenever I asked a man, speaking of family history, I say, "Hey, what's your family history of prostate cancer?" He might say, "Oh, I had an uncle had prostate cancer. And then I say, "Well what was your family history of breast cancer or ovarian cancer?"

Dr. Espo:  And they tell me, "Oh yeah, my mom had breast cancer or my sister had breast cancer." I'm like, okay, that tells me that it's a possibility, although it's not entirely likely not for certain that if your sister had breast cancer, she had a BRCA gene, but if she had a BRCA gene, it's possible that you too, you do as well. And that makes me super vigilant in making sure that your prostate cancer or your potential for prostate cancer is very low to minimum.

Dr. Espo:  So we know there's a lot of lifestyle things that increase the risk of prostate cancer. And we know that a plant-based diet, which is really hard to define, but we know that those who eat more leafy greens, berries, fruits like pomegranates, tomatoes, those are the foods that you want to have to protect your prostate and staying away from charred meats. And then you come into the conversation of sleep and then exercise, right? So all of these things together will reduce your risk. And there's a bunch of men who may have the BRCA but don't necessarily get prostate cancer. And I think that's where the lifestyle come into play.

Mason:  All right. So then with prostate cancer, you mentioned family. I just wanted to just throw in that, I remember there was a post too about brothers and if your brother has prostate cancer, the percentage going up. And so I obviously in the same family of that, but that was a pretty, that percentage was quite high. It's just worth knowing, I guess. Then let's stay in the preventative world, I guess like everything we've talked about, especially on that last podcast, we've talked a lot about herbs for men's health. Obviously you're not going to be able to focus on any area, whether it's testosterone optimization, sleep, the inclusion of certain herb's and adaptogens like Ashwagandha and Mucuna without largely affecting the prostate gland, I imagine. Is that just, obviously because you've created an environment where harmony can somewhat ensue or is prostate effected by high levels of stress as well or is there no real link there?

Dr. Espo:  No. No, no. okay. So a really good follow up question to this is what do you mean by stress?

Mason:  Yeah, well that's really great. Are we talking like what in terms of clinical markers, are we talking about hormonal markers with stress, are we talking about like a stealth stress that's in the mind? And that's really, really good distinction there. And I'd love for you to just take it in any way you feel is relevant.

Dr. Espo:  Yeah. So when it comes to stressors and prostate cancer, it's almost an arguable to say stress in an umbrella form is not going to be harmful. So in other words, stress is harmful for prostate cancer. And the reason why and most of the time what we see is that individuals who are highly stressed, which is often measured by cortisol because it's one of the major stress hormones. The other ones are the catecholomines like epinephrine, norepinephrine, adrenaline, noradrenaline those are basically our stress hormones. And then you have stress markers like interleukin-1, interleukin-1V, interleukin-6, et cetera, TNF, right? So all of these are markers, they fall within the umbrella of stress. And then they cause inflammation, right?

Dr. Espo:  So chronically elevated levels of cortisol can impair your immune system. And there's one immune cell that we know that is super helpful to protect against prostate cancer and those are NK cells, also known natural killer cells. And you're going to love this because mushrooms significantly improve the production of NK cells. It's one of the ingredients in there called AHC C, which is found mostly in mushrooms that increases the synthesis of and NK cells, which are targeted towards cancers and one of the cancers that has most effect on his prostate cancer. So-

Mason:  So good.

Dr. Espo:  Yeah, so if you wanted to develop an environment for prostate cancer to grow, to thrive, suppress the immune system, throw a bunch of inflammatory markers at it, and then feed it a diet full of sugar and you created a soup that prostate cancer will certainly love. I'm not sure exactly, it's actually hyperinsulinemia. Very, very high insulin levels for long periods of time, which will cause increase in IGF levels will cause prostate cancer cells to grow. It's not just the red meat, charred red meat, it's not just the stress. What I think is the catalyst is the insulin triggered by increased blood sugar, but also insulin can be triggered by increased cortisol levels.

Mason:  Can we just jump down the IGF a little bit? I mean, that insulin growth factor is something I've looked into. Especially when I got ask questions because it's obviously in existence in deer antler. A little bit different for us because we're using a deer antler velvet that isn't isolated yet here are a lot of there are a lot of isolated supplements out there with IGF in there. And I saw that it was pretty non conclusive with deer antler at least. But I was like, I couldn't say in terms of whether it was going to be an aggravator in those instances where... Even if there's a susceptibility and women asking as well in terms of having that same gene that makes them prone to breast cancer. I don't know if you've got any take on it?

Dr. Espo:  So is the question, does IGF, or exogenous IGF cause or is a major contributing factor to cancers?

Mason:   Even if it's just like a suspect? Yeah. Something like... Whether you know that or whether it's something you suspect?

