Dr. Gabrielle Lyon [0:00:02]

Welcome to the Dr. Gabrielle Lyon Show, where I believe a healthy world is based on transparent conversations. In today’s episode of The Dr. Gabrielle Lyon Show, I sit down with a very good friend of mine and mentor, Dr. Rob Kominiarek. He is an amazing physician and has really been an educator and a leader in the areas of age management, medicine, and hormone optimization. He’s president of ReNue Health, and he does speaking and educating all across the country. Dr. Rob is a veteran of the United States Army and has an Amazon best-selling book, all sorts of things. But what makes Dr. Rob so unique is that he’s really been a leader and on the forefront of challenging what we think about when we think about hormone replacement. In this episode, Dr. Rob and I will talk all about who is a candidate for testosterone replacement. We talk about the pros and cons, and what does the science actually say? And finally, what is the bigger picture as it relates to hormone health? I hope you enjoy this episode. I love sitting down with the incredibly charismatic Dr. Rob Kominiarek. If you liked this episode, please take a moment to like, subscribe, and share. This is what drives the podcast. Okay, without any further hesitation, let’s dive in.

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Dr. Rob Kominiarek, you and I have been friends for quite some time. I consider you a friend, a mentor, and really a pioneer in the field of testosterone and hormone replacement. In and of itself, testosterone has been very controversial, but before we talk about testosterone in detail, a little bit about its history, a little bit about some of the pivotal changes within the industry, and the way in which it’s prescribed, I just want to highlight certain metabolic aspects of testosterone. When people talk about testosterone, they often talk about the anabolic impact, which you talk about and we’re going to discuss. There are also cardiovascular and metabolic implications to having adequate levels of testosterone and low levels of testosterone. I’m just going to lay this right out on the table. Testosterone therapy, in individuals that are either insulin sensitive or insulin resistant, has different metabolic profiles, which I think is fascinating. Insulin-sensitive individuals have a decrease in lipolysis. Insulin resistant individuals with low testosterone have decreases in triglyceride storage, so triglycerides are more elevated in the blood, there is an increase in fatty acids and free fatty acids in the blood, and there is a decrease in glucose uptake. So when we think about testosterone therapy, again, we always think about the anabolic impact. What about the implications of a metabolism impact? As it relates to Type 2 diabetes, there is a decrease in glucose utilization, a change in mitochondria, a change in lipid oxidation—all kinds of things, which are fascinating.

Dr. Rob Kominiarek [0:06:33]

I would agree; it’s incredibly fascinating. It’s hard to overlook the androgenic qualities of testosterone because we’re all superficial to some degree. Vanity is never going away. Big muscles and skinny waists—everybody wants them. And if that’s what they want from their testosterone, if that’s what they want from the peptides that are such the rage, it gets them where they want to be faster, and it helps overcome all these issues.

Dr. Gabrielle Lyon [0:07:13]

I couldn’t agree with you more.

Dr. Rob Kominiarek [0:07:15]

Yeah. You have to be very disciplined and consistent to take a natural pathway towards optimizing your hormones. And it’s getting more difficult even for the uber disciplined and consistent individuals to overcome all the toxicities that we’re exposed to. So if you look at the average person, there are somewhere north of 200 different toxins floating around the body at any given time, and even when you’re eating healthy and clean, how is it that you’re going to overcome all these things that are just polluting your body—all these forever chemicals that are everywhere—let alone overcome the deficiencies that you have in your own metabolism? So if you have leptin resistance, insulin resistance, cellular inflammation, and resistance to hormones—your thyroid hormone, your testosterone, estrogen, and progesterone—how do you overcome that? And then if there are genetic issues as well, understanding CAG repeat length on the androgen receptor, exon 1, means that if you have these long CAG repeat links, you’re not going to have the sensitivity that you need, which can explain a lot of the variability that we see between individuals. Why is it that someone can have a total testosterone of 800 and a free testosterone of 15 and feel absolutely normal and have no symptomatology whatsoever? And then you have somebody who has a total testosterone of 1000 and a free testosterone of 27, yet they’re tired all the time, they’re losing muscle, they don’t feel good, their executive function is down, they’ve got no get-up-and-go, no drive, no libido, and that comes down to that genetic component, that CAG repeat length, and the longer that length, the less sensitivity you have. Add on top of that all the toxins that we have in our environment, and you have a recipe for just not feeling good.

Dr. Gabrielle Lyon [0:09:18]

I’m going to ask you a straight-shooting question. Let’s say everybody does everything right. Can they defeat the decline in testosterone?

Dr. Rob Kominiarek [0:09:34]

Yes, they can. But it’s getting more difficult to do that.

Dr. Gabrielle Lyon [0:09:41]

Got it. To what degree? See, I feel that individuals, no matter what, if their testosterone is low, can sleep, do all the things, get off SSRIs, avoid marijuana, and avoid these cannabinoids.

Dr. Rob Kominiarek [0:10:01]

Yeah, get off the marijuana, the ADD, the anxiolytics, the antidepressants, the alcohol, and all the processed foods—the cakes, the cookies, the candies, the chips—and clean up that toxic environment, because even when you clean it up, you’re still going to be exposed to things that you can’t help. The water is polluted; you need to be filtering your water. If you don’t have reverse osmosis in your home, then get the portable systems from Berkey and Alexapure; those are two really good ones. And I use them in both filters because I like to take them around and they’re easy to travel with; the filters are really good; you can filter the water really well; and I have them in the office. So doing everything you can to limit your toxicity is going to help improve those hormones’ movement across the cellular membrane into the cell and then binding at the level of the receptor. What I’m seeing more and more, and you know, I’ve been doing this now since 1996, and I really stumbled into hormone.

Dr. Gabrielle Lyon [0:10:59]

Since 1996. So I do want to talk a little bit about the history. Because you are, you have been in the group of some of the first, and I don’t want to overlook that. And I do want to talk a little bit about the history. You’ve been doing this since 1996.

Dr. Rob Kominiarek [0:11:14]

1996. I stumbled really into it; it was not really in my plans, hormones. And you probably can remember back in the day when you did residency, you spent three months talking about female reproductive health, and there was a paragraph in a textbook about male reproductive health—maybe a page or two really—and you spent maybe one residency meeting talking about it. I had a patient. I was actually opening an urgent care center for a hospital system. A motorcycle pulled out in front of a car, got T-boned, and flew off. We packed them up and sent them to the hospital. Several months later, he shows up in the office at the urgent care center and complains that he doesn’t feel good. And, long story short, he ended up losing both his testicles. So at the time, I was like, oh. I flipped open Harrison’s textbook of internal medicine and went, okay, testosterone, 200 milligrams, IM every two weeks. It sounds great, but let me call the urologist. I called the urologist, like I don’t do that. So it’s called the endocrinologist; I called the endocrinologist really, and a couple of times he says, yeah, 200 milligrams, IM every two weeks. I called it a day and hung up. So I give it to him, and he feels better for a little bit. But then he feels bad. He feels good, and he feels bad. You feel good, and you feel bad.

