Dr. Ryan Greene On Peptide Therapy For Quick Injury Recovery & Better Performance (SSOF Ep. 31)

Dr. Ryan Greene0:50

So I had this idea for what is now Monarch Athletic Club, which is essentially a one-stop shop. So I figured, what's going to make the most positive impact in people's lives? And I realized, partially because I went to Mall of America in the U.S., which is this massive mega mall, but it has everything, right? And I say that because I showed up—I'm like, "Damn, people vacation here because they can park their car and everything's taken care of." I was like, "Why don't we do that with health?

Why don't we have a place where you can just show up, you can train, you can work on your nutrition, you can get taken care of if you have physical therapy needs, and the big one is you have access to preventative medicine with someone who's educated in the space?"

And it doesn't exist. Gyms are gyms, physical therapy is physical therapy, nutrition—you're just going to go work with someone. So unless you're a professional athlete, you basically have to invest a lot of time, effort, and energy to try to pull together these team members for your overall health and wellness outcome. And that's difficult. And clearly, if you look globally, our health outcomes and health status is continually getting worse, yet we have more tech than we've ever had in human history. So what's the disparity?

And our belief is it's because we don't do the simple things. We don't do the foundational elements of health. So we created a space where it's a membership model, one price point. You get unlimited personal training, physical therapy, quarterly evaluations with preventive medicine. You can meet with the medical team whenever you want to talk about whatever you want. It's your health. We want you to have a multidisciplinary team that's there for you every single day so that we can work on whatever needs to be worked on.

Because some days, for weeks, you may be in a great spot, but then you have an injury. Well, what happens typically? Now you have to go somewhere else to get treated, then hopefully you come back and then continue your progress. We just wanted to keep that all in-house, and that includes what you eat, what goes on inside your body, hormone optimization, peptides.

Because when people feel supported and they have a community around them where they trust—like, these people actually care about me getting healthier—and I don't have to go anywhere else for any other treatment, people make progress. And that's why, to use a different model, Amazon, Walmart, things like that, Costco, do well, because you can get everything you want in one spot. So we've replicated that on the wellness side and made it cost-effective.

In the U.S., you can also bill insurance for it. So we've really made it an insane value and almost something that people, when they join with us, and if for whatever reason they move or go somewhere else, inevitably they come back and they're like, "Damn, I had it really nice here because I had everything I could possibly want. And now I have to kind of piecemeal."

And unfortunately, when you have to do that piecemeal, people tend to regress to the mean, which means what they've always done, and that's usually not super healthy or health-promoting. It's kind of just survival versus thriving.

So that's the big picture. With peptides, in the preventive space, as I was going through my various different fellowships, I did a fellowship in integrative medicine at University of Arizona with a gentleman named Dr. Andrew Weil. So I learned a lot about complementary and alternative therapies. And just in my own reading, four or five years ago, I was learning about all these different peptide therapies. People like Ben Greenfield were starting to talk about it.

And I was just interested because it resonated in the sense that it's something that we naturally produce, for the most part, that's essentially augmenting our own physiologic processes. Obviously, too much of anything can be a bad thing, but synthetic compounds, medications, things like that, can definitely have adverse effects. So this seemed like something that was a little bit more consistent with how I wanted to practice, which was, "Let's give our body the tools to do what it normally does." And go from there.

So that's when I started working in the space, doing the research, getting educated on it. And since then, it's a tool that I'm able to offer our patients. But I say that firmly in the sense that it's a tool, right? It's not taking BPC, CJC, Morelan, TB-500, MGF Muscle Growth Factor, Hex, whatever, is not going to overcome people that don't sleep, they drink too much, they train too hard, they have a shitty diet. Sorry for swearing.

James de Lacey6:48

You can.

Dr. Ryan Greene6:48

I figure people listening to this probably swear every once in a while. Can't overcome it, right? So I take a hard stance in terms of, if you want to use these supplements—supplement a lifestyle. If you don't have a firm foundation, we're sitting on shifting sand. We have no idea what's going to work and what doesn't, and potentially we increase the risk of harm because we're still learning about what these things can and cannot do over a long period of time.

