Modern TRT Is Broken (How to Fix Your Testosterone) with Ali Gilbert | Ep 253
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Are you sabotaging your hormones with a cookie-cutter testosterone protocol? Could blocking estrogen be harming your health instead of helping? Is low testosterone silently holding you back from being your best self?
Philip (@witsandweights) teams up with Ali Gilbert, the "Queen of Men’s Health," to explore testosterone replacement therapy (TRT). Ali shares her expertise on optimizing men’s hormones, health, and performance, breaking down common TRT pitfalls, outdated beliefs, and the importance of personalized approaches. Together, they dive into estrogen’s vital role in male health and the transformative power of optimized testosterone.
Learn how to optimize your testosterone and take charge of your health in ways you never thought possible.
Ali Gilbert is a fitness expert and leading advocate for men’s health. Known as the "Queen of Men’s Health," she combines her exercise science and coaching background with deep hormone optimization expertise. Ali has helped thousands of men achieve better health, performance, and confidence by addressing the root causes of hormonal imbalances with an evidence-based, no-nonsense approach.
Today, you’ll learn all about:
2:51 The Wild West of TRT clinics and red flags to watch for
6:30 Personalized protocols Vs. One-size-fits-all approaches
14:39 How stress and under-eating sabotage testosterone
18:37 Navigating difficult conversations with men
24:03 Understanding estrogen in TRT
28:39 Breaking the myth: TRT is not a shortcut to getting “jacked"
32:11 Optimal testosterone levels and symptom resolution
36:33 How TRT enhances confidence and decision-making
41:08 Ali’s journey into men’s health and creating her unique niche
48:28 Outro
Episode resources:
Website: https://ali-gilbert.com
Instagram: @thealigilbert
Facebook: @thealigilbert
YouTube: @queenofmenshealth
Why Most TRT Protocols Fail and How to Fix Them
Are you considering testosterone replacement therapy (TRT) or already on a protocol that doesn’t feel quite right? You're not alone. Many men dive into TRT expecting life-changing results, only to be met with disappointment. The truth is that most TRT protocols are fundamentally flawed, leaving men with persistent symptoms and even worse outcomes.
This post will unpack the common mistakes in modern TRT, highlight why standard protocols fail, and explore what an optimized approach looks like. If you’re ready to finally take control of your hormones and health, keep reading.
Why Most TRT Protocols Don’t Work
Cookie-Cutter Approaches The biggest issue with many TRT clinics is their one-size-fits-all approach. Patients often receive the same protocol—200 mg of testosterone weekly, paired with an estrogen blocker like anastrozole. These clinics prioritize volume over quality care, giving every patient the same treatment regardless of individual needs.
Mismanagement of Estrogen Contrary to popular belief, estrogen isn’t the villain it’s often made out to be. In men, estrogen is cardioprotective, improves insulin sensitivity, and supports libido. Blocking it can lead to joint pain, mood issues, and even long-term health risks like osteoporosis. Yet many clinics routinely prescribe aromatase inhibitors, assuming any rise in estrogen is harmful.
Overlooking Lifestyle Factors Hormones don’t exist in a vacuum. Stress, sleep, training, and nutrition all influence your hormone levels. Clinics that only focus on lab results while ignoring the human behind the labs are setting patients up for failure.
How to Fix Your TRT Protocol
Personalization is Key A good TRT protocol considers your lifestyle, symptoms, and goals—not just your lab results. Bloodwork is crucial, but it’s only one piece of the puzzle. A competent provider will ask about your diet, training, sleep, stress levels, and medical history to build a protocol tailored to your needs.
Avoid Overmedication If your protocol includes routine estrogen blockers or unnecessary medications like HCG year-round, it’s worth reconsidering. Estrogen management should be based on symptoms, not arbitrary lab values.
Inject More Strategically For most men, splitting testosterone injections into two or three smaller doses per week provides more stable hormone levels and minimizes side effects. Forget once-a-week mega doses—they lead to peaks and crashes, making you feel worse.
Why Your Lifestyle Still Matters
Even the best TRT protocol won’t save you if your lifestyle is a mess. Many men come to TRT clinics underfed, overstressed, and overtrained. These factors not only reduce testosterone but also affect how well your body responds to treatment.
Start by:
Eating enough calories to support your activity level.
Strength training regularly to maximize muscle growth and bone density.
Sleeping 7-9 hours per night to optimize recovery and hormonal balance.
Managing stress through mindfulness, therapy, or hobbies.
Myths About TRT You Should Ignore
TRT Will Make You Instantly Jacked No, injecting testosterone isn’t a shortcut to six-pack abs. It’s a tool to restore your biological baseline, not a replacement for hard work in the gym and kitchen.
You Can Stay at Low Calories Forever Low-calorie diets may help you lose weight initially, but chronic undereating will tank your metabolism and testosterone. Most men need significantly more food than they think—especially if they’re active.
Estrogen Should Be Eliminated High estrogen levels on a lab report aren’t inherently bad. They’re often a sign that your body is converting testosterone effectively, which is beneficial.
Key Takeaways
TRT is a powerful tool, but only if used correctly. Work with a knowledgeable provider who takes a holistic approach to your health.
Optimize your lifestyle before starting TRT to maximize its benefits.
Question protocols that rely on estrogen blockers or overly simplified dosing schedules.
Remember, hormones are just one part of the equation. Your training, nutrition, and recovery still matter.
