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Note: This is a rebroadcast.

When men think about optimizing their hormones, they tend only to think about raising their testosterone. But while increasing T can be important, an ideal health profile also means having testosterone that’s in balance with your other hormones as well.

Today on the show, Dr. Kyle Gillett joins me to discuss both of those prongs of all-around hormone optimization. We start with a quick overview of the different hormones that affect male health. We then get into what qualifies as low testosterone and how to accurately test yours. We also discuss what causes low testosterone in individual men, and how its decline in the general male population may be linked to both birth control and the world wars. In the second half of our conversation, we discuss how to both raise testosterone and get rid of excess estrogen, including the use of some effective supplements you may never have heard of. We then get into the risks and benefits of taking TRT, before ending our discussion with what young men can do to prepare for a lifetime of optimal T and hormonal health.

Resources Related to the Podcast

  • AoM series on testosterone, including How I Doubled My Testosterone Levels Naturally
  • AoM Podcast #761: How Testosterone Makes Men, Men
  • AoM Podcast #878: The Fitness Supplements That Actually Work 

Connect With Dr. Kyle Gillett

  • Kyle on IG
  • Gillett Health Podcast on Spotify and Apple
  • Gillett Health on YouTube
  • Gillett Health website

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Read the Transcript

Brett McKay: Brett McKay here and welcome to another edition of The Art of Manliness Podcast. When men think about optimizing their hormones, they tend only to think about raising their testosterone, but while increasing T can be important, an ideal health profile also means having testosterone that’s in balance with your other hormones as well. Today in the show, Dr. Kyle Gillette joins me to discuss both of those prongs of all around hormone optimization. We start with a quick overview of the different hormones that affect male health. We then get into what qualifies as low testosterone and how to accurately test yours. We also discuss what causes low testosterone in individual men and how it’s decline in the general male population may be linked to both birth control and the world wars. In the second half of our conversation, we discuss how to both raise testosterone and get rid of excess estrogen, including the use of some effective supplements you may never heard of. We then get into the risk and benefits of taking TRT before ending our discussion with what young men can do to prepare for a lifetime of optimal T in hormonal health. After the show is over checkout our show notes at

All right, Dr. Kyle Gillette, welcome to the show.

Dr. Kyle Gillette: Thank you. My pleasure.

Brett McKay: So you are a medical doctor. You do family practice, you specialize in obesity but also hormone optimization, helping people have healthy hormones so they live a flourishing life. And today I’d like to talk about hormones, particularly male hormones. I think when most people think about male hormone optimization, they think about testosterone and which is obvious why you do that. And we’re gonna dig deep into testosterone today. But are there other hormones that affect male health that people often overlook?

Dr. Kyle Gillette: There certainly are. So even testosterone in and of itself, there’s nothing unique about it compared to other androgens. There’s just one androgen receptor. Testosterone just happens to be the most well-known androgen. So there’s DHEA, which is a very weak androgen. It’s produced by the adrenal glands, which are small glands above the kidney. There’s DHT, which is dihydrotestosterone. This is a very strong androgen. You don’t have as much of it as testosterone, but it’s vitally important for what’s called secondary sexual characteristic development, like the deepening of the voice, growing facial hair, those secondary sexual characteristics which are vital.

Brett McKay: And also I think people often overlook estrogen plays a role in male health.

Dr. Kyle Gillette: Certainly, testosterone aromatizes and directly converts to estrogen. So the way to think about estrogen is the more estrogen the better for your health because it prevents things like heart attacks at a correct ratio to where you feel good.

Brett McKay: Okay, so we gotta have some estrogen in there at the right balance. And then there’s another hormone called SHBG. What does that do?

Dr. Kyle Gillette: So SHBG is also known as androgen binding globulin. It’s a protein, it’s made in many places, the liver makes most of it, but the testes also make some of it. And SHBG stands for sex hormone binding globulin, it most strongly binds DHT and then it binds testosterone, relatively strongly, DHEA weaker than that. And then estradiol, which is your main estrogen, even weaker than that. So think of this as regulating all of the hormones and keeping them more stable. The higher the SHBG, the more stable the level will be. Men produce a lot of testosterone during sleep. So the level is generally much higher in the morning. But if you have a very low SHBG you’ll crash and you can actually have deficient levels of testosterone in the evening routinely. But normal levels in the morning if you don’t have enough SHBG, the most common cause of an SHBG deficiency is insulin resistance, which is often due to too many calories or too many carbohydrates and sugar.

Brett McKay: So what’s interesting about all those hormones is they interact with each other. It’s a complex system so if you raise the level on one, one might go down or up. So I think a lot of guys they get too focused on, well I gotta increase this one thing or reduce this one thing. Well, if you do that you’re gonna have these cascading effects that might not be optimal.

Dr. Kyle Gillette: Correct. I actually heard an advertisement from a TRT clinic this morning and it said new studies shows that men with low testosterone are more prone to cardiovascular disease and early death and diseases of aging. And I thought to myself, this is odd because they are implying that you need testosterone replacement to prevent this. But of course that is a logical fallacy because just replacing the testosterone without figuring out what’s actually causing it in the first place, not that TRT is wrong, but you need to figure out what the cause of it is and then address it.

Brett McKay: Okay. And I hope we can talk about TRT ’cause I know a lot of guys are thinking about doing it or maybe they are doing it and they might have questions about that. Let’s talk about testosterone. So there’s two ways to measure testosterone or two measurements of testosterone that I read about. One is total testosterone and free testosterone. So first, what’s the difference between the two and as a clinician is there a particular number you focus on?

Dr. Kyle Gillette: Yeah, so total testosterone is a total amount of testosterone, whether it’s bound or unbound, when testosterones bound it in general does not bind the androgen receptor, which is on the X chromosome. And total testosterone includes a testosterone bound to albumin, which is the main protein in the blood and also SHBG which we talked about earlier. But free testosterone or any free androgen is what is going to be what is actually binding to the receptor. And then it takes it into the nucleus of the cell and then it binds to DNA to cause what’s called gene transcription. So the androgen receptor gene that’s on the X chromosome is then mostly activated by free testosterone. Oddly enough, sometimes I make the analogy of plumbing. So you have a pipe that’s your bloodstream that takes testosterone everywhere and then you have different types of cells. For example, a muscle cell or a brain cell or a germ cell in the testicle or a somatic cell in the testicle, which we don’t have to get into. But anyway, the free testosterone level can be very different in the bloodstream, which is where we measure it on a blood test versus inside the cell. So it is possible to have symptoms of low testosterone because you don’t have enough androgen in the cell but have a normal level in the blood. It’s rare but it’s possible.

And the opposite is possible, to have a low level in the blood but still have enough inside the cell that’s free to be causing normal gene transcription.

Brett McKay: Okay. So just to recap there, total testosterone is made up of bound and unbound testosterone. Bound testosterone could be bound to albumin or SHBG. And then when it’s bound to those things it can’t attach to the antigen receptor in the cell and so it can’t be… Can’t effect have those changes on the cell. Free testosterone, unbound testosterone is free testosterone. So as a clinician, when you do a blood test on a patient, what number is more important to you? Which one are you gonna be focusing on more? Is it the free or the total?

Dr. Kyle Gillette: I think both are equally important. For athletic purposes, for muscle building purposes. Usually that’s more correlated with free testosterone level. However, symptoms and how you feel is usually correlated more with total. Insurance companies and academic societies usually put more weight into total testosterone, partly because free testosterones are often measured inaccurately so often it’s more accurate to calculate your free testosterone using your total testosterone and your SHBG and then you estimate what your free testosterone is. Some societies say low testosterone is often best treated if you one, have symptoms. And then two, also have a testosterone below about 400. That’s what the urologists say. Most other societies go by 300 and I tend to agree with the level of 400 with a caveat if you have significant symptoms and with a second caveat, if you cannot improve that naturally in any way after identifying the root cause.

Brett McKay: Okay. I wanna dig more into diagnosing low testosterone because there’s lots of commercials out there. You just mentioned one or these businesses popping up where you can just go in, get a blood test and like, hey, you got low T, here’s testosterone and maybe they don’t. So you mentioned two things you look at to diagnose low testosterone, you’re gonna do blood work and if it’s below 400, coupled with if the patient is reporting symptoms of low testosterone, we’ll talk about the symptoms of low testosterone here in a bit, but let’s talk about blood work. ‘Cause I think a lot of guys out there, they think it’s a panacea, if you just take a test, you take the test and it says, oh well, your T is at 400. They’re like, well I got low T. Why isn’t one blood test alone sufficient to diagnose low testosterone?

Dr. Kyle Gillette: Yeah, in general testosterone levels can have what’s called outliers. It’s the statistical phenomenon. But it’s especially true of testosterone where you could check it one time and your testosterone that morning could be low because the last two nights you’ve had poor sleep and poor diet and other lifestyle factors. Males that are generally seeking a TRT prescription know those very well because there’s various things that you can do to artificially make your testosterone level look low that morning. So in general, the recommendation is to recheck it two to three times after a good night of sleep and normal diet and whatever you’re doing normally not after you’ve dieted down to 7% body fat to do an ultramarathon or body building show, then your testosterone is certainly going to be low. But when you’re at a healthy body fat and there’s not an artificial something else that is going to make your testosterone look low. There’s a runner, his name is Nick Bare and he also is doing a body building show and I saw that he got his total testosterone checked and he’s a healthy guy. I’m not sure what his baseline testosterone is and his total testosterone was right at 100 before his body building show.

So that was obviously secondary to the caloric deficit. That wouldn’t necessarily count as a testosterone reading that you could put stock in assessing TRT or not. But for most people they probably won’t be in a scenario like that. But it is important to get at least two readings. If you’ve been sick before, then maybe just postpone the blood test by a week. That way you get an accurate reading.

Brett McKay: Let’s move on to the symptoms. So you do the blood test, what symptoms are you looking for to diagnose low testosterone?

Dr. Kyle Gillette: Yeah, could be through any system. So it could be anything from depression, anxiety to low libido is certainly classic. Low muscle mass is not really one that we look for. Testosterone levels that are naturally produced are not as correlated as people would think with body composition and muscle mass and athletic performance. So it’s not uncommon to see a pretty high level athlete have a total testosterone of let’s say 450 and let’s say someone that has very low muscle mass and maybe even 20%, 22% body fats have a total testosterone of 1000 and there’s not as much correlation. But other things that you would look for seriously is, for example, erectile dysfunction, sexual health in general, sperm production. So if there’s a patient that is having even sub-fertility, just a little bit of trouble getting pregnant, that individual should certainly have a test of his testosterone as well.

Brett McKay: So with low libido, how does a guy know if he has low libido? Because that seems like it’d be pretty subjective.

Dr. Kyle Gillette: Yeah, libido obviously has a lot of psychosocial factors as well. It’s usually taken at a patient’s word and a lot of times when you’re testing these patients, you’ve known the patients for a while, sometimes you haven’t. But if they’re telling you that it’s low relative to what it usually is and no other factors have changed, for example, you know they’ve been married to the same person for five years, they’re not actively going through problems in the marriage, there’s not something else that would be affecting the libido. So that would usually come up in the social history. When you do a history and physical on a patient, it is important to dig into the social history to make sure there’s not something else that is affecting the libido.

Brett McKay: So besides the low libido, maybe the lack of drive, what are the consequences of suboptimal male hormone levels like chronically? Is it gonna affect your cardiovascular system? Is it gonna affect cancer? Does it affect things like that?

Dr. Kyle Gillette: It will. If someone is significantly hypogonadal for a long time, they’re at much higher risk of osteoporosis, which leads to bone fractures and even mortality as well. They’re at higher risk of neurodegenerative disease, likely largely due to low estrogen. If you don’t have a lot of testosterone, you’re probably not converting a lot of it to estrogen and if you’re not doing that then you’re also at risk of cardiovascular disease. Estrogen is very cardioprotective and helps with the production of good cholesterol to help take cholesterol out of the plaque. So they’ve done studies and you look at one group of people that have true hypogonadism, which is generally two levels under 264 or so, and then one group you give TRT and then one group you don’t give TRT, you would think that the group that you give TRT would’ve a shorter lifespan ’cause androgens do cause excess production of “bad cholesterol.” They do increase a particle called ApoB, which is the most important one to watch for cardiovascular risk. But the group that you give TRT actually has less heart attacks and strokes.

