About Hone Health
“When people say a good CEO basically works himself out of a job and spends 30 for 40% of his time recruiting, I thought that was a cute kitchen magnet that really probably wasn't real. And the reality is, it actually couldn't be more true.” – Saad Alam
Saad Alam is Founder and CEO of Hone, which is creating an entirely new type of healthcare company initially focused on helping men with low testosterone. Saad describes it as “helping men age with confidence.” Low testosterone is an alarming and growing trend, which is why testosterone treatments like Hone are on the rise. Scientific research has shown that for decades now the level of testosterone in men has been declining. The most alarming statistic is that our generation has around 50% less testosterone than our father's generation, who in turn has less testosterone than their father's generation.
And the reasons behind this are very complicated, but a large part of it seems to be due to growing environmental and plastic pollution, which have caused the level of heavy metals in our bodies to rise while micro plastics in our blood disrupt the production of testosterone and actually spur the production of estrogen. With this context, you would imagine that it's becoming easier to find out if you have low testosterone and get testosterone treatments if needed, but you would be very wrong, which is why Saad Alam founded Hone and set out to revolutionize the way that men are treated for low testosterone.
In this episode, you'll learn why testosterone in men has been dropping for decades and some of the research around that, as well as how testosterone influences everything from your mood to the level of fat your body holds, and even how you sleep. Hone has built a modern direct-to-consumer experience for men to easily test their testosterone level and then get automated at-home treatments that range from an under the skin injection to sublingual mouth drops and even a cream. We’ll cover how Hone is rebuilding the tech stack of healthcare to take what might usually take six months down to mere weeks for their customers.
This episode is our definitive guide to building and scaling a testosterone replacement telehealth company. In it we cover:
- 00:00:00 – Introduction
- 00:02:39 – Saad’s background and the genesis of Hone
- 00:10:12 – Making life whatever you want it to be
- 00:15:12 – Helping men have confidence as they age
- 00:18:25 – What is testosterone, and how does it work?
- 00:24:22 – Non-pharmaceutical treatments for low testosterone
- 00:27:23 – The risks of high and low testosterone levels
- 00:32:28 – The patient journey at Hone
- 00:44:12 – The future of health management
- 00:50:29 – Learnings from building a telehealth company
- 00:54:48 – The importance of hiring people who are better than you
Listen to the episode on Apple Podcasts, Spotify, Overcast, Google Podcasts, Amazon Music, Castbox, Pocket Casts, Player FM, Podcast Addict, iHeartRadio, or on your favorite podcast platform. You can watch the interview on YouTube here.
Our Favorite Quotes
Here are a few ideas we'll be thinking about weeks and months from now:
- “It also teaches you to really be in tune with the things that make you happy once you've reached those initial peaks of your life early on, but you got to run after them. I always tell people that if you, if you're going to be wishy-washy, you're just going to end up floating around and not doing any.”
- “I think that what you find so many people doing is they almost get paralyzed because they think that if they make a career decision or they start to move one way, they're stuck there. And I tell them no, the most beautiful thing about life is you can make it whatever the hell you want it to be.”
- “So much of it is about the discipline and the determination to make sure you can follow a plan that you've put in place for yourself, because that's really the muscle that you're building.”
- “You don't have to know what you want to do, but what you have to do is you have to pick an end goal for one year or two years, and you've got to sprint to it with as much energy as you can muster and be fully committed to it.”
- “These are going to be the simplest things you can do to make sure your testosterone is optimized. Get seven to eight hours of sleep. Don't smoke, don't drink, cut the excess sugars or refined carbohydrates out of your diet, don't play on your phone too much before you go to sleep so there's not excessive blue light until late hours of the morning because that disturbs your circadian rhythm, which doesn't allow your body to heal as well. Make sure you drink enough water every day. Exercise. Do your stress management. If you want, there are supplements like Fenugreek and ashwaganda.”
5 Ways to Dive Deeper
Want to dive deeper? Here the best content we've curated on this subject:
- Testosterone — What It Does And Doesn't Do: This primer from Harvard Medical School is a good place start for the basics of testosterone. (9 Min)
- The Optimal Indication for Testosterone Replacement Therapy in Late Onset Hypogonadism: Go deeper into the science of testosterone replacement therapy with this journal article from the Journal of Clinical Medicine. (30 Min)
- The Future of Aging: In this TED Talk, Ken Arneson covers ongoing and upcoming trends that affect how we age. (16 Min)
- The Ultimate Guide To Biohacking Your Testosterone: 17 Ways To Maximize Muscle-Building, Drive & Anti-Aging: Ben Greenfield has put together an extensive explanation and list of non-pharmaceutical methods to improve testosterone levels and aging in men. (60 Min)
- The Telehealth Era Is Just Beginning: This article from Harvard Business Review discusses the opportunities for improved healthcare that telemedicine brings to our future. (20 Min)
We covered a lot of ground in this interview. Here are links to the stories, articles, and ideas discussed:
- Eli Lilly and Company | Medicines, Science, News & More
- Hypogonadism | MedlinePlus
- Sex hormone binding globulin (SHBG) | MedlinePlus
- Dihydrotestosterone (DHT) | Wikipedia
- Luteinizing Hormone (LH) | Wikipedia
- Follicle-stimulating hormone (FHS) | Wikipedia
- Hematocrit | Wikipedia
- Clomid | Mayo Clinic
Daniel Scrivner (00:06):
Hello, and welcome to another episode of Outlier Academy. This week's episode is part of our Outlier founder series, where we dig into the ideas, frameworks, and strategies used by the world's best founders. I'm Daniel Scrivner. And on the show today, I'm joined by Saad Alam, founder and CEO of Hone, which is creating an entirely new type of healthcare company initially focused on helping men with low testosterone. Whereas Saad describes it, helping men age with confidence. Low testosterone is an alarming and growing trend, which is why testosterone treatments like Hone are on the rise. Scientific research has shown that for decades now the level of testosterone in men has been declining and I'm not talking about two or three decades, I'm talking about 70 plus decades of research. The most alarming statistic is that our generation has around 50% less testosterone than our father's generation, who in turn has less testosterone than their father's generation.
Daniel Scrivner (00:57):
And the reasons behind this are very complicated, but a large part of it seems to be due to growing environmental and plastic pollution, which have caused the level of heavy metals in our bodies to rise while micro plastics in our blood disrupt the production of testosterone and actually spur the production of estrogen. With this context, you would imagine that it's becoming easier to find out if you have low testosterone and get testosterone treatments if needed, but you would be very wrong, which is why Saad Alam founded Hone and set out to revolutionize the way that men are treated for low testosterone.
Daniel Scrivner (01:29):
In this episode, you'll learn why the testosterone in men has been dropping for decades and some of the research around that. How testosterone influences everything from your mood to the level of fat your body holds, and even how you sleep. How Hone has built a modern direct to consumer experience for men to easily test their testosterone level and then get automated at home treatments that range from an under the skin injection to sublingual mouth drops and even a cream you can apply by hand. As well as how Hone is rebuilding the tech stack of healthcare to take what might usually take six months in speed run it for their customers in mere weeks.