So I get a lot of patients who have been on growth hormone for a long time, they've been on test for a long time, they're doing Anavar, Winstrol, all sorts of that they got at—I was about to say another gym—certain gym locker rooms that just people take. And that's an unfair characterization, but it's rampant. And people just like, "Oh, scientist," or "I read this and I got it, yeah, I got it on the internet." And like, "I saw some bodybuilder said do this." I'm like, "Have you looked at your—have you looked at your liver? Have you thought about what is this doing to other aspects of your health?"

And I heard it on, I think it was the Huberman podcast with Peter Attia, and he's right. Bodybuilders these days are dying far younger than they should because they are—and we should be fortunate—they're basically forcing themselves and stressing and pushing the limit of what is the human body capable of. And we learn what it's capable of when we hit that point of no return. And unfortunately, for a lot of people, that's mortality.

So we're seeing the extremes. And in the world, we see the extremes. We got the people that push it really hard, and then those that don't do anything, which is the majority of people. And they're sedentary, diabetic, heart disease, overweight, obese. So we've got a lot of the extremes. I'm trying to get people to find a stable middle ground so that we can optimize human performance, because the body's meant to move, it should take care of itself. There's populations around the world—

Blue zones and the like that live regularly to a hundred years old without any incidence of disease, and what they're doing is not complicated. They eat clean, they move, they sleep, they pay attention to their preventive health, and they introduce themselves into communities that support them. Because if you have all those basic ingredients, then we can layer on cool stuff on top of that that will make your life incredible.

But if you don't have that, a lot of the stuff is not going to be very effective.

James de Lacey9:40

I wanted to come with some common questions that people might have, maybe learning about peptides. And the first one I guess is I like how you class it as a supplement, like a typical sports supplement. But what makes, say, a peptide different to typical, say, steroid use, like you mention people taking test, anavar, Winstrol, things like that?

Dr. Ryan Greene9:40

Yeah, it's a good question. So a lot of these hormones that people take in the bodybuilding community and just in the sport performance community, they are hormones. They cause some sort of end result, typically it's building muscle mass, something like that. But a lot of the hormones that are used, the body perceives their presence and says, "Great, we have healthy levels of whatever you're taking." I'll use testosterone as an example: you supply testosterone, anavar, whatever, testosterone levels go up, that's great.

Well, the body says, "Awesome, we don't need to produce our own right now because our test levels are good. It's coming from somewhere, it doesn't matter where." And then you start to see people who have testicular atrophy or fertility is impacted because they're taking test and anavar early. And when you shut down your natural machinery, there are unintended consequences I don't think people fully understand. And depending on how long you do it, if you don't off-cycle appropriately, it could take a long period of time for your body to recognize and reinitiate its own natural production.

And that's a big problem, and here is why: testosterone, hormones, things like that, they're neurosteroids. So they have an impact physiologically in our muscular skeletal system as well as other organ systems, but they also impact our cognitive function. And if you look at athletes with brain injury, multiple concussions, veterans with blast injuries, one of the issues that contributes to their anxiety, depression, PTSD-like presentation is hormone imbalance. Because when we hurt this, the stimulus for all the other hormones in the body decreases.

And so if you're going to take hormones or something like that and then all of a sudden you stop because you can't afford it or something happened, well, our body takes time before it recognizes that it needs to reinitiate. And then we have people that develop some not insignificant mental health issues because they're not producing the steroids, the hormones that help their brain function appropriately, maintain healthy mood. And that's a huge issue, right? We already have enough stress and anxiety and mental health disorders. We don't need to compound that by playing around with our hormones.

So that's a big one. Peptides operate in a different space because they're typically either pro-hormones, meaning they stimulate our body to produce our own hormone, or they're what are called secretagogues, which is basically a compound that tells a gland, usually in our brain, to start the cascade to produce growth hormone or IGF-1, whatever the end result may be. So those are the commonly used peptides.