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Transcript
Philip Pape: 0:01
If you're considering testosterone replacement therapy or already on it, you might be shocked to learn that most protocols are doing more harm than good. What if I told you that typical TRT treatments and protocols are leaving men worse off than before they started? Well, today we're going to expose that truth. With testosterone replacement, with Allie Gilbert, the queen of men's health, who's helped thousands of men optimize their hormones the right way, you'll discover why standard protocols often fail, what your doctor isn't telling you about dosing and timing, and how to actually fix your hormones. Whether you're on TRT or not, if you want to cut through the BS and finally understand what's going on with your testosterone, you are definitely going to enjoy this one. Going to enjoy this one.
Philip Pape: 0:51
Welcome to Wits and Weights, the podcast that blends evidence and engineering to help you build smart, efficient systems to achieve your dream physique. I'm your host, philip Pape, and today we're exposing the truth but also simplifying TRT and hormone optimization with Allie Gilbert, the queen of men's health. Allie brings an unfiltered approach to a complex topic that we, as men, don't always talk about. She's helped thousands of busy professionals fix their hormones, transform their health, and today you're going to learn why most protocols fail, what actually works for optimizing testosterone and what to do in terms of treatment and lifestyle. Allie's going to show us what a personalized approach looks like and why typical advice, even by well-meaning people, could be holding you back. Allie, thank you so much for coming on and welcome to the show. Thank you for having me.
Ali Gilbert: 1:35
This is fun. This is good because I'm fresh off my Silverback Summit men's health event, so everything we talked about is ridiculously fresh.
Philip Pape: 1:46
Ridiculously fresh. Hot pink, extreme sour patch kid fresh right. Yes, oh, I don't like sour.
Ali Gilbert: 1:52
I haven't done.
Philip Pape: 1:54
You bring those, I bring the Diet Coke and we'll just alienate a whole bunch of folks that don't get it. I love it.
Ali Gilbert: 1:58
Oh, then we'll go viral.
Philip Pape: 2:00
No worries, we will, we will. It's funny. Dr Spencer Nadalski is coming on soon Same idea. I think he posted a meme that was Whitney Houston singing nothing, and it was like here's what happens if you cut out red dyes for your health Nothing, you know what I mean. Anyway, yeah, no, I'm sure that was awesome. What I love about your work is you tell it straight, but you also have taken kind of the best of what medical experts and scientists and everything have on men's health in general and you distill it down. So I think, to set the stage, I want to look at what's wrong with what's out there first and kind of what crazy stuff you've seen, and then we can segue that into what actually works both in terms of treatment and lifestyle. Right Like training and things like that works both in terms of treatment and lifestyle. Right Like training and things like that. So like what's the craziest, most inappropriate, like TRT protocol or approach that you've seen.
Ali Gilbert: 2:56
Oh, most of them have to do with clinics down here in Florida, because in Florida it's kind of like the wild west where anybody can own a clinic. So there's one like next to the gas station, like there's so many of them, and basically you could walk in and just be like I'm going to write my name on a piece of paper and then they'll be like cool, what do you want? Windstraw, anavar, deca? Oh, you want testosterone too? Cool, we'll give it all to you. And then usually my joke is guys are going to be like where are these clinics? Can I go, you know?
Philip Pape: 3:24
so yeah right, exactly they're like. It's where you sign up for being the governor and also get your driver's license and then your TRT.
Ali Gilbert: 3:30
Yes, exactly, and a big problem with a lot of them is they give out the same protocol for everybody because they're all playing the volume game, kind of like you know a commercial gym that has a very low ticket for entry. They just need numbers. So a lot of these clinics price their services very low and then give everyone kind of the same protocol, which is 200 milligrams of testosterone every week with anastrozole, which is an estrogen blocker, and then either HCG or gonadalrelin, which they claim helps fertility. Hcg does, gonadalrelin does nothing. Hcg also like we can get into this later, but that's something that doesn't need to be taken year round. But many clinics will sell guys on that because they sell HCG and the worst protocols that I've come across.
Ali Gilbert: 4:25
I had a guy who was I think he was 53, and he was on enclomethine and anastrozole, which is probably like the worst thing that you can do to anybody, no matter their age. But it was a little ludicrous. He was on that for over a year and I was like how do you feel? And he's like like shit. So I'm like you know that's to be expected. So I usually have to educate them as to why that is not the best approach for them why they may see their labs looking pretty but they may not feel so great, and what the next best steps are.
Ali Gilbert: 5:02
Because we work with a telehealth clinic called Merrick Health and Merrick is very competent and they do a great job. So if someone's not happy with their provider or they're on a protocol that I know is not going to help them or make them feel better, then I will let them know. Hey, you can come with us All our clients go through this process and then you'll be with somebody who actually knows what they're doing. So there's a lot of crazy protocols there, guys just taking stuff that they don't need or that they were sold on that they don't even know what it does, they don't know how to pronounce it. They just take it because a lot of guys don't question this stuff, because it is not necessarily the most comfortable conversation, especially if you don't know much about it. You're not going to be like, well, I don't need that when someone who has MD after their name is telling you that you need it.
Philip Pape: 5:57
Yeah, who I'm sure is coming across as supremely confident, bordering on arrogant, which is the vibe I get a lot of times from these guys. Yes, okay, so you mentioned blood work and you also mentioned how you feel, and it is kind of interesting that someone will go on a protocol for anything and this applies to men and women and then it's not actually addressing the whole. You know you did this in the first place, right, it's not just to get a number on your labs to change, but it must start there, along with understanding symptoms. So like what is the screening process that a good clinic or provider would start with to actually personalize it?
Ali Gilbert: 6:30
Blood work obviously is necessary, but instead of just reading the numbers and going off the arbitrary ranges that many labs have come up with, it's about asking about person, like who is the human behind these lab results? What's your lifestyle like? You know? What is your diet like? How are you sleeping? Do you have any family history? How do you feel? What are your goals? How do you train?