This is 1996, so you go to the medical library, crack open some more books, and look for answers, not really finding anything. But he worked out in this gym. And the guy who owned the gym was a bodybuilder. I approached him and said, hey, I’ve got a question. Do you take testosterone? He kind of gave me the hairy eyeball, like, what do you mean? I’m like, listen, I’ve got a patient. I have them on testosterone, and he feels good. But then he feels bad. How do you take this stuff and not be on this roller coaster? And he unscrews this protein powder thing. He unscrews it, and inside was this paper where he had written down everything he took, and so he shakes that off and gives it to me.

What I saw was a testosterone sippy and a 200 mg IM on Mondays, Wednesdays, and Fridays. And I went, oh, okay. But that’s a lot, you know. So I thought, well, let me just back off the dose. And so I backed off the dose. And we tried that with this kid, and this is 1996. And he’s like, man, I feel good all the time. And that right there really piqued my curiosity. I was like, wow, wait a minute. And that’s when the journey just started. And it was a progression. We got into the early 2000s with the Women’s Health Initiative and all this stuff about hormones, cancer, and heart attacks. And I’m like, oh my God, what am I doing? And then all the studies came out saying, oh, testosterone causes prostate cancer, causes heart attacks, causes strokes and I was like, oh my God, now I’m going to kill people. So that progression of moving through that environment, and then Abraham Morgentaler’s work comes out, and it’s like, oh, wait a minute. So it’s been a journey over the last 27 years, and to where we’re at now, where we have numerous studies to show us otherwise, that it’s cardio protective, that it’s prostate protective, that it’s metabolically protective, very different from the environment over the last 15 years.

In the last 10 years, it’s been really nice to see the progression of things and the validation of, hey, wait a minute, optimizing hormones is a good thing. I’ve come to the point where I truly believe that the body has an innate ability to heal itself, given the right environment. So while I love testosterone, the big tool in the toolbox for men and women, I always wonder, is there a way to recover this individual? So in my treatment strategies, I always lay out what the potential options are for recovery, if it is an option. Sometimes it just isn’t. Can we use a biologic? Can we use a selective estrogen receptor modulator? Can we use testosterone? Are we going to use nutrition strategies, exercise, stretching, and body recomposition strategies? Are they just so overweight that we need to pull that off? So it’s a progression, and oftentimes I look at it as: First, I need to heal you, then I need to get your nutrition really straight. And then we can look at performance. So how I approach an individual depends on where they are and how old they are. How young are they? What’s their exposure to things? Where are they with their medicines? Where they are mentally, emotionally, spiritually, and financially—all these things come into play as to treatment strategy. You can always take the simple approach of just taking testosterone. And that’s a strategy.

Dr. Gabrielle Lyon [0:15:54]

I actually I like that approach. It’s a great approach.

Dr. Rob Kominiarek [0:15:57]

It’s a great approach.

Dr. Gabrielle Lyon [0:15:58]

You’re laughing?

Dr. Rob Kominiarek [0:15:59]

No, I’m not. I am not because they use that approach with a lot of people. Listen, if you want to overcome cellular resistance, you can just drive right past it, and it works really, really well. But with my inquisitive, curious nature and my ultimate belief that the body’s capable of healing itself, is there another way for certain individuals? And for some people, it’s like, listen, I want my body to perform its best naturally, if it can do it. If it can’t, guess what? We have these options to choose from, and that’s a great thing.

Dr. Gabrielle Lyon [0:16:33]

It’s interesting because I have known you for years, and you’ve certainly become more, I don’t know if the word is more holistic, but certainly more interested in environmental impact. Before we get to some of those endocrine disruptors and the toxicology of the world, which has a huge impact, I want to highlight some of the history and go through some of the major roadblocks that physicians and patients still have in their understanding of testosterone replacement. So in the late 1980s, testosterone was rarely used, and you actually had that experience. It was typically reserved for men with pituitary or hypothalamic tumors or the removal of testicles for whatever issue or trauma. And this was in the 1980s. Again, you had that experience in 19. Was it ‘98?

Dr. Rob Kominiarek [0:17:32]

My first exposure to testosterone was after I got out of the military in 1987. And that was my first exposure to testosterone cypionate. And I grew up as a young teenager with—I don’t think I have the book here; I think it’s at home—The Making of a Bodybuilder by Arnold Schwarzenegger, that was my Bible. So I was small in high school; I wanted to get bigger; I wanted to lift; and my first exposure to testosterone came in the late 1980s. And I was like, ooh, do I really want to do this? Do I not want to do this? And I opted not to do it at the time. It wasn’t until 2013, after a really bad head injury, that I actually went on testosterone.

Dr. Gabrielle Lyon [0:18:20]

Interesting. And that was also the same time that the Journal of the American Medical Association published a study in 2013 saying that testosterone increased cardiovascular risks and that there was an increase in cardiovascular risk with testosterone therapy, including strokes, heart attacks, and death. And this was a very pivotal study because the study contra-indicated, what, 20 years of medical research and literature saying that testosterone really played a role in the prevention of cardiovascular disease, which you do talk a lot about to other physicians? I do want to point out the flaws of this study that– do you remember that? Of course, you do. That observational study really got media attention. But the study was found to be tainted by the inclusion of 9% females in an all-male sterile.

Dr. Rob Kominiarek [0:19:17]

There were multiple problems with this study. But yeah, if you fast forward, what group are we talking about? So when it comes to treatment strategies, am I dealing with a 19-year-old who smokes too much weed? Or am I dealing with a 55-year-old who maybe had a previous history of MACE (major adverse cardiovascular event)? Maybe it was small. That data pool is very different. What I’m going to do for those two individuals is going to be very different. For a 55-year-old male with insulin resistance who is gaining weight and has maybe had an incidence of MACE, most of the data is pretty clear. Testosterone is going to benefit in a major way. The question that comes then is, what delivery methodology? Am I using a synthetic? Am I using a bioidentical? And what does that look like? For example, we know that synthetics, when it comes to your lipoproteins, can be neutral or even drive them negative. And if using a bioidentical, we can keep them neutral or make them positive, and the end result is the same. You’re going to raise the testosterone, but there are different effects of the lipoproteins.

Dr. Gabrielle Lyon [0:20:24]

Can you expound on that, synthetic and bioidentical, and if you’re talking about which lipoprotein? I think that the listeners would love to hear your expert opinion.

Dr. Rob Kominiarek [0:20:34]

One of the things that I’ve noticed clinically over the years is that you’ll see a change in lipoproteins when you put somebody on testosterone, which is generally beneficial in nature. So over the course of about 16–18 months of consistent therapy with lifestyle adjustment, you will see beneficial results in the lipoproteins, especially with bioidentical, and I deliver bioidentical via transdermal methods, which is a transdermal delivery system. The synthetics you’re going to get are injectables, and they’re in seed oils, and not everybody responds positively to those. For the most part, most people make decisions about their health and wellness with a minimal amount of diagnostics and laboratory testing. That is not my approach. I take a very deep dive—a CBC, a chem 14, that’s nothing. We’re going to look at 33 different hormones and their metabolites, and we’re going to take an intensive look at their lipoprotein and their family history from a cardiovascular standpoint. Because I believe, though the data does point to testosterone being cardioprotective, that, to me, there’s a yes and no there. For some individuals, it’s incredibly beneficial. For others, it could be problematic. And you have to watch that.

