In this podcast, I’m going to give an in-depth answer to a question I’ve been getting asked more and more frequently over the last 6 months: what’s my take on testosterone replacement therapy?
When should you use TRT? Why would you start TRT? Is it safe? What are the benefits and what are the risks?
One of the reasons I’ve been getting asked about TRT more often is that it’s getting more popular. So in this podcast, I’m going to talk about what TRT is, when is it clearly indicated, when is it less appropriate, and what you should consider if you’re thinking about starting (or have just started) TRT.
If you’ve ever wondered what TRT is or whether you should consider starting it, you don’t want to miss this podcast!
4:46 – What is TRT?
5:31 – When is TRT given to men?
7:41 – Why do people take TRT?
9:11 – What effect does TRT have on testosterone levels and what are the benefits of TRT?
12:51 – What are the risks of TRT?
19:02 – What’s my recommendation regarding TRT?
24:53 – How do you increase testosterone naturally?
Mentioned on the Show:
What did you think of this episode? Have anything else to share? Let me know in the comments below!
Today is the day my buttes. Today I am leaping out of the plane with the parachute, and I’m hoping there isn’t just raggedy laundry in it. Today I’m belly flopping into the old watering hole, and I’m hoping that there isn’t a pack of piranas seething under the surface. Today. All right, fine. I’m just kicking off the big book Launch Bonanza for my newest fitness book for men and women of all ages and abilities called Muscle for Life, which is releasing on January 11th next year, and it’s currently available for pre-order over at www dot Muscle for Life.
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Now, in this episode, I am going to answer, give an in depth answer. A longer answer to a question that I’ve been getting fairly often and more frequently in the last, probably six months than in the last several years, and that is testosterone replacement therapy. What’s my take on it? Is it warranted when, why?
Is it safe? What are the benefits versus the risks and so on. And I have spoken a little bit about this in previous episodes. I’ve written a little bit about it tangentially, but I haven’t given a detailed answer that gives my. Current position, I guess you could say. And one of the reasons I’ve been getting asked more and more about it is it’s getting very popular.
Just head over to Google Trends, for example, and put in testosterone replacement therapy and look at that chart over the last year or so. Also, if you go back 20 years or so and look at the testosterone prescription market, it was about a hundred million dollars in annual sales and now it’s billions.
And as I. It is also growing very quickly. So in this podcast, I’m gonna talk about what T R T is when it is clearly indicated, when there is a medical condition that it can effectively treat, and when I think it is less appropriate, which encompasses many more of the people who reach out to me. And some of the things you should consider if you are thinking about starting t r T or if you have just started.
Okay, so what is T R T? You probably know that it stands for testosterone replacement therapy, and that pretty much tells you what it is, right? It’s a form of hormone therapy that is used to restore a man’s level of testosterone into a normal range, and that would be the concentrations seen in.
Younger men, or to put specific numbers on it, that would start at about 300 nanograms per deciliter of blood. N G D L. You have probably seen that if you have been looking into trt up to 800 to maybe a thousand N G D L, that would be the. The high end of normal, anything beyond 1000 would be freakish and very rare.
Now, historically, TRT was given to men who were suffering from low testosterone because of a medical condition known as hypogonadism. And this is a situation where the testes, they produce little or no sex hormones and women can also be affected by this condition. But it doesn’t reduce their testosterone in the same way as it does in men.
It impacts female sex hormones, but that’s not relevant to this conversation. I’m really just talking to men here and talking about their testosterone levels. Now, contrary to what many people think hypogonadism can occur in men at any age, it is not exclusively a condition seen in middle aged men or beyond.
And the main symptoms of it, Reduced libido, erectile dysfunction, reduced muscle mass and strength or difficulty gaining muscle mass and strength and a lot of difficulty, not just, Oh, I’m progressing. I’m getting bigger and stronger, but it’s not as quickly as I would like. No. People with hypogonadism make very little progress in the gym.
They they seem to be a non-responder. Often also higher body fat levels in general. You’ll see that among men with hypogonadism osteoporosis or low bone mass depression, fatigue. And if somebody has hypogonadism, then TRT is definitely warranted because even though it is a. Condition that may require lifelong treatment, it may mean that they have to take these drugs for the rest of their lives.