Ali Gilbert: 6:54
All of that goes into what your labs are, because your labs are just a snapshot in time, so it's not that these don't change ever. It's literally what is reflective of what you're doing now. So if you are dehydrated, you may see certain things elevated. If you're eating high fat, for you know, a night or a few weeks or whatever, that will be reflected in the lab. So it's important to know that if someone trained the day before, or if they're extremely dehydrated, why some markers might reflect that, and not to lose their mind and say, oh, you need to go do X, y, z or you have this because this is high.
Ali Gilbert: 7:34
It's not necessarily how that works, because a lot of it can be attached to things the person did the night before, a few weeks before, a few months before. So it's important to understand everything about them so you can have the full assessment of okay, this is not someone who sits on the couch all day drinking beer. This is an active individual who eats very well, does not drink alcohol, has other stuff going on in life, maybe they're stressed. All that stuff. You can't just read the labs and be like, okay, this is all red, so we have to fix this with this pharmaceutical. Have a nice day.
Philip Pape: 8:08
The doctor approach. So then you mentioned the person sitting on the couch drinking beer versus the active person. Who do you tend to deal with most? And also would you say, hey, it's not TRT, you need, like, let's work on the lifestyle period, like I can tell that's the issue before we even go there.
Ali Gilbert: 8:24
We tend to work with guys who are active, who are, you know, business owners, high performers, and usually they stress and under eat themselves into poor health. So that's kind of our demographic. But we have worked with guys who have body fat to lose because, as you know, many men will say I'm 15 percent body fat and they're really like 20 or 25. So that's where photos come in very useful as well. So we tend to deal with guys who are like you know, I tried everything to get leaner, I tried everything to grow muscle and nothing works for me and I'm a special snowflake or I don't know what to do. And I'm also very grateful that they realize this, because a lot of people are very prideful in knowing what to do in the gym. Maybe they've been lifting for years, maybe they've been active for years. But there does come a point where, if you're after a certain goal, hiring someone that knows how to get you there not only quicker but more like efficient, so that you don't have to think of stuff and that you don't pivot and try to negotiate with yourself every time you don't feel good or the scale doesn't say what you want, or whatever. You have that objective view, and so I always tell clients I'm like I've been coaching for about 24 years, I've had a coach for seven and a half years and they're like why? And I'm like I don't wanna deal with myself, like I'd love going into the gym knowing this is my program, and then you know, whatever I'm eating or if I have a photo shoot or something I wanna get ready for, I don't have to worry about the timeline on that, whether I'm doing the right things with progress or whatever. He worries about all that. So those are the guys that we tend to deal with and a lot of them maybe are not sure if they have low testosterone or don't think they do, because their only symptoms are non-sexual symptoms, because many guys think, well, if my dick still works, that means I have high T. Not always the case. They forget about the brain fog and the lack of energy and maybe inability to sleep and kind of fat storage patterns that they never noticed before.
Ali Gilbert: 10:30
So if someone's like a hot mess on labs and their testosterone is low, then we may say you know, we have to rectify all this before we look at testosterone. But quite often it's like a chicken or the egg scenario where they really need it and if they're under coaching with us, we know we're going to handle all the lifestyle stuff, because that's something they're going to have to address anyway whether they go on testosterone or not. So I'm very pro testosterone because I could read labs and know exactly how things will be able to improve with testosterone. But it's not something guys are obligated to do and I just educate them because a lot of them have questions or concerns or they've heard any of the stigmas associated with it and it's really just a very open conversation and we have a lot of guys that are like you know what?
Ali Gilbert: 11:19
I'm not ready. Let me do everything I can to get healthy first, which I think is awesome, then we can revisit it. And so when they do that and then they get healthy, they feel good and maybe then we bring in testosterone, it can be game changing for them, because then everything becomes amplified because they're already healthy. If someone's not healthy, it's still going to take a lot of work to get them healthy. But they may not have the best experience on testosterone because their expectations are a little bit different than what they thought it would be going on.
Philip Pape: 11:54
Okay. So what if someone is because I hear this a lot like they're doing all the things they're training, eating well, maybe they are getting sleep, maybe they are managing stress and they don't have any quote-unquote symptoms, at least what they think are the symptoms and then their lab work is kind of average. Let's say, you know, like total testosterone might be in the 500s or something and they're in their 40s. Is there a situation where you could tell just from labs, despite everything else, that still there might be a potential for improving it from that point?
Ali Gilbert: 12:26
Yes, and that will depend on their luteinizing hormone and follicle stimulating hormone numbers. So LH and FSH, those are what kind of signal the testicles to produce testosterone. So if those are high, then typically the balls are done Like something's got to, you know, be looked at here, and it means that they're screaming for the body to produce it, but the body's not producing it. And we'll see that in guys. I used to say older, but we'll see that in older guys 40 plus, it used to be like 50 or 60 plus but if somebody's like super stressed and this is a stress-based low testosterone, those numbers will be quite low.
Ali Gilbert: 13:11
And so then it's taking inventory of all the stressors in their life and then seeing all right, what is the best approach for this person? Does it make sense to bring testosterone in right now, because it can help combat a lot of the stressors? What are their future goals in life? You know a lot of guys are like I don't want to be on it the rest of my life and they want to hold off as long as possible, which they absolutely should do. It is a lifelong commitment. A lot of men struggle with that, so it's really understanding what their ultimate goal is, and does this make sense now? Because it will make sense at some point.
Philip Pape: 13:48
It's just when. Yeah, I think it's important to understand. You did allude to the fact that some of this is happening at younger ages and I've heard you talk about, even from the time we're born, how men are more I don't know, not the word infantilized, but more feminized and shorter, like taint, distance and stuff like that You've talked about. It's just fascinating, stuff like that you've talked about. It's just fascinating. But one thing I want to pull on one thread is you talked about stress and under eating and you know how the marketing is in the fitness industry.
