Skip to content
The Diary of a CEOThe Diary of a CEO

Dr. Alex Tatem: Why peptide regulation built a gray market

How short amino-acid sequences unlock targeted cell receptors. Why 2023 rules pushed peptide access into a gray market shaping GLP-1 obesity care.

Dr. Alex TatemguestSteven Bartletthost
Apr 20, 20261h 29mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 3:35

    Intro

    1. AT

      This may be the most controversial thing we have on this table. This is a peptide that absolutely torches belly fat at a disproportionate rate. And what we found is not only do patients lose an incredible amount of weight, but they also get the best improvements we've ever seen in their liver health. It's absolutely wild, and I think this is going to be a trillion-dollar drug when it comes out.

    2. SB

      And I've brought you here because you're an expert on this subject matter, and it's worth saying that there was some significant news about this.

    3. AT

      Correct. From the FDA saying that in July they are going to consider legalizing seven peptides, and by pharma's estimate, it might be the most dangerous thing to their entire business model.

    4. SB

      So do you think it is plausible that Big Pharma didn't want these in the hands of regular people because they can't patent this and it's powerful?

    5. AT

      One hundred and ten percent. Because the question isn't what can peptides do? It's what can't they do?

    6. SB

      And we've got several peptides here in front of us, and I want to go through all of them.

    7. AT

      Let's do it. So this is probably the most well-known peptide for skin complexion, and it improves quality of hair and nails. And then epithalon is maybe, maybe not going to be the fountain of youth, but I'm very skeptical as far as that goes. Next, we've got this, and if you injected that at night, it would improve your quality of your sleep. Next, melanotan two, and this will actually end up giving you a deep tan in response to just a little bit of UV sun exposure. It'll also give you some of the most impressive erections you've ever had in your life. So be warned.

    8. SB

      And what else have we got?

    9. AT

      Oh my gosh. There's methylene blue, where people take it, and they think it's gonna make them live forever. Don't take this. It literally will stain your nails blue and your hair blue. These two here stimulates building muscle. This one can aid with healing after an injury. And then there's this, this, this, this.

    10. SB

      It's crazy.

    11. AT

      It's wild.

    12. SB

      So why don't I take it?

    13. AT

      Well, we need to talk about that because there are trade-offs.

    14. SB

      But also outside of the world of peptides for a second, I've got these three vials. Do you know what those are?

    15. AT

      Yeah. This is unfortunately our future if we're not careful.

    16. SB

      Explain.

    17. AT

      So what we've got here is representing the fertility trajectory for young men, and I'm so scared.

    18. SB

      This is super interesting to me. My team give me this report to show me how many of you that watch this show subscribe, and some of you have told us, according to this, that you are unsubscribed from the channel randomly. So favor to ask all of you, please could you check right now if you've hit the subscribe button, if you are a regular viewer of the show and you like what we do here. We're approaching quite a significant landmark on this show in terms of a subscriber number. So if there was one simple free thing that you could do to help us, my team, everyone here, to keep this show free, to keep it improving year over year and week over week, it is just to hit that subscribe button and to double-check if you've hit it. Only thing I'll ever ask of you. Do we have a deal? If you do it, I'll tell you what I'll do. I'll make sure every single week, every single month, we fight harder and harder and harder and harder to bring you the guests and conversations that you want to hear. I've stayed true to that promise since the very beginning of The Diary of a CEO, and I will not let you down. Please help us. Really appreciate it. Let's get on with the show. [upbeat music] Dr. Alex Tatem, there's this word that has exploded in society in recent times. In fact, when I look at the data, people searching this word has increased by four hundred percent just recently, and that word is peptides. I have no idea what peptides are. I'm someone that wants to be healthy, that wants to optimize my health, wants to live long, doesn't, doesn't love aging.

    19. AT

      Yeah.

    20. SB

      And I'm told that this word peptides is somewhat linked to it. So I've brought you here because you're an expert on the subject matter. I've watched your videos on YouTube. To start at the very beginning, Dr. Alex-

    21. AT

      Sure.

    22. SB

      What the hell is a peptide?

  2. 3:35 – 5:34

    What Exactly Is A Peptide

    1. AT

      Peptides are a structural class of medications. The best way to think about peptides is that just like we have small molecules, which are drugs that are very small, taken in a pill, and have a wide-ranging effect throughout the body, peptides are derived from little pieces of amino acids, which think of them as the Legos that make up the human body, the Legos that make up proteins. These are fragments of proteins that are designed to specifically target certain receptors and affect cells in a very targeted fashion. Or a best way to think about it is a very specific targeted key to unlock a very specific lock. So instead of a small molecule that may have a wide-ranging effect throughout the body, peptides are much, much more focused.

    2. SB

      So you've got different types of Lego cubes here. Would they be different types of peptides, or are they different types of-

    3. AT

      Amino acids

    4. SB

      ... amino acids that come together to make a peptide?

    5. AT

      The best way to think about it is my son loves Legos, which is why I'm glad we have these here. But he can take the same set of Legos, and he can build a rocket ship.

    6. SB

      Mm-hmm.

    7. AT

      And then just a few minutes later, he can build a pirate ship, and then he builds a race car, and he's using the same Legos, but he's creating very, very different things that all do very, very different things.

    8. SB

      Ah.

    9. AT

      And so peptides have become incredibly popular because, yes, we have some really fascinating peptides that can help with anti-aging, with healing, and with tissue repair. We're gonna talk about some of those hopefully. But they can do so much more than that. The first peptide that was actually isolated and used in medicine was insulin back in nineteen twenty-one, and then all the way in nineteen eighty-five in the world of urology, which is where I was trained, we had leuprolide, which is a different peptide that, again, also a peptide like insulin, but instead of having wide-ranging metabolic effects, it had an endocrine effect. It was designed to shut down the production of testosterone for prostate cancer patients that needed to have their testosterone taken away.

  3. 5:34 – 8:54

    How Peptides Actually Work In Your Body

    1. SB

      Interesting. Okay, so insulin's a peptide.

    2. AT

      Insulin's a peptide.

    3. SB

      Because it's a series of amino acids.

    4. AT

      Amino acids that are put together.

    5. SB

      Okay, so you said that the combination of amino acids forms a key.

    6. AT

      Correct.

    7. SB

      So what is the lock?

    8. AT

      The lock could be a cellular receptor. It could actually be regulating a certain pathway within the cell.

    9. SB

      Okay, so let me repeat this back to you to make sure I understand it. So-

    10. AT

      Yes

    11. SB

      ... peptides are like a key-

    12. AT

      Yes

    13. SB

      ... which you can make by configuring amino acids in a certain way, and there's different locks in our bodyThat these keys can go into. So if I take, you know, we've got some peptides on the-

    14. AT

      Right

    15. SB

      ... table in front of us here.

    16. AT

      Yeah. So a, a good way to think about it is this. If you've got a hammer, right, which is what a lot of small molecules are, like, you can do a lot with that, right? Like, you could hammer in a nail. But if you try to use that hammer when you're trying to put in a screw or you're trying to put together, you know, a, a table that you got from Ikea, it, it may not always end the way that you want to.

    17. SB

      Mm-hmm.

    18. AT

      And that's the problem that we have with a lot of small molecules. It's not that they don't do what we want them to, they do a lot of other things while they're at that job that can have significant negative side effects, which is why a lot of these small molecules actually don't make it all the way through the FDA approval process because we find something, it does what we want to do, but has significant safety concerns down the line.

    19. SB

      Mm-hmm.

    20. AT

      All right? Now, what we see with peptides, for example, I've got in my hand right now a little vial labeled, you know, BPC 157. This is probably one of the most popular peptides that we're talking about right now because BPC 157 is a synthetic version of a naturally found peptide in the gut. But what this actually does is it enhances blood vessel growth in areas of injury. And it kind of makes sense because if you think about it, our gut, our stomach, is really just this bag of acid [chuckles] that sits inside of our abdomen, and yet somehow you and I are here talking to each other and our bodies aren't eating themselves. Well, how does that work? Well, it's because we've developed a lot of really robust systems to encourage healing of the gastric lining. And so the idea is that, well, if this is one of the compounds that can help do that, and it's been proven in multiple animal models. For example, they have completely transected the Achilles tendon in rats. And then they-

    21. SB

      Transected?

    22. AT

      Transected, so they've cut across the Achilles tendon. So not just a small injury that you or I might experience in the gym where we pull it or strain it, but actually surgically cut the, uh, Achilles tendon, and then they administer it to rats, and they are healing spontaneously with administration of BPC 157. If you have an Achilles tendon injury and you're a rat, BPC 157 is one of the best things that you can ever have. Now, that is not a one-to-one translation to what we might see in humans, but as we talked about earlier with our point on safety, when they are studying BPC 157, we try to look for something called the LD1 or the LD50. How much can I give this to someone until 50% of the population that receives that dose doesn't do well or dies, okay? That's called the LD50 dose. We have yet to figure out what the LD1 dose is for this, which is the amount that it would take to hurt even 1% of the population because it is so incredibly well-tolerated. So just giving you an example of this is a compound that can have profound healing effects, at least in our

  4. 8:54 – 11:29

    Why Peptides Are Suddenly Everywhere

    1. AT

      animal models that we've seen so far. But so far, we haven't seen any precipitous negative effects in human patients when taking this, okay? But we need more data.

    2. SB

      I am mind blown, and I'm very, very excited. We've got all of the s-several peptides here in front of us. I want to go through all of that and understand which ones do which things.

    3. AT

      Sure.

    4. SB

      But there's a bigger question here-

    5. AT

      Yes

    6. SB

      ... which is why now?

    7. AT

      Mm-hmm.

    8. SB

      Why have the subject of peptides suddenly exploded into society's, uh, consciousness? What's going on? What's the big picture?