Brett McKay: Right, because what you were saying before, the testosterone creates estrogen and then the estrogen protects the heart. So let’s talk about the causes of low testosterone. What can be behind low T?

Dr. Kyle Gillette: Most commonly, metabolic syndrome. So excess calories, excess carbs, insulin resistance, high fasting insulin leads to the liver not producing SHBG. So you might be producing a decent amount of testosterone but it’s being metabolized so fast that it’s difficult to use. That’s most common. The second most common I think is sleep apnea or obstructive sleep apnea. Obviously that kind of goes hand in hand with metabolic syndrome but often it goes hand in hand with PTSD. I saw a study on young men that had just gotten out of the military and they had been diagnosed with PTSD and they tested them all for sleep apnea and something like 80% of them had sleep apnea and they were all under under a BMI of 25. So there’s certainly a lot of stress component as well. The limbic system includes places like the hypothalamus and the amygdala and downstream to that is the hippocampus and the amygdala, downstream of those is the hypothalamus and that’s some of the places of the brain that are involved in sleep regulation and breathing.

So the theory is that apneic episodes don’t just come from having a huge neck and excess body fat, but there are other factors like trauma at play. And when you have a patient with severe sleep apnea, they have a score called a AHI score and if that score is very high, like 100 or 200, you almost always see deficient testosterone levels.

Brett McKay: Okay, so having metabolic syndrome, being overweight, sleep apnea, any other causes of low testosterone?

Dr. Kyle Gillette: Yeah, so theoretically xenoestrogens could be a cause of low testosterone. These are things like phthalates. These are also things like bisphenol A, also known as BPA, you might see BPA free on water bottles from time to time. These do bind various estrogen receptors and are likely suppressive. By suppressive, I just mean they shut down the production of the hormones that lead to testosterone production to some degree. Heat damage is also kind of an honorable mention. Some people might be familiar with what varicose veins are. Varicocele is where there’s varicose veins in the scrotum and some people with varicocele can have venous cooling very well. The testes wanna be about 91 to 92 degrees where the body is 98.6 degrees. So if you can’t keep your testes at 91 or 92, then you’re going to have less testosterone production and less sperm production. And in the more severe cases you’ll have atrophy, which is shrinking because, think about them as factories. If you’re not using the factory, they start to shut down.

Brett McKay: And besides these lifestyle factors and environmental factors, you could also have just an issue with your pituitary system, right? You might have a tumor or something in pituitary gland that’s dysregulating the release of hormones.

Dr. Kyle Gillette: Correct. I suppose that would be likely one of the more common less modifiable risk factors. There’s not a lot that you can do about that. You can take supplements like vitamin B6 or like vitamin E, but a lot of times pituitary microadenomas or even macroadenomas, basically it’s a small tumor in the brainstem. The pituitary gland is where you make a lot of different hormones like growth hormone and like LH and FSH. But LH is the main hormone that’s produced there that leads to testosterone release. So there’s two different types of hypogonadism. There’s primary and secondary. So primary is where the testes are not functioning. And then secondary, think about it, it’s two steps instead of one step. So the LH can be low in secondary hypogonadism and if your LH is very low and a hormone like prolactin or IGF-1 is very high, then that might be a sign of a pituitary micro adenoma. In which case you need MRI.

Brett McKay: And LH, that’s Luteinizing Hormone, correct?

Dr. Kyle Gillette: Correct. LH is Luteinizing Hormone. FSH is follicle stimulating hormone. They do crosstalk to some degree, but LH mostly helps with testosterone production and mostly binds to the Leydig cell in the testicle. And FSH mostly binds in the seminiferous tubules and helps with spermatogenesis.

Brett McKay: So I mean listeners have probably heard reports that T levels in men have been declining in the past few decades. Do we know what’s causing this sort of general decline? Is it just all these lifestyle, like people are getting fatter, there’s not sleeping, they’re stressed, and the stuff in the environment is that kind of what we’ve decided is the cause of the lower T levels?

Dr. Kyle Gillette: The various causes that we’ve already discussed are likely the primary causes of what is causing declining testosterone levels. But I think there is another factor, and a lot of that has to do with what I’d call epigenetic drift. Some people might call it natural selection, I might call it unnatural selection, where individuals with higher testosterone levels are no longer being selected for as early. And also a lot of individuals are having kids later on in life, for example, in their 30s or even 40s, when you might have very different maternal and paternal hormone profiles. That’s one of the reasons why I recommend if men are taking medications like Finasteride or Dutasteride, that they stop their Finasteride 90 days before attempting conception and they stop Dutasteride, depending on what dose they are, usually six months before conception. By the way, spermatogenesis takes about 60 days or two months. That way they have enough time to wash out before they start producing the sperm in the germ cells so that they wouldn’t pass down any epigenetic changes to potential offspring.

Brett McKay: Okay, so maybe this is… The idea is that… Again, this is theoretical, right? The testosterone increases aggression and risk taking behaviors and that’s not as adaptive in our safe high tech modern landscape. So men with lower testosterone might be more successful these days and women choose those men for their partners and then when they have children, the men pass down his genes and then his children have lower testosterone too. And that just perpetuates, just lower testosterone in the male population overall. Also, this idea of selection, I’ve heard that, I read this somewhere, correct me if I’m wrong on this, that women on birth control, they’re not attracted to higher testosterone men. Is that true?

Dr. Kyle Gillette: Yeah, that is one of the major players of what I would call unnatural selection. Another interesting unnatural selection, I suppose, if you look at, not very recently, but the World Wars, certainly in World War I and World War II or in the Korean War or Vietnam War, but especially wars that… Even if a war has a draft, the individual that has higher testosterone and also more sensitive androgen receptors, so this is probably true throughout all of human history, you would… And this obviously cannot be proven scientifically, but theoretically that individual would be more likely to volunteer to go to the front line or to very risky positions. And if that male passes away at age 18 or age 19, then that is likely a fecundity rate of zero. So no offspring from that individual and then you start to have genetic drift.

Brett McKay: Okay, so again, this is theoretical, what you’re saying is that men with very high testosterone, they’re gonna take more risk and in doing so, that may take them out of the gene pool by taking those risks. And there’s more opportunity for that sort of risk taking during big global conflicts like the world wars, right? More high T men die, they lose the chance to reproduce and pass on their genes. And then that just contributes to the declining testosterone in men in general. And that’s gonna have echoes through the generations. And on top of that, we have selection factors going on in the mating market as well.

Dr. Kyle Gillette: Yes. And it’s not like it’s an be all end all. All or nothing. You select for high testosterone or you select for low testosterone. There’s a lot more psychosocial factors at play, but we are certainly seeing that there’s likely a decline in testosterone even a bit more than could be accounted for by just metabolic syndrome and sleep apnea. Maybe things like heat damage to the testicle, maybe things like xenoestrogens are playing some part in this, but we’ll probably never know. But it’s very fun to speculate about it.

Brett McKay: Well, the heat damage to the testicle, what would… Causes like keeping your laptop on your lap, sitting down a lot, would that cause heat damage?

Dr. Kyle Gillette: Probably not significantly enough, but if you already had a Varicocele and you already spent an hour in the jacuzzi, keeping your really hot laptop and phone directly over your scrotum is certainly not gonna help. I suppose someone could prove this at some point. They’ve actually done a lot of studies where they look at the scrotal temperature and they’ve randomized two groups of usually, college students and one group they have wear basically like a sock around their scrotum that has something really warm in it. So they warm up the scrotum artificially to 98 degrees instead of 91 or 92 degrees. And in the individuals that don’t have varicocele, they can still overcome that heat damage because their venous pooling mechanism is so good at buffering that heat damage. So that did not affect their testosterone production and it did not affect their spermatogenesis. However, in individuals that already have impaired venous cooling, for example, with varicocele or varicose veins then it did.

Brett McKay: We’re gonna take a quick break for a word from our sponsors. And now back to the show. Let’s talk about optimal levels of testosterone. So below 400, and if you’re experiencing low testosterone symptoms, that’s not good. Is there an optimal level, as like a level that guys should reach for or is it gonna differ from man to man?

Dr. Kyle Gillette: It certainly differs, but that’s kind of an easy answer. So I’ll get into it more than that. A lot of times people have told me that I say individualized, I say that word a lot because health is individualized. We are all unique, we have different genetics, we have different epigenetics and we have different growth and development past that as well. But for most men, an optimal testosterone level is between about 500 and as high as you can go naturally. So there is some individuals with a total testosterone of 1500, they almost always have really high SHBG. So a lot of times their free testosterones only 20 or 25, between about 550 and whatever you can produce top in endogenously naturally without medication.

Brett McKay: But you also said it could be lower. I mean you mentioned there are athletes who are at 450 and they’re healthy. So if you get a blood test and it’s below 500 a little bit, you probably… I mean, I guess you shouldn’t worry too much about it if you’re not experiencing any symptoms.

Dr. Kyle Gillette: Correct.

Brett McKay: Okay, that’s good to know. So let’s say a patient comes to you reporting symptoms of low T, you do a series of blood tests that show yeah, that your T levels are low, they’re below 400. What’s your first line of attack in helping this patient get his T levels up?

Dr. Kyle Gillette: First thing to look at would be LH and FSH. If those are really low, then I’m worried about the pituitary or the brain. If those are really high, then I’m worried about the health of the testicles. If they’re in between, then I look for another pathology like diabetes, metabolic syndrome, insulin resistance, sleep apnea, etcetera. I also look at prolactin and IGF-1, make sure you assess their tumor risk. And then I also look at estradiol. If it’s a very high estradiol, then estradiol is likely what is suppressing the production of LH from the pituitary. So you have estradiol, which is your main estrogen, which is causing less testosterone production. And in that case, I look at things like alcohol consumption that can up-regulate aromatase or consumption of excess calories or fat that can up-regulate aromatase, which converts testosterone to estrogen by the way. So those are the first things.

Brett McKay: Beyond that, what are you looking at?

Dr. Kyle Gillette: Beyond that, I’d like to, if pertinent, do an exam, make sure, especially if this individual is developing, if they’re an adolescent or whatnot, you need to make sure that they’re through all the tanner stages. Basically tanner stages one to five, five is done, when you’re essentially adult growth and development to make sure that they don’t have some unusual or unlikely syndrome. And then after that I’d like to look at their fasting insulin, their A1C, see if there’s something that I can correct. I look at their cortisol. If their cortisol is high, then there’s a lot of lifestyle factors and also supplements that can help control cortisol like Ashwagandha or Emodin. I look at their prolactin. So if their prolactin is just a little bit high, then maybe I do start them on some Vitamin B6 or some Vitamin E. If their estrogen is high, maybe I start them on some Calcium D-glucarate that helps with estrogen glucuronidation and metabolism. It basically helps you excrete it through your stool and then repeat labs in one, two, maybe even three months and see if we can improve those things along with, as always, diet and exercise.

Brett McKay: Okay. So it sounds like the first line of attack, if it’s not a pituitary problem, you’re gonna be primarily doing lifestyle changes, right? Quitting drinking, getting better sleep, diet, exercise to help get that insulin sensitivity back online. So yeah, lifestyle stuff would be the first line of attack and then will it take maybe one to two months before you start seeing results from that?

Dr. Kyle Gillette: Yeah, often it does. A lot of times you feel better the first week and a lot of times your testosterone production recovers very quickly. But occasionally, I use medications as well. So some people utilize a short course of HCG, which essentially binds the LH receptor, takes the place of LH and occasionally, I’ll utilize very short courses. By very short, I mean, a week or maybe two weeks of selective estrogen receptor modifiers or sometimes longer in the right patient, especially very young patients that you’re trying to stimulate endogenous production, these are often patients that desire fertility within the near to mid near future.

