Episode #129 Men’s Health Expert Dr. Tracy Gapin: Testosterone, ED, & How They Affect Everyone

My guest today is a Urologist and Male Health specialist: Dr. Tracy Gapin. Before all my females run for the door, this conversation is about someone you love and yourself. Dr. Gapin and I don’t just talk about erectile dysfunction but also about the culprits of declining or poor health. A lot of the same things that impact men’s libido and ability to perform impact most people’s health. The erection is just an indication of something else going on in the body. All humans can benefit from Dr. Gapin’s approach to health and health care. We discuss how a simple mouth swab would let someone know which way may be best for them to eat based on their genetics. Some people win on a complex carbohydrate-loaded diet. Dr. Gapin shares ideas on simple ways to turn back the aging clock, navigate hormone supplementation, and what types of blood workups to ask your physician about. We touch upon the impact of watching too much pornography and the right ways to pull back if watching it begins to destroy your real-life sex life. At the end of the show, Dr. Gapin gives a generous invitation to my listeners to get his book and other info. Enjoy

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Men’s Health Expert Dr. Tracy Gapin: Testosterone, ED, & How They Affect Everyone

My guest is a urologist and male health specialist, Dr. Tracy Gapin. Dr. Gapin specializes in male health. Before all my females run for the door, this is about a conversation about health. The joke is that when a guy gets a cold, men would be good at addressing their health issues. Typically, what will get them to the doctor, besides a serious health issue, is their sex life. We talk about erectile dysfunction. What you realize is that’s an indication that other things are not going well.

These same issues impact all of us. If you’re a female, it shows up differently. This is a conversation that could benefit any of us and certainly someone that we love. He gives you clear ideas on how to turn back the aging clock and navigate your hormone supplementation. Maybe you’re getting a little older and you’re doing a lot of the right things but you do want to supplement because you’re feeling tired or you’re not recovering the same. How do you start that? What are the ways to go? What do you ask your doctor for? What blood work do you need?

This is another great story of a real doctor who had a pretty customary practice and thought, “This is disease care versus health care.” He scratched it, opened up his own place, and gets down to the fundamentals of health, which is our lifestyle. Having said that, he does talk about how genetics can impact us and how we can learn about that. For example, certain swabs that we can do tests. All you do is swab the cheek and you realize that based on your genetics, maybe you’re somebody who does well on a complex carbohydrate diet even though everybody says that’s taboo.

I appreciate his thoroughness. This is about all of our health. This isn’t just about, “I’m a guy. My penis isn’t working.” This is about backing that into seventeen other questions. How is your sleep? What are you eating? Are you exercising? How’s your stress life? Are you watching too much pornography? All these types of questions can help us arrive at better solutions and put us more in charge of our health. I hope you enjoy.

Dr. Gapin, welcome to the show. I’m excited to talk to you. Doing my homework, you talk a lot about how women address things a little bit more meticulously. There are statistics. If a man has chest pain, he’s quicker to deal with that than a woman when we talk about heart attacks and things. We’re like, “We’re fine. We’ll push through.” Conversely, men don’t sometimes know how to start tackling their own health situations and issues. Things like erections or erectile dysfunction are great motivators. You are focused on the overarching men’s health.

I’m fortunate to be with you here. When we look at high performance, which is what I like to focus on, it’s about how do we help men take charge of their health and recognizing that we’re pretty bad about it? We tend to be passive and reactive and wait for a problem whether it’s chest pain or some other issue. I’m a board-certified urologist. I’ve been practicing for over twenty-plus years. I’m focused on men’s health.

What’s interesting is the one thing that seems to find a guy’s attention is sex. Their arm could be falling off, they could be diabetic, they could be 50 pounds overweight, and they’re like, “No big deal.” Suddenly, when the sex isn’t working as it should, that’s when they finally seek attention. I published a book called Male 2.0 a few years ago to try to transform that paradigm and help guys to think differently, be more proactive, live with intention, take charge of their health, and not wait for problems like ED or chest pain to set in.

Maybe we could baby step it. I want to get to the performance element. You’re a urologist in traditional practice and you realized it was more about disease care than health care, so to speak. Doing this show, I see more and more people like you out there. It makes me hopeful. All the different parts of medicine taking this approach are going, “It’s not working.”

They’re not just in New York City and Los Angeles but they’re in Kansas. You’re in Sarasota. It’s showing up in all these pockets. On the one side, it’s hopeful that there are more and more doctors like you that are saying, “We have to look at the whole practice.” I’m always fascinated about your own journey. In the beginning, you were navigating something with yourself. Maybe you could share how you got to this place.

I had a busy urology practice. I focused on robotic surgery and kidney stones. I was up all night in the hospital. I was focused on my career that I was neglecting my own health. I reached a tipping point where I woke up one day and I’m 30 or 35 pounds overweight. I have no energy, I’m fatigued, I can’t focus, I can’t sleep, and I feel like crap. I knew something was wrong. I found that our health care system is not made for that. It’s disease care and crisis care. I didn’t have a formal diagnosis.

It got me down this rabbit hole of health optimization, human performance, genetics, and longevity. I found my true passion and purpose as I researched this and I was able to transform my own health. I started sharing the same concept with my patients and they were having amazing results. That got me to where I am now where I jumped off a cliff and left a lucrative Urology practice so I can open the Gapin Institute for high-performance medicine and do what I love doing, which is human optimization.

