The TRT Decision Tree: How to Properly Titrate Your Dose?

All right. Welcome back to Cell to Systems. Today we are joined by the infamous Dr. Timothy Rankin. And he is going to take us through some of the really important things about testosterone for both men and women. First things first, I think we should talk about Dr. Rankin is what is testosterone? What's its role inside of the body? And that's a great place to start.

Absolutely. Jock, thanks for having me. The role of testosterone in the body is it's a, it's an androgen. And so therefore, in both men and women, it serves different roles. Certainly it's something that, you know, is a very popular topic of conversation as it pertains to aging, you know, and what that looks like. We know that it starts to fall off somewhere around the age of 35, you know, that, that suddenly we're just making less and less of it.

And so I think you see that in, in most of the, the data that's out there. You know, they're, they're looking at people that are typically over 35. But ultimately the idea is that it's going to, to do all sorts of stuff from supporting lean muscle mass. You know, it helps to, to obviously drive, you know, sex drive and everything else. And so obviously it plays a, a critical role in how you feel as well as, you know, reproduction and everything else.

So I think that it's probably a little bit long-winded to get into everything that it does for the sake of the, of, of our show today. But, but yeah, I think there, there has been some really great new studies that have come out that are well designed, you know, randomized controlled trials in the last, you know, let's say three, four years that, that ultimately I think have helped to, to demystify a little bit of, of, you know, what's going on. When should people use it? But has also left some, some interesting questions.

For sure. I think once the took that black box warning off of testosterone and we see the flood gates open up, before it was so difficult for anyone who was feeling the symptoms of low T, uh, to get any kind of treatment. You had to see an endocrinologist most of the time. Um, well there were probably some providers who were out there going ahead and prescribing it. There were certainly a huge campaign, the low T campaign that happened, gosh, about 5 to 10 years ago and it made people aware of, hey, some of these things that you might be experiencing could be related to low testosterone.

Let's talk about HPG and why that's important because a lot of people just don't understand that, hey, your total testosterone doesn't really matter. It's your free testosterone that does, and if you can explain that axis so that people understand you could have high testosterone, but if it's not making its way to the cells then it's like having low testosterone.

Yep. Yeah, exactly, and, and you see this in, in a number of different, uh, molecules and hormones around the body is that you, you take our serum, you know, you take like the, the fluid that makes up the, the blood in our body and, and you look at all the different molecules that are, that are floating around that, that ultimately, you know, all of this is, is happening at, um, milliseconds or picoseconds that, that these, these interactions occur, but at the end of the day that there's some percentage of, in this case, testosterone that is going to actually just be bound to albumin or, you know, or proteins, uh, that are floating around in that serum and they're not really free to interact with the molecules on the surface of our cells that, that, uh, that they need to, right?

And so that's, that's obviously been considered by our body over, you know, in, in millions of years, you know, how we've gotten to the, the current state of, uh, to, of our being, but the, the idea is that whatever free percentage is, uh, is floating around is the part that, that is actually going to be productive. And so I think what you're getting at is that depending on the, the types of labs that you're running or, uh, you, when you go to, you know, your provider and say, hey, I'm just feeling, you know, sluggish, feeling down, my strength isn't, isn't like, you know, great, um, you know, what options exist and they go ahead and they just give you, you know, your T number, that, that may or may not be an accurate measurement of, of what's actually going on.

Yeah, one of the things I love about you is you, when, when we discuss these types of things you always talk about the total body and, and all things. Uh, I think it's really interesting for those who are watching, listening to the podcast today. Dr. Rankin's practice is sort of the center of education in this area. There's an ongoing series of talks that are happening on a regular basis covering everything. So there are some other symptoms that are associated with this and let's talk about ranges.

So oftentimes what you'll hear is, oh gosh, you know, hey, you're within a certain range so it's normal. Uh, but what you just said is that normal level could be dramatically off. What are the ranges that are within that sample group?

