Host: Intellectual Medicine Podcast by Dr. Stephen Petteruti (Public Version)
Date: 04 February, 2025

Introduction

When you check the internet, you often see headlines claiming that most adults are unhealthy or metabolically unfit. After reading enough of those reports, it becomes easy to wonder whether the problem is the system, the country, or something closer to home.

The idea of “making America healthy again” sounds simple, yet health has never been something a nation fixes all at once. Every generation has faced infections, chronic disease, or new risks tied to modern life. Real improvement has always started at the personal level, through the small decisions people make each day about how they live, eat, move, and care for their bodies.

This episode shifts the focus away from waiting for large institutions to solve health problems and brings the conversation back to individual responsibility and practical action.

The Reality of Health Insurance

Healthcare spending continues to rise each year, yet most coverage pays for treatment after illness appears. Hospital visits, procedures, and prescriptions receive funding, while preventive habits such as exercise, nutrition, and foundational wellness often depend on personal effort and personal expense. This structure naturally encourages reactive care instead of steady prevention, which places the responsibility for day-to-day health back in the hands of the individual.

Hormones and Foundational Health

Hormones influence energy, metabolism, mood, and strength, so changes in these levels affect daily function in noticeable ways. Fatigue, weight gain, and reduced focus often follow gradual decline. Paying attention to these signals and addressing imbalances early supports long-term vitality and helps maintain strength as the years pass.

Looking Past Hype and “Breakthrough” Treatments

New drugs and highly promoted therapies often sound promising, yet the real-world benefit may be smaller than expected. Costs, side effects, and disruptions to daily life deserve the same attention as survival statistics. A steady, informed approach that favors well-understood treatments and thoughtful decisions helps protect both health and quality of life.

Environmental and Lifestyle Risks

Health is also shaped by everyday exposures. Toxins, poor diet, inactivity, and chronic stress accumulate quietly over time. Reducing these risks and strengthening the basics of sleep, movement, and nutrition often provides greater long-term benefit than chasing complex interventions later.

Listen and Go Deeper

You can listen to the full episode here [https://www.youtube.com/watch?v=ZfBwP_HX3KI]

If you want access to the full transcript, expanded clinical notes, research references, and practical tools you can use during your own medical visits, those resources are available inside the Intellectual Medicine membership. Dr. Stephen Petteruti also explores these topics in greater depth in his book Fight Cancer Like a Man, where he explains the evidence and clinical reasoning behind this vitality-focused approach. 

Join the Intellectual Medicine Community

• Membership (exclusive educational content and clinical resources): https://tinyurl.com/DrPetterutiMember
• Sign up for Dr. Steve’s Email Newsletter: https://www.intellectualmedicine.com/newsletter
• Learn more about Intellectual Medicine: https://www.intellectualmedicine.com 

Connect with Dr. Petteruti

• LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
• Instagram: https://www.instagram.com/dr.stephenpetteruti
• Facebook: https://www.facebook.com/dr.stephenpetteruti 

Subscribe to the Intellectual Medicine Podcast

• Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast 
• Spotify:  https://tinyurl.com/DrPetterutiSpotifyPodcast

Disclaimer

This podcast and accompanying materials are for educational purposes only and do not replace personalized medical care. The information presented is designed to support informed decision‑making and health literacy, not to diagnose or prescribe. Always consult your own qualified healthcare provider regarding personal health questions or treatment decisions.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without permission is prohibited.

Host: Intellectual Medicine by Dr. Stephen Petteruti (Public Version)
Date: 11 February, 2025

Introduction

Human beings are the fattest animals at the time of birth. No other organism carries as much body fat when it enters the world. In most mammals, only about 2 to 3% of birth weight is fat, and chimpanzee newborns average about 3%, yet humans begin life with far higher fat stores, which means energy conservation is built into normal human biology from day one.

That design stays with us throughout life. When energy intake exceeds energy use, the extra is stored as fat, and when this pattern repeats day after day, percent body fat gradually increases. Many people assume weight gain happens because of poor discipline, yet a large part of it comes from how the body naturally protects energy.

Losing fat, therefore, requires structure, not short bursts of dieting or temporary restriction. Once you understand how the body stores and uses energy, weight control becomes a process you can manage rather than a struggle you feel you are losing.

Two Main Drives Behind Eating

Human behavior follows two simple drives. We seek pleasure, and we avoid discomfort. Eating satisfies both at the same time.

Food removes hunger, which relieves physical discomfort, and it also activates reward pathways in the brain that create a sense of satisfaction. The brain quickly learns this connection, which is why eating feels good even when energy needs are already met.

There is also a biological reason appetite stays active. The brain represents only about 2% of body weight, yet it uses close to 20% of the body’s daily energy. That constant demand keeps hunger signals present throughout the day, so waiting to “feel full” rarely works as a reliable guide.

Calories and Why Diets Often Fail

A calorie is simply a unit used in science to measure energy. It describes heat, not food. People do not eat energy units. They eat portions of real food that have weight and volume.

Because of this, strict calorie counting often feels disconnected from normal life. Meals become numbers instead of practical choices, and most people find it hard to maintain that system long term.

Long-term research reflects this reality. Many traditional diets produce early weight loss, yet much of that weight returns over time. Short periods of restriction are difficult to sustain, and the body adapts by slowing metabolism when intake drops too sharply. That combination makes regain common.

Why Body Composition Matters More Than Weight

The number on a scale combines fat, muscle, water, and bone into one total. It cannot tell you what actually changed. Two people can weigh the same and still have very different health profiles.

Percent body fat gives clearer information. Higher body fat, especially around the abdomen, is linked with insulin resistance, heart disease, and type 2 diabetes. Muscle tissue supports strength, balance, and glucose control, which means preserving muscle is just as important as lowering fat.

Hunger Hormones and Meal Timing

Hunger is regulated by hormones, not willpower alone. One of the main signals is ghrelin, which rises when the stomach is empty and tells the brain that food is needed.

When meals are skipped or delayed for long periods, ghrelin levels rise higher, and appetite becomes intense. Eating quickly during that state often leads to larger portions before fullness registers, since the body needs time to send feedback that enough food has been consumed.

Regular meal timing helps keep these signals stable. Eating at predictable hours reduces extremes in hunger and makes portions easier to control without feeling deprived.

Simple Meals Work Better Than Constant Variety

Many people believe they need endless variety to eat well, yet too many choices often make planning harder. Each new meal introduces uncertainty about portions and ingredients, which increases the chance of overeating.

Repeating simple, balanced meals removes unnecessary decisions and keeps intake consistent. This approach is common in structured programs because predictable meals lead to predictable results. Routine during the week creates space for flexibility without losing progress.

Exercise and Medication in Context

Exercise remains important for overall health. Regular activity improves heart function, bone strength, mood, and mobility. These benefits support long-term independence and quality of life.

Fat loss, however, depends mostly on daily eating habits. A short workout burns fewer calories than many people expect, so nutrition remains the primary driver of body composition changes.

Medications may help some individuals reduce appetite or improve adherence, yet they work best alongside structured habits rather than as a replacement for them. Consistency in meals and movement still forms the foundation.

Listen to the Full Discussion

You can listen to the full episode here [https://www.youtube.com/watch?v=sNpFlDYAPyg]

For a broader explanation of the reasoning behind this perspective, Fight Cancer Like a Man by Dr. Stephen Petteruti presents these principles in a structured and practical format, outlining how to approach cancer prevention, screening, and treatment decisions with clarity.

Fight Cancer Like a Man by Dr. Petteruti: https://www.amazon.com/dp/B0GLZ9TL8N/

If you would like continued access to extended clinical notes and member-only discussions, you can join the Intellectual Medicine Community here:

• Membership: https://tinyurl.com/DrPetterutiMember
• Sign up for Dr. Steve’s email newsletter: https://www.intellectualmedicine.com/newsletter
• Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:

• LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
  Instagram: https://www.instagram.com/dr.stephenpetteruti
  Facebook: https://www.facebook.com/dr.stephenpetteruti

Subscribe to the Intellectual Medicine Podcast:

• Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
• Spotify: https://tinyurl.com/DrPetterutiSpotifyPodcast

To support deeper reflection, referenced studies explore the long-term outcomes of observation compared with intervention. These data examine survival, treatment-related complications, and the biological consequences of biopsy and hormone suppression. Reviewing this literature allows patients and clinicians to move beyond habit and consider a more individualized approach to prostate health.

Disclaimer

This podcast and its accompanying materials are for educational purposes. They are intended to support thoughtful decision-making and improve health literacy. They are not a substitute for individualized medical advice, diagnosis, or treatment. Always consult your qualified healthcare professional regarding personal medical concerns.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without written permission is prohibited.

Host: Intellectual Medicine by Dr. Stephen Petteruti (Public Version)

Date: 25 February, 2025

A rising PSA or an unexpected biopsy result can create immediate fear. Many men feel pressure to schedule surgery or radiation as soon as possible because cancer sounds urgent and dangerous. Acting quickly feels logical, and the assumption is that earlier treatment must always lead to better outcomes.

Prostate cancer often behaves slowly, especially in its early stages. Many tumors stay inside the prostate for years and do not spread to other parts of the body, which means a man can live a normal life without symptoms from the disease. When treatment starts immediately in these situations, the side effects from surgery or radiation can affect urination, sexual function, and daily comfort even though the cancer itself might never have created those problems.

New discoveries about prostate cancer

Medical literature now recognizes that a large portion of prostate cancers follow an indolent course. Indolent simply means slow-growing and unlikely to spread quickly. In practical terms, this means many men carry prostate cancer for years without it affecting their lifespan or quality of life.

Several long-term trials have compared active treatment with observation. Groups who underwent surgery or radiation often experienced more side effects, while overall survival remained similar between treated and untreated groups. These findings have encouraged physicians to rethink the idea that every early diagnosis requires immediate intervention.

The focus has therefore shifted from automatic treatment to careful evaluation. The goal is to identify which cases truly need intervention and which can be monitored safely over time.

Potential damage from radiation

Radiation therapy delivers high-energy beams to injure cellular DNA inside the prostate. The intent is to damage cancer cells so they stop dividing. The prostate sits next to the bladder and rectum, so nearby tissues receive exposure during treatment as well.

Exposure to surrounding tissue can create inflammation and long-term irritation. Some men develop radiation proctitis, which involves rectal discomfort, bleeding, and changes in bowel habits. Others experience radiation cystitis, which may include urinary urgency, burning, or blood in the urine, and these symptoms can persist long after therapy has ended.