If you’re a urologist, you’re equipped with a lot of information and access. I’m always curious about the thinking. I have this in my own experience. There are things I should be doing. I know better. Somehow, I don’t have the time or I’m not fitting it in. What was it that shifted your thinking from knowing better and maybe not practicing it? Not just in your work life but in your personal life, what were the catalysts that got you to go, “This isn’t working anymore.” This is what keeps most people back in the first place.

Most people know what to do. How do you do it? How do you live with intentions and stay true to what you know is necessary? For me, that concept started with studying epigenetics, which is the science of how our lifestyle and behavior affect our bodies’ function and how we have control over how our bodies behave. As nerdy as it is, that got me down the science of how lifestyle matters and how we can change a lot of things.

[bctt tweet=”There is no best diet or nutrition on the planet. It depends on what’s right for your body.”]

I like to joke that as amazing, wonderful, and powerful as I am as a doctor prescribing peptides, hormones, supplements, and medications, it’s the lifestyle, the coaching, and the accountability that is maybe even more important than what I do. I created this N1 Performance Health Program that incorporates medical, coaches, wearable tech, and genetics, and puts all these pieces together. I find that’s where the real magic happens, Gabby. When we bring in the coaching and accountability, that’s where you finally see the transformation.

I want to get into all the fancy stuff, the high performance, and talk about inflammation and all the things that we’re going to cover. I would like to drill down on this. Obviously, we like to be comfortable. People don’t like change. Even if we know we’re heading in the wrong direction, we’ll go, “It’s familiar to me. I eat like this. This or that is my practice. This is my relationship. This is when I usually go to bed.” Whatever the things that we’ve all built in place.

Now that you’ve seen patients for many years and now doing this different way, what would you say to someone who can’t get over that hump? What are you seeing as the breakthrough? Is it always some big health scare? Is it like, “Now I have a kid and I want to be excited.” You know. Maybe we could talk about that. First, it’s getting people in the right position to then receive the reminder information that you’re going to give them.

You have to be receptive and willing to be open to that transformation that happens and it starts in the brain. The key is to have what I call a high-performance mindset first and that is to live with intention. I work with men and women. When I work with clients, what is your why? What is it that’s important to you? What matters? Why are you doing this? You’re not coming here to lose 20, 30, or 40 pounds. You’re not doing this to fit in those jeans. That’s not what it’s about.

It’s about being loved by your partner. It’s about feeling connected in a relationship. For me, it’s all about my kids. They’re everything to me. They’re like, “How can I be the best present and engaged husband and father for my family that I can be?” That drives me to be better. That’s where you start to see that change when you have a purpose. Living with purpose, living with intention, and having a why in mind, to me is the first step.

Let’s say you have a patient, male or female. My understanding is you’re making all of these boyfriends and husbands feel so good that the women are like, “Help us out, too.” Let’s say they’re there in front of you. Even more now coming out of COVID, people are getting hit with every bad news that there is consolidated at once coming through their phone 24/7. People are more overwhelmed than ever when you talk about purpose and why.

If you have somebody reading right now and they emotionally or mentally can’t get there, how do we get them to the place of their why? Is it suspended faith? You go, “Try this for 30 days and override your own natural impulse to not do this.” How do you reach those people? I know you see them. They’re almost like behind the veil. How do you get them out of that fog and into the place where you go, “Here we go.”

I would 100% agree with you that there’s a lot of noise out there. It’s information overload. People don’t need more information. It becomes noise where you hear these Twitter wars over what you should and should not be eating, what’s the best exercise program, and what supplements. It’s insane and confusing. I have the same phrase I hear every day, it’s become a running joke in the office, “It’s simply telling me what to do.” I hear that every day. Number one is understanding what’s right for you and it comes down to individualization. I focus on data, genetics, and comprehensive testing to understand what’s right for you. Everyone’s different. Everyone’s going to respond differently.

I think of it like an iceberg. You have the part that’s showing and that typically is excess weight, low energy, brain fog, and cognitive function. Those are the main things that I tend to see over and over again. If we can do things to help the stuff above the surface and get clients feeling better, you can start to dive deep and start addressing the inflammation, the oxidative stress, dealing with the insulin resistance, and all these other physiologic nerdy processes that are important. You can’t address that upfront. They want to feel better. They want to have energy again. They want to feel like a man or woman again. It’s getting the mindset clear and giving them a few instant wins and then we can start to dive deeper.

I appreciate that. We’re in this weird transition in the world. You even talk about certain studies that talk about how testosterone has been dropping for the past several years, 1% a year. Besides the environment, whether it’s toxins in the environment or technology, humankind is in this weird transition that is uncomfortable and confusing. I don’t even know how to explain it.

We go, “Follow your biology. Let’s do the things biologically that would ground us into health.” We’re dealing with so many more unusual facets. To your point, we can give them these wins. Also, the easiest way is sometimes to do those fundamental biological things like taking a walk outside, taking your shoes off, and let’s look at some sunlight. It’s this combination of simplifying it that way, too. I don’t know.

I was on a call with a client and he’s this uber-successful network marketer who travels the world and was in Dubai for two weeks. He got back and he’s jet-lagged and feels like crap. He’s like, “Doc, why do I have no libido, no sex drive? Fix it.” He’s looking at the testosterone, there’s so much more than that. I’m showing him his cortisol, which was in the tank. Chronic stress is physiologic stress. It’s helping people understand that there needs to be a balance there. It’s going for a walk, meditation, and mindfulness.

I’m a medical doctor talking about all this stuff that I used to think was kind of woo-woo but it’s critically important to have that balance. I talk a lot about heart rate variability and how you need to balance your nervous system and that’s what you need. It’s simple stuff like going for a walk, getting some sunlight, and practicing some breathing. No one knows how important your breathing is. These simple maneuvers, that’s where the coaching comes in. It doesn’t require a prescription or medication to do that.