Clomiphene, for example, or Clomid, are great medications. But when I monitor lipoprotein levels, I do see that in certain individuals, desmosterol production goes way up. Now, that could be a problem for somebody who has a significant family history of cardiovascular events. Someone who has thrombophilia or hypo fibrinolytic disorders could have an issue; there are a lot of gray areas in medicine where you can’t say it’s 100% this or 100% that, and that’s what needs to be taken into consideration when placing individuals, male or female, on hormones. That’s why I have an issue with some of these cringy clinics that just throw testosterone at anybody who comes through the door, as if that is the solution. And listen, I love testosterone; I prescribe a ton of testosterone. But is that always the answer? That question isn’t asked often enough. Is this the right pathway for 22-year-olds to take–

Dr. Gabrielle Lyon [0:22:57]

When you start them on–

Dr. Rob Kominiarek [0:23:58]

–compared to somebody who’s older?

Dr. Gabrielle Lyon [0:22:59]

You have a pretty structured way of going about it. You mentioned enclomiphene. Number one, what is enclomiphene versus Clomid? What do you see the difference in? What are some of the results that you see? For example, do you see a certain percentage bump in testosterone? Do you see mood changes? What are some of the differences? Number one, what is it, and what are some of the clinical applications?

Dr. Rob Kominiarek [0:23:29]

So Clomid, or Clomiphene, is a selective estrogen receptor modulator that works at the level of the brain, increases gonadotropin-releasing hormone, makes more LH travel to the testicles, and makes more testosterone. That is one part of the equation; it works in the brain. The other part is the testicles. Do the testicles have enough vitamins, minerals, antioxidants, and cholesterol to be able to generate more testosterone? So there are two parts to that equation. Clomiphene you can get as enclomiphene, which has had one of the components removed from it, which is zuclomiphene, which supposedly makes it less estrogenic. I like using enclomiphene because I see a doubling in the number quite consistently, and I generally don’t see as much of a rise in desmosterol levels. That has to be to wade into the family history of the individual I’m working with and what their goals are. Some individuals may say, listen, I want to recover, I’m going to do this as naturally as possible. Okay, great. Here are her options: We have selective estrogen receptor modulators; there are peptides; there are biologics like HCG; and we have testosterone and all its different delivery methodologies. Which one do you feel I lay out all the pros and cons for the patient. Which one do you feel is the way you would like to go, and then let me give you my clinical expertise over 25+ years of using these medications on what’s probably the best pathway for you.

Now, with somebody who’s younger, I like to take a step ladder approach versus coming out in full guns right away. Because what if I’m able to recover their hypothalamic-pituitary testicular axis? Right? What if we could do that with HCG? It has worked wonderfully. What if we could do that with enclomiphene? Great, pull it away, take a drug holiday, see if we’ve rebooted the system, and save testosterone for a later date. If we use those two things and we can’t get resolution, well, now you have an answer. Now we have to use this; we don’t really have a choice. You failed this therapy, you failed that therapy, and the only thing we have left now is the big tool in the toolbox. Now for the person, it’s like being a diabetic who has to use insulin. Now, if you’re going to have to deal with some of the unwanted side effects and predictable unwanted side effects of testosterone therapy that can occur, well, now you’re going to be able to deal with them because you’re in the right mental space. That’s why I often hear individuals in the community say testosterone is great and every man walking the earth should be on testosterone. Yes and no, every man needs testosterone, but every man doesn’t need to be on exogenous testosterone.

So you have to be ready to deal with the unwanted and predictable side effects from testosterone therapy, which can be problematic. If you take 100 guys, there’s going to be 90, and you’re never going to have an issue, but then there’s going to be 10 that there’s going to be some heavy management with. And that’s where the work really comes in: dealing with those issues. People need to be well informed about their choices. And that’s why I take issue with some of the cringy, cringy, cringy places that do just minimal testing, and it’s all like a business model: what can I do to get them on testosterone? I mean, now you’ve got ads running down in the state of Florida for testosterone with a visit of $49, and you get your testosterone. And from what I’ve heard, it’s actually testosterone that’s being brought in from India, and the packaging is all being replaced to make it look like it’s a US product from US pharmaceutical companies. I mean, it’s just turned into a huge, huge industry.

Dr. Gabrielle Lyon [0:27:19]

Which definitely has issues. The positive aspect is that people are starting to recognize how important it is in cardiovascular disease, dementia, osteoporosis, and diabetes. Testosterone is not routinely used for diabetic patients.

Dr. Rob Kominiarek [0:27:39]

I use it all the time.

Dr. Gabrielle Lyon [0:27:42]

Of course you do, because you are an innovator. Of course you do, which is one of the reasons why I wanted you on the podcast. Because looking at the history of testosterone utilization, there’s Morgenhaler, and what was it? The Androgen Society? Andrology? Anyway, they created a society, I think it was The Androgen Society, with the goal of the urologist, the endocrinologist, and the family care provider all coming together and really understanding what the risks and benefits were. And I think that started in 2017, where you really excelled, as you have truly been doing this for much longer than the majority of individuals and really being–

Dr. Rob Kominiarek [0:28:29]

It’s become fashionable in the last–

Dr. Gabrielle Lyon [0:28:32]

So now it’s fashionable, which is–

Dr. Rob Kominiarek [0:28:34]

They haven’t lived through all the, oh my God, the flak I took from colleagues in the late ’90s and 2000s. And oh, my God, it was, you’re nuts, you’re crazy, you’re going to kill people. Let me tell you something. Out of the tens of thousands, maybe even hundreds of thousands at this point, of men that I’ve put on testosterone, the benefit greatly outweighs the minimal amount of risk. I mean, it’s just amazing to see what testosterone optimization therapy does for the individuals who need it. And coming back to the diabetes, back in the 90s and early 2000s, I used to see one diabetic patient a day. Now, it’s everybody that comes through the door; it’s everybody. Type 2 diabetes and insulin resistance are just so profound. I believe there are multiple reasons for that. However, when I get a mid-40s, 50-year-old guy who’s overweight and insulin resistant, I can change all those other parameters without low testosterone by adding in testosterone, overcoming the cellular resistance, getting past the inflammation of the cell while I’m calming it down, and changing those numbers. We can go from really out of control hemoglobin A1C levels of 8, 9, 10, 11, and within a year have them back at 5.0 or 4.9. So it really does work wonders to correct the metabolic syndrome.