Daniel Scrivner (02:04):
You can find the show notes and transcript for this episode at outlieracademy.com/125, that's 125. And you can learn more about Hone by visiting Honehealth.com or following Hone Health on Twitter. Please enjoy my conversation with Saad Alam of Hone. Saad Alam, welcome to Outlier Academy. I am thrilled to have you on to dive into what you're building at Hone, which is where you're focused on men's testosterone, helping men be able to have healthy testosterone. Thank you so much for joining me.
Saad Alam (02:35):
Yeah. I couldn't be more excited to talk to you in your audience, Daniel.
Daniel Scrivner (02:39):
So I want to start because I mean, you have a super interesting background and I want to talk a little bit about the genesis of Hone and how you landed on this particular problem to solve, but can you first talk a little bit about just how you grew up and some of the foundation in your career early on that kind of led to eventually building Hone?
Saad Alam (02:58):
It's interesting because it all in this weird way comes full circle. So I'm first generation Pakistani American. And so my father came here from Pakistan in the '70s and basically earned himself a PhD in particle physics at Stanford. He discovered multiple particles. And really as this young boy, all he dreamt about was figuring out how to use physics to prove there was a God, right? And so that meant he was really smart and he brought my mom here, married her, made her get an education when she didn't want to. And in our house, the thing that was important and only important was, how are your grades? Oh, you got a 98? Why not a 100? And the reality is right as a young brown boy in an American country, all you actually really care about is if other kids in your class like you, you just want to fit in a lot.
Saad Alam (03:48):
And so I was really lucky and blessed to have my parents push on me academically from a very young age. But the way I learned how to fit in was by playing sports. And I was very awkward and I was horrible at the beginning. My parents could not help me out with it, but probably around the age of like 12 or 13, I fell in love with basketball and anything in general that required me to run around and probably hit people a little bit. And so it just became a very big part of I would say my character and identity. And so I went into a join an MPH program, not wanting to go at all dropped the whole thing, actually finished off a graduate degree, ended up going to business school.
Saad Alam (04:25):
And the reality is, I hadn't learned how to think for myself completely yet at that point in time, I was still kind of caught in the am I supposed to go do something in the medical or health field and in large part, there's a deeply theological discussion around that, which is I believed I was buying my way to heaven by having impact in people's lives in this very interesting manner. And it drove a large number of my decisions, frankly. And so I went into a pharmaceutical company. I was responsible for a $4 billion brands marketing. And frankly, when I got there, it was the wrong job for me. I had to take a drug that had recently been hit with a $2 billion fine by the FDA and figure out how to market it. It wasn't what I had thought I was setting out to do, it wasn't altruistic, but God was it am really good learning experience. And eventually went to another healthcare startup. And then I built a company and my first company was based upon my brother having difficulty writing and almost dropping out of college.
Saad Alam (05:28):
And so we ended up building an enterprise level writing platform sold to large districts, ran that for five years, ended up selling the company. And to give you some more background on myself and how the early I'd say athleticism played into my life. I've worked out six days a week for the past 25 years of my life. I eat perfectly. I meditate twice a day. I track my sleep with multiple devices. I have a massive spreadsheet. I've got every device you can probably imagine in my office, in my living room. And it's just a very big part of my character. And when I turned 35, several years ago, a bunch of problems started hitting me. The first one was, my energy level started to decrease. All of a sudden it would be like two o'clock and I'd want to take a nap, which is the complete opposite of my personality.
Saad Alam (06:16):
I could feel my mental acuity and my stamina starting to slip. I couldn't recall very simple facts. I couldn't do simple math in my head like I used to. And then all of a sudden I started to gain quite a bit of weight, right? And I got those dreaded love handles that everyone hates. And then all of a sudden my libido was gone. And that was really the straw that broke the camel's back because I was sleeping right. I was eating right. I was optimizing and doing all the things I was supposed to make sure that I was at the top of my game. But the reality is that all of a sudden I'm asking myself really dark questions. Is this the beginning of me turning old? My father started having real health problems right around the age of 35. Will I be able to provide for my family?
Saad Alam (07:02):
Will I be able to chase after my dreams and build another company? And so you start asking yourself these questions, that frankly, without the right answer, they become like the self defeating negative feedback cycle in your mind of you just chipping away your confidence. And so I went to my primary care physician who at that point was a concierge level doc. So I'd argue like a pretty good physician. He takes my biomarkers. He brings me back and he literally says, Saad, you're a shining example of health. There's nothing wrong with you. But you know what? I see middle Eastern men starting to age a little bit earlier. So this could be the beginning of old age. And frankly, you're a little bit obsessive and so it could just be this millennial essential angst that's getting you. And I was like, are you kidding me?
Saad Alam (07:51):
God, I'm so happy that you went to and did seven years of med school to tell me that. And I said, I don't buy it. I'm so in tune with my body that there's no way that this is happening. And then I started seeing a different specialists and it took me about six months of seeing I'd say 10 or 11 different physicians until I finally met a group of hormone optimization and regenerative physicians. They took a look at that same blood work. And they said, Saad, you have the testosterone levels of an 80 year old man. Now in one hand, you're completely relieved because you're like, yes, I know exactly what the problem is. On the other hand, you hear the T word and you have these images of Frank Thomas or these late night infomercials. And so you say to yourself, wow, I don't know if that's the boat I want to be in.
Saad Alam (08:37):
Now the thing they said next, gave me a lot of comfort. They said a large majority of our patients are younger guys just like you. And that set this trip wire of going and that doesn't make sense. Why are there a bunch of 35 year old guys running around with hormone problems? And when you start digging into the research, and this is going to sound incredibly conspiratorial, what you find is that our father's generation had 25% more testosterone and our fathers had 50% more sperm. And that the reason for it is that there are all these environmental contaminants, the plastics, the PCBs, the fallates, they get into our food and our drinking water, the deodorants we use. And they essentially tell our bodies natural hormone production cycle to cease or the other way to say it is to stop endogenous production. And so when I first read it, I was like, oh my God, this sounds like something like the Handmaid's Tale, like a Showtime movie.
Saad Alam (09:31):
And then you start digging into it. And you realize, actually this is very, very real and you start to understand how the hormone or the HPA cycle and your body works. And you're like, wow, this is a very disturbing thing. And even more disturbing is that a lot of these changes are what they call epigenetics so they can be passed on to your offspring. So theoretically, the next generation, if you had lower testosterone or hormone problems could inherit that from you. And so I went on a treatment and it changed my life, right? Like so much so that I would not be here today. I'd not be building a company if I hadn't figured out how to get my energy and my confidence back. And so I said, all right, I know what the next one is.