Dr. Espo:  Yeah. So I think it's not just the IGF. Right... So a measure of IGF is growth hormone.... sorry. IGF is a measure of growth hormone. So you can measure growth hormone in the blood. It's highly inaccurate because it's pulsatile, which basically means growth hormone releasing hormone that tells your pituitary to release growth hormone. And that happens at various times throughout the day. So if you were to just take a random check of your growth hormone, that doesn't give you much information because it's just what was your growth hormone on November 2nd at 8:24 AM in the morning, right?

Mason:  Yeah.

Dr. Espo:  But IGF has a longer half-life and last longer. So by looking at IGF, you can look at growth hormone. And by understanding what growth hormone does to certain cancer cells, obviously causes them to grow, but there's a curve on it and it's we're at very low growth hormone levels the risk of Alzheimer's and cancers increase or high as you increase growth hormone, those things decrease. So the risk of cancers and Alzheimer's and chronic diseases decrease as you start giving more growth hormone. It's a super physiologic level. So very high levels of growth hormone, the risk goes up again.

Mason:  Got ya.

Dr. Espo:  It's like a U-shaped curve.

Mason:  Okay.

Dr. Espo:   And so when you tell me, does IGF cause cancer, number one, I'll never tell you that something causes cancer, but can it promote? Well, it depends on the environment that you are in. So there's a lot of bodybuilders who just take straight up insulin. I would say that is a higher risk for certain types of cancers. Actually, we know insulin can increase the risk of cancers. So I would say when you have to weigh the risk per verses benefit and really understand what is the relative risk, let's just put it into perspective of having a Snickers bar, it's probably more likely to increase your risk of developing a cancer promoting environment than deer antler or taking an exogenous type of supplement that might increase your own endogenous production.

Mason:  Yeah, man. Then that's the getting a like a... I always like to play around in the buffer of having a herb or is this a much an extent even like supplementation and minerals and all that kind of stuff within the whole form, majority of the time it gives you that buffer. But I like that man. It's cool. Thanks for giving me that perspective on that. And so with prostate health and when we get into testing, can you just jam a little bit about the PSA testing and just any myths around that and how we can actually be grounded and levelled and responsible in terms of how we're testing and then managing enlarged prostates or prostate cancer. If we get to that point at which we hopefully obviously don't because we're on the prevention bandwagon.

Dr. Espo:  Right. I was just having this conversation with a colleague the other day and a patient, and they're like, "Well, my doctor said I shouldn't test PSA." So okay, so you're 54 years old, your insulin levels at 18, which is high, your fasting insulin is that 18 typically it could be less than like 10 or nine. That's micro units per milliliter, and your doctor's telling me that there's really no point of testing PSA. So what else are you going to do to screen this guy to make sure he doesn't get prostate cancer? I'll just do a rectal exam. Those are highly insensitive. So basically the risk or the chance of you catching a prostate cancer on a rectal exam, if you are not a urologist is close to like 40% or 50% of the time.

Mason:  What have you got?... Obviously you've just got specialized training with urology. What are you particularly looking for? Just the feel?

Dr. Espo:  Just what you're feeling for.

Mason:  Yes.

Dr. Espo:  Right. So what's your feeling for is a nodule, you're feeling... So what I usually tell people is like if you make a fist, right, a normal-

Mason:  Don't tell me that's how you test? (laughing) Then you're doing it wrong.

Dr. Espo:  What kind of medical school did you go to? Okay. So if you are a urologist or a doctor and what's your feeling for is if you make a fist with your left hand, the palm, the left part of your hand, like at the bottom of your thumb, your femur eminence is a normal prostate. If you go on the opposite side of the culture to your pinky side, that's a boggy prostate. That's usually an enlarged prostate. And then you feel your knuckle. That's prostate cancer. So really hard is prostate cancer, normal buoyancy is.. Normal prostate and then really like just soft and mushy is more, more like an enlarged prostate. So that's when you do a DRE, what we call a DRE was a digital rectal exam.

Dr. Espo:  You're trying to see, number one, what is the size? Is it large or small? Do I feel any nodules? Is the median sulcus there? Which is like a little indentation, like a Walnut is that there? If that's not there, then that means the process is getting bigger. And then you obviously check for tenderness. So if I press it, does it hurt? Prostate cancer typically doesn't hurt, but prostatitis will. So if you're telling me that your PSA is elevated at seven, but you're telling me a burns on your pee and when you ejaculate, you're having pain, probably a prostatitis probably an infection or a chronic non bacterial prostatitis I'm less inclined to think that that's a prostate cancer also depends on your age.

Mason:  How would you, [crosstalk 00:17:56].

Dr. Espo:  So let's say you had.

Mason:  Sorry.

Dr. Espo:  Had-

Mason:  No, no, no, I was just going to say with prostatitis, in terms of treatment do you go about that with just a different, you're just like case by case or do you have a protocol?

Dr. Espo:  It depends on the type of bacteria that's found. So you can do a.. Basically you could do a urine test or you can do a prosthetic massage test. So you'll get a urine test, test that then you palpate the prostate. So you basically press the prostate, try to get a sample from that and then see if there's any type of bacteria that are growing there.

