What to Ask Your Doctor Before Starting Testosterone

Man working on laptop at determining questions to ask his doctor about testosterone

Men everywhere are suffering with plummeting testosterone levels. A recent study showed that testosterone levels have declined over 30% in the last 30 years.[1] It has become such a problem that research now indicates that 1 in 4 men over the age of 30 has low levels of testosterone.[2

And declining testosterone levels are associated with significant health issues. Here are just a few symptoms men experience with low testosterone:

  • Low sex drive
  • Erectile dysfunction
  • Weight gain, especially around the midsection
  • Loss of muscle mass 
  • Fatigue and irritability
  • Loss of mental focus
  • Hair loss
  • Loss of bone density
  • Anxiety and depression

Does any of this sound familiar? 

Man with low energy and low testosteronehttps://drtracygapin.com/blueprint

When my patients complain that they don’t quite feel like themselves, I find they often have low testosterone. One reason men fail to recognize the issue is because the symptoms of low testosterone will often develop slowly over time.  

Men will often come to see their doctor when they struggle with erectile dysfunction, but low testosterone goes far beyond the bedroom. Having a good level of testosterone is vital for all aspects of a man’s health and well-being. 

If you suffer from any of the aforementioned symptoms, it’s time to get your testosterone levels checked by a doctor. In preparation for this visit, here are some key questions you should consider.

How Do I Know if I’m Low in Testosterone?

Testosterone is a hormone produced primarily in the testes for men (and at lower levels, in the ovaries for women), but small amounts are also produced by the adrenal glands. Testosterone is part of the endocrine system and its release and regulation is controlled by the brain’s pituitary gland and hypothalamus.

To test your testosterone levels, your doctor will run some blood work, usually in the morning since that is when your hormone levels are at their highest. “Low testosterone”, or hypogonadism, occurs when a man’s level falls below optimal levels. 

This brings up a critical question: “What is optimal?!”

Most labs define the lower limit of “normal” testosterone levels to be anywhere from 250 to 350 ng/dL, depending on the lab. The problem with this is there is a massive difference between what is considered clinically “normal” and what is optimal – i.e. what men need to actually experience the benefits of healthy testosterone levels. We’ll cover this huge topic in another blog post, but suffice it to say that men typically need much higher serum testosterone levels than what the clinically “normal” range suggests.

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What Causes Low Testosterone?

A man’s testosterone peaks in early adulthood and naturally reduces as he ages. Once he enters his 30s, his levels begin to decline about 1 to 2 percent each year. Some men don’t start noticing the effects of this decrease until they hit the age of 50, but there are others who start to show symptoms even a decade or two earlier. 

In addition to age, there are a number of potential causes for low testosterone. Injury or infection to the testes and malfunction of the pituitary gland can cause low testosterone, and diseases like obesity, diabetes and cardiovascular disease are all strongly linked to testosterone deficiency. Endocrine disruptors – chemicals and toxicants in our environment – are clearly a major culprit as well. 

Low levels of vital nutrients like zinc or Vitamin D have also been found to correlate with low testosterone. Certain medications can lower testosterone, including asthma inhalers, antidepressants, and antihistamines, as well as chemotherapy.[3] And a number of lifestyle factors, such as smoking, drug abuse, poor sleep, poor diet, and obesity, can lead to low hormone levels.

How is Low Testosterone Treated?

There are a few important concepts to understand before diving into treatment options for men with testosterone deficiency. First it’s key to recognize that treatment requires a comprehensive approach. It’s never as simple as just getting testosterone therapy. It’s critical to be aware that there’s no magical one-size-fits-all solution that works for every man. Treatment varies depending on each man’s underlying health issues, genetics, symptoms, and goals. 

A key aspect of addressing low testosterone is to address underlying health issues and develop healthy lifestyle habits. Losing weight has been shown to directly improve testosterone levels. Research shows that exercise, especially weight training or high-interval training, naturally boosts testosterone.[4] Proper nutrition and sleep are critical aspects of a comprehensive approach to overcoming low testosterone and its associated symptoms. Check out the MALE 2.0 Blueprint to learn how to start incorporating healthy habits into your daily life.

Another common approach is hormone replacement therapy (HRT). Hormone replacement therapy involves artificially raising your testosterone levels via a gel, skin patch, injection or hormone pellet implants.

What Are the Benefits of Hormone Replacement Therapy?

A number of studies back up the claim that testosterone replacement therapy can provide men with real benefits. Here are just a few examples, according to a recent academic review:[5]

  • Muscle gain and improved strength: Several studies found testosterone replacement therapy improves men’s body composition, decreases fat, and increases lean body mass and muscle strength.
  • Increased bone density: Testosterone therapy has been shown to increase bone density, especially among elderly men, which puts them at a reduced risk of injury. 
  • Improved sex drive: Testosterone replacement therapy increases men’s self-reported libido, as well as the frequency of sexual acts. 
  • Improved cognitive functioning: One study found older men’s risk for Alzheimer’s disease decreased by 26% for each 10-unit increase in free testosterone. Additional studies found testosterone improves men’s spatial, mathematical, and verbal reasoning, as well as their memory. 
  • Improved mood and quality of life: Men who receive testosterone therapy report an increase in mood and well-being and a decrease in fatigue and irritability. 

What Are the Risks of Hormone Replacement Therapy?