Daniel Scrivner (10:12):
Yeah. A company completely focused on testosterone. I want to go back to one of the things that you touched on there that I think is really interesting. And then there's a million questions I want to ask you after that, but just really quickly, when you talk about following some of your parents ambitions, which everybody struggles with, we all grew up in a household, you are taught some things. A lot of us grow up in a household where there's much more modeling or there's the expectation you're going to model. And so one of the things I want to ask is going through some of those experiences, whether it was going to medical school, being in this first job where you learned a lot, but you hated it. What do you feel like you really took away from those experiences? Was it just learning to listen to yourself and do what you want to do? Was there a deeper lesson? What did you take away from those moments?
Saad Alam (10:56):
I guess the first dimension of it is in our culture and religion, there's like, God, your parents, and everything else. And so generally, if your parents want something for you and granted your parents actually do suggest everything out of love. So they actually truly want the best thing for you. But what they think is the best thing for you is also boxed by what they believe or how they believe the world operates. And so generally, if you are an immigrant coming here, you've come because you are an engineer, you are a doctor, probably maybe not really a lawyer. And so generally those are like the two boxes they want to put you in. And they want you to go into the one that seems the most prestigious and makes the most money. And then there's also this concept of your community or people of your religion that you grew up around, your aunts and uncles would be very disappointed in you if you did something other than that.
Saad Alam (11:52):
And so as I got a little bit older, I had to really understand and pull the two of them apart, which is I can exercise my free will, and if I make the decision that's best for myself based upon what I know and I'm the closest to myself, no one's going to care. Like they're still going to love you. And so I think that was the first thing I had to pull apart. I think the other thing too is, and I tell people this all the time, you don't have to know what you want to do, but what you have to do is you have to pick an end goal for one year or two years, and you've got to sprint to it with as much energy as you can muster and be fully committed to it. And generally once you get there, you don't want to give up too early.
Saad Alam (12:32):
So much of it is about the discipline and the determination to make sure you can follow a plan that you've put in place for yourself, because that's really the muscle that you're building. And then once you get there, you can say, okay, I've accomplished this, right? And you're on top of this little perch or this mountain that you've climbed and you can look around and say, what's the next one I actually want to climb? And I think that what you find so many people doing is they almost get paralyzed because they think that if they make a career decision or they start to move one way, they're stuck there. And I tell them no, the most beautiful thing about life is you can make it whatever the hell you want it to be.
Saad Alam (13:05):
And so once I decided I'm not going to finish up with med school, at first, I told my parents and the funniest thing, I had worked up all this courage and I sat them down at the dining table and I tell them and they're like, and all my dad says is but how are we going to get you married? And it's interesting because that was the thing that he was so afraid of. And I was like, listen, don't worry, I'm going to get married, that's going to happen. And I think that very often, what you think is going to be the thing that holds you back, it really isn't at the end of the day, because the way you're perceiving or framing something is very different from the other party.
Saad Alam (13:46):
And I'd also say too that when I went to work at Lilly, right, I was a 26 year old with a huge budget with a huge responsibility, even though it wasn't the job that made me happy am I grateful for that experience because I learned how to run market research. I learned how to make sure I validate large markets and that became a foundational piece of my learning and I applied it every single other place throughout my career. And I got the learning, well, this wasn't really, for me, even though the money was great, I was satisfied. I drove an nice car at that age. I was like, this doesn't really make me happy. And then it also teaches you to really be in tune with the things that make you happy once you've reached those initial peaks of your life early on, but you got to run after them. I always tell people that if you, if you're going to be wishy-washy, you're just going to end up floating around and not doing any.
Daniel Scrivner (14:35):
Yeah, no. It's all said. I was talking with a friend recently who worked in intelligence for the air force and for the defense department. And he told me about this quote that apparently the air force uses where it's all thrust, no vector, just this idea that it's basically a lot of motion, but no directionality. And I love your point about one, you need to pick a direction, two, you need to sprint in it. And then there's a bunch of soft skills that you're learning about how to be disciplined, about how to think about strategy, about how to just literally do the day to day job of moving the ball forward. And then once you get there, you can always reassess, but I love the framework of which you talk about that.
Daniel Scrivner (15:12):
I'd love to wade a little bit into testosterone and what you're building at Hone. But I want to start first by talking about I know Hone is a very mission driven company for you. How do you talk about that mission? And is that any different from how you just describe what you're building to your friends and your family?
Saad Alam (15:28):
Whenever you're building something, you actually choose an entry point that you think is easy to penetrate into scale to demonstrate that something actually works before you work out to your larger mission. Now when I talk to people at parties and they say, what do you do? I could say I have a hormone optimization company that sells kits and testosterone to people. What I actually say I do is I say I help men have confidence as they age, right? And that generally is actually what we do at the end of the day. I don't sell a bunch of medications, I give people momentum in their life so they can take momentum and create change and figure out how to be happy. And I would say the other very real undertone of the company that's beginning to come out, I believe we're about the same age.
Saad Alam (16:14):
And I bet you a lot of our listeners are men or women. I think that we will live until we're 110 or 120. I almost think it is a foregone conclusion. I don't think it's any woo-woo. I watched my father live an additional 20 years on medical advances when he should have passed away when he was 45 or 50. Right? And so I think so many things are happening underneath our feet right now that we're not even aware of it because by the time we get there, it'll just have happened. And so I think if you take your mind and you begin assuming, I'm 40 I'll live until let's even say 110. That means I'll have 60 really good years of life ahead of me, forget about the 10 really crappy years. And what it forces you to do is you fundamentally take the arc of your life that your parents probably had.
Saad Alam (17:02):
You stretch it out and you redefine it. And I think a lot of people don't realize that's the world we're living in. So when I meet a 60 year old and they're like, oh God, I feel so tired. I'm going to retire. And I was like, why? Like 60 is super young right now. Right? And when you can make the shift, it's almost like being given a gift. And what I mean by that is, at the age of 40 now. Right? I feel like I'm in my twenties. I feel like because I believe I'll live so much longer, it's almost like I'm 18 years old with maybe the experience, the bank account of a 40 year old and I can sprint at life just as hard as I would when I was 20, except with a whole lot more direction. And so I think that the undertone is we help people have confidence as they age we're going to be doing, we're going to be building this for women as well too.
Saad Alam (17:51):
And what we're really trying to do is give you the playbook to live as long as you possibly can, but be as healthy and then more importantly is happy, right? Because we went going back to that hope that large piece of it is mindset. And so in large part, probably the life you live, probably the life I live, what we are doing is trying to figure out how to scale that for the everyday person that doesn't have access to maybe some of the doctors you and I have access to, or some of the tools we have access to because the reality is that you can actually do a lot of those things without spending a lot of money. And so that's generally the way I describe it to people. We give people confidence.
Daniel Scrivner (18:25):
Yeah. It's fascinating. I want to talk a little bit about testosterone and maybe pause for a moment and do testosterone 101. And I know you are not a testosterone doctor, although you've spent a lot of time studying a lot of stuff, obviously in this area. The question that I wanted to ask was if you could kind of just lay out what testosterone is and why it matters, because obviously you talk about confidence that I assume that would be the meta benefit you get by having healthy levels of testosterone. But you know, I also know that when your testosterone's low, it leads to low energy that obviously shows up in extra fat stored on your body. You can work out less, you can have less intensity during physical activity. So talk about why is that? And maybe frame up a little bit of what testosterone is and how it works.