Radiation also works by damaging genetic material, and that same mechanism can affect healthy cells. Follow-up studies over many years have documented small increases in secondary cancers in the pelvic region after radiation.

PSA testing and biopsy limitations

PSA testing is useful for monitoring trends, yet the number can rise for many ordinary reasons. Infections, inflammation, physical activity, and temporary stress can all influence PSA values. A single elevated result does not reliably predict aggressive cancer.

A biopsy collects small pieces of tissue from the prostate using several needle insertions. Each insertion creates a small injury, which can lead to bleeding, soreness, or infection during recovery. The samples only represent tiny areas of the gland, so they can miss some spots or detect very small tumors that may never cause symptoms, and that uncertainty often creates worry without giving a clear answer about what action is truly necessary.

Because of these limits, test results must be interpreted with context and patience. Numbers alone do not determine the best course of action.

Watchful waiting as a practical path

Observation has become an accepted medical strategy for many men with early-stage prostate cancer. This method includes scheduled PSA testing, periodic imaging, and regular clinical review. The purpose is to monitor changes while maintaining normal daily function.

This approach allows life to continue without exposing the body to surgical or radiation side effects. Health is tracked carefully, and intervention remains available if meaningful progression appears. Many men value this process because it balances caution with preservation of quality of life.

Supporting overall health

Prostate health connects directly to everyday habits that affect the entire body. Factors such as immune function, percent body fat, sleep quality, nutrition, and exposure to environmental toxins influence how well the body detects and controls abnormal cells over time. Improving these areas strengthens normal defenses and gives the body a better chance of keeping small problems contained before they grow into something serious.

Maintaining a healthy waist size, staying physically active, and following consistent daily habits help lower inflammation and support metabolic stability. These steps improve energy and function while carrying little risk. Attention to these basics often provides benefits that extend far beyond one specific diagnosis.

Listen to the full conversation

You can listen to the full episode here [https://www.youtube.com/watch?v=cc2lHnjDfrk].

If you want access to the complete transcript, expanded clinical notes, detailed research references, and practical tools you can use during your own medical visits, those resources are available inside the Intellectual Medicine membership. Dr. Stephen Petteruti also explains these topics in greater depth in his book Fight Cancer Like a Man, where he outlines the evidence and clinical reasoning behind this vitality-focused approach.

Learning is strongest when ideas connect. Continue exploring these episodes that build on today’s discussion:

Continue the Conversation

If this discussion raised new questions for you, there are related episodes that expand on these themes in greater detail:

EP10 – Managing an Elevated PSA: Avoiding Unnecessary Prostate Biopsies

E16 - Prostate Cancer Prevention Is Not About Fear | What Most Doctors Miss

For a broader explanation of the reasoning behind this perspective, Fight Cancer Like a Man by Dr. Stephen Petteruti presents these principles in a structured and practical format, outlining how to approach cancer prevention, screening, and treatment decisions with clarity.

Fight Cancer Like a Man by Dr. Petteruti: https://www.amazon.com/dp/B0GLZ9TL8N/

If you would like continued access to extended clinical notes and member-only discussions, you can join the Intellectual Medicine Community here:

• Membership: https://tinyurl.com/DrPetterutiMember
• Sign up for Dr. Steve’s email newsletter: https://www.intellectualmedicine.com/newsletter
• Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:

• LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
  Instagram: https://www.instagram.com/dr.stephenpetteruti
  Facebook: https://www.facebook.com/dr.stephenpetteruti

Subscribe to the Intellectual Medicine Podcast:

• Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
• Spotify: https://tinyurl.com/DrPetterutiSpotifyPodcast

To support deeper reflection, referenced studies explore the long-term outcomes of observation compared with intervention. These data examine survival, treatment-related complications, and the biological consequences of biopsy and hormone suppression. Reviewing this literature allows patients and clinicians to move beyond habit and consider a more individualized approach to prostate health.

Disclaimer

This podcast and its accompanying materials are for educational purposes. They are intended to support thoughtful decision-making and improve health literacy. They are not a substitute for individualized medical advice, diagnosis, or treatment. Always consult your qualified healthcare professional regarding personal medical concerns.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without written permission is prohibited.

Host: Intellectual Medicine By Dr. Stephen Petteruti (Public Version)

Date: 04 March, 2025

Introduction

Finishing cancer treatment often feels like crossing a finish line. Surgery is completed, chemotherapy ends, and radiation sessions stop, so it is natural to believe the hard part is over. Many people want to close that chapter and move on with life.

However, the body does not simply forget what happened. A person who has had cancer already carries a higher risk of developing another cancer in the future. Because of that risk, health protection cannot stop after treatment, and daily habits begin to matter even more than before.

Secondary prevention focuses on keeping the body strong, resilient, and less supportive of abnormal cell growth. Instead of waiting for a problem to appear, the goal is to create conditions that make problems less likely in the first place.

Risk of Recurrence

One of the strongest predictors of future cancer is a history of cancer itself. Once someone has developed a malignancy, it indicates that certain biological or environmental pressures already exist. Those pressures do not disappear automatically when the tumor is removed.

Clinical follow-ups over many years reveal that recurrence can happen long after treatment ends. People may feel healthy for five, ten, or even twenty years before another cancer appears. This delayed pattern explains why long-term prevention deserves attention even when everything seems fine today.

Effects of Treatment

Chemotherapy and radiation play an important role in cancer care. They can shrink tumors, control spread, and save lives when disease is active. For many patients, these treatments are necessary and appropriate.

At the same time, both therapies work by damaging cells. Chemotherapy targets rapidly dividing cells, and radiation injures DNA so cells cannot reproduce. Cancer cells are affected, yet healthy cells are exposed as well, including bone marrow, immune cells, and tissues that help the body repair itself.

Understanding Tumors and Early Change

Most people think of cancer as something that appears suddenly on a scan. In reality, visible tumors usually develop after years of silent growth. A tumor large enough to be detected has already gone through many cycles of cell division.

Before that stage, small groups of abnormal cells may already exist without causing symptoms. Imaging and routine tests cannot detect those early changes. Because of this delay, waiting for a visible mass means acting late in the process.

That is why secondary prevention focuses on supporting the body at the cellular level. Strengthening internal defenses helps manage problems before they grow large enough to be seen.

Environmental and Lifestyle Factors

Many cancer risks come from the environment rather than genetics alone. Air, water, food, and daily exposures introduce substances that can irritate tissues and damage DNA over time. Heavy metals such as cadmium and lead have been identified as carcinogenic and may accumulate slowly inside the body.

Reducing these exposures lowers the overall burden on cells. Clean water, thoughtful nutrition, and testing when appropriate can all play a role. The goal is not perfection but reducing unnecessary stress on the body’s repair systems.

Body composition also influences risk. Excess body fat is associated with higher rates of several cancers because fat tissue releases inflammatory chemicals and hormonal signals that encourage abnormal growth. Losing fat while protecting muscle improves metabolic health and supports long-term resilience.

Supporting Immune Health

The immune system functions as the body’s internal defense network. It identifies abnormal cells and removes them before they multiply. This quiet process happens daily, often without notice.

Stress, poor sleep, nutrient deficiencies, and inactivity reduce this protective function. When immune efficiency drops, abnormal cells gain time to grow. Over months or years, that delay can make a meaningful difference.

Simple habits help maintain strong defenses. Regular sleep, consistent meals with adequate protein, and essential nutrients such as vitamin C, vitamin D, and zinc support immune signaling and repair. These steps may sound basic, yet they form the foundation of long-term protection.

Moving Forward

Secondary prevention is not complicated or extreme. It is built through small actions repeated every day. Lowering toxic exposures, improving body composition, supporting immune health, and making thoughtful lifestyle choices all contribute to a stronger internal environment.

These changes do not replace medical care. They work alongside it by giving the body better tools to protect itself. Over time, those daily decisions add up and create a more resilient system.

Listen and Go Deeper

You can listen to the full episode here [https://www.youtube.com/watch?v=vMpecLnsFko].

If you want access to full transcripts, expanded clinical notes, research references, and practical tools you can use during your own medical visits, those resources are available inside the Intellectual Medicine Membership. 

Dr. Stephen Petteruti also explores these topics in greater depth in Fight Cancer Like a Man, where the evidence and clinical reasoning behind this vitality-focused approach are explained in clear, practical terms.

Continue the Conversation

If this discussion raised new questions for you, there are related episodes that expand on these themes in greater detail:

EP31 – Do Men Really Die From Prostate Cancer? What the Data Actually Shows

EP33 – Testosterone, Aging, and Vitality What Medicine Isn’t Telling You

For a deeper and more structured look at this philosophy, Fight Cancer Like a Man by Dr. Stephen Petteruti walks through prevention, screening, and treatment decisions in a practical and direct way. It lays out the reasoning behind prioritizing vitality, safety, and informed choice.

If you would like access to extended clinical notes and member-only discussions, join the 

Intellectual Medicine Community:
Membership: https://tinyurl.com/DrPetterutiMember
Sign up for Dr. Steve’s email newsletter: https://www.intellectualmedicine.com/newsletter
Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:
LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
Instagram: https://www.instagram.com/dr.stephenpetteruti
Facebook: https://www.facebook.com/dr.stephenpetteruti

Subscribe to the Intellectual Medicine Podcast:
Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
Spotify: https://tinyurl.com/DrPetterutiSpotifyPodcast

To support deeper reflection, referenced studies explore the long-term outcomes of observation compared with intervention. These data examine survival, treatment-related complications, and the biological consequences of biopsy and hormone suppression. Reviewing this literature allows patients and clinicians to move beyond habit and consider a more individualized approach to prostate health. You can find this information in the Membership section of Intellectual Medicine.

Disclaimer

This podcast and its accompanying materials are for educational purposes. They are intended to support thoughtful decision-making and improve health literacy. They are not a substitute for individualized medical advice, diagnosis, or treatment. Always consult your qualified healthcare professional regarding personal medical concerns.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without written permission is prohibited.

Host: Intellectual Medicine By Dr. Stephen Petteruti (Public Version)

Date: 11 March, 2025

Introduction

For many men, the word testosterone brings quiet fear before any facts are discussed. They hear that hormone therapy might cause prostate cancer, so they choose to live with low energy, fading strength, and slower thinking instead of asking questions. Over time, fatigue becomes normal, muscle shrinks, weight increases, and daily life feels harder than it should.

At the same time, testosterone decline happens to every man with age. It is not rare or unusual, and it affects nearly every system in the body. The real issue is not whether levels fall, but what happens when they fall too far and stay there for years without being addressed.