Typically I think there are somewhere between like 300 to 1,200, but it completely depends upon the lab that you're submitting your, your labs to. So, so ultimately what, what a lot of people don't realize is that when, when someone says that something is normal it just means that for everyone that that lab has ever tested that you fall between the fifth and the 95th percentile.

And then basically if you are below the fifth percentile or above the 95th percentile, you know, I know Jock is an overachiever, you might be over that 95th percentile, but, but ultimately they're going to say you're normal or abnormal. It doesn't mean that things are terribly right or terribly wrong, but it does mean that, you know, hey, let's, let's take a moment, pause, think about this. Is it something that we actually expect to see or does this deserve further investigation?

Yeah, I think we get into now talking about, okay, you figured that out, you're going to talk to your provider about what is the right range for you, and obviously if you're doing things like we are in the gym where you're active, you're going to feel that, uh, in the lack of strength and ability to actually push the weight, um, which is why I think you see so much testosterone replacement therapy for men these days, um, and then we move on to also women.

So it's now become so incredibly important for women to have all of their hormones. Um, we can talk about all of them if you want to or we can just stay focused on testosterone because that seems to be the one that's the least understood for women and yet, uh, now is seeming to pick up a lot of steam.

Absolutely. So I think the, what are the aspects of, uh, testosterone therapy that you're hoping to, uh, to aim at some aspect of the aging process, cuz I think that for most people that are listening, you know, they're, they're probably over the age of 30, uh, and so this becomes a very interesting topic for them.

So in general the, the topics that we're going to be looking at or, you know, why would you potentially be taking testosterone replacement are going to be lean muscle mass, it's going to be bone density, it's going to be, um, you know, I mean it could be fertility, I guess, if you're, if you're young enough, um, or the opposite, you know, that, that can also actually negatively affect your fertility if you start using, uh, you know, exogenous testosterone replacement.

Um, otherwise those are sort of the big ones, you know. I think that, you know, you'd mentioned hair, sometimes that can be a double-edged sword, you know, if you're, you're trying to maintain your strength and your youthfulness and, and as your testosterone climbs, you know, you may start to see some receding hair and stuff like that. So, so I think that, that's actually, we, we could table that, but, but I think that's a really important conversation for anybody seeking testosterone replacement that it's, it's not a wonder drug, it's not, it's not something that you just take and, and don't worry about, you know, the, the side effects that, that there are some side effects that should be considered. Uh, and not, not that they're going to dissuade you from using the, the testosterone replacement, but you should just be aware that there are other medications you may want to take at the same time so you get a great result.

So let's talk about applications. Uh, so the way that it's delivered for people who do go into testosterone replacement therapy, we have, uh, gels, creams, and then there are pellets and injections. And then most recently oral testosterone, uh, which is, um, I don't know. It, it doesn't seem like that really took off. It seems like it never really achieved, um, the higher levels that some of the other things have happened. Each one of them has their downsides, right? Creams could, or gels could rub off on somebody that you're in contact with. Um, injections may not be something that somebody's really comfortable doing. Uh, when you hear about people doing testosterone replacement therapy, uh, what is the general sort of consensus on what's the best way to do it, or is there one?

Yeah, I, you know, uh, I'm a surgeon. Uh, so therefore I'm, uh, I tend to be surgically biased in, in certain things, but I'll of course let you know when, when I'm introducing my own bias. Uh, I'm a fan of the injection. Uh, and the reason that, um, you know, I, I've got small kids, the idea of, of creams and gels and things like that, uh, I think increases access to people that may not want to be exposed to that medication. Uh, if you don't have small children around the house, then that may not be as, as big of an issue for you. Uh, however, even if you've got, you know, a partner that, that may not want to be exposed to that, that, that I think just having that, that topical application that could rub off on, on, you know, other people that live in your home, uh, should be considered.