Dr. Gabrielle Lyon [0:30:15]

Absolutely. I’m going to give you a number here. So there are many great papers, and this is, let’s see, testosterone therapy has been shown to prevent the development of type 2 diabetes. In a randomized placebo-controlled trial, obese men with impaired glucose tolerance or early diabetes, which you treat all the time, were treated with testosterone. Less than 400 were treated with testosterone. For two years, in addition to lifestyle changes, there was a 41% reduction in the incidence of Type 2 diabetes. And then, among the early Type 2 diabetic patients, a reversal of diabetes occurred in 45% of the patients in the testosterone arm only. So it is really, really incredible and interesting. It’s not used as a standard of care for weight management.

Dr. Rob Kominiarek [0:31:12]

Body recomposition, because that’s what it is.

Dr. Gabrielle Lyon [0:31:15]

But listen, you are right, and we can prescribe Ozempic, Mounjaro, and all of these antidiabetic or obesity medications in a much more robust way than we can prescribe testosterone. I mean, now, but just in the history, I think that that’s really fascinating to think about, that we can treat fat tissue, but conceptually treating muscle tissue, which is one of the reasons why testosterone improves insulin sensitivity and glucose tolerance is because it affects these GLUT4 receptors in skeletal muscle. Yeah, for whatever reason, because of the red tape and because the science is so slow, we can treat obesity, but we can’t treat muscle.

Dr. Rob Kominiarek [0:32:06]

Yeah, it’s funny. Rick Collins could give you a complete legal history of testosterone over the years and how it’s, oh, what’s the word I’m looking for? It’s transgressed through the years, and now there’s–

Dr. Gabrielle Lyon [0:32:20]

He’s been on the show, and it was amazing.

Dr. Rob Kominiarek [0:32:21]

Now there’s talk of possibly removing scheduling so that it won’t have some stigma attached to it for a certain community to use it. However, I digress.

Dr. Gabrielle Lyon [0:32:34]

There was a recent study, and we should get into some of the cardiovascular aspects because you have fought uphill for this. And now Mohit Khera came out or was part of this study that was recently, I believe, published in The New England Journal of Medicine, talking about how there was no increased risk of testosterone replacement therapy within natural levels, not super therapeutic levels. That showed no increase.

Dr. Rob Kominiarek [0:33:03]

Yeah, that’s another discussion altogether. Over the years, when I first started, it used to be in Labcorp that you looked at levels of testosterone. Their parameters were 1500, and 550 was low. And every guy that I would see when I would check testosterone in my age group—I’m 58—their testosterone would be 900, 1100, 1000—that was normal. And I would only see patients who had cancer, radiation chemotherapy, or trauma, and they would be, or they were, older than I was putting on testosterone. So you didn’t see this huge number of young men, and testosterone indicated for the treatment of hypogonadism. The labs keep shifting these parameters to the left, saying that these are normal levels, but they’re using sick people to call them normal. Now it’s the point where, on the left, it’s 250, 220, 225, or something ridiculous, with the top range being 900. Well, for me, naturally, when I check my levels, I’m 1000, 1100, with a free of around 20, 23. That puts me above the range. So I make too much testosterone naturally, but that’s what normal used to look like 20 years ago, and when I check labs now, it doesn’t. These young kids come in; I had somebody here yesterday at 103. That’s crazy. So when you say levels 500; 500 to me is incredibly low. That’s not what normal looks like.

Now that’s looking at total testosterone. We really want to be looking at free testosterone because that’s what matters. And that’s about 2–3% of what’s available—what can cross the cell membrane and bind to the androgen receptor. It’s about holding up those free testosterone levels. So that’s going to tell you more about how the hormones are affecting the individual. But then again, if you have issues at the level of the cellular membrane that it can’t be transported, because if it’s not transported in the membrane, where it can bind to the antigen receptor and translocation and transcription can take place, it’s all for naught. And that’s where it’s our testosterone resistance and testosterone being able to cross across the cell membrane and have an effect at the cellular level—that’s the important part. And if your free testosterone levels are low, that’s not going to happen. If you have inflammation at the level of the cell, that’s not going to happen. If you have too much toxicity in the body, that’s not going to happen. If you have metabolic disorders, that’s not going to happen; you’re behind that metabolic 8-ball, and it’s never going to recover without using testosterone or one of the other agents of biologic or selective estrogen receptor modulators to overcome that. I find that the older men are just going straight to testosterone.

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Dr. Gabrielle Lyon [0:36:08]

Thank you to 1st Phorm for sponsoring this episode of the show. Today, I would love to talk to you about collagen protein. Yes, collagen protein is not a complete protein. But here’s what I’ve been thinking a lot about, I’ve been thinking that we really should be eating dietary protein in ratios, not just high-quality proteins like muscle meats, beef, bison, and chicken, but actually all the parts of the animal, which include collagen. I have been working very hard to add at least one scoop of collagen to my normal protein meals, and I think this is a great idea. I also believe we’re going to start to see more balanced versions of these kinds of meals. You can do the same. Head on over to 1stphorm.com/drlyon. That’s 1stphorm.com/drlyon. You can try their collagen. I’ve been using their natural collagen. This is wonderful for hair, skin, and nails; it may have some positive effect on your gut. But what’s even more interesting to me as of late is this idea of balancing the amino acids in collagen with the amino acids that you get from muscle meats like beef and chicken. So more to come on that. Head on over to 1stphorm.com/drlyon, and let’s start to diversify your protein sources.

Thank you to InsideTracker for sponsoring this episode of the show. By the way, it is absolutely time for my InsideTracker redraw. In case you’re wondering how I know that, it’s because I’ve gotten an email. InsideTracker is an amazing service. And basically, what it does is provide personal health analysis and a data driven wellness guide to help you live your best life. What this is is a series of blood biomarkers that you directly have access to, which is incredible because that means you don’t have to wait to get into your physician; you can take control of your health. This is an incredible service. Basically, you’ll go to their website, pick out a plan, and decide what you’re going to do. And they’ve added even more biomarkers, including ApoB, which, if you don’t know your ApoB number, you should because it really is an indicator for heart health and it’s preventative. They’ve also added insulin and all kinds of other things that you can have access to. And if you go to insidetracker.com and pick a plan, they have generously offered 20% off to my listeners. Again, this is a service that I use myself. Go to insidetracker.com/drlyon and you will get 20% off whatever your plan is.

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Again, I do want to highlight the length of experience that you’ve had with looking at blood labs. You’ve seen when 500 was considered low. Now, according to the guidelines—

Dr. Rob Kominiarek [0:39:28]

That’s normal. It’s crazy.

Dr. Gabrielle Lyon [0:39:31]

And this is an issue.

Dr. Rob Kominiarek [0:39:32]

It is.

Dr. Gabrielle Lyon [0:39:33]

This is an issue because we’re seeing a testosterone of 1500, individuals, providers freak out when there was a period of time where that was considered normal. How can we–

Dr. Rob Kominiarek [0:39:48]

It’s not super physiologic.

Dr. Gabrielle Lyon [0:39:48]

This is a really important part of the conversation. In terms of comfort level, where are you comfortable with individuals’ testosterone being on the higher end of normal?