This creates a simple but important question. Should you accept the decline, or should you restore your levels and focus on careful monitoring? That balance is what this discussion is really about.

Rethinking Prostate Cancer Fear

Fear around prostate cancer often begins with the belief that any cancer cell inside the prostate is undoubtedly dangerous. That belief pushes many men toward unnecessary testing and procedures before they understand what those findings mean. As a result, they will be forced to deal with anxiety and take rushed decisions that proper planning would have easily replaced.

The truth is that recent research paints a calmer picture. Medical findings should always be the basis of your reaction and not some random thing you see online, or something you must have heard from a non-medical professional. 

What Modern Research Says About Testosterone

Much of the fear about testosterone therapy came from studies published decades ago. At that time, doctors believed that higher testosterone levels directly stimulated prostate cancer growth, and that idea shaped medical practice for many years. As a result, many men were told to avoid therapy even when they clearly had symptoms of deficiency.

Newer research has questioned those assumptions. Clinical trials that followed men receiving properly tells a whole different story from the myth that has been surrounding this topic. 

Looking at the Bigger Picture of Health

Hormones do not act alone inside the body. Prostate cells exist within the same environment as every other tissue, so overall health plays a large role in long-term outcomes. When the body is inflamed, poorly nourished, or chronically stressed, disease risk increases across many systems.

Daily habits shape that environment more than most people realize. Excess body fat increases inflammation and disrupts metabolism, while poor sleep weakens immune function and recovery. Over time, these factors create more problems than a single hormone level ever could.

Supporting health through consistent meals, regular strength training, adequate sleep, and lower toxin exposure builds resilience. A stronger body handles abnormal cells more effectively and maintains function as the years pass.

Signs Testosterone May Be Too Low

Low testosterone usually shows up gradually rather than suddenly. Energy drops, workouts feel harder, and muscle mass decreases even when exercise habits stay the same. Body fat often increases around the waist, and recovery becomes slower.

Mental and emotional changes may follow. Many men describe brain fog, reduced motivation, lower confidence, and decreased mood. Libido declines, and sleep becomes lighter and less refreshing.

These changes affect daily life in practical ways. Work feels harder, movement feels heavier, and enthusiasm fades. Lab testing helps confirm the issue, yet symptoms often tell the story first.

Monitoring Without Panic

PSA testing is commonly used to monitor prostate health, but the number alone does not tell the whole story. Infection, inflammation, recent exercise, or even normal aging can temporarily raise the value. Treating one reading as an emergency often creates unnecessary stress.

Looking at trends over time provides more reliable information. Gradual changes usually reflect normal aging, while sudden shifts deserve closer review. A calm and structured approach protects both health and peace of mind.

This kind of monitoring supports better decisions. It allows men to stay informed without rushing into invasive procedures that may not be needed.

A Balanced Perspective

Testosterone therapy is not about chasing extreme levels or quick fixes. It is about restoring hormones to a healthy range so that strength, focus, and energy return to normal. When therapy is supervised and monitored, it becomes part of a structured health plan rather than a risky experiment.

At the same time, regular checkups and prostate monitoring keep safety in view. This combination of restoration and observation creates balance. It supports vitality while respecting long-term health.

When decisions are guided by evidence instead of fear, men gain both clarity and confidence. That mindset often leads to better outcomes than avoiding treatment altogether.

Listen to the Full Episode

You can listen to the full episode here [https://www.youtube.com/watch?v=DZjjeRdxt8I]. 

If you want access to full transcripts, expanded clinical notes, research references, and practical tools you can use during your own medical visits, those resources are available inside the Intellectual Medicine Membership. 

Dr. Stephen Petteruti also explores these topics in greater depth in Fight Cancer Like a Man, where the evidence and clinical reasoning behind this vitality-focused approach are explained in clear, practical terms.

Continue the Conversation

If this discussion raised new questions for you, there are related episodes that expand on these themes in greater detail:

EP09 - Male Sexual Health Explained: Testosterone, Erections, and Long-Term Vitality

EP04 - Testosterone Therapy Explained: Benefits, Risks, PSA, and Prostate Health

For a deeper and more structured look at this philosophy, Fight Cancer Like a Man by Dr. Stephen Petteruti walks through prevention, screening, and treatment decisions in a practical and direct way. It lays out the reasoning behind prioritizing vitality, safety, and informed choice.

If you would like access to extended clinical notes and member-only discussions, join the 

Intellectual Medicine Community:
Membership: https://tinyurl.com/DrPetterutiMember
Sign up for Dr. Steve’s email newsletter: https://www.intellectualmedicine.com/newsletter
Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:
LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
Instagram: https://www.instagram.com/dr.stephenpetteruti
Facebook: https://www.facebook.com/dr.stephenpetteruti

Subscribe to the Intellectual Medicine Podcast:
Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
Spotify: https://tinyurl.com/DrPetterutiSpotifyPodcast

To support deeper reflection, referenced studies explore the long-term outcomes of observation compared with intervention. These data examine survival, treatment-related complications, and the biological consequences of biopsy and hormone suppression. Reviewing this literature allows patients and clinicians to move beyond habit and consider a more individualized approach to prostate health. You can find this information in the Membership section of Intellectual Medicine.

Disclaimer

This podcast and accompanying materials are for educational purposes only and do not replace personalized medical care. The information presented is designed to support informed decision‑making and health literacy, not to diagnose or prescribe. Always consult your own qualified healthcare provider regarding personal health questions or treatment decisions.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without permission is prohibited.

Host: Intellectual Medicine by Dr. Petteruti (Public Version)

Date: 18 March, 2025

Introduction

Few medical words create instant fear the way “prostate cancer” does. The moment a PSA number rises, or a biopsy is mentioned, many men feel pressure to act immediately, as if something dangerous must be removed right away. That urgency sounds logical, yet the evidence tells a calmer story.

Early-stage prostate cancer often progresses slowly and carries an extremely low short-term death rate. When risk is already low, invasive testing does not automatically improve outcomes and can introduce problems that were never going to happen. Before agreeing to a biopsy, it helps to pause and ask one clear question. Will this test truly improve health, or will it simply create anxiety and push me toward treatment I may not need?

False Diagnosis Is the Culprit

Prostate cancer diagnoses continue to increase each year, yet deaths from prostate cancer have declined. When diagnosis rises while mortality falls, it suggests that many of the cancers being found were never life-threatening in the first place. In other words, we are labeling more men without clearly saving more lives.

As men age, the prostate commonly develops irregular or atypical cells. Under a microscope, some of these cells resemble cancer even when they grow slowly and remain confined to the gland for decades. Once the word “cancer” appears on a report, fear takes over and decisions become rushed, even though the finding may never have caused harm.

What the Long-Term Studies Show

If early surgery or radiation clearly saved lives, the benefit would appear strongly in research. Large trials have followed men with early-stage prostate cancer for many years and compared those who removed the prostate with those who chose observation. Survival rates looked very similar between the two groups.

Treatment, however, carries real consequences. Surgery can affect bladder control and sexual function, and radiation can irritate nearby tissues long after therapy ends. When the measurable benefit remains uncertain, these side effects deserve serious consideration before moving forward.

The Risks Behind a “Simple” Biopsy

A prostate biopsy is often described as minor, yet it involves multiple core needles passing through the gland to remove tissue samples. Each puncture creates bleeding and inflammation inside sensitive structures. Even when complications are uncommon, the procedure is not as harmless as it sounds.

Medical literature in other cancers has shown that needle tracks can disturb tissue barriers and occasionally spread abnormal cells. Infection, pain, and bleeding also occur often enough to matter. Beyond the physical risks, the psychological impact can be just as significant, since a small finding frequently triggers pressure for immediate treatment.

Alternatives Worth Considering

A biopsy is not the only way to gather information. PSA levels can be tracked over time to observe patterns rather than reacting to one reading. Temporary increases often settle when the test is repeated weeks later under calmer conditions.

Imaging tools such as prostate MRI can provide useful anatomical detail without puncturing tissue. Regular follow-up and observation allow doctors to assess change gradually. Because prostate cancer usually grows slowly, taking time rarely compromises safety and often prevents unnecessary procedures.

Your Body Is Already Working for You

Cancer is not an event that suddenly appears overnight. Abnormal cells form in the body regularly as part of normal biology, and the immune system continuously removes many of them. Most of this activity happens quietly without symptoms or awareness.

The prostate follows the same pattern. Small clusters of atypical cells may stay contained for years while the body keeps them under control. Understanding this process reduces panic and helps shift attention toward supporting natural defenses instead of reacting to every abnormal number.

Strengthening the Foundation of Health

Long-term protection often begins with everyday habits. Body composition, sleep, nutrition, and environmental exposures all influence how tissues behave. A healthier internal environment makes it harder for abnormal cells to thrive.

Maintaining muscle, lowering excess body fat, eating balanced meals, and staying physically active support immune function and metabolic stability. Reducing exposure to toxins and unnecessary radiation decreases ongoing cellular stress. These actions may look simple, yet their effect builds steadily over time.

A Different Way to Think About Prostate Care

Many men live for decades with monitored prostate findings while maintaining full, active lives. They continue working, exercising, and enjoying daily routines without rushing into invasive procedures. Careful observation allows them to protect both their health and their quality of life.

Prostate decisions do not have to be driven by fear. Slowing down, gathering information, and weighing the evidence leads to clearer choices. Thoughtful medicine often means doing less, not more.

Listen to the Full Episode

You can listen to the full episode here [https://www.youtube.com/watch?v=6Crij3C1X9E]. 

If you want access to full transcripts, expanded clinical notes, research references, and practical tools you can use during your own medical visits, those resources are available inside the Intellectual Medicine Membership. 

Dr. Stephen Petteruti also explores these topics in greater depth in Fight Cancer Like a Man, where the evidence and clinical reasoning behind this vitality-focused approach are explained in clear, practical terms.

Continue the Conversation

If this discussion raised new questions for you, there are related episodes that expand on these themes in greater detail:

EP09 - Don't Biopsy Your Prostate Until You Hear This (Part 2) 

EP04 - Why Early Treatment of Prostate Cancer May Be Ineffective: The Case for Conventional Therapies

For a deeper and more structured look at this philosophy, Fight Cancer Like a Man by Dr. Stephen Petteruti walks through prevention, screening, and treatment decisions in a practical and direct way. It lays out the reasoning behind prioritizing vitality, safety, and informed choice.