Philip Pape: 14:11
There's so much marketed at women and like perimenopausal women and under eating for women, and you don't hear this talked about as much for men, just like you with personal clients. It's like, oh wow, you see how much is going on in men's life. That is just the same. I mean, we're all human beings dealing with these things. Like what are the biggest challenges? You see, when it comes to stress and under eating, that the guys listening can be like, oh yeah, I identify with that and now I can kind of grasp it and do something about it.
Ali Gilbert: 14:38
Well, the first thing is okay. So you're not eating enough and obviously they're terrified to eat more. Is what you're doing now working? So we have no choice. Now we can get you lean, but if you're eating 1700 calories, how low are you willing to go? It's going to suck.
Ali Gilbert: 14:57
You know I diet on like 1500 and we have guys who eat 1500 and I'm five, three, 120 pounds. So most men are not my height or stature. So it's getting them to realize that eating more is going to help them. They may not gain a pound. I mean, we had a guy who was eating. On his off days he was at 1400. On his training days he was at like 16 or 1700. And it took until over 3000 before he actually put on weight. So that goes to show you there's a lot in the tank that was not being used and he likely was breaking down muscle. So they don't realize that yes, it worked originally to get you lean, but now we're like so low and you feel like shit. You can't train hard, you're getting injured.
Ali Gilbert: 15:49
A lot of things are screaming at you saying yo give me calories. So adding food can help. The workouts can help them train harder, because people think the only way to create a calorie deficit is by lowering calories, and then they increase activity. But you can also keep activity high and bring calories up and still maintain a deficit. They just don't think of that part. So if you increase your activity, you got to bring calories with you. And no one does that because they think, oh well, eat less, train more, that's going to work. And so therefore I'll look the way you want Not necessarily and they'll stay at low calories amount way too long.
Ali Gilbert: 16:29
Like I always use Chris Bumstead as an example, for many reasons, he went to 1500 calories when he was dieting for the Olympia. That's the Olympia, hard dieting, someone of his height and weight, really low calories. So that I use that as an example when guys complain that dieting is hard and they're hungry and blah, blah, blah. But on the other side, he only stayed there for a short time. He didn't stay there for seven months. So that doesn't mean it's going to work better the longer that you do it, because the longer you do it, the more symptoms you're going to experience. So you have to get someone metabolically healthy and the only way to raise metabolism is not through some herbal supplement or whatever. It's to actually add food. It's talking them off the ledge on how eating more is okay. If the scale does go up, it's not body fat, because you're not going to increase body fat within a couple days. Like you have glycogen, you've got water weight, you've got actual food, like you know. So it's a lot.
Philip Pape: 17:33
I've seen this too. I totally get it because the fear of gaining weight and you're right, it didn't take you three months to put on the extra weight that you're worried about. Right, it took like many years. So it's not going to. When you gain intentionally and are training to build muscle and feel your body, you're not just going to blow up.
Philip Pape: 17:50
And as far as the calories go, like I hear you, I diet on around 2000 calories. I get to eat over three when I'm gaining. Right, If I had to eat 1600 ever I would just like want to shoot myself. That's crazy. But everybody's different and there's different body sizes too. I do know someone who had bariatric surgery and he's kind of stuck in that 1600 range and he's short too. So people are different. So conversations I know this is your bag is like normalizing the conversations around all of this stuff and being vulnerable and with men and all that. Where do we even crack into that? I guess what's the biggest fear, the thing that men don't talk about, that they can be encouraged to just right here, right now, as they're listening, like start talking about it more, and that way you can get the support you need on that thing that could be holding you back.
Ali Gilbert: 18:36
I would say their relationship with their spouse, their family and their friends. Because you know, especially if it's a guy who's used to hanging out with people that like to drink or party, or maybe they're married to somebody who has like zero interest in fitness, they're not going to understand why this person wants to change. So everyone sees like if someone drinks and all of a sudden they're not drinking, they lose their mind. But like if this person showed up to the bar face planning like Buffalo Wild Wings, I don't think anyone would bat an eye Like it's the most bizarre thing. So I always ask about those relationships, because not only will men use I have to talk to my wife as a smoke screen, they're also afraid that the wife may not understand. Why are you investing in a program? Because maybe they failed many times before trying certain things and now they're going to spend money doing another thing.
Philip Pape: 19:38
Here's another one. Yeah, exactly.
Ali Gilbert: 19:41
Or that they're going to have to make changes or even go on testosterone, which maybe their spouse doesn't understand or thinks it's steroids or whatever. So there's a lot that goes into these decisions. So you have to understand where this person's coming from, because if they're surrounded by people who are just toxic to what their goals are, they have to have some hard conversations and they're not going to like that, but it's the truth. Like you know, we have ways that we can help navigate that Like this is what you say to like that and then explaining to those close to them why these changes are important for their health, for them to show up as the proper husband, father, employee, business owner, whoever it is that they know they can be and that they want to be, because maybe they've lost themselves in work or a marriage or something, and those are things that people just don't usually bring up.
Philip Pape: 20:50
Yeah, I mean from firsthand experience.
Philip Pape: 20:53
For years I know I wouldn't ever share anything like that with even my own spouse and even friends.
Philip Pape: 20:59
And for me, interestingly, ali it was a close friend who had dealt with anxiety and depression and things that I couldn't relate to all of a sudden started opening up to me as another guy and kind of encouraged me to do the same and I realized how valuable that was. And there are so many men that just from a very young age, the way they're raised and even seeing their fathers as examples and my father was very, very quiet, right so I didn't even know to express love until I got into relationships in my 20s. So I think that's really important and it's tough to talk about. It even makes me slightly uncomfortable. Now, right, it's just a thing, it's like an inherent thing. So when it comes to a spouse, for example, because a lot of our listeners are probably in their 40s, 50s, and so, just very simply, what is one thing someone can do? If today, after listening to this, they want to go open up to their spouse, like, how can they start that?