Clearly testosterone replacement therapy has its benefits, but it is important to realize it is not a panacea. Such therapy is considered most beneficial when used short-term to help your body get back on track or to treat an underlying issue like hypogonadism. But know that like all treatments, this hormone therapy comes with a number of risks and side effects that must be considered. 

Some side effects may include:

  • Acne and oily skin
  • Breast enlargement or tenderness (rare if treated properly)
  • Shrinkage of the testicles
  • Hair loss (rare)

Questions to ask about testosterone and HRT hormone replacement therapy

Additional Questions To Ask Your Doctor Before Starting HRT

 So you’ve decided to proceed with testosterone therapy. First, be aware that you should never attempt testosterone therapy alone –  it should always be done under a doctor’s supervision. But before you start, here are some key questions you should ask your doctor before embarking on a testosterone treatment plan:

  1. What Are Your Doctor’s Qualifications?
  • What expertise and experience does the doctor have in treating men’s health issues generally, and testosterone replacement therapy more specifically? 
  • How long have they been practicing this approach? 
  • Given that the science of HRT (hormone replacement therapy) is consistently evolving, how does the doctor stay up-to-date on the topic?
  • Do they attend conferences, read scientific journal articles, take training courses?
  1. Am I a Good Candidate for HRT?
  • What evidence is there that I need testosterone replacement therapy? 
  • If there is evidence, what potential causes does your doctor suspect?
  • Do I have certain medical conditions (like sleep apnea or an enlarged prostate) that make me a bad candidate for HRT?
  1. Can I Boost My Testosterone Naturally?
  • Are there things in my medical history or lifestyle that could be changed to improve my testosterone naturally?
  • Are there certain foods the doctor recommends to boost testosterone?
  • Are there certain supplements the doctor recommends?
  • How does sleep quality affect testosterone?
  • How does alcohol affect testosterone?
  • What changes in my exercise routine can I make to boost my testosterone?
  1. What Type of Treatment Does the Doctor Prefer?
  • What type of HRT does the doctor prefer (e.g., gel, injection, implant) and why?
  • How will the doctor determine which hormone dose is right for me?
  • How do they track results?
  1. What is the Expected Cost of HRT?
  • Does insurance typically cover the cost of the treatment?
  • What will my out of pocket expenses be? 
  • How long will treatment take?
  1. What Side Effects Are Expected?
  • Will there be pain or inflammation at the injection or implant site?
  • What adverse reactions should I look out for?
  1. What Improvements Can I Expect to See?
  • What symptoms should I expect to see improvements on after starting treatment?
  • How long will it take before I see results?
  • How often will I follow up with my doctor?
  • Will the doctor monitor my progress through routine blood tests or other means?


If you’re struggling with weight gain, low energy, fatigue, diminished sex-drive, or performance issues in the bedroom, know that it doesn’t have to be that way. You can overcome these issues and become unstoppable TODAY!

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In Male 2.0™, Dr. Tracy Gapin has turned everything we once thought we knew about men’s health and performance upside down. The old model of how to be “a man” is broken. A man who works himself to death.  Unfortunately, a man who tries to NOT get sick but isn’t really healthy either.  And a man who takes a pill for every ill but is never really cured. That was Male 1.0. Now, imagine being THE MAN ─ owning your performance in the bedroom, the weight room, and the boardroom. Living a fully optimized life. Becoming limitless. This is Male 2.0!

Tracy Gapin, MD, FACS  is a board-certified Urologist,  world renowned Men’s Health & Performance Expert, Author, and Professional Speaker. Using state-of-the-art biometric monitoring, nutrition and lifestyle intervention, Dr. Gapin coaches Fortune 500 executives and evolutionary leaders of business, sports medicine, and high performance. He specializes in cutting-edge precision medicine with an emphasis on epigenetics, providing men with a personalized path to optimizing health & performance. www.GapinInstitute.com

Want more tips to optimize your health?  Listen to the latest podcasts. Click HERE

Men’s Health: Reverse Aging with NAD+

Aging is inevitable – but there’s a whole new frontier for optimizing our health through the latest genetic science and biohacking that can help you to slow down the aging process and maybe even reverse aging with NAD+.  NAD (short for nicotinamide adenine dinucleotide and also known as NAD+) has recently been getting a lot of attention as a cutting-edge tool to promote longevity.  

We’re taking it all the way down the cellular level here.

Properly functioning cellular metabolism is essential to health. The sum of every chemical reaction that happens inside the body, along with its molecular interactions, keeps the body in a state of balance. This is all made possible by coenzymes (“helper molecules”) and specific proteins acting as metabolic sensors that respond to conditions in the cells and body. NAD is a tiny coenzyme that plays an important role in this delicate dance. As you age, NAD+ decreases and with it goes cellular function that prevents disease and maintains vitality.

What is NAD+ and why is it important?

NAD+ is vital to cellular metabolism because it turns nutrients into cellular energy. It also activates a set of proteins called sirtuins that regulate cellular health. NAD+ creates the cellular energy that helps us to retain our youthful function, muscle strength, and physical stamina. When sirtuins were discovered they were quickly nicknamed “the longevity genes.” 

A fascinating aspect of NAD+ is its dual role in protecting against the factors that age us. This includes inflammation, DNA damage, and failing mitochondria (cell respiration). NAD+ promotes longevity by facilitating DNA repair and protecting mitochondria from early death. As a result, NAD lowers the risks for age-related brain diseases like Alzheimers or Parkinson’s and cardiovascular diseases (a leading cause of death for men). 