If you would like access to extended clinical notes and member-only discussions, join the 

Intellectual Medicine Community:
Membership: https://tinyurl.com/DrPetterutiMember
Sign up for Dr. Steve’s email newsletter: https://www.drstephenpetteruti.com
Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:
LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
Instagram: https://www.instagram.com/dr.stephenpetteruti
Facebook: https://www.facebook.com/dr.stephenpetteruti

Subscribe to the Intellectual Medicine Podcast:
Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
Spotify: https://tinyurl.com/DrPetterutiSpotifyPodcast

To support deeper reflection, referenced studies explore the long-term outcomes of observation compared with intervention. These data examine survival, treatment-related complications, and the biological consequences of biopsy and hormone suppression. Reviewing this literature allows patients and clinicians to move beyond habit and consider a more individualized approach to prostate health. You can find this information in the Membership section of Intellectual Medicine.

Disclaimer

This podcast and accompanying materials are for educational purposes only and do not replace personalized medical care. The information presented is designed to support informed decision‑making and health literacy, not to diagnose or prescribe. Always consult your own qualified healthcare provider regarding personal health questions or treatment decisions.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without permission is prohibited.

Host: Intellectual Medicine by Dr. Petteruti (Public Version)

Date: 25 March, 2025

Introduction

Breast cancer has become so common that almost every woman knows someone who has faced it. The word alone can create fear, and that fear often pushes people toward tests and procedures before they have time to slow down and think clearly. Mammograms sit at the center of that pressure, and many women are told they must do them without anyone fully explaining the evidence.

Screening sounds protective, yet every test comes with limits, trade-offs, and side effects that deserve honest discussion. Some tests find problems earlier, yet early detection does not always change long-term outcomes. Before following any routine blindly, it helps to understand what these screenings truly show, what they miss, and how the decision fits your own body and risk profile.

When you look at the data calmly and think it through step by step, the conversation becomes less about fear and more about informed choice.

What screening tests are designed to do

Any screening test exists for one clear reason. It should lower the chance of death or serious harm from the disease it targets. If a test only finds problems earlier without improving survival or quality of life, then its value becomes questionable.

In theory, screening sounds simple. Find the disease early, treat it early, and outcomes improve. In practice, biology is rarely that straightforward. Some cancers grow quickly and need urgent care, while others grow so slowly that they never create symptoms during a person’s lifetime.

When a test detects both types without clearly distinguishing between them, many people receive diagnoses that would never have affected their lives. That is where overdiagnosis begins. A label appears on paper, anxiety rises, and treatment follows, even though the condition may have remained harmless.

What the mammogram studies actually show

Large population studies provide helpful insight into how mammograms perform in the real world. In one well-known Canadian study that followed tens of thousands of women for years, half received regular mammograms while the other half did not. The mammogram group identified cancers slightly earlier, yet the overall death rate from breast cancer remained similar between both groups.

This finding surprises many people. Earlier detection sounds reassuring, yet earlier discovery does not always change the final outcome. Some tumors grow slowly and remain confined, while others behave aggressively regardless of when they are found.

There are also trade-offs to consider. Mammograms use ionizing radiation, which accumulates over time and carries a small carcinogenic effect. The dose is low, yet repeated exposure over many years adds up. False positives add another layer of concern, as shadows on imaging often lead to biopsies that create pain, scar tissue, and emotional stress.

None of this means mammograms have no place. It means they are tools with limits. They offer information, yet they do not guarantee protection, and that distinction is important.

The role of self-exams and body awareness

While technology plays a role, personal awareness remains powerful. Many women first notice a change themselves rather than through imaging. A simple monthly self-exam builds familiarity with normal breast tissue and makes unusual findings easier to recognize.

This process does not require medical training. It relies on consistency and attentiveness. When you understand how your body usually feels, small differences stand out more clearly.

Self-exams also carry no radiation, no cost, and no physical risk. They encourage engagement with your own health rather than dependence on a machine. In many cases, combining awareness with thoughtful imaging provides a more balanced approach than relying on screening alone.

Understanding individual risk factors

Risk does not look the same for everyone. Family history, genetics, body composition, and lifestyle all influence probability. A woman with dense breast tissue or known genetic mutations faces different considerations than someone with minimal risk and easily examined tissue.

At the same time, many women who develop breast cancer have no strong family history. This reminds us that risk is influenced by environment and daily habits, not genetics alone. Smoking, excess body fat, inactivity, and exposure to toxins all contribute to long-term vulnerability.

Because risk varies, decisions should be personal rather than standardized. A single rule applied to every woman ignores important differences. Thoughtful screening means looking at the whole person rather than following a rigid schedule.

Making a thoughtful screening decision

A screening choice should feel calm and deliberate. You deserve clear information, time to think, and space to weigh benefits against downsides. Feeling pressured often leads to decisions driven by fear instead of understanding.

For some women, regular imaging provides reassurance. For others, less frequent testing combined with self-awareness feels more appropriate. Both approaches can be reasonable when guided by evidence and personal comfort.

The key is ownership. When you understand why you choose a path, you sleep better at night. Confidence comes from clarity, not from simply following orders.

Mitochondrial health and cancer biology

Prevention also extends beyond screening. Cancer begins at the cellular level, often linked to metabolic stress and mitochondrial dysfunction. Supporting the body’s internal systems may reduce risk long before any scan becomes relevant.

Healthy body composition, regular movement, balanced nutrition, restorative sleep, and reduced toxin exposure create an environment where abnormal cells struggle to thrive. These habits strengthen immune function and improve cellular repair. Over time, they influence risk in ways that no single test can replace.

Screening looks for disease after it appears. Lifestyle choices influence the likelihood that a disease appears at all. Both perspectives matter, yet prevention often receives less attention even though it shapes long-term health.

Listen and Go Deeper

You can listen to the full episode here [https://www.youtube.com/watch?v=DpXZgMTzN2A].

If you want access to full transcripts, expanded clinical notes, research references, and practical tools you can use during your own medical visits, those resources are available inside the Intellectual Medicine Membership. 

Dr. Stephen Petteruti also explores these topics in greater depth in Fight Cancer Like a Man, where the evidence and clinical reasoning behind this vitality-focused approach are explained in clear, practical terms.

Continue the Conversation

If this discussion raised new questions for you, there are related episodes that expand on these themes in greater detail:

EP17 - Biden's Prostate Cancer: The TRUTH Doctors Don't Want You To Know!

EP31 - Do Men Really Die From Prostate Cancer? What the Data Actually Shows

For a deeper and more structured look at this philosophy, Fight Cancer Like a Man by Dr. Stephen Petteruti walks through prevention, screening, and treatment decisions in a practical and direct way. It lays out the reasoning behind prioritizing vitality, safety, and informed choice.

If you would like access to extended clinical notes and member-only discussions, join the 

Intellectual Medicine Community:
Membership: https://tinyurl.com/DrPetterutiMember
Sign up for Dr. Steve’s email newsletter: https://www.intellectualmedicine.com/newsletter
Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:
LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
Instagram: https://www.instagram.com/dr.stephenpetteruti
Facebook: https://www.facebook.com/dr.stephenpetteruti

Subscribe to the Intellectual Medicine Podcast:
Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
Spotify: https://tinyurl.com/DrPetterutiSpotifyPodcast

To support deeper reflection, referenced studies explore the long-term outcomes of observation compared with intervention. These data examine survival, treatment-related complications, and the biological consequences of biopsy and hormone suppression. Reviewing this literature allows patients and clinicians to move beyond habit and consider a more individualized approach to prostate health. You can find this information in the Membership section of Intellectual Medicine.

Disclaimer

This podcast and accompanying materials are for educational purposes only and do not replace personalized medical care. The information presented is designed to support informed decision‑making and health literacy, not to diagnose or prescribe. Always consult your own qualified healthcare provider regarding personal health questions or treatment decisions.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without permission is prohibited.

Host: Intellectual Medicine Podcast by Dr. Petteruti (Public Version)
Date: 01 April, 2025

Introduction (00:00)

A newspaper headline can sound dramatic enough to make anyone anxious. You might see something like, “Prostate cancer risk jumps sharply among men who skip PSA testing,” and it immediately feels urgent, almost as if avoiding the test is reckless. In reality, many of these headlines are designed to grab attention and often leave out the context that truly matters.

Prostate care can easily run on that same momentum, where one abnormal PSA leads quickly to a biopsy and then to treatment without much time to think. However, Dr. Stephen Petteruti thinks there is more to it than what you read online. 

Read to learn more. If you want to see an in-depth discussion on this, check the members' version available at: https://www.intellectualmedicine.com/membership

What is PSA, and What Does PSA Measure? (02:58)

PSA is often spoken about as though it confirms cancer, yet it was never designed to diagnose anything on its own. It works more like a signal that tells you to look closer. Levels can rise because of inflammation, infection, enlargement, exercise, or age, so a higher number does not automatically mean something dangerous is happening.

Large screening studies give useful context for how PSA results should be interpreted. One well-known European trial followed tens of thousands of men for many years and found that the actual difference in prostate cancer deaths between those who screened and those who did not came down to only a small number of people. The headlines often focused on bold percentages that sounded alarming, yet the real change for one man was far less dramatic when the numbers were shown plainly. Seeing the data laid out this way helps you think clearly and decide your next step without feeling pushed into a procedure too quickly.

For Cases Like PSA, Statistics Can Sound Scarier Than Reality (07:01)

Medical language often makes ordinary risks feel bigger than they are. Terms like “statistically significant” or “increased risk” sound serious, yet they do not always translate into meaningful changes in everyday life. A small numerical difference across thousands of people can be labeled significant on paper while still having very little impact on what happens to one person sitting in a clinic room.

Dr. Petteruti spends time helping listeners look at numbers calmly and ask better questions. Instead of accepting a large percentage at face value, he encourages men to ask what the absolute difference really is and how that difference would affect their own lives. That small shift in thinking changes the tone of the entire conversation.

What Long-Term Research Says About Treatment (10:00)

Once a biopsy confirms cancer, many men feel pressure to remove the prostate quickly, as if surgery automatically guarantees safety. Long-term research tells a more complicated story. Randomized trials that followed men for more than a decade compared surgery with careful observation and found that overall survival was often very similar between the two groups. The PIVOT study published in The New England Journal of Medicine followed patients for nearly twenty years and did not show a significant difference in all-cause mortality between immediate surgery and observation.

Findings like these do not mean treatment is useless. They mean that the benefits are not always as clear or as universal as people assume. When the survival difference is small, side effects such as incontinence or sexual dysfunction carry more weight in the decision, because quality of life becomes just as important as the length of life.