I always bring it up because we can talk about peptides, CJC, and all these incredible things. I always like to remind people that they’re not a replacement. You still have to create the foundation. You deal with this. Also, I want to say to people, if they’re interested in talking to you, you do telemedicine as well. I appreciate that it’s not just for the people in your area. If someone wants to connect directly, they can.

Dr. Tracy Gapin photo 1

Dr. Tracy Gapin – It’s about prioritizing that deep and REM sleep because it affects the rest of your day.

If someone’s reading, let’s say they’re not dealing yet with erectile dysfunction. Let’s say that’s not even on the floor. They’re saying, “I’m whatever age I am. I’m not feeling my best. I’m not sleeping great. I’m not energized.” They come and see you. Not only do you take their blood and do other things. What also should they ask for to be looked at? Unless it’s a genderless process, let’s support men. Let’s talk about men first and let’s say if there’s a nuance difference for women.

We’re talking about lab testing, specifically. Is that where you want to go here?

Yes. People here get your bloodwork. I’ve looked at those panels. How do I know how to ask for the right things to look for?

I’ll give you some pointers. Testosterone is the most common one. Every guy talks about, “What’s my testosterone level?” A key thing to be aware of is free testosterone. Free testosterone is the bioavailable or active form. Make sure if you’re checking your testosterone, check your free testosterone. Understand that the range you see on the right side of the lab slip there is the reference range, which is the average of the population. We know that levels are plummeting. Those levels are about 40% to 50% lower than what they were years ago. We want to be at the top end of those ranges.

Don’t trust when your doctor tells you, “Your testosterone is normal.” I hate that phrase. Free testosterone should be optimized. The same with thyroid, we want to look at not just TSH. Most doctors are just going to check TSH, which is Thyroid Stimulating Hormone. Be sure your doctor is checking Free T3, which is the bioavailable active form of thyroid, and Free T4 as well. Those are way more important than TSH. You want to look at things like fasting insulin level. this is going to give you an idea of how well you’re regulating blood sugar. Hemoglobin A1C is commonly used. That’s fine but that’s a diabetes marker and it’s a lagging indicator of how your body is processing sugar.

Sometimes we don’t realize that a lot of this is when we’re already in trouble. I have a question about that. A lot of friends I know when they go into the sauna or they fast, their glucose levels will go up. Is it the thickening of the blood? I’ve been asked this a lot and I didn’t know if you had any insights into this. What happens there?

When you have an intense workout, when you do sauna, when you do cryo, that’s stress. You’re stressing your body. You’re activating heat shock proteins. It’s stress, make no mistake about it. Short-term bursts of stress like that are good for the body. Stress helps your body become more resilient and you grow from that and it’s important and valuable.

What happens with stress? Stress raises your hormone called cortisol, which is your stress hormone. What does that do? That’s made to elevate your blood sugar to handle whatever stress that you’re facing as if you were being chased by a lion or tiger back in the caveman era. That’s a normal response but then it comes back down quickly. It’s normal to see a slight bump.

I work with a lot of clients where I’ll give them a continuous glucose monitor and we’ll track that and we’ll see. You have a crummy night of sleep and you haven’t eaten anything in 12, 16, and 18 hours and your blood sugar will still spike. That’s a common stress response and it’s understanding what that means and how to interpret it. That gets to the fun nuance of wearable tech and tracking stress.

You’re not pushing one device more than another. People can decide what they want. There is something interesting and it’s about tracking glucose, at least understanding. For example, when we’re tired, if we drink coffee, that has a completely different impact on our system than if we’re rested. I appreciate that opportunity for people to see.

For example, I have a friend who’s healthy but every time he blueberries, he’d had these weird spikes. He had something going on with his relationship with blueberries. Normally, is there a better fruit? I don’t like to get hooked onto monitors because we should be able to tap into also how we’re feeling. How you eat and how it impacts you is different than me and getting to know that. I like that video aspect of a glucose monitor.

It’s helpful to understand what foods you’re eating are more impactful to you and which are not. For me, potatoes and red wine, don’t touch me but other things like oatmeal crush me. Knowing these things is helpful. You don’t need to do it long-term. You can do it for 2, 4, or 6 weeks and that’s it. Maybe do it again a couple of months later. This ties in also to the individualization of what I do in performance medicine. Depending on your situation, a lot of times, we’ll do food sensitivity testing. Your friend may very well have an inflammatory response specifically to blueberries.

He does. He’s incredibly healthy and he didn’t know that. You talk a lot about turning back the time and some basic things. My hope is to not only interpret and make it achievable for people to make small gains. What are you drinking, vodka? You’re showing us that you’re hydrating. Unless it’s something else.

This goes into the whole concept of not using plastic water bottles. I’m big on carbon block filter water so you clear the toxins. You should always have a stainless steel water bottle for your water or glass but never plastics.

What is it we eat, a credit card a week or something of plastic? It’s crazy. Everyone wants to feel their best. You talk about simple things we can do to either turn back the time or at least slow it down. You mentioned oxidative stress. Maybe we could talk about inflammation and some other things.

We’ve come a long way in this field of longevity. The science is exploding seemingly almost every day where we now understand these pathways. ANPK, sirtuins, and mTOR are the three main genetic pathways, if you will, for longevity. Understanding how to turn these genes on and off has become the passion and a race to see who can do that.

[bctt tweet=”Live with intention. Create the life that you want.”]