Mason:  Right. Got you.

Dr. Espo:  So then that'll determine what the therapy will be. Now, look, you don't always have to go with antibiotics, but it depends on the duration and how bad it is. Now sometimes you'll find the bacteria with a person who is asymptomatic. And I would say, I don't know if we really need to go ahead and aggressively go after this, but it depends on the individual. My concern with a non-treated prostatitis or a prostate infection, is it becoming a chronic non-bacterial infection. And I see that all the time because you have a lot of urologists are, a lot of men won't go to the doctor. So if you're listening to this podcast, please, if you take nothing else from this, just go to the doctor and get a checkup. Just have your doctor examine you.

Dr. Espo:  So men won't go to the doctor, at the end when it's all resolved or they're feel like they're okay two months later, they're in chronic pain and there's no bacteria there because that bacteria has caused so much inflammation to the nerves and the prostate tissue that they can't recover. So as a naturopathic physician, my last option is an antibiotic, but it doesn't necessarily mean I'm completely opposed to it. Right. Because we then have to consider, like for example, if you're a 95-year-old woman who has a BMI of 17, and you have the pneumonia, I'm not giving you, oregano oil, go on antibiotics because your risk of dying is very high. So I take that approach with it. But certainly there are herbs that can be used that are natural antibacterial, antifungal, antiparasitic herbs that can help fight a prostate infection. The issue is that the prostate is such a hard area to reach.

Mason:  Yeah. Have you looked at other ways besides orally like have you in terms of suppositories or enemas or anything like that?

Dr. Espo:  Yeah. So those antibacterial herbs will not cross the colon or the rectum to get to the prostate. But there is research showing that the probiotics that colonize your colon will also colonize your prostate.

Mason:  Like bifidus?

Dr. Espo:  It depends on, I'm not sure which strain it was, but I know that when they gave individuals, whatever strains that they were giving them as a probiotic, it changed the flora in their prostate as well.

Mason:  Okay. Wow.

Dr. Espo:  So they do communicate and those nerves also communicate. So the nerves that impact your prostate also are impacting your rectum and your colon. So the first thing I ask men, well, who have our prostate chronic prostatitis. I asked them, "Well, are you eating dairy and are you constipated?" I look at those two things. I say, well, you're probably, if you're constipated, you're probably causing irritation to those nerves, which will also cause irritation to the prostate.

Mason:  Yeah. Right. Okay. So you get that colon connection there. Big time with the prostate. Right. Okay. Well let's-

Dr. Espo:  Speaking of the PSA, yes you can... I would check PSA. I checked PSA density, so I check how high is the PSA compared to the prostate? So just put it in comparison. A small prostate should make very little PSA and the large prostate will probably make a little bit more. But if you have a small prostate and your PSA is high, I'm more concerned than if you have a big prostate and your PSA is high.

Mason:  Okay. What ages are you recommending going and getting checked?

Dr. Espo:   It depends. So you know, you were discussing if you have a brother your risk of prostate cancer goes up. Typically, if a man has a first degree family member with prostate cancer, I'm screening them at about 40.

Mason:  Okay.

Dr. Espo:  Right. And that is only to get a baseline.

Mason:  Yeah. Right.

Dr. Espo:  Especially 40 if they're black or African American. All right.

Mason:  Yeah. African Americans are really prone to prostate cancer, right?

Dr. Espo:  They are more prone to prostate cancer than-

Mason:   African, like those African genetics.

Dr. Espo:  African or African American or black will typically have a higher risk of prostate cancer. They actually have a higher risk of aggressive prostate cancer. And that's the prostate cancer that you want to kill.

Mason:  Is that because I know that folks.. African folks are a little bit more susceptible to kidney deficiencies as well.

Dr. Espo:  Kidney again, so...

Mason:  Kidney deficiency in general. I mean, and I don't know if that's obviously in proximity might be a little bit of a connection. I don't know?

Dr. Espo:  Yeah. I haven't thought about it in that aspect. It's something that I think you should look into. I haven't thought about it that way.

Mason:  I mean, I haven't really either. That's kind of like just a little bit of a hobby looking at the elemental deficiency, constitutional stuff that comes out of Taoism and classical Chinese medicine. But I'll look into it. I'll put it on the list Ralph.


Mason:  And then when once you get past those inflammatory conditions and you start edging towards the realms of their being prostate cancer, how do you then gauge, when is it time to intervene using whether it's palpitation, PSA levels, age, so on and so forth. When is the surgeries rife? Right? People are getting rushed into prostate surgery. And there's like a lack of appropriateness. It's like none of you ever like practice much martial arts, but there's one thing you'd learn is an appropriate reaction to the stimulus, right? So if it's just a drunk friend, it's just like, cool, we'll just get him down. It's not an appropriate time to be breaking arms or choking out or anything like that.