    9. AT

      So this is really interesting. In 2013, there was actually a court case in the United States. It was the s- It was called Myriad Genetics case. This was the company that actually patented the BRCA1 and BRCA2 genes. They discovered the genes that cause breast cancer. All right? This was mind-blowing. They identified the specific genes that would predispose patients to developing both breast, ovarian, and since we've learned, also prostate cancer. It was a fantastic discovery, but they patented it, and they said, "We now own this intellectual property." And then everyone else said, "No, no, no, that's, that's the human body. You can't patent that." And the Supreme Court actually sided with that argument, saying that if something is natural, it's found within us, okay, I can't patent, you know, your muscle cells, right? Which is a wonderful thing, but the unintentioned, unintentional byproduct of that is all of a sudden-

    10. SB

      Mm

    11. AT

      ... pharma had no incentive whatsoever to pursue really promising compounds that they could not monetize. So that happens in 2013. At the same time, I believe it was around 2012, 2013, there was a terrible event that happened in New England where there was a compounding pharmacy that was not doing the right thing, and they ended up having a bunch of contaminated specimens that caused a fungal meningitis. A bunch of patients got really sick. It was a huge scandal. And all of a sudden, the FDA s-stepped in and said, "Hey, historically, all right, states have been allowed to regulate compounding pharmacies themselves, but we need some federal oversight here because this is not acceptable." Completely agree with that. And they introduced a new set of regulations on top of compounding pharmacies, basically saying what you can and cannot make. And what they eventually said is, "Well, the only-- you can only make three things. You can make things that are in the USP, uh, United States Pharmacopeia, okay? Things that have been, you know, well-described, already published, things that are already in drugs that are already on the market, or three, things that are on a very specific list that we're gonna give you." Okay? And in that list, they actually included a lot of these very promising compounds that were stuck in drug development, you know,

  5. 11:29 – 17:36

    The Real Role Of Compounding Pharmacies

    1. AT

      limbo.

    2. SB

      And you say compounding pharmacies.

    3. AT

      Yeah.

    4. SB

      You said that a few times. What is a compounding pharmacy? Just, just so I'm clear on the definition.

    5. AT

      Back in the 1800s or, you know, early 1900s, if you ever needed a medication, you'd go see the pharmacist who had a shop down the road, and he would actually make your medication in front of you, and he would do that custom for every single patient that came by.

    6. SB

      Mm-hmm.

    7. AT

      All right? And it was only since the advent of modern factories that we had the modern pharmaceutical industry come about. But the truth is, is that, again, you know, that's kind of paint by numbers. You're creating this one pill, and, you know, uh, it always seemed kind of crazy that the adult dose is s- one standardized dose for all adults.

    8. SB

      Yeah.

    9. AT

      Like, if you look at what your body composition is versus some of my patients, why is the dose in your blood pressure medicine the exact same? Like, that doesn't seem to be quite right, but it is what it is. So when patients fall outside of that and they need custom medication, we still have-Have those people who make custom formulations of medications, but instead of it being just your local pharmacist who's using a mortar and pestle and, you know, is creating something in his back office, these are now large, sophisticated industrial operations that can make custom formulations for patients. All right?

    10. SB

      I think, I think the important context-

    11. AT

      Yeah

    12. SB

      ... for people that don't understand how drug development occurs is that to get chemicals like the ones we have in front of us on the table through FDA approval, you've got to spend millions and millions and millions of dollars.

    13. AT

      Tens if not hundreds of millions of dollars.

    14. SB

      Sometimes hundreds of millions of dollars.

    15. AT

      Yeah. An incredible amount of money. And-

    16. SB

      And if you know you can't protect it, once you've spent a hundred million dollars, you have no incentive to just do charity work.

    17. AT

      Absolutely not, okay? Because you have shareholders, and you have to make payroll. And so because drug development is so expensive, there is no incentive for commercial pharmaceutical companies to pursue the development of these compounds. And then on the other side of that, while we have compounding pharmacies that, you know, for them it makes sense. What if we could just make these compounds and then sell them directly to patients? We make a small margin when we sell it. This makes sense for us. Well, they could do that starting in about 2014, whenever that legislation finished. All right?

    18. SB

      What did it do?

    19. AT

      Essentially, what it did is it gave a, it gave a assignment to each one of these compounds. It was either gonna be category one, which is you, uh, can compound this. This is on our specific list of approved compoundable drug ingredients. Number two was, "Hey, we see some negative safety signals here. You cannot make this." Okay? Something goes in category two, it's forbidden. And then we have category three, which is, "We just need more information." And all of these original compounds, these peptides that we're so interested in now, were originally on that first list, category one. All right? And so they were able to be compounded. We could prescribe them to patients. I prescribed them to patients, all right, from 2014 onward. But then in 2023, the FDA at that time switched all of those peptides, 19 of them that were popular, to category two, and then they were banned. Overnight, we got notifications in our email inboxes from our compounding pharmacy partners saying, "Hey, we can't make this anymore. We're sorry."

    20. SB

      So I've got two questions then.

    21. AT

      Yes.

    22. SB

      Um, the first is, when you were prescribing these peptides to your patient-

    23. AT

      Yes

    24. SB

      ... were you seeing incredible results?

    25. AT

      Very much so. Very mu- Now, again, you have to use the right key for the right lock, okay? But I think a, a really good example. All right. So there is a compound that is not technically a peptide, it is a small molecule, but it was lumped in with all of these and was the victim to the same process, uh, something called MK- 六 百 七 十 七 , also known as ibutamoren. So this is a small molecule, but when a patient takes it, it's orally available, it binds to this receptor called ghrelin, and it actually stimulates the release of significant growth hormone. But what was really interesting is that it would actually stimulate hunger a profound amount, and all of a sudden, patients that were struggling with cachexia, okay, so being very, very thin, very malnourished, maybe they're going through cancer treatment-

    26. SB

      Ghrelin's the thing that makes us feel hungry, right?

    27. AT

      Absolutely.

    28. SB

      Yeah.

    29. AT

      Yeah. So they were able to stimulate the hunger response, and patients were actually able to eat more to meet caloric goals. And so this was a medication that was fantastically effective at that. Again, it had gone through some clinical trials, but was never taken all the way to commercial. And so it was never gonna be available from CVS or Walgreens, but you could get it from a compounding pharmacy. And so that was one that made a big difference for us. We also had other peptides. So, uh, GHRP-two and GHRP-six were some of the ones we were using at that time. Uh, those are growth hormone releasing peptides that stimulate the release of your body's natural growth hormone, which can help with tissue repair, can also help with fat loss and with building muscle. We also had BPC-one five seven, and we had, uh, derivatives like Thymosin Beta-4. These are also compounds that can help stimulate angiogenesis, so making new blood vessels, all right-

    30. SB

      Mm-hmm

  6. 17:36 – 20:42

    Are Pharma Companies Prioritizing Profits Over Patients?

    1. AT

      RFK himself. You know, he himself has characterized that move done in 2023 as being illegal.

    2. SB

      With everything you know about the medical industry, do you think it is plausible that Big Pharma-

    3. AT

      One hundred and ten percent

    4. SB

      ... didn't want-

    5. AT

      One hundred and ten percent

    6. SB

      ... these in the hands of regular people because they can't patent this and it's powerful?

    7. AT

      So ultimately, the way to think about it is this. Um, pharma may not have a compound that directly competes for BPC-one five seven.

    8. SB

      BPC-one five seven?

    9. AT

      So this is the medication or the co- peptide that can aid with healing after an injury, okay? So it's not necessarily there's direct competition, but at the end of the day-Your average patient going throughout their daily life only has so much money that they can spend on medicine.

    10. SB

      Mm-hmm.

    11. AT

      And $10, $15, however much money that goes to this, doesn't go to a prescription drug from a commercial pharmaceutical company. And so there is real concern that potentially that was at play during that decision. And I-

    12. SB

      You said 110%. [laughs]

    13. AT

      Yeah. I-- Well, you know, it, it's interesting because, you know, I try to s- walk a very fine line between what I can prove, uh, versus what I suspect after being in this space for a long time.

    14. SB

      Mm-hmm.

    15. AT

      And you know, ultimately, you know, I don't think it's accurate to characterize pharmaceutical companies or really any other entity as being, you know, evil or, or bad. The truth is maybe a little bit more ominous. The truth is, is that they are these large machines that are designed to prioritize profit over everything.

    16. SB

      Yeah.

    17. AT

      And that's everything.

    18. SB

      I think this is one of the really interesting observations I've had the higher I've gone in my career, is that oftentimes, you know, we heard about the Illuminati. Like, when I was growing up, I was like, "Oh, there's this Illuminati."

    19. AT

      Yeah.

    20. SB

      And you think of it as these, like, shadow hooded people that get together and decide evil things. But I-- the further I've gone in business, the more I've realized that the Illuminati or these evil forces are actually just machines that were designed to optimize for profit.

    21. AT

      Correct. Correct.

    22. SB

      So, like, corporations-

    23. AT

      Yeah

    24. SB

      ...are the Illuminati.

    25. AT

      Yeah. And so I don't actually think that there's necessarily, you know, a, a group of maniacal individuals, you know, the legion of doom, you know, plotting to, like, take away your health. But at the same time, I think that there are these large organizations that really couldn't care less about your health. You know, they are prioritizing what's important for them, and, uh, regular people just get caught up in the mix. And what's challenging is that, as a physician, you know, I took a Hippocratic oath. You know, I care about my patients, and so those are the people that are in front of me every single day that are seeking to improve their lives to recover from injury. I have, you know, fertility patients that are just dying to start their family, and I have patients that are suffering from hormonal imbalances that haven't felt right in years. I, I treat erectile dysfunction in men that have been struggling for years after prostate cancer treatment. I mean, these are people that are broken and hurting. You want to be able to help them. And so I feel that as a very strong personal calling that I have to be the advocate for that patient, both in the room whenever I'm treating them and taking care of them, but also when I'm talking to others and I'm, you know, speaking out about these issues. Like, I want access to these medications because I care about the patients who benefit from them.

  7. 20:42 – 21:16

    Why Peptides Are Back After Being Banned—What Happened Behind The Scenes

    1. SB

      So they banned these peptides that we have here.

    2. AT

      Correct.