I’ll share a brief story about a study that came out years ago out in California from the Fahy group. They gave men growth hormone, Metformin, and DHEA for a year. We got a whole lot of conversation about growth hormones but bear with me for the moment. They measured their biological age before and after that year. They compared it to a group of men who did not have those three drugs. That group of men was 1.5 years younger whereas the other group got a year older. It’s 2.5 years difference in aging with one year on that manipulation.

I’m not here to promote growth hormone. The fact is that we’re learning how to turn back the clock. Anti-aging used to have such a bad rep. When I was in urology for years, we thought it was a big joke and now I can’t get enough of it. I love it. I’m obsessed with the science coming out. It’s understanding how things like Senolytics, Bacitin, Rapamycin, and all these cutting edge tools, how can we use them to affect these genetic pathways? It’s a lot of funds, a lot of science around it, and we’re learning every day.

For me, what you’re talking about is universal. This is all the genders. Did people start at 35? The other thing is I don’t know. Is there a time when you go, “Slow down. You’re too young to start this stuff.” Also, does that mean that once you start, it’s game on for the rest of your life taking this stuff?

It’s not a matter of getting on a certain supplement and staying on it for the rest of your life. That’s not what we’re wanting to do. It is important to understand that you start aging from the day you were born. There are amazing studies showing that there’s a methylation process, which is how there are methyl groups attaching to our DNA and that’s how you can measure to quantify aging. It’s a validated way that scientists can compare and measure aging. We see that process happening from birth. It’s a lifelong process. How can you slow that? A lot of it, we can do without necessarily any supplementation.

We know fasting. If you look at animal studies, fasting alone and quit freaking eating has been shown to extend lifespan. It’s not about taking a certain magic pill, magic drug, or supplement. It’s about understanding all the different inputs into your human system and how those come together and how you can tweak different aspects of that to extend your lifespan. More importantly, it’s not just living to 100 and being like your grandparents. It’s about living to 100 and being as healthy and optimized as you feel you are today, right here, and right now. That’s healthspan.

Feeling good. Being in pain and discomfort is hard on you. No wonder, you see certain people and they’re so grumpy. For things like Metformin, for example, you can get that now by going online and doing an appointment. They have groups that have doctors that you can interview. There are a lot of people who say, “Maybe my doctor won’t give that to me.” I have friends who have gotten it online by doing telemedicine appointments and then getting the prescription. I want to let people know that a lot of this stuff is pretty available. You still would want to do it in conjunction with somebody who would tell you how to do it.

That’s one part of it. I take metformin myself every day because the science is there for it. It’s been probably one of the most studied drugs on the planet. It’s been around for several years. It’s great when it comes to activating A&P kinase, which is one of those three genes associated with longevity. It’s amazing. There’s nuance to understanding that it’s not just taking metformin and I’m going to live longer. There are a lot of pieces that come in. It’s like a symphony. It’s fine-tuning all the different instruments to play together in harmony. There’s not any one aspect, one magic thing that you can do that’s going to fix everything else.

Do you still get a benefit from it? Let’s say somebody was like, “I’m not ready to take GH or I’m not comfortable yet.” You would still get benefits from metformin.

Absolutely. I hardly don’t prescribe growth hormones. There are peptides that we can use to promote your body to produce growth hormones naturally. To me, that’s much more of a normal physiologic state. Growth hormone is secreted in surges throughout the day and the biggest surge tends to be at midnight. I like peptides because they’re able to increase that normal and healthy variation in your growth hormone that you don’t get when you take exogenous growth hormone. That’s just a big burst.

You have BPC-157, CJC, and ipamorelin. What were the ones that you liked?

I like all of them. It depends on the situation. BPC-157 comes from enzymes in the stomach. To clarify for the readers, we’re talking about peptides. Peptides are simply short proteins. They’re chains of amino acids. They’re molecules that our body recognizes already because they’re derived from enzymes that we’re used to already. BPC comes from the stomach. Thymosin Alpha is amazing for immune function. That comes from our thymus gland, which shrinks and involute as we get older.

CJC and ipamorelin are mimicking hormone-releasing hormones from the hypothalamus, which is what stimulates the pituitary to make growth hormones. That’s amazing. BPC comes from the stomach and is great for inflammation both in the gut as well as systemically. You could also put it in joints. It’s great for joints. Thymosin Beta is great for musculoskeletal soft tissue repair and recovery. There are peptides for anxiety, memory, focus, concentration, sleep, sex, hair, and skin. It’s amazing.

Is it pointless to take them orally? Is it almost better to always do the injectables?

It depends on the type. You’re bringing up a great point that if you look at the molecular size of most peptides, you can’t absorb it through the GI tract and so they’re not meant to be taken orally. There are a few that I won’t name out there that are on the market that is oral and I’m like, “It can’t work because I know the size of it and it can’t get absorbed.”

Oral BPC, in particular, is great if you’re specifically working on the gut itself. You’re right, most peptides are injectable. Some are topical. There are a couple that is great for anxiety and sleep that are topical. There are some that are nasal sprays. It depends on what you’re trying to accomplish. I want to emphasize that you need that foundation. This is the icing on your cake. If you haven’t baked your cake, you can’t get the icing yet.

Dr. Tracy Gapin photo 2

Dr. Tracy Gapin – I am very intentional about creating time for breathing exercises and actual meditation. How do you, on a busy day, find time for that? It’s living with attention and creating time for that.