Mason:  And that seems like the word cancer is thrown in someone's face and it's like no matter what type it is, it's like that same reaction having a very intense reaction to just a drunk friend that just needs to be cuffed a little bit. And I know some prostate cancers could definitely be aggressive. I'm obviously curious, I'm not an expert in the area, but what's appropriate action? Is rushing into surgery necessary? Are the levels of surgeries going on necessary. Is everyone getting hysterical about it? Let's dive in.

Dr. Espo:  I am so happy you asked that question because I don't if your viewers, obviously your viewers can't see the smile on face right now because I love that question. And you should actually just take a screenshot and just say, this is how Ralph is smiling.

Mason:  Oh, don't worry. We've got the video recording as well. So guys, you can jump over on Instagram TV or YouTube and catch the video.

Dr. Espo:  Let me make sure my hair's good.

Mason:  Yeah. I should've told you that.

Dr. Espo:  Okay. So I love this question because there are different types or grades or ratings of prostate cancer. So we usually rate prostate cancer based on something we call a Gleason, right? So a Gleason is a score that a pathologist will take a prostate tissue and say this patient has a Gleason. So the Gleason score is one to five, and you get two scores, so to a some of 10. So the pathologist can look at one set of cells and say this is a Gleason five, like that's really aggressive, poorly differentiated, this is a bad looking cancer. And then they can look at another one and say, well this one's also a Gleason five. This is also really poorly differentiated, really aggressive. You are a Gleason 10.

Dr. Espo:  I've seen a dozen of those where it's just like there is no option here. You have to have your prostate removed because this is really, really bad. So now the AUA, the American Urological Association suggest that prostatectomy or prostate surgery should be considered when you have a Gleason six or above... I'm sorry, a Gleason seven or above is when you should start considering that. A Gleason six is borderline. So I'm a little bit of the thought that you should really take in the totality of the presentation. So number one is how quickly has the prostate level been increasing? So if you went from prostate level of one to two to three to four over four years, I'm concerned, that's increasing quite, quite rapidly. Or if you're going to one to two, to four to eight, that's a doubling time. That's extremely risky. So that's something you take into consideration.

Dr. Espo:  Then you do something called The 4KScore and a 4KScore takes into consideration four different types of PSA. So when you get a regular PSA scores, you're giving you total PSA, you could also do free PSA and then The 4K add two more PSAs. And those, you have an algorithm, when you take into consideration and you include all of them, you get a score and if the score is above seven, your risk of having an aggressive prostate cancer is high. But if your score is less than seven, 7%, then your risk of having an aggressive prostate cancers is lower. So I used that as a consideration as well.

Dr. Espo:  Then you look at family history and then you look at diet and lifestyle. Like if you smoked and if you drank and if you ate like crap and you have this family history and you had a Gleason six, I'm probably going to tell you, you know what, let's be very, very aggressive with this. Then I would say we should do MP-MRI, which is called a Multi-parametric MRI, which is a very, very specific and very advanced MRI that can look at your prostate and identify nodules very, very clearly and then also identify how risky they are for prostate cancer.

Dr. Espo:  So your question was very simple, but it's a very complex scenario and algorithm. And essentially what it comes down to is urologists are a little bit more, they're really a bit more excited to do surgery because look, their thought is, well, if I see a sign of cancer, let me just get rid of it so there's very little to no risk. Rather than saying, Oh, let me just watch it. But a lot of men don't want to have prostatectomies, they don't want their prostate removed because it can lead to incontinence. It can lead to erectile dysfunction. It can lead to chronic pain and it's not a cure....

Dr. Espo:  If you miss a little bit of your prostate during the surgery, there's a risk of it coming back. Now, it depends on if it's spread or not, but I've seen men who get a prostate removed, their PSA is zero and then two years later their PSA is at like 0.8 and I'm like, huh. Point eight is low, but it's high if you don't have a problem with prostate. There are some breast cancers that can cause a PSA to increase, but that's like a canary in a coal mine. So you have to take all of these things into consideration.

Dr. Espo:  What I usually tell men is see two urologists and then see a integrative naturopathic functional medicine doctor who understands urology, who understands prostate cancer so they can really just be your quarterback and show you, "This is the whole picture. I'm not here to remove your prostate and I'm also not here. I'm also here to make sure you live forever. I have your best interests in mind. I don't have your pros... You know, the surgery is not my best. It's not in my best interest. So let me give you my, you know, 40,000 foot view."

Mason:  Are urologists often surgeons as well?

Dr. Espo:  Yes. Most of the time they are, there are urologists who don't do surgery, but most of the time they do.

Mason:   [inaudible 00:31:07] Yeah. So what do they call them? Scalp jockeys.

Dr. Espo:  I can't remember that.

Mason:  I get it. If you've got a particular skill and you've been trained in a particular way, you want to play the safe game, but is it the safe game longterm, they don't have to be there 20 years from now with you when you don't have a prostate, so.

Dr. Espo:  Right.