Brett McKay: Besides diet, exercise, sleep, managing stress, you mentioned a few supplements that you recommend men taking to optimize male hormones. Are there ones that you recommend for just any guy who… Maybe they don’t have any problems with testosterone but they just want to feel good? Are there ones that you like and that are safe?

Dr. Kyle Gillette: Creatine 5g-10g a day would be a great start. L-carnitine would be a consideration, especially if they’re interested in athletic performance optimization or body composition optimization, L-carnitine would be reasonable. Consider checking a TMAO to make sure that it doesn’t convert to that in too high of a rate. Another reasonable addition if someone has high estradiol would be Calcium D-glucarate to make sure that they’re binding up extra estrogen and excreting it.

Brett McKay: I’ve heard that Boron can impact testosterone. How does boron increase T levels?

Dr. Kyle Gillette: Boron works okay for people with really high SHBGs. It increases free testosterone by decreasing SHBG. The effect wears off to some degree if you take Boron for a very long period of time. If you have very low levels or you’re insufficient or deficient in Boron, it works extremely well and a lot of people consume Dates or Raisins because they tend to be relatively high in Boron.

Brett McKay: There’s another something I’ve been hearing about lately, Tongkat ali, I think that’s how you pronounce it. What’s going on with that one?

Dr. Kyle Gillette: Tongkat ali is also known as Longjack. So Tongkat’s active ingredients are Eurypeptides, one of which is Eurycomanone. And Tongkat is helpful because it upregulates a couple different enzymes in the steroidogenesis pathway. There’s been plenty of human study on it, with mixed results and it looks like the cause of the mixed results is, sometimes people have great activity of those enzymes. So that’s not the rate limiting step in testosterone production. So think of it as a signal, think of your testicles as a factory. Tongkat is a signal to that factory to ramp up production, but if your factory is already operating at maximum capacity or it’s limited by something else, then that’s not going to improve your testosterone level. Tongkat works on very similar enzymes that are also upregulated by insulin and IGF-1. So in general, if you’re in a caloric deficit or if you’re trying to lose weight or body fat, Tongkat will work better. If you have a low fasting insulin or a lower end IGF-1, Tongkat will also likely work better. And I’ve seen this anecdotally as well.

Brett McKay: A couple years ago, I remember ZMA was a big supplement that was pushed for increasing testosterone levels. Anything to that?

Dr. Kyle Gillette: ZMA is very reasonable to add if you have a low alk phos. So if you look at your CMP, which is your metabolic panel, there’ll be an enzyme called alkaline phosphatase. Alkaline phosphatase along with GGT are two intracellular enzymes. And the lower these two are the more likely you are to have insufficient levels of Zinc and magnesium. That’s why when I have input to various companies designing a supplement to optimize testosterone, I almost always put in Zinc, Magnesium and Vitamin D. You just wanna make sure these aren’t the right limiting step. Think about trying to optimize your testosterone is like trying to get into a fraternity. You’re not just making best friends with one of the people and then just hoping that nobody else will blackball you. You wanna make sure that you address each individual because if you… Let’s say you forget your Vitamin D and forget your Zinc, you’re deficient in Zinc, you’re deficient in Vitamin D, those two things will hold you back.

Brett McKay: Once you start down this path of increasing your testosterone or getting them optimized, is there any benefit to getting them higher? So let’s say you started off at 400, you had low T symptoms and then through lifestyle changes and maybe taking some supplements, you bump it up to like a 700. Are you gonna get any more benefit from testosterone by getting it up to 800 or 900?

Dr. Kyle Gillette: Past about 600, there’s little to no benefit, other than bragging rights.

Brett McKay: At what point would you have a patient go on testosterone replacement therapy?

Dr. Kyle Gillette: At any point when the risks outweigh the benefits and they understand both the risks and the benefits in their own terms.

Brett McKay: So what are the risk of TRT?

Dr. Kyle Gillette: Yeah, one of the risks is it causes more fluid retention and swelling. One of the risks is if you hyper convert to estrogen, estrogen will then bind to the liver and cause more SHBG and platelet production. And if your platelets go very high past a certain point, we know that people on oral estrogen, the blood clot risk is associated with how high their platelets and SHBG go. It’s likely the same for TRT. So if you go on TRT and you go into a huge bulk and you start consuming a bunch of alcohol and your platelets skyrocket, then it is gonna increase your blood clot risk. So TRT is not in and of itself going to improve health, it’s just going to be a tool to help you achieve a lot of your goals. Another risk of testosterone is if people have heard of medications called statins. Those work by decreasing the activity of an enzyme called HMG-CoA reductase. Any androgen including testosterone increases the activity of this enzyme. So often people’s cholesterol and it’s not actually cholesterol, they are lipoproteins, but people’s “bad cholesterol” gets worse. That’s why we watch that ApoB number very closely because we know that ApoB is the particle that is going to lead to plaque formation in areas like the coronary artery.

Brett McKay: And I guess the benefits of TRT is that you’ll mitigate those symptoms of low testosterone?

Dr. Kyle Gillette: Correct. And there’s of course other benefits as well like the benefits of estrogen, that we discussed earlier, being it’s cardioprotective benefit. And one of the main benefits of testosterone in a lot of individuals that I see start is they might have a… Let’s say they have an A1C of 5.7 or 5.8, which is technically pre-diabetes. You’re very unlikely to get diabetes on testosterone compared to if you are not on TRT. So a lot of individuals, perhaps they’re, I wouldn’t say doomed, but very likely to get diabetes and TRT can make a huge difference, especially when combined with other insulin sensitizing medications to prevent that.

Brett McKay: Do you keep people on TRT indefinitely? Is it like once you start to keep doing it or are there periods where you’re like, “Well, we’re gonna take you off and see what happens” or well how does that work?

Dr. Kyle Gillette: Most individuals are on indefinitely, but not everyone. Occasionally there’ll be a patient that is profoundly hypogonadal and the benefit of testosterone at that time is just huge. Let’s say it’s a patient who has a BMI of 40 and they weigh 400 pounds and they also don’t have a huge amount of lean body mass to lose in proportion. Everybody who weighs 400 pounds is gonna have a lot of lean body mass, but just less relative to your average person and they wanna maintain as much of that as possible. They need that tool in order to exercise, even if it’s somewhat of a placebo tool, that still helps. So if it gets them having a very healthy lifestyle, they go on that medication, perhaps they go on another medication like a GLP-1 for a short period of time and then they don’t really know what their baseline testosterone is. So maybe after two years they’ve learned those lifestyle interventions. They very slowly are ready to come off of every medication and then you can use a medication like HCG to help restore natural production. Perhaps one week of a medication like Enclomiphene or Novedex or even Raloxifene. And then you see what their natural production capability is. You give them a few weeks and perhaps they restore to a total testosterone of 600s, which is likely quite good in that situation or perhaps they go down to 100s again.

But a lot of people would want that chance to go back to producing their testosterone naturally. And in some cases it does work. I would say 90% of people that start on testosterone are going to remain on it indefinitely. But I would also say that 90% of people that go on testosterone can very likely regain at least their previous level of testosterone if they were to want to come off.

Brett McKay: Well, here’s a question. With female hormone therapy, you might start taking it during menopause to help with symptoms, but at a certain point, once menopause is over, I think you’re supposed to get off those hormones. Does something like that happen for men? I mean, you might do TRT throughout your 50s and 60s and then at a certain point you’re in your 70s and you’re like, Well I don’t need to do this anymore. Or are there 80-year-old or 90-year-old guys taking TRT?

Dr. Kyle Gillette: There are 80 or 90-year-old guys taking TRT. Occasionally, you’ll do a dose adjustment. It just kind of depends on the situation, but a lot of times when males reach that age, they are less likely to have as much benefit and they are more likely to have slightly more harm. So it’s a moving target over time where you get out the scale and you’re weighing the risks and the benefits and at that point when a patient’s already on TRT, you also weigh the risks of how difficult it would be to come off, which is not extremely difficult. But it is difficult because there’s medication regimens that you have to go with and even with those medications often there is a short period of time when you don’t feel great.

Brett McKay: So we’ve been talking about optimizing male hormones in grown men, but let’s say we got some dads and moms out there listening and they’ve got boys who are about to start or are in the middle of puberty. What can they do for their sons? What can young guys do to make sure they set themselves up for a lifetime of male hormone optimization?

Dr. Kyle Gillette: First and foremost, no huge dirty bulk in early adolescence. What I mean by that is, I mean, let’s say there’s somebody that’s trying to put on weight for football or whatever other reason, can’t think of any reasons where it would be worth it, but they’re putting on weight and also putting on fat. Adipose tissue in fat, adipose tissue is fat, that is going to increase the conversion to estrogen and estrogen is gonna close the growth plates of the bone. So that’s gonna prevent you from reaching full stature, both in height and other areas of your skeletal developments as well. So that’s a great initial recommendation. Thinking about gut health and fiber consumption is also very important. That’s gonna prevent, again from over, it’s called intrahepatic circulation of estrogen. Estrogen is not necessarily the enemy. In fact, a little bit of estrogen is neat to what’s called priming the pituitary in order to fully kickstart adolescence.

And that’s one of the reasons why boys with very high body masses have higher estrogens. The pituitary gets primed too early and something called precocious puberty is happening, which is too early of puberty. So that’s another thing to consider. In addition to that, you wanna have a reasonable balance between cardiovascular exercise and resistance training. You certainly want to do both because adolescents can be thought of as your free endogenous steroids of, I’ll say cycle, just because people understand it. But your free endogenous steroid boost where you know you are going to be one, super sensitive to all the androgens that are released, probably most people remember puberty and you’ll also be having a lot of androgen around, regardless of what you do, even if your health hasn’t been great. So when that endogenous steroid burst happens, that is the perfect time to take advantage of those lifestyle tools to build up very high bone mineral density and very high lean body mass without putting on excess body fat.

Brett McKay: I imagine young people getting plenty of sleep is important too.

Dr. Kyle Gillette: Yes, extremely important. And that might be one of the most common causes of suboptimal hormone profiles in adolescents.

Brett McKay: What about supplementation? Is supplementation something you encourage in young people to optimize their hormones or is you just focus on the diet and exercise?

Dr. Kyle Gillette: With the oversight of a doctor, I do encourage supplementation, if it makes sense. For example, let’s say there’s a young person and they get a stool test and the beta-glucuronidase enzyme is very high. We know that that individual is just recycling their estrogen over and over again, that makes something like a Calcium D-glucarate or with the oversight of the doctor maybe even a very low dose of an aromatase inhibitor, a very reasonable addition. And then if you get blood tests, you can actually check the hormones to make sure that they’re increasing at the correct rates, that your DHT is optimal, your testosterone’s optimal, your estradiol is optimal, your IGF-1 is optimal, and then you can tweak a supplement. Supplements are just like medications, they have pharmacologic effects so they have an effect on the body and the body metabolizes them.

So things like Creatine can be very reasonable. Creatine does not affect the development of the kidneys. I did a podcast with my good friend James O’Hara recently. We get a lot of questions from pediatricians because the AAP, which is a society of pediatricians, still recommends no Creatine supplementation whatsoever up to the age of 18. So not even, not even a 17-year-old. So I just kind of thought that was… And it’s been 15 years. So they’re gonna update their recommendation within the next couple years whenever they have a joint meeting. But that’s definitely a vestige of times past when we thought that Creatine was harmful to healthy kidneys. You just check a Cystatin C because Creatine makes your creatinine blood marker look abnormally high. Falsely high. So Creatine can make sense in a lot of kids as well. And then if there is a kid that has really low insulin IGF-1, sometimes Tongkat makes sense in that individual.