People have to be reminded. You’re talking about epigenetics. 20% of our deal is our genetics and 80% is our lifestyle. You have the power to turn off and on, the guys that are working in your favor or not. I also always like to encourage people. Yes, your eyes are blue. That’s a genetic feature. We inherit our families’ lifestyles more than, “My mom’s always fought her way. That’s my sentence.” Not really. “My dad got Alzheimer’s when he was 72. That’s going to be my fate as well.”

I want to remind people that, to empower us, we have so much but we have to figure it out too. It takes a little bit of effort. For you, can we talk about the ingredients of the cake and maybe we can go a little deeper? Let’s remind people of your approach to what the patient needs to do first and then let’s talk about the fun, extra, and little boosty stuff like the peptides.

I love that you mentioned epigenetics because that’s what it’s all about. When we look at nutrition, for example, genetics has a huge factor there. For example, I see a lot of men and women who are obese. There are genes like the FTO gene, for example. People call it the fat gene. That increases the risk of being obese. That particular gene has to do with the way your body senses when you’re hungry or when you’re full.

Leptin and ghrelin.

It has to do with ghrelin receptors and it has to do with knowing when to stop eating. People with FTO variations who are obese don’t know when to stop eating. Changing the diet behaviorally to match that is critical. Other people have genes like the PLIN1 gene that has to do with carbohydrate metabolism. They will lose weight with higher complex carbs, which is completely opposite of this keto trend that we’re on. It’s understanding where you stand. You may lose weight with more complex carbs. I’m not talking about cakes, cupcakes, and candies.

Rice and beans.

We’re talking about sweet potatoes, broccoli, and all the good and healthy carbs. We can look at genetics to help us understand the ratio of carbs, proteins, and fats. Everyone’s different with that. Some people require more fats than others. That’s why I hate the Twitter battle on what’s the best diet because there is no best diet or nutrition plan. It depends on what’s right for your body. It’s a lot.

I appreciate it but you also have people who are monetizing by creating a lane. To your point, someone might benefit from the carnivore diet. I honor that. I personally eat high-quality protein. I seem to function better on that. I eat vegetables. People also have to be careful because it’s become commercialized like being vegan, being vegetarian, and being a carnivore. Everybody’s trying to say, “This is the only way.” When we talk about epigenetics, are their test to go, “Am I this person that does this or that?” Can they figure that out?

Yes. When I work with clients, we start with a cheek swab and we send it to the lab and we get your genetic report back in a couple of weeks. That tells us exactly the information that we’re talking about here. You can know what’s right for you. For example, you mentioned the carnivore diet. The APOE gene is the gene that helps you process saturated fats. People who have a certain variant of the APOE gene, if you are eating a lot of saturated fats, red meat, dairy, pork, cheese, and milk, you have a markedly increased risk of cognitive decline, Alzheimer’s disease, and cardiovascular disease. If you limit saturated fat in those individuals, that risk completely goes away and you’re on par with the population.

There’s no perfect diet. With a simple cheek swab, we can figure out what’s right for you. Rather than what you should be eating, the better focus might be is what should you not be eating? We have two simple things, one is is sugar and the other is vegetable oil, canola oil, seed oils, and sunflower oil. All of the Omega-6 inflammatory oil, that’s everywhere. Get rid of those two things.

Simplify it. Olive oil, avocado oil, and coconut oil. Not everybody responds well even to coconut oil. I have a friend who goes to the bathroom and it’s a no-go. Because these are being presented as the healthier oils, that’s still even within that as a personal quest. The other thing is not that it’s unfair but it’s such a get-you moment when you go to the market and let’s say someone’s being conscientious and they think, “Canola, sunflower, or safflower sounds good.”

All of this is in every single thing that we eat, every dressing, every chip. They make popcorn unless you buy the one popped in coconut oil. I would encourage people to make their own dressings. It takes three minutes. If you are going to eat chips, see the oils. There are a few chips like Siete and a couple of others. I don’t work with them. They seem to be doing a better job with these oils. Those oils will kick your butt. You talk a lot about chronic inflammation and these are the things that will keep you in chronic inflammation.

It’s sad. I was at Target with my wife buying a bag of almonds. Almonds are a great snack. It has a ton of Omega-3, the healthy polyunsaturated fat. It’s a good snack to rely on when you need something. What was interesting and sad was that you can get a bag of almonds and you look at the ingredients. Everything you purchase, especially if it’s in a bag, you need to look at the ingredients. Almonds are fantastic. The bag next to it is dry roasted almonds and you look at the ingredients. What do you guess the first ingredient was? Canola oil, salt, and almonds.

It tastes good, too. That’s the thing.

You’re like, “I’m getting almonds.” In fact, you’re causing more harm than good. It’s those little micro-decisions. Focus on the ingredients and avoid those inflammatory oils.

We all know we need to exercise. Do you create a loose framework for people like 20 minutes, 4 times a week? How do you get them to approach their movement life?

I should probably hire you to work with all my clients so that you, the athlete, can teach them. Most of the men I work with simply need, “How do I get out of my executive office and do something?” Most of them are not at the point where they necessarily even know what to do on a daily basis. How do you incorporate strength training, interval training, and some cardio? The guys that are working out tend to do too much cardio and not enough strength and intervals.

Genetics also can help us in that sense as well. Your genetics can tell us whether you’re going to respond better to interval versus endurance training. We can use that to help create a customized plan as well. That comes down to coaching. As you know, Gabby, it’s accountability. It’s staying focused on your bigger passion and a bigger goal. It takes commitment. As you know, it’s not easy.