Mason:  So man, thanks for that. Such good information. Really good. It's bringing up a lot of reminders for me, I can make sure I'm staying onto it, but especially, just being able to have this information to share with like family members fathers and all that. So it's like, yeah. Awesome. Now testosterone levels in general we've talked about in the last pod how we don't necessarily, we're not necessarily aiming to just have like through the roof testosterone levels that, having it in levels we can't even prove that increased levels are going to relate to like super increased output and it's generally just making sure that it's not bottomed out or super excessive. Is there an association between testosterone levels and prostate issues? First of I'll ask you that quick snappy question

Dr. Espo:  Prostate issues as a totality of prostate cancer?

Mason:  Well, just as a totality.

Dr. Espo:  So increased dihydrotestosterone and its metabolites can increase your risk of enlarged prostate and some type of prostate cancers, but it's not the testosterone that is the issue. So I answered your short question with a short answer, but if you really want me to go in, I can.

Mason:  Yeah. Well let's go. What's the issue there? Because obviously beyond prostate health, this is going to have a huge effect on our overall health.

Dr. Espo:  Yeah. So what we've found is that the dihydrotestosterone, there's a beta and an alpha metabolite we call 3 alpha diol and 3 beta diol. And those are metabolites of DHT, and DHT alone can bind to androgen receptors, it binds to androgen receptors with a significantly increased affinity compared to testosterone. That's why a lot of men who take testosterone and they get acne or they get alopecia. So they lose their hair. That's because of the androgen gen receptors. So it has all to do androgen receptor sensitivity.

Mason:  Really? They get alopecia from testosterone therapy?

Dr. Espo:  Yeah, they certainly can. Yep. But then you have to look at the DHT and its metabolites. And the literature shows that the metabolites, these alpha and beta dial metabolics of DAC combined two estrogen receptors, and if the estrogen receptors that can cause the prostate to become poorly differentiated. So there's SGO receptors that cause the prostate to grow largely, but not maliciously. And then there's estrogen receptors that cause the prostate to grow maliciously. And it's the metabolites of the HT that bind to those receptors that cause it to grow maliciously, malignantly cause it to grow, what we say poorly differentiated, which then will cause the prostate to be more prone to prostate cancer.

Mason:  So is it estrogen mimicking?

Dr. Espo:  It's not estrogen mimic? Well, that an interesting question. Is it estrogen mimicking? I guess if you had defined estrogen mimicking as the ability to bind to estrogen receptors, then yes, it would.

Mason:  All right. Are those are the same... I don't know much about these pathways, but always what sticks in my head is 16 alpha hydroxy estrone being one that is turning on that I don't know if this is like a bit generalized, but the genes that can lead to prostate and breast cancer, is that kind of in that realm of those receptors that have been here?

Dr. Espo:  Different, actually a little bit different. So it's the four hydroxy metabolite of estrogen, so the 4OH estrogone that is more detrimental. And what it does, it causes DNA adducts. So actually, it does bind to estrogen receptors, but it actually goes into the nucleus, bind to your DNA and breaks up these DNA bonds and causes DNA adducts. So it genuinely destroys your DNA directly, whereas the two hydroxy estrogone is less likely to do that, is a little bit more protective and is has a lower affinity to make DNA adducts.

Dr. Espo:  And a great way to get rid of four hydroxy estrogone and two hydroxy estrogone is with methylation. And as you know with the Dutch test, which I just think it's an exceptional test, you can test those metabolites in your urine and you can also see how much of that is be converted to the methylated forms. And that'll tell you, are you capable of getting rid of these things if and when you are exposed to them.

Mason:  Cool. Okay, great. I mean, yeah, like we love Carrie. And I think the ladies have had it. We've recommended Dutch tests a lot, but of course, guys, and I'm really feeling it. I don't know, I'd love to get in there myself and get some actual, there's some real live panels going, so worth going and doing. But so I mean, this is something that comes around to springtime at the moment here. It's liver season and we just naturally go in there and just increase those methylators and whether it's just the B12 and betaine''ss and broccoli's and MSM, methylsulfonylmethane and so on and so forth. Just I guess really good to just get in there and clean house as well. The cruciferous vegetables. Right?

Dr. Espo:  Absolutely. And I think beyond that is why not just get it at the source and prevent your body from aromatizing all of this testosterone into estrogen, into E1.

Mason:  So then we do go into the conversation of aromatase inhibitors. I mean, I know a favorite is nettle root? I guess like a passion flower kind of fits in there.

Dr. Espo:  Passion flower has crisen in it. Yep.

Mason:  Okay. And that's, and that's what's causing that action?

Dr. Espo:  Yes, it is. Doses have to be very high, however. A high dose will be-

Mason:  On which level?

Dr. Espo:  Of crisen.

Mason:  Of crisen, okay.

Dr. Espo:  Of crisen. So the doses have to be higher because it's absorbed pretty poorly. So there is one company, I don't know the name of it but they do like liposomal and-

Mason:  Livon it. Is it those guys, the little satchels? The little-

Dr. Espo:  I don't remember. What was it called?