Um, I think the injections, they tend to be in a thicker vehicle. Vehicle being, you know, what, what are you mixing the actual hormone with? Um, and so while there are some injections that have become incredibly popular, they're in a saline vehicle, for lack of a better term, and pushing those through a small needle is very, very easy. So, I think that the, the length and diameter of the needle is certainly to be considered when it comes to ease of injection as well as comfort. Uh, and so that's certainly something to consider.

Uh, oral I'm not a fan of, and, and the reason being is that anytime that you consume something by mouth that, that ultimately it goes to your gut. And what a lot of people don't realize is that, um, our intestines aren't directly next to just our regular body circulation that, that's actually going through, you know, our muscles and our arms and our legs and everything else, that they, they actually go through what's called your portal vein. And so it's, as it's getting into our bloodstream, it's actually going straight to your liver.

And, and so ultimately the liver can experience something called the first pass effect, which is that if you're consuming a medication it's appropriate, you know, that the dose is appropriate for your entire body, but now your liver is seeing the, the full force of that medication before it's being able to, to be absorbed into other areas. That there's a lot of times where oral medications may actually cause some problems with your liver due to the fact that, that suddenly your liver is seeing a way, way higher concentration of that medication than the rest of your body. So, for those reasons not a fan of the oral, but I certainly understand where, where people could, could be freaked out by the needle.

And on top of that, um, I think at the end of the day they just haven't proven to be as effective, um, in providing the, the actual end result, um, as far as I know, right? So, the other piece is to talk about environmental exposure. For years we've been drinking water out of plastic bottles, right? And we still do it when we need to. You see it all the time. There's been all sorts of talk about estrogens in plastics and having an effect on the endocrine system. Now, there's a whole bunch of talk about scents and the phthalates that actually keep those scents, uh, active, being endocrine disruptors. There are a number of, uh, environmental things that can cause, uh, disruptions to the endocrine system and many people just are not aware of them.

I, I think that, that's an area where I try to shoot it straight as, as best I can and, and, you know, uh, if there is, you know, data or studies I can fall back on. I think that, yes, in general there's, there are absolutely contaminants within plastic and things like that, that, that can be detrimental to our health. As they pertain to specific subcategories of people, I think it's really hard to say. I, I don't know that we've got studies that are sufficiently large enough other than just being concerned. You know, and I think, I think that's okay, and I think it's okay to start at a place of, we want to do the very best for ourselves and for our family and ensure that, that we're going to be around for a long time and, and maybe even, maybe even more important than the, uh, duration of life, the really the quality. Right? You know, if you were unable to walk and exercise and all this other stuff, you know, being alive suddenly takes on a very different meaning.

So from that standpoint I, I absolutely think that there needs to be more investigation and there are plenty of things that, uh, we don't necessarily want to put into our bodies even though they may be convenient for manufacturers, uh, but, but ultimately as it pertains to, you know, specific impacts on our hormone levels, our thyroid or otherwise, you know, I think that we still just need more research.

Uh, sleep apnea has been tied to low testosterone, and sleep apnea, I think you just had a big talk at your practice about, uh, sleep and everything associated with that. Sleep apnea definitely has an effect on, uh, testosterone, and what's interesting is there are so many people, myself included, for years I didn't know that I had sleep apnea, and when I was finally diagnosed it's like, holy mackerel, wow, but what a difference that CPAP makes. It takes a little bit of time to get used to it, uh, but, you know, you think about in the gym, we, we break down muscle and then in recovery is where we rebuild it. So, making sure you're getting the appropriate amount of oxygen during that period of time, super important. Give me your take on sleep apnea and, and how it affects the body on a whole, including testosterone.

Oh, man, you know, that, like, before you even get to testosterone, just talk about just feeling alert, awake, rejuvenated, you know, my god, sleep, sleep may be unparalleled in its ability to be able to, to make you feel like you're back. So, I think that, you know, right out the gate, I, I don't think anyone taking testosterone replacement is, is expecting to see, you know, these, these wild, you know, anabolic steroid driven, you know, muscular hypertrophy results that bodybuilders are looking for.

