FDA Reverses Peptide Ban as Compounded Drugs Threaten Pharma Revenue

配制药物威胁药企营收，FDA撤销多肽禁令 配制多肽以远低于专利药的成本提供靶向临床治疗，推动监管层面走向官方重新分类。 Alex Tatem 博士剖析了多肽作为高度特异性细胞信号传导机制的运作方式，并将其靶向特性与传统药物进行了对比。他探讨了 FDA 针对配制药房发布禁令背后的政治与经济摩擦、未受监管的灰色市场的出现，以及近期的监管转变。讨论重点介绍了其广泛的实际应用，从通过 GLP-1 减重、利用 BPC-157 进行组织修复，到优化睡眠、焕活肌肤和维持肌肉。此外，Tatem 博士还就导致医生职业倦怠的系统性原因、体育界的体能增强药物，以及针对男性生殖健康的外科干预措施坦率分享了见解。 多肽是由氨基酸构成的精准分子链，其作用方式如同针对特定细胞受体的钥匙，相较于全身性小分子药物，产生副作用的风险显著更低。 (5:34) 受2013年美国最高法院判定天然生物序列不可申请专利的影响，大型跨国药企因缺乏专利保护与高投资回报动力，一度大幅搁置了天然多肽药物的研发。 (8:54) 在2023年突遭禁令后，FDA定于2026年7月举行听证会，重新评估将BPC-157、TB-500及Epithalon等七种核心多肽移回Category 1合法复合药房制药目录。 (24:48) 绝大多数多肽在口服后会被胃酸和消化酶迅速水解失活，因此通常必须通过皮下或肌肉注射才能达到预期的治疗效果。 (28:01) 相较于大型药企固定周剂量的商业自动注射笔，503A复合药房的替尔泊肽等GLP-1制剂支持分次微量给药，可平稳维持血药浓度并减轻肠胃道不良反应。 (29:20)

Urologist Dr. Alex Tatem argues that targeted peptide therapies offer precise biological interventions with fewer systemic side effects than traditional pharmaceuticals, though patent structures and regulatory restrictions have pushed patients into risky gray markets. Precision Lock-and-Key Biological Mechanisms (5:34) Peptides are short chains of amino acids that Dr. Tatem describes as targeted "keys" designed to activate specific cellular receptors, contrasting with traditional small-molecule drugs that act like blunt "hammers" causing widespread off-target side effects. While clinical use began a century ago with insulin in 1921 and later Lupron in 1985, recent applications focus on targeted tissue signaling. A prime example is BPC-157, a synthetic peptide sequence derived from human gastric juice that stimulates localized blood vessel formation (angiogenesis) to accelerate tendon and mucosal healing, exhibiting high tolerability in preclinical models without an identifiable lethal toxicity threshold. Because peptides consist of amino acids, normal digestive enzymes and stomach acids degrade oral forms into basic nutrients before they can deliver a therapeutic signal. Consequently, with rare exceptions such as specific arginate salt gut formulations or topical GHK-Cu creams for skin collagen synthesis, peptides must generally be administered via subcutaneous or intramuscular injections to reach circulation intact. Patent Law, Compounding Bans, and Gray Markets (8:54) The commercial peptide landscape shifted following the 2013 U.S. Supreme Court decision in Association for Molecular Pathology v. Myriad Genetics, which established that naturally occurring biological sequences cannot be patented. Because unpatentable peptides offer little intellectual property exclusivity, large pharmaceutical manufacturers historically had minimal incentive to spend upwards of $100 million on clinical trial pipelines. Licensed 503A compounding pharmacies stepped in to fill this gap, offering customized, microdosed formulations until late 2023, when the FDA reclassified 19 prominent peptides into Category 2, effectively halting their legal compounding. Dr. Tatem attributes this regulatory clampdown in part to corporate economic pressure, noting that low-cost compounded alternatives divert market share from high-priced patented drugs. The ban created a "forbidden fruit" effect that drove consumer demand toward an unregulated gray market selling chemical vials labeled "For Research Use Only." Dr. Tatem warns that these products risk microbial or heavy metal contamination. However, access may soon shift: on April 15, 2026, the FDA scheduled a July 2026 hearing to evaluate returning seven key peptides—including BPC-157, TB-500, MOTS-c, and DSIP—back to Category 1 for legal compounding. Metabolic Therapies and Muscle Preservation (43:32) Metabolic management has become the primary commercial driver of the peptide sector. GLP-1 receptor agonists like semaglutide and tirzepatide delay gastric emptying and enhance insulin sensitivity, generating projected revenues that rival leading artificial intelligence companies. Dr. Tatem cautions, however, that rapid weight loss induces severe caloric deficits that break down vital skeletal muscle alongside fat tissue. To counter this catabolic state without the fertility-suppressing effects of exogenous testosterone, pharmaceutical pipelines are advancing monoclonal antibody myostatin inhibitors, such as bimagrumab, roledumab, and trevogrumab, to preserve lean mass. The next therapeutic frontier is retatrutide, an unreleased triple-receptor agonist targeting GLP-1, GIP, and glucagon receptors. Clinical trial data show retatrutide achieves 20% to 25% total body weight loss while substantially clearing liver fat in non-alcoholic steatohepatitis. Dr. Tatem projects retatrutide will become a trillion-dollar drug for Eli Lilly, though he notes that patients who cease GLP-1 therapies without maintaining permanent nutritional and exercise habits inevitably regain lost weight. Metabolic Roots of Declining Male Fertility (67:53) Dr. Tatem connects metabolic health directly to a broader reproductive health crisis, pointing to projections showing an exponential collapse in global sperm counts from 1973 toward critically low densities by 2045. This decline is largely propelled by systemic insulin resistance and obesity compounded by environmental toxins. Correcting underlying metabolic dysfunction with GLP-1 medications can restore endocrine function; Dr. Tatem cites a clinical patient whose sperm count increased tenfold after losing 100 pounds on tirzepatide. For advanced vascular complications where medical management fails, mechanical interventions become necessary. Dr. Tatem highlights that approximately 30 million men in the United States suffer from erectile dysfunction, with oral PDE5 inhibitors failing roughly 15% of patients on their initial trial. In severe, end-stage vascular cases resulting from diabetes or prostate cancer treatment, surgeons can implant internal three-piece inflatable penile prostheses, providing a durable mechanical alternative that bypasses damaged vascular tissue while preserving sensory nerves. While peptides offer highly targeted therapeutic mechanisms for metabolic and tissue recovery, their future depends on forthcoming regulatory reviews and resolving intellectual property incentives. Dr. Tatem emphasizes that peptides are medical adjuncts rather than replacements for exercise and nutrition, warning patients to seek physician-guided treatment rather than unregulated research chemicals.

泌尿外科专家兼多肽学者 Alex Tatem 博士指出，多肽作为由氨基酸构成的靶向生物信号分子，正在深刻改变代谢管理、组织修复与内分泌调节的医学实践；但他强调，天然多肽专利保护的缺失导致了商业资本的冷遇与监管博弈，迫使患者在合规配制受限与高风险灰色市场之间艰难权衡。 锁钥机制与注射给药的生物学特性 (3:35) Tatem 解释称，传统小分子药物如同粗暴的“重锤”，在发挥疗效的同时常因击中多个非预期靶点而带来广泛副作用；相比之下，多肽由特定氨基酸序列折叠而成，在人体内如同精密钥匙对应专一受体。以源于人体胃液保护机制的 BPC-157 为例，该合成多肽通过促进损伤区域的血管新生来加速组织修复，在动物完全断裂跟腱模型中诱导了自愈，且在毒理学测试中表现出极宽的耐受空间。 在给药途径上，人体消化道会将绝大多数口服多肽视为普通蛋白质，胃酸与蛋白酶会迅速将其拆解为游离氨基酸并使其失去生物信号功能。因此，除经特殊盐修饰用于胃黏膜局部治疗的剂型外，大多数治疗性多肽必须经由皮下或肌肉注射进入血液循环。外用制剂则存在特例，例如铜三肽 GHK-Cu 可通过外用乳霜促进胶原蛋白合成，而 Semax 则能通过鼻腔黏膜喷雾直接向中枢神经系统递送信号。 专利博弈、监管审查与黑市风险 (8:54) 2013 年美国最高法院在 Myriad Genetics 案中确立了天然生物序列不可被授予专利的法律准则。这一判决直接削弱了大型制药企业斥资数亿美元推进天然多肽临床审批的商业动力，使未受专利保护的多肽制剂主要依赖合规 503A 配制药房按处方配制。然而，FDA 在 2023 年将包括 BPC-157 在内的 19 种多肽移出允许配制的类别，官方理由为缺乏充分临床试验数据，但 Tatem 认为这也与制药巨头维护专利垄断药品的商业利益密切相关。 监管禁令随即引发了“禁果效应”，患者需求未被消灭，而是转移至缺乏监管的网络“仅供研究使用”（RUO）灰色市场。Tatem 将购买未经检验的科研多肽比作食用“加油站寿司”，警告其存在严重的无菌缺失、杂质超标及内毒素风险。政策拐点正初步显现：FDA 已计划在 2026 年 7 月召开正式听证会，审议将 BPC-157、TB-500、MOTS-c 等 7 种核心多肽重新移回合法配制类别。 代谢重塑、肌肉保护与三靶点突破 (53:58) 在代谢健康领域，替尔泊肽等 GLP-1 受体激动剂通过延缓胃排空与提升胰岛素敏感性确立了治疗标杆。Tatem 重点预测，由礼来研发的三重受体激动剂 Retatrutide（同时激活 GLP-1、GIP 及胰高血糖素受体）将在临床中带来 20% 至 25% 的全身减重幅度，并在改善非酒精性脂肪性肝炎（NASH）上取得突破性进展，未来有望成为产值达万亿美元的单品。 然而，剧烈的热量缺口极易引发肌肉流失等分解代谢后果。Tatem 强调，针对减重期肌肉保留，医药行业正加速研发阻断肌肉分解酶的单克隆抗体（如 Bimagrumab 等肌肉生长抑制素抑制剂）。在抗衰老与组织修复领域，临床更倾向于联合使用 CJC-1295 与 Ipamorelin 等促生长激素分泌物，以刺激垂体生理性分泌生长激素与 IGF-1；Tatem 明确反对直接滥用外源性生长激素，警示其存在诱发严重胰岛素抵抗、关节积液压迫神经甚至肢端肥大症的风险。 代谢衰退与男性生殖健康危机 (67:53) Tatem 指出，环境毒素（如微塑料）与现代生活方式引发的胰岛素抵抗和肥胖，正在导致全球男性精子数量与活动力呈现持续性衰落，其模型警示若按既有轨迹发展，到 2045 年男性整体生育力可能面临极严峻的局面。临床证据表明代谢与内分泌紧密相连，Tatem 分享了一位重度肥胖且少精的患者案例，该患者在通过替尔泊肽减重 100 磅并改善代谢后，精子计数实现了十倍增长，成功自然恢复生育能力。 对于长期代谢损伤与糖尿病导致的终末期血管性勃起功能障碍（ED），全美患者群体高达约 3000 万人，且一线口服药物在约 15% 的患者中初次尝试即告失败。作为泌尿外科专家，Tatem 详细解析了隐蔽式可充气阴茎假体植入术，该手术耗时约 13 分钟，通过生理盐水储液囊与内置泵体完全替代受损的血管充血机制，在保留患者原有感觉神经与射精体验的前提下，提供了极高满意度的持久解剖修复方案。 Tatem 总结认为，多肽并非取代健康饮食与阻力训练的“免费午餐”，但其作为高度专一的生物靶向工具，为解决代谢紊乱与器官衰退提供了传统小分子化学药无法比拟的临床精准度。这一新兴医学领域的未来，有赖于监管机构厘清配制药房与专利药物的权界，在消除地下黑市安全隐患的同时，确保广大患者享有安全合法的治疗途径。

## Background 本期内容由知名播客频道《The Diary Of A CEO》（主持人 Steven Bartlett）于 2026 年 4 月 20 日发布在 YouTube 平台上。节目邀请了国际知名泌尿男科专家、研究肽类长达 12 年的 Alex Tatem 博士，围绕 FDA 对 19 种多肽的突击封杀内幕、大药企的利益博弈、多肽在人体代谢与抗衰修复中的实际运作机制，以及全球男性生育力和勃起功能障碍等健康危机展开全面剖析。 ## TL;DR Alex Tatem 博士用通俗的“乐高积木”比喻拆解了多肽高特异性的生物学机制，并重点分析了 BPC-157、替尔泊肽以及研发中的瑞他鲁肽（Retatrutide）等在创伤修复、内脏减脂及逆转代谢紊乱上的惊人表现。对话尖锐揭露了大药企因天然多肽无法申请专利而动用监管力量打压复方药房、逼迫公众流向昂贵处方药或危险黑市的商业现实。此外，Tatem 博士深入探讨了 GLP-1 药物导致的肌肉流失隐患、前沿肌生成抑制素抗体的前景，并结合三管精液模型与自身从医经历，直面全球男性生育力暴跌和代谢疾病恶化的严峻危机，同时详细科普了治疗终末期勃起功能障碍的阴茎假体植入手术。 ## Atmosphere & style 整场对话在严谨硬核的医学解密与深沉动人的真情流露之间自然切换，现场长桌上摆满的实物药瓶与人体模型为讨论注入了强烈的现场探索感。Steven Bartlett 的提问敏锐直接且充满好奇，而 Tatem 博士则兼具科学家的清晰逻辑与一线医者的同理心——他不仅毫无保留地调侃自己的身体劳损与用药实践，更在回忆艰难手术抢救和自身备孕不育的经历时红了眼眶。这种剥离掉权威架子、直面体制残酷与人性脆弱的真诚表达，让听众在吸收前沿生物黑客与代谢医学知识的同时，深受医者仁心与生命脆弱性的震撼与感染。 ## Bulletin - [46:16](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=2776s) 多肽产业规模正逼近整个人工智能行业，仅司美格鲁肽与替尔泊肽年营收预计突破550亿美元，算上复合药房体量已达数百亿美元规模。 - [24:48](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=1488s) FDA迎来重大监管转向，计划于当年7月重新审议将BPC-157、TB-500等7种核心多肽从二类禁用清单移回允许复方药房合法配制的一类清单。 - [53:56](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=3236s) 下一代三靶点药物Retatrutide（瑞他鲁肽）引入胰高血糖素受体，不仅减重达20%至25%，还能强效逆转脂肪肝，但民间在获批前已出现地下注射风潮。 - [01:08:10](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=4090s) 全球男性生育力正面临断崖式危机，自1973年以来精子总数持续滑坡，其首要可逆元凶是肥胖与胰岛素抵抗，而非不可控的外界毒素。 ## Key takeaways - [02:48](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=168s) 多肽是由氨基酸构成的蛋白质片段，机制犹如高特异性的“精密钥匙”，能精准靶向细胞受体，脱靶副作用远低于传统小分子药物的“大锤式”打击。 - [05:34](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=334s) BPC-157作为胃源性保护多肽，在动物实验中实现了跟腱全层离断后的自发愈合，且在常规毒理学测试中耐受性极高、未测出LD1上限。 - [09:14](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=554s) 2013年最高法院裁定天然存在的物质不得申请专利，直接导致传统大药企丧失研发天然多肽的动力，为503A复合药房提供了薄利多销的市场空间。 - [12:30](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=750s) FDA在2023年突然将19种主流多肽列入禁用清单，背后不仅出于三期临床数据缺失的监管推断，也深陷大药企游说与利益挤压的博弈。 - [20:42](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=1242s) 官方禁令反而引发了“禁果效应”与社交媒体狂潮，导致大量贴有“仅供科研使用（RUO）”标签的劣质多肽流入灰色市场，带来严重安全隐患。 - [28:01](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=1681s) 除极少数特殊剂型外，绝大多数多肽口服会被胃酸与消化酶破坏成普通氨基酸，必须通过皮下或肌肉注射绕过胃肠道方能生效。 - [29:58](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=1798s) 503A配制药房的小药瓶允许医生根据患者情况采用“微剂量分频给药”，既维持了全天候平稳血药浓度，又极大减轻了原厂笔单次大剂量的严重胃肠副作用。 - [36:44](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=2204s) 多肽并不能凭空创造肌肉，IGF-1 LR3等物质仅能提供辅助，没有规律高强度的抗阻器械刺激与蛋白质补充，增肌绝无可能发生。 - [38:09](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=2289s) GLP-1受体激动剂通过平抑血糖峰值显著提升胰岛素敏感性，但刺激生长激素分泌的促泌剂多肽会对抗胰岛素，代谢综合征患者需慎用。 - [39:02](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=2342s) 外用铜三肽GHK-Cu能穿透吸收并刺激真皮层胶原蛋白与弹性蛋白再生，改善面部潮红与细纹，属于目前少数合规且证据充分的外用抗衰多肽。 - [40:51](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=2451s) Semax能通过鼻黏膜给药穿透血脑屏障促进神经突触修复，而DSIP与Selank则针对性重置生物节律并诱导慢波深度睡眠。 - [43:30](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=2610s) GLP-1药物带来的剧烈热量赤字会导致肌肉同步流失，医学界正研发Bimagrumab等肌生成抑制素单克隆抗体，以实现只减脂不掉肌肉的突破。 - [52:46](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=3166s) Melanotan II虽能极速美黑但存在诱发黑色素瘤风险，其带来的强烈勃起副反应已被剔除色素沉积机制并正式开发为商业处方药PT-141。 - [01:02:18](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=3738s) 停用GLP-1药物后体重必然出现反弹，建立可持续的底层健康生活习惯或长期维持超低微剂量是避免成果全面回退的必要策略。 - [01:25:11](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=5111s) 美国有3000万男性患有勃起功能障碍且约15%口服药无效，耗时仅13分钟的全内置充气式阴茎假体植入术成为保留快感与逆转病变海绵体的终极救赎方案。 ## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=0s) 开篇预告：改变游戏规则的肽与暗藏的危机 演播室的长桌上摆满了各式各样的药瓶，Dr. Alex Tatem 指着其中一种神秘的化合物直言，这可能是桌上最具争议的存在——它能够以不成比例的惊人速度专门消解腹部脂肪。更不可思议的是，临床观察发现它不仅能让患者实现剧烈减重，还能带来前所未见的肝脏健康改善，未来极有可能成为一款价值“数万亿美元”的重磅药物。与此同时，监管层面正酝酿着一场地震：美国食品药品监督管理局（FDA）预计在七月份重新审议并将七种肽类物质合法化。这一动向被认为直接威胁到了大型跨国药企的商业根基；在被问及大药厂是否因为无法为天然结构申请专利而试图打压肽类普及排挤普通大众时，Dr. Tatem 毫不犹豫地给出了“110%肯定”的回答，因为肽的应用潜力几乎没有上限。 桌上的小药瓶被逐一检视，揭示了当下生物黑客与功能医学领域最火热的前沿物质：有广为人知用于改善皮肤光泽、强健发质与指甲的美容肽；有被部分人奉为“青春之泉”但 Dr. Tatem 对此持保留态度的依匹伐隆（Epithalon）；有夜间注射以显著提升深度睡眠质量的调控肽；以及极具戏剧性的黑色素诺坦2号（Melanotan II）——该物质仅需微量紫外线照射就能让皮肤呈现深邃的小麦色晒黑效果，但 Tatem 幽默地特别警告，它还会带来“你这辈子经历过最持久凶猛的勃起”。不过，他也对滥用现象泼了冷水，比如很多人盲目服用期望延年益寿的亚甲基蓝（Methylene Blue），不仅缺乏可靠延寿证据，还会把指甲和头发彻底染成蓝色。 除了肌肉生长刺激剂与组织创伤修复肽，Dr. Tatem 还展示了三支触目惊心的小试管，它们代表着现代年轻男性精子质量与生育能力暴跌的残酷轨迹，直言“如果我们再不警惕，这就是我们不可逆的未来”。 - **腹部脂肪靶向肽**：具备极高选择性减脂与逆转肝损伤潜力，被预测具有万亿美元级市场规模。 - **FDA 关键动向**：预计在 7 月份推进 7 种被禁肽类的重新合法化评估。 - **黑色素诺坦2号（Melanotan II）**：促进极速晒黑并伴随强烈的勃起刺激副反应。 - **亚甲基蓝（Methylene Blue）警告**：盲目跟风不仅难以延年益寿，还会导致头发与指甲变蓝。 - **男性生育力危机**：微量精液样本对照直观展示了全球男性生殖健康断崖式下跌的现实。 --- ### [01:58](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=118s) 订阅呼吁：保持节目的纯粹与深入 在进入更深入的医学探讨前，主持人 Steven Bartlett 与观众分享了一则后台数据。团队监测发现，大量日常追更的忠实观众会在不知不觉中被系统自动取消订阅。Steven 坦言频道正处于向全新里程碑数字冲刺的关键节点，他恳请大家顺手核对订阅状态，并承诺团队会继续拼尽全力，每周挖掘最具深度的嘉宾与前沿对话，以此回馈观众并保持节目的完全免费与独立制作。 --- ### [02:48](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=168s) 什么是“肽”：用乐高积木解密生命钥匙 近年来公众对“肽（Peptides）”一词的关注度呈现爆发式增长，搜索量骤增超过400%。作为一名希望优化身体机能、延缓衰老却对生化机制感到困惑的普通人，Steven 向 Dr. Tatem 抛出了最底层的疑问：肽到底是什么？Dr. Tatem 解释道，肽是一类独特的药物结构类别。现代医药中最常见的传统“小分子药物（Small Molecules）”体积微小，通常制成口服药片，进入人体后往往会在全身范围内产生弥散性、广泛性的生理影响。而肽则是源自氨基酸构成的蛋白质片段。 为了让非专业人士直观理解，Dr. Tatem 拿出了乐高积木做比喻：氨基酸就像是构成人体和蛋白质的基础积木块。正如他的小儿子能用同一套乐高积木在一分钟内拼成一艘冲向外太空的火箭，拆开后又能拼成一艘海盗船，紧接着又改装成一辆赛车一样；相同的氨基酸积木通过不同顺序与三维结构的排列组合，就能折叠成执行完全不同生理任务的“定制功能肽”。 从机制上讲，小分子药物往往像一把大锤，而肽更像是一把精密制造的“钥匙”，专门去开启细胞表面高度特定的“锁”（受体或细胞通路）。人类对肽的医学应用其实历史悠久：世界上第一个被人工分离并应用于临床的肽正是1921年问世的**胰岛素（Insulin）**；而在泌尿外科领域，1985年获批的**亮丙瑞林（Lupron）**也是一种肽类激素，它通过精准下调内分泌级联反应来切断晚期前列腺癌患者体内的睾酮供应。 ```mermaid flowchart TD accTitle: 肽与小分子药物机制对比 accDescr: 对比传统小分子药物的广谱作用模式与肽类物质的高特异性钥匙开锁模式 subgraph SmallMolecule ["传统小分子药物 (以口服药片为主)"] direction TB SM["小分子结构"] --> Hammer["功能类似'大锤'"] Hammer --> Broad["广谱作用于全身多器官"] Broad --> SideEffects["伴随较多脱靶效应与潜在毒性"] end subgraph PeptideMechanism ["功能性肽 (Peptides)"] direction TB AA["氨基酸基础积木 (Lego)"] --> Fold["特定空间构象折叠"] Fold --> Key["高特异性'钥匙'"] Key --> Receptor["精准锁定靶细胞受体/信号通路"] Receptor --> Precision["高度定向修复 / 极少脱靶副作用"] end ``` --- ### [05:34](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=334s) 靶向钥匙与钝锤的较量：以BPC-157为例的神奇修复机制 深入对比小分子药物与肽的差异，Dr. Tatem 指出，小分子药物就像一把笨重的大铁锤——用来钉钉子固然干脆利落，但如果拿它去拧螺丝，或者组装一套结构精细的宜家（IKEA）家具，结果往往会把周围的板材砸得稀烂。许多研发中的小分子药物正是因为缺乏精准度，在起效的同时触发了全身性毒副作用，最终倒在严苛的 FDA 临床审批流程中。相比之下，肽由于天然模拟人体内部的信号语言，靶向性极其明确。 Dr. Tatem 从桌上拿起一瓶备受推崇的 **BPC-157** 进行剖析。BPC-157 是一种人工合成的五胜肽片段，其原型天然存在于哺乳动物的胃液中。人体的胃部在本质上是一个充满强酸的“强腐蚀性消化袋”，但人体自身组织却没有被强酸消化溶解，原因就在于胃黏膜演化出了极为强大的自我修复机制，而 BPC 体系正是促进局部血管新生（Angiogenesis）的核心物质。科学家将这种分子机制提取出来，在动物模型中展现出了极其震撼的组织修复能力。 在一项经典的动物实验中，研究人员将大鼠的跟腱（Achilles tendon）进行**全层完全离断手术**——这不是健身房中常见的韧带拉伤或撕裂，而是彻底切断。随后为实验大鼠给药 BPC-157，大鼠断裂的跟腱竟然实现了自发性的结构愈合。更令人瞩目的是其极高的安全性边界：在毒理学研究中，通常会测定导致半数实验对象死亡的半数致死量（LD50），甚至更严苛的 1% 致死量（LD1）。然而在针对 BPC-157 的多项安全测试中，研究人员至今都无法确定其 LD1 剂量的上限，因为其在生物体内的耐受性极其优秀，至今未观察到明显的突发性毒副作用。 - **BPC-157 源起**：基于人体胃黏膜强效防御机制提取合成的胃源性保护多肽。 - **核心生物活性**：高效激活创伤部位微血管生成，将营养与修复因子定向输送至无血管或少血管区域（如韧带、肌腱）。 - **重磅动物实验证据**：实现实验鼠手术离断跟腱的结构性自发愈合并恢复功能。 - **卓越安全性表现**：常规毒理学测试中未能测出 LD1 剂量，体现出极佳的生理相容性与低毒性特征。 ### [09:14](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=554s) 为什么多肽突然爆发？2013年最高法院判决与商业死局 面对桌上摆放的一整排多肽药物试剂瓶，主持人发出疑问：为什么多肽这个话题在当下突然引爆了整个社会的关注？Dr. Alex Tatem 指出，这一切的转折点始于 2013 年美国最高法院对“巨擘遗传公司案”（Myriad Genetics case）的历史性判决。当时，该公司成功测序并识别出诱发乳腺癌、卵巢癌以及前列腺癌的高危基因——BRCA1 与 BRCA2，并随即申请了专利，声称拥有其知识产权。这一举动引发了轩然大波，反对者认为人体天然存在的东西不能被注册为专利。最终最高法院判定：任何源自人体、天然存在的事物（例如人体肌肉细胞或基因序列），均不可申请专利。 这一保护人体的判决却产生了一个意想不到的负面副产品：商业制药公司彻底丧失了研发这些天然化合物的动力。如果一种极具前景的天然分子不能被专利垄断，大药企就无法在后续获得排他性的商业回报，整个传统研发渠道因而陷入停滞。 ```mermaid flowchart TD accTitle: 多肽商业与监管演变流程 accDescr: 展现从2013年基因判决到2023年FDA下架多肽的整个逻辑链条 subgraph Legal["法律与专利转折 (2013)"] A["最高法院判决: 天然物质不可申请专利"] --> B["传统大药企丧失研发动力 (无法独家垄断)"] end subgraph Compounding["复合药房崛起 (2014-2023)"] B --> C["复合药房填补空白: 薄利多销直接提供给患者"] C --> D["FDA设立三类监管目录: 19种核心多肽列入第一类允许配制"] end subgraph Ban["监管收紧与封杀 (2023)"] D --> E["2023年FDA突然将19种多肽转入第二类 (全面禁用)"] E --> F["官方理由: 缺乏完整临床试验数据"] E --> G["潜在动机: 商业大药企利益受到挤压"] end ``` ### [10:20](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=620s) 复合药房的历史变迁与FDA的三类监管清单 大约在同一时期（2012至2013年间），新英格兰地区发生了一起严重的公共卫生丑闻：一家复合药房（Compounding Pharmacy）因操作违规导致制剂遭受污染，引发了致命的真菌性脑膜炎疫情，大量患者受到感染。过去，复合药房一直由各州自行监管，但这起事故促使美国食品药品监督管理局（FDA）强势介入，实施全联邦层面的统一监管，明文规定复合药房可以生产和不能生产的药物范围。 为了让听众理解这一背景，Dr. Tatem 解释了“复合药房”的本质。在19世纪或20世纪初，患者买药是去街角药房，由药剂师用研钵和研杵针对个人情况现场调配定制药物；随着现代化工业流水线的建立，制药业走向标准化批量生产。但流水线生产往往是“一刀切”的——无论是体脂率极低的健美运动员，还是超重慢性病患者，其降压药的成年人标准剂量可能完全一致，这在生理学上并不完全合理。现代复合药房不再是拿着研钵的小作坊，而是能够为特定患者定制剂量和配方的大型高科技工业企业。 2014年监管法规敲定后，FDA将复合原料划分为三类监管清单： - **第一类（Category 1）**：列入批准清单的活性成分，明确允许复合药房合法配制。早期绝大部分备受瞩目的多肽均在此列。 - **第二类（Category 2）**：存在明确负面安全信号的物质，严禁配制。 - **第三类（Category 3）**：尚待进一步研究并补充数据的成分。 ### [12:30](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=750s) 药企利润逻辑与2023年多肽的“一夜封杀” 将一种新药推过 FDA 的完整审批流程通常需要耗费数千万甚至数亿美元。对于以营利为目的、背负股东回报和员工薪资压力的大型药企而言，在缺乏专利垄断保护的情况下斥巨资进行临床开发无异于“做慈善”，因此它们直接放弃了天然多肽的开发。这给复合药房创造了生存空间：它们跳过数亿美元的专利研发成本，直接合法合成这些化合物，以较低的利润空间开具处方并销售给患者。从 2014 年起，包括 Dr. Tatem 在内的临床医生开始合法为患者开具这些多肽处方。 然而到了 2023 年，局势急转直下。FDA 在几乎没有任何预兆的情况下，突然将原本位于第一类清单中的 19 种主流多肽一夜之间转移到第二类禁用清单中。医生们瞬间收到了来自合作复合药房的群发邮件，告知其因监管突变，所有相关多肽制剂必须立刻停产。 ### [14:19](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=859s) 临床疗效、明星多肽与被禁背后的利益博弈 当主持人询问这些被禁的多肽此前在临床上是否真的有效时，Dr. Tatem 给出了极其肯定的回答，强调只要“用对钥匙开对锁”，它们的改善效果十分惊人，且在规范使用下并未观察到严重的不良反应（Adverse Events，如严重过敏或呼吸困难）： - **MK-677（Ibutamoren，伊布莫仑）**：虽然分子结构上属于小分子而非严格意义上的多肽，但它被归入同类监管。这是一种口服的生长激素释放肽/胃饥饿素（Ghrelin）受体激动剂，不仅能显著促进自体生长激素释放，还会极度激发饥饿感。临床上它曾是治疗恶病质（Cachexia，如癌症晚期严重消瘦、营养不良患者）的特效手段，能帮助极度虚弱的患者恢复进食并摄入维持生命所需的热量。 - **GHRP-2 与 GHRP-6（促生长激素释放肽）**：能够刺激脑下垂体释放自体天然生长激素，广泛用于组织修复、减脂及促进肌肉合成。 - **BPC-157 与 胸腺肽β4（Thymosin Beta-4 / TB-500 衍生化合物）**：能够显著促进血管生成（Angiogenesis，即新生血管的生成）和机体软组织修复，常用于加速各类创伤与运动损伤患者的康复进程。 针对官方封杀的理由，FDA 当时召集专家开会给出的正式说法是：由于这些化合物从未走完正规商业药企昂贵的三期临床审批流程，因此属于“缺乏充分安全性数据”，在监管逻辑上被推定为“存在潜在风险”。但 Dr. Tatem 尖锐地指出，在多年的临床广泛应用中，现实世界并没有出现群体性的安全灾难。更深层次的阻力可能来自于传统商业制药巨头的利益诉求：患者在复合药房购买多肽所花费的资金流出了传统制药体系，正如他所讽刺的那样，大药企“确实热爱医学，但前提必须是它们自家的药物”。 ### [17:31](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=1051s) 药企的资本逻辑与“禁令”背后的利益博弈 当被问及大型制药公司（Big Pharma）是否出于自身利益而极力阻止普通大众获取肽类物质时，亚历克斯·塔特姆博士（Dr. Alex Tatem）毫不犹豫地给出了“110% 确信”的回答。现任政府官员以及小罗伯特·F·肯尼迪（RFK Jr.）本人甚至曾公开指出，FDA 在 2023 年对肽类实施的突击禁令实质上是“非法的”。塔特姆博士解释道，尽管制药巨头旗下未必有一款与 BPC-157（一种能强效促进组织与创伤愈合的肽）直接竞争的现成专利药，但每个普通消费者的医疗预算都是有限的——如果患者将每月有限的开支用于几十美元的复合肽制剂，这笔钱就绝不会流向商业药企昂贵的专利处方药。 ```mermaid flowchart TD accTitle: 药企资本驱动机制示意图 accDescr: 展示制药企业并非传统意义上的恶魔，而是以利润最大化为目标的庞大机器及其对患者的影响 subgraph CapitalEngine["资本逻辑机器"] A["商业制药公司"] -->|"机器法则"| B["追求股东利润最大化"] B -->|"排斥无专利低成本竞品"| C["限制复合肽合法供应"] end subgraph PatientImpact["临床前线困境"] C -.->|"挤压替代治疗手段"| D["消耗高额专利处方药支出"] D --> E["普通患者深陷慢病与功能障碍"] end subgraph MedicalMission["一线医生使命"] F["希波克拉底誓词"] -->|"临床倡导者"| G["争取有效、可及的治疗方案"] end ``` 谈及医疗体制的现状，史蒂文·巴特利特（Steven Bartlett）与塔特姆博士达成了一种冷峻的共识：商业世界的残酷之处不在于存在某些像“光明会（Illuminati）”或“毁灭军团”那样身披斗篷在暗室策划剥夺公众健康的恶棍，而在于“整个大型商业机构本就是被设计为将利润置于一切之上的精密机器”。在这些机器眼中，患者的健康微不足道。作为一名恪守希波克拉底誓词的临床医生，塔特姆博士坦言这让他感到巨大的道德撕裂感——在他每天坐诊的诊室里，坐满了前列腺癌术后长期受勃起功能障碍折磨的男性、急于组建家庭却饱受不孕不育折磨的年轻夫妻，以及受激素失衡摧残多年的普通人。他认为一线医生必须充当病人的捍卫者，不仅要在诊室里救治他们，更要在公共舆论中为大众争取这些药物的使用权利。 ### [20:42](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=1242s) 禁令两周年的反弹：“禁果效应”与社交媒体狂潮 距离 2023 年 FDA 叫停大批肽类复合制剂大约过去了两年，公众对肽的讨论不降反升，甚至形成了前所未有的全网热潮。针对这一现象，塔特姆博士指出了背后极其微妙的心理与传播机制：“这完全是‘禁果效应’（Forbidden Fruit Effect）在起作用。”大众的心态非常直白——如果这些物质真的毫无效果，监管部门何必大费周章地连夜查禁？正是官方的封杀，从反面印证了它们立竿见影的功效。 与此同时，这种爆发离不开移动互联网媒介生态与政治力量的合流： - **TikTok 与短视频裂变**：过去两年来，各类关于身体改造、伤病恢复与生物黑客的短视频呈病毒式扩散，绕过了传统医学垄断话语权。 - **高层政治风向逆转**：美国卫生与公众服务部（HHS）及 RFK Jr. 等领导层的介入，让原本处于灰色地带的监管争议被彻底推向聚光灯下。 ### [21:16](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=1276s) 震撼病例：从极度肥胖到精子计数翻十倍的“人生逆转” 在谈到肽类化合物创造的最不可思议的临床奇迹时，塔特姆博士分享了一位严重代谢障碍导致不育的年轻男性的真实康复故事。在传统泌尿男科门诊中，最令人沮丧的群体之一就是极度肥胖合并重度少精甚至无精症的年轻人。严重的胰岛素抵抗与肥胖彻底摧毁了患者的内分泌轴，下丘脑与脑垂体无法发出足够的促性腺激素信号，睾丸随之陷入停摆状态。 ```mermaid flowchart LR accTitle: 代谢综合征致不育与肽干预机制 accDescr: 展示重度肥胖导致男性不育的内分泌病理机制，以及替尔泊肽如何通过减重与修复代谢从根本上扭转精子生成 subgraph Pathology["病理机制：治标不治本"] P1["重度肥胖与胰岛素抵抗"] --> P2["内分泌与促性腺轴停摆"] P2 --> P3["严重少精症 / 不孕不育"] P4["传统手段仅刺激睾丸"] -.->|"未解决根本病因"| P2 end subgraph PeptideIntervention["多肽突破：根源扭转"] T1["替尔泊肽 Tirzepatide"] --> T2["成功减重 100 磅"] T2 --> T3["逆转胰岛素抵抗"] T3 --> T4["精子计数提升 10 倍达正常水平"] end ``` 以往的对症下药——单纯使用促排或外源刺激药物强行让睾丸“开工”——往往收效甚微，因为激素失衡只是表象，真正的病根在于全身性的严重代谢崩溃。但让重度肥胖患者仅凭意志力减重又极其困难。突破出现在 GLP-1/GIP 类多肽药物（如替尔泊肽 Tirzepatide 与司美格鲁肽 Semaglutide）普及之后： - 塔特姆博士接诊的一位男性患者在替尔泊肽的辅助下，配合严格的饮食管理与规律运动，**成功减重 100 磅（约 45.4 公斤）**。 - 就在录制节目的前一周复查中，该患者的**精子计数暴增了整整 10 倍**，完全恢复到了正常受孕范围。 - 这一改变不仅避免了高额痛苦的辅助生殖周期，更从根本上扭转了一个年轻家庭的人生轨迹，而这波澜壮阔的转变最初仅仅始于一枚微小的多肽分子。 ### [22:46](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=1366s) 像手机 App 一样多能：肽的多靶点潜力与 AI 驱动的产业重塑 为了向大众解释肽类在人体内的运作逻辑，塔特姆博士打了一个极其生动的比方：肽就像智能手机上的各种应用程序（Apps）。在移动 App 出现之前，人们想要在线处理银行业务极其繁琐低效；而 App 出现后，除了替你叠衣服以外，手机几乎能处理一切日常任务。肽分子在生物学层面扮演着类似的角色——人体本身就具备极其精密的受体网络，而各种特定的短肽就像专门编写的应用程序代码，能精准启动特定的生理修复与调节程序。 从功能版图来看，肽的应用早已跨越了传统药物的狭隘边界： - **减重与代谢管理**：以司美格鲁肽和替尔泊肽为代表的 GLP-1 类多肽，通过神经与消化双重靶点调控代谢。 - **皮肤新生与抗衰**：铜肽（GHK-Cu）可强效改善皮肤质地并刺激胶原蛋白合成。 - **肠道黏膜修复**：BPC-157 在溃疡性结肠炎和肠漏症的黏膜再生中表现出惊人潜力，成为近期 FDA 专项审查的焦点。 - **神经与睡眠节律重塑**：特定肽分子能直接修复大脑松果体功能，重新调谐褪黑素分泌与昼夜节律周期。 塔特姆博士指出，面对肽类时，问题不再是“它们能做什么”，而是“有什么是它们做不到的”。令人玩味的是，传统制药巨头虽然在公共舆论和监管层面阻击非专利复合肽，暗地里却在疯狂布局——各大跨国药企纷纷豪掷数以十亿计的美元与 AI 肽类研发初创公司签约，利用人工智能算法设计高通量合成肽。在不久的将来，由药企背书、价格高昂的商业化专利肽产品势必呈指数级涌入处方药市场。 ### [24:48](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=1488s) 重磅政策转折：FDA 拟将 7 种“重磅”肽移回一类合法化名录 访谈录制当天恰逢 4 月 15 日，美国医药界迎来了一则重磅突发新闻。FDA 刚刚发布正式新闻稿，宣布将于当年 7 月召开听证会，正式审议将 7 种核心肽类化合物从严厉限制的“二类（Category 2）”名单移回允许复方药房合法调剂的“一类（Category 1）”名单。这标志着对关键肽类长达两年的高压封锁首次出现实质性松动。 ```mermaid flowchart TD accTitle: 拟重归一类合法名录的 7 种核心肽类分布 accDescr: 展现本次 FDA 拟解禁的 7 种核心多肽及其主打的生理功能分支 subgraph SevenPeptides["FDA 拟解禁复方制剂的 7 种关键多肽"] subgraph Repair["组织修复与血管新生"] P1["BPC-157: 肠胃黏膜与肌腱韧带创伤修复"] P2["TB-500: 促进局部血液供应与细胞骨架构建"] P3["KPV: 抗炎免疫调节与血管生成"] end subgraph Metabolic["线粒体与耐力代谢"] P4["MOTS-c: 瓶装运动分子 / 上调 ATP 生成与提升最大摄氧量"] end subgraph NeuroSleep["脑功能提升与深度睡眠修复"] P5["Semax: 强效神经营养与认知专注力提升"] P6["DSIP: 诱导深度慢波睡眠"] P7["Epithalon: 松果体与褪黑素时钟调节"] end end ``` 塔特姆博士在现场逐一拆解了这 7 种备受瞩目的先锋多肽的临床价值： - **BPC-157**：本次松绑清单中的头号明星，核心功用是强效促成运动损伤、韧带撕裂及胃肠溃疡的系统性组织修复。 - **TB-500**：BPC-157 的黄金协同搭档，其作用类似向战损部位输送“工程兵部队”，通过激活肌动蛋白（Actin）并促进局部微血管增生，为受损组织基质的物理重建提供血液供应。 - **KPV**：一种具有强效抗炎特性并促进血管生成与组织再生的短肽。 - **MOTS-c**：常被生物黑客界誉为“装在药瓶里的耐力运动”。它源于线粒体基因组，通过直接上调细胞能量代谢通路产生更多 ATP，能够显著提升人体的最大摄氧量（VO2 max）与运动耐受度。 - **Semax**：专注于神经系统与大脑认知功能优化的高效脑力肽，在提升专注力与思维清晰度方面表现亮眼。 - **DSIP（诱导睡眠肽）与 Epithalon（松果体素原）**：两者共同主打中枢神经系统的调休与抗衰老，在重置人体睡眠-觉醒节律周期、促进深层恢复性睡眠中扮演着不可替代的角色。 ### [26:33](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=1593s) 灰色市场的崛起与“仅供科研使用”的文字游戏 当监管机构在 2023 年对多肽类药物施加禁令后，市场并未如官方预期的那样停止运转，反而迅速催生了庞大的灰色市场。Dr. Alex Tatem 将这一现象比作美国当年的“禁酒令”时期：一旦政府出台一刀切的禁令，黑市与私酒作坊便应运而生，不仅伴随着走私与黑帮活动，还带来了劣质、受污染产品的泛滥。多肽禁令的后果如出一辙，各类灰色网站开始公然贩售贴有“仅供科研使用（Research Use Only, RUO）”标签的小药瓶。 这种标签是商家精心构筑的法律避风港，旨在规避 FDA 的管辖范围。商家声称“这瓶药水只是卖给你做小白鼠实验的，不是让人类注射的”，但买卖双方心知肚明，买家购买它们就是为了给自己注射。Dr. Tatem 直言，这种灰色市场产品的质量控制毫无保障，在网上购买它们就像去“加油站吃生鱼片（gas station sushi）”——虽然你确实能买到并吃下去，但你根本无法确认那到底是不是真正的生鱼片，而且结局往往会很糟糕。尽管确实有些人在灰色市场上碰巧获得了效果，但缺乏标准化的生产环境蕴含着巨大的安全隐患，这也是为什么医疗专业人士坚决主张将多肽规范化地纳入“503A 配制药房（503A compounding pharmacy）”监管框架的原因。 ```mermaid flowchart TD accTitle: 监管禁令如何催生多肽灰色市场 accDescr: 展示监管禁令导致合法渠道关闭，进而催生不受监管的灰色市场与假借科研名义销售的链条。 subgraph Ban["监管介入"] A["2023年官方封禁多肽"] --> B["合规获取渠道关闭"] end subgraph GrayMarket["灰色市场与风险"] B --> C["催生灰色市场（黑市）"] C --> D["贴上『仅供科研使用』标签规避FDA"] D --> E["缺乏质控与标准化（类似『加油站生鱼片』）"] E --> F["买家自行注射面临严重安全风险"] end subgraph Solution["合规出路"] F -.-> G["回归 503A 配制药房规范化监管"] end ``` ### [28:01](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=1681s) 多肽的给药机制：为什么不能像吃鸡肉一样口服？ 多肽在生物学结构上本质是由氨基酸链接而成的短链分子。如果将蛋白质粉比作积木散落在一手心的碎片，那么多肽就是拼装成特定形态的一小块积木组件。人类的胃肠道系统经过漫长的进化，天生具备极其高效的蛋白质消化机制，任何通过口服进入胃部的蛋白质或多肽，都会被消化道迅速分解、碾碎成单独的氨基酸碎片。 这意味着，如果直接饮用 TB-500 等多肽液体，人体消化系统根本分不清它和一块鸡胸肉有什么区别，其特异性的结构与药理功能会在瞬间被胃酸和消化酶破坏殆尽。尽管极少数多肽存在口服特例（例如某些经过特殊化学修饰、能够耐受胃肠道环境的特定剂型 BPC-157），但绝大多数多肽必须绕过消化道，采用皮下注射（Subcutaneous）或肌肉注射（Intramuscular）的方式进入体内。对于普通患者而言，皮下注射最为简便常用——只需在腹部“捏起一英寸肉（pinch an inch）”，将针头扎入皮下脂肪层即可完成给药。 ### [29:03](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=1743s) 原厂自动注射笔 vs 503A 配制药房小药瓶 在给药工具和产品呈现上，市场存在两种截然不同的形态。以市面上领先的 GLP-1 药物、礼来公司（Eli Lilly）生产的替尔泊肽（Tirzepatide，商品名 Mounjaro）为例，其原厂采用的是高度工程化的“自动注射笔（auto-injector pen）”。这种笔内置齿轮刻度，患者只需旋转调节固定剂量，按在皮肤上便会自动触发进针注药，无需手动抽药或计算计量，操作极为傻瓜化，但它也完全锁死了患者的用药灵活性。 与之相对的，则是摆在桌上的另一件极具争议的物品：由 503A 合规配制药房生产的西林瓶装替尔泊肽注射液。与全自动注射笔相比，小西林瓶需要患者使用小号注射器手动抽吸药液，虽然需要学习剂量换算，却赋予了临床上无限的调配自由度。原厂注射笔就像“填色涂鸦本（paint by numbers）”，规则固定、每周一次强制给药；而配制药房的小药瓶则像一块空白画布，具备无穷的用药排列组合可能。 ### [29:58](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=1798s) 药企的商业护城河与 FDA 的公器私用 这种由配制药房生产的小药瓶之所以被药企视为“对其商业模式最具威胁的存在”，核心在于它打破了垄断并提供了真正的“个体化精准医疗（personalization of medicine）”。原厂药要求每周单次大剂量注射，许多患者在第 5、6 天时会经历明显的药效衰退和食欲反扑，甚至在刚注射完的前几天遭受剧烈的恶心、呕吐等严重胃肠道副作用。而在 503A 配制药房的模式下，医生可以让患者进行“微剂量分频给药（microdosing）”——将原本一周一次的庞大剂量拆分成一周多次极小剂量注射，既维持了全天候平稳的血药浓度，又完美规避了单次冲击带来的剧烈不良反应。 然而，患者每在配制药房消费一美元，礼来和诺和诺德（Novo Nordisk）等大药企就少赚一美元。原厂凭借替尔泊肽特定剂型的手握专利，虽然配制药房生产的是复合配方（例如替尔泊肽复配烟酰胺 Niacinamide），在法律和给药形式上并非原厂药的纯粹复制品，理应在现行法规下受到个性化配药豁免的保护。但制药巨头不愿陷入耗资巨大、耗时冗长的专利诉讼战，而是转而动用极其强大的游说力量向 FDA 施压。 - 这种游说促成了前所未有的行政打压：FDA 专员 Marty Makary 针对“打击配制 GLP-1 药物”所发布的推文数量，甚至超过了他在任期间谈论糖尿病或心脏病等公共健康危机的推文总和。 - 药企成功将私营专利的维权成本转嫁给了社会——他们无需动用昂贵的企业律师团打官司，而是直接让纳税人资助的监管机构充当市场“打手”，利用公权力去踩死民间竞争对手。 - 理想的医疗生态绝非非黑即白，原厂药有坚实的数据支持，适合标准化的患者；而配药房的灵活微量给药则挽救了那些无法耐受严重副作用的重症人群，两者的并存才是以患者为中心的健康医疗环境。 ### [34:13](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=2053s) 医生亲身实践：从举重深蹲到多肽微剂量管理 在畅谈多肽改善皮肤、减脂、增肌、认知增强与改善慢性病的广泛益处后，Dr. Alex Tatem 坦然承认自己也是多肽的实际使用者。目前他体内唯一使用的多肽正是替尔泊肽（Tirzepatide），且采用的是非常严苛的“超低微剂量”。 Dr. Tatem 分享了他亲身的体型转变动机：几个月前，热衷力量举（Powerlifting）的他体重一度飙升到了将近 240 磅（约 108.8 公斤）。尽管当时他能完成超过 500 磅（约 226.8 公斤）的惊人硬拉成绩，但庞大的体重大大牺牲了日常心肺与活动机能——每次爬两三层楼梯就会气喘吁吁、中途必须停下歇息。出于对长期健康与长寿（Longevity）的综合考量，他下定决心减轻体重负担，于是开始亲自尝试微剂量的替尔泊肽，并在实践中深刻体会到了该分子在极低剂量下所爆发出的惊人代谢调控潜能。 ### [35:09](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=2109s) 医生的自律与个人诉求：从运动创伤恢复到改善酒渣鼻 当主持人询问 Alex Tatem 医生为何自己没有尝试更多其他肽类时，Tatem 坦言，目前缺乏合法的监管框架让他能够合规获取这些化合物。作为一名临床医生，他坚信自己必须以身作则为患者树立榜样，这也是他站出来积极倡导通过合法、安全途径恢复肽类药物供应的原因。主持人随即抛出一个假设性问题：如果这些肽类明天就能完全合法化，他个人最渴望使用哪些？ Tatem 幽默地感慨起年龄带来的身体变化。得知主持人今年 33 岁后，他打趣说："等你过了 35 岁，现实就变得非常残酷了。"他提到，现在只要睡觉时脖子姿势稍有不对，醒来可能就需要戴两周颈托。作为一名经常去健身房举铁的人，体内积累了各种劳损和小伤痛，尤其是他的右肩极为敏感——如果在没有彻底热身的情况下尝试大重量卧推，一旦拉伤，整整一个月都无法正常训练。过去两年里，他无数次渴望能合法使用 BPC-157 和 TB-500 来加速软组织修复与愈合。 此外，Tatem 长期受困于严重的酒渣鼻（玫瑰痤疮，rosacea）。面部经常无故泛红充血，看起来像被严重晒伤一样。有时周二早晨去诊所上班，员工还会误以为他周末在院子里干了重活暴晒所致，这让他颇为无奈。对于这类皮肤血管高反应性与炎症问题，三肽铜复合物 GHK-Cu 表现出极佳的修护效果，是他个人非常希望能够合规使用的另一款肽类。 - **BPC-157 与 TB-500**：针对肌肉拉伤、关节微损伤及韧带软组织损伤，具有加速组织再生和创伤修复的协同潜力。 - **GHK-Cu（铜三肽）**：能有效缓解面部红斑、抗炎并修复皮肤屏障，改善酒渣鼻等顽固皮肤发红症状。 --- ### [36:44](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=2204s) 肽类增肌的迷思：IGF-1 LR3 与不可替代的规律健身 针对社交媒体上大肆宣扬的"肽类能让人轻松暴涨肌肉"的言论，Tatem 进行了彻底的辟谣。他指出这纯粹是营销噱头与认知误区。在目前所有的肽类中，勉强能与增肌产生联系的只有他手中拿到的 IGF-1 LR3。IGF-1 LR3 是胰岛素样生长因子-1（IGF-1）的长效合成类似物，处于生长激素级联反应的下游。虽然健美运动员常通过高剂量使用生长激素来增加体型和辅助减脂，但单纯依靠肽类来获得显著的瘦体重（lean mass）是行不通的。 Tatem 强调，肽类无法凭空创造肌肉组织，任何药物都无法替代高强度的器械训练与机械刺激。他经常遇到一些患者天真地以为只要注射睾酮就能自动长出肌肉，这完全违背了人体生理学机制。药物或许能提供极其微弱的辅助底色，但没有外界的超负荷机械刺激与刻苦训练，肌肉绝不可能生长。他严肃地告诉患者，医生永远无法取代私人健身教练和注册营养师的职责，优化身体状态必须是一场全方位的综合战役（"full court press"）。 ```mermaid flowchart TD accTitle: Peptide Muscle Growth Misconception accDescr: Flowchart showing why peptides cannot replace training and nutrition for muscle hypertrophy. subgraph Misconception["常见认知误区"] A["依赖 IGF-1 LR3 / 睾酮"] -->|"被动注射，缺乏运动"| B["无法获得显著瘦体重"] end subgraph CorrectPath["真正的增肌三角模型"] C["足量机械刺激（健身训练）"] --> D["肌纤维微损伤与合成启动"] E["科学膳食（营养师方案）"] --> D F["医疗优化与恢复辅助（肽类/激素调节）"] --> D D --> G["肌肉肥大与高质量瘦体重增长"] end ``` --- ### [38:09](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=2289s) 代谢调控：GLP-1 改善胰岛素敏感性与促生长因子的反作用 谈及当今社会广泛存在的代谢综合征与胰岛素抵抗，Tatem 直言，目前在调节葡萄糖耐受和胰岛素反应方面表现无可争议的黄金标准当属 GLP-1 受体激动剂类药物。其核心机制在于有效延缓胃排空速率，使得进食后食糜中的碳水化合物被更平缓、更缓慢地吸收入血，从而彻底抹平了餐后血糖剧烈飙升的峰值，极大幅度地恢复了外周组织对胰岛素的敏感性。 与此同时，Tatem 发出了重要的临床警示：患者在选择肽类时必须明确自身的代谢底色。许多旨在刺激脑下垂体分泌生长激素或提升外周血清 IGF-1 水平的肽类化合物，在生理层面上往往具有对抗胰岛素的效应，容易导致空腹及餐后血清葡萄糖水平上升。如果一名患者本就饱受胰岛素抵抗或糖耐量受损的困扰，盲目使用促生长激素类肽可能会使血糖控制雪上加霜。 ```mermaid flowchart TD accTitle: GLP-1 and GH Peptides Metabolic Pathways accDescr: Comparison of metabolic effects between GLP-1 agonists and Growth Hormone secretagogues on glucose regulation. subgraph GLP1["GLP-1 受体激动剂通路"] A["延缓胃排空速率"] --> B["食物吸收平缓化"] B --> C["平抑餐后血糖波峰"] C --> D["显著提升机体胰岛素敏感性"] end subgraph GH_Pathway["促 GH / IGF-1 肽类通路"] E["提升血清生长激素与 IGF-1 水平"] --> F["诱发肝糖输出增加 / 拮抗胰岛素"] F --> G["血清葡萄糖水平上升（高血糖风险）"] end ``` - **GLP-1 机制优势**：通过降低胃肠动力、抚平血糖波动曲线，从根本上减轻胰岛 β 细胞负担，改善胰岛素抵抗。 - **促 GH 肽类禁忌**：刺激生长轴系可能导致外周血糖升高，代谢综合征及糖尿病前期患者需慎重评估。 --- ### [39:02](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=2342s) 外用抗衰老黑科技：铜三肽 GHK-Cu 的皮肤再生原理 关于肽类是否能制成外用乳霜或口服制剂，Tatem 表示，虽然网络黑市上充斥着各种伪劣宣称，但就真正具备充分生物学与临床支持的合规外用制剂而言，铜三肽 GHK-Cu 是最具代表性的范例。人体内的 GHK-Cu 水平会随着年龄的增长而显著下降，但当将其以乳霜形式局部外敷于面部皮肤时，其穿透与生物利用效果非常显著。 GHK-Cu 能深度激活胶原蛋白（collagen）与弹性蛋白（elastin）的合成机制，从而改善皮肤紧致度、淡化细纹并均匀肤色。它在重塑皮肤微观组织层面的表现，甚至能达到许多人斥巨资做激光医美所追求的效果。Tatem 补充道，外用软膏剂型的 GHK-Cu 在监管属性上与注射用肽完全不同，目前公众在市面上可以通过合法合规的护肤品渠道直接购买。 回顾自己的从医生涯，Tatem 坦承自己在大学和医学院时期是彻底的怀疑论者，当时充斥着阿特金斯饮食等各种铺天盖地的商业炒作，他一度对所有健康与抗衰老概念嗤之以鼻。直到日后他在临床上亲眼见证了患者真实且显著的逆龄改善，并深入研读了其背后的生物化学机制，才意识到这些活性肽绝非虚无缥缈的伪科学，外用肽在视觉和生理层面确实能够切实减缓皮肤老化的步伐。 | 评估维度 | 外用 GHK-Cu 乳霜 | 注射型 GHK-Cu / 传统医美 | |:--- |:--- |:--- | | **主要功能** | 刺激真皮层胶原蛋白与弹性蛋白再生，改善肤色，淡化细纹 | 全身性抗炎或针对局部的即时物理收紧（如激光光子） | | **给药途径** | 经皮渗透，局部日常外用涂抹 | 皮下注射 / 临床光电设备侵入性操作 | | **监管状态** | 归属化妆品/护肤外用监管，目前可合法直接购买 | 属处方注射剂，需复合药房调配并受严格法案监管 | | **安全性体验** | 无痛、低刺激性、依从性高 | 需承受进针疼痛或医美术后红肿恢复期 | --- ### [40:51](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=2451s) 脑力赋能与深度睡眠：Semax、DSIP 与 Selank 的神经修复机制 主持人 Steven 结合自身的高压工作习惯发问：他经常一天连录两到三场深度播客，连续在聚光灯下工作长达 12 个小时，脑力消耗极大，是否存在能有效提升认知表现的肽类？Tatem 在严正声明医生处方合规的前提下，介绍了有望在当年七月重新合法化的一款关键化合物——鼻喷剂型 Semax。 Semax 最早由俄罗斯科研团队合成研究，是一种由 7 个氨基酸组成的促智神经肽。初期的临床研究发现，创伤性脑损伤（TBI）以及急性中风患者在使用 Semax 后，神经功能的恢复速度显著提升。它能显著上调脑源性神经营养因子及相关认知信号通路，帮助神经元突触连接，强化逻辑语言构建与信息检索能力。更为独特的是，Semax 可以通过鼻黏膜给药，绕过血脑屏障直接作用于中枢神经靶点，具有极高的神经调控效率。 除了脑力爆发，Tatem 关注到跨时区商旅人士普遍面临的昼夜节律破坏问题，并列举了调节神经与睡眠周期的针对性肽类： - **DSIP（促慢波睡眠肽）**：专门辅助机体重置被打乱的生理昼夜节律，特别适合频繁倒时差、昼夜颠倒的高压人群。 - **Selank（促智安神肽）**：通常建议在睡前一小时通过鼻黏膜喷雾使用。它能显著安抚神经系统兴奋度、缓解焦虑，诱导机体平稳进入极具修复价值的慢波深睡眠（Delta 波睡眠），从而让大脑在有限的休息时间内得到最高质量的代谢废物清除与精力修复。 --- ### [43:03](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=2583s) 未来获取渠道与普及趋势：503A 配制药房与处方监管 关于这些被限制的肽类未来如果被重新批准合法化，大众应当如何安全获取的问题，Tatem 给出了明确的医疗路径：患者必须通过持有正规资质的执业医师进行全面评估并开具处方，然后由美国符合标准的 503A 配制药房（503A Compounding Pharmacies）进行无菌定制化调配。 主持人感慨，当未来技术走向合规普及，大家可能都会习以为常地进行日常自我注射。事实上这种现象在当下的 Ozempic（司美格鲁肽）浪潮中已经初露端倪——身边已有大量朋友在规律注射且反馈极佳。Tatem 肯定了这种治疗范式的演变，指出在严格的专业医疗与药房监管体系护航下，肽类药物正在逐步展现出深刻重塑现代健康管理与预防医学的潜力。 ### [43:30](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=2610s) GLP-1药物带来的肌肉流失隐患与肌生成抑制素抑制剂的前景 GLP-1受体激动剂的大范围普及正在逐步消除公众对“注射针头”的心理抗拒与污名化。Steven Bartlett提到，身边的朋友在用药后瘦身效果极其惊人，甚至到了让人认不出来的程度；但与此同时，这种在短时间内发生剧烈身体改变的现象，会本能地触发人类某种史前的警觉——潜意识里总会怀疑“这人是不是身体出大问题了”。Alex Tatem博士深表赞同，并指出GLP-1药物引发的快速减重背后隐藏着一个巨大的医学隐患：当人体处于极端的卡路里赤字状态时，身体会进入严重的异化代谢（Catabolism，分解代谢状态）。人体在分解组织时缺乏精准的选择性，它不仅会分解脂肪，还会同步分解肌肉，而肌肉是人体代谢中最关键、最活跃的组织。若想真正优化胰岛素敏感性，维持肌肉质量是绝对不可或缺的前提。 目前，在配合抗阻力量训练时，最能够强效保留肌肉的传统化合物是睾酮（Testosterone）。然而，睾酮疗法（TRT）具有显著的局限性：对于有生育计划的男性患者而言，外源性睾酮会彻底关闭其精子生成机制；对于年轻或特定生理阶段的女性患者来说，常规使用睾酮也不合适。因此，睾酮并不是一个适用于所有减重人群的普适方案。 ```mermaid flowchart TD accTitle: GLP-1与肌肉流失及下一代抗体药物的作用机制 accDescr: 展示GLP-1引发卡路里赤字导致肌肉流失，以及单克隆抗体阻断分解通路的机制 subgraph GLP1_Effect["GLP-1 减重通路"] A["使用 GLP-1 受体激动剂"] --> B["剧烈卡路里赤字 (Caloric Deficit)"] B --> C["机体进入异化分解代谢 (Catabolism)"] C --> D1["脂肪分解 (期望效果)"] C --> D2["肌肉组织同步流失 (严重代谢隐患)"] end subgraph Muscle_Preservation["下一代肌肉保留方案"] E["新型单抗 / 肌生成抑制素抑制剂"] --> F["阻断 Activin / Myostatin 肌肉分解通路"] F --> G["显著保留瘦体重与代谢核心组织"] D2 -.->|临床干预靶点| E end ``` Tatem博士透露，医学界即将迎来多肽的“兄长级”前沿产品——更为复杂的生物制剂：单克隆抗体（Monoclonal Antibodies），尤其是专门用于抑制肌肉分解酶类的**肌生成抑制素抑制剂（Myostatin Inhibitors）**。目前正处于研发管线中的三大代表性化合物包括： - **Bimagrumab**（礼来公司 / Eli Lilly）：它能够精准结合激活素（Activin，被比喻为肌生成抑制素的“果酱配花生酱”受体复合结构），从而阻断肌肉流失信号。 - **Roledumab**：由其他大型制药企业研发的肌肉保留化合物。 - **Trevogrumab**：处于管线阶段的同类抗体药物。 这些药物的终极目标，是让患者即使在极端卡路里赤字的状态下，依然能够牢牢保住肌肉。听到这里，Steven感叹未来的减重体验简直不可思议：人们将能通过一边注射多肽燃脂，一边注射抗体保肌。Tatem博士指出，面对人体这一极其复杂的动态平衡系统，患者必须与受过专业系统培训的医生进行深入沟通，而当下医学界最大的痛点之一正是针对这些新兴生物制剂的临床医生专业教育仍然严重不足。 --- ### [46:16](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=2776s) “多吃蔬菜多去健身房”为何在现代肥胖危机前失效 面对外界常有的质疑——“为什么不干脆多吃绿叶蔬菜、老老实实去健身房，做个自律的自然人就好？”——Tatem博士直言，他个人完全支持并践行吃蔬菜与力量训练，但大众必须面对残酷的现实：美国当前的肥胖率根据不同数据库及BMI界定标准，已经高达40%至70%。现实表明，“少吃多动、进健身房”这套传统口号在社会整体层面上已经彻底失效。 现代社会充斥着“食物荒漠”（Food Deserts）以及高热量却极度缺乏微量营养素的超加工食品。作为一名常年上台执刀的外科医生，Tatem博士分享了一个令人不寒而栗的手术室日常现象：许多被送上手术台的患者体格极其庞大、属于重度甚至病态肥胖（Morbidly Obese），但当切开组织时会发现，那些由蛋白质构成的、维系人体基本结构的结缔组织竟然薄如蝉翼（"paper paper thin"）。这类人群长期摄入海量热量并囤积了巨量脂肪，但体内长期处于严重的蛋白质与微量营养匮乏状态。因此，多肽药物绝不仅仅是少数极客圈“生物黑客（Biohackers）”的优化玩具，更是拯救被慢性代谢疾病吞噬的庞大普通群体、缓解整个医疗系统崩溃危机的关键救命稻草。 - **产业规模横向对比**：当前全球前四大人工智能大语言模型（LLM）头部企业的总营收估算约为580亿至620亿美元；而仅司美格鲁肽（Semaglutide）和替尔泊肽（Tirzepatide）这两款多肽类药物在当年的营收总和就将突破550亿美元。如果再计入科研用途市场（RUO）及配方药房（Compounding Pharmacies）的庞大流通体量，多肽产业的真实市场规模已经与全球AI行业的营收旗鼓相当。 --- ### [49:25](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=2965s) 寻医者的误区与天下没有免费的午餐 很多患者走进诊室直接向Tatem博士发问：“我到底需要买哪种多肽？”博士的反问往往让他们愣住：“那你究竟有什么健康问题？”患者常抱怨自己精力差、性欲低下，但Tatem博士指出，如果核心诉求是这些，临床首要任务是筛查患者的睾酮水平，而非盲目跟风使用多肽。这就好比一个人走进家装工具店问“我需要什么工具”，店员必须先搞清你想造什么——解决问题可能需要锯子、螺丝刀（比作多肽），也可能需要调整性激素，或者单纯改变饮食与作息。多肽从来都不是包治百病的万能神药，它仅仅是医生工具箱里的又一把专业工具。 对于大众渴望“走捷径、不劳而获”的人性弱点，Tatem博士笑着坦言自己也希望有捷径，但他当天早晨依旧在4点45分被闹钟叫醒，先去健身房举铁，然后才赶去诊所出诊。GLP-1药物固然是现代医学中最接近“捷径”的突破，但它绝不会替你进健身房举起杠铃去抗击肌肉衰减。Steven结合自己多年主持节目的经历感慨道，人生最重要的一个真理就是“天下绝无免费的午餐（No free lunch）”——任何事物都存在代价与权衡（Trade-off）。无论是伴侣关系（充满陪伴但也需要磨合让步），还是养育孩子（Tatem博士调侃自己极爱孩子但“已经很多年没睡过整觉了”）。同样，当面对效果看似神奇的多肽时，公众必须保持清醒：巨大的益处背后必然伴随着代价，而当下面对多肽最大的隐患与代价之一，就是许多人甚至无法确定自己注射进体内的究竟是什么成分。 ### [51:40](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=3100s) 多肽采购风险与减脂新宠 Tesamorelin 在深入了解具体化合物之前，必须警惕从“仅限科研用途”（Research Use Only）网站订购多肽的现实风险。这类来源缺乏严格监管，购买者根本无法确知厂家是否彻底去除了内毒素（endotoxins），也无法保证实际到手的产品成分与标签相符。这是目前非正规渠道使用多肽最大的隐患所在。 随后，Alex Tatem 博士拿出了 Tesamorelin（替莫瑞林）作为商业化多肽的典范。与许多处于灰色地带的物质不同，Tesamorelin 是一款完全合法的处方药，医生可以直接开具处方，患者能直接在 CVS 或 Walgreens 等正规药店柜台取药。它的独特之处在于不仅能有效促进生长激素（GH）分泌，而且特别擅长精准减除“内脏脂肪”（visceral fat）和腹部脂肪（belly fat）。这一特性让健美运动员趋之若鹜，将其视为备赛刷脂的利器。然而，天下没有免费的午餐：如果停药且没有做出实质性的生活方式改变，减掉的脂肪很快就会原路返回。 - **商业可及性**：正规处方药，美国大型连锁药店（CVS、Walgreens）均可合法配药。 - **靶向机制**：促进自身生长激素分泌，专一针对顽固的腹部及内脏脂肪进行剥离。 - **核心局限**：必须配合生活方式干预；一旦停用且饮食运动未调整，体脂会迅速反弹。 --- ### [52:46](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=3166s) 从快速晒黑到勃起强化：Melanotan II 与 PT-141 紧接着讨论的是 Melanotan II（美诺亭-2），这是一种黑素皮质素受体激动剂（melanocortin receptor agonist）。该多肽能够显著提高皮肤对紫外线的敏感度，使用者仅需接受微量的阳光照射，就能迅速获得极深的古铜色日晒肤色。虽然 Tatem 博士打趣说自己坦然接受了天生的苍白肤色、并不追求美黑，但他强调 Melanotan II 的功效是真实确凿的。当然，它的安全性存疑，学界一直担忧过度刺激黑素细胞受体可能存在诱发或刺激恶性黑色素瘤（melanoma）的潜在风险。 Melanotan II 还伴随一个极具戏剧性的“副作用”：它能带来人生中最强烈的勃起反应。这一效果甚至引出了主持人的调侃：“这简直是让人直接变身了！”事实上，医药界早已注意到这一机制，并在此基础上开发出了衍生分子 PT-141（Bremelanotide，布美诺肽）。PT-141 目前已成为正式批准上市的商业处方药，它剔除了 Melanotan II 导致皮肤变黑的色素沉积作用，完整保留了对中枢性功能的刺激与改善效果。 --- ### [53:56](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=3236s) 未批先火的下一代三靶点减重神药 Retatrutide 谈话转向了当前多肽领域最激进的现象：未上市前沿药物在民间的地下流行。过去普通人只能在广告或科研新闻中看着新药流口水，但在“仅限科研”产业链的推波助澜下，公众获取前沿化合物的时间线被彻底颠覆。其中最具代表性的就是礼来公司（Eli Lilly）研发中的重磅三靶点激动剂 Retatrutide（瑞他鲁肽）。 为了理清 Retatrutide 为何引发狂热，Tatem 博士拆解了 GLP-1 药物的发展进化树： ```mermaid flowchart TD accTitle: GLP-1 药物进化代际机制对比 accDescr: 展示从单受体、双受体到三受体激动剂的靶点拓展与功能差异 subgraph Gen1["第一代：单靶点激动剂"] G1["Semaglutide 司美格鲁肽"] --> R1["GLP-1 受体"] R1 --> E1["延缓胃排空 / 抑制热量摄入"] end subgraph Gen2["第二代：双靶点激动剂"] G2["Tirzepatide 替尔泊肽"] --> R1 G2 --> R2["GIP 受体"] R2 --> E2["代谢调节协同"] end subgraph Gen3["第三代：三靶点激动剂"] G3["Retatrutide 瑞他鲁肽"] --> R1 G3 --> R2 G3 --> R3["胰高血糖素受体 (Glucagon)"] R3 --> E3["动员肝脏脂肪与糖原"] E3 --> E4["逆转 NASH / 显著修复肝功能"] end ``` 肝脏是人体储存糖原和脂肪的“能量仓库”，当长期热量超标时，脂肪堆积会导致非酒精性脂肪性肝炎（NASH）乃至肝硬化。Retatrutide 突破性地引入了胰高血糖素受体激活机制，不仅实现了空前的减重幅度，更在临床数据中展现出前所未见的肝脏脂肪清除与肝健康修复效果。令人惊愕的是，尽管该药尚未完成商业化审批，但健身爱好者和普通大众已经在科研网站上自行购买并注射长达两年之久，它甚至已经成为职业健美选手备赛刷脂的标配。当主持人戏谑地问 Tatem 博士是否也在偷偷使用时，他笑着坚决否认：“我可以坦白地说，我绝对没碰过 Retta，但这种‘药物未出、民间先用’的技术平权现象确实令人大开眼界。” --- ### [56:16](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=3376s) 生长激素促泌剂与 Somatotropin 的权衡利弊 随后，两人将焦点转向了抗衰老领域经典的生长激素轴调控。外源性生长激素在 1990 年代立法收紧之前曾极度盛行，但它属于“粗暴的直接干预”。为了实现更自然的生理性脉冲释放，科学家开发了促泌剂（secretagogues）。在这一领域中，CJC-1295 与 Ipamorelin（伊帕瑞林）是公认最经典且强效的“黄金搭档”： - **CJC-1295**：生长激素释放激素（GHRH）类似物，通过 GHRH 受体通路下达指令； - **Ipamorelin**：生长素释放肽（Ghrelin）受体激动剂，通过胃饥饿素通道发挥作用。 两者联合使用，通过双重协同机制刺激垂体释放内源性生长激素，进而指挥肝脏分泌 IGF-1，促进肌肉合成、燃烧脂肪、加速组织修复并显著提升发质与皮肤紧致度。 针对直接注射外源性生长激素 Somatotropin（重组人生长激素），Tatem 博士详细剖析了其收益与可怕的副作用边界。在夜间适量注射能改善深层睡眠、焕活发质与皮肤、加速肌肉增长并消除脂肪。然而，一旦剂量超标或滥用，代价极其高昂： | 机制 / 反应 | 具体副作用表现 | |:--- |:--- | | **血糖紊乱** | 长期高血糖引发严重的**胰岛素抵抗**（Insulin Resistance）。 | | **骨骼异常重塑** | 导致**肢端肥大症**（Acromegaly），颌骨与面部特定骨骼异常增生，造成不可逆的面容粗狂变形。 | | **关节腔滑膜水肿** | 关节间隙积液压迫神经，健美运动员常因此在晨起或卧推、举哑铃时突然手部麻木无力而被迫摔落器械。 | | **潜在肿瘤风险** | 虽然没有证据表明它会凭空制造全新的恶性肿瘤，但对于体内已有的潜伏癌细胞，具有潜在的促生长恶化风险。 | --- ### [59:13](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=3553s) 端粒酶激活与细胞寿命：即将登场的 Epithalon 最后，Tatem 博士拿出了备受抗衰界瞩目的多肽 Epithalon（艾匹索隆），并透露该物质预计将在当年 7 月正式面向他们开放。Epithalon 的核心运作逻辑直击人类衰老的根本生物学机制——细胞分裂过程中的端粒缩短。 当人体衰老、细胞通过有丝分裂（mitosis）进行自我复制时，复制酶本身的物理体积会占据染色体末端的部分空间。这就好比一台复印机在扫描长篇代码时，每次都会因为边缘遮挡而切掉末尾的几个字符。随着分裂次数增加，被切掉的关键遗传信息越来越多，细胞最终走向衰老和凋亡。而 Epithalon 的设计初衷正是增强端粒酶（telomerase）活性，修复并补齐染色体末端被削减的代码，从底层延长单细胞的生命周期。 ### [01:00:04](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=3604s) 衰老机制、端粒酶与 Epithalon 的争议 谈到人体的衰老机制，染色体末端的端粒（telomere）扮演着关键角色。端粒常被形容为一段所谓的“垃圾信息”，但科学界早已确认，端粒变短与机体衰老及潜在的不良健康结局直接相关。体内存在一种能够帮助修复或延长端粒的酶，称为端粒酶（telomerase）。多肽化合物 Epithalon（松果体素多肽）的作用机制正是促进端粒酶活性。因此，有些人将其奉为“青春之泉”式的抗衰神药。然而，Dr. Alex Tatem 对这种“长生不老”的过度神化持极大的怀疑态度；但他承认，Epithalon 在修复大脑中调控昼夜节律（circadian rhythm）的区域方面，确实展现出了一定的积极效益。 ### [01:00:43](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=3643s) 普通人如何选择多肽：多肽的三大监管分类指南 面对海量的多肽信息，普通大众究竟该如何判断自己是否应该尝试多肽？Dr. Alex Tatem 建议将目前市场上的多肽划分为三大类别，以便清晰认知其合法性与安全性： ```mermaid flowchart TD accTitle: 多肽的三大监管分类 accDescr: 展示合法商业处方、待重分类复方与仅限科研多肽的区别 subgraph Legality ["监管与获取途径"] C1["类别一：商业药房合法处方<br/>（GLP-1、PT-141、催产素等）"] C2["类别二：复方监管过渡池<br/>（预计7月解禁的7种多肽）"] C3["类别三：仅限科研用途 RUO<br/>（黑市、灰色渠道，严禁盲目自用）"] end C1 --> Safe["医患合作：正规评估与处方"] C2 -.->|从禁止复方转为允许复方| Safe C3 --> Danger["高风险：纯度不明、剂量错误、严重污染"] ``` - **第一类（合法处方药）：** 属于可以直接在商业药房开具合法处方的多肽，例如 GLP-1 受体激动剂、用于改善性功能的 PT-141（Bremelanotide，布美诺肽）以及催产素（Oxytocin）等。 - **第二类（待重分类化合物）：** 目前该类别处于监管真空，主要涉及有望在 7 月份正式移出“禁止复方调剂”清单、转入“允许复方调剂”的 7 种核心多肽。 - **第三类（仅限科研用途 Research Use Only, RUO）：** 市场上其余所有未经批准的多肽基本都属于此类。 Dr. Tatem 强烈告诫患者绝不要自行网购“仅限科研用途”的多肽，因为普通人根本无法验证其纯度、正确剂量或是否受到细菌与杂质污染。公众正确的做法应当是主动学习相关医学知识，然后与专业医生深入沟通自身的具体健康诉求。医生应该是患者通向极致健康道路上的“合作伙伴”，双方应共同探讨工具箱里是否有合适的多肽选项来攻克病症。 ### [01:02:18](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=3738s) 停用 GLP-1 药物后的反弹真相 对于诸如司美格鲁肽（Semaglutide / Ozempic）和替尔泊肽（Tirzepatide）等爆火药物，大家最关心的问题莫过于：“一旦停药会发生什么？”Dr. Tatem 坦言，现有的临床数据非常明确：停药后体重必然会反弹。逻辑其实非常简单——药物是一剂强行推动天平倾斜的外力，如果在此期间没有彻底改变任何底层生活方式，外力一旦撤走，身体自然会退回原状。 研究显示，如果患者在用药期间同步建立了健康的生活习惯，停药后虽然仍会反弹一部分体重，但并不一定会全盘打回原形。此外，长期的临床策略还可以采用“极低维持剂量”方案，让患者在不必承担过重药物负担的前提下，长期保持来之不易的减重成果。 ### [01:03:07](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=3787s) 未来十年的重磅神药：Retatrutide 与万亿美元市场 当被问及目前及未来最令人兴奋的技术与多肽是什么时，Dr. Tatem 毫不犹豫地指向了 Retatrutide（瑞他鲁肽）。无论是已经公布的严格临床试验数据，还是那些自行通过各种渠道获取该物质的早期尝试者所反馈的案例，Retatrutide 带来的身体成分重塑效果堪称“疯狂”。 - **惊人的减重数据：** 使用者能在相对极短的周期内减掉总体重的 20% 至 25%。 - **“GLP-1 界的法拉利”：** 它的减脂速度和效能超越现有的一切同类药物，虽然它并不适合所有人，但足以彻底重塑肥胖与代谢疾病的治疗格局。 - **商业与专利格局：** 针对“是否人人都可生产该药”的疑问，Dr. Tatem 澄清该分子专利由礼来公司（Eli Lilly）独家严密把控，未来必将面临极其严厉的专利维权。这预计将是一款名副其实的“万亿美元级别”药物。 ### [01:04:13](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=3853s) 硅谷极客为何痴迷“多肽鸡尾酒” 多肽在当下被不少人冠以“硅谷神药”的称号。Dr. Tatem 透露，自己曾亲眼见过一些硅谷科技创始人配置的“多肽堆叠配方”（peptide stacks），其庞杂程度连他这位专业医生看了都直呼“太夸张了”。硅谷精英阶层之所以对多肽表现出近乎狂热的执念，根源在于他们对机体最高性能表现的病态追求。 从大剂量咖啡因到口含尼古丁袋（Zyn），这类创业者时刻渴望通过微调各种生理参数来换取认知与体能的巅峰。相比于副作用巨大、伴随严重心血管和内分泌危害的高剂量雄激素与合成代谢类固醇（anabolic steroids），多肽为他们提供了一套兼具灵活度与精细调节能力的控制杠杆。再加上由于当前的监管限制，获取和使用多肽带有某种“极客 DIY”的地下色彩，这种探索边界的不羁气质与硅谷的叛逆极客精神可谓一拍即合。 而在日常门诊中，患者最常向 Dr. Tatem 抛出的两大问题正是：“我到底该打哪种多肽？”以及“你能帮我开处方吗？”面对后者，他不得不一遍遍耐心地向这群年轻男性科普严苛的监管现状——目前在普通零售药房（如 CVS 或 Walgreens）能名正言顺开出的合法多肽，除了减肥控糖的 GLP-1 药物外，绝大多数都并不适用于门诊中常见的年轻健康人群。 ### [01:05:59](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=3959s) 商业赞助与周边产品介绍 - **LinkedIn Ads：** Steven Bartlett 谈及许多企业创始人困惑广告投流为何没有转化，核心痛点往往是文案并未精准触达决策层。LinkedIn 拥有超过 10 亿职场人士，其中约 1.3 亿为企业决策者，支持按职位、资历、公司规模及技能进行极度精准的定向，带来顶级的 B2B 广告投资回报率（ROAS）。前往 `linkedin.com/diary` 投放首笔 250 美元，可获赠 250 美元抵用金。 - **《The Diary Of A CEO》对话卡牌与 1% 日记：** 节目正式推出广受期待的捆绑套装。每位录制嘉宾都会在日记中为下一位到访者留下一个独家问题，这些问题仅收录于对话卡牌中，现已成为情侣、企业团队与家庭深度沟通的高效媒介；搭配用于重构个人微习惯的“1% 日记”，观众可前往 `thediary.com` 进行购买咨询。 ### [01:07:53](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=4073s) 皮肤抗衰老领域的王牌：GHK-Cu 针对是否存在针对皮肤与面部老化的“超级多肽”，Dr. Tatem 给出了一个毫无争议的答案：GHK-Cu（三肽-1铜 / 蓝铜胜肽）。在改善皮肤质地、气色与外观维度上，GHK-Cu 是目前已知受关注度最高、也是应用最广泛的多肽化合物，正被大量探索用于促进皮肤修复与再生。 ### [01:08:10](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=4090s) 三只小瓶与男性生育力危机：从 1973 年到 2045 年 在短暂提及多肽在生发方面的报告依然较为零散后，史蒂文·巴特利特（Steven Bartlett）拿出三个装有带色液体的玻璃瓶，调侃道：“离开多肽的世界一秒钟，我手里拿了这三个瓶子，我都有些害怕了。”亚历克斯·塔特姆博士（Dr. Alex Tatem）看了一眼便严肃地指出：“如果我们不加小心，这不幸就是我们的未来。” 这三个瓶子直观模拟了年轻男性生育力的历史与预测走势：代表 1973 年的瓶子几乎完全不透明，浑浊且致密；2026 年的瓶子颜色明显变淡；而代表 2045 年的瓶子则已经彻底清澈见底。塔特姆博士解释称，瓶中液体的浑浊度对应的是男性的“前向运动精子总数”（total motile sperm count），即每次射精中健康游动的精子密度。从 1973 年至今，男性的精子浓度、活力与质量正在经历指数级的持续滑坡。尽管多场学术会议上有人质疑这是否只是检测手段的误差，但经受住时间与严苛审查的各项研究证实，这种全球性的生育力断崖式暴跌是无可辩驳的事实。 谈及背后的驱动因素，微塑料和环境毒素固然是无法规避的外在侵害，但塔特姆博士强调，**最关键、也是最可干预的风险因素是胰岛素抵抗、代谢疾病以及肥胖**。由此，前文探讨的多肽疗法展现出了深远意义：如果能及早使用多肽等手段阻止代谢综合征的发展，人类历史上或许将首次拥有逆转这一生育危机的武器。他再次提及门诊中的真实案例：一名肥胖患者在代谢改善后精子数量暴增了 10 倍。试想如果在其刚刚超重而非重度肥胖时就低剂量介入，初级保健医生就能解决问题，患者甚至根本不需要走进专科医生的诊室。 - **三瓶模型对比**： - **1973 年**：液体深浓不透明，代表精子数量充沛、运动能力旺盛的时代。 - **2026 年**：颜色显著变浅，反映当下男性精液质量与浓度的全方位下滑。 - **2045 年**：完全清澈透明，警示若不改变现状，未来年轻男性或将面临广泛的无精或生育枯竭困境。 - **核心诱因**：不可抗的环境毒素/微塑料 vs. 可逆转的头号元凶——胰岛素抵抗与代谢功能障碍。 --- ### [01:10:36](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=4236s) 代谢紊乱是万病之源与男科医生的极简聚焦 塔特姆博士进一步指出，审视当今任何发达国家的医疗困境，代谢疾病与代谢功能障碍绝对是头号元凶。正如小罗伯特·F·肯尼迪（RFK Jr.）曾提及探索疾病的根本原因一样，除了某些特定感染与非代谢性病症外，心脏病、组织灌注不足、恶性肿瘤以及他专攻的男性勃起功能障碍（ED），底层都与肥胖和代谢紊乱紧密相连。“如果我们作为一个社会能消除这一祸患，或者将其降到最低，”塔特姆博士半开玩笑地感慨，“那或许我终于能让自己彻底失业了。” 谈及自己的执业范畴，塔特姆博士将自己的领域定义为泌尿外科延伸出的“男性健康”（Men's Health）。