Taking a Closer Look at the Biopsy Itself (11:14)

A prostate biopsy sounds routine, yet it is still an invasive procedure that involves multiple needle passes through delicate tissue. Most men experience bleeding or discomfort, and a small number develop infections that require treatment. The procedure also raises a question that researchers have explored in other cancers, which is whether needles can disturb cells along their path. While this appears to be uncommon in prostate cancer, similar effects have been documented elsewhere, which reminds us that a biopsy is not a neutral step.

Equally important, there is no strong evidence showing that the biopsy itself reduces the chance of dying from prostate cancer. It provides information, and that information only has value if it meaningfully changes what you do next. If the result would not alter your plan, then it is worth asking whether the procedure is necessary at that moment.

Seeing Prostate Cancer in a Wider Context (16:51)

When you step back and look at prostate cancer across an entire population, another interesting pattern appears. Autopsy studies have shown that many men who died of completely unrelated causes were found to have small prostate cancers that never affected their lives. A large review reported incidental prostate cancer in about one in five men overall and in more than half of men over ninety, with most of these tumors being small and low grade. This helps explain the old saying that many men die with prostate cancer rather than because of it.

This broader view does not suggest ignoring the disease. It simply reinforces the idea that not every finding demands immediate intervention and that some cases can be monitored safely with thoughtful follow-up.

A Vitality First Approach (18:52)

Dr. Petteruti describes a calmer path that focuses on gathering information without rushing into irreversible steps. He often looks at PSA trends over time and uses imaging, such as MRI, to assess risk before recommending anything invasive. Alongside that, he works with patients on lifestyle changes and supportive therapies that improve overall health, then tracks progress carefully. The goal is to create an environment where the body stays strong while decisions remain deliberate.

This approach gives men space to think and keeps control in their hands, which is often what gets lost when fear drives the conversation.

Listen to the Full Episode

You can listen to the full episode here : https://youtu.be/6Crij3C1X9E

If you want access to full transcripts, expanded clinical notes, research references, and practical tools you can use during your own medical visits, those resources are available inside the Intellectual Medicine Membership. 

Dr. Stephen Petteruti, DO also explores these topics in greater depth in his book Fight Cancer Like a Man, where the evidence and clinical reasoning behind this vitality-focused approach are explained in clear, practical terms.

Continue the Conversation

If this discussion raised new questions for you, there are related episodes that expand on these themes in greater detail:

EP07 – Don’t Biopsy Your Prostate Until You Hear This (Part 1)

EP10 – Managing an Elevated PSA: Avoiding Unnecessary Prostate Biopsies

If you would like access to extended clinical notes and member-only discussions, join the 

Intellectual Medicine Community:
Membership: https://tinyurl.com/DrPetterutiMember
Sign up for Dr. Steve’s email newsletter: https://www.intellectualmedicine.com/newsletter
Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:
LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
Instagram: https://www.instagram.com/dr.stephenpetteruti
Facebook: https://www.facebook.com/dr.stephenpetteruti

Subscribe to the Intellectual Medicine Podcast:
Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
Spotify: https://tinyurl.com/DrPetterutiSpotifyPodcast

To support deeper reflection, referenced studies explore the long-term outcomes of observation compared with intervention. These data examine survival, treatment-related complications, and the biological consequences of biopsy and hormone suppression. Reviewing this literature allows patients and clinicians to move beyond habit and consider a more individualized approach to prostate health. You can find this information in the Membership section of Intellectual Medicine.

Disclaimer

This podcast and its accompanying materials are for educational purposes. They are intended to support thoughtful decision-making and improve health literacy. They are not a substitute for individualized medical advice, diagnosis, or treatment. Always consult your qualified healthcare professional regarding personal medical concerns.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without written permission is prohibited.

Host: Intellectual Medicine by Dr. Petteruti (Public Version)

Date: 08 April, 2025

Introduction

No man should ever have his prostate biopsied.

That sentence sounds bold at first, yet it comes from years of clinical observation and careful review of what actually happens to men after the needle goes in. An elevated PSA often creates fear, and fear tends to push people toward fast decisions. In many cases, those decisions lead to procedures that create lifelong side effects without clear proof that they extend life.

When the word “cancer” enters the conversation, everything suddenly feels urgent. Doctors talk about biopsies, surgery, or radiation as if action alone equals protection. Yet once you look closely at the evidence, you begin to see that rushing into invasive steps may cause more harm than benefit, especially in the early stages of prostate disease.

Mortality Rate of Prostate Cancer

Prostate cancer sounds frightening, yet the numbers tell a calmer story. Most men diagnosed with early or localized prostate cancer have a very high survival rate. 

This means something important. When survival is already high, it becomes difficult to prove that aggressive early treatment is what made the difference. Many men would have done well without surgery or radiation in the first place, yet they still carry the side effects of those treatments for the rest of their lives.

The Biopsy Procedure

A prostate biopsy sounds simple when it is explained in the clinic. In reality, it involves multiple core samples taken through the gland, often twelve or more passes, each one puncturing tissue. Bleeding, pain, and infection are common, and some men feel unwell for days afterward.

Even after going through all of that, the result may still be unclear. A negative biopsy does not guarantee that nothing is present, because the needle may have missed the area. A positive biopsy may detect tiny clusters of cells that would never have caused harm, yet once the word “cancer” appears on paper, the pressure to treat becomes intense.

So the man ends up caught between uncertainty and anxiety. He either repeats the procedure or moves toward surgery, even though no one can clearly show that this path improves long-term survival.

Cellular Spread and Treatment Outcomes

Another concern rarely discussed in plain terms is what happens when tissue is repeatedly punctured. When a needle enters a suspicious area, it disrupts the natural barriers that may have been containing those cells. In other cancers, researchers have documented tumor cells along needle tracks, which shows that spread through instrumentation is biologically possible.

Findings changes how we think about early intervention. If removing or irradiating the gland does not clearly improve survival, then the value of detecting tiny abnormalities through biopsy becomes questionable, especially when the side effects are permanent.

Monitoring and Smarter Alternatives

There is another way to approach an elevated PSA that does not begin with a needle. PSA levels can be followed over time to watch for patterns, and imaging, such as MRI, can provide structural information about the gland without puncturing it. This approach gives doctors useful data while preserving comfort and function.

At the same time, overall health plays a major role. Immune strength, body composition, and exposure to toxins all influence how the body handles abnormal cells. Supporting the body through consistent habits often provides a steadier foundation than rushing into procedures that cannot guarantee protection.

This kind of thinking shifts the focus from reacting to every lab number toward understanding the whole picture. It keeps decisions thoughtful and grounded in evidence rather than driven by fear.

Listen to the Full Episode

You can listen to the full episode here [https://youtu.be/R17HjMKGBPg]  

If you want access to full transcripts, expanded clinical notes, research references, and practical tools you can use during your own medical visits, those resources are available inside the Intellectual Medicine Membership. 

Dr. Stephen Petteruti also explores these topics in greater depth in Fight Cancer Like a Man, where the evidence and clinical reasoning behind this vitality-focused approach are explained in clear, practical terms.

Continue the Conversation

Learning is strongest when ideas connect. Continue exploring these episodes that build on today’s discussion:

EP13 - Don't Biopsy Your Prostate Until You Hear This (Part 2) 

EP04 - Why Early Treatment of Prostate Cancer May Be Ineffective: The Case for Conventional Therapies

If you would like access to extended clinical notes and member-only discussions, join the 

Intellectual Medicine Community:
Membership: https://tinyurl.com/DrPetterutiMember
Sign up for Dr. Steve’s email newsletter: https://www.intellectualmedicine.com/newsletter
Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:
LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
Instagram: https://www.instagram.com/dr.stephenpetteruti
Facebook: https://www.facebook.com/dr.stephenpetteruti

Subscribe to the Intellectual Medicine Podcast:
Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
Spotify: https://tinyurl.com/DrPetterutiSpotifyPodcast

To support deeper reflection, referenced studies explore the long-term outcomes of observation compared with intervention. These data examine survival, treatment-related complications, and the biological consequences of biopsy and hormone suppression. Reviewing this literature allows patients and clinicians to move beyond habit and consider a more individualized approach to prostate health. You can find this information in the Membership section of Intellectual Medicine.

Disclaimer

This podcast and accompanying materials are for educational purposes only and do not replace personalized medical care. The information presented is designed to support informed decision‑making and health literacy, not to diagnose or prescribe. Always consult your own qualified healthcare provider regarding personal health questions or treatment decisions.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without permission is prohibited.

Host: Intellectual Medicine by Dr. Petteruti (Public Version)

Date: 15 April, 2025

Introduction

Prostate cancer screening often begins with a simple blood test and quickly turns into a series of decisions that feel urgent and irreversible. Yet very few men are ever asked a more important question first: where is this path actually leading? 

Before agreeing to any test or procedure, it helps to understand the long-term outcomes tied to those choices. When you examine the history, the studies, and the real-world consequences, the conversation becomes far more nuanced than most clinical visits allow.

Historical Evolution of Prostate Treatment

In the mid-1800s, a British surgeon performed one of the first modern prostatectomies and described prostate cancer as a rare disease. Today, it is described as common and even inevitable with age. Autopsy research has shown that a significant portion of men over 50, and most men over 90, have malignant-appearing cells in the prostate despite never suffering symptoms during life.

As prostate removal became standard practice in the mid-20th century, mortality from prostate cancer did not decline in proportion to the intensity of treatment. Later studies, including large outcome trials, found that surgery or radiation did not clearly outperform observation when long-term survival was examined. These findings force an important question: are we detecting dangerous disease, or are we often labeling dormant cells that were never destined to cause harm?

PSA Testing and the Biopsy Question

The PSA test introduced a new era of screening. While it can provide useful trend information, it does not reliably distinguish between benign enlargement, inflammation, and clinically significant cancer. A single elevated number often triggers biopsy discussions, even though the number alone cannot predict future behavior.

Biopsies involve multiple core needle samples, and they carry risks that are often minimized in conversation. Infection, bleeding, and hospitalization are possible. More importantly, the long-term outcome data do not clearly show that early tissue diagnosis changes survival in many cases of localized disease.

Advanced imaging, such as multiparametric MRI, reported using the PI-RADS system, offers anatomical insight without immediate tissue disruption. A PSMA PET scan, on the other hand, is generally reserved for confirmed cancer to determine whether the disease has spread beyond the gland. These tools provide context, yet they must be interpreted carefully and within a broader strategy.

Active Surveillance and Gleason Scores

Active surveillance is frequently presented as a balanced middle path. In practice, it often includes repeated biopsies over time. Yet no current test, including the Gleason score, can reliably predict which localized cancers will become aggressive.