NAD is the building block for ALL of our systems such as the lymphatic, cardiovascular and nervous systems. It is responsible for our immune function, insulin regulation, and fatty acid oxidation. Without it, we would literally die!

Improving Health Through NAD+ Boosting Photo Credit: The Sinclair Lab

NAD+ and Aging

A NAD+ molecule isn’t consumed alone to create energy like fuel in a car. Instead, it works with proteins to carry out essential biological processes like cellular energy creation and maintaining healthy DNA. Sirtuins are some of the proteins that play a key role in these processes. They only function in the presence of NAD+ and this means that the body needs to constantly synthesize it to maintain cellular function. However, NAD levels markedly decline with age, creating an energy deficit that decreases the body’s ability to retain optimal health.

Sirtuins and NAD+ work together to help promote overall health.

For example, at age 50 a typical person may have only half the NAD+ they did in their younger years but by age 80, NAD+ levels drop to only 1-10 percent of the levels measured in youth. But recent studies have now shown that increasing NAD+ in the body can restore the body’s cellular function as though turning back time – actually slowing down the aging process. Essentially, men can reverse aging by restoring healthy levels of NAD+.

One study done on mice, showed an average 5 percent increase in their lifespan —even though supplementation did not begin until the mice were nearing the end of their natural lifespan of 24 months. That would be the equivalent of gaining nearly an additional four years of life to today’s average human expectancy of 79 years!

Another side effect of decreased NAD+ is that muscles begin to shrivel and grow weaker due to vascular aging (thinning and aging of blood vessels, reducing cellular health). Vascular aging is responsible for many disorders for men.  These may include cardiac and neurologic conditions, muscle loss, and impaired wound healing. The process can be slowed down with regular exercise, but gradually even exercise becomes less effective at holding off this weakening.  In further research findings, mice with NAD+ supplementation showed between 56 and 80 percent greater exercise capacity. This points to a reversal in vascular aging and an ability to maintain a youthful physical stamina. 

Furthermore, in two different animal models of neurodegenerative disease, increasing cellular NAD+ reduced the severity of the disorder, normalized neuromuscular function, and delayed memory loss.  Most studies started on mice, but more recently clinical studies have shown positive effects on humans. You can begin to see how crucial NAD+ is to a vital life – and how its depletion can rob you of this vitality as you age.

Reversing Aging with NAD+ Precursors

Most of the ways of increasing NAD+ do not include supplementing with NAD+ itself, but rather precursors to NAD+. There are 5 precursors to NAD+:

  • tryptophan
  • nicotinic acid (pyridine-3-carboxylic acid)
  • nicotinamide (nicotinic acid amide)
  • nicotinamide mononucleotide (NMN)
  • and nicotinamide riboside (NR).

We can get NAD+ in our bodies through diet.  This is done by consuming foods with NAD+ precursors in them – like fish, crimini mushrooms, and raw green vegetables. However, you can’t really eat enough of anything to significantly boost NAD+ levels. Taking a NAD+ precursor supplement can help mitigate the decline, improve cellular health, and even mitigate loss of telomeres.

NMN and NR are the most popular precursors found in the latest anti-aging supplements. However, NR (a unique member of the vitamin B3 family) has been found to be the most efficient. If you’re a wine fan, you may be familiar with another famous anti-aging compound: resveratrol. NR is 4x more bioavailable than resveratrol, quickly kicking the red-wine derivative to the curb.

It has a positive impact on Metabolism

NR doesn’t just have anti-aging effects, it has a positive impact on metabolism. Mice on high-fat diets with NR supplementation gained 60 percent less weight than they did on the same diet without NR. In addition, none of the mice on NR showed signs of diabetes. Instead, their energy levels improved. 

Nicotinamide adenine dinucleotide (NAD+) is an important target to extend lifespan and health span.

NAD+ Supplements

Renowned Harvard University geneticist David Sinclair is the pioneer in the supplementation business of NAD+ with Elysium Health. Although his anti-aging claims were first met with controversy because most studies had been done on mice (https://khn.org/news/a-fountain-of-youth-pill-sure-if-youre-a-mouse/), the study arena has since been expanded to human trials done at the Mayo Clinic and the University of Washington.  Gaining support of researchers at the top of their field, these human studies point to the same benefits found in our small furry friends.

Dr. Sinclair has conducted a study to show the effectiveness of his supported supplement, Basis.  Previous studies had shown an increase in NAD+ over a 24 hour period. His study sought to determine whether cellular NAD+ levels could be sustained over the entire study period of eight weeks, and it did.

In a placebo-controlled trial of 120 healthy adults between the ages of 60-80, participants taking the recommended dose of Basis saw cellular NAD+ levels increase by an average of 40 percent over baseline after 30 days, sustained at this number to 60 days. Participants taking twice the recommended dose saw those levels increase by 90 percent after 30 days and 55 percent at 60 days. 

ChromaDex, another leading anti-aging company has taken the running lead in scientific support for their supplement TruNiagen. With over 100 preclinical trials, 5 published studies and 3 FDA safety reviews, the evidence surrounding NAD+ supplementation is overwhelming.