Saad Alam (19:09):
Okay. So let me describe the problem we solve and then I'll talk about how testosterone works in a biological perspective and even how it mechanically works in your body. So first thing is, most people believe that when guys are coming to us, they're saying I want bigger muscles and I want better sex. Those are all positive benefits. But the reality is that guys are coming to us and they're saying I can't get on the ground and play with my kids anymore. I can't have a real relationship with my partner or spouse because I can't sit down and have the patience to have a real conversation. They say I can't earn more money for the people I love because I can't go to work and focus so I can get that promotion. Right? So these are deep identity based issues that our guys are coming to us with.
Saad Alam (19:54):
Now that being said, there are testosterone receptors on every one of the cells in your body and testosterone works differently in different cells. But maybe the punchline is, if you have low testosterone, you have energy problems, you have focus problems, you gain weight, you can have libido problems, it's highly misdiagnosed as being depressed. So there are a lot of antidepressants given out to men every single year when it's really just a hormone imbalance, it also leads to higher rates of dementia if you have low testosterone, it leads to more brittle bones. And so the most interesting research that's come out recently is that previously what people thought is that if you take testosterone, you have a higher chance of cardiovascular disease. The more recent research is showing if you were hypogonadal, that is the clinical term for having low testosterone, and you take testosterone, you have fewer comorbidities, you have fewer cardiovascular events, you have lower rates of diabetes, lower rates of depression.
Saad Alam (20:57):
And so the most important thing to think about is if you think about the energy and vigor you had in your twenties, and then by the time you get into your thirties, it slows down just a little bit, but just subtly, not in a very real way. And then by the time you hit your forties or your fifties, you really feel like you've started to kind of lose that extra step. And that extra step can manifest itself in so many different ways based upon your personality, you have to start thinking to yourself, if I wanted to feel like I did when I was younger, I would probably want to replace this hormone. Now, let me give you the biology lesson. And I'm very happy you pointed that out. I am not a medical physician and so this is not clinical physician advice.
Saad Alam (21:39):
So what ends up happening is you have this little gland in your brain. And so imagine if you were to draw a line between your eyes into the base of your skull and that little gland is called your hypothalamus and underneath your hypothalamus, you have your pituitary gland. And imagine the two of those structures combined are like a Thermo stat for all the hormones in your body. Now, what ends up happening is you have this hormone that is secreted from your pituitary gland, it is called luteinizing hormone. That luteinizing hormone travels through your body, into your testes. And in your testes, you have these cells called latex cells and it basically activates them. And once they're activated, there is testosterone that is produced. Now the testosterone does one of three things, actually four things. The first thing is it is what we'll call free testosterone.
Saad Alam (22:28):
And it is available for your body's cells to use in whatever function they need to use testosterone. That's like the most positive one. The second one is there is what we call a bunch of SHBG, sex hormone binding globulin in your body in albumin. And it basically finds that testosterone and it hugs it or it binds it so it can't be useful in your body. The other two things are very interesting. Your testosterone converts in what they call DHT. And so DHT is actually a far more anabolic hormone, or most people actually know it as the hormone that's responsible for men's hair loss if you were predisposed to it. The fourth thing it does is it converts into estrogen. And so estrogen, all men have it. It's actually very good for us. Not obviously elevated levels, but having some in your body is incredibly protective.
Saad Alam (23:14):
Now what ends up happening is that testosterone and that estrogen travel through your body and then your hypothalamus and your pituitary, they sense how much you have of it, and based upon how much you have of it tells them to either secrete more or less LH, there's also FSH, but primarily, really LH is the one that we really focus on. And so as you get older, let's call it from 30 onwards, your body begins losing its natural ability to produce one to two percentage points of testosterone per year. And so with that, the way that really manifests itself is those latex cells we talked about in your testes, just imagine they slowly start to shut off.
Saad Alam (23:53):
And so by the time you're 40, you have lost ability for your body to naturally produce 10 to 20% of what you could produce when you're in your thirties, by the time in your fifties, 30 to 40%. And so based upon what your hormone and markers look like your age and also your fertility desires, our physicians can actually get a pretty accurate reading and understanding of what we should do to help restore you back to youthful levels.
Daniel Scrivner (24:16):
I mean, that's fascinating. Thank you for that overview, you did a much more thorough job than I expected.
Saad Alam (24:21):
Daniel Scrivner (24:22):
No, that was amazing. No, it's amazing. That's what I love. I want to ask a couple of stupid questions. And one of the stupid questions that I wanted to ask was I'm sure a lot of men come and just think, okay, I have a low testosterone, but maybe if I just go harder in the gym, maybe if I just lift heavier or do more cardio, there're natural things I can do to elevate my testosterone. I would imagine that's probably true, but it can't make up for the deficit that they might have in testosterone. Talk a little bit about are there natural things that people can do and what are the limitations there?
Saad Alam (24:55):
Oh my God, yes. So I'm very happy you brought this up. What we always tell people to do, and we give them a bunch of life science counseling alongside of this. And this is also important because I don't want people to think we're a testosterone male that gives testosterone to anyone. You actually have to be clinically proven to have testosterone deficiency in two separate occasions in order to even qualify for a treatment. And so there are a bunch of guys out there that are upset that we don't qualify them because frankly they don't qualify. But this is important. These are going to be the simplest things you can do to make sure your testosterone is optimized. Get seven to eight hours of sleep. Don't smoke, don't drink, cut the excess sugars or refined carbohydrates out of your diet, don't play on your phone too much before you go to sleep so there's not excessive blue light until late hours of the morning because that disturbs your circadian rhythm, which doesn't allow your body to heal as well.
Saad Alam (25:52):
Make sure you drink enough water every day. Exercise. Do your stress management. If you want their supplements like Venue Greek ashwaganda, are they an absolute silver bullet? No, not at all, but will they help your body naturally improve it? Do they have research backed efficacy studies to demonstrate their work? Yes. Also, very important to understand that, Daniel, what your body may need versus what my body may need to naturally improve our testosterone levels. Very different based upon the individual. And another easy one, if you haven't been doing compound exercises, squats, dead lifts, or bench presses that activate some of the bigger muscles in your body, you probably should because those can also help improve your testosterone levels naturally.
Saad Alam (26:40):
There are a couple of limitations. First one being is if you are one of those guys that has very low LH levels, because maybe you live in an urban area, there's a ton of pollution and they've naturally been depressed because there's so many of these estrogen plastics running around in your body, you can do a lot of those things, but it's really not going to improve it the way you need to because there's probably some medical intervention that's necessary. The second way that's also a little bit harder. Let's say that your bodies' latex cells have started to shut off a little bit prematurely or they're accelerated due to your genetics, no matter how much of that stuff you do, there will probably always be a deficit, and in those cases you have to take testosterone exogenously.