    3. SB

      And we're sat here two years after the ban, I believe, roughly two years after that ban.

    4. AT

      Yeah.

    5. SB

      And suddenly everybody's talking about peptides again.

    6. AT

      Yes.

    7. SB

      Why? What's going on?

    8. AT

      So I think what we're seeing is the forbidden fruit effect because this was banned, and all of a sudden, "Oh, well, why'd they ban it? Well, they wouldn't have banned it if it weren't working, right?" And we're also seeing the effect of TikTok and short-form content being spread very rapidly, very virally, and that's been going on for two years now, combined with new, uh, emphasis from administration leadership and HHS and RFK.

  8. 21:16 – 22:46

    The Most Shocking Patient Transformation From Peptides

    1. SB

      What is the most incredible impact that you've seen peptides create in a patient?

    2. AT

      Oh my gosh, I have the best story for you. So one of the most frustrating, uh, things about my practice is treating infertility in young men that have significant metabolic dysfunction. These are young men that have a low sperm count, right? So they can't get pregnant because they just don't have the numbers to make it happen. And you're looking at them, and they're morbidly obese. Okay? They have high insulin resistance, all right, and their endocrine system has been damaged by that obesity. So they don't ha- have low testosterone levels, and their brain is not making enough of the signals to stimulate their testicles. Now, we have medications that we can use to help stimulate that to make more of that signal to stimulate the testicles, right?

    3. SB

      Yeah.

    4. AT

      But really, what is eating at them, what is causing this, is not that chemical imbalance. That's the, the symptom. That's not the, the problem, okay? And treating symptoms doesn't really get you very far. And so I would have patients that I would take care of, and we would never see a significant improvement in their numbers because losing weight is really, really hard, you know, regardless of all of the education and resources I try to give them. But now we have peptides in the form of GLP-1 drugs like semaglutide and tirzepatide, and I just saw a patient last, last week who increased his sperm count 10 times over and is now in a normal range because he's lost 100 pounds due to using tirzepatide, exercising, and improving his diet, and he has totally changed his life.

  9. 22:46 – 24:48

    When You Should (And Shouldn’t) Use Peptides In Your Life

    1. SB

      And that started with a peptide?

    2. AT

      It started with a peptide.

    3. SB

      So I-- we've got lots of peptides on the table in front of you.

    4. AT

      Yes.

    5. SB

      We will go to the-- into them individually. But just, can you give me a t- a high-level view of the types of areas in our health and life that these peptides can help with? So we've talked there about infertility-

    6. AT

      Correct

    7. SB

      ...as a downstream consequence of the, like, weight loss and f- fixing meta- metabolic health. What e- what other parts of the body do peptides touch?

    8. AT

      The best way to think about it is like this: so peptides are almost like an app on your phone. So imagine before we had apps. Like, I, I'm old enough to remember trying to log on and do my banking online before we had apps, and gosh, it was so painful, right? Like, there were ways to accomplish things, but they were very inconvenient and in a roundabout way. And now all of a sudden we have these apps on our phone that can do just about anything except fold your laundry, right?

    9. SB

      Mm-hmm.

    10. AT

      You know, there are some limits to it, but I mean, really the sky's the limit from an electronic standpoint, and really that's what peptides are. So the thing is, is that we have peptides that can help you lose weight, like the GLP-1 drugs. We have peptides that can improve skin quality, like, uh, GHK-Cu. We have peptides that can help heal your gut, like BPC 157, particularly effective pa- in ulcerative colitis, which is something that's being investigated with the FDA's planned upcoming meeting on it. We also have peptides that can help with sleep and with, uh, recovering the gland in your brain that's responsible for melatonin and regulating your sleep-wake cycles. So the question isn't, you know, what can peptides do? It's kind of, well, what can't they do? And if they can't do that yet, can we develop a peptide that can accomplish that task?And the answer is probably, and simultaneously, while there may be resistance from pharmaceutical industry in these peptides, the ones that we're most interested in right now, they have signed multi-billion dollar deals with other pharmaceutical companies that are involved in peptide, uh, development aided by AI to try and fast-track their own peptide, uh, products.

    11. SB

      Interesting.

    12. AT

      And so we are going to see exponentially more of these products come down the pipeline from pharmaceutical companies in the form of commercial products.

  10. 24:48 – 26:25

    The Latest FDA Update

    1. SB

      And it's worth saying that there was some significant news today.

    2. AT

      Correct.

    3. SB

      What happened today, but also what's going on? And just for anyone that doesn't know, it's April the 15th.

    4. AT

      Yes.

    5. SB

      So-

    6. AT

      So today, uh, we got a re- press release from the FDA saying that in July they are going to consider seven peptides for removing from Category 2 back to Category 1.

    7. SB

      Legalizing them.

    8. AT

      Legalizing them. Okay? And, uh, some of the heavy hitters from that list include BPC, uh, one five seven.

    9. SB

      Which is the one we talked about to do with, like, repair an injury.

    10. AT

      Absolutely. Okay. And then we have, uh, the brother to that, which is TB five hundred, this vial over here. This improves blood flow to an injured area. You could think of this as sending the soldiers, as sending the cells that are required for rebuilding that tissue matrix that was damaged by a tear or a cut. All right? On top of that, uh, we're also getting something called, uh, KPV. May not have it here, but that is another, uh, peptide that has been linked to angiogenesis and tissue repair. We're also getting MOTS-c, and in, you know, some patients will call it exercise in a vial. It improves your VO2 max and your exercise tolerance, and by up-, uh, regulating the energy pathway, basically making more ATP, the energy that we all use to move, it makes more of that available. All right? We're also going to get Desip, Epithalon, and Semax, which are all peptides that affect cognitive function, so improving thinking. Like, uh, Semax is a great option for that. And then Desip and Epithalon both have roles in regulating, uh, sleep and recovery.

  11. 26:25 – 28:01

    How People Are Actually Getting “Illegal” Peptides

    1. SB

      Wow.

    2. AT

      Yeah. Pretty wild.

    3. SB

      And I've got to say, how does... So some of them are, are becoming legalized.

    4. AT

      Right.

    5. SB

      But even the ones that aren't legal right now, a lot of people are taking them anyway.

    6. AT

      Correct.

    7. SB

      So my, my question is, how are people getting them? Listen, I don't want to promote illegal drugs here. This is not that kind of show.

    8. AT

      No.

    9. SB

      But I just want to know what's going on.

    10. AT

      No, this is-- Well, this is important to talk about, right? Because we have to understand, like, what's going on in the marketplace. The moment that these drugs were banned or these medications were banned in twenty twenty-three, it was kind of like the United States experiment at banning alcohol. It didn't go very well, right?

    11. SB

      Yeah.

    12. AT

      All of a sudden, you know, they-- we, you know, the mob came around, and we started, you know, seeing unregulated, uh, uh, saloons and unregulated alcohol, uh, production, and it was contaminated with all this stuff that you didn't want. And so we're like-

    13. SB

      And people are traveling.

    14. AT

      Yeah, exactly. It's just... It, it, it's not a good idea, right? And so what happened is we banned these, and the gray market stepped in. And so these are companies that will sell peptides that have on the label, "For research use only." All right? And the idea is that that takes them out of the FDA's jurisdiction because they're not selling it for people to inject into themselves out of the FDA's hands. I'm just creating a vial of this magical juice that you can use for your rat, okay? That's the idea. We all know that's not what's really happening. But because there isn't any quality control, it's kind of like getting gas station sushi. Like, yeah, you can do it, but you don't really know if it's sushi, and it may not end very well for you.

    15. SB

      Yeah.

    16. AT

      And so, again, not saying that there aren't some pl- uh, people who have gotten good results with, uh, research use only, uh, peptides, but again, it's not standardized, which is why I think moving this back into the five oh three A compounding world is the best

  12. 28:01 – 29:58

    How To Take Peptides Safely -What Most People Get Wrong

    1. AT

      thing for everyone.

    2. SB

      Which is the le- legal-

    3. AT

      Legal

    4. SB

      ... framework.

    5. AT

      Correct.

    6. SB

      Okay, so how does one take a peptide?

    7. AT

      That's a great question. So what's interesting is that, as we mentioned, you know, peptides are just made up of building blocks of amino acids, and, you know, if you were to go make yourself a, a protein shake, you know, what is that gonna look like from a Lego standpoint? It just looks like this, a handful of Legos in your hand, right?

    8. SB

      All sort of ground up and-

    9. AT

      All ground up into individual pieces, right?

    10. SB

      Okay.

    11. AT

      Well, the thing is, is that your gut is designed to break up any sort of protein that you ingest orally into these little pieces.

    12. SB

      Okay.

    13. AT

      And so if you were to, say, I don't know, drink some of, you know, this TB five hundred, your body wouldn't be able to tell the difference in between that and a piece of chicken.

    14. SB

      'Cause it would, it would break it all apart in my gut.

    15. AT

      It would break it all apart. Now, there are some very s- uh, unique exceptions to that. There's a form of BPC one five seven that actually is tolerated in the gut, but by and large, the overwhelming majority of these have to be injected either subcutaneously or into the muscle, and that's usually a preference.

    16. SB

      Subcutaneous being my belly.

    17. AT

      Under-- Just underneath the skin. You know, as I tell patients, just pinch an inch, inject under the skin. We do that for a lot of other medications as well.

    18. SB

      Is that what this is?

    19. AT

      Yeah, so this is a prescription Mounjaro pen. So Mounjaro is the brand name for tirzepatide. All right? Tirzepatide being the leading GLP-1 product right now from Lilly. So this produces more weight loss per milligram than any other product that we've got out right now.

    20. SB

      Is this the mechanism in which people inject peptides?

    21. AT

      No, a little bit different.

    22. SB

      A little bit different.