A Gleason score describes how abnormal cells appear under the microscope. Higher scores are associated with less favorable prognosis, but even then, long-term studies have not demonstrated a guaranteed survival advantage from immediate aggressive treatment in many men with localized disease.

Androgen Deprivation Therapy and Promised Outcomes

Hormone suppression therapy, often called androgen deprivation therapy, was historically used for advanced metastatic disease to reduce pain. In modern practice, it is sometimes introduced earlier in the disease course.

The consequences are predictable. Fatigue, muscle loss, metabolic changes, cognitive decline, and increased cardiovascular risk are well-documented. These effects are not rare complications; they are expected physiological outcomes of suppressing testosterone.

Before accepting such therapy, it is reasonable to ask whether the expected benefits match the biological cost.

Listen and Go Deeper

You can listen to the full episode here [https://www.youtube.com/watch?v=DpXZgMTzN2A].

If you want access to full transcripts, expanded clinical notes, research references, and practical tools you can use during your own medical visits, those resources are available inside the Intellectual Medicine Membership. 

Dr. Stephen Petteruti also explores these topics in greater depth in Fight Cancer Like a Man, where the evidence and clinical reasoning behind this vitality-focused approach are explained in clear, practical terms.

Continue the Conversation

If this discussion raised new questions for you, there are related episodes that expand on these themes in greater detail:

EP09 – Don’t Biopsy Your Prostate Until You Hear This (Part 2)

EP10 – Managing an Elevated PSA: Avoiding Unnecessary Prostate Biopsies

For a deeper and more structured look at this philosophy, Fight Cancer Like a Man by Dr. Stephen Petteruti walks through prevention, screening, and treatment decisions in a practical and direct way. It lays out the reasoning behind prioritizing vitality, safety, and informed choice.

If you would like access to extended clinical notes and member-only discussions, join the 

Intellectual Medicine Community:
Membership: https://tinyurl.com/DrPetterutiMember
Sign up for Dr. Steve’s email newsletter: https://www.drstephenpetteruti.com
Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:
LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
Instagram: https://www.instagram.com/dr.stephenpetteruti
Facebook: https://www.facebook.com/dr.stephenpetteruti

Subscribe to the Intellectual Medicine Podcast:
Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
Spotify: https://tinyurl.com/DrPetterutiSpotifyPodcast

To support deeper reflection, referenced studies explore the long-term outcomes of observation compared with intervention. These data examine survival, treatment-related complications, and the biological consequences of biopsy and hormone suppression. Reviewing this literature allows patients and clinicians to move beyond habit and consider a more individualized approach to prostate health. You can find this information in the Membership section of Intellectual Medicine.

Disclaimer

This podcast and its accompanying materials are for educational purposes. They are intended to support thoughtful decision-making and improve health literacy. They are not a substitute for individualized medical advice, diagnosis, or treatment. Always consult your qualified healthcare professional regarding personal medical concerns.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without written permission is prohibited.

Host: Intellectual Medicine by Dr. Stephen Petteruti (Public Version)

Date: April 22, 2025

Introduction

A good doctor provides you with choices, information you can trust, and options based on research. Prostate cancer treatment often revolves around drastic interventions like surgery, radiation, or chemical castration. While these approaches may sound decisive, long-term data have shown that they often do more harm than good.

The key to effective prostate cancer treatment lies in vitality and active monitoring rather than jumping straight into aggressive procedures. With advancements in science, we now have better ways to evaluate elevated PSA levels and prostate health, enabling more thoughtful, balanced decisions.

Removal Guaranteed Harm

The typical approach to prostate cancer treatment often involves surgery or radiation when something seems abnormal. However, extensive studies have shown that these treatments often result in more harm than benefit.

Long-term survival data from studies conducted over 15 years reveal no significant difference in survival between men who underwent aggressive treatments and those who did not. These treatments come with a cost, including pain, hardship, and additional financial burdens, without offering a clear survival benefit.

Chemical Castration

Androgen Deprivation Therapy, also known as chemical castration, is frequently used to lower testosterone levels in men with prostate cancer. While this might seem like a logical treatment, the side effects can be debilitating.

ADT has been linked to fatigue, muscle loss, mental fog, and depression. Rising PSA levels are often used to justify this treatment, but PSA is an imperfect marker. Increased PSA doesn’t always indicate cancer progression, meaning that ADT may expose patients to harmful side effects without improving survival rates.

Understanding PSA Results

The PSA test is commonly used to detect prostate cancer, but it doesn't tell the whole story. A rising PSA level is often treated as an urgent signal for immediate action, yet it doesn’t necessarily mean that cancer is progressing.

Men are frequently pushed into aggressive treatments based on rising PSA levels, even though this test isn't always an accurate reflection of cancer growth. It's important to interpret PSA results cautiously, alongside other diagnostic tools and a full understanding of a patient’s overall health, age, and risk factors.

Next Steps to Take About Your Prostate

You don’t need a tissue diagnosis to make informed decisions about your prostate health. The goal should be to maintain vitality and create an internal environment that resists cancer. The majority of prostate cancer cells are actually atypical dormant cells. These cells can stay in the prostate gland for a lifetime without causing harm.

Studies show that many men over 90 years old have these atypical dormant cells without experiencing any symptoms or harm. Rather than rushing into surgery or radiation, consider the possibility of living with these dormant cells and avoiding unnecessary interventions.

Treatment Bias Explained

There’s a major bias in the medical field surrounding prostate cancer treatments. For decades, doctors have been under the assumption that aggressive treatments like surgery and radiation improve survival rates. Yet, research has shown no significant difference in survival outcomes between patients who undergo these treatments and those who don’t, particularly in early-stage prostate cancer.

Many patients undergo surgery or radiation, convinced that these treatments will save their lives. However, the reality often doesn’t match the expectation. After surgery, some men face painful side effects such as leaking urine or erectile dysfunction. Despite these negative effects, many attribute their survival to the surgery, even if the outcome was merely a coincidence.

The Non-Biopsy Approach

At Intellectual Medicine, we focus on a non-biopsy approach for evaluating prostate cancer risk. This method involves using biometrics and imaging studies to assess the risk of progression or metastasis, without the need for invasive procedures. By taking a more thoughtful approach, a clearer picture of a man’s prostate health can be provided and can be used to guide the patient through the decision-making process.

Three key factors are considered for a non-invasive evaluation:

• PSA (Prostate-Specific Antigen): A blood test that can indicate elevated prostate levels.
• PHI (Prostate Health Index): A more comprehensive biomarker that provides additional insight.
• Prostate MRI: A scan that helps visualize the prostate and its condition.

For men with low-risk profiles, such as a PSA below 20, a PHI under 55, and a PIRADS score of 0 to 3 from an MRI, no biopsy is recommended. Instead, the Intellectual Medicine pathway can be followed. This includes incorporating lifestyle changes, nutrition, supplementation, and repurposed drug therapy.

Continue the Conversation

If this discussion raised new questions for you, there are related episodes that expand on these themes in greater detail:

EP15 – Beyond the Hype: Why Ivermectin Isn’t the Answer — and What Might Be

EP28 – Prostate Supplements Explained: What Science Actually Shows vs Common Assumptions

For a deeper and more structured look at this philosophy, Fight Cancer Like a Man by Dr. Stephen Petteruti walks through prevention, screening, and treatment decisions in a practical and direct way. It lays out the reasoning behind prioritizing vitality, safety, and informed choice.

If you would like access to extended clinical notes and member-only discussions, join the 

Intellectual Medicine Community:
Membership: https://tinyurl.com/DrPetterutiMember
Sign up for Dr. Steve’s email newsletter: https://www.drstephenpetteruti.com
Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:
LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
Instagram: https://www.instagram.com/dr.stephenpetteruti
Facebook: https://www.facebook.com/dr.stephenpetteruti

Subscribe to the Intellectual Medicine Podcast:
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To support deeper reflection, referenced studies explore the long-term outcomes of observation compared with intervention. These data examine survival, treatment-related complications, and the biological consequences of biopsy and hormone suppression. Reviewing this literature allows patients and clinicians to move beyond habit and consider a more individualized approach to prostate health. You can find this information in the Membership section of Intellectual Medicine.

Disclaimer

This podcast and its accompanying materials are for educational purposes. They are intended to support thoughtful decision-making and improve health literacy. They are not a substitute for individualized medical advice, diagnosis, or treatment. Always consult your qualified healthcare professional regarding personal medical concerns.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without written permission is prohibited.

Host: Intellectual Medicine by Dr. Stephen Petteruti (Public Version)

Date: May 6, 2025

Introduction

Testosterone is often reduced to a conversation about sex drive or muscle size. In reality, it influences far more than that. It affects how clearly you think, how steady your mood feels, how strong your body remains, and how well you recover from stress or exercise. When levels decline slowly over time, the change can feel subtle at first. Energy dips in the afternoon. Motivation fades. Strength does not respond the way it once did.

Many people are told this is simply aging. Yet when other hormone-producing organs slow down, medicine replaces what is missing. The testicles are hormone-producing organs as well. When their output drops, the effects reach the brain, muscles, bones, mood, and long-term vitality. Growing older in years is unavoidable. Losing strength and clarity without asking questions does not have to be automatic.

Our Body Is a Self-Healing Machine

The human body is designed to adapt and repair. When hormones are balanced, systems communicate clearly. When they fall out of balance, symptoms begin to appear. Slower thinking, reduced stamina, and lower motivation are often accepted as normal, yet they may reflect hormonal decline rather than irreversible damage.

Testosterone supports the way brain cells signal each other. It influences immune response and helps preserve muscle mass. Without adequate levels, even consistent exercise may not prevent gradual loss of strength. Aging is chronological, yet many physical changes associated with aging are influenced by hormones.

Benefits of Testosterone

Testosterone functions as both a hormone and a signaling molecule in the brain. It supports memory formation and mental sharpness. Word-finding difficulty and hesitation can sometimes be linked to lower levels.

It also plays a central role in muscle development and bone density. Adequate testosterone supports joint stability because strong muscles protect joints. Many patients report improvement in chronic pain when hormones are restored to appropriate levels. Skin quality and elasticity are also hormonally influenced, affecting both men and women.

Concerns about prostate cancer and heart disease have historically shaped hesitation around testosterone therapy. Current research does not show a clear link between properly managed testosterone replacement and increased heart attack or prostate cancer risk. Monitoring and appropriate screening remain essential.

Calming Effect of Testosterone

Testosterone is often misunderstood as a hormone that promotes aggression. In clinical practice, deficiency is frequently associated with irritability, low mood, and reduced stress tolerance. Many individuals describe improved emotional stability when levels are restored.

