Longevity University: Health, Peptides & Optimzation

Disclosure: Longevity University is presented by XYRx, a men's longevity telehealth company. Host Milan Costich is XYRx's founder and president.

Milan's labs came back mostly strong: solid metabolic health and the highest testosterone he's ever had. The exception was his cholesterol, with LDL at 169. Dr. Rehan calls it Milan's "bleeding neck," the one health risk worth attacking first, and builds a three-month plan to bring it down.

They get into why total cholesterol alone doesn't tell the whole story, what HDL, LDL, and ApoB each say about plaque risk, and why a coronary calcium score is the first test Dr. Rehan wants before anything else. Then the plan, built on three prongs: lifestyle, diet, and medication. Instead of starting with a statin, Dr. Rehan explains why he'd reach for Zetia (ezetimibe) first, how it works differently, and the side effects he's seen with statins in his own practice. On diet: leaner red meat, fried food, cooking oils, carb quality and portion size, cheese, and eggs. On lifestyle: dropping 3 to 5 pounds of mostly fat over three months.

Milan gets his baseline tests now and retests in three months to see if small changes are enough.

0:00 Intro

1:41 Finding Milan's "Bleeding Neck"

5:36 What Really Drives Plaque Risk

11:45 Start Small: Baseline Tests & the Calcium Score

17:59 The 3-Month Plan: Statin vs. Zetia

24:44 Diet Changes: Red Meat, Fried Food & Oils

31:16 Carbs, Cheese & Eggs

39:19 Exercise & Fat Loss

41:30 Recap: The 3-Month Challenge

Every week, Physician Dr. Rehan Muttalib and XYRx founder Milan Costich on the real science of male longevity: peptides, GLP-1s, training, and recovery.

Longevity University

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Longevity University is presented by XYRx, a men's longevity telehealth company co-owned by the hosts.

No peptides this week. Dr. Rehan just competed at the IBJJF Master Worlds in Las Vegas, the biggest tournament of the year for the Masters black belt divisions, and he expected to win it. He lost in the third round.

In this episode he walks Milan through the whole thing: what his expectations were going in, why this one hurt more than most, and the honest admission that a lot of his self-worth is still tied to winning. Milan, who competed from age ten until his late twenties and later coached fighters, shares his own struggle with the same wiring and how he eventually stopped letting other people define his wins.

They cover the hardest part of losing (walking back into the academy and hearing everyone's advice), the "internal compass" Dr. Rehan uses to decide what feedback to keep, the one preventable mistake he identified (cardio after moving up a weight class) and the sprint and VO2 max plan to fix it, why consistency beats emotion for both athletes and patients on a health journey, and whether the answer is to block out fear or, per Jon Jones and Musashi, to sit with it.

Also: immigrant parents and high expectations, Keenan Cornelius on how one big win erases past failures, Zen in the Art of Archery, and why Dr. Rehan's next goal is making competition day feel like a training day.

Next tournament: October.

0:00 Intro

1:19 What Master Worlds Is

3:03 Expectations Going In, and the Loss

8:47 Handling a Loss Now vs. Before

13:28 Where Self-Worth Comes From

20:47 Why He Started Jiu-Jitsu

24:54 Everyone's Advice After a Loss, and the Internal Compass

28:35 The Real Lesson: Cardio Was the Gap

34:50 Discipline, Staying in Shape, and Cheesecake

41:17 Ignoring Emotions Is a Superpower

44:06 Losing as a Coach, and Letting People Down

50:09 One Big Win Washes Away the Failures

54:15 What I'm After Is Freedom

57:43 Milan's Message to Dr. Rehan

Every week, Physician Dr. Rehan Muttalib and XYRx founder Milan Costich on the real science of male longevity: peptides, GLP-1s, training, and recovery.

Longevity University

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The FDA advisory committee met at the end of July and voted on seven peptides, recommending six of them for compounding at 503A and 503B pharmacies. Milan and Dr. Rehan go through the full list: what each peptide was actually evaluated for, what it does in the body, what people are really using it for, and which one didn't make the cut.