And so a, a great night's sleep can, can be the starting point of that way before you even get to replacement. You know, so within the, you know, if you look at the, the cortisol levels within the first 30 minutes of sleep, being able to get into that, that deep sleep that you're getting this big burst of insulin-like growth factor that ultimately is allowing you to be able to actually absorb some of the protein that's going to allow your muscles to recover after you've just put all the work in, right? Obviously, the, the reason that, that muscles respond is you're not making them strong at the gym. You're actually beating them up. Right? You're, you're tearing down that muscle fiber and, and because of the trauma that you have induced upon your body that your body is now trying to, to rebuild itself stronger to tolerate that beating again, of, of which I think you, you like to beat yourself five to seven times a week if I understand correctly.

Yeah, that was about right. I'd take eight if they had it.

Um, a day, two a days is the, I think that's the, the playground of, you know, 20 somethings.

Well, you know, the, the interesting thing is I usually do my gym workout in the morning. I'm now on this StarFormer thing at a friend of ours practice. And then I'm doing the Peloton at night. So technically speaking on just about every day I get a two a day, but it's really, you know, I'm also chasing a body fat percentage that isn't normal for somebody my age. So, you know, I think at the end of the day we'll see how long that lasts.

That's great, man. Yeah, so anyway, to get back to your, to answer your question, sleep in and of itself, before we even get to testosterone replacement, is, is a wonderful, wonderful way to optimize your, your health, your well-being, and your recovery, right? And, and really it boils down to if you like being physically fit, you like those activities, whether it's for competition or lifestyle or otherwise, you have to get a good night's sleep. Period, full stop.

Now once you've done that, once you, you assume that you've got a good night's sleep, you've got your CPAP or whatever it may be that allows you to get there, personally I'm a huge fan of Eight Sleep, which is like a temperature controlled mattress setup. That was it. That's been a game changer for me. It's just been an incredible way to be able to essentially have this device optimize your body temperature to, to really enhance deep sleep, REM, etc.

And so once, once you now are getting the right amount of sleep, the right, you know, kind of sleep so that your body can most effectively restore itself, now let's add in testosterone, you know, and the ability for your body to, to rebuild itself and, and increase lean mass is absolutely better, assuming that you have optimized your testosterone for, and whatever that means for you. So, so this is actually an interesting area where as we continue to grow into the, the wellness space, again I love to operate, but, but ultimately I think that when I started my practice our, our mission statement is simply to improve quality of life. Has nothing to do with surgery, and so that's been an area where I found the, you know, the, the wellness avenue and, and trying to actually optimize people's health and well-being. You know, the, the, the surgical side was predicated upon, okay, everyone feels amazing and we want you to look as good as you feel.

But then there are plenty of times where people will give you those little breadcrumbs of like, something's, something's a little bit off. And so if you take that second to figure out what that is and, you know, you find out that somebody is, you know, one, maybe they've got sleep apnea, maybe they're sleeping like crap, maybe that's what's going on. Uh, but you move beyond that to, you know, okay, like, where, where are you and are you at an age appropriate level of testosterone? Let's say you figure, figure out that you're, your total testosterone, your free testosterone is, is actually off. You know, then I think moving into testosterone therapy makes a ton of sense.

And, and we now have good data from just a couple of years ago showing that you can actually optimize your lean muscle mass as well as your bone density and, and ultimately not have any of the negative cardiovascular risk factors that people thought you would have for many, many years. Uh, there was a great study in '24, I think, called the TRAVERSE study that, that looked at all of those things. There was 5,000 men and, uh, I think they're all aged 40 to 80, 85. Uh, they've got increases in, in bone density, they've got increases in muscle mass. There's no increased risk for cardiovascular events. And so I think that for the, the right person that, that this is ultimately been a great way to be able to enhance your, your longevity and your quality of life.