It was previously thought that NAD+ could not be given in oral form and only intravenously due to poor bioavailability and low intestinal absorption.  Newer research shows that oral forms of NAD+ supplementation do have positive effects.  NADOVIM is one of the first and earliest supplements on the market to contain actual NAD+ instead of NAD+ precursors in its formulation. https://nadovim.com/top-5-reasons-to-take-nadovim-a-doctors-perspective/

Researchers are still willing to explore the value of IV infusions of NAD+. This is a new area for further, detailed study and could potentially be an effective delivery method in some ways. Preliminary animal study evidence suggests that intravenously administered NAD+ may hold some interesting promise. Currently, there are no pre-clinical or clinical human studies, but this is a fast-moving advancement in what we are learning about the way NAD+ and NAD+ precursors are processed in tissues and across the blood-brain barrier. Stay tuned.

How to Increase NAD+ Levels Naturally

Before you go out and buy a Vitamin B3 or NR supplement, remember that reversing aging requires a systems-based, holistic approach. There is no such thing as a magic anti-aging pill. NAD+ treatment in addition to other lifestyle changes and structures is what ultimately adds more years to your life. It is important to take a high quality NAD+ supplement.  Also, here are additional recommendations to ensure you increase NAD+ and its anti-aging effects.


Fasting, or reducing your calorie intake for extended periods, is an excellent method for indirectly boosting the body’s NAD+ levels. It has been shown that, fasting is effective in increasing NAD+ levels.  However, a drastic reduction in calorie intake or fasting long term can have a counterproductive effect. Consider intermittent fasting or adopting a low carb-ketogenic diet to provide similar positive results.


Exercise is one of the easiest and most cost-effective methods for boosting NAD+ levels. In a nutshell, exercise forces our body muscles to produce more mitochondria. The increased production of mitochondria results in a natural boost in NAD+ levels in the body.


Research has shown that too much direct sunlight exposure can deplete the body of NAD+ because our body uses NAD+ to repair sun damaged cells from over exposure to UV rays. Reduce exposure to strong sunlight and wear sunscreen.

Healthy Diet

Eating a well balanced whole foods diet full of NAD+ precursor rich foods is a one-way ticket to reversing aging. Be sure to add more of the following into your diet: 

  • Fish – Varieties of fish like tuna, salmon and sardines are rich sources of NAD+ for the body. Be sure to source your fish from sustainable, wild-caught sources.
  • Green Vegetables – green vegetables contain all sorts of nutrients in them which are beneficial in a variety of ways including NAD+ precursors. Of these vegetables peas and asparagus have the highest amount.
  • Whole Grains – high in Vitamin B3 which also contains RN. Remember that vegetables and grains that are cooked or processed lose their nutrition as well as the vitamin source. Therefore, it is recommended that you should also eat raw vegetables and choose whole grains (rice, quinoa, etc) over processed foods such as chips and cereals.
Reduce Alcohol Intake

Alcohol interferes with healthy cellular processes and reduces the efficacy of NAD+. In fact, alcohol consumption has been shown to directly reduce levels of NAD+ (and testosterone) in the body. 

NAD+ precursors, exercise and caloric restriction can increase NAD+ levels.
NAD+ helps you get energy out of the food you eat, it protects cells from stress, it maintains healthy sleep cycles and it helps your cells repair damaged DNA.


If you are looking for supplements that reverse aging, the NAD+ research is very promising.  It should be considered as a part of a holistic health plan for every aging male.  Without exercise and a whole foods diet, NAD+ supplementation will have minimal effects. For men who are looking to take their performance and health to the next level, NAD+ can give you that extra edge.

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In Male 2.0, Dr. Tracy Gapin has turned everything we once thought we knew about men’s health and performance upside down. The old model of how to be “a man” is broken. A man who works himself to death. A man who tries to NOT get sick but isn’t really healthy either. A man who takes a pill for every ill but is never really cured. That was Male 1.0. Now, imagine being THE MAN ─ owning your performance in the bedroom, the weight room, and the boardroom. Living a fully optimized life. Becoming limitless. This is Male 2.0!

Tracy Gapin, MD, FACS  is a board-certified Urologist, Men’s Health Expert, Author, and Professional Speaker. Using state-of-the-art biometric monitoring, nutrition and lifestyle intervention, Dr. Gapin coaches Fortune 500 executives and evolutionary leaders of business, sports medicine, and high performance. He specializes in cutting-edge precision medicine with an emphasis on epigenetics, providing men with a personalized path to optimizing health & performance. www.SmartMensHealth.com 

How to Prevent Prostate Cancer

Prostate cancer prevention - Dr Tracy Gapin

Did you know that September is Prostate Cancer Awareness Month? Organizations such as the Prostate Cancer Foundation (PCF) promote awareness and testing during the month of September, encouraging preventive testing and raising funds toward developing new treatments. (https://www.pcf.org/blue/) However, prostate health education is an important topic for men year round.

Prostate cancer is the most prevalent cancer diagnosed in men. The PCF estimates that 1 in 9 men in the United States will develop prostate cancer in their lifetime. It’s important to undergo routine screening and do everything you can to avoid prostate cancer. 

Routine screening consists of an annual PSA blood test and prostate exam. Screening should begin at the age of 50, unless you are African American or have a first degree relative with prostate cancer.  In these previously mentioned cases, testing should start at the age of 40.

Today we’re going to talk about some steps you can take to reduce your risk of developing prostate cancer. Remember that small decisions you make every day can go a long way!  