Ali Gilbert: 21:48
Like any difficult fun conversation. You don't do it when someone like first gets home from work or they're stressed, or if kids are running around. You know, set time aside and just be like I have something that I think is very important for us as a family that I would love to talk to you about. When can we do that? And then you know if it's entering a coaching program or going on TRT. You have to like explain the benefits of that, because it won't be news to anybody that the person's been feeling this way. Maybe their mood has sucked libido's down, productivity, like showing up as a father, all that stuff. So it's going to be like the elephant in the room.
Ali Gilbert: 22:31
But harnessing that and then addressing it and acknowledging it kind of helps that conversation flow and say like this is something I truly help or I truly think that can help me. This is going to allow me to kind of push off any scary things like diseases, stuff like that. This is why it's important for my health and kind of take the conversation from there Because, finances aside, like it's either paying for it now or paying for medical bills and other stuff that can come with ignoring your health, which a lot of guys will. They don't want to confront lab work, they don't want to know, they don't want to address it, they just internalize it. So once they see on paper like this needs to change, then that brings a whole other conversation with it that we can't ignore this. This is something that we have to address together and I'm not asking your permission for this. I'm asking for your support in doing this.
Philip Pape: 23:36
Yeah, and I imagine that can be a huge relief for some people to just get it off your chest. Whatever happens, it's wonderful to be able to say that. Okay, so let's go back into some nuts and bolts, ali, and talk about the TRT stuff again a little bit. And you mentioned estrogen management, estrogen blockers, things like that. What about that? Should guys be aware of that? I guess a lot of these providers maybe get wrong and you have to be aware of red flags, things like that. You know, as you're building this protocol.
Ali Gilbert: 24:03
Blocking estrogen became a thing from the bodybuilding world and we did like I always bring this up on our TRT panel at Silverback because it's such a hot topic. So men need estrogen, just like women need testosterone, and one of the biggest benefits of testosterone replacement in men is the conversion of testosterone to estrogen, because estrogen is cardioprotective, it is neuroprotective, it helps your libido, it helps your insulin sensitivity. A lot of good things come from that. When you block or suppress it to satisfy a lab marker, you're doing a huge detriment to a man's health, and I always use the analogy of women in menopause. They go through menopause and they lose estrogen. What happens? Belly fat, osteoporosis, insulin resistance, cardiovascular issues. So it's the same as when guys block and suppress it, and a lot of clinics don't understand this and they think, well, estrogen's bad, it's going to cause gyno, it's going to cause water retention, strokes, all this shit. It's not true and the doctors that I associate with have done tons of work researching this and the real science of how estrogen acts in men. And when you see estrogen high on a lab panel in a man who's on TRT, that's a good thing. So it also depends when he did his injection, like if he did his injection Monday and then gets labs drawn on Tuesday, everything's going to be high and then it slowly tapers until his next shot. Or if men are on once a week, yeah, you're going to see it really high at first and then it's going to slowly drop off. So there's a lot that goes into reading those labs.
Ali Gilbert: 25:54
But the lab marker of estrogen is not actually reflective of how much estrogen a man has, because it does not work as an endocrine hormone. It works as a paracrine hormone, so it's really just kind of like a fraction of what is in a man's body or in the tissue and all of that. So it's something that a lot of our providers just ignore. None of our clients are on estrogen blockers and they feel amazing. It's when guys are on estrogen blockers and they're like my joints hurt, my libido's not where I thought it should be, and so then these clinics are like, oh, maybe you need more testosterone, and then with more testosterone comes more conversion. So then, oh, we need more anastrozole. I'm like, oh, my God, not how it works. So that's a huge hot topic in the TRT space, because people think like, oh, I feel my nipples are sensitive, I need an astrozole and it's like no, that's a normal fluctuation of hormones you're experiencing. That goes away.
Philip Pape: 26:54
And just to be clear, this is measured through estradiol on the labs. Yeah, just so folks know, because I definitely have heard that story. Now, sometimes it's because their T goes like over a thousand and maybe they're on too high of a dose or something. But, like you said, it's not the downstream effect is not what we're worried about, it's the baseline protocol. We're worried about not trying to block the estrogen. What about aromatase inhibitors, ais? Right, like, where does that come into this discussion?
Ali Gilbert: 27:19
It's the same thing. So anastrozole, letrozole, aromacin yeah, those are all the estrogen blockers, because they all get prescribed and even, like what you mentioned, with T going over a thousand, like there are some physicians that are like, oh, we can't let it go that high and I'm like why is it bad? Because anything over a thousand is bad. I'm like why Then they have nothing to back it up. Some guys feel amazing in the two thousands, some guys feel awesome when they're like 1400. Like, yeah, it's okay, you know they freak out.
Philip Pape: 27:51
So what does a good protocol look like for most guys? I mean kind of the steps that you take them through.
Ali Gilbert: 27:56
They're on injections. It's two to three days a week, every other day pretty much it's, you know, monday, wednesday, friday. It's two to three days a week, every other day. Pretty much it's Monday, wednesday, friday. That's going to be a great protocol to start with and start there and do nothing else.
Philip Pape: 28:10
Okay, that's good, we like simple, because I know you have your testosterone school right. You still have that taking people through all of this and trying to simplify it. What from all of that? I mean, you've already addressed a lot of the, I guess, myths, we'll call them, but is there something else that people don't understand that.
