Reddit AMA #1 Podcast Style, Asking Professionals

Author: AlphaMD

Our first full Reddit AMA podcast video, multiple questions covered pulled from an AMA thread. Individual questions found on our channel's AMA playlist:

Reddit AMA #1 Thread:

This editable transcript was computer generated and might contain errors. People can also change the text after it was created.

Brian Mckinley: Okay. Hey, welcome back. So this is Alpha MD and this is going to be going up on our YouTube channel. Today, we're going to be doing a Ama from Reddit, you posted this up last week, asked a couple of different people to ask professionals their opinion on things. We've gotten some good questions. We're going to go over them today. My name's Brian Garrett is here with me today.

Garrett Soames: Hello.

Brian Mckinley:  And we're gonna go through a couple of these questions, they're going to pop up on the screen as we kind of chat about them. We replied to the thread a little bit we're going to be linking back to that thread probably chopping up some of these later. This is our first video and format doing this. So you know any suggestions you have for us to improve the format that type of stuff in the future, feel free to leave that below perfectly cool. But yeah, let's go ahead and dive right into that. Why don't we Um, so what we have here is someone first question. What's your take on aromatase inhibitors?

Brian Mckinley:  And so there's a couple of things about that. So what it, what is that right? What are a eyes? When you all go on to your tea, you're injecting or adding outside testosterone to your body. Your body likes to maintain a stable environment between testosterone estrogen. It doesn't like when they change. And so when you add more testosterone, your body tries to change that ratio back to the way it was take some of that testosterone turns it into estrogen. AI is essentially tell your body. Do not do that. And in a lot of cases, that's what a lot of people do want, because they're looking to get more testosterone, not necessarily more estrogen, And so there's a lot of opinions on this which is either AI's do nothing Ais. Are good guys, are bad.

Brian Mckinley:  And so what's the opinion of professionals and people who would prescribe it? Well, the answer is that like all those are correct. Those are all correct answers.

Brian Mckinley:  And when it comes down to is personal need because every single person is different, right? So some people, maybe they need more estrogen in their life, where? Okay, they add some testosterone extra. Estrogen is good for them. It turns out, they don't get any of the negative side effects from it, because what it also does is it can improve your mood. If it's the right amount it can help a lot with libido. And estrogen is also responsible for maintaining a lot of other bodily functions that can also help with like weight loss, things like that. And so having a healthy balance of that is quite good and so some people may not need it at all, and it may be beneficial to not prescribe it. Whereas on the opposite side of that.

Brian Mckinley:  Some people don't need it and then do get prescribed. It and what it does is just bottom out there estrogen. So for those people, that's totally not good. Now all of a sudden, you know, they're having libido issues. They can't drop weight. Their feelings, get all mixed up and the third and final one. Someone has a lot of side effects. You know, we have we have patients who, you know, after they inject same day they get, you know, essentially sensitive nipples. Like they have the side effects and the absolutely need it. They take the pill. Those sensitive nipple feelings, go away. There's no concern for any gyno or anything like that. And so what it really is is you need your provider To take a look at that with you us as a TRT provider, our main approach is to not prescribe it, unless people need it.

Brian Mckinley:  Kind of see how you go because again, the thing about bottoming out that estrogen can actually make you feel really bad. And you're not, you're not going to know until you see someone. How they respond to treatment. So, like, one size doesn't fit all on this category. And so for us, it's good. If it's good for you, it's bad. Bad for you. You need someone to look at it AIs are useful. They do what they do, but they're completely separate for everyone. That's our take on it. And I think Garrett's gonna handle this next one here.


Garrett Soames:  Yeah, so let's see. We got a question from pristine disaster 484. And the question was Can a small dose of TRT 50 to 80 milliliters, and I'm assuming he meant milligrams weekly. And small dose of Inflamathine. Not Clomid be used. The reason for the inflamophen is to keep a small number of my production going. Some people say it's useless. The only reason would be to keep other hormones that the testosterone produces like pregnant alone and DHEA etc. So yeah, basically ultimately the the level of testosterone recommended or I should say that this person was asking about 50 to 80 milligrams weekly.

Garrett Soames:  For one that is an exceptionally low dose. The average man converts one milligram of testosterone to anywhere from four to six.

