The Testosterone Myth That’s Costing Men Years of Their Lives | Ep 299 with Shalin Shah CEO of Marius Pharmaceuticals

0:04So, Shalin, it's really great to have you today and talking around this topic that we're going to dive into because it's something that I've been asking doctors about, my doctor. I've been asking friends about. It seems like every friend once a week tells me that they are doing something with testosterone therapy, and I can't even figure out where or how to get tested. And I'm about to be 42 in like a couple weeks, and this is something that's been on my mind. But I also can't really get necessarily a straight answer from anyone. And I hear so many, there's negatives, there's positives, I don't even know.

0:42But why is there such a conversation nowadays? Like right now in 2026, why are so many people talking about testosterone? So it comes down to this overall concept of like health and wellness, right? How prevalent this is in 2026 now, right? And the fact that also patients or effectively consumers have reclaimed their health care to a certain degree, right? I think a lot of people are fed up with the system, mainly centered around sick care. You know, you spend seven minutes with a doctor on average. It's hard to get an appointment. That can take months in itself. And you're really not fixing any problems, right?

1:25You're just throwing on some Band-Aids at best. So people, plus the information out there, right? Think about how much more information is at their fingertips. So people have taken their health back into their own hands, and I think that's an incredibly powerful and important step at fixing healthcare. Again, we certainly need professionals. We need our doctors. We need our nurse practitioners and so forth. But people need to care about their healthcare. So them spending this time and starting this process journey, incredibly valuable. So again, testosterone sits at the foundation level of our general health, right?

2:02I mean, there are a couple of things that you got to be doing for your health that are non-negotiable. That's diet, sleep, stress, exercise. But the next layer on top of that is your hormonal health. And testosterone is a key hormone. There's actually an androgen receptor on nearly every organ in the body, right? So whether that's your brain, your heart, bone, muscle, all of these processes involve testosterone. So now that this is becoming better known, people are talking about it. People are asking their doctors about it. Or they're also going their own route to get testing because historically it has been challenging.

2:37The molecule testosterone has really been stigmatized. If you go back, you know, you mentioned about to turn 42, right? You remember the days of baseball and steroids, right? Testosterone got really mixed up in all that and also in the Olympics in 88. Ben Johnson, Canadian sprinter, was found positive with testosterone, among other things. And that, you know, they threw the baby out with the bathwater and banned it from a controlled substance perspective back in 1990. So again, a lot of stigma around this topic for many, many years, a lot of myths and misconceptions that are being corrected, which is a good thing.

3:20I think we're moving in the right direction, but medical sort of science takes a long time to correct. But nonetheless, people are interested in their health and they're figuring out how important this is, not just about sexual health, not just about muscle building, but their overall metabolic health. And that's why this is front and center today. What would you say are the two to three biggest myths right now around testosterone that if you could just eliminate those myths? So two are around its safety. So people think testosterone causes heart attacks. That's not true. The largest randomized trial in history around testosterone was done specifically to look at testosterone and heart attack risk, and it found there was no correlation.

4:04So that has been done and put to bed. That study actually came out, it was the Traverse study, came out in 2023. So it's already two and a half years old there. But it's still making its way into general public. But frankly, patients and providers are still just finding out about this, right? That's one. Second is that testosterone causes prostate cancer. Also, a myth that's been put to bed, not just by the study that I just mentioned, but numerous other studies that have been done historically, and all the way back to the original paper that propoded this, basically. It was a study in the 1940s with three patients.

4:45One was female, so you had two guys, and one guy got prostate cancer, right? He was an older gentleman, which they all have that chance anyway. So that's another big one. But I think the third general misconception is, and I call it a misunderstanding, is just how important this is. Again, I mentioned there's an androgen receptor on every organ in your body. So it plays a role in your cognitive health, in your cardiovascular health, your bone health, your muscle health, your fat metabolism, even all the way down to your mitochondrial, right, which is your cellular level. There's a role for testosterone in those processes.