Dr. Rob Kominiarek [0:40:05]

Resolution of symptomatology; the number for me means nothing. I want resolution of symptoms, and that’s going to come, depending on where that level of free testosterone is, because it’s not the total testosterone that matters. It’s the free testosterone that can cross the cell membrane and bind to the antigen receptor. Then there are the genetics that come into play. So that androgen receptor has 8 exons, and exon 1 is responsible for transcription of what’s happening. So if your CAG repeat length on exon 1 is too long, you’re going to have an insensitivity to testosterone. So there are multiple reasons why the level of your total testosterone is irrelevant. And when people focus on that, and I mean this humbly because there was a time when I did, it tells me you don’t understand testosterone. The total testosterone number is irrelevant. Watch the free testosterone. And if we had a test, there isn’t an economically viable test to look at CAG repeating. There are tests out there, but they’re not commercially available. They’re not economically sound. Maybe someday we’ll be able to do that. And that would be great, because that would certainly help with treatment. But everyone is different; they really are. Not every individual is the same, and it comes down to all those factors. You need to be able to transport, translocate, and transcribe the hormone, and if those aren’t working, it’s not going to happen. If you have inflammation at this level of the cell and that biolipid membrane, that’s not going to happen; toxicity is too high; metabolic disorders; there are so many other things that need to be in place and functioning well for the hormone to be effective. And that’s why I always talked about how you’ve got to heal the person first.

Dr. Gabrielle Lyon [0:42:00]

And have you found that those individuals that you suspect have a CAG repeat and are androgen insensitive, when you remove other insults, for example, mercury or lead, or, I don’t know, mycotoxins, or other environmental type issues, do you see that their free testosterone comes up? Or do you just have to administer? What would be some strategies to increase free testosterone?

Dr. Rob Kominiarek [0:42:33]

So that’s the goal—free testosterone. The easiest way to do it and why so many people do it, I was like, why does this work this way? So with my curiosity, I want to solve this; I really want to understand this. And why are there all these differences between individuals? Why is it just not the same for everybody? So you can drive past that cellular resistance to a point. However, when the toxicity is really bad, when the cellular inflammation is really bad, and when there are CAG repeat length issues, when I challenge them with testosterone, it doesn’t solve the issue.

Dr. Gabrielle Lyon [0:43:08]

Fascinating. Meaning, they don’t feel better? We don’t worry about the testosterone.

Dr. Rob Kominiarek [0:43:14]

For somebody in the office, I can challenge them with testosterone. In 15 minutes, what’s going to happen? Eyes light up, cheeks get rosy, because where does testosterone work? It works in the brain. So if they’re sitting in front of me, it’s like, Okay, we’re going to challenge you right now to see how bad this is. Boom, 15 minutes, they light up. They’re like, Oh, my God, I didn’t know I could feel like this. I need to go home, I need to find my wife. They’re ready to go. They want to, I need to go to the gym, I want to pick stuff up and put it down and pick it up again. Because it works in the brain and makes you want to do work. That’s what it does for men. When that fails to happen in front of me when I challenge them, I know we’ve got serious issues. I know that, by default, the toxicity is pretty bad. The inflammation is pretty bad. I’m not overcoming the cellular resistance, there could be a CAG repeat length. So coming back to the levels, it doesn’t matter to me, if I see it’s greater than 1500. And the free is 30, 40, 50. Now I’m overcoming the cellular resistance and I’m getting results. While I’m doing that, I’m detoxing him. I’m dealing with all the other metabolic issues. Because it comes down to some basic human psychology. The discipline, the consistency, what’s their emotional state, their spiritual state, because when you get so far behind the 8-ball, you need to get traction and get moving forward. Right, they need to see some progress, some hope. It’s like, Oh, I can see it now. You know, they get motivated, they want to do more. So oftentimes, it is, right out of the gate, it’s like we’re going to go straight to testosterone because they have just way too much to overcome and then we’re going to do everything else alongside of it.

Dr. Gabrielle Lyon [0:44:57]

What about women? Do women also have CAG repeat issues?

Dr. Rob Kominiarek [0:45:01]

It certainly can come into play. Testosterone is a different animal for women; they certainly need it just as well. Usually, it starts to fall off in the mid-30s, but it can fall off sooner. There are other considerations: women feel thyroid, men feel testosterone. So for women, it’s always thyroid issues and birth control issues. We’ve been talking about this for years. If you put a woman on birth control, you’re creating a catabolic state, and you better be prepared to deal with it. And there are some great individuals out there doing phenomenal work in healing all these young women from their teenage years up into their 40s with all these birth control-induced catabolic states and crashing their metabolism. You need to be able to deal with that. It’s the same thing with Dual GIP/GLP-1. Now we’re going to have triple agonists that are coming out. You’re going to create a catabolic state, and you need to know how to deal with that. What good does it do to pull the fat off of somebody if you’re going to waste their muscle in the process and make him skinny fat. So you need to understand how to use those medicines and use them well.

Dr. Gabrielle Lyon [0:46:12]

When, let’s circle back to the younger individual and then kind of go forward to older individuals, more mature, as they say. By the way, for the listener, I have been in your clinic. I’ve spent time in your clinic. I call you when I have very complicated cases and want to talk to the community.

Dr. Rob Kominiarek [0:46:36]

Yoda. I’m the wizard behind the curtain.

Dr. Gabrielle Lyon [0:46:38]

Dr. Rob, what about this person? Did you put him on—

Dr. Rob Kominiarek [0:46:39]

That’s me, the wizard behind the curtain. Do this, do that. I’ll tell you what to do.

Dr. Gabrielle Lyon [0:46:45]

Yeah, I would agree with that. So if anyone is lucky enough to be mentored by you, then they’re in for a very funny, charismatic journey. You are all those things.

Dr. Rob Kominiarek [0:46:55]

I’m in the process right now. We’ve been filming. I’m in the process of getting all of my life’s work on video. We’ve got that filmed, and I’m actually working with somebody that’s, I think, going to bring that all to fruition because at some point, I need to make sure that this gets passed on if something happens to me, which eventually it will at some point.

Dr. Gabrielle Lyon [0:47:16]

Well, eventually, yes, nobody gets out alive; we will definitely share that and have you on. I mean, this is something I’d love to bring you on quarterly, where we talk about some of these new, evolving therapies. Let’s discuss: when an individual is young, you will typically trial them on a Clomid-type compound. And I actually learned this coming into your office: a handful—I don’t know if it’s 10% or 15%—will get extreme anxiety when you put them on testosterone, which is completely counterintuitive. So you tend to do this stepwise approach where you start them on Clomid; I’m curious as to the dose. And if you dose it every day, or if you’re using Clomiphene, the dosing and strategy versus when you use Clomid or HCG, how do you put that into play? And then what are you looking for in the labs?