Prostate Cancer Awareness Month Topics:

Sex is Fun!

A study by the National Institutes of Health in 2004 initially suggested that frequent sexual activity might reduce the incidence of prostate cancer.

The Health Professionals Follow-up Study, which followed 32,000 men for 18 years, also supports this. Men with frequent sexual activity showed a 20% lower risk of prostate cancer. Jennifer Rider, the study’s lead author, suggests, “Safe sexual activity could be good for prostate health.” Studies also show that regular sexual activity reduces stress and improves mood.

Sex and prostate cancer prevention - Dr Tracy Gapin and Smart Men's Health Blog

How can exercise prevent prostate cancer?

Evidence is mounting that inflammation and oxidation both play key roles in the development of prostate cancers and other conditions. Fortunately, research from the prevention side suggests that regular exercise may be one of the best natural antioxidants.

A study published recently in the Journal of Clinical Oncology specifically evaluated the effects of exercise in prostate cancer patients. They studied men who exercised vigorously for at least 3 hours per week. 49% showed reduced overall mortality, and 61% reduced prostate cancer mortality, compared to men having less than 1 hour per week of vigorous activity.

Other studies show that exercise is effective at reducing risks of prostate cancer development, possibly decreasing prostate cancer development, and diminishing the side effects that may be caused by treatment medications. A recent Swedish study supported these findings, concluding that both resistance training and aerobic exercise clearly improve prostate cancer-specific and overall survival.

And, don’t forget that intense exercise can actually alter your DNA. A period of intense exercise can positively change your gene regulation.

Medications – Proscar and Avodart

Proscar and Avodart are prescriptions that men use to “shrink” the prostate by lowering the number of male sex hormones. The drugs block an enzyme that converts testosterone into dihydrotestosterone (DHT), a much more potent hormone.

The Prostate Cancer Prevention Trial (PCPT) studied whether finasteride (Proscar) reduced the incidence of prostate cancer. The trial found that men who had taken finasteride developed fewer prostate cancers than in men who had not. However, the men who had taken finasteride and developed prostate cancer had more aggressive tumors. The number of deaths from prostate cancer was the same in both groups.

The Reduction by Dutasteride of Prostate Cancer Events Study (REDUCE) studied whether the drug dutasteride (Avodart) reduced the risk of prostate cancer. This study also showed that there were fewer prostate cancer diagnoses in men who took dutasteride compared with the men who did not. Overall, Avodart did not significantly reduce the number of aggressive cancers though.

What about testosterone replacement therapy?

The news media has fueled concerns that there may be an adverse connection between testosterone replacement therapy and increased prostate cancer risk, but studies have not borne this out.

A recent study looked at over 1,000 men who were receiving testosterone therapy. Over the 5 years the researchers conducted the study, only eleven (or 1%) of the men’s doctors diagnosed them with prostate cancer. This is well below the historically-expected 7% incidence. These men did not appear to experience any increased prostate cancer risk with their testosterone replacement.

Another study assessed almost 150,000 men who had previously undergone treatment for prostate cancer and were currently receiving testosterone replacement therapy. Researchers found no increase in prostate cancer mortality or overall mortality in the men receiving testosterone.

A recent study actively monitored men with low grade prostate cancer. These men’s doctors were also treating them with testosterone therapy. The study concluded there was no significant progression of disease in these men either.

In fact, a recent report suggests that testosterone therapy may actually be therapeutic in men with hormone-refractory advanced prostate cancer.

Studies show that low testosterone levels correlate with an increased risk of prostate cancer. This finding is somewhat counter-intuitive given the scientific community’s longstanding notion that hormone therapy “pours gas on the fire” of prostate cancer. But the literature clearly shows that testosterone therapy does NOT increase your risk of prostate cancer.

Will statins help or hinder?

 Researchers have been interested in the possible connection of cholesterol-reducing medications and prostate cancer. Several of the 18 trials researchers conducted, revealed a reduced risk of cancer recurrence after both surgery and radiation therapy. These trials suggest that statins may reduce the progression of prostate cancer.

Ongoing research continues to look into this possibility, as well as to determine whether statins may also reduce the incidence of prostate cancer.

Metformin and Men's Health - Dr Tracy Gapin

How about Metformin?

Metformin is a prescription medication used primarily to manage diabetes. Studies suggest Metformin may have a protective effect on the progression of prostate cancer. A study of nearly 4,000 diabetic men found those men taking Metformin, when diagnosed with prostate cancer, were less likely to die from cancer or other causes than men taking other diabetes drugs.

Prior research looking at whether metformin might reduce the risk of prostate cancer development did not show a benefit. More studies are currently underway to look at both prevention and management.

What about taking aspirin?

The jury is still out on how or whether aspirin might help reduce the risk of prostate cancer. After extensive studies on aspirin’s effects, researchers found many of the studies demonstrated it had a protective effect and others did not.

If your doctor has you on an aspirin regimen after a heart attack or stroke, follow their current recommendations.

Are there other things I can do?

Absolutely! There are many lifestyle choices that will not only help you prevent prostate cancer, but also boost overall health and well-being, reduce stress, and improve fitness. Many of the dietary recommendations experts have already proven as successful for weight loss, will also reduce your risk of developing prostate cancer.

Your Diet Matters!