Ali Gilbert: 28:27
You'd like them to understand that we don't talk about enough. Oh gosh, when do I start?
Philip Pape: 28:30
Open-ended question.
Ali Gilbert: 28:31
You know I'll go off what the comments that I got on Instagram because I get trolled incessantly. That's great, that's great.
Ali Gilbert: 28:36
By people who don't understand it. So there's many reels where I'm talking about this stuff or I'm saying, like you know, you can inject all the steroids and testosterone you want and sit on the couch and you're not going to turn into, like you know, a model or bodybuilder or whatever. And of course, people come at me with this one study that took 600 milligrams injected, which is not TRT dose of testosterone, and people showed to grow muscle without doing anything. Well, people don't know how to read studies. They don't know how studies work. So just because someone grows muscle, that does not mean they look like they've grown muscle. That does not cut body fat down and instantaneous. Oh my gosh, it's like it gets me so heated because it's so stupid. So then people are like well, I have friends that are on everything and they look amazing and they don't really train. I'm sure they don't look amazing and I'm sure you're lying.
Philip Pape: 29:27
I've never met a person like that in my life, yeah.
Ali Gilbert: 29:30
Oh my God, the guys that are like, yeah, trt is going to make me jacked. It's not like the purpose of TRT is to bring you to where you biologically should be. That is it. So when men think, oh, I'm going to look, you know, like whoever they want to look like and get a six pack, I'm like you do realize that even bodybuilders who are on grams of testosterone, they still go to the gym Like they still got to work and they still got to diet and they still got to, you know, do all the other stuff. It doesn't just mean you put a needle in your butt and then you look amazing.
Ali Gilbert: 30:03
So that is one thing that I'm not sure the internet will ever understand, because I did a reel on Jeff Bezos where I was like talking about how, like the new CEO, flex is having a six pack and taking care of yourself and having your health and all of that, and I showed his before and after, from when he was like a dweeb at Amazon to what he looks like now and immediately. A lot of these comments are like he's on TRT, he's on trend, he's on steroids, he's on growth hormone, he has time and money, and I'm like these are all excuses from weak minded individuals, insecure people, yeah yeah, like of all business owners, entrepreneurs I know, myself included I'm not like, oh, I've got like nine hours nothing to do. I think I'll just work out all day. It doesn't work like that, and if you're again on TRT or even growth hormone or whatever, does not mean you're going to look certain way. So that's one of the biggest misconceptions.
Ali Gilbert: 30:59
The other one that I wish people understand is that it can be very health promoting for men, like it can improve quality of life, improve their ability to resist cancers or other diseases and cardiovascular issues Like now. We've seen studies that show low testosterone put somebody at an increased risk of heart attack, stroke and all-cause mortality, increased risk of prostate cancer, increased risk of basically all types of things that people don't want to confront in their life. And a lot of people don't understand that because they've heard bad things. So then they just regurgitate whatever they've heard on the internet and that's not true.
Philip Pape: 31:44
So no, no, it's good, Like the fact that you take tea to get biologically normal, where you need to be, which makes sense. And given that humans live far longer than we did, you know long ago, we're getting to the point, men and women, where hormones drop and you're going to need that eventually, like you said. And the health promoting part I want to ask about that Is there, and this is very difficult with studies is there a causal link or is it correlational, because those who have higher testosterone have maybe better health promoting lifestyles? What's your thought on that?
Ali Gilbert: 32:10
It's causational. So the doctors that I associate with and I always say that because I'm not a medical professional, so this is not me like my opinion hey, these. So this is not me like my opinion hey, these guys have done the research and they know how to differentiate, because a lot of the prostate cancer studies are correlation not causation, so it's filtering out the ones that make no sense with the ones that actually do. And there's a lot of evolved literature showing this, but a lot of physicians don't read it because either hormones are not their specialty, they don't have time, whatever the case. But there is a lot of new literature out there showing the benefit of having optimal testosterone levels as a man, and what is optimal Generally.
Philip Pape: 32:54
I know it depends, but when someone hits symptom resolution.
Ali Gilbert: 32:58
But I would say, if they're 600 plus and that range has been lowered twice in the last few decades on men because they show up with lower and lower teeth. So most guys are told if they're three or 400, oh, you're fine, you're good, you're normal.
Philip Pape: 33:16
Right, then the average used to be, I don't know, eight or 900. And then it's come down to like 400 or something.
Ali Gilbert: 33:22
I don't know it used to start at 350 and go to 1100. And now it starts at like the lowest I've seen is like 186 or 189, which is like abysmal. Like you don't want people walking around with test levels that low, you know, and being told that they're okay. But this is mostly when they go to either a primary GP or somebody who just does not understand hormones and is tied to what insurance companies regulations have to be.
Philip Pape: 33:50
Yep, I totally get it All right. So you mentioned training, and this is probably a myth that we're going to debase. You hear people say okay, now I'm on TRT, what do I do differently with my training? Right, my answer would be nothing like train optimally for yourself, no matter what. I'm sure that's what you're going to say, right, like people want to know, no matter who you are, you need to train guys.
Ali Gilbert: 34:10
Yeah, it happens like all the time, like in Facebook groups and you know, on my Q and A and Instagram. It's like you know, best diet for TRT, best training for TRT? I'm like there is none and you guys make me think like I should make one up because that would sell really well, it would sell. Unfortunately, I have integrity and I refuse to do that.
Philip Pape: 34:31
Oh my God, or you can just be silly about it. When they opened the document, it said just like any other training program or something Right.
Ali Gilbert: 34:38
They'll be like fuck, I paid $5 for this.