Dr. Rob Kominiarek [0:48:14]

Let me give you a case example—a teaching case. So in something I’m really passionate about, there are so many young men today that, oh, just don’t know where to turn, being told that being masculine is bad, that being masculine is toxic, or somehow there’s something wrong with them. Let me tell you something: there’s nothing wrong with you. There’s no such thing as toxic masculinity. There are two poles: the feminine pole and the masculine pole. It’s a beautiful thing created by God, and when the two come together, wonderful things happen. So there’s nothing wrong with men being a man or being masculine. But we’ll take a 19-year-old, for example, who suddenly doesn’t feel like playing sports, doesn’t feel like dating, or even, as I get this complaint a lot, has erectile problems. This is late teenagers or early 20s. Check their testosterone levels; they’re low. Immediately, I go looking for an offender. So what are the big ones? Anxiolytics, antidepressants, and marijuana are usually the big ones, the top three. So with ADD and ADHD medications, where do all these medicines work? They work in the brain.

So it’s first the removal of the source. Marijuana use in the area where I live tends to be a big issue. There’s been a lot of marijuana use ever since the so-called legalization. Oh, marijuana must not be bad; it does all these great things. Well, it doesn’t do great things for your hormones. It’ll crash them. So first, let’s say we get rid of the marijuana and see what we can do. I’m going to take a step-ladder approach to that. I like to use enclomiphene or HCG with young men. If they’re needle-phobic, I’m going to use enclomiphene. If they’re not needle-phobic, HCG is a great way to go. There’s just an enormous amount of data in HCG, and young men are recovering from hypogonadism, and it works really well. If those were to fail, then we always have testosterone to use. However, I almost never get there with a young man. So it’s about spending time with them—the mom and dad explaining what the issue is, putting together a treatment plan, following that plan, and then, at some point, removing the medicine to see if we’ve rebooted the system and if it’s going to do what it needs to do. So, the first step is really removing all of the offending agents, if that’s possible. Sometimes it’s not possible.

Dr. Gabrielle Lyon [0:50:45]

Do you know the mechanism of action as to why marijuana creates such a negative impact on that hormone?

Dr. Rob Kominiarek [0:50:51]

It’s incredibly estrogenic. It works in the central structures of the brain, and it just destroys gonadotrophin-releasing hormones, LH and FSH. It negatively impacts the brain’s hormone secretion. So using it every now and then, but smoking three times a week, four times a week, or daily, is very bad from a hormone standpoint.

Dr. Gabrielle Lyon [0:51:17]

It seems to be, like you said, more of a trend these days, and they’re smoking more marijuana, using anxiolytics, and then requiring some kind of counterbalance. When you dose Clomid, how do you do it? Do you dose it daily? Do you start with 12.5 mg? Do you start with 25, or do you start with 50? I think it’s all across the board for providers.

Dr. Rob Kominiarek [0:51:46]

It is. I go anywhere from 6.25 to 25 milligrams, depending on the individual and sensitivity. You can have unwanted side effects from enclomiphene. I’ve had individuals, and not very often, but headaches can be common. I had one person who ended up with dyscalculia and couldn’t do math. So we pulled it away, and suddenly, his ability to do math came back. So, well, that’s not an option. I do watch lipoproteins, and you can see the derangement of lipoproteins with those medications. So which one’s better, HCG or Clomiphene? It depends on the individual; we kind of work it out. But my goal is always to have them off therapy at some point. So it depends on all these little factors as to what I’m going to use and how long we’re going to use it. Enclomiphene, or Clomiphene, I generally use every other day or third day; there are individuals who do better on it every day. When I used it, trying to recover from my head injury and get things going, I was using it every third day, then every other day, then every day, and still wasn’t getting movement the way I needed to at the time. That’s one of the reasons. HCG didn’t work for me; I got incredibly anxious on HCG. So I ended up moving to testosterone, which solved the issue at the time. Then, after a few years, I’m like, okay, I really believe I can recover my system naturally. How am I going to do this? So it depends on the individual.

Dr. Gabrielle Lyon [0:53:27]

How long do you initially trial them on Clomid for? Are you looking for an increase in LH? Are there certain lab values that you’re looking to say, okay, this is actually doing the job that we intended it to?

Dr. Rob Kominiarek [0:53:41]

Trial them for 3-6 months, and then remove them. If they’ve removed the toxins that caused the problem in the first place, there’s a good chance you’ll recover. The other issue you run into is that they feel so good on it and don’t ever want to come off of it. You know, there’s just like, everything works great. I like taking a ticket every third day, and things function just fine. I’m not stopping. Okay.

Dr. Gabrielle Lyon [0:54:05]

Is there a certain percentage increase in testosterone that would be average? Or is it just completely individual?

Dr. Rob Kominiarek [0:54:12]

It’s individual, but in general, I see a doubling in the number.

Dr. Gabrielle Lyon [0:54:17]

That’s right, you mentioned that.

Dr. Rob Kominiarek [0:54:20]

500 will always be there; 99% of the time, it’s going to be over 1000. So if I started there and their number was 500, it was going to be over 1000. The question that comes to mind is, what are we generating in free testosterone? And is it having an effect at the cellular level? And if it’s not resolving symptomatology, it’s like, well, we trialed it, it didn’t work, let’s try another path. You know, are we going to use a peptide called kisspeptin? Are we going to use HCG? At this point, are we just going to go to testosterone?

Dr. Gabrielle Lyon [0:54:50]

Do you give it up to three months, or do you know pretty quickly if Clomid is going to work?

Dr. Rob Kominiarek [0:54:56]

It depends on the individual. Some people, literally the first pill, they’re like, oh my god, something’s different. Then other people need to be on it for four to six weeks before they start to notice a change.

Dr. Gabrielle Lyon [0:55:09]

Do you look at LH or FSH before deciding which agent you’re going to use?

Dr. Rob Kominiarek [0:55:14]

That’s part of the initial workup. I’m looking at LH, FSH, total testosterone, free testosterone, pregnenolone, progesterone, DHEA, IGF-1, IGF binding protein-3, growth hormone, and on the thigh, T3, T4, TPO, and TSH.

Dr. Gabrielle Lyon [0:55:32]

I’m laughing because I’ve called you out on–

Dr. Rob Kominiarek [0:55:35]

Do you know what my lab profiles look like? There’s sheets of–

Dr. Gabrielle Lyon [0:55:38]

I do, but the listener doesn’t know, and they need to know.

Dr. Rob Kominiarek [0:55:41]

I look at everything. Then I got calculations that we run.

Dr. Gabrielle Lyon [0:55:46]

And then you run certain calculations. Because I’ve called him and said, why are using IGF binding protein-3? And then we go back and forth. But as it relates to HCG, and also one of the other questions I want to get at is, are you looking for an LH or FSH that’s less than 5 to know if it even is going to be effective?

Dr. Rob Kominiarek [0:56:08]

In a normal production of LH and FSH, an LH of 5 or greater is going to be normal, and 7 or greater for FSH in men. So I am looking to see those numbers. But again, it really comes all the way back to free testosterone, and what do those levels look like? If you have a low free T, you’re not going to get penetration at the level of the cell. I need that above 2%, at a minimum. I’d like to see 4%, 5%, really; that’s where you’re going to see a lot of changes.

Dr. Gabrielle Lyon [0:56:38]

What about HCG? How do you dose it? Do you dose it at the standard 250 to 500, three times a week? Where are you in those?