Research shows that t r T can effectively improve many of the symptoms associated with hypogonadism, and it greatly improves quality of life. As you can imagine if you could reverse most or all of the side effects that I just mentioned, that changes a dude’s life. Now most of the people, most of the guys reaching out to me asking about TR r t do not have hypogonadism.
In recent years, TRT has become a lot more popular among men who don’t have this condition, but who just want to fight the gradual decline that is associated with. The gradual decline of testosterone, and that generally begins in the, in men in their thirties. And then research shows that it continues at an average rate of about 1.6% per year thereafter.
So testosterone levels slowly decline. And this is also often referred to as age related hypogonadism. And like I mentioned, I think it was in the intro. Maybe the beginning of this podcast, testosterone prescription sales have soared. Just 20 years ago, it was a hundred million dollar market, a hundred million in annual sales.
Now it’s a multi billion dollar market. Also, research shows that testosterone deficiency is on the rise here in the us. For example, one recent study estimated that nearly 80% of men with obesity type two diabetes metabolic syndrome. Dyslipidemia arterial hypertension and or chronic obstructive pulmonary disease also have hypogonadism, also have low testosterone levels.
And since two out of three men in the United States have one or more of those conditions, the overall percentage of men with low testosterone is scandalously high, shockingly high disgrace. Hi. Now, a lot of the men who ask me about t r t want to know what exactly it’s going to accomplish with their testosterone levels and what the benefits are going to be and what the risks are.
If they can just feel younger, if they can have more energy, if they can have more sex drive, more sexual prowess, if they can feel a bit. More vital, a bit younger. They hope they can gain muscle faster. They hope they can get stronger faster stay leaner easier. And the answer to all of those types of questions is pretty simple.
Research shows that if your testosterone is low or reaching the bottom of the range of normal, which again is around 300 nanograms per less per deciliter. Blood, then t r t will likely help you feel more energetic and be better in bed and have more vitality, and it may help you gain muscle and strength a little bit faster.
I’m gonna talk a little bit more about that in a minute. It is not going to be as dramatic. In your body composition as people selling you, TRT would have you believe, but it can make a difference. And a good example of this in the research literature is a coordinated set of seven placebo controlled double blind studies that was published in the mid 2000 tens that looked at 788 men.
And these were known as the testosterone trials and what they found, T r t can improve overall sexual activity, sexual desire, erectile function. It can increase muscle mass, strength and power. It can increase self-reported mobility, bone strength. It can help reduce fat mass. These studies also show that t r t doesn’t improve vitality, so it doesn’t seem to improve energy levels in most people, at least not to a significant degree.
It can have a. Modest positive effect on mood. So it may alleviate depressive symptoms to a small degree. It doesn’t appear to improve cognitive function, and it also can increase the noncalcified coronary artery plaque volume, and that can be dangerous because what it means is it makes the lumen, which is the inside space of an artery that the blood flows through.
Now, despite that researchers did not go as far as saying that TRT can increase your risk of cardiovascular problems. Probably because the number of studies that show that testosterone therapies do not have a negative effect on cardiovascular health are. Robust, but the scientists did think that longer, larger studies are warranted to see if t r t is indeed heart healthy.
Now, if I were to stop the discussion there and say, Hey, There’s a simple overview of the research on t r t, and so now you can make your own decision. A lot of guys would probably be rushing to the local anti-aging clinic to, to get their script. A lot of guys who don’t even have low testosterone or.
Don’t even have symptoms of low testosterone, but who just would like better sex and more muscle and more strength and stronger bones, and a better body composition, lower body fat levels and so forth. But before you click off this podcast and rush over to the clinic, let’s talk about some of the risks, some of the downsides.
So first, you should know that t r t is not going to do much for you. It will do very. For you if you don’t have symptoms of low testosterone. So if you feel healthy, if you generally have high energy levels, if you generally sleep well, if you don’t suffer from anxiety, if you are able to make progress in the gym, you don’t feel weak.
You don’t look weak, then. The downsides of trt, which I will get into, are likely going to outweigh the upsides because proper TRT protocols brings your testosterone up to a healthy, normal level. Usually around 600 nanograms per deciliter. Maybe a little bit higher, maybe a little bit lower, but that. The usually the sweet spot for most guys with a proper TRT protocol, you’re not even pushing to 800 or a thousand and certainly not beyond 1000.