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I have friends who are Ultramarathoners and they’re freaky and they want to go run 100 miles and that makes them feel good. I honor if that’s someone’s experience. If we’re talking about householders like most of us, interval training, resistance training, and time under tension are usually going to benefit a larger group of people. Minutes and minutes of cardio in front of a television are better than nothing but I don’t know that it’s maximizing their time. A sprint would suck and maybe you don’t feel good and it feels like it’s a jog. Ten of those for 20 or 30 yards might be better.

A lot of us, as we get older, we don’t want to huff and puff like a sprint. I went to the beach and was pulling a sled and I thought, “Seriously, I’m still doing this right now.” These are all the things that support us in a real way. Have you had anyone who comes to your office that’s like, “I figured it out.” I hate the word hack because we all know that work is what it is. However, somebody who created some practice at their office has been benefiting them in the movement way or even in the food way, in an eating way.

It’s understanding that there are a lot of things that you can do without a gym. There are a lot of things you can do without weights, barbells, or dumbbells. You could do it with nothing. I have coaches that work with my clients as well. I could stand right here and I could do squats, lunges, crunches, planks, lateral lunges, and push-ups. There are all kinds of things that I can do with no equipment. In 10 minutes, I’ve got a decent and better workout. The guys think is complicated. It doesn’t have to be complicated. It can be that simple. It’s the accountability, staying true to yourself, and creating a schedule, an intentional and purposeful action in your life.

People are like, “I’m in my work clothes.” I also remind people too that if you did a little bit of walking directly after eating a meal or some body squats, when you talk about insulin, glucose spikes, and things like that, that does help minimize some of that. There are little things we can do. We talked about movement, food, and testing for maybe figuring out what’s best for you. What about sleep? What are you encouraging your clients? People might say, “I go to bed at midnight and I get up at 8:00. I got eight hours.” That may not be the same eight hours as 10:00 to 6:00.

I always emphasize sleep because probably one of the most common issues that my clients have is trouble with sleep. Either they stay up too late or they keep waking up throughout the night and they can’t fall asleep. A lot of that has to do with our hormones. It comes back to cortisol. When you have crummy sleep because you don’t get enough quality hours, it raises cortisol. Cortisol crushes our hormones. It makes us store fat. It alters our mood. It makes us make bad decisions. It becomes an ugly and vicious cycle.

The key is that you need good quality sleep and by that, I mean deep sleep and REM sleep. Those are the key phases of sleep. For example, if you were to take an Ambien, a sleeping pill, or if you were to drink a bunch of alcohol, you’re going to sleep but you’re getting crummy quality sleep. You don’t get the restorative aspects that you need because you stay in light sleep the whole time. You don’t get that deep sleep and REM sleep that you need. It’s all about getting good quality sleep.

How do I know is the obvious next question and the answer is you got to track it and that gets us to wearable tech. There are a ton of devices out there. I’m agnostic as to which one you choose. You got to be tracking your sleep and seeing how that’s affecting your performance. I will track my sleep every night. I’ll check my heart rate variability first thing in the morning and I’ll understand how that’s affecting my actions and behaviors throughout the day. It’s all about prioritizing that deep and REM sleep because it affects the rest of your day.

Is it a percentage or is it an actual amount of time you want to be in either one of those?

We aim for around an hour of deep sleep and two hours of REM sleep, give or take, somewhere in that ballpark range. How long should you sleep? Typically, 7 to 8 hours is the average. Genetics remarkably can help us understand that. What Chronotype are you? You have sleep centers and clocks in your brain and genes can help us. In general, 7 to 8 hours is the target.

I see many people who will stay up till midnight working on their computers and then they’re up at 4:00. You have no chance. You’re not going to lose weight. You’re not going to build muscle. You’re not going to be at your best. You’re not going to have a good sexual function because that’s directly affecting everything else in your body.

Dr. Gapin, maybe we can take a second on that. You can have somebody who’s eating very well, maybe they even have a good relationship, they get enough exercise but they aren’t sleeping enough. You’re always behind the eight ball no matter what.

That’s right. Let’s go back to where we started this conversation, sexual function. I want to briefly dive into physiology. To have an erection, you need to increase blood flow to the penis. That requires arterial dilation, the vasodilation of the arteries. What causes that? It’s the hormone nitric oxide. Nitric oxide is a hormone. What affects nitric oxide production? Insulin sensitivity. Insulin sensitivity directly affects nitric oxide secretion by your endothelial, by the lining of your blood vessels.

If you have crummy sleep that raises cortisol and raises your blood sugar, your body can’t handle it, it generally promotes insulin resistance, and it crushes nitric oxide production, hence, you can’t have good quality erections. Do you see how they’re all tied together? It’s all interrelated. That’s the system’s approach to health that I emphasize.

When we talk about erection, people can take blue pills and all these other things. You have long-term solutions. You talk about gut health even helping support erections, sleep, and managing stress. I didn’t know you could do PRP injections into your penis. What happens there exactly?

PRP is platelet-rich plasma. That simply means we draw your blood from your arm, we spin it down in the center for you, and we separate the different layers of products in your blood. We are extracting and isolating the platelets and all the good and healthy growth factors from your blood. We can then inject that directly into the penis and we are creating a high concentration of those critical growth factors that are important for promoting angiogenesis. It’s the process of creating new blood vessels and new blood flow. After all, an erection is increased blood flow. That’s why it’s being done.

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Dr. Tracy Gapin – How can I be the best, present, engaged husband, and father for my family that I can be? That drives me to be better. That’s where you start to see change when you have a purpose.

Did I hear you say that you use some of this technology for kidney stones? Is that something else? Is that right?