Garrett Soames:  as far as a total testosterone, so a level again, if you were to inject 50, 50 milligrams, you would at best, get your testosterone level either to 200 That's four up to 300 again, that's six. You know, if it were to convert one milligram to six of total testosterone. So what that means, Is that that dose? All it would function to do, would be the suppress your testosterone and since most guys have come in and that we treat our 350 or below you know, 50 milligrams a week would actually make you lower than you were when you first started TRT.

Garrett Soames:  So that's one thing to consider but the the bulk of the question I think mainly would be well if I add something like Clomid or in climate to that regimen, wouldn't it increase my testosterone production and help me you know, make up that difference. So, you know, a lot of guys aren't familiar with Clomid or Chlamathine. They're basically, two two medicines that do the exact same thing. They're both selective, estrogen receptor modulators or you may have heard the term serum. Um, a serum X directly on the estrogen receptors of the hypothalamus and and pituitary glands. Basically.

Garrett Soames:  By blocking the estrogen receptors because estrogen I should say this estrogen is the main feedback mechanism to the hypothalamus that basically says you have enough testosterone. So as Brian was talking about with aromatase inhibitors, you can actually technically increase your testosterone just by having less estrogen attaching and and telling your natural production to shut down. Um, within limits, ultimately. Adding something like, in climate blocks that estrogen from attaching. So, your body still thinks that you're low in testosterone and you produce more testosterone naturally.

Garrett Soames:  You that basically will make your pituitary gland release gonadotropin, releasing hormone, which then elevates the last two hormones in that cycle, which are FSH all stimulating hormone and LH, which is luteinizing hormone. so that's pretty fancy but basically what it means is FSH and LH are what are increased when you take medicines like and climate FSH attaches to the sotoli cells in the testicles and those are specifically for sperm LH or the late excels, which produce testosterone. So you basically tell your testicles by adding those medicines to both in produce sperm and produce testosterone.

Garrett Soames:  Long story short, they are often used as an alternative to testosterone for guys who don't want to try testosterone it. But the important thing to remember with these, these medications is They only work in men with secondary hypogonadism not primary harmonism. Primary hypogonadism. again is is the most common cause about 90% or more of men who have hypogonadism have it because they're testicles just aren't working correctly. So that's primary. Secondary means the pituitary for some reason isn't sending the signal down there to produce more. So what that means is Klama theme clomid which is clomid or in climophen two different medicines.


Garrett Soames:  To increase FSH and LH only working about 10% of men with hypogonals because it only works in men with secondary hypogonals.

Garrett Soames:  so, again, to go back to the original question, There is a one in 10 chance that this adding clomid will actually increase your testosterone level.

Garrett Soames:  And so, there's the only benefit to doing a low dose testosterone, level exogenous testosterone, level plus adding in cloning would be. It might slightly increase. Your testosterone above the baseline, but adding remember adding testosterone already, shut down your natural production. so, ultimately You're shutting it down on one side and then turning it on with the other and even then you're only turning on the testosterone production part in about 10% of men. So

Garrett Soames:  the only benefit and there I should say this. There's not there's really no studies that have been done that. Add a serm to TRT at least, none that I could find in a pretty deep dive on. PubMed. um, the logically speaking having the FSH and LH you know, being released and basically tickling the testicles to keep working, Would suggest that it would be a possible replacement for hCG, which is commonly used in an attempt to maintain fertility. But it's better than hCG because HCG does not help you produce sperm. It just prevents atrophy of the testicles so that you can produce sperm later when you stop to your team. However, if you take something like Clomid,

Garrett Soames: Because of the FSH. Which comes with that one. Remember, hCG only attaches to the LH receptors. because there's the increased FSH, you can technically produce sperm while on TRT, if you add a CERN

Garrett Soames:  so long, long story short, you I have certainly prescribed them together in men who are trying to, you know, have a baby And while on TRT and I have seen that successfully work to maintain sperm counts to a level that will allow them to get a woman pregnant.

Garrett Soames:  And then, the last part of that question, regarding pregnenolone and DHEA testosterone is needed to produce these secondary hormones, like pregnant alone and DHEA, but all those can be supplemented DHEA supplement over the counter Think you could probably get a month's worth for like 12, 15 bucks. Pregnant alone is also over the counter and a pill form. I think you can get that for again under 20 bucks most of the time. So since those are relatively cheaply, supplemented And have no side effects, whereas Clomid and Clomiphene are known to cause problems with vision and other things. I don't recommend, you do it, unless you absolutely are. Can't come off to your tea and are trying to get your spouse pregnant.