Now when you do go beyond 1000, especially when you go beyond 1500 nanograms per deciliter, yeah, great things happen as far as your body composition goes. That though, Beyond the range of what can be achieved naturally. And that of course has bigger and bad side effects. You are now essentially on steroids and yes, there are many other steroids that people who are into steroids take, but the base of any good steroids cycle is a lot of testosterone, and that’s because it works.
Now, I mentioned that there are risks associated with trt. There are risks associated with introducing exogenous hormones into your body. Hormones that are not created by your body, you are putting them in your body, and the risks are exaggerated by some people by TR r t haters. But if. Objectively review the research.
You’ll see, for example, that t r T can increase the risk of prostate cancer, and there are quite a few studies that refute that, but scientists are still learning about how testosterone replacement therapy, and prostate cancer are connected. It is something to be aware of. It might not be an issue, but you can’t say that with any certainty.
Yet studies also show that t r t can enlarge the prostate. It can increase the risk of male breast cancer. It can cause an abnormally high amount of hemoglobin to be present in the blood, and that can then increase the incidence of vascular problems including stroke, heart attack, and deep vein thrombosis and blood clotting is also a possibility.
It can increase the risk of blood clotting through the. Mechanism through the increase in hemoglobin in the blood it can exacerbate sleep apnea, it can lower sperm quality. It can cause skin conditions like acne, redness, and itchiness, and it can cause gynecomastia or man boobs, and those man boobs can become painful.
and all of that is why the FDA’s position is the only approved way to get t r t is if you have classic hypogonadism, if you have an actual medical condition, not simply age related hypogonadism, not the. Age associated decline with testosterone. So when you were younger, let’s say you had high, normal, healthy levels of testosterone, now you’re older and you don’t have low testosterone per se, but it’s not as high as it once was.
And that of course means that you don’t feel quite as good as you did and you maybe don’t perform in the bedroom. Quite as well as you once did, and in the gym you can’t gain muscle and strength as quickly and easily. You can’t recover from your workouts as easily as when you were younger and so forth.
And the reason for that, the FDA says is that the benefit and the safety of t r T has not been established for the treatment of. Low testosterone due to aging versus again, the medical condition of hypogonadism that can occur at any age. And the FDA notes that there is evidence that T RT can increase the risk of cardiovascular issues and strokes, which of course you would not want to do as you are getting older.
And your risk for those things is probably going up to some degree. By getting older. Now, if you dig around online, you will find a lot of counterpoints. You will find that this is something that many people will dispute fervently and critics often say that the studies. That the FDA are using for their argument are retrospective and observational in nature, that they are weak evidence that they use higher doses of TRT than what is commonly used, so it doesn’t actually reflect the standard TRT protocols.
People will say that the FDA is misreporting results misinterpreting or misreporting. The evidence and is not recognizing issues is not acknowledging issues with the study designs that would weaken their position. , and in some cases there are studies that seem to prove the opposite of what they’re saying.
So one meta-analysis, for example, that the FDA has referred to showed similar risk for cardiovascular issues and mortality between T r T and placebo. What’s more critics of the FDA’s position will often point out that having low testosterone is a health condition unto itself. That research shows that if you have low testosterone as a guy, it can increase your mortality, your risk of dying from anything and everything.
It can increase your risk of coronary artery disease. And studies have also shown reduced mortality and reduced risk of heart attack and stroke with long term testo. Treatments. So where does all this leave us? What is a summary of my recommendation For those of you who are considering t r t? Just curious about it.
Maybe just started it. You now know there are risks associated with it. It is not all benefit and no risk, and I can speak to this personally, right? So if I had classic hypogonadism, I would be on t r t because for all the reasons that I’ve discussed. Also, if I were older, I am 37 and don’t have any symptoms of low testosterone.
I haven’t gotten blood work done. Ever. I guess if I have, I’m not remembering it because I don’t really have a reason to get regular blood work done. People who secretly use steroids get regular blood work done, but I’m not one of those people, so I can’t say where my testosterone is at, but I have no symptoms of low testosterone.
That’s not surprising given my age and my lifestyle. But if I were 47 or 57 and I was doing everything I could to naturally maintain high testosterone levels, which I will talk about also in a minute, and I still had symptoms of low testosterone. and if I went and got blood work done and found out that yes, I do indeed have low testosterone levels, if it came back at 300 N G D L or less, then I would get on trt because at that point it’s a matter of quality of life.
