3 Key Takeaways from our Longevity Docs Mastermind.

Your weekly sneak peek into the world of Longevity Docs.

May 12, 2024

Hi Longevity Docs!

Two weeks ago, 100 physicians from Sweden, the UK, Canada, Thailand, Mexico, Colombia, Australia, and 17 US states gathered in New York for our inaugural Longevity Docs Mastermind. Thirty speakers discussed biomarkers of aging, disease prevention, hormonal health, building longevity clinics, patient-doctor relationships, and cutting-edge therapies and technologies. Here are my 3 key takeaways:

1. Longevity Medicine is just Good Medicine

Most doctors aim to provide the best care possible, detect diseases before they appear, reduce suffering through innovation, and optimize their patients' lives even if they are not sick. However, this model faces challenges: it is not covered by insurance, not yet adopted by health systems, and lacks funded clinical trials. Despite these hurdles, practicing longevity medicine is about improving the quality and length of life. Longevity medicine is simply good medicine.

2. Data-powered individualized care is the future

More physicians, clinics, and health systems are showing interest in longevity. True democratization of the field will come with strong evidence and data. Multi-omics data combined with AI and quantum computing will revolutionize medicine. Each individual will become their own clinical trial and part of a decentralized science research program. The future will be N-of-1 research.

3. Community is foundation of longevity

I was amazed by the positive energy, generosity, and passion of our members. Everyone was eager to learn and collaborate, support each other, and grow together. This sense of community is often missing in modern medical practice and society at large. Community is the most precious asset of humanity and longevity and we need to preserve it.

As medicine becomes more personalized, physicians have the opportunity to leverage their collective intelligence to practice good medicine and reverse the impact of unhealthy aging for everyone.

Stay Young!

David

PS: You can feel the good energy on this recap video 👇

Longevity Docs Mastermind - NYC, October 5-6, 2024

Based on our survey and the high demand for several masterminds a year from doctors, we are announcing: Longevity Docs Mastermind - NYC, October 5-6, 2024. This event will feature more in-depth sessions, more networking opportunities, and more days. See you in NYC!