Depression, anxiety, and short temper can accompany low testosterone in both men and women. Hormonal evaluation does not replace psychological care when needed, yet it can form part of a broader assessment. Emotional balance is tied closely to hormonal health.

Truth About Blood Levels

Blood tests provide a starting point, not a final answer. Baseline labs help screen for conditions such as elevated PSA or abnormal blood counts before therapy begins. Testosterone can increase red blood cell production, which is beneficial within limits but must be monitored.

Levels alone do not determine whether therapy is appropriate. Symptoms, age, and overall health all play a role. Ongoing monitoring of blood count and estrogen levels ensures safety during treatment.

Total vs. Free Testosterone

When measuring testosterone, two values are important: total testosterone and free testosterone. Total testosterone reflects the entire amount circulating in the bloodstream. Free testosterone represents the portion that is unbound and biologically active.

A man may have a normal total level yet still experience symptoms if most of that hormone is bound to carrier proteins and unavailable for use. Evaluating both measurements provides a clearer picture of hormonal status.

Creams for Hair Loss

Some men worry that testosterone therapy may accelerate male pattern hair loss if they are genetically predisposed. Testosterone can convert into dihydrotestosterone, which influences hair follicles.

Topical compounds and DHT-blocking medications are sometimes used to reduce this effect. These options should be discussed with a clinician who understands hormonal balance and potential trade-offs.

Duration of Treatment and Long-Term Perspective

Testosterone therapy can be continued long term when monitored appropriately. Some individuals choose to stop for personal or financial reasons, and lifestyle measures such as strength training and maintaining healthy body fat can support natural production.

Even with ideal habits, hormone levels decline over time. Decisions about therapy should be based on education, safety, and personal values rather than fear.

A Perspective on Vitality

Muscle loss, cognitive decline, and reduced independence are common late-life concerns. Hormonal balance plays a role in preserving strength and mental clarity. Protecting muscle mass supports mobility and reduces disability risk.

There are also risks when hormones are misused. Anabolic steroids obtained without medical supervision can cause long-term harm. Structured, physician-guided therapy differs significantly from unsupervised enhancement.

One patient in advanced age, even while facing serious illness, maintained intimacy and vitality late into life. His story illustrates a broader principle: physical decline is not always as rigid as assumed. Vitality can persist longer than expected when health is actively supported.

If this overview raises questions, the full podcast explores these themes in greater depth, including dosing strategies, receptor sensitivity, testicular preservation, and long-term monitoring. The member version also expands on practical clinical details for those considering therapy.

Continue the Conversation

If this discussion sparked new thoughts, there are other episodes that build on these ideas and examine them from different angles:

EP06 – The Truth About Testosterone: Does It Really Cause Prostate Cancer?

For a deeper and more structured look at this philosophy, Fight Cancer Like a Man by Dr. Stephen Petteruti walks through prevention, screening, and treatment decisions in a practical and direct way. It lays out the reasoning behind prioritizing vitality, safety, and informed choice.

If you would like access to extended clinical notes and member-only discussions, join the 

Intellectual Medicine Community:
Membership: https://tinyurl.com/DrPetterutiMember
Sign up for Dr. Steve’s email newsletter: https://www.drstephenpetteruti.com
Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:
LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
Instagram: https://www.instagram.com/dr.stephenpetteruti
Facebook: https://www.facebook.com/dr.stephenpetteruti

Subscribe to the Intellectual Medicine Podcast:
Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
Spotify: https://tinyurl.com/DrPetterutiSpotifyPodcast

To encourage deeper review, referenced studies examine long-term outcomes of observation compared with intervention. These data explore survival patterns, treatment complications, and the biological impact of biopsy and hormone suppression. Reviewing this literature supports a more individualized approach to prostate health.

Disclaimer

This podcast and its accompanying materials are for educational purposes. They are designed to support thoughtful decision-making and improve health literacy. They do not replace individualized medical advice, diagnosis, or treatment. Always consult your qualified healthcare professional regarding personal medical concerns.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without written permission is prohibited.

Host: Intellectual Medicine by Dr. Stephen Petteruti (Member Version)

Date: May 6, 2025

Episode Summary

• Testosterone supports brain speed, mood stability, muscle strength, bone health, sexual function, and long-term vitality.
• Age-related testosterone decline is common, but symptoms such as low energy, reduced libido, loss of muscle, and brain fog should be evaluated rather than dismissed.
• Blood tests establish safety baselines, but free testosterone is the active form and often more important than total levels.
• Properly supervised testosterone therapy does not show increased risk of prostate cancer or heart attack in current research and requires monitoring of PSA, blood count, and estrogen.
• Long-term vitality depends on informed decisions, hormone balance, strength training, and preserving independence with age.

Quick Checklist

Before starting or continuing testosterone therapy, keep the main safety and monitoring steps in view. Testosterone affects the whole body, so decisions should be thoughtful and structured rather than casual. This checklist serves as a clear guide for safe and long-term use:

• Obtain baseline labs before therapy, including PSA, complete blood count, thyroid panel, and both total and free testosterone.
• Evaluate symptoms alongside lab results. Loss of libido, low energy, poor recovery, depressed mood, and reduced strength should be considered during assessment.
• Monitor hemoglobin, hematocrit, and estrogen levels during treatment to prevent complications such as erythrocytosis or hormonal imbalance.
• Preserve testicular function when using testosterone by incorporating appropriate medical support under physician supervision.
• Maintain supportive habits such as strength training, body fat control, adequate sleep, and stress regulation to enhance long-term outcomes.

00:00 Introduction

Testosterone is often treated as if it only affects sex drive or muscle size. In reality, that is only a fragment of the truth. The body uses testosterone to support brain function, mood, strength, bone health, energy, and long-term vitality. Because testosterone levels drop gradually over time, many people hardly notice the change at first, yet the signs are usually present. You may feel tired without a clear reason, think a little slower than before, or notice that recovery after exercise takes longer than it did a few years ago.

Medicine has made decline sound normal. Brain fog is called aging, muscle loss, and low energy are brushed aside and treated like the normal life cycle. Yet when the thyroid gland slows down, doctors replace thyroid hormone. The testicles are also hormone-producing organs. When their output fades, the effect spreads through the entire body.

Testosterone works like a messenger. It helps brain cells communicate, supports muscle and bone strength, and influences mood and motivation. Growing older in years is unavoidable. Withering in strength and clarity does not have to be accepted without asking questions.

02:50 Our body is a self-healing machine

The body has regulatory systems that constantly repair tissue, balance hormones, and maintain internal stability. These systems do not abruptly stop working at midlife. What changes over time is the hormonal environment that supports them. When hormone production declines, repair slows, recovery weakens, and performance drops.

In many clinical settings, decline is labeled as normal aging. Slower recall, reduced muscle mass, lower stamina, and decreased drive are often dismissed rather than investigated. When the thyroid underperforms, replacement therapy is standard practice. When insulin production fails, insulin is prescribed. The testicles also produce hormones that influence multiple organs, including the brain, muscles, bones, and cardiovascular system. Yet declining testosterone is frequently ignored or minimized.

Chronological aging is unavoidable. Functional decline is influenced by biology that can be evaluated and, in many cases, supported. The decision to intervene should be based on symptoms, laboratory data, and long-term health strategy rather than cultural assumptions about what aging should look like.

03:16 Benefits of testosterone

Testosterone functions beyond sexual health. In the brain, it supports neuronal signaling and influences memory formation, processing speed, and concentration. Lower testosterone levels have been associated with reduced cognitive performance and increased risk of mood disturbance. Both men and women rely on adequate testosterone for neurological stability.

Muscle tissue is highly dependent on testosterone. During adolescence, rising testosterone levels drive muscle growth and strength development. Later in life, as testosterone declines, maintaining lean muscle mass becomes more difficult even with regular exercise. Reduced muscle mass contributes to decreased strength, slower metabolism, and higher risk of injury.

Bone density is also influenced by testosterone. Lower levels correlate with weaker bones and increased fracture risk. Joint stability depends in part on muscular support, and many patients report reduced musculoskeletal pain when hormone levels are optimized.

Long-standing fears about testosterone therapy have been reexamined. Current evidence does not show a consistent increase in prostate cancer incidence among men receiving properly monitored therapy. Cardiovascular data remain complex, but large studies have not demonstrated a clear rise in heart attack or stroke risk when treatment is supervised and individualized. Monitoring blood count and other markers remains essential.

06:54 Calming effect of testosterone

Testosterone is often assumed to increase aggression. Clinical observation frequently shows the opposite pattern when testosterone levels are low. Men with inadequate testosterone may present with irritability, low motivation, reduced confidence, and depressed mood.

Restoring testosterone to appropriate levels often improves emotional stability and stress tolerance. Some clinicians have incorporated testosterone therapy into treatment plans for men with persistent depressive symptoms when laboratory findings support deficiency.

It is important to distinguish therapeutic restoration from supraphysiologic dosing. Excessive hormone levels can produce instability. The objective of treatment is physiological balance. When levels are maintained within an appropriate range and monitored carefully, many patients report improved mood, steadier energy, and clearer thinking.

11:55 Truth about blood levels

Blood tests are helpful, but they are not the final decision maker. The first reason to check blood work is to create a starting point. A baseline helps identify whether there are conditions that require caution before beginning therapy.

One important marker is PSA, which stands for prostate-specific antigen. If PSA is very high, such as above 10 and in some cases above 20, it deserves careful review before starting testosterone. This does not always mean therapy cannot be done, but it requires thoughtful supervision.

Another test is a complete blood count. Some men carry a genetic condition called hemochromatosis, which causes the body to store too much iron. Over time, excess iron can damage the liver, kidneys, and brain. Testosterone therapy can increase red blood cell production because it stimulates the kidneys to release a hormone called erythropoietin. This hormone signals the bone marrow to make more red blood cells. A mild rise in blood count is expected, but if it climbs too high, a condition called erythrocytosis can develop. In that case, donating blood may be recommended.

Blood tests also help evaluate heart health, blood sugar, and thyroid function. These systems affect energy, mood, and strength. Lab values provide useful information, but symptoms and clinical judgment carry equal weight.

13:45 Total vs. free testosterone

When testosterone is measured in the blood, two main numbers can be reported: total testosterone and free testosterone. Understanding the difference is essential.

Total testosterone represents the entire amount of testosterone circulating in the bloodstream. However, not all of it is available for the body to use. A large portion of testosterone binds to a protein called sex hormone binding globulin, or SHBG. When testosterone is attached to this protein, it cannot enter cells and perform its function.