Dr. Rob Kominiarek [0:56:49]

As a maintenance, 250 maybe Monday, Wednesday, and Friday. Initially starting out, I’m just going to use a larger amount to get things going and see if we can get some changes. Are they going to feel those changes, too? Because ultimately, you want resolution of the symptomatology.

Dr. Gabrielle Lyon [unclear 0:57:07]

So much feelings.

Dr. Rob Kominiarek [unclear 0:57:08]

Well, that’s what it’s all about. You’re not getting results. Well, that’s what it’s all about. I mean, it’s the same thing with women; it’s like, what good is it of going on progesterone, estrogen, testosterone, and thyroid if you don’t feel better? If you’re not throwing your feet out of the bed, hit the ground going, I’m ready to go today; let’s go; I can’t wait. So if you’re taking hormones and they’re not solving those things, there are other issues. Remember, any doctor can make any delivery methodology work, and they put you on all kinds of different hormones. However, if nothing else is working, if your sleep is off, if your nutrition is off, if your exercise is off, if your mental sanity is just wiped out, if you’re just so stressed, no hormone can overcome poor nutritional habits and poor lifestyle habits. I don’t care how much you take. All those other things need to be in line.

Dr. Gabrielle Lyon [0:58:02]

First of all, I do agree with you. How long do you give HCG to work?

Dr. Rob Kominiarek [0:58:10]

Six to eight weeks generally.

Dr. Gabrielle Lyon [0:58:15]

And what is your comfort level in terms of the length of time you will keep a patient on it?

Dr. Rob Kominiarek [0:58:20]

Indefinitely.

Dr. Gabrielle Lyon [0:58:23]

They don’t build up antibodies?

Dr. Rob Kominiarek [0:58:24]

You can over time, and there are certain individuals for whom you’ll get a couple years down the road. And that loses its effectiveness, and it’s time to move on.

Dr. Gabrielle Lyon [0:58:33]

Where do you think the industry or practice is going? What do you think is next? Just to clarify, the reason I’m asking you this is because you have always been one step ahead of where the trends are going. And what you’re seeing in the clinic—do you think it’s environmental medicine? What is next? What is going to be the next iteration of therapy?

Dr. Rob Kominiarek [0:59:01]

That’s a really good question, and I wish I knew the answer. I can feel, and I’ll use the word “industry” for lack of better terms, that there’s this shift happening in medicine. And I firmly believe it’s headed towards health coaching and more of a partnership model. There is so much disease prevalent not only in the United States but around the world. And the old healthcare system is just not working. We really need to partner with other individuals to modify lifestyle factors. So I see the use of more health coaching and a movement away from traditional health care. Hormones aren’t going anywhere. They’re here to stay. And there may be, you know, thanks to certain political groups, changes with respect to testosterone and scheduling. We’ll have to see.

Dr. Gabrielle Lyon [1:00:06]

For the listener, Dr. Rob is not in studio. I’ve been begging him to come in studio. The interviews are always a little more difficult when they’re remote. There’s a slight delay.

Dr. Rob Kominiarek [1:00:22]

This fall, I promise because I’m going to be in Houston right before your book release.

Dr. Gabrielle Lyon [1:00:30]

Yes, right before the book release. But anyway, just to apologize for the listener, there’s a little interruption that happens, and it is just because the lag of not being in person because Dr. Rob is super, super lazy, didn’t want to fly in.

Dr. Rob Kominiarek [1:00:51]

I need an assistant for my assistant just to keep my schedule.

Dr. Gabrielle Lyon [1:00:54]

We all do. So, the idea of health coaching, I think is great. I love seeing you talk more about environmental toxins. The barrier to entry for some physicians, I do want to mention because I learned this from you. When individuals see an increase in hemoglobin hematocrit when they are placed on testosterone freaks a lot of providers out and a lot of people out, and you have a high tolerance for that. You also taught me that it’s not polycythemia. It is erythrocytosis. I’d love for you to explain this because I think that there’s an unnecessary fear for people.

Dr. Rob Kominiarek [1:01:37]

There is. So we’re not talking about– let’s divide this up. There’s the bodybuilding community and the overuse of DHT derivative steroids and testosterone that can lead to really high levels of hemoglobin hematocrit. In testosterone replacement therapy, testosterone optimization therapy, it is expected and even desired to see testosterone-induced erythrocytosis. It is not polycythemia rubra vera. Completely. One is blood cancer, and one is an expected and desired result of testosterone therapy. You’re going to see a little bit more of testosterone induced erythrocytosis with injectable versus transdermal, but they can occur with any delivery methodology, whether it be pellet therapy, injection, transdermal, oral, it can happen.

It is desired and expected and not anything that needs to be worried about, unless the patient is having symptoms such as erythromelalgia, so burning and tingling in the hands, red face, increased blood pressure, shortness of breath. In the tens of thousands of men I’ve put on testosterone over the years, maybe six people I’ve actually had to use therapeutic phlebotomy. You can reverse that process by dropping the dosage down, extending the time and the dosage, or even withholding therapy for a moment of time, and those numbers will come down. You can use therapeutic phlebotomy. It is not something that needs to be done with any regularity. Not long ago, I had a physician come to me who felt terrible. He was just, I feel terrible, I feel sick, something’s not right, and he was donating blood on a monthly basis, most of it being done by himself. So he would get his own bags and then he would draw his own blood because I need to phlebotomize myself, and so he induced an anemia. So I see silly things like that happen. It’s not necessary.

Dr. Gabrielle Lyon [1:03:58]

What level of hemoglobin hematocrit to tolerate, do you feel, is safe?

Dr. Rob Kominiarek [1:04:05]

Any. I personally do not chase anything down unless they’re symptomatic. The last person that I recommended doing therapeutic phlebotomy to was a man in his 60s who purchased a home in Colorado that’s 12,600 and some feet, and this was new. He lives at roughly sea level, flew to Colorado, goes to his home in the mountains and suddenly feels short of breath. To me, that’s a red flag. Let’s think cardiac. We actually took a really close look at his cardiac parameters. He turned out he had some plaque in the left anterior descending artery that was a problem. So that was another, but part of the treatment plan is well, let’s phlebotomize you right now and see if that helps. And we went ahead and did that and corrected the shortness of breath. When he got back down to sea level, nothing was an issue. But it was interesting how when he got into the mountains all of a sudden, there was a little bit of an issue. We phlebotomized him. Relieved it at that point, but we went ahead and chased down some cardiac, because I felt something didn’t smell right. It turned out that he did have an obstruction in his left anterior descending.

So not very often do I phlebotomize people, and it’s not necessary; it’s over-utilized. Now, if you’re doing something else, you’re chasing down bodybuilding protocols and using obscene amounts of DHT derivative steroids, well, yeah, you may have to because you end up with renal problems, hypertension problems, all kinds of issues.

Dr. Gabrielle Lyon [1:05:33]

But we don’t know anyone who’s doing that.