And then in some kids that do have optimal hormone profiles, let’s say there’s an athlete and he’s developing or she’s developing and they have very high testosterone, very high IGF-1, that’s great, you know that Myostatin levels are gonna be really high after you have that burst of androgen during adolescence. Myostatin is gonna stop the muscle from developing and cause you to start putting more fat into the tissue. I think that Myostatin inhibitors, week ones like Fortetropin, which comes from fertilized egg yolks or Epicatechin. CocoaVia is a good source of Epicatechin. Different cocoa powders have a lot of Epicatechin. Green tea has EGCG, which is another Epicatechin. Basically, those take down the levels of Myostatin. Those are also very reasonable to take for the right patient.

Brett McKay: What about, should parents be sweating about xenoestrogens in their kids? Like, make sure they get certain types of deodorants or cosmetic products and avoiding plastics?

Dr. Kyle Gillette: Bisphenol A and phthalates. Yes. That’s kind of where I personally draw the line, where if you are worried about every single thing, we live in an unnatural environment, more so than ever. So those are usually the ones that I say to avoid. If you live in an area that more likely has contaminants and microplastics, a lot of times I do recommend testing your water. There are a lot of services that do this. I personally used MyTapScore to test both the water, from the tap and the water through my Berkey filter. If you have young children. And that seems like a very reasonable time to use a water filter if you don’t know what the contents of your water is. And then as far as foods, of course, avoiding ultra processed foods, I think, it was ultra processed mac and cheese that got a bad name for having high phthalates. I assume they fixed that by now, but I actually don’t know. So a lot of times it’s the same recommendations as any other whole food diet. And then know your sources, try to avoid contaminants at very high levels and use the Pareto principle, try to do right most of the time and you’ll get most the benefit even if you’re just doing it some of the time.

Brett McKay: Well Kyle, this has been a great conversation. Where can people go to learn more about your work?

Dr. Kyle Gillette: My hub is on Instagram, kylegillettmd, and it’s Gillett Health on all other platforms. I do have a podcast that we fairly recently have, I guess, gotten pretty good audio and video of, but that’s on YouTube, Spotify and Apple Podcasts. We have a clinically, I guess, a clinical grade podcast. And then we have a layman’s podcast that we’re gonna call After Hours, which should provide good entertainment.

Brett McKay: Fantastic. Well, Dr. Kyle Gillett, thanks for your time. It’s been a pleasure.

Dr. Kyle Gillette: Thank you.

Brett McKay: My guest today was Dr. Kyle Gillett. You can find more information about his work at his website, Also, check out his podcast, Gillett Health podcast and check out our show notes at where you’ll find links to resources where we delve deeper into this topic.

Well, that wraps up another edition of The AOM podcast. Make sure to check out our website at, where you can find our podcast archives as well as thousands of articles that we’ve written over the years about pretty much anything you think of. And if you’d like to enjoy ad-free episodes of the AOM podcast, you can do so on Stitcher Premium. Head over to, sign up, use code MANLINESS at checkout for a free month trial. Once you’re signed up, download the Stitcher app on Android or iOS and you can start enjoying ad-free episodes of the AOM podcast. And if you haven’t done so already, I’d appreciate if you take one minute to give us a review on Apple podcast or Spotify, it helps out a lot, and if you’ve done already, thank you. Please consider sharing the show with a friend or family member who you think could get something out of it. As always, thank you for the continued support. And until next time, it’s Brett McKay, reminding you to not only listen to the AOM podcast, but put what you’ve heard into action.

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By: Brett & Kate McKay
Title: Podcast #893: Optimize Your Testosterone
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Published Date: Wed, 03 Jul 2024 14:29:00 +0000

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The Future of Men’s Mental Health

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vanity cover male menopause e1720306464812 1

Part 5 —Male Menopause: Speaking Out About the Unspeakable Passage

This is the 5th in a series of articles on the Future of Men’s Mental Health. In Part 1, I addressed the questions, “Men and Mental Health, What Are We Missing?” Part 2 focused on the way that “Mental Health Crises Are Putting Everyone at Risk.” In Part 3, I explored Gender-Specific Healing and Man Therapy. In Part 4, I shared Recent Research From Leading Neuroscientists.

            The title of the first chapter of my book, Male Menopause, was titled, “Putting the Men Back in Menopause.” I detailed my initial explorations this way:

“When I began researching this book, I was skeptical about the concept of ‘male menopause.’ I had been a therapist for over thirty years and had worked with thousands of midlife men and women. Is there really a change of life that men go through?”

            I went on to describe my encounter with one of the earliest proponents of male menopause, the writer Gail Sheehy.

“While browsing through my local bookstore, I was drawn to a copy of Vanity Fair magazine. Well, to be absolutely honest, I was drawn to the cover photo of  Sharon Stone, nude to the waist, with her hands cupping, but only partially covering, her breasts. Sharon was staring seductively into the eyes of the reader, with two-inch letters emblazoned across her bare midriff proclaiming, ‘WILD THING!’ I was sure there was something important Sharon had to tell me.”

            I went on to say,

“However, I never read the article to find out, because just to the left of Sharon’s blond hair, right below the April 1993 dateline, were the words that grabbed me by the throat (actually a bit farther south than my throat)—‘Male Menopause: The Unspeakable Passage by Gail Sheehy.’ Those words spoke in a quiet but insistent voice.”

            Male Menopause was published in 1997 and soon became an international best-seller. It has since been translated into more than fifteen foreign languages. My follow up book, Surviving Male Menopause: A Guide for Women and Men, was published in 2000. There continues to be a great deal of confusion and controversy surrounding the whole concept of what goes on at mid-life for men. As Sheehy recognized in the 1993 article,

“If menopause is the silent passage, ‘male menopause’ is the unspeakable passage. It is fraught with secrecy, shame, and denial. It is much more fundamental than the ending of the fertile period of a woman’s life, because it strikes at the core of what it is to be a man.”

I was one of the early researchers who was speaking out about Male Menopause (also called Andropause or Manopause). Here are a few of the important things I’ve learned over the years and have shared in my books and articles.

What is Male Menopause?

Male Menopause begins with hormonal, physiological, and chemical changes that occur in all men generally between the ages of forty and fifty-five, though it can occur as early as thirty-five or as late as sixty-five. These changes affect all aspects of a man’s life. Male Menopause is, thus, a physical condition with psychological, interpersonal, social, and spiritual dimensions.

What is The Purpose of Male Menopause?

“The purpose of Male Menopause is to signal the end of the first part of a man’s life and prepare him for the second half. Male Menopause is not the beginning of the end, as many fear, but the end of the beginning. It is the passage to the most passionate, powerful, productive, and purposeful time of a man’s life.”

What Are The Most Common Symptoms of Male Menopause?

  • Loss of libido and sexual desire, particularly with the partner you are with.
  • Increased fantasy about having sex with others.
  • Difficulty developing and maintaining erections.
  • Increased irritability and anger.
  • Taking longer to recover from injuries and illness.
  • Having less endurance for physical activity.
  • Increased anxiety and worry.
  • Loss of self-confidence and joy.

What Are Common Life Changes Associated with Male Menopause?

  • Hormone levels are dropping, particularly testosterone.
  • Sexual vigor is diminishing.
  • Children are leaving.
  • Parents are dying.
  • Job horizons are narrowing.
  • Friends are dying or getting serious illnesses.
  • Martha Weinman Lear, writing in the New York Times Magazine summed it up this way.

“The past floods by in a fog of hopes unrealized, opportunities not grasped, women not bedded, potentials not fulfilled, and the future is a confrontation with one’s own mortality.”

Over the years, I have found two common extreme views: (1) Male Menopause doesn’t exist. Only women go through a hormonally driven change of life. (2) If men do go through a change, it is only a hormonal change, and can be “cured” by giving men supplemental testosterone.

            I’ve learned that neither of these views are true. Men do experience a change of life, whether we call it Male Menopause, Andropause, or Manopause. I called it Male Menopause because I believe there are more similarities than differences between what women and men experience. I also believe, as does, Gail Sheehy, that it is much more complex than simply a loss of hormones and

“It is much more fundamental than the ending of the fertile period of a woman’s life, because it strikes at the core of what it is to be a man.”

Surviving Male Menopause Together. How Can Couples Navigate the Change of Life?

After Male Menopause was published and become an international best-seller with 15 foreign editions, I received letters from women all over the world asking questions about the relational aspects of what men go through. I wrote the book Surviving Male Menopause: A Guide for Women and Men to answer questions including the following:

  • How does male menopause differ from the midlife crisis?
  • Why do men have affairs at this time of life?
  • What are the best methods for treating erectile dysfunction?
  • Why do menopausal men act so much like adolescent boys?
  • What can a woman do to help a man get through male menopause?

Is There Anything Good About Male Menopause?

Like so many complex aspects of life, when we try to oversimplify things, we lose the very essence of what we are trying to study. When we deny the reality of a “male change of life” and reduce it to a “midlife crisis” or simply see the change in medical terms, we give men few options.

For most of human existence our lifespan was quite limited to around forty years. Men and women rarely lived long enough to experience a “change of life.” Life was a climb up a mountain and we reached the peak when we were in our 20s and had produced children to keep our species going. Then, it was a quick decline down the mountain once the children were old enough to survive.

            But now humans can live into our 80s, 90s, and beyond. Now there is another mountain to climb and what we call Male Menopause is simply the transition to the second mountain. If top of the first mountain is called “Adulthood,” the peak of the second mountain, is “Super-Adulthood” or “Elderhood.” That is why I say that

“Male Menopause is not the beginning of the end, as many fear, but the end of the beginning.”

Too Many Men Are Dying Before Their Time

These are confusing and challenging times for most people, but particularly for men. It has been said that “Old age is not for sissies.” While many men are embracing the later years, too many are losing hope and giving up. The suicide rate for men is much higher than the rate for women and gets even worse the older we get.

Take a look at this chart from the Centers for Disease Control (CDC):

Suicide rate among adults age 55 and older, by age group and sex: United States, 2021

graph deaths men women

We see the men’s death rates on the left and women’s on the right for four different age groups. It is clear that death by suicide is a huge problem for men as we age. The male/female ratio for ages between 55 and 85+ are almost 5 times higher for males. This is a tragedy and a crisis. Clearly older men are feeling pressures that women do not experience and are losing hope for a better future. This needs to change.

Welcome to the Second Mountain and an Expanded Understanding of Midlife and Aging

            My friend and colleague, Chip Conley, is transforming our understanding of midlife and what we can look forward to as we prepare for and climb the second mountain of life. Says Conley, “The midlife crisis is the butt of many jokes, but this long-derided life stage has an upside.” In his new book, Learning to Love Midlife: 12 Reasons Why Life Gets Better with Age, he expands our vision.

“What if we could reframe our thinking about the natural transition of midlife not as a crisis, but as a chrysalis: a time when something profound awakens in us, as we shed our skin, spread our wings, and pollinate the world with our wisdom?

            We know midlife and aging is not all sweetness and light. It isn’t easy letting go of old ways that no longer work for us. We all know what happens to the caterpillar. As Conley reminds us,

“When it is fully grown, it uses a button of silk to fasten its body to a twig and then forms a chrysalis. Within this protective chrysalis, the transformational magic of metamorphosis occurs. While it’s a bit dark, gooey, and solitary, it’s a transition, not a crisis. And, of course, on the other side is a beautiful, winged butterfly.”

You can learn more about Chip’s work and his book on his website,

Learning About Men’s Health, Male Menopause, and How to Live Well in the Second Half of Life

There is a lot we need to learn about life in the second half. Chip Conley suggest that there are three stages of midlife:

  • Early midlife (Age 35-50)

During early midlife we tend to experience some of the challenging physical and emotional transitions—a bit like an adult puberty. We realize we are no longer young, but not yet old.

  • The second stage of midlife (50-59)

This is the core of midlife in our fifties when we’ve settled into this new era and are seeing some of the upside. We begin to see opportunities for growth and finding passions we never knew we had.

  • Later midlife (60-75)

            We are still young enough to see and plan for what’s next, our senior years. Says Chip,

“At 63, I am just getting acquainted with this third stage, but I do know it’s also when our body reminds us it doesn’t want to be forgotten.”