Philip Pape: 34:40
Yeah, I know a coach that had something like that. It was like the best foods for this, that. And then you open the document and it said like whatever works for you. It was just funny, Okay. So how often should people be checking their blood work At what age? Should they set a baseline as young as they can in their 20s and then go from there? What are your thoughts on that?
Ali Gilbert: 34:58
Yeah, I think everyone should get it done, you know, starting in their 20s, and most of our clients get blood work twice a year, maybe more often. If they do go on testosterone, the provider will usually ask for labs at three months, but everyone's different. But, honestly, twice a year is a good cadence in which to get labs done.
Allan: 35:20
That's what I do personally cadence in which to get labs done. That's what I do personally. Hi, my name is Alan and I just want to give a shout out to Philip Pape of Wits and Weights for being a huge part of the foundation for my continued health and well-being. Philip exemplifies a nutrition coach who demonstrates how much he cares. Philip works tirelessly and with dedication to provide coaching, support and major content for us to use. He creates a practical approach from research and Philip empowers all of us to use food as quality for our health. He is skilled in how to assess and direct nutrition. Philip creates a community full of wisdom, support and camaraderie. In summary, philip Pape is the real deal. He knows how to assess and direct nutrition and he continues to steer me in the right direction. Thank you, philip.
Philip Pape: 36:14
Just like training, nutrition, everything else lifestyle-related guys need to be aware of that changes. Not that you have to do differently, but like it opens up avenues you had maybe closed off because of your symptoms and now you know what I'm saying. Like it kind of opens up new doors in your life when you're on TRT.
Ali Gilbert: 36:33
Yeah, a lot of guys. They start to notice their confidence increases and they're quicker to make decisions, whereas before they might've been more passive or slower in executing stuff. So a lot of them are like, oh my gosh, I like was able to say yes or no or, you know, decide something quite quickly. And it becomes this like the aura changes on Zoom to like they look more confident, they act like it, they can sleep better too. Like they look more confident, they act like it, they can sleep better.
Ali Gilbert: 37:05
And when you sleep better, it solves a lot of problems where you can train harder, you can eat more, you can do a lot of things that maybe you couldn't do before. So it kind of just gives them their life back in a sense, where now they're actually able to be a man. And that can be like associated with negative things, and I don't think it is at all, because somebody who had trouble making decisions or standing up for themselves or taking the lead, who can now do that, is a really good thing, especially if they own a business or they're in a high stress job. The last thing you want to do when you're in a high pressure, high stress environment is to waver on decisions that need to be made quickly. So those are things that guys will comment on.
Philip Pape: 37:48
Yeah, I think that's awesome and I agree there's no. You know, if you were going to use the word toxic, which I can't stand anymore when it comes to this stuff. I used to be a super shy introvert and I didn't go on T to get past it myself, I went to public speaking courses and now I do a podcast and stuff like that, but it helps you help more people, it helps you speak up, like you said, it helps you make an impact, the fact that you can be more confident and, as a man, I think that is something a lot of men are missing. And when you hear surveys of how the world has been changing and we're not going to get into politics or anything but a lot of men feel like they don't have that sense of being a man and being a provider and being a protector. And you could do it in a way that's still completely in line with the other values that we value in society.
Philip Pape: 38:32
Anyway, that's just my little side thing, because I totally agree that men need that. Can you tell, talking to somebody, that they need help? Do you have that voodoo empathy? Oh yeah, it's easy. It's easy, okay. Okay, tell me more about that.
Ali Gilbert: 38:48
You know there's a lot of men that they're just very unsure of a lot of things. And this is different than being skeptical of the need for TRT, because absolutely somebody should question something that's a lifelong commitment. But it's more of like. You know, they can't just like go, they have to like, they hold themselves back, they go back and forth. You know they're very passive. Where it's like, there's people I can bulldoze and go at them because they don't have the confidence to be able to like stand up. It's hard to articulate and I don't do that purposely because you know, oh, this guy's weak minded, I'm going to fucking lay the hammer like. That's now how I am.
Ali Gilbert: 39:31
It's more you have to approach some guys more of like a softer, coddling approach, where some guys you can be harder and more direct, because a lot of men who have low testosterone have high anxiety and sometimes that high anxiety stays when they go on, testosterone goes away or it can be amplified.
Ali Gilbert: 39:51
So just because someone has anxiety doesn't mean they have low T, but quite often there are guys who have very low T, high anxiety, and they question everything. So instead of questioning everything, which a lot of women do like, a lot of women are like but what if this happens and if this and then that and then that? And I'm like stop, like guys will do the same thing. So I have to spend a little extra time helping them understand their decisions, talking them through the best pathway for them, stuff like that. And then physically, like you can see certain character traits that they have like more of a feminine look and I don't know, like soft skin, like because like when a guy does go into saucer like he's, his jawline changes his whole, like demeanor, even over zoom, like it's like damn, you got confidence, now All right, and just their ability to communicate becomes a lot better. It's hard to say, but I can usually just I think that's cool.
Philip Pape: 40:50
I mean it came to mind because I mean, you're kind of unique in the space, right, allie? You know this. You're unique being a woman doing this and the way you speak about it. I mean, I'm not sure if there's got to be a few others out there, but this is more of your story and I'm sure you get this question all the time. But, like, what drew you to helping men specifically?
Ali Gilbert: 41:08
I always joke it's because I have daddy issues and really want to save the men, but people don't get it. So then I'm like that doesn't make sense. But I did have a compromised relationship with my father growing up, which does contribute to needing some sort of validating in with men. How can I help them? And it really turned into I want them to end up not like him, I want them to live their best life. But the real story was basically when I graduated with the exercise science degree, I was like I want to train athletes, like we all do, and then you realize they're all broke and that's not going to really do well.