Start by adopting a diet lower in saturated fats and higher in plant-based fats. Your body and brain need fat to thrive, but studies have shown that a diet high in animal fats was more likely to be associated with an increased risk for prostate cancer.

A number of studies have shown that men who ate the most dairy products such as milk, cheese, and yogurt on a daily basis had a higher risk of prostate cancer. Studies are conflicting, but the mechanism could be because of the presence of saturated fat, insulin-like growth factor (IGF), or elevated hormone levels.

Some fats are superstars, however. Studies have linked the omega-3 fatty acids found in fish such as salmon, tuna, and herring to reduced prostate cancer risk. If fish isn’t your favorite, try a good quality fish oil supplement. Avoid trans-fatty acids, though, as numerous studies proved they promote cancer. The most common foods containing trans-fatty acids are butter and processed or fried foods.

BBQ’s are fun – but charred meat, not so much

Overcooking or charring meat creates carcinogenic compounds called heterocyclic amines. Animal studies have shown that these can cause prostate cancer. In addition, charbroiling red meat or chicken with skin produces another set of carcinogens called polycyclic aromatic hydrocarbons (PAHs). 

Research shows that intake of PAHs triggers mutations in prostate cell DNA, leading to a chronic inflammatory response in the prostate. We’ve already discussed that inflammation leads to an increased risk of development of prostate cancer. It appears that the combination of mutation and inflammation appear to be a key in this development. 

Steaming or baking meats, thereby avoiding overcooking meats, can significantly reduce the amount of carcinogens present.

The bitter truth about sugar

Cutting the amount of simple sugars and carbohydrates you intake may slow prostate cancer growth. Studies have linked excess sugar intake to prostate cancer growth through increased insulin levels. 

Compounding the problem, insulin resistance has been shown to reduce levels of proteins that are important for stimulating prostate cancer cell death. Numerous studies have shown that sugar “feeds” cancer cells. 

ANOTHER reason not to eat gluten

Doctors typically recommended adopting a gluten-free diet to aid patients with celiac disease, an inflammatory bowel condition. By reducing inflammation, a gluten-free diet may have a role in cancer prevention as well. Foods with no gluten include all fruits, vegetables, meat, fish, and eggs.

Many believe the vitamins and minerals present in fruits and vegetables reduce the risk of prostate cancer. Although, studies have yet to prove any specific nutrient guarantees to reduce your risk. Cruciferous vegetables have unique antioxidant properties that seem to enable them to counteract some of the damage caused by carcinogens. A well-rounded selection of fruits and vegetables introduces necessary enzymes and tends to make you feel fuller, so you have less room for other high-fat, high-calorie foods.

A tomato a day keeps cancer away? Well, it’s a pretty good start! Kudos for Prostate Cancer Awareness!

Several animal studies have suggested that lycopenes, present mostly in tomatoes, may reduce prostate tumor growth. Some human studies have shown that a diet high in lycopene may be linked to a decreased risk of prostate cancer.  Other studies are inconclusive.

Note that these studies utilize the whole, fresh tomato, not the sugar-laden spaghetti sauce. There is no data showing a benefit to taking lycopene supplements in lieu of the real food.

To reduce the risk of developing prostate cancer, men should reach for foods rich in antioxidants and nutrients and low in pro-inflammatory and carcinogenic substances.  Colorful fruits and vegetables, fresh herbs, leafy and pungent greens, seeds, nuts, and berries all contain powerful anti-cancer nutrients. 

The Mediterranean isn’t just a great place to vacation

Consider adopting the Mediterranean diet, loaded with fresh fruits and vegetables, tomatoes, garlic, fish, red wine, and olive oil. This heart-healthy diet may be very beneficial for prostate cancer prevention, and will keep the whole family fit and well!

30-Day Health Challenge for Prostate Cancer Awareness Month

Whether it’s Prostate Cancer Awareness Month or any time during the year, check out the 30-Day Health Challenge for Prostate Cancer Awareness Month. It was developed specifically to increase your knowledge around reducing your risk for prostate cancer, yet it is an excellent all-around way to rethink your lifestyle.

I designed the challenges to help you look at your current situation and consider areas of change and improvement. Many of the daily challenges will benefit women as well, especially Day 24, Day 28, and all of the other non-prostate-specific days!  

Regardless of your diet or lifestyle, knowledge is one of the biggest and best ways to reduce prostate cancer risk. By staying informed on the latest research and developments regarding prostate cancer research, men can make small changes that can lead to big improvements.

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Tracy Gapin, MD, FACS  is a board-certified Urologist,  world renowned Men’s Health & Performance Expert, Author, and Professional Speaker. Using state-of-the-art biometric monitoring, nutrition and lifestyle intervention, Dr. Gapin coaches Fortune 500 executives and evolutionary leaders of business, sports medicine, and high performance. He specializes in cutting-edge precision medicine with an emphasis on epigenetics, providing men with a personalized path to optimizing health & performance. www.GapinInstitute.com

Want more tips to optimize your health?  Listen to the latest podcasts. Click HERE

What is Heart Rate Variability and Why Does It Matter To You?

Fit man working out

Heart rate variability (HRV) has stormed into the mainstream health and fitness world as one of the best indicators of daily and overall well-being. It’s an effective marker for sleep, recovery, performance, and health of the heart and autonomic system. 