Free testosterone is the portion that is not bound. This is the active form. It enters cells, interacts with receptors, and supports brain function, muscle growth, bone density, libido, and mood. A person can have a normal total testosterone level but still feel symptoms of deficiency if free testosterone is low.

This difference explains why some men are told their levels are normal even though they feel tired, lose muscle, or experience reduced libido. If only total testosterone is checked, the picture may be incomplete. Measuring free testosterone provides a clearer understanding of what the body can actually use.

Symptoms that may suggest low free testosterone include reduced sexual desire, difficulty with erections, low energy, decreased motivation, slower recovery after exercise, depressed mood, and loss of muscle mass. These symptoms can overlap with thyroid problems or chronic stress, which is why a broader evaluation is important.

Treatment decisions should not rely on one single lab number. If a patient reports improved energy, better mood, stronger workouts, and improved sexual function, that improvement carries meaning even if the lab value sits in the middle of a reference range. On the other hand, if levels are high but side effects appear, adjustments may be required.

Testosterone therapy also requires monitoring of estrogen. Some testosterone converts into estrogen, which plays a role in bone strength and sexual function. If estrogen rises too high, unwanted effects such as breast tissue growth can occur. If it drops too low, bone and libido may suffer. Many clinicians aim for an estrogen range between 20 and 40, though reference ranges vary by laboratory.

Preserving natural testicular function is another consideration. When external testosterone is given without support, the testicles may shrink over time because they reduce their own production. Medications such as clomiphene, enclomiphene, hCG, or gonadorelin can be used to stimulate the testicles and maintain function under medical supervision.

Understanding total and free testosterone helps prevent oversimplified decisions. It ensures therapy is based on biology, symptoms, and long-term health rather than a single number.

21:26 Creams for hair loss

Some men worry that testosterone therapy will cause hair loss. Hair thinning in men is often related to genetics and a hormone called dihydrotestosterone, or DHT. DHT is a stronger form of testosterone that can shrink hair follicles in men who are genetically sensitive.

Testosterone can increase DHT levels. If a man is already prone to male pattern baldness, therapy may speed up a process that was likely going to happen over time.

There are options to manage this risk. One approach is using topical prescription creams that act directly on the scalp. These treatments target hair follicles with minimal absorption into the bloodstream. Another option is medications such as finasteride, which reduce the conversion of testosterone into DHT. Blocking DHT can help preserve hair, though it must be balanced carefully because DHT also contributes to sexual function in some men.

Hair loss management should be individualized. The decision depends on family history, cosmetic preference, and overall treatment priorities. Monitoring and discussion with a qualified clinician ensures that hormonal therapy supports vitality without ignoring side effects.

22:33 Duration of the treatment

A common question is how long testosterone therapy should continue. The honest answer is that it can be continued for life if it remains safe, affordable, and aligned with personal values. There is no fixed expiration date. Testosterone is a hormone your body naturally produces. When levels fall and symptoms appear, replacing it is similar in principle to replacing thyroid hormone when the thyroid slows down.

Stopping therapy is always a personal decision. Some men may choose to stop for financial reasons or philosophical reasons. Others may prefer to age without intervention. That choice does not make anyone careless or uninformed. The role of a physician is to provide information, monitor safety, and guide decisions, not to impose treatment.

Strength training, maintaining a healthy body fat percentage, and sleeping well can support natural testosterone levels. However, even disciplined and healthy men experience a gradual decline over time. Therapy becomes one available option, not an obligation.

Some clinicians recommend an occasional short break, sometimes called a hormone holiday, such as skipping a scheduled dose every few weeks. The theory is that this may keep hormone receptors responsive over the long term. Most men feel stable during short breaks because testosterone remains in the system for some time. Long-term therapy, when properly monitored, can be sustainable for decades.

24:59 How we live is what we control

Aging in years cannot be stopped, yet the way strength, mobility, and clarity change over time can be influenced. One major cause of disability in older adults is sarcopenia, which means loss of muscle mass. Weak muscles make daily tasks harder. Climbing stairs, opening jars, and getting out of a car all depend on muscle strength.

Testosterone supports muscle maintenance. Strong muscles protect joints, improve balance, and lower the risk of falls. Maintaining muscle also supports bone density, which lowers fracture risk. Brain health is also connected to hormone balance. Lower hormone levels have been linked in research to increased risk of cognitive decline.

Lifestyle choices remain important. Walking regularly, lifting weights, eating balanced meals, and keeping body fat within a healthy range all support vitality. Hormone therapy does not replace these habits. It works alongside them. The central idea is that while death is inevitable, years of unnecessary weakness or decline may be influenced by thoughtful action.

Each person chooses how to approach aging. Some will prefer organic decline. Others will use every safe and credible tool available. What remains constant is personal responsibility in making informed decisions.

26:16 Other side effects

No medical therapy is free from potential side effects, and testosterone is no exception. One common effect is acne, especially on the chest or back. This happens because testosterone can stimulate oil glands in the skin. If acne appears, the dose can often be adjusted. In some cases, dividing the weekly dose into two smaller injections can smooth hormone levels and reduce skin reactions.

Hair thinning is another concern for men who are genetically prone to male pattern baldness. Testosterone can increase levels of DHT, a hormone that influences hair follicles. Monitoring and preventive strategies, such as topical treatments or DHT-modulating medications, can be considered when appropriate.

It is important to distinguish medical testosterone therapy from anabolic steroid abuse. High-dose anabolic steroids used for bodybuilding can damage the brain, heart, and reproductive system. They can suppress natural testosterone production and sometimes cause long-term harm. Medical therapy aims to restore physiological levels, not create extreme muscle growth.

Over-the-counter supplements that claim to “boost” testosterone rarely provide meaningful improvement in men with true deficiency. In most symptomatic men over 40, replacing testosterone itself is the effective treatment when clinically appropriate.

30:16 Motivational story of a patient

A story illustrates the broader message about vitality. Years ago, a patient in his mid-80s with stage four lung cancer was receiving supportive care, including testosterone therapy. During a visit, he was asked about his breathing. He replied that he only became short of breath during intimacy with his wife.

At 85 years old, facing advanced cancer, he remained engaged in life, connection, and intimacy. He passed away a few months later. His final months were not defined by weakness or resignation but by participation in living.

The lesson is not that testosterone cures disease. The lesson is that vitality can be preserved longer than many people expect. Strength, connection, and purpose can continue deep into later years when health is supported intentionally. Aging does not require surrendering energy or identity. It requires informed choices and steady attention to the systems that keep the body functioning well.

Key Takeaway

Testosterone is a foundational hormone that affects the brain, muscles, bones, mood, skin, and sexual health. When it declines, the whole body feels the effect. Slower thinking, lower energy, weaker recovery after exercise, reduced confidence, and changes in libido can all reflect falling testosterone levels rather than unavoidable aging.

Blood work helps create a starting point, yet numbers alone do not determine treatment. Total testosterone shows how much is present in the bloodstream, while free testosterone shows how much is actually available for the body to use. Symptoms, physical function, and overall health must be considered together with laboratory values.

When therapy is used, the focus is on restoration to a healthy physiological range under medical supervision. Monitoring blood count and estrogen keeps treatment balanced and safe. Strength training, body composition control, and cardiovascular health remain essential. The central principle is that growing older does not require surrendering clarity, strength, or vitality without first examining the hormonal foundation that supports them.

Continue the Conversation

If this discussion sparked new thoughts, there are other episodes that build on these ideas and examine them from different angles:

EP06 – The Truth About Testosterone: Does It Really Cause Prostate Cancer?

For a deeper and more structured look at this philosophy, Fight Cancer Like a Man by Dr. Stephen Petteruti walks through prevention, screening, and treatment decisions in a practical and direct way. It lays out the reasoning behind prioritizing vitality, safety, and informed choice.

If you would like access to extended clinical notes and member-only discussions, join the 

Intellectual Medicine Community:
Membership: https://tinyurl.com/DrPetterutiMember
Sign up for Dr. Steve’s email newsletter: https://www.drstephenpetteruti.com
Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:
LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
Instagram: https://www.instagram.com/dr.stephenpetteruti
Facebook: https://www.facebook.com/dr.stephenpetteruti

Subscribe to the Intellectual Medicine Podcast:
Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
Spotify: https://tinyurl.com/DrPetterutiSpotifyPodcast

To encourage deeper review, referenced studies examine long-term outcomes of observation compared with intervention. These data explore survival patterns, treatment complications, and the biological impact of biopsy and hormone suppression. Reviewing this literature supports a more individualized approach to prostate health.

Suggested References

Don't just take my word for it. The following research challenges the 'standard of care' by highlighting the data on survival and the real cost of overtreatment. These studies are the map for moving away from blind protocols and toward biological precision.

Hackett GI. Long Term Cardiovascular Safety of Testosterone Therapy: A Review of the TRAVERSE Study. World J Mens Health. 2025;43(2):282-290. doi:10.5534/wjmh.240081

Haider, Ahmad et al. “Incidence of prostate cancer in hypogonadal men receiving testosterone therapy: observations from 5-year median followup of 3 registries.” The Journal of urology vol. 193,1 (2015): 80-6. doi:10.1016/j.juro.2014.06.071

Kaplan, Alan L et al. “Testosterone Therapy in Men With Prostate Cancer.” European urology vol. 69,5 (2016): 894-903. doi:10.1016/j.eururo.2015.12.005

Keren D, Goshen A, Strauss T and Springer S (2025) Study protocol: associations between hormonal profile and physical and cognitive functions in middle-aged men—a one-year cohort follow-up study. Front. Public Health 13:1654077. doi: 10.3389/fpubh.2025.1654077

Mohammad, Osama S et al. “Supraphysiologic Testosterone Therapy in the Treatment of Prostate Cancer: Models, Mechanisms and Questions.” Cancers vol. 9,12 166. 6 Dec. 2017, doi:10.3390/cancers9120166

Snyder PJ, Kopperdahl DL, Stephens-Shields AJ, et al. Effect of Testosterone Treatment on Volumetric Bone Density and Strength in Older Men With Low Testosterone: A Controlled Clinical Trial. JAMA Intern Med. 2017;177(4):471-479. doi:10.1001/jamainternmed.2016.9539

Disclaimer

This podcast and its accompanying materials are for educational purposes. They are designed to support thoughtful decision-making and improve health literacy. They do not replace individualized medical advice, diagnosis, or treatment. Always consult your qualified healthcare professional regarding personal medical concerns.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without written permission is prohibited.