madman
Super Moderator
Testosterone levels have dropped more than 25% over the past two decades — and the downstream effects on brain health, cardiovascular function, energy, and libido are only beginning to be understood. Leslie sits down with Shalin Shah, CEO of Marius Pharmaceuticals, to go deep on one of the most stigmatized and misunderstood hormones in medicine.
Shalin Shah is the CEO of Marius Pharmaceuticals, makers of Kyzatrex — the first FDA-approved oral testosterone product that absorbs lymphatically, avoiding the liver toxicity that killed previous oral attempts. He testified before the FDA expert panel in December 2025, which recommended sweeping changes to how testosterone is prescribed, labeled, and regulated in the United States. In this conversation, Leslie and Shalin cover what's driving the global decline in testosterone levels, the difference between total and free testosterone, why the standard ranges may be masking widespread deficiency, and what modern therapy actually looks like across injections, creams, and oral options. They also discuss the Traverse Study — the largest randomized controlled study ever conducted on testosterone therapy — and what it finally proved about cardiovascular risk. Leslie shares her own experience on topical testosterone as part of her HRT protocol, and they talk about why this conversation matters just as much for women as it does for men.
Whether you're curious about your own hormone levels, supporting someone you love, or just trying to understand what's happening in this space in 2026 — this conversation is for you.
Chapters
00:00:00 Introduction & Leslie's Personal Story
00:02:18 The State of Testosterone Today
00:05:57 What's Causing the Decline
00:08:00 Symptoms of Low T & Why You Should Get Tested
00:10:10 Why Your Doctor Probably Isn't Testing You
00:12:24 What's a Normal Testosterone Level?
00:16:20 Testosterone and Women
00:20:00 Leslie's HRT Journey & Treatment Options
00:25:20 Natural Ways to Boost Your Levels
00:30:03 The FDA Panel — What Was Discussed
00:33:20 The Prostate Cancer Study — 3 People, 80 Years of Policy
00:36:30 What Needs to Change & What's Next
00:40:34 Outro