I turned 80 last December and am well into the stage of Eldership. It’s a time where we are called to share what we know and have learned over our lifespan. Three years ago I started the MenAlive Academy for Gender-Specific Healthcare. The Academy offer programs for both men and women who want to learn about the unique mental, emotional, and relational issues that men face. It also offers programs for healthcare providers who are working with men and their families.

            As my colleague Marianne J. Legato, M.D., Founder of the Foundation for Gender-Specific Medicine says,

“Everywhere we look, the two sexes are startingly and unexpectedly different not only in their normal function but in the ways they experience illness.”

If you would like more information about the MenAlive Academy for Gender-Specific Healthcare, drop me a note to and put “MenAlive Academy” in the subject line. If you’d like to read more articles like these, I invite you to subscribe to our free weekly newsletter.

The post The Future of Men’s Mental Health appeared first on MenAlive.

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By: Jed Diamond
Title: The Future of Men’s Mental Health
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Published Date: Sat, 06 Jul 2024 23:01:53 +0000

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Podcast #983: Grid-Down Medicine — A Guide for When Help Is NOT on the Way

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If you read most first aid guides, the last step in treating someone who’s gotten injured or sick is always: get the victim to professional medical help.

But what if you found yourself in a situation where hospitals were overcrowded, inaccessible, or non-functional? What if you found yourself in a grid-down, long-term disaster, and you were the highest medical resource available?

Dr. Joe Alton is an expert in what would come after the step where most first aid guides leave off. He’s a retired surgeon and the co-author of The Survival Medicine Handbook: The Essential Guide for When Help is NOT on the Way. Today on the show, Joe argues that every family should have a medical asset and how to prepare to be a civilian medic. We discuss the different levels of first aid kits to consider creating, from an individual kit all the way up to a community field hospital. And we talk about the health-related skills you might need in a long-term grid-down disaster, from burying a dead body, to closing a wound with super glue, to making an improvised dental filling, to even protecting yourself from the radiation of nuclear fallout.

Resources Related to the Podcast

  • AoM Article: How to Use a Tourniquet to Control Major Bleeding
  • AoM Article: The Complete Guide to Making a DIY First Aid Kit
  • AoM Article: How to Suture a Wound
  • AoM Article: What Every Man Should Keep in His Car
  • AoM Article: Improvised Ways to Close a Wound
  • AoM Podcast #869: The Survival Myths That Can Get You Killed With Alone Winner Jim Baird

Connect With Joe Alton

  • Doom and Bloom website
  • Doom and Bloom on YouTube
  • Doom and Bloom on FB

Cover of "the survival medicine handbook," featuring a red first aid kit on a road under a stormy sky, by Joseph Alton MD and Amy Alton APRN.

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Brett McKay: Brett McKay here and welcome to another edition of the Art of Manliness podcast. If you read most first aid guides, the last step in treating someone who’s gotten injured or sick is always get the victim to professional medical help. But what if you found yourself in a situation where hospitals were overcrowded, inaccessible, or non-functional? What if you found yourself in a grid-down, long-term disaster and you were the highest medical resource available? Dr. Joe Alton is an expert in what would come after the step where most first aid guides leave off. He’s a retired surgeon and the co-author of The Survival Medicine Handbook: The Essential Guide for When Help is NOT on the Way. Today on the show, Joe argues that every family should have a medical asset and how to prepare to be a civilian medic. We discuss the different levels of first aid kits to consider creating from an individual kit all the way up to a community field hospital. And we talk about the health-related skills you might need in a long-term grid-down disaster from burying a dead body, to closing a wound with superglue, to making an improvised dental filling, to even protecting yourself from the radiation of nuclear fallout. After the show is over, check out our show notes at

All right, Joe Alton, welcome to the show.

Joe Alton: Hey, thanks for having me. I really appreciate it, Brett.

Brett McKay: So you are a retired obstetrician and pelvic surgeon, and you’ve stayed busy in your retirement by helping families prepare medically for long-term disasters. How’d you end up doing that?

Joe Alton: Well, Brett, I was exposed to disaster medicine very early in my career as a volunteer DMAT member, Disaster Medical Assistance Team member for the aftermath of Hurricane Andrew down here in South Florida in 1992. And that led me, like many Floridians honestly are now, to become what you would call a hurricane prepper. And that means instead of the three days worth of food and supplies the average American has on hand, we’d have a couple of weeks worth. But I really have to say, it was Hurricane Katrina in 2005 that opened my eyes to medical preparedness, serious medical preparedness. I mean, it was then that I saw what happens when the ambulance isn’t just around the corner. And that’s not because we didn’t have hundreds of medical personnel converging on the Gulf Coast. I knew it was going to be a big disaster. So that was going on even before the storm was completely through. But the providers and the technology were just not able to get to victims due to all the flooding. I figured that any number of disasters could actually do that. An earthquake, for example, could make roads impassable and people couldn’t get to you, for example.

Really, any disaster with enough casualties can overwhelm the existing infrastructure. If there’s a three car wreck in a two ambulance town, I mean, you could have a bad outcome. So I figured if I can teach the average person how to deal with injuries and illness and put some supplies in their hands, well, then maybe some tragic outcomes might be avoided. So my mission became to place a medically prepared person in every family before a disaster occurs.

Brett McKay: All right. So you co-authored a book called The Survival Medicine Handbook. And this is a tome of a book. It is, I think it was 700 pages. You co-authored this book with your wife, who’s also a nurse practitioner and a midwife. And your goal is, again, it’s a comprehensive guide to medicine in a situation where it’s a grid down situation. You might not have immediate medical access. And so how to manage things you might encounter in that period. I’m sure a lot of people have read first aid books on, say wilderness first aid or maybe prepper first aid, but you argue that those books will only get you so far in a long-term disaster scenario. How so?

Joe Alton: Well, there are a lot of books on first aid, even for wilderness settings. And many of them are really quite good, but they fail to take into account that in a true survival, long-term survival scenario, there’s no access to medical medicine, modern medicine, rather, for the foreseeable future. And that becomes a problem when every chapter of your first aid book or your medical book ends with, and get to the hospital or, and seek a qualified medical professional. Because in real terms, no such thing exists when the medical infrastructure is collapsed. And so our entire book is pretty unique in that it assumes that some disaster has happened and you no longer have the option of accessing modern medical care, maybe for the long run. And the book addresses the average citizen in plain English, as if they were the last line of defense when it comes to your family’s wellbeing in a disaster. That’s because it’s a real possibility.

Brett McKay: So a lot of the first aid books out there are geared towards taking care of the situation so you can get to medical help. But in a long-term disaster, professional medical help may not be available. So what considerations do you have to think about to deal with that situation?

Joe Alton: Well, let’s take an injury for an example. I mean, what is the difference between today and in a grid down situation when it comes to encountering somebody who’s sick and injured? Let’s say even in the normal times, let’s say they broke their leg in a car accident. What do you want to do? You want to stabilize that person, do what you can for them and get them to the nearest medical asset. That makes sense. So you’re not a doctor after all. And once you ship the patient off, your responsibility has been discharged and you’re on your merry way. But what if that’s not an option? I mean, grid down, your responsibility extends from the point of injury to full recovery. Will you be able to provide daily wound care for this person? Would you be able to identify if a wound infection is occurring? Would you have a plan of action to rehab that person and get them on their feet again, make them productive as a group member as they most certainly would have to be in an off-grid disasters type setting. I mean, you have to do this and that’s the difference. You have to be ready to be the highest medical asset left and be effective in that role.

Brett McKay: And another thing we’re going to talk about in detail later on in a bit, another thing you have to think about as the medical asset in your family is you have to think about preventative medicine. It’s just basic things you don’t have to think about because we live in the 21st century, sanitation, hygiene, things like that to prevent sicknesses.

Joe Alton: You’re absolutely right. The important thing to know is that you can prevent headaches and heartaches as the family medic if you have a plan to enforce sanitation and water disinfection and food preparation, things like that. And these are sort of part of your job description.

Brett McKay: As part of the medical asset. So one of the things you talk about in the intro of the book in the first few chapters is before you start thinking about buying medical gear, I know guys love that. It’s the one thing I think a lot of guys love about survival or prepping is buying gear. It’s fun. But you say before you even do that, there’s two things you probably need to think about in order to become a medical asset. One is establish a community, put yourself in a strong community and then two, get your personal health in order. So first, how can being part of a robust community help with medical care or healthcare in a long-term survival situation?

Joe Alton: Well, I mean, as a community, let’s take some examples from TV. Have you seen the show, Alone?

Brett McKay: Yes.

Joe Alton: Well, there you go. In Alone, they drop you off alone with some supplies, probably as much as a person might be able to reasonably carry a fair distance. And they plop you off into the off-gridest of off-grid locations. And that person has to find water. They have to make it drinkable. They have to find food. They have to cook it properly. They have to make a shelter. They have to worry about personal protection. They have to deal with injuries and other medical issues that occur along the way. I mean, how much easier would it be to have a group of like-minded individuals with that common goal of surviving? I mean, these guys survive and they survive for an extraordinary amount of time in my opinion, but it’s not for a normal lifetime. I mean, they’re there for 90 days. And when at the end of the 90 days, they look pretty ragged. I mean, a person can survive alone for a time, but you can see on Alone, on the show Alone, that it’s a pretty miserable existence. So that’s something that I think is so important to have people that can thrive.

And how about skills? I mean, I have medical skills, but I have very few tactical skills. For example, I probably couldn’t take a part in AR-15. I probably wouldn’t be very good in a firefight, but there probably are people that would be. And having people with skills that can complement each other would make for the possibility of the existence that could make a village.

Brett McKay: Yeah. Now we had an Alone contestant, a winner on the podcast a while back ago, Jim Baird.

Joe Alton: Oh, yeah.

Brett McKay: Him and his brother won. And one of the big takeaways from that conversation I had with him and also watching the season that he was on, on Alone, it was amazing to see how little tiny injuries could just devastate you. That actually ended people’s time on the show. You just, you sprang an ankle and then you’re done. Even having another person there, it wasn’t enough. You needed to have maybe two or three more people because that one person couldn’t do, you’re basically working for two people now and they just didn’t have the energy for it.

Joe Alton: Yep. [chuckle]

Brett McKay: Yeah. Okay. So have a community. What about personal health? What parts of your personal health should you have in order in order to be ready medically for a long-term grid down scenario?

Joe Alton: Well, what I hope people are doing now, I mean, eating a healthy diet, exercising, staying away as much as possible from addictive substances that wouldn’t be around in a grid down situation, like maybe alcohol or tobacco on top of that. And this is something that people are surprised to hear me say is that you should be using the high-tech available today to fix issues that would be a problem off the grid. I mean, if you have a bum knee, that’s not going to be very helpful off the grid and would certainly not increase your chances of survival. So see an orthopedic surgeon now, get it fixed. You have terrible vision, consider a LASIK procedure. For example, I had classic near sightedness blind as a bat. I got it done probably 30 years ago, probably one of the first people to get it. And now I have the eyes of an eagle, a very old eagle now, I’ll admit, but still.

Brett McKay: Okay. So yeah, get your health in order. So you’re ready for that scenario. So you talk about becoming a medical asset in your family. And when you’re a medical asset, it means you take on different responsibilities. You’re not just providing first aid, but there’s other roles you take on. We mentioned one of them. You’re sort of the chief sanitation officer of your family. Any other responsibilities that a medical asset needs to take on in order to take care of the healthcare of their family?

Joe Alton: Well, Brett, I mean, of course you’re the chief medical officer, but you’re gonna have to deal with a lot of other things too. You’re gonna have to deal with dental issues as well. Now, I’m not talking about a week without power due to a storm. I’m talking about a long-term scenario, a few months off the grid. And you’re going to wind up facing as many patients on a daily basis with dental problems as medical problems. And you’ll even have to extract a tooth now and then. 90% of dental emergencies in the past were treated that way. I’m not talking about Roman times. I’m talking about the early to mid 20th century. And you’re going to be responsible also for making sure we talked a little bit about water disinfecting. You got to make sure water is disinfected properly. Foods prepared and cooked thoroughly. Human waste is disposed of safely. These are things that are part of your job description. You’re also the chaplain. You may not have to deal with bullet wounds on a daily basis. I hope, at least I hope not, but you’re going to see anxiety and depression on a daily basis of some major disaster hits.