Daniel Scrivner (27:23):
Yeah, it's fascinating. Another stupid question that I would ask is you talk about lose men losing testosterone and this fact that from the time you're 30 to the time you're 40, you've lost say 30 to 40%, it's that power of compounding where it's a small number every single year, but then you multiply that over a decade, it's a pretty big departure. You know, when I hear those numbers, it certainly sounds alarming, that decade by decade you're losing another third, another third over your ability. Is there anything negative about having elevated testosterone levels as you age? Because just at a high level, it sounds like, well, why shouldn't everybody have more testosterone as they age to help with things like bone brittleness, mental acuity, all of those things?
Saad Alam (28:03):
There's a threshold, right? Meaning generally, and this is a little bit archaic because it's based upon population studies that also are looking at bell curve distributions, but generally, a healthy testosterone level is between 900 and 300 nanograms per deciliter, regardless of age. It shouldn't be a true statement, but that is a true statement according to the medical community. And so some guys will naturally run at 1200. Some guys will naturally run at 1800. Some guys may run at 2000. I met a guy at a conference that ran at 2100 naturally. Right? And I think that one, you have to understand what is the trend line of your life. Did you normally run at 2100 and now you're running at 1200? That's a 900 point decrease. And for you, even though you're above the threshold, it's probably unhealthy. Or I would say you're feeling the effects of low testosterone and you should be elevated.
Saad Alam (28:59):
Versus someone else might naturally run at 400 and if you took them from 400 to a 12 or 1300, you probably put them into a little bit of a red zone. I want to make sure that I say that there's a gray area here based upon the individual. If your testosterone level is too high, it can actually present some longer term healthcare problems if they're not supposed to be there. And when I say not supposed to be there once again, you have to look at the trend line and think about where you were previous in your life. There are certain side effects, right? And this is really important. A lot of what we spend our time doing, we are, we kind of like call ourselves the most conservative clinic out there about 15 to 20% of guys. They have an elevated hematocrit number after they take testosterone. It is the overproduction of red blood cells.
Saad Alam (29:45):
Now, one could say that doesn't seem like a big deal because when you live in elevated parts of the world, you have more red blood cells, they help you carry more oxygen. That's actually what a lot of runners do. But the problem is when you have an elevated hematocrit level, you theoretically could have more cardiovascular events. Or if you had an operation, you could bleed out a little bit easier. And so I'm one of those guys, every six months, I have to go donate a liter of blood, right? And that's the easiest way you solve it. And that would be the biggest issue, which is if your testosterone levels are elevated too high for a prolonged period of time, there could be some real cardiovascular events that could happen.
Daniel Scrivner (30:24):
Yeah. I want to ask maybe one more question and then talk a little bit about the patient experience for someone going through Hone. But the question that I want to ask, just to ask again, it's probably a stupid question, but I want to ask all the inverse questions. So we talked about having healthy testosterone and obviously some of the issues that can come if it's some of the risks of being more elevated. On the flip side, are there any benefits to being low testosterone? And I know it's a dumb question.
Saad Alam (30:51):
I'll say this, I actually don't think I can speak intelligently, or I would say fact based on whether having low testosterone is good. But what I can say is if you have low testosterone, let's say you're underneath that 300 nanograms for deciliter threshold, but you do not have symptoms, meaning you don't have low energy, meaning you don't have libido problems, meaning you can focus fine, you shouldn't worry about it. And it's really important that people don't just chase the number that the physician is giving you, that they holistically take a look at what's happening with their life right now and think about, is this something I actually want to spend time optimizing? If there's no problem, there's no problem, there's no problem. And I'll maybe even use myself as an example. I learned that I had a testosterone level of about 180 nanograms for deciliter, which is very, very low.
Saad Alam (31:44):
I went to 400 on my first go around using a fertility drug that naturally increased my testosterone level. I felt good, but I felt like I'd feel a little bit better. And that's so much of what we do is helping people think through the qualitative aspect of this. I then went to 600. I felt absolutely wonderful. And then I said, doc, fuck it, sorry, I shouldn't have sworn.
Daniel Scrivner (32:05):
No, you go for it.
Saad Alam (32:07):
Okay, good. I said, let's go to 800, then let's go to 1200. And the problem is the higher I went, I had to be very Honest, I just felt over stimulated and I didn't like it. And so interestingly, my sweet spot is between 600 and 650. And that's where I keep my testosterone because after two years of playing with it enough, I said, that's where I want to be and that's where I feel more comfortable.
Daniel Scrivner (32:28):
Yeah. It's so interesting. So I want to talk about before we go any further pause for a second and talk about the patient experience of Hone because we've talked about obviously just a couple of assumptions that may not be true, so you can push back on these, but I'm guessing people are finding out about Hone thinking, well, maybe I have low testosterone or I think I do, maybe I have some of these symptoms, I'm mentally foggy. I'm starting to get a little bit more fat on my body. I'm not super confident. They go and look out Hone and land on your webpage, from there through getting set up with the treatment. And again, you said you're the most conservative clinic. So it sounds like not everybody obviously gets approved. What does that experience look like? And then we can talk about some of the pros and cons and go into it a little bit deeper.
Saad Alam (33:09):
So let me quickly take a second and pause on the experience I went through, which is indicative of the problem a lot of other people go through. They're, 35, 40, 45, 50 years old, their primary care physician laughs them out of the room or tells them they have depression and they go, holy crap, that's horrible. Maybe they take an antidepressant or maybe they don't listen to the physician. They then go through five or 10 more years of just slowly and progressively getting worse, thinking it's just old age. They finally go to a specialist, that specialist tells them to get their blood done. They've got to go somewhere else to get their blood done. They, again, got to go to another specialist because that first specialist wasn't going to be able to help them. And they ping pong around the healthcare system until they finally find someone that says you have low testosterone, but very often they're going to say I won't treat it because they don't get reimbursed enough and so you end up at a testosterone clinic.
Daniel Scrivner (34:00):
All the things that are wrong about the medical system.
Saad Alam (34:04):
All the things that are wrong, there's no coordination of care. There's no one that's really looking over your back to make sure that you get the best care. And then what ends up happening is if you go to a testosterone clinic or even your physician's office, you're going in generally every single week or two times a week for a shot, just a horrible experience and it takes a ton of time. So the way we do it is you basically purchase a kit from us for $45. Kit goes out to you, prick your finger, and you're going to give us eight drops of blood on what looks like a fancy piece of filter paper. You're going to give us those drops of blood and you're going to send it to one of our labs. Our lab's going to analyze that for eight different hormones. Once the hormones have been analyzed and assuming that your sample came out fine, which comes out fine about 94% of the time, we then do a 30 minute audio visual consult, which is basically just a FaceTime consult with a hormone optimization physician that is licensed, right?