Book Early-Bird Ticket

💬 Buzz in the Chat

Debating Testosterone Therapy

A question for the esteemed group: what are thoughts on testosterone supplementation? It has had some bad press recently with the: In a 14 to three vote, most of the FDA advisory committee agreed that, although the benefits of the patch appeared to be small, they could be described as “clinically meaningful.” But the committee then voted unanimously to recommend against approving the drug because of the lack of data about its long term safety. Does anyone use it for patients and any issues?
Wholeheartedly believe optimizing testosterone is paramount for all men. Patches don’t get levels remotely close to where they need to be, so not surprising if they showed no benefit. The benefits of T optimization massively outweigh the risks when done correctly.
I like to do IM or SQ, and yes twice or three times a week, depending on tolerance and clinical response. Remember though that micronutrients and diet play a huge role in response to effect of hormones. I like to make sure they get creatine, Zinc, Etc. Does anyone else have a good micronutrient Eval? I had used spectra cell/vibrant for a while and also use the big labs when they want to use insurance
Concentration for commercial patch are next to nothing. So no surprise that they only see marginal benefits.
I'm actually quite concerned about. On the one hand, I recognize the importance of optimizing hormones in both male and female patients. On the other hand, I think many doctors are too quick to pull out the injections. Does anybody have a really solid protocol on helping restart natural production of testosterone in men? My understanding is once you start a guy on injectable testosterone, you've committed him for life because you've essentially shut off his own production and some guys never recover their own function
Correcting T Improves CV health and has absolutely zero causative effect on prostate ca.
+1 to the importance of physiological testosterone support in men. I am actually surprised by the reticence of many practitioners to offer this given the strong evidence base and even stronger anecdotal experience among many clinicians for decades.
What else can be supplemented with clomiphene/enclomiphene/HCG To maximize the impact? My understanding is that some of it has to do with CNS inflammation, which could potentially be mitigated with LDN. Anything else that has been effective?
Yes! I think most doctors understand that testosterone doesn't increase prostate cancer risk (saturation model, etc) but many still think that TRT increases the risk of CV disease events. This is because of two, awful, retrospective studies from 2013/14 that did for testosterone what the WHI did for Estrogen. TRT is one of the very best things for CV health. 🎉
100%. I think what a lot of people also miss is what hormone optimization enables you to do. I think we have all seen light switches go off for so many patients once T support is on board- and they subsequently become super motivated and disciplined about exercise, diet and self regulation. It’s such a big unlock that has so many other positive downstream effects outside of the therapy itself.
I use TRT as a last resort for my patients. Literally ANY male when motivated can naturally uptick testosterone. Just takes a bit of effort, nutrition and supplementation.
I disagree. Not all males can increase testosterone to an optimal level, although many can that seek testosterone therapy.
100% agree with this. With our marketing and segmentation we attracted a lot in the 30s crowds and we saw so many young men and women who were otherwise doing EVERYTHING right- eating super clean, doing resistance training 3-4x, sleeping well, and yet had Ts at a very low level. I’m pretty convinced environmental endocrine disruptors are playing a much bigger role than we could have imagined. Even some pro athletes, which was especially surprising…
In my experience with Nof1, there are multiple profiles that define male gonadal function. For example, early heart disease in parents and grandparents — multiple MIs and strokes starting in the 30s-40s — are associated with less than optimal carb metabolism, lipid profiles, and hormonal levels— and a 30 yr can present as 50 yr in the data—-optimizing lifestyle and habits (like sleep) does not necessarily relate to optimizing hormones - such as testosterone, glucose and/or lipids— that's why we do what we do! 😊
Correcting T improves CV health abnd has absolutely zero causative effect on prostate cancer.
I agree with T having no negative CV effects and no increase in prostate cancer risk with one caveat. You must follow DHT levels. I tell pts T has two pop off valves. When T gets a bit too high with HRT, T can get converted to Estrogen through aromatase or DHT through 5 alpha reductase. If it goes to DHT and DHT levels rise, the high DHT can increase risk of prostate cancer. I tell all my patients this and that we must monitor DHT and Estrogen levels every 6 months. To me, not measuring Estrogen and DHT in men receiving TRT is malpractice.
Remembering back 40+ years when one of my Columbia cardio professors was publishing papers on increased risk of heart disease with too-low T.
Gann et al. (1996) conducted a case-control study and found that men with higher levels of DHT were at an increased risk of developing prostate cancer. The study concluded that DHT levels may be a predictor of prostate cancer risk. Rittmaster et al. (2008) performed a study investigating the association between DHT levels and prostate cancer risk in a cohort of men. The study found that higher levels of DHT were associated with an increased risk of high-grade prostate cancer. Vaughan et al. (2016) conducted a meta-analysis of prospective cohort studies and found a positive association between circulating DHT levels and the risk of developing prostate cancer. The analysis suggested that higher levels of DHT may be a risk factor for prostate cancer.
I agree those should be monitored, but as far as I’m aware DHT doesn’t increase cancer risk. It can cause BPH.
And there have been many more studies published regularly corroborating low T-heart disease link since
In this study that you quoted, they actually found that a higher DHT was associated with LOWER prostate cancer risk. And, even if higher baseline DHT was associated with more cancer, we can't say that it's the cause of cancer. For example, in women we know that higher estrogen levels in menopause are associated with increased risk of breast cancer. But, that's because women who are overweight have higher serum estrogen and it's the being overweight that increases breast cancer risk (not estrogen).
That has always been my understanding. I believe control arm of the REDUCE trial on finasteride showed the same thing, I’ll have to go back and look.
Finally, we have prospective studies, including the recent TRAVERSE, that backup the "Saturation Model" of DHT on the prostate gland. Yes, if starting from zero DHT, giving DHT (by way of TRT) can activate prostate cancer cell growth. But, if total testosterone is more than about 230, adding additional Testosterone (and DHT) doesn't further activate cell growth.
That's why strength training, especially squats, deadlifts and other compound heavy weight movements are the best longevity drugs😁

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Single dose creatine improves cognitive performance and induces changes in cerebral high energy phosphates during sleep deprivation

The inverse effects of creatine supplementation and sleep deprivation on high energy phosphates, neural creatine, and cognitive performances suggest that creatine is a suitable candidate for reducing the negative effects of sleep deprivation.

Nature - Recommended by Dr. Sohaib Imtiaz

Effective management of atherosclerosis progress and hyperlipidemia with nattokinase: A clinical study with 1,062 participants

We evaluate the accuracy of 15 popular cardiopulmonary exercise testing CPET systems to assess respiratory variables, substrate use, and energy expenditure during simulated exercise.

Frontiers in Cardiovascular Medicine - Recommended by Dr. Woodson Merrel

A 2-yr Randomized Controlled Trial on Creatine Supplementation during Exercise for Postmenopausal Bone Health

Two years of creatine supplementation and exercise in postmenopausal women had no effect on BMD; yet, it improved some bone geometric properties at the proximal femur.

Med Sci Sports Exerc. - Recommended by Dr. Tommy Wood

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🗓️ Events & conferences

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Founders Longevity Forum: London - June 10-11, 2024
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