Dr. Rob Kominiarek [1:05:36]

No, that’s not what I do. It’s not what you do. But that’s a whole different world that I’m not part of. And there’s Tom O’Connor. He specializes in treating guys that have used DHT derivative steroids and continue to use them. That’s kind of his world.

Dr. Gabrielle Lyon [1:05:56]

What I’m hearing you say, and what the listeners should understand, is that there has been a standard of practice of recommending routine phlebotomy to lower hemoglobin hematocrit, and what I’m highlighting here is that Dr. Rob, who has been in practice for 20+ years, he’s been really doing this. He has been looking critically at the literature and seeing that it may not be necessary.

Dr. Rob Kominiarek [1:06:26]

It’s not, and it got to a point where The Hematologist put out a paper clearly stating that testosterone induced erythrocytosis does not require any treatment and stop confusing it. Part of the problem is a lot of doctors use polycythemia and erythrocytosis interchangeably. Erythrocytosis is an elevation of hemoglobin or hematocrit. There’s no elevation in platelets or any other parameters. Polycythemia is an elevation of the entire bloodline. If they have polycythemia, you can diagnose that with a JAK2 gene test. So let’s not confuse the two terms, they’re not interchangeable. When we’re talking about a medication induced erythrocytosis, testosterone erythrocytosis, that does not require therapeutic phlebotomy. What you should be doing in your treatment of individuals is adjusting the dosage, either the frequency, the amount, the timing.

Dr. Gabrielle Lyon [1:07:25]

I love that. Another barrier to entry for physicians and also patients is this idea that testosterone induces prostate cancer. This was discussed in the 40–

Dr. Rob Kominiarek [1:07:38]

That myth is dead.

Dr. Gabrielle Lyon [1:07:39]

You know what, I say that about cholesterol and people still talk about dietary cholesterol. Can you please talk about that?

Dr. Rob Kominiarek [1:07:48]

Having normal upper quartile levels of testosterone is protective of the heart, it is protective of the prostate, it is protective of the brain. Testosterone is good, muy bueno, for both men and women. Enough of these myths; they’ve been disproven. There are literally hundreds of studies on the cardiovascular standpoint. Now we just had the TRAVERSE trial, which showed again, even though I think the study was kind of like ehh, that is to prove the point. It’s cardio-protective, and we know that. If you look at all the Intermountain studies, middle-aged men with major adverse cardiovascular events, where do you want to be? It shows that again, being in the upper quartile is cardio-protective, they live longer. Having low levels of testosterone is not good. You’re shortening your health span and ultimately shortening your lifespan.

And that’s what we’re really talking about is, this is about your health span, this is about your lifespan. What do you want your life to look like? Life is hard any way you cut it. It’s going to be hard to be healthy, and it’s going to be even harder to be sick. So I choose healthy. Life’s hard. You’re going to have to put in effort. You’re going to have to forego things because you’re going to have to miss out on things because you want to get your sleep. You need to exercise, meaningfully exercise, on a daily basis. You need to be strength-training; stop endurance training. For God’s sakes, that’s another one that drives me crazy. Then there’s another study that was out in March. You’re always wondering, you see these endurance athletes like, oh, God, they’re in really great shape. But they’re having heart attacks and strokes.

In the last six weeks, I know of three women, very sadly, my heart goes out to these families, that passed away in their 40s from acute coronary syndrome. Some of them were new to exercise and going aggressive without ever being appropriately screened prior to starting these exercise programs. But also doing these endurance things, they’re not good. Don’t get me wrong; cardiovascular exercise is good for the heart. Running is good, aerobic exercise is good. These extreme endurance things though, it’s been proven time and time again, for longevity, not the best way to go. Strength training, man, lift weights, pick them up, put them down, stay strong. Got to keep muscle, got to keep healthy muscle, got to grow muscle. You got to do everything to prevent muscle loss especially as you age; you have to. Period. You want to live. And it’s all about being able to do this, the 1.4 Newton-kg it takes to get your butt out of a chair. The second you can’t do that, you’re in a nursing home. That’s it. Now you’ve got somebody else caring for you. It’s a thin, it’s a slow, spiral to death. So I spend a lot of time, when I exercise, working on from the abs down.

Dr. Gabrielle Lyon [1:10:36]

Getting up from the chair?

Dr. Rob Kominiarek [1:10:37]

Yeah, I do a lot of legwork. You want to have strong hips, strong legs. I mean, I work on my entire body. But man, you got to stay strong. That’s how you’re going to prevent disability and disease. Stay strong, keep the muscle. It’s all about the muscle.

Dr. Gabrielle Lyon [1:10:53]

So you’re saying muscle is the organ of longevity?

Dr. Rob Kominiarek [1:10:56]

Yes, I agree. 100%.

Dr. Gabrielle Lyon [1:11:00]

Dr. Rob Kominiarek, I just adore you. Thank you so much for spending time talking about these issues and treatments. You truly are a pioneer in this space. We will have you back on, and I will link all the ways where people can find you. And he’s finally got his act together on Instagram, so we’ll link that.

Dr. Rob Kominiarek [1:11:21]

Yes. I just started using Instagram over the last three months.

Dr. Gabrielle Lyon [1:11:26]

It’s brutal.

Dr. Rob Kominiarek [1:11:27]

I was so hesitant, and it’s been fun. Yeah, please come find me on Instagram because I do put stuff on there.

Dr. Gabrielle Lyon [1:11:31]

I will tag you, so we can collaborate. And my Instagram is much better.

Dr. Rob Kominiarek [1:11:36]

Of course it is. Listen, I was an old dog that finally got convinced to go learn some new tricks. I’m like, alright, I’m going to do this.

Dr. Gabrielle Lyon [1:11:43]

Yeah, who convinced you?

Dr. Rob Kominiarek [1:11:45]

I don’t know, it’s just a couple of guys who–

Dr. Gabrielle Lyon [1:11:46]

I love you, my friend. And we will link everything here. If people want to go see you in person, I will also link your clinic and all of the things. Thank you again. I’d love to have you back on in the next quarter where we can talk more about some of the other emerging studies and probably some more of the toxicology and what people can do to improve their cellular health.

Dr. Rob Kominiarek [1:12:09]

Got to seek the truth. Got to find out the truth. There’s always another way. But yeah, I’ll see you definitely. I think it’s October and November. I’m in Houston, I think both months. I think I’m there October and November.

Dr. Gabrielle Lyon [1:12:23]

Well, got a place for you to stay.

Dr. Rob Kominiarek [1:12:25]

Yeah, I’ll be there, and we’ll do it live.

Dr. Gabrielle Lyon [1:12:29]

Yeah, talk soon.

Dr. Rob Kominiarek [1:12:30]

All right. Take care.

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Dr. Gabrielle Lyon [1:12:32]

The Dr. Gabrielle Lyon podcast and YouTube are for general information purposes only and do not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice. No patient-doctor relationship is formed. The use of information on this podcast, YouTube, or materials linked from the podcast or YouTube is at the user’s own risk. The content of this podcast is not intended to substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professional for any such conditions. This is purely for entertainment and educational purposes only.