There are others, like TB-500 we use a lot, that helps stimulate your thymic gland to basically help improve your immune system function to help deal with inflammation and sometimes autoimmune issues. That functions in a little different pathway. But the most common peptides that people use have to do with some sort of growth hormone elevation or muscle recovery.

And the benefit, so to speak, is it's not downregulating our own production, it's upregulating our own production, which is more sustainable, theoretically, than taking an actual hormone and suppressing our own natural production, which takes longer to regain. And sometimes people don't, if they take things for a very long time. So hopefully that answered the question. The peptides are a little bit more of the precursor, the stimulating molecule, versus taking a lot of these hormones which is the end result. And the end result tends to tell us, "Well, we don't need to make our own," and that can be problematic.

James de Lacey13:16

Is it stimulating enough of some of these more anabolic hormones to be really significant for improving performance for peptides, compared to, say, like a steroid, for example?

Dr. Ryan Greene13:45

So it depends. But here's what I will tell you: peptides are designed to be utilized in appropriate dosing for a long period of time. If you're looking for like a quick performance improvement, off the record, totally not medical advice, like steroids would be the faster response, but they are far more detrimental to your physiology.

The peptide utilization is kind of like exercise. Exercising once does nothing for you. Eating one salad, not going to change a poor diet. So the idea is that you're using it to enhance what you're already doing, to either keep you performing at a high level or recover faster or decrease joint pain so that you can keep performing at a high level, volume, whatever, over months, versus just like, "I'm going to go on a cycle for the next four weeks and explode."

So it's just different. I think of peptides like more of like the endurance sport, and steroids is kind of like your fast sprint. Does that make sense?

James de Lacey14:19

Yeah, that makes sense. Are there any risks currently with using various peptides there, or are we still kind of in the dark of we're still learning what could potentially happen?

Dr. Ryan Greene14:50

We're still learning, right. So in the U.S., the pharmacies that are able to produce peptides, for the most part, are pretty reputable. But it seems like fairly often the FDA comes in and shuts them down for doing something, and then another one pops up. So in terms of the safety, efficacy, quality, you really need to do your homework in terms of where you're sourcing your peptides from and understand, are they just an online, direct-to-consumer lab company, or is it a legitimate certified pharmacy? Like, that's part A.

Part B, in terms of the research, we just don't have enough longitudinal data to understand. We know with, for instance, synthetic growth hormone—omnitrope, somatropin, norditropin—they've been around forever. But they were designed to help cancer patients maintain muscle mass and not develop cachexia, or they're helping kids with growth development issues to elongate growth plates. They weren't designed for human performance.

And those things are synthetically compounded agents. Once they're in your system, they're going to make something grow. They're super effective, I will not doubt that. But that growth may be muscle, could be bone, could be cancer cell, could be immune system cell. Like, Andre the Giant had a growth hormone tumor and his face got wide, he grew enormous, and eventually his heart failed because his heart also grew because it's a muscle. And it eventually got so big that it couldn't support itself with adequate blood flow and he had a heart attack.

So those are the things that like the synthetic compounds we know pretty well. Like, too much exposure for too long a period of time can be problematic. Peptides, we're still learning. They've been used abroad in Europe and other places a little bit more liberally, so we have some decent evidence. But anyone that's going to come in with a fine-tooth comb would tell you that, based on our current accepted evidence-based standard, it's still evolving.

But the physiology of what's happening in terms of taking naturally occurring compounds, introducing them into your system to stimulate your body to pick up in areas that it's weak in terms of producing chemicals, compounds, hormones, or helping with inflammation, in my opinion, is probably a safer route to go than utilizing a lot of these synthetic hormones that people are more familiar with.

James de Lacey17:32

Is there much current evidence, like human trials with peptides? I know you mentioned funding's a bit impossible, but is it mainly animal trials so far?

Dr. Ryan Greene18:06

For the most part, there's some small, very poorly powered human studies, but they're mostly either case reports or again, like small cohort studies. So yeah, I mean if you have, like Dr. Andy Galpin's a good buddy of mine, like he would tell you that there's some decent trials out there. But it's more on the science and the physiology and the efficacy and safety profile, versus like looking at human performance, saying "These people did CJC, these didn't, this is how their performance improved."