Dr. Rehan also names the one he's most excited about, and it isn't the one everybody expects. It's not BPC-157.

Covered in this episode: what an advisory committee recommendation does and doesn't mean, why FDA-regulated sourcing is the real story for patients, DSIP getting rejected for sleep, BPC-157 for ulcerative colitis and why it creates an environment for healing rather than acting as a bandaid, the Wolverine stack and why it sometimes does nothing, KPV as the stronger anti-inflammatory, Semax for stroke, migraines, trigeminal neuralgia and focus, Epitalon for telomeres and insomnia, and MOTS-c as an AMPK activator and exercise mimetic, including how Dr. Rehan cycles it and pairs it with a GLP-1 when weight loss stalls.

00:00 The One He's Most Excited About

01:19 What the FDA Advisory Committee Actually Voted On

02:42 The 7 Peptides, and the 1 That Got Rejected

06:51 Why 503 Pharmacy Access Is the Real Story

07:58 His #1 Pick, Revealed

08:39 BPC-157: Ulcerative Colitis, Gut Healing, Blood Flow

13:50 TB-500 and KPV: The Wolverine Stack and Why It Sometimes Fails

21:36 Semax: Stroke, Migraines, Trigeminal Neuralgia, Focus

33:42 Epitalon: Telomeres, Sleep, and the Fountain of Youth Claim

38:35 MOTS-c: The Exercise Mimetic

46:22 What Happens Next With the FDA

Every week, Physician Dr. Rehan Muttalib and XYRx founder Milan Costich on the real science of male longevity: peptides, GLP-1s, training, and recovery.

Longevity University

YouTube: https://youtube.com/@longevityuniversity

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Dr. Rehan

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Eight months ago, Farshad's A1C was 6.2. His regular doctor had already flagged it at 5.7, he made changes, and it went up anyway. That's what brought him to Dr. Rehan. In this episode of our new series Longevity Intervention, Dr. Rehan sits him down and reads him the follow-up bloodwork.

Testosterone from the low 300s to 410, and free testosterone from 10 to 53. Total cholesterol from 218 to 202. Triglycerides, the number that told Dr. Rehan he needed an intervention, from 194 to 85. And the one that made the doctor emotional: A1C from 6.2 to 5.6, out of pre-diabetes and back in the normal range. Along the way, Dr. Rehan explains why losing body fat raises testosterone on its own, why he draws his own A1C line at 6, and why his plan for Farshad is to change nothing and retest in three months. Farshad's verdict: he's living proof this works, none of the changes were crazy, and he has family and friends waiting on his numbers before they start. Plus the shirt-off reveal he's planning for his 50th birthday in March.

Every week, Physician Dr. Rehan Muttalib and XYRx founder Milan Costich on the real science of male longevity: peptides, GLP-1s, training, and recovery.

Longevity University

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Milan's bloodwork and DEXA results, revealed live on air. He had Dr. Rehan keep everything sealed until cameras rolled, so the reactions are real. Six months after his last labs: testosterone up from 660 to ??? at age 46, no TRT, on the lowest dose of enclomiphene. Then the number that went the wrong way, and the conversation it forces about cholesterol, statins, and whether the fix is worse than the problem. Plus the six week DEXA comparison, Dr. Rehan's honest take on chicken, the red light bed Milan has been quietly using, a sub-20% body fat goal, and a plan to make the friend group compete on health. Retest is booked for November. And Dr. Rehan's own labs go on the table in a future episode.

0:00 Intro

2:28 What Milan Changed in Six Months

11:29 Testosterone: 660 to 813, No TRT

15:39 Cholesterol and the Statin Question

23:05 The Cholesterol Reveal

27:43 A1C and the Rest of the Panel

31:57 Diet Adjustments and the Chicken Take

39:31 DEXA Results and the Sub-20% Goal

50:03 The Red Light Bed

55:09 The November Plan and Competing on Health

Every week, Physician Dr. Rehan Muttalib and XYRx founder Milan Costich on the real science of male longevity: peptides, GLP-1s, training, and recovery.