You need not only to be sympathetic and understanding, but you’re going to also have to be confidential as well. Nothing loses the trust of a group than a non-confidential medic, somebody that doesn’t keep people’s private things to themselves. Well, one other thing, you also actually going to be the quartermaster who decides when your limited supplies of medical items are dispensed. It’s not a committee decision. It should be the medic.

Brett McKay: You also have in here medical archivists. So you got to keep track of people’s issues.

Joe Alton: Yes, that’s right. That’s another thing. And that’s something you should probably do now. If you knew who was going to be in your extended family or in a mutual assistance group, you should probably interview them beforehand and keep everything of course, confidential, as I mentioned, and you should definitely learn what their medical issues are, what their family history is, what vices they might have. I mean, are they heavy smokers or do they drink a lot? And you should try to sort of steer them in the direction of getting healthier. And the fact that you would know what medicines, let’s say a person is on, would help you sort of encourage them to get more of these medicines, stockpile some of them so that you don’t have somebody with very high blood pressure showing up at your retreat with their last three days of blood pressure medicine and that’s it.

Brett McKay: Okay. So let’s get into skills and gear here. Do you recommend people like just a lay as an average citizen, take any sort of formal intensive training to get ready for a grid down disaster scenario when it comes to healthcare?

Joe Alton: I think a good start is just go through your municipality and see what courses that they have available. Many times they have free courses available for first responders or CERT members, Community Emergency Response Team members, other people that will be willing to volunteer in disaster settings. Sometimes they’ll have stop the bleed courses. Seek these out. And like I said, they might even be free. And there are, of course, a lot of wilderness first aid courses out there, a lot of companies that put forth these kinds of courses. You can find them online. I’m sure your experience may vary with them, I have to say. But all of these courses do prepare you to do what you need to do, stabilize and transport victims in normal times, but not so much for long-term care. So therefore, what I recommend to people is that when you take each class, think about what you would do if transport to a modern medical facility was not an option. What would you do with that particular individual, that particular sickness or that particular injury? And that’s the key is to have the right mindset and a plan of action in situations where you’re not going to be able to take that person to a higher medical asset.

Brett McKay: One of the most useful things that I’ve done, I really enjoyed it, too. I need to go back and do it again. I took like a first aid CPR certification class. It was done at one of the community colleges here in town. It was a couple hours, I believe. But not only did you do the CPR, but they just went over like basic first aid, what to do about burns, head injuries, big wounds. And I remember I learned a lot. But what I realized is that knowledge and like we actually practice some skills, like how to how to bandage things and things like that. But I realized that stuff, that knowledge and those skills, they degrade if you don’t use them. Like you have to constantly refresh yourself on it.

Joe Alton: You’re absolutely right. We teach wound care class and wound closure class. And I teach people how to suture close simple wounds and things like that. And more importantly, when to close a simple wound and when to leave it open and provide open wound care. And I always make sure I give people extra sutures to take home and they keep their instruments so that they can practice. Now, whether they all do or not, that depends. But you have to develop muscle memory for just about any of these things. And the more you do it, the more effective you’ll be at.

Brett McKay: Okay. So take some sort of class that’s out there. You can find different things out there, but as you do kind of keep in mind, well, how can I take this further and how would I apply this in a long-term grid down situation?

Joe Alton: It’s a mindset.

Brett McKay: Yeah. Let’s talk about medical supplies now. And you’ve got, I love this section because I love checklists. You have these checklists for different medical kits. You think people should start building up so they’re ready for that long-term situation. The first kit is an individual first aid kit. What are some of the things that you would recommend people keep in this individual first aid kit? So every person in your house or your group is going to have one of these, correct?

Joe Alton: Right. Ideally, you would want everybody in the group to have it. In the military now, everybody carries, every infantryman, for example, carries an IFAK kit and the medic carries a more advanced kit that allows him to put an IV in and things like that. But these guys will carry things like a tourniquet to stop bleeding, maybe a burn gel and dressings, elastic wraps to wrap orthopedic injuries, things like that. And I think that that would be a good start for a first aid kit. We have a number of kits on our store that we designed that are very compact, but they manage to deal with a number of different issues that are most commonly seen. So an individual first aid kit, I think for every member of the family would be good, especially in situations where you have to be on the road. So it just depends on the situation. Does your 10-year-old have to carry a first aid kit to school? No, probably not. But in a true long-term disaster situation, which is what I write about, this is something that everybody should have.

Brett McKay: Yeah. This is good just to have if you go on a hike or backpacking trip. I always carry one and it’s got things, band-aids, got Benadryl in there. We got pain relievers, so Tylenol, Advil.

Joe Alton: Right. Moleskine, things like that.

Brett McKay: Moleskine, things like that. And you also have, I thought it was in raw honey packets. What’s the raw honey packets for?

Joe Alton: Raw honey has actually very strong and actually accepted medically antibacterial properties. And so you can use raw honey for a number of things. And of course you can use it to treat hypoglycemia, low blood sugar cases, but you can also put it on burns and other injuries and it actually would have an antibacterial effect.

Brett McKay: That’s interesting. Alright, so that’s the first kit. Start building up a basic individual first aid kit. The next one is the vehicle kit. What’s the vehicle kit for and what kind of stuff are you keeping in that?

Joe Alton: Well, the vehicle kit is more extensive and it really allows you to carry things that you might not be able to carry. Like in other words, a sturdy pair of boots if you found yourself stranded in a blizzard or something like that. And you have to actually go somewhere, although of course it might be better to stay in the car. It has changes of clothes, it would have foldable, multi-tool, shovels, tow ropes, flares, rock saw, things that would help you in situations where you’re in your vehicle. And also it has more of every item.

And the reason why is because you’re not physically carrying this. And so you have the ability to deal with not only things, but do you deal possibly with multiples of things, more than one injury?

Brett McKay: Yeah, we got an article on the site about what to keep in your car. And people are like, that’s kind of a lot of stuff. Like, when would you ever use that? It can come in handy. So my dad, I remember it was this probably 30 years ago. He was driving from Oklahoma City to Albuquerque on I-40 and in the middle of the Texas panhandle. He got stuck in a blizzard, and he was in his car, I think, for a while. I mean, I think it was like a day, but it was well stocked. He had blankets and he had some stuff. And so he was able to ride it out until he’s able to get towed out.

Joe Alton: It’s something that can be a serious thing if you have to make the right decisions. There’s one guy who got stranded. He decided he was going to go for help, and they found him the next morning and he did not make it.

Brett McKay: All right, so the third kit is the family kit. You’re going to keep this at your home, or if you got a retreat somewhere, you’re going to keep it there. And this thing is massive. This was a lot of fun to look through because it’s so big. You break it up into different modules. So what sorts of modules do we have in this family kit?

Joe Alton: Well, of course, we talked about dental situations, so a dental module would be there. You would have, depending on the makeup of your group, you would have maybe a module for a delivery of a baby. You might have your surgical modules with the ability to do more extensive things like sewing some tendons together, things like that. A lot of daily wound care items, because this is something that you can easily do if you are able to stay in place.

Eye care modules, things like that, in case there’s foreign objects. And a lot of people, when they do activities of daily survival that they’re not really accustomed to, they can injure themselves. And so you could be chopping wood and you wind up getting a splinter in your eye. So we have the ability to deal with foreign objects that could get caught in your eye. Just a lot of different things. We’re beginning to get to kits that have hundreds of items. And indeed some of our biggest kits in our entire line will have hundreds of items in them.

Brett McKay: Yeah. One potential module you might have, if you’ve got small kids, a pediatric module. So you have… Make sure you have medications for them.

Joe Alton: Yes, exactly. So you have all sorts of stuff in these situations. You want to have maybe growth diaries, and then you can identify basically how well your young people are doing by, if they’re growing in a normal fashion. And so that’s something that they might have. You have a lot of different sized things, like a CPR mask for an infant would be different than a CPR mask for an adult, and blood pressure cuffs, things like that. So there are a lot of items that are sort of size differential.

Brett McKay: So the fourth kit is… This is if you’re going all in, you want to actually have a field hospital. What sorts of items are in this kit?

Joe Alton: Oh, boy, that’s… I got about 10 pages of…

Brett McKay: I’m looking at it right now.

Joe Alton: And each page has 50 items each. So, I mean, you would have everything from, gosh, biohazard suits to operating tables to… I mean, we’re talking about a real mash unit kind of deal.

Brett McKay: When would you want to do that? I mean, you have a question in the book that you try to answer, which is, how much is enough? When do you know? Well, yeah, maybe I’m good at the family kit and I don’t need to go field hospital.

Joe Alton: Well, I think that it’s probably very few people that will reach the point where field hospital is what they’re going to wind up being responsible for. So I think that people really just need to get the items that are going to be able to deal with the most common issues that they’ll expect to be confronted with. And what we have here, I mean we’re talking about medical…

I’m looking through my list right here because I don’t remember all 500 things that are on here, but we’re talking about automatic portable defibrillators, and we’re talking about oxygen concentrators and things like that. Things that you would need if you had… You would have to have some solar power, for example, to get enough power to, let’s say, do some oxygen concentration. These are some of these items that you’re going to need a little power. And if you’re ready to put together a field hospital, you will have taken power into account. So at least if it’s solar power.

Brett McKay: Another point you make, kind of a broader mindset point you have to take when it comes to medical care in a long term disaster scenario, is that you have to adjust your expectations of what’s possible in this situation. I think today we take it for granted. It’s like, well, if something happens to me, I just go to the doctor and I’ve got medicine. Or if even like a serious thing happens. It’s not so serious. There’s things we can do. I mean, I guess what I’ve read is that people are surviving gunshot wounds more often because our skill and technology has gotten better.

One of the points you make is that in a long term situation, long term disaster situation, the best you can do is maybe just make people feel comfortable and you might not be able to cure them. You have to be okay with that.

Joe Alton: We have to be very, very realistic about what can be done and what can’t be done. In an off grid situation, you can expect a gunshot wound to the abdomen or a gunshot wound to the chest to probably have a 70% death rate. And it’s a terrible thing to say and certainly not the case today with modern medical facilities, but it’s what’s going to happen. And if it’s not the actual trauma from the injury itself, it’s the chances for infection.

Again, remember, your skin is your armor, and so once you have breached that armor, you have that chance of infection.

Brett McKay: That brings up a point I want to talk about. In the book, you talk about how you can plant a garden with herbs and plants that have medicinal purposes. But what do you do about prescription medicines like antibiotics for infection? Is it possible to stockpile antibiotics?

Joe Alton: There are some companies that are beginning to offer, “emergency antibiotic packs” with a televisit, as long as you fill out an application and do a televisit. So these are becoming more popular. They’re just popping up now. And I believe that there’ll be a thriving industry in this probably in the next few years, or at least until the state medical boards get a hold of them.

Brett McKay: What about special medications like insulin? Say someone’s diabetic, is that tough to stop…

Joe Alton: Brett, insulin like that are basic insulins like regular and NPH are actually over the counter in most states these days. You can get them as you need them.

Brett McKay: We’re going to take a quick break for your word from our sponsors.

And now back to the show. We’ve talked about supplies, we’ve talked about getting some training, hoping we can talk about some specific skills here in a bit. But I want to turn to this idea of hygiene and sanitation, because if anyone’s read any history book about war, war up until the 20th century, really, most of the casualties came from poor sanitation. Men were dying of dysentery, cholera, things like that. In a grid down scenario, there might be a situation where you no longer have flushing toilets. So you have to think about human waste. So what do you do about human waste in a grid down scenario?