    23. AT

      So this is an auto-injector pen, and so what you do is you're able to actually ratchet the dose there on the right side, and then you pinch an inch in your skin, and then push it up against, and it'll auto deploy. And so there's nothing that you need to do. You don't have to learn how to draw up medication and inject. Whenever you're administering peptides at home, especially for patients that have obtained them from research use only markets, they usually come in just little vials that need to be drawn up with a needle, okay? Now, the benefit of that is that you can do custom dosing, all right? But the drawback is, is that, well, you have to know how to calculate that and

  13. 29:58 – 38:09

    Why Big Pharma Feels Threatened By Peptides

    1. AT

      put it together. This may be the most controversial thing we have on this table, andBy pharma's estimate, it might be the most dangerous thing to their entire business model because this is tirzepatide, the exact same thing that you had in that pen, but this is made by a high-quality 503A compounding pharmacy. And the reason why this is, uh, so controversial right now is because it offers an incredible amount of flexibility because what you have in your hand there is very standardized, and you administer it once a week because that's what's approved by interest.

    2. SB

      This is like the Ozempic thing everyone's been talking about.

    3. AT

      Exactly.

    4. SB

      Yeah.

    5. AT

      Right? But think of that as paint by numbers, okay? You are-- This co- this, uh, section is this color, this section is that color. All right? Think of this as-

    6. SB

      The thing you've got in your hand

    7. AT

      ... right now. Yeah, exactly. Just a vial of tirzepatide as being able-- having infinite permutations and dosing ability because you can draw this up with a small syringe and do microdosing. So instead of one large dose once a week, because what many patients will experience is they'll have a return of their hunger by the end of the week, and they end up losing ground, you can actually, instead of doing a full dose once a week, you could do multiple mini doses throughout the week with this formulation and with this presentation of the medication. All right? But the challenge is, is that that is the benefit that allows this to be compounded by compounding pharmacies because they are able to provide something that is similar to what's in your hand, all right, but it offers more flexibility that may be the right choice for some patients. So personaliz-personalization of medicine, okay? But the challenge is, is that if you spend however much money on this, you're not giving it to Lilly. And so as a result, we have seen an unprecedented crackdown in the United States from the FDA in trying to shut down compounding pharmacies and prevent them from making these medications, even though that ability to customize, the fact that this is not an exact copy of what's in your hand right now, should protect it under current legislation. But there is now enough pressure from the powers that be and from lobbyists from both Lilly and Novo Nordisk that, which are the two companies that make the GLP-1 medications, that we're seeing Marty Macri, the FDA commissioner, has now tweeted more about cracking down on compounded GLP-1 medications than he's tweeted about diabetes or heart disease in his entire time in office.

    8. SB

      And just so I understand, I want to play this back to you to make sure I understand.

    9. AT

      Sure.

    10. SB

      In my hand here, I have tirzepatide-

    11. AT

      Tirzepatide

    12. SB

      ... on my left.

    13. AT

      Yep.

    14. SB

      And this is made by Lilly-

    15. AT

      Right

    16. SB

      ... which is a corporate company-

    17. AT

      Right

    18. SB

      ... who's patented it, so they can make lots of money from it.

    19. AT

      Correct.

    20. SB

      In my right hand, I have t-tirzepatide.

    21. AT

      Tirzepatide with niacinamide.

    22. SB

      With niacinamide.

    23. AT

      Yep.

    24. SB

      And this is not patentable.

    25. AT

      So Lilly has a patent on the tirzepatide molecule in that formulation in your hand.

    26. SB

      Mm-hmm.

    27. AT

      Okay. And if anyone violates a patent, that can be pursued in US court.

    28. SB

      Yeah.

    29. AT

      Patent law, right? But what's interesting is that Lilly and Novo Nordisk know that that's different in your right hand. It doesn't look the same. You can dose it differently. And they know that if they were gonna fight that in court, it would cost a lot of money and take a lot of time. So you know what's a lot easier? Calling your friend at the FDA and getting him to step on the competition so you don't have to. And then who's paying for that enforcement? It's not the lawyers that the pharma company is paying for. Uh, it's the taxpayer paying for the FDA through taxes.

    30. SB

      And you seem to imply that this was actually better because you could take it in a more flexible dose. You could take a little bit, a lot. You can take it when you want, whereas this is kind of once a, once a week.

  14. 38:09 – 39:02

    How Peptides Could Transform Your Insulin Levels

    1. AT

      life.

    2. SB

      What about some of these metabolic disorders and diseases in terms of, like, insulin-

    3. AT

      Yeah

    4. SB

      ... resistance? People on The Diary Of A CEO, the audience, are very interested to learn about insulin. I see that a lot in the comment section and in a lot of the data.

    5. AT

      Yeah.

    6. SB

      So how can-- if someone's struggling with their insulin levels or their, you know, their glucose response, how does these peptides help?

    7. AT

      Honestly, the best peptides for that right now are the GLP-1 drugs.

    8. SB

      Mm-hmm.

    9. AT

      Okay? Hands down. Because what you're doing is you are slowing gastric emptying, and so you have a slower absorption of that bolus of food that you've eaten, so your glucose doesn't spike.

    10. SB

      Okay.

    11. AT

      And so as a result, that increases insulin sensitivity significantly. Now, again, you have to be careful about what peptide you're using for what. A lot of these peptides that boost growth hormone and boost, let's say, IGF-1, those can actually increase serum glucose, and that may not be what you want if you are someone that is trying to work on your insulin sensitivity.

  15. 39:02 – 40:50

    Do Peptides Work As Creams? What You Need To Know

    1. SB

      And do any of these peptides come as, like, creams or as pills or anything like that?

    2. AT

      If you look online, you can probably find a version of everything. But if we're talking about actual legitimate formulations, the best example of a topical cream is gonna be GHK-Cu. And this is interesting because this is a copper tripeptide that has been found to decrease in expression and concentration as we age. But when it is applied topically, it's highly effective-

    3. SB

      Topically?

    4. AT

      Topically, so putting on a cream on your face. All right? It's been found to be extremely beneficial in regenerating the quality of skin, so complexion, all right, increasing the amount of collagen and elastin, the things that we need to keep our faces taut and youthful, the things that people will pay lots of money to go get lasered to get improvements. Not that it's a, a replacement for that, but that's a topical form that, believe it or not, you could go out and buy today because topical GHK-Cu is regulated very differently than the injectable form.

    5. SB

      Is it expensive?

    6. AT

      Usually.

    7. SB

      You know, growing up, I thought all these sort of anti-aging creams were bullshit. But, but you're telling me that this has actually been associated with-

    8. AT

      Yeah

    9. SB

      ... improving signs of aging.

    10. AT

      I will tell you this. When I was going through college and medical school, I was the biggest skeptic. [laughs] Like-

    11. SB

      Mm

    12. AT

      ... I did not believe any of the health or wellness claims that we saw coming out at the time. And again, you know, that was at a time where we were getting bombarded with stuff about the Atkins diet and this, that, or the other. But then all of a sudden, you start having patients come back to you, and they're testifying as the benefits they've seen from these things, and you start to actually look at the biochemistry behind them, and you're like, "There's a lot of science backing this up. This isn't just mumbo jumbo." And so believe it or not, yeah, there are creams that can slow the process of aging, at least from a visual standpoint, when it comes to your skin. I have yet to figure out anything that, uh, you know, makes me as energetic as I was in my early 20s, but, you know, I'm working on

  16. 40:50 – 43:18

    How Peptides May Unlock Better Cognitive Performance

    1. AT

      it.

    2. SB

      Mm-hmm. [laughs] But on that point of energy and cognition, if I wanted to become a better podcaster-

    3. AT

      Yeah

    4. SB

      ... and, you know, I sit here sometimes... Sometimes we do two in a day, which means I might sit here for eight hours. Once we did-- I think a couple of times we've done three in a day-

    5. AT

      That's brutal

    6. SB

      ... which is 12 hours of recording.

    7. AT

      Yeah.

    8. SB

      But what would you recommend if I was trying to improve my cognitive performance?

    9. AT

      So again, as a physician who likes keeping my license-

    10. SB

      Oh, yeah

    11. AT

      ... I wouldn't say necessarily recommend, but I would say if we're looking at how these medications have been used and potentially one that may be legal again coming this July, pending what the FDA says, intranasal Semax. And this was one that was originally studied actually in Russia many years ago, and what they found is that this seven amino acid peptide, when it was administered after a, a TBI, so a traumatic brain injury, all right, or acute injury, that patients tended to bounce back faster.Also, they saw evidence of it improving outcomes after stroke, and it also seems to upregulate the same sort of factors that help with cognition and with, you know, connecting sentences and bits of data in your brain. And so it's also one of the-- interestingly enough, one of the ones that is available, you know, intranasally because it goes through the mucous membranes and gets right where you need it. And so that's gonna be a really, really fascinating, uh, compound to see back on the market, and then we can actually get more data regarding efficacy and, you know, across a wide population.

    12. SB

      So interesting.

    13. AT

      Yeah.

    14. SB

      And you, you in- you sniff that through your nose.

    15. AT

      Sniff it like, like you would for any nasal decongestant, right? You know, if you have allergies or something like that. Also, for someone like yourself, you travel a lot, you know, you're going in between different time zones, you're balancing multiple obligations at different odd times of the day. I, I shudder to think what your circadian rhythm looks like, my friend. Um, but you know, that is what we have some of these other compounds that are co- uh, gonna be available for. So if we look at, uh, uh, Desip, okay, that has been shown to be helpful with regulating your circadian rhythm. All right? That is one of the ones that's gonna be approved, hopefully here soon again in July, right?

    16. SB

      Mm-hmm.

    17. AT

      And then, you know, on top of that, um, you've got, you know, uh, things like Solank, which is another one that can help calm you as you're going to sleep about an hour ahead of time, and again, ho-help those, you know, deep delta wave brainwaves that are so restorative whenever you actually are, you know, resting.

    18. SB

      Where will we be able to buy these when and if they are legalized?

    19. AT

      So from, uh, 503A compounders here in the United States with a prescription from a physician.

    20. SB

      So you still need a prescription?

    21. AT

      Still need a prescription, correct.