Longevity University

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Are peptides safe? Dr. Rehan has heard every fear in the clinic. In this episode, he and Milan break down the three biggest: cancer, addiction and dependence, and allergic reactions. Only one of them holds up.

They cover the BPC-157 cancer debate and what the mechanism actually suggests, the screenings that rule out a preexisting tumor, why growth hormone peptides catch unfair blame, the GLP-1 weight-regain numbers and how smarter titration changes them, Milan's experience dosing down while feeling his best, MCAS and why sourcing is the one risk Dr. Rehan calls truly real, the FDA advisory committee's vote to recommend six peptides, and the needle phobia keeping people out of peptides altogether.

0:00 Intro

1:47 Fear #1: Cancer Risk

15:59 Fear #2: Addiction & Dependence

22:41 Stuck on GLP-1s Forever?

37:19 Fear #3: Allergic Reactions

45:35 Recap & the FDA Peptide Vote

48:49 Needle Phobia & Other Honorable Mentions

Every week, Physician Dr. Rehan Muttalib and XYRx founder Milan Costich on the real science of male longevity: peptides, GLP-1s, training, and recovery.

Longevity University

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Dr. Rehan breaks down the three fundamentals he believes matter most for longevity: movement, recovery, and knowing your own body. He and Milan get into why mobility beats chasing heavy weights, the minimum effective dose of strength training and zone 2 cardio, building VO2 max with the Norwegian 4x4, and the sobering stat behind hip fractures in older adults. All of it adds up to less than five hours a week.

Then they cover the recovery side: what actually makes sleep restorative, how late meals, alcohol, and cannabis sabotage it, a dead-simple approach to nutrition and protein intake, and where meditation fits. They close with the third pillar: learning to read your body's feedback and pairing it with objective data like labs and wearables.

0:00 Intro

5:20 What Longevity Actually Means

7:46 Pillar 1: Movement & Mobility

17:43 Strength Training: The Minimum Effective Dose

24:41 Cardio, VO2 Max & Zone 2

37:51 Pillar 2: Recovery Starts With Sleep

46:22 Meditation & Mental Health

50:39 Nutrition, Simplified

1:01:01 Pillar 3: Knowing Your Own Body

Every week, Physician Dr. Rehan Muttalib and XYRx founder Milan Costich on the real science of male longevity: peptides, GLP-1s, training, and recovery.

Longevity University

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Milan tried TRT the way most guys do: walked into a wellness clinic, got injected the same day, and tripled his testosterone. A few months later it took everything he had just to get out of bed. In this episode, Milan shares the full story of his TRT crash with Dr. Rehan, and they break down what actually went wrong: an aggressively dosed aromatase inhibitor, crashed estrogen, and a clinic that couldn't see him for five weeks when it mattered.

Dr. Rehan explains why he rarely reaches for TRT first, how enclomiphene works as a gentler alternative that preserves your natural production and fertility, and why aromatase inhibitors are being overprescribed at men's health clinics across the country. Plus: the surprising percentage of erectile dysfunction cases actually caused by low testosterone, the labs you should be checking every three months if you're on TRT, and a patient story that shows just how badly unsupervised testosterone therapy can go.

This podcast is for educational purposes only.

0:00 Cold Open

0:23 Intro

1:10 Milan's TRT Story: From Low T to the Crash

8:16 Enclomiphene, Explained

13:14 Wellness Clinics & the Aromatase Inhibitor Problem

17:04 Do You Actually Have Low T?

19:02 How to Do TRT Safely

24:02 A Patient's TRT Horror Story

29:13 Enclomiphene vs. TRT: Milan's Verdict

32:14 Peptides, Testosterone & What's Next

Every week, Physician Dr. Rehan Muttalib and XYRx founder Milan Costich on the real science of male longevity: peptides, GLP-1s, training, and recovery.