Studies also show that a higher HRV has been linked to a lower risk of mortality, especially for sudden cardiac death

HRV might be one of the best tools to tracking acute and chronic health concerns. So what is HRV and why does it matter to you? 

What is heart rate variability? 

Heart rate variability (HRV) is the variation that occurs in the intervals between consecutive heartbeats. 

Okay, but what does that actually mean? 

Let’s start with understanding your heart rate, which is not the same as heart rate variability. Your heart rate (HR) is the amount of times your heart beats in a minute. If you take your pulse on your wrist, your heart rate is the number of pulses you feel in a 60-second timeframe. 

Heart rate variability is actually referring to the silent period in between those beats or pulses. Your heart doesn’t actually beat at a steady rate. If you have a heart rate of 60 beats per minute, your heart isn’t actually beating every second consistently. There are slight millisecond variations between each heartbeat. 

We’re not like the Tin Man. Our hearts aren’t machines that beat at the same rate consistently. Our hearts are gentle, sensitive organs that have slight (but healthy) irregularities.

Although measured in milliseconds, you can actually feel the difference in the “silent” intervals between your heartbeats. Right now, put your fingers on your wrist and search for your pulse. Take a few deep breaths in and out. You’ll probably notice that the time between beats gets longer while you’re exhaling—that’s because your heart rate is slowing down. You’ll notice the interval gets shorter when you’re inhaling because of an increase in heart rate. Referred to as sinus arrhythmia, this is the most basic way that our heart rate varies. 

I’ll reiterate that you actually want variation in your heart rate intervals, because that shows that you’re healthy! 

How does heart rate variability change? 

Your heart rate variability isn’t a static number. It’s constantly changing based on different events and scenarios, both internally and externally. 

Keep in mind that heart rate variability refers to the variation of the intervals between heartbeats. It’s not a number or time period itself. 

So a “low” HRV means that the intervals between your heartbeats are more consistent and steady. There is low or less variability. For example, if your heart rate were 60 beats per minute, the majority of your intervals might be precisely 1 second. 

A “high” HRV means that there is a lot more variation in the intervals between your heartbeats. With a 60 beats/minute HR, you might have one beat after 1.03 seconds, another after 1.06 seconds, then 1.05 seconds, then 1.01 seconds. There is more variation in the time between the beats. 

How does heart rate variability work? 

Heart rate variability is directly linked to, and controlled by, the autonomic nervous system. HRV actually is an indicator of how well your nervous system is functioning. 

There are two sides to the autonomic nervous system: the sympathetic and parasympathetic systems. 

The sympathetic system is what triggers the stress-induced fight or flight response. It raises your adrenaline and cortisol, and it prepares your body to take action against some stressor. The sympathetic system should be activated as a short-term response to certain stressful events, but it can be seriously unhealthy for your mental and physical state to live in a high sympathetic state. 

The parasympathetic system is what helps restore homeostasis (balance) in your body by pulling down the response of the sympathetic system. This controls the rest, recovery, and digestion processes. 

When your body is stressed, the sympathetic system kicks into gear. This releases stress hormones and increases your cardiac output. Basically, it tells your heart to pump out more blood, so the blood can transport oxygen to the muscles and tissues—which will help you in the fight or flight response. When the sympathetic system is engaged, your heart rate variability decreases. Your heart is generally beating faster and more consistently. 

After the stressful situation is gone, the parasympathetic system activates to slow your heart rate back down to resting. This increases your heart rate variability to restore homeostasis. 

In general, you want a higher HRV. This is because a higher HRV, or more variability between heartbeats, indicates that your body has a strong ability to tolerate stress.

A high HRV indicates that your parasympathetic system is working. A low HRV indicates that your sympathetic system is engaged, which means you’re body is being stressed out (mentally or physically). 

Why is this important? Your body needs to be able to respond to stressors, so you don’t get eaten by a bear (for example). But you can’t live in that stressed state or it would do damage to your heart. Essentially, the autonomic system and heart rate variability enable your heart to respond to different needs and situations. 

Key point: If you have a low variation in heart rate variability compared to your baseline, something is likely stressing out your body. 

Why do we need to track heart rate variability? 

Heart rate variability is the biggest marker we have to the health and wellness of our autonomic nervous system. And the nervous system is tied to every automatic process in the body like regulation of blood sugar, blood pressure, body temperature, sweat, digestion, and more.

When we understand how our autonomic nervous system is functioning, we can better understand how almost every process in our body is operating. 

HRV is especially used as an indicator of fitness, our body’s ability to handle and recover after stress, and our heart health. A high HRV is an indication of a healthy cardiovascular system. A lower heart rate with a high HRV means that your parasympathetic system and heart are working effectively to bring your body back to homeostasis after stress or exercise. 

HRV is one of the most sensitive changes in the body. The interval between your heartbeats is one of the first indicators that something is wrong. Watching for these fluctuations can alert you to changes in your health well before other symptoms show up. 

What are some examples of when HRV might change? 

  • Stress or lack of sleep: Your HRV will likely drop when you’re stressed or sleep deprived, and you’ll need more time for recovery. 
  • Intense endurance exercise: Working out acutely lowers your HRV because your body is stressed out. But during recovery, your HRV will jump back up. If it doesn’t increase, you may be training too hard or too often. This is important to track if you’re on a fitness or training plan. 
  • Substances: Drugs, alcohol, and smoking all lower your HRV. You may notice that you’ll have a lower HRV after a night out because your body is stressed while trying to detox. 
  • Dehydration: Your HRV will lower quickly when dehydrated, because it doesn’t have the water it needs to function properly. When you re-hydrate, it should increase again. 