Absolutely, and let's think about it, right? I mean, as people get older and they lose that, we've all seen that MRI slice of a leg of someone who works out, uh, and then someone who doesn't, the 70 year old man that doesn't. And it's like all fat and some muscle, and then the person that works out is muscle and some fat. The reality is that you see older people these days, and you mentioned it earlier, who are just not mobile. Uh, then they're at risk for falling. If your bone density is off, you're at risk for a break. You wind up with a broken hip, you wind up in the hospital and you have a, uh, a pneumonia. Uh, this is serious stuff.

And so I think Gabrielle Lyon, Dr. Lyon has been a great proponent of, you know, really pumping skeletal muscle mass, coming from a geriatric, uh, medicine sort of perspective, understanding longevity and health span, as you mentioned, is just so important today. We have the information to make sure that that's happening the right way. And so, yeah, I, I think we're at that point in time where we have the information, uh, but you need to be working with a provider, uh, to really understand and be looking at the blood work. Now, uh, we're both biased, uh, obviously you are and I am because I'm a user of Function Health and your wife works for Function Health.

So...

And I use it as well. I, I, I get myself signed up for, uh, for my, uh, MRI screening as well. So I'm excited about that. Yo, we'll be able to look into, see how much fat I have in my thigh. It'll be great.

Yeah, I want a discount code. So, uh, if you can work, if you, if you can work that out with Kanika...

We'll, we'll make sure that we get the discount code for you.

Awesome. Um, yeah, I think it's super important to, to, to remind ourselves that things like DEXA scans, super important to really be, uh, keeping an eye on what is your total body fat percentage? What is your visceral body fat percentage? Because that's hormonally active, uh, and can wreak havoc if you've got too much of it. Uh, and then what is your skeletal muscle mass and how are you maintaining it? A lot of that's going to come down to diet. You mentioned it before, protein. Making sure that you have the appropriate amount of protein in your diet, carbohydrates to fuel your workouts, and then fats also play into hormones.

There, there was, there was one thing that you had mentioned about the, uh, about protein that, that I always like to, I always to give a little nod to carbs. And, and I think the, the reason being is actually, so part of the speaker series, uh, we just had, uh, a cardiologist, Dr. Nicole Harkin, that was on, uh, she gave a lecture 3 weeks ago, 4 weeks ago, something like that. And of course everybody loves protein, right? It's like, it's like the hero supplement right now. People love it. It's great, amazing. Um, I was actually sitting in an airport listening to this guy next to me, uh, eavesdropping. It's one of my favorite things to do in the airport. Uh, so I'm eavesdropping on this guy talking about how his wife has created this, uh, this protein supplement company and that there is zero sugar. It is just pure protein and that, like, how that's so amazing.

And I, I just didn't have the heart to, to explain to him that, that there's, there is literally a, basically a glucose protein or a glucose amino acid channel. To be able to get protein into the cell, you have to have something that actually transports it there, and you need a little bit of sugar to make that happen. So I'm not saying you need to, like, you know, go eat like a McFlurry along with your, with your protein. But, it, you know, if you just decide to completely abandon carbs in every single form, you're also going to just, like, hamstring yourself. It's not, it's, it's not going to be as effective. You've got to have a little bit of glucose to put in there. So, you know, in whatever way, shape or form, it could be a little bit of juice, a little bit of something, you know, just use, you know, whole milk for, you know, for, for lack of a better term. I mean, there, there's just a little bit of sugar in, in milk that's going to be able to allow those proteins to get into your system and actually get into the cell in a much more efficient way.