It’s not about body composition. Trying to gain another inch on my biceps, it’s my life is going to be a lot more enjoyable. Every waking hour is going to be a lot better at 600. N G D L than 200, for example. So those are really the only two scenarios where I personally would get on T rt. I would not get on T R T if I didn’t have low testosterone.
If I had symptoms, maybe I probably wouldn’t have all of them, but if I had some symptoms that. I thought could be from low testosterone and maybe some anxiety. Maybe poor sleep, maybe low sex drive. And then I went and got my testosterone levels tested and they came back totally normal. I would look for another cause.
I wouldn’t just get on drugs. I also would not get on T R T if my testosterone levels were. Low-ish. They wouldn’t be 100, 200, maybe not even 300, but let’s say it’s 400, 3 50, maybe four 50, So not. Great. Not terrible, but I had no symptoms of low testosterone. It’s very important that you also consult symptoms because 400 might work just fine in one guy.
He has no symptoms whatsoever. Feels good. Good sex, good workouts, and 400 and another guy might cause symptoms of low testosterone. In that range of three to 400, you’ll see that you will new. You will usually not see that if you go higher, if you’re looking at five, 600 plus. But there are plenty of guys out there who are in the 400 s and who feel totally fine.
And I think it is. If it were me, I would not get on t r t if I were that guy. If I had no symptoms and it came back at 400 and even if my doctor was saying, Hey, this is close to to, to low, you could get on and you’re gonna feel better. I wouldn’t do it. I also would not get on T R T if I have low-ish testosterone and my only symptoms.
So again, let’s say it’s three to 400. My only symptoms were lower energy levels and poor mood. And I guess I’d throw depression in there. As well because again, research shows that t r t is probably not gonna help much with those things, and therefore the downsides are probably going to outweigh the upsides.
That is not always the case. There are always outliers, there are always exceptions to that rule. There are some people who. Notice dramatic improvements in energy levels and mood and less depression and anxiety. But in a couple of cases, I’m thinking of, those are not T R T cases, those are super physiological cases.
Those are going from, call it three, 400 ngl. N G D L to 2000 plus N G D L. Yeah, that’s gonna make you feel like a Superman. But again, take all of the risks that I have discussed in this podcast. Magnify them, add some more into the mix. That’s what the super physiological use of testosterone that’s what that looks like.
And also, of course, Not recommend t rt. If you are concerned about the risks, maybe you have health conditions that are already related to some of the risks. Maybe you have genetic predispositions and you wanna stay away from it. Then that would also make sense to me. For example, if you have a history of cardiovascular problems, might not want to get on T RT unless you absolutely have.
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Now let’s let’s wrap up this discussion with a few of the things you can do to increase your testosterone naturally. And these are the things I would recommend to anyone before they get on trt, regardless of their situation. Even in the case of classic hypogonadism. The tips I’m going to share might be able to help.
It is less likely to resolve the situation, of course, than with someone who does not have classic hypogonadism. If it’s simply age related, then what I’m going to share can make a huge difference. But even if it’s not age related, even if it is a medical condition, of course consult with your doctor first.
But I. Stand by the advice And I think any competent doctor would say, Yeah, we should be doing these things regardless. Like maybe we do have to go on t r T, but it makes sense to, and I’ll get into the list, it makes sense to do strength training, resistance training, lift some weights, because research shows that people who do this regularly, Have higher testosterone levels than well men in particular, who don’t.
And this has even been seen in elderly men, obese men, healthy and unhealthy. Young and old. Research also shows that a higher carb diet with plenty of healthy fats, a lot of unsaturated fats, mono unsaturated fats in particular, are great for this. You do also want some saturated fat in your diet, of course, but.
As a rule of thumb, probably no more than about 10% of your daily calories should come from saturated fat. Research shows that minimizing stress can help a lot with naturally increasing testosterone levels in testosterone production. And the reason for that is if there’s too much stress, It’s not that stress is bad per se, right?
Acute stress can be great. That’s what we’re doing in the gym. Chronic stress though, where stress levels are chronically high, that can lead to chronically high cortisol levels, which is a catabolic hormone, and that can lead to lower testosterone levels. So cortisol and testosterone have an inverse relationship.