And the other part that's tough with that is, to your point that you said initially, the population we want to study this in are the elite sport athletes, and we cannot, right, because it's illegal. So right there we're going to have a hard time kind of setting the standard in terms of like, how is this going to work in the high-performing individuals? And then it trickles down to the rest of us.

So hopefully we will find sources of funding that are a little bit more benevolent in nature and not necessarily profit-driven, that will help us fund some larger human trials. In the interim, it takes people like myself and other practitioners that use peptides on people regularly to develop our own small case studies, look at people's performance, make sure their overall health outcomes continue to progress and not introduce any risk of a negative health outcome.

At that point it's this is what we know about the molecule, this is what we've seen in animal studies, here's what we've seen in small human groups. In my opinion, if we're not directly causing harm and we're monitoring closely, which is again another big issue for people because you can order peptides online from a ton of different websites, but is it a high quality? Are you using it appropriately? Are you paying attention to the health metrics that matter that could be associated with a negative outcome? Probably not.

For the most part, if you have an educated practitioner that knows what they're doing and it's getting a high quality supplement, then they can educate you on what may be beneficial for you and monitor to see if we're appreciating the intended outcome.

James de Lacey20:08

Let's say someone's listening to this now and they're interested in maybe going down this road and experimenting with some peptides. Maybe they're just a hobbyist martial artist. They want to improve the quality of life, maintain build muscle mass, improve body composition, things like that. Where should they get started on this journey?

Dr. Ryan Greene20:33

So what I would have everyone do is one, you need lab data. Right? We just want to know that overall kidney liver markers of inflammation, potential diabetes risk factors, things that could be compounded by the use of hormones are present or not present. Because if they are, we want to know, and most people don't get blood work regularly. So you would want to know, same with your car, what's happening with the engine. Same thing with the body. You want to have a baseline so we at least know where we're starting.

The other parts are, if you're not eating well, hydrating, sleeping, none of this matters. It's a moot point. Assuming we have all of that, then what I would do is I would really write down and appreciate what are your goals. To your point, I want to feel better, recover, build some muscle mass, improve my body composition. Very common.

And in those cases, something like a sermorelin or CJC-1295 ipamorelin, things that are going to help boost our natural growth hormone, IGF production, help us get better sleep, recover better, will be beneficial because that's going to help us perform more volume more frequently, which will allow us to achieve a lot of those goals that we're hoping for. And that's why it's illegal in pro sport. Because if you have a pitching athlete that can get back and do nine innings every two days versus four days, that's a competitive advantage.

Again, the reason it's illegal in pro sports is it's a competitive advantage. So if you can get up and do more volume more frequently, that's an advantage. For the rest of us, you and me and anyone listening, for the most part it just allows us to train at a higher volume more consistently, which will then theoretically help you build more muscle mass, burn body fat. Because if you can go harder more frequently, theoretically your health outcomes and goals that you want to achieve can be done in a more expeditious manner.

So that's the common one that I talk about, is the sermorelin, tesamorelin, CJC-1295, ipamorelin. Anything with the suffix morelin is pretty good in terms of recovery. But it's not an anabolic agent, I'll say that 100%. It is not going to stimulate muscle protein synthesis in the way a testosterone or an anabar does. What it's allowing you to do is recover so that you can do more more often, which should theoretically then allow you to achieve strength and muscle mass goals.

So that's a pretty well-known, well-studied, often utilized peptide family, is the morelin family. The one downside is it does increase insulin sensitivity. So most people do it right before you go to bed because that's when we tend to have the largest growth hormone production is when we're sleeping, which is why sleep is important for recovery. But sometimes these things cause hypoglycemia, so low blood sugar, and I have a decent number of patients, especially early on, who would use these peptide compounds to try to help improve body composition, but they'd end up eating 2,000 calories right before they went to bed because they were ravenous, and it had the opposite effect.

