Dear Mark: Health Framework from Scratch, Balancing Life as a Father, Guilty Pleasures, Health Wearables, and Oral TRT

It’s time for another edition of Dear Mark where I’m answering the questions from the last Q&A for paid subscribers. Let’s go:

Great question. The funny thing is I think my ideas about health and fitness would pretty much end up in the same place because I always start with the principle of evolution and natural selection. Start with what makes sense in the light of the fact that humans are organisms subject to the laws of evolution and the pressures of natural selection. Because we exist in environments that impose filters on our reproductive success, those members of the species that have certain characteristics will thrive and have more offspring. Those with less congruent characteristics are less likely to reproduce, and because everything in biology is at least influenced by genetics, that selective filter I just described determines which characteristics, traits, attributes, and genetic profiles succeed, survive, and reproduce—which ones emerge and are present in the world. What constitutes a healthy human diet, exercise, and lifestyle was written by the winners.

So you start there. You start with the fact that our biology expects a certain environmental framework. And then you must grapple with the fact that the environment is changing more rapidly than ever. A perfect environment for human flourishing never existed in the past and certainly does not exist now. It’s a moving target, but 

So that’s the basic framework. That is the foundation, the infrastructure, the scaffolding. But it’s just the theory. Until you actually test it in your own life, it’s just words and ideas, a hypothesis.

The next part is where it comes together. Now you have to determine what works best for you. Because you are a unique snowflake. You truly are. There is no other human being on earth, past or present or likely future, that has the same genetic makeup as you do. No one has had the same pre- and perinatal environment as you did. No one had the same childhood, the same experiences growing up, and grew up in the same exact spot you did with the exact same family makeup, the regular breakfasts you ate, the shows you watched, the peers you had. All these segments of your development combined with your unique genetics create a unique set of alleles and gene expression that make up who you are. And so you need to apply the principles, the framework, the foundational biological evolutionary prism to your own life, your own genetic makeup, and see how it affects you. This is the n=1 experiment. The experiment of one, that one being you.

The only thing that might trip me up is the fact that so much of my realization about the importance of evolutionary biology sprang from my negative experience as an elite endurance athlete. It took me 20 years to realize that what I thought was my calling, running marathons and doing triathlons, was destroying me. That experience, coupled with my lifelong interest in biology, science, and evolution, led me to the realization that looking to our ancient environment could give clues for what was optimal for our modern bodies. Does that happen without the 20 years of beating my body up? I honestly don’t know.

First question: When I was building my businesses, I had the same priorities as you do. Family and finances were the most important part of my life. I sacrificed a lot too but I always made it to the soccer games, coached little league, ate around the dinner table, took my wife out on date nights, and poured everything left over into business. Where I did sacrifice was in maintaining and cultivating friendships. That definitely suffered, and I’m making up for it now with businesses going well and kids grown up and flourishing. But that is a real sacrifice you might have to make. There’s only so much time and energy and you only get a short time with your kids.

If I had to go back and do it differently, I’d make time to set once or twice monthly meetups with friends. Get it on the calendar so you can easily plan around it without sacrificing quality time with family or focus on your career. Or, and this is what I ended up doing, treat your gym time as social hour. You’re going to be training anyway, why not have some friends along for the ride?

But in essence, you will have to sacrifice something when you’re starting out (and with three young kids, you are starting out). The beauty is that the more you do and the better you get at everything, the more energy you’ll have. The stronger your relationships with your spouse and kids, the more support they’ll give you in your professional life. Time will open up and extend. The sacrifice will be short lived because you’ll get better and better at navigating all the competing responsibilities until, eventually, it turns into a symphony rather than a competition.

Second question: When I'm in France, mushroom truffle rigatoni is often my guilty pleasure.

Bailey's Irish Cream would be a guilty pleasure for a drink.

I don’t Whoop. I don’t use Oura. I don’t wear an Apple Watch. I don’t do any of that. Having constant updates on whether I’m happy or not, whether I’m feeling stressed, or how recovered I am and being led by numbers makes me feel less than human. Over-optimization isn’t benign.

People who are really pushing the limits—whether they’re taking large amounts of performance-enhancing drugs, chasing some elite extreme athletic goal, or trying to get a handle on serious health issues that have been confirmed with lab work—those people should probably pay more attention to the numbers. There’s a case to be made for living by the numbers when you’re in that situation.

It used to be that they weren’t accurate enough. Now they might be too accurate. Sure, accuracy is generally better than inaccuracy, but sometimes that works against you. If it’s so sensitive that it fluctuates wildly because you got twenty fewer minutes of sleep last night, or the half-glass of Pinot you splurged on was 14% alcohol instead of 13, you’re going to be led astray. You’ll be chasing every little shift in the numbers, making spurious correlations between what you did that day and what the numbers said the next morning. Getting noceboed and placeboed left and right.

Sometimes too much information is worse than none.

There is a way to use these devices that I like, and that’s to train your intuition. Pay attention long enough to see what kinds of foods, exercise, sleep patterns, alcohol consumption, or daily walks have on the numbers. Learn what works and what doesn’t, and then stop paying so much attention. When you get the message, hang up.

That said, I have plenty of friends and trusted colleagues, athletes, etc that do get a lot out of the devices. I speak only for myself.

As for Mike Holland, I actually follow him on Instagram. I’m definitely not a morning routine or training guy, but I will sometimes use his 10 minute movement routine as a quick pick me up. It’s a great way to get your body lubed up and ready for the day.

I’m not sold on them. The most common is enclomiphene, a selective estrogen receptor modulator that indirectly increases testosterone by manipulating luteinizing hormone and follicle stimulating hormone to convince your body to start producing more. And the studies show that while it works in certain populations, it does not in people with primary hypogonadism in whom the glands simply don’t make enough testosterone no matter the input. Older guys with a lower innate T production capacity generally do better with straight TRT. The orals may also lower IGF-I, which might sound good to the people fixated on longevity and trying to reduce growth of all sorts, but IGF-I has a pretty significant effect on quality of life, tissue health, growth, and resilience. 

The beauty of injectable TRT is that it just works. It works for anyone, no matter what the cause is of your low testosterone levels. Now the often-cited advantage of enclomiphene is that it preserves fertility because it doesn’t suppress natural production of testosterone. That’s true, but if that is an issue for you with the injections, you can add in HCG, about 250 IU two to three times a week, and that should preserve testicular function, fertility, and size. 

All that said, check with your doctor. They’ll be able to run the labs required to determine whether you’ll respond to enclomiphene or if you should just go with TRT.

Thanks for all the questions, and thanks for reading. Take care.

Mark