Mason:  L-I-V-O-N. Livon.

Dr. Espo:  I don't remember. That might be them. I don't use very much. What I do is I try to establish a lifestyle that prevents you from aromatizing because I think that has a larger impact. It's kind of like taking a piss in the ocean. If you.. If you try to take a piss in the ocean, it feels like you're doing something, but in the grand scheme of things, you're really not doing too much. So I think making sure you're having a low insulin type of diet or diet that is not conducive to hyperinsulinemia and I bet is void or limited and alcohol because alcohol will induce aromatase enzyme. You exercise and keep body fat down and weight train and keep your anaerobic activity high so that you can induce growth hormone and testosterone and keep cortisol levels down because those are the things that will push you to aromatase.

Mason:  Speaking of training, man, you're looking good.

Dr. Espo:  Oh yeah. I actually injured my shoulder recently. So my-

Mason:  So you're like this is nothing?

Dr. Espo:  You don't look so big anymore. I said, yeah, because all I could do is work out my legs. So I said, "Give me till the summer. I'll have a bottom just like J-Lo.

Mason:  I notice how jacked curves we're looking. In terms of training, just briefly... your life revolves around the optimization often, and therefore you've been a men's health specialist. It's like a very, very relevant for us to take a peak into the routine. What type of training you're doing, and then off the back of that, just have you got any supplements and things that you've taking around your training routine would just be like really nice to just get an insight. And you say a lot on the Instagram, so I'll say it for you. You don't say that what you take, everyone should take. So this is just Dr.Espo's routine.

Dr. Espo:  Yeah, this is my own personal routine. So my type of training revolved around weight training with very little rest. I don't do a lot of power lifting. I'm not trying to be the world's strongest man. And my goal of training is to induce an anaerobic response to increase lactic acid in a very short period of time in order to induce an optimal hormonal response. Because we do know that lactic acid in a very short burst will cause your body and your lighting cells to make more testosterone. That we know that is the mechanism by which we think weight training increases testosterone. So that's number one.

Dr. Espo:  I don't do endurance exercise, so you won't catch me running a half marathon. The most, I'll probably run it as a five K because you know, beyond 45 minutes of endurance high intensity or high zone, zone four, zone five or zone, yeah, zone three, zone four type of wei.. Endurance training, you will start increasing cortisol levels at approximately the 45 to 60 minute Mark. So you won't catch me doing that. Instead, I do short bursts of exercise that allow me to increase my aerobic capacity. So that would be like the Airdyne or I'll do like the Tabata type of training as part of my cardio. And then my downtime is yoga and stretching.

Dr. Espo:  So I am not a yoga expert. I would love to be because my mobility is crap. But beyond the mobility part, I find that we do need a little bit of... I mean, I live in New York, man. It's intense. It's stimulating. And I think yoga is a great way to just zone yourself out.

Mason:  What style of yoga's are you doing?

Dr. Espo:  Yeah.And then my supplements are, I do creatine monohydrate. I do beta alanine, I do some branch chain amino acids because I do time restricted feeding. So I typically only eat for about six to eight hours of the day. And if I work out fasting, I want to make sure that I'm optimizing my muscle synthesis. So branching amino acids helped me do that. And then all my other... my herbs, I do rhodiola, ashwagandha I actually do some deer antler as well. I actually, honestly, I love yours. I've noticed the best impact with that. I know a few other companies, I've used it I'm not saying that to brown nose, I actually find your product to be very good.

Mason:  Thanks man. Yeah, it's a really good product. I'm really proud of that one.

Dr. Espo:  Yeah. And surprisingly, I kind of liked the taste of it, so don't [inaudible 00:43:28]. A lot of people are like, "I hate the taste." I'm like, "Oh, it's actually not that bad."

Mason:  Yeah, I agree.

Dr. Espo:  And then yeah, that's pretty much it. And then B vitamins and et cetera and fish oil.

Mason:  On the fish oil as well. You got to get those omega's in.

Dr. Espo:  Yes, absolutely. I do a lot of flax and chia, but I like to get my EPA and DHA straight, so I do that.

Mason:  Yeah, of course, man. So good. Hey before, you know, we've gone on for a little bit here, but we've got a while longer for possibly the most important conversation we'll be having in Brovember is around mental health. Suicide levels have been crazy high. Unacceptably high in men, in the Western world. I might just like open... Let's just open that book and dive down. Do you want to just like start us off in this conversation and your work around it?

Dr. Espo:  Yeah, I think this is a really important conversation to have because a lot of men don't really realize that one of major killers in men under the age of 30 is suicide or accidents or homicide. And it's really important to discuss because approximately 20% of all accidents and injuries are due to suicide in men, depending on your age. So usually from like 20 to about 35 is when you're at the highest risk. And as you get older, that risk tends to decrease. But I really want to emphasize the fact that mental health is super important and it's important because you need to know when you're not well, and it's okay to say when you're unwell. I think there's a little bit of a stigma around saying you're mentally fatigued or anxious or depressed or moody, right?