You’re right. Low-intensity shockwave therapy is a treatment that is used for kidney stones. It’s where we deliver sound waves through the skin into the kidneys. I did it for twenty-plus years in urology on how to treat kidney stones. That same technology we found also promotes angiogenesis, which is new blood flow. You’ve probably heard of the term GAINSWave. That is the treatment where we deliver the sound waves to the penis to promote new blood flow. When I combine it with that PRP and exosomes, that’s where you get to see some great results.

It’s exciting when they talk about P-Shots and all these other things. It’s cool as long as we’re not using that to bypass these root issues that we need to always take and do our homework all the time. If you have someone who comes to you and let’s say they’re in overall good health and there’s no real reason physically for maybe being impetus or having erectile dysfunction, how do you manage that? I’m sure that you see that occasionally.

There are four general causes of ED and one is blood flow. 80% of men with ED, it’s blood flow issues. Whether it’s poor blood flow coming in or they can have a venous leak or blood leaking out. Number one is poor blood flow. Number two would be hormones. Testosterone is the one we most commonly think of. DHEA, thyroid, insulin, cortisol, and all hormones can affect sexual function. We talked about insulin and insulin resistance as part of that.

The third would be nerves. You need good, healthy, and normal nerve function down there. Anyone who’s diabetic or has peripheral neuropathy or maybe they’ve had prostate or colon surgery down there, that can affect the nerve function. The fourth one is psychosocial. These are things like relationship with your partner, attraction, and if there’s any infidelity. Porn addiction is incredibly common these days. All those things that affect the brain and neurotransmitters and all that stuff would be the fourth category.

How do we treat these guys? It’s taking the time to listen and to work with them to understand which one of those it is, do the appropriate testing, and then choose a treatment that matches. You see these clinics popping up everywhere and you’re only qualification is, do you have a credit card? For a lot of those guys, it’s not going to work if they’re not properly selected. What we do at my institute is to focus on the right selected treatment.

I hate to put you on the hook but since you’re the right person to ask, the fact that pornography is everywhere, is it an unrealistic expectation, or do you need that level to get stimulated? I’m sure you’re seeing younger men coming in with erectile dysfunction because they do have more access to porn. How does one deal with that? It’s like an expectation like three girls and everybody shaved and tattooed, “This is what it would take for me to get excited.” How do you help these guys? My poor husband, it’s been boring for a long time.

I put out a blog article on my blog within the first six months I was writing. I got a massive response from around the world. Young men in their twenties were asking, “How can I work with you? How can you help me with this? It’s a big problem.” It’s a massive issue, especially for the younger guys. A lot of is coaching. There’s no magic pill. There are no drugs that I can recommend. There’s no prescription or medication that’s going to cure that. It’s coaching, counseling, and working with your partner. It takes time. At some point, the neurotransmitters, the dopamine receptors in your brain have been affected and it takes time to get those back.

What is that P called? Norepinephrine and dopamine. It’s PEA or something. It’s that thing that you get when you’re all guns blazing, “I’m excited. Here we go.” You have seen men maybe abstaining from pornography and rebuilding their real relationships and intimacy. They can get the elastic back if you will.

It takes time and it takes pure abstinence as well. It’s this fantasy world that’s been created where real life cannot possibly match that. It’s unrealistic expectations. It affects marriages. It crushes relationships where the woman thinks that either the man is not attracted to her or that there’s infidelity. It crushes her confidence. It’s a problem. It’s abstinence, working with your partner, and taking time.

You would think giving up sugar would be hard. Asking these guys to be abstinent is interesting.

Abstaining from porn.

I thought you meant from sex altogether. I was like, “That’s a tough one.”

Sometimes abstaining from sex for a week will help improve that as well.

All of a sudden, you’re excited. You’re like, “It’s a real person. Let’s go.” There are two more things. I have a lot of friends that are high performance or people who are athletes who use certain things to get these boosts in their mid-late 20s and 30s. Now they’re saying, “I don’t want to have to rely on this. I also don’t know how to navigate coming off some of this extra support, whether it’s a growth hormone or testosterone.” Could we guide somebody who is looking to get themselves naturally a little back on track without this extra support if they have been high-level performance?

You’re talking about them taking growth hormone, testosterone, steroids, and that kind of stuff. Is that what you’re saying?

Yes. You’ll even see a football player that’s been given stuff early in their life. How do you say, “I’m going to try to get back to a place where I can support myself as naturally as possible.”

It’s tough because when men or women have been on growth hormone, for example, steroids for a long time, a lot of peptides that we use to naturally stimulate things don’t work as well because those receptors have been burned. A lot of it is weaning some of those doses down slowly over time while you’re optimizing other systems at the same time. It’s a tricky balance. the longer someone has been on those drugs and steroids, the more challenging that is.

If somebody comes in and they’re 50 or 55 and they’re doing things right, we talked about certain hormones, no matter who you are, they start to diminish. Are you comfortable getting people on things that they might take from here on out?

When I’m working with a man and I’m recommending testosterone therapy, a common question is, “Does this mean I need to be on it forever?” My simple answer is, “No. You can stop whenever you want to feel like crap again. Stop and it’s fine.” When you optimize hormones, guys feel amazing that they don’t want to stop it. It’s optimizing it.

Let’s say a guy’s testosterone level is slightly below where we want to be. That’s where a lot of natural approaches can be helpful. Most guys I see now with this testosterone pandemic we’re dealing with, their levels are in the tank and you’re never going to get them to where they need to be with strength training, sleep, micronutrients, and the basic foundational stuff. They need help. When you give them that help, they feel so good and they’re like, “You’re never taking this away from me again.” It becomes easy at that point.