与许多涉猎广泛的通科医生不同，他的临床方向高度专注且近乎苛刻，主要集中在五大维度： ```mermaid flowchart TD accTitle: 男科专科核心临床诊疗领域 accDescr: 展现亚历克斯·塔特姆博士高度聚焦的五大核心诊疗模块 subgraph CoreFocus["亚历克斯·塔特姆博士的核心临床专科"] direction TB A["男性健康与激素管理<br/>(低睾酮症及进阶激素调控)"] B["男性性功能障碍<br/>(勃起功能障碍 ED)"] C["佩罗尼氏病<br/>(阴茎纤维性海绵体炎/弯曲畸形)"] D["男性不育症<br/>(精子质量与生育力恢复)"] E["前列腺癌术后并发症<br/>(尿失禁与渗漏修复)"] end ``` 这种极致专业化的执业选择源自他从小的性格习惯。他笑称自己小时候吃三明治都会拆开来一片片精准地吃：“在这个世界上，你可以做很多事情但都表现平平；或者你也可以挑出四到五件事，做到极其精通。这对我而言非常奏效。” --- ### [01:12:14](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=4334s) 外科住院医生的地狱磨砺与那场改变人生的出血手术 史蒂文注意到五年前照片中的塔特姆博士与如今判若两人，面容与神态差异巨大。塔特姆博士随即敞开心扉，讲述了美国外科住院医师规范化培训对其身体和心灵的残酷摧残。在长达五年的时间里，他每周在医院高压运转 80 到 100 个小时，几乎无法正常进食，严重睡眠不足，自我关怀完全归零。尽管这种体制号称是为了锤炼外科医生在灯光聚焦、全场不利的极端高压下独当一面、稳住整间手术室并挽救患者的能力，但它对人性的消耗是毁灭性的。 在培训临近结束时，一场凶险的手术将他推向了绝望的边缘。那是一名在县立公立医院就诊、没有医疗保险且濒临肾衰竭的困难患者。患者残存的肾功能极其微弱，却长了一颗位置极其刁钻致命的肾脏肿瘤。按常规操作，为了切除肿瘤必须切除整个肾脏，但这意味着患者将立即跌入彻底的终末期肾病。为了保住这颗肾脏，医疗团队决定放手一搏，完成了一台难度极高的保肾切除手术。然而，当晚值班的塔特姆博士接到了紧急电话：患者血压断崖式下跌，情况急转直下。 ```mermaid flowchart TD accTitle: 凶险急救手术及心理蜕变轨迹 accDescr: 展现从高危肾脏手术、深夜大出血急救到心理崩溃并最终重构自我健康理念的过程 A["高危保肾手术<br/>(位置刁钻的肾脏肿瘤)"] --> B["术后深夜血压骤降<br/>(内部急性大出血)"] B --> C["二次开腹急救<br/>(血泊中被迫切除肾脏 / 遭受主治叱责)"] C --> D["走廊崩溃痛哭<br/>(身心被摧垮 / 质疑从医意义与自我价值)"] D --> E["床旁彻夜看护<br/>(握住患者的手直至康复)"] E --> F["理念重构与觉醒<br/>(确诊低睾酮症 / 践行医者自渡与健康优先)"] ``` 在深夜赶往医院后，他和另一位非日间配合的主治医生紧急开腹。腹腔打开的瞬间，温热的血液喷涌而出，染透了他的术前衣。他们在血泊中紧急抽吸、拼命寻找出血点，却发现根本无法避免这一血管解剖引发的险情。伴随着主治医生的严厉训斥，他们最终不得不将患者仅存的肾脏完全切除。走出手术室的那一刻，浑身是血的塔特姆博士独自蹲在空无一人的走廊里失声痛哭：“我当时整个人都碎掉了。我花了这么多年接受训练，我到底够不够好？经过这一切，明天还值得过吗？” 手术后，他守在病床旁，连续多日握着那位患者的手，直到患者奇迹般地挺过了难关并康复出院。这场刻骨铭心的经历彻底逆转了他的生存哲学：**医生若要救人，必先学会自救与践行所信**。检查显示，长期剥夺睡眠与极度应激导致他年仅三十几岁就患上了低睾酮症。正如退伍军人长期处于战场应激会导致海马体退化一样，高强度的外科培训让他的皮质醇与压力常年爆表。七年过去，他重新修复自己的内分泌系统与健康，才完成了从身心破碎到重获新生的转变。 --- ### [01:16:22](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=4582s) 脆弱与共情：当医生自己成为无法生育的患者 史蒂文敏锐地捕捉到塔特姆博士在叙述这段往事时眼中闪烁的泪光与看向远方的凝重神情，轻声询问这份深沉情感的源头。塔特姆博士坦言，他在门诊面对那些因激素失衡而痛苦不堪、因精子质量低下而无法成为父亲的年轻男性时，他看到的其实就是曾经的自己。 他动容地回忆道：“当年我和妻子第一次尝试备孕时，无论如何都怀不上。我们最终不得不去走体外受精（IVF，试管婴儿）这条路。我至今都清晰记得，当时我坐在冰冷的诊室里，握着她的手，对眼前为什么行不通毫无头绪、给不出任何答案，那一刻我深感自己根本算不上一个男人。”正是这种切身经历过的屈辱、无力与绝望，让他无法对前来求医的患者保持冷漠的技术性抽离，也成为他深耕男性激素与生育力治疗最深沉的心理底色。 ### [01:17:12](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=4632s) 医者的使命感：不仅服务权贵，更要关怀普通大众 亚历克斯·塔特姆博士（Dr. Alex Tatem）动情地分享了自己从医的核心动力。当看到那些努力照顾自己身体却始终不见起色、或者在步入晚年后遭遇前列腺癌与勃起功能障碍（ED）折磨的男性患者时，他总会不由自主地联想到自己的父亲、叔叔和祖父。他坦言自己也曾经历过那种身体失控的无助感，而眼前的每一位患者，都是某人的父亲、叔伯或兄弟。“这就是上天召唤我去照顾的人群，”塔特姆博士动情地表示，正因深切关怀患者，他才如此执着于探索前沿医学工具，渴望为所有人提供一切可能的手段，让他们恢复健康、找回幸福，并在家人面前展现出最好的自己。 史蒂芬·巴特利特（Steven Bartlett）对此表达了由衷的敬意，感谢他将这些晦涩难懂的医学知识化繁为简，并成为普及健康权益的倡导者。史蒂芬指出，许多健康问题的解决方案其实早已存在，但往往被巨富阶层垄断，普通大众根本无从得知，正需要像塔特姆博士这样的人挺身而出打破信息壁垒。塔特姆博士对此深表认同，他笑着坦言，虽然在诊疗中接触过许多身居董事会的高管富豪，但他最热爱的依然是服务那些普通劳动者——农民、建筑工人和手艺人。他幽默地调侃自己作为泌尿外科医生，归根结底不过是个“受过高等教育的管道工（over-educated plumber）”，而优质的医疗健康服务理应面向每一个人，绝非少数幸运儿的特权。 ### [01:19:17](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=4757s) 争议风暴中的“强化运动会”：揭开竞技体育的潜规则 随后，话题转向了一个备受关注却极具争议的新兴赛事——“强化运动会”（The Enhanced Games）。塔特姆博士对此表现出极高的兴趣，并深入剖析了该赛事创立的底层逻辑。世界反兴奋剂机构（WADA）自身的数据显示，多达 40% 的奥运级别顶尖运动员在职业生涯中可能曾经或正在使用违禁物质。与此形成残酷对比的是，这些全球最顶尖的运动员收入却极其微薄，许多人甚至生活在贫困线以下，而国际奥委会（IOC）本身并不会为选手赢得金牌支付一分钱奖金，所有财富都被赛事的数十亿商业赞助所收割。 强化运动会正是基于打破这种虚伪现状的理念而诞生：彻底取消违禁药物禁令，允许运动员在专业医疗团队的严密监测与科学指导下使用性能增强药物（PEDs），从而在传统田径与体育项目中挑战人类生理极限、打破世界纪录。主办方更是开出了极具吸引力的奖金——冠军可获得 25 万美元，打破世界纪录者更可斩获 100 万美元巨奖。 尽管赛事官方此前宣称仅允许使用经过 FDA 批准的药物（理论上排除了仅限兽用的群勃龙 Trenbolone 以及尚未获批的诸多肽类物质），但主办方同时表态不会进行严格的药物检测，甚至参赛名将（如澳大利亚游泳名将詹姆斯·马格努森 James Magnuson）已公开承认使用 BPC-157 等肽类化合物。塔特姆博士认为这实际上是一个完全开放的竞技舞台。比赛定于 5 月 21 日至 24 日在拉斯维加斯举行，史蒂芬现场表示自己认识赛事主办团队，热情邀请塔特姆博士一同赴现场观赛，后者当即兴奋地接受了邀请。 - **顶尖运动员用药比例**：世界反兴奋剂机构（WADA）数据显示，高达约 40% 的奥运选手存在违禁药物使用史。 - **奥运选手收入现状**：国际奥委会不提供参赛或夺冠奖金，选手仅能依靠赞助商合同，许多人甚至常年挣扎在贫困线附近。 - **强化运动会奖金机制**：赛事单项冠军奖金为 25 万美元（$250,000），打破世界纪录者直接奖励 100 万美元（$1,000,000）。 - **赛事安排**：首届赛事定于 5 月 21 日至 24 日在美国拉斯维加斯举行。 ### [01:22:16](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=4936s) 终末期血管病变的终极救赎：阴茎假体植入术 在节目的最后阶段，塔特姆博士回归自己的手术专业领域，揭开了男科医学中极度隐秘但至关重要的课题——终末期血管疾病和糖尿病所导致的顽固性勃起功能障碍（ED）。许多男性随着代谢与血管病变加重，伟哥（Viagra）和犀利士（Cialis）等口服药物彻底失效，除了带来剧烈头痛之外毫无作用。而向阴茎直接注射药物的疗法对大多数男性而言极具心理抗拒感。此时，患者不仅面临丧失性功能的绝望，长期缺乏血供还会导致阴茎海绵体萎缩、尺寸明显缩水，给男性带来毁灭性的心理打击。 作为性医学外科专家，塔特姆博士的大部分手术实践正是通过“阴茎假体植入术（Inflatable Penile Prosthesis / Implant Placement）”来彻底解决这一难题。他用汽车刹车系统作比喻通俗解释了阴茎的生理机制：男性勃起本质上是两根从骨盆延伸到阴茎主体的液压充血管道；受到刺激时血液涌入产生坚挺勃起，高潮后泄压阀打开血液回流。而长期血管硬化意味着“刹车油路”彻底坏死，血液根本无法注入。 ```mermaid flowchart TD accTitle: 阴茎假体植入系统运作机制 accDescr: 展示储水囊、阴囊液压泵以及阴茎海绵体圆柱体之间的工作回路 subgraph 隐蔽植入结构 R["生理盐水储水囊<br/>（隐蔽植入于腹部/盆腔）"] P["微型手动液压泵<br/>（隐蔽植入于阴囊皮肤下）"] C["双充气圆柱体假体<br/>（植入于海绵体自然管道内）"] end subgraph 操作流程 Action1["手动捏压阴囊内液压泵"] Action2["生理盐水从储水囊注入圆柱体"] Action3["实现自然坚硬勃起（随心控制时长）"] Action4["按下释放阀，盐水回流平复"] end R -->|提供液体| P P -->|加压充盈| C Action1 --> Action2 --> Action3 --> Action4 ``` 针对彻底失去自然充血能力的患者，塔特姆博士的手术将两根定制的人工膨胀圆柱体置入阴茎海绵体内部，在阴囊皮肤下方隐蔽放置一个犹如“第三颗睾丸”的微型挤压泵，并将生理盐水储水囊隐藏于腹腔深处。外观上完全看不出任何手术痕迹。当患者需要勃起时，只需轻捏阴囊内的泵，生理盐水便会迅速注入圆柱体，产生与自然状态无异的坚固勃起，且勃起时长完全由患者掌控，直至按下释放阀液体回流至腹部储水囊。针对史蒂芬对快感是否受损的担忧，塔特姆博士特别澄清：负责性快感与感觉传导的神经全部走形于阴茎背侧上方，假体植入置于深层海绵体内，因此患者的性快感、高潮与射精感受完全不受任何负面影响。 ### [01:25:11](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=5111s) 阴茎假体植入术与 3000 万勃起功能障碍患者的困境 亚历克斯·塔特姆博士（Dr. Alex Tatem）在现场展示了阴茎假体植入装置的构造与工作机制。他解释道，手术时会避开位于 12 点钟方位的敏感神经束，将整套装置完全植入阴茎海绵体内，外观上毫无破绽。令人惊讶的是，这样一台精细的外科植入手术，塔特姆熟练完成仅需大约 13 分钟。当斯蒂芬·巴特利特（Steven Bartlett）问及有多少人接受了这种手术时，塔特姆透露，仅他个人迄今为止就已经主刀完成了 1100 到 1200 例。 随后，塔特姆揭示了美国男性勃起功能障碍（ED）令人震惊的现实数据：目前全美受勃起功能障碍困扰的男性高达 3000 万人，这一数字甚至超过了澳大利亚的全国总人口。在这庞大的人群中，约有 15% 的人在首次尝试伟哥等口服药物时就完全无效。这意味着有数以百万计的男性在面对药物失效后陷入孤立无援的境地，迫切需要更有效的终极治疗方案。 斯蒂芬在现场好奇地询问如何解除勃起状态，塔特姆指导他寻找装置上的泄气阀门：只需用拇指按住泵体上的两个小横杆，再顺着假体末端向泵体方向挤压，伴随着生理组织的自然下垂与回缩，植入体内的液体便会流回储液囊，让阴茎恢复疲软。斯蒂芬感叹失去勃起功能对男性的打击无疑是毁灭性的，这项技术对患者而言意义非凡。塔特姆深有同感地表示，尽管他的同事们在治疗肾结石和癌症，但他在诊所里收到的拥抱和击掌击节比任何医生都要多，这让他真切感受到工作的价值，并幽默地打趣道：“除非多肽技术让我彻底失业。” ```mermaid flowchart TD accTitle: 勃起功能障碍诊疗现状与假体方案 accDescr: 展示美国ED患者规模、口服药失效比例以及假体植入手术的特点与机制 subgraph Problem["ED 流行现状与药物局限"] A["美国 ED 男性患者：约 3000 万人<br/>（超过澳大利亚总人口）"] --> B["约 15% 初次服用口服药完全无效"] B --> C["数百万男性需要二线/终极替代方案"] end subgraph Solution["充气式阴茎假体植入术"] C --> D["全内置植入手术<br/>（耗时约 13 分钟，避开12点钟神经）"] D --> E["按压囊泵充气达到坚硬勃起"] E --> F["按压释放阀复位疲软"] end ``` - **假体手术特征**：完全内置于体内，避开 12 点钟方位的神经束，单台手术平均耗时仅约 13 分钟。 - **个人手术量**：塔特姆博士个人已累计完成约 1100 至 1200 例阴茎假体植入手术。 - **患者基数与失效率**：美国现有 3000 万男性患有勃起功能障碍；统计显示约 15% 的患者初次使用口服药物即告失败。 --- ### [01:26:42](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=5202s) 医学传播与终极问题：将 10 亿美元赠予何人？ 斯蒂芬盛赞了塔特姆在多肽与男性健康科普方面的卓越贡献。他提到，在团队最初策划多肽专题节目时，备选名单中有各种各样的专家医生，但塔特姆是断层领先的第一人选，因为他不仅善于将复杂的医学机制转化为通俗语言，更展现出了罕见的同理心与真诚。得知塔特姆的 YouTube 频道当时正处于突破 10 万订阅的大关（约 9.8 万至 9.9 万），斯蒂芬号召观众一同助推他迈过这一里程碑。 节目随后进入了《CEO日记》（The Diary Of A CEO）的传统压轴环节：回答上一位匿名嘉宾留下的信封问题——“如果你能将 10 亿美元赠予一位你并不认识的人，你会给谁？他们必须把这笔钱花在什么地方？” 塔特姆思考片刻后给出了他的答案：埃隆·马斯克（Elon Musk）。他解释说，这绝非因为马斯克缺钱，而是出于对马斯克宏大愿景的敬佩。塔特姆认为，马斯克展现出了一种与优秀医生相通的人文情怀，只是作为一名工程师和企业家，马斯克是在宏观层面上试图解决人类面临的最重大危机。塔特姆特别强调了两个领域： 1. **半导体与 AI 算力自主**：马斯克在奥斯汀推进的 Terafab 等算力与芯片工程，通过递归反馈工程大幅缩短芯片迭代周期，推动芯片制造能力的突破； 2. **脑机接口技术（Neuralink）**：这一项目致力于让盲人重见光明、让失聪者恢复听力，并让截瘫患者重新站立行走。 塔特姆坚信，将这 10 亿美元交给马斯克，所能产生的人道主义价值与普惠效应，将远远超过投给世界上的任何其他人。斯蒂芬对此深表赞同，并由衷感谢塔特姆的深入分享，期待未来能就男性健康的更广泛议题与他再次对谈。 ## Notable quotes > [00:00](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=0s) 如果我们再不警惕，这就是我们不可逆的未来 — Dr. Alex Tatem > [20:42](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=1242s) 这完全是‘禁果效应’（Forbidden Fruit Effect）在起作用 — Dr. Alex Tatem > [35:09](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=2109s) 当你过了 35 岁，现实就变得非常残酷了 — Dr. Alex Tatem > [49:25](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=2965s) 天下绝无免费的午餐（No free lunch） — Steven Bartlett > [53:56](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=3236s) 我可以坦白地说，我绝对没碰过 Retta，但这种‘药物未出、民间先用’的技术平权现象确实令人大开眼界 — Dr. Alex Tatem > [01:10:36](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=4236s) 如果我们作为一个社会能消除这一祸患，或者将其降到最低，那或许我终于能让自己彻底失业了 — Dr. Alex Tatem > [01:10:36](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=4236s) 在这个世界上，你可以做很多事情但都表现平平；或者你也可以挑出四到五件事，做到极其精通。这对我而言非常奏效 — Dr. Alex Tatem > [01:12:14](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=4334s) 我当时整个人都碎掉了。我花了这么多年接受训练，我到底够不够好？经过这一切，明天还值得过吗？ — Dr. Alex Tatem > [01:17:12](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=4632s) 受过高等教育的管道工（over-educated plumber） — Dr. Alex Tatem > [01:25:11](https://www.youtube.com/watch?v=jt5hHb6kzYM&t=5111s) 除非多肽技术让我彻底失业 — Dr. Alex Tatem ## Mentioned Dr. Alex Tatem, Steven Bartlett, FDA, RFK Jr., BPC-157, Melanotan II, 亚甲基蓝 (Methylene Blue), Epithalon, 胰岛素 (Insulin), 亮丙瑞林 (Lupron), 巨擘遗传公司 (Myriad Genetics), BRCA1, BRCA2, MK-677, GHRP-2, GHRP-6, 胸腺肽β4 (Thymosin Beta-4 / TB-500), 替尔泊肽 (Tirzepatide), 司美格鲁肽 (Semaglutide), GHK-Cu, KPV, MOTS-c, Semax, DSIP, Selank, 礼来公司 (Eli Lilly), 诺和诺德 (Novo Nordisk), Mounjaro, Ozempic, Marty Makary, IGF-1 LR3, Bimagrumab, Roledumab, Trevogrumab, Tesamorelin, PT-141 (Bremelanotide), Retatrutide, CJC-1295, Ipamorelin, Somatotropin, 强化运动会 (The Enhanced Games), WADA, IOC, James Magnuson, 伟哥 (Viagra), 犀利士 (Cialis), Elon Musk, Neuralink ## Video description The FDA silently banned 19 peptides overnight, now RFK Jr is reversing it all. Dr Alex Tatem reveals the truth behind the cover-up, and what peptides can really do for your body. Dr. Alex Tatem is an internationally recognised urologist who has studied peptides for 12 years and runs a men’s health clinic. He also hosts a YouTube channel dedicated to demystifying peptides and men's health. In this explains: ◼ What peptides are, how they work, and which ones target your health problem ◼ Why the peptide industry is quietly approaching the size of the entire AI sector ◼ Why male fertility is collapsing globally and what's silently driving it ◼ What low testosterone is doing to your body and how to fix it ◼ Why 30 million men with erectile dysfunction are never told about the most effective fix 00:00:00 Intro 00:03:35 What Exactly Is A Peptide 00:05:34 How Peptides Actually Work In Your Body 00:08:54 Why Peptides Are Suddenly Everywhere 00:11:29 The Real Role Of Compounding Pharmacies 00:17:36 Are Pharma Companies Prioritizing Profits Over Patients? 00:20:42 Why Peptides Are Back After Being Banned—What Happened Behind The Scenes 00:21:16 The Most Shocking Patient Transformation From Peptides 00:22:46 When You Should (And Shouldn’t) Use Peptides In Your Life 00:24:48 The Latest FDA Update 00:26:25 How People Are Actually Getting “Illegal” Peptides 00:28:01 How To Take Peptides Safely -What Most People Get Wrong 00:29:58 Why Big Pharma Feels Threatened By Peptides 00:38:09 How Peptides Could Transform Your Insulin Levels 00:39:02 Do Peptides Work As Creams? What You Need To Know 00:40:50 How Peptides May Unlock Better Cognitive Performance 00:43:18 The Future Of Muscle Retention On GLP-1s—What’s Coming Next 00:48:23 Ads 00:49:25 The Hidden Trade-Offs Of Peptides No One Talks About 00:52:29 The Real Benefits Of Different Peptides—And How They Compare 00:57:50 The Peptide That Could Change Your Sleep Quality 01:02:18 What Happens When You Stop Taking GLP-1s? 01:06:00 Ads 01:07:53 Is There A “Super Peptide” For Anti-Aging? 01:11:24 The Truth About Peptides And Erectile Dysfunction 01:12:16 Why Medicine Burned Me Out—And What It Reveals About The System 01:19:17 The Enhanced Games Explained—And Why They’re So Controversial 01:23:06 How To Improve Erections Enjoyed the episode? Share this link and earn points for every referral - redeem them for exclusive prizes: https://doac-perks.com Independent Fact Check: https://stevenbartlett.com/wp-content/uploads/2026/04/DOAC-Alex-Tatum-Independent-Research-Further-Reading.pdf Follow Dr Alex: X - https://link.thediaryofaceo.com/DS0mGd3 Instagram - https://link.thediaryofaceo.com/36mqqnE YouTube - https://link.thediaryofaceo.com/4SagDuv Website - https://link.thediaryofaceo.com/5WRUIrQ The Diary Of A CEO: ◼️Join DOAC circle here - https://doaccircle.com/ ◼️Buy The Diary Of A CEO book here - https://smarturl.it/DOACbook ◼️The 1% Diary is back - limited time only: https://bit.ly/3YFbJbt ◼️The Diary Of A CEO Conversation Cards (Second Edition): https://g2ul0.app.link/f31dsUttKKb ◼️Get email updates - https://bit.ly/diary-of-a-ceo-yt ◼️Follow Steven - https://g2ul0.app.link/gnGqL4IsKKb Sponsors: Pipedrive - https://pipedrive.com/CEO LinkedIn Marketing - https://www.linkedin.com/DIARY Wispr - Get 14 days of Wispr Flow for free at https://wisprflow.ai/steven [Source](https://www.youtube.com/watch?v=jt5hHb6kzYM)

[0:00] Dr. Alex Tatem: 如果我们再不警惕，这就是我们不可逆的未来 [20:42] Dr. Alex Tatem: 这完全是‘禁果效应’（Forbidden Fruit Effect）在起作用 [35:09] Dr. Alex Tatem: 当你过了 35 岁，现实就变得非常残酷了 [49:25] Steven Bartlett: 天下绝无免费的午餐（No free lunch） [53:56] Dr. Alex Tatem: 我可以坦白地说，我绝对没碰过 Retta，但这种‘药物未出、民间先用’的技术平权现象确实令人大开眼界 [70:36] Dr. Alex Tatem: 如果我们作为一个社会能消除这一祸患，或者将其降到最低，那或许我终于能让自己彻底失业了 [70:36] Dr. Alex Tatem: 在这个世界上，你可以做很多事情但都表现平平；或者你也可以挑出四到五件事，做到极其精通。这对我而言非常奏效 [72:14] Dr. Alex Tatem: 我当时整个人都碎掉了。我花了这么多年接受训练，我到底够不够好？经过这一切，明天还值得过吗？ [77:12] Dr. Alex Tatem: 受过高等教育的管道工（over-educated plumber） [85:11] Dr. Alex Tatem: 除非多肽技术让我彻底失业

[3:35] Dr. Alex Tatem: Peptides are derived from little pieces of amino acids, which think of them as the Legos that make up the human body... 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. [16:46] Dr. Alex Tatem: I don't actually think that there is a group of maniacal individuals... plotting to 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. They are prioritizing what's important for them, and regular people just get caught up in the mix. [20:42] Dr. Alex Tatem: I just saw a patient last week who increased his sperm count 10 times over and is now in a normal range because he's lost 100 lbs due to using tirzepatide, exercising, and improving his diet. [26:25] Dr. Alex Tatem: 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. [34:25] Dr. Alex Tatem: I tell patients that I am not a replacement for a personal trainer. I'm your doctor—you also need your personal trainer, and most of you need a nutritionist, man. [43:23] Dr. Alex Tatem: the peanut butter to myostatin's jelly. [49:25] Steven Bartlett: there's no such thing in life as a free lunch. [60:43] Dr. Alex Tatem: Your doctor should be your partner in you getting as healthy as humanly possible. [62:18] Dr. Alex Tatem: the Ferrari of GLP-1 medications.