Garrett Soames:  But yes, there's no doubt that they Be taken together for the benefit of fertility but not for the benefit of your testosterone levels.

Brian Mckinley: Okay.

Brian Mckinley: That's a very complete answer. More than I more than I knew about Serms and…

Garrett Soames:  That might. Yeah.

Brian Mckinley: related related to that.

Brian Mckinley:  Okay, so we're gonna do this other one. Here we have someone who is asking more about TRT in general in terms of like related to Clinics. So we have do TRT clinics differ in quality of product. What's to separate them from one service and like a traditional health care service and the difference on price. So we got a couple of things there. So on, well, we'll go in this order. What separates to your key clinics from traditional hospitals or primary care practices.

Brian Mckinley:  The thing about primary care practices and hospitals are generally that your medical training when it comes to hormone therapy. Is not always as complete. And as covered, as you would think, a lot of people come to think that like, medical doctors know everything, but the thing, you know, specialists exists for a reason because people who are just trained to be a medical doctor or mid-level provider mean, that they haven't specifically limit trained in something and TRT or hormone therapy or HRT. Might as well be their own specialty. In some cases, they do have their own certifications and training programs, but the people that you see, as your primary care provider, well,


Brian Mckinley:  You know, maybe they've been practicing for 20 years and I guarantee you that they were taught by someone who was also practicing for 30 or 40 years and then retired to teaching. And so, their knowledge on the subject unless they have continued continuing education on like HRT and TRT could be up to like, 50 years old. And, you know, I'll remind you, we've had a ban on prescribing substances like this in the past and so like

Brian Mckinley:  the things have kind of changed over time where a lot of the knowledge is from what you learned today. You know? So TRT clinic right now is going to be more informed generally, at least that's how we feel about it. They're going to be, they're gonna know more about current up-to-date treatments. They're going to be more willing to work with you based on modern knowledge and not like, preconceived notions or stereotypes at some other providers might have which we have had plenty of examples. From patients transitioning, from a primary care to us because they were just not heard, they were misunderstood, or they were dated by what insurance said was allowed. And again, insurance only wants to make money. They don't want to make you healthy.

Brian Mckinley: And so do TRT clinics. Different quality of product. Absolutely. So you see a lot of online TRT clinics like our specifically. We mail products to your house, and what we do is we work with a compounding pharmacy, that we trust, And they have the exact medicine that we're looking for. That will be shipped to you, traditional health care systems, or your primary care. Provider are going to write you a script. They're not really going to be involved in sourcing the material for you unless they're immense health clinic, that type of thing. So

Brian Mckinley:  They have whatever they have in stock, they have the dosage, they have, the, the carrier agent or the castor oil, that your testosterone is held in. You're just at the whim of whatever quality that is for us. We can set the dosage and the strength of our medicine. We can adjust it as needed for patients. If you have an allergy for example, to say what's mixed with it. Because again, it has to come in something, our compounding pharmacy uses grape seed oil. Well, if you're allergic to that we can work with them, have something else made, you know, so the quality does change because we have direct influence and control over it and that's the same for a lot of online trt or mental health clinics. I would always trust them more than just a script that you take to Walgreens. And the guy at Walgreens might not know anything about it or care, you know. so, my take and when it comes to quality of product and price,

Brian Mckinley:  Different prices from different TRT companies. I'll say this, everyone is looking to make a buck right like Obviously we need to function as a business Other companies want to function as a business and it comes down to how much money they're looking to make off of their patients or their products. What corners are they looking to cut and where they spending their money? And so there are a lot of online TRT especially like some very popular TRT clinics that exist out there that charge a lot and do very little with very little oversight. It just kind of depends on you know are they doing a money grab? Are you signing and saying, I have low T, I have no proof of this, give pills and some of them might you know with us we have a very competitive

Brian Mckinley:  You know, pay rate. I would say we are in the mid tier because we want to be accessible to people. We genuinely care about men's health and we want people to have access to us. And, you know, we have this video connection which is why we're doing videos now like we actually see our patients and talk to them. And so the biggest thing when it comes to differences and quality is, you know, do some research shop around for different prices if it looks really cheap. There's a reason for that, you know, it's not that hard to get a license to make your own medications, they might make it themselves illegally. I'm not putting words in anyone stuff, but like, these are things that can happen. I would say Find someone, you're willing to trust a company who has people who like their product, who has good customer service, who has good connection with their providers because you are going to get