5:24So I think we've discounted how important this thing is and how helpful it can be for our general health. Helpful and safe, right? I think, again, when you get rid of those misconceptions, you realize that this is safe at physiologic dosing. You know, you don't question when your doctor tells you to take vitamin D because you're low. Vitamin D is a hormone. What are we doing over here? And I think that general third misconception is sort of the, you know, let's call it the trump card, the spade, right? That needs to be fixed. Hey, I want to feel like I'm 24 again. You know, I always joke with my wife.

6:04She's like, oh, are you 24? Like if I do something that seems like I'm younger, she's like, oh, are you 24? So what somebody like myself, so I'm turning 42. I definitely don't feel like the same as I did at 24. Just, you know, all the things that you mentioned don't feel like my cognitive. I don't know if that feels the same. I'm not sure. Energy probably doesn't feel the same. Definitely really hard to lose weight, hard to pretty much gain muscle, even if I work out. So these are things I'm like, you know, I think there's something off possibly. But how do I even get started? Right. And all these signs and symptoms are consistent with testosterone deficiency.

6:44But what's important is that, like you're saying, how do you start? It is a lab value, right? So there is a number. Not to say the number drives everything, but that will give you a good indication of where you are. And if you're in that lower normal range, it very well could be a testosterone issue. So for you to start really, again, medical sort of traditional system is just catching up to this. But I would go to my doctor and advocate for a testosterone test. At 42, it is warranted. You have some signs and symptoms. It's a cheap test. It would be with their standard blood panel. And I would just make sure that that happens.

7:24If you don't have a good primary care that you can go to, you can either do some of this testing through online vendors, right? You can set up an appointment at LabCorp Request and do this. or there are even at-home tests available today. So you can do an at-home test and get an indication of what direction, where you are on this scale. And again, does it warrant further investigation? I love how people are so health conscious nowadays. Longevity is like the thing, biohacking. It's great to know that we don't necessarily need to wait for the doctor to get a test, for example, that there's so many in-home tests.

8:03Like the simple thing of a test, I understand like a doctor might need to prescribe something, but the fact that you can't even get a test to figure out if they need to do something always, you know, boggles my mind. I know you just sat down with the FDA. What happened with that? So that was a landmark panel, you know, an FDA expert panel on testosterone replacement therapy. I believe there are 13 experts on the panel, all with extremely decorated CVs, decades of research in this space. But the message was very clear. Again, this is a vital metabolic hormone that we should be paying attention to.

8:43It plays a crucial role in overall men's health and female health. I will say that too. I don't want to discount that side. It's an important female hormone too. But we have a men's health crisis in this country. Men on average live seven years shorter. Their lifespan is seven years shorter than a female. So there's multiple reasons for that. But testosterone is the single best biomarker of your overall health because, again, like I mentioned, it influences all these parts of the body. So that single test can give you an insight into your cardiovascular health, your inflammation in your body, your glucose, or your metabolism there.

9:26So again, a single test that's most important. But to your question on the panel, there were three main takeaways. One was screening. So we should be screening every man for their testosterone levels, for this, again, this biomarker insight that I'm that I'm mentioning. Could it be for everyone over 40? That's an easy number to pick, but it could be even earlier. So you have a baseline, say you're 30 years old and everything's feeling great, but at least, you know, when I was 30, my testosterone level was maybe 750 nanograms per deciliter. So when I'm later in life too, not that you're treating to that number, but you understand your progression, right?

10:05Because we're all on slightly different paths there. And what might've been good for me might not have been your exact number. There's a wide range there. So testing is one. The second is broader labels because the label right now, as you look at the, that's called the package insert on a product, like a product like ours, say, Kaizotrex, it's indicated for a very narrow patient population. And in fact, most of the men that are testosterone deficient fit a broader definition. And it really doesn't matter. Like most diseases, actually I talked about this, like most diseases, you don't think about why I necessarily have this.