So I just try to warn people in terms of this may be one of the side effects that you experience. And if so, and you have to eat something, try not to just do a whole bag of potato chips. Drink water, have a scoop of almond butter or something like that.

Anyway, so that's a pretty common one, but you need to have your health foundations dialed in again. So anyway, what we figured out is we produce BPC naturally, and it helps heal our gut. So you can do BPC one of two ways. For people with irritable bowel, gut inflammation, things like that, you can take it orally, but it's not going to have the impact that we've discovered from when you synthesize it and introduce it parenterally, meaning inject it, which we've found tends to really be beneficial in terms of repair of ligament and tendon.

So for people with chronic strains, sprains, things like that, BPC, when introduced, and I've actually found it's more effective when introduced locally, closer to the site of injury versus just in your belly fat, tends to be very effective when used for two to three months in terms of helping reduce inflammation, help encourage and then expedite healing of ligament and tendonous injury. The oral form just doesn't penetrate the gut too well because it's kind of designed to stay in the lumen to help heal the endothelium or the inner lining of the gut.

So there's two ways to take it, both very effective. I take BPC orally every day. I use it parenterally every day, technically Monday through Friday. For me, I train at least once a day, sometimes twice if I have the time. I don't get as much sleep as I should, but knock on wood, I've stayed pretty well kept in terms of reducing injury.

James de Lacey26:12

So what I guess, what's the mechanism behind improving tendon, ligament, I guess health in terms of injury? And then I know you mentioned about taking BPC as well, so I've heard that it can be used for gut health or digestive health as well. So maybe dive into a little bit.

Dr. Ryan Greene26:12

Yeah, so the mechanism of BPC is still being elucidated, but one of the things that we know in terms of the muscle and the ligament and tendon standpoint is it seems to promote fibroblast activity in ligament and tendon, as well as the direction and migration of localized fibroblasts into areas that can help ligament and tendon healing.

In terms of the gut health standpoint, the BPC in terms of the collagenous support and the endothelial repair of the gut lining basically occurs as stomach acid transitions from the stomach through the intestine. And so damage occurs every time that we have a dump of some sort of fluid from our stomach into our gut, and we naturally produce this BPC in stomach acid to start repairing those endothelial cells as this acidic fluid is transitioning through.

So in terms of the exact mechanism, still being understood. Seems to improve collagen repair, especially in tendon and ligament and the gut, just endothelial support, I guess is the best way I can describe it.

James de Lacey28:10

I guess the question becomes for someone getting into this, there's a couple of things. Price point, what kind of price should people be expecting to pay for, I guess, for peptides? I'm assuming there's different prices based on the peptide. Then how do you know if you're getting good quality peptides? That's the other thing.

Dr. Ryan Greene28:10

It's a good question. Price, difficult to say, depends on where it's coming from. Most of the stuff that we get from our pharmacies is around $200 per vial per month. If it's an oral, it's probably 100 U.S., what it is in other countries.

James de Lacey28:10

How long does a vial last?

Dr. Ryan Greene28:10

30 days, so about a month.

The pills, if you're using it orally, have a longer stability profile, but those are going to be around 100 U.S., as I mentioned. Quality is the tough one. So any pharmacy that's regulated in the U.S. should have certification of certain quality metrics, purity metrics. And if they're synthesizing injectable compounds, they should be testing every new batch for purity, and you have the right to ask for those pieces of data. Your physician can get that for you. You may not be able to get it as the end user, but your physician definitely can. So you can ask for that.

In terms of if you're getting it just over the internet, the tough part is how do you know that their certificates of authenticity, purity, and quality are legitimate? I have no idea. Short answer, I have no idea.

So that's the tough part, and that's why I'm hopeful that there will be more opportunities to have high quality product that can be dispensed appropriately by well-educated practitioners. But as anything in the bodybuilding and the sport performance space, the industry in terms of the formal medical space tends to be far behind what's happening in labs all over the world, and people just use themselves as guinea pigs.

Try to figure out what works and what doesn't. So yeah, that's a risk that people take.