Brian Mckinley:  not always what you pay for. But you are gonna get the experience that you choose is a better way to say it. So if you choose someone like us, you're gonna have a face-to-face experience. You're going to be able to talk to us. Our quality of product is going to be superior to someone else's quality of product. That's, you know, that's how they differ. There's a lot out there. It's up to you to choose but be informed, look things up and really see what they look like, really see if they're trying to money. Grab you, you know, go with your gut feeling, but you know, ask other people about it.

Brian Mckinley: So very good question. Thanks for that one and we're gonna transition to more of a medical one here. Thank Garrett's going to talk about TRT and some side effects or or something like that, right?

Garrett Soames: Yeah, yeah. So let's see. This next one that we're looking at. Was someone who basically said he was seen in the ER for pancreatitis and he was wondering if that's a side effect of TRT. The it was written by our stupid earth. Our stupider said, Hey there, thanks for doing this. I've been on for about 18 months with minimal side effects and suddenly over New Years, I developed pancreatitis for the first time, Docs at the, ER, couldn't rule out TRT as a cause, but they didn't seem very knowledgeable. I'm waiting for an appointment with my endo that isn't until the end of the month. Is it possible that this is TRT related? so,

Garrett Soames:  Pancreatitis is extremely common. I used to work in the ER for over 11 years. I probably treated thousands of patients with with pancreatitis most commonly probably eight or nine times out of 10 is alcohol related. You know, have this happening, having happened over New Years, you know, again, you got a question. Well, were you partying a lot? The night before, right? Was a little more alcohol than you're used to. So that's always you know, consideration as far as what causes pancreatitis the second, most common cause it's gallstones, they block the biliary duct and then it that bile backs up and you know, swells up the pancreas. um, As far as drug-induced pancreatitis, it is a known entity. There are quite a few drugs that can cause pancreatitis certain blood pressure medicines certain antibiotics.

Garrett Soames:  And the only hormone that is known and proven to cause pancreatitis is actually estrogen. Um, there's no there's no evidence that testosterone causes pancreatitis. I did a PubMed search just to double check and make sure I wasn't, you know, out of tune or or anything. And sure enough all of that PubMed. There was not a single case study or study that proved or even showed that testosterone can cause pancreatitis. So, I think if, if there's no evidence of that, it's, it's pretty clear to say that TRT was not the cause for your pancreatitis.

Garrett Soames:  In you know in med school they they train you to say Never say never never say always so With that in mind knowing estrogen can cause pancreatitis. I guess there's a slight possibility that other sex hormones could cause pancreatitis. But again if if you if testosterone caused your pancreatitis then you are the very first person that has ever caused pancreatitis in and you should probably get be a case study so you can make some money from the journal. but ultimately,

Garrett Soames:  As you mentioned in your question that you were you were on the TRT for 18 months, prior to your pancreatitis. So typically in drug-induced pancreatitis, it's usually occurs within the first few doses. And so the fact that you tell me you've been doing trt for 18 months, in my mind, completely rules it out as the cause. So, there are idiopathic cases of pancreatitis. Meaning, we don't know. Idiopathic is literally the medical word for You know, so you could have had an idiopathic case, I don't know. But Yeah, don't blame your TRT. You're in Endo will probably tell you the same. But yeah, I think it's safe for you to get back on your your regular dose.

Brian Mckinley: Let's see here. we have another one here, that's a little bit about A little bit about the science. Of some side effects and a little bit about some actual TRT dosing. And I think this is probably the last question that we're going to be having time for in this video here.


Brian Mckinley:  So, there's gonna be a little bit of a little bit of a long one. See here. I think you're mentioning Garrett. You wanted to read this word for words. There's a lot of context here.

Garrett Soames: Yeah, I'll read it out. So Let's see, rde79 writes, Hey, I've been on TRT several years. Now when I first started, everything was great. I received all the positive benefits after a while TRT just stopped working instead of feeling good. I now feel rather terrible after injection. And for the next few days, my body feels achy sore. And I am tired pretty much no energy. It takes a good week or so before I start to feel better, This has happened over the last few years. During that time, I've switched protocols, this includes amount and frequency, reducing The dose has mitigated. Some of these problems. However, I don't get any benefits from TRT.