Dr. Espo:  It's like, no, only women can be moody around their period. Like, no, that's bullshit. Number one, not all women are moody around their period and men can be moody too. So it's okay to say that you're feeling that way. And certainly it's a life risk factor for young men. And I actually see it a lot more because I see more men, but you see young men who have the pressures of being like their dad or being like they're superheroes, right? And they want to do performance enhancing drugs and they want to take testosterone and they want to do all these things to improve their appearance or the way they appear to social media, right? But in the inside, all that shit is fake.

Mason:   It's all fake.

Dr. Espo:  It's all fake. My Instagram feed when you go into the search has bunch of guys like with six pack abs, eat this, not that have this to lose body fat. Like not everybody is like that.

Mason:  Well, and that's the thing about training. I mean... Dan Sipple, who introduced us, he was on the podcast and we were talking around about the shame sometimes that we have around building testosterone at this point. And really coming into this place where we're really potentiating ourselves, especially if you are aware of just how stupidly superficial and boofy, the #Gains Instagram fitness world is that doesn't necessarily seem to have much intention.

Mason:  And I think the other thing around these physical trainings is they're not embedded in a philosophy that has any ancient roots or any genuine intention that a human, a healthy human would have towards being just a beautiful person for themselves and community and have longevity in the way that they are, that they can continue just to, right up into the end, be able to have a chuckle and stay you know, contributing beautiful person.

Mason:  And so I think it's always important to realize how detrimental all that stuff is to mental health. And then where I found myself in when having my identity crisis. I wasn't in the bodybuilding kind of world, but I was definitely in the excessive health world that leads you down towards more orthorexia in obsession with what I was eating. But then you start getting into this like exasperation of like, if it's not about that identity crisis, if it's not about that, what is it about?

Mason:  And if there is that, well if they're, there's is, as I said, there's a that quagmire, which seems to not be, you can't on the mesh that desire to potentiate your physicality and be a robust human without associating with that part of yourself that historically had the identity wrapped so far up and in high up in those gains equaling you being a quality human or being someone that is worthy. And so I feel like that conversation is being had more and more. But not real question, I'll throw it back over to you now. I'm not necessarily the answer or anything, but yeah, you just brought that reflection up in me.

Dr. Espo:  Yeah. I mean I don't think there is an answer. I think the answer is just make sure you take care of yourself. You do need self care. You can't be macho and tough all the time. I meditate every morning. If I'm feeling down, I tell my girlfriend or I tell my family, "I'm not feeling well right now. Like I'm not doing okay." "Well why?" "Because I'm not sleeping or I'm stressed out over this." It's okay to say those things because they're there to help you and you need help sometimes. We can't be expected... just piggybacking on what you said, humans, we are social animals, we are group animals, and we do well when we have support and that's just how we've evolved. And we've seen this for centuries of just human culture and it's typically when we become supporting each other as when we can achieve the most.

Dr. Espo:  No one person has basically taken credit for the greatest inventions in the world, right? It's always been a collaborative process. And your health should be viewed the same way. If you want optimal health, it should be a collaborative process. So make sure you have the right social support, make sure you have the right access to foods, make sure you have the right access to doctors and physicians and therapists and acupuncturists and trainers and all of those, whatever you need. But build your clan so that it can support you. Don't expect to do this on your own.

Dr. Espo:  And I think that's the most important part about mental health is like, we do see a lot of mental health issues in today's society and we do see a lot of gun shootings. And whether that's a result of media or whatever it is, it doesn't matter. It's still exists and we should aware that it's manageable before it gets to that point.

Mason:  Couple of things just in terms of you talking to your family and just kind of say like, I'm not doing so well, not sleeping, not doing. I think the whole stigma around when men finally get to that point where they have to go down. It's like with the man flu, it's like tough and burly, hold on tough, tough, tough, tough. She'll be right, mate. And then if you do need to really go down, if you get the flu, the only way you can justify it as a lot of the time is to go into like victim and really sooky mode.

Mason:  And what you're talking about and just like has been really significant in my life is when you are asked like how you're doing, people who are close to you, of course you have to go around to saying it to strangers. But not needing it to be like really super charged and not necessarily needing to so much significance and victim- hood into it.

Mason:  Just being kind of like, how healthy it is just to release the pressure and just be like, "Yeah, not so great at the moment. I've just been like sad and I've been going down every now and then and not feeling like I have much motivation. I can't really see a point, whatever you know of. Although those are very significant feelings and you go and talk to someone. Even if it is like if it's not like a massive, big thing, just having like a real, it's almost a nonchalant sharing with your family. It doesn't have to come from like victimhood, but you don't have to do anything with them. You don't have to solve anything. It's just that gentle sharing consistently what you're feeling is really significant

Dr. Espo:  And it can make you feel better.

Mason:  Yeah.