Longevity University

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Dr. Rehan Muttalib and Milan Costich get into what happens after the GLP-1. Milan asks the question most people land on eventually: if these drugs cost you muscle along with the fat, is there a way to lose one and keep the other? That opens up stacking, and the single rule Dr. Rehan says matters most, which is never running two peptides that bind the same receptor. He walks through growth hormone secretagogues (sermorelin, CJC-1295, tesamorelin), why he'd reach for those long before anyone touches exogenous growth hormone, what cycling on and off actually looks like, and why the worst-case outcome with peptides is returning to baseline rather than ending up worse than you started.

From there they get into the part nobody wants to say out loud: where people are actually buying this stuff. Dr. Rehan is candid about the gray market, the "research purposes only" loophole, and why the same website can send you two completely different vials a month apart. He explains what he tells patients who admit they're buying that way, what a 503A or 503B compounding pharmacy changes, and how to check whether one is regulated. The last stretch covers the mitochondrial pathway and NAD+, why "calories in, calories out" stopped satisfying him as an explanation for the patients in front of him, whether a GLP-1 should be cycled at all, and what the next generation of these compounds is going to look like.

This episode is for educational purposes only and is not medical advice. Talk to your own physician before starting or changing any treatment.

00:00 Intro

01:51 What "stacking" means, and the one rule that matters

04:15 How many people are actually on a GLP-1

07:10 Why growth hormone has such a bad reputation

11:25 What a growth hormone secretagogue actually does

13:59 Body recomposition and muscle as longevity currency

18:45 Sermorelin, CJC-1295, and tesamorelin

24:54 Cycling on and off, and what happens when you stop

28:47 A word from our sponsor

29:28 Where to start, and how GHRPs stack

31:50 Sourcing peptides and the gray market

36:05 503A and 503B pharmacies

39:13 Adding a third peptide, and when weight loss stalls

42:27 The mitochondrial pathway

47:05 NAD+: IV, injectable, and nasal spray

51:04 Should you cycle a GLP-1?

53:32 What's coming next in this drug class

55:30 Why this is so hard to navigate alone

Every week, Physician Dr. Rehan Muttalib and XYRx founder Milan Costich on the real science of male longevity: peptides, GLP-1s, training, and recovery.

Longevity University

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Two weeks after their last conference, Dr. Rehan and Milan are back in Las Vegas for Milan's birthday and a UFC card that ended in one of the most talked-about injuries of the year: Conor McGregor's leg buckling on his very first strike.

In this episode, Dr. Rehan gives his thoughts on why he's leaning toward a full-thickness ACL tear over a meniscus injury, and what a realistic recovery timeline looks like for a fighter coming back from five years out. After that, Dr. Rehan gives the exact protocol he would put McGregor on if he does in fact need ACL surgery.

From there the guys get into Paddy Pimblett's clinical finish, that fighter's brutal weight cuts, Max Holloway's night, and why "movement practice" athletes like McGregor seem to age better than everyone else.

01:35 Vegas, Milan's birthday & watching McGregor go down

02:41 The diagnosis: why it looks like a full ACL tear

07:14 Realistic recovery timeline & what surgery can't skip

09:26 Where peptides actually help before and after surgery

11:16 The full protocol Dr. Rehan would run for McGregor

13:57 Sponsor: XYRx (code LU10)

14:39 BPC-157 and TB-500 explained

17:17 The drug-testing pool problem

18:48 ACL vs. meniscus & why surgery is unavoidable

22:49 Paddy Pimblett's finish, his camp & those weight cuts

29:48 Max Holloway, the Vegas weekend & Conor's comeback odds

Every week, Physician Dr. Rehan Muttalib and XYRx founder Milan Costich on the real science of male longevity: peptides, GLP-1s, training, and recovery.

Longevity University

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