Garrett Soames:  Some other issues that surface post-injection are tinnitus and a stuffy nose. They both resolve about a week post injection. I've changed carrier oils. I've even tried the cream. Nothing has helped any idea as to what might be going on.

Brian Mckinley: Yeah. So he also goes on to say You know, we asked him a little bit of a follow-up because there's a lot there. We need a little bit more context and you know, he went to say that he's currently taking A testosterone Siphonate 100 milligrams once a week. And then listed off some multivitamins and some other medication that wouldn't be related to this TRT. Um so there's a couple of things going on there. Obviously, this man has tried a couple of different regimens and amounts and it kind of sounds like he's just kind of trying anything to see what might cause a change or what might not cause a change. But let's take a from a TRT. Centric. Look what could be going on with his dosing?

Brian Mckinley:  That might be causing any issues, so we're gonna look at that. So testosterone sniping, 100 milligrams a week. First off, let's say this right. Testosterone cyphenate. Testosterone ethanate. There's many testosterones that are out there and the difference between them is essentially only how many carbon chains are, kind of on the end of the molecule, which means, like how quickly your body, absorbs it and how much of it kind of gets into your body over time, which changes the half-life of product and half life of the product, is, how many days, or how much amount of time before half of what you inject or take is gone. And so, What you have is okay. Well if you're doing a hundred milligrams on this day, you know by the time you reach your half-life and for testosterone cyphenate that's about two to four days depending on the individual.

Brian Mckinley:  and, You'd be down to about half by that, right? So, You would never really want to take a substance like testosterone Siphonate. Where it's half. Life is about

Brian Mckinley:  Half of a week or so, and then take it weekly. Like that is not something we would ever advise someone to do. Because when you take any, any amount of outside testosterone, it shuts down your body's natural production, right? And so that's usually not a problem because the amount that you take is usually going to raise you up higher than what your battery's natural production is providing the first place, which is why you sought out TRT initially. And so, No big deal. But when you do it once a week, what can happen is? You have this big arch of like, Okay, I injected about day, you know, that day or later, it goes up really high and then it starts to come back down. Well, What can happen with that is? It can go lower than what you were before when you started. If you're taking too low of a dose or the frequency is a

Brian Mckinley:  But say incorrect for this medication we would always advise at least twice a week because the idea is buying that three and a half days, we want the next injection to occur so that you never dip below where you were naturally. And it's always this like nice little up bump up, bump up bump and it's a lot smoother. Your body loves smooth predictable, things. It hates it hates peaks and it hates crashes, throws everything off. So, your body's gonna be angry. If you're doing that, regardless of what milligrams are taking it's it's a roller coaster. We don't like that. So, even without the dosage, we would say that like this would cost someone to feel weird because their estrogen and their testosterone gonna shoot up, they're gonna have a lot of emotions. They're gonna have a lot of side effects. They're gonna have a lot of benefits, then, you know, if a week goes before your next injection, you're gonna bottom out, you're gonna feel a distinct difference there, it's not going to feel good.


Brian Mckinley:  and now if we take the dosage into account a hundred milligrams a week, Is typically. Below what we would normally prescribe as a starting therapeutic dose. Um, we shoot for maybe 140 milligrams a week for most patients, when we start out, that's just us, depending on their, their needs, their goals, and their current testosterone levels, that's usually gets people to where they need to be. And again, that's going to be broken up into two injections typically so maybe like 70 milligrams and so A hundred milligrams once a week is definitely enough to shut down your own testosterone production. Suppress it and then have yourself get very little benefits because the dose is so low and then all the negatives of having a crash course going on in your body. So, you know, just that alone without talking about the side effects, that is what I would change about the treatment program.

Brian Mckinley:  This other stuff that's going on, I'll let Garrett kind of talk about that because that's its own separate thing.

Garrett Soames: Yeah, right. So regardless you know like Brian said that dose and the dosing schedule are certainly way off so that's I think that's pretty clear. So it's it's possible you know that rde79 could literally just change up his dose and dosing schedule, he might benefit he certainly would benefit from at least twice a week. Maybe he might be one of those guys that benefits from the Daily like Sub Q injections.