One of my favorites uses of the HRV is that you can use it to tell if you’re about to get sick. If your HRV goes down but you’re not stressed out in any way (mental or physical), you might be on your way to getting sick. In fact, HRV usually lowers even before you develop symptoms of sickness. So if you notice your HRV is lowering, you may want to take some time to rest and recover to combat any illness about to set in. 

What affects heart rate variability? 

Our heart rate variability actually changes every day based on activity, stress, and health. It’s constantly changing in response to different situations—and that’s a good thing! Heart rate variability can be affected by age, hormones, body functions, lifestyle, external events, and more. 

About 30% of our heart rate variability boils down to genetics. But the other 70% is completely controllable. You can actually improve your HRV based on your health, fitness, recovery skills, and stress resilience

In the last section, I’ll talk more about how you can direct your HRV to improve your overall health and wellness. 

How do you measure HRV? 

There are a few different methods to measure heart rate variability. One of the most popular ways is the ECG-based (electrocardiogram) method, which calculates the time between R waves in the QRS complex. These are referred to as R-R intervals. Some trackers use PPG, which measures interbeat intervals (IBI). 

Different trackers use different measurement methods. There isn’t really one “right” way to do it. So you can choose a wearable that’s best for your lifestyle and look. 

Which wearable trackers are best? Get all the info you need here: How Wearable Tech Is Revolutionizing and Personalizing Healthcare.  

How can I get started tracking HRV? 

Everyone has a unique heart rate variability based on genetics and lifestyle. There are also a lot of different ways to measure and track HRV, so it’s hard to compare different variations. So you’ll have to track your own HRV to understand what your baseline looks like in order to utilize HRV as an indicator of your personal health. 

First, you’ll want to find your HRV baseline. Note when you’re feeling “average”—not great, not bad— because that’s usually your baseline. You’ll want to keep track of this for a week or two to get a good idea of what your HRV is. If you have a tracker, it will usually help analyze your baseline for you. 

Once you have your baseline, it’s easier to see how your body is reacting. If your HRV goes down and you have a low HRV, your body might be stressed, overworked, or overwhelmed for some reason. You could have mental stress, you could be getting sick, or you might not be recovering effectively. If your HRV goes up with a high HRV, then you might be doing something healthy for you—like meditating or being creative. 

I recommend keeping a log of your HRV, whether or not you have a wearable that tracks it for you. This helps you understand all of the different variables going on in your life that could be affecting your HRV. For example, your HRV might decrease when you’re driving. If you log this several days in a row, you might start to notice that your HRV only drops in traffic—because traffic stresses you out! 

There’s a lot that can go into HRV tracking, so keeping a log is the best way to manage and analyze all of the factors at once. Learn more about how to keep a biohacking log here.  

How can I improve my HRV? 

Here’s what will decrease your HRV in the short term: 

  • Stress
  • Poor quality and quantity of sleep
  • Food intolerances, especially lactose
  • Alcohol and/or drugs
  • Sickness
  • Medications (antihistamines, antidepressants
  • Hot therapy 

Even exercise will decrease your HRV because you’re stressing out your body. Then, your HRV will start to increase as your body starts to recover. 

Here’s what will decrease your HRV long-term, which is a major indicator of poor health: 

  • Age (your HRV will likely change as you age)
  • Chronic stress or burnout
  • Poor diet 
  • Chronic inflammation 
  • Lack of fitness
  • Chronic disease
  • Lack of sleep
  • Overtraining
  • Unhealthy environment 

If your body is stressed out in any way for an extended period of time, it will show up in a decreased HRV. This means you’ll start to notice a downward trend in your HRV over time, and your “baseline” actually starts to get lower and lower. 

A low HRV over an extended period of time isn’t a problem on its own… It’s just an indicator that there’s something wrong. So if you notice this downward trend, it’s time to chat with a medical professional! 

But there are actually lifestyle changes you can make that will increase your heart rate variability by improving your recovery and improving your health. 

So what can you do to increase your HRV, in the short and long term? 

The awesome news is that these lifestyle changes also impact your epigenetics. Learn more about epigenetics and the impact on health with the following resources:

HRV is a tracker of your health, but not a health condition on its own. If you want to improve your health, it starts with hacking your genes. 

Are you ready to get your health on track? Want to know exactly how your body and heart rate variability will respond to certain situations based on your genes and lifestyle? Want greater control over your health and wellness? 

Then you need to check out my performance coaching. We’ll work together to unlock your genetic code and come up with a specific plan for your lifestyle choices and environmental factors so you can be on the path towards energy, health, vitality, and life! 

Take your life to the next level here. 

Want more tips to optimize your health and testosterone?

Listen to the latest podcasts. Click HERE

Tracy Gapin, MD, FACS  is a board-certified Urologist,  world renowned Men’s Health & Performance Expert, Author, and Professional Speaker. Using state-of-the-art biometric monitoring, nutrition and lifestyle intervention, Dr. Gapin coaches Fortune 500 executives and evolutionary leaders of business, sports medicine, and high performance. He specializes in cutting-edge precision medicine with an emphasis on epigenetics, providing men with a personalized path to optimizing health & performance. www.GapinInstitute.com