[0:00] This may be the most controversial thing [0:03] we have on this table. This is peptide [0:05] [music] that actually tortures belly fat [0:07] at a disproportionate rate. And what we [0:09] found is not only do patients lose an [0:10] incredible amount of weight, but they [0:12] also get the best improvements we've [0:14] ever seen in their liver health. It's [0:15] absolutely wild, and I think this is [0:17] going to be a trillion-dollar [music] [0:19] drug when it comes out. I have brought [0:21] you here because you're an expert on [0:22] this subject, and it's worth saying that [0:24] there was some significant news about [0:25] this. Correct. From the FDA saying that [0:28] in July they are going to consider [0:30] legalizing seven peptides. And by [0:32] pharma's estimate, it might be the most [0:34] dangerous thing to their entire business [0:35] model. [music] So, do you think it is [0:37] plausible that big pharma didn't want [0:40] these in the hands of regular people [0:41] because they can't patent this and it's [0:43] powerful? 110% because the question [0:46] isn't what can peptides do, it's what [0:48] can't they do. And we've got several [0:49] peptides here in front of us. I don't [0:51] want to go through all of them. [0:52] Let's do it. So, this is probably the [0:55] most well-known peptide for skin [0:57] complexion, and it improves quality of [0:59] hair and nails. And then epithalon is [1:01] maybe maybe not going to be the fountain [1:03] of youth, but I'm very skeptical as far [1:05] as that goes. Next, we've got this. And [1:07] if you injected that at night, it would [1:09] improve your quality of your sleep. [1:10] Next, melanotan two. And this will [1:12] actually end up giving you a deep tan in [1:14] [music] response to just a little bit of [1:16] UV sun exposure. It'll also give you [1:18] some of the most impressive erections [1:19] you've ever had in your life, so be [1:20] warned. And what else have we got? [1:22] >> Oh my gosh. There's methylene blue where [1:23] people take it and they think it's going [1:24] to make them live forever. Don't take [1:26] this. It literally will stain your nails [1:28] blue and your hair blue. These two here [1:30] stimulates building muscle. This one can [1:31] aid with healing after an injury. And [1:33] then is this. This. This. This. It's [1:36] crazy. It's wild. So, why don't I take [1:38] it? Well, we need to talk about that [1:39] because there are trade-offs. But also [1:41] Outside of the world of peptides for a [1:42] second, I've got these three vials. Do [1:45] you know what those are? Yeah, this is [1:46] unfortunately our future if we're not [1:48] careful. Explain. So, what we've got [1:50] here is representing the fertility [1:52] trajectory for young men. [1:55] I'm so scared. [1:58] This is super to me. My team give me [1:59] this report to show me how many of you [2:01] that watch this show subscribe and some [2:02] of you have told us according to this [2:04] that you are unsubscribed from the [2:06] channel randomly. So, favor to ask all [2:08] of you, please could you check right now [2:09] if you've hit the subscribe button if [2:11] you are a regular viewer of the show and [2:12] you like what we do here. We're [2:13] approaching quite a significant landmark [2:15] on this show in terms of a subscriber [2:17] number. So, if there was one simple free [2:19] thing that you could do to help us, my [2:21] team, everyone here to keep this show [2:23] free, to keep it improving year over [2:25] year and week over week, it is just to [2:27] hit that subscribe button and to double [2:28] check if you've hit it. Only thing I'll [2:29] ever ask of you. [2:31] Do we have a deal? If you do it, I'll [2:32] tell you what I'll do. I'll make sure [2:35] every single week, every single month we [2:36] fight harder and harder and harder and [2:37] harder to bring you the guests and [2:38] conversations that you want to hear. I [2:40] stay true to that promise since the very [2:41] beginning of The Diary of a CEO and I [2:43] will not let you down. Please help us. [2:46] Really appreciate it. Let's get on with [2:47] the show. [2:48] >> [music] [2:55] >> Dr. Alex Tatem. [2:59] There's this word that has exploded in [3:01] society in recent times. In fact, when I [3:02] look at the data, [3:04] people searching this word has increased [3:06] by 400% [3:08] just recently and that word is peptides. [3:12] I have no idea what peptides are. I'm [3:15] someone that wants to be healthy, that [3:17] wants to optimize my health, wants to [3:19] live long, doesn't doesn't love aging. [3:22] Yeah. [3:23] And I'm told that this word peptides is [3:25] somewhat linked to it. So, I've brought [3:27] you here because you're an expert on the [3:28] subject, man. I've watched your videos [3:29] on YouTube. [3:31] To start at the very beginning, Dr. [3:32] Alex, Sure. what the hell is a peptide? [3:35] Peptides are a structural class of [3:38] medications. The best way to think about [3:40] peptides is that just like we have small [3:42] molecules which are drugs that are very [3:45] small, taken in a pill, and have a [3:47] wide-ranging effect throughout the body. [3:49] Peptides are derived from little pieces [3:53] of amino acids, which think of them as [3:55] the Legos that make up the human body, [3:58] the Legos that make up proteins. These [4:00] are fragments of proteins that are [4:03] designed to specifically target certain [4:05] receptors and affect cells in a very [4:08] targeted fashion. Or a best way to think [4:10] about it is a very specific targeted key [4:13] to unlock a very specific lock. So, [4:16] instead of a small molecule that may [4:17] have a wide-ranging effect throughout [4:19] the body, peptides are much, much more [4:21] focused. So, you've got different types [4:24] of Lego cubes here. Would they be [4:26] different types of peptides or are they [4:28] different types of amino acids that come [4:31] together to make a peptide? [4:32] >> The best way to think about it is my son [4:34] loves Legos, which is why I'm glad that [4:36] we have these here. But, he can take the [4:38] same set of Legos and he can build a [4:41] rocket ship. And then, just a few [4:43] minutes later, he can build a pirate [4:46] ship. And then, he builds a race car. [4:48] He's using the same Legos, but he's [4:49] creating very, very different things [4:51] that all do very, different things. And [4:54] so, peptides have become incredibly [4:55] popular because, yes, we have some [4:58] really fascinating peptides that can [4:59] help with anti-aging, with healing, and [5:02] with tissue repair. We're going to talk [5:03] about some of those, hopefully. But, [5:05] they can do so much more than that. The [5:06] first peptide that was actually isolated [5:08] and used in medicine was insulin back in [5:10] 1921. [5:12] And then, all the way in 1985, in the [5:15] world of urology, which is where I was [5:16] trained, we had Lupron, which is a [5:19] different peptide that, again, also a [5:21] peptide like insulin, but instead of [5:23] having wide-ranging metabolic effects, [5:24] it had an endocrine effect. It was [5:26] designed to shut down the production of [5:28] testosterone for prostate cancer [5:30] patients that needed to have their [5:32] testosterone taken away. Interesting. [5:34] Okay, so insulin's a peptide. Insulin's [5:36] a peptide. Because it's a series of [5:39] amino acids. [5:39] >> Amino acids that are put together. Okay, [5:41] so you said that the combination of [5:43] amino acids forms a key. So, what is the [5:45] lock? The lock could be a cellular [5:48] receptor. It could actually be [5:51] regulating a certain pathway within the [5:52] cell. Okay, so let me repeat this back [5:54] to you to make sure I understand it. So, [5:56] yes. [5:56] >> Yes. Peptides are like a key, Yes. which [5:59] you can make by configuring amino acids [6:01] in a certain way, and there's different [6:04] locks in our body that these keys can go [6:06] into. So, if I take, you know, we've got [6:09] some peptides on the table in front of [6:10] us here. [6:11] >> So, a good way to think about it is [6:13] this. If you've got a hammer, right? [6:17] Which is what a lot of small molecules [6:19] are. Like you can do a lot with that, [6:20] right? Like you could hammer in a nail. [6:23] But if you try to use that hammer when [6:25] you're trying to put in a screw, or [6:26] you're trying to put together, you know, [6:29] a table that you got from IKEA, it may [6:31] not always end the way that you want to. [6:33] And that's the problem that we have with [6:34] a lot of small molecules. It's not that [6:36] they don't do what we want them to. They [6:37] do a lot of other things while they're [6:39] at that job that can have significant [6:41] negative side effects, which is why a [6:43] lot of these small molecules actually [6:46] don't make it all the way through the [6:48] FDA approval process, because we find [6:50] something, it does what we want it to [6:51] but has significant safety concerns down [6:53] the line. All right? Now, what we see [6:55] with peptides, for example, I've got in [6:57] my hand right now a little vial labeled, [7:00] you know, BPC 157. This is probably one [7:02] of the most popular peptides that we're [7:04] talking about right now, because BPC 157 [7:07] is a synthetic version of a naturally [7:10] found peptide in the gut. But what this [7:13] actually does is it enhances blood [7:16] vessel growth in areas of injury. And it [7:19] kind of makes sense, because if you [7:21] think about it, our gut, our stomach, is [7:23] really just this [7:25] bag of acid that sits inside of our [7:27] abdomen, and yet somehow you and I are [7:29] here talking to each other and our [7:30] bodies aren't eating themselves. Well, [7:32] how does that work? Well, it's because [7:34] we've developed a lot of really robust [7:35] systems to encourage healing of the [7:37] gastric lining. And so the idea is like, [7:39] well, if this is one of the compounds [7:41] that can help do that, it's been proven [7:43] in multiple animal models. For example, [7:45] they have completely transected the [7:47] Achilles tendon in rats and then they [7:49] transected transected so they've cut [7:51] across the Achilles tendon. So not just [7:53] a small injury that you or I might [7:55] experience in the gym where we pull it [7:56] or strain it, but actually surgically [7:58] cut the Achilles tendon. And then they [8:01] administer it to rats and they are [8:03] healing spontaneously with [8:05] administration of BPC 157. If you have [8:09] an Achilles tendon injury and you're a [8:10] rat, BPC 157 is one of the best things [8:13] that you can ever have. Now, that is not [8:15] a one-to-one translation to what we [8:16] might see in humans, but as we talked [8:18] about earlier with our point on safety, [8:20] when they are studying BPC 157, we try [8:23] to look for something called the LD1 or [8:25] the LD50. How much can I give this to [8:28] someone until 50% of the population that [8:30] receives that dose doesn't do well or [8:32] dies, okay? That's called the LD50 dose. [8:36] We have yet to figure out what the LD1 [8:38] dose is for this, which is [8:40] the amount that it would take to hurt [8:42] even 1% of the population because it is [8:45] so incredibly well tolerated. So, just [8:48] giving you an example of this is a [8:49] compound that can have profound healing [8:52] effects, at least in our animal models [8:54] that we've seen so far, but so far we [8:57] haven't seen any precipitous negative [9:00] effects in human patients when taking [9:02] this, okay? But we need more data. [9:05] I am mind-blown and I'm very, very [9:07] excited. We've got all of the several [9:09] peptides here in front of us. I want to [9:10] go through all of that and understand [9:11] which ones do which things. [9:13] >> Sure. But there's a bigger question [9:14] here. [9:14] >> Yes. Which is, why now? Why have the [9:18] subject of peptides suddenly exploded [9:20] into society's consciousness? What's [9:23] going on? What's the big picture? So, [9:25] this is really interesting. In 2013, [9:27] there was actually a court case in the [9:29] United States. It was the It was called [9:32] Myriad Genetics case. This was the [9:33] company that actually patented the BRCA1 [9:36] and BRCA2 genes. They discovered the [9:38] genes that cause breast cancer, all [9:39] right? This was mind-blowing. They [9:41] identified the specific genes that would [9:43] predispose patients to developing both [9:45] breast, ovarian, and since we've learned [9:47] also prostate cancer. It was a fantastic [9:49] discovery, but they patented it. And [9:50] they said, "We now own this intellectual [9:53] property." And then everyone else said, [9:55] "No, no, no, that's that's the human [9:56] body. You can't patent that." And the [9:58] Supreme Court actually sided with that [10:00] argument, saying that if something is [10:01] natural, it's found within us, okay? I [10:04] can't patent, you know, your muscle [10:05] cells, right? Which is a wonderful [10:07] thing. But the unintended unintentional [10:09] byproduct of that is all of a sudden [10:12] pharma had no incentive whatsoever to [10:14] pursue really promising compounds that [10:18] they could not monetize. So, that [10:20] happens in 2013. At the same time, I [10:22] believe it was around 2012, 2013, there [10:25] was a terrible event that happened in [10:27] New England where there was a [10:28] compounding pharmacy that was not doing [10:30] the right thing, and they ended up [10:32] having a bunch of contaminated specimens [10:35] that caused a fungal meningitis. Bunch [10:38] of patients got really sick. It was a [10:40] huge scandal. And all of a sudden the [10:42] FDA stepped in and said, "Hey, [10:43] historically, all right, states have [10:46] been allowed to regulate compounding [10:47] pharmacies themselves, but we need some [10:49] federal oversight here cuz this is not [10:50] acceptable." [10:52] Completely agree with that. And they [10:53] introduced a new set of regulations on [10:56] top of compounding pharmacies, basically [10:59] saying what you can and cannot make. And [11:01] what they eventually said is, "Well, the [11:03] only you can only make three things. You [11:05] can make things that are in the USP uh [11:08] United States Pharmacopoeia, okay? [11:10] Things that have been, you know, well [11:11] described, already published, things [11:13] that are already in drugs that are [11:15] already on the market. Or three, things [11:17] that are on a very specific list that [11:19] we're going to give you, okay? And in [11:21] that list, they actually included a lot [11:25] of these very promising compounds that [11:27] were stuck in drug development, you [11:28] know, limbo. And you say compounding [11:31] pharmacies. You said that a few times. [11:32] What is a compounding pharmacy? Just [11:34] just so I'm clear on the definition. [11:35] Back in the 1800s or you know early [11:37] 1900s, if you ever needed a medication, [11:39] you'd go see the pharmacist who had a [11:41] shop down the road and he would actually [11:42] make your medication in front of you. [11:43] And he would do that custom for every [11:44] single patient that came by, all right? [11:46] It was only since the advent of modern [11:48] factories that we had the modern [11:50] pharmaceutical industry come about. But [11:51] the truth is is that again, you know, [11:53] that's kind of paint by numbers. You're [11:54] creating this one pill and you know, it [11:57] always seemed kind of crazy that the [11:58] adult dose is one standardized dose for [12:01] all adults. Like if you look at what [12:03] your body composition is versus some of [12:05] my patients, why is the dose in your [12:07] blood pressure medicine the exact same? [12:08] Like that doesn't seem to be quite [12:09] right, but it is what it is. So when [12:12] patients fall outside of that and they [12:13] need custom medication, we still have [12:16] those people who make custom [12:18] formulations of medications. But instead [12:20] of it being just your local pharmacist [12:21] who's using a mortar and pestle and you [12:23] know, he's creating something in his [12:24] back office, these are now large [12:26] sophisticated industrial operations that [12:28] can make custom formulations for [12:29] patients. I think I think the important [12:31] context Yeah. for people that don't [12:33] understand how drug development occurs [12:35] is that to get chemicals like the ones [12:37] we have in front of us on the table [12:38] through FDA approval, you've got to [12:40] spend millions and millions and millions [12:42] of dollars. Tens if not hundreds of [12:43] millions of dollars. Sometimes hundreds [12:44] of millions of dollars. Yeah, an [12:45] incredible amount of money. And And if [12:47] you know you can't protect it once you [12:49] spend a hundred million dollars, you [12:50] have no incentive to just do charity [12:52] work. Absolutely not, okay? Because you [12:54] have shareholders and you have to make [12:56] payroll. And so because drug development [12:59] is so expensive, there's no incentive [13:02] for commercial pharmaceutical companies [13:04] to pursue the development of these [13:05] compounds. And then on the other side of [13:08] that, well we have compounding [13:09] pharmacies that you know, for them it [13:11] makes sense. What if we could just make [13:13] these compounds and then sell them [13:14] directly to patients? We make a small [13:15] margin when we sell it. This makes sense [13:16] for us. Well, they could do that [13:18] starting in about 2014 whenever that [13:20] legislation finished, all right? What [13:22] did it do? Essentially what it did is it [13:25] gave a it gave a assignment to each one [13:28] of these compounds. It was either going [13:30] to be category one, which is you can [13:33] compound this. This is on our specific [13:34] list of approved compoundable drug [13:36] ingredients. [13:37] Number two was, "Hey, we see some [13:40] negative safety signals here. You cannot [13:41] make this, okay?" Something goes in [13:42] category two, it's forbidden. And then [13:44] we have category three, which is we just [13:46] need more information. And all of these [13:48] original compounds, these peptides that [13:50] we're so interested in now, were [13:51] originally on that first list, category [13:53] one, all right? And so, they were able [13:56] to be compounded. We could prescribe [13:58] them patients. I prescribe them to [13:59] patients, all right? From 2014 onward. [14:03] But then in 2023, [14:05] the FDA at that time switched all of [14:07] those peptides, 19 of them that were [14:10] popular, to category two, and then they [14:12] were banned. Overnight, we got [14:13] notifications in our email inboxes from [14:15] our compounding pharmacy partners [14:16] saying, "Hey, we can't make this [14:18] anymore. We're sorry." So, I've got two [14:20] questions there. Um the first is when [14:23] you were prescribing these peptides to [14:25] your patient [14:26] >> Yes. [14:27] were you seeing incredible results? [14:29] Very much so. Very much Again, you have [14:32] to use the right key for the right lock, [14:34] okay? But I think a really good example, [14:37] all right? So, there is a [14:40] compound that is not technically a [14:41] peptide. It is a small molecule, but it [14:43] was lumped in with all of these and was [14:45] the victim to the same process. [14:47] Uh something called MK-677, also known [14:50] as ibutamoren. So, this is a small [14:52] molecule, but when a patient takes it, [14:54] it's orally available. It binds to this [14:56] receptor called ghrelin, and it actually [14:58] stimulates the release of significant [14:59] growth hormone. But what was really [15:01] interesting is that it would actually [15:03] stimulate hunger a profound amount. And [15:05] all of a sudden, patients that were [15:07] struggling with cachexia, okay? So, [15:09] being very, very thin, very [15:11] malnourished, maybe they're going [15:12] through cancer treatment. [15:13] >> Ghrelin's the thing that makes us feel [15:14] hungry. [15:15] >> Absolutely. Yeah. Yeah. So, they were [15:17] able to stimulate the hunger response, [15:19] and patients were actually able to eat [15:21] more to meet caloric goals. And so, this [15:23] was a medication that was fantastically [15:25] effective at that. [15:27] Again, it had gone through some clinical [15:29] trials, but was never taken all the way [15:31] to commercial. And so, it was never [15:34] going to be available from CVS or [15:35] Walgreens, but you could get it from a [15:37] compounding pharmacy. And so, that was [15:39] one that made a big difference for us. [15:41] We also had other peptides. So, [15:43] GHRP-2 and GHRP-6 were some of the ones [15:46] we were using at that time. Those are [15:48] growth hormone-releasing peptides that [15:51] stimulate the release of your body's [15:52] natural growth hormone, which can help [15:54] with tissue repair, can also help with [15:56] fat loss, and with building muscle. We [15:58] also had BPC-157, and we had derivatives [16:03] like thymosin beta-4. These are also [16:05] compounds that can help stimulate [16:07] angiogenesis, so making new blood [16:09] vessels, all right, and tissue repair. [16:10] So, if we have a patient that's injured [16:12] themselves, maybe we could help them get [16:14] back at life faster. These were all [16:16] things that were used very commonplace [16:18] for many years, and truthfully, they [16:20] weren't super popular at the time. We [16:22] were just using them, and then they were [16:23] banned overnight. And they were working. [16:26] And they were working. And they were [16:27] working, [clears throat] and we were not [16:27] seeing adverse events, which is the most [16:30] important thing. What's an adverse [16:31] event? [16:32] >> An adverse event is a patient has a [16:34] terrible side effect. They call you, [16:35] they have an allergic reaction to [16:37] something. They call, they've got [16:38] shortness of breath, and it's a direct [16:40] result of the medication that you gave [16:41] them. It was working. It was working, [16:43] and by all accounts, seemed to be [16:44] incredibly safe. [16:45] >> And then they banned it. [16:46] >> And then they banned it. Why? That's a [16:48] great question. So, officially, what [16:52] happened is there was a meeting where [16:53] they brought together the experts at the [16:55] time, and they said, "There is [16:56] insufficient data for us to say that [16:58] these are safe." Because again, they had [16:59] not gone through the full FDA approval [17:01] process. And so, as a result of lacking [17:04] that data, we're going to say that [17:05] they're too dangerous. Now, there wasn't [17:07] any evidence of any of that in the [17:08] population. These were widely used at [17:10] the time. Potentially, we had commercial [17:13] pharmaceutical companies saying, "Well, [17:15] hey, this is people spending money on a [17:18] compound, on something that isn't coming [17:20] to us. So, hey, like we love medicine, [17:23] but maybe only when it's our medicine. [17:25] Mhm. And so, there's concern that that [17:27] was at at play as well. And so, there is [17:29] not a great paper trail, and there's not [17:31] a great explanation why. And that's [17:32] something that's been iterated by our [17:34] current administration, from RFK [17:36] himself. You know, he himself has [17:37] characterized that move done in 2023 as [17:40] being illegal. With everything you know [17:41] about the medical industry, do you think [17:43] it is plausible that big farmer 110%. [17:48] didn't want 110%. [17:51] these in the hands of regular people, [17:52] because they can't patent this, and it's [17:54] powerful. So, ultimately, the way to [17:57] think about it is this. [17:59] Um [18:02] pharma may not have a compound that [18:04] directly competes for BPC-157. [18:07] BPC-157. So, this is the medication or [18:10] the peptide that can aid with healing [18:13] after an injury, okay? So, it's not [18:15] necessarily there's direct competition, [18:17] but at the end of the day, your average [18:19] patient going throughout their daily [18:21] life only has so much money that they [18:23] can spend on medicine. Mhm. And [18:25] [clears throat] [18:26] $10, $15, however much money that goes [18:28] to this [18:29] doesn't go to a prescription drug from a [18:31] commercial pharmaceutical company. [18:33] And so, there is real concern that [18:35] potentially that was at play during that [18:37] decision. You said 110%. Yeah, I well, [18:40] you know, it's interesting because you [18:42] know, I try to walk a very fine line [18:44] between what I can prove [18:46] versus what I suspect after being in [18:49] this space for a long time. And, [18:51] [clears throat] you know, ultimately, [18:53] you know, I don't think it's accurate to [18:55] characterize pharmaceutical companies or [18:58] really any other entity as being, you [19:00] know, evil or or bad. The truth is maybe [19:03] a little bit more ominous. The truth is [19:05] is that they are these large machines [19:08] that are designed to prioritize profit [19:09] over everything. [19:10] >> Yeah. And that's everything. I think [19:12] this is one of the really interesting [19:13] observations I've had the higher I've [19:15] gone in my career is that often times [19:18] here we heard about the Illuminati like [19:19] when I was growing up I was like oh [19:20] there's this Illuminati. [19:21] >> Yeah. And you think of it as these like [19:22] shadow hooded people that get together [19:24] and decide evil things but at the [19:26] further I've gone in business the more [19:27] I've realized that the Illuminati or [19:28] these evil forces are actually just [19:30] machines that were designed to optimize [19:31] for profit. [19:32] >> Correct. Correct. So like corporations [19:35] are the Illuminati. Yeah and so I don't [19:37] actually think that there is necessarily [19:39] you know a group of maniacal individuals [19:42] you know the Legion of Doom you know [19:43] plotting to like take away your health [19:45] but at the same time I think that there [19:47] are these large organizations that [19:49] really couldn't care less about your [19:50] health. You know they are prioritizing [19:52] what's important for them and regular [19:54] people just get caught up in the mix and [19:56] what's challenging is that as a [19:57] physician you know I took a Hippocratic [20:00] oath you know I care about my patients [20:02] and so those are the people that are in [20:03] front of me every single day that are [20:04] seeking to improve their lives to [20:06] recover from injury. I have you know [20:08] fertility patients that are just dying [20:09] to start their family and I have [20:11] patients that are suffering from [20:13] hormonal imbalances that haven't felt [20:15] right in years. I I treat erectile [20:16] dysfunction in men that have been [20:18] struggling for years after prostate [20:19] cancer treatment. I mean these are [20:20] people that are broken and hurting. You [20:22] want to be able to help them and so I [20:24] feel that as a very strong personal [20:26] calling that I have to be the advocate [20:28] for that patient both in the room [20:30] whenever I'm treating them and taking [20:31] care of them but also when I'm talking [20:33] to others and I'm you know speaking out [20:35] about these issues. Like I want access [20:37] to these medications because I care [20:39] about the patients who benefit from [20:40] them. [20:42] Sweden banned these peptides that we [20:44] have here. Correct. [20:45] >> And we're sat here two years after the [20:46] ban I believe roughly two years after [20:48] that ban. [20:48] >> Yeah. And suddenly everybody's talking [20:50] about peptides again. Yes. Why? What's [20:52] going on? So I think what we're seeing [20:54] is the forbidden fruit effect because [20:57] this was banned and all of a sudden oh [20:59] well why'd they ban it? Well they [21:00] wouldn't have banned it if it weren't [21:01] working right and we're also seeing the [21:03] effect of TikTok and short form content [21:05] being spread very rapidly very virally [21:08] and that's been going on for 2 years [21:09] now, combined with new emphasis from [21:13] administration leadership and HHS and [21:15] then RFK. What is the most incredible [21:18] impact that you've seen peptides create [21:21] in a patient? Oh my gosh, I have a best [21:23] story for you. So, one of the most [21:26] frustrating things about my practice is [21:29] treating infertility in young men that [21:32] have significant metabolic dysfunction. [21:34] These are young men that have a low [21:37] sperm count, right? So, they can't get [21:38] pregnant because they just don't have [21:40] the numbers to make it happen. And [21:42] you're looking at them and they're [21:43] morbidly obese, okay? They have high [21:45] insulin resistance, all right? And their [21:48] endocrine system has been damaged by [21:49] that obesity. So, they don't have have [21:51] low testosterone levels and their brain [21:53] is not making enough of the signals to [21:55] stimulate their testicles. Now, we have [21:57] medications that we can use to help [21:59] stimulate that to make more of that [22:01] signal stimulate the testicles, right? [22:03] But, really what is eating at them, what [22:06] is causing this, is not that chemical [22:08] imbalance. That's the the symptom. [22:09] That's not the the problem, okay? And [22:11] treating symptoms doesn't really get you [22:12] very far. And so, I would have patients [22:14] that I would take care of and we would [22:16] never see a significant improvement in [22:17] their numbers because losing weight is [22:18] really, really hard, you know, [22:20] regardless of all of the education and [22:21] resources I try to give them. But, now [22:23] we have peptides in the form of GLP-1 [22:26] drugs like semaglutide and tirzepatide. [22:29] And I just saw a patient last last week [22:31] who increased his sperm count 10 times [22:34] over and is now in a normal range [22:37] because he's lost 100 lb due to using [22:40] tirzepatide, exercising, and improving [22:43] his diet. And he has totally changed his [22:45] life. [22:46] >> And that started with a peptide. Started [22:47] with a peptide. [22:48] So, I we've got lots of peptides on the [22:50] table in front of you. We will go to the [22:51] into them individually, but just can you [22:53] give me a a high-level view of the types [22:56] of areas in our health and life that [22:58] these peptides can help with? So, So, [23:00] talked there about infertility Correct. [23:02] as a downstream consequence of the like [23:03] weight loss and fixing the metabolic [23:05] health. What are What other parts of the [23:07] body the peptides touch? The best way to [23:09] think about it is like this. So, [23:11] peptides are almost like an app on your [23:14] phone. So, imagine before we had apps. [23:18] I'm old enough to remember trying to log [23:19] on and do my banking online before we [23:21] had apps and gosh, it was so painful, [23:23] right? Like there were ways to [23:24] accomplish things, but they were very [23:25] inconvenient and a roundabout way. And [23:27] now all of a sudden we have these apps [23:29] on our phone that can do just about [23:31] anything except fold your laundry, [23:32] right? You know, there's some limits to [23:33] it, but I mean really the sky's the [23:35] limit from an electronic standpoint. And [23:37] really that's what peptides are. So, the [23:39] thing is is that we have peptides that [23:42] can help you lose weight like the GLP-1 [23:43] drugs. We have peptides that can improve [23:47] skin quality like GHK-Cu. [23:50] We have peptides that can help heal your [23:52] gut like BPC-157, particularly effective [23:55] in ulcerative colitis, which is [23:57] something that's being investigated with [23:58] the FDA's planned upcoming meeting on [24:00] it. We also have peptides that can help [24:03] with sleep and with recovering the gland [24:06] in your brain that's responsible for [24:07] melatonin and regulating your sleep-wake [24:09] cycles. So, the question isn't, you [24:11] know, what can peptides do? It's kind [24:12] of, well, what can't they do? And if [24:14] they can't do that yet, can we develop a [24:16] peptide that can accomplish that task? [24:19] And the answer is probably and [24:21] simultaneously while there may be [24:22] resistance from pharmaceutical industry [24:24] in these peptides, the ones that were [24:26] most interested right now, they have [24:28] signed multi-billion dollar deals with [24:31] other pharmaceutical companies that are [24:33] involved in peptide development aided by [24:35] AI to try and fast-track their own [24:38] peptide products. Interesting. [24:40] >> And so, we are going to see [24:42] exponentially more of these products [24:43] come down the pipeline from [24:45] pharmaceutical companies in the form of [24:47] commercial products. And it's worth [24:48] saying that there was some significant [24:50] news today. Correct. What happened [24:52] today, but also what's going on? And [24:53] just for anyone that doesn't know, it's [24:54] April the 15th. Yes. So, today [24:58] we got a really press release from the [25:01] FDA saying that in July they are going [25:03] to consider seven peptides for removing [25:07] from category two back to category one. [25:09] >> Legalizing them. Legalizing them, okay? [25:12] And some of the heavy hitters from that [25:15] list include BPC 157. Which is the one [25:19] we talked about to do with like repair [25:21] and injury. Absolutely, okay? And then [25:23] we have [25:24] the brother to that which is TB 500, [25:27] this vial over here. This improves blood [25:29] flow to an injured area. You could think [25:31] of this as sending the soldiers, as [25:34] sending the cells that are required for [25:36] rebuilding that tissue matrix that was [25:38] damaged by a tear or a cut, all right? [25:40] On top of that, we're also getting [25:43] something called KPV. May not have it [25:45] here, but that is another [25:48] peptide that has been linked to [25:50] angiogenesis and tissue repair. We're [25:52] also getting MOTS-c and you know, some [25:54] people just will call it exercise in a [25:56] vial. It improves your VO2 max and your [25:58] exercise tolerance and by up regulating [26:02] the energy pathway, basically making [26:03] more ATP, the energy that we all use to [26:05] move, it makes more of that available, [26:07] all right? We're also going to get DSIP, [26:10] epithalon, and C-max which are all [26:13] peptides that affect cognitive function. [26:15] So, improving thinking, like C-max is a [26:18] great option for that. And then DSIP and [26:20] epithalon both have roles in regulating [26:23] sleep and recovery. [26:25] Wow. Yeah, [clears throat] pretty wild. [26:28] And I've got to say, how does So, some [26:30] of them are becoming legalized, but even [26:32] the ones that aren't legal right now, a [26:33] lot of people are taking them anyway. [26:34] Correct. So, my my question is, how are [26:37] people getting them? Listen, I don't [26:38] want to promote illegal drugs here. This [26:40] is not that kind of But, I just [26:42] want to know what's going on. No, this [26:43] is Well, this is important to talk [26:44] about, right? Cuz we have to understand [26:46] like what's going on in the marketplace. [26:47] The moment that these drugs were banned [26:50] or these medications were banned in [26:51] 2023, It's kind of like the United [26:53] States experimented banning alcohol. It [26:55] didn't go very well, right? All of a [26:56] sudden, you know, they you know, the mob [26:59] came around and we started, you know, [27:01] seeing unregulated [27:03] uh saloons and unregulated alcohol [27:05] production and it was contaminated with [27:07] all the stuff that you didn't want. And [27:08] so like people were trafficking. Yeah, [27:09] exactly. It's just it's not a good idea, [27:11] right? And so what happened is we banned [27:14] these and the gray market stepped in. [27:16] And so these are companies that will [27:18] sell peptides that have on the label for [27:20] research use only, all right? And the [27:22] idea is that that takes them out of the [27:24] FDA's jurisdiction because they're not [27:26] selling it for people to inject into [27:27] themselves out of the FDA's hands. I'm [27:29] just creating a vial of this magical [27:32] juice that you can use for your rat, [27:34] okay? That's the idea. We all know [27:36] that's not what's really happening. But [27:38] because there isn't any quality control, [27:41] it's kind of like getting gas station [27:42] sushi. Like yeah, you can do it, but you [27:44] don't really know if it's sushi and it [27:46] may not end very well for you. And so [27:48] again, not saying that there aren't some [27:50] people who have gotten good results with [27:52] research use only peptides, but again, [27:55] it's not standardized, which is why I [27:57] think moving this back into the 503A [27:59] compounding world is the best thing for [28:01] everyone. Which is the legal [28:02] framework. Okay, so how does one take a [28:04] peptide? That's a great question. So [28:07] what's interesting is that as we [28:08] mentioned, you know, peptides are just [28:10] made up of building blocks of amino [28:11] acids. And you know, if you were to go [28:13] make yourself a protein shake, you know, [28:15] what is that going to look like from a [28:16] Lego standpoint? It just looks like [28:18] this, a handful of Legos in your hand, [28:20] right? All sort of like ground up. All [28:21] ground up in individual pieces, right? [28:23] But the thing is is that your gut is [28:25] designed to break up any sort of protein [28:28] that you ingest orally into these little [28:30] pieces. And so if you were to say, I [28:33] don't know, drink some of, you know, [28:35] this TB-500, your body wouldn't be able [28:38] to tell the difference between that and [28:39] a piece of chicken cuz it would it would [28:40] break it all apart. It'd break it all [28:41] apart. Now, there are some very [28:43] unique exceptions to that. There's a [28:45] form of BPC-157 that actually is [28:47] tolerated in the gut, but by and large [28:49] the overwhelming majority of these have [28:51] to be injected either subcutaneously or [28:53] into the muscle, and that's usually a [28:55] preference. Subcutaneous being my belly. [28:57] >> Under Just underneath the skin. You [28:58] know, as I tell patients, just pinch an [29:00] inch, inject under the skin. We do that [29:01] for a lot of other medications as well. [29:03] >> Isn't that what this is? Yeah, so this [29:05] is a prescription Mounjaro pen. So, [29:07] Mounjaro is the brand name for [29:09] tirzepatide, all right? Tirzepatide [29:11] being the leading GLP-1 product right [29:14] now from Lilly. So, this produces more [29:17] weight loss per milligram than any other [29:20] product that we've got out right now. Is [29:22] this the mechanism in which people [29:23] inject peptides? No, a little bit [29:25] different. So, this is an auto-injector [29:28] pen. And so, what you do is you're able [29:29] to actually ratchet the dose there on [29:31] the right side, and then you pinch an [29:33] inch in your skin, and then push it up [29:34] against and it'll auto-deploy. And so, [29:36] there's nothing that you need to do. You [29:37] don't have to learn how to drop [29:38] medication and inject. Whenever you're [29:40] administering peptides at home, [29:43] especially for patients that have [29:44] obtained them from research use only [29:45] markets, they usually come in just [29:47] little vials that need to be drawn up [29:49] with a needle, okay? Now, the benefit of [29:52] that is that you can do custom dosing, [29:54] all right? But, the drawback is is that, [29:56] well, you have to know how to calculate [29:57] that and put it together. This may be [30:00] the most controversial thing we have on [30:02] this table. And by Pharma's estimate, it [30:05] might be the most dangerous thing to [30:07] their entire business model. Because [30:09] this is tirzepatide, the exact same [30:12] thing that you had in that pen. But, [30:13] this is made by a high-quality 503A [30:16] compounding pharmacy. And the reason why [30:19] this is uh so controversial right now is [30:23] because it offers an incredible amount [30:24] of flexibility because what you have in [30:26] your hand there is very standardized, [30:28] and you administer it once a week cuz [30:30] that's what's approved by interest. [30:31] >> This is like the Ozempic thing [30:32] everyone's been talking about. [30:32] >> Exactly, right? But, think of that as [30:35] paint by numbers, okay? You are This co- [30:38] This section is this color, this section [30:40] is that color, all right? Think of this [30:42] as the thing you've got in your hand [30:44] right now. Yeah, exactly. Just a vial of [30:46] tirzepatide as being a having infinite [30:49] permutations and dosing ability because [30:51] you can draw this up with a small [30:53] syringe and do microdosing. So, instead [30:55] of one large dose once a week because [30:57] what many patients will experience is [30:58] they'll have a return of their hunger by [31:00] the end of the week and they end up [31:02] losing ground, you can actually, instead [31:04] of doing a full dose once a week, you [31:06] could do multiple mini doses throughout [31:08] the week with this formulation and with [31:10] this presentation of the medication. All [31:12] right? But, the challenge is is that [31:14] that is the benefit that allows us to be [31:16] compounded by compounding pharmacies [31:17] because they are able to provide [31:20] something that is similar to what's in [31:22] your hand, all right, but it offers more [31:23] flexibility that may be the right choice [31:26] for some patients. So, personal is [31:28] personalization of medicine, okay? But, [31:30] the challenge is is that if you spend [31:33] however much money on this, you're not [31:34] giving it to Lilly. And so, as a result, [31:37] we have seen an unprecedented crackdown [31:39] in the United States from the FDA in [31:42] trying to shut down compounding [31:43] pharmacies and prevent them from making [31:46] these medications even though that [31:48] ability to customize, the fact that this [31:51] is not an exact copy of what's in your [31:53] hand right now, should protect it under [31:55] current legislation. But, there is now [31:58] enough pressure from the powers that be [32:00] and from lobbyists from both Lilly and [32:03] Novo Nordisk that, which are the two [32:05] companies that make the GLP-1 [32:06] medications, that we're seeing Marty [32:09] Makary, the FDA commissioner, has now [32:12] tweeted more about cracking down on [32:14] compounded GLP-1 medications than he's [32:16] tweeted about diabetes or heart disease [32:18] in his entire time in office. And just [32:20] so I understand, I want to play this [32:21] back to you to make sure I understand. [32:23] >> Sure. [32:24] In my hand here, I have [32:27] tirzepatide on my left. [32:29] >> And this is made by Lilly, which is a [32:30] corporate company who's patented it so [32:32] they can make lots of money from it. [32:34] >> Correct. In In right hand, I have [32:37] tirzepatide. [32:38] >> Tirzepatide with niacinamide. With [32:40] niacinamide. [32:41] >> Yep. And this is not patentable. So, [32:44] Lilly has a patent on the tirzepatide [32:47] molecule in that formulation in your [32:49] hand. Okay? [32:50] >> [clears throat] [32:50] >> And if anyone violates a patent, that [32:54] can be pursued in US court. Yep. Patent [32:57] law, right? But what's interesting is [32:59] that Lilly and Novo Nordisk know that [33:03] that's different in your right hand. It [33:04] doesn't look the same. You can dose it [33:06] differently. [33:07] And they know that if they were going to [33:09] fight that in court, it would cost a lot [33:11] of money and take a lot of time. So, you [33:13] know what's a lot easier? Calling your [33:14] friend at the FDA and getting him to [33:16] step on the competition so you don't [33:17] have to. And then who's paying for that [33:20] enforcement? It's not the lawyers that [33:23] the pharma company is paying for. [33:25] Uh it's the taxpayer paying for the FDA [33:27] through taxes. And you seem to imply [33:29] that this was actually better because [33:31] you could take it in a more flexible [33:32] dose. You could take a little bit, a [33:33] lot. You can take it when you want, [33:35] whereas this is kind of once a once a [33:36] week. Well, I mean, you know, what is [33:38] better, right? So, I like this option [33:41] for many of my patients because it's [33:42] flexible. All right? So, that is [33:44] something that works for most patients. [33:46] All right? But then then again, this [33:47] works great for patients, too. Okay. But [33:49] what you want is you want an ecosystem [33:51] where you have choice so you can make [33:53] the right choice for the right patient. [33:55] For a lot of patients, they're going to [33:56] do exceedingly well on this and there's [33:58] so much data to support that. But I also [34:01] have a lot of patients who get really [34:02] ill after they do a large dose of [34:05] Mounjaro or of GLP-1 men. And if we take [34:08] that same dose and we just cut it into [34:10] multiple doses within a week, we can [34:11] avoid those side effects. [34:13] So, you've told me that these peptides [34:15] we have on the table in front of us can [34:16] improve your skin, weight loss, muscle, [34:19] energy, chronic illnesses. You talked [34:21] about the cognitive upsides. [34:23] And you talk about it very passionately. [34:25] Yeah. [34:25] So, one should ask you presumably you're [34:28] taking some peptides. I am. Yeah. So, [34:31] >> do you take? So, I will tell you that as [34:33] of right now, the only peptide I'm [34:35] taking is a small dose of tirzepatide, [34:38] all right? Which is the one we were just [34:38] talking about. [34:39] >> Yeah. Because uh back uh couple of [34:42] couple of months ago, I was probably [34:44] close to about 240 or so, and I was into [34:47] powerlifting, you know, I still am. But, [34:49] you know, it's really great to be able [34:51] to deadlift 500 lb, but then stairs [34:53] become really hard when you're trying to [34:55] walk up. You're like, I don't know. I [34:56] kind of like uh being able to not take a [34:58] break after two or three flights of [35:00] stairs. And so, I was like, okay, all [35:02] right, longevity is a priority of mine. [35:03] I'm going to slim down a little bit. I [35:05] was like, let me just try this for a [35:06] little bit. And what I found is that it [35:08] is incredibly potent and at a very low [35:09] dose, very, very tolerable. Why didn't [35:12] you take some of the others? Honestly, [35:14] because right now there is not a legal [35:16] framework for me to obtain them. And the [35:18] truth is is that I want to be an example [35:20] for my patients. And that's why I'm out [35:23] here advocating that we get access to [35:25] these peptides in a legal, safe way [35:27] again, all right? And cuz it's it's the [35:29] best thing for everyone. If they were [35:31] legal, [35:32] which ones might you consider? Oh, man, [35:34] I will tell you this. As some like I I [35:37] don't know how old you are, so even but [35:38] I'm in my [35:38] >> 33. 33? God bless you. I will tell you, [35:41] once you get over 35, man, that is [35:42] brutal, all right? I sleep on my neck in [35:44] a wrong way, and I need like a freaking [35:46] brace for like 2 weeks. And so, as [35:48] someone who spends a lot of time in the [35:50] gym, you know, working out, like you [35:51] start to accumulate all these little [35:52] aches and pains. And so, the idea of, [35:55] for example, I have a very finicky right [35:57] shoulder. If I try to do a really heavy [36:00] bench and I haven't warmed up, I can [36:02] tweak this, and it takes me out of the [36:03] fight for at least a month, okay? And I [36:05] have to do other things. You know, I [36:07] would have killed at various points in [36:08] time over the past 2 years to have had [36:10] BPC and TB-500 to hopefully speed that [36:14] sort of healing, all right? Um also, for [36:16] example, I suffer from really bad uh [36:19] rosacea. It flares constantly. [36:21] >> What's that? So, just redness of the [36:22] face, okay? That, you know, it makes me [36:25] look like I'm sunburnt. And then I come [36:26] in on the office on like a Tuesday and [36:28] then my staff's like, "Oh my gosh, you [36:29] got in the yard and do some work this [36:30] week?" I'm like, "It's just my face." Um [36:33] you know, for example, that's something [36:34] that a lot of people have reported [36:35] benefits from GH KCU from. So, again, [36:39] another compound, another peptide that [36:41] could be beneficial for a patient like [36:42] myself. What about muscle mass and [36:44] gaining muscle? Yeah, so that is an [36:47] interesting misnomer because that has [36:50] been a common selling point that you'll [36:51] see on social media, but as of right [36:54] now, the only peptide that you might [36:57] construe that way would be [37:00] this guy right here in my hand, IGF-1 [37:02] LR3, okay? Now, IGF-1 LR3 is basically [37:07] the longer-lasting version of IGF-1, [37:09] which is the downstream effect of growth [37:11] hormone. I'm sure you've heard of [37:12] bodybuilders taking growth hormone to [37:14] increase size and you know, lose fat. In [37:16] higher doses, it can help contribute to [37:18] muscle uh mass, all right? But [37:21] truthfully, if you're trying to gain [37:23] significant muscle mass, this is this is [37:25] not the way to do it. And so, the right [37:28] now, one of the things that peptides [37:30] can't do for you is independently put on [37:33] significant amounts of lean mass. You [37:34] still have to go to the gym. You still [37:36] have to go to the gym, believe it or [37:37] not. And guess what? [37:38] >> that's the end of the podcast. [37:39] I I tell you and but something that [37:41] blows my mind is that I have so many [37:42] patients that think that they can just [37:44] take testosterone and just put on muscle [37:46] naturally. And it doesn't work that way. [37:47] You might get a tiny little bit, but you [37:49] still have to have stimulus. You still [37:50] have to get in the gym, you still have [37:51] to put the work in. And so, I tell [37:53] patients that I am not a replacement for [37:55] a personal trainer. I'm your doctor, you [37:57] also need your personal trainer, and [37:58] most of you need a nutritionist, man. [38:00] And so, I'm lucky to work with some [38:02] great people in the community who [38:03] partner with me on that. But, you know, [38:05] it's a it's a full court press when [38:06] you're trying to get people to you know, [38:07] live the highest quality life. What [38:09] about some of these metabolic disorders [38:11] and diseases in terms of like insulin [38:13] Yeah. [38:13] >> resistance. People in the data we see of [38:15] the audience uh [38:16] very interested to learn about insulin. [38:18] I see that a lot in the comment section [38:19] and a lot of at [38:20] Yeah. So, how can if someone's [38:22] struggling with their insulin levels or [38:23] their you know their glucose response, [38:25] how does these peptides help? Honestly, [38:27] the best peptides for that right now are [38:28] the GLP-1 drugs. Okay, hands down. [38:31] Because what you're doing is you are [38:33] slowing gastric emptying and so you have [38:35] a slower absorption of that bolus of [38:38] food that you've eaten, so your glucose [38:40] doesn't spike. And so, as a result, that [38:42] increases insulin sensitivity [38:44] significantly. Now, again, you have to [38:46] be [clears throat] careful about what [38:47] peptide you're using for what. A lot of [38:49] these peptides that boost growth hormone [38:51] and boost, let's say, IGF-1, those can [38:54] actually increase serum glucose and that [38:57] may not be what you want if you are [38:59] someone that is trying to work on your [39:01] insulin sensitivity. [39:02] And do any of these peptides come as [39:04] like creams or as pills or anything like [39:07] that? If you look online, you can [39:09] probably find a version of everything. [39:10] But if we're talking about actual [39:11] legitimate formulations, the best [39:14] example of a topical cream is going to [39:16] be GHK-Cu. And this is interesting [39:19] because this is a copper tripeptide that [39:21] has been found to decrease in expression [39:24] and concentration as we age. But when it [39:27] is applied topically, it's highly [39:28] effective. Topically, so putting on a [39:30] cream on your face, all right? It's been [39:32] found to be extremely beneficial in [39:34] regenerating the quality of skin. So, [39:37] complexion, all right? Increasing the [39:39] amount of collagen and elastin, the [39:41] things that we need to keep our faces [39:43] taut and youthful, the things that [39:45] people will pay lots of money to go get [39:46] laser to get improvements. Not that it's [39:48] a replacement for that, but that's a [39:50] topical form that, believe it or not, [39:52] you could go out and buy today because [39:54] topical GHK-Cu is regulated very [39:57] differently than the injectable form. Is [39:59] it expensive? Usually. You know, growing [40:01] up, I thought well, these sort of [40:03] anti-aging creams were [40:05] But but you're telling me that this has [40:06] actually been associated with improving [40:09] signs of aging. I will tell you this, [40:11] when I was going through college and [40:13] medical school, I was the biggest [40:14] skeptic. Like I did not believe any of [40:17] the health or wellness claims that we [40:18] saw coming out at the time. And again, [40:20] you know, that was at a time where we [40:21] were getting bombarded with stuff about [40:22] the Atkins diet and this, that, and the [40:24] other. But then all of a sudden, you [40:26] start having patients come back to you [40:27] and they're testifying as the benefits [40:29] they've seen from these things. You [40:30] start to actually look at the [40:31] biochemistry behind them and you're [40:32] like, there's a lot of science backing [40:34] this up. This isn't just mumbo jumbo. [40:36] And so, believe it or not, yeah, there [40:39] are creams that can slow the process of [40:41] aging, at least from a visual [40:42] standpoint, when it comes to your skin. [40:44] I have yet to figure out anything that, [40:46] uh, you know, makes me as energetic as I [40:48] was in my early 20s, but you know, I'm [40:49] working on it. [40:51] But on that point of energy and [40:52] cognition, if I wanted to become a [40:54] better podcaster, [40:55] >> Yeah. and you know, I sit here [40:56] sometimes. Sometimes we do two in a day, [40:57] which means I might sit here for hours. [40:59] Once we do, I think a couple of times [41:00] we've done three in a day. That's [41:01] brutal. [41:02] >> 12 hours of recording. But what would [41:04] you recommend if I was trying to improve [41:05] my cognitive performance? [41:06] >> So, again, as a physician who likes [41:08] keeping my license, I wouldn't say [41:09] necessarily recommend, but I would say [41:11] if we're looking at how these [41:13] medications have been used, and [41:15] potentially one that may be legal again [41:17] coming this July, pending what the FDA [41:19] says, intranasal C-Max. And this is one [41:22] that was originally studied actually in [41:24] Russia many years ago. And what they [41:27] found is that this seven-amino acid [41:29] peptide, when it was administered after [41:32] a, uh, [41:33] TBI, so a traumatic brain injury, all [41:35] right, or acute injury, that patients [41:38] tended to bounce back faster. Also, they [41:40] saw evidence of it improving outcomes [41:42] after stroke. And it also seems to [41:44] upregulate the same sort of factors that [41:46] help with cognition and with, you know, [41:49] connecting sentences and bits of data in [41:51] your brain. And so, it's also one of [41:53] the, interestingly enough, one of the [41:54] ones that is available, you know, [41:56] intranasally, because it goes through [41:58] the mucus membranes and gets right where [41:59] you need it. And so, that's going to be [42:01] a really, really fascinating, uh, [42:03] compound to see back on the market, and [42:05] then we can actually get more data [42:06] regarding efficacy and, you know, across [42:08] a wide population. [42:10] So interesting. And you you you sniff [42:12] that through your nose. [42:13] >> Sniff through like like you would for [42:15] any nasal decongestant, right? And if [42:17] you have allergies or something like [42:18] that. Also, for someone like yourself, [42:20] you travel a lot. You know, you're going [42:21] in between different time zones. You're [42:23] balancing multiple obligations at [42:24] different odd times of the day. I I [42:26] shudder to think what your circadian [42:28] rhythm looks like, my friend. Um but, [42:30] you know, that is what we have some of [42:31] these other compounds that are coming [42:33] going to be available for. So, if we [42:34] look at [42:36] uh D sip, okay? That has been shown to [42:38] be helpful with regulating your [42:41] circadian rhythm. All right? That is one [42:42] of the ones that's going to be approved, [42:44] hopefully, here soon. Again, in July, [42:46] right? And then, you know, on top of [42:48] that, um you've got, you know, things [42:50] like Selank, which is another one that [42:52] can help calm you as you're going to [42:54] sleep about an hour ahead of time. And [42:56] again, hope help those, you know, deep [42:57] delta wave brain waves that are so [43:00] restorative whenever you actually are, [43:02] you know, resting. [43:03] Where will we be able to buy these when [43:05] and if they are legalized? So, from [43:09] >> [clears throat] [43:09] >> uh [43:09] 503A compounders here in the United [43:11] States with a prescription from a [43:13] physician. So, you still need a [43:15] prescription? [43:15] >> Still need a prescription, correct. [43:18] Could be quite crazy world when [43:19] everybody seem is going to be in [43:20] injecting themselves every [43:22] every day. I mean, we're already getting [43:23] to that point now with this Empatic [43:24] where I've got loads of people in my my [43:26] friendship group that are Yeah. And [43:28] they're Yeah, and they're doing great. [43:29] Yeah, they're doing great. [43:30] >> doing great. And that's what I like [43:32] about, you know, the advent of these [43:34] GLP-1s is they're removing the stigma of [43:36] a needle. And I look at some of my [43:38] friends who have been on it. I can't [43:40] recognize them. They look awesome. Are [43:41] you concerned with with any of them? You [43:44] know, I've got a couple of friends in my [43:45] circle where I'm I'm a little bit [43:47] concerned. I I don't even know if I [43:48] should be concerned, but it's just when [43:50] you see someone you know change so [43:52] dramatically so quickly, Yeah. I think [43:54] there's something in us which [43:56] something prehistoric in us which goes, [43:57] "Oh my god, there's a problem." Yeah. [43:59] One thing I'm I am concerned about is [44:01] the rapid weight loss with GLP-1 [44:03] medications. Because the problem is is [44:05] that when you go into such a radical [44:06] caloric deficit, your body goes into [44:09] catabolism, which is breaking down [44:11] tissue. And you want to break down fat, [44:12] right? But your body isn't that [44:14] judicious. It's going to break down [44:15] muscle. And muscle is the most [44:17] metabolically important tissue that any [44:19] of us have. And so if you really want to [44:21] optimize your insulin sensitivity, well, [44:23] you need to maintain your muscle. And [44:25] right now, really the only compounds [44:27] that we have that are really good at [44:28] preserving muscle with resistance [44:30] training is testosterone, right? But [44:31] that isn't going to be a good option for [44:33] our male patients that want to get [44:35] pregnant cuz testosterone turns off [44:36] fertility in men, all right? It's also [44:38] not a great idea for our female [44:40] patients, all right? Depending on their [44:41] age, testosterone TRT is a thing in [44:44] older, you know, women, menopausal, [44:46] won't go into that. But truthfully, [44:48] testosterone is not the right answer for [44:49] everybody. And so what we are going to [44:52] see come down the pipe very soon is kind [44:55] of the older brother of peptides, the [44:56] more complex form, biologics, called [44:58] monoclonal antibodies, that are [45:00] specifically designed to inhibit the [45:03] enzymes that break down muscle. So these [45:05] are specifically called myostatin [45:06] inhibitors. There are three that are [45:08] coming down the pipeline. There is one [45:10] called bimagrumab, which is owned by [45:12] Lilly. That is going to bind to the [45:14] peanut butter to myostatin's jelly, [45:16] which is called activin. And then you [45:18] have roledumab and trevogrumab, which [45:21] are two other compounds owned by [45:24] different pharmaceutical company that [45:25] are all designed to maintain muscle even [45:28] in a significant caloric deficit. This [45:30] is getting interesting now. [45:31] >> Yeah. Yeah. So you're you're telling me [45:32] I'm going to be able to inject myself [45:34] with this peptide to lose the fat and [45:36] then inject myself with something else [45:37] to keep the muscle. It's wild. [45:39] It's wild. [45:42] And and I'll tell you, you know, one of [45:44] the hardest things that I'm sure you've [45:46] heard being on the receiving end of this [45:48] is just the complexity of it. And there [45:49] are so many levers that are moving at [45:51] once. And trying to get your head around [45:53] it and balance it all. Like it requires [45:56] nuance and it requires a thoughtful [45:58] discussion with your doctor who is well [46:00] educated on them. And that's one of the [46:03] challenges is that there isn't broad [46:05] great education on these products right [46:07] now in the medical space. And so, that's [46:09] something that I'm very passionate about [46:11] is improving education across my [46:13] colleagues so that they're not afraid of [46:15] these anymore. [46:16] What do you say to people who are [46:17] listening to this now who are [46:18] out, why don't you just like eat your [46:19] greens and go to the gym? Yeah. And just [46:22] be more human and you'll be fine. I love [46:24] that. I love eating your greens and [46:26] going to the gym, okay? Um but the [46:28] unfortunate reality is that here in the [46:29] United States uh it depends on what [46:32] database you look at, but obesity rates [46:34] are estimated to be 40 to 70%, okay? [46:37] Whether you depending on what BMI cutoff [46:39] you're using, okay? BMI's not perfect, [46:41] but it is what it is. And so, the thing [46:43] is is that well, eating greens and going [46:45] to the gym are not working for us as a [46:47] society. And we could talk about how we [46:50] don't have real food anymore, we have [46:51] food deserts, we have this nut- [46:54] calorically dense but nutritionally poor [46:56] food. I'll tell you the most disturbing [46:58] thing I see as a surgeon is I'll see a [47:00] patient come in the door and they're [47:02] morbidly obese. They're a large [47:03] individual, but I have to do surgery on [47:05] them, but the connective tissue, the [47:06] stuff that's made up of protein that [47:07] makes them them that literally holds [47:09] them together is paper paper thin [47:11] because they're eating an incredible [47:13] amount of calories, they're gaining fat, [47:14] but they don't have any protein in their [47:16] diet. And that's not something that's [47:18] rare. I see that on a daily basis. And [47:20] so, the truth is is that, you know, [47:21] we're talking about this from the angle [47:23] of biohackers and people that are super [47:26] engaged in our health, but the truth is [47:28] is that this is going to be able to be [47:29] used to help our population at large [47:32] and, you know, ultimately hopefully [47:35] avoid a lot of the terrible disease [47:37] states that we're seeing overwhelm the [47:38] medical system right now. How big is the [47:40] peptide industry right now? [47:42] If we look at the top four large [47:44] language models companies, all right? [47:46] So, all the heavy hitters and how much [47:48] revenue they're generating, it's [47:49] estimated between be between 58 billion [47:53] up to maybe 62 billion. Yet the income [47:56] and the revenue from just semaglutide [47:59] and tirzepatide alone is going to be [48:02] over 55 billion this year. And so, what [48:04] we have is peptides without even [48:07] considering all of this happening in the [48:08] research space or the research use only [48:10] space. Without even considering the [48:12] peptides that we'll see come from [48:14] compounding pharmacies, we're already [48:17] approaching parity with what we're [48:18] seeing in AI as far as revenue goes. [48:21] That is the demand that we're seeing in [48:22] the marketplace. [48:24] I run multiple companies that have [48:25] multiple sales teams. And one of the [48:27] things as a founder of a company that's [48:29] often confusing is you find it hard to [48:31] figure out where sales are. So, about 10 [48:33] years ago, I started using Pipedrive in [48:35] my former company, and it's also the [48:37] reason why I switched over all of my [48:38] commercial teams in my current media [48:39] company called steven.com to use [48:41] Pipedrive as well. Not only do they [48:42] sponsor this show, but they've been an [48:44] incredibly effective way of scaling our [48:45] sales engine over the years. Pipedrive [48:47] is an easy-to-use intelligent CRM, and [48:50] at its very core, it makes your sales [48:52] process visible through one dashboard, a [48:55] visual pipeline showing every deal, what [48:58] stage it's in, what needs to happen [49:00] next, and it's all in real time with no [49:02] delay. It doesn't magically close the [49:04] deal for you, of course, but it does [49:05] replace complexity with clarity. If you [49:08] want to join over 100,000 companies [49:10] already using Pipedrive, you can use my [49:12] link for a 30-day free trial with no [49:14] credit card payment needed. Head to [49:16] pipedrive.com/ceo [49:19] to get started. That's [49:20] pipedrive.com/ceo. [49:23] I'll see you over there. [49:25] When your patients come and see you, Dr. [49:27] Alex, [49:28] what are they asking you most frequently [49:31] as it relates to peptides? What are like [49:32] the top three questions you get asked [49:34] the most? The first thing I get asked is [49:37] what peptides do I need? And then I just [49:39] look at them. I'm like, well, what's [49:40] your problem? You [laughter] know, like, [49:41] what what's bothering you? And what do [49:43] they say? You know, and then they'll [49:45] come in and they'll start talking about [49:46] energy, sex drive, and that sort of [49:48] things. And I'm like, okay, if that's [49:50] it, well, we need to check your [49:50] testosterone levels, brother. Okay? So, [49:52] instead of looking for peptides, right? [49:55] You know, you don't walk into a Home [49:56] Depot or a Lowe's, you know, and be [49:58] like, "What tools do I do I need?" And [49:59] you're like, "What are you trying to do, [50:00] right?" And then you start to talk to [50:02] someone there like, "Well, I'm trying to [50:03] build this." Okay, you need a saw, you [50:04] need a screwdriver, you need this. And [50:05] some of those tools might be peptides, [50:07] all right? But some of them may be [50:08] hormones. You know, some of it may be [50:10] diet and exercise. And so, peptides are [50:12] just another type of tool that we can [50:14] use. [50:14] >> want a shortcut, though, doctor. We all [50:16] want a quick way to to be better, and [50:18] ideally not have to do hard work. That's [50:20] like what most people, you know, the [50:20] average person is looking for. And we [50:22] hear about these peptides, we hear other [50:23] people are taking them, we hear they're [50:24] fantastic results in skin, hair, muscle, [50:26] and we go, "Fucking, what about me?" You [50:28] know what I tell patients? I'm like, [50:29] "Me, too, man." You know, but my alarm [50:31] still went off at 4:45 this morning so I [50:33] could hit the gym before I made it to [50:34] clinic because there are no real [50:36] shortcuts. There are things that can [50:38] help, right? GLP-1s are the best example [50:40] of that, right? Okay, this is the [50:41] closest thing to a shortcut you're going [50:43] to get. But the truth is is that this [50:45] isn't going to go to the gym for you, [50:46] and it's not going to lift the weights [50:47] so you can maintain that muscle mass so [50:48] you get the best possible result. Try to [50:50] hold on to your muscle while losing the [50:51] fat. One thing I've learned from doing [50:52] this podcast that that has really grown [50:55] with me over time. People ask me all the [50:56] time, like, "What's the one thing you've [50:57] learned from the podcast?" One of the [50:59] answers that I've never given that I'm [51:00] going to give now is that I've learned [51:02] that there's no such thing in life as a [51:04] free lunch. No, [51:05] >> [clears throat] [51:05] >> absolutely not. And what I mean by that [51:07] is like everything is a trade-off. And [51:11] if you ever hear on a podcast or in any [51:13] medium that something has tremendous [51:16] upsides, the first question one should [51:18] ask is what's the trade? And like just [51:20] with everything, you can apply this to [51:21] having a relationship with a partner. [51:23] Huge upsides. Also, trade-off. [51:25] Trade-off. Yeah, yeah, yeah. Kids, like [51:27] I love my children. I haven't slept in [51:28] years, right? [51:29] >> [laughter] [51:29] >> You know, like this is just this is this [51:31] is life, right? There are trade-offs. [51:32] And even with great tools, there are [51:34] trade-offs. [51:34] >> So, what are the trade-offs of these [51:36] peptides? The biggest trade-off right [51:38] now is you don't know if you're even [51:40] getting what you're what you want, [51:41] right? Because you're ordering this from [51:42] some research, you know, compound only. [51:45] You don't know whether or not they've [51:46] gotten out all the appropriate [51:47] endotoxins. You don't know if you're [51:48] getting what you actually paid for. So, [51:49] that's the biggest thing. And also, the [51:51] thing is is that, well, all right, I [51:53] these have a good example of, okay, [51:55] preventing or helping heal injury. But, [51:58] the thing is that, well, we've got other [52:00] compounds over here, you know, let's go [52:02] ahead and like let's just pull [52:04] tesamorelin as an example. So, this is [52:06] actually interesting. It's a peptide [52:08] that is commercially available right [52:10] now. I could write the script for you. [52:11] You could go pick it up from CVS or [52:12] Walgreens, okay? This is available as a [52:14] commercial product. And people really [52:16] like it because it'll help boost growth [52:17] hormone, and it happens to be uniquely [52:19] good at stripping abdominal fat, okay? [52:21] Or visceral fat. But, the thing is is [52:23] that, you know, the moment you stop [52:24] taking it for a brief period of time, [52:26] well, if you haven't changed anything [52:27] about your lifestyle, you're going to go [52:28] right back to where you were. [52:29] >> It's good at stripping abdominal fat, [52:31] belly The belly fat. This is what it's [52:33] known for. Yeah. It's good at stripping [52:35] belly fat. [52:35] >> Stripping belly fat specifically. So, [52:37] bodybuilders actually really like it for [52:38] that particular application. [52:40] >> [clears throat] [52:40] >> I had no idea there was a a peptide for [52:43] stripping belly fat. There you go, man. [52:45] You know, and like for example here, [52:46] we've got another one. So, this is [52:47] melanotan II, right? So, this is a [52:50] melanocortin receptor agonist. So, [52:52] melanocortin's this what makes you tan, [52:54] right? So, you could administer this, [52:56] all right? And it will actually end up [52:58] giving you a deep tan in response to [53:01] just a little bit of UV sun exposure, [53:03] all right? Now, I know, right? Um [53:05] listen, I've embraced my pasty [53:06] whiteness, so I'm not, you know, I'm not [53:08] necessarily my my bag, but it it's real. [53:10] Now, again, there are some safety [53:11] concerns with this because again, could [53:13] that potentially stimulate a melanoma or [53:15] something like that? But, this is [53:17] something again, it's a peptide that [53:18] gives a wildly different result than [53:20] tesamorelin, right? Because it's a [53:21] different application. [53:22] >> It does. Yeah, it does. It'll also give [53:25] you um [53:26] some of the most impressive erections [53:28] you've ever had in your life, so uh be [53:30] warned. Um [53:31] >> Wait, it's literally turning you into A [53:33] BLACK GUY. [53:34] >> [laughter] [53:36] >> FINALLY. YEAH, RIGHT? AND IT'S WILD. SO, [53:38] there's actually and there's even a [53:39] derivative of melanotan II called PT-141 [53:44] uh bremelanotide that is a commercial [53:46] product right now that you can write as [53:48] a prescription, okay? But it that [53:50] doesn't have the tanning benefit, but [53:52] has the sexual, you know, benefits. [53:54] Oh, wow. Yeah. [53:56] Keep those ones over here. We have to [53:58] talk about this. Another really [53:59] interesting thing that phenomenon that [54:01] we've seen, right? Is that now we've got [54:02] all of these companies that are making [54:04] these research use only compounds, [54:05] right? It used to be that you would have [54:07] a compound that's in drug development [54:09] and you're seeing all the advertisements [54:10] for it, you know, maybe if you follow [54:12] these sorts of things like I do cuz I'm [54:13] a nerd, right? You get excited about it, [54:14] but you don't get access to it, right? [54:16] Well, believe it or not, the next [54:18] blockbuster drug that Lilly is going to [54:19] come out with probably in the next [54:21] couple of months is this guy called [54:22] retatrutide, all right? And retatrutide [54:25] is fantastic in that it is the first [54:28] three receptor agonist GLP-1 drug. So, [54:31] the GLP-1 drugs, okay? Whenever you're [54:33] talking about semaglutide and [54:35] tirzepatide, they have slightly [54:37] different profiles. [54:37] >> This is the Ozempic category. Correct, [54:39] right? So, GLP-1 is the primary receptor [54:42] that they work on and what that will do [54:44] is it slows gastric emptying and it [54:46] limits caloric intake, all right? But [54:49] then in tirzepatide, not semaglutide, [54:51] but tirzepatide is a dual agonist. So, [54:53] it has effect on GIP, which is a [54:56] different receptor. Well, retatrutide [54:59] adds in glucagon receptor activation. [55:02] And so, believe it or not, your liver [55:04] actually acts like a repository of [55:06] energy where it stores glycogen and fat [55:09] that your body can use as energy. But [55:10] that's a problem, right? If you get too [55:12] much fat there, if you have a caloric [55:13] excess, then you can end up having [55:15] what's called NASH cirrhosis, but [55:18] non-alcoholic steatohepatitis. [55:20] Basically, inflammation of your liver [55:21] due to accumulating too much fat. It's a [55:23] problem. But by stimulating the glucagon [55:26] receptor while simultaneously hitting [55:28] GLP-1 and GIP, what we found is not only [55:31] do patients lose an incredible amount of [55:33] weight, but they also get the best [55:35] improvements we've ever seen in their [55:36] liver liver health that we've ever seen. [55:38] And people have been buying that from [55:41] research use only websites and using it [55:44] for about 2 years now. And bodybuilders [55:46] have already made this the standard in [55:47] their protocol when it comes to cutting [55:49] for a show. And it is wildly effective. [55:52] And we're now seeing the population [55:55] using a drug at scale that hasn't even [55:57] made it through [55:59] commercialization yet. What are you [56:01] smoking? You using it? No. [56:03] >> [laughter] [56:04] >> I have not I can honestly say I have not [56:06] used Retta. But I find it fascinating [56:09] though. It's absolutely wild. Yeah, and [56:11] talk about power to the people, right? [56:13] What about these others then? What else [56:14] have we got here that you think's [56:15] interesting? [56:16] >> So, um we've got these two here that I [56:18] think are really interesting. So, [56:19] CJC-1295 and Ipamorelin. So, the whole [56:22] idea is that, you know, can we stimulate [56:24] growth hormone? And there's an [56:25] interesting story behind that. You know, [56:26] actually growth hormone itself was very [56:28] very popular for many many years as an [56:30] anti-aging compound, but then we changed [56:32] some laws here in the 19 in 1990, okay? [56:34] That made it a little dicey to prescribe [56:36] growth hormone. And also, you know, it's [56:38] kind of a blunt instrument. We wanted [56:39] something to stimulate more natural [56:40] growth hormone release. So, we have this [56:42] entire class of medications called [56:43] secretagogues that help stimulate [56:44] natural growth hormone release. And [56:46] these are two of the most potent ones [56:47] that are often combined together. And [56:49] when we say growth hormone Yes. what [56:52] does growth hormone do? So, growth [56:54] hormone acts like a signal that tells [56:56] your liver to make more of another [56:58] compound we talked about, IGF-1. What [57:00] growth hormone does is growth hormone [57:02] actually stimulates building muscle, [57:03] okay? It also strips [57:06] fat, okay? And it's also been found to [57:09] help with tissue healing. Okay. And so, [57:11] there's a significant benefit in that [57:13] regard. And so, people want to boost [57:15] their growth hormone. Improves quality [57:16] of skin, improves quality of hair and [57:18] nails and that sort of thing. And so, [57:20] these two compounds together are [57:22] particularly potent. CJC-1295 [57:25] being a growth hormone-releasing hormone [57:28] derivative. And then we have Ipamorelin, [57:31] which is a ghrelin receptor agonist. So [57:34] again, release improving the release of [57:36] growth hormone through two different [57:37] synergistic mechanisms. And so, that one [57:39] is really really interesting, or these [57:41] two together. And then, on top of that, [57:43] so this one, somatotropin, another word [57:46] for growth hormone. Okay, so this is [57:48] growth hormone, okay? Just a different [57:49] word for it. So, what would happen? [57:51] Let's just take this one. Sure. [57:52] Somatotropin. Yeah. Somatotropin. Yeah. [57:55] If I bought this for research purposes, [57:58] Research purposes only. and I started [58:00] injecting some of this into me, what [58:02] would change? So, it depends on how much [58:04] you do and when you do it. So, the idea [58:07] is that if you injected that at night, [58:09] it would improve your quality of sleep, [58:10] okay? You would get a boost in your [58:13] quality of your hair, your skin, nails. [58:16] Theoretically, it'd be easier for you to [58:17] recover from injuries, hopefully put on [58:19] a little bit more muscle a little bit [58:20] easier, maybe lose a little bit of fat. [58:22] So, why don't I take it? Well, because [58:23] if you take a little bit too much, you [58:25] can actually get insulin resistance [58:27] because your glucose levels will go too [58:28] high for too long, all right? You abuse [58:30] too much for too long, you will actually [58:32] get acromegaly, so that's development of [58:34] the your bones continue to grow, but not [58:37] alongs, only in certain junctures. And [58:39] so, there's a very specific look that [58:40] bodybuilders who abuse growth hormone at [58:42] high amounts will get to them, all [58:43] right? Which is an irreversible change [58:45] to the facial bone structure. You can [58:47] also, theoretically, if you had a [58:49] cancer, maybe it could make it worse, [58:50] all right? We've never shown it that it [58:53] causes new cancers, but that could be a [58:54] concern. And, you know, on top of that, [58:56] it could give you insulin resistance [58:57] because, Okay. you know, you're again, [58:59] Yeah, exactly, right? Um, and if you [59:01] take too much, it could potentially make [59:02] your hands numb in the morning because [59:04] you get effusions into the joint space. [59:05] And so, bodybuilders will talk about [59:07] lifting a dumbbell and having to drop it [59:09] because their hand goes numb temporarily [59:10] if they're taking too much growth [59:11] hormone too soon. [59:13] And what else have we got here? Oh my [59:14] gosh. So, epithalon, so this is [59:18] the [59:20] medication that is theoretically going [59:23] to be available to us in July, okay? And [59:26] so, uh the hope is that, you know, this [59:29] is going to uh expand cell life. So, [59:32] epithalon, the uh purpose of it is it [59:35] works to enhance uh telomerase. So, at [59:39] the end of your cells, imagine it this [59:40] way, you're trying to copy the genome, [59:42] but the little copier that uh copies it, [59:45] it takes up space enough itself, so it's [59:47] kind of like it cuts off the last couple [59:48] letters every single time. This is when [59:50] you're aging, right? When you're aging. [59:51] You're creating new cells, right? Cells [59:53] divide through this process called [59:55] mitosis, where they split, all right? [59:56] Well, if you got to make an exact copy, [59:58] well, you've got to read through all [59:59] these lines of code, but because of the [60:01] way that we're built, we always end up [60:02] cutting off the last little bit of code. [60:04] Which is what how we age. Which is how [60:06] we age. It is one of the things that [60:07] contributes to aging, all right? Now, [60:09] that is considered to be {quote} [60:11] {unquote} junk information. It's at the [60:13] very end called the telomere, all right? [60:15] But, we know that shorter telomeres are [60:17] associated with aging, potentially worse [60:19] health outcomes. Then, there's an enzyme [60:21] that can help heal or repair the [60:23] telomere called telomerase. Epithalon [60:26] helps encourage that. And so, some [60:28] people are looking at that as being one [60:29] of the fountain of youth uh compounds. [60:31] I'm very skeptical as far as that goes, [60:33] but it does show some benefits when it [60:35] comes to uh you know, healing parts of [60:37] your brain that are, you know, [60:38] associated with uh regulating your [60:40] circadian rhythm. [60:43] So, the average person listening now, [60:45] they've heard a lot of stuff about a lot [60:46] of things. [60:48] How do they know if they should pursue [60:51] getting and taking peptides? Like, how [60:53] do they know? What are they looking for? [60:55] So, what I will say is that think of [60:58] peptides as falling into three [60:59] categories, all right? You got category [61:01] one, which are peptides that you can [61:02] prescribe right now, legal from, you [61:04] know, a commercial pharmacy. That [61:05] includes the GLP-1s, PT-141, uh [61:08] bremelanotide I mentioned to you [61:10] earlier, oxytocin is another one. We [61:11] have these different compounds that are [61:13] available. And then we have what we call [61:15] category two, which we don't have [61:17] anything in right now, but that will [61:19] consist of the seven peptides that are [61:21] hopefully going to be approved in July [61:23] whenever they get moved from category [61:24] two cannot compound to category one can [61:27] compound. All right? And then everything [61:29] else is kind of in this category three [61:31] where it's only available for research [61:32] use only. And so my recommendation for [61:34] patients is don't go out and buy [61:36] research use only compounds. All right? [61:38] You don't know what you're getting and [61:39] you don't know if you're dosing it [61:41] right, you don't know if it's [61:42] contaminated. So really what the public [61:44] should be doing is educating themselves [61:45] on this and then going and talking to [61:47] their doctors about what problems they [61:50] have and then potentially when those [61:52] options become available a peptide might [61:54] be part of the answer for their problem. [61:57] Okay, so speak to doctor. Yeah. Consult [61:59] with your doctor. And make it a convers- [62:01] conversation with whoever your medical [62:03] professional is about your symptoms and [62:05] what might be useful and what the range, [62:07] the toolbox, the options are Correct. To [62:09] attack those symptoms. Yes. Absolutely. [62:11] Talk [62:12] collaborate with your doctor. Your [62:13] doctor should be your partner in you [62:15] getting as healthy as humanly possible. [62:18] We talked about um trizepatide, Ozempic, [62:21] semaglutide. One of the questions that's [62:22] front of mind for everybody [62:24] whether they're taking them or watching [62:25] others take them is what happens when [62:27] you stop. We've looked at that. You [62:29] actually regain the weight. And so cuz [62:31] the truth is is that you have introduced [62:34] something into your life that has moved [62:36] the needle in one direction. But if you [62:38] don't change anything else, well, you [62:39] take that back out. Well, you're going [62:41] to go back to where you were. And so if [62:43] you're going to maintain that weight [62:44] loss, you have to make lifestyle changes [62:46] associated with that. And what we found [62:48] is that people do regain if they do make [62:50] lifestyle changes, they do regain some [62:52] of the weight but not necessarily all of [62:54] the weight. And there's also data [62:56] showing that you could potentially stay [62:58] on that medication but at a much lower [63:00] dose and then maintain your weight, [63:02] okay? So there are options to minimize [63:05] your medication burden long term. And of [63:07] all the things we've talked about today, [63:08] if you had to just pick one thing that [63:10] excites you the most that's either [63:11] coming down the pipe or here already, [63:13] Yeah. what is the thing you're most [63:14] excited about? I I your eyes wondering. [63:15] >> Uh [63:16] hands down it's that one over there, [63:17] retatrutide. Because the [63:21] changes in body composition that we have [63:23] seen both in clinical trials, okay, and [63:26] in anecdotal reports from users who have [63:29] obtained on their own are wild. We're [63:31] talking losing 20 to 25% of total body [63:35] weight within a relatively short period [63:38] of time. And I think that this is going [63:41] to be basically the Ferrari of GLP-1 [63:45] medications when it comes out. It's not [63:46] for everybody, right? It's going to go [63:48] faster than everything else, but it's [63:50] going to change the game. I think this [63:52] is going to be a trillion-dollar drug [63:55] when it comes out. And no one's going to [63:56] own the patent, so everybody will be [63:58] able to access it. Is that right? No, [63:59] no, that is going to belong solely to [64:01] Lilly. And so you are going to see and [64:03] they are going to enforce it, you know, [64:05] uh, as aggressively as they've ever [64:07] enforced anything. But you will see [64:10] profound results in patients. [64:13] People are referring to peptides as [64:15] Silicon Valley's miracle drug. [64:17] And I I wondered why that was, why it's [64:19] been associated with Silicon Valley. [64:20] Have you heard that at all? I have and [64:22] I'll tell you I've seen some, uh, [64:23] peptide stacks from, you know, Silicon [64:25] Valley, you know, uh, founders and, uh, [64:28] you know, uh, individuals that blow my [64:31] mind. I'm like, oh man, even I think [64:33] that's a lot. Why would peo- people in [64:34] Silicon Valley, why would founders be [64:36] interested in peptides? Well, I think [64:38] it's because we all want to live our, [64:39] you know, best version of our own lives, [64:41] right? We want to perform at the highest [64:42] level. And so, you know, people will do [64:44] whatever they can. They'll drink [64:45] caffeine, you know, they'll, you know, [64:47] pop a Zyn in their mouth, you know, and [64:49] they'll try to tweak whatever variable [64:51] they possibly can to get the best [64:52] possible performance. And thing is is [64:54] that anabolic steroids come with, you [64:56] know, significant side effects. And [64:57] that's not everybody's cup of tea, [64:58] right? And the health consequences from [65:00] high-dose androgens dwarf anything that [65:03] you might experience with peptides. And [65:04] so peptides offer a lot of flexibility [65:06] in pulling many different levers that [65:08] are interesting to like your regular [65:10] average, you know, person. And honestly, [65:12] you know, it requires a little bit of [65:14] DIY right now because of the nature of [65:16] these peptides. And, I think you combine [65:18] that with the kind of rogue, you know, [65:22] uh founder [65:24] uh [65:25] spirit that is common in Silicon Valley, [65:27] and I think it's a perfect fit. I asked [65:29] you a second ago, what are the three [65:30] questions that people come to you and [65:31] ask you as as a doctor? The first one as [65:33] it related to peptides was, which [65:35] peptide should I be taking? Yeah. Are [65:37] there any other questions we haven't [65:38] covered off that are commonplace in your [65:40] practice? [65:41] The second one is, you know, can you [65:43] prescribe me? And then I have to explain [65:44] to them the regulatory environment, you [65:46] know, surrounding peptides that, you [65:47] know, as of right now, the only peptides [65:49] that I can prescribe are the ones you [65:51] can get from CVS or Walgreens, which is [65:52] going to be your GLP-1 medications and a [65:54] handful of others that usually aren't [65:56] applying to the young men that I see in [65:57] my practice. [65:59] I've had so many founders speak to me [66:01] and say, why didn't this particular ad [66:03] that I ran on this platform work for me? [66:05] Maybe the copy wasn't good, the creative [66:07] wasn't strong, but usually the problem [66:08] is they're not having the right [66:09] conversation because that ad never [66:11] reached the right person. And if you're [66:13] in B2B marketing, that is much of the [66:15] game. And this is where LinkedIn ads [66:17] solves that problem for you. Their [66:19] targeting is ridiculously specific. You [66:21] can target by job title, seniority, [66:23] company size, industry, and even [66:26] someone's skill set. And their network [66:28] includes over a billion professionals. [66:30] About 