  17. 43:18 – 48:23

    The Future Of Muscle Retention On GLP-1s—What’s Coming Next

    1. SB

      Could be quite a crazy world when everybody seem- is gonna be in-injecting themselves every, every day. I mean, we're already getting to that point now with Ozempic, where-

    2. AT

      Yeah

    3. SB

      ... I've got loads of people in my, my friendship group that are-

    4. AT

      Yeah. And they're-- yeah, and they're doing great.

    5. SB

      Yeah, they're doing great.

    6. AT

      They're doing great, and that's what I like about, you know, the advent of these GLP-1s is they're removing the stigma of a needle.

    7. SB

      Mm-hmm.

    8. AT

      And I look at some of my friends who have been on it. I can't recognize them. They look awesome.

    9. SB

      Are you concerned with, with any of them?

    10. AT

      You know-

    11. SB

      I've got a couple of friends in my circle where I'm, I'm a little bit concerned. I, I don't even know if I should be concerned, but it's just-

    12. AT

      Yeah

    13. SB

      ... when you see someone you know change so dramatically, so quickly-

    14. AT

      Yeah

    15. SB

      ... I think there's something in us which-- something prehistoric in us which goes, "Oh my God, there's a problem."

    16. AT

      Yeah. One thing I'm, I am concerned about is the rapid weight loss with GLP-1 medications, because the problem is, is that when you go into such a radical caloric deficit, your body goes into catabolism, which is breaking down tissue, and you wanna break down fat, right? But your body isn't that judicious. It's gonna break down muscle, and muscle is the most metabolically important tissue that any of us have. And so if you really wanna optimize your insulin sensitivity, well, you need to maintain your muscle. And right now, really the only compounds that we have that are really good at preserving muscle with resistance training is testosterone, right? But that isn't gonna be a good option for our male patients that wanna get pregnant, 'cause testosterone turns off fertility in men. All right? It's also not a great idea for our female patients, all right? Depending on their age, testosterone, TRT is a thing in older, you know, uh, women, menopausal, won't go into that. But truthfully, uh, testosterone is not the right answer for everybody. And so what we are gonna see come down the pipe very soon is kind of the older brother of peptides, the more complex form, biologics called monoclonal antibodies, that are specifically designed to inhibit the enzymes that break down muscle. So these are specifically called myostatin inhibitors. There are three that are coming down the, uh, pipeline. There is one called Bimagrumab, which is owned by Lilly, that is going to bind to the peanut butter to myostatin's jelly, which is called activin. And then you have Piretosumab and Travogumab, which are two other compounds owned by a different pharmaceutical company that are all designed to maintain muscle even in a significant caloric deficit.

    17. SB

      This is getting interesting now.

    18. AT

      Yeah. Yeah.

    19. SB

      So you're, you're telling me I'm gonna be able to inject myself with Ozempic to lose the fat-

    20. AT

      Yeah

    21. SB

      ... and then inject myself with something else to keep the muscle.

    22. AT

      It's wild. It's wild. [laughs] And, and I'll tell you, you know, one of the hardest things that I'm sure you've heard being on the receiving end of this is just the complexity of it, and there are so many levers that are moving at once, and trying to get your head around it and balance it all, like the-- it requires nuance, and it requires a thoughtful discussion with your doctor who is well-educated on them. And that's one of the challenges is that there isn't broad, great education on these products right now in the medical space. And so that's something that I'm very passionate about, is improving education across my colleagues so that they're not afraid of these anymore.

    23. SB

      What do you say to people that are listening to this now and go, "Fucking hell, why don't you just, like, eat your greens and go to the gym-

    24. AT

      Yeah

    25. SB

      ... and just be more human, and you'll be fine"?

    26. AT

      I love that. I love eating your greens and going to the gym, okay? Um, but the unfortunate reality is that here in the United States, uh, it depends on what database you look at, but obesity rates are estimated to be forty to seventy percent, okay? Whether you-- depending on what BMI cutoff you're using, okay? BMI is not perfect, but it is what it is. And so the thing is, is that, well, eating greens and going to the gym are not working for us as a society, and we could talk about how we don't have real food anymore. We have food deserts. We have this nut-- calorically dense but nutritionally poor food. Uh, I'll tell you, the most disturbing thing I see as a surgeon is I'll see a patient come in the door, and they're morbidly obese. They're a large individual, but I have to do surgery on them, but the connective tissue, the stuff that's made up of protein that makes them them, that literally holds them together, is paper, paper thin because they're eating an incredible amount of calories, they're gaining fat, but they don't have any protein in their diet, and that's not something that's rare. I see that on a daily basis. And so the truth is, is that, you know, we're talking about this from the angle of biohackers and people that are super engaged in our health, but the truth is, is that this is gonna be able to be used to help our population at large and, you know, ultimately, hopefully avoid a lot of the terrible disease states that we're seeing overwhelm the medical system right now.

    27. SB

      How big is the peptide industry right now?

    28. AT

      If we look at the top four large language models companies, all right, so all the heavy hitters, and how much revenue they're generating, it's estimated between, be between fifty-eight billion up to maybe sixty-two billion. Yet the income and the revenue from just semaglutide and tirzepatide alone is gonna g- be over fifty-five billion this year. And so what we have is peptides, without even considering all of this happening in the research space or the research-use-only space, without even considering the peptides that, uh, we'll see come from compounding pharmacies, we're already approaching parity with what we're seeing in AI as far as revenue goes. That is the demand that we're seeing in the

  18. 48:23 – 49:25

    Ads

    1. AT

      marketplace. [paper flips]

    2. SB

      I run multiple companies that have multiple sales teams, and one of the things as a founder of a company that's often confusing is you find it hard to figure out where sales are. So about 10 years ago, I started using Pipedrive in my former company, and it's also the reason why I switched over all of my commercial teams in my current media company called stephen.com to use Pipedrive as well. Not only do they sponsor this show, but they've been an incredibly effective way of scaling our sales engine over the years. Pipedrive is an easy-to-use intelligent CRM, and at its very core, it makes your sales process visible through one dashboard, a visual pipeline showing every deal, what stage it's in, what needs to happen next, and it's all in real time with no delay. It doesn't magically close the deal for you, of course, but it does replace complexity with clarity. If you want to join over a hundred thousand companies already using Pipedrive, you can use my link for a thirty-day free trial with no credit card payment needed. Head to pipedrive.com/ceo to get started. That's pipedrive.com/ceo. I'll see you over there. [paper flips]

  19. 49:25 – 52:29

    The Hidden Trade-Offs Of Peptides No One Talks About

    1. SB

      When your patients come and see you, Dr. Alex, w-what are they asking you most frequently as it relates to peptides? What are, like, the top three questions you get asked the most?

    2. AT

      The first thing I get asked is, "What peptides do I need?" And then I just look at them. I'm like, "Well, w-what's your problem?" [laughs] You know? Like, "What, what's bothering you?"

    3. SB

      And what do they say?

    4. AT

      You know, a-and then they'll come in, and they'll start talking about, you know, energy, sex drive, and that sort of thing, so I'm like, "Okay, if that's it, well, we need to check your testosterone levels, brother." Okay?

    5. SB

      Mm-hmm.

    6. AT

      So instead of looking for peptides, right? You know, you don't walk into a Home Depot or a Lowe's, you know, and be like, "What tools do I, do I need?" And you're like, "Well, what are you trying to do?" Right? And then you start to talk to someone there. They're like, "Well, I'm trying to build this." "Okay, you need a saw. You need a screwdriver. You need this." And some of those tools might be peptides. All right?

    7. SB

      Mm-hmm.

    8. AT

      But some of them may be hormones. You know, some of it may be diet and exercise, and so peptides are just another type of tool that we can use.

    9. SB

      We all want a shortcut, though, doctors. We all want a quick way to, to be better-

    10. AT

      Yeah

    11. SB

      ... and ideally not to have to do hard work. That's, like, what most pe- you know, the average person is looking for. And we hear about these peptides. We hear other people are taking them. We hear the fantastic results in skin, hair, muscle.

    12. AT

      Yeah.

    13. SB

      And we go, "Fucking what about me?"

    14. AT

      You know what I tell patients? I'm like, "Me too, man."

    15. SB

      [laughs]

    16. AT

      You know? "But my alarm still went off at four forty-five this morning, so I could hit the gym before I made it to clinic."

    17. SB

      Mm.

    18. AT

      Because there are no real shortcuts. There are things that can help, right? GLP-1s are the best example of that, right? Okay, this is the closest thing to a shortcut you're gonna get. But the truth is, is that this isn't gonna go to the gym for you, and it's not gonna lift the weight, so you can maintain that muscle mass, so you get the best possible result and try to hold onto your muscle while losing the fat.

    19. SB

      One thing I've learned from doing this podcast that, that has really grown with me over time.

    20. AT

      Yeah.

    21. SB

      People ask me all the time like, "What's the one thing you've learned from the podcast?" One of the answers that I've never given that I'm gonna give now-

    22. AT

      Yeah

    23. SB

      ... is that I've learned that there's no such thing in life as a free lunch.

    24. AT

      No, absolutely not.

    25. SB

      [laughs] W- and what I mean by that is, like, everything is a trade-off.

    26. AT

      Yes.

    27. SB

      And if you ever hear on a podcast or in any medium that something has tremendous upsides, the first question one should ask is, what's the trade?

    28. AT

      [laughs]

    29. SB

      And, like, just with everything, you can apply this to having a relationship with a partner.

    30. AT

      Yeah.

  20. 52:29 – 57:50

    The Real Benefits Of Different Peptides—And How They Compare

    1. AT

      where you were.

    2. SB

      It's good at stripping abdominal fat, belly fat?

    3. AT

      Belly fat. This is what it's known for.

    4. SB

      Oh.

    5. AT

      Yeah.

    6. SB

      It's good at stripping belly fat?

    7. AT

      Stripping belly fat specifically, so bodybuilders actually really like it for that particular application.

    8. SB

      I had no idea there was a, a peptide for stripping belly fat.

    9. AT

      There you go, man. You know, and, like, for example, here we've got another one. So this is melanotan II, right?