Saad Alam (34:56):
So they are either endos, euros, hormone optimization specialist, someone that has to have had 10 to 15 years of experience specifically with this particular problem. You spend the first 10 minutes just talking about yourself, right? And it's actually a very cathartic event for a lot of guys because they've held so much of this inside of them and they've never had a chance to express how they're feeling. And our physicians really tried pulling. The next 10 minutes are spent, well, here are your biomarkers and let me educate you on what's happening in your body. Then the last 10 minutes are, well, here are your different treatment options. If you don't qualify for testosterone, you don't qualify for testosterone. It is what it is, but there other ways that we can help you. We're also now getting into longevity medications, we're getting to other energy medications.
Saad Alam (35:37):
And so maybe we can help you there. But then let's say you qualify for testosterone and you actually want a controlled substance, highly regulated. Some other clinics will just send it out to you. We say, I know you're going to hate this, but we're going to ask you to do another blood test. So then you have to do another blood test. Give us a little bit more blood. And basically we check to see is your testosterone low in a second reading. And also we take a look at all the safety markers. Is this safe for you to take? We then make sure the medication gets sent out to you. Every 30 days you get a new script of testosterone so there isn't an ability to abuse it.
Saad Alam (36:12):
And then on the 90th day, you actually have to do another at home blood test or you can go to a lab core followed by another physician consult that is an audio visual consult, right? And we do that every 90 days for the first year. And once we've "dialed you in and you figured out what works for yourself," then we reduce it to 60 days. But it is a very intensive handholding exercise that we go through with our patients.
Daniel Scrivner (36:35):
And I know just looking at the site that there're different ways that people can take testosterone. I know obviously talked about getting injections. It looks like there's even some stuff that you can take like a pill. I may be getting that wrong, but talk about some of the different ways that people can, I guess, ingest or take testosterone.
Saad Alam (36:49):
So we have three formulations. First formulation is a subcutaneous injection that's delivered essentially through an insulin panus with diabetics you use, you go into the subcutaneous fat of your belly. Painless, I did mine this morning. Second way is what they call a troche. That's the little pill that you're referring to, it is an under the tongue sublingual pill that kind of tastes like a Starburst. You put it under your tongue or you put it in your gum or the third one is a cream you put on the inside of your arms. Maybe you put it on your testes. That's where it's absorbed the best. Now I always ask people this, what are the proportions that you think we sell of each?
Daniel Scrivner (37:26):
That's a good question. I would guess not as much of the needles and I would guess a lot of the creams and lozenge.
Saad Alam (37:33):
Well, hold on a second, we guessed that too. We said the most invasive one is the one we should sell the most of, it's actually the opposite. 95 to 96% of what we sell are subcutaneous injections.
Daniel Scrivner (37:46):
Wow. Is it more effective?
Saad Alam (37:48):
Interestingly, the creams are the most efficacious, but the problems with the creams is you've got to put them on at night or in the morning. And the other problem is that there's like this concept of transference. So if you have a child and you put it on your arms and you're playing with your child, they can get on your child and your child can grow a mustache.
Daniel Scrivner (38:06):
Probably not great.
Saad Alam (38:07):
Well, yeah, when you have a four year old running around with a full beard, sometimes your wife could grow a mustache as well too. If you have a partner it's probably a little bit different. You probably one everyone having more testosterone, but most guys opt for the injection because it provides the single most stable concentration in your blood. And you only have to inject usually once a week, sometimes twice, but really with those insulin pins, you don't really feel it.
Daniel Scrivner (38:35):
So I'd love to talk a little bit, you walked us through your example of what you felt like before and what you felt like after and you had talked about this six month period where you were going through those initial changes and it sounds like you kind of optimized it further from there, but maybe walk us through two things. One would be how much time being treated does it take for someone to really start to see and feel the differences? And then two, what are the most common deltas of before and after and how big of a delta is that for most men?
Saad Alam (39:07):
So I'm going to give you my personal example because my personal path was a little bit different from most, but I can speak to it because we see the data and talk to patients every day. So when I initially got on, I opted to go on a fertility drug called Clomid that actually naturally increases that LH signal because of my age, because I actually believe that less is more. And I think most people don't realize it, that you want to take the least amount of any medication that you have to in order for it to be just successful enough, because the moment you take too much, the cells in your body start to down regulate and then you have to actually take more of that medication. So I went on Clomid and so Clomid took about a month and a half to work and it started with me sleeping a little bit better.
Saad Alam (39:52):
And then I started to notice that I had a little bit more energy, but honestly it was a very gentle feeling and it took a long time. I then switched from Clomid probably about six months in to subcutaneous testosterone injections. The average testosterone dosage that our physicians provide patients to get started is about a hundred milligrams per week. I take 50 milligrams per week. And just to give you a point of comparison, if you were a bodybuilder, trying to get jacked for a competition, you'd probably be taking a thousand to 1500 milligrams per week. So right. You're talking about 5% to 10% of what a bodybuilder would actually take in a very carefully controlled environment. Now, most other guys that just start strictly on testosterone, they will swear that within two weeks they're feeling differences and we can pull out testimonial after testimonial of guys that literally say, I always thought my life was over.
Saad Alam (40:48):
And now I'm literally at the point where I feel like I have a second win back in my life. So that's, that's your first question. Now in terms of the data, right? It's interesting. When I go out to raise capital, people always say, so you're building a testosterone clinic in the cloud. I say, absolutely wrong. We are building what is arguably the most complex and sophisticated longitudinal patient management system in the cloud. And so because we get biomarkers to the beginning, a lot of self validated questionnaires from the patients we can begin looking at what do the deltas look like over time? So generally, and this is on average, I'm putting this in air quotes, a patient comes to us and they have a starting testosterone level with about 280 nanograms per deciliter, over the course of six months of treatment. They usually go from a 280 to about a 620, right?
Saad Alam (41:32):
So you're talking about a 340 point delta. But then the other thing that we track, which is even more important, something called a qADAM score. A qADAM score is a validated questionnaire that they use in neurological settings to determine how you feel as a man, the strength of your erection when you're having intercourse, how often you sleep after you eat, how much energy you have in the day. The qADAM score on average increases about 22%, right? Which doesn't sound like a lot, but it's actually a massive number. The other number that we track, and this is, we got very lucky that we decided to do this at the beginning is a PHQ9 score. And so a PHQ9 score is a depression related score. And so what you actually see is on average, a guy's depression score improves by about 30% over that period of time as well, too. Right. And so as much as I like the testosterone number, I kind of care more about the qualitative measures of how your life is improved more than anything.
Daniel Scrivner (42:32):
It's huge. I'm going to leap ahead for a second. You know, you talked about at the beginning that right now you're doing this for men. Obviously, testosterone I love the way you framed up the beginning. Testosterone for a lot of men is something you know about something you don't really talk about. It seems like mostly shady infomercials or the things that at the gas station, near the counter, all the weird looking pills that you can buy to try to boost it is kind of a taboo topic you, and so you're focused on men for right now, but you talked about ultimately also expanding to be able to focus on women. I'd love to talk a little bit about I assume you haven't gotten there yet, but one of the things I'm curious about is does estrogen have the same input into confidence that it does for men and/or is it just a very different type of hormone? And is it completely different in terms of how that feels and how that changes as a woman age?