Ali Gilbert: 41:50
And you know, I grew up in Greenwich, connecticut, where it's not cheapest place to live. So I worked at a commercial gym and I was training people. I got a lot of guys who played golf and I was like, well, I don't know anything about golf, I played soccer in college. Golf is a sport and these guys are actually willing to work hard, focus type A and they could afford to train. So I was like I'm going to go all in on golf fitness, which I did, and I was the golf fitness person for years, like the go-to golf fitness person, golf digest, top 50, like all that stuff. But it brought me all men as a clientele and a lot of the conversations would go into nutrition and energy and hormones and all that and I was like no one's talking about this with these guys. So I kind of just ran with it because I enjoyed working with the guys better, simply because I related easier, because I was an athlete and you know very much like very chill, like I don't fit in in my hometown. I was not about like designer clothing and all that stuff. I just was like get to work, let's do it. So that's kind of how I landed in men's health and then just went to medical conferences, built relationships with doctors, shadowed them, learned everything I could, and then I ended up speaking at medical conferences and then kept working on those relationships to get blood work for clients, because I knew that that was kind of the missing piece of what I could do legally.
Ali Gilbert: 43:23
And now here we are where I realized there's no events that cover this stuff. So I created my own event and I have my own network of physicians and working with Merrick has been a game changer for a value add in our business and so now everyone's on the same page, because there's always this huge divide between medical and fitness and it would create conflict because a lot of men would piecemeal their health together, like they would get nutrition info from here. They would do this training program and then talk to this doctor. But this doctor is completely the opposite of what they read or what they talk to their coach about. So on paper I'm like just some fitness professional who's going to listen to me. You know, if you go back to tell your doctor, like you know, my trainer says that you know, aromatase inhibitors are bad and I should be on more than one injection a week, he's going to be like who's this chick, you know?
Ali Gilbert: 44:18
So now it's a lot different where the doctors call me and they seek me out because they see the ability to collaborate makes everybody better and everyone wins, because it's not a competition. It's more like hey, this is your lane. I can't legally prescribe medications. I can handle all the lifestyle stuff that many doctors will try to give advice on, but it either falls on deaf ears or it's not customized enough to where somebody can follow it. Let's come together so that we can produce the best experience for somebody, so that they get what they need. But then everyone talks. So I'll sit in on sessions with our clients, with their provider, so that, hey, we got this under control and he's eating this way. So that might reflect in the labs, but it's not going to be for a while. But oh, I know that he's dealing with some blood sugar issues. We've got him doing this, like all of that, so that cool, their job's easier, our job's easier and everyone wins.
Philip Pape: 45:18
That's a great way to do it, because a lot of people they have to be the center of all of that right. The client or the patient has to kind of pull and go and push and, like you mentioned multiple times, gps tend to be a little bit clueless on this. Most of them are not all. I've met a few good ones who actually want to listen and they also maybe lift weights, which is rare, but sometimes you see that. And the other thing I noticed is just even talking to you here and this is why I wanted you on is there is something about a man talking to another professional, and this is my opinion. It's just there's certain walls that are there and I feel like maybe when they talk to you, they're like all right, this is a totally different experience. You're a woman I could just open up for whatever reason. It feels like you're more you know.
Ali Gilbert: 46:00
I don't know if you get that yeah, I get that a lot, because I used to get like do guys even open up to you as a woman? Like isn't that embarrassing? And then I think, because I normalize this, I talk about it so much, something about me makes people just like tell me their whole life story, so I don't know too much right, too much of their life story, like if maybe that's astrological or you know, I'm a good listener, I don't know.
Ali Gilbert: 46:25
But at least I'm able to disarm that wall and then really get the truth. Because there is like sometimes guys will tell me something but not tell one of my coaches something, and then I'm like okay, this is not like HIPAA, but I have to go back to the client and be like, hey, you know.
Philip Pape: 46:43
Is it okay if I share this with them?
Ali Gilbert: 46:45
Yeah, so it does allow them to open up. Plus, I think it's a little bit of a pride thing, Like if a guy is sitting in front of another jacked dude he's not going to be like I can't get it up, and you know, yeah, good point.
Philip Pape: 46:57
It's competitive, like in our nature to be competitive and, like you know, you're like the primates, you know, fighting in the Savannah, kind of thing. Yeah, yeah, that's cool. Um, it's interesting, yeah, because they're like I'm obviously a man and I have. Most of my clients are actually like women, two thirds of them and I remember early on in my coaching days being kind of insecure not confident necessarily that we even want to open up, but I find it can work both ways and it can work men to men, women to women, Like it just depends on the individual right. It's not that one is better than the other, but I think you do a great job in your space with this. So, having said all that, I know there's so much about testosterone we could have gotten into. Folks should check out all of your content. Is there something you wish I would have asked, given where this conversation went and what would be your answer?
Ali Gilbert: 47:41
I mean, I don't know, I'm a very twisted individual so the direction of conversations can go multiple ways. So I don't know, that's a very odd question for me to answer because, like, I think we did cover a lot. So, yeah, I can't answer that. I'm sorry. I wish I had a more entertaining response, but I don't. No, that's a tough one.
Philip Pape: 48:00
It holds people up and I know, if I get asked that I probably am like deer in headlights myself. It's all good. It's all good, all right, cool. So where do you want?
Ali Gilbert: 48:12
people to find you, Because this is this been a great conversation on people to reach out. Everything I do is on Instagram. So on Instagram at the Allie Gilbert, a live slide in the DMS and you know just my entire page is all videos on coaching, TRT, all that stuff.
Philip Pape: 48:27
So for sure, check out at the Allie Gilbert super responsive. She was responsive and coming on to this show and I hope everybody learned a lot from this conversation. It was awesome chatting with you today, Allie, Thank you for having me.