James de Lacey30:25

I know you mentioned good practitioners that can prescribe. So I'm now based in Austin, Texas, and I've seen there's a bunch of peptide therapy places around. Is that the kind of thing that you would recommend for someone to maybe seek out if that's available in the area?

Dr. Ryan Greene30:25

Yeah, I think if you find a practitioner that's well-educated in peptide therapy, functional medicine, integrative medicine, that's a good place to start. Depending on the practitioner, they may or may not have experience in the space. Hopefully, anyone that you seek out will emphasize again those foundational elements of health that we talked about so that the peptides have the opportunity to amplify what they're doing. But that's a good place to start.

And also the thing is there's no shortage of peptides. There's probably 50 or 60 that are currently available through most, actually maybe high, maybe 30. But a lot of them had to do with sport performance initially. Now we're seeing others like PT-141 is a great one for libido, and it doesn't have the same side effect profile as taking Viagra or Cialis because it doesn't cause this massive vasodilation, which could cause complications for people with cardiac issues, which tends to be the big problem with Cialis and Viagra.

PT-141 tends to be a central nervous system libido-stimulating peptide that helps people want to engage in sexual activity. So that is recently becoming very commonly prescribed and utilized in the medical space. Has nothing to do with sport performance, but sexual performance could be very helpful, right? So there's a lot of stuff coming out.

The question is for a lot of people, and I try to make this—I say the answer is always simple: if you go in and you come out with five different peptides you're using, we also don't have the data on what works synergistically, what antagonizes what else. So kind of pick your priority and introduce some sort of regimen and see how you do.

And then if you do well, you achieve your goal, great, stick with it, and then try something different, versus just leaving a practitioner's office and you have multiple different variables you're now about to introduce into your system, and we don't really know what's going to work well, what's not, what plays well with others, what doesn't. We're still figuring that out.

So that's the other thing that I would recommend for people is have an intention in terms of what you're doing and try to chip away at your list of goals before we just toss everything in all at once.

James de Lacey33:00

Is this something then—I know you mentioned with BPC-157 it might be say a two to three months stint based on an injury—but obviously with the other ibutamorens or Ipamorelin-style peptides that are more body composition, is this something that you would take ongoingly for years, or is it something you kind of—

Dr. Ryan Greene33:00

Six months is kind of the max that I have people do it, and then I give themselves some time off because, again, we don't fully understand the long-term risk of continued exposure. So it's medical monitoring and shorter durations of therapy should kind of be the goal, at least initially.

Once we understand more, have a greater understanding of long-term safety and efficacy, then perhaps this could be something like what we see with testosterone, where as long as your PSA and your prostate does well and your hemoglobin levels are okay and you don't want to have kids, you may be able to do low-dose testosterone for the rest of your life reasonably if you want to, right? But we just don't know quite yet.

James de Lacey33:59

So I think what might be valuable for the listeners as well is I guess your own experiences using peptides: kind of what you have used or are using, what you found to be beneficial, how you felt taking certain ones and things like that. Because I think that kind of gives a little more insight into what's—

Dr. Ryan Greene34:24

Yeah, and I tell people I wouldn't recommend something that I wouldn't do myself. So I'll give you my protocol. My day-to-day is I'm up at 5:30, I train, I work, we're building multiple different businesses, so I'm in the office from 7:30, 7:45, I get home around 10:00, wind down, read.

I try to be in bed by 10:30, but recently it's been 11, 11:30. Up at 5:30 every single day, Monday through Sunday, right? So it's a lot. So I don't sleep as much as I should, and that's something I'm aware of and shame on me, but I'm working on it.

That being said, I train at least once a day. I work in a—we created a facility that has a fitness component, so I'm fortunate I can walk out my office door and go train if I have 30 minutes and want to, which is amazing, and I usually do, especially towards the end of the day because I just want to get some fresh blood flow. It's kind of my meditation to the day, movement.