    10. SB

      Okay.

    11. AT

      So this is a, a melanocortin receptor agonist. So melanocortin's, that's what makes you tan, right? So you could administer this, all right, and it will actually end up giving you a deep tan in response to just a little bit of UV sun exposure, all right?

    12. SB

      [laughs]

    13. AT

      Now, I know, right? Um, listen, I've embraced my pasty whiteness, so I'm not, you know, not necessarily my, uh, my bag, but i-it's real. Now, again, there are some safety concerns with this because, again, could that potentially stimulate a melanoma or something like that? But this is something, again, as a peptide that gives a wildly different result than tesamorelin, right? Because it's a different-

    14. SB

      It gives you a tan.

    15. AT

      It does. Yeah. It does. It'll also give you, um, uh, some of the most impressive erections you've ever had in your life, so, uh, be, be warned. Um-

    16. SB

      Wait, it's literally turning you into a Black guy. [laughs]

    17. AT

      [laughs] Finally.

    18. SB

      [laughs]

    19. AT

      Yeah, right? And it's wild. So there's actually, and there's even a derivative of melanotan II called PT140- uh, 1, uh, bremelanotide, that is a commercial product right now that you can write as a prescription, okay? But, uh, that doesn't have the tanning benefit but has the sexual, you know, benefits.

    20. SB

      Oh, wow.

    21. AT

      Yeah.

    22. SB

      Keep those ones over here

    23. AT

      Yeah. We have to talk about this. Another really interesting thing, the phenomenon that we've seen, right, is that now we've got all of these companies that are making these research-use only compounds, right? It used to be that you would have a compound that's in drug development, and you're seeing all the advertisements for it. You know, maybe if you follow these sorts of things like I do because I'm a nerd, right? You get excited about it, but you don't get access to it, right? Well, believe it or not, the next blockbuster drug that Lilly is going to come out with probably in the next couple of months is this guy called retatrutide. All right? And retatrutide is fantastic in that it is the first three receptor agonist GLP-1 drug. So the GLP-1 drugs, okay, whenever you're talking about semaglutide and tirzepatide, they have slightly different profiles.

    24. SB

      This is the Ozempic category.

    25. AT

      Correct. Right. So GLP-1 is the primary receptor that they work on, and what that will do is it slows gastric emptying, and it limits caloric intake. All right? But then in tirzepatide, not semaglutide, but tirzepatide is a dual agonist, so it has a effect on GIP, which is a different receptor. Well, retatrutide adds in glucagon receptor activation, and so believe it or not, your liver actually acts like a repository of energy, where it stores glycogen and fat that your body can use as energy. But that's a problem, right? If you get too much fat there, if you have a caloric excess, then you could end up having what's called NASH cirrhosis, but non-alcoholic steatohepatitis, basically inflammation of your liver due to accumulating too much fat. It's a problem. But by stimulating the glucagon receptor while simultaneously hitting GLP-1 and GIP, what we found is not only do patients lose an incredible amount of weight, but they also get the best improvements we've ever seen in their liver, liver health that we've ever seen. And people have been buying that from research-use only websites and using it for about two years now, and bodybuilders have already made this the standard in their protocol when it comes to cutting for a show. And it is wildly effective, and we're now seeing the population using a drug at scale that hasn't even made it through commercialization yet.

    26. SB

      Why are you smirking? You're using it.

    27. AT

      No.

    28. SB

      [laughs]

    29. AT

      I have not. I can honestly say I have not used Reta, but, uh, I find it fascinating, though. It's absolutely wild. You know, talk about power to the people, right?

    30. SB

      What about these others then? What else have we got here that you think is interesting?

  21. 57:50 – 1:02:18

    The Peptide That Could Change Your Sleep Quality

    1. AT

      for it.

    2. SB

      So what would happen-- Let's just take this one.

    3. AT

      Sure.

    4. SB

      Somatotropin.

    5. AT

      Yeah.

    6. SB

      Somatotropin.

    7. AT

      Yeah.

    8. SB

      If I bought this for research purposes and I-

    9. AT

      Research purposes only

    10. SB

      ... and I started injecting some of this into me-

    11. AT

      Yes

    12. SB

      ... what would change?

    13. AT

      So it depends on how much you do and when you do it. So the idea is that if you injected that at night, it would improve your quality of sleep. Okay? You would get a boost in your quality of your hair, your skin, nails. Uh, theoretically, it would be easier for you to recover from injuries, hopefully put on a little bit more muscle a little bit easier, maybe lose a little bit of fat.

    14. SB

      So why don't I take it?

    15. AT

      Well, because if you take a little bit too much, you can actually a-get, uh, insulin resistance because your glucose levels will go too high for too long. All right? You abuse too much for too long, you will actually get acromegaly, so that's development of the, uh, your bones continue to grow, but not along s- only in certain junctures. And so there's a very specific look that bodybuilders who abuse growth hormone at high amounts will get to them, all right, which is an irreversible change to the facial bone structure. You can also, theoretically, if you had a cancer, maybe it could make it worse. All right? Um, we've never s-shown it that it causes new cancers, but that could be a concern. And, you know, on top of that, it could give you insulin resistance because-

    16. SB

      Okay

    17. AT

      ... you know, you're again-

    18. SB

      Method.

    19. AT

      Yeah, exactly, right.

    20. SB

      Glucans.

    21. AT

      Um, and if you take too much, it could potentially make your hands numb in the morning because you get effusions into the joint space. And so bodybuilders will talk about lifting a dumbbell and having to drop it because their hand goes numb temporarily if they're taking too much growth hormone too soon.

    22. SB

      And what else have we got here?

    23. AT

      Oh, my gosh. So epithalon. So this is, uh, the, uh, medication that is, uh, theoretically gonna be available to us in, uh, July. Okay? And so, uh, the hope is that, you know, this is going to, uh, expand cell life. So epithalon, the, uh, purpose of it is it works to enhance, uh, telomerase. So at the end of your cells, imagine it this way, you're trying to copy the genome, but the little copier that copies it, it takes up space in and of itself, so it's kind of like it cuts off the last couple letters every single time.

    24. SB

      This is when you're aging, right?

    25. AT

      When you're aging. You're creating new cells, right? Cells divide through this process called mitosis, where they split. All right?Well, if you gotta make an exact copy, well, you've gotta read through all these lines of code, but because of the way that we're built, we always end up cutting off the last little bit of code. Now-

    26. SB

      Which is wh-how we age.

    27. AT

      Which is how we age. It is one of the things that contributes to aging, all right? Now, that is considered to be, quote-unquote, "junk information." It's at the very end called the telomere, all right? But we know that shorter telomeres are associated with aging, potentially worse health outcomes. Then there's an enzyme that can help heal or repair the telomere called telomerase. Epithalon helps encourage that. And so some people are looking at that as being one of the fountain of youth, uh, compounds. I'm very skeptical as far as that goes, but it does show some benefits when it comes to, uh, you know, healing parts of your brain that are, you know, associated with, uh, regulating your circadian rhythm.

    28. SB

      So the average person listening now-

    29. AT

      Yeah

    30. SB

      ... they've heard a lot of stuff about a lot of things. How do they know if they should pursue getting and taking peptides? Like, how do they know? What are they looking for?

  22. 1:02:18 – 1:06:00

    What Happens When You Stop Taking GLP-1s?

    1. SB

      We talked about, um, tirzepatide, Ozempic, semaglutide. One of the questions that's front of mind for everybody-

    2. AT

      Mm

    3. SB

      ... uh, whether they're taking them or watching others take them-

    4. AT

      Sure

    5. SB

      ... is what happens when you stop?

    6. AT

      We've looked at that. You actually regain the weight. And so-- 'cause the truth is, is that you have introduced something into your life that has moved the needle in one direction, but if you don't change anything else, well, you take that back out, well, you're gonna go back to where you were. And so if you're going to maintain that weight loss, you have to make lifestyle changes associated with that. And what we found is that people do regain-- if they do make lifestyle changes, they do regain some of the weight, but not necessarily all of the weight. And there's also data showing that you could potentially stay on that medication, but at a much lower dose, and then maintain your weight, okay? So there are options to minimize your medication burden long term.

    7. SB

      And of all the things we've talked about today-

    8. AT

      Yeah

    9. SB

      ... if you had to just pick one thing that excites you the most that's either coming down the pipe or here already-

    10. AT

      Yeah

    11. SB

      ... what is the thing you're most excited about? I see your eyes wandering.

    12. AT

      Uh, h-hands down, it's that one over there, retatrutide, because the changes in body composition that we have seen both in clinical trials, okay, and in anecdotal reports from users who have obtained it on their own are wild. We're talking losing 20 to 25% of total body weight within a relatively short period of time, and I think that this is going to be basically the Ferrari of GLP-1 medications when it comes out. It's not for everybody, right? It's gonna go faster than everything else, but it's gonna change the game. I think this is going to be a trillion-dollar drug when it comes out.

    13. SB

      And no one's gonna own the patent, so everybody will be able to access it. Is that right?

    14. AT

      No, no. That is gonna belong solely to Lilly, and so you are going to see-- and they are going to enforce it, you know, uh, as aggressively as they've ever enforced anything, but you will see profound results in patients.

    15. SB

      People are referring to peptides as Silicon Valley's miracle drug, and I, I wondered why that was, why it's been associated with Silicon Valley. Have you heard that at all?

    16. AT

      I have, and I'll tell you, I've seen some, uh, peptide stacks from, you know, Silicon Valley, you know, uh, founders and, uh, you know, uh, individuals that blow my mind. I'm like, "Oh, man, even I think that's a lot."

    17. SB

      Why would pe-people in Silicon Valley, why would founders be interested in peptides?