Dr. Espo:  And that's really what we want. We just want you to be well, and just by saying it, "I'm not feeling so great right now." It's like, Oh, okay. I've been able to come to terms with that. Well, that's what meditation is, right? But I meditate every day. I'm thinking about a million different things while I'm meditating. But I still come back to my thought. I'm like, okay, I am thinking about those things, therefore I can overcome them and overthink them. Same thing about expressing your feelings.

Mason:  Yeah, that's significant in terms of many different styles of meditation, many different ways that you can practice and have reflection in the morning. But what you are speaking to is very simple, yet profound and almost can't be captured in one particular practice because it's synonymous with a healthy human who's giving yourself space to be like, ah, you know what? You would've just gone and distracted yourself all day. However, that obviously is very important to me and it's triggering a pattern and it's going to be playing out through my day. Maybe I can grab it and do something about it. That's so good, man. Hey, is there anything else you wanna say on that?

Dr. Espo:  No, I think we've hit all the right points. I just want men to know, you know, it's, we all feel that.

Mason:  Oh yeah, we do. I just went and had a recently at a good psychological little clean out to put it in a jovial sense. But I just went and had a week offline doing a bit of that work and feel all better for us and all the benefit of not having to do it on the sly and in the shadows.

Dr. Espo:  Absolutely.

Mason:  I'll let you go in a second. I just wanted to just quickly end on andropause. I know this is probably a huge conversation, but I know we probably have a somewhat of a handle on what it is, but can I just ask you from your perspective, what is andropause and what is it in very much if you want to get like energetic and spiritual about what it is for human, I'd kind of feel in that way. It's obviously a bridging, but physiologically I assume everything we've talked about is going to help us maintain an easy transition. But what can we prepare for and look out for in ourselves or when we're observing family members going through it?

Dr. Espo:  Yeah. I think in essence andropause or mano-pause or whatever you want to call it, is the point at which men start experiencing a change in their hormones. Similar to female menopause except female menopause typically happens sometimes like this, just like your hormones drop. Whereas men, I think after the age of 30, they lose about 1.1 to like 1.6% of their testosterone per year. All right. So it seems very slow progress and essentially it's a point in which a man feels less like his 20 or 30-year-old self. And it's a psychological experience. It's a physiological experience. Sex drive is lower. They don't recover from poor sleep as well. They don't recover from poor diet as well. They have more aches and pains from weight training. They're really sore after and they have sexual dysfunction and things like that.

Dr. Espo:  That is what... and then obviously they have low testosterone levels. They don't have low testosterone levels to be in menopause or andropause. So it's essentially a period in a man's life as to which they are experiencing these things, which can be contributed to low testosterone, but it doesn't have to happen when you're 50. So it can happen younger, but that we just call that hypogonadism or low testosterone or testosterone deficiency. But it can happen when you're like 70, and that's a normal response because over time your fertility does decrease and your brain does become fatigued if you're under the chronic stress of 70 years.

Dr. Espo:  So it's something that occurs frequently, but it's not necessarily normal. Like menopause, female menopause is a normal physiologic response. But with men, that doesn't have to be that way. And I think it's largely a lifestyle issue that's comorbid with obesity and metabolic syndrome and high insulin levels and weight gain and et cetera.

Mason:  Wow. So, yeah. Right. So it's like, it's just a little bit of a wake up call away then.

Dr. Espo:  Yeah. It's like, Hey, something's wrong here. The first thing I usually come in, the first thing to go is your sexual dysfunction. And when you notice that your penis isn't working as well, that should be a sign to say, all right, let me get on top of this because something's wrong.

Mason:  So I mean, it's almost like at that, when you kind of exit that lifespan and enter into that death span, right? Like I imagine it's that same like you've in a Taoist perspective, you've basically burned through your Jing and you therefore don't have the ability to maintain and manage, the function of the skeletal system, bone marrow and androgens. Right?

Dr. Espo:  Right. Exactly. So, in Chinese medicine, it's a Jing deficiency.

Mason:  All right. I love it. And it just the fact that andropause is a wake up call and you can start getting on top of your health now integrating all these things that we're talking about and not have to go through that process. You can give yourself a wake up calls in other ways that aren't as intense.

Dr. Espo:  Right.

Mason:  All right. Man, I love it. I really appreciate you coming on for Brovember and laying all this down. I know everyone else does. But let's tune in. Obviously you've got areas that you're deeply researching. Make sure you let me know when you start cracking into something like really new and juicy. Hit me up and we'll go for around four.

Dr. Espo:  You got it, man.

Mason:  I recommend everyone go and follow you on Insta. You really rocking it even just going back to your story highlights, you've got like a heaps of really deep information on there. Are you Dr. Ralph Espo, is that right?

Dr. Espo:  It's dr.ralphesposito.

Mason:  All right, Doc, I will put it in the show notes as well. And website?

Dr. Espo:  Right now it's just Instagram. That is under development.

Mason:  Okay. Sweet. Thanks so much, bro.

Dr. Espo:   (Thanks man. Thanks for having me. 



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