Saad Alam (43:19):
So, unfortunately, I can't speak intelligently to it because I'd say that I don't know how it feels in me. And I don't think that we have enough clinical experience yet in that particular area. The only thing I can say is that the way doctors will describe men versus women is men are dense and they're binary. And what I mean by that is that when you treat a man it's like an on and off switch, you literally switch it on, you switch it off. When you're treating women, because they're so much more in tune with their emotions and have so much more clarity over how they're feeling, and because you're also modulating, not just estrogen, but for other hormones, it is far more of like a knob turning game that requires a lot more refinement than with a man. And so there is a different infrastructure, different care delivery model that has to be delivered.
Daniel Scrivner (44:12):
Yeah. Yeah. Amazing. Well, I will be very excited once you've rolled that out to be able to have you back on and we can talk about that side of the business. I want to ask a couple more questions around as I was preparing for this interview, one of the things that was very clear is that Hone is a very clear example of what the future of healthcare looks like or the future of health management. Because I feel like healthcare is kind of a polluted word. At this point, it doesn't really mean what most people, it has a lot of baggage with it. You know, you talked about the experience you went through of which is obviously far from ideal.
Daniel Scrivner (44:43):
I mean, it's literally an absolute disaster to go to your doctor and then have to ping pong between different specialists and no one wants to treat you. You have to have an enormous amount of willpower just to push through that and end up getting to a solution. You know? So you have that moment, you start thinking about how you might do that differently with Hone. One of the things I was curious about is, what was very clear in your mind that you wanted to do differently from day one, meaning before you founded the company, what were some really strong ideas you had about what the patient experience should look like and feel like, and have any of those changed or do you feel like you were directionally pretty spot on in terms of what needed to change in the way men were treated in regards to testosterone?
Saad Alam (45:20):
I think that the biggest problems we sought out to solve were as a busy adult, it is very difficult to go to multiple places and to coordinate all the different care that you were getting. Right? I would argue that just frankly, the time you spent driving to a physician's office, waiting in a physician's office, speaking to them and granted, right? When you speak to them, these are three or four minute conversations. You're out the door, you've got to go give your blood somewhere else. You're waiting for that result to come back because the doctor wants to get reimbursed more. You're going back to the office to have that consult. If you're going to a specialist, you're then getting a specialist recommendation, you're then waiting two or three weeks, maybe a month for a specialist appointment if they're even taking new people and you got to get there, right?
Saad Alam (46:07):
The whole cycle repeats itself. And the reality is the moment the primary care physician lets you go, you're done. Right? And so if you were to call your primary care physician, say, I have a question. They'd be like, I just saw 300 patients today. Like what am I supposed to do? Like realistically, like I saw 150 patients like I remember you and I would argue, the healthcare system when you were generally with your practitioner because they care, they're generally very good moments, but it's getting to those moments that take a lot of time that are difficult. And the other thing the conclusion I've come to is where healthcare breaks down is in the transition from provider to provider. And the way information gets passed on in a way that is quick for the other person to consume digest and then do something useful with.
Saad Alam (46:53):
And so what we really sought out is we said, we want it to be the most inconvenient experience. So you can do it while you're in the comfort of your home. You don't have to go into a physician's office. And we actually openly acknowledged that in order to change the care model to the way that we want it to eventually become, you've got to take physicians that understand hormones, let them initially give their 10 or 15 minute consults, watch what they're doing and say, nope, we want you to insert this next piece of information. We want you to bring in this next question. We want you to change the experience this way a little bit. And I'm, I'm very lucky because the team I have, my co-founders are all kind of like I'll say have scaled companies, very large, all health healthcare experience cared deeply about it.
Saad Alam (47:33):
And we are all consumers ourself of it. And so a large part of what you're going to see or you're going to see how you're going to see the company evolve is, we just started adding longevity medications, which most physicians don't know how to prescribe. We are focusing primarily on how do we give you more energy, right? So you can do something useful with it. And the next bolt on is people think that testosterone is a very easy and linear therapeutic category to treat, right? I go get my blood test. I get my meds. I get my next blood test. It is arguably the single most difficult telehealth business to build bar on. I know I'm all inside and out and it's because of the at home testing component, making sure you get the patient to be compliant, sending controlled medications titrating every 90 days.
Saad Alam (48:18):
It is an absolute mess that we've spent $2 million building a custom EMR just to make sure we can handle patients. Now, the beauty of it is, once you spend two years going through the difficult process of figuring out all the paper cuts of the business and fixing them with a technological solution. You then say, okay, what's the next therapeutic category that's really hard, and how do we combine them? And so the next one will go after is thyroid, right? Another eight biomarkers. Then it is medically assisted weight loss. And so really the way healthcare should look is Daniel, you come in as a patient, right? You're not a medical professional, we can't expect you to be. All you can tell us is tell me how you're not feeling good, well, I'm feeling tired. I'm feeling like I'm a little bit depressed. Maybe I've got to BMI that's three points higher than it should be.
Saad Alam (49:04):
I'm carrying some fat around my waist, and it should be our job to say, okay, normally you'd have to go to six different specialists to go treat those problems, don't worry about it. Let us collect all your biomarkers and let us make sure that we have the internal expertise to understand all the nuances of those biomarkers. And then let's put together a program that is sequential nature, which slowly pulls off each of the symptoms in a way that provides you with the least amount of treatment necessary. Versus you going to this doctor and this doctor and this doctor and this doctor, and getting four or five different medications. And that's really the way we're beginning to move because at the end of the day, our goal is to get you symptom relief as fast as possible so you can just get on with your life.
Daniel Scrivner (49:46):
Yeah. I mean, I love that framing in terms of what the experience should look like, because I definitely agree, and I've interviewed quite a few founders in this space. Recently I talked with Adrian, who's the founder of Forward, who also has a lot of just really interesting ideas and it's kind of at the forefront of creating this new version of healthcare. But one of the things that's fascinating is there's sick care, which is really, I think what we have today, which is our medical establishment does a fine enough job if you have something wrong, to be able to go in and get diagnosed, and obviously, not everyone's experience is ideal, but what seems completely missing is a health care, something like what you're providing, where you go in, you talk about the things that you're not feeling great, or the things you'd like optimize.
Daniel Scrivner (50:29):
And a doctor can help you move the needle in a positive direction, as opposed to just downside mitigation. I want to ask just maybe two closing questions and then we'll wrap up. And this is one of those interviews where you've been amazing. And I could talk with you for another hour, but I want to be respectful of your time. The first question I would ask is just, what do you feel like as you look back at the last two years of building this business, what do you feel are the biggest lessons that you've learned? And these may be ones that were especially painful. These may be ones that you did something right from day one, and didn't really know why, but you locked out. What are some of those big key lessons you feel like you've learned building Hone so far?