10:48You treat the disease, right? If you have high blood pressure, sure, you should make lifestyle adjustments, but you take blood pressure medication. You have high cholesterol, again, lifestyle is important, but you take cholesterol medication. You have low testosterone. Sure, lifestyle should be important, but take the testosterone medication because that is going to fix a lot of underlying things. So again, why is this disease stay treated differently doesn't make any sense. So the panel advocated for changes as it relates to that label. So again, men don't feel like they are using a treatment that they shouldn't be, right?

11:25This is for them. And the third one, which is really big, which adds to this whole stigma equation or should subtract from it, is testosterone should be descheduled. It is controlled three substance right now. And again, this goes back to Congress in 1990 on the back of the Olympics. It makes no sense. Testosterone, and I said it in the panel, is less abused than caffeine but more tightly restricted than cannabis in half of this country. you know it when you say it when i think about it you're right like i think of steroids and i think of oh this is bad and like back alleys picking you know something up or you go to the gym and you know like the gym bros exactly it's really it's kind of like even talking about it with some people i almost feel uncomfortable i'm like oh maybe i shouldn't talk about this like you're saying um which is why i like to i bring it up a lot because i want to understand like what are other people doing, my friends.

12:23Some of them I see online, I'm like, man, you look really great. Like what changed? And they're like, oh, well, I'm on testosterone therapy. So I'm glad that it's starting to become less stigmatized and you are helping with that. So what was what happened in your life that made you become so passionate about this and to create a company around it? So this has been about a 10-year passion project so far. And again, I think we're just getting started in the scheme of things and the change that we can bring about. But no, I mean, look, the opportunity kind of came across the desk. And I have a research background in the investment world and continued to sort of dig and dig on this topic.

13:09And there was just a massive dichotomy between the perception of testosterone and then what I was reading in terms of what it actually does, right? So in, in that disconnect was, was frankly just too big to, to ignore. It, it, again, to me, it didn't make any sense. And, and I felt that there was an opportunity to do something about it, especially considering, again, we're talking about a problem that is so big, you know, in the U S there's 25 million men that are testosterone deficient. You're talking about, you know, 100 million plus globally. I mentioned there's probably 500 million people globally, both men and female, that need testosterone.

13:50So you have such a big problem. And I looked at the solutions. And historically, this was mainly, you know, this is mainly done by injection. And we know that's a hard ask for a lot of people to do, especially on a regular basis, right? And I'll share another reason why it doesn't, you know, that doesn't really work in a second. But we went and pursued an oral option. So we said, look, if we can make this into a pill that's safe and effective, think about how many people we can help. And that really, you know, again, the combination of how misunderstood this was with how great a solution we could potentially bring to the market, couldn't ignore it.

14:34wow i mean that reminds me when i was in my 20s i took was it androstene i forget what they sold at gnc it was like yeah they have all the supplement boosters and they still sell them yeah i think i think those like became illegal eventually i got banned eventually but um i remember taking all this stuff it just reminds me of that back then and doing all this research it it's quite fascinating but i mean yeah i could for myself like thinking i travel on stuff and thinking I'm gonna have to carry needles everywhere. Just sounds very complicated, but a pill makes a lot of sense. And the difference is this is I mean, again, convenience is one thing.

15:13And that's obviously a huge thing for people. But also, what's important to know is that the way that our bodies make testosterone, we make it every day, right? So when we're sleeping, and we're at rest, and that's why sleep is so important, our hormones are resetting right so um again it's a daily physiologic rhythm that we produce our testosterone levels when you take something like an injection even even the better protocols today you're taking it once a week right so the the analogy that we like to use is like it's waking up on monday morning and having 10 cups of coffee for the entire week again i i feel like i'm saying this a lot, but that doesn't make any sense.