Joe Alton: Well, human waste should always be buried if you don’t have a toilet. Now, if you have a toilet, you have two gallons of water. Even if it’s wastewater, you can actually flush that toilet, if it’s the typical configuration of the toilet in your home today, by flushing two gallons of water into the toilet, and it will actually flush. But if you’re out, let’s say you’re on the road, you’ve been driven from your home, you’re on the road, human waste, you’re in a retreat in the forest somewhere. Human waste should be buried no closer than 200ft away from the main water source to prevent contamination.

And the medic, if you’re in a community, let’s say you’re the medic for an actual community, that you should have an idea of how to put together a community latrine. And so the dimensions would depend on the length of time, of course, that’s needed, and the number of people in your group. If you had a small group, an 18 inch wide by about 24 inch deep, several feet long, that probably would work pretty well. A longer trench in some kind of partition sheet. If your group is big enough to have more than one person using it at a time, and you keep the dirt from the trench that you dug in a nearby pile with a shovel, and that covers up the waste after each use. So that’s something that would be good for dealing with human waste.

But you’re absolutely right about the importance of sanitation. In the past, entire populations succumbed to diseases that cause diarrhea, leading to severe dehydration. You mentioned cholera and dysentery. Those can be very, very lethal. I mean, more soldiers in the civil war died of these issues than from bullets or shrapnel. So, again, this is probably the third or fourth time we’ve mentioned already, but the medicine has to strictly enforce water disinfection, proper food preparation, waste removal, and more, or infection’s gonna run rampant among other people.

Brett McKay: So here’s something I’m sure people may have thought about if they’ve kind of do these hypotheticals in the head of, like, a long term disaster scenario where you’re not gonna have access to the comforts of modern life for a long, long time. What if someone dies? What are you supposed to do with the body? ‘Cause, like 200 years ago, when someone died in your family, you knew what to do today, you call the funeral home and they take care of everything, so what are you supposed to do?

Joe Alton: This is something that most people have absolutely no idea what to do, and you have to figure out what to do with the body. The body should be placed in a body bag. These are currently commercially available, by the way, and some of them actually have handles to facilitate transport. But if you don’t have these, you can found items like plastic sheeting, bedsheets from abandoned homes. These are things that you can use. Choosing a place to bury them is important. I mean, it should be at least 200 to 250 meters. That’s about 800ft from any water that might possibly be used by the living. That’s very important.

But the funny thing is that if you can properly dispose of the dead body and in that type of location, it doesn’t have the ability… It doesn’t really cause major contamination of the environment. So that’s something that’s important to know.

Current grave guidelines suggest a depth of about five or 6ft. That’s 1.5 meters, and preferably that amount of space above the water table. In some places, that’s really difficult to achieve. Down here, our water table is like 6 inches below the ground. That’s why you see in this area, the older crypts are either concrete and they bury them in the ground, but they’re buried in concrete. Or if you go to places like New Orleans, you see that everybody’s buried above the ground.

Now, you also use something called quicklime, and that’s calcium oxide. It’s been used in burials for centuries, but people think that it’s being used to speed the decomposition of the body, but it actually preserves tissue, which is funny. So why is it useful? Because it actually eliminates odors that attracts flies and animals. And there’s actually a formula for that. 1 kg or 2.2 pounds of lime per 10 kilograms of body weight.

Brett McKay: So you mentioned dental issues. You might not think that you have to take care of a dental problem in a long term situation, but you would. I mean, what are some of the dental issues you think are treatable in a long term disaster scenario?

Joe Alton: Well, the grand majority of dental issues can be dealt with by extraction, as I mentioned earlier, including dental decay. You also need to learn how to fasten loose crowns, replace loose fillings, lost fillings, broken teeth, knocked out teeth, tooth abscesses, gum inflammation. These are all things that you can easily deal with, with the right materials, but you can definitely take care of dental decay. Lost fillings you could put together with clove oil, two drops of clove oil and zinc oxide powder will put together a hardening filling material, material type of cement that will last for a pretty good long time. And you can use it to fasten a loose crown. And of course, you need to have extractors. There are extractors for different types of teeth. And there are probably as many different types of extractors as there are different types of teeth.

Brett McKay: And of course, with dental care, an ounce of prevention is worth a pound of cures. You gotta take care of your teeth. Even in a grid down scenario, brush your teeth, floss, and avoid all the sugary foods. Don’t eat too much of that raw honey. Save that for the…

Joe Alton: Right. Save that for the hypoglycemic patients.

Brett McKay: So in this book, you cover lots of different medical care skills that you think someone might need to know in a long term situation. What do you think are, let’s say, five skills you recommend people prioritize learning, either because, they’ll be especially common or because they’re not the kind of things you’ll have time to consult a textbook or your book to figure out how to do it in an emergency.

Joe Alton: Oh, boy. Well, I have like 40 that I’d like you to know. But if I had to pick five, of course there’s a sexy, sensational stuff like how to stop bleeding. That is, of course, always very important. And there’s a whole stop the bleed apparatus nationally that will help you learn that. But we, of course, we talk about it in detail, and we also describe all the different tourniquets and things like that in our book. And they’re good. There are pros and cons.

You can also expect to deal with a lot of orthopedic issues, ankle sprains and things like that. Of course, there’s going to be respiratory infections. That’s going to be very, very common. Open wounds. You need to deal also how to deal with significant problems. I think the ability to use a flexible splint to treat a bunch of different issues, I think that’s a big skill. The use of cravat or bandana or triangular bandage. We have videos to show you how to use that in seven different ways for different things. I think those are good skills to have because they handle different issues. So I think that’s important.

And of course, as we mentioned before, maybe the most important skill to obtain is how to enforce preventative strategies against injuries and illnesses. And to do that, you have to actually get the knack of observing simple things, such as whether your people are dressed for the weather and enforcing the use of hand and eye protection during work sessions. I mentioned you can really save yourself a lot of headaches as a medic and maybe heartaches if you can keep these people protecting themselves and adequately dressed for the weather. I think that’s important.

Of course you want to be able to treat burns and you want to treat open wounds, and you want to be able to close a wound if you absolutely have to. But more importantly, you need to know when to close a wound and when to not close a wound because you can lock in some bacteria and could cause some major issues.

Brett McKay: Okay, so we got know how to stop a bleed, know how to use different splints for orthopedic bone breaks, sprains and things like that, knowing how to do preventative medicine, and then how to deal with wounds. On the wound issue, like how do you know if you should leave a wound open or close?

Joe Alton: Well, if a wound is obviously dirty, in which a lot of wounds will be, if you happen to be on the road and in a situation where you know you’re not in a controlled environment, your wound is going to be dirty. And so if it’s an animal bite, for example, it’s going to be dirty. And these days, in the emergency room, they’ll actually close some of these wounds, but off the grid, you should definitely not close them. You should treat them as an open wound and just make sure that you keep them clean.

And we talk about, in detail, the ability to perform that daily wound care. And that’s why I think that’s a very important thing to be able to know. And you have to be able to identify when a wound is not getting better and when you may need to break out that last course of antibiotics that you’ve been saving, because in the end, that could save a life.

Brett McKay: Can you superglue a wound shut? I’ve seen that. If you decide you can shut this wound, can you superglue it?

Joe Alton: Yes. I’ll tell you exactly how. Take superglue, and I want you to use the gel version of it. It’s much easier to handle than the liquid version. So take superglue gel and hold the skin together, the cut edges of the skin together, and apply a line of superglue gel on top of that, holding it together, wait for it to dry, and then take a second layer, put a line over the first layer, and then go around and around in an ever widening oval for a couple of layers, then hold that together and let that dry, and then do it one more time on top, and even a little wide, a more widened oval. And if you do that and allow that to dry properly between, then you should do okay… It should be okay.

And the good news is that we’ll have an even less chance of infection than if you close it almost any other way because of the sealing of the superglue. Now, if you don’t hold the skin together properly, you’re going to put superglue in between the two cut edges, and they’re not going to close. It’s something that you just have to do. You might practice on, make a cut in a pool noodle and try to practice with that until you get that right.

Brett McKay: In regards to tourniquet, I know tourniquet use can be controversial. People have really strong opinions about it. Anything people should take into account when they think, well, maybe I need to use a tourniquet here?

Joe Alton: Well, I’ll tell you that the committee on Tactical Combat Casualty Care has stated recently that if you know that you’re dealing with heavy bleeding, that the use of a tourniquet should be your first course of action. Normally they recommend direct pressure with your hands and with either gloved hands or a hand with a barrier between the wound and the hand, but some sort of cloth or something like that. But they’re saying if you know you’re dealing with arterial bleeding or the bleeding is just of a volume that is serious, then use that tourniquet as the first course of action.

And that is a departure from previous eras. And in World War I, they actually called it The Devil’s Instrument because a lot of people just left it on too long and wound up causing nerve damage or even amputation. But you can definitely keep a tourniquet on for a period of time, at least two hours without permanent damage.

Brett McKay: I mean, okay, so the idea of a tourniquet, you’re supposed to put that on there so you can get to professional medical help. What do you do if you have severe bleeding in a long term situation?

Joe Alton: What I would say is you would transport that person to where the bulk of your medical supplies are. And there is a way to transition from a tourniquet to a, let’s say a compression bandage that you can actually do. Now, in normal times, you want to just get that person to the hospital. But if you don’t have the ability to get somebody to a hospital, then you might just have to transition that tourniquet to a pressure dressing by itself. And if you do, then you want to use on the actual wound itself something called a hemostatic dressing. And a hemostatic dressing is impregnated with material like kaolin or chitosan. And this is a blood clotting material. And so what you do is you apply it directly on the bleeding vessel, and you hold it in place for three full minutes, and it actually will stop the bleeding, even arterial bleeding, if you apply pressure and do it for the right amount of time.

I actually was talking to somebody who was a follower of our website, and he was a purchaser for the Navy in Hampton Yards, and he talked about a study that they did in which they basically hung up a pig and they shot it with a 9 millimeter and severed its artery, its femoral artery. And so they used the quick clot material, which is a brand of hemostatic dressing, held the pressure on it, and it stopped the bleeding. And then what they did is they shot the other leg, and they took the dressing out, the hemostatic dressing out, and then put the hemostatic dressing in the second wound and actually stopped it the second time around.

So it is something that, if you know how to use these things, when you have the right materials, the right hemostatic dressings, you can actually stop the bleeding in, at least from the standpoint of the emergent bleeding.

Brett McKay: Related to this idea of bleeding like gunshot wounds, are there any special things you got to think about there?

Joe Alton: Gunshot wounds, of course, are going to be difficult to treat off the grid. You have to remember that there’s things that happen when there is a projectile that enters the body and it forms a permanent channel, which is where the bullet actually went, physically went through. That’s called permanent cavitation, but it also forms something called temporary cavitation. And temporary cavitation is a shockwave that occurs as a result of the bullet passing through with speed through the body. And so if you shot me just under my liver, for example, I would have a channel that went through the area just under my liver, but there would be liver damage, and I could bleed to death as a result of the temporary shockwave that went through and disrupted liver tissue.

Brett McKay: Okay, I’m sure everyone’s thought about this at one point. What do you do in the case of a nuclear disaster? Because I think people have heard about radiation sickness. Are there things you can do to mitigate that?

Joe Alton: Well, nuclear disasters, believe it or not, if you’re not standing at ground zero, you actually have a pretty good shot at surviving. In Hiroshima, they lost more than 100,000 people total to the bomb. But it was a city that included the military that was there at the time, had swelled to 450,000 people at the time of detonation. So you have a shot to survive this. In the early going, your goal is to prevent exposure, and you want to prevent exposure over 100 rads, let’s say. Rad is the amount of radiation that’s absorbed by a living thing. So you might want to have a radiation dosimeter, and that gauge is radiation absorbed. And it’s widely available online. You can find it anywhere. This item predicts the likelihood that you’re going to develop it. But there are three basic, different ways to decreasing the total dose of radiation.