130 million of them are decision [66:33] makers. So, when you use LinkedIn ads, [66:35] you're putting your brand in front of [66:36] the right people. And LinkedIn ads also [66:38] drive the highest B2B return on ad spend [66:41] across all ad networks in my experience. [66:43] If you want to give them a try, head [66:45] over to linkedin.com/diary. [66:48] And when you spend $250 on your first [66:50] LinkedIn ads campaign, you'll get an [66:52] extra $250 credit from me for the next [66:56] one. That's linkedin.com/diary. [66:59] Terms and conditions apply. [67:01] We have finally caved in. So many of you [67:04] have asked us if we could bundle the [67:06] conversation cards with the 1% diary. [67:08] For those of you that don't know, every [67:10] single time a guest sits here with me in [67:11] the chair, they leave a question in the [67:13] Diary of a CEO, and then I ask that [67:15] question to the next guest. We don't [67:17] release those questions in any [67:18] environment other than on these [67:20] incredible conversation cards. These [67:22] have become a fantastic tool for people [67:24] in relationships, people in teams, in [67:26] big corporations, and also family [67:28] members to connect with each other. With [67:29] that, we also have the 1% diary, which [67:31] is this incredible tool to change habits [67:33] in your life. So many of you have asked [67:36] if it was possible to buy both at the [67:37] same time, especially people in big [67:40] companies. So what we've done is we've [67:42] bundled them together, and you can buy [67:44] both at the same time. And if you want [67:45] to drive connection and instill habit [67:47] change in your company, head to the [67:49] diary.com to inquire, and our team will [67:51] be in touch. [67:53] Is there a super peptide for anti-aging [67:55] in skin and some of those issues? Oh, [67:57] for skin, GHK-Cu. GHK-Cu? Yeah. So this [68:00] is, you know, [68:01] probably the most well-known peptide for [68:05] uh use for skin complexion, and I mean, [68:08] really, it may have some small benefits [68:10] when it comes to hair, all right? But [68:11] the those reports are a little bit more [68:13] spotty. Okay. Yeah. And then so outside [68:15] of the world of peptides for a second. [68:16] Yeah. I've got these three [68:18] vials in my hand. I'm so scared. [68:21] All right. [68:24] Do you know what those are? [68:26] Oh, yeah. [68:28] Uh this is unfortunately our future if [68:31] we're not careful. [68:32] Explain. So, you know, what we've got [68:34] here is we have uh three different uh [68:38] canisters containing water that has a a [68:41] little bit of coloring in it. And what [68:43] you can see is that all the way back in [68:44] 1973, this is pretty opaque, all right? [68:47] Like, you know, this is not uh what you [68:49] would You can't see through it. And then [68:50] 2026 has a little bit of color to it. [68:52] And then we've got over here 2045, which [68:55] is totally uh clear. Uh and this [68:57] unfortunately is actually representing [68:59] the fertility trajectory for young men, [69:02] because what we're seeing is that back [69:05] in 1973, total modal sperm count, so how [69:08] many healthy swimming sperm do we have [69:09] in each ejaculation, is [69:12] exponentially higher and more dense than [69:14] what we're seeing today. And so what [69:15] we're seeing is a progressive decline in [69:18] male fertility over time. And that's [69:20] been demonstrated in multiple studies. [69:22] We've debated this at multiple meetings. [69:23] People have tried to argue that it's a [69:24] measuring difference, but as we give it [69:26] more time and as we give it more [69:28] scrutiny, this is real. We're [69:30] experiencing a significant decline in uh [69:33] sperm quality and motility and [69:35] concentration. [69:36] >> [clears throat] [69:37] >> Why? [69:38] So, the leading culprits are going to [69:41] be, yes, microplastics and environmental [69:44] toxins. Okay, things that are put in our [69:46] environment that we have been exposed to [69:48] that we can't help. But again, the [69:50] biggest modifiable risk factor is [69:53] insulin resistance and metabolic [69:54] disease. Obesity. [69:56] >> Obesity. And so, a downstream effect [69:59] that we may see from peptides like we [70:01] discussed before is we may be able to [70:04] help reverse this for the first time in [70:06] history by trying to prevent the [70:08] development of metabolic disease. Using [70:10] some of the peptides we talked about [70:11] earlier. Exactly. I gave you the example [70:13] of a patient that I saw in clinic this [70:14] past week that increased his sperm count [70:15] 10 times over. Imagine if we had given [70:18] that to him before he even got that [70:20] obese, when he just started to get a [70:21] little bit overweight and at a lower [70:22] dose. Well, he may have never ended up [70:24] in my office, right? Because his primary [70:26] care doctor would have identified that, [70:27] treated it, and he never would have [70:28] needed the specialist. [70:30] Mhm. [70:32] It's crazy. It's wild. [70:35] So, [70:36] ultimately, you know, if you look at [70:39] what are the ills that are affecting [70:40] healthcare in, you know, any first-world [70:43] nation, the number one offender is [70:46] metabolic disease and metabolic [70:47] dysfunction. And this is something that [70:50] was actually hinted at, you know, by, [70:52] you know, RFK whenever he was talking [70:54] about uh root cause of disease. Well, [70:57] yes, we have many many diseases and many [71:00] many infections that don't stem [71:01] necessarily from insulin resistance, but [71:03] if we look at cardiac disease, if we [71:05] look at issues with lack of perfusion, [71:08] my my specialty, erectile dysfunction, [71:10] right? We look at cancer. All of this is [71:12] related back to obesity and metabolic [71:14] dysfunction. And so, if we can eliminate [71:16] that, you know, as a society or we can [71:18] minimize it to as little as possible, [71:20] well, I mean, man, maybe I'd finally [71:22] work myself out of a job. [71:24] Your specialty is these erectile [71:25] dysfunction. Yeah, so my specialty is [71:28] this branch off of urology that we [71:30] broadly call men's health, okay? And so, [71:32] what that incorporates for us is going [71:34] to be low testosterone, advanced hormone [71:36] management. I take that a little bit [71:37] further than most people. That's totally [71:38] cool. And then also uh erectile [71:41] dysfunction, Peyronie's disease, which [71:43] is damage to the penis that causes [71:44] curvature, and then [71:46] uh male fertility on top of that. And I [71:49] do a little other thing uh treating [71:51] leakage after uh prostate cancer [71:52] treatment. And that's basically it. like [71:55] five things maybe, and you know, that's [71:58] it. So, I'm very very specialized [72:01] because I was the kid that, you know, [72:02] like to take my sandwiches apart and eat [72:04] it one at a time. I was very precise. [72:06] And I figured, you know, you can do a [72:07] lot of things in this world and be okay [72:08] at them, or you can pick like, I don't [72:10] know, four or five and get pretty good [72:11] at them. So, that seemed to work for me. [72:14] I was looking at a at a photo of you of [72:16] you 5 years ago and you were very [72:17] different. Yeah. [72:18] You've changed a lot. So, [72:21] I will [72:24] I will tell you this. [72:26] Um [72:28] medical training [72:30] >> [clears throat] [72:30] >> in the United States has gotten better. [72:33] But it is grueling. [72:35] It's absolutely grueling. [72:38] For 5 years, [72:39] I worked anywhere from 80 to 100 hours a [72:42] week in a hospital. [72:44] No eating, [72:45] very little sleep. [72:47] Did not care for yourself at all. [72:49] Um and again, we can argue whether or [72:51] not that's necessary all day long. [72:54] But the truth is is that it really beat [72:57] me down. [72:58] It absolutely took me apart physically [73:01] and psychologically. [73:03] In part it's designed to do that cuz the [73:05] idea is that as a surgeon you have to be [73:07] able to perform when [73:10] all the lights are on, when everything [73:11] is against you, you have to be the one [73:13] to hold it together in the operating [73:14] room and command that ship and save that [73:16] patient. [73:18] And I remember being [73:20] totally devastated towards the end of [73:22] training. And I did a very challenging [73:26] surgery on a very needy patient. [73:28] Gentleman was about to go into renal [73:30] failure, did not have a lot of kidney [73:32] left. And he had a very challenging [73:35] kidney tumor that was in a very [73:37] treacherous location. It was in a [73:39] location where he should have lost that [73:41] kidney by all measure if we were going [73:43] to take out that cancer. [73:44] And he was at a county hospital, he had [73:47] no insurance, you know, and we swung for [73:51] the fences and did a very, very [73:53] challenging operation on him. And [73:56] against our best efforts with having [73:58] everybody there, [73:59] he ended up having a bleed [74:01] postoperatively that night. And I [74:03] remember getting the call, I was on [74:04] call, and that his blood pressure had [74:07] dropped and that he did not look well [74:09] and I knew exactly what it was because [74:11] again this was a very treacherous [74:12] surgery. [74:13] And I went in in the middle of the night [74:15] with my attending who was a different [74:16] attending than the one I did the initial [74:18] surgery with. [74:19] And I remember just opening him up [74:23] and just [74:25] being covered in blood that we were [74:27] taking out of the abdominal field, that [74:29] we were evacuating, eventually [74:30] identifying the area of the bleed, and [74:33] there was no way that it could have been [74:34] avoided. I remember my attending yelling [74:36] at me and we ultimately had to take that [74:38] guy's kidney. [74:39] And [74:41] I remember [74:43] walking out of there just being totally [74:45] shattered, covered in blood, crying in a [74:47] hallway by myself, wondering if [74:50] you know, like what what was the point? [74:51] Like is there going to be a Is there a [74:52] tomorrow after this? Like I spent all [74:54] this time in this training, like am I [74:55] good enough? Am I going to be able to [74:56] make this? [74:58] And, you know, I wasn't well put [75:00] together, wasn't healthy, uh and I ended [75:04] up spending a lot of time with that [75:05] patient, literally held his hand [75:06] throughout the rest of his hospital [75:07] stay. [75:08] And he ended up recovering uh and [75:10] against all odds. [75:12] But, you know, afterwards, I took a [75:15] strong interest in not only taking care [75:19] of my patients, but also [75:22] practicing what I preach, taking care of [75:24] myself, and prioritizing my own health. [75:27] I got evaluated. I was diagnosed with [75:28] low testosterone myself. Turns out not [75:30] eating or sleeping for 5 years will do a [75:32] number on you, you know. [75:33] >> his old stress? [75:34] Through the roof, 24/7. I cannot even [75:38] imagine what, you know, there's a part [75:40] in the brain called the hippocampus that [75:42] they when they do MRIs on soldiers that [75:45] come back from war, that'll be [75:47] degenerated in them. I wonder if we did [75:49] that in surgical trainees, what that [75:51] would look like. But, I made a [75:54] commitment to take care of my patients, [75:57] to take care of myself, and make that a [75:58] priority, and [76:01] to be, you know, simultaneously the best [76:03] doctor and you know, the best father and [76:05] you know, husband I could be. [76:06] Not perfect, made a lot of mistakes [76:08] along the way, but you know, what you're [76:10] seeing from 5 years ago is where I was, [76:13] you know, I've been in training now for [76:13] 7 years, so it took a while to kind of [76:15] recover from that. But, what you're [76:16] seeing is, you know, [76:18] what focusing on health and wellness can [76:20] potentially look like. [76:22] The emotion in you is palpable when you [76:24] talk about this. [76:26] And I'm wondering where that comes from. [76:28] What is it? Cuz you're looking off into [76:30] the distance at something. [76:32] I don't know what you're looking at. [76:33] Yeah. [76:34] I mean, [76:38] I [76:40] when I'm caring for my patients and I [76:42] see a young man [76:44] that is [76:46] struggling with his fertility and he [76:48] wants to be a father. [76:50] I was that guy. [76:52] Me and my wife couldn't get pregnant [76:53] when we first tried. [76:55] We ended up having to do in vitro [76:56] fertilization and IVF. [76:58] I remember feeling like I wasn't a man [77:00] because I was sitting in that room [77:01] holding her hand and not having any [77:03] answers to why things weren't working. [77:06] Um when I see my patients who come in [77:08] that are, [clears throat] [77:09] you know, struggling because their [77:11] hormones are out of whack and no matter [77:12] how they try to take care of themselves, [77:14] something just isn't clicking. [77:16] I've been that guy. [77:18] And then when I see my other patients, [77:20] you know, that are further on in life [77:21] and struggling with things like, you [77:22] know, prostate cancer or erectile [77:24] dysfunction, whatever the case may be, I [77:25] see like I see my my my father, my [77:28] uncle, my grandfather. I like these [77:31] but and they are someone's father, [77:33] grandfather, and uncle. Like these are [77:35] our brothers and this is who I have been [77:37] called to care for. And I care for my [77:39] patients deeply. And it's because I care [77:42] for the my patients and like this is a [77:45] calling for me that I care about stuff [77:47] like this because I want my patients to [77:50] have every tool physically possible to [77:52] live their best quality of life so that [77:54] they can be whole and they can be happy [77:56] and so that they can be the best version [77:58] of themselves for their loved ones. [78:07] Well, thank you for caring. [78:09] Cuz it matters. [78:10] And uh a lot of this stuff is quite [78:13] opaque and confusing to an average [78:14] person like me, but it's going to I'm so [78:15] glad that we have people like there in [78:17] the world like you that are demystifying [78:19] all of this for us and explaining it in [78:21] simple terms, but also championing it [78:22] because, you know, one of the thing [78:24] other things I've learned from listening [78:24] to this podcast is [78:26] solutions to problems that a lot of [78:27] people are suffering with are often [78:28] right in front of us, but they need [78:30] voices and educators like yourself out [78:32] there um leading the charge so that [78:34] these types of things are available to [78:36] everyone, not just the few. [78:37] Absolutely. Not just the billionaires [78:39] who can get whatever they want straight [78:40] away any day. Yeah, I mean, [78:43] you know, it's a [78:45] one thing I I love is that I've I've [78:47] been very blessed in my practice to take [78:49] care of people that are much fancier [78:51] than I am and sit in boardrooms and that [78:52] sort of thing. But, you know what? I [78:55] love taking care of my my regular [78:58] patients who are, you know, farmers, [79:00] ironworkers, you know, tradesmen, guys [79:03] that, you know, truthfully, I have more [79:05] in common with than anyone else. You [79:07] know, I joke with my patients, I'm just [79:08] an over educated plumber at the end of [79:09] the day, right? Urologist. And so, [79:12] um it's [79:13] uh health is for everyone, not just for [79:16] the fortunate. [79:17] The last thing I wanted to talk to you [79:18] about is linked but random. Yes. [79:21] It's the Enhanced Games. [79:23] Let's do it. [79:25] >> [laughter] [79:25] >> I I am so excited about these. So, [79:28] >> Do you know them? I do, very well. So, [79:30] for those of you or for for those who [79:33] may not know, the Enhanced Games is a [79:36] project based off of the World [79:38] Anti-Doping Agency's own data. [79:40] Potentially up to 40% of athletes that [79:43] are competing at the Olympic level have [79:45] either are currently using or have used [79:47] banned substances at some point in time, [79:49] all right? And also, we know that a lot [79:51] of the compounds that are used for [79:52] enhancement maybe aren't quite so [79:55] dangerous if they're being administered [79:57] by a trained medical professional with [79:58] proper oversight. And as of right now, [80:00] that's not happening. Also, at the same [80:02] time, we know that Olympic athletes [80:05] aren't paid enough, right? These are the [80:07] best of the best of the best and they're [80:08] not even making the poverty line a lot [80:10] of years. And so, the idea is this, [80:12] well, what if we go ahead and we strip [80:14] away those rules, okay? We allow [80:16] athletes to use medications that can [80:17] enhance performance. We watch them very [80:20] closely and we have a team of doctors [80:21] and medical medical professionals [80:23] watching them. And then, let's see what [80:26] they can do at these traditional Olympic [80:28] events and see if they smash world [80:30] records. Oh, and they're going to give [80:32] 250 grand to any first place winners and [80:34] a million dollars to anyone that hits a [80:36] world record. And just for comparison, [80:39] how much are Olympic athletes getting [80:40] paid? They don't get paid to compete at [80:42] all, okay? So, they don't get paid to be [80:44] an Olympic athlete. They [80:46] uh end up getting sponsorship deals and [80:48] that's potentially the money that they [80:49] can make. [80:50] So, [80:51] yeah. Interesting. So, it's [80:52] [clears throat] basically the doping [80:53] Olympics where everyone's allowed to [80:54] dope. That's the idea. There are some [80:57] caveats in there. They're trying to say [80:58] that only FDA approved medications can [81:00] be used, okay? So, you couldn't use [81:02] something like trenbolone, which is for [81:03] veterinary use only, [81:05] um or theoretically any of the compounds [81:07] we've talked about today cuz they're not [81:08] FDA approved. But also at the same time, [81:10] they've said that they're not going to [81:11] test for those things and one of their [81:13] athletes uh Magnusson has openly [81:15] admitted to taking BPC 157 and that sort [81:18] of thing. So, I think we can kind of [81:19] figure out that it may just be a wide [81:21] open playing field, maybe. [81:23] So, [81:24] The International Olympic Committee does [81:26] not pay athletes a single cent for [81:28] winning a gold medal. [81:30] Yep. Just crazy. How many billions do [81:32] you think they make off of those with [81:33] all the advertisement? So much money. [81:36] Right? [81:37] Yeah. And this is taking place in Las [81:39] Vegas. May 21st through the 24th, I [81:41] believe. Are you going to go? [81:43] I'm going to be watching, that's for [81:44] sure. [81:45] Do you want to go? I would love to go. [81:47] That would be incredible. Well, if you [81:49] want to go, I know a few people that are [81:51] that are putting the event on, so do let [81:53] me know. I'm there, man. I'm already [81:55] interested. You got my got my attention. [81:57] Is there anything else we should have [81:58] talked about that we didn't talk about [81:59] as it relates to this subject we've [82:01] discussed today? I mean, honestly, I [82:03] think that we've gone pretty deep on [82:04] peptides and so I think we've, you know, [82:07] uh covered uh that. But one thing that I [82:10] did want to just uh leave with you cuz I [82:14] think it's pretty humorous. I think [82:15] you've talked to some of my colleagues [82:16] about this before. But, you know, one of [82:18] the things that I deal with as a [82:19] surgical specialist is the end stage of [82:21] vascular disease, the end stage of [82:22] diabetes, which is going to be erectile [82:24] dysfunction, all right? And, you know, [82:27] believe it or not, whenever we're [82:29] dealing with that in male patients, they [82:31] eventually get to a point where things [82:32] like Viagra and Cialis do not work. All [82:34] right? And that is a dark place to be as [82:36] a guy. And so, you're taking these [82:38] medications, all you're getting is a [82:39] headache and nothing else. And then, [82:41] maybe you have other options. There are [82:43] actually injections you can do in the [82:44] penis, [82:45] which is about as appetizing as you [82:46] might imagine. But, men want a better [82:49] solution, and they'll come to us as [82:51] sexual medicine specialists, you know, [82:53] seeking that. And that's what I do. So, [82:55] the bulk of my surgical practice is [82:57] actually fixing erectile dysfunction [82:59] with a procedure called implant [83:00] placement, okay? [83:01] >> Oh, no. Absolutely. So, [83:04] now, I think did Rena show you one of [83:05] these last time? She brought out I [83:07] didn't I didn't ask her. It She It makes [83:09] me like I get full body shudders when I [83:11] hear about this stuff. Yeah. The thought [83:13] of putting that up my penis. Well, so [83:15] You can show me. No, you can show me. [83:16] Well, I would tell you the good news is [83:17] you don't have to, okay? Like, that's [83:19] that's what what we have a job for, [83:20] okay? But, the way I explain to patients [83:22] is like this. So, take this out of out [83:24] of the picture, okay? Ultimately, like [83:26] the male erection is just two inflatable [83:29] tubes that start in the pelvis and go [83:30] out the shaft of the penis. It makes [83:31] sense, right? It is a hydraulic motion. [83:34] What happens is you get stimulated, get [83:36] a rush of blood into those tubes, get a [83:37] rigid erection, able to use that for [83:39] intimacy, and then when you climax, [83:40] pop-off valve opens back up and [83:42] everything drains out, all right? So, if [83:43] you can understand brakes on a car, you [83:44] can understand erections. But, the [83:46] problem is that when you have long-term [83:48] metabolic and vascular dysfunction, the [83:50] brake lines, the blood vessels that feed [83:52] those erections, they fail. And all of a [83:53] sudden, you can't get enough blood flow [83:55] for it to work. And believe it or not, [83:57] you can actually get atrophy of the [83:58] penis over time, and you actually lose [84:00] size, all right? Which no man is eager [84:03] to see, all right? But, whenever the [84:05] easy things, like oral medications, [84:07] Viagra and Cialis, don't work anymore, [84:09] the next best option, if we're looking [84:11] at patient satisfaction, durability, [84:13] concealability, is this little thing [84:15] that I do, which is what if we took our [84:19] own tubes, okay? And we put them inside [84:21] your body's natural ones. It's [84:22] invisible. Nobody looking at you could [84:24] ever tell that you've ever had anything [84:25] done. But all of a sudden when you want [84:27] to get an erection, instead of having to [84:28] rely on pills that don't work or putting [84:30] a needle in there, right? You could [84:32] reach down and there's a small pump that [84:33] we hide underneath the skin down in the [84:35] scrotum. Okay, so I joke it's like a [84:37] third testicle, but again, nothing [84:38] external, nothing you can see. And all [84:40] of a sudden, whenever you squeeze this, [84:42] what it does is it moves saline that we [84:44] hide in a little reservoir that goes in [84:46] the belly. You never feel that. Into the [84:48] cylinders and all of a sudden men are [84:50] able to get a firm, rigid erection that [84:53] looks natural, feels natural, [84:55] and they can use it as long as they want [84:57] or until their partner's sick of them. [84:59] And then press a button and it goes back [85:00] down. Do they still feel the same [85:02] pleasure? Yeah. So it does not affect [85:04] sensation. And so the nerves that affect [85:07] sensation run along the top of the [85:09] penis. If you're looking at a clock, at [85:11] the 12:00 position, and we stay totally [85:13] away from those. So this is [85:16] surgically put inside the penis. All [85:18] internal. And believe it or not, that [85:21] takes me about 13 minutes to do. How [85:22] many people have these? [85:24] Well, uh I've put in about 11 or 1,200 [85:27] personally, but [85:28] >> 1,100 or 1,200? [85:29] >> Yeah. Yeah. Yeah. [85:30] >> quite a lot of people. There'll be [85:31] people listening now that have these. [85:32] Well, you know, this is what's [85:33] interesting. If you look at in the [85:34] United States right now, okay, there are [85:36] 30 million men with erectile dysfunction [85:38] in the United States right now. That's [85:39] more than the population of Australia, [85:42] all right? [85:43] >> And if you look at statistics, the oral [85:45] medications are going to fail in 15% of [85:47] those men the first time they feel that. [85:49] And so you're talking about millions and [85:50] millions of men who aren't responding to [85:52] oral medications and need a better [85:54] option. So where's the button to [85:56] get rid of the erection? [85:57] >> those two little bars right there? These [85:58] two? Yep, go ahead and put your thumb on [86:01] I yep, do that and then squeeze from the [86:03] end of the device back [86:05] towards the pump. So squeeze squeeze. [86:07] Yep. [86:08] Right there. There you go. It's down. [86:12] And then you would have the weight of [86:13] your natural tissue push things down. [86:16] Okay, and then you Okay. There you go. [86:18] Okay. [86:19] Hm. Okay. Well, you know, I'm I'm happy [86:21] people have the options because I can [86:22] imagine [86:23] what that would be like to not be able [86:25] to get an erection. It would be [86:25] devastating, frankly. Well, I'll tell [86:27] you this. I get more hugs and high fives [86:29] than anybody else in my practice, and [86:30] that includes the guys that treat kidney [86:32] stones and cancer. So, I feel like I'm [86:33] doing some doing some good work here. [86:35] >> Until peptides put me out of business. [86:38] >> [laughter] [86:38] >> I don't think that's going to happen [86:39] anytime soon. And you have a great [86:40] YouTube channel. Thank you. I appreciate [86:42] that. [86:42] >> Which I think everybody should go check [86:43] out because you really are great at at [86:45] explaining all this stuff in simple [86:46] terms. So, I'm going to link uh Dr. [86:48] Alex's YouTube channel down below. We'll [86:50] try and collab. So, if you just click on [86:52] the Drive for CEO icon now, you'll see [86:54] Alex's channel. And I highly recommend [86:56] you go check out his content cuz he's [86:57] really really leading the charge on the [86:58] subject of peptides. When [87:00] I spoke to my team and said I want to [87:02] have a conversation about peptides, they [87:03] gave me lots of options of lots of [87:04] different types of doctors, and uh you [87:07] were by far and away uh our preference [87:09] because of the very fact that you're [87:10] very very good at communicating. You [87:11] understand people. And as you've [87:12] demonstrated today, you have a very big [87:14] heart. I appreciate that. [87:15] >> And you're clearly it's it was wonderful [87:16] to see what's actually driving you. Um [87:18] and you did that in a way which um is [87:20] irrefutably authentic. [87:22] So, please go check out Alex's channel. [87:24] Um he's around You're around 100,000 [87:26] subscribers on that channel now? Um so [87:28] close. We're at like 98, 99. Any minute [87:30] now. Okay. So, hopefully we can help [87:32] push you over [87:33] um that [87:36] that milestone. Yeah. [87:38] We have a a closing tradition, Alex, on [87:39] this podcast where the last guest leaves [87:40] a question for the next, not knowing who [87:42] they're leaving it for. Okay. Question [87:43] left for you is if you could give [87:47] $1 billion to one person you don't know [87:51] personally, who is it [87:54] and what do they have to spend it on? [87:57] Uh [88:00] Honestly, I would [88:03] give it to Elon Musk. Okay. And it's not [88:07] because I think that he's hurting for a [88:09] billion dollars right now. But, if you [88:12] look at what he is working on to [88:15] accomplish for us as a human race, [88:18] right? He I truly believe from what I've [88:21] seen that he has a similar heart for [88:23] humanity that I've seen with a lot of [88:24] physicians, but on a macro scale as an [88:28] engineer and an entrepreneur, he's [88:29] trying to solve some of the greatest [88:31] problems that are facing us today. And I [88:33] think that what we are going to see, [88:35] hopefully coming from the uh Terafab [88:38] down in Austin, is going to be wild with [88:41] recursive uh feedback and engineering on [88:44] AI chips that are going to get better [88:45] and better and better in a short period [88:47] of time and increasing, you know, [88:49] independence when it comes to, you know, [88:51] chip foundries for the United States. [88:53] Like, it's wild and I think that that [88:56] billion dollars would go further and do [88:59] more for more people than anywhere else [89:01] I could put it. And he's also working on [89:03] Neuralink, which is a really interesting [89:04] company which puts a sort of brain chip [89:06] interfaces to allow people to [89:10] hear again, see again, allow paraplegics [89:12] to walk again, um which is [89:14] really, really incredible. Dr. Alex, [89:16] thank you so much. It's so illuminating [89:18] and I can't wait to have you back again [89:19] sometime soon to talk about all the [89:20] other things we could have talked about [89:21] today. We focused on peptides [89:23] predominantly, but I know that over on [89:24] your YouTube channel you talk about a [89:25] lot more than that. So, highly recommend [89:27] everybody go check out Dr. Alex's [89:28] YouTube channel and uh it's been a [89:29] pleasure. Thank you. Thank you, Stephen. [89:31] YouTube have this new crazy algorithm [89:32] where they know exactly what video you [89:35] would like to watch next based on AI and [89:37] all of your viewing behavior. And the [89:39] algorithm says that this video is the [89:42] perfect video for you. It's different [89:44] for everybody looking right now. Check [89:45] this video out and I bet you you might [89:47] love it.