    18. AT

      Well, I think it's because we all wanna live our, you know, best version of our own lives, right? We wanna perform at the highest level, and so, you know, people will do whatever they can. They'll drink caffeine, you know, they'll, you know, pop a Zen in their mouth, you know, and they'll try to tweak whatever variable they possibly can to get the best possible performance. And the thing is, is that anabolic steroids come with, you know, significant side effects, and that's not everybody's cup of tea, right? And the health consequences from high-dose androgens dwarf anything that you might experience with peptides. And so peptides offer a lot of flexibility in pulling many different levers that are interesting to, like, your regular, average, you know, person. And honestly, you know, it requires a little bit of DIY right now because of the nature of these peptides, and I think you combine that with the kind of rogue, you know, uh, founder, uh, uh, spirit that is common in Silicon Valley, and I think it's a perfect fit.

    19. SB

      I asked you a second ago, what are the three questions that people come to you and ask you as, as a doctor? The first one, as it related to peptides, was, "Which peptide should I be taking?"

    20. AT

      Yeah.

    21. SB

      Are there any other questions we haven't covered off that are commonplace in your practice?

    22. AT

      The second one is, you know, "Can you prescribe me?" And then I have to explain to them the regulatory environment, you know, surrounding peptides that, you know, as of right now, the only peptides that I can prescribe are the ones you can get from CVS or Walgreens, which is gonna be your GLP-1 medications and a handful of others that usually aren't applying to the young men that I see in my practice.

    23. SB

      I've had

  23. 1:06:00 – 1:07:53

    Ads

    1. SB

      so many founders speak to me and say, "Why didn't this particular ad that I ran on this platform work for me?" Maybe the copy wasn't good, the creative wasn't strong, but usually the problem is they're not having the right conversation because that ad never reached the right person. And if you're in B2B marketing, that is much of the game, and this is where LinkedIn Ads solves that problem for you. Their targeting is ridiculously specific. You can target by job title, seniority, company size, industry, and even someone's skill set, and their network includes over a billion professionals. About a hundred and thirty million of them are decision-makers. So when you use LinkedIn Ads, you're putting your brand in front of the right people. And LinkedIn Ads also drive the highest B2B return on ad spend across all ad networks in my experience. If you wanna give them a try, head over to linkedin.com/diary, and when you spend two hundred and fifty dollars on your first LinkedIn Ads campaign, you'll get an extra two hundred and fifty dollar credit from me for the next one. That's linkedin.com/diary. Terms and conditions apply. [paper rustling] We have finally caved in. So many of you have asked us if we could bundle the Conversation Cards with The 1% Diary. For those of you that don't know, every single time a guest sits here with me in the chair, they leave a question in the diary of a CEO, and then I ask that question to the next guest. We don't release those questions in any environment other than on these incredible Conversation Cards. These have become a fantastic tool for people in relationships, people in teams, in big corporations, and also family members to connect with each other. With that, we also have The 1% Diary, which is this incredible tool to change habits in your life. So many of you have asked if it was possible to buy both at the same time, especially people in big companies. So what we've done is we've bundled them together, and you can buy both at the same time. And if you wanna drive connection and instill habit change in your company, head to thediary.com to inquire, and our team will be in touch. [paper rustling]

  24. 1:07:53 – 1:11:24

    Is There A “Super Peptide” For Anti-Aging?

    1. SB

      Is there a super peptide for anti-aging in skin and some of those issues?

    2. AT

      Oh, for skin, GHK-Q.

    3. SB

      GHK-Q.

    4. AT

      Yeah. So this is, you know, uh, probably the most well-known peptide for, uh, use for skin complexion and, uh, I mean, really it may have some small benefits when it comes to hair, all right, but the, those reports are a little bit more spotty.

    5. SB

      Okay.

    6. AT

      Yeah.

    7. SB

      And then so outside of the world of peptides for a second.

    8. AT

      Yeah.

    9. SB

      I've got these three vials in my hand.

    10. AT

      I'm so scared. [vials rattling]

    11. SB

      [laughs]

    12. AT

      All right.

    13. SB

      Do you know what those are?

    14. AT

      Oh, yeah. Uh, this is, uh, unfortunately our, our future if we're not careful.

    15. SB

      Explain.

    16. AT

      So, you know, what we've got here is we have, uh, three different, uh, canisters containing water that has a, a little bit of coloring in it. And what you can see is that all the way back in 1973, this is pretty opaque, all right? Like, you know, this is not, uh, what you would... You can't see through it. And then 2026 has a little bit of color to it, and then we've got over here 2045, which is totally c- uh, clear. Uh, this unfortunately is actually representing the fertility trajectory for young men because what we're seeing is that back in 1973, total modal sperm count, so how many healthy swimming sperm do we have in each ejaculation, is exponentially higher and more dense than what we're seeing today. And so what we're seeing is a progressive decline in male fertility over time, and that's been demonstrated in multiple studies. We've debated this at multiple meetings. People have tried to argue that it's a measuring difference. But as we give it more time and as we give it more scrutiny, this is real. We are experiencing a significant decline in, uh, sperm quality and motility and concentration.

    17. SB

      Why?

    18. AT

      So the leading culprits are going to be, yes, microplastics and environmental toxins, okay? Things that are put in our environment that, uh, we have been exposed to that we can't help. But again, the biggest modifiable risk factor is insulin resistance and metabolic disease. So-

    19. SB

      Obesity.

    20. AT

      Obesity. And so a downstream effect that we may see from peptides like we discussed before is we may be able to help reverse this for the first time in history by trying to prevent the development of metabolic disease.

    21. SB

      Using some of the peptides we talked about earlier.

    22. AT

      Exactly. I gave you the example of a patient that I saw in clinic this past week that increased his sperm count 10 times over. Imagine if we had given that to him before he even got that obese, when he just started to get a little bit overweight and at a lower dose. Well, he may have never ended up in my office, right? Because his primary care doctor would've identified that, treated it, and he never would've needed the specialist.

    23. SB

      Hmm. It's crazy.

    24. AT

      It's wild. So, uh, ultimately, you know, if you look at what are the ills that are affecting healthcare in, you know, any first world nation, uh, the number one offender is metabolic disease and metabolic dysfunction. And this is something that was actually hinted at, you know, by, you know, RFK whenever he was talking about, uh, root cause of disease. Well, yes, we have many, many diseases and many, many infections that don't stem necessarily from insulin resistance. But if we look at cardiac disease, if we look at issues with lack of perfusion, my, my specialty, erectile dysfunction, right? We look at cancer. All of this is related back to obesity and metabolic dysfunction. And so if we can eliminate that, you know, as a society or we can minimize it to as little as possible, well, I mean, man, maybe I'd finally work myself out of a job.

  25. 1:11:24 – 1:12:16

    The Truth About Peptides And Erectile Dysfunction

    1. SB

      Your specialty is erectile dysfunction?

    2. AT

      Yeah. So my specialty is this branch off of urology that we broadly call men's health, okay? And so what that incorporates for us is going to be low testosterone, advanced hormone management. I take that a little bit further than most people. That's totally cool. And then also, uh, erectile dysfunction, Peyronie's disease, which is damage to the penis that causes curvature, and then, uh, male fertility on top of that. And I do a little other thing of treating leakage after, uh, prostate cancer treatment. And that's basically it. I treat like five things maybe, and, you know, that's it. So I'm very, very specialized because I was the kid that, you know, liked to take my sandwiches apart and eat it one at a time. I was very precise. And I figured, you know, you can do a lot of things in this world and be okay at them, or you can pick like, I don't know, four or five and get pretty good at them. So that seemed to work for me.

    3. SB

      I was looking at, at a photo of

  26. 1:12:16 – 1:19:17

    Why Medicine Burned Me Out—And What It Reveals About The System

    1. SB

      you five years ago, and you were very different.

    2. AT

      Yeah.

    3. SB

      You've changed a lot.

    4. AT

      So I will, I will tell you this. Um, medical training in the United States has gotten better, but it is grueling. It's absolutely grueling. For five years, I worked anywhere from eighty to a hundred hours a week in a hospital. No eating, very little sleep. Did not care for yourself at all. Um, and again, we can argue whether or not that's necessary all day long, but the truth is, is that it really beat me down. It absolutely took me apart physically and psychologically. In part, it's designed to do that 'cause the idea is that as a surgeon, you have to be able to perform when all the lights are on, when everything is against you, you have to be the one to hold it together in the operating room and command that ship and save that patient. And I remember being totally devastated towards the end of training, and I did a very challenging surgery on a very needy patient. Gentleman was about to go into renal failure, did not have a lot of kidney left, and he had a very challenging kidney tumor that was in a very treacherous location. It was in a location where he should have lost that kidney by all measure if we were gonna take out that cancer. And he was at a county hospital, he had no insurance, you know, and, uh, we swung for the fences and did a very, very challenging operation on him. And against our best efforts with having everybody there, he ended up having a bleed post-operatively that night. And I remember getting the call, I was on call, and that his blood pressure had dropped and that he did not look well, and I knew exactly what it was because, again, this was a very treacherous surgery. And I went in in the middle of the night with my attending, who was a different attending than the one I did the initial surgery with, and I remember just opening him up and just being covered in blood that we were taking out of the abdominal field, that we were evacuating, eventually identifying the area of the bleed, and there was no way that it could have been avoided. I remember my attending yelling at me, and we ultimately had to take that guy's kidney. And I remember walking out of there just being totally shattered, covered in blood, crying in a hallway by myself, wondering if, you know, like, what, what was the point? Like, is there gonna be a... Is there a tomorrow after this? Like, I spent all this time in this training. Like, am I good enough? Am I gonna be able to make this? And, you know, I wasn't well put together, wasn't healthy. Uh, and I ended up spending a lot of time with that patient, literally held his hand throughout the rest of his hospital stay, and he ended up recovering, uh, and, uh, against all odds. But, you know, afterwards, I took a strong interest in not only taking care of my patients, but also practicing what I preach, taking care of myself, and prioritizing my own health. I got evaluated. I was diagnosed with low testosterone myself. Turns out not eating or sleeping for five years will do a number on you, you know?

    5. SB

      That causes all stress.