So anyway, I want to be able to perform. I want to be able to do what I want to do at a high level for as long as I want to do it. So I take nightly CJC-1295 Ipamorelin. Helps me get good quality sleep, helps me in terms of muscle recovery. Knock on wood, as I said before, haven't had any injuries, haven't been sick, and literally have not missed a day of anything—work, residency, or otherwise—in 11 years.

I ate some bad venison over a decade ago and that took me down for a day, but so in terms of my recovery, my immune system support, CJC-1295 Ipamorelin for me has been definitely a game changer.

But I'll do it for about six months and then I'll take a couple of months off. For me, what do I notice? I'm able to get up, work out, put up numbers, continue to perform at a high level, and I can literally show up and play beach volleyball or do a CrossFit class, whatever, and I can do it well. So for me, that's important. I just want to be able to do things that I enjoy at a high level. So that's my nighttime.

During the day, in the morning, I do BPC-157. And obviously just for me it's kind of just more ligament and tendon maintenance. I don't have any specific injuries, but I appreciate the value of what it's doing. So I'll do that for a couple months at a time. Right now I'm on BPC, but I'll stop probably at the end of this month, will be my third month.

And then I've been messing around with something called kisspeptin. So people that are listening probably are aware that HCG used to be used quite commonly for testosterone support. And now compounded HCG is essentially prohibited in the US—it's very difficult to get, and if you find it I'd be quite cautious using it. Kisspeptin is kind of the precursor that stimulates testes to increase testosterone production. It's one of a couple things that it does.

So I'm just kind of playing around with it to see if I notice—is my libido better, is my energy better, is my mood and cognitive function a little bit better?—and then testing my testosterone levels to kind of see where I'm at. So that's a relatively new one that I'm playing around with because for some people, if I can get them to not necessarily have to take testosterone to help with testosterone support and not necessarily have to do Clomid, and there's a peptide alternative, I'm interested in that.

So I'm doing three things right now: two in the morning, CJC at night, sleep great, perform well, have a ton of energy. I'm 35, I feel like I'm 19, I'm in a great spot. And if I slept more, I'd be unstoppable, you know? So there you go.

James de Lacey38:07

Nice. I guess what might be interesting as well is what kind of changes would someone expect to see on their blood work in terms of hormonal changes, anything like that?

Dr. Ryan Greene38:07

Yeah, so for the CJC, inflammation reduction. If we're healing better, especially if you're working out hard and you're introducing a lot of micro or macro muscular hypertrophy, or God, micro muscular inflammation secondary to tissue damage, that'd be an interesting one.

I think for A1C, people that are struggling with insulin sensitivity, maybe borderline pre-diabetic, diabetic, do we see a regression in A1C? Because we're increasing our insulin sensitivity, therefore controlling our blood sugar a little bit better. That's an interesting one.

With the BPC, especially if people have injuries, subjectively are they healing? Is pain increasing in intensity? If there's chronic inflammation secondary to repeated injury, are we improving that with BPC? The kisspeptin one is going to be a testosterone play. Is my testosterone level going up? Is my luteinizing hormone level going up? Is my free test percentage going up? That's one I'm interested in following up on.

But for the most part it's inflammation and chronic disease risk metrics such as hemoglobin A1C and kind of diabetes risk. That's what I'm interested in for right now.

James de Lacey39:48

Nice. I want to almost kind of jump back a little bit from the peptides and look at hormone optimization. Obviously you mentioned the big rocks: sleep, good nutrition, etc. Obviously we need all that. But are there any nutritional supplements that someone could take that might help—

I guess optimize testosterone, things like that. We're talking about Tongkat Ali and then Fadogia Agrestis, two commonly used compounds, those popular by Huberman, right? He kind of made those popular.

Dr. Ryan Greene40:20

Well, they were popular before Huberman. They've been used for a while in other cultures. Long story short, personally in my patients, for people who have elected to go that route to try to naturally support their hormone health, specifically testosterone, I haven't seen a lot of result. Part of that could be they weren't using it consistently, or the tough part with nutraceuticals is the quality of the supplement. It's difficult to confirm that you're getting a high quality supplement.