15:53You know, we want to replace the hormones in the most physiologic way. So if we're doing this daily via an oral, that is going to mimic your natural rhythm most closely. And from what we see, the side effect profile tends to be more favorable when you do that. I mean, that makes a lot of sense. I would imagine it's, yeah, like you're If you start with 10 and it slowly drops down, not every day is the same until you go to the end when you need to do it again versus taking the same dosage every day. So when you looked at the models for this of like direct to consumer and other things, what was the reason why you chose the business model that you have?

16:36So we, you know, again, having a non-traditional background in the sense, right? Not from pharma world. We saw what payers, right? The market is controlled by the insurance companies or the payers. And we understood that for a new drug, even if it's reasonably priced, they don't want to cover it. That's their first action or first instinct is to reject, deny. So how are we going to get a product that can help millions and millions of people if we are going to get stonewalled from day one? It's just not going to happen. right? We had the foresight to see it in that sense. I don't even think it was, you know, again, sometimes it just takes a simple new perspective.

17:24It's not wildly hard to read. You just have to be willing to do something different, right? And at the same time, again, when we commercialized, when we launched in early 23, COVID had already happened. Telehealth was already in play. Patients, again, as I mentioned in the beginning, were already being proactive about their health. Um, we, we knew testosterone was kind of in the patient's hands. So let's go speak to them directly and let's get them interested in, in this, this model. And let's, let's honestly provide it at the most affordable price that we can. So somebody doesn't have to worry about going through their insurance.

18:01Um, and, and, you know, getting Keisertrex is priced similar to a, let's call it a high end supplement, except you have, you know, a couple hundred million dollar research program, 13 years of R &D and an FDA approval behind it versus I can sell a supplement tomorrow if I wanted to. Man, I need to go get checked. I need to go get tested. No, I'm really inspired right now. I'm gonna get tested because the fact I didn't know there was also the pill option. So I'm gonna go get tested. I'm gonna come back to you. Let's see. I'm gonna try if I can and it makes sense because the you know, with me, I've had sleep apnea for a while.

18:40So there's a long time where I did not use a CPAP machine. And I there's many years I didn't sleep. And I think that has had like a detrimental effect on my body long term, for sure. I could tell a difference. Like if I don't sleep, I can't remember anything. I'm like not excited about anything. I'm pretty, you know, like I have no energy. Even though yes, you know, we've done all this work in testosterone. You know, we're out there with with a product. But again, there is a massive problem. But but The more that an individual can work, they're actually synergistic, right? At the end of the day, if you're getting good sleep, you're eating well, you're exercising, you're keeping your stress levels down, you know, yes, you might rise your hormones to a certain degree, but you might still need help, right?

19:25But then that creates a virtuous cycle. I want to pair your, I want to pair this with everything else because I want to live healthy till I'm like 125. Absolutely. I think, I think, and it's doable, right? But again, everything kind of works synergistically. It works together. You don't ignore things, right? Like I don't think there's a shortcut at the end of the day. I mean, we still advocate for this every day. Like your general health cannot be ignored, right? These are tools in the toolbox. And there's a few of them. But again, foundational level. Don't sacrifice that at all. And then everything kind of on top of that will flow nicely together.

20:03People want to get in touch with you because I'm sure, like you said, there's 50 million men, probably 50 million people, men and women that might need help in the US alone, how can they do so? So you can follow me at The Metabolic CEO on Instagram. You can look into what we're doing in terms of the research at MariusPharma.com, or you can look into Kysetrex, K-Y-Z-A-T-R-E-X.com to look into the oral option that we're talking about. Amazing. The Metabolic CEO. What a great handle. But no, I super appreciate people like yourself that you found a problem and you realize that you really need to solve the problem.

20:42But it's a major problem that you can be super passionate about. And it's something hugely long term because I think a lot of people go into business. They're not necessarily solving really a major problem or even a problem at all that outside of them have. and then you know when you when you are solving such a big problem you become so passionate and ingrained in the solution that it really comes off i can tell just how excited you are to even talk about it so thank you for the impact that you're doing and joining us today i appreciate that i appreciate talking to your audience You