Garrett Soames:  Again, we don't have full context so we don't know if he's tried those those routes but at the very least, we know. He needs to increases dose and increases frequency but those even doing that doesn't really explain some of these other symptoms, the body aches and stuff and feeling, sore and tired. I actually question whether or not his estrogen level, his as also taken a hit. If you think about it, you know, our natural estrogen production. We, it always starts to testosterone and then it's converted to estrogen. If he's if he's only injecting a hundred milligrams, he might be one of those low converters again on average, you can convert 1 milligram to four to six of total testosterone so maybe he has a low conversion and then he also maybe has high sex hormone by any globulins or, you know, high albumin levels. And so his free testosterone may be in the tanks anyways.

Garrett Soames: You know, so total Testoster, we don't know what it is there. And again, if he's not converting his low testosterone into estrogen, he's going to have symptoms of low estrogen as well. So we know low, estrogen symptoms, our body aches, joint aches, fatigue, low sex drive. You know, amongst another, you know, a bunch of other ones. So, all of the symptoms, he describes could literally just be from low estrogen, because he doesn't have enough testosterone to convert. So that's a possibility. The only thing that kind of throws me off,…

Brian Mckinley: Yeah.

Garrett Soames: you know is this tinnitus and the stuff he knows and it is for those who don't know is ringing in the ears.

Garrett Soames:  That's a little odd. You know, in my thought on that matter is, it's possible. You know, it's it's rare but it certainly can't occur. That it could be a different allergy even though he's tried different carrier oils. But there's no way he's allergic to the testosterone itself. Because again, if you were to have an electron microscope and look at natural produced testosterone and exogenous testosterone, they are, you know exactly the same So, the only thing that makes sense to me, otherwise might be actually a cortisol response. Normally, as testosterone goes up, cortisol goes down. And is testosterone goes down. Cortisol goes up. So they kind of alternate.

Garrett Soames:  however, in in an acute stress, response fight, or flight, both testosterone and cortisol both shoot up, you know, like if there were bear or something, your testosterone actually shoots up as well as your cortisol ready to fight or flight, Um, and so in living in a modern stressful society, a lot of people actually get problems with their adrenal glands and adrenal fatigue. So it's possible as he's injecting testosterone, he's been under so much stress so long That it's recognizing the testosterone rapid induction of testosterone as a stress response so his adrenal glands freak out and say, Oh, fight or flight. Here's a bunch of testosterone. Let's shoot up and and release cortisol at the same time. And all of those symptoms. He's describing could also be from this abnormal acute. Hormonal feedback response.


Garrett Soames:  From the adrenal glands, it would suggest that he lives a stressful life and that he needs to you. Do more yoga, he needs to take a vacation things like that, if that's if that's truly what's going on. But beyond that, you know again I hope this guy certainly finds some help. The first recommendation, as Brian said, the easiest thing would be to change the dose and the schedule increase the dose increase the frequency that may sort out 90% of these issues. He may again need some further testing, but again, I think we can say with confidence, it's not an allergy to the testosterone.

Brian Mckinley: Nice. Yeah. And you know a little bit of a wrap up on that one would probably be we would if that was someone who was our patient,

Brian Mckinley:  we would have a lot more context and maybe be able to give more of an exact cancer. We may be able to know. We may order like their free testosterone and kind of follow up on that. We may order an allergy panel and follow up on that. That's probably the course of action we would take. So, you know there there's some avenues there and we do hope for hope for the best. But that's just the advice that we can kind of get without, you know, being able to intervene as as their provider. But yeah, that covers I think what we're going to do for our video today. Thank you guys for watching this and you know this will probably be a full length video as it initially goes up. I'll chop it up and we'll have some probably short answers as well. You know, check our website out down below, We are Alpha MD, that's Alpha We are an online, tier key company. We do you know in person video calls like this noise. Set up. Consultations are free.

Brian Mckinley:  You know, you get your labs tested with us kind of see where you're at if any of these questions resonate with you you know look out for more future reddit threads like this because if this is popular, we're probably gonna do it again. There's some good questions and you know, if you have any thoughts or feedback for the format, you know, feel free to to leave that in the comments down below. But yeah, thank you guys for the questions. Thank you guys for watching again. Brian Stuff. MD Yeah, thank you guys.

Garrett Soames: All right. Thanks guys.

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