If cortisol levels. Too high, too often, then testosterone production is going to be suppressed. And so if you can do things to bring stress levels down, that is naturally going to bring cortisol levels down, which then takes the break off of your natural testosterone production, so to speak. Vitamin D is very important.
Easiest way to do that, of course, is supplementation. Some studies show a link between increased vitamin D and increased testosterone. It is not entirely clear. If it is that simple, but there are many other reasons to make sure that you are getting enough Vitamin D, and as far as supplementation goes, 2000 to maybe 5,000 IU per day.
Simple gets the job done in most everyone. Next on the list is take a high quality multivitamin. Take a multivitamin that has zinc, that has vitamins a c, E, because research shows that deficiencies or insufficiencies in those nutrients can lower testosterone levels. And if you are in the market for a multivitamin, check out mine, Check out Triumph.
It’s called [email protected] because it has a proper dose of Zi. And A and C and E and D and other vitamins and minerals, and it has a handful of other goodies, phytonutrients, and other things that you are not going to get in your diet. And in many cases, these are supplements that many people buy as standalone products.
Wanted to put ’em all in my mul, in my multivitamin so people could get more from the multivitamin and not have to have eight different bottles in their cabinets. So again, legion athletics.com. It’s called Triumph. And last, but certainly not least, I probably should have said this one first, actually.
Get enough sleep. Get plenty of sleep because sleep deficiency consistently, not getting enough sleep, depresses, testosterone levels, and messes with basically everything. Every important part of our physiology requires enough. Sleep. So make that a priority. Get to bed on time. Make sure your room is, your bedroom is conducive to good sleep.
That can mean different things to different people, but most of us are going to sleep best in a dark room, no light whatsoever. I use a sleeping mask to help with. It’s also important to make sure your bedroom is cool. Most people are going to sleep best probably around 70 degrees, maybe even a little bit colder than that.
Noise can also be a problem. Now, white noise is an exception. Of course. Some people like a little bit of white noise in the background. I can go both ways. I can sleep with and without it. Sometimes I feel like putting on a little bit of white noise and so I do. Sometimes I don’t. My wife hate. Any noise keeps her up.
So I, I don’t have the privilege of sleeping with my wife right now in the same bed because our daughter is four and still insists on sleeping in the bed and she moves around a lot. If I try to sleep in the bed with Romey and Sarah Romey, Rome’s her daughter. I’m gonna be woken up a number of times.
Romy is gonna be kicking me and crawling on me. So currently I’m sleeping in Romy’s bed. But when my wife and I were so lucky to be able to sleep in the same bed together, it was no noise. And another sleep tip that I’ve recently implemented that has helped a lot is I’ve stopped using an alarm unless I have to.
But in my normal day to day, I don’t, because it doesn’t really matter whether I wake up at six 30 or 6 45 or seven, or even seven 15. I would prefer to wake up earlier because then. A little bit more time in my day, and I have a lot of things to do, but I finally stopped using a, an alarm because I found that I need a bit more sleep than I guess I was willing to admit.
Previously I would usually go to bed around 10. My alarm was at six in the morning, so eight hours in bed. I usually would fall asleep fairly quickly, but I don’t sleep through the night, not. Not anymore. When I was younger, I did, but now I’m waking up, eh, one, two, maybe three times on average. Usually to go pee, sometimes for no good reason.
Fortunately, I can fall back asleep, but I’m waking up and so I was getting on average probably seven to seven and a half hours of actual sleep, and I stopped using an alarm, and I found that tonight. And I a whoop. Tracker that they sent me. So that’s what I’ve been using to track my sleep, and I’ve found that without an alarm, I am sleeping about eight hours.
Sometimes I will sleep longer than that naturally. And now I. Am remembering what it’s like to feel fully rested on a regular basis. Again, when I was younger, it was different. I would go to bed 11 30, 11 45. I’d usually be working at night straight up until getting ready for bed. I’d fall asleep in five minutes.
Black blackout, unconscious for. Six and a half, maybe seven. Rarely more than seven and a half hours. I’d wake up before my alarm and be fully rested, ready to go. Not tired, go straight to the gym, train hard, work all day. Do cardio at night. Work some more. I did that. For five or six years until my sleep started to, it was the wakings that started to mess with me.