It is becoming more cost-effective. I have seen over the years that things are becoming more accessible to more people. Do you have supplements whether it’s DHEA if it’s appropriate, creatine, or things that you are a big champion for?

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I’ll put an asterisk here that every man is different. Everyone’s an individual. I give a unique protocol. That being said, every guy needs a good and quality multivitamin with micronutrients and B vitamins. Every guy needs Omega-3 fish oil. The Omega-6 to Omega-3 ratio is critically important and one of the ways you can do that is by optimizing Omega-3. A good quality DHA like fish oil is incredibly important.

Most guys are deficient in vitamin D. You want your level of 60 to 80 or so. Most guys need vitamin D. That’s typically part of my stack. I love things like curcumin because it’s great for reducing inflammation. I love NAC for helping boost glutathione detox function. DHEA is an incredibly important hormone that gets overlooked. It’s a precursor to testosterone but it’s valuable in and of itself. DHEA is great for most men. From there, it depends on the individual. There are some basic foundational that almost every guy needs.

What has been the big difference for you now that you are dealing with females? The system is way more complex. I’m going to end this interview by talking about you. How has that been for you?

Working with women?

Yeah. This isn’t a setup. I mean the complexity of dealing with the systems from your point of view.

I find that working with women is different, I’ll put it that way. Men are from Mars and Women are from Venus holds true when it comes to health. It’s an entirely different interaction. I have a nurse practitioner who works with me. She is a woman’s health maestro. She’s incredible. Most of the women have worked with her on the hormones, especially because that’s where she’s an expert. I’ll work with them on everything else, on the genetics, the peptides, the lifestyle, the coaching, and the other lab functional testing that I do as well. It’s a different interaction. It takes a little more time. For me, a little more patience. I’m a men’s health doc but we have a lot of women who we work with as well and I appreciate that difference.

Finally, as your own patient to yourself, if you’re stressed out, you’ve got a family, you’ve got kids, you have a big practice, you’re in an interview here with me, do you have any personal practices you do to check your stress levels?

I track my HRV every morning. You can do it through a couple of different means. HRV is Heart Rate Variability and it’s simply the variation in your heartbeat from one beat to the next. That is a surrogate for your stress levels. You can track that with various wearable devices. I use a chest strap because that’s been found to be the most reliable. I use that every morning as a check for me of where I am. I also have wearables that I could check throughout the day as well.

I am intentional about creating time for breathing exercises and actual meditation. I know that sounds crazy. On a busy day, how do you find time for that? It’s living with attention. It’s creating time for that. It’s knowing how important that is. There’s one parking lot by a school, not in a creepy way, where I would park. In my car, I would turn on a meditation app on my phone. It’s that simple. It doesn’t take any magic. There’s nothing fancy. It’s ten minutes of meditation and breathing. That helps ground you and reduce that stress and helps you be present in the moment.

When you have been there for everybody all day long and you go home to your family, where do you find more to give to them? Women talk about our needs a lot and talk about having it all in balance. Men don’t do that. They get home and they get in trouble for not being present because they’re exhausted from work. In a way, I can see it from their side, like, “I was at work. I wasn’t like it was fun. I wasn’t golfing.” You then come home. How do you get that extra for them?

It’s taking that ten-minute break. Even in the car is fine. It helps you reset. Gabby, the highlight of my day is amazing. Every day, when I walk in the door and the kids are going, “Daddy.” They’re jumping on me. I’m laying on the couch. They’re tackling me. There is nothing like that in the world. If that doesn’t get you going, what does? To me, that’s my why. That gets me going.

I’ve also created a schedule in my life. When I jumped ship and left traditional urology, I did that so that I can create the life that I want. That means that I’m not stuck at the hospital till midnight anymore. I can come home and still be a dad and a husband. It’s living with intention and creating the life that you want.

Dr. Gapin, I appreciate the work you are doing. You have the Gapin Institute. Maybe remind people of all the places they can find you. I’m sure people will have questions or want to connect.

My website is GapinInstitute.com. You can also offer an opt-in. You can text HEALTH to 26786. If the readers will text the word HEALTH to 26786, they’re going to get a couple of free gifts. They’re going to get ten secrets to high-performance health and quick tips that you can implement right now to get started. you’re going to get a complimentary copy of my best-selling book, Male 2.0. You’re going to get information about my high-performance health conference. I’ll be live in Sarasota. You’ll get a link if you want to book a call with my team to see how we can help you. You’ll get that as well. You might also get a free peptide in there as well.

I’m inspired by people like you out there because I’m seeing more and more people who are like, “We have to address the problem. We got to get to the cause and not just the symptom.” Thank you for that. Good luck now that you’re adding more females to your practice.

I appreciate it.

Thank you.

Thanks, Gabby.

Thanks so much for reading. If you’d like, rate, subscribe, and leave us a review. All of my music was graciously done by Frank Zummo and Tom Thacker. If you want to see some of the behind-the-scenes action, follow me, @GabbyReece. Remember, don’t miss new episodes every Monday.

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About Dr. Tracy Gapin

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Dr. Tracy Gapin is a board-certified Urologist, Men’s Health Expert, Professional Speaker, Author, and Contributor to Entrepreneur Magazine focused on providing men with a personalized path to optimizing health and performance. He offers precision performance programs including state-of-the-art biometric monitoring, nutrition and lifestyle intervention, and bio-individualized hormone optimization to help men optimize their potential.