And then the other part with anything that's administered orally: one, digestion is necessary. How it's being processed in the liver, what's actually getting into your peripheral vascular system is different based on every person. So if you're drinking, you're taking other meds, you're taking a ton of other supplements, we may not get exposure to the concentration necessary to stimulate result. And I can't change that because that's your physiology.

So for me, if you're going to invest in some sort of optimization supplement, I prefer intramuscular, subcutaneous, IV if it's going to be crazy enough. But oral is tough because there's a lot of steps that you don't get to control in terms of digestion, processing, absorption, filtering in the liver. Does that make sense?

Vitamin D is very helpful for healthy testosterone levels, partially because vitamin D helps stimulate your melatonin, helps regulate your circadian rhythm. So if you get good sleep, you tend to get better hormone outcomes. Boron is a mineral associated with the production of healthy testosterone levels. So a lot of people in a hormone stack, they'll do vitamin D, they'll do Boron.

Zinc picolinate specifically is beneficial for decreasing sex hormone binding globulin, which if elevated can essentially cause the inability of our body to access testosterone molecules because it's being bound up on its receptor sites by SHBG. And SHBG is elevated in people that have elevated liver activity. So if they're taking a lot of meds, supplements, drinking too much, SHBG goes up. It's elevated in people that are overweight. It's elevated in people that are exposed to xenoestrogen. So whether in women it's often birth control, so synthetic estrogens, for the rest of us it's all the various different plastics and things that we're exposing ourselves to.

So zinc picolinate can help decrease SHBG, which can allow us to use our testosterone a little bit more freely and increase our free testosterone levels. So yeah, there's a handful of stuff that you could use. That being said, the best way to figure out if it's going to work for you is to try it, test and retest. What's my baseline? What am I introducing? What are my outcomes?

And even then, saying, "Okay, my test is 400, I need it to be 800. I'm going to add Tongkat, Fadogia, zinc." If it goes up, what was the... was it just... I have no idea. And that's unfortunately where people, especially in the hormone space or any performance optimization, it takes time to really see how your body is going to respond, unless you're just going to jump in and do the anabolic agent.

And most people, checking their test, investing three months in training, nutrition, some supplements, retesting, and if they don't see a lot of improvement, they're like, "Why am I doing this?" And then they just bail, versus, "Okay, that experiment didn't work. Let's try this for the next few months." And it's unfortunate because we have this instant gratification culture where if I don't get the result I want immediately, I'm not going to do it. And then we end up falling back on what we've always done for a lot of people, which is poorer health behaviors.

So I would encourage anyone who's going down this path who really wants to improve their quality of life, performance, whether it's in sport or just general life, recognize you, for the most part, I'm assuming listeners here are in their 30s to 50s, maybe late 20s. You've got decades left of your life. Why not invest some time, effort, and energy to figure out what's going to work for you to optimize your overall quality of life moving forward?

James de Lacey44:35

That's awesome. Well, in this one here, right, for anyone else, we had some technical difficulties, but I would love to continue on and get to... might have to do a round two at some point anyway. But if anyone wants to find you, follow you, what you're doing, learn more about peptides, everything like that, where can they find you?

Dr. Ryan Greene45:09

Yeah, so our website for Monarch is monarchclubs.com. Instagram is Monarch Clubs. My personal Instagram is Dr. Greene with an E at the end, underscore DO. And if you reach out, I'm really good at getting back to people rather quickly, because if you have a question and you're willing to ask it, I've always promised myself I would help out. So just don't feel bad about it. Just may take a little bit of time because we're about to open another facility, so things are getting busy.

James de Lacey45:39

Oh, long work hours.

Dr. Ryan Greene45:39

Yeah, yeah, yeah, less sleep, less sleep. No, all good.

James de Lacey45:39

But thanks for coming on, Ryan, really appreciate it. And hopefully listeners got something out of it in terms of the whole peptide chat and maybe enlightened a little bit with what's going on in the world. So thank you.

Dr. Ryan Greene46:06

Thank you for having me.