Yeah, 100%. If you go back to the old golden era bodybuilder days, you look at a guy like Mike Mentzer, uh, who was a huge proponent of carbs, carbs over protein, and the carbohydrate filling out the muscle and the way that he was training with a certain intensity, high intensity training. There have been so many people who have demonized carbohydrates when in fact it's just a, you know, it's a balanced, part of a balanced diet. And I think also, you know, there's this sort of massive, um, push towards protein where you see protein donuts and protein infused, you know, it's like, I mean, at some point in time it's like, okay, uh, the reality is that you have to have it in balance, and when you do eat that way it's amazing how great you feel.

I, I agree. Uh, you know, I, I think even actually I've, I've, I've gone to putting just a little bit of olive oil into my shakes as well. I, I think that as long as you don't overdo it, you know, it doesn't give me like any, like, digestive upset or anything like that, and it's just been a great way to get some additional oils.

You've seen the athletes talking about maybe overdoing it a little bit, uh, with regards to that. Um, last thing I want to talk about, you have become the doctor in this area that sort of is the hub of information. And what's interesting about that is you must have a lot of patients or people that aren't even your patients that are coming to you and saying, where do I go? What do I do? How do I handle this? If someone feels like they might be suffering from some of the things that you could go on to, uh, you know, any, any, uh, search engine and find what the symptoms are of low testosterone, if someone feels like they're, they're encountering that, what's the first step? Take us through the entire process as you see it of trying to discover the right way to handle this. We'll just take it step by step.

I, I think that, you know, as you are, you're talking to colleagues, friends, family, everything else, something feels off, right? There's not, there's something that's not quite right, and, and sometimes, um, you can have that, a little bit of that, like, search bias, right? That, that, you know, the internet just starts feeding you things and sort of takes you down a rabbit hole, and so I do think that it's important to have a little bit of that stop gap to talk to a professional, whether it's me, your primary care doc, Dr. Marwa Shoeb, who's our concierge primary care doc here in house, that, that has the ability to say like, okay, I see your concern. I think, I think we've got a little bit far down the path this way. We need to, like, back up a second, you know, to this level of questioning and figure out where we are in that decision tree.

And so I think that, um, that's probably the very first step. Let's just make sure that you're, you're getting, you know, good quality information that's applicable to you before you launch off and, you know, cuz I mean, the, the amazing part is that in this world of patient-driven healthcare, there are a lot of companies that, that now make it possible to order whatever medication you think is appropriate for you. And even though if it's something that is controlled by the FDA, um, or needs a prescription, you can probably find a digital prescriber out there that, that will do it for you. And I think that's a dangerous double-edged sword.

I, I think that, you know, even if they're giving you an appropriate dose of something, but you haven't gone through the, the appropriate algorithm to get there, you may be overlooking something else that could make you feel way, way better, right? You know, that you're, you're, man, I'm just really fatigued all the time and like, I, I really got to get this, like, free, you know, this testosterone. And it turns out that your thyroid is wildly off, you know. So to take a second to figure out what's actually going on, get a lay of the land, be able to have a conversation with somebody, I think is incredibly valuable.

Then at that point, I'm a huge believer on the fact that, I certainly know that I'm busy, and if it weren't for the people that take care of me trying to optimize my time, that it might not happen. And I think that becomes a, a dangerous slippery slope where I'm too busy, I don't take care of myself. Next thing you know, you know, you have some sort of like major medical issue that, that now it, you know, something could have been done earlier on. To try to enhance their, the time that we have with them since everybody is busy, uh, you get your labs drawn here, whether you choose to do a regular panel looking at things that are, uh, a, a concern, and or, you know, go with Function Health, which I, I certainly have done personally. I think that it gave me a bunch of data points that, that ensured that for the time that I had to focus on myself and my well-being, that I was getting all the information I needed to, to make the right decision for me.

Uh, it doesn't mean that I have to do something, but, uh, I just wanted all that information. So 160 data points, uh, it allows me to check that twice a year and make sure that I'm on track. Uh, then once you get to that point, depending on where you live, where you're from, everything else, you know, uh, we'll identify somebody that, that we have worked with, uh, that does a nice job, that is going to be able to get you set up with your hormone replacement. Uh, and from that standpoint, there's all the options that we had talked about earlier in terms of how would you actually get those hormones into your body.