Saad Alam (51:05):
If I had known how difficult this business was going to be to build going into it. I don't know if I wouldn't have built it. I would've thought a lot harder. Right? I actually paused for five months building the company because I was afraid of the legal and compliance and regulatory challenges around it. And we brought in the best council on the country. It's Nate Lockman from Foley, and I felt comfortable there. But I think we got lucky. And honestly, there's so much luck in this journey. One of my co-founders, he specializes in building I would say very complex software for really I'd say difficult businesses. And what we had to spend so much time doing was being part of the business ourselves on a daily basis, helping with the patients ourselves directly, and basically making sure that as we learn how to do something manually and right there was something we would do 1500 times manually.
Saad Alam (52:05):
You then build the technology solution and then you got to test the hell out of it and then build the next manual thing. I think that a lot of people, when they come into telehealth, they think, oh, I'm just going to go pull an EMR off the shelf, I'm going to use someone like Truepill to get my meds and I'm going to paste it together via API. I'm just going to push patients through the experience and spend some money on Facebook. That's not healthcare, that's bullshit. I mean, I don't mean to say that like they're providing good and they're helping patients. But the reality is that you're not creating anything that's differentiated, that's going to stand the test of time and someone's going to come eat your lunch because you haven't done anything different that's difficult. And I'd say now going through it, when people tell us they're coming, they're going to build a testosterone company.
Saad Alam (52:46):
I say, listen, God, bless you. Go for it. Like you have no clue what you're signing up for. And I think it was really having founders and a team that is so mission driven that we were like, hell or high water, we're going to figure this thing out. I'll tell you, there was a time when we were selling a lot of testosterone during COVID and our pharmacy came to us and they said, you broke us. And you're like, what do you mean? We broke you? And they're like, well, we can't sell you anymore testosterone because we've never had someone order so much this quickly. And we're like, why didn't you tell us that before? That's crazy. And they're like, well, we didn't know. And so here you are about to run out of testosterone. You've got like at this early point in time, 1500 patients, you're like, how do I solve this problem?
Saad Alam (53:28):
And everyone just jumped in. They picked up the phones and we called 1500 patients, apologized profusely, found another pharmacy, and then finally got the products to them. And I'd say the other really important thing is, if you truly are dedicated to patient care, the single most important insight that we've realized is all you have to do is get your patients medications on time every single month, nothing else matters. I'll tell you, nothing else matters. And during COVID, and when you're scaling at a relatively rapid clip, it's really hard to do perfectly. And so what I would say, the other thing that we learned the hard way is you can't just have one supplier, can't just have one EMR, can't just have one blood testing lab, you've got to create redundancy in your business, and you've got to figure out how to shift the redundancy relatively fast. And you've got to create a culture that actually is capable of doing that.
Saad Alam (54:19):
And then I'd probably say the other thing that I wish we had known going into this is that when you have a business that has multiple blood tests and requires them every 90 days, assume each of those trans transitory points are a funnel in themselves and you need someone to babysit each one of those funnels and make sure they're helping patients get all the way through because that's where you actually can lose the entire business. So that'd probably be the other really big learning that we got.
Daniel Scrivner (54:48):
Those are amazing. Final question would be just, so we talked about the lessons you learned as a business. I would love to talk about the lessons that you've learned as a CEO. You know, this is your third company that you're building with Hone. It sounds like it's probably the hardest in terms of challenges that you've taken on. What do you feel like you've learned and how have you grown building this business over the last two years?
Saad Alam (55:11):
I'd say that the first company I built, I wasn't secure enough with hiring people that were better than I was, and I didn't actively seek them out. And when people say a good CEO basically works himself out of a job and spends 30 for 40% of his time recruiting, I thought that was a cute kitchen magnet that really probably wasn't real. And the reality is, it actually couldn't be more true. And I think that the way I've grown is I've been really grateful and blessed to have an unbelievable founding team. And these guys are all killers. And then the next category, I'd say next crop of talent we brought in, all super mission driven. They cared about the customer so much. And frankly, when I find someone that's smarter than I am, that's more intelligent, and I think that can do a great job. I beg them to come work for us.
Saad Alam (56:03):
And the other really important thing is I make sure I'm really involved strategically. I've got my hands and everything at the beginning and the moment I realize they're good, I pull back, pull back and say, go ahead, do it and let's make sure that we have a conversation and I'm deeply operational with the next problem we're solving. And that's kind of like, I'd say that my work style is I want to make sure I understand the business, I can do it myself, I'm going to find someone better than I am, staff it up, and then move away and make sure you keep an eye on it. I say the other thing too is, I don't think that I was ever so intentional about a culture. And when we transitioned into this kind of like post-COVID world where everyone was 100%virtual, it was unclear to me how we would create a group of people that cared about the same thing.
Saad Alam (56:47):
And I think we spent a ton of time and effort figuring that thing out. And I'll say that this week was probably the single most important proof point of that where my father unfortunately passed away about 10 days ago. And so it was the first time I actually just stepped out of the business. I said, look, I got to handle my family stuff, I want to honor my father the right way. I want to make sure my mother is happy. My brother sees a good example. And I said, guys, you just got to take care of the shop. Right? And I came back 10 days later and the things running better than when I left it. So I'd say like, that is the two most important things in learnings I think I had in all the other operational stuff, right? I could sit here and say, I'm really smart, I'm not. Honestly, it's like, I just got really intelligent people that have helped us build the business.
Daniel Scrivner (57:33):
It's the perfect note to end on. This has been so much fun Saad. I mean, I know that this is one of the interviews that I'm going to be playing back. And I mean, so many of the ideas you shared, the little quotes have been amazing. So I'm deeply grateful for the time. Thank you so much for coming on Outlier Academy.
Saad Alam (57:48):
Yeah. Daniel, thank you so much. I appreciate you and all your listeners for giving me the chance.
Daniel Scrivner (57:54):
Thank you so much for listening. You can find the show notes and transcript for this episode at outlieracademy.com/125, it's 125. And you could learn more about Hone at honehealth.com or by following Hone Health on twitter. At outlieracademy.com, you can find all of our other founder interviews profiling incredible companies like Forward, Eight Sleep, Varda Space Industries, Common Stock, Superhuman, Primal Kitchen, 1-800-GOT-JUNK and many more. In every episode we deconstruct the ideas, frameworks, and strategies they used to build these incredible companies. You can find videos of all of our interviews on YouTube at youtube.com/outlieracademy. On our channel, you'll find all of our full length interviews as well as our favorite short clips, usually about eight to 10 from every single episode, including this one. So make sure to subscribe. We post new videos and clips every single week. And if you haven't already, make sure to follow us on Twitter and LinkedIn at Outlier Academy. Thank you so much for listening. We'll see you right here next week with a brand new episode on Wednesday.
On Outlier Academy, Daniel Scrivner explores the tactics, routines, and habits of world-class performers working at the edge—in business, investing, entertainment, and more. In each episode, he decodes what they've mastered and what they've learned along the way. Start learning from the world’s best today.
Daniel Scrivner and Mighty Publishing LLC own the copyright in and to all content in and transcripts of the Outlier Academy podcast, with all rights reserved, including Daniel’s right of publicity.