Dr. Geo Podcast-Banner-10 (1)

To celebrate the tenth episode of the Dr. Geo Podcast, I decided to give the episode to you, the listener, in the first ever Dr. Geo Q+A! 

I’ll be doing more of these in the future on the podcast and will answer your questions. The reason why I love doing these episodes is because I get to hear from men who are dealing with all things prostate and men’s health related and help them on the spot with their questions. 

So let’s get into our first question.

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EPISODES NOTES

Larry from New Jersey writes:

“Dr. Geo, why I am not having libido or sexual interest? My total testosterone level is 8 and my free testosterone level is 6.6. I also have a low estrogen number of 11.”

So here is the thing. I think a lot of clinics and a lot of people get this wrong because what they try to do is just increase total testosterone at all costs.But it’s not about testosterone only, it is about ratios between total testosterone and other hormones, particularly free testosterone and estradiol and DHT and so forth. There is also some information missing from this that would help me pinpoint exactly what would be the cause of this so let me answer in a general way. 

There are two things: your free testosterone seems to be low. In comparison to your total testosterone. So your free testosterone is at the very low end of their normal range.

That’s number one. Number two is that your estrogen seems to be very low. So estrogen of 11 is very low. I get this a lot from men, “Dr. Geo, I’m a man, isn’t lower estrogen better?”

The answer is no. What you want is proper ratios between testosterone, total testosterone and estrogen, not just to keep bringing estrogen low, you need estrogen for many things as a man, you need it for bone health, you need it for cardiovascular health and you need it for a libido as well.

You do need testosterone for libido. So if your testosterone is really low, you’re not going to have sexual interest, but you also need some estrogen for sexual interest as well. So roughly the ratio that I think it’s important for men to have a total testosterone to estrogen is roughly about 20:1 total testosterone to estrogen. 

Onto the next question. Rob from Texas writes

“My PSA is 5.6. Should I get a biopsy? I have no family history of prostate cancer.”

Guys, I get this a lot and here’s what I am going to tell you. There is a lot more information needed in order to know exactly what’s going on outside of a PSA number. First, the number for a PSA test above 5, could be a lot of benign reasons, including an enlarged prostate or inflammation of the prostate so it’s hard to say If you need a biopsy or not. I would say that if you need a biopsy, try to get one of those genetic biomarkers that include something like a 4k score or exome DX test. 

These tests can help guide you more in whether or not you should get a biopsy. And if you do get a biopsy, you want to get a targeted biopsy where the urologist uses the MRI images combined with the ultrasound to target the areas of interest. 

As always, do your research. Ask questions to your urologist before making decisions like this. 

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If you have a question you would like me to answer, send your questions to podcast@drgeo.com

To listen to the full Q+A, follow the Dr Geo Podcast on Apple, Spotify or wherever you get your podcast. You can also get the llatest research and actionable takeaways in a world of men’s health and integrative urology by signing up for Dr.Geo’s newsletter at drgeo.com

The use of the information and all links associated with this article is at the reader’s risk and is not to replace medical advice from a physician or a healthcare practitioner. Thoughts and opinions related to this article and my podcast are my own and may not reflect the views of any institution or organization I’m associated with.

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