Meet Dr. Nate Ruch, M.D.

Dr. Nathan Ruch specializes in healthspan medicine.

As the Associate Medical Director of The Princeton Longevity Center and in his private practice, Dr. Ruch guides patients on hormone optimization treatments, including Testosterone replacement therapy, menopausal and perimenopausal care, and thyroid support.

His experience has been instrumental in helping the Dr. B teams understand the intricacies of testosterone replacement therapy (TRT) for our new longevity program, Optimize It. Here, he offers insight into the patient experience.

Can you describe the type of patient who may not recognize that low testosterone is causing their symptoms? What would you connect that they had not?

Like a lot of chronic health conditions, low testosterone can sneak up on folks. It's almost like going on a two-month-long hike with your friends, and every day they put a little rock in your backpack. By the end of the hike, you're carrying 175 pounds of extra weight. But you don’t realize it because it began so slowly.

For some people who previously had normal testosterone levels, erosion occurs over a long period. It can be a self-reinforcing downward cycle of low motivation and poor exercise results—if testosterone is low, many men will have trouble retaining muscle and recovering from workouts, and their athletic performance will be poor.

So, an example would be a 48-year-old executive who comes in and just isn't performing well—athletically or in general. He’s experienced some body composition deterioration, he isn’t adequately muscled, his strength is low, and his motivation to address those things is low. Then, on lab analysis, he has a testosterone level in the 190s.

TRT can help with body composition, mood, function, athletic performance, business, mental outlook—a whole variety of things. Taking that patient and getting them up to a level that's 75th percentile for their population is transformative. It can change their entire life.

I assume these changes don’t happen overnight. What are realistic early treatment expectations?

The individual experience varies tremendously. But often, the benefits accrue slowly over the first couple of months.

With the first couple of injections, you don't really notice anything. And then, as levels increase, the machinery of your body gets turned on. And then, all of a sudden, your desire to work out is a little better. Your libido is improved. You're noticing some changes in your body—maybe your body composition is improving or your strength is a bit better. Those things don't happen like flipping a light switch. They're slow.

I level set with patients to expect not to feel anything for the first week or two. And that at 90 days, we'll do a check-in to see how they're feeling. And I encourage them to write down in their notes app how they're feeling on each of the qADAM questions. [The quantitative ADAM questionnaire is a screening tool for diagnosing androgen deficiency in aging males.] And then I have them reread that before we talk at day 90. And then it’s like, “Okay, what's the difference? What have you noticed?”

It can be really eye-opening for patients to journal their symptoms and see how things progress over time. Because a lot of times when they take a look back at how they were feeling, it's just a tremendous change.

Especially considering that Testosterone is a controlled substance, what should patients not be concerned about with Optimize It?

Appropriate guidelines are in place, and we're only treating people who have measured low testosterone levels and associated symptoms. What we're not doing is doping or taking people to super physiologic levels that are way beyond normal.

And that's where the dark side of testosterone exists—its abuse in sport, its abuse in bodybuilding and physique communities by both sexes, and the unethical behavior of some clinicians. Those have driven a lot of the action around regulation, and its status is a controlled substance.

On the flip side, aside from things providers will track that increase the risk of complications, what are some practical warnings patients should remember during treatment?

If you were diagnosed with a hormonally sensitive cancer while you're on TRT, you would want to stop treatment. If you had a blood clot or stroke for some reason, you would want to stop it. You would want to be thoughtful about the type of supplements that you're taking and make sure you're not overdoing it.

If you transition between providers, you want to make sure that prescriptions don’t overlap, because some states monitor controlled substance prescriptions, and you can get yourself in trouble.

And when you see healthcare providers or clinicians of any type, Testosterone should be on your medication list. I encounter a lot of men who, for whatever reason, are reluctant to put it on their medication list. But if you're seeing a cardiologist or whoever, it should be on your medication list.

Finally, we’re thrilled to have you advise our TRT program. But what attracted you to working with Dr. B?

The thing that attracted me to Dr. B is how you’re democratizing longevity practices. People with financial resources or physician access have been doing hormone optimization for a long time. But it just isn't available in the mainstream at an accessible price point.

It's been rewarding for me as a clinician to see men transform their lives with their hormones optimized. The ability to make a huge difference in quality of life is definitely here.