Going straight to a pellet, not a huge fan of, just because you're committing to a dose for months at a time, uh, before you get your next pellet. Whereas I think starting with, whether it's a gel, injection, or otherwise, again, not a, a fan of oral, I think it's going to be the best way to get there. And then you can actually start to, to figure out how does it make me feel? Is this better? Is it the right dose? Recheck your labs. All those things are going to be a big part of making sure that you're being treated appropriately and that we're doing everything we can to make sure you're around for a long time and feeling good for a long time.

And then at that point, then you can start to make a decision of like, okay, I've found the recipe that is, is really working for me. I feel amazing. I'm back at the gym. I'm recovering. I'm sleeping. Life is great. Now maybe I don't want to, you know, do the injection every week. I don't want to do the injection, you know, whenever. Uh, let's go to a pellet and that gives you that nice, durable, nice, smooth, uh, experience because you know where you need to be.

You know, I, I think it's really interesting that you mentioned that because you could have someone who's a hyper responder to something like a pellet and not feel great from that, uh, which, you know, I've heard people say that. So, you know, again, I don't know that there are any studies around that. I think pellets are probably widely used all over the place, but I think you kind of walking that in probably is the right way to go. You sort of understand exactly where you are and certainly if you're following your, your labs appropriately, you're going to know.

Um, one of the, again, this is going to sound like a Function Health commercial by the time we're done, but one of the things I love, I love about Function Health is I want to see the smoke signals. I actually, you know, have been in healthcare long enough where I can actually read those and know, you know, hey, what is, why is my C-reactive protein elevated? You know, that's just one example, but interesting to see, and I love what you said also too about these other indications. It could be low in DHEA, you could be low in vitamin D and K2. Uh, I love your way of thinking. I love the way you think about things from a holistic standpoint. That's so important, not just rushing off to, hey, this is the answer and I can get it online, uh, is, I agree. The worst thing you can possibly do is go that route because if you're not working with a provider and you have that relationship with that provider where they can really spend the time with you, you, you're just sort of, I don't know, it's kind of like rolling the dice in my opinion.

Totally. Yeah. And it remains to be seen. Well, as life progresses, AI progresses quickly, maybe that, maybe that changes, but I think for state of the art currently, I think you still need that human involvement.

Yeah, I think AI has got a long way to go. Microsoft just published that whole thing that was sponsored by, written by, tested by, judged by Microsoft, and they were supposedly so much better, uh, at diagnosing. The gap was 36% to like 83% accuracy, and anytime I see a delta like that, I think to myself, something's off. And so when I did the investigation with regards to that and really dug into the numbers and read the study, it's pretty clear that it may have been, uh, unfavorably weighted towards, uh, the AI. So I'm sure that it's going to play...

Yeah.

Yeah. I mean, you know, it's, it's so great that we have these incredible governance layers here in the AI world, since we're so close to it. We deal with it all the time. And certainly there are some great things about AI that are bringing forward the possibility for drug development and actually finding diseases and, and new viruses and all that good stuff. But we still have a long way to go, and I think the relationship that you create with your provider is a very important relationship. Maybe one of the most important relationships that you'll ever have is the ability to be honest and direct and have somebody be honest and direct with you about your health so that you can take the appropriate action and live the life that you want to.

So, Dr. Rankin, thank you so much for joining us today. This is the last episode of season one of Cell to Systems in the books. And it was so great to have you on.

Always a pleasure to spend time with you.

It's always a pleasure. Yeah. We look forward to catching you hopefully next season.

Sounds great. I love it.

All right, everyone. We'll see you in, in a month or so, and when we come back, there are going to be a whole bunch of new topics. They're going to be really hot because there's some big things that are happening in this space. Until then, stay happy and healthy.