One, limit time spent in the open. Radiation damage is dependent on the length of exposure. So leave areas where high levels are detected and no adequate shelter is available. That’s important. The activity of radioactive particles decreases over time, which is great. After 24 hours, the levels have dropped a 10th of their previous value or less. Then you want to increase the distance from the radiation source. A lot of this is common sense. Radiation disperses over distance. And the effects will be decreased in proportion.

Nuclear reactor meltdowns common evacuation patterns include a complete 10-mile circle. Or if you looked at the pattern, it looks like a keyhole or an old timey keyhole comprising of, let’s say, a two mile circle and an additional three miles radiation radiating from the direction of the prevailing winds. So that’s something that’s important to know.

And then shielding, shielding, shielding, shielding. Shield your people to decrease radiation where they are. In many cases, they’re going to have to shelter in place, and the shielding is going to decrease exposure exponentially. So it’s important to know how to construct a barrier between your people and the radioactive source. And denser materials will give greater protection. Now, let me talk about halving thickness for a second. When I say halving thickness, I’m saying H-A-L-V-I-N-G. Shielding effectiveness is measured in terms of this. This is the thickness of a particular material that will reduce gamma radiation, the most dangerous kind, by one half. And when you multiply halving thicknesses, you multiply your protection. So let’s say the halving thickness of concrete is 2.4 inches or 6 cm. So a barrier of 2.4 inches of concrete is going to drop between you and the radiation.

It’s going to drop the exposure by half. If you double that and make it 4.8 inches, it drops it to 1/4th, one half times one half. Tripling it drops it to 1/8th. And 10 halving thicknesses drops the total radiation exposure to one in 1024th. So if you’re in a concrete bunker that’s 24 inches thick, you are 10 halving thicknesses thick. And so you’re exposed to only 1/1024th of the outside environment. So that’s something that’s important. Now, treating radiation thickness. You treat them as you would burn patients. But once you’ve received four to 500 rads, however, there’s not too much that can be done. You either survive or you won’t.

Brett McKay: And there’s like a medication you take for your thyroid?

Joe Alton: Yes. Well, that’s a also protective thing. For one thing only. And that is thyroid cancer. And you would take… An adult would take 130 milligrams of potassium iodide once a day or 65 milligrams a day if you’re a child. And it’s very useful to prevent thyroid cancer down the road, then the people that are getting thyroid cancer from Chernobyl, those people were children when they were exposed. So if you have a limited amount of this, the brand is called Thyrosafe. We have it on our store. And this is something that you would only give… If you had limited amount, only give it to the kids.

Brett McKay: Gotcha. Well, Joe, this has been a great conversation. Where can people go to learn more about the book and your work?

Joe Alton: Well, we’ve written several books. The main one now is called The Survival Medicine Handbook: The Essential Guide for When Help is NOT on the Way. And it’s now in its fourth edition. You can find it in black and white on Amazon, in color and spiral bound versions at our site, at, along with an entire line of medical and dental kits for the serious medic in times of trouble. Now, our website at now has over 1500, 1500 articles, videos, podcasts and more on medical preparedness. We also have a YouTube channel called Dr. Bones, Nurse Amy. That’s a nickname of mine, Dr. Bones, that has about 300 videos. You also find my articles on the newsstand in Backwoods Survival Guide, Off Grid Recall, Backwoods Home, Prepper’s Survival Guide and other magazines in the homesteading and survival genres.

Oh, and on Facebook we have survival medicine, Dr. Bones, Nurse Amy groups. We have a group that’s 8000 strong there. You’ll get all my articles and videos on that too. Also have presence on PrepperNet and [0:47:03.0] ____.

Brett McKay: Fantastic. Well, Joe Alton, thanks for your time. It’s been a pleasure.

Joe Alton: Same here, Brett. Thank you so much for having me.

Brett McKay: My guest today was doctor Joe Alton. He’s the co author of the book The Survival Medicine Handbook. It’s available on You can find more information about his work at his website, Also check out our show notes at, where you can find links to resources where you can delve deeper into this topic.

Well, that wraps up another edition of the AOM podcast. Make sure to check out our website at where you find our podcast archives as well as thousands of articles that we’ve written over the years about pretty much anything you think of. And if you haven’t done so already, I’d appreciate it if you take one minute to give us a review on Apple podcast or Spotify. It helps out a lot. And if you’ve done that already, thank you. Please consider sharing the show with a friend or family member who you think would get something out of it. As always, thank you for the continued support. And until next time it’s Brett McKay reminding you to not only listen to AOM podcast, but put what you’ve heard into action.

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By: Brett & Kate McKay
Title: Podcast #983: Grid-Down Medicine — A Guide for When Help Is NOT on the Way
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Published Date: Wed, 17 Apr 2024 12:37:37 +0000

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Mens Health

Homecoming: An Evolutionary Approach for Healing Depression and Preventing Suicide

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Captura de pantalla 2024 07 13 a las 17.40.10 1
Photo by: Andreea Popa /

Part 1

Depression and suicide have been my companions as far back as I can remember. I was five years old when my mid-life father took an overdose of sleeping pills. Though he didn’t die our lives were never the same. I grew up wondering what happened to my father, when it would happen to me, and what I could do to prevent it from happening to other families.

In an article, “Being Bipolar: Living and Loving in a World of Fire and Ice,” I described my own mental health challenges and healing journey. In my book, The Irritable Male Syndrome: Understanding and Managing the 4 Key Causes of Depression and Aggression, I shared my research and clinical experience that convinced me that men and women are different in ways they deal with depression and aggression in their lives and in other ways as well.

Depression and suicide are not just problems for men, but there is something about being male that increases our risk of dying by suicide. According to recent statistics from the National Institute of Mental Health, the suicide rate among males is, on average, 4 times higher (22.8 per 100,000) than among females (5.7 per 100,000) and at every age the rate is higher among males than females:

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Even during our youth where suicide rates are relatively low, males are still more likely to die by suicide than are females. It is also clear to me as my wife and I move into our 80s, we face many challenges as we age, but it is older males who more often end their lives by suicide with rates 8 to 17 times higher than for females.

In my book, My Distant Dad: Healing the Family Father Wound, I describe my father’s slide into depression and the despair that increased when he couldn’t find work. As a writer, he wrote regular entries in his journals. I still feel the pain as I re-read them and feel his increasing shame when he couldn’t support his family:

            July 3rd:

“Oh, Christ, if I can only give my son a decent education—a college decree with a love for books, a love for people, good, solid knowledge. No guidance was given to me. I slogged and slobbered and blundered through two-thirds of my life.”

            July 24th:

“Edie dear, Johnny dear, I love you so much, but how do I get the bread to support you? The seed of despair is part of my heritage. It lies sterile for months and then it gnaws until its bitter fruit chokes my throat and swells in me like a large goiter blacking out room for hopes, dreams, joy, and life itself.”

            August 8th:

“Sunday morning, my humanness has fled, my sense of comedy has gone down the drain. I’m tired, hopelessly tired, surrounded by an immense brick wall, a blood-spattered brick world, splattered with my blood, with the blood of my head where I senselessly banged to find an opening, to find one loose brick, so I could feel the cool breeze and could stick out my hand and pluck a handful of wheat, but this brick wall is impregnable, not an ounce of mortar loosens, not a brick gives.”

            September 8th:

“Your flesh crawls, your scalp wrinkles when you look around and see good writers, established writers, writers with credits a block long, unable to sell, unable to find work, Yes, it’s enough to make anyone, blanch, turn pale and sicken.”

            October 24th:

“Faster, faster, faster, I walk. I plug away looking for work, anything to support my family. I try, try, try, try, try. I always try and never stop.”

            November 12th:

“A hundred failures, an endless number of failures, until now, my confidence, my hope, my belief in myself, has run completely out. Middle aged, I stand and gaze ahead, numb, confused, and desperately worried. All around me I see the young in spirit, the young in heart, with ten times my confidence, twice my youth, ten times my fervor, twice my education. I see them all, a whole army of them, battering at the same doors I’m battering, trying in the same field I’m trying. Yes, on a Sunday morning in November, my hope and my life stream are both running desperately low, so low, so stagnant, that I hold my breath in fear, believing that the dark, blank curtain is about to descend.”

Four days later, he took an overdose of sleeping pills and spent seven years in a mental hospital receiving “treatment” until the day he escaped. The book has a happy ending, but it took a long time to get there.

            I share what I have learned over the years in an on-line course, “Healing the Family Father Wound.”  I recently read a chapter in the book, The Palgrave Handbook of Male Psychology and Mental Health edited by J.A. Barry, et al., by Martin Seager, titled “From Stereotypes to Archetypes: An Evolutionary Perspective on Male Help-Seeking and Suicide,” that adds some important pieces to the puzzle and added to my understanding of male depression and suicide and how we can more effectively help men and their families.

An Evolutionary Understanding of Male Psychology

            “In our current age it is unfashionable to think of human gender as connected with our biology and evolution,”

says Dr. Seager.

“Gender is currently thought of primarily as a social construct, a theory that carries assumptions that gender can be fluid, molded by education or even chosen as a part of a lifestyle. Gender is increasingly seen as a collection of disposable social stereotypes, separate from and unrelated to biological sex.”

            Dr. Seager goes on to say,

“This hypothesis is bad science and even worse philosophy…When held up against the anthropological and cross-cultural evidence, a social constructionist theory of gender cannot explain clearly observable and universal patterns of male and female behavior.”

            I agree with Dr. Seager and have long held that we cannot understand or help men, or women, without recognizing our biological roots in the animal kingdom. In my book, 12 Rules For Good Men, Rule #4 is “Embrace Your Billion Year History of Maleness.” I introduce the chapter with a quote from cultural historian Thomas Berry.

“The natural world is the largest sacred community to which we belong. To be alienated from this community is to become destitute in all that makes us human.”

            I also say in the book that all humans are also mammals and we cannot understand men without recognizing that fact. Dr. Seager agrees.

“Human beings are evolved mammals and they have never stopped being so,”

says Seager.

“Whatever social, cultural and political structures are placed upon us as humans, these cannot erase our mammalian heritage and indeed are constructed upon and shaped by that heritage, though not determined or defined by it.”

            Dr. Seager goes on to say,

“Globally, across all human tribes or societies and throughout all known history and pre-history, allowing for inevitable variation across a spectrum, there are universal patterns of male and female behavior in the human species.”

Based on the most massive study of human mating ever undertaken, encompassing more than 10,000 people of all ages from thirty-seven cultures worldwide, evolutionary psychologist Dr. David Buss found that there are two human natures, one male and one female. In his book, The Evolution of Desire: Strategies of Human Mating, Dr. David Buss explains the evolutionary roots of what men and women want and explains why their desires differ so radically.

            “Within human beings perhaps the most obvious universal patterns of sexual differences are: Female: (1) Beauty, attraction and glamour (Including body adornment) and (2) Bearing and nurturance of new-born infants and young children. Male: (1) Physical protection (strength) and (2) Risk-taking,”

says Dr. Seager.

            Dr. Seager goes on to say,

“In all human cultures throughout history and prehistory there is consistent and incontestable evidence of males taking high levels of risk to protect and provide for their family, tribe, and community or nation either collectively as bands of hunters and warriors or as individuals.”

Some view male risk-taking as foolhardy, immature, self-destructive, and harmful to women and children as well as men themselves. But both Dr. Seager and I recognize that protecting women and children and risk-taking behavior are archetypal, instinctual, positive, and evolutionarily important for survival strategies.

In the second part of this series, we will continue our exploration of ways we can improve our understanding of male depression and suicide and how we can be more effective in helping men and their families.

You can learn more about the work of Martin Seager at the Centre For Male Psychology.

We need more programs for men that are evolutionary-archetypally informed. You can learn more at and If you like articles like these, I invite you to become a subscriber.

The post Homecoming: An Evolutionary Approach for Healing Depression and Preventing Suicide appeared first on MenAlive.

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By: Jed Diamond
Title: Homecoming: An Evolutionary Approach for Healing Depression and Preventing Suicide
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Published Date: Sat, 13 Jul 2024 23:40:56 +0000

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