    6. AT

      Through the roof twenty-four/seven. I cannot even imagine what... You know, there's a part in the brain, uh, called the hippocampus that they-- when they do MRIs on soldiers that come back from war, that'll be degenerated i-in them. I wonder if we did that in surgical trainees, what that would look like. But I made a commitment to take care of my patients, to take care of myself, and make that a priority and, uh, to be, you know, simultaneously the best doctor and, you know, the best father and, you know, husband that I could be. Not perfect. Made a lot of mistakes along the way, but, you know, what you're seeing from five years ago is where I was. You know, I'd been in training now for seven years, so it took a while to kind of recover from that. But what you're seeing is, you know, what focusing on health and wellness can potentially look like.

    7. SB

      The emotion in you is palpable when you talk about this, and I'm wondering where that comes from. What is it? 'Cause you're looking off into the distance at something, and I don't know what you're looking at.

    8. AT

      Yeah. I mean, I-- when I'm caring for my patients and I see a young man that is struggling with his fertility and he wants to be a father, I was that guy. Me and my wife couldn't get pregnant when we first tried. We ended up having to do in vitro fertilization, an IVF. I remember feeling like I wasn't a man because I was sitting in that room holding her hand and not having an answer as to why things weren't working. Um, when I see my patients who come in that are, you know, struggling because their hormones are out of whack, and no matter how they try to take care of themselves, something just isn't clicking, I've been that guy. And then when I see my other patients, you know, that are further on in life and struggling with things like, you know, prostate cancer or erectile dysfunction, whatever the case may be, I see, like, I see my, my, my father, my uncle, my grandfather. I... Like, these-- But-- And they are someone's father, grandfather, and uncle. Like, these are our brothers, and this is who I have been called to care for, and I care for my patients deeply. And it's because I care for my patients and, like, this is a calling for me, that I care about stuff like this because I want my patients to have every tool physically possible to live their best quality of life so that they can be whole and they can be happy, and so that they can be the best version of themselves for their loved ones.

    9. SB

      Mm-hmm. Well, thank you for caring 'cause it matters. And, uh, a lot of this stuff is quite opaque and confusing to an average person like me, but it's gla- I'm so glad that we have people out there in the world like you that are demystifying all of this for us and explaining it in simple terms, but also championing it because, you know, one of the thing-- other things I've learned from you in this podcast isSolutions to problems that a lot of people are suffering with are optioned right in front of us, but they need voices and educators like yourself out there, um, leading the charge so that these types of things are available to everyone, not just the few.

    10. AT

      Absolutely.

    11. SB

      Not just the billionaires who can get whatever they want straight away any day.

    12. AT

      Yeah. I mean, you know, it's, uh... One thing I, I love is that I've, I've been very blessed in my practice to take care of people that are much fancier than I am and sit in boardrooms and that sort of thing, but you know what? I love taking care of my, my regular patients who are, you know, farmers, iron workers, you know, tradesmen, guys that, you know, truthfully, I have more in common with than anyone else. You know, I joke with my patients, I'm just an over-educated plumber at the end of the day, right? Urologist. And so, um, it's, uh... Health is for everyone, not just for the fortunate.

  27. 1:19:17 – 1:23:06

    The Enhanced Games Explained—And Why They’re So Controversial

    1. SB

      The last thing I wanted to talk to you about is linked but random.

    2. AT

      Yes.

    3. SB

      It's the Enhanced Games.

    4. AT

      Let's do it.

    5. SB

      [laughs]

    6. AT

      I, I am so excited about these. So, um-

    7. SB

      Do you know them?

    8. AT

      I do, very well. So for those of you, or for, for those who may not know, the Enhanced Games is a project based off of the World Anti-Doping Agency's own data. Potentially up to 40% of athletes that are competing at the Olympic level have either are currently using or have used banned substances at some point in time. All right? And also, we know that a lot of the compounds that are used for enhancement maybe aren't quite so dangerous if they're being administered by a trained medical professional with proper oversight, and as of right now, that's not happening. Also, at the same time, we know that Olympic athletes aren't paid enough, right? These are the best of the best of the best, and they're not even making the poverty line a lot of years. And so the idea is this. Well, what if we go ahead and we strip away those rules? Okay? We allow athletes to use medications that can enhance performance. We watch them very closely, and we have a team of doctors and medical prof- medical professionals watching them, and then let's see what they can do at these traditional Olympic events and see if they smash world records. Oh, and they're gonna give two hundred and fifty grand to any first place winners and a million dollars to anyone that hits a world record.

    9. SB

      And just for comparison, how much are Olympic athletes getting paid?

    10. AT

      They don't get paid to compete at all, okay? So they don't get paid to be an Olympic athlete. They, uh, end up getting sponsorship deals, and that's potentially the money that they can make. So yeah.

    11. SB

      Interesting.

    12. AT

      Yeah.

    13. SB

      So it's basically the doping Olympics where everyone's allowed to dope.

    14. AT

      That's the idea. There are some caveats in there. They're trying to say that only FDA-approved medications can be used, okay? So you couldn't use something like trenbolone, which is for veterinary use only, um, or theoretically any of the compounds we've talked about today 'cause they're not FDA approved. But also at the same time, they've said that they're not gonna test for those things and one of their athletes, uh, Magnusson, has openly admitted to taking BPC 157 and that sort of thing. So I think we can kind of figure out that it may just be a wide open playing field maybe. So.

    15. SB

      The International Olympic Committee does not pay athletes a single cent for winning a gold medal.

    16. AT

      Yep.

    17. SB

      Just crazy.

    18. AT

      How many billions do you think they make off of those with all the advertisement?

    19. SB

      So much money.

    20. AT

      Right? Yeah.

    21. SB

      And this is taking place in Las Vegas.

    22. AT

      May 21st through the 24th, I believe.

    23. SB

      Are you gonna go?

    24. AT

      I'm gonna be watching, that's for sure. Yeah.

    25. SB

      Do you wanna go?

    26. AT

      I would love to go.

    27. SB

      [laughs]

    28. AT

      That would be incredible.

    29. SB

      Well, if you want to go, I know a few people that are, that are putting the event on, so do let me know.

    30. AT

      I'm there, man. I'm already interested. You got my, got my attention.

  28. 1:23:06 – 1:29:48

    How To Improve Erections

    1. AT

      last time?

    2. SB

      She brought it, and I didn't, I didn't ask her to-

    3. AT

      Do, do, do you-

    4. SB

      ... show me. It makes me like-- I get full body shudders when I think-

    5. AT

      Really?

    6. SB

      ... about this stuff. Yeah. The thought of putting that up my penis-

    7. AT

      Well, so the-

    8. SB

      You can show me. No, you can show me.

    9. AT

      Well, I will tell you, the good news is, is you don't have to.

    10. SB

      Okay.

    11. AT

      Okay? Like, that's, that's what we have a job for. Okay? But the way I explain it to patients is like this. So take this out of, out of the picture, okay? Ultimately, like, the male erection is just two inflatable tubes that start in the pelvis and go out the shaft of the penis. It makes sense, right? It is a hydraulic motion. What happens is you get stimulated, you get a rush of blood into those tubes, you get a rigid erection, able to use that for intimacy, and then when you climax, pop-off valve opens back up, and everything drains out. All right? So if you can understand brakes on a car, you can understand erections. But the problem is that when you have long-term metabolic and vascular dysfunction, the brake lines, the blood vessels that feed those erections, they fail, and all of a sudden you can't get enough blood flow for it to work. And believe it or not, you can actually get atrophy of the penis over time, and you actually lose size, all right? Which no man is eager to see.

    12. SB

      Yeah.

    13. AT

      All right? But whenever the easy things like oral medications, Viagra and Cialis, don't work anymore, the next best option if we're looking at patient satisfaction, durability, concealability, is this little thing that I do, which is what if we took our own tubes, okay, and we put them inside your body's natural ones? It's invisible. Nobody looking at you could ever tell that you've ever had anything done.But all of a sudden, when you wanna get an erection, instead of having to rely on pills that don't work or putting a needle in there, right, you could reach down and there's a small pump that we hide underneath the skin down in the scrotum, okay? So I joke it's like a third testicle, but again, nothing external, nothing you can see. And all of a sudden, whenever you squeeze this, what it does is it moves saline that we hide in a little reservoir that goes in the belly, you never feel that, into the cylinders, and all of a sudden men are able to get a firm, rigid erection that looks natural, feels natural, and they can use it as long as they want or until their partner's sick of them, and then press a button and it goes back down.

    14. SB

      Do they still feel the same pleasure?

    15. AT

      Yeah. So it does not affect sensation, and so the nerves that affect sensation run along the top of the penis, if you're looking at a clock, at the 12 o'clock position, and we stay totally away from those.

    16. SB

      So this is p- surgically put inside the penis?

    17. AT

      All internal. And believe it or not, that takes me about 13 minutes to do.

    18. SB

      How many people have these?

    19. AT

      Well, uh, I've put in about 11 or 1,200 personally. But-

    20. SB

      11 or 1,200?

    21. AT

      Yeah. Yeah, yeah.

    22. SB

      Okay, so it's quite a lot of people. There'll be people listening now that have these.

    23. AT

      Well, you know, this is what's interesting. If you look at, in the United States right now, okay, there are 30 million men with erectile dysfunction in the United States right now. That's more than the population of Australia. All right?

    24. SB

      Oh, wow.

    25. AT

      And if you look at statistics, the oral medications are gonna fail in 15 to 40% of those men the first time they fail that. And so you're talking about millions and millions of men who aren't responding to oral medications and need a better option.

    26. SB

      So where's the button to get rid of the erection?

    27. AT

      You see those two little bars right there?

    28. SB

      These two?

    29. AT

      Yep. Go ahead and put your thumb on... Yep, do that, and then squeeze, uh, from the end of the device back, uh, towards the pump.

    30. SB

      So squeeze and squeeze.

Episode duration: 1:29:48

Install uListen for AI-powered chat & search across the full episode — Get Full Transcript

Transcript of episode jt5hHb6kzYM

Get more out of YouTube videos.

High quality summaries for YouTube videos. Accurate transcripts to search & find moments. Powered by ChatGPT & Claude AI.

Add to Chrome