I started to wake up in the middle of the night. It started with one waking here and there, and then two here and there, and that started, I guess with the arrival of my son is when I started to notice a decline in my sleep. And then when my daughter arrived, I had to accept that I. I just can’t do that anymore.
And so then I started staying in bed for eight hours and now I’m in bed generally probably eight and a half to nine hours to get that eight ish hours of sleep that I need. To feel good. And so if you are currently struggling with your sleep, particularly with Wakings, if you’re struggling to consistently get enough sleep, and if you can not use an alarm, if you can just wake up between whatever it is, seven and seven 30, or even seven and eight and it’s not going to cause you problems, then I would recommend doing it.
And if you do need to be up by a certain. Then maybe if you can start going to bed a little bit earlier. And so that’s what I do. If I have to be up by a certain time, if I need to make sure I’m up by six 30 because I have a call at seven, for example, or maybe at seven cause I have a call at seven 30 or whatever, then I just make sure that now I’m giving myself nine hours in bed.
So I’m just working backward from there. And I find that when I do that, I naturally wake up before the alarm almost every time. And I’m fine. And one other point I should mention, if you are having trouble with your sleep is I noticed that my sleep has improved by getting rid of the alarm and just allowing myself to sleep as much as I need to.
Or if I do need to use the alarm again, giving myself plenty of time in bed. And that’s probably just because it’s a little bit more. Psychologically comforting, to know that it’s okay if I wake up a couple times in the middle of the night because I can sleep as much as I need to sleep, and it’s okay if I take a little bit longer than usual to fall asleep because I’m not literally on the clock, and it has allowed me to enjoy.
My sleep a little bit more, enjoy going to bed a little bit more, and that has had positive knock on effects on the quality of my sleep. Again, as reflected with my sleep tracker, which tracks disturbances. For example, I’ve noticed, for example, that my average number of disturbances, which is not awakening.
It can be, but it’s not necessarily awakening, it’s just where you’re moving around a. That number has gone down since I started getting more sleep and just spending more time in bed. And the number of disturbances per night for me is directly correlated with how rested I feel regardless of the amount of sleep.
For me, if I sleep, let’s say, eight hours total sleep as tracked by the little tracker with let’s say five to seven disturbances, I am going to wake up feeling refreshed, and I am not going to get tired during the day. I’m gonna feel good, but if it is 10 or more disturbances, I am not going to feel so rested when I wake up.
I am not going to feel so good throughout the day, especially as the day drags on and if it’s 15 or more, which happens rare. I’d say on average I’m probably around seven and nobody is zero by the way. There’s nothing wrong with disturbances. It’s normal. But there, there is a problem if it is excessive and every so often I will have the bad night of 15 disturbances and that’s not a fun day by 11:00 AM I am more tired than I was at 10:00 PM when I’m going to bed the night before.
And what I. For that, by the way, which I’d recommend is I just take a nap, a 30 or 45 minute nap. I set a timer. It usually allows me to fall into light sleep for maybe 20, 25 minutes, and that then helps me sometimes feel better for the rest of the day, all the way into the evening. Minimally, it’s usually around 12.
12 or so that I’ll take a nap if I need to, every couple of weeks I’ll have one of these freak white nights and then I will take a nap around noon. It will always get me through up until dinner time or so, so I’ll take the nap, I’ll go do my workout. I’ll feel good, I’ll be able to continue my work.
And in the afternoons I usually have calls. I usually have interviews. I like to schedule my days that way. And if I am not rested and it’s 3:00 PM and I have a podcast interview I’m going to struggle. I’m gonna have to use every ounce of my mental machinery to speak good. So the nap makes that a lot better and therefore more enjoy.
I hope you liked this episode. I hope you found it helpful, and if you did subscribe to the show because it makes sure that you don’t miss new episodes. And it also helps me because it increases the rankings of the show a little bit, which of course then makes it a little bit more easily found by other people.
Who may like it just as much as you. And if you didn’t like something about this episode or about the show in general, or if you have ideas or suggestions or just feedback to share, shoot me an email, mike muscle for life.com, muscle f o r life.com and let me know what I could do better or just what your thoughts are about maybe what you’d like to see me do in the future.
I read everything myself. I’m always looking for new ideas and constructive feedback. So thanks again for listening to this episode, and I hope to hear from you soon.